BMC Pregnancy and Childbirth最新文献

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: 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).

Background: The Tigray region of Ethiopia has a significantly high prevalence of neural tube defects (NTDs), ranging from 1.31 to 2.15% of total births. The prevalence has worsened due to ongoing regional war and conflict since October 2020. This study aims to assess NTD prevalence in these challenging conditions.

Methods: This institution-based, retrospective cross-sectional study was conducted across 11 public hospitals in the Tigray region. The study reviewed all delivery records from October 2020 to December 2023. Data were collected from hospital records, focusing on cases of neural tube defects (NTDs) and relevant maternal and neonatal characteristics. This retrospective analysis aimed to identify the prevalence of NTDs, as well as factors contributing to their occurrence. The data analysis involved using SPSS version 27 for comprehensive data management and statistical evaluation. Descriptive statistics provided an overview of the data, while binary logistic regression offered insights into the factors associated with neural tube defects. The results were systematically presented in both textual, tabular, graph formats to facilitate understanding and interpretation.

Results: Out of 54,626 delivery records, 1,612 cases of NTDs were identified (1,434 NTD cases and 178 isolated hydrocephalus cases). The specific birth prevalence of NTDs was 262.5 per 10,000 (95% CI, 249.1-276.5 per 10,000), with NTDs being the predominant cause of stillbirths. Anencephaly (136.6 per 10,000), spina bifida (110.6 per 10,000) and encephalocele (15.4 per 10,000) were the most common defects. Risk factors for NTDs include maternal age (20-29 years), rural residency, first pregnancies, a history of early neonatal death, lack of folic acid and multivitamin use, as well as neonatal factors like stillbirth, male sex, and preterm birth.

Conclusion: This study reveals the alarmingly high prevalence of neural tube defects (NTDs) in the Tigray region, with a birth prevalence of 262.5 per 10,000 births. Anencephaly, spina bifida, and encephalocele were common, contributing to stillbirths. Risk factors include maternal age (20-29), rural residency, first pregnancies, lack of folic acid and multivitamins, and neonatal factors like male sex and preterm birth. The findings stress the need for public health interventions, including folic acid awareness, better prenatal care, maternal nutrition research, stronger health systems, and a national surveillance system to prevent birth defects.

Objective: Caesarean section (CS) rates in Sri Lanka have escalated significantly, with projections indicating that over half of all births may involve CS by 2025. To address this rise and mitigate maternal morbidity, it is essential that CS procedures are medically justified. This study evaluates RobsApp®, a novel smartphone application designed to collect high-quality prospective data on CS rates based on the Robson classification.

Methods: The study utilized RobsApp® for data collection in the Professorial Unit of De Soysa Hospital for Women (DSHW), Sri Lanka. Data were collected prospectively from 1,712 deliveries between April and October 2019. The analysis focused on CS rates across different Robson categories and the quality of the collected data, comparing them with previous data obtained using traditional methods.

Results: The overall CS rate was 33.0%, with Robson category 5a accounting for most cases. Emergency CS constituted 49.6% of all procedures, with cardiotocograph (CTG) abnormalities being the leading indication. The quality of the data collected through RobsApp® met the standards recommended by the Robson guidance, as evidenced by the study's ability to accurately categorize deliveries and assess CS rates.

Conclusions: RobsApp® has proven to be an effective tool for prospective data collection, aligning well with Robson guidelines and facilitating high-quality data gathering. The study reveals a rising trend in CS rates at DSHW, particularly for reasons beyond previous CS. The inclusion of demographic data and birth weight analysis in future studies will enhance comparisons and insights into reducing CS rates.

Ethics: Ethical approval was obtained from the Ethical Review Committee, Faculty of Medicine, University of Colombo (Ref - EC-19-024) which waived the need for individual consent. Study adhered to the Helsinki Declaration.

Background: Maternal health care services and women's empowerment have received attention in the Sustainable Development Goals. Limited evidence exists on the extent of distribution of antenatal care services across the ladder of women's empowerment in Ethiopia. In this study, we sought to shed light on whether and how such disparities changed over time.

Methods: Data for the study came from the 2000 and 2016 Ethiopia Demographic and Health Surveys. The outcome variables were three measures of antenatal care services: quality antenatal care, early antenatal care, and four or more antenatal care services. Women's empowerment was measured through a newly developed index, SWPER Global. Specifically, we used two domains of the measure: attitude to violence and social independence. Disparities in antenatal care services were measured using the Erreygers concentration index, Relative Index of Inequality, Average marginal effect, and second difference of the average marginal effects. We decomposed the concentration index to study the contributions of different factors to the empowerment disparities in the services in 2000 and 2016 as well as to the over-time change in the disparities. The Oaxaca-type decomposition technique was applied to investigate social determinants' role on the change in the disparities between 2000 and 2016. A generalized linear regression model was used for the analyses.

Results: According to the concentration index, women's empowerment disparities in the utilization of antenatal care services existed in both surveys, where the services were disproportionately concentrated among women with better levels of empowerment. By the measure of average marginal effect, there were disparities favoring empowered women based mainly on the point estimates, except that the attitude toward violence disparity in 2016 occurred to the advantage of poorly empowered women. However, the confidence intervals suggest mixed findings. The concentration indices showed that disparities mostly increased in 2016 and the change was underpinned by the changes in the inequalities of various factors and sensitivities of antenatal care services with respect to these variables, such as wealth, maternal education, media exposure, place of residence, and women's empowerment itself. Overall, the results of the second difference showed no large change in the disparities between 2000 and 2016. However, relative disparities decreased substantially during the same time.

Conclusions: While concentration index-based absolute inequalities increased, relative inequalities decreased, suggesting the importance of using both absolute and relative measures in a study. The decomposition analyses suggest that working on the equitable distribution of social determinants could improve empowerment disparities in antenatal care services.

Background: People from migrant, refugee and culturally and linguistically diverse backgrounds experience significant disparities in pregnancy outcomes compared to the general population, including a higher risk of stillbirth. This study aimed to identify stillbirth-related programs or interventions for pregnant women from culturally and linguistically diverse backgrounds and explore how these interventions have been developed and/or tailored for culturally and linguistically diverse women.

Methods: We searched MEDLINE, CINAHL, Embase, and Scopus for articles published from inception to 12 Jan 2023. We included studies that report on the development and/or evaluation of a program or intervention to reduce the risk of stillbirth which has been specifically developed or tailored for pregnant women from culturally and linguistically diverse backgrounds living in high-income countries. Two independent reviewers conducted screening of the articles, data extraction, and quality appraisal. We first summarized the descriptive information of eligible studies using text and tables and then thematically grouped interventions based on approaches to meet community needs and synthesized data qualitatively.

Results: We identified 1999 studies from the database search. After removing duplicates and screening for eligibility, 9 studies met our inclusion criteria and were included in the review. Studies were conducted in Australia, the UK, US and Denmark between 1986 and 2021, with multi-ethnic populations (n = 6) or specific cultural and language groups (n = 3) (e.g. Pakistani and Indian women; African American and Hispanic population groups). Approaches to tailoring included the use of interpreters and translated materials, linking women to existing community resources and networks and community outreach delivered to women outside of hospital settings. Training of staff in cultural competence and multi-component, multiagency interventions addressing the wider social determinants of health and system-based approaches to facilitate access to language services were also identified.

Conclusion: While there are currently few targeted interventions for pregnant women from migrant, refugee and culturally and linguistically diverse backgrounds, approaches to cultural tailoring identified in this review can be used as a starting point for effectiveness testing and wider application. Ongoing work is needed to continue to address significant disparities in pregnancy outcomes for minoritised community groups. PROTOCOL REGISTRATION: The protocol for this review was registered in PROSPERO (CRD42021289321).

Background: Hypertensive Disorder during Pregnancy (HDP) is the most prevalent obstetric conditions in maternal health, but the etiology of most cases remains unexplained. Seasonal variations in the conception of HDP may offer insights into the potential seasonal-specific risk factors.

Methods: Data were sourced from the China's National Maternal Near Miss Surveillance System (NMNMSS) between January 1, 2012, and December 31, 2021. HDP status was ascertained from the diagnostic records over 400 medical institutions. The conception date was estimated based on the delivery date and duration of gestation length, and the season of conception, were categorised as winter (December to February), spring (March to May), summer (June to August), and fall (September to November). Odd ratios were calculated separately using the logistic regression model.

Results: Among the 14,073,565 pregnant women analysed, 3.98% met the study's criteria for HDP as defined in the present study. Maternal conception in spring was associated with a 10% increased risk of HDP (aOR, 1.10 [95% CI, 1.08-1.12]) compared with summer conceptions. Elevated risk of HDP was observed for maternal individuals conceiving in February, March, April, May, and June according to analyses conducted for specific months. The associations were slightly stronger in the subgroup of women diagnosed with gestational hypertension and preeclampsia. Significant disparities exist in this association among the diverse Köppen-Geiger climate zones.

Conclusion: Significant seasonal variations in the risk for HDP were observed across a range of maternal characteristics, HDP subtypes, and climatc zones. These findings imply the necessity of considering seasonally fluctuating environmental factors in the etiological investigation of HDP.

Clinical trial number: Not applicable.