Amel Fayed

Pre-existing diabetes mellitus and adverse pregnancy outcomes

BackgroundPregnancies complicated by pre-existing diabetes mellitus (PDM) are associated with a high rate of adverse outcomes, including an increased miscarriage rate, preterm delivery, preeclampsia, perinatal mortality and congenital malformations; compared to the background population. The objectives of this study are to determine the prevalence of PDM and to investigate the maternal and the neonatal outcomes of women with PDM.MethodsThis is a retrospective cohort study for women who delivered in King Khalid University Hospital (KKUH) during the period of January 1st to the 31st of December 2008. The pregnancy outcomes of the women with PDM were compared to the outcomes of all non-diabetic women who delivered during the same study period.ResultsA total of 3157 deliveries met the inclusion criteria. Out of the study population 116 (3.7%) women had PDM. There were 66 (57%) women with type 1 diabetes mellitus (T1DM) and 50 (43%) women with type 2 diabetes mellitus (T2DM). Compared to non-diabetic women those with PDM were significantly older, of higher parity, and they had more previous miscarriages. Women with PDM were more likely to be delivered by emergency cesarean section (C/S), OR 2.67, 95% confidence intervals (CI) (1.63-4.32), P < 0.001, or elective C/S, OR 6.73, 95% CI (3.99-11.31), P < 0.001. The neonates of the mothers with PDM were significantly heavier, P < 0.001; and more frequently macrosomic; OR 3.97, 95% CI (2.03-7.65), P = 0.002. They more frequently have APGAR scores <7 in 5 minutes, OR 2.61, 95% CI (0.89-7.05), P 0.057 and more likely to be delivered at <37 gestation weeks, OR 2.24, 95% CI (1.37- 3.67), P 0.003. The stillbirth rate was 2.6 times more among the women with PDM; however the difference did not reach statistical significance, P 0.084.ConclusionPDM is associated with increased risk for C/S delivery, macrosomia, stillbirth, preterm delivery and low APGAR scores at 5 min.

Effects of secondhand smoke on the birth weight of term infants and the demographic profile of Saudi exposed women.

BackgroundMaternal exposure to tobacco smoke during pregnancy is associated with detrimental effects on the mother and the fetus including; impaired fetal growth, low birth weight and preterm delivery. In utero exposure to tobacco is implicated in the etiology of many adults’ diseases including obesity, diabetes and hypertension.The objectives of this study were to evaluate the effects of Secondhand Tobacco Smoke (SHS) exposure on newborns’ anthropometric measurements and to compare the demographic profile of the women exposed to SHS to those who were not.MethodThis is a retrospective cohort study investigating the effects of SHS during pregnancy on newborns’ anthropometry. Women who self-reported SHS exposure were compared with those not exposed. The primary outcomes were birth weight, newborn length and head circumference. Univariate analysis and multivariate regression analysis were performed. Adjusted differences with 95% confidence intervals were calculated.ResultsMothers exposed to SHS constituted 31% of the cohort. The mean birth weight of infants of exposed mothers was significantly lower by 35 g, 95% CI: 2–68 g, (P = 0.037) and the mean length was shorter by 0.261 cm, 95% CI 0.058-0.464 cm, (P = 0.012) compared to the infants of unexposed mothers. Women exposed to SHS, were younger, of lower parity and more likely to be illiterate than those who were not exposed in addition, exposed women were less likely to be primiparous.ConclusionThe prevalence of exposure of Saudi pregnant women to SHS is high at 31% and it is associated with reduced birth weight, and shorter length of the newborn.

Gestational diabetes mellitus: maternal and perinatal outcomes in King Khalid University Hospital, Saudi Arabia.

BACKGROUND The prevalence of gestational diabetes mellitus (GDM) has increased worldwide, with a subsequent increase in the associated adverse pregnancy outcomes. OBJECTIVES The objective of this study was to determine the prevalence of GDM and to compare the maternal and neonatal outcomes of women with GDM with nondiabetic women. MATERIALS AND METHODS This is a retrospective cohort study investigating the maternal and the neonatal outcomes of women with GDM who delivered in King Khalid University Hospital as compared with the outcomes of nondiabetic women who delivered during the same period. The data were collected from the 1st of January to the 31st of December 2010 from the labor ward registry. The pregnancy outcomes of the women with GDM were compared with the outcomes of nondiabetic women who delivered during the same study period. RESULTS Out of 3041 women who delivered during the study period, 569 (18.7%) had GDM and 2472 (81.3%) were not diabetic. Compared with the nondiabetic women, women with GDM were more likely to be delivered by emergency cesarean section (CS), odds ratio (OR) 1.30, 95% confidence intervals (CI) (1.02-1.66), or elective CS (OR 1.72, 95% CI 1.22-2.44, P<0.001). The neonates of the mothers with GDM were significantly heavier and more frequently macrosomic (OR 1.75, 95% CI 1.14-2.71, P<0.001). There was no significant difference between the two groups in the frequency of APGAR scores less than 7 in 5 min, preterm delivery at less than 37 weeks of gestation, or in the frequency of intrauterine fetal death. CONCLUSION The prevalence of GDM in King Khalid University Hospital is among the highest in the world. GDM is associated with an increased risk for CS delivery and macrosomia.

Prevalence and Complications of Pregestational and Gestational Diabetes in Saudi Women: Analysis from Riyadh Mother and Baby Cohort Study (RAHMA)

The objectives of this study were to estimate the burden of diabetes and to explore the adverse pregnancy outcomes associated with pregestational diabetes mellitus (pre-GDM) and gestational diabetes mellitus (GDM) among the Saudi pregnant population. In this subcohort, we compared the maternal and the neonatal outcomes of diabetic women with pre-GDM and GDM to the outcomes of nondiabetic mothers who delivered during the same period. From the total cohort, 9723 women participated in this study. Of the participants, 24.2% had GDM, 4.3% had pre-GDM, and 6951 were nondiabetic. After adjustment for confounders, women with GDM had increased odds of delivering a macrosomic baby (OR: 1.6; 95% CI: 1.2–2.1). Women with pre-GDM were more likely to deliver by Cesarean section (OR: 1.65; CI: 1.32–2.07) and to have preterm delivery < 37 weeks (OR: 2.1; CI: 1.5–2.8). Neonates of mothers with pre-GDM were at increased risk of being stillbirth (OR: 3.66; CI: 1.98–6.72), at increased risk of admission to NICU (OR: 2.21; CI: 1.5–3.27), and at increased risk for being macrosomic (OR: 2.40; CI: 1.50–3.8). The prevalence of GDM and pre-GDM in the Saudi pregnant population is among the highest in the world. The conditions are associated with high maternal and neonatal morbidities and mortalities.

Riyadh Mother and Baby Multicenter Cohort Study: The Cohort Profile

Objectives To assess the effects of non-communicable diseases, such as diabetes, hypertension and obesity, on the mother and the infant. Methods A multicentre cohort study was conducted in three hospitals in the city of Riyadh in Saudi Arabia. All Saudi women and their babies who delivered in participating hospitals were eligible for recruitment. Data on socio-demographic characteristics in addition to the maternal and neonatal outcomes of pregnancy were collected. The cohort demographic profile was recorded and the prevalence of maternal conditions including gestational diabetes, pre-gestational diabetes, hypertensive disorders in pregnancy and obesity were estimated. Findings The total number of women who delivered in participating hospitals during the study period was 16,012 of which 14,568 women participated in the study. The mean age of the participants was 29 ± 5.9 years and over 40% were university graduates. Most of the participants were housewives, 70% were high or middle income and 22% were exposed to secondhand smoke. Of the total cohort, 24% were married to a first cousin. More than 68% of the participants were either overweight or obese. The preterm delivery rate was 9%, while 1.5% of the deliveries were postdate. The stillbirth rate was 13/1000 live birth. The prevalence of gestational diabetes was 24% and that of pre-gestational diabetes was 4.3%. The preeclampsia prevalence was 1.1%. The labour induction rate was 15.5% and the cesarean section rate was 25%. Conclusion Pregnant women in Saudi Arabia have a unique demographic profile. The prevalence of obesity and diabetes in pregnancy are among the highest in the world.

Knowledge of Saudi female university students regarding cervical cancer and acceptance of the human papilloma virus vaccine

We read the recent publication on the “Knowledge of Saudi female university students regarding cervical cancer and acceptance of the human papilloma virus vaccine (HPV)” by Al Sheikh et al.1 Cervical cancer is the third most common female cancer worldwide with an estimated incidence of 530,000, with 270,000 related deaths in 2012. Attributable fraction due to HPV infection was estimated to be 100%.2 Cervical cancer is one of the most common cancers among women in Saudi Arabia. Oncologist Dr. Najla Al-Mari said a study carried out in the year 2011 in 3 general hospitals showed that 55 women die annually from cervical cancer and more than 150 cases were recorded.3 The good thing on this type of cancer is that it takes years to develop. The body may contract the virus, but it remains dormant for a number of years. It is also very easy to detect because its symptoms appear before the contraction of the actual disease. This allows recognizing it and removing it in its first stages. This type of cancer can be detected in its early stages through vaginal scanning to monitor mutations of the cervical tissues. Every married woman should have a vaginal scan biennially after 3 years into her marriage. The factors that increase the risk of human papillomavirus are marriage at a young age, and marrying someone who has had multiple sexual partners. Konno et al4 reported that the highest incidence rates are in sub Saharan Africa, central, and South America. In contrast, the incidence rate is lowest in the Middle East particularly among Muslims and Jews as compared with other religious groups.4 Association of oncogenic HPV infection and the development of cervical cancer provides an opportunity for primary prevention through prophylactic vaccination. The vaccination is highly effective and safe.5 In our daily practice in the pediatric clinic, parents often enquire on available vaccines after their child finishes the recommended immunization schedule for persons aged 0 through 6 years. Recommendations from the American Academy of Pediatrics (AAP), the American Academy of Family Practice (AAFP), and the American College of Obstetricians and Gynecologists (ACOG) all recommend the bivalent or quadrivalent HPV vaccines for female children aged 11-12 years of age for the prevention of cervical, vaginal, and vulvar cancer and the related precursor lesions caused by the HPV types targeted by these vaccines.6 Two vaccines have been developed against HPV infection; one is a quadrivalent vaccine (Gardasil), and the other is a bivalent (Cervarix) vaccine. Excellent antibody responses have been reported following immunization with both quadrivalent and bivalent vaccines.7 In view of the magnitude of this problem; cervical cancer vaccine should be included in the present immunization schedule. This vaccine is available in private hospitals at a cost, and the public would like the Ministry of Health to make this vaccine freely available. We agree with the authors that there is a need to utilize all means of communication to raise awareness among the public regarding this disease.

Non-Communicable Disease Risk Factors among Employees and Their Families of a Saudi University: An Epidemiological Study

Objectives To assess the prevalence of noncommunicable disease (NCD) risk factors among Saudi university employees and their families; to estimate the cardiovascular risk (CVR) amongst the study population in the following 10years. Methods The NCD risk factors prevalence was estimated using a cross-sectional approach for a sample of employees and their families aged ≥ 18 years old, in a Saudi university (Riyadh in Kingdom of Saudi Arabia; KSA). WHO STEPwise standardized tools were used to estimate NCD risk factors and the Framingham Coronary Heart Risk Score calculator was used to calculate the CVR. Results Five thousand and two hundred subjects were invited, of whom 4,500 participated in the study, providing a response rate of 87%. The mean age of participants was 39.3±13.4 years. The majority of participants reported low fruit/vegetables consumption (88%), and physically inactive (77%). More than two thirds of the cohort was found to be either overweight or obese (72%), where 36% were obese, and 59% had abdominal obesity. Of the total cohort, 22–37% were found to suffer from dyslipidaemia, 22% either diabetes or hypertension, with rather low reported current tobacco use (12%). One quarter of participants was estimated to have >10% risk to develop cardiovascular disease within the following 10-years. Conclusion The prevalence of NCD risk factors was found to be substantially high among the university employees and their families in this study.

Demographic profile and pregnancy outcomes of adolescents and older mothers in Saudi Arabia: analysis from Riyadh Mother (RAHMA) and Baby cohort study

Objectives To investigate the impact of maternal age on pregnancy outcomes with special emphasis on adolescents and older mothers and to investigate the differences in demographic profile between adolescents and older mothers. Methods This study is a secondary analysis of pregnancy outcomes of women in Riyadh Mother and Baby cohort study according to maternal age. The study population was grouped according to maternal age into five subgroups; <20, 20–29, 30–34, 35–39 and 40+years. The age group 20–29 years was considered as a reference group. Investigation of maternal age impact on maternal and neonatal outcomes was conducted with adjustment of confounders using regression models. Results All mothers were married when conceived with the index pregnancy. Young mothers were less likely to be illiterate, more likely to achieve higher education and be employed compared with mothers ≥ 40 years. Compared with the reference group, adolescents were more likely to have vaginal delivery (and least likely to deliver by caesarean section (CS); OR=0.6, 95% CI 0.4 to 0.9, while women ≥40 years, were more likely to deliver by CS; OR 2.9, 95% CI 2.3 to 3.7. Maternal age was a risk factor for gestational diabetes in women ≥40 years; OR 1.7, 95% CI 1.3 to 2.1. Adolescents had increased risk of preterm delivery; OR 1.5, 95% CI 1.1 to 2.1 and women ≥40 years had similar risk; OR, 1.3, 95% CI 1.1 to 1.6. Conclusion Adverse pregnancy outcomes show a continuum with the advancement of maternal age. Adolescents mother are more likely to have vaginal delivery; however, they are at increased risk of preterm delivery. Advanced maternal age is associated with increased risk of preterm delivery, gestational diabetes and CS.

Maternal and Perinatal Outcomes of Pregnancies Complicated with Pregestational and Gestational Diabetes Mellitus in Saudi Arabia

Objectives: The aim of this study was to compare the maternal and the perinatal outcomes of women with Pre- Gestational Diabetes Mellitus (PGDM) with the outcomes of those with Gestational Diabetes Mellitus (GDM). Methods: In a retrospective cohort study the maternal and the neonatal outcomes of women with PGDM, were compared to the outcomes of women with GDM. Data were collected for the period of 12 months, from the 1st of January to the 31st of December 2012, from the labour ward registry. Data compared were; age, parity, mode of delivery, premature delivery, previous history of miscarriage, birth weight, macrosomia, rate of APGAR scores less than 7 at 5 minutes and stillbirth rate. Student t test was used to compare continuous variables and Chi squared was used to compare categorical variables. Multivariate analysis was used to estimate adjusted Odds Ratio (OR). Results: Of the 3413 deliveries during the study period, 3157 fulfilled the inclusion criteria; of those there were a total of 685 deliveries for diabetic women. 569 (83.1%) had GDM and 116 (16.9%) had PGDM. Of those with PGDM, 66 (57%) had T1DM and 50 (43%) had T2DM. Compared to the GDM group, women with PGDM were more likely to be delivered by caesarean section (CS), adjusted OR 2.6, 95% CI (1.66-4.09). The neonates of mothers with PGDM were significantly heavier compared to those of GDM group, p<0.001; and the frequency of macrosomia was more, adjusted OR 3.67, 95% CI (1.75-7.71). Mothers with PGDM have increased risk of preterm delivery less than 37gestations weeks, adjusted OR 2.63, 95% CI (1.49- 4.70). There was no statistically significant difference between the two groups in the rate of APGAR scores less than 7 in 5 minutes or the rate of stillbirth. Conclusion: PGDM is associated with worse pregnancy outcomes compared to GDM.

Awareness of an obstetric population about environmental tobacco smoking.

Background and Objectives: The reported rate of womens smoking is typically low. However, many pregnant women are exposed to environmental tobacco smoke (ETS), which could affect their own health and the health of their growing fetus. The aim of this study was to estimate the magnitude of the problem of exposure to ETS and assess the awareness of postpartum women to ETS and its possible effects. Designs and Settings: This was a cross-sectional study conducted on 1182 postpartum women at a university hospital in Riyadh, Saudi Arabia, between 1st January and 30th June, 2012. Materials and Methods: A structured questionnaire was used for data collection. Factors associated with the level of understanding of the possible effects of ETS exposure were analyzed. Results: The majority of the participating women knew that exposure to ETS had adverse effects on maternal and fetal health (>80%), but their knowledge of the specific effects on fetal health was limited. The level of mothers’ education was found to be associated with better knowledge of effects on mother and fetal health (P < 0.01). Conclusion: This study revealed that pregnant women in our sample had limited knowledge of the specific effects of ETS on fetal health. This shortcoming in knowledge needs to be addressed by improving health.