Pregnancy planning in women with rheumatic diseases: an integrated framework for risk stratification and multidisciplinary management

Pregnant women with type 1 diabetes (T1D) have high risk of complications despite improved care based on technology advancements. To assess the effects of pregnancy planning on fetal and maternal outcomes in T1D women treated with continuous subcutaneous insulin infusion (CSII). We retrospectively assessed maternal and neonatal outcomes in T1D women using CSII who had planned or unplanned pregnancies between 2002 and 2018. The study was done in two European countries with similar sustained programs for pregnancy planning over the study period. Data from 107 pregnancies and newborn babies were collected. Seventy-nine pregnancies (73.8%) had been planned. HbA1c was lower in planned versus unplanned pregnancy before and during all three trimesters of pregnancy (p < 0.0001). Pregnancy planning was associated with a reduction in the occurrence of iatrogenic preterm delivery (RR 0.44, 95% CI 0.23-0.95; p = 0.01). Risk reduction persisted after adjustments for mother's age above 40years and preeclampsia. High HbA1c before or during pregnancy was associated with an increased risk of iatrogenic preterm delivery (RR 3.05, 95% CI 1.78-5.22, p < 0.0001). Premature newborns needed intensive care more often than those at term (RR 3.10, 95% CI 1.53-4.31; p = 0.002). Pregnancy planning in T1D women using CSII was associated with better glucose control and decreased risk of iatrogenic preterm delivery. Hence preconception care also improves pregnancy outcome in patients using an advanced mode of insulin delivery. Planned pregnancies could further benefit from the use of new metrics of glucose control.

Impact of planning of pregnancy in women with epilepsy on seizure control during pregnancy and on maternal and neonatal outcomes

Women's behaviors before and during pregnancy can affect their infants' health. Particularly because many births in the United States are unintended, it is important to understand women's health behaviors and pregnancy planning status before they become pregnant. A telephone survey of nonpregnant women of childbearing age who belonged to a Southern California managed care plan was conducted from 1998 through 2000. Survey data were analyzed in logistic regression models assessing differences in selected behaviors between women planning pregnancy and others. Compared with women not planning pregnancy, those planning pregnancy within the next year ("soon") were less likely to report smoking (odds ratio, 0.6), and more likely to report taking a multivitamin regularly (1.4) and having had a health care visit in the past year (1.6). Women planning a pregnancy more than one year in the future had elevated odds of reporting alcohol use (1.4); they were similar to women not planning pregnancy with respect to multivitamin use and smoking behavior. Women planning pregnancy soon were more likely than women not planning pregnancy to report that a health care professional had talked to them about taking a vitamin or mineral supplement (1.6). All women of childbearing age need information about the importance of engaging in healthy behaviors. Health care providers who have regular contact with such women should send clear messages about the adverse effects of alcohol and smoking during pregnancy and the importance of taking a multivitamin regularly, regardless of women's pregnancy plans, before they become pregnant.

Women's behaviors before and during pregnancy can affect their infants' health. Particularly because many births in the United States are unintended, it is important to understand women's health behaviors and pregnancy planning status before they become pregnant.A telephone survey of nonpregnant women of childbearing age who belonged to a Southern California managed care plan was conducted from 1998 through 2000. Survey data were analyzed in logistic regression models assessing differences in selected behaviors between women planning pregnancy and others.Compared with women not planning pregnancy, those planning pregnancy within the next year ("soon") were less likely to report smoking (odds ratio, 0.6), and more likely to report taking a multivitamin regularly (1.4) and having had a health care visit in the past year (1.6). Women planning a pregnancy more than one year in the future had elevated odds of reporting alcohol use (1.4); they were similar to women not planning pregnancy with respect to multivitamin use and smoking behavior. Women planning pregnancy soon were more likely than women not planning pregnancy to report that a health care professional had talked to them about taking a vitamin or mineral supplement (1.6).All women of childbearing age need information about the importance of engaging in healthy behaviors. Health care providers who have regular contact with such women should send clear messages about the adverse effects of alcohol and smoking during pregnancy and the importance of taking a multivitamin regularly, regardless of women's pregnancy plans, before they become pregnant.

Pregnancy planning in women with epilepsy: A single center observational study with focus on epilepsy type

The aim of the study: to evaluate the role of pregnancy planning in patients with diabetes mellitus type 2 in improvement of pregnancy and birth outcomes.&#x0D; Material and methods. 80 women with type 2 diabetes mellitus who were referred to the centre “Diabetes mellitus and pregnancy” in Ott’s Research Institute of Obstetrics and Gynecology were examined.&#x0D; Results. In the group of women who underwent pre-pregnancy counseling, the course and outcome of pregnancy were significantly better. Since the frequency of gestosis was lower (60%) than in the group without pregnancy planning (86.7%), there was no gestosis of severe degree in the group of women who underwent pre-pregnancy counseling (in the group without pregnancy planning the rate of gestosis of moderate and severe degree was 25%). Frequency of preterm delivery was lower (15%) in the group of women who underwent pre-pregnancy counseling than in the group without pregnancy planning (38.3%). Also in the group of women who underwent pre-pregnancy counseling there were no fetal congenital malformations, neonatal hypoglycemic events and hypertrophic cardiomyopathy (in the group without pregnancy planning these indicators were respectively - 3.4; 28.8; 3.4%. Also in the group of women who underwent pre-pregnancy counseling there were no perinatal mortality (in the group without pregnancy planning this indicator was 3.4%.&#x0D; Conclusion: pregnancy planning in patients with diabetes mellitus significantly improves the course and outcome of pregnancy.

Objectives. Women with pregestational diabetes are advised to plan their pregnancies to optimize glycemia and reduce fetal complications. We evaluated the adequacy of pregnancy planning effort and medical planning in pregnant women with type 1 and type 2 diabetes.Methods. This retrospective cohort study surveyed pregnant women with pregestational diabetes mellitus between 2006 and 2008 in Ontario, Canada. We evaluated three measures of pregnancy planning: pregnancy planning effort, medical planning based on prepregnancy glycemic control, and folic acid use. We compared women with type 1 and type 2 diabetes and explored predictors of pregnancy planning.Results. Of the 163 women studied (89 type 1, 74 type 2 diabetes), 47% reported high pregnancy planning effort, 58% reported attempts to optimize glycemic control, and 56% took folic acid before pregnancy. Of those who reported high pregnancy planning, 20% did not medically plan their pregnancies. Rates were similar between women with type 1 and type 2 diabetes. The most important predictor of pregnancy planning was having discussed plans with their physician.Conclusions. Our findings suggest that pregnancy planning is suboptimal in women with both type 1 and type 2 diabetes, highlighting a need to improve preconception counseling for all women with pregestational diabetes.

Do the rates at which women transition among different intensities of pregnancy planning vary with age, marital status and race/ethnicity? Rates of transition from low or moderate pregnancy probability groups (PPGs) to higher PPGs vary by age, marital status and race/ethnicity. The design of prospective studies of the effects of pre- and peri-conception exposures on fecundity, pregnancy and children's health is challenging because at any specific time only a small percentage of reproductive age women is attempting to conceive. To our knowledge, there has been no population-based, prospective study that repeatedly assessed pregnancy planning, which included women who were not already planning pregnancy at enrollment and whose ages spanned the female reproductive age range. A longitudinal study was carried out that repeatedly assessed pregnancy probability in 12 916 women for up to 21 months from January 2009 to September 2010. We analyzed data from the National Children's Study Vanguard Study, a pilot study for a large-scale epidemiological birth cohort study of children and their parents. During the Vanguard Study, investigators followed population-based samples of reproductive age women in each of seven geographically dispersed and diverse study locations over time to identify when they sought to become pregnant, providing a unique opportunity to prospectively assess changes in pregnancy planning in a large sample of US women. At study entry and each follow-up contact, which occurred at 1, 3 or 6 month intervals depending on PPG, a questionnaire was used to assess behavior dimensions of pregnancy planning to assign women to low, moderate, high non-tryer and high tryer PPGs. Crude rates of pregnancy increased with higher assigned PPG, validating the utility of the instrument. The initial PPG and probabilities of transitioning from low or moderate PPG to higher PPG or pregnancy varied with age, marital status and race/ethnicity. Women aged 25 to <35 years had shorter times to transition to higher PPGs or to pregnant compared with women <25 years. Women who were not currently married had longer times to transition from any initial PPG to pregnant, high tryer or high non-tryer status than currently married women. Non-Hispanic Black (NHB) and Hispanic women had shorter time to transition from low or moderate to high non-tryer than non-Hispanic White (NHW) women. NHB women also had shorter time to transition from low to high tryer than NHW women. High tryers are more likely to be aged 25 to <30 years, to be married, and to be Hispanic, NHB or other race/ethnicity than women in the low PPG. Loss to follow-up varied by age, marital status and race/ethnicity. Although weights were not developed for the Vanguard study, the self-weighting design minimizes the bias of unweighted analysis. Nonetheless, the SEs for some estimates may be under-estimated. Our results show that demographic characteristics are strong predictors of women's behaviors toward pregnancy. The results further show that frequent follow-up assessments of pregnancy planning behavior in large numbers of women are required to recruit an unbiased sample of preconception women. These findings will be useful to investigators designing prospective studies of fecundability, pregnancy outcomes and children's health. National Institutes of Health (contracts N01-HD53414, N01-HD63416, N01-HD53410, N01-HD53415, N01-HD53396, N01-HD53413 and N01-HD-53411; grant R21 ES016846) and by the University of California Irvine Center for Occupational and Environmental Health. No competing interests. None.

THU0674 Rheumatic diseases and pregnancy: a single centre dedicated clinic experience

Pregnancy planning is a critical opportunity to enhance preconception health. "Beiyun," a culturally rooted concept in China, encompasses traditional and modern practices for preparing for pregnancy. This study used the comprehensive idea of "Beiyun" to examine the mechanisms of pregnancy planning behavior among women and men through an integrated individual-couple analysis based on the Behavior Cognition - Social Influence Theory. Using multistage stratified sampling, we recruited reproductive-aged individuals in Zhejiang, China between July and September 2023. A cross-sectional survey collected data on pregnancy planning behavior. Analyses were conducted at both individual (Study 1, all participants) and couple levels (Study 2, coupled participants) using path analysis, specifically employing the actor-partner interdependence model in Study 2. Study 1 included 1086 women and 905 men, with 57.6% and 67.7% reporting pregnancy planning, respectively. Study 2 comprised 458 heterosexual couples. At the individual level, perceived susceptibility (women: β=0.09, p=0.01; men: β=0.09, p=0.04) and behavioral norms (women: β=0.37, p<0.01; men: β=0.45, p<0.01) were significantly associated with planning behavior. Couple-level analysis revealed that women's pregnancy planning was associated with their perceived susceptibility (β=0.13, p=0.02), behavioral norms (β=0.29, p<0.01), and their partner's behavioral norms (β=0.30, p<0.01), while men's behavior was associated with their norms (β=0.35, p<0.01) and partner's perceived susceptibility (β=0.13, p=0.03). This study yielded new insights into pregnancy planning behavior, highlighting the role of individual factors and partner dynamics. Future interventions should enhance risk awareness among women and shape behavioral norms in men, considering partner dynamics in public health campaigns.

BACKGROUND: The increase in the incidence of type 2 diabetes mellitus worldwide and the improvement in the quality of diabetic and obstetric care lead to an increase in the number of pregnant women with type 2 diabetes mellitus. The incidence of obstetric and perinatal adverse outcomes in women with type 2 diabetes mellitus is often higher than in women with type 1 diabetes. In the world literature, there are few works on the effect of pregnancy planning on the course and outcome of pregnancy in women with type 2 diabetes mellitus.&#x0D; AIM: The aim of this study was to evaluate the role of pregnancy planning in patients with type 2 diabetes mellitus in improvement of pregnancy and birth outcomes.&#x0D; MATERIALS AND METHODS: We retro- and prospectively analyzed the course and outcome of pregnancy in 124 women with type 2 diabetes mellitus, who were observed in the Diabetes Mellitus and Pregnancy Center of the Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott for the period from 2010 to 2019. The study included 34 women with type 2 diabetes mellitus at the stage of pregnancy planning and 90 women during pregnancy. All patients underwent a general clinical examination, carbohydrate metabolism correction, training at the School of Diabetes Mellitus in the principles of rational nutrition, self-control of glycemia and insulin therapy. Diabetes compensation was assessed by the level of glycated hemoglobin, determined using a method certified in accordance with the National Glycogemoglobin Standartization Program and standardized in accordance with the reference values adopted in the Diabetes Control and Complications Trial, as well as by the level of glycemia (self-control at least four times a day). We also assessed the severity of vascular complications of type 2 diabetes mellitus before and during pregnancy, and identified and treated comorbidities. To assess the degree of obesity, the criteria of the World Health Organization and the pregravid body mass index calculated by the Quetelet formula were used. The severity of preeclampsia was assessed in accordance with federal clinical guidelines. Ultrasound examination of the fetus with Doppler blood flow in the vessels of the fetoplacental complex was performed using a Voluson E6 ultrasound system (GE Healthcare, USA). For the timely diagnosis of diabetic fetopathy and fetal cardiomyopathy, dynamic fetometry and echocardiography were conducted. In addition, cardiotocography was performed for antenatal assessment of the fetus from the 30th week of pregnancy. After delivery, a neonatologist assessed the condition of the newborn using the Apgar scale at the first and fifth minutes of life, and then the assessment was carried out in the early neonatal period.&#x0D; RESULTS: In the group of women who received pregravid training, the course and outcomes of pregnancy were significantly better: the frequency of preeclampsia was lower (14.7%) compared to the group of women with an unplanned pregnancy (40.0%); there was no severe preeclampsia compared to the same women (13.3%). The number of preterm births was significantly lower (14.7%) in the group of women with planned pregnancy compared to the group of women without pregravid preparation (37.8%). In addition, in the group of women planning pregnancy, there were no fetal congenital malformations, neonatal hypoglycemic conditions, hypertrophic cardiomyopathy; in the group of women with an unplanned pregnancy, these parameters being found to amount to 6.7%, 24.4% and 6.7%, respectively. There was no perinatal mortality in the group of women with a planned pregnancy; however, this parameter was shown to be 3.3% in the group of women with an unplanned pregnancy.&#x0D; CONCLUSIONS: Pregnancy planning in patients with type 2 diabetes mellitus can significantly improve the course of pregnancy and childbirth outcomes.

Background/Objectives: Compared to in the general pregnant population, pregnancy in women with type 1 diabetes (T1D) is still associated with an increased number of perinatal complications affecting both the fetus and the mother. The Great Orchestra of Christmas Charity Foundation (GOCCF) program enables the use of continuous subcutaneous insulin infusion (CSII) enhanced by a hypo-stop function and real-time continuous glucose monitoring (rtCGM) during the preconception or early pregnancy period in patients with T1D. This observational study aimed to analyze the association between pregnancy planning and pregnancy outcomes in patients who qualified for the GOCCF program. Methods: Ninety-eight women with T1D, aged 21–41 years, who began using the CSII + rtCGM system at the planning/early pregnancy stage or at a later stage in the case of an unplanned pregnancy, were eligible for this study. We analyzed glucose control, the insulin requirements, the pregestational BMI, the maternal weight gain, the occurrence of preterm births, congenital malformations and the birthweight of newborns. Results: Women who planned their pregnancies had significantly better glycemic control before and throughout the entire pregnancy, and a significantly higher proportion of them achieved a TIR (time in range) &gt; 70% (58.7% vs. 28.9%, p = 0.014) and TAR (time above range) &lt; 25% (65.2% vs. 24.4%, p &lt; 0.001). Their glucose variability at the end of the pregnancy was significantly lower (29.4 ± 5.5 vs. 31.9 ± 5.1, p = 0.030). They also gave birth later, at a mean of 37.8 ± 0.9 weeks compared to 36.9 ± 1.8 weeks in the non-planned group (p = 0.039). Preterm birth occurred in five women (10.4%) who planned their pregnancies and in fifteen women (30%) who did not, with p = 0.031. Conclusions: Pregnancy planning in women with type 1 diabetes (T1D) is associated with better glucose control before conception and throughout the entire pregnancy, resulting in better pregnancy outcomes.

Purpose - to analyze the clinical course of pregnancy, childbirth and the condition of newborns in women with sexually transmitted infections (STIs) in the anamnesis after pre-pregnancy training before assisted reproduction technology (ART) cycles. Materials and methods. A clinical analysis of pregnancy, childbirth and newborns in 100 pregnant women after ART, with a history of STIs. This women were randomly divided into two groups: Group I (main) - 50 pregnant women subject to pre-pregnancy training, obstetric and perinatal support and delivery according to our developed medical and organizational algorithms, prognostic methods and treatment and prevention schemes; Group II - 50 pregnant women who received conventional prognostic and treatment and prevention measures. The Group III (control) was included 50 practically healthy pregnant women with a successful reproductive history and uncomplicated course of this pregnancy. Statistical processing of research results was performed using standard programs Microsoft Excel 5.0 and Statistica 8.0. Results. The main complication in pregnant women of group I was placental dysfunction, which due to our proposed pre-pregnancy training and management of pregnancy, was reduced from 38.0% in the Group II to 22.0% in women of the Group I (p&lt;0.05), the structure of which was dominated by compensated (72.7%) and subcompensated (27.3%) and no decompensated forms, recurrence of STIs (the Group I - 6.0% and the Group II - 16.0%, p&lt;0.05) and colpitis (the Group I - 16.0% and the Group II - 26.0%, p&lt;0.05). In addition, it is important to reduce the level of preeclampsia (the Group I - 6.0% and the Group II - 10%). In addition, gestational anemia (48.0%) was quite common in the Group II, the level of which we managed to reduce to 24.0% (p&lt;0.05). The analysis of the clinical course of childbirth showed a significant reduction in all complications of childbirth: premature birth (the Group I - 12.0% and the Group II - 26.0%, p&lt;0,05); premature rupture of fetal membranes (the Group I - 12.0% and the Group II - 36.0%, p&lt;0.05); fetal distress (the Group I - 8.0% and the Group II - 20.0%, p&lt;0.05) and obstetric bleeding (the Group I - 10.0% and the Group II - 18.0%), which is associated with severe decrease of the main complications of the gestational period). Condition of newborns after childbirth: in the Group I in 86.07% of cases the condition of children was satisfactory, 13.59% of children were born with signs of asphyxia (mild and moderate), and the overall level of children born with asphyxia decreased 2.5 times. The rate of fetal developmental delay decreased from 14.4% in the Group II to 3.03% in the Group I. Comprehensive dynamic monitoring and pathogenetic therapy were effective for the onset of pregnancy by ART and a favorable pregnancy outcome in 81.0% of women; reduction of reproductive losses by 4.4 times and perinatal mortality by 8.5 times. Conclusions. Early diagnosis, prevention and treatment of infectious diseases in women before pregnancy, pre-pregnancy preparation and planning of pregnancy in women with a history of STIs, effectively restores reproductive function, reduce the frequency of complications of gestation, severity (frequency and duration of relapses) infectious process during pregnancy, prevent severe forms of neonatal infection, reduce perinatal morbidity and mortality. The study was conducted in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of women was obtained for the study. No conflict of interests was declared by the author. Key words: sexually transmitted infections, pre-pregnancy training, pregnancy, obstetric and perinatal complications.

Our goal was to describe the management of pregestational diabetes in pregnant women in the United Kingdom. We used electronic medical records from The Health Improvement Network database between January 1995 and June 2012 to identify the first pregnancy in women 15 to 45years of age with pregestational diabetes type 1 or type 2. Information on lifestyle factors, demographic characteristics, prescription of specific antidiabetic medications, and glycemic control measures (HbA1c) was obtained from primary care provider records. We evaluated treatment patterns and HbA1c levels within 90days before the last menstrual period (prepregnancy period) and within each trimester of pregnancy. In a cohort of 1511 pregnant women with pregestational diabetes, 60% had type 1 and 40% type 2 diabetes. Among women with type 1 diabetes, 90% received antidiabetic medication (primarily insulin) prepregnancy and 92% during the first trimester. Among women with type 2 diabetes, 54% received antidiabetic medication (primarily metformin) during the prepregnancy period and 60% during the first trimester. Among women with nontreated diabetes type 2 before pregnancy, 22% initiated treatment by the first trimester (primarily insulin); those on noninsulin antidiabetic medications often switched to insulin. The proportion of women with at least 1 HbA1c value recorded within the prepregnancy period was 33% for type 1 (n=299) and 31% for type 2 diabetes (n=189); the corresponding proportions within the first trimester were 48% and 40%, respectively. Among women with recorded HbA1c, the prevalence of HbA1c>7% prepregnancy was 70% for type 1 and 52% for type 2 diabetes; the proportions within the first trimester were 73% and 46%, respectively. Management of pregnant women with diabetes seems to follow recommendations for pharmacological treatment. However, there is substantial room for improvement in HbA1c control, that is, in the planning of pregnancy in women with diabetes, in the initiation of antidiabetic medication among women with diabetes type 2 who may need it, and likely in the compliance with treatments in women with type 2 and type 1 diabetes.

Dawn A. Marcus, Philip A. Bain. Effective Migraine Treatment in Pregnant and Lactating Women: A Practical Guide. 207 pages. Humana Press, 2009. ISBN-978-1-60327-439-5. Price: € 46.95. As the title implies, this book is a practical guide for clinicians who treat pregnant and lactating women with migraine. This is the first book focusing on this important topic and is thus most welcome. It is authored by two physicians, Dawn Marcus, who has previously authored a number of books on headache and pain, and Philip Bain. Ideally, pregnant or lactating women should not use medications, but in severe migraine cases this is not always feasible. There are several drugs that are relatively safe to use during pregnancy and lactation and these are carefully discussed in this book. The level of safety according to established risk classification systems is presented for each drug. The book covers all aspects of migraine treatment during pregnancy and lactation including treatment of acute attacks, preventive treatment and non-pharmacologic treatment. Among other topics discussed are the planning of pregnancy in women with migraine and there are guidelines for the diagnostic work-up for headache during pregnancy and lactation. Finally, there is a chapter on patient headache resources; a CD-ROM is included providing practical handouts for migraine patients. In general, the book is well written and the text is clear. Important clinical issues are highlighted making them easier to grasp. In summary, this book covers all the key aspects of treating pregnant and lactating women with migraine. It can be recommended for gynecologists, neurologists, general practitioners and other physicians treating this important patient group.