Journal of Pregnancy最新文献

Background: Ectopic pregnancy remains a significant cause of maternal morbidity and mortality worldwide, particularly in low-resource settings. The aim of this study was to investigate the prevalence, clinical profile, and management outcomes of ectopic pregnancies at Ayder Comprehensive Specialized Hospital (ACSH) in Ethiopia between January 1, 2017 and December 31, 2021.

Methods: A cross-sectional study of 152 women diagnosed with ectopic pregnancy and admitted to ACSH between 2017 and 2021 was conducted. Data, including sociodemographic characteristics, obstetric history, clinical presentation, diagnostic methods, intraoperative findings, and management outcomes, were collected retrospectively from medical records. The prevalence of ectopic pregnancy was calculated based on the total number of deliveries during the study period. Descriptive statistics were used to summarize the data.

Results: Of 23,090 deliveries in the ACSH between 2017 and 2021, 152 cases of ectopic pregnancy were registered, corresponding to a prevalence of 6.58 per 1000 deliveries. The average age of the women was 28 years (SD ± 0.5), with the majority (55.5%) between 25 and 34 years old. Most patients (78.3%) lived in rural areas. Multigravida women accounted for 58.6% of cases. There was a history of abortion in 28.3% of women and a history of previous ectopic pregnancy in 6.6%. The most common clinical findings were tender abdomen (84%), adnexal motion tenderness (53%), and cervical motion tenderness (45%). Hemoglobin levels below 11 mg/dL were observed in 41% of cases. The majority of ectopic pregnancies were diagnosed using both clinical assessment and ultrasound (88.8%). Surgical management was the primary treatment modality (92.1%), with salpingectomy performed in 92.8% of cases. Blood transfusions were required in 29.6% of patients. The median length of hospitalization was 3 days (IQR = 2).

Conclusions: With a prevalence of 6.58 per 1000 deliveries, ectopic pregnancy remains a major health problem in ACSH. Most patients presented with acute symptoms requiring surgical intervention. Early detection and improved access to reproductive health services could reduce the morbidity of ectopic pregnancy in the region.

Pregnancy is one of the primary sources of stress, and unplanned pregnancy is a crisis in women's lives. In this study, we sought to determine the effect of crisis counseling on women's anxiety with an unplanned pregnancy. This semi-experimental study was conducted using the convenience sampling method. Sixty married pregnant women aged 15-49 years with unplanned pregnancies were randomly assigned to the two groups of intervention and control (n = 30 per group), of whom five were excluded from the intervention group, and three were excluded from the control group. The data collection tools included a medical-mental health checklist, the 28-item General Health Questionnaire-28 (GHQ-28), Winfield and Taigman's Social Support Scale, and Spielberg's State-Trait Anxiety Inventory (STAI). Three individual counseling sessions were held according to Roberts' seven-stage model. The participants' state and trait anxiety scores were assessed before and one month after the counseling sessions. There was no significant difference between the two groups regarding demographic characteristics, general health score, level of social support, and the mean score of general anxiety (p > 0.05). The mean scores of state anxiety before and after the intervention in the interventional group were 45.92 ± 6.8 and 42.8 ± 4.14, respectively, and the mean of trait anxiety scores were 46.84 ± 6.82 and 44.48 ± 5.46, respectively. In the control group, the mean of state anxiety scores before and after the intervention were 46.78 ± 6.09 and 46.63 ± 7.1, respectively, and the mean of trait anxiety scores were 46.41 ± 4.54 and 46.89 ± 5.09, respectively. Crisis counseling significantly impacted both state (p = 0.004) and trait (p = 0.047) anxiety. Crisis counseling reduces trait and state anxiety in women with an unplanned pregnancy. Therefore, establishing high-risk pregnancy clinics and employing midwifery consultants to assess and reduce anxiety levels in women with unplanned pregnancies will be beneficial.

Trial registration: Iranian Registry of Clinical Trials:IRCT2017100231117N5.

Background: Malaria and preeclampsia are major pregnancy-related complications that share overlapping complement and inflammation-mediated pathways. Although adipsin has been proposed as a diagnostic biomarker for preeclampsia, its diagnostic performance in the context of concurrent malaria infection remains poorly understood. This study investigated the impact of malaria infection on plasma adipsin levels and evaluated its diagnostic performance for preeclampsia.

Methods: This case-control study included 200 pregnant women between 20 and 42 weeks of gestation, stratified into four groups: normotensive without malaria, normotensive with malaria, preeclamptic with malaria, and preeclamptic without malaria (n = 50 per group). Plasma adipsin, C3a, C5a, TNF-α, IL-6, IL-8 and IFN-γ were measured using commercial ELISA kits. Malaria infection was confirmed with Giemsa-stained blood smears. Data were analysed using Statistical Package for the Social Sciences (SPSS) Version 27.0.

Results: Amongst the participants enrolled, malaria infection was present in 50% and preeclampsia in 50% of the sample. Plasma adipsin levels were significantly elevated in malaria-infected and preeclamptic participants (p < 0.001), with the highest concentrations observed in participants with coexisting preeclampsia and malaria infection. Plasma adipsin showed strong positive correlations with C5a (ρ = 0.695), IL-6 (ρ = 0.687), and TNF-α (ρ = 0.645), and moderate correlations with malaria parasite density (ρ = 0.553), IL-8 (ρ = 0.475) and C3a (ρ = 0.437) (p < 0.001 for all). Multivariable regression showed that preeclampsia and malaria independently elevated plasma adipsin levels, with a significant negative interaction between the two conditions (p < 0.001). ROC analysis showed reduced diagnostic specificity for preeclampsia in malaria-infected participants (62.1%, AUC = 0.719, p = 0.02) compared with malaria-negative participants (87.9%, AUC = 0.823, p < 0.001).

Conclusion: Plasmodium falciparum infection significantly alters plasma adipsin levels, reducing its diagnostic specificity for preeclampsia. Malaria-adjusted reference thresholds may be necessary when considering adipsin as a biomarker in endemic regions.

Objectives: Asprosin is a newly discovered adipokine associated with insulin resistance and diabetes mellitus. Currently, its role during gestation is under investigation, as asprosin seems to increase during pregnancy, contributing to the onset of complications, like gestational diabetes. Considering the beneficial effects of myo-inositol to support the physiological pregnancy, recovering and preventing adverse maternal and fetal outcomes, we aimed to evaluate the effects of its supplementation on serum asprosin levels in pregnant women.

Design: We enrolled 40 patients at the early stages of pregnancy and randomly distributed them to a study group, which received 2-g myo-inositol and 200-μg folic acid twice a day, or to a control group, which received the sole folic acid.

Results: After 20-22 weeks of treatment, we recorded a decrease of serum asprosin values as well as of HOMA-IR index in the group supplemented with myo-inositol, while the group that took only folic acid showed an increase in asprosin levels and no worsening of insulin resistance indices (HOMA-IR index).

Limitations: The small number of patients could be a limitation of the study.

Conclusions: Asprosin may be modulated by myo-inositol. This opens the possibility of considering this adipokine as a useful marker of insulin resistance to assess in pregnant women and to efficaciously target in clinical practice. Trial Registration: ClinicalTrials.gov identifier: NCT05943158.

Background: The birthing process presents women with both physical and emotional challenges. In recent years, there has been a notable global rise in cesarean section (CS) rates-particularly elective CS-including in Jordan. Numerous personal, cultural, and healthcare system-related factors contribute to women's increasing preference for CS over vaginal delivery. This study explores the factors influencing Jordanian women's knowledge, beliefs, and preferences regarding mode of delivery and their involvement in related decision-making.

Methods: A cross-sectional study was conducted among Jordanian women in their second or third trimester of pregnancy, who were either primiparous or para-one. A structured self-administered questionnaire was used to collect data from a sample of 378 participants, encompassing demographic details, knowledge, preferences, beliefs, and decision-making related to delivery mode.

Results: Most participants (57.2%) were between 25 and 34 years of age, and 63.0% were in their third trimester. Doctors (81.5%) and nurses (39.6%) were the most frequently cited sources of information about maternal health. The average knowledge score was 71.4%, with higher knowledge levels observed among women receiving prenatal care at university-affiliated or private facilities. Preference leaned more strongly toward vaginal delivery over CS. Belief scores averaged 73.3%, though several misconceptions persisted. Decision-making scores were moderate, with higher involvement observed among women with better knowledge and more positive preferences toward vaginal delivery. Regional disparities were evident, with women in the southern region demonstrating greater decision-making participation than those in central areas.

Implications: The findings underscore the importance of enhancing prenatal education and healthcare counseling tailored to women's regional and educational contexts. Increasing awareness of the benefits and risks associated with both CS and vaginal birth can support informed, autonomous decisions and improve maternal care outcomes across Jordan.

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.