Ounjai Kor-anantakul

The effect of heavy maternal workload on fetal growth retardation and preterm delivery. A study among southern Thai women.

Heavy maternal workloads are considered to be hazardous to the fetus. The effects of physical activity during pregnancy on low birth weight (LBW), small for gestational age (SGA), and prematurity were assessed from a sample of 1797 women in a follow-up study at the antenatal clinic of two hospitals in southern Thailand. The women were interviewed twice, at 17 and 32 gestational weeks. Outcome data were obtained from medical records and the newborn gestational age determined using Dubowitzs score. The risk of SGA was elevated for women working > 50 hours/week, squatting in work, commuting > 1 hour/day, and having high psychological job demands; the risk of preterm delivery was increased with obstetrical complications. Women who worked long hours and had demanding work conditions had an elevated risk of giving birth to SGA infants but not of preterm delivery.

Are long working hours and shiftwork risk factors for subfecundity? A study among couples from southern Thailand.

OBJECTIVE: To estimate the effect of long working hours and shift work on time to pregnancy. METHODS: Cross sectional samples with retrospective data collection from two 700 bed hospitals at secondary to tertiary care level in Hatyai district, Songkhla Province, Thailand. The study was conducted from March 1995 to November 1995 among 1496 pregnant women attending the antenatal clinics. Subfecundity was defined as time to pregnancy longer than 7.8, 9.5, or 12 months (time to pregnancy was calculated from the date at which the couples started having sexual relations without any contraception until last menstrual date). RESULTS: The descriptive analyses were restricted to 1201 planned pregnancies and the analytical part to 907 working women. Separate analyses on primigravid women were also done. Logistic regressions adjusted for age, education, body mass index, menstrual regularity, obstetric and medical history, coital frequency, and potential exposure to reproductive toxic agents, showed an odds ratio (OR) associated with female exposure to long working hours of 2.3 (95% confidence interval (95% CI) 1.0 to 5.1) in primigravid and 1.6 (1.0 to 2.7) in all pregnant women. Male exposure to long working hours and shiftwork showed no association with subfecundity. The OR of subfecundity was highest when both partners worked > 70 hours a week irrespective of the cut off point used (OR 4.1 (95% CI 1.3 to 13.4) in primigravid women; OR 2.0 (95% CI 1.1 to 3.8) in all pregnant women). CONCLUSIONS: Long working hours is a risk factor for subfecundity especially for women. Shiftwork was not associated with subfecundity in this study.

Etiology and Outcome of Non-Immune Hydrops fetalis in Southern Thailand

Objective: To study the etiology and outcome of non-immune hydrops fetalis in southern Thailand. Methods: The medical records and videotape recordings of all pregnant women diagnosed with non-immune fetal hydrops, from January 1993 to December 2002 were reviewed. Results: Non-immune hydrops fetalis was documented in 71 cases. The causes of fetal hydrops were identified in 87.3%. Homozygous α-thalassemia-1 dominated as the cause of non-immune fetal hydrops (28.2%), followed by structural abnormalities (15.5%) and infection (12.7%). The underlying etiology remained unknown in 9 cases (12.7%). The overall survival rate of non-immune hydrops fetalis cases was 4.2%. Spontaneous regression occurred in 2 cases. Two cases were lost to follow up after initial evaluation. Termination of pregnancy was performed in 47 cases. There were 12 dead fetuses in utero, 2 stillbirths, 5 early neonatal deaths and only 3 cases survived. Conclusions: Homozygous α-thalassemia-1 is the most common cause of non-immune hydrops fetalis in southern Thailand, and the overall prognosis of non-immune hydrops fetalis is poor. We suggest that an effective thalassemia-screening program for prevention and control of homozygous α-thalassemia-1 be established in all areas where the α-thalassemia-1 gene is prevalent.

Maternal iodine status and neonatal thyroid-stimulating hormone concentration: a community survey in Songkhla, southern Thailand

OBJECTIVE To determine iodine intake and urinary iodine excretion (UIE) in a group of pregnant Thai women and the concentration of thyroid-stimulating hormone (TSH) in their neonates. DESIGN A prospective cohort study. SETTING Three districts of Songkhla, southern Thailand. SUBJECTS Two hundred and thirty-six pregnant women. RESULTS A quarter of the participants lacked knowledge of iodine and the prevention of iodine deficiency, although 70 % used iodized salt. Those who did not use iodized salt stated that they had no knowledge about iodine (57 %) and no iodized salt was sold in their village (36 %). The median iodine intake in the three districts was 205-240 microg/d, with 53-74 % of pregnant women having iodine intake <250 microg/d. The median UIE in the three districts was 51-106 microg/l, with 24-35 % having UIE < 50 microg/l. The mean neonatal TSH was 2.40 (sd 1.56) mU/l, with 8.9 % of neonates having TSH > 5 mU/l. CONCLUSIONS The studied women and their fetuses were at risk of mild iodine deficiency. About a quarter of the participants lacked knowledge of the importance of iodine. Education regarding the importance of iodine supplements and the promotion of iodized salt should be added to national health-care policies in order to prevent iodine-deficiency disorders, diseases that are subclinical but have long-term sequelae.

Reliability of fetal nasal bone length measurement at 11–14 weeks of gestation

BackgroundNasal bone assessment has been incorporated into Down syndrome screening in first trimester. Several studies have established the normal reference values for fetal nasal bone length in the first trimester, which were found to be varied by population. However, the study on reliability of nasal bone length measurement was limited with contradictory results. This study aimed to investigate the reliability of fetal nasal bone length measurement at 11–14 weeks of gestation in the Thai population.MethodsA total of 111 pregnant women at 11–14 weeks of gestation attending for the routine first-trimester ultrasound examination were recruited. Each case was measured separately by two examiners. Examiner 1 performed the first measurement in all cases; any of the other 5 examiners consecutively performed the second measurement. Three independent measurements were performed by each examiner and they were blinded to the results of the others. Intraobserver and interobserver variabilities were evaluated with the intraclass correlation coefficient (ICC).ResultsNasal bone measurement was successfully performed in 106/111 cases (95.5%) by at least one examiner; 89 cases were performed by two examiners. The intraobserver variability was excellent for all examiners (ICC, 0.840-0.939). The interobserver variability between different pairs of examiners varied from moderate to excellent (ICC, 0.467-0.962). The interobserver variability between examiner 1 and any other examiner was good (ICC, 0.749). The Bland-Altman plot of the interobserver differences of nasal bone length measurements between examiner 1 and any other examiner showed good agreement.ConclusionsThe reliability of the fetal nasal bone length measurement at 11–14 weeks of gestation was good. The nasal bone length measurement was reproducible. Ethnicity has an effect on fetal nasal bone length, but reliability of nasal bone length measurement is critical to accuracy of screening and should be audited on an ongoing basis.

A survey of the knowledge and attitudes of pregnant Thai women towards Down syndrome screening

Aim:  To determine the knowledge and attitudes of pregnant Thai women towards Down syndrome screening.

Maternal and fetal mortality and complications associated with cesarean section deliveries in teaching hospitals in Asia

Aim:  To compare the mortality, morbidity of emergency and elective cesarean section with vaginal delivery among Asian teaching hospitals

Influence of maternal nutrient intake and weight gain on neonatal birth weight: a prospective cohort study in southern Thailand.

Objectives. To assess the nutritional intake and gestational weight gain of pregnant women and the relationship between nutritional intake, gestational weight gain, and neonatal birth weight. Methods. A prospective cohort study was carried out in three districts of Songkhla Province in southern Thailand. Nutritional intakes were calculated based on a 24-h food record and a food frequency checklist. The women were followed until delivery and the neonatal birth weight recorded. Results. Two hundred and thirty-six pregnant women with a mean age of 27.2 ± 6.2 years were recruited. The average daily energy intake was 1806 ± 482 kcal. The average gestational weight gain was 12.2 ± 4.6 kg and the average neonatal birth weight was 3054 ± 474 g. Micronutrient intakes were overall inadequate averaging only 50–80% of recommended levels. Neonatal birth weight was significantly positively correlated with gestational weight gain (r = 0.17, p = 0.01), but was not correlated with maternal nutritional intakes. Conclusions. Pregnant women in rural areas of Songkhla Province consume adequate macronutrients with appropriate gestational weight gain, but generally consume inadequate micronutrients. A nutritional education program explaining the importance of micronutrients should be a focus of a public education program.

Variability of Nuchal Translucency Measurement

Objectives: To evaluate intra- and inter-observer variations of nuchal translucency (NT) measurements and study the duration of measurements. Subjects: One hundred and forty-seven singleton pregnant women with 10–14 weeks of gestation who had attended antenatal clinic during January 1st, 2000–August 31st, 2001 were included. Methods: Crown-rump length and NT were measured three times for each woman. Then, another examiner who was unaware of the previous results did the other three measurements. The duration of measurements was recorded. Intra-observer and inter-observer variations were analyzed by repeated ANOVA and paired t test, respectively. The correlation of NT measurements within each observer and between paired observers was evaluated by intraclass correlation coefficients (ICC). Kappa statistic was calculated for agreement. Results: Intra-observer variation of all 10 examiners at three institutes was varied from 0.20 ± 0.27 to 0.33 ± 0.41 mm. Inter-observer variation at Chiang Mai University was 0.40 ± 0.37 mm which was the highest value compared with those at Prince of Songkla and Khon Kaen University (p < 0.05). The mean duration of measurements was in range of 8–12 min. The intra-observer repeatability of the first two measurements showed ICCs varying from 0.61 to 0.94. The inter-observer repeatability of paired examiners showed a variation in ICC from 0.28–0.90. The kappa value expressing the intra- and inter-observer repeatability as being >95th or ≤95th percentile was 0.73 and 0.72, respectively. Conclusions: NT measurement was reproducible for small variation and good agreement. The duration of measurements was acceptable.

Comparing complications in intended vaginal and caesarean deliveries.

Summary A hospital-based, prospective cohort study was conducted at the tertiary care university hospital in southern Thailand, between 1 November 2001 and 31 December 2003. The purpose of this study was to compare the various complications found in vaginal and caesarean deliveries based on the original elected intended mode of delivery. There were a total of 1,429 cases, 1,242 intended vaginal deliveries and 187 intended caesarean deliveries. Major and minor complication rates were found to be significantly lower in the intended vaginal delivery group compared with the intended caesarean delivery group (2.3% and 1.3% vs 4.8% and 3.7%; p < 0.05). The most common major complication was haemorrhage, which was found more frequently in the intended caesarean delivery group (OR 7.5, 95% CI 2.6 – 21.5). After statistical adjustment, an intended caesarean delivery was found to be an independent risk factor for complications.