Explore the vast range of titles available.

Pregnancy brings numerous physiological changes to the body of the pregnant woman. Liver diseases in pregnancy contribute to increased oxidative stress, disrupting the delicate balance between reactive oxygen species and antioxidant defence. Antioxidant supplementation may have potential benefits in addressing pregnancy-related liver disorders, such as HELLP (haemolysis, elevated liver enzymes, low platelet count) and preeclampsia-associated liver dysfunction in pregnancy. The purpose of this narrative review is to review the evidence regarding oxidative stress in liver disorders during pregnancy and the role of antioxidants in alleviating oxidative stress and its effect on maternal and foetal outcomes. A narrative review study design involved a comprehensive search across three scientific databases: PubMed, Embase, and MEDLINE, published in the last 20 years. The searches were performed up to January 2024. Thirty-two studies were included in the narrative review. The most studied antioxidants were vitamins (vitamin C and E) for their role in clinical treatment, prophylaxis, and clearing surrogate oxidative stress markers. The majority of studies were on preeclampsia. Though the existing literature is not robust, available evidence suggests that antioxidant supplementation may have potential benefits in addressing pregnancy-related liver disorders, such as HELLP and preeclampsia-associated liver dysfunction in pregnancy. However, there is a need to establish consistent protocols, ethical standards, and well-designed clinical trials to clarify the timing and dosage of antioxidants in pregnancy. Antioxidants may alleviate the oxidative stress in various liver disorders during pregnancy, which still needs to be studied further for their clinical relevance.

ObjectiveTo assess the potential associations between social determinants of health (SDH) and severe maternal outcomes (SMO), to better understand the social structural framework and the contributory, non-clinical mechanisms associated with SMO.Study designProspective observational study.Study settingTertiary referral centre in south-eastern region of India.ParticipantsOne thousand and thirty-three women with potentially life-threatening complications (PLTC) were identified using WHO criteria.Risk factors assessedSocial Determinants of Health (SDH).Primary outcomesSevere maternal outcomes, which include maternal near-miss and maternal death.Statistical analysisLogistic regression to assess the association between SDH and clinical factors on SMO, expressed as adjusted ORs (aOR) with a 95% CI.ResultsOf the 37 590 live births, 1833 (4.9%) sustained PLTC, and 380 (20.7%) developed SMO. Risk of SMO was higher with increasing maternal age (adjusted OR (aOR) 1.04 (95% CI 1.01 to 1.07)), multiparity (aOR 1.44 (1.10 to 1.90)), medical comorbidities (aOR 1.50 (1.11 to 2.02)), obstetric haemorrhage (aOR 4.63 (3.10 to 6.91)), infection (aOR 2.93 (1.83 to 4.70)), delays in seeking care (aOR 3.30 (2.08 to 5.23)), and admissions following a referral (aOR 2.95 (2.21 to 3.93)). SMO was lower in patients from socially backward community (aOR 0.45 (0.33 to 0.61)), those staying more than 10 km from hospital (aOR 0.56 (0.36 to 0.78)), those attending at least four antenatal visits (aOR=0.53 (0.36 to 0.78)) and those referred from resource-limited facilities (aOR=0.62 (0.46 to 0.84)).ConclusionThis study demonstrates the independent contribution of SDH to SMO among those sustaining PLTC in a middle-income setting, highlighting the need to formulate preventive strategies beyond clinical considerations.

The COVID-19 pandemic posed significant challenges to healthcare systems worldwide. Maintaining essential health services, including maternal and child health (MCH), while addressing the pandemic is an enormous task. This study aimed to assess the impact of the COVID-19 pandemic on the utilization of MCH services in India's public primary care. It extends prior work by applying nationwide HMIS data within an interrupted time-series framework with seasonal and ARMA adjustments to estimate counterfactual trends, thereby providing national-level insights into both immediate and evolving disruptions. A retrospective analysis using Health Management Information System (HMIS) data examined 12 indicators of service utilization, covering maternal health, child health, deliveries, and newborn care. Interrupted time-series analysis compared pre-pandemic (April 2017-March 2020) and pandemic (March 2020-May 2021) was performed using Ordinary Least Squares (OLS) and Generalized Least Squares (GLS) regression models, adjusting for seasonality and autocorrelation with ARMA terms. Antenatal care (ANC) registrations decreased by 346,420 cases (-12.8%,  = 0.026) following the onset of the pandemic, with no significant recovery in the subsequent months. Tetanus toxoid vaccinations also declined markedly, with Td1 and Td2 falling by 276,152 (-13.9%,  = 0.029) and 306,607 (-16.9%,  = 0.010) cases, respectively, and remaining consistently below expected levels. Institutional deliveries dropped by 272,441 (-13.7%,  = 0.067), while home deliveries attended by skilled birth attendants decreased by 5,054 cases (-22.8%,  = 0.014). Child health services, including referrals to Special Newborn Care Units (SNCUs) and inborn admissions, were also lower than anticipated (-20.4% and -19.2%, respectively), though these changes were not statistically significant. Among all indicators, the largest and most persistent disruptions occurred in obstetric complications (maximum decline during Winter 2020-21) and SNCU inborn admissions (also at their lowest in Winter 2020-21). These two services showed minimal signs of recovery throughout the study period, underscoring the particular vulnerability of emergency obstetric and neonatal care during public health crises. The COVID-19 pandemic caused declines in MCH service utilization, with varying recovery across indicators. While services like antenatal care and vaccinations showed some stabilization over time, child health admissions and obstetric complications remained below pre-pandemic trends. Strengthening healthcare systems to maintain essential services and support recovery during and after public health emergencies is critical.

Introduction Polycystic ovary syndrome (PCOS) is a complex endocrine disorder affecting 6%-20% of reproductive-aged females globally. In India, one in five females is affected, surpassing the global average. PCOS is linked to hormonal, genetic, metabolic, and environmental factors. Recent research suggests early-life adverse experiences, such as trauma and stress, may increase the risk of PCOS by impacting the hypothalamic-pituitary-ovarian axis, immune system, and epigenetic pathways. This study aims to explore the association between Adverse Childhood Experiences (ACEs) and PCOS in young adult females in Delhi National Capital Region (NCR), a region with high prevalence rates of both conditions. Material and methods A cross-sectional study was conducted with 1,149 female participants aged 18–25 years from Delhi NCR. Participants were selected from colleges in the University of Delhi and Amity University, Noida. PCOS was identified based on self-reported prior diagnosis and the Rotterdam criteria. The ACE International Questionnaire (ACE-IQ) was used to assess 13 ACE categories across four domains: abuse, neglect, family dysfunction, and violence. Data were analyzed using chi-square tests and logistic regression to examine the relationship between ACEs and PCOS. Results Of the participants, 17.26% were diagnosed with PCOS. 71.5% reported at least one ACE, with 16% experiencing severe ACEs (4 + ACEs). Females with severe ACEs showed a 2.1-fold increased risk of developing PCOS compared to those with fewer or no ACEs. Abuse (physical, emotional, sexual), household violence, bullying, and exposure to community violence were significantly associated with higher PCOS prevalence. Conclusion The findings indicate a strong association between ACEs and PCOS, with severe childhood adversities doubling the risk of PCOS in young adult females. Addressing early-life trauma could reduce the risk of PCOS and improve long-term health outcomes. Further research is needed to explore the causal mechanisms and develop targeted therapeutic approaches for managing PCOS in individuals with a history of childhood trauma.

Currently, there is no international unanimity regarding the timings, the optimal cut-off points, and standardized methods of screening or diagnosis of gestational diabetes mellitus (GDM). The screening guidelines and recommendations for GDM evolved over time; concise information has been presented here in the review. We searched electronic databases for various guidelines for screening of GDM in PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), Embase, Cochrane, Google Scholar, Scopus, Guidelines International Network (GIN library), National Guidelines Clearinghouse (NGC); Web sites of relevant organizations; and trial registries. The mesh headings derived after reviewing the articles and were used to further search the articles are: (\"Screening Guidelines GDM\" or \"Screening Criteria for GDM\") and (\"Glucose Intolerance in Pregnancy\" or \"Gestational Diabetes Mellitus\"). The articles published from 1960 till December 2022 were included. Key outcomes included the prevalence of GDM is 14.6 according to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria and 13.4 according to Diabetes in Pregnancy Study Group India (DIPSI) criteria, making the DIPSI criterion a cost-effective method for low-resource settings. The IADPSG) criterion diagnoses and treats GDM earlier, thus reducing the complications associated with GDM in the mother and newborn. The IADPSG criteria at a cut-off of ≥140 mg/dL have a sensitivity of 81 and specificity of 93, whereas the World Health Organization (2013) criteria at the same cut-off has a lower sensitivity of 59 and specificity of 81. The risk factors of having GDM are family history, history during past pregnancy, medical history, multiple current pregnancies, and raised hemoglobin A1c. The screening guidelines have been developed by different organizations and institutions over the years. The guidelines with the threshold values for screening and their standardization for detecting GDM in Indian mothers are yet to be established.

The present study reports the levels of maternal serum calcium and magnesium from early pregnancy until delivery, along with cord levels, in women who developed preeclampsia (PE) and compares them with those without PE. A total of 324 pregnant women (216 non-PE and 108 PE women) were included in this retrospective case–control study of prospectively collected data nested in an observational cohort study. Maternal blood was collected at 4 time points during pregnancy (V1 = 11–14 weeks, V2 = 18–22 weeks, V3 = 26–28 weeks, and V4 = at delivery) and umbilical cord blood at delivery. Independent t tests were used to compare calcium, magnesium, and their ratio between two groups, and their associations with PE were studied using regression models. Calcium levels were similar between groups at all time points. Magnesium levels were lower ( p  = 0.021) at V2 in PE group as compared with non-PE group. Maternal calcium and magnesium levels were negatively associated, with blood pressure in early pregnancy. In fully adjusted logistic regression analysis, lower magnesium levels were associated with an increased risk of PE at V2 (OR 0.25 [95% CI 0.07, 0.94] p  = 0.04). Lower magnesium in mid-pregnancy was associated with higher risk of PE. These changes were observed before the diagnosis of PE, thereby suggesting that they may have a role in the etiology of PE.

Introduction: Maternal morbidity and mortality in India continues to remain high despite concerted efforts during the past decades. Objective of this study was to determine the prevalence and indicator of Potentially Lie Threatening Conditions (PLTC) and ‘near miss’ obstetric cases at different tiers of health care. Material and Methods: A cross-sectional epidemiological study was carried out over a period of 12 months as per the WHO criteria for ‘near miss’. Probability sampling was done to systematically and randomly select health facilities i.e. two primary health centers (PHC), one community health centre (CHC) and a tertiary hospital all from Doiwala block of Dehradun, Uttarakhand, India. The study included all the women attending health-care facilities, who were pregnant, in labour, or who had delivered or aborted up to 42 days ago arriving at the facility. A convenient sampling was done (a hundred percent enumeration of eligible study subjects) for the audit. Result: A total of 937 pregnant women who accessed health care had 688 live births and 231 women had one or more of the Potentially Life Threatening Conditions (PLTC). Among them, 61 women had Severe Maternal Outcome (SMO) - 51 with maternal ‘near-miss’ and 10 maternal deaths. The Severe Maternal Outcome Ratio (per 1000 live births) was 88.66. The Maternal ‘near miss’ Mortality Ratio (MNM-MR) and Mortality Index (MI) were 5.1 and 16.39% respectively. Conclusion: The WHO ‘near miss’ approach has been found to be an effective measure to assess quality of care in maternal health across countries including India.Bangladesh Journal of Medical Science Vol.14(3) 2015 p.254-257

Currently, there is no international unanimity regarding the timings, the optimal cut-off points, and standardized methods of screening or diagnosis of gestational diabetes mellitus (GDM). The screening guidelines and recommendations for GDM evolved over time; concise information has been presented here in the review. We searched electronic databases for various guidelines for screening of GDM in PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), Embase, Cochrane, Google Scholar, Scopus, Guidelines International Network (GIN library), National Guidelines Clearinghouse (NGC); Web sites of relevant organizations; and trial registries. The mesh headings derived after reviewing the articles and were used to further search the articles are: (\"Screening Guidelines GDM\" or \"Screening Criteria for GDM\") and (\"Glucose Intolerance in Pregnancy\" or \"Gestational Diabetes Mellitus\"). The articles published from 1960 till December 2022 were included. Key outcomes included the prevalence of GDM is 14.6% according to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria and 13.4% according to Diabetes in Pregnancy Study Group India (DIPSI) criteria, making the DIPSI criterion a cost-effective method for low-resource settings. The IADPSG) criterion diagnoses and treats GDM earlier, thus reducing the complications associated with GDM in the mother and newborn. The IADPSG criteria at a cut-off of ≥140 mg/dL have a sensitivity of 81% and specificity of 93%, whereas the World Health Organization (2013) criteria at the same cut-off has a lower sensitivity of 59% and specificity of 81%. The risk factors of having GDM are family history, history during past pregnancy, medical history, multiple current pregnancies, and raised hemoglobin A1c. The screening guidelines have been developed by different organizations and institutions over the years. The guidelines with the threshold values for screening and their standardization for detecting GDM in Indian mothers are yet to be established.