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Background: The aim of the study was to determine the performance of history of risk factors and universal HBA1c testing as screening tools for diabetes mellitus in the first trimester of pregnancy using OGTT as a gold standard.Methods: A prospective cross-sectional study conducted between 8 and 13±6 weeks in 305 consecutive pregnancies in the antenatal clinics of the University of Port Harcourt Teaching (UPTH) and Rivers State University Teaching Hospital (RSUTH) between January and August 2020. Each woman had oral glucose tolerance test (OGTT), and glycosylated haemoglobin (HBA1c) levels estimation. Multivariate logistic regression analysis was carried out with history of risk factors and HBA1c level as independent variables and OGTT as the dependent variable for the assessment of their predictive performances.Results: The prevalence of DM was 28.85%, 2.62% and 31.48% for GDM, pre-gestational and for both respectively. Family history of DM was associated with high specificity (91.4%) and negative predictive value (NPV) of 68.7% but low sensitivity (9.4%) and positive predictive value (PPV) (33.3%). The receiver operator characteristic curve for HBA1c revealed a significant area under the curve value: 0.653 (CI: 058-0.72), p<0.01. The optimal cut-off for HBA1c from Youden index was 5.25%. HBA1c levels had high specificity (88.5%) and NPV (75.2%) with low sensitivity (36.5%) and PPV (59.3%). Multivariate logistic regression analysis showed HbA1c as the only independent predictor of GDM (p=0.0001).Conclusions: The high prevalence of diabetes (31.48%), underscores the need for universal screening in early pregnancy. The high NPV and specificity of the risk factors for GDM and HBA1c levels better predict pregnancies that are not likely to develop GDM, but they are not suitable for diagnosis because of the low sensitivity and PPV.
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Objective To explore the risk factors of gestational diabetes mellitus(GDM)in the first trimester(12～13+6 weeks)of pregnancy,build a prediction model and verify it.Methods 433 singleton pregnant women delivered in the First People's Hospital of Shanghai from January 2020 to December 2020 were selected.They were divided into GDM group(n=188)pregnant women and non-GDM group(n=245)pregnant women according to a 75g glucose tolerance test results at 24～28 weeks of gestation.The electrochemiluminescence method measured serum biochemical indexes in early pregnancy,and glycosylated hemoglobinAlc was measured by ion exchange high-performance liquid chromatography.Using logistic regression analysis to screen the risk factors of GDM and construct a predictive model,draw the subject's work characteristic curve to analyze the model's predictive value.Ninety-five pregnant women who underwent prenatal examinations at Shanghai First People's Hospital from January 2021 to June 2021 were selected to validate the model's effectiveness.Results Compared with the non-GDM group,the level of body mass index(BMI)(23.41±11.17 kg/m2 vs 21.18±2.88 kg/m2),gamma-glutamyl transpeptidase(γ-GGT)(16.61±10.62 U/L vs 14.00±8.35 U/L),triacylglycerol(TG)(1.90±0.58 mmol/L vs 1.57±0.55 mmol/L),glycosylated hemoglobinAlc(HbAlc)(5.25%±0.47%vs 5.07±0.34%),fasting blood glucose(FBG)(4.68±0.47 mmol/L vs 4.36±0.36 mmol/L),LDL/HDL(1.53±0.49 vs 1.41±0.50),TG/HDL(2.93±0.59 vs 2.71±0.58),and TC/HDL(1.19±0.49 vs 0.95±0.45)in GDM group was increased,and the level of highdensity lipoprotein-cholesterol(HDL)(1.69±0.39 mmol/L vs 1.77±0.41 mmol/L)was decreased,the differences were statistically significant(t=2.613,2.818,5.874,4.582,17.701,2.458,3.815,5.310,-2.187,all P＜0.05).Logistic regression analysis showed that pre-pregnancy BMI,FBG,HbAlc,TG,and TC/HDL were all independent risk factors for predicting gestational diabetes(Waldχ2=4.48～35.549,all P＜0.05).The prediction model constructed based on the selected risk factors was as follows:Logit(P)=-20.562+0.085(BMI)+1.921(FBG)+1.57(HbAlc)+2.248(TG)-2.302(TC/HDL).The model predicts that the area under the curve of GDM was 0.800(95%CI:0.757～0.842),the optimal cutoff value was 0.352,and the sensitivity and specificity were 80.00%and 66.00%,respectively.Ninety-five pregnant women validated the model,and its sensitivity,specificity,and accuracy were 84.50%,91.00%,and 85.30%,respectively.Conclusion The prediction model constructed by BMI combined with FBG,HbAlc,TG and TC/HDL in the first trimester(12～13+6 weeks)of pregnancy has a high predictive value for GDM.
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Objective To explore the relationship between inflammatory indexes,fasting plasma glucose(FPG),blood lipid in early pregnancy(6 to 13W+6D)and gestational diabetes mellitus(GDM).Methods Ninety-eight pregnant women in early pregnancy who underwent prenatal examinations at the First Affiliated Hospital of Xinxiang Medical University from No-vember 2020 to October 2021 were selected as the research subjects.These pregnant women were divided into the GDM group(n=35)and normal glucose tolerance(NGT)group(n=63)according to the oral glucose tolerance test results in the second trimester of pregnancy(24-28W).All subjects kept fasting for at least 8 hours at 6 to 13W+6D of pregnancy,and the blood was collected from the median cubital vein on the morning of the second day,the white blood cell(WBC)count,neutrophil count(NC),lymphocyte count(LC),monocyte count(MC),FPG,and serum total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C)and low-density lipoprotein cholesterol(LDL-C)levels were measured.The differences in various indicators of pregnant women between the GDM group and NGT group were compared.The joint predictive factors for GDM was obtained by multivariable logistic regression model,and the independent risk factors of GDM were analyzed,and the efficiency of each risk factor in predicting the occurrence of GDM was evaluated by the receiver operating characteristic(ROC)curve.Results The FPG,WBC,LC,TC,TG and LDL-C levels of pregnant women in the GDM group were significantly higher than those in the NGT group in early pregnancy(P＜0.05);there was no significant difference in the NC,MC and HDL-C levels of pregnant women between the two groups(P＞0.05).Logistic regression model analysis results showed that the increase of FPG,WBC,TC and TG were independent risk factors affecting the occurrence of GDM(P＜0.05).Taking FPG=4.80 mmol·L-1,WBC=9.35 × 109 L-1,TC=4.05 mmol·L-1 and TG=1.61 mmol·L-1 as cut-off values,the area under the curve(AUC)of above indexes in predicting GDM were 0.779,0.721,0.685 and 0.762,respectively;the sensitivity was 0.886,0.514,0.857 and 0.543,respectively;the specificity was 0.587,0.857,0.524 and 0.873,respectively.The AUC of the combined prediction of FPG,WBC,TC and TG for GDM was 0.876,with a sensitivity of 0.857 and a specificity of 0.810.The AUC of the combined prediction of FPG,WBC,TC and TG for GDM was significantly higher than that of FPG,WBC,TC and TG in early pregnancy alone for GDM.Conclusion Elevated levels of FPG,WBC,TC and TG in early pregnancy(6 to 13W+6D)are independent risk factors for GDM,and they can be used as clinical indicators for the early prediction of GDM.The combination of the four indicators has better predictive value for GDM.
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Este artigo é fruto de uma pesquisa que teve como objetivo analisar os fatores subjacentes à gravidez precoce em mães de recém-nascidos(as) internados(as) na Unidade de Terapia Intensiva Neonatal e na Unidade de Cuidados Intermediários Canguru da Maternidade Escola Januário Cicco, em Natal, Rio Grande do Norte. Parte-se do pressuposto de que esses fatores se agregam ao contexto de vida das adolescentes e influenciam diretamente em suas trajetórias e na gestação precoce. Trata-se de uma pesquisa de enfoque misto, a partir de um estudo do tipo exploratório, orientado pelo método dialético-crítico. Para a coleta de dados, foram realizadas oito (08) entrevistas semiestruturadas e um (01) grupo focal com adolescentes de 12 a 18 anos. Os dados foram submetidos à técnica de Análise de Conteúdo. Os resultados evidenciaram que o contexto de vida social, econômico, cultural e familiar de cada adolescente apresenta diversos fatores que influenciam nos significados da gravidez na adolescência e violam a garantia do exercício de direitos como liberdade, saúde, educação, trabalho e cultura, impactando na estruturação e nos projetos de vida dessa população.(AU)
This article derives from a research that aimed to analyze underlying factors of early pregnancy in mothers of newborns admitted to the Neonatal Intensive Care Unit and the 'Kangaroo Method' Intermediate Care Unit at Januário Cicco Maternity Ward in Natal, in the State of Rio Grande do Norte in Brazil. It is considered that these issues are combined to the adolescents' life context directly influence their trajectories and early pregnancy. The research is of mixed approach by means of an exploratory study guided by the dialectical-critical method. In order to collect data, eight (08) semi-structured interviews were realized as well as a focus group that considered adolescents aged from12 to 18 years old. Data was treated by means of Content Analysis. Results point out that the social, economic, cultural and familiar context of each adolescent enables a series of factors that influence and give meaning to teenage pregnancy. It was also seen that these issues violate the guarantee and exercise of rights such as freedom, health, education, work and culture, impacting the structures of their life projects.(AU)
Este artículo es fruto de una investigación que tuvo como objetivo analizar los factores subyacentes del embarazo precoz en madres de recién-nascidos(as) internados en la Unidad de Cuidados Intensivos Neonatal e en la Unidad de Cuidados Intermedios Canguru de la Maternidad Escuela Januário Cicco en Natal-Rio Grande do Norte en Brasil. Partiendo de la suposición de que esos factores se añaden al contexto de vida de las adolescentes e influencian directamente sus trayectorias y el embarazo precoz. Tratase de una investigación con enfoque mixto, a partir de un estudio de tipo exploratorio, orientado por el método dialéctico-crítico. Para la colecta de datos, fueron realizadas ocho (08) entrevistas semiestructuradas y un (01) grupo focal con adolescentes de 12 a 18 años. Los datos fueron sometidos a la técnica de Análisis de Contenido. Los resultados mostraron que el contexto de vida social, económico, cultural y familiar de cada adolescente presenta varios factores que influyen en los significados del embarazo adolescente y violan la garantía del ejercicio de derechos como libertad, salud, educación, trabajo y cultura, incidiendo en la estructuración y los proyectos de vida de esta población.(AU)
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Humains , Adolescent , Grossesse de l'adolescente , Classe socialeRÉSUMÉ
Background: Preeclampsia (PE) affects 2-3% of all pregnancies and is a major cause of maternal and perinatal morbidity and mortality. In the last decade extensive research has been devoted to screening for PE with the aim of reducing the prevalence of the disease through pharmacological intervention in the high-risk group. In our study we used the combined screening method to evaluate the risk of developing preeclampsia in pregnant women. Our primary objective was to estimate the screen positivity rate for preeclampsia using the first trimester combined screening method (maternal risk factors and biophysical methods) in our population in a tertiary care hospital setting.Methods: Risk of preeclampsia was calculated using fetal medicine foundation algorithm accessed at https://fetalmedicine.org/research/assess/preeclampsia.Results: Using the combined screening method, 10 out of 75 women (13.33%) were found to be screen positive for risk of developing preterm preeclampsia (at <37 weeks) with a risk cut off of 1:100. Using the maternal risk factors approach only (as per NICE guidelines) again 10 out of 75 women (13.3%) were found to be screen positive. However, the subset of women who were screen positive by each method were not the same. There were only 4 out of 10 women who were screen positive by both methods. The screen positivity rate for preterm preeclampsia (<37 weeks) in our population using combined screening approach was 13%, which means aspirin would be advisable to 13/100 pregnant women to reduce the risk of preterm preeclampsia.Conclusions: Basis on our study we concluded that one cost effective method of screening could be, to offer aspirin to all women who are screen positive by the maternal risk factor approach (NICE guidelines approach). This approach does not require any extra blood test or skill to measure uterine artery pulsatility index.
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Background: Preeclampsia (PE) affects 2-3% of all pregnancies and is a major cause of maternal and perinatal morbidity and mortality. In the last decade extensive research has been devoted to screening for PE with the aim of reducing the prevalence of the disease through pharmacological intervention in the high-risk group. In our study we used the combined screening method to evaluate the risk of developing preeclampsia in pregnant women. Our primary objective was to estimate the screen positivity rate for preeclampsia using the first trimester combined screening method (maternal risk factors and biophysical methods) in our population in a tertiary care hospital setting.Methods: Risk of preeclampsia was calculated using fetal medicine foundation algorithm accessed at https://fetalmedicine.org/research/assess/preeclampsia.Results: Using the combined screening method, 10 out of 75 women (13.33%) were found to be screen positive for risk of developing preterm preeclampsia (at <37 weeks) with a risk cut off of 1:100. Using the maternal risk factors approach only (as per NICE guidelines) again 10 out of 75 women (13.3%) were found to be screen positive. However, the subset of women who were screen positive by each method were not the same. There were only 4 out of 10 women who were screen positive by both methods. The screen positivity rate for preterm preeclampsia (<37 weeks) in our population using combined screening approach was 13%, which means aspirin would be advisable to 13/100 pregnant women to reduce the risk of preterm preeclampsia.Conclusions: Basis on our study we concluded that one cost effective method of screening could be, to offer aspirin to all women who are screen positive by the maternal risk factor approach (NICE guidelines approach). This approach does not require any extra blood test or skill to measure uterine artery pulsatility index.
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Objective To report a case of early pregnancy loss with septate uterus, successfully managed by hysteroscopy guided suction & evacuation of product of conception along with removal of uterine septum in same sitting. Case report. Tertiary care hospital. One woman with early pregnancy loss with septate Design Setting Patient uterus. Hysteroscopy guided suction & evacuation of product of conception along with removal of uterine septum Intervention in same sitting. Hysteroscopy guided suction & evacuation of product of conception followed by septum removal with Result hysteroscopic scissor was performed, with minimal blood loss, in same sitting. Products of conception were sent for pathologic examination. There were no intra-operative or postoperative complications. Even though the role of septum as a Conclusion contributing factor to miscarriage in not certain, early pregnancy loss may be seen in patients with septate uterus. Blind removal of POCs with dilatation & curettage, may be complicated with retained products of conception (RPOC) or intrauterine adhesion formation, which can lead to adverse fertility outcomes in the future. Also removal of septum, which may or may not be the cause, is often performed before further pregnancy. This requires another admission & exposure to anaesthesia, along with added cost. Hysteroscopy guided resection of POC with septum removal in same sitting has been associated with complete tissue removal under vision, less damage to surrounding endometrium, cost effective combination of two surgical procedures & earlier time to conception compared with 2 sitting procedure (dilation and curettage than septum removal). Thus, hysteroscopy guided suction & evacuation of POC & septum removal in same sitting can be considered as an alternative surgical technique for management of early pregnancy loss in patients diagnosed with septate uterus. This case report demonstrates the successful application of hysteroscopic procedure in a case of early pregnancy loss with septate uterus.
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Uterine rupture is a rare but life threatening obstetrical emergency. It often occurs at term during trail of labour but rarely may occur during early pregnancy in first trimester. Here, we report a case of 28 years, G2P1+0L0 at 3 months of pregnancy with fundal rupture in shock with history of previous caesarean section. Ultrasound report revealed massive hemoperitoneum (2 litres) with dead fetus lying outside the uterine cavity. Emergency laparotomy was performed and uterine repair was done. The differential diagnosis for hemoperitoneum is early pregnancy includes bleeding corpus luteum, heterotropic pregnancy or ectopic pregnancy and molar pregnancy with secondary invasion. The possibility of uterine rupture should also be kept in mind. Prompt diagnosis and early management is important to reduce the morbidity and mortality.
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Objective To investigate the predictive value of serum ferritin(SF)in early gestation,pre-pregnancy body mass index(BMI)and gestational age for gestational diabetes mellitus(GDM).Methods A total of 260 pregnant women who had a routine prenatal examination in Wenzhou People's Hospital were collected from January 2021 to December 2022.Fasting venous blood was collected at the first prenatal examination(within 14 weeks'gestation)for SF.According to the results of 75 grams oral glucose tolerance test(OGTT)between 24 weeks and 28 weeks,they were divided into GDM group(n=62)and normal glucose tolerance(NGT)group(n=198).The general clinical data of the two groups were compared;Multivariate Logistic regression analysis was conducted to determine the independent risk factors of GDM.Receiver operating characteristic(ROC)curve was used to further analyze the predictive value of SF in early gestation,pre-pregnancy BMI and gestational age for GDM.Results Pregnant women in GDM group had higher SF,BMI and gestational age in early pregnancy than those of NGT group(P<0.05).Pre-pregnancy BMI,gestational age and SF increased in early pregnancy were independent risk factors for GDM(P<0.05).The area under the curve(AUC)of SF in early pregnancy as well as pre-pregnancy BMI and gestational age for predicting GDM were 0.612,0.691 and 0.664.The best tangent point values were 94.045ng/ml,21.125kg/m2 and 28.500 years old,respectively.The total AUC of ROC predicted GDM by SF in early gestation,pre-pregnancy BMI and gestational age was 0.750,the sensitivity and specificity were 66.1%and 79.3%,respectively.Conclusion SF in early gestation,pre-pregnancy BMI and gestational age are important factors in the development of GDM,the combined detection of SF in early pregnancy,pre-pregnancy BMI and gestational age has a certain predictive value for GDM.
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Resumen OBJETIVO: Determinar el significado clínico y el desenlace obstétrico y perinatal luego de la detección de una protuberancia corial en el estudio de tamizaje del primer trimestre de la gestación. MATERIALES Y MÉTODOS: Estudio de cohorte prospectiva efectuado, de abril del 2019 a diciembre 2021, en pacientes referidas para tamizaje del primer trimestre a una unidad de Medicina y Cirugía Fetal de tercer nivel de referencia (Prenatalia Medicina Fetal San Javier, Guadalajara, Jalisco, México). Criterio de inclusión: pacientes con medición de la longitud cráneo caudal comprendida entre 45 y 84 mm durante el tamizaje prenatal del primer trimestre. Se reportaron los hallazgos ecográficos, se obtuvieron información y datos clínicos relevantes de los expedientes electrónicos y cuando se consideró necesario se contactó al ginecoobstetra tratante y a las pacientes. Se utilizó estadística descriptiva con medidas de tendencia central y dispersión. Para el análisis comparativo se utilizó χ2 y U de Mann Whitney para contrastar diferencias entre grupos. RESULTADOS: Se evaluaron 1359 embarazos y la protuberancia corial se documentó en 19 de ellos. En 9 de 19 casos se asoció con sangrado del primer trimestre, previo a la exploración ecográfica. En 16 de 19 casos se encontraron dimensiones de la protuberancia corial mayores a 10 mm. Además, la protuberancia se asoció con episodios de amenaza de parto pretérmino en 13 de los 19 casos. CONCLUSIONES: La protuberancia corial es un hallazgo poco frecuente durante el tamizaje del primer trimestre que se asocia con sangrado y episodios de amenaza de parto pretérmino.
Abstract OBJECTIVE: To determine the clinical significance and obstetric and perinatal outcome after detection of a chorionic protrusion in the first trimester screening study. MATERIALS AND METHODS: Prospective cohort study performed in patients referred for first trimester screening to a third level referral Fetal Medicine and Surgery unit (Prenatalia Medicina Fetal San Javier, Guadalajara, Jalisco, Mexico) from April 2019 to December 2021. Patients with craniocaudal length measurements between 45 and 84 mm during first-trimester prenatal screening were included. Ultrasound findings were reported, relevant clinical information and data were obtained from electronic records, and the treating obstetrician-gynecologist and patients were contacted when necessary. Descriptive statistics with measures of central tendency and dispersion were used. For comparative analysis, 2 and Mann Whitney U were used to contrast differences between groups. RESULTS: 1359 pregnancies were evaluated and chorionic protrusion was documented in 19 of them. In 9 of 19 cases it was associated with first trimester bleeding prior to ultrasound examination. Chorionic protrusion was found to be larger than 10 mm in 16 out of 19 cases. In addition, the protrusion was associated with episodes of threatened preterm labour in 13 of 19 cases. CONCLUSIONS: Chorionic protrusion is a rare finding during first trimester screening that is associated with bleeding and episodes of threatened preterm labour.
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En Venezuela, el embarazo en adolescentes es un problema de salud pública, por su frecuencia, la repercusión sobre la calidad de vida de las madres, de sus hijos y de la sociedad en general; además, aun así, puede ser atendido y es factible su disminución. En 2014, Venezuela presentaba la Tasa Específica de Fecundidad más alta de Suramérica; y ocupaba el cuarto lugar, entre los países de Latinoamérica. Para estudiar el embarazo de adolescentes en el país se analizan los datos oficiales disponibles de la última década (2003-2012), en números, porcentajes y tasas. Asimismo, se analizan los nacimientos de madres adolescentes (2014/2015), recabados en dos hospitales públicos y dos privados: (11596 nacimientos: 2438 de madres adolescentes). De éstos: 2.403 (25,8%), en hospitales públicos y 35 (1,5%), en los privados. Del sector público, 95% de los hijos de adolescentes, son hijos de madres de 15 a 19 años y 5% de 10 a 14 años. Las tasas del grupo de 15 a 19 años (indicador oficial internacional), aumentaron en 2011 y 2012. Se analizan otras cifras y características: edad de las madres, frecuencia de legrado. En 2012, último año de información nacional disponible, se registraron (Instituto Nacional de Estadística-INE): 143 491 nacidos vivos, hijos de adolescentes, (10 a 19 años, según la OMS), que representan 23,4% del total anual de nacimientos. El embarazo en adolescentes constituye un fracaso social multisectorial, que recicla la pobreza y aumenta el subdesarrollo. Su importancia amerita la creación y aplicación de políticas públicas, así como estrategias específicas y permanentes para disminuir su incidencia(AU)
Abstract: Teenage pregnancy in Venezuela is a public health problem due to its incidence and repercussions over life-quality of mothers, their children, and the society in general. Even though with proper attention there is an incidence decrease possibility. In 2014 the Venezuelan Age-Specific Fertility Rate (15-19 age group) was the highest in South America and was the fourth among Latin America and the Caribbean nations. To study teenage pregnancy in the country last decade official available data (2003-2012) was analyzed by number, percentage, and rates. Between 2014 and 2015 the number of births from teenage mothers at two public and two private hospitals was analyzed (11 596 births: 2.438). Of those, 2.403 births were registered at public hospitals (25.8%) while 35 (1.5%) were at private clinic. At public hospitals 95% of live births were from teenage mothers (15-19 years) and 5% were mothers aged 10-14. In 2011 and 2012 the fertility rates for 1519-year-olds (international official indicator) increased. Other characteristics and tendencies are analyzed: age of mothers, abortion frequency and prenatal visits. According to the INE (National Institute of Statistics) in 2012, last year of available information, there were 143 491 live births from teenage mothers (aged 10-19 WHO) registered in Venezuela, which represents the 23.4% of the total number of annual births. Pregnancy of teenagers is a social multisectoral failure that recycles poverty and increase underdevelopment. The magnitude of the problem requires the design and implementation of public policies as well as specific permanent strategies to reduce the incidence(AU)
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Humains , Femelle , Grossesse , Enfant , Adolescent , Grossesse de l'adolescente , Qualité de vie , Classe sociale , Facteurs de risque , Pauvreté , Santé publique , Pays en voie de développementRÉSUMÉ
Objective:To analyze the current situation of pregnant women′s health promotion behavior in early pregnancy, and to explore the multiple mediating effects of self-efficacy and sense of coherence in family function and health promotion behavior.Methods:The convenience sampling method selected 208 early pregnant women who visited the obstetric clinic of the Affiliated Hospital of Qingdao University from August to December 2020 as the research object was used. The electronic questionnaires including self-made general information questionnaire, Family APGAR Questionnaire, General Self-Efficacy Scale (GSES), Sense of Coherence Scale (SOC-13), and the Health-Promoting Lifestyle ProfileⅡ (HPLP-Ⅱ) were provided to women.Results:The total score of health promotion behaviors for early pregnancy was (139.58 ± 17.27) points with a good level. The influencing factors such as exercise habits and medical payment methods had statistical significance in the effects of health-promoting behaviors in the first trimester of pregnancy ( t=4.68, -3.55, both P<0.05). Structural equation model revealed that the total effect value of family function on health-promoting behaviors was 2.654, the direct effect value was 1.729 and the indirect effect value was 0.925. Meanwhile, the mediating effects of self-efficacy, the sense of coherence and self-efficacy upon the sense of coherence accounted for 15.9%, 15.2% and 3.8% of the indirect effect respectively. Conclusions:Family function of pregnant women in early pregnancy can not only affect health promotion behavior through self-efficacy and sense of coherence, but also indirectly affect sense of coherence through self-efficacy, so as to affect health promotion behavior. Maternal related health workers can construct targeted intervention measures from the perspective of self-efficacy and sense of coherence to maintain and improve the health promotion behavior of pregnant women in the early stage of pregnancy.
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Objective:To investigate the serum thyroglobulin (Tg) levels of women in early pregnancy in Dali City, Yunnan Province, and provide a scientific basis for evaluation of individual iodine nutrition of early pregnant women in this area.Methods:Dali City, Yunnan Province was divided into 5 sampling areas according to east, west, south, north and middle. One township (town) was selected from each area, and at least 20 women in early pregnancy were selected from each township (town) as survey subjects. General condition and medical history of all subjects were collected, and random urine samples and fasting venous blood samples were collected for determination of urinary iodine and thyroid function indexes, and a portable ultrasound machine was used for thyroid ultrasonography. After excluding the patients with a history of thyroid disease and abnormal thyroid function, the level of Tg in the included early pregnant women was analyzed.Results:A total of 120 women in early pregnancy were investigated, aged from 19 to 40 years. Among them, 61 cases came from urban areas and 59 were from rural areas. The median urinary iodine was 156.54 μg/L, which was at the appropriate level of iodine nutrition. A total of 102 women with normal thyroid function in early pregnancy were included, and the Tg level was 11.56 (6.67, 15.27) ng/ml. Among them, 58 cases were in urban areas and 44 cases were in rural areas. There was no significant difference in serum Tg levels between rural and urban women in early pregnancy ( U = 1 362.50, P = 0.559). Conclusion:The serum Tg level of women in early pregnancy in Dali City can provide a reference for evaluation of individual iodine nutrition of relevant populations in this area.
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Objective:To investigate the clinical value of fetal ultrasonography in the screening of congenital heart malformations in twins at 11-13 + 6 weeks of gestation. Methods:A retrospective cohort study method was used.Cases were collected from Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital (January 2012 to December 2016) and the Fourth Hospital of Shijiazhuang City (January 2014 to December 2018). The twins with singleton or twins with cardiac malformation were screened out as the cardiac malformation group, and the twins with normal delivery during the same period were selected as the control group. Ultrasound data such as the nuchal translucency (NT), crown-rump-length (CRL), chorionicity, conception method, NT discordance, CRL discordance, NT discordance ≥20% incidence rate between twins, and the CRL discordance ≥10% incidence rate between twins in the two groups at 11-13 + 6 weeks were compared and analyzed. Results:①There were 30 cases in the cardiac malformation group (including 27 twins with singleton cardiac malformation and 3 twins with twin cardiac malformation) and 1 906 cases in the control group. ②The incidence rates of NT value ≥95th percentile and NT value ≥99th percentile in one or two pregnancies were significantly higher in the cardiac malformation group than in the control group (20.00% vs 2.20%, P<0.001; 10.00% vs 0.63%, P=0.002), the area under the ROC curve (AUC) for cardiac malformation screening was 0.589 and 0.549, respectively; CRL discordance in cardiac malformation group was higher than that in control group ( P=0.018), the incidence of CRL discordance ≥10% in the cardiac malformation group was higher than that in the control group (26.67% vs 12.70%, P=0.024), the AUC of cardiac malformation screening was 0.570; there were no significant differences in the incidence of NT discordance, the incidence of NT discordance ≥20%, pregnancy pattern and chorionicity between the two groups (all P>0.05). ③Multivariate Logistic regression analysis was performed using the incidence rates of NT value ≥95% and NT value ≥99%, CRL discordance ≥10%, and NT discordance ≥20%. The incidences of fetal NT value ≥95% and NT value ≥99% were risk factors for cardiac malformation in twins ( OR=11.095, 105.778; 95% CI=4.311-28.558, 16.984-658.796). Conclusions:Ultrasound at 11-13 + 6 weeks of gestation showing thickened value of one or two fetuses, and the CRL discordance≥10%, indicates an increased risk of cardiac malformation in the twins; NT value ≥95% and NT value ≥99% is a risk factor for heart defects in twins.
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Background Preterm birth-related complications are the leading cause of death in newborns and children under the age of 5 years. Maternal heat exposure has been associated with both sleep status during pregnancy and the increased risk of preterm birth. However, whether sleep status could mediate the association between heat exposure and preterm birth remains unclear. Objective To evaluate the association between maternal heat exposure in early pregnancy and preterm birth, and to further explore potential mediation effect of sleep status on the association between heat exposure and preterm birth. Methods A birth cohort was established in Guangzhou Panyu Maternal Child Health Hospital (Guangzhou Panyu District He Xian Memorial Hospital) from 2017 until now. Pregnant women (with gestational age between 8 and 13 weeks) were included in this study when they presented to the hospital for their first prenatal care visit and signed an informed consent. Then they were followed up until delivery. A total of 3 268 pregnant women were included for the final analysis. Questionnaires were distributed to collect the demographic characteristics, lifestyles, and sleep status of pregnant women. Daily meteorological data during the study period were collected from meteorological monitoring stations in Guangzhou and the average ambient mean temperature of four weeks before the survey was calculated and assigned for each pregnancy. The 75th, 80th, 85th, 90th, and 95th percentiles (P75, P80, P85, P90, and P95) of the average ambient temperature of all pregnant women were used as the thresholds to define heat exposure. Logistic regression was used to evaluate the effects of heat exposure in different definitions on preterm birth and sleep status (sleep duration, night sleep timing, and wake up timing). The mediation effects of sleep status on the relationship between heat exposure and preterm birth were also analyzed. Results Among all the included participants, 165 newborns were preterm births with an incidence rate of 5.0%. Heat exposures with thresholds of P90 and P95 increased the risk of preterm birth, with ORs (95%CIs) of 1.66 (1.04-2.57) and 1.90 (1.03-3.33), respectively (P<0.05). Heat exposures with thresholds of P75, P80, P85, P90, and P95 decreased the sleep duration (<9 h vs. ≥9 h, control group: ≥9 h), and the ORs (95%CIs) were 1.51 (1.25-1.83), 1.44 (1.17-1.77), 1.35 (1.08-1.70), 1.43 (1.09-1.87), and 1.45 (1.00-2.13), respectively. Heat exposures with P75 and P80 thresholds resulted in earlier wake up timing (<8: 00 vs. ≥8: 00, control group: <8: 00), with ORs (95%CIs) of 0.77 (0.63-0.93) and 0.76(0.61-0.93), respectively. No significant association was observed between heat exposure and night sleep timing. The mediation analyses showed that under heat exposure with P90 threshold, a statistically significant mediation effect was observed for sleep duration, and the proportion mediated was 6.07% (95%CI: 0.17%-25.00%) (P<0.05). No significant mediation effect was observed for night sleep timing and wake up timing. Conclusion An elevated risk of preterm birth after heat exposure in early pregnancy may be partly mediated through reducing sleep duration.
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Objective:To investigate the correlation between preeclampsia and thyroid dysfunction in pregnancy.Methods:107 early pregnant women with preeclampsia admitted to our hospital from Jan. 2017 to Jan. 2020 were all enrolled (observation group) . The observation group were in 6-34 gestational weeks, with an average parity of (1.67±0.35) times. In addition, 100 cases of normal pregnant women in the same period were selected as the control group. The control group were in 6-34 gestational weeks, with an average parity of (1.61±0.31) times. The two groups were compared at early, mid and late pregnancy in terms of thyroid function, and the correlation of preeclampsia and abnormal thyroid function was analyzed.Results:1. TSH levels in the observation group were (1.92±1.24) , (2.07±0.82) , and (2.30±1.23) mU/L in the first trimester, second trimester and third trimester, respectively, showing an upward trend. The difference between the two groups was statistically significant ( P=0.024) . FT4 levels of the observation group in the first trimester, second trimester and third trimester were (0.80±0.26) , (0.60±0.34) and (0.59±0.32) pmol/L, respectively, showing a decreased trend and the difference was statistically significant compared with those of the control group ( P=0.012) . 2. The incidence of hypothyroidism, TPOAb positive and reduced free tetraiodothyronine in the observation group was significantly higher than that in the control group ( P=0.001, 0.023, 0.005) . There was no significant difference in the incidence of hyperthyroidism or subclinical hypothyroidism between the two groups ( P=0.169, 0.846) . 3. Correlation analysis showed that preeclampsia was related to hypothyroidism, normal thyroid function with TPOAb positive and reduced free tetraiodothyronine ( P=0.000, 0.000, 0.000) . Conclusions:There are changes in thyroid function in pregnant women with preeclampsia. Hypothyroidism, positive TPOAb and reduced free tetraiodothyronine are closely related to the onset of preeclampsia.
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Objective To investigate the iodine nutritional status and thyroid function of women in early pregnancy after the implementation of a new standard of iodized salt in Chengde. Methods A total of 136 early pregnancy women who had lived in Chengde were randomly selected in this study from January 2018 to March 2020. A questionnaire survey was conducted. The iodized salt, urine and blood samples of the pregnant women were collected to analyze the salt iodine concentration, serum iodine, urinary iodine, serum thyroid stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4). Results In 2018 and 2019, the iodized salt coverage rates were 96.97% and 98.57%, the non-iodized salt rates were 3.03% and 1.43%, the iodized salt qualification rates were 95.45% and 97.14%, and the qualified iodized salt consumption rates were 93.94% and 92.86%, respectively. In addition, the median of iodized salt consumption was 22.20 mg/kg and 25.51 mg/kg, in 2018 and 2019, respectively. There was a statistically significant difference in the median urine iodine from 2018 to 2019 among women in early pregnancy (P0.05). Conclusion After the implementation of a new standard of iodized salt in Chengde, the iodine nutritional status of early pregnant women in 2019 was significantly improved, but there was still a small amount of insufficient iodine intake. The incidence of thyroid diseases in early pregnant women with abnormal iodine intake was higher than that in early pregnant women with appropriate iodine intake.
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Objective:This study examined the associations between the levels of bile acids in early pregnancy and the occurrence of overweight.Methods:From 2010 to 2012, 22 302 pregnant women were recruited by Tianjin Women and Children′s Health Center to investigate gestational diabetes. Two hundred and forty-three women with gestational diabetes mellitus provided overnight fasting blood samples in the first trimester, and 243 counterparts without gestational diabetes mellitus matched on age were selected randomly to establish a nested case-control study. The association between bile acids and overweight were evaluated by binary logistic regression with data from 166 overweight pregnant women (body mass index≥24.0 kg/m 2) and 320 normal weight subjects (body mass index <24.0 kg/m 2). Results:Compared to non-overweight group, the level of primary unconjugated bile acids in overweight group was significantly higher. After adjustment of confounding factors, the OR of cholic acid (CA)>0.086 nmol/mL for overweight was 2.09 (95% CI 1.14-3.80, adjusted P=0.040), and OR of chenodeoxycholic acid (CDCA)>0.043 nmol/mL was 2.15 (95% CI 1.22-3.78, adjusted P=0.040) compared with the lower groups. However, the significant associations between the other bile acids and overweight were not detected. Stepwise selection was used to identify significant bile acid species in logistic regression. We found that only CA was independently associated with overweight, and the OR of CA>0.086 nmol/mL vs≤0.086 nmol/mL was 2.03 (95% CI 1.11-3.74, P=0.022). Conclusion:CA and CDCA in early pregnancy maybe associated with overweight, and CA might be independently associated with overweight.
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Background: Expectant management as first line management of early pregnancy miscarriages is less accepted due to failure and increased complications reported in few studies. Proper selection of cases improves outcome of expectant management. Aim of this study was to compare success rate and complications in expectant management in three groups of early pregnancy miscarriages- Incomplete miscarriage, anembryonic pregnancy and early fetal demise.Methods: Prospective observational study conducted in tertiary care centre for 3 years, including 107 patients with USG confirmed pregnancy miscarriage <13 weeks. Patients preferring expectant management were managed as outpatient without intervention for 2 weeks after which repeat USG was done to ascertain complete miscarriage. Failed expectant management patients underwent planned surgical uterine evacuation. Emergency admission and evacuation was done, if symptomatic during waiting period. Success rate and complications like emergency evacuation, vaginal bleeding, abdominal pain, limitation of physical activity and patient satisfaction were assessed and compared in subgroups of anembryonic pregnancy, early fetal demise and incomplete miscarriage. Statistical analysis was done by chi-square test.Results: Incomplete miscarriage group had highest success rate of 88.46%. followed by anembryonic pregnancy (72.5%) and EFD (47.83%) p value = 0.007. Complication rate was highest in EFD, followed by anembryonic and the least in incomplete miscarriage all of which was statistically significant except vaginal bleeding.Conclusions: Expectant management should be offered as first line choice for all types of early pregnancy miscarriages. Proper selection of case as to type of miscarriage especially incomplete miscarriage and selected cases of anembryonic pregnancy and EFD ensures higher success rate with lesser complications. Reserving medical and surgical management for unsuitable/failed cases.
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OBJETIVO: Descrever o perfil clínico e epidemiológico da gestação na adolescência buscando possíveis diferenças em relação à gestação em mulheres adultas. MÉTODOS: Estudo ecológico a partir de dados secundários (DATA-SUS). Foram estudadas três grupos de variáveis: as relacionadas à mãe, as relacionadas ao parto e as relacionadas ao RN. A análise dos dados foi realizada pelo Teste Qui-quadrado de independência, considerando-se significante P ≤ 0,05. Foram utilizadas planilhas do Microsoft Excel, versão 2013, software Epi Info v.7, para a obtenção do Odds Ratio (OR), com intervalo de confiança (IC) de 95%. RESULTADOS: Foram avaliadas 48.277 gestações, sendo 4.453 (9,22%) em adolescentes com idade média de 16,92 anos (+1,16), e 43.824 (90,78%) em mulheres adultas com idade média de 27,89 anos (+ 5,77). As mães adolescentes eram solteiras (54,61%) e brancas (98,02%) em sua maioria e apresentaram gestação única (98,92%). A prematuridade ocorreu em 10,21%, 61,5% dos partos foram vaginais, com 99,73% ocorridos em ambiente hospitalar. Com relação ao recém-nascido, 51,99% eram do sexo masculino e o baixo peso ao nascer foi de 9,57%. Apgar < 7 no 1º minuto foi de 16,63%, e no 5º minuto, 2,14%. A presença de anomalias congênitas em filhos de mães adolescentes foi de 1,15%. CONCLUSÃO: A gravidez na adolescência se associou com menor número de consultas de pré-natal, maiores taxas de prematuridade e baixo peso, com maior ocorrência de parto vaginal e de anomalias congênitas no RN.
OBJECTIVE: To describe the clinical and epidemiological profile of pregnancy in adolescence, searching possible differences in relation to pregnancy in adult women. METHODS: Ecological study based on secondary data (DATA-SUS). Three groups of variables were studied: those related to the mother, those related to childbirth and those related to the newborn. The data analysis was performed by the Qui-square test of independence, being considered significant P ≤ 0.05. Microsoft Excel spreadsheets, version 2013, Epi Info v.7 software were used to obtain the Odds Ratio (OR), with a 95% confidence interval (CI). RESULTS: A total of 48,277 pregnancies were evaluated, of which 4,453 (9.22%) were adolescents aged 16.92 +1.16 years, and 43,824 (90.78%) in adult women aged of 27.89 years +5.77. Adolescent mothers were single (54.61%) and white (98.02%) in the majority, and presented single gestation (98.92%). Prematurity occurred in 10.21%, and 61.5% of deliveries were vaginal. With regard to the newborn, 51.99% were male and the low birth weight occurred in 9.57%. Apgar <7 in the 1st and 5th minute was present in 16.63% and 2.14% respectively. The presence of congenital anomalies in children of adolescent mothers was 1.15%. CONCLUSION: Adolescent pregnancy was associated with: a lower number of prenatal appointments, higher rates of prematurity and low birth weight, higher incidence of vaginal delivery and congenital anomalies