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Purpose: To examine the caries status of pregnant women in southeast Hungary and compare the results with a similar study completed in the same region ten years earlier to determine whether any improvement has taken place in the past decade. Another objective was to assess the effects of age, socioeconomic status and number of pregnancies on oral health.Materials and Methods: The dental examination of 130 pregnant women was carried out at the Dental Clinic of University of Szeged, Faculty of Dentistry in 2011-2013 (group 1). Caries status was examined according to WHO guidelines. In order to compare demographic and socioeconomic factors with DMF indices, find the decisive influencing factors and compare the results with the results of the previous study (group 2), two-way ANOVA and regression analyses were conducted.Results: The number of highly educated, professional, urban participants included in the present group (group 1) was greater compared with that of group 2. Despite the higher age of the pregnant women in present study, statistically significantly lower DMFT (10.05 vs 12.57, p = 0.008) and DMFS (19.41 vs 26.26, p = 0.001) scores were found than ten years ago. In both studies, the regression analyses showed that women's age was the main contributing factor to caries status.Conclusion: The lower DMFT and DMFS values and the participants' willingness to participate in the dental screening in the present study group were probably the result of their higher educational background and that they worked as professionals. [ABSTRACT FROM AUTHOR]

Background: Consumption of a diet with high adherence to a Mediterranean diet pattern (MDP) has been associated with a favorable gastrointestinal tract (GIT) microbiome. A healthy GIT microbiome in pregnancy, as defined by increased alpha diversity, is associated with lower chance of adverse perinatal outcomes. This study aimed to evaluate the impact of adherence to an MDP on GIT microbial diversity longitudinally throughout pregnancy.Methods: Adherence to MDP was scored by the Alternate Mediterranean (aMED) Diet Quality Score, after being applied to a validated Food Frequency Questionnaire. Association of aMED Scores with GIT alpha diversity profiles were compared linearly and across time using a linear mixed model, including covariates of age, body mass index (BMI), ethnicity, and parity.Results: Forty-one participants of Filipino, Japanese, Native Hawaiian, and Non-Hispanic White descent provided dietary information and microbiome samples during each trimester of pregnancy. Alpha diversity profiles changed over gestation, with decreased microbial diversity in the third trimester. aMED scores positively correlated with Chao1 Index and Observed Species Number (r = 0.244, p = 0.017, and r = 0.233, p = 0.023, respectively). The strongest association was detected in the third trimester (Chao 1: r = 0.43, p = 0.020, Observed Species Number: r = 0.41, p = 0.026). Participants with higher aMED scores had higher relative abundance of Acidaminoacaeae at the family level (p = 0.0169), as well as higher abundance of several species known to increase production of short chain fatty acids within the GIT.Conclusions: Adherence to MDP pattern is associated with increased maternal GIT microbial diversity, and promotes the abundance of bacteria that produce short chain fatty acids. Increased consumption of fruits, vegetables and legumes with low red meat consumption were key components driving this association. The effect of nutrition however, was less of an effect than pregnancy itself. Further studies are needed to determine if adherence to a Mediterranean diet translates not only into microbial health, but also into reduced risk of adverse pregnancy outcomes. [ABSTRACT FROM AUTHOR]

The aim of the study was to search for a connection between the abnormal location of placenta and the presence of genetic and acquired forms of thrombophilia.Materials and methods. A total of 132 women with the aggravated obstetrical history were examined: Group 1 – 42 patients with the history of placenta previa; Group 2 – 60 pregnant women diagnosed with placenta previa in the current pregnancy; Group 3 – 30 pregnant women with the history of placenta previa and the same abnormality in the current pregnancy. The control group included 120 women with no abnormalities in their obstetric history and with normal location of placenta during the current pregnancy. All patients were assessed for the antiphospholipid antibodies using an enzyme immunoassay. The presence of genetic forms of thrombophilia was tested (with polymerase chain reaction and three pairs of oligonucleotide primers) for the following mutations: the C677T mutation in the 5,10-methylenetetrafolate reductase gene, the prothrombin mutation in the G20210A gene, mutations in the Leiden factor V gene, polymorphism 675 4G/5G in the gene of the inhibitor of plasminogen activator type 1, polymorphism 455G/A in the fibrinogen gene.Results. The thrombophilia spectrum in patients with placenta previa during the current pregnancy and those with abnormal placenta location in the past did not significantly differ from each other. However, in patients with both abnormal placental locations in the past and the present pregnancy, there was a greater occurrence of both genetic and acquired forms of thrombophilia. In the control group, much fewer cases of either genetic or acquired thrombophilia were found.Conclusion. The obtained results suggest a connection between thrombophilia and the abnormal location of placenta. Women with the abnormal placenta location either in the past or during the current pregnancy should be routinely tested for the genetic markers of thrombophilia and for hemostasis abnormalities.

Pregnant women are susceptible to a wide range of oral health conditions that could be harmful to their own health and the future of their baby. There are many myths about the safety of dental care during pregnancy. As a result, pregnant women receive less dental care than when they are not pregnant. In our review, we tried to emphasize the importance and safety of routine dental care for pregnant women. [ABSTRACT FROM AUTHOR]

Prenatal clinical notes in electronic medical records contain a wealth of information on pregnancy complications and outcomes. Extracting this critical information provides a unique opportunity for risk assessment to identify at-risk patients who may benefit from early monitoring and intervention. We developed and validated a rule-based computerized algorithm called PregHisEx to characterize past obstetrical history (preeclampsia/eclampsia) by mining prenatal clinical notes for women delivered in 2012 within a large healthcare maintenance organization. The algorithm successfully identified cases with past history of preeclampsia/eclampsia: 2984 definite and 479 probable cases at sentence level; 2419 definite and 348 probable cases at note level; and 762 definite and 82 probable cases at pregnancy episode level. Validation conducted on a random sample of 200 notes using PregHisEx yielded 88.0 percent sensitivity, 98.9 percent specificity, 91.7 percent positive predictive value, 98.3 percent negative predictive value, and F-score of 0.90. The high-performing PregHisEx can be applied for other prenatal conditions. [ABSTRACT FROM AUTHOR]

Introduction: To improve reproductive, maternal, and child health, preconception health (PCH) care that is innovative and generationally relevant is essential. In response, Wellington-Dufferin-Guelph Public Health (WDGPH) developed and tested an evidence-based PCH electronic intervention delivered in a primary care setting. The purpose of this study was to: (1) identify the prevalence of PCH risks among women of reproductive age, (2) determine the impact of the PCH intervention on knowledge and behaviour, and (3) assess the implementation of the intervention. Methods: The PCH intervention was designed as a cohort study using a mixed method approach. 300 women aged 15–49 years participated across seven primary care sites. The intervention was implemented using a three-part model. Participants: (1) completed a Risk Assessment (RA) on tablet with results sent to their electronic medical record, (2) discussed results with primary care providers (PCPs), (3) received handout with results and key messages. Data were collected from participants (RA and two surveys), and PCPs (interviews). Results: The RA screened for 34 PCH risk factors. The number of risks identified per participant ranged from 4 to 24, averaging 15. The majority reported a positive experience using the RA and would recommend the intervention. PCPs reported many practice benefits. The study highlights the positive influence that PCPs have around PCH. Discussion: The PCH intervention is the first of its kind in Canada. The intervention is an evidence-based population health approach that may help to improve reproductive, maternal and child health. Further research, evaluation and promotion is needed. [ABSTRACT FROM AUTHOR]

Neurological disease encompasses a broad spectrum of conditions which may be affected by pregnancy, present de novo in pregnancy, or are caused by the pregnancy itself. In the UK, 9.8 women in 100,000 died during pregnancy or up to 42 days after delivery (Mothers and Babies Reducing Risk through Confidential Enquiry (MBRRACE) report 2018). Neurological diseases, including epilepsy and stroke, continues to be the second leading indirect cause of maternal mortality and the numbers have not changed since reporting began in 1985, despite the availability of easily accessible Green-top Guidelines on the management of epilepsy through the Royal College of Obstetricians and Gynaecologists (RCOG). It is important than any women of child-bearing age with a neurological condition receive appropriate pre-pregnancy counselling and that during pregnancy they are managed by an experienced multi-disciplinary team including a neurologist, specialist nurse or midwife, maternal medicine obstetrician or obstetric physician and obstetric anaesthetist. Additional benefits in care will come with improving awareness in the general public and community doctors so that appropriate support is provided to enable the safest possible pregnancy. [ABSTRACT FROM AUTHOR]

Key content: The appropriate use of imaging in pregnancy is necessary for prompt investigation and management of acute and chronic medical symptoms.Healthcare professionals should consider carefully which imaging modality and scanned area of interest will yield maximum diagnostic information.The use of shielding techniques significantly reduces the dose of ionising radiation to which the fetus is exposed.Theoretical concerns regarding magnetic resonance imaging use in pregnancy have not been supported in human studies.Gadolinium contrast should be avoided in pregnancy unless the maternal benefits outweigh fetal and neonatal risks. Learning objectives: To review the safety of different imaging modalities in pregnancy.To understand the risks and benefits of various imaging techniques in pregnancy.To review the investigations required to image common medical symptoms encountered by obstetricians. Ethical issues: Do obstetricians adequately counsel women regarding safety of imaging in pregnancy to enable them to give informed consent for the procedure? [ABSTRACT FROM AUTHOR]

Traffic-related air pollution has been linked to higher risks of infertility and miscarriage. We evaluated whether folate intake modified the relationship between air pollution and livebirth among women using assisted reproductive technology (ART). Our study included 304 women (513 cycles) presenting to a fertility center in Boston, Massachusetts (2005–2015). Diet and supplements were assessed by food frequency questionnaire. Spatiotemporal models estimated residence-based daily nitrogen dioxide (NO2), ozone, fine particulate, and black carbon concentrations in the 3 months before ART. We used generalized linear mixed models with interaction terms to evaluate whether the associations between air pollutants and livebirth were modified by folate intake, adjusting for age, body mass index, race, smoking, education, infertility diagnosis, and ART cycle year. Supplemental folate intake significantly modified the association of NO2 exposure and livebirth (P = 0.01). Among women with supplemental folate intakes of <800 μg/day, the odds of livebirth were 24% (95% confidence interval: 2, 42) lower for every 20-parts-per-billion increase in NO2 exposure. There was no association among women with intakes of ≥800 μg/day. There was no effect modification of folate on the associations between other air pollutants and livebirth. High supplemental folate intake might protect against the adverse reproductive consequences of traffic-related air pollution. [ABSTRACT FROM AUTHOR]

Background: It is unclear that how prepregnancy body mass index (BMI), gestational weight gain (GWG), and gestational diabetes mellitus (GDM) affect pregnancy outcomes in -China. Thus, we explored how BMI, GWG, and GDM affect the risks of adverse pregnancy outcomes. Methods: We performed a retrospective, population-based study included all births in Xiamen, China, 2011–2018. Demographic data and pregnancy outcomes of 73,498 women were acquired from the Medical Birth Registry of Xiamen. Women were categorized into groups on prepregnancy BMI and GWG in order to assess the risk of pregnancy outcomes. Multivariable logistic regression was performed to evaluate risk factors. Results: Overall, 6,982 (9.37%) women were obese, and 8,874 (12.07%) women were overweight. Obese women are more vulnerable to cesarean delivery, preterm birth, large-for-gestational age (LGA), and macrosomia (crude OR [cOR] 2.00, 1.89–2.12; 1.35, 1.20–1.51; 2.12, 1.99–2.26; 2.53, 2.25–2.86, respectively, adjusted ORs 1.73, 1.62–1.84; 1.25, 1.10–1.42; 2.03, 1.90–2.18; 2.77, 2.44–3.16, respectively). Similar results were observed in overweight women (cORs 1.49, 1.42–1.57; 1.02, 0.91–1.15; 1.60, 1.50–1.70; 2.01, 1.78–2.26, respectively). Furthermore, women who gain weight in excessive group were 1.43, 2.06, and 2.16 times to deliver cesarean, LGA, and macrosomia, respectively. Additionally, GDM women were easily subjected to cesarean section, preterm birth, LGA, low birth weight, and macrosamia (cORs 1.52, 1.55, 1.52, 1.37, 1.27, respectively). Conclusions: Obesity prior to pregnancy, excessive GWG, and GDM were all associated with increased odds of cesarean, LGA, and macrosomia. Blood glucose and weight control before and during pregnancy are needed that may reduce the complications of pregnancy. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aims and objectives: To determine midwives' preference for "Hands‐on" and "Hands‐off/poised" methods and to explore the impact factors. Background: With the increasing rate of obstetric anal sphincter injuries, great controversy surrounds the "Hands‐on" or "Hands‐off" method during childbirth to decrease obstetric anal sphincter injuries incidence. Without regular records and related research, determining the use of this technique in China is difficult. Design: This study used a quantitative study design, following the EQUATOR guidelines (STROBE). Methods: A nationwide cross‐sectional online survey was conducted using respondent‐driven sampling across 31 provinces in China from 1st October 2017–31st December 2017. A total of 6,425 midwives were involved. Descriptive analyses, chi‐square test and binary logistic regression were undertaken. Results: A total of 5,225 questionnaires were returned; 55.8% of the participants preferred the "Hands‐off/poised" method. The impact factors included hospital categories, total work experience in a birth unit in years, theoretical education and skill training. In the study, for situations with increased OASI risk, 100% of the midwives in the "Hands‐off" group expressed willingness to change to the "Hands‐on" method whether there was concern about impending obstetric anal sphincter injuries. Conclusion: The "Hands‐off/poised" method is heavily practised by Chinese midwives. However, majority of the midwives adopt "Hands‐on" method in the face of high risk for obstetric anal sphincter injuries. Further studies are needed to determine the association between obstetric anal sphincter injuries rate and perineal management for low‐risk birth. Relevance to clinical practice: The result indirectly illustrates the application of "Hands‐off/poised" technique in China and provides evidence for the international midwifery organisation to understand the status of Chinese midwifery to some extent. It also provides the latest data for further study of these two methods and the study of the relationship between hands‐off/poised method and obstetric anal sphincter injuries. [ABSTRACT FROM AUTHOR]

Monochorionic triplet pregnancy is a rare condition, and twin‐reversed arterial perfusion (TRAP) sequence and severe selective fetal growth restriction (FGR) are associated with high perinatal morbidity and mortality rates. We report a case of TRAP sequence and selective FGR typeIIconcurrently complicating a monochorionic triplet pregnancy. Fetoscopic laser surgery (FLS) was performed at 16 + 1 weeks of gestation and was technically successful. Inter‐fetus placental anastomoses were coagulated. The pregnancy continued until 28 + 4 weeks of gestation, when the patient presented with preterm rupture of membranes and preterm labor. Two live female newborns were delivered by a cesarean section, and their postnatal course of the neonates was uneventful and in accordance with their gestational age at birth. To our knowledge, this is the first case report of FLS resulting in favorable outcomes for a monochorionic triplet pregnancy concurrently complicated with TRAP sequence and selective FGR type II. [ABSTRACT FROM AUTHOR]

Many pregnant women rely on their health professional for nutrition information during routine antenatal visits. This review offers information to assist health professionals with advising pregnant women of the important nutrition considerations during pregnancy. The roles of some of the key nutrients are discussed, including folic acid, iodine, iron, calcium, and vitamin D. Recommendations for each of the key nutrients are covered and examples of how these can be achieved are presented. The review also details additional nutritional considerations that should be discussed during antenatal consults, including energy balance and weight gain recommendations, the importance of food safety during pregnancy, the recommended safe levels of consumption of vitamin A, caffeine, and fish, and the importance of abstaining from alcohol. Educating and supporting women during pregnancy to make healthy food choices to fulfil their needs and the needs of their growing fetus, will help to promote a healthy start to life. [ABSTRACT FROM AUTHOR]

Background: Physical activity during pregnancy is associated with reduced risk of adverse maternal and fetal outcomes. However, the majority of pregnant women are inactive and interventions designed to increase exercise during pregnancy are sparse. We evaluated the feasibility and preliminary efficacy of an exercise intervention among a diverse sample of pregnant women. Methods: The B.A.B.Y. (Behaviors Affecting Baby and You) Study is conducted at a large tertiary care facility in Western Massachusetts. We randomized 110 prenatal care patients (60% Hispanic) to an individually tailored 12-week exercise intervention arm (n = 58) or to a health and wellness control arm (n = 52) at mean = 11.9 weeks gestation. Physical activity was assessed via the Pregnancy Physical Activity Questionnaire (PPAQ). Results: After the 12-week intervention, the exercise arm experienced a smaller decrease (-1.0 MET-hrs/wk) in total activity vs. the control arm (-10.0 MET-hrs/wk; P = .03), and a higher increase in sports/exercise (0.9 MET-hrs/wk) vs. the control arm (-0.01 MET-hrs/wk; P = .02). Intervention participants (95%) reported being satisfied with the amount of information received and 86% reported finding the study materials interesting and useful. Conclusions: Findings support the feasibility and preliminary efficacy of a tailored exercise intervention in increasing exercise in a diverse sample of pregnant women. [ABSTRACT FROM AUTHOR]

Objective. To study the pathogenetic significance of genetic and acquired thrombophilia and improve the principles of prevention of preeclampsia.Materials and Methods. 65 patients were examined, who were divided into 2 groups: I group consisted of 35 women – pregnant women with repeated episodes of preeclampsia in the present pregnancy, in the II group consisted of 30 primigravida women with preeclampsia during the current pregnancy.Results. Pathogenetically substantiated prophylaxis with low molecular weight heparin, vitamins and antioxidants in patients with preeclampsia and multigenic thrombophilia in early pregnancy has improved during gestation and perinatal outcomes in pregnant women. This was significantly better outcomes have occurred in patients who were treated with early pregnancy and childbearing cycle.Conclusion. Early (antenatal) diagnosis, prevention and differentiated pathogenetic therapy can not only prevent the development of obstetric complications, and, consequently, reduce maternal mortality and morbidity, and improve perinatal outcomes in patients with various forms of thrombophilia. Pathogenic prevention of recurrent episodes of preeclampsia should be based on prevention of manifestations of pro-inflammatory status and genetic thrombophilia.

Objective  To determine the association of preeclampsia (PE) with the presence of cardiovascular risk (CVR) factors at approximately 11 years postpartum and to assess the longer term effect of PE on childhood development. Study Design  A mail-out survey was sent to all women who were previously recruited into the Kingston arm of the Pre-Eclampsia New Emerging Team's prospective cohort (n  = 112 PE and n  = 150 control). Physical and biochemical CVR markers were compared between the two groups. Physical, social, and cognitive development of the children involved in the pregnancies was evaluated using the Vineland-3 Domain-Level Parent/Caregiver Form. Results  Thirteen PE women and 28 control women returned the study questionnaire. Based on the 2017 American Heart Association High Blood Pressure Clinical Practice Guidelines, 9/13 (69.2%) of the PE women, compared with 6/28 (21.4%) of the control women, have hypertension (p  < 0.01). The median percentile rank for overall adaptive functioning was 58 (interquartile range [IQR: 21–73]) in the PE children and 81 (IQR: 61–94) in the control children (p  < 0.05). Conclusion  The development of PE leads to longer term changes in CVR markers and in childhood development at approximately 11 years postpartum. Pregnancy and the postpartum provide an early window of opportunity for early maternal and child screening and intervention for health preservation and disease prevention. [ABSTRACT FROM AUTHOR]

Objective: In complicated mono-chorionic twin pregnancies, vaso-occlusive techniques like bipolar cord coagulation (BPCC), radiofrequency ablation (RFA), interstitial laser ablation (ILA) of cord and fetoscopy guided cord coagulation with lasers are the methods proposed for selective fetal reduction. This study brings forth preliminary data of selective fetal reduction procedures at a tertiary care center in India. Material and Methods: This was a prospective observational study of 31 patients with complicated mono-chorionic twin pregnancies. Methods used were ILA, RFA and BPCC. Outcome measures included overall co-twin survival after selective feticide, survival rates with each method, miscarriage (defined as all fetal loss before 24 weeks), early fetal death (<24 hours after procedure) and late fetal death (>24 hours after the procedure) of co-twin. Results: Technical success was achieved in 30/31 (96.8%) of pregnancies. Over all take home baby rate was 63.3%. Live birth rates were 50%, 71.4% and 75% with ILA, RFA and BPCC respectively. Conclusion: Data from initial cases of selective fetal reduction in complicated mono-chorionic twins suggests that these procedures are feasible but are associated with high adverse perinatal outcome. [ABSTRACT FROM AUTHOR]

Although some cases describing delayed birth of the second twin have been published recently, delay of delivery beyond 36 weeks seems scarce. We report a case of delayed-interval delivery wherein prolongation of the second twin's delivery until term with a subsequent favorable infantile outcome. In this case, the stillbirth of the first twin occurred at 25 weeks' gestation. Prophylactic tocolysis was performed with ritodrine and magnesium sulfate, and a McDonald cerclage was performed 2 days after delivery of the first twin. Ampicillin and gentamicin were also administered for the purpose of prevention of intrauterine infection. No clinical sign of chorioamnionitis was found thereafter, and full term uneventful delivery was achieved. With this experience, we believe that delayed-interval delivery can be effective in prolonging gestation and should be an option if the first twin developed an extreme preterm delivery. [ABSTRACT FROM AUTHOR]

Aims: Maternal overweight and obesity in pregnancy are known to increase the risk of a range of complications and adverse pregnancy outcomes. This study estimates the population‐level contribution of maternal overweight and obesity to adverse pregnancy outcomes. Methods: Data derived from the Australian Capital Territory (ACT) Maternal and Perinatal Data Collection were analysed. A total of 24 161 women who had a singleton birth in 2009–2015, with maternal weight and height information available, were included. In this study, the association between risk factors and outcomes was investigated using multilevel regression modelling. Based on model predictions under various hypothetical maternal weight scenarios, the number and proportion of adverse perinatal outcomes that could be potentially prevented were estimated. Results: Maternal overweight and obesity were associated with increased risks of gestational diabetes mellitus (GDM), pre‐eclampsia, caesarean delivery, preterm birth (PTB), large for gestational age (LGA) and admission to the special care nursery or neonatal intensive care unit (SCN/NICU). The estimated proportions of adverse pregnancy outcomes attributable to overweight and obesity in pregnancy are 29.3% for GDM, 36.2% for pre‐eclampsia, 15.5% for caesarean delivery, 21.6% for longer antenatal stay in hospital (≥2 days), 16.3% for extreme PTB, 25.2% for LGA and 6.5% for SCN/NICU admission. Conclusions: Maternal overweight and obesity contribute to a large proportion of obstetric complications and adverse outcomes in the ACT. Effective intervention strategies to reduce the prevalence of overweight and obesity in pregnant women could have significant beneficial effects on pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Aim: Being able to relieve pain that occurs during delivery provides physical and emotional involvement of the mother in the birth and could reduce maternal and fetal undesirable effects. We planned this questionnaire study to evaluate the painless delivery approaches of physicians working in the fields of gynecological diseases and obstetrics. Methods: A survey was made consisting of 10 questions about the painless delivery approaches with the gynecologists and obstetricians in Turkey. Ninety-eight physicians' answers were evaluated. Results: It was observed that the painless birth in the clinics was not widespread, the low painless delivery options offered rate was low and the informing was inadequate in clinics throughout Turkey. In addition, it was concluded that physicians did not have a common idea to the effect on the action of delivery. Conclusion: The role of gynecologists and obstetricians, as well as anesthesiologists, is great in spreading painless delivery practice. We also wanted to emphasize that informing the patient during pregnancy by the gynecologic diseases and obstetricians may reduce the rate of cesarean delivery due to the patient's request. [ABSTRACT FROM AUTHOR]

Objective: To assess women's experience of group prenatal care in a rural Nigerian community.Methods: In an observational study, consenting pregnant women were enrolled in a group prenatal care program based on the CenteringPregnancy model from July 1, 2010, to June 30, 2011, in Tsibiri, Nigeria. Women were interviewed before joining the group and postnatally. A predesigned pro forma was used to assess group behavior during sessions. Descriptive and inferential statistics were applied to data.Results: In total, 161 women enrolled, and 54 of 72 scheduled prenatal sessions took place. The average number of visits was three per woman, with good group interaction and cohesion. Mothers who could mention at least five out of eight danger signs of pregnancy increased from 1.4% (2) to 13.3% (14) (P<0.001, 95% CI 4.28-19.52), while mean knowledge score for danger signs increased from 31% to 47.8% (P<0.001, 95% CI 0.86-2.16). Commitment to birth preparedness plans was impressive. The mothers enjoyed the group sessions and shared the lessons they learned with others.Conclusion: Group prenatal care was feasible and acceptable to women in the present study setting. Comparative trials would be helpful to demonstrate the benefits of the tested model in low-income settings. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the number of late preterm (LPT) births (between 34 0/7 and 36 6/7 weeks) that could have been prevented if expectant management of preterm premature rupture of membranes (PPROM) had been applied according to new recommendations. Methods: A retrospective cohort study included all births at one Swiss center between January 1, 2002 and December 31, 2012. Births were categorized using an adapted evidence-based classification. Two scenarios were considered: best scenario (maximum averted cases) and a conservative scenario (minimum averted cases). Results: Among 2017 LPT births (5.0% of all deliveries; n=40,609), 1122 (60.6%) women had PPROM. Spontaneous labor occurred in 473 (42.2%) cases and 649 (57.8%) had induction of labor or an elective cesarean section. In the latter group, 44 (6.8%) had evidence-based indications for LPT delivery and 605 (83.2%) had non-evidence-based indications. Depending on the scenario, the rate of avoided LPT cases would have varied between 4.2% (95% confidence interval [CI]: 3.4–5.2) if the conservative scenario was applied, and 30% (95% CI: 28.0–32.0) for the best scenario. Conclusion: Adoption of new guidelines for the management of PPROM will prevent a considerable number of LPT births and help decrease the adverse effects and potential disability associated with late preterm infants. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether the classification of a previous spontaneous preterm birth (sPTB) as preterm labor (PTL) with intact membranes (IM) or as preterm prelabor rupture of membranes (PPROM) impacts the efficacy of cervical pessary or vaginal progesterone for prevention of sPTB in pregnant women with short cervix on transvaginal ultrasound.Methods: This was a retrospective cohort study of asymptomatic high-risk singleton pregnancies with a short cervix and history of sPTB, treated using Arabin pessary or vaginal progesterone for primary PTB prevention, conducted at four European hospitals. A log-rank test on Kaplan-Meier curves was used to assess the difference in performance of pessary and progesterone, according to history of PTL-IM or PPROM. Linear regression analysis was used to evaluate significant predictors of gestational age at delivery.Results: Between 2008 and 2015, 170 women were treated with a pessary and 88 with vaginal progesterone. In women treated with a pessary, rate of sPTB < 34 weeks was 16% in those with a history of PTL-IM and 55% in those with a history of PPROM. In women treated with progesterone, rate of sPTB < 34 weeks was 13% in those with a history of PTL-IM and 21% in those with a history of PPROM. Treatment with a pessary resulted in earlier delivery in women with previous PPROM than in any other subgroup (P < 0.0001). Linear regression analysis showed a clear effect of PPROM history (P < 0.0001), combination of PPROM history and treatment (P = 0.0003) and cervical length (P = 0.0004) on gestational age at birth.Conclusions: Cervical pessary may be a less efficacious treatment option for women with previous PPROM; however, these results require prospective validation before change in practice is recommended. Phenotype of previous preterm birth may be an important risk predictor and treatment effect modifier; this information should be reported in future clinical trials. © 2018 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Aims: To determine the effect of music on the management of pain and anxiety in primiparous women during labour. Background: Music is cost‐effective intervention in clinical practice to reduce pain, stress, and anxiety. However, a systematic review with meta‐analysis for investigating its effects during labour is still lacking. Design: A systematic review with meta‐analysis. Data sources: MEDLINE, EMBASE, and CINAHL databases. Review methods: Randomized controlled trials or quasi‐experimental trials concerning the effects of music among primiparous women who were expected to give normal spontaneous delivery were searched and screened up to 31 July 2017. The recruited trials for this review were compliant with the standards of the Cochrane Handbook for Systematic Reviews of Interventions. Results: A total of 392 primiparous pregnant women (197 in the music intervention group and 195 in the routine care group) from five studies were included in this review. Music as an intervention seemed to lower the pain scores for primiparous women during labour, but the effect was not statistically significant. However, there was a significant benefit of music intervention compared with routine care for primiparous women during labour. In the sensitivity analysis, music intervention showed significant effect on the improvement of pain and anxiety for primiparous women during labour. Conclusion: Music intervention may be an effective intervention for the management of pain and anxiety for primiparous women during labour. [ABSTRACT FROM AUTHOR]

Objectives Data on the potential effect of dental cleaning and community water fluoridation (CWF) on pregnancy outcomes are scarce. While numerous studies confirm the cost-effectiveness of fluoride in preventing dental caries, the benefit of CWF during pregnancy has not been well established. Methods This cross-sectional study used data from 2009 to 2016 Massachusetts Pregnancy Risk Assessment Monitoring System and restricted to singleton live births (n = 9234, weighted response rate = 64.3%). Our exposures were: (1) dental cleaning alone during pregnancy; (2) CWF alone; and (3) dental cleaning and CWF combined (DC–CWF). Women without dental cleaning during pregnancy and CWF comprised our reference group. The outcome was preterm birth, (birth < 37 weeks gestation). This study used multivariate logistic regression modeling, controlling for maternal sociodemographic characteristics, previous medical risk and behavioral factors, and calculated adjusted risk ratios (aRRs) and 95% confidence intervals (CIs). Results During 2009–2016, the prevalence of preterm birth among women with a singleton live birth was 8.5% in Massachusetts. Overall, 58.7% of women had dental cleaning during pregnancy, and 63.6% lived in CWF. After adjusting for potential confounders, the associations between dental cleaning alone and preterm birth (aRR = 0.74 [95% CI 0.55–0.98]), and DC–CWF and preterm birth (aRR = 0.74 [95% CI 0.57–0.95]) were significant, while the association between CWF alone and preterm birth was not significant (aRR = 0.81 [95% CI 0.63–1.05]), compared to women without dental cleaning and CWF. Conclusions for Practice This study shows that the prevalence of preterm birth was lower among women with DC only and DC–CWF. [ABSTRACT FROM AUTHOR]

Running is a sport enjoyed by many women across the globe; however, there is little guidance regarding the specific needs of women who run during and after pregnancy. This article explores the guidance regarding physical activity for the general non-pregnant population and relates it to what is available for women who are pregnant. It also remarks on the contraindications to physical activity during pregnancy. This article includes key information of which midwives and women should be aware of during pregnancy and the postnatal period. There are several health benefits, metabolic and physiological changes that may be experienced as a result of running and this article also explores a number of initiatives that can be used by midwives to support women in their care who run. [ABSTRACT FROM AUTHOR]

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Objectives: In rural pregnant Indian women, multiple missed antenatal screening opportunities due to inadequate public health facility-based screening result in undiagnosed HIV and sexually transmitted bloodborne infections (STBBIs) and conditions (anaemia). Untreated infections complicate pregnancy management, precipitate adverse outcomes and risk mother-to-child transmission. Additionally, a shortage of trained doctors, rural women's preference for home delivery and health illiteracy affect health service delivery. To address these issues, we developed AideSmart!, an innovative, app-based, cloud-connected, rapid screening strategy that offers multiplex screening for STBBIs and anaemia at the point of care. It offers connectivity, integration, expedited communications and linkages to clinical care throughout pregnancy.Methods: In a cross-sectional study, we evaluated the AideSmart! strategy for feasibility, acceptability, preference and impact. We trained 15 healthcare professionals (HCPs) to offer the AideSmart! strategy to 510 pregnant women presenting for care to outreach rural service units of Christian Medical College, Vellore, India.Results: With the AideSmart! screening strategy, we recorded an acceptability of 100% (510/510), feasibility (completion rate) of 91.6% (466/510) and preference of 73%. We detected 239 infections/conditions (239/510, 46.8%) at the point-of-care, of which 168 (168/239; 70%) were lab confirmed, staged and treated rapidly. Of the 168 confirmed infections/conditions, 127 were anaemia, 11 Trichomonas and 30 hepatitis B virus (HBV) (25 resolved naturally, 5 active infections). Four infants (4/5; 80%) were prophylaxed for HBV and were declared disease-free at 9 months. Recruited participants were young; mean age was 24 years (range: 17-40) and 74% (376/510) were in their second trimester. Furthermore, 95% of the participants were retained throughout their pregnancy.Conclusion: The AideSmart! strategy was deemed feasible to operationalise by HCPs. It was accepted and preferred by participants, resulting in timely screening and treatment of HIV/STIs and anaemia, preventing mother-to-child transmission. The strategy could be reverse-innovated to any context to maximise its health impact. [ABSTRACT FROM AUTHOR]

Importance: Depression during pregnancy and the postpartum period is relatively common and can have adverse effects on both mother and child.Objective: To systematically review benefits and harms of primary care-relevant interventions to prevent perinatal depression, a major or minor depressive episode during pregnancy or up to 1 year after childbirth, to inform the US Preventive Services Task Force.Data Sources: MEDLINE, PubMED (for publisher-supplied records only), PsycINFO, and the Cochrane Central Register of Controlled Trials; surveillance through December 5, 2018.Study Selection: Randomized clinical trials (RCTs) and nonrandomized controlled intervention studies of interventions (eg, behavior-based, antidepressants, dietary supplements) to prevent perinatal depression in general populations of pregnant and postpartum individuals or in those at increased risk of perinatal depression. Large cohort studies were considered for harms of antidepressant use only.Data Extraction and Synthesis: Two investigators independently reviewed abstracts and full-text articles and quality rated included studies. Random-effects meta-analysis was used to estimate the benefits of the interventions.Main Outcomes and Measures: Depression status; depression symptoms; maternal, infant, and child health outcomes.Results: Fifty studies (N = 22 385) that met inclusion criteria were identified. Counseling interventions were the most widely studied interventions. Compared with controls, counseling interventions were associated with a lower likelihood of onset of perinatal depression (pooled risk ratio [RR], 0.61 [95% CI, 0.47-0.78]; 17 RCTs [n = 3094]; I2 = 39.0%). The absolute difference in the risk of perinatal depression ranged from 1.3% greater reduction in the control group to 31.8% greater reduction in the intervention group. Health system interventions showed a benefit in 3 studies (n = 5321) and had a pooled effect size similar to that of the counseling interventions, but the pooled effect was not statistically significant using a method appropriate for pooling a small number of studies (restricted maximum likelihood RR, 0.58 [95% CI, 0.22-1.53]; n = 4738; I2 = 66.3%; absolute risk reduction range, -3.1% to -13.1%). None of the behavior-based interventions reported on harms directly. A smaller percentage of participants prescribed sertraline had a depression recurrence compared with those prescribed placebo (7% vs 50%, P = .04) at 20 weeks postpartum in 1 very small RCT (n = 22 analyzed) but with an increased risk of adverse effects to the mother.Conclusions and Relevance: Counseling interventions can be effective in preventing perinatal depression, although most evidence was limited to women at increased risk for perinatal depression. A variety of other intervention approaches provided some evidence of effectiveness but lacked a robust evidence base and need further research. [ABSTRACT FROM AUTHOR]

Importance: Perinatal depression, which is the occurrence of a depressive disorder during pregnancy or following childbirth, affects as many as 1 in 7 women and is one of the most common complications of pregnancy and the postpartum period. It is well established that perinatal depression can result in adverse short- and long-term effects on both the woman and child.Objective: To issue a new US Preventive Services Task Force (USPSTF) recommendation on interventions to prevent perinatal depression.Evidence Review: The USPSTF reviewed the evidence on the benefits and harms of preventive interventions for perinatal depression in pregnant or postpartum women or their children. The USPSTF reviewed contextual information on the accuracy of tools used to identify women at increased risk of perinatal depression and the most effective timing for preventive interventions. Interventions reviewed included counseling, health system interventions, physical activity, education, supportive interventions, and other behavioral interventions, such as infant sleep training and expressive writing. Pharmacological approaches included the use of nortriptyline, sertraline, and omega-3 fatty acids.Findings: The USPSTF found convincing evidence that counseling interventions, such as cognitive behavioral therapy and interpersonal therapy, are effective in preventing perinatal depression. Women with a history of depression, current depressive symptoms, or certain socioeconomic risk factors (eg, low income or young or single parenthood) would benefit from counseling interventions and could be considered at increased risk. The USPSTF found adequate evidence to bound the potential harms of counseling interventions as no greater than small, based on the nature of the intervention and the low likelihood of serious harms. The USPSTF found inadequate evidence to assess the benefits and harms of other noncounseling interventions. The USPSTF concludes with moderate certainty that providing or referring pregnant or postpartum women at increased risk to counseling interventions has a moderate net benefit in preventing perinatal depression.Conclusions and Recommendation: The USPSTF recommends that clinicians provide or refer pregnant and postpartum persons who are at increased risk of perinatal depression to counseling interventions. (B recommendation). [ABSTRACT FROM AUTHOR]

Objective(s): To investigate the association between striae gravidarum and low back pain in pregnancy.Study Design: 200 healthy pregnant women with first, uncomplicated and singleton pregnancy at a gestation age of 36-37 weeks were evaluated for striae gravidarum Davey score. Back pain was assessed by Visual Analogue Scale and functional disability by the Turkish version of Oswestry Disability Index.Results: 118 (59%) had low back pain. The Davey score was higher in women with low back pain (6.6 ± 2.2 vs. 4.4 ± 2.1; p < 0.001). Davey score and total Oswestry Disability Index score were positively correlated with Visual Analogue Scale in women with low back pain (r = 0.570, p < 0.001 and r = 0.329, p < 0.001, respectively). There were also significant positive correlations between Davey scores and Oswestry Disability Index scores of each different situation (pain intensity, personal care and lifting, walking, sitting, standing, sleeping, sexual life, social life and travelling).Conclusion: Presence and severity of low back pain is correlated with the presence and severity of striae gravidarum in pregnant women. Therefore, the presence of low back pain can be predicted by simple striae gravidarum evaluation and follow-up. So, necessary precautions can be recommended to prevent pain and functional limitations that can occur during pregnancy. [ABSTRACT FROM AUTHOR]

Introduction: The benefits of endoscopic fetal surgery are deteriorated by the high risk of iatrogenic preterm prelabor rupture of fetal membranes (iPPROM). While previous studies have reported good sealing candidates to prevent membrane rupture, the delivery of these materials to the location of membrane puncture remains unsolved.Materials and Methods: We describe an approach to apply sealing materials onto the amnion through the fetoscopy port. We developed a device composed of an umbrella-shaped polyester coated nitinol mesh and an applicator. The spontaneously unfolding umbrella is pushed through the port, pulled against the amnion, and glued onto the amnion defect site. We tested the adhesion strength of multiple glues and tested the feasibility and reproducibility of this fetal membrane sealing approach in an ex vivo model.Results: The umbrella unfolded and was well positioned in all tests (n = 18). When applied via the fetoscopy port, umbrellas were successfully glued onto the fetal membrane, and all of them completely covered the defect (n = 5). The mean time needed for the whole procedure was 3 min.Discussion: This study is a proof of concept presenting a potential future solution for the precise local application of bioadhesives for the prevention of iPPROM. [ABSTRACT FROM AUTHOR]

Background: Although there are public policies for eradicating congenital syphilis, they do not seem to be a routine in most health services. The objective of this study was to evaluate the management of sexual partners of pregnant women with syphilis in primary health care in northeastern Brazil.Methods: This is a qualitative assessment carried out from February to October 2014 in the city of Fortaleza, Ceará, northeastern region of Brazil, through the observation of six primary health care centers and interviews with 21 professionals, six coordinators, nine women diagnosed with syphilis during antenatal care and four sexual partners. The data were submitted to thematic content analysis.Results: Important flaws were identified at the primary health centers studied regarding the management of syphilis during pregnancy. Accessing testing and treatment is difficult, and there are no standardized strategies to notify the partner. The responsibility for notifying them is transferred to the women, and counseling does not offer proper guidance nor sufficient emotional support to help them.Conclusion: The management of pregnant women and their sexual partners in our region does not comply with global recommendations. Professional qualification, sensitization, and standardization of health professionals' conduct are necessary. Offering support to health professionals on their clinical practices by means of a supervision process may contribute to the adoption of the recommended guidelines and to the promotion of care based on privacy, respect, confidentiality of information, and awareness of the problems faced by women as a result of syphilis diagnosis. [ABSTRACT FROM AUTHOR]

Homelessness during pregnancy poses significant health risks for mothers and infants. As health care providers increase their emphasis on social determinants of health, it is important to understand how unstable housing contributes to complications during pregnancy. We linked data about emergency shelter enrollees with Massachusetts Medicaid claims for the period January 1, 2008-June 30, 2015 to compare health care use and pregnancy complications for 9,124 women who used emergency shelter with those for 8,757 similar women who did not. Rates of mental illness and substance use disorders were significantly higher among homeless women. Adjusted odds of having nine pregnancy complications were also significantly higher for homeless women and remained substantially unchanged after we adjusted for behavioral health disorders. Emergency shelter users also had fewer ambulatory care visits and more months without billable care and were more likely to visit an emergency department. Homelessness and behavioral health disorders appear to be independent factors contributing to pregnancy complications and should be addressed simultaneously. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to determine the effect of fetal movement counting on maternal–fetal attachment. Methods: This study was a randomized controlled trial, conducted with experimental and control groups, each including 55 pregnant women from six family health centers in the Malatya Province, located in the east of Turkey. The data were collected by using a Personal Information Form and the Maternal Antenatal Attachment Scale. Training for fetal movement counting was provided to the experimental group. The pre‐ and posttraining maternal–fetal attachment levels of the experimental group (fetal movements that were regularly counted for 4 weeks) and the control group (continual routine monitoring) were compared. Results: In the pretraining pretest, no difference was found between the maternal–fetal attachment scores of the experimental and the control groups, whereas the maternal–fetal attachment score of the experimental group was found to be higher than that of the control group in the post‐test that was applied 4 weeks later. Conclusion: This research indicated that fetal movement counting positively affected maternal–fetal attachment. [ABSTRACT FROM AUTHOR]

Obesity is a medical condition that may be associated with bias among health care professionals, and this bias may result in disrespectful or inadequate care of patients with obesity. Obstetrician-gynecologists regularly care for patients with obesity and play an integral role in advocating for best practices in health care and optimizing health outcomes for patients with obesity. Obstetrician-gynecologists should be prepared to care for their patients with obesity in a nonjudgmental manner, being cognizant of the medical and societal implications of obesity. This Committee Opinion has been updated from its previous version to focus on obesity bias within the medical community and to provide practical guidance using people-first language instead of labels (ie, "patients with obesity" versus "obese patients") to help obstetrician-gynecologists deliver effective, compassionate medical care that meets the needs of patients with obesity. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to evaluate laboratory markers in women who got pregnant after renal transplantation.Study Design: Cross-sectional prospective study.Main Outcome Measures: Renal function parameters and maternal and fetal data were assessed in renal transplant recipients.Results: Forty-three women who got pregnant after renal transplantation (mean age, 28.5 years; mean gestational age, 35.6 weeks) were included. Most patients (53.5%) received a renal transplant from a deceased donor. Podocyturia was not significantly correlated with other renal function markers. Mean period from transplantation to pregnancy was approximately 5 years; this period was not associated with obstetric complications or changes in renal markers. A gradual increase was observed in the following parameters during pregnancy and puerperium: serum creatinine levels (P < 0.001), proteinuria (P < 0.001), urinary protein/creatinine ratio (P < 0.001), and albumin/creatinine ratio (P < 0.001). The sensitivity and specificity of protein/creatinine ratio in predicting preeclampsia were high (96.0% and 94.0%, respectively). Elevated serum creatinine levels, urinary albumin/creatinine ratio, and retinol-binding protein levels in the third trimester were associated with prematurity (P < 0.001). Preeclampsia was the main cause of renal function decline at the end of pregnancy (65.0% of cases). Approximately four (9.5%) pregnant women presented with premature rupture of membranes and 18 (42.0%) with a urinary tract infection.Conclusions: Proteinuria, urinary protein/creatinine ratio, and retinol-binding protein levels were elevated in patients with preeclampsia. Using these markers to assess renal function during pregnancy may be clinically useful for detecting and monitoring renal injury in renal transplant recipients. [ABSTRACT FROM AUTHOR]

Background: Cervical insufficiency is a significant cause of morbidity and mortality. Cervical cerclage is one option in the management of cervical insufficiency. Aim: To evaluate obstetric outcomes following insertion of a pre‐pregnancy laparoscopic transabdominal cerclage in women at high risk for pre‐term labour and/or mid‐trimester pregnancy loss. Methods: A prospective observational study of consecutive women who underwent laparoscopic transabdominal cerclage from 2007 to 2017. Eligible women had a diagnosis of cervical insufficiency based on previous obstetric history and/or a short or absent cervix and were considered not suitable for a transvaginal cerclage. The primary outcome was neonatal survival and the secondary outcome was delivery of an infant at ≥34 weeks gestation. Surgical morbidity and complications were also evaluated. Results: During the study period, 225 women underwent laparoscopic transabdominal cerclage. We present the outcomes of 121 pregnancies resulting in 125 babies. The perinatal survival rate of viable pregnancies was 98.5% with a mean gestational age at delivery of 35.2 weeks; 79.7% of babies were delivered at ≥34.0 weeks gestation. Conclusion: Laparoscopic transabdominal cerclage is a safe and effective procedure resulting in favourable obstetric outcomes in women with a poor obstetric history. For optimal success the procedure requires the correct surgical expertise, equipment and appropriate patient selection. [ABSTRACT FROM AUTHOR]

Background: The opioid epidemic remains a serious issue in the United States and presents additional challenges for women of childbearing age. An increasingly common complication of opioid use is neonatal abstinence syndrome (NAS), or infant withdrawal from in utero exposure to opioids.Purpose: The objective of our qualitative study was to identify service needs and barriers to care in the NAS epidemic in Ohio, which has among the highest rates of opioid use and NAS in the nation.Methods: Drawing on interviews with 18 healthcare providers, we investigated the challenges, opportunities, and service gaps in treating NAS. Open-ended questions covered opioid misuse and drug treatment, provision of and barriers to healthcare, and suggestions to improve prevention and programming. Content analysis identified major themes.Findings: Providers were primarily women (67%) and included individuals working in healthcare administrative positions, hospital settings, clinics, and social support positions for pregnant women or new mothers. Our results suggest that rather than an acute diagnosis, NAS is better conceptualized as a "cascade of care" including (1) prevention, (2) prenatal care, including drug treatment, (3) labor and delivery, and (4) aftercare. Providers identified challenges and opportunities at each stage of the cascade that could influence NAS outcomes.Implications For Practice: Our results suggest that greater resources, coordination, and cross-disciplinary education are urgently needed across the cascade of care to effectively address NAS.Implications For Research: Framing NAS as a cascade of care allows researchers to identify points along a cascade where mothers and infants require enhanced care and access to social and health services. [ABSTRACT FROM AUTHOR]

The article focuses on the prevention of the preeclampsia (PE), which is a pregnancy complication increasing the risk of morbidity in pregnant women. It discusses the treatment options including low-molecular-weight heparin (LMWH) with the research on pathophysiology of PE, as PE also sees an increase in the risk of cardiovascular disease and chronic kidney disease.

Background: Stillbirths represent a significant global issue, with 2.6 million cases reported in 2015. Stillbirths are often unexplained and preceded by changes in fetal movement patterns. Fetal movement counting methods may be used to monitor maternally perceived fetal movement to identify pregnancies at increased risk. Aims: This article reports on an in-depth, evidence-based practice review conducted to investigate the relationship between fetal movement counting and stillbirth rates. Methods: A comprehensive search of online databases was undertaken to identify relevant literature using keywords. The results were then appraised. Findings: Although a lack of conclusive evidence exists to support or refute the routine implementation of fetal movement counting to reduce stillbirth, indirect evidence suggests that increased maternal and professional awareness of fetal movement may assist in reducing stillbirth rates. Conclusions: Further research is required to develop an appropriate definition of reduced fetal movement, and to determine the potential implications of fetal movement counting as a diagnostic screening tool to reduce stillbirths. [ABSTRACT FROM AUTHOR]

Worldwide, a large proportion of childbearing women are overweight or obese, and it is becoming increasingly common for pregnant women to have undergone bariatric surgery before conceiving. Women with a history of sleeve gastrectomy may not be able to undertake the oral glucose tolerance test, due to the risk of dumping syndrome. There is limited research on the effects of weight loss surgery on the pregnancy oral glucose tolerance test and conducting this test on a woman who has had bariatric surgery may be an inadequate form of diagnosing gestational diabetes mellitus. A cost-effective alternative to an oral glucose tolerance test is to monitor pre-and post-meal blood glucose levels. [ABSTRACT FROM AUTHOR]

Background: This paper presents the protocol and primary findings of pregnancy cohort population-based study in Isfahan, Iran. Materials and Methods: In this cohort, 418 pregnant and 438 nonpregnant women were enrolled. In the first phase, serum concentrations of thyroid-stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), thyroid peroxidase antibody, and urinary iodine concentration (UIC) were measured. Furthermore, the thyroid ultrasound was also performed. According to the results of thyroid function tests in the first phase, local reference range for TSH, FT4, and FT3 in pregnant and nonpregnant women are determined. The 2.5th and 97.5th percentiles are determined as limits of the reference ranges. In the second phase, all pregnant women underwent prenatal care visits in each trimester and they followed for 7 days after delivery and the pregnancy outcomes data are reported. Results: The mean ± standard deviation for TSH, FT4, FT3, and UIC in the first trimester of gestation was 1.84 ± 1.32 mIU/L, 1.01 ± 0.15 ng/dL, 4.50 ± 0.64 pmol/L, and 172.0 ± 90.29 µg/L, respectively. In nonpregnant women, these values for TSH, FT4, FT3, and UIC were 2.58 ± 1.77 mIU/L, 1.10 ± 0.21 ng/dL, 4.49 ± 0.57 pmol/L, and 190.0 ± 109.6 µg/L, respectively. Conclusion: The results of the present study could contribute to establish a local thyroid function tests reference ranges in the first trimester of pregnancy. It could possibly be effective on making a local reference value to prevent of thyroid disease misdiagnosis during pregnancy and adverse pregnancy outcomes. [ABSTRACT FROM AUTHOR]

The article offers information on the 50 years of the Rhesus (Rh) D immunoglobulin (Ig) or anti-D program in Australia, which prevents the negative effects of the incompatibility between an RhD-positive baby and an RhD-negative mother, which can result in haemolytic disease of the fetus and infant.

Abstract: Aims: To observe the corrective effects of maternal extreme flexure and hip abduction combined with contralateral side‐lying on persistent foetal occipito‐posterior position. Background: Digital rotation and other methods are used for correction of a persistent foetal occipito‐posterior position. However, digital rotation readily causes damage to mother and foetus, and the correction rates of other methods are low. Design: In this observational study, pregnant women were randomly divided into 2 groups according to different postures and their outcomes were compared. Methods: A total of 238 women with persistent foetal occipito‐posterior position gave birth in our hospital between January 2015 and June 2017. Of these 238 cases, 12 women declined to participate. The 226 pregnant women were divided into study group (maternal extreme flexure and hip abduction combined with contralateral side‐lying, n = 114) and control group (contralateral side‐lying alone, n = 112). Results: The correction and spontaneous labour rates were higher in the study group than in the control group (P < .05). The duration between initial and successful correction and birth process were shorter in the study group than in the control group (P < .05). Conclusion: Maternal extreme flexure and hip abduction combined with contralateral side‐lying has better correction effect on persistent foetal occipito‐posterior position. [ABSTRACT FROM AUTHOR]

Background: Women are vulnerable to depression during their childbearing years, and giving birth to a child precipitates postpartum depression (PPD) in some women. This review focuses on comparing the effectiveness of omega-3 polyunsaturated fatty acid supplementation on depression during pregnancy or PPD after childbirth.Methods: MEDLINE, PubMed, PsycINFO, and the Cochrane Collaboration Registry of Controlled Trials etc. through July 2017 were searched. Studies of dietary intake and plasma and/or milk levels of omega-3 fatty acids and trials of benefits and effects of omega-3 fatty acids supplements on pregnant or postpartum women with depression were specifically selected.Results: Omega-3 fatty acid deficiency, due to inadequate intake, fast depletion during pregnancy and lactation, is one of the risk factors of PPD. Associations between neuroinflammation (elevated pro-inflammatory cytokines) and aberrant neurotransmission (low serotonergic transmission activity) and risk of PPD have also been reported by numerous studies. Supplementation with eicosapentaenoic acid (EPA)-rich oil can effectively reduce depression during pregnancy and PPD after childbirth. Long term treatment with docosahexaenoic acid (DHA)-rich oil can be effective in reducing the risk of PPD in healthy women, but not in lactating women. Supplementation of DHA-rich oil to women begun at pregnancy and continued after childbirth exerts no beneficial effect on depression.Conclusions: Dietary supplementation with omega-3 fatty acids rich in EPA during pregnancy or postpartum reduces some symptoms associated with depression. DHA supplementation to healthy pregnant women can also reduce the risk of PPD. [ABSTRACT FROM AUTHOR]