Low Birth Weight, and Low Ponderal Index Mediates the Association between Preeclampsia, Placenta Previa, and Neonatal Mortality
-
. NAWSHERWAN
,
Abbas KHAN
,
Nabila BEGUM
,
Zahoor AHMED
,
Sumaira MUBARIK
,
Ijaz Ul HAQ
,
Ghulam NABI
,
Naeem ULLAH
,
Cuifang FAN
,
Suqing WANG
Abstract
Background: A retrospective study was conducted to assess the mediation role of low birth weight, and low ponderal index between the preeclampsia, placenta previa, and neonatal mortality in the tertiary hospital of Hubei Province, China.
Methods: A total of 12772 neonatal births were included for data analysis. Birth weight, birth length, and neonatal mortality were recorded after birth. Sobel test based on mediation regression was used to evaluate the effect of mediator variables.
Results: Approximately, 383 (3%) and 409 (3.2%) women experienced preeclampsia and placenta previa respectively. After adjusting for covariates, the indirect effect of preeclampsia on neonatal mortality mediated by low birth weight and low ponderal index was [β 2.59 (95% CI: 0.74 – 4.44)], and [β 3.94 (95% CI: 1.50 – 6.38)] respectively. Moreover, the indirect effect of placenta previa on neonatal mortality mediated by the low birth weight was [β 1.74 (95% CI: 0.16 – 3.31)], and low ponderal index was [β 3.21 (95% CI: 0.95 – 5.48)]. The estimated mediation proportion between the preeclampsia and neonatal mortality accounting for possible mediation by low birth weight and low ponderal index was 44.5% and 34.5% respectively. Furthermore, 47.9% by low birth weight and 33.2% by low ponderal index mediate the association between placenta previa and neonatal mortality.
Conclusion: Low birth weight, and low ponderal index partially mediates the association between preeclampsia, placenta previa and neonatal mortality.
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3. Patel RM, Kandefer S, Walshetal MC et al (2015). Causes and timing of death in ex-tremely premature infants from 2000 through 2011. N Engl J Med, 372(4):331-40.
4. Oestergaard MZ, Inoue M, Yoshida S et al (2011). Neonatal mortality levels for 193 countries in 2009 with trends since 1990: a systematic analysis of progress, projec-tions, and priorities. PLoS Med, 8(8):e1001080.
5. Wang H, Liddell CA, Coates MM et al (2014). Global, regional, and national lev-els of neonatal, infant, and under-5 mor-tality during 1990-2013: a systematic anal-ysis for the global burden of disease study 2013. Lancet, 384(9947):957-79.
6. Liu L, Johnson H, Cousens S (2012). Global, regional and national causes of child mortality: an update systematic anal-ysis for 2010 with time trends since 2000. Lancet, 379(9832): 2151–61.
7. Ngoc N, Merialdi M, Abdel-Aleem H et al (2006). Causes of stillbirths and early ne-onatal deaths: data from 7993 pregnan-cies in six developing countries. Bull World Health Organ, 84(9):699–05.
8. Vogel JP, Souza JP, Mori R et al (2015). Ma-ternal complications and perinatal mortal-ity: findings of the World Health Organi-zation multicountry survey on maternal and newborn health. BJOG, 122(3):451.
9. Weiner E, Miremberg H, Grinstein E et al (2016). The effect of placenta previa on fetal growth and pregnancy outcome, in correlation with placental pathology. J Per-inatol, 36(12):1073-78.
10. Berhan Y (2014). Predictors of perinatal mortality associated with placenta previa and placental abruption: An experience from a low income country. J Pregnancy, 2014:307043.
11. Roberts JM, Redman CW (1993). Preeclampsia: more than pregnancy-induced hypertension. Lancet, 341:1447–50.
12. Sibai BM (2005). Diagnosis, prevention and management of preeclampsia. Obstet Gyne-col, 105:402-10.
13. Duley L (2009). The global impact of pre-eclampsia and eclampsia. Semin Perinatol, 33(3):130-37.
14. Ozkan H, Cetinkaya M, Koksal N (2012). Increased incidence of bronchopulmo-nary dysplasia in preterm infants exposed to preeclampsia. J Matern Fetal Neonatal Med, 25:2681-5.
15. Mohamed MA, Mohammed AH (2019). Parallel vertical compression sutures to control bleeding in cases of placenta pre-via and accreta. J Matern Fetal Neonatal Med, 32(4):641-645.
16. Umazume T, Hayasaka S, Kato F et al (2017). Sudden maternal hypoxemia dur-ing elective cesarean section in a woman with placenta previa. Clin Case Rep, 5(10):1668-1671.
17. Harper LM, Odibo AO, Macones GA et al (2010). Effect of placenta previa on fetal growth. Am J Obstet Gynecol, 203(4):330.e1-330.e5.
18. Love CD, Wallace EM (1996). Pregnancies complicated by placenta previa: what is appropriate management? Br J Obstet Gy-naecol, 103(9):864-7
19. Marimuthu Y, Sarkar S, Sakthivel M et al (2018). Association of social factors with low birth weight: a narrative review. IJCMPH, 5(8):3171-75.
20. Beddek F, Demmouche A, Mai AH et al (2014). Low birth weight in Sidi Bel Ab-bes region (West of Algeria): Retrospec-tive study of 10008 deliveries. J Blood Dis-orders Transfus, 5:1-4.
21. Siza JE (2008). Risk factors associated with low birth weight of neonates among pregnant women attending a referral hospital in Northern Tanzania. Tanzan J Health Res, 10(1):1-8.
22. Kollman M, Gaulhofer J, Lang U et al (2016). Placenta previa: Incidence, risk factors, and outcome. J Matern Fetal Neo-natal Med, 29(9):1395-8.
23. Xiong X, Mayes D, Demianczuk N (1999). The impact of pregnancy-induced hyper-tension on fetal growth. Am J Obstet Gyne-col, 180:207–13.
24. Onyiriuka AN, Okolo AA (2005). Small for gestational age, ponderal index and neo-natal polycythaemia: a study of their asso-ciation with maternal hypertension among Nigerian women. Ann Afr Med, 4(4):154–9.
25. Rasmussen S, Irgens LM (2003). Fetal growth and body proportion in preeclampsia. Obstet Gynecol,101(3):575-83.
26. Maiti S, Kanrar P, Karmakar C et al (2014). Maternal and perinatal outcome in rural Indian women with placenta previa. Br Biomed Bull, 2(4):714-18.
27. Tuzovic L, Djelmis J, Ilijic M (2003). Obstet-ric risk factors associated with placenta previa development: Case-control Study. Croat Med J, 44:728-33.
28. Bian Y, Zhang Z, Liu Q et al (2013). Mater-nal risk factors for low birth weight for term births in a developed region in Chi-na: a hospital-based study of 55,633 pregnancies. J Biomed Res, 27(1):14-22.
29. Mitao M, Philemon R, Obure J et al (2016). Risk factors and adverse perinatal out-come associated with low birth weight in Nothern Tanzania: a registry based retro-spective cohort study. Asia Pac J Reprod, 5(1):75-9.
30. Jung EJ, Cho HJ, Byun JM et al (2018). Pla-cental pathologic changes and perinatal outcomes in placenta previa. Placenta, 63:15-20.
31. Alexander GR, Himes JH, Kaufman RB et al (1996). A United States national reference for fetal growth. Obstet Gynecol, 87:163–68.
32. Preacher KJ, Kelly K (2011). Effect size measures for mediation models: quantita-tive strategies for communicating indirect effects. Psychol Methods, 16:93-115.
33. Baron RM, Kenny DA (1986).The modera-tor-mediator variable distinction in social psychological research: conceptual, stra-tegic, and statistical considerations. J Pers Soc Psychol, 51:1173–82.
34. Hafeman DM (2009). “Proportion ex-plained”: a causal interpretation for standard measures of indirect effect? Am J Epidemiol, 170:1443–48.
35. Sobel M E (1982). Asymptotic confidence intervals for indirect effects in structural equation models. Sociol Methodol, 13:290-312.
36. Imai K, Keele L, Tingley D (2010). A gen-eral approach to causal mediation analy-sis. Psychol Methods, 15:309–34.
37. MacKinnon DP. Introduction to statistical mediation analysis (2008). New York: Taylor & Fran-cis.
38. MacKinnon DP, Fairchild AJ, Fritz MS (2007). Mediation analysis. Annu Rev Psy-chol, 58:593.
39. Preacher KJ, Hayes AF (2004). SPSS and SAS procedures for estimating indirect effects in simple mediation models. Be-hav Res Methods Instrum Comput, 36:717–31.
40. Gant NF, Worley RT (1980). Hypertension in pregnancy: Concepts and management. In: Ches-ley LC (ed) Hypertension in pregnancy. Ap-pleton Century Crofts, New York, 199-204.
41. Bozdag H, Ogutcuoglu FBS, Guzin K et al (2015). The frequency and fetomaternal outcomes of early-and late-onset preeclampsia: The experience of a single tertiary health center in the bustling me-tropolis of Turkey; Istanbul. Medeniyet Medical Journal, 30(4):163-69.
42. Xiong X, Demianczuk NN , Saundrs LD et al (2002). Impact of Preeclampsia and Gestational Hypertension on Birth Weight by Gestational Age. Am J Epi-demiol, 155:203–9 .
43. Esch JJAV, Heijst AFV, Haan AFJD et al (2017). Early-onset preeclampsia is as-sociated with perinatal mortality and se-vere neonatal morbidity. J Matern Fetal Neonatal Med, 30(23):2789–94.
44. Su YY, Zhang JZ, Wang F (2017). Risk factors and adverse outcomes of preeclampsia: a tertiary care centrebased study in China. Biomed Res, 28 (3):1262-65.
45. Soyama H, Miyamoto M, Ishibashi H et al (2016). Relation between Birth Weight and Intraoperative Hemorrhage during Cesarean Section in Pregnancy with Pla-centa Previa. PLoS One, 11(11):e0167332.
46. Ananth CV, Demissie K, Smulian JC et al (2001). Relationship among placenta previa, fetal growth restriction, and pre-term delivery: A population based study. Obstet Gynecol, 98(2):299-306.
47. Zhang B, Dai Y, Chen H et al (2019). Ne-onatal mortality in hospitalized Chinese population: A meta-analysis. Biomed Res Int, 2019:7919501.
2. Blencowe H, Cousens S (2013). Review: ad-dressing the challenge of neonatal mor-tality. Trop Med Int Health, 18(3):303–12.
3. Patel RM, Kandefer S, Walshetal MC et al (2015). Causes and timing of death in ex-tremely premature infants from 2000 through 2011. N Engl J Med, 372(4):331-40.
4. Oestergaard MZ, Inoue M, Yoshida S et al (2011). Neonatal mortality levels for 193 countries in 2009 with trends since 1990: a systematic analysis of progress, projec-tions, and priorities. PLoS Med, 8(8):e1001080.
5. Wang H, Liddell CA, Coates MM et al (2014). Global, regional, and national lev-els of neonatal, infant, and under-5 mor-tality during 1990-2013: a systematic anal-ysis for the global burden of disease study 2013. Lancet, 384(9947):957-79.
6. Liu L, Johnson H, Cousens S (2012). Global, regional and national causes of child mortality: an update systematic anal-ysis for 2010 with time trends since 2000. Lancet, 379(9832): 2151–61.
7. Ngoc N, Merialdi M, Abdel-Aleem H et al (2006). Causes of stillbirths and early ne-onatal deaths: data from 7993 pregnan-cies in six developing countries. Bull World Health Organ, 84(9):699–05.
8. Vogel JP, Souza JP, Mori R et al (2015). Ma-ternal complications and perinatal mortal-ity: findings of the World Health Organi-zation multicountry survey on maternal and newborn health. BJOG, 122(3):451.
9. Weiner E, Miremberg H, Grinstein E et al (2016). The effect of placenta previa on fetal growth and pregnancy outcome, in correlation with placental pathology. J Per-inatol, 36(12):1073-78.
10. Berhan Y (2014). Predictors of perinatal mortality associated with placenta previa and placental abruption: An experience from a low income country. J Pregnancy, 2014:307043.
11. Roberts JM, Redman CW (1993). Preeclampsia: more than pregnancy-induced hypertension. Lancet, 341:1447–50.
12. Sibai BM (2005). Diagnosis, prevention and management of preeclampsia. Obstet Gyne-col, 105:402-10.
13. Duley L (2009). The global impact of pre-eclampsia and eclampsia. Semin Perinatol, 33(3):130-37.
14. Ozkan H, Cetinkaya M, Koksal N (2012). Increased incidence of bronchopulmo-nary dysplasia in preterm infants exposed to preeclampsia. J Matern Fetal Neonatal Med, 25:2681-5.
15. Mohamed MA, Mohammed AH (2019). Parallel vertical compression sutures to control bleeding in cases of placenta pre-via and accreta. J Matern Fetal Neonatal Med, 32(4):641-645.
16. Umazume T, Hayasaka S, Kato F et al (2017). Sudden maternal hypoxemia dur-ing elective cesarean section in a woman with placenta previa. Clin Case Rep, 5(10):1668-1671.
17. Harper LM, Odibo AO, Macones GA et al (2010). Effect of placenta previa on fetal growth. Am J Obstet Gynecol, 203(4):330.e1-330.e5.
18. Love CD, Wallace EM (1996). Pregnancies complicated by placenta previa: what is appropriate management? Br J Obstet Gy-naecol, 103(9):864-7
19. Marimuthu Y, Sarkar S, Sakthivel M et al (2018). Association of social factors with low birth weight: a narrative review. IJCMPH, 5(8):3171-75.
20. Beddek F, Demmouche A, Mai AH et al (2014). Low birth weight in Sidi Bel Ab-bes region (West of Algeria): Retrospec-tive study of 10008 deliveries. J Blood Dis-orders Transfus, 5:1-4.
21. Siza JE (2008). Risk factors associated with low birth weight of neonates among pregnant women attending a referral hospital in Northern Tanzania. Tanzan J Health Res, 10(1):1-8.
22. Kollman M, Gaulhofer J, Lang U et al (2016). Placenta previa: Incidence, risk factors, and outcome. J Matern Fetal Neo-natal Med, 29(9):1395-8.
23. Xiong X, Mayes D, Demianczuk N (1999). The impact of pregnancy-induced hyper-tension on fetal growth. Am J Obstet Gyne-col, 180:207–13.
24. Onyiriuka AN, Okolo AA (2005). Small for gestational age, ponderal index and neo-natal polycythaemia: a study of their asso-ciation with maternal hypertension among Nigerian women. Ann Afr Med, 4(4):154–9.
25. Rasmussen S, Irgens LM (2003). Fetal growth and body proportion in preeclampsia. Obstet Gynecol,101(3):575-83.
26. Maiti S, Kanrar P, Karmakar C et al (2014). Maternal and perinatal outcome in rural Indian women with placenta previa. Br Biomed Bull, 2(4):714-18.
27. Tuzovic L, Djelmis J, Ilijic M (2003). Obstet-ric risk factors associated with placenta previa development: Case-control Study. Croat Med J, 44:728-33.
28. Bian Y, Zhang Z, Liu Q et al (2013). Mater-nal risk factors for low birth weight for term births in a developed region in Chi-na: a hospital-based study of 55,633 pregnancies. J Biomed Res, 27(1):14-22.
29. Mitao M, Philemon R, Obure J et al (2016). Risk factors and adverse perinatal out-come associated with low birth weight in Nothern Tanzania: a registry based retro-spective cohort study. Asia Pac J Reprod, 5(1):75-9.
30. Jung EJ, Cho HJ, Byun JM et al (2018). Pla-cental pathologic changes and perinatal outcomes in placenta previa. Placenta, 63:15-20.
31. Alexander GR, Himes JH, Kaufman RB et al (1996). A United States national reference for fetal growth. Obstet Gynecol, 87:163–68.
32. Preacher KJ, Kelly K (2011). Effect size measures for mediation models: quantita-tive strategies for communicating indirect effects. Psychol Methods, 16:93-115.
33. Baron RM, Kenny DA (1986).The modera-tor-mediator variable distinction in social psychological research: conceptual, stra-tegic, and statistical considerations. J Pers Soc Psychol, 51:1173–82.
34. Hafeman DM (2009). “Proportion ex-plained”: a causal interpretation for standard measures of indirect effect? Am J Epidemiol, 170:1443–48.
35. Sobel M E (1982). Asymptotic confidence intervals for indirect effects in structural equation models. Sociol Methodol, 13:290-312.
36. Imai K, Keele L, Tingley D (2010). A gen-eral approach to causal mediation analy-sis. Psychol Methods, 15:309–34.
37. MacKinnon DP. Introduction to statistical mediation analysis (2008). New York: Taylor & Fran-cis.
38. MacKinnon DP, Fairchild AJ, Fritz MS (2007). Mediation analysis. Annu Rev Psy-chol, 58:593.
39. Preacher KJ, Hayes AF (2004). SPSS and SAS procedures for estimating indirect effects in simple mediation models. Be-hav Res Methods Instrum Comput, 36:717–31.
40. Gant NF, Worley RT (1980). Hypertension in pregnancy: Concepts and management. In: Ches-ley LC (ed) Hypertension in pregnancy. Ap-pleton Century Crofts, New York, 199-204.
41. Bozdag H, Ogutcuoglu FBS, Guzin K et al (2015). The frequency and fetomaternal outcomes of early-and late-onset preeclampsia: The experience of a single tertiary health center in the bustling me-tropolis of Turkey; Istanbul. Medeniyet Medical Journal, 30(4):163-69.
42. Xiong X, Demianczuk NN , Saundrs LD et al (2002). Impact of Preeclampsia and Gestational Hypertension on Birth Weight by Gestational Age. Am J Epi-demiol, 155:203–9 .
43. Esch JJAV, Heijst AFV, Haan AFJD et al (2017). Early-onset preeclampsia is as-sociated with perinatal mortality and se-vere neonatal morbidity. J Matern Fetal Neonatal Med, 30(23):2789–94.
44. Su YY, Zhang JZ, Wang F (2017). Risk factors and adverse outcomes of preeclampsia: a tertiary care centrebased study in China. Biomed Res, 28 (3):1262-65.
45. Soyama H, Miyamoto M, Ishibashi H et al (2016). Relation between Birth Weight and Intraoperative Hemorrhage during Cesarean Section in Pregnancy with Pla-centa Previa. PLoS One, 11(11):e0167332.
46. Ananth CV, Demissie K, Smulian JC et al (2001). Relationship among placenta previa, fetal growth restriction, and pre-term delivery: A population based study. Obstet Gynecol, 98(2):299-306.
47. Zhang B, Dai Y, Chen H et al (2019). Ne-onatal mortality in hospitalized Chinese population: A meta-analysis. Biomed Res Int, 2019:7919501.
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| Issue | Vol 49 No 4 (2020) | |
| Section | Original Article(s) | |
| Keywords | ||
| Low birth weight; Low ponderal index; Preeclampsia Placenta previa Neonatal mortality | ||
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How to Cite
1.
NAWSHERWAN ., KHAN A, BEGUM N, AHMED Z, MUBARIK S, Ul HAQ I, NABI G, ULLAH N, FAN C, WANG S. Low Birth Weight, and Low Ponderal Index Mediates the Association between Preeclampsia, Placenta Previa, and Neonatal Mortality. Iran J Public Health. 2020;49(4):654-662.
