Pregnancy-related Complications Research Articles

Miro2 sulfhydration by CBS/H2S promotes human trophoblast invasion and migration via regulating mitochondria dynamics

Insufficient cytotrophoblast (CTB) migration and invasion into the maternal myometrium leads to pregnancy related complications like Intra-uterus Growth Restriction (IUGR), and pre-eclampsia (PE). We previously found that hydrogen sulfide (H2S) enhanced CTB migration without knowing the mechanism(s) and the pathophysiological significance. By studying human samples and cell line, we found that H2S levels were lower in PE patients’ plasma; H2S synthetic enzyme cystathionine β-synthetase (CBS) was reduced in PE extravillious invasive trophoblasts. GYY4137 (H2S donor, 1 µM) promoted CBS/H2S translocation onto mitochondria, preserved mitochondria functions, enhanced cell invasion and migration. CBS knockdown hindered the above functions which were rescued by GYY4137, indicating the vital roles of CBS/H2S signal. Disturbance of mitochondria dynamics inhibited cell invasion and migration. The 185 and 504 cysteines of Mitochondrial Rho GTPase 2 (Miro2C185/C504) were highly sulfhydrated by H2S. Knockdown Miro2 or double mutation of Miro2C185/C504 to serine fragmented mitochondria, and inhibited cell invasion and migration which can’t be rescued by H2S. The present study showed that human cytotrophoblast receives low dose H2S regulation; CBS/H2S sustained mitochondria functions via Miro2C185/C504 sulfhydration to enhance cytotrophoblast mobility. These findings established a new regulatory pathway for cytotrophoblast functions, and provided new targets for IUGR and PE.

Magnitude and predictors of obstetric complications during delivery among postpartum women in Ethiopia: evidence from PMA Ethiopia longitudinal survey

IntroductionThe majority of pregnancy-related complications were preventable. However, the magnitude of complications during pregnancy and childbirth was high in sub-Saharan Africa. There was limited evidence on the magnitude of obstetric complications during childbirth and its predictors among postpartum women in Ethiopia.Methods and materialsThe research used secondary data sources based on performance monitoring for action in Ethiopia’s second cohort longitudinal survey. It was a national survey that was conducted in three large, predominantly agrarian regions (Oromia, Amhara, and SNNP) and one urban region (Addis Ababa) of Ethiopia between 2021 and 2023. It was conducted to track pregnant women’s use of essential maternal and newborn health services. It involved the enrollment of pregnant women and tracking them at six weeks, six months, and one year after giving birth. The data collected at the beginning of the survey and six weeks after childbirth were used for the analysis. Sample weights were applied to account for differences in sample allocation and response rates across regions and urban/rural areas. Multi-collinearity and intra-cluster correlation were assessed before fitting the multilevel models to ensure the accuracy of the estimates. A multi-level logistic regression model was used to assess the magnitude and predictors for the occurrence of obstetric complications during delivery. The model fit was evaluated using Akaike’s Information Criterion and Bayesian Information Criterion. Adjusted odds ratio with its 95% confidence interval was used to measure the strength of association for this study.ResultsThe magnitude of obstetric complications during delivery was found to be 33.86% with 95% CI (31.56, 36.24. Among the obstetric complications that occurred during delivery, about 15.73%with 95% CI(14.02, 17.61) of women experienced bleeding, 4.14% with 95% CI (3.30, 5.17) had their membrane rupture but labor did not start within 24 h, 2.29% with 95% CI(1.67, 3.13) had their membrane rupture before 9 months, 3.95% with 95% CI(3.16, 4.93) had faced malpresentation or malposition of the baby, 12.70% with 95% CI (11.18, 14.39) had prolonged labor lasting more than 12 h, and 12.40% with 95% CI (10.83,14.17) had convulsions. The odds of occurrence of obstetric complication during delivery among women from severely food insecure households were 1.88 times [AOR = 1.88; 95% CI (1.22, 2.90)] more likely to occur than women from food secure households. Moreover, the odds of occurrence for obstetric complications during delivery among women who had complications during their pregnancy were 2.39 times [AOR = 2.39; 95% CI (1.81, 3.16)] more likely to occur as compared to those women who had no complication during their pregnancy. On the other hand, women’s who had 1–4 live births given before this delivery were 0.61 times [AOR = 0.61; 95% (0.43, 0.88)] less likely to develop complications as compared to those women’s who had no prior live birth.Conclusion and recommendationDelivery-related obstetric complications during delivery in Ethiopia were high. Approximately one-third of postpartum women in Ethiopia experienced obstetric complications during delivery. Based on this study, women’s from severely food insecure households, those women’s who had no prior live birth, and women’s who had complications during their pregnancy were more likely to develop delivery-related obstetric complications. Thus, policy makers and program implementers who were working on maternal and newborn health should give special attention for women’s from severely food insecure households, women’s who had no prior live births, and those women’s who encountered obstetric complications during their pregnancy to decrease the occurrence of obstetric complications during delivery. In Ethiopia, various governmental organizations, such as the Ministry of Health and the Ministry of Agriculture, are dedicated to addressing food insecurity and improving nutritional access. The country has launched several effective nutritional programs, including the Productive Safety Net Program, the Targeted Supplementary Feeding Program, and the National Nutrition Program, aimed at alleviating food insecurity and enhancing nutrition. Ongoing efforts are crucial to tackle the food insecurity experienced by women, which can help to reduce obstetric related complications of women’s during delivery. It is crucial for everyone involved in maternal and newborn health to prioritize addressing the factors that lead to obstetric complications during delivery in women in order to reach the goal of ending all preventable maternal and newborn deaths by 2030.

Comparison of subfoveal choroidal thickness in pre-eclamptic, healthy pregnant, and non-pregnant women.

The purpose of the study was to compare the choroidal thickness (CT) in pre-eclamptic (PE), healthy pregnant, and age-matched healthy non-pregnant females by spectral-domain optical coherence tomography (SD-OCT) and to investigate any possible correlation between subfoveal CT (SFCT) and mean arterial pressure (MAP) in PE. This was a hospital-based, comparative study. A total of 90 females (30 in each group) aged 20-40 years were recruited prospectively over 1 year. Females with refractive error beyond ±3 D, intraocular pressure >21 mmHg, prior ocular trauma or surgeries, systemic diseases, pregnancy-related complications (except PE), and poor OCT scans were excluded. Following comprehensive ophthalmic evaluation, CT was measured bilaterally using SD-OCT (EDI) at the subfoveal region and at 1500 μm nasal and temporal to fovea. Systolic and diastolic blood pressures were recorded in all. The PE group had significantly thinner choroid (SFCT: 337.5 ± 49.8 OD, 333.0 ± 50.8 OS) as compared to the healthy non-pregnant group (SFCT: 351.6 ± 34.4 OD, 365.3 ± 33.6 OS) and healthy pregnant group (SFCT: 374.2 ± 44.1 OD, 377.2 ± 49.5 OS) (P < 0.05) in all locations (nasal, temporal, and subfoveal) in both eyes (except for OD nasal CT). However, there was no significant correlation between SFCT and MAP in the PE group. Significantly lower CT in PE without any direct correlation between SFCT and MAP may implicate that choroidal thinning in PE is governed by multifactorial choroidal vasospasm and endothelial dysfunction, instead of MAP solely.

Effect of low-dose aspirin intervention on pre-eclampsia prevention in high-risk pregnant women and its impact on postpartum hemorrhage

BackgroundPre-eclampsia, characterized by hypertension and organ dysfunction during pregnancy, poses significant risks to both maternal and fetal health. Aspirin, known for its antiplatelet properties, has been extensively utilized to mitigate pregnancy-related complications. However, the efficacy of low-dose aspirin in managing pre-eclampsia among high-risk pregnant women and its potential impact on postpartum hemorrhage remain contentious topics.MethodsA retrospective analysis was conducted on 344 pregnant women diagnosed with high-risk factors for pre-eclampsia. Among them, 152 received intervention with low-dose aspirin, while the rest did not receive it. The incidence of pre-eclampsia, as well as related complications and outcomes associated with bleeding, were compared and evaluated between the two groups.ResultsThe study findings indicate a significant reduction in the incidence of pre-eclampsia among pregnant women receiving low-dose aspirin intervention, along with a significantly reduced risk of complications. Additionally, there was no significant statistical difference in postpartum hemorrhage between the two groups (p &amp;gt; 0.05). The safety profile of aspirin usage was found to be favorable.ConclusionLow-dose aspirin demonstrates promising efficacy as an intervention strategy for high-risk preeclamptic women. It does not increase the risk of postpartum hemorrhage and reduces the occurrence of complications associated with preeclampsia. Therefore, low-dose aspirin presents a potential preventive measure against adverse outcomes associated with high-risk pregnancies related to preeclampsia. Further research is necessary to validate and elucidate the optimal dosage and timing of administration for maximal benefits.

The association of increased incidence of congenital heart disease in newborns with maternal COVID-19 infection during pregnancy

This paper aims to examine the potential link between maternal COVID-19 infection during pregnancy and the increased risk of congenital heart disease (CHD) in newborns. A comparative analysis was conducted involving two groups: mothers infected with COVID-19 during pregnancy and a control group. Data on maternal characteristics, pregnancy-related complications, and newborn outcomes were collected and analyzed. Additionally, the annual incidence rates of CHD from 2020 to 2023 were evaluated to assess trends over time. No significant differences were found between the COVID-19 cases and the control group in terms of maternal age, BMI, gravidity, parity, use of assisted reproductive technology, adverse obstetric history, or complications during pregnancy, including diabetes mellitus, preeclampsia, and thyroid abnormalities. For newborn outcomes, there were no significant differences in sex distribution, rate of cesarean delivery, Apgar scores, or birth weight. However, a significantly higher prevalence of cardiac ultrasound abnormalities was observed in the COVID-19 group (10.08%) compared to the control group (4.13%, p = 0.012). Further analysis revealed that the majority of cardiac abnormalities in the COVID-19 group occurred in mothers infected before 8 weeks of pregnancy. The annual incidence rates of CHD showed a significant increase during the COVID-19 pandemic, with the highest rate in 2023 (5.46%) compared to previous years. Maternal COVID-19 infection during pregnancy may adversely affect the development of the newborn’s heart. This could be due to the inflammatory response caused by the viral infection or other pathological processes. The findings underscore the importance of vigilant prenatal care and early detection of cardiac abnormalities during the pandemic and suggest the need for further research to explore potential mechanisms and intervention strategies.

Effects of the COVID-19 pandemic on maternal-fetal outcomes in a nonepidemic designated hospital: a retrospective study and clinical experience summary

ObjectiveTo assess the changes in maternal-fetal outcomes in a nonepidemic designated hospital during the COVID-19 pandemic.MethodsThis retrospective cohort study was conducted between January 1, 2019, and December 31, 2021 on pregnant patients. The fixed-effects regression model was used to determine changes in birth outcomes and pregnancy-related complications between three periods with the pre-epidemic cohort as the control group. Logistic regression was applied to determine the odds ratio (OR) for binary outcomes.ResultsThere were 15,261 births during the pre-epidemic period, and this number decreased by 15% and 23% to 12,980 and 11,736 in the first and second epidemic cohorts, respectively. The mean birth weight during the pre-epidemic period was 3319 which decreased to 3309 and 3272 g in the following periods. Excluding stillbirth and preterm, all other outcomes differed significantly between the three periods. Gestational diabetes mellitus (GDM) (17–19%) and maternal hypertension (9.2–11%) appeared to increase. Compared to the pre-epidemic period, the odds of macrosomia and LGA significantly decreased in the second epidemic cohort (adjusted ORs: 0.76 and 0.8), while the odds of low birth weight (LBW) and small gestation age (SGA) increased (ORs: 1.25 and 1.16). The odds of neonatal asphyxia (OR: 1.4), and hypertension (OR: 1.29) appeared to increase in the second epidemic cohort, while GDM decreased in the first cohort (OR: 0.88) and increased in the second cohort (OR: 1.15). Vaginal delivery underwent a marginal decrease in both the first and second epidemic cohorts (ORs: 0.89 and 0.92).ConclusionThe COVID-19 pandemic may have had a substantial and long-term impact on non-infected pregnant women and newborns. Our research results provided precious research information and clinical experience summary for population health research in the future.

Cannabis Use during Pregnancy: An Update.

The use of cannabis during pregnancy has emerged as a mounting cause for concern due to its potential adverse consequences on both the mother and her offspring. This review will focus on the dangers associated with prenatal exposure to cannabis, particularly those related to neurodevelopment. It will also discuss the features of maternal and placental functioning that are likely to have long-term effects on the offspring's development. The most pertinent and up-to-date materials can be found through a literature search. The literature emphasizes the substantial hazards associated with prenatal exposure to cannabis. These include impairments in cognitive function and difficulties in behavior in this particular instance. Structural and functional alterations in the brain can be noticed in offspring. The use of cannabis has been associated with an increased likelihood of experiencing pregnancy-related complications, such as giving birth prematurely and having a baby with a low birth weight. Additionally, it has been connected to potential negative effects on mental and emotional well-being. Studies have shown that when a pregnant woman is exposed to cannabis, it can negatively impact the functioning of the placenta and the growth of the fetus. This might potentially contribute to the development of placental insufficiency and restricted growth in the womb. Longitudinal studies reveal that children who were exposed to cannabis in the womb experience additional long-term developmental challenges, such as decreased cognitive abilities, reduced academic performance, and behavioral issues. In order to address the problem of cannabis usage during pregnancy, it is essential to adopt a comprehensive and coordinated strategy. This method should integrate and synchronize public health policy, education, and research initiatives. By implementing these targeted strategies, it is possible to mitigate potential health and welfare concerns for both present and future generations.

Pregnancy-Related Complications and Snake Bites Are Leading Causes of Renal Cortical Necrosis in India

Pregnancy-Related Complications and Snake Bites Are Leading Causes of Renal Cortical Necrosis in India

Assessment of Knowledge, Attitude, and Practice Toward Physical Activity and It’s Associated Factor Among Women Attending Antenatal Care at Public Health Institutions in Debre Berhan Town, North Eastern Ethiopia

Physical inactivity is linked to pregnancy-related complications. Exercise participation during pregnancy is restricted in low-middle income nations, including Ethiopia. Therefore, this study aimed to assess factors associated with physical activity practice among pregnant women attending antenatal care at public health institutions in Debre Berhan Town Northeastern Ethiopia. Institutional based cross-sectional study was conducted from March 22, 2021 to May 22, 2021 in Debre Berhan Town. The systematic random sampling technique was used to obtain the 418 participants. Data were collected by using standardized questionnaires. Data were entered, cleaned by Epi data version 3.1 and analyzed by SPSS version 25. The variables which had p-value &lt; .05 and with 95% confidence interval were declared as determine factors of antenatal physical exercise. According to this study, 222 (53.1%, CI [48.3, 57.7]), 220 (52.6% [47.8, 57.2]), and 218 (52.2% [CI 47.6, 56.7]) of respondents had good knowledge, favorable attitude, and good practice of physical exercise respectively. Age group of 30 to 34 years (AOR: 2.15, 95% CI [1.08, 4.29]), housewife (AOR: 7.81, 95% CI [1.48, 41.21]), cultural recommendation (AOR: 2.16, 95% CI [1.37, 3.39]), exercise before pregnancy (AOR: 2.69, 95% CI [1.72, 4.19]), and gestational age &gt;24 weeks (AOR: 2.538, 95% CI [1.02, 6.29]) were factors associated with practice of physical exercise during pregnancy. Physical activity during pregnancy was more common in the current study than in the national average. During an ANC visit, health care providers should improve and strengthen physical activity counseling sessions.

Pregnancy outcomes in patients with kidney transplant-A retrospective snapshot

Pregnancy in renal transplantation is a sensitive issue since fertility improves shortly after transplantation and the prevalence of pregnancy-related complications in these patients are more in comparison to non-transplanted matched cohorts. Our study aimed at assessing the outcomes of pregnancy in our transplant patients. Methods: This study was designed as a questionnaire based retrospective cross-sectional study wherein the authors contacted all their patients who underwent kidney transplantation under our care and now being followed with us or 4 other hospitals. Results: Total of 20 females conceived unplanned, out of 130 females of child bearing age who underwent kidney transplant. single pregnancy ended up in elective abortion at 4th month after transplant, rest of the pregnancies were successful and uneventful. Conclusion: Fertility related issues should be included in the counselling of kidney transplant females for planned pregnancy. Successful outcome is quite possible. There is a critical need for comprehensive support systems, including counseling, education, and resources, to empower female kidney transplant recipients in their reproductive journeys and to address the gaps in understanding family planning and contraceptive methods in the post-transplant period.

Modern contraceptive utilization among women of reproductive age in Ghana: a multilevel mixed-effect logistic regression model

BackgroundWorldwide, sexual and reproductive health remains a prominent public health concern for women of reproductive age. Modern contraceptive methods play a crucial role in enabling individuals and families to regulate fertility, thereby reducing unintended pregnancies, abortions, pregnancy-related complications, and mortality. Due to the scarcity of reliable and current data regarding the factors affecting the adoption of modern contraceptives among women of reproductive age at the national level in Ghana, this research aimed to explore the determinants of modern contraceptive usage among reproductive age women.MethodsThe study analyzed data from the 2022 Ghana Demographic and Health Survey, including a weighted sample of 6,839 reproductive-age women. By employing a multilevel logistic regression model, the study sought to determine factors associated with the utilization of modern contraceptives. Associations between explanatory variables and the outcome were evaluated using adjusted odds ratios (AORs) along with 95% confidence intervals (CIs). Statistical significance was established using a p-value threshold of less than 0.05. All statistical analyses were conducted using STATA version 17 software.ResultsThe study found that 26.36% (95% CI: 25.33-27.34%) of women of reproductive age in Ghana used modern contraceptives. Secondary education (AOR = 1.26, 95% CI = 1.03–1.53), poorer household (AOR = 1.30, 95% CI = 1.05–1.61), women’s marital status, i.e. married (AOR = 1.46, 95% CI = 1.16–1.83), living with a partner (AOR = 1.65, 95% CI = 1.32–2.06), divorced (AOR = 2.53, 95% CI = 1.48–4.31), and separated (AOR = 1.70, 95% CI = 1.21–2.37), multipara (AOR = 1.39, 95% CI = 1.04–1.87), were the factors that promote modern contraceptive utilization. Women’s age in years, i.e. 35–39 (AOR = 0.71, 95% CI = 0.52–0.97), 40–44 (AOR = 0.63, 95% CI = 0.44–0.90), and 45–49 (AOR = 0.45, 95% CI = 0.25–0.79), history of pregnancy loss (AOR = 0.86, 95% CI = 0.76–0.98), region, i.e. Greater Accra (95% CI = 0.42–0.92), Bono East (95% CI = 0.32–0.81), Northern (95% CI = 0.28–0.67), Savannah (95% CI = 0.28–0.81), and North East (95% CI = 0.20–0.63), were all associated with a lower use of modern contraceptives.ConclusionsModern contraceptive utilization was low in this study. Factors such as women’s education, socioeconomic status, and marital status were associated with increased modern contraceptive utilization, whereas women’s age and regional disparities were linked to lower usage rates. These findings emphasize the need for targeted interventions to address socioeconomic barriers and regional disparities in access to family planning services across Ghana.

Influenza Infection During Pregnancy and Risk of Seizures in Offspring

Seizure is a common neurological problem among infants and children up to age 6 years. Prenatal exposure to maternal influenza infection has been reported to be associated with childhood seizures. To evaluate the association between maternal influenza infection and risk of childhood seizures. This cohort study identified mother-offspring pairs from January 1, 2004, to December 31, 2013, using records in Taiwan's Maternal and Child Health Database. Mothers who had influenza infection during pregnancy and their first offspring were identified and assigned to the influenza group. Mothers in the control group were those without influenza during pregnancy and were matched 1:4 with mothers in the influenza group by maternal age, offspring sex, and date of delivery. Offspring were followed up until December 31, 2020. Data were analyzed between March 2023 and July 2024. Diagnosis of influenza infection during pregnancy defined using International Classification of Diseases, Ninth Revision, Clinical Modification codes 487.0, 487.1, and 487.8, or International Statistical Classification of Diseases, Tenth Revision, Clinical Modification codes J09, J10, and J11. The primary outcome was the association between maternal influenza infection during pregnancy and risk of any type of seizures during childhood, including both epilepsy and febrile seizures. Adjusted hazard ratios (AHRs) and 95% CIs were estimated using Cox proportional hazards regression models. Pregnancy-related complications were collected as covariates. A total of 1 316 107 mother-offspring pairs were enrolled, of whom 75 835 mothers (predominant maternal age, 25-29 years; 39 324 male offspring [51.9%]) were assigned to the influenza group and 1 240 272 were matched and assigned to the control group (n = 303 340; predominant maternal age, 30-34 years; 157 296 male offspring [51.9%]). In the influenza group, there was a slightly higher prevalence of placenta previa or abruption compared with the control group (1.6% [1241] vs 1.4% [4350]; P < .001). The cumulative risk of seizures was higher among offspring whose mothers had influenza infection. After controlling for potential confounders, the AHRs were 1.09 (95% CI, 1.05-1.14) for seizures, 1.11 (95% CI, 1.06-1.17) for febrile convulsions, and 1.04 (95% CI, 0.97-1.13) for epilepsy. In the subgroup analysis, no statistically significant differences were observed between the trimesters regarding the timing of influenza infection. Results of this cohort study suggest that maternal influenza infection during pregnancy was associated with an increased risk of childhood seizures, especially febrile seizures, but not epilepsy. Further studies are needed to elucidate the mechanisms underlying childhood neurological development.

Living Donation and Pregnancy-Related Complications: State of the Evidence and Call To Action for Improved Risk Assessment.

Living kidney donation and living liver donation significantly increases organ supply to make lifesaving transplants possible, offering survival benefits to the recipients and cost savings to society. Of all living donors, 40% are women of childbearing age. However, limited data exist regarding the effect of donation on future pregnancies and of pregnancy-related complications on postdonation outcomes. In February 2023, the American Society of Transplantation Women's Health Community of Practice held a virtual Controversies Conference on reproductive health, contraception, and pregnancy after transplantation and living donation. Experts in the field presented the available data. Smaller breakout sessions were created to discuss findings, identify knowledge gaps, and develop recommendations. We present the conference findings related to living donation. The evidence reviewed shows that gestational hypertension and gestational diabetes mellitus before kidney donation have been associated with an increased risk of developing postdonation hypertension and diabetes mellitus, respectively, without increasing the risk of developing an eGFR <45 ml/min after donation. The risk of preeclampsia in living kidney donors increases to 4%-10%, and low-dose aspirin may help reduce that risk. Little is known about the financial burden for living donors who become pregnant, their risk of postpartum depression, or the optimal time between donation and conception. The data on living liver donors are even scarcer. The creation of a registry of donor candidates may help answer many of these questions and, in turn, educate prospective donors so that they can make an informed choice.

Evaluation of Maternal Ischemia-Modified Albumin Levels during Pregnancy and Their Effect on Fetal Birth Weight.

Background and Objectives: The purpose of this study is to evaluate the impact of maternal ischemia-modified albumin (IMA) levels on pregnancy-related complications, fetal growth, and development over time. Materials and Methods: The prospective longitudinal and single-center study included 43 pregnant women ages 18 to 43. Routine pregnancy follow-up began at the first antenatal examination for all pregnant women before 14 weeks gestation, with IMA levels measured during the first, second, and third trimesters. The albumin cobalt binding test was used to determine the amount of ischemia-modified albumin (IMA). The patients' medical, sociodemographic, and nutritional data were analyzed. The primary outcome was to investigate how changes in maternal ischemia affected albumin levels during pregnancy and the relationship between these changes and newborn weight. Results: This study included 43 cases with a mean age of 28.5 ± 5.2 years and a mean gestation period of 39.2 ± 1.3 weeks. The mean IMA levels for cases in the first trimester, second trimester, and third trimester were 0.53 ± 0.06, 0.64 ± 0.11, and 0.64 ± 0.06, respectively. The second and third trimesters showed significantly higher levels of ischemia-modified albumin (IMA) than the first trimester (p < 0.01). There was no statistically significant difference in IMA levels between the second and third trimesters (p = 1.000; p > 0.05). There was no statistically significant correlation between fetal birth and percentage changes in IMA measurements between the first and second trimesters, the first and third trimesters, or the second and third trimesters (p > 0.05). Conclusions: Our study determined that maternal ischemia-modified albumin levels during pregnancy did not correlate with fetal birth weight. Our findings revealed that age, sociodemographic changes, BMI, weight gain, and pregnancy complications had no effect on the change in IMA levels during pregnancy. We believe that this result will serve as a benchmark for future studies on IMA levels during pregnancy.

Factors contributing to delays in accessing health facility-based maternal delivery services in Sierra Leone, 2018: A community-based cluster survey.

With a Maternal Mortality Ratio (MMR) of 516 deaths per 100,000 live-births, Sierra Leone hosts one of the highest maternal mortalities in globally. National data indicates that over 98% of maternal deaths are related to delays in accessing obstetric services. This study sought to examine factors contributing to delays in accessing maternal delivery services as perceived by women in Sierra Leone. We conducted a community-based survey among women who delivered from May 1, 2017 to June 30, 2018, in four districts of Sierra Leone. Delay one was defined as perceived delays in deciding to seek facility-based delivery. Delay two was defined as perceived delays reaching the health facility for delivery services. Data on participants' socio-demographics, delay one, delay two, three and determinants of delays one and two and three were collected using questionnaires. We calculated frequencies and proportions for factors contributing to delays as well as Prevalence Odds Ratios (POR) to identify risk factors for the delays. A total of 614 mothers were interviewed, median age 28 years (range, 14-52 years). The prevalence of Delay One was 23.3% (143/614), and Delay Two was 26.9% (165/614). Mother with secondary education were associaited with delay one (aPOR = 2.3; 95% CI:1.14, 4.46). These was an association between perceived delay-two and previous pregnancy-related complications (aPOR = 1.6; 95% CI:1.071, 2.538) and poor condition of roads (POR = 2.34; 95%CI, 1.15, 4.77). Additinally, there was an association between delay-three and previous-related complication during last pregnancy (aPOR = 1.9; 95% CI: 1.055, 3.67). This study revealed a high prevalence of perceived delays one and two for mothers to access obstetric services. Delays were mainly related to transport difficulties, low knowledge of pregnancy-related complications, and costly obstetric services. A practical strategy for birth preparedness and readiness to reduce delays is urgently needed.

The influence of the perception, attitude, and level of trust on the uptake of COVID-19 vaccinations among pregnant women attending antenatal care clinic in mbeya urban, Tanzania

BackgroundCoronavirus Disease 2019 (COVID–19) has been associated with adverse effects and death among people with low immunity, including pregnant women. Despite introducing the vaccine as the proper means to curb the spread of the pandemic, vaccine uptake is still low. This study assessed the influence of perception, attitude, and trust toward COVID-19 vaccine uptake among pregnant women attending Antenatal Care Clinics.MethodsA cross-sectional study design was used, utilizing a quantitative approach with a cross-sectional analytical design conducted in Mbeya urban, distribution of sample size during data collection based on client’s volume at three government health facilities (one tertiary health facility, one secondary health facility, and one primary health facility) in Mbeya Urban, Tanzania. Data were collected from 333 pregnant women who attended ANC during the data collection period using a questionnaire with closed-ended questions administered to respondents face-to-face. Data cleaning and analysis were done using Excel and Stata/SE 14.1 software for bivariate and multivariate data; Pearson’s chi-squire and Fisher’s test were used to analyze the independent determinants of COVID-19 vaccine uptake.ResultsThe proportion of pregnant women vaccinated with the COVID-19 vaccine was 27%. There was a statistically significant association between the respondents’ vaccine uptake with primary education and < 5 work experience to vaccine uptake P = 0.015 (AOR = 6.58; 95% CI; 1.45–29.85), and P = 0.046 (AOR = 2.45; 95% CI; 1.02–5.89) respectively. The association of attitude influence to COVID-19 vaccine uptake was statistically significant (acceptance of vaccine due to its availability, vaccine acceptance for protection against COVID-19 pandemic to respondent and her baby, experience from other vaccines) was statistically significant at P = 0.011 (AOR = 4.43; 95% CI; 1.41–13.93), P = 0.001 (AOR = 45.83; 95% CI; 18.6-112.89) respectively. The level of trust in the COVID-19 vaccine influenced respondents’ association with vaccine uptake in the 2nd and 3rd trimesters of pregnancy (P = 0.633 (AOR = 1.23; 95% CI; 0.53–2.48), respectively.ConclusionPregnant women’s positive attitude and trust in the COVID-19 vaccine influenced them to uptake it; our conclusion supports the WHO guidelines that the COVID-19 vaccine should be administered to pregnant women since it is a safer means to curb COVID-19 pregnancy-related complications.

Pregnancy in patients affected by axial-spondyloarthritis: a narrative review of disease activity and obstetric outcomes.

This review aims to summarize the most recent and updated data on pregnancy in patients with axial spondyloarthritis (axSpA), focusing on the recurrence of pregnancy-related complications, the disease activity throughout gestation and the postpartum, and the latest indications for the treatments of future mothers. We have conducted a narrative review with an online literature search on Medline and PubMed. We selected only studies written in English published until January 2024, including observational and retrospective studies, meta-analyses, and systematic reviews. Proper preconception counseling and maternal-fetal monitoring are necessary to ensure the best outcome for both the mother and her baby. Despite the limited and conflicting evidence about the prevalence of adverse pregnancy outcomes in women with axSpA compared to healthy controls, primary findings demonstrate an increased risk of preterm delivery (PTD), low birth weight (LBW), and elective cesarean section (CS). Concerning disease activity, data suggests that 25-80% of women with ankylosing spondylitis experience disease flares during pregnancy, particularly around 20 weeks of gestation. On the contrary, the data on the postpartum disease flare are heterogeneous. The use of biological drugs in pregnancy is safe and effective in controlling disease activity. Data on pregnancy outcomes in patients with axSpA are scarce and discordant. Probably the difference in maternal disease classification, the evolution of treatment indications, and the differences emerging from study designs can account for these discrepancies. The main evidence shows an increased risk of PTD, LBW, and elective CS (although the latter may reflect cultural influences rather than medical needs due to axSpA itself). The majority of drugs used to treat axSpA, including TNFi, are safe in pregnancy without harming mothers or fetuses. Further data is needed to clarify many controversial aspects in this area.

EP120 - A Retrospective Review of Pregnant Patients Referred to an Emergency General Surgery Service

Abstract Aims To gain insight into the journey and outcomes of pregnant patients referred to an emergency general surgery service. Methods Surgical handover lists from Jan 2021-Dec 2023 were reviewed to identify pregnant patients referred to the service. Data was collected from the electronic patient record on demographics, timeline, imaging, diagnosis, management and subsequent delivery method if pregnancy reached term. Results There were 91 referrals of pregnant women to the emergency general surgery service over the 3 year period. 80% were for abdominal pain. 64% of patients received a documented review by a general surgery consultant, and 35% received a documented review by an obstetric consultant. For those presenting with abdominal pain, 79% had imaging other than plain film, the most common being ultrasound abdomen (75%). 5% of patients had an MRI abdomen and pelvis, and 4% of patients had a CT abdomen and pelvis. Of the 21 patients treated for a confirmed abdominal surgical diagnosis who had a documented delivery, 29% required emergency c-sections. In comparison, out of 17 patients who had either non-surgical pathologies or extra-abdominal surgical pathologies, excluding pregnancy-related complications, 0 went on to have emergency c-sections. This is statistically significant (p=0.0241). Conclusion The investigation and management of an acute abdomen in pregnancy poses a number of unique challenges. Our dataset, though small, has hinted at unacceptable rates of consultant review and under-utilisation of cross-sectional imaging. Furthermore, there is the suggestion that patients with confirmed abdominal surgical pathology may be at increased risk of delivering via emergency c-section. There is a need for further research into this patient population.

Mothers’ Psychological Trauma Experiences Associated With Preterm Pregnancy, Birth, and Care: A Qualitative Study

Background: Preterm birth trauma has become a growing concern in achieving the sustainable development goal targets for mental, maternal, and child health. Although obstetric and developmental complications associated with preterm birth have received a great deal of research attention over the years, subjective trauma experiences of mothers are often understudied. This qualitative study aims to fill this gap by adopting a phenomenological design to explore the traumatic experiences of mothers from pregnancy to care after childbirth of preterm babies in a low-resource economy. Results: The results of our Interpretative Phenomenological Analysis (IPA) revealed three superordinate and six subordinate themes: pregnancy-related (Primary pregnancy-related complications and secondary pregnancy-related factors), healthcare-related (Trauma from invasive procedures performed on babies and trauma from the poor physical health status of the babies at NICU), and parenting-related trauma (Initial shock and denial and feelings of inadequateness and helplessness in caring for their babies). Conclusions: The study shows the complex nature of the birth trauma experienced by mothers of preterm babies. The study recommends client-centered, culturally sensitive, and trauma-focused mental health support within the maternal health system.

First-trimester predictive models for adverse pregnancy outcomes-a base for implementation of strategies to prevent cardiovascular disease development.

This study aimed to establish efficient, cost-effective, and early predictive models for adverse pregnancy outcomes based on the combinations of a minimum number of miRNA biomarkers, whose altered expression was observed in specific pregnancy-related complications and selected maternal clinical characteristics. This retrospective study included singleton pregnancies with gestational hypertension (GH, n = 83), preeclampsia (PE, n = 66), HELLP syndrome (n = 14), fetal growth restriction (FGR, n = 82), small for gestational age (SGA, n = 37), gestational diabetes mellitus (GDM, n = 121), preterm birth in the absence of other complications (n = 106), late miscarriage (n = 34), stillbirth (n = 24), and 80 normal term pregnancies. MiRNA gene expression profiling was performed on the whole peripheral venous blood samples collected between 10 and 13 weeks of gestation using real-time reverse transcription polymerase chain reaction (RT-PCR). Most pregnancies with adverse outcomes were identified using the proposed approach (the combinations of selected miRNAs and appropriate maternal clinical characteristics) (GH, 69.88%; PE, 83.33%; HELLP, 92.86%; FGR, 73.17%; SGA, 81.08%; GDM on therapy, 89.47%; and late miscarriage, 84.85%). In the case of stillbirth, no addition of maternal clinical characteristics to the predictive model was necessary because a high detection rate was achieved by a combination of miRNA biomarkers only [91.67% cases at 10.0% false positive rate (FPR)]. The proposed models based on the combinations of selected cardiovascular disease-associated miRNAs and maternal clinical variables have a high predictive potential for identifying women at increased risk of adverse pregnancy outcomes; this can be incorporated into routine first-trimester screening programs. Preventive programs can be initiated based on these models to lower cardiovascular risk and prevent the development of metabolic/cardiovascular/cerebrovascular diseases because timely implementation of beneficial lifestyle strategies may reverse the dysregulation of miRNAs maintaining and controlling the cardiovascular system.