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Cureus Nov 2023Pre-eclampsia has emerged as a significant concern in maternal healthcare worldwide, impacting the health and well-being of expectant mothers and their unborn children....
BACKGROUND
Pre-eclampsia has emerged as a significant concern in maternal healthcare worldwide, impacting the health and well-being of expectant mothers and their unborn children. This study examines the extent of pre-eclampsia knowledge and awareness among Saudi women aged 18 to 49. Recognising informed and proactive healthcare decisions is pivotal in managing and preventing pre-eclampsia.
METHODS
It is a prospective cross-sectional community-based study design. We calculated a minimum sample size of 385 participants using the Raosoft online calculator, aiming for a 5% margin of error and a 95% confidence interval. The structured questionnaire was distributed via various social media platforms to collect the data. The questionnaire consisted of two sections, namely demographics and medical history. Additionally, the questionnaire explored pre-eclampsia risk factors, symptoms, and complications. We analysed data using the Statistical Package for the Social Sciences (SPSS) version 26 (IBM Corp., Armonk, NY). We applied statistical tests, including the Chi-squared test (χ2) and the Mann-Whitney test for non-parametric variables.
RESULTS
Most of our participants were young, with a mean age of 25.94 and single (69.5%). Moreover, many (68.8%) had a bachelor's degree. A notable portion of participants stated they had no family history (86.1%) of pre-eclampsia and (98.1%) no previous experience with pre-eclampsia. Approximately 50% recognised hypertension as a symptom, while 44.1% identified persistent headaches. However, complications such as fetal and maternal death were better-known consequences of pre-eclampsia. 11.3% of participants had adequate knowledge about pre-eclampsia, 39.3% had moderate knowledge, and 49.4% had inadequate knowledge. It is a fact that higher levels of knowledge are positively correlated with advanced age, prior pregnancy experience, and a family history of pre-eclampsia.
CONCLUSION
This study highlights the limited knowledge and awareness of pre-eclampsia among Saudi women of reproductive age. Addressing this knowledge gap is crucial for preventing pre-eclampsia-related maternal and fetal complications. Policymakers and healthcare providers should consider implementing educational programs to raise awareness and improve outcomes for pregnant women in Saudi Arabia and similar regions.
PubMed: 38143610
DOI: 10.7759/cureus.49233 -
American Journal of Physiology. Heart... Jan 2024Adverse pregnancy outcomes (APOs: hypertensive disorders, gestational diabetes, preterm birth, and placental disorders) are associated with cardiovascular disease risk...
Adverse pregnancy outcomes (APOs: hypertensive disorders, gestational diabetes, preterm birth, and placental disorders) are associated with cardiovascular disease risk or blood volume abnormalities. Traditional risk factors might not identify highest risk people in the early years after APO deliveries. Test the hypothesis that vascular function is worse, and plasma volume-regulating renal hormones are lower after delivery in people who did versus did not have an APO. Adult participants 6 mo-3 years postdelivery of a singleton infant participated in this cross-sectional study. Exclusion criteria included current smoking, current use of certain medications, and diabetes outside of pregnancy. Differences in measurements between participants with versus without APOs were determined with tests or Wilcoxon tests. Associations of renal hormones with APO history were assessed with linear regression, adjusted for age, race, body mass index (BMI), and sodium consumption. Of 86 participants, 38 (44%) had an APO history. Those with APOs were more likely to identify as Black and had a higher BMI, 34.0 kg/m [interquartile range (IQR), 24.6, 39.3] versus 24.2 kg/m [IQR, 21.2, 31.3], < 0.05. Most brachial and all aortic blood pressures were higher in those with APOs: median aortic blood pressure was 102/74 versus 96/68 mmHg, ≤ 0.05. There were no differences in arterial stiffness or endothelial function between groups. Aldosterone was lower (54 [IQR, 28-84] vs. 80 [IQR, 39-150] pmol/L) in participants with past APOs. Blood pressures were higher, and aldosterone was lower in participants with past APOs. Associations of aldosterone with APO history persisted after adjustment. Neither renin nor aldosterone were related to vascular function. Adverse pregnancy outcomes (APOs) are associated with cardiovascular disease (CVD) risk. Traditional CVD risk factors may not fully capture excess CVD risk soon after APOs. Vascular dysfunction and plasma volume irregularities may be detectable. We found people with APOs had worse blood pressures, higher BMI, and lower aldosterone levels versus those without APOs in the early years after delivery. Vascular function was similar between groups. Future research should assess vascular function and renal hormones at multiple timepoints during the perinatal period.
Topics: Adult; Infant; Pregnancy; Infant, Newborn; Female; Humans; Pregnancy Outcome; Aldosterone; Cardiovascular Diseases; Cross-Sectional Studies; Premature Birth; Placenta
PubMed: 37921666
DOI: 10.1152/ajpheart.00641.2023 -
Antibodies (Basel, Switzerland) Aug 2023Today, the home pregnancy test is the most frequently performed laboratory test for self-diagnosis (home diagnostic test). It is also the first laboratory test that has... (Review)
Review
Today, the home pregnancy test is the most frequently performed laboratory test for self-diagnosis (home diagnostic test). It is also the first laboratory test that has been adapted for self-use at home. This is probably because women have always wanted to know the answer to the question: "Am I pregnant or not?" and always preferred to know the answer to this question intimately and in a discreet way. The history of the pregnancy test is also an interesting example of how the discovery of antibodies and the development of in vitro diagnostic methods based on the antigen-antibody reaction were important for the development of laboratory and clinical diagnostics. Immunodiagnostic techniques (based on the antigen-antibody reaction) are currently the basis of modern specialist laboratory diagnostics, which is essential in clinical diagnosis. The history of the pregnancy test is an interesting one and dates back to ancient times. A pregnancy test is defined as a procedure intended to reveal the presence or absence of pregnancy. Nowadays, every pregnancy test is based on the detection of human chorionic gonadotropin (hCG) in urine or blood. Human chorionic gonadotropin is secreted by the placenta right after a fertilized egg cell implants in the uterus and can be detected in both the urine and blood of pregnant women. Urine pregnancy tests are convenient for self-use at home. Blood tests are performed in medical laboratories. Specialized laboratory methods not only detect hCG but also determine the concentration of this hormone. However, both of these methods are highly accurate and common. Throughout the ages, many different methods were used to detect pregnancy at the earliest stage. Grain, wine, and various small animals were used as research tools. These were both long-term and often unreliable; most were based on folk beliefs and superstitions. Animal pregnancy tests were the first biological tests used in this field. This was a significant advance in the accurate detection of relatively early pregnancy. Animal tests in modern times are considered cruel and inhumane, no matter how reliable their results can be. Their place is now taken by much more specific, more sensitive, and definitely more ethical immunochemical tests. The pregnancy test and the methods to find out whether a woman is pregnant have gone through massive transformations, from bioassays using plants to bioassays on animals to advanced immunochemical techniques and biosensors. Modern pregnancy tests are not invasive and are very sensitive. Nowadays, it takes only about 3 min to know the answer to the question: "Am I pregnant or not?". However, it was not always as simple as it is today. This manuscript aims to show the important role played by antibodies in the development of laboratory and clinical diagnostics in the example of the interesting history of the pregnancy test.
PubMed: 37753970
DOI: 10.3390/antib12030056 -
Reproductive Sciences (Thousand Oaks,... Apr 2024Routine semen analysis provides considerable information regarding sperm parameters; however, it is not solely adequate to predict male fertility potential. In the past... (Review)
Review
Routine semen analysis provides considerable information regarding sperm parameters; however, it is not solely adequate to predict male fertility potential. In the past two decades, several advance sperm function tests have been developed. The present systematic review intends to assess the clinical utility of available advance sperm function tests in predicting the male fertility potential. A systematic literature search was conducted as per PRISMA guidelines using PubMed, MEDLINE, Google Scholar, and Cochrane Library. Different keywords either singly or in combination were used to retrieve the relevant articles related to sperm function tests, male fertility, and pregnancy outcomes. A total of 5169 articles were obtained, out of which 110 meeting the selection criteria were included in this review. The majorly investigated sperm function tests are hypo-osmotic swelling test, acrosome reaction test, sperm capacitation test, hemizona binding assay, sperm DNA fragmentation test, seminal reactive oxygen species test, mitochondrial dysfunction tests, antisperm antibody test, nuclear chromatin de-condensation (NCD) test, etc. The different advance sperm function tests analyse different aspects of sperm function. Hence, any one test may not be helpful to appropriately predict the male fertility potential. Currently, the unavailability of high-quality clinical data, robust thresholds, complex protocols, high cost, etc., are the limiting factors and prohibiting current sperm function tests to reach the clinics. Further multi-centric research efforts are required to fulfil the existing lacunas and pave the way for these tests to be introduced into the clinics.
Topics: Pregnancy; Female; Male; Humans; Infertility, Male; Semen; Sperm Motility; Spermatozoa; Fertility
PubMed: 38012524
DOI: 10.1007/s43032-023-01405-7 -
Ultrasound in Obstetrics & Gynecology :... May 2024This systematic review and meta-analysis aimed to evaluate the performance of existing externally validated prediction models for pre-eclampsia (PE) (specifically,... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
This systematic review and meta-analysis aimed to evaluate the performance of existing externally validated prediction models for pre-eclampsia (PE) (specifically, any-onset, early-onset, late-onset and preterm PE).
METHODS
A systematic search was conducted in five databases (MEDLINE, EMBASE, Emcare, CINAHL and Maternity & Infant Care Database) and using Google Scholar/reference search to identify studies based on the Population, Index prediction model, Comparator, Outcome, Timing and Setting (PICOTS) approach until 20 May 2023. We extracted data using the CHARMS checklist and appraised the risk of bias using the PROBAST tool. A meta-analysis of discrimination and calibration performance was conducted when appropriate.
RESULTS
Twenty-three studies reported 52 externally validated prediction models for PE (one preterm, 20 any-onset, 17 early-onset and 14 late-onset PE models). No model had the same set of predictors. Fifteen any-onset PE models were validated externally once, two were validated twice and three were validated three times, while the Fetal Medicine Foundation (FMF) competing-risks model for preterm PE prediction was validated widely in 16 different settings. The most common predictors were maternal characteristics (prepregnancy body mass index, prior PE, family history of PE, chronic medical conditions and ethnicity) and biomarkers (uterine artery pulsatility index and pregnancy-associated plasma protein-A). The FMF model for preterm PE (triple test plus maternal factors) had the best performance, with a pooled area under the receiver-operating-characteristics curve (AUC) of 0.90 (95% prediction interval (PI), 0.76-0.96), and was well calibrated. The other models generally had poor-to-good discrimination performance (median AUC, 0.66 (range, 0.53-0.77)) and were overfitted on external validation. Apart from the FMF model, only two models that were validated multiple times for any-onset PE prediction, which were based on maternal characteristics only, produced reasonable pooled AUCs of 0.71 (95% PI, 0.66-0.76) and 0.73 (95% PI, 0.55-0.86).
CONCLUSIONS
Existing externally validated prediction models for any-, early- and late-onset PE have limited discrimination and calibration performance, and include inconsistent input variables. The triple-test FMF model had outstanding discrimination performance in predicting preterm PE in numerous settings, but the inclusion of specialized biomarkers may limit feasibility and implementation outside of high-resource settings. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Topics: Female; Humans; Pregnancy; Pre-Eclampsia; Predictive Value of Tests; Pulsatile Flow; Risk Assessment
PubMed: 37724649
DOI: 10.1002/uog.27490 -
Urology Jan 2024To determine the prevalence of pregnancy complications, infertility, and maternal support for female urologists in comparison to the general population and other female...
OBJECTIVE
To determine the prevalence of pregnancy complications, infertility, and maternal support for female urologists in comparison to the general population and other female physicians.
METHODS
An anonymous, voluntary survey was distributed to female physicians via private physician social media groups from June to August 2021. The survey queried pregnancy demographics and complications, infertility diagnosis and treatment, workplace environment, and prior education on these topics. Results were compared between urologists and the general population and other female physicians with Fisher exact test, chi-square with Yates's correction, or Student's t tests as indicated.
RESULTS
Four thousand six hundred twelve female physicians completed the survey including 241 (5%) urologists. Compared with the general population, urologists were more likely to have a miscarriage or preterm birth, have children later in life, and undergo infertility evaluation or infertility treatment (all P < .0001). 42% of urologists reported experiencing a pregnancy complication and only 9% of those surveyed received education on the risks of delaying pregnancy. Despite being educated more often regarding the risks of delaying pregnancy compared to other physicians, urologists were less likely to have children, had fewer children, and were more likely to be discouraged from starting a family during training and practice (all P < .0001). Additionally, urologists reported shorter parental leave, worked more hours per week while pregnant, and were less likely to receive lactation accommodations compared to other female physicians (all P < .001).
CONCLUSION
Education for trainees on family planning and fostering a culture of support are deficits identified in overcoming obstetric barriers in urologists.
Topics: Pregnancy; Child; Humans; Infant, Newborn; Female; Urologists; Premature Birth; Physicians; Physicians, Women; Surveys and Questionnaires; Pregnancy Complications; Infertility; Urology
PubMed: 37852307
DOI: 10.1016/j.urology.2023.08.048 -
The Lancet. Child & Adolescent Health Oct 2023Infants born to women with HIV in settings with a high tuberculosis burden are at risk of tuberculosis infection and rapid progression to active disease. Maternal... (Randomized Controlled Trial)
Randomized Controlled Trial
Timing of maternal isoniazid preventive therapy on tuberculosis infection among infants exposed to HIV in low-income and middle-income settings: a secondary analysis of the TB APPRISE trial.
BACKGROUND
Infants born to women with HIV in settings with a high tuberculosis burden are at risk of tuberculosis infection and rapid progression to active disease. Maternal isoniazid preventive therapy might mitigate this risk, but optimal timing of therapy remains unclear. The TB APPRISE trial showed that initiation of isoniazid during pregnancy resulted in more frequent adverse pregnancy outcomes than when initiated postpartum. We aimed to determine the proportion of infants testing positive for tuberculosis infection born to mothers who initiated isoniazid therapy antepartum compared with postpartum using two commonly used tests, the test agreement, and predictors of test positivity.
METHODS
TB APPRISE was a randomised, double-blind, placebo-controlled, non-inferiority trial done at 13 study sites across eight countries (Botswana, Haiti, India, South Africa, Tanzania, Thailand, Uganda, and Zimbabwe). Pregnant women with HIV on antiretroviral therapy were randomly assigned to receive immediate isoniazid preventive therapy (28 weeks isoniazid [300 mg daily], then placebo until week 40 after delivery) or deferred treatment (placebo until week 12 after delivery, then isoniazid [300 mg daily] for 28 weeks). Mother-infant pairs were followed up until 48 weeks after delivery. We included all liveborn infants with a tuberculin skin test or interferon-γ release assay (IGRA) at 44 weeks. The outcomes assessed in this secondary analysis were tuberculosis test positivity by study group, test agreement, and predictors of test positivity. This study was registered with ClinicalTrials.gov, NCT01494038.
FINDINGS
Between Aug 19, 2014, and April 4, 2016, 956 mothers were randomly assigned, and 749 mother-child pairs were included in this secondary analysis. Of 749 infants, 694 (93%) received Bacille Calmette-Guérin (BCG) vaccination, 675 (90%) were born to mothers who had completed isoniazid treatment, 20 (3%) were exposed to tuberculosis, seven (1%) became HIV positive, and one (<1%) developed probable tuberculosis. 43 (6%; 95% CI 4-8]) of 732 infants had a positive IGRA test result and 55 (8%; 6-10) of 727 infants had a positive tuberculin skin test result. Test positivity did not differ by study group (p=0·88 for IGRA; p=0·44 for tuberculin skin test). Test agreement was poor (κ=0·107 [95% CI 0·002-0·212]). Infant tuberculin skin test positivity was associated with breastfeeding (adjusted odds ratio 6·63 [95% CI 1·57-27·9]), BCG vaccination (4·97 [1·50-16·43]), and maternal tuberculin skin test positivity at delivery (3·28 [1·70-6·33]); IGRA positivity was associated with female sex (2·09 [1·06-4·14]).
INTERPRETATION
Deferral of maternal isoniazid preventive therapy to early postpartum had no effect on infant tuberculosis acquisition in our trial population, regardless of the diagnostic test used; however, tuberculosis test agreement is poor during infancy.
FUNDING
US National Institutes of Health.
Topics: United States; Female; Infant; Humans; Pregnancy; Isoniazid; Antitubercular Agents; BCG Vaccine; Tuberculosis; HIV Infections
PubMed: 37634517
DOI: 10.1016/S2352-4642(23)00174-8 -
Journal of Ovarian Research Jan 2024To investigate the effect of L-carnitine supplementation during the controlled ovarian stimulation (COS) cycle with antagonist protocol in patients with polycystic ovary... (Randomized Controlled Trial)
Randomized Controlled Trial
Adding L-carnitine to antagonist ovarian stimulation doesn't improve the outcomes of IVF/ ICSI cycle in patients with polycystic ovarian syndrome: a double-blind randomized clinical trial.
OBJECTIVE
To investigate the effect of L-carnitine supplementation during the controlled ovarian stimulation (COS) cycle with antagonist protocol in patients with polycystic ovary syndrome (PCOS) diagnosis undergoing IVF/ICSI treatment.
METHODS AND MATERIALS
This was a double-blind clinical trial study including 110 patients with PCOS attended to Royan Institute between March 2020 and February 2023. At the beginning of the COS cycle, the eligible patients were allocated into two groups randomly according to the coding list of the drugs prepared by the statistical consultant. In the experimental group, patients received 3 tablets daily (L-carnitine 1000 mg) from the second day of menstruation of the previous cycle until the puncture day in the cases of freeze-all embryos (6 weeks) or until the day of the pregnancy test (8 weeks) in fresh embryo transfer cycle. In the control group, patients received 3 placebo tablets for the same period of time. Weight assessment and fasting blood sugar and insulin tests, as well as serum lipid profile were also measured at the baseline and ovum pick-up day. The results of the COS cycle as well as the implantation and pregnancy rates were compared between groups.
RESULTS
Finally, 45 cases in L-carnitine group versus 47 cases in the placebo group were completed study per protocol. Data analysis showed that the two groups were homogeneous in terms of demographic characteristics and baseline laboratory tests and severity of PCOS. There is no statistically significant difference in terms of the oocyte recovery ratio and oocyte maturity rate, and the number and quality of embryos, as well as the rates of the fertilization, chemical and clinical pregnancy between groups. However, the means of weight (P < 0.001) and serum levels of fasting blood sugar (P = 0.021), fasting insulin (P = 0.004), triglyceride (P < 0.001) and cholesterol (P < 0.001), LDL (P < 0.001) have significantly decreased in women after consuming L-carnitine supplementation.
CONCLUSION
The oral intake of L-carnitine during COS in PCOS women for 6 weeks had no effect on COS and pregnancy outcomes. However, taking this supplement for 6 weeks has been associated with weight loss and improved lipid profile and serum glucose.
TRIAL REGISTRATION
The study was registered in the Clinicaltrials.gov site on December 17, 2020 (NCT04672720).
Topics: Pregnancy; Humans; Female; Carnitine; Polycystic Ovary Syndrome; Blood Glucose; Sperm Injections, Intracytoplasmic; Insulins; Lipids
PubMed: 38191449
DOI: 10.1186/s13048-023-01319-7 -
International Journal of Pediatric... Feb 2024The purpose of this study is comparing the newborn hearing screening failure rate between phenylketonuria (PKU) infants and matched healthy control infants.
OBJECTIVE
The purpose of this study is comparing the newborn hearing screening failure rate between phenylketonuria (PKU) infants and matched healthy control infants.
PATIENTS AND METHODS
Between April 2021 and April 2023, data obtained from the national newborn hearing screening program were examined for patients who presented to the pediatric metabolism clinic of Konya City Hospital with a clinical and genetic diagnosis of PKU. A healthy control group, matched for age and gender, was established. The newborn hearing screening test results, demographic information, and pregnancy data of infants with PKU and the control group were compared to assess risk factors.
RESULTS
In the initial screening test, 23 out of 73 PKU infants (31.5%) and 12 out of 73 infants in the control group (16.4%) failed the test (p = 0.033). Among the 23 PKU infants who did not pass the first test, 9 (35%) also failed the second test and were referred. In contrast, all 12 infants in the control group who did not pass the first test passed the second test. The failure rate in the second test was significantly higher in PKU infants compared to the control group (p = 0.003). It was observed that the maternal age of PKU infants who underwent the second test was significantly higher than that of the control group (p < 0.029). Diagnostic hearing test results were found to be normal in all nine PKU patients who failed the secondary screening test and were referred to a tertiary center.
CONCLUSION
In our study, it was determined that infants with phenylketonuria (PKU) who did not have any risk factors for hearing loss failed the hearing screening test significantly more than healthy infants.
Topics: Infant, Newborn; Infant; Pregnancy; Female; Child; Humans; Neonatal Screening; Phenylketonurias; Hearing Loss; Risk Factors; Hearing Tests; Hearing
PubMed: 38171256
DOI: 10.1016/j.ijporl.2023.111840 -
Ginekologia Polska May 2024Genitourinary tract infections in pregnant women are one of the causes of abnormal pregnancy development including miscarriages, premature labor or premature rupture of...
OBJECTIVES
Genitourinary tract infections in pregnant women are one of the causes of abnormal pregnancy development including miscarriages, premature labor or premature rupture of membranes (PPROM). Atypical bacteria responsible for reproductive tract infections include Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma urealyticum and Ureaplasma parvum. Identification of pathogens and appropriately selected therapy can improve obstetric outcomes in patients with symptoms of threatened miscarriage or threatened preterm labor. The purpose of our study is to analyze the impact of reproductive tract infections with ureaplasma and mycoplasma bacteria during pregnancy.
MATERIAL AND METHODS
In the presented study, we retrospectively analyzed the cases of 201 pregnant patients hospitalized in the Obstetrics and Gynecology Department of Poznan Regional Hospital in 2019-2022, who had a swab taken from external os area of the cervix for atypical bacteria - Ureaplasma and Mycoplasma. Only patients with symptoms of threatened miscarriage or threatened preterm labor were included in the study group. Microbiological tests were performed in the hospital laboratory with the Mycoplasma IST 3 test from Biomerieux.
RESULTS
We found a higher incidence of preterm labor in patients with symptoms of threatened preterm labor and a genital tract infection with Ureaplasma/Mycoplasma bacteria, compared to patients not infected with Mycoplasma/Ureaplasma - 31.1% vs 20% (p = 0.098). This observation in the case of Ureaplasma/Mycoplasma monoinfection group applied to 6 patients. - 75% of the group. Pregnant patients who had co-infection with other types of bacteria (48 patients in total) gave birth before 37 weeks of pregnancy in 27.1% of cases. We obtained a significant difference (p = 0.007) when comparing groups with positive and negative cultures for Ureaplasma/Mycoplasma by the presence of monoinfection/coinfection and the week of pregnancy in which delivery occurred. We also noted the effect of atypical bacterial infection for PPROM - this complication preceded preterm delivery in 40% of ureaplasma-positive patients, compared to 20% of PPROM without infection. We found a similar rate of preterm labor and pregnancy loss in Ureaplasma/Mycoplasma-positive patients who received antibiotic therapy (35.7%) compared to a group of pregnant women who did not receive treatment (31.6%).
CONCLUSIONS
Infection of the genital tract with atypical bacteria Ureaplasma and Mycoplasma has a negative impact on the course of pregnancy. Identification of the type of microorganisms in cervical canal secretions of pregnant patients with symptoms of threatened miscarriage or preterm labor seems crucial. The impact of antibiotic therapy though, requires further analysis.
PubMed: 38717222
DOI: 10.5603/gpl.99827