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Fulltext Correlation between Oral Glucose Tolerance Test Abnormalities and Adverse Pregnancy Outcomes in Gestational Diabetes: A Cross-Sectional Study

Kalok A, Ong MY, Hasrori A, Chiang KS, Yazim F, Baharuddin S, et al.

Int J Environ Res Public Health, 2020 09 24;17(19).
PMID: 32987806 DOI: 10.3390/ijerph17196990

Gestational diabetes mellitus (GDM) is associated with maternal and neonatal complications. We aimed to evaluate the relationship between the abnormalities of the oral glucose tolerance test (OGTT) and adverse pregnancy outcomes. This was a retrospective study of GDM patients over a five-year period in a Malaysian tertiary center. The diagnosis of GDM was based on the National Institute for Health and Care Excellence (NICE) guideline. The data on patients' demographics, OGTT results, GDM treatment, and pregnancy outcomes were analyzed. A total of 1105 women were included in the final analysis. The percentage of women with isolated abnormal fasting glucose, isolated two-hour abnormality, and both abnormal values were 4.8%, 87.1%, and 8.1%, respectively. Women with both OGTT abnormalities had a higher risk of preeclampsia (odds ratio (OR) 4.73; 95% confidence interval (CI) 1.45-15.41) and neonatal hypoglycemia (OR 8.78; 95% CI 1.93-39.88). Isolated postprandial abnormality was associated with an 80% lesser risk of neonatal hypoglycemia (OR 0.19; 95% CI 0.04-0.87). Both isolated fasting and multiple OGTT abnormalities were associated with insulin therapy. Multiple OGTT abnormalities were a positive predictor of adverse pregnancy outcomes, while isolated postprandial abnormality was associated with a lesser risk of neonatal complication. Further prospective study is essential to validate these findings.
Fulltext Risk Factors of Osteoporosis and Post-Discharged Supplements and Drugs Intake in Patients with Lower Body Fractures

Ibrahim NI, Ahmad MS, Szulfarina M, Sayed Mohd Zaris SNA, Zainal Abidin NA, Mohamed IN, et al.

Iran J Public Health, 2021 Feb;50(2):415-417.
PMID: 33748009 DOI: 10.18502/ijph.v50i2.5364
Does palm oil vitamin E reduce the risk of pregnancy induced hypertension?

Mahdy ZA, Siraj HH, Khaza'ai H, Mutalib MS, Azwar MH, Wahab MA, et al.

Acta Medica (Hradec Kralove), 2013;56(3):104-9.
PMID: 24592747

In view of the high anti-oxidative potential oftocotrienol, the role of the tocotrienol-rich fraction (TRF) of palm oil in preventing pregnancy induced hypertension (PIH) was explored in a randomized double-blind placebo-controlled clinical trial in an urban teaching hospital. Healthy primigravidae were randomized to receive either oral TRF 100 mg daily or placebo, from early second trimester until delivery. Out of 299 women, 151 were randomized into the TRF arm and 148 into the placebo arm. A total of 15 (5.0%) developed PIH. Although there was no statistically significant difference in the incidence of PIH (4/151 or 2.6% in the TRF arm vs. 11/148 or 7.4% in the placebo arm, p = 0.058) between the two arms, there was a tendency towards a lower incidence of PIH in the TRF arm compared to the placebo arm. With TRF supplementation, the relative risk (RR) of PIH was 0.36 (95% CI 0.12-1.09). In conclusion, although TRF from palm oil does not statistically significantly reduce the risk of development of PIH in the population studied, the 64% reduction in incidence of PIH is substantial. The findings warrant further clinical trials, particularly in high risk populations.
Fulltext Comparison of Pregnancy Outcome between 4 and 6 cm Cervical os Dilatation to Demarcate Active Phase of Labour: A Cross-Sectional Study

Mohd Fathil N, Abd Rahman R, Mohd Nawi A, Kamisan Atan I, Kalok AH, Mohamed Ismail NA, et al.

J Pregnancy, 2023;2023:8243058.
PMID: 37404975 DOI: 10.1155/2023/8243058

This is a cross-sectional study comparing pregnancy outcomes between participants with 4 and 6 cm of cervical os dilatation at the diagnosis of the active phase of labour. It was conducted in a single tertiary centre involving low-risk singleton pregnancies at or beyond 37 weeks with spontaneous onset of labour. A total of 155 participants were recruited, 101 in group 1 (4 cm) and 54 in group 2 (6 cm). Both groups were similar in mean maternal age, mean gestational age at delivery, ethnicity, median haemoglobin level at delivery, body mass index, and parity. There were significantly more participants in group 1 who needed oxytocin augmentation (p < 0.001) for the longer mean duration (p = 0.015), use of analgesia (p < 0.001), and caesarean section rate (p = 0.002). None of the women had a postpartum haemorrhage or a third- or fourth-degree perineal tear, and none of the neonates required admission to the neonatal intensive care unit. There were significantly more nulliparas who had a caesarean section as compared to multiparas. A cervical os dilatation of 6 cm reduces the risk of caesarean section by 11% (95% CI, 0.01-0.9) and increases three times more the need for analgesia (AOR = 3.44, 95% CI, 1.2-9.4). In conclusion, the demarcation of the active phase of labour at a cervical os dilatation of 6 cm is feasible without an increase in maternal or neonatal complications.
Fulltext Effect of Acupressure at P6 on Nausea and Vomiting in Women with Hyperemesis Gravidarum: A Randomized Controlled Trial

Mohd Nafiah NA, Chieng WK, Zainuddin AA, Chew KT, Kalok A, Abu MA, et al.

Int J Environ Res Public Health, 2022 Sep 01;19(17).
PMID: 36078602 DOI: 10.3390/ijerph191710886

Hyperemesis gravidarum is characterized by severe nausea and vomiting. This study aims to illustrate the efficacy of acupressure at P6 in treating nausea and vomiting in hyperemesis gravidarum. This parallel randomized controlled trial was conducted from 2016-2017 in a tertiary hospital. Hospitalized women with ≤16 weeks of gestation and moderate to severe nausea and vomiting classified using a modified PUQE score were randomly assigned in a 1:1 ratio to either apply an acupressure wristband at the P6 point three times daily or to receive regular doses of intravenous antiemetics. The primary outcome was differences in modified PUQE scores among the groups. The secondary outcomes were differences in the rate of urine ketone clearance and the frequency of requiring rescue antiemetics. Ninety women were equally randomized into two groups, with no dropout. There was a statistically significant difference in the degrees of nausea and vomiting between the groups at 8, 16, and 24 hours post-admission (p8hours= 0.001, p16hours = 0.006, and p24hours = 0.001). The requirement of antiemetics and the rate of urine ketone clearance between the two groups were also statistically significant, at p = 0.001 and p = 0.02 respectively. There were no side effects in either group. The P6 acupressure was efficacious in alleviating nausea and vomiting among hyperemesis gravidarum women. The trial was retrospectively registered on ClinicalTrials.gov (NCT05175079).
Second twin outcome at birth: retrospective analysis in a single tertiary centre in Malaysia

Rahman RA, Mohammed Nawi A, Ishak S, Balaraman K, Abu MA, Abd Azman SH, et al.

J Perinat Med, 2024 May 27;52(4):385-391.
PMID: 38511669 DOI: 10.1515/jpm-2023-0449

OBJECTIVES: To investigate factors associated with outcome of second twin during labour.
METHODS: The study was a retrospective cohort study in a single tertiary centre in Malaysia from 2014 until 2018 involving all twin pregnancies delivered at or more than 24 weeks of gestation.
RESULTS: Total of 409 twin pregnancies were included. Dichorionic twin comprises of 54.5 % (n=223) and 45.5 % (n=186) are monochorionic. Women with dichorionic pregnancies are significantly older (p<0.001), have more pre-existing medical disorders (p=0.011) and fetal structural anomalies (p=0.009). Monochorionic pregnancies are significantly more amongst Malay (p=0.01) and conceived spontaneously (p<0.001). There are significantly more fetuses both in cephalic presentation (p=0.026), birthweight discrepancy more than 20 % (p=0.038) and shorter mean inter-twin delivery duration (p=0.048) in monochorionic pregnancies. Second twin delivered with Apgar score <7 is significantly more in dichorionic pregnancies (p=0.006). The second twin is associated with lower birthweight, small for gestational age and arterial cord pH<7.25. Within the group of women who delivered both fetuses vaginally, there was significantly more second twins with intertwin delivery duration less than 30 min who were delivered vaginally without instrumentation (p=0.018). There was significantly more second twin with intertwin delivery duration of 30 min and more with arterial cord pH<7.25 (p=0.045). Those who delivered spontaneously had inter-twin delivery duration within 15-29 min. The outcome of second twin is not influenced by type of twin, gestational age at delivery, inter-twin delivery duration, mode of delivery and presentation at birth.
CONCLUSIONS: The neonatal outcome for the second twin at birth is not influenced by type of twin, gestational age at delivery, inter-twin delivery duration, mode of delivery and presentation at birth in a cohort managed with non-active management of the second twin in Malaysia.
Fulltext The Role of Maternal Serum Ferritin in Gestational Diabetes Mellitus in Southeast Asia

Badaruddin I', Norbani A, Chin JY, Md Said ES, Selvarajoo U, Mohammad Khaidir NT, et al.

Cureus, 2024 Oct;16(10):e72155.
PMID: 39583387 DOI: 10.7759/cureus.72155

Introduction Gestational diabetes mellitus (GDM) poses a significant health concern due to the numerous risks it presents to both the mother and fetus. While serum ferritin typically declines in cases of iron deficiency anemia, which is common during pregnancy, it may increase in the presence of inflammation. This study aims to evaluate the significance of serum ferritin in the context of GDM, considering its multifaceted role in these interconnected conditions. Methodology This cross-sectional study included pregnant women attending an obstetrics clinic for an oral glucose tolerance test at Hospital Canselor Tuanku Muhriz in Kuala Lumpur, Malaysia. With consent, demographic data, risk factors for GDM, and blood samples were collected. Blood samples were analyzed for serum ferritin, fasting blood glucose, two-hour post-glucose levels, and full blood count. The assessment of risk factors for GDM and the diagnosis of GDM adhered to Malaysian guidelines. The Mann-Whitney U test was employed to compare variables between the GDM and non-gestational diabetes mellitus (non-GDM) groups. Additionally, univariate and multivariate regression analyses were conducted to investigate the role of serum ferritin in GDM. All analyses were performed using IBM SPSS Statistics for Windows, Version 28.0 (Released 2021; IBM Corp., Armonk, NY, USA), with statistical significance set at p < 0.05. Results Among 172 pregnant women with an average gestational age of 23.6 weeks, the incidence of GDM was higher in those with risk factors (84.8%) compared to non-GDM participants (75.5%). Women with GDM had a slightly higher mean serum ferritin level (50.24 ± 29.00 ng/mL) than those without GDM (45.00 ± 58.69 ng/mL). However, ferritin levels did not significantly differ between the GDM and non-GDM groups (p = 0.669) or between those with and without risk factors (p = 0.374). While a higher BMI (OR: 0.832, p = 0.017) and ferritin (OR: 1.022, p = 0.031) levels independently predicted GDM, the predictive value of ferritin was borderline significant when combined with glucose tests (area under the curve = 0.689, p = 0.051). Conclusions Higher maternal serum ferritin levels in the mid-trimester are associated with increased BMI and GDM. However, maternal serum ferritin is most effective at predicting the incidence of GDM when used alongside standard glucose measurements, especially in women with elevated BMI.
Fulltext The Relationship Between Physical Activity and Mental Health Among Individuals With Spinal Cord Injury: Protocol for a Scoping Review

Ong W, Omar NA, Zanudin A, Alias MF, Hui Wen L, Thang Xue Ee A, et al.

JMIR Res Protoc, 2024 Jun 12;13:e56081.
PMID: 38865699 DOI: 10.2196/56081

BACKGROUND: Spinal cord injury (SCI) is a devastating condition that often leads to significant impairments in physical function, leading to disability and mental health disorders. Hence, understanding the prevalence of SCI and the relationship between physical activity and mental health in individuals with SCI is crucial for informing rehabilitation strategies and optimizing outcomes.
OBJECTIVE: This study aims to comprehensively analyze existing research on the link between physical activity and mental health and identify the level of physical activity and mental health status, the barriers to physical activity, and SCI's impacts on psychological well-being in individuals with SCI.
METHODS: An electronic search strategy will be used to identify prevalence studies published since 1993 in health-related databases such as PubMed, MEDLINE, COCHRANE Library, and Wiley Library using the following query: "Spinal Cord Injury" OR "Paraplegia" OR "Tetraplegia" AND "Physical Activity" OR "Exercise" AND "Mental Health" OR "Mental Illness" OR "Mental Disorder." Bibliographies of primary studies and review articles meeting the inclusion criteria will be searched manually to identify further eligible studies. The risk of bias in the included studies will be appraised using the Joanna Briggs Institute checklist for prevalence studies by 2 review authors. Any disagreement will be resolved by reaching a consensus.
RESULTS: Funding was received in October 2023, data collection will commence in July 2024, and the results are expected by 2025. We will summarize the selection of the eligible studies using a flowchart. The data from the studies will be extracted and tabulated. This scoping review will be published in a peer-reviewed journal in accordance with PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines.
CONCLUSIONS: This scoping review underscores the complex relationship between physical activity and mental health among individuals with SCI, highlighting the level of physical activity and mental health status, barriers to physical activity engagement, and psychological implications. Understanding these dynamics is crucial in devising tailored interventions aimed at enhancing mental well-being. This synthesis of evidence emphasizes the need for personalized strategies to promote physical activity, addressing unique challenges faced by this population to foster improved mental health outcomes and overall quality of life.
TRIAL REGISTRATION: Open Science Framework osf.io/ugx7d; https://osf.io/ugx7d/.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/56081.
Fulltext The role of probiotics in improving menstrual health in women with primary dysmenorrhoea: A randomized, double-blind, placebo-controlled trial (the PERIOD study)

Zakaria IA, Mohammed Zain NA, Teik CK, Abu MA, Zainuddin AA, Abdul Aziz NH, et al.

Womens Health (Lond), 2024;20:17455057241234524.
PMID: 38444064 DOI: 10.1177/17455057241234524

BACKGROUND: Primary dysmenorrhea is associated with poorer quality of life; however, the causal mechanism remains unclear. A vast body of literature supports the use of oral probiotics for relief from the symptoms of endometriosis; however, to our knowledge, no study has prescribed probiotics for primary dysmenorrhea.
OBJECTIVE: The aim of this study is to investigate the effects of 3-month supplementation with oral probiotics on quality of life and inflammatory markers in women with primary dysmenorrhea.
DESIGN: Randomized placebo-controlled trial.
METHODS: A total of 72 patients (36 patients in each arm) were randomized to receive either oral sachets containing 5 billion colony-forming units each of Lactobacillus acidophilus BCMC (BCrobes Microbial Cells) 12130, Lactobacillus casei subsp BCMC 12313, Lactobacillus lactis BCMC 12451, Bifidobacterium bifidum BCMC 02290, Bifidobacterium longum BCMC 02120, and Bifidobacterium infantis BCMC 02129 each or placebo twice daily for 3 months. Main outcome measures were visual analog scale, verbal rating scale, physical and mental health scores using Short-Form 12-Item version 2 questionnaire, frequency of nonsteroidal anti-inflammatory drug use, and changes in inflammatory markers (interleukin-6, interleukin-8, and tumor necrosis factor alpha) before and after treatment.
RESULTS: There was no significant difference in the quality of life scores between the probiotic and placebo groups. Both groups showed significant improvement in pain (visual analog scale) and severity (verbal rating scale) scores but the probiotic group had much lower nonsteroidal anti-inflammatory drug use (odds ratio: 0.69, 95% confidence interval: 0.26-1.83) and better mental health scores (mean change: 6.5, p = 0.03 versus 6.1, p = 0.08) than the placebo group. There was a significant confounding effect of nonsteroidal anti-inflammatory drug use on quality of life scores. No significant difference was found in inflammatory cytokines.
CONCLUSION: Tested oral probiotics improved mental health and potentially reduced the use of nonsteroidal anti-inflammatory drugs; however, there was no significant change in inflammatory markers. Further research with a larger sample size is needed to confirm the findings.
REGISTRATION: This study is registered under ClinicalTrials.gov (NCT04119011).