Association of types of diabetes and insulin dependency on birth outcomes

BACKGROUND Diabetes rates among pregnant women in the United States have been increasing and are associated with adverse pregnancy outcomes.AIM To investigate differences in birth outcomes(preterm birth,macrosomia,and neonatal death)by diabetes status.METHODS Cross-sectional design,using linked Missouri birth and death certificates(singleton births only),2010 to 2012(n=204057).Exposure was diabetes non-diabetic,pre-pregnancy diabetes-insulin dependent(PD-I),pre-pregnancy diabetes-non-insulin dependent(PD-NI),gestational diabetes-insulin dependent(GD-I),and gestational diabetes-non-insulin dependent(GD-NI).Outcomes included preterm birth,macrosomia,and infant mortality.Confounders included demographic characteristics,adequacy of prenatal care,body mass index,smoking,hypertension,and previous preterm birth.Bivariate and multivariate logistic regression assessed differences in outcomes by diabetes status.RESULTS Women with PD-I,PD-NI,and GD-I remained at a significantly increased odds for preterm birth(aOR 2.87,aOR 1.77,and aOR 1.73,respectively)and having a very large baby[macrosomia](aOR 3.01,aOR 2.12,and aOR 1.96,respectively);in reference to non-diabetic women.Women with GDNI were at a significantly increased risk for macrosomia(aOR1.53),decreased risk for their baby to die before their first birthday(aOR 0.41)and no difference in risk for preterm birth in reference to non-diabetic women.CONCLUSION Diabetes is associated with the poor birth outcomes.Clinical management of diabetes during pregnancy and healthy lifestyle behaviors before pregnancy can reduce the risk for diabetes and poor birth outcomes.

Effect of upright and ambulant positions versus lying down during the active first stage of labor on birth outcomes among nulliparous women:randomized controlled clinical trial

Objective:To examine the effect of upright and ambulant positions versus lying down during the active first stage of labor on birth outcomes for nulliparous women.Methods:This is a randomized controlled clinical trial conducted at the delivery department of Damanhour Educational Institute,El Behira Governorate,Egypt.The study sample involved 150 parturient women equally divided into intervention and control groups using randomization block technique.The researchers used four tools for data collection:Demographic data interview schedule,World Health Organization Partograph,Apgar’s score,to evaluate neonatal outcomes,and visual analogue pain intensity scale.For the study group,the parturient women were encouraged to assume one of the upright positions or ambulating around the bed so as to maintain the pelvis in vertical plane as far as possible for 20-25 min for every 1 h.The control group received routine hospital care,which includes lying down in bed.IBM SPSS 23.0 was used to analyze the data.Results:Significant differences(P<0.05)were observed between the study and control groups in relation to cervical dilation,fetal head descent,uterine contractions interval,and frequency.The duration of the first stage of labor significantly reduced(P=0.018)in the intervention group compared with control group.No significant differences(P>0.05)were observed between both groups in term of emergency cesarean birth rates,oxytocin use,and neonatal outcomes.Conclusions:This study proves that upright and ambulant positions significantly enhance uterine contractility,cervical dilatation,and fetal head descent and reduce the first stage duration.

Ambient air pollution and adverse birth outcomes: a systematic review and meta-analysis

Several reviews have assessed the relationship between exposure to ambient air pollution and adverse birth outcomes during pregnancy,but the results remain controversial.The objective of this study was to assess this correlation quantitatively and to explore sources of heterogeneity.We included all published case-control or cohort studies that evaluated the correlation between ambient air pollution and low birth weight(LBW),preterm birth(PTB),and small for gestational age(SGA).Analytical methods and inclusion criteria were provided on the PROSPERO website(CRD42018085816).We evaluated pooled effects and heterogeneity.Subgroup analyses(grouped by exposure period,study settings,study design,exposure types,data source,Newcastle-Ottawa quality score(NOS),and adjustment for smoking or meteorological factors)were also conducted and publication bias was examined.The risk of bias in systematic reviews(ROBIS)tool was used to evaluate the overall risk of bias in this review.Forty studies met the inclusion criteria.We observed pooled odds ratios(ORs)of 1.03–1.21 for LBW and 0.97–1.06 for PTB when mothers were exposed to CO,NO2,NOx,O3,PM2.5,PM10,or SO2 throughout their pregnancy.For SGA,the pooled estimate was 1.02 in relation to NO2 concentrations.Subgroup analysis and sensitivity analysis decreased the heterogeneity to some extent,such as the subgroups of continuous measures(OR=0.98(0.97–0.99),I2=0.0%)and NOS>7(OR=0.98(0.97–0.99),I2=0.0%)in evaluating the association between PTB and NO2.This review was completed with a low risk of bias.High concentrations of air pollution were significantly related to the higher risk of adverse birth outcomes.However,the sources of heterogeneity among studies should be further explored.

Pregnancy Outcomes Following Transvaginal Cerclage for Cervical Insufficiency：Results From a Single-center Retrospective Study

To study maternal and perinatal outcomes after cervical cerclage in both singleton and twin pregnancies,we retrospectively reviewed women undergoing cervical cerclage for cervical insufficiency at Tongji Hospital,Wuhan,China from January 1,2010 to July 31,2015 to evaluate primary and secondary outcomes for subgroups with cervical length（CL） ≤15,〉15 to 〈25,and ≥25 mm.Of 166 patients who underwent cervical cerclage,after exclusion of patients with missed abortion and continuing pregnancy,141 patients（121 singleton and 20 twin pregnancies） were included in the analysis.Mean gestational age at birth was 34.22 and 28.27 weeks for singleton and twin pregnancies,respectively.There were 17（14.05%） and 13（33.33%） neonatal deaths in singleton and twin pregnancies,respectively.Mean age（31.60±4.62 vs.31.22±4.63 years,P=0.39） and gestational weeks at cerclage（18.50±4.62 vs.19.31±4.99,P=0.47） were similar for both groups.Mean gestational weeks at delivery（34.22±5.77 vs.28.27±6.17,P〈0.001） and the suture to delivery interval（15.72±7.15 vs.8.96±6.70,P〈0.001） were significantly longer in the singleton group.These variables indicate a linear negative correlation with the degree of CL shortening,with better outcomes in patients with CL ≥25 mm who underwent cerclage,both in singleton and twin pregnancies.No difference in mode of delivery existed between the singleton group and twin group.Our results indicate a high risk of preterm delivery in both groups,especially in the twin group.Patients with a history of preterm labor and CL 〉25 mm in the current pregnancy,possibly in a twin pregnancy,could benefit from elective cervical cerclage;however,cervical cerclage was inadvisable for twin pregnancies with a CL 〉15 and 〈25 mm.Our data emphasize the importance of re-evaluating the efficacy of cervical cerclage for twin pregnancies in well-designed clinical trials.

THE EFFECTS OF ZINC SUPPLEMENTATION TO CHINESE RURAL PREGNANT WOMEN AND THEIR PREGNANCY OUTCOME

Objective: TO assess the effects of zinc supplementation to Chinese rural pregnant with cereal-based diet and their pregnancy outcome. Methods A total of 156 women were given randomly in double blind 5mg/d (group A, GPA, n=37),10mg/d (group B, GPB, n=40), 30mg (group C, GpC, n = 39) Of zinc supplement or placebo (group D, GpD, n = 40 ) starting from, the first visit at the prenatal clinic (average 9-week gestation ) till the delivery. Results Mean dietary zinc intake of these women was about 10mg/d, and more than 65% of dietary zinc were taken from cereals, grains and vegetables. Serum zinc concentrations at 25-and 32-gestation in GpC and in the umbilical cord blood of their babies at birth significantly increased. Infants in GpC had a significantly heavier birth weight (283. 079, P = 0. 016 ) and larger head circumference(0. 63cm, P = 0. 035) than infants in GpD. The incidence of low birth weight, preterm and intrauterine growth retardation infants was significantly reduced in GpC. As compared to GpD (38. 34 ± 1. 34 weeks), the duration of gestation in GpD(39. 12± 1. 11 weeks) was prolonged (P= 0. 032). Serum zinc concentration at 25-weeks gestation was negatively correlated with duration of gestation (P = 0. 009 ). Apgar score of the infants in GpC was significantly higher than that in GpD, and serum zinc concentration at 32-weeks gestation was positively associated with infant Apgar score (P = 0. 015 ). Conclusion Zinc supplementation in 30mg/d to Chinese rural women during pregnancy could significantly improve their pregnancy outcome. Both 5mg/d and 10mg/d of zinc supplementation had no detected benefits to them.

Concentrations of Polybrominated Diphenyl Ethers in Maternal Blood,Placental Size,and Risk for Fetal Growth Restriction:A Nested Case-control Study

Objective To explore the effects of prenatal exposure to polybrominated diphenyl ethers(PBDEs)on placental size and birth outcomes.Methods Based on the perspective Wenzhou Birth Cohort,this nested case-control study included 101 fetal growth restriction(FGR)and 101 healthy newborns.Maternal serum samples were collected during the third trimester and measured for PBDEs by gas chromatography tandem mass spectrometry.The basic information of mother-newborn pairs was collected from questionnaires,whereas the placental size and birth outcomes of newborns were obtained from hospital records.Results A total of 19 brominated diphenyle ether(BDE)congeners were detected in maternal serum samples.Higher concentrations of BDE-207,-208,-209,and∑19PBDEs were detected in FGR cases than in controls.Increased BDE-207,-208,-209,and∑19PBDEs levels in maternal serum were related to decreased placental length,breadth,surface area,birth weight,birth length,gestational age,and Quetelet index of newborns.After adjusting for confounders,BDE-207 and∑19PBDE concentrations in maternal serum were significantly associated with an increased risk of FGR.Conclusion A negative association was found between PBDE levels in maternal serum and placental size and birth outcomes.Prenatal PBDE exposure may be associated with elevated risk of the incidence of FGR birth.