Previous Pregnancy Complications Research Articles

Development and internal validation of a model to predict type 2 diabetic complications after gestational diabetes

Gestational diabetes mellitus (GDM) increases the risk of early-onset type 2 diabetes, which further exacerbates the risk of developing diabetic complications such as kidney, circulatory, and neurological complications. Yet, existing models have solely focused on the prediction of type 2 diabetes, and not of its complications, which are arguably the most clinically relevant outcomes. Our aim was to develop a prediction model for type 2 diabetic complications in patients with GDM. Using provincial administrative data from Quebec, Canada, we developed a model to predict type 2 diabetic complications within 10 years among 90,143 women with GDM. The model was internally validated and assessed for discrimination, calibration, and risk stratification accuracy. The incidence of diabetic complications was 3.8 (95% confidence interval (CI) 3.4–4.3) per 10,000 person-years. The final prediction model included maternal age, socioeconomic deprivation, substance use disorder, gestational age at delivery, severe maternal morbidity, previous pregnancy complications, and hypertensive disorders of pregnancy. The model had good discrimination [area under the curve (AUROC) 0.72 (95% CI 0.69–0.74)] and calibration (slope ≥ 0.9) to predict diabetic complications. In the highest category of the risk stratification table, the positive likelihood ratio was 8.68 (95% CI 4.14–18.23), thereby showing a moderate ability to identify women at highest risk of developing type 2 diabetic complications. Our model predicts the risk of type 2 diabetic complications with moderate accuracy and, once externally validated, may prove to be a useful tool in the management of women after GDM.

The magnitude and determinants of depressive symptoms amongst women in early pregnancy in Southern Nigeria: A cross-sectional study.

BackgroundAntenatal depression (AD) is prevalent and associated with adverse pregnancy, maternal and child outcomes, yet no study has addressed its magnitude and predictors in early pregnancy in Nigeria.AimTo determine the prevalence and factors associated with AD in first half of pregnancy.SettingMulticentric health facilities in Southern Nigeria.MethodsA multicentric health-facilities-based cross-sectional study was conducted from January to July 2018. Using pretested structure interviewer-administered questionnaires, antenatal depressive symptoms were assessed amongst 511 pregnant mothers with the Edinburg Postnatal Depressive Scale tool. Socio-demographic, socio-economic, clinical, family and social factors were also measured. Descriptive statistics, bivariate and multivariable logistic regression analyses were employed to describe and identify factors associated with AD.ResultsThe prevalence of antenatal depressive symptoms in early pregnancy in this study was 29.4% (95% confidence interval [CI] 26.6–32.9). Factors independently associated with AD were intimate partner violence (adjusted odds ratios [AOR] = 8.10, 95% CI 5.00–13.14), marital dissatisfaction (AOR 5.48, 95% CI 3.48–8.38), poor social support (AOR 4.70; 95% CI 2.99–7.38), past history of depression (AOR 4.67; 95% CI 2.47–8.80), previous pregnancy complication (AOR 2.50, 95% CI 1.57–3.89), low socio-economic status (AOR 2.41, 95% CI 1.61–3.66) and unplanned pregnancy (AOR 2.35, 95% CI 1.47–3.64).ConclusionsThe prevalence of antenatal depression is high with modifiable risk factors requiring context-specific policies such as provision of family, social and economic support for mothers at the earliest possible contact in the antenatal period.

The magnitude and associated factors of childbirth fear among pregnant women attending antenatal care at public hospitals in Ethiopia: a cross-sectional study

BackgroundChildbirth fear affects 5–40% of all mothers around the world, and there is mounting evidence that it has harmful impacts on women’s health. It could potentially lead pregnant women to feel isolated and unsupported if not identified. But studies addressing this issue are limited in Ethiopia. Therefore, this study was aimed at assessing the magnitude and associated factors of childbirth fear among pregnant women attending antenatal care at public hospitals in West Wollega Zone.MethodsFacility-based cross-sectional study was conducted among 304 pregnant women selected by systematic random sampling from 20 March to 20 April 2020. A structured interviewer-administered questionnaire was adapted and used to collect data. Data were entered into EpiData version 3.1 and exported to IBM SPSS statistics version 26 for analysis. Descriptive statistics were done to calculate frequencies, mean scores, and standard deviation. Bivariate and multivariable logistic regression was used to identify factors associated with childbirth fear. Variables with p < 0.25 in bivariate analyses were selected for multivariable analysis. Finally, statistical significance was declared at p < 0.05.ResultsOut of the total of 304 participants, 298 completed the interview making the response rate 98%. The overall prevalence of childbirth fear was 28.9% with 95% CI (23.5, 34.2). Mean age of the respondents was 27.60 (SD ± 4.56) years. Having previous pregnancy complications [AOR (95% CI)], [6.949 (2.060 – 23.445), presence of long time during childbirth [AOR (95% CI)], [4.765 (1.161 – 19.564)], presence of episiotomy [AOR (95% CI)], [4.197 (1.107 – 15.917)], low social support [AOR (95% CI)], [.011 (.003 – .050)] were significantly associated with childbirth fear.ConclusionPregnant women in the study area have a significant level of childbirth fear. Previous pregnancy complications, prolonged labor, labor pain, previous perineal tear, and social support were all found to be significantly linked with childbirth fear. This calls for the need to identify and develop interventions for women to reduce childbirth fear during pregnancy.

Association of Pre-Gestational Diabetes Mellitus (Type 1 &amp; Type 2), Gestational Diabetes, and Pre-Eclampsia with Preterm Birth Among Omani Women

<i>Background</i>: To understand what results in preterm birth, the purpose of this quantitative cross-sectional study was to determine if and to what extent rates of pre-gestational diabetes mellitus, gestational diabetes mellitus, and pre-eclampsia differ between Omani women who deliver preterm infants and Omani women who deliver term infants. Shonkoff’s bio-developmental framework provided the theoretical foundation for the study. <i>Methodology</i>: A quantitative method. Specifically, this is a retrospective cross-sectional study using secondary data Secondary. Data were gathered from a simple random sample of 400 women who delivered preterm or term infants between 2015 and 2017 at Ibri hospital in Oman. Controls group included 200 women with full-term and 200 cases women with pre-term (case to control ratio was 1:1). After data extraction and cleaning, descriptive analyses and Chi-square tests of independence were conducted. <i>Results</i>: A total of 400 randomly selected participants (mean age of the participants was 29.26 (SD±5.75) years) were included in the study (200 participants gave birth to preterm infants and 200 participants gave birth to full term infants). The demographics of the women, maternal clinical characteristics, neonatal clinical characteristics, maternal complications in previous pregnancy, and maternal complications in current pregnancy, were summarized. According to the results of chi-square tests of independence, there was no association between delivery term and complications in current pregnancy, in terms of pre-gestational diabetes mellitus, GDM, and pre-eclampsia. Nonetheless, numerous statistically significant association were found between risk of preterm birth and demographic as well as clinical factors. <i>Conclusion</i>: According to the results, there was no statistically significant association between delivery term and complications in current pregnancy, in terms of pre-gestational diabetes mellitus and pre-eclampsia. However, most of the indicators related to determine the connection between education, number of infants born prematurely, maternal family history of GDM, maternal family history of gestational hypertension, maternal family history of obesity, infants’ birth weight, Apgar score at 1 minute and Apgar score at 5 minutes, and fetal demise the second research question were statistically significant with preterm birth. Finally, the researcher recommends addressing the current study’s limitation of Omani specific results in broader studies covering a greater population and diverse population demographics. Also the researcher recommends the results of this study be applied to nursing practice and education by training nurses and nursing students to identify factors in patient family histories which might suggest high risk pregnancies.

Differences in perinatal outcomes in teenage mothers with their first and third pregnancies and predictors of adverse neonatal events: A cross-sectional study

BackgroundRepeated teenage pregnancy is a major burden on the healthcare system worldwide.ObjectiveWe aimed to compare teenagers with their first and third pregnancies and to evaluate the likelihood of neonatal complications.Materials and MethodsThis cross-sectional study was performed on female teenagers (aged 19 yr) with singleton pregnancies. The subjects (n = 298) were screened over 12 months. Ninety-six women were excluded, based on the exclusion criteria. The remaining subjects (n = 202) were divided into two groups: teenagers with first pregnancy (n = 96) and teenagers with third pregnancy (n = 47). The subjects were observed throughout pregnancy and delivery. The final sample size of the first and third pregnancy groups was 96 and 47, respectively.ResultsThere was a significant risk of preeclampsia in the first pregnancy group (p = 0.01). Low birth weight, five-min Apgar score 7, and neonatal intensive care unit admission were the most significant neonatal outcomes in the first pregnancy group. In the third pregnancy group, significant predictors of neonatal complications included very young age in the first pregnancy ( 15 yr), an inter-pregnancy interval 2 yr, current anemia, and history of obstetric and/or neonatal complications in previous pregnancies.ConclusionBased on the results, teenagers with their first pregnancy had comparable obstetric outcomes (except for preeclampsia) as teenagers with their third pregnancy, whereas neonatal complications occurred more frequently in the first pregnancy group. Overall, we can predict high-risk neonates in the third pregnancy, based on the abovementioned parameters.

Gestational Anaemia and its Associated Factors in Normal Pregnant Women

Objectives: To determine the hemoglobin levels in normal pregnant women and investigate the association of anemia with gestational age, number of antenatal visits, obstetrical complications and mode of delivery.&#x0D; Methodology: This is a cross-sectional study conducted at the Lady Willingdon Hospital, Khairpur Mirs, Pakistan from May 2021 to August 2021. A total of 139 normal pregnant women were recruited during antenatal visits. Patients were grouped into normal and anemic groups based on serum hemoglobin levels. Gestational age, obstetrical complications, mode of delivery and fetal outcome were recorded to find its association with anemia. Data was analyzed on SPSS 20.0 and p-value &lt; 0.05 was considered as statistically significant.&#x0D; Results: Out of n=139 normal pregnant women, n=26 women had normal hemoglobin levels, n=49 were mild anemic, n=46 had moderate anemia whereas n=18 had severe anemia. Overall, the prevalence of gestational anemia was 81%. There was significant association between hemoglobin status and number of antenatal visits and complications in previous pregnancies. Hemoglobin status was not significantly associated with gestational age and mode of delivery.&#x0D; Conclusion: In conclusion, we found that gestational anemia is highly prevalent in Pakistan. Early detection of anemia and its correction via supplementations are recommended.

Ovarian Reserve Assessed by the Anti-Mullerian Hormone and Reproductive Health Parameters in Women With Crohn´s Disease, a Case-Control Study.

According to several studies, women with Crohn's disease (CD) had reduced fertility, which is mostly due to voluntary decisions and reduced ovarian reserve. In our study, we aimed to compare reproductive health parameters (RHP), previous pregnancy complications and outcomes, and ovarian reserve (OR) assessed by the anti-Mullerian hormone (AMH) in CD patients with healthy controls. In CD patients, we also compared OR according to disease phenotypes. Consecutive pre-menopausal women with CD from two IBD centers were included. The control group consisted of age and BMI-matched healthy controls. We used a questionnaire that included RHP, CD phenotype, and CD activity. Serum AMH was assessed by the Elecsys AMH plus essay. We enrolled 50 patients and 56 controls with a median age of 31 years. All CD patients were in clinical remission. We observed no difference in RHP or AMH (median 2.6 vs. 2.1 ug/l, p = 0.98), or the proportion of low OR (AMH<1,77, 38 vs. 41.1 %, p=0.84). The slope of age-related decrease did not differ between the groups. The subgroup of CD patients after surgery and those older than 30 years with CD for >5years had a steeper decrease in AMH (slope -0.12 vs. -0.29, p = 0.04 and -0.31 vs. -0.2, p = 0.029). In a multivariate analysis, age was the single independent predictor of low OR (OR=1.25). In women with Crohn's disease, once the disease activity is under control, the reproductive health and ovarian reserve do not substantially differ from healthy controls.

Adverse Perinatal Outcomes Among Grand Multiparous and Low Multiparous Women and Its Associated Factors in North Shewa Zone Public Hospitals: The Role of Parity.

BackgroundAdverse perinatal outcomes are the major cause of neonatal morbidity, mortality, and long-term physical and psychological consequences. Contradicting evidence across studies was reported about the impact of grand multiparity on adverse perinatal outcomes. Older literature reported increased incidence of perinatal complications in grand multiparas, but, recent reports failed to support this finding. In addition, there is a paucity of comparative studies on perinatal outcomes. Thus, the study aimed to compare the perinatal outcomes in grand multiparous (GM) and low multiparous (LM) women who give birth in North Shewa Zone Public Hospitals, Ethiopia, 2021.MethodsA comparative cross-sectional study was done among 540 (180 GM and 360 LM) women from January 1 to March 30, 2021. The data were collected using a structured and pre-tested questionnaire through interviews and reviewing patient charts. SPSS version 25 was used for data analysis. The data were entered using Epi-Data version 4.6. The Hosmer–Lemeshow goodness-of-fit was applied to test for model fitness. The statistical significance level was declared at a p-value of ≤0.05.ResultsIn this study, the prevalence of adverse perinatal outcomes was 14.1% (95% CI: 10.9–17.2). Stillbirth/IUFD (33.3%) and low APGAR score (60%) were frequently occurred complications in grand multiparas. Nevertheless, meconium aspiration (26%), admission to NICU (65.2%), macrosomia (61%), and prematurity (52.2%) were higher in low multiparous women. Age above 35 years (AOR (CI) = 2.61 (1.23–5.53)), rural residence (AOR (CI) = 8.31 (3.05–22.6)), being a government employee (AOR (CI) = 0.19 (0.05–0.69)), lack of antenatal care (AOR (CI) = 9.76 (3.03–31.5)), and previous pregnancy complications (AOR (CI) = 3.10 (1.63–5.90)) were significant predictors of adverse perinatal outcomes. However, parity did not show a statistically significant association with perinatal outcomes.ConclusionMaternal age, residence, occupation, lack of antenatal care, and previous pregnancy complications were significant associates of perinatal outcome. There was no statistically significant difference in perinatal outcome between GM and LM women. Socio-economic development, good antenatal care, and early identification and treatment of complications are needed regardless of parity.

Blastocyst quality and perinatal outcomes in women undergoing single blastocyst transfer in frozen cycles

STUDY QUESTIONIs the morphological grading system for blastocysts associated with perinatal outcomes in women undergoing frozen–thawed single blastocyst transfer (SBT)?SUMMARY ANSWERPreferential transfer of a blastocyst based on their inner cell mass (ICM) and trophectoderm (TE) grading appears to be supported by observed differences in perinatal outcomes.WHAT IS KNOWN ALREADYThe transfer of a morphologically good quality blastocyst is associated with a higher chance of implantation and pregnancy as compared to transfer of a poor quality blastocyst. However, to date, the association of the morphological parameters of the blastocyst with perinatal outcomes after blastocyst transfer remains unknown.STUDY DESIGN, SIZE, DURATIONThis retrospective cohort study started with 27 336 frozen–thawed SBT cycles from January 2013 to December 2019.PARTICIPANTS/MATERIALS, SETTING, METHODSThere were 7469 women with singleton deliveries in Peking University Third Hospital eligible for analysis. Multivariate logistic regression was used to test the risk of factors with the expression of crude odds ratios (ORs) and adjusted OR with 95% CIs.MAIN RESULTS AND THE ROLE OF CHANCETransfer of a blastocyst with a low overall grading was associated with a higher chance of female baby (48% vs 42%, adjusted OR = 1.26 (1.13, 1.39)) and a higher rate of caesarian section (C-section; 71% vs 68%, adjusted OR = 1.15 (1.02, 1.29)). Compared with Grade A ICM blastocyst transfer, Grade B ICM and Grade C ICM blastocyst transfers were associated with a lower chance of a female baby (adjusted OR = 0.83 (0.73, 0.95), 0.63 (0.50, 0.79), respectively) and a higher risk of large for gestational age (LGA; adjusted OR = 1.23 (1.05, 1.45), 1.47 (1.12, 1.92), respectively); Grade C ICM blastocyst transfer was also associated with an increased risk of macrosomia (adjusted OR = 1.66 (1.20, 2.30)). Compared with Grade A TE blastocyst transfer, there was an increased risk of small for gestational age with Grade C TE blastocyst transfer (adjusted OR = 1.74 (1.05, 2.88)). Both Grade B TE and Grade C TE blastocyst transfer had a higher chance of female baby (adjusted OR = 1.30 (1.11, 1.53), 1.88 (1.57, 2.26), respectively) and a lower risk of gestational diabetes mellitus (adjusted OR = 0.74 (0.59, 0.94), 0.67 (0.50, 0.88), respectively) than Grade A TE blastocyst transfer.LIMITATIONS, REASONS FOR CAUTIONThe main limitations of this study were its retrospective nature and the relative subjectivity of blastocyst scoring. The follow-up was conducted through a phone call and some patients may not have reported their obstetrical and neonatal outcomes, leading to a relatively lower rate of several obstetrical outcomes. Due to the missing information in our dataset, we were not able to separate out iatrogenic preterm birth nor adjust for obstetric complications in previous pregnancies as a confounder in the mutivariate analysis. Because the days of blastocyst culture in total were unclear in our dataset, analysis of the association between the time to reach blastocyst expansion and perinatal outcomes was not performed.WIDER IMPLICATIONS OF THE FINDINGSTransfer of a blastocyst with a low overall grading is associated with a higher rate of C-section and a higher chance of a female baby. The association between ICM grading and LGA would suggest that Grade A ICM blastocysts should be transferred preferentially to Grade B/C ICM blastocysts. Our results support the use of current morphological systems for embryo prioritization.STUDY FUNDING/COMPETING INTEREST(S)This study was supported by the National Key Research and Development Program of China (2018YFC1004100 to R.L.), the National Science Fund for Distinguished Young Scholars (81925013 to R.L.) and a Zhejiang University Scholarship for Outstanding Doctoral Candidates (to K.-L.H.). All authors have read the journal’s authorship agreement and policy on disclosure of potential conflicts of interest, and have no conflicts of interest to declare.TRIAL REGISTRATION NUMBERN/A.

Ovarian Vein Thrombosis Complicated by Pulmonary Embolism after Cesarean Delivery in the Presence of a Large Fibroid: Case Report and Literature Review of Contributing Factors

Ovarian vein thrombophlebitis is rare and mostly occurs during the puerperal period and in higher rates after a cesarean delivery. The objective of this case report and literature review is to highlight the rare occurrence of an ovarian vein thrombosis in a 37-year-old woman postcesarean delivery in the setting of a large uterine fibroid who subsequently developed a pulmonary embolism. The patient presented with severe abdominal pain, fever, and chills. Imaging showed a right ovarian vein thrombosis. Following initiation of anticoagulation therapy, she developed dyspnea and testing showed a subsegmental pulmonary embolism. Further investigation showed that the patient had an undiagnosed thrombophilia thus meeting the classic Virchow triad. Complete clinical recovery was observed, and anticoagulation therapy was continued for 1 year. Our case highlights the importance of recognizing ovarian vein thrombosis because of the risk of fatal complications such as pulmonary embolus. The presence of large fibroids should raise our awareness for OVT in the setting of abdominal pain and fever. The absence of complications in previous pregnancies should not alter our clinical suspicion.

Low physical activity levels 1 year after pregnancy complications.

Women with previous preeclampsia (PE), gestational hypertension (GH), or gestational diabetes mellitus (GDM) have increased cardiovascular disease (CVD) risk. Physical activity (PA) is an important CVD risk modifier. We aimed to assess PA levels, using a validated objective method, and other modifiable CVD risk factors in women with these previous pregnancy complications. One year postpartum we assessed PA levels for 1week in women with previous PE (n=68), GH (n=26), GDM (n=23), and normotensive pregnancies (n=65), using the ActiGraph-wGT3X-BT™ accelerometer. We assessed adherence to American PA guidelines (≥150min/week of moderate or ≥75min/week of vigorous intensity PA), and time spent in moderate and vigorous PA. We also assessed steps/day, blood pressure and anthropometric indices. Recommended PA levels were achieved in only 50%, 39%, and 35% following PE, GH, and GDM, respectively, not significantly different from controls (52%). Differences in moderate and vigorous PA levels and steps/day between the groups were non-significant, except from lower vigorous PA in women with previous GDM. Elevated blood pressure (systolic BP≥120mmHg and/or diastolic BP≥80mmHg) was more common after PE and GH. Overweight rates were significantly higher in PE, GH, and GDM groups compared to controls. Less than half of women achieved recommended PA levels 1year postpartum. This did not differ significantly between women with previous PE, GH, or GDM compared to controls. Measures to increase PA in postpartum women are warranted, especially in women with pregnancy complications associated with high risk of premature CVD.

Characteristics of pregnant women with diabetes using injectable glucose-lowering drugs in the EVOLVE study

Aims To examine clinical parameters, glycemic control, folic acid supplementation, and the presence of other chronic diseases during early pregnancy in the EVOLVE study population (women with pre-existing diabetes treated with injectable glucose-lowering drugs). Methods Cross-sectional baseline evaluation of EVOLVE: an international, multicenter, non-interventional study investigating the safety of injectable glucose-lowering drugs in pregnant women with pre-existing type 1 (T1D) or type 2 diabetes (T2D). Data were collected at enrollment visit interviews before gestational week 16. Results In total, 2383 women from 17 mainly European countries were enrolled in the study: 2122 with T1D and 261 with T2D; mean age was 31 and 33 years, and duration of diabetes was 15 and 6 years, respectively. For women with T1D or T2D, 63% and 75%, respectively, received basal and rapid-acting insulin, 36% and 3% rapid-acting insulin only, 0.7% and 14.0% basal insulin only, 0.2% and 5.4% premix insulin, 0.0% and 1.2% injectable glucagon-like peptide-1 receptor agonist treatment without insulin. In women with T1D or T2D, respectively, during early pregnancy, 59% and 62% had HbA1c <7.0% (53 mmol/mol); 16% and 36% reported not taking folic acid before or during early pregnancy. Overall, >40% of women had ≥1 chronic concomitant condition (predominantly thyroid disease or hypertension). Retinopathy was the most commonly reported diabetic complication. The most commonly reported previous pregnancy complication was miscarriage. Conclusions Baseline data from this large multinational population of women with pre-existing diabetes indicate that sub-optimal glycemic control, poor pregnancy planning, and chronic concomitant conditions were common in early pregnancy.

Fear of Childbirth and Associated Factors Among Pregnant Mothers Who Attend Antenatal Care Service at Jinka Public Health Facilities, Jinka Town, Southern Ethiopia

BACKGROUNDWomen face many challenges from conception to postpartum, and fear of childbirth is one of the challenges the women encounter during pregnancy. This could have resulted from different perspectives and it could in turn lead to various pregnancy and childbirth problems. Thus, understanding childbirth fear and factors associated with this is of paramount importance and this study was aimed at addressing this issue.METHODOLOGYA facility-based cross-sectional study was done on 423 pregnant mothers who came for antenatal care services at Jinka hospital and Jinka health center. The study was conducted from June 1to 30, 2018. The sample size was calculated using the single population proportion formula and samples were taken after proportional allocation was done for the hospital and health center using the proportion allocation formula. Individual participants were selected with a systematic sampling technique using k-value of 2 for both the hospital and health center and the first participant was selected by the lottery method from the first two samples. Data were entered into epi-data version 3.1.1. and exported into statistical packages for social sciences version 21.0 for cleaning and further analysis. The level of significance was declared at a p value of less than 0.05 in multivariable logistic regression model. Narratives, figures, and tables were used to put the result.RESULTFrom 423 samples, two of the questionnaires were incomplete and thus 421 were used for analysis giving a response rate of 99.5%. Around a quarter of 102 (24.2%) mothers had fear of childbirth and the remaining 319 (75.8%) had no fear of childbirth. From the factors under consideration, history of previous pregnancy complications, previous history of labor and delivery complications, educational status, and depression status were significantly associated with a mother's fear of childbirth.CONCLUSIONEven though it is physiological to have some fear of childbirth, the figure obtained is relatively higher. Factors found to have a significant effect on childbirth fear are those which could be tackled through improved health literacy and integrated maternal health services.

A case-control study to predict the risk of gestational diabetes mellitus by initial fasting blood sugar or past gestational history.

BackgroundGestational diabetes mellitus (GDM) deserves proper prevention, diagnosis, and management due to healthcare implications from both maternal and fetal concerns.ObjectiveTo evaluate the rate and investigate the risk factors for developing GDM.Materials and MethodsIn this case-control, universal screening for GDM between 24 and 28 wk of gestation was performed in 613 pregnant women attending a prenatal clinic in Tehran who were followed-up until delivery between March 2017 to March 2018. Of the 613 women, 143 had GDM and 470 had normal glucose tolerance test as the primary diagnosis. Some GDM risk factors were compared in two groups.Results Impaired glucose tolerance test was detected in 143 (23.3%) patients. Prevalence of GDM was higher in the first-trimester fasting blood sugar (FBS) 90 qmg/dl group (p 0.001). Comparison of the GDM and the normal glucose tolerance test groups demonstrated significant differences in maternal age, first-trimester FBS, third-trimester vitamin D level, maternal platelet count, maternal body mass index (BMI) (before 12 wk of gestation), weight gain during pregnancy, and the history of gestational complications in previous pregnancy (p 0.01). In logistic regression, GDM was independently associated with older maternal age, higher first-trimester FBS, the history of gestational complications in previous pregnancy, lower third-trimester vitamin D level, and higher maternal platelet count (p 0.01).ConclusionBoth patients with higher initial FBS and the history of gestational complications in previous pregnancy should be considered high risk for GDM and screened earlier.

Prevalence of Antenatal Depression and Its Associated Risk Factors Among Pregnant Mothers Attending Antenatal Care Service at Jinka Public Health Facilities, Southern Ethiopia

BACKGROUNDAntenatal depression is the most common psychiatric disorder during pregnancy with serious consequences for the mother and the fetus. However, there are few studies about this health issue in developing countries. This study aimed to determine the prevalence of antenatal depression and its associated risk factors among pregnant mothers attending antenatal care service at Jinka public health facilities, south Omo zone, Southern Ethiopia.METHODSInstitutional-based cross-sectional study design was conducted on 446 pregnant women at Jinka public health facilities, from June 1 to June 30, 2018. Beck Depression Inventory was used to assess women's level of depression. Statistical package for social science version 20.0 was used for analysis. Logistic regression was used to find out the association between explanatory and depression. The strength of association was evaluated using odds ratio at 95% confidence interval (CI).RESULTThe magnitude of antenatal depression in this study was 24.4% (20.2–28.5 at 95% CI) and it had statistically significant association with unmarried marital status adjusted odds ratio (AOR) = 13.39 [(95% CI); (3.11–57.7)], chronic medical illness AOR = 3.97 [(95% CI); (1.07–14.7)], unplanned pregnancy AOR = 6.76 [(95% CI); (2.13–21.4)], history of abortion AOR = 2.8 [(95% CI); (1.14–7.02)], history of previous pregnancy complication AOR = 4.8 [(95% CI); (2.12–17.35)], and fear of pregnancy-related complications AOR = 5.4 [(95% CI); (2.32–12.4)].CONCLUSIONSNearly one pregnant woman develops antenatal depression in every four pregnant women. Variables like unmarried marital status, chronic medical illness and unplanned pregnancy, history of previous pregnancy complications, and fear of pregnancy-related complications were associated with antenatal depression. Therefore, it is recommended that these risks factors should be evaluated during antenatal care with a view to improving maternal health.

Depression among pregnant women with husbands abroad: Case control study in hostile region of AZAD jammu and kashmir

IntroductionGoing abroad for employment is one of the common social problems which have been faced by the young males of developing countries. This included both highly qualified individuals as well as the labor class.ObjectivesTo determine the difference in the presence of depressive symptoms among pregnant women with husbands living abroad and those with husbands living with them in Azad Jammu and KashmirMethodsThe sample population comprised of pregnant women reporting for ante natal checkup at Amna hospital Rawalakot. Cases constituted the pregnant women with husbands living abroad while controls were the pregnant women with husbands living with them.PHQ-9 was used to record the presence and severity of depressive symptoms. Age, gestation, parity, rural or urban origin, education, level of family income, daily contact hours on telephone or what’s app, previous pregnancy loss or complications, number of years abroad and visits to home per year were associated with depressive symptoms.ResultsMean age of the study participants was 29.73±5.395 years. 66 (66%) had significant depression in the case group while 14 (14%) had in the control group (p-value&lt;0.001). Education and rural background had significant difference among the case and control group. Less number of visits per year of husband was strongly linked with presence of depressive symptoms among the cases.ConclusionsThis study showed a high frequency of depressive symptoms among pregnant women with husbands abroad as compared to those with husbands living with them. Special attention should be paid to the women whose husband had lesser number of visits to the country

Risk factors and comorbidities associated with magnesium deficiency in pregnant women and women with hormone-related conditions: analysis of a large real-world dataset

BackgroundAn accumulating body of literature indicates that magnesium deficiency is associated with a number of hormone-related conditions (HRC) in women, and epidemiological studies are needed to assess its prevalence and risk factors. Here, we present a secondary analysis of data pooled from four large observational studies that assessed magnesium deficiency among pregnant women and women with HRC across the Russian Federation.MethodsThe main objective of this analysis was to estimate the prevalence of magnesium deficiency in this population and to describe risk factors and comorbidities associated with low serum magnesium. Univariate logistic regression analysis was performed to identify the risk factors and comorbid conditions associated with an increased risk of low serum magnesium level.ResultsA total of 983 pregnant women and 9444 women with HRC were eligible for analysis. Prevalence of hypomagnesemia (magnesium serum level cut-off < 0.66 mmol/L/< 0.8 mmol/L) was 34.0%/78.9% in pregnant women and 21.4%/54.8% in women with HRC. The highest prevalence of magnesium deficiency was observed for osteoporosis and climacteric syndrome. Risk factors included diastolic blood pressure, previous pregnancy complications, infections and edema for pregnant women, and age, body mass index, and various comorbidities for women with HRC.ConclusionsThese results confirm the high prevalence of hypomagnesemia in pregnant women and women with HRC and underline the importance of routine screening, since risk factors are mostly non-specific.

Incidence, risk factors and impact of seasonal influenza in pregnancy: A national cohort study.

BackgroundPregnant women are particularly vulnerable to severe infection from influenza resulting in poor neonatal outcomes. The majority of evidence relates to pandemic 2009 A/H1N1 influenza. The objective of this study was to describe the characteristics and outcomes of pregnant women hospitalised with seasonal influenza.MethodsThis national, prospective, observational cohort study used the UK Obstetric Surveillance System (UKOSS) to identify all pregnant women admitted to hospital between 01/11/2016 and 31/10/2018 with laboratory confirmed influenza at any gestation and up to two days after giving birth. These were compared to women admitted to give birth that did not have influenza. Baseline characteristics, immunization status, maternal and perinatal outcomes were compared.ResultsThere were 405 women admitted to hospital with laboratory confirmed influenza in pregnancy: 2.7 per 10,000 maternities. Compared to 694 comparison women, women with influenza were less likely to be professionally employed (aOR 0.59, 95%CI 0.39–0.89) or immunised in the relevant season (aOR 0·59, 0·39–0·89) and more likely to have asthma (aOR 2.42, 1.30–4.49) or have had a previous pregnancy complication (aOR 2·47, 1·33–4·61). They were more likely to be admitted to intensive care (aOR 21.3, 2.78–163.1) and to have a cesarean birth (aOR 1·42, 1·02–1.98). Their babies were more likely to be admitted to neonatal intensive care (aOR 1.86, 1·01–3·42).ConclusionsImmunization reduces the risk of hospitalisation with influenza in pregnancy which is associated with increased risk of morbidity for both the mother and baby. There is a continued need to increase awareness of safety and effectiveness of immunization in pregnancy and provision within antenatal care settings, especially for high-risk groups.

The global antiphospholipid syndrome score in women with systemic lupus erythematosus and adverse pregnancy outcomes.

To validate the global antiphospholipid syndrome score (GAPSS) in a cohort of women with systemic lupus erythematosus (SLE) and antiphospholipid antibodies (aPL). This retrospective study included 143 women ever pregnant with SLE who presented in our outpatient clinic were included. Data on cardiovascular risk factors and aPL status were retrospectively collected and their individual GAPSS score was calculated. Significantly higher GAPSS values were found in women with any placental medicated complication (such as foetal death, placental abruption, prematurity, pre-eclampsia or intrauterine growth restriction (IUGR)) (GAPSS 8.2±3.0 vs. 3.5±3.0, p<0.001). Significantly higher GAPSS values were also found in those with recurrent miscarriages (RM) <10 weeks, foetal death, placental abruption, prematurity, pre-eclampsia or IUGR) (GAPSS 8.3±4.5 vs. 3.2±2.6, p<0.001). Patients with 3 or more consecutive early miscarriages (<10 weeks), foetal death, miscarriage <10 weeks' gestation, premature birth (<34 weeks), pre-eclampsia (<34 weeks), stillbirth, and placental infarction had significantly higher GAPSS values compared to those without previous pregnancy complications. The odds ratio of having any pregnancy morbidity when having a GAPSS value ≥8 was 20 compared to those with a GAPSS of ≤1 (p<0.001). Women with a history of aPL-related pregnancy complications had higher GAPSS values in this retrospective cohort compared to women without pregnancy complications. This study is the first step to assess the clinical utility of the GAPSS score in pregnancy. A prospective validation is needed.

Prevalence and Associated Factors of Antenatal Depressive Symptoms in Pregnant Women Living in an Urban Area of Thailand.

BackgroundDepression is a major public health problem in middle- and low-income countries. Depression in pregnancy has adverse effects on obstetric outcomes. Maternal depression remains under-recognized, under-diagnosed and undertreated in Thailand. Antenatal screening of depression is an important strategy to improve maternal and neonatal outcomes. This problem has rarely been investigated in Thailand, especially in urban areas.ObjectiveTo discover the prevalence, associated factors, and predictive factors of depression in pregnant women living in an urban area.Materials and MethodsThis cross-sectional study of 402 pregnant women was conducted during antenatal care at the Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand, from 10 September to 31 November 2019. The participants were interviewed using a structured questionnaire that included a demographic profile, obstetric conditions, socio-cultural characteristics, and a Thai language version of the Center for Epidemiologic Studies-Depression Scale to assess depressive symptoms.ResultsAmong a total 402 pregnant women, the prevalence of depressive symptoms in pregnant women in an urban area was 18.9%. Depressive symptoms in pregnant women were significantly associated with divorce (p < 0.001), low family income (p < 0.03), financial insufficiency (p < 0.001), extended family (p < 0.001), history of previous abortion (p = 0.033), history of previous pregnancy complications (p = 0.044), current alcohol use (p = 0.03), current tobacco use (p = 0.009), current substance abuse (p = 0.002), marital conflict (p < 0.001), and family conflict (p < 0.001). The significant factors predicting depression in pregnant women were extended family (AOR 3.0, 95% CI 1.59–5.51, p=0.001) and marital conflict (AOR 4.7, 95% CI 2.37–9.11, p<0.001).ConclusionThis study revealed that the prevalence of depressive symptoms in pregnant women living in an urban area in Thailand was 18.9%. The significant associated factors of depressive symptoms were divorce, low family income, financial insufficiency, extended family, previous abortion, previous pregnancy complications, current alcohol use, current tobacco use, current substance abuse, marital conflict, and family conflict. Extended family and marital conflict were significant predictive factors for antenatal depressive symptoms.