The role of the pharmacist in contraception and pre-pregnancy management for women with diabetes: a study of patient and pharmacist perspectives

2021 ◽  
Author(s):  
Kathryn Garsia ◽  
Freya MacMillan ◽  
Tinashe Dune ◽  
David Simmons
Keyword(s):  
Pregnancy Outcomes ◽  
Adverse Pregnancy Outcomes ◽  
Cultural Barriers ◽  
Diabetes In Pregnancy ◽  
Educational Materials ◽  
Pregnancy Care ◽  
Increased Risk ◽  
Awareness Raising ◽  
Adverse Pregnancy

Abstract Objectives Women with diabetes are at increased risk of adverse pregnancy outcomes compared to women with gestational diabetes (GDM) or no diabetes. Pregnancy outcomes are improved by specialist pre-pregnancy care. We aimed to explore pharmacists’ and women with diabetes’ perceptions of the roles and barriers to pharmacist participation in a diabetes contraception and pre-pregnancy program in South-Western Sydney (SWS). Methods The Diabetes Contraception and Pre-pregnancy Program (DCAPP) aims to reduce adverse pregnancy outcomes among women with diabetes. This includes awareness raising among, and through, pharmacists. Surveys to explore pharmacists’ roles in contraception and pre-pregnancy management (CPPM) were completed by SWS pharmacists and women with diabetes from diabetes clinics aged 18–50 years. Survey themes were then discussed in interviews and focus groups with pharmacists across Australia. Thematic analysis of transcripts was undertaken. Key findings Pharmacists were seen to have a role in diabetes health promotion, information distribution and referral to pre-pregnancy clinics. Pharmacists and women recognised the need for increased knowledge and educational materials about CPPM and effective awareness and coordination of CPPM services. Some pharmacists recognised deficits in their knowledge regarding diabetes in pregnancy, including CPPM and differences to GDM. Barriers to pharmacists’ involvement in CPPM included difficulty identifying applicable women and reluctance to initiate pregnancy planning and contraception conversations, often due to language and cultural barriers. Conclusions Pharmacists and women with diabetes see an important role for pharmacists in CPPM. Co-designed diabetes training for pharmacists and increased communication about DCAPP were seen important for ongoing implementation.

The Need for Personalized Risk-Stratified Approaches to Treatment for Gestational Diabetes: A Narrative Review

2021 ◽  
Author(s):  
Shamil D. Cooray ◽  
Jacqueline A. Boyle ◽  
Georgia Soldatos ◽  
Shakila Thangaratinam ◽  
Helena J. Teede
Keyword(s):  
Gestational Diabetes ◽  
Pregnancy Outcomes ◽  
Population Based ◽  
Adverse Pregnancy Outcomes ◽  
Therapeutic Interventions ◽  
Clinical Prediction Model ◽  
Increased Risk ◽  
Adverse Pregnancy ◽  
The Individual ◽  
Personalized Risk

AbstractGestational diabetes mellitus (GDM) is common and is associated with an increased risk of adverse pregnancy outcomes. However, the prevailing one-size-fits-all approach that treats all women with GDM as having equivalent risk needs revision, given the clinical heterogeneity of GDM, the limitations of a population-based approach to risk, and the need to move beyond a glucocentric focus to address other intersecting risk factors. To address these challenges, we propose using a clinical prediction model for adverse pregnancy outcomes to guide risk-stratified approaches to treatment tailored to the individual needs of women with GDM. This will allow preventative and therapeutic interventions to be delivered to those who will maximally benefit, sparing expense, and harm for those at a lower risk.

Maternal educational inequalities about adverse pregnancy outcomes observed in a rural area of a province of China during a time period (2010–2018)

2022 ◽  
pp. jech-2021-217754
Author(s):  
Lixin Li ◽  
Yanpeng Wu ◽  
Yao Yang ◽  
Ying Wu ◽  
Yan Zhuang ◽  
...  
Keyword(s):  
Pregnancy Outcomes ◽  
Maternal Education ◽  
Rural China ◽  
Education Level ◽  
Adverse Pregnancy Outcomes ◽  
Secondary Outcome ◽  
Health Examination ◽  
Educational Inequalities ◽  
Increased Risk ◽  
Adverse Pregnancy

BackgroundThe relationship between maternal education and adverse pregnancy outcomes is well documented. However, limited research has investigated maternal educational disparities in adverse pregnancy outcomes in China. This study examined maternal educational inequalities associated with adverse pregnancy outcomes in rural China.MethodsWe conducted a population-based cohort study using participants enrolled in the National Free Preconception Health Examination Project in Yunnan province from 2010 to 2018. The primary outcome was stillbirth, and the secondary outcome was adverse pregnancy outcomes, defined as a composite event of stillbirth, preterm birth or low birth weight. The study was restricted to singleton births at 20–42 weeks’ gestation. Univariate and multivariate log-binomial regression models were performed to estimate crude risk ratios (RRs) and confounding-adjusted RRs (ARRs) for stillbirth and adverse pregnancy outcomes according to maternal education level.ResultsA total of 197 722 singleton births were included in the study. Compared with mid-educated women, low-educated women were at a significantly increased risk of stillbirth (ARR, 1.20; 95% CI, 1.05 to 1.38) and adverse pregnancy outcomes (ARR, 1.11; 95% CI, 1.07 to 1.16). However, the risk of stillbirth (ARR, 1.16; 95% CI, 1.01 to 1.35) was significantly higher for high-educated women compared with mid-educated women.ConclusionCompared with women with medium education level, women with lower education level were more likely to experience adverse pregnancy outcomes, including stillbirth, and women with higher education level were more likely to experience stillbirth.

scholarly journals Interpregnancy Body Mass Index Changes: Distribution and Impact on Adverse Pregnancy Outcomes in the Subsequent Pregnancy

2018 ◽  
Vol 36 (05) ◽  
pp. 517-521 ◽  
Author(s):  
Whitney Bender ◽  
Adi Hirshberg ◽  
Lisa Levine
Keyword(s):  
Body Mass Index ◽  
Preterm Birth ◽  
Body Mass ◽  
Pregnancy Outcomes ◽  
Subsequent Pregnancy ◽  
Adverse Pregnancy Outcomes ◽  
Increased Risk ◽  
History Of ◽  
Index Changes ◽  
Adverse Pregnancy

Objective To examine the change in body mass index (BMI) categories between pregnancies and its effect on adverse pregnancy outcomes. Study Design We performed a retrospective cohort study of women with two consecutive deliveries from 2005 to 2010. Analysis was limited to women with BMI recorded at <24 weeks for both pregnancies. Standard BMI categories were used. Adverse pregnancy outcomes included preterm birth at <37 weeks, intrauterine growth restriction (IUGR), pregnancy-related hypertension, and gestational diabetes mellitus (GDM). Women with increased BMI category between pregnancies were compared with those who remained in the same BMI category. Results In total, 537 women were included, of whom 125 (23%) increased BMI category. There was no association between increase in BMI category and risk of preterm birth, IUGR, or pregnancy-related hypertension. Women who increased BMI category had an increased odds of GDM compared with women who remained in the same BMI category (6.4 vs. 2.2%; p = 0.018). The increased risk remained after controlling for age, history of GDM, and starting BMI (adjusted odds ratio: 8.2; 95% confidence interval: 2.1–32.7; p = 0.003). Conclusion Almost one-quarter of women increased BMI categories between pregnancies. This modifiable risk factor has a significant impact on the risk of GDM.

scholarly journals Predicting pregnancy outcomes from homocysteine level: an evidence from a North Indian study

2020 ◽  
Vol 9 (4) ◽  
pp. 1487
Author(s):  
Shaina Chamotra ◽  
Kushla Pathania ◽  
S. K. Verma ◽  
Ankit Chaudhary
Keyword(s):  
Pregnancy Outcomes ◽  
Homocysteine Level ◽  
Perinatal Outcomes ◽  
Normal Subjects ◽  
Adverse Pregnancy Outcomes ◽  
Intrauterine Death ◽  
Increased Risk ◽  
Causal Pathway ◽  
Mother And Child ◽  
Adverse Pregnancy

Background: Hypertensive disorders of pregnancy are a major cause of adverse pregnancy outcomes. Though the etiology of spectrum of vascular disorders of pregnancy is still not understood completely, yet abnormally elevated homocysteine level has been implicated in the causal pathway and pathogenesis. Hyperhomocysteinemia has been significantly associated with increased risk of poor maternal and foetal outcomes in terms of PIH, abruption, IUGR, recurrent pregnancy loss, intrauterine death and prematurity.Methods: The present prospective study was conducted among 180 pregnant women (57 exposed and 123 non exposed) in Kamla Nehru State Hospital for Mother and Child, IGMC Shimla, Himachal Pradesh with an objective of determining association of abnormally elevated homocysteine level in pregnancy and adverse pregnancy outcomes. Socio-demographic, clinical, biochemical including homocysteine level, laboratory, ultrasonographic parameters and foeto-maternal outcomes of pregnancy of all the participants were documented.Results: The mean homocysteine level of exposed group (23.26±10.77 µmol/L) was significantly higher than the unexposed group (8.99±2.47 µmol/L). Among hyperhomocysteinemic subjects, 10.5% had abruption, 15.8% had PRES and 8.7% PPH which was significantly higher than normal subjects. Similarly, patients with homocysteinemia had significantly higher proportion (21.3%) of poor Apgar score, more (41.9%) NICU admissions and higher frequency (4.7%) of meconium aspiration syndrome.Conclusions: The present study generates necessary evidence for associating abnormally elevated homocysteine levels with pregnancy related hypertensive ailments and adverse pregnancy outcomes. It further demands the need of robustly designed studies and trials to further explore the phenomenon. Moreover, it emphasizes on a simple and timely intervention like estimating the much-neglected homocysteine levels during pregnancy which can definitely contribute in predicting and preventing adverse perinatal outcomes.

scholarly journals Chlorination by-products (CBPs) in drinking water and adverse pregnancy outcomes in Italy

2004 ◽  
Vol 2 (4) ◽  
pp. 233-247 ◽  
Author(s):  
Gabriella Aggazzotti ◽  
Elena Righi ◽  
Guglielmina Fantuzzi ◽  
Barbara Biasotti ◽  
Gianbattista Ravera ◽  
...  
Keyword(s):  
Drinking Water ◽  
Pregnancy Outcomes ◽  
Inhalation Exposure ◽  
Preterm Births ◽  
Adverse Pregnancy Outcomes ◽  
High Exposure ◽  
Increased Risk ◽  
Adverse Pregnancy ◽  
Incident Cases ◽  
By Products

Chlorination by-products (CBPs) in drinking water have been associated with an increased risk of adverse pregnancy outcomes, including small for gestational age at term (term-SGA) and preterm delivery. Epidemiological evidence is weakened by a generally inaccurate exposure assessment, often at an ecological level. A case control study with incident cases was performed in nine Italian towns between October 1999 and September 2000. A total of 1,194 subjects were enrolled: 343 preterm births (26th–37th not completed week of pregnancy), 239 term-SGA (from 37th completed week, and weight less than the lowest 10th percentile) and 612 controls. Exposure was assessed both by applying a questionnaire on mothers' personal habits during pregnancy and by water sampling directly at mothers' homes. Levels of trihalomethanes (THMs) were low (median: 1.10 µg l−1), while chlorite and chlorate concentrations were relatively high (median: 216.5 µg l−1 for chlorites and 76.5 µg l−1 for chlorates). Preterm birth showed no association with CBPs, while term-SGA, when chlorite levels ≥200 µg l−1 combined with low and high levels of inhalation exposure are considered, suggested a dose-response relationship (adjusted-Odds Ratios (ORs): 1.52, 95%CI: 0.91–2.54 and 1.70, 95%CI: 0.97–3.0, respectively). A weak association with high exposure levels of either THMs (≥30 µg l−1), or chlorite or chlorate (≥200 µg l−1) was also found (adjusted-OR: 1.38, 95%CI: 0.92–2.07). Chlorine dioxide treatment is widespread in Italy; therefore, chlorite levels should be regularly and carefully monitored and their potential effects on pregnancy further evaluated and better understood.

Adverse Pregnancy Outcomes Are Associated With Increased Risk for Mortality

2006 ◽  
Vol 107 (Supplement) ◽  
pp. 72S
Author(s):  
Monique V. Chireau ◽  
Mimi Biswas ◽  
Emily Honeycutt ◽  
Haywood Brown ◽  
L Kristin Newby ◽  
...  
Keyword(s):  
Pregnancy Outcomes ◽  
Adverse Pregnancy Outcomes ◽  
Increased Risk ◽  
Adverse Pregnancy

scholarly journals Selected Micronutrients: An Option to Boost Immunity against COVID-19 and Prevent Adverse Pregnancy Outcomes in Pregnant Women: A Narrative Review

2020 ◽  
Author(s):  
NAWSHERWAN NAWSHERWAN ◽  
Suliman KHAN ◽  
Falak ZEB ◽  
Muhammad SHOAIB ◽  
Ghulam NABI ◽  
...  
Keyword(s):  
Immune System ◽  
Vitamin A ◽  
Pregnant Women ◽  
Immune Function ◽  
Pregnancy Outcomes ◽  
Pregnancy Complications ◽  
Adverse Pregnancy Outcomes ◽  
Adequate Intake ◽  
Adverse Pregnancy

The coronavirus disease-19 (COVID-19) negatively affects immune system. It is linked with adverse pregnancy outcomes. These complications may be linked with the infections mediated deficiency of micronutrients in pregnant women. COVID-19 cause’s malabsorption of micronutrients thereby increases the risk of their deficiency. Both micronutrients deficiencies and poor micronutrients intake can compromise immune function and may increase the risk of pregnancy complications associated with COVID-19 infection. Vitamin A, C, D, E, and selected minerals iron (Fe), selenium (Se), and zinc (Zn) are the micronutrients essential for immuno-competency and play a significant role in the prevention of adverse pregnancy outcomes. Immune function and pregnancy outcomes can be improved by adequate intake of micronutrients in diet or in supplements form. Based on regulatory links between viral infection, micronutrients, immunity, and pregnancy outcomes, this review highlights the role of micronutrients in boosting immunity to reduce or prevent pregnancy complications in COVID-19 infected women.

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