Malakauskienė, Laura

LIETUVIŠKAS SANTRAUKA

Autoriaus vardas: Johannes Karl Emanuel Kreider Tyrimo pavadinimas: Naujagimių gimimo rodikliai moterims, sergančioms hipertenziniais sutrikimais nėštumo metu

Tikslas: Palyginti motinų charakteristikas ir nėštumo baigtis tarp moterų, kurioms diagnozuoti hipertenziniai nėštumo sutrikimai (HNS), Lietuvos sveikatos mokslų universiteto ligoninėje Kauno klinikose 2024 metais.

Uždaviniai:

1. Įvertinti skirtingų HNS potipių paplitimą.
2. Išanalizuoti nėštumo ir gimdymo baigtis moterims, sergančioms HNS.
3. Palyginti nėštumo ir gimdymo baigtis tarp skirtingų HNS potipių grupių.

Metodika: Retrospektyvinis tyrimas apėmė visas moteris, kurioms 2024 m. Kauno klinikose diagnozuoti HNS (n = 2 872 gimdymai). Statistinei analizei naudoti vienfaktorė dispersinė analizė (ANOVA), chi kvadrato ir Fišerio tikslusis testai bei daugiaveiksnė logistinė regresinė analizė.

Rezultatai: 424 nėštumai (14,8 %) buvo komplikuoti HNS: gestucinė hipertenzija (6,3 %), lėtinė hipertenzija (3,4 %) ir preeklampsija (5,0 %). Preeklampsija buvo susijusi su mažesniu nėštumo amžiumi gimdymo metu (35,1 ± 3,7 sav.) ir mažesniu gimimo svoriu (2 490 ± 993 g), palyginti su kitomis grupėmis (p < 0,001). Po daugiaveiksnio koregavimo HNS potipis nebuvo nepriklausomai susijęs su hipotrofija, mažu gimimo svoriu ar cezario pjūviu. Priešlaikinis gimdymas buvo svarbiausias nepalankių neonatalinių baigčių prognozuotojas (hipotrofija: aOR 6,01; mažas gimimo svoris: aOR 91,49; abu p < 0,001).

Išvados: HNS paplitimas atitiko išsivysčiusių šalių duomenis. Nors preeklampsija nekorieguotose analizėse buvo susijusi su blogesnėmis perinatalinėmis baigtimis, šie skirtumai iš esmės paaiškinami didesniu priešlaikinio gimdymo dažniu. Priešlaikinis gimdymas, o ne konkretus HNS potipis, yra pagrindinė neonatalinių komplikacijų priežastis.

Author’s name: Odai Alcharif

Research title: Pregnancy outcomes associated by different maternal dietary patterns.

Aim: To investigate the associations between different maternal dietary patterns and their effects on obstetrical outcomes.

Objectives: 1.To determine the distribution of different maternal diets before conception among pregnant women in LSMU Hospital Kauno Klinikos (LSMUL KK). 2.To determine the distribution of different maternal diets during pregnancy among pregnant women in LSMUL KK. 3.To evaluate the pregnancy and delivery outcomes of women with different dietary patterns. 4.To compare the pregnancy and delivery outcomes of women who followed dietary recommendations during pregnancy and those who did not.

Methodology: The study was conducted among the women who delivered in LSMUL KK between October and December 2024 period. The data of the births of the period were obtained randomly by questionnaire form which was shared in the Department of Obstetrics of Kaunas clinics. Maternal characteristics, obstetrical outcomes, and neonatal outcomes were compared between women who followed a diet during pregnancy and those who did not. The study was approved by the LSMU Bioethics Committee (2024-BEC2-924; October 07th .2024).

Results: Most of the participants (n=40, 90.9%) did not follow a particular diet prior to pregnancy. Conversely, these percentages varied greatly during pregnancy as the proportion of participants who followed a diet, or nutritional recommendations increased to 47.7%. The study found no statistically significant relationship between dietary adherence and pregnancy problems such as anemia (p=0.372), gestational diabetes (p>0.4), or gestational hypertension (p=0. 870). Labor outcomes showed no difference in both comparison groups. There were no statistically significant changes in neonatal outcomes, including birth weight (p=0.263) and 1- and 5-minute Apgar scores (p>0.3).

Conclusions:

1. Most participants (90.9%) reported no specific dietary adherence prior to pregnancy, indicating a generally low level of preconception nutritional planning.
2. Dietary awareness and adherence increased significantly during pregnancy, with 47.7% of participants reporting they followed a particular diet or nutritional guidance.
3. In the study group, no significant differences were observed in the course of pregnancy or delivery outcomes when comparing women who followed different diets or nutritional recommendations during pregnancy.
4. No significant differences in pregnancy or delivery outcomes were found between the diet and non-diet women who participated in the survey.

Both the physiological changes of pregnancy and congenital or acquired disorders determine the course of pregnancy and the health of the fetus and newborn. Maternal musculoskeletal disorders (MSD’s) during pregnancy are less common, but one of the possible pregnancy pathologies that represents a significant concern due to their impact on both maternal and fetal health. This thesis aims to provide an analysis of prevalence, risk factors, management and pregnancy outcomes associated with these disorders, by conducting a comprehensive literature review. The thesis systematically reviews existing literature to identify common musculoskeletal disorders among pregnant women, evaluate contributing risk factors and asses the implications on pregnancy and delivery outcomes. Furthermore, it reviews current management and treatment strategies for these disorders to provide insight into effective interventions. The findings of this research aims to inform healthcare providers and contribute to optimizing care for pregnant women with musculoskeletal disorders, ultimately improving maternal and fetal health outcomes.

This study aims to investigate the frequency, underlying causes, prevalent pregnancy pathologies, and delivery modes associated with premature births across different maternal age groups. The research aims to assess the comparative aspects of pregnancy complications and birth outcomes among women categorised as younger (<18), within the range of 18-40, and older (>40). The study will be conducted through a retrospective analysis of pregnancy, delivery, and newborn data of women who underwent premature births at the Obstetrics and Gynaecology Clinic of the Hospital of LSMU Kaunas Clinics during the period spanning from January 1, 2021, to December 31, 2021. The research methodology will encompass a comprehensive assessment of the collected data, focusing on delineating patterns, identifying associations, and establishing comparisons among the specified age groups of women.

Goda Strudumskytė. Moterų mitybos įpročių ir svorio prieaugio įtaka gimdymo baigtims. Bakalauro baigiamasis darbas. Darbo vadovė Doc. dr. Laura Malakauskienė. Lietuvos sveikatos mokslų universitetas, Medicinos akademija, Slaugos fakultetas, Slaugos klinika. Kaunas, 2025; 45 p. Tyrimo tikslas: įvertinti moterų mitybos įpročių ir svorio prieaugio įtaką gimdymo baigtims. Tyrimo metodika: Tyrimas buvo atliktas LSMUL KK Akušerijos ir ginekologijos klinikoje, akušerijos skyriuje. Buvo naudojamas kiekybinis tyrimo metodas, duomenys surinkti anoniminės apklausos būdu. Anketa sukurta pačių autorių. Tyrimo objektas - nėščiųjų mitybos įpročiai, svorio prieaugis nėštumo metu, gimdymo baigtys. Tyrimas vykdytas 2025-02-05 – 2025-03-12.
Tyrimo rezultatai: Didžioji dalis moterų (92,8 proc.) nurodė, kad prieš šį nėštumą nesilaikė jokios specifinės dietos. Nėštumo metu 27 proc. respondenčių teigė laikęsi specialių mitybos rekomendacijų (nėščiųjų diabeto dieta (10,2 proc.), sveikesnė mityba nei iki nėštumo (9,9 proc.), neapdorotos žuvies maisto racione vengimas (6,3 proc.)). Bendroje tiriamųjų grupėje šiek tiek daugiau nei pusė moterų (63,9 proc.) pakeitė savo mitybos įpročius nėštumo metu. Nustatyta, kad nėštumo metu keitusios savo mitybos įpročius dažniau atitiko svorio prieaugio rekomendacijas (64,3 proc.) nei tos, kurios mitybos įpročių nekeitė (35,5 proc.). Vertinant bendrai, net 61,3 proc. moterų nurodė nėštumo metu priaugusios svorio daugiau arba mažiau nei rekomenduojama. Dauguma moterų pagimdė natūraliais gimdymo takais: nėštumo metu keitusios mitybos įpročius natūraliais takais pagimdė 80,3 proc., nėštumo metu mitybos įpročių nekeitusios – 72,5 proc. Statistiškai reikšmingų skirtumų tarp šių grupių, vertinant gimdymo eigą, nenustatyta. Lyginant respondenčių duomenis pagal atitikimą svorio prieaugio rekomendacijoms, reikšmingų skirtumų, vertinant gimdymo pradžią, būdą, naujagimių gimimo svorius tiek moterims atitikusios svorio prieaugio rekomendacijas (AR) ir neatitikusios rekomendacijų (NR), nenustatyta. Tyrimo išvados: 1. Dauguma moterų nesilaikė jokios specifinės dietos iki nėštumo. Nėštumo metu didesnė dalis moterų keitė mitybos įpročius ir laikėsi rekomendacijų nei iki nėštumo. 2. Daugiau nei pusė tyrime dalyvavusių moterų nėštumo metu priaugo neatitinkantį nėštumo priežiūros rekomendacijų svorio prieaugį. Tiksliausiai svorio prieaugio rekomendacijas atitiko iki nėštumo buvusios per mažo svorio nėščiosios. 3. Nei tiriamųjų moterų mitybos įpročių pasikeitimai, nei svorio prieaugio pokyčiai nenulėmė statistiškai reikšmingų skirtumų vertinant gimdymo pradžios, gimdymo būdo bei naujagimių gimimo svorių, būklių pagal Apgar duomenis.

SUMMARY Author: Sarah Nouf Title: The Impact of Maternal Age and Conception Methods on Gestational Diabetes Mellitus. Aim: To analyze the impact of maternal age and the type of conception on the risk of developing gestational diabetes mellitus (GDM) and evaluate the obstetrical outcomes. Objectives: 1. To evaluate the prevalence of Gestational diabetes mellitus (GDM) in different age groups for women. 2. To evaluate the prevalence of Gestational Diabetes Mellitus (GDM) for women conceiving naturally and through Assisted reproductive technology (ART). 3. To compare obstetrical outcomes in women with GDM conceived naturally versus through ART across different age groups. Materials and methods: A systematic review was conducted following PRISMA guidelines. Studies were identified through PubMed, the Cochrane Library, and manual searches on Google Scholar. The keywords used were: gestational diabetes mellitus, maternal age, assisted reproductive technology, in vitro fertilization, natural conception, pregnancy outcomes, and obstetric complications. Results: After applying the inclusion and exclusion criteria, 10 studies were selected for this review. These included 4 retrospective cohort studies, 1 prospective cohort study, 3 observational cohort studies, and 2 cross-sectional studies. For the first objective, which looked at the link between advanced maternal age (AMA) and GDM, 5 studies showed a clear trend: GDM rates increased with age, particularly in women over 35. The second objective focused on whether ART conception raised GDM risk. According to 7 studies, pregnancies conceived through ART had a higher chance of GDM. For the third objective, 6 studies highlighted that when AMA and ART overlap in GDM pregnancies, the risk of complications, such as preterm birth, hypertension, cesarean delivery, and neonatal hypoglycemia is higher, especially in women aged 35 and older. Conclusion: 1. Women aged 40 and above are at increased risk for developing GDM, likely due to age-related changes in insulin sensitivity and overall metabolic function. 2. Pregnancies achieved through ART show a higher occurrence of GDM, which may be related to factors such as fertility treatments, hormonal stimulation, or pre-existing health conditions in women undergoing these procedures. 3. When GDM occurs in ART pregnancies, it is associated to a higher chance of complications such as preeclampsia, cesarean birth, and neonatal complications.

Darbo tikslas. Nustatyti nėščiųjų anemijos ir COVID-19 sąsajas su nėštumo ir gimdymo baigtimis, lyginant moteris, kurioms nėštumo metu nustatyta ir nenustatyta COVID-19 infekcija. Uždaviniai:

1. Įvertinti COVID-19 dažnumą moterims, kurioms nėštumo metu nustatyta nėščiųjų anemija.
2. Palyginti nėštumo eigą ir komplikacijas moterų, kurios nėštumo metu turėjo anemiją bei nustatytą ir nenustatytą COVID-19 infekciją.
3. Įvertinti gimdymo eigą ir komplikacijas bei naujagimių duomenis moterų, kurios nėštumo metu turėjo anemiją bei nustatytą ir nenustatytą COVID-19 infekciją. Metodai. Retrospektyvusis tyrimas, analizuojantis moterų, kurios gimdė LSMUL KK Akušerijos ir ginekologijos klinikoje 2021 metais nėštumo, gimdymo ir naujagimių duomenis (gestacija 22-42 sav.). Tyrimo duomenys susisteminti „Excel Microsoft 365”, duomenų analizė atlikta „IBM SPSS 30“ programa. Rezultatai. 2021 metais nėščiųjų anemija buvo diagnozuota 314 (10,26 %) visų tais metais gimdžiusių moterų. Iš jų 40 gimdyvių (12,7 %) nustatyta COVID-19 infekcija. Lyginant nėštumo eigos ir komplikacijų duomenis reikšmingų skirtumų tarp tiriamųjų grupių nenustatyta. Pastebėta, kad chorioamnionitas dažniau nustatytas moterims, sirgusioms COVID-19 (CG 12,5 %, NCG 4,7 %; p=0,063). Didžiajai daliai moterų gimdymas prasidėjo savaime, sužadinimų dažnumas tarp lyginamų grupių statistiškai reikšmingai nesiskyrė (p=0,592). Moterys, sirgusios COVID-19 infekcija, dažniau gimdė CPO būdu (CG 42,5 %, NCG 28,5 %), nors skirtumas nebuvo statistiškai reikšmingas (p=0,105). Analizuojant lyginamųjų grupių naujagimių duomenis, reikšmingų skirtumų nebuvo. COVID-19 grupėje nustatytas didesnis neišnešiotumo dažnumas (CG 20,0 %), tačiau šis skirtumas nebuvo statistiškai reikšmingas (p=0,432). Išvados. 1. Kas dešimtai gimdyvei (12,7 %) nustatoma COVID-19 infekcija, jeigu nėštumo metu moteris turėjo nėščiųjų anemiją, ir tai yra dažniau nei bendrai visoms 2021 metų gimdyvėms, kurioms nustatyta COVID-19 infekcija (9,33 %). 2. Moterims, kurioms buvo nustatyta nėščiųjų anemija, nėštumo eigos ir komplikacijų duomenys statistiškai reikšmingai nesiskyrė tarp turėjusių (CG) ir neturėjusių (NCG) COVID-19 infekciją, nors pastebėta didesnė priešlaikinio gimdymo rizika CG grupėje. 3. Moterims, nėštumo metu turėjusioms anemiją, COVID-19 infekcija nenulėmė statistiškai reikšmingų skirtumų vertinant gimdymo pradžios, gimdymo būdo bei naujagimių būklių duomenis.

The mean age of primiparous women has been increasing continously for several decades. Higher age at first pregnancy more frequently results in pregnancy complications such as gestational diabetes, preeclampsia, placenta previa, antepartum haemorrhage. In addition, older primiparous women are exposed to a higher risk of delivery complications. Major observed examples are stillbirth, perinatal death, preterm birth and low birth weight. This evolution of the society motivates the need of a more comprehensive overview of these associated complications.

Aim: To assess the influence of COVID infection during the labor or the pregnant as a factor to maternal or newborn morbidity and mortality.

Objectives:

1. Compare pregnancy outcomes for COVID-19 and non-COVID pregnant patients.
2. Compare delivery process for COVID-19 and non-COVID patients.
3. Compare neonatal outcomes for COVID-19 and non-COVID pregnant patients’ newborns.

Methodology:

The retrospective study was conducted among the women who delivered in The Hospital of Lithuanian University of Health Sciences Kauno klinikos on 2021 period. The data of all the births of the period 2021 were obtained from the registry of the delivery department and the archive of Kaunas clinics. The study was approved by the LSMU Bioethics Committee (BEC-MF-248; February 24th, 2023). Results: During the period of 2021 there were 3,068 deliveries with 3,196 newborns. Statistical significance was found in anemia rate (COVID group15.3%, NCG 10.6%, p=0.015) and preterm delivery rate (COVID group 18.1%, NCG 10.9, p<0.001). Both groups were statistically similar regarding induction and stimulation of labor, type of delivery. Exclusively PPH rates were 8.3% among COVID patients and 5.2% NCG patients (p=0.027). Statistical significance was not found between both groups regarding newborns’ Apgar score in 1 and 5 minutes. The birth weight was similar (COVID group 3212.8g, min.336 - max 500 and NCG 3342.1g, min.408 – max. 5080). The significant difference was detected in stillbirths rates: among COVID patients it was higher 1.7%, whereas among NCG patients was lower 0.5%, p=0.018.

Conclusions: 1. Preterm delivery and pregnancy anemia was significantly more common in women with COVID-19 infection. 2. The incidence of induction and stimulation of labor, caesarean section was similar in both groups, but the frequency of postpartum hemorrhage was higher in COVID-19 group. 3. Neonatal outcomes were similar, though stillbirths rates among COVID patients was significant higher.

Author name: Yair Hollender Research title: Group B Streptococcus Colonization in Pregnant Women and Effect on Maternal and neonatal outcomes. Aim: To analyze GBS colonization prevalence among pregnant women and how GBS effect neonates and pregnant women. Objectives:

1. To evaluate GBS colonization prevalence among pregnant women.
2. To determine the relationship between GBS colonization and postpartum and neonatal complications.
3. To determine the relationship between GBS colonization and maternal and neonatal long-term complications.
4. To analyses the impact of GBS colonization on the course of pregnancy and delivery.
5. To investigate the current treatment of GBS and possibilities of GBS prevention. Material and methods: The research and data collection in this literature review was performed by reviewing the most relevant literature regarding Group B Streptococcus colonization effects on pregnant women and neonates according to the aims and objectives of the study. The main resource for the literature were PubMed and Google Scholar which yielded 33 relevant articles when applying the selected key-words and according to the inclusion and exclusion criteria. Conclusions: 1. The overall prevalence of GBS colonization among the pregnant population is approximately 21%, Serotypes Ia, Ib, II, III, and V, accounting for about 98% of the colonizing serotypes globally. Risk factors for GBS colonization includes increased maternal age, higher parity women (≥2). 2. GBS related complications during pregnancy are stillbirths, preterm birth, and intrauterine infections. 3. Neonatal GBS related diseases includes sepsis, pneumonia, meningitis, and neonatal encephalopathy. 4. Most common maternal GBS related diseases are urinary tract infections and post-partum endometritis. 5. The current preventative measures include screening for GBS colonization, identifying risk population and intrapartum antibiotic prophylaxis. Currently, anti-GBS vaccines are in the process of development. Practical recommendations: All pregnant women should be screened for GBS colonization between 36 0/7 and 37 6/7 weeks of gestation. Intrapartum antibiotic prophylaxis is indicated for women with a positive GBS, as well as women who consider at risk. The dose of Penicillin should be 5 million units IV load then 2.5-3 million units IV every 4 hours until delivery. Although IAP has reduced the rate of GBS the global burden is still significant. Therefore, the development of future preventive measures such as GBS vaccine is extremely important and should be encouraged and supported.