-
EClinicalMedicine May 2024A recently undertaken multicenter randomized controlled trial (RCT) " (TOBOGM: 2017-2022) found that the diagnosis and treatment of pregnant women with early gestational...
Cost-effectiveness of diagnosis and treatment of early gestational diabetes mellitus: economic evaluation of the TOBOGM study, an international multicenter randomized controlled trial.
BACKGROUND
A recently undertaken multicenter randomized controlled trial (RCT) " (TOBOGM: 2017-2022) found that the diagnosis and treatment of pregnant women with early gestational diabetes mellitus (GDM) improved pregnancy outcomes. Based on data from the trial, this study aimed to assess the cost-effectiveness of diagnosis and treatment of early GDM (from <20 weeks') among women with risk factors for hyperglycemia in pregnancy compared with usual care (no treatment until 24-28 weeks') from a healthcare perspective.
METHODS
Participants' healthcare resource utilization data were collected from their self-reported questionnaires and hospital records, and valued using the unit costs obtained from standard Australian national sources. Costs were reported in US dollars ($) using the purchasing power parity (PPP) estimates to facilitate comparison of costs across countries. Intention-to-treat (ITT) principle was followed. Missing cost data were replaced using multiple imputations. Bootstrapping method was used to estimate the uncertainty around mean cost difference and cost-effectiveness results. Bootstrapped cost-effect pairs were used to plot the cost-effectiveness (CE) plane and cost-effectiveness acceptability curve (CEAC).
FINDINGS
Diagnosis and treatment of early GDM was more effective and tended to be less costly, i.e., dominant (cost-saving) [-5.6% composite adverse pregnancy outcome (95% CI: -10.1%, -1.2%), -$1373 (95% CI: -$3,749, $642)] compared with usual care. Our findings were confirmed by both the CE plane (88% of the bootstrapped cost-effect pairs fall in the south-west quadrant), and CEAC (the probability of the intervention being cost-effective ranged from 84% at a willingness-to-pay (WTP) threshold value of $10,000-99% at a WTP threshold value of $100,000 per composite adverse pregnancy outcome prevented). Sub-group analyses demonstrated that diagnosis and treatment of early GDM among women in the higher glycemic range (fasting blood glucose 95-109 mg/dl [5.3-6.0 mmol/L], 1-h blood glucose ≥191 mg/dl [10.6 mmol/L] and/or 2-h blood glucose 162-199 mg/dl [9.0-11.0 mmol/L]) was more effective and less costly (dominant) [7.8% composite adverse pregnancy outcome (95% CI: -14.6%, -0.9%), -$2795 (95% CI: -$6,638, -$533)]; the intervention was more effective and tended to be less costly [8.9% composite adverse pregnancy outcome (95% CI: -15.1%, -2.6%), -$5548 (95% CI: -$16,740, $1547)] among women diagnosed before 14 weeks' gestation as well.
INTERPRETATION
Our findings highlight the potential health and economic benefits from the diagnosis and treatment of early GDM among women with risk factors for hyperglycemia in pregnancy and supports its implementation. Long-term follow-up studies are recommended as a key future area of research to assess the potential long-term health benefits and economic consequences of the intervention.
FUNDING
National Health and Medical Research Council (grants 1104231 and 2009326), Region O¨rebro Research Committee (grants Dnr OLL-970566 and OLL-942177), Medical Scientific Fund of the Mayor of Vienna (project 15,205 and project 23,026), South Western Sydney Local Health District Academic Unit (grant 2016), and Western Sydney University Ainsworth Trust Grant (2019).
PubMed: 38813447
DOI: 10.1016/j.eclinm.2024.102610 -
Turkish Journal of Medical Sciences 2024The study is aimed to determine the relationship between the delivery and breastfeeding history of the patients and the clinicopathological properties of breast cancer.
BACKGROUND/AIM
The study is aimed to determine the relationship between the delivery and breastfeeding history of the patients and the clinicopathological properties of breast cancer.
MATERIALS AND METHODS
A questionnaire was utilized for the study, which included the age of diagnosis, the number of children at the time of diagnosis, the age of the children, and the breastfeeding period of each child.
RESULTS
The study included 828 patients. The median age at diagnosis was 47 years for parous women and 42 years for nonparous women (p < 0.001). The tumor size of the patients diagnosed within the breastfeeding period was significantly larger compared to the other patients. Estrogen and progesterone receptor positivity were lower in patients diagnosed during breastfeeding. Additionally, the mean number of positive lymph nodes, dissected lymph nodes, and positive lymph node/dissected lymph node ratio in parous and breastfed patients with a nonmetastatic disease were statistically significantly higher in multivariable analysis than those patients who were nulliparous and have not breastfed.
CONCLUSION
Breast cancer is seen at a later age in patients who are parous than those who have never given birth. Patients who are parous and have breastfed tend to present with a higher stage of the disease.
Topics: Humans; Female; Breast Neoplasms; Breast Feeding; Parity; Adult; Middle Aged; Pregnancy; Aged; Surveys and Questionnaires; Receptors, Progesterone
PubMed: 38812646
DOI: 10.55730/1300-0144.5784 -
The Journal of Maternal-fetal &... Dec 2024Epidural-related maternal fever in women is a common clinical phenomenon that leads to adverse consequences for mothers and neonates. The meta-analysis aimed to quantify... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Epidural-related maternal fever in women is a common clinical phenomenon that leads to adverse consequences for mothers and neonates. The meta-analysis aimed to quantify the risk for intrapartum maternal fever after epidural analgesia (EA) stratified according to parity. The secondary objective was to investigate the association between EA and maternal outcomes.
METHODS
An electronic literature search of the Medline/PubMed, Embase, Cochrane Library, Wanfang Data, and China National Knowledge Infrastructure databases was performed to identify studies reporting the occurrence of intrapartum fever in parturients. Studies were reviewed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and meta-analysis was performed using Review Manager version 5.3.
RESULTS
Seventeen randomized controlled trials (RCTs) (5959 parturients) were included. Odds ratios for maternal fever in the analysis were 4.17 (95% confidence interval (CI) 2.93-5.94) and 5.83 (95% CI 4.96-6.87), respectively. Results of subgroup analysis according to parity were consistent. EA significantly prolonged the length of the first stage of labor (MD 34.52 [95% CI 12.13-56.91]) and the second stage of labor (MD 9.10 [95% CI 4.51-13.68]). Parturients who received EA were more likely to undergo instrumental delivery (OR 2.03 [95% CI 1.44-2.86]) and oxytocin augmentation (OR 1.45 [95% CI 1.12-1.88]). There were no differences in cesarean delivery rates between the EA and non-EA groups.
CONCLUSIONS
Parturients who received EA exhibited a higher incidence of intrapartum fever. Credibility of the subgroup analyses was low because the mixed group did not effectively represent multiparas.
Topics: Humans; Analgesia, Epidural; Female; Pregnancy; Fever; Analgesia, Obstetrical; Obstetric Labor Complications; Randomized Controlled Trials as Topic
PubMed: 38812361
DOI: 10.1080/14767058.2024.2357168 -
Frontiers in Endocrinology 2024Increased maternal cortisol secretion has been observed during pregnancy and labor. However, due to the limitations in diagnostic methods, the dynamic change of cortisol...
BACKGROUND
Increased maternal cortisol secretion has been observed during pregnancy and labor. However, due to the limitations in diagnostic methods, the dynamic change of cortisol during the short period between threatened labor and labor is unknown. In this study, we aim to evaluate the changes in serum cortisol during late pregnancy and full-term labor initiation, verifying if cortisol could serve as a biomarker for the diagnosis of labor initiation from threatened labor.
METHODS
This cross-sectional onsite study involved 564 participants of 6 different gestational stages (C: Control; T1: Trimester 1; T3: Trimester 3; E: expectant; TL: threatened labor; L: labor), all patients in the E, TL, and L groups were at full term. The serum cortisol concentration was quantified with a point-of-care test (POCT), and the gestation, age, parity, and BMI of participants were documented. Morning serum cortisol was collected between 8:00 and 10:00 a.m., except for the TL and L group women who were tested upon arrival or during latent labor. With cortisol levels or all five variables, L was distinguished from TL using machine learning algorithms.
RESULTS
Significant elevation of cortisol concentration was observed between T1 and T3, or TL and L group (P< 0.001). Women belonging to the E and TL group showed similar gestation week and cortisol levels. Diagnosis of labor initiation using cortisol levels (cutoff = 21.46 μg/dL) yielded sensitivity, specificity, and AUC of 86.50%, 88.60%, and 0.934. With additional variables, a higher specificity (89.29%) was achieved. The diagnostic accuracy of all methods ranged from 85.93% to 87.90%.
CONCLUSION
Serum cortisol could serve as a potential biomarker for diagnosis of L form TL. The rapid onsite detection of serum cortisol with POCT could facilitate medical decision-making for admission and special treatments, either as an additional parameter or when other technical platforms are not available.
Topics: Humans; Female; Pregnancy; Cross-Sectional Studies; Hydrocortisone; Adult; Biomarkers; Labor, Obstetric; Labor Onset; Young Adult; Gestational Age
PubMed: 38808114
DOI: 10.3389/fendo.2024.1379693 -
Scientific Reports May 2024Hypertensive disorders of pregnancy (HDP) are among the major causes of high maternal and fetal/neonatal morbidity and mortality rates. Patients with HDP have...
Hypertensive disorders of pregnancy (HDP) are among the major causes of high maternal and fetal/neonatal morbidity and mortality rates. Patients with HDP have significantly elevated N-terminal pro-brain natriuretic peptide (NT-proBNP) levels at diagnosis; however, the NT-proBNP levels during early pregnancy are largely unknown. This study aimed to validate the association between HDP and NT-proBNP levels. This retrospective study evaluated 103 pregnant women who developed HDP diagnosed after 35 weeks of gestation and 667 who did not. The HDP group had significantly lower early-pregnancy NT-proBNP levels than the without HDP group. However, the two groups did not significantly differ in terms of the late-pregnancy NT-proBNP levels. After adjusting for confounding factors such as age, body mass index, parity, and blood pressure levels, high early-pregnancy NT-proBNP levels were associated with a lower HDP risk. Early-pregnancy NT-proBNP levels ≥ 60.5 pg/mL had a negative predictive value of 97.0% for ruling out HDP, with a sensitivity of 87.4% and specificity of 62.5%. In conclusion, elevated early-pregnancy NT-proBNP levels were associated with a lower HDP risk. Moreover, a cutoff point of ≥ 60.5 pg/mL for early-pregnancy NT-proBNP levels had a high negative predictive value and sensitivity for ruling out HDP. These findings can provide new clinical implications.
Topics: Humans; Female; Pregnancy; Natriuretic Peptide, Brain; Adult; Peptide Fragments; Hypertension, Pregnancy-Induced; Retrospective Studies; Biomarkers; Gestational Age
PubMed: 38806648
DOI: 10.1038/s41598-024-63206-5 -
BMJ Open May 2024To assess the potential associations between social determinants of health (SDH) and severe maternal outcomes (SMO), to better understand the social structural framework... (Observational Study)
Observational Study
Impact of social determinants of health on progression from potentially life-threatening complications to near miss events and death during pregnancy and post partum in a middle-income setting: an observational study.
OBJECTIVE
To assess the potential associations between social determinants of health (SDH) and severe maternal outcomes (SMO), to better understand the social structural framework and the contributory, non-clinical mechanisms associated with SMO.
STUDY DESIGN
Prospective observational study.
STUDY SETTING
Tertiary referral centre in south-eastern region of India.
PARTICIPANTS
One thousand and thirty-three women with potentially life-threatening complications (PLTC) were identified using WHO criteria.
RISK FACTORS ASSESSED
Social Determinants of Health (SDH).
PRIMARY OUTCOMES
Severe maternal outcomes, which include maternal near-miss and maternal death.
STATISTICAL ANALYSIS
Logistic regression to assess the association between SDH and clinical factors on SMO, expressed as adjusted ORs (aOR) with a 95% CI.
RESULTS
Of the 37 590 live births, 1833 (4.9%) sustained PLTC, and 380 (20.7%) developed SMO. Risk of SMO was higher with increasing maternal age (adjusted OR (aOR) 1.04 (95% CI 1.01 to 1.07)), multiparity (aOR 1.44 (1.10 to 1.90)), medical comorbidities (aOR 1.50 (1.11 to 2.02)), obstetric haemorrhage (aOR 4.63 (3.10 to 6.91)), infection (aOR 2.93 (1.83 to 4.70)), delays in seeking care (aOR 3.30 (2.08 to 5.23)), and admissions following a referral (aOR 2.95 (2.21 to 3.93)). SMO was lower in patients from socially backward community (aOR 0.45 (0.33 to 0.61)), those staying more than 10 km from hospital (aOR 0.56 (0.36 to 0.78)), those attending at least four antenatal visits (aOR=0.53 (0.36 to 0.78)) and those referred from resource-limited facilities (aOR=0.62 (0.46 to 0.84)).
CONCLUSION
This study demonstrates the independent contribution of SDH to SMO among those sustaining PLTC in a middle-income setting, highlighting the need to formulate preventive strategies beyond clinical considerations.
Topics: Humans; Female; Pregnancy; Social Determinants of Health; Adult; Prospective Studies; Near Miss, Healthcare; Pregnancy Complications; India; Risk Factors; Young Adult; Maternal Mortality; Logistic Models; Maternal Death; Parity
PubMed: 38802274
DOI: 10.1136/bmjopen-2023-081996 -
Andes Pediatrica : Revista Chilena de... Apr 2024Worldwide, there is an alert due to the increase in the seroprevalence of hepatitis B virus (HBV). This can cause up to 3.5% of chronic diseases, of which 40% present... (Observational Study)
Observational Study
UNLABELLED
Worldwide, there is an alert due to the increase in the seroprevalence of hepatitis B virus (HBV). This can cause up to 3.5% of chronic diseases, of which 40% present secondary complications and/ or early death.
OBJECTIVE
To determine the seroprevalence of HBV in pregnant women at the time of delivery.
PATIENTS AND METHOD
Observational, descriptive, cross-sectional study with cross-association between 2018 and 2019 at the Hospital Carlos Van Buren (HCVB), in Valparaiso, Chile. All pregnant women admitted for delivery care or with an immediate newborn who had HBV surface antigen study were included. Data were collected from the pregnant woman (age, nationality, education level, parity, type of delivery, and peripartum HIV-syphilis serology) and the newborn (gestational age, weight, and APGAR score). Inferential and multivariate analysis was performed using the Stata software.
RESULTS
1,355 pregnant women were analyzed. 87.7% were Chilean, 5.5% Haitian, 4.2% Venezuelan, and 2.6% were of other nationalities. 0.3% were positive for HBV. The prevalence of HBV in Chileans was 0.08% and in Haitians 4%. Haitian nationality was at higher risk of HBV (OR = 83) vs. Chilean nationality (p = 0.0001). None presented coinfection with HIV and/or syphilis.
CONCLUSIONS
HBV seroprevalence in HCVB pregnant women was 0.3%, similar to that described in the general population in Chile. There was no coinfection with other sexually transmitted diseases. The only predictor of HBV infection was Haitian nationality.
Topics: Humans; Female; Pregnancy; Cross-Sectional Studies; Seroepidemiologic Studies; Pregnancy Complications, Infectious; Adult; Hepatitis B; Young Adult; Chile; Infant, Newborn; Adolescent; Hepatitis B virus; Prevalence; Delivery, Obstetric; Hepatitis B Surface Antigens
PubMed: 38801363
DOI: 10.32641/andespediatr.v95i2.4790 -
Animal Nutrition (Zhongguo Xu Mu Shou... Jun 2024Thirty-two primiparous and 31 multiparous Alpine goats were used to determine influences of diets varying in level and source of forage on performance in early to...
Effects of the level and source of dietary physically effective fiber on feed intake, nutrient utilization, heat energy, ruminal fermentation, and milk production by Alpine goats.
Thirty-two primiparous and 31 multiparous Alpine goats were used to determine influences of diets varying in level and source of forage on performance in early to mid-lactation for 16 wk. Diets consisted of 40%, 50%, 60%, and 70% forage (designated as 40F, 50F, 60F, and 70F, respectively) with 60F and 70F containing coarsely ground grass hay (primarily orchardgrass) and 40F and 50F containing cottonseed hulls, alfalfa pellets, and coarsely ground wheat hay. Diets contained 15.9% to 16.3% crude protein and 37.8%, 42.1%, 53.5%, and 55.4% neutral detergent fiber (NDF) with 10.0%, 15.8%, 50.1%, and 55.5% particle retention on a 19-mm sieve, and 26.1%, 29.6%, 38.3%, and 40.0% physically effective NDF (peNDF) for 40F, 50F, 60F, and 70F, respectively. Dry matter intake (2.71, 2.75, 1.96, and 1.95 kg/d) and milk yield (2.82, 2.71, 2.23, and 2.10 kg/d for 40F, 50F, 60F, and 70F, respectively) were lower ( < 0.05) for the two diets highest in forage. Digestion of organic matter was similar among diets ( 0.05), but digestibility of NDF was greater ( < 0.05) for 60F and 70F (57.5%, 58.4%, 68.9%, and 72.2% for 40F, 50F, 60F, and 70F, respectively). Diet affected ( < 0.05) milk fat (3.16%, 3.37%, 2.93%, and 2.97%) and protein concentrations (2.62%, 2.69%, 2.58%, and 2.52% for 40F, 50F, 60F, and 70F, respectively). Milk energy yield was greater ( < 0.05) for the two diets lowest in forage (7.51, 7.45, 5.68, and 5.34 MJ/d), although yield relative to dry matter intake was not affected ( > 0.05) by diet and was lower ( < 0.05) for primiparous vs. multiparous goats (2.71 and 3.09 MJ/kg). Ruminal pH and acetate proportion were greater for 60F and 70F than for the other diets and the proportion of butyrate was lower for the two diets highest in fiber. The mean lengths of time spent ruminating, eating, standing, and lying were not affected ( > 0.05) by diet or parity, but many interactions involving diet, period, hour, and parity were significant ( < 0.05). In conclusion, lactational performance of Alpine goats in early to mid-lactation will be constrained with diets high in forage of moderate quality, peNDF content, and large particle size, which appeared related to limited feed intake.
PubMed: 38800737
DOI: 10.1016/j.aninu.2024.02.002 -
Narra J Apr 2024Chronic energy deficiency (CED) in pregnant women is a condition of energy and protein deficiency that lasts for years and causes problems in the mother and fetus. Due...
Chronic energy deficiency (CED) in pregnant women is a condition of energy and protein deficiency that lasts for years and causes problems in the mother and fetus. Due to its significant consequences, determining the determinants associated with CED incidence is of utmost importance. The aim of this study was to determine the determinants of the incidence of CED in pregnant women in Indonesia. A cross-sectional study was conducted on pregnant women in Banyumas, Central Java, Indonesia, in 2022. Plausible determinants included maternal age, pregnancy interval, parity, educational attainment, nutritional knowledge, employment, frequency of antenatal care (ANC), and nutritional intake. The Chi-squared test followed by multivariate logistic regression were used to determine the factors associated with the incidence of CED. Our data indicated that 32% of the pregnant women had CED. Univariate analysis found that maternal age (=0.022), pregnancy interval (=0.009), educational attainment (=0.012), knowledge of nutrition and CED (=0.023), frequency of utilization of ANC services (=0.028), energy intake (=0.002), protein intake (=0.006), vitamin C intake (=0.016), folate intake (=0.011), and calcium intake (=0.004) were significantly associated with CED incidence in the pregnant women. Multivariate analysis indicated that extreme maternal age (OR; 3.49; 95%CI: 1.10-11.05), low educational attainment (OR: 4.12; 95%CI: 1.37-12.33), short pregnancy interval (OR; 7.30; 95%CI: 1.84-28.99), low frequency of ANC (OR: 3.06; 95%CI: 1.01-9.19) and low protein intake (OR: 6.80; 95%CI: 1.62-28.59) were associated with CED incidence. This study underscores the importance of increasing nutritional intake, frequency of ANC, and pregnancy interval among pregnant women to reduce the risk of CED and its adverse health outcomes.
Topics: Humans; Female; Indonesia; Pregnancy; Cross-Sectional Studies; Adult; Incidence; Pregnancy Complications; Energy Intake; Prenatal Care; Young Adult; Malnutrition; Risk Factors; Pregnant Women
PubMed: 38798863
DOI: 10.52225/narra.v4i1.742 -
Exploring perinatal mental health in Indonesia: A mixed-method study in Mataram, West Nusa Tenggara.Narra J Apr 2024A significant number of postpartum mothers are at risk of experiencing perinatal mental health (PMH) due to various factors. The aim of this study was to investigate...
A significant number of postpartum mothers are at risk of experiencing perinatal mental health (PMH) due to various factors. The aim of this study was to investigate risk factors for PMH issues and explore the current implementation of early screening for PMH in Mataram, West Nusa Tenggara, Indonesia. A mixed-method study, cross-sectional and ethnographic approach, was conducted at Babakan Public Health Center, Mataram, West Nusa Tenggara, Indonesia, from July to August 2023. A cross-sectional study involved 33 postpartum mothers and analyzed seven potential risk factors: age, parity, age at marriage, type of childbirth, type of family, history of adolescent mental disorder, and history of mental disorder during pregnancy. An ethnographic approach, using in-depth interviews, was utilized to gain insights regarding the implementation of PMH screening, included seven healthcare workers: six midwives and one nurse. Among the seven risk factors analyzed, only a history of adolescent mental disorder acted as risk for high PMH with an odds ratio (OR) 1.17 and =0.03. In-depth interviews revealed a consistent lack of understanding among all healthcare workers regarding PMH screening implementation: absence of early screening, lack of knowledge regarding PMH and how to identify them, reliance solely on subjective assessments for early screening, and a lack of standardized adequate PMH management. In conclusion, the history of adolescent mental disorder could lead to the development of PMH in postpartum mothers. Current screening implementation is still lacking among healthcare workers and public health centers. Therefore, integrating various stakeholders in early PMH screening is crucial to prevent future PMH in mothers and babies.
Topics: Humans; Indonesia; Female; Cross-Sectional Studies; Adult; Pregnancy; Risk Factors; Mental Disorders; Mental Health; Adolescent; Mothers; Postpartum Period; Anthropology, Cultural; Interviews as Topic
PubMed: 38798854
DOI: 10.52225/narra.v4i1.667