Pregnancy Outcomes Following Laparoscopic and Open Surgery in Pelvis during Pregnancy: a Nationwide Population-based Study in Korea

BackgroundNon-obstetric surgery during pregnancy is associated with adverse obstetric and fetal outcomes. The aim of this study was to investigate the risk of adverse pregnancy outcomes for women who underwent non-obstetric pelvic surgery during pregnancy compared with that of women that did not undergo surgery.MethodsStudy data from women who gave birth in Korea were collected from the Korea National Health Insurance claims database between 2006 and 2016. We identified pregnant women who underwent abdominal non-obstetric pelvic surgery by laparoscopy or laparotomy from the database. Pregnancy outcomes including preterm birth, low birth weight (LBW), cesarean section (C/S), gestational hypertension, gestational diabetes, and postpartum hemorrhage were identified. The adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for the pregnancy outcomes were estimated by multivariate regression models.ResultsData from 4,439,778 women were collected for this study. From 2006–2016, 9,417 women from the initial cohort underwent non-obstetric pelvic surgery (adnexal mass resection, appendectomy) during pregnancy. Multivariate logistic regression analysis indicated that preterm birth (HR, 2.01; 95% CI, 1.81–2.23), LBW (HR, 1.62; 95% CI, 1.46–1.79), C/S (HR, 1.13; 95% CI, 1.08–1.18), and gestational hypertension (HR, 1.35; 95% CI, 1.18–1.55) were significantly more frequent in women who underwent non-obstetric surgery during pregnancy compared to pregnant women who did not undergo surgery. When the laparoscopic and laparotomy groups were compared for risk of fetal outcomes, the risk of LBW was significantly decreased in laparoscopic adnexal resection during pregnancy compared to laparotomy (odds ratio, 0.62; 95% CI, 0.40–0.95).ConclusionNon-obstetric pelvic surgery during pregnancy was associated with a higher risk of preterm birth, LBW, gestational hypertension, placenta previa, placental abruption, and C/S. Although the benefits and safety of laparoscopy during pregnancy appear similar to those of laparotomy in regard to pregnancy outcomes, laparoscopic adnexal mass resection was associated with a lower risk of LBW.     

Relative perinatal safety of salmeterol vs formoterol and fluticasone vs budesonide use during pregnancy

BackgroundRecent asthma guidelines endorse the safety of long-acting β₂-agonists (LABAs) and of mild and moderate doses of inhaled corticosteroids (ICSs) when required to control asthma during pregnancy, yet do not state a preferred medication within each class.ObjectiveTo estimate the relative perinatal safety with the use of salmeterol and formoterol (LABAs) and that of fluticasone and budesonide (ICSs) during pregnancy.MethodsA subcohort of pregnancies from asthmatic women was selected from health care administrative databases of Quebec, Canada. Low birth weight (LBW) was defined as weight less than 2,500 g, preterm birth (PB) as delivery before 37 weeks of gestation, and small for gestational age (SGA) as a birth weight below the 10th percentile. The effect of treatment with salmeterol vs formoterol and fluticasone vs budesonide on the outcomes was determined with generalized estimating equation models.ResultsThe LABA and ICS subcohorts were composed of 547 (385 salmeterol and 162 formoterol users) and 3,798 (3,190 fluticasone and 608 budesonide users) pregnancies, respectively. No statistically significant differences were observed for LBW (odds ratio [OR], 0.91; 95% confidence interval [CI], 0.44-1.88), PB (OR, 1.11; 95% CI, 0.56-2.23), and SGA (OR, 1.16; 95% CI, 0.67-2.02) newborns between women exposed to salmeterol vs formoterol or between women exposed to fluticasone vs budesonide (LBW: OR, 1.08; 95% CI, 0.76-1.52; PB: OR, 1.07; 95% CI, 0.78-1.49; and SGA, OR: 1.10; 95% CI, 0.85-1.44).ConclusionThis study does not provide evidence of greater perinatal safety for one LABA or one ICS over the other.     

The effect of active and passive maternal smoking before and during pregnancy on neonatal weight at birth

IntroductionSmoking during pregnancy is a risk factor for adverse pregnancy outcomes. Data on the correlation between passive maternal smoking and pregnancy outcomes remain limited. We investigated the effect of active smoking and environmental tobacco smoke (ETS) during pregnancy on neonatal birthweight, including the risk for low birthweight (LBW).Material and methodsThe study was conducted between 2010 and 2012. A group of 8625 women were surveyed during postpartum hospitalization. Outcome measures included mean birthweight of newborns. Additionally, odds ratios with confidence intervals were calculated to investigate the risk for LBW in active and passive smoking groups of mothers.ResultsLower birthweight (46 g – 307 g; p < 0.05) and a higher risk for LBW (OR = 1.35, 95% CI: 1.05–1.75; p < 0.05) were observed in all infants born to smoking mothers. A negative effect of ETS in pregnancy on the reduction of mean birthweight was also found. Additionally, we analyzed the cumulative effect of active and passive smoking on neonatal birthweight. A statistically significant reduction in neonatal weight at birth was found in a group of women who smoked actively and passively during pregnancy (130 g; p < 0.05).ConclusionsSmoking is associated with decreased birthweight and in a group of active smoking mothers increased risk for LBW. This effect is dose-dependent and is also present in a group of women who smoked before pregnancy. There is also a cumulative effect of active smoking and ETS causing decreased neonatal birthweight and increased risk for low birthweight.     

低出生体重儿的发生与母亲既往生育史的相关性分析

目的探讨母亲既往生育史对单胎活产低出生体重儿发生的影响因素。方法选取375名住院产妇所生的单胎活产低出生体重儿（LBW）,与同期分娩的单胎活产正常体重儿5157例进行病例对照分析,比较母亲既往生育史对低出生体重儿发生的影响。结果既往自然流产史、早产史和不良孕产史是LBW发生的危险因素（OR=1.57 95%CI1.110-2.25）、（OR=4.84 95%CI 2.01-11.66）、（OR=2.09 95%CI 1.22-3.57）,并且主要针对于早产LBW（OR=1.6595%CI 1.11-2.44）、（OR=6.55 95%CI 2.70-15.91）、（OR=2.18 95%CI 1.21-3.91）,既往低出生体重史是足月LBW发生的危险因素（OR=7.93 95%CI 1.72-36.46）结论 LBW的发生与既往自然流产史、早产史、不良孕产史、低出生体重史密切相关。对以上这些妇女再次怀孕的孕前、孕期均应做好保健服务,以有效减少LBW的发生。     

Systematic review with meta-analysis: Non-alcoholic fatty liver disease and the association with pregnancy outcomes

Background/AimsMaternal and fetal outcomes in pregnant patients with Non-alcoholic fatty liver disease (NAFLD) have been largely unexplored. To determine the level of evidence associated with maternal and fetal outcomes in pregnant women with NAFLD.MethodsWe conducted a comprehensive literature search. The studies included pregnant patients with a previous, current or subsequent diagnosis of NAFLD. We used a random-effects model using odds ratios (OR) with 95% confidence intervals (CI).ResultsTwenty-two studies, with 13,641 female NAFLD patients were reviewed. The results highlight that NAFLD patients had a statistically significant increased likelihood of baseline diabetes mellitus (OR, 6.00; 95% CI, 2.21–16.31; P<0.001; n=7), baseline Hypertension (OR, 3.75; 95% CI, 2.13–6.59; P<0.001; n=4), gestational hypertension (OR, 1.83; 95% CI, 1.03–3.26; P=0.041; n=2), and pre-eclampsia (OR, 2.43; 95% CI, 1.46–4.04; P=0.001; n=3). The odds for a past and current history of gestational diabetes mellitus were OR, 3.78; 95% CI, 2.21–6.44; P<0.001; n=5 and OR, 3.23; 95% CI, 1.97– 5.31; P<0.001; n=6, respectively. As for fetal outcomes, pregnant NAFLD patients were significantly more likely to have a premature birth (OR, 2.02; 95% CI, 1.44–2.85; P<0.001; n=4), large for gestational age birth (OR, 2.01; 95% CI, 1.72–2.37; P<0.001; n=2) or a history of prior miscarriage or abortion (OR, 1.15; 95% CI, 1.02–1.30; P=0.02; n=2). Egger’s regression revealed no evidence of publication bias (P>0.05).ConclusionsThis meta-analysis provides pooled evidence that NAFLD is associated with a substantial increase in maternal diabetic and hypertensive complications and multiple adverse fetal outcomes. This data is important for clinicians managing these patients before, during and after pregnancy.     

Interactions between Prepregnancy Overweight and Passive Smoking for Macrosomia and Large for Gestational Age in Chinese Pregnant Women

IntroductionPrevious analysis showed that passive smoking and overweight were associated with an increased risk of gestational diabetes mellitus (GDM) in a synergistic manner, while GDM increased the risk of macrosomia/large for gestational age (LGA). This study aimed to examine any interactive effects between passive smoking and overweight/obesity on risk of macrosomia/LGA.MethodsFrom 2010 to 2012, 22,302 pregnant women registered for pregnancy at a primary hospital in Tianjin, China. Data were collected longitudinally; that is, from their first antenatal care visit, at the glucose challenge test (GCT) time (24–28 weeks of gestation) and at delivery. Passive smoking was self-reported. Macrosomia was defined as birth weight ≥4,000 g. Binary logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs). Additive interaction was used to test the synergistic effect.ResultsPassive smokers accounted for 57.4% of women (n = 8,230). Using nonpassive smoking and prepregnancy body mass index (BMI) <24.0 kg/m² as the reference, the adjusted ORs of overweight alone and passive smoking alone for macrosomia were 2.39 (95% CI: 2.11–2.71) and 1.17 (95% CI: 1.04–1.32). Copresence of passive smoking and prepregnancy BMI ≥24.0 kg/m² increased the OR to 2.70 (95% CI: 2.28–3.20), with a significant additive interaction. After further adjustment for GDM or GCT, the OR of copresence of both risk factors was slightly attenuated to 2.52 (2.13–3.00) and 2.51 (2.11–2.98), with significant additive interaction. However, the additive interaction between prepregnancy overweight/obesity and passive smoking for LGA was nonsignificant.ConclusionsPrepregnancy overweight/obesity was associated with an increased risk of macrosomia in Chinese women synergistically with passive smoking during pregnancy, and most of the association was not modified by hyperglycemia during pregnancy.     

Metabolic Syndrome in Offspring of Parents with Metabolic Syndrome: A Meta-Analysis

BackgroundThe metabolic syndrome (MetS) represents a clustering of risk factors for cardiovascular diseases that includes abdominal obesity, hypertension, dyslipidemia, and insulin resistance.ObjectivesThe objective of this study was to reassess the parent-offspring association of MetS since the available findings are still controversial.MethodsThe Cochrane Library, PubMed, Embase, and Web of Science databases were searched to identify relevant articles. All studies comparing MetS status between the offspring of parents with MetS and offspring of parents without MetS were included in the analysis.ResultsA total of 9 studies met the inclusion criteria and they were analyzed. Offspring of at least 1 parent with MetS had a higher risk of MetS (OR 3.88, 95% CI 2.58–5.83, p < 0.001). Sons and daughters of fathers with MetS both had a higher risk of MetS (OR 2.31, 95% CI 1.70–3.12, p < 0.001, and OR 1.73, 95% CI 1.37–2.18, p < 0.001, respectively). Sons and daughters of mothers with MetS both had a higher risk of MetS (OR 1.95, 95% CI 1.37–2.76, p = 0.0002, and OR 1.91, 95% CI 1.54–2.35, p < 0.001, respectively).ConclusionThis meta-analysis showed that there is a higher risk of MetS in the offspring of parents with MetS. However, there was no differential association of MetS according to gender and/or age of the offspring.     

On the way to universal coverage of maternal services in Iringa rural District in Tanzania. Who is yet to be reached?

BackgroundStrategies to tackle maternal mortality in sub-Saharan Africa include expanding coverage of reproductive services. Even where high, more vulnerable women may not access services. No data is available on high coverage determinants. We investigated this in Tanzania in a predicted high utilization area.MethodsData was collected through a household survey of 464 women with a recent delivery. Primary outcomes were facility delivery and ≥4 ANC visits. Determinants were analysed using multivariate regression.ResultsAlmost all women had attended ANC, though only 58.3% had ≥4 visits. ≥4 visits were more likely in the youngest age group (OR 2.7 95% CI 1.32–5.49, p=0.008), and in early ANC attenders (OR 3.2 95% CI 2.04–4.90, p<0.001). Facility delivery was greater than expected (87.7%), more likely in more educated women (OR 2.7 95% CI 1.50–4.75, p=0.002), in those within 5 kilometers of a facility (OR 3.2 95% CI 1.59–6.48, p=0.002), and for early ANC attenders (OR 2.4 95% CI 1.20–4.91, p=0.02).ConclusionRural contexts can achieve high facility delivery coverage. Based on our findings, strategies to reach women yet unserved should include promotion of early ANC start particularly for the less educated, and improvement of distant communities'' access to facilities.     

Risk Factors of Acoustic Neuroma: Systematic Review and Meta-Analysis

PurposeMany epidemiological studies have investigated environmental risk factors for the development of acoustic neuroma. However, these results are controversial. We conducted a meta-analysis of case-control studies to identify any potential relationship between history of noise exposure, smoking, allergic diseases, and risk of acoustic neuroma.ResultsEleven case-control studies were included in our meta-analysis. Acoustic neuroma was found to be associated with leisure noise exposure [odds ratio (OR)=1.33, 95% confidence interval (CI): 1.05–1.68], but not with occupational noise exposure and ever noise exposure (OR=1.20, 95% CI: 0.84–1.72 and OR=1.15, 95% CI: 0.80–1.65). The OR of acoustic neuroma for ever (versus never) smoking was 0.53 (95% CI: 0.30–0.94), while the subgroup analysis indicated ORs of 0.95 (95% CI: 0.81–1.10) and 0.49 (95% CI: 0.41–0.59) for ex-smoker and current smoker respectively. The ORs for asthma, eczema, and seasonal rhinitis were 0.98 (95% CI: 0.80–1.18), 0.91 (95% CI: 0.76–1.09), and 1.52 (95% CI: 0.90–2.54), respectively.ConclusionOur meta-analysis is suggestive of an elevated risk of acoustic neuroma among individuals who were ever exposed to leisure noise, but not to occupational noise. Our study also indicated a lower acoustic neuroma risk among ever and current cigarette smokers than never smokers, while there was no significant relationship for ex-smokers. No significant associations were found between acoustic neuroma and history of any allergic diseases, such as asthma, eczema, and seasonal rhinitis.     

Association between hair dye use and cancer in women: a systematic review and meta-analysis of case-control studies

BackgroundThe use of hair dye for cosmetic purposes appears to be increasing worldwide. As 50–80% of women use hair dye throughout their lifetimes, the possible association between hair dye use and cancer is a public health concern.MethodThis systematic review was performed by retrieving studies from PubMed, Scopus, WOS, and ProQuest databases. The inclusion criteria were case-control studies evaluating the association between hair dye use and cancer in women. Women with cancer who have used any hair dye were the focus of our study.ResultsThe present study combined 28 studies, to assess the association between hair dye use and cancer. The pooled odds ratio (OR) of hematopoietic system cancers among those who have generally ever used any type of hair dyes was 1.10 (95% CI:1.01–1.20) in 17 studies. In 11 studies investigating hair dye made before and after 1980 as a risk factor for cancer, the pooled OR for cancer was 1.31(95% CI:1.08–1.59). Likewise, in the 13 studies that evaluated the association of light and dark hair dye with cancer, the risk among those using dark hair dye increased by 9%, compared to non-users (OR=1.09; 95% CI:0.95–1.25).ConclusionThe present study suggests that, although the use of hair dye may increase the risk of cancer among users, a more detailed evaluation is required to assess the type of hair dye use in terms of guidelines and metrics.     

Maternal and neonatal outcomes of grand multiparity in Khartoum,Sudan

ObjectivesGrand multiparity is a major health problem that leads to adverse maternal and perinatal outcomes. We aimed to assess the maternal and perinatal outcomes of grand multiparity.MethodsA case-control study was conducted in Saad Abualila Hospital, Khartoum, Sudan from February to December 2019. The cases were grand multiparous (≥ 5 deliveries) women. The controls were women with low parity (multiparous women who delivered two to four times). Maternal and perinatal characteristics were compared between the two groups. Logistic regression analysis was performed.ResultsThere was a significant association between grand multiparity and higher maternal age (adjusted odds ratio [AOR]=1.19, 95% confidence interval [CI]=1.16–1.23), lower education level (AOR=3.38, 95% CI=2.49–5.58) and lower antenatal care attendance (AOR=1.73, 95% CI=1.02–2.92). Grand multiparous women were at increased risk for Anemia (AOR=1.48, 95% CI=1.08–2.03), diabetes mellitus (AOR=10.61, 95% CI=4.89–23.00), caesarean delivery (AOR=1.87, 95% CI=1.40–2.48), preterm birth (AOR=1.90, 95% CI=1.37–2.62) and admission to the neonatal intensive care unit (AOR=3.8, 95% CI=1.95–7.75).ConclusionsGrand multiparity was associated with poor maternal and neonatal outcomes. Development of a national health program addressing family planning, health education and improvement of antenatal, intrapartum and neonatal care are needed.     

Effects of n-3 polyunsaturated fatty acid supplementation on pregnancy outcomes: a systematic review and meta-analysis

IntroductionThere are limited studies exploring the effects of n-3 PUFA supplementation on pregnancy outcomes. The goal of this study was to review relevant studies in order to determine the effect of n-3 polyunsaturated fatty acid (n-3 PUFA) supplementation on pregnancy outcomes based on eligible randomized controlled trials (RCTs).Material and methodsQualified studies were searched by keywords in PubMed, the Cochrane library and Embase. Studies from other pertinent sources were also reviewed, and RCTs published before January 2021 were reviewed. For each study, we assessed and synthesized the outcomes by relative risk (RR) or weighted mean difference (WMD) combined with the 95% confidence interval (95% CI).ResultsWe included 13 studies with 9069 patients. Compared with the control group, n-3 PUFA significantly decreased the incidence of preterm delivery (RR = 0.898, 95% CI: 0.819–0.984) and low birthweight (RR = 0.797, 95% CI: 0.655–0.970), and increased the birth weight (WMD = 99.340, 95% CI: 10.503–188.177) and birth length (WMD = 0.449, 95% CI: 0.236–0.663). There was no significant difference in pregnancy-induced hypertension, preeclampsia, intrauterine growth retardation (IUIG), early preterm delivery, anti-hypertensive therapy, gestational diabetes or head circumference at birth between the two groups.ConclusionsThe available evidence shows that n-3 PUFA is not beneficial in reducing the incidence of maternal pregnancy outcomes such as gestational diabetes mellitus and hypertension; but it is beneficial to neonatal health such as decreasing the incidence of preterm delivery and low birthweight and increasing birth weight and birth length.     

Association of Physical Activity and Sitting Time with Overweight/Obesity in Chinese Occupational Populations

AbstractThe aim of this study was to explore association of physical activity and sitting time with overweight/obesity in Chinese occupational populations for the development of intervention and prevention strategies for obesity.MethodsA total of 23,112 participants were selected from the 2010–2012 China National Nutrition and Health Survey (CNNHS). A logistics regression model was used to examine the associations of physical activity and sitting time with overweight/obesity by gender after adjusting for age, educational level, marital status, and family economic level.ResultsThe prevalence of overweight/obesity based on the WHO definition and the WGOC definition was 30.8% and 41.3%, respectively. Male employees with moderate and heavy occupation activity intensity had a lower risk for overweight/obesity than those with light occupation activity intensity (moderate: OR 0.90, 95% CI 0.82–0.98; heavy: OR 0.75, 95% CI 0.65–0.86), and the risk of overweight/obesity of male employees with long work-time spent sitting was higher than those with short work-time spent sitting (2–4.9 h/day: OR 1.26, 95% CI 1.14–1.40; ≥5 h/day: OR 1.29, 95% CI 1.15–1.44). The risk of overweight/obesity of male employees with active transportation mode was lower than those with inactive transportation mode (OR 0.91, 95% CI 0.84–0.99), while the risk of overweight/obesity of female employees with active transportation mode was higher (OR 1.14, 95% CI 1.04–1.25). Female employees with leisure-time physical activity (LTPA) for ≥150 min/week had lower risk of overweight/obesity than those with LTPA for <150 min/week (OR 0.69, 95% CI 0.56–0.84). There was no significant association of leisure-time sitting and housework time with overweight/obesity in Chinese occupational populations.ConclusionOccupation activity intensity, LTPA, transportation mode, and work sitting time were associated with overweight/obesity. Reducing work sitting time, moderate and heavy occupation activity intensity, and an active transportation mode could help male employees decrease the risk of overweight/obesity. Increasing leisure-time physical activity could reduce the risk of overweight/obesity in women. Our findings provided insight into the association of physical activity and sitting time with overweight/obesity. It will be necessary to carry out workplace-based interventions, have an active transportation mode, and increase leisure-time physical activity to decrease the risks of overweight/obesity.     

Effect of maternal HIV and malaria infection on pregnancy and perinatal outcome in Zimbabwe

OBJECTIVE: To investigate the effect of isolated or concomitant infection with malaria and HIV on pregnancy and neonatal outcome. METHODS: Data were collected on pregnant women admitted during the rainy seasons in the obstetric division of a district referral hospital in northern Zimbabwe in 2000 and 2001. The effects of malaria and HIV infection were determined by multivariate analysis. RESULTS: The prevalence of HIV seropositivity and symptomatic malaria in 986 pregnant women was 8.3% and 14.7%, respectively. HIV-infected women were more likely to develop malaria attacks during pregnancy than seronegative women (odds ratio [OR] = 3.96, 95% confidence interval (CI): 2.42-6.46). Malaria and HIV infections were associated with increased risk of stillbirth (OR = 4.74, 95% CI: 1.34-16.78) and preterm delivery (OR = 4.10, 95% CI: 2.17-7.75), respectively. They were independently associated with increased risk of low birth weight (malaria: OR = 10.09, 95% CI: 6.50-15.65; HIV: OR = 3.16, 95% CI: 1.80-5.54) and very low birth weight (malaria: OR = 5.04, 95% CI: 1.00-25.43; HIV: OR = 10.74, 95% CI: 2.12-54.41), low Apgar score (malaria: OR = 4.45, 95% CI: 1.42-13.94; HIV: OR = 5.94, 95% CI: 1.66-21.30), and fetal growth restriction (malaria: OR = 3.98, 95% CI: 2.51-6.30; HIV: OR = 4.07, 95% CI: 2.40-6.92). Dual infection with malaria and HIV was associated with increased risk of maternal, perinatal, and early infant death. CONCLUSIONS: Women with single HIV or malaria infection have a significantly increased risk of adverse outcomes of pregnancy and childbirth. Dual infection has additional detrimental effects on maternal and infant survival in an area where HIV and malaria coexist.     

A meta-analysis of pregnancy outcomes in women with polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a common reproductive disorder associated with many characteristic features, including hyperandrogenaemia, insulin resistance and obesity which may have significant implications for pregnancy outcomes and long-term health of the woman. This meta-analysis was conducted to evaluate the risk of pregnancy and neonatal complications in women with PCOS. Electronic databases were searched for the following MeSH headings: PCOS, hyperandrogenism, pregnancy outcome, pregnancy complications, diabetes mellitus, type II. A handsearch of human reproduction and fertility and sterility was also conducted. Studies in which pregnancy outcomes in women with PCOS were compared with controls were considered for inclusion in this meta-analysis. Fifteen of 525 identified studies were included, involving 720 women presenting with PCOS and 4505 controls. Women with PCOS demonstrated a significantly higher risk of developing gestational diabetes [odds ratio (OR) 2.94; 95% confidence interval (CI): 1.70-5.08], pregnancy-induced hypertension (OR 3.67; 95% CI: 1.98-6.81), pre-eclampsia (OR 3.47; 95% CI: 1.95-6.17) and preterm birth (OR 1.75; 95% CI: 1.16-2.62). Their babies had a significantly higher risk of admission to a neonatal intensive care unit (OR 2.31; 95% CI: 1.25-4.26) and a higher perinatal mortality (OR 3.07; 95% CI: 1.03-9.21), unrelated to multiple births. In conclusion, women with PCOS are at increased risk of pregnancy and neonatal complications. Pre-pregnancy, antenatal and intrapartum care should be aimed at reducing these risks.     

Fetal Growth and Adipose Fat Tissue Trajectories in Twin Pregnancies after Gastric Bypass Surgery

IntroductionPrevious studies demonstrated a continuous decline in fetal growth throughout singleton pregnancy after bariatric surgery. However, intrauterine growth in twin pregnancy is subjected to further underlying processes. This study was to investigate the longitudinal assessment of fetal biometry and abdominal fat thickness of twin pregnancies conceived after gastric bypass (GB) surgery and compare them to body mass index-matched (BMIM) and obese (OB) controls.Materials and MethodsWe retrospectively assessed ultrasound data of 30 women with dichorionic-diamniotic twin pregnancy (11 women after GB surgery, 9 OB mothers with pregestational BMI ≥30 kg/m², and 10 BMIM and age-matched controls). We assessed fetal growth parameters including fetal subcutaneous adipose tissue thickness (FSCTT) as well as newborn biometry after delivery. Patient characteristics were obtained from the medical records.ResultsThe rise in FSCTT curves was markedly slower in the twin offspring of women with history of GB as compared to the offspring of OB mothers and offspring of BMIM controls. Hence, FSCTT was significantly decreased in the GB offspring as compared to both control groups at 34 weeks of gestation. Also, growth curves of abdominal circumference were decreased in the offspring of GB patients as compared to OB mothers. Infants of mothers with history of GB showed significantly lower birth weight percentiles compared to newborns of OB mothers (27.2 vs. 48.8 pct, p = 0.025). There was no significant difference in inter-twin birth weight difference between the offspring of GB (median: 9.9%, interquartile ranges [IQR]: 6.5–20.0) versus OB (median: 14.6%, IQR: 8.2–21.6) and BMIM controls (median: 9.0%, IQR: 6.3–12.6, p = 0.714).ConclusionsIn summary, intrauterine growth delay in twin pregnancies after GB is assumed to be a multifactorial event with altered metabolism as the most important factor. However, special attention must be paid to the particularity of twin pregnancies as they seem to be subject to other additional mechanism.     

Pregnancy Outcomes in HIV-Infected Women of Advanced Maternal Age

Abstract

Background: There is limited information on pregnancy outcomes in women with HIV who are of a more advanced maternal age.Methods: Data from a national observational study in Italy were used to evaluate the risk of nonelective cesarean section, preterm delivery, low birthweight, major birth defects, and small gestational age-adjusted birthweight according to maternal age (<35 and ≥35 years, respectively).Results: Among 1,375 pregnancies with live births, 82.4% of deliveries were elective cesarean sections, 15.8% were nonelective cesarean sections, and 1.8% were vaginal deliveries. Rates of nonelective cesarean section were similar among mothers ≥35 and <35 years (odds ratio [OR], 1.22; 95% CI, 0.90–1.65;P = .19). Preterm delivery and low birthweight were significantly more common among women ≥35 years in univariate but not in multivariate analyses. Newborns from women ≥35 and <35 years showed no differences inZ scores of birthweight, with a similar occurrence of birthweight <10th percentile (12.1% vs 12.0%; OR, 1.02; 95% CI, 0.71–1.46;P = .93). The overall rate of birth defects was 3.4% (95% CI, 2.4–4.4), with no differences by maternal age (≥35 years, 3.5%; <35 years, 3.3%; OR, 1.05; 95% CI, 0.56–1.98;P = .88).Discussion: In this study of pregnant women with HIV, older women were at higher risk of some adverse pregnancy outcomes, such as preterm delivery and low birthweight. The association, however, did not persist in multivariable analyses, suggesting a role of some predisposing factors associated with older age.     

Risk Factors of Unplanned Readmission after Anterior Cervical Discectomy and Fusion: A Systematic Review and Meta-Analysis

PurposeWith an increasing number of anterior cervical discectomy and fusion (ACDF) being conducted for degenerative cervical disc disease, there is a rising interest in the related quality of management and healthcare costs. Unplanned readmission after ACDF affects both the quality of management and medical expenses. This meta-analysis was performed to evaluate the risk factors of unplanned readmission after ACDF to improve the quality of management and prevent increase in healthcare costs.Materials and MethodsWe searched the databases of PubMed, EMBASE, Web of Science, and Cochrane Library to identify eligible studies using the searching terms, “readmission” and “ACDF.” A total of 10 studies were included.ResultsAmong the demographic risk factors, older age [weighted mean difference (WMD), 3.93; 95% confidence interval (CI), 2.30–5.56; p<0.001], male [odds ratio (OR), 1.23; 95% CI, 1.10–1.36; p<0.001], and private insurance (OR, 0.34; 95% CI, 0.17–0.69; p<0.001) were significantly associated with unplanned readmission. Among patient characteristics, hypertension (HTN) (OR, 2.14; 95% CI, 1.41–3.25; p<0.001), diabetes mellitus (DM) (OR, 1.59; 95% CI, 1.20–2.11; p=0.001), coronary artery disease (CAD) (OR, 2.87; 95% CI, 2.13–3.86; p<0.001), American Society of Anesthesiologists (ASA) physical status grade >2 (OR, 2.13; 95% CI, 1.68–2.72; p<0.001), and anxiety and depression (OR, 1.39; 95% CI, 1.29–1.51; p<0.001) were significantly associated with unplanned readmission. Among the perioperative factors, pulmonary complications (OR, 22.52; 95% CI, 7.21–70.41; p<0.001) was significantly associated with unplanned readmission.ConclusionMale, older age, HTN, DM, CAD, ASA grade >2, anxiety and depression, pulmonary complications were significantly associated with an increased occurrence of unplanned readmission after ACDF.     

The impact of abnormal autoimmune function on reproduction: maternal and fetal consequences

The impact of abnormal autoimmune function on reproductive success has remained a highly controversial issue. This is, at least partially, due to the relative lack of demographic data from women with established autoimmune diseases. We, therefore, investigated 163 women with proven autoimmune diseases and 73 controls in a demographic study of reproductive success and impact of abnormal autoimmunity on pregnancy and offspring. Women with autoimmune diseases experienced fewer pregnancies overall (p=0.04) and fewer pregnancy losses (p=0.05). Offspring from women with autoimmune diseases demonstrated a significantly increased prevalence of confirmed autoimmune diseases (p=0.04; OR 3.759; 95%CL 1.04-1.27), which increased further if suspected, but not yet confirmed, cases were added (p=0.001; OR 8.592; 95%CL 1.05-55.0). Women with autoimmune diseases exhibited a trend towards lower cesarean section delivery during their own birth and a significantly increased prevalence of disease in vaginally delivered offspring (p=0.014; OR 6.041; 95%CL 1.32-38.22). Autoimmune diseases impair female fecundity even before the diseases become clinically overt. Offspring are at increased risk to develop autoimmune diseases, though they may differ from those of their mothers. This risk appears to correlate with mode of delivery and may be the consequence of varying cell traffic dynamics with vaginal and cesarean section deliveries.     

Respiratory effects of biomass fuel combustion on rural fish smokers in a Nigerian fishing settlement: a case control study

BackgroudThe aim was to study the prevalence of respiratory symptoms and assess the lung function of fish smokers in Nigeria.MethodsA case control study was done among fish smokers in Nigeria. Women aged 15 years or older (n=210) involved in fish smoking and equal number of matched controls were interviewed on respiratory symptoms and their peak expiratory flow rate (PEFR) measured. Data was analysed using chi square test, student''s t-test and odd ratios.ResultsBoth groups were similar in their personal characteristics. The test group had significantly increased occurrence of sneezing (153; 72.86%), catarrh (159; 75.71%), cough (138; 65.71%) and chest pain (59; 28.10%) compared with the control group, odds ratio (OR) 2.49, 95% confidence interval CI (1.62–3.82), P < 0.001), OR 3.77,95% CI (2.44– 5.85), P < 0.001, OR 3.38, 95% CI (2.22–5.15), P < 0.001, and OR 6.45,95% CI (3.22–13.15), P < 0.001, respectively. The mean PEFR of 321±58.93 L/min among the fish smokers was significantly lower than 400±42.92 L/min among the controls (p = 0.0001).ConclusionFish smokers have increased risk of respiratory symptoms and reduced pulmonary function. There is a need for protective equipment and periodic evaluation.