Pregnant Women In Singapore Research Articles

Seroprevalence of cytomegalovirus among pregnant women in Singapore

BackgroundCytomegalovirus (CMV) is the most common congenital infection in pregnancy with potential long-term adverse effects on the fetus. There is limited data on CMV seroprevalence in pregnant women in Singapore, with last reported study dating back over two decades. We look at the latest CMV seroprevalence in antenatal population in Singapore.MethodsBetween January 2021 and August 2021, 385 pregnant women receiving antenatal care at Singapore General Hospital were randomly selected for CMV IgG test to be performed on their blood samples collected during the first trimester of their pregnancies. Positivity for CMV IgG represents past exposure prior to pregnancy.ResultsOverall CMV seroprevalence was 71.7% (276/385) (95% CI 067, 0.76, p value < 0.001). The trend of CMV IgG positivity increased with age, 68.3% (95% CI 0.60, 0.76, p value < 0.001) in those aged 20–29, 72.5% (95% CI 0.66, 0.78, p value < 0.001) in the 30–39 age group, and 79.0% (95% CI 0.67, 0.76, p value 0.012) in women over 40.ConclusionsThere is a declining trend in CMV seroprevalence among pregnant women in Singapore, which indicates that a substantial portion of this population faces the risk of primary maternal CMV infection during pregnancy. Emerging research suggests that prenatal treatment with valacyclovir effectively reduces the likelihood of vertical transmission. Considering this evidence, it is imperative to reevaluate the recommendations for universal maternal CMV screening during pregnancy.

Effectiveness Of Hydrotherapy In Reducing Labour Pain: A Systematized Literature Review

Background: Waterbirth has gained popularity as an alternative birthing option globally, yet its implementation and acceptance in clinical practice remain limited in Singapore. Study Aim: This systemized literature review aims to investigate the effectiveness of waterbirth in reducing labour pain compared to traditional births among pregnant women in Singapore. Methodology: This systematized literature review used databases such as CINAHL (Cumulative Index to Nursing and Allied Health Literature), Ovid MEDLINE, PubMed, EMBASE (Excerpta Medica Database), and Web of Science. Selected articles were appraised using the Joanna Briggs Institute Checklist. Conclusion: A systematized review of the literature shows that warm showers for labour and immersion in water for labour comprise a multidimensional analysis of their potential impact on the birthing process. Both methods have demonstrated subjective advantages, including pain reduction and a reduction in labour time

Attitudes and practices of exercise among pregnant mothers in Singapore.

There is increasing evidence demonstrating the safety and benefits of physical activity (PA) in uncomplicated pregnancies. Literature has shown that pregnant women around the world do not engage in adequate exercise. This study aims to assess the current practices of exercise among pregnant women in Singapore, determine the proportion of women meeting different PA targets and evaluate the factors influencing the practice of exercise. In this cross-sectional study, pregnant women in different trimesters of pregnancy from KK Women's and Children's Hospital and Singapore General Hospital were surveyed. Information regarding patient demographics, attitudes and perceptions of exercise, and practice of exercise was collected. The International Physical Activity Questionnaire (IPAQ) was used to determine the amount of PA. A total of 201 pregnant women aged 20-44 years were surveyed. Almost all (99.0%) participants thought that exercise was beneficial in pregnancy. Only 31.6% of them engaged in any moderate or vigorous leisure-time PA (LTPA) and they were active for a median of 120 min/week. Only 12.6% of the pregnant women met the national recommendations of at least 150 min of moderate exercise per week. The amount of total PA performed was lower among women in later trimesters of pregnancy and higher among working mothers. Although most Singaporean pregnant women perceived exercise as beneficial, the majority did not engage in PA. Most of the participants did not meet the international PA targets and recently published national guidelines. More can be done to promote the uptake of exercise in pregnancy and optimise metabolic management of pregnant women in Singapore.

Attitudes and precaution practices towards COVID-19 among pregnant women in Singapore: a cross-sectional survey

BackgroundCOVID-19 may predispose pregnant women to higher risks of severe disease and poorer neonatal outcome. Psychological sequalae of this pandemic may pose a greater conundrum than its clinical aspects. It is currently unknown that how pregnant women cope with this global pandemic and its ramifications. The aims of the study are to understand the attitudes and precaution practices of non-infected pregnant women towards the COVID-19 outbreak in Singapore.MethodsAn online cross-sectional survey of COVID-19 awareness among pregnant women attending antenatal clinics in Singapore was conducted. An internet link was provided to complete an online electronic survey on Google platform using a quick response (QR) code on mobile devices. The online survey consists of 34 questions that were categorized into 4 main sections, namely 1) social demographics 2) attitude on safe distancing measures 3) precaution practices and 4) perceptions of COVID-19. Multiple linear regression analysis was performed to examine women’s precaution practices among six independent socio-demographic variables, including age, ethnicity, education, front-line jobs, history of miscarriage and type of antenatal clinic (general, high risk).ResultsA total of 167 survey responses were obtained over 8 weeks from April to June 2020. The majority of women were aged ≤35 years (76%, n = 127), were of Chinese ethnicity (55%, n = 91), attained tertiary education (62%, n = 104) and were not working as frontline staff (70%). Using multiple linear regression models, Malay ethnicity (vs. Chinese, β 0.24; 95% CI 0.04, 0.44) was associated with higher frequency of practicing social distancing. Malay women (β 0.48; 95% CI 0.16, 0.80) and those who worked as frontline staff (β 0.28; 95% CI 0.01, 0.56) sanitized their hands at higher frequencies. Age of ≥36 years (vs. ≤30 years, β 0.24; 95% CI 0.01, 0.46), Malay (vs. Chinese, β 0.27; 95% CI 0.06, 0.48) and Indian ethnicity (vs. Chinese, β 0.41; 95% CI 0.02, 0.80), and attendance at high-risk clinic (vs. general clinic, β 0.20; 95% CI 0.01, 0.39) were associated with higher frequency of staying-at-home.ConclusionSocial demographical factors including age > 36 years old, Malay ethnicity, employment in front line jobs and attendance at high-risk clinics are likely to influence the attitudes and precaution practices among pregnant women towards COVID-19 in Singapore. Knowledge gained from our cross-sectional online survey can better guide clinicians to communicate better with pregnant women. Hence, it is important for clinicians to render appropriate counselling and focused clarification on the effect of COVID-19 among pregnant women for psychological support and mental well being.

Determinants of childbirth self-efficacy among multi-ethnic pregnant women in Singapore: A structural equation modelling approach

ObjectiveThis study aims to examine the relationships among sociodemographic and obstetric factors, fear of childbirth, psychosocial well-being and childbirth self-efficacy using a structural equation modelling approach. DesignIt adopted an exploratory cross-sectional study among 205 multi-ethnic pregnant women in Singapore. We used structural equation modelling to examine our hypothetical model, which integrates the concepts of Bandura's self-efficacy theory and previous literature reviews. The Childbirth Self-Efficacy Inventory, the Childbirth Attitudes Questionnaire and the World Health Organisation (Five) Well-Being Index were employed to measure childbirth self-efficacy, fear of childbirth and psychological well-being, respectively. FindingsThe structural equation model showed that multiparous women (β = 0. 24, P < 0.01), with better psychological well-being (β = 0.26, P < 0.001) were more likely to have higher childbirth self-efficacy; whereas Chinese women (β = -0.32, P < 0.01) with previous caesarean section (β = -0.17, P < 0.05) and higher fear of childbirth (β = -0.30, P < 0.001) were more likely to have lower childbirth self-efficacy. The structural equation model had good fit with the data (incremental fit index = 0.925, Tucker-Lewis index = 0.911, comparative fit index = 0.923, and root means square error of approximation = 0.048). ConclusionFindings of this study highlight that ethnic Chinese, multiparous women, previous caesarean section, psychological well-being and fear of childbirth were determinants of childbirth self-efficacy among pregnant women in Singapore. Enhancement of self-efficacy can increase coping ability and reduce fear of childbirth and thus promote normal childbirth. Future self-efficacy enhancing interventions among pregnant women should be tailored by age, ethnicity, parity and prior modes of birth.

Coverage and determinants of influenza vaccine among pregnant women: a cross-sectional study

BackgroundPregnant women are at increased risk of influenza-related complications. The World Health Organisation recommends influenza vaccination to this high-risk population as highest priority. However, achieving high influenza vaccine coverage among pregnant women remains challenging. We conducted a cross-sectional survey to estimate the coverage and determinants of influenza vaccination among pregnant women in Singapore.MethodsBetween September and November 2017, pregnant women aged ≥21 years were recruited at two public hospitals in Singapore. Participants completed an anonymous, self-administered online questionnaire assessing participants’ influenza vaccination uptake, knowledge of and attitudes towards influenza and the influenza vaccine, vaccination history, willingness to pay for the influenza vaccine, and external cues to vaccination. We estimated vaccine coverage and used multivariable Poisson models to identify factors associated with vaccine uptake.ResultsResponse rate was 61% (500/814). Only 49 women (9.8, 95% Confidence Interval (CI): 7.3–12.7%) reported receiving the vaccine during their current pregnancy. A few misconceptions were identified among participants, such as the belief that influenza can be treated with antibiotics. The most frequent reason for not being vaccinated was lack of recommendation. Women who were personally advised to get vaccinated against influenza during pregnancy were 7 times more likely to be vaccinated (prevalence ratio (PR) = 7.11; 95% CI: 3.92–12.90). However, only 12% of women were personally advised to get vaccinated. Other factors associated with vaccine uptake were vaccination during a previous pregnancy (PR = 2.51; 95% CI: 1.54–4.11), having insurance to cover the cost of the vaccine (PR = 2.32; 95% CI: 1.43–3.76), and higher vaccine confidence (PR = 1.62; 95% CI: 1.30–2.01).ConclusionsInfluenza vaccination uptake among pregnant women in Singapore is low. There is considerable scope for improving vaccination coverage in this high-risk population through vaccination recommendations from healthcare professionals, and public communication targeting common misconceptions about influenza and influenza vaccines.

Iron status and risk factors of iron deficiency among pregnant women in Singapore: a cross-sectional study

BackgroundIron deficiency is the most prevalent nutrient deficiency and the most common cause of anaemia worldwide. Because of the increased iron requirements during pregnancy, iron deficiency can lead to maternal anaemia and reduced newborn iron stores. We examined the proportion and risk factors of iron deficiency among pregnant women in a developed Asian country.MethodsWithin a prospective cohort in Singapore, 985 Asian women were assessed for iron status at 26–28 weeks’ gestation, with plasma ferritin and soluble transferrin receptor (sTfR) measurements. Iron status was determined according to plasma ferritin concentrations at ≥30 μg/L (iron sufficiency), 15 to < 30 μg/L (modest iron depletion) and < 15 μg/L (severe iron depletion). Multivariable ordinal logistic regression was used to analyze risk factors for modest and severe iron depletion.ResultsThe median (25-75th percentile) plasma ferritin concentration was 24.2 (19.9–30.6) μg/L. Overall, 660 (67.0%) and 67 (6.8%) women had modest and severe iron depletion, respectively. Higher plasma sTfR was observed in women with severe iron depletion than among those with iron sufficiency (median 17.6 versus 15.5 nmol/L; p < 0.001). Age < 25 years (odds ratio 2.36; 95% confidence interval 1.15–4.84), Malay (2.05; 1.30–3.24) and Indian (1.98; 1.14–3.44) ethnicities (versus Chinese), university qualification (1.64; 1.13–2.38), multiparity (1.73; 1.23–2.44) and lack of iron-containing supplementation (3.37; 1.25–8.53) were associated with increased odds of modest and severe iron depletion.ConclusionsNearly three-quarters of Singaporean women were iron deficient in the early third trimester of pregnancy. These results suggest universal screening and supplementation of at-risk pregnancies may be evaluated as a preventive strategy.Trial registrationNCT01174875. Registered 1 July 2010 (retrospectively registered).

Adherence to a healthy eating index for pregnant women is associated with lower neonatal adiposity in a multiethnic Asian cohort: the Growing Up in Singapore Towards healthy Outcomes (GUSTO) Study

Evidence linking maternal diet quality during pregnancy with infant birth outcomes is limited in Asia. We investigated the association of maternal diet quality with the risk of preterm birth, offspring birth size, and adiposity in a multiethnic Asian birth cohort. Dietary intakes of 1051 pregnant women were ascertained at 26-28 wk of gestation with the use of 24-h recalls and 3-d food diaries, from which diet quality (score range: 0-100) was measured by the Healthy Eating Index for pregnant women in Singapore (HEI-SGP). Gestational age was established by first-trimester ultrasound dating scan. Neonatal weight and length were measured at birth. Body composition was assessed by air displacement plethysmography in a subset of infants (n = 313) within 72 h after birth, and abdominal adiposity was assessed by MRI (n = 316) within the first 2 wk of life. Associations were assessed by multivariable linear regression for continuous outcomes and logistic regression for preterm birth. The mean ± SD maternal HEI-SGP score was 52.1 ± 13.6. Maternal diet quality during pregnancy was not associated with preterm birth or birth weight. Greater adherence to the HEI-SGP (per 10-point increment in HEI-SGP score) was associated with longer birth length [β (95% CI): 0.14 (0.03, 0.24 cm)], lower body mass index (in kg/m2) at birth [-0.07 (-0.13, -0.01)], lower sum of triceps and subscapular skinfold thickness [-0.15 (-0.26, -0.05 mm)], lower percentage body fat [-0.52% (-0.84%, -0.20%)], lower fat mass [-17.23 (-29.52, -4.94 g)], lower percentage abdominal superficial subcutaneous adipose tissue [-0.16% (-0.30%, -0.01%)], and lower percentage deep subcutaneous adipose tissue [-0.06% (-0.10%, -0.01%)]. Higher maternal diet quality during pregnancy was associated with longer birth length and lower neonatal adiposity but not with birth weight and preterm birth. These findings warrant further investigation in independent studies. This trial was registered at clinicaltrials.gov as NCT01174875.

Sleep and Dietary Patterns in Pregnancy: Findings from the GUSTO Cohort.

Evidence on the association between sleep, diet, and eating behaviors in pregnant women is lacking. We examine this in a cohort of apparently healthy pregnant women. At 26–28 weeks gestation, 497 participants completed the Pittsburgh Sleep Quality Index to assess sleep and a 24-h recall to assess dietary intake. Diet quality was assessed by the Healthy Eating Index for pregnant women in Singapore (HEI-SGP) score and previously derived dietary patterns (vegetables-fruit-rice, seafood-noodles, and pasta-cheese-meat pattern). Eating behaviors studied included the longest night-time fasting interval, frequency of consumption occasions, energy from discretionary foods, and nighttime eating. Adjusted means were estimated between poor/good quality and short/normal sleepers using linear regressions, including covariates. Good sleep quality versus poor sleep quality, was associated with better diet quality (mean HEI-SGP 54.6 vs. 52.0; p = 0.032), greater adherence to the vegetables-fruit-rice pattern (mean 0.03 vs. −0.15; p = 0.039), lesser adherence to the seafood-noodle pattern (mean −0.14 vs. 0.03; p = 0.024), and a trending lower calories from discretionary foods (mean 330.5 vs. 382.6 kcal; p = 0.073), after adjusting for covariates. After additional adjustment for anxiety, only sleep quality and the seafood-noodle pattern remained significantly associated (p = 0.018). Short sleep was not associated with any diet or eating behavior. In conclusion, good sleep quality is associated with a better diet quality and a greater adherence to the vegetable-fruit-rice pattern, but with lesser adherence to the seafood-noodle diets in pregnant women.

Breastfeeding attitude, health-related quality of life and maternal obesity among multi-ethnic pregnant women: A multi-group structural equation approach

BackgroundIdentifying the factors influencing breastfeeding attitude is significant for the implementation of effective promotion policies and counselling activities. To our best knowledge, no previous studies have modelled the relationships among breastfeeding attitude, health-related quality of life and maternal obesity among multi-ethnic pregnant women; the current study attempts to fill this research gap. ObjectivesThis study investigated the relationships among maternal characteristics, health-related quality of life and breastfeeding attitude amidst normal weight and overweight/obese pregnant women using a multi-group structural equation modelling approach. DesignExploratory cross-sectional design was used. SettingAntenatal clinics of a university-affiliated hospital ParticipantsPregnant women were invited to participate; 708 (78.8%) agreed to participate in the study. MethodsWe examined a hypothetical model on the basis of integrating the concepts of a breastfeeding decision-making model, theory of planned behaviour-based model for breastfeeding and health-related quality of life model among 708 multi-ethnic pregnant women in Singapore. The Iowa Infant Feeding Attitude Scale and Medical Outcomes Study Short Form Health Survey were used to measure breastfeeding attitude and health-related quality of life, respectively. ResultsTwo structural equation models demonstrated that better health-related quality of life, higher monthly household income, planned pregnancy and previous exclusive breastfeeding experience were significantly associated with positive breastfeeding attitude among normal and overweight/obese pregnant women. Among normal weight pregnant women, those who were older with higher educational level were more likely to have positive breastfeeding attitude. Among overweight/obese pregnant women, Chinese women with confinement nanny plan were less likely to have positive breastfeeding attitude. No significant difference existed between normal weight and overweight/obese pregnant women concerning estimates of health-related quality of life on breastfeeding attitude (Critical Ratio=−0.193). The model satisfactorily fitted the data (Incremental Fit Index=0.924, Tucker–Lewis Index=0.905, Comparative Fit Index=0.921 and Root Means Square Error of Approximation=0.025). Health-related quality of life was found to affect breastfeeding attitude in multi-ethnic pregnant women. ConclusionsThis relationship implied the importance of early culturally specific interventions to enhance health-related quality of life for improving positive breastfeeding attitude among pregnant women across different ethnic groups.

A healthy eating index to measure diet quality in pregnant women in Singapore: a cross-sectional study

There are limited tools to assess diet quality in pregnant women in an Asian population. A healthy eating index for pregnant women in Singapore (HEI-SGP) was developed and its association with maternal characteristics examined. The HEI-SGP was adapted from the Healthy Eating Indices (HEI) and Alternate Healthy Eating Index for Pregnancy (AHEI-P) and modified accordingly to recommendations from the Singapore dietary guidelines for pregnant women. It included eight components to reflect the dietary adequacy and quality of food groups and two nutrient-based components to reflect nutrients to be taken in moderation. Total scores range from 0 to 100. Study participants were from a mother-offspring cohort study – Growing Up in Singapore Towards healthy Outcomes (GUSTO), selected using criterion based sampling. Dietary intakes of these women were ascertained at 26–28 weeks of gestation using 24-hour recalls and 3-day food diaries. The HEI-SGP differentiated the diets qualitatively in the cohort of 955 women. The scores had a wide range of 12.6 - 94.3, with mean score of 52.4 (standard deviation 13.8) and were categorised by tertiles. Using one way ANOVA and chi-square tests, participants in the high tertile, compared to those in the middle and low tertiles, were more likely to meet recommendations for intakes of total fruits, whole fruits, total vegetables, dark green leafy and orange vegetables and dairy food groups (p < 0.001 for all). Those in the low tertile had significantly higher percentage of energy from total fat (p < 0.001) and saturated fat (p < 0.001), and lower percentage of energy from protein (p < 0.001) compared to participants from the two higher tertiles. From adjusted multinomial logistic regression analyses, women with poorer diet quality tended to be younger (odds ratio (OR) = 0.94; 95 % confidence interval (CI): 0.90-0.97), belonged to the Malay ethnic group (OR = 2.54; 95 % CI: 1.55-4.16), had lower household incomes (OR = 2.00, 95%CI: 1.03-3.87), were less educated (OR = 1.96, 95%CI: 1.19-3.25), single or had previous pregnancies (OR: 1.51; 95%CI 1.02, 2.24). The HEI-SGP has shown to be useful for differentiating diet quality and may be used to identify women ‘at risk’ of poor diets during pregnancy and whom require early intervention. NCT01174875

Whole grain intake, determined by dietary records and plasma alkylresorcinol concentrations, is low among pregnant women in Singapore.

To quantify whole grain intake in pregnant women in Singapore in order to provide the first detailed analysis of whole grain intake in an Asian country and in pregnant women. Analysis of 24-h diet recalls in a cross-sectional cohort study and analysis of a biomarker of whole grain intake (plasma alkylresorcinols) in a subset of subjects. The Growing Up in Singapore Towards healthy Outcomes-mother offspring cohort study based in Singapore. 998 pregnant mothers with complete 24-h recalls taken during their 26-28th week of gestation. Plasma samples from a randomly select subset of 100 subjects were analysed for plasma alkylresorcinols. Median (IQR) whole grain intake for the cohort and the 30% who reported eating whole grains were 0 (IQR 0, 9) and 23.6 (IQR 14.6, 44.2) g/day respectively. Plasma alkylresorcinol concentrations were very low [median (IQR)=9 (3, 15) nmol/L], suggesting low intake of whole grain wheat in this population. Plasma alkylresorcinols were correlated with whole grain wheat intake (Spearman's r=0.35; p<0.01). Whole grain intake among pregnant mothers in Singapore was well below the 2-3 (60-95 g) servings of whole grains per day recommended by the Singapore Health Promotion Board. Efforts to increase whole grain intake should be supported to encourage people to choose whole grains over refined grains in their diet.

Awareness of and attitudes toward congenital cytomegalovirus infection among pregnant women in Singapore

ObjectiveTo assess the level of awareness of congenital cytomegalovirus (CMV) infection and attitudes toward prenatal CMV serologic testing among pregnant women. MethodsA questionnaire was distributed to pregnant women who attended a specialist outpatient clinic at Singapore General Hospital, Singapore, between September and December 2010. ResultsAmong 200 respondents, 40 (20.0%) were aware of CMV. Healthcare workers were more likely to be aware of CMV (odds ratio 6.91, confidence interval 2.14–22.30; P=0.001). Most respondents found it “very” or “somewhat” easy to adhere to standard guidelines for primary prevention of CMV. Among the respondents, 62.0% (124/200) would like to be given the option of prenatal CMV screening and 72.0% (144/200) were keen to be screened. On multivariate analysis, respondents who were keen to undergo serologic screening for CMV were not more likely to consider invasive testing or termination of pregnancy should the test results demonstrate primary maternal CMV infection. ConclusionPregnant women who were keen to undergo CMV testing demonstrated attitudes toward invasive testing and termination of pregnancy that were not significantly different from those of women who would refuse testing. Patient choice and expectations should be considered in the implementation of preventive measures against congenital CMV.