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Yılmaz Sezer N, Aker MN, Yücel A, Çalışıcı D. The effect of virtual reality and music on anxiety, non-stress test parameters, and satisfaction of high-risk pregnant women undergoing non-stress tests: Randomized controlled trial. Eur J Obstet Gynecol Reprod Biol 2024; 296:52-58. [PMID: 38394716 DOI: 10.1016/j.ejogrb.2024.02.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Prenatal tests cause high-risk pregnant women to experience high anxiety levels. AIM This paper investigated the effect of Virtual Reality (VR) and music on anxiety, non-stress test parameters, and satisfaction of high-risk pregnant women undergoing non-stress tests (NSTs). METHODS This was a randomized controlled trial. The sample consisted of 102 participants randomized into three groups (VR = 34, music = 34, and control = 34). Maternal anxiety was assessed using the Spielberger State-Trait Anxiety Inventory-S (STAI-S) before and after NSTs. Satisfaction was evaluated using the Visual Analogue Scale (VAS) after NSTs. NST parameters were evaluated after NSTs. The findings were reported based on the Consolidated Standards of Reporting Trials (CONSORT). RESULTS The VR and music groups had significantly lower mean posttest STAI-S scores than the control group (p <.05). There was no significant difference in NST findings (reactive/nonreactive) between the groups (p >.05). The VR group had a significantly shorter reactive NST duration than the control group (p <.05). The VR and music groups had significantly higher mean VAS-satisfaction scores than the control group (p <.05) CONCLUSION: Virtual reality and music during NSTs help high-risk pregnant women experience less anxiety and satisfy them more with the procedure. We recommend that obstetric midwives and nurses use these low-cost, simple, and noninvasive methods to reduce anxiety in high-risk pregnant women during prenatal testing.
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Affiliation(s)
| | | | - Aykan Yücel
- University of Health Sciences, Ankara City Hospital, Ankara, Turkey
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Dhiman S, Sharma A, Gupta A, Vatsa R, Bharti J, Kulshrestha V, Yadav S, Dadhwal V, Malhotra N. Fetomaternal outcomes in pregnant women with congenital heart disease: a comparative analysis from an apex institute. Obstet Gynecol Sci 2024; 67:218-226. [PMID: 38356351 PMCID: PMC10948205 DOI: 10.5468/ogs.23264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/28/2023] [Accepted: 01/21/2024] [Indexed: 02/16/2024] Open
Abstract
OBJECTIVE With advancements in cardiac surgical interventions during infancy and childhood, the incidence of maternal congenital heart disease (CHD) is increasing. This retrospective study compared fetal and cardiac outcomes in women with and without CHD, along with a sub-analysis between cyanotic versus non-cyanotic defects and operated versus non-operated cases. METHODS A 10-year data were retrospectively collected from pregnant women with CHD and a 1:1 ratio of pregnant women without any heart disease. Adverse fetal and cardiac outcomes were noted in both groups. Statistical significance was set at P<0.05. RESULTS A total of 86 pregnant women with CHD were studied, with atrial septal defects (29.06%) being the most common. Out of 86 participants, 27 (31.39%) had cyanotic CHD. Around 55% of cases were already operated on for their cardiac defects. Among cardiovascular complications, 5.8% suffered from heart failure, 7.0% had pulmonary arterial hypertension, 8.1% presented in New York Heart Association functional class IV, 9.3% had a need for intensive care unit admission, and one experienced maternal mortality. Adverse fetal outcomes, including operative vaginal delivery, mean duration of hospital stay, fetal growth restriction, preterm birth (<37 weeks), low birth weight (<2,500 g), 5-minute APGAR score <7, and neonatal intensive care unit admissions, were significantly higher in women with CHD than in women without heart disease. CONCLUSION Women with CHD have a higher risk of adverse fetal and cardiac outcomes. The outcome can be improved with proper pre-conceptional optimization of the cardiac condition, good antenatal care, and multidisciplinary team management.
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Affiliation(s)
- Soniya Dhiman
- Department of Obstetrics and Gynaecology, All India Institute of Medical Science, New Delhi,
India
| | - Aparna Sharma
- Department of Obstetrics and Gynaecology, All India Institute of Medical Science, New Delhi,
India
| | - Akanksha Gupta
- Department of Obstetrics and Gynaecology, All India Institute of Medical Science, New Delhi,
India
| | - Richa Vatsa
- Department of Obstetrics and Gynaecology, All India Institute of Medical Science, New Delhi,
India
| | - Juhi Bharti
- Department of Obstetrics and Gynaecology, All India Institute of Medical Science, New Delhi,
India
| | - Vidushi Kulshrestha
- Department of Obstetrics and Gynaecology, All India Institute of Medical Science, New Delhi,
India
| | - Satyavir Yadav
- Department of Cardiology, All India Institute of Medical Science, New Delhi,
India
| | - Vatsla Dadhwal
- Department of Obstetrics and Gynaecology, All India Institute of Medical Science, New Delhi,
India
| | - Neena Malhotra
- Department of Obstetrics and Gynaecology, All India Institute of Medical Science, New Delhi,
India
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Kim S, Jung S, Lee DH, Chang CL, Bae M, Kim AR, Lee SJ, Lim S. Outbreak investigation of Serratia marcescens bloodstream infection in an obstetric ward for high-risk pregnant women. BMC Infect Dis 2024; 24:266. [PMID: 38418981 PMCID: PMC10900556 DOI: 10.1186/s12879-024-09134-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/13/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Serratia marcescens is a gram-negative bacterium that is widespread in the environment. S. marcescens bacteremia can be fatal during pregnancy and cause persistent chorioamnionitis. This study reports an outbreak of Serratia marcescens bloodstream infection (BSI) among high-risk pregnant women in an obstetric ward. The purpose of this study is to report our experience with the usefulness of the ATP test in hospital environmental management and to confirm that bloodstream infections of patients with the same strain were correlated by WGS testing. METHODS This retrospective study collected the data of inpatients with S. marcescens bacteremia in obstetric ward for high-risk pregnant women from August 22, 2021, to October 14, 2021. We performed: an adenosine triphosphate (ATP) bioluminescence test in the environment with a high-contact area; environmental culture; on-site monitoring and staff education; and whole-genome sequencing (WGS) to evaluate genetic relationships among S. marcescens isolates. RESULTS S. marcescens BSI occurred in four consecutive patients. None of the patients had central venous catheters. An ATP bioluminescence test revealed that high-contact areas and areas for injection preparation were not clean (≥ 1000 relative light units). However, S. marcescens was not identified in the environmental cultures, likely due to intensive environmental cleaning and discarding of potentially contaminated specimens before the culture test. On-site monitoring and education were conducted for 1 month. There were no further reports of BSI until 6 months after the last patient was discharged. WGS performed on three isolates from three patients indicated that the isolated S. marcescens was likely from the same strain. CONCLUSIONS We controlled an S. marcescens outbreak by improving environmental cleaning as well as education of and behavior changes in healthcare workers. Using the ATP bioluminescence test can provide feedback on environmental cleaning and education. WGS played a role in determining the spread of BSI caused by the same strain.
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Affiliation(s)
- Seulki Kim
- Department of Internal Medicine, Division of Infectious Diseases, Pusan National University Yangsan Hospital, 20 Geumo-Ro, Mulgeum-Eup, Yangsan, 50612, Republic of Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Sunah Jung
- Infection Prevention Department, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Dong Hyung Lee
- Department of Obstetrics and Gynecology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
- Department of Obstetrics & Gynecology, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Chulhun L Chang
- Department of Laboratory Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Moonsuk Bae
- Department of Internal Medicine, Division of Infectious Diseases, Pusan National University Yangsan Hospital, 20 Geumo-Ro, Mulgeum-Eup, Yangsan, 50612, Republic of Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - A Reum Kim
- Department of Internal Medicine, Division of Infectious Diseases, Pusan National University Yangsan Hospital, 20 Geumo-Ro, Mulgeum-Eup, Yangsan, 50612, Republic of Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Su Jin Lee
- Department of Internal Medicine, Division of Infectious Diseases, Pusan National University Yangsan Hospital, 20 Geumo-Ro, Mulgeum-Eup, Yangsan, 50612, Republic of Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Seungjin Lim
- Department of Internal Medicine, Division of Infectious Diseases, Pusan National University Yangsan Hospital, 20 Geumo-Ro, Mulgeum-Eup, Yangsan, 50612, Republic of Korea.
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Republic of Korea.
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Kraus EM, Chavan NR, Whelan V, Goldkamp J, DuBois JM. Reproductive decision making in women with medical comorbidities: a qualitative study. BMC Pregnancy Childbirth 2023; 23:848. [PMID: 38082419 PMCID: PMC10712035 DOI: 10.1186/s12884-023-06093-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND A growing number of reproductive-age women in the U.S. have chronic medical conditions, increasing their risk of perinatal morbidity and mortality. Still, they experience unintended pregnancies at similar rates to low-risk mothers. We have limited understanding of how these individuals consider decisions about pregnancy and contraceptive use. The purpose of this study was to understand factors that influence reproductive decision-making among pregnant women with chronic medical conditions. METHODS We conducted 28 semi-structured interviews with pregnant women with pre-existing medical conditions admitted to a tertiary maternal hospital to examine factors influencing reproductive decision making. Maternal demographic characteristics, medical history, and pregnancy outcome data were obtained through participant surveys and abstraction from electronic health records. Interview transcripts were coded and analyzed using Dedoose® with both deductive and inductive content analysis. RESULTS Out of 33 eligible participants, 30 consented to participate and 28 completed interviews. The majority of participants identified as black, Christian, made less than $23,000 yearly, and had a variety of preexisting medical conditions. Overarching themes included: 1) Perceived risks-benefits of pregnancy, 2) Perceived risks-benefits of birth control, 3) Determinants of contraceptive utilization, and 4) Perceived reproductive self-agency. Contraception was viewed as acceptable, but with concerning physical and psychological side effects. Although some considered pregnancy as a health threat, more experienced pregnancy as positive and empowering. Few planned their pregnancies. CONCLUSIONS Preexisting health conditions did not significantly influence reproductive decision-making. Barriers to birth control use were generally based in patient value-systems instead of external factors. Interventions to improve uptake and use of birth control in this cohort should focus on improving care for chronic health conditions and influencing patient knowledge and attitudes toward contraception.
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Affiliation(s)
- Elena M Kraus
- Department of Obstetrics, Gynecology and Women's Health, Maternal Fetal Medicine, Saint Louis University School of Medicine, St. Louis, MO, 63117, USA.
- Department of Obstetrics & Gynecology, Creighton University School of Medicine, Omaha, NE, 68178, USA.
| | - Niraj R Chavan
- Department of Obstetrics, Gynecology and Women's Health, Maternal Fetal Medicine, Saint Louis University School of Medicine, St. Louis, MO, 63117, USA
| | - Victoria Whelan
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Jennifer Goldkamp
- Mercy Clinic Maternal and Fetal Medicine, Saint Louis, MO, 63141, USA
| | - James M DuBois
- Division of General Medical Sciences, Washington University School of Medicine, St. Louis, MO, 63110, USA
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Kabiri D, Amsalem H, Watad H, Lipschuetz M, Haj-Yahya R, Alter R, Ezra Y. Assessing the Clinical Significance of Third-Trimester Post-Coital Bleeding. Fetal Diagn Ther 2023; 51:168-174. [PMID: 38071960 PMCID: PMC10994628 DOI: 10.1159/000535707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 12/04/2023] [Indexed: 04/04/2024]
Abstract
INTRODUCTION This study aimed to evaluate the impact of third-trimester post-coital bleeding (PCB) on pregnancy outcomes. METHODS A retrospective cohort study was conducted at two tertiary medical centers, including all pregnant women between 24 and 34 weeks of gestation referred due to vaginal bleeding over an 11-year period. The study population includes all singleton deliveries; within this population, women were further classified into three groups: those admitted due to vaginal bleeding related to PCB, those admitted due to vaginal bleeding not related to PCB, and those who did not report vaginal bleeding. The primary outcome measure was delivery prior to 37 weeks of gestation, while secondary outcome measures included maternal and neonatal complications. Baseline characteristics of the two groups were compared. RESULTS During the study period, there were a total of 51,698 deliveries. Among these, 230 cases involved bleeding between 24 and 34 weeks of gestation, 34 (14.8%) were identified as PCB, and 196 as bleeding unrelated to intercourse. In addition, 51,468 pregnancies without bleeding were analyzed as the general population for comparison. The incidence of preterm labor before 37 weeks of gestation was notably higher in both women with PCB (14.7%) and those with bleeding unrelated to coitus (20.9%) compared to the general population (5.6%); however, there was no statistically significant difference between the two bleeding groups (p = 0.403) while both were significantly different from the general population (p < 0.001). The odds ratio for preterm birth before 37 weeks of gestation after PCB was 3.29 (95% CI: 1.26-8.56, p = 0.0149). There were no significant differences between the PCB and bleeding unrelated to intercourse groups in terms of maternal and neonatal complications. CONCLUSION This study found that third-trimester PCB is a risk factor for preterm delivery, with rates similar to other causes of third-trimester bleeding but significantly higher than the general population without bleeding. These findings challenge the assumption that PCB is benign.
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Affiliation(s)
- Doron Kabiri
- Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hagai Amsalem
- Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hadel Watad
- Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Lipschuetz
- Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Rani Haj-Yahya
- Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Roie Alter
- Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yossef Ezra
- Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Jadhav KP, Sridhar KS, Kandi S, Jariwala PV. A 'dreaded' complication of stuck prosthetic valve in the first trimester pregnancy. J Cardiol Cases 2023; 28:261-264. [PMID: 38126053 PMCID: PMC10730274 DOI: 10.1016/j.jccase.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/12/2023] [Accepted: 08/14/2023] [Indexed: 12/23/2023] Open
Abstract
A dramatic rise in cardiac output with a decrease in afterload are the hallmark of hemodynamic variations induced by normal pregnancy, which requires significant cardiac adaptation. Females with rheumatic mitral valve disease who have had a mitral valve replacement in the past are increasingly choosing to become pregnant. Hypercoagulability of pregnancy, problems with anticoagulant therapy along with hemodynamic changes in pregnancy increase the risk of cardiac complications in this subset. There is a paucity of research on the management of problems in patients with cardiac prosthetic valves. We present a case of primigravida with a history of mitral valve replacement, presenting with a stuck valve. Learning objectives •Pregnancy is a pro-thrombotic state•Pregnancy with a mechanical heart valve has high risk of stuck vale despite adequate anti-coagulation•Management of such high-risk cases must be carried out at a tertiary care center with all facilities•Multi-disciplinary approach is required to deal with pregnant women with mechanical heart valve.
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Affiliation(s)
| | - Kale Satya Sridhar
- Department of Cardiothoracic Surgery, Yashoda Hospital, Somajiguda, Hyderabad, India
| | - Sujatha Kandi
- Department of Obstetrics and Gynaecology, Yashoda Hospital, Somajiguda, Hyderabad, India
| | - Pankaj V. Jariwala
- Department of Cardiology, Yashoda Hospital, Somajiguda, Hyderabad, India
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Park M, Ahn S. An explanatory model of quality of life in high-risk pregnant women in Korea: a structural equation model. Korean J Women Health Nurs 2023; 29:302-316. [PMID: 38204390 PMCID: PMC10788389 DOI: 10.4069/kjwhn.2023.11.13.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 11/05/2023] [Accepted: 11/13/2023] [Indexed: 01/12/2024] Open
Abstract
PURPOSE This study aimed to develop and validate a structural model for the quality of life (QoL) among high-risk pregnant women, based on Roy's adaptation model. METHODS This cross-sectional study collected data from 333 first-time mothers diagnosed with a high-risk pregnancy in two obstetrics and gynecology clinics in Cheonan, Korea, or participating in an online community, between October 20, 2021 and February 20, 2022. Structured questionnaires measured QoL, contextual stimuli (uncertainty), coping (adaptive or maladaptive), and adaptation mode (fatigue, state anxiety, antenatal depression, maternal identity, and marital adjustment). RESULTS The mean age of the respondents was 35.29±3.72 years, ranging from 26 to 45 years. The most common high-risk pregnancy diagnosis was gestational diabetes (26.1%). followed by preterm labor (21.6%). QoL was higher than average (18.63±3.80). Above-moderate mean scores were obtained for all domains (psychological/baby, 19.03; socioeconomic, 19.00; relational/spouse-partner, 20.99; relational/family-friends, 19.18; and health and functioning, 16.18). The final model explained 51% of variance in QoL in high-risk pregnant women, with acceptable overall model fit. Adaptation mode (β=-.81, p=.034) and maladaptive coping (β=.46 p=.043) directly affected QoL, and uncertainty (β=-. 21, p=.004), adaptive coping (β=.36 p=.026), and maladaptive coping (β=-.56 p=.023) indirectly affected QoL. CONCLUSION It is essential to develop nursing interventions aimed at enhancing appropriate coping strategies to improve QoL in high-risk pregnant women. By reinforcing adaptive coping strategies and mitigating maladaptive coping, these interventions can contribute to better maternal and fetal outcomes and improve the overall well-being of high-risk pregnant women.
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Affiliation(s)
- Mihyeon Park
- College of Nursing, Chungnam National University, Daejeon, Korea
| | - Sukhee Ahn
- College of Nursing, Chungnam National University, Daejeon, Korea
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Testouri F, Hamza M, Amor AB, Barhoumi M, Fakhfakh R, Triki A, Belhadj A. Anxiety and Depression Symptoms in At-Risk Pregnancy: Influence on Maternal-Fetal Attachment in Tunisia. Matern Child Health J 2023; 27:2008-2016. [PMID: 37326790 DOI: 10.1007/s10995-023-03736-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVES To investigate maternal prenatal anxiety and depression in high-risk pregnancies and examine their influence on maternal-fetal attachment. METHODS We included 95 hospitalized high-risk pregnant women. The Hospital Anxiety and Depression Scale (HADS) and the Prenatal Attachment Inventory (PAI) were used to assess the primary objective. Internal consistency and construct validity of the PAI were investigated. RESULTS The average age was 31 years and gestational age ranged from 26 to 41 weeks. Prevalence of depressive symptoms was 20% and anxiety symptoms 39%. Cronbach alpha coefficient of the PAI Tunisian version was 0.8 and the construct validity in favour of one factor model. PAI scores correlated negatively and significatively with the HADS total score (r = - 0.218, p = 0.034) and was attributed to the depression dimension only (r = - 0.205, p = 0.046). CONCLUSIONS FOR PRACTICE Emotional wellbeing of pregnant women especially in high-risk pregnancies should be explored in order to prevent consequences on women, their growing fetus, and prenatal attachment.
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Affiliation(s)
- Ferdaous Testouri
- Faculty of Medicine of Tunis, University of Tunis El Manar, Djebal Lakhdhar, 1007, Tunis, Tunisia
| | - Meriem Hamza
- Faculty of Medicine of Tunis, University of Tunis El Manar, Djebal Lakhdhar, 1007, Tunis, Tunisia.
- Child and Adolescent Psychiatry Department, Mongi Slim Hospital, 2046, Sidi Daoud, Tunisia.
- Research Lab, LR22SP01 Mother-Child Health, Tunis, Tunisia.
| | - Anissa Ben Amor
- Faculty of Medicine of Tunis, University of Tunis El Manar, Djebal Lakhdhar, 1007, Tunis, Tunisia
- Gynecology-Obstetrics Department, Mongi Slim Hospital, 2046, Sidi Daoud, Tunisia
| | - Marwene Barhoumi
- Faculty of Medicine of Tunis, University of Tunis El Manar, Djebal Lakhdhar, 1007, Tunis, Tunisia
| | - Radhouane Fakhfakh
- Faculty of Medicine of Tunis, University of Tunis El Manar, Djebal Lakhdhar, 1007, Tunis, Tunisia
- Department of Epidemiology and Statistics, Abderrahmen Mami Hospital, 2080, Ariana, Tunisia
- Research Lab, LR22SP01 Mother-Child Health, Tunis, Tunisia
| | - Amel Triki
- Faculty of Medicine of Tunis, University of Tunis El Manar, Djebal Lakhdhar, 1007, Tunis, Tunisia
- Gynecology-Obstetrics Department, Mongi Slim Hospital, 2046, Sidi Daoud, Tunisia
- Research Lab, LR22SP01 Mother-Child Health, Tunis, Tunisia
| | - Ahlem Belhadj
- Faculty of Medicine of Tunis, University of Tunis El Manar, Djebal Lakhdhar, 1007, Tunis, Tunisia
- Child and Adolescent Psychiatry Department, Mongi Slim Hospital, 2046, Sidi Daoud, Tunisia
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Meza-Rodríguez MDP, Farfan-Labonne B, Avila-García M, Figueroa-Damian R, Plazola-Camacho N, Pellón-Díaz G, Ríos-Flores BA, Olivas-Peña E, Leff-Gelman P, Camacho-Arroyo I. Psychological distress, anxiety, depression, stress level, and coping style in HIV-pregnant women in Mexico. BMC Psychol 2023; 11:366. [PMID: 37915068 PMCID: PMC10621089 DOI: 10.1186/s40359-023-01416-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 10/27/2023] [Indexed: 11/03/2023] Open
Abstract
PURPOSE To evaluate the presence of psychological distress (PD) and its association with the mental health and coping styles of pregnant women living with HIV (PWLWH). METHOD An observational, cross-sectional descriptive study was performed. Seventy-three PWLWH were included. Patients responded to a psychometric battery for PD, depression, anxiety, stress, and coping style evaluation. The scales used in the study were: Goldberg's 30-item General Health Questionnaire (GHQ-30), State-Trait Anxiety Inventory (STAI), Zung Depression Self-Measurement Scale (ZDS), Nowack Stress Profile, Lazarus and Folkman's Coping Styles Questionnaire. RESULTS PD was observed in 31.5% of the participants. PD-positive patients showed a higher probability of presenting traits of depression and anxiety and medium/high stress levels. Besides, they preferentially used emotion-focused coping styles. CONCLUSION PD is associated with a higher probability of presenting anxiety and depression in PWLWH. Emotion-focused coping style could be a factor in decision-making associated with risk behaviors in PWLWH.
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Affiliation(s)
- María Del Pilar Meza-Rodríguez
- Coordinación de Investigación en Psicología, Instituto Nacional de Perinatología, Montes Urales 800, CDMX, C.P. 11000, México
| | - Blanca Farfan-Labonne
- Departamento de Fisiología y Desarrollo Celular, Instituto Nacional de Perinatología, Montes Urales 800, CDMX, C.P. 11000, México
| | - Miroslava Avila-García
- Departamento de Infectología e Inmunología, Instituto Nacional de Perinatología, Montes Urales 800, CDMX, C.P. 11000, México
| | - Ricardo Figueroa-Damian
- Departamento de Infectología e Inmunología, Instituto Nacional de Perinatología, Montes Urales 800, CDMX, C.P. 11000, México
| | - Noemí Plazola-Camacho
- Departamento de Infectología e Inmunología, Instituto Nacional de Perinatología, Montes Urales 800, CDMX, C.P. 11000, México
| | - Gabriela Pellón-Díaz
- Departamento de Neurociencias, Instituto Nacional de Perinatología, Montes Urales 800, CDMX, C.P. 11000, México
| | - Braulio Alfonso Ríos-Flores
- Departamento de Neurociencias, Instituto Nacional de Perinatología, Montes Urales 800, CDMX, C.P. 11000, México
| | - Efraín Olivas-Peña
- Departamento de Neurociencias, Instituto Nacional de Perinatología, Montes Urales 800, CDMX, C.P. 11000, México
| | - Phillipe Leff-Gelman
- Departamento de Investigación en Salud Reproductiva y Perinatal, Instituto Nacional de Perinatología, Montes Urales 800, CDMX, C.P. 11000, México
| | - Ignacio Camacho-Arroyo
- Unidad de Investigación en Reproducción Humana, Instituto Nacional de Perinatología-Facultad de Química, Universidad Nacional Autónoma de México, Montes Urales 800, Lomas de Chapultepec Miguel Hidalgo, Ciudad de México, C.P. 11000, México.
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Imai RY, Monteagudo PT, Mattar R, Dib SA, Dualib PM, de Almeida-Pititto B. Inadequate pregnancy planning in diabetics, and its impact on glycemic control and complications. Arch Gynecol Obstet 2023; 308:1229-1238. [PMID: 36220977 DOI: 10.1007/s00404-022-06806-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/26/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION To assess the intention of actual pregnancy and its influence on glycated hemoglobin (HbA1c) profile before and during the pregnancy of women with previous diabetes mellitus (DM). METHODS Prospective cohort study included pregnant women with previous DM assisted from October/2018 to October/2019. Data were collected with standardized questionnaire and from medical records. Comparisons of variables of interest (Student's t test, Mann-Whitney or chi-square test) were performed between the group of women who did or denied report having interest to become pregnant. And a logistic regression analysis were performed considering prematurity or fetal/neonatal complication as dependent variables. RESULTS Sixty patients were included, with HbA1c mean of pre-pregnancy, first and third trimesters of 9.3, 8.1 and 6.8%, respectively. 7.7% women had HbA1c ≤ 6.5% in pre-pregnancy and 16.7% in first trimester. 83.3% reported having received guidance on the importance of glucose control and contraception before their current pregnancy. Although 28.3% reported the intention to become pregnant, only 28.3% reported regular use of any contraceptive method before it, none of which had HbA1c in the recommended goal for pregnancy. Glycemic control did not differ between groups intending or not to become pregnant. Women with adequate glycemic control in first trimester had a lower frequency of prematurity (p = 0.015) and fetal complications (p = 0.001), and better control at the end of pregnancy. DISCUSSION Although most of these women reported having had information about the importance of a planned pregnancy, adequate glycemic control of women with diabetes before and during the pregnancy is still not a reality nowadays. It might be necessary to improve medical communication in pregnancy planning.
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Affiliation(s)
- Roberta Yukari Imai
- Graduation Program in Medicine, Universidade Federal de São Paulo, Rua Botucatu, n° 740, Vila Clementino, São Paulo, SP, CEP 04023-062, Brazil
| | - Patrícia Teófilo Monteagudo
- Department of Medicine, Discipline of Endocrinology, Universidade Federal de São Paulo, Rua Sena Madureira, n° 1500, Vila Clementino, São Paulo, SP, CEP 04021-001, Brazil.
- Department of Medicine, Discipline of Internal Medicine, Universidade Federal de São Paulo, Rua Sena Madureira, n° 1500, Vila Clementino, São Paulo, SP, CEP 04021-001, Brazil.
| | - Rosiane Mattar
- Department of Medicine, Discipline of Obstetrics, Universidade Federal de São Paulo, Rua Napoleão de Barros, n° 875, Vila Clementino, São Paulo, SP, CEP 04024-002, Brazil
| | - Sergio Atala Dib
- Department of Medicine, Discipline of Endocrinology, Universidade Federal de São Paulo, Rua Sena Madureira, n° 1500, Vila Clementino, São Paulo, SP, CEP 04021-001, Brazil
- Post-Graduation Program in Endocrinology and Metabology, Universidade Federal de São Paulo, Rua Estado de Israel, n° 639, Vila Clementino, São Paulo, SP, CEP 04022-001, Brazil
| | - Patricia Medici Dualib
- Department of Medicine, Discipline of Endocrinology, Universidade Federal de São Paulo, Rua Sena Madureira, n° 1500, Vila Clementino, São Paulo, SP, CEP 04021-001, Brazil
| | - Bianca de Almeida-Pititto
- Post-Graduation Program in Endocrinology and Metabology, Universidade Federal de São Paulo, Rua Estado de Israel, n° 639, Vila Clementino, São Paulo, SP, CEP 04022-001, Brazil
- Department of Preventive Medicine, Universidade Federal de São Paulo, Rua Botucatu, n° 740, Vila Clementino, São Paulo, SP, CEP 04023-062, Brazil
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11
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Tambvekar SE, Adki S, Sheriar NK. Pregnancies in Elderly Mothers over 40 years: What to Expect from the Rising New Age High-Risk Cohort? J Obstet Gynaecol India 2023; 73:358-362. [PMID: 37701086 PMCID: PMC10492723 DOI: 10.1007/s13224-022-01701-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 08/04/2022] [Indexed: 03/29/2023] Open
Abstract
Introduction Elderly women are believed to experience many risks associated with pregnancy. Literature fails to provide a clear consensus on the age group in which there is a rise in risk and pathophysiology contributing. 'Pregnancies over forty' are increasing in society, owing to changing lifestyles and sensibilities of youth and the advent of assisted reproductive techniques. In India, studies on elderly pregnant women above 40 years of age are lacking. The aim of this study is to assess these pregnancies, their course, obstetric and perinatal outcomes in women delivering above 40 years. Methods The study group (Group A) comprised of pregnancies in 50 women at age ≥ 40 years on the date of delivery. The control group (Group B) had 50 women who delivered subsequent to the study group and age < 40. Various parameters and outcomes including parity, gestational age, number of gestations, co-existing medical illnesses, the incidence of hypertensive diseases of pregnancy (HDP), gestational diabetes mellitus (GDM), pre-term labor, mode of delivery, birth weight and obstetric and neonatal outcomes were compared. Chi-square test and independent T test were used for statistical analysis. Results While a good number of patients conceived spontaneously and with basic infertility management, i.e., 84% in the elderly gravid group (Group A) and 96% in the control group (Group B), the number of patients who required ART in Group A were statistically significant (Group A 16% and Group B 4%). Incidence of pre-existing medical diseases like hypertension, diabetes mellitus, thyroid dysfunction, other auto-immune diseases and chronic diseases were noted to be high (26%) in Group A (statistically significant difference). Incidence of HDP, GDM and fetal growth restriction were high in Group A. Tendency to have the presence of fibroid uterus was high in patients in Group A, i.e., 24%, compared to only 8% in the control group; difference was statistically significant. Proportion of pre-term deliveries were high in Group A. Cesarean section rate was high in Group A, though it was not statistically significant. Other perinatal observations and neonatal outcomes were comparable in both groups; differences were not statistically significant. Conclusion The study reveals an association of a high-risk course of pregnancies in women above the age of 40 years. Proportions of IVF pregnancies are higher in elderly women. Interestingly, the proportion of women in elderly group who conceived spontaneously and with basic infertility management including IUI was 84% in the present study. Medical comorbidities and incidence of fibroids were high in elderly women. Obstetric and neonatal outcomes of these pregnancies when managed efficiently are favorable.
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Affiliation(s)
- Sunil E. Tambvekar
- Nowrosjee Wadia Maternity Hospital, Seth G. S. Medical College, Parel, Mumbai, Maharashtra 400706 India
| | - Shilpa Adki
- Indira IVF Centre, Allahabad, Uttar Pradesh India
| | - Nozer K. Sheriar
- Holy Family Hospital, Hinduja Hospital, Breach Candy Hospital, Mumbai, Maharashtra India
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12
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Smorti M, Ponti L, Ghinassi S, Mauri G, Pancetti F, Mannella P. Do prenatal depressive symptoms developed by hospitalized women with high-risk pregnancy persist to post-partum? Psychiatry Res 2023; 325:115224. [PMID: 37148834 DOI: 10.1016/j.psychres.2023.115224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/19/2023] [Accepted: 04/23/2023] [Indexed: 05/08/2023]
Abstract
This study aims to explore the level of depressive symptoms during pregnancy and after childbirth comparing women hospitalized due to high-risk pregnancy (clinical group) and women with low-risk pregnancy (control group). Seventy pregnant women (26 clinical group and 44 control group) filled in the Edinburgh Postnatal Depression Scale both during pregnancy and three months after childbirth. Results showed that the clinical group reported significant higher levels of prenatal depression than the control group, while no differences were found on postnatal depression. Data highlighted that hospitalization could represents a significant stressor that can exacerbate depression in women with high-risk pregnancy.
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Affiliation(s)
- Martina Smorti
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Italy
| | - Lucia Ponti
- Department of Humanities, University of Urbino, Italy.
| | - Simon Ghinassi
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Giulia Mauri
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Italy
| | - Federica Pancetti
- Division of Obstetrics and Gynaecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Paolo Mannella
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
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Rajkumar T, Freyne J, Varnfield M, Lawson K, Butten K, Shanmugalingam R, Hennessy A, Makris A. Remote blood pressure monitoring in high risk pregnancy - study protocol for a randomised controlled trial (REMOTE CONTROL trial). Trials 2023; 24:334. [PMID: 37198630 DOI: 10.1186/s13063-023-07321-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 04/20/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Pregnant women at high risk for developing a hypertensive disorder of pregnancy require frequent antenatal assessments, especially of their blood pressure. This expends significant resources for both the patient and healthcare system. An alternative to in-clinic assessments is a remote blood pressure monitoring strategy, in which patients self-record their blood pressure at home using a validated blood pressure machine. This has the potential to be cost-effective, increase patient satisfaction, and reduce outpatient visits, and has had widespread uptake recently given the increased need for remote care during the ongoing COVID-19 pandemic. However robust evidence supporting this approach over a traditional face-to-face approach is lacking, and the impact on maternal and foetal outcomes has not yet been reported. Thus, there is an urgent need to assess the efficacy of remote monitoring in pregnant women at high risk of developing a hypertensive disorder of pregnancy. METHODS The REMOTE CONTROL trial is a pragmatic, unblinded, randomised controlled trial, which aims to compare remote blood pressure monitoring in high-risk pregnant women with conventional face-to-face clinic monitoring, in a 1:1 allocation ratio. The study will recruit patients across 3 metropolitan Australian teaching hospitals and will evaluate the safety, cost-effectiveness, impact on healthcare utilisation and end-user satisfaction of remote blood pressure monitoring. DISCUSSION Remote blood pressure monitoring is garnering interest worldwide and has been increasingly implemented following the COVID-19 pandemic. However, robust data regarding its safety for maternofoetal outcomes is lacking. The REMOTE CONTROL trial is amongst the first randomised controlled trials currently underway, powered to evaluate maternal and foetal outcomes. If proven to be as safe as conventional clinic monitoring, major potential benefits include reducing clinic visits, waiting times, travel costs, and improving delivery of care to vulnerable populations in rural and remote communities. TRIAL REGISTRATION The trial has been prospectively registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12620001049965p, on October 11th, 2020).
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Affiliation(s)
- Theepika Rajkumar
- School of Medicine, Western Sydney University, Penrith, NSW, Australia.
- Department of Medicine, Campbelltown Hospital, South Western Sydney Local Health District, Campbelltown, NSW, Australia.
| | - Jill Freyne
- Australian E-Health Research Centre, Health and Biosecurity, CSIRO, Brisbane, QLD, Australia
| | - Marlien Varnfield
- Australian E-Health Research Centre, Health and Biosecurity, CSIRO, Brisbane, QLD, Australia
| | - Kenny Lawson
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Kaley Butten
- Australian E-Health Research Centre, Health and Biosecurity, CSIRO, Brisbane, QLD, Australia
| | - Renuka Shanmugalingam
- School of Medicine, Western Sydney University, Penrith, NSW, Australia
- Department of Renal Medicine, Liverpool Hospital, Liverpool, NSW, Australia
- University of New South Wales, Kensington, NSW, Australia
| | - Annemarie Hennessy
- School of Medicine, Western Sydney University, Penrith, NSW, Australia
- Department of Medicine, Campbelltown Hospital, South Western Sydney Local Health District, Campbelltown, NSW, Australia
| | - Angela Makris
- Department of Renal Medicine, Liverpool Hospital, Liverpool, NSW, Australia
- University of New South Wales, Kensington, NSW, Australia
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14
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Bahrami N, Farahani E, Yousefi B, Hosseinpour F, Griffiths MD, Alimoradi Z. Association of social capital with mental health and quality of life among low- and high-risk pregnant women. Midwifery 2023; 123:103727. [PMID: 37229841 DOI: 10.1016/j.midw.2023.103727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 05/08/2023] [Accepted: 05/10/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Social capital means having resources and support in relationships and social ties. It can affect the individual's quality of life and mental health. The present study investigated the association between social capital with psychological status and quality of life among low-risk and high-risk pregnant women. METHODS The present cross-sectional study was conducted with the participation of 394 pregnant women receiving prenatal care in urban comprehensive health centers in Qazvin, Iran. Two-stage sampling was used to select comprehensive health centers by random cluster sampling and then pregnant women randomly. Social capital, quality of life (QoL), psychological status, and demographic and obstetric characteristics were assessed. Uni-variable and multivariable linear regression models were used to analyze the data. RESULTS Among the participants, 267 had low-risk pregnancies (67.77%) and the remainder were high-risk. The mean age of participants was 27.94 years (SD=5.86), the mean gestational age was 23.63 weeks (SD=7.71). The mean overall quality of life score among low-risk pregnant women was 32.00 (SD=5.27) and among high-risk pregnant women was 29.70 (SD=3.65). High-risk pregnant women experienced significantly higher anxiety and depression and fear of COVID-19. Social capital had a significant and weak relationship with anxiety among low-risk pregnant women (r = 0.22, p < 0.001). Also, a weak and significant relationship between social capital and anxiety (r = 0.24, p = 0.007), depression (r = 0.24, p = 0.007) and fear of COVID-19 (r = 0.27, p = 0.002) was found among high-risk pregnant women. CONCLUSION Women with high-risk pregnancies experienced lower quality of life, higher anxiety and depression, and greater fear of COVID-19. There was also a weak relationship between social capital and the aforementioned variables among high-risk pregnant women. Designing and implementing interventions to increase quality of life and reduce anxiety and stress among high-risk pregnant women appears to be warranted.
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Affiliation(s)
- Nasim Bahrami
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin 34197-59811, Iran
| | - Elaheh Farahani
- Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Bahareh Yousefi
- Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Fatemeh Hosseinpour
- Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Mark D Griffiths
- Psychology Department, Nottingham Trent University, United Kingdom
| | - Zainab Alimoradi
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin 34197-59811, Iran.
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15
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Anolak H, Lau F, Davis D, Browne J, Watt B. Creative arts intervention in support of women experiencing a high-risk pregnancy: A qualitative descriptive thematic analysis. Sex Reprod Healthc 2023; 36:100830. [PMID: 36898309 DOI: 10.1016/j.srhc.2023.100830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 02/09/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND Mental illness can have negative effects on both the pregnant woman and her unborn child. Studies that use the creative arts as interventions have proven to be beneficial to women's antenatal mental health and wellbeing, however, these studies are limited and emergent. Music, drawing and narrative (MDN) is an established music therapy intervention, stemming from guided imagery and music (GIM), that has the potential to support positive mental health and wellbeing. Yet, to date, there have been limited studies on the use of this form of therapy with inpatient antenatal women. AIM To describe antenatal inpatient women's experiences of participating in a MDN session. METHODS Qualitative data were collected from a sample of 12 inpatient pregnant women who participated in MDN group sessions of drawing to music. Post intervention interviews explored the mental and emotional health of participants. A thematic analysis of the transcribed interview data was performed. FINDINGS Through reflection women were supported to acknowledge both the positives and difficulties of pregnancy as well as establish meaningful connections through shared experience. These thematic findings highlighted that MDN enabled this group of pregnant women to better communicate their feelings, validate emotions, engage in positive distractions, develop greater connections, improve optimism, experience calmness, and learn from others. CONCLUSION This project demonstrates that MDN may offer a viable method for supporting women experiencing high risk pregnancies.
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Affiliation(s)
- Helena Anolak
- Federation University, Mt Helen, PO Box 663, Ballarat, VIC 3353, Australia.
| | - Farrah Lau
- Flinders University, Sturt Rd, Bedford Park, S.A 5042, Australia.
| | - Deborah Davis
- University of Canberra, 11 Kirinari St, Bruce, ACT 2617, Australia.
| | - Jenny Browne
- University of Canberra, 11 Kirinari St, Bruce, ACT 2617, Australia.
| | - Bec Watt
- Flinders University, Sturt Rd, Bedford Park, S.A 5042, Australia.
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Hinton L, Dumelow C, Hodgkinson J, Montgomery C, Martin A, Allen C, Tucker K, Green ME, Wilson H, McManus RJ, Chappell LC, Band R. 'Nesting networks': Women's experiences of social network support in high-risk pregnancy. Midwifery 2023; 120:103622. [PMID: 36893551 DOI: 10.1016/j.midw.2023.103622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 01/27/2023] [Accepted: 02/03/2023] [Indexed: 02/18/2023]
Abstract
OBJECTIVE Social support, an individual's social relationships (both online and offline), may provide protection against adverse mental health outcomes, such as anxiety and depression, which are high in women who have been hospitalised with high-risk pregnancy. This study explored the social support available to women at higher risk of preeclampsia during pregnancy by examining personal social networks. DESIGN Semi-structured interviews were accompanied by social network mapping using the web-based social networking tool GENIE. SETTING England. PARTICIPANTS Twenty-one women were recruited, of whom 18 were interviewed both during pregnancy and postnatally between April 2019 and April 2020. Nineteen women completed maps pre-natally, 17 women completed maps pre-natally and post-natally. Women were taking part in the BUMP study, a randomised clinical trial that included 2441 pregnant individuals at higher risk of preeclampsia and recruited at a mean of 20 weeks' gestation from 15 hospital maternity units in England between November 2018 and October 2019. RESULTS Women's social networks tightened during pregnancy. The inner network changed most dramatically postnatally with women reporting fewer network members. Interviews revealed networks were primarily 'real-life' rather than online social networks, with members providing emotional, informational, and practical support. Women with a high-risk pregnancy valued the relationships they developed with health professionals during pregnancy, and would like their midwife to have a more central role in their networks by providing informational and, where needed, emotional support. The social network mapping data supported the qualitative accounts of changing networks across high-risk pregnancy. CONCLUSION Women with a high-risk pregnancy seek to build "nesting networks" to support them through pregnancy into motherhood. Different types of support are sought from trusted sources. Midwives can play a key role. PRACTICE IMPLICATIONS As well as highlighting other potential needs during pregnancy and the ways in which they can be met, support from midwives has a key role. Through talking to women early in their pregnancy, signposting information and explaining ways to contact health professionals regarding informational or emotional support would fill a gap that currently is met by other aspects of their network.
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Affiliation(s)
- L Hinton
- The Healthcare Improvement Studies (THIS) Institute, University of Cambridge.
| | - C Dumelow
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - J Hodgkinson
- Institute of Applied Health Research, University of Birmingham, Birmingham
| | - C Montgomery
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - A Martin
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - C Allen
- School of Health Sciences, University of Southampton, Southampton, UK. SO17 1BJ
| | - K Tucker
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | | | - H Wilson
- Department of Women and Children's Health, King's College London, London
| | - R J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - L C Chappell
- Department of Women and Children's Health, King's College London, London
| | - R Band
- School of Health Sciences, University of Southampton, Southampton, UK. SO17 1BJ
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17
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Sands G, Evans K, Spiby H, Eldridge J, Pallotti P, Evans C. Birth environments for women with complex pregnancies: A mixed-methods systematic review. Women Birth 2023; 36:39-46. [PMID: 35431173 DOI: 10.1016/j.wombi.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 04/04/2022] [Accepted: 04/08/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Birth environments can help support women through labour and birth. Home-like rooms which encourage active birthing are embraced in midwifery-led settings. However, this is often not reflected in obstetric settings for women with more complex pregnancies. AIM To investigate the impact of the birth environment for women with complex pregnancies. METHODS This was a mixed-methods systematic review, incorporating qualitative and quantitative research. A literature search was implemented across three databases (Medline, CINAHL, Embase) from the year 2000 to June 2021. Studies were eligible if they were based in an Organisation for Economic Cooperation and Development country and reported on birth environments for women with complex pregnancies. Papers were screened and quality appraised by two researchers independently. FINDINGS 30,345 records were returned, with 15 articles meeting inclusion criteria. Studies were based in Australia, the UK, and the USA. Participants included women and health professionals. Five main themes arose: Quality of care and experience; Supportive spaces for women; Supportive spaces for midwives; Control of the space; Design issues. DISCUSSION Women and midwives found the birth environment important in supporting, or failing to support, a positive birth experience. Obstetric environments are complex spaces requiring balance between space for women to mobilise and access birthing aids, with the need for medical teams to have easy access to the woman and equipment in emergencies. CONCLUSION Further research is needed investigating different users' needs from the environment and how safety features can be balanced with comfort to provide high-quality care and positive experiences for women.
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Affiliation(s)
- Gina Sands
- School of Health Sciences, B Floor, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK.
| | - Kerry Evans
- School of Health Sciences, B Floor, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK
| | - Helen Spiby
- School of Health Sciences, B Floor, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK
| | - Jeanette Eldridge
- School of Health Sciences, B Floor, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK
| | - Phoebe Pallotti
- School of Health Sciences, B Floor, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK
| | - Catrin Evans
- School of Health Sciences, B Floor, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK
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18
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Lapinsky SC, Ray JG, Brown HK, Murphy KE, Kaster TS, Vigod SN. Twin pregnancy and severe maternal mental illness: a Canadian population-based cohort study. Arch Womens Ment Health 2023; 26:57-66. [PMID: 36629920 DOI: 10.1007/s00737-023-01291-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 01/06/2023] [Indexed: 01/12/2023]
Abstract
Twin pregnancy is a risk factor for postpartum depression and anxiety. Whether this translates into a higher risk of severe maternal mental illness in the short-term or long-term is unknown. This study was a population-based retrospective cohort study, using linked health administrative databases for the entire province of Ontario, Canada. Included were primiparas aged 15-50 years with a twin vs. singleton hospital livebirth, between January 1, 2003, and March 31, 2019. Propensity-score inverse probability of treatment weights accounted for potential confounding. The primary outcome of severe mental illness comprised a composite of an emergency department visit or hospitalization for mental illness or self-injury, or death by suicide, assessed in the first year after birth, and in long-term follow-up, up to 17 years thereafter. Fifteen thousand twenty-four twin and 796,804 (15,022 weighted) singleton births were included, with a mean (IQR) duration of follow-up of 9 (5-13) years. After weighting, the mean (SD) maternal age was 31.3 (5.5) years. In the first 365 days postpartum, severe mental illness occurred at rates of 10.5 and 8.7 per 1000 person-years in twin and singleton mothers, respectively, corresponding to a hazard ratio (HR) of 1.21 (95% CI 1.07-1.47). From 366 days onward, the corresponding figures were 5.9 and 6.1 per 1000 person-years (HR 0.96, 95% CI 0.89-1.04). Individuals with a twin birth appear to experience an increased risk for severe mental illness in the first year postpartum, but not thereafter. This suggests a potential need for targeted counselling and mental health services for mothers within the first year after birth.
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Affiliation(s)
- Stephanie C Lapinsky
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. .,Department of Obstetrics and Gynaecology, Temerty Faculty of Medicine, University of Toronto, 123 Edward Street, 12th floor, Toronto, Ontario, M5G 0A8, Canada. .,ICES, Toronto, Ontario, Canada.
| | - Joel G Ray
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Departments of Medicine and Obstetrics and Gynaecology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Hilary K Brown
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Women's College Hospital and Research Institute, Toronto, Ontario, Canada.,Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - Kellie E Murphy
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Obstetrics and Gynaecology, Temerty Faculty of Medicine, University of Toronto, 123 Edward Street, 12th floor, Toronto, Ontario, M5G 0A8, Canada.,Department of Obstetrics and Gynaecology, Sinai Health System, Toronto, Ontario, Canada
| | - Tyler S Kaster
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Simone N Vigod
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Women's College Hospital and Research Institute, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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19
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Chen Y, Dai J, Wang Y, Guo L, Huang Q. Postpartum post-traumatic stress disorder symptoms in high-risk pregnancies: Associated resilience and social support. J Psychosom Res 2023; 165:111098. [PMID: 36470754 DOI: 10.1016/j.jpsychores.2022.111098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/14/2022] [Accepted: 11/17/2022] [Indexed: 11/20/2022]
Affiliation(s)
- Ying Chen
- Nanjing Stomatological Hospital, Medicine School of Nanjing University, China.
| | - Jiayang Dai
- Yangzhou University, School of Nursing, School of Public Health, China
| | - Yuanyuan Wang
- Yangzhou University, School of Nursing, School of Public Health, China
| | - Lu Guo
- Yangzhou University, School of Nursing, School of Public Health, China
| | - Qian Huang
- Nanjing Stomatological Hospital, Medicine School of Nanjing University, China
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Huri M, Zullino S, Marinelli L, Clemenza S, Petraglia F, Mecacci F. Does chronic low molecular weight heparins use during pregnancy increase the risk of postpartum hemorrhage? Thromb Res 2023; 222:12-15. [PMID: 36542942 DOI: 10.1016/j.thromres.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/29/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Mor Huri
- Obstetrics and Gynaecology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.
| | - Sara Zullino
- High Risk Pregnancy Unit, Department for Women and Children Health, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Laura Marinelli
- Obstetrics and Gynaecology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Sara Clemenza
- High Risk Pregnancy Unit, Department for Women and Children Health, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Felice Petraglia
- Obstetrics and Gynaecology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Federico Mecacci
- Obstetrics and Gynaecology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy; High Risk Pregnancy Unit, Department for Women and Children Health, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
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Sesilia K, Susanna P, Virve K, Mika G, Veli-Matti U, Marja K. The outcome of pregnancies after bariatric surgery: an observational study of pregnancies during 2004-2016 in Finland. Arch Gynecol Obstet 2023. [PMID: 36703011 DOI: 10.1007/s00404-023-06935-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 01/12/2023] [Indexed: 01/28/2023]
Abstract
PURPOSE Overweight and obesity are major risk factors for perinatal morbidity and mortality, and the need for bariatric surgery (BS) among fertile-aged women is increasing. This study evaluates the outcome of post-BS pregnancies and deliveries. METHODS All 20-45-year-old patients delivering between 2004 and 2016 in Finland were included. Patients with previous BS were identified from the hospital discharge register, and the medical birth register was queried for data on pregnancies, deliveries, and perinatal outcomes. The data were matched using personal identification codes, and the outcomes of women with previous BS were compared with those of other pregnancies. RESULTS Women with previous BS (n = 314) constituted the bariatric group. When compared with the non-bariatric group (n = 750,019), they were older (p < 0.001), heavier (p < 0.001) and had more previous pregnancies (p < 0.001). The overall incidence of pregnancy-induced hypertension (p = 0.002), gestational diabetes (GDM) (p = 0.018), pre-term contractions (p = 0.023), pre-term delivery (p = 0.003), labour induction (p < 0.001), planned (p = 0.001) and unplanned (p = 0.036) caesarean sections and low birthweight infants (p < 0.001) were significantly higher in the bariatric group. When compared with body mass index-specific categories, the main outcomes were increased incidence of GDM and small for gestational age (SGA) newborns in the bariatric group. CONCLUSION BS can be considered a safe and advisable treatment for obesity among fertile-aged women. The pregnancy outcome is associated with post-BS weight, but the risk for GDM and small for gestational-age newborns is increased.
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Salama MH, Hanna H, Nawara M. Frequency of third trimester umbilical artery Doppler for improving neonatal outcomes in high-risk pregnancies: a randomized trial. Obstet Gynecol Sci 2023. [PMID: 36593702 DOI: 10.5468/ogs.22130] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 11/29/2022] [Indexed: 01/04/2023] Open
Abstract
Objective Umbilical artery Doppler ultrasonography is useful for high-risk prenatal surveillance. However, according to a systematic review and meta-analysis by the Cochrane pregnancy and childbirth group, the optimal frequency with which such surveillance should occur remains unclear. In the current study, we aimed to investigate whether performing umbilical artery Doppler on a weekly basis enables earlier detection of changes in utero-placental blood flow than the recommended bi-weekly (i.e., fortnightly) regimen and its impact on perinatal outcomes. Methods This randomized controlled study included 292 high-risk pregnant women in their third trimester who attended the Ain Shams University Maternity Hospital in Egypt from January 2018 to September 2019. The women were randomly assigned to two groups to undergo either bi-weekly or once-weekly umbilical artery Doppler ultrasound. Results In the primary analysis performed according to the intention-to-treat basis, we observed no difference in the primary outcome of fetal admission to the neonatal intensive care unit (NICU) within the first 24 hours (risk difference, -2.63; 95% confidence interval [CI], -12.92 to 7.65). Furthermore, no significant differences in secondary outcomes were observed (apart from stillbirth). Conclusion Weekly umbilical artery Doppler is not superior to bi-weekly surveillance in preventing admission to the NICU and most other studied outcomes. Therefore, the bi-weekly regiment may be more convenient for women and more cost-effective for health care organizations. (trial registration: NCT03584763 at clinicaltrials.gov).
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Osmundo GDS, da Costa RA, Ruocco RMA, Francisco RPV. Pregnancy in women living with perinatally acquired HIV: Perinatal outcomes and drug resistance profile. Clinics (Sao Paulo) 2023; 78:100174. [PMID: 36870111 PMCID: PMC9995930 DOI: 10.1016/j.clinsp.2023.100174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/27/2023] [Accepted: 02/10/2023] [Indexed: 03/06/2023] Open
Abstract
OBJECTIVES To analyze the perinatal outcomes of Perinatally acquired HIV Infection (PHIV) in pregnant women. METHOD This retrospective cohort study included singleton pregnancies in Women Living with HIV (WLH) between 2006 and 2019. Patient charts were revised, and maternal characteristics, type of HIV infection (perinatal vs. behavioral), Antiretroviral Therapy (ART) exposure, and obstetric and neonatal outcomes were assessed. The HIV-related aspects considered were: Viral Load (VL), CD4+ cell count, opportunistic infections, and genotype testing. Laboratory analyses were performed at baseline (first appointment) and 34 weeks of gestation. RESULTS There were 186 WLH pregnancies, and 54 (29%) patients had PHIV. Patients with PHIV were younger (p < 0.001), had less frequently stable partnerships (p < 0.001), had more commonly serodiscordant partners (p < 0.001), had a longer time on ART (p < 0.001), and had lower rates of undetectable VL at baseline (p = 0.046) and at 34 weeks of gestation (p < 0.001). No association was observed between PHIV and adverse perinatal outcomes. Among patients with PHIV, third trimester anemia was associated with preterm birth (p = 0.039). Genotype testing was available only for 11 patients with PHIV, who presented multiple mutations related to ART resistance. CONCLUSIONS PHIV did not seem to increase the risk of adverse perinatal outcomes. However, PHIV pregnancies have a higher risk of viral suppression failure and exposure to complex ARTs.
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Affiliation(s)
- Gilmar de Souza Osmundo
- Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil.
| | - Rafaela Alkmin da Costa
- Divisão de Clínica Obstétrica, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Rosa Maria Aveiro Ruocco
- Divisão de Clínica Obstétrica, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Rossana Pulcineli Vieira Francisco
- Disciplina de Obstetrícia, Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
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Williamson SP, Moffitt RL, Broadbent J, Neumann DL, Hamblin PS. Coping, wellbeing, and psychopathology during high-risk pregnancy: A systematic review. Midwifery 2023; 116:103556. [PMID: 36427386 DOI: 10.1016/j.midw.2022.103556] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 11/10/2022] [Accepted: 11/12/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Complications during pregnancy can negatively impact the physical and psychological wellbeing of mothers. This systematic review aimed to synthesise evidence which has examined the impact of high-risk conditions developed during pregnancy on women's coping, wellbeing, and symptoms of psychopathology. DATA SOURCES Medline (Ovid), PsycINFO (ProQuest), Scopus, Web of science, AMED (Ebsco), CINAHL (Ebsco) and ProQuest databases were searched in May 2021 with no restrictions on publication date. STUDY SELECTION English-language literature was reviewed to identify 31 articles. DATA EXTRACTION Fifteen articles examined Gestational Diabetes Mellitus (GDM: 48%), nine examined multiple high-risk pregnancy conditions (29%), four examined Hypertensive disorders of pregnancy, Preeclampsia (PE: 13%), two did not specify the condition examined (7%), and one examined Pregnancy-Related Acute Kidney Injury (PR-AKI: 3%). The most common study design was quantitative, non-randomised, and survey-based. DATA SYNTHESIS Twenty-seven articles (87%) reported a high-risk pregnancy resulted in decreased wellbeing and ability to cope, and increased symptoms of psychopathology. The remaining four articles (13%) reported no difference in wellbeing or psychopathology outcomes for women experiencing high-risk compared to healthy pregnancies. Moreover, hypertensive disorders and GDM were associated with ineffective submissive or avoidant coping, reduced wellbeing, and quality-of-life, and exacerbated symptoms of anxiety and depression. CONCLUSION High-risk pregnancy negatively impacts coping, wellbeing, and psychopathology, and preventive and supportive interventions to mitigate this should focus on empowering women to feel optimistic and in control of their pregnancy. A holistic and culturally sensitive approach is recommended, where pregnant women (and their partners or support people) are involved in healthcare decisions, thus promoting wellbeing, coping, satisfaction, and improved treatment outcome.
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Affiliation(s)
| | - Robyn L Moffitt
- School of Psychology, Deakin University, Melbourne, Australia
| | | | - David L Neumann
- School of Applied Psychology, Griffith University, Gold Coast, Australia
| | - Peter S Hamblin
- Department of Endocrinology and Diabetes, Western Health, Melbourne, Australia; Institute for Health Transformation, Faculty of Health, Deakin University, Melbourne, Australia; Department of Medicine, Western Health, University of Melbourne, Melbourne, Australia
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Kang DI, Park E. Do taegyo practices, self-esteem, and social support affect maternal-fetal attachment in high-risk pregnant women? A cross-sectional survey. Korean J Women Health Nurs 2022; 28:338-347. [PMID: 36617485 PMCID: PMC9830115 DOI: 10.4069/kjwhn.2022.12.16] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/16/2022] [Indexed: 12/31/2022] Open
Abstract
PURPOSE The incidence of high-risk pregnancies is increasing in Korea as the birth age increasesdue to late marriage. Maternal-fetal attachment is an important factor that affects children even afterchildbirth, but it is difficult for high-risk pregnant women to form maternal-fetal attachment. Thecurrent study aimed to explore whether taegyo practice (i.e., pregnant women's efforts for fetal goodgrowth and development), self-esteem, and social support influenced the degree of maternal-fetalattachment in women with high-risk pregnancies. METHODS The participants included 226 pregnant Korean women at ≥20 gestational weeks, hospitalized with 15 high-risk pregnancy conditions as defined by the Ministry of Health and Welfare.Recruitment via convenience sampling was done at four sites in Busan, Korea. Surveys were distributed and collected from February 1 to 28, 2022. Data analysis was conducted using descriptive statistics, the t-test, one-factor analysis of variance, Pearson correlation coefficients, and hierarchicalmultiple regression. RESULTS On average, participants were 33.97±4.23 years of age and at 31.65±6.23 gestational weeks.Preterm labor (35.4%) and gestational diabetes (21.0%) were the most common high-risk conditions. Maternal-fetal attachment was positively correlated with taegyo practice (r=.70, p<.001),self-esteem (r=.53, p<.001), and social support (r=.53, p<.001), all with statistical significance. Taegyo practice (β=.50, p<.001) and social support (β=.17, p=.030) explained 53% of variance in maternal-fetal attachment in women with high-risk pregnancies. CONCLUSION Nurses caring for women with high-risk pregnancies during hospitalization can usethese findings by promoting taegyo practice and enhancing social support to increase maternal-fetalattachment.
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Affiliation(s)
- Da-In Kang
- Department of Nursing, Pukyong National University, Busan, Korea
| | - Euna Park
- Department of Nursing, Pukyong National University, Busan, Korea
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Mirzakhani K, Khadivzadeh T, Faridhosseini F, Ebadi A. Development and psychometric evaluation of the High-Risk Pregnancy Well-Being Index in Mashhad: a methodological study. Reprod Health 2022; 19:218. [PMID: 36457135 PMCID: PMC9714023 DOI: 10.1186/s12978-022-01529-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 11/04/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Assessment of well-being in high-risk pregnancy (HRP) is the key to achieve positive maternal and fetal outcomes. Although there are a wide range of instruments for well-being assessment, none of them is comprehensive for well-being assessment in HRP. The present study aimed at the development and psychometric evaluation of the High-Risk Pregnancy Well-Being Index (HRPWBI). METHODS This methodological study was conducted using the Waltz's four-step method. The dimensions of well-being in HRP were determined based on a conceptual model and the blueprint and the item pool of HRPWBI were developed. Then, the face and the content validity were assessed and item analysis was performed. Construct validity was also assessed through exploratory factor analysis with principal component analysis on the data obtained from 376 women with HRP in Mashhad, Iran. Finally, internal consistency, test-retest stability, sensitivity, and interpretability of HRPWBI were assessed. RESULTS The scale- content validity index (SCVI) of HRPWBI was 0.91. In factor analysis, 33 items were loaded on seven factors which explained 53.77% of the total variance. Internal consistency, relative stability, absolute stability, sensitivity, and interpretability of HRPWBI were confirmed with a Cronbach's alpha of 0.84, a test-retest intraclass correlation coefficient of 0.97, a standard error of measurement of 0.92, a minimal detectable change of 8.09, and a minimal important change of 2.92, respectively. CONCLUSION HRPWBI is a valid and reliable instrument for well-being assessment among women with HRP. It can be used to assess well-being and the effects of well-being improvement interventions on well-being among women with HRP.
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Affiliation(s)
- Kobra Mirzakhani
- grid.411583.a0000 0001 2198 6209Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran ,grid.411583.a0000 0001 2198 6209Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Talat Khadivzadeh
- grid.411583.a0000 0001 2198 6209Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran ,grid.411583.a0000 0001 2198 6209Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farhad Faridhosseini
- grid.411583.a0000 0001 2198 6209Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas Ebadi
- grid.411521.20000 0000 9975 294XBehavioral Sciences Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran ,Research Center for Life & Health Sciences & Biotechnology of the Police, Direction oh Health, Rescue & Treatment, Police Headquarter, Tehran, Iran
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Unlu Bidik N, Hamlaci Baskaya Y. Expectant Fathers' perceptions towards high-risk pregnancy and experiences in this period: A study of hermeneutic phenomenology. Appl Nurs Res 2022; 68:151639. [PMID: 36473719 DOI: 10.1016/j.apnr.2022.151639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/20/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022]
Abstract
BACKROUND High-risk pregnancy affects maternal and infant health negatively and it may be the beginning of a process with traumatic outcomes for women and their spouses. Identifying the experiences and perceptions of expectant fathers in this process is important to develop support factors for women and their spouses. OBJECTIVE To identify expectant fathers' perceptions towards high-risk pregnancy and their experiences during the high-risk pregnancy period. PARTICIPANTS Fifteen expectant fathers whose spouses were admitted to the hospital due to high-risk pregnancy were interviewed for the study. DESIGN This study was conducted using an interpretive paradigm based on the Heideggerian hermeneutic phenomenology, which is a qualitative research method. Data were collected through in-depth telephonic interviews. The interviews were recorded, transcribed verbatim and analyzed thematically. FINDINGS Four main themes were obtained: "Emotional burden", "Coping mechanisms", "Adaptation to fatherhood" and "High-risk pregnancy journey". The expectant fathers said that they had so many emotions during this process, could cope by praying and with support from their spouses, longed for their unborn child and had increased responsibilities due to paternity. CONCLUSIONS The results of this study indicated that men struggled emotionally, had very few coping strategies, questioned the high-risk pregnancy process, had several expectations and formed father-infant attachment during the high-risk pregnancy. Further studies are needed that review how midwives and nurses can support expectant fathers in this process and that provide opportunities for the improvement of clinical roles in this regard.
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Lanci A, Mariella J, Ellero N, Canisso IF, Dondi F, Castagnetti C. High-Risk Pregnancy Is Associated With Increased Alpha-Fetoprotein Concentrations in the Amniotic Fluid and Foal Plasma. J Equine Vet Sci 2022; 119:104124. [PMID: 36154851 DOI: 10.1016/j.jevs.2022.104124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 08/30/2022] [Accepted: 09/07/2022] [Indexed: 12/14/2022]
Abstract
This study aimed to determine alpha-fetoprotein (AFP) concentrations in amniotic fluid, plasma of mares and respective foals: carrying normal pregnancies and delivering healthy foals (n = 20; Group 1); carrying apparently normal pregnancies and delivering sick foals (n = 15; Group 2); carrying high-risk pregnancies and delivering sick foals (n = 14; Group 3). High-risk pregnancy was defined by a history of premature udder development/lactation or increased of the combined thickness of the uterus and placenta, or vulvar discharge and/or mares' systemic illness. Sick foals were affected by neonatal encephalopathy, sepsis, prematurity/dysmaturity, or hypoxic-ischemic encephalopathy. Based on histological examination of the chorioallantois, AFP trend was analyzed in pregnancies with pathologic (PFM) and normal fetal membranes (NFM). Concentrations of AFP were measured using a commercially available immunoassay previously validated for horses. Mares' plasma AFP did not change during the last 15-20 days of pregnancy in the three groups, and there was no difference among them. Amniotic fluid AFP was higher in Group 3 (P = .014). Foals' plasma AFP concentration was higher from birth to 72hours in foals of Group 2 and 3 than in healthy ones, and foals of Group 3 had the highest value. The strong association (r = 0.84; P < .0001) between AFP in amniotic fluid and foals' plasma at birth is likely due to the presence of AFP in fetal urine. AFP was higher in pregnancy with PFM than with NFM in mare's plasma at admission (P = .031), amniotic fluid (P = .004), foal's plasma at birth (P = .002), at 24 (P = .005) and at 72 hours of life (P = .004). AFP is higher in pregnancy with histopathological lesions of the chorioallantois providing the evidence of the differences between pregnancy with a normal placental barrier and the more compromised ones. The increased AFP concentration in the amniotic fluid and plasma of high-risk foals suggests upregulation.
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Affiliation(s)
- Aliai Lanci
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, Bologna, Italy
| | - Jole Mariella
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, Bologna, Italy
| | - Nicola Ellero
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, Bologna, Italy
| | - Igor F Canisso
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois Urbana-Champaign, Urbana, IL
| | - Francesco Dondi
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, Bologna, Italy
| | - Carolina Castagnetti
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, Bologna, Italy; Health Science and Technologies Interdepartmental Center for Industrial Research (HST-ICIR), University of Bologna, Ozzano dell'Emilia, Bologna, Italy
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Mohammadi S, Shojaei K, Maraghi E, Motaghi Z. Explaining the Psychological Distress of Women with High-Risk Pregnancies in Iran: A Qualitative Study. Iran J Nurs Midwifery Res 2022; 27:560-566. [PMID: 36712296 PMCID: PMC9881562 DOI: 10.4103/ijnmr.ijnmr_321_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 12/19/2021] [Accepted: 09/21/2022] [Indexed: 01/31/2023]
Abstract
Background Psychological Distress (PD) is one of the most common mental disorders during pregnancy and involves stress, anxiety, and depression. According to the literature, High-Risk Pregnancy' (HRP) is a major physiological risk factor associated with PD during pregnancy. The main purpose of this study was to explore the perception and experience of women with HRP who, based on standard questionnaires, had moderate-to-severe stress and anxiety scores. Materials and Methods This qualitative study was conducted using conventional content analysis from December 2020 to June 2021. To this aim, 16 women with HRP were purposefully selected from Imam Khomeini Hospital in Ahvaz, Iran, with maximum diversity. In-depth, semi-structured, individual interviews were conducted to collect the data. The MAXQDA software was used for data analysis. Results Data analysis led to the extraction of two main categories and nine subcategories. "Disrupted peace" and "inefficient adaptation to the situation" were the two extracted categories. The former included the five subcategories of concerns about pregnancy complications, concerns about the parenting process, concerns about the couple's relationship, fear of Covid-19, and occupation-related stress. The latter included the three subcategories of unpleasant feelings, current pregnancy experiences, and previous pregnancy experiences. Conclusions This study highlighted a wide range of psychosocial factors involved in the PD of women with HRP. These findings can be used to design appropriate prevention strategies to manage the mental health problems of these women in order to turn their pregnancy into a pleasurable experience.
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Affiliation(s)
- Solmaz Mohammadi
- Student Research Committee, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Kobra Shojaei
- Department of Obstetrics and Gynecology, Fertility, Infertility and Perinatology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Elham Maraghi
- Department of Biostatistics and Epidemiology, Faculty of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Zahra Motaghi
- Reproductive Health Department, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran,Address for correspondence: Dr. Zahra Motaghi, Reproductive Health Department, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran. E-mail:
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Sielhorst J, Roggel-Buecker U, Neudeck KC, Kahler A, Rohn K, Luettgenau J, Bollwein H, Hollinshead F, Sieme H. Effect of acetylsalicylic acid on uterine blood flow, gestation length, foal birth weight and placental weight in pregnant Thoroughbred mares - a clinical pilot study. J Equine Vet Sci 2022;:104107. [PMID: 36002117 DOI: 10.1016/j.jevs.2022.104107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/15/2022] [Accepted: 08/17/2022] [Indexed: 11/23/2022]
Abstract
The aim of this double-blinded placebo-controlled study was to investigate the effect of acetylsalicylic acid (ASA) on uterine blood flow, gestation length, placental and foal weights in pregnant mares. Sixteen Thoroughbred mares of different age (13.3 ± 4.1) and parity (7.4 ± 3.1) were randomly assigned to three treatment groups. Mares in group C (n = 4) served as controls and received 5000 mg lactose orally once daily from D 120 (D 0 = day of ovulation) until parturition. Mares in group ASA1 (n = 7) received 5000 mg ASA orally once daily from D 120 until parturition. Mares in group ASA2 (n = 5) received the same dose ASA as group ASA1 from D 120 to D 285, but twice daily from D 285 until parturition. Mares were examined by ultrasonography on D 14, 28 and 60, and in 21-days intervals from D 120 until parturition. The cross-sectional area, time average maximum velocity (TAMV), and pulsatility index were measured in both uterine arteries and the blood flow volume was calculated for each uterine artery and then summarized. All 16 mares carried a normal pregnancy and delivered live foals. In group ASA2 TAMV in the ipsilateral artery was significantly higher (P = 0.03) and these mares showed a tendency of increased total blood flow volume (P = 0.07) during late pregnancy (D 305 to 346). Results indicate that oral administration of 5000 mg of ASA twice daily in pregnant mares causes a rise in uterine blood flow during late pregnancy.
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Aliabadi S, Shayan A, Refaei M, Tapak L, Moradveisi L. The effect of individual counseling based on the GATHER principles on perceived stress and empowerment of the mothers with high-risk pregnancies: an experimental study. BMC Psychiatry 2022; 22:396. [PMID: 35698043 PMCID: PMC9195445 DOI: 10.1186/s12888-022-04047-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/10/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND High-risk pregnancy causes different responses, including negative emotions, feelings of vulnerability and psychological stress in the mother. The aim of this study was to investigate the effect of individual counseling on the empowerment and the perceived stress of high-risk pregnant mothers. METHODS This study was a two-group experimental study. The study was performed on 82 high-risk pregnant women hospitalized in Fatemieh Hospital in Hamadan, Iran. Inclusion criteria were high-risk pregnancy, being literate, gestational age 24 to 36 weeks. The samples were divided into experimental and control groups using randomized block design. Data were collected using Cohen's perceived stress scale and Kameda empowerment questionnaires. For the experimental group, four sessions of individual counseling according to GATHER principles (Greet, Ask, Tell, Help, Explain, and Return) were performed for 45-60 minutes for two consecutive weeks. SPSS 25 software was used for data analysis. RESULTS The mean score of the perceived stress after the intervention in the control and experimental groups were 27.07(5.80) and 25.30(4.95), respectively (P = 0.097). There was a substantial difference in the mean score of empowerment 84.76)9.14) and 88.75 (6.17) (P < 0.001) and different dimensions of empowerment (self-efficacy, Future image, self-esteem, Support and assurance from others) between the control and intervention groups after the intervention. CONCLUSIONS The findings of this study indicate individual counseling is effective in empowering the mothers with high-risk pregnancy but has no significant effect on their perceived stress.
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Affiliation(s)
- Sahar Aliabadi
- grid.411950.80000 0004 0611 9280Department of Mother and Child Health, Mother and Child Care Research Center, School of Nursing and Midwifery, Hamadan University of medical sciences, Hamadan, Iran
| | - Arezoo Shayan
- grid.411950.80000 0004 0611 9280Department of Midwifery and Reproductive Health, Mother and Child Care Research Center, School of Nursing and Midwifery, Hamadan University of medical sciences, Hamadan, Iran
| | - Mansoureh Refaei
- Department of Mother and Child Health, Mother and Child Care Research Center, School of Nursing and Midwifery, Hamadan University of medical sciences, Hamadan, Iran.
| | - Leili Tapak
- grid.411950.80000 0004 0611 9280Department of Biostatistics, School of Public Health, Modeling of Noncommunicable Diseases Research Center, Hamadan University of medical sciences, Hamadan, Iran
| | - Latif Moradveisi
- grid.411950.80000 0004 0611 9280Research Center for Behavioral Disorders and Substance Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
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Mikaelsen I, Johansen AN, Tappert C, Eggebø TM. Induction of labor in twin pregnancies - A retrospective cohort study. Sex Reprod Healthc 2022; 32:100724. [PMID: 35436694 DOI: 10.1016/j.srhc.2022.100724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 03/22/2022] [Accepted: 03/28/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To investigate outcomes in spontaneous and induced twin deliveries. Secondary aims were to study impact of delivery interval and breech presentation of the first twin. METHODS This retrospective cohort study comprised 354 twin deliveries at a tertiary Norwegian hospital. Spontaneous labor onset and induction of labor were compared in women with planned vaginal delivery and gestational age ≥ 34 weeks. The main outcome was intrapartum cesarean section. Secondary outcomes were umbilical arterial pH and five-minute Apgar scores. RESULTS Among the induced labors, 63/229 (27.5%) women underwent intrapartum cesarean section, compared to 45/125 (36%) in spontaneous labors (P = 0.10). Odds ratio for intrapartum cesarean section in induced labors was 0.65 (95% CI 0.40-1.04) after adjusting for maternal age and parity. Median umbilical arterial pH was significantly lower in the second twins in both spontaneous and induced labors, 7.28 (6.94-7.43) vs. 7.32 (7.16-7.42), and 7.27 (6.90-7.48) vs. 7.29 (7.08-7.45), respectively. pH < 7.00 rarely occurred. Second twins born after a delivery interval > 30 min had a significantly higher frequency of pH < 7.10 than those with a shorter interval, P < 0.01. No significant difference was found in frequency of pH < 7.10 between breech-presenting and cephalic-presenting first twins (P = 0.65). One unexpected intrapartum fetal death occurred after labor induction. CONCLUSION Our results support spontaneous onset and induction of labor as safe. Intrapartum cesarean section rates did not differ significantly between spontaneous and induced labors. Delivery interval > 30 min was associated with a lower pH in the second twin.
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Affiliation(s)
- Ingrid Mikaelsen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Anine Nikoline Johansen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Christian Tappert
- Departement of Obstetrics, Trondheim University Hospital (St. Olav's Hospital), Trondheim, Norway
| | - Torbjørn Moe Eggebø
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Center for Fetal Medicine, Trondheim University Hospital (St. Olav's Hospital), Trondheim, Norway; Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway
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Jeong DE, Hyun SM, Cho I, Lee KN, Ahn K, Ji Kim H, Yoon Park J, Oh KJ. The association between maternal pre-pregnancy body mass index and pregnancy outcomes of preeclampsia. Taiwan J Obstet Gynecol 2022; 61:441-446. [PMID: 35595435 DOI: 10.1016/j.tjog.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To evaluate the effects of pre-pregnancy maternal body mass index (BMI) to pregnancy outcomes in patients diagnosed as preeclampsia. MATERIALS AND METHODS This was a retrospectively study on women who had been diagnosed as preeclampsia and delivered at Seoul National University Bundang Hospital between June 2017 and March 2020. Multifetal gestation, major fetal anomaly, and fetal death in utero were excluded. A total of 150 singleton pregnancies were included and divided into four groups according to the pre-pregnancy BMI classification: underweight (<18.5 kg/m2, n = 6), normal (18.5-22.9 kg/m2, n = 66), overweight (23.0-24.9 kg/m2, n = 26), and obese (≥25.0 kg/m2, n = 52). Pregnancy outcomes including gestational age at delivery, birthweight, and delivery modes were reviewed. RESULTS The rates of preterm birth before 34 weeks of gestation were 67%, 49%, 35%, and 27% for underweight group, normal BMI group, overweight group, and obese group, respectively (p-trend = 0.006). The birthweight of newborn increased significantly as pre-pregnancy BMI increased (p-trend<0.001). The proportions of small for gestational age (SGA) were highest in underweight group and decreased as pre-pregnancy BMI increased (67%, 41%, 42%, and 10% for each group, respectively, p-trend<0.001). CONCLUSION The rates of preterm birth before 34 weeks and SGA increased as pre-pregnancy BMI decreased in patients with preeclampsia. IMPLICATIONS FOR PRACTICE Women with underweight before pregnancy are at the highest risk for preterm birth and SGA, therefore they need to be monitored more intensively when diagnosed as preeclampsia.
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Affiliation(s)
- Da Eun Jeong
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Su Min Hyun
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Iseop Cho
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyong-No Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kwanghee Ahn
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyeon Ji Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jee Yoon Park
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Kyung Joon Oh
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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Smorti M, Gemignani A, Bonassi L, Mauri G, Carducci A, Ionio C. The impact of Covid-19 restrictions on depressive symptoms in low-risk and high-risk pregnant women: a cross-sectional study before and during pandemic. BMC Pregnancy Childbirth 2022; 22:191. [PMID: 35260098 PMCID: PMC8902730 DOI: 10.1186/s12884-022-04515-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 02/03/2022] [Indexed: 11/10/2022] Open
Abstract
Background The COVID-19 social restrictions have increased the risk for depression compared to the previous period in Italian women with Low-Risk Pregnancy (LRP). lLess is known about the impact of COVID-19 restrictions on High-Risk Pregnancy (HRP). This study aimed: 1) to explore levels of depression in women who become pregnant before and during COVID-19 pandemic, distinguishing between LRP and HRP; 2) to analyze the impact of COVID-19 restrictions on pregnancy experience in LRP and HRP. Methods A before-during COVID-19 pandemic cross-sectional study was carried out on 155 pregnant women (Mean age = 34.18), between 23 and 32 weeks of gestation. 77 women were recruited before COVID-19 pandemic (51.9% LRP; 48.1% HRP) and 78 women were recruited during COVID-19 pandemic (51.3% LRP; 48.7% HRP). HRP group was enrolled during hospitalization for high-risk pregnancy. Participants filled out Edinburgh Postnatal Depression Scale. Moreover, only COVID-19 group answered an open-ended question about the impact of restriction on pregnancy experience. Results HRP women reported higher levels of depressive symptoms than LRP. No difference emerged for COVID (before/during) but an interaction effect between COVID-19 and obstetric condition was found. The qualitative results showed the impact of restrictions on emotions and concerns. Conclusion Respect to the previous period, LRP women during COVID-19 presented an increased risk for depressive symptoms than HRP. The HRP women during COVID-19 seemed to use hospitalization as a resource to find a social support network with other pregnant women and to be reassured on the clinical ongoing of pregnancy.
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Affiliation(s)
- Martina Smorti
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Via Savi 10, 56126, Pisa, Italy.
| | - Angelo Gemignani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Via Savi 10, 56126, Pisa, Italy
| | - Lucia Bonassi
- Department of Mental Health, ASST Bergamo-Est, Seriate, Italy
| | - Giulia Mauri
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Via Savi 10, 56126, Pisa, Italy
| | - Alessia Carducci
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Via Savi 10, 56126, Pisa, Italy
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Fernandes JMPA, de Aguiar Pontes Pamplona Y, Vaz JA, Pereira AR, Barbieri CLA, Braga ALF, Martins LC. Association between high-risk pregnancy and environmental contaminants in the Metropolitan Region of Baixada Santista, Brazil. Environ Sci Pollut Res Int 2022; 29:14552-14560. [PMID: 34613545 DOI: 10.1007/s11356-021-16794-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 09/24/2021] [Indexed: 06/13/2023]
Abstract
The Metropolitan Region of Baixada Santista (MRBS) is a highly contaminated area. High-risk pregnancy is one factor that leads to a higher chance of both morbidity and mortality of the mother-fetus binomial. The purpose of this study is to analyze the association between exposure to environmental contaminants and high-risk pregnancy. Case-control study, using a probabilistic and random sample composed of 201 high-risk pregnant women (cases) and 201 no high-risk pregnant women (control) followed up during prenatal care at a Public Hospital. The instrument used was a self-administered questionnaire. Contaminated areas data were obtained from the Environmental Company of the São Paulo State. The participants were georeferenced by their place of residence. Descriptive analysis, Chi-square test, and univariate and multiple logistic regression analysis were performed. The multiple logistic regression model demonstrated that living in a contaminated area (OR = 1.565; 95%CI: 1.033; 2.370), preterm delivery in the current pregnancy (OR = 1.989; 95%CI: 1.239; 3.194), and more than 35 years old (OR = 2.822; 95%CI: 1.692; 4.706) are factors jointly related to high-risk pregnancy. Environmental contaminants play an important role in high-risk pregnancy, and mitigating measures are needed to improve the environment and reduce high-risk pregnancy.
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Affiliation(s)
- Joice Maria Pacheco Antonio Fernandes
- Exposure and Environmental Risk Assessment Group-Postgraduate Program in Collective Health, Catholic University of Santos, Av. Conselheiro Nebias, 300, Santos, São Paulo, CEP: 11045-003, Brazil
| | - Ysabely de Aguiar Pontes Pamplona
- Exposure and Environmental Risk Assessment Group-Postgraduate Program in Collective Health, Catholic University of Santos, Av. Conselheiro Nebias, 300, Santos, São Paulo, CEP: 11045-003, Brazil
| | - Jhonnes Alberto Vaz
- Centro de Ciencias Exatas, Arquitetura E Engenharia da Universidade Católica de Santos, Av. Conselheiro Nebias, 300, Santos, São Paulo, CEP: 11045-003, Brazil
| | - Amanda Rodrigues Pereira
- Exposure and Environmental Risk Assessment Group-Postgraduate Program in Collective Health, Catholic University of Santos, Av. Conselheiro Nebias, 300, Santos, São Paulo, CEP: 11045-003, Brazil
| | - Carolina Luísa Alves Barbieri
- Exposure and Environmental Risk Assessment Group-Postgraduate Program in Collective Health, Catholic University of Santos, Av. Conselheiro Nebias, 300, Santos, São Paulo, CEP: 11045-003, Brazil
| | - Alfésio Luís Ferreira Braga
- Exposure and Environmental Risk Assessment Group-Postgraduate Program in Collective Health, Catholic University of Santos, Av. Conselheiro Nebias, 300, Santos, São Paulo, CEP: 11045-003, Brazil
- Environmental Epidemiology Study Group, Laboratory of Experimental Air Pollution, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 450, São Paulo, CEP: 01246-903, Brazil
| | - Lourdes Conceição Martins
- Exposure and Environmental Risk Assessment Group-Postgraduate Program in Collective Health, Catholic University of Santos, Av. Conselheiro Nebias, 300, Santos, São Paulo, CEP: 11045-003, Brazil.
- Environmental Epidemiology Study Group, Laboratory of Experimental Air Pollution, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 450, São Paulo, CEP: 01246-903, Brazil.
- , São Paulo, Brazil.
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Ibanoglu MC, Oskovi-Kaplan ZA, Ozgu-Erdinc AS, Kara O, Sahin D. Comparison of the Kisspeptin levels in early onset preeclampsia and late-onset preeclampsia. Arch Gynecol Obstet 2022; 306:991-996. [PMID: 35039882 DOI: 10.1007/s00404-021-06359-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 12/06/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Maternal Kisspeptin plays role in cell migration which is responsible for trophoblast invasion. We aimed to investigate the role of Kisspeptin as an invasion marker in the early-onset and late-onset preeclampsia cases. STUDY DESIGN In this case-control study, 125 patients were included: 20 patients with early-onset preeclampsia and 20 gestational-age-matched healthy controls; 45 patients with late-onset preeclampsia and 40 gestational-age-matched controls). Maternal plasma Kisspeptin concentration was measured and compared in groups regarding the presence of early-onset and late-onset preeclampsia. RESULTS In the late-onset PE group, significantly higher maternal plasma Kisspeptin values were observed compared with the control group at > 34 weeks of gestation (68.7 ± 93.4 pg/ml vs 68.5 ± 57.9 pg/ml; p = 0.004). Before the 34th week of gestation, plasma Kisspeptin levels did not show a significant difference when patients with early-onset PE and gestational-age matched controls were compared (66.8 ± 87.9 pg/ml vs 48.5 ± 91.3 pg/ml; p = 0.56). CONCLUSION Plasma Kisspeptin levels were significantly higher in women with late-onset preeclampsia, while no significant difference was observed in early-onset preeclampsia when compared with healthy gestational age-matched controls. The role of Kisspeptin proteins is still not clearly defined in the pathogenesis of preeclampsia.
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Affiliation(s)
- Mujde Can Ibanoglu
- Department of Obstetrics and Gynecology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey
| | - Z Asli Oskovi-Kaplan
- Department of Obstetrics and Gynecology, TOBB Economy and Technical University, Ankara, Turkey.
| | - A Seval Ozgu-Erdinc
- Department of Obstetrics and Gynecology, TOBB Economy and Technical University, Ankara, Turkey
| | - Ozgur Kara
- Department of Perinatology, University of Health Sciences, Ankara City Hospital, Antakya, Hatay, Turkey
| | - Dilek Sahin
- Department of Perinatology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
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Yu X, Liu Y, Huang Y, Zeng T. The effect of nonpharmacological interventions on the mental health of high-risk pregnant women: A systematic review. Complement Ther Med 2022; 64:102799. [PMID: 34995769 DOI: 10.1016/j.ctim.2022.102799] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 12/31/2021] [Accepted: 01/03/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To evaluate the effect of nonpharmacological interventions on the mental health of high-risk pregnant women. METHODS This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 (PRISMA) statement. The Cochrane Library, Embase, CINAHL, PubMed and Web of Science databases were systematically searched for randomized controlled trials and quasi-randomized controlled trials from inception to April 2021. The quality of the studies was assessed using the Cochrane Risk of Bias Tool 2.0. Data were independently extracted and narratively synthesized. RESULTS Fifteen studies involving 1723 pregnant women were selected. Nonpharmacological interventions included cognitive behavioral interventions, yoga, relaxation interventions, psychological and educational support interventions, and acupressure. Cognitive behavioral interventions and yoga for high-risk pregnant women had potential benefits on the symptoms of anxiety, stress and depression. There was insufficient evidence that relaxation interventions, psychological and educational support interventions and acupressure had positive effects on these women's mental health. CONCLUSIONS This review showed that cognitive behavioral interventions and yoga during pregnancy may benefit women with high-risk pregnancies. However, due to methodological limitations of this review, further studies with robust methodological designs are needed to verify the efficacy.
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Affiliation(s)
- Xiaoyan Yu
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan 430030, China
| | - Yu Liu
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan 430030, China.
| | - Yi Huang
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan 430030, China
| | - Tieying Zeng
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan 430030, China
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Rajendiran P, Saravanan N, Ramamurthy M, Sankar S, Aruliah R, Nandagopal B, Sridharan G. Standardization of an in-house multiplex real-time polymerase chain reaction for the simultaneous detection of Toxoplasma gondii, Rubella virus, cytomegalovirus, herpes simplex Virus 1 and 2, and Treponema pallidum infection among pregnant women. Indian J Public Health 2022; 65:369-374. [PMID: 34975080 DOI: 10.4103/ijph.ijph_1271_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background An in-house multiplex real-time polymerase chain reaction (PCR) was developed in two cocktails for the identification of six Toxoplasma gondii, Rubella virus, cytomegalovirus, herpes simplex virus (1 and 2), and Treponema pallidum (syphilis) (TORCH-S) agents, which causes congenital infection among pregnant women. Objective Standardization and validation of an in-house multiplex real-time PCR assay for the detection of TORCH-S infection. Methods This study was conducted from February 2017 to February 2019. Primers specific for T. gondii, Rubella virus, cytomegalovirus, herpes simplex virus (1 and 2), and T. pallidum were designed using Primer3 software (https://bioinfo.ut.ee/primer3-0.4.0/). The primer sequences obtained were subjected to BLAST analysis using BLAST database. Synthetic DNA was obtained to use as positive control templates for all the six TORCH-S agents. The lower limit of the detection was performed using plasmid construct for each virus serially diluted from 10-1 to 10-9. Results An in-house multiplex real-time PCR was standardized and validated in two cocktails for TORCH-S agents, cocktail-1 (HSV1, rubella, and T. gondii), and cocktail-2 (HSV2, CMV, and T. pallidum). The lower limit of the detection for HSV1, rubella, and Toxoplasma were 60.7 copies/10 μl input, 76.4 copies/10 μl input, and 34.4 copies/10 μl input and for HSV2, CMV, and T. pallidum were 80.8 copies/10 μl input, 166 copies/10 μl input, and 43.7 copies/10 μl input, respectively. Conclusion TORCH-S infection is one of the significant reasons for irregular pregnant outcomes. It is absolutely important to screen TORCH-S infection for women who had the histories of abnormal pregnancies to prevent birth defects and perinatal complications. This multiplex real-time PCR assay provides a rapid, sensitive, and specific technique to detect these six TORCH-S agents.
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Affiliation(s)
- Prashanth Rajendiran
- Sri Sakthi Amma Institute of Biomedical Research, Sri Narayani Hospital and Research Centre, Sripuram, Vellore, Tamil Nadu, India
| | - Nithiyanandan Saravanan
- Sri Sakthi Amma Institute of Biomedical Research, Sri Narayani Hospital and Research Centre, Sripuram, Vellore, Tamil Nadu, India
| | - Mageshbabu Ramamurthy
- Sri Sakthi Amma Institute of Biomedical Research, Sri Narayani Hospital and Research Centre, Sripuram, Vellore, Tamil Nadu, India
| | - Sathish Sankar
- Sri Sakthi Amma Institute of Biomedical Research, Sri Narayani Hospital and Research Centre, Sripuram, Vellore, Tamil Nadu, India
| | - Rajasekar Aruliah
- Environmental Molecular Microbiology Research Laboratory, Department of Biotechnology, Thiruvalluvar University, Serkadu, Vellore, Tamil Nadu, India
| | - Balaji Nandagopal
- Sri Sakthi Amma Institute of Biomedical Research, Sri Narayani Hospital and Research Centre, Sripuram, Vellore, Tamil Nadu, India
| | - Gopalan Sridharan
- Sri Sakthi Amma Institute of Biomedical Research, Sri Narayani Hospital and Research Centre, Sripuram, Vellore, Tamil Nadu, India
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Vieira VDS, Feiten TDS, Ferrari RS, Dalcin PDTR, Ziegler B. Predictive factors for premature birth and respiratory exacerbation in pregnancies of women with cystic fibrosis. J Pediatr (Rio J) 2022; 98:33-38. [PMID: 34115976 PMCID: PMC9432334 DOI: 10.1016/j.jped.2021.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE In this present study, the authors evaluated the predictive factors for adverse maternal-fetal outcomes in pregnancies of women with cystic fibrosis (CF). Patients were followed up by a referral center for adults in southern Brazil. METHODS This is a retrospective cohort study that used data from electronic medical records regarding pregnancies of women diagnosed with CF. RESULTS The study included 39 pregnancies related to 20 different women. The main adverse outcomes were high prevalence rates of premature birth (38.5%) and maternal respiratory exacerbation (84.6%). Lower body mass index (BMI) values (< 20.8) and younger ages of CF diagnosis increased the risk of premature birth. The presence of methicillin-resistant and absence of methicillin-sensitive Staphylococcus aureus, as well as a younger age of diagnosis, increased the risk of maternal respiratory exacerbation during pregnancy. CONCLUSIONS Conception in women with CF is often associated with maternal and fetal complications. Continuous monitoring by a multidisciplinary team should emphasize appropriate nutritional status, investigation of bacterial colonization, and immediate attention to respiratory exacerbations.
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Affiliation(s)
- Vanessa de Souza Vieira
- Hospital de Clínicas de Porto Alegre (HCPA), Fisioterapeuta Residente em Saúde da Criança e do Adolescente, Porto Alegre, RS, Brazil
| | - Taiane Dos Santos Feiten
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Ciências Pneumológicas, Porto Alegre, RS, Brazil
| | - Renata Salatti Ferrari
- Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Fisioterapia, Porto Alegre, RS, Brazil
| | - Paulo de Tarso Roth Dalcin
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Ciências Pneumológicas, Porto Alegre, RS, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Pneumologia, Porto Alegre, RS, Brazil
| | - Bruna Ziegler
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Ciências Pneumológicas, Porto Alegre, RS, Brazil; Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Fisioterapia, Porto Alegre, RS, Brazil.
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Dwitama MA, Masni, Nur R, Indarty A, Tahir A M, Mallongi A, Basir M, Mahfudz, Ansyari A. Mapping of high-risk detection of women pregnancy on antenatal care in Talise Health Center, Palu City, Indonesia. Gac Sanit 2021; 35 Suppl 2:S152-S158. [PMID: 34929800 DOI: 10.1016/j.gaceta.2021.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/30/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to map pregnant women with high-risk pregnancies based on age, parity, pregnancy history, childbirth history, illness history, and CED status history as well as the relationship between the six factors. METHOD This study utilized a survey method with descriptive data without the intervention of variables but observed phenomena or sought the relationship between phenomena and other variables. The survey was conducted with an approach using Geographic Information Systems (GIS). There were 243 respondents obtained using the Lemeshow formula, while the data were analyzed using spatial techniques and Chi-Square test with p>0.05. RESULTS The results of spatial analysis using a 1: 50,000 scale map showed that; (1) high-risk and very high-risk pregnancies dominated Talise, (2) based on age, parity, pregnancy history, childbirth history, illness history, and CED status, cases of high-risk pregnancies were all detected in Talise, (3) age (p=0.000). Furthermore, pregnancy history (p=0.004) correlated with a high-risk pregnancy. Besides, parity, childbirth history, illness history, and CED status did not correlate with high-risk pregnancy since the p-value>0.05; (4) age and pregnancy history influenced the high-risk pregnancy.
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Affiliation(s)
| | - Masni
- Faculty of Public Health, Universitas Hasanuddin, Makassar, Indonesia
| | - Rosmala Nur
- Public Health Department, Faculty of Public Health, Universitas Tadulako, Indonesia
| | - Apik Indarty
- Reproduction Health Department, Faculty of Public Health, Universitas Hasanuddin, Indonesia
| | - Muh Tahir A
- Reproduction Health Department, Faculty of Public Health, Universitas Hasanuddin, Indonesia
| | - Anwar Mallongi
- Environmental Health Department, Faculty of Public Health, Universitas Hasanuddin, Indonesia
| | - Muhammad Basir
- Agrotechnology Department, Faculty of Agriculture, Universitas Tadulako, Indonesia
| | - Mahfudz
- Agrotechnology Department, Faculty of Agriculture, Universitas Tadulako, Indonesia
| | - Alam Ansyari
- Agrotechnology Department, Faculty of Agriculture, Universitas Tadulako, Indonesia
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Baltacı N, Başer M. The Effect of Lullaby Intervention on Anxiety and Prenatal Attachment in Women with High-Risk Pregnancy: A Randomized Controlled Study. Complement Med Res 2021; 29:127-135. [PMID: 34818646 DOI: 10.1159/000520139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/07/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Women with high-risk pregnancy experience anxiety and low mother-fetal attachment when faced with signs of danger and health problems. This study aimed to investigate the effects of lullaby intervention on anxiety and prenatal attachment in women with high-risk pregnancy. MATERIALS AND METHODS This randomized controlled trial was conducted in the perinatology clinic of a state maternity hospital in Turkey. Seventy-six women with high-risk pregnancy were included. The intervention group listened to lullabies for 20 min once a day, and accompanied by lullabies touched their abdomen and thought about their babies, but the control group did not. Data were collected using the Pregnant Information Form, the State Anxiety Inventory, and the Prenatal Attachment Inventory. RESULTS Baseline anxiety did not differ in the intervention versus control group (47.83 ± 10.74 vs. 44.10 ± 8.08, mean difference 3.73 [95% Cl -1.18 to 8.64], p = 0.13), but after the 2nd day lullaby intervention anxiety was lower in the intervention group versus control group (33.66 ± 9.32 vs. 43.06 ± 8.10, mean difference -9.40 [95% Cl -13.91 to -4.88], p < 0.01). Baseline prenatal attachment did not differ in the intervention versus control group (56.03 ± 10.71 vs. 53.86 ± 9.98, mean difference 2.16 [95% Cl -3.18 to 7.51], p = 0.42), but after the 2nd day lullaby intervention prenatal attachment was higher in the intervention group versus control group (66.70 ± 7.60 vs. 54.36 ± 9.52, mean difference 12.33 [95% Cl 7.87 to 16.78], p < 0.01). In the within-group analysis the intervention group had lower anxiety and better prenatal attachment (p < 0.01), but not in the control group (p > 0.05). CONCLUSION Lullaby intervention can play an effective role in reducing anxiety and improving prenatal attachment. The use of this integrative, noninvasive, non-pharmacologic, time-efficient, and natural intervention is suggested in the care of pregnant women.
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Affiliation(s)
- Nazlı Baltacı
- Department of Nursing, Faculty of Health Sciences, Ondokuz Mayıs University, Samsun, Turkey
| | - Mürüvvet Başer
- Department of Nursing, Faculty of Health Sciences, Erciyes University, Kayseri, Turkey
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Morrakotkhiew W, Chirdkiatgumchai V, Tantrakul V, Thampratankul L. Early developmental outcome in children born to mothers with obstructive sleep apnea. Sleep Med 2021; 88:90-5. [PMID: 34740171 DOI: 10.1016/j.sleep.2021.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/17/2021] [Accepted: 10/12/2021] [Indexed: 11/22/2022]
Abstract
Obstructive sleep apnea (OSA) during pregnancy leads to adverse maternal and perinatal outcomes. There have been limited studies evaluated the effect of intrauterine exposure to maternal OSA on childhood developmental outcomes. This study was aimed to evaluate the early development of children born to mothers with gestational OSA and the impact of continuous positive airway pressure (CPAP) treatment. METHODS: Children aged 6-36 months, born to high risk pregnant mothers who had overnight polysomnography performed, were invited to participate. The Ages and Stages Questionnaires, third edition (ASQ-3), age-specific parent-completed questionnaires determining five developmental domains (communication, gross motor, fine motor, problem-solving, and personal-social) were used for developmental screening. Children who had a score of at least one domain less than -1 SD of age cut-off were determined as having a risk of developmental delay (RDD). RESULTS: There were 159 children (47% male, mean age 18 months) enrolled. The maternal PSG showed non-OSA, mild OSA, and moderate OSA in 14%, 46%, and 40%, respectively. Forty-two children (26%) had RDD, and the most affected domains were fine motor and problem-solving. Maternal moderate OSA was significantly associated with RDD (adjusted OR 5.39, 95%CI 1.11-26.12, P 0.037). Subgroup analysis showed that maternal moderate OSA with no CPAP treatment was significantly associated with RDD (OR 6.43, 95%CI 1.34-30.89, P = 0.020) CONCLUSION: Gestational moderate OSA in high-risk pregnancy mothers likely had a negative effect on early childhood developmental outcomes, particularly the mothers who did not have appropriate CPAP treatment.
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Sayili U, Ozgur C, Bulut Gazanfer O, Solmaz A. Comparison of Clinical Characteristics and Pregnancy and Neonatal Outcomes Between Turkish Citizens and Syrian Refugees with High-Risk Pregnancies. J Immigr Minor Health 2021; 24:1177-1185. [PMID: 34635997 PMCID: PMC8504429 DOI: 10.1007/s10903-021-01288-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2021] [Indexed: 11/25/2022]
Abstract
Refugee women experience more negative pregnancy and neonatal outcomes, such as low birth weight and preterm birth. The aim of the present study was to compare the clinical characteristics and pregnancy and neonatal outcomes between Turkish citizens and Syrian refugees with high-risk pregnancies. This prospective cohort study was conducted between March and December 2020 in Sanliurfa, Turkey. The maternal characteristics and pregnancy and neonatal outcomes were compared between the two groups. In this study, a total of 302 high-risk pregnant women (233 Turkish citizens and 69 Syrian refugees) were included. Parity and pregnancy spacing shorter than 2 years were significantly higher in Syrian refugees. Age, previous abortion or miscarriage and rates of cesarean section (C/S) were significantly higher in Turkish citizens. The live birth (Turkish: 94.8% vs Syrian: 92.8%), preterm birth (Turkish: 10% vs Syrian: 9.4%), low birth weight (Turkish: 7.7% vs Syrian: 3.1%) rates and birth weight (g) (Turkish: 3097.5 ± 501.3 g; Syrian: 2980.2 ± 395.0 g) were not significantly different between Turkish citizens and Syrian refugees with high-risk pregnancy. Similar pregnancy and neonatal outcomes could be attributed to the Syrians receiving adequate and free maternity care, similar to the Turkish citizens.
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Affiliation(s)
- Ugurcan Sayili
- Karakopru District Health Directorate, Republic of Turkey Ministry of Health, Sanliurfa, Turkey
| | - Cigdem Ozgur
- Haliliye District Health Directorate, Republic of Turkey Ministry of Health, Sanliurfa, Turkey
| | - Oznur Bulut Gazanfer
- Public Health Services Presidency, Sanliurfa Provincial Health Directorate, Republic of Turkey Ministry of Health, Sanliurfa, Turkey
| | - Abdullah Solmaz
- Public Health Services Presidency, Sanliurfa Provincial Health Directorate, Republic of Turkey Ministry of Health, Sanliurfa, Turkey
- Department of Pediatrics, School of Medicine, Harran University, Sanliurfa, Turkey
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Stritzel H, Maslowsky J. Higher Rates of Twinning Among Repeat Vs First-Time Teenage and Young Adult Mothers in the United States, 2009-2018. J Pediatr Adolesc Gynecol 2021; 34:739-744. [PMID: 33910087 PMCID: PMC8410677 DOI: 10.1016/j.jpag.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/30/2021] [Accepted: 04/09/2021] [Indexed: 10/21/2022]
Abstract
STUDY OBJECTIVE Few studies examining predictors of twinning consider younger mothers who do not use assisted reproductive technologies (ART). Higher parity is associated with greater odds of having a twin birth, but it is unclear whether this association is present among young women. We tested the hypothesis that the rates and odds of twinning would increase with parity among teenage and young adult mothers who did not use ART. DESIGN, SETTING, AND PARTICIPANTS We conducted a retrospective, population-based cohort study using 2009-2018 United States National Vital Statistics data on 11,383,370 (58.94% first, 41.06% repeat) births to adolescent and adult women aged 15-24 years. INTERVENTIONS None. MAIN OUTCOME MEASURES Rates and odds of twinning by parity among teenage (15-19 years) and young adult (20-24 years) mothers. RESULTS The adjusted twin birth rate among first-time teenage mothers was 13.28 per 1000 births compared to 16.62 twins per 1,000 births among repeat teenage mothers. This difference by parity was present but smaller among mothers aged 20-24 (18.31 vs 21.44 twins per 1000 births for first-time and repeat young adult mothers, respectively). CONCLUSION Repeat young mothers, particularly teenage mothers, are a high-risk group in terms of infant and maternal health outcomes; their higher rate of twinning puts them at an additional risk for adverse birth outcomes. Practitioners may counsel young mothers at risk for subsequent unintended pregnancy on elevated risk of twinning.
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Affiliation(s)
- Haley Stritzel
- Population Research Center, Department of Sociology, The University of Texas at Austin, Austin, Texas
| | - Julie Maslowsky
- Department of Kinesiology and Health Education, Department of Population Health, Population Research Center, The University of Texas at Austin, Austin, Texas.
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Hazari KS, Abdeldayem R, Paulose L, Kurien N, Almahloul Z, Mohammad H, Elgergawi TFA, Alkhanbouli M, Mahmoud K, Fazari AB, Hassan A, Bayoumi R. Covid-19 infection in pregnant women in Dubai: a case-control study. BMC Pregnancy Childbirth 2021; 21:658. [PMID: 34583679 DOI: 10.1186/s12884-021-04130-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 09/15/2021] [Indexed: 12/15/2022] Open
Abstract
Background Whilst the impact of Covid-19 infection in pregnant women has been examined, there is a scarcity of data on pregnant women in the Middle East. Thus, the aim of this study was to examine the impact of Covid-19 infection on pregnant women in the United Arab Emirates population. Methods A case-control study was carried out to compare the clinical course and outcome of pregnancy in 79 pregnant women with Covid-19 and 85 non-pregnant women with Covid-19 admitted to Latifa Hospital in Dubai between March and June 2020. Results Although Pregnant women presented with fewer symptoms such as fever, cough, sore throat, and shortness of breath compared to non-pregnant women; yet they ran a much more severe course of illness. On admission, 12/79 (15.2%) Vs 2/85 (2.4%) had a chest radiograph score [on a scale 1-6] of ≥3 (p-value = 0.0039). On discharge, 6/79 (7.6%) Vs 1/85 (1.2%) had a score ≥3 (p-value = 0.0438). They also had much higher levels of laboratory indicators of severity with values above reference ranges for C-Reactive Protein [(28 (38.3%) Vs 13 (17.6%)] with p < 0.004; and for D-dimer [32 (50.8%) Vs 3(6%)]; with p < 0.001. They required more ICU admissions: 10/79 (12.6%) Vs 1/85 (1.2%) with p=0.0036; and suffered more complications: 9/79 (11.4%) Vs 1/85 (1.2%) with p=0.0066; of Covid-19 infection, particularly in late pregnancy. Conclusions Pregnant women presented with fewer Covid-19 symptoms but ran a much more severe course of illness compared to non-pregnant women with the disease. They had worse chest radiograph scores and much higher levels of laboratory indicators of disease severity. They had more ICU admissions and suffered more complications of Covid-19 infection, such as risk for miscarriage and preterm deliveries. Pregnancy with Covid-19 infection, could, therefore, be categorised as high-risk pregnancy and requires management by an obstetric and medical multidisciplinary team.
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Self A, Papageorghiou AT. Ultrasound Diagnosis of the Small and Large Fetus. Obstet Gynecol Clin North Am 2021; 48:339-357. [PMID: 33972070 DOI: 10.1016/j.ogc.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Antenatal imaging is crucial in the management of high-risk pregnancies. Accurate dating relies on acquisition of reliable and reproducible ultrasound images and measurements. Quality image acquisition is necessary for assessing fetal growth and performing Doppler measurements to help diagnose pregnancy complications, stratify risk, and guide management. Further research is needed to ascertain whether current methods for estimating fetal weight can be improved with 3-dimensional ultrasound or magnetic resonance imaging; optimize dating with late initiation of prenatal care; minimize under-diagnosis of fetal growth restriction; and identify the best strategies to make ultrasound more available in low-income and middle-income countries.
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Affiliation(s)
- Alice Self
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Aris T Papageorghiou
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK.
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Salazar MR, Espeche WG, Leiva Sisnieguez CE, Minetto J, Balbín E, Soria A, Yoma O, Prudente M, Torres S, Grassi F, Santillan C, Carbajal HA. Nocturnal hypertension and risk of developing early-onset preeclampsia in high-risk pregnancies. Hypertens Res 2021; 44:1633-1640. [PMID: 34480133 DOI: 10.1038/s41440-021-00740-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/02/2021] [Accepted: 08/06/2021] [Indexed: 01/21/2023]
Abstract
To test the hypothesis that nocturnal hypertension identifies risk for early-onset preeclampsia/eclampsia (PE), we conducted an historical cohort study of consecutive high-risk pregnancies between 1st January 2016 and 31st March 2020. Office blood pressure (BP) measurements and ambulatory blood pressure monitoring (ABPM) were performed. The cohort was divided into patients without PE or with early- or late-onset PE (<34 and ≥34 weeks of gestation, respectively). The relative risks of office and ABPM hypertension for the development of late- or early-onset PE were estimated with multinomial logistic regression using no PE as a reference category. Four hundred and seventy-seven women (mean age 30 ± 7 years, with 23 ± 7 weeks of gestation at the time of the BP measurements) were analyzed; 113 (23.7%) developed PE, 69 (14.5%) developed late-onset PE, 44 (9.2%) developed early-onset PE. Office and ambulatory BP increased between the groups, and women who developed early-onset PE had significantly higher office and ambulatory BP values than those with late-onset PE or without PE. Hypertension prevalence increased across groups, with the highest values in early-onset PE. Nocturnal hypertension was the most prevalent finding and was highly prevalent in women who developed early-onset PE (88.6%); only 1.6% of women without nocturnal hypertension developed early-onset PE. Additionally, nocturnal hypertension was a stronger predictor for early-onset PE than for late-onset PE (adjusted OR, 5.26 95%CI 1.67-16.60) vs. 2.06, 95%CI 1.26-4.55, respectively). In conclusion, nocturnal hypertension was the most frequent BP abnormality and a significant predictor of early-onset PE in high-risk pregnancies.
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Affiliation(s)
- Martin R Salazar
- Unidad de Enfermedades Cardiometabólicas, Servicio de Clínica Médica, Hospital Gral. San Martín, La Plata, Argentina. .,Facultad de Ciencias Médicas, UNLP, La Plata, Argentina.
| | - Walter G Espeche
- Unidad de Enfermedades Cardiometabólicas, Servicio de Clínica Médica, Hospital Gral. San Martín, La Plata, Argentina.,Facultad de Ciencias Médicas, UNLP, La Plata, Argentina
| | - Carlos E Leiva Sisnieguez
- Unidad de Enfermedades Cardiometabólicas, Servicio de Clínica Médica, Hospital Gral. San Martín, La Plata, Argentina.,Facultad de Ciencias Médicas, UNLP, La Plata, Argentina
| | - Julián Minetto
- Unidad de Enfermedades Cardiometabólicas, Servicio de Clínica Médica, Hospital Gral. San Martín, La Plata, Argentina.,Facultad de Ciencias Médicas, UNLP, La Plata, Argentina
| | | | - Adelaida Soria
- Servicio de Obstetricia, Hospital Gral. San Martín, La Plata, Argentina
| | - Osvaldo Yoma
- Servicio de Obstetricia, Hospital Gral. San Martín, La Plata, Argentina
| | - Marcelo Prudente
- Servicio de Obstetricia, Hospital Gral. San Martín, La Plata, Argentina
| | - Soledad Torres
- Servicio de Obstetricia, Hospital Gral. San Martín, La Plata, Argentina
| | - Florencia Grassi
- Servicio de Obstetricia, Hospital Gral. San Martín, La Plata, Argentina
| | - Claudia Santillan
- Servicio de Obstetricia, Hospital Gral. San Martín, La Plata, Argentina
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Frosolini A, Marioni G, Gallo C, de Filippis C, Lovato A. Audio-vestibular disorders and pregnancy: A systematic review. Am J Otolaryngol 2021; 42:103136. [PMID: 34182351 DOI: 10.1016/j.amjoto.2021.103136] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/13/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE During pregnancy a woman's body undergoes many physiological changes that involve all systems and organs, including sensory ones. We conducted this systematic review to highlight current evidence and treatment options in pregnant women with audio-vestibular disorders. MATERIALS AND METHODS A search was made on the following databases: PubMed, PubMed Central, Web of Science and Scopus. This research protocol was deposited in the PROSPERO Database. RESULTS After application of inclusion-exclusion criteria, 30 manuscripts were included in the review. Many authors (14/15) found a slight alteration of audiometric tests during pregnancy, with a reported recovery postpartum in most of the studies (5/7). Regarding sudden sensorineural hearing loss (SSNHL), we found four articles for a total of 69 patients: the treatment of choice was intravenous Dextran 40 and intra-tympanic corticosteroids. Most included studies (4/6) found neither clinical nor epidemiological associations between otosclerosis and pregnancy in large-based sample studies. Few investigations regarded Eustachian tube function and vertigo. CONCLUSIONS According to our results, many variations of hearing acuity during pregnancy are slight and transient and require only clinical observation. In large samples, otosclerosis appeared not to be associated with pregnancy. Clinicians should consider intra-tympanic steroids in managing SSNHL during pregnancy. Further more accurate research is needed to deepen and clarify the association between pregnancy and audio-vestibular disorders.
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Goldstein E, Nervik K, Hagen S, Hilliard F, Turnquist A, Bakhireva LN, McDonald R, Ossorio PN, Lo J, Zgierska AE. A socioecological framework for engaging substance-using pregnant persons in longitudinal research: Multi-stakeholder perspectives. Neurotoxicol Teratol 2021; 87:106997. [PMID: 34023390 PMCID: PMC8440364 DOI: 10.1016/j.ntt.2021.106997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/05/2021] [Accepted: 05/17/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Understanding the impact of substance use during pregnancy on fetal development and child health is essential for designing effective approaches for reducing prenatal substance exposures and improving child outcomes. Research on the developmental impacts of prenatal substance exposure has been limited by legal, ethical, and practical challenges. This study examined approaches to engage substance-using (with an emphasis on opioids) pregnant persons in longitudinal research, from multi-stakeholder perspectives. METHODS The present study solicited the expertise of 1) an advisory group of community stakeholders, including people with lived experienced of opioid/substance use; and 2) an online survey with content experts. Qualitative analysis examined facilitators and barriers to recruiting and retaining substance-using pregnant persons through a socioecological lens at the individual, interpersonal, organizational, community, and policy levels. RESULTS Stakeholders (N = 19) prioritized stigma, loss of confidentiality, legal consequences, and instability (e.g., homelessness and poverty) as important barriers that prevent substance-using persons from enrolling in research studies. Of 70 survey respondents, most self-identified as researchers (n = 37), followed by clinicians (n = 19), and 'others' (n = 14). Survey respondents focused on retention strategies that build trusting relationships with participants, including incentives (e.g., transportation and childcare support), participant-friendly study design, and team-related factors, (e.g., attitudes and practices). CONCLUSION The stakeholder input and survey data offer key insights strengthening our understanding of facilitators and barriers to research participation, and ways to overcome barriers among substance-using pregnant persons. A socioecological framework can be used to identify and address these factors to increase recruitment and long-term retention of high-risk populations.
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Affiliation(s)
- Ellen Goldstein
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, 1100 Delaplaine Ct, Madison, WI 53715, United States of America.
| | - Kendra Nervik
- Department of Sociology, University of Wisconsin, 8128 William H. Sewell Social Sciences Building, 1180 Observatory Drive, Madison, WI 53706-1393, United States of America.
| | - Shelbey Hagen
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, 1100 Delaplaine Ct, Madison, WI 53715, United States of America.
| | - Florence Hilliard
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, 1100 Delaplaine Ct, Madison, WI 53715, United States of America.
| | - Alyssa Turnquist
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, 1100 Delaplaine Ct, Madison, WI 53715, United States of America.
| | - Ludmila N Bakhireva
- College of Pharmacy Substance Use Research and Education (SURE) Center, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 09 5360, Albuquerque, NM 87131, United States of America; Department of Family and Community Medicine, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 09 5360, Albuquerque, NM 87131, United States of America; Division of Epidemiology, Biostatistics, and Preventive Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 09 5360, Albuquerque, NM 87131, United States of America.
| | - Ryan McDonald
- Department of Obstetrics & Gynecology, University of Wisconsin School of Medicine and Public Health, McConnell Hall, 1010 Mound Street, Madison, WI 53715, United States of America.
| | - Pilar N Ossorio
- University of Wisconsin Law School, 975 Bascom Mall, Rm. 9103, Madison, WI 53706-1399, United States of America; University of Wisconsin, Morgridge Institute for Research, 330 N. Orchard St, Madison, WI 53715, United States of America.
| | - Jamie Lo
- Department of Obstetrics & Gynecology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, L466, Portland, OR 97239, United States of America.
| | - Aleksandra E Zgierska
- Department of Family and Community Medicine, Pennsylvania State University College of Medicine, 700 HMC Crescent Road, Hershey, PA 17033, United States of America.
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Sung YS, Zhang D, Eswaran H, Lowery CL. Evaluation of a telemedicine program managing high-risk pregnant women with pre-existing diabetes in Arkansas's Medicaid program. Semin Perinatol 2021; 45:151421. [PMID: 34274150 DOI: 10.1016/j.semperi.2021.151421] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We aim to evaluate the effects of the telemedicine program, High-Risk Pregnancy Program at University of Arkansas for Medical Sciences (UAMS), on health services utilization and medical expenditures among pregnant women with pre-existing diabetes and their newborns. RESEARCH DESIGN AND METHODS The study sample was selected from the Arkansas Medicaid claims linked to infant birth/death certificates and UAMS telemedicine records from 2013 through 2016. We used propensity score matching based on participants' characteristics to create three groups - UAMS telemedicine care, UAMS in-person care, and non-UAMS prenatal care. We compared inpatient and outpatient care services, medication use and caesarean section rates, severe maternal morbidity, infant mortality and preterm birth rates and medical expenditures. RESULTS The UAMS telemedicine group had fewer inpatient admissions (1.18 vs 1.31; 95% CI: -0.27, 0.00), lower insulin use rates (41.86% vs 59.88%; 95% CI: -29.00%, -7.05%) and lower maternal care expenditures ($7,846 vs $10,644; 95% CI: -$4,089, -$1,507) compared with the UAMS in-person care group. Women receiving UAMS telemedicine had more prenatal care visits (10.45 vs 8.57; 95% CI: -2.96, -0.81), higher insulin use rates (41.86% vs 26.74%: 95% CI: 4.63%, 25.60%) and similar maternal care expenditures ($7,846 vs $7,051), compared with those receiving non-UAMS in-person care. Caesarean section, severe maternal morbidity, and infant mortality rates were similar across the three groups. CONCLUSION UAMS telemedicine was associated with improved utilization of prenatal care among pregnant women with pre-existing diabetes. Telemedicine services did not differ from usual in-person services in clinical outcomes and medical expenditures.
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Affiliation(s)
- Yi-Shan Sung
- Institute for Digital Health & Innovation, University of Arkansas for Medical Sciences
| | - Donglan Zhang
- Department of Health Policy and Management, College of Public Health, University of Georgia, 100 Foster Road, Wright Hall 205D, Athens, GA 30677, United States.
| | - Hari Eswaran
- Institute for Digital Health & Innovation, University of Arkansas for Medical Sciences; Department of Health Policy and Management, College of Public Health, University of Georgia, 100 Foster Road, Wright Hall 205D, Athens, GA 30677, United States
| | - Curtis L Lowery
- Institute for Digital Health & Innovation, University of Arkansas for Medical Sciences; Department of Health Policy and Management, College of Public Health, University of Georgia, 100 Foster Road, Wright Hall 205D, Athens, GA 30677, United States
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