BMC Pregnancy and Childbirth最新文献

{"title":"Complicated grief following the perinatal loss: a systematic review.","authors":"Xi Zhang, Ye Chen, Meizhen Zhao, Mengmei Yuan, Tieying Zeng, Meiliyang Wu","doi":"10.1186/s12884-024-06986-y","DOIUrl":"10.1186/s12884-024-06986-y","url":null,"abstract":"<p><strong>Background: </strong>Perinatal loss is a severe stressor that usually triggers distressing symptoms of acute grief. Moreover, acute grief can worsen with time and become a chronic debilitating state known as complicated grief. However, there is a lack of comprehensive reviews on this topic. This systematic review aims to synthesize the existing literature on complicated grief following the perinatal loss.</p><p><strong>Methods: </strong>We systematically searched PubMed, Embase, Cochrane Library, CINAHL, ProQuest, and Web of Science to identify articles on complicated grief symptoms and influencing factors following perinatal loss. We performed a comprehensive, structured evaluation in full compliance with PRISMA guidelines.</p><p><strong>Results: </strong>A systematic search produced 1163 results. Of these, 38 articles met the full-text screening criteria, and 10 pieces of literature met the inclusion criteria. Individuals may experience complicated grief following perinatal loss, manifesting in symptoms such as emotional reactions, physical responses, and social impairments. Furthermore, based on existing evidence, influencing factors include demographic characteristics, reproductive characteristics, marital relationships, social support, and coping strategies.</p><p><strong>Conclusions: </strong>Complicated grief following perinatal loss is easily overlooked and has not been adequately studied. Further empirical research is needed to explore the symptoms and factors influencing this condition. A better understanding of complicated grief will help develop and optimize care strategies, informing future clinical practice and improving psychological support for individuals affected by perinatal loss.</p><p><strong>Trial registration: </strong>PROSPERO registration number: CRD42023473510.</p>","PeriodicalId":9033,"journal":{"name":"BMC Pregnancy and Childbirth","volume":"24 1","pages":"772"},"PeriodicalIF":2.8,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11583632/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142692552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of amniotic fluid, blood and urine samples for the diagnosis of toxoplasmosis in pregnant women candidates for amniocentesis using serological and molecular techniques.","authors":"Rohallah Abedian, Bahman Rahimi Esboei, Shirafkan Kordi, Hadi Shokrollahnia Roshan, Hajar Ziaei Hezarjaribi, Zahra Rahmani, Mahbobeh Montazeri, Mahdi Fakhar","doi":"10.1186/s12884-024-06979-x","DOIUrl":"10.1186/s12884-024-06979-x","url":null,"abstract":"<p><strong>Backgrounds: </strong>Toxoplasmosis, a prevalent parasitic infection, is primarily caused by Toxoplasma gondii (T. gondii). This infection poses a significant threat to neonates during pregnancy and individuals with compromised immune systems. Consequently, it is imperative to develop a novel diagnostic approach that combines high sensitivity with low-risk sampling to effectively manage patients. The aim of this study is to utilize serological and molecular techniques for the diagnosis of T. gondii infection in 100 pregnant women who were under the care of a gynecologist and were candidates for amniocentesis.</p><p><strong>Methods: </strong>During the 15-19th weeks of pregnancy, a total of 100 samples each of amniotic fluid, buffy coat, plasma, and urine simultaneously were collected from pregnant women candidates for amniocentesis in Mazandaran province, northern Iran. This study involved various assessments: (1) detecting anti-T. gondii IgM and IgG in plasma through chemiluminescence assay (2) determining IgG avidity in plasma using the Enzyme-linked immunosorbent assay technique (3) identifying of T. gondii DNA in amniotic fluid, buffy coat and urine by nested PCR (nPCR) and quantitative real-time PCR (qPCR) methods targeting the REP-529 gene, as well as genotyping using GRA6 target genes, and (4) assessing the sensitivity and specificity of the nPCR and qPCR tests.</p><p><strong>Results: </strong>Out of 100 pregnant women screened, 70 were between the ages of 31 to 40 years old. Among them, 23 and 44 had one and two previous pregnancies. Additionally, 13 and 8 women had one and two history of abortions, respectively. Following serologic testing, 52% of the individuals were positive for T. gondii antibodies. Of these, 52 samples were positive for IgG antibodies, and one sample was positive for both IgG and IgM antibodies. Notably, all 52 cases with IgG positivity exhibited a high level of IgG avidity. Regarding the molecular testing of amniotic fluid samples, two pregnant women tested positive in the nPCR assay, while three tested positive in the qPCR assay. Furthermore, genotyping revealed that all positive samples belonged to type I of the T. gondii genotype. Moreover, none of the 100 buffy coat and urine samples tested positive for T. gondii using the nPCR and qPCR techniques.</p><p><strong>Conclusion: </strong>The findings of the current study suggest that serological methods alone may not be reliable in diagnosing congenital toxoplasmosis and cannot rule out the diagnosis of toxoplasmosis and must be approved by molecular tests.</p>","PeriodicalId":9033,"journal":{"name":"BMC Pregnancy and Childbirth","volume":"24 1","pages":"771"},"PeriodicalIF":2.8,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11583409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142692562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: What tools are available to assess climate and environmental health impacts on perinatal families with an equity lens? A rapid review of the Canadian context.","authors":"Alysha T Jones, Émilie Tremblay, Anne-Lise Costeux, Jacqueline Avanthay Strus, Adrienne Barcket","doi":"10.1186/s12884-024-06944-8","DOIUrl":"10.1186/s12884-024-06944-8","url":null,"abstract":"","PeriodicalId":9033,"journal":{"name":"BMC Pregnancy and Childbirth","volume":"24 1","pages":"773"},"PeriodicalIF":2.8,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11583558/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142692554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Socioeconomic determinants of preterm birth: a prospective multicenter hospital-based cohort study among a sample of Kazakhstan.","authors":"Gulmira Zhurabekova, Zhibek Oralkhan, Aru Balmagambetova, Akzhenis Berdalinova, Maygul Sarsenova, Bibigul Karimsakova, Nazym Altynbay, Azhar Malik, Kuanysh Tastambek","doi":"10.1186/s12884-024-06984-0","DOIUrl":"10.1186/s12884-024-06984-0","url":null,"abstract":"<p><strong>Background: </strong>Preterm birth (PTB) is the most stubborn cause of neonatal morbidity and mortality globally. Social determinants are one of the predictors of health disparities and conflicting when regarding the etiology of PTB. The current study objected to investigate the impact of the factors especially from socioeconomic aspects and provided a snapshot of the indicators of PTB in Kazakhstan.</p><p><strong>Material and methods: </strong>A multi-center hospital-based cohort study was conducted on 3,000 singleton pregnant women in Kazakhstan to investigate whether socioeconomic status (SES) influences PTB in Kazakhstan. The study involved clinical data collection and structured questionnaires covering socioeconomic status, health behaviors, and obstetric history, with a final sample of 2,235 women successfully followed through to delivery. The social, demographic, and other health-related determinants for preterm birth were analyzed using bivariate and multivariate statistical methods. The associations between factors and PTB were evaluated by chi-squared tests in bivariate analysis. Independent variables with p < 0.1 in the bivariate analysis were included in a logistic regression model.</p><p><strong>Result: </strong>History of PTB in previous pregnancies, maternal body mass index, housing stability, history of teen pregnancy, parity and general health status of mother were associated with PTB in bivariate analysis. In the logistic regression model, variabls significantly associated with PTB included a history of previous preterm birth, history of teen pregnancy, lower pre-gestational body mass index, primiparity and poorer maternal general health status. Additionally, the significance of the variables varied among the different subtypes of PTB heterogeneity. Women who were divorced, widowed and separated (OR = 5.1; 95% CI: 1.9-13.7) and those who pregnant for first time (OR = 3.8; 95% CI: 1.9-7.7), those with gestational diabetes (OR = 5.2; 95% CI: 1.7-16.3) had increased risk of extremely and very preterm birth, respectively. Women with a low body mass index (OR = 2.3; 95% CI: 1.3-3.9) and those with a history of teen pregnancy (OR = 0.4; 95% CI: 0.2-0.7) had increased risk of moderate to late preterm.</p><p><strong>Conclusion: </strong>These results contribute to a better understanding of PTB predictors in Kazakhstan and highlight the need for comprehensive maternal care strategies to improve pregnancy outcomes.</p>","PeriodicalId":9033,"journal":{"name":"BMC Pregnancy and Childbirth","volume":"24 1","pages":"769"},"PeriodicalIF":2.8,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11577921/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of varied feeding protocols on gastrointestinal function recovery in the early postoperative period following repeat cesarean section: a randomized controlled trial.","authors":"Xiao-Li Hu, Yu-Peng Wang, Lu-Ping Wu, Xiao-Feng Shi, Li-Hua Yu, Ai-Hua Zhang, Xiao-Xiao Zhu, Xiao-Feng Weng","doi":"10.1186/s12884-024-06983-1","DOIUrl":"10.1186/s12884-024-06983-1","url":null,"abstract":"<p><strong>Background: </strong>With the adjustment of China's birth policy, the repeat cesarean sections raises concerns about potential gastrointestinal mechanical injuries and disturbances in gastrointestinal neurohormonal regulation, affecting the postoperative recovery of gastrointestinal function. These affect maternal nutritional status, prolong recovery, extend hospitalization, increase medical costs, and lead to neonatal care challenges.This study is to examine the effects of different postoperative feeding protocols on the restoration of gastrointestinal function in women undergoing repeat cesarean section.</p><p><strong>Methods: </strong>A total of 103 women were randomly assigned to three groups: experimental group A (n = 35), experimental group B (n = 34), and a control group (n = 34). In group A, women without choking symptoms received a clear fluid diet postoperatively, followed by a pureed diet after 6 h, and a regular soft diet after passing flatus. In group B, women chewed gum postoperatively, followed by a clear fluid diet after 2 h, a pureed diet after 6 h, and a regular soft diet after passing flatus. The control group received a clear fluid diet, a pureed diet after passing flatus, and a regular soft diet after defecation. Outcomes measured included recovery of gastrointestinal function, blood biochemical markers, comfort level, exclusive breastfeeding rate, and newborn weight loss.</p><p><strong>Results: </strong>The baseline maternal data across the three groups demonstrated no significant differences (P > 0.05). Both experimental groups A and B showed earlier recovery of postoperative gastrointestinal function compared to the control group, though there was no significant difference between the two experimental groups (P > 0.05). Additionally, postoperative comfort levels were significantly higher in both experimental groups than in the control group (P < 0.05).</p><p><strong>Conclusions: </strong>Early feeding is safe and effective for women who underwent repeat cesarean sections.It has been shown to accelerate gastrointestinal recovery, significantly improve maternal comfort and satisfaction.In cases where immediate postoperative oral intake is not feasible, chewing gum demonstrates a comparable promotive effect, providing a viable substitute in facilitating recovery.</p><p><strong>Trial registration: </strong>This trial has been prospectively registered at Chinese Clinical Trial Registry (ChiCTR2200065825) and the first registration date was 11/16/2022.</p>","PeriodicalId":9033,"journal":{"name":"BMC Pregnancy and Childbirth","volume":"24 1","pages":"768"},"PeriodicalIF":2.8,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11577904/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obstetric and neonatal outcomes in the management of twin pregnancies with gestational diabetes using the IADPSG criteria for singleton pregnancies.","authors":"Jue Ma, Dongjian Yang, Juanxiu Lv, Shujing Liu, Li Gao, Yan Bi, Yanlin Wang","doi":"10.1186/s12884-024-06970-6","DOIUrl":"10.1186/s12884-024-06970-6","url":null,"abstract":"<p><strong>Background: </strong>This study evaluates the effectiveness of the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria, typically applied to singleton pregnancies, in managing gestational diabetes mellitus (GDM) in twin pregnancies. Focusing on a Chinese cohort, it contrasts the clinical outcomes and complications in twin pregnancies with and without GDM.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study at our hospital from January 2019 to December 2021, including all twin deliveries except those before 28 weeks of gestation, with prior diabetes, or unknown GDM status. GDM was diagnosed using a 75 g oral glucose tolerance test based on the IADPSG criteria, and management involved dietary or insulin interventions. We assessed outcomes such as hypertensive disorders (gestational hypertension, preeclampsia, and eclampsia), membrane rupture, preterm birth, small for gestational age (SGA), large for gestational age (LGA), and neonatal intensive care unit (NICU) admissions.</p><p><strong>Results: </strong>Among 1003 twin pregnancies, 21.7% had GDM, with 11.5% receiving insulin. GDM was associated with older maternal age, higher BMI, and a family history of diabetes. Pregnant women with GDM had lower weekly weight gain (0.44 kg/week vs. 0.58 kg/week, p < 0.001) and experienced a higher risk of SGA neonates (aOR = 1.68, 95% CI: 1.06-2.67) and increased NICU admissions (aOR = 1.30, 95% CI: 1.00-1.69) compared to those without GDM. Additionally, dichorionic twins with GDM showed higher risks of SGA and NICU admissions, while monochorionic twins had no significant differences. A U-shaped relationship was identified between weekly weight gain and the rates of SGA and NICU admissions, with the lowest risk observed at a weekly weight gain of 0.75 kg for SGA and 0.57 kg for NICU admissions.</p><p><strong>Conclusions: </strong>Applying singleton-derived IADPSG criteria to twin pregnancies may mitigate some maternal risks but elevates the risk for SGA neonates, suggesting a need for tailored diagnostic and management strategies for twin pregnancies.</p><p><strong>Trial registration: </strong>Retrospectively registered.</p>","PeriodicalId":9033,"journal":{"name":"BMC Pregnancy and Childbirth","volume":"24 1","pages":"770"},"PeriodicalIF":2.8,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11577653/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Human papillomavirus infections during pregnancy and adverse pregnancy outcomes: a Scandinavian prospective mother-child cohort study.","authors":"Magdalena R Værnesbranden, Anne Cathrine Staff, Johanna Wiik, Katrine Sjøborg, Corina S Rueegg, Meryam Sugulle, Karin C Lødrup Carlsen, Berit Granum, Guttorm Haugen, Gunilla Hedlin, Katarina Hilde, Björn Nordlund, Eva M Rehbinder, Knut Rudi, Håvard O Skjerven, Birgitte K Sundet, Cilla Söderhäll, Riyas Vettukattil, Christine M Jonassen","doi":"10.1186/s12884-024-06958-2","DOIUrl":"10.1186/s12884-024-06958-2","url":null,"abstract":"<p><strong>Background: </strong>Human papillomaviruses are common in the urogenital tract amongst women of childbearing age. A few studies indicate a possible association between human papillomavirus infections in pregnancy and adverse pregnancy outcomes whilst other studies find no such association. We aimed to investigate the association between human papillomavirus infections during pregnancy and adverse pregnancy outcomes linked to placental dysfunction, including hypertensive disorders of pregnancy, gestational diabetes mellitus and newborns small for gestational age.</p><p><strong>Materials and methods: </strong>Pregnant women from the general population in Norway and Sweden were enrolled at the time of routine mid-gestational ultrasound examination. Urine samples collected at mid-gestation in 950 and at delivery in 753 participants, were analyzed for 28 human papillomavirus genotypes, including 12 high-risk genotypes. Participants completed electronic questionnaires at enrollment and medical records were reviewed for background characteristics and for the following adverse pregnancy outcomes: hypertensive disorders of pregnancy including gestational hypertension, preeclampsia, superimposed preeclampsia, eclampsia and Hemolysis Elevated Liver enzymes and Low Platelets (HELLP) syndrome, gestational diabetes mellitus, and newborns small for gestational age. Associations between adverse pregnancy outcomes and (a) any human papillomavirus, high-risk human papillomavirus and human papillomavirus genotype 16 infection at mid-gestation, (b) multiple genotype infections at mid-gestation, and (c) persisting infections during pregnancy were assessed with univariable and multivariable logistic regression models. Missing covariates were imputed using multiple imputation.</p><p><strong>Results: </strong>At mid-gestation, 40% (377/950) of women were positive for any of the 28 genotypes, 24% (231/950) for high-risk genotypes and human papillomavirus 16 was found in 6% (59/950) of the women. Hypertensive disorders of pregnancy was observed in 9% (83/950), gestational diabetes mellitus in 4% (40/950) and newborns small for gestational age in 7% (67/950). Human papillomavirus infection with any genotype, high-risk or human papillomavirus genotype 16 at mid-gestation was not associated with adverse pregnancy outcomes. No associations were found for multiple genotype infections at mid-gestation or persisting infections.</p><p><strong>Conclusion: </strong>In a general population of pregnant women, we found no evidence of human papillomavirus infections during pregnancy being associated with hypertensive disorders of pregnancy, gestational diabetes mellitus, or newborns small for gestational age.</p><p><strong>Trial registration: </strong>Trial registration The study is registered at ClincialTrials.gov; NCT02449850 on May 19th, 2015.</p>","PeriodicalId":9033,"journal":{"name":"BMC Pregnancy and Childbirth","volume":"24 1","pages":"764"},"PeriodicalIF":2.8,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11575420/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142675084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased adverse pregnancy outcomes among decreased assisted reproductions during the COVID-19 pandemic: insights from a birth cohort study in Southwest China.","authors":"Jinnuo Hu, Jiaxin Liu, Qin Zeng, Jiuzhi Zeng, Min Luo, Dan He, Yan Zhang, Piao Zhang, Juan Ming, Weixin Liu","doi":"10.1186/s12884-024-06935-9","DOIUrl":"10.1186/s12884-024-06935-9","url":null,"abstract":"<p><strong>Objectives: </strong>We elucidate the impact of the coronavirus disease 2019 (COVID-19) pandemic on assisted reproductive technology (ART) services and birth outcomes and establish an evidence-based framework to maintain the high quality of ART healthcare services and ensure continuous improvement of birth outcomes.</p><p><strong>Methods: </strong>A total of 19,170 pregnant women from Sichuan, Guizhou and Chongqing in Southwest China between 2018 and 2021 were included in this study. The log-binomial regression model was employed to analyse the changes in the probability of adverse birth outcomes, such as low birth weight (LBW), preterm birth (PTB), Apgar score < 7 at 1 min and congenital anomalies (CAs) and their relationship with ART before and after the pandemic. In this analysis, confounding factors such as family annual income, maternal ethnicity, delivery age, subjective prenatal health status, vitamin or mineral supplementation during pregnancy and level of prenatal care provided by the hospital were controlled.</p><p><strong>Results: </strong>ART mothers had the highest probability of giving birth to LBW babies (relative risk (RR): 2.82, 95% confidence interval (CI): 2.32-3.41), experiencing PTB (RR: 2.72, 95% CI: 2.78-3.22) and delivering babies with an Apgar score < 7 at 1 min (RR: 1.73, 95% CI: 1.05-2.69). Before the pandemic, the ART rate increased from 4.42% in 2018 to 6.71% in 2019 (rate difference of 2.29%, P < 0.001). After the pandemic, the ART rate decreased from 6.71% in 2019 to 6.55% in 2020 (rate difference of - 0.16%, P = 0.752). Compared with the pre-pandemic period, the rate difference for LBW decreased from - 0.21% (P = 0.646) in 2018-2019 to an increase of + 0.89% (P = 0.030) in 2019-2020. Similarly, PTB showed an increase in rate difference from + 0.20% (P = 0.623) before the pandemic to + 0.53% (P = 0.256) afterwards. Apgar score < 7 at 1 min had a negative rate difference of - 0.50% (P = 0.012), which changed to a positive value of + 0.20% (P = 0.340). For CAs, the rate difference increased from + 0.34% (P = 0.089) prior to the outbreak to + 0.59% (P = 0.102) at post-outbreak. In 2018 (pre-pandemic), ART was the most significant predictor of LBW, exhibiting an RR of 3.45 (95% CI: 2.57-4.53). Furthermore, in 2020, its RR was 2.49 (95% CI: 1.78-3.42). Prior to the onset of the pandemic (2018), ART (RR: 3.17, 95% CI: 2.42-4.08) was the most robust predictor of PTB. In 2020, its RR was 2.23 (95% CI: 1.65-2.97).</p><p><strong>Conclusion: </strong>ART services have been significantly impacted by the COVID-19 pandemic, and the resulting delays in ART services have had notable implications for maternal birth outcomes.</p>","PeriodicalId":9033,"journal":{"name":"BMC Pregnancy and Childbirth","volume":"24 1","pages":"766"},"PeriodicalIF":2.8,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11575422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142675086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in medications for autoimmune disorders during pregnancy and factors for their discontinuation: a population-based study.","authors":"Sabine Mainbourg, Odile Sheehy, Jessica Gorgui, Evelyne Vinet, Anick Bérard","doi":"10.1186/s12884-024-06932-y","DOIUrl":"10.1186/s12884-024-06932-y","url":null,"abstract":"<p><strong>Objectives: </strong>The medications used for autoimmune diseases have significantly evolved in recent years, but there is limited knowledge about how treatment practices changed during pregnancy. This study aimed to describe the temporal trends of immunosuppressants, immunomodulators and biologics use during pregnancy among women with autoimmune diseases, compare their use before, during, and after pregnancy, and identify factors predicting the discontinuation of these medications during pregnancy.</p><p><strong>Methods: </strong>Using data from the Quebec Pregnancy Cohort (1998-2015), which included women under the RAMQ prescription drug plan for at least 12 months before and after pregnancy, the analysis focused on those with at least one International Classification of Diseases Ninth or Tenth Revision code in the year before pregnancy for inflammatory bowel disease, rheumatoid arthritis, spondylarthropathies, connective tissue diseases, systemic lupus erythematosus, or vasculitis. Exposure to immunosuppressants, immunomodulators and biologics were evaluated before and during the pregnancy. Discontinuation during pregnancy was defined as having no prescriptions filled during pregnancy or overlapping with the first day of gestation (1DG), given that at least one prescription was filled in the year prior to pregnancy. Generalized estimating equations were applied to estimate adjusted odds ratios (aOR) for predicting medication discontinuation during pregnancy.</p><p><strong>Results: </strong>Among 441,570 pregnant women, 3,285 had autoimmune diseases. From 1998 to 2014, the use of immunomodulators increased from 3.7% to 11.9%, immunosuppressants from 4.1% to 13.7%, and biologics from 0% to 15.6%. During pregnancy, compared to before, there was a significant decrease in exposure to immunomodulators (8.6% to 5.4%), immunosuppressants (14.2% to 8.7%), and biologics (5.1% to 4.7%). Factors influencing discontinuation varied by medication type; for immunosuppressants, prior biologics use (aOR = 2.12, 95%CI 1.16-3.85) and the year of pregnancy (aOR = 0.93, 95%CI 0.89-0.98) were key factors, while for biologics, it was only the year of pregnancy (aOR = 0.68, 95%CI 0.54-0.86).</p><p><strong>Conclusions: </strong>The use of immunomodulators, immunosuppressants, and biologics has increased over time. However, exposure during pregnancy decreased, with recent years showing a lower rate of discontinuation. Understanding the factors influencing medication discontinuation during pregnancy can improve management strategies for women with autoimmune diseases.</p>","PeriodicalId":9033,"journal":{"name":"BMC Pregnancy and Childbirth","volume":"24 1","pages":"765"},"PeriodicalIF":2.8,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11575194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142675087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When midwives ask permission to discuss weight with pregnant women with high body weight: a qualitative study.","authors":"Sofie Gyrup, Anne-Sofie Kortegaard, Sissel Due Jensen, Pernille Andreassen, Dorte Hvidtjørn","doi":"10.1186/s12884-024-06888-z","DOIUrl":"10.1186/s12884-024-06888-z","url":null,"abstract":"<p><strong>Background: </strong>In 2021, 15% of pregnant women in Denmark had a Body Mass Index (BMI) of 30 kg/m² or more, which is associated with complications for both mothers and children. Healthcare professionals often feel insecure when discussing weight with pregnant women with high body weight, and people with high body weight are exposed to stigmatisation. To counter this, different tools have been developed to support respectful weight-related conversations, often recommending asking permission to talk about weight. This study explored the experiences of both pregnant women living with a BMI equally or above 30 kg/m² and midwives when asking for permission to discuss weight during the initial midwife consultation.</p><p><strong>Methods: </strong>We observed nine midwifery consultations and, by way of purposive sampling, interviewed six pregnant women with high body weight, while nine midwives participated in two focus group interviews. A hermeneutic-phenomenological approach by Max van Manen was applied for the analysis.</p><p><strong>Results: </strong>We identified three themes in this study. \"Addressing weight triggers risk and ambivalence\", which explores the lived experiences of pregnant women, their personal history with their body weight and midwives' hesitancy to initiate weight-related conversations with pregnant women who have a high body weight. \"Asking for permission - for whose sake?\" highlights the experiences of asking permission among midwives and that pregnant women with a high body weight did not perceive the question as an opportunity to decrease weight-related conversations. \"Weight conversation - a cue to feel wrong and guilty or to feel recognised as an individual?\" emphasising that trust and shared decision-making are crucial factors for a relevant weight-related conversation but also that the conversation might trigger feelings such as guilt and self-doubt.</p><p><strong>Conclusion: </strong>Pregnant women with high body weight had a long history with their body weight that affected all aspects of their lifeworld and influenced weight-related conversations in the midwifery consultation. Some midwives hesitated to address weight, but seeking permission eased this challenge. Despite the midwife asking for permission, some of the pregnant women felt uneasy during the conversation, leaving them with a feeling of self-doubt. Relevant conversations occurred when women engaged in decision-making and trusted the midwife.</p>","PeriodicalId":9033,"journal":{"name":"BMC Pregnancy and Childbirth","volume":"24 1","pages":"767"},"PeriodicalIF":2.8,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11575119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142675088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}