Journal of Pregnancy最新文献

Background: Pregnancy complications are known to be risk factors for the onset of depression and anxiety symptoms. This study assessed associations between pregnancy complications, including concurrent complications, and symptoms of anxiety and depression among pregnant women living in France.

Methods: A cross-sectional study was carried out among 492 pregnant women. Sociodemographic and obstetric characteristics were collected using an online questionnaire. Depression and anxiety symptoms were evaluated using the Edinburgh Postnatal Depression Scale and the Spielberger State-Trait Anxiety Inventory, respectively. Multivariate logistic regressions were employed to identify associations between mental health outcomes and pregnancy complications.

Results: While 37% of women declared no pregnancy complications, 9.76% declared two or more complications, and 63% of participants had at least one complication. Among these latter, 68.9% had a high risk of depression, 83.9% elevated state anxiety, and 77.4% elevated trait anxiety. State anxiety scores were significantly higher in women who felt they did not receive adequate social support from their partner, family, and friends and who reported dissatisfaction with medical care. Adjusting for confounders, we identified that women with complications had higher odds of experiencing higher state anxiety scores (adjusted OR: 2.94; 95% CI: 1.40-6.10). Positive associations were also observed between gestational diabetes mellitus and increased likelihood of reporting depressive symptoms (adjusted OR: 1.99; CI:1. 20-3.29) and high state anxiety scores (OR: 3.31; CI: 1.22-9.01).

Conclusion: We found a high prevalence of depression and anxiety among pregnant women with complications. Gestational diabetes mellitus was positively associated with antenatal depression and high state anxiety levels. These findings suggest that women with complications have a higher risk of developing depressive and anxious symptoms. Screening for and treating physical and mental health problems in women experiencing pregnancy complications and poor mental health symptoms are crucial to safeguard the well-being of the mother and the fetus.

Background: Cervical insufficiency is one of the main risk factors for preterm birth. It has been suggested that a more diverse vaginal microbial colonization might lead to cervical insufficiency and subsequently further increase the risk for preterm birth. To date, the microbial colonization in women with cervical insufficiency has not been sufficiently categorized. Therefore, this study is aimed at describing the vaginal microbial colonization in this high-risk collective and exploring a possible association with preterm birth.

Methods and study design: All women treated for cervical insufficiency from June 2021 until March 2024 at the Division for Obstetrics and Feto-Maternal Medicine of the Medical University of Vienna were evaluated for inclusion. Vaginal bacterial/fungal culture results during pregnancy were used for the characterization of the vaginal microbial colonization and categorized in 17 predefined microbial groups.

Results: We included 118 women with cervical insufficiency with available vaginal culture results, of whom 58.5% experienced preterm birth. Lactobacillus spp., coagulase-negative staphylococci, Enterococcus spp. and Ureaplasma spp. were the most frequently detected microorganisms. Further, we conducted a secondary exploratory analysis of the association of each individual microbial group with preterm birth, which found an absence of lactobacilli (p = 0.047) and the presence of a more diverse microbial composition with Gram-negative anaerobes, Ureaplasma spp. and Enterococcus spp. to be more frequent in PTB.

Conclusion: Cervical insufficiency is associated with a diverse vaginal microbial colonization. Especially colonization with coagulase-negative staphylococci, Ureaplasma spp., and Enterococcus spp. seems to play an important role in cervical insufficiency. Lactobacillus spp. absence was associated with subsequent preterm birth.

Introduction: This randomized controlled pilot trial evaluated a behavioral physical activity (PA) intervention for individuals with pregnancy hyperglycemia and explored the feasibility of a fully powered efficacy trial.

Materials and methods: The pilot trial sought to enroll and randomize participants to a 5-week-long behavioral PA intervention that promoted walking or stepping (i.e., in place or around a small area) versus a general wellness intervention (that provided no information on PA, diet, or metabolism), both delivered remotely via weekly, 10-20-min-long counseling sessions with a lifestyle coach. Participants (N = 20) completed surveys, including the Pregnancy Physical Activity Questionnaire, and wore ActiGraph CentrePoint watches for 7 days at baseline and at follow-up. Nineteen participants (95%) completed follow-up study visits. A subset (85%) had neonatal anthropometric measurements due to pandemic-related restrictions.

Results: One hundred and twenty individuals were screened, with 54% (n = 65) meeting eligibility criteria and receiving physician approval to contact; 26% of the eligible enrolled, were randomized, and completed a baseline visit. Ninety percent of those randomized to the PA intervention (n = 9) completed it, rating the PA intervention as excellent (56%) or very good (44%). The PA intervention mitigated late pregnancy declines in self-reported walking and running activity (follow-up minus baseline: 0.22 MET h/week [95% CI -0.41, 0.84] in the PA intervention vs. -0.70 [-1.31, -0.10] in controls), and there was the suggestion of improvements in neonatal birthweight for gestational age Z-score and subscapular skinfold.

Conclusion: Findings suggest that the behavioral PA intervention promoting unsupervised, moderate-intensity walking or stepping, which could easily be delivered in conjunction with clinical medical nutrition therapy, was acceptable. The intervention may mitigate late pregnancy declines in moderate-intensity PA and remains to be investigated in a full-scale randomized controlled efficacy trial.

Trial registration: ClinicalTrials.gov identifier: NCT06125704.

Background: This study explored the associations between positive cell-free DNA (cfDNA) screening results and the decisions made by pregnant women regarding invasive diagnosis and continuation of pregnancy.

Methods: We collected follow-up invasive diagnosis results, pregnancy decisions, and related clinical information for 767 singleton pregnancies with positive cfDNA screening results for common trisomies and genome-wide copy number variants (CNVs) from a cohort of 113,654 singleton pregnancies.

Results: A total of 547 (0.48%) cases of high-chance common trisomies and 220 (0.19%) cases of high-chance CNVs (≥ 3 Mb) were identified through cfDNA screening. The acceptance rate for invasive prenatal diagnosis (IPD) was 89.8% (474/520) in high-chance common trisomies and 75.9% (151/195) in those with high-chance CNVs. The positive predicted value of cfDNA screening was 65.4% for common trisomies (310/474) and 29.1% for CNVs (44/151) in this study. After IPD through SNP array-based chromosomal microarray analysis (CMA), 15.2% (23/151) of high-chance CNVs were classified as pathogenic. Eighty-three percent of pathogenicity (23/24) was observed in concordant high-chance CNVs driven by fetal signals only; 97.1% of parents chose to terminate their pregnancies with confirmed fetal common trisomies, and 95.7% of parents chose to terminate their pregnancies with confirmed pathogenic CNVs.

Conclusions: Currently, the vast majority of cases with positive prenatal cfDNA screening findings underwent IPD. While the technical PPVs were satisfactory, the parental pregnancy choices were largely dependent on the confirmation results. Our findings further demonstrate the clinical utility of prenatal cfDNA screening for CNVs.

Objective: The objective of the study is to compare hepcidin-25 levels between normal pregnant women and those with thalassemia minor.

Methods: This prospective cohort study involved pregnant women with either normal pregnancies or thalassemia minor. Hepcidin-25 levels and iron study panels were measured at three time points: in the first trimester before the start of iron supplementation (gestational age [GA] < 14 weeks), in the third trimester (GA 28-32 weeks), and after GA 36 weeks.

Results: The study included 125 pregnant women, comprising 93 with normal pregnancies and 32 with thalassemia minor. The hepcidin levels in the thalassemia minor group at GA 28-32 weeks and after GA 36 weeks were significantly lower than those in the normal pregnancy group (p values < 0.01 and 0.01, respectively). The study group exhibited mild anemia and lower Hb levels throughout pregnancy compared with the control group.

Conclusion: Hepcidin-25 levels are significantly lower in pregnant women with thalassemia minor, but other iron profiles in these women are comparable to those in normal pregnancies, with no evidence of iron overload. Pregnancy with thalassemia minor is associated with mild anemia that cannot be fully corrected by iron supplementation. However, iron supplementation does not lead to iron overload and should be prescribed as part of standard antenatal care.

Background: Whether the timing of birth affects fetal or maternal outcomes is still controversial. Compared with multiparae, primiparae are a special obstetric group that are more likely to develop labor abnormalities that require intervention. The aim of this study was to investigate the time of delivery and perinatal morbidity with a focus on uncomplicated but first-time pregnancies.

Methods: This retrospective study analyzed all births of uncomplicated first-time mothers who intended vaginal delivery. The delivery times were clustered into 2-h intervals and by day of the week. A 5-min Apgar score ≤ 7, an umbilical artery pH value < 7.10, and BE > - 12 were defined as surrogate markers for perinatal morbidity. Other markers examined included the occurrence of a pathological cardiotocogram, the performance of fetal blood analysis via scalp sampling, admission to the neonatal intensive care unit (NICU), the mode of delivery, or the occurrence of labor arrest.

Results: A total of 586 women who intended vaginal delivery were analyzed. The distribution of timepoints of birth divided into 2-h intervals corresponded to a normal distribution (p = 0.97). The probability of having an arterial umbilical pH value < 7.1 was highest on Friday between 2:00 and 4:00 PM (p = 0.035). A base excess below - 12 was most frequent on Sunday between 4:00 and 6:00 AM (p = 0.027). Fetal blood analysis via scalp sampling was performed less frequently than expected on the weekend (Saturday p = 0.031; Sunday p = 0.046), whereas the distribution of mode of delivery did not differ across the investigated periods.

Conclusions: We detected timepoints when laboratory signs of increased fetal distress were more frequent; although there was no difference in peripartal monitoring, the decision to perform a scalp blood gas analysis or the mode of delivery changed during these periods. On weekends, fetal blood analysis via scalp sampling was carried out less frequently than expected. An increased rate of severe asphyxia or a worse 5-min APGAR was not observed in the neonates at any timepoint. Primiparae should not be underestimated as a supposedly uncomplicated group, as they can present a particular obstetric challenge.

Background: Poor knowledge of danger signs during pregnancy can have serious consequences on the health of both the mother and the baby. In addition to this inability to recognize signs of obstetric complications, it serves as a barrier to making a decision to access healthcare and therefore is one of the factors responsible for the first level of delay that contributes to maternal mortality. Previous studies conducted in the country were focused on assessing maternal knowledge about obstetric danger signs during pregnancy. However, there is a scarcity of information or little is known about the current knowledge of the husbands about obstetric danger signs during pregnancy and influencing factors regarding the obstetric danger signs during pregnancy in Ethiopia, particularly in Chencha town, southern regional state.

Methods: A community-based cross-sectional study was conducted among 422 husbands living in selected kebeles in Chencha town from September 1 to 30, 2022. A random sampling technique was used to select kebeles in Chencha town, southern region. Data were collected using a structured and pretested questionnaire. Collected data were analyzed using the statistical package for social science (SPSS) Version 25. Results were presented in the form of percentage, frequency tables, and pie charts. Binary logistic regression was performed to check for an association between independent and outcome variables at p < 0.05 and a 95% confidence interval (CI). Then, the variables with p value < 0.25 were entered into multivariate logistic regression to identify statistically significant variables. Before adjusting in the multivariable analysis, the candidate variables for the multivariable analysis were checked for multicollinearity using the variance inflation factor, which ranged from 1.1 to 1.87. The Hosmer-Lemeshow test was used to assess the model's fitness (0.124).

Results: The study found that 45.5% (95% CI: 41%-50%) of husbands are aware of the danger sign during pregnancy. Factors such as the wife's secondary educational level (AOR = 4.700, 95% CI: 2.330-9.478), more than secondary educational level (AOR = 3.132, 95% CI: 1.549-6.364), previous obstetric complications (AOR = 1.796, 95% CI: 1.145-2.817), access to media information (AOR = 1.881, 95% CI: 1.117-3.166), and follow-up of antenatal care (AOR = 1.839, 95% CI: 1.175-2.880) were statistically significantly associated with married men's knowledge of obstetric danger signs during pregnancy.

Conclusions: This study indicated that the current knowledge of husbands about the danger sign during pregnancy was low. Therefore, strengthening the provision of information on danger signs during pregnancy in ANC and information on behavioral communication of husbands regarding partner support is recommended.

Background: African refugee communities in Uganda encounter significant barriers to maternal health services, particularly regarding men's involvement in maternal health. This study explored the perspectives of African refugees and stakeholders on men's engagement in couple's maternal health decisions, utilizing an interdependence-based theoretical model as a framework.

Methods: This qualitative study, conducted in Uganda's Nakivale refugee settlement, included 14 in-depth interviews with healthcare providers, community leaders, and religious leaders, along with eight focus group discussions (n = 78) with refugee men and women. Participants were purposefully recruited to represent diverse experiences. Data were analyzed through deductive analysis to identify factors influencing men's engagement and couple's behaviors in maternal health, emphasizing predisposing factors that affect motivation and communal coping.

Results: Key individual-level factors influencing engagement included men's financial status, mental health, and peer/community influence. At the couple level, closeness, trust, commitment, communication, and joint household decision-making were crucial for fostering male participation. Couples with a high transformation of motivation viewed maternal health as a shared concern rather than an individual one. Those practicing effective communal coping, discussing and jointly deciding to address maternal health issues, also expressed higher engagement in health-promoting behaviors, such as saving for birth, attending antenatal visits together, utilizing family planning, and sharing household chores.

Conclusions: Maternal health should be reframed as a shared responsibility between partners, not solely women's issue. To effectively engage African refugee couples and improve outcomes, interventions must prioritize men's involvement alongside women-focused efforts, eventually addressing couples together. These initiatives should enhance men's financial literacy, mental health, knowledge, and relationship quality to foster equitable discussions, decisions, and behaviors between refugee couples.

Introduction: Hyperemesis gravidarum (HG), which is characterized by severe nausea and vomiting, can lead to maternal complications and adverse fetal outcomes. The neutrophil-to-lymphocyte ratio (NLR) is a potentially simple and cost-effective marker for detecting this condition. The aim of this study was to consolidate the current evidence regarding the utility of NLR in diagnosing and assessing the severity of HG.

Methods: A systematic search of Scopus, PubMed, Web of Science, Embase, and Google Scholar was conducted before March 2024. The selected articles were reviewed. Analytical cross-sectional studies reporting NLR values in patients with HG were included. Two independent authors reviewed the articles and assessed them for bias. A meta-analysis with random effects was conducted to compare NLR values between HG and healthy patients and to evaluate its association with the severity of symptoms assessed through the modified Pregnancy-Unique Quantification of Emesis, such as ketonuria and C-reactive protein levels. The GRADE system determined the certainty of the evidence.

Results: Fifteen studies were included, predominantly case-control. Pooled analysis revealed a significant elevation in NLR among patients with HG compared with healthy pregnant women (MD: 1.76; 95% CI: 1.15-2.37; I ² = 98%). NLR levels were elevated in moderate (MD: 1.15; 95% CI: 0.08-2.22; I ² = 91%) and severe cases (MD: 1.25; 95% CI: 0.40-2.11; I ² = 84%) compared with mild presentations. Evidence ranged from moderate to low.

Discussion: With low certainty, the mean NLR was higher in patients with HG than in healthy pregnant women, with moderate certainty regarding severity. These findings suggest the potential utility of NLR; however, further research on neonatal and long-term outcomes is needed.

Precis: These results indicate that NLR could be useful, but additional studies are necessary to understand its impact on neonatal and long-term outcomes.

Background: The primary objective is to identify the correlation between placental weight and neonatal blood glucose levels among pregnancies with gestational diabetes mellitus (GDM). The secondary objectives are to identify the relationships between prepregnancy maternal weight and BMI and placental weight, birth weight and the placental weight-to-birth weight ratio, birth weight and neonatal blood glucose levels, and birth weight and placental weight. Methods: A retrospective cross-sectional study was conducted on GDM patients. The inclusion criteria were a singleton pregnancy, maternal age of 18-40 years, and delivery at term. The obstetric database was accessed to retrieve the consecutive records of GDM for a comprehensive review of the medical records. Maternal and neonatal outcomes, such as placental weight and neonatal blood glucose levels, were collected. Results: A total of 3503 cases were reviewed, and 737 met the inclusion criteria. Placental weight was significantly correlated with prepregnancy maternal weight or BMI, maternal BMI at delivery, and birth weight. The placental weight-to-birth weight ratio was also significantly correlated with prepregnancy maternal weight and birth weight. Placental weight was not significantly correlated with neonatal blood glucose levels, whereas increased birth weight was inversely correlated with neonatal blood glucose levels within 1 h after birth. Conclusions: In women with GDM, placental weight is not significantly correlated with neonatal blood glucose levels, while birth weight is. Birth weight is directly correlated with placental weight. Additionally, prepregnancy maternal weight and BMI are associated with placental weight and the placental weight-to-birth weight ratio.