ORCID Profile
0000-0002-5116-5601
Current Organisations
University of Tsukuba
,
University of Southern California
,
Mongolian national Institute of Physical education
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Publisher: Public Library of Science (PLoS)
Date: 11-02-2016
Publisher: Public Library of Science (PLoS)
Date: 13-08-2014
Publisher: Springer Science and Business Media LLC
Date: 10-03-2017
DOI: 10.1038/SREP44093
Abstract: Caesarean section (CS) is increasing globally, and women with prior CS are at higher risk of uterine rupture in subsequent pregnancies. However, little is known about the incidence, risk factors, and outcomes of uterine rupture in women with prior CS, especially in developing countries. To investigate this, we conducted a secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health, which included data on delivery from 359 facilities in 29 countries. The incidence of uterine rupture among women with at least one prior CS was 0.5% (170/37,366), ranging from 0.2% in high-Human Development Index (HDI) countries to 1.0% in low-HDI countries. Factors significantly associated with uterine rupture included giving birth in medium- or low-HDI countries (adjusted odds ratio [AOR] 2.0 and 3.88, respectively), lower maternal educational level (≤6 years) (AOR 1.71), spontaneous onset of labour (AOR 1.62), and gestational age at birth weeks (AOR 3.52). Women with uterine rupture had significantly higher risk of maternal death (AOR 4.45) and perinatal death (AOR 33.34). Women with prior CS, especially in resource-limited settings, are facing higher risk of uterine rupture and subsequent adverse outcomes. Further studies are needed for prevention/management strategies in these settings.
Publisher: Wiley
Date: 05-05-2017
DOI: 10.1111/PPE.12363
Abstract: Maternal and neonatal outcomes have improved substantially. During the same period, the caesarean delivery rate soared. The aim of this analysis was to determine whether an increase in caesarean rate was associated with an improvement in perinatal outcome at an institutional level in low- and middle-income countries. The WHO Global Survey on Maternal and Perinatal Health (WHOGS) and the WHO Multi-Country Survey on Maternal and Newborn Health (WHOMCS) were two multi-country, facility-based, cross-sectional surveys conducted in 2004-08 and 2010-11, respectively. The increase in caesarean rate and the change of prevalence of adverse perinatal outcomes were calculated using a two-point estimator of percent change annualized (PCA) method. Maternal, perinatal, and neonatal composite indexes were used as the outcomes. A linear mixed model was used to assess the association between the change of caesarean rate and the change of perinatal outcome. A total of 259 facilities in 20 countries participated in both surveys, with 217 844 women in WHOGS and 227 734 women in WHOMCS. The caesarean rate in these facilities increased, on average, by 4.0% annually, while the prevalence of adverse perinatal outcomes decreased by 4.6% annually. However, after adjustments for potential confounders, no association was found between the increase in caesarean rate and the change of adverse outcome indexes, regardless of whether starting caesarean rates were already high (above 10%) or not. In low- and middle-income countries, the increases in caesarean rates were not associated with improved perinatal outcomes regardless of whether the starting caesarean rate was already high or not.
Publisher: Wiley
Date: 03-2014
Abstract: To assess the relationship between education and severe maternal outcomes among women delivering in healthcare facilities. Cross-sectional study. Twenty-nine countries in Africa, Asia, Latin America, and the Middle East. Pregnant women admitted to 359 facilities during a period of 2-4 months of data collection between 2010 and 2011. Data were obtained from hospital records. Stratification was based on the Human Development Index (HDI) values of the participating countries. Multivariable logistic regression analyses were conducted to assess the association between maternal morbidity and education, categorised in quartiles based on the years of formal education by country. Coverage of key interventions was assessed. Severe maternal outcomes (near misses and death). A significant association between low education and severe maternal outcomes (adjusted odds ratio, aOR, 2.07 95% confidence interval, 95% CI, 1.46-2.95), maternal near miss (aOR 1.80 95% CI 1.25-2.57), and maternal death (aOR 5.62 95% CI 3.45-9.16) was observed. This relationship persisted in countries with medium HDIs (aOR 2.36 95% CI 1.33-4.17) and low HDIs (aOR 2.65 95% CI 1.54-2.57). Less educated women also had increased odds of presenting to the hospital in a severe condition (i.e. with organ dysfunction on arrival or within 24 hours: aOR 2.06 95% CI 1.36-3.10). The probability that a woman received magnesium sulphate for ecl sia or had a caesarean section significantly increased as education level increased (P < 0.05). Women with lower levels of education are at greater risk for severe maternal outcomes, even after adjustment for key confounding factors. This is particularly true for women in countries that have poorer markers of social and economic development.
Publisher: American Physiological Society
Date: 09-2013
DOI: 10.1152/AJPRENAL.00407.2012
Abstract: Salt reabsorption is the major energy-requiring process in the kidney, and AMP-activated protein kinase (AMPK) is an important regulator of cellular metabolism. Mice with targeted deletion of the β1-subunit of AMPK (AMPK-β1 −/− mice) had significantly increased urinary Na + excretion on a normal salt diet. This was associated with reduced expression of the β-subunit of the epithelial Na + channel (ENaC) and increased subapical tubular expression of kidney-specific Na + -K + -2Cl − cotransporter 2 (NKCC2) in the medullary thick ascending limb of Henle. AMPK-β1 −/− mice fed a salt-deficient diet were able to conserve Na + , but renin secretion increased 180% compared with control mice. Cyclooxygenase-2 mRNA also increased in the kidney cortex, indicating greater signaling through the macula densa tubular salt-sensing pathway. To determine whether the increase in renin secretion was due to a change in regulation of fatty acid metabolism by AMPK, mice with a mutation of the inhibitory AMPK phosphosite in acetyl-CoA carboxylase 1 [ACC1-knockin (KI) S79A mice] were examined. ACC1-KI S79A mice on a normal salt diet had no increase in salt loss or renin secretion, and expression of NKCC2, Na + -Cl − cotransporter, and ENaC-β were similar to those in control mice. When mice were placed on a salt-deficient diet, however, renin secretion and cortical expression of cyclooxygenase-2 mRNA increased significantly in ACC1-KI S79A mice compared with control mice. In summary, our data suggest that renin synthesis and secretion are regulated by AMPK and coupled to metabolism by phosphorylation of ACC1.
Publisher: Elsevier BV
Date: 11-2014
Publisher: Elsevier BV
Date: 05-2013
Publisher: Wiley
Date: 03-2014
Abstract: To evaluate how the effect of maternal complications on preterm birth varies between spontaneous and provider-initiated births, as well as among different countries. Secondary analysis of a cross-sectional study. Twenty-nine countries participating in the World Health Organization Multicountry Survey on Maternal and Newborn Health. 299 878 singleton deliveries of live neonates or fresh stillbirths. Countries were categorised into very high, high, medium and low developed countries using the Human Development Index (HDI) of 2012 by the World Bank. We described the prevalence and risk of maternal complications, their effect on outcomes and their variability by country development. Preterm birth, fresh stillbirth and early neonatal death. The proportion of provider-initiated births among preterm deliveries increased with development: 19% in low to 40% in very high HDI countries. Among preterm deliveries, the socially disadvantaged were less likely, and the medically high risk were more likely, to have a provider-initiated delivery. The effects of anaemia [adjusted odds ratio (AOR), 2.03 95% confidence interval (CI), 1.84 2.25], chronic hypertension (AOR, 2.28 95% CI, 1.94 2.68) and pre-ecl sia/ecl sia (AOR, 5.03 95% CI, 4.72 5.37) on preterm birth were similar among all four HDI subgroups. The provision of adequate obstetric care, including optimal timing for delivery in high-risk pregnancies, especially to the socially disadvantaged, could improve pregnancy outcomes. Avoiding preterm delivery in women when maternal complications, such as anaemia or hypertensive disorders, are present is important for countries at various stages of development, but may be more challenging to achieve.
Publisher: Wiley
Date: 12-07-2020
DOI: 10.1002/IJGO.13241
Publisher: Elsevier BV
Date: 05-2018
Publisher: Springer Science and Business Media LLC
Date: 21-03-2017
DOI: 10.1038/SREP44868
Abstract: Early initiation of breastfeeding (EIBF) within 1 hour of birth can decrease neonatal death. However, the prevalence of EIBF is approximately 50% in many developing countries, and data remains unavailable for some countries. We conducted a secondary analysis using the WHO Global Survey on Maternal and Perinatal Health to identify factors h ering EIBF. We described the coverage of EIBF among 373 health facilities for singleton neonates for whom breastfeeding was initiated after birth. Maternal and facility characteristics of EIBF were compared to those of breastfeeding hour after birth, and multiple logistic regression analysis was performed. In total, 244,569 singleton live births without severe adverse outcomes were analysed. The EIBF prevalence varied widely among countries and ranged from 17.7% to 98.4% (average, 57.6%). There was less intra-country variation for BFI hours. After adjustment, EIBF was significantly lower among women with complications during pregnancy and caesarean delivery. Globally, EIBF varied considerably across countries. Maternal complications during pregnancy, caesarean delivery and absence of postnatal/neonatal care guidelines at hospitals may affect EIBF. Our findings suggest that to better promote EIBF, special support for breastfeeding promotion is needed for women with complications during pregnancy and those who deliver by caesarean section.
Publisher: Wiley
Date: 10-08-2015
Publisher: American Physiological Society
Date: 05-2010
DOI: 10.1152/AJPRENAL.00005.2010
Abstract: The ultrasensitive energy sensor AMP-activated protein kinase (AMPK) orchestrates the regulation of energy-generating and energy-consuming pathways. AMPK is highly expressed in the kidney where it is reported to be involved in a variety of physiological and pathological processes including ion transport, podocyte function, and diabetic renal hypertrophy. Sodium transport is the major energy-consuming process in the kidney, and AMPK has been proposed to contribute to the coupling of ion transport with cellular energy metabolism. Specifically, AMPK has been identified as a regulator of several ion transporters of significance in renal physiology, including the cystic fibrosis transmembrane conductance regulator (CFTR), the epithelial sodium channel (ENaC), the Na + -K + -2Cl − cotransporter (NKCC), and the vacuolar H + -ATPase (V-ATPase). Identified regulators of AMPK in the kidney include dietary salt, diabetes, adiponectin, and ischemia. Activation of AMPK in response to adiponectin is described in podocytes, where it reduces albuminuria, and in tubular cells, where it reduces glycogen accumulation. Reduced AMPK activity in the diabetic kidney is associated with renal accumulation of triglyceride and glycogen and the pathogenesis of diabetic renal hypertrophy. Acute renal ischemia causes a rapid and powerful activation of AMPK, but the functional significance of this observation remains unclear. Despite the recent advances, there remain significant gaps in the present understanding of both the upstream regulating pathways and the downstream substrates for AMPK in the kidney. A more complete understanding of the AMPK pathway in the kidney offers potential for improved therapies for several renal diseases including diabetic nephropathy, polycystic kidney disease, and ischemia-reperfusion injury.
Location: United States of America
Location: Mongolia
No related grants have been discovered for Ganchimeg Togoobaatar.