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Pregnancy in women with type 1 or 2 diabetes mellitus (DM) is associated with an increased risk for complications in both the mother and her fetus. The impact of these complications on modifiable risk factors may substantially improve pregnancy outcomes and reduce malformation rates in children. This is a goal of pregravid preparation (PGP) in this category of patients. The review gives the main points of PGP in patients with types 1 and DM and shows the results of main studies providing evidence for PGP in DM. In particular, by the moment of conception, DM patients should achieve a glycosylated hemoglobin (HbA1c) goal of <6% no later than 4 weeks before conception and during the first trimester of pregnancy, take folic acid in a high dose (at least 4000 µg, or 4 mg, daily), quit tobacco smoking and alcohol use, receive potentially teratogenic drugs, and, if need be, lose weight (the target body mass index of <27 kg/m2).
Pregnancy in women with type 1 or 2 diabetes mellitus (DM) is associated with an increased risk for complications in both the mother and her fetus. The impact of these complications on modifiable risk factors may substantially improve pregnancy outcomes and reduce malformation rates in children. This is a goal of pregravid preparation (PGP) in this category of patients. The review gives the main points of PGP in patients with types 1 and DM and shows the results of main studies providing evidence for PGP in DM. In particular, by the moment of conception, DM patients should achieve a glycosylated hemoglobin (HbA1c) goal of <6% no later than 4 weeks before conception and during the first trimester of pregnancy, take folic acid in a high dose (at least 4000 µg, or 4 mg, daily), quit tobacco smoking and alcohol use, receive potentially teratogenic drugs, and, if need be, lose weight (the target body mass index of <27 kg/m2).
The literature review examines the data on the role of folic acid in the human body, especially in women of the reproductive period. An analysis of research studies was conducted to assess the effect of folic acid and folate deficiency on organogenesis and placental formation. In addition, folate deficiency is associated with severe pregnancy complications, including placental abruption, spontaneous miscarriages, intrauterine growth retardation, and preeclampsia. Also, it plays a role in developing congenital malformations of the cardiovascular, nervous, visual and musculoskeletal systems. It was found that with hyperhomocysteinemia, the risk of complications with a self-enhancing cascade of pathological changes during the gestation period increases significantly. In this regard, when planning a pregnancy, it is recommended that all women examine the levels of homocysteine concentration. It is also mandatory to investigate the levels of homocysteine concentration in women with a history of obstetric complications – placental abruption, miscarriage, and the family history of stroke, myocardial infarction and thrombosis in relatives below the age of 45-50 years. Keywords: Folic acid, folates, folate deficiency, hyperhomocysteinemia, pregnancy, miscarriage.
Background: Postdated pregnancy is one of the most common obstetric problems associated with increased maternal morbidity, prenatal morbidity, and mortality. Pregnancy at 37-40 weeks of gestation is called the term from the last menstrual period. If the pregnancy exceeds 40 weeks, it is called a postdated pregnancy, but when pregnancy is prolonged beyond 42 weeks, it is called post-maturity or post-term pregnancy. Objective: This study aimed to determine the adverse effects of postdate pregnancy on mothers and fetuses. Methodology: This was a descriptive, prospective, cross-sectional, hospital-based study conducted at Omdurman Maternity Hospital from January 2018 to June 2018. An interview questionnaire was used to collect data. Data were collected by trained doctors in the labor room. One hundred and thirty-eight (138) postdated pregnant women were included in this study after obtaining informed consent through a structured questionnaire. Demographic and clinical data concerning personal history, booking status, mode of delivery, maternal complications, and fetal complications were recorded. Results: During the study period, 2751 women delivered, of which 138 were postdated deliveries, with a prevalence of 5%. Most women's age range was 31-34 years 48.6%). Their education level was mostly secondary school (42%). Primigravida 65%), booked were 75.4%. Previous history of postdate pregnancy was 34.1%, normal vaginal delivery was 79 .7%, cesarean section was 14.5%, and instrumental delivery 5.8%. Cesarean section indications were cervical dystocia (14.4%), cephalopelvic disproportion (9.5%), meconium-stained liquor with fetal distress (33.3%), pathological cardiotocography (CTC) (19%), and failure to progress (23.8%). Maternal complications included post-partum hemorrhage (PPH) (7.2%), perineal tears (.7%, cervical tears (1.4%), and postpartum infections (1.4%). Fetal complications were 14.5%, Shoulder Dystocia 2.9%, asphyxia (6.5%), and meconium aspiration (5.1%). The mean APGAR score was 1.1667, less than three in only 3.6%, and > 7 in 86.9%. Neonatal death was 3%. Approximately 18 neonates were admitted to the Neonatal Intensive care unit (NICU) and only five of them were admitted for more than one week. Conclusion: Postdate pregnancy prevalence in this study was 5%, which was associated with maternal risk of cesarean section delivery, instrumental delivery, postpartum hemorrhage, and postnatal infection.
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