Pregnancy Symptoms Research Articles

Prevalence and course of pregnancy symptoms using self-reported pregnancy app symptom tracker data

During pregnancy, almost all women experience pregnancy-related symptoms. The relationship between symptoms and their association with pregnancy outcomes is not well understood. Many pregnancy apps allow pregnant women to track their symptoms. To date, the resulting data are primarily used from a commercial rather than a scientific perspective. In this work, we aim to examine symptom occurrence, course, and their correlation throughout pregnancy. Self-reported app data of a pregnancy symptom tracker is used. In this context, we present methods to handle noisy real-world app data from commercial applications to understand the trajectory of user and patient-reported data. We report real-world evidence from patient-reported outcomes that exceeds previous works: 1,549,186 tracked symptoms from 183,732 users of a smartphone pregnancy app symptom tracker are analyzed. The majority of users track symptoms on a single day. These data are generalizable to those users who use the tracker for at least 5 months. Week-by-week symptom report data are presented for each symptom. There are few or conflicting reports in the literature on the course of diarrhea, fatigue, headache, heartburn, and sleep problems. A peak in fatigue in the first trimester, a peak in headache reports around gestation week 15, and a steady increase in the reports of sleeping difficulty throughout pregnancy are found. Our work highlights the potential of secondary use of industry data. It reveals and clarifies several previously unknown or disputed symptom trajectories and relationships. Collaboration between academia and industry can help generate new scientific knowledge.

A Neglected Area: Restless Leg Syndrome in Pregnancy and The Role of the Obstetric and Gynecology Nurse

Restless legs syndrome is the most common movement disorder in pregnancy and is more common in pregnant women than in healthy women and men. However, it is not well known among obstetricians. Similarly, the awareness of pregnant women about restless legs syndrome is also low. Genetics, the brain’s dopamine system and iron metabolism are thought to be effective in the pathophysiology of the disease in pregnancy. The disease usually disappears after delivery, but if not treated, sleep disorders, psychological problems, decreased quality of life, as well as symptoms of pregnancy and birth-related complications such as preeclampsia, the threat of miscarriage, premature birth, difficult birth, cesarean delivery and intrauterine growth retardation may occur. Diagnosis in pregnancy is made using the basic criteria of the International Restless Legs Syndrome Working Group. Non-pharmacological methods are primarily recommended for treatment. However, if symptoms are severe, more reliable drugs should be considered. In symptom management, it is essential to control anemia, sleep apnoea, and drug use that exacerbate restless legs syndrome. To reduce the severity of restless legs syndrome during pregnancy, non-pharmacological treatments such as moderate exercise, yoga, hot/cold water applications, relaxation exercise, relaxing background music, and sleep hygiene can be recommended. Obstetrics and gynecology nurses, who have a crucial role and responsibility in pregnancy follow-up, should be able to provide effective and quality care to women in the prepartum, peripartum, intrapartum, and postpartum periods with a comprehensive approach in line with evidence-based practices.

THU473 Acute Hypercalcemia In The Setting Of Acute Fatty Liver Of Pregnancy, A Case Report

Abstract Disclosure: M. Ahmad: None. M. Mack: None. A. Arif: None. L.A. Tejada: None. U. Siddiqui: None. Introduction: Hypercalcemia in pregnancy is rare and often goes unrecognized due to the overlapping symptoms of hypercalcemia and pregnancy. The most common cause of hypercalcemia in pregnant patients is primary hyperparathyroidism, with malignancy, milk alkali syndrome and familial hypocalciuric hypercalcemia being less common. Additionally, endogenous PTHrP production by breast and placental tissue have also been described as rare causes of hypercalcemia in pregnancy. We describe an interesting case of severe hypercalcemia in a pregnant woman presenting with acute fatty liver of pregnancy (AFLP) which rapidly corrected after delivery. Case description: The patient was a 32-year-old female with a past medical history of hypothyroidism and type 2 diabetes mellitus who presented to the emergency department at 32 weeks gestation due to four days of nausea, vomiting and epigastric pain. The patient’s vital signs were as follows: blood pressure: elevated to 133/79 mmHg, heart rate: 75 beats per minute, temperature: 36.7 C, and respiratory rate: 12 breaths per minute. On physical exam, the patient had diffuse abdominal tenderness with no vaginal bleeding. The patient’s blood work was significant for: bicarbonate: 17 mmol/L, creatinine: 1.26 mg/dL (baseline 0.7 mg/dL), corrected calcium of 15.1 mg/dL, ALP: 438 IU/L, AST: 653 IU/L, ALT: 666IU/L, total bilirubin: 2.3 mg/dL, INR 1.3, and ammonia: 43 mcmol/L. She was taken to the operating room for emergent cesarian delivery for concerns of AFLP. Further workup of the patient’s hypercalcemia, revealed a low normal PTH level of 11 pg/dL (normal 11-65 mg/dL), PTHrP level of <5 mg/dL, TSH of 1.37 uIU/ml, 25-OH vitamin D 55 ng/ml, and 1,25-OH vitamin D: 20 pg/ml. After delivery, the patient had alleviation of her symptoms and was kept on dextrose 5% with lactated ringers at 100 cc/h for a total of two days and had complete resolution of her hypercalcemia (corrected calcium of 10.2 mg/dL on discharge). The patient follows with endocrinology as an outpatient and since has had normal calcium levels. Discussion: Hypercalcemia in pregnancy is rare, only affecting 0.03% of women in the reproductive age group, with primary hyperparathyroidism being the most common cause. Hypercalcemia in pregnancy can often be missed due to the hemodilution of serum calcium in pregnancy and also the nonspecific symptoms present in pregnant patients. Our case describes a patient presentation of severe hypercalcemia with AFLP, who had rapid correction of her calcium levels after delivery. The exact mechanism of her severe hypercalcemia developed remains unclear, however, given its rapid resolution with delivery of the placenta potential etiologies include the AFLP itself or possibly the placenta contributing to hypercalcemia. Through this case report, we hope to highlight a possible association between AFLP and hypercalcemia. Presentation: Thursday, June 15, 2023

SAT251 A Tale Of Two Calcium Disorders: Hypercalcemia In Pregnancy

Abstract Disclosure: M. Stezzi: None. C. Hayes: None. M. Misiura: None. E. Skutnik: None. G.A. Perilli: None. S. Koshy: None. Introduction: Hypercalcemia in pregnancy is a rare event that can be difficult to diagnose given nonspecific presentation of symptoms and distinguishing it from typical symptoms of pregnancy. Primary hyperparathyroidism is the leading cause of hypercalcemia in pregnancy. Management presents a challenge as drug treatment and surgery options are limited. We present two cases of the uncommon non PTH mediated hypercalcemia in pregnancy. Case 1: A 31-year-old pregnant female G1P0 with no past medical history presented at 38 weeks from her obstetrician’s office for elevated blood pressures. She was admitted for preeclampsia without severe features. On initial labs, corrected calcium level was elevated 14.6 mg/dl (8.5-10.1). Her PTH was appropriately suppressed at <6.3 pg/mL. The patient’s PTHrP was slightly elevated at 3.6 pmol/L (0.0-3.4). She was treated with calcitonin. Due to her preeclampsia, labor was induced with subsequent cesarian section. The day after, the corrected calcium level markedly improved to 8.7 mg/dL. Her hypercalcemia was secondary to the humoral response of pregnancy caused by PTHrP produced by the placenta. Case 2: A 38-year-old pregnant female G3P1011 with a past medical history of hypertension presented at 35 weeks and 6 days after getting an MRI for back pain which showed evidence of metastases and a burst fracture of the T9 vertebra. A left breast mass was palpable on exam. On arrival, labs showed a corrected calcium 12.5 mg/dL. Further work up revealed appropriately suppressed PTH <6.3 pg/mL and PTHrP elevated at 29 pmol/L (0.0-3.4). Corrected calcium peaked at 14.5 mg/dL. Cesarian section was performed. Treatment was initiated with four doses of calcitonin and a dose of zoledronic acid. After two days of treatment, corrected calcium was 12.2 mg/dL. Corrected calcium measured 9.3 mg/dL at discharge. Biopsy revealed invasive ductal cell carcinoma. She was also found to have diffuse bone metastasis to the spine and liver. Her hypercalcemia was secondary to invasive ductal cell carcinoma with metastasis. Discussion: Hypercalcemia in pregnancy is difficult to diagnose and treat due to nonspecific maternal symptoms and changes in homeostasis of calcium and vitamin D. Management is difficult as medications used in hypercalcemia outside of pregnancy may be contraindicated. Calcitonin has been used safely in pregnancy. Bisphosphonates are used for life threatening cases of hypercalcemia due lack of long-term data on fetal effects. Short term effects of bisphosphonates are transient neonatal hypocalcemia and low birth weight. Denosumab is not used in pregnancy. Cinacalcet is used in primary hyperparathyroidism. Cinacalcet has been safely used in pregnancy in animal studies. In conclusion, hypercalcemia in pregnancy requires prompt diagnosis and treatment with the mainstay acceptable therapies for non PTH mediated hypercalcemia being intravenous fluids and calcitonin. Presentation: Saturday, June 17, 2023

Maternal concentrations of phthalates and Attention-Deficit Hyperactivity Disorder (ADHD-) related symptoms in children aged 2 to 4 years from Odense child cohort

BackgroundPhthalates are endocrine disrupting chemicals used in everyday consumer products. Several epidemiological studies have examined the association between prenatal phthalate concentration and Attention-Deficit Hyperactivity Disorder (ADHD) in offspring, but the findings have been inconclusive. ObjectivesTo investigate the association between maternal urinary concentrations of phthalate metabolites during pregnancy and ADHD related symptoms in children at 2 to 4 years in a large prospective cohort. MethodsIn the Odense Child Cohort from Denmark were women recruited in early pregnancy from 2010 to 2012. Phthalate concentrations were measured in urine samples collected in 3rd trimester and separated into low and high weight phthalates. Parents filled in the Child Behavior Checklist for ages 1.5 to 5 years (CBCL/1½-5), including a 6-item ADHD symptom scale at children aged 2 to 4 years. Data were analysed by use of adjusted negative binomial regression. ResultsA total of 658 mother–child pairs were included. Urinary phthalate metabolite concentrations were generally low compared to previous cohorts. A doubling in maternal concentration of the low-weighted phthalate metabolite MCPP was significantly associated with lower ADHD symptoms score in children (IRR: 0.95 (95 % CI 0.91–0.98)), strongest in girls (IRR: 0.92 (0.87–0.98)). Sex differences were observed. High maternal phthalate metabolite concentrations were associated with lower ADHD symptom score in girls, significant trends across tertile of MCPP and MnBP (p = 0.018, p = 0.038, respectively). In boys, maternal concentrations of high-molecular-weight phthalates (MBzP, ∑DiNP and ∑DEHP) were associated with an almost significantly higher ADHD symptom score (IRR for a doubling in concentration: 1.04 (95 % CI: 0.99–1.10), IRR: 1.05 (95 % CI: 0.97–1.13), IRR: 1.04 (95 % CI: 0.99–1.10), respectively). ConclusionMaternal concentration of the low-weighted phthalate metabolite MCPP was significantly associated with a lower ADHD symptom score in children, strongest in girls. Maternal concentrations of high-molecular-weight phthalates were associated with non-significant increase in ADHD symptom score in boys.

Reducing anxiety and depression symptoms in pregnancy: Case report of maternal mental health from Indonesia

Reducing anxiety and depression symptoms in pregnancy: Case report of maternal mental health from Indonesia

Predicting postpartum depressive symptoms by evaluating self-report autonomic nervous system reactivity during pregnancy

ObjectiveAltered self-reported autonomic reactivity is associated with worse mental health in the general population. Although dysfunctional changes in ANS during pregnancy have been investigated in relation to depressive symptoms, no studies addressed the relationship between self-report autonomic reactivity during pregnancy and depressive symptoms after the delivery. The present study aimed to assess the impact of prepartum self-reported autonomic reactivity on the development of postpartum depressive symptoms. MethodsIn this longitudinal study, 170 women were assessed during pregnancy (i.e., second or third trimester) and after childbirth (i.e., one month after the delivery). Self-reported autonomic reactivity was assessed through the Body Perception Questionnaire – Short Form that evaluates the autonomic functions related to organs above (i.e., supradiaphragmatic reactivity) and below (i.e., subdiaphragmatic reactivity) the diaphragm. In addition, prepartum and postpartum depressive symptoms were evaluated using the Patient Health Questionnaire – 9. ResultsFindings showed that higher prepartum supradiaphragmatic reactivity predicted higher depressive symptoms in the postpartum period (β = 0.112, p = 0.009) after controlling for prepartum depressive symptomatology and other potential covariates. ConclusionsEvaluation of self-reported autonomic activity may be a useful tool to identify antenatally women at risk of postpartum depressive symptoms. Future studies are needed to evaluate the effectiveness of interventions aimed at reducing the threat-responsive autonomic reactivity at rest and improving adaptive autonomic regulation to prevent postpartum depression.

Relationship between health practices with attitudes towards pregnancy and motherhood and pregnancy symptoms in Iranian pregnant women: a cross-sectional study

ObjectivesPregnancy is a vulnerable period for women’s health, and health practices play an essential role in this period. This study aimed to determine the relationship between health practices with attitudes...

The Effect of Digital Mindfulness Interventions on Depressive, Anxiety, and Stress Symptoms in Pregnant Women: A Systematic Review and Meta-Analysis.

Introduction. Pregnancy is a unique time in a woman's life that can be both exciting and challenging. It is also a period that can be associated with significant stress, anxiety, and depression, which can have negative consequences for both the mother and the baby. Mindfulness interventions are known to be a well-suited treatment and prevention method for psychiatric symptoms in pregnancy, and web-based applications have been explored. We here present an up-to-date systematic review and meta-analysis of randomized-controlled trials to investigate the effect of digital-based mindfulness interventions on depressive, anxiety, and stress symptoms during pregnancy. Methods. The systematic literature search and data extraction was performed by two independent raters. It resulted in 13 eligible studies overall comprising 1373 participants. We conducted random-effects meta-analyses for depressive, anxiety, and stress symptoms after completion of a digital mindfulness intervention (compared to a control group). Results. Digital mindfulness intervention methods were significantly able to reduce depression (g = -0.47, 95% CI [-0.9; -0.09]) and anxiety symptoms (g = -0.41, 95% CI [-0.77; -0.05]), but not stress symptoms. These effects were moderated by the attrition rate (βDepression = 0.025, pDepression < 0.01; βAnxiety = 0.022, pAnxiety < 0.01; βStress = 0.022, pStress < 0.01). Primiparity also had a significant influence on the intervention effect regarding depression symptoms (β = 0.033, p = 0.024). Conclusions. Digital mindfulness interventions are a promising method to reduce mental health symptoms in pregnant women. We identified certain parameters moderating this effect, for example, primiparity and the attrition rate.

The Awareness and Knowledge of Normal and Abnormal Signs and Symptoms of Pregnancy Among Women of Childbearing Age in Saudi Arabia.

Pregnancy is a natural physiological process that leads to the outstanding outcome of giving birth. It involves normal and abnormal signs and symptoms that women need to be aware of during this period. This study aims to assess the awareness and knowledge about normal and abnormal signs and symptoms of pregnancy among women of childbearing age in Saudi Arabia. This is an online questionnaire-based cross-sectional study done in 2023 among women in Saudi Arabia, aged 18 to 45. The estimated sample size was 385 after applying inclusion and exclusion criteria. However, 981 responses were collected and included. A total of 981 participants were included in our study. The study findings noted that the majority of women demonstrated a good level of knowledge about the normal signs and symptoms of pregnancy. About 82% of the women reported that they knew mood swings were normal symptoms during pregnancy, 80.1% were aware of nausea, 75.9% knew about fatigue, and 68.9% knew about fainting or dizziness. The findings noted that less than half of the participants were fully aware of the abnormal obstetric signs. For the abnormal signs and symptoms during the first trimester, only 45.2% were fully aware of the symptoms. In the second trimester, 39.0% were fully aware of the symptoms. Only 30.5% of the participants were fully aware of the abnormal signs and symptoms in the third trimester. The study established a statistically significant relationship between age and knowledge of abnormal symptoms during the first, second, and third trimesters (P=0.027, 0.041, and 0.006) (r=0.139, 0.105, and 0.146). Furthermore, a statistically significant relationship was found between the level of education of the participants and the level of awareness of abnormal symptoms during the first trimester (P=0.043). However, there was no significant relationship between education level and the level of knowledge regarding abnormal symptoms during the second and third trimesters (r=0.22, 0.061, P=0.578, 0.603). The study found that the majority of women had a good level of awareness and knowledge about normal signs and symptoms of pregnancy, while less than half of the women were fully aware of the abnormal signs and symptoms at different stages of pregnancy. The older respondents and people with higher levels of education demonstrated more knowledge. The two variables, age and education level, had a statistically significant relationship with knowledge of abnormal signs and symptoms of pregnancy with education level being only significant during the first trimester period. Our study concluded that women had different symptoms during pregnancy, both normal and abnormal. Their knowledge about these signs and symptoms was considerably moderate, but further awareness about the normality of these signs is needed. The study recommends more research to measure women's awareness about normal and abnormal symptoms of pregnancy, and more awareness programs should be carried out in the region as a way of enhancing a better understanding of normal and abnormal pregnancy symptoms. This will go a long way in helping women through their pregnancy and make them more comfortable.

A Challenging Case: Colorectal Cancer During Pregnancy

Introduction: Colorectal cancer (CRC) occurring in younger women can lead to an increased incidence of colorectal cancer during pregnancy. The estimated frequency of malignancy during pregnancy with colorectal cancer specifically estimated at 1 in 13,000 pregnancies. However, the exact causes of colorectal cancer during pregnancy are not yet fully understood. Diagnosing and managing colorectal cancer during pregnancy pose significant challenges because the symptoms can be masked by the normal signs and symptoms of pregnancy. Case Pesentation: A 42-year-old pregnant patient, Mrs. L, presented with abdominal pain, a history of dark-colored bowel movements, and a lump on the left side of her neck that had been present for a year. She had also experienced a weight loss of 5 kg both before and during pregnancy, and there was no previous history of malignancy. The patient underwent various diagnostic procedures, including pregnancy ultrasound, abdominal ultrasound, and colonoscopy biopsy. Based on the comprehensive evaluation of the patient's medical history, physical examination, and supporting tests, she was diagnosed with stage IV rectal adenocarcinoma with metastases to the liver, kidney, and lymph nodes. The patient was in her second pregnancy (G2P1Ab0) at 27-29 weeks of gestation. Conclusion: Colorectal cancer during pregnancy poses diagnostic and therapeutic challenges, as the signs and symptoms are often attributed to the normal progression of pregnancy, resulting in delayed diagnosis at an advanced stage. Early detection, evaluation, and monitoring of nonspecific symptoms are crucial, and a multidisciplinary approach is necessary for the management of colorectal cancer during pregnancy.

Evaluation of dry eye and meibomian gland function in pregnancy.

To evaluate the signs and symptoms of dry eye in healthy pregnant women and investigate the effect of pregnancy on meibomian gland loss using non-contact meibography. Healthy pregnant women and age-matched healthy non-pregnant women were included in the study. Subjective symptoms were assessed using the Ocular Surface Disease Index (OSDI). The first and average non-invasive break-up times (first-NIBUT and avg-NIBUT, respectively) were determined, and the Schirmer test was applied. Non-contact meibography was performed. The study included a total of 62 women, 30 pregnant (study group) and 32 non-pregnant (control group). There was no significant difference between the groups in terms of OSDI score and the Schirmer test (p > 0.05). The mean first-NIBUT and avg-NIBUT values of the study group (13.1 ± 5.3 and 13.7 ± 4.5s) were significantly lower than the control group (16.0 ± 2.4 and 16.4 ± 1.5s) (p: 0.015 and p: 0.040, respectively). The mean meibomian gland losses in the upper and lower eyelids were significantly higher in the study group (16.9 ± 8.2% and 11.6 ± 10.2%) compared to the control group (9.7 ± 6.2% and 5.6 ± 4.7%) (p < 0.001 and p: 0.011, respectively). It is considered that loss of the meibomian glands may occur during pregnancy, and this may predispose pregnant women to evaporative dry eye. Although dry eye does not cause significant ocular surface symptoms in pregnancy, NIBUT and non-contact meibography can be considered as effective diagnostic methods for the detection of dry eye in pregnant women.

Risk factors for the development of postpartum depression in individuals who screened positive for antenatal depression

BackgroundWomen with antenatal depression often have a higher risk of developing postpartum depression (PPD) after delivery. A number of factors associated with the PDD in those previously reporting antenatal depression have been suggested, but further research is needed. This study aimed to investigate factors associated with developing subsequent postnatal depression in women who had screened positive for antenatal depression.MethodsThis study was carried out in Hangzhou women’s Hospital. 578 women who experienced antenatal depression from this cohort were enrolled in this study. The sociodemographic and clinical characteristics of the participants were collected and tabulated against the incidence of postnatal depression. Binary logistic regression was used to estimate the effects of the principal underlying variables. The Chinese-version Edinburgh Postnatal Depression Scale (EPDS) was used to screen for PPD. Antenatal screening for depression was conducted at 28–34 weeks during pregnancy and postpartum depressive symptoms were assessed at 6 weeks after childbirth in the women. Path Analysis of Structural Equation Model (SEM) was employed to explore the direct, indirect, and total effects of risk factors of PPD.Results57.6% (n = 333) of the participants subsequently developed PPD in our study. The results of the logistic analysis indicated that ages ≤ 35 years old (OR = 1.852; 95%CI: 1.002–3.423), non-one-child families (OR = 1.518; 95%CI: 1.047-2.200), and rare care from partner during pregnancy (OR = 2.801; 95%CI: 1.038–7.562), the antenatal EPDS score (OR = 1.128; 95%CI: 1.052–1.209), pyrexia during pregnancy (OR = 2.43; 95%CI: 1.358–4.345), fairly good (OR = 1.836; 95%CI: 1.009–3.340), fairly bad (OR = 3.919; 95%CI:2.072–7.414) and very bad postpartum sleep quality (OR = 9.18; 95%CI: 2.335–36.241) were associated with increased risk of PPD (compared to very good postpartum sleep quality). In path analysis model, antenatal EPDS score (standardized total β = 0.173) and pyrexia during pregnancy (standardized total β = 0.132) had both direct and indirect effects (the impact on outcome variables needs to be determined through other variables) on PPD. Sleep quality after delivery (standardized β = 0.226) and one-child family (standardized β = 0.088) had direct effects only on PPD.ConclusionThe results from our study indicated that more than 50% of the women who experienced antepartum depression would subsequently develop PPD. Depressive symptoms and pyrexia during pregnancy increase PPD scores, and these effects were in part mediated via poor sleep quality during the postpartum period.

Side Effects of COVID-19 Vaccines in Pregnant and Lactating Mexican Women and Breastfed Infants: A Survey-Based Study.

COVID-19 vaccines' safety has been extensively studied; however, further analysis is required in pregnant women, nursing mothers, and breastfed infants. Our aim was to compare the extension and severity of self-reported COVID-19 vaccine side effects in pregnant and breastfeeding women, and breastfed infants. In this cross-sectional study, COVID-19-vaccinated subjects were enrolled using an online survey in Mexico. Women were classified by pregnancy and breastfeeding status at the time of vaccination (n = 3167). After the first or only dose, there was a trend toward fewer systemic effects in pregnant women (p = 0.06). BNT162b2 (Pfizer-BioNTech) had a higher frequency of local symptoms in pregnancy. Lactating women experienced fewer local symptoms after the first or single dose (p = 0.04) and the opposite occurred after the second dose (p = 0.001). ChAdOx1 (AstraZeneca) increased the chances of developing both local and systemic symptoms after the first dose but decreased them after the second dose. The severity was similar across groups, although the result of lack of association in pregnancy requires studies with a larger sample size. Irritability was the most reported symptom in breastfed infants. This study contributes to the knowledge about the side effects in pregnant and lactating women, and breastfed babies.

The Impact of Malaria among pregnant women in Papua New Guinea: A Systematic Review of Epidemiology, Prevention &amp; Treatment.

BACKGROUND:&#x0D; Malaria in pregnancy is a serious public health problem in Papua New Guinea (PNG), where both Plasmodium falciparum and P. vivax are endemic. Malaria infection during pregnancy can cause maternal anemia, low birth weight, preterm delivery and congenital malaria, which can have serious consequences for the health and survival of mothers and infants. The aim of this literature review was to assess &amp; summarize the current state of knowledge and practice on malaria epidemiology, prevention and treatment in pregnant women and their newborns in PNG, based on ten research papers published from 1986 to 2021.&#x0D; Subjects and Methods:&#x0D; This was a systematic review conducted by searching articles from Google Scholar database and Mendeley Elsevier database and PubMed. The inclusion criteria were namely articles published in 1900 to 2022 years, cross sectional design study, and using quantitative method. The study subjects were pregnant women who visited antenatal clinics with or without malaria, research locations in Papua New Guinea. The exclusion criteria were articles that did not available in full text and located not in Papua New Guinea. The articles were then critically appraised and synthesized according to five main themes: anemia and iron deficiency, submicroscopic malaria infections, placental malaria infection, and knowledge, attitudes and practices concerning malaria in pregnancy &amp; congenital malaria.&#x0D; Results:&#x0D; A total of 10 papers were included in the review, covering various aspects of malaria epidemiology, prevention and treatment in pregnant women and their newborns in PNG. The main findings of the papers were: (1) anemia was very common and associated with splenomegaly, iron deficiency and malaria infection; (2) submicroscopic infections were common, but not associated with maternal anemia or low birth weight; (3) placental malaria infection was detected in 18.5% of placentas, and was associated with maternal anemia, low birth weight and preterm delivery; (4) there was a general awareness of the term “malaria”, but it was often confused with other illnesses or pregnancy symptoms; (5) congenital malaria infection was detected in 5.6% of newborns, mostly due to P. falciparum.&#x0D; Conclusion:&#x0D; This literature review provided useful evidence and recommendations for improving malaria prevention and control in pregnant women and their newborns in PNG, but also highlighted the need for more research and action to address the remaining challenges and gaps. The review concluded that malaria in pregnancy is a serious public health problem in PNG that requires comprehensive and integrated approaches to achieve its elimination by 2030.&#x0D; Keywords: Malaria in pregnancy, Papua New Guinea, Anemia, Submicroscopic malaria infections, Placental malaria infection

Combining early pregnancy bleeding with ultrasound measurements to assess spontaneous abortion risk among infertile patients

Approximately 15% of all clinically recognized pregnancies in patients with infertility result in spontaneous abortion. However, despite its potential to have a profound and lasting effect on physical and emotional well-being, the natural history of spontaneous abortion in women with infertility has not been described. Although vaginal bleeding is a common symptom in pregnancies conceived via reproductive technologies, its prognostic value is not well understood. This study aimed to evaluate the combination of early pregnancy bleeding and first-trimester ultrasound measurements to determine spontaneous abortion risk. This was a retrospective cohort study of patients with infertility who underwent autologous embryo transfer resulting in singleton intrauterine pregnancy confirmed by ultrasound from January 1, 2017, to December 31, 2019. Early pregnancy symptoms of bleeding occurring before gestational week 8 and measurements of crown-rump length and fetal heart rate from ultrasounds performed during gestational week 6 (6 0/7 to 6 6/7 weeks of gestation) and gestational week 7 (7 0/7 to 7 6/7 weeks of gestation) were recorded. Modified Poisson regression with robust error variance was adjusted a priori for patient age, embryo transfer day, and transfer of a preimplantation genetic-tested embryo to estimate the relative risk and 95% confidence interval of spontaneous abortion for dichotomous variables. The relative risks and positive predictive values for early pregnancy bleeding combined with ultrasound measurements on the occurrence of spontaneous abortion were calculated for patients who had an ultrasound performed during gestational week 6 and separately for patients who had an ultrasound performed during gestational week 7. The primary outcome was spontaneous abortion in the setting of vaginal bleeding with normal ultrasound parameters. The secondary outcomes were spontaneous abortion with vaginal bleeding and (1) abnormal crown-rump length, (2) abnormal fetal heart rate, and (3) both abnormal crown-rump length and abnormal fetal heart rate. Of the 1858 patients who were included (359 cases resulted in abortions and 1499 resulted in live births), 315 patients (17.0%) reported vaginal bleeding. When combined with ultrasound measurements from gestational week 6, bleeding was significantly associated with increased spontaneous abortion only when accompanied by absent fetal heart rate (relative risk, 5.36; 95% confidence interval, 3.36-8.55) or both absent fetal heart rate and absent fetal pole (relative risk, 9.67; 95% confidence interval, 7.45-12.56). Similarly, when combined with ultrasound measurements from gestational week 7, bleeding was significantly associated with increased spontaneous abortion only when accompanied by an abnormal assessment of fetal heart rate or crown-rump length (relative risk, 5.09; 95% confidence interval, 1.83-14.19) or both fetal heart rate and crown-rump length (relative risk, 14.82; 95% confidence interval, 10.54-20.83). With normal ultrasound measurements, bleeding was not associated with increased spontaneous abortion risk (relative risk: 1.05 [95% confidence interval, 0.61-1.78] in gestational week 6 and 0.80 [95% confidence interval, 0.36-1.74] in gestational week 7), and the live birth rate was comparable with that in patients with normal ultrasound measurements and no bleeding. Patients with a history of infertility who present after embryo transfer with symptoms of vaginal bleeding should be evaluated with a pregnancy ultrasound to accurately assess spontaneous abortion risk. In the setting of normal ultrasound measurements, patients can be reassured that their risk of spontaneous abortion is not increased and that their live birth rate is not decreased.

Differences in Psychological Symptoms in Pregnancy and Postpartum before and during COVID-19: A Cross-sectional Study

Differences in Psychological Symptoms in Pregnancy and Postpartum before and during COVID-19: A Cross-sectional Study

The effects of vitamin D on sleep quality and pregnancy symptoms in pregnant women: a randomized, tripled-blinded and placebo-controlled clinical trial

PurposeBecause of the importance of having enough sleep in life and health, this study aims to determine the effect of vitamin D supplementation on sleep quality and pregnancy symptoms (primary outcomes) and side effects (secondary outcome).Design/methodology/approachIn this triple-blind randomized controlled clinical trial, 88 pregnant women with gestational age of 8–10 weeks and serum vitamin D concentration less than 30 ng/ml were allocated into vitamin D (n = 44) and control (n = 44) groups by blocked randomization method. The vitamin D group received a 4,000 IU vitamin D pill, and the control group received a placebo pill daily for 18 weeks. Independent t-, Mann–Whitney U and ANCOVA tests were used to analyze the data.FindingsThe post-intervention mean (SD: standard deviation) of total sleep quality score in the vitamin D and placebo group were 1.94 (2.1) and 4.62 (1.71), respectively. According to the Mann–Whitney U test, this difference between the two groups was statistically significant (p < 0.001). The mean (SD) of pregnancy symptoms in the vitamin D and placebo groups was 23.95 (16.07) and 26.62 (13.84), respectively, and there was no significant difference between the two groups based on ANCOVA test (p = 0.56). Considerable side effects were not observed in any groups.Originality/valueThis study was conducted due to the contradictory results of the effect of vitamin D on sleep quality and the high prevalence of sleep disorders and pregnancy symptoms.

Prevalence of Anemia during 1st Trimester and Physiological symptoms of Pregnancy A Single Center Study

Abstract:&#x0D; Background: Anemia in pregnancy accounts for one fifth maternal deaths worldwide and is associated with high maternal morbidity, mortality and adverse pregnancy outcomes. Pregnancy is associated with a variety of physiological symptoms, which can be distressing and need to be managed.&#x0D; Objectives: To determine the frequency of anemia and frequency of physiological symptoms of pregnancy in the first trimester with a view to developing tools to increase awareness to prevent, and timely escalation of the care.&#x0D; Methodology:&#x0D; A cross-sectional analytic study was conducted on data for women attending a rural health center for their first antenatal visit from January to November 2021. A formal interview of eligible participants was conducted by on duty doctor to determine pregnancy related symptoms and demographic data. Hemoglobin, and urine analysis reports were obtained from the hospital’s laboratory. Data was entered in Microsoft excel Sheet and analyzed using SPSS 21 and reported as frequencies and percentages.&#x0D; Results: &#x0D; The mean age of participants was 27.2 ± 4.6 years and mean Hb levels were 9.82 ±0.66 g/dl. The overall frequency of anemia was 96.5%. Majority were mildly anemic (71.5%), 5.9% were moderately anemic, 0.3% were severely anemic. Nausea and vomiting were the most common symptoms reported in 190 (23.7%) females. Heart burn was reported in 117 (14.6%), urinary tract infection (UTI) in 97 (12.1%), constipation in 39 (4.9%), backache in 33 (4.1%) and 28 (3.5%) women reported pelvic pain in the first trimester.&#x0D; Conclusion: &#x0D; There was high prevalence of anemia among pregnant women in the first trimester which calls for awareness and education of the community. Most common symptoms found in our population were nausea and vomiting, followed by heart burn and urinary tract infection.

Pregnancy Symptoms and COVID-19 Fear Experienced by Pregnant Women

Pregnancy Symptoms and COVID-19 Fear Experienced by Pregnant Women