Browsing by Author "Lackovic, Milan"

The study aimed at identification and analysis of adverse COVID-19 outcomes (admission to intensive care units due to COVID-19, acute respiratory distress syndrome, mechanical ventilation, and death) among hospitalized pregnant and nonpregnant women, which are critical for informed decision-making in obstetric diagnostics and healthcare. This was a retrospective observational study conducted on a series of inpatient pregnant women comparatively followed up with nonpregnant women hospitalized between 15 July 2020 to 20 January 2022 across multidisciplinary hospitals in three cities of Kazakhstan. Following group matching with propensity score for COVID-19 disease severity, residence status, and age, the study ultimately included 156 participants, of whom 50% were pregnant, from an initial sample of 314 female inpatients diagnosed with COVID-19. All findings were considered statistically significant at a -value < 0.05. Laboratory investigations revealed significantly elevated levels of erythrocyte sedimentation rate, creatinine, neutrophils, platelet count, alanine aminotransferase, aspartate aminotransferase, lymphocyte count, and C-reactive protein in pregnant inpatients compared to nonpregnant inpatients. Furthermore, pregnant women exhibited significantly higher levels of D-dimer (2402.97 ng/mL vs. 793.91 ng/mL) and procalcitonin (0.398 ng/mL vs. 0.134 ng/mL) compared to their nonpregnant counterparts. Overall, 16.88% of the pregnant women were admitted to the intensive care unit, whereas among the nonpregnant women, only 2.6% were hospitalized. The most lethal outcomes (8.3%) occurred among pregnant women, while for nonpregnant women, there were two cases (1.3%). Pregnant women diagnosed with COVID-19 may exhibit more severe clinical symptoms and encounter more adverse outcomes compared to their nonpregnant counterparts. Future research should incorporate larger matched samples to comprehensively explore the association between additional factors and clinical conditions.

Background and objectives: During the COVID-19 pandemic, a possible overlap of obesity and COVID-19 infection has raised concerns among patients and healthcare professionals about protecting pregnant women from developing a severe infection and unwanted pregnancy outcomes. The aim of this study was to evaluate the associations of body mass index with clinical, laboratory, and radiology diagnostic parameters as well as pregnancy complications and maternal outcomes in pregnant patients with COVID-19. Materials and methods: Clinical status, laboratory, and radiology diagnostic parameters and pregnancy outcomes were analyzed for pregnant women hospitalized between March 2020 and November 2021 in one tertiary-level university clinic in Belgrade, Serbia, due to infection with SARS-CoV-2. Pregnant women were divided into the three sub-groups according to their pre-pregnancy body mass index. For testing the differences between groups, a two-sided p-value <0.05 (the Kruskal-Wallis and ANOVA tests) was considered statistically significant. Results: Out of 192 hospitalized pregnant women, obese pregnant women had extended hospitalizations, including ICU duration, and they were more likely to develop multi-organ failure, pulmonary embolism, and drug-resistant nosocomial infection. Higher maternal mortality rates, as well as poor pregnancy outcomes, were also more likely to occur in the obese group of pregnant women. Overweight and obese pregnant women were more likely to develop gestational hypertension, and they had a higher grade of placental maturity. Conclusions: Obese pregnant women hospitalized due to COVID-19 infection were more likely to develop severe complications.

Migraine is a prevalent neurological disorder that significantly impacts the quality of life for affected individuals. The pathogenesis behind migraines is not yet fully understood, but hormonal changes, especially fluctuations in, estrogen and progesterone levels, have a significant role in the susceptibility of women to migraines. Pregnancy introduces a unique set of challenges for women who experience migraines, as they must navigate the complexities of managing their condition while safeguarding the health of both them and their unborn child. Pharmacological options for treating migraines during pregnancy are limited, and, therefore, there is a growing interest in exploring alternative approaches to migraine symptom relief and management. Physical activity during pregnancy provides a range of benefits, and it has gained attention as a potentially valuable tool for alleviating migraine symptoms in pregnant patients. This review explores the intricate relationship between migraines and pregnancy, emphasizing how physical activity and other alternative approaches may influence the frequency, severity, and overall experience of migraines during pregnancy. Through collaboration with healthcare providers and the adoption of personalized management strategies, women can strike a balance that supports both their own well-being and the healthy development of their unborn child. By examining existing research and emerging insights, we aim to provide a comprehensive understanding of the potential benefits and considerations of incorporating physical activity and other treatment options into migraine management strategies for pregnant women. Further research is needed to elucidate the specific mechanisms linking migraines, pregnancy, and physical activity, enabling the development of more targeted interventions and guidelines.

During the last two and a half years, clinical manifestations, disease severity, and pregnancy outcomes have differed among pregnant patients with SARS-CoV-2 infection. These changes were preceded by the presence of new variants of SARS-CoV-2, known in the literature as variants of concern. The aim of this study is to describe the differences between maternal clinical characteristics and perinatal outcomes among pregnant women with COVID-19 during four waves of the COVID-19 epidemic in Serbia. This retrospective study included a series of 192 pregnant patients who were hospitalized due to the severity of their clinical status of SARS-CoV-2 infection. During four outbreaks of COVID-19 infection in Serbia, we compared and analyzed three sets of variables, including signs, symptoms, and characteristics of COVID-19 infection, clinical endpoints, and maternal and newborn parameters. During the dominance of the Delta variant, the duration of hospitalization was the longest (10.67 ± 1.42 days), the frequency of stillbirths was the highest (17.4%), as well as the frequency of progression of COVID infection (28.9%) and the requirement for non-invasive oxygen support (37%). The dominance of the Delta variant was associated with the highest number of prescribed antibiotics (2.35 ± 0.28), the most common presence of nosocomial infections (21.7%), and the highest frequency of corticosteroid therapy use (34.8%). The observed differences during the dominance of four variants of concern are potential pathways for risk stratification and the establishment of timely and proper treatments for pregnant patients. Early identification of the Delta variant, and possibly some new variants with similar features in the future, should be a priority and, perhaps, even an opportunity to introduce more accurate and predictive clinical algorithms for pregnant patients.

: The aim of this study was to analyze the presence of gestational diabetes mellitus (GDM) on maternal and fetal perinatal parameters, as well to evaluate the influence of GDM on neonatal early motoric development. : In this prospective study, we evaluated 203 eligible participants that were admitted to obstetrics department for a labor. GDM was assessed by evaluation of maternal parameters, fetal parameters, as well its impact on infants early motoric development (Alberta Infant Motor Scale-AIMS). : Presence of GDM was significantly positively associated with: pre-pregnancy weight, obesity degree, weight at delivery, gestational weight gain (GWG), body mass index (BMI) at delivery, GWG and increased pre-pregnancy BMI, glucose levels in mother's venous blood after the delivery, positive family history for cardiovascular disease, pregnancy-related hypertension, congenital thrombophilia, drug use in pregnancy, large for gestational age (LGA), mode of delivery (Cesarean section and instrumental delivery). Likewise, GDM association was detected for tested ultrasound parameters (biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), femoral length (FL)), length at birth, birth weight, newborn's head circumference, newborn's chest circumference, AIMS supination and pronation at three months, AIMS supination, pronation, sitting and standing at six months. Only Amniotic Fluid Index and AIMS supination at three months of infant's age remained significantly associated in multivariate regression model. : The presence of significant positive association of numerous tested parameters in our study on perinatal outcomes and early motoric development, points to the necessity of establishing appropriate clinical decision-making strategies for all pregnant woman at risk and emphasize the importance of providing adequate glycaemia control options and further regular follow ups during the pregnancy.

Background and objectives: Maternal obesity influences pregnancy course in several different manners, and imbalanced nutrition during pregnancy may lead to various adverse pregnancy outcomes. Additionally, nutritional status during pregnancy may have implications for the health of the offspring and may possibly influence early motor development in children. The aim of this study was to assess the impact of excessive gestational weight gain (EGWG) on pregnancy outcomes and infant's motor development within the first twelve months of life. Materials and methods: The study included 200 participants divided in two groups based on their gestational weight gain. Maternal, perinatal, and neonatal factors were analyzed, and early motor development was assessed using the Alberta infant motor scale (AIMS). Results: EGWG was significantly associated with: pre-pregnancy BMI (p < 0.001), family history for cardiovascular diseases (p = 0.013) and diabetes mellitus (p = 0.045), hypertensive disorder of pregnancy (p = 0.003), gestational diabetes mellitus (p < 0.001), gestational anemia (p = 0.001), vitamin D deficiency (p = 0.001), metformin use (p = 0.045), pre-labor premature rupture of membranes (p = 0.031), amniotic fluid index (p = 0.047), and APGAR score in the first five min of life (p = 0.007). Scored by AIMS, EGWG was significantly associated with parameters of early motor development at the age of three AIMS total (p < 0.001), six AIMS total (p < 0.001), nine AIMS total (p < 0.001), and twelve AIMS total (p < 0.001) months of infant's life. Conclusions: The link between EGWG and adverse neurodevelopmental outcomes in offspring is a complex and multifaceted issue. Our results imply significant alterations in early motor development in the group of infants born from mothers who gained weight excessively during pregnancy. Further studies are needed to unravel the intricacies of this relationship and inform strategies for preventive interventions and supportive care during pregnancy and infancy.

During the last three years, since the emergence of the COVID-19 pandemic, a significant number of scientific publications have focused on resolving susceptibility to the infection, as well as the course of the disease and potential long-term complications. COVID-19 is widely considered as a multisystem disease and a variety of socioeconomic, medical, and genetic/epigenetic factors may contribute to the disease severity and outcome. Furthermore, the SARS-COV-2 infection may trigger pathological processes and accelerate underlying conditions to clinical entities. The development of specific and sensitive biomarkers that are easy to obtain will allow for patient stratification, prevention, prognosis, and more individualized treatments for COVID-19. miRNAs are proposed as promising biomarkers for different aspects of COVID-19 disease (susceptibility, severity, complication course, outcome, and therapeutic possibilities). This review summarizes the most relevant findings concerning miRNA involvement in COVID-19 pathology. Additionally, the role of miRNAs in wide range of complications due to accompanied and/or underlying health conditions is discussed. The importance of understanding the functional relationships between different conditions, such as pregnancy, obesity, or neurological diseases, with COVID-19 is also highlighted.

Introduction: Pre-pregnancy obesity is a significant public health concern with profound implications for maternal and child health. The burgeoning evidence suggests that maternal obesity prior to conception is intricately linked with an increased risk of gestational complications, as well as with adverse neonatal outcomes. Furthermore, the long and short-term health of offspring, including the risk of early motor development impairment, obesity, and metabolic syndrome in childhood and adulthood, may be adversely affected as well. Addressing pre-pregnancy obesity is critical for improving overall maternal and child health outcomes, and therefore, the aim of this study was to evaluate the connections linking pre-pregnancy obesity with infants' motor development within the first twelve months of infants' lives. Material and methods: This study included 200 mother-infant pairs divided into two groups based on their pre-pregnancy body mass index values. To assess infants' early motor development, we used the Alberta Infant Motor Scale (AIMS) and evaluated the parameters of infants' early motor development at the ages of three, six, nine, and twelve months. Results: Pre-pregnancy overweight/obesity was significantly associated with excessive gestational weight gain (p < 0.001), fetal macrosomia (p = 0.022), and a family history of diabetes and cardiovascular diseases (p = 0.048 and p = 0.041, respectively), as well as with all observed parameters of early motor development at the ages of three, six, nine, and twelve months: AIMS 3 months total (p < 0.001), AIMS 6 months total (p < 0.001), AIMS 9 months total (p < 0.001), and AIMS 12 months total (p < 0.001). Furthermore, pre-pregnancy overweight/obesity was a significant predictor for AIMS 6 months total (p = 0.043) and AIMS 6 months supination (p = 0.017). Conclusions: Pre-pregnancy obesity is a critical determinant of pregnancy outcomes and offspring early motor development, with possible far-reaching implications for children's long-term well-being. Addressing this issue requires a comprehensive approach that includes preconception weight management, targeted interventions during the pregnancy and postpartum periods, and ongoing research to better understand the underlying mechanisms and develop effective strategies for prevention and management.

Nowadays, children are able to enrich their reality via the Internet. Unfortunately, this may increase their risk of becoming victims of cyberbullying. We analyzed the health characteristics and risk behavior of two cohorts of children in Serbia; those who reported being exposed to cyberbullying and those who did not. The statistical differences and logistic regression models were applied to the data on 3267 students collected from 64 schools participating in the 2017 Serbian Study on health behavior in school-age children (HBSC). Children exposed to cyberbullying reported having the following health problems on a daily basis: headache (18.5%), back pain (19.5%), depression (21.6%), irritability or bad mood (17.7%), nervousness (16.0%), sleep problems (16.1%), and dizziness (21.2%). As for the different types of risk behavior, cigarette smoking ranging from six to nine days ever was the most prevalent (26.9%). It was followed closely by getting drunk more than 10 times ever (24.1%). Compared to non-victims, victims were found to be at a higher risk of perceived back pain (OR = 2.27), depression (OR = 1.43), irritability or bad mood (OR = 2.07), nervousness (OR = 2.23), and dizziness (OR = 2.43) as well as being injured once or twice (OR = 1.98) or three or more times (OR = 4.09). Victims were associated with further risk factors: having smoked more than five cigarettes ever in life (OR = 1.73) and having gotten drunk two to three times (OR = 1.71) or four or more times (OR = 1.65). As the number of school-age children using social media continues to rise, we must prioritize educating them about self-help and community resources for addressing related health issues with greater speed and intensity. The findings from Serbia suggest that while children may be aware of their health issues, they may be unaware of their link to cyberbullying, which could hinder their ability to address these issues promptly. The respondents' attention to the health implications of cyberbullying could be increased by reformulating the survey questions used in the HBSC study.

Our study aimed to analyze the reliability, consistency, and temporal stability of the Alberta Infant Motor Scale (AIMS) in Serbian infants. Additionally, we aimed to present a percentile distribution of AIMS in the tested population. The prospective study included 60 infants that were divided into three age groups: 0-3 months, 4-7 months, and 8-14 months. The Serbian version of AIMS was tested by two raters on two different occasions (test/retest) with a five day period between tests. The observed inter-rater reliability (intraclass correlation coefficient (ICC)) was more than 0.75 for all AIMS scores, except for standing (ICC 0.655 = moderate) in the age group of 4-7 months on retest between raters. The observed intra-rater reliability (ICC) was more than 0.75 for all AIMS scores except standing (ICC 0.655 = moderate) in the age group 4-7 months in test-retest for Rater One, and for sitting (ICC 0.671 = moderate) and standing (ICC 0.725 = moderate) in the age group between 0-3 months on test-retest for Rater Two. The Serbian version of AIMS was shown to have high consistency and high reliability with good to high temporal stability. Thus, it can be used in the evaluation of infants' motor development in Serbia.

Background and objectives: During the COVID-19 pandemic, Serbia has faced devastating losses related to increased mortality rates among men and women of all ages. With 14 registered cases of maternal death in 2021, it became obvious that pregnant women are faced with a serious threat that jeopardises their life as well as the life of their unborn child. Studying the consequences of the COVID-19 pandemic on maternal outcomes is vivifying and stimulating for many professionals and decision-makers, and knowing the contextual characteristics can facilitate the application of literature findings in practice. Therefore, the aim of this study was to present findings of maternal mortality in Serbia associated with SARS-CoV-2 infected and critically ill pregnant women. Methods: Clinical status and pregnancy-related features were analysed for a series of 192 critically ill pregnant women with confirmed SARS-CoV-2 infection. According to the treatment outcome, pregnant women were divided in two study groups: a group of survivors and a group of deceased patients. Results: A lethal outcome was recorded in seven cases. Pregnant women in the deceased group were presenting at admission more commonly with X-ray-confirmed pneumonia, a body temperature of >38 °C, cough, dyspnea, and fatigue. They were more likely to have a progression of the disease, to be admitted to intensive care unit, and be dependent from mechanical ventilation, as well as to have nosocomial infection, pulmonary embolism, and postpartum haemorrhage. On average, they were in their early third trimester of pregnancy, presenting more commonly with gestational hypertension and preeclampsia. Conclusions: Initial clinical manifestations of SARS-CoV-2 infection, such as dyspnea, cough, fatigue, and fever, could be a potent factors in risk stratification and outcome prediction. Prolonged hospitalization, ICU admission, and associated risk of hospital-acquired infections require strict microbiological surveillance and should be a constant reminder of rational antibiotics use. Understanding and identification of risk factors associated with poor maternal outcomes among pregnant women infected with SARS-CoV-2 should warn medical professionals of potentially unwanted outcomes and can be used for organising an individualised treatment for a pregnant patient's specific needs, including a guide to necessary consultations with medical specialists in various fields.

Stroke during pregnancy and preeclampsia are two distinct but interrelated medical conditions, sharing a common denominator-blood control failure. Along with cardiovascular diseases, diabetes, dyslipidemia, and hypercoagulability, hypertension is undoubtedly a major risk factor associated with stroke. Even though men have higher age-specific stroke rates, women are facing higher life-long stroke risk, primarily due to longer life expectancy. Sex hormones, especially estrogen and testosterone, seem to play a key link in the chain of blood pressure control differences between the genders. Women affected with stroke are more susceptible to experience some atypical stroke manifestations, which might eventually lead to delayed diagnosis establishment, and result in higher morbidity and mortality rates in the population of women. Preeclampsia is a part of hypertensive disorder of pregnancy spectrum, and it is common knowledge that women with a positive history of preeclampsia are at increased stroke risk during their lifetime. Preeclampsia and stroke display similar pathophysiological patterns, including hypertension, endothelial dysfunction, dyslipidemia, hypercoagulability, and cerebral vasomotor reactivity abnormalities. High-risk pregnancies carrying the burden of hypertensive disorder of pregnancy have up to a six-fold higher chance of suffering from stroke. Resemblance shared between placental and cerebral vascular changes, adaptations, and sophisticated auto-regulatory mechanisms are not merely coincidental, but they reflect distinctive and complex cardiovascular performances occurring in the maternal circulatory system during pregnancy. Placental and cerebral malperfusion appears to be in the midline of both of these conditions; placental malperfusion eventually leads to preeclampsia, and cerebral to stoke. Suboptimal performances of the cardiovascular system are proposed as a primary cause of uteroplacental malperfusion. Placental dysfunction is therefore designated as a secondary condition, initiated by the primary disturbances of the cardiovascular system, rather than an immunological disorder associated with abnormal trophoblast invasion. In most cases, with properly and timely applied measures of prevention, stroke is predictable, and preeclampsia is a controllable condition. Understanding the differences between preeclampsia and stroke in pregnancy is vital for healthcare providers to enhance their clinical decision-making strategies, improve patient care, and promote positive maternal and pregnancy outcomes. Management approaches for preeclampsia and stroke require a multidisciplinary approach involving obstetricians, neurologists, and other healthcare professionals.

: The aim of our study was to assess the influence of prepregnancy Body Mass Index (BMI) changes as well as excessive gestational weight gain (GWG) on maternal and fetal perinatal parameters. Furthermore, we aimed to analyze the influence of increased prepregnancy BMI values and excessive GWG on neonatal early motoric development. : The 203 eligible female participants were evaluated. Prepregnancy Body Mass Index (BMI) and excessive gestational weight gain (GWG) defined according to Institute of Medicine 2009 guidelines in the USA were assessed with tested maternal and fetal perinatal parameters and infants early motoric development (Alberta Infant Motor Scale-AIMS). : Significant predictors of increased prepregnancy BMI in perinatal period include: weight at delivery ( = 0.001), GWG ( = 0.002) and BMI at delivery ( < 0.001), while significant predictors of excessive GWG in perinatal period are: prepregnancy BMI ( = 0.029) and BMI at delivery ( < 0.001). In the group of participants with both increased prepregnancy BMI and excessive GWG versus others, significant predictors were: hypertension (HTA) ( = 0.019), amniotic fluid index (AFI) ( = 0.047), Pronation (AIMS) ( = 0.028) and Supination (AIMS) ( = 0.029). : Increased prepregnancy BMI and excessive GWG are significantly associated with numerous perinatal factors that could alter the pregnancy course, pregnancy outcome and early motoric development of newborn. Moreover, increased prepregnancy BMI is shown to be a significant predictor of excessive GWG; thus, early selection of pregnant women for close monitoring of weight gain during pregnancy will have positive effects on reducing the risk of less favorable pregnancy course and early motoric development of newborn.