Use of Oral Glucose Tolerance Testing and HbA1c At 6-14 Gestational Weeks to Predict Gestational Diabetes Mellitus In High-Risk Women

Objective:To study the prediction of gestational diabetes mellitus (GDM) in high-risk pregnant women by testing the 1-hour (1hPG) and 2-hour plasma glucose (2hPG) after an oral glucose tolerance test and the glycated hemoglobin (HbA1c) in early pregnancy (6-14 weeks).Methodology:We recruited 1311 pregnant women at high risk for diabetes from the Obstetrics Clinic of Daxing District People's Hospital between June 2017 and December 2019. Fasting blood glucose (FPG) and HbA1c were tested and a 75 g oral glucose tolerance test (OGTT) with 1-hour blood glucose (1hPG) and 2-hour blood glucose (2hPG) was performed during the first trimester of pregnancy. The women were seen at 24-28 weeks to follow-up for GDM. We calculated the receiver operating characteristic (ROC) and the area under the ROC curve (AUC) to determine the predictive values for early pregnancy FPG, 1hPG, 2hPG, and HbA1c for GDM in high-risk pregnant women.Results:The prevalence of pregestational diabetes mellitus among pregnant women at high risk of diabetes was 5.6%, and GDM was 24.7%. The AUCs for the predictive value of FPG, 1hPG, 2hPG, and HbA1c in high-risk pregnant women were 0.64, 0.76, 0.71, and 0.67, respectively. The AUC for 1hPG prediction of GDM in high-risk pregnant women is greater than FPG, 2hPG, and HbA1c. All differences were statistically significant.Conclusion:FPG, 1hPG, 2hPG, and HbA1c measured in the first trimester pregnancy of high-risk women are significant predictors of GDM. 1hPG was the most significant predictive value for GDM in high-risk pregnant women.

The role of maternal echocardiography and uterine artery Doppler at 11-14 weeks in the prediction of pre-eclampsia in nulliparous women

Background: Pre-eclampsia (PE) complicates 2% of pregnancies and may have serious effects on mother and child, which makes it an important threat to public health in both developed and developing countries. Once high-risk women are identified, they can be targeted for more intense prenatal surveillance and preventative measures. Predicting PE in the first trimester requires the use of maternal echocardiography and the uterine artery pulsatility index (UAPI). Objective of the study was to see whether maternal echocardiography and uterine artery Doppler at 11-14 weeks can predict subsequent development of PE in nulliparous women.Methods: This prospective observational cohort study was carried out in outdoor patients of obstetrics and gynecology of Bangabandhu Sheikh Mujib Medical University (BSMMU), with collaboration with department of cardiology, National Institute of Nuclear Medicine and Allied Sciences (NINMAS), BSMMU, Dhaka, during 01 December 2013 to July 2015. A total of 135 healthy nulliparous women at 11-14 weeks of gestation were included in this study. Data was processed and analyzed by statistical package for the social sciences (SPSS) version 24.0.Results: Among 135 patients, two (1.5%) patients developed preeclampsia during 1st follow-up (20-28 weeks) and four (2.9%) patients developed preeclampsia during (29-36 weeks). Mean total peripheral resistance was found to be 1332.0±75.2 dynes/sec/cm5 in preeclampsia and 1157.0±139.2 dynes/sec/cm5 in non preeclamptic pregnancy. The difference between two groups was statistically significant. MAP and total peripheral resistance were statistically significant (p<0.05) between two groups.Conclusions: In first trimester of pregnancy UAPI is the best predictor for detection of PE.

ANALYSIS OF PERINATAL CARE INDICATORS OF THE ALMATY MEGAPOLIS

Анализ демографических показателей за последние десять лет в г. Алматы выявил, что на фоне относительно стабильных показателей рождаемости (17,7 до 18,2‰), общей смертности (8,03 до 6,49‰) наблюдалось значительное снижение младенческой (с 17,4 до 8,05‰) и повышение материнской смертности (с 2,4 до 15,4 на 100 тыс. живорожденных). Несмотря на снижение распространенности анемии с 31,8% до 18,8%, удельный вес её все еще высокий, являющейся фоном для развития преэклампсии и ухудшения течения экстрагенитальных заболеваний, среди которых наиболее часто встречаются болезни почек и мочевыделительной системы (10,1%), системы кровообращения (3,5%), органов дыхания (3,3%); развития осложнений в виде невынашивания беременности (16,9%), преждевременных родов (7,2%), акушерских кровотечений (1,2%), учащения операции кесарева сечения (до 30,0%), органоуносящих операций (0,4%). В этих условиях созрела необходимость создания системы мониторинга женщин группы высокого риска, включающей наблюдение за ними, коррекцию лечения, проведение профилактики патологических состояний с использованием современных цифровых технологий. An analysis of demographic indicators over the past ten years in Almaty revealed that against the background of relatively stable birth rates (from 17.7 to 18.2‰), overall mortality (from 8.03 to 6.49‰), there was a significant decrease in infant mortality (from 17,4 to 8.05 ‰) and perinatal mortality (from 20.1‰ to 8.0‰), an increase in maternal mortality (from 2.4 to 15.4 per 100 thousand live births). Despite the decrease in the prevalence of anemia from 31.8% to 18.8%, its proportion is still high, which is a background for the development of preeclampsia and worsening of the course of extragenital diseases, among which diseases of the kidneys and urinary system (10.1%) , circulatory system (3.5%), respiratory system (3.3%) are most common; the development of complications in the form of miscarriage (16.9%), premature birth (7.2%), obstetric bleeding (1.2%), increased frequency of cesarean section (up to 30.0%), organ-carrying operations (0.4%). In these conditions, need to create a monitoring system for high-risk women, including monitoring them, correcting treatment, and preventing pathological conditions using modern digital technologies.

A survey study of the impact of COVID-19 on women at high risk for infant mortality in Central Indiana

Background/Objective: The WeCare program aims to reduce infant mortality through the community health worker model by assisting high risk women of child-bearing age. The COVID-19 pandemic introduced additional challenges for women already at high risk factor for infant mortality (IM). The aim of this survey study is to assess the impact of the COVID-19 pandemic in this population. Methods: Enrolled WeCare participants were given an optional COVID-19 phone survey (modified from the IeDEA survey*) between August 2020 and May 2021 to assess the impact of COVID-19 on their daily lives, income, food security, and mental health. Trained research assistants and community health workers administered surveys. Verbal consent was obtained over the phone. Data was entered into REDCap. From REDCap, data was exported to SAS version 9.4 to calculate descriptive statistics and chi square tests. Results: Fifty-six primarily women of color (68%) completed the survey. Sixty-two percent of women lived in high-risk zip codes for infant mortality in Central Indiana. Fifty-seven percent of women worked prior to the outbreak. Forty-eight percent of the working women lost income, and seventy percent of women worked jobs requiring interaction with the public. These women experienced greater food insecurity (38%), depression (24%), and anxiety (31%) compared to before the pandemic (p<0.001). Conclusion/Discussion: The demographics and residence of those interviewed were representative of the WeCare cohort (NS differences in race/ethnicity/age). In comparing the prevalence of food insecurity, depression and anxiety between the survey sampled during covid and prior to covid, all factors were significantly increased. These vulnerable women (many pregnant or postpartum), often major breadwinners in their household, held jobs putting them at high risk for covid infections, and lost these high-risk jobs at an alarming rate. These data confirm the detrimental impact of COVID-19, especially on a population already at high risk for IM. Acknowledgement of original authors of the *IeDEA survey: Suzanne Goodrich, Michael Scanlon, Leslie Enane, Kara Wools-Kaloustian

Epigenetic Dysregulation of KCNK9 Imprinting and Triple-Negative Breast Cancer

Genomic imprinting is an inherited form of parent-of-origin specific epigenetic gene regulation that is dysregulated by poor prenatal nutrition and environmental toxins. KCNK9 encodes for TASK3, a pH-regulated potassium channel membrane protein that is overexpressed in 40% of breast cancer. However, KCNK9 gene amplification accounts for increased expression in <10% of these breast cancers. Here, we showed that KCNK9 is imprinted in breast tissue and identified a differentially methylated region (DMR) controlling its imprint status. Hypomethylation at the DMR, coupled with biallelic expression of KCNK9, occurred in 63% of triple-negative breast cancers (TNBC). The association between hypomethylation and TNBC status was highly significant in African-Americans (p = 0.006), but not in Caucasians (p = 0.70). KCNK9 hypomethylation was also found in non-cancerous tissue from 77% of women at high-risk of developing breast cancer. Functional studies demonstrated that the KCNK9 gene product, TASK3, regulates mitochondrial membrane potential and apoptosis-sensitivity. In TNBC cells and non-cancerous mammary epithelial cells from high-risk women, hypomethylation of the KCNK9 DMR predicts for increased TASK3 expression and mitochondrial membrane potential (p < 0.001). This is the first identification of the KCNK9 DMR in mammary epithelial cells and demonstration that its hypomethylation in breast cancer is associated with increases in both mitochondrial membrane potential and apoptosis resistance. The high frequency of hypomethylation of the KCNK9 DMR in TNBC and non-cancerous breast tissue from high-risk women provides evidence that hypomethylation of the KNCK9 DMR/TASK3 overexpression may serve as a marker of risk and a target for prevention of TNBC, particularly in African American women.

Screening Echocardiogram in High-Risk Women with Class III Obesity to Predict the Risk of Preeclampsia

Objective Women with obesity and other comorbidities such as hypertension and diabetes are at an increased risk of preeclampsia and perinatal morbidity. This study evaluates whether screening echocardiogram can identify women with obesity at a higher risk of preeclampsia. Methods We conducted a retrospective cohort study of women with class III obesity (body mass index [BMI] ≥40 kg/m2) and one or more medical comorbidities associated with an increased risk of preeclampsia (such as diabetes, hypertension, and rheumatologic disease) undergoing screening echocardiogram. Abnormal findings were defined as the presence of one or more of the following: diastolic dysfunction, ejection fraction of ≤45%, or cardiac chamber enlargement or hypertrophy. Multivariable logistic regression was used to estimate the odds ratio (OR) of gestational hypertension/mild preeclampsia, severe preeclampsia, and any preterm delivery <37 weeks associated with abnormal echocardiographic findings when controlling for potential confounders. Results Of 267 eligible women, 174 (64%) underwent screening echocardiograms. Sixty-nine women (40%) had abnormal echocardiograms. Maternal clinical characteristics were similar between women with normal echocardiographic findings and women with abnormal findings. Women with abnormal echocardiograms were more likely to have chronic hypertension (78 vs. 62%, p = 0.04) and a history of preeclampsia (27 vs. 10%, p = 0.02). After controlling for confounders, women with abnormal echocardiogram were at an increased risk of hypertensive disorders of pregnancy, OR 6.80 (95% confidence interval [CI] 3.32–13.93, p = 0.01), and in particular severe preeclampsia, OR 8.77 (95% CI 3.90–19.74, p = 0.01). Conclusion Among pregnant women with class III obesity and medical comorbidities, screening echocardiogram may help identify a subset of women at the highest risk of developing preeclampsia. Key Points

Intelligent SMOTE Based Machine learning Classification for Fetal State on Cardiotocography Dataset

A major contributor to under-five mortality is the death of children in the 1st month of life. Intrapartum complications are one of the major causes of perinatal mortality. Fetal cardiotocograph (CTGs) can be used as a monitoring tool to identify high-risk women during labor. The objective of this study was to study the precision of machine learning algorithm techniques on CTG data in identifying high-risk fetuses. CTG data of 2126 pregnant women were obtained from the University of California Irvine Machine Learning Repository. Out of 2126 CTG dataset 78% of them were normal, 14% were suspect, and 8 % had a pathological fetal state. To improve data imbalance SMOTE is applied followed by five different machine learning classification models were trained using CTG data. Sensitivity, precision, and F1 score for each class and overall accuracy of each model were obtained to predict normal, suspect, and pathological fetal states. For the model validity two statistical parameters MCC & kappa (k) are used. SMOTE based all the classification algorithm provides the higher degree of accuracy with minimum value is 96% and RF algorithm had the highest prediction accuracy about 98.01% which is quite satisfactory. Model validation statistical parameters MCC & kappa is maximum achieved by RF about 0.968 & 1 and for SVC is 0.977 & 1 respectively. Finally proposed work also compared with previous state of art techniques.

Perceptions and Practice of Preconception Care by Healthcare Workers and High-Risk Women in South Africa: A Qualitative Study

Preconception care is biomedical, behavioural, and social health interventions provided to women and couples before conception. This service is sometimes prioritised for women at high risk for adverse pregnancy outcomes. Evidence revealed that only very few women in Africa with severe chronic conditions receive or seek preconception care advice and assessment for future pregnancy. Thus, this study aimed to explore the perceptions and practice of preconception care by healthcare workers and high-risk women in Kwa-Zulu-Natal, South Africa. This exploratory, descriptive qualitative study utilised individual in-depth interviews to collect data from 24 women at high risk of adverse pregnancy outcomes and five healthcare workers. Thematic analysis was conducted using Nvivo version 12. Five main themes that emerged from the study include participants’ views, patients’ access to information, practices, and perceived benefits of preconception care. The healthcare workers were well acquainted with the preconception care concept, but the women had inconsistent acquaintance. Both groups acknowledge the role preconception care can play in the reduction of maternal and child mortality. A recommendation is made for the healthcare workers to use the ‘One key’ reproductive life plan question as an entry point for the provision of preconception care.