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Background: While the relationship between hemoglobin (Hb) concentrations and pregnancy outcomes has been studied often, most reports have focused on a specific Hb cutoff used to define anemia. Fewer studies have evaluated pregnancy outcomes across the entire range of Hb values. Moreover, to date, most studies of the relationship of Hb concentrations to pregnancy outcomes have been done in high-income countries. Thus, we have sought to determine the relationship between the range of maternal Hb concentrations and adverse birth outcomes among South Asian pregnant women., Methods: For this study, we used data collected from two South Asian countries (Pakistan - Sindh Province and two sites in India - Belagavi and Nagpur) in a prospective maternal and newborn health registry study. To assess the association between Hb concentrations and various maternal and fetal outcomes, we classified the Hb concentrations into seven categories. Regression analyses adjusting for multiple potential confounders were performed to assess adverse pregnancy outcomes across the range of Hb concentrations., Findings: Between January 2012 and December 2018, 130,888 pregnant women were enrolled in the South Asian sites had a Hb measurement available, delivered and were included in the analyses. Overall, the mean Hb concentration of pregnant women from the sites was 9.9 g/dL, 10.0 g/dL in the Indian sites and 9.5 g/dL in the Pakistan site. Hb concentrations < 7 g/dL were observed in 6.9% of the pregnant Pakistani women and 0.2% of the Indian women. In both the Pakistani and Indian sites, women with higher parity and women with no formal education had lower Hb concentrations. In the Pakistani site, women > 35 years of age, women with ≥4 children and those who enrolled in the third trimester were more likely to have Hb concentrations of < 7 g/dL but these associations were not found for the Indian sites. When adjusting for potential confounders, for both India and Pakistan, lower Hb concentrations were associated with stillbirth, preterm birth, lower mean birthweight, and increased risk of low birthweight. In the Pakistani site, there was evidence of a U-shaped relationship between Hb concentrations and low birth weight, and neonatal mortality, and in India with hypertensive disease., Interpretation: This study documented the relationship between maternal Hb concentrations and adverse pregnancy outcomes in women from the Pakistani and Indian sites across the range of Hb values. Both low and high Hb concentrations were associated with risk of at least some adverse outcomes. Hence, both low and high values of Hb should be considered risk factors for the mother and fetus.

Background: Pregnant women infected with HEV develops adverse pregnancy outcomes like, abortions, intrauterine fetal death, still births, neonatal deaths, preterm delivery and maternal mortality., Aim: To correlate oestrogen and its receptors ESR1α and ESR2β levels with HEV-associated feto-maternal outcomes., Material & Methods: A total of 142 pregnant women with HEV infection and 142 pregnant controls were included in study from Department of Obstetrics & Gynaecology and Department of Medicine, Maulana Azad Medical College (MAMC) and associated Lok Nayak Hospital (LNH), New Delhi. Three millilitre of blood sample was collected in plain for quantification of oestrogen, and its receptors ESR1α and ESR2β using commercially available third-generation ELISA kits., Results: The levels of oestrogen, ESR1α and ESR2β were considerably higher in HEV-infected pregnant women (20.11 ± 18.19 ng/mL, 10.58 ± 3.27 ng/mL, 10.42 ± 4.71 ng/mL respectively) than pregnant controls (11.74 ± 6.42 ng/mL, 9.11 ± 1.63 ng/mL, 9.01 ± 1.18 ng/mL respectively)(P < 0.0001). It was found that oestrogen levels were significantly higher in pregnant women infected with HEV who had preterm delivery, low birth weight babies and fetal loss (19.64 ± 17.60 ng/mL, 19.71 ± 17.63 ng/mL, 33.62 ± 23.20 ng/mL respectively) than who had full term delivery, average birth weight babies and live babies (11.71 ± 8.77 ng/mL, 11.99 ± 9.44 ng/mL, 16.58 ± 14.98 ng/mL respectively)(P < 0.05). A significant negative correlation was observed between baby birth weight and oestrogen levels in HEV-infected pregnant women., Conclusion: The high level of oestrogen plays an important role in preterm delivery, low birth weight babies and fetal mortality in pregnant women with HEV infection through placental dysfunction. Moreover, oestrogen level is a significant predictor for preterm delivery and maternal mortality and ESR2β levels is a significant predictor for maternal mortality in pregnant women infected with HEV., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: To assess the association of TLR4 (rs4986790 and rs4986791) and TNF-a (rs1800629) genes polymorphisms and TLR4mRNA levels with preterm birth., Methods: Hospital-based case-control study on women of Caucasoid morphological subtype ethnicity in Northern India. Inclusion criteria for cases: women aged between 18-40 years with preterm birth (<37 weeks gestation), and for controls: women who delivered a term neonate consecutive to an enrolled case. Three polymorphisms TLR4 (Asp299 Gly, Thr399 Ill) and TNF-á (-308G/A) and TLR4 mRNA levels were compared between cases and controls., Results: From 2012-2015, 559 cases and 559 controls were recruited. TLR4 mRNA levels were found to be higher (P<0.001) in cases [(0.7 (0.04)] than in controls [(0.5 (0.04)]. No association was found between TLR4 Asp299 Gly, TLR4 Thr399 Ill and TNF-a (-308G/A) with preterm birth., Conclusions: Increased TLR4 mRNA levels seem to be associated with preterm birth, and can be investigated further as a potential biomarker for identifying women at risk.

A number of studies have focused attention on various biochemical abnormalities evoked due to exposure to organochlorine pesticides (OCPs). The aim of the present study was to analyze the OCP residues in maternal and cord blood of women and assess the levels of different non-enzymatic oxidative stress markers as well as to establish correlation with OCP levels, if any. Thirty women in each group of full-term delivery (FTD; > or =37 weeks of gestation) and preterm delivery (PTD; <37 weeks of gestation) were enrolled in this study. Levels of OCPs like Hexachlorocyclohexane (HCH), endosulfan, p,p(') Dichlorodiphenyldichloroethylene (DDE) and p,p' Dichlorodiphenyltrichloroethane (DDT) were analyzed by gas chromatography. Non-enzymatic oxidative stress was measured by the quantification of malondialhyde (MDA), protein carbonyl, reduced glutathione (GSH) and ferric-reducing ability of plasma (FRAP). MDA and protein carbonyl levels were increased significantly, while the levels of GSH and FRAP were decreased in PTD in comparison to FTD cases. We have observed higher levels of beta-HCH and alpha-endosulfan and increased oxidative stress in PTD than FTD cases. In PTD cases, a significant positive correlation was observed between maternal blood levels of beta-HCH and MDA (r = .78), beta-HCH and GSH (r = -.65), gamma-HCH and MDA (r = .89), gamma-HCH and GSH (r = -.74) and alpha-endosulfan and MDA (r = .54) in PTD cases. We also found significant correlations between cord blood levels of beta-HCH and MDA (r = .59), beta-HCH and GSH (r = -.69), gamma-HCH and MDA (r = .62) and alpha-endosulfan and MDA (r = .54) in PTD cases. In conclusion, our results suggest that higher levels of some of the OCP residues may be associated with PTD and increased oxidative stress.

Background & Objective: Low birth weight (LBW) babies are a vulnerable group and represent two outcomes--preterm birth (preterm LBW) and term with intrauterine growth retardation (term LBW). LBW babies are considered to have low nutrient reserve, but the extent of deficiency as compared to the normal babies and the differences between preterm LBW and term LBW are unclear. This study was carried out to look at key anthropometric, biochemical and clinical (ABC) parameters of LBW babies, both preterm and term, in comparison to a control group of term normal weight babies., Methods: A group of 500 babies was selected at birth from a tertiary care teaching hospital and categorized into LBW (n = 251) with preterm LBW (n = 59), term LBW (n = 192) and term controls (n = 249). Two controls were dropped as tests could not be performed in the available cord blood sample. Key anthropometric and biochemical parameters were measured. Socio-economic status, age, parity, height and pre-delivery haemoglobin of the mothers were also recorded., Results: The maternal characteristics were comparable in the three groups. Socio-economically, majority of them belonged to lower middle or upper lower class (Class III and IV) representing the non affluent. All the anthropometric measurements and nutrients measured namely total protein, albumin, cholesterol, triglycerides, calcium, magnesium, zinc and iron were significantly lower in LBW babies compared to term control babies. These values were lowest in preterm LBW followed by term LBW. Total iron binding capacity (TIBC) showed inverse association with iron. Some of the babies including control babies had protein, albumin, calcium and iron below the normal range and mean albumin, calcium and iron levels were below the normal range in all the three subsets., Interpretation & Conclusion: Preterm and term LBW babies are born with significantly lower nutrient reserves at birth compared to term control babies. Normal weight babies from the non affluent sections also have low nutrients especially albumin, calcium and iron. As these levels are liable to be further lowered by recurrent infections and inappropriate feeding habits, nutritional surveillance, extra feeding and supplements like calcium and iron are recommended for such vulnerable babies to promote optimum growth and to prevent deficiencies. This is important as currently, there are no clear or uniform recommendations for extra feeding and nutrient supplements to LBW babies and no supplements other than exclusive breast feeding are recommended for term normal birth weight babies. Extra nutritional inputs for LBW and selected non affluent babies along with care of the prospective and prenatal mothers for ensuring adequate transfer of nutrients to the offspring seem necessary. Such interventions can be integrated with the existing health care programmes to reach all the beneficiaries.