Pregnancy In Taiwan Research Articles

Assessment of iodine nutritional status and gestational thyroid function reference ranges during the first trimester of pregnancy in Taiwan.

Iodine nutrition is critical for fetal neurodevelopment in the first trimester of pregnancy, a period associated with dramatic changes in thyroid function. The aim of this study was to evaluate iodine nutritional status and thyroid function reference ranges in the first trimester in Taiwan. Pregnant women aged 20 years and above in the first trimester were recruited in Taipei Veterans General Hospital, Taiwan from March 2019 to July 2022. Each participant provided a spot urine sample for measurement of urinary iodine concentration (UIC) and a blood sample for checkup of thyroid function and thyroid autoantibodies. A simple food frequency questionnaire was also completed. A total of 209 women with a mean age of 32.9 ± 4.4 years were enrolled. The median UIC was 160.9 μg/L (interquartile range [IQR]: 105.0-246.2 μg/L), indicating overall iodine sufficiency. The gestational thyroid function reference ranges were: thyroid stimulating hormone (TSH) (median: 0.93 [0.007-2.9] µIU/mL), free T4 (1.3 [0.93-2.2] ng/dL), free T3 (3.0 [2.3-5.0] ng/dL), total T4 (9.9 [6.4-16.9] ng/dL), and total T3 (135 [88-231] ng/dL). If the nonpregnant reference range of serum TSH was used, eight women (4.8%) would be misclassified as having subclinical hyperthyroidism, and two women (1.2%) with subclinical hypothyroidism would be missed. In multivariate analysis, nulliparous (adjusted odds ratio [OR] from model 1-3: 2.02, 2.05, 2.02; 95% CI, 1.08-3.77, 1.10-3.81, 1.11-3.66; p = 0.027, 0.023, 0.022, respectively) and multivitamin nonusers (adjusted OR from model 1-3: 1.86, 1.85, 1.78; 95% CI, 1.04-3.34, 1.03-3.32, 1.004-3.71; p = 0.038, 0.039, 0.049, respectively) had increased odds of having lower UIC levels <150 μg/L. The iodine nutritional status in the first trimester is adequate in Taiwan; however, certain subgroups such as nulliparous and multivitamin nonusers are still at risk for iodine deficiency. Gestational thyroid function reference ranges are needed for correct diagnosis of thyroid dysfunction in pregnancy.

Long-term follow up of fecundability after ectopic pregnancy in Taiwan: a nationwide population-based study.

Ectopic pregnancy (EP) occurs when a fertilized ovum is implanted outside the uterine cavity. Its incidence is 2% of all pregnancies and is known to decrease fertility. This study aimed to measure pregnancy rates after EP, identify the various parameters influencing pregnancy, and compare these variables in women with and without a history of EP, as well as determine in which medical facilities women with EP seek medical help. The data was extracted from the National Health Insurance Research Database during 2000-2013. The study group included of women with a history of one EP (study group) and women without EP (control group). The chi-square/Fisher exact test was performed for categorical variables, and t-tests were used for continuous variables. The EP group had a higher cumulative pregnancy rate (41.55%) than the control group (37.14 %), and a 1.16 times higher rate in developing pregnancy (p < 0.001). While the pregnancy rate in the EP group was initially lower than in the control group during the first 5 years, it surpassed the control group's rate between the 10 th and 14 th years. Fecundability after EP was lower at the beginning but increased at long-term follow-up.

Factors Associated With Influenza Vaccination During Pregnancy: A Real-World Evidence-Based Study.

Pregnant women are at increased risk of influenza-related complications. However, the rate of influenza vaccination among pregnant women in Taiwan is low. By analyzing real-world data in this study, we investigated the factors associated with influenza vaccination during pregnancy in Taiwan. This study was a cross-sectional study. We collected real-world data from 2 databases in Taiwan: the Birth Certificate Database and the National Health Insurance Research Database. The study population was pregnant between October 2014 and December 2016 in Taiwan. The multivariate logistic regression was performed to identify factors associated with influenza vaccination, including maternal sociodemographics, trimester, comorbidities, and health-care utilization. The vaccination rate of among pregnant women was 8.2%. Factors significantly associated with a high likelihood of influenza vaccination were age between 30 and 34 years (odds ratio [OR]: 1.14; 95% confidence interval [CI]: 1.10-1.19), second trimester (OR: 1.80; 95% CI: 1.75-1.85), income equal to or exceeding NT$ 38 201 (OR: 1.92; 95% CI: 1.86-1.99), hypertension (OR: 1.16; 95% CI: 1.05-1.29), cardiovascular disease (OR: 1.29; 95% CI: 1.17-1.42), autoimmune disease (OR: 1.47; 95% CI: 1.38-1.58), and chronic pulmonary disease (OR: 1.24; 95% CI: 1.18-1.31). A low level of urbanization, at least 1 hospitalization in the previous year, and the presence of pregnancy complications (eg, gestational diabetes, preeclampsia, and placenta previa) were associated with a lower likelihood rate of influenza vaccination. The influenza vaccination rate among pregnant women in Taiwan was low. Age, gestational age, income level, urbanization level, hypertension, cardiovascular disease, autoimmune disease, chronic pulmonary disease, and pregnancy complications may be associated with influenza vaccination among pregnant women.

Technological experiences and end-users’ identification work – investigating expectant mothers’ prenatal ultrasound experiences and their reconfigurations

ABSTRACT Investigating expectant mothers’ pregnancy in Taiwan, this paper examines prenatal ultrasound as an ongoing invention of its users in general and pregnant women in particular. Instead of being passive consumers, pregnant women actively invent and reconfigure prenatal ultrasound using flexible interpretation and strategic reinscription. There is an inevitably ambivalent technological experience of prenatal ultrasound across cultures. Whereas pregnant women are pleased and reassured to see their babies ‘on the screen,’ my analysis shows that, prenatal ultrasound as a passive diagnostic tool that cannot offer active treatment, and the fact that prenatal ultrasound helps to make up morality surrounding pregnancy, constitutes the main source of mothers-to-be’s negative technological experiences of prenatal ultrasound. Whereas prenatal ultrasound has been regarded as an indispensable and authoritative method of keeping users informed, adopting a hybrid approach, pregnant women still actively refer to local knowledge to understand their pregnancy.

Trends in epidemiology of hyperglycemia in pregnancy in Taiwan, 2008-2017.

Hyperglycemia in pregnancy (HIP) increases the risk of adverse pregnancy outcomes. The increasing prevalence of overweight or obesity and the increasing proportion of pregnant women with advanced maternal age (AMA) in the recent decade may affect its prevalence. We analyzed the secular trend of HIP prevalence in 2008-2017 in Taiwan and investigated the impact of AMA in this study. This cross-sectional study used data from Health and Welfare Data Science Center. Pregnant women who registered their data in the Birth Certificate Application in 2008-2017 were recruited. Diagnosis of HIP was defined by ICD-9-CM and ICD-10-CM codes. In 2008-2017, 151,306-211,768 pregnant women were recruited in different years. The proportion of women with AMA increased from 15.8% to 32.1%. Meanwhile, the prevalence increased from 0.5% to 0.9% for preexisting diabetes, 0.2% to 0.4% for undiagnosed diabetes, and 11.4% to 14.5% for GDM. Maternal age was significantly associated with the prevalence of HIP. For women aged <30 years, 30-34 years and ≥35 years, the prevalence of preexisting diabetes were 0.51%, 0.75% and 1.24%, respectively (p<0.05); the prevalence of undiagnosed diabetes were 0.18%, 0.24% and 0.37%, respectively (p<0.05); and the prevalence of GDM were 10.57%, 14.77% and 18.13%, respectively (p<0.05). In all age groups, the prevalence of HIP increased over time in 2008-2017. The prevalence of HIP increased in Taiwan in 2008-2017, which may result from the increasing proportion of pregnant women with AMA and the change in the diagnostic criteria for GDM.

The pregnancy outcome and drug usage during pregnancy among Taiwanese inflammatory bowel disease patients

AbstractInflammatory bowel disease (IBD) is a chronic gastrointestinal disorder characterized by relapsing inflammation and severe mucosal damage in the intestine. Young IBD women are often worried about their fertility, the disease activity during pregnancy, the heritability of the disease to their unborn child, and also the effect of their disease on the pregnancy itself. The pregnancy outcome and drug usage during pregnancy are rarely discussed in an area of low IBD prevalence. To evaluate (a) decision‐making around drug therapy during pregnancy and (b) the prognosis for pregnant IBD patients in an area of low IBD prevalence. We conducted a retrospective analysis across seven medical centers in Taiwan from February 2009 to February 2019. Maternal and fetal/neonatal outcomes were analyzed. A total of 17 patients (21 pregnancies) were enrolled. The mean age of patients was 35.9 ± 4.6 years. Six patients (35.3%) had fertility worries and two (11.8%) had infertility. Five patients had Crohn's disease (CD), of whom 60% had undergone prior abdominal surgery. The remaining 12 patients had ulcerative colitis (UC), of whom 8.3% had undergone prior abdominal surgery (significantly lower than CD patients [P = .02]). There were no significant differences between the CD and UC groups in terms of age, age of primigravida, height, weight, fertility worries, or infertility. Abortion, miscarriage, or stillbirth was seen in 23.8% of patients, and 14.3% of patients needed treatment to prevent miscarriage. Low birth weight (&lt;2500 g) was seen in 14.3% of births, and 14.3% had associated complications. There was no significant difference between CD and UC patients in terms of pregnancy outcome. During pregnancy, 33.3% of patients changed their drug regimens, stopping the use of 5‐ASA (9.5%), immunosuppressants (4.8%), corticosteroids (4.8%), or biologics (9.5%). However, if IBD progressed during pregnancy, corticosteroids were considered (19.4%) for disease control. These are real‐world experiences of IBD during pregnancy in Taiwan. High rates of abortion, miscarriage, or stillbirth and treatment to prevent miscarriage were noted. Among all subjects, 33.3% of patients changed their drug regimen during pregnancy. Corticosteroids were also considered if IBD progressed during pregnancy in this study.

Secular trend in prevalence and socioeconomic correlates of diabetes in pregnancy in Taiwan.

To assess the trend in prevalence and socioeconomic correlates of diabetes in pregnancy (DIP) in Taiwan from 2007 to 2014. In all, 1 606 344 pregnancies, including 199 383 DIP (1693 with pre-pregnancy type 1 diabetes [T1DM], 17 171 with pre-pregnancy type 2 diabetes [T2DM], and 180 519 with gestational diabetes mellitus [GDM]) were investigated. Logistic regression models were performed to identify the covariates significantly associating with DIP. Over the study period, the prevalence of pre-pregnancy T2DM increased by 568.44%; the prevalence of T1DM and GDM also increased but with a smaller magnitude. However, only the prevalence of pre-pregnancy T2DM showed an increase after socioeconomic variables were considered. Compared with immigrant mothers, native-born mothers had a significantly higher adjusted odds ratio of DIP, particularly pre-pregnancy T1DM (3.33, 95% confidence interval 1.57-7.05). Additionally, indigenous mothers and those from rural areas had a higher prevalence of pre-pregnancy T2DM but lower prevalence of GDM. Lower maternal education and income were associated with higher prevalence of pre-pregnancy T1DM but lower prevalence of pre-pregnancy T2DM and GDM. Socioeconomic variables largely accounted for the increased secular trend in pre-pregnancy T1DM and GDM, but the prevalence of pre-pregnancy T2DM still doubled, which was independent of socioeconomic covariates.

Self-management experience of first-time diagnosed gestational diabetes mellitus: A focus group interview.

Gestational diabetes mellitus (GDM) has become the most common complication in women during pregnancy in Taiwan. Since several clinical trials have demonstrated benefits of aggressive treatment, which rely heavily on self-management. The present study was conducted to explore the self-management experience of women with first-time diagnosed GDM. A qualitative descriptive approach was applied to conduct this study. Purposive sampling was used to recruit patients with first-time diagnosed GDM from the maternity outpatient clinics of medical centre in Taiwan. A total of three focus groups interviews with 22 women were conducted to collect the data. Content analysis was applied to analyse the data. Four themes were identified: (1) unexpectedly having a high-risk pregnancy, (2) different perceptions for self-management, (3) implementation predicament of self-management and (4) maternal duty to ensure the safety of mother and child.

Attention deficit hyperactivity disorder among children related to maternal job stress during pregnancy in Taiwan: a prospective cohort study.

Attention deficit hyperactivity disorder (ADHD) is the most common neurobehavioral disorders. Although studies have suggested relationships between ADHD in children and maternal psychosocial stress during pregnancy, little is known about the effects of work-related mental stress. Considering the increasing number of pregnant women who continue to work during the gestation period, this study investigated whether work-related stress during pregnancy is related to offspring ADHD. The Taiwan Birth Cohort Study followed selected representative mother-infant pairs in a face-to-face interview since a child was 6 months old. A total of 10,556 working pregnant women who completed follow-up 8years later were included. Whether the 8-year-old child had ever received a diagnosis of ADHD were inquired. Self-reported job stress during pregnant period was obtained 6months after delivery. Factors including perinatal and socioeconomic factors as well as the mother's job conditions were further analyzed with logistic regression. Among those who continued working during pregnancy, 3850 (36.5%) mothers reported having job stress during pregnancy, and 210 (2.0%) of the children were diagnosed as having ADHD before 8years of age. Compared with mothers who reported no job stress, the adjusted odds ratio of child ADHD was 1.91 (95% CI 1.21-3.07) for mothers with "very stressful" jobs during pregnancy and 1.53 (95% CI 1.04-2.25) for mothers with "rather stressful" jobs. Among pregnant female workers, higher levels of job stress were related to the higher occurrence of ADHD in their children.

Status and related factors of depression, perceived stress, and distress of women at home rest with threatened preterm labor and women with healthy pregnancy in Taiwan

Background: Women with threatened preterm labor (TPTL) resting at home face several life challenges, but their psychological well-being has been ignored. This study aimed to explore the status and related factors of the psychological status of women with TPTL resting at home, and to compare the psychological status differences between TPTL and healthy pregnant women. Methods: A cross-sectional, multiple time-point study was conducted to repeatedly assess depression, perceived stress, and distress in 49 TPTL women and 62 healthy pregnant women during pregnancy in Taiwan. Mann-Whitney U tests were used to compare the psychological status differences between these women and the generalized estimating equation was used to identify the factors related to their psychological status. Results: The TPTL women's perceived stress at 24–27 weeks (p=0.047) and 32–35 weeks (p=0.04) and distress at each time point was significantly greater than that of healthy pregnant women (p<0.001). The common distress experienced by TPTL women was the inability to provide self-care and family care, the baby's health and safety, and to request leave from work for bed rest. Positive personalities, gestational age, preterm birth history, follow-up status and employment have been shown to be related to the psychological status of TPTL women. LimitationsThe major limitation of this study is the small sample size. Conclusion: This study contributed to a better understanding of the emotional burdens of women with TPTL resting at home. Such findings highlight the need for constructing effective interventions to alleviate the psychological burden of these women.

Impact of hysterosalpingography after operative treatment for ectopic pregnancy in Taiwan: A 16-year Nationwide Population-Based Analysis.

By retrieving records from Taiwan's National Health Insurance (NHI) system's database, the current study aimed to investigate the impacts of hysterosalpingography (HSG) to patients after ectopic pregnancy (EP) operations in Taiwan.In this retrospective cohort study, insurance claims data from 1997 to 2013, derived from a cohort of 1 million people randomly sampled to represent all NHI beneficiaries, were analyzed. Patients after ectopic pregnancy (EP) operations were identified via the inclusion of the corresponding NHI procedure codes. We further divided the patients into 2 groups by whether received subsequent HSG, EP-HSG, and EP-no-HSG. Patients with history of previous pregnancies (PP) and subsequent HSG were grouped as PP-HSG. We sought to evaluate the following pregnancies (FP) rate, interval to FP in EP-HSG compared with that in EP-no-HSG, and PP-HSG.EP-HSG had significantly higher FP rate odds ratio than EP-no-HSG (OR, 1.64; 95% CI, 1.24–2.16, P < .001). EP-HSG had lower FP rate odds ratio than that in PP-HSG, but no significant difference (33.1% vs 34.6%, P = .654). The INTERVAL(HSG-FP) in EP-HSG was no significantly different from that in PP-HSG (843.34 ± 82 days vs 644.72 ± 24.30 days, P = .077). There was significant positive correlation between FP after EP and number of HSG (r = 0.070∗∗, P < .001). There were significant negative correlation between FP and EP age (r = −0.270∗∗, P < .001), FP and INTERVAL(EP-HSG) (r = −0.212∗∗, P = .001). The multivariate analysis showed that INTERVAL(EP-HSG) less than 1 year is the predictor factor of INTERVAL(EP-FP) (hazard ratio: 1.422; 95% CI: 1.130–1.788; P = .003). It was evident that the longer the INTERVAL(EP-HSG), the lower the FP rate odds ratio; and the older the EP age, the lower the FP rate odds ratio. (OR, 95% CI; >1 year: 0.59, 0.41–0.86; >2 year: 0.42, 0.32–0.55; >25 years old: 0.47, 0.38–0.57; >30 years old: 0.29, 0.24–0.35; >35 years old: 0.12, 0.08–0.18, all P < .001).Receiving HSG after EP, short INTERVAL(EP-HSG), EP age less than 30 years old, had significant positive impacts on the FP. We encourage shortening the INTERVAL(EP-HSG), and the counseling of women on the most appropriate way to conceive thereafter.

Pregnancy is not a risk factor for idiopathic sudden sensorineural hearing loss: A nationwide population-based study

Conclusion Sudden sensorineural hearing loss (SSNHL) in pregnancy is rare. It usually occurs in the third trimester. SSNHL in pregnancy does not increase risks during delivery or subsequent stroke.Objectives This study aimed to investigate the incidence and to determine the factors associated with SSNHL in pregnancy.Method Data were retrieved from Taiwan's National Health Insurance Database (NHIRD), covering the years 2000–2009. Patients admitted for SSNHL during pregnancy were enrolled. An age-matched controlled cohort was randomly selected from pregnant women without SSNHL in the NHIRD. The clinical characteristics of both cohorts were collected for further analyses.Results Thirty-three patients with SSNHL in pregnancy were enrolled. The estimated incidence of SSNHL in pregnancy in Taiwan was 2.71 per 100,000 pregnancies. The incidence of SSNHL in pregnancy was lower than that of the general female population. The incidence of SSNHL in the third trimester was higher compared to the other two. The incidence of SSNHL occurring in the 30–39 years old age group was higher than other groups. Women with better socioeconomic status had a higher incidence of SSNHL. There were no identified systemic diseases before SSNHL. Two patients had pre-eclampsia and one patient had premature delivery. Nevertheless, SSNHL in pregnancy did not increase the risk for stroke.

Comparisons of four dietary assessment methods during pregnancy in Taiwanese women

ObjectiveThe purpose of this methodology study is to examine the relative validity of four dietary assessment methods during pregnancy and to understand the pros and cons of each method. Materials and methodsWe recruited 181 healthy pregnant women with less than 20 weeks of gestation and collected information through personal and telephone interviews in Taipei, Taiwan. Dietary assessment methods including 24-hour recalls, 3-day food records, and the weekly food frequency questionnaire during the 3 trimesters and the meal-based Chinese food frequency questionnaire (CFFQ) in the 3rd trimester were used in this prospective study. ResultsThe percentages of energy from protein (15%), fat (31–34%), and carbohydrate (50–54%) were similar by the recall and record methods. The energy intakes from 24-hour recalls were 1924 kcal, 1980 kcal, and 2172 kcal in the 1st, 2nd, and 3rd trimesters, respectively. The weekly food frequency questionnaire resulted in significantly higher intakes of all energy nutrients, especially for protein and fat intakes (percentages and densities) for the 3 trimesters; a further adjustment for the food list is needed. The CFFQ showed comparable results with the quantitative methods in estimating dietary patterns for the entire pregnancy. The 24-hour recalls by telephone interviews provided reasonable results in the assessment of the average nutrient intakes during the trimesters. ConclusionThe combinations of 24-hour recalls for the short-term dietary changes and the CFFQ for long-term dietary patterns are suggested as appropriate dietary assessment methods during pregnancy in Taiwan.

Prescriptions for category D and X drugs during pregnancy in Taiwan: a population-based study

This study aimed to investigate the most prescribed medications and principle diagnoses for category D and X drugs during pregnancy using a population-based dataset in Taiwan. The data for the present study were sourced from the Taiwan Longitudinal Health Insurance Database 2000. We selected 14 125 women who had live singleton births between 1 January 2009 and 31 December 2011. In total, 217 226 prescriptions prescribed to these pregnant women were identified. Of the total 217 226 prescriptions, 1.1% were category D or X drugs; in the first, second, and third trimesters of pregnancy, 1.8%, 0.7%, and 0.5% of prescriptions were category D or X drugs, respectively. Progestins (15.3%) and propylthiouracil (10.7%) were the two most frequently prescribed category D or X drugs during pregnancy. In particular, progestins (20.4%) and estrogens (15.6%) were the most frequently prescribed category D or X drug in the first trimester of pregnancy. Propylthiouracil was the most prescribed category D or X drug in the second (20.3%) and third trimesters (23.1%) of pregnancy, respectively. The most common principal diagnosis during pregnancy was "disorders of menstruation and other abnormal bleeding from the female genital tract" (22% of all principal diagnoses for prescribing category D and X drugs). Our study found that the physicians obviously reduced the use of category D and X drugs for women after becoming aware that they were pregnant.

Sexual Activity during Pregnancy in Taiwan: A Qualitative Study.

BackgroundPregnancy is a special period in a woman's life that involves physical and mental changes. These changes are influenced by cultural, social, religious, and emotional factors among others.AimThe aims of this article were to gather information, to describe the changes and behavior of sexual experiences in pregnancy, and to identify the reasons why pregnant women from central Taiwan decrease coital frequency during pregnancy.MethodsThis phenomenological qualitative research was intended to respond to open-ended questions that allowed the respondents to elaborate on the individuals' experiences. We collected data from in-depth, tape-recorded, and semi-structured interviews conducted in a cross-sectional study of 62 healthy pregnant women. The investigation ended when three consecutive interviewed subjects could not offer any new activities, which indicated that the study had reached its saturation point.Main Outcome MeasuresWe performed data collection and content analysis to ensure standards of rigor and reliability. Credibility was enhanced by prolonged engagement, triangulation, referential adequacy, member checking, and expert review; we categorized meaningful unit-codes in a mutually exclusive and exhaustive manner into perceptions, experiences, and practices such that common themes were grouped into categories.ResultsThree themes emerged: negative aspects of sexual experiences; stress and emotional responses; and changes in sexual practices. The majority of the women stopped engaging in coital activities during pregnancy. We determined that in most cases, the 62 participants obtained information regarding sexual activity during pregnancy from postpartum women and the Internet.ConclusionsThe current evidence-based findings encourage the provision of sexuality education to newlyweds and the discussion of sex-related issues during pregnancy. We propose developing strategies for increasing sexual knowledge and focusing on emotional support to decrease pregnant women's anxiety regarding sexuality in Taiwan. Liu HL, Hsu P, and Chen KH. Sexual activity during pregnancy in Taiwan: A qualitative study. Sex Med 2013;1:54–61.

Primary and Repeated Surgeries for Ectopic Pregnancies and Distribution by Patient Age, Surgeon Age, and Hospital Levels: An 11-Year Nationwide Population-Based Descriptive Study in Taiwan

Study ObjectiveTo describe the changing trend, repeat operation rate, and distribution of laparoscopy, as compared with laparotomy, in treating ectopic pregnancy, according to patient age, preoperative conditions, surgeon age, and hospital accreditation level, in Taiwan over 11-years. DesignRetrospective cohort study (Canadian Task Force classification II-2). SettingPopulation-based nationwide insurance database. PatientsWomen who underwent either laparotomy or laparoscopy because of ectopic pregnancy. InterventionsWomen who had National Health Insurance (NHI) underwent various surgical procedures to treat ectopic pregnancy. Data for this study were obtained from the Inpatient Expenditures by Admissions files of the NHI Research Database, released by the NHI program in Taiwan between 1997 and 2007. Measurements and Main ResultsA total of 43 170 women with 44 928 operations were identified. Only the primary surgeries, via either laparotomy or laparoscopy, performed because of ectopic pregnancy were included for analysis. The annual number of procedures to treat ectopic pregnancies decreased in the later years of the 11-year study. Laparotomy decreased significantly, from 81.2% in 1997 to 26.2% in 2007, whereas laparoscopic procedures increased significantly, from 18.8% in 1997 to 73.8% in 2007, as evidenced at log-linear regression analysis (p < .001). The rate of repeat operations because of persistent ectopic pregnancy was higher in the laparoscopy group than in the laparotomy group (0.38% vs 0.14 %; p < .001). Patients were more likely to undergo the same type of operation for the repeated surgery (i.e., laparotomy to laparotomy in 73.1% or laparoscopy to laparoscopy in 80.2%; p = 0.43). Use of laparoscopy (58.1%) and laparotomy (41.9%) differed according to patient age, preoperative comorbidities, surgeon age, and hospital accreditation level and ownership type. With older patients, those with preoperative anemia or shock, and elder surgeons, there was a greater chance that laparotomy would be performed. The probability of undergoing laparotomy was greater in patients in regional hospitals, local hospitals, and office-based clinics compared with those in medical centers. ConclusionsThere has been considerable change in the type of surgical approach used to treat ectopic pregnancy in Taiwan over the past 11 years. Laparoscopy is preferred to laparotomy, and has become the standard surgical approach to treating ectopic pregnancies in Taiwan. However, laparoscopy is associated with a higher rate of repeat operations. The laparoscopic approach signifies a profound change in treating ectopic pregnancies among patients, surgeons, and hospital types.

Different cut-off points for different trimesters? the use of edinburgh postnatal depression scale and beck depression inventory to screen depression during pregnancy in Taiwan

Background:Compared with postpartum depression, validating self-reported questionnaires to detect depression during pregnancy has gained much less attention. Furthermore, it is not known whether it is appropriate to use the same cut-off point to detect depression in different trimesters of pregnancy.Methods:One hundred and eighty-five Taiwanese women during pregnancy who completed the EPDS-T and the BDI-II were interviewed by psychiatrists with the structural interview, Mini-International Neuropsychiatric Interview (MINI), to establish DSM-IV diagnosis of major depressed disorder. We analyzed and compared the sensitivity, specificity, and validity of EPDS-T and the BDI-II against the MINI diagnosis in the second and third trimesters.Results:We identified 12/13 as the optimal cut-off of EPDS-T, at which the sensitivity of the scale was 83%, specificity 89%. The optimal cut-off of BDI-II was 11/12, at which the sensitivity of the scale was 74%, specificity 83%. The area under the curve (AUC) of the receiver-operating characteristic (ROC) analysis was 0.92 for EPDS-T and 0.84 for BDI. There were different optimal cut-off points of EPDS-T for detecting major depression during different trimesters: 13/14 for the second trimester and 12/13 for the third trimester. There was no different optimal cut-off point of BDI-II for different trimesters.Conclusions:EPDS-T has a satisfactory sensitivity and specificity, and a better validity than BDI-II for detecting major depressive disorder during pregnancy in Taiwanese pregnant women. Although it is possible that different cut-off points should be used to detect depression in different trimesters.

Prevalence of lower urinary tract symptoms during pregnancy in Taiwan.

Women often complain of symptoms related to urination during their pregnancy, but data are limited on the clinical profile and lower urinary tract symptoms (LUTS) of pregnant women in Taiwan. This study assessed the prevalence and predisposing factors of LUTS in Taiwanese women during pregnancy. A cross-sectional survey was designed to collect data on the prevalence of LUTS during pregnancy. Women attending the antenatal clinic of a medical center in central Taiwan were recruited and asked to complete a LUTS questionnaire including 12 questions on symptoms related to urination. 799 normal pregnant women were included in this study. The most common LUTS were nocturia (60.2%) and stress urinary incontinence (SUI; 46.1%), followed by urgency (34.1%), frequency (27.8%), incomplete emptying (26.2%), a bearing-down sensation (23.8%), and voiding difficulty (12.6%). The prevalence of nocturia, SUI, urgency, and frequency generally increased as gestational age advanced. There was a significantly higher prevalence of SUI in multiparous women than in nulliparous women; however, the prevalence of urgency, frequency, incomplete emptying, bearing-down sensation, and straining was significantly higher in nulliparous women than in multiparous women. High parity, high body weight before pregnancy and advanced gestational age were the predisposing factors of SUI during pregnancy. Only 6.5% of the pregnant women studied complained that SUI caused a social or hygienic problem based on the International Continence Society (ICS) criteria. This study provides a profile of LUTS in Taiwanese women during pregnancy. Nocturia was the most common lower urinary tract symptom. Nocturia, SUI, urgency, and frequency increased as gestational age advanced. Parity was a predisposing factor for LUTS during pregnancy, with multiparous women experiencing significantly more SUI while nulliparous women had higher prevalence of other LUTS.