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The World Health Organization Fetal Growth Charts: A Multinational Longitudinal Study of Ultrasound Biometric Measurements and Estimated Fetal Weight.
PloS Medicine. 2017 Jan; 14(1):e1002220.BACKGROUND: Perinatal mortality and morbidity continue to be major global health challenges strongly associated with prematurity and reduced fetal growth, an issue of further interest given the mounting evidence that fetal growth in general is linked to degrees of risk of common noncommunicable diseases in adulthood. Against this background, WHO made it a high priority to provide the present fetal growth charts for estimated fetal weight (EFW) and common ultrasound biometric measurements intended for worldwide use. METHODS AND FINDINGS: We conducted a multinational prospective observational longitudinal study of fetal growth in low-risk singleton pregnancies of women of high or middle socioeconomic status and without known environmental constraints on fetal growth. Centers in ten countries (Argentina, Brazil, Democratic Republic of the Congo, Denmark, Egypt, France, Germany, India, Norway, and Thailand) recruited participants who had reliable information on last menstrual period and gestational age confirmed by crown-rump length measured at 8-13 wk of gestation. Participants had anthropometric and nutritional assessments and seven scheduled ultrasound examinations during pregnancy. Fifty-two participants withdrew consent, and 1,387 participated in the study. At study entry, median maternal age was 28 y (interquartile range [IQR] 25-31), median height was 162 cm (IQR 157-168), median weight was 61 kg (IQR 55-68), 58% of the women were nulliparous, and median daily caloric intake was 1,840 cal (IQR 1,487-2,222). The median pregnancy duration was 39 wk (IQR 38-40) although there were significant differences between countries, the largest difference being 12 d (95% CI 8-16). The median birthweight was 3,300 g (IQR 2,980-3,615). There were differences in birthweight between countries, e.g., India had significantly smaller neonates than the other countries, even after adjusting for gestational age. Thirty-one women had a miscarriage, and three fetuses had intrauterine death. The 8,203 sets of ultrasound measurements were scrutinized for outliers and leverage points, and those measurements taken at 14 to 40 wk were selected for analysis. A total of 7,924 sets of ultrasound measurements were analyzed by quantile regression to establish longitudinal reference intervals for fetal head circumference, biparietal diameter, humerus length, abdominal circumference, femur length and its ratio with head circumference and with biparietal diameter, and EFW. There was asymmetric distribution of growth of EFW: a slightly wider distribution among the lower percentiles during early weeks shifted to a notably expanded distribution of the higher percentiles in late pregnancy. Male fetuses were larger than female fetuses as measured by EFW, but the disparity was smaller in the lower quantiles of the distribution (3.5%) and larger in the upper quantiles (4.5%). Maternal age and maternal height were associated with a positive effect on EFW, particularly in the lower tail of the distribution, of the order of 2% to 3% for each additional 10 y of age of the mother and 1% to 2% for each additional 10 cm of height. Maternal weight was associated with a small positive effect on EFW, especially in the higher tail of the distribution, of the order of 1.0% to 1.5% for each additional 10 kg of bodyweight of the mother. Parous women had heavier fetuses than nulliparous women, with the disparity being greater in the lower quantiles of the distribution, of the order of 1% to 1.5%, and diminishing in the upper quantiles. There were also significant differences in growth of EFW between countries. In spite of the multinational nature of the study, sample size is a limiting factor for generalization of the charts. CONCLUSIONS: This study provides WHO fetal growth charts for EFW and common ultrasound biometric measurements, and shows variation between different parts of the world.
Geneva, Switzerland, WHO, Special Programme for Research and Training in Tropical Diseases [TDR], 2006. 25 p. (TDR/SDI/06.1.)Syphilis is a curable infection caused by a bacterium called Treponema pallidum. This infection is sexually transmitted, and can also be passed on from a mother to her fetus during pregnancy. As a cause of genital ulcer disease, syphilis has been associated with an increased risk of HIV transmission and acquisition. Most persons with syphilis tend to be unaware of their infection and they can transmit the infection to their sexual contacts or, in the case of a pregnant woman, to her unborn child. If left untreated, syphilis can cause serious consequences such as stillbirth, prematurity and neonatal deaths. Adverse outcomes of pregnancy are preventable if the infection is detected and treated before mid-second trimester. Early detection and treatment is also critical in preventing severe long term complications in the patient and onward transmission to sexual partners. Congenital syphilis kills more than one million babies a year worldwide but is preventable if infected mothers are identified and treated appropriately as early as possible. (excerpt)
Chung-Hua Fu Chan Ko Tsa Chih / Chinese Journal of Obstetrics and Gynecology. 1993 Aug; 28(8):457-459.Perinatal medicine is a new branch of medicine related to pregnancies that has developed during the past 30 years in the world. It was first introduced to China at the end of the 1970s. In 1981, the Society of Obstetrics and Gynecology of the Chinese Medical Association organized the first academic meeting on perinatal science in China. With the help of the World Health Organization, China invited experts in this field to hold seminars in China, training key personnel from various provinces, cities and autonomous regions, who then spread the knowledge all over the country. The development of perinatal medicine in China has been characterized by the following. (excerpt)
Statement by the chairman of the Technical Working Group on the Clinical and Therapeutic Evolution of HIV Infection in Mothers and Children.
In: International Conference on the Implications of AIDS for Mothers and Children: technical statements and selected presentations jointly organized by the Government of France and the World Health Organization, Paris, 27-30 November 1989. Geneva, Switzerland, WHO, Global Programme on AIDS, 1989. 28-30. (SE:WHO/GPA/DIR/89.12)An estimated 2 million women worldwide are infected with human immunodeficiency virus (HIV), and many of these women will transmit HIV infection to their infants. Perinatal transmission accounts for at least 80% of cases of HIV infection in children. The presence of maternal antibodies renders it impossible to diagnose HIV infection in the 1st 18 months of life with current screening tests. Thus, diagnosis must be based on a combination of epidemiologic risk factor assessment, clinical signs and symptoms, and laboratory findings. If the clinical manifestations of HIV infection are to become more useful and adaptable to all world regions, they should be specifically classified and defined on the basis of universal nomenclature. Also needed is more information on the pathogenesis of the different syndromes observed in HIV-infected children. Pneumocystis carinii pneumonia--the 1st type of pattern-- appears earlier and has a much worse prognosis than lymphoid interstitial pneumonia--the 2nd disease pattern observed in children. Preliminary clinical trials suggest that zidovudine may improve the survival time in HIV-infected children, normalize height and weight, and bring about regression in certain neurological signs. More trials are needed on this promising development, as well as to investigate the possibility that the administration of zidovudine to pregnant women and/or neonates in the last 24 hours of life can prevent the vertical transmission of HIV infection.
Statement by the chairman of the Technical Working Group on the Epidemiology of HIV Infection in Mothers and Children.
In: International Conference on the Implications of AIDS for Mothers and Children: technical statements and selected presentations jointly organized by the Government of France and the World Health Organization, Paris, 27-30 November 1989. Geneva, Switzerland, WHO, Global Programme on AIDS, 1989. 25-7. (WHO/GPA/DIR/89.12)The prevalence of perinatal human immunodeficiency virus (HIV) transmission is rapidly increasing, and it is estimated that 2 million women and over 500,000 infants will be infected by the end of 1989. Although transplacental transmission during the 1st trimester of pregnancy appears to be the source of most pediatric HIV infection, the virus can also be transmitted during delivery or postnatally. The role of breastfeeding as a risk factor is an urgent research priority given the beneficial health effects of this practice. Clarification of the effect of the stage of maternal infection on transmission also is needed. Women with symptomatic HIV infection appear more likely to transmit the disease, yet recently acquired infection may be more highly infectious. Prospective studies of children of HIV-infected women should seek to elaborate the natural history of disease, cofactors such as breastfeeding and nutritional status that may influence the course of the disease, predictive factors for an unfavorable prognosis, the influence of immunizations and prophylactic treatments to prevent superinfection, and the impact of optimal prenatal care on the child's prognosis. Health education that teaches women of childbearing age how to avoid contracting HIV remains the most effective measure against the perinatal transmission of HIV. To ensure that the public receives consistent information, HIV prevention campaigns should be closely linked to existing programs in maternal-child health, sexually transmitted disease control, family planning, and immunization.
In: International Conference on the Implications of AIDS for Mothers and Children: technical statements and selected presentations jointly organized by the Government of France and the World Health Organization, Paris, 27-30 November 1989. Geneva, Switzerland, WHO, Global Programme on AIDS, 1989. 23-4. (WHO/GPA/DIR/89.12)Large gaps exist in knowledge of the clinical, immunologic, and virologic correlates of human immunodeficiency virus (HIV) transmission from infected mothers to their infants. Physiological changes in the immune system of pregnant women as well as maternal antibodies to certain virus-encoded proteins may affect the natural history of HIV infection. Also relevant may be the stage of the mother's infection and the time of HIV transmission to the fetus. There is some evidence that maternal antibodies to the immunodominant hypervariable loop in gag protein 120 may reduce the risk of transmission to the fetus. More basic research in virology and immunology is needed for the development of prophylactic and therapeutic approaches to maternal-infant HIV infection. Research priorities include the following: the impact of pregnancy on clinical outcome and virological and immunologic markers in HIV-infected women; correlates of perinatal transmission such as virus characteristics and load, neutralizing antibodies, and cell-mediated immunity; possible immunologic or chemotherapeutic interventions to decrease perinatal transmission; and the standardization of virologic and immunologic markers for pediatric HIV infection.
Statement by the chairman of the Technical Working Group on Diagnosis of HIV Infection in Women and Children.
In: International Conference on the Implications of AIDS for Mothers and Children: technical statements and selected presentations jointly organized by the Government of France and the World Health Organization, Paris, 27-30 November 1989. Geneva, Switzerland, WHO, Global Programme on AIDS, 1989. 39-40. (WHO/GPA/DIR/89.12)According to World Health Organization estimates, there are about 2 million women and children throughout the world infected with the human immunodeficiency virus (HIV), most of whom remain asymptomatic and unidentified. At least 30% of infants whose mothers are HIV-positive will become infected before, during, or soon after birth. At present, HIV antibody tests are unable to diagnose perinatally acquired HIV infection in infants under 18 months of age. In such cases, the diagnosis can be made only on the basis of clinical signs and symptoms such as unexplained neurological abnormalities, developmental regression, recurrent severe bacterial infections that fail to respond to conventional therapy, lymphocytic interstitial pneumonitis, or opportunistic infections related to cellular immunodeficiency. Given the importance of timely diagnosis of HIV infection, research focused on both the development of sensitive, specific laboratory tests for the diagnosis of HIV in infants under 18 months of age and refinement of the case definition of pediatric acquired immunodeficiency syndrome (AIDS) should be prioritized. Policy decisions as to whether women of reproductive age should be tested for HIV infection should be based on laboratory testing and counseling resources, the availability of medical and social services for women and children, and the overall prevalence of HIV infection in the locality or country.
Geneva, Switzerland, WHO, 1981. 76 p. (WHO Technical Report Series No. 657)This report on the effect of female sex hormones on fetal health and development aimed to evaluate research on the specific types of sex hormones and their uses, to determine their safety with respect to fetal development and infant health, and to recommend further research in these areas. Theoretically, sex hormones can affect any stage of fetal development. Sex hormones appear to act by promoting synthesis of messenger ribonucleic acid (mRNA) in target tissues, so that research should focus on the specific proteins formed under the direction of newly synthesized mRNA to elucidate potential morphological and physiological effects of exogenous hormones. Following are some research avenues: cytogenetic research, microscopic and macroscopic examination, observations on births and later life, animal teratology, and epidemiological studies. Epidemiological studies not only help elucidate causal associations but also provide public health data. Studies of sex hormones and fetal development and infant health must be free of bias and often suffer from problems of defining pregnancy outcome. Also sex steroids are frequently administered at the same time as other drugs, leading to confounding effects of drug interactions. In order to assess existing data, it is necessary to disaggregate the data from different reports and then to regroup them according to the indications for use, i.e., infertility, contraception, pregnancy testing, supportive therapy during pregnancy, contraception during pregnancy, contraception during breast feeding. Likewise data must be disaggregated according to different types of exposure, i.e., preconception or postconception. The bulk of this monograph is spent disaggregating study data based on the above-stated rationales. The following recommendations are made for indications for use of sex hormones: 1) they should not be used as pregnancy tests; 2) diethylstilbestrol should not be prescribed to a suspected pregnant woman; 3) benefits of progestin therapies must first be proven before they can be recommended for use in supporting pregnancy; 4) oral contraceptives given before pregnancy seem to have no effect on subsequent pregnancy; and during lactation combined therapy should not be given.
World Health Organization, (Technical Report Series.). 1965; 22.A report of the Scientific Group on the Physiology of Lactation which met in Geneva, December 2-7, 1963, is presented. Major aspects covered include: 1) growth of the mammary gland; 2) milk secretion; 3) biochemical activities of the mammary gland; 4) the physiology of suckling; and 5) factors of human lactation and breast feeding. It is recommended that WHO should: 1) provide grants and research fellowships to enable research workers in the field of lactation to extend their experience by working for a time in other appropriate research centers; 2) support the establishment of laboratories in certain countries for the titration of hormones in cases of normal and abnormal lactation; 3) make contact with organizations engaged in the collection of primate pituitary tissues to obtain their advice and help in organizing the extension of the collection to other parts of the world and in arranging for the preparation of extracts, especially of human prolactin and somatotrophin for international use; 4) make contact with individuals and organizations engaged in the collection of hypothalamic tissue with the object of improving facilities for collection; and 5) encourage studies on human lactation in relation to malnutrition and undernutrition in developing countries.
Geneva, World Health Organization, 1964. (Technical Report Series No. 280.) 30 p.A WHO Scientific Group on the Biology of Human Reproduction was convened in Geneva from April 2-8, 1963, for the purpose of advising the Director-General on developments and major research needs in that field. The biology of human reproduction is an extremely broad scientific topic, which impinges to some degree on virtually all the basic medical disciplines. Major topics included in the report are: 1) comparative aspects of reproduction; 2) neuroendocrine aspects of reproduction; 3) biology of the gonads and gametes; 4) gestation; 5) biochemistry of the sex steroids; 6) immunological aspects of reproduction; and 7) pharmacological aspects of reproduction. The Group recommends: 1) that WHO assist in the development of fundamental knowledge of the biology of human reproduction and of other fields on which that knowledge is based and 2) that WHO convene meetings of appropriate specialist groups to consider practical methods of implementing certain proposals concerning organization of surveys, provision of services, and promotion of relevant research.
Lancet. 1990 Jul 28; 336(8709):221-4.The World Health Organization (WHO) has developed an acquired immunodeficiency syndrome (AIDS) projection model based on available human immunodeficiency virus (HIV) serologic survey data and annual rates of progression from HIV infection to AIDS. The model assumes a progression rate to AIDS, for adults, of 75% within 15 years and 95% within 20 years, and, for children, of 25% in the 1st year, 45% by the end of the 2nd year, 60% by the end of the 3rd year, and 80% by the 4th year. Application of this model suggests that, by early 1990, over 3 million women, most of whom were of childbearing age and 80% of whom are in sub-Saharan Africa, were infected with HIV. The model further suggests that, by the end of 1989, there will be excess of 800,000 AIDS cases in African women and close to 300,000 pediatric AIDS cases; by the end of 1992, these figures are projected to be 600,000 cases in women and 600,000 cases in children. Since the majority of these African cases will go undiagnosed, and untreated, death can be expected to occur within a year after symptoms. AIDS will obviously have a major impact on child and adult mortality rates in regions such as sub-Saharan Africa. In countries where 10% or 20% of pregnant women are HIV- infected (a not uncommon phenomenon in Central African cities), the child mortality rate can be expected to be 118 or 136/1000 live births, respectively. In addition, a 5-10% prevalence of HIV infection among sexually active adults in these cities can be expected to double or triple the adult mortality rate by the early 1990s and lead to a 10% increase in the number of uninfected orphans in Africa. As growing numbers of women and children become infected with the HIV virus, African governments will be forced to address the need for greater social support to these families.
HUMAN RIGHTS QUARTERLY. 1990; 12(1):156-78.As a result of heated controversy and the need to reach a compromise solution, the Commission on Human Rights' Draft Convention on the Rights of the Child (1989 version) raises the abortion issue only in a preamble. This preamble asserts that, ". . .the child, by reason of his physical and mental immaturity, needs special safeguards and care, including appropriate legal protection, before as well as after birth." Still unclear, however, is the role of a preamble to an international treaty and the exact meaning of the preamble paragraph. The United Nations has a history of using preamble to express general policy concerns that are not necessarily pursued or even addressed in the operative part of the document itself and have little juridical value. Moreover, a close reading of the preamble shows no evidence of a mandate to recognize the right to life of the unborn child or of a redefinition of the term "child" to encompass the fetus. What the preamble does do is lend authority to the already widespread practice of individual stakes taking whatever measures they consider appropriate to protect the fetus. The preamble's recognition that the fetus is deserving of appropriate protection cannot be interpreted as an endorsement of the right to life per se, and experience has shown that increasing the level of protection awarded to the fetus does not have to imply any restrictions on the availability of legal abortion.
In: Advances in international maternal and child health. Volume 7. 1987, edited by D.B. Jelliffe and E.F.P. Jelliffe. Oxford, England, Clarendon Press, 1987. 170-9.General principles of the WHO Essential Drug List (EDL) and the International Non-Proprietary Names (INN) list and their application to maternal and child health are summarized. 8 principles of good prescribing habits are introduced, such as careful dosing for infants, children, pregnant or lactating women, elderly, or those with liver or kidney disease. Most INN drug names are identical to the generic names used in the country of origin, but some are coined from common chemical or pharmacological stems. Drugs for pregnant women should be limited in number, and used with care since almost all cross the placenta and may not be tolerated by the fetus with its immature liver and kidneys. The most serious reason for restricting certain drug intake by pregnant women is the risk of teratogenicity, particularly in the 1st trimester. Potential teratogens include antiepileptics, barbiturates, cytotoxics, anticoagulants, and female sex hormones. Salicylates should not be taken near term. Opioid analgesics should not be used during labor. Drugs dangerous for the infant during breastfeeding include high dose oral contraceptives, the antithyroid drugs thiouracil and iodine, diazepam and lithium. Education and training in pharmacokinetics for personnel in maternal-child health should be included. Fixed combinations of drugs are not advisable: out of 220 drugs in the EDL, there are only 11 drug combinations.
Washington, D.C., PAHO, 1989. xvii, 365 p. (PAHO Scientific Publication No. 514)The epidemiology of acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV) infection in the Americas is examined in 1) a collection of articles; 2) a round-table debate on epidemiologist Alexander Langmuir's position that projections of the incidence of AIDS in the US are too high; and 3) a documenting series of abstracts and reports on the fight against AIDS. The experiences of Canada, the US, Mexico, Colombia, Brazil, Venezuela and Caribbean countries, including Cuba, Dominican Republic and Haiti, are covered. The articles highlight differences in modes of transmission of AIDS and their public health implications. They also deal with perinatal transmission, methods of testing, the inadequacies of public education, legal and ethical issues and the problems of blood banks. The abstracts and reports include descriptions of the contemporary status of the AIDS epidemic, the Global Program on AIDS of the World Health Organization and the activities of the Pan American Health Organization; a report on the First Pan American Teleconference on AIDS (Quito, Ecuador, 1987); summaries on sexual transmission, criteria for HIV screening programs, information for health workers, AIDS and the workplace, public education, mental and neurologic disorders associated with AIDS, nutrition, testing methods and animal models for HIV infection and AIDS; and a summary report on the World Summit of Ministers of Health on Programs for AIDS Prevention (London, 1988).
[Unpublished] 1988. Presented at the 116th Annual Meeting of the American Public Health Association [APHA], Boston, Massachusetts, November 13-17, 1988. 7 p.In most developing countries, particularly those in Africa and the Caribbean, equal numbers of women as men are affected by the acquired immunodeficiency syndrome (AIDS) and have the potential to infect their fetuses. Thus, any consideration of the AIDS problem in developing countries must give serious attention to women and children. Current research suggests a perinatal transmission rate of 30-40% and there is concern that AIDS-related pediatric deaths will undermine child survival efforts in countries that have begun to reduce infant and child mortality rates. A number of clinical issues that are now poorly understood require immediate research so that findings can be incorporated into AIDS prevention strategies. Among these issues are: the impact of pregnancy on progression of human immunodeficiency virus (HIV) infection to AIDS; factors that affect an HIV-infected mother's chance of infecting her fetus; the safety of breastfeeding; immunization; the relationships between HIV infection and various contraceptives; and the potential impact of HIV infection on fertility. The extent and nature of the social and financial impact of AIDS at the family and community levels must also be better understood. In the interim, UNICEF has proposed 6 programmatic approaches to prevent women from becoming infected, to prevent perinatal transmission, and to address the AIDS-related needs of women and children. 1st, traditional birth attendants should be trained in AIDS prevention measures and provided with supplies to ensure infection control. 2nd, women must be able to receive consistent, appropriate advice from both maternal-child health workers and family planning staff about contraception and their future health. 3rd, the issue of counseling for women should be broadened beyond that associated with routine prenatal HIV screening. 4th, AIDS education efforts for school-age children must be expanded. 5th, more attention should be given to the social service needs of AIDS-infected women and children. And 6th, there is an urgent need to improve protocols and treatment facilities for those affected with HIV and AIDS.
Journal of Family Law. 1981-1982; 20(2):241-61.Abortion, a topic which challenges the religious and moral values of many individuals, has an impact on population control relied upon by some nation-states in achieving economic and social development. This is seen in India, and previously in the Eastern European states of Czechoslovakia, Bulgaria, East Germany, Hungary, Poland and Romania after WW II. In these states abortion is accepted largely for economic reasons. Abortion has strongly emerged as an issue in the development of international law, particularly in the area of human rights. This article studies that emergence by looking at the right to privacy, its expression in various human rights documents, and both the restrictive and liberal view of its application to woman's right to terminate a pregnancy, without external interference. The fetus' right to life is discussed and finally the interests of women, the fetus, and the public are analyzed to determine the importance of each of these interests to world peace and public order. International human rights agreements, e.g., the Universal Declaration on Human Rights, express the right to privacy in general terms, making it difficult to determine the scope of the right. In a case brought before the European Commission on Human Rights, 2 West German nationals' claimed the scope of the right to privacy includes the right of the woman to decide whether to terminate her pregnancy the commission held that such interference was not a breach of the woman's right to respect for her private life. The primary goal of human rights is to establish maximum respect for the individual and it is in this context that the right of a woman to choose to terminate a pregnancy is analyzed. Autonomy is an element of respect for the individual. Denying women the legal right or information to control fertility limits their ability to control their health, educational, political, social and cultural status. The fact that fertility control substantially affects the status of women is recognized in international human rights agreements. Sex equality is achieved by giving women the right to abortion. Legal proscriptions against abortion are inconsistent with the goals and objectives of human rights, especially the individual woman's right to respect and autonomy.