Influenza vaccination in pregnancy — current data on safety and effectiveness

Pregnant women are at risk of severe and complicated influenza, and so are children aged 2-5 years. Despite numerous recommendations, influenza vaccination coverage in pregnant women is still low. The trigger for this article was the development of new quadrivalent influenza vaccines along with the publication of new studies on the safety and effectiveness of inactivated influenza vaccines in pregnant women, administered also in the first trimester of pregnancy. The inactivated quadrivalent influenza vaccine is a safe and effective measure for preventing influenza in both mother and child. Live attenuated influenza vaccines are contraindicated in pregnant women, whereas inactivated influenza vaccines should be recommended to all pregnant women, either healthy or with comorbidities. Influenza vaccines can be administered during any pregnancy trimester, at least two weeks before delivery. The time of vaccination depends on vaccine availability; however, it should not be postponed unless there are significant medical contraindications

Dietary vitamin and mineral intakes in a sample of pregnant women with either gestational diabetes or type 1 diabetes mellitus, assessed in comparison with Polish nutritional guidelines

Objectives: Maintaining proper nutrition during pregnancy is crucial for pregnant women and especially for who havebeen diagnosed with type 1 diabetes mellitus (T1DM) or who develop gestational diabetes mellitus (GDM).Material and methods: To measure differences in vitamin and mineral intakes among women with normal pregnancies,pregnant women with GDM, and pregnant women with pre-gestational T1DM; and to assess the women’s dietary intakes in comparison with Polish nutritional guidelines. The analysis was conducted among 83 pregnant women (29 GDM patients, 26 T1DM patients and 28 normal pregnancy participants) from whom we collected seven-day 24-hour dietary records during the second part of their pregnancies.Results: There were no statistically significant differences observed for most of the vitamin and mineral intakes across the three groups. However, we did observe a significant difference in the vitamin C and calcium intakes between groups. The mean vitamin C and calcium intakes were significantly higher in the control group than among the diabetic patients. Insufficient dietary calcium intakes were found among 52.3% of the GDM patients and 61.6% of the T1DM participants, while only 28.6% of the normal pregnancy patients experienced a calcium deficiency. The highest incidence of inadequate intake in each of the GDM, T1DM and control groups was observed for vitamin D (100%, 100%, 100%), folate (97.7%, 100%, 100%), iron (97.7%, 100%, 100%), and iodine (97.7%, 92.4%, 85.7%), respectively.Conclusions: Diet alone may not be enough to provide adequate levels of vitamins and minerals for most micronutrients. Supplement use reduces the risk of inadequate intake for many micronutrients, but diet-related issues during pregnancy and pregnancy diagnosed with diabetes remain, and they deserve to be addressed during public health interventions

Dietary macronutrients and fluid intakes in a sample of pregnant women with either gestational diabetes or type 1 diabetes mellitus, assessed in comparison with Polish nutritional guidelines

Objectives: Pregnancy is a critical period during which environmental factors such as nutrition can affect development. Maintaining proper nutrition becomes even more significant when pregnant women have diabetes. The aim of this study was to measure changes in energy and macronutrient intakes among pregnant women and patients diagnosed either with gestational diabetes mellitus (GDM) during pregnancy, or, type 1 diabetes mellitus (T1DM) before pregnancy, and to assess the pregnant women’s dietary intakes in comparison with Polish Institute of Food and Nutrition nutritional guidelines.Material and methods: The analysis was conducted among 83 pregnant women (29 GDM patients, 26 T1DM patients and 28 normal pregnancy patients — the control group) from whom we gathered nutritional data during the second part of their pregnancies. Data on each woman’s diet during pregnancy was collected is self-completed dietary records during seven consecutive 24-hour periods.Results: The mean macronutrient intake of the GDM patients was 32.1% fat, 19.5% protein, and 48.3% carbohydrates; in the T1DM group the results were 34.2%, 19.4% and 46.4% respectively; and in control group they were 31.8%, 17.6% and 50.5% respectively. This study showed that many of the pregnant women did not reach the recommended level of energy intake during pregnancy. Moreover, most of the women exceeded their fat requirements, and fat intake as a proportion of energy intakes also exceeded the guidelines in more than 60% of the women across all groups.Conclusions: The implications and possible causes of excessive fat intake during pregnancy and pregnancies complicated by diabetes are underestimated and undertreated by obstetricians and warrant further investigation, especially in association with gestational weight gain, maternal and fetal perinatal complications, and post-gestational diabetes

Association between intrahepatic cholestasis in pregnancy and gestational diabetes mellitus. A retrospective analysis

Objectives: Intrahepatic cholestasis of pregnancy (ICP) is a liver specific disorder affecting 0.08%–27.6% pregnant women. It is characterized by reduced expression of the primary bile acid farnesoid receptor (FXR). In recent studies, it has been showed that FXR has an impact on normal glucose homeostasis. Based on that it was suggested that the level of bile acids correlates with glucose level. The aim of the study was to evaluate the association between ICP and gestational diabetes mellitus (GDM).  Material and methods: 102 singleton patients complicated by ICP were included to the study and divided into two groups: non-GDM group (74 patients) and GDM group (28 patients). ICP was diagnosed based on the serum bile acids level > 10 μmol/L and GDM with the 75 g oral glucose tolerance test and FIGO guidelines. Demographic and clinical outcome data (including maternal age, BMI and infant weight) and ICP and GDM biochemical markers were collected.  Results: The incidence of GDM in ICP patients was 27.45%. 73% of women included to the study developed mild cholestasis. Lower levels of serum bile acids were correlated with GDM group. When compared mean total bilirubin level was significantly higher in non-GDM group. Transaminases (ALT, AST) and neonate condition including mean birth weight revealed no significant difference between the groups. On the other hand, prevalence of large for gestational age was significantly higher in non-GDM group (p < 0.00001).  Conclusions: The incidence of ICP is higher in women with GDM

Adjunctive Pessary Therapy after Emergency Cervical Cerclage for Cervical Insufficiency with Protruding Fetal Membranes in the Second Trimester of Pregnancy: A Novel Modification of Treatment

Aim. To evaluate the effectiveness of adjunctive pessary therapy after emergency cervical cerclage (ECC) in improving perinatal outcome in cervical insufficiency with fetal membranes protruding into the vagina. Material and Methods. A retrospective analysis of patients treated at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, between 2008 and 2013. The study group consisted of 15 women treated with ECC and a pessary and the control group consisted of 17 patients treated with cerclage only. Results. The mean gestational age at delivery was significantly higher in the study group (34.7 versus 29.7 weeks, p=0.03). The period between cerclage insertion and delivery was significantly longer in the study group (82.9 versus 52.1 days, p=0.045). The mean neonatal birthweight and neonatal “discharge alive” ratio were higher in the study group, although not statistically significant (2550 g versus 1883 g, p=0.14, and 93.3% versus 70.5%, p=0.18, resp.). NICU hospitalization rates were comparable (33.3% versus 35.3%, p=0.9). Conclusions. Adjunctive pessary therapy allows delaying delivery in women treated with ECC due to cervical insufficiency with protruding fetal membranes. It also seems to improve neonatal outcome, although the differences are not statistically significant. Further prospective study is required to prove these findings