Jingyi Duan

Intimate partner violence and contraception use among women in Sub-Saharan Africa

To determine the association between contraceptive use and intimate partner violence (IPV) in Sub‐Saharan African women.

Interpregnancy Body Mass Index Changes and Risk of Stillbirth

Background/Aims: To examine the association between interpregnancy body mass index (BMI) change and stillbirth. Methods: Retrospective study using Missouri maternally linked cohort files (1978–2005). A total of 218,389 women were used in the analysis. BMI was classified as: underweight (<18.5), normal (18.5–24.9), overweight (25–29.9), or obese (≧30.0). Weight change was defined based on BMI category (i.e. normal-normal, normal-obese, etc.). Cox proportional hazard regression models were used to generate adjusted hazard ratios (HR) and 95% CI for the risk of stillbirth in the second pregnancy. Results: Significant findings were associated with interpregnancy BMI changes involving overweight mothers becoming obese (HR = 1.4, 95% CI 1.1–1.7), normal-weight mothers becoming overweight (HR = 1.2, 95% CI 1.0–1.4) or obese (HR = 1.5, 95% CI 1.1–2.1), or obese mothers maintaining their obesity status across the two pregnancies (HR = 1.4, 95% CI 1.2–1.7). Other weight change categories did not show significant risk elevation for stillbirth. Conclusions: BMI change appears to play an important role in subsequent stillbirth risk.

Changes in prepregnancy body mass index between pregnancies and risk of preterm phenotypes.

We examined whether the risk of preterm birth and its subtypes (medically indicated and spontaneous preterm) are influenced by changes in prepregnancy body mass index (BMI) between the first and second pregnancies. A population-based, retrospective cohort analysis was performed using the Missouri (1978 to 2005) longitudinally linked cohort data sets. Women with their first two successive singleton live births ( N = 436,502) were analyzed. The risks for preterm birth and its subtypes were evaluated using multivariate logistic regression modeling. Compared with women who maintained normal interpregnancy BMI, women who lowered their weight from normal to underweight were more likely to experience preterm and spontaneous preterm birth (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.4 to 1.6). Women with BMI changes from normal weight to obese (OR 1.4, 95% CI 1.2 to 1.6) and normal weight to overweight (OR 1.2, 95% CI 1.1 to 1.3) were at increased risk of medically indicated preterm birth. A decrease in prepregnancy BMI from normal to underweight is associated with increased risk of spontaneous preterm birth, and prepregnancy BMI increases from normal to overweight or to obese BMI are associated with increased risk of medically indicated preterm birth.

Younger maternal age (at initiation of childbearing) and recurrent perinatal mortality.

OBJECTIVE To assess whether young maternal age at initiation of childbearing is associated with recurrence of perinatal mortality (PM), as well as its components: stillbirth and neonatal death. STUDY DESIGN We conducted a population-based, retrospective cohort study on the Missouri maternally linked longitudinal data files comprising adolescent (10-19 years; n = 73,533) or mature (20-24 years; n = 78,618) mothers in their first pregnancy with follow-up in their second pregnancy to document the occurrence of PM or its components. The study covered the period 1989-2005. We used unconditional logistic regression modeling to generate odds ratios and to control for confounding. RESULTS A history of perinatal mortality, stillbirth, or neonatal mortality increased the risk of a recurrence by 4-5 times. Among women with a history of PM or stillbirth in the first pregnancy, maternal age at initiation of pregnancy was not a risk factor for subsequent PM or its components. However, adolescent mothers with a history of neonatal mortality in the first pregnancy were about 5 times as likely to experience stillbirth in the second pregnancy, as compared to their mature counterparts. CONCLUSIONS Young maternal age at the initiation of childbearing is not associated with an overall increased risk of recurrent perinatal loss. However, prior history of neonatal mortality among teen mothers is strongly predictive of subsequent stillbirth.

Comparison of the Effectiveness of Low-Dose Indinavir/Ritonavir (IDV/r)- Versus Atazanavir/Ritonavir (ATV/r)-Based Generic Antiretroviral Therapy in NNRTI-Experienced HIV-1 Infected Patients in India

Background: Currently, data on the effectiveness of second-line antiretroviral regimens using indinavir/ritonavir (IDV/r) and atazanavir/ritonavir (ATV/r) along with 2 nucleoside reverse transcriptase inhibitor (NRTI) in resource-poor settings is limited. Methods: Observational follow-up study on 441 patients who experienced treatment failure to first-line nonnucleoside reverse transcriptase inhibitor (NNRTI)-based treatment. Multivariate Cox Proportional Hazards Model was used to assess comparative effectiveness of treatment regimens. Results: A total of 63 patients (14.8%) had failed second line treatments, of which 53 patients (17.2%) were using IDV/r while 10 patients (8.5%) were on ATV/r. After adjusting for age, weight, gender, and baseline CD4 count, patients who took IDV/r were more than twice as likely to experience treatment failure as compared to those who were on ATV/r (hazard ratio [HR] 2.18; 95% confidence interval [CI] 1.14, 4.15). Successful response to second-line therapy was not different between the 2 treatment groups when patients weighed less than 55 kg at baseline (log rank P value = 1.00) in contrast to the individuals weighing ≥55 kg (P < .0001). Conclusion: We found that successful response to second-line therapy was twice as likely in the ATV/r group; however, this difference was eliminated in patients less than 55 kg.