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Biomedical subjects

M Temmerman

Publications and source records attributed to M Temmerman.

At least 73 records · Page 4Linked to original sources
PubMed1995

Mass antimicrobial treatment in pregnancy. A randomized, placebo-controlled trial in a population with high rates of sexually transmitted diseases.

Sexually transmitted diseases (STDs) are highly prevalent in pregnant women in many developing countries and have been associated with poor obstetric outcomes. Case detection and treatment of STDs in women is problematic and expensive, underscoring the need for other strategies. To explore the potential benefits of routine antimicrobial therapy on pregnancy outcome, we carried out a randomized, double-blind, clinical trial in one of the antenatal clinics in Nairobi, Kenya. Four hundred pregnant women between 28 and 32 weeks' gestation were given a single dose of 250 mg ceftriaxone intramuscularly or a placebo. There was a significant difference between ceftriaxone and placebo-treated women in infant birth weight (3,209 versus 3,056 g, P = .01). In addition, there was a trend toward lower rates of birth weight < 2,500 g (4.0% versus 9.2%, P = .08) and postpartum endometritis (3.8% versus 10.4%, P = .05) in the intervention than in the placebo group. Neisseria gonorrhoeae was isolated from the cervixes of postpartum women in 1.8% of the intervention group as compared to 4.2% of the control group. These data suggest a beneficial effect of antimicrobial prophylaxis on pregnancy outcome. Larger studies should be carried out to examine the public health impact of this intervention.

Adult↗
PubMed1995

HIV-1 and immunological changes during pregnancy: a comparison between HIV-1-seropositive and HIV-1-seronegative women in Nairobi, Kenya.

OBJECTIVE: To assess changes in the proportion of CD4 and CD8 T-lymphocyte profiles during pregnancy, at delivery and postpartum, and to determine whether HIV-1 infection affects the normal profile. DESIGN AND METHODS: A total of 416 pregnant HIV-1-infected women and an age and parity-matched HIV-seronegative group of 407 pregnant women were enrolled into a prospective study on the impact of HIV-1 infection on pregnancy. Maternal blood was obtained for lymphocyte subset determination at enrollment, delivery and 6 weeks postpartum. Whole blood sample drawn in EDTA-containing tubes were used to determine T-helper/inducer (CD4) and T-suppressor/cytotoxic (CD8) cells by direct immunofluorescence using monoclonal antibodies. RESULTS: No relationship was found between gestational age and any immunological variable. The CD4 percentage was lower postpartum than antenatally, in both HIV-1-seropositive and seronegative women, but this was not true for absolute CD4 counts. CD8 absolute counts and percentages were significantly higher postpartum than antenatally. The differences between HIV-1-seropositive and seronegative women in changes over pregnancy in CD4 and CD8 cells and their ratio, were not statistically significant. CONCLUSION: Our findings do not support a short-term synergistic effect of HIV-1 and pregnancy on the immune function as determined by T-lymphocyte subsets.

Adult↗
PubMed1994

Mother-to-child transmission of human immunodeficiency virus type 1: report from the Nairobi Study.

Mother-to-child transmission of human immunodeficiency virus type 1 (HIV-1) is a significant problem in countries with endemic HIV-1 infection. Between 1986 and 1991, 365 children of HIV-1-infected mothers and 363 control children were studied in Kenya. The overall risk of transmission from mother to child, determined by serologic evidence of infection by age > or = 12 months and excess mortality in the HIV-1-exposed group, was 42.8% (range, 27.6%-62.2%). Marriage was the only maternal characteristic associated with transmission (odds ratio, 2.2; 95% confidence interval, 1.2-4.2; P < .05). Children who experienced growth failure were more likely to be infected. In 44% of children ultimately infected, the pattern of antibody response implied intrapartum or postnatal exposure to HIV-1. Of potential postnatal exposures examined, duration of breast-feeding beyond age 15 months and the mother being married were independently associated with increased risk of infection and seroconversion of children. The percentage of HIV infection attributable to breast-feeding > or = 15 months was 32%. The frequency of mother-to-child transmission of HIV-1 was high; a substantial proportion of infection occurred postnatally, possibly through breast-feeding.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Maternal human immunodeficiency virus-1 infection and pregnancy outcome.

OBJECTIVE: To study the impact of maternal human immunodeficiency virus type 1 (HIV-1) infection on pregnancy outcome. METHODS: Between January 1989 and December 1991, 406 HIV-1-seropositive and 407 HIV-1-seronegative age- and parity-matched pregnant women from Nairobi, Kenya, all at less than 28 weeks' gestation, were recruited into a prospective study of HIV-1 infection in pregnant women and their offspring. Both groups were followed until 6 weeks postpartum. RESULTS: Three hundred fifteen HIV-1-seropositive women and 311 HIV-1-seronegative controls were followed until delivery. Seropositive women were younger at sexual debut and reported more lifetime partners and more sexually transmitted diseases (STDs) than the seronegative controls. The seropositive women had higher rates of genital ulcer disease (4.7 versus 2.0%; P = .08), genital warts (4.9 versus 2.0%; P = .03), and positive syphilis serology (7.9 versus 3.2%; P < .001), but there were no differences between the groups in isolation rates of Neisseria gonorrhoeae (6.8 versus 7.1%) and Chlamydia trachomatis (11.5 versus 9.0%). Maternal HIV-1 infection was associated with significantly lower birth weight (2913 versus 3072 g; P = .0003) and with prematurity (21.1 versus 9.4%; P < .0001), but not with small for gestational age size (4.2 versus 3.2%; P = .7). The stillbirth rate was higher in seropositive women, yet not statistically significant (3.8 versus 1.9%; P = .2). Women with a CD4 count lower than 30% had a higher risk of preterm delivery (26.3 versus 10.1%; P < .001). Postpartum endometritis was more common in HIV-1-infected women than in seronegative controls (10.3 versus 4.2%; P = .01) and was inversely correlated with the CD4 percentage. No histopathologic placental abnormalities attributable to HIV-1 were detected. CONCLUSION: Maternal HIV-1 infection was significantly associated with prematurity and postpartum endometritis, but not with fetal growth retardation. There was a trend toward a higher stillbirth rate in HIV-1-seropositive mothers.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Detection of human immunodeficiency virus type 1 (HIV-1) in heel prick blood on filter paper from children born to HIV-1-seropositive mothers.

The human immunodeficiency virus type 1 (HIV-1) DNA PCR results of 94 dried blood spot (DBS) samples on filter paper and corresponding venous blood in EDTA obtained from infants born to HIV-1-seropositive mothers were compared. In addition, the results of HIV-1 DNA PCR on DBS and the HIV-1 RNA PCR from plasma of 70 paired samples were compared. A 100% specificity and a 95% sensitivity for HIV-1 DNA PCR on DBS compared with results for venous blood were observed for the 94 paired samples. The results of the DBS HIV-1 DNA PCR and HIV-1 RNA PCR of 70 corresponding plasma samples correlated perfectly (100%). The DBS HIV-1 DNA PCR method proved reliable for HIV-1 detection.

Adult↗
PubMed1993

Pregnancy outcome and placental weights: their relationship to HIV-1 infection.

The relationship between placental characteristics, including weight and inflammation, and pregnancy outcome was examined as part of a case control study looking into the impact of maternal HIV-1 infection on pregnancy outcome. Cases defined as low birth weight (< 2500g) or stillbirth deliveries, were compared to controls defined as mothers who delivered a live born neonate weighing 2500g or more. The mean placental weight and the mean foetal/placental weight ratio were significantly lower in cases (n = 253) than in controls (n = 216) (p < .05). Placental inflammation (chorioamnionitis) was significantly associated with prematurity (p < .001) and with stillbirth (p < .05), maternal HIV-1 antibody being a risk factor for chorioamnionitis in the preterm group. These data support a correlation between placental weight and pregnancy outcome, and suggest that maternal HIV-1 infection is a risk factor for chorioamnionitis in HIV-1 seropositive preterm deliveries.

Case-Control Studies↗
PubMed1992

Rapid increase of both HIV-1 infection and syphilis among pregnant women in Nairobi, Kenya.

OBJECTIVE: To determine the prevalence of HIV-1 and syphilis antibodies in a population of pregnant women in Nairobi, Kenya, between 1989 and 1991. METHODS: As part of an ongoing prospective study on the effect of HIV-1 infection and sexually transmitted diseases, 4883 pregnant women were screened for HIV-1 and syphilis antibodies in one health-centre in Nairobi. RESULTS: HIV-1 seroprevalence increased from 6.5 to 13.0% (P < 0.001) and syphilis seroreactivity from 2.9 to 5.3% (P = 0.002), while there was no change in gonococcal infection rates. The most rapid increase in HIV-1 prevalence was observed in women aged less than 25 years. There was no evidence of demographic fluctuations in the population during this time, or of changes in sexual behaviour, except that fewer women enrolled in 1991 reported having more than one sex partner, compared with women enrolled in 1989 (39.1 versus 20.0%; P = 0.0001). HIV-1-seropositive women were more likely to be seroreactive for syphilis than HIV-1-seronegative mothers (7.7 versus 3.2%; odds ratio = 2.5; 95% confidence interval, 1.7-3.8; P < 0.001), but there was no difference between the two groups in terms of gonorrhoea prevalence. CONCLUSION: These data confirm an association between HIV-1 and syphilis infection, and indicate that both are spreading rapidly among women in Nairobi outside high-risk groups. Increased efforts to control both infections are urgently required.

Antibodies, Viral↗
PubMed1992

Cervical cancer screening and detection of genital HPV-infection and chlamydial infection by PCR in different groups of Kenyan women.

A pilot study was conducted in Nairobi, Kenya, to evaluate the feasibility of a larger study on the prevalence of cervical cancer and precancerous lesions and on the role of Sexually Transmitted Diseases (STD) as risk factors for cervical cancer in Kenya. 692 women were screened for cervical cancer by cytology in 3 City Commission family planning clinics and in 1 City Commission STD referral clinic in Nairobi. In one family planning clinic and in the STD clinic, a sample of the participating women (n = 212) was also screened for genital Human Papillomavirus (HPV) and chlamydial infection by Polymerase Chain Reaction (PCR). Of all women screened for cancer, 5.1% had a PAP smear showing mild dysplasia, 1.2% moderate dysplasia and 0.15% severe dysplasia or worse. Of the women screened for genital HPV infection and for chlamydial infection, the following results can be reported: in women attending the family planning clinic, HPV-DNA was detected in 3.7% (0.9% HPV6/11 and 2.8% HPV 16/18/31/33) and Chlamydia trachomatis in 6.4%; in women attending the STD clinic, HPV-DNA was detected in 16.5% (1% HPV6/11 and 2.8% HPV 16/18/31/33) and Chlamydia trachomatis in 4%. A significantly higher frequency of HPV-infection was observed in the STD clinic, while this was not the case for chlamydial infection.

Adolescent↗
PubMed1991

Cost-effectiveness of routine ultrasound examination in first trimester of pregnancy.

The findings of first-trimester ultrasound scans are analyzed. The patients were divided into two groups according to the reliability of their alleged date of last menstrual period and the regularity of their menstrual cycle. The cost-effectiveness of a routine first trimester scan as compared to a selective approach is calculated. Based on these data we question the performance of a routine first-trimester scan.

Belgium↗
PubMed1990

Impact of single session post-partum counselling of HIV infected women on their subsequent reproductive behaviour.

During an ongoing study investigating the impact of maternal HIV infection on pregnancy outcome at a large maternity hospital in Nairobi, Kenya, asymptomatic HIV positive women who had recently delivered were informed of their HIV sero-status and counselled by a trained nurse regarding contraception and reproductive behaviour in a single session. Both HIV infected women and a comparison group of uninfected women matched for pregnancy outcome were followed up after an interval of one year. Contraceptive use, condom use and pregnancy rates were similar in both groups. Only 37% of HIV infected women had informed their partners of their sero-status. The single session of counselling for the HIV positive women did not seem to influence decisions on subsequent condom use or reproductive behaviour. More intensive approaches to counselling need to be developed and evaluated, but may be difficult to implement in the busy maternity and antenatal clinics commonly found in developing countries.

Abortion, Induced↗
PubMed1990

Infection with HIV as a risk factor for adverse obstetrical outcome.

We carried out a case-control study to investigate the role of sexually transmitted diseases (STDs), including infection with HIV, as risk factors for adverse outcome of pregnancy. Overall, 1507 women were enrolled within 24 h of delivery. Cases (n = 796) were mothers of low-birthweight infants (less than 2500 g) or of stillborns. Low-birthweight infants were divided into preterms (n = 373) and neonates small for gestational age (n = 234). Stillborns were separated into intrauterine fetal deaths (n = 120), and intrapartum fetal deaths (n = 69). Controls were selected from mothers delivering a live baby of greater than or equal to 2500 g (n = 711). The maternal HIV seroprevalence in the control group was 3.1%. Prematurity was associated with maternal HIV antibody [8.6% seropositive; adjusted odds ratio (OR) 2.1; 95% confidence interval (CI) 1.1-4.0], as was being born small for gestational age (7.7% seropositive; adjusted OR 2.3; 95% CI 1.2-4.2). In mothers who delivered a stillborn baby, both intrauterine fetal death (11.7% seropositive; adjusted OR 2.7; 95% CI 1.3-5.5) and intrapartum fetal death (11.6% seropositive; adjusted OR 2.9; 95% CI 1.3-6.5) were independently associated with HIV seropositivity in the mother. Maternal syphilis was confirmed as an important risk factor for intrauterine fetal death (14.3% positive; adjusted OR 4.8; 95% CI 2.4-9.5). No significant association was found between other STDs, including gonococcal and chlamydial infection, and adverse obstetrical outcome. These results suggest an association between maternal HIV infection and adverse obstetrical outcome, defined as low birthweight and stillbirth.

Abortion, Spontaneous↗