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Maternal mortality rates within the United States have reached an all-time high.  Annually, nearly seven hundred women die from pregnancy-related complications, a number of which were highly preventable.  When taking a closer look at these statistics, these deaths disproportionately affect Native American and African American women, making them two to three times more likely to suffer from poorer pregnancy outcomes.  This paper examines the variety of factors that contribute to such a disproportionate maternal mortality rate, including geographic differences, racial and economic inequalities, and the accessibility of healthcare.  Despite attempts to fix these issues, systemic and intrinsic issues persist, and individuals continue to suffer.  This paper highlights the need to address maternal mortality disparities that affect marginalized groups, improved accessibility to healthcare for all, and overall policy reform in order to solve this issue indefinitely.

BACKGROUND: Obstetricians-gynecologists (OB/GYNs) play a critical role for their pregnant patients during their perinatal period, but research on OB/GYNs knowledge, attitudes, and perceptions regarding plant-based dietary patterns (PBDP) and how this may influence recommendations to patients is lacking. An online cross-sectional survey was conducted to examine OB/GYNs knowledge, attitudes, and perceptions towards a PBDP. METHODS: Postcards were mailed in June 2023 to a convenience sample of 5,000 OB/GYNs across the US using a mailing list provided by the American College of Obstetricians and Gynecologists. Postcards had a brief study description and a QR code that linked to an online survey asking questions about demographics, behavior (e.g., nutritional habits), and other factors that may influence knowledge, attitudes, and perceptions towards a PBDP for their patients. RESULTS: Ninety-six OB/GYNs completed the full questionnaire (~2% response rate). Most (92%) felt that it is within an OB/GYNs role to incorporate nutrition education and counseling within practice. However, 72% felt inadequately trained to discuss nutrition and diet-related issues with patients. Despite a perceived lack of nutrition training, 86% reported that a PBDP was safe and health-promoting, and 81% reported that a well-planned PBDP could adequately meet all nutritional needs of pregnant and lactating patients. CONCLUSION: Findings suggest that OB/GYNs are generally knowledgeable about the components and health benefits of a plant-based diets. However, nutrient adequacy misconceptions and lack of sufficient training to discuss nutrition with patients may result in OB/GYNs not recommending PBDPs to patients. These findings underscore the need to enhance OB/GYN graduate medical education and training by integrating education on PBDPs, therefore improving a clinicians ability to confidently and effectively counsel pregnant persons on this aspect of perinatal care.

Summary: This study sought to examine the effects of childhood adversity on the longitudinal associations between perinatal sleep quality and depressive symptoms, and to determine the prospective associations between these constructs over time. A cross‐lagged autoregressive model was used to examine the longitudinal association between sleep quality and depressive symptoms at four points during the perinatal period: 18 and 32 weeks of pregnancy, and 6 and 12 weeks postpartum. Longitudinal mediation models were used to examine whether sleep quality or depressive symptoms mediated the effects of childhood adversity on these symptoms. Most participants (86%) reported poor sleep quality during pregnancy. Significant cross‐lagged effects of depressive symptoms on subsequent sleep quality were observed during pregnancy and postpartum. Depressive symptoms significantly mediated the effects of childhood trauma on sleep quality during pregnancy, but sleep quality did not significantly mediate the effects of childhood trauma on depressive symptoms. While sleep quality and depressive symptoms tend to co‐occur, our analyses indicate that perinatal depressive symptoms work as the primary driver of sleep quality over time. Childhood adversity may have long‐reaching effects in women as it was associated with more depressive symptoms in the perinatal period, which in turn appeared to undermine sleep quality. [ABSTRACT FROM AUTHOR]

Background: Carotenoids, found in vegetables and fruits, act as antioxidants and are a source of vitamin A. Carotenoids may play an important role in maternal and fetal health (e.g., eye health and brain development) and the prevention of pre-eclampsia, preterm birth, small for gestational age babies and/or intrauterine growth restriction. No studies have examined relationships among carotenoid concentrations, intake of vegetables and fruit, and weeks of gestation. Understanding of the stability of carotenoid concentrations across gestation, despite increasing demands placed on the body (e.g., increase in metabolic demands, body mass and volume), may help inform specific guidelines for vegetable and fruit intake during pregnancy. Aim: This study aimed to investigate the relationships of vegetable and fruit intake, body mass, volume, density and gestation with the carotenoid reflection score. Method: Carotenoid concentration in the fat of women throughout their pregnancy was assessed using a non-invasive Veggie Meter™ device which measures carotenoid reflection spectroscopy from the fingertip. Gestation and vegetable and fruit intake were self-reported. Body mass and body volume were measured via a 3D body scanner and force plate. Correlations between baseline visit measures, differences between visit I and II and repeated measures correlations (up to four visits) were analysed for all measures. Findings: Only nine of the 35 women (25.7%) in this study met the guideline of 7+ a day for vegetable and fruit intake. Carotenoid reflective scores tended to be lower for those with greater body mass (r = -0.48, 95% CI = -0.70, -0.18; p < 0.001) and volume (r = -0.50, 95% CI = -0.71, -0.20; p < 0.001). Although women increased their vegetable and fruit intake with increased gestation (rrm = 0.60, 95% CI = 0.2, 0.83; p = 0.01), their carotenoid reflective score did not increase (rrm = -0.29, 95% CI = -0.66, 0.19; p = 0.22). Conclusion: Supporting previous recommendations for the general population that vegetable and fruit intake should increase relative to body size, the current study findings suggest it may be advisable for women to progressively consume more vegetables and fruit to align with increases in body mass throughout pregnancy. [ABSTRACT FROM AUTHOR]

Background: Over 50% of pregnant women use pregnancy applications (apps). Some app s lack credibility, information accuracy, and evidence-based clinical advice, containing potentially harmful functionality. Previous studies have only conducted a limited analysis of pregnancy app functionalities, expert involvement/evidence-based content, used commercialization techniques, and user perception. Methods: We used the keyword "pregnancy" to scrape (automatically extract) apps and app information from Apple App Store and Google Play. Unique functionalities were derived from app descriptions and user reviews. App descriptions were screened for evidence-based content and expert involvement, and apps were subsequently analyzed in detail. Apps were opened and searched for used commercialization techniques, such as advertisements or affiliate marketing. Automated text analysis (natural language processing) was used on app reviews to assess users' perception of evidence-based content/expert involvement and commercialization techniques. Results: In total, 495 apps were scraped. 226 remained after applying exclusion criteria. Out of these, 36 represented 97%/88% of the total market share (Apple App Store/Google Play), and were thus considered for review. Overall, 49 distinct functionalities were identified, out of which 6 were previously unreported. Functionalities for fetal kick movement counting were found. All apps are commercial. Only 15 apps mention the involvement of medical experts. 10.3% of two-stars user reviews include commercial topics, and 0.6% of one-/two-/three-/five stars user reviews include references to scientific content accuracy. Conclusion: Problematic features and inadequate advice continue to be present in pregnancy apps. App developers should adopt an evidence-based development approach and avoid implementing as many features as possible, potentially at the expense of their quality or over-complication ("feature creep"). Financial incentives, such as grant programs, could support adequate content quality. Caregivers play a key role in pregnant individuals' decision-making, should be aware of potential dangers, and could guide them to trustworthy apps. [ABSTRACT FROM AUTHOR]

Introduction: Pregnant and breastfeeding women at substantial risk for HIV infection in sub-Saharan Africa can benefit from biomedical interventions such as pre-exposure prophylaxis (PrEP). We estimated the benefit that pregnant and breastfeeding women may derive from PrEP service delivery in order to guide PrEP roll-out in the target population in Zambia. Methods: Between September and December 2021, we conducted a discrete choice experiment (DCE) among a convenient sample of 389 pregnant and breastfeeding women not living with HIV in Lusaka, Zambia. Women aged 18 years or older, with a documented negative HIV result in their antenatal card responded to a structured questionnaire containing 12 choice sets on service delivery attributes of PrEP: waiting time at the facility, travel time to the facility dispensing PrEP, location for PrEP pick-up, health care provider attitude and PrEP supply at each refill. Mixed logit regression analysis was used to determine the participant's willingness to trade off one attribute of PrEP for the other at a 5% significance level. Willingness to wait (WTW) was used to determine the relative utility derived from each attribute against waiting time. Results: Waiting time at the facility, travel time to the facility, health care provider attitude and amount of PrEP supply at each refill were important attributes of PrEP service delivery (all p < 0.01). Participants preferred less waiting time at the facility (β = −0.27, p < 0.01). Women demonstrated a strong preference for a 3-months' supply of PrEP (β = 1.69, p < 0.01). They were willing to wait for 5 h at the facility, walk for more than an hour to a facility dispensing PrEP, encounter a health care provider with a negative attitude in order to receive PrEP enough for 3 months. Conclusion: Patient-centered approaches can help to inform the design and implementation of PrEP services among pregnant and breastfeeding women. In this study, we found that a reduction in clinic visits—including through multi-month dispensing of PrEP—could improve uptake of services in antenatal and postnatal settings. [ABSTRACT FROM AUTHOR]

Systemic lupus erythematosus (SLE), an autoimmune condition, presents pregnancy-related risks, impacting maternal and fetal health. The immune cell composition and gene expression profiles in pregnant SLE patients, as well as the molecular mechanisms of active SLE patients during pregnancy, remain unclear. In our study, we enrolled 12 patients: three active SLE individuals (SLE-AT group, SLEDAI > 12, non-pregnant women), three inactive SLE individuals (SLE-NP group, SLEDAI ranging 0 to 6, non-pregnant women), three pregnant women with active SLE (SLE-C group, SLEDAI > 12), and three pregnant women with inactive SLE (SLE-NC group, SLEDAI range 0 to 6 score). Transcriptome analysis of peripheral blood mononuclear cells (PBMCs) was conducted using the 10x Genomics technique. We observed upregulation of genes like CCDC15 and TRBV4-2 in T cells and CMPK2, IFIT1, and OAS2 in monocytes in the SLE-C group. Notably, gene sets related to Cell Cycle and IFN Response showed significant differences between the SLE-C and SLE-NC groups in naïve CD8 T cells. Our comparison of immune cell type ratios and transcriptional patterns between active and inactive SLE during pregnancy sheds light on the single-cell level changes in SLE status during pregnancy, offering insights for future SLE prediction and treatment strategies. PLAIN LANGUAGE SUMMARY: Systemic lupus erythematosus (SLE) is a complex autoimmune disease. Furthermore, SLE women have an increased likelihood of encountering adverse pregnancy outcomes such as diabetes and hypertension. The etiology of SLE involves a multifaceted interplay of genetic, immune, endocrine, and environmental factors, which contributes to a breakdown in the immune system's tolerance to self-antigens. Recent studies have highlighted a strong correlation between the severity of renal involvement in lupus nephritis and B cell dysfunction in patients, as elucidated through single-cell transcriptomics. Additionally, comparative studies have revealed notable differences in the immune cell profile between pregnant women with lupus and healthy pregnant women. A key observation the marked reduction in the proportion of CD4+ T cells in pregnant women suffering from lupus. Despite these findings, the detailed transcriptomic alterations within high-resolution immune cell profiling during activate phase of SLE in pregnancy remain inadequately understood. In our study, we focused on comparing the transcriptomic expression patterns of peripheral blood immune cells between pregnant women with active SLE and those with stable SLE. Our data confirmed significant differences in IFN signaling and pregnancy-related factors in T cells, NK cells, B cells, and macrophages, contrasting the immune cells of pregnant women with active SLE against those with stable SLE. Additionally, the proportion of CD56+ NK cells was significantly increased in pregnant women with SLE. The correlation between the transcriptomic profiles of immune cells and the activity of SLE during pregnancy may provide potential strategies for predicting and treating SLE during pregnancy. [ABSTRACT FROM AUTHOR]

Background: Many prevention of vertical transmission (PVT) studies assess outcomes within 12 months postpartum and exclude those lost to follow-up (LTFU), potentially biasing outcomes toward those retained in care. Setting: Five public facilities in western Kenya. Methods: We recruited women living with HIV (WLH) ≥18 years enrolled in antenatal clinic (ANC). WLH retained in care (RW) were recruited during pregnancy and followed with their children through 6 months postpartum; WLH LTFU (LW, last visit >90 days) after ANC enrollment and ≤6 months postpartum were recruited through community tracing. Recontact at 3 years was attempted for all participants. Primary outcomes were retention and child HIV-free survival. Generalized linear regression was used to estimated risk ratios (RRs) for associations with becoming LTFU by 6 months postpartum, adjusting for age, education, facility, travel time to facility, gravidity, income, and new vs. known HIV positive at ANC enrollment. Results: Three hundred thirty-three WLH (222 RW, 111 LW) were recruited from 2018 to 2019. More LW versus RW were newly diagnosed with HIV at ANC enrollment (49.6% vs. 23.9%) and not virally suppressed at study enrollment (40.9% vs. 7.7%). 6-month HIV-free survival was lower for children of LW (87.9%) versus RW (98.7%). At 3 years, 230 WLH were retained in care (including 51 previously LTFU before 6 months), 30 transferred, 70 LTFU, and 3 deceased. 3-year child HIV-free survival was 81.9% (92.0% for children of RW, 58.6% for LW), 3.7% were living with HIV, 3.7% deceased, and 10.8% had unknown HIV/vital status. Being newly diagnosed with HIV at ANC enrollment was the only factor associated with becoming LTFU (aRR 1.21, 95% CI: 1.11 to 1.31). Conclusions: Outcomes among those LTFU were worse than those retained in care, underscoring the importance of retention in PVT services. Some, but not all, LW re-engaged in care by 3 years, suggesting the need for PVT services must better address the barriers and transitions women experience during pregnancy and postpartum. [ABSTRACT FROM AUTHOR]

Purpose: To investigate sleep duration and sleep loss during antenatal period and assess associative factors, including maternal characteristic and mood symptoms. Methods: A cohort of 3038 women was enrolled. Self-reported sleep duration and sleep loss, the latter being calculated from preferred sleep need and actual sleep duration, were measured in early, mid- and late pregnancy, and at delivery. The associations with age, BMI, parity, education, smoking, napping, and depressive and anxiety symptoms were evaluated. Results: Sleep duration was longest in early pregnancy and shortest at delivery (7.93 h–7.76 h, p < 0.001). The proportion of short sleepers (< 6 h) increased from 1.4% to 5.9% throughout the studied period (p < 0.001). Mean sleep loss remained stable in early- and mid-pregnancy, lowering in late pregnancy (p < 0.001) and increasing again until delivery (p = 0.003). The number of women with notable sleep loss (> 2 h) was similar during the first three measurement points (9.4%, 8.9% and 9.5%), but increased until delivery (14.1%, p < 0.001). Older, multiparous, and more-depressive women slept less (p < 0.001, p < 0.001, p = 0.017). Women with higher BMI were more likely to sleep < 6 h in late pregnancy (p = 0.012). Multiparous, more-depressive, and higher-BMI women reported more sleep loss (p < 0.001, p < 0.001, p = 0.049). Conclusion: We confirmed earlier reported decrease in sleep duration at the end of pregnancy. As a novel finding, we showed a notable increase in sleep loss during the last month of pregnancy. Various factors were associated with both short sleep and sleep loss, especially multiparity, napping and depressive symptoms. [ABSTRACT FROM AUTHOR]

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Service delivery and care of street-involved pregnant women is recognized as a complex issue, and as such comorbidities, addictions, and risky behaviors can result in significantly higher risks of contracting HIV. We inquired into the experiences of service providers who work in community-based supportive intervention programs for vulnerable street-involved, pregnant, and early parenting women in precarious housing situations who are living with HIV or are at risk of contracting HIV, across the continuum of care. We used a qualitative descriptive design and interviewed 22 service providers from local government and non-governmental community agencies about their experiences delivering services to this population. Four key themes emerged from the data: focus on outcomes and success, understanding tensions in service delivery, challenges in accessing appropriate services and resources, and attention to moving forward. We highlight the complex tensions experienced by service providers in a health and social care system that centers on measurable and quantifiable outcomes while overlooking larger issues that shape equitable care. Our study highlights the need for alternative approaches to service delivery that are focused on the lives of women. [ABSTRACT FROM AUTHOR]

Background: Aquatic activities are becoming increasingly popular as a form of exercise during pregnancy. However, the effects of these activities on the physical and mental health outcomes of pregnant women during and after pregnancy as well as fetal outcomes remain unclear. This meta-analysis evaluated the current evidence regarding the effects of aquatic activities during pregnancy on neonatal and maternal outcomes. Methods: Three databases (PubMed, Cochrane Central electronic database, Embase) were searched from inception to July 17, 2024 for randomized controlled trials (RCTs) comparing the effects of aquatic activities versus standard prenatal care or no exercise on neonatal and maternal outcomes. Pooled outcome measures were determined using random-effects models. Results: Ten RCTs including 1949 patients met the criteria for inclusion in this meta-analysis. The results showed that prenatal aquatic activities could significantly improve maternal weight control (mean difference [MD]= -0.91, 95% confidence interval [CI]= -1.64 to -0.18, P = 0.01, I2 = 0.00%), improve maternal quality of life (standard mean difference [SMD] = 0.16, 95%CI = 0.03 to 0.28, P = 0.01, I2 = 0.00%), and extend fetal birth length (MD = 0.48, 95%CI = 0.10 to 0.87, P = 0.01, I2 = 0.00%) compared with standard prenatal care or no exercise, while no significant differences were observed in fetal birth weight, Apgar score at 1 min, Apgar score at 5 min, pH of umbilical cord blood, gestational age, rate of preterm delivery, incidence of postnatal depression and mode of delivery. Conclusions: Prenatal aquatic activities can significantly improve maternal weight control and quality of life during pregnancy, and may promote longer birth length. However, additional studies are needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Background: Meningioma in the parasellar region may lead to visual impairment, so intraoperative neurological monitoring is essential for enucleation surgery. However, intraoperative neurological monitoring in pregnant women is challenging, as the anesthesia management must consider the effects and risks to the fetus. Remimazolam is a newly introduced intravenous anesthetic that has little effect on blood pressure. However, the effects of remimazolam on intraoperative neuromonitoring are little known. We treated a pregnant patient with parasellar meningioma who developed visual impairment, using remimazolam for anesthesia and intraoperative neurophysiological monitoring of the visual evoked potential. Case presentation: A 34-year-old woman who was 20 weeks pregnant presented with visual acuity disturbances. Neuroimaging demonstrated a parasellar meningioma, and rapid tumor growth and worsening of symptoms subsequently occurred. Craniotomy for tumor removal was performed under anesthesia with remimazolam, which allowed monitoring of the visual evoked potentials. Her visual acuity was restored postoperatively, and no adverse events occurred in the fetus. Conclusion: Our experience with intraoperative neuromonitoring of a pregnant woman in the third trimester showed that anesthesia with remimazolam allows safe brain surgery combined with intraoperative visual evoked potential monitoring. Further research is needed to determine the effects of remimazolam on the fetus, as well as the safe dosage and duration of exposure. [ABSTRACT FROM AUTHOR]

Introduction: Maternal overweight or obesity has been associated with metabolic syndrome through 1 year postpartum, but it remains unknown whether a culturally-modified, motivationally-targeted, and individually-tailored Lifestyle Intervention could improve postpartum cardiometabolic health among Hispanic women with overweight or obesity. Methods: Proyecto Mamá was a randomized controlled trial conducted in Western Massachusetts from 2014 to 2020 in which Hispanic women with overweight/obesity were randomized to a Lifestyle Intervention (LI) involving diet and exercise or to a comparison Health and Wellness Intervention (HW). Biomarkers of cardiovascular risk (i.e., lipids, C-reactive protein) and insulin resistance (fasting insulin, glucose, HbA1c, homeostasis model assessment [HOMA-IR], leptin, adiponectin) were measured at baseline (early pregnancy), mid-pregnancy, and 6 weeks, 6 months, and 12 months postpartum. Generalized linear mixed effect models were used to evaluate differences in the change in biomarkers over the course of postpartum follow-up time. Results: In intent-to-treat analyses among eligible women (LI; n=51, HW; n=58) there were no significant differences in changes in biomarkers of CVD risk or insulin resistance over the postpartum year; for example, the intervention effect for total cholesterol was 6.98 (SE: 6.36, p=0.27) and for HbA1c was −0.01 (SE: 0.4, p=0.85). In pooled analyses, regardless of intervention arm, women who participated in any vigorous activity had less of an increase in HbA1c (intervention effect = −0.17, SE: 0.05, p=0.002) compared to those with no vigorous activity, and similarly beneficial associations with other cardiovascular risk biomarkers (p<0.05). Discussion: Women who participated in vigorous activity, regardless of their assigned intervention arm, had more favorable changes in biomarkers of insulin resistance. Significance: Women with overweight/obesity during pregnancy are at an increased risk of adverse cardiometabolic profiles and future development of type 2 diabetes and cardiovascular disease. Hispanic women are disproportionately affected by cardiometabolic disorders but have largely been excluded from lifestyle intervention studies. Although providing a lifestyle intervention to Hispanic women with overweight/obesity resulted in no significant differences in postpartum cardiometabolic biomarkers, women who articipated in vigorous activity, regardless of their assigned intervention arm, had favorable changes in insulin resistance biomarkers. These findings suggest that the intensity of physical activity may be important for improving postpartum cardiometabolic biomarkers among high-risk, Hispanic women. [ABSTRACT FROM AUTHOR]

Background: Safety data from randomized trials of antiretrovirals in pregnancy are scarce. We evaluated maternal bone and renal data from the International Maternal Pediatric Adolescent AIDS Clinical Trials Network 2010 trial, which compared the safety and efficacy of 3 antiretroviral therapy regimens started in pregnancy: dolutegravir + emtricitabine/tenofovir alafenamide (DTG + FTC/TAF), dolutegravir + emtricitabine/tenofovir disoproxil fumarate (DTG + FTC/TDF), and efavirenz/emtricitabine/tenofovir disoproxil fumarate (EFV/FTC/TDF). Methods: A subset of participants underwent dual-energy X-ray absorptiometry scans at postpartum week 50 only. Maternal bone mineral density (BMD) Z-scores were compared between arms. Maternal creatinine was measured at enrolment and periodically through week 50 postpartum, and by-arm differences in average weekly change in estimated creatinine clearance were compared. Results: Six hundred forty-three participants were randomized to DTG + FTC/TAF (N = 217) or DTG + FTC/TDF (N = 215) or EFV/ FTC/TDF (N = 211). Median age = 27 years (IQR 23, 32), median CD4 count = 466 cells/mm3 (IQR 308, 624); 564 (88%) women enrolled in Africa and 479 (74%) breastfed. Week 50 postpartum dual-energy X-ray absorptiometry results from 154 women were included in the analysis. Hip and spine BMD was on average higher in women in the DTG + FTC/TAF and lower in the DTG + FTC/ TDF and EFV/FTC/TDF arms, but no significant differences in BMD Z-scores were observed between treatment groups. The weekly rate of change in estimated creatinine clearance differed among treatment groups during the antepartum period, but not over the full study follow-up. Conclusions: Markers of bone and renal toxicity did not differ significantly through week 50 postpartum among women randomized to start DTG + FTC/TAF or DTG + FTC/TDF or EFV/FTC/ TDF in pregnancy. [ABSTRACT FROM AUTHOR]

Introduction: Thyroid dysfunction is the most common endocrinological disorder in pregnancy, only second to diabetes. If not treated, they can have adverse effects on maternal and neonatal outcomes. Maternal complications include miscarriage, anaemia, preeclampsia, gestational hypertension, placental abruption, preterm delivery, increased rate of caesarean section, and postpartum haemorrhage. Fetal outcomes include preterm birth, low birth weight (LBW), perinatal morbidity and mortality, increased NICU admission; and neuropsychological and cognitive impairment. Thus it is important to adopt appropriate strategies to identify women at risk of these adverse outcomes for early detection and initiation of effective treatment, hence the study was undertaken. Methodology: A cross - sectional study was conducted in 400 pregnant women attending antenatal outpatient department in a tertiary care after obtaining ethical committee approval. This study was conducted from march 2020 to September 2023, after obtaining written informed consent from patients. Demographic data included maternal age, parity, years of marital life, infertility, family history of thyroid disorder, menstrual history. Maternal comorbidities pertaining to thyroid dysfunction include history of miscarriage, anaemia, preeclampsia, gestational hypertension, oligohydramnios, preterm delivery and increased rate of caesarean section. Fetal outcomes include LBW, Low Apgar score, and increased NICU admission. Routine hematological parameters and estimation of T3, T4 and TSH was conducted. The categorical variables were assessed using Pearson chi-square test and continuous variable using t test. The test was considered significant when the p value is less than 0.05. Results: The prevalence of thyroid disorders in this study was 16% (64/400 patients), with subclinical hypothyroidism (10.75%) being the commonest, followed by overt hypothyroidism (3.25%) and subclinical hyperthyroidism (2%). Thyroid disorders seen in more proportion of patients with gravida 1(68.75%) compared to gravida 2 (31.25%) which was significant. More proportion of patients with thyroid disorders have anaemia, preeclampsia, gestational diabetes mellitus and significant family history when compared with euthyroid patients and this was significant statistically. Preterm labour, assisted labour and cesarean section was seen in more patients with thyroid disorders compared to euthyroid patients. Fetal complications like low birth weight, low APGAR score and need for NICU admission was seen in more babies with mothers having thyroid disorders which was significant statistically. Conclusion: Our study shows high complication rates associated with thyroid disorders in pregnancy, thus insisting on screening for thyroid disorders for better foetal and maternal outcomes. [ABSTRACT FROM AUTHOR]

Depression and posttraumatic stress disorder are two common mental disorders after negative life events. This study was conducted to evaluate the depression and posttraumatic stress levels of pregnant women after the large-scale earthquakes that occurred in Turkey in 2023. The study was carried out with 395 pregnant women who visited maternity outpatient clinics of a public hospital in a province in southern Turkey. The data were collected with the Beck Depression Inventory (BDI) and the Post-Traumatic Stress Disorder Checklist – Civilian Version (PCL-C). Descriptive statistics, the independent-samples t-test, and the Pearson correlation test were used in the analyses of the data. Among all participants, 3.8 percent had a likely depression risk, and 31.9 percent exhibited posttraumatic stress disorder symptoms. A statistically significant relationship was found between the earthquake exposure of the participants and their BDI and PCL-C total scores (p <.05). The BDI scores of the participants also had statistically significant relationships to their PCL-C scores (p <.05). In this study, it was discerned that posttraumatic stress disorder symptoms were prevalent among pregnant women in the post-earthquake period. Psychological support is needed to improve the mental health of the pregnant women after earthquakes. [ABSTRACT FROM AUTHOR]

Aims: The aim of the study is to report the clinical and pharmacological observations from a pregnant patient treated with erlotinib in the second and third trimesters of pregnancy. Methods: Maternal and neonatal blood levels and safety of erlotinib and its metabolites were evaluated. Child development was monitored for 6 years. Results: A 31‐year‐old woman with stage IV lung adenocarcinoma with EGFR exon19 deletion began treatment with erlotinib 150 mg/day at 17 weeks of gestation. Although foetal growth retardation and oligohydramnios were observed at several times during the pregnancy, treatment was continued due to the severity of the maternal presentation, with ongoing foetal monitoring. The foetus seemed to tolerate and recover well without specific interventions. A healthy baby boy was delivered at 37 weeks gestation. The child grew and developed without any obvious issues. At last follow‐up, at age 6 years, he was attending school at a grade appropriate for his age without health or developmental problems. Blood levels of erlotinib were 397–856 ng/mL at 18–37 weeks of gestation and 1190 ng/mL at 8 weeks postpartum. The blood concentration ratios of OSI‐413‐to‐erlotinib ranged from 0.167 to 0.253 at 18–37 weeks of gestation, excluding 24 weeks, and 0.131 at 8 weeks postpartum. The maternal‐to‐foetal transfer rate of erlotinib, OSI‐420 and OSI‐413 were 24.5, 34.8 and 20.3%, respectively. Conclusion: Erlotinib use during the second and third trimester of pregnancy did not seem to cause any untoward effects on the developing foetus, or any long‐lasting effects that could be detected during 6 years of follow‐up of the child. [ABSTRACT FROM AUTHOR]

Purpose: Sleep disturbances, which are common during pregnancy, may compromise labor. Nevertheless, little is known about associations between sleep disturbances and the likelihood of ending up induction of labor (IOL). Accordingly, we aimed to evaluate the connections between sleep disturbances during pregnancy and IOL. Methods: Altogether 1778 women from the FinnBrain Birth Cohort Study with gestation weeks over 37 + 6 were enrolled in the study. The women were divided into IOL (n = 331) and spontaneous onset of labor (SOL, n = 1447) groups. Sleep disturbances in late pregnancy were evaluated using the Basic Nordic Sleep Questionnaire. Logistic regression analyses were conducted with adjustments for age, body mass index, parity, smoking, and depressive symptoms. Results: Sleep disturbances were frequent in both IOL and SOL groups. In the IOL group 43.0% and in the SOL group 39.0% had poor general sleep quality (P = 0.186). Nocturnal awakenings occurred most commonly, in 94.0% and 93.9%, respectively (P = 0.653). In the IOL group, more women (22.7%) were habitual snorers than in the SOL group (17.0%, P = 0.017), however, the difference lost the statistical significance in adjusted analysis (P = 0.848). Women in the IOL group were more likely to be short sleepers (< 7 h) compared to those in the SOL group (20.2% and 15.4%, respectively, P = 0.034) with no difference after adjustment (P = 0.133). The two groups showed no differences in sleep loss (P = 0.252). Conclusions: Deterioration in sleep quality was noticeable in pregnant women, but it was unconnected with IOL. As the frequency of IOL is increasing, more research for related risk factors is needed. [ABSTRACT FROM AUTHOR]

Insomnia in pregnancy is common and highly comorbid with depression. To investigate if: 1) depressive symptoms decrease after cognitive behavioural therapy for insomnia (CBT I) delivered in pregnancy, and 2) changes in insomnia symptoms represent a mechanism linking CBT-I treatment and reduced symptoms of postpartum depression. A two-arm, single-blind, parallel groups randomized controlled trial (RCT) design was used to evaluate the impact of a 5-week CBT-I intervention adapted for pregnant people with insomnia (N = 62). Participants were eligible if they were pregnant, between 12 and 28 weeks gestation, and met diagnostic criteria for insomnia. Participants completed questionnaires assessing symptoms of insomnia and depression pre-intervention (T1), post-intervention (T2), and six months postpartum (T3). A path analysis model was used to test direct and indirect effects simultaneously. There was a significant direct effect of CBT-I on postpartum depressive symptoms at T3. Additionally, significant indirect treatment effects on depressive symptoms at T3 emerged, through depressive symptoms at T2 and through improvements in insomnia that persisted from T2 to T3. Limitations to the current study include limited generalizability, the non-depressed sample, and variability in treatment and assessment delivery (in-person vs. online). CBT-I treatment in pregnancy may indirectly reduce postpartum depressive symptoms, through sustained improvements in insomnia symptoms. • Research on the effectiveness of CBT-I in pregnancy to alleviate depressive symptoms is mixed. • CBT-I delivered in pregnancy had lasting anti-depressive effects in the postpartum period. • CBT-I reduces postpartum depressive symptoms through sustained improvements in postpartum insomnia symptoms. • CBT-I in pregnancy may indirectly reduce postpartum depressive symptoms. [ABSTRACT FROM AUTHOR]

Background: Gestational diabetes mellitus (GDM) affects >50% of pregnancies in many Arab countries. However, few studies have explored the impact of Ramadan fasting on pregnant women with GDM and no such study has been conducted in Oman. Therefore, this is the first study in Oman which aimed to examine the experience of pregnant women with GDM during Ramadan fasting. Methods: This study employed a rigorous qualitative design, guided by a constructivist grounded theory approach. Semi-structured interviews were conducted with women with GDM in the North Batinah Governorate of Oman at four primary health-care institutions. Purposive and theoretical sampling was utilized. Results: The experiences of 20 women were discussed during the interviews. Two main themes, “encouraging experiences” and “worrying experiences” emerged from the constant comparative analysis. Encouraging experiences included belief, family influence, embarrassment, sharing spiritual moments, and coping approaches. Worrying experiences included health problems, fear of harming babies, and advice from health-care professionals. This led to the development of the core category “Finding A Balance,” which means that women with GDM who fasted and did not fast during Ramadan were attempting to maintain their blood sugar to avoid harming themselves and their fetus. Conclusion: The insights gained from understanding the experiences of pregnant women with GDM are crucial as they guide the development of the best approaches to health education and supportive programs for pregnant women with GDM. Pregnant women with GDM who wish to fast should be informed about the potential risks associated with fasting during pregnancy.

Abstract Background Meningioma in the parasellar region may lead to visual impairment, so intraoperative neurological monitoring is essential for enucleation surgery. However, intraoperative neurological monitoring in pregnant women is challenging, as the anesthesia management must consider the effects and risks to the fetus. Remimazolam is a newly introduced intravenous anesthetic that has little effect on blood pressure. However, the effects of remimazolam on intraoperative neuromonitoring are little known. We treated a pregnant patient with parasellar meningioma who developed visual impairment, using remimazolam for anesthesia and intraoperative neurophysiological monitoring of the visual evoked potential. Case presentation A 34-year-old woman who was 20 weeks pregnant presented with visual acuity disturbances. Neuroimaging demonstrated a parasellar meningioma, and rapid tumor growth and worsening of symptoms subsequently occurred. Craniotomy for tumor removal was performed under anesthesia with remimazolam, which allowed monitoring of the visual evoked potentials. Her visual acuity was restored postoperatively, and no adverse events occurred in the fetus. Conclusion Our experience with intraoperative neuromonitoring of a pregnant woman in the third trimester showed that anesthesia with remimazolam allows safe brain surgery combined with intraoperative visual evoked potential monitoring. Further research is needed to determine the effects of remimazolam on the fetus, as well as the safe dosage and duration of exposure.

Abstract Background Aquatic activities are becoming increasingly popular as a form of exercise during pregnancy. However, the effects of these activities on the physical and mental health outcomes of pregnant women during and after pregnancy as well as fetal outcomes remain unclear. This meta-analysis evaluated the current evidence regarding the effects of aquatic activities during pregnancy on neonatal and maternal outcomes. Methods Three databases (PubMed, Cochrane Central electronic database, Embase) were searched from inception to July 17, 2024 for randomized controlled trials (RCTs) comparing the effects of aquatic activities versus standard prenatal care or no exercise on neonatal and maternal outcomes. Pooled outcome measures were determined using random-effects models. Results Ten RCTs including 1949 patients met the criteria for inclusion in this meta-analysis. The results showed that prenatal aquatic activities could significantly improve maternal weight control (mean difference [MD]= -0.91, 95% confidence interval [CI]= -1.64 to -0.18, P = 0.01, I2 = 0.00%), improve maternal quality of life (standard mean difference [SMD] = 0.16, 95%CI = 0.03 to 0.28, P = 0.01, I2 = 0.00%), and extend fetal birth length (MD = 0.48, 95%CI = 0.10 to 0.87, P = 0.01, I2 = 0.00%) compared with standard prenatal care or no exercise, while no significant differences were observed in fetal birth weight, Apgar score at 1 min, Apgar score at 5 min, pH of umbilical cord blood, gestational age, rate of preterm delivery, incidence of postnatal depression and mode of delivery. Conclusions Prenatal aquatic activities can significantly improve maternal weight control and quality of life during pregnancy, and may promote longer birth length. However, additional studies are needed to confirm these findings.

BACKGROUND: Stress and anxiety during pregnancy are extremely prevalent and are associated with numerous poor outcomes, among the most serious of which are increased rates of preterm birth and low birth weight infants. Research supports that while in-person mindfulness training is effective in reducing pregnancy stress and anxiety, there are barriers limiting accessibility. OBJECTIVE: The aim of this paper is to determine if mindfulness meditation training with the Headspace app is effective for stress and anxiety reduction during pregnancy. METHODS: A longitudinal, single-arm trial was implemented with 20 pregnant women who were instructed to practice meditation via the Headspace app twice per day during the month-long trial. Validated scales were used to measure participants levels of stress and anxiety pre- and postintervention. Physiological measures reflective of stress (heart rate variability and sleep) were collected via the Oura Ring. RESULTS: Statistically significant reductions were found in self-reported levels of stress (P=.005), anxiety (P=.01), and pregnancy anxiety (P

Background:Parvovirus infection is an important cause of fetal loss during all three trimesters of pregnancy. Objectives:This study was conducted to investigate the prevalence, susceptibility rate, and risk factors of B19-V in women aged 15 to 45 in the Al-Hamza region of Babil, Iraq, considering the negative effects of the infection. Materials and Methods:Between January 2022 and March 2023, blood samples were taken from 116 women, including those with and those without a history of bad obstetric history (BOH). Enzyme-linked immunosorbent assay (ELISA) was used to test sera taken from the study participants for B19 IgM and immunoglobulin G (IgG) antibodies. Those samples tested positive for IgG B19 were further subjected to polymerase chain reaction amplification and sequencing, targeting partial gene sequences of the nonstructural viral protein 1 (VP1) gene. Results:For human parvovirus IgG and IgM, the seropositivity was 44% and 16.5%, respectively. The following variables were associated in this study with greater seroprevalence rates of IgG and IgM, respectively: age 36–45 years (72.7%, 36.4%); abortion (80%, 32.5%); education (82.2%, 33.3%); unemployment (61%, 22.2%); and overcrowding (73.3%, 31.1%). In this case–control study, positive amplicons (700 bp) were detected from 27 samples out of 40 women of childbearing age who tested positive for IgG. Sequence analysis of the partial sequence of the VP1 gene in all positive amplicons was 100% identical with each other and with human parvovirus B19 (NC: 00088.3). According to the current study, about 66% of women are serologically negative and at risk of contracting parvovirus B19. Conclusion:Our findings conclude that pregnant women in Iraq, particularly those with BOH, must undergo frequent serological screening for B19-V during all three trimesters and be given the necessary advice to avoid B19-V infection to improve their pregnancy outcomes.

Objective: Toxoplasmosis is a parasitic infection caused by Toxoplasma gondii. Immunocompromised individuals and pregnant women are at risk, with the latter group being susceptible to miscarriages. This study aimed to determine the seropositivity of T. gondii antibodies and potential risk factors in pregnant women diagnosed with diabetes mellitus. Methods: The research was conducted at the Ankara City Hospital Perinatology Clinic between October 2021 and June 2022. The study included 277 pregnant women diagnosed with diabetes mellitus and 277 healthy pregnant women who had given birth. Retrospective analysis of anti-T. gondii immunoglobulin (Ig)G and IgM levels was performed for patients between January 2020 and February 2022. Participants were administered an informed consent form and a questionnaire. Data were analysed using SPSS 22. Results: Among pregnant women with diabetes, IgG seropositivity was 18.4%, IgM was 0.0%, and IgG+IgM was 0.0%. In healthy pregnant women, IgG seropositivity was 12.3%, IgM was 0.4%, and IgG+IgM was 0.4%. Overall, seropositivity rates were 15.3% for IgG, 0.2% for IgM, and 0.2% for IgG+IgM. The difference between the two groups was statistically significant (p

Introduction. Renal colic during pregnancy is a common cause of pain in the lower back. Currently, with a diagnosed kidney or ureter stone, the standard treatment is serial drainage of the urine tract using an internal ureter stent, with replacement of the drainage before delivery, followed by surgery to remove the stone after delivery.Objective. To study the effectiveness and safety of ureteroscopic interventions in the treatment of urolithiasis in pregnant women in comparison with the method of serial drainage of the upper urinary tract during gestation followed by surgical treatment of urolithiasis 4 weeks after delivery.Materials & methods. The study group consisted of 119 patients with a confirmed diagnosis of urolothiasis using instrumental diagnostic methods and a gestational age up to and including the 27th week. Two groups were formed based on treatment approaches for urolithiasis: group 1 included 59 patients (49.6%) who underwent surgical removal of the stone; group 2 included 60 patients (50.4%) who underwent internal ureteral stent replacement every 4 – 6 weeks prior to delivery and subsequent ureteroscopy There were no significant differences in age, body mass index, or number of pregnancies between the two groups.Results. The frequency of complete stone removal in groups 1 and 2 was 96.6 and 96.7%, respectively. The median amount of time spent on urolithiasis treatment in groups 1 and 2 was 60 [45; 72] and 97 [54; 105] minutes, respectively (p = 0.002). Migration of the ureteral stent in group 2 was observed in 13.3% of cases (p = 0.05). Among group 1 patients who underwent ureteroscopic intervention aimed at stone removal, the incidence of internal drainage dislocation was 3.4%. Encrustation of the ureteral stent in groups 1 and 2 was observed among 2 (3.4%) and 17 (28.3%) patients, respectively (p < 0.001). The bed-day (median time in days spent in hospital for drainage replacement and time of surgical treatment of urolithiasis) in groups 1 and 2 was four and eight days, respectively (p < 0.05). The frequency of natural childbirth in groups 1 and 2 was 81.35% and 55.0%, respectively (p = 0.002).Conclusion. Urolithiasis among pregnant women is a complex multifactorial disease that affects not only the health of the mother, but also the condition of the developing foetus. It is possible to perform surgical treatment with high efficiency and low complication rate, which improves the quality of life.

Histiocytic sarcoma is an extremely rare disease that's hard to diagnose and treat, often leading to a poor prognosis. Here, we present a case report detailing a rare occurrence of HS in a 37-year-old pregnant woman who first presented with left shoulder pain, palpitations, and a productive cough at 20 weeks of gestation. Her diagnostic evaluations were performed, including different imaging modalities such as chest X-rays, CT scans, and MRI. Imaging revealed a large mediastinal mass with extensive involvement of the adrenal glands, lungs, and lymph nodes. The definitive diagnosis of HS is based on pathological and morphological features, and the immunohistochemistry report plays a key role. In our case, the diagnosis of HS was confirmed through pathological evaluation and immunohistochemistry, with a positive CD68 result obtained from a supraclavicular lymph node biopsy. A hospital committee comprising medical specialists like hematologists-oncologists, pathologists, pulmonologists, and obstetricians was brought together to assess the case collectively. The patient received chemotherapy, which alleviated her symptoms and maintained her condition. Based on the committee's recommendations, despite a healthy fetus and normal obstetric sonograms, the decision was made to terminate the pregnancy with the consent of the patient and her family. Despite initial improvement postchemotherapy, the patient's condition worsened, necessitating intubation. Tragically, two months after the initial admission, the patient passed away due to severe complications. In this case report, we provide a literature review and review of the patient's imaging reports. Since the patient is pregnant and HS is uncommon, it's important to highlight that this case is unique and worth sharing.

Objective: Vitamin B12 deficiency, an essential vitamin for the human body, is common in Turkey, and infants are at risk in this regard. This study was intended to investigate the effect of vitamin B12 levels of breastfeeding mothers with infant vitamin B12 and homocysteine levels. Material and Methods: A total of 214 infants aged 1-6 months and their mothers who applied to the infancy outpatient clinic of İstanbul Medeniyet University Göztepe Training and Research Hospital were included in the study. In this study, vitamin B12 levels of the mothers, vitamin B12, folic acid, and homocysteine levels in the infants were primarily analyzed, and the associated risk factors were secondarily determined. Results: The rate of adequate vitamin B12 levels in infants was 20.09% (n=43), and the rate of normal homocysteine levels in mothers of infants with sufficient vitamin B12 and normal homocysteine levels was 383.93 pg/mL and 379.07 pg/mL. 66.27% sensitivity and 75.56% specificity were calculated when 220 pg/mL was taken as the vitamin B12 cut-off value, which predicts homocysteine elevation. Conclusion: This study predicted that only one in five infants had sufficient vitamin B12 levels, but if breastfeeding mothers had sufficient vitamin B12 levels, infants were much less likely to have vitamin B12 deficiency. Since adequate vitamin B12 levels are important for infants, especially in terms of neurodevelopment, we believe that it is necessary to evaluate pregnant women in our society in terms of vitamin B12 levels and to provide vitamin B12 support.

Abstract Background Vitamin D deficiency, a common occurrence among pregnant women, is an emerging public health concern worldwide. According to research, prenatal vitamin D deficiency is associated with various complications. This study assessed the vitamin D status of pregnant women in Yanbian, Jilin Province, as well as the correlation and predictive value of their vitamin D levels in relation to gestational length (weeks) and fetal weight, aiming to provide a basis for clinical diagnosis and treatment. Methods We conducted a population-based retrospective study involving 510 pregnant women from August 2019 to October 2022. Blood samples were collected at 16–20 weeks of gestation for the detection of serum vitamin D levels. Statistical analyses were performed using SPSS 28.0 and R 4.1.0 software. Multifactorial logistic regression analysis was employed to establish whether each variable was a risk factor for deliveries at ≤ 38 gestational weeks and low fetal weight. These results were used to construct a risk prediction model, and the model’s predictive efficacy was evaluated. Results or differences with p

A healthy and balanced diet is a critical requirement for pregnant women as it directly influences both the mother’s and infant’s health. Poor maternal nutrition can lead to pregnancy-related complications with undesirable effects on the fetus. This requirement is equally important for pregnant women with celiac disease (CD) who are already on a gluten-free diet (GFD). Although the GFD is the sole treatment option for CD, it still presents some challenges and confusion for celiac women who wish to conceive. Poorly managed CD has been linked to miscarriages, preterm labor, low birth weight, and stillbirths. Current CD guidelines primarily focus on screening, diagnosis, treatment, and management but lack an evidence-based approach to determine appropriate energy requirements, recommended weight gain during pregnancy, target macronutrient distribution from the diet, the recommended intake of vitamins and minerals from diet and/or supplementation, timing for starting supplementation, and advised portions of gluten-free foods during pregnancy. We recommend and call for the development of such guidelines and/or authoritative papers in the future.

Amaç: Bu araştırmanın amacı gebe okulu programlarında eğitimci olarak görev alan ebe ve hemşirelerin endokrin bozucular konusundaki bilgi ve tutumlarını incelemektir.Yöntem: Fenomenolojik tipte tasarlanan araştırmanın evreni, İstanbul ilindeki gebe okulu programlarında eğitimci olarak görev yapan 44 ebe/hemşireden oluşmuştur (N=44). Ölçüt örnekleme yöntemi kullanılarak örneklem veri doygunluğu takip edilmiş ve doygunluk sağlandığında veri toplama işlemi tamamlanmıştır (n=7). 13 Eylül 2021 tarihinde yapılan araştırmada, veriler odak grup yöntemi ile araştırmacılar tarafından oluşturulan yarı yapılandırılmış görüşme formuyla toplanmıştır. Nicel veriler, tanımlayıcı istatistiksel analizler kullanılarak, nitel veriler ise içerik analiziyle değerlendirilmiştir. Bulgular: Ebe ve hemşirelerin görüşme formuna verdikleri cevaplar doğrultusunda; endokrin bozucuların önemi, endokrin bozucular bilgisi, endokrin bozucular farkındalığı oluşturma ve gebe eğitimine entegrasyon şeklinde dört adet tema oluşturulmuştur. Prenatal dönem eğiticilerinin endokrin bozucuların öneminin farkında olmalarına rağmen konu hakkındaki bilgilerinin yetersiz olduğu belirlenmiştir. Ayrıca katılımcıların konunun prenatal eğitimlerde yer alması ve farkındalık geliştirilebilmesi için çeşitli önerilerinin bulunduğu saptanmıştır. Sonuç: Ebe ve hemşirelerin endokrin bozuculara yönelik çok fazla bilgilerinin olmadığı hatta kısmen yanlış bilgilere sahip oldukları görülmüştür. Eğitici eğitimlerinin içeriğine endokrin bozucularla ilgili konuların eklenerek bilinçlendirme çalışmalarının arttırılması gerektiği sonucuna varılmıştır.

Amaç: Gebelik süreci annelerde sağlıklı yaşam davranış değişikliği açısından kilit rol oynamaktadır. Çalışma gebelerde e-sağlık okuryazarlığı ile sağlıklı yaşam davranışları arasındaki ilişkiyi belirlemek amacıyla yapılmıştır.Yöntemler: Tanımlayıcı tasarımlı çalışma Ondokuz Mayıs Üniversitesi Sağlık Uygulama ve Araştırma Merkezi Kadın Hastalıkları ve Doğum Anabilim Dalına bağlı birimlerde 15.01-15.07.2023 tarihleri arasında yürütülmüştür. Çalışma verileri; Kişisel Bilgi Formu, E-Sağlık Okuryazarlığı Ölçeği ve Gebelikte Sağlıklı Yaşam Davranışları Ölçeği kullanılarak toplanmıştır.Bulgular: Gebelerin Gebelikte Sağlıklı Yaşam Davranışları Ölçeği alt boyutlarından puan ortalamalarının; Gebelik sorumluluğu 18,03±2,75, Hijyen 18,19±2,34, Beslenme 32,31±6,05, Fiziksel aktivite 10,25±3,05, Seyahat 19,30±4,96, Gebeliği kabullenme 17,36±3,23 ve ölçek toplamının ise 115,71±15,80 olduğu saptanmıştır. Gebelerin E-Sağlık Okuryazarlığı Ölçeği puan ortalamasının 27,69±7,45 olduğu belirlenmiştir. Gebelerin Gebelikte Sağlıklı Yaşam Davranışları Ölçeği ve alt boyutları puan ortalamaları ile E-Sağlık Okuryazarlığı Ölçeği puan ortalamaları arasında istatistiksel olarak anlamlı ve pozitif yönde bir ilişki bulunmuştur (p

Co-designed health initiatives are gaining popularity in Aotearoa (New Zealand). However, emerging research identifies potential pitfalls for Indigenous populations, particularly Māori (Indigenous Peoples of Aotearoa), when Kaupapa Māori principles are ignored. Using the Indigenous He Pikinga Waiora Implementation (HPW) framework as a guide, this paper provides an autoethnographic reflective account of the co-design process that led to the development and implementation of the Whirihia holistic assessment tool for the Kaupapa Māori antenatal wānanga (workshop) Whirihia Te Korowai Aroha. The co-design process resulted in a culturally appropriate and responsive holistic assessment tool that provided a quality health needs assessment pathway for māmā hapū (pregnant women) and their whānau (family). This reflective account provides examples of key considerations that align to the HPW framework in the hope that it will afford some guidance for fellow emerging researchers who wish to undertake ethical co-designed health research with Māori (and non-Māori) communities and organisations.Glossary of Māori words: Aotearoa: New Zealand; hapū: sub-tribes; hapūtanga: pregnancy; hui: meeting; ipu: clay pot; iwi: tribe; Kaupapa Māori: Māori ideology incorporating the knowledge, skills, attitudes and values of Māori society; māmā: mothers; māmā hapū: pregnant women; Māori: Indigenous people of Aotearoa; Pākehā: non-Māori (most often New Zealand European); pēpi: infant; pono: true, valid, honest, genuine; pōwhiri: welcome ceremony; te ao Māori: Māori world view; te reo Māori: Māori language; tika: correct, accurate, appropriate; tikanga: values and beliefs; wahakura: woven flax basket that can be used in the parental bed; waiata: song; wānanga: workshop; whakawhānau: birth; whakawhanaungatanga: relationship/connections; whānau family; whenua: afterbirth; land.

ABSTRACT Objective Design Setting and Population Methods Main Outcome Measures Results Conclusions Trial Registration To assess the effectiveness and acceptability of a pillow‐like position modification device to reduce supine sleep during late pregnancy, and to determine the impacts on the severity of sleep‐disordered breathing (SDB) and foetal well‐being.Randomised cross‐over study.Individuals in the third trimester of pregnancy receiving antenatal care at a tertiary maternity hospital in Australia.Participants used their own pillow for a control week and an intervention pillow for a week overnight, in randomised order. Sleep position and total sleep time for each night of both weeks were objectively monitored, with a sleep study and foetal heart rate monitoring performed on the last night of each week.Primary outcome = percentage of sleep time in the supine position; secondary outcomes = apnoea–hypopnoea index, foetal heart rate decelerations and birthweight centile.Forty‐one individuals were randomised with data collected on 35 participants over 469 nights. There was no difference in percentage of total sleep time in the supine position overnight between the control or intervention pillow week (13.0% [6.1, 25.5] vs. 16.0% [5.6, 27.2], p = 0.81 with a mean difference of 2.5% [95% CI] = −0.7, 5.6, p = 0.12), and no difference in the severity of SDB or foetal heart rate decelerations across weeks. However, increased supine sleep was significantly related to a higher apnoea–hypopnoea index (rs = 0.37, p = 0.003), lower birthweight (rs = −0.45, p = 0.007) and lower birthweight centile (rs = −0.45, p = 0.006). The proportion of supine sleep each night of the week varied widely both within and across participants, despite awareness of side‐sleeping recommendations.We found no evidence to suggest that the adoption of a pillow designed to discourage supine sleep was effective in late pregnancy, with women spending an average of 1 h per night supine. Alternative devices should be investigated, incorporating lessons learnt from this study to inform trials of supine sleep minimisation in pregnancy.Clinical Trial: (Australia New Zealand Clinical Trials Registry): ACTRN12620000371998 [ABSTRACT FROM AUTHOR]

In the United States, tuberculosis (TB) screening is recommended for pregnant individuals with TB risk factors. We conducted a retrospective study of perinatal TB infection testing and treatment in a tertiary health system. Of 165 pregnant individuals with positive TB infection tests, only 9% completed treatment within 4.6 years of follow-up. [ABSTRACT FROM AUTHOR]

Background: Generalized anxiety disorder (GAD)–characterised by excessive and uncontrollable worry–is the most frequently diagnosed anxiety disorder during pregnancy and the postpartum period. Identification of GAD often relies on assessment of its cardinal feature, pathological worry. The Penn State Worry Questionnaire (PSWQ) is the most robust measure of pathological worry to date but has not been extensively evaluated for use during pregnancy and the postpartum period. This study evaluated the internal consistency, construct validity, and diagnostic accuracy of the PSWQ in a sample of pregnant and postpartum women with and without a principal GAD diagnosis. Methods: One hundred forty-two pregnant and 209 postpartum women participated in this study. Sixty-nine pregnant and 129 postpartum participants met criteria for a principal diagnosis of GAD. Results: The PSWQ demonstrated good internal consistency and converged with measures assessing similar constructs. Pregnant participants with principal GAD scored significantly higher on the PSWQ than those with no psychopathology and postpartum participants with principal GAD scored significantly higher than those with principal mood disorders, other anxiety and related disorders, and no psychopathology. A cut-off score of 55 and 61 or greater was determined for detecting probable GAD during pregnancy and the postpartum period, respectively. Screening accuracy of the PSWQ was also demonstrated. Conclusions: This study underscores the robustness of the PSWQ as a measure of pathological worry and probable GAD and supports its use in the detection and monitoring of clinically significant worry symptoms during pregnancy and postpartum period. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the quality of ChatGPT responses to common issues in obstetrics and assess its ability to provide reliable responses to pregnant individuals. The study aimed to examine the responses based on expert opinions using predetermined criteria, including "accuracy," "completeness," and "safety." Methods: We curated 15 common and potentially clinically significant questions that pregnant women are asking. Two native English‐speaking women were asked to reframe the questions in their own words, and we employed the ChatGPT language model to generate responses to the questions. To evaluate the accuracy, completeness, and safety of the ChatGPT's generated responses, we developed a questionnaire with a scale of 1 to 5 that obstetrics and gynecology experts from different countries were invited to rate accordingly. The ratings were analyzed to evaluate the average level of agreement and percentage of positive ratings (≥4) for each criterion. Results: Of the 42 experts invited, 20 responded to the questionnaire. The combined score for all responses yielded a mean rating of 4, with 75% of responses receiving a positive rating (≥4). While examining specific criteria, the ChatGPT responses were better for the accuracy criterion, with a mean rating of 4.2 and 80% of the questions received a positive rating. The responses scored less for the completeness criterion, with a mean rating of 3.8 and 46.7% of questions received a positive rating. For safety, the mean rating was 3.9 and 53.3% of questions received a positive rating. There was no response with an average negative rating below three. Conclusion: This study demonstrates promising results regarding potential use of ChatGPT's in providing accurate responses to obstetric clinical questions posed by pregnant women. However, it is crucial to exercise caution when addressing inquiries concerning the safety of the fetus or the mother. Synopsis: ChatGPT demonstrated the ability to provide accurate and comprehensive responses to common obstetric questions. [ABSTRACT FROM AUTHOR]

• Megacolon is a rare clinical condition consisting of an abnormally dilated colon in the absence of mechanical obstruction. • Megacolon can complicate pregnancy in terms of maternal morbidity and mortality and obstetrical outcomes. Pregnancy, on the other hand, can exacerbate chronic constipation through hormonal and mechanical mechanisms. • A case of megacolon is reportedpresenting accidentally during the routine mid-trimester fetal ultrasound as a suspicious pelvic mass of unknown aetiology (mean diameter > 10 cm). • Chronic constipation in women of reproductive age should receive greater clinical attention during pre- and periconception care. • A multi-disciplinary approach, timely diagnosis and delivery planning are fundamental to ensure favourable outcomes for both the mother and fetus when dealing with megacolon during pregnancy. Megacolon is a rare clinical condition consisting of an abnormally dilated colon in the absence of mechanical obstruction. Megacolon can complicate pregnancy in terms of maternal morbidity and mortality (volvulus, ileus, systemic toxicity, bowel perforation, sepsis) and obstetrical outcomes (preterm birth, premature rupture of membranes, dystocia). Pregnancy, on the other hand, can exacerbate chronic constipation through hormonal and mechanical mechanisms. A case of megacolon, first detected during pregnancy in an otherwise healthy nulliparous woman, is reported. The diagnosis was suspected on observation of a pelvic mass of unknown aetiology (mean diameter > 10 cm) constricting and dislocating the gravid uterus contralaterally during a routine mid-trimester fetal ultrasound. The diagnostic work-up and management are discussed. Chronic constipation in women of reproductive age should receive greater clinical attention during pre- and periconception care. A multi-disciplinary approach, timely diagnosis and delivery planning are fundamental to ensure favourable outcomes for both the mother and fetus when dealing with megacolon during pregnancy. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to assess pregnant women's perceptions of prenatal attachment and breastfeeding self-efficacy. Material and Methods: The aim of this study is to assess pregnant women's perceptions of prenatal attachment and breastfeeding self-efficacy. Results: It was found that the Prenatal Attachment Inventory (PAI) total mean score of the pregnant women was 54.44±14.67 and the prenatal breastfeeding self-efficacy scale (PBSES) mean score was 68.32±13.65. There was a positive correlation between PAI and PBSES scores of the pregnant women (p<0.0001, r=0.817). Conclusion: Some sociodemographic and obstetric characteristics of the pregnant women were determined to affect both prenatal attachment and prenatal breastfeeding self-efficacy levels. [ABSTRACT FROM AUTHOR]

Co-designed health initiatives are gaining popularity in Aotearoa (New Zealand). However, emerging research identifies potential pitfalls for Indigenous populations, particularly Māori (Indigenous Peoples of Aotearoa), when Kaupapa Māori principles are ignored. Using the Indigenous He Pikinga Waiora Implementation (HPW) framework as a guide, this paper provides an autoethnographic reflective account of the co-design process that led to the development and implementation of the Whirihia holistic assessment tool for the Kaupapa Māori antenatal wānanga (workshop) Whirihia Te Korowai Aroha. The co-design process resulted in a culturally appropriate and responsive holistic assessment tool that provided a quality health needs assessment pathway for māmā hapū (pregnant women) and their whānau (family). This reflective account provides examples of key considerations that align to the HPW framework in the hope that it will afford some guidance for fellow emerging researchers who wish to undertake ethical co-designed health research with Māori (and non-Māori) communities and organisations. Glossary of Māori words: Aotearoa: New Zealand; hapū: sub-tribes; hapūtanga: pregnancy; hui: meeting; ipu: clay pot; iwi: tribe; Kaupapa Māori: Māori ideology incorporating the knowledge, skills, attitudes and values of Māori society; māmā: mothers; māmā hapū: pregnant women; Māori: Indigenous people of Aotearoa; Pākehā: non-Māori (most often New Zealand European); pēpi: infant; pono: true, valid, honest, genuine; pōwhiri: welcome ceremony; te ao Māori: Māori world view; te reo Māori: Māori language; tika: correct, accurate, appropriate; tikanga: values and beliefs; wahakura: woven flax basket that can be used in the parental bed; waiata: song; wānanga: workshop; whakawhānau: birth; whakawhanaungatanga: relationship/connections; whānau family; whenua: afterbirth; land. [ABSTRACT FROM AUTHOR]

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A healthy and balanced diet is a critical requirement for pregnant women as it directly influences both the mother's and infant's health. Poor maternal nutrition can lead to pregnancy-related complications with undesirable effects on the fetus. This requirement is equally important for pregnant women with celiac disease (CD) who are already on a gluten-free diet (GFD). Although the GFD is the sole treatment option for CD, it still presents some challenges and confusion for celiac women who wish to conceive. Poorly managed CD has been linked to miscarriages, preterm labor, low birth weight, and stillbirths. Current CD guidelines primarily focus on screening, diagnosis, treatment, and management but lack an evidence-based approach to determine appropriate energy requirements, recommended weight gain during pregnancy, target macronutrient distribution from the diet, the recommended intake of vitamins and minerals from diet and/or supplementation, timing for starting supplementation, and advised portions of gluten-free foods during pregnancy. We recommend and call for the development of such guidelines and/or authoritative papers in the future. [ABSTRACT FROM AUTHOR]

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Vitamin D deficiency, a common occurrence among pregnant women, is an emerging public health concern worldwide. According to research, prenatal vitamin D deficiency is associated with various complications. This study assessed the vitamin D status of pregnant women in Yanbian, Jilin Province, as well as the correlation and predictive value of their vitamin D levels in relation to gestational length (weeks) and fetal weight, aiming to provide a basis for clinical diagnosis and treatment. Methods: We conducted a population-based retrospective study involving 510 pregnant women from August 2019 to October 2022. Blood samples were collected at 16–20 weeks of gestation for the detection of serum vitamin D levels. Statistical analyses were performed using SPSS 28.0 and R 4.1.0 software. Multifactorial logistic regression analysis was employed to establish whether each variable was a risk factor for deliveries at ≤ 38 gestational weeks and low fetal weight. These results were used to construct a risk prediction model, and the model's predictive efficacy was evaluated. Results or differences with p < 0.05 were considered statistically significant. Results: Multifactorial logistic regression analysis revealed that vitamin D ≤ 14.7 ng/mL(OR: 1.611; 95% CI: 1.120–2.318; P = 0.010), Bone Mineral Density (BMD) T-value ≤-1(OR: 1.540; 95%CI: 1.067–2.223; P = 0.021), and gestational hypertension(OR: 7.173; 95% CI: 1.482–34.724; P = 0.014) were the independent risk factors for deliveries at ≤ 38 gestational weeks. Additionally, vitamin D ≤ 14.7 ng/mL(OR: 1.610; 95%CI: 1.123–2.307; P = 0.009), BMD T-value ≤ -1(OR: 1.560; 95%CI: 1.085–2.243; P = 0.016), and gestational hypertension(OR: 4.262; 95% CI: 1.058–17.167; P = 0.041) were the independent risk factors for low fetal weight (< 3400 g). Conclusion: This study revealed that low vitamin D levels are an independent risk factor for a short gestational length and low fetal weight. Prenatal low BMD T-value and comorbid hypertensive disorders were also found to increase the risk of a short gestational length and low fetal weight. [ABSTRACT FROM AUTHOR]

Simple Summary: Fetal macrosomia is when a baby's weight at birth is equal to or greater than 4000 g or 4500 g. The rising incidence of macrosomia poses a significant challenge in obstetrics, as it can have serious health consequences for both mothers and babies. The maternal gut microbiome can influence the health of pregnant women and their babies, with potential effects on birth weight. However, research on the link between the microbiome and birth weight, especially macrosomia, is limited; further investigation is needed. Here, we discovered a connection between the maternal gut microbiome and macrosomia. Our findings present novel opportunities for preventing macrosomia by manipulating the composition of the intestinal microbiota. Early prediction models using gut microbiota and clinical indicators can predict macrosomia. Fetal macrosomia is defined as a birthweight ≥4000 g and causes harm to pregnant women and fetuses. Studies reported that the maternal intestinal microbiome plays a key role in the establishment, growth, and development of the fetal intestinal microbiome. However, whether there is a relationship between maternal gut microbiota and macrosomia remains unclear. Our study aimed to identify gut microbiota that may be related to the occurrence of macrosomia, explore the possible mechanisms by which it causes macrosomia, and establish a prediction model to determine the feasibility of predicting macrosomia by early maternal gut microbiota. We conducted a nested case-control study based on an early pregnancy cohort (ChiCTR1900020652) in the Maternity and Child Health Hospital of Hunan Province on fecal samples of 93 women (31 delivered macrosomia as the case group and 62 delivered normal birth weight newborns as the control group) collected and included in this study. We performed metagenomic analysis to compare the composition and function of the gut microbiome between cases and controls. Correlation analysis was used to explore the association of differential species and differential functional pathways. A random forest model was used to construct an early pregnancy prediction model for macrosomia. At the species level, there were more Bacteroides salyersiae, Bacteroides plebeius, Ruminococcus lactaris, and Bacteroides ovatus in the intestinal microbiome of macrosomias' mothers compared with mothers bearing fetuses that had normal birth weight. Functional pathways of the gut microbiome including gondoate biosynthesis, L-histidine degradation III, cis-vaccenate biosynthesis, L-arginine biosynthesis III, tRNA processing, and mannitol cycle, which were more abundant in the macrosomia group. Significant correlations were found between species and functional pathways. Bacteroides plebeius was significantly associated with the pathway of cis-vaccenate biosynthesis (r = 0.28, p = 0.005) and gondoate biosynthesis (r = 0.28, p < 0.001) and Bacteroides ovatus was positively associated with the pathway of cis-vaccenate biosynthesis (r = 0.29, p = 0.005) and gondoate biosynthesis (r = 0.32, p = 0.002). Bacteroides salyersiae was significantly associated with the pathway of cis-vaccenate biosynthesis (r = 0.24, p = 0.018), gondoate biosynthesis (r = 0.31, p = 0.003), and L–histidine degradation III (r = 0.22, p = 0.291). Finally, four differential species and four clinical indicators were included in the random forest model for predicting macrosomia. The areas under the working characteristic curves of the training and validation sets were 0.935 (95% CI: 0.851~0.979) and 0.909 (95% CI: 0.679~0.992), respectively. Maternal gut microbiota in early pregnancy may play an important role in the development of macrosomia and can be used as potential predictors to prevent macrosomia. [ABSTRACT FROM AUTHOR]

Background The WHO's global hepatitis strategy aims to achieve viral hepatitis elimination by 2030. Migrant children and pregnant persons represent an important target group for prevention strategies. However, evidence on the burden of chronic hepatitis B (CHB) infection and the factors affecting its incidence is lacking. Methods EMBASE, Global Health, Global Index Medicus, Web of Science and Medline were searched for articles in any language from 1 January 2012 to 8 June 2022. Studies reporting CHB prevalence, disease severity, complications and/or prevention strategies, including vaccination, prevention of vertical transmission and access to care/treatment for migrant children and pregnant migrants, were included. Pooled estimates of CHB prevalence and hepatitis B vaccination (HBV) coverage among migrant children were calculated using random effects meta-analysis. Findings 42 studies were included, 27 relating to migrant children and 15 to pregnant migrants across 12 European countries, involving data from 64 773 migrants. Migrants had a higher incidence of CHB than host populations. Among children, the pooled prevalence of CHB was higher for unaccompanied minors (UAM) (5%, [95% CI: 3–7%]) compared to other child migrants, including internationally adopted children (IAC) and refugees (1%, [95% CI: 1–2%]). Region of origin was identified as a risk factor for CHB, with children from Africa and pregnant migrants from Africa, Eastern Europe and China at the highest risk. Pooled estimates of HBV vaccine coverage were lower among UAM (12%, [95% CI: 3–21%]) compared to other child migrants (50%, [95% CI: 37–63%]). Conclusion A range of modifiable determinants of HBV prevalence in migrant children and pregnant persons were identified, including sub-optimal screening, prevention and continuum of care. There is a need to develop evidence-based approaches in hepatitis care for these groups, thereby contributing towards global viral hepatitis elimination goals. [ABSTRACT FROM AUTHOR]

Millard-Gubler syndrome is a pontine syndrome caused by a lesion in the lower pons region. It is characterised by ipsilateral facial paralysis and VI paresis and contralateral brachiocrural palsy. We present the case of a female patient, G4P2A1, at 21 weeks of gestation, with preeclampsia, complaints of blurred vision, diplopia, and right hemiparesis, in whom a clinical diagnosis of Millard-Gubler syndrome was made. Neuroimaging showed an intraparenchymal haemorrhage towards the central portion of the bulbopontine junction. An extensive aetiological study was carried out to determine the cause of the hypertensive disorder syndrome during pregnancy. The patient improved satisfactorily from the neurological deficit after delivery of an early stillbirth. [ABSTRACT FROM AUTHOR]

Introduction: The extent to which individuals living with HIV experience residential and healthcare mobility during pregnancy in the UK is unknown. We aimed to determine a minimum estimate of residential and healthcare mobility during pregnancy in people living with HIV in the UK in 2009–2019 to explore patterns of and factors associated with mobility and to assess whether mobility was associated with specific HIV outcomes. Methods: We analyzed data from the Integrated Screening Outcomes Surveillance Service to assess pregnancies with HIV in the UK and included livebirths and stillbirths with estimated delivery in 2009–2019. Residential mobility was defined as changing residential postcode between notification and delivery, and healthcare mobility was defined as changing NHS Trust or Strategic Health Authority (SHA) in that same timeframe. We used logistic regression to determine factors associated with residential and healthcare mobility and with detectable delivery viral load. Results: Among 10 305 pregnancies, 19.6% experienced residential mobility, 8.1% changed NHS Trust, and 4.5% changed SHA during pregnancy. Mobility was more likely to be experienced by younger women, migrants, and those with new antenatal diagnosis; residential but not healthcare mobility declined over time. In a fully adjusted model, mobility was not associated with having a detectable viral load at delivery. Higher proportions of infants were lost to follow‐up after mobile pregnancies than after non‐mobile pregnancies. Conclusions: This analysis provides new knowledge on mobility during pregnancy in the context of HIV, but further research is needed to understand its broader impacts and its utility as a marker to help identify families requiring additional follow‐up and support. [ABSTRACT FROM AUTHOR]

Ecological nutrition aims to unravel the extensive web of nutritional links that drives animals in their interactions with their ecological environments. Nutrition plays a key role in the success of European wild rabbit (Oryctolagus cuniculus) and could be affected by the breeding status of the animals and reflected in the metabolome of this species. As nutritional needs are considerably increased during pregnancy and lactation, the main objective of this work was to determine how the breeding status (pregnant and lactating) of European wild rabbit does affects nutritional requirements and their metabolome (using targeted and untargeted metabolomics), aiming to find a useful biomarker of breeding status and for monitoring nutritional requirements. To address this gap, 60 wild European rabbits were studied. Animals were divided according to their breeding status and only pregnant (n = 18) and lactating (n = 11) rabbit does were used (n = 29 in total). The body weight and length of each animal were analyzed. The relative and absolute chemical composition of the gastric content and whole blood sample were taken, and targeted and untargeted metabolomics were analyzed. As a main result, there were no differences in biometric measurements, gastric content, and targeted metabolomics, except for live weight and nonesterified fatty acids (NEFA), as pregnant animals showed higher live weight (+12%; p = 0.0234) and lower NEFA acid levels (−46%; p = 0.0262) than lactating females. Regarding untargeted metabolomics, a good differentiation of the metabolome of the two breeding groups was confirmed, and it was proven that pregnant animals showed higher plasmatic levels of succinic anhydride (3.48 more times; p = 0.0236), succinic acid (succinate) (3.1 more times; p = 0.0068) and propionic acid (3.98 more times; p = 0.0121) than lactating animals. However, lactating animals showed higher levels of N‐[(3a,5b,7b)‐7‐hydroxy‐24‐oxo‐3‐(sulfoxide) cholan‐24‐yl]‐Glycine (cholestadien) (2.4 more times; p < 0.0420), 4‐maleyl‐acetoacetate (MAA) (3.2 more times; p < 0.0364) and irilone (2.2 more times; p = 0.0451) than pregnant animals, any of these metabolites could be used as a potential biomarker. From these results, it can be concluded that the most notable changes were observed in the metabolome of individuals, with most of the changes observed being due to energy and protein mobilisation. [ABSTRACT FROM AUTHOR]