Introduction Gestational diabetes mellitus (GDM) affects approximately 14%–17% of pregnancies worldwide, with the vast majority of cases occurring in low‐resource settings. There is an ongoing debate concerning the optimal screening and diagnosis of GDM, as the current diagnostic recommendation of performing a universal oral glucose tolerance test (OGTT) for every pregnant woman (WHO, 2013) is resource‐intensive and can potentially lead to overdiagnosis. This narrative literature reviews aimed to evaluate the diagnostic sensitivity of alternative, less resource‐demanding screening methods that could be appropriately used for low‐resource settings. Methods For this narrative review, observational studies were identified via PubMed. The PRISMA guidelines were used to guide this process. As the studies investigated very diverse screening methods, no statistical meta‐analysis was performed due to methodological heterogeneity; instead, the results were synthesized narratively. Results Ten studies were included, examining various alternatives such as fasting plasma glucose thresholds (sensitivity 95.6%), selective screening strategies (sensitivity 73.6%), capillary blood glucose testing (sensitivity 67.9%, 79.3%, and 92.5% for different fasting cut points), and glycated hemoglobin (HbA1c) measurements (sensitivity approximately 84%, depending on the cut‐offs). Discussion All alternatives showed inferior sensitivity compared to the standard OGTT; therefore, none can currently substitute the OGTT. However, basically all approaches have the potential to either reduce the number of OGTTs or improve access to GDM screening for more patients. Further research and validation are necessary for all approaches to safely reduce the number of OGTTs without compromising diagnostic accuracy.
Background Recent advancements in assisted reproductive technology and delayed parenthood have led to a surge in twin pregnancies, with a high incidence of preterm birth (PTB) due to cervical insufficiency. Current guidelines recommend cervical cerclage for twin pregnancies before 24 weeks; however, data on cerclage efficacy beyond 24 weeks is scarce. Objective This exploratory, hypothesis‐generating study is aimed at examining the associations of cervical cerclage on pregnancy duration and neonatal outcomes in twin pregnancies with a short cervix between 24 and 27 + 6 weeks. Methods This retrospective cohort study, conducted between July 1991 and July 2023 at Women′s Hospital, Zhejiang University School of Medicine, involved twin pregnancies with a short cervix (≤ 25 mm) during the gestational period ranging from 24 weeks to 27 + 6 weeks. Skilled obstetricians performed cervical cerclage. Data on maternal and neonatal outcomes were collected and analyzed using statistical tests, with statistical significance set at p < 0.05. Results A total of 73 twin pregnancies were analyzed. Participants were categorized into ultrasound‐indicated cerclage group ( n = 22), physical examination‐indicated cerclage group ( n = 33), and control group ( n = 18). The ultrasound‐indicated cerclage group showed significantly longer presentation‐to‐birth intervals (60.77 ± 21.64 days, p = 0.007) and higher birth weights (larger twin: 2273.33 ± 566.09 g, p = 0.026; smaller twin: 2086.90 ± 526.58 g, p = 0.029) compared with the control group. No significant differences were found in gestational age at delivery, Apgar scores, cesarean delivery rates, maternal morbidity, and neonatal morbidity among both groups. Conclusions Ultrasound‐indicated cerclage in twin pregnancies at 24–27 + 6 weeks was observed to prolong presentation‐to‐birth interval and increase birth weight, whereas physical examination‐indicated cerclage showed no statistically significant association with the measured outcomes. A randomized controlled clinical trial is needed to validate these findings.
Purpose This study is aimed at evaluating postpartum women′s vaccination status in two major maternity hospitals in Athens, Greece, and identifying demographic, socioeconomic, and behavioral factors influencing vaccine acceptance. Methods A cross‐sectional study was conducted at Leto General Hospital and Alexandra Hospital. Postpartum women completed a questionnaire covering demographics, obstetric history, vaccination status (COVID‐19, tetanus–diphtheria–acellular pertussis [Tdap], influenza, and respiratory syncytial virus [RSV]), and reasons for vaccine acceptance or refusal. Data were analyzed to assess the potential factors associated with vaccination uptake. Results A total of 725 postpartum women participated (Site 1: 531, Site 2: 194; median age: 34 years). Overall, 51.2% received at least one vaccine during pregnancy, with the highest uptake observed for Tdap (42.5%), followed by influenza (19.6%) and COVID‐19 vaccination (3.6%). RSV vaccination was negligible (< 1%). Influenza vaccination was significantly higher in Site 1 (22.2%) compared with Site 2 (12.4%, p < 0.001), whereas uptake rates for the other vaccines did not differ significantly between sites. Key barriers to vaccination included lack of physician advice (Site 1: 29.0%, Site 2: 18.6%), personal choice (Site 1: 12.4%, Site 2: 14.9%), and safety concerns, which were more prevalent in Site 2. Higher educational attainment and urban residence remained independently associated with vaccine uptake, after adjustment for potential confounding factors. Conclusion Maternal immunization in Greece still remains a great challenge, since only 14.62% of the studied sample received multiple vaccines. Enhancing immunization strategies necessitates targeted interventions that address provider–patient communication, systemic barriers, and perceptions of vaccine safety in order to improve adherence to recommended vaccination schedules.
BACKGROUND:Gestational diabetes mellitus (GDM) increases maternal and neonatal risks and its reported prevalence has risen with evolving diagnostic criteria and screening strategies. Although screening at 24-28 weeks is widely recommended, optimal testing methods and the value of screening outside that window remain contested. The aim of this narrative review is to critically examine the clinical significance, epidemiology, and pragmatic screening strategies for GDM first identified or retested in late pregnancy (the third trimester) after normal midpregnancy screening. METHODS:This narrative synthesis integrates findings from observational studies, retrospective cohorts, guideline statements, and relevant systematic reviews (including a 2024 meta-analysis) to summarize current knowledge and highlight gaps. RESULTS:Reports show that repeat testing can detect new GDM cases. For example, one published retrospective cohort reported an 18.3% incidence among high-risk women retested in the third trimester. Observational evidence and published reviews indicate associations between late-diagnosed GDM and higher rates of shoulder dystocia, cesarean delivery, and low 5-min Apgar scores, though findings for macrosomia, neonatal hypoglycemia, and NICU admission are inconsistent. The short interval between late diagnosis and delivery limits the potential impact of interventions, and diagnosis itself may increase medicalization. Standard IADPSG OGTT thresholds were derived from 24-32-week cohorts and their applicability in later gestation is uncertain. Pragmatic, selective strategies-targeted retesting based on ultrasound or clinical risk, or screening with random glucose/HbA1c to detect overt hyperglycemia-may reduce unnecessary OGTTs while identifying clinically meaningful cases. CONCLUSIONS:As a narrative review, this article synthesizes current evidence to conclude that late-onset GDM is clinically relevant but understudied; universal third-trimester OGTT is not yet supported by robust outcome data. Prospective studies are needed to define optimal screening populations, diagnostic criteria, and management in late pregnancy.
OBJECTIVE:Pulse diagnosis holds significant importance in traditional Chinese medicine (TCM). The accurate identification of pregnancy pulse patterns is crucial in TCM diagnosis, as it provides valuable insights into a patient's health status and enables the development of personalized treatment strategies. However, the complexity and variability of pulse characteristics across different stages of pregnancy pose a significant challenge for TCM practitioners. METHODS:To address the issue, a novel one-dimensional convolutional neural network (1DCNN) integrated with a gated recurrent unit (GRU) and an improved squeeze-and-excitation network (ISENet), named 1DCNN-GRU-ISENet, is proposed to identify the pregnancy pulse of three stages. Specifically, the 1DCNN is employed to construct parallel convolutional branches and series-stacked blocks. This architecture not only functions as a residual network but also enhances the network's depth, enabling effective extraction of pulse features. By incorporating this structure, the model is capable of capturing more intricate and subtle characteristics of the pulse within different frequency ranges, leading to improved feature representation and enhanced performance. Simultaneously, the integration of GRUs facilitates comprehensive learning of pulse temporal features. Moreover, the ISENet assigns varying weights to different feature components based on pulse trends, effectively focusing on and highlighting crucial spatial features. RESULTS:Through rigorous evaluation with a locally collected research dataset, our network achieves accuracy rates of 90.8%, 91.6%, and 91.5% in identifying pregnancy pulse patterns for the three stages, respectively. Additionally, our model demonstrates good performance across various metrics, including average precision, sensitivity, F1 score, and AUC, with scores of 91.7%, 91.5%, 0.916, and 97.1%, respectively. CONCLUSION:These results underscore the effectiveness of our proposed network in accurately classifying pulse patterns and showcase its potential for practical application in assisting with auxiliary diagnosis in the context of TCM pulse evaluation.
