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International Urogynecology Journal Jul 2024The objective was to study the incidence of urinary incontinence (UI), associated risk factors and quality of life (QOL) in postpartum women.
INTRODUCTION AND HYPOTHESIS
The objective was to study the incidence of urinary incontinence (UI), associated risk factors and quality of life (QOL) in postpartum women.
METHODS
A prospective study was conducted with 406 postpartum women at Rajavithi Hospital and followed up over the phone between June 2020 and September 2021. Inclusion criteria were singleton pregnant women aged 18-45 years, and gestational age ≥ 37 weeks. Baseline characteristics (age, body mass index, birthweight, gestational age, parity, delivery type, smoking, and alcohol and caffeine intake) were recorded. UI was defined as a score ≥ 16.7% using the Urogenital Distress Inventory. Incontinence-related QOL was evaluated using the Incontinence Impact Questionnaire: a score of ≥ 70 indicated poor QOL. Outcomes were assessed during the postpartum period at 2 days, 6 weeks, 3 months, and 6 months. Multivariate logistic regression was used to analyze risk factors for UI.
RESULTS
The incidence of self-reported UI at 2 days, 6 weeks, 3 months, and 6 months postpartum were 39%, 3%, 1%, and 0% respectively. Caffeine consumption during pregnancy was only a risk factor for UI (adjusted RR 1.61, 95%CI 1.27-2.05, p < 0.001) after adjusting for age, BMI, birthweight, parity, delivery type, alcohol, smoking, and pelvic floor exercise. Three women with UI had poor QOL, whereas all women without UI reported a good QOL.
CONCLUSION
In our study sample, urinary incontinence was found in one-third of women during the early postpartum period, but for most women symptoms improved with the first 6 weeks and all resolved at 6 months. In this study, caffeine consumption during pregnancy was the only risk factor for UI.
PubMed: 38951165
DOI: 10.1007/s00192-024-05833-0 -
Nutrition & Diabetes Jun 2024This study aimed to assess whether the Haptoglobin (Hp) genotype influences the relationship between hemoglobin (Hb) levels and the development of gestational diabetes...
BACKGROUND
This study aimed to assess whether the Haptoglobin (Hp) genotype influences the relationship between hemoglobin (Hb) levels and the development of gestational diabetes mellitus (GDM). Additionally, it sought to evaluate the interaction and joint association of Hb levels and Hp genotype with GDM risk.
METHODS
This retrospective study involved 358 women with GDM and 1324 women with normal glucose tolerance (NGT). Peripheral blood leukocytes were collected from 360 individuals at 14-16 weeks' gestation for Hp genotyping. GDM was diagnosed between 24-28 weeks' gestation. Interactive moderating effect, joint analysis, and mediation analysis were performed to evaluate the crosslink of Hb levels and Hp genotype with GDM risk.
RESULTS
Women who developed GDM had significantly higher Hb levels throughout pregnancy compared to those with NGT. Increase first-trimester Hb concentration was associated with a progressive rise in GDM incidence, glucose levels, glycosylated hemoglobin levels, Homeostasis Model Assessment for Insulin Resistance (HOMA-IR) values, cesarean delivery rates, and composite neonatal outcomes. Spline regression showed a significant linear association of GDM incidence with continuous first-trimester Hb level when the latter exceeded 122 g/L. Increased first-trimester Hb concentration was an independent risk factor for GDM development after adjusting for potential confounding factors in both the overall population and a matched case-control group. The Hp2-2 genotype was more prevalent among pregnant women with GDM when first-trimester Hb exceeded 122 g/L. Significant multiplicative and additive interactions were identified between Hb levels and Hp genotype for GDM risk, adjusted for age and pre-pregnancy BMI. The odds ratio (OR) for GDM development increased incrementally when stratified by Hb levels and Hp genotype. Moreover, first-trimester Hb level partially mediated the association between Hp genotype and GDM risk.
CONCLUSION
Increased first-trimester Hb levels were closely associated with the development of GDM and adverse pregnancy outcomes, with this association moderated by the Hp2-2 genotype.
Topics: Humans; Female; Pregnancy; Diabetes, Gestational; Haptoglobins; Retrospective Studies; Adult; Pregnancy Trimester, First; Genotype; Hemoglobins; China; Risk Factors; Asian People; Glycated Hemoglobin; Blood Glucose; Insulin Resistance; East Asian People
PubMed: 38951151
DOI: 10.1038/s41387-024-00309-y -
Zhonghua Fu Chan Ke Za Zhi Jun 2024
Review
Topics: Humans; Pregnancy; Prenatal Diagnosis; Female; Genetic Therapy; Genetic Testing; Mutation; Immune System Diseases; Fetal Therapies
PubMed: 38951082
DOI: 10.3760/cma.j.cn112141-20240111-00030 -
Zhonghua Fu Chan Ke Za Zhi Jun 2024To investigate the effects of cervical cold knife conization (CKC) on preterm delivery, other pregnancy complications and neonatal outcomes, and explore the...
To investigate the effects of cervical cold knife conization (CKC) on preterm delivery, other pregnancy complications and neonatal outcomes, and explore the relationship between preterm delivery risk and the depth and volume of conization. The clinical data and pregnancy outcomes of 272 women who underwent CKC in Peking Union Medical College Hospital from January 2002 to March 2018 (conization group) and 1 647 pregnant women who gave birth in Peking Union Medical College Hospital during January to December 2019 (control group) were collected. The preterm delivery, premature rupture of membranes, other pregnancy complications and neonatal outcomes of the two groups were compared, and the relationship between the depth and volume of conization and the risk of preterm delivery in postoperative singleton pregnancy was analyzed. (1) There were no significant differences between the two groups in delivery age, parity, proportion of singleton pregnancy, proportion of assisted reproductive technology (all >0.05). (2) The rate of preterm delivery in the conization group was significantly higher than that in the control group [14.8% (39/264) vs 5.7% (91/1 589); =28.397, <0.001]. There were still significant differences in preterm delivery rates between the two groups at <34 weeks and 34-37 weeks (all <0.01). There was no significant difference in the incidence of premature rupture of membrane between the two groups [23.5% (62/264) vs 23.4% (372/1 589); =0.001, =0.979], but the incidence of preterm premature rupture of membrane in the conization group was significantly higher than that in the control group [11.4% (30/264) vs 2.2% (35/1 589); =56.132, <0.001]. (3) The rate of cesarean section in the conization group was higher than that in the control group [59.6% (162/272) vs 38.8% (639/1 647); =41.377, <0.001]. The birth weight of preterm infants in the conization group was significantly higher than that in the control group [(2 409±680) vs (2 150±684) g; =2.184, =0.030]. However, there were no statistically significant differences in the incidence of gestational diabetes mellitus, hypertensive disorders in pregnancy, the birth weight of full-term infants, incidence of small for gestational age infant and neonatal intensive care unit admission rate between the two groups (all >0.05). (4) The preterm delivery rates of coning depth >15 mm, cone size ≥2 cm and cone size <2 cm were higher than that in the control group (all <0.05). When the coning depth ≤15 mm, the preterm delivery rate in the conization group was higher than that in the control group, but there was no significant difference (=0.620). The rate of preterm delivery of pregnant women with coning depth >15 mm was significantly higher than those with coning depth ≤15 mm (=3.084, 95%: 1.474-6.453; =0.001). There was no significant difference in the preterm delivery rate between pregnant women with cone size >2 cm and those with cone size ≥2 cm (=1.700, 95%: 0.935-3.092; =0.077). The risk of preterm delivery and preterm premature rupture of membranes in subsequent pregnancies are increased after cervical CKC, and the risk of preterm delivery is positively correlated with the depth of cervical coning.
Topics: Humans; Female; Pregnancy; Conization; Pregnancy Outcome; Premature Birth; Adult; Fetal Membranes, Premature Rupture; Cervix Uteri; Pregnancy Complications; Retrospective Studies; Infant, Newborn; Uterine Cervical Neoplasms; Uterine Cervical Dysplasia
PubMed: 38951080
DOI: 10.3760/cma.j.cn112141-20240202-00072 -
Zhonghua Fu Chan Ke Za Zhi Jun 2024To investigate the relationship between the polymorphism of endoplasmic reticulum aminopeptidase 1 (ERAP-1) gene and the occurrence of pre-eclampsia (PE). A...
To investigate the relationship between the polymorphism of endoplasmic reticulum aminopeptidase 1 (ERAP-1) gene and the occurrence of pre-eclampsia (PE). A case-control study was conducted in Beijing Obstetrics and Gynecology Hospital from October 2018 to October 2021. A total of 51 PE pregnant women with onset gestational age<34 weeks were selected as the PE group, and 48 normal pregnant women during the same period were selected as the control group. Venous blood samples were collected from the pregnant women before delivery and umbilical cord within 5 minutes after delivery. Single nucleotide polymorphisms (SNP) of ERAP-1 gene in the pregnant women and their fetus were detected by next-generation sequencing. Univariate analysis and multivariate logistic regression analysis were used to analyze all the SNP loci and alleles detected in the two groups, and the significant SNP were screened. (1) A total of 13 target SNP loci of maternal ERAP-1 gene were selected by univariate analysis. Among them, the frequency distribution of genotypes at 96096828, 96121524, 96121715, 96122260 and 96122281 showed statistically significant differences between PE group and control group (all <0.05). Multivariate logistic regression analysis showed that the risk of PE in pregnant women with TC genotype at locus 96121524 was 2.002 times higher than those with TT genotype (95%: 0.687-5.831, =0.020). (2) A total of 4 target SNP loci of ERAP-1 gene in fetal were selected by univariate analysis, and there was no statistical significance in gene polymorphism of the 4 loci between PE group and control group (all 0.05). Multivariate logistic regression analysis showed that the risk of PE in fetus with genotype AA at locus 96121406 was 0.236 times that of fetus with genotype GG (95%: 0.055-1.025, =0.016). ERAP-1 gene with TC genotype at 96121524 in the mother and GG genotype at 96121406 in the fetus might be related to the incidence of PE.
Topics: Humans; Female; Pregnancy; Pre-Eclampsia; Aminopeptidases; Minor Histocompatibility Antigens; Case-Control Studies; Polymorphism, Single Nucleotide; Genotype; Genetic Predisposition to Disease; Alleles; Adult; Gene Frequency; Fetus
PubMed: 38951078
DOI: 10.3760/cma.j.cn112141-20240201-00070 -
Zhonghua Fu Chan Ke Za Zhi Jun 2024To explore the feasibility of using ultrasonic convex array probe compressing abdominal wall to increase success rate of external cephalic version (ECV) without...
To explore the feasibility of using ultrasonic convex array probe compressing abdominal wall to increase success rate of external cephalic version (ECV) without anesthesia in full-term and near-term pregnancy. Totally 190 singleton and non-cephalic presentation pregnant women in 36-39 weeks of gestation performed ECV from April 2019 to August 2023 in the First Affiliated Hospital of Nanjing Medical University were analyzed. According to whether use the ultrasound probe compressing fetal breech or not, the pregnant women were divided into two groups: 81 cases in the probe-compressing group (including primipara 61 cases and multipara 20 cases) and 109 cases in the non-probe-compressing group(including primipara 72 cases and multipara 37 cases). Clinical data, ECV related factors and complications were analyzed and compared between the two groups. (1) The overall success rate of ECV was 64.2% (122/190). There was no significant difference in the success rate of ECV between probe-compressing group and non-probe-compressing group [69.1% (56/81) vs 60.6% (66/109), =1.490, =0.222]. The total vaginal delivery rate after successful ECV was 81.1% (99/122), while 71.1% (54/76) in primipara and 97.8% (45/46) in multipara, respectively. (2) Compare to the non-probe-compressing group, the success rate of ECV in primipara was significantly higher in the probe-compressing group [45.8% (33/72) vs 70.5% (43/61)], but the gestational age was shorter and the height was higher in the probe-compressing group (all <0.05). The success rate of ECV of multipara in the probe-compressing group (65.0%, 13/20) was lower than that in the non-probe-compressing group (89.2%, 33/37), but there was no significant difference between the two groups (>0.05). (3) Multivariate logistic regression analysis showed that abdominal wall compressed by ultrasound probe (=2.601, 95%: 1.113-6.075; =0.027) and amniotic fluid index (AFI; =1.010, 95%: 1.001-1.020; =0.028) were positive factors for the successful rate of ECV in primipara pregnant women. (4) The main complication of ECV was transient fetal heart rate reduction (8.9%,17/190), the incidence in the probe-compressing group was significantly higher than that in the non-probe-compressing group [14.8% (12/81) vs 4.6% (5/109); =5.967, =0.015]. No statistical differences were found in rates of complications between the ECV successful and unsuccessful pregnant women, and between probe-compressing and non-probe-compressing groups (all >0.05). No adverse maternal and neonatal outcomes related to ECV were observed. The ultrasonic convex array probe compressing could significantly improve the success rate of ECV in primipara without increasing the incidence of adverse maternal and fetal outcomes. The success rate of ECV in primipara is influenced by AFI and operation mode.
Topics: Humans; Female; Pregnancy; Version, Fetal; Adult; Ultrasonography, Prenatal; Anesthesia; Pregnancy Outcome; Feasibility Studies; Labor Presentation
PubMed: 38951077
DOI: 10.3760/cma.j.cn112141-20231226-00280 -
BMJ Open Jul 2024Compared with older women diagnosed with breast cancer, younger women are more likely to die of breast cancer and more likely to suffer psychosocially in both the...
Helping ourselves, helping others: the Young Women's Breast Cancer Study (YWS) - a multisite prospective cohort study to advance the understanding of breast cancer diagnosed in women aged 40 years and younger.
PURPOSE
Compared with older women diagnosed with breast cancer, younger women are more likely to die of breast cancer and more likely to suffer psychosocially in both the short-term and long term. The Young Women's Breast Cancer Study (YWS) is a multisite prospective cohort study established to address gaps in our knowledge about this vulnerable and understudied population.
PARTICIPANTS
The YWS enrolled 1302 women newly diagnosed with stages 0-IV breast cancer at age 40 years or younger at 13 academic and community sites in North America between 2006 and 2016. Longitudinal patient-reported outcome data are complemented by clinical data abstraction and biospecimen collection at multiple timepoints.
FINDINGS TO DATE
Key findings related to fertility include that nearly 40% of participants were interested in pregnancy following diagnosis; of those who reported interest, 10% pursued fertility preservation. Overall, approximately 10% of YWS participants became pregnant in the first 5 years after diagnosis; follow-up is ongoing for pregnancies after 5 years. Studies focused on psychosocial outcomes have characterised quality of life, post-traumatic stress and fear of recurrence, with findings detailing the factors associated with the substantial psychosocial burden many young women face during and following active treatment. Multiple studies have leveraged YWS biospecimens, including whole-exome sequencing of tumour analyses that revealed that select somatic alterations occur at different frequencies in young (age≤35) versus older women with luminal A breast cancer, and a study that explored clonal hematopoiesis of indeterminate potential found it to be rare in young survivors.
FUTURE PLANS
With a median follow-up of approximately 10 years, the cohort is just maturing for many relevant long-term outcomes and provides outstanding opportunities to further study and build collaborations to address gaps in our knowledge, with the ultimate objective to improve care and outcomes for young women with breast cancer.
TRIAL REGISTRATION NUMBER
NCT01468246.
Topics: Humans; Female; Breast Neoplasms; Prospective Studies; Adult; Quality of Life; Young Adult; Pregnancy; Fertility Preservation; North America; Patient Reported Outcome Measures; Stress Disorders, Post-Traumatic
PubMed: 38951008
DOI: 10.1136/bmjopen-2023-081157 -
BMJ Open Jul 2024The estimated prevalence of postpartum depression (PPD) worldwide, in China, and Shanghai is 17.2%, 18.0% and 23.2%, respectively. In 2021, Shanghai housed a population...
INTRODUCTION
The estimated prevalence of postpartum depression (PPD) worldwide, in China, and Shanghai is 17.2%, 18.0% and 23.2%, respectively. In 2021, Shanghai housed a population of 3.2 million childbearing-age migrant women, most of whom migrated to the city with their husbands for economic reasons. There is a general lack of help-seeking behaviour for mental disorders in China due to the perceived risk of social stigmatisation. In Shanghai, 70% of women did not seek professional help for perinatal mental health problems. We aim to gather information from multiple perspectives, such as the migrant women with PPD and perinatal depression (PND), their caregivers, health service providers and communities, to understand the help-seeking behaviour of postpartum migrant women with PPD or PND in China.
METHODS AND ANALYSIS
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework for Scoping Reviews will guide this review. A bilingual research librarian developed a comprehensive search strategy to retrieve published and unpublished English and Chinese studies involving factors influencing women's PPD or PND help-seeking behaviour in China. This literature includes perceptions, views, patterns, acceptance and refusal, tendencies, probability, service accessibility and utilisation, and facts. We will search PubMed, Embase, Web of Science and CINAHL for English literature and CINKI for Chinese literature. Backward and forward snowball approaches will be used to identify additional relevant papers from the reference lists of selected papers. Two independent reviewers will screen the title and abstract and review the full text of selected papers to identify eligible articles for data extraction. We will build a Microsoft Access database to record the extracted data. The results will be presented in tables and a causal map to demonstrate the relationships between extracted variables and help-seeking behaviours for PPD and PND. A conceptual simulation model will be formulated based on the information from the literature to validate the logic of the relationships between variables, identify knowledge gaps and gain insights into potential intervention approaches. Experts and stakeholders will be invited to critique and comment on the results during group model building (GMB) workshops in Shanghai. These comments will be essential to validate the findings, receive feedback and obtain additional insights.
ETHICS AND DISSEMINATION
The literature review component of our study does not require ethical approval because the information and data collected will be obtained from publicly available sources and will not involve human subjects. Our collaborating research partner, International Peach Maternal Child Hospital, obtained the IRB approval (GKLW-A-2023-020-01) for screening and enrolling participants in GMB workshops. Stanford University received IRB approval under protocol number 67 419. The full review will be presented at a relevant conference and submitted to a peer-reviewed scientific journal for publication to report findings.
Topics: Humans; Female; China; Transients and Migrants; Depression, Postpartum; Help-Seeking Behavior; Patient Acceptance of Health Care; Research Design; Pregnancy; Review Literature as Topic
PubMed: 38951005
DOI: 10.1136/bmjopen-2023-082571 -
BMJ Open Jul 2024The natural and best approach to give newborns the nutrients they need for healthy growth and development is through breast feeding. Breastfeeding rates fall more...
BACKGROUND
The natural and best approach to give newborns the nutrients they need for healthy growth and development is through breast feeding. Breastfeeding rates fall more sharply with time for mothers under the age of 20 years.
AIM
This study sought to explore the challenges experienced by adolescent mothers who visit the department of obstetrics and gynaecology of Korle Bu Teaching Hospital in Ghana.
METHOD
This study employed a qualitative phenomenology design and collected data from adolescent mothers. Data were gathered with the aid of a semistructured in-depth interview guide from 13 breastfeeding adolescent mothers. Data for the study were analysed using content analysis. The study was conducted at the obstetrics and gynaecology department of Korle Bu Teaching Hospital, Ghana.
FINDINGS
Two major themes were generated from the study to be the challenges that confront adolescent breastfeeding mothers, and they are maternal factors of breastfeeding barriers and societal factors of breastfeeding barriers. Subcategories were generated for both themes during the process.
CONCLUSION AND RECOMMENDATION
Training of pregnant adolescents during antenatal care visits on how to manage the inability to lactate, breastfeeding stress, painful and sore nipple, engorged breast, stigma from society will lessen their burden. Furthermore, training close family members and friends on how to be kind and support adolescent mothers during breast feeding is important. In-service training should be organised for health workers to enhance their knowledge and practice of approaching and guiding adolescent mothers on effective breast feeding and the provision of cubicles in public places where adolescent mothers can comfortably breastfeed.
Topics: Humans; Breast Feeding; Ghana; Female; Adolescent; Hospitals, Teaching; Mothers; Qualitative Research; Young Adult; Pregnancy; Infant, Newborn; Interviews as Topic; Pregnancy in Adolescence; Health Knowledge, Attitudes, Practice
PubMed: 38950996
DOI: 10.1136/bmjopen-2023-077504 -
BMJ Open Jul 2024Toxoplasmosis is a zoonotic parasitic disease caused by . It has a wide host range and is capable of vertical transmission in pregnant women, which may lead to...
BACKGROUND
Toxoplasmosis is a zoonotic parasitic disease caused by . It has a wide host range and is capable of vertical transmission in pregnant women, which may lead to undesirable pregnancy outcomes such as congenital malformations, miscarriage, premature birth and stillbirth. This study investigated the seroprevalence of infection among pregnant women attending the antenatal clinic at Namwala District Hospital in Southern Zambia.
METHODS
This was a cross-sectional study where blood was collected, and the serum was tested for IgG and IgM. A questionnaire was administered to participants on demographic characteristics and risk factors. Data were entered in Microsoft Excel and exported to STATA version 14 for analysis.
RESULTS
A total of 401 women were enrolled in the study from 3 March to 5 August 2021. The seroprevalence of IgG was 4.2% (n=17), while the seroprevalence of IgM was 0.7% (n=3). The median age was 27 (IQR: 24-30) years, and a larger proportion had primary-level education (n=223, 55.6%). The majority (81.6%) of the women were married. None of the risk factors investigated in this study were significant for infection.
CONCLUSION
There was a low seroprevalence of infection among pregnant women in the Namwala district of Southern Province, Zambia, and regular screening may not be warranted in this population. Continued research on toxoplasmosis is recommended to understand its epidemiology across Zambia.
Topics: Humans; Female; Zambia; Cross-Sectional Studies; Seroepidemiologic Studies; Adult; Pregnancy; Toxoplasmosis; Risk Factors; Toxoplasma; Young Adult; Immunoglobulin M; Antibodies, Protozoan; Pregnancy Complications, Parasitic; Immunoglobulin G; Prenatal Care
PubMed: 38950992
DOI: 10.1136/bmjopen-2024-084582