The effectiveness of integrated online health-coaching on physical activity and excessive gestational weight gain: a prospective randomized-controlled trial.

PURPOSE: Low levels of physical activity during pregnancy go along with increased risks for numerous health complications. We investigated whether an integrated lifestyle intervention leads to higher levels of physical activity and reduces the rate of excessive gestational weight gain (EGWG). METHODS: We conducted a randomized-controlled trial on 97 pregnant women, randomly assigned to receive an additional telehealth lifestyle intervention (experimental group, EG; n = 49) or conventional antenatal care (control group, CG; n = 48). The core lifestyle intervention comprised regular video calls, providing integrated personal support and motivation to physical activity. The primary outcome was change in physical activity measured in steps per day. An additional exploratory outcome was the proportion of participants with EGWG. RESULTS: The mean step count during the third trimester was 6483 steps/day (EG) and 5957 steps/day (CG), respectively (p = 0.078). Repeated-measures ANOVA revealed a significant interaction effect (p = 0.045) reflecting an overall increase of 497 steps per day in the EG vs. a decrease of 300 steps per day in the CG. The proportion of participants who met the IOM recommendation for total weight gain during pregnancy was significantly higher in the EG (p = 0.048) and the ratio of women that gained excessively was higher in the CG (p = 0.026). CONCLUSIONS: We assume that the personalized online intervention supports women in increasing or at least maintaining their level of physical activity during the course of pregnancy. Additionally, it reduces the rate of excessive weight gain.

[Follow-up Routine in Primary Care of Women after Hypertensive Disorders in Pregnancy - a Single-Center, Survey-Based Study]. / Versorgungsrealität von Frauen nach hypertensiver Schwangerschaftserkrankung ­ eine monozentrische fragebogenbasierte Analyse.

INTRODUCTION: Women with a history of a hypertensive disorders of pregnancy have a significantly higher risk of future cardiovascular diseases and are therefore recommended to participate in screening examinations and counseling on primary prevention. To understand the current routine of postpartum care, we examined how many women engage in follow-up examinations and whether counseling takes place. METHODOLOGY: Single-center, survey-based study of 113 women affected by hypertensive disorders of pregnancy between 2014 and 2019. Descriptive analysis was used to analyze the responses. RESULTS: A total of 54% of the women engaged in follow-up. Of the participants, 47% were informed about their diagnosis in a personal conversation and possible consequences were pointed out. Of the 67 women with a BMI≥25 kg/m2, 23% received a recommendation to increase physical activity, and 13% of these women were advised to reduce their weight. Significantly more women with a higher burden of disease (BMI, p=0.027; arterial hypertension, p=0.016) and a severe form of hypertensive pregnancy disorder (eclampsia, intensive care treatment, each p=0.016) engaged in follow-up care. CONCLUSIONS: The present results suggest that the strategies to prevent cardiovascular diseases and detect cardiovascular risk factors have not been consistently pursued. After a hypertensive disorder of pregnancy, every woman should receive a recommendation to engage in follow-up examinations.

Position Paper of the Task Force for Obstetrics and Prenatal Medicine (AGG - Section Preterm Birth) on the Placement, Removal and Surveillance of the Arabin Cervical Pessary in Patients at Risk for Spontaneous Preterm Birth.

This position paper describes clinically important, practical aspects of cervical pessary treatment. Transvaginal ultrasound is standard for the assessment of cervical length and selection of patients who may benefit from pessary treatment. Similar to other treatment modalities, the clinical use and placement of pessaries requires regular training. This training is essential for proper pessary placement in patients in emergency situations to prevent preterm delivery and optimize neonatal outcomes. Consequently, pessaries should only be applied by healthcare professionals who are not only familiar with the clinical implications of preterm birth as a syndrome but are also trained in the practical application of the devices. The following statements on the clinical use of pessary application and its removal serve as an addendum to the recently published German S2-consensus guideline on the prevention and treatment of preterm birth.

Encouraging early clinical experience with deliberately delayed temporary fetoscopic tracheal occlusion for the prenatal treatment of life-threatening right and left congenital diaphragmatic hernias.

OBJECTIVE: In order to assess the effect of deliberately delayed percutaneous fetoscopic tracheal occlusion on survival of fetuses with life-threatening congenital diaphragmatic hernia. METHODS: Eight fetuses with life-threatening congenital diaphragmatic hernia underwent fetoscopic tracheal balloon occlusion between 29 + 0 and 32 + 4 weeks of gestation. Delayed occlusion was chosen in order to minimize potentially negative pulmonary effects from premature delivery as a result of fetal surgery. In addition, we wanted to become able to provide all available postnatal intensive care treatment means in these patients. RESULTS: Six of the 8 fetuses survived to discharge from hospital. CONCLUSION: Delayed fetoscopic tracheal balloon occlusion may be rewarded with lung growth sufficient to allow survival of fetuses with life-threatening congenital diaphragmatic hernia.