Journal of Pregnancy最新文献

Background: Globally, inadequate gestational weight gain is a significant public health problem. It may lead to poor pregnancy outcomes. It is associated with the development of a small for gestational age fetus, prematurity, and low birthweight. It is grave trouble in middle- and low-income countries like Ethiopia. However, evidence is scarce on the magnitude of inadequate gestational weight gain and associated factors in our country, particularly in the study area. Hence, this study is aimed at assessing inadequate gestational weight gain and associated factors among pregnant women in Gamo zone public hospitals in South Ethiopia.

Methods: A facility-based cross-sectional study was conducted from February 01, 2024, to March 30, 2024, among systematically selected 373 pregnant women. The data were collected by using a structured interviewer-administered questionnaire, patient record review, and physical measurements. A binary logistic regression model was used to assess the association between dependent and independent variables. A p value < 0.05 with its 95% confidence interval (CI) was considered statistically significant and interpreted accordingly.

Results: The magnitudes of inadequate gestational weight gain were 53.1% (95% CI: 48%, 58.4%). First ANC visit after 8 weeks of gestational age (adjusted odds ratio (AOR) = 1.79; 95% CI: 1.02, 3.14), unable to read and write (AOR = 2.86; 95% CI: 1.37, 5.98), and primigravidity (AOR = 2.86; 95% CI: 1.37, 5.98) were the significant predictors of inadequate gestational weight gain.

Conclusion: The findings of this study revealed that more than half of pregnant women still gain inadequate weight, and it has complex relationships with various factors, including women's education, primigravidity, and gestational age at first ANC contact. Therefore, a comprehensive approach is needed that considers the interplay of these various factors to effectively address the issue of inadequate gestational weight gain.

Background: Preterm premature rupture of the membranes (PPROM) is the spontaneous rupture of fetal membranes before the 37th gestational week. Despite the importance of the duration of the latency period (time duration between occurrence of PPROM and childbirth), the knowledge regarding its predictive factors is limited and inconsistent.

Aim: The present study is aimed at identifying the predictive factors of short-term and long-term latency among PPROM cases.

Methods: A retrospective cohort study was conducted using hospital-based data from a single academic tertiary care hospital between January 2018 and December 2022. Demographic and clinical characteristics of 200 participants admitted due to PPROM were collected. Latency duration was categorized into three categories: less than 48 h; 48 h-7 days (considered as short-term latency); and more than 7 days (considered as long-term latency). In order to investigate the predictors of short-term and long-term latency among PPROM cases, univariable (using ꭓ², Exact F statistic, and analysis of variance) and multivariable models (multivariable multinomial logistic regression model) were used.

Results: The only significant predictor of latency duration between 48 h and 7 days, compared with latency duration of < 48 h, was lower gestational age at admission (4% decrease with each day increasing in gestational age at admission, p = 0.02). The significant predictors of latency duration of > 7 days compared with latency duration of < 48 h were lower gestational age at admission (8% decrease with each day increasing in gestational age at admission, p < 0.001), normal glucose tolerance status (7.95 times increased chance, p = 0.003), cervical dilation of <2 cm vs. ≥ 2 cm dilatation at admission (3.27 times increased chance, p = 0.013), and pregnancy termination due to reaching 34 weeks of gestation (36.63 times increased chance, p < 0.001) compared with termination due to labor pain. These variables explained 42.3% of variance for latency duration.

Conclusion: Obstetricians can expect longer latency period when PPROM cases are admitted at lower gestational age, having normal glucose tolerance status, and cervical dilation of <2 cm vs. ≥ 2 cm dilatation at admission.

Congenital heart disease (CHD) is the most common fetal anomaly worldwide. The definite etiology of most CHD is not recognized. A direct genetic etiology is considered for a minority of patients. Most etiologies are attributed to epigenetic and environmental factors. Placental malformation is an overlooked cause of CHD that has recently received attention. This narrative review presents a hypothesis based on clinical reports and animal studies. The placenta and fetal heart have concomitant developmental regulatory pathways, and their diseases have a two-way communication. Placental insufficiency may result in cardiac remodeling. Conversely, placental diseases are more frequent in association with fetal CHD. Fetal vascular malperfusion and genetic defects may play a role in placental and fetal heart disorders. Disturbed embryonic blood flow, such as syncytialization deformities and umbilical cord disorders, may lead to cardiac underdevelopment. Genetic, epigenetic, hormonal, and regulatory factors, including the NOTCH signaling pathway, SUMO-modulated stress responses, and autophagy-related genes, can affect both placental and fetal heart development. This novel information about the interplay between the placenta and fetal heart provides a new perspective on the etiologic factors of CHD and placental insufficiency. The current study aims to clarify the common causes of placental and fetal heart disorders.

Preterm birth (PTB) remains a challenging issue in the reproductive field, and cervical maturation is an essential physiological prerequisite for parturition. The cervix is rich in smooth muscle cells, and their abnormal contractility is a key trigger for premature cervical remodeling, which may further lead to spontaneous PTB. Herein, we found that high serum arachidonic acid (AA) expression in PTB mice may predict potential harms through untargeted metabolomics analysis. After AA intervention, immunofluorescence/qPCR/WB revealed that the expression of cervical smooth muscle contraction indexes calponin/oxytocin receptor (OR)/connexin-34 and premature birth-related factors cyclooxygenase-2 (COX-2) increased significantly, indicating that AA acting on cervical smooth muscle cells may lead to premature birth. WB results showed that the expression of phosphorylated myosin light chain (p-MLC) in cervical smooth muscle cells treated with AA increased significantly, and myosin light chain (MLC) protein was closely related to smooth muscle contraction. After adding the Ras homolog gene family member A (RhoA)/Rho-associated coiled-coil forming protein kinase (ROCK) pathway inhibitor, the expression of p-MLC decreased significantly, indicating that AA could induce MLC phosphorylation through the RhoA/ROCK signaling pathway to cause cervical smooth muscle shrinkage and lead to premature birth. In summary, our findings provided evidence that AA enhanced cervical smooth muscle contraction and led to PTB by inducing MLC phosphorylation through the RhoA/ROCK signaling pathway. Hence, our study provided new insights into mechanisms linking cervical smooth muscle contraction to PTB muscle shrinkage, suggesting that AA could be a potential novel drug intervention target for PTB therapy.

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.