Rasmieh A. Alzeidan

Preconception care for diabetic women for improving maternal and fetal outcomes: a systematic review and meta-analysis

BackgroundPreexisting diabetes mellitus is associated with increased risk for maternal and fetal adverse outcomes. Despite improvement in the access and quality of antenatal care recent population based studies demonstrating increased congenital abnormalities and perinatal mortality in diabetic mothers as compared to the background population. This systematic review was carried out to evaluate the effectiveness and safety of preconception care in improving maternal and fetal outcomes for women with preexisting diabetes mellitus.MethodsWe searched the following databases, MEDLINE, EMBASE, WEB OF SCIENCE, Cochrane Library, including the CENTRAL register of controlled trials and CINHAL up to December 2009, without language restriction, for any preconception care aiming at health promotion, glycemic control and screening and treatment of diabetes complications in women of reproductive age group with type I or type II diabetes. Study design were trials (randomized and non-randomized), cohort and case-control studies. Of the 1612 title scanned 44 full papers were retrieved of those 24 were included in this review. Twelve cohort studies at low and medium risk of bias, with 2502 women, were included in the meta-analysis.ResultsMeta-analysis suggested that preconception care is effective in reducing congenital malformation, RR 0.25 (95% CI 0.15-0.42), NNT17 (95% CI 14-24), preterm delivery, RR 0.70 (95% CI 0.55-0.90), NNT = 8 (95% CI 5-23) and perinatal mortality RR 0.35 (95% CI 0.15-0.82), NNT = 32 (95% CI 19-109). Preconception care lowers HbA1c in the first trimester of pregnancy by an average of 2.43% (95% CI 2.27-2.58). Women who received preconception care booked earlier for antenatal care by an average of 1.32 weeks (95% CI 1.23-1.40).ConclusionPreconception care is effective in reducing diabetes related congenital malformations, preterm delivery and maternal hyperglycemia in the first trimester of pregnancy.

Pre-pregnancy care for women with pre-gestational diabetes mellitus: a systematic review and meta-analysis

BackgroundPre-gestational diabetes mellitus is associated with increased risk for maternal and fetal adverse outcomes. This systematic review was carried out to evaluate the effectiveness and safety of pre-pregnancy care in improving the rate of congenital malformations and perinatal mortality for women with pre-gestational diabetes mellitus.MethodsWe searched the following databases, MEDLINE, EMBASE, WEB OF SCIENCE, Cochrane Library, including the CENTRAL register of controlled trials and CINHAL up to December 2011, without language restriction, for any pre-pregnancy care aiming at health promotion, glycemic control and screening and treatment of diabetes complications in women with type I or type II diabetes mellitus. Study design were trials (randomized and non-randomized), cohort and case–control studies.ResultsOf the 2452 title scanned 54 full papers were retrieved of those 21 studies were included in this review. Twelve cohort studies at low and medium risk of bias, with 3088 women, were included in the meta-analysis. Meta-analysis suggested that pre-pregnancy care is effective in reducing congenital malformation, Risk Ratio (RR) 0.25 (95% CI 0.16-0.37), number needed to treat (NNT) 19 (95% CI 14–24), and perinatal mortality RR 0.34 (95% CI 0.15-0.75), NNT = 46 (95% CI 28–115). Pre-pregnancy care lowers glycosylated hemoglobin A1c (HbA1c) in the first trimester of pregnancy by an average of 1.92% (95% CI −2.05 to −1.79). However women who received pre-pregnancy care were at increased risk of hypoglycemia during the first trimester of pregnancy RR 1.51 (95% CI 1.15-1.99).ConclusionPre-pregnancy care for women with pre-gestational type 1 or type 2 diabetes mellitus is effective in improving rates of congenital malformations, perinatal mortality and in reducing maternal HbA1C in the first trimester of pregnancy. Pre-pregnancy care might cause maternal hypoglycemia in the first trimester of pregnancy.

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.

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.

The effectiveness of breath carbon monoxide analyzer in screening for environmental tobacco smoke exposure in Saudi pregnant women

BACKGROUND: Exposure to environmental tobacco smoke (ETS) has harmful effects on the pregnancy outcomes similar to those observed in actively smoking pregnant women. The aim of this study was to estimate the sensitivity and specificity of the breath carbon monoxide (BCO) analysis in the assessment of smoking status among Saudi pregnant women, including ETS exposure compared to self-reported tobacco smoke exposure. METHODS: A cross-sectional design was used during January 2012, 560 pregnant women, irrespective of their gestational age, agreed to undergo BCO testing and completed the data collection sheet for the study. Sensitivity, specificity, positive and negative predictive values were calculated to compare the BCO test with self-reported exposure to ETS. RESULTS: Of the study population 151 (27%) women self-reported ETS exposure during the index pregnancy, 409 (73%) self-reported non-exposure. Sensitivity of the test was 32.5% (95% CI; 25.2-40.3%), the Specificity was much higher at 69.2% (95% CI; 64.4-73.5%), the positive predictive value was 28% (95% CI, 21.9-35.1%), and the negative predictive value was 73.5% (95% CI; 68.9-77.7%). CONCLUSION: The BCO test is an ineffective tool to detect the level of ETS exposure among Saudi pregnant women.

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.

Adapting evidence-based clinical practice guidelines at university teaching hospitals: A model for the Eastern Mediterranean Region

RATIONALE, AIMS, AND OBJECTIVES Clinical practice guidelines (CPGs) are significant tools for evidence-based health care quality improvement. The CPG program at King Saud University was launched as a quality improvement program to fulfil the international accreditation standards. This program was a collaboration between the Research Chair for Evidence-Based Healthcare and Knowledge Translation and the Quality Management Department. This study aims to develop a fast-track method for adaptation of evidence-based CPGs and describe results of the program. METHODS Twenty-two clinical departments participated in the program. Following a CPGs awareness week directed to all health care professionals (HCPs), 22 teams were trained to set priorities, search, screen, assess, select, and customize the best available CPGs. The teams were technically supported by the programs CPG advisors. To address the local health care context, a modified version of the ADAPTE was used where recommendations were either accepted or rejected but not changed. A strict peer-review process for clinical content and methodology was employed. RESULTS In addition to raising awareness and building capacity, 35 CPGs were approved for implementation by March 2018. These CPGs were integrated with other existing projects such as accreditation, electronic medical records, performance management, and training and education. Preliminary implementation audits suggest a positive impact on patient outcomes. Leadership commitment was a strength, but the high turnover of the team members required frequent and extensive training for HCPs. CONCLUSION This model for CPG adaptation represents a quick, practical, economical method with a sense of ownership by staff. Using this modified version can be replicated in other countries to assess its validity.

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.