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Common motives of admission of pregnant ladies from traditionally gold mining areas
in Sudan
Nawal Ali Ahmed Mohamed1, Ahmed Amin Mohammed Ahmed1, Osman Abdlgadir Osman2, Eglal Hamza Mohammed Ebrahim2, Sahar
Alshareef Hasbsedo Ahmed3, Eldaw Breima Suliman Mohamed4,5, Islam Isa Abibdall2, Ahmed Mohamed Hamid Ibrahim2, Esraa Ahmed
Hussein Mohmed6, Maha Elrasheed Bakri Ismail6, Awad Eljeed Abogooda3, Abdelaal Ahmed Daldoum Masroub3, Hussain Gadelkarim
Ahmed3,7.
1Department of Obstetrics and Gynecology, Faculty of Medicine & Health Sciences, University of Kordofan, El Obeid, Sudan.
2Research Unit, El Obeid Specialized Pediatric Hospital, El Obeid, NK, Sudan.
3Prof Medical Research Consultancy Center- MRCC, El Obeid, NK, Sudan
4Department of Microbiology, Faculty of Medical Laboratory Science, University of Kordofan, El-Obeid, Sudan.
5Shikan College of Medicine, El-Obeid, Sudan.
6Minstry of Health, NK, El Obeid, Sudan.
7Department of Histopathology and Cytology, FMLS, University of Khartoum, Sudan.
ABSTRACT
Background: Metallic elements play a vital role in the health of both the fetus and the mother. This study aimed
to identify the primary reasons for admitting pregnant women from regions in Sudan where primitive gold mining
is prevalent. Methodology: Between January 2018 and December 2023, this descriptive retrospective hospital-
based study was conducted at El-Obeid Obstetrics and Gynecology Teaching Hospital. All information regarding
the participants in the study was extracted from hospital records. Results: The leading causes of hospital
admission for the majority of patients were prior scarring, labor, MEM&PIHE, and PPROM (representing 26%,
11%, 9%, and 5%, respectively). Patients originating from rural areas exhibited the highest prevalence rates of
PIHE, PP, PPROM, PS, and anemia, accounting for 87.5%, 83.3%, 75%, and 61.5%, respectively. Conclusion: This
study showed that primitive gold mining affects pregnant women in several ways that require community-level
intervention. As mining expands rapidly across the nation without safety protocols, more research is needed to
determine these individuals' exposure levels.
Keywords: Pregnancy, Gold mining, labor, Sudan.
Correspondence to: Dr. Nawal AA, Email: nawalaliahmed79@gmail.com
Cite this article: Mohamed AA, Mohammed Ahmed AA, Osman OA, Ebrahim EHM, Ahmed SAH, Mohamed EBS, Abibdall II,
Ibrahim AMH, Mohmed EAH, Ismail MEB, Abogooda AE, Masroub AAD, Ahmed HG. Common motives of admission of pregnant
ladies from traditionally gold mining areas in Sudan. Medical Research Updates 2024;2(1): 10-22. DOI: 0000
INTRODUCTION
Metallic elements are crucial to fetal and
maternal health. Fetuses can absorb metals via
the placental barrier, which may disrupt
neural tube closure. Abnormal neural tube
closure three to four weeks post-conception
causes neural tube defects (NTDs), which have
a complicated genetic and environmental
etiology. New population-level association
studies have examined the link between
maternal environmental exposure and NTDs,
notably metals [1].
Environmental factors during pregnancy can
affect fetus and future generations' fitness. It
was found that feeding Caenorhabditis elegans
mothers ursolic acid (UA), a plant-derived
chemical, during reproduction reduced
neurodegeneration in their offspring and F2
progeny [2]. A study explored the role of
placental total mercury (T-Hg) as a biomarker
of prenatal mercury (Hg) exposure and
offspring risk for neural tube abnormalities
(NTDs). There was a strong correlation
between placental T-Hg and T-Hg in umbilical
cord, kidney, liver, and brain tissues [3].
Industrialization in the 20th century increased
heavy metal exposure. Human poisoning is
most often caused by mercury, cadmium, and
arsenic. Water, air, and food can induce acute
or chronic poisoning, and heavy metal
bioaccumulation harms human tissues and
organs. Heavy metals disrupt growth,
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proliferation, differentiation, damage repair,
and apoptosis. These metals cause toxicity by
producing ROS, diminishing antioxidant
defenses, enzyme inactivation, and oxidative
stress. Skin, liver, prostate, lung, urinary
bladder, thyroid, kidney, and gastrointestinal
cancers are frequently linked to heavy metal
exposure. Dysregulated microRNAs (miRNAs)
have been linked to several human
malignancies. Recent studies have shown that
microRNA dysregulation causes numerous
tissue cancers [4].
Traditional gold mining in Sudan has been
booming in recent years, with little safety
measures taken. In the mining districts, the
majority of workers put themselves and their
families at risk of exposure to high quantities
of mercury. Consequently, the purpose of this
research was to determine the most prevalent
reasons for admitting pregnant women from
Sudanese regions that have a primitive gold
mining.
MATERIALS AND METHODS
This is a descriptive retrospective hospital-
based study that took place at El-Obeid
Obstetrics and Gynecology Teaching Hospital
between January 2018 and December 2023.
The sample size includes all pregnant women
from domestic gold mining areas such as
Sodari, Jabrat Alsheekh, Um andraba, Elmrkh,
Abozaiema, Alswanee, Algmah, Um Loaly,
Abuhadeed, Abufroa, Um badir, Hamrat
Alsheekh, Hamrat Alwiz, and Kagmer.
All data pertaining to the study individuals
were obtained from hospital records. Aside
from demographic information such as age,
occupation, and residence, patients' vital
identifying variables were also acquired from
her records, including: parity, gestational age
at presentation. Recurrent abortion, history of
congenital deformity, and fetal fate. History of
chronic illness and maternal outcomes.
Pregnant women with singleton pregnancies
from domestic mining areas who visited the
maternity service at El-Obeid Obstetrics and
Gynecology Teaching Hospital during the
study period. Pregnant women having
repeated pregnancies, as well as those
suffering from chronic illnesses such as
diabetes, hypertension, and asthma.
Data analysis
The data were first organized in a
conventional spreadsheet and then entered
into the SPSS version 24 software application.
Descriptive statistics in the form of frequency
tables, percentages, and graphs. Statistically
significant results were calculated using the
95% confidence level and interval to perform
chi square tests. A p-value of <0.05 was judged
statistically significant.
RESULTS
This study investigated 150 pregnant ladies
aged 18 to 46 years with a mean age of 27
years. About 97/150(65%) presenting from
urban areas and the remaining 53/150(35%)
from rural areas. Most patients were aged 25-
29 years, followed by 20-
constituting 37/150(25%), 33(22%), and
31(21%), respectively, as indicated in Table 1,
Fig 1.
Table 1. Distribution of the study subjects by age and resident
Age group
Urban
Rural
Total
<20 years
7
18
25
20-24
11
22
33
25-29
12
25
37
30-34
11
13
24
35+
12
19
31
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Total
53
97
150
Figure 1. Description of patients by residence and age
As indicated in Table 2, Fig2, the reason for
hospital admission for most patients was
previous scar followed by MEM&PIHE, Labor,
and PPROM, representing 39/150(26%),
16(11%), 13(9%), and 8(5%), respectively.
The highest proportions of PIHE, PP, PPROM,
PS, and anemia were seen among patients
coming from rural areas, representing,
14/16(87.5%), 5/6(83.3%), 6/8(75%), and
24/39(61.5%), correspondingly.
For previous scar, most patients aged 25-29,
followed by 20-24, constituting 16/39(41%),
and 12(31%), in that order. For MEM, most
patients aged 20-24 followed by <20 years,
representing 6/16(37.5%), and 4(24%),
respectively, whereas, for PIHE most patients
were in age range <20 followed by 20-24,
constituting, 6/16(37.5%), and 5/16(31.3%),
per capta.
Table 2. Distribution of the study subjects by reason of admission and demographical characteristic
Variable
PPROM
Labor
MEM
SM
PIHE
PP
PPH
PS
Anemia
Other
Total
Residence
Urban
2
6
6
5
2
1
2
15
2
12
53
Rural
6
7
10
2
14
5
3
24
5
21
97
Total
8
13
16
7
16
6
5
39
7
33
150
Age
<20 years
1
3
4
3
6
0
0
2
1
5
25
20-24
0
2
6
0
5
1
0
12
1
6
33
25-29
1
1
2
1
1
1
4
16
1
9
37
30-34
2
4
2
0
1
1
0
4
3
7
24
35+
4
3
2
3
3
3
1
5
1
6
31
13%
21%
23%
21%
23%
19%
23%
26%
13%
19%
17%
22%
25%
16%
20%
<2 0 Y E A R S 20- 2 4 Y R S 25- 2 9 Y R S 30- 3 4 Y R S ≥ 3 5 Y R S
Urban Rural Total
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Total
8
13
16
7
16
6
5
39
7
33
150
PPROM: Pre-labor rupture of membrane and preterm labor, MEM: Miscarriage, ectopic pregnancy,
and molar pregnancy, SM: Severe malaria, PIHE: Pregnancy induced hypertension and eclampsia,
PP: Placenta previa, PS: Previous scar
Figure 2. Description of the patients by reason of admission and demographical characteristic
Table 3, Fig 3 summarized the distribution of
the
characteristics. Most patients were Multipara
followed by Nulliparous, and Grand-multipara,
representing 100/150(66.7%), 33(22%), and
17(11.3%). Most Nulliparous, Multipara, and
Grand-multipara, presented PIHE (24.2%), PS
(37%), and PIHE (17.6%), in that order.
Regarding association with previous
pregnancy outcomes, AW, MS, IUFD, CMF,
IUFD+MS were more frequently associated
with PS (34.7%), PS (25%), PS (25%), MEM
(100%), and PIHE (100%), in that order.
Concerning gestational age, most problems
were associated with 30-39 weeks, followed
by <20 weeks, >39, and 20-29 weeks,
constituting 98/150(65.3%), 13(86.7%),
11(7%), and 9(6%), correspondingly. AW was
predominantly associated with PS (35%), MS
with PS (25%), IUFD with PS (25%), CMF with
MEM (100%).
Table 3
Variable
PPROM
Labor
MEM
SM
PIHE
PP
PPH
PS
Anemia
Other
Total
Parity
Nulliparous
1
6
4
2
8
0
0
0
1
11
33
Multipara
5
6
12
4
5
5
5
37
5
16
100
Grand-
multipara
2
1
0
1
3
1
0
2
1
6
17
25%
46%
38%
71%
13% 17%
40% 38%
29%
36% 35%
75%
54%
63%
40%
88% 83%
60% 62%
71%
64% 65%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
PPROM Labor MEM SM PIHE PP PPH PS Anemia Other Total
Urban Rural <20 years 20-24yrs 25-29yrs 30-34yrs ≥35yrs
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Total
8
13
16
7
16
6
5
39
7
33
150
Previous Pregnancy outcomes
AW
4
7
11
4
5
4
3
33
6
18
95
MS
2
0
2
0
1
1
0
3
0
3
12
IUFD
1
1
0
1
1
1
2
3
0
2
12
CMF
0
0
1
0
0
0
0
0
0
0
1
IUFD+MS
0
0
0
0
1
0
0
0
0
0
1
Total
7
8
14
5
8
6
5
39
6
23
121
Gestational Age (week)
<20weeks
0
0
8
2
0
0
0
0
2
1
13
20-29
3
0
0
1
1
0
0
0
1
3
9
30-39
5
9
2
4
15
6
1
38
4
14
98
>39
0
4
0
0
0
0
2
1
0
4
11
Total
8
13
10
7
16
6
3
39
7
22
131
AW: Alife and Well, IUFD: Intrauterine Fetal Death, CMF: Congenital Malformation, MS:
Miscarriage
Figure 3.
DISCUSSION
The majority of patients in this series were
admitted because of the existence of a
previous scar (26%). Scar pregnancy is an
uncommon and potentially fatal condition in
which an embryo implants and proliferates
within a uterine scar or scar from a previous
cesarean section [5]. hen an embryo implants
on the scar from a prior cesarean section, the
result is a condition known as a cesarean scar
ectopic pregnancy (CSEP). The percentage of
live deliveries that require a caesarean section
has increased from 20.7% in 1996 to 32.1% in
2021, an increase of 50% in the past decade.
Consequently, CSEP has become more
common. It is crucial to accurately diagnose
-20%
0%
20%
40%
60%
80%
100%
120%
PPROM SM PP PPH PS Anemia
Other Labor MEM PIHE Total
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and appropriately treat CSEP because it can
cause severe morbidity including potentially
fatal hemorrhage, uterine rupture, placental
accreta spectrum, hysterectomy, and death
[6].
In the current study, there were reports of
pregnancy-induced hypertension, eclampsia,
and miscarriage in several patients. Chronic
hypertension, gestational hypertension, and
pre-eclampsia are all part of hypertensive
disorders of pregnancy (HDP), which is among
the most prevalent pregnancy problems. The
number of pregnancies afflicted by pre-
eclampsia could be significantly reduced with
the use of new technologies that screen
pregnant women for the condition early on
and then prescribe tailored aspirin
prophylaxis. Recent developments in pre-
eclampsia diagnosis, such as testing based on
placental growth factor, have further
improved the identification of pregnancies
with the greatest risk of serious problems.
Trial results have improved the target blood
pressure for chronic hypertension
management and the date of delivery for non-
severe pre-eclampsia, according to the
corresponding literature [7, 8]. There is a
potential link between toxic metals like lead
(Pb), cadmium (Cd), arsenic (As), and mercury
(Hg) and an increased risk of gestational
hypertension and preeclampsia [9]. There is a
correlation between prenatal exposure to
metal mixtures and unfavorable pregnancy
and birth outcomes, including miscarriage,
low birth weight, preterm birth, and small for
gestational age. There are noteworthy
correlations between mercury (Hg) and
unfavorable outcomes during pregnancy and
childbirth, which illustrate a wide range of
impacts and possible interactions [10].
Several patients who participated in the
present investigation exhibited symptoms of
preterm labor and rupture of membranes
prior to labor. The rupture of embryonic
membranes prior to the initiation of labor is
referred to as pre-labor rupture of membranes
(PROM). PROM is detected in 3040% of
preterm labor and 315% of all pregnancies
worldwide [11].
Certain patients who participated in the
current investigation exhibited placenta
previa. Both placenta previa and placenta
accreta are associated with increased
maternal and fetal morbidity and mortality.
There may be associations between metal
exposure and placenta previa and placenta
accreta. The present investigation examined
the correlations between concentrations of
maternal metals (specifically selenium [Mn],
cadmium [Cd], lead [Pb], mercury [Hg], and
selenium [Cd], lead, and selenium [Pb]) and
placenta previa [12].
While the current study shed light on the
effects of rudimentary gold mining on
pregnant women, it is important to
acknowledge its limitations, which include the
lack of a control group and the inability to
measure metal density.
In conclusion: This study reported diverse
impacts of primitive gold mining on pregnant
women and their fetuses require immediate
community-level intervention. It is crucial that
additional research investigate the precise
level of exposure among these individuals, as
mining continues to expand rapidly across the
nation in a rudimentary fashion, devoid of any
safety protocols.
Acknowledgement
Authors would like to thank people at El Obeid
Teaching Hospital for their help in data
collection. Special thanks are extended to
Sarmad Maher Osman Ahmed, Afraa
Hamdan Saad Rahma, and Omsaiama
Dawood Musa Mohamed Ahmed for their
help.
Ethical consideration
Official agreements from the Ministry of
Health in North Kordofan and the Obstetrics
and Gynecology Department at El Obeid
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Teaching Hospital were secured. All
information was kept confidential.
Ethical Approval
This study's proposal was approved by the
Human Research Ethics Committee at MRCC
(Approval Number: HREC
0003/MRCC.02/24).
Conflict of interest
Authors declare no conflict of interest.
Funding
Authors have funded this research
Data Availability:
All raw data of this research are available from
corresponding author.
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