A satisfação da grávida com os cuidados das enfermeiras obstétricas durante a pandemia COVID-19 / Pregnant women's satisfaction with the care provided by nurse midwives during the COVID-19 pandemic / Satisfacción de las embarazadas con la atención de las enfermeras obstétricas durante la pandemia de COVID-19

Resumo Enquadramento: Em tempo de pandemia, as consultas de enfermagem de vigilância da gravidez sofreram alterações, nomeadamente na restrição de acompanhantes. Por esse motivo, é importante a avaliação da satisfação das grávidas com a assistência de enfermagem durante este contexto pandémico. Objetivo: Avaliar a satisfação da grávida com a assistência das enfermeiras obstétricas nas consultas de vigilância da gravidez durante o contexto de pandemia COVID-19. Metodologia: Estudo transversal descritivo de natureza quantitativa, com uma amostra de 196 grávidas. Aplicado a Escala de Satisfação dos Pacientes com a Assistência de Enfermagem (General Practice Nurse Satisfaction Scale - GPNS), constituída pelas dimensões: relacionamento interpessoal e comunicação, confiança, credibilidade e dedicação. Resultados: As grávidas apresentam-se em média mais satisfeitas na dimensão relacionamento interpessoal e comunicação e menos satisfeitas na dimensão dedicação. Conclusão: As grávidas apresentam-se satisfeitas com a assistência de enfermagem percecionando a sua importância. Tal reforça a pertinência das consultas serem realizadas por um Enfermeiro Especialista em Enfermagem de Saúde Materna e Obstétrica.

Abstract Background: Prenatal nursing appointments underwent changes during the COVID-19 pandemic, namely in the restriction of companions. For this reason, it is important to assess pregnant women's satisfaction with nursing care during this period. Objective: To assess pregnant women's satisfaction with nurse midwife-led prenatal appointments during the COVID-19 pandemic. Methodology: A qualitative descriptive cross-sectional study was conducted with a sample of 196 pregnant women. The Portuguese version of the General Practice Nurse Satisfaction Scale (Escala de Satisfação dos Pacientes com a Assistência de Enfermagem) was administered to the sample. The tool consists of the following dimensions: interpersonal relationship and communication, confidence, credibility, and dedication. Results: Pregnant women are, on average, more satisfied in the interpersonal relationship and communication dimension and less satisfied in the dedication dimension. Conclusion: Pregnant women are satisfied with nursing care and acknowledge its importance. This finding reinforces the importance of nurse midwife-led consultations.

Resumen Marco contextual: En tiempos de pandemia, las citas de enfermería para el seguimiento del embarazo cambiaron, sobre todo la restricción de acompañantes. Por esta razón, es importante evaluar la satisfacción de las mujeres embarazadas con los cuidados de enfermería durante este contexto pandémico. Objetivo: Evaluar la satisfacción de las mujeres embarazadas con la atención prestada por las enfermeras obstétricas en las consultas de seguimiento del embarazo durante la pandemia de COVID-19. Metodología: Estudio descriptivo transversal de carácter cuantitativo, con una muestra de 196 mujeres embarazadas. Se aplicó la Escala de Satisfacción de los Pacientes con Asistencia de Enfermería (General Practice Nurse Satisfaction Scale - GPNS), compuesta por las siguientes dimensiones: relaciones interpersonales y comunicación, confianza, credibilidad y dedicación. Resultados: Las mujeres embarazadas están, de media, más satisfechas en la dimensión relaciones interpersonales y comunicación, y menos satisfechas en la dimensión dedicación. Conclusión: Las embarazadas se mostraron satisfechas con los cuidados de enfermería y se dieron cuenta de su importancia. Esto refuerza la pertinencia de que las consultas sean realizadas por una enfermera especializada en Enfermería de Salud Materna y Obstétrica.

Assessment of prevalence of elevated blood lead levels and risk factors among children and pregnant women in Bihar, India.

BACKGROUND: While modeled estimates and studies in contaminated areas indicate high lead exposure among children in Bihar, India, local data on lead exposure in the child population is limited. OBJECTIVES: To characterize lead exposure, and assess potential sources of lead exposure among a state-representative sample of children and their pregnant mothers residing in Bihar. METHODS: Blood samples were collected from 697 children under five and 55 pregnant women from eight districts in Bihar. Blood lead levels were determined using capillary blood and a portable lead analyzer. Household demographics, home environment, behavior, and nutrition information were collected through computer-assisted personal interviews with primary caregivers. Logistic regression was used to assess associations between potential risk factors and elevated blood lead levels. RESULTS: More than 90% of children and 80% of pregnant women reported blood lead levels ≥ 5 µg/dL. Living near a lead-related industry and pica behavior of eating soil were significantly associated with increased odds of having elevated blood lead levels. Additional risk factors for having a blood level ≥5 µg/dL included the use of skin lightening cream (aOR = 5.11, 95%CI: 1.62, 16.16) and the use of eyeliners (aOR = 2.81, 95%CI: 1.14, 6.93). Having blood lead levels ≥ 10 µg/dL was also significantly associated with the household member who had an occupation or hobby involving the use of lead (aOR = 1.75, 95%CI: 1.13, 2.72). DISCUSSION: Elevated blood lead levels were prevalent among children and pregnant women in Bihar, indicating the urgent need for a comprehensive lead poisoning prevention strategy.

Association between thyroid autoimmunity and antinuclear antibody prevalence among pregnant women: a cross-sectional study in Qingdao, China.

Objective: To identify the relationship between thyroid autoimmunity and antinuclear antibody (ANA) prevalence in Chinese pregnant women. Methods: The study involved 1923 first-trimester women who were measured for thyroid stimulating hormone (TSH) level, thyroid autoantibodies (thyroperoxidase antibody [TPOAb] and thyroglobulin antibody [TgAb]) and ANA titer. Social demographic data were collected through standardized questionnaires. Results: In this study, 23.3% of pregnant women tested positive for TPOAb and 9.9% tested positive for TgAb. Women with a positive ANA were more likely to be TPOAb-positive or TgAb-positive than women with a negative ANA (adjusted odds ratio [AOR] 1.96, 95% confidence interval [CI] 1.47-2.62 for TPOAb [+]; AOR 3.12, 95% CI 2.18-4.48 for TgAb[+]). In addition, ANA titers were closely associated with thyroid autoimmunity. Women with an ANA titer of >1:320 had a significant higher risk of being TPOAb positive or TgAb positive (AOR 4.49, 95% CI 1.48-13.66 for TPOAb [+]; AOR 5.51, 95% CI 1.65-18.49 for TgAb [+]). The higher the ANA titer, the greater the risk of developing thyroid autoimmunity, especially for those with a high ANA titer. Conclusions: ANA positivity is strongly correlated with thyroid autoimmunity. Further study is warranted to clarify the causal relationship between thyroid autoimmunity and ANA in pregnant women.This research is essential to evaluate and predict the risk of co-existing autoimmune disorders,leading to improved care for pregnancy and neonatal health.

Longitudinal Analysis of One-Carbon Metabolism-Related Metabolites in Maternal and Cord Blood of Japanese Pregnant Women.

One-carbon metabolism (OCM) is a complex and interconnected network that undergoes drastic changes during pregnancy. In this study, we investigated the longitudinal distribution of OCM-related metabolites in maternal and cord blood and explored their relationships. Additionally, we conducted cross-sectional analyses to examine the interrelationships among these metabolites. This study included 146 healthy pregnant women who participated in the Chiba Study of Mother and Child Health. Maternal blood samples were collected during early pregnancy, late pregnancy, and delivery, along with cord blood samples. We analyzed 18 OCM-related metabolites in serum using stable isotope dilution liquid chromatography/tandem mass spectrometry. We found that serum S-adenosylmethionine (SAM) concentrations in maternal blood remained stable throughout pregnancy. Conversely, S-adenosylhomocysteine (SAH) concentrations increased, and the total homocysteine/total cysteine ratio significantly increased with advancing gestational age. The betaine/dimethylglycine ratio was negatively correlated with total homocysteine in maternal blood for all sampling periods, and this correlation strengthened with advances in gestational age. Most OCM-related metabolites measured in this study showed significant positive correlations between maternal blood at delivery and cord blood. These findings suggest that maternal OCM status may impact fetal development and indicate the need for comprehensive and longitudinal evaluations of OCM during pregnancy.

Healthcare Professionals' Beliefs and Views towards Exercise during Pregnancy: A Cross-Sectional Study in Greece.

BACKGROUND: Healthcare professionals appear to play a key role in shaping pregnant women's views and attitudes towards lifestyle issues, such as exercise. The aim of this study is to investigate the views and beliefs of Greek midwives and obstetricians regarding exercise during pregnancy. METHODS: This is a cross-sectional study conducted during the period of January 2022-March 2023. For this study, 237 Greek midwives and obstetricians employed in healthcare settings in Attica, Greece completed an anonymous and self-report questionnaire. Four different/independent models of multivariate analyses of variance were conducted. RESULTS: The vast majority of these healthcare professionals (88.6%) believed that exercise during pregnancy is generally beneficial. According to the multivariate analyses, healthcare professionals with postgraduate/doctoral studies were more likely to believe that (a) exercise is generally beneficial (p = 0.03), (b) pregnant women should be informed about it (p = 0.028), (c) informing pregnant women is necessary/useful (p = 0.023), and (d) pregnant women showed interest in it (p = 0.034). Also, freelance midwives were more likely to believe that pregnant women should be informed about exercise (p = 0.006), and that they showed interest in it (p = 0.034). In addition, (a) freelance midwives (p = 0.050), and those who had experience in antenatal counselling (p = 0.037), as well as (b) obstetricians who were largely experienced in monitoring normal pregnancies (p = 0.001), were less likely to associate exercise during pregnancy with the occurrence of placental abruption. CONCLUSION: Alongside healthcare professionals' educational level, their professional setting and professional experience emerge as key factors and need to be considered when designing innovative interventions to support exercise during pregnancy.

Prevalence of Human Toxoplasmosis in Spain Throughout the Three Last Decades (1993-2023): A Systematic Review and Meta-analysis.

Humans are infected by Toxoplasma gondii worldwide and its consequences may seriously affect an immune deprived population such as HIV and transplanted patients or pregnant women and foetuses. A deep knowledge of toxoplasmosis seroprevalence in Spain is needed in order to better shape health policies and educational programs. We present the results of the first systematic review and meta-analysis on the human prevalence for this disease in Spain. Databases (PubMed, Web of Science, SCOPUS and Teseo) were searched for relevant studies that were published between January 1993 and December 2023 and all population-based cross-sectional and longitudinal studies reporting the human seroprevalence in Spain were revised. Within the population analysed, our targeted groups were immunocompetent population, pregnant women and immunocompromised patients. Among 572 studies and 35 doctoral theses retrieved, 15 studies and three doctoral theses were included in the meta-analysis. A random effects model was used for the meta-analyses due to the high heterogeneity found between studies (I2: 99.97), since it is a statistically conservative model, in addition to allowing better external validity. The global pooled seroprevalence was 32.3% (95% CI 28.7-36.2%). Most of the studies carried out were in pregnant women and the meta-analysis reported that the pooled seroprevalence of toxoplasmosis in pregnant women in Spain was 24.4% (24,737/85,703, 95% CI 21.2-28.0%), based on the random effects model. It is recommended to continue monitoring the seroprevalence status of T. gondii in order to obtain essential guidelines for the prevention and control of the infection in the population.

Awareness of postpartum depression among midwives and pregnant women in Arkhangelsk, Arctic Russia.

BACKGROUND: Postpartum depression (PPD) affects approximately 17% of the women worldwide with nearly half of all cases going undetected. More research on maternal mental health, particularly among healthcare professionals and pregnant mothers, could help identify PPD risks and reduce its prevalence. OBJECTIVE: Given that awareness of PPD is a crucial preventive factor, we studied PPD awareness among midwives and pregnant women in Arkhangelsk, Arctic Russia. METHODS: A qualitative study was conducted using in-depth semi-structured interviews. Midwives and pregnant women were recruited from the women's clinic of the Arkhangelsk municipal polyclinic. Seven midwives and 12 pregnant mothers were interviewed. RESULTS: Midwives described limited time for psychological counselling of pregnant women; they reported that their primary focus was on the physiological well-being of women. Pregnant women have expressed a desire for their families to share responsibilities. The participants considered PPD as a mix of psychological and physiological symptoms, and they also highlighted a discrepancy between the expectations of pregnant women and the reality of motherhood. The present study underscored the limited understanding of PPD identification. CONCLUSIONS: The findings suggest that there is a need for increased awareness among midwives and pregnant women regarding PPD. Prevention programs targeting PPD with a specific emphasis on enhancing maternal mental health knowledge are warranted.

Main findings: Pregnant women and midwives in an Arctic Russian setting have low awareness of postpartum depression.Added knowledge: Improved awareness among pregnant women and midwives about the mental health of women after childbirth, educating pregnant women about symptoms of postpartum depression, encourage them to express their needs and collaboration with family supporters may help to reduce postpartum depression burden.Global health impact for policy and action: Updated campaigns and prevention programs with the focus on increasing the knowledge on mental health among pregnant women and health personnel may be effective support for Primary health care.

A descriptive epidemiology in syphilis in Tokyo, 2019-2022.

The number of syphilis cases in Tokyo has been found to increase in recent years. We conducted a descriptive epidemiology to elucidate the actual status of syphilis. Data on age, sex, disease stage, and presumed sexual partner of syphilis cases reported in Tokyo were tabulated and analyzed. A total of 9,419 syphilis cases have been reported between 2019 and 2022. There was a particularly sharp rise in the number of reported cases from 2021 to 2022. Comparing 2020 to 2022, the number of syphilis cases among women in their 20s, rapidly increased, more than triple. Furthermore, the number of pregnant women among syphilis cases increased in 2022. Despite the rapid increase in the number of young women with syphilis, there has been no increase in cases of congenital syphilis. One of the reasons may be that syphilis was detected early in pregnancy due to the high antenatal checkup rate in Tokyo. However, the continued incidence of syphilis among young women may increase congenital syphilis in the future. Public health strategy should include educational activities targeting high-risk populations or adolescents, early and appropriate testing, and treatment for preventing progression of syphilis.

Machine learning predicts the serum PFOA and PFOS levels in pregnant women: Enhancement of fatty acid status on model performance.

Human exposure to per- and polyfluoroalkyl substances (PFASs) has received considerable attention, particularly in pregnant women because of their dramatic changes in physiological status and dietary patterns. Predicting internal PFAS exposure in pregnant women, based on external and relevant parameters, has not been investigated. Here, machine learning (ML) models were developed to predict the serum concentrations of PFOA and PFOS in a large population of 588 pregnant participants. Dietary exposure characteristics, demographic parameters, and in particular, serum fatty acid (FA) data were used for the model development. The fitting results showed that the inclusion of FAs as covariates significantly improved the performance of the ML models, with the random forest (RF) model having the best predictive performance for PFOA (R2 = 0.33, MAE = 1.51 ng/mL, and RMSE = 1.89 ng/mL) and PFOS (R2 = 0.12, MAE = 2.65 ng/mL, and RMSE = 3.37 ng/mL). The feature importance analysis revealed that serum FAs greatly affected PFOA concentration in the pregnant women, with saturated FAs being associated with decreased PFOA levels and unsaturated FAs with increased levels. Comparison with one-compartment pharmacokinetic model further demonstrated the advantage of the ML models in predicting PFAS exposure in pregnant women. Our models correlate for the first time blood chemical concentrations with human FA status using ML, introducing a novel perspective on predicting PFAS levels in pregnant women. This study provides valuable insights concerning internal exposure of PFASs generated from external exposure, and contributes to risk assessment and management in pregnant populations.

Iron deficiency anemia status in Iranian pregnant women and children: an umbrella systematic review and meta-analysis.

BACKGROUND: Iron deficiency anemia (IDA) is a global health challenge, especially affecting females and children. We aimed to conduct an umbrella systematic review of available evidence on IDA's prevalence in Iranian pregnant women and children. METHODS: We searched the Web of Science, Science Direct, PubMed, Scopus, and Google Scholar databases for articles published by April 2023. Meta-analyses investigating the status of IDA in Iran were included. The findings of seven meta-analyses comprising 189,627 pregnant women with a mean age of 26 and 5,890 children under six years old were included in this study. The methodological quality of each study was evaluated with the Assessment of Multiple Systematic Reviews (AMSTAR2) instrument. RESULTS: We estimated the prevalence of IDA at 15.71% in pregnant women and 19.91% in young children. According to our subgroup analysis of pregnant women, IDA's prevalence in urban and rural regions was 16.32% and 12.75%; in the eastern, western, central, southern, and northern regions of Iran, it was estimated at 17.8%, 7.97%, 19.97%, 13.45%, and 17.82%, respectively. CONCLUSION: IDA is common in young children and pregnant females and is a significant public health concern in Iran. The present umbrella review results estimated that Iran is in the mild level of IDA prevalence based on WHO classification. However, due to sanctions and high inflation in Iran, the prevalence of anemia is expected to increase in recent years. Multi-sectoral efforts are required to improve the iron status of these populations and reduce the burden of IDA in the country.

Network analysis of posttraumatic stress and posttraumatic growth symptoms among women in subsequent pregnancies following pregnancy loss.

BACKGROUND: Pregnant women who have undergone pregnancy loss often display both posttraumatic stress (PTS) and posttraumatic growth (PTG). However, the precise relationship and structure of symptomatic levels of PTS and PTG have not been well understood. This study aimed to assess the associations between PTS and PTG symptoms in women during subsequent pregnancies following a previous pregnancy loss. METHODS: A total of 406 pregnant women with a history of pregnancy loss were included in this study. The Impact of Events Scale-6 (IES-6) and the Posttraumatic Growth Inventory Short Form (PTGI-SF) were used to assess symptoms of PTS and PTG, respectively. The Graphical Gaussian Model was employed to estimate the network model. Central symptoms and bridge symptoms were identified based on "expected influence" and "bridge expected influence" indices, respectively. The stability and accuracy of the network were examined using the case-dropping procedure and nonparametric bootstrapped procedure. RESULTS: The network analysis identified PTG3 ("Ability to do better things") as the most central symptom, followed by PTS3 ("Avoidance of thoughts") and PTG6 ("New path for life") in the sample. Additionally, PTS3 ("Avoidance of thoughts") and PTG9 ("Perception of greater personal strength") were bridge symptoms linking PTS and PTG clusters. The network structure was robust in stability and accuracy tests. CONCLUSIONS: Interventions targeting the central symptoms identified, along with key bridge symptoms, have the potential to alleviate the severity of PTS experienced by women with a history of pregnancy loss and promote their personal growth.

Petersen's Hernia in a Pregnant Woman Following Roux-en-Y Gastric Bypass Surgery: The Importance of Emergency Surgical Treatment.

Roux-en-Y gastric bypass (RYGB) patients are at risk of creating potential spaces for possible internal hernias during the procedure. During pregnancy, the pregnant uterus elevates the bowel, increasing intra-abdominal pressure. Cases reported to date have described mild abdominal pain and no evidence of peritoneal irritation, with inconclusive ultrasound and MRI findings for diagnosis of Petersen's hernia. We present the case of a 42-year-old female patient with a history of RYGB eight years earlier without complications, with a pregnancy of 34 weeks of gestation. Symptomatology began with colicky abdominal pain in the epigastric, with irradiation to the right upper quadrant. On physical examination, revealed a painful abdomen on the median and deep palpation in the epigastric and right upper quadrant, the rest of the studies were inconclusive. As there was no improvement of the symptoms in 12 hours, an emergency diagnostic laparoscopy was performed, finding a strangulated Petersen's hernia requiring resection, with the closure of the gastric pouch, intestinal anastomosis, and Stamm gastrostomy with closure of the mesenteric gap. Therefore, a pregnant patient presenting with upper quadrant abdominal pain with a history of RYGB, even one with normal labs and imaging, should be assumed to have an internal hernia until proven otherwise. The emergency surgical approach is associated with early resolution and prevents its progression with catastrophic results.

Exploring the relationships between pre-pregnancy BMI, gestational weight gain, and nutritional intake: a real-world investigation in Shandong, China.

This study investigated the associations between gestational weight gain (GWG), pre-pregnancy body mass index (BMI), and prenatal diet quality in pregnant women from Shandong, China. We analyzed a sample of 532 early-stage pregnant women registered at an outpatient clinic. Diet quality was evaluated using the Chinese Healthy Dietary Index for Pregnancy (CHDI-P), encompassing three dimensions: diversity, adequacy, and limitation, with an overall score out of 100. Dietary intake was documented via 24-h dietary recalls spanning three consecutive days and subsequently translated to a CHDI-P score. At the time of enrollment, BMI was measured on-site and classified as underweight (<18.5), normal weight (18.5-24.9), overweight (25.0-29.9), and obese (≥30.0). Pregnant women were also categorized into inadequate, adequate, and excessive weight gain groups based on their GWG. We employed a Tukey-adjusted generalized linear model to compare the CHDI-P scores between the pre-pregnancy BMI groups and GWG groups. The results revealed that the underweight group had significantly higher total scores and limitation total scores on the CHDI-P (p < 0.001). Conversely, the overweight and obese groups were more susceptible to suboptimal dietary quality. Notably, the inadequate weight gain group displayed significantly elevated food adequacy scores compared to the other two groups (p < 0.05). This indicates that greater GWGs do not necessarily align with principles of adequate nutrition.

Influence of the COVID-19 Outbreak in Vulnerable Patients (Pediatric Patients, Pregnant Women, and Elderly Patients) on an Emergency Medical Service System: A Pre- and Post-COVID-19 Pandemic Comparative Study Using the Population-Based ORION Registry.

Background and Objective: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread all over the world. To assess the influence of the COVID-19 pandemic on emergency medical services (EMS) for vulnerable patients transported by ambulance. Materials and Methods: This study was a retrospective, descriptive study with a study period from 1 January 2019 to 31 December 2021 using the Osaka Emergency Information Research Intelligent Operation Network (ORION) system. We included all pediatric patients, pregnant women, and elderly patients ≥ 65 years of age transported by ambulance in Osaka Prefecture. The main outcome of this study was difficult-to-transport cases. We calculated the rate of difficult-to-transport cases under several conditions. Results: For the two year-long periods of 1 January 2019 to 31 December 2019 and 1 January 2021 to 31 December 2021, a total of 887,647 patients were transported to hospital by ambulance in Osaka Prefecture. The total number of vulnerable patients was 579,815 (304,882 in 2019 and 274,933 in 2021). Multivariate logistic regression analysis showed that difficult-to-transport cases were significantly more frequent in 2021 than in 2019. Difficult-to-transport cases were significantly less frequent in the vulnerable population than in the non-vulnerable population (adjusted odds ratio 0.81, 95% confidence interval 0.80-0.83; p < 0.001). Conclusion: During the pandemic (2021), difficult-to-transport cases were more frequent compared to before the pandemic (2019); however, vulnerable patients were not the cause of difficulties in obtaining hospital acceptance for transport.

[Knowledge, attitudes and practices in oral health of breastfeeding women]. / Connaissances, attitudes et pratiques en santé orale des femmes allaitantes.

The benefits of breastfeeding on the health of infants and mothers are no longer in doubt. On the other hand, the advantages in terms of maxillofacial development and the risks of prolonged breastfeeding on oral health are much less discussed. An exploratory qualitative study, carried out within the pediatric dentistry functional unit of the dental care service of the Lille University Hospital Center in 2022, aimed to analyze the knowledge, attitudes and practices in oral health of breastfeeding women. This article will discuss the gaps in prevention as well as the obstacles and levers to improving care.

Associations of COVID-19 lockdown with birth weight in China.

Background: During the special period of the global spread of COVID-19, pregnant women are sensitive groups to the impacts of COVID-19 epidemic. However, the effects of lockdown measures implemented in response to the COVID-19 on fetal birthweight remain unclear. Objectives: This study investigated the associations of COVID-19 lockdown with birth weight in Chinese population. Methods: We collected 730,153 data of participants from hospitals of five cities in the south of China, we defined the time period of level I response (1/23-2/24/2020) as level I lockdown, and women who were pregnant during level I lockdown as the exposure group. Women who were pregnant during the same calendar month from 2015 to 2019 were defined as the unexposed group. We quantitatively estimate the individual cumulative exposure dose by giving different weights to days with different emergency response levels. Generalized linear regression models were used to estimate the association between COVID-19 lockdown exposure with birth weight and risk of low birth weight (<2,500 g) and macrosomia (>4,000 g). Results: The birth weight of the exposed group is heavier than the unexposed group (3,238.52 vs. 3,224.11 g: adjusted ß = 24.39 g [95% CI: 21.88, 26.91 g]). The exposed group had a higher risk of macrosomia (2.8% vs. 2.6%; adjusted OR = 1.17 [95% CI: 1.12, 1.22]). More obvious associations were found between COVID-19 lockdown and macrosomia in women who experienced the lockdown in their early pregnancy. Women who experienced the lockdown at their 4-7 weeks of pregnancy showed statistically significant heavier birth weight than unexposed group (after adjustment): ß = 1.28 (95% CI: 1.11, 1.46) g. We also observed a positive association between cumulative exposure dose of COVID-19 lockdown in all pregnant women and birth weight, after divided into four groups, Q1: ß = 32.95 (95% CI: 28.16, 37.75) g; Q2: ß = 18.88 (95% CI: 14.12, 23.64) g; Q3: ß = 19.50 (95% CI: 14.73, 24.28) g; Q4: ß = 21.82 (95% CI: 17.08, 26.56) g. However, there was no statistically significant difference in the risk of low birth weight between exposed and unexposed groups. Conclusions: The COVID-19 lockdown measures were associated with a heavier birth weight and a higher risk of macrosomia. Early pregnancy periods may be a more susceptible exposure window for a heavier birth weight and a higher risk of macrosomia. We also observed a positive association between cumulative exposure dose of COVID-19 lockdown and birth weight. The government and health institutions should pay attention to the long-term health of the infants born during the COVID-19 lockdown period, and follow up these mothers and infants is necessary.

Evaluation of cesarean delivery rates and factors associated with cesarean delivery among women enrolled in a pregnancy cohort study at two tertiary hospitals in Thailand.

BACKGROUND: Cesarean delivery rates have increased globally resulting in a public health concern. We estimate rates of cesarean deliveries among Thai women using the World Health Organization (WHO) Robson Classification system and compare rates by Robson group to the Robson guideline for acceptable rates to identify groups that might benefit most from interventions for rate reduction. METHODS: In 2017 and 2018, we established cohorts of pregnant women aged ≥ 18 years seeking prenatal care at two tertiary Thai hospitals and followed them until 6-8 weeks postpartum. Three in-person interviews (enrollment, end of pregnancy, and postpartum) were conducted using structured questionnaires to obtain demographic characteristics, health history, and delivery information. Cesarean delivery indication was classified based on core obstetric variables (parity, previous cesarean delivery, number of fetuses, fetal presentation, gestational week, and onset of labor) assigned to 10 groups according to the Robson Classification. Logistic regression was used to identify factors associated with cesarean delivery among nulliparous women with singleton, cephalic, term pregnancies. RESULTS: Of 2,137 participants, 970 (45%) had cesarean deliveries. The median maternal age at delivery was 29 years (interquartile range, 25-35); 271 (13%) participants had existing medical conditions; and 446 (21%) had pregnancy complications. The cesarean delivery rate varied by Robson group. Multiparous women with > 1 previous uterine scar, with a single cephalic pregnancy, ≥ 37 weeks gestation (group 5) contributed the most (14%) to the overall cesarean rate, whereas those with a single pregnancy with a transverse or oblique lie, including women with previous uterine scars (group 9) contributed the least (< 1%). Factors independently associated with cesarean delivery included age ≥ 25 years, pre-pregnancy obesity, new/worsen medical condition during pregnancy, fetal distress, abnormal labor, infant size for gestational age ≥ 50th percentiles, and self-pay for delivery fees. Women with existing blood conditions were less likely to have cesarean delivery. CONCLUSIONS: Almost one in two pregnancies among women in our cohorts resulted in cesarean deliveries. Compared to WHO guidelines, cesarean delivery rates were elevated in selected Robson groups indicating that tailored interventions to minimize non-clinically indicated cesarean delivery for specific groups of pregnancies may be warranted.

Associação do comportamento alimentar com o estado nutricional de gestantes de alto risco internadas em um centro de referência no nordeste / Association of eating behavior with the nutritional status of high-riskpregnant women admitted to a reference center in the Northeast

Introduction: Pregnancy is a period of physical and physiological changes that progresses without complications when free from factors that can compromise maternal and fetal health. Diabetes mellitus, high blood pressure, obesity and inadequate weight gain are the most common causes of gestational risk, and these can be strongly associated with the nutritional status, eating habits and behavior of the pregnant woman. Objective: To describe and associate eating behavior with the nutritional status of high-risk pregnant women admitted to a reference center in the Northeast. Materials and methods: This is a cross-sectional study carried out with patients admitted to high-risk wards at the Instituto de Medicina Integral Prof. Fernando Figueira – IMIP (Recife-PE), anthropometric data and data related to eating behavior were collected (TEMS instrument). Results: Around 56,4% of pregnant women had a prepregnancy BMI classified as overweight or obese, with only 16% classified as underweight. The evaluation of the evolution of weight gain demonstrated that 66.4% had insufficient weight gain, while 12,8% had high gestational weight gain. Discussion: When analyzing eating behavior through the TEMS instrument, the relationship of giving a good image when eating had a significant value (p < 0,05) as well as considerations of choosing healthy foods and related to obtaining energy are directly associated with the current BMI, therefore, note- It is clear that emotional, social, physiological and economic factors influence the choice of food. Conclusion: The high prevalence of overweight and obesity found in this population demonstrates the influence of eating behavior on nutritional status. Reinforcing the importance of preventive measures to identify risk factors and obtain adequate nutritional monitoring during pregnancy with the aim of reducing damage to health and promoting autonomy to make more appropriate and healthy food choices.(AU)

Introdução: A gestação é um período de mudanças físi-cas e fisiológicas que evolui sem complicações quando isentade fatores que podem acarretar no comprometimento dasaúde materna e fetal. O diabetes mellitus, hipertensão arte-rial, obesidade, ganho de peso inadequado são as mais fre-quentes causadoras do risco gestacional, podendo estas serfortemente associadas com o estado nutricional, hábito ecomportamento alimentar da gestante. Objetivo: Descrever e associar o comportamento alimen-tar com o estado nutricional de gestantes de alto risco inter-nadas em um centro de referência no Nordeste. Materiais e métodos: Trata-se de um estudo do tipotransversal realizado com pacientes internadas nas enferma-rias de alto risco do Instituto de Medicina Integral Prof.Fernando Figueira – IMIP (Recife- PE), foram coletados dadosantropométricos, dados relacionados ao comportamento ali-mentar (instrumento TEMS). Resultados: Cerca de 56,4% das gestantes tinham IMCpré-gestacional classificados em sobrepeso ou obesidade sendo apenas 16% classificadas como baixo peso. A avalia-ção da evolução do ganho ponderal demonstrou que 66,4%apresentaram um ganho de peso insuficiente, enquanto12,8% tiveram um ganho de peso gestacional elevado. Discussão: Ao analisar o comportamento alimentar atravésdo instrumento TEMS, a relação de passar uma boa imagemao se alimentar teve valor significativo (p < 0,05) bem comoconsiderações de escolher alimentos saudáveis e relacionadosa obter energia estão diretamente associados com o IMCatual, assim sendo, nota-se que fatores emocionais, sociais, fi-siológicos, econômicos influenciam na escolha dos alimentos. Conclusão: A elevada prevalência do excesso de peso eobesidade encontrada nessa população demonstra a influência do comportamento alimentar no estado nutricional.Reforçando a importância de medidas preventivas para identificar fatores de risco e obter um acompanhamento nutricio-nal adequado durante a gestação com...(AU)

Effects of the combination of exercise and education in the treatment of low back and/or pelvic pain in pregnant women: Systematic review and meta-analysis.

BACKGROUND: Lumbopelvic pain is considered the most frequent complication during pregnancy. OBJECTIVE: To compare whether the combination of exercise with education is more effective for the treatment of low back and/or pelvic pain (PP) than each of these interventions separately in pregnant women. SEARCH STRATEGY: A systematic review was performed in WOS, PEDro, PubMed, Cochrane, and ClinicalTrials.gov. The terms used were low back pain, PP, pregnancy, pregnant woman, exercise, exercise therapy, health education, and prenatal education. SELECTION CRITERIA: The PICO question was then chosen as follows: P-population: pregnant women with nonspecific low back pain or PP; I-intervention: exercise therapy plus health education; C-control: only exercise therapy or only health education; O-outcome: characteristics of pain, disability, and kinesophobia; S-study designs: randomized controlled trial. DATA COLLECTION AND ANALYSIS: Two reviewers independently screened articles for eligibility. The following inclusion criteria were applied for the selection of studies: (i) published in the past 10 years; (ii) exercise plus health education was administered compared with a group receiving either exercise or education alone; and (iii) the sample consisted of pregnant women with nonspecific low back pain or PP. This review excluded: (i) nonrandomized controlled trials; and (ii) articles whose full text was not available. The meta-analysis was performed using the random-effects model, due to the observed heterogeneity. MAIN RESULTS: A total of 13 articles were selected. There is a significant decrease in pain in the combination of exercise and education compared with education alone (standardized mean difference, -0.29 [95% confidence interval, -0.47 to -0.11]). With respect to disability, there is a significant decrease in the exercise and education group compared with the group that only addressed education (standardized mean difference, -0.37 [95% CI, -0.60 to -0.14]). One article analyzed kinesophobia, reporting no significant changes. CONCLUSION: The combination of exercise and education seems to be more effective in reducing pain and disability in pregnant women with low back and/or PP than the use of education alone. In kinesophobia, the results found are not significant.

Consumption of Acetaminophen During Pregnancy: A Survey on Knowledge, Attitudes and Practices of Lebanese Women.

OBJECTIVES: Use of acetamoniphen (paracetamol or N-acetyl-para-aminophenol [APAP]) during pregnancy is considered safe; however certain practices have been related to the risk of developing neurodevelopmental disorders in offspring. Therefore, the present study aimed to assess women's knowledge, attitudes and practices (KAP) towards the use APAP during pregnancy and its associated factors. METHODS: This cross-sectional study was conducted between May 15 and August 31, 2020, among pregnant Lebanese women and those who had given birth in the last 12 months. Online self-administered questionnaire was used for data collection. KAP were described and a knowledge score was generated. Multivariable linear models were used to test the association of participants' sociodemographic characteristics with their knowledge and practices related to the use of APAP. RESULTS: Out of 305 participants, 72.8% had moderate knowledge about the use of APAP during pregnancy. Actually, more than 50% of them were unable to differentiate between APAP and other pain medications, determine the maximum recommended daily dose, specify the minimum time to wait between doses and identify potential effects of APAP on both mother and unborn child. A higher level of education was associated with a higher knowledge score (ß = 2.32, 95%CI=[0.91; 3.73]; p = 0.001). Moreover, women had positive attitudes towards APAP use, perceiving a low risk of toxicity. Indeed, 70.5% of women used APAP at least once during their pregnancy, with 63.7% using it safely. Women with higher knowledge, experiencing at least five somatic symptoms and having a low socioeconomic level tended to be more APAP users (p < 0.05). CONCLUSIONS FOR PRACTICE: Health professionals have the responsibility to give adequate and personalized advice to women regarding their medicines.