Pregnancy Program Research Articles

O-092 The ‘Pleasure&Pregnancy’ eHealth programme and its effect on the sexual functioning and ongoing pregnancy rates of couples with unexplained subfertility: a randomized controlled trial

Abstract Study question Does offering the ‘Pleasure&Pregnancy programme’ rather than expectant management affect sexual desire, pleasure and satisfaction, intercourse frequency and ongoing pregnancy rates in subfertile couples? Summary answer The ‘Pleasure&Pregnancy programme’ limits the decline in sexual desire and intercourse frequency but does not affect sexual pleasure and satisfaction and ongoing pregnancy rates. What is known already Dutch guidelines advise six months of non-interactive expectant management, in couples with unexplained subfertility and Hunault-prognosis of minimally 30%, rather than immediately starting assisted reproduction. Adherence to this advice is limited as both couples and fertility clinic staff feel an urge for action. Underpowered studies indicated that face-to-face sex-counselling may increase the pregnancy rates of these couples. Interactive eHealth programmes proved as effective as face-to-face sex counselling in other patient populations. Our group developed the interactive six months Pleasure&Pregnancy web-based programme, aiming to help couples maintain or improve sexual pleasure and activity and consequently increase chances on naturally conceived pregnancies. Study design, size, duration This multi-centre trial randomised 701 couples between six months of the Pleasure&Pregnancy programme (n = 349) or expectant management, the current standard of care (n = 353) from 2016 to 2021. The Pleasure&Pregnancy web-based programme contains eight modules combining psychosexual education with couple communication, mindfulness and sensate focus exercises and additionally enables couples to interact with professionals and peers. Sexual outcomes were assessed with a diary and reliable questionnaires at baseline, three and six months. Participants/materials, setting, methods Heterosexual couples with unexplained subfertility and a Hunault-prognosis of minimally 30% were included after their diagnostic work-up in 41 Dutch fertility clinics. All analyses were according to intention-to-treat principles. Differences between groups in ongoing pregnancy rates (naturally conceived within six months after randomization; primary outcome) were expressed as relative risks (RR). Linear mixed models assessed time, group and interactive effects on female/male sexual desire, pleasure and satisfaction, and intercourse frequency; mean differences (MD) are provided. Main results and the role of chance Response rates at baseline, three and six months for the diaries assessing sexual pleasure (Quality of Sexual Experience; QSE) were, respectively: 55.8%, 33.9% and 16.8%. For the International Index of Erectile Function (IIEF) and the Female Sexual Function Index (FSFI) questionnaires assessing intercourse frequency, sexual desire and satisfaction response rates were, respectively: 83.2%, 50.8% and 41.2%. The probability of a naturally conceived ongoing pregnancy within six months after randomization did not differ between the randomized groups, and was 22% (n = 78/349) in the Pleasure&Pregnancy-group and 24% (n = 83/353) in the control group (RR 0.94; 95% CI 0.67 to 1.32). Neither did the groups differ in time to pregnancy (log rank p = 0.46). Both female and male sexual pleasure and satisfaction was comparable in both groups and did not change over time. Male sexual desire (scale 2-10) remained over time in the Pleasure&Pregnancy-group but decreased in the control group (MD 0.47, 95%CI 0.28 to 0.67, p < 0.001) and a similar trend was observed in females (MD 0.16, 95%CI -0.02 to 0.33, p = 0.086). Intercourse frequency declined over time in both groups (MD over 6 months -1.05, 95% CI -1.47 to -0.62, p < 0.01), but less in the Pleasure&Pregnancy- group (MD 0.3, 95% CI 0-0.6; p = 0.05). Limitations, reasons for caution The intended sample size of 1164 was not reached, although the inclusion period was doubled. Web-based tracking showed limited intervention adherence, indicating the need for per protocol analysis in addition to this intention-to-treat analysis. Examining user experiences with the Pleasure&Pregnancy programme would be of interest and might explain adherence rate. Wider implications of the findings Clinics are advised to offer the Pleasure&Pregnancy or similar programme to care for the sexual health of couples with unexplained subfertility. The Pleasure&Pregnancy programme did not increase naturally conceived ongoing pregnancy rates but did help couples maintain their sexual desire and intercourse frequency, while continuing to attempt natural conception. Trial registration number NTR5709

Sperm DNA Fragmentation Index: A Comparison Study of Success Rates among Natural, Intrauterine Insemination (IUI) and In Vitro Fertilization (IVF)-Intra Cytoplasmic Sperm Injection (ICSI) Pregnancy Programs

Background: Some studies have reported a relationship between the sperm DNA fragmentation index (DFI) and the rate of fertilization and pregnancy. This study was designed to assess the mean sperm DNA fragmentation in pregnancies that occur in infertile couples, whether in natural pregnancy, intrauterine insemination (IUI), and in vitro fertilization (IVF) – intra cytoplasmic injection (ICSI).
 Methods: This research is an observational analytic study with a cross-sectional design. The sample taken in this study were infertile patients that underwent natural pregnancy or IUI or IVF-ICSI at Yasmin Infertility Clinic of Dr. Ciptomangunkusumo Hospital period 2018-2020 with a consecutive sampling technique. The research data was processed and analyzed by the Mann-Whitney test using the SPSS application.
 Results: The mean DFI of sperm in men with infertile couples who successfully conceived naturally was 10.7% (mild), while IUI was 20.4% (moderate), and IVF-ICSI was 30.5% (poor). The mean DFI in semen samples of men from infertile couples who underwent a natural program was significantly lower in those who successfully conceived compared to those who did not. Similar results were also shown in the IUI and IVF-ICSI programs, which showed a significantly lower DFI compared to non-pregnant women.
 Conclusion: DFI can be applied as a marker for selecting the type of pregnancy program in infertility management.

Timing and temporal trends of influenza and pertussis vaccinations during pregnancy in three Australian jurisdictions: The Links2HealthierBubs population-based linked cohort study, 2012-2017.

Antenatal inactivated influenza (IIV) and pertussis-containing vaccines (dTpa) offer protection against severe respiratory infections for pregnant women and infants <6months of age. Both vaccines are recommended in pregnancy; however, little is known about temporal or jurisdictional trends and predictors of uptake. To identify gaps and predictors of IIV and/or dTpa vaccinations in Australian pregnancies from 2012 to 2017. We conducted a probabilistically linked, multi-jurisdictional population-based cohort study, drawing from perinatal data collections and immunisation databases. We used a generalised linear mixed model with a random effect term to account for clustering of multiple pregnancies within mothers, to calculate vaccination uptake, and identify predictors of uptake by maternal demographic, pregnancy, and health characteristics. Of 591 868 unique pregnancies, IIV uptake was 15%, dTpa 27% and 12% received both vaccines. Pertussis vaccinations in First Nations pregnancies were 20% lower than non-Indigenous pregnancies; dTpa was strongly associated with IIV uptake (risk ratio (RR): 8.60, 95% CI 8.48-8.73). This trend was temporally and jurisdictionally consistent. First Nations women were more likely to have had IIV in pregnancy before the introduction of dTpa in the pregnancy program: (RR: 1.48, 95% CI 1.40-1.57), but less likely after dTpa implementation (RR: 0.78, 95% CI 0.76-0.80). Inequity in vaccine uptake between First Nations and non-Indigenous pregnancies, and dismal rates of vaccination in pregnancy overall need urgent review, particularly before the next influenza pandemic or pertussis outbreak. If antenatal dTpa is driving IIV uptake, changes in antenatal healthcare practices are needed to ensure vaccines are offered equitably and optimally to protect against infection.

Granulocyte colony-stimulating factor in reproductive-related disease: Function, regulation and therapeutic effect

Granulocyte colony-stimulating factor (G-CSF) is one of the cytokines which plays important roles in embryo implantation and normal pregnancy. At the maternal-fetal interface, G-CSF can be synthesized by multiple cells, and participates in regulation of trophoblast development, endometrial decidualization, placental metabolism and angiogenesis. Moreover, as an important medium of intercellular communication, G-CSF has also been shown to exert key roles in crosstalk between cellular components at the maternal-fetal interface. Recently, our study demonstrated that G-CSF derived from M2 macrophage could promote trophoblasts invasion and migration through activating PI3K/AKT/Erk1/2 pathway, thereby involving in normal pregnancy program. Herein, we will summarize the role and regulation of G-CSF in normal pregnancy and reproductive-related disease, and the clinical applications of G-CSF in patients undergoing in vitro fertilization with thin endometrium, repeated implantation failure, and women suffered with recurrent spontaneous abortion.

MATERNAL MORBIDITY: INVENTORY FEASIBILITY AND ACCEPTABILITY OF MEASUREMENT TOOLS AT THE LEVEL OF MARRAKECH-MOROCCO

The measurement of less severe maternal morbidity represents many challenges forwomen during pregnancy and postpartum, and for the organization of health services. In orderto explore the different aspects of the feasibility and acceptability of implementing morbiditymeasurement tools at the primary health care network level, a qualitative and quantitativemixed descriptive study was conducted at the level of the primary health care network in theprefecture of Marrakech. The objectives are: (1) to test the tools for measuring maternalmorbiditylesssevereproposedbytheWHOanddescribethestateofplayofthismorbidity, (2) to study the feasibility and acceptability of integrating these tools into the Pregnancy and Childbirth Surveillance Program inMarrakech, and (3) to validating and proposing a new tool adapted to our Moroccan context. The data were collected by questionnaires administered face-to-face for 257 women in antenatal care and 253 women in postpartum care recruited at the level of ten health centers. Most of the women who participated in the study (55.95% antenatal and 52.17% postpartum care) were not in good health. Of these women, 35.79% had direct complications and 33.85% indirect (medical) complications. In terms of feasibility, the results suggest that the implementation of the tools presents challenges in terms of time, resources and coordination. Regarding the acceptability of the WMOs, the women surveyed perceive it as a useful information tool that promotes communication with health professionals and makes it possible to assess their state of health and ensure their holistic care.

Screening for Pregnancy Program Patients with Vaginal Swab and Pap Smear Examination

Background: Pregnancy programs not only require data on the size and shape of the uterus. The health of the vagina and cervix as sperm recipients should also be required, examined by vaginal swab and Pap smear. Objective: To describe the importance of vaginal swabs and Pap smears for the success of the pregnancy program. Methods: This research is a descriptive study. The data collected were secondary data from the medical records of pregnant patients during the first year of practice at the Reproductive/Obstetrics and Gynecology Polyclinic of AMC Muhammadiyah Hospital Yogyakarta from July 2019 to June 2020. The results of vaginal swab and Pap smear using descriptive analysis. Results and Discussion: 58 subjects enrolled in this research. The result of the vaginal swab and Pap smear examination showed normal and abnormal/pathogenic. Vaginal swab examination found more pathogenic microorganisms than nonpathogenic ones (58.6% vs 3.5%). The Pap smear examination found abnormal results (1.7%). These results show that vaginal swab and Pap smear are required for patients with pregnancy programs Conclusion: Vaginal swab and Pap smear examinations are necessary when infertile patients need pregnancy programs. Abstrak: Latar belakang: Program kehamilan tidak hanya memerlukan data tentang ukuran dan bentuk rahim. Kesehatan vagina dan serviks sebagai penerima sperma semestinya juga diperlukan, dengan pemeriksaan swab vagina dan Pap smear. Tujuan: untuk mengetahui perlunya pemeriksaan swab vagina dan Pap smear dalam keberhasilan program kehamilan. Metode: Penelitian ini merupakan penelitian deskriptif. Data merupakan data sekunder dari rekam medis pasien program kehamilan saat praktek tahun pertama di Poliklinik Reproduksi/Kebidanan dan Kandungan RS AMC Muhammadiyah Yogyakarta sejak bulan Juli 2019–Juni 2020. Hasil pemeriksaan swab vagina dan Pap smear dianalisis secara deskriptif. Hasil dan Pembahasan:Didapatkan 58 subyek penelitian yang mengikuti program kehamilan. Hasil pemeriksaan swab vagina menunjukkan 58,6% berupa mikroorganisma patogen dan 3,5% berupa mikroorganisme nonpatogen. Hasil pemeriksaan Pap smear abnormal sebesar 1,7%. Hasil ini menunjukkan bahwa swab vagina dan Pap smear perlu dilakukan pada pasien program kehamilan. Kesimpulan: Pemeriksaan swab vagina dan Pap smear perlu dilakukan pada pasien yang sedang program kehamilan.

Outcomes from a hybrid implementation-effectiveness study of the living well during pregnancy Tele-coaching program for women at high risk of excessive gestational weight gain

BackgroundExcess gestational weight gain (GWG) is associated with short-term perinatal complications and longer term cardiometabolic risks for mothers and their babies. Dietitian counselling and weight gain monitoring for women at risk of high pregnancy weight gain is recommended by clinical practice guidelines. However, face-to-face appointments, during a time with high appointment burden, can introduce barriers to engaging with care. Telephone counselling may offer a solution. The Living Well during Pregnancy (LWdP) program is a dietitian-delivered telephone coaching program implemented within routine antenatal care for women at risk of excess GWG. This program evaluation used a hybrid implementation-effectiveness design guided by the RE-AIM framework to report on the primary outcomes (reach, adoption, implementation, maintenance) and secondary outcomes (effectiveness) of the LWdP intervention.MethodsThe LWdP program evaluation compared data from women participating in the LWdP program with a historical comparison group (pregnant women receiving dietetic counselling for GWG in the 12 months prior to the study). The primary outcomes were described for the LWdP program. Between group comparisons were used to determine effectiveness of achieving appropriate GWG and pre and post intervention comparisons of LWdP participants was used to determine changes to dietary intake and physical activity.ResultsThe LWdP intervention group (n = 142) were compared with women in the historical comparison group (n = 49). Women in the LWdP intervention group attended 3.4 (95% CI 2.9–3.8) appointments compared with 1.9 (95% CI, 1.6–2.2) in the historical comparison group. GWG was similar between the two groups, including the proportion of women gaining weight above the Institute of Medicine recommendations (70% vs 73%, p = 0.69). Within group comparison showed that total diet quality, intake of fruit and vegetables and weekly physical activity were all significantly improved from baseline to follow-up for the women in LWdP, while consumption of discretionary food and time spent being sedentary decreased (all p < 0.05).ConclusionThe LWdP program resulted in more women accessing care and positive improvements in diet quality, intuitive eating behaviours and physical activity. It was as effective as face-to-face appointments for GWG, though more research is required to identify how to engage women earlier in pregnancy and reduce appointment burden.

Maternal adiposity inversely associates with physical activity in 2‐year‐old girls

BackgroundAnimal studies suggest that maternal obesity and high fat diet during pregnancy program physical activity (PA) patterns in the offspring. However, such nexus has not been established in humans. The purpose of this study was to evaluate the association of maternal adiposity measured early in pregnancy with offspring PA at age 2 years while taking into consideration confounding and modifying factors.MethodsWomen (n=152) were enrolled early in pregnancy (&lt;10 weeks). At enrollment, maternal adiposity [air displacement plethysmography, fat mass index (FMI, kg/m2] was measured, and maternal dietary quality (Healthy Eating Index), age, race, and education level were assessed. Gestational weight gain was measured at the research facility. Offspring birthweight and sex were self‐reported. At age 2 years, parental feeding practices (child feeding questionnaire) were assessed whereas anthropometrics (length and weight) and physical activity (ankle worn accelerometers) were objectively measured. Offspring body mass index z‐scores were calculated. Generalized linear regression analysis with a natural log link was done to model the association of maternal FMI and offspring PA. The interaction between maternal FMI and covariates (i.e., all variables listed above) was assessed. Our final model was created using principles of purposeful selection. The best subset of these terms was identified by observation of minimum model AIC statistic.ResultsThere was interaction between maternal FMI and offspring sex in association with offspring total PA [average activity counts (AC)/day] at 2 years of age. Specifically, PA decreased with increasing maternal FMI but only in girls (β=‐0.02, p=0.0470). In addition, total PA was higher in children born to women with college education compared to children born to women without college education (β=0.09, p=0.0369). Minutes spent in sedentary time increased (β= 0.01, p=0.0422) while minutes spent in light PA tended to decrease (β=‐0.01, p=0.0536) with increasing maternal FMI in girls compared to boys.ConclusionsThere is sexual dimorphism in the association of maternal adiposity measured early in pregnancy with offspring PA at age 2 years. PA levels in 2‐year‐old girls was negatively associated with increasing maternal adiposity.

The Factors Affecting Post Date Pregnancy in Third Trimester Pregnant Women at Balung Regional Hospital Jember District in 2019

Introduction: An overdue pregnancy or post date pregnancy is one that lasts between 40 and 42 weeks. Late pregnancy can be caused by several factors, including age, gravida, fetal location, and post date history. Objective: The purpose of this study was to identify and analyze the Factors Affecting Post Date Pregnancy at Balung Regional hospital in 2019. Post date can increase the risk of perinatal mortality and morbidity Methods: The design in this study is a descriptive analytic method with a cross sectional approach, using simple random sampling consisting of 620 pregnant women in the third trimester. Data were analyzed by chi-square test. The results of this study were 53.5% of pregnant women in the third trimester aged 20-34 years, 52.49% of multigravida mothers, 74.5% of mothers with normal fetal position and 73.7% of mothers without post-date history.). Results: The results of bivariate analysis showed that the age factor indicated (p = 0.000), gravida (p = 0.000), fetal location (p = 0.000), post date history (p = 0.000). Significance value showed 0.000 &lt; 0.050. Thus (X2 Count &gt; X2 table) it is concluded that H0 is rejected. Conclusion: It is hoped that the results of community research are more selective in planning pregnancy programs and increasing the role of families in actively participating in the welfare of pregnant women and fetuses.

A rare full-term delivery in a chronic peritoneal dialysis patient

We aimed to report the case of a 37 years old woman, caucasian, who got pregnant after seven months of dialysis initiation and had a full-term weeks successful delivery. We also reviewed and presented the reported cases of peritoneal dialysis pregnancies in the last 6 years. The patient started renal replacement therapy due to focal segmental glomerulosclerosis and chronic tubular nephritis. In the same year, she got pregnant and started pre-maternal care in the high-risk pregnancy program. Peritoneal dialysis prescription was adjusted according to the patient’s tolerance and laboratory parameters. No complications occurred during the first and second trimester. In the first quarter of the third trimester, an antihypertensive drug was initiated for maintenance of blood pressure. She delivered a healthy baby via spontaneous vaginal at 39 weeks. Birth was induced due to the advanced pregnancy time and the risk of worsening arterial pressure. Our experience showed that peritoneal dialysis is a viable option during pregnancy according to the patient's residual renal function and promotes a successful pregnancy period with the correct adaptations on peritoneal dialysis prescription. Collaboration and support amongst family, nephrologist and gynecologist doctors, multidisciplinary team and the patient are crucial to ensure treatment quality and successful outcomes.

Epidemiology of Infant Deaths in Predominant Tribal Areas of Two Districts of Gujarat: Results of Pregnancy and Mortality Surveillance Program.

To understand epidemiology of the neonatal and infant deaths in predominant areas of two tribal districts of Gujarat. A secondary analysis of pregnancy and mortality surveillance data was done to understand the causes and determinants of infant deaths in predominant tribal areas of two districts of Gujarat, India from 2015 to 2018. All pregnancies, their outcomes, and infant deaths were prospectively registered. A verbal autopsy tool was used to understand the cause of death. A total of 25,130 live births were recorded; 20,994 (83.5%) deliveries occurred at the hospital. Total 1,309 infant deaths (IMR-52.08/1,000 live births) and 879 neonatal deaths (NMR-34.97/1,000 live births) occurred during the program duration. The odds of infant deaths was high among male child aOR-1.5 (CI:1.3-1.7, p < 0.001), born to illiterate/primary educated mother aOR-1.2 (1.03-1.4, 0.013), born at home or on the way aOR-1.4 (1.1-1.8, 0.003), born with low birth weight (< 2.5kg), aOR-3.7 (3.2-4.3, < 0.001), born preterm (< 37 wk) aOR-1.9 (1.7-2.2, < 0.001), and born twins aOR-1.5 (1-2.1, 0.037) in comparison to female child, born to secondary/or above educated mother, born in hospital, born normal weight (>= 2.5kg), born full-term (>= 37 wk), and born single, respectively. The asphyxia/respiratory distress syndrome (RDS) 282 (56%), sepsis/pneumonia and asphyxia/RDS 188 (63%), and sepsis/pneumonia 281 (65%) were leading cause of death among 0-3 d, 4-28 d, and 29-365 d infant deaths. There is a need to improve quality of intrapartum and postpartum care. Additionally, sepsis detection among infants and referral by community health workers also need to be improved to reduce infant mortality due to sepsis.

The Relationship between Age, Parity, Early Detection, K1-K4 Visits, Integrated ANC, Three Times Obgyn’s Ultrasound Examination, and Maternal Mortality

Maternal mortality is one of the indicators of health-care quality and effectiveness. Maternal mortality increases and decreases due to several factors. This article aims to analyze the factors that cause the increase and decrease in the maternal mortality rate. The research method is a cohort prospective, using a systematic sampling technique with the principle of proportionality. The number of samples is 150 data taken from the Tapin District Health Office, South Kalimantan, Indonesia. Statistical data analysis was performed using statistical descriptions and statistical inferential. The results of hypothesis testing indicate that age, early detection, K1 – K4 visits, integrated ANC and 3x SpOG ultrasound have a significant effect on maternal mortality. The parity does not have a significant effect on maternal mortality. Therefore, the pregnancy program must pay attention to age. During pregnancy, pregnant women must go through the process of early detection, K1 – K4 visits, integrated ANC.Parity must be considered so that babies can be born with conditions without deficiencies. Keywords: Age; Parity; Early Detection; K1 – K4 Visits; ANC, Ultrasound; Maternal Mortality.

Racial disparities in reliable contraceptive use in women with heart disease*

Objective The aim of the study was to investigate the differences in reliable contraceptive use between black women and white women with maternal cardiac disease. Methods The study comprised a retrospective cohort of women with maternal cardiac disease managed by the University of Alabama at Birmingham (UAB) Comprehensive Pregnancy and Heart Program (CPHP). Women were included if they had attended one or more prenatal visits at the UAB CPHP and delivered at the UAB hospital between March 2015 and June 2019. The primary outcome was reliable contraceptive use within 2 months postpartum, defined by receipt of long-acting reversible contraception (i.e., an intrauterine contraceptive device or an etonogestrel implant) or female sterilisation. All outcomes were compared based on self-reported race. Results One hundred and forty-nine women met the inclusion criteria. Black women (n = 63) were more likely than white women (n = 86) to use reliable contraception (65% vs 43%; p = 0.008). Black women were less likely than white women to be undecided or decline contraception at the time of admission (13% vs 27%; p = 0.037). There was no difference in reliable contraceptive use between black women (n = 20, 63%) and white women (n = 23, 72%) with modified World Health Organisation (WHO) class III/IV lesions (p = 0.42). Conclusion Black women with maternal cardiac disease were more likely than white women to receive reliable contraception. Interventions to prevent unintended pregnancy in women with maternal cardiac disease should focus on improving reliable contraceptive use, especially for women with modified WHO class III/IV lesions.

Elevated Anthropometric and Metabolic Indicators among Young Adult Offspring of Mothers with Pregestational Diabetes: Early Results from the Transgenerational Effect on Adult Morbidity Study (the TEAM Study).

Exposure to maternal diabetes in utero increases the risk in the offspring for a range of metabolic disturbances. However, the timing and variability of in utero hyperglycemic exposure necessary to cause impairment have not been elucidated. The TEAM Study was initiated to evaluate young adult offspring of mothers with pregestational diabetes mellitus. This paper outlines the unique enrollment challenges of the TEAM Study and preliminary analysis of the association between exposure to diabetes in pregnancy and adverse metabolic outcomes. The TEAM Study enrolls offspring of women who participated in a Diabetes in Pregnancy (DiP) Program Project Grant between 1978 and 1995. The DiP Study collected medical and obstetric data across pregnancy. The first 96 eligible offspring of women with pregestational diabetes were age-, sex-, and race-matched to adults from the National Health and Nutrition Examination Survey (NHANES) 2015-2016 with an OGTT. Descriptive and regression analyses were employed to compare TEAM participants to NHANES participants. Among a subset of TEAM participants, we compared the metabolic outcomes across maternal glucose profiles using a longitudinal data clustering technique that characterizes level and variability, in maternal glucose across pregnancy. By comparing categories of BMI, TEAM Study participants had over 2.0 times the odds of being obese compared to matched NHANES participants (for class III obesity, OR = 2.81; 95% confidence interval (CI): 1.15, 6.87). Increasing levels of two-hour glucose were also associated with in utero exposure to pregestational diabetes in matched analyses. Exposure to pregestational diabetes in utero may be associated with an increased risk of metabolic impairment in the offspring with clinical implications.

Fear-Related Reasons for Avoiding Sexual Intercourse in Early Pregnancy: A Cross-Sectional Study.

IntroductionSeveral studies have reported women's worry that sexual intercourse may harm the course of pregnancy. This worry might lead to avoidance of sexual intercourse during pregnancy.AimTo assess if fears about harming the pregnancy are associated with avoidance of sexual intercourse during pregnancy.MethodsA cross-sectional study was conducted on 250 Vietnamese pregnant women in the first or second trimester who visited our hospital for antenatal care. We explored 5 types of fears including miscarriage/preterm labor, premature rupture of membranes, bleeding, infection, and injury to the fetus. Fears were measured by modified questions from the Reasons For Not Engaging in Sexual Activity During Pregnancy questionnaire. Using the total fear score, pregnant women were categorized into having low, moderate, and high fear.Main Outcome MeasureNot having sexual intercourse during the past 4 weeks.Results72 (28.8%) pregnant women had no sexual intercourse for the past 4 weeks. All types of fear were considered important among pregnant women; the more important fears were infection and injury to the fetus. In multivariable regression analysis, the prevalence of not having sexual intercourse was higher in both women who had moderate (adjusted prevalence ratio = 2.84, 95% CI 1.42–5.67) and high fear (adjusted prevalence ratio = 4.39, 95% CI 2.28–8.44).ConclusionAvoidance of sexual intercourse was common among Vietnamese pregnant women and was associated with the fears about harming the pregnancy. This can be a target in the health education programs for pregnancy couples.Thanh C. Phan, Long B. Hoang, Thanh K. Tran, et al. Fear-Related Reasons for Avoiding Sexual Intercourse in Early Pregnancy: A Cross-Sectional Study. Sex Med 2021;9:100430.

Comparison of saliva cotinine and exhaled carbon monoxide concentrations when smoking and after being offered dual nicotine replacement therapy in pregnancy.

Background and AimsAlthough English Stop Smoking Services routinely offer dual nicotine replacement therapy (NRT) to help pregnant women to quit smoking, little is known about how nicotine and tobacco smoke exposures following this compare with that from smoking. We compared, in pregnant women when smoking and after being offered dual NRT, saliva cotinine and exhaled carbon monoxide (CO) concentrations and numbers of daily cigarettes smoked.Design and SettingSecondary analysis of data from three sequential, observational, mixed‐methods cohort studies conducted as part of the Nicotine Replacement Effectiveness and Delivery in Pregnancy programme. Participants were recruited on‐line or in Nottingham University Hospitals (UK) antenatal clinics between June 2019 and September 2020.ParticipantsForty pregnant women, who agreed to try stopping smoking.InterventionParticipants were offered dual NRT, agreed a smoking quit date and received an intervention to improve adherence to NRT.MeasurementsSaliva cotinine and exhaled CO concentrations and reported number of cigarettes smoked per day.FindingsThere were no differences in saliva cotinine concentrations at baseline and day 7 post quit date [n = 20, mean difference = −32.31 ng/ml, 95% confidence interval (CI) = −68.11 to 3.5 ng/ml; P = 0.074, Bayes factor = 0.04]. There were reductions in the reported number of cigarettes smoked per day (n = 26, mean difference = −7 cigarettes, 95% CI = −8.35 to −5.42 cigarettes, P < 0.001) and concurrently in exhaled CO concentrations (n = 17, ratio of geometric means = 0.30 p.p.m., 95% CI = 0.17–0.52 p.p.m.; P < 0.001).ConclusionPregnant women who smoke and are offered dual nicotine replacement therapy (NRT) appear to show no change in their exposure to cotinine compared with their pre‐NRT exposure levels but they report smoking fewer cigarettes, as validated by reductions in exhaled carbon monoxide concentrations.

The effects of offering immediate postpartum placement of IUDs and implants to pregnant patients with heart disease

ObjectiveTo evaluate the effects of offering immediate postpartum long-acting reversible contraception to pregnant patients with heart disease. Study DesignRetrospective cohort of pregnant patients with cardiac disease managed by a Comprehensive Pregnancy & Heart Program. Patients were divided into 2 cohorts: pre-immediate postpartum LARC Program implementation (March 2015 to January 2017) and post-implementation (February 2017 to June 2019). The primary outcome was LARC (intrauterine device [IUD] or etonogestrel implant) use postpartum, defined as LARC either immediately postpartum or at the postpartum visit. Secondary outcomes included contraception intent at delivery and IUD expulsion rate of IUDs placed immediately postpartum. ResultsOf 159 included patients, 96 (60%) delivered during the post-implementation period. LARC use tripled after program implementation, 11% vs 35%, p < 0.01. Specifically, immediate postpartum IUD use increased from 1 (1.6%) to 10 (10.4%), p = 0.05, and use of immediate postpartum implant increased from 0 to 14 (14.6%), p = 0.002. Rates of women without contraception plans at delivery decreased from 32% to 14%, p < 0.01, as did the number of women using medroxyprogesterone acetate: 16% vs 4%, p = 0.01. Tubal ligation rates were not different before and after program implementation: 24% and 29%, p = 0.46. Postpartum visit rates were similar between Pre and Post groups: 70% and 72%, p = 0.78, respectively. One immediate postpartum IUD expulsion occurred. ConclusionLARC use tripled in pregnant patients in an obstetric heart disease program after implementation of an immediate postpartum LARC Program. Access to immediate postpartum IUDs and implants should be a public health priority for women with heart disease to reduce their disproportionate burden of maternal morbidity and mortality. ImplicationsAccess to immediate postpartum IUDs and implants should be a public health priority for women with heart disease – as well as all people with high-risk health conditions – to reduce their disproportionate burden of maternal morbidity and mortality.

Maternal DHA Supplementation during Pregnancy and Lactation in the Rat Protects the Offspring against High-Calorie Diet-Induced Hepatic Steatosis.

Maternal supplementation during pregnancy with docosahexaenoic acid (DHA) is internationally recommended to avoid postpartum maternal depression in the mother and improve cognitive and neurological outcomes in the offspring. This study was aimed at determining whether this nutritional intervention, in the rat, protects the offspring against the development of obesity and its associated metabolic disorders. Pregnant Wistar rats received an extract of fish oil enriched in DHA or saline (SAL) as placebo by mouth from the beginning of gestation to the end of lactation. At weaning, pups were fed standard chow or a free-choice, high-fat, high-sugar (fc-HFHS) diet. Compared to animals fed standard chow, rats exposed to the fc-HFHS diet exhibited increased body weight, liver weight, body fat and leptin in serum independently of saline or DHA maternal supplementation. Nevertheless, maternal DHA supplementation prevented both the glucose intolerance and the rise in serum insulin resulting from consumption of the fc-HFHS diet. In addition, animals from the DHA-fc-HFHS diet group showed decreased hepatic triglyceride accumulation compared to SAL-fc-HFHS rats. The beneficial effects on glucose homeostasis declined with age in male rats. Yet, the preventive action against hepatic steatosis was still present in 6-month-old animals of both sexes and was associated with decreased hepatic expression of lipogenic genes. The results of the present work show that maternal DHA supplementation during pregnancy programs a healthy phenotype into the offspring that was protective against the deleterious effects of an obesogenic diet.

The Relationship Between Husband Support and Behavior of Pregnant Teenagers to Face Pregnancy During the Covid-19 Pandemic in Gombong, Kebumen, Indonesia

Background: Age influences pregnancy and childbirth. Pregnant women aged less than 20 years old or pregnant adolescents are not physically and mentally ready to cope with pregnancy or childbirth. The husband's support highly determines the health status of the mother. This research aimed to determine the relationship between husband support and the behavior of pregnant adolescents to face pregnancy during the COVID-19 pandemic in the Gombong District, Kebumen Regency. Methods: This study used a cross-sectional approach. The population was all pregnant women aged less than 20 years in the Gombong District, Kebumen Regency. It used a saturated sampling technique involving 256 people. Data were analyzed using univariate and bivariate analysis to answer the percentage and the Chi-Square test to answer the research hypothesis. Results: The study showed that 130 (50.8%) husbands did not support the mothers, and 126 (49.2%) husbands supported the mothers. The result also showed that 116 (45.3%) of the pregnant women showed positive behavior, while140 (54.7%) pregnant women showed negative behavior. The chi-square test found a p-value of 0.005, which proved a significant relationship between the husband's support and the behavior of pregnant adolescents to overcome pregnancy during the covid-19 pandemic. Conclusion: Pregnant teenagers with husband support will prepare for pregnancy and childbirth programs more maturely to ensure the safety of both mother and fetus.

Arsenic concentrations in the placenta are associated with dysregulation of placental microRNA expression

BACKGROUND AND AIM: Normal placental function is essential for successful pregnancy outcomes and programming lifelong health. MicroRNAs (miRNAs) are epigenetic post-transcriptional regulators of gene expression that participate in critical processes during early development, including embryogenesis, implantation and placentation. Placental function and placental miRNA expression are both susceptible to environmentally-induced dysregulation. Gestational exposure to arsenic is associated with adverse birth weight outcomes in newborns, as well as increased risk of chronic disease in the long-term. We hypothesize that prenatal exposure to arsenic can alter the expression of placental miRNAs which may in turn impact newborn health. METHODS: This study used data from 272 mother-infant pairs from the New Hampshire Birth Cohort Study (NHBCS) and 149 from the Rhode Island Child Health Study (RICHS). Placental arsenic concentrations were determined by ICP-MS, and small RNA sequencing determined the abundance of all miRNAs expressed in the placenta. We used negative binominal generalized linear models, fit separately to each cohort, to identify miRNAs that are associate with placental arsenic concentrations. We then aggregated cohort-level results using an inverse variance weighted fixed-effects meta-analysis approach. RESULTS:We identified that a doubling of placental arsenic concentration was associated with a 0.19-fold-increase in the expression of miRNAs 509-3p and 514a-5p (FDR 0.1). Using bioinformatic miRNA target prediction, followed by pathway analysis, we found that mRNAs targeted by these two miRNAs participate in various biochemical pathways critical for cell-to-cell adhesion, systemic blood pressure maintenance and various nervous system processes (q0.1). CONCLUSIONS:Arsenic may disrupt miRNA expression in the placenta, leading to dysregulation of the placenta’s transcriptional landscape, which in turn could contribute to the developmental programming of chronic disease risk. Future work aims to identify associations between early life health outcomes and differential expression of arsenic-sensitive placental miRNAs. KEYWORDS: Arsenic, microRNA, Epigenetics, Placenta, Sequencing