Alcohol consumption during pregnancy: Cross-sectional survey

Objectiveto assess the prevalence and pattern of alcohol consumption pre-conception and/or during the first trimester using the Alcohol Use Disorders Identification Test (AUDIT), Alcohol Use Disorders Identification Test – Consumption (AUDIT-C) and T-ACE (Tolerance, Annoyance, Cut Down and Eye-Opener) alcohol screening questionnaires, and determine the socio-demographic predictors of drinking in this time period.Designcross sectional survey of a consecutive sample of 500 pregnant women attending their first antenatal appointment at approximately 10–11 weeks gestation.Settingtwo antenatal clinics in the South West of England.Findingsof the 409 women respondents, we found a quarter of women reported drinking alcohol despite being aware they are pregnant. Between two to three in every 100 women reported drinking six or more units on a single occasion (heavy episodic or ‘binge’ drinking) at least monthly or weekly in the past three months. A similar proportion reported exceeding the recommended drinking limits of one to two units, once or twice a week. The majority of heavy episodic drinkers were otherwise low risk drinkers. 5.4% of respondents had an AUDIT-C score of 3 or more, and 22.2% a T-ACE score of 2 or more, indicating risk drinking in the peri-conception period. Drinking pre-conception and/or during the first trimester was more likely if women were multiparous and of white ethnicity.Key conclusionsin this study pregnant women attending an antenatal appointment were willing to complete brief alcohol screening questionnaires. A minority of women reported drinking pre-conception and/or during the first trimester with a small percentage drinking at levels potentially harmful to the fetus.Implications for practiceuse of these questionnaires would help midwives gather information about alcohol use to help identify women drinking at levels in excess of recommended limits in order that appropriate advice and support be offered.     

Attitude of German women towards hormone therapy: results of a lay survey

Abstract

Objective: Hormone therapy (HT) use has experienced a substantial change since publication of Women’s Health Initiative (WHI) controlled trial. We aimed to investigate the attitude towards HT in German women aged 45–60 years.

Study design: A questionnaire was sent to 9785 randomly selected women in Germany aged between 45 and 60 years.

Results: Response rate was 19.3% (n?=?1,893). Of those, 81% experienced climacteric symptoms. Vasomotor symptoms were most frequently reported (71.2%; n?=?1332). Of the respondents, 19.7% (n?=?369) used HT. The most frequently mentioned benefits of HT were the improvement of climacteric complaints (71.2%; n?=?1346), followed by the relief of osteoporosis (37.2%; n?=?697) and the “anti-aging” effect (16.3%; n?=?305). Breast cancer was stated as the main risk (64.9%; n?=?1215), closely followed by weight gain (53.4%; n?=?1000) and thromboembolism (48%; n?=?898). About 44% of the women who has been advised by gynaecologists choose a HT, whereas this rate dropped down to 14.3% and 11.3% for women who have been advised by friends or media.

Conclusion: German women were generally aware of the main risks and benefits of HT. “More informed” women appear to be more likely to use HT compared to “less informed” women. The media produces negative impression of HT.     

Reference values for clinical chemistry tests during normal pregnancy

Objective  Reference values are usually defined based on blood samples from healthy men or nonpregnant women. This is not optimal as many biological markers changes during pregnancy and adequate reference values are of importance for correct clinical decisions. There are only few studies on the variations of laboratory tests during normal pregnancies, especially during the first two trimesters. It is thus a need to establish such reference values.
Design  Longitudinal study of laboratory markers in normal pregnancies.
Setting  Uppsala University Hospital, Sweden.
Population  Healthy pregnant females.
Methods  We have studied 25 frequently used laboratory tests during 52 normal pregnancies. Each woman was sampled up to nine times and the samples were divided according to collection time into the following groups: gestational week 7–17; week 17–24; week 24– 28; week 28–31; week 31–34; week 34–38; predelivery (0–2 weeks before delivery) and postpartum (>6 weeks after delivery). The 2.5 and 97.5 percentiles for these markers were calculated according to the recommendations of the International Federation of Clinical Chemistry on the statistical treatment of reference values.
Results  Reference intervals are reported for plasma alanine aminotransferase, albumin, alkaline phosphatase, pancreas amylase, apolipoprotein A1, apolipoprotein B, aspartate aminotransferase, bilirubin, calcium, chloride, creatinine, cystatin C, ferritin, γ-glutamyltransferase, iron, lactate dehydrogenase, magnesium, phosphate, potassium, sodium, transferrin, triglycerides, thyroid-stimulating hormone, urate and urea during these pregnancy periods.
Conclusions  Most of the analytes change during normal pregnancy. It is thus of importance to use special reference values during pregnancy.     

A meta-analysis of the effectiveness of yoga-based interventions for maternal depression during pregnancy

Prompt and effective treatment of maternal depression during pregnancy is important as it is an independent predictor of negative maternal and fetal outcomes. Yoga is an increasingly popular non-pharmacological modality. This study thus aimed to undertake a meta-analysis of the efficacy of yoga-based interventions for maternal depression during pregnancy. A total of 8 clinical studies were systematically reviewed, and 6 studies with a total of 405 pregnant mothers were included in the final meta-analysis. Applying per-protocol analysis and a random-effects model, the pooled standardized mean difference (SMD) from baseline depressive score was −0.452 (95% CI: −0.816 to −0.880, P = 0.015), supporting a statistically significant beneficial effect of yoga-based interventions on mood. Overall, yoga-based interventions are a promising non-pharmacological option, however, most trials examined were preliminary, recruited only participants with mild depression, did not blind study participants and had relatively small sample sizes. Larger randomized, controlled trials should be encouraged.     

Disseminated gonococcal infection during pregnancy

Background: Disseminated gonococcal infection in pregnancy is rare with the incidence of 0.04–0.09% in pregnant women. Its most common manifestation is arthritis. Case: A 38-year-old woman, G₁P₀, 36⁺ weeks pregnancy came to hospital with decreased fetal movement. She had purulent vaginal discharge and history of self treatment 1 month earlier. She had a fever with arthritis for 3 days. Purulent joint fluid from arthrocentesis of her right wrist demonstrated intracellular Gram negative diplococcal bacteria. The diagnosis was disseminated gonococcal infection. She was successfully treated with parenteral ceftriaxone followed by oral cefixime. Cesarean section was performed due to preterm premature rupture of the membranes. The maternal and neonatal outcomes were uneventful. Conclusion: Disseminated gonococcal infections are not rare, however, disseminated gonococcal infection in pregnancy is a rare condition. Clinicians should be suspicious of the disease when a pregnant patient presents with arthritic symptoms.     

妊娠期人乳头瘤病毒感染

人乳头瘤病毒(HPV)感染是一种常见的性传播感染,文章讨论了妊娠与HPV感染之间的相互影响,介绍了妊娠期尖锐湿疣的临床特点与治疗方法,以及妊娠期HPV阳性且宫颈筛查异常患者的处理原则。     

Poor marital support associate with anxiety and worries during pregnancy in Greek pregnant women

Objective

a wide range of psychosocial variables may influence pregnant women's psychological status. However the association between marital and social support, anxiety and worries during pregnancy is a relatively neglected area of research. Therefore, the aim of this study was to examine the relationship between marital support, social support, antenatal anxiety and pregnancy worries after controlling for the effects of background variables.

Setting

public hospital in Athens, Greece.

Design

a cross-sectional study.

Participants

165 pregnant women attending an antenatal clinic for antenatal screening between January 2011 and March 2011.

Methods

anxiety was measured using the State scale of the State-Trait Anxiety Inventory, pregnancy worries were measured with the Cambridge Worry Scale, social support with the Social Support Questionnaire-6 and marital satisfaction with the Quality of Marriage Index. Pearson's correlation coefficients were calculated among all study variables, followed by hierarchical multiple linear regression.

Findings

a STAI score of ≥43 was taken as indicative of anxiety and 44.4% of participants responded with a score of 43 or above. Linear regression analysis showed that conception after IVF treatment and low marital satisfaction were both significantly related to anxiety and pregnancy worries. In addition, low income level was significantly related to pregnancy worry whereas low educational level was related to anxiety.

Conclusion

the risk factors found in this study could help clinicians target anxiety screening to high-risk populations of pregnant women. Health care professionals and midwives in particular should be trained in the detection and management of anxiety and worries during pregnancy.     

人类免疫缺陷病毒感染对妊娠结局的影响

目的 探讨夫类免疫缺陷病毒（HIV）感染对妊娠结局的影响及母婴垂直传播的发生情况。方法 应用酶联免疫吸附试验对2678例孕妇及其婴幼儿的外周血HIV抗体进行检测,其中资料完整的86例HIV抗体阳性孕妇为HIV组,另选择与HIV组年龄、孕周相匹配的HIV抗体检测阴性的40例健康孕妇及其婴幼儿作为对照组。采用回顾性分析的方法,对两组孕妇的妊娠结局进行跟踪随访。结果 （1）HIV组孕妇中,流产、早产、低体重儿及小于胎龄儿的发生率分别为9．3％（8／86）14．0％（12／86）、16．3％（14／86）及10．5％（9／86）,明显高于对照组的2．5％（1／40）、5．0％（2／40）、7．5％（3／40）及2．5％（1／40）。两组比较,差异有显著性（P＜0．05）。（2）HIV组孕妇中,合并念珠菌性阴道尖及尖锐湿疣的发生率分别为9．3％与8．1％,明显高于对照组的2．5％及2．5％,两组比较,差异有显著性（P＜0．05）。（3）HIV组孕妇中,母婴HIV垂直传播发生率为12．8％;而对照组孕妇所分娩的婴儿中,HIV抗体检测均为阴性,发生率为0％。两组孕妇HIV感染垂直传播率比较,差异有极显著性（P＜0．01）。结论 孕妇感染HIV后可显著增加流产、早产、低体重儿及小于胎龄儿等不良妊娠结局的发生率,同时增加念珠菌性阴道炎、尖锐湿疣的感染机会,母婴HIV垂直传播的发生率亦明显升高。加强孕期保健、预防HIV感染至关重要。     

Cost effectiveness of a screen-and-treat program for asymptomatic vaginal infections in pregnancy: towards a significant reduction in the costs of prematurity

OBJECTIVE: The purpose of this investigation was to determine the cost-saving potential of a simple screen-and-treat program for vaginal infection, which has previously been shown to lead to a reduction of 50% in the rate of preterm births. STUDY DESIGN: To determine the potential cost savings, we compared the direct costs of preterm delivery of infants with a birth weight below 1900g with the costs of the screen-and-treat program. We used a cut-off birth weight of 1900g because, in our population, all infants with a birth weight below 1900g were transferred to the neonatal intensive care unit. The direct costs associated with preterm delivery were defined to include the costs of the initial hospitalization of both mother and infant and the costs of outpatient follow-up throughout the first 6 years of life of the former preterm infant. The costs of the screen-and-treat program were defined to include the costs of the screening examination and the resulting costs of antimicrobial treatment and follow-up. All calculations were based on health-economic data obtained in the metropolitan area of Vienna, Austria. RESULTS: The number of preterm infants with a birth weight below 1900g was 12 (0.5%) in the intervention group (N=2058) and 29 (1.3%) in the control group (N=2097). The direct costs per preterm birth were found to amount to EUR (euro) 60262. Overall, the expected total savings in direct costs achieved by the screen-and-treat program and the ensuing 50% reduction in the number preterm births with a birth weight below 1900g amounted to more than euro 11 million. The costs of screening and treatment were found to amount to merely 7% of the direct costs saved as a result of the screen-and-treat program. CONCLUSION: A simple preterm prevention program, consisting of screening and antimicrobial treatment and follow-up of women with asymptomatic vaginal infection, leads not only to a significant reduction in the rate of preterm births but also to substantial savings in the direct costs associated with prematurity.     

The influence of gender roles on health seeking behaviour during pregnancy in Turkey

Objectives To explore the impact of gender roles in relation to health seeking behaviour during pregnancy and childbirth.

Methods The study was conducted in neighbourhoods with low antenatal care rates in three provinces of Turkey. The study population consisted of pregnant women who never got or discontinued antenatal care and their peers, families and community leaders. Sixteen focus group discussions and 125 in-depth interviews were conducted with a total of 239 participants.

Results Pregnancy and childbirth are interwoven strongly with gender roles. Since the patriarchal system acknowledges women through the means of childbirth, women are expected to have many children. Hence women experience pregnancy as a burden and are not motivated to seek antenatal care. During pregnancy, only ‘serious’ conditions are considered as legitimate reasons for accessing care. However, the decision regarding whether a pregnant woman is seriously sick or not belongs to the responsibilities of elder women, which delays service use.

Conclusions Providing information regarding the value of antenatal care also to elder women is essential in increasing the demand to the services. Incorporating gender perspectives into daily health practice and maintaining access to high quality reproductive care services are vital in reducing the gender based barriers to care.     

妊娠合并心脏病的筛查和管理

妊娠合并心脏病是目前导致孕产妇死亡的主要原因之一,因此在孕前和孕期保健期间,医务人员应严密关注孕产妇的心脏健康状况。对孕产妇严格地进行心脏病筛查并规范管理,对于降低心脏病孕产妇死亡率具有至关重要的作用。因为妊娠期和产褥期心脏病孕产妇的病理生理学特点,所以其与普通心脏病患者的血流动力学有明显的区别,筛查和管理也与一般的孕产妇和心脏病妇女不同,应强调预防在先和多学科合作的综合管理。     

Sickle cell disease in pregnancy

With advances in management, many women with sickle cell disease now survive to have children. The high risk of fetal and maternal sequelae mandates multidisciplinary management involving an obstetrician, a haematologist, an anaesthetist and a haemoglobinopathy specialist nurse. Hydroxyurea, a new treatment for sickle cell disease, is contraindicated in pregnancy. Exchange transfusion may be indicated in women with a serious obstetric or haematological complications. In those with sickle cell disease, the entire pregnancy is a high-risk period that warrants close monitoring. It is thus important for every obstetrician to be familiar with the condition.