- MVP Journal of Medical Sciences
- Stuart Campbell lecture: Hypertensive disorders in pregnancy: improving perinatal outcomes
- Perinatal outcomes of hypertensive disorders in pregnancy at a referral hospital, Southern Ethiopia
- Association between isolated hypothyroxinaemia in early pregnancy and perinatal outcomes
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Abstract Background: It was a retrospective observational study to know demographic factors, maternal and perinatal outcome in patients of hypertensive disorders of pregnancy admitted in a medical college and tertiary health care center. Introduction: Hypertensive disorders of pregnancy are one of the important cause of maternal morbidity and mortality in India. Delivery at early gestational age in patients of HDP is associated with high perinatal morbidity and mortality resulting from prematurity. LADA Latent Autoimmune Diabetes in Adults is by WHO defined as a variant of autoimmune type 1 diabetes, which is islet autoantibody positive, but not insulin requiring at the time of diagnosis [ 16 ].
Descriptive data if normally distributed were described by mean and standard deviation, if not normally distributed by median and range min and max. The non-parametric Mann-Whitney U-test, was used for not normally distributed data. All tests were two-sided.
MVP Journal of Medical Sciences
All variables were transformed to binary and tried in single regression analysis. Independent variables in each multiple regression can be derived from the tables, or the descriptions in the results section. There were pregnancies complicated by diabetes and pregnancies without diabetes, in total. Within the PDM group 37 women Mean maternal age for women with PDM was The T2DM mothers tended to be older, There were no maternal deaths, neither among mothers with or without diabetes.
Stuart Campbell lecture: Hypertensive disorders in pregnancy: improving perinatal outcomes
Mothers with any diabetes type, compared to the group without diabetes, had higher early-pregnancy BMI Complications of pregnancy and perinatal outcomes for women with any type of diabetes, or without diabetes in Kronoberg. Among mothers with diabetes, only birth week remained associated, AOR R 2 0. Factors affecting odds for delivery by Cesarean Section CS in mothers with any type of diabetes type 1, type 2 or gestational diabetes or no diabetes controls during pregnancy in Kronoberg.
COR crude odds ratio in logistic regression, forward Wald. Frequency of LGA among all mothers, with and without diabetes, was Only two children, in the PDM group, 4. Women with T1DM had a 9. In multiple regression analysis, among the mothers with any type of diabetes during pregnancy, the following factors remained significant for LGA after adjustment R 2 0. In multiple regression analysis the adjusted odds ratio AOR for marital status living alone tended to be 5. Among mothers with diabetes AOR R 2 0. The main daily dose of basal insulin during pregnancy and at the time for delivery was similar in the two groups.
There were no differences found in LGA or CS rates related to the use of, type of or dose of insulin during pregnancy. HbA1c levels or the type or dose of insulin used during pregnancy did not affect the risk for congenital malformations or intrauterine mortality. In this population based study we examined maternal and fetal outcomes and predisposing factors in all pregnancies complicated by diabetes during — within the whole Health Care Region Kronoberg in southern Sweden.
For comparison, a group of pregnancies not complicated by diabetes matched for age, parity and date of delivery, was investigated.
A French study found that the risk was increased in both overweight and obese mothers [ 17 ]. The women with GDM gained less weight during pregnancy, however, compared to those with PDM and to the control group, which is interpreted as an effect of the care given. Our findings are in agreement with a review that included papers of both T1DM and T2DM pregnancies — from many countries globally, that also found that women with T2DM were older It is noteworthy that even the mean weight of the T1DM mothers in early pregnancy was in the overweight range, in congruence with recent findings that obesity was common in T1DM patients, especially in the women, also from Kronoberg [ 20 ].
Women that have had GDM are more likely to develop T2DM than those with normal glucose tolerance during pregnancy, but studies vary in their estimates of risk [ 21 ].
A large Australian study of patients — found a cumulative risk for T2DM of Our study, in line with other studies worldwide, showed an association between the demographic characteristics of pregnant women and development of GDM. Ethnic origin has been demonstrated to have a large influence on the prevalence of gestational diabetes with mothers of Asian or African origin having respectively, four and two times higher risk to develop GDM, compared to mothers of Caucasian origin [ 25 , 26 ].
This finding is notable considering that there was a total of 9 and 3. This may indicate that there is a need for more vigilant monitoring of pregnant non-Caucasian women using lower fasting and post-load glucose thresholds to diagnose gestational diabetes [ 26 ]. This was also higher than the average in in Sweden, As all pregnancies complicated by any type of diabetes, and especially PDM, are followed more frequently with ultrasound, and if the fetal growth is considered abnormally increased a CS is scheduled for gestational week The increased rate of CS was in accordance with the findings of increased rates of CS in all pregnancies complicated by diabetes found in a retrospective study, from Israel [ 28 ].
Obesity and excessive weight gain during pregnancy have been associated with increased risk of LGA children [ 30 ]. The risk for LGA was 9. The etiology behind the increased risk of LGA in the T1DM pregnancies is not fully understood but findings point towards the effect of a disturbed maternal lipid metabolism with high levels of Free Fatty Acids FFAs and Triglycerides TG in the fetal metabolic environment, resulting in LGA neonates independently of maternal BMI and good glycemic control [ 33 ], so in T1DM pregnancies, fetal macrosomia is still a significant problem despite modern therapy, why further investigations are warranted [ 34 ].
There is no doubt, however, that globally there are many pregnant women with T2DM now, and that research to find ways to better their prognosis is urgent [ 37 ]. More specifically, two malformations one Morbus Down and one retentio testis and one late intrauterine death were observed in the T2DM group. This must, however, be interpreted with caution due to very few events and the limited number of pregnant women with T2DM in this cohort, but other factors like maternal obesity, might to some extent explain those results.
We found that early pregnancy BMI was a significant risk factor. One might also speculate, however, if the low proportion of adverse outcomes, except for LGA, in our study, is a result of the care providing model with extra involvement of specialized diabetes nurses. Obesity in pregnancies complicated by diabetes, especially type 1 diabetes, where obesity is now more prevalent, was found to be associated with increased risk of LGA neonates. That weight gain during pregnancy was lower among the pregnancies complicated by diabetes, and that the frequency of LGA, or other complications, except for delivery by Cesarean Section, was not elevated in the group with gestational diabetes, indicated that this model of antenatal diabetes care delivered mainly by specialist diabetes nurses may have contributed to the improved outcomes for GDM, and for pregestational type 1 and type 2 diabetes, except for level of HbA1c in the last trimester, which could be lower in women with T1DM, as could the prevalence of LGA children.
Neither had any influence on the design or conduction of the study, the interpretation of the results, or the decision to publish. Consent to participate was approved to be waived due to risk of missing selective groups with worst outcome, retrospective nature of study, and value of population based data.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Lena Lendahls, Email: es. Mona Landin-Olsson, Email: es. Maria Thunander, Email: es. National Center for Biotechnology Information , U. Hypertensive disorders in pregnancy remain a major global health issue not only because of the associated high adverse maternal outcomes but there is a close accompaniment of significant perinatal morbidity and mortality especially in Sub-Saharan Africa SSA.
However, the perinatal burden of HDP in Ghana has not been explored. We conducted this study to determine the perinatal outcomes of HDP at a tertiary hospital in Ghana. Data collection involved baseline review of all the obstetric population who had just delivered to identify those with HDP. An informed consent was obtained after which a structured questionnaire was adminstered to the hypertensive mothers. The medical records of the mothers and their babies were also reviewed to determine the perinatal outcome indicators of relevance to the study.
Perinatal outcomes of hypertensive disorders in pregnancy at a referral hospital, Southern Ethiopia
Data obtained were analyzed using SPSS version We included women with HDP and singleton births with a mean gestational age at delivery of Adverse perinatal outcomes determined include the following: 91 Also, stillbirth, early neonatal death, intrauterine growth restriction and low birth weight occurred in 25 6. Most of the adverse perinatal outcomes were significantly more common in those with preeclampsia compared to the other hypertensive disorders. There is a significant burden of perinatal morbidity and mortality associated with HDP in the Ghanaian obstetric population and these adverse outcomes were more prevalent in preeclampsia compared to the other hypertensive disorders.
Regular goal-oriented clinical audit into perinatal morbidity and mortality associated with HDP and an active multidisciplinary approach to the management of these disorders in the hospital might improve the clinical outcomes of women with maternal hypertension. Hypertensive disorders in pregnancy HDP remain a major global health issue not only because of the associated high adverse maternal outcomes but there is a close accompaniment of significant perinatal morbidity and mortality [ 1 , 2 , 3 ].
Although most obstetricians worry more about the risk of maternal death in women whose pregnancies are complicated by hypertensive disorders the risk of perinatal death is more daunting. The other side of the coin is the occurrence of serious short and long term complications in the surviving newborns such as the risk of neuro-developmental deficits especially in poorly resourced countries [ 1 ].
Generally, there is disproportionately high neonatal mortality in SSA and most of these occur during the first 4 weeks of life although being a newborn is not, in itself, a disease. It is estimated that for every early neonatal death there is another baby that is born dead stillbirth and HDP account for most of these perinatal losses especially in low resource settings [ 5 ]. The adverse perinatal outcomes associated with hypertensive disorders are generally referable to placental insufficiency, placental abruption and prematurity-related complications [ 2 , 3 ].
Perinatal mortality is a key indicator of maternal care and a reflection of the quality of obstetric and pediatric care available [ 5 ].
Association between isolated hypothyroxinaemia in early pregnancy and perinatal outcomes
Global perinatal mortality rate is estimated as 47 per total births with excessively wide disparity between the developed 10 per births and less developed regions such as West Africa 76 per births. In Ghana, the perinatal mortality is estimated as 45 per deliveries [ 5 ]. More recently, the maternal outcomes associated with HDP at KBTH were determined and a high burden of maternal morbidity and mortality were reported [ 6 ].
- Stuart Campbell lecture: Hypertensive disorders in pregnancy: improving perinatal outcomes.
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However, the data regarding perinatal outcomes of these heavily prevalent disorders are lacking in our indigenous setting. In KBTH, where the current study was undertaken, there is a general knowledge based on clinical practice and expert opinion among the obstetric and pediatric healthcare providers that HDP accounts significantly for a high proportion of perinatal adverse events although scientific documentation of this clinical impression is limited. The objective of the study was to determine the perinatal outcomes of hypertensive disorders in pregnancy among pregnant women obtaining maternity and childbirth services at Korle Bu Teaching Hospital in Accra, Ghana.
In this study, we included all women with hypertensive disorders in pregnancy delivering at KBTH who consented to partcipate in the study. Women with twin gestations were also excluded from the study to avoid their potential confounding effect on the adverse perinatal outcomes associated with HDP. After the initial daily baseline data extraction on all the parturient, women with hypertensive disorders were identified and their folder numbers recorded. These women were then assigned study identification numbers after which they were then traced to their respective maternity wards where they had been admitted following delivery.
This selected group of women were approached and informed to be included in the study and those who gave written informed consent were included. The purpose of the study was explained to the mothers independently prior to data collection and they were informed that their participation was purely voluntary. The mothers were also informed that failure to participate in or withdraw from the study would not upset the quality of care they would receive for their respective medical conditions.
Their basic socio-demographic characteristics were obtained using a structured questionnaire and their medical records were also reviewed to determine the perinatal outcomes of their pregnancies. The babies of these women including those admitted to the neonatal intensive care unit-NICU were followed up on daily basis to find out if they had developed any complication till they were discharged from the hospital.
The data obtained from the interviews and the medical records included socio-demographic information such as age, educational status, marital status and obstetric data such as gravidity, parity, gestational age at booking and delivery. The maternal outcomes associated with HDP have recently been published elsewhere [ 6 ].
Perinatal outcomes indicators determined included birth weight, neonatal respiratory distress, the need for NICU admission, APGAR scores, stillbirths and neonatal deaths.