Determinants of Preeclampsia among Women Attending Delivery Services in Public Hospitals of Central Tigray, Northern Ethiopia: A Case-Control 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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Cost-Effectiveness of Contraceptive Use in Indonesia after the Implementation of the National Health Insurance System
Since 2014, Indonesia has initiated to implement a national health insurance system, which included both of short- (SARC) and long-acting reversible contraceptive (LARC) into the benefit package. The aim of this study was to analyze the cost-effectiveness of contraceptive use in Indonesia after the implementation of the national health insurance in 2014-2017. A decision tree model was developed to analyze the cost-effectiveness of contraceptive use in Indonesia in 2014-2017 by comparing two strategies of pregnancy prevention: contraceptive and non-contraceptive. For contraceptive strategy, we took into account SARC and LARC. In a comparison with non-contraceptive, we calculated that the incremental cost-effectiveness ratio (ICER) of SARC would be $5.18, $4.80 and $3.76 per pregnancy averted for injection, condom, and pill, respectively. For LARC, we calculated that the ICER would be $1.67 and $0.84 for implant and intrauterine device (IUD), respectively, compared with non-contraceptive. In general, the cost-effectiveness value of LARC ($1.25) was much better than SARC ($4.58). The cost of contraceptive was considered to be the most influential parameter affecting both the ICER of SARC and LARC. In conclusion, the use of LARC in Indonesia was considered to be more cost-effective than SARC since the implementation of national health insurance system. In particular, IUD yielded the greatest cost-effectiveness value, compared with other methods.
Effect of COVID-19 on Mortality of Pregnant and Postpartum Women: A Systematic Review and Meta-Analysis
Background. Based on what is known at this time, pregnant women are at an increased risk of severe illness from COVID-19 compared to nonpregnant women. Additionally, pregnant women with COVID-19 might have an increased risk of adverse pregnancy outcomes. To investigate the effects of coronavirus disease 2019 (COVID-19) on mortality of pregnant and postpartum women, we performed a systematic review of available published literature on pregnancies affected by COVID-19. Methods. Web of Science, SCOPUS, and MEDLINE- databases were searched for original studies concerning the effect of COVID-19 on mortality of pregnant and postpartum women published by July 10, 2020. Meta-analyses of proportions were used to combine data and report pooled proportions. Results. 117 studies with a total of 11758 pregnant women were included. The age ranged between 15 and 48 years. Most subjects were infected with SARS-CoV-2 in the third trimester. Disease severity was not reported in 1125 subjects. Maternal mortality was 1.3%. In 100% of fatal cases with adequate data, fever alone or with cough was one of the presenting symptoms. Also, dyspnea (58.3%) and myalgia (50%) were the most common symptoms. Sore throat (8.3%) and gastrointestinal symptoms (anorexia, nausea) (8.3%) were rare. The rate of comorbidities was 20% among COVID-19 deaths. The majority of COVID-19-infected women who died had cesarean section (58.3%), 25% had a vaginal delivery, and 16.7% of patients were not full term. Conclusion. COVID-19 infection in pregnant women was associated with higher rates (and pooled proportions) of cesarean section and mortality. Because new data are continuously being generated and published, the findings of this study can be complete and updated with new researches. The results of this study can guide and improve prenatal counseling of COVID-19-infected pregnant women.
Predictors of Preterm Birth among Mothers Who Gave Birth in Silte Zone Public Hospitals, Southern Ethiopia
Background. A preterm birth is the leading cause of death in both neonatal and children under five years of age every year throughout the world, particularly in Sub-Saharan Africa. The causes of a preterm birth are complex and multifactorial; many risk factors that contribute it are not fully understood. The aim of this study was to identify predictors of a preterm birth among mothers who gave birth in Silte Zone Public Hospitals, Southern Ethiopia (2019/20). Methods and Materials. A hospital-based unmatched case-control study design was carried out from July 15th to October 30th, 2019, by assigning mothers who gave preterm births as cases and those with term births as controls. A total of 365 respondents (91 cases and 274 controls) were selected by a consecutive simple random sampling until the required sample size was achieved. For each case, three consecutive controls were included. Data were collected using a structured interview questionnaire complement with record reviewing. The data were entered into Epi Info 7 and exported into SPSS 25 for analysis. Descriptive analysis was computed to obtain summary values for cases and controls separately. All candidate variables in bivariate analysis were entered into the multivariable logistic regression model by using the backward likelihood ratio selection methods. Finally, variables with value ≤ 0.05 were considered as potential determinants of a preterm birth and reported in the form of adjusted odds ratio with 95% confidence interval. Results. Among a total of 365 mothers who gave live birth, 91 (24.9%) were cases compared to 274 (75.1%) which were controls. The final multivariable logistic regression analysis results showed that having history of a previous preterm birth (; ), having shorter interpregnancy interval (; ), experiencing obstetric complication (; ), and having infant born with low birth weight (; ) were found to be independent predictors of a preterm birth. Conclusions. According to this finding, mothers having previous history of a preterm birth, experiencing obstetric complication, having shorter interpregnancy interval, and having infant born with low birth weight were reported as the independent predictors of a preterm birth. Improving the quality of antepartum and intrapartum, counseling on birth space, creating awareness on family planning, and early screening of preterm determinants are mandatory.
Maternal Serum Cytokine Concentrations in Healthy Pregnancy and Preeclampsia
The maternal immune response is essential for successful pregnancy, promoting immune tolerance to the fetus while maintaining innate and adaptive immunity. Uncontrolled, increased proinflammatory responses are a contributing factor to the pathogenesis of preeclampsia. The Th1/Th2 cytokine shift theory, characterised by bias production of Th2 anti-inflammatory cytokine midgestation, was frequently used to reflect the maternal immune response in pregnancy. This theory is simplistic as it is based on limited information and does not consider the role of other T cell subsets, Th17 and Tregs. A range of maternal peripheral cytokines have been measured in pregnancy cohorts, albeit the changes in individual cytokine concentrations across gestation is not well summarised. Using available data, this review was aimed at summarising changes in individual maternal serum cytokine concentrations throughout healthy pregnancy and evaluating their association with preeclampsia. We report that TNF-α increases as pregnancy progresses, IL-8 decreases in the second trimester, and IL-4 concentrations remain consistent throughout gestation. Lower second trimester IL-10 concentrations may be an early predictor for developing preeclampsia. Proinflammatory cytokines (TNF-α, IFN-γ, IL-2, IL-8, and IL-6) are significantly elevated in preeclampsia. More research is required to determine the usefulness of using cytokines, particularly IL-10, as early biomarkers of pregnancy health.
Antenatal Depression and Associated Factors among Pregnant Women Attending Antenatal Care Service in Kochi Health Center, Jimma Town, Ethiopia
Background. Antenatal depression has immense public health importance, as it can adversely affect both the mother and child health. The problem contributes to the disease burden in both developed and developing countries. Despite this, it is less investigated and not getting the necessary attention in the study setting. Objective. The aim of the study was to assess the prevalence of antenatal depression and associated factors among women attending antenatal care (ANC) service in Kochi Health Center, Jimma town, southwest Ethiopia, 2019. Method. Institutional based cross-sectional survey was conducted on 314 pregnant women attending Kochi Health Center from February 15 to April 15, 2019. A systematic random sampling technique was used to include the study participants. Antenatal depression was assessed using the Patient Health Questionnaire (PHQ-9) tool. Data was collected through face-to-face interviews using a pretested and structured questionnaire. Descriptive statistics was done to summarize the dependent and independent variables. Moreover, the chi-square test analysis was done to determine the association between the outcome and explanatory variables. Results. A total of 314 pregnant women participated in the study, making a response rate of 96.7%. The study has revealed a total of 52 (16.6%) of the respondent had antenatal depression. A chi-square test of independence analysis showed a significant association between antenatal depression and marital status, family history of depression, pregnancy planning, history of abortion, social support, and intimate partner violence (). Conclusion. The study has shown that the prevalence of antenatal depression was high and associated with multiple psychosocial, clinical, and obstetric factors. Therefore, screening pregnant women for depression and the provision of necessary mental health services is recommended to mitigate the adverse health outcome of the problem.
Using Social Marketing to Reduce Intention of Cesarean Section in Iranian Women
Introduction. In Iran, the rate of cesarean section is three times more than the acceptable rate considered by the World Health Organization. This study aimed at reducing the selection of cesarean section by primigravida through an intervention based on social marketing in Boyer-Ahmad County, Iran, 2015. Methods. In this field trial, 39 of primigravida women were identified and selected as a target group. Formative research (a quantitative survey and a qualitative study) was done to achieve the social marketing mix. The tailored intervention was developed based on the findings of formative research. The intervention was implemented for one month for pregnant women who had cesarean section intention. Their intention for the cesarean section was studied again one month after the implementation of the intervention. The effectiveness of the intervention was evaluated by the proportion test. Results. The average age of the women was 25.82. All of the women 38.5 percent had a diploma degree and lower than and 61.5 percent had a university degree. Before the intervention, 39 women intended to do Cesarean. The intention of 30 pregnant women was changed significantly one month after the intervention. Conclusion. The study showed the effectiveness of an intervention based on consumer-oriented social marketing theory and could be used to reduce Cesarean intention. More studies about related factors of vaginal delivery selection especially from behavioral intention up to behavior are suggested.