3rd Trimester Research Articles

Dynamics of serum levels and reference ranges of copeptin in the 3rd trimester of pregnancy in healthy pregnant women with uncomplicated pregnancy and delivery.

Copeptin is a stable fragment of vasopressin. Copeptin levels have been found to reflect the degree of endothelial stress in various conditions, including acute coronary syndrome. Copeptin may be a bio marker for endothelial stress during pregnancy. However, there is still a lack of understanding of its dynamics and levels throughout pregnancy. This study aims to describe intra-individual and longitudinal changes in copeptin levels at 30th and 36th gestational weeks in healthy pregnant women with uncomplicated pregnancy and delivery and to establish specific reference ranges. A total of 125 pregnant women with uncomplicated pregnancy and delivery were included. These women were monitored throughout their pregnancy and gave birth at the Department of Obstetrics and Gynecology Olomouc University Hospital. The blood was taken at ~30 and ~36 gestational weeks. Serum copeptin levels were measured using a Kryptor Compact PLUS analyzer. For statistics, we used R software and the "referenceRanges" package. It was found that serum levels of copeptin were significantly higher in the 36th week group than in the 30th week group (P < 0.05). Cook's distance was used to eliminate outliers. The 30th week median was 3.377 pmol/l, reference range = 1.343-7.829 pmol/l, and the 36 week was median 4.735 pmol/l and reference range = 2.06-13.2 pmol/l. In the 36th week reference range, the median was higher than in healthy, non-pregnant women (P < 0.05). Copeptin values can exceed 10 pmol/l, particularly after the 36th week. In the 3rd trimester, this value may indicate cardiovascular and endothelial overload. Copeptin levels were found to vary significantly depending on gestational week. The proposed reference ranges take into account the increased secretion of vasopressin in pregnancy. The existence of specific upper reference limits represents a potential advantage in detecting pregnant women prone to hypertensive disease in the 3rd trimester.

Fecal incontinence risk factors and pregnancy.

We conducted an analysis on 231 pregnant women. A proctologist examined the patients three times: in the 1st trimester (within the first 15 weeks), in the 3rd trimester (29-40 weeks), and 12 months after childbirth. The total number of fecal incontinence observations among women included in the study was 66 cases (28.6%), detected at the final visit. Risk factors for fecal incontinence with a high probability were age over 36 years (P = 0.001), low physical activity (P = 0.034), three or more pregnancies resulting in childbirth (P = 0.022), history of hemorrhoids (P = 0.027), perianal discomfort on the first visit (P = 0.045), and constipation on the first visit (P = 0.006). Factors such as being overweight, marital status, education, living conditions, living area, and infant size did not have significance for fecal incontinence. Pregnancy- and obstetric-related risk factors contributing to fecal incontinence are multifactorial, including factors such as multiple childbirths with trauma to the pelvic muscles or anal sphincter muscles, chronic constipation, age, and vaginal deliveries. However, currently, there is no clear concept for the prevention of fecal incontinence in pregnant women. The prevalence of fecal incontinence among pregnant women is 12.9%, which increases to 28.6% one year after childbirth. The most common complaint was involuntary passage of intestinal gas. Risk factors for fecal incontinence with a high probability included being over 36-years old, low physical activity, three or more pregnancies resulting in childbirth, a history of hemorrhoids, perianal discomfort, and constipation in the 1st trimester of pregnancy.

CORRELATION BETWEEN VARIOUS ANTHROPOMETRIC AND MUSCULOSKELETAL MEASUREMENTS AND HEMORRHOIDS IN PREGNANCY

Purpose: The aim of this study was to determine the presence of hemorrhoids in pregnancy and symptoms related to hemorrhoids and to evaluate the relationship between hemorrhoids in pregnancy and various anthropometric and musculoskeletal parameters. Methods: The retrospective cross-sectional study included pregnant women in 3 different trimesters (1st, 11-15 weeks; 2nd, 16-23 weeks; 3rd, 24-40 weeks) without any anorectal problems before pregnancy. The presence of hemorrhoids and other anorectal symptoms during pregnancy was evaluated with yes/no questions on self-reported scales. Results: Evaluation was made of 268 pregnant women (92, 1st Trimester; 107, 2nd Trimester; 69, 3rd trimester). In the whole study sample, waist circumference measurement (p = 0.042; OR = 1.13; 95% CI 1.07–1.92), bi-iliac width (p = 0.036; OR = 1.17; 95% CI 1.09–1.38), rectus abdominis muscle strength (p = 0.006; OR = 0.45; 95% CI 0.04–0.58), Diastasis-recti-abdominis grade measured from umbilicus level (p = 0.023; OR = 1.38; 95% CI 1.14–1.83), hypermobility score (p = 0.006; OR = 3.34; 95% CI 1.98–7.94) and parity (p = 0.032; OR = 2.47; 95% CI 1.85–7.19) were found to be important risk factors for the presence of hemorrhoids in pregnancy. Conclusion: This is the first study to have evaluated hemorrhoids and hemorrhoid-related symptoms and to examine the associated risk factors comprehensively. It was also demonstrated for the first time that waist circumference measurement, bi-iliac width, increased grade of Diastasis-recti-abdominis measured at umbilicus level, hypermobility score, and decreased rectus abdominis muscle strength were risk factors for hemorrhoids in pregnancy.

Effects of an individualized nutritional educational program in pregnant women: A randomized controlled trial in Japan.

To evaluate the effectiveness of an individualized nutritional education program in promoting adequate nutrient intake in pregnant women. A stratified randomized controlled trial was conducted. Participants were stratified by factors affecting the primary outcome and randomly assigned to the intervention or control groups. Intervention group participants received an individualized 30-min booklet-based education program in their 2nd and 3rd trimesters; the control group received usual care. The primary outcome was protein intake after the intervention, which was compared between the intervention and control groups. Secondary outcomes included comparing the amount of increase of protein before and after the intervention. Nutrient intake was measured using a self-administered short dietary history questionnaire, and analyses of covariance and t tests were performed. Of the 130 participants, 66 were assigned to the intervention group and 64 to the control group. There was no difference in protein intake between the two groups after the intervention (p = .051, 95% CI [-0.021, 12.4]). Comparing the increase in protein intake before and after intervention, the intervention group was 7.4 g/day higher than that of the control group (p = .040; F = 4.31; effect size = 0.36). The primary outcome, a comparison of protein intake between the groups after the program, revealed no significant differences. However, on comparing the amount of protein increase before and after the intervention, the intervention group's increase was significantly higher than that of the control group. Results indicate the potential for individualized face-to-face interventions for pregnant women in Japan.

Prevalence of Anemia in Pregnant Women and Its Associated Socioeconomic Factors

Background: Anemia during pregnancy is an important public health problem, in developing countries. This community based study was conducted in Northeast India to study the prevalence of anemia along with the associated socioeconomic factors.
 Methods: The present one-year cross sectional study was carried out in the selected villages under Lahowal Block of Dibrugarh District and the relevant data was collected in a pre-designed and pre-tested proforma by house to house interviews. The sample size was calculated 310. Clinical examination was done and haemoglobin estimation was performed using Sahli’s acid hematin method. Data were analyzed in Microsoft Excel using percentage, range, t-test and ANOVA; wherever applicable. A significance level of 5% was taken with 95% confidence interval
 Results: Anemia was seen in 89.68% of the subjects. The highest mean hemoglobin (Hb) level was observed in the 1st trimester subjects (9.14 gm/dl), while the lowest mean Hb-level was observed in the 3rd trimester subjects (8.90 gm/dl). A significant difference was observed between the mean Hb-levels of the study subjects belonging to nuclear families and joint families, subjects belonging to different socio-economic status, different levels of education, different professions, those consuming tobacco and those not consuming tobacco, and those consuming betel nut and not consuming betel nut.
 Conclusion: There was a high prevalence of anemia in pregnancy which was related to the socioeconomic status, occupational status, level of education, type of family, and personal habits in these women.

Comparison of Left Ventricular Stroke Volume in 2nd- and 3rd-Trimester Fetuses Measured by the Product of VTI and Aortic Annular Area With That Assessed by Simpson's Single-Plane Rule Using the STE Technique.

The aim of the study was to compare left ventricle stroke volume in healthy, eutrophic fetuses in the 2nd and 3rd trimesters evaluated using the velocity time integral and aortic annulus area with left ventricular stroke volume measured using Simpson's single-plane rule and to determine the discrepancy equation. The study included 354 fetuses. In each fetus, during the same examination, simultaneous assessment of stroke volume was performed by pulsed-wave Doppler using the product of the velocity time integral and aortic annulus area and by the fetalHQ® software using Simpson's single-plane rule. The Mann-Whitney U test was used to compare the "product-derived" stroke volume and stroke volume using fetalHQ® software values in the 2nd and 3rd trimesters separately. The agreement between the two methods were verified using Bland-Altman analysis. A linear regression model was used to obtain the discrepancy equation. In the 2nd trimester, the mean percentage difference between both the techniques showed that the stroke volume values determined using pulsed-wave Doppler were, on average, 88% higher than the stroke volume values determined using fetalHQ®. The upper limit of agreement between the compared techniques was approximately 146% and the lower limit of agreement was equal to 29.6%. In the 3rd trimester, the results indicated that the stroke volume values determined using pulsed-wave Doppler were, on average, 76% higher than the stroke volume values determined using fetalHQ®. The upper limit of agreement between the compared techniques was approximately 129% and the lower limit of agreement was 23%. Based on the results of the linear regression models, discrepancy formulas of the stroke volume values were obtained. The equations to calculate the predicted mean and standard deviations were used to compute the reference intervals for the mean, 5th and 95th centiles. The calculation of left ventricular stroke volume using pulsed Doppler has higher result in relation to stroke volume determined using Simpson's rule significantly. The aortic annulus area showed a higher correlation regarding stroke volume than the velocity time integral in both the 2nd and 3rd trimesters. Stroke volume increased with the increase in aortic annulus area, whereas the velocity time integral remained relatively constant. The retrospective analysis of the collected material enabled the determination of the discrepancy equation.

Folic acid and iodine supplement use from preconception through to six weeks postpartum in New Zealand women

Folic acid (FA) and iodine supplements are recommended by the Ministry of Health (MOH) for pregnant and/or lactating women in New Zealand (NZ)(1). Evidence suggests that many NZ women are not just taking FA and iodine in the form of a single-nutrient supplement (SNS) but are taking FA and iodine as part of a multivitamin supplement (MVS) which may or may not contain the recommended doses, and some are using a combination of both(2). No NZ study has examined the daily dose taken from both SNS and MVS for both FA and iodine across all time periods (2, 3). The aim of this study was to investigate what nutritional supplements containing FA and iodine were taken by postpartum NZ women, preconception, during the three trimesters of pregnancy and post-partum, and examine how well the women’s supplement use aligned with the NZ MOH recommendations. This cross-sectional observational study utilised data gathered on FA and iodine supplement use from an anonymous survey between February and August 2022. Descriptive statistics including frequency and percentages were reported. Folic acid and iodine weekly intakes from SNS and MVS were calculated by multiplying the amount of nutrient in each supplement, with the number of times per day taken, and the average number of days taken per week reported. A total of 584 women were included in the analysis. In addition to the SNS for FA (0.8mg and 5mg) and iodine (150 ug), women took 28 different MVS. Fifty-eight percent (preconception; 30% from SNS, 18% from MVS, and 10% from both) and 96% (1st trimester pregnancy; 61% from SNS, 17% from MVS, and 19% from both) of women took FA containing supplements. More than 75% of women reported taking iodine containing supplements during pregnancy (1st and 2nd trimesters: 93%, 3rd trimester: 89%) and postpartum (76%).Approximately 60% took SNS, 18% took only MVS and 14% took both. Based on the MOH recommendations, only 30% (preconception) and 62% (1st trimester) achieved sufficiency of FA supplementation at 0.8mg/day; 35% (preconception) and 69% (1st trimester) achieved sufficiency of FA at 5mg/day; around 50% women achieved sufficiency of iodine supplementation at 150 µg/day during pregnancy while only 37% during postpartum. The balance either took none, an insufficient dose or a dose that exceeded the recommended dose and many took them during non-recommended periods (FA after the 1st trimester; iodine preconception). Most women reported taking FA and/or iodine containing supplements at some point before, during and after their pregnancy. However, it is concerning that a large number of women do not seem to be adhering to the MOH recommendations for FA and iodine supplementation.

IJCM_52A: Profile and outcome of gestational diabetes mellitus in a tertiary care teaching hospital

Background: Gestational Diabetes Mellitus (GDM) is a Glucose tolerance disorder first diagnosed during pregnancy. WHO recommend that all pregnant women or at least women with predisposing risk factors should be screened at the beginning of the 3rd trimester of pregnancy with the Oral Glucose Tolerance Test (OGTT). Here, blood glucose level is screened 2hrs after giving a 75g oral glucose load. This is recommended for both screening and diagnosis. Not many studies have been done regarding the outcome of GDM mothers in India. Objective: 1. To describe the Obstetric profile of the mothers 2. To assess the outcome of GDM among the Mothers 3. To determine the neonatal outcome of GDM. Methodology: Study setting: The study was carried out at Kasturba Medical College Hospital, Attavar, and District Lady Goschen Hospital, Mangalore. Study design: Hospital based retrospective study. Study population: Pregnant women admitted to above mentioned hospitals with GDM and the new born. Inclusion criteria: All women diagnosed with GDM and have delivered in District Lady Goschen Hospital or KMCH Attavar. Sample size was 266. Results: Our study concluded that 24.8% of the women with GDM also had Pregnancy Induced Hypertension, which is comparable to the study done in Qatar where they found 19.2% of the women with GDM suffered from PIH. We also found that 15.8% of the women suffered from Pre-Eclampsia, over twice the percentage of people surveyed in the Qatari study. However the amount of babies suffering from Macrosomia was only 6.8% as opposed to 10.3% according to the aforementioned study and 19.3% as was found in a study in Poznan, Poland. Conclusion: No significant association was found between obstetric profile and antenatal & postpartum complications.

Dysregulated placental expression of kynurenine pathway enzymes is associated with inflammation and depression in pregnancy

BackgroundPerinatal depression (including antenatal-, postnatal-, and depression that spans both timepoints) is a prevalent disorder with high morbidity that affects both mother and child. Even though the full biological blueprints of perinatal depression remain incomplete, multiple studies indicate that, at least for antenatal depression, the disorder has an inflammatory component likely linked to a dysregulation of the enzymatic kynurenine pathway. The production of neuroactive metabolites in this pathway, including quinolinic acid (QUIN), is upregulated in the placenta due to the multiple immunological roles of the metabolites during pregnancy. Since neuroactive metabolites produced by the pathway also may affect mood by directly affecting glutamate neurotransmission, we sought to investigate whether the placental expression of kynurenine pathway enzymes controlling QUIN production was associated with both peripheral inflammation and depressive symptoms during pregnancy. Methods68 placentas obtained at birth were analyzed using qPCR to determine the expression of kynurenine pathway enzymes. Cytokines and metabolites were quantified in plasma using high-sensitivity electroluminescence and ultra-performance liquid chromatography, respectively. Maternal depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS) throughout pregnancy and the post-partum. Associations between these factors were assessed using robust linear regression with ranked enzymes. ResultsLow placental quinolinate phosphoribosyl transferase (QPRT), the enzyme responsible for degrading QUIN, was associated with higher IL-6 and higher QUIN/kynurenic acid ratios at the 3rd trimester. Moreover, women with severe depressive symptoms in the 3rd trimester had significantly lower placental expression of both QPRT and 2-amino-3-carboxymuconate-6-semialdehyde decarboxylase (ACMSD); impaired activity of these two enzymes leads to QUIN accumulation. ConclusionOverall, our data support that a compromised placental environment, featuring low expression of critical kynurenine pathway enzymes is associated with increased levels of plasma cytokines and the dysregulated kynurenine metabolite pattern observed in depressed women during pregnancy.

Pregnancy Associated Plasma Protein-A (PAPP-A) as a Marker to Distinguish Normotensive with Early 2nd Trimester and Late 3rd Trimester Onset of Preeclampsia

Introduction: Preeclampsia is a hypertensive condition that occurs after 20 weeks of gestation accompanied by target organ damage. Complications of preeclampsia can cause intrauterine fetal growth retardation, and placental hypoperfusion, even in the most serious situations, namely termination of pregnancy and death of the fetus and/or mother. Pregnancy-associated plasma protein-A (PAPP-A) is a high molecular weight glycoprotein that is produced in the placenta and secreted into the maternal bloodstream. However, based on several studies that have been conducted, there is uncertainty in the results of assessing PAPP-A levels obtained in pregnant women in the second and third trimesters. Aim: Proving differences in PAPP-A levels in the second and third trimesters in the incidence of early-onset preeclampsia and normotensive pregnancy. Methods: An analytic observational study with a cross-sectional approach was carried out in the delivery room of RSUP Dr. Kariadi Semarang, Halmahera Health Center, Ngesrep Health Center, Bulu Health Center, and private midwife practice in Semarang City. The subjects of the study were six 2nd-trimester preeclampsia patients, fourteen 3rd-trimester preeclampsia patients, and twenty normotensive pregnancy patients who met the inclusion and exclusion criteria. Data were analyzed using Mann Whitney with a significance of p<0.05 Results: There was a significant difference in PAPP-A levels (p<0.001) between the preeclampsia and normotensive pregnancy groups, whereas PAPP-A levels were higher in the preeclampsia group. There were significant differences in PAPP-A levels (p<0.001) between the 2nd-trimester preeclampsia, 3rd-trimester preeclampsia, and normotensive pregnancies, where the highest PAPP-A levels were found in the 2nd-trimester preeclampsia group. Conclusion: There was a significant difference in PAPP-A levels between the second and third trimesters of early-onset preeclampsia compared to normotensive pregnancies, where PAPP-A levels were higher in the second and third trimesters of early-onset preeclampsia. Elevated PAPP-A levels in the second and third trimesters are associated with an increased risk of early-onset preeclampsia.

Co-infections of malaria and hepatitis B among pregnant women in Igbo-Eze North LGA of Enugu State, Nigeria

Acute hepatitis B virus (HBV) and malaria infections pose serious health risks to the general population and may worsen victims' physical and financial well-being. The objective of this study was to determine the frequency of HBV and malaria co-infections during LGA among expectant mothers. This study used a cross-sectional, prospective design. Blood samples were collected from both pregnant and non-pregnant women for parasitological and serological examinations in the study area. This was performed to compare the severity of infections between pregnant and non- pregnant women, as pregnant women are more susceptible to infections. The study included 50 women who attended antenatal care at the time of this project and 10 non-pregnant women who came to the hospitals for check-ups. Samples of people aged 18 to 52 years were collected. Age groups of 18-28 and 40-50 years had the greatest 30(50%) and lowest 8(13%) populations of women screened for malaria and hepatitis B co-infection, respectively. The 1st and 3rd trimesters were followed by the 2nd trimester, which had the highest prevalence. Only the second trimester had a 2% prevalence rate of hepatitis B. Farmers were the group most likely to contract malaria (92%). The percentage of government employees who had malaria and hepatitis B was the highest 20%), followed by traders (5%). Ogrute, the seat of the Local Government had a high rate of malaria infection despite having several medical facilities and less farming activities. Olido (25%), followed by Ogrute (14 point 3%), had the highest rate of co-infection with hepatitis B and malaria. The PCV ranges of 25–27(100%) and 28–30(100%) had the highest prevalence of malaria. This study shows how persistent malaria and hepatitis B are also associated with decreased packed cell volume (PCV) in pregnant women.

Maternal Seafood Consumption during Pregnancy and Cardiovascular Health of Children at 11 Years of Age.

Nutrition is critical during pregnancy for the healthy growth of the developing infant, who is fully dependent on maternal dietary omega-3 supply for development. Fatty fish, a main dietary source of omega-3, is associated with decreased cardiovascular risk in adults. We conducted a longitudinal study based on a mother-offspring cohort as part of the project Infancia y Medio Ambiente (INMA) in order to assess whether fish intake during pregnancy relates to cardiovascular health in children. A total of 657 women were included and followed throughout pregnancy until birth, and their children were enrolled at birth and followed up until age 11-12. A semi-quantitative food frequency questionnaire was used to assess the daily intake of foods during the 1st and 3rd trimesters of pregnancy. Cardiovascular assessments included arterial stiffness (assessed by carotid-femoral pulse wave velocity [PWV]) and retinal microcirculation (photographic assessment of central retinal arteriolar and venular equivalent [CRAE and CRVE]). The association between maternal fish consumption and cardiovascular outcomes of offspring at 11 years of age was evaluated using multivariable linear regression models. There were no statistically significant differences in any cardiovascular endpoint in children whose mothers had a higher fish consumption during pregnancy compared to those with a lower fish consumption. We found a slightly higher PWV (β = 0.1, 95% CI = 0.0; 0.2, p for trend = 0.047) in children whose mothers had a higher consumption of canned tuna during the 1st trimester of pregnancy. Fish intake during pregnancy was found to be unrelated to the offspring's cardiovascular health at 11 years of age. The beneficial cardiovascular effects of fish consumption during pregnancy on the offspring are still inconclusive.

Risk factors for spontaneous preterm deliveries above twenty-eight complete weeks of gestation

Purpose: To identify risk factors for spontaneous preterm delivery (SPD) given that it is associated with high neonatal morbidity and mortality. Material and methods: This case-control study was carried out between 1st February and 31st July 2021. Women who delivered spontaneously between 28 and ˂37 weeks (cases) or at ≥37 weeks (controls) were recruited. The main variables recorded included maternal age and parity, inter-pregnancy interval, if the pregnancy was intended, medical, obstetrical and family past-histories, gestational age at delivery, number of gestation and pathologies during current gestation. Fisher exact test, t-test and logistic regression were used for comparison. P<0.05 was considered statistically significant. Results: Our frequency of preterm delivery was 15.3% (116/759 births), with 9.9% (75/759) being SPD. Significant risk factors for SPD were premature rupture of membranes (aOR 19.96, 95%CI 11.04-45.82), inter-pregnancy interval ˃60 months (aOR 13.02, 95%CI 6.11-33.01), Nulliparity (aOR 10.21, 95%CI 5.72-21.31), 1st degree family history of SPD (aOR 7.73, 95%CI 1.54-11.39), malaria in the 3rd trimester (aOR 6.89, 95%CI 2.15-8.63), multiple pregnancies (aOR 6.43, 95%CI 3.21-9.79), severe anemia (Hb ˂6g/dl) in the 3rd trimester (aOR 5.73, 95%CI 2.04-10.60) and unintended pregnancies (aOR 2.44, 95%CI 1.98-7.88). Conclusion: Women with multiple or unintended pregnancies and those with the pre-gestational risk factors identified above should be well followed up during pregnancy to allow prevention, if not, early diagnosis of SPD. Moreover, prevention of the above-identified pathologies in pregnancy is mandatory if we want to reverse the rate of SPD

Perinatal photoperiod associations with bipolar disorder and depression: A systematic literature review and cross-sectional analysis of the UK Biobank database

Season-of-birth associations with psychiatric disorders point to environmental (co-)aetiological factors such as natural photoperiod that, if clarified, may allow interventions toward prevention. We systematically reviewed the literature concerning season-of-birth and bipolar disorder and depression and explored associations between the perinatal natural photoperiod and these outcomes in a cross-sectional analysis of the UK Biobank database. We used mean daily photoperiod and relative photoperiod range (relative to the mean) in the 3rd trimester and, separately, in the first 3 months post birth as metrics. From review, increased risk of depression with late spring birth is compatible with increased odds of probable single episode-, probable recurrent-, and diagnosed depression (OR 2.85 95 %CI 1.6–5.08, OR 2.20 95 %CI 1.57–3.1, and OR 1.48 95 %CI 1.11–1.97, respectively) with increasing 3rd trimester relative photoperiod range for participants who experienced relatively non-extreme daily photoperiods. Risk of bipolar disorder with winter-spring birth contrasted with no consistent patterns of perinatal photoperiod metric associations with bipolar disorder in the UK Biobank. As natural photoperiod varies by both time-of-year and latitude, perinatal natural photoperiods (and a hypothesized mechanism of action via the circadian timing system and/or serotonergic circuitry associated with the dorsal raphe nucleus) may reconcile inconsistencies in season-of-birth associations. Further studies are warranted.

Lessons Learned From Three Patients Who Underwent Cesarean Section and Cardiac Valvular Surgery Simultaneously: Anesthesiologists’ Perspective

Background: Cardiac valvular disease constitutes a challenge during pregnancy. Herein, we present our experience with three patients who underwent caesarean section and cardiac valvular surgery simultaneously. The purpose of this case series was to outline the clinical characteristics and to highlight the surgical/anesthesiologic pitfalls to be considered in patients who will undergo cardiac valvular surgery and caesarean section simultaneously. Methods: This retrospective case series was implemented using data extracted from the medical files of three patients who underwent cardiac valvular surgery and caesarean section in the obstetrics and gynecology and cardiovascular surgery departments of our tertiary care center. Demographic data, history, echocardiographic findings, surgical and anesthesiologic techniques as well as perioperative information and therapeutic outcomes were recorded. Results: Three pregnant women with an average age of 33.67 years were diagnosed with various cardiac valvular pathologies on the 3rd trimester. Owing to their diminished cardiac reserves and clear indications for cesarean section, the patients underwent cardiac valvular surgery subsequent to the cesarean section. Procedures were completed successfully on all patients and mothers and infants were discharged after a maternal follow-up in intensive care unit. Conclusion: We suggest that cardiac valve surgery can be performed simultaneously just after cesarean section in selected cases. Risks and benefits must be analyzed well prior to the decision making for the absolute necessity of the invasive procedure. Close collaboration between disciplines, well equipped referral centers, trained personnel and increased awareness on possible complications are the key points for successful surgical management of pregnant women with cardiac valve disease.

Clinical Effectiveness of Continuous Glucose Monitoring in Pregnancies Affected by Type 1 Diabetes.

Background: Continuous glucose monitoring (CGM) improves neonatal outcomes in type 1 diabetes pregnancies; however, its effectiveness has not been assessed in a real-world setting in the United States. Objective: The Triple C Study aimed to examine the clinical effectiveness, assessed through maternal glucose control and gestational health outcomes, of CGM use compared with self-monitoring of blood glucose (SMBG) in pregnancies associated with type 1 diabetes in a real-world setting. Research Design and Methods: We retrospectively identified 160 type 1 diabetes pregnancies at the Barbara Davis Center for Diabetes managed with CGM therapy (n = 109) or SMBG (n = 51) over a 6.5-year period (2014-2020). Obstetric care was provided at multiple practices. CGM use was defined as ≥60% wear in the second and third trimesters of pregnancy. Data were obtained from the electronic medical record system, hospital records, and vital statistics departments (Colorado and Wyoming). We used Student's t-test for continuous variables and chi-square test for categorical variables to compare outcomes between groups. Results: The CGM group had more participants meeting trimester-specific hemoglobin A1C (HbA1c) goals throughout pregnancy and postpartum (P < 0.01 in each time period). The CGM group had fewer participants never meeting HbA1c goals in any trimester than the SMBG group (P < 0.001). There were no significant differences in neonatal outcomes between groups, other than for macrosomia (12.8% CGM vs. 29.4% SMBG, P = 0.01). Infants of CGM users required a neonatal intensive care unit admission less often (52.9% CGM vs. 68.3% SMBG, P = 0.0989). Conclusions: CGM use was associated with improved maternal glucose levels in a diverse real-world cohort.

Prenatal insomnia disorder may predict concurrent and postpartum psychopathology: A longitudinal study.

While insomnia symptoms may be a risk factor for mental disturbances, few studies evaluated "Insomnia Disorder" and its relationship with perinatal psychopathology. Pregnant women were recruited during their last routine assessment before being hospitalized for delivery during the 3rd trimester at the Gynaecological Unit of the University Hospital of Ferrara and Udine, Italy, from January 2022 to January 2023. Our assessment included baseline evaluation (T0), and evaluations at 1 month (T1) and 3 months (T2) in the postpartum period, with specific questionnaires for insomnia disorder, such as Sleep Condition Indicator, mood and anxiety symptoms and psychosocial functioning, such as Edinburgh Postnatal Depression Scale, Mood Disorder Questionnaire, State-Trait Anxiety Inventory, Work and Social Adjustment Scale. At T0, 181 pregnant women were included. Insomnia disorder affected 22.3% at T0, 23.5% at T1 and 16.2% at T2. Women with insomnia disorder at baseline were significantly more affected by concurrent anxiety and depressive symptoms, had higher bipolar diathesis and poorer psychosocial functioning in the perinatal period. Prenatal insomnia disorder predicted anxiety (T0: odds ratio 4.44, p << 0.001; T1: odds ratio 4.009, p = 0.042) and depressive symptoms (T0: odds ratio 2.66, p = 0.015; T1: odds ratio 11.20, p = 0.001; T2: odds ratio 12.50 p = 0.049) in both the prenatal and postnatal period. It also predicted poor psychosocial function during the prenatal (odds ratio 3.55, p = 0.003) and postpartum periods (T1: odds ratio 2.33, p = 0.004). Insomnia disorder is emerging as an important prenatal factor that may contribute to concurrent and postpartum psychopathology.

Evaluation of changes in exhausted T lymphocytes and miRNAs expression in the different trimesters of pregnancy in pregnant women.

Throughout the three trimesters of a typical pregnancy, we looked at changes in the expression of miRNAs and exhausted T lymphocytes for this study. Fifty healthy subjects were included in this study. The frequency of exhausted T lymphocytes was measured in isolated PBMCs using flow cytometry. PD-1, TIM-3, and related miRNAs gene expression were assessed using qRT-PCR. The analyses revealed a significant decline in PD-1 and Tim-3 expression in PBMCs from RPL women (p = 0.0003 and p = 0.001, respectively). In addition, PD-1 and TIM-3 expression increased significantly in the 2nd trimester compared with the 1st trimester of healthy pregnant women (p < 0.0001 and p = 0.0002, respectively). PD-1 and TIM-3 expression was down-regulated in the 3rd trimester compared with the 1st and 2nd trimesters. In the present study, we demonstrated that TIM-3+/CD4+, TIM-3+/CD8+, PD-1+/CD4+, and PD-1+/CD8 + exhausted T lymphocytes increased in the circulation of women in the 2nd trimester compared to the 1st and 3rd trimester. In the 3rd trimester, the expression of miR-16-5p increased significantly (p < 0.0001). miR-125a-3p expression was down and upregulated in 2nd (p < 0.0001) and 3rd (p = 0.0007) trimesters compared to 1st trimester, respectively. This study showed a significant elevation of miR-15a-5p in 3rd trimester compared to 1st trimester of pregnant women (p = 0.0002). Expression pattern of PD-1 and TIM3 in exhausted T lymphocytes is different not only between normal pregnant and RPL women but also in different trimesters of pregnancy. So, our results showed the role of these markers in the modulation lymphocytes activity in different stages of pregnancy.

Sex-specific association between maternal mild anemia and children's behavioral development: a birth cohort study.

There has been limited research on maternal anemia affecting children's behavioral development, with a lack of studies focusing on sex differences in this association. Based on the Ma'anshan Birth Cohort, 2132 mother-child pairs were included. Maternal anemia was evaluated based on the hemoglobin concentration and children's behavioral development was assessed by Achenbach Child Behavior Checklist 1.5-5. Binary logistic regression models indicated that compared with children born of mothers without anemia throughout pregnancy, maternal mild anemia during pregnancy or only anemia in the 3rd trimester was associated with increased risks of aggressive behaviors in boys. Maternal mild anemia only in the 2nd trimester was associated with increased risks of attention problems in boys. In girls, maternal mild anemia during pregnancy was associated with increased risks of withdrawn, internalizing problems and total problems. Girls born of mothers with mild anemia only in the 2nd trimester had higher risks of total problems. Maternal mild anemia in both 2nd and 3rd trimesters was associated with increased risks of internalizing problems in girls. Our study identified sex-specific effects of maternal mild anemia during pregnancy on children's behavioral development problems.

Long working hours and obstetric complications: A cross-sectional study among female doctors

ObjectiveTo investigate the effects of long working hours on pregnancy complications and obstetric outcomes among female doctors working in tertiary care hospitals of Karachi. Study designA cross-sectional study was conducted on 149 female MBBS graduates (mean age: 33.5 ± 7.3 years) who had conceived at least once, currently working in two tertiary-care hospitals of Karachi. Data was collected through a self-administered questionnaire containing questions regarding demography and course of 1st pregnancy of the participants including working hours, antenatal and natal complications. Means and standard deviations were calculated for continuous variables with frequencies and percentages for categorical variables. The association between long working hours and different antenatal and natal complications was investigated using Chi-square test and T-test. ResultsOut of 149 participants included in final analysis, 85.9 % doctors gave birth to alive babies while 12.8 % had miscarriages and 1.3 % had stillbirth. Mean working hours during the three trimesters were found to be 53.76, 53.66 and 48.7, respectively. 43 % doctors experienced at least one antenatal complication during their pregnancy. Women who worked more than or equal to 55 h per week during 1st, 2nd and 3rd trimester of their pregnancy experienced more antenatal complications than women who worked less than 55 h (p-value=0.042, 0.021 and 0.018 respectively). 61.7 % females experienced at least one natal complication, most common of which was induction of Labour (39.1 %). Natal complications were significantly associated with increased workload during 2nd trimester (mean 58 vs 46 h, p-value 0.040). Doctors belonging to surgical specialty had 2.7 times higher risk of developing at least one natal complication than doctors of medical specialty (95 % Cl: 1.235–5.870). ConclusionLong working hours during pregnancy are associated with antenatal complications among female doctors. Natal complications were only significantly related to long working hours during 2nd trimester of pregnancy, however, female surgeons are more prone to develop natal complications than doctors belonging to medical specialties.