Obstetric Clinic Research Articles

Correlation between fetal subcutaneous fat thickness and insulin resistance through cord blood analysis immediately after delivery

ObjectivesThis study aimed to determine whether fetal subcutaneous tissue (SCT) thickness, measured using ultrasound immediately before and after delivery, can reflect changes in glucose metabolism immediately after delivery. We also evaluated the impact of insulin resistance changes during pregnancy by comparing pregnant women with well-controlled gestational diabetes mellitus (GDM) and those with normal glucose metabolism. Study designThe study participants were 117 pregnant women, including 97 controls and 20 patients with GDM who visited our obstetric clinic between February and December 2022. The participants were scheduled for cesarean delivery at a gestational age of ≥37 weeks. SCT thickness before delivery was measured using ultrasound and within 48 h after delivery using Holtain calipers. The glucose and insulin concentrations were quantified from cord blood collected immediately after delivery. Based on these results, a Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) was performed to assess insulin resistance. Independent t-test or Wilcoxon rank-sum test for continuous variables and Fisher’s exact test for categorical variables were used to compare the various parameters. Correlations among the variables in each group were assessed by calculating the correlation coefficient (Pearson’s correlation). ResultsSCT thickness measured using ultrasound and calipers demonstrated a strong correlation where pregnant women with GDM exhibited thicker fetal SCT and neonate skinfolds than in those without GDM. Glucose and insulin levels in the cord blood were significantly elevated (p < 0.05) in the gestational diabetic group, along with remarkable differences (p < 0.001) in HOMA-IR. These variables indicated a higher prevalence of glucose intolerance in the neonates of mothers with GDM. In pregnant women with GDM, there was a statistically significant correlation between fetal abdominal SCT thickness and glucose levels (r = 0.64, p < 0.01) and HOMA-IR (r = 0.48, p < 0.05). ConclusionsMeasuring the subcutaneous fat thickness of the fetus shortly before delivery is beneficial for predicting insulin resistance in neonates. This is considered particularly useful for women with effectively managed GDM, where the presence of conditions such as macrosomia may not be pronounced.

An evaluation of serum blood parameters and amyloid-A levels in women with hyperemesis gravidarum; A prospective observational study.

This study aimed to investigate whether serum amyloid A (AA) level can be used as a biomarker in women with hyperemesis gravidarum (HEG). This prospective observational study was conducted at the Antalya Training and Research Hospital Gynecology and Obstetrics Clinic, Türkiye, between July and December 2023. Forty women diagnosed with HEG and 40 healthy women were included. No statistically significant differences were observed between the groups in terms of sociodemographic data such as age, body mass index, family history, educational status, economic level, place of residence, occupation, smoking and alcohol use, or drug habits. However, obstetric characteristics such as number of miscarriages, number of dilatation curettages, and gestational age and laboratory values including complete blood count, hematocrit, leukocyte, neutrophil, lymphocyte, platelet, free T4, albumin, alanine aminotransferase, aspartate aminotransferase, urea, creatinine, hs-C-reactive protein, and sodium (P > .05) all differed significantly. In addition, significant differences were observed between the HEG and healthy groups in terms of numbers of gravidities (2 [1-3] vs 1 [0-1], respectively, P < .001), numbers of parities (1 [0-1] vs 1 [0-1], P < .001), numbers of living children (1 [0-2] vs 1 [0-1], P < .001), presenting complaints (nausea 0 [0%], nausea + vomiting 0 [0%], none 40 [100.0%] vs nausea 27 [67.5%], nausea + vomiting 13 [32.5%], none 0 [0%], P < .001), serum thyroid-stimulating hormone (1.16 ± 0.56 vs 1.81 ± 0.624, P = .004), potassium (4.1 ± 0.7 vs 3.8 ± 0.2, P = .001), and AA values (7.29 ± 2.61 vs 10.74 ± 3.04, P < .001). At receiver operating characteristic analysis, the area under the curve (AUC: 0.881) was statistically significant for serum AA (P: <.001), with a cutoff value of ≥ 8.79 ([95% confidence interval] 0.743-0.919, sensitivity 87.4%, specificity 80.2%). The positive predictive value of serum AA was 81.1% and the negative predictive value was 80.4%. The study results showed that serum AA can be used as a diagnostic biomarker in HEG. Prospective studies involving more participants are now required to confirm our results.

Glycated CD59 is a potential biomarker for gestational diabetes mellitus.

To explore the diagnostic value of glycated CD59 (gCD59) in gestational diabetes mellitus (GDM). A total of 707 pregnant women who underwent the first visit in the obstetric outpatient clinic of the Affliated Suqian Hospital of Xuzhou Medical University from January 2022 to July 2023 were included, and were grouped according to the International Association of the Diabetes and Pregnancy Study Groups(IADPSG) diagnostic criteria, and finally 113 cases in the GDM group and 559 cases in the normal glucose tolerance (NGT) group were included, and the concentration of gCD59 was determined by enzyme-linked immunosorbent assay (ELISA). The baseline data characteristics of the two groups were compared, the risk factors for GDM were explored by multivariate binary logistic analysis, and the diagnostic value of gCD59 in predicting GDM was explored by receiver operating characteristic (ROC) curve analysis. The level of gCD59 in the GDM group was significantly higher than that in the NGT group (1.49 SPU vs 0.87 SPU). Multivariate regression analysis showed that gCD59, diastolic blood pressure (DBP) and thyroid stimulating hormone (TSH) were independent risk factors for GDM.The area under the curve (AUC) of gCD59 for the diagnosis of GDM was 0.681 (95% CI: 0.583-0.717), with a sensitivity of 71.7% and a specificity of 58.3%. In combination with fasting glucose, gCD59 effectively diagnosed GDM with higher AUC of 0.871 (95% CI: 0.708-1.000). gCD59 is an independent risk factor for GDM and a good biomarker for the diagnosis of GDM.

A Comprehensive Analysis of Wait Times in Ambulatory Obstetrics and Gynecology Clinic at a Tertiary Care Hospital in Pakistan.

Objective Wait times are an important determinant of patient satisfaction measured objectively and associated significantly with it. It is a measure of time taken from the arrival of patients to the registration desk of a facility to the time they access service. This study focuses on current patient pathways at the Obstetrics and Gynecology Outpatient (OBGYN) Ambulatory Clinic at Shalamar Hospital and assesses wait times by stratifying it at each step of the pathway. Methodology Data on consultation times was obtained from 105 patient processes over three months. We had in-depth discussions with the doctors, nurses, and paramedical staff to better comprehend the medical conditions, the terminologies, the structural hierarchy, and the functions of the department. Based on this the patient journey through the clinic was further dissected into operational steps including the check-in process, patient vitals screening, patient history, physical examination, medical hierarchy, referral for further testing or procedures, and lastly prescription generation. Results The average wait time for obstetrics and gynecology patients is 45.18±39.37 minutes. The average time the patients waited for the check-in process was 1.73±1.80 minutes, for the vitals screening was 3.08±10.07 minutes, for patient history and examination was 19.90±22.71 minutes, and for consultation within the medical hierarchy (SR and Consultants) patients waited 1.31±5.71 minutes. For those patients who had no other tests or procedures recommended, the prescription generation required a further 4.10±3.14 minutes. While those who had tests or procedures recommended waited 5.75±28.27 minutes for voucher generation for the specific test or procedure and 9.31±11.35 minutes for the test or procedure itself. Conclusion The obstetrics and gynecology clinic at Shalamar Hospital has average wait times comparable to others in the region of approximately 45 minutes. The longest wait during the visit is before patient history and examination approximately 20 minutes. To improve wait times, the clinic should implement staggered appointments, use a token system, manage queues better, follow clinic hours, and improve coordination between doctors. This will allow for improved patient experiences, faster patient turnovers, and increased patient inflow.

How Does the Anxiety of Primiparae Affect Their Readiness for Newborn Care? Ethnic Primiparous Experiences.

The study was conducted to investigate the relationship between pregnancy-related anxiety levels of primiparae living in an ethnic region and their readiness for postnatal hygienic care of newborns. The study conducted between February and May 2023 included 201 "18-40-year-old primiparae" who lived in an ethnic region and volunteered to participate in the study. The population of the study consisted of all pregnant women who presented to the Gynecology and Obstetrics Clinic, Pregnancy Outpatient Clinic of a city hospital. The "Pregnant Women Personality and Obstetric Characteristics Form," "Pregnant Women's Readiness for Newborn Hygienic Care Scale," and "Spielberg State-Trait Anxiety Inventory" were used as data collection tools. The mean age of the 201 primiparae participating in the study was 26.11 ± 3.05years. Although 71.1% of them felt confident about baby care before the baby was born, 95.5% needed help with baby care after birth. Their readiness for stress and newborn hygienic care was at a "medium" level. There was a statistically significant negative relationship between the scores they obtained from the Pregnant Women's Readiness for Newborn Hygienic Care Scale and Spielberg State-Trait Anxiety Inventory (p = 0.011; r = - 0.180). The participating primiparae experienced moderate levels of anxiety, and the increase in their anxiety levels negatively affected their readiness for the hygienic care of their newborn babies. Thus, when primiparae are provided with healthy newborn care, their anxiety levels should.

Associations between Parenting and Cognitive and Language Abilities at 2 Years of Age Depend on Prenatal Exposure to Disadvantage

To investigate whether parenting or neonatal brain volumes mediate associations between prenatal social disadvantage (SD) and cognitive/language abilities and whether these mechanisms vary by level of disadvantage. Pregnant women were prospectively recruited from obstetric clinics in St Louis, Missouri. Prenatal SD encompassed access to social (eg, education) and material (eg, income-to-needs, health insurance, area deprivation, and nutrition) resources during pregnancy. Neonates underwent brain magnetic resonance imaging. Mother-child dyads (N=202) returned at age 1-year for parenting observations and at age 2-years for cognition/language assessments (Bayley-III). Generalized additive and mediation models tested hypotheses. Greater prenatal SD associated nonlinearly with poorer cognitive/language scores. Associations between parenting and cognition/language were moderated by disadvantage, such that supportive and non-supportive parenting behaviors related only to cognition/language in children with lesser prenatal SD. Parenting mediation effects differed by level of disadvantage: both supportive and non-supportive parenting mediated prenatal SD-cognition/language associations in children with lesser disadvantage, but not in children with greater disadvantage. Prenatal SD-associated reductions in neonatal subcortical grey matter (β=.19, q=.03), white matter (β=.23, q=.02), and total brain volume (β=.18, q=.03) were associated with lower cognition, but did not mediate associations between prenatal SD and cognition. Parenting moderates and mediates associations between prenatal SD and early cognition and language, but only in families with less social disadvantage. These findings, although correlational, suggest that there may be a critical threshold of disadvantage, below which mediating or moderating factors become less effective, highlighting the importance of reducing disadvantage as primary prevention.

Observational Study of Men and Women with Breast Cancer in Terms of Overall Survival.

This cohort study represents a retrospective and anonymized data analysis of 2162 breast cancer cases (19 males and 2143 females), registered over a period of 12 years, from 1 January 2010 to 31 December 2021, in the Clinic of Obstetrics and Gynecology, Diakoneo Diak Klinikum Schwäbisch Hall, Germany. According to the Kaplan-Meier survival analysis, the estimated overall 3-year survival rate was 91.1% for women and 88.9% for men. The log-rank test of equality of survival distributions indicated a statistically significant difference in survival times between the two groups (p = 0.009). In the subsequent age-matched Kaplan-Meier analysis, the p-value was below the significance threshold (p = 0.068). Male breast cancer is a rare disease that may show some particularities in terms of survival compared to female breast cancer.

Factors influencing modern contraceptive usage among women aged 15-49 years: a cross-sectional study

Introduction: This study aimed to examine the factors that influence modern contraceptive use among married women of reproductive age in Kirkuk City, Iraq. Methods: A cross-sectional study was conducted to gather data from a convenience sample of 500 married women of reproductive age attending family planning units at 10 healthcare facilities, Azadi, Kirkuk Teaching Hospital, and private gynecological and obstetric clinics. Data were collected using a structured questionnaire from October 1st, 2023, to February 1st, 2024. The statistical analysis involved descriptive and inferential techniques. Results: The prevalence of contraceptive use among participants was 74.6%, with about (21%) reporting condom use and (16.0%) withdrawal usage. However, intrauterine devices were reported in (12.6%). Side effects were significantly (p&lt;0.001) associated with contraceptive method choices, with 52% of the users experiencing adverse effects. External pressures to have additional children or become pregnant significantly (p=0.037) influenced contraceptive method choices. There were fewer modern contraceptive methods due to unsafety (30.9%), discomfort (23.6%), and side effects, such as headache (18%), weight gain (16%), and irregular bleeding (14%). Conclusions: Modern contraceptive use is affected by healthcare, safety, side effects, reproductive health, and personal choices. Providing complete knowledge and access to modern contraceptives helps couples make informed reproductive health decisions, empowers women to regulate their fertility, supports their personal and reproductive objectives, and promotes their health and well-being. Keywords: birth control, childbearing age, Iraq, modern contraceptive, side effects

The early prediction of gestational diabetes mellitus by machine learning models

BackgroundWe aimed to determine the best-performing machine learning (ML)-based algorithm for predicting gestational diabetes mellitus (GDM) with sociodemographic and obstetrics features in the pre-conceptional period.MethodsWe collected the data of pregnant women who were admitted to the obstetric clinic in the first trimester. The maternal age, body mass index, gravida, parity, previous birth weight, smoking status, the first-visit venous plasma glucose level, the family history of diabetes mellitus, and the results of an oral glucose tolerance test of the patients were evaluated. The women were categorized into groups based on having and not having a GDM diagnosis and also as being nulliparous or primiparous. 7 common ML algorithms were employed to construct the predictive model.Results97 mothers were included in the study. 19 and 26 nulliparous were with and without GDM, respectively. 29 and 23 primiparous were with and without GDM, respectively. It was found that the greatest feature importance variables were the venous plasma glucose level, maternal BMI, and the family history of diabetes mellitus. The eXtreme Gradient Boosting (XGB) Classifier had the best predictive value for the two models with the accuracy of 66.7% and 72.7%, respectively.DiscussionThe XGB classifier model constructed with maternal sociodemographic findings and the obstetric history could be used as an early prediction model for GDM especially in low-income countries.

Investigating the Effect of Educational Film Presentation on the Anxiety Level of Mothers Visiting the Preoperative Anesthesia Clinic

With the increasing number of pediatric surgeries and the transfer of caregiving roles to parents, appropriate preparation and reduction of their stress levels for proper care of children before and after surgery is essential. If parental anxiety can be reduced through various methods, not only can it improve parental performance and their comfort, but it can also prevent the impact of anxiety on the child. Therefore, we aimed to investigate the effect of educational film presentation on the anxiety level of mothers visiting the obstetric anesthesia clinic at the Children's Medical Center in 2020. This study was a randomized double-blind controlled trial conducted as an intervention. Sampling was done randomly, and the study population consisted of two groups of 38 individuals, whose children were candidates for MRI. The intervention group watched the educational film, while the second group served as the control group. Subsequently, their anxiety levels were assessed and compared using the Beck Anxiety Inventory. The data were entered into SPSS Ver. 21 software and analyzed accordingly. The mean age of mothers in this study was 33.41 years with a standard deviation of 7 years. The mean age of children was 3.79 years with a standard deviation of 3.4 years. Among the children, 30 were girls (39.5%) and 46 were boys (60.5%). The mean age of girls was 4.35 years with a standard deviation of 4.16 years, while the mean age of boys was 3.433 years with a standard deviation of 2.787 years. Overall, 39 participants (50.6%) watched the educational film, while 38 participants (49.4%) were in the control group. The mean score of anxiety level according to the Beck Anxiety Inventory (BAI) was 9.47 with a standard deviation of 9.77. The level of anxiety was significantly higher in the intervention group who watched the educational film compared to the control group (P=0.012). The results of the present study indicated that parental anxiety increased after watching the educational video on anesthesia methods. It is recommended that alternative strategies be considered for reducing parental anxiety in future studies.

Adverse Pregnancy Outcomes in Patients With Systemic Lupus Erythematosus: A Retrospective Cohort Study

Systemic Lupus Erythematosus (SLE) is a complex autoimmune disease that may result in adverse pregnancy outcomes, posing a significant risk to both the mother and the fetus. The major purpose of the current study was to investigate the impact of SLE on the outcomes of pregnancy among women with SLE. This was a retrospective cohort study. Two groups of pregnant women, one with Systemic Lupus Erythematosus (SLE) and one without SLE, were included at the Gynecology and Obstetrics Clinic of Ayatollah Mousavi Hospital in Zanjan, Iran, from 2019 to 2020. Participants from both cohorts completed a checklist of study variables based on their medical records. The data were analyzed using binary logistic regression, chi-square test, analysis of variance, and independent samples t-test with SPSS software version 23. The research involved 400 pregnant women, with the mean age of the SLE and non-SLE groups being 36.68±4.90 and 29.46±6.56 years, respectively. The most prevalent adverse outcome was cesarean section (271 [67.8%]), significantly higher in the SLE group (54.5% vs. 10.0%, P=0.0001). The likelihood of experiencing spontaneous abortion, preterm labor, cesarean section, and LBW was increased by more than 6.5 times (odds ratio, 6.54; 95% CI, 2.22-19.27; P=0.001), 3.6 times (odds ratio, 3.67; 95% CI, 1.47-9.18; P=0.005), 18.9 times (odds ratio, 18.94; 95% CI, 6.46-55.49; P=0.0001), and 3 times (odds ratio, 3.04; 95% CI, 1.09-8.46; P=0.030) in individuals with SLE, respectively. Women with SLE have an increased likelihood of encountering spontaneous abortion, preterm labor, cesarean section, and delivering a low-birth-weight infant.

Trajectory of pelvic floor muscle training adherence in Chinese women with postpartum stress urinary incontinence and its related factors: A longitudinal study

ObjectiveNumerous studies have shown that pelvic floor muscle training (PFMT) adherence in women with postpartum stress urinary incontinence is low and influenced by many factors. However, most previous studies have been cross-sectional studies on PFMT adherence. Neglecting physiological and psychological recovery after childbirth may lead to changes in the adherence to PFMT. This longitudinal study investigated the developmental trajectory of PFMT adherence at 8, 10, and 12 weeks postpartum and the associated factors in China. MethodsA total of 213 women with postnatal stress urinary incontinence who visited the obstetric pelvic floor clinic of a Grade A tertiary specialist maternity hospital in Beijing, China between January 2018 and January 2019 were selected. Compliance levels were measured using PFMT compliance questionnaires at 8, 10, and 12 weeks postpartum. Data on self-efficacy, postpartum social support, and other influencing factors were collected at 12 weeks postpartum. Differences in PFMT compliance scores were analyzed using repeated-measures analysis of variance. Multiple stepwise linear regression analyses were used for multivariate analysis. ResultsThe PFMT compliance scores at 8, 10, and 12 weeks postpartum were 13.47 ​± ​4.42, 10.76 ​± ​4.46, and 7.95 ​± ​5.54, which were at a moderate level and showed a decreasing trend over time. Multiple stepwise line regression analysis showed that the factors influencing compliance with PFMT in women with postpartum stress urinary incontinence were knowledge-attitude-practice of PFMT (t ​= ​4.251, P ​< ​0.001), postpartum social support level (t ​= ​4.304, P ​< ​0.001), and self-efficacy level of PFMT (t ​= ​8.577, P ​< ​0.001). ConclusionThe PFMT compliance of Chinese women with postpartum stress urinary incontinence was moderate, with a downward trend. More effective methods should be chosen to improve women's PFMT compliance based on their situation, such as improving patient self-efficacy, social support, and knowledge-attitude-practice.

Impact of COVID-19 pandemic on specialty training in obstetrics and gynaecology in Hong Kong: is there a concern about the future prospect?

IntroductionThe COVID-19 pandemic in the past few years led to major adjustments in the provision of healthcare. This study aimed to investigate trainees’ perception of impact of the pandemic on specialty training in Obstetrics & Gynaecology (O&G) in Hong Kong.MethodsA cross-sectional questionnaire survey was performed on all the O&G trainees and the young fellows of the Hong Kong College of Obstetricians and Gynaecologists (HKCOG). The questionnaires included 5 parts: demographic data, impact on clinical activities, redeployment, educational activities and career progression.ResultsA total of 104 questionnaires (92.9%) were received for final analysis. The majority of the participants had reductions in elective and emergency operations, as well as exposure to in-patient admissions and out-patient clinics in both obstetrics and gynaecology. The reduction was most significant in elective gynaecology operations. One-third (34.6%) of the participants had been redeployed to other departments, and educational activities were reduced during the pandemic. Around 58% of the trainees were concerned with the reduction in clinical exposure, and 78% worried they would not be able to log sufficient number of surgical procedures. Basic trainees were significantly more worried than higher trainees. Around half of the trainees had doubts or regrets about choosing to undergo O&G specialty training.ConclusionThe O&G trainees in Hong Kong perceived that the COVID-19 pandemic had significant negative impacts on their training. Many trainees were worried they would not be able to attain the required level of competence when they complete their specialist training.

Airborne SARS-CoV-2 RNA detected during deliveries with unmasked patients

Healthcare workers in obstetric clinics may be exposed to airborne SARS-CoV-2 when treating patients with COVID-19. In this study, performed during the midst of the pandemic, air samples were collected in delivery rooms during childbirth and analysed for SARS-CoV-2 RNA content. Six of 28 samples collected inside delivery rooms were positive for SARS-CoV-2, but none in anterooms or corridors. Five of the six positive samples were from the same occasion. This indicates that some patients could be major sources of exhaled virus, although the individual variation is large, and it is thus difficult to predict the risk of infection.

Prenatal ozone exposure and variations of the gut microbiome: Evidence from a Chinese mother-infant cohort

BackgroundThe gut microbiome is central to human health, but the potential impact of ozone (O3) exposure on its establishment in early life has not been thoroughly examined. Therefore, this study aimed to investigate the relationship between prenatal O3 exposure and the variations of the human gut microbiome during the first two years of life. DesignA cohort study design was used. Pregnant women in the third trimester were recruited from an obstetric clinic, and long-term follow-ups were conducted after delivery. The gut microbiome was analyzed using the 16 S rRNA V3-V4 gene regions. Functional pathway analyses of gut microbial communities in neonates were performed using Tax4fun. The average concentrations of ambient O3 and other air pollutants from pregnancy to delivery were calculated using the China High Air Pollutants (CHAP) dataset, based on the permanent residential addresses of participants. Multiple linear regression and mixed linear models were utilized to investigate the associations between prenatal O3 exposure and gut microbiome features. ResultsPrenatal O3 exposure did not significantly affect the gut microbial alpha diversity of mothers and neonates. However, it was found to be positively associated with the gut microbial alpha diversity in 24-month-old infants. Prenatal O3 exposure explained 13.1 % of the variation in neonatal gut microbial composition. After controlling for potential covariates, prenatal O3 exposure was associated with neonatal-specific gut microbial taxa and functional pathways. Furthermore, the mixed linear models showed that prenatal O3 exposure was negatively associated with variations of Streptococcus (p-value = 0.001, q-value = 0.005), Enterococcus (p-value = 0.001, q-value = 0.005), Escherichia-Shigella (p-value = 0.010, q-value = 0.025), and Bifidobacterium (p-value = 0.003, q-value = 0.010). ConclusionsThis study is the first to examine the effects of prenatal O3 exposure on gut microbial homeostasis and variations. It demonstrates that prenatal O3 exposure is associated with variations in certain aspects of the gut microbiome. These findings provide novel insights into the dynamics and establishment of the human microbiome during the first two years of life.

Depressive Symptoms during Pregnancy and the Postpartum Period: A Tertiary Hospital Experience.

Background and Objectives: The prevalence of depressive symptoms during pregnancy is about 20%, and 10-15% in the postpartum period. Suicide is a worrying cause of death among women in these periods. Although ICD-10 lacks specific definitions for perinatal depression (it is planned in ICD-11), the DSM-5 defines it. Various etiological factors and treatment options are being investigated. This study aimed to examine potential etiological factors in order to contribute to potential preventive and therapeutic approaches. Material and Methods: A prospective study at the Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia, from October 2023 to January 2024 was conducted. Two hundred and five healthy women were surveyed before giving birth (37+ gestational weeks) and 2 weeks and 2 months after childbirth. The following factors were examined: sociodemographic, psychological, and obstetric (using a specially designed questionnaire); relationship quality (DAS-32); and depression, anxiety, and stress symptoms (EPDS; DASS-21). Results: Depression frequency was 26.3% before childbirth, 20% in the second week, and 21.9% in the second month after delivery. DASS-21 test results showed a statistically significant correlation before delivery and two weeks postpartum (p = 0.02). Factors that are significantly associated with the presence of depressive symptoms include the following: before childbirth-miscarriages (p < 0.01); in the second week after childbirth-personal experiences of a difficult birth (p < 0.01), cesarean delivery instead of planned vaginal delivery (p = 0.03), and application of epidural anesthesia (p = 0.04); and in the second month after childbirth-satisfaction with financial status (p = 0.035). Relationship quality is significantly correlated with DASS-21 test results before childbirth, in the second week, and in the second month after childbirth (p < 0.01), and it is significantly different in women with and without depressive symptoms (before childbirth, in the second week, and in the second month after childbirth, p < 0.01). Conclusions: There are risk factors that can be addressed preventively and therapeutically during pregnancy and in labor. This could be achieved through psychotherapy, partner support, and appropriate management of labor.

Canadian Midwives' Experiences with Nutrition in Their Training and Practice: A Cross-Sectional Study.

Midwives are primary prenatal care providers well-positioned to offer nutrition advice to pregnant individuals; however, no Canadian study has assessed midwives' experience with nutrition education. The objective of this study was to investigate Canadian midwives' experiences with nutrition in their practice, their level of nutrition education, and their recommendations on select nutrition topics. This cross-sectional study used an anonymous online survey consisting of 4 sections: demographics, opinions on the importance of nutrition, nutrition recommendations for pregnancy, and nutrition topics that midwives would like more information on. Responses were recorded using Likert-type scales, multiple choice, or open-ended questions. Eligible participants, registered Canadian midwives, were recruited through advertisements in e-newsletters via national and provincial midwifery associations, social media posts, and emails to midwifery clinics. An independent samples t test compared differences in means for continuous outcomes, the χ2 test compared categorical variables, and the Mann-Whitney U test compared ordinal variables. A P <.05 was considered statistically significant. In total, 161 midwives completed the online survey. Most midwives (92.5%) indicated that nutrition for pregnancy was important, and 83.2% believed their role in providing nutrition information to pregnant women was important. Almost two-thirds (63.8%) of midwives received nutrition education. Comfort levels were highest (median = 4) when providing nutrition advice on healthy eating, weight gain, Listeria, anemia, heartburn, safe food handling, nutrition for breastfeeding, and weight gain for women with obesity. Almost all the midwives (99.4%) had provided nutrition information to pregnant women, and 85.2% of their recommendations aligned with Canadian guidelines and literature. Canadian midwives valued the importance of nutrition during pregnancy and their role in providing nutrition information to pregnant women. The level of comfort in advising on nutrition ranged from uncomfortable to very comfortable depending on the topic, and most (85.2%) of their advice aligned with Canadian guidelines and relevant literature.

Influence of male body mass index on semen analysis parameters and in vitro fertilization outcomes.

Concurrent global increase of prevalence of obesity and male fertility implies link between overweight and obesity with male subfertility. This hypothesis is supported by numerous population-based epidemiological studies. Increase in body mass index (BMI) is associated with poor sperm quality in fertile, and more noticeable in infertile men. Nevertheless, some studies disprove damaging effect of BMI on semen quality. To examine the influence of men's BMI in infertile couples undergoing in vitro fertilization (IVF) on semen analysis parameters and IVF outcomes. Study encompassed all couples who underwent IVF at Gynecology and Obstetrics Clinic Narodni Front in Belgrade during 2018 and 2019. Exclusion criteria were azoospermia, conditions and diseases that could affect the semen analysis parameters (diabetes, malignant diseases treated with radiation and/or chemotherapy, trauma or surgery of the genital organs, mumps or undescended testicles in childhood). Evaluated semen analysis parameters included semen ejaculate volume, sperm pH, sperm count, sperm motility, and sperm morphology. IVF outcomes comprised total number of embryos, number and percentage of obtained good-quality embryos and clinical pregnancy rates. Based on BMI value, participants were divided into a group of underweight (Group 1), normally weight (Group 2), overweight (Group 3), and obese men (Group 4). After applying inclusion and exclusion criteria, 411 men (couples) were included in the analysis. The largest number of men were overweight, while the smallest belonged to the group of underweight participants. There are no significant differences in the semen analysis parameters between study groups. Correlation analysis shown weak and insignificant correlation between BMI and semen analysis parameters. The number and proportion of good quality embryos is significantly lower in overweight and obese study groups compared to normal weight and underweight groups (2.89, 2.91, 2.42, and 2.36, respectively, P = .041). The differences in other IVF outcomes: total number of embryos (3.61, 3.74, 3.21, and 3.37, respectively) and clinical pregnancy rates (41.26%, 43.09%, 42.78%, and 39.95%, respectively) between study groups were not significant (P > .05). BMI does not significantly affect semen analysis parameters, but a higher BMI is associated with a lower number and proportion of good quality embryos in IVF outcomes.

Examining the Relationship Between Spiritual Well-Being and Pregnancy Distress in Pregnant Women

Aim: This study was conducted to determine the relationship between pregnant women's spiritual well-being levels and their pregnancy-related stress. Material and Methods: The sample of the descriptive and correlational study consisted of 250 pregnant women aged 18 years and over with the 12th week of pregnancy and above who were admitted to the Obstetrics and Gynecology outpatient clinic of a Training and Research Hospital between November 2020 and April 2021 and who agreed to participate in the study. The data were obtained by collecting the Personal Information Form, Spiritual Well-Being Scale (SWBS), and Tilburg Pregnancy Distress Scale (TPDS). The SPSS statistical program was used to evaluate the data. Results: The mean age of the pregnant women was 26.5±5.3 years. It was determined that 39.6% of the pregnant women were secondary school graduates, 72% had planned pregnancies, 31.6% were primiparous and 60% were in the third trimester. A statistically significant, negative, and weak relationship was found between the spiritual well-being levels of pregnant women and pregnancy-related stress (r=-0.33, p=0.000). Conclusion: In this study, the spiritual well-being of pregnant women was determined to be high, and pregnancy-related stress was found to be low. However, it was found that as the spiritual well-being of pregnant women increased, their pregnancy-related stress decreased.

The relationship between pregnancy-related anxiety, trait anxiety, and internet use in pregnant women: a cross-sectional study

Introduction: Pregnancy-related anxiety leads to some negative maternal and fetal complications. Determining prenatal and natal anxiety and associated factors can help identify high-risk women who need intervention during pregnancy and develop early intervention strategies. The aim of this study is to determine pregnancy-related, and trait anxiety in the prenatal period and its affecting factors. Methods: This cross-sectional and descriptive study was conducted with 245 pregnant women in the obstetrics clinic of a tertiary healthcare institution between March and August 2022. The sociodemographic, obstetric, and internet use of the participants were questioned. Pregnancy-related anxiety was assessed by using Pregnancy-Related Anxiety Questionnaire-Revised-2 (PRAQ-R2), and trait anxiety was assessed by using State–Trait Anxiety Inventory-I (STAI-II). Results: Pregnant women’s mean scale score for STAI (trait) was 45.54 ± 6.32, for PRAQ-R2 total score was 27.80 ± 8.32, for PRAQ- Fear of giving birth score was 10.12 ± 3.92, PRAQ- Worries about bearing a physically or mentally handicapped child score was 10.44 ± 4.11, and PRAQ- Concern about own appearance score was 7.24 ± 2.86. Pregnancy-related Anxiety Scale score was higher in nulliparous than multiparous (p=0.002) and 30-35 age groups than others (p=0.014). Having a chronic disease is related to a higher anxiety score (p=0.028). Trait anxiety scores were higher in nulliparous (p=0.005), those with low income, those with chronic diseases (p=0.032), and those with a history of children with congenital diseases (p=0.013). Anxiety scores were higher in pregnant women who used the internet as a source of information about pregnancy (p=0.002), and those who use the internet more (p=0.023). There was a significant positive correlation between STAI (trait) anxiety and PRAQ total score ( r:0.292, p&amp;lt;0.001 ), PRAQ- Fear of giving birth (r:0.145, p=0.024), PRAQ- Worries about bearing a physically or mentally handicapped child (r:0.270, p&amp;lt;0.001), and PRAQ- Concern about own appearance (r:0.254, p=&amp;lt;0.001). Conclusion: Pregnancy-related anxiety was higher in nulliparous, 30-35 age groups, having a chronic disease, husbands' high education status, and having trait anxiety. Information obtained from the internet and the time spent on the internet are associated with increased pregnancy anxiety. Future studies should focus more on predicting factors affecting pregnancy-related anxiety and estimating risks for pregnant women.