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The association of serum total bile acid levels with gestational diabetes mellitus: a systematic review and meta-analysis. 血清总胆汁酸水平与妊娠糖尿病的关系:系统综述和荟萃分析。
IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-12 DOI: 10.1186/s12884-024-06954-6
Mohammadamin Parsaei, Mohadese Dashtkoohi, Mohammad Haddadi, Pegah Rashidian, Zeinab Mansouri, Sedigheh Hantoushzadeh

Background: Given the high prevalence of gestational diabetes mellitus and its significant impact on maternal and neonatal health, identifying reliable biomarkers for prediction and diagnosis is essential. The increased incidence of gestational diabetes mellitus among patients with intrahepatic cholestasis of pregnancy suggests a possible association between serum total bile acid levels and gestational diabetes mellitus. This study evaluated the relationship between total bile acid levels and gestational diabetes mellitus incidence.

Methods: A systematic search was performed on February 19, 2024, for studies examining the association between total bile acid levels and gestational diabetes mellitus incidence in both the general pregnant population and patients diagnosed with intrahepatic cholestasis of pregnancy. Meta-analyses were conducted to compare pooled total bile acid levels between patients with and without gestational diabetes mellitus, as well as to assess gestational diabetes mellitus prevalence in patients with mild (10 ≤ total bile acid < 40 µmol/L) vs. moderate-to-severe intrahepatic cholestasis of pregnancy (total bile acid ≥ 40 µmol/L).

Results: 15 observational studies involving 7,238 pregnant women were systematically reviewed. Our meta-analysis found significantly higher serum total bile acid levels in women diagnosed with gestational diabetes mellitus compared to controls in the general population (Hedge's g = 0.29 [0.03,0.54]). However, subgroup analysis indicated that total bile acid levels were only significantly higher in patients measured earlier in pregnancy, before the gestational diabetes mellitus diagnosis, compared to healthy controls (Hedge's g = 0.48 [0.33,0.64]), while no significant difference in total bile acid levels was observed when measurements were taken after the gestational diabetes mellitus diagnosis (Hedge's g = 0.00 [-0.26,0.27]). Additionally, we found that the prevalence of gestational diabetes mellitus was significantly lower in patients with mild intrahepatic cholestasis of pregnancy compared to those with moderate-to-severe intrahepatic cholestasis of pregnancy (Log odds ratio=-0.56 [-0.95,-0.17]).

Conclusions: This study highlights a complex relationship between serum total bile acid levels and gestational diabetes mellitus incidence, influenced by the timing of measurement. Elevated total bile acid levels early in pregnancy may predict gestational diabetes mellitus, but its diagnostic value may decline later in pregnancy.

Trial registration: The review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) on 3/3/2024 under CRD42024516164.

背景:鉴于妊娠糖尿病的高发病率及其对孕产妇和新生儿健康的重大影响,确定用于预测和诊断的可靠生物标志物至关重要。妊娠期肝内胆汁淤积症患者中妊娠期糖尿病的发病率增加,这表明血清总胆汁酸水平与妊娠期糖尿病之间可能存在关联。本研究评估了总胆汁酸水平与妊娠糖尿病发病率之间的关系:2024年2月19日,我们对普通孕妇和被诊断为妊娠期肝内胆汁淤积症患者的总胆汁酸水平与妊娠期糖尿病发病率之间关系的研究进行了系统检索。我们进行了元分析,以比较妊娠糖尿病患者和非妊娠糖尿病患者的总胆汁酸水平,并评估轻度(总胆汁酸结果为 10 ≤)妊娠糖尿病患者的妊娠糖尿病发病率:对涉及 7,238 名孕妇的 15 项观察性研究进行了系统回顾。我们的荟萃分析发现,与普通人群中的对照组相比,确诊为妊娠糖尿病的妇女血清总胆汁酸水平明显更高(Hedge's g = 0.29 [0.03,0.54])。然而,亚组分析表明,与健康对照组相比(Hedge's g = 0.48 [0.33,0.64]),只有在妊娠早期,即确诊妊娠糖尿病之前测量的患者总胆汁酸水平才显著较高;而在确诊妊娠糖尿病之后测量的患者总胆汁酸水平则无显著差异(Hedge's g = 0.00 [-0.26,0.27])。此外,我们还发现,与中重度妊娠肝内胆汁淤积症患者相比,轻度妊娠肝内胆汁淤积症患者的妊娠糖尿病患病率明显较低(对数比值=-0.56 [-0.95,-0.17]):本研究强调了血清总胆汁酸水平与妊娠期糖尿病发病率之间的复杂关系,并受到测量时间的影响。妊娠早期总胆汁酸水平升高可预测妊娠糖尿病,但在妊娠后期其诊断价值可能会下降:该综述方案于2024年3月3日在国际系统综述前瞻性注册中心(PROSPERO)注册,注册号为CRD42024516164。
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引用次数: 0
Effect of antenatal education on pregnant women`s knowledge, attitude and preferences of delivery mode. 产前教育对孕妇对分娩方式的了解、态度和偏好的影响。
IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-12 DOI: 10.1186/s12884-024-06922-0
Eman Hassan El-Shrqawy, Amina Elnemer, Hanan Mohamed Elsayed

Background: Childbirth is considered as the happiest action that occurs in any parent's life. Although childbirth is a natural process, the choice of delivery mode is one of the concerns of pregnant women. Consequently, the objective of this study to assess the effect of antenatal education on pregnant women`s knowledge, attitude, and preferences of delivery mode.

Methods: A quasi-experimental research design was utilized to achieve the study utilizing 140 purposive sample of pregnant women selected from antenatal outpatient clinics at the New Obstetrics and Gynecology Hospital in Mansoura, Egypt.

Results: The study findings reported that there was a significant improvement in total scores of the intervention group`s knowledge and attitude toward the modes of delivery, with a highly statistically significant difference (p < 0.001) at post-intervention compared to the control group.

Conclusion: Prenatal education sessions were linked to a significantly improved maternal outcome in terms of knowledge, attitude, and preferences for delivery mode (p < 0.001).

Trial registration: ClinicalTrials.gov, NCT06561984, registered on August 19, 2024, retrospectively registered.

背景:分娩被认为是父母一生中最幸福的事情。虽然分娩是一个自然的过程,但分娩方式的选择是孕妇关心的问题之一。因此,本研究旨在评估产前教育对孕妇分娩方式的知识、态度和偏好的影响:方法:采用准实验研究设计,从埃及曼苏拉新妇产科医院产前门诊中选取 140 名孕妇作为目的性样本进行研究:研究结果表明,干预组对分娩方式的知识和态度的总分有了显著提高,差异具有高度统计学意义(p 结论:产前教育课程与分娩方式相关联:产前教育课程与孕产妇在分娩方式的知识、态度和偏好方面明显改善的结果有关(p 试验注册:临床试验网(ClinicalTrials.gov),NCT06561984,注册日期:2024 年 8 月 19 日,回顾性注册。
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引用次数: 0
The association of Helicobacter pylori with adverse pregnancy outcomes in three European birth cohorts. 欧洲三个出生队列中幽门螺杆菌与不良妊娠结局的关系。
IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-12 DOI: 10.1186/s12884-024-06901-5
Raquel Galan, Lucy Pembrey, Mariona Bustamante, Ruth Aguilar, Dan Mason, Marta Vidal, Marc Bañuls, Theano Roumeliotaki, Juana Mari Delgado-Saborit, Natalia Marin, Martine Vrijheid, Vicky Bempi, Gemma Moncunill, Carlota Dobaño, Manolis Kogevinas, Marianna Karachaliou

Background: Helicobacter pylori is a prevalent infection that may complicate pregnancy, but evidence remains limited, controversial and may not apply to all pregnant women.

Objective: This study aims to evaluate whether Helicobacter pylori is a risk factor for adverse pregnancy outcomes and to identify vulnerable subpopulations.

Study design: Multiplex serology was utilized to measure blood levels of immunoglobulin G against eight Helicobacter pylori antigens in 1372 pregnant women from three European birth cohorts: BiB (United Kingdom), Rhea (Greece) and INMA (Spain). Outcomes of interest included gestational diabetes mellitus, gestational hypertension, preeclampsia, preterm birth and small for gestational age neonates, as well as prenatal anxiety and depression. Adjusted logistic regression models were used to evaluate the association between Helicobacter pylori seropositivity (overall and by antigen) and antigen specific antibody levels with the outcomes. We examined effect modification of the associations by ethnicity.

Results: Helicobacter pylori seropositivity was detected in 18.8% (258/1372) of pregnant women. Preeclampsia was the least common outcome (26/830). Helicobacter pylori seropositivity was associated with the development of two or more adverse pregnancy outcomes (gestational hypertension, gestational diabetes, preterm birth, small gestational age and preeclampsia) [OR:1.32 (95% CI: 1.06-1.65), p-value: 0.01], especially in women with high antibody levels to OMP antigen [OR: 2.12 (95% CI: 1.62-2.76), p-value: 0.001]. Women with high antibody levels to Helicobacter pylori antigens GroEL and NapA were more likely to develop preeclampsia [OR: 2.34 (95% CI: 1.10-8.82), p-value: 0.03; OR: 4.09 (95% CI: 1.4-11.93), p-value 0.01)]. Helicobacter pylori seropositivity increased the odds of developing any hypertensive disorder during pregnancy among women of western ethnicity (948/1372) [OR:3.35 (95% CI: 1.29-8.74), p-value 0.03].

Conclusion: Our study suggests that Helicobacter pylori seropositivity is a risk factor for multiple adverse pregnancy outcomes and particularly in women of western origin for hypertensive disorders during pregnancy. Moreover, pathogen specific characteristics reflected in the antibody responses against OMP, GroEL and NapA seem to determine disease associations.

背景:幽门螺杆菌是一种可能导致妊娠并发症的流行性感染,但相关证据仍然有限,且存在争议,可能并不适用于所有孕妇:本研究旨在评估幽门螺旋杆菌是否是导致不良妊娠结局的风险因素,并确定易受感染的亚人群:研究设计:采用多重血清学方法测量来自三个欧洲出生队列的 1372 名孕妇血液中针对八种幽门螺旋杆菌抗原的免疫球蛋白 G 水平:BiB(英国)、Rhea(希腊)和 INMA(西班牙)。研究结果包括妊娠糖尿病、妊娠高血压、子痫前期、早产和胎龄小新生儿,以及产前焦虑和抑郁。调整后的逻辑回归模型用于评估幽门螺旋杆菌血清阳性率(总体和抗原)和抗原特异性抗体水平与结果之间的关系。我们还研究了种族对相关性的影响:18.8%的孕妇(258/1372)检测出幽门螺杆菌血清阳性。子痫前期是最不常见的结果(26/830)。幽门螺杆菌血清阳性与两种或两种以上不良妊娠结局(妊娠高血压、妊娠糖尿病、早产、小胎龄和子痫前期)的发生有关[OR:1.32(95% CI:1.06-1.65),P 值:0.01],尤其是在 OMP 抗原抗体水平较高的妇女中[OR:2.12(95% CI:1.62-2.76),P 值:0.001]。幽门螺杆菌抗原 GroEL 和 NapA 抗体水平高的妇女更容易患子痫前期[OR:2.34(95% CI:1.10-8.82),P 值:0.03;OR:4.09(95% CI:1.10-2.76),P 值:0.001]:4.09(95% CI:1.4-11.93),P 值:0.01)]。幽门螺杆菌血清阳性会增加西方族裔妇女(948/1372)在妊娠期间罹患任何高血压疾病的几率[OR:3.35(95% CI:1.29-8.74),P 值:0.03]:我们的研究表明,幽门螺旋杆菌血清阳性是导致多种不良妊娠结局的危险因素,尤其是西方裔妇女妊娠期高血压疾病。此外,针对 OMP、GroEL 和 NapA 的抗体反应所反映的病原体特异性似乎决定了疾病的关联性。
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引用次数: 0
Are rates of clinical interventions during pregnancy and childbirth different for refugees and asylum seekers in high-income countries? A scoping review. 高收入国家的难民和寻求庇护者在怀孕和分娩期间的临床干预率是否有所不同?范围综述。
IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-12 DOI: 10.1186/s12884-024-06893-2
Alix Bukkfalvi-Cadotte, Gargi Naha, Ashra Khanom, Amy Brown, Helen Snooks

Background: Adequate maternity care and appropriate clinical interventions during labour and delivery can reduce adverse perinatal outcomes, but unnecessary interventions may cause harm. While studies have shown that refugees and asylum seekers face important barriers when accessing maternity care, there is a lack of high-quality quantitative data on perinatal health interventions, such as induction of labour or caesarean sections, among refugees and asylum seekers and the findings reported in the literature tend to be inconsistent. Our goal was to examine and synthesise the evidence regarding the rates of intrapartum clinical interventions in women who are refugees and asylum seekers in high-income countries compared to other population groups.

Methods: We conducted a scoping review of peer-reviewed studies published in English since 2011 that report original quantitative findings regarding intrapartum clinical interventions among refugees and asylum seekers in high-income countries compared to those in non refugee, non asylum seeker populations. We examined reported rates of clinical pain relief, labour induction and augmentation, episiotomies, instrumental deliveries, and caesarean sections.

Results: Twenty-five papers were included in the review. Findings indicate that refugees and asylum seekers were less likely to receive pain relief, with 16 out of 20 data points showing unadjusted ORs ranging from 0.20 (CI: 0.10-0.60) to 0.96 (CI: 0.70-1.32). Similarly, findings indicate lower odds of instrumental delivery among refugees and asylum seekers with 14 of 21 data points showing unadjusted ORs between 0.25 (CI: 0.15-0.39) and 0.78 (CI: 0.47-1.30); the remaining papers report no statistically significant difference between groups. There was no discernable trend in rates of labour induction and episiotomies across studies.

Conclusions: The studies included in this review suggest that asylum seekers and refugees are less likely to receive clinical pain relief and experience instrumental delivery than non-refugee groups in high-income countries. This review strengthens our understanding of the links between immigration status and maternity care, ultimately informing policy and practice to improve perinatal health and the provision of care for all.

背景:在分娩过程中,充分的产科护理和适当的临床干预可以减少围产期的不良后果,但不必要的干预可能会造成伤害。研究表明,难民和寻求庇护者在获得产科护理时面临着重大障碍,但目前缺乏有关难民和寻求庇护者围产期保健干预措施(如引产或剖腹产)的高质量定量数据,文献中报道的结果也往往不一致。我们的目标是对高收入国家的难民和寻求庇护者与其他人群相比的产前临床干预率的相关证据进行研究和综合:我们对 2011 年以来发表的同行评审英文研究进行了范围界定,这些研究报告了与非难民、非寻求庇护者人群相比,高收入国家难民和寻求庇护者产前临床干预的原始定量研究结果。我们研究了临床镇痛、引产和扩产、外阴切开术、器械助产和剖腹产的报告率:共有 25 篇论文被纳入审查范围。研究结果表明,难民和寻求庇护者接受镇痛的几率较低,20个数据点中有16个未调整OR值介于0.20(CI:0.10-0.60)至0.96(CI:0.70-1.32)之间。同样,研究结果表明,难民和寻求庇护者使用器械分娩的几率较低,21 个数据点中有 14 个数据点显示未经调整的 OR 值介于 0.25(CI:0.15-0.39)和 0.78(CI:0.47-1.30)之间;其余论文报告的组间差异无统计学意义。不同研究的引产率和外阴切开术率没有明显趋势:本综述中的研究表明,与高收入国家的非难民群体相比,寻求庇护者和难民接受临床镇痛和工具性分娩的可能性较低。本综述加强了我们对移民身份与孕产妇护理之间联系的理解,最终为改善围产期健康和为所有人提供护理的政策和实践提供了信息。
{"title":"Are rates of clinical interventions during pregnancy and childbirth different for refugees and asylum seekers in high-income countries? A scoping review.","authors":"Alix Bukkfalvi-Cadotte, Gargi Naha, Ashra Khanom, Amy Brown, Helen Snooks","doi":"10.1186/s12884-024-06893-2","DOIUrl":"10.1186/s12884-024-06893-2","url":null,"abstract":"<p><strong>Background: </strong>Adequate maternity care and appropriate clinical interventions during labour and delivery can reduce adverse perinatal outcomes, but unnecessary interventions may cause harm. While studies have shown that refugees and asylum seekers face important barriers when accessing maternity care, there is a lack of high-quality quantitative data on perinatal health interventions, such as induction of labour or caesarean sections, among refugees and asylum seekers and the findings reported in the literature tend to be inconsistent. Our goal was to examine and synthesise the evidence regarding the rates of intrapartum clinical interventions in women who are refugees and asylum seekers in high-income countries compared to other population groups.</p><p><strong>Methods: </strong>We conducted a scoping review of peer-reviewed studies published in English since 2011 that report original quantitative findings regarding intrapartum clinical interventions among refugees and asylum seekers in high-income countries compared to those in non refugee, non asylum seeker populations. We examined reported rates of clinical pain relief, labour induction and augmentation, episiotomies, instrumental deliveries, and caesarean sections.</p><p><strong>Results: </strong>Twenty-five papers were included in the review. Findings indicate that refugees and asylum seekers were less likely to receive pain relief, with 16 out of 20 data points showing unadjusted ORs ranging from 0.20 (CI: 0.10-0.60) to 0.96 (CI: 0.70-1.32). Similarly, findings indicate lower odds of instrumental delivery among refugees and asylum seekers with 14 of 21 data points showing unadjusted ORs between 0.25 (CI: 0.15-0.39) and 0.78 (CI: 0.47-1.30); the remaining papers report no statistically significant difference between groups. There was no discernable trend in rates of labour induction and episiotomies across studies.</p><p><strong>Conclusions: </strong>The studies included in this review suggest that asylum seekers and refugees are less likely to receive clinical pain relief and experience instrumental delivery than non-refugee groups in high-income countries. This review strengthens our understanding of the links between immigration status and maternity care, ultimately informing policy and practice to improve perinatal health and the provision of care for all.</p>","PeriodicalId":9033,"journal":{"name":"BMC Pregnancy and Childbirth","volume":"24 1","pages":"742"},"PeriodicalIF":2.8,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11558906/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142614067","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
Modelling the temporal trajectories of human milk components. 模拟母乳成分的时间轨迹。
IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-11 DOI: 10.1186/s12884-024-06896-z
József Baranyi, Tünde Pacza, Mayara L Martins, Sagar K Thakkar, Tinu M Samuel

Background: This paper demonstrates how available data can be explored and utilized to conclude generic patterns in the temporal changes in Human Milk (HM) composition.

Methods: The temporal trajectories of selected human milk components (HMC-s) were described, in the first four months postpartum, by a primary model consisting of two phases: a short linear phase in the colostrum, triggered by the parturition; and a longer second phase, where the concentration of the component converges to a steady state. The model was fitted to data available in a recently published database of temporal HMC trajectories both at the levels of individual molecules (such as specific fatty acid, oligosaccharide, and mineral molecules) and molecule-groups (such as total protein, total fat).

Results: The properties of the trajectories suggest that experimental designs should follow non-equidistant sampling times, with increasingly longer time intervals after the first week postpartum. A selected parameter, the final stationary level, of the primary model was then studied as a function of geographical location (secondary modelling).

Conclusions: We found that the total variation of the concentration of specific HMC-s is dominantly due to the inherent biological differences between individual mothers and to less extent to the geographical location.

背景:本文展示了如何探索和利用现有数据来总结母乳(HM)成分时间变化的一般模式:方法:在产后头四个月中,所选母乳成分(HMC-s)的时间轨迹由一个包含两个阶段的初级模型来描述:初乳中的线性阶段较短,由产后引发;第二阶段较长,成分浓度趋于稳定状态。该模型与最近公布的 HMC 时间轨迹数据库中单个分子(如特定脂肪酸、寡糖和矿物质分子)和分子组(如总蛋白质、总脂肪)的数据进行了拟合:轨迹的特性表明,实验设计应遵循非等距采样时间,产后第一周后时间间隔应越来越长。然后研究了主要模型中的一个选定参数,即最终静止水平与地理位置的函数关系(二次建模):我们发现,特定 HMC-s 浓度的总体变化主要是由于母亲个体之间固有的生理差异造成的,与地理位置的关系不大。
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引用次数: 0
Building a machine learning-based risk prediction model for second-trimester miscarriage. 建立基于机器学习的二胎流产风险预测模型。
IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-09 DOI: 10.1186/s12884-024-06942-w
Sangsang Qi, Shi Zheng, Mengdan Lu, Aner Chen, Yanbo Chen, Xianhu Fu

Background: Second-trimester miscarriage is a common adverse pregnancy outcome that imposes substantial economic and psychological pressures on both the physical and mental well-being of patients and their families. Currently, there is a scarcity of research on predictive models for the risk of second-trimester miscarriage.

Methods: Clinical data were retrospectively collected from patients who were in the second trimester of pregnancy (between 14+0 and 27+6 weeks gestation), whose main diagnosis was "threatened abortion" and who were hospitalized at the Women and Children's Hospital of Ningbo University from January 2020 to October 2023. Following preliminary data processing, the patient cohort was randomly stratified into a training cohort and a validation cohort at proportions of 70% and 30%, respectively. The Boruta algorithm and multifactor analysis were used to refine feature factors and determine the optimal features linked to second-trimester miscarriages. The imbalanced dataset from the training cohort was rectified by applying the SMOTE oversampling approach. Seven machine-learning models were built and subjected to a comprehensive analysis to validate and evaluate their predictive capabilities. Through this rigorous assessment, the optimal model was selected. Shapley additive explanations (SHAP) were generated to provide insights into the model's predictions, and a visual representation of the predictive model was built.

Results: A total of 2006 patients were included in the study; 395 (19.69%) of them had second-trimester miscarriages. XGBoost was shown to be the optimal model after a comparison of seven different models utilizing metrics such as accuracy, precision, recall, the F1 score, precision-recall average precision, the receiver operating characteristic-area under the curve, decision curve analysis, and the calibration curve. The most significant feature was cervical length, and the top ten features of second-trimester miscarriage were found using the SHAP technique based on relevance rankings.

Conclusion: The risk of a second-trimester miscarriage can be accurately predicted by the visual risk prediction model, which is based on the machine learning mentioned above.

背景:二胎流产是一种常见的不良妊娠结局,对患者及其家庭的身心健康造成了巨大的经济和心理压力。目前,有关第二胎流产风险预测模型的研究还很少:回顾性收集2020年1月至2023年10月在宁波大学附属妇女儿童医院住院的妊娠后三个月(孕14+0周至27+6周)、主要诊断为 "威胁流产 "的患者的临床数据。经过初步数据处理后,患者队列被随机分层为训练队列和验证队列,比例分别为 70% 和 30%。采用 Boruta 算法和多因素分析来完善特征因子,并确定与二胎流产相关的最佳特征。训练队列中的不平衡数据集通过应用 SMOTE 过度采样方法得到纠正。建立了七个机器学习模型,并对其进行了全面分析,以验证和评估其预测能力。通过这种严格的评估,选出了最佳模型。生成了夏普利加法解释(SHAP),以提供对模型预测的洞察力,并建立了预测模型的可视化表示:研究共纳入 2006 名患者,其中 395 人(19.69%)为二胎流产。在利用准确率、精确度、召回率、F1 分数、精确度-召回率平均精确度、接收者操作特征-曲线下面积、决策曲线分析和校准曲线等指标对七个不同模型进行比较后,XGBoost 被证明是最佳模型。最重要的特征是宫颈长度,根据相关性排名使用 SHAP 技术找到了第二胎流产的十大特征:结论:基于上述机器学习的可视化风险预测模型可准确预测二胎流产的风险。
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引用次数: 0
Weight-based disparities in perinatal care: quantitative findings of respect, autonomy, mistreatment, and body mass index in a national Canadian survey. 围产期护理中基于体重的差异:加拿大全国调查中关于尊重、自主、虐待和体重指数的定量发现。
IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-08 DOI: 10.1186/s12884-024-06928-8
Nisha Malhotra, Cecilia M Jevitt, Kathrin Stoll, Wanda Phillips-Beck, Saraswathi Vedam

Background: Qualitative studies document episodes of weight-related disrespectful care, particularly for people with high body mass index (BMI ≥ 30) and reveal implicit and explicit biases in health care providers. No large quantitative studies document the pervasiveness of weight stigma or if experiences change with increasing BMI.

Methods: The multi-stakeholder RESPCCT study team designed and distributed a cross-sectional survey on the experiences of perinatal services in all provinces and territories in Canada. From July 2020 to August 2021, participants who had a pregnancy within ten years responded to closed and open-ended questions. Chi square analysis assessed differences in mean scores derived from three patient-reported experience measures of autonomy (MADM), respect (MOR), and mistreatment (MIST). Controlling for socio-demographic factors, multivariate logistic regression analysis explored relationships between different BMI categories and respectful care.

Results: Of 4,815 Canadians who participated, 3,280 with a BMI of ≥ 18.5 completed all the questions. Pre-pregnancy BMI was significantly associated with race/ethnicity, income sufficiency, and education but not with age. Individuals with higher BMIs were more likely to experience income insufficiency, have lower levels of education, and more frequently self-identified as Indigenous or White. Those with BMI ≥ 35 exhibited notably higher odds of reduced autonomy (MADM) scores, with an unadjusted odds ratio of 1.62 and an adjusted odds ratio of 1.45 compared to individuals with a normal weight. Individuals with BMIs of 25-25.9, 30-34.9, and ≥ 35 exhibited odds of falling into the lower tercile of respect (MOR) scores of 1.34, 1.51, and 2.04, respectively (p < .01). The odds of reporting higher rates of mistreatment (top 33% MIST scores) increased as BMI increased.

Conclusions: While socio-demographic factors like race and income play significant roles in influencing perinatal care experiences, BMI remains a critical determinant even after accounting for these variables. This study reveals pronounced disparities in the provision of respectful perinatal care to pregnant individuals with higher BMIs in Canada. Data suggest that those with higher BMIs face disrespect, discrimination, and mistreatment. Identification of implicit and explicit weight bias may give providers insight enabling them to provide more respectful care.

背景:定性研究记录了与体重相关的不尊重护理事件,尤其是对体重指数(BMI≥30)高的人,并揭示了医疗服务提供者的隐性和显性偏见。目前还没有大型定量研究记录体重蔑视的普遍性,或体重蔑视是否会随着体重指数的增加而改变:由多方利益相关者组成的 RESPCCT 研究小组设计并发布了一项横断面调查,内容涉及加拿大所有省份和地区的围产期服务体验。2020 年 7 月至 2021 年 8 月,十年内怀孕的参与者回答了封闭式和开放式问题。卡方分析评估了患者报告的自主性(MADM)、尊重(MOR)和虐待(MIST)三项体验测量的平均得分差异。在控制了社会人口学因素后,多变量逻辑回归分析探讨了不同体重指数类别与尊重护理之间的关系:在参加调查的 4815 名加拿大人中,有 3280 名体重指数≥ 18.5 的人完成了所有问题。孕前体重指数与种族/民族、收入充足程度和教育程度有明显关系,但与年龄无关。体重指数较高的人更有可能收入不足、受教育程度较低,而且更经常自我认定为土著或白人。与体重正常的人相比,体重指数≥35 的人自主性(MADM)评分降低的几率明显更高,未调整的几率比为 1.62,调整后的几率比为 1.45。体重指数分别为 25-25.9、30-34.9 和≥35 的人,其尊重(MOR)得分处于较低三等分的几率分别为 1.34、1.51 和 2.04(P 结论:体重指数为 25-25.9、30-34.9 和≥35 的人,其尊重(MOR)得分处于较低三等分的几率分别为 1.34、1.51 和 2.04:虽然种族和收入等社会人口因素在影响围产期护理体验方面发挥着重要作用,但即使考虑了这些变量,体重指数仍是一个关键的决定因素。本研究揭示了加拿大在为体重指数较高的孕妇提供有尊严的围产期护理方面存在的明显差异。数据表明,体重指数较高的孕妇面临不尊重、歧视和虐待。对隐性和显性体重偏差的识别可能会给提供者带来启示,使他们能够提供更加尊重的护理。
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引用次数: 0
Association of joint exposure to organophosphorus flame retardants and phthalate acid esters with gestational diabetes mellitus: a nested case-control study. 共同接触有机磷阻燃剂和邻苯二甲酸酯与妊娠糖尿病的关系:一项巢式病例对照研究。
IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-08 DOI: 10.1186/s12884-024-06925-x
Qi Lang, Xianfeng Qin, Xiangyuan Yu, Shudan Wei, Jinyan Wei, Min Zhang, Chaochao Zhao, Jun Zhang, Dingyuan Zeng, Xiaoying Zhang, Bo Huang

Background: Organic phosphate flame retardants (OPFRs) and phthalate acid esters (PAEs) are common endocrine-disrupting chemicals that cause metabolic disorders. This study aimed to assess the association between joint exposure to OPFRs and PAEs during early pregnancy in women with gestational diabetes mellitus (GDM).

Methods: Seven OPFRs and five PAEs were detected in the urine of 65 GDM patients and 100 controls using gas chromatography-tandem triple quadrupole mass spectrometry (GC-MS). The association of OPFRs and PAEs with GDM was assessed using logistic regression, weighted quantile sum (WQS) regression, and Bayesian kernel machine regression (BKMR) models.

Results: Levels of dibutyl phthalate (DBP), di-2-ethylhexyl phthalate (DEHP), diethyl phthalate (DEP), dimethyl phthalate (DMP), tris (2-butoxyethyl) phosphate (TBEP), tributyl phosphate (TBP), tris (2-chloroethyl) phosphate (TCEP), tris (1,3-dichloro-2-propyl) phosphate (TDCPP), tri-ortho-cresyl phosphate (TOCP), and triphenyl phosphate (TPHP) increased in the GDM group, and the OPFRs and PAEs, except for BBP and TMCP, were associated with GDM in the logistic regression analysis. In the WQS model, the mixture of OPFRs and PAEs was significantly positively associated with GDM (OR = 3.29, 95%CI = 1.27-8.51, P = 0.014), with TDCPP having the highest WQS index weight. BKMR analysis reinforced these results, showing that the overall association of joint exposure to the OPFRs and PAEs with GDM increased at exposure levels of the 55th to 75th percentiles. Independent exposure to TDCPP (OR = 1.42, 95%CI = 1.09-1.86, P = 0.011) and TBEP (OR = 1.29, 95%CI = 1.04-1.60, P = 0.023) were associated with an increased risk of GDM.

Conclusions: Environmental exposure to OPFRs and PAEs is significantly associated with GDM. These findings provide evidence for the adverse effects of exposure to OPFRs and PAEs on the health of pregnant women.

背景:有机磷酸盐阻燃剂(OPFRs)和邻苯二甲酸酯(PAEs)是常见的干扰内分泌的化学物质,可导致代谢紊乱。本研究旨在评估妊娠期糖尿病(GDM)妇女在孕早期共同暴露于 OPFRs 和 PAEs 之间的关联:方法:采用气相色谱-串联三重四极杆质谱法(GC-MS)检测了 65 名 GDM 患者和 100 名对照组尿液中的 7 种 OPFR 和 5 种 PAE。采用逻辑回归、加权量子和(WQS)回归和贝叶斯核机器回归(BKMR)模型评估了 OPFRs 和 PAEs 与 GDM 的关系:结果:邻苯二甲酸二丁酯(DBP)、邻苯二甲酸二-2-乙基己酯(DEHP)、邻苯二甲酸二乙酯(DEP)、邻苯二甲酸二甲酯(DMP)、磷酸三(2-丁氧基乙基)酯(TBEP)、磷酸三丁酯(TBP)、磷酸三(2-氯乙基)酯(TCEP)、磷酸三(1、在逻辑回归分析中,除 BBP 和 TMCP 外,其他 OPFR 和 PAE 均与 GDM 相关。在 WQS 模型中,OPFR 和 PAE 的混合物与 GDM 显著正相关(OR = 3.29,95%CI = 1.27-8.51,P = 0.014),其中 TDCPP 的 WQS 指数权重最高。BKMR 分析强化了这些结果,显示 OPFRs 和 PAEs 的联合暴露与 GDM 的总体关联在暴露水平处于第 55 百分位数至第 75 百分位数时增加。独立暴露于 TDCPP(OR = 1.42,95%CI = 1.09-1.86,P = 0.011)和 TBEP(OR = 1.29,95%CI = 1.04-1.60,P = 0.023)与 GDM 风险增加有关:结论:环境中暴露于 OPFRs 和 PAEs 与 GDM 密切相关。这些发现为暴露于 OPFRs 和 PAEs 对孕妇健康的不利影响提供了证据。
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引用次数: 0
Completion of maternal and child health continuum of care and associated factors in West Gondar Zone, North West Ethiopia, 2023: a community based cross sectional study. 2023 年埃塞俄比亚西北部西贡达区妇幼保健连续护理的完成情况及相关因素:一项基于社区的横断面研究。
IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-08 DOI: 10.1186/s12884-024-06949-3
Asrat Mekonnen Tegegne, Yohannes Ayanaw Habitu, Yeshiwas Ayale Ferede, Elsa Awoke Fentie

Background: The maternal and child health continuum of care integrates services from pre-pregnancy through childhood to enhance maternal and child outcomes. It is crucial for reducing maternal and child mortality by focusing on comprehensive health interventions. Despite its significance, comprehensive studies on the continuum remain limited. This study aimed to assess the completion of the maternal and child health continuum of care and associated factors among mothers with index children aged 12-23 months in the West Gondar Zone, Northwest Ethiopia, in 2023.

Methods: A community-based cross-sectional study was conducted from May 1-30, 2023, by interviewing mothers of 12-23-month-old children in West Gondar zone. A simple random sampling method was used to select 1,019 mothers. Data were collected via KoboCollect and analyzed in Stata version 14.0. Binary logistic regression was used to examine associations between independent variables and the continuum of care. Variables with a p value < 0.2 in bi-variable analysis were included in the multivariable model. Finally, adjusted odds ratios (AOR) with 95% confidence intervals (CI) and p values < 0.05 were used to determine statistical significance. The Hosmer and Lemeshow goodness-of-fit test was computed.

Results: The overall rate of completion of the maternal and child health continuum of care was 6.19% (95% CI: 4.69-7.68). The factors associated were having the first ANC visit before 16 weeks of pregnancy [AOR: 4.25 (CI: 2.14-8.47)], birth preparedness and complication readiness [AOR: 3.02 (CI: 1.41-6.46)], history of modern contraceptive use [AOR: 2.34 (CI: 1.16-4.73)], intended pregnancy [AOR: 3.25 (CI: 1.63-6.48)], receiving maternal services during ANC visits [AOR: 2.69 (CI: 1.07-6.80)], and the health facility being less than an hour away from home [AOR: 2.53 (CI: 1.06-6.03)].

Conclusions: The maternal and child health (MCH) continuum of care in West Gondar was low. Key factors affecting completion included birth preparedness and complication readiness, early ANC initiation, planned pregnancy, family planning use, proximity to health facilities, and maternal health services provided during ANC. Efforts should target these factors and ensure services at each stage of the continuum to stay mothers along the path of the MCH continuum of care.

背景:孕产妇和儿童健康持续护理整合了从孕前到儿童时期的各种服务,以提高孕产妇和儿童的成果。它以综合保健干预为重点,对降低孕产妇和儿童死亡率至关重要。尽管其意义重大,但有关持续护理的全面研究仍然有限。本研究旨在评估 2023 年埃塞俄比亚西北部西贡达尔区有 12-23 个月指标婴儿的母亲完成妇幼保健连续护理的情况及相关因素:方法:2023 年 5 月 1 日至 30 日,在西贡达尔区对有 12-23 个月大婴儿的母亲进行了访谈,开展了一项基于社区的横断面研究。研究采用简单随机抽样法,共抽取了 1,019 名母亲。数据通过 KoboCollect 收集,并用 Stata 14.0 版进行分析。采用二元逻辑回归法检验自变量与持续护理之间的关联。结果母婴健康持续护理的总体完成率为 6.19%(95% CI:4.69-7.68)。与之相关的因素有:在怀孕 16 周前进行首次产前检查[AOR:4.25 (CI:2.14-8.47)]、分娩准备和并发症准备[AOR:3.02 (CI:1.41-6.46)]、使用现代避孕药具史[AOR:2.34 (CI:1.16-4.73)]、计划怀孕[AOR:3.25(CI:1.63-6.48)]、产前检查期间接受孕产妇服务[AOR:2.69(CI:1.07-6.80)]、医疗机构离家不足一小时[AOR:2.53(CI:1.06-6.03)]:结论:西贡德尔的母婴保健(MCH)连续性较低。影响完成率的关键因素包括分娩准备和并发症准备、早期产前保健的启动、计划怀孕、计划生育的使用、医疗机构的邻近程度以及产前保健期间提供的孕产妇保健服务。应针对这些因素做出努力,并确保在持续护理的每个阶段提供服务,使母亲在妇幼保健持续护理的道路上一直走下去。
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引用次数: 0
Neighborhood socioeconomic status and postpartum depression among commercial health insurance enrollees: a retrospective cohort study. 商业健康保险参保者的邻里社会经济地位与产后抑郁症:一项回顾性队列研究。
IF 2.8 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Pub Date : 2024-11-08 DOI: 10.1186/s12884-024-06882-5
Onur Baser, Lauren Isenman, Erdem Baser, Wenjing Li, Burhan Cigdem

Background: Postpartum depression (PPD) is a prevalent psychological condition. Although the effect of obstetrical and maternal complications on PPD are well described, the impact of neighborhood socioeconomic status (SES) on PPD is relatively unexplored.

Objectives: This study examined the relationship between neighborhood SES score and PPD.

Methods: A summary SES measure for each U.S. zip code was constructed using income, education, and occupational 2021 Census data and linked to national commercial claims for 2017-2023. PPD status using diagnosis codes at outpatient and inpatient visits, and prescription drug use 3, 6, 9, and 12 months postpartum, were determined. Multivariate analysis controlled for potential confounders.

Results: PPD prevalence in commercial claims was 11.48%. Patients with PPD had higher rates of obstetrical (OR: 1.555, p < .0001) and maternal complications (OR: 1.145, p < .0001), and more lifestyle risk factors (OR: 1.113, p < .0001). Comorbidity scores were higher for patients with PPD. Controlling for age and clinical factors, living in a disadvantaged neighborhood was associated with an increased incidence of PPD (OR: 1.137, p < .0001).

Limitations: Claims data may include potential inaccurate coding of diagnoses/procedures. Clinical information is limited to conditions and treatments defined by ICD-10-CM codes. Area-based SES measures inevitably misclassify people on both ends of the socioeconomic spectrum (this misclassification is random; direction of bias is known).

Conclusions: The inverse and significant effect of area-based high SES on PPD rates demonstrates that preventive efforts may require interventions focusing on both the patient and the lived environment.

背景:产后抑郁症(PPD)是一种普遍存在的心理疾病。虽然产科和产妇并发症对产后抑郁症的影响已经有了很好的描述,但邻里社会经济地位(SES)对产后抑郁症的影响却相对缺乏研究:本研究探讨了邻里社会经济地位得分与 PPD 之间的关系:利用 2021 年人口普查的收入、教育和职业数据构建了每个美国邮政编码的 SES 衡量摘要,并与 2017-2023 年的全国商业索赔相链接。利用门诊和住院就诊时的诊断代码确定 PPD 状态,并确定产后 3、6、9 和 12 个月的处方药使用情况。多变量分析控制了潜在的混杂因素:商业索赔中的 PPD 患病率为 11.48%。PPD患者的产科检查率较高(OR:1.555,P 局限性:索赔数据可能包括不准确的诊断/手术编码。临床信息仅限于由 ICD-10-CM 代码定义的病症和治疗。基于地区的社会经济地位测量不可避免地会对社会经济光谱两端的人群进行错误分类(这种错误分类是随机的;偏差方向是已知的):基于地区的高社会经济地位对 PPD 发病率的反向显著影响表明,预防工作可能需要同时关注患者和生活环境的干预措施。
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引用次数: 0
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