Preconception Stage Research Articles

A good start for all children: integrating early-life course medical and social care through Solid Start, the Netherlands’ nationwide action programme

The foundations of human wellbeing are laid in early life during the preconception stage and the 1,000-days of life from conception to the child's second birthday. This period is therefore receiving scrutiny as a concept for guiding pregnancy-care innovation and public health policy. The Dutch government took responsibility to invest in this. In September 2018, the Dutch Ministry of Health, Welfare, and Sport launched the Solid Start action programme. Coordinated nationally, the programme is implemented locally through coalitions in all 342 Dutch municipalities involving collaboration between medical and social-care professionals, policymakers, parents and organisations. The programme has generated a nationwide movement in which medical and social-care professionals now develop forms of structural collaboration that support (future) parents by offering evidence-based interventions that simultaneously enhance early healthy human development and prevent unwanted pregnancies. Although monitoring of the programme does not currently make it possible to address the causal effects of the programme itself, lessons can be distilled which have contributed to the successful implementation of this nationwide programme. These lessons include 1) having and maintaining an unambiguous narrative, 2) creating a lasting sense of urgency among stakeholders, and 3) ensuring that the programme is multi-sectoral.

Changing paradigm of malnutrition among Bangladeshi women of reproductive age and gaps in national Nutrition Policies and Action Plans to tackle the emerging challenge.

The main objective of this paper is to document the changing paradigm of malnutrition in Bangladesh and estimating how this is creating an intergenerational risk. This paper also examines national policy responses to tackle the silent epidemic of double burden of malnutrition. Publicly available datasets of five Bangladesh Demographic and Health Surveys were used to see the changing paradigm of malnutrition among Bangladesh women. In addition to that, four national policies concerning, maternal and child health; and nutrition were reviewed using CDC's 2013 Policy Analytical Framework. In Bangladesh, the share of ever-married women aged 15-49 who were underweight declined sharply between 2007 and 2017-2018, from 30 to 12%. In the same period, the proportion of women who were overweight or obese increased from 12 to 32%. Despite remarkable progress in reducing undernourishment among women, the share of well-nourished remained unchanged: 58% in 2007 and 56% in 2017-2018, mainly due to the shift in the dominant burden from undernutrition to overnutrition. This shift occurred around 2012-2013. Currently, in Bangladesh 0.8 million of births occur to overweight women and 0.5 million births occur to underweight women. If the current trend in malnutrition continues, pregnancies/births among overweight women will increase. Bangladesh's existing relevant policies concerning maternal health and nutrition are inadequate and mostly address the underweight spectrum of malnutrition. Both forms of malnutrition pose a risk for maternal and child health. Underweight mothers are at risk of having anemia, antepartum/postpartum hemorrhage, and premature rupture of membranes. Maternal obesity increases the risk of perinatal complications, such as gestational diabetes, gestational hypertension, and cesarean deliveries. Currently, around 24% of the children are born to overweight/obese mothers and 15% to underweight mothers. Bangladesh should revise its national policies to address the double burden of malnutrition among women of reproductive age across pre-conception, pregnancy, and post-natal stages to ensure optimum maternal and child health.

Complicated pregnancy and perinatal outcomes in women with type 1 and type 2 diabetes mellitus

Complicated pregnancy and perinatal outcomes in women with type 1 and type 2 diabetes mellitus

Artificial intelligence-based pre-conception stage construction budget decision-making model and tool for residential buildings

PurposeDeveloping a reliable cost estimate at the early stage of construction projects is challenging due to inadequate project information. Most of the information during this stage is qualitative, posing additional challenges to achieving accurate cost estimates. Additionally, there is a lack of tools that use qualitative project information and forecast the budgets required for project completion. This research, therefore, aims to develop a model for setting project budgets (excluding land) during the pre-conceptual stage of residential buildings, where project information is mainly qualitative.Design/methodology/approachDue to the qualitative nature of project information at the pre-conception stage, a natural language processing model, DistilBERT (Distilled Bidirectional Encoder Representations from Transformers), was trained to predict the cost range of residential buildings at the pre-conception stage. The training and evaluation data included 63,899 building permit activity records (2021–2022) from the Victorian State Building Authority, Australia. The input data comprised the project description of each record, which included project location and basic material types (floor, frame, roofing, and external wall).FindingsThis research designed a novel tool for predicting the project budget based on preliminary project information. The model achieved 79% accuracy in classifying residential buildings into three cost_classes ($100,000-$300,000, $300,000-$500,000, $500,000-$1,200,000) and F1-scores of 0.85, 0.73, and 0.74, respectively. Additionally, the results show that the model learnt the contextual relationship between qualitative data like project location and cost.Research limitations/implicationsThe current model was developed using data from Victoria state in Australia; hence, it would not return relevant outcomes for other contexts. However, future studies can adopt the methods to develop similar models for their context.Originality/valueThis research is the first to leverage a deep learning model, DistilBERT, for cost estimation at the pre-conception stage using basic project information like location and material types. Therefore, the model would contribute to overcoming data limitations for cost estimation at the pre-conception stage. Residential building stakeholders, like clients, designers, and estimators, can use the model to forecast the project budget at the pre-conception stage to facilitate decision-making.

Congenital Myotonic Dystrophy type 1: prenatal manifestations regarding a case

Introductions: myotonic dystrophy type 1 is a genetic disorder with great clinical variability in which there is a positive association between the number or size of the cytosine, thymine, guanine triplet repeats and the severity of the manifestations. The disorder exhibits an intergenerational anticipation phenomenon that explains the earlier age of onset of signs and the greater expression of clinical signs. Objetive: to describe the prenatal manifestations of myotonic dystrophy type 1. Clinical case: 22-year-old female patient with a diagnosis of DM1 since she was 6 years old and with a family history of the disorder through the mother's line who came to the clinic with a 22-week pregnancy. Multiple signs were reported when performing prenatal fetal ultrasonography due to: presentation maintained in the pelvic region, slight ventriculomegaly, lower limbs extended and with ventral flexion on the trunk as well as both equinus feet. The birth occurred with a gestation period of 33.6 weeks, the Apgar test was 3-3-3, birth weight 2450 gr. Conclusions: the severity of the congenital form of myotonic dystrophy type 1 requires close monitoring by a multidisciplinary team that extends from the preconception stage, to detect the possible complications described thatworsen the quality of life of patients and their families, and may even to the death of both the mother and the newborn, especially during the first year of life.

Зміни рівнів про- і протизапальних цитокінів у жінок із хронічним ендометритом та можливість медикаментозної корекції цих рівнів на преконцепційному етапі

The incidence of chronic endometritis is more than twice higher the prevalence of other clinical forms of intrauterine pathology, leading to infertility, unsuccessful attempts of in vitro fertilization and spontaneous abortion. There is a lack of data on the alteration of pro- and anti-inflammatory cytokine production in chronic endometritis and their role in the subsequent development of miscarriage. Purpose - to investigate the levels of pro-inflammatory cytokines tumor necrosis factor alpha (TNF-α) and interferon gamma (INF-γ), as well as the anti-inflammatory cytokine interleukin 10 (IL-10) in cervical mucus of women with chronic endometritis and to assess the impact of the developed comprehensive preconception treatment on normalizing cytokine disorders in these women. Materials and methods. The levels of pro-inflammatory cytokines TNF-α and INF-γ, as well as the anti-inflammatory cytokine IL-10, were determined using the enzyme-linked immunosorbent assay method in the cervical mucus of 426 women with chronic endometritis who were planning pregnancy. Among them, 168 patients (the Group I) received preconception comprehensive treatment, which included broad-spectrum antibacterial agents (azithromycin), hormonal estrogen-progestin therapy (Femoston 2/10) and L-arginine. The remaining 258 women (the Group II) did not receive treatment for chronic endometritis at the preconception stage. The control group consisted of 30 healthy individuals. Data analysis was performed using mathematical statistical methods, calculating the mean sample values (M), variance (σ) and standard errors of the mean (m). The Student’s t-test was applied, and probabilities were determined using the statistical program «STATISTICA» (StatSoft Inc., USA). Results. In the cervical mucus of women with chronic endometritis, an increase in the levels of pro-inflammatory cytokines INF-γ by 2.8 times (p<0.001) and TNF-α by 2 times (p<0.001) was detected, along with a 2-fold decrease in the concentration of the anti-inflammatory cytokine IL-10 (p<0.001). The shift in the cytokine balance towards pro-inflammatory cytokines is associated with a high frequency of miscarriage in these women. After the treatment of chronic endometritis, women had a 2.6 times lower level of INF-γ (p<0.05), a 2 times lower level of TNF-α (p<0.01), and a 1.7 times higher level of IL-10 (p<0.05) compared to untreated patients. Conclusions. Women with chronic endometritis experience a cytokine imbalance, characterized by an excessive increase in pro-inflammatory cytokines and a decrease in anti-inflammatory cytokines. Women with chronic endometritis who are planning pregnancy require comprehensive preconception treatment, which includes the administration of azithromycin, femoston 2/10 and L-arginine in addition to traditional preconception folate prophylaxis. This treatment, by promoting improved conditions for implantation, leads to a 15% increase in the pregnancy rate and a 1.9-fold reduction in the frequency of spontaneous abortion. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Epigenetic mechanisms of intrauterine fetal senescence: little-known effects of hyperhomocysteinemia during pregnancy

Today, a whole body of evidence base has been formed showing the negative effect of hyperhomocysteinemia (HHC) during pregnancy on the intrauterine fetal development: risk factors associated with development of congenital neural tube defects, congenital heart defects and non-syndromic oral facial clefts. In addition, numerous studies have shown that HHC is a risk factor for serious pregnancy complications such as repeated pregnancy loss, preterm birth, preeclampsia, placental abruption, intrauterine growth restriction, gestational diabetes mellitus. At the same time, despite multiple clinical and experimental studies, the significance of HHC effects continues to support the interest to this issue. In recent years, new data were revealed about littleknown phenomena pregnancy-associated maternal HHC such as "epigenetic fetal aging" and "fetal atherogenesis". Epigenetic aging is an individual indicator of aging that captures interindividual differences at disease onset throughout life occurring during intrauterine development being reveaked as DNA hypomethylation. Moderate HHC during pregnancy causes fetal DNA hypomethylation, which, according to recent research, may represent the main mechanism underlying health in childhood and adulthood. "Fetal atherogenesis" is another understudied HHC effect emphasizing that the formation of atherosclerotic plaques begins not in adulthood, but in utero. A body of studies has shown that the formation of thickening and fatty streaks in vascular intima involved in the pathogenesis of atherosclerosis begins antenatally. The discovery of new aspects of negative intrauterine HHC impact on fetal development necessitates a detailed study of HHC causes as non-modifiable (genetic defects in enzyme systems), and more importantly, conditionally modifiable causes (lack of cofactors, excessive methionine consumption, medications) for their timely leveling. It is also important to study approaches to HHC correction at the preconception stage of a female reproductive function in order to correctly "program" fetus and newborn development.

Epigenetic mechanisms of fetal programming in excessive intake of synthetic folates at the preconception stage

To date, there is no doubt that taking folic acid at the perigravid stage in an adequate dosage has a positive effect on fetal development and the course and outcome of pregnancy. There is extensive evidence that during pregnancy, folate deficiency is associated with spontaneous miscarriages, premature birth, and premature detachment of the normally positioned placenta, and it can cause intrauterine malformations of the nervous and cardiovascular systems of the fetus.
 Understanding the need to reduce such severe complications, which have both medical and social significance, has contributed in a number of countries to the introduction of programs for food fortification and routine prescribing of folic acid preparations to pregnant women. The measures taken significantly reduced the incidence of fetal congenital malformations, but at the same time, this strategy had a negative effect, resulting in a chronic overdose of synthetic folic acid. Recent studies have shown that the accumulation of non-metabolized folic acid in a pregnant woman may be associated with obstetric pathology and impaired development of fetuses and newborns. There is growing evidence that prolonged folic acid overdose during pregnancy, especially in the presence of altered levels of other vitamins, may lead to such diseases in children as autism and multiple amyotrophic sclerosis. Thus, this issue requires in-depth study in order to move from the routine prescription of folic acid preparations to personalized nutritional support for women at the preconception stage and during pregnancy.

Exploring Health Behaviours, Attitudes and Beliefs of Women and Men during the Preconception and Interconception Periods: A Cross-Sectional Study of Adults on the Island of Ireland.

Preconception health is increasingly seen as a key target for improving population health in the UK and Ireland, yet little is known about the attitudes and beliefs of adults regarding preconception care strategies. This online cross-sectional survey aimed to explore the health behaviours, attitudes and beliefs of adults of reproductive age in regard to preconception health and care. The survey was developed by reviewing the previous literature and engaging with those from the target group. It is one of the first surveys to assess the attitudes and beliefs of adults of reproductive age across the Island of Ireland regarding preconception health and care. Results from 386 individuals with a mean age of 29.9 ± 10.3 years were included. A variety of health behaviours, attitudes and beliefs were investigated, with differences being identified between women and men and between participants with or without children (i.e., in the preconception or interconception stage). The majority of respondents held beliefs that preconception care was important, but there was greater emphasis on women than men in terms of the need to engage in health-promoting preconception health behaviours. This study highlights the need to improve preconception health awareness in women and men in the preconception and interconception stage. Findings indicate that efforts to improve preparation for pregnancy among adults of childbearing age are needed, to ensure optimal engagement in preconception health behaviours, with efforts being tailored based on sex and parental status.

Течение и исходы беременности, наступившей в результате экстракорпорального оплодотворения, у пациенток с хроническим эндометритом, получавших комплексное лечение с использованием препарата «Суперлимф» на прегравидарном этапе (рандо­мизированное контролируемое испытание «ТЮЛЬПАН 2»)

Течение и исходы беременности, наступившей в результате экстракорпорального оплодотворения, у пациенток с хроническим эндометритом, получавших комплексное лечение с использованием препарата «Суперлимф» на прегравидарном этапе (рандо­мизированное контролируемое испытание «ТЮЛЬПАН 2»)

Markers of systemic endotheliosis in early-onset preeclampsia relapse

Aim: to assess the blood level of biological endothelial damage markers in women with previous early-onset preeclampsia (еPE) during both the preconception (PC) stage and the first trimester of pregnancy.Materials and Methods. A prospective single-center cohort study was conducted. The control group comprised 40 women with uncomplicated pregnancies. The observation group consisted of 97 patients with a history of ePE, stratified based on pregnancy outcome into the comparison group (n = 59) characterized by a favorable gestational course, and the main group (n = 38) with relapsed еPE (30 patients were excluded from the study). Markers of systemic endotheliosis were determined in women at the PC stage and at 11–13 weeks of gestation: endothelin-1 (ET-1) and endothelial extracellular vesicles (EVs; CD-144).Results. At the PC stage, women in the control group and patients from the comparison group had comparable median (Me) ET-1 levels – 0.39 and 0.40 pmol/ml (p = 0.5935), respectively; at the same time, patients with relapsed еPE vs. control group had it significantly elevated (Me = 0.55 pmol/ml; p = 0.0382). At gestational age of 11–13 weeks, ET-1 level was significantly higher in the group with relapsed еPE (Me = 0.93 pmol/ml) than in control group (Me = 0.29 pmol/ml; p < 0.0001) and comparison group (Me = 0.42 pmol/ml; p = 0.0003). No significant changes in E-EVs (CD-144) level at various PС stages were observed, whereas in the study groups such parameters remained differed.Conclusion. Biological markers evidencing about systemic endothelial dysfunction/destruction – ET-1 and E-EVs (CD-144) in patients with previous ePE can be considered as predictive tests of disease relapse with an accuracy of 63.5 % and 83.0 % at the PС stage and 85.7 % and 94.2 % at gestational age of 11–13 weeks, respectively.

Developmental and environmental modulation of fecal thyroid hormone levels in wild Assamese macaques (Macaca assamensis).

Thyroid hormones are key modulators of development, as well as mediators of environmental conditions, by regulating developmental processes and metabolism in primates. Hormone measurement in noninvasively collected samples, that is, feces and urine, is a valuable tool for studying the endocrine function of wildlife, and recent studies have demonstrated the feasibility of measuring thyroid hormones in fecal samples of zoo-housed and wild nonhuman primates. Our study aimed to (i) validate the measurement of immunoreactive fecal total triiodothyronine (IF-T3) in wild Assamese macaques (Macaca assamensis) and (ii) to investigate its developmental changes and its response to environmental changes, including stress responses, in immature individuals. Fecal samples and environmental parameters were collected from individuals of three social groups of wild Assamese macaques living at Phu Khieo Wildlife Sanctuary, Northeastern Thailand. Our study confirmed the methodological feasibility and biological validity of measuring IF-T3 in this population. Specifically, the biological validation demonstrated higher IF-T3 levels in immatures compared to adults, and higher levels in females during late gestation compared to the preconception stage. Our analysis of IF-T3 levels in developing immature macaques revealed a significant increase with age. Furthermore, we found a positive association between IF-T3 and immunoreactive fecal glucocorticoid levels, an indicator of the physiological stress response. Neither minimum temperature nor fruit abundance predicted variation in IF-T3 levels in the immatures. Our findings indicate the possibility for differing effects of climatic factors and food availability on thyroid hormone level changes in immature versus adult animals and in wild compared to experimental conditions. Overall, our study provides the basis for further investigations into the role of thyroid hormones in shaping species-specific traits, growth, and overall primate development.

Fertility at an advanced age: Its possibilities and risks

Recent decades have seen an increase in late parenthood, whether naturally or by means of assisted reproductive technology. With increasing maternal and paternal age the risk of obstetric pathologies increases for mothers, and perinatal pathologies increase for both mothers and offspring. We must consider this when discussing family planning with our patients. What risks must we take into account in this situation? Further research is necessary on the long-term effects of late parenthood on the offspring. We will talk about the correlation between advanced maternal and paternal age and autism spectrum disorders. This topic should be present in the information we give patients who consult us at the pre-conception stage.

СРАВНИТЕЛЬНАЯ ОЦЕНКА ТЕЧЕНИЯ И ИСХОДОВ БЕРЕМЕННОСТИ У ПАЦИЕНТОК С НЕДИФФЕРЕНЦИРОВАННОЙ ДИCПЛАЗИЕЙ СОЕДИНИТЕЛЬНОЙ ТКАНИ ПРИ ИСПОЛЬЗОВАНИИ ОБЩЕПРИНЯТОЙ И ПЕРСОНАЛИЗИРОВАННОЙ ПРЕГРАВИДАРНОЙ ПОДГОТОВКИ

Background. Preparation for pregnancy in patients with extragenital pathology is an important problem of current obstetrics. Purpose. To perform comparative assessment of the course and outcomes of pregnancy in patients with undifferentiated connective tissue dysplasia (UCTD) after using conventional and personalized preconception preparation. Material and methods. A total of 262 patients were examined, including 159 with UCTD. Group I (the main group) included 125 patients with minor heart abnormalities and at least 4 signs of undifferentiated connective tissue dysplasia, who underwent the generally accepted preconception preparation: folic acid – 400 μg/day, potassium iodide – 200 μg/day orally for 3 months. Group II (the intervention group) consisted of 34 patients who received personalized preconception preparation: folic acid – 400 μg/day orally, potassium iodide – 200 μg/day orally for 3 months, Mg2+ preparations at a dose of 300 mg/day, glycine –400 mg/day, multivitamin complex containing vitamin B1 (10 mg/day), vitamin B2 (10 mg/day), vitamin B6 (10 mg/day), vitamin E (400 mg/day) for 3 months. Group III (the control group) included 103 patients without signs of UCTD who received a standard amount of preconception preparation. The evaluation of the effectiveness of personalized preconception preparation was carried out according to the criteria of evidence-based medicine. Relative risk (RR), relative risk reduction (RRR), absolute risk reduction (ARR), the number of patients who needed treatment to prevent 1 adverse outcome (NNT), the odds ratio (OR) for a particular outcome were calculated. Results of the study. In the intervention group, statistically significant results were obtained in terms of reducing the risk of developing a threatened miscarriage and preterm birth in patients with undifferentiated connective tissue dysplasia, as well as reducing the absolute risk of developing isthmic-cervical isufficiency. Conclusions. Identification of signs of UCTD at the preconception stage and the use of personalized preconception preparation in this group of patients contributes to the improvement of perinatal outcomes.

Food insecurity screening procedures used in reproductive healthcare settings.

Food insecurity is an important determinant of health and should be identified by clinicians during routine reproductive healthcare. The procedures used in reproductive healthcare settings to identify people experiencing food insecurity have not been fully researched. The objective of this study was to synthesize evidence from published studies that describe the procedures implemented by clinicians in healthcare settings to identify food insecurity in pregnant women, or women of reproductive age (15 years-49 years). Four databases were searched in April 2022 to identify studies that met the eligibility criteria. Studies that used tools that were both validated or newly developed were considered, as were studies that incorporated food insecurity screening as part of a multidomain screening tool. Two authors completed the screening, data extraction, and quality assessment independently. There were 1075 studies identified; after screening, 7 studies were included in the narrative synthesis, including studies relating to women who were pregnant or in the postpartum period; none of the included studies related to women in the preconception stage. Four screening tools were identified: 2- and 6-item tools specifically focused on food insecurity, a 58-item multidomain tool incorporating 4 food insecurity items, and a modified version of the 2-item tool. Methods of implementing screening varied across studies. Three described subsequent processes that supported food-insecure patients once identified. Few published studies have investigated optimal screening tools and their implementation within reproductive healthcare settings to address food insecurity for this priority population group. Further research is required to determine: the optimal tool, preferable screening methods from the perspectives of both patients and clinicians, and potential strategies for implementation in countries outside of the United States. An additional evidence gap remains about referral pathways and appropriate supports for this population once food insecurity is identified. PROSPERO registration no. CRD42022319687.

Preconception diet and its relationship with hemoglobin in rural and urban women of San Francisco Cozoaltepec and Puerto Escondido, Oaxaca

Introduction: during pregnancy, pregnant women have nutritional needs that are calculated based on recommendations for non-pregnant women (preconception stage), as well as caloric needs, which depend on physical activity and development. One of the main problems with the diet is insufficient iron intake due to the increase in muscle mass and blood volume. Objective: to describe the preconception diet of women with prenatal care and its relationship with hemoglobin in the rural area of San Francisco Cozoaltepec and the urban area of Puerto Escondido, belonging to the Oaxacan coast region. Methods: to evaluate the nutrition of the preconception diet, the "Frequency of food consumption" questionnaire and the "24-hour recall" were used. To assess the hemoglobin level, the "first clinical record" attached to the medical record was taken. Results: sixty pregnant women were included (25,83±0,92 years in the urban area and 26,03±1,18 years in the rural area, respectively). During the first stage of pregnancy, the hemoglobin concentration was within normal parameters, with greater significance in the rural area (13,24 ± 0,30 units). Conclusion: the hemoglobin concentration in both study areas was within normal parameters; however, the value in the rural area is higher compared to the urban area, and this difference is related to altitude above sea level. An inadequate nutritional status was also observed in both populations

Assessment of First-Trimester Utero-Placental Vascular Morphology by 3D Power Doppler Ultrasound Image Analysis Using a Skeletonization Algorithm: The Rotterdam Periconception Cohort

ABSTRACT Abnormal uteroplacental vascular development is one of the primary causes of the major disorders of pregnancy. Identification of this aberrant development in the preconception stage and in the first trimester, when measures to prevent complications are most effective, remains a challenge. Recent advances in offline imaging processing and Doppler techniques have allowed ultrasonographic analysis of placental volume (PV) and uteroplacental vascular volume (uPVV) in the first trimester. The ability of ultrasound to assess specific vascular morphology is not fully understood. The aim of this study was to investigate morphologic development of the first-trimester human uteroplacental vasculature in vivo using 3-dimensional power Doppler ultrasound and advanced image processing to generate the uteroplacental vascular skeleton (uPVS). Data were obtained from the VIRTUAL Placenta study, an ongoing observational study including adult women carrying a singleton pregnancy at less than 10-week gestational age (GA). At least 2 study visits were scheduled in the first trimester, at 7, 9, and 11 weeks' GA. The image quality of ultrasound scans was scored on a 4-point scale ranging between 0 (optimal) and 3 (unusable), and PV was measured using VOCAL software. The uPVV was measured using a virtual reality desktop system with the V-scope volume-rendering application. A skeletonization algorithm was then applied to the uPVV segmentation to generate the uPVS, and 7 morphological uPVS characteristics were used to determine the density of vascular branching within the placenta. A total of 214 women from the VIRTUAL cohort were eligible for inclusion, and 81% of all ultrasound data were of sufficient quality for generation of the uPVS. The distribution of endpoints, vessel points, bifurcation points, and crossing points in the uPVS and the distribution of uPVS characteristics per cm3 uPVV show consistent morphologic patterns throughout the first trimester. Moderate to strong positive correlations between uPVS characteristics and PV and strong positive correlations between uPVS characteristics and uPVV were identified. All uPVS characteristics increased significantly through the first trimester, except for uPVS average length, which remained constant between 7, 9, and 11 weeks' GA. When stratifying for placenta-related complications among the cohort, no significant differences in the uPVS characteristics were seen at 7 weeks' GA (n = 94). However, at 9 weeks (n = 170), there were significantly fewer number of vessel points (P = 0.040), bifurcation points (P = 0.050), crossing points (P = 0.020), and a shorter total network length (P = 0.023) among pregnancies with placenta-related complications. At 11 weeks' GA (n = 129), uPVS average vascular thickness was significantly lower in pregnancies with placenta-related complications (P = 0.007), but no other uPVS differences were observed. At 11 weeks' GA, pregnancies with placenta-related complications were found to have an increased density of vascular branching in the uPVV. The results of this study demonstrate a quantitative morphologic analysis of the human uteroplacental vasculature in the first trimester of pregnancy and key differences in the vascular morphology between pregnancies with and without placenta-related complications.

Congenital heart disease: follow-up program for women in the pre-conception stage and during pregnancy

Congenital heart disease: follow-up program for women in the pre-conception stage and during pregnancy

LEVEL OF KNOWLEDGE OF WOMEN ABOUT THE RISKS ASSOCIATED WITH OVERWEIGHT DURING PREGNANCY

Worldwide half of women start pregnancy with overweight/obese, which greatly increases the risk of pregnancy and birth complications. Recommendations to improve preconception care emphasize the need to ensure that women of reproductive age understand factors that increase the obstetric and perinatal risks connected with high body mass index (BMI).
 Aim. Study whether women who start pregnancy with overweight were known of the increased risks of the gestational complications associated with a high (BMI) and the barriers and limitations that women had to optimize their body weight before conception.
 Materials and methods. total of 117 pregnant were enrolled in the research. The first group included 68 overweight women (BMI 25.0-29.9 kg/m2), the second - 49 normal body weight women (BMI 18.5-24.9 kg/m2) before pregnancy. Two questionnaires were used: "Questionnaire on the assessment of the level of knowledge of women about the risks associated with overweight during pregnancy" and "Barriers and limitations that women had to optimize body weight before conception". Patients filled out the presented questionnaires individually during the first antenatal visit (9-12 weeks). The results were statistically analyzed using Statistica 10.0 program pack (StatSoft Inc., USA) and Microsoft Excel statistical analysis package. The differences between the groups were considered statistically significant at p<0.05.
 Results. It was shown that the majority of women knew that overweight increased the general risk of pregnancy complications regardless of the woman's BMI. However, the chances of underestimating the high risk of operative delivery in overweight patients were (OR=3.80; 95% CI: 1.83-7.87; p<0.001 and OR=3.69; 95% CI: 1.58 -8.64; p=0.004), premature birth (OR=2.96; 95% CI: 1.47-5.95; p=0.003 and OR=2.99; 95% CI: 1.31-6 .83; p=0.015), adverse neonatal outcomes (OR=2.96; 95% CI: 1.47-5.95; p=0.0031), and especially fetal congenital anomalies of development (OR=5.50; 95 % CI: 2.62-11.54; p<0.001 and OR=12.38; 95% CI: 4.56-33.58; p<0.001) among patients of the first and second groups, respectively. An underestimation of the risk of diabetes, caesarean section, premature birth, and negative perinatal outcomes, and especially congenital fetal abnormalities, has been confirmed if weight loss occurs before conception. The main barriers and limitations for women to optimize their weight before pregnancy were insufficient basic knowledge about the risk of gestational, especially perinatal complications during pregnancy and childbirth associated with overweight, family culture and habits, unsuccessful repeated irregular attempts to weight lose, lack of information and consulting medical professionals on this issue. Only 14.7 % of women reported that they were satisfied with their appearance and health and did not need to lose weight.
 Conclusions. Being overweight, usually caused by incorrect lifestyle, including dietary choices and lack of physical activity, has long-term negative health consequences for women and their children. The preconception, pregnancy, and postpartum periods are unique opportunities for intervention to establish sustainable healthy lifestyles. It remains relevant to develop programs aimed at improving women's knowledge about overweight as a factor of high obstetric and perinatal risks, and lifestyle modeling with the aim of optimizing body weight at the preconceptional stage.

Vitamins and minerals, education, and self-care need during preconception to 1000 days of life in Southeast Asia: An expert panel opinion.

Addressing maternal malnutrition and its drivers is paramount in Southeast Asia. This article summarizes the key clinical learnings and evidence-based opinions from the experts to understand the need for vitamins and minerals supplementation, education, and self-care from preconception to the first 1000 days of life, which warranted further attention since COVID-19 pandemic. Evidence describing the importance of vitamins and minerals during preconception, pregnancy, and lactation stages was identified using literature databases. A pre-meeting survey was conducted to determine the current practices and challenges in Southeast Asia. Based on the literature review and clinical experience, experts defined the topics, and an online meeting was held on 13th July 2021. During the meeting, nine experts from Southeast Asia provided evidence-based opinion on the vitamins and minerals supplementation, education, and self-care need during preconception, pregnancy, and lactation stages. The expert opinions underpin maternal malnutrition as a prevalent issue and discuss appropriate interventions and prevention strategies for women in Southeast Asia. The recent pandemic further impacted nutrition status, pregnancy, and neonatal health outcomes. The expert panel emphasized a need to improve existing inadequacies in education, self-care, and social support, and discussed the role of policymakers in addressing the barriers to dietary changes. As inadequacies in regular vitamins and minerals supplementation, education, and self-care for women of reproductive age implicate maternal and child health outcomes, there is an urgent need for addressing malnutrition concerns in this population. Thus, a strong partnership between policymakers, healthcare professionals, and other relevant sectors is required.