Identifying Symptom Clusters Among Pregnant Women During Early and Late Pregnancy

Abstract Objectives Symptom assessment and management among women in early and late pregnancy remains concerned, in consideration of multiple co-occurring symptoms; however, evaluation of multidimensional nature of symptom experience (e.g., frequency, severity and distress) and relevant symptom cluster among them is insufficient. To shed light on this understudied field, our study investigated the status of multiple psychosomatic symptoms among women and identified symptom clusters in different gestational stages. Methods A convenience sample of 557 pregnant women were recruited at two tertiary hospitals in Shandong, China. They were asked to complete the Memorial Symptom Assessment Scale, and sociodemographic and clinical information. Spearman correlation analysis, partial correlation networks, and hierarchical cluster analysis were carried out to identify optimal number of symptom clusters. Results Top five scores for symptoms in early pregnancy were nausea, lack of appetite, feeling drowsy, lack of energy, and vomiting; and weight gain, difficulty sleeping, sweating, lack of energy, and dry mouth scored highly in late pregnancy. Four clusters (pregnancy reaction symptom cluster, mood-fatigue symptom cluster, change in libido and food taste symptom cluster, and dry mouth-bloating symptom cluster) were identified in early pregnancy, and three clusters (mood-fatigue symptom cluster, sleep-bloating symptom cluster, and fluid deficiency symptom cluster) were determined in late pregnancy. Conclusion Women experience multiple psychosomatic symptoms during pregnancy, and the manifestation of symptoms varies in different stages. Our study has provided new insights into symptom clusters of pregnant women. These results might potentially support the development of assessment and management of multiple co-occurring symptoms in this population.

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Anxiety, depression and social support in Chinese pregnant women with a history of recurrent miscarriage: a prospective study

10.21203/rs.3.rs-32650/v1 ◽

2020 ◽

Cited By ~ 1

Author(s):

Jia Qu ◽

Xueling Weng ◽

Ling-ling Gao

Keyword(s):

Social Support ◽

Pregnant Women ◽

Early Pregnancy ◽

Recurrent Miscarriage ◽

Late Pregnancy ◽

Anxiety And Depression ◽

Convenience Sample ◽

History Of ◽

Anxiety Depression ◽

Prospective Longitudinal

Abstract Background: Women with a history of recurrent miscarriage(RM) are a more vulnerable population, caring for the pregnant women with a history of RM is quite needed. Although evidence suggests an association among anxiety, depression and social support. Yet, it is unclear about changes in and relationships between anxiety, depression and social support among the pregnant women with a history of RM throughout the pregnancy period. The aim of this study was to examine the changes in and relationships among anxiety, depression and social support across three trimesters of pregnancy in Chinese women with a history of RM. Methods: A prospective, longitudinal study was employed. The study was carried out between September 2016 and October 2017 in a teaching hospital in Guangzhou, China. A convenience sample of 166 pregnant women with a history of RM completed the measures at their 6-12, 20-24 and 32-36 gestational weeks. data were collected by a master student with Zung Self-Rating Anxiety Scale, the Edinburgh Postnatal Depression Scale, and the Perceived Social Support Scale. Results: Anxiety decreased from the early pregnancy to late pregnancy while depression first declined from early pregnancy to mid-pregnancy then remained to late pregnancy. Social support increased from early pregnancy to mid-pregnancy and then remained to late pregnancy. There were correlations in anxiety, depression and social support across the three trimesters of pregnancy. Conclusions: Anxiety and depression are highly prevalent in pregnant women with a history of RM, especially in early pregnancy, which merits clinical attention. Social support was an important buffer against anxiety and depression across the pregnancy. Interventions targeting women with RM may improve the health outcomes of women and their children.

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Clinical Characteristics of Pregnant Women With COVID-19 In Japan: A Nationwide Questionnaire Survey

10.21203/rs.3.rs-146179/v1 ◽

2021 ◽

Author(s):

Tatsuya Arakaki ◽

Junichi Hasegawa ◽

Akihiko Sekizawa ◽

Tomoaki Ikeda ◽

Isamu Ishiwata ◽

...

Keyword(s):

Pregnant Women ◽

Early Pregnancy ◽

Screening Test ◽

Universal Screening ◽

Clinical Characteristics ◽

Severe Infection ◽

Late Pregnancy ◽

Maternal Characteristics ◽

Route Of Infection ◽

Positive Rate

Abstract Background: Few reports have presented an overall view of pregnant women with coronavirus disease 2019 (COVID-19) across an entire country and throughout the entire gestation period. Furthermore, no such reports are available for Japan. We examined the clinical characteristics and outcomes of pregnant women with COVID‑19 on a national scale in Japan.Methods: A nationwide questionnaire-based survey for all 2,185 maternity services in Japan was conducted between July and August 2020. Information regarding maternal characteristics and epidemiological, clinical, treatment, and perinatal outcomes of pregnant women diagnosed with COVID-19 between 16 January and 30 June 2020 were collected. Main outcome measures were incidence of pregnant women with COVID-19 and infant infection, positive rate of the universal screening test for asymptomatic pregnant women, identification of infection route and rates of maternal death, and severe cases.Results: Responses from 1,418 institutions were assessed (65% of all delivery institutions in Japan). Seventy-two pregnant women were reported to have been diagnosed with COVID-19. The positive rate of the universal screening test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among asymptomatic pregnant women was 0.03% (2/7428). The most common route of infection was familial (57%). Fifty-eight pregnant women with COVID-19 were symptomatic, of whom five (8.6%) had a severe infection and one died (a tourist). Severe respiratory symptoms, oxygen administration, and pneumonia were frequently reported in the third trimester and postpartum period compared with in early pregnancy (22.2% vs 2.5% [P=0.03], 38.9% vs 7.5% [P=0.01], and 50.0% vs 7.5% [P<0.01], respectively). All pregnant women with COVID-19 underwent caesarean sections, regardless of symptoms. There were no SARS-CoV-2 transmissions to newborns.Conclusions: In Japan, the number of cases of COVID-19 infection in pregnant women is very low. Compared with early pregnancy, late pregnancy may be a risk factor for exacerbation of symptoms and familial transmission is the most common route of infection. The importance of infection prevention should be emphasised, especially in women in late pregnancy, their families, and any cohabitants.Trial registration: None

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Sleep Patterns in Pregnant Women with Obesity Differentially Affect Energy Intake and Metabolic Health

Current Developments in Nutrition ◽

10.1093/cdn/nzaa054_056 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 984-984

Author(s):

Emily Flanagan ◽

Abby Altazan ◽

Jasper Most ◽

Robbie Beyl ◽

Daniel Hsia ◽

...

Keyword(s):

Weight Gain ◽

Pregnant Women ◽

Energy Intake ◽

Early Pregnancy ◽

Late Pregnancy ◽

Sleep Time ◽

Metabolic Health ◽

Sleep Patterns ◽

Gestational Weight ◽

Gain Energy

Abstract Objectives During pregnancy, altered glucose kinetics coupled with disrupted sleep increase the risk for adverse metabolic health outcomes. The aim of this prospective, observational study in pregnant women with obesity was to 1) examine sleep patterns in early and late pregnancy; and 2) identify how changes in sleep patterns impact gestational weight gain, energy intake and metabolic health. Methods In 52 healthy pregnant women with obesity (27.4 ± 0.6 y; BMI: 36.3 ± 0.7 kg/m,2), energy intake (intake-balance method), and changes in weight, fasting glucose, insulin, lipids and habitual sleep (5 consecutive nights via wrist worn accelerometer) were assessed from early (13,0–15,6 weeks) to late (35,0–36,6) pregnancy. A change to habitual sleep parameters (increase or decrease) was defined as ± one-half of the standard deviation of the 5-day measurement in early pregnancy. Results Results In early pregnancy, time spent in bed (TIB) was 9.40 ± 0.13 h and varied 1.61 ± 0.11 h across the 5 nights. Total sleep time (TST) and sleep efficiency (SE) significantly declined from early to late pregnancy 7.05 ± 0.13 h to 6.46 ± 0.15 h (P < 0.001) and 76 ± 0.1% to 71 ± 0.2% (P < 0.001), respectively. Women who increased TIB (11 of 52) had a significant decrease in plasma glucose −11.6 ± 4.3% (P < 0.01) and a trend towards lower insulin (−57.8 ± 33.5%; P = 0.09) and HOMA-IR (−72.4 ± 37.3%; P = 0.058) across pregnancy compared to women who decreased their TIB (13 of 52). Women who increased TIB had a significantly lower daily energy intake (−540 ± 163 kcal; P < 0.01) and tended to have less gestational weight gain (−146.7 ± 87.6 g/wk; P = 0.10). There was no difference in weight gain, energy intake or plasma markers between women who increased or decreased TST or SE. Conclusions Although sleep time and sleep quality decline throughout pregnancy, TIB had the greatest impact on metabolic health in pregnant women with obesity. Women spending more TIB consumed fewer calories. Our data suggest that the relationship between glucose metabolism and sleep during pregnancy is at least in part explained by lower energy intakes, possibly due to shorter eating windows. Studies that manipulate the eating window, independent of sleep timing are needed to understand the benefits to metabolic health for women during pregnancy. Funding Sources National Institutes of Health [R01DK099175].

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Changes in baroreceptor sensitivity for heart rate during normotensive pregnancy and the puerperium

Clinical Science ◽

10.1042/cs0980259 ◽

2000 ◽

Vol 98 (3) ◽

pp. 259-268 ◽

Cited By ~ 31

Author(s):

Melanie J. BLAKE ◽

Allison MARTIN ◽

Brad N. MANKTELOW ◽

Charles ARMSTRONG ◽

Aidan W. HALLIGAN ◽

...

Keyword(s):

Heart Rate ◽

Pregnant Women ◽

Early Pregnancy ◽

High Frequency ◽

Post Partum ◽

Late Pregnancy ◽

Late Gestation ◽

Control Group ◽

Pulse Interval ◽

Normotensive Pregnancy

Normal pregnancy is associated with marked changes in cardiovascular haemodynamics, which in part may be due to changes in autonomic control mechanisms. Baroreflex sensitivity for heart rate (BRS) was calculated in the supine and standing positions using power spectral analysis of pulse interval (PI) and systolic blood pressure (SBP) in 16 normotensive pregnant women and 10 normotensive non-pregnant controls. The pregnant women were studied on three occasions during their pregnancy (early, mid- and late gestation) and once during the puerperium. Supine total SBP variability increased between early and late pregnancy by 79% [95% confidence intervals (CI) 30%, 145%; P < 0.001], and supine high-frequency PI variability decreased by 75% (CI 51%, 88%; P < 0.001). Supine BRS fell by 50% (P < 0.001), with values returning to early-pregnancy levels in the puerperium, which were similar to those recorded in the control group. Standing SBP variability and BRS values were unchanged during pregnancy and post partum. The low/high frequency ratio of PI variability, taken as a surrogate measure of sympathovagal balance, increased by 137% (CI 42%, 296%; P < 0.01) in the supine but not the standing position from early to late pregnancy. This was due to a decrease in high-frequency variability rather than to an increase in low-frequency variability, suggesting that these changes may have been due to vagal withdrawal rather than increased sympathetic activity. Normotensive pregnancy is associated with a marked decrease in supine BRS, although the exact mechanisms for these changes remain unclear. Further studies are required to define whether changes in BRS and sympathovagal tone in early pregnancy can be used to predict the onset of pregnancy-induced hypertension.

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The erythrocyte incorporation of absorbed non-haem iron in pregnant women

British Journal Of Nutrition ◽

10.1079/bjn2001390 ◽

2001 ◽

Vol 86 (3) ◽

pp. 323-329 ◽

Cited By ~ 16

Author(s):

Paul G. Whittaker ◽

Jon F.R. Barrett ◽

Tom Lind

Keyword(s):

Pregnant Women ◽

Early Pregnancy ◽

Oral Absorption ◽

Late Pregnancy ◽

Late Gestation ◽

Stable Isotope Ratios ◽

Early Gestation ◽

Haem Iron ◽

In Pregnancy ◽

High Absorption

Studies of Fe absorption in pregnancy often make unfounded assumptions of erythrocyte incorporation. Therefore, we measured the absorption and utilisation of Fe during early and late pregnancy by the erythrocyte incorporation of two stable isotopes. 8·5 mg57Fe (oral) and 0·5 mg58Fe (intravenous) were given to five non-pregnant women, to five women in early gestation (12 weeks) and five women in late gestation (36 weeks). The stable isotope ratios in whole blood 14 d later were measured by MS. Together with estimation of body Fe mass, this enabled the calculation of Fe absorption and erythrocyte incorporation. In non-pregnant women, Fe absorption averaged 20·3 (range 10·2–34·3) %. It was not significantly different in early pregnancy (11·8 (range, 4·4–24·8) %), but during late pregnancy Fe absorption increased to 59·0 (range 38·2–77·2) %. All non-pregnant and early-pregnancy subjects had normal Fe status, but two women in late pregnancy had evidence of Fe insufficiency. During early and late pregnancy, mean erythrocyte incorporation was 63·4 (SD 12·1) % AND 71·0 (sd 10·4) % respectively, significantly reduced (P=0·003) compared with non-pregnant subjects (90·1 (sd 6·0) %). Decreased erythrocyte incorporation of absorbed Fe in early pregnancy is compatible with reduced Fe demand and low oral absorption. However, during late pregnancy decreased erythrocyte incorporation associated with high absorption and Fe insufficiency is different from the high erythrocyte incorporation which occurs in non-pregnant Fe-deficient women. This suggests that part of the aetiology of Fe deficiency during pregnancy may be the reduction of Fe utilisation.

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Thyroxine Supplementation in Pregnant Women After Thyroidectomy for Thyroid Cancer and Neonatal Birth Weight

Frontiers in Endocrinology ◽

10.3389/fendo.2021.728199 ◽

2021 ◽

Vol 12 ◽

Author(s):

Zheng Ding ◽

Fei Guo ◽

Yulai Zhou ◽

Xiaoyi Huang ◽

Zhiwei Liu ◽

...

Keyword(s):

Thyroid Cancer ◽

Birth Weight ◽

Pregnant Women ◽

Early Pregnancy ◽

Late Pregnancy ◽

Thyroid Stimulating Hormone ◽

Control Group ◽

Inverse Association ◽

Neonatal Birth Weight ◽

Maternal Thyroid

Patients are often supplemented with a sufficient dose of thyroxine after thyroidectomy for thyroid cancer. However, the influence of thyroxine supplementation on fetal growth in pregnant women after thyroidectomy for thyroid cancer remains unclear. The aim of this study was to investigate the effect of thyroxine supplementation on neonatal birth weight. This cohort study included 49,896 pregnant women (278 patients with a history of thyroidectomy for thyroid cancer and 39,363 control cases after exclusion). Thyroid parameters were examined in pregnant women and their newborns. The associations between maternal thyroid function and neonatal birth weight and small for gestational age were studied using regression analyses. In the levothyroxine supplementation group, free thyroxine (FT4) levels were significantly higher in both early pregnancy (P < 0.001) and late pregnancy (P < 0.001) groups than in the control group. Furthermore, levels of neonatal thyroid stimulating hormone (P = 0.032) and birth weight (P = 0.043) were significantly lower than those in the control group. We also observed a significant inverse association between maternal FT4 levels in early pregnancy and neonatal birth weight (P=0.028), especially in male newborns (P=0.036). In summary, after thyroidectomy for thyroid cancer, a sufficient dose of thyroxine supplementation in early pregnancy is significantly associated with reduced birth weight and may need to be monitored.

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Symptom clusters in patients receiving chemotherapy: A systematic review

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2021-003325 ◽

2021 ◽

pp. bmjspcare-2021-003325

Author(s):

Carolyn S. Harris ◽

Kord M. Kober ◽

Yvette P. Conley ◽

Anand A. Dhruva ◽

Marilyn J. Hammer ◽

...

Keyword(s):

Systematic Review ◽

Adjuvant Chemotherapy ◽

De Novo ◽

Symptom Assessment ◽

Symptom Clusters ◽

Symptom Cluster ◽

Registration Number ◽

Secondary Outcomes ◽

Symptom Assessment Scale ◽

Methodological Considerations

Background and purposeSince 2001, symptom cluster research has grown considerably. However, because multiple methodological considerations remain, ongoing synthesis of the literature is needed to identify gaps in this area of symptom science. This systematic review evaluated the progress in symptom clusters research in adults receiving primary or adjuvant chemotherapy since 2016.MethodsEligible studies were published in English between 1 January 2017 and 17 May 2021; evaluated for and identified symptom clusters ‘de novo;’ and included only adults being treated with primary or adjuvant chemotherapy. Studies were excluded if patients had advanced cancer or were receiving palliative chemotherapy; symptoms were measured after treatment; symptom clusters were pre-specified or a patient-centred analytic approach was used. For each study, symptom instrument(s); statistical methods and symptom dimension(s) used to create the clusters; whether symptoms were allowed to load on more than one factor; method used to assess for stability of symptom clusters and associations with secondary outcomes and biomarkers were extracted.ResultsTwenty-three studies were included. Memorial Symptom Assessment Scale was the most common instrument and exploratory factor analysis was the most common statistical method used to identify symptom clusters. Psychological, gastrointestinal, and nutritional clusters were the most commonly identified clusters. Only the psychological cluster remained relatively stable over time. Only five studies evaluated for secondary outcomes.DiscussionWhile symptom cluster research has evolved, clear criteria to evaluate the stability of symptom clusters and standardised nomenclature for naming clusters are needed. Additional research is needed to evaluate the biological mechanism(s) for symptom clusters.PROSPERO registration numberCRD42021240216.

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Lactose digestion in pregnant African-Americans

Public Health Nutrition ◽

10.1079/phn2003489 ◽

2003 ◽

Vol 6 (8) ◽

pp. 801-807 ◽

Cited By ~ 5

Author(s):

David M Paige ◽

Frank R Witter ◽

Yvonne L Bronner ◽

Lisa A Kessler ◽

Jay A Perman ◽

...

Keyword(s):

African American ◽

African Americans ◽

Pregnant Women ◽

African American Women ◽

Early Pregnancy ◽

Lactose Intolerance ◽

Late Pregnancy ◽

American Women ◽

African American Population ◽

The Status

AbstractObjective:This paper reports on the status of lactose digestion during early and late pregnancy and at 8 weeks postpartum in an African-American population. The hypothesis is that lactose digestion and milk tolerance do not change throughout pregnancy anddo not differ from those of non-pregnant African-American women.Design and subjects:This longitudinal study determined lactose digestion after ingesting 240 ml of 1% fat milk containing 12g of lactose at: (1) early pregnancy, prior to 16 weeks (n = 148); (2) late pregnancy, 30–35 weeks (n = 77); and (3) 8 weeks postpartum (n = 93). One hundred and one comparably matched non-pregnant African-American women served as controls.Results:Prevalence of lactose digestion, as measured by breath hydrogen, was 80.2% in the control women, 66.2% in early pregnancy, 68.8% in late pregnancy and 75.3% postpartum. The prevalence of women reporting symptoms was approximately 20% regardless of lactose absorption status. However, the control women reported significantly more symptoms than did the pregnant women.Conclusions:This study indicates that there is no significant change in lactose digestion during pregnancy. The prevalence of lactose intolerance for the pregnant African-American women studied is similar to that for non-pregnant African-American women and similar to previous prevalence reports in adult African-Americans. There was no change in the tolerance of lactose noted during pregnancy in these women. There were, however, fewer symptoms reported by the lactose-maldigesting pregnant women.

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Comparison of urinary 5-L-oxoproline (L-pyroglutamate) during normal pregnancy in women in England and Jamaica

British Journal Of Nutrition ◽

10.1079/bjn19970023 ◽

1997 ◽

Vol 77 (2) ◽

pp. 183-196 ◽

Cited By ~ 18

Author(s):

Alan A Jackson ◽

Chandarika Persaud ◽

Geoff Werkmeister ◽

Irene S. M McClelland ◽

Asha Badaloo ◽

...

Keyword(s):

Pregnant Woman ◽

Pregnant Women ◽

Early Pregnancy ◽

Late Pregnancy ◽

Normal Pregnancy ◽

Progressive Increase ◽

Significant Difference

Urinary 5-L-oxoproline was measured during normal pregnancies in Southampton, England and Kingston, Jamaica. The CV of 5-L-oxoproline excretion in urine, determined over 7 d in a non-pregnant woman and three pregnant women, was 10–36%. Compared with non-pregnant women, urinary 5-L-oxoproline increased three to four times from early pregnancy in women in Southampton, a highly significant difference, and remained elevated at similar levels during mid and late pregnancy. For women in Kingston, the excretion of 5-L-oxoproline was similar to that of Southampton women in the non-pregnant group and during early pregnancy. However, there was a progressive increase in the excretion of 5-L-oxoproline as pregnancy advanced and by late pregnancy excretion was from three to ten times greater than the average for the non-pregnant women. There was a significant difference between the women in Southampton and the women in Kingston during mid and late pregnancy, with women in Kingston excreting twice as much 5-L-oxoproline during late pregnancy. If the excretion of 5-L-oxoproline is a measure of glycine insdciency, the results would indicate that in some pregnancies the ability of the mother to provide glycine for herself and the developing fetus is marginal or inadequate and the constraint appears more marked in Jamaica than in England.

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Clinical characteristics of pregnant women with COVID-19 in Japan: a nationwide questionnaire survey

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-04113-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Tatsuya Arakaki ◽

Junichi Hasegawa ◽

Akihiko Sekizawa ◽

Tomoaki Ikeda ◽

Isamu Ishiwata ◽

...

Keyword(s):

Pregnant Women ◽

Early Pregnancy ◽

Screening Test ◽

Universal Screening ◽

Clinical Characteristics ◽

Severe Infection ◽

Late Pregnancy ◽

Maternal Characteristics ◽

Route Of Infection ◽

Positive Rate

Abstract Background Few reports have presented an overall view of pregnant women with coronavirus disease 2019 (COVID-19) across an entire country and throughout the entire gestation period. Furthermore, no such reports are available for Japan. We examined the clinical characteristics and outcomes of pregnant women with COVID‑19 on a national scale in Japan. Methods A nationwide questionnaire-based survey for all 2,185 maternity services in Japan was conducted between July and August 2020. Information regarding maternal characteristics and epidemiological, clinical, treatment, and perinatal outcomes of pregnant women diagnosed with COVID-19 between 16 January and 30 June 2020 were collected. Main outcome measures were incidence of pregnant women with COVID-19 and infant infection, positive rate of the universal screening test for asymptomatic pregnant women, identification of infection route and rates of maternal death, and severe cases. Results Responses from 1,418 institutions were assessed (65% of all delivery institutions in Japan). Seventy-two pregnant women were reported to have been diagnosed with COVID-19. The positive rate of the universal screening test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among asymptomatic pregnant women was 0.03% (2/7428). The most common route of infection was familial (57%). Fifty-eight pregnant women with COVID-19 were symptomatic, of whom five (8.6%) had a severe infection and one died (a tourist). Severe respiratory symptoms, oxygen administration, and pneumonia were frequently reported in the third trimester and postpartum period compared with in early pregnancy (22.2% vs 2.5% [P = 0.03], 38.9% vs 7.5% [P = 0.01], and 50.0% vs 7.5% [P < 0.001], respectively). All pregnant women with COVID-19 underwent caesarean sections, regardless of symptoms. There were no SARS-CoV-2 transmissions to newborns. Conclusions In Japan, the number of cases of COVID-19 infection in pregnant women is very low. Compared with early pregnancy, late pregnancy may be a risk factor for exacerbation of symptoms and familial transmission is the most common route of infection. The importance of infection prevention should be emphasised, especially in women in late pregnancy, their families, and any cohabitants.

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