Effects of mHealth-Based Lifestyle Interventions on Gestational Diabetes Mellitus in Pregnant Women With Overweight and Obesity: Systematic Review and Meta-Analysis.

BACKGROUND: The increasing incidence of gestational diabetes mellitus (GDM) is a global health problem that is more likely to occur in pregnant women with overweight or obesity. Adhering to a healthy lifestyle is associated with a reduced risk of GDM. With the development of IT, mobile health (mHealth) interventions have become widely available in health care. However, there are no definitive conclusions on the effectiveness of mHealth-based lifestyle interventions in preventing GDM. OBJECTIVE: This study aims to evaluate the impact of mHealth-based lifestyle interventions on GDM and other pregnancy outcomes in pregnant women with overweight or obesity. METHODS: A systematic literature search was conducted in 5 English databases (MEDLINE, Embase, Web of Science, CENTRAL, and CINAHL) and 4 Chinese databases (CBM, CNKI, Vip, and Wanfang) to identify randomized controlled trials (RCTs) on the effectiveness of mHealth-based interventions for GDM from inception to January 10, 2023. In total, 2 authors independently screened the studies and extracted the data. The quality of the included studies was examined using the Cochrane risk-of-bias tool. Data synthesis was conducted using Review Manager (version 5.4; The Cochrane Collaboration). RESULTS: A total of 16 RCTs with 7351 participants were included in this study. The included studies were published between 2014 and 2021 and were conducted in China, the United States, Australia, New Zealand, the United Kingdom, Ireland, and Norway. The sample sizes of the studies ranged from 75 to 2202, and the duration of the mHealth-based lifestyle interventions ranged from 4 to 28 weeks. Compared with usual care, mHealth-based lifestyle interventions significantly reduced the incidence of GDM (odds ratio [OR] 0.74, 95% CI 0.56-0.96; P=.03; I2=65%), preterm birth (OR 0.65, 95% CI 0.48-0.87; P=.004; I2=25%), macrosomia (OR 0.59, 95% CI 0.40-0.87; P=.008; I2=59%), and gestational weight gain (mean difference=-1.12 kg, 95% CI -1.44 to -0.80; P<.001; I2=43%). The subgroup analysis showed that interventions delivered via apps (OR 0.55, 95% CI 0.37-0.83; P=.004; I2=44%), provided by obstetricians (OR 0.69, 95% CI 0.51-0.93; P=.02; I2=60%), and targeted at Asian populations (OR 0.44, 95% CI 0.34-0.58; P<.001; I2=0%) and that used the International Association of Diabetes and Pregnancy Study Groups diagnostic criteria (OR 0.58, 95% CI 0.39-0.86; P=.007; I2=69%) showed a statistically significant reduction in the risk of GDM. CONCLUSIONS: mHealth-based lifestyle interventions had a favorable impact on the prevention of GDM in pregnant women with overweight and obesity. Future studies need to further explore the potential of mHealth-based interventions for GDM through better design and more rigorous large-scale RCTs. TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42021286995; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=286995.

The readmission of a parturient with natural delivery after discharge due to residual fetal membrane: A case report.

RATIONALE: Placental residue is a relatively common and sophisticated disease among obstetric delivery complications. A failure to detect placental residue in time may cause poor outcomes such as postpartum hemorrhage and puerperal infection. PATIENT CONCERNS: We present the case of a 33-year-old full-term singleton parturient with placental residue. Upon precipitate labor and childbirth, the placenta and fetal membranes were examined to be intact. However, 1 day after discharge, she felt that there was discharge from the vagina and thus presented to our emergency department. DIAGNOSES: The patient was diagnosed with residual membranes and readmitted to the hospital for uterine curettage. INTERVENTION: Uterine curettage was performed under B-ultrasound guidance. OUTCOME: The patient was discharged smoothly without any postoperative complications. LESSONS: This paper can provide significant enlightenment for the prevention and early treatment of placental residue, including enhancing the risk awareness of high-risk patients, standardizing the process of clinical examination of the placenta, and early uterine contraction promotion to assist in the discharge of residual tissue, so as to reduce the occurrence of placental residue.

Chinese pregnant women's knowledge, attitude, and practice of self-protection against coronavirus disease 2019 during the post-pandemic period: A structural equation modeling-based survey.

This study aimed to investigate the Chinese pregnant women's levels of knowledge, attitude, and practice (KAP) of self-protection against coronavirus disease 2019 (COVID-19) during the post-pandemic period, to aid the development of targeted health education. An online questionnaire was conducted for 2156 Chinese pregnant women from October 1, 2021, to December 31, 2021, to collect socio-demographic and KAP information. Structural equation modeling (SEM) was used to determine self-protection-related factors. The mean age of the participants was 30 ± 4.1 years. SEM indicated that pregnant women's level of knowledge can directly and indirectly affect the practice of self-protection (r = 0.23) through their belief, with a correlation coefficient of 0.56 and 0.46 between knowledge and belief and belief and practice, respectively. The "basic protection" and "hospital visits after infection" exerted the greatest impact on knowledge formation, with correlation coefficients of 0.85 and 0.89, respectively. Attitude had a direct effect on practice with a correlation coefficient of 0.46. "Awareness of prevention and control" and "family and social support" had the greatest impact on belief formation, with correlation coefficients of 0.77 and 0.73, respectively. Pregnant Chinese women were generally familiar with COVID-19 knowledge, and their levels of knowledge and beliefs particularly affect the practice of self-protection. Health education aimed at improving pregnant women's knowledge and belief toward self-protection against COVID-19 may be an effective way to guide them toward positive practices and promote their health and that of their babies.

Knowledge, attitude and practice regarding occupational protection against COVID-19 among midwives in China: A nationwide cross-sectional study.

Midwives assume the roles in protecting perinatal women and newborns, meanwhile defending their own safety during the epidemic of COVID-19. Since there is currently no specific treatment available that targets the disease, strictly compliance with various infection prevention and control measures appears utmost important to achieve their occupational safety. We then explored the status quo and influencing factors of the knowledge, attitude and practice (KAP) of occupational protection against the COVID-19 among midwives in China. This online cross-sectional survey was conducted on 2663 midwives across the China during the early stages of the pandemic with a self-reported structured questionnaire. 97.4% and 92.9% of them were identified with positive attitude and appropriate practice, respectively, whereas only 6.4% showed good level of knowledge about the occupational protection toward the COVID-19. Midwives with older age, keeping on working during the breakout period, completing the training programs, caring the confirmed COVID-19 cases and having family members with cold-like symptoms were significantly associated with their KAP status. This study could provide valuable information not only for policy makers and administrators to optimize resource allocation and design education programs on targeted midwives, but also serve as a baseline for measuring changes in subsequent, post-intervention KAP studies.

Global distribution of soapberries (Sapindus L.) habitats under current and future climate scenarios.

Sapindus (Sapindus L.) is a widely distributed economically important tree genus that provides biodiesel, biomedical and biochemical products. However, with climate change, deforestation, and economic development, the diversity of Sapindus germplasms may face the risk of destruction. Therefore, utilising historical environmental data and future climate projections from the BCC-CSM2-MR global climate database, we simulated the current and future global distributions of suitable habitats for Sapindus using a Maximum Entropy (MaxEnt) model. The estimated ecological thresholds for critical environmental factors were: a minimum temperature of 0-20 °C in the coldest month, soil moisture levels of 40-140 mm, a mean temperature of 2-25 °C in the driest quarter, a mean temperature of 19-28 °C in the wettest quarter, and a soil pH of 5.6-7.6. The total suitable habitat area was 6059.97 × 104 km2, which was unevenly distributed across six continents. As greenhouse gas emissions increased over time, the area of suitable habitats contracted in lower latitudes and expanded in higher latitudes. Consequently, surveys and conservation should be prioritised in southern hemisphere areas which are in danger of becoming unsuitable. In contrast, other areas in northern and central America, China, and India can be used for conservation and large-scale cultivation in the future.

Psychological effects of the COVID-19 outbreak on nurses working in tertiary women's and children's hospitals from Sichuan, China: A cross-sectional study.

The evolving COVID-19 pandemic is placing unprecedented pressures on health systems. Accumulative studies suggest that nurses were more likely to develop negative psychiatric outcomes following a public health disaster than other medical staffs, due to their more frequent and closer contact with patients. We examined the psychological status of nurses working in the tertiary women's and children's hospitals in Sichuan, China, in order to explore the possible effect of the COVID-19. The cross-sectional survey was conducted at the peak period of COVID-19 among 1971 nurses. Their anxiety, depression and self-efficacy were assessed by the seven-item anxiety scale (GAD-7), the nine-item Patient Health Questionnaire (PHQ-9), and the General Self-efficacy Scale (GSES), respectively. 1934 valid questionnaires were returned with a response rate of 98.1%. We found that 29.3% and 22.7% of the nurses were identified with anxiety and depressive symptoms, respectively. The median score of GSES was 30, which was at the upper middle level among all populations. Nurses having longer working years and cold-like symptoms, those who were at work during breakout period and working in pediatric ward were significantly associated with the presence of anxiety and depression. Findings suggest that the epidemic of COVID-19 does not necessarily affect the psychological health of nurses working in women's and children's hospitals in Sichuan. The results of this study could serve as valuable suggestions to direct the promotion of psychological well-being among targeted nurses.