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A prospective observational study on maternal diet pre- and post-GDM diagnosis and pregnancy outcomes in individuals with/without GDM. 一项前瞻性观察研究,研究对象为确诊为 GDM 前后的母体饮食以及患有/未患有 GDM 的孕妇的妊娠结局。
IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-14 DOI: 10.1186/s12884-024-06961-7
Ying Liu, Nafei Guo, Yawen Dai, Lan Zhang, Junying Li, Xuemei Li, Hui Jiang

Aims: To investigate (1) the association between maternal dietary choices during the first and second trimesters and the diagnosis of gestational diabetes mellitus (GDM), (2) the association between a GDM diagnosis and dietary choices during pregnancy, and (3) the differences in pregnancy outcomes between individuals with and without GDM.

Methods: A prospective cohort study. Pregnant individuals with singleton pregnancy aged 19 ∼ 44 years, without severe pregnancy complications were enrolled in the study. Dietary data were collected at three time points during routine antenatal appointments: 8 ∼ 12 weeks gestation(n = 993), 20 ∼ 24 weeks gestation(n = 732), and 32 ∼ 36 weeks gestation(n = 536). GDM diagnosis and pregnancy outcomes were collected during follow-up from the electronic medical record (EMR).

Results: A total of 93 participants (12.9%) were diagnosed with GDM. Livestock and poultry meat intake during the second trimester were associated with an increased risk of developing GDM (aOR 1.371, 95%CI 1.070-1.756, P = 0.013), and a GDM diagnosis may lead to decreased intake of cereals and its products (P = 0.001), potatoes and its products (P < 0.001), and fruit (P = 0.002) and increased intake of fish, shrimp and shellfish (P = 0.001), eggs (P = 0.015), and milk and milk products (P = 0.011) in the third trimester. Individuals with GDM related to lower risk of excessive gestational weight gain (aOR 0.384, 95%CI 0.188-0.646, P = 0.001) but may increase the risk of fetal macrosomia (aOR 3.873, 95%CI 1.364-10.996, P = 0.011).

Conclusions: Understanding maternal dietary choices around GDM diagnosis is crucial for accurate nutritional assessment and effective education programs. While our findings suggest dietary changes may occur post-diagnosis, further research is needed to confirm these patterns and the potential benefits of early dietary counseling for individuals with GDM.

目的:研究(1)孕期前三个月和后三个月孕妇饮食选择与妊娠糖尿病(GDM)诊断之间的关系;(2)GDM诊断与孕期饮食选择之间的关系;(3)GDM患者与非GDM患者妊娠结局的差异:前瞻性队列研究。方法:这是一项前瞻性队列研究。研究对象为年龄 19 ∼ 44 岁、无严重妊娠并发症的单胎孕妇。在常规产前检查的三个时间点收集饮食数据:妊娠 8 ∼ 12 周(993 人)、妊娠 20 ∼ 24 周(732 人)和妊娠 32 ∼ 36 周(536 人)。随访期间从电子病历(EMR)中收集 GDM 诊断和妊娠结果:结果:共有 93 人(12.9%)被确诊为 GDM。结果:共有 93 名参与者(12.9%)被确诊为 GDM,妊娠后三个月畜肉和禽肉摄入量与 GDM 发生风险增加有关(aOR 1.371,95%CI 1.070-1.756,P = 0.013),GDM 诊断可能导致谷物及其制品(P = 0.001)、马铃薯及其制品(P 结论:妊娠后三个月畜肉和禽肉摄入量与 GDM 发生风险增加有关(aOR 1.371,95%CI 1.070-1.756,P = 0.013):了解确诊 GDM 时产妇的饮食选择对于准确的营养评估和有效的教育计划至关重要。虽然我们的研究结果表明确诊后饮食可能会发生变化,但还需要进一步的研究来证实这些模式以及早期饮食咨询对 GDM 患者的潜在益处。
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引用次数: 0
Evaluation of fetal heart size, morphology and function with fetal growth restriction using fetal HQ. 利用胎儿 HQ 评估胎儿生长受限时胎儿心脏的大小、形态和功能。
IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-14 DOI: 10.1186/s12884-024-06966-2
Yunqi Chen, Xiaoli Lv, Lijuan Yang, Dan Hu, Min Ren

Background: Fetal growth restriction (FGR) is associated with various perinatal complications. Limited research has focused on the fetal heart in the context of FGR. This study aimed to investigate the application value of fetal heart quantification (HQ) technology in evaluating the size, morphology, and function of the heart in FGR.

Methods: A total of 31 fetuses diagnosed with FGR in our hospital from April 2022 to May 2024 were included, alongside another 31 normal fetuses matched for gestational age as the control group. Ultrasound Doppler parameters of the middle cerebral artery (MCA), umbilical artery (UA), venous catheter, and fetal HQ parameters were collected for comparative analysis, and perinatal data were followed up.

Results: Fetuses with FGR exhibited significant differences in various parameters of the MCA and UA compared to the control group (P < 0.05). The four-chamber view end-diastolic transverse width, end-diastolic area, left ventricular (LV) end-diastolic area, end-systolic area, end-systolic length, end-diastolic volume, end-systolic volume, and right ventricular (RV) end-systolic area in the FGR group were significantly lower than those in the control group (P < 0.05). In the 24-segment analysis, the LV fractional shortening in the FGR group was greater than in the control group at segments 12 to 14, while the end-diastolic diameter (ED) at segments 5 to 13 of the LV and segments 1 to 14 of the RV were smaller than those in the control group, with statistical significance (P < 0.05). Analysis of each subgroup indicated that fractional shortening (FS) in the early-onset group was significantly greater than in the late-onset group at RV segments 2 to 8. LV-ED at segments 1 to 15 and RV-ED at segments 1 to 16 were significantly smaller in the early-onset group than in the control group, and LV ED segments 20 to 21 were significantly smaller in the early-onset group compared to the late-onset group (P < 0.05). FS in the mild group was significantly larger than in the normal group at LV segments 10 to 16. The severe group exhibited significantly smaller LV segment 2 to 11 ED and the mild group showed smaller RV segments 1 to 13 compared to the control group (P < 0.05).

Conclusions: Fetal HQ is a promising technique for evaluating the cardiac function, size, and morphology in cases of FGR.

背景:胎儿生长受限(FGR)与各种围产期并发症有关。目前针对胎儿心脏的研究还很有限。本研究旨在探讨胎儿心脏定量(HQ)技术在评估FGR胎儿心脏大小、形态和功能方面的应用价值:方法:选取我院2022年4月至2024年5月期间确诊为FGR的31例胎儿作为研究对象,同时选取胎龄匹配的31例正常胎儿作为对照组。收集大脑中动脉(MCA)、脐动脉(UA)、静脉导管的超声多普勒参数和胎儿HQ参数进行对比分析,并对围产期数据进行随访:结果:与对照组相比,FGR 胎儿的 MCA 和 UA 各项参数均有显著差异(P 结论:胎儿 HQ 是一种很有前途的胎儿 HQ 检测方法:胎儿 HQ 是一种评估 FGR 胎儿心脏功能、大小和形态的有效技术。
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引用次数: 0
The role of neighborhood on preterm birth among a high-risk group of birthing people in Boston, MA. 邻里关系对马萨诸塞州波士顿市高危人群早产的影响。
IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-14 DOI: 10.1186/s12884-024-06957-3
Yarden S Fraiman, Serena A Rusk, Janet Rich-Edwards, Xiaboin Wang, Jonathan S Litt

Background: Preterm birth (PTB) is associated with adverse short- and long-term health. There are known racial, ethnic, and socioeconomic inequities in PTB. Because of historical de jure and modern-day de facto segregation and neighborhood divestment, neighborhoods are a source of structural racism and disenfranchisement and a potential target for policies and interventions to reduce PTB inequity. However, the role of neighborhoods on PTB, specifically among high-risk birthing people, is largely unexplored.

Methods: The Boston Birth Cohort is a longitudinal birth cohort of birthing people-infant dyads at a safety-net hospital in Boston, MA between 2000 and 2018. The primary outcome was preterm birth at 35 weeks or prior. The primary predictor was neighborhood defined by census tract. We used generalized linear mixed effects models to test our hypothesis that neighborhood accounts for a signficiant proportion of PTB risk among socially at-risk birthing people.

Results: In multilevel models, neighborhoods were a significant predictor of preterm birth, yet accounted for only 3% of the variability in outcome. In models stratified by race, individual-level factors such as prior preterm birth, nativity status, and advanced birthing person age were significant predictors of PTB.

Conclusions: Neighborhood is a significant, though small, predictor of preterm birth in a high-risk birthing population. These findings suggest that individual-level interventions, rather than neighborhood-level policies, may be more effective in reducing preterm birth among high-risk birthing populations.

背景:早产(PTB)与不利的短期和长期健康有关。众所周知,早产在种族、民族和社会经济方面存在不平等。由于历史上和现代事实上的种族隔离和邻里撤资,邻里是结构性种族主义和剥夺公民权的根源,也是减少早产不平等的政策和干预措施的潜在目标。然而,街区对婴儿出生后不平等的作用,特别是在高危分娩人群中的作用,在很大程度上还没有被研究:波士顿出生队列是马萨诸塞州波士顿市一家安全网医院在 2000 年至 2018 年期间对分娩者-婴儿二元组进行的纵向出生队列研究。主要结果是 35 周或之前的早产。主要预测因素是由人口普查区定义的邻里关系。我们使用广义线性混合效应模型来检验我们的假设,即邻里关系在社会高危分娩人群的早产风险中占很大比例:在多层次模型中,邻里关系是早产的重要预测因素,但只占结果变化的 3%。在按种族分层的模型中,个人层面的因素,如之前的早产、出生状况和高龄产妇年龄,都是早产的重要预测因素:结论:在高危分娩人群中,邻里关系是早产的一个重要预测因素,尽管其影响较小。这些研究结果表明,个人层面的干预措施,而不是邻里层面的政策,可能会更有效地减少高危分娩人群中的早产现象。
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引用次数: 0
Administration patterns of magnesium sulphate for women with preeclampsia and immediate newborn outcomes in Kawempe National Referral Hospital-Uganda: a cohort study. 乌干达 Kawempe 国家转诊医院对子痫前期妇女的硫酸镁给药模式和新生儿即刻预后:一项队列研究。
IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-14 DOI: 10.1186/s12884-024-06915-z
Mariam Birungi, Jane Nakibuuka, Mark Kaddumukasa, Josephine Najjuma, Christopher J Burant, Shirley Moore, Carol Blixen, Elly T Katabira, Martha Sajatovic, Scovia Nalugo Mbalinda

Background: Preeclampsia is the second leading cause of maternal death in Uganda. WHO recommends using magnesium sulphate (MgSO4) to prevent and treat preeclampsia with severe features (PEC) and eclampsia. MgSO4 is used to prevent eclampsia and treat women who experience an eclamptic convulsion to avoid severe maternal/infant illnesses and death. We set out to assess MgSO4 administration patterns in women with PEC or eclampsia and the immediate newborn outcomes of neonates.

Methods: This was an analytical observational cohort study at Kawempe National Referral Hospital in Uganda. Two hundred ten pregnant mothers with PEC or eclampsia were recruited in the study after receiving the loading dose of MgSO4 and then followed through labour and delivery to observe MgSO4 administration patterns and immediate newborn outcomes using Apgar and Thompson scores. SPSS version 23 was used to analyse data, and both bivariate and multivariate logistic regressions were used to determine factors associated with the low Apgar score at five minutes.

Results: Overall, majority of the patients received more than one dose with 33.3% received a sixth dose of MgSO4. The majority, 84.8%, of the mothers delivered live babies, 31.0% babies had complications, and were admitted to the neonatal intensive care unit (NICU). NICU admissions were mostly due to respiratory distress21.4%, preterm delivery21.0%, and 5.5% died within seven days. Majority 93.3% of the newborns had an Apgar score of seven and above at five minutes, of the newborns who were Thompson scored, 70.4% scored between 1 to 10 which is mild HIE. Initiation of MgSO4 treatment within one hour from prescription (AOR = 0.49, CI: 0.01-1.94), 4-hourly timing of the first maintenance dose (AOR = 0.22, CI: 0.06-0.79) and having complete doses of MgSO4 treatment (AOR = 0.89, CI: 0.03-3.05) decreased the likelihood of having low Apgar scores at five minutes.

Conclusions: Timely administration of the first maintenance dose of MgSO4 decreases the likelihood of low Apgar score at 5 min and NICU admission in newborns, and most NICU admissions were due to respiratory distress and preterm delivery.

背景介绍子痫前期是乌干达产妇死亡的第二大原因。世卫组织建议使用硫酸镁(MgSO4)预防和治疗重度子痫前期(PEC)和子痫。硫酸镁用于预防子痫和治疗子痫抽搐的妇女,以避免严重的母婴疾病和死亡。我们旨在评估 PEC 或子痫产妇的 MgSO4 给药模式以及新生儿的即时预后:这是一项在乌干达 Kawempe 国家转诊医院进行的分析性观察队列研究。研究招募了 210 名患有先兆子痫或子痫的孕产妇,她们在接受了硫酸镁的负荷剂量后,在整个分娩过程中接受了跟踪,以观察硫酸镁的给药模式和新生儿的即时预后(使用阿普加评分和汤普森评分)。研究使用 SPSS 23 版进行数据分析,并使用二元和多元逻辑回归来确定与 5 分钟时 Apgar 评分低相关的因素:总体而言,大多数患者接受了一次以上的剂量,33.3%的患者接受了第六次剂量的硫酸镁。大多数(84.8%)产妇产下活婴,31.0%的婴儿出现并发症,被送入新生儿重症监护室(NICU)。入住新生儿重症监护室的原因主要是呼吸窘迫21.4%,早产21.0%,5.5%的婴儿在七天内死亡。大多数 93.3% 的新生儿在 5 分钟内的阿普加评分为 7 分及以上,在汤普森评分的新生儿中,70.4% 的评分在 1-10 分之间,属于轻度 HIE。在处方后一小时内开始 MgSO4 治疗(AOR = 0.49,CI:0.01-1.94)、4 小时内开始首次维持剂量(AOR = 0.22,CI:0.06-0.79)以及完成 MgSO4 治疗剂量(AOR = 0.89,CI:0.03-3.05)可降低 5 分钟时出现低 Apgar 评分的可能性:结论:及时给予首个维持剂量的硫酸镁可降低新生儿5分钟后出现低Apgar评分和进入新生儿重症监护室的可能性,大多数新生儿进入新生儿重症监护室的原因是呼吸窘迫和早产。
{"title":"Administration patterns of magnesium sulphate for women with preeclampsia and immediate newborn outcomes in Kawempe National Referral Hospital-Uganda: a cohort study.","authors":"Mariam Birungi, Jane Nakibuuka, Mark Kaddumukasa, Josephine Najjuma, Christopher J Burant, Shirley Moore, Carol Blixen, Elly T Katabira, Martha Sajatovic, Scovia Nalugo Mbalinda","doi":"10.1186/s12884-024-06915-z","DOIUrl":"10.1186/s12884-024-06915-z","url":null,"abstract":"<p><strong>Background: </strong>Preeclampsia is the second leading cause of maternal death in Uganda. WHO recommends using magnesium sulphate (MgSO4) to prevent and treat preeclampsia with severe features (PEC) and eclampsia. MgSO4 is used to prevent eclampsia and treat women who experience an eclamptic convulsion to avoid severe maternal/infant illnesses and death. We set out to assess MgSO4 administration patterns in women with PEC or eclampsia and the immediate newborn outcomes of neonates.</p><p><strong>Methods: </strong>This was an analytical observational cohort study at Kawempe National Referral Hospital in Uganda. Two hundred ten pregnant mothers with PEC or eclampsia were recruited in the study after receiving the loading dose of MgSO4 and then followed through labour and delivery to observe MgSO4 administration patterns and immediate newborn outcomes using Apgar and Thompson scores. SPSS version 23 was used to analyse data, and both bivariate and multivariate logistic regressions were used to determine factors associated with the low Apgar score at five minutes.</p><p><strong>Results: </strong>Overall, majority of the patients received more than one dose with 33.3% received a sixth dose of MgSO4. The majority, 84.8%, of the mothers delivered live babies, 31.0% babies had complications, and were admitted to the neonatal intensive care unit (NICU). NICU admissions were mostly due to respiratory distress21.4%, preterm delivery21.0%, and 5.5% died within seven days. Majority 93.3% of the newborns had an Apgar score of seven and above at five minutes, of the newborns who were Thompson scored, 70.4% scored between 1 to 10 which is mild HIE. Initiation of MgSO4 treatment within one hour from prescription (AOR = 0.49, CI: 0.01-1.94), 4-hourly timing of the first maintenance dose (AOR = 0.22, CI: 0.06-0.79) and having complete doses of MgSO4 treatment (AOR = 0.89, CI: 0.03-3.05) decreased the likelihood of having low Apgar scores at five minutes.</p><p><strong>Conclusions: </strong>Timely administration of the first maintenance dose of MgSO4 decreases the likelihood of low Apgar score at 5 min and NICU admission in newborns, and most NICU admissions were due to respiratory distress and preterm delivery.</p>","PeriodicalId":9033,"journal":{"name":"BMC Pregnancy and Childbirth","volume":"24 1","pages":"753"},"PeriodicalIF":2.8,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11566436/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142614061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A systematic literature review on how consumer and community involvement have shaped and influenced pre-pregnancy care interventions for women with diabetes. 关于消费者和社区参与如何塑造和影响糖尿病妇女孕前护理干预措施的系统性文献综述。
IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-13 DOI: 10.1186/s12884-024-06951-9
Rachel Hicks, Tinashe Dune, Veronica Gu, David Simmons, Freya MacMillan

Background: Diabetes and pregnancy studies have found better outcomes when interventions were developed with consumer (individuals with lived experience of diabetes) and community involvement. When consumers are central to development and delivery of interventions, study participants have better engagement and outcomes, particularly for individuals from culturally and linguistically diverse (CALD) and/or lower socio-economic backgrounds. Our study aims to examine the scope of consumer and community involvement (CCI) in the construction and implementation of pre-pregnancy care (PPC) interventions and discuss a framework for consumer-lead intervention development.

Methods: A systematic literature review was conducted, examining 3 electronic databases. A meta synthesis analysis of tabulated data summarized in a literature matrix was undertaken with a phenomenological approach to develop a Pre-Pregnancy Care CCI-Driven Intervention Framework.

Results: Overall, 4642 papers were identified, with 29 meeting inclusion criteria. The meta-synthesis and literature matrix identified several common themes across previous studies. These were: barriers to accessing (PPC) such as negativity and stigma in care from behaviours, attitudes and perceptions of HCPs; limited appointment availability not aligning with work and family commitments; fear of losing a "normal" pregnancy journey; awareness of risk but unwillingness to discuss if consumers have not established trust with HCPs; inaccessibility to CALD appropriate PPC and contraception; and digitisation of PPC information resources including peer support and social media. From these results, a PPC Consumer-Driven Intervention Framework for Women with Pregestational Diabetes was developed with recommendations.

Conclusion: Consumers have been under-involved in the majority of previous developments and implementation of interventions for women with diabetes and pregnancy, and their representation as stakeholders in interventions is paramount to the longevity of intervention outcomes. To assist community involvement in diabetes pregnancy intervention design and delivery we created a new framework, for improving clinical and social outcomes in healthcare, empowering relationships between HCPs and consumers, and highlighting the value of lived experience and women-centred care for increased community engagement.

背景:糖尿病和妊娠研究发现,如果干预措施是在消费者(有糖尿病生活经验的人)和社区参与下制定的,则会取得更好的效果。当消费者成为干预措施制定和实施的核心时,研究参与者的参与度和结果都会更好,尤其是来自文化和语言多样性(CALD)和/或社会经济背景较差的个人。我们的研究旨在考察消费者和社区参与(CCI)在孕前保健(PPC)干预措施的构建和实施中的范围,并讨论消费者主导干预措施开发的框架:方法:对 3 个电子数据库进行了系统的文献综述。方法:对 3 个电子数据库进行了系统的文献综述,并采用现象学方法对汇总在文献矩阵中的表格数据进行了元综合分析,以制定孕前护理 CCI 驱动的干预框架:共发现 4642 篇论文,其中 29 篇符合纳入标准。元综合和文献矩阵在以往的研究中发现了几个共同的主题。这些主题是:获得(PPC)的障碍,如保健医生的行为、态度和观念对护理的否定和污名化;预约时间有限,与工作和家庭承诺不一致;害怕失去 "正常 "的怀孕旅程;意识到风险,但如果消费者没有与保健医生建立信任,则不愿意讨论;无法获得 CALD 适宜的 PPC 和避孕方法;以及 PPC 信息资源的数字化,包括同伴支持和社交媒体。根据这些结果,我们为患有妊娠糖尿病的妇女制定了以消费者为导向的 PPC 干预框架,并提出了建议:结论:在以往针对女性糖尿病患者和孕妇的干预措施的开发和实施过程中,消费者的参与度一直较低,而他们作为利益相关者在干预措施中的代表性对于干预措施成果的持久性至关重要。为了帮助社区参与糖尿病妊娠干预措施的设计和实施,我们创建了一个新的框架,以改善医疗保健的临床和社会成果,增强保健医生和消费者之间的关系,并强调生活经验和以妇女为中心的护理对提高社区参与度的价值。
{"title":"A systematic literature review on how consumer and community involvement have shaped and influenced pre-pregnancy care interventions for women with diabetes.","authors":"Rachel Hicks, Tinashe Dune, Veronica Gu, David Simmons, Freya MacMillan","doi":"10.1186/s12884-024-06951-9","DOIUrl":"10.1186/s12884-024-06951-9","url":null,"abstract":"<p><strong>Background: </strong>Diabetes and pregnancy studies have found better outcomes when interventions were developed with consumer (individuals with lived experience of diabetes) and community involvement. When consumers are central to development and delivery of interventions, study participants have better engagement and outcomes, particularly for individuals from culturally and linguistically diverse (CALD) and/or lower socio-economic backgrounds. Our study aims to examine the scope of consumer and community involvement (CCI) in the construction and implementation of pre-pregnancy care (PPC) interventions and discuss a framework for consumer-lead intervention development.</p><p><strong>Methods: </strong>A systematic literature review was conducted, examining 3 electronic databases. A meta synthesis analysis of tabulated data summarized in a literature matrix was undertaken with a phenomenological approach to develop a Pre-Pregnancy Care CCI-Driven Intervention Framework.</p><p><strong>Results: </strong>Overall, 4642 papers were identified, with 29 meeting inclusion criteria. The meta-synthesis and literature matrix identified several common themes across previous studies. These were: barriers to accessing (PPC) such as negativity and stigma in care from behaviours, attitudes and perceptions of HCPs; limited appointment availability not aligning with work and family commitments; fear of losing a \"normal\" pregnancy journey; awareness of risk but unwillingness to discuss if consumers have not established trust with HCPs; inaccessibility to CALD appropriate PPC and contraception; and digitisation of PPC information resources including peer support and social media. From these results, a PPC Consumer-Driven Intervention Framework for Women with Pregestational Diabetes was developed with recommendations.</p><p><strong>Conclusion: </strong>Consumers have been under-involved in the majority of previous developments and implementation of interventions for women with diabetes and pregnancy, and their representation as stakeholders in interventions is paramount to the longevity of intervention outcomes. To assist community involvement in diabetes pregnancy intervention design and delivery we created a new framework, for improving clinical and social outcomes in healthcare, empowering relationships between HCPs and consumers, and highlighting the value of lived experience and women-centred care for increased community engagement.</p>","PeriodicalId":9033,"journal":{"name":"BMC Pregnancy and Childbirth","volume":"24 1","pages":"748"},"PeriodicalIF":2.8,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11562801/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142614055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Nutritional status and factors associated with gestational weight gain in the city of São Paulo, 2012 to 2020: a retrospective cohort study. 2012年至2020年圣保罗市妊娠体重增加的营养状况和相关因素:一项回顾性队列研究。
IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-13 DOI: 10.1186/s12884-024-06955-5
Fernanda Ferreira Corrêa, Eliana de Aquino Bonilha, Wesley Pereira da Silva, Tarcisio Cantos de Melo, Marcus V L Dos Santos Quaresma, Carmen Simone G Diniz

Background: Gestational weight gain (GWG) is a critical issue related to postpartum health in newborns and mothers. In Brazil, pregnant women's public health recommends monitoring GWG. Therefore, the objective of this study is to evaluate gestational weight gain and associated health factors of pregnant women monitored at Unified Health System (SUS) in the city of São Paulo between 2012 and 2020.

Methods: This is a retrospective cohort study of pregnant women seen from 2012 to 2020 in São Paulo, Brazil. The database used was from the Integrated Health Care Management System related to the Live Birth Information System. Data distribution was assessed using the Kolmogorov-Smirnov test. Comparisons between groups according to weight gain (LWG vs. AWG vs. EWG) were performed using analysis of variance (ANOVA) with Tukey post hoc. Inclusion criteria considered that pregnant women had a recorded initial weight before 13 weeks and up to 15 days before delivery and a single pregnancy. The final database includes 276.220 pregnant women.

Results: The frequency of women according to initial body mass index (BMI) was 12.004 (4.4%) underweight, 132.049 (48.3%) normal weight, 78.856 (28.8%) overweight, and 50.660 (18.5%) living with obesity. The population consisted of 59.881 (21.9%), 37.217 (13.6%) and 176.471 (64.5%) women with LWG, AWG and EWG, respectively. Weight gain was associated with initial BMI, type of birth, color/ethnicity, marital status, women's age and antenatal care visits.

Conclusion: The proportion of pregnant women with inadequate weight gain is high, relating initial BMI, type of birth, color/ethnicity, marital status, women's age and antenatal care visits. Interventions such as nutritional education should be suggested to help achieve adequate GWG.

背景:妊娠体重增加(GWG)是关系到新生儿和母亲产后健康的一个关键问题。在巴西,孕妇的公共卫生建议监测妊娠体重增加。因此,本研究旨在评估 2012 年至 2020 年期间圣保罗市统一卫生系统(SUS)监测的孕妇的妊娠体重增加和相关健康因素:这是一项回顾性队列研究,对象是2012年至2020年期间在巴西圣保罗就诊的孕妇。所使用的数据库来自与活产信息系统相关的综合医疗保健管理系统。数据分布采用 Kolmogorov-Smirnov 检验进行评估。根据体重增加情况(LWG vs. AWG vs. EWG)进行组间比较,采用方差分析(ANOVA),Tukey post hoc。纳入标准为孕妇的初始体重记录在 13 周前至分娩前 15 天内,且为单胎妊娠。最终数据库包括 276 220 名孕妇:根据初始体重指数(BMI),12.004(4.4%)名孕妇体重不足,132.049(48.3%)名孕妇体重正常,78.856(28.8%)名孕妇体重超重,50.660(18.5%)名孕妇患有肥胖症。人群中分别有 59.881(21.9%)、37.217(13.6%)和 176.471(64.5%)名女性患有 LWG、AWG 和 EWG。体重增加与初始体重指数、分娩类型、肤色/种族、婚姻状况、妇女年龄和产前检查次数有关:结论:体重增加不足的孕妇比例很高,这与初始体重指数、分娩类型、肤色/种族、婚姻状况、妇女年龄和产前检查次数有关。应建议采取营养教育等干预措施,以帮助实现适当的体重增长。
{"title":"Nutritional status and factors associated with gestational weight gain in the city of São Paulo, 2012 to 2020: a retrospective cohort study.","authors":"Fernanda Ferreira Corrêa, Eliana de Aquino Bonilha, Wesley Pereira da Silva, Tarcisio Cantos de Melo, Marcus V L Dos Santos Quaresma, Carmen Simone G Diniz","doi":"10.1186/s12884-024-06955-5","DOIUrl":"10.1186/s12884-024-06955-5","url":null,"abstract":"<p><strong>Background: </strong>Gestational weight gain (GWG) is a critical issue related to postpartum health in newborns and mothers. In Brazil, pregnant women's public health recommends monitoring GWG. Therefore, the objective of this study is to evaluate gestational weight gain and associated health factors of pregnant women monitored at Unified Health System (SUS) in the city of São Paulo between 2012 and 2020.</p><p><strong>Methods: </strong>This is a retrospective cohort study of pregnant women seen from 2012 to 2020 in São Paulo, Brazil. The database used was from the Integrated Health Care Management System related to the Live Birth Information System. Data distribution was assessed using the Kolmogorov-Smirnov test. Comparisons between groups according to weight gain (LWG vs. AWG vs. EWG) were performed using analysis of variance (ANOVA) with Tukey post hoc. Inclusion criteria considered that pregnant women had a recorded initial weight before 13 weeks and up to 15 days before delivery and a single pregnancy. The final database includes 276.220 pregnant women.</p><p><strong>Results: </strong>The frequency of women according to initial body mass index (BMI) was 12.004 (4.4%) underweight, 132.049 (48.3%) normal weight, 78.856 (28.8%) overweight, and 50.660 (18.5%) living with obesity. The population consisted of 59.881 (21.9%), 37.217 (13.6%) and 176.471 (64.5%) women with LWG, AWG and EWG, respectively. Weight gain was associated with initial BMI, type of birth, color/ethnicity, marital status, women's age and antenatal care visits.</p><p><strong>Conclusion: </strong>The proportion of pregnant women with inadequate weight gain is high, relating initial BMI, type of birth, color/ethnicity, marital status, women's age and antenatal care visits. Interventions such as nutritional education should be suggested to help achieve adequate GWG.</p>","PeriodicalId":9033,"journal":{"name":"BMC Pregnancy and Childbirth","volume":"24 1","pages":"746"},"PeriodicalIF":2.8,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11562861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142614135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The effect of diabetes education on maternal and neonatal outcomes in pregnant women diagnosed with gestational diabetes. 糖尿病教育对确诊妊娠糖尿病孕妇的产妇和新生儿预后的影响。
IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-13 DOI: 10.1186/s12884-024-06971-5
Serap Topkara, Çağanay Soysal

Background: Education during pregnancy is important for the development of the pregnant woman's ability to adapt to change and for a healthy birth. In this study, we aimed to examine the effects of education through a diabetes education program on maternal and newborn health in women diagnosed with gestational diabetes.

Materials and methods: In our study, we compared the maternal and neonatal health outcomes of pregnant women who participated in the diabetes education program and were diagnosed with gestational diabetes with the outcomes of pregnant women who did not participate in the diabetes education program and were diagnosed with gestational diabetes. The study included patients who were diagnosed with diabetes between 24and 26 weeks gestation at a tertiary education and research hospital and who underwent a 75-gram OGTT test. Age, BMI, parity, method of delivery, weight gain during pregnancy, newborn birth weight, gestational age and Apgar scores were compared.

Results: The study included 119 patients and analyzed maternal-neonatal outcomes. There were no statistically significant differences in age (33 ± 5.7 versus 31 ± 5.2), body mass index (BMI) (32.2 vs. 31.2), gravidity, parity, number of miscarriages, mode of delivery, family history of diabetes, smoking, prenatal corticosteroid use, and gestational age at delivery. The HbA1c value (p: 0.013), the total weight gain during pregnancy (p: 0.015), the need for insulin treatment (p: 0.002), and the birth weight (0.005) were significantly higher in the group without diabetes education.

Conclusion: In our study, diabetic school education was associated with lower HbA1c levels, less weight gain and less need for insulin therapy. When the results were categorized by insulin use, it was found that in patients using insulin, those who received diabetic school education had fewer macrosomic fetuses, whereas in patients not using insulin, those who received diabetic school education had lower maternal weight gain during pregnancy.

背景:孕期教育对于培养孕妇适应变化的能力和健康分娩非常重要。在这项研究中,我们旨在研究通过糖尿病教育计划对确诊患有妊娠糖尿病的妇女的孕产妇和新生儿健康的影响:在研究中,我们比较了参加糖尿病教育计划并被诊断为妊娠糖尿病的孕妇与未参加糖尿病教育计划并被诊断为妊娠糖尿病的孕妇的孕产妇和新生儿健康结果。研究对象包括在一家三级教育研究医院妊娠 24 至 26 周期间被诊断为糖尿病并接受 75 克 OGTT 测试的患者。比较了年龄、体重指数、胎次、分娩方式、孕期体重增加、新生儿出生体重、胎龄和阿普加评分:研究共纳入 119 名患者,分析了母婴结局。在年龄(33 ± 5.7 对 31 ± 5.2)、体重指数(BMI)(32.2 对 31.2)、孕期、奇偶数、流产次数、分娩方式、糖尿病家族史、吸烟、产前使用皮质类固醇和分娩时的胎龄方面,差异无统计学意义。未接受糖尿病教育组的 HbA1c 值(P:0.013)、孕期总体重增加(P:0.015)、胰岛素治疗需求(P:0.002)和出生体重(0.005)均显著高于未接受糖尿病教育组:在我们的研究中,糖尿病学校教育与较低的 HbA1c 水平、较少的体重增加和较少的胰岛素治疗需求有关。根据使用胰岛素的情况对结果进行分类后发现,在使用胰岛素的患者中,接受糖尿病学校教育者的巨大胎儿较少,而在未使用胰岛素的患者中,接受糖尿病学校教育者的孕期体重增加较少。
{"title":"The effect of diabetes education on maternal and neonatal outcomes in pregnant women diagnosed with gestational diabetes.","authors":"Serap Topkara, Çağanay Soysal","doi":"10.1186/s12884-024-06971-5","DOIUrl":"10.1186/s12884-024-06971-5","url":null,"abstract":"<p><strong>Background: </strong>Education during pregnancy is important for the development of the pregnant woman's ability to adapt to change and for a healthy birth. In this study, we aimed to examine the effects of education through a diabetes education program on maternal and newborn health in women diagnosed with gestational diabetes.</p><p><strong>Materials and methods: </strong>In our study, we compared the maternal and neonatal health outcomes of pregnant women who participated in the diabetes education program and were diagnosed with gestational diabetes with the outcomes of pregnant women who did not participate in the diabetes education program and were diagnosed with gestational diabetes. The study included patients who were diagnosed with diabetes between 24and 26 weeks gestation at a tertiary education and research hospital and who underwent a 75-gram OGTT test. Age, BMI, parity, method of delivery, weight gain during pregnancy, newborn birth weight, gestational age and Apgar scores were compared.</p><p><strong>Results: </strong>The study included 119 patients and analyzed maternal-neonatal outcomes. There were no statistically significant differences in age (33 ± 5.7 versus 31 ± 5.2), body mass index (BMI) (32.2 vs. 31.2), gravidity, parity, number of miscarriages, mode of delivery, family history of diabetes, smoking, prenatal corticosteroid use, and gestational age at delivery. The HbA1c value (p: 0.013), the total weight gain during pregnancy (p: 0.015), the need for insulin treatment (p: 0.002), and the birth weight (0.005) were significantly higher in the group without diabetes education.</p><p><strong>Conclusion: </strong>In our study, diabetic school education was associated with lower HbA1c levels, less weight gain and less need for insulin therapy. When the results were categorized by insulin use, it was found that in patients using insulin, those who received diabetic school education had fewer macrosomic fetuses, whereas in patients not using insulin, those who received diabetic school education had lower maternal weight gain during pregnancy.</p>","PeriodicalId":9033,"journal":{"name":"BMC Pregnancy and Childbirth","volume":"24 1","pages":"747"},"PeriodicalIF":2.8,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11562731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142614101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Adaptation and psychometric evaluation of the breastfeeding self-efficacy scale to assess exclusive breastfeeding: a cross-sectional study in rural China. 母乳喂养自我效能感量表的改编和心理测量学评估:一项在中国农村地区进行的横断面研究。
IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-13 DOI: 10.1186/s12884-024-06948-4
Linhua Li, Zhengjie Cai, Xinru Zhou, Jieyuan Feng, Chang Sun, Yuju Wu, Scott Rozelle, Huan Zhou

Background: Despite the benefits of exclusive breastfeeding, the proportion of exclusively breastfed children remains low in rural China. Self-efficacy is one of the most crucial modifiable factors predicting breastfeeding behavior. However, existing instruments in China do not specifically measure self-efficacy for exclusive breastfeeding but rather measure self-efficacy for any breastfeeding. Furthermore, they have been validated only in high-income Chinese settings. We sought to adapt and validate an instrument to measure exclusive breastfeeding self-efficacy within rural Chinese contexts.

Methods: We introduced relevant items to Dennis' Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF), which can assess maternal self-efficacy for exclusive breastfeeding. It was then implemented in a multistage random cluster sampling design and cross-sectional survey with home-visit interviews among women 0-6 months postpartum (n = 654) in the rural areas of four counties in Sichuan, China. We performed item-total and adjusted item-total correlations, as well as exploratory factor analysis to remove redundant items and determine the latent factor structure. We further applied confirmatory factor analysis to test the dimensionality of the scale. We then assessed the reliability of the scale and conducted tests of predictive and divergent validity. Known group comparisons were made by primiparous status and breastfeeding support level. We compared the validated Exclusive Breastfeeding Self-Efficacy Scale with the BSES-SF in terms of reliability and validity to explore the added value of scale modification.

Results: Our modification of the BSES-SF to target exclusive breastfeeding produced 19 items. This was further reduced to 15 items based on adjusted item-total correlations and exploratory factor analysis, forming the Exclusive Breastfeeding Self-Efficacy Scale. This scale had three dimensions: "Breast milk supply and quality," "Breastfeeding skills," and "Exclusive breastfeeding" subscales. The Exclusive Breastfeeding Self-Efficacy Scale demonstrated strong internal consistency and overall reliability with a Cronbach's alpha coefficient of 0.91. Predictive and divergent validity and known group comparison assessments supported its validity. Robust psychometric evaluations demonstrated enhanced validity and reliability compared to the original BSES-SF.

Conclusions: Our Exclusive Breastfeeding Self-Efficacy Scale is valid and reliable for measuring exclusive breastfeeding self-efficacy within rural Chinese contexts and is ready for adaptation and validation for clinical and programmatic use elsewhere, particularly within LMICs.

背景:尽管纯母乳喂养好处多多,但在中国农村地区,纯母乳喂养的儿童比例仍然很低。自我效能感是预测母乳喂养行为最关键的可调节因素之一。然而,中国现有的工具并不专门测量纯母乳喂养的自我效能感,而是测量任何母乳喂养的自我效能感。此外,这些工具仅在高收入的中国环境中进行过验证。我们试图在中国农村地区改编并验证一个测量纯母乳喂养自我效能感的工具:方法:我们引入了丹尼斯母乳喂养自我效能感量表-简表(BSES-SF)的相关项目,该量表可评估母亲纯母乳喂养的自我效能感。然后,我们采用多阶段随机整群抽样设计,对中国四川四县农村地区产后 0-6 个月的妇女(n = 654)进行了横断面调查和家访访谈。我们进行了项目-总相关和调整项目-总相关以及探索性因子分析,以去除冗余项目并确定潜在因子结构。我们还进一步应用了确认性因子分析来检验量表的维度。然后,我们对量表的可靠性进行了评估,并对预测效度和发散效度进行了测试。我们根据初产情况和母乳喂养支持水平对已知组别进行了比较。我们将经过验证的纯母乳喂养自我效能量表与 BSES-SF 在信度和效度方面进行了比较,以探讨量表修改的附加价值:结果:我们针对纯母乳喂养对 BSES-SF 进行了修改,共产生了 19 个项目。根据调整后的项目-总相关性和探索性因子分析,我们将其进一步缩减为 15 个项目,形成了纯母乳喂养自我效能量表。该量表有三个维度:"母乳供应和质量"、"母乳喂养技巧 "和 "纯母乳喂养 "三个分量表。排他性母乳喂养自我效能感量表的内部一致性和整体可靠性很强,Cronbach's alpha 系数为 0.91。预测效度和发散效度以及已知的小组比较评估均支持其有效性。与原始的 BSES-SF 相比,稳健的心理测量评估证明了其更高的有效性和可靠性:我们的纯母乳喂养自我效能量表在测量中国农村地区的纯母乳喂养自我效能方面是有效和可靠的,可以在其他地方,特别是在低收入和中等收入国家的临床和项目中使用。
{"title":"Adaptation and psychometric evaluation of the breastfeeding self-efficacy scale to assess exclusive breastfeeding: a cross-sectional study in rural China.","authors":"Linhua Li, Zhengjie Cai, Xinru Zhou, Jieyuan Feng, Chang Sun, Yuju Wu, Scott Rozelle, Huan Zhou","doi":"10.1186/s12884-024-06948-4","DOIUrl":"10.1186/s12884-024-06948-4","url":null,"abstract":"<p><strong>Background: </strong>Despite the benefits of exclusive breastfeeding, the proportion of exclusively breastfed children remains low in rural China. Self-efficacy is one of the most crucial modifiable factors predicting breastfeeding behavior. However, existing instruments in China do not specifically measure self-efficacy for exclusive breastfeeding but rather measure self-efficacy for any breastfeeding. Furthermore, they have been validated only in high-income Chinese settings. We sought to adapt and validate an instrument to measure exclusive breastfeeding self-efficacy within rural Chinese contexts.</p><p><strong>Methods: </strong>We introduced relevant items to Dennis' Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF), which can assess maternal self-efficacy for exclusive breastfeeding. It was then implemented in a multistage random cluster sampling design and cross-sectional survey with home-visit interviews among women 0-6 months postpartum (n = 654) in the rural areas of four counties in Sichuan, China. We performed item-total and adjusted item-total correlations, as well as exploratory factor analysis to remove redundant items and determine the latent factor structure. We further applied confirmatory factor analysis to test the dimensionality of the scale. We then assessed the reliability of the scale and conducted tests of predictive and divergent validity. Known group comparisons were made by primiparous status and breastfeeding support level. We compared the validated Exclusive Breastfeeding Self-Efficacy Scale with the BSES-SF in terms of reliability and validity to explore the added value of scale modification.</p><p><strong>Results: </strong>Our modification of the BSES-SF to target exclusive breastfeeding produced 19 items. This was further reduced to 15 items based on adjusted item-total correlations and exploratory factor analysis, forming the Exclusive Breastfeeding Self-Efficacy Scale. This scale had three dimensions: \"Breast milk supply and quality,\" \"Breastfeeding skills,\" and \"Exclusive breastfeeding\" subscales. The Exclusive Breastfeeding Self-Efficacy Scale demonstrated strong internal consistency and overall reliability with a Cronbach's alpha coefficient of 0.91. Predictive and divergent validity and known group comparison assessments supported its validity. Robust psychometric evaluations demonstrated enhanced validity and reliability compared to the original BSES-SF.</p><p><strong>Conclusions: </strong>Our Exclusive Breastfeeding Self-Efficacy Scale is valid and reliable for measuring exclusive breastfeeding self-efficacy within rural Chinese contexts and is ready for adaptation and validation for clinical and programmatic use elsewhere, particularly within LMICs.</p>","PeriodicalId":9033,"journal":{"name":"BMC Pregnancy and Childbirth","volume":"24 1","pages":"749"},"PeriodicalIF":2.8,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11562730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142614058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Perinatal and obstetric-neonatal outcomes following frozen embryo transfer cycles with a thinner endometrium: a retrospective study. 子宫内膜较薄的冷冻胚胎移植周期的围产期和产科-新生儿结局:一项回顾性研究。
IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-12 DOI: 10.1186/s12884-024-06946-6
Xin Li, Ting Luan, Jueyun Lu, Yi Wei, Juanjuan Zhang, Chun Zhao, Xiufeng Ling

Objective: The purpose of this study was to evaluate the relationship of thin endometrial thickness (EMT) on the maternal and child health outcome of frozen-thawed embryo transfer (FET) cycles with singletons.

Methods: The retrospective cohort study included 1,771 live singleton deliveries, with 273 in the thin endometrium group (EMT ≤ 7.5 mm) and 1,498 in the control group (EMT > 7.5 mm). Pregnancy, perinatal complications and neonatal outcomes were compared between the two groups.

Results: Women in the thinner endometrium group had higher rates of preeclampsia (7.69% vs. 7.00%), placenta previa (4.39% vs. 2.43%), postpartum haemorrhage (15.38% vs. 11.42%) than the control groups, although they were not significantly different. Significant difference was observed in the rates of placental abruption (1.09% vs. 0.07%, P = 0.001), abnormal placental cord insertion (3.66% vs. 1.74%, P = 0.011), placental adherence (15.38% vs. 7.14%, P < 0.001) between the two groups. No significant difference could be found regarding preterm labour, macrosomia, Apgar ≤ 7, large for gestational age (LGA) and appropriate for gestational age (AGA), and singletons from the thinner endometrium group had a significantly lower birthweight than those from the controls. Then after adjusting for confounders, thinner endometrium was still statistically significantly associated with placental adherence, postpartum haemorrhage and low birthweight (LBW).

Conclusion: These findings highlight the important role of endometrial thickness in influencing perinatal and obstetric-neonatal outcomes in FET cycles. The study contributes to the growing body of evidence supporting the clinical relevance of endometrial thickness in FET cycles and underscores the need for close monitoring and management of pregnancies in women with a thin endometrium. Future research should focus on elucidating the underlying mechanisms and identifying effective interventions to improve endometrial thickness and pregnancy outcomes in this patient population.

研究目的本研究旨在评估薄子宫内膜厚度(EMT)与单胎冷冻解冻胚胎移植(FET)周期的母婴健康结果之间的关系:这项回顾性队列研究包括 1,771 例活产单胎,其中薄子宫内膜组(EMT ≤ 7.5 mm)273 例,对照组(EMT > 7.5 mm)1,498 例。对两组的妊娠、围产期并发症和新生儿结局进行了比较:结果:与对照组相比,子宫内膜较薄组的妇女发生子痫前期(7.69% 对 7.00%)、前置胎盘(4.39% 对 2.43%)和产后出血(15.38% 对 11.42%)的比例较高,但没有显著差异。在胎盘早剥率(1.09% 对 0.07%,P = 0.001)、胎盘脐带插入异常率(3.66% 对 1.74%,P = 0.011)、胎盘粘连率(15.38% 对 7.14%,P 结论:这些研究结果突显了产后护理的重要作用:这些发现强调了子宫内膜厚度在影响 FET 周期围产期和产科-新生儿结局中的重要作用。这项研究为越来越多的证据支持 FET 周期中子宫内膜厚度的临床相关性做出了贡献,并强调了密切监测和管理子宫内膜薄妇女妊娠的必要性。未来的研究应侧重于阐明潜在的机制,并确定有效的干预措施,以改善这一患者群体的子宫内膜厚度和妊娠结局。
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引用次数: 0
Effect of crystalloid solution co-loading infusion rate on the dose requirements of prophylactic phenylephrine for preventing hypotension following combined spinal-epidural anesthesia for cesarean delivery. 晶体液联合输注率对预防性苯肾上腺素剂量需求的影响,以防止剖宫产脊髓硬膜外联合麻醉后出现低血压。
IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-12 DOI: 10.1186/s12884-024-06937-7
Xiao-Min Zhang, Jing Qian, Lin Liu, Yue-Ping Shen, Fei Xiao

Background: Intravenous fluid administration and prophylactic vasopressor infusion are the primary methods for preventing spinal anesthesia-induced hypotension during cesarean delivery. However, evidence regarding the impact of different volumes of crystalloid solution on the phenylephrine infusion dosage for preventing this hypotension remains inconclusive. This study aimed to determine the effect of two IV fluid infusion rates (10 or 20 mL/kg/h) on phenylephrine requirement for preventing spinal anesthesia-induced hypotension.

Methods: Eighty healthy parturients undergoing elective cesarean delivery under combined spinal-epidural anesthesia were enrolled. Participants were randomly assigned to receive either 10 mL/kg/h (group 10) or 20 mL/kg/h (group 20) of lactated Ringer's solution. The first patient in each group received 0.5 µg/kg/min of phenylephrine infusion immediately after intrathecal injection. The phenylephrine dose in subsequent patients was adjusted by increments or decrements of 0.05 µg/kg/min based on the previous patient's response. The ED50 of phenylephrine infusion for preventing spinal-induced hypotension for cesarean delivery was estimated using a modified up-down sequential analysis, with probit analysis applied as a backup sensitivity analysis.

Results: The ED50 values for preventing spinal anesthesia-induced hypotension were 0.30 µg/kg/min (95% CI, 0.29-0.32 µg/kg/min) for group 10, and 0.19 µg/kg/min (95% CI, 0.16-0.22 µg/kg/min) for group 20, respectively. The estimated relative potency for phenylephrine in group 10 compared to group 20 was 1.52 (95%CI, 1.24-1.97), showing a significant difference in the ED50 values between the two groups.

Conclusion: This study found that a higher crystalloid co-loading rate significantly reduces prophylactic phenylephrine requirement for preventing spinal anesthesia induced hypotension.

Trials registration: https://www.chictr.org.cn/showproj.html?proj=125918 (Trial number: ChiCTR2100048002).

背景:静脉输液和预防性输注血管加压素是预防剖宫产过程中脊髓麻醉诱发低血压的主要方法。然而,不同容量的晶体液对预防低血压的苯肾上腺素输注剂量的影响仍无定论。本研究旨在确定两种静脉输液速度(10 或 20 mL/kg/h)对预防脊髓麻醉引起的低血压的苯肾上腺素需求量的影响:方法:80 名健康产妇在脊柱-硬膜外联合麻醉下接受择期剖宫产。参与者被随机分配接受 10 mL/kg/h(第 10 组)或 20 mL/kg/h(第 20 组)的乳酸林格氏液。每组的第一名患者在鞘内注射后立即接受 0.5 µg/kg/min 的苯肾上腺素输注。其后患者的苯肾上腺素剂量根据前一位患者的反应以 0.05 µg/kg/min 为单位递增或递减。采用改良的上下顺序分析法估算了输注苯肾上腺素预防剖宫产脊柱诱发低血压的 ED50 值,并应用 probit 分析作为后备敏感性分析:第10组和第20组预防脊髓麻醉诱发低血压的ED50值分别为0.30微克/千克/分钟(95% CI,0.29-0.32微克/千克/分钟)和0.19微克/千克/分钟(95% CI,0.16-0.22微克/千克/分钟)。第 10 组与第 20 组相比,苯肾上腺素的估计相对效力为 1.52(95%CI,1.24-1.97),两组的 ED50 值差异显著:本研究发现,较高的晶体液联合负荷率可显著降低预防性苯肾上腺素的需求量,从而预防脊髓麻醉诱发的低血压。试验注册:https://www.chictr.org.cn/showproj.html?proj=125918(试验编号:ChiCTR2100048002)。
{"title":"Effect of crystalloid solution co-loading infusion rate on the dose requirements of prophylactic phenylephrine for preventing hypotension following combined spinal-epidural anesthesia for cesarean delivery.","authors":"Xiao-Min Zhang, Jing Qian, Lin Liu, Yue-Ping Shen, Fei Xiao","doi":"10.1186/s12884-024-06937-7","DOIUrl":"10.1186/s12884-024-06937-7","url":null,"abstract":"<p><strong>Background: </strong>Intravenous fluid administration and prophylactic vasopressor infusion are the primary methods for preventing spinal anesthesia-induced hypotension during cesarean delivery. However, evidence regarding the impact of different volumes of crystalloid solution on the phenylephrine infusion dosage for preventing this hypotension remains inconclusive. This study aimed to determine the effect of two IV fluid infusion rates (10 or 20 mL/kg/h) on phenylephrine requirement for preventing spinal anesthesia-induced hypotension.</p><p><strong>Methods: </strong>Eighty healthy parturients undergoing elective cesarean delivery under combined spinal-epidural anesthesia were enrolled. Participants were randomly assigned to receive either 10 mL/kg/h (group 10) or 20 mL/kg/h (group 20) of lactated Ringer's solution. The first patient in each group received 0.5 µg/kg/min of phenylephrine infusion immediately after intrathecal injection. The phenylephrine dose in subsequent patients was adjusted by increments or decrements of 0.05 µg/kg/min based on the previous patient's response. The ED50 of phenylephrine infusion for preventing spinal-induced hypotension for cesarean delivery was estimated using a modified up-down sequential analysis, with probit analysis applied as a backup sensitivity analysis.</p><p><strong>Results: </strong>The ED50 values for preventing spinal anesthesia-induced hypotension were 0.30 µg/kg/min (95% CI, 0.29-0.32 µg/kg/min) for group 10, and 0.19 µg/kg/min (95% CI, 0.16-0.22 µg/kg/min) for group 20, respectively. The estimated relative potency for phenylephrine in group 10 compared to group 20 was 1.52 (95%CI, 1.24-1.97), showing a significant difference in the ED50 values between the two groups.</p><p><strong>Conclusion: </strong>This study found that a higher crystalloid co-loading rate significantly reduces prophylactic phenylephrine requirement for preventing spinal anesthesia induced hypotension.</p><p><strong>Trials registration: </strong>https://www.chictr.org.cn/showproj.html?proj=125918 (Trial number: ChiCTR2100048002).</p>","PeriodicalId":9033,"journal":{"name":"BMC Pregnancy and Childbirth","volume":"24 1","pages":"743"},"PeriodicalIF":2.8,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11558886/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142614099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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BMC Pregnancy and Childbirth
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