Pregnant Thai Women Research Articles

Restless Legs Syndrome in Pregnant Thai Women: Prevalence, Predictive Factors, and Natural Course.

Background and PurposeRestless legs syndrome (RLS) is a common sleep-related neurological disorder that affects the quality of sleep. This study aimed to estimate the prevalence, predictive factors, and natural course of RLS, and its effect on sleep quality in pregnant Thai women.MethodsA cross-sectional study that included 214 pregnant women was performed. RLS was diagnosed according to the revised criteria of the International RLS Study Group (IRLSSG). General demographic and antenatal-care data were reviewed. Scores on the Thai versions of the Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index, and the IRLSSG Rating Scale were determined.ResultsRLS was diagnosed in 24 of the pregnant women (11.2%): 4.2%, 25.0%, and 70.8% in the first, second, and third trimesters, respectively. Multiple logistic regression analysis revealed that a hemoglobin level (Hb) less than 11 g/dL [odds ratio (OR)=3.21, 95% CI=1.27–8.13] and a history of RLS (OR=16.62, 95% CI=1.52–181.32) were associated with RLS during pregnancy. Subjects with RLS significantly had higher Thai-ESS scores (p<0.01). All subjects with RLS had severe symptoms that subsided within 1 week after delivery. No immediate labor complication was associated with RLS.ConclusionsOur study has confirmed a high prevalence of RLS and its impacts on sleep in pregnant women. An Hb of less than 11 g/dL and a history of RLS are predictive factors for RLS developing during pregnancy. Pregnancy-related RLS has a benign course and usually disappears within 1 week after delivery.

Obstructive sleep apnea as a risk factor for preeclampsia–eclampsia

Preeclampsia-eclampsia remains one of the leading causes of maternal and perinatal morbidity and mortality. Emerging evidence suggests that obstructive sleep apnea (OSA), which has been linked to hypertension in the general population, may play role in hypertensive disorders in pregnancy, including preeclampsia-eclampsia. However, little research has been conducted in Asia (no data in Thailand) on the effects of OSA on preeclampsia-eclampsia. We aimed to examine the association between OSA and preeclampsia-eclampsia among Thai pregnant women. We conducted a large prospective cohort study among Thai pregnant women who were in the second trimester of singleton pregnancy. The Berlin Questionnaire was administered to evaluate the risk for OSA. Preeclampsia-eclampsia was diagnosed by standard clinical assessment. Multivariate models were applied in adjustment for confounding factors. Enrolled were 1345 pregnant women. The overall prevalence of high risk for OSA was 10.1% (95% confidence intervals [CIs] 8.5-11.7), and it was significantly associated with pre-pregnancy body mass index and score on the Perceived Stress Scale. An adjusted odds ratio (OR) for preeclampsia-eclampsia in women with high risk for OSA was 2.72 (95% CI 1.33-5.57). Pregnant women with high risk for OSA are at increased risks for preeclampsia-eclampsia compared to those with low risk for OSA. Our results support a role for screening for OSA by BQ during antenatal care.

Correlation between lower uterine wall thickness measured by transabdominal ultrasonography and cervical length measured by transvaginal ultrasonography in Thai pregnant women

BackgroundPreterm labor is one of major obstetric challenges and can be predicted by cervical length at mid-trimester. In some settings, transvaginal ultrasound is not available and the screening and prevention of preterm labor will be suboptimal. We hope to find a correlation between other marker i.e. lower uterine wall thickness measured by transabdominal ultrasonography and cervical length measured by transvaginal ultrasonography in Thai pregnant women during 16–32 weeks of gestation. MethodsThis study was a cross-sectional study. 166 singleton pregnant women were invited to participate in the study between June 2015 and December 2015. Transabdominal ultrasonography was performed to measure the lower uterine wall thickness and transvaginal ultrasonography was performed to measure the cervical length. The Spearman's rank correlation was used to evaluate the correlation between the two parameters. The inter-observer variation was assessed by using Bland–Altman plot. The outcomes of all pregnancies were followed and only those who delivered at term were included for the calculation of normal value of lower uterine wall thickness. ResultsThere was a highly positive correlation between lower uterine wall thickness and cervical length (rs = 0.767, n = 166, p < 0.001). For those who had short cervical length (defined as less than 30 mm) at GA 16–24 weeks (n = 10), the mean corresponding lower uterine wall thickness was 4.4 mm (SD 0.50). The inter-observer variation of the measurement of lower uterine wall thickness and cervical length were small. The lower uterine wall thickness tended to be slightly thinner when the gestation advanced. (mean 5.4 mm at 16–20 weeks and 5.1 mm at 28–32 weeks). ConclusionThere was a highly positive correlation between lower uterine wall thickness measured by transabdominal ultrasonography and cervical length measured by transvaginal ultrasonography in Thai pregnant women.

Tolerability of trivalent inactivated influenza vaccine among pregnant women, 2015

BackgroundThailand recommends influenza vaccination among pregnant women. We conducted a cohort study to determine if the prevalence of adverse events following immunization (AEFIs) with influenza vaccine among Thai pregnant women was similar to that often cited among healthy adults.MethodsWomen who were ≥17 gestational weeks and ≥18 years of age were recruited. Demographic and health history data were collected using structured questionnaires. Women were provided with symptom diary, ruler to measure local reaction(s), and thermometer to measure body temperature. AEFIs were defined as any new symptom/abnormality occurring within four weeks after vaccination. The diaries were abstracted for frequency, duration, and level of discomfort/inconvenience of the AEFIs. Serious adverse events (SAEs) and the likelihood of AEFIs being associated with vaccination were determined using standard definitions.ResultsAmong 305 women enrolled between July–November 2015, median age was 29 years. Of these, 223 (73%) were in their third trimester, 271 (89%) had completed secondary school or higher, and 20 (7%) reported ≥1 pre-existing conditions. AEFIs were reported in 134 women (44%; 95% confidence interval [CI] 38–50%). Soreness at the injection site (74, 24%; CI 19–29%), general weakness (50, 16%; CI 12–21%), muscle ache (49, 16%; CI 12–21%), and headache (45, 15%; CI 1–19%) were most common. Of those with AEFIs, 120 (89%) reported symptom/abnormality occurred on day 0 or day 1 following vaccination. Ten women (7%) reported the AEFIs affected daily activities. The AEFIs generally spontaneously resolved within 24 h of onset. There were two vaccine-unrelated SAEs. Of 294 women with complete follow-up, 279 (95%) had term deliveries, 12 (4%) had preterm deliveries, and 3 (1%) had miscarriage or stillbirth.ConclusionIn our cohort, AEFIs with influenza vaccine occurred with similar frequency to those reported among healthy adults in other studies, and were generally mild and self-limited. No influenza vaccine-associated SAEs were identified.

Comparison of the Screening Tests for Gestational Diabetes Mellitus between "One-Step" and "Two-Step" Methods among Thai Pregnant Women.

Objective To compare the prevalence and pregnancy outcomes of GDM between those screened by the “one-step” (75 gm GTT) and “two-step” (100 gm GTT) methods. Methods A prospective study was conducted on singleton pregnancies at low or average risk of GDM. All were screened between 24 and 28 weeks, using the one-step or two-step method based on patients' preference. The primary outcome was prevalence of GDM, and secondary outcomes included birthweight, gestational age, rates of preterm birth, small/large-for-gestational age, low Apgar scores, cesarean section, and pregnancy-induced hypertension. Results A total of 648 women were screened: 278 in the one-step group and 370 in the two-step group. The prevalence of GDM was significantly higher in the one-step group; 32.0% versus 10.3%. Baseline characteristics and pregnancy outcomes in both groups were comparable. However, mean birthweight was significantly higher among pregnancies with GDM diagnosed by the two-step approach (3204 ± 555 versus 3009 ± 666 g; p=0.022). Likewise, the rate of large-for-date tended to be higher in the two-step group, but was not significant. Conclusion The one-step approach is associated with very high prevalence of GDM among Thai population, without clear evidence of better outcomes. Thus, this approach may not be appropriate for screening in a busy antenatal care clinic like our setting or other centers in developing countries.

Oral hygiene status, self-reported oral malodor, oral hygiene practices, and oral health knowledge: A cross-sectional study in a group of Muslim Thai pregnant women

Objective: The aim of this study is to determine oral hygiene status, self-reported oral malodor, oral hygiene practices, oral health knowledge, and the differences across educational levels in a group of Muslim Thai pregnant women. Subjects and Methods: This was a cross-sectional study conducted at Yaring, Pattani, Thailand. A total of 88 pregnant women were invited to participate in this study. The enrolled patients answered a self-administered questionnaire comprising sociodemographic data, self-perceived oral malodor, oral hygiene practices, as well as their knowledge about the causes and effects of gingivitis during the prenatal period. Gingival health, plaque deposit, and tongue coating were assessed using the modified gingival index (MGI), the plaque index (PI), and the Winkel index (WTCI), respectively. The associations of educational levels with clinical measures and questionnaire responses were analyzed using SPSS version 17. Results: The pregnant women had moderate levels of gingival inflammation (MGI = 1.36 ± 0.40), visible plaque deposit (PI = 1.43 ± 0.47), and thinly dispersed tongue coating (WTCI = 5.40 ± 2.82). MGI significantly decreased as educational levels increased (P = 0.041). Although 90% of the participants had knowledge pertaining to good oral hygiene habits, a high number of participants reported a short brushing time (77%), irregular tooth brushing after meals (66%), irregular tongue cleaning (46%), and a bad breath experience (71%). Furthermore, a significant number of pregnant women lacked knowledge of or misunderstood oral-systemic health relationships. Oral hygiene practices and oral health knowledge were not significantly different across educational levels. Conclusion: The majority of Muslim Thai pregnant women had fair oral hygiene, improper self-oral hygiene care, and inadequate knowledge of the importance of oral-systemic health relationships.

Acceptance of Influenza Vaccination among Pregnant Women attending the Antenatal Care Clinic, King Chulalongkorn Memorial Hospital

Objectives: To determine the acceptance rate and associated factors of influenza vaccination among Thai pregnant women. Materials and Methods: A cross-sectional descriptive study was conducted at King Chulalongkorn Memorial Hospital from November 2014 to March 2015. Pregnant women were asked to complete self-administered questionnaires that collected data on acceptance of vaccination, knowledge, attitude and practice regarding to influenza vaccination during pregnancy. The associated factors were determined by logistic regression analysis. Results: A total of 412 women completed the questionnaires. Acceptance rate of influenza vaccination among the participants was 40.5% (95% CI 35.9-45.3). Most participants (320 women, 77.7%) had good knowledge about influenza and the vaccine. Factors positively associated with the acceptance were ‘advice from physicians’ (adjusted OR 2.61, 95% CI 1.55-4.39), ‘notification about vaccination in current pregnancy’ (adjusted OR 1.84, 95% CI 1.17-2.89), ‘protection of newborn’ (adjusted OR 2.83, 95% CI 1.74-4.62) and ‘cost of vaccination’ (adjusted OR 2.36, 95% CI 1.46-3.82). Negatively associated factors included ‘experience of side effects following past vaccination’ (adjusted OR 0.19, 95% CI 0.05-0.74), ‘belief that vaccination is unnecessary’ (adjusted OR 0.42, 95% CI 0.21-0.86), and ‘unsafe during the first trimester’ (adjusted OR 0.55, 95% CI 0.34-0.90). Conclusion: Acceptance rate of influenza vaccination during pregnancy among women in King Chulalongkorn Memorial Hospital was 40.5%. To increase vaccination rate, health care providers should advise or mention on influenza vaccination and provide information to support that the immunization can protect their newborns and is safe at any trimester.

Lived experience of blood glucose self-monitoring among pregnant women with gestational diabetes mellitus: a phenomenological research.

To explore and describe lived experience of blood glucose self-monitoring among pregnant Thai women with gestational diabetes mellitus. Self-monitoring of blood glucose is an essential practice among pregnant women with diabetes to prevent complications in pregnancy and the newborn infant. Phenomenological research was employed to understand lived experiences in glycemic control. Thirty participants were approached and interviewed using a semistructured interview guides. Qualitative data were analysed following Colaizzi's method. The findings revealed three themes: being worried about diabetes and blood testing, trying to control it and being patient for the child. Their worry comprised three dimensions: (1) wondering about the impacts of diabetes on the child, (2) concern about maternal health and (3) being worried about doing blood test. Trying to control diabetes was composed of three dimensions: (1) learning to test blood glucose, (2) being afraid of elevated blood sugar and (3) being aware of what to eat. Being patient for the child was composed of three dimensions: (1) overcoming food desires, (2) tolerating the fingerprick pain and (3) satisfaction with the outcomes. Women with gestational diabetes experienced being worried and afraid regarding blood glucose self-monitoring; however, they could overcome and tolerate this with some difficulties. These findings can be used to guide nursing practice in assessment of perception and response towards blood glucose self-monitoring in order to improve achievement of a good glycaemic control among pregnant women with gestational diabetes mellitus.

Hematological Characterizations and Molecular Diagnostic Aspects of Hb Wiangpapao [α44(CE2)Pro→Ser (α1), CCG>TCG; HBA1: c.133C>T], a New α-Globin Variant Found in a Pregnant Thai Woman

We report the hematological parameters and provide a rapid molecular analysis method for detection of Hb Wiangpapao [α44(CE2)Pro→Ser, CCG>TCG; HBA1: c.133C>T], a new α-globin variant found in a pregnant Thai woman. Her red cell indices were measured by an automated blood counter. The results were: red blood cell (RBC) count 4.03 × 1012/L, Hb 13.1 (g/dL), packed cell volume (PCV) 0.39 L/L, mean corpuscular volume (MCV) 97.0 fL, mean corpuscular hemoglobin (Hb) (MCH) 32.5 pg, mean corpuscular Hb concentration (MCHC) 33.4 g/dL, and RBC distribution width (RDW) 9.4%. The Hb typing by high performance liquid chromatography (HPLC) showed 13.6% abnormal Hb at a retention time of 2.20 min. that was difficult to distinguish from Hb A. On the capillary electrophoresis (CE) electropherogram, this hemoglobinopathy peak did not separate from the Hb A peak. DNA sequencing showed a C>T transition at the first position of codon 44 (CCG>TCG) of the α1-globin gene that led to a substitution of proline for serine. This mutation has not been recorded in the public databases. Therefore, we named it Hb Wiangpapao as it was first discovered in the Wiangpapao District, Chiang Rai, Thailand. The multiplex allele-specific polymerase chain reaction (ASPCR) for detection of Hb Wiangpapao was developed and revealed a 510 bp specifically amplified fragment. The better understanding of hematological characterizations and the newly developed multiplex ASPCR for diagnosis of Hb Wiangpapao are useful for genetic counseling and family education.

Serum 25-hydroxyvitamin D in pregnant women during preterm labor.

Pregnancy complications hypothesized to be related to vitamin D include preeclampsia, gestational diabetes, low birth weight, preterm delivery, Cesarean section and infectious disease. There have been a few studies which have demonstrated maternal serum vitamin D to be associated with preterm labor. The objective was to evaluate the serum vitamin D concentrations in Thai pregnant women with and without preterm labor and to find the prevalence of vitamin D deficiency and insufficiency in both groups. Blood samples were collected from pregnant women with and without preterm labor (matched for gestational age). Serum 25-hydroxyvitamin D (25-OHD) concentrations were measured by chemiluminescence method. A total of 60 pregnant women were included into the study, 30 patients in the preterm labor group and another 30 patients in the control group. The serum 25-OHD concentration was 21.0±7.5 ng/mL and the prevalence of vitamin D deficiency was 48.3% in total group of pregnant women. The serum 25-OHD concentrations were not different between the preterm labor and the control groups (20.9±8.4 vs 21.2±6.7 ng/mL, p=0.91). The prevalence of vitamin D deficiency and insufficiency were not different between the preterm labor and the control groups (53.3% vs 43.3%, p=0.44 and 83.3% vs 90%, p=0.45, respectively). The serum 25-hydroxyvitamin D concentrations and the prevalence of vitamin D deficiency and insufficiency were not different between the preterm labor and the control groups. The serum 25-OHD could not predict preterm labor in this Thai population.

Comparison of gestational weight gain recommendations between study from Thai population and U.S. Institute of Medicine

Objective: To identify which recommendations of weight gain aresuitable for Thai pregnant women to deliver a normal birth weight neonate. Materials and Methods : This retrospective study was performed by reviewing 1,657 medical records of singleton pregnant women who delivered normal birth weight healthy neonates at Department of Obstetrics and Gynecology, Prapokklao Hospital during July 1 st , 2013 – June 30 th , 2014. Pre-pregnancy BMI was categorized according to U.S.Institute of Medicine (IOM) 2009. Gestational weight gain and pregnancy outcomes were compared using IOM and Thai Siriraj Hospital recommendations. One-way ANOVA was used to compare continuous data and Chi-square test was used to compare discrete data among two groups. Results: Mean gestational weight gain of our population in underweight, normal weight, overweight, and obese groups were 13.73±5.43 kg, 13.52±5.63 kg, 11.35±5.65 kg, and 8.81±7.41 kg, respectively. Significant difference of maternal age, pre-pregnancy BMI, gestational weight gain and neonatal birth weight were found among groups (p<0.001). About one-third of both underweight group and normal weight group gained the appropriate weight based on the IOM recommendations whereas two-thirds of both groups gained the appropriate weight using Thai Siriraj recommendations. While the performances of both sets of recommendations were similar in obese women, the Thai Siriraj recommendations performed better in the overweight group, In total, 56.3% of women and 34.8% of women could gain weight within the recommendations of Thai Siriraj and IOM respectively while the neonatal outcomes of both groups of women were comparable. Conclusion: Thai Siriraj recommendations for weight gain during pregnancy appear to be more suitable for our population than the U.S. IOM ones.

Timing of elective cesarean delivery at term and its impact on maternal and neonatal outcomes among Thai and other Southeast Asian pregnant women.

The impact of timing of elective cesarean delivery (CD) at term on maternal and neonatal outcomes among Thai and other Southeast Asian pregnancies was investigated. The rate of spontaneous labor before the scheduled CD, as well as maternal characteristics predicting spontaneous labor, was also evaluated. Data on maternal and neonatal outcomes of 1221 singleton pregnancies scheduled for either an elective repeat CD or an elective primary CD at 37-40 weeks of gestation were studied. The association between maternal characteristics and the risk of spontaneous labor was evaluated by univariate and multivariate analyses. There were no significant differences in severe maternal complications between performing an elective CD at 39 weeks and at the other gestational ages. Severe neonatal complications were significantly decreased when a CD was performed electively from 38 weeks onwards. A total of 503 women (41.2 %) went into spontaneous labor before the scheduled CD. Using 39 weeks as the reference group, scheduling a CD at 37 or 38 weeks decreased the risk of spontaneous labor (6.67-fold and 4.55-fold, respectively) while scheduling a CD at 40 weeks had a 2.54-fold increased risk. A history of previous CD and teenage pregnancy were also predictors of spontaneous labor; adjusted odds ratios were 14.27 and 3.93, respectively. The timing of elective CD at term had impacts on pregnancy outcomes among Thai and other Southeast Asian women. Gestational age at scheduled CD, a previous CD and teenage pregnancy were predictors of spontaneous labor.

Obstructive sleep apnea and the risk of preterm delivery.

The aim of this study was to evaluate the risk of obstructive sleep apnea (OSA) to preterm delivery (PTD), using the Berlin Questionnaire (BQ). This was a large, prospective cohort study among pregnant Thai women. The BQ was employed for symptom-based OSA screening during the second trimester, and PTD was recorded in 1345 pregnant women. Multivariate models were applied in controlling for potential confounders. The overall prevalence of the high risk of OSA was 10.1%, and it was significantly associated with pre-pregnancy body mass index and score on the Perceived Stress Scale. An adjusted odds ratio for PTD in women with a high risk of OSA was 2.00 (95% confidence intervals (CIs)=1.20, 3.34). Stratified analyses, after adjusting for confounding factors, indicated that a high risk of OSA was associated with an increased risk of spontaneous preterm delivery (odds ratio (OR)=2.45, 95% CI=1.20, 5.02), but not with preterm premature rupture of membranes (OR=1.61, 95% CI=0.61, 4.26), and medically indicated preterm delivery (OR=1.83, 95% CI=0.72, 4.64). Pregnant women with a high risk of OSA are at an increased risk of having PTD, compared with pregnant women with a low risk of OSA.

Knowledge, attitudes and beliefs related to seasonal influenza vaccine among pregnant women in Thailand

BackgroundIn 2009, Thailand recommended pregnant women be prioritized for influenza vaccination. Vaccine uptake among Thai pregnant women is lower than other high-risk groups. MethodsDuring December 2012–April 2013, we conducted a cross-sectional survey of a convenience sample of Thai pregnant women aged ≥15 years attending antenatal clinics at public hospitals in 8 of 77 provinces. A self-administered questionnaire covered knowledge, attitudes, and beliefs related to influenza vaccination using the Health Belief Model. We examined factors associated with willingness to be vaccinated using log-binomial regression models. ResultsThe survey was completed by 1031 (96%) of 1072 pregnant women approached. A total of 627 (61%) women had heard about influenza vaccine and were included in the analysis, of whom 262 (42%) were willing to be vaccinated, 155 (25%) had received a healthcare provider recommendation for influenza vaccination and 25 (4%) had received the influenza vaccine during the current pregnancy. In unadjusted models, high levels of perceptions of susceptibility (prevalence ratio [PR] 1.5, 95% CI 1.2–2.0), high levels of belief in the benefits of vaccination (PR 2.3, 95% CI 1.7–3.1), moderate (PR 1.7, 95% CI 1.2–2.3) and high (PR 3.4, 95% CI 2.6–4.5) levels of encouragement by others to be vaccinated (i.e., cues to action) were positively associated with willingness to be vaccinated. Moderate (PR 0.5, 95% CI 0.4–0.7) and high levels of (PR 0.5, 95% CI 0.4–0.8) perceived barriers were negatively associated with willingness to be vaccinated. In the final adjusted model, only moderate (PR 1.5, 95% CI 1.1–2.0) and high levels of cues to action (PR 2.7, 95% CI 2.0–3.6) were statistically associated with willingness to be vaccinated. ConclusionCues to action were associated with willingness to be vaccinated and can be used to inform communication strategies during the vaccine campaign to increase influenza vaccination among Thai pregnant women.

Pre-pregnancy body mass index and gestational weight gain in Thai pregnant women as risks for low birth weight and macrosomia.

Maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) have been reported to be associated with pregnancy outcomes. Due to the nutrition transition in Thailand, the double burden of malnutrition is increasing and this may have negative consequences on birth outcomes. This study aimed to investigate the relationship between pre-pregnancy BMI and GWG with the risks of low birth weight and macrosomia. We performed a secondary analysis of data obtained from an iodine supplementation trial in mildly iodine-deficient Thai pregnant women. Pre-pregnancy BMI was classified using the WHO classification. GWG was categorized using the IOM recommendation. Binary and multinomial logistic regressions were performed. Among 378 pregnant women, the prevalence of pre-pregnancy underweight (BMI<18.5 kg/m2) and overweight (BMI>=25 kg/m2) were 17.2% and 14.3%, respectively. Normal weight women had the highest median GWG [15.0 (12.0, 19.0) kg] when compared to overweight women [13.2 (9.0, 16.3) kg]. Forty-one percent of women had excessive GWG, while 23% of women gained weight inadequately. Women with a high pre-pregnancy BMI had a 7-fold higher risk of having a macrosomic infant. Women who had excessive GWG were 8 times more likely to deliver a newborn with macrosomia. Both high pre-pregnancy maternal weight and excessive weight gain during pregnancy increase risk of infant macrosomia. Therefore, maintaining normal body weight before and throughout pregnancy should be recommended in order to reduce the risk of excessive infant birth weight and its associated complications.

Correlations of third-trimester hiatal biometry obtained using four-dimensional translabial ultrasonography with the delivery route in nulliparous pregnant women.

Purpose:The goal of this study was to evaluate normal hiatal dimensions in the third trimester in nulliparous Thai pregnant women and to establish which biometric factors were associated with various pregnancy outcomes.Methods:Fifty-seven consecutive nulliparous pregnant Thai women in their third trimester were recruited on a voluntary basis from April to October 2014. All subjects underwent four-dimensional (4D) translabial ultrasonography. Hiatal biometric parameters were measured at rest, while performing a Valsalva maneuver, and during contraction. Information about the patients’ eventual deliveries was obtained from their medical records.Results:The mean values of the patients’ age, body mass index, and gestational age at the time of examination were 27.4±5.47 years, 26.7±3.48 kg/m2, and 36.6±1.49 weeks, respectively. No subjects had vaginal lumps or experienced prolapse greater than stage 1 of the Pelvic Organ Prolapse Quantification system. Ultrasonography showed that the mean values of the hiatal area at rest, while performing a Valsalva maneuver, and during contraction were 13.10±2.92 cm2, 17.50±4.81 cm2, and 9.69±2.09 cm2, respectively. The hiatal area at rest, the axial measurement at rest, and the axial measurement while performing a Valsalva maneuver were significantly associated with the route of delivery (P=0.02, P=0.04, and P=0.03, respectively).Conclusion:The route of delivery was associated with hiatal biometric values measured using 4D translabial ultrasonography, based on the results of nulliparous Thai women in the third trimester.

Neutralizing dengue antibody in pregnant Thai women and cord blood.

BackgroundThe WHO ‘Global Strategy for Dengue Prevention and Control, 2012–2020’ addresses the growing need for the treatment of dengue, and targets a 25% reduction in morbidity and 50% in mortality (using 2010 estimates as baseline). Achieving these goals requires future dengue prevention strategies that will employ both potential vaccines and sustainable vector-control measures. Maternally transferred dengue antibody is an important factor in determining the optimal age for dengue vaccination.ObjectivesTo estimate the seroprevalence of dengue antibodies among mothers living in an area of high endemicity – Ban Pong, Ratchaburi Province – and to assess maternal dengue antibodies transferred to cord blood.Materials & MethodsA cross-sectional study was conducted with 141 pregnant women who delivered at Ban Pong Hospital, Ratchaburi, Thailand. Maternal-cord paired sera were tested for dengue neutralizing (NT) antibody by PRNT50 assay. A ratio of ≥ 1:10 NT titer to dengue serotype was considered seropositive.ResultsMost mothers (137/141, 97.2%) had NT antibodies to at least one dengue serotype in their sera. At birth, the proportion of cord sera with NT antibodies to DEN-1, DEN-2, DEN-3, and DEN-4, were high and similar to the sera of their mothers, at 93.6%, 97.2%, 97.9%, and 92.2%, respectively. The dengue geometric mean titers (GMT) in cord blood were significantly higher than the maternal antibodies (p<0.001): highest in DEN-2, followed by DEN-3, and then DEN-1. The GMT of DEN-4 was the lowest among all four serotypes.ConclusionsDengue infection is highly prevalent among pregnant women in this dengue-endemic area. Most of the cord blood had transferred dengue antibodies, which may have an impact on the disease burden in this population.

The effects of mindfulness eating and yoga exercise on blood sugar levels of pregnant women with gestational diabetes mellitus

AimThis randomized controlled trial was carried out to investigate the effect of mindfulness eating and yoga exercise on blood sugar levels among pregnant Thai women with GDM. BackgroundInterventions promoting achievement of good glycemic control result in desired pregnancy outcomes. Little is known about the health benefits of mindfulness eating and yoga exercise on blood sugar levels among pregnant with GDM. MethodsA randomized controlled trial was carried out. Main outcome measures were capillary fasting plasma glucose, 2-h postprandial blood glucose, and hemoglobin A1c. ResultsThe intervention group showed significantly reduced fasting plasma glucose, 2-h postprandial blood glucose, and glycosylated hemoglobin (HbA1c) in the intervention group (p<0.05). ConclusionsMindfulness eating and yoga exercise had health benefits on glycemic control in pregnant women with GDM. It should be recommended in clinical and community health services.

Relation between gestational weight gain and pregnancy outcomes

The aim of this study was to evaluate the effects of gestational weight gain on pregnancy outcomes in pregnant Thai women with different pre-pregnancy body mass indexes (BMI). A retrospective study was carried out by reviewing 5200 medical records of pregnant women who delivered at the Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital during 1 September 2011-1 August 2012. Inclusion criteria were singleton pregnancy with available pre-pregnant weight and maternal height. Pre-pregnancy BMI were categorized according to World Health Organization criteria. Pregnancy outcomes of interest were appropriate-for-gestational-age infants. The optimal gestational weight gain for each BMI group was proposed to achieve a high proportion of appropriate-for-gestational age infants. Patients were divided into four groups according to their pre-pregnancy BMI: underweight (21.3%), normal weight (64.1%), overweight (11.5%), and obese (3.1%). Optimal gestational weight gain ranges for each group were 10-18, 8-16, 6-14 and 4-8 kg, respectively. Our proposed criteria seem to be realistic, with 60% of pregnant Thai women able to adhere to the recommendation, compared to 40.5% adherence to the 2009 Institute of Medicine recommendation. There were no significant complications when following either of the recommendations. Adverse pregnancy outcomes, including large for gestational age, cesarean section, and severe pre-eclampsia, were significantly decreased in women who complied with our recommendation. To achieve a high proportion of appropriate-for-gestational-age infants, Thai pregnant women could follow our gestational weight gain recommendation.

Persistence of antibodies targeting B cell epitopes of Plasmodium falciparum VAR2CSA (P3114)

Abstract P. falciparum infection poses a major health risk for 85 million women during pregnancy, due to placental pathology resulting from the binding of malaria-infected erythrocytes to trophoblasts via the pregnancy-specific parasite adhesin VAR2CSA. We have demonstrated a correlation between high avidity antibodies (Ab) to VAR2CSA and protection from placental malaria. Ab to most malarial adhesins appear to be short lived, requiring exposure to antigen to sustain serum IgG. In the current study, we used serum collected longitudinally from pregnant Cameroonian women receiving antimalarial prophylaxis to help establish the half-life of Ab to VAR2CSA. VAR2CSA IgG levels were determined using a bead-based multianalyte platform. The half-life of IgG to VAR2CSA (5yr) was short compared to that found in pregnant Thai women (142 yr) and for viruses (ex. measles: 457 yr), but longer than for other non-pregnancy associated malarial antigens (ex. MSP-1: 2yr). Differences in IgG half-life between the two sites could be due to differences in malaria transmission: seasonal in Thailand, but year around in Africa. In Africa, frequent exposure to VAR2CSA during pregnancy may cause prolonged antigenic stimulation leading to continuous B cell activation with formation of short-lived plasmablasts and not long-lived B cells. Knowing how long IgG to VAR2CSA persists is important for establishing continuous protective immunity against malaria in pregnant women.