Third Trimester Of Pregnancy Research Articles

Changes in paternal perinatal depression and its predictors from third trimester of pregnancy to one-year post-partum: a longitudinal study

Introduction: Paternal depression is not as widely recognized as maternal depression. Studies in Japan have examined the factors associated with paternal depression, but these have been limited to specific regions rather than conducted on a nationwide scale. This study aimed to examine changes in paternal perinatal depression from the last trimester of pregnancy to one year postpartum. Additionally, we explored the relationship between paternal perinatal depression and fathers' feelings toward their infants. Methods: This study used a longitudinal design. We initially planned to collect data from over 384 cases based on sample size calculations, and successfully collected data from 494 men in the first survey. However, more than half of the participants dropped out in the second and subsequent surveys, resulting in 201 men completing the longitudinal survey over a one-year period. Results: The mean Edinburgh Postnatal Depression Scale, Japanese version (EPDS-J) score in the last trimester of pregnancy was 9.274 (95% confidence interval [CI] 8.413-10.134), which was the highest throughout the study period. The mean EPDS-J score was lowest at 3-5 months postpartum, with a score of 7.682 (95% CI 6.816-8.547). At all time points, occupational stress and partner relationships were associated with EPDS-J scores. Conclusions: Reducing paternal perinatal depression requires controlling for occupational stress and maintaining good marital relationships. The findings suggest that addressing work-life balance is crucial for Japanese fathers to enhance their whole-family well-being. Keywords: fathers, marital relationship, occupational stress, perinatal depression

Neuropsychological performance in women at risk of postpartum depression and postpartum psychosis.

While neuropsychological deficits are commonly observed in affective and psychotic disorders, this remains unexplored in these disorders when they occur during pregnancy and the postpartum period. A neuropsychological test battery was administered to women defined at risk of postpartum depression (PD, N = 53) because having either a current or past diagnosis of major depressive disorder, women at risk of postpartum psychosis (PP, N = 43) because of a diagnosis of bipolar disorder or schizoaffective disorder and/or a previous episode of PP and women not at risk (NR, N = 48) in the third trimester of pregnancy. Generalized and specific cognitive abilities were compared between groups. Women at risk of PP presented worse executive functions and processing speed compared to NR and worse performance compared to women at risk of PD across all cognitive domains. In addition, women at risk of PP who developed a psychiatric relapse in the first four weeks post-partum showed worse verbal learning and memory, visual memory, executive functions and processing speed in pregnancy compared to NR, whereas women at risk of PP who remained well presented neuropsychological performance that was intermediate between that of the women NR and those at risk of PP who developed symptoms. There were no differences in performance between women at risk of PD and the NR women, even if 31 women at risk of PD presented depressive symptoms at the time of cognitive assessment. Our findings in women at risk of PP align with neuropsychological findings in individuals with, or at risk of psychosis unrelated to pregnancy. In addition, initial evidence that women at risk of PP who develop a psychiatric relapse in the postpartum show a particularly poor neuropsychological performance in pregnancy suggests that this could be considered part of a phenotype for the disease and help guiding future preventive strategies in this clinical population. In women at risk of PD, the presence of depressive symptoms did not influence cognitive performance.

The Risk Factors for Anemia in Women at Third Trimester of Pregnancy in the Primary Health Center of Tanjung Sekayam: A Case-Control Study

Background: The presence of anemia in pregnant women significantly affects the health of both mothers and their fetuses. Around 37% of pregnant women worldwide experience anemia. In the Community Health Center of Tanjung Sekayam, the prevalence of anemia in women at the third trimester of their pregnancy was notably high, at 50.4%. Objectives: This study aims to identify the risk factors for anemia in women at third trimester of pregnancy in the working area of the Community Health Center of Tanjung Sekayam Subdistrict, Sanggau Regency. Methods: This study was an observational research with a case-control design. The study population consisted of 153 women at third trimester of pregnancy, receiving antenatal care in the Community Health Center of Tanjung Sekayam. The samples included 62 respondents, selected through a simple random sampling, comprising of 31 cases and 31 controls. Data were collected using questionnaires and analyzed with the Chi-Square test to assess the factors associated with the occurrence of anemia. Results: There was a relation among maternal age (p=0.000; OR=22.9), interpregnancy interval (p=0.024; OR=6.9), parity (p=0.011; OR=2.2), nutritional status (chronic energy deficiency) (p=0.000; OR=11.3), compliance (p=0.021; OR=3.9), and knowledge (p=0.001; OR=8.2) and the prevalence of anemia in the third trimester. However, the family support did not show any significant relation. Conclusions: Maternal age, pregnancy interval, parity, nutritional status, compliance with iron tablet intake, and knowledge are related to the prevalence of anemia in third trimester of pregnancy. Family support did not show any significant relation with the incidence of anemia, possibly due to the limitations in measuring the family support itself and other factors, such as discomfort in consuming iron tablets and forgetfulness. More structured interventions and intensive education on the importance of iron and nutrition during the pregnancy are needed to reduce the risk of anemia.

KANET evaluation in patients with SARS-CoV-2.

To determine a possible correlation between SARS-CoV-2 infection during pregnancy and altered fetal behavior. Kurjak's antenatal neurodevelopmental test (KANET) was applied from 28 to 40weeks in 38 gestations (group A) diagnosed with COVID-19 infection during the first week and 43 non-COVID pregnant women (group B). No statistically significant differences considering maternal age (33±3.9 years for group A vs. 31±4.1 years for group B) and gestational age (33±1.6weeks for group A compared to 33±2.1weeks for group B) were observed. KANET scores were not different between the two groups. Fetal behavior differences are not altered in women diagnosed with SARS-CoV-2 infection during the third trimester of pregnancy.

Validation of a sleep-disordered breathing screening questionnaire during pregnancy and comparison between mothers and bedpartners prediction of risk

BackgroundSleep Disordered Breathing (SDB) in pregnant patients ranges from 3 to 27% and varies depending on gestational age and method used to diagnose. SDB increases the risk of advanced pregnancy complications such as gestational diabetes mellitus, pregnancy-induced hypertension, and preeclampsia. Screening and diagnosis of SDB during pregnancy remains a challenge, with existing screening tools underperforming during pregnancy. This study aimed to validate a previously developed model for predicting SDB during late pregnancy and compare the predictive value of bedpartner responses.MethodsNinety-six women in the third trimester of pregnancy underwent polysomnography and completed the Berlin Questionnaire (BQ), with 81 bedpartners completing the BQ about their pregnant partner. A subset of BQ items (snoring volume and tiredness upon awakening) along with BMI > 32 kg/m2was utilised to calculate the Wilson Optimized Model (WOM), which demonstrated strong predictive properties in development.ResultsSDB (RDI/hr ≥ 5) was detected in 43.8% of women. BQ identified 72% of pregnant mothers as high risk for SDB (Sensitivity = 83%, Specificity = 37%), compared to 29% of mothers identified by the WOM (Sensitivity = 45%, Specificity = 83%). At RDI of ≥ 15, the WOM correctly classified more women according to SDB risk than the BQ (76.0% vs. 41.7% cases correct,X2(1) = 23.42,p < .001), with no difference at RDI ≥ 5. Bedpartners were more likely to report high risk for SDB on the WOM than pregnant women themselves (38.3% vs. 28.4%), however predictive ability was not improved by bedpartner input (RDI ≥ 5 bedpartner AUC = 0.69 v mother AUC = 0.73).ConclusionBQ largely overestimates the prevalence of SDB in pregnancy compared to the WOM which underestimates. Utilising bedpartner responses didn’t improve screening for SDB in late pregnancy. More work is needed to develop a pregnancy-specific tool for quick and accurate screening for SDB.

Reliability of trans-cerebellar diameter for gestational age in comparison to crown rump length

Background and objective: accurate estimation of gestational age is important for perfect antenatal care, as many pregnant women may don’t know their last menstrual period &amp; not have a first-trimester ultrasound that is accurate in estimating the gestational age, and the routine fetal biometry in the second &amp; third trimesters may be unreliable for some reason. Therefore, it’s necessary to develop an ultrasonographic parameter capable of reliably estimating gestational age at any point during pregnancy. This study aims to compare the accuracy of trans-cerebellar diameter (TCD) in n 2nd and 3rd trimesters for the calculation of estimated gestational age with the first-trimester crown rump length (CRL) which is the most accurate measurement for the estimation of gestational age. Methods: This is a prospective study conducted in Erbil from the 1st of January 2021 to the 10thof August 2022. A total sample of 258 antenatal women was included. The ultrasound examination was performed by a GE Voluson ultrasound system (GE health care 2015) machine using a 3.5 MHZ curved transducer. The CRL was taken between 6-13 weeks of gestational age, and TCD between 15-38 weeks. TCD is measured by keeping the calibers on the outer margin of the cerebellar hemisphere. Data were analyzed using the statistical package for social science SPSS V. 26. Results: The mean transcerebral diameter during different gestational ages was 16.35 (±0.76) less than 18 weeks gestation, 21.48 (±1.7) between 18-25 weeks gestation, 28.03 (±1.79) between 25-32 weeks gestation, 35.52 (± 1.84) above 32 weeks gestation respectively. There is a statistically significant linear correlation between TCD and ECRL with (rho=0.992) (P &lt;0.001) Conclusion: The accuracy of the TCD in the second &amp; third trimester of pregnancy is comparable with the estimated CRL in the first trimester, so this will help us in the estimation of the gestational age for pregnant women with unknown LMP and unavailable first-trimester dating scan.

In Vivo Activity of Intestinal P-Glycoprotein and Hepatic Organic Anion Transporters Polypeptide in Pregnancy and Postpartum.

This study investigates the influence of pregnancy on the in vivo activity of the intestinal P-glycoprotein (P-gp) and hepatic organic anion transporters polypeptide (OATP/BCRP) using, respectively, fexofenadine and rosuvastatin as probe drugs. Eleven healthy participants were investigated during the third trimester of pregnancy (Phase 1, 28 to 38 weeks of gestation) and in the postpartum period (Phase 2, 8 to 12 weeks postpartum). In both phases, after administration of a single oral dose of fexofenadine (60 mg) and rosuvastatin (5 mg), serial blood samples were collected for up to 24 h. Rosuvastatin and fexofenadine in plasma were analyzed by LC-MS/MS using previously validated methods. The pharmacokinetic parameters of fexofenadine and rosuvastatin (Phoenix WinNonLin software) with normal distribution (Shapiro-Wilk test) are presented as geometric mean and 90% confidence interval. Phases 1 and 2 were compared using the t test (P < .05). Fexofexadine AUC0-24 values do not differ (P-value: .0715) between Phase 1 (641.9ng h/mL [500.6-823.1]) and Phase 2 (823.8ng h/mL [641.5-1057.6]) showing that pregnancy (third trimester) does not alter intestinal P-gp activity. However, rosuvastatin AUC0-24 values are higher (P-value: .00005) in Phase 1 (18.7 ng h/mL [13.3-26.4]) when compared to Phase 2 (9.5 ng h/mL [6.7-13.4]), suggesting inhibition of OATP1B1/OATP1B3 transporters. In conclusion, pregnancy assessed during the third trimester does not alter the intestinal P-gp activity but reduces the activity of hepatic OATP1B1/OATP1B3 transporters. Therefore, adjustments in dosage regimens may be necessary for drugs with low therapeutic index, substrates of the OATP1B1/OATP1B3 transporters, administered during the third trimester of pregnancy.

Machine learning approach for the prediction of macrosomia

Fetal macrosomia is associated with maternal and newborn complications due to incorrect fetal weight estimation or inappropriate choice of delivery models. The early screening and evaluation of macrosomia in the third trimester can improve delivery outcomes and reduce complications. However, traditional clinical and ultrasound examinations face difficulties in obtaining accurate fetal measurements during the third trimester of pregnancy. This study aims to develop a comprehensive predictive model for detecting macrosomia using machine learning (ML) algorithms. The accuracy of macrosomia prediction using logistic regression, k-nearest neighbors, support vector machine, random forest (RF), XGBoost, and LightGBM algorithms was explored. Each approach was trained and validated using data from 3244 pregnant women at a hospital in southern China. The information gain method was employed to identify deterministic features associated with the occurrence of macrosomia. The performance of six ML algorithms based on the recall and area under the curve evaluation metrics were compared. To develop an efficient prediction model, two sets of experiments based on ultrasound examination records within 1-7 days and 8-14 days prior to delivery were conducted. The ensemble model, comprising the RF, XGBoost, and LightGBM algorithms, showed encouraging results. For each experimental group, the proposed ensemble model outperformed other ML approaches and the traditional Hadlock formula. The experimental results indicate that, with the most risk-relevant features, the ML algorithms presented in this study can predict macrosomia and assist obstetricians in selecting more appropriate delivery models.

COMPREHENSIVE MIDWIFERY CARE FOR A PRIMIGRAVIDA WITH BACK PAIN

During the third trimester of pregnancy, a woman will usually experience changes that will cause a lot of discomfort, one of which is back pain. This complaint can be overcome with non-pharmacological treatment, one of which is endorphin massage. Based on data at PMB "N" in 2023, out of 82 third trimester pregnant women, 73.58% experienced back pain discomfort. This study aims to determine midwifery care to reduce the intensity of back pain in third trimester pregnant women. Data collection methods with interviews, observations, and documentation studies. The subject of this midwifery care is Mrs. "A" G1P0A0 37 weeks gestation with complaints of back pain discomfort. The results showed that the comprehensive midwifery care carried out took place normally without any complication. During pregnancy, Mrs. "A" experienced back pain discomfort in the third trimester and was given endorphin massage care to relieve back pain. After the intervention was carried out 5 times, namely with the frequency of endorphin massage starting on the first day of the visit to the PMB and carried out again on day 3, day 5, day 6 and day 7 after the visit to the PMB, the back pain in Mrs. "A" decreased and she said she felt comfortable and more relaxed. It can be concluded comprehensive midwifery care in Mrs. "A" runs normally and effectively to overcome the discomfort experienced. This comprehensive midwifery care is expected to be applied to minimize complications that may occur during pregnancy, childbirth, newborn, postpartum to contraceptive services. Keywords: Back Pain, Endorphin Massage, Use of Video

INTERVENTION OF 5-FINGER HYPNOTIC RELAXATION TECHNIQUE IN COMPREHENSIVE MIDWIFERY CARE FOR FOR A MULTIPAROUS WOMAN WITH PREGNANCY-RELATED ANXIETY

During the third trimester of pregnancy, women often experience various discomforts, including anxiety. One non-pharmacological treatment to alleviate this anxiety is the Five-Finger Hypnosis technique. At Clinic "A" in 2023, out of 143 pregnant women, 50 in the third trimester reported experiencing anxiety. This study aims to evaluate the effectiveness of midwifery care using the Five-Finger Hypnosis technique to reduce anxiety in third-trimester pregnant women. Data collection methods included interviews, observations, and documentation review. The subject of this study was Mrs. "L," a G1P0A0 patient at 35 weeks and 6 days of gestation, who reported anxiety during pregnancy. The results showed that comprehensive midwifery care was conducted normally without complications. Mrs. "L" received the Five-Finger Hypnosis intervention six times: on the first day of her clinic visit and again on the 3rd, 6th, 8th, 11th, and 14th days following her initial visit. After these sessions, her anxiety significantly decreased, and she reported feeling more comfortable and relaxed. This study concludes that comprehensive midwifery care, including the Five-Finger Hypnosis technique, was effective in reducing anxiety for Mrs. "L." Such care can be beneficial in minimizing potential complications during pregnancy, childbirth, the newborn period, postpartum, and contraceptive services. Keywords: Anxiety, 5 finger hypnosis, Midwifery care

Genetics of glucose homeostasis in pregnancy and postpartum.

Pregnancy is accompanied by maternal metabolic adaptations to ensure fetal growth and development, including insulin resistance, which occurs primarily during the second and third trimesters of pregnancy, and a decrease in fasting blood sugar levels over the course of pregnancy. Glucose-related traits are regulated by genetic and environmental factors and modulated by physiological variations throughout the life course. We addressed the hypothesis that there are both overlaps and differences between genetic variants associated with glycaemia-related traits during and outside of pregnancy. Genome-wide SNP data were used to identify genetic variations associated with glycaemia-related traits measured during an OGTT performed at ~28 weeks' gestation in 8067 participants in the Hyperglycaemia and Adverse Pregnancy Outcome (HAPO) Study. Associations outside of pregnancy were determined in 3977 individuals who also participated in the HAPO Follow-Up Study at 11-14 years postpartum. A Bayesian classification algorithm was used to determine whether SNPs associated with fasting and 2 h glucose and fasting C-peptide during pregnancy had a pregnancy-predominant effect vs a similar effect during pregnancy and postpartum. SNPs in six loci (GCKR, G6PC2, GCK, PPP1R3B, PCSK1 and MTNR1B) were significantly associated with fasting glucose during pregnancy, while SNPs in CDKAL1 and MTNR1B were associated with 1 h glucose and SNPs in MTNR1B and HKDC1 were associated with 2 h glucose. Variants in CDKAL1 and MTNR1B were associated with insulin secretion during pregnancy. Variants in multiple loci were associated with fasting C-peptide during pregnancy, including GCKR, IQSEC1, PPP1R3B, IGF1 and BACE2. GCKR and BACE2 were associated with 1 h C-peptide and GCKR, IQSEC1 and BACE2 with insulin sensitivity during pregnancy. The associations of MTNR1B with 2 h glucose, BACE2 with fasting and 1 h C-peptide and insulin sensitivity, and IQSEC1 with fasting C-peptide and insulin sensitivity that we identified during pregnancy have not been previously reported in non-pregnancy cohorts. The Bayesian classification algorithm demonstrated that the magnitude of effect of the lead SNP was greater during pregnancy compared with 11-14 years postpartum in PCSK1 and PPP1R3B with fasting glucose, in three loci, including MTNR1B, with 2 h glucose, and in six loci, including IGF1, with fasting C-peptide. Our findings support the hypothesis that there are both overlaps and differences between the genetic architecture of glycaemia-related traits during and outside of pregnancy. Genetic variants at several loci, including PCSK1, PPP1R3B, MTNR1B and IGF1, appear to influence glycaemic regulation in a unique fashion during pregnancy. Future studies in larger cohorts will be needed to replicate the present findings, fully characterise the genetics of maternal glycaemia during pregnancy and determine similarities to and differences from the non-gravid state.

An analytic cross-sectional study of Somali women on the sexual and psychosocial status during pregnancy

BackgroundPregnancy is associated with physical, psychological, hormonal, and social alterations that may lead to detrimental effects on sexual function and psychological well-being. This study sought to examine sexual function and psychosocial well-being of pregnant women in Somalia in comparison with their non-pregnant counterparts.MethodsWe enrolled 487 consecutive women in monogamous marriages. Data included maternal age, gravida, parity, gestational week, education status of wives and husbands, and residence area. The participants completed the Female Sexual Function Index (FSFI) and the Brief Symptom Inventory-18 (BSI-18).ResultsOf 487 women, 241 were pregnant, and 246 were non-pregnant. The overall incidence of sexual dysfunction was 57.7%, being 64.0% for pregnant and 51.6% for non-pregnant women (p = 0.010). Pregnant women exhibited significantly lower FSFI scores on desire, arousal, lubrication, and orgasm, and significantly higher total BSI, anxiety, depression and somatization scores. The frequencies of sexual dysfunction were 57.9%, 45.9%, and 78.9% during the first, second, and third trimesters, respectively (p = 0.0001). As compared with the first and second trimesters, and non-pregnancy, the third trimester of pregnancy was associated with a significantly lower total FSFI score and significantly decreased levels of desire, arousal, lubrication, and orgasm, as well as a significantly higher total BSI score and a significantly increased level of anxiety. In regression analysis, pregnancy was inversely associated with sexual function parameters of desire, arousal, lubrication, and orgasm, and with BSI parameters of depression, anxiety and somatization.ConclusionOur findings suggest that pregnant women experience considerable sexual and psychosocial deterioration as compared with their non-pregnant counterparts.

Use and non-adherence to antiretroviral therapy among Refugee HIV positive pregnant mothers aged 18–49 years in Kyangwali refugee camp, Western Uganda

IntroductionRefugee HIV positive mothers experience significant obstacles in accessing, utilizing and adhering to antiretroviral therapy (ART). Identifying ART non-adherence can help in the development of interventions aimed at improving adherence and subsequently effectiveness of ART among the refugee mothers. We describe the use and the factors associated with non-adherence to ART among Refugee HIV positive pregnant mothers aged 18–49 years in Kyangwali Refugee Camp, Uganda.MethodsWe conducted a cross-sectional study among HIV positive pregnant mothers aged 18–49 years in Kyangwali refugee camp between May and June 2023. Using a structured questionnaire, we collected data on use, and factors associated with non-adherence to ART. We used modified Poisson regression analysis to determine factors associated with non-adherence to ART.ResultsOf the 380 participants enrolled, 192 (50.5%) were married, mean age 32.1 years. Overall, 98.7; 95% Confidence Interval (CI) [97.5–99.8%] were using ART and 27.4; 95% CI [22.9–31.9%] were non-adherent. Non-adherence was associated with: Initiating Prevention of Mother to Child Transmission (PMTCT) care in the third trimester of pregnancy (adjusted Prevalence ration(aPR): 2.06; 95% CI: 1.27–3.35), no need to get permission to seek PMTCT services aPR 1.61; 95% CI [1.07–2.42] and poor attitude of PMTCT providers aPR 1.90; 95% CI [1.20–3.01].Conclusion and recommendationsNon-adherence to ART was generally high; therefore limiting the effectiveness of the PMTCT program in this setting. Refugee context specific education interventional programs aimed at early initiation into HIV care, strong social and psychological support from families, communities and health care providers are vital to improve adherence in this setting.

Hair cortisol concentrations across pregnancy and maternal postpartum depressive symptoms - The ELFE cohort

Postpartum depression and depressive symptoms have a major impact on maternal and infant health and well-being, yet to date their aetiology remains unclear. One hypothesis suggests a link between these symptoms and variations in prenatal cortisol levels, but existing evidence is limited and inconclusive. This study aims to provide additional evidence to disentangle the relationship between prenatal cortisol concentrations and subsequent occurrence of postpartum depressive symptoms. Cortisol for all three trimesters of pregnancy was extracted from the hair of 775 women participating in the French ELFE cohort. Depressive symptomatology at two months postpartum was assessed through the Edinburgh Postpartum Depression Scale (EPDS). Associations between prenatal cortisol levels and EPDS scores were tested using propensity-score weighted logistic regression models to control for confounders. An increase in mean cortisol concentrations was observed from the first to the third trimester of pregnancy.No significant differences in hair cortisol concentrations were found during the first and second trimesters between women who experienced postpartum depressive symptoms and those who did not. However, an association was observed between third trimester hair cortisol concentrations and depressive symptoms at two months postpartum. Women whose cortisol concentrations fell within the second quartile had a higher risk of subsequent PPDS (aOR = 2.67, 95%CI [1.01, 7.08]).Using a large sample from the general population, we observed an association between hair cortisol levels during the third trimester of pregnancy and postpartum depressive symptoms. Nevertheless, our results suggest that future studies could benefit from investigating other biomarkers of the reactivity of the corticotropic axis.

The maternal microbiome in normal pregnancy and at delivery by cesarean section and the early developmental phase of the neonatal microbiome—presentation of a longitudinal pilot study

Abstract Aim In this study by Foessleitner et al., both the maternal microbiome in the third trimester of pregnancy and the factors that influence the development of the child’s microbiome after cesarean delivery were investigated. Methods Maternal vaginal and rectal swabs were collected at inclusion in the last trimester of pregnancy and on the day of the cesarean section. In addition, placental and intrauterine swabs as well as infant dermal, buccal, and meconium swabs were taken during the cesarean section immediately after birth and subsequently on the second/third day of life. All samples were analyzed for microbial composition using 16s rRNA amplicon sequencing. Results A total of 30 mothers and their newborns were included in the study, with microbiome samples available for all maternal, intrauterine cavity, and placenta samples, as well as for 18 out of the 30 newborns. The vaginal and rectal microbiome was stable over the course of the third trimester and showed no significant changes (permutational multivariate analysis of variance [PERMANOVA]; p &gt; 0.05). Both the intraoperative samples (placental, intrauterine) and the neonatal swabs at the time of birth were consistently sterile. However, rapid infant microbial colonization subsequently occurred, with neonatal buccal mucosa and stool samples showing significantly different microbial colonization from their mothers as early as the second/third day of life (PERMANOVA; p &lt; 0.01). Conclusion The conclusion of the presented study was therefore that the vaginal and rectal microbiome of healthy pregnant women does not change in the last trimester, the infant and the placenta are not microbially colonized at the time of birth, and the development of the newborn’s microbiome after birth appears to be influenced mainly by environmental exposure.

Multiple mediation analysis of a task-shared psychosocial intervention for perinatal anxiety: Exploratory findings from a randomized controlled trial in Pakistan

BackgroundThe “Healthy Mother Healthy Baby” (HMHB) study is a phase three, single-blind randomized clinical trial conducted at Holy Family Hospital (HFH) in association with Rawalpindi Medical University (RMU). We aimed to examine the mediators of a specialized psychosocial approach based on Cognitive Behavioural Therapy principles, targeting pregnant women experiencing anxiety. The HMHB intervention was effective in treating perinatal anxiety symptoms and preventing future depressive episodes. MethodsThe trial randomized participants into two arms: the HMHB intervention or Enhanced Usual Care (EUC), following World Health Organization guidelines. The HMHB intervention comprised strategies to strengthen social support networks, improving mother-baby bonding and strategies to deal with interpersonal conflicts, economic challenges, and societal gender preferences using cognitive and behavioural techniques and culturally resonant illustrations. Participants underwent rigorous data collection at three pivotal timepoints: baseline, third trimester, and 6-weeks postnatal. The primary outcome was anxiety symptom severity scores using the Hospital Anxiety and Depression Scale (HADS) at 6-weeks post-childbirth. Four potential mediators – social support, behavioural activation, perceived stress, and pregnancy experience – were assessed in the third trimester of pregnancy. ResultsA total of 1200 participants were randomized to the HMHB and EUC arms. In the six-week follow-up time point, 379 participants remained in the EUC group, and 387 continued in the HMHB group. Post-intervention, HMHB participants displayed significant improvements in postnatal anxiety and depression scores. Mediation analyses revealed social support and pregnancy hassles as significant mediators of the intervention's effect on postnatal anxiety outcomes, while only social support emerged as a significant mediator for depression outcomes. ConclusionThe HMHB intervention showed promising results in improving anxiety and depression scores among pregnant women. Significant mediation effects suggest the importance of targeting social support and managing pregnancy-related hassles for optimal intervention effectiveness.

Use of dulaglutide in a pregnant woman with type 2 diabetes until third trimester of pregnancy

Use of dulaglutide in a pregnant woman with type 2 diabetes until third trimester of pregnancy

Prospective evaluation of ultrasonographic fetal cardiac morphometry and functions in the third trimester of pregnancies with gestational diabetes mellitus.

This study aimed to compare cardiac morphological and functional changes in fetuses of patients with diet-regulated gestational diabetes mellitus (GDM-A1), insulin-regulated GDM (GDM-A2), and a control group. A prospective cohort study included pregnant women aged 18-40 years with singleton pregnancies. Fetal biometric, cardiac morphological, and functional measurements were recorded using Z-scores at 34-37 weeks of gestation. The study included 87 patients. Both right and left ventricular wall thicknesses were significantly different between the three groups (p < 0.001 and p < 0.001, respectively). Z-scores of the mitral valve, left and right EDD were significantly lower in GDM-A1 and GDM-A2 groups compared to the control group (p < 0.001, p < 0.001, p = 0.002, respectively). Right and left ventricular areas were decreased only in GDM-A2 group compared to the control group (p = 0.003 and p = 0.001, respectively). MPI and IVRT values were also significantly higher in the same groups (p = 0.016, p < 0.001, respectively). Gestational diabetes increased IVS and ventricular wall thicknesses in both right and left ventricles, irrespective of whether it was controlled by diet or insulin. Cardiac functional changes were observed in the GDM-A2 group.

Association between Exposure to Metals during Pregnancy, Childhood Gut Microbiome, and Risk of Intestinal Inflammation in Late Childhood.

Alterations to the gut microbiome and exposure to metals during pregnancy have been suggested to impact inflammatory bowel disease. Nonetheless, how prenatal exposure to metals eventually results in long-term effects on the gut microbiome, leading to subclinical intestinal inflammation, particularly during late childhood, has not been studied. It is also unknown whether such an interactive effect drives a specific subgroup of children toward elevated susceptibility to intestinal inflammation. We used an amalgamation of machine-learning techniques with a regression-based framework to explore if children with distinct sets of gut microbes and certain patterns of exposure to metals during pregnancy (metal-microbial clique signature) had a higher likelihood of intestinal inflammation, measured based on fecal calprotectin (FC) in late childhood. We obtained samples from a well-characterized longitudinal birth cohort from Mexico City (n = 108), Mexico. In the second and third trimesters of pregnancy, 11 metals were measured in whole blood. Gut microbial abundances and FC were measured in stool samples from children 9-11 years of age. Elevated FC was defined as having FC above 100 μg/g of stool. We identified subgroups of children in whom microbial and metal-microbial clique signatures were associated with elevated FC (false discovery rate (FDR) < 0.05). In particular, we found two metal-microbial clique signatures significantly associated with elevated FC: (1) low cesium (Cs) and copper (Cu) in the third trimester and low relative abundance of Eubacterium ventriosum (OR [95%CI]: 10.27 [3.57,29.52], FDR < 0.001) and (2) low Cu in the third trimester and high relative abundances of Roseburia inulinivorans and Ruminococcus torques (OR [95%CI]: 7.21 [1.81,28.77], FDR < 0.05). This exploratory study demonstrates that children with specific gut microbes and specific exposure patterns to metals during pregnancy may have higher fecal calprotectin levels in late childhood, denoting an elevated risk of intestinal inflammation.

How can the pain sensitivity to be affected by maximal progressive exercise test during pregnancy?

The multidimensional etiology of pain may explain the beneficial effects of regular physical activity, as evidenced by increased pain tolerance. Physically active people find it easier to exert themselves, which enables them to increase their physical activity, which in turn leads to a reduction in pain. However, no study investigated the physical activity and exercise tests as modulators of pain sensitivity in pregnant women. Therefore, this study aimed to investigate the changes in pain perception in pregnant women during pregnancy, with a particular interest in the effects of maximal progressive exercise test (CPET) and self-performed physical activity (PA). Thirty-one women with an uncomplicated singleton pregnancy (aged 23-41 years; M = 31.29, SD = 4.18) were invited to participate in pain sensitivity measurements before and after CPET twice during pregnancy (with an 8-week break). We found that pregnant women had a significantly lower pain threshold after a maximal exercise test than before, regardless of whether the test was performed in the second or third trimester of pregnancy. This effect was most pronounced in women with low levels of physical activity. Second, women with high physical activity had higher pain tolerance than women with moderate and low physical activity. In addition, physical activity levels predicted changes in pain tolerance over the course of pregnancy, with negative changes in women with low physical activity and positive changes in women with moderate physical activity. Finally, these associations were not reflected in differences in the subjective pain experience.