Pregnancy Period Research Articles

Family planning utilization among postpartum women in the Bule Hora District, southern Ethiopia

BackgroundContraception use remains low in Ethiopia, particularly within the first year after childbirth. While some women might have medical conditions that limit their contraceptive options, the primary obstacle to wider family planning adoption is not a specific health problem. Instead, it is the lack of equitable access to high-quality family planning services. This barrier significantly hinders women's ability to make informed decisions about their reproductive health. This study examines postpartum family planning utilization and its associated factors among postpartum mothers in the Bule Hora District.MethodsWe conducted a community-based cross-sectional study. A multistage sampling technique was employed to recruit a total of 630 women who had given birth. To collect the data, structured, standardized, and pretested questionnaires were used, and the collected data were coded and entered into Epi-data version 4.6. The data were analyzed using SPSS version 25. Both bivariable and multivariable logistic regressions were used to identify factors associated with postpartum family planning utilization.ResultsThe study found that 71.3% of women utilized postpartum family planning. Significant associations were found between postpartum family planning utilization and various factors, including counseling on family planning during pregnancy [adjusted odds ratio (AOR) = 1.79, 95% confidence interval (CI) 1.61–2.82], delivery (AOR = 2.62, 95% CI 1.56–4.38), and the postpartum period (AOR = 2.71, 95% CI 1.75–4.21). Women who resumed sexual activity after birth (AOR = 1.92, 95% CI 1.25–2.96), and who had at least four antenatal care visits (AOR = 3.09, 95% CI 1.61–5.92) were also more likely to use postpartum family planning. Women with grand multiparity were 69% less likely to use family planning methods than primiparous women (AOR = 0.31, 95% CI 0.13–0.73).ConclusionPostpartum family planning use in this study was higher than the national average. Factors such as parity; counseling during the pregnancy, delivery, and postpartum periods; and early resumption of sexual activity were linked to increased contraceptive use. These findings suggest that enhanced counseling during antenatal, delivery, and postnatal care could significantly increase contraceptive use.

Protocol for a randomized controlled trial to evaluate the effectiveness of a telehealth group intervention to reduce perinatal depressive symptoms

BackgroundPerinatal depression and anxiety (PDA) affect approximately 20 % of individuals and are associated with adverse outcomes, including preterm birth, low birth weight, and impaired cognitive development of the child. Telehealth may reduce access barriers to needed mental health services. However, lack of disseminated, standardized study protocols aimed at investigating the role of telehealth in reducing PDA symptoms limits the ability to compare findings across studies. The purpose of this paper is to provide a conceptual framework and a randomized controlled trial protocol (RCT) for use in future studies. Methods and analysisAn RCT was designed to evaluate the effectiveness of a group videoconference intervention (VCI) to reduce PDA symptoms across pregnancy and postpartum period. Participants are randomly assigned to study groups: VCI + standard of care, or attention control (AC) + standard of care. Both groups have weekly one-hour group videoconference sessions for 9 weeks. The VCI groups are facilitated by a mental health professional using a manualized program based on mindfulness-based practices and cognitive behavioral therapy (MBCT). The AC groups are facilitated by a registered nurse using a manualized program for childbirth and parenting education. The primary outcomes are depressive symptoms as measured by the Edinburgh Postnatal Depression Scale (EPDS) and anxiety symptoms as measured by the Generalized Anxiety Disorder (GAD-7). ConclusionThis RCT study protocol can be used as a standard approach to improve the ability to compare findings across studies, applied in any setting (e.g., rural or urban), and adapted to diverse communities.Trial Registration:ClinicalTrials.govNCT03932760

Public health, policy, and clinical interventions to improve perinatal care for migrant women and infants in high-income countries: a systematic review

Migrant women who are pregnant or postpartum and their infants are often at increased risk of poorer perinatal outcomes compared to host country populations. This review aimed to identify public health, policy, and clinical interventions to improve maternity care for migrant women and their infants in high-income countries (HICs). In this systematic review we searched EMBASE, EMCARE, MEDLINE and PsycINFO, CENTRAL, Scopus, CINAHL Plus, Web of Science, and grey literature from inception to 13th March 2024, with no language or date restrictions (PROSPERO: CRD42022380678). Interventional and observational studies assessing the effectiveness of any intervention to improve perinatal care for migrant women and their infants in HICs delivered in the pregnancy, peripartum, or postpartum period (up to one year after birth) were included. Quantitative outcomes were extracted. Qualitative studies were excluded. The main outcomes of interest were preterm birth, birthweight, and appointment attendance. Quantitative synthesis was conducted using Harvest plots and binomial exact calculations. 15,689 records were retrieved, 29 studies comprising data from 16,763,837 women were included. 22 studies (75.9%) included multiple interventions. Five interventions had strong evidence of effectiveness. Two clinical interventions: 100.0% of studies including specialist multidisciplinary teams improved one or more of the main outcomes of interest, namely preterm birth, birthweight, and appointment attendance (95% confidence interval 73.5-100.0%; p<0.001); and 90.9% of studies including specialist in-person interpreting improved one or more of the main outcomes of interest (58.7-100.0%; p=0.012). Three public health or policy interventions: 100.0% of social welfare interventions (75.3%-100.0%; p<0.001) improved one or more of the main outcomes of interest; 100.0% of maternal education interventions (71.5-100.0%. p<0.001), and 83.3% of studies assessing access to free healthcare (51.6-97.9%; p=0.039). The findings suggest that multicomponent interventions comprising multidisciplinary teams, in-person interpreting, maternal education, and social welfare support can improve perinatal outcomes for migrant women and their infants. Removing financial barriers to care may improve perinatal outcomes and be cost saving to healthcare systems. However, these findings should be interpreted with caution given that most included studies were of poor quality and that sensitivity analysis restricting to interventional studies only did not demonstrate any effect on the main outcomes of interest. KS is supported by a National Institute for Health Research (NIHR) Doctoral Fellowship (NIHR302577). HRJ is supported by an NIHR Advanced Fellowship (NIHR303183). HRJ is supported by NIHR Applied Research Collaboration (ARC) South London. MM is supported by a Medical Research Council Clinical Research Training Fellowship (Grant number MR/W01498X/1). GF is supported by a Nuffield Department of Population Health Clinical Research Fellowship. MK is an NIHR Senior Investigator (NIHR303806). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

Deep learning model for detection acute cardiogenic pulmonary edema in cases of preeclampsia

&lt;span lang="EN-US"&gt;The physiological changes during the pregnancy period increase the risk of developing pulmonary edema and acute respiratory failure. This condition falls under critical medical emergencies associated with maternal mortality. This study utilized a convolutional neural networks (CNN) architectural model employing chest Xray dataset images. CNN utilizes the convolution process by moving a convolutional kernel of a certain size across an image, allowing the computer to derive new representative information from the multiplication of portions of the image with the utilized filter.&lt;/span&gt;&lt;span lang="EN-US"&gt;To simplify, the vanishing gradient issue occurs when information dissipates before reaching its destination due to the lengthy path between input and output layers. This study was developed model for detection acute cardiogenic pulmonary Edema in pre-eclampsia cases using chest Xray images, implemented using PyTorch, Keras, and MxNet. The validated model achieved its optimum with accuracy 90.65% and binary cross-entropy loss (BCELoss) value of 0.4538. It exhibited an improved sensitivity value of 83.514% using a 5% dataset and a specificity value of 57.273%. This indicates an increase in sensitivity value by 83.514% using a 5% data set and a specificity value of 57.273%. The research results demonstrate an improvement in accuracy compared to several similar studies that also utilized CNN models.&lt;/span&gt;

Influence of garden cress seeds supplementation on immunity, hormonal status, and milk quality during the last third of pregnancy and lactation period of rabbit does

During the last third of pregnancy period, rabbits are exposed to many challenges, such as health complications and oxidative stress. The present study aims to use garden cress seeds (GAC) as a natural antioxidant to mitigate these challenges and evaluate its effects on reproductive performance, immunity, hormones, protein profile and milk quality. A total of 24 pregnant V-Line rabbits (pregnant at 20 days proved by palpation), with an initial body weight of 2395.83 g and about 6–7 months of age, were randomly distributed to 4 groups, the control group was fed the basal diet without GAC, the other treated groups GAC 3, GAC 4.5 and GAC 6 were fed the basal diet supplemented with 3, 4.5, and 6% GAC, respectively. The experiment lasted six weeks. The results revealed that treated female rabbits with different levels of GAC did not have a noticeable effect on milk yield, average daily milk yield, or most of the milk analysis parameters (milk density, total solids, solids not fat, lactose, ash, and protein). On the other hand, GAC showed a significant increase in milk fat, and GAC 3% rabbits displayed a higher percentage of milk fat (p < 0.050) than the other groups. Likewise, treatment with GAC also had a significant impact on serum total protein, globulin, IgG, and IgM. The 3% GAC rabbits showed significantly higher total protein, globulin, and IgM values than the control group. However, all GAC treatments significantly improved serum IgG and the best value was found in the 3% GAC group. In conclusion, our results demonstrated that feeding lactating rabbits a diet supplemented with GAC could be considered a good strategy to enhance immunity, protein profile, MY and milk fat. The best results were obtained with the GAC 3% treatment.

Conceptualising maternal mental health in rural Ghana: A realist qualitative analysis.

In low-and-middle income countries, maternal mental health needs remain neglected, and common mental disorders during pregnancy and after birth are routinely associated with hormonal changes. The psycho-social, and spiritual components of childbirth are often downplayed. A qualitative study was conducted as part of a wider realist evaluation on health systems responsiveness to examine the interrelationships between pregnant and postnatal women, their families, and their environment, and how these influence women's interactions with healthcare providers in Ghana. Data collection methods combined six qualitative interviews (n= 6) and 18 focus group discussions (n= 121) with pregnant and postnatal women, their relatives and health care providers (midwives, community mental health nurses) at the primary healthcare level. Data analysis was based on the Context-Mechanism-Outcome heuristic of realist evaluation methodology. A programme theory was developed and iteratively refined, drawing on Crowther's ecology of birth theory to unpack how context shapes women's interactions with public and alternative health care providers. We found that context interacts dynamically with embodiment, relationality, temporality, spatiality, and mystery of childbirth experiences, which in turn influence women's wellbeing in three primary areas. There is an intricate intersection of pregnancy with mental health impacting women's expectations of temporality, which does not always coincide with the timings provided by formal healthcare services. Societal deficiencies in social support structures for women facing economic challenges become particularly evident during the pregnancy and postnatal period, where women need heightened assistance. Socio-cultural beliefs associated with the mystery of childbirth, support the role of private providers in offering women a feeling of protection from uncertainty. Co-production of context specific interventions, including the integration of maternal and mental health policies, with relevant stakeholders can help formal healthcare providers accommodate women's perspectives on spirituality and mental health, which can subsequently help to make health system responsive to maternal mental health conditions.

Diagnosing american bison pregnancy during its two last trimesters: Comparison between rectal palpation associated with ultrasonography and hormonal assays in serum or in feces

The study aimed to propose sensitive, specific and easy pregnancy diagnosis for American Bison. Trans-rectal Palpation and Ultrasonography (TRPUS), concentration of Pregnancy Associated Glycoproteins (PAG), Progesterone (P4), Estrone (E1), Estrone-Sulfate (E1S) in serum and P4 and E1S in feces were compared. Immunoassay was used for PAG, whereas steroids were assayed using Liquid Chromatography coupled to Mass Spectrometry. Pregnancy and its period were retrospectively assessed after calving. Animals included were distributed as follows: 40 were non-pregnant, 27 were in their second and 15 in their third trimester of gestation. Fisher’s test was used to determine sensitivity and specificity of TRPUS. Thresholds leading to best sensitivities and specificities for hormonal assays were determined using Receiver Operating Characteristic Curves. Although TRPUS requires contention, palpation skills, it was conclusive in 70.63 % of cases and good sensitivity (97.50 %) and decent specificity (83.33 %) were observed. Concentrations of PAG, P4, E1S and E1 in serum were higher in Pregnant animals (P), with thresholds giving decent specificity and sensitivity (lower sensitivity for E1 and E1S: 92.11 %; lower specificity for P4: 93.48 %). In feces, P4 and E1S were higher in P: pregnancy diagnosis using E1S assay in feces showed 100 % of sensitivity and specificity. In conclusion, assaying E1S in feces during the two last trimesters of American Bisons pregnancy is a sensitive and specific gestation diagnosis. Pregnancy diagnosis using TRPUS can be useful in ranches but requires contention and skill adaptation. Serum hormonal assays can help evaluating the pregnancy period but also require contention.

N-3 Fatty Acid Supplementation in Mothers and Infants for Childhood Psychomotor and Cognitive Development: An Updated Systematic Review and Meta-Analysis.

Long-chain n-3 polyunsaturated fatty acid (PUFA) consumption in maternal and infants has been positively associated with cognitive and visual development. Tails even meta-analysis showed mixed results. To evaluate the effects of maternal and infant n-3 PUFA supplementation on childhood psychomotor and cognitive development, PubMed, Embase, the Cochrane Library, PsycINFO and clinicaltrials.gov were searched. Randomized controlled trials were included to evaluate the effect on child cognitive and psychomotor outcomes of n-3 PUFA supplementation in mothers or infants (age ≤ 2 years). Findings were pooled with mean differences (MD) with 95% confidence intervals (95% CIs). Heterogeneity was explored using I2 and subgroup analyses, stratified for maternal (pregnancy and/or lactation) and infant (preterm infant and term infant). We identified 47 articles, with 14 trials on mothers and 33 on infants. Pooled results showed that infants' mental development index (MDI) increased with n-3 PUFA supplementation (MD = 2.91, 95% CI: 1.32-4.51, I2 = 65.1%). Subgroup analysis of MDI also demonstrated a benefit in preterm infants (MD = 4.16, 95% CI: 1.40-6.93, I2 = 49.5%) and term infants (MD = 2.28, 95% CI: 0.27-4.29, I2 = 70.1%). No significant association was found in subgroup analyses of supplementation to mothers during pregnancy or lactation period. Supplementation did not increase the psychomotor development index (PDI) in the mother or infant group. Language composite score increased for infants whose mothers accepted supplementation in pregnancy or breastfeeding (MD = 8.57, 95% CI: 5.09-12.04, I2 = 70.2%). The cognitive composite score did not improve in any subgroup. Intelligence Quotient (IQ) increased in the infants' group with n-3 PUFA supplementation (MD = 2.54, 95% CI: 0.45-4.63, I2 = 66.0%). Furthermore, IQ in term infants also improved (MD = 2.91, 95% CI: 0.24-5.57, I2 = 69.2%). The funnel plot and Egger's test confirmed no publication bias in any endpoints. Supplementation with n-3 PUFA during pregnancy or breastfeeding in mothers has increased language abilities. Furthermore, direct supplementation in term infants can improve intelligence in later childhood. However, insufficient evidence supports the claim that supplementation improves cognitive abilities.

Association of Severe Maternal Morbidity With Subsequent Birth

Women who experience severe maternal morbidity (SMM) might have lasting health issues, and the association of SMM with the probability of future reproductive intentions is unknown. To examine the association between SMM in a first birth and the probability of a subsequent birth. Retrospective, population-based cohort study conducted among 1 046 974 women in Sweden who had their first birth between 1999 and 2021. Overall SMM and SMM subtypes were identified among all deliveries at 22 weeks of gestation or later (including complications within 42 days of delivery) from the Swedish Medical Birth Register and National Patient Register. All women with a recorded first delivery were followed up from 43 days postpartum until the first day of the last menstrual period of the second pregnancy that resulted in a birth (stillbirth or live birth) or until death, emigration, or end of follow-up on December 31, 2021. Multivariable Cox proportional hazards regression was used to estimate associations between SMM and time to subsequent birth with adjusted hazard ratios (aHRs). Sibling analysis was performed to evaluate potential genetic and familial confounding. A total of 36 790 women (3.5%) experienced an SMM condition in their first birth. Women with any SMM had a lower incidence rate of subsequent birth compared with those without SMM in their first delivery (136.6 vs 182.4 per 1000 person-years), with an aHR of 0.88 (95% CI, 0.87-0.89). The probability of subsequent birth was substantially lower among women with severe uterine rupture (aHR, 0.48; 95% CI, 0.27-0.85), cardiac complications (aHR, 0.49; 95% CI, 0.41-0.58), cerebrovascular accident (aHR, 0.60; 95% CI, 0.50-0.73), and severe mental health conditions (aHR, 0.48; 95% CI, 0.44-0.53) in their first birth. The associations were not influenced by familial confounding as indicated by sibling analyses. Our findings suggest that women who experience SMM in their first birth are less likely to have a subsequent birth. Adequate reproductive counseling and enhancing antenatal care are crucial for women with a history of SMM.

Caesarean Section at a Selected Tertiary Hospital in Dhaka: Indications and Feto-Maternal Consequences

Background: Cesarean section (CS) delivery has substantially increased globally over the past few decades. Unnecessary C-sections can cause infections, excessive bleeding and various health complications for mothers and babies. In Bangladesh, more than 860,000 C-sections per year are medically unnecessary. Objectives: To determine the indications along with fetal and maternal consequences of CS deliveries. Methods: A cross-sectional study was conducted in paying wards in the Department of Gynaecology and Obstetrics of a selected tertiary level hospital in Bangladesh. A sum of 306 patients were recruited to be a part of this study. Medical documents were used as sources of data and face-to-face interviews were conducted. Descriptive analysis was performed. Results: Mean age was 26.35 ± 5.08 years; 58.5% were multiparous; mean duration of current pregnancy was 35.89 ± 4.23 weeks; 85% deliveries were performed by CS; indications revealed 26.3% cases for less fetal movement and 12.9% for history of previous caesarean section; 91.5% babies were live births; mean birth weight was 2.82 ± 0.53 kg, APGAR scoring at 5th minute was good for 95% fetuses; maternal condition during discharge was stable in 93.1% cases and mean length of hospital stay was 4.30 ± 1.83 days. Conclusion: It can be suggested that the health authorities should formulate specialized programs and spread awareness about the ill effects of caesarean deliveries. The authorities should provide awareness to pregnant women on every comprehensive checkup about the pros and cons of C-section delivery and how to maintain good physical health throughout their pregnancy period.

Prenatal ozone exposure and risk of intellectual disability.

Knowledge of relationships between tropospheric ozone and mental and developmental health outcomes is currently inconclusive, with the largest knowledge gaps for children. This gap is important to address as evidence suggests that climate change will worsen ozone pollution. We examine the association of average ozone exposure during the preconception period, and first, second and third trimesters of pregnancy on the odds of intellectual disability (ID) in Utah children. For the period of 2002-2020, we assembled daily, tract-level ozone concentration data, data on ID case status, and data on cases' full siblings and population controls. We analyzed the data using generalized estimating equations. Ozone was positively associated with the odds of ID in cases vs. their siblings (in the preconception, first, second and third trimester exposure windows, all p < 0.05, n = 1042) and vs. population controls (only in the second trimester exposure window, p < 0.05, n = 5179). The strength of the association was largest during the second trimester in both analyses. A second trimester average ozone level increase of 10 ppb was associated with a 55.3% increase in the odds of ID relative to full siblings (95% confidence interval [CI]: 1.171-2.058) and a 22.8% increase in the odds of ID relative to population controls (CI: 1.054-1.431). Findings were robust to different subsets of sibling controls as well as several sensitivity analyses. Results document that ozone has a measurable relationship with children's cognitive development in Utah. Evidence suggests that climate change will worsen ozone pollution. The potential amplifying effect of climate change on ozone is more certain than it is for fine particulate matter. This means that ozone and health research will remain relevant into the future. Currently, several systematic reviews and meta-analyses have concluded that knowledge about ozone and cognitive health is insufficient, especially for children. Using two different study designs, we find that prenatal ozone exposure is associated with risk of intellectual disability in children.

Early-life exposure to outdoor temperature and the risk of childhood allergic diseases: A multicentre retrospective cohort study

Few research studies have shown the impact of temperature on childhood allergy, and less is known about the efficacy of mitigation methods such as the use of air-conditioning (AC). We aim to determine whether pre-schoolers’ allergic diseases and symptoms are associated with pregnant and postnatal exposure to ambient air temperature, and whether the use of AC mitigates this effect. A retrospective cohort study was conducted in nine Chinese cities between 2019 and 2023, involving 20,012 children aged 3–6 years. Demographics, socioeconomic status (SES), and indoor environmental factors were recorded. The exposure to twenty meteorological parameters, including temperature and seven air pollutants, was calculated. The relationship between temperature exposure with childhood allergic diseases and symptoms was studied using a two-level logistic regression analysis. We observed a significantly increased risk of childhood first-wave and second-wave allergic diseases associated with increased temperature exposure, especially daily minimum temperature (TEM-min), during pregnancy and postnatal period. The temperature increase during the first two trimesters and the third trimester were more important for asthma and food allergy, respectively. Sensitivity analysis revealed that children who did not have COVID-19 were more vulnerable to the allergy risk of temperature exposure. Temperature exposure was found to be significantly more associated with first-wave and second-wave allergic diseases in children who lived in non-air-conditioned homes. This change was more pronounced during prenatal exposure, particularly for daily maximum (TEM-max) exposure during the summer. Our findings indicate that temperature increases during early life has a significant impact on childhood allergies, which could be mitigated by AC use.

Reference intervals for 23 common biochemical parameters during pregnancy and the first six postpartum months

The concentration of many biochemical parameters changes significantly during pregnancy and the postpartum period, causing a need for specific reference values for biochemical parameters in these life periods. We have collected blood samples in pregnancy week 18, 28 and 36 and six weeks, four months and six months postpartum from 139 healthy women. Blood samples from 59 healthy never-pregnant women were included as controls. Serum samples were analyzed for 23 common biochemical parameters and reference intervals for pregnancy and postpartum periods were computed with the non-parametric method in accordance with recommendations from IFCC and CLSI. The dynamics of different biochemical parameters during and after pregnancy vary considerably between parameters. Some analytes like serum amylase and HDL cholesterol do not differ from never-pregnant values. Of the 23 parameters, serum alkaline phosphatase, chloride, gamma-glutamyl transferase and sodium and urea which were still significantly changed at six months postpartum compared to never-pregnant women. The physiological changes related to pregnancy and lactation have profound effects on biochemical parameters, denoting the use of specific reference intervals for both pregnancy and the postpartum period.

Knowledge Regarding Lactation Diet Among Caregivers of Postnatal Mothers in a View to Develop Information Booklet

Background: The role of primary caregiver is crucial in providing care to primigravida mothers in improving health by supporting breastfeeding. According to UNICEF poor nutrition taken by lactating mother is more affecting on infants as well as mothers health. Caregivers are most responsible for provision of postnatal care at hospital and at home too as they used their previous experiences during taking care of postnatal mothers. Food taboos during lactation are stronger than the pregnancy period. According to ministry of family and health welfare it is important to fill the gap between knowledge and practices. The aim of this study is to assess the knowledge and self-reported cultural practices regarding diet during lactation among caregivers with a view of developing information booklet. Methodology: Quantitative research approach is been adopted wherein the non-experimental exploratory research design was used for this study. Approval was taken from IEC, BV (DU) CON, Pune. Non-probability purposive sampling technique was used to collect data from caregivers which was validated from the experts and reliability, pilot study was done to conduct the study. The study was conducted on 200 caregivers of primipara postnatal mothers from selected hospitals of Pune city. The collected data was analyzed using descriptive and inferential statistics. Result: Majority (73%) findings of the caregivers have average knowledge regarding diet during lactation and also it showed significant association between age, religion, relationship with postnatal mother and dietary pattern of postnatal mother. Conclusion: To conclude this study on basis of above findings, the aim of this study is achieved. Hence researcher has developed information booklet to update complete knowledge regarding diet during lactation also myths were discussed with the help of evidences.

Association Between Zinc Status and Insulin Resistance/Sensitivity Check Indexes in Gestational Diabetes Mellitus.

Gestational diabetes mellitus (GDM) is considered the most common metabolic disorder of the pregnancy period. It is characterized by pancreatic beta-cell dysfunction in the setting of chronic insulin resistance. Zinc is a nutrient involved in numerous metabolic processes and shows a relationship with glycometabolic disorders and GDM. The latest data have demonstrated the association of zinc with insulin sensitivity and resistance. The exact role of zinc in the connection with indexes of insulin resistance and insulin sensitivity is still not fully clarified. The aim of the study is to analyze the newly calculated indexes Glu/Zn, Ins/Zn, and HOMA-IR/Zn as surrogate markers to explore the correlation between serum zinc status and some indexes of insulin sensitivity and insulin resistance. The possible role of these indexes as markers of insulin resistance in pregnant women was analyzed too. An ROC analysis demonstrated that HOMA-IR/Zn with AUC 0.989, p < 0.001 (95% CI 0.967-1.000) and Ins/Zn with AUC 0.947, p < 0.001 (95% CI 0.889-1.000) in the GDM group, and only HOMA-IR/Zn index with AUC 0.953, p < 0.001 (95% CI 0.877-1.000) in healthy pregnant women, have good power as markers of insulin resistance in both groups. We speculate that these new ratios could be suitable for the assessment of pregnant women at high risk of insulin resistance development and, probably, for the evaluation of the specific pathophysiologic characteristics of women with GDM.

Interventions in women with type 2 diabetes mellitus in the pre-pregnancy, pregnancy and postpartum periods to optimise care and health outcomes: A systematic review.

Type 2 diabetes is a chronic condition affecting increasing numbers of women of reproductive age. Recent UK data show more severe adverse offspring outcomes (stillbirth, neonatal death) than in infants of those with Type 1 diabetes. This systematic review aimed to evaluate randomised controlled trials (RCTs) undertaken in the pre-pregnancy, pregnancy and the postpartum periods in women with Type 2 diabetes, to optimise care and health outcomes. Six electronic databases were searched for eligible studies from January 2000 to September 2023; eligibility included RCTs of behavioural components, supplementation, pharmacotherapy and/or medical devices. Studies were screened in duplicate, and data were extracted on outcomes including behavioural, anthropometry, clinical measures and maternal and offspring outcomes. A narrative synthesis was performed. Eleven trials (12 papers) were included (total 1356 women with Type 2 diabetes, n = 25-502). Ten interventions were conducted in pregnancy, and one in the postpartum period. No pre-pregnancy RCTs were identified. Interventions included pharmacotherapies and supplementation, a diabetes-specific antenatal programme, continuous glucose monitoring and postpartum exercise. We found a paucity of interventions limited by inadequate design, statistical power and poor reporting. The largest Type 2 diabetes pregnancy study to date demonstrated evidence of benefit for adding metformin to a standard insulin regimen compared to insulin alone. Other interventions need replication in larger studies among more diverse groups. This review identified few RCTs targeting women of reproductive age with Type 2 diabetes particularly lacking in the preconception and postpartum periods. Tailored pre-pregnancy, pregnancy and postpartum interventions for women with Type 2 diabetes to optimise care and health outcomes are urgently needed.

Exhaled Breath Volatile Organic Compounds in Pregnancy: A Pilot Study.

This study aimed to assess the volatile organic compounds (VOC)s in breath samples collected non-invasively from pregnant women during pregnancy and postpartum and compare it to non-pregnant controls. This pilot study included 50 subjects: ten pregnant patients in their first trimester, ten in second trimester, ten in third trimester, ten in the first postpartum week, and ten non-pregnant subjects as a control. We collected exhaled breath from subjects who reported to be healthy and free of any respiratory symptoms. Clinical and demographic data were collected. The samples were analyzed for VOCs using a selected-ion flow-tube mass spectrometer (SIFT-MS). The VOCs monitored were twenty-two compounds selected for their common presence in exhaled breath. During pregnancy and postpartum period, there were differences in five compounds mainly: 2-propanol, acrylonitrile, 1-nonene, 2-nonene, and hydrogen sulfide. Significant differences in VOCs were identified during each trimester compared to controls. Volatile organic compounds could be measured safely and noninvasively in pregnant women. VOCs differed significantly among non-pregnant, pregnant women and postpartum period. The utilization of this novel assay to identify fetal conditions or identifying women at risk premature delivery should be further investigated in future studies.

Synopsis of the 2023 U.S. Department of VA and U.S. DoD Clinical Practice Guideline for the Management of Pregnancy.

This Clinical Practical Guideline provides recommendations based on a systematic review of the evidence to address critical decision points in the management of pregnancy. The guideline is intended to improve patient outcomes and local management of patients who are pregnant. This CPG is based on a systematic review of both clinical and epidemiological evidence and was developed by a panel of multidisciplinary experts. The Work Group provides clear and comprehensive evidence-based recommendations incorporating current information and practices targeting practitioners throughout the DoD and VA Health Care systems. The guideline is intended to improve patient outcomes and local management of patients who are pregnant. This CPG does not address every aspect of routine pregnancy care and is not intended to be a comprehensive guide to all care needed in pregnancy. It also addresses some clinically important and generally accepted standards of pregnancy care interventions that do not have sufficient high-quality evidence to support standalone recommendations. Additionally, it highlights emerging topics that have the potential to impact pregnancy care in the future and identifies gaps in the literature that warrant further research. The development of all VA/DoD guidelines is directed by the Evidence-Based Practice Guideline Work Group and adheres to the standards for trustworthy guidelines that were set by the National Academy of Medicine. A patient focus group was convened to assess important aspects of treatment for patients and to gain information about patient values and preferences. The Lewin Group, a contracted third party with expertise in CPG development, facilitated meetings and the development of key questions using the population, intervention, comparison, outcome, timing, and setting format. Consensus was achieved among the Work Group through an iterative process involving discussions on conference calls and in person during the recommendation development meeting. An independent third party, ECRI, conducted the systematic evidence review, which the guideline Work Group then used to develop recommendations using the Grading of Recommendations Assessment, Development and Evaluation system (7-9). The search methods and results are detailed in the full guideline. This CPG provides 28 clinical practice recommendations that cover selected topics that the Work Group deemed had high priority need for evidence-based standards. The recommendations are divided into 3 main categories: routine care, complicated obstetrics, and mental health. An algorithm delineating recommended interventions and appropriate timing of these interventions over the course of the pregnancy and postpartum period was also created. The CPG is not intended to define standards of care nor address all care needed in pregnancy; it does provide comprehensive guidance for routine pregnancy care. It aligns with the VA and DOD's goal of providing care that is consistent in quality and utilization of resources in efforts to reduce errors and inappropriate variations in practices. In total, the Work Group identified 71 items needing further study, including areas requiring stronger evidence to support current recommendations and newer topics that will guide future guideline development.

Engagement in antenatal and HIV care among pregnant women before and after Option B+ policy implementation in South Africa.

Substantial gains have been made in South Africa in the prevention of vertical transmission of HIV over the past decade. to determine whether engagement in antenatal and HIV care among pregnant Women Living with HIV (WLWH) differed after Option B+ implementation. We analysed cohort data from a pregnancy and birth defects surveillance system in KwaZulu-Natal (KZN). We report on two co-primary outcomes related to engagement in HIV care: 1) timing and number of ANC visits during the pregnancy period; and 2) timing of ART initiation (both self-reported ART use in interviews and observed initiation of treatment in maternal records). The association of policy era on the timing of ANC presentation was assessed using log-binomial regression modelling. We also report proportions initiating ART before or during pregnancy stratified by policy era. Data from 40,357 women, including 16,016 (40%) WLWH were analysed. During the Option B+ era, 24% of pregnant WLWH attended their first antenatal care visit during the first trimester, compared to 16% during the Option B era (RR=1.52;95%CI=1.41-1.64). The proportion of women living with HIV who initiated ART prior to pregnancy was also higher during the Option B+ era compared to the Option B era, though this result was limited by missingness in the data. Engagement in antenatal and HIV care improved after Option B+ implementation. In the Option B+ era, South Africa has made significant progress towards the goal of eliminating mother-to-child transmission of HIV. There has been an increase in the proportion of pregnant WLWH initiating ART prior to pregnancy and presenting for antenatal care (ANC) during the first trimester.The findings suggest improved timing and frequency of ANC visits during pregnancy, moving towards the UNAIDS 2025 targets.

Effects of light compression on chronic venous disease, edema and comfort in women during pregnancy and postpartum period: a prospective randomized study.

Lower limb edema associated with venous disorders is an increasingly common problem in pregnant women. The study aimed to assess the use of compression class 1 (ccl1=18-21 mmHg) in lower limb edema and CVD prevention in pregnant and postpartum women. 51 pregnant women (second trimester) were randomly recruited into either a study group CG with compression ccl1 or a control group NCG, both with physical activity (PA) recommendation. The assessment concerned venous system condition, limb size, and compression comfort. Edema was diagnosed as ≥10% measurement increase. Venous reflux (8/22 CG, 1/16 NCG) and an onset of CVD (6/22 CG, 1/16 NCG) were diagnosed in the first measurement. After postpartum, a significant reduction of the great saphenous vein (GSV) diameter in the proximal part of the left lower limb in CG (P=0.014) and expansion of the small saphenous vein (SSV) in the proximal part of the left lower limb in NCG (P=0.028) were observed. An analysis of the limb sizes in the second measurement revealed a significant increase of all circumferences and volumes in the NCG, and of lower leg volumes in the CG. Edema was diagnosed in five women in the NCG in the second measurement. Consequently, compression was recommended for the new group (NCG+C), and a significant edema reduction (P=0.026) occurred in the third measurement. Compression ccl1 reduces the risk of edema, venous insufficiency, and improves women's quality of life during pregnancy and postpartum.