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genetic diseases and congenital anomalies place a significant burden on the health of new-borns and their mothers. Despite the availability of a variety of prenatal screening tests, mothers' knowledge has been documented to determine uptake. This study aims to assess the knowledge of pregnant women about birth defects and the associated correlates with regard to willingness to do prenatal screening. a cross-sectional descriptive study was conducted among 422 antenatal mothers recruited sequentially as they attended antenatal clinics at the Lagos University Teaching Hospital. An interviewer-administered questionnaire was used to determine their knowledge of birth defects and willingness to do prenatal testing. majority of the participants (92.2%) had at least secondary education. The mean total knowledge score of the respondents was 63%. Age and knowledge scores were not significantly correlated (r=-0.071, p=0.14). Being employed predicted higher knowledge scores (95% CI: 0.09, 2.09, p=0.03). Respondents who had primary school education and those who replied \"I don't know\" to willingness to test had significantly lower knowledge scores (95% CI: -15.01, -1.19, p=0.02 and 95% CI: -4.52, -0.68, p=0.01 respectively). Majority (79.1%) of the respondents were willing to undergo testing. Respondents' level of education was significantly associated with willingness to test (p=0.03). the observed knowledge gaps were considerable. There is need for improvement in education, the empowerment of women and access to quality healthcare including prenatal screening.

Iron deficiency anaemia in pregnancy is a significant contributor to maternal and perinatal morbidity and mortality globally. Despite international and national guidelines for its screening and treatment, knowledge and prescription practices of healthcare providers vary. To determine maternal healthcare workers' screening and treatment practices for iron deficiency in anaemic pregnancy women in two states in Nigeria. This cross-sectional study sampled maternal healthcare workers from 84 randomly selected public health facilities in Lagos and Kano States. Data on methods of diagnosis and prescription practices for iron deficiency anaemia were collected using a self-administered questionnaire. Means and percentages were reported using probability weights, and a comparison of practices of anaemia treatment between doctors and nurses/midwives was done using Chi-square test or Fishers exact. Of the 467 maternal healthcare workers surveyed (232 from Lagos, 235 from Kano), 40.0% were doctors, 54.0% nurses or midwives and 6.0% community health extension workers. In the sample, 27.6% always and 58.7% sometimes screened anaemic pregnant women for iron deficiency; among these, 84.7% screened using complete blood count. Oral iron for treatment of iron deficiency anaemia was prescribed by 96.9%. Intravenous iron for treatment was prescribed by 30.2%, but by only by 18.6% as first-line drug (as iron dextran by 69.3% and as iron sucrose by 31.5% of intravenous iron prescribers). Commonest reasons for low usage of intravenous iron were cost and need for venepuncture. Fifty-three percent of maternal healthcare workers' prescribed iron supplements for anaemia during concomitant infection, with the prescription practice similar among doctors versus nurse/midwives (p = 0.074). We found suboptimal levels of screening for iron deficiency among anaemic pregnant women. Iron deficiency anaemia in pregnancy is almost exclusively treated with oral iron by maternal healthcare workers in the two Nigerian states, similarly between doctors and nurses/midwives. Further research into potential reasons for low screening for iron deficiency and low use of intravenous iron are needed.

Background Anaemia and depression are common conditions which affect pregnant and postpartum women. Evidence points to associations between anaemia and iron deficiency during pregnancy, and mental health disorders like depression. However, it is unclear the association between improvement in anaemia severity or iron levels during pregnancy and incidence of postpartum depression. Objectives This study examined association between improvement in anaemia severity and iron levels during pregnancy after four weeks of treatment and the incidence of depression at two weeks postpartum. Methods This cohort study nested within a clinical trial in Lagos Nigeria, included 438 anaemic (haemoglobin concentration < 11 g/dL) pregnant women at 20–32 weeks’ gestation without depression followed up until two weeks postpartum. Participants received either intravenous or oral iron treatment at enrolment. Repeat screening for anaemia and iron deficiency (serum ferritin < 30ng/mL) was done at four weeks post-treatment. The outcome, depression (score > 10), was measured at two weeks postpartum using validated Edinburgh Postnatal Depression Scale. Associations between improvement in anaemia severity and iron levels after four weeks post-enrolment versus depression at two weeks postpartum were examined using logistic regression analysis, adjusting for confounders. Results Mean age of women was 29.5 ± 5.6years. Median haemoglobin concentration of 9.3 (IQR: 8.8–9.8)g/dL and median serum ferritin 44.4 (IQR: 22.1–73.7)ng/mL at enrolment. Prevalence of postpartum depression was 5.8% (95%CI: 3.8–8.5%). There was a non-significant association between improvement in anaemia severity at four weeks post-enrolment and postpartum depression, aOR: 0.15 (95%CI: 0.02–1.15). The odds for postpartum depression was nearly five times higher in women who had postpartum haemorrhage, aOR: 4.90 (95%CI: 1.18–20.36). In the subgroup with iron deficiency ( n  = 148), no association was found between an improvement in iron levels four weeks post-enrolment and the odds for postpartum depression, aOR: 1.14 (95%CI: 0.09–3.93). Conclusion Improvement in anaemia severity during late pregnancy was non-significantly associated with lower risk for postpartum depression; no association between improvement in iron levels and postpartum depression. It is likely that an improvement in anaemia severity in early pregnancy will lessen the burden of postpartum depression; however, this study is limited by sample size to draw this conclusion.

ObjectivesPre-eclampsia causes significant maternal and perinatal morbidity and mortality. It also causes changes in the cardiovascular, endothelial and metabolic systems, from which women may not fully recover after delivery. This study examined the association between the time of onset of pre-eclampsia and the risk for cardiovascular disease (using glucose tolerance, lipid profile and blood pressure) and renal function at 6 weeks post partum.Study designA prospective cohort study.SettingLagos University Teaching Hospital, Idi-Araba, Mother and Child Centre, Gbaja, Surulere and Lagos Island Maternity Hospital, Lagos, Nigeria.Participants44 women with pre-eclampsia were studied and data on their sociodemographic characteristics, gestational age at diagnosis and blood pressure were collected on admission. They were followed up through delivery till 6 weeks post partum, when blood pressure check, 75 g oral glucose tolerance test, fasting lipid profile and serum creatinine were done.Outcome measuresThe exposure was pre-eclampsia. The outcomes were cardiovascular disease risk markers, viz persistent hypertension, glucose intolerance and dyslipidaemia, and renal function at 6 weeks post partum in women who had pre-eclampsia.Statistical analysisData were analysed using Stata V.16.1. Mann Whitney-U test was used to compare medians and Fisher's exact test was used to compare the categorical variables.ResultsOf the women studied, 13 (29.5%) had early onset pre-eclampsia and 31 (70.5%) had late onset pre-eclampsia. Mean gestational age at diagnosis was 30.8±1.57 weeks in women with early-onset pre-eclampsia and 35.6±1.26 weeks in women with late-onset pre-eclampsia (p<0.001). There was no significant difference in terms of disease severity in women who had early-onset compared with late-onset disease. Of the cardiovascular risk markers assessed at 6 weeks post partum, only serum triglyceride was found to be statistically higher in women with early onset compared with late onset pre-eclampsia, median values of 135 mg/dL (130-182 mg/dL) vs 128 mg/dL (121-139 mg/dL), p = 0.008. Only eight (18.2%) of the pre-eclamptic women became normotensive at the end of puerperium.ConclusionThe prevalence of persistent hypertension at 6 weeks post partum is high in women with pre-eclampsia. Serum triglyceride concentration was significantly higher in early onset compared with late onset pre-eclampsia; subsequent studies powered to determine the full cardiovascular risk and how long to follow postnatal women up will be beneficial.

Background Endometriosis is the presence of active ectopic endometrial glands and stroma at other sites outside the uterine cavity. It is a common cause of chronic pelvic pain which is sometimes debilitating, and inflammation is one of the known triggers of endometriosis. Interleukins 6 and 16 (IL-6 and IL-16) are proinflammatory cytokines which play essential roles in inflammatory diseases. We therefore investigated the relationship between genetic polymorphisms of interleukins 6 and 16, and the development of endometriosis in Nigerian women. Method One hundred and thirty (130) consenting women were consecutively enrolled, sixty-five (65) of whom had endometriosis and 65 age-matched women as reference group, surgically confirmed as not having endometriosis. Spectrophotometric determination of serum concentrations of Interleukins 6 and 16 was carried out and the genotyping of IL-6 (rs1800795) and IL-16 (rs4778889, rs11556218, rs4072111) genes were performed using TaqMan assays. Results Serum IL-16 concentration was significantly higher in women with severe chronic pelvic pain compared to those with mild pain ( p  = 0.023). The C allele of rs4778889 was associated with endometriosis (OR: 1.80, 95% CI: 1.08 – 3.02, p  = 0.024). Conclusion Serum IL-16 and IL-16 rs4778889 may be important markers for endometriosis in Nigerian, and by extension, African women. Multicentre African studies would clarify this.

Background Anaemia during pregnancy causes adverse outcomes to the woman and the foetus, including anaemic heart failure, prematurity, and intrauterine growth restriction. Iron deficiency anaemia (IDA) is the leading cause of anaemia and oral iron supplementation during pregnancy is widely recommended. However, little focus is directed to dietary intake. This study estimates the contribution of IDA among pregnant women and examines its risk factors (including dietary) in those with moderate or severe IDA in Lagos and Kano states, Nigeria. Methods In this cross-sectional study, 11,582 women were screened for anaemia at 20-32 weeks gestation. The 872 who had moderate or severe anaemia (haemoglobin concentration < 10 g/dL) were included in this study. Iron deficiency was defined as serum ferritin level < 30 ng/mL. We described the sociodemographic and obstetric characteristics of the sample and their self-report of consumption of common food items. We conducted bivariate and multivariable logistic regression analysis to identify risk factors associated with IDA. Results Iron deficiency was observed among 41% (95%CI: 38 – 45) of women with moderate or severe anaemia and the prevalence increased with gestational age. The odds for IDA reduces from aOR: 0.36 (95%CI: 0.13 – 0.98) among pregnant women who consume green leafy vegetables every 2-3 weeks, to 0.26 (95%CI: 0.09 – 0.73) among daily consumers, compared to those who do not eat it. Daily consumption of edible kaolin clay was associated with increased odds of having IDA compared to non-consumption, aOR 9.13 (95%CI: 3.27 – 25.48). Consumption of soybeans three to four times a week was associated with higher odds of IDA compared to non-consumption, aOR: 1.78 (95%CI: 1.12 – 2.82). Conclusion About 4 in 10 women with moderate or severe anaemia during pregnancy had IDA. Our study provides evidence for the protective effect of green leafy vegetables against IDA while self-reported consumption of edible kaolin clay and soybeans appeared to increase the odds of having IDA during pregnancy. Health education on diet during pregnancy needs to be strengthened since this could potentially increase awareness and change behaviours that could reduce IDA among pregnant women with moderate or severe anaemia in Nigeria and other countries.

Background Accurate prediction of foetal gestational age is of critical importance as it can positively affect the outcome of pregnancy. Routine sonographic estimation of gestational age using biparietal diameter, head circumference, abdominal circumference and femur length is popular but has limitations especially when used as a singly or in late pregnancy. Often pregnant women in low-middle-income countries like Nigeria register for antenatal care late in pregnancy, necessitating the need for a single, cost-effective parameter that requires minimal skills to measure gestational age accurately in late pregnancies. This study examined the accuracy of ultrasonographic transcerebellar diameter compared to other foetal biometric parameters for dating in third trimester of pregnancy. Methodology An analytic cross-sectional study conducted at Lagos University Teaching Hospital, Idi-Araba, Lagos, on 110 pregnant women in their third trimester. Data was collected using an interviewer administered questionnaire. Transabdominal ultrasound scan was done to determine the gestational age by measuring the biparietal diameter, head circumference, abdominal circumference, femur length and transcerebellar diameter. Spearman’s correlation coefficient was used to determine the correlation between the biometric measurements; Accuracy was determine using gestational age from menstrual date as gold standard and comparisons made using Chi square test. Results Mean age of participants was 31.5 ± 5.8 years; mean gestational age 236 ± 25 days. Compared to biparietal diameter, head circumference, abdominal circumference, and femur length, transcerebellar diameter correlates best with gestational age ( r  = 0.8837, p  < 0.001). At an error margin of ± 2weeks, transcerebellar diameter had a high predictive accuracy of 84.6%, though significantly less than that for abdominal circumference alone, 86.4% ( p  = 0.003), and also less than that for all four well known foetal biometric parameters (biparietal diameter, head circumference, abdominal circumference, and femur length) combined, 85.5% ( p  < 0.001). Conclusion Transcerebellar diameter has a better correlation with gestational age than other routine foetal biometric parameters and has high predictive accuracy for dating in third trimester of pregnancy. It may thus play a relevant role in low resource settings where there is shortage of staff and limited skills in obstetric ultrasonography. Clinical trial number Not applicable for this study.

Objective To determine if genetic polymorphism of VEGF is associated with the development of endometriosis in Nigerian women. Study design Case control study of 100 women (50 healthy controls and 50 with endometriosis). Serum VEGF concentration of participants were determined using enzyme-linked immunosorbent assay (ELISA) technique. Genomic DNAs were isolated from peripheral blood samples and quantified by nanodrop spectrophotometer one. Single nucleotide polymorphisms genotyping was carried out by polymerase chain reaction and restriction fragment length polymorphism (PCR–RFLP). Results Mean age of participants was 32.96 ± 6.91 years for control and 32.04 ± 7.56 years for cases. VEGF levels in case and control groups were not statistically different (82.68 pg/ml [69.11–121.11 pg/ml] vs. 82.81 pg/ml [72.90–113.82 pg/ml] respectively; p  = 0.967). All four genotypes examined were in Hardy–Weinberg equilibrium. Minor allele frequency of − 460T > C, − 1154G > A, + 936C > T and + 2578C > A were 24%, 8%, 6% and 10% in the control and 19%, 9%, 5% and 14% in endometriosis patients. However, allele and genotype distributions of − 460T > C, − 1154G > A, + 936C > T and + 2578C > A VEGF polymorphisms in endometriosis patients and control were not significantly different ( p  > 0.05). Conclusion Our preliminary findings revealed no association between endometriosis and − 460T > C, − 1154G > A, + 936C > T and + 2578C > A of VEGF genes among Nigerian women.

IntroductionPostpartum anaemia is often caused by iron deficiency with onset during the antepartum period and can be exacerbated by excessive blood loss at birth. Its prevalence is estimated as 50–80% in low-income and middle-income countries. It poses adverse consequences on the mother and negatively impacts her ability to care for her newborn. Prompt treatment of postpartum anaemia is thus important. Adherence to oral iron is reportedly low in Nigeria due to its side effects and forgetfulness by the mothers. Intravenous iron such as ferric carboxymaltose, given as a single dose, might help overcome adherence issues, but investigation in a high-quality randomised control trial in Nigeria is first required while evaluation of challenges around its implementation is also warranted.ObjectiveTo determine the clinical effectiveness, tolerability and safety, of using intravenous ferric carboxymaltose (intervention) vs oral ferrous sulphate (control) for treating moderate to severe iron deficiency anaemia in postpartum women and to evaluate implementation of ferric carboxymaltose in treating postpartum anaemia in Nigeria.Methods and analysisThis study is an open-label randomised controlled trial with a concurrent implementation study. It is a hybrid type 1 effectiveness-implementation design conducted in four states across Northern and Southern Nigeria. A total of 1400 eligible and consenting women with postpartum moderate to severe anaemia (haemoglobin concentration <100 g/L) will be randomised to intravenous ferric carboxymaltose; a single dose at 20 mg/kg to a maximum of 1000 mg infusion administered at enrolment (intervention) or oral ferrous sulphate; 200 mg (65 mg elemental iron) two times per day from enrolment until 6 weeks postpartum (control). The primary outcome, proportion of participants who are anaemic (Hb <110 g/L) at 6 weeks postpartum will be analysed by intention-to-treat. Haemoglobin concentration, full blood count, serum iron, serum ferritin, transferrin saturation and total iron binding capacity will be measured at specific intervals. Implementation outcomes such as acceptability and feasibility of using ferric carboxymaltose for postpartum anaemia treatment in Nigeria will be assessed.Ethics and disseminationThis study is approved by the ethics committee of the teaching hospitals, Ministry of Health of the four states as required, National Health Research Ethics Committee and the drug regulatory agency, National Agency for Food and Drug Administration and Control (NAFDAC). Findings of this research will be presented at conferences and will be published in international peer-reviewed journals and shared with stakeholders within and outside Nigeria.Trial registration numberInternational standard randomised controlled trial number: ISRCTN51426226.

IntroductionPregnancy in sickle cell disease is fraught with many complications including pre-eclampsia (PE) and intrauterine growth restriction (IUGR). Previously, we found an abnormality in prostacyclin–thromboxane ratio in sickle cell pregnant women, a situation that is also found in non-sickle pregnancies with PE and unexplained IUGR. Low-dose aspirin (LDA) has been shown to reduce the incidence of PE and IUGR in high-risk women by reducing the vasoconstrictor thromboxane while sparing prostacyclin, in effect ‘correcting’ the ratio. It has been found to be safe for use in pregnancy but has not been tested in sickle cell pregnancy. We hypothesise that LDA will reduce the incidence of IUGR and PE in pregnant haemoglobin SS (HbSS) and haemoglobin SC (HbSC) women.Methods and analysisThis is a multisite, double blind, randomised controlled trial, comparing a daily dose of 100 mg aspirin to placebo, from 12 to 16 weeks’ gestation until 36 weeks, in Lagos state, Nigeria. Four hundred and seventy-six eligible pregnant HbSS and HbSC women will be recruited consecutively, randomly assigned to either group and followed from recruitment until delivery. The primary outcome will be the incidence of birth weight below 10th centile for gestational age on INTERGROWTH 21 birth weight charts, or incidence of miscarriage or perinatal death. Secondary outcomes will include PE, maternal death, preterm delivery, perinatal death, number of crises, need for blood transfusion and complications such as infections and placental abruption. Analysis will be by intention to treat and the main treatment effects will be quantified by relative risk with 95% CI, at a 5% significance level.Ethical approvalEthical approval has been granted by the Health Research and Ethics committees of the recruiting hospitals and the National Health Research and Ethics Committee. Study findings will be presented at conferences and published appropriately.Trail registration numberPACTR202001787519553; Pre-results.