Effect of diarrheal illness during pregnancy on adverse birth outcomes in Nepal

Kira L. Newman, Kathryn Gustafson, Janet A. Englund, Amalia Magaret, Subarna Khatry, Steven C. LeClerq, James M. Tielsch, Joanne Katz, Helen Y. Chu

Research output: Contribution to journalArticle

Abstract

Background. Adverse birth outcomes, including low birthweight, small for gestational age (SGA), and preterm birth, contribute to 60%-80% of infant mortality worldwide. Little published data exist on the association between diarrhea during pregnancy and adverse birth outcomes. Methods. Data were used from 2 community-based, prospective randomized trials of maternal influenza immunization during pregnancy conducted in rural Nepal from 2011 to 2014. Diarrheal illnesses were identified through longitudinal household-based weekly symptom surveillance. Diarrhea episodes were defined as at least 3 watery bowel movements per day for 1 or more days with 7 diarrhea-free days between episodes. The Poisson and log-binomial regression were performed to evaluate baseline characteristics and association between diarrhea during pregnancy and adverse birth outcomes. Results. A total of 527 of 3693 women in the study (14.3%) experienced diarrhea during pregnancy. Women with diarrhea had a median of 1 episode of diarrhea (interquartile range [IQR], 1-2 episodes) and 2 cumulative days of diarrhea (IQR, 1-3 days). Of women with diarrhea, 85 (16.1%) sought medical care. In crude and adjusted analyses, women with diarrhea during pregnancy were more likely to have SGA infants (42.6% vs 36.8%; adjusted risk ratio = 1.20; 95% confidence interval, 1.06-1.36; P = .005). Birthweight and preterm birth incidence did not substantially differ between women with diarrhea during pregnancy and those without. Conclusions. Diarrheal illness during pregnancy was associated with a higher risk of SGA infants in this rural South Asian population. Interventions to reduce the burden of diarrheal illness during pregnancy may have an impact on SGA births in resource-limited settings.

Original languageEnglish (US)
JournalOpen Forum Infectious Diseases
Volume6
Issue number2
DOIs
StatePublished - Feb 1 2019

Fingerprint

Nepal
Diarrhea
Parturition
Pregnancy
Small for Gestational Age Infant
Premature Birth
Gestational Age
Cost of Illness
Infant Mortality
Human Influenza
Immunization
Odds Ratio
Mothers
Confidence Intervals

Keywords

  • Birth outcomes
  • Diarrhea
  • Nepal
  • Pregnancy
  • Small for gestational age

ASJC Scopus subject areas

  • Oncology
  • Clinical Neurology

Cite this

Newman, K. L., Gustafson, K., Englund, J. A., Magaret, A., Khatry, S., LeClerq, S. C., ... Chu, H. Y. (2019). Effect of diarrheal illness during pregnancy on adverse birth outcomes in Nepal. Open Forum Infectious Diseases, 6(2). https://doi.org/10.1093/ofid/ofz011

Effect of diarrheal illness during pregnancy on adverse birth outcomes in Nepal. / Newman, Kira L.; Gustafson, Kathryn; Englund, Janet A.; Magaret, Amalia; Khatry, Subarna; LeClerq, Steven C.; Tielsch, James M.; Katz, Joanne; Chu, Helen Y.

In: Open Forum Infectious Diseases, Vol. 6, No. 2, 01.02.2019.

Research output: Contribution to journalArticle

Newman, KL, Gustafson, K, Englund, JA, Magaret, A, Khatry, S, LeClerq, SC, Tielsch, JM, Katz, J & Chu, HY 2019, 'Effect of diarrheal illness during pregnancy on adverse birth outcomes in Nepal', Open Forum Infectious Diseases, vol. 6, no. 2. https://doi.org/10.1093/ofid/ofz011
Newman KL, Gustafson K, Englund JA, Magaret A, Khatry S, LeClerq SC et al. Effect of diarrheal illness during pregnancy on adverse birth outcomes in Nepal. Open Forum Infectious Diseases. 2019 Feb 1;6(2). https://doi.org/10.1093/ofid/ofz011
Newman, Kira L. ; Gustafson, Kathryn ; Englund, Janet A. ; Magaret, Amalia ; Khatry, Subarna ; LeClerq, Steven C. ; Tielsch, James M. ; Katz, Joanne ; Chu, Helen Y. / Effect of diarrheal illness during pregnancy on adverse birth outcomes in Nepal. In: Open Forum Infectious Diseases. 2019 ; Vol. 6, No. 2.
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abstract = "Background. Adverse birth outcomes, including low birthweight, small for gestational age (SGA), and preterm birth, contribute to 60{\%}-80{\%} of infant mortality worldwide. Little published data exist on the association between diarrhea during pregnancy and adverse birth outcomes. Methods. Data were used from 2 community-based, prospective randomized trials of maternal influenza immunization during pregnancy conducted in rural Nepal from 2011 to 2014. Diarrheal illnesses were identified through longitudinal household-based weekly symptom surveillance. Diarrhea episodes were defined as at least 3 watery bowel movements per day for 1 or more days with 7 diarrhea-free days between episodes. The Poisson and log-binomial regression were performed to evaluate baseline characteristics and association between diarrhea during pregnancy and adverse birth outcomes. Results. A total of 527 of 3693 women in the study (14.3{\%}) experienced diarrhea during pregnancy. Women with diarrhea had a median of 1 episode of diarrhea (interquartile range [IQR], 1-2 episodes) and 2 cumulative days of diarrhea (IQR, 1-3 days). Of women with diarrhea, 85 (16.1{\%}) sought medical care. In crude and adjusted analyses, women with diarrhea during pregnancy were more likely to have SGA infants (42.6{\%} vs 36.8{\%}; adjusted risk ratio = 1.20; 95{\%} confidence interval, 1.06-1.36; P = .005). Birthweight and preterm birth incidence did not substantially differ between women with diarrhea during pregnancy and those without. Conclusions. Diarrheal illness during pregnancy was associated with a higher risk of SGA infants in this rural South Asian population. Interventions to reduce the burden of diarrheal illness during pregnancy may have an impact on SGA births in resource-limited settings.",
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AB - Background. Adverse birth outcomes, including low birthweight, small for gestational age (SGA), and preterm birth, contribute to 60%-80% of infant mortality worldwide. Little published data exist on the association between diarrhea during pregnancy and adverse birth outcomes. Methods. Data were used from 2 community-based, prospective randomized trials of maternal influenza immunization during pregnancy conducted in rural Nepal from 2011 to 2014. Diarrheal illnesses were identified through longitudinal household-based weekly symptom surveillance. Diarrhea episodes were defined as at least 3 watery bowel movements per day for 1 or more days with 7 diarrhea-free days between episodes. The Poisson and log-binomial regression were performed to evaluate baseline characteristics and association between diarrhea during pregnancy and adverse birth outcomes. Results. A total of 527 of 3693 women in the study (14.3%) experienced diarrhea during pregnancy. Women with diarrhea had a median of 1 episode of diarrhea (interquartile range [IQR], 1-2 episodes) and 2 cumulative days of diarrhea (IQR, 1-3 days). Of women with diarrhea, 85 (16.1%) sought medical care. In crude and adjusted analyses, women with diarrhea during pregnancy were more likely to have SGA infants (42.6% vs 36.8%; adjusted risk ratio = 1.20; 95% confidence interval, 1.06-1.36; P = .005). Birthweight and preterm birth incidence did not substantially differ between women with diarrhea during pregnancy and those without. Conclusions. Diarrheal illness during pregnancy was associated with a higher risk of SGA infants in this rural South Asian population. Interventions to reduce the burden of diarrheal illness during pregnancy may have an impact on SGA births in resource-limited settings.

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