Journal of Pregnancy最新文献

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.

Background: Amniocentesis (AC) remains the most commonly performed prenatal invasive diagnostic test. The data available till now have been collected before the era of high-end ultrasound machines, NIPS, and chromosomal microarrays. In selected cases, whole-exome sequencing is also offered prenatally. The evolution of ultrasound, NIPS, and genetic testing has made us revisit this topic. Objective: We aimed to research and revisit AC data regarding the indications, procedures, genetic testing methods, and outcomes. We reinforce the knowledge of AC, offer tips to minimize complications, and help communicate and counsel patients based on the AC data. Methods: It was a retrospective study from October 2019 to March 2023 in a tertiary care fetal medicine center in a university hospital. A total of 321 patients who underwent AC were analyzed. We observed the demographic details, indications, procedure details, and maternal-fetal and neonatal outcomes. Results: During the study period, 321 patients underwent AC. Abnormal ultrasound findings (71%) were the most common indication for AC. Then, 9% (30/321) had abnormal genetic results. Down syndrome was the most common abnormality (14), followed by Edwards syndrome. Then, 47.96% of cases were in age > 35 years. We had three cases of bloody tap, one leak per vagina, and two missed abortions following AC. Then, 58% had live births. Conclusion: AC is a relatively safe procedure, and even with the advent of NIPS, it remains the gold standard prenatal diagnostic genetic testing method. Major structural anomalies and parental chromosomal anomalies are irreplaceable indications of AC. The technique and expertise of health professionals dictate the complication rate of that center. Chromosomal microarray, DNA storage, and whole-exome sequencing have added an extended armamentarium to our discovery of genetic diseases. Maternal and neonatal outcomes after AC are favorable, so do not hesitate to carry out this invasive test when indicated.

Objective: This study is aimed at evaluating maternal birth weight, recorded in Japan's Maternal and Child Health Handbooks, as a predictor for large for gestational age (LGA) neonates compared to traditional pregnancy factors. Methods: In this retrospective study, we analyzed maternal and neonatal data from 374 singleton, full-term pregnancies at Keiju General Hospital (2017-2020). Maternal birth weight was obtained from Japan's Maternal Child Health Handbooks, and fasting plasma glucose was measured during the 75-g oral glucose tolerance test (OGTT). Logistic regression models assessed the predictive contributions of maternal birth weight and fasting plasma glucose, adjusted for maternal and pregnancy factors. Results: Among 374 patients, 9.8% of neonates were classified as LGA. This group had a higher proportion of a family history of diabetes (p = 0.04) and greater maternal height (p = 0.01), pre-pregnancy weight (p = 0.004), weight before delivery (p = 0.03), and maternal birth weight (p = 0.001) than the non-LGA group. Multivariate analysis showed that maternal birth weight remained a significant predictor of neonatal birth weight after adjusting for other risk factors (odds ratios: 2.92 for maternal birth weight between 3500 and 3999 g and 4.77 for birth weight ≥ 4000 g). Conclusion: This study suggests the potential of incorporating maternal birth weight to improve LGA risk prediction. These findings provide foundational data for further research into the integration of maternal birth weight in risk assessment models and its potential clinical applications.

Background: Preinduction cervical ripening in previous caesarean pregnancy is limited to intracervical Foley catheter. This study is aimed at finding the vaginal birth rates, improvement of Bishop score, and safety of osmotic dilator (Dilapan-S) among women with previous caesarean pregnancy. Methods: We conducted this single-group clinical study after the approval of the institute ethics committee, clinical trial registration, and obtaining informed consent. We recruited women above 18 years with a prior caesarean section at term and a Bishop score of less than 6 by systematic random sampling prospectively. The first or second author inserted two to a maximum of five osmotic dilators (Dilapan-S) in the cervical canal. After 24 h, we removed Dilapan and induced labour with a low-dose oxytocin regimen up to a maximum dose of 24 mIU/min. We assessed the improvement of the Bishop score and vaginal birth rates for efficacy and safety concerns like bleeding, fragmentation, displacement, infections, and scar dehiscence. Results: Eighty-two women completed the study. The Bishop score significantly improved from a mean of 2.6 before to 5.3 after Dilapan. Three opted for a caesarean section after Dilapan removal and refused oxytocin infusion. Seventy-nine women completed the trial of labour. Forty-one (52%) achieved active labour (52%). Twenty-seven delivered vaginally, and 52 required emergency caesarean section (34% vaginal birth rate; 18 spontaneous, nine instrumental, four with forceps, and five with vacuum). None had entrapment, fragmentation, or upward displacement of Dilapan. Two women had scar dehiscence, and one had a traumatic postpartum haemorrhage. There was no maternal or perinatal mortality. Conclusions: We conclude that the hygroscopic dilator Dilapan effectively ripens the cervix before labour induction in women with a previous caesarean scar. They are safe, but more extensive studies are needed to evaluate scar-related complications during labour. Trial Registration: Clinical Trial Registry of India: CTRI/2019/03/017927.

Background: Many pregnant women are reluctant to follow the recommendation concerning oral iron prophylaxis due to concerns about gastrointestinal (GI) side effects. Objective: To assess the frequency of GI complaints during low-dose oral iron prophylaxis and compare three iron formulas in equipotent doses: ferrous fumarate versus ferrous bisglycinate versus ferrous sulphate, in healthy women with an uncomplicated single pregnancy. Methods: Results from two randomized, double-blind studies are reported: the Gentofte study comprising 404 women allocated into four groups taking 20, 40, 60, and 80 mg of elemental iron as ferrous fumarate/day and the Naestved study comprising 78 women allocated into two groups: 25 mg of elemental iron as ferrous bisglycinate/day and 50 mg of elemental iron as ferrous sulphate/day between meals from 15 to 19 weeks of gestation to delivery. GI complaints (nausea, vomiting, epigastric pain/pyrosis, belching, meteorism, borborygmi, intestinal colic, flatulence, loose stools, constipation, and use of laxatives), as well as black stools, were recorded by interview at the time of inclusion and at regular intervals during gestation. Results: At inclusion, the frequency of total combined GI complaints in all women (n = 482) was 21%. The Gentofte study showed that in the groups taking 20-60 mg iron/day as fumarate, there was no association between the iron dose and the frequency of GI side effects. An iron dose of 80 mg as fumarate was associated with significantly higher frequencies of constipation and the use of laxatives. Comparing the three equipotent doses of iron formulas, which can prevent iron deficiency, ferrous bisglycinate 25 mg iron had the most favourable GI side effect profile, while ferrous fumarate 40 mg iron and ferrous sulphate 50 mg iron had higher but similar GI side effect profiles. The frequency of black stools increased with the iron dose. Ferrous bisglycinate 25 mg iron had a lower frequency of black stools (8%) than ferrous fumarate 40 mg iron (22%) and ferrous sulphate 50 mg iron (31%). Conclusion: Low-dose iron supplementation appears to have no clinically significant GI side effects, as none of the included women presented with GI complaints of such severity that it necessitated either reduction of iron dose, change to an alternative iron formula, or discontinuation of iron supplement. However, ferrous bisglycinate 25 mg iron/day is associated with significantly fewer GI complaints than ferrous fumarate 40 mg iron/day and ferrous sulphate 50 mg iron/day. Ferrous bisglycinate may be preferred for iron prophylaxis, especially in women experiencing GI side effects when taking other conventional iron formulas.