Pub Date : 2024-08-21DOI: 10.1101/2024.08.20.24312329
Oluwapelumi Oloyede, Lulu Xu, Lola Adepoju
Hypertensive disorders in pregnancy (HDPs) significantly contribute to maternal and fetal complications, particularly in adolescent pregnancies. This study examines the prevalence and predictors of gestational hypertension (gHTN) among U.S. adolescents between 2016 and 2022, using data from the CDC's Birth Data Files. The analysis included various maternal factors, such as age, race, education, BMI, prenatal care, and participation in the Women, Infants, and Children (WIC) Nutritional Program. Logistic Regression and Random Forest models were employed to evaluate these predictors, with Random Forest showing superior predictive performance. The study found that gHTN prevalence increased from 6.72% in 2016 to 9.51% in 2022, with BMI, month prenatal visits began, WIC participation, and race emerging as key predictors. The findings highlight the importance of early prenatal care and targeted support for adolescents to manage gHTN, emphasizing the need for interventions that address modifiable risk factors such as BMI and access to nutritional programs. This research underscores the critical need for continued efforts to mitigate the rising trend of gHTN in adolescent pregnancies and improve maternal and fetal outcomes in this vulnerable population. Future studies should focus on identifying additional predictors and tailoring interventions to meet the unique needs of adolescent mothers.
{"title":"Gestational Hypertension in Adolescent Mothers: A 2016-2022 Trend Analysis","authors":"Oluwapelumi Oloyede, Lulu Xu, Lola Adepoju","doi":"10.1101/2024.08.20.24312329","DOIUrl":"https://doi.org/10.1101/2024.08.20.24312329","url":null,"abstract":"Hypertensive disorders in pregnancy (HDPs) significantly contribute to maternal and fetal complications, particularly in adolescent pregnancies. This study examines the prevalence and predictors of gestational hypertension (gHTN) among U.S. adolescents between 2016 and 2022, using data from the CDC's Birth Data Files. The analysis included various maternal factors, such as age, race, education, BMI, prenatal care, and participation in the Women, Infants, and Children (WIC) Nutritional Program. Logistic Regression and Random Forest models were employed to evaluate these predictors, with Random Forest showing superior predictive performance. The study found that gHTN prevalence increased from 6.72% in 2016 to 9.51% in 2022, with BMI, month prenatal visits began, WIC participation, and race emerging as key predictors. The findings highlight the importance of early prenatal care and targeted support for adolescents to manage gHTN, emphasizing the need for interventions that address modifiable risk factors such as BMI and access to nutritional programs. This research underscores the critical need for continued efforts to mitigate the rising trend of gHTN in adolescent pregnancies and improve maternal and fetal outcomes in this vulnerable population. Future studies should focus on identifying additional predictors and tailoring interventions to meet the unique needs of adolescent mothers.","PeriodicalId":501409,"journal":{"name":"medRxiv - Obstetrics and Gynecology","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142185482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-19DOI: 10.1101/2024.08.16.24312096
Paola Cristina Toapanta-Pinta, Mercy Dolores Rosero-Quintana, Soraya Chavez-Espinosa, Cristhian Vasco-Toapanta, Investigacion en Salud Infantil y Perinatal (ISIP), Santiago Vasco-Morales
Introduction: Adolescent pregnancy is a global public health issue with significant implications for maternal and neonatal health, particularly in regions with limited access to healthcare services. Objective: To investigate the prevalence of adolescent pregnancies and perinatal outcomes at the Isidro Ayora Gyneco-Obstetric Hospital during the period 2009-2022. Method: A cross-sectional study was conducted based on records from the Perinatal Information System. Adolescent women and their newborns were included. Multiple pregnancies and cases with incomplete data were excluded. The Chi-square test was applied, and multinomial logistic regression models were used. Ethical Approval: 009-DOC-FCM-2023 Results: Out of a total of 26,236 live births, 6,700 (25.53%) were born to adolescent mothers. Many of these mothers were of mestizo ethnicity (94.91%) and had secondary education (80.28%). Multivariate analyses indicated that younger adolescents (<14 years) belonged to minority ethnic groups, substance abuse during pregnancy, underwent episiotomy, and their neonates had a low Apgar score in the first minute of life. Conclusions: Adolescent pregnancy remains a public health issue in Ecuador, associated with adverse neonatal outcomes. It is crucial to implement health policies that address the socioeconomic and cultural determinants of adolescent pregnancy and to conduct prospective studies to better understand the factors involved in these perinatal outcomes.
{"title":"Adolescent pregnancy prevalence, maternal characteristics, and perinatal outcomes","authors":"Paola Cristina Toapanta-Pinta, Mercy Dolores Rosero-Quintana, Soraya Chavez-Espinosa, Cristhian Vasco-Toapanta, Investigacion en Salud Infantil y Perinatal (ISIP), Santiago Vasco-Morales","doi":"10.1101/2024.08.16.24312096","DOIUrl":"https://doi.org/10.1101/2024.08.16.24312096","url":null,"abstract":"Introduction:\u0000Adolescent pregnancy is a global public health issue with significant implications for maternal and neonatal health, particularly in regions with limited access to healthcare services.\u0000Objective:\u0000To investigate the prevalence of adolescent pregnancies and perinatal outcomes at the Isidro Ayora Gyneco-Obstetric Hospital during the period 2009-2022.\u0000Method:\u0000A cross-sectional study was conducted based on records from the Perinatal Information System. Adolescent women and their newborns were included. Multiple pregnancies and cases with incomplete data were excluded. The Chi-square test was applied, and multinomial logistic regression models were used.\u0000Ethical Approval:\u0000009-DOC-FCM-2023\u0000Results:\u0000Out of a total of 26,236 live births, 6,700 (25.53%) were born to adolescent mothers. Many of these mothers were of mestizo ethnicity (94.91%) and had secondary education (80.28%). Multivariate analyses indicated that younger adolescents (<14 years) belonged to minority ethnic groups, substance abuse during pregnancy, underwent episiotomy, and their neonates had a low Apgar score in the first minute of life.\u0000Conclusions:\u0000Adolescent pregnancy remains a public health issue in Ecuador, associated with adverse neonatal outcomes. It is crucial to implement health policies that address the socioeconomic and cultural determinants of adolescent pregnancy and to conduct prospective studies to better understand the factors involved in these perinatal outcomes.","PeriodicalId":501409,"journal":{"name":"medRxiv - Obstetrics and Gynecology","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142185484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-19DOI: 10.1101/2024.08.18.24312191
Yuying Zhang, Li Luo, Shuaihui Du, Die Hou, Yaling Zhang, Limin He, Lihua Zhou
Objective: The purpose of this study is to develop and validate the scale of health education demand of patients with HPV infection based on KANO model, so as to provide a tool for further exploring the types of health education demand and influencing factors of patients with HPV infection. Methods: This study is a scale development and validation study using a three-stage cross-sectional design. In stage 1, a preliminary item pool is formed using literature review, semi-structured interviews and the Delphi method. In stage 2, six experts were invited to assess content validity. A cross-sectional survey was conducted on 1169 patients with HPV infection, Questionnaire results from 583 patients were used for exploratory factor analysis. In stage 3, the remaining 586 patients to validate the factor structure through confirmatory factor analysis. Results: In stage 1, an initial 35-item scale was developed and the items were transformed positive and reverse based on KANO model. In stage 2, Exploratory factor analysis formed a scale of 28 items in 5 factors: disease information demand, social support, emotional demand, family support and health education style demand. Cronbach’s alpha was 0.940 for the entire scale and 0.763~0.908 for the five subscales in the positive items, 0.955 for the entire scale and 0.739~0.946 for the five subscales in reverse items. The content validity index of the scale: S-CVI/UA=0.91, S-CVI/Ave=0.98. In stage 3, the confirmatory factor analysis showed that the c2/df, RMSEA, CFI and TLI of the positive items after four model modifications were 3.650, 0.067, 0.901 ,0.888, and the SRMR value was < 0.001. The fitting of the five-factor model was good. Conclusion: The KANO model based questionnaire on health education demand of HPV infected patients has good reliability and validity, and is suitable for the investigation of health education demand of HPV infected patients.
{"title":"Development and validation of the health education demand scale for HPV infected patients based on KANO model","authors":"Yuying Zhang, Li Luo, Shuaihui Du, Die Hou, Yaling Zhang, Limin He, Lihua Zhou","doi":"10.1101/2024.08.18.24312191","DOIUrl":"https://doi.org/10.1101/2024.08.18.24312191","url":null,"abstract":"Objective: The purpose of this study is to develop and validate the scale of health education demand of patients with HPV infection based on KANO model, so as to provide a tool for further exploring the types of health education demand and influencing factors of patients with HPV infection.\u0000Methods: This study is a scale development and validation study using a three-stage cross-sectional design. In stage 1, a preliminary item pool is formed using literature review, semi-structured interviews and the Delphi method. In stage 2, six experts were invited to assess content validity. A cross-sectional survey was conducted on 1169 patients with HPV infection, Questionnaire results from 583 patients were used for exploratory factor analysis. In stage 3, the remaining 586 patients to validate the factor structure through confirmatory factor analysis.\u0000Results: In stage 1, an initial 35-item scale was developed and the items were transformed positive and reverse based on KANO model. In stage 2, Exploratory factor analysis formed a scale of 28 items in 5 factors: disease information demand, social support, emotional demand, family support and health education style demand. Cronbach’s alpha was 0.940 for the entire scale and 0.763~0.908 for the five subscales in the positive items, 0.955 for the entire scale and 0.739~0.946 for the five subscales in reverse items. The content validity index of the scale: S-CVI/UA=0.91, S-CVI/Ave=0.98. In stage 3, the confirmatory factor analysis showed that the c2/df, RMSEA, CFI and TLI of the positive items after four model modifications were 3.650, 0.067, 0.901 ,0.888, and the SRMR value was < 0.001. The fitting of the five-factor model was good.\u0000Conclusion: The KANO model based questionnaire on health education demand of HPV infected patients has good reliability and validity, and is suitable for the investigation of health education demand of HPV infected patients.","PeriodicalId":501409,"journal":{"name":"medRxiv - Obstetrics and Gynecology","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142224360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-13DOI: 10.1101/2024.08.13.24311793
Aneela Reddy, Sara Rizvi, Anita Moon-Grady, Rima Arnaout
Although screening of prenatal congenital heart disease (CHD) has improved over the last decade, the diagnosis rate can still be as low as 40%. The axial 4 chamber (A4C) is the most reliably obtained cardiac view in the fetal screening ultrasound but alone only has a maximum clinical sensitivity of 50-60%, particularly in large multicenter studies in low-risk populations. Standard biometrics, like cardiac axis (CA), cardiothoracic ratio (CTR) and cardiac chamber fractional area change (FAC), have individually been shown to be useful for CHD screening and can all be obtained from A4C alone. However, these biometrics are vastly underutilized because they are time-consuming to extract and difficult to interpret all at once. We hypothesized that using six standard biometrics in combination can improve complex CHD screening versus any one biometric alone. K-means clustering was performed to segregate the patterns of heart measurements into clusters. Sensitivity and specificity for CHD was 87% and 75%, respectively. Here, we demonstrate that a composite of six standard biometric has better sensitivity and accuracy for CHD than any one biometric alone and better than A4C visual assessment.
{"title":"Improving prenatal detection of congenital heart disease with a scalable composite analysis of six fetal cardiac ultrasound biometrics","authors":"Aneela Reddy, Sara Rizvi, Anita Moon-Grady, Rima Arnaout","doi":"10.1101/2024.08.13.24311793","DOIUrl":"https://doi.org/10.1101/2024.08.13.24311793","url":null,"abstract":"Although screening of prenatal congenital heart disease (CHD) has improved over the last decade, the diagnosis rate can still be as low as 40%. The axial 4 chamber (A4C) is the most reliably obtained cardiac view in the fetal screening ultrasound but alone only has a maximum clinical sensitivity of 50-60%, particularly in large multicenter studies in low-risk populations. Standard biometrics, like cardiac axis (CA), cardiothoracic ratio (CTR) and cardiac chamber fractional area change (FAC), have individually been shown to be useful for CHD screening and can all be obtained from A4C alone. However, these biometrics are vastly underutilized because they are time-consuming to extract and difficult to interpret all at once. We hypothesized that using six standard biometrics in combination can improve complex CHD screening versus any one biometric alone. K-means clustering was performed to segregate the patterns of heart measurements into clusters. Sensitivity and specificity for CHD was 87% and 75%, respectively. Here, we demonstrate that a composite of six standard biometric has better sensitivity and accuracy for CHD than any one biometric alone and better than A4C visual assessment.","PeriodicalId":501409,"journal":{"name":"medRxiv - Obstetrics and Gynecology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142185485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-07DOI: 10.1101/2024.08.06.24311582
Austin M Gabel, Lindsay Cheu, Mindy Pike, Kelsey L Olerich, Alisa Kachikis, Stephen McCartney, Raj Shree
Hypertensive disorder of pregnancy (HDP) is associated with an increased risk for later-life cardiovascular disease (CVD). Whether the HDP pregnancy itself confers risk towards CVD later in life is suggested in several epidemiologic studies. Given this connection and that the HDP exposure itself may play a role, understanding whether markers associated with cardiovascular risk vary based on HDP history in the years following pregnancy may assist with risk stratification and development of targeted interventions. We measured 77 proteins (CVD-associated and inflammatory markers) in n=22 individuals with a history of HDP and n=43 matched controls with no HDP history at a median of 4 years after pregnancy. Several CVD-associated proteins (fibrinogen, fetuin-A, L-selectin, and alpha-1-acid glycoprotein) were significantly elevated, by orders of magnitude, in individuals with a history of HDP compared to normotensive pregnancies (all p<0.0001). In multivariable linear regression models controlling for age, body mass index, chronic hypertension, and diabetes, a history of HDP remained associated with higher levels of CVD-associated proteins (all p<0.0001). We clustered samples based on global patterns of CVD protein expression and found a significant difference in CVD protein expression patterns between post-Normal and post-HDP samples. Conversely, differences in circulating inflammatory markers were largely insignificant or more subtle than that observed with the CVD-associated proteins. Identification of biomarkers associated with CVD in the intervening years after HDP but before evident CVD is critical to understanding post-HDP cardiovascular risk to provide insight for the development of therapeutic interventions that mitigate CVD event risk in this high-risk population.
{"title":"Elevated Cardiovascular Biomarkers Following Hypertensive Disorder of Pregnancy","authors":"Austin M Gabel, Lindsay Cheu, Mindy Pike, Kelsey L Olerich, Alisa Kachikis, Stephen McCartney, Raj Shree","doi":"10.1101/2024.08.06.24311582","DOIUrl":"https://doi.org/10.1101/2024.08.06.24311582","url":null,"abstract":"Hypertensive disorder of pregnancy (HDP) is associated with an increased risk for later-life cardiovascular disease (CVD). Whether the HDP pregnancy itself confers risk towards CVD later in life is suggested in several epidemiologic studies. Given this connection and that the HDP exposure itself may play a role, understanding whether markers associated with cardiovascular risk vary based on HDP history in the years following pregnancy may assist with risk stratification and development of targeted interventions. We measured 77 proteins (CVD-associated and inflammatory markers) in n=22 individuals with a history of HDP and n=43 matched controls with no HDP history at a median of 4 years after pregnancy. Several CVD-associated proteins (fibrinogen, fetuin-A, L-selectin, and alpha-1-acid glycoprotein) were significantly elevated, by orders of magnitude, in individuals with a history of HDP compared to normotensive pregnancies (all p<0.0001). In multivariable linear regression models controlling for age, body mass index, chronic hypertension, and diabetes, a history of HDP remained associated with higher levels of CVD-associated proteins (all p<0.0001). We clustered samples based on global patterns of CVD protein expression and found a significant difference in CVD protein expression patterns between post-Normal and post-HDP samples. Conversely, differences in circulating inflammatory markers were largely insignificant or more subtle than that observed with the CVD-associated proteins. Identification of biomarkers associated with CVD in the intervening years after HDP but before evident CVD is critical to understanding post-HDP cardiovascular risk to provide insight for the development of therapeutic interventions that mitigate CVD event risk in this high-risk population.","PeriodicalId":501409,"journal":{"name":"medRxiv - Obstetrics and Gynecology","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141939013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-06DOI: 10.1101/2024.07.30.24311213
Hannah B Edwards, Carlos Sillero-Rejon, Christalla Pithara-McKeown, Frank de Vocht, Hugh McLeod, Sabi Redwood, Elizabeth M Hill, Brent Opmeer, David E Odd, Karen Luyt
Executive Summary: This study set out to evaluate the longer term sustainability, effectiveness, and cost effectiveness of the National PReCePT Programme (NPP) in England, and explore trends and MgSO4 guidance implementation practices in the devolved nations, Scotland and Wales. We found that the majority of improvement in MgSO4 use seemed to take place in the first year or two following the NPP. Benefits were largely sustained over the 4 years of follow-up, with an overall appearance of plateau in recent years. There was some indication of a slight declining trend in use coinciding with the COVID-19 pandemic, that continued to the end of 2022 (the end of the currently available data). Regional disparities in use of MgSO4 reduced since the NPP was launched. We estimated that the NPP was associated with around 597,000 GBP net monetary benefit (NMB) from a lifetime societal perspective, with an 89% probability of being cost-effective for babies with less than 30 weeks gestation. This NMB increased to 4.2M GBP when including babies up to 32 weeks gestation. By 2022, MgSO4 use in Wales had caught up with levels in England, with levels in Scotland not far behind. The NMB of implementing MgSO4 for babies up to 32 weeks gestation in the three nations has increased over time, generating approximately 125M GBP in England, 8M GPB in Scotland and 5M GBP in Wales in 2022. Consequently, the benefit forgone for not achieving optimal MgSO4 uptake has also reduced over time, although there remains considerable scope for improving performance in each nation. The improvements in implementing MgSO4 have generated health gains and cost savings associated with CP prevention. Investing additional resources in implementing MgSO4 further would be likely to be cost-effective in all three nations. Our analysis highlighted how devolved nation activities were (directly or indirectly) shaped by PReCePT methodology. Qualitative interviews with clinical leads involved in implementing MgSO4 in Scotland and Wales, where the NPP was not implemented, shed light on the separate but similar initiatives implemented there, explaining the increasing trends also observed in the devolved nations (e.g. the Maternity and Children Quality Improvement Collaborative (MCQIC) Preterm Perinatal Wellbeing Package (PPWP) in Scotland, improvement interventions mirroring PERIPrem in Wales, and British Association for Perinatal Medicine Toolkits in both nations). Challenges and enablers were linked to perinatal team relationships; local leadership with protected time and funding; access to national performance data; staff clarity and confidence on guidance and administration of treatment; opportunities for and commitment to co-creating meaning around the intervention; skills, competencies and resources available to adopters; and engagement in continuous improvement activities (e.g. audit and feedback, benchmarking and missed case reviews). Findings reiterate the need for local champions with backfill
{"title":"PReCePT Devolved Nations Evaluation Report","authors":"Hannah B Edwards, Carlos Sillero-Rejon, Christalla Pithara-McKeown, Frank de Vocht, Hugh McLeod, Sabi Redwood, Elizabeth M Hill, Brent Opmeer, David E Odd, Karen Luyt","doi":"10.1101/2024.07.30.24311213","DOIUrl":"https://doi.org/10.1101/2024.07.30.24311213","url":null,"abstract":"Executive Summary:\u0000This study set out to evaluate the longer term sustainability, effectiveness, and cost effectiveness of the National PReCePT Programme (NPP) in England, and explore trends and MgSO4 guidance implementation practices in the devolved nations, Scotland and Wales. We found that the majority of improvement in MgSO4 use seemed to take place in the first year or two following the NPP. Benefits were largely sustained over the 4 years of follow-up, with an overall appearance of plateau in recent years. There was some indication of a slight declining trend in use coinciding with the COVID-19 pandemic, that continued to the end of 2022 (the end of the currently available data). Regional disparities in use of MgSO4 reduced since the NPP was launched. We estimated that the NPP was associated with around 597,000 GBP net monetary benefit (NMB) from a lifetime societal perspective, with an 89% probability of being cost-effective for babies with less than 30 weeks gestation. This NMB increased to 4.2M GBP when including babies up to 32 weeks gestation. By 2022, MgSO4 use in Wales had caught up with levels in England, with levels in Scotland not far behind. The NMB of implementing MgSO4 for babies up to 32 weeks gestation in the three nations has increased over time, generating approximately 125M GBP in England, 8M GPB in Scotland and 5M GBP in Wales in 2022. Consequently, the benefit forgone for not achieving optimal MgSO4 uptake has also reduced over time, although there remains considerable scope for improving performance in each nation. The improvements in implementing MgSO4 have generated health gains and cost savings associated with CP prevention. Investing additional resources in implementing MgSO4 further would be likely to be cost-effective in all three nations. Our analysis highlighted how devolved nation activities were (directly or indirectly) shaped by PReCePT methodology. Qualitative interviews with clinical leads involved in implementing MgSO4 in Scotland and Wales, where the NPP was not implemented, shed light on the separate but similar initiatives implemented there, explaining the increasing trends also observed in the devolved nations (e.g. the Maternity and Children Quality Improvement Collaborative (MCQIC) Preterm Perinatal Wellbeing Package (PPWP) in Scotland, improvement interventions mirroring PERIPrem in Wales, and British Association for Perinatal Medicine Toolkits in both nations). Challenges and enablers were linked to perinatal team relationships; local leadership with protected time and funding; access to national performance data; staff clarity and confidence on guidance and administration of treatment; opportunities for and commitment to co-creating meaning around the intervention; skills, competencies and resources available to adopters; and engagement in continuous improvement activities (e.g. audit and feedback, benchmarking and missed case reviews). Findings reiterate the need for local champions with backfill","PeriodicalId":501409,"journal":{"name":"medRxiv - Obstetrics and Gynecology","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141939020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-05DOI: 10.1101/2024.08.04.24311470
Jiayan Chen, Peiyan Wang, Changji Xiao, Kalibinuer Kelaimu, Youjie Zeng, Feng Lyu, Xianshu Gao, Xiaomei Li, Jun Hu
Objective: Recent investigations have proposed a link between gut microbiomes (GMs) and various cancers, yet the involvement of GMs in vulvar cancer (VC) remains unclear. The objective of this study was to discover the causal association between GMs and VC and identify the GM taxa with potential effect. Methods: Utilizing Mendelian randomization (MR) with genome-wide association study (GWAS) summary statistics, we analyzed 211 GM taxa and 190 VC cases with 167,189 healthy controls. The main analysis used the inverse-variance weighted (IVW) approach, complemented by weighted median test, MR-PRESSO global test, and leave-one-out analysis. Results: Four nominally significant causal relationships were identified between GM taxa and VC. Class Betaproteobacteria [odds ratio (OR)=0.064, 95% confidence interval (CI): 0.004-0.946, fp=0.045], order Burkholderiales [OR=0.074, 95% CI: 0.009-0.630, p=0.017], genus Intestinibacter [OR=0.073, 95% CI: 0.009-0.617, p=0.016], and genus RuminococcaceaeUCG003 [OR=0.162, 95% CI: 0.028-0.938, p=0.042] were linked to a lower chance of VC. The MR-Egger intercept test and MR-PRESSO global test confirmed the lack of horizontal pleiotropy (p>0.05), and leave-one-out analysis indicated result robustness. Conclusion: Our findings highlight four potential causal relationships and specific intestinal flora associated with decreased VC risk, offering insights for VC prevention and treatment.
{"title":"Causal relationship between gut microbiota and vulvar cancer: a two-sample bi-directional Mendelian randomization study","authors":"Jiayan Chen, Peiyan Wang, Changji Xiao, Kalibinuer Kelaimu, Youjie Zeng, Feng Lyu, Xianshu Gao, Xiaomei Li, Jun Hu","doi":"10.1101/2024.08.04.24311470","DOIUrl":"https://doi.org/10.1101/2024.08.04.24311470","url":null,"abstract":"Objective: Recent investigations have proposed a link between gut microbiomes (GMs) and various cancers, yet the involvement of GMs in vulvar cancer (VC) remains unclear. The objective of this study was to discover the causal association between GMs and VC and identify the GM taxa with potential effect. Methods: Utilizing Mendelian randomization (MR) with genome-wide association study (GWAS) summary statistics, we analyzed 211 GM taxa and 190 VC cases with 167,189 healthy controls. The main analysis used the inverse-variance weighted (IVW) approach, complemented by weighted median test, MR-PRESSO global test, and leave-one-out analysis. Results: Four nominally significant causal relationships were identified between GM taxa and VC. Class Betaproteobacteria [odds ratio (OR)=0.064, 95% confidence interval (CI): 0.004-0.946, fp=0.045], order Burkholderiales [OR=0.074, 95% CI: 0.009-0.630, p=0.017], genus Intestinibacter [OR=0.073, 95% CI: 0.009-0.617, p=0.016], and genus RuminococcaceaeUCG003 [OR=0.162, 95% CI: 0.028-0.938, p=0.042] were linked to a lower chance of VC. The MR-Egger intercept test and MR-PRESSO global test confirmed the lack of horizontal pleiotropy (p>0.05), and leave-one-out analysis indicated result robustness. Conclusion: Our findings highlight four potential causal relationships and specific intestinal flora associated with decreased VC risk, offering insights for VC prevention and treatment.","PeriodicalId":501409,"journal":{"name":"medRxiv - Obstetrics and Gynecology","volume":"94 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141939015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Infertility is a global health issue that affects millions of couples worldwide, In Nigeria, the prevalence of infertility is particularly high underscoring the need for a better understanding of the factors contributing to male infertility at which Seminal Fluid Analysis (SFA) is the most important characteristics. This study aimed to assess the prevalence of abnormal seminal fluid and its associated factors among patients attending fertility clinics in Osogbo, Nigeria. Methods and Findings: A descriptive cross-sectional study design was used among male patients attending fertility centers in Osogbo, Osun State. Fisher's formula (n=z^2pq/d^2) was used to determine the sample size. 305 respondents were selected using multistage sampling technique. Pre-tested questionnaire was used to collect data from respondents. Patients who consented to the study were also made to undergo seminal fluid analysis. The results were analysed using IBM Statistical Product for Service Solution (SPSS) version 27. Descriptive statistics was used for all variables. Bivariate and multivariate analysis were done at p<0.05 as level of significance. Majority of the respondents, 257 (84.3%) had at least one abnormality of Seminal fluid. Multiple regression analysis revealed that respondents who were habitual drunkard were about five times more likely to have at least one abnormality in their seminal fluid (OR: 4.990, p: 0.004, C.I.: 1.688-14.749) and smokers were three times more likely to have at least one abnormality in their seminal fluid (p=0.005, OR=3.300 and C.I=1.396-4.273). Also, respondents with history of sexually transmitted infection were 3.5 times more likely to have at least one abnormality in their seminal fluid (p=0.039, OR=3.595 and C.I=1.072-14.146). Conclusions: The study observed high prevalence of abnormal seminal fluid which was significantly associated with lifestyle habits such as smoking, alcohol as well as previous history of sexually transmitted infection. The study recommended that advocacy program for healthy lifestyle, early screening and public health education will further reduce the burden of abnormal seminal fluid and by implication, infertility among couples.
{"title":"PREVALENCE OF ABNORMAL SEMINAL FLUID AND ASSOCIATED FACTORS AMONG PATIENTS ATTENDING FERTILITY CLINICS IN OSOGBO: A CROSS SECTIONAL STUDY","authors":"Kehinde Awodele, Sunday Charles Adeyemo, Eniola Dorcas Olabode, Adeniyi Olaonipekun Fasanu, Akintunde Rasaq Akindele, Lanre Olaitan, Olufunso Abidemi Olagunju, Adeola Dorcas Aderinwale","doi":"10.1101/2024.08.01.24311347","DOIUrl":"https://doi.org/10.1101/2024.08.01.24311347","url":null,"abstract":"Background: Infertility is a global health issue that affects millions of couples worldwide, In Nigeria, the prevalence of infertility is particularly high underscoring the need for a better understanding of the factors contributing to male infertility at which Seminal Fluid Analysis (SFA) is the most important characteristics. This study aimed to assess the prevalence of abnormal seminal fluid and its associated factors among patients attending fertility clinics in Osogbo, Nigeria. Methods and Findings: A descriptive cross-sectional study design was used among male patients attending fertility centers in Osogbo, Osun State. Fisher's formula (n=z^2pq/d^2) was used to determine the sample size. 305 respondents were selected using multistage sampling technique. Pre-tested questionnaire was used to collect data from respondents. Patients who consented to the study were also made to undergo seminal fluid analysis. The results were analysed using IBM Statistical Product for Service Solution (SPSS) version 27. Descriptive statistics was used for all variables. Bivariate and multivariate analysis were done at p<0.05 as level of significance. Majority of the respondents, 257 (84.3%) had at least one abnormality of Seminal fluid. Multiple regression analysis revealed that respondents who were habitual drunkard were about five times more likely to have at least one abnormality in their seminal fluid (OR: 4.990, p: 0.004, C.I.: 1.688-14.749) and smokers were three times more likely to have at least one abnormality in their seminal fluid (p=0.005, OR=3.300 and C.I=1.396-4.273). Also, respondents with history of sexually transmitted infection were 3.5 times more likely to have at least one abnormality in their seminal fluid (p=0.039, OR=3.595 and C.I=1.072-14.146). Conclusions: The study observed high prevalence of abnormal seminal fluid which was significantly associated with lifestyle habits such as smoking, alcohol as well as previous history of sexually transmitted infection. The study recommended that advocacy program for healthy lifestyle, early screening and public health education will further reduce the burden of abnormal seminal fluid and by implication, infertility among couples.","PeriodicalId":501409,"journal":{"name":"medRxiv - Obstetrics and Gynecology","volume":"79 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141882243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-27DOI: 10.1101/2024.07.25.24310973
Nikolai Ruhliada
Uterine fibroids are one of the most common tumors in women worldwide. Considering the negative impact of uterine fibroids on pregnancy in women of reproductive age, myomectomy is the operation of choice. We examined reproductive outcomes in patients undergoing laparoscopic myomectomy for various types of fibroid nodules. Objective: To evaluate reproductive outcomes in patients with infertility and uterine fibroids after laparoscopic myomectomy. Materials and methods: The study included 38 women aged 18 to 45 years with uterine fibroids and infertility. All patients underwent elective laparoscopic myomectomy. The study was conducted among patients who applied routinely to the St. Luke's Clinical Hospital of St. Petersburg in 2021. At least 2 years of follow-up after possible surgical treatment was acceptable as a time interval for conception. Pregnancy was confirmed by visualizing the fertilized egg in the uterine cavity. Data on the type and number of laparoscopic myomectomies and the characteristics of myoma nodes, such as their number, size and location, were collected from medical records. Obstetric and gynecological history data was also obtained, including the number and outcomes of pregnancies. Results: The study found that of 38 patients with uterine fibroids and infertility, 24 women (63%) became pregnant within 2 years after laparoscopic myomectomy. Of these, 13 (54.1%) were delivered by cesarean section, and 11 (45.9%) were delivered naturally. Of the 5 women with subserous fibroid nodes (FIGO type 7), 5 (100%) became pregnant. Of the 19 patients with intramural subserous nodes (FIGO types 5 and 6), 11 (58%) became pregnant. Of the 24 women with intramural nodes (FIGO type 4), 8 (33%) became pregnant. In 5 (100%) women who became pregnant after removal of the subserous node (FIGO type 7), vaginal delivery was performed. In 7 (63.6%) patients who became pregnant after removal of an intramural-subserous node (FIGO types 5 and 6), delivery was performed by cesarean section, in 4 (36.4%) by natural delivery. In 6 (75%) women who became pregnant after removal of an intramural node (FIGO type 4), delivery was performed by cesarean section, in 2 (35%) by natural delivery. Of 14 women suffering from infertility and having only 1 fibroid node, 11 became pregnant (78.5%), of 19 patients with 2 fibroids, 11 (58%) became pregnant, of 5 women who had 3 or more fibroid nodes became pregnant 2 (40%). Of the 11 women who became pregnant after myomectomy of 1 node, 5 (45.4%) had a cesarean section and 6 (54.6%) had a natural delivery. Of the 11 women who became pregnant after removal of 2 fibroids, 6 (54.5%) had a cesarean section, 5 (45.5%) had a vaginal delivery, of 2 women who became pregnant after removal of 3 or more fibroids, 2 (100%) were performed by caesarean section. In addition, we found that out of 4 women who had fibroids measuring less than 3 cm, only 1 (25%) became pregnant; out of 9 patients with fibroids from 3 to 5 cm, 7 (29%) became
{"title":"Laparoscopic myomectomy and futher reproductive outcomes.","authors":"Nikolai Ruhliada","doi":"10.1101/2024.07.25.24310973","DOIUrl":"https://doi.org/10.1101/2024.07.25.24310973","url":null,"abstract":"Uterine fibroids are one of the most common tumors in women worldwide. Considering the negative impact of uterine fibroids on pregnancy in women of reproductive age, myomectomy is the operation of choice. We examined reproductive outcomes in patients undergoing laparoscopic myomectomy for various types of fibroid nodules.\u0000Objective: To evaluate reproductive outcomes in patients with infertility and uterine fibroids after laparoscopic myomectomy.\u0000Materials and methods: The study included 38 women aged 18 to 45 years with uterine fibroids and infertility. All patients underwent elective laparoscopic myomectomy. The study was conducted among patients who applied routinely to the St. Luke's Clinical Hospital of St. Petersburg in 2021. At least 2 years of follow-up after possible surgical treatment was acceptable as a time interval for conception. Pregnancy was confirmed by visualizing the fertilized egg in the uterine cavity. Data on the type and number of laparoscopic myomectomies and the characteristics of myoma nodes, such as their number, size and location, were collected from medical records. Obstetric and gynecological history data was also obtained, including the number and outcomes of pregnancies.\u0000Results: The study found that of 38 patients with uterine fibroids and infertility, 24 women (63%) became pregnant within 2 years after laparoscopic myomectomy. Of these, 13 (54.1%) were delivered by cesarean section, and 11 (45.9%) were delivered naturally. Of the 5 women with subserous fibroid nodes (FIGO type 7), 5 (100%) became pregnant. Of the 19 patients with intramural subserous nodes (FIGO types 5 and 6), 11 (58%) became pregnant. Of the 24 women with intramural nodes (FIGO type 4), 8 (33%) became pregnant. In 5 (100%) women who became pregnant after removal of the subserous node (FIGO type 7), vaginal delivery was performed. In 7 (63.6%) patients who became pregnant after removal of an intramural-subserous node (FIGO types 5 and 6), delivery was performed by cesarean section, in 4 (36.4%) by natural delivery. In 6 (75%) women who became pregnant after removal of an intramural node (FIGO type 4), delivery was performed by cesarean section, in 2 (35%) by natural delivery. Of 14 women suffering from infertility and having only 1 fibroid node, 11 became pregnant (78.5%), of 19 patients with 2 fibroids, 11 (58%) became pregnant, of 5 women who had 3 or more fibroid nodes became pregnant 2 (40%). Of the 11 women who became pregnant after myomectomy of 1 node, 5 (45.4%) had a cesarean section and 6 (54.6%) had a natural delivery. Of the 11 women who became pregnant after removal of 2 fibroids, 6 (54.5%) had a cesarean section, 5 (45.5%) had a vaginal delivery, of 2 women who became pregnant after removal of 3 or more fibroids, 2 (100%) were performed by caesarean section. In addition, we found that out of 4 women who had fibroids measuring less than 3 cm, only 1 (25%) became pregnant; out of 9 patients with fibroids from 3 to 5 cm, 7 (29%) became ","PeriodicalId":501409,"journal":{"name":"medRxiv - Obstetrics and Gynecology","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141785203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-24DOI: 10.1101/2024.07.24.24310928
Tienyi M Daniel, DENNIS FRANCIS MROSSO, BARAKA VYAMUNGU, ALLY MACHIMU, HASSANI MWASI, REHEMA RAMADHANI
Aim: To assess the knowledge regarding pregnancy induced hypertension among pregnant mothers attending antenatal care at Makole health center. Methods: Analytical cross-section study design involving 160 participants was conducted at Makole health center. Interviewer and self-administered structured questionnaire was used to assess the objectives of the study. coded, checked and then analyzed using Statistical Package for Social Science (SPSS) version 20 so as to develop descriptive statistical information presented inform of table, pie chart, histogram, and bar charts. Results: Among 160 participants who were recruited in the study pregnant women aged 25 years or less constituted the majority 53(33.2%) with participants mean age of 22.61 with interquartile range of 18 to 43 years. Majority of the respondents had secondary education level 81 (50.6), while majority of the participants 111 (69.4%) were married. A greater proportion 101 (63.1%) of the pregnant women were Christians. With regard to occupational status, majority were self-employed 74(46.2%). While the majority of the respondents 126(78.8%) had low level of knowledge, 12(7.5%) had moderate level of knowledge and 22(13.8%) had high knowledge of pregnancy induced hypertension. The study found that the prevalence of PIH among pregnant women attending at Makole health center to be 8.1%. Conclusion: Though the prevalence of pregnancy induced hypertension was low, a bigger proportion of these women did not have good knowledge of the disease and its complications. From the study findings the majority of the participants who were found to have experienced PIH had low level of knowledge. However, older pregnant women were ranging from moderate level of knowledge to high level of knowledge compared to the younger pregnant women whom majority of them had low level of knowledge. Also, health care providers should strengthen the awareness of pregnant women about pregnancy-induced hypertension in antenatal care clinics.
{"title":"Assessing Knowledge About Pregnancy Induced Hypertension Among Pregnant Women Attending Antenatal Care at Makole Health Center","authors":"Tienyi M Daniel, DENNIS FRANCIS MROSSO, BARAKA VYAMUNGU, ALLY MACHIMU, HASSANI MWASI, REHEMA RAMADHANI","doi":"10.1101/2024.07.24.24310928","DOIUrl":"https://doi.org/10.1101/2024.07.24.24310928","url":null,"abstract":"Aim: To assess the knowledge regarding pregnancy induced hypertension among pregnant mothers attending antenatal care at Makole health center.\u0000Methods: Analytical cross-section study design involving 160 participants was conducted at Makole health center. Interviewer and self-administered structured questionnaire was used to assess the objectives of the study. coded, checked and then analyzed using Statistical Package for Social Science (SPSS) version 20 so as to develop descriptive statistical information presented inform of table, pie chart, histogram, and bar charts.\u0000Results: Among 160 participants who were recruited in the study pregnant women aged 25 years or less constituted the majority 53(33.2%) with participants mean age of 22.61 with interquartile range of 18 to 43 years. Majority of the respondents had secondary education level 81 (50.6), while majority of the participants 111 (69.4%) were married. A greater proportion 101 (63.1%) of the pregnant women were Christians. With regard to occupational status, majority were self-employed 74(46.2%). While the majority of the respondents 126(78.8%) had low level of knowledge, 12(7.5%) had moderate level of knowledge and 22(13.8%) had high knowledge of pregnancy induced hypertension. The study found that the prevalence of PIH among pregnant women attending at Makole health center to be 8.1%. Conclusion: Though the prevalence of pregnancy induced hypertension was low, a bigger proportion of these women did not have good knowledge of the disease and its complications. From the study findings the majority of the participants who were found to have experienced PIH had low level of knowledge. However, older pregnant women were ranging from moderate level of knowledge to high level of knowledge compared to the younger pregnant women whom majority of them had low level of knowledge. Also, health care providers should strengthen the awareness of pregnant women about pregnancy-induced hypertension in antenatal care clinics.","PeriodicalId":501409,"journal":{"name":"medRxiv - Obstetrics and Gynecology","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141774277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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