To compare the perinatal adverse outcomes of obese and non-obese pregnant women with Gestational Diabetes Mellitus (GDM).
This is a Cross-sectional study. Data were collected from the medical records ...of patients diagnosed with GDM at Unimed Hospital Center in the city of Joinville, from 2011 to 2017. Maternal-fetal characteristics, therapies and complications of pregnant women diagnosed with GDM were analyzed. The subjects of the study were separated into two groups: obese and non-obese GDM patients. Statistical analysis was performed by calculating multinomial logistic regression, adjusted using the 95% confidence interval (CI).
A total of 442 patients were described as having gestational diabetes, of which 260 (58.8%) were diagnosed with obesity and 182 (41.1%) were non-obese. Maternal characteristics diverged regarding the Body Mass Index (BMI) (30.0vs22.5 P = 0.000), Gestational Age (GA) from GDM diagnosis (26.95vs29.07 P = 0.002), cesarean section (c-section) (86.2%vs75.9% P = 0.003), the incidence of chronic Hypertension (10.3%vs4.2% P = 0.011), treatment by dieting (29.0%vs48.1% P = 0.000) and metformin (44.5%vs34.7% P = 0.027) of obese and non-obese pregnant women, respectively. As for newborns, there was a reduction in weight (3185.8vs3,217.4 P = 0.045) and in the number of newborns of normal weight (13.8%vs23.6% P = 0.005), of newborns from obese and non-obese mothers, respectively. After ratio calculation, it was noticed that obese pregnant women had a higher chance of undergoing a c-section (OR 2.137 CI 95%, 1257-3.631). There was no significance found in other pregnancy outcomes.
Pregnant women diagnosed with GDM and obesity are approximately twice as likely to undergo Cesarean Surgery, compared to non-obese women. As a result, newborns will have a greater influence on the outcomes and occasional events of cesarean section.
•Maternal obesity is closely linked to the rate of cesarean sections.•Obese patients were approximately twice as likely to perform cesarean sections compared to patients with recommended weight.•Associated with the increased rate of cesarean sections in obese patients, newborns will have a proportional influence of outcomes and adversities of the procedure.
To determine risk for cardiac readmissions among women without cardiac diagnoses present at delivery up to 9 months after delivery hospitalization discharge.
Delivery hospitalizations without cardiac ...diagnoses were identified from the 2010-2014 Nationwide Readmissions Database and linked with subsequent cardiac hospitalizations over the following 9 months. The temporality of new-onset cardiac hospitalizations was calculated for each 30-day interval from delivery discharge up to 9 months postpartum. Multivariable log-linear regression models were fit to identify risk factors for cardiac readmissions adjusting for patient, medical, and obstetrical factors with adjusted risk ratios as measures of effect (aRR).
Among 4.4 million delivery hospitalizations without a cardiac diagnosis, readmission for a cardiac condition within 9 months occurred in 26.8 per 10,000 women. Almost half of readmissions (45.9%) occurred within the first 30 days after delivery discharge with subsequent hospitalizations broadly distributed over the remaining 8 months. Factors such as hypertensive diseases of pregnancy (aRR 2.19, 95% CI 2.09, 2.30), severe maternal morbidity at delivery (aRR 2.06, 95% CI 1.79, 2.37), chronic hypertension (aRR 2.52, 95% CI 2.31, 2.74), lupus (aRR 4.62, 95% CI 3.82, 5.60), and venous thromboembolism during delivery (aRR 3.72, 95% CI 2.75, 5.02) were all associated with increased risk for 9-month postpartum cardiac admissions as were Medicaid (aRR 1.57, 95% CI 1.51, 1.64) and Medicare insurance (aRR 3.06, 95% CI 2.70, 3.46) compared to commercial insurance and maternal ages 35-39 and 40-54 years (aRR 1.24, 95% CI 1.17, 1.32, aRR 1.74, 95% CI 1.60, 1.90, respectively) compared to maternal age 25-29 years.
Among women without a cardiac diagnosis at delivery, multiple medical factors and obstetrical complications are associated with development of new cardiac disease requiring readmission in the postpartum period. Given that pregnancy complications and comorbidities may be associated with intermediate-term health outcomes, these findings support the importance of continued health care access after six weeks postpartum.
Resumo O objetivo deste estudo foi investigar os fatores associados aos níveis pressóricos em gestantes participantes do Estudo MINA-Brasil, inscritas no pré-natal da Estratégia de Saúde da Família ...em Cruzeiro do Sul, Acre, Amazônia Ocidental Brasileira. Modelos múltiplos de regressão linear foram utilizados, adotando-se nível de significância de 5%. A maioria das gestantes participantes tinha média de idade de 24 anos (DP 6,3), 44,0% eram primigestas e 59,1% das gestantes apresentaram ganho de peso gestacional semanal excessivo. A ocorrência de hipertensão arterial foi de 0,7%. Os fatores associados positivamente aos níveis de pressão arterial sistólica foram: índice de massa corporal pré-gestacional (β = 0,984, IC95%: 0,768-1,200) e ganho de peso gestacional semanal (β = 6,816, IC95%: 3,368-10,264). Para os níveis de pressão arterial diastólica foram positivamente associados idade da gestante (β = 0,111, IC95%: 0,002-0,221), escolaridade (β = 2,194, IC95%: 0,779-3,609), índice de massa corporal pré-gestacional (β = 0,589, IC95%: 0,427-0,751) e ganho de peso gestacional semanal (β = 3,066, IC95%: 0,483-5,650). Esses resultados reforçam a necessidade de maior atenção pré-natal no cuidado materno para prevenção de distúrbios hipertensivos no final da gravidez.
Abstract The scope of this study was to investigate the factors associated with blood pressure levels among pregnant women participating in the MINA-Brazil Study, registered in the Family Health Strategy in Cruzeiro do Sul in the Western Brazilian Amazon. Multiple linear regression models were used, adopting a level of significance of 5%. The majority of pregnant participants were less than 24 years of age, 44% were primigravidae, and 59.1% had excessive weekly gestational weight gain. The frequency of hypertension was 0.7%. Factors positively associated with systolic blood pressure levels in pregnancy were pre-pregnancy body mass index (β = 0.984, CI95%: 0.768-1.200), and weekly gestational weight gain (β = 6.816, CI95%: 3.368-10.264). Diastolic blood pressure levels in pregnancy were positively associated with maternal age (β = 0.111, CI95%: 0.002-0.221), maternal schooling (β = 2.194, CI95%: 0.779-3.609), pre-pregnancy body mass index (β = 0.589, CI95%: 0.427-0.751), and weekly gestational weight gain (β = 3.066, CI95%: 0.483-5.650). These findings stress the importance of the role of antenatal care to prevent hypertensive disorders during pregnancy.
Resumen Antecedentes: El lupus eritematoso sistémico es una enfermedad autoinmunitaria multisistémica que afecta principalmente a mujeres en edad fértil. La nefritis lúpica es la manifestación ...clínica más frecuente durante la gestación y constituye un factor de riesgo para la pérdida del embarazo, en especial en pacientes con insuficiencia renal. Además, presenta mayor riesgo de pérdida fetal, restricción del crecimiento intrauterino e hipertensión. Casos clínicos: El primer caso se trata de una gestante de 28 + 2 semanas con daño renal grave y anticuerpos anti-DNA en título elevado. En el segundo caso destaca el debut con sintomatología de dificultad respiratoria y edemas como manifestaciones clínicas de nefropatía lúpica tipo V a las 23 semanas de gestación. En ambas pacientes destaca la prematuridad como complicación perinatal, así como el crecimiento intrauterino retardado en el primer caso. Por último, se describen los resultados clínico-analíticos tras el inicio terapéutico específico en ambos casos. Conclusiones: El diagnóstico diferencial del debut de nefritis lúpica durante la gestación continúa siendo un desafío, a pesar de los avances en cuanto a marcadores angiogénicos. La valoración clínica continúa siendo la piedra angular de este proceso diagnóstico y de sus implicaciones en cuanto a complicaciones del embarazo actuales y futuras.
Spontaneous rupture of uterine vessels during pregnancy is a life-threatening condition though, it has a rare occurrence. This case report discusses about a 32-year-old lady at 16 weeks of gestation ...presented with spontaneous rupture of uterine artery and she was managed with emergency laparotomy with suturing of ruptured artery. She had delivered a healthy baby after 37 weeks of gestation by a caesarean section due to pregnancy induced hypertension at 36 weeks of gestation.
ABSTRACT INTRODUCTION: Idiopathic thrombocytopenic purpura (ITP) is an acquired immune disorder that causes a reduction in platelet count, called thrombocytopenia. ITP during pregnancy usually ...presents some complications that may impair the outcome of pregnancy. OBJECTIVE: This literature review aimed to identify the main complications of ITP in pregnancy and its consequences. METHODOLOGY: The bibliographic search was performed through scientific articles available in the Scielo and PubMed databases, of which 64 articles were selected, both in Portuguese and English. RESULTS: The risk of postpartum hemorrhage, placental abruption, and neonatal thrombocytopenia are some complications that may occur during pregnancy. CONCLUSION: Pregnant women must be properly monitored during pregnancy so that there are no major complications.
Objective: To determine the frequency of subclinical hypothyroidism in women with pathological pregnancies and the association between elevated thyroid-stimulating hormone (TSH) and pregnancy ...outcome.
Subjects and methods: A cross-sectional prospective study investigated value of TSH and free thyroxine (FT4) in (1) pregnant women with hypertension (HTA) (N = 62) or preeclampsia (PE) (N = 50), (2) women with gestational diabetes mellitus (GDM) (N = 92) in pregnancy, and (3) women with normal pregnancies (control) (N = 201). The level of statistical significance was set at p < .05.
Results: Of the total 404 respondents, the highest incidence of subclinical hypothyroidism was in the group with preeclampsia 22%, followed HTA group 9.6%; GDM group 10.9% and in the control group 9% (p < .001). Higher levels of TSH were in the preeclampsia (2.5 ± 1.54 mIU/L) and in the HTA (2.03 ± 0.97 mIU/L) compared with the control group (1.95 ± 0.86 mIU/L); (p < .001). Weight gain in pregnancy was significantly higher in women with TSH >3 mIU/L (p = .003). There were no differences in the average TSH value between GDM (1.93 ± 1.03 mIU/L) and control group (p = .962).
Conclusions: Early detection and optimal treatment of thyroid dysfunction before and in the first trimester of pregnancy reduces the risk of adverse pregnancy outcomes.
The aim of this study was to estimate the rate of Mother-to-child Transmission (MTCT) of HIV to neonates in a reference university hospital in Sao Luis city, the capital of Maranhao State (MA), ...evaluating MTCT-associated factors. A retrospective cohort study based on data from the Notifiable Diseases Data System (SINAN) was carried out and included all HIV-exposed neonates notified from 2013 to 2017 by the university hospital. The study population comprised 725 HIV-exposed neonates, of whom 672 neonates were exposed and uninfected, and 53 were exposed and infected. The estimated rate of MTCT in the period of 2013 to 2017 was 7.3%. Most pregnant women were ≥ 20 years old (86.9%), reported ≥ 8 years of schooling (53.2%), reported full-time or independent paid work (46.9%) and were residents in other cities of the state (61.7%). Regarding healthcare, 86.3% received prenatal care, 74.6% received Antiretroviral Therapy (ART) as prophylaxis during pregnancy, 81.8% received ART prophylaxis during childbirth and 78.1% underwent cesarean section. Among the neonates, 92.8% received ART prophylaxis and 94.3% were not breastfed. Despite these variables, the 7.3% MTCT rate found in this study makes it clear that the interventions recommended by the Ministry of Health were not fully adopted.
Postpartum hemorrhage is the leading cause of maternal morbidity and mortality worldwide, and incidence in the United States, although lower than in some resource-limited countries, remains high. ...Women of color are at a disproportionate risk of developing a life-threatening postpartum hemorrhage. Risk assessment tools are available but because they lack specificity and sensitivity, all pregnant women are considered at risk. Early identification of and intervention in a hemorrhage requires an interdisciplinary team approach to care and can save the lives of thousands of women each year.
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