Obstetric Outpatient Clinic Research Articles

Trajectory of gestational weight gain in patients with gestational diabetes mellitus

Introduction: Weight gain in pregnancy is a significant modifiable factor that impacts immediate and future health of the mother and her fetus Hence, worldwide guidelines are developed about weight gain in pregnancy. In a recent study patients with abnormal glucose tolerance test and diagnosed with gestational diabetes had less deviation from expected gestational weight gain. Purpose: The aim of our study is to look at the trajectory of gestational weight gain for women diagnosed with gestational diabetes followed at the King Faisal Specialist Hospital and Research Centre (KFSH&RC) Methods: Our study population included 215 pregnant women with singleton pregnancy diagnosed with diabetes mellitus who attended the obstetrics outpatient clinic and family health clinics from first antenatal visit until delivery. Results: From among the 215 women in the study cohort, the total number of weight gain was 143. The number of patients who lost weight was 48, and the number of patients who remained stable were 24. Overall, the amount of weight gain for women in this study was comparable to the expected. Conclusion: In our study we found the patients diagnosed with gestational diabetes mellitus have a wide range of changes in their weight gain trajectory from previously expected parameters in the healthy population, which might be explained by other factors like adherence to diet, exercise and medications designed control the metabolism.

A Decision Aid to Support Tubal Sterilization Decision-Making Among Pregnant Women

Tubal sterilization is common, especially among individuals with low income. There is substantial misunderstanding about sterilization among those who have undergone the procedure, suggesting suboptimal decision-making about a method that permanently ends reproductive capacity. To test the efficacy of a web-based decision aid for improving tubal sterilization decision quality. This randomized clinical trial conducted between March 2020 and November 2023 included English- or Spanish-speaking pregnant cisgender women aged 21 to 45 years who had Medicaid insurance and were contemplating tubal sterilization after delivery. Participants were recruited from outpatient obstetric clinics in 3 US cities. Participants were randomized 1:1 to usual care (control arm) or to usual care plus a web-based decision aid (MyDecision/MiDecisión) (intervention arm). The aid includes written, audio, and video information about tubal sterilization procedures; an interactive table comparing contraceptive options; values-clarifying exercises; knowledge checks; and a summary report. The co-primary outcomes were tubal sterilization knowledge and decisional conflict regarding the contraceptive decision. Knowledge was measured as the percentage of correct responses to 10 true-false items. Decisional conflict was measured using the low-literacy Decision Conflict Scale, with lower scores on a range from 0 to 100 indicating less conflict. Among the 350 participants, mean (SD) age was 29.7 (5.1) years. Compared with the usual care group, participants randomized to the decision aid had significantly higher tubal sterilization knowledge (mean [SD] proportion of questions answered correctly, 76.5% [16.9%] vs 55.6% [22.6%]; P < .001) and lower decisional conflict scores (mean [SD], 12.7 [16.6] vs 18.7 [20.8] points; P = .002). The greatest knowledge differences between the 2 groups were for items about permanence, with more participants in the intervention arm answering correctly that tubal sterilization is not easily reversible (90.1% vs 39.3%; odds ratio [OR], 14.2 [95% CI, 7.9-25.4]; P < .001) and that the tubes do not spontaneously "come untied" (86.6% vs 33.7%; OR, 13.0 [95% CI, 7.6-22.4]; P < .001). MyDecision/MiDecisión significantly improved tubal sterilization decision-making quality compared with usual care only. This scalable decision aid can be implemented into clinical practice to supplement practitioner counseling. These results are particularly important given the recent increase in demand for permanent contraception after the US Supreme Court decision overturning federal abortion protections. ClinicalTrials.gov Identifier: NCT04097717.

The Mediating Role of Family Functions Between Pregnancy-Related Anxiety and Sleep Quality: A Cross-Sectional Study.

To examine the relationship between pregnancy-related anxiety, family functions, and sleep quality, and to determine whether family functions mediate the relationship between pregnancy-related anxiety and sleep quality. A cross-sectional survey was conducted on pregnant women between April to August in 2022 in the obstetrics outpatient clinic of a tertiary care hospital in the Ningxia Hui Autonomous Region of China. A total of 1014 pregnant women aged 18 years and older were surveyed. They completed questionnaires, including: general demographic characteristics, the Pregnancy-related anxiety scale (PAQ), the Family Adaptation, Partnership, Growth, Affection, and Resolve (APGAR), and the Pittsburgh Sleep Quality Index Questionnaire (PSQI). Model 4 in PROCESS was used to analyze the relationships among pregnancy-related anxiety, family functions, and sleep quality, with family functions as a mediator. Among the 1014 pregnant women, the pregnancy-related anxiety scale score was (21.84 ± 5.64). The total score of the family functions scale was (8.10±2.26), and the overall sleep quality scale score was (7.89±2.99). When participants were grouped according to different socio-demographic characteristics, the study showed that all variables differed from anxiety, family functions or sleep quality, except for age, pre-pregnancy BMI and whether or not they had a first birth, which was not associated with anxiety, family functions, or sleep quality (P<0.05). The pregnancy-related anxiety was positively associated with sleep quality (P<0.01), while family functions were negatively associated with sleep quality (P<0.01). In addition, family functions mediate the relationship between pregnancy-related anxiety and sleep quality during pregnancy, on the first and second trimesters, intermediation rate is 9.31% (P<0.05), and on the third trimesters, intermediation rate is 21.38% (P<0.05). Pregnancy- related anxiety is a risk factor for sleep quality, however, family functions are protective factors for sleep quality. Family functions play an intermediary role in sleep quality caused by pregnancy-related anxiety, especially on the third trimesters. This finding may provide a scientific basis for developing intervention strategies to improve the sleep quality of pregnant women.

Evaluation of the Effectiveness of Digital Storytelling on Fertility Awareness among Women: A Randomized Controlled Experimental Study

This study aims to determine the effectiveness of the digital storytelling (DS) method to raise fertility awareness (FA). This research is a pretest-posttest randomized controlled experimental study. The population of the study consisted of women who applied to the gynecology and obstetrics outpatient clinics of state hospital in March and October 2023 for who voluntarily agreed to participate in the study. Data for the study were gathered using Personal Introduction Form and Fertility Awareness Scale. physical and cognitive awareness levels of women in the intervention and control groups were similar before FA (P&gt;0.05), and after training was given to the experimental group, all awareness levels increased significantly in the intervention group (P

Implementing point-of-care hemoglobin A1C testing in an obstetrics outpatient clinic.

A1C ≥6.0% is associated with increased risk of adverse outcomes in pregnant diabetic patients. A1C testing is recommended by the American Diabetes Association as a secondary measure of glycemic control in pregnant patients. To determine the utility of A1C point-of-care testing (POCT) during pregnancy to facilitate rapid counseling and diabetes care, particularly in relatively low-income transient patient populations. We performed a single-center, retrospective analysis of patients presenting to an outpatient obstetrics office with routine, in-laboratory A1C testing, before and after the implementation of POCT for A1C (n = 70 and n = 75, respectively). Demographics, results, physician referral to a nutritionist, counseling, and outcomes were retrieved from patient electronic medical records. In total, 9% and 23% of the in-laboratory and POCT groups, respectively, were referred for nutrition services (P = .02). Of these, 22% of the in-laboratory group and 42% of the POCT group received immediate counseling (P < .01). An inverse correlation was observed between A1C level at study entry and gestational weeks at delivery, with a Pearson r value of -0.39 (-0.58 to -0.16) for the in-laboratory group and -0.38 (-0.57 to -0.14) for the POCT group. No statistically significant difference in pregnancy outcomes was observed. Implementation of A1C POCT was associated with immediate counseling and management of the health of pregnant patients, but was not associated with improved outcomes, in a low-resource patient population.

Identifying gestational diabetes mellitus and assessing risk factors in affected women: a comprehensive study.

Gestational diabetes mellitus (GDM) is a prevalent pregnancy complication associated with adverse health outcomes for both mothers and offspring. This study aimed to identify risk factors for GDM, a condition with a rapidly increasing global prevalence. We conducted a study involving 474 pregnant women who attended the obstetrics outpatient clinic of Kafkas University Faculty of Medicine Hospital between January 2022 and June 2023. Risk factors for GDM were assessed based on criteria recommended by the American Diabetes Association and the Committee on Practice of the American College of Obstetricians and Gynecologists. Statistical analyses, including descriptive statistics, Chi-square tests, Mann-Whitney U tests, and multivariate logistic regression. Individuals with GDM (mean age: 31.26±6.09 years) were significantly older than those without GDM (mean age: 28.36±4.89 years; p<0.001). Obesity prevalence was higher in the GDM group (32.5%) compared to the non-GDM group (14.3%; p<0.001). Individuals with GDM had higher rates of pre-diabetes (3.3% vs. 0.3%; p=0.007), a history of gestational diabetes (25.2% vs. 5.7%; p<0.001), high blood sugar in previous pregnancies (13.8% vs. 1.4%; p<0.001), and diabetes mellitus in 1st-degree relatives (40.7% vs. 20.3%; p<0.001). GDM was associated with increased pregnancies (p<0.001), preterm births (p<0.001), macrosomic babies (p=0.026), congenital anomalies (p=0.011), high cholesterol (p=0.036), and polyhydramnios (p=0.001) in previous pregnancies, as well as polyhydramnios in the index pregnancy (p=0.008). Regular exercise in previous pregnancies differed significantly based on GDM presence (p=0.037). Recognizing modifiable risk factors is crucial for preventing GDM and reducing associated health risks. Healthcare providers should be vigilant, especially among those with a family history of GDM, previous GDM, advanced maternal age, and other risk factors. Early lifestyle interventions show promise. Further research is needed for accurate GDM prediction.

Kovid-19 Pandemisinden Öğrenilen Dersler: Hayatı Tehdit Eden Bir Dönemde Gebelik Kaygı Düzeyi Artıyor

Aim: We aimed to highlight the psychological effects of the disease in the pandemic process along with the epidemiological data in pregnant women with COVID 19 infection, and the effects of increased anxiety in pandemic on pregnancy outcomes. Material and methods: This study was performed in 100 women of 15 to 49 years of reproductive age who applied to the Gynecology and Obstetrics Outpatient Clinic, Pandemic Outpatient Clinic and the Pregnant Outpatient Clinic. Fourty-six pregnant women with positive COVID 19 PCR test were compared with negative COVID 19 PCR test as control group. Patients were administered a questionnaire and Beck Anxiety Inventory. Results: An evaluation using the Beck Anxiety Scale revealed that anxiety levels were significantly higher in the COVID-19 positive pregnant group compared to the COVID-19 negative pregnant group (p=0.001). When comparing the groups in terms of becoming pregnant and giving birth during the pandemic, it was found that "severe anxiety" significantly increased in the COVID-19 negative pregnant group (p=0.032) Conclusion: We found that being COVID-19 positive, based on the Beck Anxiety Inventory, significantly increased the anxiety levels during pregnancy when compared to negative groups.

The relationship of preterm birth with fetal fibronectin level in cervicovaginal fluid and cervical lenght in ultrasonography

Objective: In this study, the compatibility between fetal fibronectin determination and the use of cervical length measured by transvaginal ultrasonography of patients who were at risk of preterm birth in the examination performed at 24-34 weeks of gestation, and patients with an increased risk of preterm birth according to the result were defined. &#x0D; &#x0D; Method: 40 patients who applied to Mustafa Kemal University Training and Research Hospital Gynecology and Obstetrics outpatient clinic between May 2021 and May 2022 were included in the study. Fibronectin results were evaluated using the liquid ELISA method taken from the vaginal secretion by a swap. Cervical lengths were evaluated as 25 mm and below, between 25-30 mm and 30 mm and above in statistical data.&#x0D; &#x0D; Results: For fFN-positive patients, the preterm delivery rate of patients with a cervical length of 25 mm and less was determined as 100%, while the rate of preterm birth was determined as 77.8% for patients with a cervical length between 25 mm and 30 mm. In addition, the preterm labor rate of fFN-positive patients with a cervical length of 30 mm and above was determined as 78.57%. &#x0D; &#x0D; Conclusion: All patients with a cervical length of 25 mm or less have a positive fFN test, and a strong correlation can be established between these two values. Accordingly, fFN positivity was found to have a higher sensitivity in determining the probability of preterm delivery compared to the cervical length ratio.

The correlation between iron deficiency anemia and hypothyroidism during pregnancy

Abstract Background: Pregnant women are often iron deficient, and this has adverse effects on thyroid metabolism. Impaired maternal thyroid function in pregnancy may cause neurodevelopmental delay in the offspring. Objectives: To investigate if maternal iron status is a determinant of thyroid stimulating hormone (TSH) and/or free T4 (FT4) concentrations during pregnancy. Materials and Methods: A case–control study was conducted in the Department of Obstetrics and Gynecology at Azadi Teaching Hospital, Kirkuk, Iraq over a period of 7 months from February 1st to September 1st, 2020. It included 80 pregnant women with singleton pregnancy in the obstetric outpatient clinic and labor room. Verbal consent was obtained. They were divided into: (1) case group: it included 40 cases of iron deficiency (ID) anemic pregnant women with hemoglobin level of 105 g/L and less in the second and third trimesters. (2) Control group: It included 40 cases of healthy pregnant women. Estimation of gestational age was done depending on the date of last menstrual cycle, and/or early ultrasound scan. Results: In this study, 80 pregnant women in their second and third trimesters participated. Fifty percent were anemic, had elevated serum soluble transferrin receptor and negative body iron stores, 35% had a free T4 less than 7.5 pmol/L, and 47.5% had a TSH more than 4.0 mIU/L. 47.5% who were hypothyroid had negative body iron store. Serum ferritin, soluble transferrin receptor, and body iron stores were highly significant predictors of thyroid status. Conclusions: Poor maternal iron status predicts both higher TSH and lower free T4 concentrations during pregnancy. On the basis of results, we had there may be a correlation between ID anemia of pregnant women and their thyroid status.

#84 : Should Women Who Had Recurrent Miscarriage be Offered Karyotyping Analysis of the Product of Conception: A Survey of Patients’ View

Background and Aims: Recurrent miscarriage (RM) affects 2-3% of couples. Approximately 60% of miscarriages result from fetal aneuploidy. Current international guidelines do not recommend routine genetic analysis of product of conception (POC). Nevertheless, a national survey reported that 78% of women wanted to know the cause of their miscarriage. In addition, a majority of patients thought they had done something wrong, leading to miscarriages. The identification of the cause of their miscarriages may help to reduce their guilty feelings. This study aims to assess women’s views on the karyotyping of the POC to determine if the existing guideline should be amended. Method: Women who attended the Obstetrics and Gynecology outpatient clinic were recruited. They were asked to fill in a questionnaire consisting of 24 questions. Results: A total of 149 women were recruited. The desire to know the karyotype of POC, which was assessed by a 100 mm Visual analogue Scale, was 85.1 ± 24.3 (mean ± SD). 77.6% of women expressed that they wanted to perform karyotyping of POC even though they were informed that there was no apparent beneficial effect of genetic testing of POC on the prognosis. Nevertheless, only 10.7% of women were given the option to check the karyotype. More than one-third of women were willing to spend equal to or more than two thousand Hong Kong dollars on a karyotyping test, which is comparable to the current market price (Figure 1). Conclusion: Our findings suggested that women had a strong desire to know the karyotyping of POC even though they were well informed of the limitation of the karyotype test. To respect and empower our clients, physicians should consider offering the karyotype of POC.

Impact of Implementing Point of Care Hemoglobin A1C Testing in an Obstetrics Outpatient Clinic

Abstract Hemoglobin A1C ≥ 6.0% is associated with increased risk of adverse outcomes in pregnant, diabetic patients and is recommended as a secondary measure of glycemic control in pregnant patients by the American Diabetes Association. However, the utility of A1C point of care testing (POCT) during pregnancy to facilitate rapid counseling and diabetes care, particularly in relatively low-income transient patient populations is unknown. We performed a single center, retrospective analysis of patients presenting to an out-patient obstetrics office with routine, In-lab A1C (n= 70) testing and after the implementation of POCT for A1C (n=75). Demographics, results, physician referral to a nutritionist, counseling, and outcomes were retrieved from the electronic medical record. 9% and 23% of the In-lab group and POCT respectively were referred for nutrition services (p=0.02). 22% of the In-lab group and 42% of the POCT groups received immediate counseling (p&amp;lt;0.01). An inverse correlation was observed between entry A1C and the weeks at delivery with a Pearson r of -0.39 (-0.58-0.16) for the In-lab group and -0.38 (-0.57--0.14) for the POCT group. In conclusion, the implementation of POC A1C testing was associated with immediate counseling and management of pregnant patients.

Secondary Syphilis with Giant Condyloma Acuminatum in Pregnant Women: A Report from a Limited Resource Area

Introduction: This report shows a case of secondary syphilis in pregnancy with Giant Condyloma Acuminatum (GCA) co-infection DD/condyloma lata which was resolved with alternative treatment of syphilis. Case illustration: A 21-year-old, primigravid woman came to obstetrics outpatient clinic in rural SoE Hospital, East Nusa Tenggara, with a complaint of mass enlargement around vulva (minor and major labia) since 2 months before. Based on Last Menstrual Period (LMP), she was in 34 + 6 weeks of gestation. There were coin lesions in the palms. On genital examination, there was protruded mass sized around 15 x 10 cm, erythematous, and it easily bled on the center part which was suspected to be GCA. Treponema Pallidum rapid (TP-rapid) test using AIM© syphilis rapid test revealed positive results. The patient was diagnosed with secondary syphilis in pregnancy mixed with GCA with dd/condyloma lata and administered Ceftriaxone 1 g intramuscularly once daily for 14 days. She delivered at 41-42 weeks of gestation and a baby girl with 1,980 grams of body weight according to symmetric Intrauterine Growth Restriction (IUGR) was born. No clinical signs of congenital syphilis found. Discussion: Vertical transmission which occurs in each stage of syphilis is related to the presence of spirochetes in the blood circulation. Infants born from syphilis pregnant women consist of 56% of jaundice, 14% of hearing impairment, 8% of renal disease, 8% of mental retardation, and 6% of IUGR or Small for Gestational Age (SGA). Conclusion: Secondary syphilis coinfection with GCA in pregnancy is a rare case report. Syphilis is a significant public health problem globally, especially in Indonesia.

Evaluating WIC Engagement andFood Insecurity Among Active Duty Military Families.

Nearly a quarter of active duty service members identified as food insecure in a 2022 Department of Defense report. Food insecurity impacts military readiness, retention, and recruitment. The Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a federal food supplementation program that can mitigate food insecurity for service members with children less than 5 years of age. To date, there is a lack of standardized screening for WIC eligibility or enrollment for service members and their families. This project sought to evaluate WIC awareness and enrollment as well as the prevalence of food insecurity at Walter Reed National Military Medical Center. A 26-question survey was developed to assess WIC awareness, source of WIC information, food insecurity, and nutritional insecurity. Our team developed and utilized a novel WIC screening algorithm to rapidly screen families for WIC eligibility. These tools were administered to families presenting for care at the Walter Reed National Military Medical Center pediatrics and obstetric outpatient clinics during the month of July 2022. This study was approved by the institutional review board at Walter Reed. A total of 108 (25%) of the 432 surveyed participants were eligible for WIC, with odds of WIC eligibility increasing for lower-ranking and younger service members. Of the 432 participants, 354 (81.9%) were aware of WIC. Enlisted service members were more likely than officers to know about WIC (P = 0.03), and of the 354 participants aware of WIC, a higher proportion of enlisted rank respondents learned about WIC from a military source (P = 0.01). Among the 108 participants eligible for WIC, only 38 (35.2%) reported being enrolled in WIC. Among WIC-eligible respondents who knew about WIC, being enrolled in the WIC program was not associated with rank, branch of service, sponsor gender, or sponsor age. Despite proven efficacy, WIC remains an underutilized resource for eligible military families. Our results show that a standardized screening approach at Walter Reed National Military Medical Center increased identification of WIC-eligible active duty service members by 180%, with approximately $150,000 a year in increased food supplementation benefits. Military healthcare and readiness leaders should embrace efforts to increase knowledge of, referral to, and enrollment in WIC to increase family health, well-being, and military family readiness.

The effect of vitamin D deficiency on urinary incontinence during third trimester pregnancy.

Urinary incontinence (UI) is a common problem which is associated with impaired quality of life. Vitamin D plays a crucial role for pelvic floor muscle function. The aim of this study was to investigate the effect of vitamin D deficiency on UI in pregnant women in the third trimester of pregnancy. All pregnant women at > 28 weeks of gestation who were followed in the gynecology and obstetrics outpatient clinic were screened. The patients were assessed for UI during routine follow-up. The Incontinence Severity Index was used to determine the severity of UI. A total of 210 patients were included as the study group and 40 patients were included as the control group. Both groups were compared based on the International Incontinence Severity Index scores. Of the patients, 40% had a history of UI and 84% had vitamin D deficiency. Pregnant women with vitamin D deficiency had statistically significant UI, compared to pregnant women in the control group. The severity of UI was also significantly higher in the patients with vitamin D deficiency. Urinary incontinence is significantly associated with vitamin D deficiency in pregnant women.

Sexual quality of life and marital adjustment in pregnant women

In a cross-sectional study, researchers investigated pregnant women’s quality of sexual life and marital adjustment. The sample consisted of 312 pregnant women admitted to the gynecology and obstetrics outpatient clinic of State Hospital between June and November 2020. Data were collected using a personal information form, the Quality Scale-Female (SQLQ-F), and Marriage Adjustment Test (MAT). Participants with one child had a significantly higher median SQLQ-F score than those with three or more children. Participants with 8–12 wk of pregnancy had a significantly higher median SQLQ-F score than those with 25 wk of pregnancy or longer (p < 0.05). There was a positive correlation between SQLQ-F and MAT scores (r = 0.447. p < 0.001), suggesting that the higher the quality of sexual life, the better the marital adjustment. Health care professionals should be aware of the effect of sexual life on marital adjustment.

KNOWLEDGE LEVELS, ATTITUDES, AND BEHAVIORS OF PREGNANTS ABOUT PRENATAL SCREENING TESTS: A SECTIONAL STUDY

Aim: To determine the knowledge levels, attitudes, and behaviors of pregnant women who come to the obstetrics clinic in a university hospital about prenatal screening tests.&#x0D; Method: It is a descriptive cross-sectional study. The population consists of approximately 900 pregnant women who are 28 weeks and beyond, who applied to …….. University Faculty of Medicine, Obstetrics and Gynecology outpatient clinic between October-December 2021. The research questionnaire was applied face to face to those who agreed to participate in the study. The data form consisting of 21 questions included questions about the descriptive characteristics and obstetric histories of pregnant women.&#x0D; Results: 254 people participated. The mean gestational week of the participants was 34.9±3.9 (min:28-max:41). The most common screening tests were detailed ultrasound (80.7%) and double screening tests. Those who received information from their obstetrician had a significantly higher rate of having the test. When the participants' knowledge scores about prenatal screening tests are evaluated, respectively; Detailed ultrasound knowledge score was 5.6±0.9, Double test 5.0±1.3, Oral Glucose Tolerance Test 4.8±1.1, and Triple test 4.7±1.2(min:2-max:7). When the reasons for not having prenatal screening tests were questioned, the most common answer for all screening tests was "I don't think the test is necessary". For the OGTT, the second most common reason for not having it done was because they heard from the media that the test was harmful. The fact that the pregnant women had a double and triple screening, went to regular controls and had a high double-triple test knowledge score had a significant effect. Amniocentesis was recommended for 3.5% of the pregnant women based on prenatal test results, but none of them had amniocentesis. In case of unfavorable prenatal test results, the majority of pregnant women were considering continuing the pregnancy.&#x0D; Conclusion: In this study, we found that the rate of testing increased with the increasing knowledge level of pregnant women and physician counseling. In this context, health professionals should provide women with the necessary education about screening and diagnostic tests to enable them to make informed decisions.

Prenatal Attachment and Mental Well-Being Among Expectant Fathers Amidst COVID-19: A Cross-Sectional Study.

Background The COVID-19 pandemic has posed significant threats to global physical and mental health, notably impacting the psychological management of pregnancy. The mental health of parents plays a critical role in fostering the emotional bond with their unborn child, referred to as prenatal attachment. Despite the significance of this bond, research has primarily concentrated on maternal outcomes, often neglecting the paternal aspect during the pandemic. This study investigates the correlation between coronavirus disease 2019 (COVID-19) risk perception and paternal prenatal attachment, further exploring the mediating role of well-being within this association. Methods A total of 141 expectant fathers attending the gynecology and obstetrics outpatient clinic with their partners were recruited. Participants completed measures including the Paternal Antenatal Attachment Scale (PAAS), the World Health Organization Well-being Index (WHO-5), and the COVID-19 Perceived Risk Scale (CPRS). Results Data analysis revealed a significant negative correlation between COVID-19 risk perception and well-being (ß = -.34, p < .001). There was a positive correlation between well-being and prenatal attachment (ß = .37, p = .002). The prenatal attachment was also positively linked to COVID-19 risk perception (ß = .20, p = .047). Furthermore, well-being mediated the relationship between COVID-19 risk perception and prenatal attachment. Conclusion The findings underscore the potential of the COVID-19 risk perception to disrupt the prenatal attachment process for expectant fathers by interfering with psychological well-being. However, it can also promote prenatal attachment through various mechanisms. Consequently, acknowledging and understanding the experiences of fathers during pregnancy is of paramount importance. Future longitudinal studies are necessitated to examine the parent-child relationship dynamics that have evolved under the influence of the pandemic.

Postpartum Breastfeeding Practices and Attitudes in Parents: A Randomized Study to Evaluate the Effects of Individual and Group Breastfeeding Education of Mothers and Fathers.

Background Antenatal breastfeeding training is defined as the provision of breastfeeding information during pregnancy, which can be given in various ways, such as individual training and group training. The inclusion of fathers in this educational approach is associated with the initiation of breastfeeding, exclusive breastfeeding and duration of breastfeeding. However, studies involving fathers are limited. This randomized controlled study aimed to compare the effects of individual and group training given to parents and those of normal hospital practices on mothers' breastfeeding self-efficacy and fathers' attitudes toward breastfeeding. Methods The study was conducted randomly in a training and research hospital between March 2014 and September 2014 and included 180 people. Of them, 90 were prospective mothers who were in the third trimester of their pregnancy and were living with their husbands and received service from the obstetrics outpatient clinic of the hospital. The expecting mothers and their husbands were randomly assigned to three groups: individual training, group training and control group. After randomization, prospective mothers and fathers in all groups received training. In the first week, sixth week, and fourth month after delivery, the mothers' breastfeeding self-efficacy and breastfeeding attitudes as well as the attitudes of the fathers' toward breastfeeding were evaluated. Results There were no differences between the groups in terms of variables such as age, education status, family type, breastfeeding education status, and mode of delivery. There were significant differences between the scores obtained from the Breastfeeding Self-Efficacy Scale and its subscales in all three groups during the postpartum period (p <0.05). The highest scale scores were obtained at the postpartum fourth month in the individual training and control groups and at the postpartum sixth week in the group training group. There were differences between the scores obtained by the mothers and fathers during the postpartum process from the Iowa Infant Feeding Attitude Scale (p<0.05). Conclusion The analysis of all the results indicates that breastfeeding education given to parents in the antenatal period increases their breastfeeding self-efficacy and provides them with a positive attitude toward breastfeeding. However, further research is needed to determine whether individual or group training contributes to the development of breastfeeding self-efficacy and attitudes.

Abstract P427: Effects Of Sedentary Activity In Pregnancy

Introduction: Preeclampsia is a multi-organ syndrome of late pregnancy characterized by gestational hypertension and proteinuria. There is strong evidence that maternal vascular dysfunction may be involved in the pathogenesis of this disorder. Regular physical activity during pregnancy has the potential to reduce this risk. Although physical activity during pregnancy is recommended, patient adherence is low. Therefore, the aim of this study was to determine the extent to which physical activity was associated with cardiovascular function throughout pregnancy in order to serve as an important intervention to prevent adverse pregnancy outcomes. Methods: Pregnant patients in their first trimester were recruited from obstetric outpatient clinics at the University of Iowa. Once consented, research participants completed a study visit during each trimester of pregnancy. Participants were administered the Pregnancy Physical Activity Questionnaire, a 36-item survey that asked about the amount of physical activity performed within the past 12 weeks. Participants’ vitals, BMI, and measures of vascular endothelial function and aortic stiffness were obtained at each visit. Results: Physical activity was measured in MET hours per week in each trimester of pregnancy. Pregnant women engaged in less physical activity by the end of their pregnancy, with an average of 193.6 MET hrs/week during the first trimester compared to 166.9 MET hrs/week during the third trimester. Sedentary time was found to be positively correlated with BMI during the second (β = .114, 95% CI [.020, .209], p-value = .018) and third trimesters of pregnancy (β = .212, 95% CI [.083, .340], p-value = .001). In addition, sedentary time positively correlated with aortic stiffness during the third trimester (ρ = .192, p-value = .014). Conclusion: Excess gestational weight gain is associated with short- and long-term pregnancy complications, including the development of preeclampsia. We found that women were less active later in pregnancy, and that increased sedentary time was associated with higher BMI in the second and third trimesters. Therefore, it is imperative that physical activity be highly encouraged throughout pregnancy to help prevent adverse health outcomes.

Does the immigration affect prenatal attachment levels?

ABSTRACT Pregnancy is an important period in which mother-infant attachment begins, includes bio-psychological changes, and has physical and psychological effects on the future life of the fetus. This study aims to evaluate the prenatal attachment levels of Syrian refugee and Turkish mothers in Turkey and to determine the variables that affect these. This cross-sectional study conducted in the obstetric outpatient clinics with 397 pregnant women 197 Syrian and 200 native women. Inclusion criteria were a pregnancy of at least 20 weeks, no communication or mental disorders, no chronic diseases, no diagnosis of high-risk pregnancy, literacy in the pregnant Turkish women, Turkish language proficiency in the pregnant Syrian women, and residence in Turkey for at least three years. Data were collected using a Sociodemographic form and The Prenatal Attachment Inventory (PAI). The data were analyzed by conducting independent t-tests, and hierarchical multiple linear regression analysis. The mean prenatal attachment score of Turkish pregnant women (61.79 ± 8.55) was higher than Syrian women (48.38 ± 10.39) (p < .05). Education level, pre-pregnancy counseling, regular checkup, support from spouses, relatives, and friends, and being a refugee of pregnant women were determined as predictors of prenatal attachment. The results showed that 67 percent of the total variance in the prenatal attachment levels could be explained in model 2 (F = 35.524, R2 variation = .673, p = .001). The low prenatal attachment level of Syrian pregnant women was a result of the detrimental impacts of being a refugee on pregnancy. The integration of transcultural knowledge, culture-specific perspectives, and cross-cultural theories into clinical practices is essential for immigrant women.