BMC Pregnancy and Childbirth最新文献

Background: Pregnancy and postpartum are considered vulnerable periods for new parents to develop obsessive-compulsive disorder (OCD). The aim of this study was threefold: (1) to establish the prevalence of OCD symptoms and its course in the peripartum period; (2) to examine comorbidity with depressive symptoms; and (3) to investigate which sociodemographic, obstetric, and individual characteristics are predictors of OCD symptoms.

Methods: A longitudinal study included 397 women during pregnancy (T1) and 6-12 weeks postpartum (T2). Participants filled out the obstetrical and demographic sheet, Anxiety Sensitivity Index (ASI), Emotional Stability subscale from the International Personality Item Pool-50 (IPIP-50), Brief Resilience Scale (BRS) all at T1, and Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and Edinburgh Postpartum Depression Scale (EPDS) at T1 and T2.

Results: In this sample, 15.1% of women reported OCD symptoms during pregnancy and 15.1% in the postpartum, with 9.8% of women who had symptoms at both time points. However, the majority of women experienced symptoms of mild severity, according to the Y-BOCS. Of the women experiencing OCD symptoms, 33% and 43% had comorbid depressive symptoms in pregnancy and the postpartum period, respectively. The level of OCD symptoms significantly decreased after childbirth. None of the sociodemographic or obstetric variables were a significant predictor of OCD symptoms during pregnancy or postpartum. After controlling for current depression symptoms, higher psychological concerns of anxiety sensitivity (but not physical and social concerns) and higher neuroticism were significant predictors of higher levels of OCD symptoms both at T1 and T2. At the same time, higher resilience was a significant predictor of lower levels of OCD symptoms only at T1.

Conclusion: One in six women has OCD symptoms in the peripartum period, with substantial comorbidity with depression symptoms. Women who are high on neuroticism and anxiety sensitivity are prone to OCD symptoms, while resilience is a significant protective factor.

Clinical trial number: Not applicable.

Introduction: Gestational diabetes mellitus (GDM), or hyperglycemia first diagnosed in pregnancy, affects 7-10% of all pregnancies worldwide. Perinatal risk rises with increasing glycemia at oral glucose tolerance test (OGTT). The new (2013) WHO criteria recommend a lower fasting, and a higher post-load threshold for GDM diagnosis in comparison to the old (1999) WHO criteria. To date, however, outcomes of GDM treatment for those affected by the altered diagnostic criteria, has not been well investigated. We hypothesized that intensive GDM treatment according to the new (2013) GDM criteria would result in a reduction in infants with birth weight > 90th centile (large for gestational age, LGA), in comparison to treatment according to the old criteria (1999).

Methods: The TANGO-DM trial is an open label, multicenter randomized controlled trial. Participants are pregnant with a gestational age between 16 + 0 and 32 + 0 weeks, who underwent a 1-step venous 2- or 3-point 75-gram oral OGTT, were eligible if they had glucose concentrations discordant between the old (1999) and the new (2013) criteria. After informed consent, women are randomized to either intensive GDM treatment, consisting of dietary advice and glucose monitoring and, if euglycemia is not reached, antihyperglycemic agents, or normal obstetric care without GDM treatment. The primary outcome is large-for-gestational-age infants (birth weight > 90th percentile). Secondary outcome measures include maternal complications, obstetric complications, neonatal complications, obstetric interventions, quality of life, and healthcare and societal costs. Outcomes will be analyzed according to the intention-to-treat principle. The study is powered to detect a reduction in LGA from 16% in the untreated to 10% in the treated group, which requires 1032 participants (516 per arm; alpha-error 5% for 80% power).

Discussion: The TANGO-DM trial will provide high-level evidence to support or refute the use of the new 2013 WHO diagnostic criteria in terms of their ability to lower the number of large for gestational age infants and/or improve maternal and perinatal outcomes and/or costs in women with gestational diabetes.

Trial registration: Central Committee on Research Involving Human Subjects (CCMO) (NL63013.018.18). Registered on 22 September 2018.

Background: Preterm birth (PTB) is a leading cause of neonatal mortality and long-term disability worldwide. However, the molecular mechanisms underlying PTB remain incompletely understood, and the etiology of many PTB cases is still largely unexplained. Due to their close association with PTB, monocytes serve as an ideal matrix for identifying peripheral biomarkers predictive of preterm birth risk.

Objective: This study aims to identify and validate biomarkers that could predict PTB, improving clinical diagnostic accuracy and enhancing preventive measures against PTB.

Methods: This study conducted a comprehensive transcriptomic analysis of monocytes obtained from PTB patients (gestational age = 28-36 weeks) and age-matched healthy controls (HC, gestational age = 37^+ 1-41^+ 4 weeks). Blood samples were collected within 30 min of hospital admission and prior to labor initiation to ensure consistency. We further validated the findings after screening for potential biomarkers using quantitative real-time PCR (qPCR). While the sample size was relatively small, this study provides foundational evidence supporting the role of CXCL3 and IL-6 as biomarkers for PTB, laying a framework for future prospective research.

Results: We identified 295 significantly differentially expressed genes compared to the control group, and Weighted Gene Co-expression Network Analysis (WGCNA) further revealed genes significantly associated with PTB. These genes are involved in immune pathways such as rheumatoid arthritis, influenza A, and the MAPK signaling pathway. Machine learning analysis and qPCR validation identified two essential genes-CXCL3 and IL-6. Based on these two genes, the diagnostic model achieved an AUC value of 1 in the discovery cohort, distinguishing PTB patients from healthy controls.

Conclusion: The immune responses observed in peripheral blood mononuclear cells (PBMCs) may be closely related to the mechanisms underlying PTB. Monocyte-derived genes CXCL3 and IL-6 are promising biomarkers for predicting PTB risk, offering new diagnostic tools for clinical practice. These findings have the potential to enhance PTB prevention and management strategies.

Background: Gestational weight gain (GWG) plays a critical role in determining birth outcomes, especially in twin pregnancies. However, the association between GWG and adverse birth outcomes in twin pregnancies remains inconclusive. This study aims to define GWG according to different classification criteria and explore their associations with adverse birth outcomes in twin pregnancies.

Methods: This was a prospective cohort study that included 1,029 twin pregnant women recruited from Qingdao Women and Children's Hospital between September 2018 and December 2020. Participants were categorized into insufficient, adequate, and excessive GWG groups using both the interquartile range (P25-P75) method and the Institute of Medicine (IOM) criteria. Logistic regression models were employed to assess the associations between GWG and adverse birth outcomes, including preterm birth (PTB), low birth weight (LBW), and small for gestational age (SGA).

Results: According to the interquartile range method, women in the insufficient GWG group had a significantly increased risk of PTB (OR: 2.13, 95% CI: 1.55-2.94), LBW (OR: 2.01, 95% CI: 1.33-3.05), and SGA (OR: 1.62, 95% CI: 1.03-2.54) compared to adequate GWG group. In contrast, the excessive GWG group was associated with a reduced risk of LBW (OR: 0.64, 95% CI: 0.45-0.92) and SGA (OR: 0.51, 95% CI: 0.28-0.91) after adjusting for potential confounders. Similar trends were observed using the IOM criteria, with a significantly increased risk of PTB and LBW in twin pregnant women with insufficient GWG and a reduced risk of SGA with excessive GWG.

Conclusions: Achieving an appropriate level of weight gain during pregnancy is essential to reduce the risk of adverse birth outcomes in women with twin pregnancies.

Background: Limited research has examined the potential association between triglyceride glucose-body mass index (TyG-BMI) and gestational diabetes mellitus (GDM). The objective of this investigation was to analyze this linkage and evaluate TyG-BMI's capability to predict GDM.

Methods: This research employed secondary data derived from a prospective cohort in South Korea, which included 588 pregnant women with singleton gestations, collected between November 2014 and July 2016. To investigate the connection between TyG-BMI and GDM, logistic regression and sensitivity analyses were performed. Furthermore, an analysis of receiver operating characteristics (ROC) was conducted to assess the prognostic accuracy of TyG-BMI in relation to GDM.

Results: The cohort exhibited a mean age of 32.07 ± 3.80 years, with 36 individuals (6.12%) manifesting GDM during the interval of 24 to 28 weeks of gestation. Following the adjustment for possible confounding variables, an increased TyG-BMI was associated with an elevated risk of GDM, as indicated by an odds ratio (OR) of 1.02 (95% CI: 1.01-1.04). Additionally, the area under the curve (AUC) for TyG-BMI's predictive performance was recorded at 0.7979 (0.7143-0.8814), with an optimal threshold established at 211.03, which resulted in a specificity of 86.23% and a sensitivity of 66.67%.

Conclusions: In this South Korean cohort, increased TyG-BMI during early pregnancy (10-14 weeks) was significantly associated with the onset of GDM (during pregnancy 24-28 weeks). TyG-BMI could be integrated into clinical practice as a complementary preliminary screening tool for detecting women who are at increased risk of GDM.

Objective: We aimed to investigate the association between the triglyceride-glucose index (TyG index) and the ratio of triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) with fetal macrosomia in nulliparous pregnant women.

Design: A prospective case-control study.

Setting: Ankara Etlik Zubeyde Hanim Maternal's Health Education and Training Hospital.

Population: Nulliparous singleton pregnant women.

Methods: A prospective case-control study was conducted from January 2023 to June 2024.

Main outcome measure: Demonstrating the relationship between the TyG index and the TG/HDL-C with fetal macrosomia.

Results: In all, 302 nulliparous singleton pregnant women were grouped into a study group (n = 151) and a control group (n = 151). Pregnant women who had a higher TyG index and TG/HDL-C valıue had a significantly higher incidence of fetal macrosomia. The optimal sensitivity/specificity value for the TG/HDL-C to detect macrosomic fetus was > 3,63, which is the cut-off value for using the TG/HDL-C at a specificity of 89% and a sensitivity of 83% with the best area under the curve of 0,927 and a 95% confidence interval of 0,892-0,954. For the TyG index, the other main parameter of the present study, a cut-off point of > 4,88 was optimal, with a sensitivity of 0,76 and a specificity of 0,78 at this cut-off point. However, no differences were observed in maternal age, body mass index, gravidity, history of abortion, smoking status and working status.

Conclusion: A higher TyG index and a higher TG/HDL-C ratio in maternal blood in late gestation indicate a metabolic process that causes fetal macrosomia. The cut-off value for the TyG index (> 4.88) at 78% specificity and a cut-off value for the TG/HDL-C ratio (> 3,63) at 89% specificity can be used as a predictive test. Physicians should be more cautious about the risk of macrosomic fetuses when these values of the current test results are available. The limitation of this study, however, was that it only concerned a single center.

Trial registration: The trial is registered at www.clinicaltrails.gov [registration number: NCT06463990; registration date: 01/June/2024 (retrospectively registered)].

Objective: Fear of childbirth (FOC) is a common problem during pregnancy and can be associated with increased maternal and fetal complications. Therefore, this study aimed to determine the frequency and intensity of FOC and some related individual, family, and social factors.

Methods: This cross-sectional study was performed on 473 nulliparous women selected by convenience sampling. Data was collected by socio-demographic characteristics and factors related to the FOC questionnaire, the Wijma delivery expectation questionnaire, the Jerabeck communication skills inventory, and the Spanier dyadic adjustment questionnaire. Data analysis was performed in SPSS version 21 using descriptive and analytic statistics (the Mann-Whitney U, the Kruskal-Wallis, the Pearson and Spearman correlation coefficients, and linear regression).

Results: The mean scores of FOC, communication skills, and the dyadic adjustment were 53.90 ± 25.20, 112.61 ± 24.34, and 103.00 ± 21.11, respectively. The linear regression results showed a significant relationship between FOC and communication skills, dyadic adjustment, age, knowledge of labor and its stages, socioeconomic class, satisfaction with socioeconomic class, satisfaction with monthly income, spouse's support, family's support, support of spouse's family, friends' support, fear of damage to the infant, fear of death during labor, fear of childbirth complications, confidence in the ability to give birth, and common social beliefs about natural delivery (P < 0.001).

Conclusion: Considering the significant impact of some factors on fear of childbirth, it becomes crucial to conduct screenings to identify individuals at risk of FOC. Moreover, to prevent this fear and its adverse consequences such as a high rate of elective cesarean section, the following strategies are recommended: helping promote mothers' awareness about childbirth, offering social support through healthcare providers, and paying attention to risk factors and predictors of childbirth fear such as age and socioeconomic status, communication skills and dyadic adjustment.

Background: Gestational diabetes mellitus (GDM) is diabetes with reduced glucose tolerance that is found or diagnosed during pregnancy, which seriously affects the health of mothers and infants, and its incidence is increasing year by year. The necroptotic apoptosis regulator RIP3 has been proposed to be active in managing pancreatic islet cell survival and inflammatory response. Still, its role and mechanism in GDM have not yet been clarified.

Method: The effect of high glucose induction and RIP3 on the viability of Pancreatic β-cells and insulin secretion was observed in vitro experiments. C57BL/6J mice were used to establish the GDM model. Weight, serum glucose levels, and insulin levels were measured to evaluate the improvement of diabetes symptoms in GDM mice by sh-RIP3. The levels of IL-1β, IL-6, and TNF-α were determined by ELISA and qRT-PCR assays. Hematoxylin and Eosin (HE) staining assay was applied to detect islet cell morphology and inflammatory damage in pancreatic tissue. Progeny weight and litter size were also recorded to evaluate reproductive function in GDM mice. Western blot was performed to express TLR4/MyD88/NF-κB signal-related proteins.

Results: Knockdown of RIP3 ameliorated GDM symptoms, improved glucose tolerance and insulin sensitivity, suppressed inflammation, and enhanced fetal outcomes, possibly by TLR4/MyD88/NF-κB signaling pathway activation in GDM mice.

Conclusion: The present study provided evidence that the downregulation of RIP3 alleviates insulin resistance and inflammation in GDM mice by mediating the TLR4/MyD88/NF-κB signaling pathway, which made RIP3 a new potential therapeutic target for GDM treatment in the future.

Introduction: The overall experience women gain from the childbirth process is a significant outcome that is highly complex, subjective, and based on personal judgment. Cultural, social, and environmental contexts and societal policies can also influence it. The present systematic study and meta-analysis aim to conduct a comprehensive review to estimate the prevalence of negative childbirth experiences.

Methods: Published observational studies were reviewed without any time restrictions to conduct this systematic review. Relevant material was searched thoroughly in the PubMed/Medline, Embase, Web of Science, Scopus, ProQuest, and Google Scholar databases. Two authors independently evaluated the studies' quality using a modified Joanna Briggs checklists (JBI) version. Cochran's Q and I² tests were used to assess the heterogeneity of the studies. R software was used for the meta-analysis.

Results: The study was based on a review of 19 observational studies published between 2001 and 2024 that examined the prevalence of negative childbirth experiences. The total sample size of the included studies was 73,353 women. Meta-analytic pooling of the prevalence of negative childbirth was 16% (95% CI: 10-22%). The evaluation of publication bias suggested a very strong likelihood of a small study effect due to the meta-analysis.

Conclusions: Based on our study, the overall prevalence of negative childbirth experiences was calculated to be 16%. However, considering the short-term and long-term effects of this experience on various aspects of women's lives, greater attention should be paid to making pregnancy and childbirth more pleasant and to interventions to improve women's childbirth experiences.

Background: Air pollution exposure during pregnancy has been associated with adverse birth outcomes. Uncertainties remain about the effect at very low exposure levels. The aim of this study was to explore the association of maternal exposure to air pollutants during pregnancy at very low exposure levels with birth weight and estimate the health impact.

Methods: The MATEX birth cohort (226,551 singleton births in 2012-2016) was linked with eight modelled air pollutants (PM_2.5, PM₁₀, PM_coarse, NO₂, NO_x, CO, SO₂, O₃) at home address during pregnancy. Multiple regression was used to estimate the change in birth weight (in g) associated with individual-level mean exposure during pregnancy. We tested different adjustment models and conducted sensitivity analyses. We also estimated the potential number of low birth weight cases attributable to PM_2.5 to quantify the public health issues at the prevailing low exposure levels.

Results: PM_2.5 was associated with the largest reduction of birth weight (-6.5 g per 1 µg/m³) followed by PM_crs (-4.9 g) and PM₁₀ (-3.0 g). Among the gaseous pollutants the strongest reduction in birth weight was observed for NO₂ (-0.8 g), followed by CO (-0.5 g), NO_x (-0.4 g) and SO₂ (-0.2 g). On the contrary, O₃ was associated with a modest increase in birth weight (+ 0.9 g). Effects on births weight were observed also below WHO guideline values. When accounting for the prevailing exposure levels in Finland, CO was associated with the biggest reduction in birth weight. The effect of PM_2.5 exposure on birthweight corresponds to a loss of 30 g at mean exposure. Assuming a causal relationship, about 700 cases of low birth weight could be attributable to PM_2.5 in Finland during the study period.

Conclusions: No clear evidence on safe exposure level was found in this study. All pollutants were associated with reduced birthweight except ozone. Causality and confounding due to correlations warrant specific attention.