Trimester Of Pregnancy Research Articles

Epidural anesthesia as a sole anesthetic for a parturient with cardiac disease and low ejection fraction – a case report in resource limited setup

Introduction and importance: The effective care of pregnant women with cardiac conditions relies on collaboration among the obstetrician, cardiologist, and anesthesiologist throughout the peripartum period. Limited research exists regarding the safety of specific anesthetic approaches for patients with congestive heart failure (CHF), particularly in the context of pregnancy. Case presentation: This was a 28-year-old woman who was pregnant with her third child (gravida III, para II) and has not had a menstrual period for the past 8 months. She had been receiving antenatal care at a local health center. Currently, she was experiencing symptoms including coughing, difficulty breathing, epigastric pain, and chest pain, which had been present for 1 week. Upon examination, she was diagnosed with New York Heart Association class IV CHF with pulmonary edema, and preeclampsia with severe features, and she was in the third trimester of pregnancy. Clinical discussion: Pre-existing medical conditions can adversely affect pregnancy outcomes for women and their offspring, especially in resource-poor settings in Africa. The goals of anesthetic management are avoidance of myocardial depression, maintaining normovolemia, avoiding an overdose of drugs during induction as the circulation time is slow, and avoiding sudden hypotension when regional anesthesia is the choice. Conclusion: We believe that successful management of anesthesia for this critical case depends on a thorough understanding of the pathophysiology of the disease condition, the selection of anesthetic techniques, and the decision-making of our team. We showed epidural anesthesia could be safely used to manage high-risk cardiac patients, however, further interventional study is needed to prove safety.

Physical activity during the first trimester of pregnancy: an observational, cross-sectional study

Physical activity during the first trimester of pregnancy: an observational, cross-sectional study

A Mini Review of the Literature with a Special Focus on India on the Prevalence of Indian Traditional Medicine (ITM) use During Pregnancy

Background: Although pregnancy has been an integral part of women’s lives for millennia, not all women have found the process comfortable. About 65 percent of women in India consume Indian traditional herbs during pregnancy. Herbal medicines are used nowadays by up to half of the world's population. Phytomedicines isolated from plants contain a wide variety of bioactive components that can have both negative and positive effects. Many herbal plants, such as Sage (Salvia fruticosa), golden cotula (Matricaria aurea), anise (P. anisum), peppermint (Mentha aquatica), and cumin (Cuminum cyminum), etc., are used in pregnancy. To minimize the adverse effects, the use of Indian traditional medicine can be the best possible alternative. Objective: Regarding the usage of herbal medicines in India, there are large research gaps and a lack of a regulatory framework. This article aims to highlight the most common traditional Indian remedies used by pregnant women, along with their uses and any possible interactions between herbal remedies and prescription drugs. Method: Several databases, including the WHO guidelines, PubMed, Bentham Science, Elsevier, Springer Nature, Wiley, and Research Gate, were used to compile the data for the article following a thorough analysis of the various research findings connected to pregnancy and herbs for pregnancy care. Result: An overview of the use of herbal medicine is given in this review, along with information on its limitations and general safety. The prevalence of herbal medicine use during pregnancy in India is then discussed, along with the uses, adverse effects, side effects, and efficacy of the most popular herbal medications. Conclusion: The use of herbal medicine during pregnancy is a common phenomenon. The outcomes of this study showed Indian Traditional medicines are known to have numerous advantages that can be helpful during or after pregnancy, including raising milk production, reducing nausea, easing labor pains, reducing morning sickness, or reducing flatulence, however, some herbal remedies have the potential to be teratogenic, poisonous, and abortive, especially during the first trimester of pregnancy because the active components of some medicinal plants can cross the placental barrier and get to the foetus. To determine the safety of taking herbal medications, studies, especially clinical trial trials, must be conducted.

Diagnostic et prise en charge de l'infection congénitale à cytomégalovirus

AbstractCongenital cytomegalovirus (CMV) infection affects almost 1 % of newborns, with a risk of sequelae of 17-20 %. Primary maternal infection during the first trimester of pregnancy is the most significant risk factor for severe disease. To prevent primary maternal infection, primary prevention strategies (hygiene and information measures) have been shown to be effective but are still insufficient. Although not yet recommended by the health authorities, screening enables cases of primary maternal infection to be detected as early as possible, so that transmission can be prevented by administering valaciclovir. This strategy has proved effective, reducing maternal-fetal transmission of CMV by 70 %. Screening is based on CMV serology (IgG and IgM), supplemented by IgG avidity testing if IgM are present. It is essential that screening and initiation of treatment should be as early as possible to optimize the efficacy of this strategy. PCR on amniotic fluid, proposed in the case of a first trimester maternal primary infection, can be used to diagnose fetal infection. It is also indicated in the event of abnormalities detected on ultrasound. CMV infection in newborns can be confirmed by PCR on saliva or urine, and treatment with valaganciclovir can be initiated in cases of symptomatic congenital infection.

Analysis of the skin layers and its appendages of developing human fetuses at different trimesters of pregnancy

Analysis of the skin layers and its appendages of developing human fetuses at different trimesters of pregnancy

Factors affecting the accuracy of fetal cardiac ultrasound screening in the first trimester of pregnancy.

Most studies on the performance of first-trimester cardiac screening have concentrated on comparing the detection rate between different protocols and not on the actual reason for false-negative results. Herein, we report the performance of first-trimester congenital heart disease (CHD) screening and factors that may affect the detection rate of CHDs. This retrospective observational study included patients who underwent first-trimester screening and subsequently gave birth at our facility. We analyzed the performance of first-trimester screening for CHD and major CHD (CHD requiring cardiac surgery or interventional catheterization within 12months of birth). Of the 6614 fetuses included, 53 had CHD and 35 had major CHD. For the prenatal diagnosis of CHD, the detection rate, specificity, positive predictive value, negative predictive value, and first-trimester detection rate for CHD were 64.1%, 99.9%, 94.4%, 99.7%, and 82.9%, respectively; the respective values for major CHD were 85.7%, 99.96%, 93.75%, 99.92%, and 85.7%. The detection rate was not significantly different when classified by crown-rump length or number of fetuses. A weak correlation was observed between low detection rate of major CHD and lower maternal body mass index (BMI) (correlation ratio: 0.17). The detection rate was significantly higher when the fetus was scanned with its spine at the 5-7 o'clock position (posterior spine) than at other positions (odds ratio: 3.82, 95% confidence interval: 1.16-12.5, p = 0.02). Posterior spine contributes to an improved diagnostic rate in first-trimester CHD screening. In addition, sonographers must recognize that low maternal BMI is a risk factor of false-negative results.

OA08 Ocrelizumab in pregnancy in a patient with juvenile onset systemic lupus erythematosus

Abstract Introduction Juvenile-onset systemic lupus erythematosus (jSLE) is a multisystem autoimmune disease that results in increased disease activity compared to adult-onset SLE. jSLE in pregnancy results in a greater incidence of disease flares as well as adverse pregnancy outcomes. Management of SLE in pregnancy is particularly difficult due to lack of safety data for immunosuppressant medications and is therefore limited. Ocrelizumab is a humanised monoclonal antibody that selectively targets CD20 B cells and is approved for the treatment of multiple sclerosis. Despite never being trialled in a patient with active SLE in pregnancy, this case demonstrates its use with a successful outcome. Case description An 18-year-old female was diagnosed at age 14 with juvenile onset systemic lupus erythematosus with the presence of a photosensitive malar rash, arthralgia, alopecia, aphthous ulcers and headache. At the time of diagnosis her investigations revealed ANA 1:5120 with homogenous pattern, high dsDNA, low C3 and C4, thrombocytopenia, antibodies to Smith, Ro, RNP, anti-Rib-P, strongly positive lupus anticoagulant antibodies and low titre anti-cardiolipin IgG and IgM. Previous treatment included methotrexate, mycophenolate mofetil and cyclosporin which were discontinued either due to patient choice, inefficacy or adverse reaction. Azathioprine was contraindicated due to low TMPT. Rituximab was trialled and although effective had to be stopped due to adverse reaction. Unfortunately, she experienced a primigravida pregnancy loss at 15-20 weeks secondary to active SLE and pre-eclampsia. Shortly after this, she developed a rare case of anti-fascin antibody neuropathy and was treated with ocrelizumab. Six months later during her second pregnancy, she was treated with hydroxychloroquine 400 mg, aspirin 150 mg, folic acid 5 mg and low molecular weight heparin prophylaxis which were continued throughout the pregnancy. Due to concerns of active lupus at 13 weeks due to facial rash and fatigue, prednisolone was commenced at 10 mg daily and continued. After careful consideration, Ocrelizumab was given in the second trimester at 17 and 19 weeks’ gestation. Following this, symptoms remained under control and disease activity was low with normal C3/C4 and dsDNA levels without significant proteinuria. A newborn baby was delivered at 38 weeks by caesarean section without complication or foetal abnormalities. Both the mother and baby remain under close follow- up but have not demonstrated adverse outcomes at 3 months postpartum. Discussion This case demonstrates the use of Ocrelizumab in the second trimester of a high-risk pregnancy complicated by active jSLE. At present, there is no license for use of Ocrelizumab in SLE and no safety data on its use in pregnancy. However, there was a good outcome for this patient which resulted in no antenatal or postpartum complications and the successful birth of a healthy newborn without foetal abnormalities. Ocrelizumab is used for the treatment of early relapsing-remitting multiple sclerosis (RRMS) and is increasingly used by neurologists in women of childbearing age despite being unlicensed for use in pregnancy. Concerns of its use in pregnancy surround B cell depletion in the neonate which while tends to be transient, causes significant concern regarding long term immunological development and response to vaccination. B cell depleting therapies are widely used in the context of active and refractory SLE and therefore use of Ocrelizumab has been evaluated in cases of SLE in two phase III clinical trials. The first study examined the efficacy of Ocrelizumab in SLE without renal involvement (BEGIN) and the second recruited patients with lupus nephritis (BELONG). The BEGIN study was terminated early due to lack of response and the BELONG study was terminated due to a significant increase in serious infections (in the Ocrelizumab plus mycophenolate treatment group). However, results on disease activity were positive with complete renal response being achieved non-statistically more frequently in the Ocrelizumab treated patients versus placebo. Real world evidence shows the importance of achieving disease control in SLE around pregnancy to prevent adverse outcomes. The decision for the use of Ocrelizumab therefore needs to be balanced carefully against potential harm to the baby either from direct foetal exposure to the drug, or from gestation in an immunocompromised mother. Key learning points • Pre-pregnancy counselling is of paramount importance in severe cases of active SLE and when possible, pregnancy should be postponed in these instances until disease activity is stabilised with contraception counselling offered to those on teratogenic immunosuppressive agents. • A multidisciplinary approach to the management of complex SLE in pregnancy in essential with obstetrician, midwife, maternal medicine physician and rheumatologist input. • The benefit of potentially life-saving immunosuppressive treatment should be carefully balanced against the poor outcomes of active SLE in pregnancy and decisions should be made on a case-by-case basis.

Pregnancy Associated Osteoporosis

Pregnancy-associated osteoporosis (PAO) is a rare and debilitating bone disease which affects young pre-menopausal women, typically presenting with vertebral fractures in the third trimester or post-partum stages of pregnancy and lactation. In September 2024 issue of The Practising Midwife we published a Spotlight article on this disease. This Voices article provides the thoughts of patients, to enable a greater disease understanding among midwives.

Impact of foetal sex on first trimester placental markers and pregnancy outcome: a prospective study

Impact of foetal sex on first trimester placental markers and pregnancy outcome: a prospective study

Predictor Role of Intimate Domestic Violence During Pregnancy and Mental Health in Maternal Competency with Moderating Role of Motherinfant Attachment: A Structural Equation Model

Introduction: Intimate domestic violence causes psychological consequences in pregnancy and maternal competency. We aimed to assess the effect of domestic violence on mental health and maternal competency with the moderating role of mother-infant attachment behavior. Methods: This prospective longitudinal study was conducted on 254 primiparous mothers in the third trimester of pregnancy referring to selected health centers in Qazvin province, Iran. Data collection tools were questionnaires. Data were analyzed by SPSS and Smart Partial Lease Square3 software. Results: The results of the structural equations model showed that domestic violence has a positive and significant effect on mental health disorders (β = 0.87). Mental health disorder has a negative and significant effect on parental acceptance (β = -0.55). Domestic violence has a negative and significant effect on mother-infant attachment behavior (β = -0.83), also mother-infant attachment behavior is a moderator of the relationship between pregnancy violence and maternal competency (T-value = 3.17). Conclusion: The results revealed that domestic violence during pregnancy affects the mental health of pregnant mothers and maternal competency and mother-infant attachment behavior moderates this relationship. Therefore, it is recommended that mothers facing domestic violence be identified and receive psychological support and counseling, and also improve maternal competence and mother-infant attachment behavior in mothers exposed to violence.

Electrocardiographic Changes in Second and Third Trimester in Bangladesh: A Comparative Study

Background: During pregnancy, there are notable changes in cardiovascular function to meet the increasing needs of the developing baby. The objective of this study was to compare ECG in pregnant women during their second and third trimesters with a control group of non-pregnant women in Bangladesh. This study aims to offer valuable insights into the cardiovascular changes that happen during pregnancy. This study's findings are important for maternal health research and clinical practice in Bangladesh and beyond. Objective: The purpose of this study is to analyze and compare the ECG variations in women during the second and third trimesters of pregnancy. Methods: The study took place in the gynecology Department at CMH Saidpur, Bangladesh. This study was conducted from March 2023 to August 2023. During this period, 75 pregnant patients in their 2nd trimester and 75 patients in their 3rd trimester were chosen as cases from antenatal outdoor, while 75 non-pregnant women of the same age were selected as the control group. We use the purposive sampling method. Results: During pregnancy, there were notable changes in BMI, heart rate, and PR interval. BMI decreased in the second trimester and increased in the third trimester.22.67% were nulliparous and 77.33% were multiparous in 2nd trimester. In the third trimester, 26.67% were nulliparous and 73.33% multiparous. So, no significant difference in parity. Heart rate increased in both trimesters, while the PR interval shortened in both trimesters. No significant changes were observed in the durations of the QRS complex or QT interval. In our study, the QTc interval displayed a significant rise. ST depression, which may suggest decreased blood flow, was exclusively seen in pregnant women, particularly in the third trimester. Conclusion: We found no significant changes in age, but BMI, heart rate, and PR interval were significantly different from the control group throughout pregnancy. No significant QRS complex or QT interval duration changes were identified. The QTc interval rose. ST depression, more prominent in the third trimester, only affected pregnant women. As shown by ST depression, pregnancy may change cardiac function, electrical activity, and ischemia.

The Effect of Murottal Al-Qur'an on the Anxiety of Pregnant Women in the Third Trimester in the Independent Practice of Midwives in the Bandung City Region

Background: Anxiety is still widespread among pregnant women in Indonesia, and the frequency of this condition is relatively significant. During the third trimester of pregnancy, pregnant women experience a higher level of anxiety compared to the previous trimester. This is because they are more concerned about the labor and delivery procedure that they will go through as well as the pain that they will face during the birth process—taking in the murottal of the Al-Qur'an, which has the potential to induce a soothing effect. Purpose: The aim of this study is to investigate how murottal Al-Qur'an influences third trimester pregnant women's anxiety level. Methode: The study design was a quasi-experiment with a control design that was used before and after the experiment. The study sample was made up of 60 pregnant women from Bandung who were in their third trimester and were between 28 and 36 weeks along. There were 30 expecting women in each of the two groups: the control group and the intervention group. Anxiety observation sheets were used to gather information. The results were looked at with the Mann Whitney test. Result: The intervention group was found to have a mean difference of 9.27, while the control group had a mean difference of 1.17. The Mann-Whitney test results, which were obtained by comparing the posttest results of the intervention group and the control group, indicated that murottal Al-Qur'an had a significant impact on the reduction of anxiety in third-trimester expectant women (p value = 0.017 < 0.05). Conclusion: Murottal al-Qur'an affects anxiety of third-trimester pregnant women.. Suggestion: It is hoped that future researchers will carry out further research by adding variables that can influence the anxiety of pregnant women in the third trimester and a larger number of respondents studied.

Do pregnant women with restless legs syndrome experience better sleep with physical activity?

Pregnant women benefit greatly from exercise due to its powerful impact on maternal and perinatal outcomes. The purpose of our study was to assess whether exercise improves objective sleep quality in pregnant women suffering from restless legs syndrome. This cross-sectional study is based on data from a large, naturalistic, consecutive cohort study in pregnant women recruited by four sleep centres, in Bologna, Milan and Turin (Italy), and Lugano (Switzerland), named the Life-ON study. Objective sleep parameters of 316 pregnant women were measured using polysomnographic recordings during the second trimester of pregnancy, and a self-reported assessment was used to evaluate physical activity. Pregnant women with restless legs syndrome (n = 91) who engaged in physical activity (n = 28) experienced better sleep efficiency (84.20% versus 82.10%, p = 0.01), less stage 1 sleep (10.50% versus 11.40%, p = 0.04) and wake after sleep onset (52.20 min versus 76.40 min, p ≤ 0.001), as well as reduced periodic leg movements during sleep (5.50 per hr versus 16.40 per hr, p < 0.001) when compared with the sedentary restless legs syndrome group (n = 63). Sleep structure was also better conserved in physically active pregnant women without restless legs syndrome compared with the inactive restless legs syndrome negative group. Overall, this study provides further evidence of the benefits of physical activity in pregnant women by illustrating its positive impact on sleep structure.

When faced with macrocytic anemia in a pregnant woman, consider a vitamin B12 deficiency: About a case and review of the literature

The demonstration of a macrocytic anemia, especially aregenerative, during pregnancy, especially if associated with other abnormalities of other lineages (white blood cells and platelets) can be severe in pregnant women, hence the need to look for the causal condition which may be a deficiency cause especially in vitamin B12 or other more serious pathology. We report a case of pan cytopenia of deficiency origin during the 3rd trimester of pregnancy treated in our training. Pancytopenia of deficiency origin remains exceptional during pregnancy, especially in vitamin B12, and given its hemorrhagic and infectious severity, its discovery requires investigation and vitamin deficiency must be sought, particularly in the face of macrocytic anemia.

Effect of an educational intervention program on pregnant women’s ability to cope with childbirth pain in Western Kenya

INTRODUCTION Childbirth pain has remained a major challenge to women of child-bearing age over the years. Studies have shown that most women are not aware of the coping strategies to employ during childbirth. Severe childbirth pain can lead to adverse maternal and neonatal outcomes. Therefore, it is imperative to develop safe and innovative methods to cope with childbirth pain. The study aimed to investigate the effects of an educational program on women's ability to cope with childbirth pain in the context of lower and middle-income countries. MATERIALS AND METHODS A Quasi-experimental design was used to assess the impact of an educational intervention built on self-efficacy theory. Pregnant mothers were recruited at antenatal care services and were assigned to either the control group or the intervention group. The intervention group received two sessions of 2 hours each of the intervention between the 32nd– 35th weeks of gestation. Follow-up and evaluation on outcome measures were conducted within 48 hours after delivery. The strength of pain was measured by the visual analogue pain scale and the Mac-Gill pain questionnaire. RESULTS Findings indicate that relative to the control group, the intervention group was significantly more likely to demonstrate lower perceived pain both on the visual analogue scale (P&lt;0.001) and the McGill pain questionnaire (P&lt;0.001). Further analysis revealed that the non-intervention group had increased severe pain [OR=3.099,95% CI (1.080-8.887), P=0.035], unbearable pain [OR=27.930,95% CI (9.354-83.399), P=&lt;0001], while permanent employment reduced unbearable pain [OR=0.038 95% CI (0.003-0.549), P=0.016]. CONCLUSION AND RECOMMENDATIONS The educational intervention program was effective in decreasing pain intensity and severity during childbirth. Training programs should be integrated into the antenatal care program and offered to mothers during the third trimester of pregnancy to enhance women's coping skills during childbirth.

Cerebellar Purkinje cell activity regulates white matter response and locomotor function after neonatal hypoxia.

Neonatal hypoxia (Hx) causes white matter (WM) injury, particularly in the cerebellum. We previously demonstrated Hx-induced reduction of cerebellar Purkinje cell (PC) activity results in locomotor deficits. Yet, the mechanism of Hx-induced cerebellar WM injury and associated locomotor abnormalities remains undetermined. Here, we show that the cerebellar WM injury and linked locomotor deficits are driven by PC activity and are reversed when PC activity is restored. Using optogenetics and multielectrode array recordings, we manipulated PC activity and captured the resulting cellular responses in WM oligodendrocyte precursor cells and GABAergic interneurons. To emulate the effects of Hx, we used light activated Halorhodopsin targeted specifically to the PC layer of normal mice. Suppression of PC firing activity at P13 and P21 phenocopied the locomotor deficits observed in Hx. Moreover, histopathologic analysis of the developing cerebellar WM following PC inhibition (P21) revealed a corresponding reduction in oligodendrocyte maturation and myelination, akin to our findings in Hx mice. Conversely, PC stimulation restored PC activity, promoted oligodendrocyte maturation and enhanced myelination, resulting in reversed Hx-induced locomotor deficits. Our findings highlight the crucial role of PC activity in cerebellar WM development and locomotor performance following neonatal injury.Significance statement Adult survivors of prematurity often experience locomotor incoordination secondary to cerebellar dysfunction. The cerebellum develops in the last trimester of pregnancy, a period that preterm neonates miss. Here, we show how neonatal hypoxia alters the crosstalk between neurons and oligodendrocytes in the developing cerebellum. Through loss-of-function and gain-of-function experiments, we unveiled that neuronal activity drives cerebellum-associated white matter injury and locomotor dysfunction after hypoxia. Importantly, restoring neuronal activity using direct neurophysiological stimulation reversed the hypoxia-induced white matter injury and locomotor deficits. Early cerebellar neuronal stimulation could serve as a potential therapeutic intervention for locomotor dysfunction in neonates.

Influence between Body Mass Index and Blood Pressure With Results of Urine Protein Examination in Pregnant Women at Bangkalan Health Center

Background: Preeclampsia is an increase in blood pressure that occurs after the 20th week of gestation. Until now, the exact cause of preeclampsia is not known. During the second trimester of pregnancy the pressure in the renal veins (renal venous pressure) changes and increases. Increased renal venous pressure causes proteinuria, especially in the orthostatic position, which causes a slightly greater change in kidney size. Purpose: The aim of this study was The Relationship Between Body Mass Index And Blood Pressure With Results Of Urine Protein Examination In Pregnant Women At Bangkalan Health Center. Methods: Analytical Research Design with a cross sectional approach. Independent variable Body Mass Index and Blood Pressure, dependent variable results of urine protein examination. The sample of this study were 210 pregnant women who carried out Integrated ANC at the Bangkalan Health Center, the sampling technique used Simple random sampling. Secondary data collection by looking at medical record data, statistical tests using Rank Spearman. Results: Based on statistical tests using Rank-Spearman, the results showed ρ value (0.024) &lt;α (0.05) indicating that there is a relationship between Body Mass Index and urine protein examination results. The results of the study ρ value (0.020) &lt;α (0.05) there is a relationship between blood pressure and the results of urine protein examination. Conclusion: Detection of proteinuria is very important in the diagnosis and treatment of hypertension in pregnancy. Proteinuria is the last symptom to appear in patients with preeclampsia.

Health literacy in pregnant women facing prenatal screening: a short report from “SaperePer” project

Abstract Advancements in health promotion and prenatal medicine have made noninvasive prenatal testing (NIPT) a common practice during pregnancy, but understanding prenatal health information becomes crucial not only for the well-being of the mother but also for that of the unborn child. Analyze health-related information during pregnancy is fundamental, and this work fits perfectly with this topic, reporting preliminary results from the pilot study “SaperePer”. A health-related questionnaire was administered to 358 women in the first trimester of pregnancy, aiming to study different outcomes: 1.level of knowledge of NIPT; 2.number of screening tests undergone; 3.willingness to undergo a diagnostic test with a high outcome risk of screening test; 4.willingness to end the pregnancy following a diagnosis of pathology. The questionnaire was divided into 3 sections: personal characteristics and lifestyle habits, prenatal health behavior scale (PHBS), and knowledge of NIPT. Preliminary results showed that the level of knowledge of NIPT was higher in older, atheist, working, wealthy highly educated, and preliminary informed women, as well as the higher number of screening tests undergone and the propensity to undergo an invasive diagnostic test after a high-risk screening result (KS and MW tests p &amp;lt; 0.05). On the contrary, women with lower education, faithful and, even more, not preliminary and appropriately informed during prenatal counseling showed lower knowledge of NIPT, lower number of tests undergone, and meager chances to undergo an invasive diagnostic test or to end the pregnancy after a positive diagnosis of pathology (KS and MW tests p &amp;lt; 0.05). In conclusion, this study evaluated health-related information during the first but crucial stages of pregnancy, opening a new understanding of how health literacy and correct prenatal counseling could increase awareness and health promotion in pregnant women, particularly in those women with lower cultural tools. Key messages • Health literacy and correct prenatal counseling could increase awareness and health promotion in pregnant women. • Understanding prenatal health information becomes crucial both for maternal and prenatal well-being.

Anemia in pregnancy and adverse maternal health outcomes - birth-registry based study from Georgia

Abstract Anemia in pregnancy is an important public health challenge; however, it has not been thoroughly studied in Georgia. We assessed the prevalence of anemia during pregnancy across Georgia and the association between anemia in the third trimester of pregnancy and adverse maternal outcomes. We used data from the Georgian Birth Registry and included pregnant women who delivered between January 1, 2019, and August 31, 2022 (n = 158,668). The prevalence of anemia (hemoglobin (Hb) &amp;lt; 110 g/L) at any time during pregnancy was calculated per region. Women in the third trimester were classified into three groups, based on their lowest measured Hb value: no (Hb ≥ 110 g/L, reference group); mild (Hb 100-109 g/L); and moderate to severe anemia (Hb &amp;lt; 99 g/L). Adjusted odds ratios (aOR) with 95% confidence intervals (CIs) were calculated for the associations between anemia status and post-delivery intensive care unit (ICU) admission and preterm delivery. The prevalence of anemia occurring at least once during pregnancy was 40.6%, with large regional differences in anemia prevalence (25.1%-47.0%). Of 105,811 pregnant women with Hb measurements in the third trimester, 71.0% had no anemia; 20.9%, mild anemia; and 8.1%, moderate or severe anemia. The odds of post-delivery ICU admission did not increase linearly with decreasing Hb value (P for trend .13), and the relationship was inverse for preterm delivery (P for trend .01). Key messages • A considerable proportion of pregnant women in Georgia have anemia during pregnancy, and the prevalence and quality of reporting differ across regions. • To accelerate national progress toward the SDGs and mitigate the consequences of anemia, equal countrywide access to high-quality ANC programs and complete registration of Hb values should be ensured.

Study on Factors Associated with Poor Seizure Control in Epileptic Patients during Pregnancy

The management of epilepsy during pregnancy is always challenging. This study aims to analyze the factors associated with poor seizure control during pregnancy and to describe the most commonly used antiseizure drugs in these patients. We conducted a casecontrol study of pregnant patients with epilepsy between 2017 and 2022. 50 pregnant women with poorly controlled epilepsy were taken as cases and 50 pregnant women with well-controlled epilepsy were taken as controls. Patients were evaluated in the first and second trimesters of pregnancy and after delivery. Patients’ mean age was 32.6 years. 53% had focal epilepsy, 40% had generalized epilepsy and 5 % had undetermined epilepsy. The factors associated with poor control of seizure during pregnancy were duration of epilepsy, poor seizure control in the year prior to pregnancy, treatment with 2 or more antiseizure drugs, untreated epilepsy, missed medication dosages, decline in plasma concentrations of antiepileptic drug, presence of focal activity in EEG and abnormal imaging findings. Anti-seizure medications most widely used in monotherapy were lamotrigine, levetiracetam, carbamazepine, and valproate. EWMCJ Vol. 12, No. 1&amp;2, January-July 2024: 99-103