International Journal of Women's Health最新文献

Background: Obstructed labour, a sequel of prolonged labour, remains a significant contributor to maternal and perinatal deaths in low resource settings.

Objective: We evaluated the modified WHO labour care guide (LCG) in detecting prolonged/obstructed labour compared to the traditional partograph at publicly funded maternity centers in Southwestern Uganda.

Methods: LCG was deployed to monitor labour by trained health care providers in 2023. We reviewed all patient labour monitoring records for the first quarter of 2024 (LCG-intervention) and 2023 (partograph-before LCG introduction) from eight randomized maternity centers. Our primary outcome was the proportion of women diagnosed with prolonged and or obstructed labour. Secondary outcomes included: mode of delivery, labour augmentation, stillbirths, maternal deaths, Apgar score, uterine rupture, postpartum haemorrhage and tool completion. Data was collected in REDcap and analyzed using STATA v17; statistical significance was p < 0.05.

Results: A total of 991 (49.3%) and 1020 (50.7%) women were monitored using the LCG and partograph, respectively. The mean maternal and gestation ages were similar between the two groups, reported at 25.9 (SD=5.6) years, and 39.4 (SD=1.8) weeks, respectively. Overall, 120 (12.4%) cases of prolonged/obstructed labour were diagnosed (100 for LCG versus 20 for partograph); LCG had six times higher odds of diagnosing prolonged/obstructed labour compared to the partograph (aOR = 5.94;CI 95%3.63-9.73, P < 0.001). Detection of obstructed labour alone using LCG increased 12-fold compared to the partograph (aOR = 11.74;CI 95%3.55-38.74, P < 0.001). We observed increased Caesarean section rates (aOR=6.12;CI 95%4.32-8.67, P < 0.001), augmentation of labour (aOR = 3.11;CI 95%1.81-5.35, P < 0.001), Apgar Score at 5 minutes (aOR = 2.29;CI 95%1.11-5.77, P = 0.025) and tool completion rate (aOR = 2.11;CI 95%1.08-5.44, P < 0.001). We observed no differences in stillbirths, maternal deaths, postpartum haemorrhage and uterine rupture.

Conclusion: Our data shows that LCG diagnosed more cases of prolonged and obstructed labour compared to the partograph among women delivering at rural publicly funded midwife-led facilities in Southwestern Uganda. More controlled and powered studies should evaluate the two tools in different facilities and sub-populations.

Trial registration: This trial registration was registered with clinical trials.gov number NCT05979194 on 2023-08-07, and the protocol was published by BMJ open, as 10.1136/bmjopen-2023-079216 on 15 April 2024.21 Trial registration number NCT05979194 clinical trials.gov.

Purpose: Polycystic Ovary Syndrome (PCOS) is a complex endocrine-metabolic disorder and is associated with a variety of health disorders. The management of PCOS requires a multidisciplinary health care approach. The COVID-19 pandemic affected access and delivery of health care. The aim of this study was to assess the impact of the pandemic on the health and health care experience of those affected by PCOS.

Patients and methods: An online survey was conducted January 2021 to July 2022 in Canada, open to anyone who identified as having PCOS. Data collected in REDCap included questions on demographics, symptoms, and experience of PCOS management during the pandemic.

Results: The majority (59%) of respondents (n=194, mean age 34±8 years) experienced pandemic-related employment changes and self-reported a high stress level (73±21/100). Of those who reported changes in body weight, 58% gained weight, which they attributed to unhealthy eating habits and a lack of exercise during the pandemic, and 16% lost weight, which they credited to increased physical activity and a shift towards healthier eating habits. The respondents ascribed the impact of COVID-related changes to clinic cancellations, delayed appointments, long wait times for referrals and lab work, lack of access to exercise facilities and insufficient social support. Some respondents voluntarily reduced access to health care services to limit COVID exposure. COVID-19-related health status was perceived as more important than their own PCOS-related symptoms. Virtual appointments via telehealth were regarded as beneficial for 20% of users.

Conclusion: Individuals with PCOS reported an overall reduction in COVID-related access to health care and supports. Some adapted to the use of telemedicine, while others experienced increased stress due to a lack of access to health care and an inability to manage their PCOS symptoms. The pandemic further highlighted that those with PCOS often experience a lack of accessibility to multidisciplinary health care and supports needed to manage their condition.

Introduction: Sarcopenia may affect the onset of gestational diabetes mellitus (GDM). However, the causal relationship between sarcopenia and GDM remains unclear. In this study, we used a bi-directional Mendelian randomization (MR) approach to explore this intricate relationship.

Methods: This study utilized data from FinnGen datasets and genome-wide association studies. A bi-directional MR study was conducted. First, a forward MR analysis evaluated the causality of sarcopenia on GDM risk, with sarcopenia-related traits as exposures and GDM as the outcome. Second, in the reverse MR analysis, we assessed whether GDM influenced sarcopenia-related traits. Finally, sensitivity analysis was conducted to assess the robustness of the MR analysis.

Results: Forward MR analysis revealed that appendicular lean mass (odds ratio [OR] = 1.2182, 95% confidence interval [CI]: 1.1397-1.3021, P < 0.0001), right-hand grip strength (OR= 1.4194, 95% CI: 1.0773-1.8701, P= 0.0128), left-hand grip strength (OR= 1.6064, 95% CI: 1.2829-2.0115, P < 0.0001), and usual walking pace (OR= 3.3676, 95% CI: 1.8769-6.0423, P < 0.0001) were associated with an increased risk of GDM. However, according to the reverse MR results, GDM had no causal effect on sarcopenia. No pleiotropy was observed.

Conclusion: In summary, sarcopenia had a significant causal influence on GDM, while GDM did not causally affect sarcopenia.

Purpose: To evaluate the association between depression and age of natural menopause in American women.

Patients and methods: This cross-sectional study utilized eight cycles of the National Health and Nutrition Examination Survey (NHANES) conducted from 2005 to 2023. We assessed depression using the Patient Health Questionnaire-9 (PHQ-9). We obtained ANM information from the Reproductive Health questionnaire. We screened menopausal women between the ages of 40 and 70 years, excluding those with surgical menopause. We used multivariable logistic regression models to investigate the association between depression and ANM. Additionally, we conducted subgroup analyses and interaction tests.

Results: A total of 4732 women were included, and the mean age of natural menopause was 47.9 ± 6.8 years. Of these, 1123 (23.7%) were classified as early menopause, 2971 (62.8%) as normal menopause, and 638 (13.5%) as late menopause. Preliminary analysis showed a positive association between PHQ-9 score and the risk of early menopause (OR = 1.11, 95% CI = 1.06-1.16). After full adjustment in multivariate logistic regression, it was estimated that each one-unit increase in the PHQ-9 score was associated with a 7% increased risk of early menopause (OR = 1.07, 95% CI = 1.02-1.12). After classifying depression into three grades: no, mild, and severe, it was found that, compared with American women without depression, the risk of early menopause increased significantly. American women with major depression had an increased risk of early menopause (OR = 2.49, 95% CI = 1.10-5.63). In College or above (OR = 1.10, 95% CI = 1.02-1.19), PIR≤1 (OR = 1.10, 95% CI = 1.04-1.16), Current smoker (OR = 1.12, 95% CI = 1.00-1.24), the positive association between depression and early menopause was more significant.

Conclusion: In this cross-sectional study, the severity of depression in American women was positively correlated with the risk of early menopause. This suggests that women should pay more attention to their mental health and actively manage depression. For women with depression, early intervention and treatment may help improve their reproductive health and delay menopause.

Purpose: A global survey conducted by The International Society of Aesthetic Plastic Surgery (ISAPS) in 2022 reported 18.8 million non-surgical cosmetic procedures, with women representing 87%. Recent literature has shined a light on the possible implication of female sex hormones on the perception of pain, but the influence of these hormones on pain perception secondary to aesthetic procedures have scarcely been studied. Our study aimed to investigate the influence of the menstrual cycle on pain perception during non-surgical aesthetic procedures. The study explored the correlation between different phases of the menstrual cycle, the presence of premenstrual symptoms, and the severity of pain experienced by participants.

Patients and methods: A questionnaire-based cross-sectional study was conducted at dermatology clinics in Saudi Arabia. 383 complete responses were collected from participants who provided data on demographic factors, aesthetic procedures, menstrual status, premenstrual symptoms, and pain severity.

Results: The 383 participants reported that the most frequent procedures were laser hair removal (82.5%) and injectables. Pain perception was highest for laser hair removal across all menstrual phases (4.5±2.66, 4.8±3.06 and 4.3±3.48), and lowest for Ultherapy (1.56±1.66, 1.40±1.36 and 1.37±1.37). Significant positive correlations were found between premenstrual symptom severity and pain perception in laser hair removal and injectables. Linear regression analysis revealed a significant negative association between age and pain perception in laser hair removal, while age had a positive association with other procedures.

Conclusion: In conclusion, pain perception during non-surgical aesthetic procedures varies across menstrual phases and is influenced by the type of procedure. The negative relationship between age and pain in laser hair removal requires further research. These findings can help practitioners better manage patient expectations and experiences during these cosmetic treatments.

Purpose: Maternal mortality in Malawi is high, with low coverage of maternity care being a contributing factor. To improve maternal health coverage, an Android-based, integrated mobile health (mHealth) app called YendaNafe was introduced to community health workers (CHWs) in the Neno district, rural Malawi. This study evaluates the impact of this app on the uptake of antenatal care (ANC), facility-based births, and postnatal care (PNC), compared to a reference period where CHWs provided the same services without mHealth, using the interrupted time series analysis.

Patients and methods: Using aggregated monthly data and segmented quasi-Poisson regression models, we compared the effects of mHealth on selected maternal health outcomes. The models were adjusted for the COVID-19 pandemic, the occurrence of cyclones, and a cholera epidemic. We analyzed data from six eligible health facilities and their respective catchment areas in which CHWs were using YendaNafe, and compared 12 months before and 12 months after its introduction.

Results: The use of YendaNafe was associated with a 22% immediate increase in facility-based births (aIRR 1.22, 95% CI 1.12-1.33, p<0.001) but not an immediate increase in new ANC visits (aIRR 1.02,95% CI 0.90-1.14, p=0.77), ANC in the first trimester (aIRR 1.17, 95% CI 0.95-1.45 p=0.13), or PNC visits (aIRR 1.03, 95% CI 0.79-1.36, p=0.81). For long-term effect, YendaNafe was associated with an increase in new ANC visits (aIRR 1.04, 95% CI 1.01-1.07, p <0.01) and ANC in the first trimester (aIRR 1.03,95% CI 1.00-1.07 p=0.046), but not facility-based births (aIRR 1.01, 95% CI 0.99-1.03, p=0.46) or PNC (aIRR 0.97 95% CI 0.93-1.01, p=0.14).

Conclusion: mHealth shows potential of increasing utilization of new ANC visits, ANC in the first trimester and facility-based births. Further research is needed to understand why mHealth did not have an effect on PNC.

Background: Dyslipidemia is linked to pregnancy complications, but its causal role remains uncertain. This two-sample Mendelian Randomization (MR) study investigated the causal relationship between lipid traits and pregnancy complications and evaluated the impact of lipid-modifying drug targets.

Methods: Genetic instruments for lipid traits and targets for lipid-modifying drugs were obtained from the Global Lipids Genetics Consortium. Three pregnancy complications' summary statistics came from the FinnGen R9 database. Significant drug targets underwent further analysis using Expression Quantitative Trait Loci data, and mediation analysis identified potential mediators.

Results: Increased high-density lipoprotein cholesterol (HDL-C) reduced the incidence of preeclampsia (OR: 0.755, 95% CI: 0.639-0.891, p=0.001, FDR=0.012) and gestational diabetes mellitus (GDM) (OR: 0.835, 95% CI: 0.741-0.942, p=0.003, FDR=0.018). Genetic proxies for cholesteryl ester transfer protein (CETP) inhibition correlated with a decreased risk of preeclampsia (OR: 0.863, 95% CI: 0.786-0.947, p=0.002, FDR=0.027), while genetic inhibition of HMG-CoA reductase (HMGCR) increased preeclampsia risk (OR: 1.700, 95% CI: 1.189-2.431, p=0.004, FDR=0.036). Genetically mimicking the enhancement of lipoprotein lipase (LPL) related to a reduced risk of GDM (OR: 0.681, 95% CI: 0.560-0.829, p=1.29×10^-4, FDR=0.004). Higher LPL expression in subcutaneous adipose tissue also reduced GDM risk (OR: 0.642, 95% CI: 0.454-0.909, p=0.013). Waist circumference (4.2%) and waist-to-hip ratio adjusted by BMI (5.7%) partially mediated LPL's effect on GDM risk.

Conclusion: Elevated HDL-C levels help prevent preeclampsia and GDM. CETP and LPL could be therapeutic targets for preeclampsia and GDM, respectively. However, caution is advised with HMGCR-targeting drugs, as they may increase the preeclampsia risk.

Objective: To understand whether human papillomavirus (HPV) and cytological testing (TCT [ie, "thinprep" cytological testing]) results can provide more information beyond visual information for vaginal colposcopy examinations to upgrade or downgrade the visual diagnosis of vaginal colposcopy.

Patients and methods: Data from 519 patients, who underwent vaginal colposcopy at the Beijing Obstetrics and Gynecology Hospital (Beijing, China) between January and June 2020, were included. Preoperative HPV and TCT results were statistically analyzed, and were divided into 3 groups according to postoperative cervical tissue pathological diagnosis: negative; low-grade squamous intraepithelial (LSIL); and high-grade squamous intraepithelial lesion (HSIL). Positive and negative predictive values for cervical inflammation, LSIL, and HSIL in patients diagnosed using vaginal colposcopy, based on cervical pathological grouping, and differences in HPV and TCT results among patients who underwent vaginal colposcopy, were analyzed.

Results: The age of patients diagnosed with cervicitis, LSIL, and HSIL using colposcopy gradually decreased, and the proportion of HPV16/18 infection in the HSIL group was significantly higher than the other 2 groups. There were significant differences in TCT results among the groups. According to pathological results from cervical tissue specimens, among all groups diagnosed using colposcopy, the age of the HSIL group was significantly younger than that of the other groups, and the proportion of patients with a TCT greater than LSIL was significantly higher than that of the other groups.

Conclusion: HPV did not provide additional information for vaginal colposcopy. Young(er) patients and those with a TCT greater than LSIL may consider upgrading the vaginal colposcopy diagnosis based on imaging information.

Purposes: To investigate the effects of a self-management-cluster-based pregnancy care model (SMB-CPCM) on the psychological status and delivery outcomes of pregnant women with gestational diabetes mellitus (GDM).

Patients and methods: A total of 120 pregnant women with GDM who had been filed and had regular obstetric examinations in a tertiary-level hospital in Bengbu City between 1 April 2023 and 1 April 2024 were included in the study using the convenience sampling method. Sixty women each were grouped into a study group and a control group using the randomised numeric table method. The study group implemented the SMB-CPCM and the control group used the conventional pregnancy healthcare model. We compared the differences in self-management ability, blood glucose concentration, delivery outcome, and psychological status.

Results: Self-management ability scores were higher in both groups following the intervention than before the intervention (P<0.001), and the increase was more notable in the study group (t=9.237, P<0.001). Anxiety scale (63.31±4.73, 48.29±4.20) and depression self-assessment scale scores(60.70±3.49, 41.69±4.76) in the study group were lower after the intervention than before the intervention(t=13.322, 18.115, P<0.001). Following the intervention, fasting blood glucose(5.39±0.42, 4.92±0.45) and postprandial 2-h blood glucose(6.70±0.71, 5.92±0.64) exhibited a reduction compared to the pre-intervention period (P<0.001). Furthermore, this decline was more pronounced in the study group (t=4.267, 4.584, P<0.001). The study group demonstrated an elevated spontaneous delivery rate compared to the control group (χ² =5.168, P<0.05). Additionally, the rates of gestational hypertension (χ² =4.941), pre-term labour (χ² =3.890), and macrosomia (χ² =4.050) were reduced in the study group when compared to the control group (P<0.05).

Conclusion: SMB-CPCM can effectively control the blood glucose levels of pregnant women with GDM and improve their self-management ability, psychological status, and delivery outcomes. SMB-CPCM shows a good prospect in the management of gestational diabetes and is worth promoting. Future research can explore the impact of SMB-CPCM on long-term health outcomes of pregnant women with diabetes, so as to comprehensively evaluate its clinical value.

Background: COX20-related mitochondrial complex IV deficiency is a rare autosomal recessive metabolic disorder that arises from biallelic loss-of-function mutations. Given the lack of specific treatments, affected children are at a heightened risk of disability. Consequently, prenatal counseling and prenatal diagnosis should be conducted to reduce the birth rate of children with such mitochondrial diseases. We report a case of COX20 gene associated mitochondrial complex IV deficiency in a child, and describe the prenatal counseling and prenatal diagnosis of the mother in subsequent pregnancies to provide reference for prenatal counseling and prenatal diagnosis of this disease.

Case presentation: In this study, we presented a case of a pediatric patient who displayed symptoms such as gait instability, ataxia, cognitive impairment, dysarthria, muscle weakness, and absent reflexes. Through the application of whole-exome sequencing (WES), compound heterozygous COX20 mutations (c.41A>G and c.259C>T) were detected, leading to the confirmation of a diagnosis of mitochondrial complex IV deficiency. A thorough review of the existing literature revealed seven additional cases carrying the same mutations. Moreover, this report delineated the process of prenatal counseling and diagnostic testing that was undertaken for the subsequent pregnancy of the patient's mother.

Conclusion: The presence of ataxia, cognitive impairment, and peripheral neuropathy in children should prompt consideration of COX20-related mitochondrial disease. Utilizing WES is beneficial for identifying COX20 mutations, and offering prenatal counseling and diagnostic testing to mothers of affected children can reduce the birth rate of children with such mitochondrial diseases.