Routine Pregnancy Care Research Articles

The effect of pregnancy pilates-assisted childbirth preparation training on urinary incontinence and birth outcomes: a randomized-controlled study

PurposeTo examine the effect of pregnancy pilates-assisted birth preparation training on urinary incontinence (UI) including stress urinary incontinence (SUI) and urge urinary incontinence (UUI) during pregnancy, and the postpartum period and birth outcomes.MethodIn this single-center, single-blind, randomized, controlled study, 126 participants who have 28–30 weeks of gestation and nulliparous were randomly assigned to receive either the (n = 63) or control group (n = 63). The study was carried out between March and August 2022. Pregnancy pilates intervention was applied twice in a week, a total of 8 weeks to pilates group. The control group was given routine obstetric and pregnancy care. A personal data form and the Michigan Incontinence Severity Index Form (M-ISI) were used as data collection tools.ResultsThe mean weight gains of the experimental group during pregnancy were significantly lower than the control group. The experimental group had almost twice the rate of vaginal birth than those of the control group. The duration of labor mean score of experimental group was 5 h and 43 min less than the duration of labor of the control group (p < 0.001). After intervention, and postpartum period, the SUI and UUI severity of the experimental group was significantly lower than those of the control group (p < 0.001).ConclusionPilates-assisted childbirth preparation training reduced the severity of UI including SUI and UUI symptoms during pregnancy and the early postpartum. In addition, pilates-assisted childbirth preparation training contributes to decrease in weight gain during pregnancy, the increase in the vaginal birth rate, and the shortening of the duration of labor.Trial registrationNCT06185439

Factors effecting on health-promoting behaviors in iranian pregnant women and their husbands: the actor-partner interdependence model (APIM)

IntroductionPregnancy is an important period of life for women and their husbands as the couple’s health is essential. The present study evaluated the impact of some factors (marital adjustment with depressive symptoms) on health-promoting behaviors in pregnant women and their husbands based on the actor-partner interdependence model (APIM).Materials and methodsThis descriptive study examined 211 couples (pregnant women and their husbands) in pregnancy clinics of Babol University of Medical Sciences using a convenience sampling method. The participants completed Spanier’s Dyadic Adjustment Scale (DAS) (1979), Edinburgh Postnatal Depression Scale (EPDS) (1987), and Walker’s Health Promoting Lifestyle Profile II (HPLPII) questionnaire (1997). The relationships between women and their husbands were also evaluated using structural equation modeling with R software according to the Lavaan (latent variable analysis) package based on APIM-SEM.ResultsThe pregnant women’s marital adjustment positively affected their health-promoting behaviors (β = 0.456, 95% Cl: 0.491–0.998, p < 0.001) and their husbands’ (β = 0.210, 95% Cl: 0.030–0.726, p = 0.048). Pregnant woman’s depressive symptoms also negatively affected their health-promoting behaviors (β=-0.088, 95% Cl: -0.974–0.074, P = 0.236) and their husbands’ health-promoting behaviors (β=-0.177, 95% Cl: -0.281 – -0.975, P = 0.011). Furthermore, the husband’s marital adjustment only positively affected his studied behaviors (β = 0.323, 95% Cl: 0.0303–0.895, P < 0.001) but did not affect the pregnant woman’s health behaviors. The husband’s depressive symptoms had a negative impact on his studied behaviors (β = 0.219, 95% Cl: -0.122 – -0.917, P = 0.001) and did not affect the pregnant woman’s depressive symptoms. Our findings confirmed the mediating role of depressive symptoms in pregnant women and their husbands on the association of marital adjustment and health-promoting behaviors. According to the actor-partner study, a pregnant woman’s marital adjustment scores positively affected her studied behaviors and her husband (β = 0.071, 95% Cl: 0.042–0.278, P = 0.015) by decreasing her depression score. Therefore, the husband’s marital adjustment score positively affected his studied behaviors by decreasing his depression score (β = 0.084, 95% Cl: -0.053 -0.292, P = 0.005), and it did not affect his wife’s health-promoting behaviors.Discussion and conclusionThese findings suggest healthcare providers, obstetricians, and psychologists evaluate the husbands’ symptoms of depression and health-promoting behaviors in the routine pregnancy care of pregnant women. They also pay great attention to marital adjustment as a determinant of reducing depressive symptoms in pregnant women and their husbands.

Mental health and its relationship with quality of life in pregnant Iranian women with a history of primary infertility

Introduction: Considering the relatively high prevalence of infertility and its numerous psycho-social problems, the present study was conducted with the aim of investigating stress, depression, and anxiety and their relationship with the quality of life in pregnant women with a history of primary infertility. Method: This descriptive-analytical cross-sectional study was conducted on 120 pregnant women with a history of primary infertility who referred to the infertility clinic of Al-Zahra Hospital in Tabriz. Eligible participants were selected using a convenient sampling method. Data were collected using an individual-social questionnaire, the Cohen's Perceived Stress Scale, Edinburgh Postnatal Depression Scale, Vandenberg's Pregnancy-Related Anxiety Questionnaire, and Quality of Life Gravidarum. Data analysis was done in SPSS24 software using Pearson and Spearman correlation tests, independent t-test, one-way ANOVA, and multivariate linear regression. Results: The median (percentile 25-75) of perceived stress score in mothers was 44.0 (40.2-46.0). The mean±standard deviation scores of anxiety, depression, and quality of life were 66.1±11.4 (score range: 17-119), 16.3±3.2 (score range: 0-30), and 32.3±5.2 (score range: 9-63), respectively. There was no significant correlation between perceived stress and depression and quality of life; however, a significant negative correlation was observed between anxiety and quality of life. Conclusion: The results of the present study indicated a decrease in mental health in pregnant women following primary infertility. Moreover, anxiety scores had a significant and inverse correlation with quality of life. Therefore, it seems necessary to provide programs to improve the mental health of these women along with routine pregnancy care by health care providers.

Validation of the first-trimester machine learning model for predicting pre-eclampsia in an Asian population.

To evaluate the performance of an artificial intelligence (AI) and machine learning (ML) model for first-trimester screening for pre-eclampsia in a large Asian population. This was a secondary analysis of a multicenter prospective cohort study in 10 935 participants with singleton pregnancies attending for routine pregnancy care at 11-13+6 weeks of gestation in seven regions in Asia between December 2016 and June 2018. We applied the AI+ML model for the first-trimester prediction of preterm pre-eclampsia (<37 weeks), term pre-eclampsia (≥37 weeks), and any pre-eclampsia, which was derived and tested in a cohort of pregnant participants in the UK (Model 1). This model comprises maternal factors with measurements of mean arterial pressure, uterine artery pulsatility index, and serum placental growth factor (PlGF). The model was further retrained with adjustments for analyzers used for biochemical testing (Model 2). Discrimination was assessed by area under the receiver operating characteristic curve (AUC). The Delong test was used to compare the AUC of Model 1, Model 2, and the Fetal Medicine Foundation (FMF) competing risk model. The predictive performance of Model 1 was significantly lower than that of the FMF competing risk model in the prediction of preterm pre-eclampsia (0.82, 95% confidence interval [CI] 0.77-0.87 vs. 0.86, 95% CI 0.811-0.91, P = 0.019), term pre-eclampsia (0.75, 95% CI 0.71-0.80 vs. 0.79, 95% CI 0.75-0.83, P = 0.006), and any pre-eclampsia (0.78, 95% CI 0.74-0.81 vs. 0.82, 95% CI 0.79-0.84, P < 0.001). Following the retraining of the data with adjustments for the PlGF analyzers, the performance of Model 2 for predicting preterm pre-eclampsia, term pre-eclampsia, and any pre-eclampsia was improved with the AUC values increased to 0.84 (95% CI 0.80-0.89), 0.77 (95% CI 0.73-0.81), and 0.80 (95% CI 0.76-0.83), respectively. There were no differences in AUCs between Model 2 and the FMF competing risk model in the prediction of preterm pre-eclampsia (P = 0.135) and term pre-eclampsia (P = 0.084). However, Model 2 was inferior to the FMF competing risk model in predicting any pre-eclampsia (P = 0.024). This study has demonstrated that following adjustment for the biochemical marker analyzers, the predictive performance of the AI+ML prediction model for pre-eclampsia in the first trimester was comparable to that of the FMF competing risk model in an Asian population.

A Prediction Model of Preeclampsia in Hyperglycemia Pregnancy.

To investigate the risk factors associated with preeclampsia in hyperglycemic pregnancies and develop a predictive model based on routine pregnancy care. The retrospective collection of clinical data was performed on 951 pregnant women with hyperglycemia, including those diagnosed with diabetes in pregnancy (DIP) and gestational diabetes mellitus (GDM), who delivered after 34 weeks of gestation at the Maternal and Child Health Hospital Affiliated to Anhui Medical University between January 2017 and December 2019. Observation indicators included liver and kidney function factors testing at 24-29+6 weeks gestation, maternal age, and basal blood pressure. The indicators were screened univariately, and the "rms" package in R language was applied to explore the factors associated with PE in HIP pregnancy by stepwise regression. Multivariable logistic regression analysis was used to develop the prediction model. Based on the above results, a nomogram was constructed to predict the risk of PE occurrence in pregnant women with HIP. Then, the model was evaluated from three aspects: discrimination, calibration, and clinical utility. The internal validation was performed using the bootstrap procedure. Multivariate logistic regression analysis showed that cystatin C, uric acid, glutamyl aminotransferase, blood urea nitrogen, and basal systolic blood pressure as predictors of PE in pregnancy with HIP. The predictive model yielded an area under curve (AUC) value of 0.8031 (95% CI: 0.7383-0.8679), with an optimal threshold of 0.0805, at which point the sensitivity was 0.8307 and specificity of 0.6604. Hosmer-Lemeshow test values were P = 0.3736, Brier score value was 0.0461. After 1000 Bootstrap re-samplings for internal validation, the AUC was 0.7886, the Brier score was 0.0478 and the predicted probability of the calibration curve was similar to the actual probability. A nomogram was constructed based on the above to visualize the model. This study developed a model for predicting PE in pregnant women with HIP, achieving high predictive performance of PE risk through the information of routine pregnancy care.

The Effect of Mindfulness Interventions on the Sleep Quality of Pregnant Mothers in the Second and Third Trimesters of Pregnancy

Background: Sleep disorder is a common problem during pregnancy and a large percentage of pregnant women (especially in the third trimester of pregnancy) experience changes in their natural sleep pattern. Considering the fact that sleep disorder can cause many complications before, during and after childbirth, it is necessary to achieve good sleep quality during pregnancy. Therefore, the present research investigated the effect of mindfulness interventions on the quality of sleep among pregnant mothers in the second and third trimesters of pregnancy. Materials and Methods: The present randomized clinical trial study used pre-education-post-education design in Sabzevar Health Center from 2019 to 2020 on all pregnant women referred for receiving prenatal care. A sample of 98 women who met the inclusion criteria were divided into intervention (n=50) and control groups (n=48). The sleep quality and depression anxiety and stress -21 (DASS-21) questionnaires, were completed by two groups at pre-test, post-test, and one month after the educational intervention. The intervention group received 6 sessions (1 hour and 30 minutes) of mindfulness lessons during 2 months, while the control group received routine pregnancy care and a mindfulness session was performed after completion of the post-education. Data was analyzed by SPSS software (version 20) and descriptive and repeated measures analysis were used. Results: Mindfulness interventions were effective in changing the sleep quality of pregnant mothers (P&lt;0.05). Also, the mean scores of anxiety, stress and depression questionnaires of pregnant mothers, as confounding variables on sleep quality, was significantly changed during different stages of the study (P&lt;0.05). Conclusion: Mindfulness training significantly increased the sleep quality of pregnant mothers. Therefore, mindfulness interventions can be used as effective interventions in improving psychological wellbeing during pregnancy and also reducing the anxiety and stress of pregnant women.

The effect of counseling with cognitive behavior approach on self-esteem and body image in lactating mothers: randomized clinical trial

BackgroundSome of the women experience low self-esteem and negative body image in pregnancy and postpartum. These two factors along with other factors can reduce the rate of exclusive breastfeeding among women. Cognitive-behavior therapy (CBT) is one of the psychological approaches that is effective on the betterment of many of the psychological and personality disorders such as body image disorders as well as improvement of self-esteem. The aim of this randomized control trial is to recognize the effects of CBT during pregnancy period on self-esteem, body image (primary outcome) and exclusive breastfeeding (secondary outcome).MethodIn this randomized controlled trial, 70 eligible pregnant women referring to health centers of Tabriz- Iran were assigned to two groups of 35 as intervention and control groups using randomized blocking method. For intervention group, 8 sessions of CBT based on Cash and Strachan’s body image protocol and Michael Freeʼs for self-esteem were performed. Control group was received routine pregnancy care by their health provider. Rosenberg self-esteem scale and multidimensional body self-relation questionnaire (MBSRQ) were completed before intervention, immediately after intervention and 4 weeks after delivery. Likewise, exclusive breastfeeding questionnaire was completed 4 weeks after childbirth. Independent t-test, chi square and repeated measures ANOVA tests were used to analyze the data.ResultsAccording to repeated measures ANOVA test and with controlling baseline score, the mean scores on self-esteem (AMD): 7.18; 95%confidence interval (CI): 4.43 to 9.94; p < 0.001)) and body image (AMD: 49.74; 95%CI = 28.57 to 70.91; p < 0.001) in the intervention group were significantly higher than the control group. Also, after intervention, the mean score of body image subscales including appearance evaluation (p = 0.010), appearance orientation (p = 0.001), fitness evaluation (p = 0.004), fitness orientation (p = 0.001), health evaluation (p = 0.001), health orientation (p = 0.018), and illness orientation (p = 0.002) was significantly higher in the intervention group than the control group.ConclusionsCBT was effective on the improvement of self-esteem and body image and through which might lead to the increase of exclusive breastfeeding among women.Trial registration numberIRCT20110524006582N33. First Date of registration: 17/10/2022. Submission ID 4ca86cd4-8459-4b86-9fe5-63f6a8184956.

A Survey on the Relationship Between Fetal Heart Rate in the First Trimester and Gestational Diabetes

Background: Gestational diabetes mellitus (GDM) can complicate pregnancy. Ultrasound examination of the fetal heart rate (FHR) is essential to routine pregnancy care. Several studies have reported the effect of GDM on FHR. Objectives: This study aimed to evaluate the relationship between FHR in the first trimester and GDM. Methods: This cohort study was conducted on 214 pregnant women. The FHR of all fetuses was measured once in the first and second trimesters after a glucose challenge test (GCT). Based on the GCT, all pregnant women were divided into two groups (GDM and healthy). The data were analyzed by SPSS software version 16 to investigate the relationship between GDM and the first-trimester FHR. Results: The mean FHR of the first trimester in GDM and healthy pregnant women was 164.38 ± 7.20 and 164.25 ± 7.43, respectively (P = 0.930). After GCT, the mean FHR in GDM and healthy pregnant women was 144.97 ± 7.60 and 146.65 ± 8.71, respectively (P = 0.326). The FHR in the first trimester and after GCT in GDM and healthy pregnant women were not significantly different. The logistic regression results showed that FHR cannot predict GDM. Conclusions: Based on the results, the fetus’s heart rate cannot be used to predict gestational diabetes.

Routine screening of abnormal vaginal flora during pregnancy reduces the odds of preterm birth: a systematic review and meta-analysis

Prematurity is the leading cause of perinatal mortality and the morbidity among children under the age of 5. The prevalence of preterm birth is between 5 and 18% worldwide. Approximately 30% of preterm deliveries occur as a consequence of fetal or maternal infections. Bacterial vaginosis can increase the risk of ascending infections. However, there is no recommendation or protocol for screening of abnormal vaginal flora. The aim of this systematic review was to investigate the effectiveness of routine screening of abnormal vaginal flora during pregnancy care. We conducted our systematic search in the following databases: MEDLINE via PubMed, Embase, and Cochrane Library. Studies reporting on pregnant women with no symptoms of bacterial vaginosis were included in our analysis if they provided data on the outcome of their pregnancy. The intervention group went through screening of abnormal vaginal flora in addition to routine pregnancy care. Odds ratio (OR) with 95% confidence intervals (CIs) was used as effect size measure. From each study the total number of patients and number of events was extracted in both the intervention and control arm to calculate OR. Altogether we included 13 trials with 143,534 patients. The screening methods were Gram stain, pH screening, pH self-screening and pH screening combined with Gram stain. Regular screening of vaginal flora compared to no screening significantly reduces the odds of preterm birth before 37 weeks (8.98% vs 9.42%; OR 0.71, CI 0.57–0.87), birthweight under 2500 g (6.53% vs 7.24%; OR 0.64, CI 0.50–0.81), preterm birth before 32 weeks (1.35% vs 2.03%; OR 0.51, CI 0.31–0.85) and birthweight under 1000 g (0.86% vs 2.2%; OR 0.33, CI 0.19–0.57). In conclusion, the routine screening of abnormal vaginal flora might prevent preterm birth, extreme preterm birth, low birthweight deliveries and very low birthweight deliveries. Further research is needed to assess the problem more accurately.

Vaccination during pregnancy: A golden opportunity to embrace.

Immunization strategies are part of routine pregnancy care to prevent infectious diseases in the mother, the fetus, and the newborn. Maternal immunization recommendations followed the recognition of the consequences of infectious diseases in pregnancy, including vertical transmission and perinatal consequences. The recent COVID-19 pandemic highlighted the issue of vaccination among pregnant individuals. Recommendations vary globally; however, Tdap, influenza, and, recently, COVID-19 vaccines are routinely recommended during pregnancy. There are several new maternal immunization products in the pipeline, including those directed against malaria, cytomegalovirus, Group B Streptococcus, herpes simplex virus, and respiratory syncytial virus. Important challenges must be addressed in all countries to guarantee that pregnant individuals and their babies receive the best care possible, including uptake of recommended immunizations by their entire target population groups. These challenges include disseminating appropriate data for vaccine recommendations and many others, such as ensuring stakeholder endorsement, achieving in-country distribution and administration, adequate vaccine supply, and a well-organized healthcare system, ideally offering the immunization free of charge. More recently, the hesitancy of pregnant women to receive immunizations highlights the relevance of cultural aspects and other contextual factors affecting vaccine uptake among pregnant individuals.

Sonographic Flow-Mediated Dilation Imaging versus Electronic EndoCheck Flow-Mediated Slowing by VICORDER in Pregnant Women—A Comparison of Two Methods to Evaluate Vascular Function in Pregnancy

The evaluation of endothelial function is gaining interest and importance during pregnancy, since the impaired adaptation in early pregnancy has been associated with an increased risk in preeclampsia and fetal growth restriction. To standardize the risk assessment and to implement the evaluation of vascular function in routine pregnancy care, a suitable, accurate and easy to use method is needed. Flow-mediated dilatation (FMD) of the brachial artery assessed by ultrasound is considered to be the gold standard for measuring the vascular endothelial function. The challenges of the FMD measurement have so far prevented its introduction into clinical routine. The VICORDER® device allows an automated determination of the flow-mediated slowing (FMS). The equivalence of FMD and FMS has not yet been proven in pregnant women. We collected data of 20 pregnant women randomly and consecutively while they presented for a vascular function assessment in our hospital. The gestational age at investigation was between 22 and 32 weeks of gestation, three had preexisting hypertensive pregnancy disease and three were twin pregnancies. The results for FMD or FMS below 11.3% were considered to be abnormal. Comparing FMD to FMS results in our cohort revealed a convergence in 9/9 cases, indicating normal endothelial function (specificity of 100%) and a sensitivity of 72.7%. In conclusion, we verify that the FMS measurement is a convenient, automated and operator-independent test method of endothelial function in pregnant women.

Effect of Tele-Medicine on Health Anxiety and Pregnancy-Related Anxiety in Pregnant Women during the COVID-19 Epidemic in Iran.

The global spread of the new coronavirus has increased the necessity of innovations to increase the quality of health care. This study was intended to examine the impact of tele-medicine on health anxiety and pregnancy-related anxiety in pregnant women during the COVID-19 epidemic in Iran. This quasi-experimental study was performed between March and May 2020. Sampling was done using multi-stage random sampling method. A total of 104 pregnant women were in two groups (intervention: n = 52, control: n = 52). Data were collected using a demographic and obstetric information questionnaire, the Health Anxiety Questionnaire, and Van den Bergh's Pregnancy-Related Anxiety Questionnaire. The intervention group received counseling services for 2 months by researchers through telephone conversations, text messages, and applications such as WhatsApp, Telegram, and Instagram. In addition to routine pregnancy care, they could contact the researchers by phone and receive the necessary advice in case of any questions, ambiguities, or problems. The control group included pregnant women who received only routine pregnancy care. After the intervention, health anxiety scores of pregnant women in the control group were significantly higher than those of the experimental group (t98 = 13.54, p < 0.001). Also, the mean (SD) scores of pregnancy-related anxiety in the control group were significantly higher compared with the intervention group (t98 = 3.80, p < 0.001). Using tele-medicine, especially during the COVID-19 pandemic can reduce unnecessary referrals of pregnant women to medical centers and their risk of developing the disease, on the one hand, and by reducing women's anxiety, however, it can improve psychological consequences.

Understanding social needs in pregnancy: Prospective validation of a digital short-form screening tool and patient survey

Social determinants of health significantly affect health outcomes, yet are infrequently addressed in prenatal care. This study aimed to improve the efficiency and experience of addressing social needs in pregnancy through: (1) testing a digital short-form screening tool; and (2) characterizing pregnant people's preferences for social needs screening and management. We developed a digital short-form social determinants of health screening tool from PRAPARE (Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences), and a survey to query patients' preferences for addressing social needs. Instruments were administered online to peripartum participants, with equal representation of patients with public and private insurance. We calculated the sensitivity and specificity of the short-form tool vs PRAPARE. Quantitative responses were characterized using descriptive statistics. Free-text responses were analyzed with matrix and thematic coding. Survey data were analyzed by subgroups of historically marginalized populations. A total of 215 people completed the survey. Participants were predominantly White (167; 77.7%) and multiparous (145; 67.4%). Unmet social needs were prevalent with both the short-form tool (77.7%) and PRAPARE (96.7%). The sensitivity (79.3%) and specificity (71.4%) of the short-form screener were high for detecting any social need. Most participants believed that it was important for their pregnancy care team to know their social needs (material: 173, 80.5%; support: 200, 93.0%), and over half felt comfortable sharing their needs through in-person or digital modalities if assistance was or was not available (material: 117, 54.4%; support: 122, 56.7%). Free-text themes reflected considerations for integrating social needs in routine prenatal care. Acceptability of addressing social needs in pregnancy was high among all groups. A digital short-form social determinants of health screening tool performs well when compared with the gold standard. Pregnant people accept social needs as a part of routine pregnancy care. Future work is needed to operationalize efficient, effective, patient-centered approaches to addressing social needs in pregnancy.

The effectiveness of couple-centered counseling on the anxiety and concerns of pregnant adolescents

Introduction: Adolescents are at higher risk for mental health problems during pregnancy. Objective: The present study was designed to investigate the impact of couple-centered counseling on pregnancy anxiety and concerns in female adolescents. Materials and Methods: Materials and Methods: The present quasi-experimental study was conducted on primigravida adolescents referring to health centers in Hamadan City, Iran. Using the convenience sampling method, 90 pregnant adolescents were assigned to two groups (intervention group=45, control group=45) using a randomized block design. Both groups completed the demographic questionnaire, pregnancy-related anxiety questionnaire, and Cambridge worry scale. The intervention group received five counseling sessions with the presence of their spouses, in addition to routine pregnancy care. The control group only received routine prenatal care. Posttest was taken four weeks after finishing the consulting intervention. The groups were compared in terms of pregnancy-related anxiety and pregnancy worry scores using the independent t-test, the Chi-square test, the Fisher exact test, and the analysis of variance or covariance. In case of a significant difference between the groups, Cohen’s d effect size was calculated. Results: There was no significant difference between the two groups regarding age, education, and occupation of adolescents and their spouses, duration of the marriage, housing situation, family members, and economic situation. The mean scores of pregnancy concerns in the intervention group (10.80±4.78) were significantly (P=0.001, Cohen’s d=2.41) lower than the control group (22.33±4.78). The mean scores of pregnancy anxiety in the intervention group (35.86±8.04) were significantly (P=0.001, Cohen’s d=2.74) lower than the control group (57.93±8.04). Conclusion: Couple-centered counseling can reduce the anxiety and concerns of primigravid adolescents. It is recommended to use this effective, accessible, and acceptable approach to maintain and promote the mental health of pregnant adolescents.

Prevalence of elevated alanine aminotransferase (ALT) in pregnancy: A cross-sectional labor and delivery-based assessment.

Since liver tests are not routinely checked in pregnancy, the prevalence of abnormal liver tests and liver-related abnormalities in pregnancy in a US-based population is not known. We sought to determine the prevalence of abnormal alanine aminotransferase (ALT) among pregnant Individuals who present to labor and delivery for evaluation and to evaluate prevalence of underlying diagnosed liver conditions. Prospective study evaluating liver tests in consecutive samples obtained on the labor and delivery unit. Patient characteristics were compared between those with and without abnormal ALT and those with and without abnormal ALT without a liver-related diagnosis made in clinical practice, using t tests for continuous measures and χ2 or Fisher’s exact tests as appropriate for categorical measures. Logistic regression was utilized to identify factors associated with abnormal ALT in this subcohort to determine predictors of abnormal ALT in those without a known liver-related diagnosis. We collected 1024 laboratory specimens from 996 patients. Of these patients, 131 of 996 (13.2%) had elevated ALT ≥25 IU/L; 20 (2%) had ALT ≥50, 6 (0.6%) had ALT ≥125 and 3 (0.3%) had ALT ≥250. 61/131 (46.6%) of patients with ALT ≥25 IU/L had not had LTs checked during routine pregnancy care. 20 (15%) of individuals with abnormal LT had preeclampsia; 5 (4%) had cholestasis of pregnancy; 1 (0.8%) had hepatitis C; there were no other chronic liver diseases diagnosed. There were no significant demographic or clinical differences between those with and without ALT ≥25, whether liver disease diagnosis was made or not. We identified an over 10% prevalence of abnormal LTs in consecutive pregnant individuals who presented to L&D, most of whom did not have a liver-related condition diagnosed in clinical practice. Among those with liver-related diagnoses, PE and ICP were the most common among individuals with ALT≥25 IU/mL, with chronic liver disease rarely diagnosed. Further evaluation of the role of ALT testing as part of routine prenatal care is needed, particularly in establishing a baseline prevalence of liver test abnormalities in pregnancy and independent association with pregnancy outcomes.

Optimising weight gain in pregnancy: key challenges and solutions for maternal obesity prevention.

Pregnancy is a high-risk period for excess gestational weight gain and subsequent obesity development. Antenatal lifestyle interventions are prioritised to optimise weight, with current evidence demonstrating efficacy and associated reduction in risk of adverse maternal and neonatal outcomes. Yet, evidence to guide the field from efficacy-based to implementation research within real-world settings is lacking, and several key challenges remain. Here, we discuss key considerations to support the implementation of accessible, relevant, effective, and low-cost lifestyle interventions in routine pregnancy care. This includes identifying what components of lifestyle interventions are most effective, with pragmatic guidance on how to conduct implementation research, improving rigour in reporting to ensure learnings from implementation are captured, and recognising and addressing the socioecological aspects of obesity prevention, including supporting women living with socioeconomic disadvantage and reducing weight stigma.

Implementing a Perinatal Depression Screening in Clinical Routine: Exploring the Patient's Perspective.

Introduction Perinatal depression (PND) is a frequently observed mental disorder, showing a prevalence of up to 20% and resulting in unfavorable maternal and neonatal outcomes. Targeted screening for PND offers the potential to identify and treat undiagnosed cases and help prevent its deleterious consequences. The aim of the present study was to evaluate participantsʼ personal attitudes and acceptance of a routine screening program for PND in pregnancy care, identify any potential underlying factors, and appraise the general perspective on perinatal mental health problems. Methods In total, 732 women in their second trimester of pregnancy took part in a PND screening program that was incorporated in routine prenatal care using the Edinburgh Postnatal Depression Scale (EPDS) and completed a web-based survey on screening acceptance. Results Participants viewed PND screening as useful (78.7%, n = 555/705), especially in terms of devoting attention to perinatal mental health problems (90.1%, n = 630/699), easy to complete (85.4%, n = 606/710), and without feelings of discomfort (88.3%, n = 628/711). Furthermore, women with previous or current mental health issues rated the usefulness of screening significantly higher, as did women with obstetric risks (p < 0.01 – p = 0.04). The final regression model explained 48.4% of the variance for screening acceptance. Conclusion Patient acceptance for PND screening was high in our study cohort, supporting the implementation of screening programs in routine pregnancy care with the potential to identify, sensitize, and treat undiagnosed patients to reduce stigmatization and offer access to tailored dedicated PND care programs.

Outcomes in Pregnant Persons Immunized with a Cell-Based Quadrivalent Inactivated Influenza Vaccine: A Prospective Observational Cohort Study.

Objective: To evaluate pregnancy and infant outcomes among persons immunized with a cell-based quadrivalent inactivated influenza vaccine (IIV4c) during routine pregnancy care. Design: Prospective observational cohort. Setting: US-based obstetrics/gynecology clinics. Population: Pregnant persons. This US-based, prospective observational cohort study evaluated the safety of quadrivalent inactivated influenza vaccine (IIV4c; Flucelvax® Quad) in pregnant persons immunized over 3 influenza seasons between 2017 and 2020. Pregnant persons were immunized with IIV4c as part of routine care, after which their health care provides HCPs with all observational data to a single coordinating center. Follow-up data were collected at the end of the second trimester and/or at the time of pregnancy outcome. A scientific advisory committee reviewed the data. Prevalence point estimates were reported with 95% confidence intervals (CIs). Pregnancy outcomes included: live birth, stillbirth, spontaneous abortion, elective termination, and maternal death. Infant outcomes included: preterm birth (<37 weeks gestational age), low birth weight (<2500 g), or major congenital malformations (MCMs). Of the 665 evaluable participants, 659 (99.1%) had a live birth. No stillbirths (0% [95% CI 0.0–0.6]), 4 spontaneous abortions (1.9% [0.5–4.8]), and 1 elective termination (0.5% [0.0–2.6]) were reported. Among 673 infants, 9.2% (upper 95% CI 11.5%) were born prematurely, 5.8% (upper 95% CI 7.6%) had low birth weight, and 1.9% (upper 95% CI 3.1%) were reported to have an MCM. No maternal deaths were reported. Of the 2 infants who died shortly after birth, one was adjudicated as not related to the vaccine; the other’s cause could not be determined due to maternal loss to follow-up. The prevalence of adverse pregnancy outcomes or preterm birth, low birth weight, or MCMs in newborns was similar in persons vaccinated with IIV4c compared to the rates observed in US surveillance systems. The safety profile of IIV4c in pregnant persons is consistent with previously studied influenza vaccines.

Evaluation of the Effectiveness of Supportive Group Therapy on Fear of Delivery in Pregnant Women, 2021

Background and Objective: Fear of childbirth is one of the major problems in delivery and the postpartum period. In most women, fear of childbirth is associated with increased pain, prolonged labor and unpleasant labor experience, and increased rate of elective cesarean section Materials and Methods: This interventional study was conducted on 90 pregnant women referred to health centers in Kordkuy, Iran. They were randomly assigned to two groups: intervention and control. The inclusion criteria entailed a wish for cesarean delivery or being doubtful about the mode of delivery, primigravida, singleton pregnancy, the age range of 18-35 years, reading and writing literacy, gestational age of 22-30 weeks at the beginning of the study, and a healthy fetus based on ultrasound examinations in the first trimester. The exclusion criteria were as follows: clear and identifiable obstacles to natural childbirth at the time of sampling, mental and neurological disorders, smoking, drug, and alcohol addiction, repeated abortions, and a history of infertility. The data collection tools included the Wijma Delivery Expectancy/Experience Questionnaire (version A) and the demographic information form. The intervention in the experimental group was performed in five one-hour sessions, while the control group received routine pregnancy care. The data were analyzed in SPSS software using independent chi-square and independent t-tests. Results: Before the intervention, demographic variables, such as age, occupation, and education, were homogeneous between the intervention and control groups. At the end of the support group therapy sessions, the mean fear of childbirth score in the intervention group was 69.22, which was significantly lower than that in the control group (84.58) (P&lt;0.001). Conclusion: Midwifery counseling in the form of supportive group therapy is effective in reducing the fear of childbirth. Considering that some pregnant women were compelled to undergo a cesarean section due to the opposition of their husbands, it is necessary to conduct studies on the effects of support group therapy on the fear of childbirth in groups consisting of pregnant women, as well as their spouses and families.

The effectiveness of Mindfulness Based on Cognitive Therapy (MBCT) on quality of life and optimism of adolescent pregnant women

Background: Pregnancy during adolescence causes a person to face many challenges, so that its contradiction with the adolescent's identity structure can have negative effects on her psychological dimension, especially on optimism and quality of life. Since the health of the pregnant mother is one of the health priorities of any country, the present study aimed to investigate the effectiveness of mindfulness (MBCT) on the quality of life and the optimism of adolescent pregnant mothers. Methods: The present study was performed as an interventional study with a pre-test-post-test design on 88 adolescent pregnant women referring to health centers in Ahvaz. Participants were divided into 44 groups of intervention and control. For the intervention group, 8 sessions of 90-minute mindfulness counseling were held weekly. The control group also received routine pregnancy care. Participants completed the LOT-R and SF-36 quality of life questionnaires before and after the intervention. Data were analyzed by SPSS26 software. Findings: There was a significant difference in the overall quality of life between the control and experimental groups before and after the intervention (p &lt;0.001).