Samia A. Esmaeil

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.

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.

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.

Knowledge, Expectations and Source of Information of Pregnant Saudi Women Undergoing Second Trimester Ultrasound Examination

Background: In Saudi Arabia, most antenatal units offer routine Ultrasound Scan (USS) in early and mid-trimester of pregnancy. USS examination is essential source of information for the obstetrical management of the pregnancy as well as a source of joy and reassurance for the mother about the wellbeing of her baby. Methods: A cross-sectional survey was conducted at the obstetrics ultrasound department at King Khalid University Hospital in Riyadh, Saudi Arabia. A questionnaire was designed to investigate the knowledge of the mothers about the purpose of the USS, their expectations and the source of the information provided to them about the mid-trimester USS examination in addition to the respondents demographic characteristics. Descriptive statistics were used for demographic variables. Association between women’s source of information and educational level was analyzed with chi-square test. P<0.05 was considered significant. Results: 600 women consented and completed the questionnaire. Most of the participants were 21-30 years of age and (51.4%) had university education or higher while only 1.8% of the respondents were illiterate. 28-30% of the respondents thought the purpose of the scan is to know the gender of the baby or to confirm that the baby is alive. Only 20% of the respondents reported purposes of the USS examination was to screen for congenital malformations. The obstetrician was the main source of information and the nurse was the least. The utilization of any source of information about USS examination increased with the increase of the level of maternal education. Conclusion: Saudi mothers’ knowledge about the purpose of mid-trimester USS is modest. Utilization of healthcare providers other than the obstetrician and contemporary technology for information provision will improve mothers’ knowledge and choices and put them at the center of health care.