Birth In Pregnant Women Research Articles

Discontinuation Of Long-Established Hydroxyprogesterone Caproate; Call For Awareness And Drug-Substitutes: A Letter To The Editor.

Madam, 17-Hydroxyprogesterone caproate is a synthetic progestin medication used to prevent preterm birth in pregnant women with a prior history of preterm birth. The drug has been used worldwide, including in Pakistan (local brand names Gravibinan and Proluton) for the prevention of PTBs and recurrent miscarriages. The drug is potent, cost-effective and readily available as IM injections. The FDA approved drug in 2011 after the Meis trial, which was regarded as a game-changer. [1] But many subsequent trials showed that the drug did not significantly lowered the risks of preterm births. The PROLONG study, much larger than the Meis trial, that was conducted in association with the FDA between 2009 and 2018 as a confirmatory trial showed practice-changing results that 17 OHPC did not significantly reduce the risk of PTB and neonatal morbidity, hence not confirming treatment efficacy. [2] The FDA ultimately in 2023 issued a statement recalling Makena (17-OHPC) and its generics from the market stating that the drug had no significant role in reducing the risk of PTBs and has potential risks to the offspring in the long term. [3] A study by C. Murphy et. al published in the American Journal of Obstetrics and Gynecology showed an increased risk of prostate, colorectal and pediatric brain cancer in offspring exposed to 17 OHPC especially during the first trimester. [4] Micronized progesterones (locally available as Progefik and U-Progest) on the contrary, are chemically similar to human progesterone and are therefore regarded as ‘body-identical’. They are administered orally or vaginally and have similar effects as 17-OHPC in the prevention of PTB. A comparative study in India by Shambhavi et.al was one of the various studies to show that no significant difference in the two medications for the prevention of PTB and neonatal morbidity. [5] Micronized progesterone has largely gained popularity in recent years and has replaced 17-OHPC in preventing PTBs especially in women with short cervix. 17-OHPC is still being widely prescribed in Pakistan. Efforts should be made to spread awareness among the healthcare practitioners regarding the disapproval by FDA for continued use of 17-OHPC. Pakistan’s Drug Regulation Authority needs to act accordingly regarding the continued approval of the drug in the country and spread awareness about its substitutes with better potency and reduced risks. Moreover, continued research about the efficacy of other progesterones administered to reduce PTBs and their potential risk factors in the long run is needed.

Metabolomic profiling of preterm birth in pregnant women living with HIV

BackgroundPreterm birth is a leading cause of death in children under the age of five. The risk of preterm birth is increased by maternal HIV infection as well as by certain antiretroviral regimens, leading to a disproportionate burden on low- and medium-income settings where HIV is most prevalent. Despite decades of research, the mechanisms underlying spontaneous preterm birth, particularly in resource limited areas with high HIV infection rates, are still poorly understood and accurate prediction and therapeutic intervention remain elusive.ObjectivesMetabolomics was utilized to identify profiles of preterm birth among pregnant women living with HIV on two different antiretroviral therapy (ART) regimens.MethodsThis pilot study comprised 100 mother-infant dyads prior to antiretroviral initiation, on zidovudine monotherapy or on protease inhibitor-based antiretroviral therapy. Pregnancies that resulted in preterm births were matched 1:1 with controls by gestational age at time of sample collection. Maternal plasma and blood spots at 23–35 weeks gestation and infant dried blood spots at birth, were assayed using an untargeted metabolomics method. Linear regression and random forests classification models were used to identify shared and treatment-specific markers of preterm birth.ResultsClassification models for preterm birth achieved accuracies of 95.5%, 95.7%, and 80.7% in the untreated, zidovudine monotherapy, and protease inhibitor-based treatment groups, respectively. Urate, methionine sulfone, cortisone, and 17α-hydroxypregnanolone glucuronide were identified as shared markers of preterm birth. Other compounds including hippurate and N-acetyl-1-methylhistidine were found to be significantly altered in a treatment-specific context.ConclusionThis study identified previously known as well as novel metabolomic features of preterm birth in pregnant women living with HIV. Validation of these models in a larger, independent cohort is necessary to ascertain whether they can be utilized to predict preterm birth during a stage of gestation that allows for therapeutic intervention or more effective resource allocation.

Addition of Cervical Elastosonography to Cervical Length to Predict Preterm Birth in Pregnancy Women with Prior Preterm Birth: A preliminary prospective study.

To investigate the characteristics of cervical elastosonography in pregnancies and establish an ultrasound-based combing predictor for improving the prediction in pregnant women with prior-preterm birth who might ultimately undergo preterm birth (PTB). 169 singleton pregnancies with prior-preterm birth were examined by cervical elastography from January to November of 2021. According to the ultrasound image and result of the following-up, the patients were separated into preterm groups and full-term groups with or without cerclage. There were five elastographic parameters: Elasticity Contrast Index (ECI), Cervical hard tissue Elasticity Ratio (CHR), External Cervical os Strain rate (ES), Closed Internal Cervical os Strain rate (CIS), CIS/ES ratio and CLmin. Multivariable logistic regression was used to screen out the most significant predictors. The area under the receiver operating characteristic curve (AUC) was calculated to evaluate the ability of prediction. The PTB group without cerclage showed significantly softer cervix stiffness, while those with cerclage showed significantly harder. CHRmin with P < 0.05 in the univariate logistic regression analysis was screened as a more valuable cervical elastosonography parameter than other ones. The combination of CLmin and CHRmin in un-cerclage and integrating CHRmin, maternal age and pre-pregnancy BMI in cerclage presented good predictive value. The results of AUC were higher than CLmin, respectively (0.775 vs 0.734, 0.729 vs 0.548). The addition of cervical elastography parameters (such as CHRmin) might improve the ability to predict preterm birth in pregnant women with previous preterm delivery, which was better than using CL alone.

The Impact of COVID-19 on Preterm Birth Among Pregnant Women in Al-Qassim, Saudi Arabia.

Pregnant women are regarded as a unique group due to the distinct immunological condition that pregnancy produces, which makes pregnant women more susceptible to respiratory infections like coronavirus disease 2019 (COVID-19) and its consequences. During pregnancy, many viral infections have been recognized to increase the risk of adverse obstetrical outcomes such as preterm delivery. The purpose of this study was to investigate the effects of COVID-19 infection on preterm birth in pregnant women in the Al-Qassim region of Saudi Arabia. This retrospective cohort study was conducted in Saudi Arabia between December 2019 to October 2021. The target subjects were pregnant women with live singleton gestations who underwent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) testing for COVID-19 infection during their delivery hospitalization. Data gathered included patient demographic information, clinical characteristics, and pregnancy outcomes. Data were analyzed using R version 4.1.1 (R Core Team (2021); R Foundation for Statistical Computing, Vienna, Austria). A total of 381 pregnant women were included. The median maternal age of women was 31.0 years (IQR: 27.0, 35.0) and the median BMI value was 30.5 kg/m2 (IQR: 26.9, 34.8). The most common comorbidities were diabetes (7.1%) and asthma (4.5%). A known history of preterm birth was prevalent among 2.9%. Of the participants,13.6% had a prenatal COVID-19 infection, of whom 57.7% had their infections resolved. The prevalence of positive PCR testing was 13.6%. Preterm birth occurred in 46 women (12.1%, 95%CI 9.1-15.9). Preterm birth was significantly associated with having a maternal age of ≥35 years, having high frequencies of parity, and having a past history of preterm birth, as well as having a history of hypertension and diabetes. Preterm birth was not significantly associated with having a confirmed COVID-19 infection at delivery. It was shown that preterm birth is evident among women with COVID-19 infection. Preterm birth is significantly associated with old age, multiparity, and a history of preterm delivery. Preterm birth is not significantly associated with having a confirmed COVID-19 infection at delivery. More research regarding infection-related adverse effects is advised and should be highlighted.

The Relationship Between Prenatal Distress And Pregnant Women's Readiness for Labor at PMB Imelda, Lebak District

Preparation for childbirth is everything that is understood and prepared in terms of welcoming the birth of pregnant women, prenatal distress in pregnancy has a direct impact on the fetus. Psychological disorders can affect the physical and mental health and well-being of the mother and her baby, this psychological condition is related to the baby's development process. The purpose of this study was to determine the relationship between the level of prenatal distress and delivery readiness at PMB Imelda, Lebak Regency in 2022. The research design used correlation analytic methods using a cross sectional approach. The population in this study were pregnant women in PMB Imelda, totaling 40 people. The type of sampling in this study is total sampling. Data were taken using PDQ and P4K questionnaires. The results showed that of the 32 respondents who had high prenatal distress, 70.0% of the respondents had unprepared labor readiness and of the 8 respondents with low prenatal distress, 7.5% were unprepared for delivery. The results of the Chi Square test showed that there was a significant relationship between prenatal distress and delivery readiness (p = 0.002). Thus the level of prenatal distress affects the readiness of the mother in childbirth. There needs to be an effort to improve maternal readiness in childbirth by implementing a program to increase readiness in childbirth to reduce prenatal distress.

The effect of prenatal education in two ways, face-to-face and virtual, on the fear of natural childbirth in pregnant women.

This study was designed and implemented to compare the effect of prenatal education on the fear of natural birth in pregnant women. This research was a semi-experimental study with a control group conducted on 96 pregnant women in Mashhad. People were randomly allocated to face-to-face and virtual groups. The Wijma childbirth experience/expectation questionnaire version A and the midwifery personal information form were used as pre-test and post-test tools. In the face-to-face and virtual groups, the average scores before and after the intervention were different, which indicated a decrease in fear of Natural childbirth in pregnant women, which was statistically significant. The changes in fear of natural childbirth score were significantly different between the three groups, and these changes were higher in the face-to-face group than in the other two groups. Attendance in natural childbirth preparation classes in face-to-face and virtual training methods positively affects the fear of natural childbirth. Therefore, encouraging and supporting women to participate in training courses increase the women's desire for natural childbirth.

The Association of Abnormal Doppler and Abnormal Amniotic Fluid Volume in the Third Trimester of Pregnancy with Preterm Birth in Pregnant Women in Agra, India.

Aim This article determines the association and diagnostic effectiveness of abnormal Doppler and abnormal amniotic fluid volume (AFV) in the third trimester of pregnancy with preterm births. Methods The third trimester screening protocol of the Samrakshan program of the Indian Radiological and Imaging Association utilizes trimester-specific fetal Doppler studies and ultrasound assessments, estimation of the risk for preterm preeclampsia (PE), assessment of the fetal environment, growth, and structure, and staging of fetal growth restriction. A multivariate logistic regression model was used to explore associations of abnormal Doppler and AFV with preterm birth. The diagnostic effectiveness of Doppler and amniotic fluid measurements for preterm births was assessed. Results One hundred and sixty-one (25.6%) of the 630 women had a preterm birth before 37 gestational weeks. Eighty (21.1%) of the 379 women with normal AFV and normal fetal Doppler studies in the third trimester had a preterm birth. The proportion of preterm birth declined from 35.14% in 2019 to 19.53% in 2022 (chi-square test p = 0.009). Preterm birth was associated with preterm PE (adjusted odds ratio: 3.66, 95% confidence interval: 1.42, 9.44) in a multivariate logistic regression model. Both abnormal fetal Doppler and AFV did not have a good discriminatory ability for preterm births. Conclusion Integration of fetal Doppler studies helped reduce the preterm birth rate by providing an objective measure of fetal well-being, contrary to a common belief that the use of color Doppler in the third trimester may result in iatrogenic increased preterm birth. Preterm births are associated with preterm PE and early identification of high-risk women and early initiation of low-dose aspirin may have an added benefit on preterm birth rates.

Immunomodulatory Effects of Metformin Treatment in Pregnant Women With PCOS.

Polycystic ovary syndrome (PCOS) is a common endocrine disorder associated with low-grade systemic inflammation and increased risk of pregnancy complications. Metformin treatment reduces the risk of late miscarriage and preterm birth in pregnant women with PCOS. Whether the protective effect of metformin involves immunological changes has not been determined. To investigate the effect of metformin on the maternal immunological status in women with PCOS. A post-hoc analysis was performed of two randomized controlled trials, PregMet and PregMet2, including longitudinal maternal serum samples from 615 women with PCOS. Women were randomized to metformin or placebo from first trimester to delivery. Twenty-two cytokines and C-reactive protein were measured in serum sampled at gestational weeks 5 to 12, 19, 32, and 36. Metformin treatment was associated with higher serum levels of several multifunctional cytokines throughout pregnancy, with the strongest effect on eotaxin (P < .001), interleukin-17 (P = .03), and basic fibroblast growth factor (P = .04). Assessment of the combined cytokine development confirmed the impact of metformin on half of the 22 cytokines. The immunomodulating effect of metformin was more potent in normal weight and overweight women than in obese women. Moreover, normoandrogenic women had the strongest effect of metformin in early pregnancy, whereas hyperandrogenic women presented increasing effect throughout pregnancy. It appears that metformin has immunomodulating rather than anti-inflammatory properties in pregnancy. Its effect on the serum levels of many multifunctional cytokines demonstrates robust, persisting, and body mass-dependent immune mobilization in pregnant women with PCOS.

Antenatal azithromycin to prevent preterm birth in pregnant women with vaginal cerclage: A randomized clinical trial.

To assess whether antenatal azithromycin given to pregnant women with vaginal cerclage can reduce preterm birth or not. We randomized 50 pregnant ladies who underwent cerclage at Ain Shams University Maternity Hospital in group A (receiving 500 mg Azithromycin oral tablets (Zithrokan®, Hikma, Egypt) one tablet orally twice daily for three days in 3 courses at 14th, 24th and 32nd week, plus usual antenatal care) and an identical group B (receiving usual antenatal care). Our primary outcome was gestational age at delivery, and secondary outcomes were birthweight, mode of delivery, and maternal, and perinatal complications. This study was registered on ClinicalTrials.gov with number: NCT04278937. Pregnancy was more prolonged in the Azithromycin group (delivery at 36.8 weeks vs 34.1 weeks; p=0.017). Also, a higher birthweight was observed in the Azithromycin group (2932.6 gm vs 2401.8 gm; p=0.006). No significant difference was found between the two groups as regards to other outcomes (miscarriage, stillbirth, neonatal intensive care unit admission, antepartum hemorrhage, postpartum pyrexia, need for blood transfusion). Adding antenatal azithromycin to women undergoing cerclage prolongs pregnancy and reduces the risk of preterm birth, with a slight increase in birthweight.

Prior childbirth experience and attitude towards subsequent vaginal birth after one caesarean delivery in Lagos, Nigeria: a cross-sectional study

BackgroundPrior caesarean delivery (CD) impacts CD rates in many parts of the world. In low and middle-income countries, few women attempt a trial of labour after caesarean delivery (TOLAC) due to inadequate resources for safe vaginal birth after caesarean delivery (VBAC). The CD rates continue to rise as more women undergo repeat CD. In Nigeria, VBAC rate is low and the contribution of women’s prior childbirth experiences and delivery wishes to this situation deserves further investigation. This study examined the parturient factor in the low VBAC rate to recommend strategies for change.ObjectiveTo describe prior caesarean-related childbirth experiences and attitudes towards subsequent vaginal birth in pregnant women with one previous CD.MethodThis cross-sectional study of antenatal clinic attendees in a tertiary hospital employed the convenience sampling method to recruit 216 consenting women with one previous CD. Structured questionnaires were used to collect information on participants' prior caesarean-related birth experiences, attitudes to vaginal birth in the index pregnancy, future delivery intentions and eventual delivery route. Univariate and bivariate analyses compared delivery wishes based on CD type. SPSS version 22.0 was used for data analysis.ResultsThe modal maternal and gestational age groups were 30–39 years (68.1%) and 29–34 weeks (49.1%) respectively; majorities (60.6%) were secundigravida; 61.6% experienced labour before their CDs while 76.9% had emergency CDs. Complications were documented in 1.4% and 11.1% of mothers and babies respectively. Ninety percent reported a satisfactory overall childbirth experience. A majority (83.3%) preferred TOLAC in the index pregnancy because they desired natural childbirth while 16.7% wanted a repeat CD due to the fear of fetal-maternal complications. The previous CD type and desire for more babies were significantly associated with respondents' preferred mode of delivery (p = 0.001 and 0.023 respectively). Women with previous emergency CD were more likely to prefer vaginal delivery.ConclusionsAntenatal women prefer TOLAC in subsequent pregnancies despite prior satisfactory caesarean-related birth experiences. Adoption of TOLAC in appropriately selected cases will impact women's psyche positively and reduce CD rate.

The Rate of Gestational Weight Gain are Associated with Preterm Birth in Pregnant Women at Low Risk for Preterm Birth: A Single-Center, Observational Study

Background: Preterm birth (PTB) is the main cause of infant disease and death worldwide. Approximately 70% of neonatal deaths and 36% of infant deaths worldwide are caused by premature birth. Gestational weight gain (GWG) is associated with adverse pregnancy outcomes. This study explored the relationship between the rate of GWG and PTB among pregnant women at low risk of preterm birth. Methods: Our study used a cohort of mother-child pairs with a one-and-a-half-year follow-up from January 2020 to June 2021. We excluded pregnant women with undisputed high-risk factors for PTB and the remaining women were considered the low-risk group. The average rate of GWG was utilized in this research as the measure of GWG. Multivariate logistic regression was used to evaluate the relationship between GWG and PTB among pregnant women at low risk for preterm birth. Results: The final cohort study of mother-child pairs included 3480 pregnant women in the low-risk group. Women with low GWG had a higher possibility of PTB than those with adequate GWG. Comparing underweight women with an adequate GWG rate to underweight women with a low GWG rate, PTB risk increased by 2.52-fold with a low GWG rate. Compared to women with adequate GWG, underweight women with excessive GWG had significantly higher odds of PTB. No significant results were observed for pregnant women classified as overweight or obese. Conclusions: A reasonable GWG during pregnancy can effectively reduce the risk of PTB, especially for pregnant women with low pre-pregnancy body mass index. Low or excessive GWG may lead to an increased risk of PTB.

Frequency and outcomes of extremely early preterm birth in pregnant women with new coronavirus infection COVID-19

Frequency and outcomes of extremely early preterm birth in pregnant women with new coronavirus infection COVID-19

Placental factors in the development of preterm birth in pregnant women with comorbidity

Premature birth (PB) is a polyetiological problem that depends on many factors, accompanied by violations of the placenta functional competence, changes in its metabolic, hormone-producing and protective functions. The objective: to establish the importance of placental factors in the development of PB in pregnant women with comorbid pathology. Materials and methods. The levels of fetal and placental proteins (placental alfa microglobulin-1, α2-microglobulin of fertility, trophoblastic β1-glycoprotein) and hormones (estriol, placental lactogen, progesterone) were determined in 33 pregnant women with threat of PB at 26–34 weeks of gestation (main group), who had concomitant comorbid pathology in the stage of unstable remission. The control group included 26 healthy pregnant women who were representative for gestational age. Results. In pregnant women with comorbid pathology a decrease of the placenta protein-synthesizing function and the hormone-producing function of the trophoblast was found, which makes it difficult to launch the syntoxic adaptation programs of the mother’s organism, which are responsible for maintaining the pregnancy with the subsequent development of placental dysfunction, the result of which is PB.The markers of these disorders are a 3-fold decrease in the level of trophoblastic β1-glycoprotein (p&lt;0.0001) and a 1.7-fold decrease in the concentration of α2-microglobulin of fertility (p&lt;0.0001) with a simultaneous 4-fold increase of placental alfa microglobulin-1 concentration (p&lt;0.0001) and a decrease in the levels of placental lactogen by 1.6 times (p&lt;0.0001), estradiol by 40 % (p&lt;0.0001) and progesterone by more than 2 times (p&lt;0.0001) compared to healthy pregnant women.Conclusions. In patients with comorbid pathology there are disorders in the secretion of pregnancy proteins due to a decrease in the levels of trophoblastic β1-glycoprotein and α2-microglobulin of fertility and an increase in the level of placental alfa microglobulin-1 and disorders of the hormone-producing function of the trophoblast due to a decrease in the secretion of placental lactogen, progesterone, and estradiol. The disturbance of the secretion of the pregnancy zone proteins and hormones are the early markers for the initiation of premature birth caused by placental dysfunction in pregnant women with comorbid pathology.

THADA, SDHAF4, and MACF1 Gene Polymorphisms and Placental Expression in Women with Gestational Diabetes.

Gestational diabetes mellitus (GDM) is a metabolic disorder in pregnant women leading to various complications. Consequently, factors predisposing its development are being sought. Previous studies have shown that the pathogenesis of GDM is similar to that of type 2 diabetes, and it is therefore thought that the two diseases may have a common genetic basis. The aim of this study was to examine the associations between thyroid adenoma-associated (THADA) rs7578597 T&gt;C, succinate dehydrogenase complex assembly factor 4 (SDHAF4) rs1048886 A&gt;G, and microtubule-actin crosslinking factor 1 (MACF1) rs2296172 A&gt;G gene polymorphisms and the risk of GDM development as well as selected clinical parameters in women with GDM. We also examined the expression of these genes in the placenta of women with and without GDM in association with clinical parameters. This case-control study included 272 pregnant women with GDM and 348 pregnant women with normal glucose tolerance. There were no statistically significant differences in the distribution of the THADA rs7578597 T&gt;C, SDHAF4 rs1048886 A&gt;G, and MACF1 rs2296172 A&gt;G gene polymorphisms between pregnant control women and women with GDM. The associations between clinical parameters such as body mass before pregnancy, body mass at birth, body mass increase during pregnancy, BMI before pregnancy, BMI at birth, BMI increase during pregnancy, glycated hemoglobin (HbA1c), daily insulin requirement, childbirth time, and newborn body mass and APGAR score, and the THADA rs7578597 T&gt;C, SDHAF4 rs1048886 A&gt;G, and MACF1 rs2296172 A&gt;G genotypes were statistically non-significant. We only observed lower values of body mass before pregnancy and body mass at birth in women with the SDHAF4 rs1048886 AG genotype in comparison with AA genotype carriers. There was no statistically significant difference in the expression of THADA, SDHAF4, and MACF1 genes in the placenta between women with GDM and healthy women. There were also no statistically significant correlations between THADA, SDHAF4, and MACF1 gene expression in the placenta and clinical parameters. The results of our study suggest that THADA rs7578597 T&gt;C, SDHAF4 rs1048886 A&gt;G, and MACF1 rs2296172 A&gt;G gene polymorphisms are not significant factors associated with GDM onset. In addition, SDHAF4 rs1048886 A&gt;G may be associated with body mass before pregnancy and body mass at birth in pregnant women.

Tiroid Disfonksiyonu Olan Gebelerin Demografik Özelliklerinin Araştırılması- Ege Üniversitesi Örneklemi

Aim: Thyroid diseases can cause maternal and fetal adversities, and proper diagnosis, follow-up and&#x0D; treatment during pregnancy requires special attention. In the evaluation of thyroid functions during&#x0D; pregnancy, free thyroxine (FT4) is used primarily with thyroid-stimulating hormone (TSH). Our aim is to&#x0D; investigate the prevalence and the effects of thyroid dysfunction during pregnancy.&#x0D; Material and Methods: Our study is a prospective study including 960 pregnant women and spanning&#x0D; from November 2017 to May 2019 in Ege University Endocrinology outpatient clinic.100 pregnant&#x0D; women with thyroid dysfunction out of 960 pregnant women were included in the study. Maternal&#x0D; age, gestational trimester, family history of the thyroid disorder, TSH, FT4, free triiodothyronine (FT3),&#x0D; anti-thyroid peroxidase antibody (Anti-TPO), anti-thyroglobulin antibody (Anti-TG), thyrotropin (TSH)&#x0D; receptor antibody (TRAb) were collected. The correlations between TSH, FT3 and FT4 were examined.&#x0D; Results: In the study, the mean age of pregnant patients was 29.33 ± 5.97. Anti-TPO was positive %18 and&#x0D; Anti-TG was positive (5%). 24 of 100 (24%) patients had nodules. 1 (8.3%) patient with hyperthyroidism&#x0D; was positive for TRAb. Age differences in patients with or without nodule were not statistically significant.&#x0D; 1 (1%) of the patient had Graves disease, 81 (81%) had subclinical hypothyroidism, 7 (7%) had clinical&#x0D; hypothyroidism, 11 (11%) had gestational thyrotoxicosis. The frequency of prematurity was determined&#x0D; in 7 patients (15.6%) by the data of 45 pregnant women who gave birth.&#x0D; Conclusion: TSH levels in pregnant patients with positivity for anti-TPO and anti-TG were significantly&#x0D; higher than pregnant patients with negativity for anti-TPO and anti-TG. In addition, the relationship&#x0D; between thyroid diseases and nodule frequency, autoimmunity, premature birth in pregnant women&#x0D; were not detected. More comprehensive study series are needed.

Evaluation of the effects of COVID-19 disease and the trimester in which the disease is diagnosed on obstetric and neonatal outcomes: A retrospective cohort study.

To evaluate the effects of COVID-19 disease and the trimester in which the disease is diagnosed on obstetric and neonatal outcomes. This retrospective cohort study was conducted with 358 patients who had or had not been diagnosed with COVID-19 during their pregnancy, had a miscarriage or had given birth. COVID-19 disease during pregnancy was associated with higher maternal hypertensive disease, preterm birth, low birth weight, low first- and fifth-minute Apgar scores, and need for neonatal intensive care unit. The incidence of preterm birth, low birth weight, low first- and fifth-minute Apgar scores, and need for neonatal intensive care unit in those diagnosed with COVID-19 in the second trimester was significantly higher than those diagnosed with COVID-19 in other trimesters. The frequency of cesarean section was observed most in those diagnosed with COVID-19 in the 3rd trimester, while it was observed in those diagnosed with COVID-19 at least in the first trimester. The presence of COVID-19 during pregnancy may be associated with an increased risk of iatrogenic preterm birth. The frequency of preterm birth in pregnant women diagnosed with COVID-19 in the second trimester is higher than in pregnant women diagnosed with COVID-19 in other trimesters. As the pregnancy trimester at the time of diagnosis progresses, the frequency of cesarean section increases. While the risk of maternal hypertensive disease increases more in pregnant women with COVID-19, the effect of the trimester in which COVID-19 was passed on the risk of maternal hypertensive disease is not observed.

Placenta, the Key Witness of COVID-19 Infection in Premature Births.

Adverse perinatal outcomes, such as increased risks of pre-eclampsia, miscarriage, premature birth, and stillbirth have been reported in SARS-CoV-2 infection. For a better understanding of COVID-19 complications in pregnancy, histopathological changes in the placenta, which is the interface between mother and foetus, could be the place to look at. The aim of this study was to determine placental histopathological changes and their role in preterm birth in pregnant women with SARS-CoV-2 infection. We performed a prospective, observational study in a COVID-only hospital, which included 39 pregnant women with SARS-CoV-2 infection and preterm birth compared with a control group of 39 women COVID-19 negative with preterm birth and a placental pathology exam available. The microscopic examination of all placentas revealed placental infarction (64.1% vs. 30.8%), decidual arteriopathy (66.7% vs. 23.1%), intervillous thrombi (53.8% vs. 38.5%), perivillous fibrin deposits (59% vs. 46.2%), inflammatory infiltrate (69.2% vs. 46.2%), chorangiosis (17.9% vs. 10.3%), and accelerated maturation of the villi (23.1% vs. 28.2%).

Maternal preterm birth prediction in the United States: a case-control database study

BackgroundPreterm birth is serious public health worldwide, and early prediction of preterm birth in pregnant women may provide assistance for timely intervention and reduction of preterm birth. This study aimed to develop a preterm birth prediction model that is readily available and convenient for clinical application.MethodsData used in this case-control study were extracted from the National Vital Statistics System (NVSS) database between 2018 and 2019. Univariate and multivariate logistic regression analyses were utilized to find factors associated with preterm birth. Odds ratio (OR) and 95% confidence interval (CI) were used as effect measures. The area under the curve (AUC), accuracy, sensitivity, and specificity were utilized as model performance evaluation metrics.ResultsData from 3,006,989 pregnant women in 2019 and 3,039,922 pregnant women in 2018 were used for the model establishment and external validation, respectively. Of these 3,006,989 pregnant women, 324,700 (10.8%) had a preterm birth. Higher education level of pregnant women [bachelor (OR = 0.82; 95%CI, 0.81–0.84); master or above (OR = 0.82; 95%CI, 0.81–0.83)], pre-pregnancy overweight (OR = 0.96; 95%CI, 0.95–0.98) and obesity (OR = 0.94; 95%CI, 0.93–0.96), and prenatal care (OR = 0.48; 95%CI, 0.47–0.50) were associated with a reduced risk of preterm birth, while age ≥ 35 years (OR = 1.27; 95%CI, 1.26–1.29), black race (OR = 1.26; 95%CI, 1.23–1.29), pre-pregnancy underweight (OR = 1.26; 95%CI, 1.22–1.30), pregnancy smoking (OR = 1.27; 95%CI, 1.24–1.30), pre-pregnancy diabetes (OR = 2.08; 95%CI, 1.99–2.16), pre-pregnancy hypertension (OR = 2.22; 95%CI, 2.16–2.29), previous preterm birth (OR = 2.95; 95%CI, 2.88–3.01), and plurality (OR = 12.99; 95%CI, 12.73–13.24) were related to an increased risk of preterm birth. The AUC and accuracy of the prediction model in the testing set were 0.688 (95%CI, 0.686–0.689) and 0.762 (95%CI, 0.762–0.763), respectively. In addition, a nomogram based on information on pregnant women and their spouses was established to predict the risk of preterm birth in pregnant women.ConclusionsThe nomogram for predicting the risk of preterm birth in pregnant women had a good performance and the relevant predictors are readily available clinically, which may provide a simple tool for the prediction of preterm birth.

Analyzing pregnancy course and outcomes in women with varying degrees of severity of novel coronavirus infection COVID-19 in Saint Petersburg: the lessons from pandemic

Introduction. Today, two years after the first outbreak of the novel coronavirus infection (NCI) COVID-19, there is still insufficient data to fully assess risks and pattern of the course of this infectious disease in pregnant women.Aim: to conduct a comparative analysis of perinatal pregnancy outcomes as well as clinical and laboratory data in COVID-19 patients at the time of delivery and those suffering from the disease during pregnancy.Materials and Methods. A retrospective comparative study was carried out after analyzing pregnancy and childbirth histories in 191 women admitted for delivery in three obstetric medical organizations of Saint Petersburg in the years 2020–2021. Perinatal outcomes of pregnancy as well as clinical and laboratory data in patients suffering from COVID-19 during pregnancy were analyzed: Group 1 – 57 patients with asymptomatic and mild form of verified COVID-19; Group 2 – 50 patients with COVID-19 of moderate and severe course; Group 3 – 52 patients who underwent COVID-19 in the third trimester of pregnancy. Group 4 (control) consisted of 32 women lacking COVID-19.Results. Comparing delivery outcomes in Group 1 vs. Group 2 revealed a significantly higher rate of urgent deliveries – 54 (94.7 %) and 38 (76.0 %) (χ2 = 7.76) respectively, as well as a significantly lower number of premature births – 3 (5.3 %) and 12 (24.0 %) (χ2 = 7.76) respectively. Comparison of Group 1 vs. Group 3 showed significantly fewer natural births – 33 (57.8 %) and 42 (80.8 %) (χ2 = 6.63) respectively, but a greater rate of caesarean section – 24 (42.0 %) and 10 (19.2 %) (χ2 = 6.63). Comparison of Group 1 vs. Group 4 revealed a significantly higher number of women with acute and progressive fetal hypoxia (fetal distress) – 16 (28.1 %) and 2 (6.3 %) (χ2 = 6.05) respectively. These data allow us to state about an impact of the severity of infectious process SARS-CoV-2-caused disease and its timeframe during pregnancy on the timing and method of delivery. No significant data were obtained that might allow to state that the infectious process directly caused increased rate of premature birth in pregnant women with moderate and severe COVID-19. At hospital admission and discharge, patients with mild and asymptomatic COVID-19 were significantly less likely to have neutrophilia – 5 (8.8%) and 42 (84.0%) (χ2 = 61.2; p &lt; 0.001) respectively, increased aspartate aminotransferase – 4 (7.0 %) and 38 (76.0 %) (χ2 = 53.15; p &lt; 0.001), lactate dehydrogenase (LDH) – 0 (0.0 %) and 12 (24.0 %) (χ2 = 15.41; p &lt; 0.001), C-reactive protein (CRP) – 6 (10.5 %) and 49 (98.0 %) (χ2 = 81.58; p &lt; 0.001), creatinine reduction – 0 (0.0 %) and 11 (22.0 %) (χ2 = 13.98; p &lt; 0.001) respectively. In groups with severe, mild and asymptomatic COVID-19, a strong direct correlation was established the CRP level and leukocyte count, between level of serum CRP and alanine aminotransferase; a less noticeable relationship was observed between serum CRP and LDH concentrations, CRP and total protein level.Conclusion. It was shown that no specific effect of SARS-CoV-2 infection was exerted on majority of parameters related to normal course of labor, as well as on condition of neonates born to patients with COVID-19 of varying severity. In patients with COVID-19 at the time of delivery, changes in clinical and laboratory parameters corresponded to the disease severity.

Effects of motivational interviews on childbirth perceptions and childbirthself-efficacy in nulliparous pregnant women: a randomised-controlled trial

ABSTRACT Background Motivational interviews (MI) may change the perspective of birth in pregnant women by changing their negative thoughts and increasing their self-efficacy. Objective This study was conducted to identify the effects of MI on childbirth perceptions and childbirth self-efficacy in nulliparous pregnant women who had traumatic childbirth perceptions. Methodology The research was carried out as a randomised-controlled trial wıth 166 pregnant women, including 83 experimental group and 83 control group. In the collection of data, the Traumatic Childbirth Perception Scale (TCPS) and the Childbirth Self-Efficacy Inventory (CSEI-C32) were utilised. Four sessions of MI were held with the pregnant women in the experimental group at weekly intervals whereas no initiative was applied to the pregnant women in the control group. Results As per the measurements performed after the MI held with the experimental group, it was found that the experimental group had a significantly lower mean TCPS score than the control group (p < 0.001). The experimental group also had a significantly higher mean CSEI-C32 score than the control group (p < 0.001). Conclusion MI can be effective in reducing the traumatic childbirth perceptions and increasing childbirth self-efficacy. However, further research is required to assess the effectiveness MI on traumatic birth perception and self-efficacy.