Early Pregnancy Serum Metabolite Profiles Associated with Hypertensive Disorders of Pregnancy in African American Women: A Pilot StudyRead the full article
Journal of Pregnancy publishes original research articles, review articles, and clinical studies related to all aspects of pregnancy and childbirth. Topics include biomedical aspects of pregnancy labour, maternal health and breastfeeding.
Journal of Pregnancy maintains an Editorial Board of practicing researchers from around the world, to ensure manuscripts are handled by editors who are experts in the field of study.
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Solving the Obstetrical Paradox: The FETAL Technique—A Step toward Noninvasive Evaluation of Fetal pH
Every year, about 85 percent of the approximately 5 million births in North America are evaluated with the electronic fetal monitoring (EFM). Clinicians use the EFM as a proxy to assess fetal oxygenation status, fetal well-being, and potential compromise. Despite the widespread use of this technology, neonatal hypoxia and acidosis continue to make up a high proportion of neonatal morbidity at term. Indeed, though the fetal heart rhythm is inextricably linked to fetal acid-base status, EFM has not been shown to reliably predict neonatal pH status nor has it reduced adverse maternal or neonatal outcomes. As a consequence, the high false-positive rate of EFM for predicting adverse neonatal outcomes has led to an increase in the rate of operative vaginal and cesarean delivery, with elevated rates of associated maternal and neonatal morbidity. This fact invariably leads to a paradox we have henceforth defined as the “obstetrical paradox.” Herein, we explore the potential solutions to this paradox and introduce a novel noninvasive technique to assess fetal acid-base status in utero known as the “FETAL technique” (Fourier Evaluation of Tracings and Acidosis in Labour). The FETAL technique, currently under investigation, applies the discrete Fourier transformation to EFM tracings to determine the spectral frequency distribution of the fetal heart rate. These specific frequency distributions correlate with specific umbilical pH values and may provide the missing link between fetal heat rate patterns and acid-base status at birth. As we work toward realizing the full potential benefits of EFM, finding the best assessment strategies to evaluate fetal pH in real time remains a key goal in obstetrics.
Quality of Prenatal Care and Associated Factors among Pregnant Women at Public Health Facilities of Wogera District, Northwest Ethiopia
Background. Prenatal care refers to services a pregnant woman receives during pregnancy to ensure a healthy outcome for herself and her newborn. However, only limited studies have so far been done to assess the quality of prenatal care in the study area. Thus, this study is aimed at assessing the quality of prenatal care and associated factors at public health facilities in Wogera district, northwest Ethiopia. Methods. An institution-based cross-sectional study was conducted in Wogera district from March to April 2019. A total of 465 pregnant women were interviewed using a semi-structured interviewer-administered questionnaire; consecutive sampling was used to select the participants. The binary logistic regression analysis model was fitted to identify the potential predictor variables. Variables with <0.2 values were fitted into the multivariable logistic regression analysis model; <0.05 values and an adjusted odds ratio (AOR) with a 95% confidence interval (CI) were used to declare factors associated with the quality of prenatal care. Results. The overall quality of prenatal care was 32.7% (95% CI: 28.1, 37.2). Four or more prenatal care visits (; 95% CI: 1.2, 4.7), high maternal education (; 95% CI: 1.03, 7.93), over USD 175.5 monthly household income (; 95% CI: 1.1, 7.8), and the availability of maternity waiting areas (; 95% CI: 1.2, 5.0) were positively associated with the quality of the care. Conclusion. The overall quality of prenatal care in this study was low. Therefore, promoting focused prenatal care and increasing infrastructure, encouraging maternal education, and compensating for the healthcare costs for women with low household income might enhance the quality of the care.
Early Pregnancy Screening for Women at High-Risk of GDM Results in Reduced Neonatal Morbidity and Similar Maternal Outcomes to Routine Screening
The Australasian Diabetes in Pregnancy Society recommends screening high-risk women for gestational diabetes mellitus (GDM) before 24 weeks gestation, under the assumption that an earlier diagnosis and opportunity to achieve normoglycemia will minimize adverse outcomes. However, little evidence exists for this recommendation. The study objective was to compare the pregnancy outcomes of high-risk women diagnosed with GDM before 24 weeks gestation and routinely diagnosed women after 24 weeks gestation. A retrospective audit was conducted of all pregnancies diagnosed with GDM using International Association of Diabetes and Pregnancy Study Groups criteria over 12 months at a tertiary Australian hospital. Adverse perinatal outcomes were compared between “Early GDM” diagnosed before 24 weeks () and “Late GDM” diagnosed from 24 weeks (). Early GDM had a significantly lower newborn composite outcome frequency (hypoglycemia, birth trauma, NICU/SCN admission, stillbirth, neonatal death, respiratory distress, and phototherapy) compared to Late GDM (20.3% vs. 30.0%, ). Primary cesarean, hypertensive disorders, postpartum hemorrhage, birthweight >90th percentile, macrosomia, and preterm birth frequencies were not significantly different between groups. Therefore, high-risk women diagnosed with GDM in early pregnancy were not more likely to have an adverse outcome compared to routinely diagnosed women. As they are a high-risk group, this may indicate a possible benefit to the early diagnosis of GDM.
Sociodemographic Factors Associated with Women’s Perspectives on Male Involvement in Antenatal Care, Labour, and Childbirth
Background. Evidence suggests that in patriarchal societies such as Ghana, access to and survival of maternal and child healthcare services require the active involvement of men. However, interventions to promote men’s involvement in maternal and child health care are less likely to succeed if the views and concerns of women are not considered. This study provides an understanding of women’s perspective on men’s involvement in antenatal care, labour, and childbirth in the Northern Region of Ghana. Methods. Data for this cross‐sectional study were collected from 300 pregnant women using a structured questionnaire. Logistic regression models were then used to determine the socio‐demographic factors associated with women’s perspectives on men’s involvement in antenatal care, labour, and childbirth. Results. The mean age of the participants was 28 (SD = 5.21) years. More than four-fifths of the women in this study express the desire for male partner involment in natenatal care (ANC) services (n = 258, 86%) and as companions during labour and child birth (n = 254, 84.7%). We found that married women were 9.8 times more likely (95%CI 1.59, 60.81) to encourage male involvement in ANC compared to women who were unmarried. The probability of encouraging male involvement in ANC decreased with increased level of education among the women while support for male companionship during childbirth increased significantly with an increased level of education. After accounting for the effect of other significant covariates, there was good evidence to suggest that married women (p = 0.002), women with only primary/Junior High School education (p = 0.048) and those with two (p = 0.010), three (p = 0.008), or ≥4 (p = 0.044) previous pregnancies had a desire for male partner involvement in ANC while women who attained secondary (p = 0.004) or tertiary (p = 0.001) level education expressed the desire for male companionship in labour and childbirth in the adjusted model. Conclusion. Male involvement in antenatal care, labour, and childbirth received overwhelming support from the women in this study.
Factors Associated with Apgar Score among Newborns Delivered by Cesarean Sections at Gandhi Memorial Hospital, Addis Ababa
Background. Newborns can be assessed clinically using the Apgar score test to quickly and summarily assess the health of newborn physical condition immediately after delivery and to determine any immediate need for extra medical or emergency care. This study is aimed at assessing factors associated with Apgar score among newborns delivered by cesarean sections and factors associated with Apgar score. Method. Institutional-based cohort study design was conducted. All eligible study participants were included. Training was given for data collectors and supervisors. Regular supervision and follow-up was made. Data was entered into Epi Info version 7 computer software by investigators and was transported to SPSS version 20 computer program for analysis. Bivariate and multivariate analysis was used to identify factors associated with Apgar score. Result. A total 354 newborn babies were included into the study. Majority of baby had low Apgar score at one minute and high Apgar score at five minutes. About 30.2% of newborn baby had Apgar score below seven minutes. On the other hand, about 12.8% of all newborns had low Apgar score at five minutes. It had been found that those neonates who were born when skin incision to delivery time is greater than three minutes were about fourfolds more likely to have low Apgar score than those who were born when skin incision to delivery time is less than three minutes (AOR 3.645) (95% CI (0.116-26.421)). Conclusion. Newborn babies have a low Apgar score at one minute as compared to five minutes. But low Apgar score at five minutes has long-term sequel. Therefore, it is very important to reduce factors associated with low Apgar score at both minutes.
Neonatal and Maternal Complications of Placenta Praevia and Its Risk Factors in Tikur Anbessa Specialized and Gandhi Memorial Hospitals: Unmatched Case-Control Study
Background. Placenta praevia is a disorder that happens during pregnancy when the placenta is abnormally placed in the lower uterine segment, which at times covers the cervix. The incidence of placenta praevia is 3-5 per 1000 pregnancies worldwide and is still rising because of increasing caesarean section rates. Objective. To assess and identify the risk factors and maternal and neonatal complications associated with placenta praevia. Method and Materials. Target populations for this study were all women diagnosed with placenta praevia transvaginally or transabdominally either during the second and third trimesters of pregnancy or intraoperatively in Tikur Anbessa Specialized and Gandhi Memorial Hospitals. The study design was unmatched case-control study. Data was carefully extracted from medical records, reviewed, and analyzed. Unconditional logistic regression analysis was performed using adjusted odds ratios (AOR) with 95% confidence intervals. Results. Pregnancies complicated by placenta praevia were 303. Six neonatal deaths were recorded in this study. The magnitude of placenta praevia observed was 0.7%. Advanced maternal age (≥35) (AOR 6.3; 95% CI: 3.20, 12.51), multiparity (AOR 2.2; 95% CI: 1.46, 3.46), and previous history of caesarean section (AOR 2.7; 95% CI: 1.64, 4.58) had an increased odds of placenta praevia. Postpartum anemia (AOR 14.6; 95% CI: 6.48, 32.87) and blood transfusion 1-3 units (AOR 2.7; 95% CI: 1.10, 6.53) were major maternal complications associated with placenta praevia. Neonates born to women with placenta praevia were at increased risk of respiratory syndrome (AOR 4; 95% CI: 1.24, 13.85), IUGR (AOR 6.3; 95% CI: 1.79, 22.38), and preterm birth (AOR 8; 95% CI: 4.91, 12.90). Conclusion. Advanced maternal age, multiparity, and previous histories of caesarean section were significantly associated risk factors of placenta praevia. Adverse maternal outcomes associated with placenta praevia were postpartum anemia and the need for blood transfusion. Neonates born from placenta praevia women were also at risk of being born preterm, intrauterine growth restriction, and respiratory distress syndrome.