Cost-effectiveness analysis of serological prenatal screening for pregnant women in King Abdulaziz University Hospital: a single-center retrospective study

Background: Congenital primary infections with Toxoplasma gondii, cytomegalovirus (CMV), Epstein–Bar virus (EBV), rubella, and hepatitis B virus (HBV) are viral infections transmitted transplacentally through the blood to the fetus and can be life-threatening. Therefore, we aimed to determine the prevalence of these infections and assess the cost-effectiveness of blood tests among pregnant women with positive serologies.Methods: This retrospective review was conducted among pregnant women with positive prenatal screening serology test results between January 2013 to July 2018. A p-value of <0.05 was used to calculate statistical significance.Results: Overall, 9095 pregnant women delivered in the last 5 years. Of these, 97 had positive prenatal screening serology and were enrolled in our study. Of 97, 61 (62.9%) were Saudis and 36 (37.1%) non-Saudis. The prevalence rates of rubella, CMV, EBV, and HBV were 78.35%, 59.79%, 14.43%, and 5.15%, respectively. Additionally, 44 of 97 women developed undesired antepartum outcomes, whereas 47 had adverse neonatal outcomes. CMV, HBV, and rubella were significantly associated with adverse pregnancy outcomes (P<0.005). During the study period, USD 1460228.27 was spent to screen 9095 pregnant women and USD 15573.68 to diagnose 97 pregnant women with positive serology.Conclusions: Because infections with toxoplasma, CMV, EBV, rubella, and HBV can cause serious risk to the mother and fetus during pregnancy. Thus, setting new hospital policies regarding early screening for high-risk pregnancies and early detection of these infections during prenatal visits are inevitable to avoid undesired outcomes.

Health Effects of Air Pollution on Fetus

In many previous studies for the relationship between air pollution and birth outcome, the exposure was based on the data for environmental monitoring site. We reviewed the epidemiologic studies that evaluated the health effects of air pollution on birth outcome such as low birth weight and preterm births. We identified the air pollution exposure during pregnancy was related with low birth weight and preterm birth, although there are differences between studies for the critical period of vulnerability. also suggests that the indoor and personal exposure to VOCs during pregnancy may contribute the adverse pregnancy outcomes. The biological mechanisms whereby air pollution might influence health of fetus are not clearly established. Controlling for potential confounders and valid assessment of exposure are the problem remained in these epidemiologic studies. In the future, more studies are need to investigate the effect of air pollution on preterm birth or stillbirths, considering the various exposure period, and the biological mechanism. also results should be taken into account for future advisories and evaluation of environmental policy .

Developmental Changes of Spectral and Chaotic Indexes of Heart Rate Variability in Normal Fetuses

PURPOSE: The purposes of this study were to determine the normal values of spectral and chaotic indexes and to assess the maturational process of autonomic and chaotic control of fetal heart rate according to gestational age. METHODS: Three hundred and thirty-seven mothers with normal singleton pregnancies, who were 23 weeks or more in gestational age, was randomly chosen. For more than 40 minutes fetal heart rates and fetal movements were recorded and were downloaded to a computer. From each heart rate data, we extracted 25 minutes (3,000 points) worth of time series of dimension were calculated and then 2 weeks' average were compared to find the maturational change of them. RESULTS: LF power and LF/HF ratio which are indexes of cardiac sympathetic tone increased significantly (P=0.0001) with gestational age from 23 to 38 weeks. The HF power did not show significant developmental change. Correlation dimension, an index of chaotic control, tended to decrease with the gestational age (P=0.0001). It was 4.07 +/- 0.13 before 24 weeks and, after it reached the peak of 4.15 +/- 0.14 at 31-32 weeks, it gradually decrease to a slight but significant lower value of 3.67 +/- 0.08 at 41-42 weeks. CONCLUSION: Magnitude of cardiac sympathetic modulation increases until 37-38 weeks. On the average, fetal heart rate is regulated at least by four independent variables throughout the gestation and after 23 weeks of gestation. Complexity of heart rate control system peaks at 31-32 weeks then slightly decreases until term gestation, probably to synchronize the heart rate to other physiologic functions.