Pregnancy History Research Articles

Assessment of Risk Factors for the Development of Diabetic Retinopathy in T2D

Objective: To estimate the risk factors that contributes to the incidence of diabetic retinopathy (DR) in type 2 diabetes (T2D). Methodology: We conducted serial fundus photography in individuals at high risk of developing type 2 diabetes, including after the onset of diabetes. The ETDRS (Early Treatment Diabetic Retinopathy Study) grading system was used to evaluate the fundus photographs. Results: A total of 400 participants with a 3:3.6 male-to-female ratio were included in this study. The T2 DM patients with mean age 48.73±9.24 and 47.53±8.53 years with and without retinopathy respectively were observed, which shows that there is a non-significant difference (p=0.801). The differences in weight and BMI in T2 D participants with and without diabetic retinopathy were also not significant. The study found that the history of pregnancy, history of gestational DM, measures of HOMA-B, HOMA-IR, insulin genic inde, oral disposition inde, urine albumin to creatinine ratio, and hs-CRP were not associated with the presence of retinopathy. Association of nonglycemic risk factors in T2D. The study found that mean HbA1c during follow-up was significantly associated (P 0.0001) with the prevalence of retinopathy, The study found that retinopathy was associated with measures of higher blood pressure (systolic blood pressure, diastolic blood pressure, and presence of hypertension) and lipid profile. Conclusions: The development of DR can occur in the early stages of T2D. Hemoglobin A1c was found to be a significant risk factor for the occurrence of DR across the intact glycemic range in patients with T2D.

Pregnancy and Childbirth Fear of Women from Poland, Greece, Turkey, Belarus, and Russia.

Background/Objectives: Pregnancy and childbirth in many women cause various situations, from physical to emotional. The analysis of selected factors affecting pregnancy and childbirth in a group of women from Poland, Greece, Turkey, Belarus, and Russia and self-assessment of their impact on fear of pregnancy and childbirth. Material and Methods: A total of 2017 women were surveyed, including 584 pregnant women, 528 postpartum women, and 906 non-pregnant and never-pregnant women. The study used an original questionnaire, including questions on socio-demographics and the history of pregnancy and childbirth. The material status of the respondents was assessed using the Family Affluence Scale. Results: The age range of respondents was 19-50. The surveyed women most often reported (p < 0.001) fear (n = 928) and excitement (n = 901). A positive correlation was found between anemia, infections, and fear in women from Belarus. No correlation was found between low, average, or high material status and the perception of pregnancy in women from the studied countries. Significantly (p < 0.001), women from Turkey had more children (p < 0.001) than women from other countries. With the exception of Russia, statistical correlations were shown between the feeling of fear of pregnancy and childbirth and the way the previous/current pregnancy was delivered and the experience of an artificial/natural miscarriage in the past. In general, 630 women had given birth vaginally, and 283 women had given birth by cesarean section. In the group of currently pregnant women, 22 women had had natural miscarriages in Belarus, 37 in Poland, 27 in Greece, 29 in Turkey, and 9 in Russia. Conclusions: When thinking about pregnancy, respondents in all groups most often felt joy and excitement, as well as fear and excitement, about childbirth. Natural miscarriage was experienced most frequently by women in Poland and Greece and induced in Belarus. The largest number of women who had cesarean section were from Poland and Belarus.

Application of whole exome sequencing in carrier screening for high-risk families without probands.

This study aimed to screen the genetic etiology for the high-risk families including those with an adverse pregnancy history, a history of consanguineous marriages, or a history of genetic diseases, but lack of proband via whole exome sequencing (WES). 128 individuals from high-risk family were tested by WES. The candidate variants were analyzed according to the ACMG criteria to screen the potential carriers. At-risk couples (ARCs) who harbored the same causative gene were provided with precise fertility guidance to avoid the birth of children with birth defects. The total detection rate was 36.72%, with pathogenic/likely pathogenic (P/LP) variants found in 47 individuals, and variants of uncertain significance (VUS) were found in 34. Among couples with adverse pregnancy history: P/LP variants were found in 38 individuals, and VUS were found in 26, for a detection rate of 34.55%; among members of family history of genetic disease or consanguineous marriages: P/LP variants were found in nine individuals, and VUS were found in 8, for a detection rate of 50.00%. Otherwise, we detected 19 ARCs who both carried P/LP variants in the same gene, with a theoretical offspring prevalence of up to 7.42%. In the absence of probands, carrier screening using WES can provide an efficient tool for screening the molecular etiology of high-risk families.

The experience of miscarriage and its impact on prenatal attachment during the following pregnancy: A mixed-methods study

BackgroundIn France, miscarriage affects nearly 200,000 women every year. This life event may generate negative effects on the mother-child relationship and the mother's mental health in the following pregnancy. ObjectivesTo investigate the influence of body satisfaction, partner support, resilience and previous experience of a miscarriage on prenatal attachment in pregnant women. DesignThis is a cross-sectional mixed-methods study. Women answered an online questionnaire in the period between November 2022 to April 2023. Participants267 French pregnant women who had previously experienced a miscarriage were recruited for this study. MeasurementsStudy outcomes included prenatal attachment, resilience, partner support, history of previous pregnancies and miscarriages, the current pregnancy, and questions relating to body experience. FindingsParticipants who reported a high investment in the current pregnancy, high partner support and a positive image of their body had higher levels of prenatal attachment. The experience of miscarriage also seems to influence prenatal attachment: pregnancy investment at the time of miscarriage had a positive influence, while medical experience had no significant impact. While the global resilience score was not related to prenatal attachment, sense of control was positively linked to prenatal attachment. Key conclusions and implications for practiceThese results highlight the importance of considering miscarriage as a perinatal loss with potential for long-lasting impact on women, which deserves particular attention from professionals. Enhancing partner support and helping women build a positive image of their pregnant body can also have a role in fostering prenatal attachment to the foetus.

Seeking abortion accompaniment: experiences and self-managed abortion preferences of hotline callers after abortion legalisation in Argentina

BackgroundUntil the legalisation of abortion in Argentina in 2021, the Socorristas en Red, a network of feminist collectives, provided support and information (‘accompaniment’) to people self-managing their abortion with medications....

KARAKTERISTIK PASIEN PREEKLAMPSIA DI RUMAH SAKIT UMUM DAERAH SOEDIRAN MANGUN SOEMARSO WONOGIRI JAWA TENGAH

Preeclampsia is a condition of increased blood pressure accompanied by proteinuria during pregnancy. Preeclampsia is one of the causes of maternal and fetal death. Efforts to reduce the incidence of preeclampsia are one of the efforts to reduce maternal mortality, one of which is by knowing the characteristics of preeclampsia patients to plan to overcome the risk of preeclampsia in the future. This study aims to determine the characteristics of preeclampsia patients at Wonogiri Regional Hospital dr. Soediran Mangun Soemarso, Wonogiri, Central Java. This research was conducted in a retrospective cross-sectional manner on the medical records of preeclampsia patients in Wonogiri Regional Hospital dr. Soediran Mangun Soemarso, Wonogiri, Central Java during 2019-2022. Sampling was carried out using a purposive sampling method among pregnant women who gave birth in the hospital from November 2021 – Januari 2022. A total of 106 medical record data from pregnant women were obtained in this study. The average age of pregnant women in this study was 31.37 ± 6.72 years with the majority aged 20 – 35 years with a history of giving birth more than twice. The majority of preeclampsia patients at Wonogiri Regional Hospital were severe preeclampsia patients (53.8%). A total of 59 pregnant women gave birth using the vaginal delivery method and 47 pregnant women gave birth using the cesarean method. Maternal age and pregnancy history are factors related to the risk of preeclampsia which can influence the mother's delivery method. Further research is needed on risk factors for preeclampsia in a wider population so as to improve the health of mothers and babies during pregnancy

Risk factors for tubal patency and their impact on pregnancy rate after partial salpingectomy and end-to-end anastomosis.

To explore the risk factors for tubal patency after partial salpingectomy and end-to-end anastomosis, and their impact on pregnancy outcomes. A total of 300 patients with tubal pregnancy who underwent partial salpingectomy and end-to-end anastomosis in Zhengzhou Maternal and Child Health Hospital from January 2020 to April 2023 were enrolled in the study. Hysterosalpingography was performed after surgical treatment to examine the tubal patency. Lasso-Logistic regression was used to analyze the risk factors for postoperative tubal patency, and Spearman's correlation was used to analyze the impact of each risk factor on the pregnancy rate. Hysterosalpingography showed that the fallopian tube was not obstructed in 225 cases (unobstructed group), the tube was not completely patent (n=54) or blocked (n=21) (obstructed group). Univariate analysis showed that age, diameter of the tubal pregnancy sac, location of tubal pregnancy, timing of surgery, pelvic adhesion, anastomotic method, length of remaining tubal, history of pelvic surgery, number of intraoperative electrocoagulation, intraoperative blood loss, and experience of surgeons were factors affecting postoperative tubal patency (all P<0.01). Lasso regression analysis identified location of tubal pregnancy, pelvic adhesion, anastomotic method, length of remaining tubal, history of pelvic surgery, number of intraoperative electrocoagulation, and experience of surgeons as influencing factors. Multivariate Logistic regression analysis showed that tubal isthmus pregnancy, pelvic adhesion, open anastomosis surgery, history of pelvic surgery, and number of intraoperative electrocoagulation were independent risk factors for postoperative tubal patency, while length of remaining tubal and years of surgeon's work experience were independent protective factors for postoperative tubal patency (all P<0.01). A total of 295 patients were followed up for 1 year, 192 cases (65.08%) were pregnant, including 172 cases of intrauterine pregnancy (89.58%) and 20 cases of ectopic pregnancy (10.42%). Spearman correlation analysis showed that tubal isthmus pregnancy, pelvic adhesion, open abdominal anastomosis surgery, pelvic surgery history, and times of intraoperative electrocoagulation were negatively correlated with postoperative pregnancy, while the remaining tubal length and years of surgeon's working experience were positively correlated with postoperative pregnancy rate (all P<0.01). For tubal patency of patients after partial salpingectomy combined with end-to-end anastomosis, the history of tubal isthmus pregnancy, pelvic adhesion, open abdominal anastomosis, pelvic surgery, and the number of intraoperative electrocoagulation are independent risk factors, which are negatively correlated with postoperative pregnancy. The remaining tubal length and the years of surgeon's work experience are independent protective factors, which are positively correlated with postoperative pregnancy.

MMP-8 in Periodontal Sites of Postpartum and without-Any-Pregnancy Women.

The hypothesis that physiological changes in women can affect periodontal tissues is the subject of this study, and inflammatory markers such as matrix metalloproteinase-8 can measure susceptibility to inflammation. The study aimed to analyze MMP-8 levels in periodontal sites of postpartum women and women without a history of pregnancy, comparing health parameters and periodontal disease. This is a case-control study with 40 participants, 20 cases (women in the postpartum period) and 20 controls (women without any pregnancy), who underwent clinical periodontal examination and the collection of crevicular gingival fluid. The ELISA test was used to detect MMP-8 levels. Postpartum women had worse periodontal parameters, such as bleeding index on probing, number of sites with CAL ≥ 3, and fewer teeth present. In the group of women without a history of pregnancy, a significantly lower MMP-8 level was observed in healthy sites and a higher one was observed in periodontal pockets (p < 0.01). In contrast, in postpartum women, MMP-8 levels were elevated in both healthy sites and periodontal pockets (p > 0.01). The MMP-8 levels in gingival fluid appear to be related to periodontal clinical parameters and may be a possible marker of enzymatic changes involved in periodontal tissue destruction in postpartum women.

Exploring the link: Systemic immune-inflammation index as a marker in endometriosis—Insights from the NHANES 2001–2006 cross-sectional study

Objective The systemic immuno-inflammatory index (SII), a novel immune marker of inflammation, has not been previously associated with endometriosis. The objective of this research is to explore the link between SII and the occurrence of endometriosis. Methods Utilizing data from the National Health and Nutrition Examination Survey (NHANES) spanning 2001 to 2006, we screened and extracted relevant information from the population. Participants missing data on either SII or endometriosis were excluded. We divided the remaining cohort into quartiles based on SII levels: Q1 (SII &lt; 249, n = 848), Q2 (249 ≤ SII &lt; 604.55, n = 847), Q3 (604.55 ≤ SII &lt; 825.35, n = 847), and Q4 (SII ≥ 852.35, n = 848). Multiple linear regression and smooth curve fitting techniques, were to evaluate the non-linear association between SII and endometriosis. Results The study included 3,390 adults aged 20 to 55. Multiple linear regression analysis revealed a significant positive correlation between SII and endometriosis [3.14, 95% CI (2.22, 4.45), P &lt; 0.01]. This correlation was consistent across subgroups defined by marital status, poverty income ratio, BMI, alcohol consumption, and age at first menstrual period. However, the relationship between SII and endometriosis was significantly modified by age, education, and history of pregnancy in the stratified analyses. The curve fitting indicated an S-shaped curve, with an inflection point at SII = 1105.76. Conclusion The SII may serve as a predictive marker for endometriosis risk among women in the United States, offering a potentially simple and cost-effective approach. However, given the cross-sectional design of this investigation, further validation in prospective studies is necessary.

Alcohol: a cardiovascular friend or foe?

This review comprehensively explores the multifaceted implications of alcohol consumption on health. While acknowledging the potential cardiovascular benefits of moderate alcohol intake, concerns arise with excessive use, especially related to some specific cancer types. The detailed evidence emphasizes the importance for healthcare professionals to convey a balanced message, advocating moderation for cardiovascular benefits while acknowledging potential cancer risks linked to excessive consumption. Regarding moderate consumption, the overall balance favors intake, supported by studies like the Global Burden of Disease Study 2020. The intricate risk-benefit ratio of alcohol use demands tailored explanations based on individual characteristics and habits, considering overall risk profiles for cardiovascular diseases, alcohol-related cancers (for example, breast cancer has been associated with moderate alcohol consumption, although the evidence is not conclusive), and other health issues. Factors such as age, pregnancy, cognitive tasks, and personal history influencing the likelihood of alcohol abuse should inform personalized advice on moderate alcohol consumption. Collaborative efforts among stakeholders, including government agencies and healthcare organizations are crucial for providing up-to-date, comprehensive information. Clinical guidelines stress the complexities of the alcohol-heart healthy relationship, advocating moderation and individualized advice. Within personalized advice, the significance of moderate alcohol consumption, particularly in the form of wine within a Mediterranean diet, is highlighted. Wine is seen as a fundamental component of a wholesome diet, aligning with healthy dietary patterns, rather than a medicinal remedy. Acknowledging wine's integration into sound nutrition contributes to heart-healthy lifestyles, in line with Mediterranean dietary traditions. Healthcare professionals play a pivotal role in guiding patients on alcohol intake, considering specific health status and risk factors. Public health campaigns focus on educating individuals to make informed choices about alcohol consumption in the broader context of cardiovascular health. In conclusion, achieving cardiovascular health without undue risks necessitates a balanced and personalized approach to alcohol consumption, guided by healthcare professionals and public health recommendations.

Association between socioeconomic and motherhood characteristics with receiving community-based treatment services among justice-involved young female drug users: a retrospective cohort study in Taiwan

BackgroundDrug-involved individuals who contact treatment services in Taiwan are mostly driven by criminal justice systems either as an alternative or adjunct to criminal sanctions for a drug offence. With a focus on justice-involved young female drug users, the present study examines the extent to which socioeconomic and motherhood characteristics are associated with receiving deferred prosecution, a scheme diverting drug offenders to community-based addiction treatment.MethodsWe identified a cohort of 5869 women under the age of 30 arrested for using Schedule II drugs (primarily amphetamine-like stimulants) from the 2011–2017 National Police Criminal Records in Taiwan. Information concerning socioeconomic characteristics, pregnancy and live birth history, and deferred prosecution was obtained through linkage with the 2006–2019 National Health Insurance, birth registration, and deferred prosecution datasets. Multinomial logistic regression was used to evaluate the association with stratification by recidivism status.ResultsWithin six months of arrest, 21% of first-time offenders (n = 2645) received deferred prosecution and 23% received correction-based rehabilitation; the corresponding estimates for recidivists (n = 3224) were 6% and 15%, respectively. Among first-time offenders, low/unstable income was associated with lower odds of deferred prosecution (adjusted odds ratio [aOR] = 0.71; 95% CI: 0.58, 0.88). For recidivists, those with low/unstable income (aOR = 1.58) or unemployment (aOR = 1.58) had higher odds of correction-based rehabilitation; being pregnant at arrest was linked with reduced odds of deferred prosecution (aOR = 0.31, 95% CI: 0.13, 0.71) and correction-based rehabilitation (aOR = 0.50, 95% CI: 0.32, 0.77).ConclusionsFor the young women arrested for drug offences, disadvantaged socioeconomic conditions were generally unfavored by the diversion to treatment in the community. Childbearing upon arrest may lower not only the odds of receiving medical treatment but also correctional intervention. The criminal prosecution policy and process should be informed by female drug offenders’ need for treatment and recovery.

Proportion of hydatidiform molar gestations among patients undergoing uterine evacuation for missed abortions, associated demographics and risk factors -Experience at a single center over 18 months

Objectives: Gestational trophoblastic diseases represent a significant obstetric morbidity among women of reproductive age, with a potential to impact women’s health substantially. Molar pregnancies present as clinical aberrations in embryogenesis and placentation during the first trimester of pregnancy. Cases with missed abortions and spontaneous incomplete abortions requiring uterine evacuation, could be an opportunity to look for molar pregnancies through histopathology which otherwise could be missed. We aim to study the proportion of hydatidiform molar gestations among patients undergoing uterine evacuation in cases of missed abortion and to evaluate the demographic and risk factors associated with hydatidiform molar gestations. Material and Methods: A prospective observational, descriptive study was conducted at the Department of Obstetrics and Gynecology of a tertiary care teaching hospital over a period of 18 months. Data was collected using a pre-tested study questionnaire which included the objectives, besides the inclusion and exclusion criteria. The abortus and uterine evacuated tissue was sent for histopathologic examination by a single histopathologist. Analysis of various epidemiological characteristics and risk factors was done using the Statistical Package for the Social Sciences software version 21. Results: Out of 67 patients presenting with missed abortions or incomplete abortions during the study period, five had hydatidiform molar gestations; an incidence of 7.5%. Upon histological examination 3 (4.5%) patients had a complete mole, 2 (3%) had a partial mole while 62 (92.5%) had non-molar histopathology. Eleven (16.4%) of the study participants had a history of previous spontaneous pregnancy loss/recurrent pregnancy losses. Three among five cases detected to have molar gestations had a history of prior spontaneous abortions (60%), and the difference observed was statistically significant (P = 0.019; Odds Ratio [95% Confidence interval] 10.25 [1.459–70.257]). Hyperthyroidism and high levels of serum beta-human chorionic gonadotrophin (β-HCG) were associated with molar gestations and this was statistically significant. Conclusion: The risk of developing molar gestation is higher in patients who had previous first-trimester losses. Importantly, this should be a differential diagnosis in instances with elevated β-HCG and high thyroid hormone levels. Histopathological examination of products of conception should be considered as an essential assessment in all presentations of spontaneous abortions requiring uterine evacuation.

Frequency of self reported abortion and associated factors in Iran

ABSTRACT Background: There are few reliable Iranian-induced abortion data. The aim of this paper was to investigate the prevalence and socioeconomic characteristics of women and men who report having had or been a partner in an abortion. Materials and Methods: A cross-sectional survey of women and men aged 15–49 years referred to the health center that randomly selected from 110 health center that was used. Results: Data from 1520 women and men surveys were analyzed. One in 10 women and one in 12 men had experienced or been a partner in an abortion. In adjusted analyses, women and men in the 34–49 age group [adjusted odds ratio (AOR) 0.62, 95% (CI) 0.41, 0.96], the importance of religion in fertility (AOR = 0.42; 95% CI 0.26, 0.67), dissatisfied general health (AOR = 0.52; 95% CI 0.32, 0.87), and history of unwanted pregnancy for twice (AOR = 2.32; 95% CI 1.43, 3.77) and history of unwanted pregnancy for three-time or more (AOR = 2.69; 95% CI 1.59, 5.49) were associated with significantly increased odds of abortion. Haven’t heard of medication abortion, that is, abortion with tablets (AOR = 0.43; 95% CI 0.29, 0.67) was associated with significantly reduced odds of abortion. Conclusions: The findings contribute to scarce information about abortion in Iranian. Due to the high prevalence of abortion and the country’s population growth policy, Iranian women need a full range of sexual and reproductive health services, including contraceptive counseling and accessible abortion care.

Antenatal Glycemic Management and Postpartum Cardiovascular Disease Risk Screening

ObjectivesThis study aims to evaluate the cardiovascular disease (CVD) risk profiles of patients referred to the Maternal Health Clinic (MHC) with a history of gestational diabetes mellitus (GDM). MethodsEligible patients had their MHC appointment at 6 months postpartum between November 2011 and May 2022 and experienced GDM in their most recent pregnancy. Included participants were then divided into subgroups comparing methods of glycemic control: diet-controlled GDM and insulin-controlled GDM. Additionally, the MHC recruited 47 patients who have not experienced a complication in pregnancy to act as a comparator group in research studies. Demographics, medical and pregnancy history, and CVD risk scores were compared between the 3 groups. ResultsIn total, 344 patients with GDM were included in the analysis; 165 were insulin-controlled and 179 diet-controlled. When measuring the median 30-year Framingham risk score based on both BMI and lipids, there was a significant stepwise increase seen from the unexposed group, the diet-controlled GDM, and the insulin-controlled groups, respectively (all P < 0.05). The presence of metabolic syndrome showed a stepwise increase in prevalence when comparing the unexposed group, diet-exposure group, and the insulin-exposure group, respectively (16.7%; 21.5%–44.8%, P < 0.05). ConclusionsOur findings reinforce the prevalence of maternal CVD risk among GDM-diagnosed patients in the postpartum period and the necessity for screening. More specifically, our findings show how CVD risk may differ based on required interventions for glycemic control throughout pregnancy. Future research should aim to compare a more diverse patient population to optimise the generalizability of glycemic control-specific CVD outcomes.

Factors associated with contraceptive use among women with epilepsy: A cross‐sectional study

AbstractBackgroundEpilepsy is the most common neurologic disorder globally. Women with epilepsy (WWE) have a special need for contraception and careful pregnancy planning. This study aimed to determine the utilization of modern contraceptive methods and associated factors among WWE at neurology clinics in Addis Ababa, Ethiopia.MethodsA cross‐sectional study was conducted on women of reproductive age attending neurology clinics for an epilepsy diagnosis at three referral hospitals in Addis Ababa, Ethiopia, from June to December 2020. Data was collected using a structured and pretested questionnaire administered by a trained interviewer. Simple descriptive analysis, bivariate analysis, and multivariable logistic regression were performed as appropriate.ResultsOnly 29.7% of the women were using a modern contraceptive method. Contraceptive implants were the most popular method used (29.9% of contracepting women). Being married was associated with higher utilization of modern contraceptive methods [adjusted odds ratio [OR] (95%, confidence interval [CI]) 3.91 (1.80, 8.50)]. Women who were from an urban area [adjusted OR (95% CI) 0.29 (0.11, 0.78)], who had never been pregnant [adjusted OR (95% CI) 0.34 (0.17, 0.68)], and who had never been counseled on contraception [adjusted OR (95% CI) 0.47 (0.28, 0.78)] had lower odds of modern contraceptive method utilization compared to the respective counterparts.ConclusionIn this study, only a third of WWE were using a modern contraceptive method. Marital status, place of residence, previous history of pregnancy, and history of family planning counseling were independent predictors of modern contraceptive utilization.

Distribution Characteristics of Rh Phenotype and Feasibility of Compatible Blood Transfusion in Pregnant and Postpartum Women

To analyze the distribution characteristics of Rh phenotype in pregnant and postpartum women in Chongqing area, and to explore the clinical significance of Rh phenotype in pregnant and postpartum women and the feasibility of Rh phenotype compatible blood transfusion. The ABO blood group and Rh phenotype of 65 161 pregnant and postpartum women were detected by microcolumn gel method, and 48 122 males in the same period were taken as controls. The data were analyzed by Chi-square test. There were 112 870 cases (99.64%) of RhD+ in 113 283 samples. In RhD+ cases, CCDee (48.39%) and CcDEe (32.88%) were the main phenotypes. The first case of D-- phenotype in Chongqing area was detected. 413 cases (0.36%) of RhD- were detected, with ccdee (52.78%) and Ccdee (33.41%) as the main phenotypes. Compared with RhD- group, RhD+ group showed statistically significant difference in Rh phenotype distribution (P < 0.01). Among 65 161 maternal samples, the positive rate of 5 antigens of Rh blood group from high to low was D > e > C > c > E, and there was no significant difference compared with male samples (P >0.05). There was no significant difference in the distribution of Rh phenotype between males and pregnant/postpartum women, as well as between pregnant/postpartum women with different ABO blood groups (P >0.05). In pregnant and postpartum women, there was no significant difference in distribution of Rh phenotype among the normal pregnancy population, the population with adverse pregnancy history, the population using human assisted reproductive technology (ART) and the population with infertility (P >0.05). There was no significant difference in the distribution of Rh phenotype between the 4 populations mentioned above and the inpatients in the local general Grade A hospitals and the blood donors (P >0.05). In RhD positive pregnant and postpartum women, the probability of finding compatible blood for CcDEe phenotype was 100%, the probability of finding compatible blood for CCDee, CcDee and CCDEe phenotypes was 45%-60%, the probability of finding compatible blood for ccDEE, ccDEe and CcDEE phenotypes was 5%-10%, and the probability of finding compatible blood for other phenotypes was lower than 0.5%. The supply of blood with CCDee and ccDEE phenotypes can meet the compatible transfusions requirements of 7 Rh phenotypes in more than 99% of patients. Rh phenotype detection should be carried out for pregnant and postpartum women, and it is feasible to carry out Rh phenotype-matched or compatible blood transfusion for pregnant and postpartum women who need blood transfusion.

Sweetened Beverage Tax Implementation and Change in Body Mass Index Among Children in Seattle

Sweetened beverage taxes have been associated with reduced purchasing of taxed beverages. However, few studies have assessed the association between sweetened beverage taxes and health outcomes. To evaluate the association between the Seattle sweetened beverage tax and change in body mass index (BMI) among children. In this longitudinal cohort study, anthropometric data were obtained from electronic medical records of 2 health care systems (Kaiser Permanente Washington [KP] and Seattle Children's Hospital Odessa Brown Children's Clinic [OBCC]). Children were included in the study if they were aged 2 to 18 years (between January 1, 2014, and December 31, 2019); had at least 1 weight measurement every year between 2015 and 2019; lived in Seattle or in urban areas of 3 surrounding counties (King, Pierce, and Snohomish); had not moved between taxed (Seattle) and nontaxed areas; received primary health care from KP or OBCC; did not have a recent history of cancer, bariatric surgery, or pregnancy; and had biologically plausible height and BMI (calculated as weight in kilograms divided by height in meters squared). Data analysis was conducted between August 5, 2022, and March 4, 2024. Seattle sweetened beverage tax (1.75 cents per ounce on sweetened beverages), implemented on January 1, 2018. The primary outcome was BMIp95 (BMI expressed as a percentage of the 95th percentile; a newly recommended metric for assessing BMI change) of the reference population for age and sex, using the Centers for Disease Control and Prevention growth charts. In the primary (synthetic difference-in-differences [SDID]) model used, a comparison sample was created by reweighting the comparison sample to optimize on matching to pretax trends in outcome among 6313 children in Seattle. Secondary models were within-person change models using 1 pretax measurement and 1 posttax measurement in 22 779 children and fine stratification weights to balance baseline individual and neighborhood-level confounders. The primary SDID analysis included 6313 children (3041 female [48%] and 3272 male [52%]). More than a third of children (2383 [38%]) were aged 2 to 5 years); their mean (SE) age was 7.7 (0.6) years. With regard to race and ethnicity, 789 children (13%) were Asian, 631 (10%) were Black, 649 (10%) were Hispanic, and 3158 (50%) were White. The primary model results suggested that the Seattle tax was associated with a larger decrease in BMIp95 for children living in Seattle compared with those living in the comparison area (SDID: -0.90 percentage points [95% CI, -1.20 to -0.60]; P < .001). Results from secondary models were similar. The findings of this cohort study suggest that the Seattle sweetened beverage tax was associated with a modest decrease in BMIp95 among children living in Seattle compared with children living in nearby nontaxed areas who were receiving care within the same health care systems. Taken together with existing studies in the US, these results suggest that sweetened beverage taxes may be an effective policy for improving children's BMI. Future research should test this association using longitudinal data in other US cities with sweetened beverage taxes.

Comparison of Different Ultrasonic Screening Methods and Analysis of High Risk Factors for Fetal Cardiac Malformation in Second Trimester of Pregnancy.

Current study aims to compare the application of two-dimensional (2D) color doppler ultrasound (CDU) and four-dimensional (4D) ultrasound spatiotemporal image correlation (STIC) in fetal congenital heart disease in the second trimester of pregnancy and to analyze the high risk factors of the disease. From August 2019 to July 2021, 135 second-trimester patients with highly suspected congenital heart malformations were selected who underwent prenatal screening at South Taihu Hospital Affiliated to Huzhou University. 2D-CDU, 4D STIC, and postnatal examination were completed in all patients. 2D-CDU, 4D STIC and 2D-CDU combined with 4D STIC were used to detect fetal cardiac malformations and classify cardiac malformations. The sensitivity, specificity, positive predictive value, negative predictive value and coincidence rate of 2D-CDU, 4D STIC and 2D-CDU combined with 4D STIC were compared. The results of 2D-CDU, 4D STIC and 2D-CDU combined with 4D STIC screening were analyzed for consistency using the results of postpartum diagnosis as the gold standard. Moreover, effects of maternal gestational factors on fetal cardiac malformations by univariate and multivariate analysis. 2D-CDU combined with 4D STIC showed significantly higher section display number than 2D-CDU or 4D STIC in the view of ductal arch, aortic arch, and aortic short-axis. A total of 45 cases of fetal congenital heart malformation were detected in 135 patients in the second trimester, 40, 38 or 42 cases were detected by 2D-CDU, 4D STIC or 2D-CDU combined with 4D STIC, respectively. The sensitivity, specificity, positive predictive value, negative predictive value and coincidence rate of 2D-CDU combined with 4D ultrasound in congenital heart malformation screening were higher than those of 2D-CDU or 4D STIC. Kappa agreement analysis showed that the diagnostic results of 4D STIC and 2D-CDU combined with 4D ultrasound in fetuses with suspected congenital heart malformation were in excellent agreement (κ > 0.75), while 2D-CDU was in good agreement with postpartum diagnosis (κ < 0.75). Univariate and multivariate regression analysis revealed that maternal age ≥ 35, drinking during pregnancy, and history of adverse pregnancy and childbirth were all independent risk factors for fetal cardiac malformations, while folic acid supplementation was an independent protective factor for fetal cardiac malformations. 2D-CDU combined with 4D echocardiography may be superior to single 2D-CDU or 4D STIC in the screening of fetal congenital heart malformation in the second trimester. In order to reduce the incidence of fetal heart anomalies, we should strengthen the screening of pregnancy anomalies in high-risk pregnant women and control the risk factors.

Factors Predicting Completion of Four or More Antenatal Care Visits in Sarlahi District, Nepal.

A significant number of women die from pregnancy and childbirth complications globally, particularly in low- and middle-income countries (LMICs). Receiving at least four antenatal care (ANC) visits may be important in reducing maternal and perinatal deaths. This study investigates factors associated with attending ≥ 4 ANC visits in Sarlahi district of southern Nepal. A secondary analysis was conducted on data from the Nepal Oil Massage Study (NOMS), a cluster-randomized, community-based longitudinal pregnancy cohort study encompassing 34 Village Development Committees. We quantified the association between receipt/attendance of ≥ 4 ANC visits and socioeconomic, demographic, morbidity, and pregnancy history factors using logistic regression; Generalized Estimating Equations were used to account for multiple pregnancies per woman. All pregnancies resulting in a live birth (n=31,867) were included in the model and 31.4% of those pregnancies received 4+ ANC visits. Significant positive associations include socioeconomic factors such as participation in non-farming occupations for women (OR=1.52, 95% CI: 1.19, 1.93), higher education (OR=1.79, 95% CI: 1.66, 1.93) and wealth quintile OR=1.44, 95% CI: 1.31, 1.59), nutritional status such as non-short stature (OR=1.17, 95% CI: 1.07, 1.27), obstetric history such as adequate interpregnancy interval (OR=1.31, 95% CI: 1.19, 1.45) and prior pregnancy but no live birth (OR=2.14, 95% CI: 1.57, 2.92), symptoms such as vaginal bleeding (OR=1.35, 95% CI:1.11, 1.65) and awareness of the government's conditional cash transfer ANC program (OR=2.26, 95% CI: 2.01, 2.54). Conversely, belonging to the lower Shudra caste (OR=0.56, 95% CI: 0.47, 0.67), maternal age below 18 or above 35 (OR=0.81, 95% CI:0.74, 0.88; OR=0.77, 95% CI: 0.62, 0.96)), preterm birth (OR=0.41, 95% CI: 0.35, 0.49), parity ≥ 1 (OR=0.66, 95% CI: 0.61, 0.72), and the presence of hypertension during pregnancy (OR=0.79, 95% CI: 0.69, 0.90) were associated with decreased likelihood of attending ≥ 4 ANC visits. These findings underscore the importance of continuing and promoting the government's program and increasing awareness among women. Moreover, understanding these factors can guide interventions aimed at encouraging ANC uptake in the most vulnerable groups, subsequently reducing maternal-related adverse outcomes in LMICs. The clinicaltrial.gov trial registration number for NOMS was #NCT01177111. Registration date was August 6th, 2010.

BMI status and weight trajectories across females’ reproductive years and risk of adverse pregnancy outcomes: a prospective cohort study

BackgroundPrepregnancy body mass index (BMI) is a well-established risk factor of adverse pregnancy outcomes (APOs). The associations of long-term and short-term weight trajectories with APOs are less clear. ObjectivesThis study aimed to determine the associations of weight trajectories during females’ reproductive years, before and between pregnancies, with risk of APOs. MethodsWe followed 16,241 females (25,386 singleton pregnancies) participating in a prospective cohort, the Nurses’ Health Study II. Weight at age 18 y, current weight, and height were assessed at baseline (1989), and weight was updated biennially. Pregnancy history was self-reported in 2009. The primary outcome was a composite of hypertensive disorders of pregnancy (HDP), gestational diabetes (GDM), preterm birth, and stillbirth. Secondary outcomes were individual APOs. The associations of weight change with APOs were estimated using log-binomial regression, adjusting for demographic, lifestyle, reproductive factors, and baseline BMI (in kg/m2). ResultsThe mean (standard deviation [SD]) age at first in-study pregnancy was 33.7 (4.1) y. The mean (SD) time from age 18 y to pregnancy, baseline to pregnancy, and between pregnancies was 16.3 (4.0), 6.1 (3.0), and 2.9 (1.6) y, with a corresponding weight change of 6.4 (9.1), 3.1 (5.8), and 2.3 (4.8) kg, respectively. Of the pregnancies, 4628 (18.2%) were complicated by ≥1 APOs. Absolute weight change since age 18 y was most strongly associated with APOs. Compared with females whose weight remained stable (0–2 kg) since age 18, females who gained >2 kg had higher risk of APO (2.1–9.9 kg, relative risk [RR]: 1.12; 95% confidence interval [CI]: 1.02, 1.23; 10.0–14.9 kg, RR: 1.43; 95% CI: 1.29, 1.60; ≥15 kg, RR: 1.87; 95% CI: 1.69, 2.08), primarily driven by HDP and GDM. The associations of per 1 kg weight gain before and between pregnancies with HDP were nearly identical. ConclusionsWeight trajectories prior to and between pregnancies were associated with the risk of APOs, particularly HDP. Longer periods of weight gain, corresponding to greater absolute weight gain, were most strongly associated with higher risk of APOs.