BMC Pregnancy and Childbirth最新文献

Antenatal corticosteroids are a well-established treatment for fetal lung maturation before 34 + 0 weeks of gestation. The administration of dexamethasone and betamethasone in late preterm - between 34 + 0 and 36 + 6 weeks of gestation - is still highly debated and subject of recent research. This topic was recently addressed by a retrospective observational cohort study aiming to investigate the benefits, short- and long-term risks of the application of antenatal corticosteroids in the late preterm phase. This commentary will discuss the main findings of the article and its implications for further research.

Background: This study aims to assess anxiety severity among patients with and to elucidate the predominant psychological factors, informing the development of targeted anxiety management strategies.

Methods: The cross-sectional study recruited 421 GDM patients via convenience sampling from Guangdong Province, China. Self-administered questionnaires, including the Pregnancy-related Anxiety Scale, Simplified Coping Style Questionnaire, Type D Personality Scale, Perceived Social Support Scale, and General Self-Efficacy Scale, were utilized to gather data. Data analysis was performed using Structural Equation Modeling (SEM) in AMOS 25.0 and SPSS 25.0.

Results: Among patients with GDM, anxiety was significantly and positively associated with negative coping styles (β = 0.190, P < 0.01) and Type D personality (β = 0.167, P < 0.01), indicating their roles in exacerbating anxiety. In contrast, positive coping (β=-0.136, P < 0.01), perceived social support (β=-0.206, P < 0.01) and general self efficacy (β=-0.49, P < 0.01) had direct negative impacts on anxiety, suggesting their protective influence. Mediation analysis revealed that negative coping and Type D personality exerted significant mediating effects on anxiety, with the pathway from negative coping through Type D personality explaining 16% of the indirect effect (β = 2.302, 95% CI: 1.411 ~ 3.350) and the pathway from Type D personality through perceived social support explaining 32% of the indirect effect (β = 4.528, 95% CI: 3.231 ~ 5.913).

Conclusion: The study identifies key psychological modifiers of anxiety in GDM, suggesting that targeted psychological support could mitigate anxiety and improve pregnancy outcomes.

Background: In previous studies, the incidences of premature births and large for newborn gestational age (LGA ) infants were higher with blastocyst transfer than with cleavage-stage embryo transfer in infants conceived via frozen embryo transfer (FET) cycles. However, those previous studies reported unbalanced baseline characteristics between the blastocyst transfer group and the cleavage embryo transfer group. Therefore, in this study, we used propensity score matching to compare the birth weight and newborn gestational age of live-born singletons between blastocyst and cleavage-stage embryo transfer in FET cycles.

Methods: From January 2018 to April 2023, 706 cases of singleton delivery resulting from FET cycles that met the inclusion and exclusion criteria were included in this study, of which 180 cases resulted from cleavage embryo transfer and 526 cases resulted from blastocyst transfer. Using propensity score matching, we obtained a well-balanced cohort with 173 pairs of cases. We compared the neonatal perinatal outcomes of this cohort, including birth weight and newborn gestational age, which are the primary outcomes. Moreover, we used multivariate linear regression to analyze whether the type of embryo transferred in a FET cycle was correlated with neonatal birth weight or newborn gestational age.

Results: After propensity score matching, there were no significant differences in any of the baseline characteristics between the blastocyst transfer group and cleavage-stage embryo transfer group. There were also no differences between the two groups in terms of the mean birth weight (g) (3380 [3050,3665] vs. 3380 [3002.5,3650], p = 0.941), newborn gestational age (days) (275 [269,280] vs. 275 [270,281], p = 0.282) or other perinatal outcomes. Multiple linear regression analysis revealed that the type of embryo transferred in a FET cycle was not correlated with neonatal birth weight or gestational age.

Conclusions: Blastocyst transfer had perinatal outcomes similar to those of cleavage-stage embryo transfer for live-born singletons in FET cycles and did not influence the mean birth weight or gestational age of the neonates.

Clinical trial number: Not applicable.

Background: Gestational diabetes mellitus (GDM) affects a significant proportion of pregnant women, impacting both physical and psychological well-being. This study aimed to investigate the factors influencing quality of life (QoL) in women with GDM.

Methods: This systematic review followed PRISMA guidelines and was registered in PROSPERO (ID: CRD42024612587). A comprehensive search was conducted in PubMed, Scopus, ProQuest, Web of Science, and CINAHL, using MeSH terms related to gestational diabetes and quality of life. Eligible studies included adult women with gestational diabetes and assessed factors influencing their quality of life. The included studies were related to various stages including antenatal, during pregnancy or postpartum. Data extraction was performed independently by two authors, and study quality was evaluated using the Newcastle-Ottawa Scale (NOS). Statistical analyses were conducted in STATA, including meta-analysis with a random-effects model.

Findings: The findings reveal that women with GDM experience significantly lower QoL compared to healthy pregnant women, with sexual dysfunction being a notable contributor. Women with GDM reported lower sexual desire, satisfaction, and higher pain levels, which were significantly associated with poorer QoL, particularly in mental health and pain domains. Socio-demographic factors such as age, education, income, and marital status were significantly linked to QoL, with younger women and those with lower education or income reporting poorer outcomes. Psychological factors, including stress, depression, and anxiety, negatively impacted QoL, while social support, self-efficacy, and illness acceptance were positively correlated with better QoL outcomes. Additionally, stress was found to be the main predictor of QoL for women over 30, while social relationships were more important for younger women. Treatment with insulin or a combination of insulin and oral hypoglycemic agents was associated with lower QoL compared to dietary management alone.

Conclusion: This systematic review identified key psychosocial and medical factors influencing the quality of life in women with gestational diabetes. The findings emphasize the importance of addressing psychological well-being, social support, and treatment approaches to enhance QoL in these women. Further research is needed to explore interventions targeting mental health and stress management to improve outcomes for women with gestational diabetes.

Background: Preoperative anxiety is a prevalent health issue that, if left unaddressed, may contribute to an elevated risk of perioperative complications. Limited data exist on this concern in Africa, with no studies conducted in Sudan. This research aims to evaluate the prevalence and associated factors of preoperative anxiety in Sudanese women scheduled for elective cesarean delivery.

Methods: A cross-sectional study was conducted among women scheduled for elective cesarean delivery at Gadarif Maternity Hospital. A questionnaire was used to collect sociodemographic and clinical data. The "State-Trait Anxiety Inventory-State" (STAI-S) subscale was used to assess preoperative anxiety.

Results: A total of 234 women participated in this study. The median (interquartile) of their age and parity was 28.0 (24.0-32.0) years and 3 (1-5), respectively. The mean anxiety score on the STAI-S was 41.24, and 96 (41%) of the women exhibited significant anxiety (STAI-S score of 44 or higher). Univariate regression analysis revealed that none of the investigated factors (age, parity, number of antenatal care visits, body mass index, educational level, residence, occupation, history of infertility, history of stillbirth, history of cesarean delivery, history of surgery other than cesarean delivery, family history of surgical complications, and history of blood transfusion) were associated with preoperative anxiety.

Conclusion: This study revealed that 41.0% of women scheduled for elective cesarean delivery experienced significant preoperative anxiety. Interestingly, this anxiety was not found to be associated with any of the factors previously reported to be linked with preoperative anxiety in other countries.

Background: The incidence of inadequate or excessive gestational weight gain (GWG) is an indicator of reproductive health problems. However, scientific evidence for the effect of nutrition education during pregnancy on GWG and neonatal birth weight (BW) in urban settings in Ethiopia is sparse. This study aimed to assess the effect of nutrition education during pregnancy on GWG and neonatal birth weight (BW) in urban settings in Southeast Ethiopia.

Methods: A community-based two-arm parallel cluster randomized controlled trial was conducted among 447 randomly selected pregnant women attending antenatal care (224 intervention and 223 control) from February to December 2021. Study participants were selected by multistage cluster sampling followed by systematic sampling. Women receiving the intervention received six nutrition education sessions, while women in the control group received standard care. GWG was the difference between the last recorded weight before delivery and the weight recorded during the first trimester. BW was measured within the first hour of delivery. The generalized structural equations model (GSEM) and structural equations model (SEM) were used to examine the direct, indirect, and total effects of nutrition education on GWG and BW via the dietary diversity score (DDS), food security (FS), and knowledge.

Results: The GSEM revealed that receiving intervention during pregnancy had a total effect on GWG [(AOR = 2.056, 95% CI: 1.705, 2.695)]. Having dietary diversity had direct and total effects on GWG [(AOR = 1.105, 95% CI: 1.022, 1.196)]. Having food security had a total effect on GWG [(AOR = 1.928, 95% CI: 1.817, 2.052)]. Having fruit and vegetable knowledge had a total effect on GWG [(AOR = 1.971, 95% CI: 1.856, 2.105)]. The SEM revealed that receiving intervention during pregnancy had a direct effect on BW (unstandardized β = 0.144, 95% CI: 0.034, 0.252). Similarly, it revealed that receiving intervention during pregnancy had a direct effect on DDS (β = 0.580, 95% CI: 0.024, 1.038). Likewise, it indicated that receiving intervention during pregnancy had a total effect on increasing BW (β = 0.137, 95% CI: 0.029, 0.243). Nevertheless, there was no statistically observed indirect effect of nutrition education during pregnancy on GWG and BW via mediators.

Conclusion: The SEM revealed that receiving nutrition education interventions during pregnancy had a total effect on GWG and direct and total effects on BW. The generalized structural equation modelling (GSEM) and structural equation modelling (SEM) findings show that integrating theory-based nutrition education during pregnancy will improve gestational weight gain (GWG) and birth weight (BW) in Ethiopia.

Trial registration: The trial was registered on Pan African Clinical Trials Registry (PACTR202201731802989, retrospectively registered on 24/01/ 2022).

Objective: Chromosomal variations are known to play a role in the etiology of fetal growth restriction (FGR). Here, we intend to investigate the significance of Chromosomal Microarray Analysis (CMA) in the prenatal diagnosis of definite FGR.

Method: 182 pregnant women with FGR participated in our study, undergoing CMA to identify chromosomal abnormalities. The cohort was categorized into isolated FGR, FGR with ultrasound soft marker abnormalities, and FGR associated with structural malformations.

Results: The detection rates of PCNVs in FGR with structural anomalies are significantly higher than those in the isolated FGR group and the FGR group with abnormal ultrasound soft markers (19.0% vs. 2.1%, 19% vs. 1.5%; χ²=9.33, p = 0.005). Compared to FGR with a single system malformation, the diagnostic rate of chromosomal variations in FGR with multiple system malformations is markedly increased (60% vs. 6.3%; p = 0.028). Advanced maternal age, early-onset FGR, and severe FGR do not appear to influence the diagnostic rate of chromosomal variations (p > 0.05).

Conclusion: Chromosomal variations pose a significant risk in FGR with structural abnormalities, associated with the number of organ systems involved. Notably, advanced maternal age, early-onset FGR, and severe FGR do not affect the diagnostic rate of chromosomal variations in FGR.

Objectives: Previous studies suggested that immune factors may play critical roles in female infertility, but their causal links remain unclear. To address this gap, this study employs the Mendelian randomization (MR) to delineate the causal association between circulating immune factors and female infertility.

Methods: This study employed summary-level data from three genome-wide association studies (GWAS) encompassing 731 peripheral immune cell signatures, 41 circulating cytokines, and five female infertility phenotypes to reveal the causal relationship between immune factors and female infertility. Causalities of exposure-outcome pairs were explored mainly using two-sample MR, and comprehensive sensitivity analyses were deployed to validate the reliability of the results. Multi-variable Mendelian randomization (MVMR) was further employed to examine the potential mediating effects between significant exposures.

Results: Following false discovery rate (FDR) correction and sensitivity analyses, univariable Mendelian randomization identified distinct causal immune signatures across infertility subtypes. Peripheral levels of Naive CD8br %CD8br, MIP1B and IL17 were causally associated with general female infertility, and higher circulating MIP1B level decreased the risk of ovarian infertility. Furthermore, peripheral levels of CD80 on monocyte and MIP1B were causally associated with a higher risk of tubal infertility, three peripheral immune cell features (CD86 + myeloid DC AC, HLA DR + NK %NK, CD16 on CD14- CD16 + monocyte) were causal for uterine factor infertility, and three cytokines (MIP1B, IL18, IL17) were genetic causes of cervical infertility, vaginal infertility, other or unspecified origin infertility (FIOTHNAS). MVMR further revealed that MIP1B's effects on general female infertility and FIOTHNAS were substantially attenuated upon adjusting for circulating levels of IL17 and IL18.

Conclusion: Our results highlight that immune response contributes to female infertility risk through subtype-specific mechanisms, providing clues for following clinical research and treatment.

Background: Vaginal bleeding (VB) as a common pregnancy problem affects approximately one fourth of pregnancies and leads to abortion in 50% of cases. The occurrence of vaginal bleeding during pregnancy heightens the probability of experiencing diverse adverse pregnancy outcomes. The existing scientific research regarding the relationship between vaginal bleeding and adverse pregnancy outcomes in Iranian women is restricted and presents conflicting findings. Consequently, this research examines the association of vaginal bleeding during pregnancy and unfavorable outcomes in Iranian women.

Methods: This population based retrospective cohort study was conducted in 11 provinces of Iran. The necessary data were collected using the questionnaires and medical records from 3634 pregnant women. The association between vaginal bleeding and stillbirth, premature birth, low birth weight, premature membrane rupture of the membranes (PPROM), gestational diabetes, and pre-eclampsia was done using univariable and multivariable logistic regression.

Results: The prevalence of vaginal bleeding has a declining trend based on BMI and birth cohort of women. Multivariable logistic regression showed that the odds of low birth weight (OR = 1.52, 95%CI: 1.04-2.24), PPROM (OR = 2.12, 95%CI: 1.19-3.76), preterm birth (OR = 1.74, 95%CI: 1.19-2.56), and stillbirth (OR = 2.10, 95%CI: 1.59-2.77) are significantly higher in women who experience vaginal bleeding during pregnancy in compared to women who do not have vaginal bleeding.

Conclusions: Although a declining trend of vaginal bleeding was found, these findings indicate an increased risk of stillbirth, preterm birth, and low birth weight due to VB. Educational interventions to prevent adverse pregnancy outcomes among high-risk women are suggested.

Background: Weight-biased clinical practices and institutional characteristics can have a wide impact on the quality of care provided to women with obesity. This may substantially increase their risks for poor birth outcomes. The current study assessed experienced weight stigma by women during childbirth in maternity care settings in Switzerland. We aimed to identify frequencies, sources, and manifestations of weight-related stigmatization, hypothesizing that such stigma impacts birth outcomes, specifically cesarean birth (CB).

Methods: Data from a nationwide cross-sectional online survey was used to investigate the frequencies, sources, and manifestations of experienced weight stigma during childbirth. Binomial logistic regression was applied to predict CB from experienced weight stigma. Mediation analysis assessed the role of experienced weight stigma in the association between body mass index (BMI) and CB.

Results: In a total of 1352 women who gave birth in the last five years, women with obesity (BMI ≥ 30 kg/m2) experienced weight stigma more often than their peers with healthy weight (BMI 18.5-24.9 kg/m2). Obstetricians were identified as a major source of weight stigma, accounting for 77.8% of stigmatization experienced by women, compared to stigmatization perceived from nurses (21.7%) and midwives (23.8%). Overall, weight stigma was mostly experienced in the form of dismissive or critical comments towards a woman's figure or weight. Significantly more women with obesity indicated being blamed for weight-related risks during childbirth than their healthy-weighted peers (χ²(2) = 22.2, P < 0.001). An increase in the frequency of experienced weight stigma was related to higher odds of intrapartum CB ([aOR], 1.08; 95% CI, 1.02,1.15; P < 0.05), and it partially mediated the relationship between increased pre-pregnancy BMI and CB (b = 0.07, SE = 0.029; P < 0.05).

Conclusion: Women with obesity reported the highest proportion of weight stigmatization during childbirth, experiencing stigma more frequently than women without obesity. This increased frequency of weight stigma was associated with higher odds of CB. Raising awareness among healthcare providers and reducing potential biases and stigmatization may improve care quality and health outcomes for women with obesity.