The iron status of rural Nigerian women in the second and third trimesters of pregnancy: implications for the iron endowment and subsequent dietary iron needs of their babies

INTRODUCTION

The aim of the study was to determine the iron status of rural-dwelling pregnant Nigerian women in the second and third trimesters, and to predict their risk of giving birth to babies with suboptimal iron endowment.

METHODS

This was a prospective cohort study conducted between April and August 2021. A total of 174 consecutive and consenting pregnant rural dwellers, who met the inclusion criteria, were recruited by convenience sampling from the antenatal clinic of a public hospital in Nsukka, a semirural town in south-east Nigeria. The study participants were aged 21-40 years, and their iron status was determined by measuring blood haemoglobin (Hb) and serum ferritin (SF) concentration. Hb concentration was determined by the cyanmethemoglobin method and the SF concentration was determined by enzyme immunoassay method.

RESULTS

Almost half (47.7%) of the participants had Hb concentrations below 11 g/dL, while about two out of every five (40.8%) had SF concentrations less than 15 µg/L. The prevalence of iron deficiency, iron deficiency anaemia (IDA) and non-iron deficiency anaemia were 40.8%, 23.6% and 24.7%, respectively. The mean SF levels varied with maternal age, gestation stage, pregnancy intervals and the intake of iron supplements. The mean SF concentration was higher in the second trimester than in the third. The mean SF concentration ± standard deviation (37.10±3.02 µg/L) was higher in the group that took iron supplements than in the group that did not (20.76±2.11 µg/L). However, two out of five participants in both groups had SF concentrations less than 15.0 µg/L.

CONCLUSION

The prevalence of IDA was quite high among the participants in both trimesters even with the widespread intake of the recommended oral iron supplements. About four out of 10 of the participants had SF concentrations of less than 15 µg/L and were thus judged at risk of giving birth to babies with poor iron deposits. Therefore, more effective strategies are needed to monitor and prevent IDA among pregnant women in rural populations of Nigeria and, by inference, other parts of tropical Africa.

OBSTETRIC AND PERINATAL ASPECTS OF METABOLIC DISORDERS IN PREGNANT WOMEN

OBJECTIVE

The aim: To determine the feasibility of using Tivortin in metabolic disorders during pregnancy and its effect on the course of pregnancy, childbirth, fetal and neonatal status.

PATIENTS AND METHODS

Materials and methods: We examined 210 pregnant women with metabolic disorders using clinical and laboratory data, uterine artery Doppler, determi¬nation of lipid peroxidation and antioxidant system, leptin and placental growth factor content. The fetal condition was assessed by ultrasound examination with Doppler, determination of biophysical profile, and cardiotocography.

RESULTS

Results: Metabolic disorders in pregnant women increase the risk of obstetric and perinatal complications by activating lipid peroxidation and inhibiting the antioxidant system, reducing the content of placental growth factor and increasing the level of leptin in the blood plasma. After treatment, there was a significant decrease in leptin levels and an increase in placental growth factor levels, normalization of lipid peroxidation and antioxidant system, uterine artery pulsatility index and umbilical cord peak systolic velocity index, systolic-diastolic ratio, fetal biophysical profile and cardiotocography. The incidence of complications in childbirth decreased by 3 times, surgical interventions - by 2 times, postpartum infectious complications - by 1.7 times, and the birth of infants in a state of asphyxia - by 1.8 times.

CONCLUSION

Conclusions: Metabolic disorders in pregnant women are a significant factor in the development of obstetric and perinatal complications due to the intensity of lipid peroxidation and depression of the antioxidant system, and a decrease in the content of placental growth factor. The use of Tivortin in the treatment of pregnant women with metabolic disorders has proven its safety and efficacy.

The role of continuous glucose monitoring in pregnancy

The risks associated with diabetes in pregnancy include congenital anomalies, stillbirth and miscarriage, and correlate with glycaemia. The optimisation of diabetes during pregnancy is therefore both challenging and essential. Technology has revolutionised how clinicians and patients manage diabetes. This review article focuses on the role of continuous glucose monitoring (CGM) in pregnancy, assessing the evidence available and providing an update on current guidance.

Remdesivir use in pregnancy during the SARS-CoV-2 pandemic

OBJECTIVE

To ascertain the composite maternal and neonatal outcomes in pregnant individuals with moderate, severe, or critical coronavirus disease 2019 (COVID-19) treated with remdesivir.

MATERIALS AND METHODS

This is a secondary analysis of the COVID in Pregnancy Registry in Houston, Texas. Women were included if they met the criteria of moderate, severe or critical COVID-19 illness. Composite adverse maternal outcome was defined as any of the following outcomes: placental abruption, pregnancy-related hypertension, chorioamnionitis, stroke, delivery with estimated blood loss >1000 mL, diagnosis of pulmonary embolism or deep venous thromboembolism, or maternal death. Composite adverse neonatal outcome was defined as any of the following: Apgar score ≤3 at 5 min, arterial cord pH <7.0, positive SAR-CoV-2 test, intraventricular hemorrhage, periventricular leukomalacia, stillbirth, or neonatal death. Comparative analyses between participants receiving remdesivir versus those not exposed were performed.

RESULTS

A total of 994 patients were diagnosed with COVID-19 infection. Of these, 95 (9.6%) met criteria for moderate, severe, or critical disease. Forty-one percent of these patients (n = 39) received remdesivir. Baseline demographic characteristics were not different between groups. No patients reported an allergic reaction with the administration of remdesivir; however, 16.7% of the patients had the medication discontinued due to transaminitis. Patients receiving the drug were more likely to have a longer illness duration on admission, more likely to require oxygen support on arrival and have a longer hospital stay.

CONCLUSIONS

Remdesivir appears to be safe, well tolerated within our cohort with no cases of recorded adverse reaction.

A SINGLE-CENTER EXPERIENCE

OBJECTIVE

The aim: Presentation of a single-center experience of cardiac surgery with cardiopulmonary bypass (CPB) in pregnant women with critical cardiac pathology. The possibility of minimally invasive technique in this group of patients were presented.

PATIENTS AND METHODS

Materials and methods: The present study included 19 cases of multidisciplinary care with CPB surgery in pregnant women in single center from December 2013 to December 2020. 8 patients underwent J-form median mini-sternotomy. Maternal and neonatal outcomes depending on the type of surgery (urgent or elective) were reviewed.

RESULTS

Results: There were no negative maternal consequences; there were 4 perinatal losses (21%): three after urgent and one after elective interventions. All other pregnancies (n=15) finished successfully with the birth of healthy newborns. We compared some values in two groups (urgent and elective) of patients who underwent CPB surgery during pregnancy. Despite the variability in some parameters the difference between the groups was not significant. Follow-up was from 5 to 72 months (39.7±16.9) without negative consequences.

CONCLUSION

Conclusions: Multidisciplinary team management is an effective strategy for pregnant women with cardiac pathology. Elective cardiac surgery in expert centers during pregnancy is a safe and effective option. Urgent CPB cardiac surgery during pregnancy increases the risk for the fetus. J-form median mini-sternotomy is a good option during pregnancy in high-experienced centers.

The trajectory of fear of birth during and after pregnancy in women living in a rural area far from the hospital and its labour ward

INTRODUCTION

There is a growing interest in fear of childbirth. The prevalence, reasons and treatment have been investigated, but the development of fear of birth during and after pregnancy in a sample of women from a rural area is less studied. The aim of this study was to explore the trajectories of fear of birth and associated factors in a sample of women living in a rural area of Sweden.

METHODS

A longitudinal cohort study of women were recruited to a continuity-of-care project in mid-pregnancy and followed up 2 months after birth. Data were collected by two questionnaires. Fear of birth was assessed using the Fear of Birth Scale (FOBS) in mid-pregnancy, in retrospect after birth and looking forward to a possible future birth.

RESULTS

The questionnaire was completed by 280 women in mid-pregnancy and by 236 women after giving birth. The mean FOBS fluctuated over time: it was highest in pregnancy, lower after birth and then increased once more when women were thinking about a future birth. Factors associated with developing fear after birth were mainly related to having had an emergency caesarean section, epidural, augmentation, or neonatal care that resulted in a less positive birth experience. Reduction of fear was associated with antenatal support. For some women, the levels of fear did not change, and these women were characterised with worse self-rated health but also more negative experiences of having given birth.

CONCLUSION

Fear of birth seemed to change over time and was associated with women's emotional wellbeing, circumstances accompanying the actual birth and the whole birth experience. Support during pregnancy could change the trajectory of fear of birth. Women whose levels of fear were high rated their health lower and had a more negative birth experience. More research is needed into how best to help women overcome their fear of birth.

Pathomorphological characteristics and immunohistochemical features of placentae from hiv-positive pregnant women with fetal growth retardation

OBJECTIVE

The aim: To study the pathomorphological characteristics and immunohistochemical features of placentae from human immunodeficiency virus-positive (HIV-positive) pregnant women with FGR.

PATIENTS AND METHODS

Materials and methods: The study material was 32 placentae, including 12 placentae from HIV-positive pregnant women with FGR (study group), 10 placentae from HIVpositivepregnant women without FGR (comparison group) and 10 placentae from HIV-negative women with physiological pregnancy (control group). An immunohistochemical study was performed using monoclonal antibodies (MCA) against CD31+ and vascular endothelial growth factor (VEGF).

RESULTS

Results: Pathomorphologic changes of the placentae from HIV-positive pregnant women with FGR were characterized by edema in the umbilical cord tissue, partial dissection of the vascular wall fibers, dysmucoidosis; intracellular edema and hemorrhage in the fetal membrane tissues. In the placentae tissue it was found marked manifestations of degenerative changes in the form of the areas of fibrinoid necrosis, pronounced manifestations of dysmucoidosis, vacuolation of the villi stroma, an increase in the number of avascular villi and immature villi of small caliber with the phenomena of syncytiotrophoblast focal hyperplasia. An immunohistochemical study with MCA against CD31+ revealed the expression (optical density) of the vascular endothelial cells up to 2 points, and the expression level up to 3 points in the isolated areas with the appearance of the expression on the villi surface and in their thickness. During immunohistochemical studies with VEGF the expression level and its optical density increased up to 2-3 points, in some areas the expression of deposits were detected on the villi surface, in their thickness and in the intervillous space.

CONCLUSION

Conclusions: The comparative pathomorphological and immunohistochemical study of the placentae demonstrated more significant changes in the group of HIV-positive pregnant women with FGR. In the placentae of HIV-positive pregnant women with FGR immunohistochemical examinations revealed a high level of CD31+ and VEGF expression.

The effect of beta-blockers on foetal birth weight in pregnancies in women with structural heart disease: a prospective cohort study

OBJECTIVE

To examine whether treatment with beta-blockers (BBs) in pregnant women with structural heart disease (SHD) resulted in a decrease in foetal birth weight (FBW) in a South African cohort.

METHODS

This was a prospective cohort study conducted in a tertiary-level hospital in Cape Town from 2010 to 2016. Of the 178 pregnant women with SHD, 24.2% received BBs for a minimum of two weeks. Adverse foetal outcomes and mean FBW were compared between the BB groups and subgroups (congenital, valvular, cardiomyopathy and other). Adverse foetal outcome was defined as: low birth weight (LBW) < 2 500 g, Apgar score < 7, premature birth (< 37 weeks) and small for gestational age (SGA).

RESULTS

BB exposure during pregnancy was found to be associated with a non-significant increased FBW (2 912 vs 2 807 g, p = 0.347). A significant decrease (p = 0.009) was noted in FBW for valvular SHD pregnancies using BBs, while a significant increase (p = 0.049) was observed for the same outcome in the cardiomyopathy subgroup using BBs. A significant increase was observed for SGA (p = 0.010) and LBW (p = 0.003) pregnancies within the valvular subgroup when exposed to BBs.

CONCLUSIONS

BB use in pregnant women with SHD in a South African cohort showed no association with a decrease in FBW or an increase in adverse foetal outcomes when compared to non-BB usage.

[Qilin Pills improve sperm quality in patients with oligozoospermia]

OBJECTIVE

To observe the therapeutic effect of Qilin Pills (QLP) on oligoasthenospermia.

METHODS

This prospective study included 168 patients diagnosed with oligozoospermia in our hospital between September 2015 and September 2017, and all of them failed to achieve pregnancy. We randomly divided them into a QLP group (n = 82) and a placebo control group (n = 86) to receive oral QLPs or placebo pills, respectively, both at 6 g tid for 6 months. We followed up the patients and recorded their routine semen parameters every month during the medication and the rate of pregnancy in their spouses.

RESULTS

After 6 months of treatment, the QLP group, as compared with the placebo controls, showed significantly improved sperm concentration (25.13 ×10⁶/ml vs 11.62 ×10⁶/ml, P < 0.01), grade a+b sperm (33.81% vs 17.32%, P < 0.01), grade a sperm (22.84% vs 13.56%, P < 0.01) and sperm motility (56.33% vs 26.23%, P < 0.01); and 26 pregnancies were achieved in the QLP group (32.91%), remarkably more than 13 in the placebo control group (15.85%) (P < 0.01).

CONCLUSIONS

Qilin Pills can effectively improve sperm quality and increase the rate of pregnancy.

Fetal alcohol spectrum disorders - diagnostic difficulties in the neonatal period and new diagnostic approaches

Fetal alcohol spectrum disorders (FASD) is a group of disorders that can occur in children whose mothers consumed alcohol in pregnancy. Diagnosis of fetal alcohol syndrome is based on the appearance of growth deficiency, the presence of the three key features of facial dysmorphism (short palpebral fissures, thin upper lip, smooth or flattend philtrum) and/or disorders in the central nervous system (minimum 3) and prenatal exposure to alcohol (confirmed if possible). Early diagnosis of fetal alcohol syndrome - after birth or in infancy - is very often impossible or very difficult due to the incomplete manifestation of the key dysmorphic features. The latest reports offer the chance of diagnosing children in the neonatal period. The research focuses on the analysis of ethanol metabolites in the biological tissues in pregnant women or newborns. These unique ethanol metabolites include: fatty acid ethyl esters (FAEE) present in the meconium, blood, hair of the mother and the newborn, ethyl glucuronide in the placenta and meconium, urine, nails and hair, and phosphatidylethanol (PEth) found in the infant blood. The presence of fatty acid ethyl esters in the meconium could be a non-invasive and cost-effective method of early detection of disorders associated with prenatal alcohol exposure.

Clinical case of successful management of acute myocardial infarction during pregnancy

OBJECTIVE

Introduction: There have recently been increasingly frequent reports of myocardial infarction (MI) in pregnancy and in the postpartum period. Pertinent and timely treatment affect maternal and fetal morbidity and mortality.

PATIENTS AND METHODS

Clinical case: We are reporting about a 42 years old woman at the 19th week of gestation, with complains of chest pain with irradiation into the left arm, and shortness of breath. It was known from the history of present illness, that at the time of the event ventricular fibrillation was recorded and resuscitation measures with cardioversion were performed. Subsequently, after an additional examination in the hospital, a diagnosis of MI has been determined. Coronary angiography with cardiac ventriculography (CVG) has been performed and stenosis of left anterior descending coronary artery (LAD) and right coronary artery (RCA) detected. A revascularization with the insertion of the bare-metal stent system has performed and double antiplatelet therapy prescribed. At 37 weeks of gestation, the patient gave birth to a healthy child by caesarean section.

CONCLUSION

Conclusions: This clinical case illustrates the importance of minimizing the time to hospitalization of a pregnant woman with a MI to a specialized center for timely and complete diagnostic measures, which, in turn, allow to properly choose the tactics of patient management. Timely revascularization and properly selected anticoagulation are the key factors of the successful management in this category of patients.

Role of uterine blood flow disturbances in the development of late gestosis

OBJECTIVE

Introduction: Chronic endometritis (CE) associated lesions lessen the implantation potential of endometrium and aggravate the course of invasive processes in the uterine vessels The aim: Study of changes in doplerometric parameters of blood flow in spiral and uterine arteries in 17-18 weeks of pregnancy in women with СE in anamnesis.

PATIENTS AND METHODS

Materials and methods: Сalculation of systolic/diastolic ratio (SDR), pulse index (PI) and resistive index (RI) has been carried out in 70 pregnant had CE in past history and 10 healthy pregnant women who experienced neither chronic endometritis before pregnancy nor preeclampsia.

RESULTS

Results: SDR in SA patients with CE in history and follow-up development of preeclampsia is by 19& higher the control values (р<0,05); PI was 85& higher than the similar one in the control group and RI was 86& higher (р<0,01). In women with a preconception preparation that had a subsequent development of preeclampsia SDR in the spiral artery by 9,7& (p <0,05), PI by 31,7&, and IR by 30,3& (p <0,05) was lower than the corresponding indices in the group of untreated women.

CONCLUSION

Conclusions: The findings show the increase in resistance of preplacental bed vessels in women with untreated CE in past history at the aforementioned stage, and the more apparent are the curves of blood flow rate at this stage, the more severe will be the follow-up course of preeclampsia.

Urinary tract infections during pregnancy - an updated overview

Urinary tract infections (UTIs) are the most common type of infection during pregnancy, affecting up to 10% of pregnant women. They are also recognized as the second most common ailment of pregnancy, after anemia. Three clinical types of pregnancy-related UTI are distinguished: asymptomatic bacteriuria (ASB), cystitis, and pyelonephritis. A particular form of ASB is the presence of Group B streptococci in the urinary tract of the pregnant woman. All clinical types of UTI may lead to serious maternal and fetal complications. Therefore, unlike in the nonpregnant female patient, all UTIs during pregnancy, including the asymptomatic infection, require treatment. In some patients, antibiotic prophylaxis should also be introduced. In the present work, we collectively summarize current practical recommendations from a number of international bodies and organizations.