Women In Late Pregnancy Research Articles

Prenatal Yoga to Relief Back Pain among Pregnant Women

Back pain is a kind of discomfort that frequently develops during pregnancy, especially among pregnant women in late pregnancy or those with a history of back pain in previous pregnancy. Prenatal yoga can relief back pain discomfort since it promotes good posture and stretch the spine's central nervous system. This study aims to determine the effect of yoga exercise on back pain among pregnant women in the third trimester.This was a pre-experimental study with one group pretest posttest design. The current study involved 30 pregnant women in the third trimester, who were assigned into the treatment group (participated in prenatal yoga exercise) and the control group (did not participate in prenatal yoga exercise), consisting of 15 samples, respectively. The study instrument applied here was Faces Pain Scale-Revised a questionnaire (FPS-R). It was found that there was a significant effect of prenatal yoga exercise to relief back pain among pregnant women in the third trimester (p less than 0.05). It can be concluded that prenatal yoga was beneficial for relieving back pain among pregnant women in the third trimester. Thus, prenatal yoga technique is considered an appropriate method for supproting the succes of pregnancy.

The Mid-Upper Arm Circumference as a Substitute for Body Mass Index in the Assessment of Nutritional Status among Pregnant Women: A Cross-Sectional Study.

To compare mid-upper arm circumference (MUAC) with body mass index (BMI) and propose MUAC cut-off points corresponding to BMIs of <18.5 kg/m2 (underweight) and ≥30.0 kg/m2 (obesity) for pregnant Sudanese women, a cross-sectional community-based study was conducted in the city of New Halfa, Sudan. Healthy pregnant women were recruited. Body parameters such as height, weight, and MUAC were measured. The MUAC (cm) cut-off values for underweight and obesity were determined using receiver operating characteristic (ROC) curve analysis. Of 688 pregnant women, 437 were in early pregnancy (<20 weeks of gestation) and 251 were in late pregnancy (≥20 weeks of gestation). There was a significant positive correlation between BMI and MUAC among women in both early pregnancy (r = 0.734) and late pregnancy (r = 0.703). The cut-off points of MUAC for detecting underweight and obesity were found to be 24.0 cm and 29.0 cm, respectively, for women in early pregnancy, with good predictive values. For women in late pregnancy, the cut-off points for detecting underweight and obesity were 23.0 cm and 28.0 cm, respectively. We concluded that for Sudanese pregnant women, the MUAC cut-off points identified in the study for diagnosing underweight and obesity are both sensitive and specific.

Single and joint associations of exposure to polycyclic aromatic hydrocarbons with blood coagulation function during pregnancy: A cross-sectional study

Association linking polycyclic aromatic hydrocarbons (PAHs) to blood coagulation function during pregnancy remains absent. Hence, we conducted a cross-sectional study including 679 late pregnant women (27.2 ± 5.1 years old) drawn from Zunyi birth cohort, Southwest China. During late pregnancy, ten urinary PAHs metabolites and four clinical blood coagulation parameters were measured, including activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT), and fibrinogen (FIB). Multiple linear regression, Restricted cubic spline (RCS) regression, Bayesian kernel machine regression (BKMR), and quantile g-computation (Q-g) regression were used to investigate their single, nonlinear, and mixed associations. Each 2.7-fold increment in 2-hydroxyfluorene (2-OHFlu), 9-hydroxyfluorene (9-OHFlu), 1-hydroxyphenanthrene (1-OHPhe), 2-hydroxyphenanthrene (2-OHPhe), and 3-hydroxyphenanthrene (3-OHPhe) were associated with 0.287 s, 0.190 s, 0.487 s, and 0.396 s shorter APTT, respectively; each 2.7-fold increment in 2-OHPhe was associated with a 0.047 s longer PT; each 2.7-fold increment in 9-hydroxyphenanthrene (9-OHPhe) and 1-hydroxypyrene (1-OHPyr) were associated with 0.087 s and 0.031 s shorter TT, respectively; and each 2.7-fold increment in 1-hydroxynaphthalene (1-OHNap) was associated with 0.032 g/L higher FIB level. The nonlinear association of 2-OHPhe with APTT and 1-OHNap with FIB were also observed. Furthermore, the shortened APTT and TT associated with PAHs mixture were indicated by BKMR and Q-g model. BKMR also revealed a nonlinear association of 2-OHPhe with PT and an interaction effect of 2-OHPhe and 3-OHPhe on APTT. Our results indicate that urinary PAHs was associated with shortened coagulation time and increased FIB. Therefore, more attention should be paid for late pregnant women to prevent PAHs-associated risk of thrombosis. Future perspective studies to confirm our findings and explore the underlying biological mechanism are warranted.

Abstract #1402115: A Case of Starvation Ketoacidosis in Pregnancy Secondary to Perforated Appendicitis

Starvation ketoacidosis in pregnant patients is a rare but life-threatening condition. There are few case reports in the literature of starvation ketoacidosis of pregnancy with no consensus on treatment. We present a case of starvation ketoacidosis in pregnancy that was successfully treated with dextrose and insulin infusion. A 35-year-old pregnant woman with a history of prior gestational diabetes diagnosed in a previous but not current pregnancy presented at 33 weeks of gestation with severe abdominal and poor oral intake for 3 days prior to admission. On evaluation, the patient was found to have a perforated appendix with peritonitis and was taken to the operating room for open laparotomy. During surgery, she was noted to have an anion gap metabolic acidosis. Arterial blood gas revealed pH of 7.06 (range 7.35-7.45), pCO2 of 43mmHg (range 32-35 mmHg), pO2 of 120 mmHg (range 83-108 mmHg), and bicarbonate of 12 mmol/L (range 22-26 mmol/L). Further blood work demonstrated serum bicarbonate of 14 mmol/L (range 21-30 mmol/L), and an anion gap of 18 (4-16). Beta-hydroxybutyrate was elevated at 58.5 mg/dL (range 0-3 mg/dL), with serum glucose of 134 mg/dL (range 70-99 mg/dL) and normal lactate of 1.3 mmol/L (range 0.5-2.2 mmol/L). Urinalysis demonstrated 2+ ketones (range negative). She was started on a dextrose 5% infusion with insulin infusion at a fixed rate to overcome any inherent insulin resistance and suppress lipolysis. Metabolic parameters were corrected in 12 hours and the patient was extubated in 24 hours. At 48 hours, insulin and dextrose infusions were discontinued. She then underwent cesarian section 1.5 weeks later due to development of pelvic abscess requiring surgical intervention. She delivered a healthy baby girl. Women in late pregnancy are at increased risk for ketosis during even brief periods of fasting. This is due to increased relative insulin resistance and enhanced lipolysis, a protective mechanism to ensure adequate glucose supply to the growing fetus. Prompt recognition of ketosis and timely management are essential to prevent profound acidosis and avoid maternal-fetal mortality. Although there is no consensus on management of starvation ketoacidosis in pregnancy, most case reports suggest carbohydrate administration is the cornerstone of treatment, although insulin administration can be considered if there is concern for marginal insulin reserve or there is treatment failure with carbohydrate administration alone. In our case, given the profound degree of acidosis, simultaneous administration of carbohydrate and insulin was pursued with rapid resolution of the patient’s metabolic derangements.

Importance of relative binding of bisphenol A and bisphenol S to plasma proteins for predicting their in vivo potencies

Many studies suggest that the potential impact of bisphenol S (BPS) as an endocrine disruptor is comparable to that of bisphenol A (BPA). However, in vitro-to-in vivo and from animal to human extrapolations require knowledge of the plasma free fraction of the active endocrine compounds. The present study aimed to characterise BPA and BPS binding to plasma proteins both in humans and different animal species. The plasma protein binding of BPA and BPS was assessed by equilibrium dialysis in plasma from adult female mice, rats, monkeys, early and late pregnant women as well as paired cord blood, early and late pregnant sheep and foetal sheep.The fraction of free BPA was independent of plasma concentrations and ranged between 4% and 7% in adults. This fraction was 2 to 3.5 times lower than that of BPS in all species except sheep, ranging from 3% to 20%. Plasma binding of BPA and BPS was not affected by the stage of pregnancy, BPA and BPS free fractions representing about 4% and 9% during early and late human pregnancy, respectively. These fractions were lower than the free fractions of BPA (7%) and BPS (12%) in cord blood.Our results suggest that similarly to BPA, BPS is extensively bound to proteins, mainly albumin. The higher fraction of free BPS compared to BPA may have implications for human exposure assessment since BPS free plasma concentrations are expected to be 2 to 3.5 times higher than that of BPA for similar plasma concentration.

Type of Attitude Towards Pregnancy of Women in the Context of a New Coronavirus Infection Caused by COVID-19

The subject of the study is the type of attitude towards pregnancy in the context of a new coronavirus infection caused by COVID-19. The aim of the study is to identify relationships between the type of attitude towards pregnancy and early maladaptive patterns of women in the context of a new coronavirus infection caused by COVID-19. The author analyzes in detail the possible prerequisites for the occurrence of affective disorders in women in late pregnancy in conditions of instability, uncertainty of the world in the context of a new coronavirus infection caused by COVID-19. At the same time, pregnancy is considered as a crisis period in a woman's life. Research methodology: conceptual position on early maladaptive schemes by J. Young, methodological development on the types of attitude of a pregnant woman I.V. Dobryakova. The study was conducted on the basis of the Altai Regional Clinical Center for Maternal and Childhood Protection with pregnant women aged 18 to 40 years. Scientific novelty of the study: the existence of relationships between the types of attitudes in the context of a new coronavirus infection caused by COVID-19 and early maladaptive patterns has been theoretically substantiated and empirically proven. Qualitative differences in the types of attitudes towards pregnancy in women of different ages under the conditions of a new coronavirus infection caused by COVID-19 were determined. Beliefs that are significantly associated with understanding life in the context of a new coronavirus infection have a positive correlation with anxious and depressive types of attitudes towards pregnancy. Pregnant women under the age of 25 are more likely to worry about the possible fragility and uncertainty of reality than women of other age groups, which may be due to the actualization of early maladaptive schemes and the high level of infantility of women in this age group. Based on the research data, it seems important to further develop a correctional program for pregnant women in order to adaptively comprehend the existing reality and accept the low controllability of the world as a whole.

Association of arsenic exposure and clinical hematological changes during pregnancy: Findings from a prospective Wuhan birth cohort study

BackgroundAnimal studies have reported arsenic-induced disturbed erythropoiesis parameters. However, the effects of exposure to arsenic on hematological parameters among pregnant women are unclear. ObjectivesWe aimed to evaluate trimester-specific associations between arsenic metabolites and erythropoietic parameters measured repeatedly during pregnancy. MethodsA total of 1945 pregnant women from a birth cohort study were included. We detected arsenic species in urine sampled at each trimester and extracted erythropoietic parameters in different trimesters from the medical records. We used linear regressions with generalized estimating equations (GEEs) to examine the relationship between arsenic metabolites concentrations at different trimesters and erythropoietic parameters. We utilized GEEs to calculate the odds ratio (OR) for anemia during pregnancy. ResultsAdjusted trimester-specific analysis showed that higher monomethylated arsenic (MMA) and %MMA were related to remarkably reduced hemoglobin (Hb) and mean corpuscular hemoglobin (MCH). Additionally, elevated urinary MMA concentration and %MMA in the early trimester were associated with an increased risk of microcytic anemias in the late trimester. ConclusionsOur study demonstrated a significant inverse relationship between gestational arsenic exposure and Hb and MCH. Notably, higher MMA and lower methylation capacity to metabolize inorganic arsenic (iAs) in early pregnancy might increase the likelihood of microcytic anemia among pregnant women in late pregnancy.

Morphological Variation in the Pelvic Floor Muscle Complex of Nulliparous, Pregnant, and Parous Women.

Specific levator ani muscle imaging measures change with pregnancy and vaginal parity, though entire pelvic floor muscle complex (PFMC) shape variation related to pregnancy-induced and postpartum remodeling has never been quantified. We used statistical shape modeling to compute the 3D variation in PFMC morphology of reproductive-aged nulliparous, late pregnant, and parous women. Pelvic magnetic resonance images were collected retrospectively and PFMCs were segmented. Modes of variation and principal component scores, generated via statistical shape modeling, defined significant morphological variation. Nulliparous (have never given birth), late pregnant (3rd trimester), and parous (have given birth and not currently pregnant) PFMCs were compared via MANCOVA. The overall PFMC shape, mode 2, and mode 3 significantly differed across patient groups (p < 0.001, = 0.002, = 0.001, respectively). This statistical shape analysis described greater perineal and external anal sphincter descent, increased iliococcygeus concavity, and a proportionally wider mid-posterior levator hiatus in late pregnant compared to nulliparous and parous women. The late pregnant group was the most divergent, highlighting differences that likely reduce the mechanical burden of vaginal childbirth. This robust quantification of PFMC shape provides insight to pregnancy and postpartum remodeling and allows for generation of representative non-patient-specific PFMCs that can be used in biomechanical simulations.

The Impact of the COVID-19 Pandemic on the Level of Physical Activity, Emotional State, and Health Habits of Women in Late Pregnancy and Early Puerperium.

The study population was women 1-8 days postpartum. Participants were divided into three groups depending on when they were recruited: (1) prepandemic (Ppan: n = 252, December 2019-March 2020), (2) COVID1 group (Cov1: n = 262, May 2020-September 2020), and (3) COVID2 group (Cov2: n = 226, June 2021-September 2021). The Ppan group included women from before the pandemic. The Cov1 group included patients after some restrictions were lifted. The Cov2 group included women after vaccinations became available. Research tools included a demographical questionnaire (age, education, childbirth details), the Pregnancy Physical Activity Questionnaire (PPAQ), the Edinburgh Postnatal Depression Scale (EPDS), and the Health Behavior Inventory (IZZ). Regression analysis showed that regardless of other variables, women who gave birth during the pandemic spent less energy on total physical activity compared to the prepandemic group (Cov1: β = -18.930, 95%CI: -36.499 to -1.361; Cov2: β = -26.527, 95%CI: -44.322 to -8.733). We also found that as the risk of depression increased, engagement in general health habits decreased during the pandemic. The Covid-19 pandemic decreased the level of some subdomains of physical activity in pregnant women, with a general negative correlation between emotional state and healthy habits.

Maternal and infant outcomes in women with and without gestational diabetes mellitus in the COVID-19 era in China: Lessons learned.

The global COVID-19 pandemic has required a drastic transformation of prenatal care services. Whether the reformulation of the antenatal care systems affects maternal and infant outcomes remains unknown. Particularly, women with gestational diabetes mellitus (GDM) are among those who bear the greatest brunt. Thus, this study aimed to evaluate the impact of COVID-19 lockdown during late pregnancy on maternal and infant outcomes in women stratified by the GDM status in China. The participants were women who experienced the COVID-19 lockdown during late pregnancy (3185 in the 2020 cohort) or not (2540 in the 2019 cohort) that were derived from the Beijing Birth Cohort Study. Maternal metabolic indicators, neonatal outcomes, and infant anthropometrics at 12 months of age were compared between the two cohorts, stratified by the GDM status. Participants who experienced COVID-19 lockdown in late pregnancy showed lower gestational weight gain than those in the control cohort. Nevertheless, they displayed a worse metabolic profile. COVID-19 lockdown during pregnancy was associated with higher glycosylated hemoglobin (HbA1c) (β= 0.11, 95% CI = 0.05-0.16, q-value = 0.002) and lower high density lipoprotein cholesterol level (HDL-C) level (β=-0.09, 95% CI = -0.14 to -0.04, q-value = 0.004) in women with GDM, adjusted for potential confounders. In normoglycemic women, COVID-19 lockdown in late pregnancy was associated with higher fasting glucose level (β= 0.10, 95% CI = 0.08-0.12, q-value <0.0001), lower HDL-C level (β=-0.07, 95% CI = -0.08 to -0.04, q-value <0.0001), and increased risk of pregnancy-induced hypertension (adjusted OR=1.80, 95%CI=1.30-2.50, q-value=0.001). The fasting glucose level decreased less from early to late pregnancy in women who experienced COVID-19 lockdown than in the controls, regardless of the GDM status. The HDL-C has risen less with COVID-19 lockdown in the normoglycemic subgroup. In contrast, no significant differences regarding neonatal outcomes or infant weight were found between the two cohorts. Experiencing the COVID-19 lockdown in pregnancy was associated with worse maternal metabolic status but similar neonatal outcomes and infant weight.

Comparison of factor structures of the Pittsburgh sleep quality index between mid- and late pregnancy among Korean women: a cross-sectional study

BackgroundSleep disturbance in pregnant women needs to be accurately assessed in a timely manner during pregnancy, to receive assessment-driven accurate intervention. This study aims to compare the factor structure of the Pittsburgh Sleep Quality Index (PSQI) among women in mid- and late pregnancy and evaluate the psychometric features of the Korean version of the PSQI.MethodsThe survey questionnaire with the PSQI, Center for Epidemiological Studies Depression scale, and pregnancy stress, was completed by 281 women in mid- or late pregnancy. Exploratory factor analysis determined the best factor structure of the PSQI, and the Pearson correlation coefficient examined a convergent validity with depressive symptoms and pregnancy stress. Internal consistency was examined using Cronbach’s alpha.ResultsIn both mid- and late-pregnancy women, a two-factor structure model was identified. However, each factor’s different components were named differently. For women in mid-pregnancy, it was named “quantitative sleep quality” and “subjective sleep quality,” and for those in later stages of pregnancy, they were named “perceived sleep quality” and “daily disturbance.” The PQSI score showed a significantly positive correlation between depressive symptoms and pregnancy stress in mid- (r = 0.57 and r = 0.39, respectively), and late pregnancy (r = 0.48 and 0.28, respectively). The overall Cronbach’s alpha for the PSQI was 0.63.ConclusionsThe Korean version of the PSQI demonstrated excellent construct and convergent validity, making it suitable to assess the sleep quality of women in middle to late stages of their pregnancy. The PSQI was found to have a two-factor structure in the mid-and late pregnancy, but the components were different. As sleep quality changes with each gestational stage, factors affecting it during mid- and late pregnancy need to be separately examined. It will make it easier for medical professionals to provide pregnant women sleeping irregularly, with the right kind of intervention.

Symposium 2-5 - Clinical characteristics of pregnant women with COVID‑19 in Japan from a nationwide questionnaire survey

BackgroundWe examined the clinical characteristics and outcomes of pregnant women with COVID‑19 on a national scale in Japan.MethodsA nationwide questionnaire-based survey for all maternity services in Japan by the Japan Association of Obstetricians and Gynaecologists was conducted in July 2020 and July 2021, respectively. Information regarding maternal characteristics and epidemiological, clinical, treatment, and perinatal outcomes of pregnant women with COVID-19 during the first wave and second to fourth wave were collected.ResultsResponses from 1,418 and 1,288 institutions were assessed (65% and 60% of all delivery institutions in Japan.) Seventy-two and 1,474 pregnant women with COVID-19 were reported in the first wave and second to fourth wave, respectively. The most common route of infection was familial. Of the all patients, 80% were symptomatic, 7% had severe respiratory symptoms and one died (a tourist). The third trimester of pregnancy was the most common timing of diagnosis and severe cases were frequently reported in late pregnancy compared with in early pregnancy. Most pregnant women with COVID-19 had a cesarean section if delivery was necessary. In severe cases, preterm delivery due to infection was also common. There were no SARS-CoV-2 transmissions to newborns.ConclusionsThe importance of infection prevention should be emphasized, especially in women in late pregnancy, their families, and any cohabitants. The pregnant women in late pregnancy with COVID-19 need careful observation and follow-up.

Gut Dysbiosis Promotes Preeclampsia by Regulating Macrophages and Trophoblasts.

Preeclampsia is one of the leading causes of maternal and perinatal morbidity and is characterized by hypertension, inflammation, and placental dysfunction. Gut microbiota plays key roles in inflammation and hypertension. However, its roles and mechanisms in preeclampsia have not been fully elucidated. 16S rRNA gene sequencing and targeted metabolomics were conducted on stool samples from 92 preeclamptic patients and 86 normal late-pregnant women. Then, fecal microbiota transplantation and in vitro and in vivo functional experiments were performed to explore the roles and mechanisms of gut microbiota in preeclampsia development. We revealed the gut microbiota dysbiosis in preeclamptic patients, including significant reductions in short-chain fatty acid-producing bacteria and short-chain fatty acids. The gut microbiota of preeclamptic patients significantly exacerbated pathologies and symptoms of preeclamptic rats, whereas the gut microbiota of healthy pregnant women had significant protective effects. Akkermansia muciniphila, propionate, or butyrate significantly alleviated the symptoms of preeclamptic rats. Mechanistically, they significantly promoted autophagy and M2 polarization of macrophages in placental bed, thereby suppressing inflammation. Propionate also significantly promoted trophoblast invasion, thereby improved spiral arterial remodeling. Additionally, we identified a marker set consisting of Akkermansia, Oscillibacter, and short-chain fatty acids that could accurately diagnose preeclampsia. Our study revealed that gut microbiota dysbiosis is an important etiology of preeclampsia. Gut microbiota and their active metabolites have great potential for the treatment and diagnosis of preeclampsia. Our findings enrich the gut-placenta axis theory and contribute to the development of microecological products for preeclampsia.

Adverse maternofoetal outcomes associated with ionised calcaemia, total calcaemia, albuminaemia, and calcium supplementation in pregnancy: Analysis from a resource-limited setting.

Disorders of total calcium (tCa) in pregnancy have been associated with adverse maternofoetal outcomes. However, studies evaluating this from the viewpoint of ionised calcaemia are practically inexistent. This study estimates the prevalence of some adverse maternal and foetal outcomes and the potential effect of ionised calcium (iCa), tCa, albumin and calcium supplementation on some maternofoetal outcomes. A cross-sectional study was conducted among 1074 pregnant women in late pregnancy from four health facilities in the Nkongsamba Health District. Data were collected by interview, analysis of maternal blood samples and measurement of maternal and foetal parameters. Total calcaemia and albuminaemia were measured by atomic absorption spectrophotometry, while iCa and pH were measured using ion-selective potentiometry. Associations were measured using the odds ratio in simple and multiple logistic regression. The prevalence of low birth weight, macrosomia, and hypertension in pregnancy was 6.27 [4.97-7.89]%, 4.78 [3.65-7.89]%, 10.24 [8.57-12.20]%, respectively. Following multiple logistic regression, women with iCa levels ≤ 1.31mmol/L had significantly increased odds of hypertension in pregnancy (AOR = 2.47 [1.63-3.74], p-value = 0.000), having babies with low birth weight (AOR = 2.02[1.33-3.61], p-value = 0.002), low birth length (AOR = 2.00 [1.34-2.99], p-value = 0.001), low brachial circumference (AOR = 1.41[1.10-1.81], p-value = 0.007), first minute Apgar score < 7 (AOR = 3.08[1.70-5.59], p-value = 0.000) and fifth minute Apgar score < 7 (AOR = 2.86[1.32-6.16], p-value = 0.007). Ionised calcaemia had no significant association with maternal body mass index immediately after birth and the head circumference of the baby. Total calcaemia was found to have no significant association with any of the selected outcomes, while women with total albuminaemia ≤ 30mg/L had significantly higher odds of having babies with low birth weight (AOR = 3.40[1.96-5.91], p-value = 0.000), and Apgar scores < 7 at the first (AOR = 2.07[1.16-3.70], p-value = 0.013). Calcium supplementation showed no significant association with any of the selected outcomes except for the first (OR = 0.42[0.24-0.72], p-value = 0.002) and fifth minute Apgar score (OR = 0.25[0.12-0.50], p-value = 0.000). The prevalence of low birth weight, macrosomia, and hypertension in pregnancy was 6.27 [4.97-7.89]%, 4.78 [3.65-7.89]%, 10.24 [8.57-12.20]%, respectively. Maternal iCa levels ≤ 1.31mmol/L significantly increase the odds of having babies with low birth weight, low birth length, low brachial circumference at birth, low Apgar scores at the first and fifth minutes and maternal hypertension in pregnancy. Low maternal albuminaemia is significantly associated with low birth weight, and Apgar score < 7 at the first minute. None f the selected maternofoetal outcomes directly depend on total calcaemia, given that none of the associations was statistically significant. Even though iCa levels remain relatively normal in normal pregnancies, it remains the strongest predictor of foetal outcomes. Calcium supplementation significantly improves the Apgar scores at the first and fifth minute. Routine pregnancy follow-up should include evaluating maternal calcaemic states, particularly the ionised fraction, to detect the low-normal concentrations likely to impact maternal and foetal outcomes. Normal iCa levels for pregnant women need revisiting.

Metformin Versus Insulin in the Managment of Gestational Diabetes Mellitus

Background: Insulin and metformin have been used extensively in the management of gestational diabetes mellitus (GDM).Insulin has been the primary medical treatment if maternal glucose targets are not achieved by dietary therapy.Insulin is safe for the fetus, because it does not normally cross the placenta. oral antidiabetic agents, glibenclamideand metformin are the most studied agents to treat GDM patients.Objective: To examine If oral metformln Is as effective as Insulin ln the prevention of fetal macrosomy lnpregnancies complicated with gestational diabetes mellitus.Method: This study is an open -labeled prospective randomized controlled study that was carried out in Basramaternity-outpatient clinics in the tertiary level hospital ln Basra. One hundred women with GDM who didnot attain euglycaemia with diet participated. Women were randomized to therapy with insulin n= 50 or oralmetformin n=50. Incidence of macrosomia in infants and neonatal morbidity was measured.Results: There were no statistically significant differences tn the incidence of macrosomia (16°/o versus 20°/o), and neonatal morbidity between insulin and metformtn group. Around 15 (30°/o) of the metformin treatedwomen needed supplemental insulin. They were more obese,(36.2 versus 30.6) kg/m2 bad higher fasting bloodglucose level (7.4mmol/L versus 6.1 mmol/L) and needed medical treatment for GDM earlier ( 27 versus 32 wks )than women who were normoglycemic with metformin alone. There was a tendency to a higher rate of caesareansections in the metformin group than in the insulin group.Conclusion: Metformin seems to be suitable for the prevention of fetal macrosomia , especially in lean or moderatelyoverweight women developing GDM in late pregnancy Women with considerable obesity, high fasting bloodglucose and an early need for pharmacological treatment may be more suitable for insulin therapy.

Reducing the Risk of Gestational Diabetes Mellitus in Pregnant Women with Metabolic Syndrome by Dietary Intervention During Early Pregnancy

Objective: The study objective was to explore the clinical observation of reducing the risk of gestational diabetes mellitus (GDM) in pregnant women with metabolic syndrome (MS) by dietary intervention during early pregnancy. Methods: Singleton pregnant women who set early pregnancy filings and had regular prenatal care and delivery at Zengcheng Hospital of Guangzhou Women and Children's Medical Center of Guangdong Province from January 2020 to June 2021 were screened out according to the diagnostic criteria for MS promulgated by the International Diabetes Federation in 2005. Pregnant women meeting the diagnostic criteria for MS were randomly divided into the intervention group (n = 80) and the control group (n = 80). The changes in the indicators of MS (fasting plasma glucose [FPG], total cholesterol [TC], triglyceride [TG], high-density lipoprotein [HDL], low-density lipoprotein [LDL], systolic blood pressure [SBP], and diastolic blood pressure [DBP]) in early and late pregnancy were observed, and the incidence of GDM was analyzed. Results: There was no significant difference (P &gt; 0.05) in TC, TG, FPG, LDL, HDL, SBP, or DBP of women in early pregnancy between the two groups. There was no significant difference (P &gt; 0.05) in TC and TG of women in late pregnancy between the two groups. The FPG, LDL, SBP, and DBP of the intervention group were lower than those of the control group, and the HDL of the intervention group was higher than that of the control group, which showed a significant difference in the two groups (P &lt; 0.05). The incidence of GDM in the intervention group was lower than those of the control group (P &lt; 0.05). Conclusion: Pregnant women with MS before their pregnancy were at a high risk of GDM. Diet and exercise interventions in early pregnancy could improve the indicators of their blood metabolism and lipid metabolism, which could effectively reduce the incidence of GDM and thus improve the adverse pregnancy outcome and ensure the safety of the mothers and the infants.

Sequential Screening Strategy in Early, Middle, and Late Pregnancy in Women at High Risk of Hyperglycemia.

BackgroundHyperglycaemia in pregnancy (HIP) is closely associated with short- and long-term adverse fetal and maternal outcomes. However, the screening and diagnostic strategies for pregnant women with risk factors for HIP are not set. This prospective study aimed to explore a screening strategy for women at high risk for HIP.MethodsA total of 610 pregnant women were divided into experimental (n=305) and control (n=305) groups. Pregnant women underwent a 75-g OGTT in early (<20 weeks), middle (24–28 weeks), and late pregnancy (32–34 weeks) in the experimental group and only in middle pregnancy in the control group. The general conditions, HIP diagnosis, and perinatal outcomes of the two groups were compared.ResultsIn the experimental group, HIP was diagnosed in 29.51% (90/305), 13.44% (41/305), and 10.49% (32/305) of patient in early, middle, and late pregnancy, respectively. The total HIP diagnosis rate was significantly higher in the experimental group (53.44% vs. 35.74%, P<0.001). Multivariate logistic regression analysis revealed that previous gestational diabetes mellitus (GDM) (odds ratio, OR=9.676, P<0.001), pre-pregnancy body mass index (BMI) ≥23 kg/m2 (OR=4.273, P<0.001), and maternal age ≥35 years (OR=2.377, P=0.010) were risk factors for HIP diagnosis in early pregnancy. Previous GDM (OR=8.713, P=0.002) was a risk factor for HIP diagnosis in late pregnancy. No significant differences in perinatal clinical data were observed between the experimental and control groups. The gestational age at delivery was significantly earlier in the experimental subgroup with early-HIP than in the experimental and control subgroups with normal blood glucose (NBG). The weight gain during pregnancy was lower in the experimental early-HIP, middle-HIP, and control NBG subgroups.ConclusionsWe recommend sequential screening in early and middle pregnancy for high-risk pregnant women with maternal age ≥35 years or pre-pregnancy BMI ≥23 kg/m2, and in early, middle, and late pregnancy for high-risk pregnant women with a previous history of GDM.Trial RegistrationThis study was registered in the Chinese Clinical Trial Registry (no. ChiCTR2000041278).

Effects of Low-dose Antibiotic Exposure on Fetal Growth and Development

Objective To analyze maternal blood exposure to non-therapeutic antibiotics in late pregnancy and explore the effects of low-dose antibiotics on fetal growth and development.Methods A total of 104 pregnant women in late pregnancy (28-32 weeks) without serious pregnancy complications were enrolled,who had regular antenatal examination and delivery in Peking Union Medical College Hospital and did not use therapeutic antibiotics 2 months before pregnancy and in the whole pregnant process.The levels of antibiotics in the maternal blood were detected by liquid chromatography-tandem mass spectrometry,and the pregnant women were assigned into an antibiotic exposure group (antibiotic positive) and a non-exposure group (antibiotic negative).The length,weight,placental weight,and placental volume of the newborns in the two groups were measured,and the data were statistically analyzed by t test or χ2 test.Results The maternal blood antibiotic test showed 7 positive cases (6.73%,antibiotic exposure group) and 97 negative cases (93.27%,non-exposure group). The average length of newborns in the antibiotic exposure group and the non-exposure group was (49.57±1.40) cm and (48.85±1.77) cm,respectively,with no significant difference (t=1.060,P=0.363).The average weight of newborns in the antibiotic exposure group and the non-exposure group was (3558.57±382.95) g and (3275.36±356.41) g,respectively,with significant difference (t=2.021,P=0.046).The mean placental weight in the antibiotic exposure group and the non-exposure group was (676.43±124.59) g and (631.96±129.25) g,respectively,with no significant difference (t=0.881,P=0.380).The mean placental volume in the antibiotic exposure group and the non-exposure group was (724.67±174.91) cm3 and (676.82±220.86) cm3,respectively,with no significant difference (t=0.560,P=0.388).Compared with those in the non-exposure group,the neonatal length,neonatal weight,placental weight,and placental volume in the antibiotic exposure group increased by 1.47%,8.65%,7.04%,and 7.07%,respectively.Conclusion There are antibiotics in the environment,and maternal blood exposure to non-therapeutic antibiotics can promote the growth and development of the fetus and placenta,especially increasing the fetal weight.

Sofosbuvir-based therapy for late pregnant women and infants with severe chronic hepatitis C: A case series study.

Data on sofosbuvir-based therapy for pregnant women and infants with severe chronic hepatitis C (CHC) are lacking. Two late pregnant women and one female infant with severe CHC were enrolled for treatment. Pregnant Women 1 and 2 and Infant 3 were 30, 33, and 1.2 years old, respectively; the gestational ages of pregnant Women 1 and 2 were 31 and 26 weeks, respectively. Notably, pregnant Women 1 and 2 and Infant 3 had hepatitis C virus (HCV) RNA levels of 139 000, 198 000, and 8 450 000 IU/ml; alanine aminotransferase levels of 420, 781, and 220 U/L; and received sofosbuvir/ledipasvir, sofosbuvir/velpatasvir, and sofosbuvir/ledipasvir for 12 weeks, respectively. All three patients were safely cured with favorable tolerance, and two newborns were both breastfeeding and were consistently negative for the anti-HCV antibody during the 1-year follow-up after birth. Additionally, two newborns and Infant 3 had normal growth parameters during the follow-up year one. In conclusion, this case series study found that sofosbuvir-based therapy for pregnant women and infants with severe CHC is safe and effective. The data may fill the gap and provide evidence of the use of sofosbuvir-based therapy as a reference when similar severe CHC situations are encountered during clinical practice.

Differences in Hemoglobin A1c during Pregnancy between Non-Hispanic Black versus White Women with Prepregnancy Diabetes.

The objective of this was to determine whether the change in hemoglobin A1c (HbA1c) from early to late pregnancy differs between non-Hispanic Black and White women with prepregnancy diabetes. A retrospective analysis was performed from an integrated prenatal and diabetes care program from 2012 to 2016. We compared HbA1c as a continuous measure and secondarily, HbA1c <6.5%, cross-sectionally, and longitudinally in early (approximately 10 weeks) and late (approximately 31 weeks) pregnancies. Linear and logistic regression were used and adjusted for age, body mass index, White diabetes class, medication use, diabetes type, gestational age at baseline HbA1c measurement, and baseline hemoglobin. Among 296 non-Hispanic Black (35%) and White pregnant women (65%) with prepregnancy diabetes (39% type 1 and 61% type 2), Black women were more likely to experience increased community-level social determinants of health as measured by the Social Vulnerability Index (SVI) and were less likely to have type 1 diabetes and have more severe diabetes versus White women (p < 0.05). Black women had higher mean HbA1c (7.8 vs. 7.4%; beta: 0.75; 95% confidence interval [CI]: 0.30-1.19) and were less likely to have HbA1c < 6.5% at 10 weeks compared with White women (24 vs. 35%; adjusted odds ratio: 0.45; 95% CI: 0.24-0.81) but not after adjusting for SVI. At 31 weeks, both groups had similar mean HbA1c (both 6.5%) and were equally as likely to have HbA1c < 6.5% (57 vs. 54%). From early to late pregnancy, Black women had a higher percentage decrease in HbA1c (1.3 vs. 0.9%; beta = 0.63; 95% CI: 0.27-0.99) and were equally as likely to have an improvement or stable HbA1C < 6.5% from 10 to 31 weeks, with both groups having a similar mean HbA1c (6.5%) at 31 weeks. Despite experiencing greater community-level social determinants of health, Black women with pregestational diabetes had a larger reduction in HbA1c and were able to equally achieve the target of HbA1c < 6.5% by late pregnancy compared with White women as part of an integrated diabetes and prenatal care program. · An integrated diabetes and pregnancy care program may decrease racial and ethnic disparities in glycemic control.. · Black women had a larger reduction in HbA1c versus White women.. · Black women were able to equally achieve the target of HbA1c < 6.5% by late pregnancy versus White women..