BMC Pregnancy and Childbirth最新文献

Background: Taking a sufficient number of skilled antenatal care (SANC) visits is incontrovertibly connected to safe motherhood. This study aims to shed light on the prevalence and potential factors associated with disparities in the SANC taking behavior of pregnant mothers in rural and urban Bangladesh.

Methods: For this purpose, a nationally representative secondary dataset from the Bangladesh Demographic and Health Survey (BDHS, 2017-18) has been considered. The information regarding the last birth of mothers who delivered within three years preceding the survey has been analyzed. We have applied the Conway-Maxwell-Poisson regression model (CMPRM) to deal with the overdispersion in skilled ANC count data, as this model shows the least AIC compared to the classical negative-binomial regression model (NBRM) and the generalized Poisson regression model (GPRM).

Results: Significant disparity (p-value < 0.001) has been observed in the mean number of SANC taken by rural (3.17) and urban (4.52) women. The analysis revealed that covariates have significantly different effects on SANC visits in rural areas compared to urban areas. For instance, women aged 35 and above in rural settings exhibited a 37% higher incidence rate of SANC visits (IRR = 1.37) compared to those under 20. Educational attainment had a pronounced impact, with rural women showing a 39% (IRR = 1.39) increase in SANC visits for primary education, 57% (IRR = 1.57) for secondary education, and 64% (IRR = 1.64) for higher education, compared to uneducated women. In contrast, in urban areas, higher education resulted in only a 35% (IRR = 1.35) increase.

Conclusion: Our findings from this study indicate that the concerned authority should come forward, and policymakers should emphasize various factors that are mainly responsible for the noteworthy different SANC status of pregnant women living in rural and urban areas in Bangladesh. Doing so, it can be hoped that the required number of ANC visits (eight or more) in both types of residences in Bangladesh, recommended by the World Health Organization (WHO), will be satisfied to ensure safer motherhood.

Background: The study aims to adapt the validity and reliability of the Pregnancy Quality of Life Scale in Turkish society.

Methods: The study was carried out methodologically between April 2021 and April 2022 at Bayburt State Hospital, the only public hospital operating in the city center of Bayburt. In the study, a total of 355 pregnant women who met the research criteria and volunteered to participate were examined without selecting a sample. Validity and reliability analysis of language and content validity, explanatory and confirmatory factor analysis, and Cronbach- α coefficient were used.

Results: The factor structure of the Turkish form of the scale was consistent with the original form. As a result of the explanatory appropriate. The internal consistency coefficient was calculated as the total Cronbach-α coefficient of the scale was 0.628 for the first trimester, and 0.628 for the II. trimester 0.727 for trimester, III. Trimester it is 0.698 for a trimester.

Conclusion: As a result of the validity and reliability study, the Turkish version of the Pregnancy Quality of Life Scale can be used as a valid and reliable measurement tool.

Background: Haemolytic disease of the foetus and newborn (HDFN) is an immune disorder driven by maternal alloimmunisation against foetal/newborn red blood cell antigens. HDFN can cause significant morbidity and mortality, with symptoms in the foetus ranging from mild anaemia to hydrops fetalis. While in newborns, HDFN can lead to severe forms of neonatal hyperbilirubinaemia and kernicterus. This systematic review (SR) aimed to identify and summarise real-world evidence (RWE) related to the patient burden/experience and economic burden of HDFN.

Methods: Electronic database searches supplemented by handsearching of grey literature, were conducted to identify studies that reported the clinical patient burden/experience, and economic burden of HDFN in Europe, the Middle East, and Africa (EMEA). Data from eligible studies were summarised in a narrative synthesis due to heterogeneity between studies.

Results: A total of 26 relevant publications were identified for inclusion in the SR, consisting of one study that directly measured Health Related Quality of Life, 9 studies reporting on proxy outcomes for patient burden and 18 studies reporting on economic burden (this includes two double-counted studies reporting more than one outcome type). Neurodevelopment, academic development, behaviour and personality were assessed as proxy outcomes for patient burden given the limited identification of patient-reported outcome data. These studies suggested potential neurodevelopmental impairments in children with HDFN. Despite these indirect insights into patient burden, identified data were limited and results should be interpreted with consideration of the inherent heterogeneity in design and endpoints assessed across RWE studies. Economic burden data were primarily limited to healthcare resource use outcomes, with limited reported data on healthcare costs, it is difficult to draw notable conclusions on the true economic burden of HDFN.

Conclusions: The current SR provides a clear summary of the available evidence for the patient experience and economic burden of HDFN. While the limited evidence indicates that HDFN does confer a significant burden on patients, the review identifies the need for further well-powered and representative observational studies using well-defined outcome measures to aid a greater understanding of the burden and experience of HDFN.

Trial registration: The protocol for this systematic review was registered in PROSPERO CRD42022328444.

Background: Three million babies die in the early neonatal period while 2.6 million are stillborn per year worldwide, and one of three deaths can be prevented. The perinatal mortality rate in Nepal is around 31 per 1000 births. Although the perinatal and neonatal death rates have decreased recently, it still poses a major challenge to the health system of Nepal. The objective of the study is to determine the causes of perinatal deaths by integrating Minimally Invasive Tissue Sampling (MITS) in hospital perinatal deaths and incorporating verbal autopsy in community deaths in Kaski district of Nepal.

Methods: The study will be conducted among the perinatal deaths reported in the five hospitals implementing the Maternal and Perinatal Death Surveillance and Response (MPDSR) system in Kaski district of Nepal. We will also conduct verbal autopsy (VA) among community perinatal deaths reported in the district. All the perinatal deaths reported in the study sites will be enrolled in the first stage of the study. Minimally Invasive Tissue Sampling (MITS) will be conducted among the consenting cases of perinatal deaths to retrieve relevant tissue samples and specimens. The specimens will undergo standard histopathological, microbiological, biochemical, and molecular tests. The "Cause of Death Panel" will finalize MITS informed cause of death following the customized protocol for the project and the cause so derived will be compared with that obtained by the review of deaths by the MPDSR committees of the hospitals. The Female Community Health Volunteers will be trained and mobilized to identify community perinatal deaths and trained personnel will conduct VA. Community engagement activities will be conducted to provide awareness to prevent perinatal deaths.

Discussion: The mechanism of counting and accounting for deaths in a systematic manner is important and it can provide evidence to determine changes in clinical practice and to develop guidelines and training packages for preventive measures. The outcome will be helpful to standardize methods to establish the accurate causes of perinatal deaths and develop strategies to minimize the deaths. The selected pathological investigations can be integrated into the existing death surveillance system in order to effectively determine the causes of death.

Improving dietary intake during pregnancy can mitigate adverse consequences for women and their children. The effective techniques and features for supporting and sustaining dietary change during pregnancy and postpartum are minimally reported. The primary aims of this systematic review and meta-analysis were to summarise the effectiveness of dietary interventions for pregnant woman, identify which behaviour change techniques (BCTs) and intervention features were most frequently used and determine which were most effective at improving dietary intake. Six databases were searched to identify randomised control trials (RCTs) reporting on dietary intake in pregnant women over the age of sixteen, with an active intervention group compared to a control group receiving usual care or less intensive interventions. The Cochrane Risk of Bias Tool 1 was used to assess study validity. BCTs were coded by two authors using Michie et al.'s BCT taxonomy V1. A random effect model assessed intervention effects on indices of dietary quality and food groups (fruit, vegetables, grains and cereals, meat, and dairy) in relation to the use of BCTs and intervention features. Thirty- seven RCTs met the inclusion criteria. High heterogeneity was observed across intervention characteristics and measures of fidelity. Only half of the available BCTs were used, with eleven used once. The BCT category Reward and threat was successful in improving dietary quality and vegetable intake, whilst 'Action planning' (1.4) from the category Goals and planning significantly improved dietary quality. Interventions delivered by a nutrition professional and those that included group sessions improved dietary quality more than those delivered by other health professionals, research staff, or application-delivered interventions and delivered via other modalities. Future dietary interventions during pregnancy should incorporate and report on BCTs used in the intervention. Successful design elements for improving antenatal dietary intake may include multimodal interventions delivered by nutrition professionals and the use of Rewards and Goal setting.

Background: We aimed to establish a predictive nomogram to evaluate the incidence of residual tissue in patients with endogenic cesarean scar ectopic pregnancy after negative pressure aspiration.

Methods: This retrospective study included patients treated in the gynecology department of our institution from May 2017 to August 2023 who underwent negative pressure suction treatment, ultrasound examinations before and after treatment, and received telephone follow-up for at least 6 months. A total of 899 patients met the inclusion criteria and were divided into a training cohort (629 patients, 70%) and a validation cohort (270 patients, 30%). Independent predictive factors were established using multivariate logistic regression. The resulting nomogram was validated using 1,000 bootstrap resampling, and calibration curves were plotted. Receiver operating characteristic (ROC) analysis was performed to calculate the area under the curve, sensitivity, specificity, and other metrics to assess its discriminative performance. Clinical decision curves were constructed to evaluate clinical applicability and quantify the net benefit within a range of threshold probabilities. The model was externally validated in the validation cohort.

Results: Predictive factors included in the nomogram included age (hazard ratio [HR]: 1.220, 95% confidence interval [CI]: 1.135-1.316), BMI (HR: 0.890, 95% CI: 0.796-0.986), intraoperative major hemorrhage (HR: 4.457, 95% CI: 1.610-12.292), maximum diameter of the gestational sac (HR: 1.572, 95% CI: 1.295, 1.914), and thickness of the remaining muscle layer of the lower uterine segment (HR: 1.572, 95% CI: 0.014, 0.430). The ROC curve of the resulting nomogram showed similar area under the curve values for the training (0.809, 95% CI: 0.751-0.867) and validation cohorts (0.814, 95% CI: 0.739, 0.888). The Hosmer-Lemeshow test indicated good model fit (P = 0.861), and the calibration curve was close to the ideal diagonal line. Decision curve analysis demonstrated good net benefit, and external validation confirmed its reliability.

Conclusions: The model may aid in individual clinical decision-making, allowing clinicians to perform immediate postoperative assessments for patients with endogenous ectopic pregnancy in cesarean section scars treated with negative pressure suction, identify high-risk subpopulations, and select appropriate supplementary treatment in advance, making it particularly suitable for low-income areas and resource-limited primary hospitals.

Background: Research on the relationship between fetal sex and neonatal outcomes in pregnant women with gestational diabetes mellitus (GDM) is limited, and existing findings have yielded inconsistent results. Therefore, the aim of our study was to investigate the impact of fetal sex on neonatal outcomes in mothers with GDM.

Methods: We conducted a systematic search of six database) PubMed, Cochrane Library, Scopus, Web of Science, SID (Persian database), and Embase (up to January 1, 2025. The quality of the included studies was assessed using the Newcastle-Ottawa Quality Assessment Scale. Subgroup analyses differentiated between retrospective and prospective cohorts for the primary outcomes. Sensitivity analyses were performed using the leave-one-out approach to evaluate the robustness of the pooled results. Additionally, a meta-regression analysis was conducted, considering maternal age, gestational weight gain, and BMI for both male and female infants.

Results: From 702 studies screened, twelve observational studies were included in the analysis. The results revealed a significant increase in the rates of macrosomia (RR 1.47, 95% CI 1.23 to 1.77, 6 studies, 121,230 neonates; p < 0.0001), cesarean delivery (RR 1.05, 95% CI 1.03 to 1.06, 6 studies, 127,704 neonates; p < 0.0001), large for gestational age (LGA) (RR 1.21, 95% CI 1.08 to 1.36, 6 studies, 16,863 neonates; p < 0.0001), small for gestational age (SGA) (RR 1.14, 95% CI 1.05-1.25, 6 studies, 16,863 neonates; p = 0.002), and a 5-minute Apgar score of less than 7 (RR 1.26, 95% CI 1.11 to 1.43, 2 studies, 104,881 neonates; p = 0.0003) in male neonates compared to female neonates. However, there were no significant differences in the rates of preterm delivery (p = 0.86), jaundice (p = 0.75), and a 1-minute Apgar score of less than 7 (p = 0.08) between male and female neonates in women with GDM.

Conclusion: The findings suggest that male infants are at a greater risk of experiencing specific adverse outcomes in the context of GDM. Further research is needed to establish tailored interventions and guidelines to improve the care and management of women with GDM and their infants.

Background: Despite the association between the gut dysbiosis and metabolic disorders, the main bacterial phylum in the first trimester of pregnancy that predisposes mothers to gestational diabetes mellitus (GDM) in the second trimester is not clear around the world.

Materials and methods: Three-hundred healthy women aged 18-40 years who were in the first trimester were participated in this cohort study and followed to the screening time for GDM diagnosis (in 24-28 weeks of pregnancy). Stool samples were gathered in the first trimester. GDM was diagnosed based on the International Association of Diabetes and Pregnancy Groups. In total, thirty mothers were diagnosed with GDM. Controls (N = 60) were selected from non-GDM participants matching to the GDM in terms of pre-pregnancy weight, weight gain, dietary intake and familial history of diabetes. The dominant phylum population was determined based on 16SrRNA gene expression.

Results: Mothers with lower Bacteroidetes and Actinobacteria population in the first trimester were more susceptible to GDM in the screening time (p < 0.001 and p < 0.001). The Firmicutes to Bacteroidetes ratio was significantly higher in mothers with GDM than the controls (p < 0.001). A significant negative correlation was observed between the gut Bacteroidetes (p < 0.001, p < 0.001, p < 0.001) and Actinobacteria (p = 0.004, p < 0.001, p = 0.02) population in the first trimester with the the serum FBS, 1 h-PG and 2 h-PG levels in the screening time. However, the gut Firmicutes to Bacteroidetes ratio (p = 0.003, p = 0.01) showed a significant positive correlation with serum FBS and 1 h-PG levels.

Conclusions: A higher Bacteroidetes and Actinobacteria population in the gut of mothers at the first trimester was associated with lower risk of GDM in the screening time. Higher Firmicutes to Bacteroidetes ratio in the gut of mothers was associated with fasting and 1-h glucose intolerance in the screening time.

Background: The purpose of this study was to evaluate the effect of individual education and care given to pregnant women in their living spaces on prenatal distress, risk perception, and labour anxiety.

Method: The study was conducted with 60 pregnant women primiparous pregnant women over 20 weeks of gestation. Data for this quasi-experimental, pretest-posttest designed randomised control group study were collected using the Prenatal Distress Scale, the Perception of Pregnancy Risk Questionnaire, and the Oxford Worries about Labour Scale. Education and care were provided in four 30-minute sessions, scheduled on mutually agreed-upon days and times in the living spaces of the pregnant women in the intervention group. These sessions were based on modules prepared by the researchers according to the women's trimesters. Pregnant women in the control group received routine pregnancy follow-ups concurrently with the intervention group.

Results: The mean posttest score of the pregnant women was 33.5 ± 4.1 in the intervention group and 23.6 ± 4.9 in the control group (p = 0.001). The mean posttest score for the Risk Perception Scale was 3 ± 0.9 in the intervention group and 5.6 ± 2.2 in the control group. For Prenatal Distress, the mean post-test score was 1.4 ± 2.2 in the intervention group and 13.2 ± 9.1 in the control group (p = 0.001).

Conclusion: The results of this study show that providing education to pregnant women in their living spaces following a disaster effectively reduces their risk perceptions, prenatal distress, and labour anxiety.

Date of registration: 26.10.2023 (NCT06110819).