Continuous glucose monitors provide detailed information regarding glycemic control in pregnant patients with type 1 diabetes. Little data have been published examining the association between ...continuous glucose monitor parameters and perinatal outcomes among gravidas with type 1 diabetes using continuous glucose monitors.
This study aimed to examine the association between perinatal outcomes and time-in-range as assessed by continuous glucose monitors used in pregnant individuals with type 1 diabetes. We hypothesized that higher time-in-range would be associated with lower risk of adverse perinatal outcomes.
This multicenter retrospective cohort study included all gravidas with type 1 diabetes using continuous glucose monitors who delivered from 2020 to 2022 at 5 University of California sites. Only those with continuous glucose monitor target range set to 70 to 140 mg/dL (±10 mg/dL) were included. Time-in-range (%) was recorded at 12, 16, 20, 24, 28, and 32 weeks. The primary maternal and neonatal outcomes were preeclampsia and large for gestational age, defined as birthweight ≥95th percentile. Kruskal–Wallis tests were used to compare median time-in-range between those with and without the primary outcomes. Log-binomial regression was used to obtain risk ratios, with adjustment for microvascular disease and years with type 1 diabetes.
A total of 91 patients were included. Most used an insulin pump (81%) and did not have diabetic microvascular disease (72%). Median time since diagnosis of type 1 diabetes was 16 years, and median periconception hemoglobin A1c was 6.7%. Compared with those with preeclampsia, normotensive gravidas had significantly higher time-in-range at nearly every time point. A similar pattern was observed for those with normal-birthweight infants compared with large-for-gestational-age infants. On adjusted analyses, every 5-unit increase in time-in-range at 12 weeks was associated with 45% and 46% reductions in the risks of preeclampsia and large for gestational age, respectively (preeclampsia: adjusted risk ratio, 0.55; 95% confidence interval, 0.30–0.99; large for gestational age: adjusted risk ratio, 0.54; 95% confidence interval, 0.29–0.99).
Higher time-in-range is associated with lower risk of preeclampsia and large for gestational age. This association is observed early in gestation, when each 5-unit increase in time-in-range is associated with ∼50% reduction in the risk of these complications. These findings can be used to counsel patients regarding the risk of pregnancy complications at specific time-in-range values, and to encourage patients that even small improvements in time-in-range can have significant impact on pregnancy outcomes. Larger studies are needed to further explore these findings and to identify optimal time-in-range to reduce perinatal complication rates.
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OBJECTIVEIt was aimed to examine the effects of attitudes and beliefs regarding sexuality on sexual function during pregnancy. STUDY DESINGDescriptive cross-sectional type research was conducted ...throughout Turkey between December 2021 and April 2022. The sample was made up of 718 pregnant women across Turkey. The data were obtained through "Data Collection Form", "Attitudes and Beliefs Scale about Sexuality during Pregnancy (ABSSP)" and "Female Sexual Function Scale (FSFI)" using online questionnaires using snowball sampling method. RESULTSThe mean age of the participants was 27.48 ± 4.26 and the gestational weeks were 26.65 ± 6.87. A negative relationship was found between the ABSSP total score average and age, marriage age, gestational week and living child. It was determined that the women's ABSSP total score average and all sub-dimensions were positively related to each other. It was determined that there was a positive relationship between the lower dimension of anxiety and sexual desire, arousal, satisfaction, orgasm and pain and negative. Gender/Attraction sub-dimension was found to be positively related to sexual desire, arousal, lubrication, satisfaction and FSFI total score average. Concern about pregnancy was found to be negatively related to sexual desire, arousal and satisfaction positive, orgasm and pain with lower size. CONCLUSIONThe study findings show that sexual beliefs and sexual desire situations during pregnancy are negatively affected. Sexuality can be negatively affected in societies where counseling on sexuality is inadequate during pregnancy and superstition and behaviors are common.
Maternal death due to COVID-19 Hantoushzadeh, Sedigheh; Shamshirsaz, Alireza A.; Aleyasin, Ashraf ...
American journal of obstetrics and gynecology,
07/2020, Volume:
223, Issue:
1
Journal Article
Peer reviewed
Open access
Despite 2.5 million infections and 169,000 deaths worldwide (as of April 20, 2020), no maternal deaths and only a few pregnant women afflicted with severe respiratory morbidity have been reported to ...be related to COVID-19 disease. Given the disproportionate burden of severe and fatal respiratory disease previously documented among pregnant women following other coronavirus-related outbreaks (SARS-CoV in 2003 and MERS-CoV in 2012) and influenza pandemics over the last century, the absence of reported maternal morbidity and mortality with COVID-19 disease is unexpected.
To describe maternal and perinatal outcomes and death in a case series of pregnant women with COVID-19 disease.
We describe here a multiinstitution adjudicated case series from Iran that includes 9 pregnant women diagnosed with severe COVID-19 disease in their second or third trimester. All 9 pregnant women received a diagnosis of SARS-CoV-2 infection by reverse transcription polymerase chain reaction nucleic acid testing. Outcomes of these women were compared with their familial/household members with contact to the affected patient on or after their symptom onset. All data were reported at death or after a minimum of 14 days from date of admission with COVID-19 disease.
Among 9 pregnant women with severe COVID-19 disease, at the time of reporting, 7 of 9 died, 1 of 9 remains critically ill and ventilator dependent, and 1 of 9 recovered after prolonged hospitalization. We obtained self-verified familial/household cohort data in all 9 cases, and in each and every instance, maternal outcomes were more severe compared with outcomes of other high- and low-risk familial/household members (n=33 members for comparison).
We report herein maternal deaths owing to COVID-19 disease. Until rigorously collected surveillance data emerge, it is prudent to be aware of the potential for maternal death among pregnant women diagnosed as having COVID-19 disease in their second or third trimester.
Cardiovascular disease contributes to approximately one third of all maternal mortality and remains a significant source of peri‑ and postpartum morbidity. As more women at risk for and with ...cardiovascular disease are desiring pregnancy, it is imperative that general cardiologists and obstetricians participate collaboratively in preconception counseling and are more facile with management of these lesions during peri‑ and postpartum periods. This review aims to address this growing need and highlights the management strategies for some of the major high risk cardiac conditions encountered during pregnancy including anticoagulation, cardiomyopathies as well as severe mitral and aortic stenosis; aortopathy, pulmonary hypertension, and severe congenital heart lesions will not be addressed.
A pregnant mother undergoes significant changes in acid-base status as well as sodium and calcium metabolism to combat her physiological needs of pregnancy. Pregnant patients experience mild ...respiratory alkalosis due to the stimulation of the respiratory center by progesterone. This is associated with a corresponding increase in bicarbonate excretion by kidneys; as a result, the pH remains slightly high (7.40-7.45) but within the normal range. Pregnant women are predisposed to starvation ketosis as compared to nonpregnant states due to relative insulin resistance and increased production of the counter-regulatory hormone. Physiological mild hyponatremia occurs during pregnancy due to increased AVP secretion caused by resetting of osmoreceptors in the hypothalamus at a lower osmolality, but values below 130 mEq/L require a diagnostic workup and intervention. Gestational diabetes insipidus can occur due to increased production or decreased destruction of enzyme vasopressinase. Secretion of parathyroid hormone-related peptide by the placenta and breasts and two- to three-fold increased calcium and phosphate absorption in the maternal gut are the key changes in calcium metabolism during pregnancy. Though rare, both hypo- and hypercalcemia in pregnancy are associated with significant maternofetal morbidity and mortality.
Ahmed A. Fetomaternal Acid-Base Balance and Electrolytes during Pregnancy. Indian J Crit Care Med 2021; 25(Suppl 3):S193-S199.
Cushing's syndrome (CS) encompasses various causes of hypercortisolism including adrenocorticotropic hormone (ACTH) secreting pituitary adenoma with or without bilateral adrenal hyperplasia, an ...adrenal adenoma or carcinoma, ectopic ACTH or corticotrophin-releasing hormone (CRH) secretion by a neoplasm or exogenous corticosteroid therapy. The diagnosis of CS in pregnancy presents a challenge due to overlapping clinical features of pregnancy (weight gain, striae, acne). If untreated, CS in pregnancy is associated with increased risk of maternal and fetal complications.
With fewer than 250 cases currently published, we aim to review the clinical presentations, diagnostic methods, management, and outcomes of patients with CS in pregnancy to help optimise our clinical practice.
This is a single-centre, retrospective review of woman with documented hypercortisolism receiving antenatal care at a tertiary maternity hospital in Perth between 2006 to 2022. Data were collated from electronic and chart reviews. OMNI calculator was used for birthweight calculations. Local ethics and patient consent were obtained.
Five women and seven pregnancies were identified. Four women had a pituitary source of ACTH-dependent CS as confirmed by brain magnetic resonance imaging. One woman had an ectopic source of ACTH. Two women were diagnosed during pregnancy. All pregnancies occurring prior to treatment of the Cushing's disease were complicated by secondary hypertension and diabetes.
CS represents a rare and difficult to diagnose condition in pregnancy. When untreated, maternal and fetal outcomes are compromised. Close monitoring of the associated complications with involvement of a multidisciplinary team are recommended.
Abdominal pain in late pregnancy Chilaka, Chioma; Walker, Kate F.
Obstetrics, gynaecology and reproductive medicine,
December 2019, 2019-12-00, Volume:
29, Issue:
12
Journal Article
Peer reviewed
Abdominal pain in late pregnancy is a common presentation and can pose a diagnostic and management dilemma to clinicians. An acute abdomen affects 1 in 500 pregnancies with approximately 0.5%–2% of ...pregnant women needing surgical interventions in pregnancy. The majority of acute abdominal complaints will present in a similar manner to the non-pregnant patient, however the anatomical and physiological changes of pregnancy can complicate the diagnosis and management options. Appendicitis remains the most common cause of an acute abdomen in pregnancy. Management should be tailored depending on the patient and the severity of the condition. Special consideration should be made for the fetus but the life of the mother should be of primary concern. Surgery can therefore be performed at any stage of pregnancy if, on balance, it is the most appropriate option. Clinicians should not neglect obstetric causes of pain and endeavour to always diagnose the underlying cause of the abdominal pain to aid management. This article explores the different aetiologies of pain in late pregnancy and latest advances in management.
Perinatal opioid use disorder (OUD) is a life-threatening condition that significantly impacts women in rural areas. Medication assisted treatment (MAT) is the recommended treatment but can be ...difficult to access. Pregnant women may initially present for treatment of OUD in the emergency department, on labor and delivery units, or in an office setting, each of which presents unique challenges. Initiation of MAT in the appropriate setting, based on accurate assessment of gestational age, is a centrally important component of care for perinatal OUD. However, initiating treatment may present challenges to providers who lack experience treating this disorder. Vermont and New Hampshire are predominantly rural states which have focused on expanding MAT access for pregnant women using two different approaches to integrating treatment with maternity care.
•Rural pregnant women are in urgent need of treatment for opioid use disorder.•Pregnant women with opioid use disorder may present in various clinical settings.•Accurate pregnancy dating and starting medication assisted therapy are key.•Treatment models for opioid use in pregnancy in rural locations exist.•Coordinated obstetrics and addiction care is critical.
Despite illicit substance use in pregnancy occurring across all demographic groups, minority pregnant and delivering patients with a low income tend to undergo testing at a higher rate than their ...counterparts. National guidelines for indications do not exist and ordering of toxicology testing may be applied inequitably.
This study aimed to evaluate whether any documented indications in a large cohort of patients were associated with a positive toxicology test and whether indications for urine toxicology testing were applied consistently to different demographic groups.
This was a retrospective cohort study reviewing pregnant and delivering patients who underwent toxicology testing on obstetrical units at 1 institution from May 30, 2015, to December 31, 2018. Age, race, marital status, median income of residential ZIP code, indications for testing, and test results were collected for each patient by individual chart review. Indications included preterm complications (preterm prelabor rupture of membranes or preterm labor), abruption or hypertension, reported substance use, fetal complications, maternal complications, and none. Multivariate logistic regression models were analyzed for the association between indication and test result and the likelihood of marijuana as the sole positive test result. Logistic regression was used to evaluate the relationship of indication for testing with maternal race.
Among 20,274 births, 551 patients underwent toxicology testing during the study period. No indication for drug toxicology testing was associated with a positive result, except reported current or previous substance use. Compared with White patients, Black and Hispanic women were 4.26 times (95% confidence interval, 2.55-7.09) and 5.75 times (95% confidence interval, 2.89-11.43) more likely to have toxicology testing for an indication other than reported substance use, respectively. Of all patients with positive test results (n=194), 48% tested positive for marijuana only.
Compared with their White counterparts, Black and Hispanic pregnant and delivering patients may be more frequently toxicology tested for indications less clearly associated with illicit substance use. The absence of evidence-based guidelines for toxicology testing on obstetrical units risks inequitable care and stigmatization of patient groups.
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