Associations of History of Displacement, Food Insecurity, and Stress With Maternal-Fetal Health in a Conflict Zone: A Case Study

Abstract

Background: In populations with a history of conflict, early identification of pregnant women who are at risk of adverse pregnancy outcomes is challenging, especially if sonography is not available. We evaluated the performance of symphysis-fundal height (SFH) for identification of high-risk pregnancies and investigated if food security and diet quality, clinical biomarkers, and stress were associated with SFH and two known indicators of maternal-fetal well-being, sonography-estimated fetal weight and amniotic fluid index (AFI). Methods: For this cross-sectional study, 61 women with high-risk pregnancies were recruited after referral to the obstetrics and gynecology unit at San José Hospital in Popayán, Colombia. Multiple stepwise linear and ordered logistic regressions were used to identify associations of SFH, sonography-estimated fetal weight and AFI classification with history of displacement, food insecurity, post-traumatic stress symptoms as well as biopsychosocial risk evaluated through the Colombian risk scale. Results: History of displacement was associated with lower SFH Z-scores, but higher hemoglobin, taking iron supplements and a higher diastolic blood pressure were associated with higher SFH Z-scores. SFH was also associated with AFI but not with sonography-estimated fetal weight. Stress indicators were associated with a higher AFI. In contrast family support, an element of the Colombian biopsychosocial risk assessment, was associated with a higher sonography-estimated fetal weight, whereas more hours of sleep/day were associated with lower sonography-estimated fetal weight. Conclusion: SFH was not only associated with biological factors known to affect maternal/fetal health but also with history of displacement, thus validating its use in conflict areas for pregnancy assessment. Associations of biopsychosocial stressors with maternal-fetal outcomes highlight the need for a systematic assessment of stress in pregnant women from conflict zones.

INTERGROWTH-21 Identifies High Prevalence of Low Symphysis–Fundal Height in Indigenous Pregnant Women Experiencing Multiple Infections, Nutrient Deficiencies, and Inflammation: The Maternal Infections, Nutrient Deficiencies, and Inflammation (MINDI) Cohort

“…SFH is widely used in developing countries to screen for SGA with a reported specificity of ≥80% ( 1 , 58 , 59 ). However, the utility of SFH goes beyond the prediction of SGA, given its association with not only fetal weight but also amniotic fluid volume and GA ( 3 , 19 ). Our goal had been to apply both CLAP and the new international INTERGROWTH standards for SFH ( 12 ) to our MINDI cohort.…”

“…SFH also has been used for the detection of multiple gestations ( 18 ) and for identifying low (oligohydramnios) or high (polyhydramnios) amniotic fluid volume ( 3 ). Recently, the intake of iron supplements, higher hemoglobin, and higher diastolic blood pressure were associated with higher SFH z scores calculated using INTERGROWTH standards in a Colombian population of mixed ethnic backgrounds ( 19 ). However, associations of SFH with other clinical indicators of maternal health have not been investigated.…”

Prevalencia de bocio y yodo-deficiencia en embarazadas indígenas de cinco áreas no metropolitanas de Colombia 2019

“…Como variables clínicas de estudio se midieron los niveles de yodo en orina, la presencia de bocio y la restricción en el crecimiento intrauterino. La edad gestacional fue categorizada por trimestres, con base en la fecha de última menstruación, ultrasonido obstétrico o a partir del dato actualizado de la altura uterina, que ha demostrado utilidad en estudios previos de investigación con embarazadas en condiciones de vulnerabilidad 29 . La restricción en el crecimiento intrauterino, si se sospechaba clínicamente, era confirmada con la ecografía obstétrica, si existía su reporte y con la altura uterina actualizada.…”