Day 1 :
- Reproductive Health
Location: 1
Session Introduction
Bethany Helm
Medway Maritime Hospital
Title: The effectiveness of eHealth weight-management interventions for pregnant and postpartum women: a systematic review and meta-analysis.
Biography:
Bethany Helm completed her MbCHb undergraduate degree in 2020 at the University of Birmingham. She undertook an intercalated degree in BMedSc Public Health and Population Sciences in 2018 and untdertook a systematic review with a Maternal Health focus for her degree dissertation. She is currently completing her FY1 year in the London & KSS foundation school at Medway Maritime Hospital.
Abstract:
Aims/Objectives: To determine the efficacy of eHealth weight management interventions on promoting postpartum weight loss and minimising excessive GWG in pregnant women.
Background: The prevalence of excessive gestational weight gain (GWG) and postpartum weight retention are increasing globally with associated risks to mother and child. Effective weight-management interventions for pregnant and postpartum women are required. eHealth interventions can deliver weight loss advice remotely, attain wide-reach and provide personalised feedback and goals; thus, easy implementation in this cohort is expected.
Materials and methods: A systematic review and meta-analysis was conducted following the PRISMA guidance. A search was conducted using MEDLINE, EMBASE, Psych Info, The Cochrane Library, PubMed, and the JMIR, up until January 2018. We searched for RCTs of eHealth weight management interventions in pregnant and postpartum women. Search terms included pregnancy, postpartum, eHealth, weight, weight loss and RCT. Study selection was conducted independently against the inclusion criteria. The primary outcome was weight-change. Secondary outcomes included physical activity and BMI. The Cochrane Risk of Bias Tool was used to assess methodological quality of trials.
Results, Summary/Conclusions: Of the 2233 identified studies, 16 met inclusion criteria and were summarised in a narrative review. 14 studies were included in a statistical meta-analysis; 6 compared eHealth interventions to usual care in postpartum women and 8 for pregnant women. eHealth interventions significantly improved postpartum weight loss (kg)(mean difference (MD) -2.61 [-3.66, -1.57] P< .0.001, I2=58%), but were unable to limit GWG (kg) in pregnant women (MD -0.15 [-1.44, 1.13] P= .81, I2=65%). Impact of these results is unclear due to the inclusion of pilot studies, lack of long-term trials and a substantial risk of bias and heterogeneity. All studies were conducted in high-income countries, implying that eHealth requires greater focus for implementation into low-income countries. eHealth interventions require further development and more rigorous trialling to support their use for weight-management in pregnant and postpartum women.
- Pregnancy and Childbirth
Location: 4
Session Introduction
Dr INDHUMATHI SHANMUGAM
Velammal Medical College, India
Title: Identifying Risk Factors that Delays Pregnancy in Endometriosis , Fibroid and Miscellaneous conditions – evidence based observational study.
Biography:
Abstract:
According to WHO, infertility is defined as failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. Endometriosis, fibroid and miscellaneous conditions ( such as PCOS, uterine anomalies) are often contributing reasons for female infertility. 5-10% of infertile women have Fibroid but it is the only cause in 1-2.4%. Studies have suggested that 25%- 50% of infertile women have endometriosis. These are many a times associated with symptoms of dysmenorrhea, dyspareunia, deep pelvic pain, dysuria and dyschezia. Many literatures discuss on diagnosing endometriosis , fibroid, and evolving procedures. This study focus on identifying the risk factors associated with Fibroid and Endometriosis in women with infertility and their influence on duration of infertility.
Aims and Objective:
To identify the risk factors influencing duration of infertility.
Materials And Methods
This is a retrospective cross sectional observational study conducted in Fertility Centre,SAT Hospital, Medical College, Thiruvananthapuram, India among Women with infertility who underwent laparoscopy during January 2017 to November 2018. Inclusion Criteria: Patients of primary or secondary infertility subjected to laparoscopy. 102 patients were recruited and observed. The study variables taken were as under; Socio demographic factors, Menstrual history, Associated symptoms, Reproductive history, Family history of endometriosis, Life style factors ,Visual diagnosis of endometriosis using revised ASRM classification.
Among the 29 categorical study variables, 20 were dichotomous and 10 had more than 2 groups.
Statistical analysis:
The relationship between infertility duration and 5 symptoms was found using the binary logistic regression. The associations of 5 symptoms of pain with diagnostic events were analysed by chisquare contingency table. The significant risk factors to predict the probability of infertility duration more than 3 years were determined by multiple linear regression analysis
Results:
In this study, out of 102 patients, 40.2% had infertility duration less than 3 years and 59.8% had more than 3 years. 41.2% diagnosed with Fibroid, 22.5% endometriosis and 36.3% miscellaneous conditions. The duration of infertility more than 3 years in patients with endometriosis, fibroid and miscellaneous conditions were 63.5%, 55% and 57.5% respectively. 57.8% had dysmenorrhoea, 38.2% pelvic pain and 36.3% Dyspareunia . The diagnosis of endometriosis and fibroid showed significant association with dysmenorrhea(p value 0.000) and dyspareunia(p value 0.061). 98% of endometriosis had dysmenorrhea (OR-0.02), 73% had dyspareunia(OR-0.27) compared to miscellaneous conditions.The other symptoms dysuria(0.292), pelvic pain (0.347) did not show association with diagnosis. The risk factors associated with probability of increased duration of infertility (more than 3 years) are; Frequent cycles (less than 21 days), presence of dysmenorrhea, family history of endometriosis and underweight BMI.
Conclusion:
There have been standard guidelines for managing various causes of infertility considering its duration. Identifying the significant risk factors that increase the duration of infertility, helps in early diagnosis and intervention. The knowledge on modifiable factors help in creating awareness among reproductive women. The risk factors associated with prolonged duration of infertility according to this study were Frequent cycles (less than 21 days), presence of dysmenorrhea, family history of endometriosis and underweight BMI.