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JAMA Network Open Sep 2022Glycemic control is the cornerstone of gestational diabetes management. Glycemic control trajectories account for differences in longitudinal patterns throughout...
IMPORTANCE
Glycemic control is the cornerstone of gestational diabetes management. Glycemic control trajectories account for differences in longitudinal patterns throughout pregnancy; however, studies on glycemic control trajectories are scarce.
OBJECTIVE
To examine whether glycemic control trajectories from gestational diabetes diagnosis to delivery were associated with differential risk of perinatal complications.
DESIGN, SETTING, AND PARTICIPANTS
This population-based cohort study included individuals with gestational diabetes with longitudinal electronic health record data from preconception to delivery who received prenatal care at Kaiser Permanente Northern California (KPNC) and were enrolled in KPNC's telemedicine-based gestational diabetes care program between January 2007 and December 2017. Data analysis was conducted from September 2021 to January 2022.
EXPOSURES
Glycemic control trajectories were derived using latent class modeling based on the American Diabetes Association's recommended self-monitoring of blood glucose measurements. Optimal glycemic control was defined as at least 80% of all measurements meeting the targets at KPNC clinical settings.
MAIN OUTCOMES AND MEASURES
Multivariable Poisson regression models were used to estimate the associations of glycemic control trajectories with cesarean delivery, preterm birth, shoulder dystocia, large- and small-for-gestational-age, and neonatal intensive care unit admission and stay of 7 days or longer.
RESULTS
Among a total of 26 774 individuals (mean [SD] age, 32.9 [5.0] years; 11 196 Asian or Pacific Islander individuals [41.8%], 1083 Black individuals [4.0%], 7500 Hispanic individuals [28.0%], and 6049 White individuals [22.6%]), 4 glycemic control trajectories were identified: stably optimal (10 528 individuals [39.3%]), rapidly improving to optimal (9151 individuals [34.2%]), slowly improving to near-optimal (4161 individuals [15.5%]), and slowly improving to suboptimal (2934 individuals [11.0%]). In multivariable models with the rapidly improving to optimal trajectory group as the reference group, glycemic control trajectories were associated with perinatal complications with a gradient across stably optimal to slowly improving to suboptimal. For individuals in the stably optimal trajectory group, there were lower risks of cesarean delivery (adjusted relative risk [aRR], 0.93 [95% CI, 0.89-0.96]), shoulder dystocia (aRR, 0.75 [95% CI, 0.61-0.92]), large-for-gestational age (aRR, 0.74 [95% CI, 0.69-0.80]), and neonatal intensive care unit admission (aRR, 0.90 [95% CI, 0.83-0.97]), while for patients in the slowly improving to suboptimal glycemic control trajectory group, risks were higher for cesarean delivery (aRR, 1.18 [95% CI, 1.12-1.24]; (P for trend < .001), shoulder dystocia (aRR, 1.41 [95% CI, 1.12-1.78]; P for trend < .001), large-for-gestational-age (aRR, 1.42 [95% CI, 1.31-1.53]; P for trend < .001), and neonatal intensive care unit admission (aRR, 1.33 [95% CI, 1.20-1.47]; P for trend < .001). The risk of small-for-gestational-age was higher in patients in the stably optimal group (aRR, 1.10 [95% CI, 1.02-1.20]) and lower in the slowly improving to suboptimal group (aRR, 0.63 [95% CI, 0.53-0.75]).
CONCLUSIONS AND RELEVANCE
These findings suggest that slowly improving to near-optimal and slowly improving to suboptimal glycemic control trajectories were associated with increased risk of perinatal complications. Future interventions should help individuals achieve glycemic control early after gestational diabetes diagnosis and throughout pregnancy to decrease the risk of perinatal complications.
Topics: Adult; Blood Glucose; Cohort Studies; Diabetes, Gestational; Female; Glycemic Control; Humans; Infant, Newborn; Infant, Newborn, Diseases; Pregnancy; Premature Birth; Shoulder Dystocia
PubMed: 36173631
DOI: 10.1001/jamanetworkopen.2022.33955 -
The Pan African Medical Journal 2019The association of myoma and pregnancy is becoming more frequent due to the increasing age of first pregnancy. It may affect the outcome of fertility, pregnancy, labor...
The association of myoma and pregnancy is becoming more frequent due to the increasing age of first pregnancy. It may affect the outcome of fertility, pregnancy, labor and peripartum course. A 37 years old patient was referred to our unit for discovering uterine leiomyoma at 37 weeks of pregnancy. Ultrasound screening showed a praevia isthmic leiomyoma measuring 16cm. A caesarean delivery was scheduled and a large interstitial isthmic uterine myoma measuring 25cm was found. Hysterectomy was corporeal. The post-operative and puerperium course was normal.
Topics: Adult; Cesarean Section; Female; Humans; Hysterectomy; Leiomyoma; Pregnancy; Pregnancy Complications, Neoplastic; Ultrasonography, Prenatal; Uterine Neoplasms
PubMed: 31692727
DOI: 10.11604/pamj.2019.33.216.14898 -
Reproductive Health Mar 2021Obstructed labor is a preventable obstetric complication. However, it is an important cause of maternal mortality and morbidity and of adverse outcomes for newborns in... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Obstructed labor is a preventable obstetric complication. However, it is an important cause of maternal mortality and morbidity and of adverse outcomes for newborns in resource-limited countries in which undernutrition is common resulting in a small pelvis in which there is no easy access to functioning health facilities with a capacity to carry out operative deliveries. Therefore, this systematic review and meta-analysis aimed to estimate the incidence, causes, and maternofetal outcomes of obstructed labor among mothers who gave birth in Ethiopia.
METHOD
for this review, we used the standard PRISMA checklist guideline. Different online databases were used for the review: PubMed, Google Scholar, EMBASE, Cochrane Library, HINARI, AFRO Library Databases, and African Online Journals. Based on the adapted PICO principles, different search terms were applied to achieve and access the essential articles. The search included all published and unpublished observational studies written only in the English language and conducted in Ethiopia. Microsoft Excel 16 was used for data entrance, and Stata version 11.0 (Stata Corporation, College Station, Texas, USA) was used for data analysis.
RESULTS
I included sixteen (16) primary studies with twenty-eight thousand five hundred ninety-one (28,591) mothers who gave birth in Ethiopia. The pooled incidence of obstructed labor in Ethiopia was 12.93% (95% CI: 10.44-15.42, I = 98.0%, p < 0.001). Out of these, 67.3% (95% CI: 33.32-101.28) did not have antenatal care follow-up, 77.86% (95% CI: 63.07-92.66) were from the rural area, and 58.52% (95% CI: 35.73- 82.31) were referred from health centers and visited hospitals after 12 h of labor. The major causes of obstructed labor were cephalo-pelvic disproportion 64.65% (95% CI: 57.15- 72.14), and malpresentation and malposition in 27.24% (95% CI: 22.05-32.42) of the cases. The commonest complications were sepsis in 38.59% (95% CI: 25.49-51.68), stillbirth in 38.08% (95% CI: 29.55-46.61), postpartum hemorrhage in 33.54% (95% CI:12.06- 55.02), uterine rupture in 29.84% (95% CI: 21.09-38.58), and maternal death in 17.27% (95% CI: 13.47-48.02) of mothers who gave birth in Ethiopia.
CONCLUSION
This systematic review and meta-analysis showed that the incidence of obstructed labor was high in Ethiopia. Not having antenatal care follow-up, rural residency, and visiting hospitals after 12 h of labor increased the incidence of obstructed labor. The major causes of obstructed labor were cephalo-pelvic disproportion, and malpresentation and malpresentation. Additionally, the commonest complications were sepsis, stillbirth, postpartum hemorrhage, uterine rupture, and maternal death. Thus, promoting antenatal care service utilization, a good referral system, and availing comprehensive obstetric care in nearby health institutions are recommended to prevent the incidence of obstructed labor and its complications.
Topics: Cephalopelvic Disproportion; Dystocia; Ethiopia; Female; Humans; Incidence; Infant, Newborn; Maternal Mortality; Obstetric Labor Complications; Pregnancy; Pregnancy Outcome; Prenatal Care; Sepsis; Uterine Rupture
PubMed: 33691736
DOI: 10.1186/s12978-021-01103-0 -
American Journal of Translational... 2021This research was designed to probe into the influences of natural shoulder delivery combined with free position delivery on pregnant outcome and genital tract of...
OBJECTIVE
This research was designed to probe into the influences of natural shoulder delivery combined with free position delivery on pregnant outcome and genital tract of puerperants.
METHODS
Totally 128 puerperants who gave birth in our hospital from May 2018 to November 2019 were selected as the research objects. Among them, 66 in traditional position combined with traditional shoulder delivery were assigned to a conventional group (CG), and 62 in free position combined with natural shoulder delivery were assigned to a research group (RG). Their psychological mood, pain degree, pregnancy outcome, labor time, postpartum recovery and genital tract injury were compared.
RESULTS
Compared with the CG, the scores of visual analogue scale (VAS) pain, postpartum self-rating depression scale (SDS) and self-rating anxiety scale (SAS) in the RG during delivery were lower (<0.05); the first, second, third and total labor stages in the RG were shorter (<0.05). What's more, in the RG, the incidences of lateral episiotomy, urinary retention, stress urinary incontinence, transit cesarean section, shoulder dystocia and neonatal asphyxia were lower, while the perineum integrity and natural delivery rates were higher (<0.05); the postpartum height of uterus, lochia discharge and blood loss were lower, while milk yield was higher (<0.05).
CONCLUSION
Natural shoulder delivery combined with free position delivery can effectively improve the pregnancy outcome, benefit the postpartum recovery, shorten the labor process and reduce the degree of genital tract injury. Hence, it is worthy of clinical application.
PubMed: 35035762
DOI: No ID Found -
International Journal of Environmental... May 2021Objective-to overview, compare and generalize results of randomized clinical trials analyzing different oxytocin doses to prevent postpartum hemorrhage, initiate and... (Review)
Review
Objective-to overview, compare and generalize results of randomized clinical trials analyzing different oxytocin doses to prevent postpartum hemorrhage, initiate and maintain uterine contraction after Caesarean delivery. Methods-'PubMed', 'EMBASE', 'CENTRAL', and 'CINAHL' electronic databases were searched for clinical trials analyzing the effectiveness of different dose of oxytocin given intravenously during surgery for uterine contraction and to reduce postpartum hemorrhage. A systematic review of relevant literature sources was performed. Results-our search revealed 813 literature sources. A total of 15 randomized clinical trials, comparing different doses of oxytocin bolus and infusion used after caesarean delivery have met the selection criteria. Conclusion-oxytocin bolus 0.5-3 UI is considered an effective prophylactic dose. Recommended effective prophylactic oxytocin infusion dose is 7.72 IU/h, but it is unanswered whether we really need a prophylactic infusion of oxytocin if we choose effective bolus dose size and rate. Adverse hemodynamic effects were observed when a 5 UI oxytocin bolus was used. However, topics such as bolus dose size, infusion dose size and requirement as well as bolus injection rate, still remain unanswered. The doses that are recommended in the guidelines of peripartum hemorrhage prophylaxis are not confirmed by randomized controlled double-blind trials and more research should cover this topic.
Topics: Cesarean Section; Female; Humans; Oxytocics; Oxytocin; Postpartum Hemorrhage; Pregnancy; Randomized Controlled Trials as Topic; Uterine Inertia
PubMed: 34068723
DOI: 10.3390/ijerph18095029 -
Acta Clinica Croatica Jun 2021The objective of this study was to assess the relationship between women's age and risk of pregnancy-related complications. The study was a retrospective cohort analysis...
The objective of this study was to assess the relationship between women's age and risk of pregnancy-related complications. The study was a retrospective cohort analysis of the pregnancy-related complications and outcomes between two age groups of parturient women. Categorical data were expressed as absolute and relative frequencies. Statistical analysis was performed using χ-test. The incidence of gestational diabetes was higher in the 40-47 age group as compared with the 20-24 age group. The rates of hypertension, preeclampsia, intrahepatic cholestasis of pregnancy and hypothyroidism did not differ between the two groups. The rates of labor induction, oxytocin use, vaginal delivery, and need for episiotomy were higher in younger age group. Dystocia and breech presentation as indications for cesarean section were more common among younger women. According to study results, the risk of gestational diabetes and rates of cesarean delivery increased with advanced maternal age.
Topics: Cesarean Section; Delivery, Obstetric; Female; Humans; Labor, Induced; Pregnancy; Retrospective Studies; Risk Assessment
PubMed: 34744280
DOI: 10.20471/acc.2021.60.02.16 -
International Journal of Environmental... May 2022Background: The optimal treatment strategy for the follow-up and management of women with glucokinase maturity-onset diabetes of the young (GCK−MODY)during pregnancy... (Review)
Review
Background: The optimal treatment strategy for the follow-up and management of women with glucokinase maturity-onset diabetes of the young (GCK−MODY)during pregnancy remains unknown. Data regarding maternal and fetal outcomes are lacking. Aim: This paper summarizes the existing literature regarding the maternal and fetal outcomes of women with glucokinase MODY to guide future treatment strategy. Methods: A literature search was conducted in Pubmed, Embace, and Cochrane library with citation follow-up using the terms: glucokinase, MODY, diabetes, pregnancy, gestation, and outcomes. We searched for articles with known fetal mutational status. Relevant outcomes included: birthweight, large for gestational age (LGA), small for gestational age (SGA), macrosomia, cesarean delivery (CD), shoulder dystocia, congenital anomalies, miscarriages, preterm births, and long-term outcomes. Results: Fourteen relevant manuscripts were identified describing maternal and fetal outcomes. The percentage of LGA and macrosomia in 102 glucokinase -unaffected offspring (GCK−) was significantly higher than in the glucokinase -affected offspring (GCK+) (44% vs. 10%, p < 0.001 and 22% vs. 2%, p < 0.001, respectively). Among the 173 GCK(+) offspring, only 5% were SGA, which can be expected according to the normal distribution. We observed higher rates of CD and shoulder dystocia in the GCK(−) offspring. Conclusions: GCK(−) offspring have significantly higher birthweights and more birth complications. The optimal treatment strategy to guide management should take into consideration multiple variables other than fetal mutational status.
Topics: Birth Weight; Diabetes Mellitus, Type 2; Female; Fetal Macrosomia; Glucokinase; Humans; Infant, Newborn; Pregnancy; Pregnancy in Diabetics; Shoulder Dystocia
PubMed: 35627517
DOI: 10.3390/ijerph19105980 -
Proceedings of the National Academy of... Mar 2021Uterine contractile dysfunction leads to pregnancy complications such as preterm birth and labor dystocia. In humans, it is hypothesized that progesterone receptor...
Uterine contractile dysfunction leads to pregnancy complications such as preterm birth and labor dystocia. In humans, it is hypothesized that progesterone receptor isoform PGR-B promotes a relaxed state of the myometrium, and PGR-A facilitates uterine contraction. This hypothesis was tested in vivo using transgenic mouse models that overexpress PGR-A or PGR-B in smooth muscle cells. Elevated PGR-B abundance results in a marked increase in gestational length compared to control mice (21.1 versus 19.1 d respectively, < 0.05). In both ex vivo and in vivo experiments, PGR-B overexpression leads to prolonged labor, a significant decrease in uterine contractility, and a high incidence of labor dystocia. Conversely, PGR-A overexpression leads to an increase in uterine contractility without a change in gestational length. Uterine RNA sequencing at midpregnancy identified 1,174 isoform-specific downstream targets and 424 genes that are commonly regulated by both PGR isoforms. Gene signature analyses further reveal PGR-B for muscle relaxation and PGR-A being proinflammatory. Elevated PGR-B abundance reduces and and increases expression, which manifests a genetic profile of compromised oxytocin signaling. Functionally, both endogenous PLCL2 and its paralog PLCL1 can attenuate uterine muscle cell contraction in a CRISPRa-based assay system. These findings provide in vivo support that PGR isoform levels determine distinct transcriptomic landscapes and pathways in myometrial function and labor, which may help further the understanding of abnormal uterine function in the clinical setting.
Topics: Animals; Female; Gene Expression Regulation; Intracellular Signaling Peptides and Proteins; Mice; Mice, Mutant Strains; Parturition; Pregnancy; Receptors, Oxytocin; Receptors, Progesterone; TRPC Cation Channels; Transcriptome; Uterine Contraction
PubMed: 33707208
DOI: 10.1073/pnas.2011643118 -
Preventive Veterinary Medicine Jan 2023Dystocia or difficult calving in cattle is detrimental to the health of the afflicted cows and has a negative economic impact on the dairy industry. The goal of this...
Dystocia or difficult calving in cattle is detrimental to the health of the afflicted cows and has a negative economic impact on the dairy industry. The goal of this study was to create a data-driven tool for predicting the calving difficulty of non-heifer cows using input variables that are known prior to the moment of insemination. Compared to past studies, we excluded input variables that can only be known during or after insemination, such as birth weight and gestation length. This makes the model suitable for informing mating decisions that could reduce the incidence of difficult calvings or mitigate their consequences. We used a dataset consisting of 131,527 calving records of Holstein cattle, from which we derived a total of 274 phenotypic features and estimated breeding values. The distribution of classes in the dataset was 96.7 % normal calvings, and 3.3 % difficult calvings. We used a gradient boosted trees (XGBoost) as the learning model and a bagging ensemble approach to deal with the extreme class imbalance. The model achieved an average area under the ROC curve of 0.73 on unseen test data. Using feature importance analysis, we identified a number of features that have a high discriminatory value for calving difficulty, including maternal and paternal breeding values, and past phenotypic measurements of the cow.
Topics: Animals; Cattle; Female; Pregnancy; Birth Weight; Cattle Diseases; Dairying; Dystocia; Insemination; Reproduction; Risk Factors
PubMed: 36521412
DOI: 10.1016/j.prevetmed.2022.105812 -
PloS One 2021In the present study, records on 115,291 heifers distributed in 113 herds were used to investigate the association between age at the first calving (AFC) and lactation...
In the present study, records on 115,291 heifers distributed in 113 herds were used to investigate the association between age at the first calving (AFC) and lactation performance, lactation curve, the length of the first calving interval (CI), calf birth weight (CBW), and the incidence of dystocia in Holstein heifers in Iran. Based on the AFC, the heifers were classified into eight classes: AFC of 541 to 690 d, 691 to 720 d, 721 to 750 d, 751 to 780 d, 781 to 810 d, 811 to 840 d, 841 to 900 d, and 901 to 1200 d (AFC1 to AFC8, respectively). Multiple regression mixed models were used to investigate the association between AFC and lactation curve parameters, partial and 305-d lactation performance, 100- and 305-d SCS, and the length of the first calving (CI) interval. The mean (SD) and median AFC across all heifers was 760.2 (74.01) and 750 d, respectively. Of 115,291 heifers included, 28,192 and 7,602 heifers were, respectively, ≤ 720 and > 900 d when calving for the first time. More than 44% of the heifers were at 691 to 750 d (23 to 25 months) of age when calving for the first time. An increased AFC was associated with increased partial and 305-d lactation performance, 100- and 305-d SCS, initial milk yield, milk production at the peak of lactation, upward and downward slopes of the lactation curve. The 305-d fat percentage was associated with AFC; however, there was no association between AFC and 305-d protein percentage. An increased AFC was also associated with decreased milk production persistency, delayed peak time, longer CI, and higher calf birth weight. Compared to heifers calving for the first time between 691 to 780 d (23 to 26 months) of age, both increasing and decreasing AFC were associated with increased risk of dystocia. Controlling AFC is an important management factor in achieving a lower risk of dystocia, higher lactation performance, lower SCS, and shorter length of the calving interval.
Topics: Age Factors; Animals; Birth Weight; Cattle; Dairying; Dystocia; Female; Gravidity; Iran; Lactation; Milk; Parturition; Pregnancy; Weight Gain
PubMed: 33395420
DOI: 10.1371/journal.pone.0244825