Midwives' Knowledge, Attitudes, and Practice Regarding COVID-19 Vaccination for Pregnant Women: A Nationwide Web-Based Survey in Italy

This cross-sectional survey investigated the knowledge, attitudes, and practices concerning the COVID-19 vaccination for pregnant women among midwives in Italy and the associated factors. Midwives with at least five years of midwifery education and who had received information about the COVID-19 vaccination from official government organizations or scientific journals were more likely to know in which trimester this vaccine can be administered. A higher perceived utility of this vaccination was observed among midwives working in the public sector, in those concerned by being infected by SARS-CoV-2, who have received at least one dose of this vaccination, in those who considered COVID-19 a severe disease for pregnant women and their fetus, and who believed that the vaccination is safe. One-third of the midwives routinely provided information and half recommended this vaccination. Midwives with more years of activity, who received information about the vaccination from official government organizations or scientific journals, those who had never assisted patients with SARS-CoV-2, and those who believed in midwives' role in COVID-19 prevention were more likely to routinely provide information. Participants who perceived a higher utility of this vaccination, those who believed in midwives' role in COVID-19 prevention, those who received information from official government organizations or scientific journals were more likely to routinely provide a recommendation for the vaccine. Midwives' knowledge must be improved for ensuring that they communicate and recommend the vaccination to their patients.

Irisin participates in the beneficial effects of exercise in preventing gestational diabetes mellitus in overweight and obese pregnant women and a mouse model

Objective

We aimed to explore whether irisin participates in the beneficial effects of exercise in preventing gestational diabetes mellitus (GDM) in overweight and obese pregnant women.

Study design

Sixty overweight and obese pregnant women each in the exercise and control groups were randomly selected from our previous randomized controlled trial. Eighteen obese model mice were generated and divided into exercise and control groups in which body weight, abdominal circumference, anal temperature, glucose tolerance test, and insulin tolerance test were recorded. The plasma irisin level, the expression of PGC-1α/FNDC5 and brown (UCP1) and beige adipose (CD137, TMEM26, and TBX-1) marker genes were detected in muscle and adipose tissue.

Results

In the human study, women in the exercise group had a significantly higher irisin level and lower insulin resistance level than those in the control group. Enhanced expression of beige adipose tissue marker genes (CD137, TMEM26, and TBX-1) in omental adipose tissue and the CD137 gene in subcutaneous adipose tissue were found in the exercise group compared to the control group. In a mouse model, body weight and abdominal circumference were decreased, while glucose homeostasis and insulin sensitivity were significantly improved, and anal temperature was elevated after exercise intervention. A significantly higher level of irisin was revealed in the exercise group after undergoing exercise treatment. The expression of the beige adipose marker genes CD137 and TBX-1 was significantly higher in the exercise group than in the control group in posterior subcutaneous adipose tissue from the inguinal area and interscapular adipose tissue respectively.

Conclusion

Our observations show that regular exercise during pregnancy can increase irisin levels, promote white fat beiging/browning, improve glucose homeostasis and enhance body energy expenditure, which may be one of the mechanisms by which exercise prevents GDM.

Physical and Mental Effects of Foot Baths Among Women in Labor: Protocol for a Pre-Post Test Experimental Design

BACKGROUND

Foot baths are used in complementary and alternative therapy to improve the duration and quality of sleep and reduce tension, anxiety, fatigue, and confusion. They are also known to improve the frequency of labor contractions and to increase their duration in women; thus, they are commonly used by midwives in clinical settings in Japan. However, the physical and mental effects of foot baths during labor are unknown.

OBJECTIVE

This study aims to assess the physical and mental effects of foot baths based on biomarker levels and self-administered questionnaires.

METHODS

A single-arm pre-post test trial design is being used in this study, and the study is being conducted at a general hospital in Tochigi Prefecture, Japan. The target study population is women in the first stage of labor, the phase when the uterus starts to contract and when the cervix dilates to 10 cm, or those undergoing labor induction. Participants who meet the eligibility criteria are recruited, and written informed consent is obtained from them. They are asked to answer the questionnaire and to collect 1.5 mL of saliva in 2 microtubes each, before and after the intervention. The intervention is foot baths for 15-20 minutes using a foot bath device. Data on delivery, such as gestational age, gravidity, parity, diagnosis following the last vaginal examination, and presence or absence of membrane rupture, are retrieved from the medical records. The primary outcomes are salivary cortisol levels before and after the foot baths. The secondary outcomes are levels of relaxation and comfort, labor pain, body warmth, vital signs, and interval of labor pain before and after the foot baths, which are assessed using a numerical rating scale. A paired t test or Wilcoxon signed-rank test will be performed to compare the data for salivary cortisol levels and numerical rating scale scores.

RESULTS

Data collection started on April 1, 2022. As of October 2022, we had enrolled 10 participants. Because of the COVID-19 pandemic in Japan, it is difficult for medical personnel to freely interact with women in labor until the results of the COVID-19 polymerase chain reaction test are available in the research facility, complicating the recruitment process.

CONCLUSIONS

This is the first prospective study to assess the effects of foot baths using a biomarker during the first stage of labor. The findings on the effects of foot baths on women in labor will provide novel insights that may improve the outcomes of delivery. A randomized controlled trial to investigate the effects of foot baths to obtain robust evidence should be conducted in the future.

TRIAL REGISTRATION

University Hospital Medical Information Network-Clinical Trial Registry UMIN000046539; https://tinyurl.com/2wwj7dns.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/39985.

Postpartum hepatitis and host immunity in pregnant women with chronic HBV infection

In order to develop immune tolerant to the fetal, maternal immune system will have some modification comparing to the time before pregnancy. Immune tolerance starts and develops at the maternal placental interface. In innate immunity, decidual natural killer (dNK) cells, macrophages and dendritic cells play a key role in immue tolerance. In adaptive immunity, a moderate increase of number and immune inhibition function of regulatory T cells (Treg) are essential for immune tolerance. The trophoblast cells and immune cells expressing indoleamine 2,3-dioxygenase (IDO), the trophoblast cells expressing HLA-G, and Th1/Th2 shifting to Th2 dominant and Th17/Treg shifting to Treg domiant are in favor of maternal fetal immune tolerance. Steroids (estrogen and progesterone) and human chorionic gonadotropin (HCG) also participate in immune tolerance by inducing Treg cells or upregulating immunosuppressive cytokines. Most of the patients with chronic HBV infection are in the "HBV immune tolerance period" before pregnancy, and the liver disease is relatively stable during pregnancy. In chronic HBV infection women, after delivery, the relative immunosuppression in vivo is reversed, and Th1 is dominant in Th1/Th2 and Th17 is dominant in Th17/Treg balance. After delivery, the number of Treg decrease and NK cells increase in quantity and cytotoxicity in peripheral blood. Liver NK cells may cause liver inflammation through a non-antigen specific mechanism. After delivery, the number of CD8⁺ T cells will increase and HBV specific T cell response recovers from the disfunction in pregnancy. Under the background of postpartum inflammation, the rapid decrease of cortisol after delivery, and especially the enhancement of HBV specific T cell response induced by HBV DNA and cytokines, are the main reasons for postpartum hepatitis. HBeAg positive, especially HBeAg<700 S/CO, and HBV DNA>3-5Log₁₀IU/ml are risk factors for postpartum hepatitis. Antiviral treatment in late pregnancy can reduce the incidence of mother to child transmission (MTCT) in chronic HBV infection women. Chronic HBV infection women have hepatitis both during pregnancy and more often in 12 weeks postpartum. It is generally agreed that postpartum hepatitis is mild symptoms and self-limited. Delaying drug withdrawal to 48 weeks can increase the seroconversion rate of HBeAg in delivery women with elevated alanine aminotransferase (ALT) in pregnancy.

Prevalence of sexual violence and associated factors among women attending antenatal care in Debre Markos at public health institutions in north-west Ethiopia, 2021

Background

Sexual violence refers to being forced to perform any unwanted sexual act. Due to the negative effects on both the mother and the fetus, sexual assault during pregnancy is a public health concern. Knowing the prevalence of sexual violence during pregnancy helps policymakers understand the extent of the problem and can be considered the first step toward implementing interventions for prevention and treatment. This study was done to determine the prevalence of sexual violence and its associated factors during pregnancy in public hospitals in Debre Markos.

Methods

An institution-based cross-sectional study was conducted among 306 pregnant women in Debre Markos, north west Ethiopia from May 1 to June 30, 2021, 2021. A systematic random sampling procedure was used to select study participants. Data were collected using a structured and interviewer-administered questionnaire, and a pre-test was done. Both bi-variable and multivariable logistic regression analyses were undertaken to identify significantly associated variables with sexual violence. The adjusted odds ratio (AOR) with its 95% confidence interval (CI) at a p-value of ≤ 0.05 was used to claim statistical association.

Results

There were 304 interviewed respondents with a response rate of 99.3%. In this study, the overall prevalence of sexual violence among pregnant mothers during the current pregnancy was 19.4%. A husband who had no formal education {AOR = 3.48; 95% CI: 1.06, 11.39}, pregnant mothers who had no formal education {AOR =  6.1; 95% CI: 1.50-18.11}, pregnant mothers who had secondary education {AOR = 2.80, 95% CI: 1.15, 6.81}, being a housewife {AOR = 3.87, 95 CI:1.21, 12.37}, and being a governmental employee {AOR = 4.49, 95% CI: 1.22, 16.40} were factors associated with sexual violence at the value of p ≤ 0.05.

Conclusions and recommendations

In this study, approximately one-fifth of the study participants experienced sexual violence during their current pregnancy. To reduce this, interventions should focus on the education of women as well as their partner about violence against women and on initiatives to economically empower women.

Teratoma of the Tongue in a Fetus: A Case Report and Review of the Literature

Teratomas are tumors composed of multiple embryonic germ layers of tissue, and those occurring in the tongue of the fetus are extremely rare. This paper reports the case of a 20-week-old fetus diagnosed with oral masses combined with a cleft lip and palate using prenatal ultrasonography. The patient decided to terminate the pregnancy due to economic factors after prenatal genetic consultation. The mother underwent induction termination and delivered a stillborn male fetus. The mass originated from the tongue and was pathologically confirmed as a mature teratoma by histology. Teratoma of the tongue is a rare congenital tumor that is usually benign. Its etiology is multifactorial, and prenatal karyotyping is necessary. Ultrasound is the main method of prenatal diagnosis, and magnetic resonance imaging is an effective complement to ultrasonography. Tumors can cause other malformations and abnormalities, and their location and size have an essential impact on prognosis. The imaging approach should focus on the associated abnormalities in order to assess the impact of the mass on the fetal airway and swallowing. Appropriate follow-up imaging can be helpful in the dynamic assessment of management.

Art-based interventions for women's mental health in pregnancy and postpartum: A meta-analysis of randomised controlled trials

OBJECTIVE

Pregnant and postpartum women are vulnerable to psychological problems with a high estimated prevalence. To date, there is no meta-analysis that specifically assesses the effectiveness of art-based interventions to improve mental health in pregnant and postpartum women. The objective of this meta-analysis was to assess the efficacy of art-based interventions when delivered to pregnant and postpartum women.

METHODS

Systematic literature searches were conducted from the inception to 6 March 2022 in seven English databases, including PubMed, Embase, Cochrane Central Register, CINAHL, ProQuest, Scopus, and Web of Science. Randomised controlled trials (RCTs) reporting art-based interventions targeting the improvement of women's mental health in pregnancy and postpartum were included. Cochrane risk of bias tool was applied to assess evidence quality.

RESULTS

Twenty-one randomised controlled trials (RCTs) involving 2,815 participants were eligible for data analysis. A pooled analysis demonstrated that art-based interventions significantly reduced anxiety (SMD = -0.75, 95% CI = -1.10 to -0.40) and depression symptoms (MD = -0.79, 95% CI = -1.30 to -0.28). However, art-based interventions did not alleviate stress symptoms as expected in our findings. Subgroup analysis demonstrated that intervention implementation time, intervention duration and music selected by the participants vs. not could have influence on the efficacy of art-based intervention for anxiety.

CONCLUSION

In perinatal mental health, art-based interventions may be effective in alleviating anxiety and depression. In the future, we still need to conduct high-quality RCTs to validate our findings and enrich clinical application of art-based interventions.

"I was having an internal conflict with myself." COVID-19 vaccination decision-making processes among pregnant women

BACKGROUND

Vaccination serves as an efficient primary means of control for infectious diseases. However, in the case of the COVID-19 pandemic, pregnant women within the United States had the lowest rates of COVID-19 vaccination and reported the lowest intent to vaccinate.

OBJECTIVES

To explore the decision-making process for COVID-19 vaccination for people pregnant during the pandemic.

DESIGN

A secondary analysis of data from a mixed-methods study that examined the impact of COVID-19 on experiences of prenatal care, birth support, and delivery in the Southern United States.

METHODS

This study used a descriptive phenomenological approach to thematically analyze in-depth interviews (n = 20) with adult women who were pregnant by January 2020 and had their prenatal care and delivery during the pandemic beginning in March 2020. The transcripts were de-identified, coded, and thematically analyzed to saturation to identify drivers of COVID-19 vaccine decision-making based on COVID-19 vaccination status and timing. Comparative analyses were conducted to assess differences in decision-making processes based on race/ethnicity and parity. Participants also completed a sociodemographic survey that included their COVID-19 vaccination status.

RESULTS

Two themes emerged, the weighing of parallel risks and priorities from different sources resulting in vaccine decisional conflict and the need to reconcile that conflict via multiple strategies. All participants weighed priorities and risks from multiple areas of their lives and described internal conflict around vaccination. Participants described tailoring decisions to household dynamics, reconciling public and private values around vaccination, and the impact of their identities on the decision-making process. While many described concerns over vaccine safety and fetal health, uniquely, many highlighted weighing the impact of prior pregnancy loss history, with some choosing other preventive measures like social distancing or mask-wearing, which they deemed less risky.

CONCLUSION

Pregnant people make complex COVID-19 vaccination decisions, which must be considered in future vaccine messaging and advocacy for this group.

Salient beliefs and intention to use pre-exposure prophylaxis among pregnant and breastfeeding women in Zambia: Application of the Theory of Planned Behaviour

Primary HIV prevention is a priority for pregnant and breastfeeding women in sub-Saharan Africa; however, such services should be designed to optimise uptake and continuation. Between September and December 2021, we enrolled 389 women who were not living with HIV into a cross-sectional study from antenatal/postnatal settings at Chipata Level 1 Hospital. We used the Theory of Planned Behaviour to study the relationship between salient beliefs and intention to use pre-exposure prophylaxis (PrEP) among eligible pregnant and breastfeeding women. On a seven-point scale, participants had positive attitudes towards PrEP (mean = 6.65, SD = 0.71), anticipated approval of PrEP use from significant others (mean = 6.09, SD = 1.51), felt confident that they could take PrEP if they desired (mean = 6.52, SD = 1.09) and had favourable intentions to use PrEP (mean = 6.01, SD = 1.36). Attitude, subjective norms, and perceived behavioural control significantly predicted intention to use PrEP respectively (β = 0.24; β = 0.55; β = 0.22, all p < 0.01). Social cognitive interventions are needed to promote social norms supportive of PrEP use during pregnancy and breastfeeding.

"PrEP protects us": Behavioural, normative, and control beliefs influencing pre-exposure prophylaxis uptake among pregnant and breastfeeding women in Zambia

Background

Although pre-exposure prophylaxis (PrEP) is recommended for pregnant and breastfeeding women at elevated HIV risk, uptake has been low in Zambia.

Methods

In in-depth interviews, we explored beliefs about PrEP among 24 HIV-negative pregnant and breastfeeding Zambian women. Thematic analysis was used to identify behavioural, normative and control beliefs likely to influence PrEP uptake.

Results

Most women viewed PrEP as a good method of protecting themselves and their babies from HIV infection. Partners were cited as key referents in decision making about PrEP use. Many women felt that PrEP use was not entirely in their control. Most reported that they would not use PrEP if their partners did not approve. Health care providers with negative attitudes, long distance to clinics, and extended waiting times were cited as barriers to PrEP uptake.

Conclusion

HIV-negative pregnant and breastfeeding women had a positive attitude towards PrEP but barriers to uptake are multifaceted.

Seasonal differences in hair growth rates of captive aye-aye, red ruffed, and black-and-white ruffed lemurs

Hair can be an important source of biological information, providing a record of such things as pollutant exposure, hormonal levels, and stable isotope ratios. Hair as a biological sample is easily accessible, easily stored, and resists degradation. Analysis of hair is particularly useful when studying rare and endangered species, such as lemurs, since it can be sampled noninvasively. However, to better interpret the results of stable isotope or other analyses, it is important to understand hair growth rates. We measured hair growth rates in captive aye-ayes (Daubentonia madagascariensis), red ruffed lemurs (Varecia rubra), and black-and-white ruffed lemurs (Varecia variegata), both in winter (December 23, 2013, to January 13, 2014) and summer (July 10-31, 2013) at the Duke Lemur Center. Hair growth per week in all three species of lemurs differed significantly between the boreal summer and boreal winter. The aye-aye, black-and-white ruffed lemur, red ruffed lemur had a mean weekly hair growth of 0.195, 0.209, and 0.232 cm, respectively, in the summer. While the aye-aye, black-and-white ruffed lemur, and red ruffed lemur had a mean weekly hair growth of 0.239, 0.464, and 0.479 cm, respectively, in winter. We found no effect of age on hair growth rates, neither in the boreal summer, nor in the boreal winter for black-and-white ruffed lemurs and red ruffed lemurs. A pregnant black-and-white ruffed female displayed negligible hair growth during the northern winter, suggesting that pregnancy may affect the partitioning of resources away from such things as hair growth.

Acceptability and Feasibility of a Low-Cost Device for Gestational Age Assessment in a Low-Resource Setting: Qualitative Study

BACKGROUND

Ultrasound for gestational age (GA) assessment is not routinely available in resource-constrained settings, particularly in rural and remote locations. The TraCer device combines a handheld wireless ultrasound probe and a tablet with artificial intelligence (AI)-enabled software that obtains GA from videos of the fetal head by automated measurements of the fetal transcerebellar diameter and head circumference.

OBJECTIVE

The aim of this study was to assess the perceptions of pregnant women, their families, and health care workers regarding the feasibility and acceptability of the TraCer device in an appropriate setting.

METHODS

A descriptive study using qualitative methods was conducted in two public health facilities in Kilifi county in coastal Kenya prior to introduction of the new technology. Study participants were shown a video role-play of the use of TraCer at a typical antenatal clinic visit. Data were collected through 6 focus group discussions (N=52) and 18 in-depth interviews.

RESULTS

Overall, TraCer was found to be highly acceptable to women, their families, and health care workers, and its implementation at health care facilities was considered to be feasible. Its introduction was predicted to reduce anxiety regarding fetal well-being, increase antenatal care attendance, increase confidence by women in their care providers, as well as save time and cost by reducing unnecessary referrals. TraCer was felt to increase the self-image of health care workers and reduce time spent providing antenatal care. Some participants expressed hesitancy toward the new technology, indicating the need to test its performance over time before full acceptance by some users. The preferred cadre of health care professionals to use the device were antenatal clinic nurses. Important implementation considerations included adequate staff training and the need to ensure sustainability and consistency of the service. Misconceptions were common, with a tendency to overestimate the diagnostic capability, and expectations that it would provide complete reassurance of fetal and maternal well-being and not primarily the GA.

CONCLUSIONS

This study shows a positive attitude toward TraCer and highlights the potential role of this innovation that uses AI-enabled automation to assess GA. Clarity of messaging about the tool and its role in pregnancy is essential to address misconceptions and prevent misuse. Further research on clinical validation and related usability and safety evaluations are recommended.

Comparison of syphilis seropositivity between non-immigrant and immigrant populations in the Anatolian side of Istanbul, Turkiye: Results of five-years retrospective study

OBJECTIVE

Our study aimed to evaluate the seropositivity for syphilis in non- immigrant and immigrant populations and compare the results regarding demographic data.

METHODS

In accordance with the reverse algorithm, syphilis tests were performed between May 2014 and December 2018 in hospitals in our service zone for syphilis screening or symptomatic disease.

RESULTS

A total of 135.328 non- immigrant and 6.641 immigrant were screened for syphilis. Seropositivity rates were 1.3% in the non- immigrant and 3.8% in immigrant groups (p=0.0001). There was a statistically significant difference in terms of seropositivity rates between the various age groups in the local group and immigrant groups (except 18 25 age group) (p<0.05). Syphilis seropositivity rates were found to be lower in indigenous population than immigrant groups according to the years tested (p=0.0001). The seropositivity rates were 2.4% and 3.2% among the males (p=0.025) and 0.6% and 4.0% among females (p=0.0001) in non-immigrantand immigrant groups, respectively. Whereas, 0.6% of pregnant women in the local group and 3.7% of pregnant women in immigrant groups were seropositive for syphilis (p=0.0001). Among the HIV positive group, syphilis seropositivity was only observed in the non-immigrant group with a rate of 23.0% (p=0.0001).

CONCLUSION

The antibodies against syphilis were found more frequently in immigrants than non-immigrant. Among the HIV positive individuals syphilis seropositivity was only observed in the non-immigrant group.

Long Axial Field-of-View PET for Ultra-Low-Dose Imaging of Non-Hodgkin Lymphoma during Pregnancy

Generally, positron emission tomography imaging is not often performed in the case of pregnant patients. The careful weighing of the risks of radiation exposure to the fetus and benefits for cancer staging and the swift onset of treatment for the mother complicates decision making in clinical practice. In oncology, the most commonly used PET radiotracer is 2-deoxy-2-[fluorine-18] fluoro-D-glucose (¹⁸F-FDG), a glucose analog which has established roles in the daily routines for, among other applications, initial diagnosis, staging, (radiation) therapy planning, and response monitoring. The introduction of long axial Field-of-View (LAFOV) PET systems allows for PET imaging with a reduced level of injected ¹⁸F-FDG activity while maintaining the image quality. Here, we discuss the first reported case of a pregnant patient diagnosed with follicular lymphoma using LAFOV PET imaging for the staging and therapy selection. The acquired PET images show diagnostic quality images with clearly distinguishable areas of lymphadenopathy, even with only 34 MBq of injected ¹⁸F-FDG activity, leading to a considerable decrease in the level of radiation exposure to the fetus.

The Epidemiology, Associated Factors and Bacterial Profile of Asymptomatic Bacteriuria in Pregnant Women: A Retrospective Chart Review Study in Saudi Arabia

Purpose

Asymptomatic bacteriuria (ASB) is the presence of significant amounts of bacteria within the urinary tract in the absence of urinary tract infection (UTI) symptoms, resulting in negative neonatal and pregnancy consequences. This study determined the prevalence, bacteriology patterns, and associated factors with ASB among pregnant women in both primary and hospital levels of care in the Eastern Province of Saudi Arabia.

Methods

This retrospective chart review study included pregnant women between 18 and 50 years who performed the screening urine culture test during their first antenatal visit between 2017 and 2021, without UTI symptoms. The collected data involved the demographic, medical, and obstetric characteristics, and urine culture results. T-tests and chi-squared tests were used for bivariate associations followed by binary logistic regression models.

Results

ASB was positive among 03.42% of the 6471 pregnant women included in the study. Logistic regression revealed that the risk of positive ASB increased in pregnant women in the first and second trimesters (OR = 2.04, 95% CI = 1.41-2.93 and OR= 1.50, 95% CI = 1.03-2.19, respectively), as well as pregnant women with a history of previous UTI (OR = 2.98, 95% CI = 2.14-4.15). The predominant organism isolates were E. coli, followed by GBS, Klebsiella pneumoniae, and Enterococcus faecalis.

Conclusion

With limited data on ASB among pregnant women in Saudi Arabia, findings from the current study could help decision-makers in the country assess the epidemiological characteristics of the condition. Further study is recommended to investigate the susceptibility patterns of commonly prescribed antibiotics with different uropathogens to guide the clinicians who deal with these cases. Additionally, a large national study across the other regions in the kingdom is suggested to calculate the prevalence of ASB in Saudi Arabia.

Contrast Agents during Pregnancy: Pros and Cons When Really Needed

Many clinical conditions require radiological diagnostic exams based on the emission of different kinds of energy and the use of contrast agents, such as computerized tomography (CT), positron emission tomography (PET), magnetic resonance (MR), ultrasound (US), and X-ray imaging. Pregnant patients who should be submitted for diagnostic examinations with contrast agents represent a group of patients with whom it is necessary to consider both maternal and fetal effects. Radiological examinations use different types of contrast media, the most used and studied are represented by iodinate contrast agents, gadolinium, fluorodeoxyglucose, gastrographin, bariumsulfate, and nanobubbles used in contrast-enhanced ultrasound (CEUS). The present paper reports the available data about each contrast agent and its effect related to the mother and fetus. This review aims to clarify the clinical practices to follow in cases where a radiodiagnostic examination with a contrast medium is indicated to be performed on a pregnant patient.

Tuberculosis Infection in Pregnant People: Current Practices and Research Priorities

Women are significantly more likely to develop tuberculosis (TB) disease within the first 90 days after pregnancy than any other time in their lives. Whether pregnancy increases risk of progression from TB infection (TBI) to TB disease is unknown and is an active area of investigation. In this review, we discuss the epidemiology of TB and TBI in pregnancy, TBI diagnostics, and prevalence in pregnancy. We also review TBI treatment and highlight research priorities, such as short-course TB prevention regimens, drug-resistant TB prevention, and additional considerations for safety, tolerability, and pharmacokinetics that are unique to pregnant and postpartum people.

Legacy Chemical Pollutants in House Dust of Homes of Pregnant African Americans in Atlanta

We developed and applied a method for measuring selected persistent organic pollutants (POPs) (i.e., polybrominated diphenyl ethers (PBDEs), organochlorine pesticides, and polychlorinated biphenyls (PCBs)) in dust collected from pregnant African Americans (AAs) in Atlanta using isotope dilution gas chromatography-tandem mass spectrometry. Limits of quantification were ranged from 0.10 to 2.50 ng/g dust. NIST standard reference material measurements demonstrated the robustness of our method. Our accuracies ranged from 82 to 108%, relative standard deviations ranged from 2 to 16%, and extraction recoveries ranged from 76 to 102%. We measured POPs in dust collected from 34 homes of pregnant AAs participating in the Atlanta AA birth cohort study who were enrolled from 2016 to 2019. Concentrations of POPs were detected in all samples with the frequencies of detection ranging from 8 to 100%. Concentrations of PBDE congeners 99 and 47, p,p'-DDT, and PCB153 were detected at some of the highest concentrations with geometric means of 1270, 730, 63.4 and 240 ng/g, respectively. The ratio of DDT/DDE was quite large (~2.7) indicating that p,p'-DDT remains intact in homes for long periods of time. These data demonstrate that care should be taken to remediate POPs in indoor dust, especially in vulnerable, disparate segments of the population.

Consequences of SARS-CoV-2 Infection in Pregnant Women and Their Infants: A Systematic Review

Coronavirus disease 2019 (COVID-19) is a worldwide health problem, particularly for pregnant women. This review assesses the effects of COVID-19 on pregnant women and their infants. A systematic search was performed of studies published on PubMed, Web of Science, Google Scholar, and Embase from January 2020 to January 2021, without restriction by language. This review included 27 studies (22 from China, one from the United States, one from Honduras, one from Italy, one from Iran, and one from Spain), which cumulatively evaluated 386 pregnant women with clinically confirmed COVID-19 and their 334 newborns. Of the 386 pregnant women, 356 had already delivered their infants, four had medical abortions at the time of research, 28 were still pregnant, and two died from COVID-19 before they were able to give birth. Cesarean sections were performed on 71% of pregnant women with COVID-19 to give birth. Fever and cough were common symptoms among women. Premature rupture of membranes, distress, and preterm birth were pregnancy complications. Low birth weight and a short gestational age were common outcomes for newborns. The common laboratory findings among pregnant women were lymphopenia, leukocytosis, and elevated levels of C-reactive protein. Chest computed tomography revealed abnormal viral lung changes in 73.3% of women. Eleven infants tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. There was no evidence of vertical transmission. Most infants were observed to have lymphopenia and thrombocytopenia. The clinical features of pregnant women were found to be similar to those of generally infected patients. There is evidence of adverse pregnancy and neonatal outcomes caused by COVID-19.

Problematic behaviours associated with generalized anxiety disorder during pregnancy and the postpartum period: A thematic analysis

Generalized anxiety disorder (GAD) is one of the most common anxiety disorders in pregnancy and the postpartum (perinatal) period. Perinatal women with GAD engage in problematic behaviours, yet the focus and function of these behaviours remain unknown.

OBJECTIVE

Given that worry during the perinatal period is largely maternally focused, the objective of this study was to explore the accompanying behavioural features of GAD during pregnancy and the postpartum period.

DESIGN

A qualitative study was conducted.

METHODS

Twenty-five pregnant (n = 10) and postpartum (n = 15) women were recruited through clinical referrals and the Hamilton community. Following the completion of a semistructured diagnostic interview and symptom measures, participants participated in one of seven focus groups to learn about behaviours utilized in response to their worries. A thematic analysis was conducted to identify behaviour themes and subthemes in pregnant and postpartum women.

RESULTS

Five behaviour themes and 12 subthemes were identified. Specifically, participants endorsed engaging in excessive reassurance seeking, checking and repeating, overcontrol, overpreparation and avoidance behaviours.

CONCLUSIONS

Our results confirm that perinatal women with GAD engage in comparable problematic behaviours to those with GAD in the general population, yet the presentation, frequency and focus of those behaviours differ. These findings have implications for theoretical formulations of GAD, and the clinical management of this disorder during the perinatal period.

Association between maternal serum uric acid and preeclampsia

OBJECTIVE

The aim of this study is to compare the changes in serum uric acid levels among preeclamptic pregnant women and healthy pregnant women.

METHODS

Two hundred and twenty-four (224) pregnant women were enrolled. Serum uric acid levels were analysed in the two groups at the time of referral and prior to the delivery.

RESULTS

The mean uric acid in all pregnant women was 5.61 mg/dL. The mean uric acid in women with preeclampsia was 6.51 ± 1.53 and in normotensive women was 4.72 ± 1.58, which was seen significant. The mean age of the mother, gestational age and BMI were not significant with the levels of uric acid. The elevation in serum levels of uric acid increased the risk of preeclampsia by 1.98 folds.

CONCLUSION

There is a significant increase in the serum levels of uric acid in pregnant women with preeclampsia as compared to normotensive women. This can be one of a significant indicator of preeclampsia.

Adherence challenges with daily oral pre-exposure prophylaxis during pregnancy and the postpartum period in South African women: a cohort study

INTRODUCTION

Daily oral pre-exposure prophylaxis (PrEP) can reduce HIV acquisition. However, prevention effectiveness requires daily adherence prior to and during periods of sexual activity. Little is known about pharmacologic measures of PrEP adherence during pregnancy and postpartum and the factors related to optimal adherence during periods of sexual activity in this population.

METHODS

Between August 2019 and October 2021, we enrolled pregnant women without HIV at their first antenatal care visit followed-up through 12 months postpartum. Eligible women ≥16 years old received HIV prevention counselling and were offered oral PrEP (TDF-FTC). We quantified tenofovir-diphosphate (TFV-DP) in dried blood spots in women who reported taking PrEP in the past 30 days (at quarterly follow-up visits). We used regression models with generalized estimating equations to evaluate correlates of TFV-DP (any vs. none, and ≥2 vs. <2 doses/week), adjusting for maternal age and pregnancy status.

RESULTS AND DISCUSSION

In 382 women who started PrEP in pregnancy, returned for follow-up and reported PrEP use in the past 30 days, the median age was 27 years (interquartile range [IQR] = 23-32), and the median time on PrEP was 168 days (IQR = 84-252 days). Half of the samples had quantifiable TFV-DP at any time point (52%), declining from 67% of pregnant women 3 months post-initiation to 31% of postpartum women by 12 months. Overall, 72% had concentrations corresponding to <2 doses/week; 25% ≥2 doses/week; 3% 7 doses/week. Concentrations were lower in postpartum versus pregnancy (age-adjusted odds ratio [aOR] = 0.44; 95% confidence interval [CI] = 0.35-0.54). The correlation of self-reported adherence and TFV-DP ranged from -0.07 in pregnancy to 0.25 in postpartum women. Variables associated with having quantifiable TFV-DP included partner living with HIV/unknown serostatus (aOR = 1.50; 95% CI = 1.01-2.22), and reported frequency of sexual activity in the past month (aOR sex >5/month vs. no sex or <5 times/month = 2.11; 95% CI = 1.58-2.82) adjusting for age and pregnancy versus postpartum status. TFV-DP concentrations declined over follow-up time (aOR for 6 vs. 3 months = 0.49; 95% CI = 0.36-0.67).

CONCLUSIONS

Objectively measured adherence to PrEP was low overall and did not correlate with self-reported use. There is an urgent need for objective adherence measures to support clinical decision-making as well as adherence support interventions as part of PrEP services for pregnant and postpartum women at risk of HIV.

A Case of Clostridioides difficile Infection of a Pregnant Woman Treated with Colectomy

Clostridioides difficile-associated pseudomembranous colitis (PMC) is a life-threatening inflammatory bowel disease. Here, we aimed to present a 40-year-old woman at 25 weeks of gestation whose pregnancy was terminated earlier than expected. Unfortunately, despite fidaxomicin and oral vancomycin, the patient's diarrhea did not improve, and she had to undergo a subtotal colectomy. C. difficile infections developing in pregnant women can be catastrophic for both baby and maternal health. Also, antibiotic stewardship is crucial in the prevention of PMC. Therefore, unnecessary and prolonged use of antibiotics should be avoided.

Pregnant and Breastfeeding Women's Attitudes and Fears Regarding COVID-19 Vaccination: A Nationwide Cross-Sectional Study in Saudi Arabia

INTRODUCTION

Contracting coronavirus disease (COVID-19) during pregnancy has been linked to an increased risk of severe maternal and fetal complications. Mass vaccination is considered a promising solution to successfully combat the COVID-19 pandemic. It includes vaccinating of pregnant and breastfeeding women. The success of a vaccine is determined not only by its efficacy, but also by its acceptability. Therefore, our study aimed to explore the acceptability and reluctance of pregnant and breastfeeding women to receive COVID-19 vaccination in Saudi Arabia.

METHODS

This cross-sectional study was conducted in Saudi Arabia from March 2022-beginning to June 2022-end. Using an online self-administered questionnaire with a convenience sampling technique, we assessed women for pregnancy, gravidity, parity, high-risk pregnancy, trimester of pregnancy, and current or planned breastfeeding. Furthermore, we assessed patients with preexisting chronic illnesses. The questionnaire comprised sociodemographic data and items drawn from Goncu Ayhan et al, including vaccination history, perception of risk related to the COVID-19 pandemic, impact of the COVID-19 pandemic, and acceptance and attitude toward future COVID-19 vaccination.

RESULTS

A total of 854 women (615 pregnant and 192 breastfeeding women) were included. Predictors of COVID-19 vaccination acceptance were found in women with a high level of education, those who lived with an elderly family member, and had close contact with a COVID-19-positive person. The reasons for declining vaccination included COVID-19 diagnosis during pregnancy and concerns about side effects of COVID-19 vaccines. A total of 503 (58.9%) women believed that COVID-19 vaccines had the potential to harm their babies. Only 415 (48.6%) agreed they would take the COVID-19 vaccine if it were recommended for pregnant women.

CONCLUSION

Pregnant and breastfeeding women fear COVID-19 vaccination due to safety concerns for their babies. COVID-19 vaccine acceptance varies among pregnant and breastfeeding women, regardless of whether they receive the COVID-19 vaccine. Our study underlines the importance of public education campaigns to improve the overall quality of information on COVID-19 vaccination, particularly among pregnant and breastfeeding women.

One-Step Laparoscopic Abomasopexy for Left Displacements of the Abomasum in Pregnant Cattle: A Retrospective Study

Although technical descriptions have been published, the applicability of left-flank laparoscopy for the surgical correction of left displacement of the abomasum (LDA) in pregnant cattle has not yet been fully assessed. This study aimed to investigate the postoperative performance of one-step laparoscopic abomasopexy for the correction of LDA during late pregnancy. Fifteen pregnant Holstein cattle with LDA were treated with one-step laparoscopic abomasopexy between days 259 and 274 of gestation. This technique was performed in a standing position. Under endoscopic observation via trocars introduced from the left flank, the animals underwent a surgical procedure to place the bar part of a toggle-pin-suture (TPS) device into the lumen of the abomasum through a long cannula. A suture of a TPS device was secured to the ventral abdominal wall by using a long applicator. No cases experienced postoperative complications, and all had a normal delivery on postoperative day 17.4 ± 4.9. Three of the 15 animals exhibited foot diseases and mastitis after calving. The reproductive performance was recorded during lactation periods, showing a service conception rate of 2.9 ± 1.2 and 110.5 ± 39.1 open days. The one-year survival rate was 60% (9/15). The positive postoperative results demonstrate the benefits of one-step laparoscopic abomasopexy in pregnant bovine cases with LDA.