Gestational weight gain and pregnancy outcomes in Chinese women with type 2 diabetes mellitus: evidence from a tertiary hospital in Beijing.

Objective: To examine the effects of gestational weight gain on pregnancy outcomes and determine the optimal range of weight gain during pregnancy for Chinese women with type 2 diabetes mellitus. Methods: This retrospective cohort study included 691 Chinese women with type 2 diabetes mellitus from 2012 to 2020. The study utilized a statistical-based approach to determine the optimal range of gestational weight gain. Additionally, multivariate logistic regression analysis was conducted to assess the impact of gestational weight gain on pregnancy outcomes. Results: (1) In the obese subgroup, gestational weight gain below the recommendations was associated with decreased risks of large for gestational age (adjusted odds ratio [aOR] 0.19; 95% confidence interval [CI] 0.06-0.60) and macrosomia (aOR 0.18; 95% CI 0.05-0.69). In the normal weight subgroup, gestational weight gain below the recommendations of the Institute of Medicine was associated with decreased risks of preeclampsia (aOR 0.18; 95% CI 0.04-0.82) and neonatal hypoglycemia (aOR 0.38; 95% CI 0.15-0.97). (2) In the normal weight subgroup, gestational weight gain above the recommendations of the Institute of Medicine was associated with an increased risk of large for gestational age (aOR 4.56; 95% CI 1.54-13.46). In the obese subgroup, gestational weight gain above the recommendations was associated with an increased risk of preeclampsia (aOR 2.74; 95% CI 1.02, 7.38). (3) The optimal ranges of gestational weight gain, based on our study, were 9-16 kg for underweight women, 9.5-14 kg for normal weight women, 6.5-12 kg for overweight women, and 3-10 kg for obese women. (4) Using the optimal range of gestational weight gain identified in our study seemed to provide better prediction of adverse pregnancy outcomes. Conclusion: For Chinese women with type 2 diabetes, inappropriate gestational weight gain is associated with adverse pregnancy outcomes, and the optimal range of gestational weight gain may differ from the Institute of Medicine recommendations.

Association of acetaminophen use with perinatal outcomes among pregnant women: a retrospective cohort study with propensity score matching.

BACKGROUND: Although acetaminophen is widely used in women during pregnancy, its safety has not been clearly stated. The study aimed to investigate the association between acetaminophen use and adverse pregnancy outcomes in pregnant women in China. METHODS: We conducted a retrospective cohort study by collecting data on pregnant women who delivered in the Beijing Obstetrics and Gynecology Hospital from January 2018 to September 2023. An acetaminophen use group and a control group were formed based on prenatal exposure to acetaminophen. The pregnancy outcomes that we focused on were stillbirth, miscarriage, preterm birth, APGAR score, birth weight, and congenital disabilities. Pregnant women exposed to acetaminophen were matched to unexposed in a 1:1 ratio with propensity score matching, using the greedy matching macro. SPSS software was used for statistical analysis. Multivariable logistics regression was used to assess the association between acetaminophen use during pregnancy and adverse pregnancy outcomes. RESULTS: A total of 41,440 pregnant women were included, of whom 501 were exposed to acetaminophen during pregnancy, and 40,939 were not exposed. After the propensity score matching, the acetaminophen use and control groups consisted of 501 pregnant women each. The primary analysis showed that acetaminophen exposure during pregnancy was associated with an increased risk of stillbirth (adjusted OR (aOR) = 2.29, 95% CI, 1.19-4.43), APGAR score < 7 at 1 min (aOR = 3.28, 95% CI, 1.73-6.21), APGAR score < 7 at 5 min (aOR = 3.54, 95% CI, 1.74-7.20), APGAR score < 7 at 10 min (aOR = 3.18, 95% CI, 1.58-6.41), and high birth weight (HBW) (aOR = 1.75, 95% CI, 1.05-2.92). Drug exposure during the first and second trimesters increased the odds of stillbirth, miscarriage, APGAR < 7, and the occurrence of at least one adverse pregnancy outcome. In addition, the frequency of drug use more than two times was associated with a higher risk of preterm birth and APGAR score < 7. CONCLUSIONS: Exposure to acetaminophen during pregnancy was significantly associated with the occurrence of adverse pregnancy outcomes, particularly exposure in the first and second trimesters and frequency of use more than twice. It is suggested that acetaminophen should be prescribed with caution in pregnant women.

Social Determinants Among Pregnant Clients With Perinatal Depression, Anxiety, Or Serious Mental Illness.

To characterize co-occurring social determinants of health for clients experiencing perinatal anxiety and depression (perinatal mood and anxiety disorders) or serious mental illness (SMI) in a diverse population receiving prenatal care in a safety-net health system, we conducted a latent class analysis, using data from a social determinants screener in pregnancy for the health system's clients during 2017-20. The sample included clients with positive screens for depression or anxiety or SMI diagnoses. Prenatal clients with a positive screen for perinatal mood and anxiety disorders or SMI comprised 13-30 percent of classes, characterized by more than two co-occurring social determinants (for example, co-occurring socioeconomic and interpersonal factors). The study findings highlight the salience of social determinants among prenatal patients experiencing perinatal mood and anxiety disorder and SMI and suggest the necessity of consistent screening for both social determinants and perinatal mental health. Policies to address social determinants within and beyond health care settings are critical.

The Impact of Environmental and Occupational Noise on Maternal and Perinatal Pregnancy Outcomes.

Importance: Pregnant women are exposed to both occupational and environmental noise during their pregnancy. The association between noise and adverse health outcomes is well known. Less is known about the relationship between noise and its effects on the embryo/fetus and pregnancy. Objectives: The purpose of the study is to review what is known about the effect(s) of environment and occupational noise during pregnancy on maternal and perinatal outcomes. Evidence Acquisition: Electronic databases (PubMed, CINAHL, and Embase) were searched from 1995-2023 with the only limitation being that the articles were in English. Studies were selected that examined associations between environmental and occupational noise and pregnancy outcome, maternal outcome, or perinatal outcome. Results: There were 233 articles identified. After reviewing all abstracts and selected full texts, 25 publications were used as the basis of this review. Multiple studies have been undertaken evaluating the effects of noise on embryonal/fetal growth, fetal development, maternal hypertension, gestational diabetes, and maternal anxiety and depression. The overall effects of occupational and environmental exposure on both fetal and maternal outcomes remain uncertain. Conclusions: Further high-quality studies are needed to determine the association between noise and pregnancy outcomes. Relevance: Even though this review suggests a relationship between noise and maternal/fetal outcomes, confirmation will require well designed future studies.

Analysis of the correlation between general postpartum well-being and depression in primiparas: A cross-sectional study.

To investigate the status quo and influencing factors of general postpartum well-being in primiparas, analyze its correlation with postpartum depression, and provide a theoretical foundation for enhancing the postpartum well-being of primiparas. From the start of November 2021 to the end of December 2021, the General Information Questionnaire, General Well-Being Scale, and the Edinburgh Postpartum Depression Scale were used to survey primiparas in a tertiary hospital, and the correlation between general well-being and postpartum depression was analyzed. We surveyed a total of 225 primiparas. The average score for general well-being in primiparas was 77.84 ±â€…6.83, and the total score for postpartum depression was 9.11 ±â€…2.51. Confinement location, planned pregnancy, pregnancy complications, neonatal sex, medical expenses, etc, had statistically significant effects on the general well-being scores (P < .05), whereas per capita monthly income, pregnancy complications, maternal and infant care skills, and medical expenses had statistically significant effects on postpartum depression scores (P < .05). Postpartum depression scores were negatively correlated with general well-being, health anxiety, energy, sad or happy mood, relaxation, and tension. There is a negative correlation between the general well-being of primiparas and postpartum depression, suggesting that in clinical care, the focus should be on primiparas with pregnancy complications, and psychological counseling should be provided in advance to prevent postpartum depression and the resulting decrease in well-being.

Factors associated with antenatal depression among women attending antenatal care at Mubende Regional Referral Hospital: a cross-sectional study.

INTRODUCTION: This study aimed to investigate the prevalence, severity, and factors associated with antenatal depression among women receiving antenatal care at Mubende Regional Referral Hospital (MRRH) in Uganda. Antenatal depression is a critical concern for maternal and child well-being, as it is associated with adverse outcomes such as preterm birth, abortion, low birth weight, and impaired maternal-infant bonding. Despite several international guidelines recommending routine screening for antenatal depression, local Ugandan guidelines often overlook this essential aspect of maternal care. METHODS: A cross-sectional study involving 353 pregnant women utilized the Patient Health Questionnaire 9 (PHQ-9) to assess antenatal depression. Participants were categorized as having antenatal depression if their total PHQ-9 score was ≥ 5 and met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for either major or minor depression. Psychosocial demographic and obstetric characteristics were recorded. Logistic regression analysis identified factors linked to antenatal depression. RESULTS: The burden of antenatal depression was notably high, affecting 37.68% of the participants. Among those with antenatal depression, the majority exhibited mild symptoms 94 (70.68%). The significant factors associated with antenatal depression, revealed by multivariate analysis, included younger age (≤ 20 years), older age (≥ 35 years), history of domestic violence, alcohol use, gestational age, history of abortion, history of preeclampsia, and unplanned pregnancies. CONCLUSION: This study revealed a significantly high prevalence of antenatal depression, emphasizing its public health importance. Most cases were classified as mild, emphasizing the importance of timely interventions to prevent escalation. The identified risk factors included age, history of domestic violence, alcohol use, first-trimester pregnancy, abortion history, previous preeclampsia, and unplanned pregnancy.

Prevalence of Maternal Fever and Associated Factors among Postnatal Women at Kawempe National Referral Hospital, Uganda: A Preliminary Study.

Fever is one of the most important signs of infection and can provide useful information for further assessment, diagnosis, and management. Early detection of postnatal fever could reduce severe outcomes, such as maternal mortality due to puerperal sepsis. The purpose of this cross-sectional study was to determine the prevalence of and associated factors of postnatal fever among postnatal women at Kawempe National Referral Hospital. Three hundred postnatal women were recruited. Temperature measurements were conducted and a 29-item questionnaire was completed along with the extraction of health history from the medical records of the participants. The prevalence of maternal fever was 58/300 (19.3%). Multivariable analysis indicated that only four factors-HIV-positive status (AOR = 2.56; 95% CI = 1.02-6.37), labor complications (AOR = 6.53; 95% CI = 2.40-17.71), prolonged labor (AOR = 3.12; 95% CI = 1.11-8.87), and more than 24 h spent in postnatal care (AOR = 5.16; 95% CI = 2.19-12.16)-were found to be significantly associated with postnatal fever. The prevalence of postnatal maternal fever among postnatal women at Kawempe National Referral Hospital was higher than that in other reports in the literature. The factors significantly associated with maternal fever were HIV-positive status, complications during labor, prolonged labor, and more than 24 h spent in postnatal care. Health workers involved in the provision of labor and obstetric services must follow guidelines to assess fever and manage the underlying conditions causing it.

Incidence of Adverse Perinatal Outcomes among Women Exposed to Maternal Near-Misses in Arsi Zone in Ethiopia: Prospective Cohort Study in 2022.

Background: Exposure to maternal near-misses has a massive effect on adverse perinatal outcomes. Hence, investigating the effect of maternal near-misses on perinatal outcomes can aid in the reduction of perinatal morbidity and mortality. The study is aimed at assessing the incidence of adverse perinatal outcomes among women exposed to maternal near-misses at Arsi Zone public hospitals in Ethiopia in 2022. Method: The study included a prospective cohort of 335 women at Arsi Zone public hospitals from December 2021 to June 2022. Women who were admitted for management of pregnancy were followed. The exposed group was women with maternal near-misses screened based on disease-validated criteria. The nonexposed group was made up of women who delivered without complications. Trained data collectors used pretested, structured questionnaires to collect data from women. Pertinent data was also extracted from the clients' logbooks. Data was transferred from EpiData version 3.1 to SPSS version 25 for analysis, logistic regression was computed, and 95% confidence intervals were declared at a p value of 5% significance level. Result: The incidence of adverse perinatal outcomes was higher in the exposed women than in the nonexposed women (56% versus 16%). Contrasted with the nonexposed, women exposed to maternal near-misses had a higher incidence of stillbirth (22% vs. 0.5%), low birth weight (13% vs. 3%), and preterm birth (12% vs. 2%). After adjusting for confounders, exposed women had a twofold increased risk of adverse perinatal outcomes compared to nonexposed women. Delivery mode, delay in seeking care, transport mode, and delay in receiving treatment were the risk factors for negative pregnancy outcomes. Conclusion: In exposed women, a higher incidence of adverse perinatal outcomes was linked to aforementioned risk factors. Evidence-based practice intended to decrease delays in providing maternal care services does indeed improve perinatal outcomes.

Trajectories tracking of maternal and neonatal health in eastern China from 2010 to 2021: A multicentre cross-sectional study.

Background: China's fertility policy has dramatically changed in the past decade with the successive promulgation of the partial two-child policy, universal two-child policy and three-child policy. The trajectories of maternal and neonatal health accompanied the changes in fertility policy are unknown. Methods: We obtained data of 280 203 deliveries with six common pregnancy complications and thirteen perinatal outcomes between 2010 and 2021 in eastern China. The average annual percent change (AAPC) was calculated to evaluated the temporal trajectories of obstetric characteristics and adverse outcomes during this period. Then, the autoregressive integrated moving average (ARIMA) models were constructed to project future trend of obstetric characteristics and outcomes until 2027. Results: The proportion of advanced maternal age (AMA), assisted reproduction technology (ART) treatment, gestational diabetes mellitus (GDM), anaemia, thrombocytopenia, thyroid dysfunction, oligohydramnios, placental abruption, small for gestational age (SGA) infants, and congenital malformation significantly increased from 2010 to 2021. However, the placenta previa, large for gestational age (LGA) infants and stillbirth significantly decreased during the same period. The AMA and ART treatment were identified as independent risk factors for the uptrends of pregnancy complications and adverse perinatal outcomes. The overall caesarean section rate remained above 40%. Importantly, among multiparas, a previous caesarean section was found to be associated with a significantly reduced risk of hypertensive disorders of pregnancy (HDP), premature rupture of membranes (PROM), placenta previa, placental abruption, perinatal asphyxia, LGA infants, stillbirths, and preterm births. In addition, the ARIMA time series models predicted increasing trends in the ART treatment, GDM, anaemia, thrombocytopenia, postpartum haemorrhage, congenital malformation, and caesarean section until 2027. Conversely, a decreasing trend was predicted for HDP, PROM, and placental abruption premature, LGA infants, SGA infants, perinatal asphyxia, and stillbirth. Conclusions: Maternal and neonatal adverse outcomes became more prevalent from 2010 to 2021 in China. Maternal age and ART treatment were independent risk factors for adverse obstetric outcomes. The findings offered comprehensive trajectories for monitoring pregnancy complications and perinatal outcomes in China, and provided robust intervention targets in obstetric safety. The development of early prediction models and the implementation of prevention efforts for adverse obstetric events are necessary to enhance obstetric safety.

Congenital Anomalies in Multiple Pregnancy: A Literature Review.

Importance: Multiple pregnancy is relatively common in many countries and is associated with various pregnancy complications, including preterm birth, low birth weight, and congenital anomalies. In particular, a poorer prognosis has been reported when congenital anomalies overlap with other pregnancy complications in multiple pregnancy compared with singleton pregnancy. Objective: This study reviews the characteristics of congenital anomalies that occur in multiple gestations as compared with singleton pregnancies. Evidence Acquisition: An extensive manual search of major electronic databases was conducted in June 2023. This literature review provides a comprehensive coverage of the congenital anomalies in multiple pregnancy. Results: Most studies have shown that multiple gestations are associated with an increased risk of congenital anomalies compared with singleton pregnancies. In addition, higher rates of congenital anomalies and concordance have been observed in monozygotic versus dizygotic twins. The effect of assisted reproductive therapies on the risk of congenital anomalies appears to be smaller in multiple gestations than in singleton pregnancies. Conclusions: Multiple pregnancy is significantly associated with an increased risk of congenital anomalies. Relevance: This review provides obstetrical providers with the requisite knowledge to offer appropriate antenatal care and prenatal anomaly screening to patients with multiple pregnancies.

Optimal gestational weight gain in Taiwan: A retrospective cohort study.

OBJECTIVE: Maternal body mass index (BMI) and gestational weight gain (GWG) are believed to be associated with fetal conditions and maternal complications. The aim of this study was investigating the influence of maternal prepregnancy BMI and GWG on pregnancy outcomes and exploring the optimal GWG in Taiwanese singleton women. MATERIALS AND METHODS: Retrospective records of 8146 singleton pregnant women between 2017 and 2019, obtained from a tertiary center in Taiwan were reviewed, and the associations between maternal prepregnancy BMI, GWG, and perinatal outcomes were analyzed. The patients were divided into five groups based on prepregnancy BMIs, defined by Taiwan Health Promotion Administration, as underweight (BMI <18.5 kg/m2), normal-weight (18.5 ≤ BMI <24 kg/m2), overweight (24.0 ≤ BMI <27.0 kg/m2), mild obese (27.0 ≤ BMI <30 kg/m2) and moderate-to-severe obese (BMI ≥30.0 kg/m2), and the lowest risks of different complications were summarized in each group. Also, using the Institute of Medicine and Japanese guidelines as reference, the Taiwanese recommendations for GWG were revised. RESULTS: The rate of cesarean section, hypertensive disorder, preeclampsia, preeclampsia with severe features, and preterm birth were higher in prepregnancy overweight and obese women than in normal-weight women (p < 0.05). In the Taiwanese population, the recommended GWG for underweight pregnant women is 11-15 kg, for normal-weight pregnant women, it is 9.4-13.5 kg, for overweight pregnant women, it is 7.9-11.4 kg, for mild obese pregnant women, it is 7.3-10 kg, and for moderate-to-severe obese pregnant women, it is 4.9-9 kg with lowest perinatal complications. CONCLUSIONS: Unsatisfactory controlled prepregnancy weight (BMI ≥24) and inappropriate body weight gain during pregnancy can increase the risk of adverse pregnancy complications. Taiwanese GWG guidelines should be revised based on the characteristics and clinical data of the local population.

Influencing factors of sleep quality in pregnant: a structural equation model approach.

BACKGROUND: To describe the changes in the level of sleep quality during pregnancy among pregnant women in Urumqi; also to construct a structural equation model of the factors influencing the sleep quality of pregnant women, to analyze the path relationship between the influencing factors, and to take reasonable interventions to prevent and reduce the occurrence of sleep disorders among pregnant women. METHODS: 986 pregnant women who gave birth in Urumqi Maternal and Child Health Hospital and Urumqi Youai Hospital between August 2021 and May 2023 were selected. The Pittsburgh Sleep Quality Index (PSQI), Self-Rating Anxiety Scale (SAS), and Edinburgh Postpartum Depression Scale (EPDS) were used to assess the sleep, anxiety, and depression of pregnant women, Building a structural equation model based on AMOS 23.0 Tools. RESULTS: The results of structural equation modeling showed that: basic characteristics, obstetrical characteristics, tocolysis, lifestyle, psychological had a direct effect on the PSQI, with path coefficients of 0.243, 0.106, 0.140, 0.174, 0.658, the corresponding T-values for each path are 4.585, 2.677, 2.578, 2.297, and 9.036. The indirect effect of basic characteristics, obstetric characteristics and lifestyle on PSQI was 0.123, 0.020, 0.027. CONCLUSIONS: The high incidence of sleep disorders in pregnant women and their close association with psychological symptoms in pregnant women should focus on screening and counseling regarding psychological disorders in pregnant women, thus improving the quality of sleep in pregnant women.

[Prevalence and Trends in Prepregnancy Overweight and Obesity in Northern Iceland 2004-2022].

INTRODUCTION: Prepregnancy overweight and obesity is an increasing public health issue worldwide, including Iceland, and has been associated with higher risk of adverse maternal and birth outcomes. The aim of this study was to investigate trends in prepregnancy weight amongst women in North Iceland from 2004 to 2022, and the prevalence of overweight and obesity in this population. MATERIAL AND METHODS: This retrospective cross-sectional study included all women who gave birth at Akureyri Hospital in North Iceland between 2004 and 2022 (N = 7410). Information on age, parity, height, and prepregnancy weight was obtained from an electronic labour audit database. Body mass index (BMI) was calculated from self-reported height and weight, and the median BMI and proportions in each of the six BMI categories were calculated for four time periods. RESULTS: Median BMI increased significantly from 24.5 kg/m2 in 2004-2008 to 26.2 kg/m2 in 2019-2022. On average, BMI increased by 0.15 kg/m2 with each passing year (p<0.001). The prevalence of normal weight decreased from 53% to 40% and the entire BMI distribution shifted towards a higher BMI. The proportion of women in obesity class I (BMI 30.0 - 34.9) increased from 12.8% to 17.3%, the proportion of women in obesity class II (BMI 35.0 - 39.9) doubled (3.7% to 8.1%) and tripled in obesity class III (BMI ≥ 40.0; 1.6% to 4.8%). CONCLUSION: Prepregnancy weight of women in Northern Iceland has gradually increased over the last 19 years and 30% of pregnant women are now classified as obese. Further studies on the subsequent effects on maternal and birth outcomes are needed, with a focus on strategies to decrease adverse effects and reverse this trend.

Pregnancy health in a multi-state U.S. population of systemically underserved patients and their children: PROMISE cohort design and baseline characteristics.

BACKGROUND: Gestational weight gain (GWG) is a routinely monitored aspect of pregnancy health, yet critical gaps remain about optimal GWG in pregnant people from socially marginalized groups, or with pre-pregnancy body mass index (BMI) in the lower or upper extremes. The PROMISE study aims to determine overall and trimester-specific GWG associated with the lowest risk of adverse birth outcomes and detrimental infant and child growth in these underrepresented subgroups. This paper presents methods used to construct the PROMISE cohort using electronic health record data from a network of community-based healthcare organizations and characterize the cohort with respect to baseline characteristics, longitudinal data availability, and GWG. METHODS: We developed an algorithm to identify and date pregnancies based on outpatient clinical data for patients 15 years or older. The cohort included pregnancies delivered in 2005-2020 with gestational age between 20 weeks, 0 days and 42 weeks, 6 days; and with known height and adequate weight measures needed to examine GWG patterns. We linked offspring data from birth records and clinical records. We defined study variables with attention to timing relative to pregnancy and clinical data collection processes. Descriptive analyses characterize the sociodemographic, baseline, and longitudinal data characteristics of the cohort, overall and within BMI categories. RESULTS: The cohort includes 77,599 pregnancies: 53% had incomes below the federal poverty level, 82% had public insurance, and the largest race and ethnicity groups were Hispanic (56%), non-Hispanic White (23%) and non-Hispanic Black (12%). Pre-pregnancy BMI groups included 2% underweight, 34% normal weight, 31% overweight, and 19%, 8%, and 5% Class I, II, and III obesity. Longitudinal data enable the calculation of trimester-specific GWG; e.g., a median of 2, 4, and 6 valid weight measures were available in the first, second, and third trimesters, respectively. Weekly rate of GWG was 0.00, 0.46, and 0.51 kg per week in the first, second, and third trimesters; differences in GWG between BMI groups were greatest in the second trimester. CONCLUSIONS: The PROMISE cohort enables characterization of GWG patterns and estimation of effects on child growth in underrepresented subgroups, ultimately improving the representativeness of GWG evidence and corresponding guidelines.

The correlation between serum total bile acid and adverse perinatal outcomes in pregnant women with intrahepatic cholestasis of pregnancy (ICP) and non-ICP hypercholanemia of pregnancy.

BACKGROUND: The association between excessive serum total bile acid (TBA) and adverse perinatal outcomes in individuals with non-intrahepatic cholestasis of pregnancy (non-ICP) hypercholanemia has not been determined, and it is unclear if this link is similar to that observed in patients with ICP. OBJECTIVE: To examine the adverse perinatal outcomes in two specific subcategories: those with ICP and those with non-ICP, including individuals with liver disease and asymptomatic hypercholanemia of pregnancy (AHP), at different levels of TBA. Investigate the correlation between TBA levels and adverse perinatal outcomes of ICP, liver disease, and AHP. METHODS: From 2013 to 2021, pregnant women with excessive TBA levels were taken from the electronic medical record database of our hospital and categorized into three groups: ICP (n = 160), liver disease (n = 164), and AHP (n = 650). This was done as part of a retrospective cohort research project. Multivariable regression and subgroup analyses were performed to examine the association between TBA levels and adverse perinatal outcomes in each group. RESULTS: The study found no significant differences in adverse perinatal outcomes between the ICP and liver disease groups at different TBA levels. However, at moderate TBA levels, both groups had a higher risk of adverse perinatal outcomes than the AHP group (p < 0.017). Among liver disease cases with TBA ≥ 100µmol/L, three cases of perinatal deaths (6.67%) associated with moderate-to-severe acute hepatitis occurred between 27 and 33 weeks of gestation. A 59% higher chance of perinatal death was found for every 10 µmol/L rise in TBA, even after significant variables and confounders were taken into account (adjusted odds ratio (aOR) = 1.59; 95% confidence interval (CI): 1.06-2.40; p = 0.03). CONCLUSIONS: If a pregnant woman has moderate-to-severe liver disease and TBA ≥ 100µmol/L, preterm termination of pregnancy (before 34 weeks) may be considered.

If someone doesn't have ICP but does have moderate-to-severe hepatitis and TBA levels of 100 µmol/L or more, they should be treated more aggressively, and their pregnancies should be terminated earlier (before 34 weeks) than what is usually done for ICP.

Association between antenatal common mental disorders symptoms, and adverse obstetric and perinatal outcomes: A community-based prospective cohort study in Eastern Ethiopia.

BACKGROUND: Maternal common mental disorders have broad implications for maternal and child mental and physical health that may have a long-lasting social and economic impact. This study aimed to assess the association between symptoms of antenatal common mental disorders and obstetric and perinatal outcomes in Eastern Ethiopia. METHODS: A community-based prospective cohort study was conducted and a total of 1011 randomly selected pregnant women were followed up from February 1, 2021, to January 30, 2022. The modified Poisson regression model with a robust variance was fitted to examine the effect of the symptoms of antenatal common mental disorders on obstetric and perinatal outcomes. RESULTS: Antenatal common mental disorders (SRQ ≥ 6) were presented among 390 (38.58 %) pregnant women. In the final multivariate Poisson regression model, women with antenatal common mental disorders symptoms had an increased risk of some pregnancy complications (ARR = 1.65, 95 % CI: 1.59, 1.84). In the current study, symptoms of antenatal common mental disorders increased also the risk of preterm birth (ARR = 1.71; 95 % CI: 1.20, 2.42) and low birth weight (ARR = 1.93; 95 % CI: 1.36, 2.74). LIMITATION: The indirect effects of some potential mediators and moderators were not assessed in this study. CONCLUSION: The study found a high rate of symptoms of antenatal common mental disorders and adverse obstetric and perinatal outcomes. Antenatal common mental disorders symptoms may have considerable effects on individual and combined pregnancy complications and adverse perinatal outcomes.