Impact of postpartum weight change on metabolic syndrome and its components among women with recent gestational diabetes mellitus.

BACKGROUND: While postpartum weight changes may affect the levels of metabolic parameters, the direct effects of weight changes in the postpartum period on changes in the prevalence rates of metabolic syndrome and its components remain unstudied. This study aimed to investigate the effects of postpartum weight changes between 6 weeks and 6 months on changes in the prevalence rates of metabolic syndrome and its components in women who have recently experienced gestational diabetes mellitus. METHODS: This prospective cohort study included 171 postpartum women with recent gestational diabetes mellitus, who underwent serial weight and metabolic risk factor assessments at 6 weeks and 6 months postpartum. Weight changes between these time points were classified as weight loss (> 2 kg), weight stability (± 2 kg), or weight gain (> 2 kg). Metabolic syndrome comprised the following metabolic risk factors: large waist circumference, elevated blood pressure, elevated fasting plasma glucose levels, high triglyceride levels, and low high-density lipoprotein cholesterol levels. RESULTS: Of the 171 women in our cohort, 30 women (17.5%) lost > 2 kg of body weight, while 85 (49.7%) maintained a stable weight and 56 (32.8%) gained > 2 kg. The weight loss group experienced significant changes in the prevalence rates of the following metabolic risk factors compared to the weight stability and weight gain groups: large waist circumference (% change: - 26.7 vs - 5.9 vs 5.4, respectively; p = 0.004), elevated fasting plasma glucose levels (% change: - 3.4 vs 18.9 vs 26.8, respectively; p = 0.022), and high triglyceride levels (% change: - 30.0 vs 0 vs - 7.2, respectively; p = 0.024). A significantly greater decrease in the prevalence of metabolic syndrome was also found in the weight loss group than in the other two groups (% change: - 20.0 vs 11.8 vs 14.2, respectively; p = 0.002). CONCLUSIONS: Weight changes from 6 weeks to 6 months postpartum significantly altered the prevalence rates of metabolic syndrome and its components in women with recent gestational diabetes mellitus. Early postpartum weight loss can reverse metabolic risk factors and reduce the prevalence of metabolic syndrome. TRIAL REGISTRATION: Thai Clinical Trials Registry: Registration no. TCTR20200903001. Date of registration: September 3, 2020. Date of initial participant enrolment: September 7, 2020.

Metabolic syndrome (MetS) is a frequent diagnosis with consequences for the occurrence of cardiovascular diseases. Women with gestational diabetes mellitus (GDM) are especially vulnerable to the development of MetS. In this study, we investigated how postpartum weight changes, specifically between 6 weeks and 6 months postpartum, impact MetS and its components in women who have recently experienced GDM. The results of our study showed that women who lost > 2 kg of body weight between 6 weeks and 6 months postpartum had significant decreases in the prevalence rates of metabolic risk factors, leading to a lower prevalence of MetS, compared to women who maintained a stable weight (± 2 kg) or gained > 2 kg. Our findings suggest that such weight loss is beneficial for preventing MetS; thus, strategies should be developed to support women with GDM in achieving postpartum weight loss. These strategies may include personalized dietary counseling, exercise programs, and behavioral support tailored to the specific needs and challenges faced by this population.

Lactation duration and development of type 2 diabetes and metabolic syndrome in postpartum women with recent gestational diabetes mellitus.

BACKGROUND: The World Health Organization and United Nations Children's Fund recommend exclusive breastfeeding (EBF) for the first six months of an infant's life. Although evidence suggests that maintaining breastfeeding has positive impacts on glucose and lipid metabolism in postpartum women with a history of gestational diabetes mellitus (GDM), no study has investigated whether such effects differ between breastfeeding intensities. This study aimed to evaluate the impact of maintaining breastfeeding on prediabetes, type 2 diabetes mellitus (T2DM), and metabolic syndrome (MetS) six months postpartum in women with GDM. This study also examined the potential variations in glucometabolic outcomes between EBF at six months and partial breastfeeding at six months. METHODS: This prospective cohort study included 130 women with recent GDM who experienced live births between 7 September 2020 and 31 January 2023 at a university hospital in Bangkok, Thailand. All the women were free of T2DM and MetS at baseline (six weeks postpartum). We followed up these women six months postpartum to assess their breastfeeding practices (EBF at six months, partial breastfeeding at six months, or not maintaining breastfeeding) and evaluate their progression to prediabetes, T2DM, and MetS. Maintaining breastfeeding was defined as breastfeeding for six months. EBF was determined using the "recall since birth" method. RESULTS: Of the 130 participants included, the rates of prediabetes, T2DM, and MetS six months postpartum were 33% (n = 43), 2% (n = 3), and 17% (n = 22), respectively. In the unadjusted model, maintaining breastfeeding was associated with a reduction in the risks of prediabetes and MetS but not T2DM. After adjusting for potential confounders, maintaining breastfeeding was a significant protective factor only for prediabetes. The adjusted risk ratios and 95% confidence intervals were 0.54 (0.29, 0.99) for prediabetes and 0.47 (0.19, 1.06) for MetS. When EBF at six months and partial breastfeeding at six months were separately analyzed, the risks of prediabetes and MetS differed between the two groups. In the EBF at six months-to-partial breastfeeding at six months comparison, the adjusted risk ratios (95% confidence intervals) of prediabetes and MetS were 0.46 (0.22, 0.97) vs. 0.79 (0.25, 2.49) and 0.34 (0.11, 0.99) vs. 0.69 (0.22, 2.07), respectively. CONCLUSIONS: Maintaining breastfeeding reduced the risk of prediabetes and MetS, but not of T2DM, six months postpartum; these effects were significant only with EBF. These findings indicate that supporting maternal efforts to practice EBF for six months may improve women's health after GDM. TRIAL REGISTRATION: Thai Clinical Trials Registry Registration No. TCTR20200902003. Date of registration: September 2, 2020. Date of initial participant enrollment: September 7, 2020.

Effect of prenatal counseling on postpartum follow-up and contraceptive use in women with gestational diabetes mellitus: a randomized controlled trial.

BACKGROUND: Postpartum visit attendance for glucose screening and uptake of effective contraception is crucial after a pregnancy with gestational diabetes mellitus. Although postpartum women with recent gestational diabetes mellitus are generally advised in the early postnatal period to attend postpartum visits, data have shown suboptimal rates of postpartum glucose testing and of highly effective contraceptive use among these women. Compared with the early postnatal period, the antenatal period is when women and healthcare providers have more contact. This may facilitate a better relationship between the pregnant woman and her healthcare providers, thereby improving the women's trust in the providers' counseling. OBJECTIVE: This study aimed to investigate if adding prenatal counseling to routine, early-postnatal counseling increases the rates of glucose screening and contraceptive use by 6 weeks postpartum among pregnant women with gestational diabetes mellitus. STUDY DESIGN: A randomized controlled trial of 280 women diagnosed with gestational diabetes mellitus was conducted. Participants were randomly allocated (1:1, stratified using a permuted block method) to the intervention group (receiving prenatal counseling at 35-36 weeks of gestation plus routine, early-postnatal counseling) or the control group (receiving only routine, early-postnatal counseling). The 2 primary outcomes were glucose screening and highly effective contraceptive uptake by 6 weeks postpartum. The secondary outcome was the use of any contraceptive by 6 weeks postpartum. Data were analyzed according to the intention-to-treat principle. RESULTS: The rate of postpartum glucose screening was 86.4% (121/140) in the intervention group, which was significantly higher than the rate of 50.7% (71/140) in the control group (adjusted relative risk, 1.70; 95% confidence interval, 1.27-2.28). The uptake of highly effective contraceptive methods was increased in the intervention group when compared with the control group (59.3% vs 30.7%; adjusted relative risk, 1.90; 95% confidence interval, 1.31-2.74). The uptake of any contraceptive method by 6 weeks postpartum was reported by 122 of 140 participants (87.1%) in the intervention group and by 77 of 140 participants (55.0%) in the control group (adjusted relative risk, 1.58; 95% confidence interval, 1.19-2.10). CONCLUSION: Adding prenatal counseling to routine, early-postnatal counseling significantly increased the rates of glucose screening and contraceptive use by 6 weeks postpartum among pregnant women with gestational diabetes mellitus. Given that the incorporation of counseling on postpartum glucose testing and effective contraceptive use into standard prenatal care requires minimal increases in expenditure and manpower, implementation of this counseling strategy in clinical practice seems advisable.

Long-term observational study of renal outcome after preeclampsia: Role of soluble fms-like tyrosine kinase-1(sFlt-1)/ placental growth factor (PlGF) and endoglin.

Introduction: Preeclampsia (PE) is an important complication of pregnancy that can lead to chronic kidney disease. Soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF), the sFlt-1/PlGF ratio and endoglin are biomarkers for the differential diagnosis of PE and other diseases. We aimed to explore the correlation of these biomarkers with long-term renal function, blood pressure and the urine albumin/creatinine ratio (UACR) in PE patients. Methods: 34 patients with PE were enrolled. Blood samples for sFlt-1, PlGF, endoglin and the urine albumin/creatinine ratio (UACR) were collected at the time of PE diagnosis (at 35-40 weeks' gestational age (GA) (87.50% of cases). After delivery, the patients were followed up at three months and one year to assess blood pressure, renal function and the UACR. Results: Thirty-four PE patients were included, and 17 completed the study. The estimated glomerular filtration rate (eGFR) decreased significantly at three months and one year after follow-up (128.20 ± 10.34 to 120.75 ± 10.166 ml/min/1.73 m2 (p = 0.001) at three months and 126.71 ± 9.948 to 114.29 ± 11.274 ml/min/1.73 m2 (p < 0.001) at one year). The endoglin level correlated significantly with the eGFR level during PE, but there was no correlation of any biomarker with eGFR, blood pressure, or the UACR at one year. Conclusion: Women with PE have a reduction of eGFR at three months and one year after the diagnosis of PE. Only endoglin is correlated with eGFR antepartum; however, it is not correlated with long-term renal function, blood pressure or the UACR.

Acceptance of COVID-19 vaccination during pregnancy among Thai pregnant women and their spouses: a prospective survey.

BACKGROUND: Vaccination is one of the most reliable interventions against coronavirus disease 2019 (COVID-19). Although pregnant women's attitudes toward COVID-19 vaccination are well studied, husbands' views toward COVID-19 vaccination for these women have not been surveyed. We aimed to determine the rates and associated factors of accepting attitudes toward COVID-19 vaccination during pregnancy among Thai pregnant women and their spouses and to evaluate the actual rate of vaccination during pregnancy among these women. METHODS: A prospective survey was conducted at a tertiary care center in Bangkok, Thailand. A total of 176 Thai pregnant woman/husband dyads who attended our antenatal care clinic between 1 July 2021 and 30 September 2021 were consecutively recruited for evaluations of their accepting attitudes toward COVID-19 vaccination during pregnancy. After delivery, data on COVID-19 vaccination during pregnancy among pregnant women were extracted from the hospital's electronic database. RESULTS: After exclusion of five pregnant women with prepregnancy COVID-19 vaccination, 171 women and 176 male partners were included. The rates of accepting attitudes toward COVID-19 vaccination during pregnancy were 60.8% and 61.4%, respectively. Multivariate analysis showed that having a husband who favored COVID-19 vaccination for his wife was independently associated with COVID-19 vaccine acceptance among pregnant women (adjusted odds ratio 4.82; 95% confidence interval 2.34, 9.94). However, confidence in vaccine safety was an associated factor of the husband's willingness to have his wife vaccinated for COVID-19 during pregnancy (adjusted odds ratio 12.56; 95% confidence interval 2.35, 67.18). The actual rate of vaccination during pregnancy was 88.3%. CONCLUSIONS: Although the rates of accepting attitudes toward COVID-19 vaccination during pregnancy among Thai pregnant women and their spouses were modest, the actual rate of being vaccinated during pregnancy was high.

Vaccination is an important tool to fight against the coronavirus disease 2019 (COVID-19) pandemic. In this study, we investigated the rates and associated factors of accepting attitudes toward COVID-19 vaccination during pregnancy among Thai pregnant women and their spouses. The actual rate of vaccination during pregnancy among the enrolled women was also evaluated. We recruited 176 Thai pregnant woman/husband dyads who attended our antenatal care clinic between 1 July 2021 and 30 September 2021. The results showed that 60.8% of pregnant women and 61.4% of husbands had accepting attitudes toward COVID-19 vaccination during pregnancy. Having a husband who favored COVID-19 vaccination for his wife was a significant factor for COVID-19 vaccine acceptance among pregnant women, whereas confidence in vaccine safety was a significant predictor of the husband's willingness to have his wife vaccinated for COVID-19 during pregnancy. The majority (96.2%) of the women who accepted vaccination were vaccinated against COVID-19 during pregnancy. On the other hand, 76.1% of the women who were initially reluctant to be vaccinated ultimately received COVID-19 vaccines during pregnancy. The actual rate of being vaccinated among the enrolled women was 88.3%. Given the results of this study, physicians, hospital administrators, and policymakers should focus on those who show vaccine hesitancy or refusal and implement intensive interventions because there is a possibility to change their attitudes if they have more knowledge and gain more trust in the vaccines.

Glucose levels during gestational diabetes pregnancy and the risk of developing postpartum diabetes or prediabetes.

BACKGROUND: Blood glucose levels during pregnancy may reflect the severity of insulin secretory defects and/or insulin resistance during gestational diabetes mellitus (GDM) pregnancy. We hypothesized that suboptimal glycemic control in women with GDM could increase the risk of postpartum type 2 diabetes mellitus (T2DM) or prediabetes. Our objective was to evaluate the impact of plasma glucose levels throughout GDM pregnancy on the risk of postpartum T2DM or prediabetes. METHODS: The medical records of 706 women with GDM who underwent a postpartum 75-g, 2-hour oral glucose tolerance test at our institution between January 2011 and December 2018 were reviewed. These women were classified into 2 groups according to glycemic control during pregnancy: ≤ 1 occasion of either fasting glucose ≥ 95 mg/dL or 2-hour postprandial glucose ≥ 120 mg/dL was defined as optimal glycemic control or else was classified as suboptimal glycemic control. Rates of postpartum T2DM and prediabetes were compared between women with optimal (n = 505) and suboptimal (n = 201) glycemic control. RESULTS: The rates of postpartum T2DM and prediabetes were significantly higher in the suboptimal glycemic control group than in the optimal glycemic control group: 22.4% vs. 3.0%, P < 0.001 for T2DM and 45.3% vs. 23.5%, P < 0.001 for prediabetes. In a multivariate analysis, suboptimal glucose control during pregnancy was an independent risk factor for developing either postpartum T2DM or prediabetes. The adjusted odds ratios were 8.4 (95% confidence interval, 3.5-20.3) for T2DM and 3.9 (95% confidence interval, 2.5-6.1) for prediabetes. CONCLUSION: Our findings suggest that blood glucose levels during GDM pregnancy have an impact on the risk of postpartum T2DM and prediabetes.

Risk score for predicting primary cesarean delivery in women with gestational diabetes mellitus.

BACKGROUND: Women with gestational diabetes mellitus (GDM) have a higher risk of cesarean delivery (CD) than glucose-tolerant women. The aim of this study was to develop and validate a risk score for predicting primary CD in women with GDM. METHODS: A risk score for predicting primary CD was developed using significant clinical features of 385 women who had a diagnosis of GDM and delivered at our institution between January 2011 and December 2014. The score was then tested for validity in another cohort of 448 individuals with GDM who delivered between January 2015 and December 2018. RESULTS: The risk score was developed using the features nulliparity, excess gestational weight gain, and insulin use. The scores that classified the pregnant women as low risk (0 points), intermediate risk (1-3 points), and high risk (≥ 4 points) were directly associated with the primary CD rates of the women in the development cohort: 14.7, 38.2 and 62.3%, respectively (P <  0.001). The model showed good calibration and acceptable discriminative power with a C statistic of 0.724 (95% confidence interval, 0.670-0.777). Similar results were observed in the validation cohort. CONCLUSION: A risk score using the features nulliparity, excess gestational weight gain, and insulin use can estimate the risk for primary CD in women with GDM.

Characteristics associated with loss to post-partum follow-up among adolescent mothers.

AIM: To identify the rate and associated factors of loss to post-partum follow-up among adolescent mothers. METHODS: A matched case-control study was conducted among Thai adolescents who gave birth between January 2011 and December 2016 and were scheduled for a 6-week post-partum visit. Cases (n = 568) included mothers who did not return for follow-up whereas controls (n = 568) were mothers who attended a post-partum visit. Cases were matched with controls according to age group and date of delivery. RESULTS: During the study period, 2335 Thai adolescent mothers were scheduled for a post-partum visit. Of these, 568 mothers (24.3%) did not return for post-partum care. The strongest predictor for loss to post-partum follow-up was inadequate number of antenatal visits (adjusted odds ratio [aOR] 2.14, 95% confidence interval [CI] 1.51-3.04), followed by being single/separated/divorced (aOR 1.58, 95% CI 1.08-2.29) and lower level of education (aOR 1.57, 95% CI 1.14-2.17). Being a student was a positive factor associated with post-partum visit attendance (aOR 0.57, 95% CI 0.40-0.80). CONCLUSION: Approximately one quarter of adolescent mothers did not attend a post-partum visit. Three independent characteristics associated with loss to post-partum follow-up included inadequate number of antenatal visits, being single/separated/divorced and lower level of education. Being a student was positively associated with post-partum visit attendance. Intensive intervention programs including using technology to remind post-partum women, home visits and counseling during the immediate post-partum period should be implemented to increase the post-partum attendance rate among adolescent mothers.

Maternal characteristics and pregnancy outcomes among illicit drug-using women in an urban setting.

OBJECTIVE: To identify characteristics and pregnancy outcomes among pregnant illicit drug users living in an urban area, and to describe trends in drug use over an 8-year period. MATERIALS AND METHODS: Data on pregnant women living in the Bangkok Metropolitan Region who delivered at our institution during 2008-2015 were studied. Women with drug use (n = 197) and women without drug use (n = 787) were compared in terms of maternal characteristics and pregnancy outcomes. RESULTS: The pregnant drug user rate markedly rose from 0.46% in 2008 to 1.28% in 2015. All pregnant drug users consumed amphetamine-type stimulants (ATS). The most important factor related to drug use was smoking (adjusted odds ratio [aOR] 41.03, 95% confidence interval [CI] 18.90-89.04). Other significant characteristics were teenage pregnancy (aOR 1.78, 95% CI 1.01-3.18), low level of education (aOR 4.97, 95% CI 1.18-20.90 for secondary school and aOR 5.61, 95% CI 1.28-24.49 for primary school or lower), and inadequate number of antenatal visits (aOR 2.20, 95% CI 1.16-4.17 for 1-3 visits and aOR 14.05, 95% CI 7.54-26.16 for no visit). Women of non-Thai ethnicity were less likely to use drugs (aOR 0.15, 95% CI 0.04-0.54). Pregnant drug users had a significantly higher risk of anemia (aOR 1.73, 95% CI 1.05-2.85), preterm delivery (aOR 2.35, 95% CI 1.29-4.29), low birth weight (aOR 2.26, 95% CI 1.23-4.17) and small for gestational age infants (aOR 3.19, 95% CI 1.39-7.33), but lower risk of cesarean section (aOR 0.43, 95% CI 0.21-0.86) than non-drug users. CONCLUSION: Compared to urban pregnant women without drug use, women who consumed drugs were younger, had lower level of education, poorer self-care and poorer pregnancy outcomes. ATS was the single most commonly used drug.

Inappropriate gestational weight gain among teenage pregnancies: prevalence and pregnancy outcomes.

OBJECTIVE: To study the prevalence and pregnancy outcomes of inappropriate gestational weight gain (GWG) among teenage pregnant women. METHODS: A retrospective descriptive study was conducted on 2,165 teenage pregnant women who attended our antenatal clinic between January 2007 and August 2015. Adverse pregnancy outcomes, including maternal and neonatal outcomes of women with inappropriate GWG, including underweight and overweight, were studied and compared with those of women with appropriate GWG. RESULTS: Complete data of 1,943 women were obtained. Among these women, the mean age was 17.4±1.4 years and mean body mass index at first visit was 19.1±3.0 kg/m2. The prevalence of inappropriate GWG was 61.7%. Underweight women were more likely to experience anemia and preterm delivery, whereas overweight women required more cesarean sections because of cephalopelvic disproportion and preeclampsia, compared to women with appropriate weight gain (all P<0.001). The rates of gestational diabetes mellitus among women who were underweight, overweight, or appropriate weight were not significantly different. CONCLUSION: More than 60% of teenage pregnancies showed inappropriate GWG. GWG had a significant impact on pregnancy outcomes.

Timing of elective cesarean delivery at term and its impact on maternal and neonatal outcomes among Thai and other Southeast Asian pregnant women.

AIM: The impact of timing of elective cesarean delivery (CD) at term on maternal and neonatal outcomes among Thai and other Southeast Asian pregnancies was investigated. The rate of spontaneous labor before the scheduled CD, as well as maternal characteristics predicting spontaneous labor, was also evaluated. METHODS: Data on maternal and neonatal outcomes of 1221 singleton pregnancies scheduled for either an elective repeat CD or an elective primary CD at 37-40 weeks of gestation were studied. The association between maternal characteristics and the risk of spontaneous labor was evaluated by univariate and multivariate analyses. RESULTS: There were no significant differences in severe maternal complications between performing an elective CD at 39 weeks and at the other gestational ages. Severe neonatal complications were significantly decreased when a CD was performed electively from 38 weeks onwards. A total of 503 women (41.2 %) went into spontaneous labor before the scheduled CD. Using 39 weeks as the reference group, scheduling a CD at 37 or 38 weeks decreased the risk of spontaneous labor (6.67-fold and 4.55-fold, respectively) while scheduling a CD at 40 weeks had a 2.54-fold increased risk. A history of previous CD and teenage pregnancy were also predictors of spontaneous labor; adjusted odds ratios were 14.27 and 3.93, respectively. CONCLUSION: The timing of elective CD at term had impacts on pregnancy outcomes among Thai and other Southeast Asian women. Gestational age at scheduled CD, a previous CD and teenage pregnancy were predictors of spontaneous labor.

Comparison of tissue adequacy for histologic examination from Ipas MVA plus and Wallach Endocell in women with abnormal uterine bleeding.

AIM: The aim of this study was to compare endometrial tissue adequacy sampling by Wallach Endocell and manual vacuum aspiration (Ipas MVA plus) in women with abnormal uterine bleeding. Pain and immediate complications from each method were also compared. MATERIAL AND METHODS: Two hundred and forty women with abnormal uterine bleeding were randomly assigned to two methods of endometrial sampling: MVA (n = 122) and Endocell (n = 118). The basic characteristic features of the women, the difficulty of the procedure, pain score by visual analogue scale, immediate complications, and treatment were recorded. Endometrial tissue adequacy and histopathologic diagnoses were evaluated. RESULTS: The adequacy of tissue samples was 81.1% in the MVA group and 85.6% in the Endocell group (P = 0.356). There was a significant difference in the rates of difficult procedure between the two groups (27.0% in MVA vs 14.4% in Endocell; P = 0.016). Moderate to severe pain was significantly higher in the MVA group compared to the Endocell group: 60.7% and 19.5%, respectively (P < 0.001). Other immediate minor complications were also observed to be significantly higher in the MVA group (44.3%) than in the Endocell group (30.5%) (P = 0.028). Although medication required for pain was higher in the MVA group (23.0%) than in the Endocell group (12.0%), the difference was not significant (P = 0.130). The two most common histopathologic findings obtained from MVA and Endocell specimens were proliferative endometrium (32.4%) and atrophic endometrium (27.1%). CONCLUSION: MVA was comparable to Endocell in terms of tissue adequacy. Moderate to severe pain was experienced significantly more in the MVA group; however, the requirement of pain treatment was not significantly different between the groups.

Risk score comprising maternal and obstetric factors to identify late preterm infants at risk for neonatal intensive care unit admission.

AIM: The aim of this study was to develop and validate an antepartum risk score based on maternal and obstetric characteristics to predict the requirement for neonatal intensive care unit (NICU) admission among late preterm infants. MATERIAL AND METHODS: A chart review was performed of 455 singleton late preterm deliveries at our institution between July 2010 and December 2011. Logistic regression analysis was used to develop a risk score, which was derived from ß coefficients of the significant variables. A receiver-operator curve was plotted to determine the optimal cut-off score for predicting NICU admission. Validation of the score was tested in another cohort of 450 women who delivered a singleton late preterm infant between January 2012 and June 2013. RESULTS: A total of 98 infants (21.5%) in the development cohort were admitted to the NICU. The significant factors for NICU admission included: premature rupture of membranes, antepartum hemorrhage, medical disorders during pregnancy, prenatal estimation of fetal weight, gestational age at delivery, and mode of delivery. These six variables were integrated into a risk-scoring model, which ranged from -2 to 9 points. A cut-off score of ≥1 produced the maximum area under the receiver-operator curve of 0.764. At this cut-off point, the sensitivity was 79.6% and specificity was 73.1%. When the risk score was tested in the validation cohort, similar results were demonstrated. CONCLUSION: An antepartum risk score was developed to predict the requirement for NICU admission among late preterm infants and was validated in an independent cohort.

Comparison of gestational diabetes mellitus rates in women with increased and normal white blood cell counts in early pregnancy.

AIM: To compare the rates of gestational diabetes mellitus (GDM) among Thai or other South-East Asian women with increased and normal peripheral white blood cell (WBC) counts in early pregnancy. The risk of GDM in relation to WBC count was also determined. METHODS: We included singleton pregnant women who sought their first antenatal care in our institution between May 2010 and December 2011. Subjects were 595 gravidas with an increased WBC count while controls were 595 pregnancies with a normal WBC count. Data of pregnant women were collected. The WBC of each woman was obtained from a complete blood count performed in the first trimester. The rates of GDM between both groups were compared. The odds ratio (OR) with 95% confidence interval (CI) of GDM development in the subject group was determined by multivariate analysis. RESULTS: Data on 570 subjects with increased WBC and 575 controls with normal WBC were obtained. The rate of GDM was significantly higher in subjects compared to controls at 13.2% versus 5.2% (P<0.001) with a crude OR of 2.75 (95% CI, 1.77-4.28). By multivariate analysis, the subject group was found at increased risk of GDM compared to the control group, with an adjusted OR of 2.20 (95% CI, 1.39-3.47). CONCLUSION: Thai or other South-East Asian women with an increased WBC count in early pregnancy had a significantly higher rate of GDM than women having a normal WBC count. Our results demonstrate that WBC count is an independent risk factor for GDM.

Pain control in laparoscopic gynecologic surgery with/without preoperative (preemptive) parecoxib sodium injection: a randomized study.

OBJECTIVE: To determine the effectiveness of preoperative parecoxib sodium injection for pain relief after laparoscopic gynecologic surgery. MATERIAL AND METHOD: A prospective double-blind, randomized study was conducted in 268 patients who underwent laparoscopic gynecologic surgery at Vajira Hospital between November 1, 2010 and March 31, 2011. The patients were randomly allocated into two groups to receive either single intravenous 40 mg parecoxib (treatment group; n = 133) or normal saline (control group; n = 135) 30 min before surgery. The degree of postoperative pain was assessed every 2 h in the first 8 h postoperation, then every 4 h until completion of 24 h by using a verbal rating scale. Total consumption of meperidine over a 24-h period and the adverse events relevant to parecoxib sodium were also recorded. RESULTS: Mean pain scores at all measured times in the treatment group were insignificantly lower than those in the control group (p = 0.106). The mean 24-h postoperative meperidine consumption in the treatment group was significantly lower compared to that in the control group (26.3 +/- 28.1 mg and 39.1 +/- 34.6 mg, respectively, p = 0.001). The proportion of patients requiring meperidine in the treatment group was significantly lower than that in the control group (58.6% and 70.3%, respectively, p = 0. 045). No serious adverse events were observed in both groups. CONCLUSION: Preoperative parecoxib sodium significantly reduced postoperative meperidine requirement and consumption, while insignificantly declined the pain scores. Serious adverse events were not encountered

Role of neutrophil to lymphocyte ratio as a prognostic indicator for epithelial ovarian cancer.

OBJECTIVE: To determine whether level of preoperative peripheral blood neutrophil to lymphocyte ratio (NLR) was a prognostic indicator for epithelial ovarian cancer (EOC) patient. The present study further aimed to evaluate the impact of the change of preoperative/postoperative NLR on the survival. MATERIAL AND METHOD: Medical records of the patients undergoing an operation for EOC in Vajira Hospital between January 1, 2004 and December 31, 2009 were reviewed. Demographic, clinicopathological, and laboratory data were assessed. Preoperative NLR level was divided into high (more than 2.6) and low (2.6 or less) groups and their association with survival were determined. The survival of the subjects according to their preoperative NLR compared to postoperative level was also evaluated. RESULTS: Mean age of 129 subjects was 49.6 +/- 12.5 years. Median pre- and post-operative NLR were 2.8 (range 0.86 to 30.0) and 2.7 (range 0.16 to 31.3), respectively. Seventy-one patients (55.0%) had high preoperative NLR and 64 (53.8%) had high postoperative value. High preoperative and pre- and post-operative NLR were significantly associated with advanced stage and suboptimal surgery. While high post-operative NLR was significantly associated with advanced stage but not suboptimal surgery. In univariable analysis, preoperative/postoperative high/high NLR tended to associate with poor progression free survival (PFS) but not overall survival (OS), with p = 0.019 and p = 0.052 respectively. By multivariable analysis, the advanced stage and suboptimal surgery, but not preoperative and postoperative NLR, were independent poor prognostic factors for PFS and OS. CONCLUSION: The level of preoperative NLR and the change of preoperative/postoperative NLR level tended to associate with PFS more than OS of EOC patient.

Seasonal variation in the prevalence of preeclampsia.

OBJECTIVE: To determine whether there is a seasonal impact on the prevalence of preeclampsia in the tropical climate of Bangkok. MATERIAL AND METHOD: Medical records of all singleton pregnant women who delivered in the authors' institution between 2008 and 2009 were reviewed. The meteorological variables during the study period were obtained from database of the Thai Meteorological Department. The period of study was then divided into two main seasons: monsoon and dry seasons. The rates of preeclampsia occurring in the two seasons, based on the date of conception and date of delivery, were compared. RESULTS: Data of 7,013 gravidas were included for analysis. Of these, 327 (4.7%) developed preeclampsia. The monsoon season had lower mean maximum temperature (37.0 degrees C vs. 38.1 degrees C, p = 0.114), was more humid (77.0% vs. 68.7%, p < 0.001) and had higher daily rainfall (196.5 mm vs. 37.0 mm, p < 0.001) than dry season. Women who conceived in the dry season were at greater risk to develop preeclampsia than those who conceived in the monsoon season (5.3% vs. 3.7%, adjusted OR 1.51; 95% CI 1.18-1.93). The preeclampsia rates of women who delivered in both seasons were not significantly different: 5.0% in the dry season vs. 4.3% in the monsoon, p = 0.178. CONCLUSION: There is a seasonal impact on the prevalence of preeclampsia based on the time of conception, but not the time of delivery. The rate of preeclampsia is significantly higher when conception occurs in the dry season.

Risk assessment for preeclampsia in women with gestational diabetes mellitus.

AIM: To develop a clinical model to assess the risk of preeclampsia in women with gestational diabetes mellitus (GDM). METHODS: We studied clinical characteristics of 813 consecutive women who had GDM between January 2003 and February 2008 at our institution. The clinical features which were significantly associated with preeclampsia by multiple logistic regression analysis were integrated into a risk model. The diagnostic performance of this model was then evaluated from a receiver-operating characteristic (ROC) curve analysis. RESULTS: A total of 78 women with GDM (9.6%) developed preeclampsia. In a multivariable analysis, first-trimester BMI > or =27 kg/m(2) (P<0.001), GDM diagnosed within 20 weeks of gestation (P<0.001), and poor glycemic control (P<0.001) were associated with preeclampsia. These three factors were incorporated into a risk-scoring model which ranged from 0 to 3 points. At the optimal cut-off score of > or =2, the sensitivity, specificity, and area under the curve (AUC) for preeclampsia were high at 76.9% [95% confidence interval (CI) 69.0-85.2], 92.8% (95% CI 85.9-98.1), and 0.849 (95% CI 0.792-0.905), respectively. CONCLUSION: A model based on clinical data yielded predicted the development of preeclampsia in women with GDM.

A risk score for selective screening for gestational diabetes mellitus.

OBJECTIVE: To develop a risk score to predict women who are likely to have an abnormal glucose challenge test (GCT) for gestational diabetes mellitus (GDM) screening. STUDY DESIGN: A cohort of 1876 pregnant women who underwent a GCT between March 2005 and December 2005 at our institution were studied. A multivariable analysis was performed to determine the clinical features that were significantly associated with an abnormal GCT. These factors were incorporated into the equation which was subsequently transformed to the risk score. The validity of this risk score was then tested in a different cohort of 1900 women who underwent a GCT between October 2006 and July 2007. RESULTS: Of 1876 women in the derivation cohort, 586 (31.2%) had positive GDM screening. In a multivariable analysis, age, body mass index, family history of diabetes, prior macrosomia, and history of >or=2 spontaneous abortions were significantly associated with an abnormal GCT. These five variables were added into the equation to determine the risk score. At a cutoff score of >or=380, the sensitivity, specificity, positive predictive value, and negative predictive value to predict an abnormal GCT were 86.9%, 45.0%, 41.8%, and 88.3%, respectively. When the equation with the same cutoff score was tested in the validation cohort, a similar diagnostic performance was obtained. By adopting this risk scoring approach to GDM screening, 41.3% of women could avoid GCT. CONCLUSION: Our risk score based on clinical data is simple, noninvasive, costless, and reliable to identify women who are likely to have an abnormal GCT.