Arsenic exposure during pregnancy and postpartum maternal glucose tolerance: evidence from Bangladesh

Background Arsenic exposure has been associated with gestational diabetes mellitus. However, the extent to which arsenic exposure during pregnancy is associated with postpartum glucose intolerance is unknown. Methods We studied 323 women in Bangladesh. We assessed arsenic exposure in early pregnancy via toenail and water samples. We measured fasting glucose and insulin in serum at a mean (SD) of 4.0 (3.5) weeks post-delivery. We ran covariate-adjusted, linear regression models to examine associations of arsenic concentrations with HOMA-IR, a marker of insulin resistance, and HOMA-β, a marker of beta cell function. Results Median (IQR) arsenic concentration was 0.45 (0.67) μg/g in toenails and 2.0 (6.5) μg/L in drinking water. Arsenic concentrations during pregnancy were not associated with insulin resistance or beta cell function postpartum. HOMA-IR was 0.07% (− 3.13, 3.37) higher and HOMA-β was 0.96% (− 3.83, 1.99) lower per IQR increment in toenail arsenic, but effect estimates were small and confidence intervals crossed the null. Conclusions Although arsenic exposure during pregnancy has been consistently associated with gestational diabetes mellitus, we found no clear evidence for an adverse effect on postpartum insulin resistance or beta cell function.

Psychosocial health in pregnancy and postpartum among women living with - and without HIV and non-pregnant women living with HIV living in the Nordic countries – Results from a longitudinal survey study

Background The success of antiretroviral therapy has normalized pregnancy among women living with HIV (WWH) with a very low risk of perinatal transmission of HIV. Despite these advances, WWH still face complex medical and psychosocial issues during pregnancy and postpartum. The aim of this study was to assess differences in psychosocial health outcomes between pregnant WWH, non-pregnant WWH, and pregnant women without HIV, and further identify factors associated with probable depression in the third trimester and postpartum. Methods In a longitudinal survey study, participants were included from sites in Denmark, Finland, and Sweden during 2019–2020. Data was collected in the 3rd trimester, 3 and 6 months postpartum using standardized questionnaires assessing depression, perceived stress, loneliness, and social support. Mixed regression models were used to assess changes over time within and between groups. Logistic regression models were used to identify factors associated with depression in pregnancy and postpartum. Results A total of 47 pregnant WWH, 75 non-pregnant WWH, and 147 pregnant women without HIV were included. The prevalence of depression was high among both pregnant and non-pregnant WWH. There was no significant difference between pregnant and non-pregnant WWH in depression scores, perceived stress scores, or social support scores at any time point. Compared to pregnant women without HIV, pregnant WWH reported worse outcomes on all psychosocial scales. Social support and loneliness were associated with an increased odds of depressive symptoms in the adjusted analysis. Conclusions A high burden of adverse psychosocial outcomes was observed in both pregnant and non-pregnant women living with HIV compared to pregnant women without HIV. Loneliness and inadequate social support were associated with increased odds of depression in pregnancy and should be a focus in future support interventions.

Use of B-Cell–Depleting Therapy in Women of Childbearing Potential With Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorder

Purposeof Review: There is considerable heterogeneity in the use of B cell depletion in women of childbearing age, likely driven at least in part by the discrepancy between the product labels and what is known about the physiology of IgG1, including breastmilk and placental transfer.Recent Findings:We provide practical considerations on the use of this medication class in women of childbearing potential. We discuss pre-pregnancy planning including vaccinations, safety of B cell depletion during pregnancy as well as postpartum considerations including breastfeeding.Summary:B cell depleting monoclonal antibodies have shown to be effective for pre-pregnancy and postpartum prevention of inflammatory activity in multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). B cell depleting therapies are large IgG1 monoclonal antibodies which have minimal transfer across the placenta and into breastmilk. Consideration of risks and benefits of these therapies should be considered in counseling women planning pregnancy and postpartum.

Optimal Ambulatory Vital Sign Targets in Pulmonary Hypertension Pregnant Women via Time-Dependent Survival Analysis

Background: Pulmonary hypertension (PH) can cause complications in pregnant women due to significant hemodynamic fluctuation or right heart failure as well as death during pregnancy and postpartum. Those in critical condition would be sent to the intensive care unit (ICU) for observation and treatment. However, evidence to suggest the safe target vital signs is limited and none specific to pregnancy with PH.Methods: This retrospective study of consecutive obstetric patients with PH admitted to ICU of the First Affiliated Hospital of Air Force Military Medical University of China, from January 2011 to May 2020, consisted of 92 cases analyzed using time-dependent Cox regression to consider the dynamic features of vital signs. Results: 7/92 maternal deaths occurred. Most of these deaths occurred within the first three days of admission to the ICU. The vital signs for survival were stable and normal compared to death. Three vital signs were identified as risk factors in the maternal in-hospital mortality model via backward selection: SpO2（HR，0.93；95%CI，0.88-0.97；P=0.003）, heart rate（HR，0.94；95%CI，0.90-0.99；P=0.027）, and mean arterial pressure (MAP) （HR，1.09；95%CI，1.00-1.18；P=0.045）. Log of relative hazard ratios of mortality is linearly negatively related to SpO2 value with a U-shaped correlation with heart rate and MAP (both lower and higher values were associated with high mortality). The optimal range of SpO2 <73%, MAP was 65–95 mmHg, and heart rate was 59–125 beats per minute (bpm). Further exploration showed that the cumulative and the longest consecutive time of abnormal vital signs also affect the outcome. For example, SpO2<73% accumulated for 5 h or continuously up to 2 h increases mortality.Conclusions: Pregnant women with PH who died in the hospital experienced long-term abnormal fluctuations in MAP, heart rate, and SpO2 during ICU stay. Maintaining SpO2>73%, MAP at 65–95mmHg, and heart rate at 59–125 bpm can significantly reduce in-hospital maternal mortality. The effects of the abnormal SpO2, heart rate, and MAP on in-hospital maternal mortality should be combined with the cumulative time and the longest duration.Trial Registry: ChiCTR2100046637.

COGNITIVE INTERVENTION TO THE WOMEN WHO ATTEND THE "BREASTFEEDING SUPPORT GROUP"

Introduction: Breast milk is the best food to meet the nutritional needs of the child, exclusively for the first 6 months and up to two years of age, favoring the establishment of the mother-child bond. Objective: To carry out a cognitive intervention to the women who attend the “breastfeeding support group”. Method: Quantitative research, with a quasi-experimental design, in a census sample made up of 11 pregnant women and 19 breastfeeding women. The Iowa Infant Feeding Attitudes Scale (IIFAS) was used. Results: 33.30% (10) are between 33-35 years old, 63% (19) in the puerperium, 56% (17) with primary education, 60% (18) carry out agricultural / cattle raising activities, 53% (16) in free union. In the pre-intervention, the women had a positive attitude with a score of 17-48 towards artificial breastfeeding 83% (25), in the post-intervention the positive attitude towards breastfeeding changed 87% (26), with a significant difference of p <0.01, in the items of the IIFAS instrument in the pre-intervention a mean and standard deviation of 2.07 ± 1.16, with an increase in the post-intervention of 4.48±0.65, a significance difference <0.05 in the total of questions in the pre-intervention from 35.23, increased after the intervention to 76.13, their attitude changed to exclusive breastfeeding. Conclusions: the cognitive intervention increased the positive attitude towards exclusive breastfeeding, highlighting that a timely educational intervention of promotion, support and accompaniment during pregnancy and postpartum guarantees the duration and exclusivity of breastfeeding. Keywords: breastfeeding, breastfeeding behavior, breastfeeding, knowledge, attitudes and health practice