Oral Glucose Tolerance Test in Pregnancy and Subsequent Maternal Hypertension

Objective The aim of the study is to evaluate whether values and the shape of the glucose curve during the oral glucose tolerance test (OGTT) in pregnancy identify women at risk of developing hypertension (HTN) later in life. Methods This category includes the secondary analysis of a follow-up from a mild gestational diabetes mellitus (GDM) study that included a treatment trial for mild GDM (n = 458) and an observational cohort of participants with abnormal 1-hour glucose loading test only (normal OGTT, n = 430). Participants were assessed at a median of 7 (IQR 6–8) years after their index pregnancy, and trained staff measured their blood pressure (systolic blood pressure [SBP]; diastolic blood pressure [DBP]). The association between values and the shape of the glucose curve during OGTT in the index pregnancy and the primary outcome defined as elevated BP (SBP ≥120, DBP ≥80 mm Hg, or receiving anti-HTN medications), and secondary outcome defined as stage 1 or higher (SBP ≥130, DBP ≥80 mm Hg, or receiving anti-HTN medications) at follow-up were evaluated using multivariable regression, adjusting for maternal age, body mass index, and pregnancy-associated hypertension during the index pregnancy. Results There was no association between fasting, 1-hour OGTT, and the outcomes. However, the 2-hour OGTT value was positively associated (adjusted odds ratio [aRR] per 10-unit increase 1.04, 95% CI 1.01–1.08), and the 3-hour was inversely associated (aRR per 10-unit increase 0.96, 95% CI 0.93–0.99) with the primary outcome. When the shape of the OGTT curve was evaluated, a monophasic OGTT response (peak at 1 hour followed by a decline in glucose) was associated with increased risk of elevated BP (41.3vs. 23.5%, aRR 1.66, 95% CI 1.17–2.35) and stage 1 HTN or higher (28.5 vs. 14.7%, aRR 1.83, 95% CI 1.15–2.92), compared with a biphasic OGTT response. Conclusion Among persons with mild GDM or lesser degrees of glucose intolerance, the shape of the OGTT curve during pregnancy may help identify women who are at risk of HTN later in life, with biphasic shape to be associated with lower risk. Key Points

Prevalence and Determinants of Unintended Pregnancy among Women Receiving Antenatal Care Services: A Facility-Based Cross-Sectional Study in Ghana

Globally, unintended pregnancy represents an important public health challenge with significant social, economic and clinical repercussions which are worse in low-income and middle-income countries. Appropriate use of modern contraceptives averts significant proportions of unintended pregnancies and pregnancy complications. The objective of this study was to determine the prevalence and determinants of unintended pregnancy and explore modern contraceptive use among pregnant women A cross-sectional study was conducted among pregnant women receiving antenatal care at Korle-Bu Teaching hospital in Ghana using a face-to-face structured interview. Descriptive analysis was performed and multivariable logistic regression was used to assess the determinants of unintended pregnancy. Among the included 450 pregnant women receiving antenatal care, 155 (34.4%) had unintended pregnancy out of which 33 (21.3%) were using contraceptives prior to conception. In all, 14.2% (64/450) were using modern contraceptives. There was a significant difference between women and their partners regarding the perception of their index pregnancy as unintended (34.4% versus 31.6%, p-value <0.001). Significant determinants of unintended pregnancy include younger maternal age [aOR:5.706, 95%CI (1.860, 19.732)], unmarried status [aOR:5.238, 95%CI (2.882, 9.735)], previous childbirth [(aOR:2.376, 95%CI (1.460, 4.758], number of pregnancies ≥6 [aOR:2.640, 95%CI (1.210, 5.854)], number pregnancies ≤2 [aOR:0.417, 95%CI (0.252, 0.682)], previous caesarean birth [aOR:2.034, 95%CI (1.154, 3.306)] and contraceptive use prior to index pregnancy [aOR:2.305 95%CI (1.283-4.162)]. The prevalence of unintended pregnancy remains markedly high while prior contraceptive use was relatively low among women receiving antenatal care. Evidence-based interventions including specialized client education are vital in improving optimal use of contraceptive services. We recommend further research including community-based qualitative studies to better understand the factors associated with contraceptive uptake and outcomes of unintended pregnancy.

Lifestyle and Risk Factors in Hemorrhoidal Disease

Constipation, a low fiber diet, a high Body Mass Index, pregnancy, and a sedentary lifestyle are often assumed to increase the risk of hemorrhoidal disease (HD). However, evidence regarding these factors is controversial. This mini-review aims to examine and critically analyze the association between main risk factors and the prevalence of HD, focusing both on the patient's clinical history and on a tailored treatment. Moreover, some practical suggestions about lifestyle and conservative approaches are given to help clinicians in the management of patients with HD and to obtain the best results from therapy.

Gestational Diabetes and Incident Heart Failure: A Cohort Study

<b>Objective: </b>To assess whether gestational diabetes mellitus (GDM) is associated with an increased risk of heart failure (HF). <p><b>Research Design and Methods</b>: We conducted a population-based cohort study using information from the Ministry of Health and Long Term Care of Ontario (Canada) health-care administrative databases. We identified all women in Ontario with a GDM diagnosis with a livebirth singleton delivery between July 1, 2007 and March 31, 2018. Women with diabetes or HF before pregnancy were excluded. GDM was defined based on laboratory test results and diagnosis coding. The primary outcome was incident HF hospitalization, over a period extending from the index pregnancy until March 31, 2019. The secondary outcome was prevalent peripartum cardiomyopathy (PPCM) at index pregnancy. Estimates of association were adjusted for relevant cardiometabolic risk factors.</p> <p><b>Results</b>: Among 906,319 eligible women (mean age: 30 years [SD: 5.6], 50,193 with GDM [5.5%]), there were 763 HF events over a median 7 years. GDM was associated with a higher risk of incident HF (adjusted hazard ratio [aHR]: 1.62, 95% CI: 1.28, 2.05), compared to no-GDM. This association remained significant after accounting for chronic kidney disease, post-partum diabetes, hypertension, and coronary artery disease (aHR: 1.39, 95% CI: 1.09, 1.79). GDM increased the odds of PPCM (adjusted odds ratio: 1.83, 95% CI: 1.45, 2.33).</p> <p><b>Conclusions</b>: In a large observational study, GDM was associated with an increased risk of HF. Consequently, diabetes screening during pregnancy is suggested to identify women at risk of HF.</p> <br> <p> </p>

Gestational Diabetes and Incident Heart Failure: A Cohort Study

<b>Objective: </b>To assess whether gestational diabetes mellitus (GDM) is associated with an increased risk of heart failure (HF). <p><b>Research Design and Methods</b>: We conducted a population-based cohort study using information from the Ministry of Health and Long Term Care of Ontario (Canada) health-care administrative databases. We identified all women in Ontario with a GDM diagnosis with a livebirth singleton delivery between July 1, 2007 and March 31, 2018. Women with diabetes or HF before pregnancy were excluded. GDM was defined based on laboratory test results and diagnosis coding. The primary outcome was incident HF hospitalization, over a period extending from the index pregnancy until March 31, 2019. The secondary outcome was prevalent peripartum cardiomyopathy (PPCM) at index pregnancy. Estimates of association were adjusted for relevant cardiometabolic risk factors.</p> <p><b>Results</b>: Among 906,319 eligible women (mean age: 30 years [SD: 5.6], 50,193 with GDM [5.5%]), there were 763 HF events over a median 7 years. GDM was associated with a higher risk of incident HF (adjusted hazard ratio [aHR]: 1.62, 95% CI: 1.28, 2.05), compared to no-GDM. This association remained significant after accounting for chronic kidney disease, post-partum diabetes, hypertension, and coronary artery disease (aHR: 1.39, 95% CI: 1.09, 1.79). GDM increased the odds of PPCM (adjusted odds ratio: 1.83, 95% CI: 1.45, 2.33).</p> <p><b>Conclusions</b>: In a large observational study, GDM was associated with an increased risk of HF. Consequently, diabetes screening during pregnancy is suggested to identify women at risk of HF.</p> <br> <p> </p>

Pregnant women utilization of dental services: still a challenge in low resource setting

Background Poor oral health in pregnancy can be associated with poor pregnancy outcome, however, dental consultation among pregnant women appears to be low. Methods This was a questionnaire-based study of 413 women who attended the antenatal clinic of University of Nigeria Teaching Hospital (UNTH), Ituku/Ozalla, Enugu. The information obtained was analyzed using SPSS version 22. A p-value of less than 0.05 was considered statistically significant. Results Only 36 (8.7%) of the respondents had dental consultations in index pregnancy for complaints such as tooth ache and decay (66.7%) and pain as well as swelling of the gum (33.3%). The most common reason given for not visiting a dentist during the index pregnancy was the visit not being relevant to their pregnancy outcome (69.2%). After counseling them, only 249 (60.3%) agreed to have dental consultation during subsequent pregnancies. The relationship between visiting the dentist and place of residence (< 0.001), occupation (0.019) and frequency of brushing/ changing of brush (0.005, < 0.001 respectively) were statistically significant. Conclusion The prevalence of dental consultation during pregnancy is very low. Pregnant women should be encouraged to have routine dental consultation with oral health counseling and check-up incorporated as part of routine antenatal care.

Recurrent uterine rupture in third trimester of pregnancy

We report a case of recurrent upper segment uterine rupture in a 31-year-old woman at 32+5/40 weeks of gestation. She had fundal uterine rupture 3 years ago in her first pregnancy at 40 weeks of gestation. There was no history of uterine malformation or prior uterine surgery. However, we noted that she had had three laparoscopic procedures for endometriosis treatment. She was scheduled to have an elective repeat caesarean section at 34+6/40 weeks of gestation in the index pregnancy. Unfortunately, she presented at 32+5/40 weeks with features of acute abdomen and signs of fetal distress. She had a category 1 caesarean section and was found to have fundal uterine rupture at the same site. She had a smooth uneventful recovery following a timely intervention and discharged home on day 5 postoperatively in a good condition with her baby girl.

Huge Cystadenocarcinoma of the Ovary Disguising as Degenerating Uterine Fibroid in Pregnancy: Case Report and Literature Review

Background: Ovarian malignancy is rare in pregnancy and constitutes 3 – 6% of all ovarian tumours associated with pregnancy. It is usually asymptomatic, detected during routine antenatal ultrasound scan. Treatment is mainly surgical. The aim of this report is to share our experience in the management of a referred case of papillary serous cystadenocarcinoma of the ovary disguising as degenerating uterine fibroid in pregnancy. The diagnostic challenges and treatment are highlighted with a view to improving care in our setting.Case presentation: A 29 year old gravida 2 para 1 with one living child was referred to our unit at 25 weeks gestation with complaint of progressive painful abdominal distension with dyspnoea noticed in the index pregnancy. Ultrasound scans were suggestive of uterine fibroid in pregnancy with degenerative changes for which she had conservative management. Due to worsening symptoms, she had laparotomy and a huge ovarian mass was removed alongside the affected ovary. Histology confirmed Serous Papillary Cyst Adenocarcinoma of the ovary. She is doing well on adjuvant chemotherapy. Conclusion: A high index of suspicion for ovarian malignancies in pregnancy, coupled with complementing MRI (when available) with ultrasound to differentiate degenerating uterine fibroids is suggested/recommended.

Oral Glucose Tolerance Test Results in Pregnancy Can Be Used to Individualize the Risk of Future Maternal Type 2 Diabetes Mellitus in Women With Gestational Diabetes Mellitus

OBJECTIVE: We aimed to quantify the risk of future maternal T2DM in women with GDM based on the type and number of abnormal 75g-OGTT values and the diagnostic criteria used for the diagnosis of GDM. <p>RESEARCH DESIGN AND METHODS: We conducted a population-based retrospective cohort study of all nulliparous women with a live singleton birth who underwent testing for GDM using a 75g-OGTT in Ontario, Canada (2007-2017). We estimated the incidence rates (per 1000 person years), overall risk (expressed as adjusted hazard ratio [aHR]), and risk at 5-year post the index pregnancy of future maternal T2DM. Estimates were stratified by the type and number of abnormal OGTT values, as well as by the diagnostic criteria for GDM (Diabetes Canada vs. IADPSG criteria). </p> <p>RESULTS: A total of 55,361 women met the study criteria. The median duration of follow-up was 4.4 (IQR 2.8-6.3, maximum 10.3) years. Using women without GDM as reference (incidence rate 2.18 per 1000py), women with GDM were at an increased risk of future T2DM, with the risk being higher for the Diabetes Canada compared with the IADPSG criteria (incidence rate 18.74 [95%-CI 17.58-19.90] vs. 14.07 [95%-CI 13.24-14.91] per 1000py, respectively). The risk of future maternal T2DM increased with the number of abnormal OGTT values, and was highest for women with 3 abnormal values (incidence rate 49.93 per 1000py; aHR 24.57 [95%-CI 21.26-28.39]). The risk of future T2DM was also affected by the type of OGTT abnormality: women with an abnormal fasting value had the greatest risk while women with an abnormal 2-hour value had the lowest risk for future T2DM (aHR 14.09 [95%-CI 12.46-15.93) vs. 9.22 [95%-CI 8.19-10.37]), respectively). <a></a><a>Similar findings to those described above were observed when the risk of T2DM at a fixed time point of 5-years post the index pregnancy was considered as the outcome of interest</a>.</p> <p>CONCLUSION: In women with GDM, individualized information regarding the future risk of T2DM can be provided based on the type and number of abnormal OGTT values, as well as the diagnostic criteria used for the diagnosis of GDM. </p>