Pregnancy Risk Research Articles

The Relationship Between Chronic Energy Deficiency and Anemia in Pregnant Women at The Madandan Community Health Center Rantetayo District Tana Toraja Regency

Chronic Energy Deficiency in pregnant women negatively impacts maternal health and fetal development, leading to weight loss, fatigue, weakness, and reduced immunity. CED also increases the risk of anemia, which can decrease oxygen supply and disrupt vital organ function. Anemia in pregnant women can cause fatigue, reduced productivity, and a higher risk of pregnancy and childbirth complications. This quantitative cross-sectional study aimed to analyze the relationship between CED and anemia in 40 pregnant women out of a total population of 64 at the Madandan Community Health Center, Tana Toraja. Data collection was carried out using a questionnaire, and the analysis employed a chi-square test. The results of Fisher's Exact Test indicated a significant association (p 0.000 < 0.05) between Chronic Energy Deficiency and anemia among pregnant women seeking treatment at the Madandan Community Health Center. The study recommends that community health centers enhance education on balanced nutrition for pregnant women through prenatal clinics, including up-to-date nutritional information, regular health monitoring, and provision of appropriate supplements to reduce the risk of anemia.

Reasons for contraceptive discontinuation among women of reproductive age in Kano, Nigeria: A qualitative study

Women’s attempts to achieve their desired levels of fertility are hindered when they stop using contraceptives, which could lead to unwanted pregnancies. This study aimed to assess reasons for contraceptive discontinuation among women of reproductive age in urban and rural areas of Kano State, Nigeria. Qualitative data were collected in urban and rural communities of Kano State in February to May, 2022 from women of reproductive age group, their male partners, family planning service providers, and community and religious leaders. Focus group discussions (FGD), and key informant interviews (KII), using multi-stage sampling methods explored previous experience with contraceptive use, fertility consequences and reasons for contraceptive discontinuation. Following data collection, digitally recorded data were transcribed verbatim, translated, and coded using thematic analysis through an inductive approach. Study reported the high discontinuation rates and identified side effects as the primary reason for discontinuation, with injectable contraceptives being the most commonly discontinued method. Other reported reasons for contraceptive discontinuation by respondents in both urban and rural groups were: method failure, intention to get pregnant, health concerns, husband disapproval, methods not available, inconvenience to use and interference with body structure or functions. The high contraceptive discontinuation poses significant risks of unintended pregnancies and unsafe abortions, thereby increasing maternal morbidity and mortality rates in Kano State. These consequences emphasize the need for family planning interventions that incorporate quality of care in service provision to address contraceptive discontinuation. Engaging men and other social influencers in family planning programs and services will help gather support for contraception, rather than focusing exclusively on women.

Impact of timing of pregnancy and genetic risk on local therapy choices for young women with breast cancer

BackgroundIt is unknown whether timing of pregnancy before, during, or after breast cancer (BC) is associated with surgical choices in young women with breast cancer. MethodsA retrospective chart review identified patients who had a pregnancy within 5 years prior to breast cancer diagnosis (PpBC), were pregnant during breast cancer diagnosis (PrBC), or had a pregnancy within 5 years after BC diagnosis (SPBC). Chi-square test and logistic regression analysis were used to compare surgical choice—unilateral surgery (ULS) or bilateral mastectomy (BM)—between groups. ResultsOf 109 women, 36 (33.0 ​%) had PpBC, 18 (16.5 ​%) had PrBC, and 55 (50.5 ​%) had SPBC. 42.2 ​% had stage II BC and 31.2 ​% had triple negative BC (TNBC). 100 patients had genetic testing and 30 (30 ​%) had a germline pathogenic mutation. Overall, 49.5 ​% of women underwent BM, and this was similar between groups. On logistic regression, genetic mutation (OR 5.44, p ​= ​0.003) and ER-negative tumor subtype (TNBC OR 11.9, p ​= ​0.017; ER-/HER2+ OR 23.2, p ​= ​0.015) were associated with higher rates of BM. ConclusionIn this study, approximately half of women with pregnancy within 5 years of BC diagnosis underwent BM. Genetic predisposition and ER-negative tumor subtype was predictive of this choice while timing of pregnancy was not.

Unintended pregnancies in the context of intimate partner violence: Findings from the ELSA-Study

Abstract Intimate partner violence against women (IPV) is a widespread problem with serious consequences for victims and for society. Women affected by IPV have an empirically proven particular risk of unintended pregnancies. ELSA “Experiences and Living Conditions of Unintended Pregnant Women - Counselling and Care Services” is the first study in Germany to analyse the connections between the situations of women and unintended pregnancies. Using an online questionnaire, women from 1) a random representative sample of residents with a child under 6 years of age and 2) a sample of 662 women from abortion facilities or counselling centres were surveyed in 2021. The data (n = 5,101) were analysed in order to compare the life situation and needs of victimized versus non-victimized women. 333 women (6.5% of the total sample; 95% CI [6.2, 7.6]) reported IPV. Victimized women had a 5.6 times higher risk for an unintended pregnancy (95% CI [4.2, 7.5]) and 3.2 times higher risk for an abortion (95% CI [2.0, 5.0]). The pregnancy was sig. more frequently the result of forced sex (CV= .210***). Victims with unintended pregnancies had a sig. poorer mental health before (t(510) = 7.081***), during (t(510) = 5.501***) and after birth (t(456) = 5.234***) as well as before (t(503) = 4.905***), during (t(224) = 3.408) and after (t(503) = 3.352***) abortion. They were sig. more likely to report feelings of guilt and shame (CV = .182***), self-blame (CV = .149***) and anxiety (CV = .190***) after the pregnancy was determined and they received sig. more unsolicited information from the medical staff (CV = .254**). The result shows that victimized women are in an increased risk situation in the context of unintended pregnancies. Health care professionals can play a special role in prevention and intervention. Nationwide awareness-raising training, protocols and commitment are required. Key messages • The study confirms international findings on IPV and unintended pregnancies for Germany. • There is a need for a sensitive approach within the health system to enhance prevention.

Utilization of modern contraceptives and associated factors among women of homeless reproductive age in Adama town, Oromia, Ethiopia

BackgroundFamily planning refers to a conscious effort by a couple to limit or space the number of children they have through the use of contraceptive methods. Contraceptive utilization is a practice that helps individuals or couples avoid unwanted pregnancy. A lack of family planning puts homeless individuals at a higher risk of unwanted pregnancies and sexually transmitted infections. However, there is little data about modern contraceptive utilization among homeless women in the study area.ObjectivesIt has aimed to assess the utilization of modern contraceptives and associated factors among homeless reproductive-age women in Adama town, 2023.MethodsA community-based cross-sectional study was conducted in Adama town among 286 homeless women. A convenience sampling technique was used. The data were collected through face-to-face interviews using a pretested structured questionnaire. The collected data were cleaned, coded, and entered into Epi Info, and the data were exported to the Statistical Package for Social Sciences (SPSS) version 22. Descriptive statistics were used to characterize the study population. The associations between dependent and independent variables were modeled using binary logistic regression. The adjusted odds ratio (AOR) and 95% confidence interval (CI) were used to estimate associations, and a P value < 0.05 was considered to indicate statistical significance.ResultsOut of the planned 289 respondents, 286 (98.9%) were participated. The prevalence of modern contraceptive utilization was 56.6% [95% CI: (50.7, 62.2)]. Among the utilizers, implants (52.5%), injectables (42%), and pills (5.5%) were used. Homeless women aged 25–34 years [AOR = 4.22, 95% CI: (1.77, 10.05)], a formal education [AOR = 3.04, 95% CI: (1.21, 7.60)], a slept off-street [AOR = 2.81, 95% CI: (1.25, 6.34)], a monthly income greater than or equal to 2400 Ethiopian birr [AOR = 4.18, 95% CI: (2.11, 8.29)], a sexual intercourse AOR = 3.14, 95% CI: (1.17, 8.40)], and a history of pregnancy after joining the street life [AOR = 9.21, 95% CI: (3.67, 23.12)] were factors significantly associated with the utilization of modern contraceptives.ConclusionThe prevalence of modern contraceptive utilization among homeless women was relatively higher than in previous studies. The associated factors for contraceptive utilization included age, education, place for sleeping, income, sexual intercourse and history of pregnancy after joining the street life. The Regional and Adama town Health Bureau and facilities should develop targeted interventions (considering age, educational, and other disparities) to reduce the unmet need for modern contraception and halt unnecessary health outcomes among homeless women, their children, and families.

Long-term outcomes in women diagnosed with heart failure in connection to delivery

Abstract Background Heart failure (HF) among young patients may be from various causes, often triggered by heightened physical demands like pregnancy. Data regarding outcomes of women diagnosed with HF in conjunction to pregnancy and delivery are varied. There remains a notable gap in understanding the outcomes observed in women diagnosed with heart failure in conjunction with delivery. Also, long-term follow-up studies are crucial to elucidate the impact of pregnancy-associated HF on future cardiovascular. Purpose To study the interplay between pregnancy, HF, and subsequent cardiovascular risk. Method Using the personal identification numbers (PINs) that all individuals in Sweden have enables linkage of data between different registers. Data from the National Patient Register (NPR), Swedish Medical Birth Register (MBR) and the Cause of Death Register were also used. All women 18 to 50 years of age registered in the in MBR in the period 1st January 1997 to 31st December 2019 were included. Women with first-time HF in relation to delivery were identified using the international classification code for diseases (ICD-10) I50, I42, I43 and 090.3 together with co-morbidities. Every patient was compared with 5 controls without HF from the Total Population Register matched on age at delivery and calendar year of delivery. Outcomes: all-cause mortality, and any cardiovascular disease (CVD) diagnosed during the observation time. Results A total of 286 cases and 1,430 controls were included. The prevalence of comorbidities at baseline for both patients and controls was low; congenital heart disease (1.4%, vs. 0%), pulmonary hypertension (1.0% vs. 0%), valvular heart disease (5.9% vs. 0%), myocardial infarction 0.7% vs. 0%), arrhythmia (5.9% vs. 0%), hypertension (6.3 % vs. 0.1%), (all p&amp;lt;0.05). Preeclampsia prior to HF diagnosis had 31% of patients vs. 0.2% of controls (p&amp;lt;0.001). Patients exhibited higher mortality rates at 4.9% during median follow up 9.0 (IQR 5.6-13.0) years vs. 0.3%, median follow up 9.4 (6.2-13.5) years and hazard ratios (HR) for all-cause mortality HR (95% CI) of 18.20 (5.99 - 55.31) (p&amp;lt;0.001) compared to controls. During median follow up of 3.2 (0.0-9.2) years 60.1% of patients were diagnosed with CVD both at in-/out-patient settings compared with 4.1% in controls during 9.4 (5.8-13.5) years of follow up. Comparing patients with controls the HR (95% CI) was 22.24 (16.50 - 29.96) p&amp;lt;0.0001 for CVD diagnosis during follow-up, see Figure 1. Conclusion In conjunction with delivery, and in the years thereafter, women with heart failure diagnosis had more than eighteen times higher risk of mortality than women without heart failure. The risk of CVD event in the heart failure group is highest in conjunction with delivery. Figure 1. Cumulative incidence functions for all-cause mortality, CVD in- or out-patient visit adjusted for death as competing risk, comparing cases with controls.

Delivery mode and subsequent birth rate: A nationwide register-based analysis in Finland.

The study aimed to calculate the subsequent birth rate for different delivery modes, comparing them with spontaneous vaginal deliveries, using a comprehensive nationwide high-quality registry. Data from the National Medical Birth Register (MBR) were used to evaluate the birth rate after different delivery modes. All first deliveries for a mother during the years 2004 to 2016 were included. For these women, all second pregnancies from the MBR during the years 2004 to 2018 were retrieved and combined with the data of the first deliveries. A Cox regression model was used to evaluate the risk for the second pregnancy after giving birth the first time. The results were interpreted with adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs). A total of 375 619 women with a first and second pregnancy leading to birth were included in this study. Of these, a total of 50 579 women underwent assisted vaginal delivery, 50 429 had an unplanned cesarean section (CS), 22 021 had elective CS, and 252 593 had spontaneous vaginal delivery as a mode of delivery in their first pregnancy. Women with assisted vaginal delivery (aHR, 1.23 [CI, 1.21-1.24]) and unplanned CS (aHR, 1.03 [CI, 1.02-1.05]) had higher birth rates after the first birth, and women with elective CS as a mode of delivery had lower birth rates (aHR, 0.86 [CI, 0.84-0.88]) when compared with women who had spontaneous vaginal delivery. The findings of this study indicate that the CS operation itself is not the only cause of the observed lower birth rate; rather, there are underlying factors that have a greater impact on birth rates.

Hubungan Risiko Kehamilan Berdasarkan Kartu Skor Poedji Rochjati (KSPR) dengan Persalinan Sectio Caesarea dan Morbiditas Perinatal di Wilayah Puskesmas Mojo Kabupaten Kediri

Maternal Mortality Rate in Indonesia is still high, namely 177 per 100.000 live births. KSPR is a simple tool for early detection of risk factors in pregnant women. Pregnant women with high risk are more likely to experience complication during pregnancy and childbirth so that the possibility of caesarean delivery and perinata morbidity is igher. Complication during pregnancy and childbirth are also a factor in the high MMR. This study aims to determine the relationship between the risk of pregnant women based on the KSPR scoring results with caesarean section deliveries and perinatal morbidity. The research method uses observational analytic with retrospective data collection. The sample in this study were pregnant women who underwent ANC at the Mojo Health Center, Kediri Regency, from Januari to December 2021 who were included in the inclusion criteria and were determined using simple random sampling technique. Data collection trough secondary data in the form of register books, maternal cohorts, medical records, and data collection sheet. Research data were analyzed using the chi-square test. The results showed that the majority of respondents (54%) had high-risk pregnancies (KRT). The results of the statistical test between the risk of pregnancy and sectio caesarea delivery obtained p value = 0,022 and the results of the statistical test between the risk of pregnancy and perinatal morbidity obtained p value = 0,946. These data indicate that there is a significant relationship between the risk of pregnancy and caesarean delivery and there is no significant relationship between risk of pregnancy and perinatal morbidity.

Domestic Violence Experience, Past Depressive Disorder, Unplanned Pregnancy, and Suicide Risk in the First Year Postpartum: Mediating Effect of Postpartum Depression.

This study aimed to examine the relationship between domestic violence, past depressive disorder, unplanned pregnancy, suicide risk, and postpartum depression among Korean women using a mediation model approach. A web-based, cross-sectional survey was performed from September 21 to September 30, 2022. Participants included 1,486 women in their first year postpartum from Chungnam Province, South Korea. The generalized linear model mediation was analyzed using the R-based Jamovi 2.3.21 version program. Of all participants, 8.7% had domestic violence experience, 7.5% had been diagnosed with depressive disorder by the doctor in the past, 33.0% had reported that the last pregnancy was unplanned, 39.9% had postpartum depression, and 11.2% of the participants had a suicide risk. Among the participants with a high risk of suicide, 34.4%, 37.5%, 53.1%, and 96.9% reported experiencing domestic violence, past depressive disorder, an unplanned pregnancy, and postpartum depression, respectively. Postpartum depression partially mediated the relationship between domestic violence, past depressive disorder, and suicide risk and completely mediated the relationship between unplanned pregnancy and suicide risk. Our findings highlight the necessity for screening and early intervention for suicide risk and postpartum depression from pregnancy to the first year postpartum.

Accelerating adverse pregnancy outcomes research amidst rising medication use: parallel retrospective cohort analyses for signal prioritization

BackgroundPregnant women are significantly underrepresented in clinical trials, yet most of them take medication during pregnancy despite the limited safety data. The objective of this study was to characterize medication use during pregnancy and apply propensity score matching method at scale on patient records to accelerate and prioritize the drug effect signal detection associated with the risk of preterm birth and other adverse pregnancy outcomes.MethodsThis was a retrospective study on continuously enrolled women who delivered live births between 2013/01/01 and 2022/12/31 (n = 365,075) at Providence St. Joseph Health. Our exposures of interest were all outpatient medications prescribed during pregnancy. We limited our analyses to medication that met the minimal sample size (n = 600). The primary outcome of interest was preterm birth. Secondary outcomes of interest were small for gestational age and low birth weight. We used propensity score matching at scale to evaluate the risk of these adverse pregnancy outcomes associated with drug exposure after adjusting for demographics, pregnancy characteristics, and comorbidities.ResultsThe total medication prescription rate increased from 58.5 to 75.3% (P < 0.0001) from 2013 to 2022. The prevalence rate of preterm birth was 7.7%. One hundred seventy-five out of 1329 prenatally prescribed outpatient medications met the minimum sample size. We identified 58 medications statistically significantly associated with the risk of preterm birth (P ≤ 0.1; decreased: 12, increased: 46).ConclusionsMost pregnant women are prescribed medication during pregnancy. This highlights the need to utilize existing real-world data to enhance our knowledge of the safety of medications in pregnancy. We narrowed down from 1329 to 58 medications that showed statistically significant association with the risk of preterm birth even after addressing numerous covariates through propensity score matching. This data-driven approach demonstrated that multiple testable hypotheses in pregnancy pharmacology can be prioritized at scale and lays the foundation for application in other pregnancy outcomes.

Outcomes of antenatal depression in women and the new-born: a retrospective cohort study.

To determine what effect maternal antenatal depression has on pregnancy and infant outcomes in the Lleida health region. Retrospective observational cohort study in pregnant women between 2012 and 2018 in the Lleida health region. Variables included age, body mass index, caesarean section, pre-eclampsia, birth weight, and Apgar score. We performed multivariate analysis, with linear regression coefficients and 95% confidence interval (CI). Antenatal depression was diagnosed in 2.54% pregnant women from a total sample of 17177. Depression is significantly associated with a higher risk pregnancy and low birth weight. Pre-eclampsia, 1-minute Apgar score, and caesarean section were not significantly associated with depression. Antenatal depression increases the risk of pregnancy complications. In addition, depression in the mother increases the probability of low birth weight.

Ag induced plasmonic TiO2 for photocatalytic degradation of pharmaceutical under visible light: Insights into mechanism, antimicrobial and cytotoxicity studies

Global concerns include water scarcity and shortage, which are escalated by organic pollutants such as naproxen (NPX) that deteriorate drinking water and taint access to safe drinking water by humans. Moreover, NPX may cause gastrointestinal difficulties, cardiovascular risks, kidney damage, allergic reactions, liver toxicity, bleeding issues and pregnancy risks, hence it is essential to remove it in water. Ag-TiO2 was synthesized by hydrothermal method for NPX degradation. Ag on TiO2 reduced the band gap and surface area of TiO2 and resulted in a plasmonic Ag-TiO2 composite of 0.2 % Ag. The photocatalytic degradation of 0.2 % Ag-TiO2 was 80 % in 180 minutes using a solar simulator during NPX degradation with a first order reaction rate that was 3.6 times faster than that of pure TiO2 and the catalyst showed good stability for four cycles. The dual activity of Ag0 surface plasmon resonance improved light absorption capability and enhanced charge transfer for increased photodegradation rate and stability. The antibacterial studies demonstrated that 0.2 % Ag-TiO2 posted strong antibacterial properties under light irradiation and less in the dark, with a greater effect on gram-negative than gram-positive bacteria. The minimum inhibitory concentration (MIC) values of 620, 1250, 2500, 2500 µg/mL were attained against B. subtilis, S. aureus, E. coli and S. typhimurium bacteria, respectively. The low cell toxicity of 0.2 % Ag-TiO2 was determined using human embryonic kidney (HEK293) cells with an inhibitory concentration (IC50) of 61.09 ± 0.24 µg/mL under light irradiation. Radical trapping experiments demonstrated that hydroxyl radicals (OH•) played a vital role during the degradation and bactericidal activity of NPX under light irradiation. This work advances new insights on the synthesis of less toxic nanoparticles with high photocatalytic and bactericidal activity for possible applications at industrial scale.

Childbearing after treatment for obstetric fistula: perspectives from survivors in Malawi

Women who suffer from an obstetric fistula endure more than just physical pain. Their ability or desire to bear children may also be affected due to physical damage to their reproductive organs. In addition, they may suffer from emotional trauma which is likely to affect their decision to have children. The aim of this study therefore was to explore in more detail the perspectives of obstetric fistula survivors about childbearing after treatment for their condition. This qualitative study was conducted at a non-governmental organisation in the Central Region of Malawi. Data was collected using in-depth interviews from 18 women who had suffered from an obstetric fistula. The study revealed that many women either had no further desire for children or were unable to bear children. Fear of dying and resulting pain from the fistula surgery deter women from wanting further pregnancies. However, there was still strong emphasis placed on childbearing, especially for the younger women who desired children as a means of maintaining their marriages. The risk of further pregnancies and mitigation strategies for reducing obstetric fistulas, should be fully communicated to women. Those who become infertile as a result of obstetric fistula may also require appropriate counselling.

Low Social Support is Associated With Postpartum Depression Symptoms Among Illinois Postpartum Women.

Postpartum depression (PPD) occurs after delivery, with severity and onset varying by individual. Women with low social support may be at higher risk for PPD. This study examined the association between social support and self-reported postpartum depression symptoms (PDS) among Illinois postpartum women. Using 2016-2020 data from the Illinois Pregnancy Risk Assessment Monitoring System (PRAMS) (n = 5886), instrumental support (physical, hands-on support) and partner emotional support were each categorized as high/low and were combined in a composite measure (high = high on both types, moderate = high on one type, and low = low on both types). PDS were self-reported. Crude and adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated using logistic regression. Overall, 9.6% (95% CI = 8.8-10.4) of Illinois postpartum women experienced PDS. Of Illinois postpartum women, 63.5% (95% CI = 62.1-64.9) had high composite support, 29.3% (95% CI = 28.0-30.6) had moderate composite support, and 7.1% (95% CI = 6.4-7.9) had low composite support. After adjustment for maternal characteristics, instrumental support, partner emotional support, and a composite measure of support were each significantly associated with PDS. Compared to women with high composite support, women with low composite support had six times the odds of PDS (aOR = 6.1, 95% CI = 4.5-8.2), and women with moderate composite support had nearly three times the odds of PDS (aOR = 2.7, 95% CI = 2.2-3.4). PDS was associated with instrumental support, partner emotional support, and a composite measure of support in Illinois postpartum women. This suggests the importance of addressing social support for postpartum individuals.

Pregnancy Anxiety and Risk of Gestational Diabetes Mellitus Among a Diverse U.S. Cohort.

Background: Pregnancy anxiety increases the risk of preterm birth but less is known about the impacts on glucose intolerance during pregnancy, such as gestational diabetes mellitus (GDM). The present study examined the relationship between pregnancy anxiety and the risk of GDM in a prospective cohort Centering and Racial Disparities (CRADLE) study of racially diverse pregnant women in the United States. Methods: This is a prospective analysis among racially diverse pregnant women in the United States who enrolled in the CRADLE study. Pregnancy anxiety was assessed twice using the Pregnancy-Specific Anxiety Scale (PSAS): the baseline survey at <20 gestational weeks (GW) and the second survey at >30 GW. GDM was screened at 24-30 GW and diagnosed based on the Carpenter and Coustan criteria. The associations of baseline PSAS score (>9 [median] versus ≤9) and PSAS score change with GDM risk were estimated using multivariable logistic regressions with adjustment for potential confounders. Results: Among a total of 2,310 women (40.74% Black, 20.91% Hispanic), 154 (6.67%) developed GDM. No association was found between baseline PSAS and GDM (adjusted odds ratio [OR]: 0.99; 95% confidence interval [CI]: 0.70-1.42) after adjusting for confounders. Individuals with an increased PSAS during pregnancy had 52% higher GDM risk (adjusted OR: 1.52, 95% CI: 1.04-2.23) compared with those with no change or decreased scores. Conclusions: Pregnant individuals who increased their pregnancy-specific anxiety level during pregnancy had a higher risk of developing GDM. Clinical Trials Registration Identifier: NCT02640638. Registered with ClinicalTrials.gov December 29, 2015. Study recruitment began February 24, 2016. URL of ClincialTrials.gov registration site: https://clinicaltrials.gov/ct2/show/NCT02640638?term=NCT02640638&draw=2&rank=1.

Mitigating Risk, Optimizing Care: Antiseizure Medications, Pregnancy, and Autism Spectrum Disorder Risk.

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Effects of the continuous Medicaid coverage provision of the family first coronavirus response act on postpartum Medicaid coverage, depression symptoms, and birth control use.

The 2020 Family First Coronavirus Response Act (FFCRA) extended Medicaid coverage for enrollees without rechecking eligibility. Before that, women were eligible for Medicaid coverage up to 60 days postpartum. We examine the FFCRA's effect on Medicaid postpartum coverage, depression symptoms, and birth control use beyond 60 days after delivery. We use data from the 2016-2021 Pregnancy Risk Assessment Monitoring System (PRAMS). The primary sample includes 56,828 women who were income eligible up to 60 days postpartum or beyond in their state. We employ a difference-in-differences design comparing outcomes before and after the FFCRA between women who were not income eligible for Medicaid coverage beyond 60 days postpartum in their state and those who were income eligible. We estimate models without and with controlling for state-specific trends in outcomes over time. N/A. There is an 8.1 percentage-point increase in the likelihood of having Medicaid coverage without controlling for state-specific trends, and 5.4 percentage-points when controlling for state-specific trends (both p < 0.05). There is a decline in likelihood of being uninsured by 3 percentage-points (p < 0.05) without state-specific trends and a smaller and non-significant decline when including state-specific trends. Estimated effects on depression symptoms and birth control use are small and statistically non-significant. Following the FFCRA, there was an increase in Medicaid coverage beyond 60 days postpartum among women who would have been income ineligible for Medicaid after 60 days. However, there is a less pronounced effect on likelihood of being uninsured, which might be partly due to some switching from private to Medicaid coverage. There were no discernable effects on depression symptoms and birth control use. Examining additional health and health care utilization measures over a longer postpartum period is needed to further understand the FCCRA effects on these outcomes.

Exome sequencing for nonimmune hydrops fetalis and clinical utility of data reanalysis.

Nonimmune hydrops fetalis (NIHF) presents as life-threatening fluid collections in multiple fetal compartments and may be led by numerous etiologies. To establish the diagnostic yield of exome sequencing for single-gene disorders in unexplained NIHF and to evaluate the clinical utility of data reanalysis. A series of 53 unexplained cases of NIHF were enrolled, including 39 cases met a strict definition of NIHF, and 14 cases with increased nuchal translucency (NT) and/or cystic hygroma in combination with other fluid collections. Trio ES from fetal samples and parental blood was performed, and clinical reports were returned by geneticists and genetic counselors. Multidisciplinary team forums were conducted for accurate diagnoses and improved patient management. The clinical follow-up assessments were conducted, and the reanalysis was performed for cases with a non-positive result. Diagnostic variants were identified in 22.6% (12/53) of the cases, and variants of potential clinical significance were detected in an additional 13.2% (7/53) of the cases. Of them, 3 possible diagnoses (3/41, 7.3%) were obtained during reanalysis. Notably, half of the diagnosed cases were from the group exhibiting only skin edema and increased nuchal translucency and/or cystic hygroma. The diagnostic rate in this group was 42.8% (6/14), while in the classically defined NIHF group, the rate was 15.4% (6/39). The pregnancy termination and live birth rates of the cases with positive genetic testing results were found to be statistically significantly different from those with negative results (91.7% vs 53.6% and 8.3% vs 36.6%, P < 0.05 for both). ES provides high incremental diagnostic yield for NIHF after standard-of-care testing, and reevaluating non-diagnostic exomes in light of updated knowledge can maximize diagnostic yield. Identifying the etiology of NIHF facilitates prenatal diagnosis, improves the management of NIHF cases, and predicts recurrence risk in future pregnancies.

The Safety of Alcohol Pharmacotherapies in Pregnancy: A Scoping Review of Human and Animal Research.

Alcohol pharmacotherapies pose unknown teratogenic risks in pregnancy and are therefore recommended to be avoided. This limits treatment options for pregnant individuals with alcohol use disorders (AUD). The information on the safety of these medications during pregnancy is uncertain, prompting a scoping review. The objective of this review was to investigate available information on the safety of alcohol pharmacotherapies in pregnancy. Studies published between January 1990 and July 2023 were identified through searches in BIOSIS, Embase, PsycINFO and MEDLINE databases, using terms related to pregnancy and alcohol pharmacotherapies. The alcohol pharmacotherapies investigated were naltrexone, acamprosate, disulfiram, nalmefene, baclofen, gabapentin and topiramate. Studies were screened by two independent reviewers. Covidence software facilitated the management, screening and extraction of studies. A total of 105 studies were included in the review (naltrexone: 21, acamprosate: 4, disulfiram: 3, baclofen: 3, nalmefene: 0, topiramate: 55, gabapentin: 32) with some studies investigating multiple medications. Studies investigating naltrexone's safety in pregnancy focussed on opioid use disorders, with limited evidence regarding its safety in the context of AUD. Despite concerns about higher rates of some pregnancy complications, studies generally indicate naltrexone as a safer option compared with opioid agonists or alcohol during pregnancy. Acamprosate was not clearly associated with adverse effects of exposure in pregnancy, with two pre-clinical studies suggesting potential neuroprotective properties. Disulfiram has a high risk of congenital anomalies when used in pregnancy, believed to be due to its mechanism of action. Prenatal topiramate has also been associated with an increased risk of congenital anomalies, particularly oral clefts. There were mixed results concerning the safety of prenatal gabapentin and little to no literature investigating the safety of baclofen or nalmefene during pregnancy. There is insufficient research on the safety of alcohol pharmacotherapies in pregnancy. Despite this, given alcohol's teratogenic effects, naltrexone could be considered to help maintain abstinence in pregnant individuals with AUD, particularly when psychosocial treatments have failed.

The women's cardiovascular disease risk perception after hypertensive disorders of pregnancy: A qualitative meta-synthesis

BackgroundHypertensive disorders of pregnancy is associated with increased risk of cardiovascular disease later in life, but studies suggest that women with previous hypertensive disorders of pregnancy are not aware of this. Little is known about how these women perceive the condition and the associated long-term risks. ObjectivesThis study aims to examine and synthesize qualitative evidence on the perceptions and awareness of women with hypertensive disorders of pregnancy following perceived cardiovascular disease risk. MethodsComputer searches of Pub Med, Embase, Web of Science, Cochrane Library, CINAHL, CNKI, Wanfang database, Vip and SinoMed for all qualitative studies that met the inclusion criteria. The time frame for the search was from the establishment of the database to April 2024. Literature quality was assessed using the Australian Joanna Briggs Institute Centre for Evidence-Based Health Care Qualitative Research quality assessment criteria, and results were summarised and integrated using a pooled integration approach. ResultsEleven studies that fulfilled the inclusion criteria and quality assessment were included in the meta synthesis. Three themes were identified during the analysis: (1)Factors affecting perceived cardiovascular risk in women with hypertensive disorders of pregnancy; (2)Women with hypertensive disorders of pregnancy use different strategies to cope with cardiovascular risk; (3)Needs and expectations for coping with cardiovascular disease risk. ConclusionsBoth women with hypertensive disorders of pregnancy and healthcare providers lack knowledge of the link between hypertensive disorders of pregnancy and cardiovascular risk. Healthcare professionals should establish a multidimensional support model, pay timely attention to postpartum women's psycho-emotional and risk awareness, and give individualised health education to promote health behaviour change. At the same time, professionals should be given standardised training and personalised follow-up services to reduce the incidence of cardiovascular disease in the future.