Effect of Obesity on Gestational and Perinatal Outcomes

Purpose To assess the impact of pre-pregnancy obesity (body mass index [BMI] ≥ 30 kg/m2) on the gestational and perinatal outcomes. Methods Retrospective cohort study of 731 pregnant women with a BMI ≥ 30 kg/m2 at the first prenatal care visit, comparing them with 3,161 women with a BMI between 18.5 kg/m2 and 24.9 kg/m2. Maternal and neonatal variables were assessed. Statistical analyses reporting the demographic features of the pregnant women (obese and normal) were performed with descriptive statistics followed by two-sided independent Student's t tests for the continuous variables, and the chi-squared (χ2) test, or Fisher's exact test, for the categorical variables. We performed a multiple linear regression analysis of newborn body weight based on the mother's BMI, adjusted by maternal age, hyperglycemic disorders, hypertensive disorders, and cesarean deliveries to analyze the relationships among these variables. All analyses were performed with the R (R Foundation for Statistical Computing, Vienna, Austria) for Windows software, version 3.1.0. A value of p < 0.05 was considered statistically significant. Results Obesity was associated with older age [OR 9.8 (7.8–12.2); p < 0.01], hyperglycemic disorders [OR 6.5 (4.8–8.9); p < 0.01], hypertensive disorders [OR 7.6 (6.1–9.5); p < 0.01], caesarean deliveries [OR 2.5 (2.1–3.0); p < 0.01], fetal macrosomia [OR 2.9 (2.3–3.6); p < 0.01] and umbilical cord pH [OR 2.1 (1.4–2.9); p < 0.01). Conversely, no association was observed with the duration of labor, bleeding during labor, Apgar scores at 1 and 5 minutes after birth, gestational age, stillbirth and early neonatal mortality, congenital malformations, and maternal and fetal injury. Conclusion We observed that pre-pregnancy obesity was associated with maternal age, hyperglycemic disorders, hypertension syndrome, cesarean deliveries, fetal macrosomia, and fetal acidosis.

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Gestational Outcomes in Patients with Severe Maternal Morbidity Caused by Hypertensive Syndromes

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics ◽

10.1055/s-0040-1701464 ◽

2020 ◽

Vol 42 (02) ◽

pp. 074-080

Author(s):

Daisy de Lucena Feitosa Lins Pinheiro ◽

Francisco Edson de Lucena Feitosa ◽

Edward Araujo Júnior ◽

Francisco Herlânio Costa Carvalho

Keyword(s):

Maternal Morbidity ◽

Near Miss ◽

World Health ◽

Severe Maternal Morbidity ◽

Maternal Near Miss ◽

Categorical Variables ◽

Continuous Variables ◽

Cross Sectional ◽

Hypertensive Disorders ◽

The Impact

Abstract Purpose To evaluate the impact of the presence of criteria for severe maternal morbidity and maternal near miss associated with hypertensive disorders on maternal and perinatal outcomes in a maternity school. Methods The present is a sub-analysis of a larger study involving 27 centers in Brazil that estimated the prevalence of serious maternal morbidity and near miss. It is an analytical and cross-sectional study with a quantitative approach, involving 928 women who were cared for at Maternidade Escola Assis Chateaubriand (MEAC, in Portuguese), Universidade Federal do Ceará (UFC, in Portuguese), from July 2009 to June 2010. The women were diagnosed with near miss according to the World Health Organization (WHO) criteria. The sample was divided into 2 groups: patients with (n = 827) and without hypertension (n = 101). The results were considered statistically significant when p < 0.05. The Pearson chi-squared and Fisher Exact tests were used for the categorical variables, and the Mann–Whitney U test was used for the continuous variables. Results In total, 51 participants with maternal near miss criteria were identified, and 36 of them had hypertensive disorders. Of these, 5 died and were obviously excluded from the near miss final group. In contrast, we observed 867 cases with non-near miss maternal morbidity criteria. During this period, there were 4,617 live births (LBs) in the institution that was studied. Conclusion In the severe morbidity/maternal near miss population, the presence of hypertensive complications was prevalent, constituting a risk factor for both the mother and the fetus.

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Impact of COVID-19 pandemic on maternity services and challenges faced by pregnant women delivering at a tertiary care centre in South India

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20214058 ◽

2021 ◽

Author(s):

Parvathi Teja Naik ◽

Rupesh Bala Murugan ◽

Haritha Sagili ◽

Subitha Lakshminarayanan ◽

Priyadarshini Muruganandhan ◽

...

Keyword(s):

High Risk ◽

Pregnant Women ◽

Tertiary Care ◽

World Health ◽

Categorical Variables ◽

Contraceptive Device ◽

Care Hospital ◽

Continuous Variables ◽

Maternity Services ◽

The Impact

Background: Coronavirus disease 2019 (COVID-19), was declared a pandemic by the World Health Organization (WHO) on March 11, 2020. India entered a nationwide lockdown on March 25, 2020, disrupting regular health services. Hence this study was conducted to estimate the impact of the COVID-19 pandemic on maternity services and to describe the challenges faced by pregnant women. Methods: A descriptive cross-sectional study conducted from July 2020 to October 2020 at tertiary care hospital, Puducherry, India. 422 pregnant women delivered during this period were included and detailed questionnaire was administered regarding antenatal, intrapartum, postnatal services and, challenges faced during the pandemic via telephonic call. Responses were documented in Epicollect version 5, transferred to Microsoft excel and analysed using Stata version 14.2. Continuous variables were expressed as mean (SD), and Categorical variables as proportions. Results: The 100% response rate was achieved with 32.5% high risk pregnancies. The 71.8% women availed direct emergency medical services while 28.2%. were referrals. The 79.9% and 25% of the women in third trimester had less antenatal visits and discontinued haematinics respectively. The 47.4% had first trimester testing, 30% didn’t receive lactation support. 81% and 69% of primiparous and multiparous women respectively had adopted postpartum Intrauterine contraceptive device as contraception. The 35-50% women faced challenges in availing essential obstetric care services.Conclusions: Development of robust linkage system between existing primary healthcare and tertiary care for managing both low and high-risk pregnancies is of paramount importance to alleviate maternal and perinatal mortality and morbidity.

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Differential effect of pre-pregnancy low BMI on fetal macrosomia: a population-based cohort study

BMC Medicine ◽

10.1186/s12916-021-02046-w ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Guoju Li ◽

Yuhan Xing ◽

Guolan Wang ◽

Jun Zhang ◽

Qin Wu ◽

...

Keyword(s):

Cohort Study ◽

Protective Effect ◽

Pregnant Women ◽

Differential Effect ◽

Maternal Age ◽

Interactive Effect ◽

Population Based ◽

Fetal Macrosomia ◽

Low Bmi ◽

The Impact

Abstract Background The differential effect of pre-pregnancy low BMI on macrosomia has not been fully addressed. Herein, we conducted a city-wide population-based cohort study to illuminate the association between pre-pregnancy low BMI and macrosomia, stratifying by maternal age, parity, and GDM status. Methods All pregnant women who paid their first prenatal visit to the hospital in Qingdao during August 1, 2018, to June 30, 2020, were recruited to this study. The interactive effect of maternal age and pre-pregnancy low BMI on macrosomia was evaluated using logistic regression models, followed by strata-specific analyses. Results A total of 105,768 mother-child pairs were included, and the proportion of fetal macrosomia was 11.66%. The interactive effect of maternal pre-pregnancy BMI and age was statistically significant on macrosomia irrespective of parity (nullipara: Padjusted=0.0265; multipara: Padjusted=0.0356). The protective effect of low BMI on macrosomia was most prominent among nullipara aged 35 years and above (aOR=0.16, 95% CI 0.05–0.49) and multipara aged 25 years and below (aOR=0.17, 95% CI 0.05–0.55). In nullipara without GDM, the risk estimates gradually declined with increasing conception age (20-to-24 years: aOR=0.64, 95% CI 0.51–0.80; 25-to-29 years: aOR=0.43 95% CI 0.36–0.52; 30-to-34 years: aOR=0.40 95% CI 0.29–0.53; and ≥35 years: aOR=0.19, 95% CI 0.06–0.60). A similar pattern could also be observed in nullipara with GDM, where the aOR for low BMI on macrosomia decreased from 0.54 (95% CI 0.32–0.93) in pregnant women aged 25–29 years to 0.30 (95% CI 0.12–0.75) among those aged 30–34 years. However, younger multiparous mothers, especially those aged 25 years and below without GDM (aOR=0.21, 95% CI 0.06–0.68), were more benefited from a lower BMI against the development of macrosomia. Conclusions Maternal low BMI is inversely associated with macrosomia irrespective of maternal age and parity. The impact of pre-pregnancy low BMI on macrosomia varied by maternal age and parity. The protective effect of a lower maternal BMI against fetal macrosomia was more prominent in nulliparous mothers aged 35 years and above, whereas multiparous mothers younger than 25 years of age were more benefited.

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Hypertensive Disorders: Prevalence, Perinatal Outcomes and Cesarean Section Rates in Pregnant Women Hospitalized for Delivery

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics ◽

10.1055/s-0040-1714134 ◽

2020 ◽

Vol 42 (11) ◽

pp. 690-696

Author(s):

Francisco Lírio Ramos Filho ◽

Carlos Maurício de Figueiredo Antunes

Keyword(s):

Pregnant Women ◽

Preterm Infants ◽

Apgar Score ◽

Low Birthweight ◽

Case Control Study ◽

Perinatal Outcomes ◽

Cesarean Deliveries ◽

Hypertensive Disorders ◽

Belo Horizonte ◽

Control Study

Abstract Objective To evaluate the prevalence of hypertensive disorders, perinatal outcomes (preterm infants, low birthweight infants and Apgar score < 7 at the 5th minute and fetal deaths) and the cesarean rates in pregnant women hospitalized for delivery at the Maternidade Hilda Brandão da Santa Casa de Belo Horizonte, Belo Horizonte, state of Minas Gerais, Brazil, from March 1, 2008 to February 28, 2018. Methods A case-control study was performed, and the groups selected for comparison were those of pregnant women with and without hypertensive disorders. Out of the 36,724 women, 4,464 were diagnosed with hypertensive disorders and 32,260 did not present hypertensive disorders Results The prevalence of hypertensive disorders was 12.16%; the perinatal outcomes and cesarean rates between the 2 groups with and without hypertensive disorders were: preterm infants (21.70% versus 9.66%, odds ratio [OR] 2.59, 95% confidence interval [CI], 2.40–2.80, p < 0.001); low birthweight infants (24.48% versus 10.56%; OR 2.75; 95% CI, 2.55–2.96; p < 0.001); Apgar score < 7 at the 5th minute (1.40% versus 1.10%; OR 1.27; 95% CI, 0.97–1.67; p = 0.84); dead fetuses diagnosed prior to delivery (1.90% versus 0.91%; OR 2.12; 95% CI, 1.67–2.70; p < 0.001); cesarean rates (60.22% versus 31.21%; OR 3.34; 95% CI, 3.14–3.55; p < 0.001). Conclusion Hypertensive disorders are associated with higher rates of cesarean deliveries and higher risk of preterm infants, low birthweight infants and a higher risk of fetal deaths.

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Fetal movement counting is associated with the reduction of delayed maternal reaction after perceiving decreased fetal movements: a prospective study

Scientific Reports ◽

10.1038/s41598-021-90240-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Shigeki Koshida ◽

Shinsuke Tokoro ◽

Daisuke Katsura ◽

Shunichiro Tsuji ◽

Takashi Murakami ◽

...

Keyword(s):

Pregnant Women ◽

Maternal Behavior ◽

Multivariable Analysis ◽

Perinatal Outcomes ◽

Fetal Movement ◽

Post Intervention ◽

Fetal Movements ◽

Adverse Perinatal Outcomes ◽

The Impact ◽

Maternal Reaction

AbstractMaternal perception of decreased fetal movement is associated with adverse perinatal outcomes. Although there have been several studies on interventions related to the fetal movements count, most focused on adverse perinatal outcomes, and little is known about the impact of the fetal movement count on maternal behavior after the perception of decreased fetal movement. We investigated the impact of the daily fetal movement count on maternal behavior after the perception of decreased fetal movement and on the stillbirth rate in this prospective population-based study. Pregnant women in Shiga prefecture of Japan were asked to count the time of 10 fetal movements from 34 weeks of gestation. We analyzed 101 stillbirths after the intervention compared to 121 stillbirths before the intervention. In multivariable analysis, maternal delayed visit to a health care provider after the perception of decreased fetal movement significantly reduced after the intervention (aOR 0.31, 95% CI 0.11–0.83). Our regional stillbirth rates in the pre-intervention and post-intervention periods were 3.06 and 2.70 per 1000 births, respectively. Informing pregnant women about the fetal movement count was associated with a reduction in delayed maternal reaction after the perception of decreased fetal movement, which might reduce stillbirths.

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617 Who Benefits the Most from Burn Camps?

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.267 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

pp. S162-S163

Author(s):

Jennifer B Radics-Johnson ◽

Daniel W Chacon ◽

Li Zhang

Keyword(s):

Retrospective Review ◽

Burn Injury ◽

Statistical Significance ◽

Categorical Variables ◽

P Value ◽

Continuous Variables ◽

Self Evaluation ◽

Significant Difference ◽

Return Home ◽

The Impact

Abstract Introduction Burn camps provide a unique environment and activities for children that have experienced a burn-injury. Positive outcomes from attending burn camp include increased self-esteem, decreased feelings of isolation and a greater sense of self-confidence. In a 3-year retrospective review of camper evaluations from one of the largest and longest running week-long burn camps in the nation for ages 5–17, we aimed to assess if a child’s gender, age, TBSA or ethnicity affected the impact that burn camp had on a child. Methods A 3-year retrospective review of a Burn Camp’s camper evaluation forms was conducted for campers that attended burn camp between 2017–2019. Camp rosters were reviewed to determine the camper gender, age, TBSA and ethnicity. Camper self-evaluation forms completed at the end of each camp session were reviewed to record camper responses to questions regarding their opinions on the impact camp had on them as well as how camp will impact their lives once they return home. Categorical variables were summarized as frequency and percentage, and continuous variables were described as median and range. To check the relationship between two categorical variables, Chi-square test was used. To compare the continuous variable among groups, Kruskal-Wallis ANOVA was used. Statistical significance was declared based on a p value< 0.5. Results Within 2017–2019, there were 413 camper records. Participants’ demographic characteristics are summarized in Table 1. There were 208 males (50.3%) and 205 females (49.6%). The median age of campers were 11.86, 12.44 and 12.45 for 2017–2019, with the range from 5.16 years to 17.96 years. The median TBSA were 20, 20 and 18 for 2017–2019, with the range from 0.08 to 90. Collectively there were 47.7% Hispanic (n= 197); 24.2% Whites (n=100); 13.1% Black (n= 54); 4.6% Asian (n=19) and 7.7% Other (n=32). There were 395 camper self-evaluation forms submitted. Results of three questions there we were interested in are summarized collectively in Table 2. 57% of campers responded, “Yes, Definitely” to the question “After going to this event, will you feel more comfortable being around your classmates or friends?” 54% responded, “ Yes, Definitely” to the question “Do you feel more confidents in sharing your burn story with others when returning home?” and 51% responded “Yes, Definitely” to “Did you learn anything that will help you when you return home?” Conclusions In analyzing the camper responses, there was no statistically significant difference in responses comparing gender, age, TBSA or ethnicity.

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The Compliance of Prescribed Activity Restriction in Women at High Risk for Preterm Birth

American Journal of Perinatology ◽

10.1055/s-0040-1714358 ◽

2020 ◽

Author(s):

Ghamar Bitar ◽

Anthony Sciscione

Keyword(s):

Preterm Birth ◽

High Risk ◽

Medical Center ◽

Compliance Rate ◽

Tertiary Care ◽

Prescribing Patterns ◽

Categorical Variables ◽

Continuous Variables ◽

Activity Restriction ◽

The Impact

Objective Despite lack of evidence to support efficacy, activity restriction is one of the most commonly prescribed interventions used for the prevention of preterm birth. We have a departmental policy against the use of activity restriction but many practitioners still prescribe it in an effort to prevent preterm birth. We sought to evaluate the rate and compliance of women who are prescribed activity restriction during pregnancy to prevent preterm birth. Study Design This was a single-site retrospective questionnaire study at a tertiary care, academic affiliated medical center. Women with a history of preterm delivery or short cervix were included. Once patients were identified, each patient was contacted and administered a questionnaire. We assessed the rates of activity restriction prescription and compliance. Secondary outcomes included details regarding activity restriction and treatment in pregnancy. Continuous variables were compared with t-test and categorical variables with Chi-square test. The value p < 0.05 was considered significant. Results Among the 52 women who responded to the questionnaire, 18 reported being placed on activity restriction by a physician, with 1 self-prescribing activity restriction, giving a rate of our primary outcome of 19 of 52 (36.5%). All women reported compliance with prescribed activity restriction (100%). Gestational age at delivery was not different in women placed on activity restriction. Conclusion This questionnaire suggests that approximately one in three high-risk women were placed on activity restriction during their pregnancy despite a departmental policy against its use. The 100% compliance rate in patients placed on activity restriction is a strong reminder of the impact prescribing patterns of physicians can have on patients. Key Points

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Clinical manifestations and perinatal outcomes of pregnant women with COVID-19: a systematic review and meta-analysis

Scientific Reports ◽

10.1038/s41598-020-75096-4 ◽

2020 ◽

Vol 10 (1) ◽

Cited By ~ 1

Author(s):

Jeong Yee ◽

Woorim Kim ◽

Ji Min Han ◽

Ha Young Yoon ◽

Nari Lee ◽

...

Keyword(s):

Systematic Review ◽

Pregnant Women ◽

Fetal Death ◽

Web Of Science ◽

Meta Analysis ◽

Clinical Manifestations ◽

Perinatal Outcomes ◽

Current Review ◽

The Mean ◽

The Impact

Abstract This systematic review and meta-analysis aimed to evaluate the impact of COVID-19 on pregnant women. We searched for qualified studies in PubMed, Embase, and Web of Science. The clinical characteristics of pregnant women with COVID-19 and their infants were reported as means and proportions with 95% confidence interval. Eleven studies involving with 9032 pregnant women with COVID-19 and 338 infants were included in the meta-analysis. Pregnant women with COVID-19 have relatively mild symptoms. However, abnormal proportions of laboratory parameters were similar or even increased, compared to general population. Around 30% of pregnant women with COVID-19 experienced preterm delivery, whereas the mean birth weight was 2855.9 g. Fetal death and detection of SARS-CoV-2 were observed in about 2%, whereas neonatal death was found to be 0.4%. In conclusion, the current review will serve as an ideal basis for future considerations in the treatment and management of COVID-19 in pregnant women.

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The Impact of Shave Biopsy on The Management of Patients with Thin Melanomas

The American Surgeon ◽

10.1177/000313481107700826 ◽

2011 ◽

Vol 77 (8) ◽

pp. 1050-1053 ◽

Cited By ~ 5

Author(s):

Michael Lowe ◽

Nikki Hill ◽

Andrew Page ◽

Suephy Chen ◽

Keith A. Delman

Keyword(s):

General Anesthesia ◽

Diagnostic Method ◽

Clinical Situation ◽

Categorical Variables ◽

Tumor Characteristics ◽

Continuous Variables ◽

Primary Cutaneous Melanoma ◽

Deep Margin ◽

Biopsy Methods ◽

The Impact

Disagreement persists regarding the role that various biopsy methods should play in the diagnosis of primary cutaneous melanoma. We analyzed the indications for sentinel lymph node (SLN) biopsy and the rates of SLN involvement among biopsy techniques and deep margin status to attempt to determine impact of shave biopsy on surgical management of patients with thin melanoma. All patients who underwent SLN biopsy for melanoma with Breslow thickness less than 1 mm between 1998 and 2006 were identified. Patient and tumor characteristics were compared using χ2 tests for categorical variables. Continuous variables were reported as a mean ± standard deviation and analyzed using t test. Of the 260 patients diagnosed with thin melanomas, 159 (61.2%) were diagnosed by shave biopsy; 101 (38.8%) were diagnosed by other techniques. Of the 159 patients diagnosed by shave biopsy, 18.2 per cent (n = 29) underwent SLN biopsy with the only indication being positive deep margin. The frequency of SLN positivity did not differ between the biopsy groups (3.1% vs 4.0%, P = 0.726) or between groups that had positive or negative deep margins (3.0% vs 3.3%, P = 0.839, respectively). For patients unable to undergo general anesthesia, the increased rate of performing SLN biopsy resulting from shave biopsy should limit its use in these patients. However, shave biopsy is a reasonable diagnostic method for patients at low risk for general anesthesia, particularly because it results in comparably low rates of positive SLN. Thus each patient's unique clinical situation should be considered when deciding which biopsy technique is appropriate.

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LO43: First Nations emergency care visits in Alberta: Descriptive results of a retrospective cohort study

CJEM ◽

10.1017/cem.2020.98 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S22-S22

Author(s):

P. McLane ◽

C. Barnabe ◽

B. Holroyd ◽

A. Colquhoun ◽

L. Bill ◽

...

Keyword(s):

Cohort Study ◽

First Nations ◽

Emergency Care ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Categorical Variables ◽

Continuous Variables ◽

Data Set ◽

Care Visit ◽

The Impact

Introduction: Emergency care serves as an important health resource for First Nations (FN) persons. Previous reporting shows that FN persons visit emergency departments at almost double the rate of non-FN persons. Working collaboratively with FN partners, academic researchers and health authority staff, the objective of this study is to investigate FN emergency care patient visit statistics in Alberta over a five year period. Methods: Through a population-based retrospective cohort study for the period from April 1, 2012 to March 31, 2017, patient demographics and emergency care visit characteristics for status FN patients in Alberta were analyzed and compared to non-FN statistics. Frequencies and percentages (%) describe patients and visits by categorical variables (e.g., Canadian Triage Acuity Scale (CTAS)). Means and standard deviations (medians and interquartile ranges (IQR)) describe continuous variables (e.g., distances) as appropriate for the data distribution. These descriptions are repeated for the FN and non-FN populations, separately. Results: The data set contains 11,686,288 emergency facility visits by 3,024,491 unique persons. FN people make up 4.8% of unique patients and 9.4% of emergency care visits. FN persons live further from emergency facilities than their non-FN counterparts (FN median 6 km, IQR 1-24; vs. non-FN median 4 km, IQR 2-8). FN visits arrive more often by ground ambulance (15.3% vs. 10%). FN visits are more commonly triaged as less acute (59% CTAS levels 4 and 5, compared to non-FN 50.4%). More FN visits end in leaving without completing treatment (6.7% vs. 3.6%). FN visits are more often in the evening – 4:01pm to 12:00am (43.6% vs. 38.1%). Conclusion: In a collaborative validation session, FN Elders and health directors contextualized emergency care presentation in evenings and receiving less acute triage scores as related to difficulties accessing primary care. They explained presentation in evenings, arrival by ambulance, and leaving without completing treatment in terms of issues accessing transport to and from emergency facilities. Many factors interact to determine FN patients’ emergency care visit characteristics and outcomes. Further research needs to separate the impact of FN identity from factors such as reasons for visiting emergency facilities, distance traveled to care, and the size of facility where care is provided.

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