Healthcare professional perspectives on improving inter-pregnancy care after a baby loss for women with type 1 and type 2 diabetes.

AIMS: Women with diabetes (WWD) (type 1 and type 2) are around four times more likely to experience baby loss: miscarriage, stillbirth, neonatal death or termination of pregnancy for medical reasons. Many WWD become pregnant again soon after loss. This study aimed to explore healthcare professional perspectives on improving inter-pregnancy care for WWD after baby loss, as they play a crucial role in facilitating access to support for WWD to prepare for subsequent pregnancy. METHODS: Eighteen healthcare professionals recruited through social media and professional networks between November 2020 and July 2021 participated in a semi-structured remote interview. Data were analysed using thematic analysis. RESULTS: Three main themes were identified: (1) supporting WWD who want to become pregnant again after baby loss; (2) recognising multiple hidden burdens in the inter-pregnancy interval after loss; (3) discontinuities and constraints in inter-pregnancy care. Most participants tended to assume WWD wanted time and space before thinking about pregnancy after loss, so they did not routinely broach the subject. Participants reported receiving little or no training on managing sensitive conversations. Care provision varied across providers, and unclear referral pathways were challenging to navigate. Participants reported concerns that not all healthcare professionals knew how to mitigate pregnancy risks. CONCLUSIONS: It is unclear who is responsible for supporting WWDs preconception health between baby loss and subsequent pregnancy. Healthcare professionals may be reticent to initiate conversations about pregnancy for fear of causing upset or distress. Future research is required to scope out ways to raise awareness among healthcare professionals and practical tips on sensitively raising the topic of subsequent pregnancy.

Gestational diabetes mellitus in Cameroon: prevalence, risk factors and screening strategies.

Background: The burden of gestational diabetes (GDM) and the optimal screening strategies in African populations are yet to be determined. We assessed the prevalence of GDM and the performance of various screening tests in a Cameroonian population. Methods: We carried out a cross-sectional study involving the screening of 983 women at 24-28 weeks of pregnancy for GDM using serial tests, including fasting plasma (FPG), random blood glucose (RBG), a 1-hour 50g glucose challenge test (GCT), and standard 2-hour oral glucose tolerance test (OGTT). GDM was defined using the World Health Organization (WHO 1999), International Association of Diabetes and Pregnancy Special Group (IADPSG 2010), and National Institute for Health Care Excellence (NICE 2015) criteria. GDM correlates were assessed using logistic regressions, and c-statistics were used to assess the performance of screening strategies. Findings: GDM prevalence was 5·9%, 17·7%, and 11·0% using WHO, IADPSG, and NICE criteria, respectively. Previous stillbirth [odds ratio: 3·14, 95%CI: 1·27-7·76)] was the main correlate of GDM. The optimal cut-points to diagnose WHO-defined GDM were 5·9 mmol/L for RPG (c-statistic 0·62) and 7·1 mmol/L for 1-hour 50g GCT (c-statistic 0·76). The same cut-off value for RPG was applicable for IADPSG-diagnosed GDM while the threshold was 6·5 mmol/L (c-statistic 0·61) for NICE-diagnosed GDM. The optimal cut-off of 1-hour 50g GCT was similar for IADPSG and NICE-diagnosed GDM. WHO-defined GDM was always confirmed by another diagnosis strategy while IADPSG and GCT independently identified at least 66·9 and 41·0% of the cases. Interpretation: GDM is common among Cameroonian women. Effective detection of GDM in under-resourced settings may require simpler algorithms including the initial use of FPG, which could substantially increase screening yield.

Characteristics relevant to cardiovascular disease among adults of African and Indian origin in Guyana

Characteristics relevant to cardiovascular disease, including anthropometry, arterial blood pressure, serum cholesterol levels, chest radiography and electrocardiography, were investigated in a survey of 843 men and women aged 35-54 years of African and Indian origin living in 2 communities in Guyana. Clinical experience suggested a high incidence of hypertension and a low incidence od ischaemic heart disease. Africans were taller and heavier than Indians but their other characteristics were, in general, similar except that their mean blood pressure levels and R amplitudes in certain ECG leads were consistently higher. Hypertension was common and was more significantly correlated with obesity and , probably independently, with body size. Serum cholesterol levels, with mean values of about 222mg/100ml, were strongly correlated with factors associated with obesity in men but not women. Cardiothoracic ratios, measured from chest films, were greater than values regarded as normal for Europeans because of a relative narrowness of thoracic diameters. Prevalence of S-T-segment and T-wave defects in ECGs classified by the Minnesota Code was as high as reported from communities where ischaemic heart disease is clinically more frequent. Hypertension, cardiac enlargement, obesity and cholesteraemia were more prevalent when defects involved lateral leads(I, aVL, V5 and V6) than in subjects with normal ECGs, suggesting that the majority of important abnormalities occurred primarily in the left ventricle and were probably related to hypertension rather than to coronary insufficiency without hypertension. Analysis od S-T and T-wave defects, both of blood pressure and by lead position, might show meaningful differences between populations which, by present methods of presentation, appear to have surprisingly similar prevalences of ECG abnormalities.(AU)

Congenital malformations in Jamaica. An analysis of the perinatal population of the University Hospital of the West Indies

The perinatal population of the University Hospital of the West Indies, Jamaica, has been examined in order to establish the incidence of congenital malformations in general and the distribution of individual malformations. Our figures suggest that the general incidence is somewhere between that seen in developed countries and in the underdeveloped countries. The incidence of anencephaly is low and the incidence of congenital heart disease is high. There is a higher incidence of malformation in mothers under 15 years. (AU)

Anthropometric measurements of Guyanese adults of African and East Indian racial origins

Anthropometric measurements were made of Guyanese men and women aged 35-54 years of African and East Indian origin living in adjacent communities. Africans were taller with greater shoulder widths and slightly smaller hip widths than East Indians. Africans men had larger upper arm circumferences and smaller triceps skinfolds than East Indians, an indication of greater muscular development. The relative leg length and ratio of the lateral to the antero-posterior diameters of the thorax were similar in the two races. The difference in size was less between male and female Africans than between male and female East Indians. Obesity was common in women of both ethnic groups, a feature which often occurs in emerging countries and which may lead to an increase in the incidence of conditions such as hypertension and diabetes. (AU)

Congenital malformations in Jamaica: an analysis of the perinatal population of the University Hospital of the West Indies

The perinatal population of the University Hospital of the West Indies, Jamaica, has been examined in order to establishthe incidence of congenital malformations in general and the distribution of individual malformations. Our figures suggest that the general incidence is somewhere between that seen in developed countries and in underdeveloped countries. The incidence of anencephaly is low and the incidence of congenital heart disease is high. There is a higher incidence of malformation in mothers under 15 years.(AU)

XYY Sex chromosomes in a Jamaican with orthopaedic abnormalities

A male Jamaican patient is described with a bilateral deformities of the knee, mental retardation, and hypogonadism. He was found to have retarded bone age, varicose ulceration, a height of 227 cm (89 1/2in.) and a XYY sex chromosome constitution. The relation of these features to the presence of 2 Y chromosomes is discussed, and a paternal age effect is suggested in the origin of the condition. (Summary)

Calorie requirements of children recovering from protein-calorie malnutrition

Weight gains in forty-seven malnourished infants have been studied in relation to the type of diet given during the recovery phase. Twenty-three (group P) were given substantially more calories than the rest (group O). Group P gained weight at a significantly greater rate (10.6 as against 7.65 g. per kg. per day). The response was particularly striking in marasmic infants, who grew more rapidly than those admitted to hospital with kwashiorkor. The rapid weight gains were achieved with relatively modest protein intakes (about 4 g. per kg. per day). This finding will be important in countries where malnutrition is a serious problem and where it is easier to provide calories than protein. (Summary)

Growth of Guyanese infants of African and East Indian racial origins, with some observations on mortality

Mean heights at various intervals over the first 2 years of life were calculated for Guyanese infants of East Indian ethnic groups who were born in 1964 and attended 14 clinics in rural areas. Compared with East Indians, African infants grew faster and weighed more at all ages, although their mortality experience was greater. It is suggested that Africans have a greater potential size than East Indians as a result of inherited factors. Compared with results from developing countries, weight increments in both ethnic groups were small from the 4th to 15th months, a time when mortality was relatively high. This growth pattern is found in many developing countries and reflects weaning difficulties. Profound changes in population, mortality rates and birth rates occurring in Guyana over the past century are summerised. (Summary)

An investigation of clustering of cases of leukaemia in Jamaican children

The cause of leukaemia is not yet known. Recently attention has been drawn to its epidemiological aspects and in particular to clustering of cases, i.e. association of cases in regard to time of occurrence and locality. If this phenomenon can be demonstrated, it suggests an environmental factor, virus infection being one possibility. The present study is an attempt to apply mathematical methods of analysis to 58 cases of childhood leukaemia presenting in Kingston, Jamaica, from January 1, 1958, to December 31, 1966. Of these 58 cases, 37 were domicile in the parish of Kingston and St. Andrew and 21 were from the rest of Jamaica. Owing to geographical factors it is felt that whereas the case finding rate for the Kingston and St. Andrew cases is high, the number of cases from the Jamaican countryside which are included in this series can represent only a fraction of the expected total. The sex incidence in the series was 30 boys to 28 girls. There were 35 cases of acute lymphatic leukaemia, 8 acute stem cell, 10 acute myeloid, 4 chronic myeloid and one case of erythro-leukaemia. The peak age incidence was in the fifth year. Acute lymphatic leukaemia was mostly found in those under six years, acute myloid in the over sixes and in the under twos. The incidence of recorded cases of leukaemia has risen over the period studied. In 1964 there was a distict peak of 15 cases (an epidemic year). Some degree of seasonal incidence was shown in a reduction in cases in the last three months of the year, the six months April to September having 37 cases as against 21 for the other half year. Finally the incidence of pairing in Kingston cases was - Leukemia pairs - distance 1 Km, 1 Km, 2 Km, time 1 year, 6 months, 6 months, respectively, expected pairs 12.6, 6.5, 17.9 respectively, observed pairs 16, 7, 22, respectively. The degree of clustering is consistently greater than that calculated on a chance basis. However the increase of observed pairs over expected pairs does not achieve statistical significance. A larger series might be needed to demonstrate clustering in a conclusive fashion (AU)