Impact of bariatric surgery on maternal gestational weight gain and pregnancy outcomes in women with obesity: A population-based cohort study from Qatar.

BACKGROUND: Bariatric surgery is performed in obese women of reproductive age to help achieve a healthy prepregnancy weight to reduce the complications associated with obesity in pregnancy. However, these procedures can impact maternal nutrition and gestational weight gain (GWG). This study evaluates the maternal and neonatal outcomes in women with prepregnancy bariatric surgery and determines the impact on GWG. METHODS: This study included 24 weeks gestation or more pregnancies, with a maternal BMI at delivery of 30 kg/m2 or more. It was categorized into two groups based on whether they had prepregnancy bariatric surgery (exposed) or not (unexposed). The outcomes included gestational diabetes (GDM), gestational hypertension (GHT), mode of delivery, preterm birth (PTB), GWG, birthweight (BW) and customized BW centiles, low birthweight (LBW), congenital anomalies, and admission to the neonatal intensive unit (NICU). Categorization was also done based on the adequacy of GWG (low, adequate, and excess). RESULTS: A total of 8,323 women were included in the study, 194 of whom had prepregnancy bariatric surgery. After adjusting for confounders, the exposed group had a mean GWG 1.33 kg higher than the unexposed group (95% CI 0.55-2.13, p = 0.001). The exposed group had higher odds of PTB (aOR 1.78, 95% CI 1.16-2.74, p = 0.008), CD (aOR 6.52, 95% CI 4.28-9.93, p < 0.001), LBW in term babies (aOR 2.60, 95% CI 1.34-5.03, p = 0.005), congenital anomalies (aOR 2.64, 95% CI 1.21-5.77, p = 0.015), low APGAR score (aOR 3.75, 95% CI 1.12-12.5, p = 0.032) and 80.4g lesser birthweight (95% CI -153.0, -5.8; p = 0.034). More women in the low GWG category had LBW babies (28.6% versus 6.7% in the high GWG group, p = 0.033), lowest mean BW and median BW centiles (2775 grams versus 3289 grams in the high GWG group, p = 0.004 and 57.5% versus 74.5% in the high GWG group, p = 0.040, respectively). CONCLUSION: The findings of this study highlight differences in perinatal outcomes such as preterm birth, low birth weight, congenital anomalies, cesarean deliveries, and gestational weight gain between post-bariatric women and controls. These insights can help inform the planning and provision of appropriate maternity care to enhance patient safety and outcomes. The results of this study can also guide the counseling of reproductive age-group women who are planning to undergo bariatric surgery.

COVID-19 vaccine hesitancy in perinatal women: a cross sectional survey.

OBJECTIVES: To explore attitudes to COVID-19 vaccination among perinatal women. METHODS: A nationwide online, cross-sectional survey was conducted in Qatar from 15th October 2020 to 15th November 2020 with voluntary participation open to all adult residents. Of the respondents, the population group for this study comprised the 341 pregnant and breastfeeding participants. The survey utilized a composite questionnaire incorporating a validated instrument to measure vaccine attitudes. The responses were recorded and analysed with statistical analysis being performed with SPSS software. Outcome measures included intentions towards vaccination and potential factors influencing vaccine hesitancy (contextual factors, vaccine specific concerns and group/individual influences). RESULTS: Perinatal women exhibited a vaccine hesitancy rate of 25% towards COVID-19 immunisation. The main concerns of the group were of infection risks and main factor determining vaccine hesitancy was of vaccine specific safety concerns. Previous vaccine "acceptors" showed vaccine hesitancy to COVID-19 immunisation. A third of the group cited non availability of the vaccine as a concern. CONCLUSIONS: COVID-19 vaccine trials amongst pregnant and lactating women have lagged behind those for general populations and this has compounded concerns around safety in this special group. Perinatal women constitute a vulnerable group and play an important role in vaccination of wider family members. This study highlights the need for trials and data for COVID-19 vaccine in this group to be able to achieve appreciable numbers needed for herd immunity and ultimately control of the pandemic.

Antenatal survey of women's birthing choices in Qatar.

Objectives Attitudes towards labour care and women's choices for their preferred mode of delivery are documented in studies from the around the world, however less is known about women's birth choices in the Middle East. This study was designed with the aim of exploring beliefs and attitudes in this region. Methods Voluntary participation in an ethics-approved survey was offered to pregnant women attending the antenatal clinic at Sidra Medicine from August 2018 to January 2019 with no exclusion criteria. Results Of the 346 respondents, 58.1% were Arabic and the remainder expatriates. This group composition allowed comparison between women native and non-native to the Gulf region. Arabic and non-Arabic women differed significantly in previous birth experiences: the Arabs had had more doctor-led deliveries (45 vs. 34%), epidurals (56.6 vs. 45%) and episiotomies (65.7 vs. 54%). 70.2% of the respondents chose a normal delivery as their preferred birth mode though a smaller majority of the Arabic subgroup did (63.2 %). 60.4% preferred delivery by doctors and longer hospital stays (47.6), more so Arabic participants (64.7 and 68.6 %). Significantly less Arabs, would choose husbands as birth partners (51.2 vs. 86.2%) and more expressed a gender preference for doctors. Other group choices are presented. Conclusions Though women in this region made comparable choices about mode of delivery as their Western counterparts, they demonstrated an expectation of a culturally distinct and more medicalized approach to care in labour. The findings highlight the need for further studies to inform regional obstetric care and health education interventions as well as tailoring maternity care services.

The impact of the COVID-19 pandemic on the perinatal mental health of women.

Objectives The physical health impact of the coronavirus disease infection (COVID-19) has received attention worldwide; however, data around the psychological impact of the pandemic is still emerging and little has been reported on psychological effects among vulnerable groups. This study was undertaken with the aim of studying the impact of the COVID-19 pandemic and related restrictions on perinatal mental health among women in Qatar. Methods A cross- sectional survey of women accessing maternity services in Qatar was carried out during the months of June and July 2020 at the local peak of the pandemic. Background data including relevant demographic details, pregnancy and mental health history, concerns, as well as helpful stress-reducing factors reported by women was collected. Depression and anxiety symptomatology was studied using the Patient Health Questionnaire Anxiety-Depression Scale (PHQ-ADS). Results The survey results revealed a high prevalence of anxiety and Depressive symptomatology (34.4 and 39.2% respectively), based on PHQ-ADS scoring. These rates appeared much higher than the reported pre-pandemic prevalence and were not affected by occupation, previous mental health problems or pregnancy complications. Women's most commonly reported concerns as well as coping factors are discussed. Conclusions Results indicate a marked increase in anxiety and depressive symptoms during the COVID-19 pandemic, among pregnant and puerperal individuals, who constitute a vulnerable group with respect to mental health morbidity. These findings can be used to inform public health interventions, among which, consideration should be given to routine mental health screening of vulnerable groups during major health crises.

CD14+/CD31+ monocytes expanded by UM171 correct hemophilia A in zebrafish upon lentiviral gene transfer of factor VIII.

Emerging gene therapy clinical trials test the correction of hemophilia A (HA) by replacing factor VIII (FVIII) in autologous hematopoietic stem cells (HSCs). Although it is known that platelets, monocyte/macrophages, and mesenchymal stromal cells can secrete transgenic FVIII, a systematic examination of blood lineages as extrahepatic sources of FVIII, to our knowledge, has not yet been performed. In this study, we sought to provide a comprehensive map of native and lentivirus-based transgenic FVIII production from HSC stage to mature blood cells, through a flow cytometry analysis. In addition, we generated a model of transient HA in zebrafish based on antisense RNA, to assess the corrective potential of the FVIII-transduced HSCs. We discovered that FVIII production begins at the CD34+ progenitor stage after cytokine stimulation in culture. Among all mature white blood cells, monocytes are the largest producers of native FVIII and can maintain protein overexpression during differentiation from HSCs when transduced by a FVIII lentiviral vector. Moreover, the addition of the HSC self-renewal agonist UM171 to CD34+ cells during transduction expanded a subpopulation of CD14+/CD31+ monocytes with excellent ability to carry the FVIII transgene, allowing the correction of HA phenotype in zebrafish. Finally, the HA zebrafish model showed that f8 RNA is predominantly localized in the hematopoietic system at the larval stage, which indicates a potential contributory role of FVIII in hematopoiesis that warrants further investigation. We believe that this study may be of broad interest to hematologists and researchers striving to advance knowledge and permanent treatments for patients with HA.

Maternal vaccine hesitancy towards COVID-19 immunisation of children in Qatar: a population-based cross-sectional study.

OBJECTIVES: This study was conducted in Qatar to explore beliefs and attitudes among mothers towards coronavirus disease 2019 (COVID-19) vaccination for their children and to understand major factors influencing vaccine hesitancy among these mothers. METHODS: A population-based, online cross-sectional survey was conducted between 15 October and 15 November 2020. A composite questionnaire incorporating a validated vaccine hesitancy tool was developed and administered in both English and Arabic. Approval was obtained from the local ethics committee. Participation was voluntary and offered to all adult residents of Qatar through an online link available on social media platforms and local news portals. Only adult respondents who self-identified as mothers were included in the present study. No personal identifying data were collected. RESULTS: Of the mothers surveyed, 29.4% exhibited COVID-19 vaccine hesitancy regarding their children. This exceeded these mothers' rate of personal vaccine hesitancy (27.5%). Hesitancy rates varied significantly with ethnicity, with the highest among Qatari mothers (51.3%). Intention to vaccinate children did not differ significantly between mothers who accepted the vaccine for themselves and those who did not. Overall, the main reported concerns related to long-term vaccine safety. To a significant extent, mothers relied most on self-directed research on vaccine safety for decision-making. CONCLUSIONS: The rate of maternal COVID-19 vaccine hesitancy exceeded both those mothers' rate of personal vaccine hesitancy and the hesitancy rate in the general population. The intention to vaccinate children was independent of maternal vaccination history. Factors influencing maternal vaccine hesitancy differ from those influencing personal hesitancy and require an informed public health response.

Once a cesarean, always a cesarean? Obstetricians' approach to counseling for trial of labor after cesarean.

BACKGROUND: Despite no observed increase in obstetrical complication rates, cesarean delivery rates are increasing worldwide. A significant proportion of planned cesarean deliveries are performed for patients with 1 previous cesarean delivery who opt for an elective repeat cesarean delivery rather than a trial of labor after cesarean delivery. The facilitation of informed decision-making by healthcare professionals may influence patient choices and could affect the trial of labor after cesarean delivery uptake rates. OBJECTIVE: This study aimed to assess how obstetricians in the Middle Eastern region approach counseling of patients with a previous cesarean delivery concerning birth choices in the current pregnancy. STUDY DESIGN: This was a prospective survey-based study. An online survey of obstetricians in the 2 largest state maternity hospitals in Doha, Qatar, was conducted with participation offered voluntarily. The survey gathered background demographic data and investigated the obstetrician's awareness of factors that could influence the success of the trial of labor after cesarean delivery and the obstetrician's approach to counseling women. The data collected were transferred to SPSS (version 23.0; IBM Corp, Armonk, NY) for analysis. Descriptive statistics were performed, and nonparametric analysis of continuous variables and chi-squared analysis of discrete variables were cross-referenced with gender, length of time of specialist qualification, and personal family experience of cesarean delivery. RESULTS: Most respondents had training in the Middle East and generally practiced obstetrics in this region, and >80% of the respondents had more than 5 years of experience in the specialty. The obstetrician's gender or length of experience did not significantly influence the attitude to the assessment of risks and benefits. Furthermore, there was little consensus among the group about factors that were the most and the least important for the success of the trial of labor after cesarean delivery. The group emphasized the importance of the patient's wishes in choosing the mode of birth. If a relative contraindication to the trial of labor after cesarean delivery was present, half of the obstetricians would emphasize the various negatives of the approach to the patient during counseling. Most participants favored a dedicated trial of labor after cesarean delivery clinic to reduce cesarean delivery rates. The participants did not feel that supporting the trial of labor after cesarean delivery would be improved with legal department support. CONCLUSION: Obstetricians had different approaches in the counseling for trial of labor after cesarean delivery, and this can influence the patients' acceptance of the trial of labor after cesarean delivery, thereby affecting cesarean delivery rates.

Obstetric violence: Comparing medical student perceptions in India and the UK.

OBJECTIVE(S): Obstetric Violence refers to professional deficiencies in maternity care, which can occur in both low and high resource settings. Examples include non-dignified care, lack of respect when giving care, discrimination and abandonment of care. The objective of this study was to assess knowledge and attitudes towards obstetric violence in a cohort of medical students in India and the UK. STUDY DESIGN: An online survey was sent to 240 UK and 280 Indian medical students. This incorporated a video showing a dramatized scenario of obstetric violence. The survey assessed participant's demographics and prior knowledge of obstetric violence. Participants scored their perceptions of eight behaviours in the video on visual analogue scales. Participants were asked to reflect on their own practice and score this. Comparisons of survey responses between UK and Indian participants were made using chi squared/Student's t-test. RESULTS: 62 Indian medical students and 58 UK medical students completed the survey. Indian medical students were significantly more likely to be male (p < 0.001). 26 % of UK participants had previously heard the term obstetric violence, compared to 34 % of Indian participants (p = 0.15). Both were able to correctly define obstetric violence at similar rates (32 % versus 34 %). Indian medical students were significantly less critical (p < 0.001) of all eight scored behaviours in the video of obstetric violence compared to their UK counterparts. UK medical students were significantly less likely to agree that the video had changed their perception on how teams should behave and act in this context (p < 0.001). 90 % of UK participants and 38 % of Indian participants had received training in professional behaviours. 14 % of UK participants had seen examples of obstetric violence in clinical practice compared to 49 % of Indian participants. CONCLUSIONS: UK and Indian medical students were able to identify behaviours associated with obstetric violence, although the majority were previously unaware of the term. Indian medical students in this study were less critical of obstetric violence in the video, which may be because of cultural reasons, greater numbers of male students, greater exposure to obstetric violence or less training on professional behaviours. Standardised training to prevent obstetric violence should be part of undergraduate medical training internationally.

Anxiety, Depression and Behavioural Changes in Junior Doctors and Medical Students Associated with the Coronavirus Pandemic: A Cross-Sectional Survey.

INTRODUCTION: Medical students are known to have high levels of depression, anxiety and stress from the high-pressure environments that they study and train in. The coronavirus pandemic presents source of stress and anxiety to large populations in general, and to healthcare professionals in particular. This study was undertaken to assess the psychological effects of this pandemic on the mental health of medical students and trainees. MATERIALS AND METHODS: An online questionnaire was designed to capture information on the participant's anxieties related to the pandemic and included a validated tool for the assessment of anxiety and depression symptoms (GAD-7 and PHQ-9, respectively). The questionnaire was prepared on Google Forms, and the link to the questionnaire was disseminated to 113 medical students and junior doctors on 19 April 2020, and the survey closed on 22 April 2020 midnight. RESULTS: The survey was sent to 113 students, and 83 students participated. Of the participants, 47 (56.6%) were female and 36 (43.4%) were male, and 80 (96.4%) were aged less than 30 years old. Formal anxiety and depression scores using the GAD-7 and PHQ-9 tools indicated 15/82 (18.3%) had anxiety scores of 0 (lowest possible) and 21/82 (25.6%) had the lowest possible depression score of 0. However, 6/82 (7.3%) had scores that were classified as severe depression. Females had significantly higher median anxiety (5 v 2, p < 0.002) and depression scores (5 v 3, p = 0.025) than male participants. Direct patient care and care of patients with Covid-19 did not result in significant deterioration in anxiety and depression. CONCLUSION: Female students/junior doctors showed higher anxiety and depression scores than males. Direct patient care and care of patients with Covid-19 did not result in a measurable deterioration in anxiety and depression in this study. In this stressful pandemic situation, it is imperative to look after the mental health of healthcare workers as well as patients.

Intestinal parasitic infections in pregnancy - A review.

Intestinal parasitic infections are widespread worldwide and with increased global travel and transport of food, these are not entirely limited to traditionally endemic areas. The prevalence of parasitic infections in endemic areas among pregnant women ranges from 24 to 70 % with approximately 10 % of women having multiple parasites. Pregnancy with its increased nutritional demands and altered immunological defenses is an especially vulnerable time for acquiring parasitic infections, which may be associated with adverse outcomes such as anaemia, which in some cases may even contribute to mortality. The presence of a helminthic infections during pregnancy may also cause immunological effects that can contribute to maternal morbidity and mortality as well as affecting the maternal immune response and immune system function in the baby after birth. Mass administration of anthelminthic drug therapy has been applied in endemic areas but there is inconclusive evidence of its benefit in improving pregnancy outcomes, however, no safety concerns have been highlighted with the use of the recommended drugs for parasitic infections.

Obstetric violence: Clinical staff perceptions from a video of simulated practice.

OBJECTIVES: Obstetric Violence refers to professional deficiencies in maternity care. Examples include non-dignified care, discrimination and abandonment of care. Obstetric violence has been described in both low and high resource settings. The objective of this study was to assess knowledge and attitudes towards obstetric violence in a cohort of multinational obstetric nursing/midwifery staff and obstetricians at a private maternity hospital in Qatar. STUDY DESIGN: An online survey for anonymous completion was sent to the hospital email accounts of obstetric nursing/midwifery staff and obstetricians at Sidra Medicine (n = 640). The survey incorporated a video showing a dramatized scenario of obstetric violence. The survey assessed the participant's demographics and knowledge of the term obstetric violence. The participants scored their perceptions on the behaviors in the video using a visual analogue scale. The participants were then asked to reflect on their own practice. Comparisons of the survey responses were made between both doctors and nursing/midiwfery staff members using student's t-test. RESULTS: 50 obstetricians and 167 obstetric nursing/midwifery staff fully completed the survey. Fifty two percent had previously heard of the term obstetric violence, and 48% could define it correctly. 136 (63%) had witnessed obstetric violence at some point in their career. Significant differences were seen when each professional group was asked to report on the behavior of the opposite professional team as depicted in the video (p = 0.01 and p < 0.001). Doctors completing the survey were also more critical of the doctors-in-training than were the midwifery/nursing staff (p = 0.06). Obstetricians and nursing/midiwfery responders identified patient dignity, privacy and patient-centred care as the leading professional deficiencies seen in the video. Obstetricians were significantly less likely to change their perceptions of how a care team should interact with a patient compared to the obstetric nursing/midwifery group (p < 0.001). CONCLUSIONS: This questionnaire study demonstrates that the majority of staff in this cohort were aware of obstetric violence and able to identify negative behaviours in the video and then reflect on how this impacts care they provide. Further studies are needed to identify ways in which obstetric violence can be prevented in both low resource and high resource settings.

Stillbirth: Perceptions among hospital staff in the Middle East and the UK.

Objectives Stillbirth is an important and yet relatively unacknowledged public health concern in many parts of the world. Public awareness of stillbirth and its potentially modifiable risk factors is a prerequisite to planning prevention measures. Cultural and regional differences may play an important role in awareness and attitudes to stillbirth prevention. The objective of this study was to evaluate and compare the awareness of stillbirth among hospital staff in Qatar and the UK, representing two culturally different regions. Study design An online population survey for anonymous completion was sent to the hospital email accounts of all grades of staff (clinical and non-clinical) at two hospitals in Qatar and one tertiary hospital Trust in the UK. The survey was used to gather information on the participants' demographic background, the experience of stillbirth, knowledge of stillbirth, awareness of information and support sources, as well as attitude towards investigation and litigation. Data were analysed using descriptive and comparative statistics (Chi-Square test and Fisher's exact test). Results 1002 respondents completed the survey, including 349 in the Qatar group and 653 in the UK group. There were significant differences in group demographics in terms of language, religion, gender, nationality and experience of stillbirth. The groups also differed significantly in the knowledge of stillbirth, its incidence and risk factors. The two groups took different views on apportioning blame on healthcare services in cases of stillbirth. The Qatar group showed significantly less awareness of available support organisations and relied significantly more on online sources of information for stillbirths (p < 0.001). Conclusions This comparative study demonstrated significant differences between the two culturally distinct regions in the awareness, knowledge and attitudes towards stillbirths. The complex cultural and other factors that may be contributory should be further studied. The results highlight the need for increasing public awareness around stillbirth as part of effective prevention strategies.