Risk Factors In Pregnant Women Research Articles

Developing and Testing PREDHIS (Pregnant Dental Health Information System): A Self-Detection Tool for Oral Disease Risk Factors in Pregnant Women

During pregnancy, gum sensitivity and the possibility of gum bleeding increases. Thedental and oral examination program during pregnancy can be carried out in conjunction with thepregnancy check-up program schedule and suggests the use of the Pregnant Women's Healthy Dental Card (KASIH) for dental and oral disease risk assessment since early pregnancy which is then referred to the Dental Clinic. However, the implementation has not been maximized due to the lack of cooperation of the party in charge of health services, as well as the insignificant number of visits of pregnant women referred to the dental clinic from the MCH clinic due to the mother's perception of the need for a healthy oral cavity. This study aims to produce a detection tool application that is feasible according to experts and acceptable to pregnant women as a tool that is able to detect risk factors for oral and dental disease in pregnant women independently. This study was Research and Development with a sample of 15 pregnant women as a test sample for acceptance of the development model. the result is PREDHIS as self-detection tool which android- based mobile apps, said to be very feasible according to the assessment of information technology experts, dental health experts and maternal and child health experts, and has a good level of user acceptance in providing usefulness and convenience based on the assessment of pregnant women. Hence, this study shown that a system can be built, namely the PREDHIS which is able to detect risk factors for oral and dental disease in pregnant women independently which is feasible and acceptable according to needs assessment.

Outcome of pregnant women admitted to critical care unit with confirmed severe COVID-19: A center experience.

To explore the traits and risk factors of pregnant women admitted to intensive care units (ICUs) with COVID-19. Moreover, the study classifies outcomes based on differing levels of required respiratory support during their intensive care stay. This retrospective and descriptive study included all pregnant women with COVID-19 admitted to the adult critical care unit at a specialized tertiary hospital in Riyadh, Saudi Arabia. Between January 2020 and December 2022. A total of 38 pregnant women were identified and were eligible for our study. The mean age of the patients was 32.9 (19-45) years, and the average Acute Physiology and Chronic Health Evaluation IV (APACHI IV) score was 49.9 (21-106). Approximately 60.5% of the patients suffered from superimposed infections during their ICU stay. Approximately 81.6% patients were delivered by C-section, 33 of the newborns survived, and 5 died. The crude mortality rate among pregnant women in our cohort was 15.8%. Patients treated with high-flow nasal cannula (HFNC) were mostly discharged or delivered normally, while the mechanical ventilation (MV) and extracorporeal membrane oxygenation groups mostly underwent C-sections. Most of the surviving newborns were on HFNC and MV. Patients with multiple infections had the longest ICU stay and had the highest risk of death. The results of this study highlight the characteristics of pregnant women admitted to the ICU at a specialized tertiary healthcare center in Saudi Arabia. The APACHI IV scores accurately predicted patient's mortality, duration of MV, and length of ICU stay. In our study, we shared our experience of managing severe COVID-19 infections in pregnant patients.

Prevalence of Hepatitis B and C Infection and its Associated Risk factors in Pregnant Women Visiting Hospitals of Southern Punjab

Background: Hepatitis B and C infections remain formidable challenges to global health, with significant morbidity and mortality rates, especially among pregnant women. These infections pose substantial risks not only to the infected individuals but also to their unborn children, due to the potential for vertical transmission. In Pakistan, particularly in the Southern Punjab region, the prevalence and impact of these infections demand rigorous investigation to inform public health strategies. Objective: This study aimed to assess the prevalence of Hepatitis B and C infections among pregnant women visiting selected hospitals in Southern Punjab, Pakistan, and to identify associated risk factors, thereby contributing to the formulation of targeted intervention strategies. Methods: Employing an analytical cross-sectional design, this study involved 422 pregnant women from the outpatient departments of Gynecology at Nishtar Hospital, Shahbaz Sharif Hospital in Multan, and Bismillah Medical Complex in Kahror Pacca, between December 1, 2023, and March 5, 2024. Participants were selected using a convenience sampling technique. Data on demographic characteristics and potential risk factors were collected through a structured questionnaire. Hepatitis B and C seropositivity was determined through specific serological tests. The analysis was performed using SPSS version 25, focusing on the prevalence rates and the identification of major and minor risk factors for the transmission of Hepatitis B and C. Results: The study found an 8.3% prevalence rate for Anti-HCV and a 5.2% prevalence rate for HBsAg among the participants. Notable risk factors included ear or nose piercings, history of blood transfusions, and previous cesarean sections. Socio-demographic analysis revealed higher rates of infection among participants with lower educational levels, those residing in rural areas, and among certain age groups and parity statuses. Conclusion: The observed prevalence rates of Hepatitis B and C infections among pregnant women in Southern Punjab highlight the critical need for enhanced screening programs, targeted vaccination initiatives, and comprehensive education campaigns to mitigate the risk of vertical transmission and reduce the burden of these infections.

Low-birth-weight scorecard for early prevention: the accuracy for predicting low-birth-weight infants based on maternal risk factor

Introduction: Babies with low birth weight (LBW) have a risk of complications and health problems. One of the efforts to prevent LBW births is to detect risk factors in pregnant women. This study aimed to test the accuracy of an early LBW detection scorecard based on maternal risk factors. Methods: The research design used was observational analytical. The sample in this study was 177 mothers who were registered and delivered at hospitals and public health centers in Surabaya and were selected using a purposive sampling method. The research instruments used were LBW scorecard, maternal medical records, and baby’s scale. The accuracy of the scorecard was measured with Mann-Whitney test, and Receiver Operating Characteristic (ROC) curve. Results: The LBW scorecard which was based on maternal factors analysis can significantly predict LBW births (p = 0.000). Based on the ROC curve analysis, it was known that the early detection scorecard has a cut-off point of 3.5, and an accuracy of 88.70%, which indicated that the scorecard has high accuracy in predicting LBW. Conclusions: The LBW early detection scorecards is able accurately to predict the incidence of LBW births. Through analysis and calculation of maternal risk factor, it can be seen whether the mother is at risk of giving birth to a LBW or normal weight baby. Early detection of LBW can improve services for at-risk babies, resulting in a positive impact on their health outcomes.

The Characteristics of Preeclampsia and Eclampsia Patients at Dr. T.C. Hillers Regional Hospital Maumere

Preeclampsia can occur from the time the mother is pregnant until 48 hours to 6 weeks after giving birth and is associated with an increased complication rate of 2-8% during pregnancy, contributing to 9 - 26% of maternal deaths. This condition can have significant prolonged effects on both the mother and the baby. Considering the high rates of morbidity and mortality in mothers and babies due to preeclampsia, this study aims to understand the characteristics of patients with preeclampsia at T.C. Hillers Regional Hospital of Maumere within the period of January 1st to December 31st, 2022. This study is a retrospective descriptive study using secondary data. The data collection was performed on patients diagnosed with preeclampsia and eclampsia during the study period. The results showed that most participants were between 20-34 years old, had a body mass index (BMI) of ≥ 25, multigravida (had multiple pregnancies), housewives, High School graduates, and had a history of chronic hypertension. Based on risk factors, 35.5% of the subjects were ≥ 35 years old, 31% were primigravida (first-time pregnant), 26% were obese, 21% had a history of hypertension in previous pregnancies, 10,5% had chronic hypertension, 3% had multiple gestations, 1% of the subjects had a pregnancy interval >10 years, and 0.5% had diabetes mellitus. This study provides an overview of the characteristics and risk factors of pregnant women with preeclampsia in Maumere.

Pengaruh Penggunaan Aplikasi “Bumil Bahagia” Berbasis Android terhadap Tingkat Pengetahuan Faktor Risiko PEAD pada Ibu Hamil di Kabupaten Banyumas

Preeclampsia is one of the biggest problems in pregnancy and is a cause of infant and maternal death every year in the world. The low knowledge of pregnant women is one of the factors in recognizing the condition of their pregnancy. The use of digital health brings a lot of medical information exchange between patients and health workers, health services in the context of differential diagnosis, access to health is more efficient and cost effective. This study aims to determine the effect of using the android-based "pregnant mother happy" application on the level of knowledge of PEAD risk factors in pregnant women in Banyumas district. Pre-experimental design research. Sempel used the cluster sampling approach for pregnant women aged 20-34 weeks' gestation. The results of the Wilcoxon test with a p value <0.001, before being given the intervention the knowledge of pregnant women was in the good category (51.9%), after being given the intervention it increased (66.7%). There is an effect of the use of the Android-based “happy pregnant woman” application on the level of knowledge of PEAD risk factors in pregnant women in Banyumas district in 2023.

Danger Signs and 4T Risk Factors of Pregnant Women

The number of cases of maternal death in 2020 was 122, an increase of 25 cases compared to 2019, which was 97 cases of maternal death. The highest number of maternal death cases was in West Lombok district with 43 cases. The maternal mortality rate in NTB Province has increased from 93.92 per 100,000 live births to 119.05 per 100,000 live births. When compared with the performance achievements in the RPJMN, the NTB province is still below the national target. The 4T factors (too old, too young, too closely spaced between pregnancies and too many children) can increase cases of complications in the mother. Birth interval between one child and another child of less than 2 years can increase the risk of maternal death. Delivery at intervals of less than 24 months (too often) is a high-risk group for postpartum hemorrhage. This research aimed to determine the risk factors experienced by pregnant women so that prevention can be taken to prevent maternal death during childbirth. The research method used a quantitative analytical observational with a Focus Group Discussion (FGD) approach. The research results showed that pregnant women did not understand the danger signs and risk factors for 4T, so that pregnant women are able to take preventive measures. Apart from that, this research also provides anticipatory solutions so that pregnant women and their husbands can avoid further complications related to the risks of 4T. This research concludes that the understanding of pregnant women and their husbands regarding the danger signs and risks of 4T has increased so that they are able to know the mother's condition during pregnancy and are able to plan and have a healthy pregnancy.

Deficiency of Iron: A Risk Factor in Pregnant Women in the District Swat

Iron is an essential element for the body. Its requirements increase during pregnancy. Improper use of iron may lead to anaemia in the mother. Anaemia may lead to complications such as abortion, stillbirth, and congenital abnormalities in the fetus of pregnant women. This study aimed to determine the iron level and problems associated with iron deficiency in pregnant women in Swat District. Samples were collected from eight hundred pregnant women. The iron status was determined by measuring haemoglobin levels using Sahli’s Method and the Haematology Analyzer. In total, 54 % were anaemic. The age group 41-45 was highly anaemic (100 %) followed by 15-20 (74 %) while the 31-35 age group was the least anaemic (42 %). The Underweight was the highly anaemic group (83 %) and the obese were the least anaemic group (12 %). Pregnant women with second trimester gestational age were the least anaemic (34 %) while the third trimester was the highly anaemic (67 %). It was concluded that iron deficiency is a common issue in pregnant women in District Swat.

Assessment of Kidney Impairment and Related Risk Factors in Pregnant Women Attending the University Center for Public Health and Rango Health Centers in the Southern Province of Rwanda

BackgroundPregnant women are susceptible to kidney function impairment due to physiological and metabolic changes induced by pregnancy. A series of studies suggested an overall progressive increase in glomerular filtration rate approximating 40-50% of the non-pregnant state.ObjectiveTo determine the prevalence of kidney impairment and related risk factors in pregnant women attending the University Center for Public Health and Rango health centers in Rwanda.MethodsAn analytical cross-sectional study that enrolled 139 consecutive pregnant women was conducted. Serum creatinine and qualitative urine protein and glucose determinations were carried out using standard laboratory methods to assess the integrity of kidney function. ResultsThe prevalence of kidney impairment in pregnant women was 20.9% comprising mainly women in the 2nd trimester of pregnancy (60.4%). Among the women with kidney impairment, 2.9% had high blood pressure. Of the overall study participants, 8.6% had glycosuria whilst 5% had proteinuria. The majority had gravida of one. There was a significant association between hypertension, glucosuria, age and gravida with kidney impairment (P = 0.001).ConclusionsFindings show that pregnancy with or without putative risk factors is associated with kidney impairment in apparently healthy women, as shown by the high prevalence of 20.9%. We therefore recommend routine screening of kidney dysfunction during pregnancy.Rwanda J Med Health Sci 2023;6(3):379-388

Bacterial abundance and antimicrobial resistance patterns of uropathogens among pregnant women with asymptomatic bacteriuria: Association with glycemic status

ObjectivesAntimicrobial resistance (AMR), a growing global menace, poses a significant threat to maternal and fetal health. Gestational diabetes mellitus (GDM) causes double trouble in pregnancy, increasing the risk of a variety of infectious morbidities while also raising the possible association with AMR. Asymptomatic bacteriuria (ASB) is a common problem in pregnancy, but little research has been done to date explicitly examining the relationship between GDM and ASB and yielded conflicting results. Even fewer studies have specifically examined the relationship between GDM and AMR in women with ASB. Retrieving the most recent information on the disease burden, the range of causative pathogens, their patterns of AMR, and associated risk factors in pregnant women is crucial to stop the exponential rise in AMR in pregnancy and improve maternal and neonatal outcomes of infectious morbidities. Hence, this study was planned to investigate the association between glycemic status and the contemporary bacterial profile, antimicrobial resistance(AMR), and associated variables among pregnant women with ASB Study designThis prospective, hospital-based, cross-sectional study was conducted among 320 pregnant women; divided into two groups, GDM and non-GDM. Data regarding sociodemographic and clinical characteristics were collected using a structured questionnaire. Clean-catch midstream urine samples were investigated for the presence of significant bacterial uropathogens and their AMR pattern was determined using recommended culture methods. ResultsWe found ASB in 46.25% of study participants with significantly higher occurrence in the GDM group. Dominant isolates were Escherichia coli followed by Klebsiella pneumoniae. AMR was noted in 51.35% and multidrug resistance(MDR) in 23.65% of isolates. Overall AMR, MDR and higher degrees of AMR were higher among uropathogens isolated from the GDM group as compared to the non GDM group, although the difference was not statistically significant. ConclusionThe high occurrence of ASB in pregnancy along with substantially high AMR in this study suggests the need for effective infection control and stewardship programmes. By defining the association of ASB and AMR with hyperglycemia, our study calls for the exploitation of this potential association in halting the pandemic of AMR and in improving the management of infectious morbidities, thus in-turn alleviating their undesired maternal and infant outcomes.

Predictors of postpartum depression in threatened preterm labour: Importance of psychosocial factors

BackgroundPostpartum depression (PPD) is more common in high-risk pregnancies. One of the main causes of high-risk pregnancy is threatened preterm labour (TPL), a stressful event which involves psychological consequences for the mother. The objective of this study was to identify those psychosocial factors that may imply a greater risk of PPD in TPL women. Material and methodsA prospective cohort study was carried out, consisting of a sample of 149 pregnant women who suffered from a TPL during pregnancy, and 61 controls. At the time of inclusion, demographic, obstetric, biological, and psychosocial variables were collected. At 3 months postpartum, depressive symptoms were evaluated along with their predictive factors. ResultsWomen who suffered TPL showed higher scores in depressive symptomatology (F (1, 208)=7.46, p=.007), as well as higher probability of PPD diagnosis than controls (χ2 (1)=8.05, p=005). Higher maternal age (+.335), lower educational level (−2.15), history of trauma (+.28) and higher trait anxiety scores (+.314) were the main predictors of PPD after TPL. ConclusionsExperiencing TPL during pregnancy, carries a higher risk of PPD. This risk is mediated by sociodemographic and psychological factors related to chronic stress. The detection of these potentially modifiable risk factors in pregnant women after experiencing TPL would help prevent PPD and improve the maternal–infant prognosis.

Prevalence and risk factors of urinary tract infection in pregnant women

Urinary tract infections (UTIs) are the most prevalent in pregnant women. There are associated risk factors that predispose the acquisition of a UTI in pregnancy, which can cause serious complications for mother and child. To determine the prevalence of UTI and associated risk factors in pregnant women at the Hospital Básico de Sangolquí. Observational, cross-sectional, analytical study conducted in 570 pregnant women from January 1 2021 to August 30 2022. The prevalence and risk factors associated with UTI were analyzed through 95% confidence intervals (95% CI) and odds ratio (OR) calculation. The global prevalence of UTI in pregnant women was 37.7% (IC 95% 33.7-41.7). The most frequent etiology was Escherichia coli (65.4%), followed by Staphylococcus spp. (21.8%). The age of pregnant women ranged from 12 to 45 years, with an average of 27.55 ± 7 years, out of which those with a previous history of UTI were at greater risk of presenting UTI (OR 4.05; 95% CI 2.65-6.18), followed by diabetes mellitus (OR 2.25; 95% CI 2.48-3.44), and overweight (OR 1.48; 95% CI 1.05-2.10). Regarding gestational age, the third trimester was a protective factor for UTI (OR 0.65; 95% CI 0.46-0.92]). The prevalence of UTI for pregnant women was 37.7%. The most frequent etiology was Escherichia coli. A history of UTI prior to pregnancy was the main risk factor.

Diagnosis and Management of Fetal Growth Restriction

Fetal Growth Restriction (FGR) or Intrauterine Growth Restriction (IUGR) is one of the complications in pregnancy that is quite common, especially in developing countries, which is one of the contributors to neonatal mortality and morbidity rates. This literature review aims to provide related information, so that proper diagnosis and management can be carried out to reduce fetal morbidity and mortality rates. We searched from online databases and used review articles, research, guidelines from professional organizations, such as POGI from Indonesia, ACOG from the USA, and RCOG from the UK. Risk factor assessment and examination of fundal height can be the first steps in diagnosing IUGR. If suspicion is found, ultrasound (USG) and Doppler velocimetry can be performed. IUGR management mostly works in influencing the vasodilation of the placenta as the most common cause of IUGR events. Fetal Growth Restriction can be diagnosed immediately by screening for risk factors in pregnant women.

Urinary Tract Infection and Associated Factors among Pregnant Women Receiving Antenatal Care at a Primary Health Care Facility in the Northern Region of Ghana.

Urinary tract infection (UTI) is frequently encountered during pregnancy and is associated with adverse maternal, fetal, and neonatal effects. However, very little information is available on the prevalence of UTI among pregnant women in the northern part of Ghana, a region with a high birth rate. This study employed a cross-sectional analysis of the prevalence, antimicrobial profile, and risk factors associated with UTI in 560 pregnant women attending primary care for antenatal check-ups. Sociodemographic obstetrical history and personal hygiene information were obtained using a well-structured questionnaire. Afterward, clean catch mid-stream urine samples were collected from all participants and subjected to routine microscopy examination and culture. Of 560 pregnant women, 223 cases (39.8%) were positive for UTI. There was a statistically significant association between sociodemographic, obstetric, and personal hygiene variables and UTI (p < 0.0001). Escherichia coli (27.8%) was the commonest bacterial isolate followed by CoNS (13.5%) and Proteus species (12.6%). These isolates exhibited greater resistance to ampicillin (70.1-97.3%) and cotrimoxazole (48.1-89.7%) but were fairly susceptible to gentamycin and ciprofloxacin. Gram-negative resistance to meropenem was up to 25.0%, and Gram positives resistance to cefoxitin and vancomycin was up to 33.3% and 71.4% respectively. The current findings extend our knowledge of the high frequency of UTIs and associated risk factors in pregnant women with E. Coli being the predominant and usual isolate. Variation existed in the resistance pattern of isolates to various drugs, underscoring the need to perform urine culture and susceptibility before treatment.

MOTIVATION AND HESITANCY TOWARDS THE COVID-19 VACCINE IN EXPECTING MOTHERS

The practical and efficient prevention of the transmission of COVID-19 infection is through vaccination. However, there are challenges associated with refusing or postponing vaccination due to skepticism regarding the efficacy and safety of vaccines, particularly among pregnant women. The risk factors of pregnant women tend to make this vulnerable group reluctant to uptake the vaccines. Motivation influences personal hesitancy in deciding, especially regarding the COVID-19 vaccine. Therefore, this study investigated the correlation between motivation and hesitancy related to COVID-19 vaccines in expectant mothers at the Bening Nawangsari Midwife Clinic, Bekasi City. In this cross-sectional study, as many as 301 pregnant mothers were chosen using the consecutive sampling method. The Motivations of Vaccination Questionnaire and The Reasons for Hesitation Questionnaire were employed when collecting the data. After calculating the data with the Chi-Square test, a significant relationship between motivation and vaccine hesitancy was revealed (p-value= 0.001). It was concluded that there was a significant relationship between expectant mothers' motivation and hesitation to receive the COVID-19 vaccine.

Ultrasound Assessment of Abdominal Muscle Thickness With and Without Lumbopelvic Pain in Pregnant Women.

Lumbopelvic pain (LPP) is a very common cause of discomfort during pregnancy, but its etiology remains unclear. The association between abdominal muscle thickness and LPP in pregnant women has not been studied extensively, despite the significant abdominal changes that occur during pregnancy. This study aimed to examine the relationship between abdominal muscle thickness and LPP in pregnant women. In this study, 49 pregnant women in their second trimester participated. The intensity of LPP was assessed using a numerical rating scale. Ultrasound imaging was used to measure the thickness of abdominal muscles, including the rectus abdominis, external oblique, internal oblique, and transversus abdominis muscles. Participants were classified into two groups, the LPP group and non-LPP group, and the abdominal muscle thickness was compared between the two groups. The statistical significance level was set at P < .05. There were 24 and 25 participants in the LPP and non-LPP groups, respectively. Internal oblique (IO) thickness was significantly thinner in the LPP group than in the non-LPP group (5.4 ± 0.2 mm versus 6.1 ± 0.2 mm; P = .042). Multivariate logistic regression analysis showed that IO thickness was significantly associated with LPP (odds ratio, 0.516; 95% confidence interval, 0.284-0.935; P = .019). This study suggested that LPP in second trimester pregnancy might be related to IO thickness. Further longitudinal studies are needed to understand the role of this muscle as an LPP risk factor for pregnant women.

The incidence of Jarisch-Herxheimer reactions and associated risk factors in pregnant women and nonpregnant women: A retrospective chart review at a university hospital in Japan.

Jarisch-Herxheimer reactions (JHR) is a transient adverse event that occurs during initial antimicrobial treatment for syphilis patients, and is known to develop uterine contractions and fetal distress in pregnant women complicated with syphilis. The aim of this study is to identify risk factors for JHR in patients with syphilis, and to clarify whether pregnancy status is a risk factor for JHR, and to describe the characteristics of pregnant women who develop JHR. This was a retrospective chart review in a singleton university hospital in Japan. We collected data of syphilis patients who were diagnosed and treated at department of obstetrics and gynecology, dermatology between January 2010 and May 2022. There were no validated diagnostic criteria for JHR, we defined JHR as one or more of the following in addition to raised body temperature (≧38.0°C) within 24 h of initial antibiotic treatment: headache, chills, myalgias, tachycardia (≧110 bpm), new rash. There were 30 syphilis patients. Of whom nine (30%) were pregnant women and all their neonates were not diagnosed with congenital syphilis. Five patients (17%) developed JHR at the time of initial treatment (JHR group, n=5). There was no difference between JHR group and non-JHR group (n=25) in pregnancy status. Secondary syphilis was an only significant risk factor for JHR. Two pregnant women with JHR were both treated for secondary syphilis in the third trimester of pregnancy. Pregnancy status was not a risk factor for JHR in syphilis patients. Further research is needed.

Factors Associated with Post-Traumatic Stress Symptoms in Pregnant and Postpartum Women.

Background: Evidence of post-traumatic stress disorder (PTSD) symptoms related to the COVID-19 pandemic during the perinatal period and the associated risk factors are still limited. Thus, we aimed to investigate the PTSD symptoms associated with the COVID-19 pandemic in a large sample of both pregnant and postpartum women. Methods: A cross-sectional study was conducted on 3319 pregnant and up to 6-month postpartum women from Spain. An online survey was completed between June 2020 and January 2021. The assessment included measures of PTSD symptoms associated with COVID-19 (evaluated with 10 questions from the PTSD checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), pandemic-related concerns and health background (assessed by the Coronavirus Perinatal Experiences-Impact Survey), and demographic characteristics. Results: We found that >40% of women suffered from symptoms of PTSD associated with the COVID-19 pandemic. Difficulty concentrating and irritability were the most common symptoms, showing marked alterations in arousal and reactivity associated with the traumatic event. Being younger, suffering from pandemic concerns and distress, changes due to the pandemic and previous mental health problems were risk factors associated with PTSD symptoms in perinatal women. In addition, whereas being an immigrant (non-Spanish) was a risk factor for pregnant women, having other children and financial problems were risk factors for postpartum women. COVID-19 infection did not appear to be a risk factor for symptoms of PTSD in perinatal women. Conclusions: The increased risk of PTSD in pregnant and postpartum women highlights the importance of early detection and treatment of PTSD for pregnant and postnatal women, both during and beyond the pandemic. Trial Registration: ClinicalTrials.gov Identifier (NCT04595123).

Hurricane Michael and Adverse Social and Mental Health Risk Factors.

To assess changes in mental health and social risk factors in pregnant women in counties affected by Hurricane Michael (October 2018). Data from the Universal Perinatal Risk Screen (UPRS) and vital statistics for the state of Florida were obtained. Prenatal risk factors (unplanned pregnancy, mental health services, high stress, use of tobacco or alcohol, young children at home or with special needs, trouble paying bills) were compared in the year before and year after Hurricane Michael in affected counties (n = 18,887). Log-Poisson regression with robust variance was used for binary outcomes, adjusting for maternal age, race, BMI, and education. A smaller proportion of pregnant women were screened in the months after the hurricane. No changes were seen in overall scores. The proportion referred was lower in the 1 month after Michael compared to that in 1 month before Michael (RR 0.78, 95% CI = 0.71, 0.86), but greater in the year after (RR = 1.07, 95% CI: 1.04, 1.10). Most individual risk factors on the screener did not change significantly, except having an illness that required ongoing medical care was less common in the short term (3 months after vs. 3 months before: aRR = 0.76, 95% CI: 0.66, 0.87), and more common in the longer term (1 year after vs. 1 year before, aRR = 1.09, 95% CI: 1.02, 1.18). Birth certificate data suggested smoking during pregnancy was higher among women who experienced Michael during their pregnancies (aRR = 1.15, 95% CI: 1.01, 1.32). Perinatal screening and referral declined in the short-term aftermath of Hurricane Michael.

Pregnancy Complications in Women With Pregestational and Gestational Diabetes Mellitus.

Diabetes mellitus (DM) is a major risk factor for complications of pregnancy. Based on information for all inpatient births in Germany, we assessed the risks for selected pregnancy complications in women with pregestational diabetes mellitus (preDM) or gestational diabetes mellitus (GDM). The underlying data comprised all singleton births contained in the inpatient perinatal medicine quality assurance statistics for the years 2013-2019. The frequencies of premature birth, elevated birth weight (large for gestational age, LGA), cesarean section, transfer of the newborn to the perinatal unit, and stillbirth were stratified by maternal age and diabetes status (preDM, GDM, no DM). Poisson regression was used to calculate the relative risks (RR) with 95% confidence intervals (95% CI) for the whole period and for each individual year in women with preDM or GDM relative to women without DM. Among the 4 991 275 singleton births included, GDM was documented in 283 210 (5.7%) and preDM in 46 605 (0.93%) cases. GDM was associated with higher RR for premature birth (1.13 [1.12; 1.15]), LGA (1.57 [1.55; 1.58]), cesarean section (1.26 [1.25; 1.27]), and transfer of the newborn (1.54 [1.52; 1.55]). These associations were even stronger in women with preDM: premature birth (2.13 [2.08; 2.18]), LGA (2.72 [2.67; 2.77]), cesarean section (1.62 [1.60; 1.64]), transfer of the newborn (2.61 [2.56; 2.66]). PreDM increased the risk of stillbirth (RR: 2.34 [2.11; 2.59]); GDM was associated with a lower risk (RR: 0.67 [0.62; 0.72]). For women with preDM, the risk of pregnancy complications increased over the study period. GDM and preDM are still associated with elevated risks of pregnancy complications. In the case of preDM, the risks may be attributable to the fact that the hyperglycemia is more severe and is already present before conception. Continuous monitoring should include risk factors in pregnant women and care-relevant aspects.