Total Body Photography and Sequential Digital Dermoscopy in Pregnant Women

Background: Melanocytic nevi can vary in size and number in pregnant women, and the differential diagnosis with melanoma may be challenging. Objectives: To describe changes in total body photography of pregnant women and dermoscopy aspects of their nevi. Methods: A prospective cohort study with 703 melanocytic nevi from 18 women was performed, comparing them in the first and third trimester of pregnancy. Images were analyzed between the 2 periods for changes in dermoscopic aspects. Results: Total body photography images indicated that 44% of patients had new lesions. Regarding the observed changes, there were symmetric or regular changes of the network (23% of cases), occurrence of new globules/dots (12.4%), new vascular structures (3.2%), new streaks (1.7%), and new structureless area (1.0%). Moreover, 55.0% of the nevi increased in size. Enlarging of the nevi was observed mostly on the abdomen (87.1%; P < 0.001) and showed more network changes (27.1%; P = 0.014) and formation of new globules and dots (16.0%; P < 0.001). Patients with a risk of developing melanoma presented more frequently enlarged nevi (45%; P = 0.019). The association between streak formation and skin type was significant (P = 0.012) and was more frequent in skin type II (2.7%), when compared with skin types III (1.3%) and IV (0%).

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The sFlt-1 to PlGF Ratio in Pregnant Women with Rheumatoid Arthritis: Impact of Disease Activity and Sulfasalazine Use

Rheumatology ◽

10.1093/rheumatology/keab372 ◽

2021 ◽

Author(s):

Rugina I Neuman ◽

Hieronymus T W Smeele ◽

A H Jan Danser ◽

Radboud J E M Dolhain ◽

Willy Visser

Keyword(s):

Rheumatoid Arthritis ◽

Cohort Study ◽

Disease Activity ◽

Pregnant Women ◽

Gestational Age ◽

Third Trimester ◽

Low Disease Activity ◽

The Third ◽

Observational Prospective Cohort Study ◽

Plgf Ratio

Abstract Objectives An elevated sFlt-1/PlGF-ratio has been validated as a significant predictor of preeclampsia, but has not been established in women with rheumatoid arthritis (RA). We explored whether the sFlt-1/PlGF-ratio could be altered due to disease activity in RA, and could be applied in this population to predict preeclampsia. Since sulfasalazine has been suggested to improve the angiogenic imbalance in preeclampsia, we also aimed to examine whether sulfasalazine could affect sFlt-1 or PlGF levels. Methods Making use of a nationwide, observational, prospective cohort study on pregnant women with RA, sFlt-1 and PlGF were measured in the third trimester. A total of 221 women, aged 21–42 years, were included, with a median gestational age of 30 + 3 weeks. Results No differences in sFlt-1 or PlGF were observed between women with high, intermediate or low disease activity (p= 0.07 and p= 0.41), whereas sFlt-1 and PlGF did not correlate with DAS28-CRP score (r=-0.01 and r=-0.05, respectively). Four (2%) women with a sFlt-1/PlGF-ratio ≤38 developed preeclampsia in comparison to three (43%) women with a ratio > 38, corresponding to a negative predictive value of 98.1%. Sulfasalazine users (n = 57) did not show altered levels of sFlt-1 or PlGF in comparison to non-sulfasalazine users (n = 164, p= 0.91 and p= 0.11). Conclusion Our study shows that in pregnant women with RA, the sFlt-1/PlGF-ratio is not altered due to disease activity and a cut-off ≤38 can be used to exclude preeclampsia. Additionally, sulfasalazine use did not affect sFlt-1 or PlGF levels in this population.

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COVID-19 Lockdown Increased the Risk of Preterm Birth

Frontiers in Medicine ◽

10.3389/fmed.2021.705943 ◽

2021 ◽

Vol 8 ◽

Author(s):

Ting-ting Lin ◽

Chen Zhang ◽

Lei Chen ◽

Li Jin ◽

Xian-hua Lin ◽

...

Keyword(s):

Cohort Study ◽

Preterm Birth ◽

Pregnant Women ◽

Population Based ◽

Second Trimester ◽

Spontaneous Preterm Birth ◽

Third Trimester ◽

Very Preterm ◽

Increased Risk ◽

The City

Purpose: To estimate whether the city-specific lockdown in Shanghai induced by the COVID-19 pandemic affected preterm birth rates among uninfected pregnant women in different trimesters.Methods: The population-based retrospective cohort study was conducted in the International Peace Maternity and Child Health Hospital (IPMCH) in Shanghai, China. Pregnant women without COVID-19 received perinatal healthcare during lockdown (from January 24, 2020 to March 24, 2020) and non-lockdown (from January 24, 2019 to March 24, 2019) period and giving birth to a live infant at IPMCH were enrolled. 1:1 propensity score matching and Inverse probability of treatment weighting were used to evaluate preterm birth (<37 weeks), very preterm birth (<34 weeks), preterm birth with premature rupture of membranes (PROM-PTB), spontaneous preterm birth with intact membranes (S-PTB), and medically induced preterm birth (MI-PTB) between two groups.Results: 8,270 pregnant women were in the lockdown group, and 9,815 were in the non-lockdown group. Pregnant women in second trimester during lockdown had a higher risk of PTB than those during the non-lockdown period [OR: 1.43 (CI 1.01–2.02), ARD: 1.7% (CI 0.04–3.4%), p = 0.045]. Furthermore, pregnant women in third trimester during lockdown had a higher risk of PROM-PTB than those during the non-lockdown period [OR: 1.64 (CI 1.09–2.47), ARD: 0.9% (CI 0.2–1.6%), p = 0.02]; no group differences were found related to rates of VPTB, S-PTB or MI-PTB.Conclusion: In this cohort study in China, we found that there was an increased risk in preterm birth for non-infected women in COVID-19 lockdown who were in their second trimester.

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Study protocol of the PIMPI-project, a cohort study on acceptance, tolerability and immunogenicity of second trimester maternal pertussis immunization in relation to term and preterm infants

BMC Infectious Diseases ◽

10.1186/s12879-021-06559-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Maarten M. Immink ◽

Mireille N. Bekker ◽

Hester E. de Melker ◽

Nynke Y. Rots ◽

Elisabeth A. M. Sanders ◽

...

Keyword(s):

Cohort Study ◽

Pregnant Women ◽

Preterm Infants ◽

Control Group ◽

Second Trimester ◽

Care Providers ◽

Search Query ◽

Third Trimester ◽

Igg Antibody ◽

Term Infants

Abstract Background Maternal immunization confers passive immunity to the fetus by transplacental antibody transfer. Infants may be better protected against pertussis if the mother received a diphtheriae, tetanus and acellular pertussis (Tdap) vaccination in the second trimester of pregnancy compared to the third trimester. This study evaluates IgG antibody concentrations in term and preterm infants at birth and 2 months after birth after maternal Tdap-vaccination between 200 and 240 w of gestation vs third trimester Tdap-vaccination. Further aims are assessing the determinants that underlie acceptance of second trimester maternal Tdap-vaccination as well as the tolerability of vaccination. Methods This prospective cohort study consists of two parts. In the acceptance part, pregnant women complete a questionnaire on determinants that underlie acceptance of a second trimester Tdap-vaccination, which is offered subsequently between 200 and 240 w of gestation. Vaccinated women complete an additional questionnaire on vaccination tolerability. Vaccinated women may also participate in the immunogenicity part, in which blood is drawn from mother at delivery and from infant at birth and 2 months after birth. Women are also eligible for the immunogenicity part if they received a Tdap-vaccination between 200 and 240 w of gestation via the national immunization program and get hospitalized for an imminent preterm delivery. Blood sampling continues until 60 term and 60 preterm mother-infant-pairs have been included. Pertussis-specific IgG antibody concentrations are determined in serum using a fluorescent bead-based multiplex immunoassay. For term infants, non-inferiority in IgG antibody concentrations against pertussis toxin (anti-PT) will be assessed referred to a historical control group in which mothers were Tdap-vaccinated between 300 and 320 w of gestation. For preterm infants, non-inferiority of anti-PT IgG concentrations is referred to as 85% of infants having ≥ 20 international units/mL at 2 months after birth. Discussion This study investigates acceptance, tolerability and immunogenicity regarding maternal Tdap-immunization between 200 and 240 w of gestation. Its results provide insight into the effects of second trimester Tdap-vaccination on IgG antibody concentrations in term and preterm infants before primary infant vaccinations. Results on acceptance and tolerability guide antenatal care providers in communication with pregnant women and maintain the safety of second trimester Tdap-vaccination. Trial registration: EU Clinical Trials Register, 2018-002976-41, retrospectively registered 24 July 2019, https://www.clinicaltrialsregister.eu/ctr-search/search?query=2018-002976-41.

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Relationship between anaemia, coagulation parameters during pregnancy and postpartum haemorrhage at childbirth: a prospective cohort study

BMJ Open ◽

10.1136/bmjopen-2021-050815 ◽

2021 ◽

Vol 11 (10) ◽

pp. e050815

Author(s):

Manisha Nair ◽

Shakuntala Chhabra ◽

Saswati Sanyal Choudhury ◽

Dipika Deka ◽

Gitanjali Deka ◽

...

Keyword(s):

Cohort Study ◽

Pregnant Women ◽

Postpartum Haemorrhage ◽

Severe Anaemia ◽

Third Trimester ◽

Coagulation Parameters ◽

The Third ◽

Mild Anaemia ◽

Moderate Anaemia ◽

D Dimer

ObjectivesTo investigate the association between coagulation parameters and severity of anaemia (moderate anaemia: haemoglobin (Hb) 7–9.9 g/dL and severe anaemia: Hb <7 g/dL) during pregnancy and relate these to postpartum haemorrhage (PPH) at childbirth.DesignA prospective cohort study of pregnant women recruited in the third trimester and followed-up after childbirth.SettingTen hospitals across four states in India.Participants1342 pregnant women.InterventionNot applicable.MethodsHb and coagulation parameters: fibrinogen, D-dimer, D-dimer/fibrinogen ratio, platelets and international normalised ratio (INR) were measured at baseline. Participants were followed-up to measure blood loss within 2 hours after childbirth and PPH was defined based on blood loss and clinical assessment. Associations between coagulation parameters, Hb, anaemia and PPH were examined using multivariable logistic regression models.Outcomes measuresAdjusted OR with 95% CI.ResultsIn women with severe anaemia during the third trimester, the D-dimer was 27% higher, mean fibrinogen 117 mg/dL lower, D-dimer/fibrinogen ratio 69% higher and INR 12% higher compared with women with no/mild anaemia. Mean platelets in severe anaemia was 37.8×109/L lower compared with women with moderate anaemia. Similar relationships with smaller effect sizes were identified for women with moderate anaemia compared with women with no/mild anaemia. Low Hb and high INR at third trimester of pregnancy independently increased the odds of PPH at childbirth, but the other coagulation parameters were not found to be significantly associated with PPH.ConclusionAltered blood coagulation profile in pregnant women with severe anaemia could be a risk factor for PPH and requires further evaluation.

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382Association between nutrient supplementation and depressive symptom in Pregnancy: a multicenter prospective cohort study

International Journal of Epidemiology ◽

10.1093/ije/dyab168.122 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

Author(s):

Yunli Chen ◽

Yu Jiang

Keyword(s):

Vitamin D ◽

Cohort Study ◽

Folic Acid ◽

Depressive Symptom ◽

Pregnant Women ◽

Dietary Fiber ◽

Prospective Cohort ◽

Third Trimester ◽

Nutrient Supplementation ◽

In Pregnancy

Abstract Background There are few researches about the association between nutrient supplementation and depressive symptom in pregnancy in large prospective cohort studies. Methods In Chinese Pregnant Women Cohort Study (CPWCS), twenty-four hospitals distributed in 15 provinces in China were selected as centre sites. Related information were collected in the first, second and third trimester respectively. Nutrient supplements include folic acid, vitamin D, calcium, iron, docosahexaenoic acid (DHA), dietary fiber, and probiotics. Edinburgh postnatal depression scale (EPDS) was used to assess the mood of depression. Univariable and multivariable Generalized Estimating Equation were applied to analyze the association of nutrient supplementation and depressive symptom in pregnancy. Results A total of 5759 pregnant women were included in our study. Results showed that 93.3%(5374/5759), 92.8%(5189/5591) and 94.2%(4056/4307) women supplemented one or more nutrients in the first, second and third trimester separately. The detection rates of antenatal depression was 30.77%(1772/5759), 28.13%(1573/5591) and 28.44%(1225/4307) separately. Multivariable analyses suggested that supplementing one or more nutrients was significantly associated with depression (OR = 0.812, p = 0.013). When analyzed separately, depression was negatively related to vitamin D (OR = 0.850, p = 0.001), calcium (OR = 0.880, p = 0.006), and DHA (OR = 0.903, p = 0.040), but not associated with supplement of folic acid, dietary fiber, iron, or probiotics. Conclusions Depressive symptom is highly prevalent among Chinese pregnant women, and supplement of vitamin D, calcium, and DHA are preventive factors of depressive symptom in pregnancy. Key message About a third of Chinese pregnant women have depressive symptom, and supplement of vitamin D, calcium, and DHA are preventive factors of depressive symptom in pregnancy.

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Effects of Maternal Weight Gain and Macronutrients Intakes During the Third Trimester of Pregnancy on Birth Weight: A Prospective Cohort Study in Pregnant Women in Sleman, Indonesia

Indian Journal of Public Health Research & Development ◽

10.37506/ijphrd.v11i4.7592 ◽

2020 ◽

Keyword(s):

Cohort Study ◽

Weight Gain ◽

Birth Weight ◽

Pregnant Women ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Maternal Weight Gain ◽

Maternal Weight ◽

Third Trimester ◽

The Third

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Prevalence of anemia and factors associated with pregnant women in West Sumatra, Indonesia: Findings from VDPM Cohort Study

Jurnal Gizi dan Dietetik Indonesia (Indonesian Journal of Nutrition and Dietetics) ◽

10.21927/ijnd.2019.7(3).97-106 ◽

2020 ◽

Vol 7 (3) ◽

pp. 97

Author(s):

Arif Sabta Aji ◽

Yusrawati Yusrawati ◽

Safarina G Malik ◽

Nur Indrawaty Lipoeto

Keyword(s):

Public Health ◽

Risk Factors ◽

Vitamin D ◽

Cohort Study ◽

Pregnant Women ◽

Pregnant Mother ◽

Third Trimester ◽

The Third ◽

West Sumatra ◽

Prevalence Of Anemia

ABSTRAK Latar belakang: Anemia kehamilan masih menjadi masalah kesehatan masyarakat di negara berkembang yang berkontribusi terhadap risiko tinggi komplikasi kehamilan. Indonesia sebagai negara berkembang memiliki risiko anemia yang lebih tinggi yang bisa disebabkan oleh kekurangan asupan zat gizi mikro, infeksi, atau faktor sosial-demografis lainnya. Tujuan: Identifikasi prevalensi dan faktor risiko anemia pada ibu hamil yang tinggal di Sumatera Barat, Indonesia. Metode: Penelitian ini adalah analisis data sekunder dari studi kohort prospektif yaitu "“Vitamin D Pregnant Mother (VDPM) di Sumatera Barat". Subyek ibu hamil trimester diperoleh dari Puskesmas di Provinsi Sumatera Barat. Waktu penelitian dilakukan pada Januari-Maret 2017. Data demografi, sosial ekonomi, antropometri, dan Riwayat kesehatan ibu diteliti. Regresi logistik biner multivariatdigunakan untuk menentukan faktor-faktor terkait anemia. Dalam semua kasus, nilai p kurang dari 0,05 dianggap signifikan secara statistik. Hasil: 176 ibu hamil yang memenuhi kriteria inklusi diambil dalam penelitian ini. Prevalensi anemia ditemukan sebesar 61,90%. Rerata konsentrasi hemoglobin adalah 10,56 ± 1,41 g / dL. Prevalensi anemia sedang dan ringan masing-masing adalah 34% dan 27%. Status anemia ibu hamil trimester ketiga berhubungan dengan wanita yang memiliki <upah minimum/bulan (AOR: 5.15; 95% CI: 1.30-20.47), pengetahuan gizi ibu yang rendah (AOR: 15.88; 95% CI: 3.82- 66.02), IMT sebelum kehamilan <25 kg/m2 (AOR: 11.82; 95% CI: 2.70-51.69), dan tidak patuh konsumsi suplemen zat besi (AOR: 29.69; 95% CI: 6.58-133.91). Kesimpulan: Terdapat masih tingginya prevalensi anemia pada wanita hamil di Sumatera Barat. Oleh karena itu, meningkatkan kesadaran akan suplementasi zat besi dan kesehatan yang berkaitan dengan nutrisi selama kehamilan perlu dipertimbangkan untuk meningkatkan status kesehatan ibu untuk mengurangi anemia. Namun, penelitian lebih lanjut diperlukan dengan ukuran sampel yang besar untuk mengkonfirmasi temuan ini.KATA KUNCI: anemia; faktor risiko; kehamilan; trimester ketiga; Sumatra Barat ABSTRACT Background: Anemia during pregnancy remain to be a public health problem in developing countries which contributes to the high risk of adverse pregnancy outcomes. Indonesia as developing country has a higher risk of anemia that could be due to high of deficiencies of micronutrients intake, infection, or other socio-demographic factors. Objectives: The aim of this study was to determine the prevalence and risk factors anemia among pregnant women living in West Sumatra, Indonesia. Methods: The study is a secondary data analysis of prospective cohort study named “Vitamin D Pregnant Mother (VDPM) study in West Sumatra”. The third trimester pregnant women were enrolled from the public health centers in West Sumatra Province from January to March 2017. Structured questionnaires were used to collect data of demographic, socio-economic, anthropometry, and maternal health from all the study subjects. A multivariate binary logistic regression had been used to determine the associated factors of anemia. In all cases, P value less than 0.05 was considered statistically significant. Results: 176 pregnant women who fulfilled the inclusion criteria were enrolled this study. The prevalence of anemia was 61.90%. The mean of hemoglobin concentration was 10.56±1.41 g/dL. Moderate and mild anemia prevalence were 34% and 27%, respectively. The third trimester of pregnant women anemia status were associated with women who had <minimum wage/month (AOR: 5.15; 95%CI: 1.30-20.47), low-moderate maternal nutrition knowledge (AOR: 15.88; 95%CI: 3.82-66.02), pre-pregnancy BMI <25 kg/m2 (AOR: 11.82; 95%CI: 2.70-51.69), and no adherence iron supplement intake status (AOR: 29.69; 95%CI: 6.58-133.91). Conclusions: There was a high prevalence of anemia status in the third pregnant women in West Sumatra. Therefore, raise awareness of iron supplementation and health related to nutrition during pregnancy need to be considered to improve maternal health status to reduce anemia. However, further studies required with large sample size to confirm this finding.KEYWORDS: anemia; risk factors; third trimester; pregnancy; West Sumatra

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Multi-micronutrient supplementation during pregnancy for prevention of maternal anaemia and adverse birth outcomes in a high-altitude area: a prospective cohort study in rural Tibet of China

British Journal Of Nutrition ◽

10.1017/s000711451700229x ◽

2017 ◽

Vol 118 (6) ◽

pp. 431-440 ◽

Cited By ~ 3

Author(s):

Yijun Kang ◽

Shaonong Dang ◽

Lingxia Zeng ◽

Duolao Wang ◽

Qiang Li ◽

...

Keyword(s):

Cohort Study ◽

Birth Weight ◽

Pregnant Women ◽

High Altitude ◽

Preterm Delivery ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Third Trimester ◽

The Third ◽

High Altitude Area

AbstractAnaemia during pregnancy, characterised by Hb <110 g/l, is a specific risk factor for adverse maternal and perinatal outcomes in developing countries. The objective of this study was to determine the effectiveness of daily antenatal supplementation with multiple micronutrients (MMN) compared with folic acid (FA) on the occurrence of anaemia among pregnant women and their infants’ health in a high-altitude area. A prospective cohort study was carried out in two rural counties in Tibet from 2007 to 2012. A total of 1149 eligible pregnant women were allocated daily supplementation with FA in one county and MMN containing a recommended allowance of twenty-three vitamins and minerals in another county starting ≤24 weeks of gestation and continuing until delivery. Compared with the FA group, prenatal supplementation with MMN was significantly associated with reduced odds of anaemia in the third trimester. This was demonstrated in the primary outcome, with an adjusted OR (AOR) of 0·63; 95 % CI 0·45, 0·88 and P=0·007 and also reduced odds of preterm delivery (AOR: 0·31; 95 % CI 0·15, 0·61; P=0·001). There was no difference between MMN and FA groups in mean birth weight (adjusted mean difference: 36·78; 95 % CI −19·42, 92·98 g; P=0·200), whereas MMN supplementation significantly reduced the odds of low-birth weight (LBW) babies (AOR: 0·58; 95 % CI 0·36, 0·91; P=0·019). In conclusion, the antenatal MMN supplementation in rural Tibet is associated with a reduction of maternal anaemia in the third trimester, and may potentially decrease the risk of preterm delivery and LBW babies.

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Mid-upper arm circumference in pregnant women and birth weight in newborns as substitute for skinfold thickness: findings from the MAASTHI cohort study, India

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03915-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Giridhara R. Babu ◽

Aritra Das ◽

Eunice Lobo ◽

Deepa R ◽

Daisy A. John ◽

...

Keyword(s):

Cohort Study ◽

Birth Weight ◽

Pregnant Women ◽

Body Fat ◽

Skinfold Thickness ◽

Upper Arm ◽

Arm Circumference ◽

Total Body Fat ◽

Total Body ◽

Mid Upper Arm Circumference

Abstract Background Estimating total body fat in public hospitals using gold-standard measurements such as air displacement plethysmography (ADP), deuterium oxide dilution, or dual-energy X-ray absorptiometry (DXA) is unaffordable, and it is challenging to use skinfold thickness. We aimed to identify the appropriate substitute marker for skinfold thickness to estimate total body fat in pregnant women and infants. Methods The study is part of a prospective cohort study titled MAASTHI in Bengaluru, from 2016 to 19. Anthropometric measurements such as body weight, head circumference, mid-upper arm circumference (MUAC), and skinfold thickness were measured in pregnant women between 14 and 36 weeks of gestational age; while measurements such as birth weight, head, chest, waist, hip, mid-upper arm circumference, and skinfold thickness were recorded for newborns. We calculated Kappa statistics to assess agreement between these anthropometric markers with skinfold thickness. Results We found the highest amount of agreement between total skinfold thickness and MUAC (Kappa statistic, 0.42; 95 % CI 0.38–0.46) in pregnant women. For newborns, the highest agreement with total skinfold thickness was with birth weight (0.57; 95 % CI 0.52–0.60). Our results indicate that MUAC higher than 29.2 cm can serve as a suitable alternative to total skinfolds-based assessments for obesity screening in pregnancy in public facilities. Similarly, a birth weight cut-off of 3.45 kg can be considered for classifying obesity among newborns. Conclusion Mid-upper arm circumference and birth weight can be used as markers of skinfold thickness, reflecting total body fat in pregnant women and the infant, respectively. These two anthropometric measurements could substitute for skinfold thickness in low- and middle-income urban India settings.

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