Journal of Pregnancy最新文献

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.

Introduction: Herbal medicine is described by the World Health Organization (WHO) as plant-derived compounds, either raw or processed, that are thought to have therapeutic advantages. Herbal medication is becoming more and more popular worldwide, particularly during pregnancy. The WHO estimates that 80% of people utilize herbal remedies. In Ethiopia, grandmothers and grandfathers frequently use herbal medicine at home to treat common health issues. Instead of using medically proven treatments during their pregnancy, the majority of expectant mothers trust herbal remedies. Objective: The aim of this study was to assess the magnitude and associated factors of herbal medicine use during pregnancy among women attending antenatal care in public health institutions of central Tigray, northern Ethiopia. Methods: Facility-based cross-sectional study was conducted from March 01 to May 15, 2020. Data were collected using a structured and pretested questionnaire. Data were entered into Epi-data manager version 7.2.5 and analyzed using SPSS version 23. Both binary and multivariate logistic regression analyses were carried out to assess the associated factors. Variables with p value less the 0.2 in bivariate analysis were transferred to multivariate analysis, and variables with p value ≤ 0.05 were considered as significant. Result: Out of the total 333 respondents, making a response rate of 100%, 176 (52.9%) used herbal medicine during current pregnancy. The most common medicines used during pregnancy were garlic (59.4%) and ginger (51.7%). Occupation that is housewife had educational status (AOR = 11.816, 95% CI 1.848-35.535), illiterate (AOR = 1.886, 95% CI 1.586-2.241), residency/rural (AOR = 2.905, 95% CI 1.173-7.197), and average monthly income less than 500 Ethiopian birrs (AOR = 7.621, 95% CI 2.691-21.585) were factors that are significantly associated with the use of herbal medicine during pregnancy. Conclusion and Recommendation: Based on our results, herbal medicine use during pregnancy is highly practiced in this study, and occupation, residency, educational status, and average monthly income were the significantly associated factors of herbal medicine use during pregnancy. There is a need to educate and counsel pregnant women on the harmful effects of herbal medicine use during pregnancy by the health care personnel and health extension worker.

Background: Hypertensive disorders of pregnancy (HDP) are associated with placental insufficiency and adverse perinatal outcomes-over half (58.9%) of women with HDP at Mbarara Regional Referral Hospital (MRRH) have adverse perinatal outcomes. The cerebroplacental ratio (CPR) is an important predictor and prevents approximately 30% of these adverse perinatal outcomes. We determined the prevalence and factors associated with abnormal CPR among women with HDP at MRRH. Methods: We conducted a cross-sectional study from December 2022 to May 2023 at the high-risk obstetrics unit of MRRH. We consecutively enrolled all women with hypertensive disorders and gestational ages ≥ 26 weeks and performed obstetric Doppler studies to document the pulsatility index (PI) of the umbilical artery (UA) and middle cerebral artery (MCA) and then calculated the CPR as a ratio of the MCA-PI and UA-PI. The prevalence of women with an abnormal CPR ≤ 1.0 was expressed as a percentage. We used robust modified Poisson regression analysis to determine the factors associated with abnormal CPR. Results: We enrolled 128 women with hypertensive disorders in pregnancy, with a mean age of 28.8 ± 6.3 years. Of these, 67 (52.3%) had abnormal CPR. The factors associated with abnormal CPR were severe pre-eclampsia (adjusted prevalence ratio (aPR): 5.0, 95% CI: 1.28, 29.14) and eclampsia (aPR: 5.27, 95% CI: 1.11, 34.27). Conclusion: On average, half of the women with hypertensive disorders have abnormal CPR. Women with severe pre-eclampsia or eclampsia are more likely to have abnormal CPR. Obstetric Doppler studies with CPR may be warranted for all pregnant women with severe pre-eclampsia and eclampsia. We recommend further research to assess perinatal outcomes among those with and without abnormal CPR to profile women with HDP at increased risk of adverse perinatal outcomes.

Background: There are limitations to predicting perinatal asphyxia, as current tools rely almost entirely on fetal cardiotocography (CTG). The fetal lack of responsiveness scale (FLORS) is a new diagnostic alternative based on the physiological phenomena associated with fetal hypoxia. Objectives: The objective of this study was to develop, validate, and assess the diagnostic accuracy of the FLORS for predicting severe perinatal hypoxia (SPH). Study Design: A two-phase retrospective observational cross-sectional analytical study was conducted. Phase 1 involved the formulation and retrospective validation of the FLORS. A total of 366 fetal CTG records were evaluated twice by seven readers. Phase 2 was a collaborative, retrospective, multicenter diagnostic test study that included 37 SPH and 366 non-SPH cases. Results: Phase 1: A numeric, physiology-based scale was developed and refined based on expert opinions. The median time to apply the scale per reading was 38 s. Cronbach's alpha, which is a reliability measure, was significant (p = 0.784). The kappa index for test-retest agreement was moderate to reasonable, with a median value of 0.642. For interobserver agreement, the kappa index per variable was as follows: baseline, 0.669; accelerations, 0.658; variability, 0.467; late/variable decelerations, 0.638; slow response decelerations, 0.617; and trend to change, 0.423. Phase 2, including 37 SPH and 366 non-SPH cases, showed a sensitivity of 62.2% and specificity of 75.4% for the 2-point score, whereas the 3-point score had a sensitivity of 35.1% and specificity of 89.9%. The area under the curve (AUC) was significant at 0.73 (CI 0.645-0.818). Conclusions: FLORS demonstrated significant internal consistency and observer agreement, with a promising sensitivity-specificity balance and significant AUC. Further research is needed to assess its impact on perinatal hypoxia and cesarean delivery.