Pregnancy hypertension risk increased by traffic-related air pollution

A new report from the National Toxicology Program (NTP) suggests that traffic-related air pollution increases a pregnant woman’s risk for dangerous increases in blood pressure, known as hypertension.

NTP scientists evaluated published research on the link between traffic-related air pollution, or TRAP, and hypertensive disorders broken down by pollutant measurements of TRAP, such as particulate matter (PM2.5). PM is the term for a mixture of solid particles and liquid droplets found in the air, and PM2.5 refers to fine inhalable particles, with diameters that are generally 2.5 micrometers or smaller. The average human hair is about 70 micrometers in diameter, about 30 times larger than the largest fine particle.

“What we found when we reviewed the literature is that exposure to PM2.5 from traffic emissions was associated with development of hypertensive disorders in pregnant women,” said Brandy Beverly, Ph.D., lead scientist and researcher at the National Institute of Environmental Health Sciences, part of the National Institutes of Health. “When these women are exposed to PM2.5 during their entire pregnancy, the likelihood of developing preeclampsia increases by about 50%.”

Other components of TRAP that NTP evaluated included nitrogen oxides, carbon monoxide, black carbon, and elemental carbon, along with parameters like traffic density and mothers’ proximity to main roads.

For example, the literature suggests that women who live within a quarter of a mile of a major roadway or in high traffic density regions may be at an increased risk for developing hypertensive disorders of pregnancy.

TRAP comes from the combustion of fossil fuels by motor vehicles. These vehicle emissions are mixtures of gases and particles that are easily inhaled and have adverse health effects. TRAP is known to be a major risk factor for cardiovascular disease, including hypertension.

Hypertensive disorders of pregnancy complicate more than 10% of pregnancies worldwide and are a leading cause of maternal and fetal illness and death. According to the American College of Obstetrics and Gynecology, mothers with hypertension during pregnancy are more likely to have a pre-term delivery. Their infants are at greater risk for low birthweight and a range of long-term health problems associated with pre-mature birth.

“Hypertensive disorders of pregnancy refer to a range of clinical conditions, all of which include high blood pressure during pregnancy,” said Beverly. “The disorders are classified into four distinct types, based on differences in the timing and onset of the symptoms.”

Research shows using both marijuana and alcohol during early pregnancy may disrupt fetal development

New preclinical research reported in animal models shows that exposure to compounds found in marijuana called cannabinoids (CBs), which includes cannabidiol (CBD) and tetrahydrocannabinol (THC), during early pregnancy can cause malformations in the developing embryo.

Stained sections of fetal mouse brains. (Left) Control. (Right) Mouse exposed to alcohol and a cannabinoid on the 8th day of pregnancy. Black arrow highlights enlarged cerebral ventricle caused by the loss of the midline septal region.Dr. Scott Parnell, UNC Chapel Hilll

The research also demonstrated that co-exposure to CBs and alcohol increased the likelihood of birth defects involving the face and brain. The study, funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health, was published in Scientific Reports.

“Prenatal alcohol exposure is a leading preventable cause of birth defects and neurodevelopmental abnormalities in the United States,” said NIAAA Director, George F. Koob, Ph.D. “Since marijuana and alcohol are frequently used simultaneously, the combined effects of cannabinoids and alcohol are worrisome as well as the dangers of either substance alone.” 

The detrimental effects of prenatal alcohol exposure on human development are well known and include an array of lifelong physical, cognitive, and behavioral problems collectively called fetal alcohol spectrum disorders (FASD). Alcohol can disrupt fetal development at any stage during pregnancy, even the earliest stages before a woman knows she is pregnant. The effects of marijuana exposure during pregnancy and the combined effect of alcohol and marijuana are less known. 

In the study, scientists led by Scott Parnell, Ph.D., at the Bowles Center for Alcohol Studies at the University of North Carolina in Chapel Hill, administered a variety of CBs alone and in combination with alcohol in varying amounts to mice on day eight of pregnancy, which is similar to the third and fourth weeks of pregnancy in humans. The CBD amounts administered were within what is considered a therapeutic range for several medical conditions in humans. The THC concentration administered was similar to levels reached by a person smoking marijuana.

The researchers found that one-time exposure to CBD and THC caused eye, brain, and facial malformations similar to those caused by prenatal alcohol exposure alone. The researchers also found that when mice were given both CBs and alcohol, the likelihood of these birth defects more than doubled. They confirmed this finding in a zebrafish model.

Further investigation by Parnell’s team revealed clues about the mechanisms by which alcohol and CBs interact at the cellular level. They found that alcohol and CBs converge on the Sonic Hedgehog pathway to inhibit signaling between molecules in cells that control growth and development in the embryo. The Sonic Hedgehog pathway plays a key role in the development of animals and humans.

“Our finding that simultaneous exposure to alcohol and CBs induces the highest rate of birth defects, even at low doses of these substances emphasizes the need for more research to better understand the effects of alcohol and CBs on the developing embryo,” said Parnell.

This news release describes a basic research finding. Basic research increases our understanding of human behavior and biology, which is foundational to advancing new and better ways to prevent, diagnose, and treat disease. Science is an unpredictable and incremental process — each research advance builds on past discoveries, often in unexpected ways. Most clinical advances would not be possible without the knowledge of fundamental basic research.

HIV medication poses prescribing dilemma in poor countries

The recent discovery that an anti-HIV medication called dolutegravir can cause birth defects among pregnant women poses ethical challenges for doctors and patients in low-resource settings, according to reports.

Anti- HIV drug link to birth defect in women

An April 19, 2019 NPR article examined the dilemma between prescribing patients dolutegravir or giving them an older treatment drug called efavirenz, which is less effective than dolutegravir and may be associated with long-term health risks for the patient but is not associated with risk of birth defects.

Daniel Wikler, Mary B. Saltonstall Professor of Ethics and Population Health at Harvard T.H. Chan School of Public Health, said it would indefensible if poor countries developed policies that would give all women the older, less effective drug because they might get pregnant. “That would mean that some women are going to die because they’re at risk for pregnancy,” he said.

According to UNAIDS,

  • There were approximately 36.9 million people worldwide living with HIV/AIDS in 2017.
  • Of these, 1.8 million were children (<15 years old).
  • An estimated 1.8 million individuals worldwide became newly infected with HIV in 2017 – about 5,000 new infections per day. This includes 180,000 children (<15 years). Most of these children live in sub-Saharan Africa and were infected by their HIV-positive mothers during pregnancy, childbirth or breastfeeding.
  • Approximately 75% of people living with HIV globally were aware of their HIV status in 2017. The remaining 25% (over 9 million people) still need access to HIV testing services. HIV testing is an essential gateway to HIV prevention, treatment, care and support services.
  • The vast majority of people living with HIV are in low- and middle-income countries.

Improving quality service delivery in rural communities through policy literacy

By Ahmed Sahid Nasralla (De Monk)

Nurse-In-Charge at the Kpandebu Community Health Center, Lilly E. Moiwo, said pregnant and lactating mothers refused to come to the center and instead rely on ‘peppeh doctas’ (quack nurses) in the community

Quality service delivery is a challenge in rural communities in Sierra Leone as a result of lack of understanding of government policies, especially relating to essential services such as education, health and social protection.

This came out clearly from a skit performed by school pupils, teachers, parents and education authorities on the Free Quality Education Program (FQEP) during a policy literacy session organised by Non-Governmental Organisation SEND Sierra Leone at their Kailahun Town office, Eastern Sierra Leone, last week.

The skit, laced with misconceptions and misinformation on the FQEP, set the stage for frank discussion among community people and public service providers on the three key areas of education, health and social protection. Starting with education, participants lamented the numerous challenges of accessing quality schooling before now and assessed the extent to which the newly introduced FQEP will go to address those challenges in the short, medium and long terms.

“The FQEP is being implemented over a five-year period (2019-2023) and in phases; so not all of these challenges will be addressed immediately,” said Allieu Marah, SEND Sierra Leone SABI Project Officer.

Explaining the FQEP policy, the Deputy Director of Education in Kailahun District, Foday Conteh, provided answers to the frequently asked questions on the program including which children are covered; responsibilities of Government on one hand and the parents/guardians on the other; which schools will benefit from the schooling feeding program and where will the school bus scheme operate.

Participants were shocked to learn that parents/guardians could face penalties of fine or imprisonment if they fail to send their children/wards to school (Education Act 2004).

Furthermore, they were amazed to learn that FQEP covers only public schools (Government owned and government assisted schools). Many of the schools in rural communities are community owned and these are not covered by the FQEP. Education officials are still counting the number of children in these community schools across the country that are missing out on the FQEP.

Nevertheless, Conteh said the Ministry has adopted a set of criteria such schools have to meet before they are approved as public schools. According to the criteria, community schools must have a good structure plus a playground that are big enough to accommodate the pupils; they must have good WASH facilities, and a reasonable trained and qualified number of teachers.

“We have received applications from community schools and many of them will be approved in due course,” said Conteh; adding however that henceforth any NGO or faith based organisation that wishes to establish a school is mandated to seek approval from the Ministry of Basic and Senior Secondary Education, prior to establishing the school.

In the area of the Free Health Care Initiative (FHCI) the general complain from the community people is that they are usually asked to pay money before they can be treated or given essential drugs even though such should be free. However, Matron Sando Kamara from the Kailahun Government Hospital insisted that FHCI is free for children under-five years’ old, pregnant women and lactating mothers; and lately People with Disability (PWDs) and Ebola survivors have been added to this primary beneficiary group.

“The only instances they (FCHI beneficiaries) pay money is when the drugs are not readily available in our stores. Sometimes the drugs delay to reach to the hospital; so we write prescriptions and ask them to go and buy them outside from the pharmacies,” explained Matron Kamara.

In Kpandebu, Dama Chiefdom, Kenema District, Nurse-In-Charge at the Kpandebu Community Health Center, Lilly E. Moiwo, reported that most of the pregnant and lactating mothers refused to come to the center and instead rely on ‘peppeh doctas’ (quack nurses) in the community.

“For example, children Under-5 are only brought to the center when they convulse,” she said.

However, Moiwo disclosed that unlike before there are no more special clinic days for pregnant women.

“Now they can come any day; every day is clinic day,” she said.

On Social Protection, especially relating to the rights and privileges of PWDs, participants learned that every person with disability has a right to free education in tertiary institutions accredited by the Tertiary Education Commission and approved by the Ministry responsible for education. Moreover, a person with disability shall not be denied admission to or expelled from an educational institution by reason only of his/her disability.

PWDs also have right to access public facilities, to employment and equal rights at the job place. Furthermore, they should be involved in all committees in their communities- from the School Management Committee to Ward Development Committee and Ward Education Committee.

Apart from helping community people understand their rights and responsibilities, the policy literacy sessions also guide communities to channel their concerns relating to essential service delivery through the appropriate authorities at ward, chiefdom, district and national level.

“These policy literacy sessions are implemented under the SABI Project funded by UKaid through Christian Aid. SABI doesn’t approve the community schools for the FQEP or provide the essential drugs for the FHCI; what it does is to enable communities to understand their rights and responsibilities and take action by channeling their concerns through the right bodies or heads,” said Marrah.

Operational in every district in Sierra Leone, the project seeks to strengthen community-led accountability, increasing awareness of, and demand for, the delivery of basic services – including health, education, social protection, water and energy.

The policy literacy sessions are organized by SEND Sierra Leone in 30 wards in Kailahun, Kenema, Kono, Western Urban and Western Rural districts.

Credit: Development and Economic Journalists Association (DEJA-SL)

Sierra Leone: President Bio warns healthcare workers to report on time for work

Sierra Leone president, Rtd. Brig. Julius Maada Bio, on Monday surprised healthcare workers at the Princess Christian Maternity Hospital (PCMH-Cottage) with an unannounced visit to check on the condition of the facility.


The president arrived at the hospital at 8:30am, the official report time for work, to monitor compliance by workers to report for work on time.

During his tour of the facilities, which is housing the Ola During Children’s Hospital at Fourah Bay Road in the east of Freetown, the President noticed that one of the matrons was not on her seat long after the clock-in time for all public workers. He interrogated the Doctor-in-Charge on the possible reason for her absence and asked that she be reprimanded and urgent actions be taken to enforce the recent measures for all government workers.

President Bio expressed his dissatisfaction over conditions at the hospital, saying that the facility was overcrowded and hygiene situation needed urgent attention. He commended  workers who showed for work early.

“In terms of turnout for personnel, we must be happy because I met the Doctor and most of the other senior staff on time. With the exception of very few that I did not meet for which I have left warnings, we must congratulate them for their hard work. We will challenge them that everyone is in their office by 8:30am because if we want to bring change we must start it with how we manage time,” he said.

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On the deplorable state of the health facilities, President Bio added that: “What I am not pleased with is that this place, where people give birth to children is not conducive. I have heard a lot about it and that is why I have decided to come and see for myself and definitely, this facility is not enough for the women who come here to deliver.  I have seen it and it is now the business of government to see where we can improve and help save the lives of our compatriots,” he said.

Doctor-in-Charge, A.V Koroma said the PCMH is a national referral centre that receives over two thousand patients on a monthly basis.

He thanked the Ministry of Health and Sanitation for their support in terms of drugs to the centre. He cited challenges such as lack of beds to accommodate more patients and called on the government to assist with more beds to accommodate the growing rate of patients at the hospital.