Background
Leukocyte telomeres and maternal health
Nutrition and infection in pregnancy
Methods
Participants and inclusion criteria
Recruitment procedure and ethical approval
Data collection
Infection and nutritional assessment
Leukocyte telomere length analysis
Screening for genitourinary infections
Demographic, dietary, and anthropometric data
Statistical analysis
Results
Sociodemographic, anthropometric and behavioral data and leukocyte telomere length
Descriptive | Simple linear regression | ||||
---|---|---|---|---|---|
Total N (%) or mean +/-SD | Leukoctye telomere length mean+/-SD(T/S) | β | CI | p | |
Age in years | 28.16 ± 6.10 | 1.16 ± 0.22 | -2.96 | [.010; -0.02] | 0.003** |
Age | |||||
<20 | 13 (4.3) | 1.18 ± 0.21 | Ref. | ||
≥ 20-35 | 244 (82.2) | 1.17 ± 0.22 | -0.11 | [-021; 0.06] | 0.31 |
>35 | 40 (13.5) | 1.11 ± 0.22 | -0.14 | [-013; 0.11] | 0.90 |
Gestational age (weeks) at recruitment | 13.04 ± 3.5 | 0.012 | [0.01; 0.2] | 0.74 | |
Residence | |||||
Urban | 104 (35.0) | 1.17 ± 0.21 | Ref. | ||
Rural | 193 (65.0) | 1.14 ± 0.25 | 0.5 | [-03; 0.08] | 0.32 |
Occupation | |||||
Paying Job | 150 (50.5) | 1.19 ± 0.23 | refer | ||
Unemployed | 147 (49.5) | 1.17 ± 0.22 | 0.8 | [-0.01; 0.05] | 0.14 |
Living with a partner (na = 296) | |||||
Yes | 273 (92.2) | 1.17 ± 023 | Ref. | ||
No | 23 (7.8) | 1.11 ± 0.16 | -0.06 | [-0.15; 0.04] | 0.26 |
Educational level | |||||
Never schooled | 146 (49.2) | 1.15 ± 0.23 | Ref. | ||
Primary | 61 (20.5) | 1.06 ± 0.18 | -0.16 | [-0.16; -0.3] | .005** |
Secondary or higher | 90 (30.3) | 1.24 ± 0.21 | 0.17 | [0.03; 0.14] | .003* |
Body Mass Index (BMI) (kg/m2) | 23.09 (3.39) | 1.16 ± 0.22 | -2.11 | [-0.02; 0.01] | 0.03* |
BMI (category) (na = 293) | |||||
Underweight | 11 (3.8) | 1.12 ± 0.26 | Ref. | ||
Normal Weight | 215 (73.4) | 1.18 ± 0.22 | 0.10 | [-0.06;0.17] | 0.39 |
Overweight | 55 (18.7) | 1.11 ± 0.23 | -0.04 | [-0.15; 0.11] | 0.73 |
Obese | 12 (4.1) | 1.16 ± 0.25 | 0.31 | [-014; 0.19] | 0.75 |
Alcohol use (at least 2-4 times per month) | |||||
No | 228 (76.8) | 1.17 ± 0.25 | Ref. | ||
Yes | 69 (23.2) | 1.16 ± 0.21 | 0.01 | [-0.05; 0.06] | 0.83 |
Gender-based Violence | |||||
Yes | 12 (4.0) | 1.17 ± 0.22 | Ref. | ||
No | 285 (96.0) | 1.05 ± 016 | 0.10 | [-0.24; 0.01] | 0.08 |
Obstetrical history, pregnancy outcomes and telomere length
Descriptive | Simple Linear regression | ||||
---|---|---|---|---|---|
Total N (%) or mean +/-SD) | Leukocyte telomere Length ( mean +/-SD T/S) | Β | CI | p | |
Maternal parity | |||||
Nullipara | 20 (6.7) | 1.23 ± 0.19 | Ref | ||
Primipara | 99 (33.3) | 1.15 ± 0.21 | -1.44 | [-0.09; 0.01] | 0.15 |
Multipara | 178 (60.0) | 1.16 ± 0.23 | -1.14 | [-0.16; 0.04] | 0.25 |
History of stillbirth | |||||
No | 286 (96.3) | 1.16 ± 0.22 | Ref | ||
Yes | 11 (3.7) | 1.13 ± 0.25 | -0.03 | [-0.17; 0.10] | 0.60 |
Previous miscarriage (na = 292) | |||||
No | 250 (85.7) | 1.16 ± 0.22 | Ref | ||
Yes | 42 (14.3) | 1.16 ± 0.21 | -0.01 | [-0.08; 0.06] | 0.81 |
Previous Caesarian Section (na = 287) | |||||
No previous C. Section | 261 (90.9) | 1.16 ± 0.22 | Ref | ||
Previous C. Section | 26 (9.1) | 1.12 ± 0.19 | -0.06 | [-0.13; 0.04] | 0.32 |
Previous Preterm Labor/ birth | |||||
No | 246 (82.8) | 1.17 ± 0.22 | Ref | ||
Yes | 51 (17.2) | 1.16 ± 0.23 | 0.01 | [-0.06; 0.07] | 0.84 |
Mode of delivery | |||||
Caesarian section | 58 (19.5) | 1.17 ± 0.25 | Ref | ||
Vaginal | 239 (80.5) | 1.16 ± 0.21 | 0.03 | [-0.05; 0.08] | 0.61 |
Gestational age, weeks | 38.81± 2.1 | 1.16 ± 0.22 | 0.04 | [-01; 0.02] | 0.59 |
Gestational age, weeks (preterm only <37 weeks) (n = 27) | 33.59 ± 2.61 | 1.15 ± 0.15 | 0.09 | [-0.19;0.03] | 0.62 |
Preterm delivery (<37 weeks) | |||||
No | 270 (90.9) | 1.16 ± 0.23 | Ref | ||
Yes | 27 (9.1) | 1.46 ± 0.16 | -0.01 | [-09; 0.08] | 0.84 |
Preterm delivery (<34 weeks) | |||||
No | 286 (96.3) | 1.16 ± 0.23 | Ref | ||
Yes | 11 (3.7) | 1.17 ± 0.14 | 0.01 | [-0.13; 0.14] | 0.98 |
Late preterm delivery (34-<37 weeks) | |||||
No | 281 (94.6) | 1.15 ± 0.17 | Ref | ||
Yes | 16 (5.4) | 1.16 ± 0.23 | -0.02 | [-0.13; 0.09] | 0.79 |
Birthweight (n = 297) (grams) | 3153.22 ± 544.45 | 1.16 ± 0.22 | -0.08 | [-0.01;0.02] | 0.15 |
Birthweight preterm (<37 weeks) (n = 27) (grams) | 2063.33 ± 616.85 | 1.15 ± 0.16 | 0.14 | [-0.06; 0.14] | 0.47 |
Low birth weight (<2500 g) | 1874.80 ± 451.84 | 1.18 ± 0.16 | 0.27 | [-0.05;0.025] | 0.20 |
Inflammation and infections in pregnancy and leukocyte telomere length
Descriptive | Simple Linear regression | ||||
---|---|---|---|---|---|
Total N (%) or mean ±SD) | Leukocyte telomere Length mean ±SD (T/S) | Β | CI | P | |
Markers of Acute and Chronic Inflammation | |||||
C Reactive Protein (CRP mg/l) | 5.08 ± 12.33 | 1.16 ± 0.22 | 0.02 | [-0.01; 0.03] | 0.67 |
CRP(>5 mg/l) (na = 296) | |||||
No | 219 (74.0) | 1.16 ± 0.23 | ref | ||
Yes | 77 (26) | 1.17 ± 0.21 | 0.04 | [-0.04; 0.07] | 0.53 |
α1-acid glycoprotein (AGPg/dl) | 0.61 ± 0.41 | 1.16 ±0.22 | -0.45 | [-0.07; 0.04] | 0.64 |
α1-acid glycoprotein (AGP>1 g/l) | |||||
No | 275 (92.6) | 1.17. ±0.23 | ref | ||
Yes | 22 (7.4) | 1.13 ± 0.15 | -0.04 | [-0.13; 0.06] | 0.48 |
Presence of Infectious Disease | |||||
Urinary Tract Infections (UTI) | |||||
No | 259 (87.2) | 1.17 ± 0.23 | Ref | ||
Yes | 38 (12.8) | 1.16 ± 0.16 | -0.01 | [-0.08; 0.07] | 0.84 |
UTI strain (n = 38) | |||||
Stenotrophomonas maltophilia | 2 (5.3) | ||||
Escherchia coli | 22 (57.9) | ||||
Klebsialla pneumoniae | 11 (28.9) | ||||
Staphylococcus epidermitis | 3 (7.9) | ||||
Sexually Transmitted Infection (STI) | |||||
No | 189 (63.6) | 1.18 ± 0.23 | ref | ||
Yes | 108 (36.4) | 1.13 ± 0.22 | -0.104 | [-0.102; 0.005] | 0.07 |
Type of STI | |||||
Chlamydia trachomatis | |||||
No | 235 (79.1) | 1.17 ± 0.22 | ref | ||
Yes | 62 (20.9) | 1.12 ± 0.25 | -010 | [-0.12; 0.01] | 0.08 |
Trichomonas vaginalis | |||||
No | 282 (94.9) | 1.16 ± 023 | ref | ||
Yes | 15 (5.1) | 1.17 ± 0.19 | 0.002 | [-0.11; 0.12] | 0.99 |
Candida albicans | |||||
No | 233 (78.5) | 1.17 ± 0.23 | ref | ||
Yes | 64 (21.5) | 1.14 ± 0.19 | -0.51 | [-0.09; 0.03] | 0.25 |
Nutrition in pregnancy and leukocyte telomere length
Descriptive | Simple Linear regression | ||||
---|---|---|---|---|---|
Total N (%) or mean ±SD) | Leukocyte telomere length mean ±SD (T/S) | β | CI | P | |
Hemoglobin (g/dl) | 11.23 ± 1.13 | 1.16 ±0.22 | 0.04 | [-0.01; 0.03] | 0.47 |
Anemia (<11 g/dl) | |||||
No | 205 (69.0) | 1.15 ± 0.21 | Ref | ||
Yes | 92 (31.0) | 1.19 ± 0.24 | 0.07 | [-02;0.09] | 0.21 |
STFR (mg/L) (Soluble Transferrin Receptors) | 4.81 ± 1.49 | 1.16 ±0.22 | -0.13 | [-0.03; -0.01] | 0.02* |
STFR (mg/L) Deficiency | |||||
No deficiency (≤8.3 mg/L) | 287 (96.6) | 1.17 ± 0.22 | Ref | ||
Deficiency (>8.3 mg/L) | 10 (3.4) | 1.04 ± 0.18 | -0.10 | [-0.26; 0.17] | 0.08 |
Retinol Binding Protein (RBP) (μmol/L) | 1.38 ± 0.40 | 1.16 ± 0.22 | -2.19 | [-0.13; -0.01] | 0.03* |
RBP(μmol/L) Deficiency | |||||
No deficiency (≥0.83 μmol/L) | 239 (80.5) | 1.17 ± 0.18 | Ref | ||
Deficiency (< 0.83 μmol/L) | 58 (19.5) | 1.16 ± 0.23 | 0.03 | [-0.05; 0.08] | 0.66 |
Ferritin (μg/L) | 73.52 | 1.16 ± 0.22 | -0.09 | [-0.01; 0.03] | 0.12 |
Ferritin Deficiency (<12 μg/L) | |||||
No Deficiency (<12 μg/L) | 240 (80.8) | 1.16 ± 0.22 | Ref | ||
Deficiency (≥12 μg/L) | 58 (19.2) | 1.17 ± 0.23 | -0.01 | [-0.07; 0.06] | 0.84 |
Minimum Dietary Diversity for Women (MDDW) | 4.61 ± 1.68 | 1.16 ± 0.22 | -0.03 | [-0.06; 0.3] | 0.56 |
MDDW Deficiency | |||||
Adequate MDDW | 145 (48.8) | 1.15 ± 0.22 | Ref | ||
Low MDDW | 152 (51.2) | 1.17 ± 0.23 | -0.03 | [-0.07; 0.04] | 0.50 |
Mid-Upper Arm Circumference (MUAC) d(cm)(Mean +/-SD) | 25.72 ± 3.06 | 1.16 ± 0.23 | -0.09 | [-0.02; 0.002] | 0.30 |
MUAC Indication of Malnutrition | |||||
≥23 cm | 236 (79.5) | 1.16 ± 0.23 | Ref | ||
<23 cm | 58 (19.5) | 1.18 ± 0.22 | -0.04 | [-0.09; 0.04] | 0.45 |
Multivariable linear regression
Linear regression model full model | Adjusted model | |||||||
---|---|---|---|---|---|---|---|---|
Β | SE | CI | P | β | SE | CI | P | |
Age (years) | -0.140 | 0.02 | [-0.01; -0.001] | 0.01 | -0.15 | 0.02 | [-0.01; -0.001] | 0.008** |
Occupation | ||||||||
Paying Job | ref | |||||||
Housewife | -0.002 | 0.025 | [-0.05; 0.048] | 0.97 | - | - | - | - |
Education Level | ||||||||
Never schooled | ref | |||||||
Primary | -0.190 | 0.033 | [-0.17; 0.041] | 0.002 | -0.21 | 0.033 | [-0.18; -0.05] | 0.001** |
Secondary or higher | 0.122 | 0.030 | [-0.001; 0.12] | 0.045 | 0.11 | 0.109 | [-0.004; 0.11] | .070 |
Body Mass Index (BMI) kg/m2 | -0.094 | 0.004 | [-0.014; 0.01] | 0.101 | - | - | - | - |
Gender Based Violence (GBV) | ||||||||
Yes | ref | |||||||
No | -0.107 | 0.063 | [-0.25; 0.01] | 0.053 | - | - | - | - |
Parity Nullipara(reference) | ref | - | - | - | - | |||
Primipara | -0.020 | 0.055 | [-0.125; 0.09] | 0.75 | - | - | - | - |
Multipara | 0.046 | 0.027 | [.0.03; 0.074] | 0.430 | - | - | - | - |
Birth weight | 0.053 | .0001 | [-0.01; 0.001] | 0.350 | ||||
Sexually transmitted Infections | ||||||||
No | ref | |||||||
Yes | -0.071 | 0.026 | [-0.84; 0.018] | 0.202 | ||||
sTFR (mg/L) | -0.156 | 0.009 | [-0.04; 0.007] | 0.006 | -015 | 0.008 | [-0.04; -0.007] | 0.005** |
Retinol Binding Protein (RBP) (μmol/L) | -0.093 | 0.031 | [-0.11; 0.010] | 0.098 | -0.11 | 0.03 | [-0.12; -0.001] | 0.04 |
Ferritin (μg/L) | -0.130 | .0001 | [-0.01; 0.001] | 0.023 | -0.124 | 0.001 | [-0.01; -0.001] | 0.027* |