High-risk Mothers Research Articles

Neonatal Outcome in High Risk Pregnancies Based on Umbilical Arterial Blood Gas Analysis

The purpose of this study is to evaluate the correlation between umbilical arterial blood gas and short term outcome of the neonates born. This prospective observational cohort study was carried out at Department of Paediatrics, MLB Medical College, Jhansi on 120 term neonates delivered by caesarean sections or normal vaginal delivery of high risk mother based on Neonatal Resuscitation Program (NRP) between July 2017 to July 2018. All neonates were divided into two groups: 1) Group I (52 cases) consists of neonates with umbilical cord pH less than 7.2, whereas Group II (68 cases) consists of neonates with umbilical cord pH more than 7.2. Male babies and LSCS delivery were higher in both groups. The most common risk factors in mother are anemia (26%) and MSL (23%). All the cases were full term babies and have normal birth weight. Mean PO2 level was 11±6 and in group II it was 14±8. Mean PCO2 in group I was 63.7±13.7 while in group II it was 52.1±7.9. Mean bicarbonate was 21.36±3.54 and in group II it was found to be 24.13±3.25. On statistical analysis difference between pH, PCO2, PO2, BE and bicarbonate was significant. In group I, neonates required resuscitation in 57.69% (30 out of 52 cases), but in group II, only (10.29) (7 out of 68) cases required resuscitation. In group I, 48.07% (25 of 52) newborns were admitted to the NICU, whereas 5.88% (4 of 68) neonates in group II were admitted to the NICU. Encephalopathy is observed in 15 instances (28.85%) in Group I, but only 4 cases (5.88%) in Group II. HIE symptoms were frequently seen in the initial hours or days following delivery. Convulsion occurred in 11 instances (21.15.0%) in Group I, but only 3 cases (4.41%) in Group II. Convulsive disorders as sign of moderate encephalopathy had been presented more in neonates who had acidosis in 24 to 48 hours after birth. In group I, 26 cases (50.0%) had delayed in attaining oral feed until an hour, but in group II, only 4 cases (5.88%) cases had delay in attaining oral feed until an hour. The statistical association between delayed attainment of full meal and infant pH is significant. HIE is significantly higher in group 1. The average hospitals stay among academic newborns in Group I was 3.9613.199 days. The length of hospital stray in academic newborns exhibited an inverse connection with umbilical cord pH. In group II, the average length of hospital stay is 2.151.479 days. When compared to group II, group I experienced a considerably longer hospital stay. At 1 and 5 minutes of birth, a new-born with cord blood pH <7.2 had an APGAR score of 5.60±1.963 and 7.88±1.437, whereas a baby with cord blood pH >7.2 had an APGAR score of 8.70±0.964 and 8.70±0.964. According to statistical study, the APGAR score is significantly related to the pH of the cord blood. Umbilical cord blood ABG has been conducted as a definitive factor for fetus evaluation. The pH of umbilical cord blood is the best current criteria for diagnosing foetal hypoxemia during labour and determining appropriate postnatal care decisions.

Impact of extreme maternal age on neonatal outcomes

Background: Pregnancies at extreme ages of reproductive life are considered to be at high risk for mother and neonate. The aim of the study was to determine neonatal risks associated with extreme maternal age.Methods: A retrospective cohort study was conducted at Befelatanana Maternity covering the period from 1 January to 31 December 2018. Data was collected from neonate’s medical files.Results: Of 789 neonates from mothers with extreme age included, 64.7% were from mothers under the age of 18, and 35.3% from mothers aged 40 and over. They were compared to 519 neonates from mothers aged 20-30. Maternal age under 18 was a risk factor for Apgar index below 7 at the 5th minute RR 1.69 (95% CI 1.17, 2.44), preterm birth RR 2.19 (95% CI 1.70, 2.80), low birthweight RR 2.03 (95% CI 1.53, 2.53) and admission to neonatalogy RR 2.64 (95% CI 2.20, 3.16). Also, the neonatal risks of pregnancy after 40 years were fetal death in utero RR 2.97 (95% CI 1.51, 5.85), low birthweight RR 2.47 (95% CI 1.97, 3.10), preterm birth RR 2.85 (95% CI 2.21, 3.68), and admission to Neonatalogy RR 3.06 (95% CI 2.54, 3.68).Conclusions: The extreme age of the mother is therefore a risk of neonatal adverse outcomes. Rigorous prenatal follow-up is needed for these high-risk pregnancies.

A Prospective Cohort to Evaluate Second-trimester Fetal Echocardiography Accuracy and to Evaluate Perinatal Outcomes in Iran

Background: Congenital heart defects (CHDs) are the most costly congenital disorders and despite significant advances in the diagnostic modalities, still its perinatal and neonatal consequences require extensive studies. In the current study, we investigated diagnostic value of fetal heart echocardiography for CHDs diagnosis while postnatal echocardiography was considered as Gold standard. Additionally, maternal and perinatal outcomes were evaluated.
 Methods: In this prospective Cohort study, 400 high risk pregnant women with regards to carrying a fetus with CHDs underwent fetal echocardiography during pre and postnatal period and maternal, fetal and neonatal outcomes were followed. Moreover, diagnostic value of fetal echocardiography for predicting CHDs was calculated.
 Results: Among 400 fetal echocardiographies done, CHDs was found in 63 fetuses and consequently postnatal echocardiography confirmed the diagnosis in 52 (82.53%) of them. The most common CHDs were atrial and ventricular septal defects (ASD and/or VSD). Although there were no association between presence of CHDs with consanguineous marriage, maternal age, maternal body mass index, smoking, pregnancy complications, fetal weight, gestational age, neonatal gender, and associated anomalies, the first and fifth Apgar Scores were significantly lower in neonates with CHDs on postnatal echocardiography.
 Conclusion: Second trimester fetal echocardiography, especially among high risk mothers has high diagnostic value for fetal CHDs diagnosis. This Imaging technique can lessen postnatal complications by facilitating early diagnosis and subsequent planned delivery in a proper well-equipped center.

Clinical and laboratory predictors of fetal and neonatal alloimmune thrombocytopenia.

Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is the most common cause of intracranial hemorrhage (ICH) in thrombocytopenic term infants. We investigated clinical and laboratory predictors of severe FNAIT in a tertiary care referral center. Retrospective cohort study over a 30-year period. We defined FNAIT as recurrence of neonatal thrombocytopenia in a subsequent pregnancy; and severe outcomes as any of: (1) a birth platelet count below 20 × 109 /L; (2) ICH or (3) fetal death. We used a generalized estimating equations analysis and classification tree analysis to identify risk factors for severe FNAIT in a subsequent pregnancy. During index pregnancies (n=135 in 131 mothers), 71 infants (52.6%) had severe outcomes including a platelet count <20 × 109 /L (n=45), fetal or neonatal ICH (n=32), or fetal death (n=4). During subsequent pregnancies (n=72), 15 infants (20.8%) had severe outcomes including birth platelets <20 × 109 /L (n=10), ICH (n=2), or death (n=3). Forty-two women (58.3%) received antenatal intravenous immune globulin (IVIG) during subsequent pregnancies. Eight mothers (n=9 infants) had severe FNAIT outcomes despite receiving antenatal IVIG. Maternal antibodies to human platelet antigens (HPA) was the only independent predictor of severe FNAIT in a subsequent pregnancy (OR=25.3, p=.004). Nevertheless, one of 43 infants from antibody-negative mothers had a severe outcome. The presence of anti-HPA is highly indicative of the diagnosis of severe FNAIT; however, we observed one infant who had severe FNAIT recurrence, defined using strict clinical criteria, without a maternal antibody. Improved diagnostic and therapeutic strategies are needed to prevent severe FNAIT in high-risk mothers.

Pierre robin sequence with patent ductus arteriosus: A case report

When Pierre Robin sequence is associated with many congenital abnormalities, prompt diagnosis and treatment are essential. As Pierre robin sequence can cause significant upper respiratory tract obstruction and aspiration pneumonia it needs detailed evaluation and early correction. Here we report a two years-old girl child with patent ductus arteriosus associated with cleft palate and tongue tie (Pierre Robbin sequence) who was promptly treated. This type of presentation is rare and important. A girl child with a Pierre robin sequence, associated with PDA was under follow-up since birth. The baby was mildly tachypnoeic &amp; was started on diuretics at one month of age. Early closure of PDA with a device was done at 11 months of age. At the age of two years, corrective surgery was done for cleft palate, and tongue tie (Pierre Robin sequence). Pierre Robin sequence may be associated with congenital heart disease, like ventricular septal defect, patent ductus arteriosus, and atrial septal defect in 20 percent of patients. If not treated, the airway obstruction can produce cardiac or respiratory failure, pulmonary hypertension, etc. Early diagnosis and timely intervention helps to alleviate the difficulties. Antenatal screening in high-risk mothers and early identification of the congenital anomaly are the only methods to detect and treat such congenital anomalies.

A Retrospective Cross Sectional Study on Clinical Profile of Neonatal Seizures in a Tertiary Care Government Hospital, Western India

Background: Convulsion during the first few weeks of life in a newborn is a frequent problem. Such disturbances may have many causes contributing to their etiology and have prognostic significance as well. Objective: This study aimed to determine the etiology, effect of gestational age, onset, types, and mortality of neonatal convulsions. We also aimed to evaluate the clinical parameters, computed tomography (CT) brain scan, neurosonogram, metabolic profile, and cerebrospinal fluid analysis as well as the response of antiepileptic drugs and outcome in these babies. Materials and Methods: A retrospective cross-sectional study was done at the neonatal intensive care unit of a tertiary care teaching hospital. The study group comprised 358 neonates with neonatal seizures (163 inborn and 195 referred) admitted over 2 years. Data were entered in Microsoft Excel and analyzed in SPSS version 12 (Chicago, Illinois, USA). Results: Out of 10,232 live births, 163 had seizures in the neonatal period, giving an incidence of 15.9/1000 live births. The most common type of seizure was tonic accounting for 33.2%. The most common etiology was perinatal asphyxia – 50.8%, followed by central nervous system infection – 20.1%. One hundred and twenty-six out of 358 patients expired contributing to mortality of 35.1%. All the newborns with perinatal asphyxia had seizures within the first 7 days. Conclusions: Improvement in antenatal and perinatal care with early identification of high-risk mothers will reduce the incidence of birth asphyxia and thereby of neonatal convulsions. Subtle seizures are most common and should not be missed. CT brain scan and neurosonogram are useful in the early detection of cerebral edema, ischemic hypodensities, and hemorrhage which contributes to prognostic significance.

Newborns in the early neonatal period in a group of mothers at high obstetric and perinatal risk

AIM: We aimed at assessing the status of newborns in the early neonatal period in a group of mothers at high prenatal risk for preeclampsia (PE), fetal growth restriction (FGR), preterm birth (PTB), and fetal chromosomal abnormalities (FCA).&#x0D; MATERIALS AND METHODS: We prospectively analyzed the status of 435 singletons. Mothers in the first-trimester underwent prenatal screening with risk assessment. Group 1 (study group, n=231) included high-risk subgroups for FCA (subgroup 1A, n=67), maternal PE (subgroup 1B, n=66), FGR (subgroup 1C, n=46), and PTB (subgroup 1D, n=52). We excluded risk combinations. Group 2 (controls) included 204 children of low-risk women.&#x0D; RESULTS: Group 1 had a higher incidence of mild-to-moderate asphyxia compared with group 2 (p 0.05) and was more frequent in 1B, 1C, and 1D subgroups. Moreover, the frequency of severe asphyxia was similar between the groups (p 0.05). Intrauterine growth restriction (IUGR) and developmental delay were more frequent in group 1 than in group 2 (p 0.05). Moreover, group 1 children required monitoring and treatment more frequently that in group 2 (p 0.05). The frequency of infectious complications in group 1 and 1A, 1B, and 1C subgroups was equally higher than that of group 2 (p 0.05), while respiratory distress syndrome predominated in group 1 (subgroup 1D) and was not observed in group 2. The discharge rate was 95.7% in group 1 and 84.0% in group 2 (p 0.05). On days 3 to 5, 16% and 3.4% of children in groups 1 and 2, respectively, were transferred to the second stage of aftercare (p 0.05).&#x0D; CONCLUSIONS: In the early neonatal period, children born to high-risk mothers, as opposed to those born to low-risk mothers, were significantly more likely to have asphyxia, IUGR, infectious complications, and indications for continued treatment in the second stage of nursing.

Joint Roles of Oxytocin- and Dopamine-Related Genes and Childhood Parenting Experience in Maternal Supportive Social Network.

How genes and parenting determine maternal social support availability, an important preventive factor of postpartum depression, has been little studied. Our study aimed to examine the interaction effects of maternal sociality-related gene and parenting on maternal social support. We analyzed data of 115 triads of Japanese grandmothers, mothers, and their infants. An interaction between parenting and cumulative genetic risk, calculated on the sociality-related genes (OXTR rs53576, rs2254298, rs1042778; COMT rs4680), was found. Mothers with high genetic risk received less social support if received poorer parenting (B = - 0.02, 95%CI = - 0.04 to - 0.01), while no association among low-risk mothers. Poorer social support was associated with severer depression in high-risk mothers (B = - 0.88, 95%CI = - 1.45 to -0.30). Our results suggest that mothers carrying risk alleles of sociality-related genes are particularly sensitive to childhood parenting, underscoring the importance of childhood parenting and genetic risk to understand maternal help-seeking behavior.

Blessing of the moon: cultural beliefs, birth timing and child health in Nepal

In many South Asian contexts, specific dates are auspicious and inauspicious for health-related behaviours and outcomes. This study analysed the effect of lunar date-related auspicious beliefs in Nepal on childbirths and neonatal health outcomes. Using the daily birth records from a tertiary maternity hospital, we empirically examined whether births occurred disproportionally around full moon days. We found an average of 10.7 extra births on and before full moon days, with an average of 7.5 extra Caesarean deliveries on full moon days. We demonstrated that births occurring on or before the full moon day have poor neonatal health outcomes. However, a subsample analysis suggested better health outcomes for low-risk mothers and worse health outcomes for high-risk mothers. These findings suggest that low-risk mothers may move their deliveries to auspicious dates with fewer complications than high-risk mothers. The results emphasise the need for additional research to distinguish health service demand from supply influences on birth timing in Nepal.

Challenging the Sensitive Window Hypothesis: Timing Effects of Maternal Depressive Symptoms on the Intergenerational Transmission of Maltreatment and Psychopathology in the Next Generation

Objective: The current study explored the role of maternal depressive symptoms in the intergenerational transmission of childhood maltreatment and developmental psychopathology. Based on the sensitive window hypothesis, the effects of earlier versus later maternal depression symptoms on child development were analysed. Method: Ninety-nine mother-child dyads, 65% of which had high-risk teenage mothers, participated in a longitudinal study with three assessments in the first 18 months of the child’s life (T1–T3) and a 4th reassessment (T4) at the child’s preschool age. Using serial mediation analyses, we tested whether the relationship between the mother’s own maltreatment history (Childhood Experience of Care and Abuse Questionnaire) and the child’s psychopathological outcome at preschool age was mediated in a causal effect chain by maternal depression in the first 2 years of life, by current maternal depression (Beck Depression Inventory-II) and by current maternal child abuse potential (Child Abuse Potential Inventory). The children’s emotional problems and externalizing symptoms were assessed at preschool age by parent or teacher Strengths and Difficulties Questionnaire ratings. Results: The results indicated that especially later maternal depression mediated the relationship between maternal childhood maltreatment and negative developmental outcomes in the next generation. The effects of maltreatment type on maternal depression were rather nonspecific. However, mental abuse affected existing risk factors more directly over time compared to physical and sexual abuse. Additionally, the impact of early life maltreatment and maternal depression on child psychopathology varied by rater. The pathway to externalizing symptoms was significant only in teacher ratings and for the pathway to emotional problems only in maternal ratings. Conclusions: The present findings suggest that early maternal depression followed by ongoing maternal depression plays a mediating role in the intergenerational cycle of maltreatment. Therefore, in the future, interventions should be offered at an early stage, but also extend well beyond the first 2 years of a child’s life, addressing maternal depression and trauma.

Pregnancy outcome among high-risk pregnant women in the rural area of Belagavi.

India has around 25% high-risk pregnant mothers, which leads to about 75% perinatal morbidities.(1) The early prediction of a high-risk pregnancy and planning interventions can help in preventing complications and result in good pregnancy outcomes. To study the pregnancy outcome among the high-risk pregnant women of a rural area and to associate pregnancy outcomes of high-risk pregnant women with modified Coopland's criteria. Study design: 1-year Longitudinal study from 2016 to 2017, Study population: The high-risk pregnant women attending PMSMA camp, Study area: Kinaye, Primary Health Centre, Belagavi. Sample size: 147, Data collection was done using a pretested predesigned questionnaire after obtaining patient consent and ethical clearance. Chi-square test was used to study the association of variables and categorical data presented as percentages. Among the participants, 40.4% of the pregnant women had low-risk scores; 45.9% had high-risk scores, and 13.7% had severe-risk scores according to Coopland's high-risk pregnancy scoring. Nearly 29.5% high-risk pregnancies resulted in bad fetal outcomes. As Coopland's score in the high-risk group increased, the chance of having good fetal outcomes decreased, and this association was found to be statistically significant. 70.5% of the high-risk mothers had good pregnancy outcomes. The scoring system can be used by health workers for the prediction of high-risk pregnancy and plan treatment and preventive measures.

Paracetamol preceding very preterm birth: Is it safe?

The use of paracetamol for pain relief in pregnancy is common. However, the influence of paracetamol on the perinatal adaptation of high-risk infants has not been studied. These data are important for safety, since another inhibitor of prostaglandin synthesis is harmful to infants born very preterm and increases serious morbidity. We studied whether the use of paracetamol had an adverse influence on neonatal adaptation and the outcomes of infants during the first hospitalization. We studied the patient records of high-risk mothers and their infants born before 32 weeks of gestation for multiple variables over a period of 84 months in Oulu University Hospital, a regional tertiary care hospital caring for high-risk deliveries and providing neonatal intensive care. In a matched cohort setting, the exposition was defined as paracetamol use <24 h before childbirth. The controls had consumed no paracetamol up to 1 week before delivery. Infants with major anomalies were excluded. The primary outcome was defined as the need for early interventional treatments for the preterm infants. Outcomes during the first hospitalization were also studied. Altogether, 170 fetuses from 149 mothers were exposed to paracetamol during the study period. The control population, delivering during the same period, consisted of 118 non-exposed fetuses from 104 mothers. Among them, the mothers were pairwise matched according to their medications, amniotic fluid leakage time, clinical infections, and delivery mode. After matching, 72 mothers/group remained, resulting in 88 paracetamol-exposed infants and 85 controls. No perinatal adverse reactions were detected. There were no differences in either circulatory support during the first postnatal day or in the risk for major diseases during the first hospitalization. Paracetamol-exposed infants needed fewer acute delivery room therapies (51.1% vs 65.9%, mean difference -14.89; 95% confidence interval -0.29 to -0.003). Maternal total paracetamol dose in the 1 week before delivery correlated positively with Apgar scores. Antenatal paracetamol given within 24 h before birth had no adverse effects on extremely or very preterm infants. The long-term safety of paracetamol and the potential acute benefits for preterm infants during perinatal transition remain to be proven in larger, prospective settings.

Effect of smartphone app-based health care intervention for health management of high-risk mothers: a study protocol for a randomized controlled trial

BackgroundThe 4th Industrial Revolution with the advent of the smart era, in which artificial intelligence, such as big data analysis and machine learning, is expected, and the provision of healthcare services using smartphones has become a reality. In particular, high-risk mothers who experience gestational diabetes, gestational hypertension, and prenatal and postpartum depression are highly likely to have adverse effects on the mother and newborn due to the disease. Therefore, continuous observation and intervention in health management are needed to prevent diseases and promote healthy behavior for a healthy life.MethodsThis randomized controlled trial will provide mothers 18 years of age or older with health care information collected based on evidence-based literature data using a smartphone app for 6 weeks. About 500 mothers will be selected in consideration of the dropout rate due to the characteristics of mothers. The study group and control group will be computer-generated in a 1:1 ratio through random assignment. The research group will receive health management items through the app, and health management information suitable for the pregnancy cycle is pushed to an alarm. The control group will receive the health management information of the paper. We also followed the procedure for developing mobile apps using the IDEAS framework.DiscussionThese results show the effectiveness of smart medical healthcare services and promote changes in health behaviors throughout pregnancy in high-risk mothers.Trial registrationClinical trial registration information for this study has been registered with WHO ICTRP and CRIS (Korea Clinical Research Information Service, CRIS). Clinical trial registration information is as follows:Study of development of integrated smart health management service for the whole life cycle of high-risk mothers and newborns based on community, KCT0007193. Registered on April 14, 2022, prospectively registered. This protocol version is Version 1.0. April 14, 2022.

Effective Strategies for the Use o Contraceptive Methods in the Postpartum Period by Adolescent Mothers in Iran Using Nominal Group Technique

Background and Objectives Unplanned pregnancy in the first year after delivery in high-risk and adolescent mothers can have numerous complications. This study aims to investigate the effective strategies for the use of contraceptive methods in the postpartum period by adolescent mothers in Iran. Subjects and Methods This qualitative study, using the nominal group technique (NGT), was conducted in 2019 during a journal club with the presence of professors and students in midwifery and reproductive health. The NGT included five steps: Recording of ideas during 5 minutes of silence, clarifying ideas, prioritizing important ideas, voting, and selecting the first five priorities. Results Five priorities were education, counseling, providing the contraceptive methods, modification of population policies, and correct identification of the vulnerable groups. Accordingly, strategies were categorized as (a) evidence-based education and counseling on appropriate use of contraceptive methods during pregnancy, after delivery, and during postnatal visits, (b) providing contraceptive methods to the high-risk group of women for free in health centers, and (c) modification of population policies. Conclusion There are appropriate strategies for the contraceptive use such as education, counseling, providing the contraceptive methods, and modification of population policies that can temporarily prevent pregnancy in high-risk adolescent women in Iran.

Identificación de factores que se asocian a alto riesgo de desarrollar diabetes gestacional

ObjectivesThe main objective is to determine the current prevalence of recognised risk factors for gestational diabetes mellitus (GDM) in our region, and to define the profile of patients at higher risk of developing this condition. We also investigate patient acceptability of the screening tests. Material and methodsThis is an ambispective study with 1,448 pregnant women recruited between December 2017 and July 2019 from a single centre. Inclusion criteria were no diabetes mellitus prior to the pregnancy, no history of GDM in any previous pregnancy, no history of bariatric surgery before the pregnancy, and GDM screening tests performed. ResultsThe prevalence of GDM was 6.7%. Risk factors associated with development of GDM were: age≥27.5 years (OR: 3.8; 95% CI: 2.01-9.16); BMI≥28.5kg/m2 (OR: 2.3; 95% CI: 1.47-3.59); history of diabetes mellitus in first-degree relatives (OR: 2.3; 95% CI: 1.5-3.66); and multiple pregnancy (OR: 2.8; 95% CI: 0.86-6.36); Prevalence of GDM increased with the number of risk factors presented by patients: from 1.4% with no risk factor, to 25.2% with 3. The O'Sullivan test (50g glucose) and oral glucose tolerance test (100g glucose) were perceived as “unpleasant” by 26.8% and 65.4% of patients, respectively. ConclusionsAge≥27.5 years, BMI≥28.5kg/m2, history of diabetes mellitus in first-degree relatives, and multiple pregnancy are factors related to an increased risk of GDM; these factors would be enough to identify most pregnant women developing GDM. Our findings may be used to improve programmes aimed at early diagnosis of gestational diabetes and supporting high-risk mothers in antenatal care.

Socioeconomic differences in the association between maternal age and maternal obesity: a register-based study of 707,728 women in Finland.

To examine the association between maternal age and maternal obesity across socioeconomic groups and to determine whether socioeconomic status modifies the association between maternal age and maternal obesity with a view to informing public health policies. Data for this register-based study were sourced from the Finnish Medical Birth Register and Statistics Finland, using the information of 707,728 women who gave birth in Finland from 2004 to 2015. We used multivariable regression models to assess the association between maternal age and maternal obesity across socioeconomic groups. We further assessed interactions on both multiplicative and additive scales. Across all socioeconomic groups, the adjusted odds ratio for the association between maternal age and maternal obesity increased, peaking for women 35 years or older. Using women below 20 years of age in the category of upper-level employees as a single reference group, in the category of upper-level employees, the adjusted odds ratio and 95% confidence intervals among women 35 years or older was 1.92 (1.39-2.64) for maternal obesity. Equally, the adjusted odds ratio and 95% confidence intervals in the category of long-term unemployed was 4.35 (3.16-5.98). Synergistic interactions on both multiplicative and additive scales were found across age and socioeconomic groups. The association between maternal age and maternal obesity was strongest among women 35 years or older with lower socioeconomic status. Population-level interventions that address maternal risk factors from teenage years are needed alongside individual-level interventions that target high-risk mothers in areas of low socioeconomic status and maternal obesity.

Risk factors for adverse outcomes following haploidentical hematopoietic cell transplantation with posttransplant cyclophosphamide: a two-center analysis.

Allogeneic hematopoietic cell transplantation (HCT) is a potentially curative therapy for several malignant hematologic diseases and alternative donors, including haploidentical, play a significant role in HCT. Despite the increasing use of haplo-HCT with PTCy, some questions remain open. The objective of the present study was to investigate risk factors for adverse outcomes after haplo-HCT with PTCy. This is a retrospective study conducted at two Brazilian centers. A total of 103 patients with hematologic malignancies who underwent first allogeneic, haploidentical HCT with PTCy were included. Risk factors for death were age at transplant (HR = 1.03 for each year; p = 0.002) and high/very high disease risk index (DRI; HR = 2.77; p = 0.0007) and mother as the donor compared with other donors (HR = 3.53; p = 0.005). In multivariate analysis, PFS was significantly poorer for older patients (HR = 1.02; p = 0.006), high/very high DRI (HR = 2.39; p = 0.003), and mother as the donor compared with other donors (HR = 3.18; p = 0.006). Relapse rate was higher for high/very high DRI (HR = 4.01; p = 0.002) and mother as the donor compared with other donors (HR = 2.52; p = 0.05). NRM was higher for older patients (HR = 1.03 for each year; p = 0.03). Tacrolimus was a protective factor for grades II-IV aGVHD (HR = 0.46; p = 0.04) compared with cyclosporine. Peripheral blood (PBSC) was a risk factor for cGVHD (HR = 3.48; p = 0.006), while tacrolimus was protective (HR = 0.30; p = 0.009). Mother as the donor compared with other donors was also a risk factor for poorer OS, PFS, and relapse, suggesting that this combination should be avoided. Tacrolimus was protective for both grades II-IV aGVHD and cGVHD, suggesting that tacrolimus may be more effective than cyclosporine in preventing GVHD. PBSC was a risk factor for cGVHD without any impact on relapse. Prospective studies comparing tacrolimus with cyclosporine are awaited.

Effect of Relaxation Technique on Anxiety, Stress, and Depression Scores of High-risk Pregnant Women Prone to Preeclampsia and the Physiological Indicators of Their Babies

Background and Objective: Stress, anxiety, and depression during pregnancy have adverse effects on both mother and baby. Stress and anxiety have been reported as high-risk factors for preeclampsia. Relaxation exercises can reduce the adverse effects of high-risk pregnancies in mothers prone to preeclampsia and improve pregnancy outcomes. Materials and Methods: This clinical trial study was conducted on 100 high-risk pregnant women referring to healthcare centers in Isfahan, Iran. The samples were randomly divided into experimental (n=46) and control (n=50) groups. Relaxation in was performed the experimental group in 16 sessions. Mean scores of stress, anxiety, and depression were measured and recorded using the Depression, Anxiety, and Stress Scale-21 Items Questionnaire. The collected data were analyzed by statistical tests in SPSS 16 software. Results: The mean scores of stress, anxiety, and depression were obtained at 6.80, 4.49, and 5.98 in the experimental group, respectively, and 1.20, 0.94, and 1.03 in the control group, respectively. The results showed that the mean scores of stress and anxiety were significantly lower after the intervention in the test group than in the control group (P&lt;0.05). However, the mean score of depression was not significantly different between the two groups (P&gt;0.05). No Neonatal significant difference was observed between the two groups in the physiological indices, including mean 1- and 5-minute Apgar scores, weight, height, and head circumference (P&gt;0.05). Conclusion: Based on the results of this study, relaxation reduced the level of anxiety and stress among high-risk pregnant mothers. Therefore, the implementation of this technique during pregnancy is recommended for high-risk pregnant women prone to preeclampsia.

Antenatal intravenous immunoglobulins in pregnancies at risk of fetal and neonatal alloimmune thrombocytopenia: comparison of neonatal outcome in treated and nontreated pregnancies

Maternal alloantibodies to human platelet antigen-1a can cause severe intracranial hemorrhage in a fetus or newborn. Although never evaluated in placebo-controlled clinical trials, most Western countries use off-label weekly administration of high-dosage intravenous immunoglobulin in all pregnant women with an obstetrical history of fetal and neonatal alloimmune thrombocytopenia. In Norway, antenatal intravenous immunoglobulin is only recommended in pregnancies wherein a previous child had intracranial hemorrhage (high-risk) and is generally not given in other human platelet antigen-1a alloimmunized pregnancies (low-risk). To compare the frequency of anti-human platelet antigen-1a-induced intracranial hemorrhage in pregnancies at risk treated with intravenous immunoglobulin vs pregnancies not receiving this treatment as a part of a different management program. This was a retrospective comparative study wherethe neonatal outcomes of 71 untreated human platelet antigen-1a-alloimmunized pregnancies in Norway during a 20-year period was compared with 403 intravenous-immunoglobulin-treated pregnancies identified through a recent systematic review. We stratified analyses on the basis of whether the mothers belonged to high- or low-riskpregnancies. Therefore, only women who previously had a childwith fetal and neonatal alloimmune thrombocytopenia were included. Two neonates with brain bleeds were identified from 313 treated low-risk pregnancies (0.6%; 95% confidence interval, 0.2-2.3). There were no neonates born with intracranial hemorrhage of 64 nontreated, low-risk mothers (0.0%; 95% confidence interval, 0.0-5.7). Thus, no significant difference was observed in the neonatal outcome between immunoglobulin-treated and untreated low-risk pregnancies. Among high-risk mothers, 5 of 90 neonates from treated pregnancies were diagnosed with intracranial hemorrhage (5.6%; 95% confidence interval, 2.4-12.4) compared with 2 of 7 neonates from nontreated pregnancies (29%; 95% confidence interval, 8.2-64.1; P=.08). The most reliable data hitherto for the evaluation of intravenous immunoglobulins treatment in low-risk pregnancies is shown herein. We did not find evidence that omitting antenatal intravenous immunoglobulin treatment in low-risk pregnancies increases the risk of neonatal intracranial hemorrhage.

STRATEGI AKSELERASI PENURUNAN STUNTING WILAYAH PESISIR KABUPATEN PEKALONGAN

Stunting is a chronic nutritional problem caused by lack of nutritional intake for a long time, resulting in growth disorders in children, namely the child's height is lower or shorter than the standard age. The incidence of stunting in Indonesia is ranked fifth in the world, where 38 percent of the total number of children under five are stunted. The number of stunting rates in Pekalongan Regency is still quite high, recorded in 2020 from 10.316 children under five who were weighed, as many as 1.631 toddlers or 15.81 percent, although this was better than 2019, which recorded 21.43 percent of toddlers suffering from stunting. Stunting. The research objectives are to identify stunting problems in coastal areas, identify efforts and health programs that have been carried out related to the SUN (Scaling up Nutrition) program, and analyse the SWOT efforts and health programs that have been carried out as an effort to handle stunting reduction acceleration. The research design used by the writer was exploratory research with a qualitative approach supported by statistical data by triangulation of sources through in-depth interviews with key informants, and accompanying informants to seek apperceptions of various sources. The research instrument used guidance interviewing. The location of this research was in Jeruk Sari, Tegal Dowo and Karang Jompo villages. The results of the research on Handling Stunting through the SUN (Scaling up Nutrition) program in the three research areas (Jeruk Sari Village, Tegal Dowo Village and Karang Jompo Village) have been carried out quite well. Several SUN programs were carried out in the form of giving PMT, measuring toddlers, giving PMT to high-risk mothers and also Posyandu activities and mother's classes. Based on the results of in-depth interviews with triangulated informants, it was stated that the implementation of the program was more of a specific nutrition intervention. Sanitation improvements due to the tidal wave are still getting attention considering the condition of the third region being in an area affected by the tidal wave throughout the year. Culture and public trust are also considered as obstacles in accelerating stunting handling programs. The writer concludes that the SUN program that has been carried out in the three research areas is still in the form of specific nutrition interventions, namely interventions in the form of giving PMT to toddlers and pregnant women with rest and measuring toddlers. Sensitive nutrition interventions are still not optimally carried out. It is necessary to increase good cooperation between other cross-sectors so that the acceleration of stunting handling can be carried out.