Monitoring Of Pregnant Women Research Articles

Comparison of Glycemic Metrics Measured Simultaneously by Intermittently Scanned Continuous Glucose Monitoring and Real-Time Continuous Glucose Monitoring in Pregnant Women with Type 1 Diabetes.

Background: We aimed to compare clinically important glycemic metrics with focus on mean sensor glucose and time-below-target range (TBR) during nighttime obtained with intermittently scanned continuous glucose monitoring (isCGM) and real-time CGM (rtCGM) in early pregnancy in women with type 1 diabetes. Materials and Methods: A prospective, observational study including 20 women with type 1 diabetes simultaneously monitored with isCGM (Freestyle Libre; Abbott) and rtCGM (Envision™ Pro; Medtronic) for 7 days in early pregnancy. Time-in-target range (TIR) was defined as 3.5-7.8 mmol/L. Results: Gestational age was median 66 (interquartile range 63-74) days and HbA1c was 48 mmol/mol (43-54). Median difference between isCGM and rtCGM was 0.1 mmol/L (-0.1 to 0.5) (P = 0.50) and -0.1 mmol/L (-0.4 to 0.2) (P = 0.35) for 24 h and during nighttime, respectively. For 24 h, TBR was 3.9% (1.6-7.0) versus 2.0% (0.6-3.7) (P = 0.06) and TIR was 57.2% (50.8-76.5) versus 69.6% (55.4-81.5) (P = 0.001) for isCGM and rtCGM, respectively. During nighttime TBR was 6.5% (0.4-16.7) versus 0% (0.0-0.8) (P = 0.003), TIR was 55.4 (41.1-81.0) versus 68.8 (52.4-80.3) (P = 0.005) and 75% versus 40% of the women had ≥1 glucose reading <3.5 mmol/L. Conclusions: In pregnant women with type 1 diabetes, mean sensor glucose was reported similar when measured by isCGM and rtCGM. However, during nighttime isCGM measured a clinically relevant higher percentage of TBR compared with rtCGM. Thus, the type of CGM device used may influence adjustments of insulin dose based on the concern for nocturnal hypoglycemia. ClinicalTrials.gov (NCT03770767).

Can placental growth factors explain birthweight variation in offspring of women with type 1 diabetes?

Maternal hyperglycaemia alone does not explain the incidence of large offspring amongst women with type 1 diabetes. The objective of the study was to determine if there is an association between placental function, as measured by angiogenic factors, and offspring birthweight z score in women with type 1 diabetes. This cohort study included samples from 157 Continuous Glucose Monitoring in Pregnant Women with Type 1 Diabetes (CONCEPTT) trial participants. Correlations were estimated between birthweight z score and placental growth factor (PlGF) and soluble fms-like tyrosine kinase (sFlt-1) levels measured at baseline and at 24 and 34weeks of gestation. Linear regression was used to assess the relationship between birthweight z score and placental health, as measured by PlGF and sFlt-1/PlGF ratio, stratified by glycaemic status (continuous glucose monitoring and HbA1c measures) and adjusted for potential confounders of maternal BMI, smoking and weight gain. Higher PlGF levels and lower sFlt-1/PlGF ratios represent healthy placentas, while lower PlGF levels and higher sFlt-1/PlGF ratios represent unhealthy placentas. Among CONCEPTT participants, the slopes relating PlGF levels to birthweight z scores differed according to maternal glycaemia at 34weeks of gestation (p = 0.003). With optimal maternal glycaemia (HbA1c < 48mmol/mol [6.5%]/ or continuous glucose monitoring time above range ≤ 30%), birthweight z scores were reduced towards zero (normal weight) with increasing PlGF values (representing a healthy placenta), and increased with decreasing PlGF values. With suboptimal glycaemic status (HbA1c ≥ 48mmol/mol [6.5%] or time above range > 30%), increasing PlGF values were associated with heavier infants. Those with a healthy placenta (PlGF > 100) and suboptimal glycaemic control had a higher mean z score (2.45) than those with an unhealthy placenta (mean z score = 1.86). Similar relationships were seen when using sFlt-1/PlGF ratio as a marker for a healthy vs unhealthy placenta. In women with type 1 diabetes, infant birthweight is influenced by both glycaemic status and placental function. In women with suboptimal glycaemia, infant birthweight was heavier when placentas were healthy. Suboptimal placental function should be considered in the setting of suboptimal glycaemia and apparently 'normal' birthweight.

The cost implications of continuous glucose monitoring in pregnant women with type 1 diabetes in 3 Canadian provinces: a posthoc cost analysis of the CONCEPTT trial.

Background:The Continuous Glucose Monitoring in Women with Type 1 Diabetes in Pregnancy Trial (CONCEPTT) found improved health outcomes for mothers and their infants among those randomized to self-monitoring of blood glucose (SMBG) with continuous glucose monitoring (CGM) compared with SMBG alone. In this study, we evaluated whether CGM or standard SMBG was more or less costly from the perspective of a third-party payer.Methods:We conducted a posthoc analysis of data from the CONCEPTT trial (Mar. 25, 2013, to Mar. 22, 2016). Health care resource data from 215 pregnant women, randomized to CGM or SMBG, were collected from 31 hospitals in 7 countries. We determined resource costs posthoc based on prices from hospitals in 3 Canadian provinces (Ontario, British Columbia, Alberta). The primary outcome was the difference between groups in the mean total cost of care for mother and infant dyads, paid by each government (i.e., the third-party payer) from randomization to hospital discharge (time horizon). The secondary outcome included CGM and SMBG costs not paid by governments (e.g., glucose monitoring devices and supplies).Results:The mean total cost of care was lower in the CGM group compared with the SMBG group in each province (Ontario: $13 270.25 v. $18 465.21, difference in mean total cost [DMT] −$5194.96, 95% confidence interval [CI] −$9841 to −$1395; BC: $13 480.57 v. $18 762.17, DMT −$5281.60, 95% CI −$9964 to −$1382; Alberta: $13 294.39 v. $18 674.45, DMT −$5380.06, 95% CI −$10 216 to −$1490). There was no difference in the secondary outcome.Interpretation:Government health care costs are lower when CGM is paid by the patient, driven by lower costs from reduced use of the neonatal intensive care unit in the CGM group; however, when governments pay for CGM equipment, there is no overall cost difference between CGM and SMBG. Governments should consider paying for CGM, as it results in improved maternal and neonatal outcomes with no added overall cost. Trial registration:ClinicalTrials.gov, no. NCT01788527

Efficacy of flash glucose monitoring in pregnant women with poorly controlled pregestational diabetes (FlashMom): A randomized pilot study

Background and aimsGood glycemic control is crucial to reduce the risk of adverse pregnancy outcomes. Our aim was to evaluate the efficacy of Flash Glucose Monitoring (FGM) on glucose control in women with pregestational diabetes. Methods and resultsForty women with inadequately controlled type 1 (T1D, n = 34) and type 2 (T2D, n = 6) diabetes at conception were randomly assigned to two arms: the Flash Glucose group (FG, n = 21) using FGM, and the control group (CG, n = 19) using self-monitoring of blood glucose (SMBG). Glycated hemoglobin (HbA1c, %), time in (TIR), below (TBR) and above (TAR) range, glucose variability as well as the occurrence of maternal and neonatal adverse outcomes, were evaluated.HbA1c decreased significantly (p < 0.01) and similarly (−0.65 ± 0.7 vs. −0.67 ± 0.8 for FG and CG, respectively; p = 0.89) in both groups during pregnancy. HbA1c reduction was positively associated with the number of daily FGM scans (p < 0.01). TBR (12.1 ± 2.0% vs. 19.6 ± 3.9%, p = 0.04) and the mean of the daily serum glucose difference (MODD) index (59.1 ± 5.4 vs. 77.7 ± 4.6, p = 0.02) were significantly lower in FG at second trimester. The rates of perinatal adverse outcomes were not different in the two studied groups. ConclusionsIn women with pregestational diabetes, FGM and SMBG had similar efficacy on glucose control during pregnancy. FGM showed additional advantages in terms of TBR and glucose variability. Achievement of good metabolic results depended on the adequate use of glucose sensor. RegistrationAt ClinicalTrials.gov as NCT04666818 on December 14, 2020.

Gestante con COVID - 19 y Diabetes Mellitus con evolución desfavorable

Se presenta un caso de multigesta con edad gestacional avanzada, de 35 años, quien cursó con gestación de 25 semanas e infección por SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). Tenía antecedente de diabetes mellitus II con tratamiento y controles irregulares. La paciente estuvo asintomática por 5 días tras el diagnóstico, presentando distress respiratorio y compromiso de sensorio en el lapso de 24 horas. Ingresa por emergencia, presentando falla multiorgánica y falta de latidos fetales, por lo que es transferida a UCI (unidad de Cuidados Intensivos). Se le realiza cesárea tras compensación hemodinámica. El producto es un óbito fetal de 24 semanas. Continúa con tratamiento en UCI, donde fallece 19 días después. Se recomienda considerar el seguimiento más estrecho en gestantes con enfermedades concomitantes, como diabetes.

Aile Hekimlerinin Maternal Kronik Hepatit B Enfeksiyonu Yönetimi Hakkındaki Farkındalık Durumu

Giriş ve Amaç: Hepatit B virüs (HBV) enfeksiyonu tüm dünyada giderek azalma eğiliminde olan halk sağlığı açısından önemli bir hastalıktır. HBsAg pozitif saptanan gebede hastalığın şiddeti ve tedavi gerekip gerekmediği yakın takip edilmelidir. Bu çalışmada gebelik ve bebek takiplerinin yakından izleminin yapıldığı birinci basamak aile hekimlerinde maternal kronik hepatit B yönetimi hakkındaki farkındalıklarını belirlemeyi amaçladık.&#x0D; Yöntem: Çalışmaya birinci basamak sağlık hizmetlerinde görev yapmakta olan aile hekimleri dahil edildi. Katılımcılara maternal kronik hepatit B enfeksiyonu yönetimi ile ilgili ve elektronik ortamda doldurabilecekleri anket soruları oluşturuldu. &#x0D; Bulgular: Çalışmamıza 125 (%57.1)’i kadın ve 94 (%42.9)’ü erkek olmak üzere toplam 219 hekim katıldı. Hekimlerin 43 (%19.6)’ü aile hekimi uzmanı, 97 (%44.3)’si aile hekimliği asistanı ve 79 (%36.1)’i pratisyen hekim olarak çalışmaktaydı. Katılımcıların yaş ortalaması 31±7.36 yıl, çalışma yılı ortalaması 5±7.6 yıl idi. Hekimlere hepatit B enfeksiyonu hakkında yeterli bilgiye sahip olup olmadıklarını sorduk. 137 (%62.6) hekim yeterli bilgiye sahip olduğunu belirtti. Hekimlerin 126 (%30.5)’sı hepatit B virüsünün anneden bebeğe intrauterin dönemde geçtiğini, 195 (%47.2)’i doğum esnasında ve 92 (%22.3)’si postnatal dönemde geçtiğini ifade etti. Katılımcıların 187 (%85.4)’sinin emzirmede sakınca olmadığını belirtti. 184 (%84) hekim gebelik döneminde annelere hepatit B enfeksiyonu taraması yapıldığını, 143 (%65.3) hekim HBsAg ve AntiHBs negatif olan gebeye gebelik döneminde hepatit B aşısı yapılabileceğini belirtti. Katılımcıların 156 (%36.4)’sı HBsAg pozitif tespit edilen gebeyi enfeksiyon hastalıkları veya gastroenteroloji uzmanına yönlendirdiğini, hepatit B’li anne bebeğine hepatit B aşısı ve hepatit B immünglobulin yapılmalıdır diyen hekimlerin sayısı sırasıyla 178 (%40.6) ve 197 (%45) idi. Hepatit B’li anneden doğan bebeğin takibinde 163 (%38.5) hekim “HBsAg pozitif saptanan bebeği pediatrik enfeksiyon kliniğine yönlendiririm”, 76 (%18) hekim “hepatit B aşı uygulamasından sonra AntiHBs bakarım”, 72 (%17) hekim “hepatit B aşı uygulamasından sonra HBsAg bakarım” ve 112 kişi “AntiHBs

A summary of research progress on intelligent information processing methods for pregnant women's remote monitoring

The monitoring of pregnant women is very important. It plays an important role in reducing fetal mortality, ensuring the safety of perinatal mother and fetus, preventing premature delivery and pregnancy accidents. At present, regular examination is the mainstream method for pregnant women's monitoring, but the means of examination out of hospital is scarce, and the equipment of hospital monitoring is expensive and the operation is complex. Using intelligent information technology (such as machine learning algorithm) can analyze the physiological signals of pregnant women, so as to realize the early detection and accident warning for mother and fetus, and achieve the purpose of high-quality monitoring out of hospital. However, at present, there are not enough public research reports related to the intelligent processing methods of out-of-hospital monitoring for pregnant women, so this paper takes the out-of-hospital monitoring for pregnant women as the research background, summarizes the public research reports of intelligent processing methods, analyzes the advantages and disadvantages of the existing research methods, points out the possible problems, and expounds the future development trend, which could provide reference for future related researches.

Региональный акушерский мониторинг – инновационный инструмент управления кластером родовспоможения

Roszdravnadzor selected 18 best practices of implementation of various projects in the healthcare sector that are recommended for use in all regions of the Russian Federation, among them – a cloud automated system “Regional obstetric monitoring”. The system is designed for continuous monitoring of pregnant women in the region, starting from the stage of registration at the dispensary, appointment and implementation of the action plan, delivery (or other outcome of pregnancy) and up to the end of 42 days of the postpartum period. The article presents the mechanism of the system and the first results of obstetric monitoring.

Cuidados à saúde da gestante no âmbito da Atenção Primária

Introdução: Garantir o acesso e o acolhimento de todas as mulheres, durante as diversas fases do ciclo gravídico-puerperal, desenvolvendo atividades de promoção e prevenção à saúde, cura e reabilitação, além de cuidados com o recém-nascido, são atividades requeridas na Atenção Primária à Saúde. Avaliar essas ações é fundamental para melhora da qualidade dos serviços prestados. Objetivo: Neste trabalho, o objetivo foi verificar quais são os cuidados ofertados à saúde da gestante na Atenção Primária, de acordo com o Protocolo da Atenção Básica da Saúde das Mulheres. Materiais e Métodos: Realizou-se um estudo transversal em 15 Unidades de Saúde da Família- USF, em área urbana, de um município do Brasil. Foi utilizado roteiro semiestruturado, em forma de entrevista com os gerentes de 15 USF. Resultados: Os resultados mostram padronização no fluxograma de gestante e prontuários utilizados em todas as unidades. Em 93,33% das unidades ocorrem o mapeamento dos domicílios com gestantes e visitas domiciliares e em 86,67% acontece o monitoramento das gestantes na área de abrangência das equipes de saúde da família. O tratamento curativo odontológico ocorre em 93,34% das USF e em 73,34% há práticas de educação em saúde bucal durante a gestação. Conclusão: Conclui-se que há uniformidade dos prontuários e do fluxograma na Atenção Primária à Saúde da gestante, entretanto, constituem ainda um desafio a busca ativa e visitas domiciliares, assim como as práticas educativas e o cuidado odontológico.

Resultados del embarazo en mujeres con infección por virus de la inmunodeficiencia humana

Introduction: Since the appearance of the first cases of human immunodeficiency virus infection, a great improvement in its treatment and control has been achieved, turning it into a chronic disease. This also occurs in the treatment and monitoring of pregnant women who carry the virus, who also pass on the disease to their children less frequently. In this study the monitoring and results of the pregnancy of women who carry the infection and are monitored in the University Hospital Virgen de las Nieves in Granada were analysed. Methods: To this end, the medical records of the women who met these requirements were collected, and the variables that affect the control of the infection and its transmission to the child were studied. The cases with mother-to-child transmission and the ones in which the mother were infected perinatally were studied more thoroughly. Outcomes: The results obtained are favourable when it comes to the control of the HIV infection of these patients, especially after the introduction of the zidovudine as a prophylaxis during labour. There have not been any new cases of mother-to-child transmission since 1997. Conclusions: Pregnancies in women with human immunodeficiency virus infection were managed efficiently with good outcomes in general, and most of the women gave birth seronegative children.

Zika virus RNA and IgM persistence in blood compartments and body fluids: a prospective observational study

Characterisation of the dynamics of Zika virus persistence following acute infection is needed to inform blood donor and diagnostic testing policies and understand the natural history of Zika virus infection. We aimed to characterise the natural history, persistence, and clinical outcomes of Zika virus infection through a prospective study in initially asymptomatic Zika virus RNA-positive blood donors. Zika virus-infected blood donors identified through Zika virus nucleic acid amplification test (NAAT) screening at three blood collection organisations in the USA were enrolled into a 1-year follow-up study, with blood and body fluid samples and detailed symptom data collected at up to seven visits. All samples were tested for Zika virus RNA by real-time PCR (rtPCR); follow-up plasma, whole blood, and urine were also tested by replicate NAAT. Plasma was tested for flavivirus-specific IgM and IgG by ELISA. Zika virus RNA persistence for each assay or sample type and plasma antibody persistence from estimated date of plasma NAAT-detectable infection were calculated from follow-up data using survival statistical methods. Between July 6, 2016 and March 7, 2017, we enrolled 53 participants. From the estimated date of plasma NAAT-detectable infection, Zika virus RNA was detectable in plasma for 9·9 days (95% CI 8·1-12·0), in red blood cells for 95·4 days (62·8-129·1), and in whole blood for 73·5 days (39·8-107·5). Replicate NAATs (one or more of eight replicates positive) extended detection of Zika virus RNA in plasma to 34·8 days (19·9-56·2) and in whole blood (at least one of two tests positive) to 104·8 days (76·7-129·9). Urine was rtPCR reactive up to 14·5 days (10·5-20·3) and saliva up to 26·4 days (19·7-38·7). Zika virus IgM persisted for 237·7 days (128·7-459·5) from estimated time since plasma NAAT-detectable infection. Zika virus RNA fell below detectable limits more rapidly in the saliva of participants with pre-existing dengue virus IgG than in those without. Of 25 donors identified pre-seroconversion with symptom data at the first or second study visit, 16 (64%) developed multiple Zika virus-related symptoms after asymptomatic index donations, compared with nine (36%) of 25 donors detected after seroconversion. Determination of viral marker persistence is enhanced by follow-up of blood donors who are pre-symptomatic or asymptomatic, Zika virus RNA-positive, and antibody negative. Zika virus RNA persists in red blood cells for several months following clearance from plasma and body fluids, and replicate, highly sensitive NAATs extend RNA detection in all compartments. Whole blood testing can extend detection of acute infection for diagnostics and monitoring of pregnant women, sexual partners, and travellers. National Heart, Lung, and Blood Institute, Biomedical Advanced Research and Development Authority.

Atuação da doula durante o ciclo gravídico-puerperal: uma revisão de literatura

El parto es un proceso natural y fisiológico que representa una etapa muy importante en la vida de la mujer. En este contexto, la inserción de las doulas en el trabajo de parto favorece el emponderado y la autonomía de la mujer a la hora del parto. El objetivo del estudio fue evidenciar la actuación de las doulas durante el ciclo gravid-puerperal de acuerdo las publicaciones científicas y analizar cómo funciona la doula en el ciclo gravid-puerperal según las publicaciones científicas. Se trata de un estudio de revisión de literatura, por el método de revisión integrativa y con enfoque cualitativo. La recolección dedatos se realizó en el mes de marzo de 2020 en las bases de datos de LILACS, BDENF y Medline. Se utilizaron los descriptores de DECS y el operador booleano AND. Se incluyen estudios primarios que responden a la pregunta de la investigación, en inglés, portugués y español y que se relacionaron con el tema en los años 2010 a 2019. En cuanto a los criterios de exclusión fueron: revisión de literatura.textos duplicados, no disponibles, documentos de tesis, mamografía y que no tenía ninguna conexión con el tema. Al final de la muestra se obtuvo 12 artículos, que fueron cuidadosamente analizados. El estudio se dividió en dos categorías en que la primera muestra cómo es el rendimiento de la doula en el ciclo de la gravid-puerperal y la segunda trata de la humanización del parto y las acciones de doula. En vista de lo anterior, se concluye que el rendimiento de las doulas durante el ciclo gravitatorio puerperal es importante en el seguimiento de las mujeres embarazadas, las mujeres en trabajo de parto y las que han dado a luz recientemente, ya que permite una atención más humanizada, de calidad, planeado e individualizado.

Continuous glucose monitor use with and without remote monitoring in pregnant women with type 1 diabetes: A pilot study.

BackgroundTo examine whether continuous glucose monitoring (CGM) with remote monitoring by followers (family/friends) changes glucose management, follower interventions, and health outcomes compared to CGM alone in pregnant women with diabetes.MethodsWe prospectively stratified first trimester pregnant women with Type 1 Diabetes to CGM Share (remote monitoring) or CGM Alone. We enrolled a main follower per woman. We retrospectively acquired data for pregnant women who did not use CGM (no CGM). We compared hemoglobin A1c (HbA1c) between groups. We compared sensor glucose, follower interventions, and gestational outcomes between CGM Alone and CGM Share. Longitudinal mixed effects models were used for analyses of changes in outcomes over time.ResultsHbA1c decreased in all groups throughout pregnancy and was significantly lower over time in women using CGM Share (n = 15) compared to CGM Alone (n = 13) or no CGM (n = 8) (p = 0.0042). CGM Share users had lower median sensor glucose levels (p = 0.0331) and percent time spent >180 mg/dL (p = 0.0228) across pregnancy. There were no significant differences in maternal and fetal outcomes between groups. CGM Share followers had more alerts for hypoglycemia, but did fewer interventions.ConclusionsIn this small pilot study, use of CGM with remote monitoring improved some glycemic metrics in pregnant women with diabetes.

Acceptability and satisfaction with pregnancy and newborn diagnostic assessment (PANDA) system providing prenatal care in Burkina Faso

Introductionles technologies mobiles en santé sont de plus en plus utilisées comme solutions innovantes pour améliorer les services de soins prénatals (SPN) dans les soins de première ligne. Cette étude a évalué l´acceptabilité et la satisfaction de l´utilisation du système Pregnancy and Newborn Diagnostic Assessment (PANDA) lors des SPN au Burkina Faso.Méthodesune étude transversale utilisant une approche mixte a été menée auprès de 35 utilisatrices des SPN et de 35 agents de santé dans le district sanitaire de Koupéla, dans la région du Centre-Est du Burkina Faso en septembre 2017. Des entretiens et 4 focus groups ont été réalisés auprès des utilisatrices des SPN et des d´entretiens semi-structurés auprès des professionnels de soin. Une analyse descriptive des données quantitatives a été effectuée avec le logiciel SPSS et les données qualitatives ont fait l’objet d´une analyse thématique avec NVivo 10.Résultatsle système PANDA a été très bien accepté et très apprécié par les utilisatrices et les prestataires de soins. Les motifs de satisfaction chez les utilisatrices étaient l´amélioration des échanges avec les prestataires de soin et l´accès à des soins de meilleure qualité à moindre coût. Les agents de santé ont apprécié la pertinence du système PANDA et l´amélioration des prestations fournies, du suivi et de la prise en charge des femmes enceintes.Conclusionle système PANDA est très bien accepté et apprécié au niveau des soins primaires aussi bien par les prestataires de soins que par les utilisatrices de services de soins prénataux au Burkina Faso.

Holder monitoring in pregnant women with cardiac arrhythmia

Holder monitoring in pregnant women with cardiac arrhythmia

OC28.03: Home blood pressure monitoring in pregnant women during antenatal and postpartum period: a systematic review and meta‐analysis

OC28.03: Home blood pressure monitoring in pregnant women during antenatal and postpartum period: a systematic review and meta‐analysis

Evaluation of Treatment Strategies to Manage Diabetes Mellitus in Pregnancy: Use of Fetal Sonography Compared to Monitoring of Maternal Blood Glucose Alone

Introduction When planning the treatment of women with gestational diabetes, the current standard approach also takes fetal growth development into account. The treatment of pregnant women with type 1 diabetes mellitus (DM) used to be based exclusively on maternal blood glucose values. This study investigated the impact of including fetal growth parameters in the monitoring of pregnant women with type 1 diabetes mellitus. Patients/Method 199 pregnant women with type 1 DM were included in a cohort study. The patient population was divided into two study cohorts. In the mBG cohort (n = 94; investigation period: 1994 – 2005) treatment was monitored using only maternal blood glucose (mBG) values; the aim was to achieve standard target glucose values (mean BG < 5.5 mmol/l, postprandial: at 1 h < 7.7 mmol/l, at 2 h < 6.6 mmol/l). In the fUS collective (n = 101, investigation period: 2006 – 2014) fetal growth parameters were additionally included when monitoring treatment from the 22nd week of gestation, and maternal target glucose values were then individually adjusted to take account of fetal growth. This study aimed to investigate the impact of these two different ways of monitoring treatment on perinatal and peripartum outcomes. Results 91.4% of all patients were normoglycemic at the time of delivery (HbA 1c < 6.7%); 58.9% of patients achieved strict normoglycemia (HbA 1c < 5.7%). No differences were found between the two study cohorts (fUS vs. mBG: HbA 1c < 6.7%: 93.9 vs. 88.4%, n. s.; mean blood glucose (BG): 5.4 ± 0.6 to 6.6 ± 1.1 vs. 5.9 ± 0.7 to 7.4 ± 1.9 mmol/l, n. s.). Patients from the fUS cohort required significantly lower weight-adjusted maximum insulin doses (0.9 ± 0.3 vs. 1.0 ± 0.4 IE/kg bodyweight, p < 0.05). Pregnancy complications occurred significantly less often in the fUS cohort (preeclampsia: 7.1 vs. 20.9%, p = 0.01; premature labor: 4.0 vs. 23.3%, p < 0.001; cervical insufficiency: 0.0 vs. 11.6%, p = 0.001), and there were significantly fewer cases with neonatal hyperbilirubinemia (19.2 vs. 40.7%, p = 0.001). There was no difference in the rates of LGA infants between the two cohorts (21.2 vs. 24.4%, n. s.). Conclusion Using maternal blood glucose values combined with fetal growth parameters to monitor DM treatment allows therapeutic interventions to be individualized and reduces the risk of maternal and infant morbidity. The metabolism of patients in the fUS cohort was significantly more stable and there were fewer variations in glucose values. It is possible that the detected benefits are due to this metabolic stabilization.

Epidemiology of postpartum hemorrhages in the Umbrian population in the years 2006-2017.

Postpartum haemorrhage (PPH) is one of the main causes of mortality and severe maternal morbidity and its incidence is increasing also in Western countries. Aim of this study is to estimate the incidence and the trend of PPH in the Umbrian population using the validated Umbrian health database and to identify possible determinants for the development of PPH. The source of the data was the regional Healthcare Database of the Umbria Region. The population of interest was represented by women who gave birth in Umbria between 2006 and 2017. The PPH was identified from the hospital data using the ICD-9-CM 666.x codes. Demographic data, principal and secondary diagnoses and data on maternal morbidity and blood component transfusion were collected. The incidence of PPH was calculated taking into account cases of PPH over the total number of births. The determinants of PPH, the associated morbidity and the variation in the severity of the PPH over time have been identified by logistic regression models. In Umbria, between 2006 and 2017, 93,403 births were registered (69% by vaginal delivery and 31% by caesarean section) and the rate of caesarean sections decreased by about 4%. The incidence of PPH increased three-fold during this period with an increase (p<0.001) of women with PPH who received transfusions. Regarding the caesarean sections, the PPH trend increased by 53% (p=0.3), while in the vaginal deliveries the PPHs increased by 233% (p<0.001). Logistic regression analysis showed that possible risk factors for the occurrence of PPH are maternal morbidity (OR 22.8, 95% CI 18.5-30.0), twin birth (OR 2.0, 95% CI 1.3-3.2) and antepartum haemorrhage (OR 5.7, 95% CI 3.1-10.4). The incidence of PPH has increased in recent years, while the morbidity associated with PPH has remained substantially unchanged. The study identified several risk factors responsible for PPH that can be used in the monitoring of pregnant women and for planning prevention strategies such as Patient Blood Management.

Using the BELT Framework to Implement an mHealth Pilot Project for Preventative Screening and Monitoring of Pregnant Women in Rural Burkina Faso, Africa

Introducing mHealth in resource-poor communities is not without technical, financial, and infrastructural challenges. Even today, little is known about the process of implementing sustainable mHealth services in these regions. The Broadband/Bandwidth, Education/Environment, Leadership, & Technology (BELT) framework helps guide stakeholders in identifying the core contextual elements that ensure successful implementation and organizational readiness. Hence, this paper describes challenges experienced when implementing the Strengthening Relationships and Enhancing Access to Maternal Services (STREAMS) project using this framework, in a rural community in Burkina Faso, Africa. Methods and Findings: A focused ethnography using participant observation documented implementing the STREAMS process through the use of descriptive field notes. Despite having a champion who drove implementation, challenges that arose were mainly due to problems of Internet connectivity and a lack of participants’ baseline computer skills, which had negative consequences on the initial training sessions and subsequent service delivery. Conclusions: Availability of limited information on the rural context/demographics and similar mHealth projects in Burkina Faso led to a misfit between the initial plan and the contextual reality. Having access to this type of background information is especially important to the success of mHealth initiatives providing humanitarian aid. Keywords: Africa, Antenatal Care, BELT, Burkina Faso, Community Health, Framework, Internet Connectivity, mHealth, Postpartum Monitoring, Pregnancy, STREAMS, UN-Sustainable Development Goal #3

Modelling potential cost savings from use of real-time continuous glucose monitoring in pregnant women with Type 1 diabetes.

AimTo investigate potential cost savings associated with the use of real‐time continuous glucose monitoring (RT‐CGM) throughout pregnancy in women with Type 1 diabetes.MethodsA budget impact model was developed to estimate, from the perspective of National Health Service England, the total costs of managing pregnancy and delivery in women with Type 1 diabetes using self‐monitoring of blood glucose (SMBG) with and without RT‐CGM. It was assumed that the entire modelled cohort (n = 1441) would use RT‐CGM from 10 to 38 weeks’ gestation (7 months). Data on pregnancy and neonatal complication rates and related costs were derived from published literature, national tariffs, and device manufacturers.ResultsThe cost of glucose monitoring was £588 with SMBG alone and £1820 with RT‐CGM. The total annual costs of managing pregnancy and delivery in women with Type 1 diabetes were £23 725 648 with SMBG alone, and £14 165 187 with SMBG and RT‐CGM; indicating potential cost savings of approximately £9 560 461 from using RT‐CGM. The principal drivers of cost savings were the daily cost of neonatal intensive care unit (NICU) admissions (£3743) and the shorter duration of NICU stay (mean 6.6 vs. 9.1 days respectively). Sensitivity analyses showed that RT‐CGM remained cost saving, albeit to lesser extents, across a range of NICU costs and durations of hospital stay, and with varying numbers of daily SMBG measurements.ConclusionsRoutine use of RT‐CGM by pregnant women with Type 1 diabetes, would result in substantial cost savings, mainly through reductions in NICU admissions and shorter duration of NICU care.