scholarly journals Management of Pregnant Women after Bariatric Surgery

2018 ◽  
Vol 2018 ◽  
pp. 1-14 ◽  
Author(s):  
Jürgen Harreiter ◽  
Karin Schindler ◽  
Dagmar Bancher-Todesca ◽  
Christian Göbl ◽  
Felix Langer ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Pregnant Women ◽  
Daily Intake ◽  
Reproductive Age ◽  
Nutritional Deficiencies ◽  
Current Evidence ◽  
Oral Glucose ◽  
Effective Treatment Option ◽  
Glucose Levels ◽  
In Pregnancy

The prevalence of obesity is growing worldwide, and strategies to overcome this epidemic need to be developed urgently. Bariatric surgery is a very effective treatment option to reduce excess weight and often performed in women of reproductive age. Weight loss influences fertility positively and can resolve hormonal imbalance. So far, guidelines suggest conceiving after losing maximum weight and thus recommend conception at least 12–24 months after surgery. As limited data of these suggestions exist, further evidence is urgently needed as well for weight gain in pregnancy. Oral glucose tolerance tests for the diagnosis of gestational diabetes mellitus (GDM) should not be performed after bariatric procedures due to potential hypoglycaemic adverse events and high variability of glucose levels after glucose load. This challenges the utility of the usual diagnostic criteria for GDM in accurate prediction of complications. Furthermore, recommendations on essential nutrient supplementation in pregnancy and lactation in women after bariatric surgery are scarce. In addition, nutritional deficiencies or daily intake recommendations in pregnant women after bariatric surgery are not well investigated. This review summarizes current evidence, proposes clinical recommendations in pregnant women after bariatric surgery, and highlights areas of lack of evidence and the resulting urgent need for more clinical investigations.

scholarly journals The Burden of Hyperglycemia First Detected in Pregnancy Among Indonesian Women

2020 ◽  
Author(s):  
Najmiatul Fitria ◽  
Ivan Surya Pradipta ◽  
Bobby Indra Utama ◽  
Maarten Postma ◽  
Antoinette van Asselt ◽  
...  
Keyword(s):  
High Risk ◽  
Maternal Health ◽  
Pregnant Women ◽  
Fasting Blood Glucose ◽  
World Health ◽  
Oral Glucose ◽  
High Risk Women ◽  
Glucose Levels ◽  
Risk Of Death ◽  
In Pregnancy

Abstract OBJECTIVE: Despite improvements, Indonesian maternal health falls short of the Sustainable Development Goals. Using contemporary electronic healthcare records, this study explored the burden of Hyperglycemia First Detected in Pregnancy (HFDP) and its association with the determinants of maternal health in Indonesia. METHODS: Electronic Health Records data were extracted on high-risk pregnant women without pre-existing diabetes who were screened for HFDP between 2014 and 2015 at two West Sumatera hospitals. Screening consisted of an oral glucose tolerance test (OGTT), grouping women into Diabetes In Pregnancy (DIP, glucose 126 mg/dl), Gestational Diabetes Mellitus (GDM, glucose 92-125 mg/dl), or high-risk women without elevated glucose levels (glucose < 92 mg/dl); following the World Health Organization (WHO) standard. Maternal and neonatal outcomes, including mortality, were associated with the three diabetes statuses, using general and generalized linear models (depending on the type of outcome) adjusted for maternal age and parity. RESULT: 3536 pregnant women were screened, of which 722 (21%) had HFDP; 655 (19%) were classified as GDM and 67 (2%) as DIP. Women with HFDP did not have a significantly higher risk of death: OR 1.36 (95%-CI 0.71-2.62) for GDM and 0.90 (95%-CI 0.12-6.67) for DIP. We did observe a significantly lower neonatal death rate for children born of GDM women, with three deaths (1%) compared to 178 (6%) in high-risk normal FBG women (p-value < 0.01). This observation was not replicated when comparing DIP to normal FBG women (OR 0.58; 95%-CI 0.26-1.29). CONCLUSION: The observed lack of difference in pregnancy outcomes between HFDP and pregnant women with normal fasting blood glucose levels (at the time of screening) reflects the considerable residual risk of these women. Nevertheless, have and calls for closer monitoring of high-risk women irrespective of their OGTT results. Larger sample-sized studies are warranted to replicate findings with sufficient accuracy to detect possibly smaller, but meaningful differences.

scholarly journals High burden of anemia among pregnant women in Tanzania: a call to address its determinants

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Bruno F. Sunguya ◽  
Yue Ge ◽  
Linda Mlunde ◽  
Rose Mpembeni ◽  
Germana Leyna ◽  
...  
Keyword(s):  
Food Insecurity ◽  
Pregnant Women ◽  
Reproductive Age ◽  
Gis Mapping ◽  
Demographic And Health Surveys ◽  
Health Coverage ◽  
Nutritional Knowledge ◽  
Women Of Reproductive Age ◽  
Anemia In Pregnancy ◽  
In Pregnancy

Abstract Background Anemia in pregnancy is behind a significant burden of maternal mortality and poor birth outcomes globally. Efforts to address it need evidence on trends and its pertinent factors as they vary from one area to another. Methods We pooled data of 23,203 women of reproductive age whose hemoglobin levels were measured from two Tanzania Demographic and Health Surveys (TDHS). Of them, 2,194 women were pregnant. Analyses employed descriptive analyses to determine the burden of anemia, its characteristics, and severity; GIS mapping to determine the regional changes of anemia between 2005 and 2015; and logistic regression to determine the remaining determinants of anemia among pregnant women using Stata 15. Results The burden of anemia among pregnant women in Tanzania has remained unprecedently high, and varies between regions. There was no significant decline of anemia in general between the two periods after adjusting for individual, households, reproductive, and child characteristics [AOR = 0.964, 95% CI = 0.774–1.202, p = 0.747). Anemia is currently prevalent in 57% of pregnant women in Tanzania. The prevalence is more likely to be higher among women aged 15–19 years than those aged between 20–34 years. It is more likely to be prevalent among those within large families, with no formal education, food insecurity, lack of health insurance, had no antimalaria during pregnancy, and had low frequency of ANC attendance. On the other hand, delivery in a health facility may be potentially protective against anemia. Conclusions Anemia in pregnancy remained persistently high and prevalent among 57% of pregnant women in Tanzania. Efforts to address anemia are crucial and need to be focused in regions with increasing burden of anemia among pregnant women. It is imperative to address important risk factors such as food insecurity, strengthening universal health coverage, empowering women of reproductive age with education and especially nutritional knowledge and advocating for early antenatal booking, attendance, and facility delivery.

scholarly journals Laboratory Testing for and Diagnosis of Nutritional Deficiencies in Pregnancy Before and After Bariatric Surgery

2014 ◽  
Vol 23 (2) ◽  
pp. 129-137 ◽  
Author(s):  
Meghana D. Gadgil ◽  
Hsien-Yen Chang ◽  
Thomas M. Richards ◽  
Kimberly A. Gudzune ◽  
Mary M. Huizinga ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Laboratory Testing ◽  
Nutritional Deficiencies ◽  
Before And After ◽  
In Pregnancy

scholarly journals Serum and urine vitamin D metabolite analysis in early preeclampsia

2018 ◽  
Vol 7 (1) ◽  
pp. 199-210 ◽  
Author(s):  
J A Tamblyn ◽  
C Jenkinson ◽  
D P Larner ◽  
M Hewison ◽  
M D Kilby
Keyword(s):  
Vitamin D ◽  
Pregnant Women ◽  
Reproductive Age ◽  
Vitamin D Metabolites ◽  
Serum Concentrations ◽  
Control Serum ◽  
Significant Difference ◽  
Paired Serum ◽  
In Pregnancy ◽  
Serum And Urine

Vitamin D deficiency is common in pregnant women and may contribute to adverse events in pregnancy such as preeclampsia (PET). To date, studies of vitamin D and PET have focused primarily on serum concentrations vitamin D, 25-hydroxyvitamin D3 (25(OH)D3) later in pregnancy. The aim here was to determine whether a more comprehensive analysis of vitamin D metabolites earlier in pregnancy could provide predictors of PET. Using samples from the SCOPE pregnancy cohort, multiple vitamin D metabolites were quantified by liquid chromatography–tandem mass spectrometry in paired serum and urine prior to the onset of PET symptoms. Samples from 50 women at pregnancy week 15 were analysed, with 25 (50%) developing PET by the end of the pregnancy and 25 continuing with uncomplicated pregnancy. Paired serum and urine from non-pregnant women (n = 9) of reproductive age were also used as a control. Serum concentrations of 25(OH)D3, 25(OH)D2, 1,25(OH)2D3, 24,25(OH)2D3 and 3-epi-25(OH)D3 were measured and showed no significant difference between women with uncomplicated pregnancies and those developing PET. As previously reported, serum 1,25(OH)2D3 was higher in all pregnant women (in the second trimester), but serum 25(OH)D2 was also higher compared to non-pregnant women. In urine, 25(OH)D3 and 24,25(OH)2D3 were quantifiable, with both metabolites demonstrating significantly lower (P < 0.05) concentrations of both of these metabolites in those destined to develop PET. These data indicate that analysis of urinary metabolites provides an additional insight into vitamin D and the kidney, with lower urinary 25(OH)D3 and 24,25(OH)2D3 excretion being an early indicator of a predisposition towards developing PET.

scholarly journals Glycemia after Betamethasone in Pregnant Women without Diabetes—Impact of Marginal Values in the 75-g OGTT

Healthcare ◽  
2020 ◽  
Vol 8 (1) ◽  
pp. 40
Author(s):  
Ioannis Kakoulidis ◽  
Ioannis Ilias ◽  
Anastasia Linardi ◽  
Aikaterini Michou ◽  
Charalampos Milionis ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Tolerance Test ◽  
Insulin Dosage ◽  
Oral Glucose ◽  
Glycemic Profile ◽  
Normal Glucose ◽  
Marginal Values ◽  
The Mean ◽  
Monitoring Treatment ◽  
In Pregnancy

Betamethasone (BM) administration in pregnancy has been shown to reduce the incidence and severity of neonatal respiratory distress syndrome. Its known diabetogenic impact, combined with placental insulin resistance, leads to a transient increase in glycemia. However, its effect on glucose homeostasis in pregnancy has not been adequately investigated. We closely monitored and assessed the glycemic profile of 83 pregnant women, with normal glucose metabolism, who were given BM during their hospitalization due to threatened premature labor. A significant change in the glycemic profile in most patients was noted, lasting 1.34 ± 1.05 days. Sixty-six of eighty-three women were eventually treated with insulin to maintain glycemia within acceptable limits. The mean ± SD insulin dosage was 12.25 ± 11.28 units/day. The need for insulin therapy was associated with higher BM doses and the presence of marginal values in the 75-g oral glucose tolerance test (OGTT) at 60 min. Our study demonstrates, following BM administration, the need for increased awareness and individualized monitoring/treatment of pregnant women with normal—yet marginal—values in the 75-g OGTT.

Inverse relation between fruit and vegetable intake and the risk of gestational diabetes mellitus

2019 ◽  
Vol 89 (1-2) ◽  
pp. 37-44 ◽  
Author(s):  
Parvin Mirmiran ◽  
Somayeh Hosseinpour-Niazi ◽  
Lida Moghaddam-Banaem ◽  
Minoor Lamyian ◽  
Azita Goshtasebi ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Pregnant Women ◽  
Vegetable Intake ◽  
Vegetable Consumption ◽  
Reproductive Age ◽  
Oral Glucose ◽  
Dietary Intakes ◽  
Fruit And Vegetable

Abstract. Background: The aim of this study was to investigate the association of intakes of fruit, vegetable and dairy with gestational diabetes mellitus (GDM). Methods: This prospective study was conducted over a 17 month period, on a random sample of pregnant women (n = 1026), aged 18–45 y, in their first half of pregnancy, attending prenatal clinics in five hospitals’ affiliated to universities of medical sciences in different districts of Tehran, Iran. Dietary intakes were assessed during gestational age ≤ 6 weeks using a 168-item validated semi-quantitative food frequency questionnaire. Between 24 and 28 weeks of gestation, all pregnant women underwent a scheduled 100 g 3-h oral glucose tolerance test. Diagnosis of GDM was based on criteria set by the American Diabetes Association. Results: Of 1026 study participants, 71 had GDM, with a mean age and pre-pregnancy BMI of 26.7 ± 4.3 y and 25.4 ± 4.5 Kg/m2, respectively. High fruit and vegetable intakes were negatively associated with GDM risk. Compared with women who consumed < 2.1 servings/day, odds ratio (ORs) for those who consumed ≥ 4.9 servings/day was 0.44 (95% CI: 0.20–0.93), after adjustment for confounding factors. Fruit and vegetable intakes were significantly and inversely associated with the GDM; ORs (95% CIs) for GDM among participants with the highest, compared to the lowest quartiles were 0.48 (0.18–0.89) for fruit and 0.46 (0.22–0.99) for vegetables intake. No association was found between dairy products and GDM. Conclusions: Fruit and vegetable consumption in women of reproductive age have beneficial effects in the prevention of GDM.

The Spiritual and Ethical Implications of Medication-Assisted Recovery in Pregnancy: Preserving the Dignity and Worth of Mother and Baby

2019 ◽  
Vol 46 (3) ◽  
Author(s):  
Cayce Watson ◽  
April Mallory ◽  
Amy Crossland
Keyword(s):  
Pregnant Women ◽  
Work Practice ◽  
Social Work Practice ◽  
Opioid Use Disorder ◽  
Current Evidence ◽  
Opioid Use ◽  
Community Based Interventions ◽  
Medication Assisted Treatment ◽  
Ethical Implications ◽  
In Pregnancy

Reducing harm, supporting autonomy, and affirming dignity are foundational values in social work practice.  Attempts to balance personal beliefs, faith, and ethical responsibilities with client-centered therapies can elicit internal conflicts for practitioners.  These challenges are even more evident when working with opioid dependent pregnant women in medication-assisted recovery.  Medication-assisted treatment (MAT) is evidence-based and a recommended first-line approach for treating opioid use disorder in pregnancy; however, neonates exposed to opiates, either street drugs or MAT, may develop neonatal abstinence syndrome (NAS).  Disagreement among treatment providers, insufficient resources for pregnant clients, and incomplete service delivery compound the stigma surrounding pregnant women living with opioid misuse.  This article explores current evidence and best practices for pregnant women with opioid use disorder, the spiritual and ethical dilemmas of social workers supporting a harm reduction approach, and recommendations for individual and community-based interventions that support the dignity and worth of both mother and baby.

AN EPIDEMIOLOGICAL STUDY ON THE PREVALENCE OF HYPOTHYROIDISM IN PREGNANT WOMEN AND ITS OUTCOME

2021 ◽  
pp. 48-50
Author(s):  
Vinita singh ◽  
Sneha kumari
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Pregnant Women ◽  
Neonatal Outcome ◽  
Reproductive Age ◽  
P Value ◽  
Overt Hypothyroidism ◽  
Thyroid Disorder ◽  
Neonatal Complications ◽  
In Pregnancy

Thyroid disorders are the most common endocrine disorders affecting women of reproductive age group Hypothyroidism is common in pregnancy with an estimated prevalence of 2-3% Maternal hypothyroidism leads to many maternal and perinatal complications like miscarriage, gestational diabetes mellitus, pre-eclampsia, pre-term labor, placental abruption, and fetal death. AIMS AND OBJECTIVE: To nd out the effect of hypothyroidism on the course of pregnancy, to study the neonatal outcome, to know the prevalence of subclinical and overt hypothyroidism in pregnant women. MATERIALS AND METHODS: This prospective study was conducted in the department of Obstetrics and Gynecology, Nalanda medical college and hospital, Patna. All pregnant women attending the obstetric unit during this period were included in the study after informed consent 10 ml of blood sample of pregnant women was drawn at the rst visit in the rst trimester; then it was centrifuged and stored at -70 degree Celsius until assays, which were done after delivery, TFT was assessed by quantitative analysis of serum TSH and FT4 (ELISA). The pregnancy outcome variables like miscarriages, preterm deliveries, IUGR, preeclampsia, anemia, low birth weight, intrauterine fetal demise, antepartum hemorrhage, stillbirth, postpartum hemorrhage, birth asphyxia were studied. The neonatal outcome was also studied. The statistical analysis was done using the odds ratio. P-value <0.05 was considered signicant. RESULTS: Out of the 250 pregnant women 25 had hypothyroidism (9.5%). The prevalence of subclinical hypothyroidism was more as compared to the overtone (Table 2). Abortions were seen in 12.5% of subclinical and 11.1% of overt hypothyroid women. PIH and abruptions were signicantly higher in subclinical cases (P<0.05) while in the overt group both complications were higher as compared to the normal women but the p-value was not signicant for abruption. More of the hypothyroid women had preterm delivery (37.5% in subclinical and 44.4% in the overt group), Regarding neonatal complications, IUD and Early neonatal deaths were signicantly higher in overt hypothyroidism (P<0.01) Hypothyroid women had more low birth weight babies (31.25% in subclinical and 35.5% in overt) and IUGR babies (18.70% in subclinical and 22.21% in overt), CONCLUSION: The present study shows that, though the occurrence of hypothyroidism in pregnancy is less yet it causes many maternal and neonatal complications therefore universal screening of thyroid disorder should be done in pregnancy.

Diagnosis and therapy of bacterial vaginosis in pregnancy

2014 ◽  
Vol 5 (3) ◽  
pp. 88-95 ◽  
Author(s):  
Kira Valentinovna Shalepo ◽  
Veronika Viktorovna Nazarova ◽  
Yuliya Nikolayevna Menukhova ◽  
Yelena Vasilyevna Shipitsyna ◽  
Alevtina Mikhailovna Savicheva
Keyword(s):  
Reproductive Health ◽  
Health Outcomes ◽  
Bacterial Vaginosis ◽  
Pregnant Women ◽  
Reproductive Age ◽  
Women Of Reproductive Age ◽  
Diagnosis And Therapy ◽  
In Pregnancy

Bacterial vaginosis (BV) is the most common vaginal disorder in women of reproductive age. This review presents literature data regarding a role of BV in adverse reproductive health outcomes, describes current methods used for BV diagnosis and issues of treatment of this disease in pregnant women.

Endocrine pancreatic function in women with gestational diabetes

1986 ◽  
Vol 113 (3_Suppl) ◽  
pp. S19-S23 ◽  
Author(s):  
Claus Kühl ◽  
Peter J. Hornnes
Keyword(s):  
Gestational Diabetes ◽  
Glucose Tolerance ◽  
Pregnant Women ◽  
Insulin Response ◽  
Normal Glucose Tolerance ◽  
Oral Glucose ◽  
Insulin Degradation ◽  
Insulinogenic Index ◽  
Insulin Responses ◽  
In Pregnancy

Abstract. Glucose tolerance deteriorates in normal human pregnancy but 99% of all pregnant women retain normal glucose tolerance whereas the remaining 1% develop abnormal glucose tolerance and are designated gestational diabetics. The possibility that glucose tolerance deteriorates in pregnancy because of diabetes-like changes in the secretory function of the endocrine pancreas has been investigated in gestational diabetics and healthy controls. Even though the insulin responses to oral glucose and mixed meals are equally large in gestational diabetics and normal pregnant women, the insulin responses of the gestational diabetics differ in two pertinent ways from those of the normals. First, a delayed insulin response is frequently seen, and second, the insulin response per unit of glycaemic stimulus (the 'insulinogenic index') is normally significantly lower than that of the normal pregnant women. Diabetes-like changes in the secretion of glucagon are not seen in neither group. Insulin degradation is unaffected by pregnancy and the proinsulin share of the total plasma insulin immunoreactivity does not increase in pregnancy. It is therefore likely that the main reason for the diabetogenicity of pregnancy is insulin resistance. Most pregnant women are able to increase their insulin secretion and thus overcome the resistance. Some pregnant women do, however, seem to have a more limited insulin secretory capacity which eventually may lead to the development of gestational diabetes.

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