Physical activity and sleep duration during pregnancy have interactive effects on caesarean delivery: a population-based cohort study in Tianjin, China

Obstetric and pregnancy-related factors associated with caesarean delivery in Bangladesh: a survey in Rajshahi district

OBJECTIVES

Caesarean section (CS) delivery is the most common operative obstetric procedure globally. The increasing trend of CS deliveries poses a significant threat to both child and maternal health. The adverse maternal outcomes associated with caesarean delivery represent a substantial public health concern worldwide. This study aimed to identify emerging obstetric and pregnancy risk factors and maternal outcomes associated with CS delivery among women in Rajshahi district, Bangladesh.

DESIGN

This was a cross-sectional study.

SETTING

Data were collected from 9 Upazilas with 233 community clinics of Rajshahi district, Bangladesh.

PARTICIPANTS

Multistage sampling technique was utilised for selecting sample from the population. A total of 540 mothers with a live infant were enrolled in the study. Descriptive statistics, χ2 test, logistic regression and ROC curve were used to analyse the data.

RESULTS

The mean age of respondents was 26.28 years (SD 4.96); among them, the proportion of CS was 34.44%, with a higher proportion occurring in private clinics (82.8%) compared with public hospitals (17.2%). The likelihood of having a CS increased with factors such as insufficient sleep duration (p=0.002), oedema problems (p=0.014), inadequate supplements of micronutrients (p=0.009), severe headaches with blurred vision (p=0.028) and inadequate food consumption during pregnancy (p=0.032). The probability of experiencing obstetric fistula or postpartum anaemia (p=0.049) was higher among mothers who had a CS in their most recent live birth than mothers who had a vaginal birth.

CONCLUSION

The study found that having a CS increases the risk of maternal complications like an obstetric fistula or postpartum anaemia. Considering these results, it is recommended to urgently introduce carefully evaluated clinical practices to assess if vaginal delivery is possible. Counselling women about the delivery method is important to decrease unnecessary CS in Bangladesh.

Associations of maternal sleep trajectories during pregnancy and adverse perinatal outcomes: a prospective cohort study

OBJECTIVE

Sleep problems are common in pregnant women and sleep is altered during pregnancy. However, the associations between sleep trajectory patterns and adverse maternal and neonatal outcomes are unclear. The current study aims to identify sleep trajectory patterns and explore their associations with adverse perinatal outcomes in a prospective cohort study.

METHODS

Pregnant women (N = 232) completed the Pittsburgh Sleep Quality Index each trimester during pregnancy in Tianjin, China. Perinatal outcomes were extracted from the hospital delivery records. Latent class growth analysis (LCGA) described the trajectories of sleep timing, duration, and efficiency. Multivariable linear regression and multivariable logistic regression were employed to evaluate associations between sleep trajectory patterns and perinatal outcomes.

RESULTS

Trajectories were identified for bedtime (early, 49.1%; delaying, 50.9%), wake-up time (early, 82.8% of the sample; late, 17.2%), duration (short, 5.2%; adequate 78.0%; excessive, 16.8%), and efficiency (high, 88.4%; decreasing, 11.6%). Compared with women in more optimal sleep groups, those in the late wake-up, excessive duration, and decreasing efficiency groups had babies with shorter birth lengths (β range, -0.50 to -0.28, p < 0.05). Moreover, women in the decreasing efficiency group had babies with lower birth weight (β, -0.44; p < 0.05). Women in the delaying bedtime group had greater odds of preterm delivery (OR, 4.57; p < 0.05), while those in the decreasing efficiency group had greater odds of cesarean section (OR, 3.12; p < 0.05).

CONCLUSIONS

Less optimal sleep trajectory patterns during pregnancy are associated with perinatal outcomes. Therefore, early assessment of maternal sleep during pregnancy is significant for identifying at-risk women and initiating interventions to reduce perinatal outcomes.

Perioperative Exercise Testing in Pregnant and Non-Pregnant Women of Reproductive Age: A Systematic Review

BACKGROUND

Women have classically been excluded from the development of normal data and reference ranges, with pregnant women experiencing further neglect. The incidence of Caesarean section in pregnant women, and of general operative management in young women (both pregnant and non-pregnant), necessitates the formal development of healthy baseline data in these cohorts to optimise their perioperative management. This systematic review assesses the representation of young women in existing reference ranges for several functional exercise tests in common use to facilitate functional assessment in this cohort.

METHODS

Existing reference range data for the exercise tests the Six Minute Walk Test (6MWT), the Incremental Shuttle Walk Test (ISWT) and Cardiopulmonary Exercise Testing (CPET) in young women of reproductive age were assessed using the MEDLINE (Ovid) database, last searched December 2023. Results were comparatively tabulated but not statistically analysed given underlying variances in data.

RESULTS

The role of exercise testing in the perioperative period as an assessment tool, as well as its safety during pregnancy, was evaluated using 65 studies which met inclusion criteria.

CONCLUSION

There is a significant lack of baseline data regarding these tests in this population, especially amongst the pregnant cohort, which limits the application of exercise testing clinically.

Retracted: The effects of a midwife-led weight management program for pregnant women: A randomized controlled trial

BACKGROUND

Inappropriate weight gain during pregnancy may present risks for maternal and newborn health. Pregnancy is considered the optimal time to intervene on women's health behaviors such as eating habits and physical activity. However, current clinical practice guidelines for weight management during pregnancy were not fully based on randomized trials, thus lacking specific "active intervention ingredients" that are proven effective in achieving appropriate gestational weight gain. Therefore it is essential to develop and implement an evidence-based weight management program for pregnant women.

OBJECTIVE

To examine the effects of a midwife-led weight management program on improving appropriate gestational weight gain, health literacy, experience of antenatal care, and maternal and neonatal outcomes among Chinese pregnant women.

DESIGN

A two-group randomized controlled trial.

SETTINGS AND PARTICIPANTS

A total of 426 pregnant women were recruited from a tertiary women's hospital in eastern China.

METHODS

Participants were randomly allocated to either intervention group (n = 213) or control group (n = 213). Women in the intervention group participated in a midwife-led weight management program during pregnancy, while women in the control group received the conventional obstetrician-led antenatal care. We assessed women at the first antenatal contact, 35-36 weeks gestation and 2-3 days postpartum. Data on gestational weight gain, health literacy, experience of antenatal care, and maternal and neonatal outcomes were compared between the two groups. Dummy variable analysis was conducted to reveal the effect of weight management program on gestational weight gain.

RESULTS

The overall gestational weight gain between the two groups was not statistically different (t = -1.377, P = 0.170). Compared with women in the control group, the odds of having inappropriate gestational weight gain was lower in the intervention group (OR = 0.270, 95%CI 0.169, 0.431). Further subgroup analyses showed that women in the intervention group had lower risk of inadequate gestational weight gain (OR = 0.305, 95%CI 0.180, 0.515) and excessive gestational weight gain (OR = 0.236, 95%CI 0.138, 0.404) than those in the control group. The score of experience of antenatal care was significantly higher in the midwife-led weight management group than that in the control group (193.70 ± 18.51 versus 165.70 ± 28.23, P < 0.001). Women's health literacy score was higher in the intervention group than control group [74.41 (69.57, 81.77) versus 71.88 (66.23, 77.18), P = 0.004].

CONCLUSION

Compared with the conventional antenatal care, the midwife-led weight management program could facilitate appropriate gestational weight gain, enhance health literacy, and promote positive experience of antenatal care for Chinese pregnant women.

Study on the sleep quality of women pregnant with a second child and the influencing factors

OBJECTIVES

To investigate the sleep quality of women pregnant with a second child and the influencing factors and provide a scientific basis for health care guidance to clinically improve the sleep quality of pregnant women.

METHODS

A total of 162 women pregnant with a second child at a first-class tertiary hospital in Changsha from January to August 2018 were selected as the research subjects. General demographic characteristics were collected, and the Pittsburgh Sleep Quality Index (PSQI) scale was used to assess their sleep quality. Multivariate logistic regression analysis was used to explore the influencing factors of the sleep quality of women pregnant with a second child.

RESULTS

The PSQI score (except hypnotic drugs) and total score of pregnant women with second birth were higher than those of normal female population, and the difference was statistically significant (P < 0.05). Univariate analysis showed statistically significant differences in sleep quality among women pregnant with a second child of different ages, marital relationships, gender expectations, education levels, monthly family incomes, planned or unplanned pregnancy, and gestational weeks (P < 0.05). The results of the multi-factor analysis showed that the low education level (OR = 0.224, P = 0.001), low family monthly income (OR = 3.035, P = 0.014), expectation of gender (OR = 0.065, P = 0.038), and dissatisfaction with marital relationship (OR = 0.275, P = 0.001) were the primary risk factors of poor sleep quality of in women with second pregnant.

CONCLUSIONS

The overall sleep quality of women pregnant with a second child is poor, and 37.65% have sleep quality problems. Low education levels, low family monthly incomes, fetal gender expectations, and poor relationship between husband and wife are the main factors affecting the sleep quality of women pregnant with a second child. Pregnant women with the above factors should pay attention to their sleep quality and take necessary measures for intervention and guidance to improve the level of health care during pregnancy.

Maternal sleep during pregnancy and adverse pregnancy outcomes: A systematic review and meta-analysis

AIMS/INTRODUCTION

Sleep problems are important public health concern worldwide. We carried out a meta-analysis to quantitatively evaluate whether sleep duration was associated with pregnancy outcomes, and the associations were modified by important characteristics of studies.

MATERIALS AND METHODS

Based on PubMed, Embase and the Cochrane Central Register of Controlled Trials databases, we searched for published literature related to maternal sleep duration and adverse pregnancy outcomes before 30 June 2021. We carried out risk of bias assessment, subgroup analyses and sensitivity analysis. The relative risks or odds ratios with 95% confidence intervals (CI) were used to estimate the pooled effects.

RESULTS

A total of 5,246 references were identified through a database search, and 41 studies were included in the study. Pregnant women with short sleep duration had 1.81-fold (95% CI 1.35-2.44, P < 0.001) the risk of developing gestational diabetes mellitus. The association between short sleep duration and the risk of gestational hypertension, cesarean section, low birthweight, preterm birth and small for gestational age were not significant (P > 0.05). Furthermore, long sleep duration was significantly correlated with gestational diabetes mellitus (odds ratio1.24. 95% CI 1.12-1.36, P < 0.001) and CS (odds ratio 1.13. 95% CI 1.04-1.22, P = 0.004), whereas long sleep duration was not linked with gestational hypertension, low birthweight, preterm birth and small for gestational age (P > 0.05).

CONCLUSIONS

Short/long sleep duration appeared to be associated with adverse pregnancy outcomes, specifically with an increased risk of gestational diabetes mellitus. Sleep should be systematically screened in the obstetric population.