广义Matern硬核点过程(Generalized Matern Hard-Core Point Process,GMHCPP)是在硬核点过程的基础上通过引入竞争函数和删减函数来限制保留概率的一种排斥点过程。针对两层异构蜂窝网络模型中宏基站与微基站的性能进行了深入研究,获得...广义Matern硬核点过程(Generalized Matern Hard-Core Point Process,GMHCPP)是在硬核点过程的基础上通过引入竞争函数和删减函数来限制保留概率的一种排斥点过程。针对两层异构蜂窝网络模型中宏基站与微基站的性能进行了深入研究,获得了该模型的覆盖概率和平均可达速率的近似表达式。首先,基于宏基站的性能差异及其排斥性生成保留概率函数,进而,将宏基站的部署以GMHCPP建模。然后,采用蒙特卡罗模拟方法对基站分布进行仿真,并绘制出了平均干扰信号比与路径损耗因子的关系图,根据该函数图,拟合得到了用泊松点过程近似时GMHCPP的增益因子表达式。最后,将增益因子代入覆盖概率和平均可达速率公式,对两层异构蜂窝网络模型的性能指标进行了仿真与分析。展开更多
Background: Maternal mortality remains a major public health problem worldwide. Objectives: Our study aims to present the results of an analysis of reviews of maternal deaths at HGOPY. Methodology: This was a descript...Background: Maternal mortality remains a major public health problem worldwide. Objectives: Our study aims to present the results of an analysis of reviews of maternal deaths at HGOPY. Methodology: This was a descriptive cross-sectional study with retrospective data collection from archived records and reviewed maternal death reports. Our study lasted 8 months, from October 1, 2023 to May 31, 2024. The study covered maternal death files at the HGOPY over an 8-year period, from 1st of January 2016 to the 31st of December 2023. Data were processed and analyzed using Statitical Paquage for Social Science (SPSS) version 26.0. Results: We counted a total of 160 maternal deaths, of which 97 had been reviewed. We excluded 61 deceased women reviewed and retained 33. We recorded a cumulative total of 160 maternal deaths and 19,651 live births. The peak in the proportion of maternal deaths at the Yaoundé Gynaeco-Obstetric and Paediatric Hospital was in 2021, with a proportion of 0.013. No maternal deaths had been reviewed between 2016 to 2017. Most deaths (64%) occurred between 37 and 40 weeks. The majority (30.5%) were aged between 30 and 35. The data show that 80.6% of maternal deaths were due to direct obstetric causes, while 19.4% were due to indirect causes. Most deaths (69.4%) were preventable. Only 8.3% were not preventable. Conclusion: Concerted efforts must be made to adapt maternal death prevention and management strategies to local contexts in order to significantly reduce these alarming figures.展开更多
Background: Birth weight has been identified as one of the most significant predictors of a child’s physical growth, development, and survival in later life. A quest to provide an answer on the impact of maternal ant...Background: Birth weight has been identified as one of the most significant predictors of a child’s physical growth, development, and survival in later life. A quest to provide an answer on the impact of maternal anthropometry on neonatal birth weight necessitated this study. Materials and methods: It is a cross-sectional descriptive hospital based study that involved 130 participants selected using a systematic sampling method, utilizing a semi-structured, pre-tested interviewer administered questionnaire. Data were collected using a standard procedure and were summarized using proportions, and the Chi square test was used to explore the association between categorical variables. Predictors of birth weight were determined using logistic regression. The level of statistical significance was set at p Results: Participants had a mean age of 28.6 ± 5.1 years, mean weight of 72.2 ± 11.2 kg and mean height of 1.63 ± 0.07m while the mean fetal birth weight was 3.10 ± 0.56 kg. There was a significant association between maternal delivery body mass index and neonatal birth weight (p Conclusion: The prevalence of low birth weight and macrosomia in this study population was high. The focus should be geared towards balanced nutrition support for all mothers at booking so as to mitigate the risks associated with these extremes of birth weight.展开更多
Introduction: The Coronavirus pandemic was responsible for an unprecedented health crisis that shook the world with its high contagiousness and lethality. Its impact on maternal and fetal health places pregnant women ...Introduction: The Coronavirus pandemic was responsible for an unprecedented health crisis that shook the world with its high contagiousness and lethality. Its impact on maternal and fetal health places pregnant women at high risk. The aim of our study was to determine the factors associated with the occurrence of COVID-19 in pregnant women, and the maternal and perinatal outcomes of infected patients. Methodology: This was a case-control study involving 42 cases matched to 42 controls recruited from two public and tertiary hospitals in the cities of Yaoundé and Douala over a period from November 31 to May 31, 2024. Cases were defined as deliveries or records of COVID-19 deliveries confirmed positive by reverse transcription polymerase chain reaction (RT-PCR) or by a COVID-19 rapid diagnostic test (Covid-RDT). Controls were defined as deliveries or records of deliveries negative to the same test. They were matched by the hospital. Non-consenting births and unusable records were excluded. The data collected were recorded on a pre-established, pretexted data sheet examining sociodemographic, clinical characteristics and maternal and perinatal outcomes which were then analyzed using SPSS version 23.0 software. Results: After multivariate analysis, the independent sociodemographic factors were: belonging to the [30 - 40] age group (OR: 4.4;P = 0.010), being married (OR: 8.1;P = 0.030);being unemployed (OR: 3;P = 0.040). Independent clinical factors were: being in the third trimester of pregnancy (OR: 1.1;P = 0.017), being diabetic (OR: 5;P = 0.033) and being obese (OR: 11.5;P = 0.043). Independent factors associated with maternal outcome were: caesarean section (OR: 10;P = 0.001);admission to intensive care (OR: 30.7;P = 0.013);SO2 ≤ 94% (OR: 11.7;P = 0.033);HR > 100 (OR: 15.5;P = 0.001). Independent factors associated with perinatal outcome were: weight Conclusion: The factors associated with the occurrence of COVID-19 in pregnant women are multiple, and maternal outcome depends on its condition on admission, and has a significant impact on perinatal health, including mode of delivery. Emphasis must be placed on prevention and optimal management of these associated factors.展开更多
Background: The maternal and neonatal morbidity caused by prolonged labour, maternal exhaustion and other factors push clinicians to speed up the delivery process by employing equipment such as vacuum suction or force...Background: The maternal and neonatal morbidity caused by prolonged labour, maternal exhaustion and other factors push clinicians to speed up the delivery process by employing equipment such as vacuum suction or forceps to save the newborn. The purpose of this study was to determine the prevalence of vacuum-assisted vaginal delivery (VAVD) and its associated short-term maternal and neonatal outcomes at Ndola Teaching Hospital. Methods: A retrospective cross-sectional descriptive study through the analysis of routine data for women with singleton-term pregnancies who delivered by vacuum compared with spontaneous vaginal delivery was done at a tertiary hospital for the years 2020 and 2021. Chi-square and Logistic regression were used to investigate factors of vacuum delivery and to adjust for potential confounders. Results: Results showed that VAVD was mostly performed in women who had delayed second stage of labour (25.4%), maternal exhaustion (16.0%), foetal distress in the second stage of labour (12.3%). The overall VAVD prevalence was 3.7% (581/15591). Logistic regression showed that multiparous women were noted to be 87.5% (aOR 0.125;95% CI 0.025 - 0.629;p = 0.012) less likely to undergo VAVD compared to nulliparous women. Registrars were almost 6 times (aOR 5.650;95% CI 1.458 - 22.222, p = 0.012) more likely to conduct VAVD compared to midwives. Episiotomy was 3 times (aOR 3.390;95% CI 1.185 - 9.524;p Conclusion: The findings indicate the underutilisation of VAVD at NTH based on the low prevalence of 3.7%. VAVD outcomes were affected by multiparity, skill level and Episiotomy procedure, in addition, VAVD influenced admission to the NICU. Hence, there is a need to increase skills in VAVD among first-line healthcare workers such as midwives and intern doctors.展开更多
Introduction: Uterine rupture is certainly one of the most serious, as it immediately jeopardises the vital prognosis of the mother and foetus. It is a common obstetric tragedy in our delivery rooms in countries with ...Introduction: Uterine rupture is certainly one of the most serious, as it immediately jeopardises the vital prognosis of the mother and foetus. It is a common obstetric tragedy in our delivery rooms in countries with limited resources, reflecting the poor quality of obstetric care and, consequently, an unmet obstetric need. Methods: This was a descriptive and analytical cross-sectional study with prospective data collection over a four-year period from 1 January 2020 to 31 December 2023 at the University Hospital Centre (CHU) of Bouaké, in the Obstetrics and Gynaecology Department. The variables studied were epidemiological characteristics, therapeutic aspects and factors associated with maternal. Results: The prevalence of uterine rupture was 0.63%. The average age was 32, with patients aged 35 and over accounting for 33.68%, married 44.21% and 70% not in education. Patients with uterine rupture had been evacuated in 85.26% of cases. Uterine rupture was diagnosed in 97.89% of cases during labour. Maternal lethality due to rupture was 15.79%. The causes of maternal death were dominated by haemorrhagic shock (53.33%). Factors statistically associated with death were age ≥ 35 years (OR: 3.14), duration of labour ≥ 12 hours (OR: 5.8), multiparity (OR: 19.04), admission delay beyond 2 hours (OR: 4.36), haemoglobin level ≤ 7 g/dl (OR: 36.84), coma or obnubilation (OR: 71.82), haemorrhagic shock (OR: 243.94) and occurrence of post-operative complications (OR: 76.45). Conclusion: The frequency of uterine rupture remains significant in the department (0.63%), with maternal mortality still high (15.79%). The key to reducing uterine rupture and its consequences lies in timely referral and early, appropriate management.展开更多
Introduction: The objective of this work was to study maternal deaths noted on arrival in the Gynecology and Obstetrics Department at Fousseyni Daou Hospital in Kayes over a period of 10 years. Materials and Methods: ...Introduction: The objective of this work was to study maternal deaths noted on arrival in the Gynecology and Obstetrics Department at Fousseyni Daou Hospital in Kayes over a period of 10 years. Materials and Methods: This was a cross-sectional, descriptive study with data collection over a period of 10 years;The data collection was retrospective over nine years from January 1, 2013 to December 31, 2021 and prospective over one year from January 1, 2022 to December 31, 2022. This study focused on all patients whose death was noted on arrival during pregnancy, labor or in the postpartum period in the Gynecology-Obstetrics Department of Fousseyni Daou Hospital. Confidentiality and anonymity were respected. The processing and analysis of statistical data were carried out using SPSS 20.0 software. Results: During the study period, we recorded 93 cases of death noted on arrival out of a total of 606 maternal deaths, i.e., a frequency of 15.34%. The average age was 27 years with the extremes of 20 years and 34 years. They came mainly from rural areas at 74%, were married at 82%, uneducated at 51.6%, housewives at 87.1%. The profession of the spouses is worker at 37.6%. In our sample, evacuated patients were the most represented with 75.3%. Postpartum hemorrhage was the most frequent reason for admission with 22.6%. The deceased patients had no medical history at 86%. In our series, 59.5% of the deceased patients had not had antenatal consultations (CPN). Patients who died on arrival and who had given birth at home were the most represented with 54.8%. Deaths from immediate postpartum hemorrhage complicated by shock were the most frequent with 25.8% followed by severe anemia 8.6%. Deaths were mainly due to direct obstetric causes at 76.3%. In these deaths observed on arrival, the 2nd delay was identified at 48.4%. Conclusion: Maternal deaths observed on arrival remain frequent in the Kayes region. The main causes are immediate postpartum hemorrhage and anemia, which are almost all preventable causes of maternal death following the 1st and 2nd delay.展开更多
The oviduct epithelium is the initial maternal contact site for embryos after fertilization,offering the microenviron-ment before implantation.This early gestation period is particularly sensitive to stress,which can ...The oviduct epithelium is the initial maternal contact site for embryos after fertilization,offering the microenviron-ment before implantation.This early gestation period is particularly sensitive to stress,which can cause reduced fertil-ity and reproductive disorders in mammals.Nevertheless,the local impact of elevated stress hormones on the ovi-duct epithelium has received limited attention to date,except for a few reports on polyovulatory species like mice and pigs.In this study,we focused on the effects of chronic maternal stress on cattle,given its association with infertil-ity issues in this monoovulatory species.Bovine oviduct epithelial cells(BOEC)differentiated at the air–liquid interface(ALI)were stimulated with 250 nmol/L cortisol for 1 or 3 weeks.Subsequently,they were assessed for morphology,bioelectrical properties,and gene expression related to oviduct function,glucocorticoid pathway,cortisol metabo-lism,inflammation,and apoptosis.Results revealed adverse effects of cortisol on epithelium structure,featured by deciliation,vacuole formation,and multilayering.Additionally,cortisol exposure led to an increase in transepithelial potential difference,downregulated mRNA expression of the major glucocorticoid receptor(NR3C1),upregulated the expression of cortisol-responsive genes(FKBP5,TSC22D3),and significant downregulation of oviductal glycopro-tein 1(OVGP1)and steroid receptors PGR and ESR1.The systematic comparison to a similar experiment previously performed by us in porcine oviduct epithelial cells,indicated that bovine cultures were more susceptible to elevated cortisol levels than porcine.The distinct responses between both species are likely linked to their divergence in the cortisol-induced expression changes of HSD11B2,an enzyme controlling the cellular capacity to metabolise cortisol.These findings provide insights into the species-specific reactions and reproductive consequences triggered by maternal stress.展开更多
Maternal consumption of a high-fat diet has been linked to increased risks of obesity and impaired glucose metabolism in offspring.However,the precise epigenetic mechanisms governing these intergenerational effects,pa...Maternal consumption of a high-fat diet has been linked to increased risks of obesity and impaired glucose metabolism in offspring.However,the precise epigenetic mechanisms governing these intergenerational effects,particularly during the early stages of offspring development,remain poorly understood.In this study,female C57BL/6J mice were randomly assigned to either a high-fat diet or normal chow diet throughout gestation and lactation.Methylated DNA immunoprecipitation(MeDIP)coupled with microarray analysis was employed to identify differentially methylated genes in the livers of offspring at weaning age.We found that maternal high-fat diet feeding predisposes offspring to obesity and impaired glucose metabolism as early as the weaning period.DNA methylation profile analysis unveiled a significant enrichment of differentially methylated genes within the natural killer(NK)cell-mediated cytotoxicity pathway.MeDIP-PCR validated reduced methylation levels of specific genes within this pathway,including tumour necrosis factorα(TNF-α),phosphoinositide 3-kinase(PI3K),and SHC adaptor protein 1(SHC1).Consistently,the expressions of TNF-α,PI3K,and SHC1 were significantly upregulated,accompanied by elevated serum TNF-αand interleukin-6(IL-6)levels in offspring from dams fed with high-fat diet.Moreover,we assessed the expressions of genes associated with NK cell activities,uncovering a notable rise in hepatic granzyme B levels and a trend towards increased CD107a expression in offspring from dams fed a high-fat diet.In addition,methylation levels of TNF-α,PI3K,and SHC1 promoters were inversely correlated with glucose response during glucose tolerance testing.In conclusion,our findings underscore the critical role of the NK cell-mediated cytotoxicity signaling pathway in mediating DNA methylation patterns,thereby contributing to the programming effects of maternal high-fat diet consumption on offspring glucose metabolism as early as the weaning period.展开更多
BACKGROUND Food insecurity(FI)during pregnancy negatively impacts maternal health and raises the risk of gestational diabetes mellitus(GDM)and pregnancy-induced hypertension(PIH),resulting in adverse outcomes for both...BACKGROUND Food insecurity(FI)during pregnancy negatively impacts maternal health and raises the risk of gestational diabetes mellitus(GDM)and pregnancy-induced hypertension(PIH),resulting in adverse outcomes for both mother and baby.AIM To investigate the relationships between FI and pregnancy outcomes,particularly GDM and PIH,while also examining the mediating role of the dietary diversity score(DDS).METHODS A cross-sectional study was undertaken to examine this relationship,involving 600 pregnant women.Participants were women aged 18 years or older who provided complete data on FI and pregnancy outcomes.The FI was measured via the Household Food Security Survey Module,with GDM defined as fasting plasma glucose levels of≥5.1 mmol/L or a 2-hour oral glucose tolerance test value of≥8.5 mmol/L.The DDS is determined by evaluating one's food consumption based on nine distinct food groups.A logistic regression model was used to explore the relationship between FI and PIH,and GDM.RESULTS Seventeen percent of participants reported experiencing FI during pregnancy.The study found a significant association between FI and an elevated risk of GDM[odds ratio(OR)=3.32,95%CI:1.2-5.4].Once more,food-insecure pregnant women had higher rates of PIH(OR=0.10,95%CI:0.02-0.45)and they also faced a higher likelihood of neonatal complications,such as neonatal intensive care unit’s admissions and the birth of infants with extremely low birth weight.The FI wasfurther linked to metabolic disruptions,such as elevated fasting blood sugar(FBS),low-density lipoprotein cholesterol,and triglyceride levels.Our results indicate that the DDS acts as a significant mediator in the relationship between FI and the incidence of GDM.In particular,the mediation analysis showed that approximately 65%of the effect was mediated through DDS(P=0.002).CONCLUSION These findings underscore the serious challenges that FI presents during pregnancy and its effects on maternal and infant health.Additionally,the study explored how DDS mediates the relationship between FI and the incidence of GDM.展开更多
Introduction:Diabetes mellitus(DM),a metabolic disorder,leads to organ damage due to chronic hyperglycemia with multiple pathogenic processes.Gestational diabetes mellitus(GDM)poses risks to mothers and offspring,incr...Introduction:Diabetes mellitus(DM),a metabolic disorder,leads to organ damage due to chronic hyperglycemia with multiple pathogenic processes.Gestational diabetes mellitus(GDM)poses risks to mothers and offspring,increasing the incidence of structural congenital heart disease(CHD)and myocardial hypertrophy in newborns.Objective:This review aimed to examine the association between maternal diabetes mellitus and CHD.Methods:This systematic review used the STROBE and TRIPOD checklists registered in PROSPERO(CRD42024513858).It focused on diagnostic test accuracy using the Munn et al.protocol for systematic assessment,emphasizing the“PIRD”:Population,Index Test,Reference Test,Diagnosis of Interest.This review aimed the following PIRD model question:‘Does diabetic pregnant woman inffuence in fetal cardiac malformation?’using PRISMA 2020 statement.A systematic review was conducted on 19 October 2023 in the following databases:PubMed/MEDLINE,Embase(Elsevier),CINAHL(EBSCO),Scopus(Elsevier),Web of Science(Clarivate Analytics),LILACS,and SciELO.Only articles in English,Spanish,and Portuguese languages were selected.Results:Seven studies between 2018 and 2023 were selected.The studies differed in terms of the cardiac ultrasound parameters used to assess CHD and diagnose diabetes mellitus in pregnancy.They highlight the importance of fetal echocardiography in detecting CHD prenatally and assessing the impact of diabetes mellitus on fetal cardiac health,recommending proactive care planning and early intervention for better outcomes.Conclusions:The studies highlight the impact of maternal diabetes mellitus,particularly GDM,on fetal cardiac development and support early detection by fetal echocardiography.Standardization and collaboration are essential to reffne management and outcomes in high-risk pregnancies.展开更多
This study evaluated the effectiveness of Chinese herbal foot bath therapy in improving sleep quality among postpartum women of advanced maternal age.A quasi-experimental design was used,involving 60 participants with...This study evaluated the effectiveness of Chinese herbal foot bath therapy in improving sleep quality among postpartum women of advanced maternal age.A quasi-experimental design was used,involving 60 participants with sleep disturbances recruited from Zouping County Traditional Chinese Medicine Hospital.Participants were divided into control and experimental groups,and sleep quality was assessed using the Pittsburgh Sleep Quality Index(PSQI)before and after the intervention.The experimental group received Chinese herbal foot bath therapy,while the control group did not.Post-intervention results showed a significant improvement in sleep quality for the experimental group,with a mean PSQI score of 7.79(SD=2.90),compared to 13.45(SD=2.57)in the control group,indicating continued poor sleep.Statistical analysis confirmed that the therapy led to significant improvements across overall and component PSQI scores.The study concludes that Chinese herbal foot bath therapy is a safe,non-invasive,and cost-effective method to enhance sleep quality among postpartum women,especially those of advanced maternal age.It holds promise as a complementary treatment option and could be integrated into standard postpartum care practices to address sleep disturbances without relying on pharmacological interventions.展开更多
BACKGROUND The full implementation of the national two-child policy has presented significant challenges in ensuring the safety of pregnant women.AIM To investigate the effect of cervical balloon fluid volume on mater...BACKGROUND The full implementation of the national two-child policy has presented significant challenges in ensuring the safety of pregnant women.AIM To investigate the effect of cervical balloon fluid volume on maternal processes,maternal and infant outcomes,and anxiety during pregnancy.METHODS A total of 100 singleton term pregnancies with cervical maturity induction and anxiety were selected using a lottery method;50 women were included.Cervical balloons were used for all participants.In the control group,80 mL of fluid was injected into both balloons;in the observation group,80 and 100 mL were injected into the vaginal and cervical balloons,respectively.The two groups were compared for cervical maturity,labor duration,anxiety,maternal and infant outcomes,and effects on cervical ripening.RESULTS After treatment,the cervical maturity test(Bishop)score was significantly higher in the observation group(9.76±1.19)than in the control group(7.62±0.83),and the Hamilton Anxiety Scale score was lower in the observation group(7.32±0.85)than in the control group(13.05±1.12).The observation group showed higher rates of natural delivery and lower rates of cesarean section than the control group.The first and total stages of labor were shorter in the observation than in the control group;no significant differences were found in the second and third stages.The incidence of complications was lower in the observation group[1(2.00%)vs 9(18.00%)for complications;49(98.00%)vs 41(82.00%)for non-complications].CONCLUSION The selected fluid volumes to promote cervical maturity and induce labor stabilize maternal mood,increase the natural delivery rate,shorten labor,and improve maternal and infant outcomes.展开更多
Theincreasing prevalence of gestational diabetesmellitus(GDM)is associated with an array of pregnancy complications and enduring health challenges in bothmothers and their offspring.Studies have indicated that exposur...Theincreasing prevalence of gestational diabetesmellitus(GDM)is associated with an array of pregnancy complications and enduring health challenges in bothmothers and their offspring.Studies have indicated that exposure to the intrauterine environment can prompt adaptations in the offspring,thereby programming transgenerational inheritance.Physical activity during pregnancy,as a non-pharmacological intervention,mitigates metabolic risks through epigenetic modifications,mediating placental adaptations,the action of exercise factors,and gut microbiota.Here,we provide a review summarizing how regular exercise can reduce the risk of GDM and positively influence pregnancy outcomes.It also discusses the exercise-induced reduction in obesity,insulin resistance,and fatty liver disease in the offspring of GDM,outlining the mechanisms that underpin these health benefits.This review underscores the importance of exercise in safeguarding the health of GDM mothers and their offspring.展开更多
Objective: To examine the effects of comprehensive nursing interventions on maternal and infant outcomes in pregnant women diagnosed with gestational diabetes mellitus (GDM). Methods: A quasi-experimental design was e...Objective: To examine the effects of comprehensive nursing interventions on maternal and infant outcomes in pregnant women diagnosed with gestational diabetes mellitus (GDM). Methods: A quasi-experimental design was employed, involving 60 pregnant women with GDM who were purposively selected and randomly allocated into experimental and control groups, each comprising 30 participants. The experimental group received comprehensive nursing interventions and pregnancy monitoring, while the control group received standard nursing care. Data collection was conducted using demographic questionnaires, pregnancy indicators, and maternal-infant outcome measurement tools. The collected data were analyzed using Microsoft Excel and the Statistical Package for Social Sciences (SPSS). Results: The findings indicated significant improvements in fasting blood glucose, postprandial blood glucose, amniotic fluid index, and neonatal birth weight in the experimental group compared to the control group. However, no statistically significant differences were observed in body mass index (BMI) or pregnancy weight gain. Comprehensive nursing interventions were associated with a significant reduction in maternal complications, including polyhydramnios, postpartum hemorrhage, and preeclampsia, as well as neonatal complications such as neonatal pneumonia, macrosomia, and hypoglycemia. Conclusion: Comprehensive nursing interventions have a positive impact on maternal and neonatal outcomes in pregnant women with GDM.展开更多
OBJECTIVES:To investigate the effect of Bushen Tongluo recipe(BSTLR, 补肾通络方) on rats with diabetic kidney disease(DKD) and to explore the underlying mechanism of action. METHODS:The rat model of DKD was establishe...OBJECTIVES:To investigate the effect of Bushen Tongluo recipe(BSTLR, 补肾通络方) on rats with diabetic kidney disease(DKD) and to explore the underlying mechanism of action. METHODS:The rat model of DKD was established, and rats were treated with different doses of BSTLR. Body weight and the levels of urinary protein, α1-microglobulin, glucose, blood urea nitrogen, creatinine, Cystatin C, superoxide dismutase, malondialdehyde, and catalase were analyzed biochemically or by enzyme-linked immunosorbent assay. The pathological damage to renal tissues was assessed by hematoxylin-eosin staining. Immunohistochemical staining was carried out to detect the expression levels of fibronectin, E-cadherin, α-smooth muscle actin, laminin, vimentin, collagen type Ⅳ in kidney tissues. Western blot analysis was conducted to analyze the expression levels of Nephrin, Desmin, Podocin, transforming growth factor-β1, mothers against decapentaplegic homolog 3(Smad3), Notch1, jagged, hairy and enhancer of split 1(Hes1) in kidney tissues, and the expression levels of maternally expressed gene 3(MEG3) and mi R-145 were measured by quantitative reverse transcription-polymerase chain reaction. Moreover, dual-luciferase reporter assay was employed to verify the binding of mi R-145 to MEG3. RESULTS:BSTLR increased the body weight of DKD rats, effectively ameliorated the renal function and pathological injury in DKD, regulated the balance of renal oxidative stress, inhibited the TGF/Notch signaling pathway, and affected the variations in the lnc RNA MEG3/mi R-145 axis. CONCLUSION:BSTLR improved oxidative stress homeostasis, inhibited the TGF/Notch signaling pathway, and regulated the lnc RNA MEG3/mi R-145 axis, effectively delaying the progression of DKD.展开更多
Background: Dying in childbirth is one of the most common causes of death for women. While maternal mortality rates, defined as deaths per 100,000 live births, have been steadily dropping in most countries worldwide, ...Background: Dying in childbirth is one of the most common causes of death for women. While maternal mortality rates, defined as deaths per 100,000 live births, have been steadily dropping in most countries worldwide, maternal mortality rates have doubled in the United States in the last twenty years. This commentary examines the various contributing factors to this trend. Methods: A literature review was performed using the keywords: maternal mortality, United States, disrespectful maternity care, obstetric violence, provider perspectives, and disparities. Maternal mortality statistics were obtained from the World Health Organization website. Results: Medical factors associated with maternal mortality include increased maternal age and cardiovascular conditions. Social factors include barriers to healthcare access, delays in receiving medical care, reduction in reproductive health services in some states, and non-obstetrical deaths such as accidents, domestic violence, and suicide. Racial inequities and disparities of care are reflected in higher maternal mortality rates for minorities and people of color. Disrespectful maternity care or obstetric violence has been reported worldwide as a factor in delay of lifesaving obstetrical care and reluctance by a pregnant person to access the healthcare system. About one in five US women has reported experiencing mistreatment, varying from verbal abuse to lack of privacy, from coerced procedures to neglect during childbirth. Conclusion: This commentary highlights the importance of inclusion of providers in research on respectful maternity care. Provider burnout, moral distress, limited time, and burden of clinical responsibilities are known challenges to respectful and comprehensive medical care. The association of disrespectful care with poor maternal outcomes needs to be studied. Exploring root causes of disrespectful childbirth care can empower nurses, midwives, and physicians to improve their environment and find solutions to reduce a potential cause of maternal mortality.展开更多
Introduction: Pregnancies at advanced maternal age (AMA) are those occurring after the age of 35 years old. They carry a high risk of maternal-fetal morbidity and mortality, thus constituting a public health problem. ...Introduction: Pregnancies at advanced maternal age (AMA) are those occurring after the age of 35 years old. They carry a high risk of maternal-fetal morbidity and mortality, thus constituting a public health problem. Several African countries have reported an upward trend in both the age of childbirth and the frequency of women with AMA over the past 20 years. In the Democratic Republic of Congo (DRC), where maternal and neonatal morbidity and mortality remain very high, data on AMA pregnancies go back more than 20 years. Objective: We propose evaluating obstetrical outcomes among women in AMA in our setting and the associated factors. Methods: This retrospective cohort study will be conducted in two healthcare facilities (ESS) in Kinshasa. The study population will consist of all women who delivered a single fetus after 28 weeks of gestation between January 2012 and December 2022 (10 years) in the selected ESS. The data collected will be analyzed using R software version 4.2.0. Quantitative variables will be summarized as means with standard deviation or medians with interquartile range. Qualitative variables will be presented as proportions (%). Multivariate logistic regression will be used to determine the main maternal-fetal complications associated with AMA and predictors of obstetric outcomes. P Discussion: The high maternal and infant mortality rates in DRC are among the highest in the world. The context of maternal age has become a topic of growing interest due to its potential implications for the health of women and newborns, it is crucial to identify the risk factors associated with obstetric outcomes by identifying obstetrical outcomes associated with advanced maternal age in the DRC. Many Congolese women tend to start their maternity journey at a relatively young age. However, there is also an emerging trend towards delayed childbearing, particularly in urban areas and among women with access to education and family planning services. Conclusion: The results of this study will enable us to update the frequency of AMA pregnancies in our environment. The socio-demographic and clinical profile of these pregnancies will be determined. The main maternal-fetal complications associated with AMA in our setting and the associated factors will be identified.展开更多
Background:Given the pervasive issues of obesity and diabetes both in Puerto Rico and the broader United States,there is a compelling need to investigate the intricate interplay among body mass index(BMI),pregesta-tio...Background:Given the pervasive issues of obesity and diabetes both in Puerto Rico and the broader United States,there is a compelling need to investigate the intricate interplay among body mass index(BMI),pregesta-tional,and gestational maternal diabetes,and their potential impact on the occurrence of congenital heart defects(CHD)during neonatal development.Methods:Using the comprehensive System of Vigilance and Surveillance of Congenital Defects in Puerto Rico,we conducted a focused analysis on neonates diagnosed with CHD between 2016 and 2020.Our assessment encompassed a range of variables,including maternal age,gestational age,BMI,pregestational diabetes,gestational diabetes,hypertension,history of abortion,and presence of preeclampsia.Results:A cohort of 673 patients was included in our study.The average maternal age was 26 years,within a range of 22 to 32 years.The mean gestational age measured 39 weeks,with a median span of 38 to 39 weeks.Of the 673 patients,274(41%)mothers gave birth to neonates diagnosed with CHD.Within this group,22 cases were linked to pre-gestational diabetes,while 202 were not;20 instances were associated with gestational diabetes,compared to 200 without;and 148 cases exhibited an overweight or obese BMI,whereas 126 displayed a normal BMI.Conclusion:We identified a statistically significant correlation between pre-gestational diabetes mellitus and the occurrence of CHD.However,our analysis did not show a statistically significant association between maternal BMI and the likelihood of CHD.These results may aid in developing effective strategies to prevent and manage CHD in neonates.展开更多
Hypertensive disorders of pregnancy are among the leading causes of severe maternal morbidity and mortality, particularly in developing countries. Hypertensive disorders of pregnancy are among the leading causes of se...Hypertensive disorders of pregnancy are among the leading causes of severe maternal morbidity and mortality, particularly in developing countries. Hypertensive disorders of pregnancy are among the leading causes of severe maternal morbidity and mortality, particularly in developing countries, maternal hypocalcaemia being a factor favouring the onset of arterial hypertension during pregnancy. The aim was to determine the maternal and perinatal prognosis of patients with hypertensive disorders of pregnancy as a function of serum ionised calcium levels. Material and Methods: A cross-sectional analytical study of 114 patients with arterial hypertension during pregnancy or during pregnancy or in the postpartum period at the HGR/Panzi from 1 January 2021 to 30 June 2022, text was entered using Microsoft Office Word 2010 and the tables were analysed using Excel 2010. The data was analysed using SPSS version 20.0 and Stata 14.0. The associations of the variables were calculated using Pearson's chi-square test, with a significance threshold set at a value of p < 0.05. Study of risk factors, Odds ratios and their confidence intervals were estimated in a univariate analysis. The most determining factors were identified by multivariate analysis using the Forward conditional logistic regression model. Results: The mean gestational age was 34.43 ± 4.327 amenorheas weeks, 46.6% of patients had a vaginal delivery, 66.65% of which were indicated for maternal prognosis, maternal complications were associated with maternal hypocalcaemia in 81, 82% (P = 0.043) and an OR = 3.255 (P = 0.0158) threefold risk that the patient presenting with a complication is likely to be in a state of hypocalcaemia at 95% confidence index, and fetal prognosis was not significantly related to maternal calcaemia. Conclusion: Maternal hypocalcaemia is one of the factors that can influence maternal-foetal complications maternal-fetal complications, early management and prevention of this pathology is pathology is important to reduce maternal-fetal morbidity and mortality.展开更多
文摘广义Matern硬核点过程(Generalized Matern Hard-Core Point Process,GMHCPP)是在硬核点过程的基础上通过引入竞争函数和删减函数来限制保留概率的一种排斥点过程。针对两层异构蜂窝网络模型中宏基站与微基站的性能进行了深入研究,获得了该模型的覆盖概率和平均可达速率的近似表达式。首先,基于宏基站的性能差异及其排斥性生成保留概率函数,进而,将宏基站的部署以GMHCPP建模。然后,采用蒙特卡罗模拟方法对基站分布进行仿真,并绘制出了平均干扰信号比与路径损耗因子的关系图,根据该函数图,拟合得到了用泊松点过程近似时GMHCPP的增益因子表达式。最后,将增益因子代入覆盖概率和平均可达速率公式,对两层异构蜂窝网络模型的性能指标进行了仿真与分析。
文摘Background: Maternal mortality remains a major public health problem worldwide. Objectives: Our study aims to present the results of an analysis of reviews of maternal deaths at HGOPY. Methodology: This was a descriptive cross-sectional study with retrospective data collection from archived records and reviewed maternal death reports. Our study lasted 8 months, from October 1, 2023 to May 31, 2024. The study covered maternal death files at the HGOPY over an 8-year period, from 1st of January 2016 to the 31st of December 2023. Data were processed and analyzed using Statitical Paquage for Social Science (SPSS) version 26.0. Results: We counted a total of 160 maternal deaths, of which 97 had been reviewed. We excluded 61 deceased women reviewed and retained 33. We recorded a cumulative total of 160 maternal deaths and 19,651 live births. The peak in the proportion of maternal deaths at the Yaoundé Gynaeco-Obstetric and Paediatric Hospital was in 2021, with a proportion of 0.013. No maternal deaths had been reviewed between 2016 to 2017. Most deaths (64%) occurred between 37 and 40 weeks. The majority (30.5%) were aged between 30 and 35. The data show that 80.6% of maternal deaths were due to direct obstetric causes, while 19.4% were due to indirect causes. Most deaths (69.4%) were preventable. Only 8.3% were not preventable. Conclusion: Concerted efforts must be made to adapt maternal death prevention and management strategies to local contexts in order to significantly reduce these alarming figures.
文摘Background: Birth weight has been identified as one of the most significant predictors of a child’s physical growth, development, and survival in later life. A quest to provide an answer on the impact of maternal anthropometry on neonatal birth weight necessitated this study. Materials and methods: It is a cross-sectional descriptive hospital based study that involved 130 participants selected using a systematic sampling method, utilizing a semi-structured, pre-tested interviewer administered questionnaire. Data were collected using a standard procedure and were summarized using proportions, and the Chi square test was used to explore the association between categorical variables. Predictors of birth weight were determined using logistic regression. The level of statistical significance was set at p Results: Participants had a mean age of 28.6 ± 5.1 years, mean weight of 72.2 ± 11.2 kg and mean height of 1.63 ± 0.07m while the mean fetal birth weight was 3.10 ± 0.56 kg. There was a significant association between maternal delivery body mass index and neonatal birth weight (p Conclusion: The prevalence of low birth weight and macrosomia in this study population was high. The focus should be geared towards balanced nutrition support for all mothers at booking so as to mitigate the risks associated with these extremes of birth weight.
文摘Introduction: The Coronavirus pandemic was responsible for an unprecedented health crisis that shook the world with its high contagiousness and lethality. Its impact on maternal and fetal health places pregnant women at high risk. The aim of our study was to determine the factors associated with the occurrence of COVID-19 in pregnant women, and the maternal and perinatal outcomes of infected patients. Methodology: This was a case-control study involving 42 cases matched to 42 controls recruited from two public and tertiary hospitals in the cities of Yaoundé and Douala over a period from November 31 to May 31, 2024. Cases were defined as deliveries or records of COVID-19 deliveries confirmed positive by reverse transcription polymerase chain reaction (RT-PCR) or by a COVID-19 rapid diagnostic test (Covid-RDT). Controls were defined as deliveries or records of deliveries negative to the same test. They were matched by the hospital. Non-consenting births and unusable records were excluded. The data collected were recorded on a pre-established, pretexted data sheet examining sociodemographic, clinical characteristics and maternal and perinatal outcomes which were then analyzed using SPSS version 23.0 software. Results: After multivariate analysis, the independent sociodemographic factors were: belonging to the [30 - 40] age group (OR: 4.4;P = 0.010), being married (OR: 8.1;P = 0.030);being unemployed (OR: 3;P = 0.040). Independent clinical factors were: being in the third trimester of pregnancy (OR: 1.1;P = 0.017), being diabetic (OR: 5;P = 0.033) and being obese (OR: 11.5;P = 0.043). Independent factors associated with maternal outcome were: caesarean section (OR: 10;P = 0.001);admission to intensive care (OR: 30.7;P = 0.013);SO2 ≤ 94% (OR: 11.7;P = 0.033);HR > 100 (OR: 15.5;P = 0.001). Independent factors associated with perinatal outcome were: weight Conclusion: The factors associated with the occurrence of COVID-19 in pregnant women are multiple, and maternal outcome depends on its condition on admission, and has a significant impact on perinatal health, including mode of delivery. Emphasis must be placed on prevention and optimal management of these associated factors.
文摘Background: The maternal and neonatal morbidity caused by prolonged labour, maternal exhaustion and other factors push clinicians to speed up the delivery process by employing equipment such as vacuum suction or forceps to save the newborn. The purpose of this study was to determine the prevalence of vacuum-assisted vaginal delivery (VAVD) and its associated short-term maternal and neonatal outcomes at Ndola Teaching Hospital. Methods: A retrospective cross-sectional descriptive study through the analysis of routine data for women with singleton-term pregnancies who delivered by vacuum compared with spontaneous vaginal delivery was done at a tertiary hospital for the years 2020 and 2021. Chi-square and Logistic regression were used to investigate factors of vacuum delivery and to adjust for potential confounders. Results: Results showed that VAVD was mostly performed in women who had delayed second stage of labour (25.4%), maternal exhaustion (16.0%), foetal distress in the second stage of labour (12.3%). The overall VAVD prevalence was 3.7% (581/15591). Logistic regression showed that multiparous women were noted to be 87.5% (aOR 0.125;95% CI 0.025 - 0.629;p = 0.012) less likely to undergo VAVD compared to nulliparous women. Registrars were almost 6 times (aOR 5.650;95% CI 1.458 - 22.222, p = 0.012) more likely to conduct VAVD compared to midwives. Episiotomy was 3 times (aOR 3.390;95% CI 1.185 - 9.524;p Conclusion: The findings indicate the underutilisation of VAVD at NTH based on the low prevalence of 3.7%. VAVD outcomes were affected by multiparity, skill level and Episiotomy procedure, in addition, VAVD influenced admission to the NICU. Hence, there is a need to increase skills in VAVD among first-line healthcare workers such as midwives and intern doctors.
文摘Introduction: Uterine rupture is certainly one of the most serious, as it immediately jeopardises the vital prognosis of the mother and foetus. It is a common obstetric tragedy in our delivery rooms in countries with limited resources, reflecting the poor quality of obstetric care and, consequently, an unmet obstetric need. Methods: This was a descriptive and analytical cross-sectional study with prospective data collection over a four-year period from 1 January 2020 to 31 December 2023 at the University Hospital Centre (CHU) of Bouaké, in the Obstetrics and Gynaecology Department. The variables studied were epidemiological characteristics, therapeutic aspects and factors associated with maternal. Results: The prevalence of uterine rupture was 0.63%. The average age was 32, with patients aged 35 and over accounting for 33.68%, married 44.21% and 70% not in education. Patients with uterine rupture had been evacuated in 85.26% of cases. Uterine rupture was diagnosed in 97.89% of cases during labour. Maternal lethality due to rupture was 15.79%. The causes of maternal death were dominated by haemorrhagic shock (53.33%). Factors statistically associated with death were age ≥ 35 years (OR: 3.14), duration of labour ≥ 12 hours (OR: 5.8), multiparity (OR: 19.04), admission delay beyond 2 hours (OR: 4.36), haemoglobin level ≤ 7 g/dl (OR: 36.84), coma or obnubilation (OR: 71.82), haemorrhagic shock (OR: 243.94) and occurrence of post-operative complications (OR: 76.45). Conclusion: The frequency of uterine rupture remains significant in the department (0.63%), with maternal mortality still high (15.79%). The key to reducing uterine rupture and its consequences lies in timely referral and early, appropriate management.
文摘Introduction: The objective of this work was to study maternal deaths noted on arrival in the Gynecology and Obstetrics Department at Fousseyni Daou Hospital in Kayes over a period of 10 years. Materials and Methods: This was a cross-sectional, descriptive study with data collection over a period of 10 years;The data collection was retrospective over nine years from January 1, 2013 to December 31, 2021 and prospective over one year from January 1, 2022 to December 31, 2022. This study focused on all patients whose death was noted on arrival during pregnancy, labor or in the postpartum period in the Gynecology-Obstetrics Department of Fousseyni Daou Hospital. Confidentiality and anonymity were respected. The processing and analysis of statistical data were carried out using SPSS 20.0 software. Results: During the study period, we recorded 93 cases of death noted on arrival out of a total of 606 maternal deaths, i.e., a frequency of 15.34%. The average age was 27 years with the extremes of 20 years and 34 years. They came mainly from rural areas at 74%, were married at 82%, uneducated at 51.6%, housewives at 87.1%. The profession of the spouses is worker at 37.6%. In our sample, evacuated patients were the most represented with 75.3%. Postpartum hemorrhage was the most frequent reason for admission with 22.6%. The deceased patients had no medical history at 86%. In our series, 59.5% of the deceased patients had not had antenatal consultations (CPN). Patients who died on arrival and who had given birth at home were the most represented with 54.8%. Deaths from immediate postpartum hemorrhage complicated by shock were the most frequent with 25.8% followed by severe anemia 8.6%. Deaths were mainly due to direct obstetric causes at 76.3%. In these deaths observed on arrival, the 2nd delay was identified at 48.4%. Conclusion: Maternal deaths observed on arrival remain frequent in the Kayes region. The main causes are immediate postpartum hemorrhage and anemia, which are almost all preventable causes of maternal death following the 1st and 2nd delay.
基金German research Foundation(DFG,grant numbers:CH2321/1–1 and SCHO1231/7–1)JH has received a scholarship from the Chinese Scholarship Council(CSC No.:201908350115).
文摘The oviduct epithelium is the initial maternal contact site for embryos after fertilization,offering the microenviron-ment before implantation.This early gestation period is particularly sensitive to stress,which can cause reduced fertil-ity and reproductive disorders in mammals.Nevertheless,the local impact of elevated stress hormones on the ovi-duct epithelium has received limited attention to date,except for a few reports on polyovulatory species like mice and pigs.In this study,we focused on the effects of chronic maternal stress on cattle,given its association with infertil-ity issues in this monoovulatory species.Bovine oviduct epithelial cells(BOEC)differentiated at the air–liquid interface(ALI)were stimulated with 250 nmol/L cortisol for 1 or 3 weeks.Subsequently,they were assessed for morphology,bioelectrical properties,and gene expression related to oviduct function,glucocorticoid pathway,cortisol metabo-lism,inflammation,and apoptosis.Results revealed adverse effects of cortisol on epithelium structure,featured by deciliation,vacuole formation,and multilayering.Additionally,cortisol exposure led to an increase in transepithelial potential difference,downregulated mRNA expression of the major glucocorticoid receptor(NR3C1),upregulated the expression of cortisol-responsive genes(FKBP5,TSC22D3),and significant downregulation of oviductal glycopro-tein 1(OVGP1)and steroid receptors PGR and ESR1.The systematic comparison to a similar experiment previously performed by us in porcine oviduct epithelial cells,indicated that bovine cultures were more susceptible to elevated cortisol levels than porcine.The distinct responses between both species are likely linked to their divergence in the cortisol-induced expression changes of HSD11B2,an enzyme controlling the cellular capacity to metabolise cortisol.These findings provide insights into the species-specific reactions and reproductive consequences triggered by maternal stress.
基金sponsored by National Natural Science Foundation of China(81800703)Postdoctoral Fellowship Program of China Postdoctoral Science Foundation(GZC20231088)+8 种基金Beijing Nova Program(Z201100006820117 and 20220484181)Beijing Municipal Natural Science Foundation(7184252)the Fundamental Research Funds for the Central Universitiesthe Fundamental Research Funds for the Central Universities(BMU2021MX013)Peking University Clinical Scientist Training Program(BMU2023PYJH022)Peking University Medicine Seed Fund for Interdisciplinary ResearchChina Endocrine and Metabolism Young Scientific Talent Research Project(2022-N-02-01)China Diabetes Young Scientific Talent Research ProjectBethune-Merck Diabetes Research Fund of Bethune Charitable Foundation。
文摘Maternal consumption of a high-fat diet has been linked to increased risks of obesity and impaired glucose metabolism in offspring.However,the precise epigenetic mechanisms governing these intergenerational effects,particularly during the early stages of offspring development,remain poorly understood.In this study,female C57BL/6J mice were randomly assigned to either a high-fat diet or normal chow diet throughout gestation and lactation.Methylated DNA immunoprecipitation(MeDIP)coupled with microarray analysis was employed to identify differentially methylated genes in the livers of offspring at weaning age.We found that maternal high-fat diet feeding predisposes offspring to obesity and impaired glucose metabolism as early as the weaning period.DNA methylation profile analysis unveiled a significant enrichment of differentially methylated genes within the natural killer(NK)cell-mediated cytotoxicity pathway.MeDIP-PCR validated reduced methylation levels of specific genes within this pathway,including tumour necrosis factorα(TNF-α),phosphoinositide 3-kinase(PI3K),and SHC adaptor protein 1(SHC1).Consistently,the expressions of TNF-α,PI3K,and SHC1 were significantly upregulated,accompanied by elevated serum TNF-αand interleukin-6(IL-6)levels in offspring from dams fed with high-fat diet.Moreover,we assessed the expressions of genes associated with NK cell activities,uncovering a notable rise in hepatic granzyme B levels and a trend towards increased CD107a expression in offspring from dams fed a high-fat diet.In addition,methylation levels of TNF-α,PI3K,and SHC1 promoters were inversely correlated with glucose response during glucose tolerance testing.In conclusion,our findings underscore the critical role of the NK cell-mediated cytotoxicity signaling pathway in mediating DNA methylation patterns,thereby contributing to the programming effects of maternal high-fat diet consumption on offspring glucose metabolism as early as the weaning period.
基金The research received approval from Children’s Hospital of Shanxi Committee (Approval Number:KLT6230511).
文摘BACKGROUND Food insecurity(FI)during pregnancy negatively impacts maternal health and raises the risk of gestational diabetes mellitus(GDM)and pregnancy-induced hypertension(PIH),resulting in adverse outcomes for both mother and baby.AIM To investigate the relationships between FI and pregnancy outcomes,particularly GDM and PIH,while also examining the mediating role of the dietary diversity score(DDS).METHODS A cross-sectional study was undertaken to examine this relationship,involving 600 pregnant women.Participants were women aged 18 years or older who provided complete data on FI and pregnancy outcomes.The FI was measured via the Household Food Security Survey Module,with GDM defined as fasting plasma glucose levels of≥5.1 mmol/L or a 2-hour oral glucose tolerance test value of≥8.5 mmol/L.The DDS is determined by evaluating one's food consumption based on nine distinct food groups.A logistic regression model was used to explore the relationship between FI and PIH,and GDM.RESULTS Seventeen percent of participants reported experiencing FI during pregnancy.The study found a significant association between FI and an elevated risk of GDM[odds ratio(OR)=3.32,95%CI:1.2-5.4].Once more,food-insecure pregnant women had higher rates of PIH(OR=0.10,95%CI:0.02-0.45)and they also faced a higher likelihood of neonatal complications,such as neonatal intensive care unit’s admissions and the birth of infants with extremely low birth weight.The FI wasfurther linked to metabolic disruptions,such as elevated fasting blood sugar(FBS),low-density lipoprotein cholesterol,and triglyceride levels.Our results indicate that the DDS acts as a significant mediator in the relationship between FI and the incidence of GDM.In particular,the mediation analysis showed that approximately 65%of the effect was mediated through DDS(P=0.002).CONCLUSION These findings underscore the serious challenges that FI presents during pregnancy and its effects on maternal and infant health.Additionally,the study explored how DDS mediates the relationship between FI and the incidence of GDM.
文摘Introduction:Diabetes mellitus(DM),a metabolic disorder,leads to organ damage due to chronic hyperglycemia with multiple pathogenic processes.Gestational diabetes mellitus(GDM)poses risks to mothers and offspring,increasing the incidence of structural congenital heart disease(CHD)and myocardial hypertrophy in newborns.Objective:This review aimed to examine the association between maternal diabetes mellitus and CHD.Methods:This systematic review used the STROBE and TRIPOD checklists registered in PROSPERO(CRD42024513858).It focused on diagnostic test accuracy using the Munn et al.protocol for systematic assessment,emphasizing the“PIRD”:Population,Index Test,Reference Test,Diagnosis of Interest.This review aimed the following PIRD model question:‘Does diabetic pregnant woman inffuence in fetal cardiac malformation?’using PRISMA 2020 statement.A systematic review was conducted on 19 October 2023 in the following databases:PubMed/MEDLINE,Embase(Elsevier),CINAHL(EBSCO),Scopus(Elsevier),Web of Science(Clarivate Analytics),LILACS,and SciELO.Only articles in English,Spanish,and Portuguese languages were selected.Results:Seven studies between 2018 and 2023 were selected.The studies differed in terms of the cardiac ultrasound parameters used to assess CHD and diagnose diabetes mellitus in pregnancy.They highlight the importance of fetal echocardiography in detecting CHD prenatally and assessing the impact of diabetes mellitus on fetal cardiac health,recommending proactive care planning and early intervention for better outcomes.Conclusions:The studies highlight the impact of maternal diabetes mellitus,particularly GDM,on fetal cardiac development and support early detection by fetal echocardiography.Standardization and collaboration are essential to reffne management and outcomes in high-risk pregnancies.
文摘This study evaluated the effectiveness of Chinese herbal foot bath therapy in improving sleep quality among postpartum women of advanced maternal age.A quasi-experimental design was used,involving 60 participants with sleep disturbances recruited from Zouping County Traditional Chinese Medicine Hospital.Participants were divided into control and experimental groups,and sleep quality was assessed using the Pittsburgh Sleep Quality Index(PSQI)before and after the intervention.The experimental group received Chinese herbal foot bath therapy,while the control group did not.Post-intervention results showed a significant improvement in sleep quality for the experimental group,with a mean PSQI score of 7.79(SD=2.90),compared to 13.45(SD=2.57)in the control group,indicating continued poor sleep.Statistical analysis confirmed that the therapy led to significant improvements across overall and component PSQI scores.The study concludes that Chinese herbal foot bath therapy is a safe,non-invasive,and cost-effective method to enhance sleep quality among postpartum women,especially those of advanced maternal age.It holds promise as a complementary treatment option and could be integrated into standard postpartum care practices to address sleep disturbances without relying on pharmacological interventions.
基金Supported by the Wuxi Municipal Health Commission Maternal and Child Health Research Project,No.FYKY202202.
文摘BACKGROUND The full implementation of the national two-child policy has presented significant challenges in ensuring the safety of pregnant women.AIM To investigate the effect of cervical balloon fluid volume on maternal processes,maternal and infant outcomes,and anxiety during pregnancy.METHODS A total of 100 singleton term pregnancies with cervical maturity induction and anxiety were selected using a lottery method;50 women were included.Cervical balloons were used for all participants.In the control group,80 mL of fluid was injected into both balloons;in the observation group,80 and 100 mL were injected into the vaginal and cervical balloons,respectively.The two groups were compared for cervical maturity,labor duration,anxiety,maternal and infant outcomes,and effects on cervical ripening.RESULTS After treatment,the cervical maturity test(Bishop)score was significantly higher in the observation group(9.76±1.19)than in the control group(7.62±0.83),and the Hamilton Anxiety Scale score was lower in the observation group(7.32±0.85)than in the control group(13.05±1.12).The observation group showed higher rates of natural delivery and lower rates of cesarean section than the control group.The first and total stages of labor were shorter in the observation than in the control group;no significant differences were found in the second and third stages.The incidence of complications was lower in the observation group[1(2.00%)vs 9(18.00%)for complications;49(98.00%)vs 41(82.00%)for non-complications].CONCLUSION The selected fluid volumes to promote cervical maturity and induce labor stabilize maternal mood,increase the natural delivery rate,shorten labor,and improve maternal and infant outcomes.
基金supported by grants from the National Natural Science Foundation of China(Grant No.82401994)the Top Medical Expert Team of the Wuxi Taihu Talent Plan(Grant Nos.DJTD202106,GDTD202105)+1 种基金the Medical Key Discipline Program of theWuxi Health Commission(Grant Nos.ZDXK2021007,CXTD2021005)Top Talent Support Program for Young and Middle-Aged People of Wuxi Health Committee(Grant No.HB2023079).
文摘Theincreasing prevalence of gestational diabetesmellitus(GDM)is associated with an array of pregnancy complications and enduring health challenges in bothmothers and their offspring.Studies have indicated that exposure to the intrauterine environment can prompt adaptations in the offspring,thereby programming transgenerational inheritance.Physical activity during pregnancy,as a non-pharmacological intervention,mitigates metabolic risks through epigenetic modifications,mediating placental adaptations,the action of exercise factors,and gut microbiota.Here,we provide a review summarizing how regular exercise can reduce the risk of GDM and positively influence pregnancy outcomes.It also discusses the exercise-induced reduction in obesity,insulin resistance,and fatty liver disease in the offspring of GDM,outlining the mechanisms that underpin these health benefits.This review underscores the importance of exercise in safeguarding the health of GDM mothers and their offspring.
文摘Objective: To examine the effects of comprehensive nursing interventions on maternal and infant outcomes in pregnant women diagnosed with gestational diabetes mellitus (GDM). Methods: A quasi-experimental design was employed, involving 60 pregnant women with GDM who were purposively selected and randomly allocated into experimental and control groups, each comprising 30 participants. The experimental group received comprehensive nursing interventions and pregnancy monitoring, while the control group received standard nursing care. Data collection was conducted using demographic questionnaires, pregnancy indicators, and maternal-infant outcome measurement tools. The collected data were analyzed using Microsoft Excel and the Statistical Package for Social Sciences (SPSS). Results: The findings indicated significant improvements in fasting blood glucose, postprandial blood glucose, amniotic fluid index, and neonatal birth weight in the experimental group compared to the control group. However, no statistically significant differences were observed in body mass index (BMI) or pregnancy weight gain. Comprehensive nursing interventions were associated with a significant reduction in maternal complications, including polyhydramnios, postpartum hemorrhage, and preeclampsia, as well as neonatal complications such as neonatal pneumonia, macrosomia, and hypoglycemia. Conclusion: Comprehensive nursing interventions have a positive impact on maternal and neonatal outcomes in pregnant women with GDM.
文摘OBJECTIVES:To investigate the effect of Bushen Tongluo recipe(BSTLR, 补肾通络方) on rats with diabetic kidney disease(DKD) and to explore the underlying mechanism of action. METHODS:The rat model of DKD was established, and rats were treated with different doses of BSTLR. Body weight and the levels of urinary protein, α1-microglobulin, glucose, blood urea nitrogen, creatinine, Cystatin C, superoxide dismutase, malondialdehyde, and catalase were analyzed biochemically or by enzyme-linked immunosorbent assay. The pathological damage to renal tissues was assessed by hematoxylin-eosin staining. Immunohistochemical staining was carried out to detect the expression levels of fibronectin, E-cadherin, α-smooth muscle actin, laminin, vimentin, collagen type Ⅳ in kidney tissues. Western blot analysis was conducted to analyze the expression levels of Nephrin, Desmin, Podocin, transforming growth factor-β1, mothers against decapentaplegic homolog 3(Smad3), Notch1, jagged, hairy and enhancer of split 1(Hes1) in kidney tissues, and the expression levels of maternally expressed gene 3(MEG3) and mi R-145 were measured by quantitative reverse transcription-polymerase chain reaction. Moreover, dual-luciferase reporter assay was employed to verify the binding of mi R-145 to MEG3. RESULTS:BSTLR increased the body weight of DKD rats, effectively ameliorated the renal function and pathological injury in DKD, regulated the balance of renal oxidative stress, inhibited the TGF/Notch signaling pathway, and affected the variations in the lnc RNA MEG3/mi R-145 axis. CONCLUSION:BSTLR improved oxidative stress homeostasis, inhibited the TGF/Notch signaling pathway, and regulated the lnc RNA MEG3/mi R-145 axis, effectively delaying the progression of DKD.
文摘Background: Dying in childbirth is one of the most common causes of death for women. While maternal mortality rates, defined as deaths per 100,000 live births, have been steadily dropping in most countries worldwide, maternal mortality rates have doubled in the United States in the last twenty years. This commentary examines the various contributing factors to this trend. Methods: A literature review was performed using the keywords: maternal mortality, United States, disrespectful maternity care, obstetric violence, provider perspectives, and disparities. Maternal mortality statistics were obtained from the World Health Organization website. Results: Medical factors associated with maternal mortality include increased maternal age and cardiovascular conditions. Social factors include barriers to healthcare access, delays in receiving medical care, reduction in reproductive health services in some states, and non-obstetrical deaths such as accidents, domestic violence, and suicide. Racial inequities and disparities of care are reflected in higher maternal mortality rates for minorities and people of color. Disrespectful maternity care or obstetric violence has been reported worldwide as a factor in delay of lifesaving obstetrical care and reluctance by a pregnant person to access the healthcare system. About one in five US women has reported experiencing mistreatment, varying from verbal abuse to lack of privacy, from coerced procedures to neglect during childbirth. Conclusion: This commentary highlights the importance of inclusion of providers in research on respectful maternity care. Provider burnout, moral distress, limited time, and burden of clinical responsibilities are known challenges to respectful and comprehensive medical care. The association of disrespectful care with poor maternal outcomes needs to be studied. Exploring root causes of disrespectful childbirth care can empower nurses, midwives, and physicians to improve their environment and find solutions to reduce a potential cause of maternal mortality.
文摘Introduction: Pregnancies at advanced maternal age (AMA) are those occurring after the age of 35 years old. They carry a high risk of maternal-fetal morbidity and mortality, thus constituting a public health problem. Several African countries have reported an upward trend in both the age of childbirth and the frequency of women with AMA over the past 20 years. In the Democratic Republic of Congo (DRC), where maternal and neonatal morbidity and mortality remain very high, data on AMA pregnancies go back more than 20 years. Objective: We propose evaluating obstetrical outcomes among women in AMA in our setting and the associated factors. Methods: This retrospective cohort study will be conducted in two healthcare facilities (ESS) in Kinshasa. The study population will consist of all women who delivered a single fetus after 28 weeks of gestation between January 2012 and December 2022 (10 years) in the selected ESS. The data collected will be analyzed using R software version 4.2.0. Quantitative variables will be summarized as means with standard deviation or medians with interquartile range. Qualitative variables will be presented as proportions (%). Multivariate logistic regression will be used to determine the main maternal-fetal complications associated with AMA and predictors of obstetric outcomes. P Discussion: The high maternal and infant mortality rates in DRC are among the highest in the world. The context of maternal age has become a topic of growing interest due to its potential implications for the health of women and newborns, it is crucial to identify the risk factors associated with obstetric outcomes by identifying obstetrical outcomes associated with advanced maternal age in the DRC. Many Congolese women tend to start their maternity journey at a relatively young age. However, there is also an emerging trend towards delayed childbearing, particularly in urban areas and among women with access to education and family planning services. Conclusion: The results of this study will enable us to update the frequency of AMA pregnancies in our environment. The socio-demographic and clinical profile of these pregnancies will be determined. The main maternal-fetal complications associated with AMA in our setting and the associated factors will be identified.
基金The San Juan Bautista School of Medicine’s Institutional Review Board approved the study(EMSJBIRB-7-2021).
文摘Background:Given the pervasive issues of obesity and diabetes both in Puerto Rico and the broader United States,there is a compelling need to investigate the intricate interplay among body mass index(BMI),pregesta-tional,and gestational maternal diabetes,and their potential impact on the occurrence of congenital heart defects(CHD)during neonatal development.Methods:Using the comprehensive System of Vigilance and Surveillance of Congenital Defects in Puerto Rico,we conducted a focused analysis on neonates diagnosed with CHD between 2016 and 2020.Our assessment encompassed a range of variables,including maternal age,gestational age,BMI,pregestational diabetes,gestational diabetes,hypertension,history of abortion,and presence of preeclampsia.Results:A cohort of 673 patients was included in our study.The average maternal age was 26 years,within a range of 22 to 32 years.The mean gestational age measured 39 weeks,with a median span of 38 to 39 weeks.Of the 673 patients,274(41%)mothers gave birth to neonates diagnosed with CHD.Within this group,22 cases were linked to pre-gestational diabetes,while 202 were not;20 instances were associated with gestational diabetes,compared to 200 without;and 148 cases exhibited an overweight or obese BMI,whereas 126 displayed a normal BMI.Conclusion:We identified a statistically significant correlation between pre-gestational diabetes mellitus and the occurrence of CHD.However,our analysis did not show a statistically significant association between maternal BMI and the likelihood of CHD.These results may aid in developing effective strategies to prevent and manage CHD in neonates.
文摘Hypertensive disorders of pregnancy are among the leading causes of severe maternal morbidity and mortality, particularly in developing countries. Hypertensive disorders of pregnancy are among the leading causes of severe maternal morbidity and mortality, particularly in developing countries, maternal hypocalcaemia being a factor favouring the onset of arterial hypertension during pregnancy. The aim was to determine the maternal and perinatal prognosis of patients with hypertensive disorders of pregnancy as a function of serum ionised calcium levels. Material and Methods: A cross-sectional analytical study of 114 patients with arterial hypertension during pregnancy or during pregnancy or in the postpartum period at the HGR/Panzi from 1 January 2021 to 30 June 2022, text was entered using Microsoft Office Word 2010 and the tables were analysed using Excel 2010. The data was analysed using SPSS version 20.0 and Stata 14.0. The associations of the variables were calculated using Pearson's chi-square test, with a significance threshold set at a value of p < 0.05. Study of risk factors, Odds ratios and their confidence intervals were estimated in a univariate analysis. The most determining factors were identified by multivariate analysis using the Forward conditional logistic regression model. Results: The mean gestational age was 34.43 ± 4.327 amenorheas weeks, 46.6% of patients had a vaginal delivery, 66.65% of which were indicated for maternal prognosis, maternal complications were associated with maternal hypocalcaemia in 81, 82% (P = 0.043) and an OR = 3.255 (P = 0.0158) threefold risk that the patient presenting with a complication is likely to be in a state of hypocalcaemia at 95% confidence index, and fetal prognosis was not significantly related to maternal calcaemia. Conclusion: Maternal hypocalcaemia is one of the factors that can influence maternal-foetal complications maternal-fetal complications, early management and prevention of this pathology is pathology is important to reduce maternal-fetal morbidity and mortality.
