Mutairu Ezimokhai

Biosocial factors affecting vitamin D status of women of childbearing age in the united arab emirates

Low serum 25-OHD in female Arab subjects, which may predispose their infants to hypocalcaemia, has been suggested to be due to inadequate sunshine exposure, but may include other sociobiological factors. The effects of duration of sunshine exposure--weighted against the magnitude of clothing (UV exposure) and other sociobiological variables such as age, education and living accommodation--on serum 25-OHD and mineral status of 33 UAE national women of childbearing age were compared with those of 25 non-Gulf Arabs and seventeen Europeans. Serum concentrations of calcium, phosphorus, alkaline phosphatase and intact parathyroid hormone among the groups were not significantly different. The serum concentration of 25-OHD in UAE nationals was 8.6 ng/ml (4.5-17.4), mean +/- 1 SD, and in non-Gulf Arabs 12.6 ng/ml (6.0-26.4); both these values were significantly lower (p = < 0.0001) than the 64.3 ng/ml (49-84.3) found in Europeans. Compared with Europeans, the UAE and non-Gulf Arabs in this study were younger, had fewer years of education and had significantly lower clothing and UV scores (p < 0.0001). Furthermore, there was a positive correlation (r = 0.59425) between serum 25-OHD and UV score, but not with length of exposure. After adjusting for other confounding variables, nationality, clothing and UV scores remained major determinants of serum 25-OHD (p < 0.0001). Therefore, limited skin exposure to sunlight appears to be an important determinant of vitamin D status in our subjects. Strategies to increase vitamin D stores should include vitamin D supplementation or advice on effective sunlight exposure.

The age and symptomatology of natural menopause among United Arab Emirates women.

OBJECTIVES To determine the median age of natural menopause in United Arab Emirates women, the factors affecting that age and the prevalence of climacteric symptoms amongst those women. METHODS A population-based survey was conducted on a community sample of United Arab Emirates women who had had natural menopause defined as cessation of menstruation for at least 6 months at the end of reproductive years. A total of 742 women aged 40 years and above were recruited from both urban and rural areas of the country using the multi-stage stratified cluster sampling technique. Data were collected using a structured questionnaire and face to face interviews and included a number of familial, reproductive and life-style variables. RESULTS The median age of the menopause in the United Arab Emirates is 48 years (mean = 47.3 +/- 3.29, range 40-59). This is significantly lower than the median age reported from the West (50.3 years). The subject median age of the menopause was significantly related to that of the mother (P < 0.001), older sister (P < 0.001), parity (P < 0.0001) and the previous use of oral contraceptive pills for more than 1 year (P < 0.001). Hot flushes were the commonest feature of the menopause occurring in 45% of women. CONCLUSION The age of natural menopause in United Arab Emirates women, as in other developing countries, is less than in Western women and may be influenced by genetic factors, parity and previous use of oral contraceptives. Climacteric symptomatology, however, is similar in the different patient groups.

The effect of maternal fasting on the fetal biophysical profile

Objectives: To determine fetal biophysical profile changes in women observing Ramadan with uncomplicated singleton pregnancy. Methods: In this cross‐sectional observational study healthy women who were observing Ramadan at 30 weeks or more of gestation were recruited as well as a non‐fasting control group matched for age, parity, and gestational age. Ultrasound examination included assessment of amniotic fluid volume, fetal bladder volume, fetal biophysical profile, and umbilical artery Doppler flow. Results: A total of 162 pregnant women were observed. Mean umbilical artery pulsatility index, vertical amniotic pool depth, and fetal bladder volume were similar in the study and control groups. However, there was a significant difference in biophysical scores between the two groups. In the fasting group, 30 of 81 fetuses (37%) had a score of 6/8 compared with 11 of 81 fetuses (13.6%) in the control group (P=0.001). All fetuses in both groups with a biophysical score of 6/8 showed no breathing movements. Conclusions: Fetal breathing movements are reduced during maternal fasting.

Consanguinity and the age of menopause in the United Arab Emirates

Objective: The study examined the association between some biosocial factors, consanguinity and age at natural menopause in the United Arab Emirates (UAE). Method: A cross‐sectional population‐based study using a multi‐stage sampling design and face‐to‐face interview. Results: In a sample of 800 UAE females aged 40 years and above, there were 742 (85.8%) respondents. The median age of natural menopause was 48 years. The bodyweight, parity number, occupation, smoking habits and consanguinity in marriage were the significant variables associated with the age at natural menopause. There were statistically significant differences between women in consanguineous and non‐consanguineous marriages with regard to BMI (P<0.002), occupation (P<0.008), weight (P<0.0001), age (P<0.03), age of menopause (P<0.005), parity (P<0.0001), mothers age at menopause (P<0.007) and sisters age at menopause (P<0.002). Conclusion: The study showed that among UAE women, consanguinity of marriage, maternal and sisters age at menopause, BMI, parity number and smoking habits significantly influence the natural age of menopause.

Obstetric outcome in grand multipara in the United Arab Emirates. A case control study.

Abstract Objective: To compare the obstetric outcome in grand multiparous and low parous United Arab Emirates women. Method: The records of 418 grand multiparous women (study group), defined as having had given birth at least 5 times after completed 22 weeks gesta- tional age, and 418 women of parity 2–4 (control group) were reviewed. Results: Mean parity in the study group was 7.9±2.4. The number of subjects who attended for antenatal care and the number of visits were equal in both groups. Diabetes mellitus (both overt and gestational) was significantly more common in the study group (p<0.0001) but there was no significant increase in the incidence of other obstetric complications nor in perinatal mortality rate. Babies of grand multiparous mothers required significantly more admissions to special care unit because of maternal diabetes mellitus (p<0.0002). Conclusion: Diabetes mellitus was more common in grand multiparous United Arab Emirates women but the incidence of other obstetric complications was similar to lower parity women.

The Effect of Intermittent Maternal Fasting on Computerized Fetal Heart Tracing

OBJECTIVE:To determine effects of maternal fasting on antepartum computerized fetal heart tracing analysis.STUDY DESIGN:This was a cross-sectional study of two groups of healthy pregnant women who were recruited, a fasting and a nonfasting control group. Each pregnant woman gave a blood sample, and had a computerized fetal heart tracing.RESULTS:A total of 124 pregnant women were studied. The mean hours since the last oral intake were significantly different between the two groups (p=0.003). Fetuses of fasted mothers had fewer episodes of large acceleration compared to the controls (p=0.001). This difference was significantly associated with maternal appreciation of fetal movement (p=0.003).CONCLUSION:The number of large accelerations in computerized fetal heart tracing is decreased in pregnant women abstaining from food and water.

Abnormal Vascular Coiling of the Umbilical Cord in Gestational Diabetes Mellitus

The objective of this study was to identify abnormal vascular coiling of the umbilical cord in neonates of mothers with gestational diabetes mellitus. The umbilical cords of 57 neonates of gestational diabetic mothers were examined and the coiling index determined by dividing the total number of complete vascular coils by the length of the cord in centimeters. Obstetric history, delivery data and neonatal outcome were also evaluated. These variables were compared with those obtained for 389 normal pregnancies. The frequency distribution of umbilical coiling index in the control population and gestational diabetic mothers were normal (10th and 90th percentiles = 0.17 and 0.37; mean ± SD = 0.26 ± 0.09 and 0.24 ± 0.12 coils/cm, respectively). Non-coiling and hyper-coiling were significantly more frequent with diabetic than with normal pregnancy (p = 0.004; p = 0.008, respectively). Both abnormalities of umbilical vascular coiling were also significantly associated with adverse perinatal outcome (p = 0.04) and emergency cesarean delivery (p < 0.0001) in the diabetic and control (p = 0.03; p < 0.0001, respectively) groups. Neonates of gestational diabetic mothers are therefore more likely to have hyper-coiled or non-coiled umbilical blood vessels. Perinatal morbidity and emergency cesarean delivery are increased in this subgroup.

Obstetric outcome of excessively overgrown fetuses (≥= 5000 g): a case-control study

Abstract Aims. To compare the obstetric outcome of excessively-and appropriately-grown fetuses. Methods. Medical records of mothers who delivered excessively overgrown fetuses, defined as birthweight ≥ 5000 g, in our hospital between 1996 and 2000 (n = 47, study group), and a control group who delivered fetuses with normal birthweight (n = 47) were reviewed. Results. Incidence of excessively overgrown fetuses was 0.24% and 68% were boys. Mothers in this group were significantly older, overweight and multiparous (p < 0.0001) and had gestational diabetes mellitus (p < 0.0001) and prolonged pregnancies (p = 0.04). A previous big baby was also significant (p < 0.0001) and the commonest risk factor. There were no obvious risk factors in nine (19.1%) cases. More than half (n = 28,59.5%) of these babies were delivered vaginally without clinical suspicion of excessive fetal size. Duration of second stage of labor and incidence of maternal trauma were similar in both groups. Cesarean delivery (p = 0.0003), postpartum hemorrhage (p = 0.004), birth asphyxia (p = 0.007), shoulder dystocia (p < 0.0001) and fetal trauma (p = 0.03) were significantly more frequent in the study group. Conclusions. Excessively overgrown fetuses are associated with the same risk factors as fetal macrosomia and should be delivered by cesarean if diagnosed antenatally because of increased maternal and perinatal morbidity during vaginal delivery.

Women's perceptions and experiences of childbirth in United Arab Emirates.

Abstract Aims: To determine womens perceptions and experiences of childbirth in United Arab Emirates [UAE]. Methods: A consecutive sample of 715 women who delivered during a 3 month period were interviewed on the third postnatal day about their experience and satisfaction with maternity care using a structured questionnaire. Results: 95 (13.2 %) women had negative feelings including fear, anger, sorrow and regret, guilt, jealousy, sense of failure and disappointment while the rest felt that childbirth was enjoyable and that they had been well-informed, especially by nurses, about their perinatal care. Subjects delivered by cesarean (N = 104, 14.5 %) were significantly less satisfied with the information provided by their caregivers and their involvement in decision-making before the operation than the vaginal group (p = 0.001). Irrespective of mode of delivery, most participants strongly agreed that cesarean is worse than vaginal delivery whatever the reason and should be performed only for medical reasons. Adverse maternal experiences were significantly more frequent with cesarean delivery (p = 0.00001), older age (p = 0.04), primiparity (p = 0.03), higher education (p = 0.03), lack of antenatal care (p = 0.03) and prolonged labor (p = 0.04). Conclusions: Childbirth experience and the prevalence and correlates of postnatal psychosocial morbidity in UAE are not different from those observed elsewhere.

The role of extracellular calcium in pregnancy-induced attenuation of phenylephrine contraction in rat aorta with functional endothelium

The effect of pregnancy on the supply of calcium ions for the contractile responses of rat aortic rings to phenylephrine was investigated. The contractility of intact aortic rings from pregnant rats, compared with that of similar rings from non-pregnant rats, to phenylephrine and potassium chloride was significantly decreased. Contractions of rings from non-pregnant rats, pretreated with phenylephrine or potassium chloride, in response to calcium chloride were greater than those of similarly treated rings from pregnant rats. When the concentration of calcium chloride in the medium bathing the rings was reduced to 0.8 mmol·l-1, the contractile response to phenylephrine was significantly (P<0.005) inhibited in rings from both pregnant and non-pregnant rats but to a greater extent in rings from non-pregnant rats. Contractions of aortic rings from pregnant rats in response to phenylephrine in calcium-free medium were similar to those of rings from non-pregnant rats, suggesting equal dependence on calcium from intracellular stores. The results suggest that pregnancy decreased the response to calcium influx into the aortic smooth muscle cells through both receptor-and voltage-operated calcium entry pathways. Since de-endothelialisation reversed the pregnancy-induced diminished contraction to phenylephrine, it is likely that pregnancy interferred with contractions induced by activation of receptors with phenylephrine through enhanced production of endothelium-derived relaxing factor(s).