Objective To assess the effect of 25-hydroxyvitamin D (25-OHD) levels on pregnancy outcomes and birth variables.Design Systematic review and meta-analysis. Medline (1966 to August 2012, PubMed (2008 to August 2012, Embase (1980 to August 2012, CINAHL (1981 to August 2012, the Cochrane database of systematic reviews, and the Cochrane database of registered clinical trials. Data sourcesStudy selection Studies reporting on the association between serum 25-OHD levels during pregnancy and the outcomes of interest (pre-eclampsia, gestational diabetes, bacterial vaginosis, caesarean section, small for gestational age infants, birth weight, birth length, and head circumference). Data extractionTwo authors independently extracted data from original research articles, including key indicators of study quality. We pooled the most adjusted odds ratios and weighted mean differences. Associations were tested in subgroups representing different patient characteristics and study quality.Results 3357 studies were identified and reviewed for eligibility. 31 eligible studies were included in the final analysis. Insufficient serum levels of 25-OHD were associated with gestational diabetes (pooled odds ratio 1.49, 95% confidence interval 1.18 to 1.89), pre-eclampsia (1.79, 1.25 to 2.58), and small for gestational age infants (1.85, 1.52 to 2.26). Pregnant women with low serum 25-OHD levels had an increased risk of bacterial vaginosis and low birthweight infants but not delivery by caesarean section. ConclusionVitamin D insufficiency is associated with an increased risk of gestational diabetes, pre-eclampsia, and small for gestational age infants. Pregnant women with low 25-OHD levels had an increased risk of bacterial vaginosis and lower birth weight infants, but not delivery by caesarean section. IntroductionVitamin D insufficiency has been associated with several adverse health outcomes, including pregnancy outcomes, and is increasingly recognised as a public health concern. Observational data suggest a link between low 25-hydroxyvitamin D (25-OHD) levels-the best measure of vitamin D status in humans-and an increased risk of adverse pregnancy outcomes such as gestational diabetes, pre-eclampsia, infections, caesarean section, and fetal growth restriction. 1 Despite these findings, the knowledge and understanding of the clinical importance and implications of these associations are limited. A systematic review of the association between 25-OHD levels in the first trimester and subsequent adverse pregnancy outcomes concluded that there was no clear definition of vitamin D deficiency in pregnancy.2 Although this review identified several studies showing inverse associations between maternal 25-OHD levels in the first trimester and the risk of adverse pregnancy outcomes, the authors did not perform a meta-analysis of the data and quantification of the association, citing inconsistent reporting of results across studies. RESEARCHThe literature on vitamin D insufficiency in pregnancy is growing rapidly, with several studie...

Common risk factors for different alcohol consumption patterns are unintended pregnancy and substance use behaviors prior to pregnancy. Other risk factors were specific to the different patterns. Targeted strategies that address the needs of alcohol or nicotine using women and that can reduce the risk of unintended pregnancy may be beneficial.

Pakistan is one of the 34 countries that have not achieved the neonatal tetanus (NT) global elimination target set by the World Health Organization (WHO). NT, caused by Clostridium tetani, is a highly fatal infection of the neonatal period. It is one of the most underreported diseases and remains a major but preventable cause of neonatal and infant mortality in many developing countries. In 1989, the World Health Assembly called for the elimination of NT by 1995, and since then considerable progress has been made using the following strategies: clean delivery practices, routine tetanus toxoid (TT) immunization of pregnant women, and immunization of all women of childbearing age with three doses of TT vaccine in high-risk areas during supplementary immunization campaigns. This review presents the activities, progress, and challenges in achieving NT elimination in Pakistan. A review of the literature found TT vaccination coverage in Pakistan ranged from 60% to 74% over the last decade. Low vaccination coverage, the main driver for NT in Pakistan, is due to many factors, including demand failure for TT vaccine resulting from inadequate knowledge of TT vaccine among reproductive age females and inadequate information about the benefits of TT provided by health care workers and the media. Other factors linked to low vaccination coverage include residing in rural areas, lack of formal education, poor knowledge about place and time to get vaccinated, and lack of awareness about the importance of vaccination. A disparity exists in TT vaccination coverage and antenatal care between urban and rural areas due to access and utilization of health care services. NT reporting is incomplete, as cases from the private sector and rural areas are underreported. To successfully eliminate NT, women of reproductive age must be made aware of the benefits of TT vaccine, not only to themselves, but also to their families. Effective communication strategies for TT vaccine delivery and health education focusing on increasing awareness of NT are strongly suggested. It is imperative that the private and government sectors work cooperatively to report NT cases and improve routine TT vaccination coverage.

reterm birth is defined as delivery of a live born infant before 37 weeks of completed gestation. 1 Worldwide, about 15 million babies (more than 10% of all births) are born preterm. 1 There are three commonly used or established categories of preterm birth based on gestational age: very early (<32 weeks), early (32 0/7 -33 6/7 weeks), and late preterm (LP; 34 0/7 -36 6/7 weeks). "Late preterm" was introduced to replace the "near term" descriptor to differentiate this group as more similar to preterm infants and more vulnerable compared to term infants. 2 The increase in preterm birth rates in recent years can be largely attributed to increases in LP births. 3 The Canadian preterm birth rate was approximately 8.1% in 2006 to 2007 and almost three quarters (74.0%) of these births were late preterm. 4 Indeed, LPs are the largest and fastest growing subgroup of preterm births, a trend that constitutes a growing public health concern given its increased risk of morbidity compared to longer gestations. 5 Despite assumptions that LP infants are similar to term infants, LPs are physiologically and metabolically immature. 5 LP infants are more likely to be diagnosed with temperature instability, hypoglycemia, respiratory distress, apnea, jaundice, and feeding difficulties during birth and in the first month of life. 5 Although less is known about long-term outcomes for LPs and their families, recent reports suggest that there are subtle developmental delays that present as poor school outcomes, 6 cognitive impairments, and behavioural and emotional problems. 7 In addition, mothers of LPs tend to report both short-term and long lasting distress, including breastfeeding difficulties, anxiety and depression, and post-traumatic stress. 5,[8][9][10][11][12] Given the large population attributable risk associated with the LP gestation category, such findings may have major implications for health and education services.Although the benefits associated with breastfeeding for infants and mothers are well documented, 13 the rates of exclusive breastfeeding at 4 to 6 months are far from optimal in many countries, 14 including Canada, 15 which fail to meet WHO's recommendation of exclusive breastfeeding for the first six months of life. 16 In Canada, the rate of breastfeeding initiation is promising at 90.3%, however only 14.4% of mothers surveyed reported exclusively breastfeeding at 6 months. 15 Preterm birth is a risk factor for early discontinuation of breastfeeding, along with other known factors such as maternal age,