Stillbirths in Bahrain: Analysis of patients admitted to a major tertiary hospital during a five-year period.

A retrospective study of the epidemiology and clinical manifestation of invasive aspergillosis in a major tertiary care hospital in Bahrain.

Pregnancy is a physiologically demanding phase marked by profound changes that elevate oxidative stress levels, posing potential risks to maternal and fetal health. Oxidative stress, resulting from an imbalance between reactive oxygen species (ROS) production and antioxidant defense mechanisms, has been implicated in various pregnancy complications. Antioxidants, renowned for their ability to counteract ROS and mitigate cellular damage, have emerged as a potential intervention to ameliorate adverse outcomes during pregnancy. The paper highlights the physiological changes in pregnancy that contribute to heightened oxidative stress, emphasizing the link between oxidative stress and complications such as pre-eclampsia, gestational diabetes, preterm birth, and intrauterine growth restriction. This paper emphasizes the imperative for robust, well-designed clinical trials to elucidate the optimal timing, dosages, and formulations of antioxidants in pregnancy. It calls for a comprehensive approach to establish clear guidelines and recommendations for antioxidant supplementation. In conclusion, this review underscores the potential of antioxidants as a promising intervention to mitigate oxidative stress-related pregnancy complications. However, the inconclusive nature of current evidence necessitates further rigorous research endeavors. Through this exploration, it accentuates the urgency for standardized protocols, ethical considerations, and extensive clinical studies to unlock the full potential of antioxidants in improving maternal and fetal health outcomes during pregnancy. Keywords: Antioxidants, Pregnancy, Maternal Health, Fetal Health, Oxidative Stress, Reactive Oxygen Species (ROS), Preeclampsia, Gestational Diabetes, Fetal Development

Background High-risk pregnancies, encompassing pregnancy-induced hypertension (PIH), gestational diabetes mellitus (GDM), preeclampsia toxemia (PET), and intrauterine growth restriction (IUGR), represent intricate medical challenges with potential repercussions for maternal and fetal health. This research undertakes a comprehensive comparative investigation into the variations of Doppler indices and placental parameters within the context of these high-risk conditions when juxtaposed against pregnancies characterized as normal. Methodology Employing a rigorous cross-sectional study design, a diverse cohort of pregnant individuals with gestational diabetes, IUGR, PIH, and preeclampsia was meticulously assembled. Additionally, a group of normal pregnant women served as the comparative reference. Doppler ultrasound assessments, viz, pulsatility index (PI), were carefully performed to estimate blood flow velocities within critical maternal and fetal vessels, while placental parameters were meticulously quantified, encompassing dimensions, vascular architecture, and morphological features. Results Except in the GDM group, all high-risk groups had reduced estimated placental weight and actual birth weight than normal pregnant women. All high-risk groups showed a highly significant elevation of the PI of the umbilical artery and PI of the middle cerebral artery (MCA) than normal but the PI of MCA was significantly reduced in the PET group than in normal individuals. The cerebro-placental ratio in the GDM and IUGR groups revealed markedly greater values, whereas PET showed lower values. IUGR and PIH groups showed a substantial reduction in the fetal birth weight. All high-risk groups (GDM, IUGR, PIH, and PET) showed a highly significant reduction in luminal area umbilical artery 1 than the normal pregnant women. In IUGR, marginal placental insertion was very high, followed by GDM and PET groups. Conclusions This study reveals that Doppler indices, placental parameters, newborn weight, and their related ratios may beutilizedto anticipate gestation difficulties and gain insight into the pathophysiology of problematic conceptions.

To evaluate the maternal and fetal outcomes of 12 pregnant women diagnosed with pemphigoid gestationis, in conjunction with a review of the literature. A retrospective review was conducted on the medical records of 12 patients diagnosed with pemphigoid gestationis who presented between January 2014 and January 2024. Twelve pregnant patients with pemphigoid gestationis were included in the study. The disease manifested during the first pregnancy in six patients. Mean maternal age was 30 years, mean gestational age at delivery was 33 weeks, and mean birth weight was 2146 g. Neonatal lesions were identified in two neonates. Intrauterine growth restriction, starting at an average of 33 weeks of gestation, was observed in four patients. Oligohydramnios was noted in two patients, hypertension in one patient, placental abruption in one patient, and gestational diabetes mellitus in one patient. During pregnancy, five patients were treated with oral steroids, six patients with intravenous steroids, and nine patients with topical steroids. Neonatal intensive care unit admission occurred in six neonates, and maternal intensive care unit admission was required for one patient. Patients with pemphigoid gestationis are at significant risk for severe maternal morbidity and adverse fetal outcomes in both the antepartum and postpartum periods. Early diagnosis of vesiculobullous lesions and close monitoring as high-risk pregnancies through a multidisciplinary approach are recommended.

Background and Aim: Insomnia, stress, and anxiety affect the mental wellbeing and distorts the work-life balance of health workers influencing their performance at work. This study aimed to assess the relationship of shift work with insomnia, anxiety, and stress among nurses in a tertiary care hospital in Bahrain. Methods: We used a cross-sectional study design. Our study population was 345 nurses in a major tertiary care hospital in Bahrain. The sample was selected based on the population probability to size method. Nurses completed a questionnaire that contained items, including sociodemographic data, Bergen’s Insomnia Scale, Perceived Stress Scale, and Shift Work Disorder scale. Results: The prevalence of insomnia was highest (85.7%) in the youngest nurses (20 to 30 years), Bahrainis (92.2%), nurses working in Surgical (85.5%) and Pediatrics (80.0%) departments, with 1 to 5 years of shift work experience (81.0%), and 1 to 3 night shifts a month (92.0%). Nurses with very high levels of stress were between the ages of 20-30 years, Bahrainis, had a B.Sc. degree, were in the Pediatrics Department, worked for 4 to 6-night shifts per month, and did not consume caffeinated drinks (p

This study aimed to determine caregivers' perspectives on difficulties encountered while seeking care for adolescents with sickle cell disease (SCD). It explored the social, emotional, and financial impact of caring for an adolescent with SCD on their caregivers. A mixed-method study in a major tertiary care hospital in Bahrain was conducted between June and August 2019. Cross-sectional questionnaires and thematic analyzed interviews were performed with 101 and 18 Bahraini caregivers of adolescents with SCD (aged 10-18 years), respectively. Lack of parking lots (52.5%) and traffic jams (27%) were identified as the most common challenges in seeking hospital care for adolescents with SCD. These difficulties, including prolonged waiting in the emergency room, discouraged more than half of the caregivers who preferred to seek care from smaller healthcare centers. Most caregivers reported receiving a high degree of support from their families, who emotionally encouraged them to facilitate patient care (73.3%). Therefore, their relationships with their friends, colleagues, and relatives were not significantly affected. Catastrophic health expenditure occurred in 14.8% of caregivers. Qualitative themes that emerged were A) the intricacy of caring for adolescents with SCD, B) dissatisfaction with hospital facilities, and C) insufficient healthcare services, wherein caregivers reported adolescents' experiences with services during hospital visits. Subthemes for the intricacy of caring for adolescents with SCD were 1) the psychological tragedy, summarizing the initial caregivers' feelings after the confirmed diagnosis, 2) caregiving hardships that described the caregivers' emotional and health burden while accepting and adjusting to the disease, and 3) the cost of care on families, which highlights the financial burden of the disease on families. The caregivers of adolescents with SCD experienced several overwhelming challenges, including problems in accessing healthcare and receiving medical services, in addition to influences on the emotional, financial, and social aspects of their lives.

ObjectiveThis study aimed to determine caregivers’ perspectives on difficulties encountered while seeking care for adolescents with sickle cell disease (SCD). It explored the social, emotional, and financial impact of caring for an adolescent with SCD on their caregivers.Study designA mixed-method study in a major tertiary care hospital in Bahrain was conducted between June and August 2019. Cross-sectional questionnaires and thematic analyzed interviews were performed with 101 and 18 Bahraini caregivers of adolescents with SCD (aged 10–18 years), respectively.ResultsLack of parking lots (52.5%) and traffic jams (27%) were identified as the most common challenges in seeking hospital care for adolescents with SCD. These difficulties, including prolonged waiting in the emergency room, discouraged more than half of the caregivers who preferred to seek care from smaller healthcare centers. Most caregivers reported receiving a high degree of support from their families, who emotionally encouraged them to facilitate patient care (73.3%). Therefore, their relationships with their friends, colleagues, and relatives were not significantly affected. Catastrophic health expenditure occurred in 14.8% of caregivers. Qualitative themes that emerged were A) the intricacy of caring for adolescents with SCD, B) dissatisfaction with hospital facilities, and C) insufficient healthcare services, wherein caregivers reported adolescents’ experiences with services during hospital visits. Subthemes for the intricacy of caring for adolescents with SCD were 1) the psychological tragedy, summarizing the initial caregivers’ feelings after the confirmed diagnosis, 2) caregiving hardships that described the caregivers’ emotional and health burden while accepting and adjusting to the disease, and 3) the cost of care on families, which highlights the financial burden of the disease on families.ConclusionThe caregivers of adolescents with SCD experienced several overwhelming challenges, including problems in accessing healthcare and receiving medical services, in addition to influences on the emotional, financial, and social aspects of their lives.

BackgroundThe use of traditional historic risk factors to identify gestational diabetes mellitus (GDM) will miss half of women with gestational diabetes mellitus. Our aim was to evaluate whether impaired glucose tolerance is a risk factor for vaginal candidiasis in pregnant women.Patients and MethodsIn a cross-sectional study, we compared the prevalence of impaired glucose tolerance in 64 pregnant women with vaginal candidiasis (positive microscopy) and 59 Candida-negative control subjects. Subjects underwent standardized 75-gram oral glucose tolerance testing between the 24th and 28th weeks of their pregnancies. Patients were included only if they had no known diabetes mellitus or historic risk factors for gestational diabetes mellitus, and had not been receiving antibiotic or steroid therapy. We compared glucose levels at fasting, 30 minutes, 60 minutes and 120 minutes, and perinatal and neonatal outcomes in the two groups.ResultsThere were no statistical differences between cases and controls in demographic characteristics. Glucose concentrations were higher in pregnant women with vaginal candidiasis than in control subjects at fasting (89 vs. 84 mg/dL, P=0.021), 30 minutes (139 vs. 126 mg/dL, P=0.050), and 60 minutes (124 vs. 106 mg/dL, P=0.018) after intake of 75 gram of glucose. The two groups did not differ in glucose level at 120 minutes after glucose administration. Gestational diabetes prevalence was 3.1% and 3.4% in the study and control group, respectively (P=0.274).ConclusionThe tolerance to glucose in pregnant women with vaginal candidiasis seems discretely impaired.

Protective effect of preconception high dose vitamin D3 supplementation in gestational diabetes mellitus rats via modulation of placental LCPUFA metabolism, one carbon cycle components, inflammation, oxidative stress, and angiogenesis.

Background: Diabetes during pregnancy is a major risk factor for congenital heart disease (CHD), particularly septal defects and ventricular hypertrophy. Hemoglobin A1c (HbA1c) and the Oral Glucose Tolerance Test are screening measures used to diagnose and control diabetes in pregnancy. This retrospective study compares gestational and pre-gestational diabetes and CHD outcomes, the effects of glycemic control, diabetic treatment, and other maternal factors. Methods: Medical records of 217 infant-mother dyads from 2020-2024 were analyzed. Maternal HbA1C levels from the first and second trimesters were recorded. Fetal and postnatal echocardiograms were reviewed to identify CHD. An abnormal postnatal echocardiogram during the first three months of life was deemed to have CHD. Data was analyzed using descriptive statistics, logistic regression, and an ROC was calculated on HbA1C for the predictive value on CHD. Results: CHD was diagnosed in 21.7% of infants. Mean gestational age was 36 weeks 5 days (24-41 weeks) and mean maternal age was 32.6 years (18-45 years). Mean birth weight was 3096 grams (640-5465 grams). CHD was more common in those with pre-gestational diabetes than gestational diabetes 26.4% vs 15.6%; p = 0.055. The most frequent CHDs were atrial septal defect (44.7%), patent ductus arteriosus (36%), left ventricular hypertrophy (27.6%), and ventricular septal defect (22.3%). Among mothers, the classes of diabetes were type 2 diabetes (45%), gestational diabetes (44%), prediabetes (8.8%) and type 1 diabetes (2.3%). Logistic regression analysis showed that higher first-trimester HbA1c levels was significantly associated with an increased odd of CHD; OR 1.42 (CI: 1.10–1.86); p = 0.009. Second-trimester HbA1c levels were not significantly associated with CHD; p > 0.05. A decreasing trend in HbA1c and gestational age was significant for CHD, OR 0.81 (CI: 0.68-0.95); p = 0.012. The ROC curve for HbA1c resulted with an AUC of 0.67 (CI: 0.53-0.81); p = 0.015. Conclusion: Poor first-trimester glycemic control is significantly associated with an increased odds of CHD in infants born to diabetic mothers including gestational diabetes. Increasing gestational age and decreasing HbA1c trends are protective factors, emphasizing the importance of early pregnancy diabetes management. HbA1c levels are moderately predictive of CHD.

Gestational Diabetes Mellitus (GDM) is frequently associated with chronic, low-grade inflammation. Whether this environment affects offspring anthropometry during early childhood remains to be elucidated. The aim of this study was to investigate the associations between maternal and fetal (cord blood-umbilical artery) inflammatory biomarkers and offspring weight and BMI up to 1 year in pregnancies with GDM. In this prospective secondary analysis of the MySweetheart study, we included 193 women with GDM and their offspring. Maternal and fetal (N=39) predictors included serum levels of inflammatory biomarkers including CRP, IL-6, and TNF-α at 24-32 weeks of gestational age (GA) and in the cord blood. Offspring outcomes were small and large for gestational age (SGA, LGA), sex- and age-adjusted weight, and BMI at birth and at 1 year. Univariate and multivariate regression models were performed. Associations were adjusted for maternal pre-pregnancy BMI, age, and ethnicity. Mean maternal age was 33.6 ± 4.8 years, and pre-pregnancy BMI 25.9 ± 5.6 kg/m2. Their mean gestational age at the 1st GDM visit was 29 ± 2.4 weeks. Gestational age at delivery was 39.7 ± 1.1 weeks, with a mean birthweight of 3.4 ± 0.46kg; 11.8% of offspring were LGA and 10.8% were SGA. At 1 year of age, mean offspring weight was 9.8 ± 1.2kg and BMI z-score 0.23 ± 1.1 kg/m2. In the models including only maternal predictors, TNF-α at 24-32 weeks of GA was positively associated with SGA and inversely with offspring weight and BMI at birth and at 1 year (p ≤0.034). In the models including only fetal predictors and the combined model, CRP was inversely associated with BMI at 1 year (p ≤0.020). In women with GDM, maternal and fetal inflammatory biomarkers distinctively influenced offspring anthropometry during the first year of life, independent of maternal age, prepregnancy BMI and ethnicity. These results suggest that low-grade inflammation during pregnancy may affect the developing offspring by leading to a decrease in weight and BMI and may have implications for future personalized follow-up of women with GDM and their offspring.

Maternal lipids and placental lipases in complicated pregnancy

Pregnant women who develop pre-eclampsia (PE) and/or intra-uterine growth restriction (IUGR) have reduced polyunsaturated fatty acid (PUFA) status compared to healthy pregnancy(1). It is unknown if pregnant women diagnosed with Gestational Diabetes Mellitus (GDM), and their offspring, also have compromised PUFA status. To determine if women with GDM, and their offspring, have altered PUFA status compared to healthy pregnancy. Pregnant women were recruited from Glasgow Scotland, and Brisbane, Australia from antenatal clinics for this cross sectional study. Third trimester maternal blood samples were collected after an overnight fast and cord blood samples were collected at delivery. Plasma fatty acids were analysed using gas chromatography from women with GDM (n = 37) and healthy pregnancies (n = 27) and their respective offspring (n = 31, from women with GDM, and n = 27 from healthy women). T-tests were used to determine significant differences between maternal with GDM and healthy pregnancy, as well as for their offspring and significance was set at p<0.05. Previously, erythrocyte fatty acids were analysed from women with PE (n = 21), IUGR (n = 13) and healthy pregnancies (n = 86)(1). All results were expressed as mol percent of total fatty acids. There were no differences in maternal plasma arachidonic acid (4.51 ± 1.23 vs. 4.72 ± 0.64, p = 0.39) and plasma EPA & DHA (2.33 ± 0.74 vs 2.69 ± 1.04, p = 0.14) in women with GDM and healthy pregnancies, respectively. There were no differences in fetal plasma arachidonic acid (11.58 ± 2.26 vs. 12.63 ± 1.69, p = 0.08) and plasma EPA & DHA (4.44 ± 1.17 vs. 4.44 ± 1.00, p = 0.89) in offspring from women with GDM and healthy pregnancies, respectively. Women with PE and IUGR had approximately 25% lower erythrocyte EPA & DHA and 35% lower erythrocyte arachidonic acid compared to healthy pregnant(1). Offspring from women with PE and IUGR had approximately 25% lower erythrocyte EPA & DHA and 22% lower erythrocyte arachidonic acid compared to healthy pregnancy(1).Women with PE and IUGR had lower PUFA status likely due to reduced PUFA synthesis(1) and offspring from women with PE and IUGR had reduced PUFA status likely due to ectopic fat in placenta tissue(2). Women with GDM do not have compromised PUFA status suggesting there is no reduced synthesis and transport of PUFA. Offspring from women with GDM do not have reduced PUFA status suggesting there is no problem with PUFA transport across the placenta, unlike offspring from women with PE and/or IUGR. Women with GDM, and their offspring, do not have compromised plasma PUFA status compared to healthy pregnancy.

Neonatal outcomes and its association among gestational diabetes mellitus with and without depression, anxiety and stress symptoms in Malaysia: A cross-sectional study

Objective:To assess the validity of Diabetes in Pregnancy Study Group India (DIPSI) guidelines, a modified version of the WHO criterion to diagnose gestational diabetes mellitus (GDM).Materials and Methods:A total of 1 463 consecutive pregnant women in the second and third trimester of pregnancy underwent 75 g oral glucose tolerance test (OGTT) and 2-h plasma glucose (PG) was measured by the glucose oxidase-peroxidase (GOD-POD) method. GDM was diagnosed with 2-h PG ≥ 7.8 mmol/L (WHO criteria) and the rest were classified as normal glucose tolerant (NGT) women. GDM women were advised medical nutrition therapy (MNT) for two weeks. Those who failed to reach the target glycemic level of FPG < 5.0 mmol/L and 2-h PG < 6.67 mmol/L with MNT were advised insulin. All of them were followed throughout pregnancy until delivery. Birth weight of 90th percentile (> 3.45 kg) in the neonates was considered as macrosomia (primary outcome).Results:The mean maternal age and body mass index were 23.60±3.32 years and 21.5±4.06 kg/m2 respectively. The mean gestational age was 27.9±5.56 weeks. DIPSI criterion identified 196 women (13.4%) as GDM and the rest as NGT. Insulin was required in 19 (9.7%) women with GDM. Macrosomia was observed in 9.9% GDM women with intervention and 9.8% in NGT (P = 1.000).Conclusion:DIPSI criterion is a one step-cost effective and evidence-based procedure to diagnose GDM in any socio-economic setting.