BMC Pregnancy and Childbirth最新文献

Introduction: Preeclampsia (PE) is a severe pregnancy complication with limited early diagnostic and therapeutic options. Ferroptosis, an iron-dependent cell death pathway, has emerged as a potential mechanism in PE pathogenesis. This study investigated ferroptosis-related genes (FRGs) in PE to identify diagnostic biomarkers and therapeutic targets.

Methods: Differentially expressed genes were identified from GEO databases and intersected with FRGs. Hub genes were selected using RandomForest and LASSO algorithms. Their diagnostic potential was evaluated through ROC analysis. Regulatory networks were constructed using transcription factors, microRNAs and potential drug targets. Hub gene expression was validated through immunohistochemistry, Western blot, and RT-qPCR in placental tissues and hypoxic trophoblasts.

Results: We identified 25 ferroptosis-related differentially expressed genes enriched in ferroptosis and HIF-1 pathways. Four hub genes (NDRG1, P4HA1, LDHA, and IDO1) showed high diagnostic efficiency (AUC=0.9182). Immune cell analysis revealed altered levels of plasma cells, CD8+ T cells, Tregs, monocytes, and M2 macrophages in PE, correlating significantly with hub gene expression. We identified 84 mRNA-miRNA and 119 mRNA-TF interactions. Among 19 potential drugs, Tetrahydro-NAD showed promising targeting potential. Experimental validation confirmed elevated expression of NDRG1, P4HA1, and LDHA, and decreased IDO1 in PE tissues and hypoxic conditions.

Discussion: This study identified four FRGs as potential PE biomarkers and therapeutic targets, providing new insights into PE pathogenesis through integrated bioinformatics and experimental validation. These findings may facilitate early PE diagnosis and treatment development.

Background: Anxiety is highly prevalent during pregnancy and postpartum, and access to treatment can be difficult due to a range of barriers (e.g., time, distance, and service availability). Online treatments have the potential to circumvent these barriers and may, therefore, be beneficial for the perinatal population. The present study leveraged qualitative methods to understand participants' perspectives on their use of a six-module online self-directed Cognitive Behavioral Therapy (CBT) program for perinatal anxiety as part of a randomized controlled trial.

Methods: A mixed qualitative method design was used for this study. A total of 95 perinatal women were randomized to an intervention or waitlist control condition for an online self-directed program (Overcoming Perinatal Anxiety; OPA). Both waitlist and intervention participants provided open-ended feedback on each module via online surveys. A subset of individuals (n = 20) assigned to the intervention condition completed a virtual qualitative interview about their experiences using the program. Data obtained from open-ended survey questions and qualitative interviews were analyzed using Conventional Content Analysis (open-ended survey) and Reflexive Thematic Analysis (interviews).

Results: Open-ended survey data were categorized into three themes, with associated sub-themes: User experience (subthemes: accessibility and modality), Perceptions of content (sub-themes: validating, informative, hopeful, anxiety-inducing, emotionally "heavy", and helpful), and Barriers to program engagement (subthemes: lack of time and energy, technical difficulties, challenging and external factors). Qualitative interview data were categorized into the following main themes, with associated subthemes: Tensions in engaging with the self-directed program (subthemes: connecting and multi-tasking, "finding the time," module length and pacing, pen to paper, and "thanks for the reminder but don't rush me"), "I'm not alone," (subthemes: relating to the content, sharing anxiety with "inner circle," and voicing a desire to connect with other "moms feeling the same way"), and "I'm managing my anxiety" (subthemes: "understanding my anxiety," using "strategies to help with my anxiety," "taking time for myself," and moving forward).

Conclusion: Findings highlight that online self-directed treatment can be an acceptable and feasible option for perinatal anxiety. Findings show promise for the scalability of OPA to improve access to psychological treatment for perinatal people experiencing anxiety.

Trial registration: Clinical Trial Identifier: NCT04844138 (clinicaltrials.gov). Trial registration submitted: [April 5, 2021] accepted: [April 14, 2021].

Objective: To analyze the reciprocal predictive relationship or quasi-causal relationship between fear of childbirth and antenatal depression in pregnant women via cross-lagged modeling.

Methods: Pregnant women who attended prenatal examinations at a Grade 3 A hospital in Bengbu City, Anhui Province, from November 2022 to March 2023 were randomly selected as the study subjects. A total of 219 pregnant women were followed up longitudinally three times during pregnancy using the General Information Questionnaire, the Wijma Expectation/Experience of Childbirth Questionnaire, and the Edinburgh Postnatal Depression Inventory, and were then statistically analyzed using a cross-lagged model.

Results: The results revealed a positive correlation between maternal fear of childbirth and prenatal depression score on all three measures (r = 0.426, 0.519, 0.420, P < 0.001). Repeated measures ANOVA showed that maternal fear of childbirth tended to gradually increase during pregnancy, while prenatal depression first decreased and then stabilized. The results of the cross-lagged model showed that the T1 and T2 fear of childbirth scores significantly predicted the T2 and T3 prenatal depression scores (β = 0.184, 0.112, P < 0.05). The T1 fear of childbirth score significantly predicted the T2 fear of childbirth score (β = 0.127, P < 0.05), but the T2 fear of childbirth score was not significantly predictive of the T3 fear of childbirth score (β = 0.060, P > 0.05).

Conclusion: Fear of childbirth and antenatal depression interact with each other during pregnancy, and this relationship develops dynamically, with fear of childbirth having a more stable and lasting predictive effect on antenatal depression. Maternal mental health status can be assessed early in pregnancy via our pregnancy health care services to guide targeted interventions throughout the perinatal period.

Objective: This study aimed to develop and evaluate a nomogram for predicting preterm birth in patients with intrahepatic cholestasis of pregnancy (ICP), with a view to assisting clinical management and intervention.

Methods: This retrospective observational study included 257 pregnant women with ICP from Sichuan Provincial People's Hospital between January 1, 2022 and July 30, 2024. The routine clinical and laboratory information of these patients were also collected. We used the least absolute shrinkage and selection operator (LASSO) and multivariable logistic regression analysis to investigate the association between clinical and laboratory data and preterm birth in ICP patients. A nomogram was developed to predict the likelihood of preterm birth in ICP patients. The prediction accuracy of the model was evaluated by consistency index (C-index), receiver operating characteristic (ROC) curve, area under the curve (AUC), and calibration curve. Decision curve analysis (DCA) was used to evaluate its applicability in clinical practice.

Results: Among the 257 ICP patients, 56 (21.79%) were diagnosed with preterm birth. Cases were randomly divided into a training set (154 cases) and a test set (103 cases). A nomogram was developed to predict preterm birth in ICP patients based on height, twin pregnancy (TP), gestational age at diagnosis (GA at diagnosis), and total bile acid level (TBA) at diagnosis. The calibration curve of the training set was close to the diagonal (C-index = 0.864), and the calibration curve of the test set was also close to the diagonal (C-index = 0.835). These results indicate that the model has a good consistency. The AUC of the training group and the test group were 0.864 and 0.836, respectively, indicating the good accuracy of the model. The DCA reveals that this nomogram could be applied to clinical practice.

Conclusion: The combination of TBA level, TP, height and GA at diagnosis is an effective model for identifying preterm birth in ICP patients. These results will help guide the clinical management and treatment of patients with ICP, thereby reducing maternal and infant safety issues caused by preterm birth.

Background: The Non-pneumatic Anti-Shock Garment (NASG) serve as a crucial first-aid device designed to apply pressure to the lower body. This device can save women's lives through reducing blood loss and stabilizing the women until definitive treatment is available. Between 2013 and 2015, health institutions in Ethiopia that implemented the NASG reported reduction of 80% in maternal deaths from haemorrhagic shock.So far, a number of studies have been carried out across various regions of Ethiopia to evaluate the extent of Non-pneumatic Anti-Shock Garment. However, the findings have yielded inconsistent conclusions, particularly in developing countries such as Ethiopia. The aim of this study is, therefore, to assess the pooled prevalence of non-pneumatic anti-shock garment utilization and associated factors in Ethiopia.

Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) checklist was employed in this study. Relevant articles, written in English, were searched in electronic databases like Medline, Embase, Hinari, AJOL, the Web of Science, Google Scholar and SienceDirect. All observational studies completed or published up to May 31, 2023 and reporting on magnitude of non-pneumatic anti-shock garment utilization and its associated factors were included. The first author name, year of publication, region, town, study design, population, sample size, response rate, total cases and prevalence were all extracted using data extraction format. Data were analyzed using STATA V.15 statistical software. We estimated the pooled odds ratio (OR) along with 95% confidence interval (95% CI).

Results: In this review, we included eight published papers comprising 2690 study participants. The estimated pooled utilization of non-pneumatic anti-shock garment was 43.2% (95% CI: 35.88, 50.52; I² = 93.5%; P-value < 0.001). In particular, the availability of the NASG at an institution, receiving training on the NASG and having good knowledge regarding NASG utilization were significantly associated with increased odds for NASG utilization.

Conclusion: The reported estimates of the level of NASG utilization in Ethiopia have remained poor. The availability of the NASG at an institution, receiving training on the NASG, and having good knowledge regarding NASG utilization were significantly associated with NASG utilization in Ethiopia. Therefore, the current study reinforces the need to implement and to scale up the use of the NASG to prevent excessive blood loss after childbirth.

Review registration: Registered in PROSPERO database on April 08, 2023 with registration number of CRD42023412128.

Background: For many women, having a baby is one of the most exciting and rewarding experiences; however, not everyone experiences the same positivity and pleasure when pregnant or having a new baby. For some, the ongoing hormonal and physical changes, mood swings, and personal and familial situations can create a lonely experience that can lead to distress and mental health issues. Wāhine Māori (Māori women) experience greater rates of postnatal distress (PND) and are less likely to seek help than women of European descent. Screening for PND could help identify those at risk of developing mental health issues or distress before it escalates. However, it is unclear how often Māori mothers are screened, or what their experiences of screening are.

Method: Using a Māori-centred approach, we explored the experience of wāhine Māori of mental health screening during the perinatal period.

Results: Eleven wāhine Māori were interviewed about their experiences, with transcripts analysed using thematic analysis. Four themes and 12 subthemes were found in the data. Participants reported feeling a lack of relationship with their midwives, experiencing inconsistent care, lacking trust, that their views were unimportant, fearing judgment, concerns about losing their children to authorities if they disclosed mood issues and a lack of culturally appropriate care.

Conclusions: There was an overall sense of inadequate screening support for mental health concerns among Māori mothers in Aotearoa New Zealand. These results indicate the need for more culturally appropriate screening tools and a genuinely holistic approach to perinatal services encompassing a more whānau-centred approach to maternal care.

Non-communicable diseases (NCDs) represent the leading cause of death and disability worldwide, and those NCDs contributing most burden - cardiometabolic illness, diabetes, cancer, chronic respiratory disease - can be largely prevented through improvements in health behaviours such as tobacco use, harmful use of alcohol, exposure to environmental hazards, unhealthy dietary habits, and physical inactivity. Despite concerted efforts at all levels of health care provision and policy, population-level health behaviour change still presents an ongoing challenge to primary care clinicians, public health practitioners, health promotion specialists and government agencies around the world. An individual's age can influence their health behaviour decision-making as younger people often perceive the potential implications of their current poor health behaviours as remote in time and possibility, which may significantly limit their motivation to make a positive health behaviour change in the present. Yet public health researchers and practitioners recognise that a lifecourse approach to public health policies and interventions has the potential to reduce the risk of NCDs developing before conception and throughout life, as well as impacting the transmission of the benefits of health improvement from one generation to the next. Given the growing awareness of the benefits of a lifecourse approach to public health, a focus on improving preconception health at a population-level provides a unique opportunity for behaviour change motivation, NCD prevention and reducing inequalities across generations. Through this narrative review, we describe how three main public health strategies - health policy, health promotion and health services - may address the challenge of improving preconception health. We also explore the potential value of leveraging parental motivation in the preconception period to achieve positive health behaviour change and, in doing so, meet broader public health goals. We set out a framework for drawing on established public health methods and priorities to address structural inequalities and harness parental motivation and concern for their offspring to build and enable new and positive health behaviours that benefit current and future generations.

Background: Adolescent pregnancy is associated with adverse outcomes, and although there has been a global decline in the incidence of teenage pregnancies and neonatal deaths, the absolute number remains significant. This study aimed to evaluate temporal trends in live births and neonatal deaths from adolescent mothers, as well as to identify the effect of adolescent pregnancy on neonatal death.

Methods: This is a population-based study of all live births from mothers residing in Sao Paulo state, Brazil, between 2004 and 2020. The Prais-Winsten model was used to analyze annual trends for live births from adolescent mothers, neonatal mortality rates, and the percentage of neonatal deaths within specific demographic groups. The Kaplan-Meier survival curve evaluated the time to neonatal death. A Poisson regression model was utilized to identify maternal and neonatal characteristics associated with the risk of neonatal death.

Results: The present study encompassed a total of 9,870,181 live births, with 14.4% occurring to adolescent mothers. There were 75,504 neonatal deaths, with 14,159 (18.8%) of those occurring in the neonates born to adolescent mothers. The annual percentage change in live births to adolescent mothers decreased by -3.03% (95%CI: -4.12% to -1.93%). The neonatal mortality rates showed a declining trend within both adolescent and non-adolescent mothers. Infants born to adolescent mothers had a higher probability of neonatal death and an earlier age of death when compared to non-adolescent mothers' infants. Poisson multiple regression analysis indicated an elevated risk of neonatal death for seven tested variables (adolescent mothers, inadequate prenatal care, multiple gestation, non-hospital delivery, low birth weight, male sex and congenital anomalies) and a reduction on risk of death for neonates born from cesarean section.

Conclusions: The study showed a reduction in live births to adolescent mothers and neonatal deaths among adolescent mothers from 2004 to 2020 in the state of Sao Paulo. Was also shown a risk association between been born to adolescent mothers and neonatal death.

Introduction: Short inter-birth intervals negatively impact maternal and child health; however, data on their prevalence and associated factors in Tanzania are limited. This study investigates the prevalence of short inter-birth intervals and the associated factors among women of reproductive age in Tanzania.

Methods: This was a cross-sectional study utilizing the 2022 Tanzania Demographic and Health Survey and Malaria Indicator Survey dataset. The study population included women aged 15-49 years with at least two births within five years preceding the survey. A short inter-birth interval was defined as a birth occurring < 33 months after the preceding birth. A generalized linear model with Poisson as a link and robust standard errors was used to examine factors associated with short inter-birth intervals. A p-value < 0.05 was considered statistically significant.

Results: A total of 8,350 births from 6,034 women were included in this analysis. The mean (± SD) age of the women was 31.6 ± 6.8 years. The overall prevalence of short inter-birth intervals was 42.6%. Younger age (aPR 3.12, 95% CI 2.88-3.52 for age 15-24 years, and aPR 1.74, 95% CI 1.62-1.1.86 for age 25-34 years), being married (aPR 1.27, 95% CI 1.03-1.57), late age at first childbirth (aPR 1.24, 95% CI 1.17-1.32) for a 20-24 years and aPR 1.55, 95% CI 1.39-1.73 for ≥ 25 years), and higher birth order (aPR 1.02, 95% CI 1.03-1.19; aPR 1.24, 95% CI 1.14-1.34; aPR 1.72, 95% CI 1.58-1.86 for 3rd, 4th, and 5th or more birth orders, respectively, compared to 2nd birth order) were independently associated with short inter-birth intervals. Additionally, there was significant variation in the prevalence of short inter-birth intervals across different zones and levels of household wealth. Women from richer (aPR 0.87, 95% CI: 0.80-0.95) and richest (aPR 0.84, 95% CI: 0.74-0.94) households exhibited a lower prevalence of short inter-birth intervals.

Conclusion: This study highlights the significant prevalence of short inter-birth intervals among women of reproductive age in Tanzania. The associated factors include younger age, marital status, delayed first childbirth, higher birth order, geographical disparities, and lower household wealth. These findings highlight the need for targeted interventions to promote birth spacing and improve maternal and child health outcomes.

Objective: This study aimed to investigate the risk factors and pregnancy outcomes associated with recurrent tuberculosis (TB) during pregnancy among patients with a history of TB who underwent in vitro fertilization and embryo transfer (IVF-ET).

Methods: A retrospective case-control study was conducted at the Reproductive Center of Lanzhou University First Hospital, covering the period from January 2005 to September 2023. The study included infertile patients who had undergo IVF and had a documented history of TB. Patients who experienced recurrent TB during pregnancy were designated as the study group, while those who did not experience recurrence were assigned to the control group, matched at a 1:2 ratio. Both univariate and multivariate analyses were performed to identify risk factors associated with pregnancy outcomes.

Results: Pregnancy and neonatal outcomes were significantly worse among patients in the study group who experienced TB recurrence following IVF-ET. Among the 26 patients in the study group, only four achieved live births, with two neonatal deaths occurring within two months of delivery. Significant risk factors for TB recurrence identified included the GnRH agonist protocol, elevated estradiol and progesterone levels on the trigger day, and twin pregnancies (P < 0.05). Further multivariate analysis confirmed that high estradiol levels (≥ 5000 pg/ml) on the trigger day and twin pregnancies were independent predictors of TB recurrence.

Conclusion: Elevated estradiol levels (≥ 5000 pg/ml) on the day of human chorionic gonadotropin (hCG) trigger, as well as twin pregnancies, have been identified as independent risk factors for recurrent TB among pregnant patients with a history of TB who undergo embryo transfer. Given these findings, it is advisable for such patients to consider single embryo transfer and to utilize frozen embryo transfer cycles to mitigate the associated risks.