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Objective:  Maternal body mass index (BMI) and cardiac biomarkers, such as N-terminal pro-B-type natriuretic peptide (NT-proBNP), have been subjects of interest in obstetric research due to their potential implications for maternal and fetal health. Previous studies have explored the relationship between maternal BMI and various pregnancy outcomes, but the impact on NT-proBNP levels remains unclear. This study aims to investigate whether maternal BMI influences NT-proBNP levels in the third trimester of pregnancy, which could provide insights into maternal cardiovascular health during late gestation., Study Design:  A total of 234 singleton pregnant women in their third trimester (28-40 weeks) were recruited from Antenatal Care Clinic. Exclusion criteria included preexisting cardiac or renal conditions, hypertension, diabetes mellitus, and other specific medical conditions. Participants were categorized into BMI groups (< 23, 23-24.9, 25-29.9, and ≥30 kg/m 2 ), and their NT-proBNP levels were measured using quantitative enzyme-linked immunosorbent assay kits. Statistical analyses including Spearman correlation, chi-squared test, Kruskal-Wallis test, and regression analysis were performed to assess the association between maternal BMI and NT-proBNP levels., Results:  The study population exhibited a range of BMI and NT-proBNP levels within normal ranges. No significant correlation was found between maternal age, parity, and NT-proBNP levels. Similarly, no significant association was observed between maternal BMI and NT-proBNP levels across different BMI categories. Trend analyses showed no consistent relationship between BMI and NT-proBNP levels. Multivariate and univariate regression analyses confirmed the lack of significant association between maternal BMI and NT-proBNP levels., Conclusion:  Contrary to expectations, this study found no significant effect of maternal BMI on NT-proBNP levels in the third trimester of pregnancy. These findings suggest that factors other than maternal BMI may predominantly influence NT-proBNP levels during late gestation. Further research is warranted to elucidate the complex interactions between maternal physiology, BMI, and cardiovascular biomarkers during pregnancy., Key Points: · This study aimed to examine the influence of maternal BMI on NT-proBNP.. · No significant correlation between maternal BMI and NT-proBNP levels was found.. · Other factors likely influence NT-proBNP levels, warranting further research.., Competing Interests: None declared., (Thieme. All rights reserved.)

Objective We evaluated the relationship between maternal body mass index (BMI) and death or bronchopulmonary dysplasia (BPD). We hypothesized that in extremely low birth weight (ELBW; BW < 1,000 g) infants, the risk of death or BPD would be greater if the maternal BMI deviated further from the ideal BMI of 24. Study Design ELBW infants admitted to AdventHealth Neonatal Intensive Care Unit (NICU) between calendar years 2012 and 2017 were included in this retrospective observational study. BPD was defined as continuous supplemental oxygen use at 36 weeks post-menstrual age. Result There was no association between the deviation of maternal BMI from the ideal of 24 and the composite outcome of death or BPD (6.9 ± 6.7 vs. 7.06 ± 6.6, pp = 0.966). However, there was a lower risk of death with a higher maternal BMI (p = 0.024). BPD was also associated with a higher maternal BMI (p = 0.045). Conclusion Maternal BMI was not associated with the composite variable of death or BPD in ELBW infants. The lack of association was due to the contrast between high BMI and a lower risk of death and a higher risk for BPD. Key Points Maternal BMI was not associated with the composite outcome of death or BPD. Elevated BMI was associated with a higher risk of BPD. Elevated BMI was associated with a lower risk of death. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to assess the association of maternal body mass index (BMI) with a composite of severe maternal outcomes., Study Design: Secondary analysis of a cohort of deliveries on randomly selected days at 25 hospitals from 2008 to 2011. Data on comorbid conditions, intrapartum events, and postpartum course were collected. The reference group (REF, BMI: 18.5-29.9kg/m 2 ), obese (OB; BMI: 30-39.9kg/m 2 ), morbidly obese (MO; BMI: 40-49.9kg/m 2 ), and super morbidly obese (SMO; BMI ≥ 50kg/m 2 ) women were compared. The composite of severe maternal outcomes was defined as death, intensive care unit (ICU) admission, ventilator use, deep venous thrombosis/pulmonary embolus (DVT/PE), sepsis, hemorrhage, disseminated intravascular coagulation (DIC), unplanned operative procedure, or stroke. Patients in the REF group were matched 1:1 with those in all other obesity groups based on propensity score using the baseline characteristics of age, race/ethnicity, previous cesarean, preexisting diabetes, chronic hypertension, parity, cigarette use, and insurance status. Multivariable Poisson's regression was used to estimate adjusted relative risks (aRRs) and 95% confidence intervals (CIs) for the association between BMI and the composite outcome. Because cesarean delivery may be in the causal pathway between obesity and adverse maternal outcomes, models were then adjusted for mode of delivery to evaluate potential mediation., Results: A total of 52,162 pregnant patients are included in the analysis. Risk of composite maternal outcomes was increased for SMO compared with REF but not for OB and MO [OB: aRR=1.06, 95% CI: 0.99-1.14; MO: aRR=1.10, 95% CI: 0.97-1.25; SMO: aRR=1.32, 95% CI: 1.02-1.70]. However, in the mediation analysis, cesarean appears to mediate 46% (95% CI: 31-50%) of the risk of severe morbidity for SMO compared with REF., Conclusion: Super morbid obesity is significantly associated with increased serious maternal morbidity and mortality; however, cesarean appears to mediate this association. Obesity and morbid obesity are not associated with maternal morbidity and mortality., Key Points: · Super morbid obesity is associated with increased morbidity.. · Cesarean appears to mediate the association between super morbid obesity and morbidity.. · Obesity and morbid maternal obesity are not associated with morbidity.., Competing Interests: None declared., (Thieme. All rights reserved.)

Objective: The aim of this study was to evaluate whether the risk of perinatal depression is associated with body mass index (BMI) category., Study Design: We performed a retrospective cohort study of women who completed an Edinburgh Postnatal Depression Scale (EPDS) questionnaire during the antepartum period at an integrated health system from January 2003 to May 2018. Risk of perinatal depression was defined as a score of ≥10 on the EPDS or an affirmative response to thoughts of self-harm. Risk of perinatal depression was compared by first trimester BMI category, defined as underweight (BMI: <18.5 kg/m 2 ), normal weight (BMI: 18.5-24.9 kg/m 2 ), overweight (BMI: 25.0-29.9 kg/m 2 ), or obese (BMI: ≥30.0 kg/m 2 ). Univariable analyses were performed using χ , Fisher's exact test, analysis of variance, Kruskal-Wallis, and Wilcoxon rank-sum tests as appropriate to evaluate the association between maternal BMI category, demographic and clinical characteristics, and risk of perinatal depression. Logistic multivariable regression models were performed to adjust for potential confounders identified as variables with 2 , Fisher's exact test, analysis of variance, Kruskal-Wallis, and Wilcoxon rank-sum tests as appropriate to evaluate the association between maternal BMI category, demographic and clinical characteristics, and risk of perinatal depression. Logistic multivariable regression models were performed to adjust for potential confounders identified as variables with p  < 0.10 in univariable analysis., Results: Our analysis included 3,420 obese women, 3,839 overweight women, 5,949 normal weight women, and 1,203 underweight women. The overall median gestational age at EPDS administration was 27 weeks (interquartile range: 23-29). Overweight and obese women were more likely to be non-Hispanic Black, Hispanic, multiparous, to have public insurance, prepregnancy diabetes, and chronic hypertension as compared with normal or underweight women ( p  < 0.001). In univariable analysis, the risk of perinatal depression was not significantly different among underweight (10.8%, odds ratio [OR]: 0.86, 95% confidence interval [CI]: 0.79-1.18) or overweight women (12%, OR: 0.96, 95% CI: 0.79-1.18); however, the risk was higher among obese women (14.7%, 95% CI: 1.21-1.55) compared with normal weight women (11.2%). In multivariable analysis, obesity remained associated with an increased risk of perinatal depression (adjusted OR: 1.19, 95% CI: 1.04-1.35)., Conclusion: Obesity is associated with an increased risk of perinatal depression as compared with women of normal weight., Key Points: · Maternal obesity is associated with an increased risk of perinatal depression.. · Maternal BMI is associated with increased risk of perinatal depression.. · Maternal obesity is an independent risk factor for perinatal depression.., Competing Interests: None declared., (Thieme. All rights reserved.)

Objective: Maternal prepregnancy body mass index (BMI) represents a surrogate marker of fetal exposures to the maternal metabolism during pregnancy. Yet, it remains poorly understood whether this marker indicates risk of altered trajectories in postnatal growth and development in children born preterm. This study aimed to determine whether maternal prepregnancy BMI is associated with altered growth and development in children born preterm., Study Design: A retrospective cohort study evaluated prepregnancy BMI as the exposure for childhood outcomes using linear regression and mixed effects models. The 38 children included in this follow-up evaluation originally participated in a prospective, observational cohort study to determine longitudinal levels of lipid species in preterm human milk expressed by women who delivered prior to 32 weeks. Childhood outcomes in this study were anthropometric measures during hospitalization ( n  = 38), after discharge through 36 months ( n  = 34) and Bayley-III developmental scores through 18 months corrected age ( n  = 26)., Results: In 38 children born prior to 32 weeks, higher maternal prepregnancy BMI was independently associated with higher preterm infant growth velocity during hospitalization, but not associated with in-hospital change in length or head circumference and/or postdischarge growth. In univariate linear regression models, higher maternal BMI was associated with lower cognitive scores at 18 months corrected age. This significant association remained in an adjusted model accounting for relevant influences on early childhood development., Conclusion: Increasing maternal prepregnancy BMI may reflect risk of altered growth and cognitive development in children born preterm., Key Points: · Maternal BMI was associated with early preterm infant weight gain.. · Maternal BMI was not associated with postdischarge growth.. · Increased maternal BMI may be associated with lower cognitive function scores in offspring.., Competing Interests: None declared., (Thieme. All rights reserved.)

Objective  The objective of this study was to determine the effect, if any, of maternal body mass index (BMI) and amniotic fluid index (AFI) on the accuracy of sonographic estimated fetal weight (EFW) at 40 to 42 weeks' gestation. Methods  This was a retrospective cohort study of singleton gestations with ultrasound performed at 40 to 42 weeks from 2010 to 2013. In this study, patients with documented BMI and sonographic EFW and AFI, concurrently, within 7 days of delivery were included. Chronic medical conditions and fetal anomalies were excluded from this study. The primary variable of interest was the rate of substantial error in EFW, defined as absolute percentage error (APE) >10%. Results  A total of 1,000 pregnancies were included. Overall, the APE was 6.0 ± 4.5% and the rate of substantial error was 17.4% (n  = 174). There was no significant difference in APE or rate of substantial error between BMI groups. In the final multivariable logistic regression model, the rate of substantial error was increased in women with oligohydramnios (OR 1.79; 95% CI: 1.10–2.92). Furthermore, oligohydramnios was significantly more likely to overestimate EFW while polyhydramnios was more likely to underestimate EFW. Maternal BMI did not affect the accuracy of sonographic EFW. Conclusion  Sonographic EFW may be affected by extremes of AFI in the postdates period. Maternal BMI does not affect EFW accuracy at 40 to 42 weeks. [ABSTRACT FROM AUTHOR]

Objective To evaluate the effect of prepregnancy body mass index (BMI), energy and macronutrient intakes during pregnancy, and gestational weight gain (GWG) on the body composition of full-term appropriate-for-gestational age neonates. Study Design This is a cross-sectional study of a systematically recruited convenience sample of mother-infant pairs. Food intake during pregnancy was assessed by food frequency questionnaire and its nutritional value by the Food Processor Plus (ESHA Research Inc, Salem, OR). Neonatal body composition was assessed both by anthropometry and air displacement plethysmography. Explanatory models for neonatal body composition were tested by multiple linear regression analysis. Results A total of 100 mother-infant pairs were included. Prepregnancy overweight was positively associated with offspring weight, weight/length, BMI, and fat-free mass in the whole sample; in males, it was also positively associated with midarm circumference, ponderal index, and fat mass. Higher energy intake from carbohydrate was positively associated with midarm circumference and weight/length in the whole sample. Higher GWG was positively associated with weight, length, and midarm circumference in females. Conclusion Positive adjusted associations were found between both prepregnancy BMI and energy intake from carbohydrate and offspring body size in the whole sample. Positive adjusted associations were also found between prepregnancy overweight and adiposity in males, and between GWG and body size in females. [ABSTRACT FROM AUTHOR]

Objectives The aim of the study was to identify the characteristics associated with spontaneous labor onset in pregnant patients undergoing expectant management at greater than 39 weeks' gestation and delineate perinatal outcomes associated with spontaneous labor compared with labor induction. Study Design This was a retrospective cohort study of singleton pregnancies at ≥39 0/7 weeks' gestation delivered at a single center in 2013. The exclusion criteria were elective induction, cesarean delivery or presence of a medical indication for delivery at 39 weeks, more than one prior cesarean delivery, and fetal anomaly or demise. We evaluated prenatally available maternal characteristics as potential predictors of the primary outcome-spontaneous labor onset. Multivariable logistic regression was used to generate two parsimonious models: one with and one without third trimester cervical dilation. We also performed sensitivity analysis by parity and timing of cervical examination, and compared the mode of delivery and other secondary outcomes between patients who went into spontaneous labor and those who did not. Results Of 707 eligible patients, 536 (75.8%) attained spontaneous labor and 171 (24.2%) did not. In the first model, maternal body mass index (BMI), parity, and substance use were identified as the most predictive factors. Overall, the model did not predict spontaneous labor (area under the curve [AUC]: 0.65; 95% confidence interval [CI]: 0.61–0.70) with high accuracy. The addition of third trimester cervical dilation in the second model did not significantly improve labor prediction (AUC: 0.66; 95% CI: 0.61–0.70; p = 0.76). These results did not differ by timing of cervical examination or parity. Patients admitted in spontaneous labor had lower odds of cesarean delivery (odds ratio [OR]: 0.33; 95% CI: 0.21–0.53) and neonatal intensive care unit (NICU) admission (OR: 0.38; 95% CI: 0.15–0.94). Other perinatal outcomes were similar between the groups. Conclusion Maternal characteristics did not predict spontaneous labor onset at ≥39 weeks' gestation with high accuracy. Patients should be counseled on the challenges of labor prediction regardless of parity and cervical examination, outcomes if spontaneous labor does not occur, and benefits of labor induction. Key Points Majority of patients will attain spontaneous labor at ≥39 weeks. Maternal characteristics do not predict labor at ≥39 weeks. Spontaneous labor has associated lower perinatal risks. A shared decision model should be utilized in counseling patients who may choose expectant management. [ABSTRACT FROM AUTHOR]

Objective Obesity in pregnancy bears unique maternal and fetal risks. Obesity has also been associated with chronic inflammation, including elevated serum levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α). Higher serum lipopolysaccharide (LPS) levels have been implicated in driving this inflammation, a phenomenon called metabolic endotoxemia (ME). GLP-2, a proglucagon-derived peptide, is believed to be integral in maintaining the integrity of the intestine in the face of LPS-mediated endotoxemia. We hypothesized that obesity and/or excess weight gain in pregnancy would be associated with an increase in maternal and neonatal markers of ME, as well as GLP-2. Study Design Paired maternal and neonatal (cord blood) serum samples (n = 159) were obtained from our pregnancy biobank repository. Serum levels of LPS, endotoxin core antibody-immunoglobulin M (EndoCAb-IgM), and GLP-2 were measured by ELISA. IL-6 and TNF-α were measured using a Milliplex assay. Results were stratified by maternal body mass index (BMI), maternal diabetes, and gestational weight gain (GWG). Results Maternal IL-6 is significantly decreased in the obese, diabetic cohort compared with the nonobese, nondiabetic cohorts (95.28 vs. 99.48 pg/mL, p = 0.047), whereas GLP-2 is significantly increased (1.92 vs. 2.89 ng/mL, p = 0.026). Neonatal TNF-α is significantly decreased in the obese cohort compared with the nonobese cohort (12.43 vs. 13.93 pg/mL, p = 0.044). Maternal GLP-2 is significantly increased in women with excess GWG compared with those with normal GWG (2.27 vs. 1.48 ng/mL, p = 0.014). We further found that neonatal IL-6 and TNF-α are negatively correlated with maternal BMI (–0.186, p = 0.036 and –0.179, p = 0.044, respectively) and that maternal and neonatal IL-6 showed a positive correlation (0.348, p < 0.001). Conclusion Although we observed altered levels of markers of inflammation (IL-6 and TNF-α) with maternal obesity and diabetes, no changes in LPS or endoCAb-IgM were observed. We hypothesize that the increased GLP-2 levels in maternal serum in association with excess GWG may protect against ME in pregnancy. Key Points Maternal serum levels of GLP-2, a proglucagon-derived peptide, are increased in obese, diabetic gravidae. Maternal serum GLP-2 levels are also increased in association with excess gestational weight gain compared with normal gestational weight gain. GLP-2 may be increased in association with obesity and weight gain to protect against metabolic endotoxemia in pregnancy. [ABSTRACT FROM AUTHOR]

Objective  Antenatal and early neonatal nutritional environment may influence later metabolic health. Infants of mothers with gestational diabetes mellitus (GDM) have higher risk for childhood obesity and metabolic syndrome (MetS). Leptin and adiponectin are known biomarkers for MetS and may guide interventions to reduce later obesity. We sought to examine the relationship between birthweight, early infancy feeding practices, and biomarkers for MetS in offspring of women with mild GDM. Study Design  Secondary analysis of a prospective observational follow-up study on the offspring of women who participated in a multicenter randomized treatment trial on mild GDM. Children were evaluated by research coordinators and biospecimens collected at the age of 5 to 10. Plasma concentrations of leptin and adiponectin were compared between large for gestational age (LGA) and average birthweight (AGA) infants, and according to whether solid foods were introduced early (<6 months of age) or at the recommended age (≥6 months of age). Multivariable analysis adjusted for fetal sex, race/ethnicity, and maternal body mass index. Results  Leptin and adiponectin were measured in 336 plasma samples. In bivariate analysis, compared with AGA children, LGA children had lower leptin (5.0 ng/mL [3.6–6.0] vs. 5.8 ng/mL [4.5 = 6.6], p  = 0.01) and similar adiponectin (6.3 µg/mL [5.1–7.9] vs. 6.4 µg/mL [5.3–8.6], p  = 0.49) concentrations. Maternal/child characteristics were similar between the early/delayed solid feeding groups. Leptin and adiponectin concentrations were similar in the early fed and delayed feeding groups (5.8 ng/mL [4.6–6.7] vs. 5.6 ng/mL [4.2–6.6], p  = 0.50 and 6.4 µg/mL [5.4–8.1] vs. 6.4 µg/mL [5.1–8.8], p  = 0.85, respectively). After controlling for covariates, children who were LGA and AGA at birth had similar leptin concentrations. Conclusion  Birthweight and early infancy feeding practice are not associated with alterations in leptin and adiponectin in children of women with mild GDM. Key Points Adipocytokines are markers of metabolic status. Children of women with mild GDM may be at risk for MetS. Biomarkers similar in LGA and AGA groups. Biomarkers similar in early and delayed solid-fed groups. Nonhuman milk does not modify effect of feeding practice. [ABSTRACT FROM AUTHOR]

Objective  We aimed to assess the risk of developing gestational diabetes mellitus (GDM) in women with a normal A1C (<5.7) compared with those with an A1C in the pre-diabetic range (5.7–6.4). Study Design  This study comprises of a retrospective cohort of non-anomalous singleton pregnancies with maternal body mass index (BMI) ≥40 at a single institution from 2013 to 2017. Pregnancies with multiple gestation, late entry to care, type 1 or 2 diabetes, and missing diabetes-screening information were excluded. The primary outcome was development of GDM. Secondary outcomes included fetal growth restriction, macrosomia, gestational age at delivery, large for gestational age, delivery BMI at delivery, total weight gain in pregnancy, induction of labor, shoulder dystocia, and cesarean delivery. Bivariate statistics were used to compare demographics, pregnancy complications, and delivery characteristics of women who had an early A1C < 5.7 and A1C 5.7 to 6.4. Multivariable analyses were used to estimate the odds of the primary outcome. Results  Eighty women (68%) had an early A1C <5.7 and 38 (32%) had a A1C 5.7 to 6.4. Women in the lower A1C group were less likely to be Black (45 vs. 74%, p  = 0.01). No differences in other baseline demographics were observed. The median A1C was 5.3 for women with A1C < 5.7 and 5.8 for women with A1C 5.7 to 6.4 (p  < 0.001). GDM was significantly more common in women with A1C 5.7 to 6.4 (3.8 vs. 24%, p  = 0.002). Women with pre-diabetic range A1C had an odd ratio of 11.1 (95% CI 2.49–48.8) for GDM compared with women with a normal A1C. Conclusion  Women with class III obesity and a pre-diabetic range A1C are at an increased risk for gestational diabetes when compared with those with a normal A1C in early pregnancy. Key Points One in 3 women with class III obesity had a pre-diabetic range early A1C. Class III obese women who have a pre-diabetic A1C have a higher risk of gestational diabetes. In this high-risk population, early A1C results in the pre-diabetic range are associated with higher rates of gestational diabetes. [ABSTRACT FROM AUTHOR]

Objective  The main purpose of this article is to evaluate whether identification and treatment of women with mild gestational diabetes mellitus (GDM) during pregnancy affects subsequent maternal body mass index (BMI), anthropometry, metabolic syndrome, and risk of diabetes. Study Design  This is a follow-up study of women who participated in a randomized controlled treatment trial for mild GDM. Women were enrolled between 5 and 10 years after their index pregnancy. Participants underwent blood pressure, height, weight, and anthropometric measurements by trained nursing personnel using a standardized approach. A nurse-assisted questionnaire regarding screening and treatment of diabetes or hypercholesterolemia, diet, and physical activity was completed. Laboratory evaluation included fasting serum glucose, fasting insulin, oral glucose tolerance test, and a lipid panel. Subsequent diabetes, metabolic syndrome, obesity, and adiposity in those diagnosed with mild GDM and randomized to nutritional counseling and medical therapy (treated) were compared with those who underwent routine pregnancy management (untreated). Multivariable analyses were performed adjusting for race/ethnicity and years between randomization and follow-up visit. Results  Four-hundred fifty-seven women with mild GDM during the index pregnancy were included in this analysis (243 treated; 214 untreated) and evaluated at a median 7 years after their index pregnancy. Baseline and follow-up characteristics were similar between treatment groups. Frequency of diabetes (9.2 vs. 8.5%, p =0.80), metabolic syndrome (32.2 vs. 34.3%, p =0.63), as well as adjusted mean values of homeostasis model assessment for insulin resistance (2.5 vs. 2.3, p =0.11) and BMI (29.4 vs. 29.1 kg/m 2 , p =0.67) were also not different. Conclusion  Identification and treatment of women with mild GDM during pregnancy had no discernible impact on subsequent diabetes, metabolic syndrome, or obesity 7 years after delivery. [ABSTRACT FROM AUTHOR]

Objective Maternal preconception diet influences pregnancy health and fetal outcomes. We examined the relationship between preconception fatty acid (FA) intake and uterine artery indices in mid-gestation in a large, heterogeneous cohort of nulliparous individuals. Study Design This is a secondary analysis of the nuMom2b (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be) study. Dietary ω-6 and ω-3 FA intake was assessed with food frequency questionnaires and uterine artery indices were obtained via Doppler studies in the second trimester. For our primary outcome of pulsatility index (PI) > 1.6, we compared proportions by each dichotomous FA exposure and tested differences with chi-square test. Results For PI > 1.6, odds ratio for the unfavorable FA quartile compared with remaining quartiles for the exposures were 0.96 to 1.25, p = 0.157 (ω-6 FA); 0.97 to 1.26, p = 0.124 (ω-3 FA); 0.87 to 1.14, p = 1.00 (ω-6:ω-3 FA ratio). Conclusion No significant associations between self-reported maternal preconception ω-6 and ω-3 FA intake and uterine artery Doppler indices measured during the second trimester were observed. Key Points Maternal diet impacts pregnancy health/fetal outcomes. ω-3 and ω-6 FA intake influences cardiovascular health. FA intake may affect blood flow to fetoplacental unit. Results are limited by inadequate adherence to dietary recommendations. [ABSTRACT FROM AUTHOR]

Objective This study aimed to examine associations of fetal biometric and amniotic fluid measures with intrapartum primary cesarean delivery (PCD) and develop prediction models for PCD based on ultrasound parameters and maternal factors. Study Design Secondary analysis of the National Institute of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Fetal Growth Studies—singleton cohort (2009–2013) including patients with uncomplicated pregnancies and intent to deliver vaginally at ≥37 0/7 weeks. The estimated fetal weight, individual biometric parameters, fetal asymmetry measurements, and amniotic fluid single deepest vertical pocket assessed at the final scan (mean 37.5 ± 1.9 weeks) were categorized as <10th, 10th to 90th (reference), and >90th percentiles. Logistic regression analyses examined the association between the ultrasound measures and PCD. Fetal and maternal SuperLearner prediction algorithms were constructed for the full and nulliparous cohorts. Results Of the 1,668 patients analyzed, 249 (14.9%) had PCD. The fetal head circumference, occipital–frontal diameter, and transverse abdominal diameter >90th percentile (adjusted odds ratio [aOR] = 2.50, 95% confidence interval [95% CI]: 1.39, 4.51; aOR = 1.86, 95% CI: 1.02, 3.40; and aOR = 2.13, 95% CI: 1.16, 3.89, respectively) were associated with PCD. The fetal model demonstrated poor ability to predict PCD in the full cohort and in nulliparous patients (area under the receiver-operating characteristic curve [AUC] = 0.56, 95% CI: 0.52, 0.61; and AUC = 0.54, 95% CI: 0.49, 0.60, respectively). Conversely, the maternal model had better predictive capability overall (AUC = 0.79, 95% CI: 0.75, 0.82) and in the nulliparous subgroup (AUC = 0.72, 95% CI: 0.67, 0.77). Models combining maternal/fetal factors performed similarly to the maternal model (AUC = 0.78, 95% CI: 0.75, 0.82 in full cohort, and AUC = 0.71, 95% CI: 0.66, 0.76 in nulliparas). Conclusion Although a few fetal biometric parameters were associated with PCD, the fetal prediction model had low performance. In contrast, the maternal model had a fair-to-good ability to predict PCD. Key Points Fetal HC >90th percentile was associated with cesarean delivery. Fetal parameters did not effectively predict PCD. Maternal factors were more predictive of PCD. Maternal/fetal and maternal models performed similarly. Prediction models had lower performance in nulliparas. [ABSTRACT FROM AUTHOR]

Objective This study aimed to develop a predictive model of feeding mother's own milk (MOM) at discharge using social determinants of health (SDOH), maternal and neonatal factors after deliveries at <33 weeks of gestational age (GA), or birth weight <1,500 g. Study Design Secondary analysis of a retrospective cohort in an inner-city hospital before (Epoch-1, 2018–2019) and after (Epoch-2, 2020–2021) implementing a donor human milk (DHM) program. Results Among 986 neonates, 495 were born in Epoch-1 (320 Hispanic White, 142 Non-Hispanic Black, and 33 Other) and 491 in Epoch-2 (327, 137, and 27, respectively). Feeding any MOM was less frequent in infants of non-Hispanic Black mothers than in those of Hispanic mothers (p < 0.05) but did not change with epoch (p = 0.46). Among infants who received any MOM, continued feeding MOM to the time of discharge was less frequent in infants of non-Hispanic Black mothers versus those of Hispanic mothers, 94/237 (40%) versus 339/595 (57%; p < 0.05), respectively. In multivariate analysis including SDOH and maternal variables, the odds of feeding MOM at discharge were lower with SDOH including neighborhoods with higher poverty levels, multiparity, substance use disorder, non-Hispanic Black versus Hispanic and young maternal age and increased with GA but did not change after implementing DHM. The predictive model including SDOH, maternal and early neonatal variables had good discrimination (area under the curve 0.85) and calibration and was internally validated. It showed the odds of feeding MOM at discharge were lower in infants of non-Hispanic Black mothers and with feeding DHM, higher need for respiratory support and later initiation of feeding MOM. Conclusion Feeding MOM at discharge was associated with SDOH, and maternal and neonatal factors but did not change after implementing DHM. Disparity in feeding MOM at discharge was explained by less frequent initiation and shorter duration of feeding MOM but not by later initiation of feeding MOM. Key Points In this cohort study of preterm infants, factors of feeding MOM at discharge included (1) SDOH; (2) postnatal age at initiation of feeding MOM; and (3) maternal and neonatal factors. Feeding MOM at the time of discharge was less frequent in infants of non-Hispanic Black mothers versus those of Hispanic mothers. Disparity in feeding MOM at discharge was explained by less frequent initiation and shorter duration of MOM feeding but not by later postnatal age at initiation of feeding MOM. [ABSTRACT FROM AUTHOR]

Objective Low fetal fraction (FF) on cell-free DNA (cfDNA)-based noninvasive prenatal screening (NIPS) is a common etiology for indeterminate results. As maternal Black race is implicated as a risk factor for low FF and more indeterminate results, we sought to evaluate this association. Study Design This was a single-institution, retrospective cohort study of cfDNA-based NIPS performed between May 2017 and May 2022 with complete clinical data abstraction. We compared FF, indeterminate rates, and total cfDNA concentration among self-reported Black, White, and Other groups from NIPS results from 2017 to 2022 with full clinical data abstraction. Using linear regression and interaction testing, we evaluated associations between self-reported race, FF, indeterminate rate, and total cfDNA concentration. Results In total, 1,591 participants met the inclusion criteria; 70.8% (n = 1,126) self-identified as White, 6.9% (n = 110) as Black, and 22.3% (n = 355) self-identified with another race. Mean FF was not different between the White, Black, or Other groups (11.8 vs. 11.2 vs. 11.7%, respectively, p = 0.52). This remained true after adjusting for body mass index (BMI), gestational age (GA) at draw, and fetal sex (all p > 0.17). Interaction testing for FF and total cfDNA by race with BMI, GA at draw, and fetal sex demonstrated no effect modification. Conclusion In our population, maternal self-identified race, particularly Black race, does not affect FF. Biological plausibility for race-based differences on clinical tests requires ongoing thoughtful consideration. Key Points NIPS is widely used to screen for fetal aneuploidy. FF is an important test metric, and low FF is associated with adverse outcomes, like aneuploidy. In existing studies, Black race is implicated as a risk factor for lower FF. Our study found no differences in FF between groups by self-reported race. Biological plausibility for race-based differences on clinical tests requires ongoing consideration. [ABSTRACT FROM AUTHOR]

Objective  To test the hypothesis that maternal height is associated with adverse perinatal outcomes, controlling for and stratified by maternal body mass index (BMI). Study Design  This was a retrospective cohort study of all births in California between 2007 and 2010 (n  = 1,775,984). Maternal height was categorized into quintiles, with lowest quintile (≤20%) representing shorter stature and the uppermost quintile (≥80%) representing taller stature. Outcomes included gestational diabetes mellitus (GDM), preeclampsia, cesarean, preterm birth (PTB), macrosomia, and low birth weight (LBW). We calculated height/outcome associations among BMI categories, and BMI/outcome associations among height categories, using various multivariable logistic regression models. Results  Taller women were less likely to have GDM, nulliparous cesarean, PTB, and LBW; these associations were similar across maternal BMI categories and persisted after multivariable adjustment. In contrast, when stratified by maternal height, the associations between maternal BMI and birth outcomes varied by specific outcomes, for example, the association between morbid obesity (compared with normal or overweight) and the risk of GDM was weaker among shorter women (adjusted odds ratio [aOR], 95% confidence interval [CI]: 3.48, 3.28–3.69) than taller women (aOR, 95% CI: 4.42, 4.19–4.66). Conclusion  Maternal height is strongly associated with altered perinatal risk even after accounting for variations in complications by BMI. [ABSTRACT FROM AUTHOR]

Objective  Obesity during pregnancy impedes fetal iron endowment. In adults, both iron depletion and hypoxia stimulate erythropoietin (Epo) production, while hepcidin, the primary iron regulator, is inhibited by Epo and stimulated by obesity. To understand this relationship in fetuses, we investigated obesity, inflammation, and fetal iron status on fetal Epo and hepcidin levels. Study Design  Epo, hepcidin, C-reactive protein (CRP), and ferritin levels were measured in 201 newborns of 35 to 40 weeks' gestation with historical risk factors for a low fetal iron endowment, including half with maternal obesity. Results  Epo was unrelated to fetal size, but Epo was directly related to maternal body mass index (BMI; kg/m 2) (p  < 0.03) and CRP (p  < 0.0005) at delivery. Epo levels were twice as likely to be elevated (≥50 IU/L) while comparing the lowest quartile of ferritin with the upper three quartiles (p  < 0.01). Hepcidin was directly related to ferritin (p  < 0.001) and indirectly related to maternal BMI (p  < 0.015), but BMI became nonsignificant when undergoing multivariate analysis. Hepcidin was unrelated to Epo. Conclusion  Although some of the fetal responses involving Epo were similar to adults, we did not find a hepcidin–Epo relationship like that of adults, where fetal liver is the site of both hepcidin and Epo production. [ABSTRACT FROM AUTHOR]

Objective  The aim of this study is to assess the feasibility of visualizing the middle cerebral artery (MCA), establishing the normogram for MCA pulsatility index (PI) and peak systolic velocity (PSV), and calculating cerebroplacental ratio (CPR) at 12 to 14 weeks. Study Design  Prospective cross-sectional study on 186 gravidas presenting for nuchal translucency (NT) assessment. Maternal body mass index (BMI), fetal crown-rump length (CRL), biparietal diameter (BPD), and NT were obtained. Color Doppler was utilized to visualize the MCA and measure PI, PSV, and umbilical artery PI. Normograms for MCA PI and PSV, and for CPR, were constructed. Regression analysis was used for the reference range of MCA PI and CPR according to CRL and BPD. Chi-square and t -test were utilized. p -Value of < 0.05 was considered significant. Results  MCA was successfully visualized in 176/186 (94.6%), PI and PSV measured on 148/186 (79.6%) and 145/186 (78.0%), respectively, and CPR calculated in 133/186 (71.5%). There was no significant effect of BMI, CRL, or BPD on successful assessment of MCA or CPR. Normograms for MCA PI and CPR revealed no significant relation with CRL or BPD. Conclusion  MCA and CPR assessment is feasible at 12 to 14 weeks. A reference range for MCA Doppler indexes and CPR at 12 to 14 weeks has been established. This may prove helpful in the early evaluation of fetuses identified as at-risk for adverse neonatal outcome. [ABSTRACT FROM AUTHOR]

Objective  We aim to quantify the impact of obesity on maternal intensive care unit (ICU) admission. Materials and Methods  This is a population-based, retrospective cohort study of Ohio live births from 2006 to 2012. The primary outcome was maternal ICU admission. The primary exposure was maternal body mass index (BMI). Relative risk (RR) of ICU admission was calculated by BMI category. Multivariate logistic regression quantified the risk of obesity on ICU admission after adjustment for coexisting factors. Results  This study includes 999,437 births, with peripartum maternal ICU admission rate of 1.10 per 1,000. ICU admission rate for BMI 30 to 39.9 kg/m 2 was 1.24 per 1,000, RR: 1.20 (95% confidence interval [CI]: 1.07, 1.35); BMI 40 to 49.9 kg/m 2 had ICU admission rate of 1.80 per 1,000, RR: 1.73 (95% CI: 1.38, 2.17); and BMI ≥ 50 kg/m 2 had ICU admission rate of 2.98 per 1,000, RR: 1.73 (95% CI: 1.77, 4.68). After adjustment, these increases persisted in women with BMI 40 to 49.9 kg/m 2 with adjusted relative risk (adjRR) of 1.37 (95% CI: 1.05, 1.78) and in women with BMI ≥ 50 kg/m 2 , adjRR: 1.69 (95% CI: 1.01, 2.83). Conclusion  Obesity is a risk factor for maternal ICU admission. Risk increases with BMI. After adjustment, BMI ≥ 40 kg/m 2 is an independent risk factor for ICU admission. [ABSTRACT FROM AUTHOR]

Objective We sought to determine if the rate of recurrent spontaneous preterm birth (PTB) in women treated with 17-α hydroxyprogesterone caproate (17-OHPC) is modified by maternal body mass index (BMI). Study Design We performed a secondary analysis of the Maternal-Fetal Medicine Units Network omega-3 fatty acid supplementation to prevent recurrent PTB randomized controlled trial. All women received 17-OHPC. Results A total of 708 women were included. Rates of spontaneous PTB did not vary significantly by BMI category. With stratification by obesity class and gestational age at delivery, the unadjusted risk for PTB using earlier gestational cutoffs (< 35, 32, and 28 weeks) demonstrated an association between preterm delivery and increasing severity of obesity. With adjustment for potential confounders, there was no statistically significant relationship between BMI and spontaneous PTB. Conclusion We demonstrated that the risk of PTB in women receiving 250 mg 17-OHPC is not dependent on maternal BMI after adjustment for confounding variables. Pharmacokinetic studies have demonstrated a wide variation in plasma concentration of 17-OHPC across the population with likely considerable overlap in plasma concentrations among the obese and nonobese population. Further studies are needed to evaluate the impact of BMI on efficacy of 17-OHPC prior to any dose adjustment in this population. [ABSTRACT FROM AUTHOR]

Objective Current literature on the risks and outcomes of obesity in pregnancy almost exclusively utilizes prepregnancy body mass index (BMI). Given the rising obesity rate across the United States along with a paucity of available information on the relationship between delivery BMI and maternal and neonatal outcomes, our study aimed to determine the association of maternal BMI at delivery with antepartum, intrapartum, and neonatal complications at an academic referral hospital. Study Design This study is a secondary analysis of data collected for a prospective cohort study of Coronavirus Disease-2019 (COVID-19) in pregnancy. This analysis included all patients who delivered term singleton infants between May 1, 2020, and April 30, 2021, at the University of Iowa Hospitals and Clinics. Demographic and clinical data were obtained from the electronic medical record. The relationship between maternal BMI and maternal and neonatal characteristics of interest was assessed using logistic regression models. A statistical significance threshold of 0.05 was used for all comparisons. Results There were 1,996 women who delivered term singleton infants during the study period. The median BMI at delivery was 31.7 kg/m 2 (interquartile range: 27.9, 37.2), with 61.1% of women having a BMI ≥ 30.0 kg/m 2. Increasing BMI was significantly associated with nonreassuring fetal status, unscheduled cesarean birth, overall cesarean birth rate, postpartum hemorrhage, prolonged postpartum stay, hypertensive diseases of pregnancy, neonatal hypoglycemia, neonatal intensive care unit admission, decreased APGAR score at 1 minute, and increasing neonatal birth weight. Even when controlling for preexisting hypertension in a multivariate model, increasing BMI was associated with gestational hypertension and preeclampsia. Conclusion Increased maternal BMI at delivery was associated with adverse perinatal outcomes. These findings have implications for clinical counseling regarding risks of pregnancy and delivery for overweight and obese patients and may help inform future studies to improve safety, especially by examining reasons for high cesarean rates. Key Points Sixty-one percent of delivering patients had a BMI 3 30 kg/m 2 at delivery. There was a higher cesarean rate with increasing delivery BMI. For every 5-unit increase in maternal BMI, neonatal weight increased by 0.47 g. [ABSTRACT FROM AUTHOR]