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Objective Methods Results Conclusion The aim of the present study was to evaluate the obstetric complications associated with isolated fetal congenital heart disease (CHD) by comparing pregnancies with and without this condition.In this retrospective matched comparative study at Siriraj Hospital, Thailand, we included 233 postnatally confirmed fetal CHD cases and 466 unaffected fetuses. Controls were selected at a 2:1 ratio, ensuring that they matched the cases in terms of maternal age, parity, and history of preterm deliveries.Fetal CHD was significantly associated with an increased risk of spontaneous preterm labor (30% vs 9.7%; adjusted odds ratio [aOR] 2.42; 95% confidence interval [CI]: 1.35–4.36; P = 0.003), delivery before 34 gestational weeks (11.6% vs 0.6%; aOR 12.33; 95% CI: 3.32–45.78; P < 0.001), and pre‐eclampsia (11.6% vs 2.8%; aOR 2.19; 95% CI: 1.01–4.76; P = 0.047). Newborns with CHD were significantly more likely to be small for gestational age (10.7% vs 5.2%; aOR 2.09; 95% CI: 1.11–3.94; P = 0.022). Intriguingly, a prenatal diagnosis of CHD was associated with a reduced risk of preterm delivery in affected pregnancies (P = 0.002).Pregnancies affected by isolated fetal CHD demonstrated a higher propensity for several adverse outcomes. These findings underscore the importance of prenatal CHD detection and tailored perinatal care to potentially improve both pregnancy outcomes and neonatal health. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion To evaluate the optimal timing for fetal weight estimation during the third trimester.This retrospective cohort study involved fetal weight estimations from both early (28+0–36+6 weeks) and late (37+0 weeks and beyond) third trimester. These estimations were converted to predicted birth weights using the gestation‐adjusted projection formula. Birth weight predictions were compared with actual birth weights, to identify the most effective timing for weight prediction.The study included 3549 cases, revealing mean percentage errors (MPE) of −3.69% for early sonographic assessments, −2.5% for late sonographic assessments, and −1.9% for late clinical assessments. A significant difference was found between early and late sonographic estimations (P < 0.001), whereas late sonographic and clinical assessments did not differ significantly (P = 0.771). Weight predictions for fetuses below the 10th and above the 90th centiles were less accurate than for those within the 10th–90th centiles (P < 0.001). In women with obesity, late clinical estimations were less precise (MPE of −5.85) compared with non‐obese women (MPE of −1.66, P < 0.001). For women with diabetes, early sonographic estimations were more accurate (MPE of −1.31) compared with non‐diabetic patients (MPE of −3.94, P < 0.001) though this difference did not persist later in pregnancy.Sonographic and clinical weight predictions in the late third trimester were more accurate than earlier third‐trimester sonographic assessments, hence continuous follow up and assessments closer to term are important. In women with diabetes, no adjustments in weight prediction methods are necessary. Accurately predicting birth weights for abnormally small or large fetuses remains challenging, indicating the need for improved screening and diagnostic strategies. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to demonstrate the establishment of adrenal sparing in intrauterine growth restricted (IUGR) human fetuses. IUGR fetuses are a subgroup of small for gestational age (SGA) fetuses that are unable to reach their own growth potential because of chronic hypoxia and undernutrition. We hypothesized that in IUGR fetuses the adrenal gland is relatively larger and secretion of noradrenaline (NA), adrenaline (A), and cortisol is increased. Study Design: This is a prospective observational study including 65 singleton pregnancies (42 IUGR and 23 controls). Using two‐dimensional ultrasound, we measured fetal adrenal diameters and adrenal/abdominal circumference (AD/AC) ratio between 25 and 37 weeks. We considered only one measurement per fetus. In 21 pregnancies we also measured NA, A, and cortisol levels in arterial and venous fetal cord blood collected at the time of delivery. Results: The AD/AC ratio was significantly higher in IUGR fetuses than in controls. Cord NA and A levels were significantly higher in IUGR fetuses than in controls. An increase in cortisol secretion in IUGR fetuses was observed but the difference was not statistically significant. Conclusions: Adrenal sparing correlates with a relative increase in adrenal measurements and function. Synopsis: The adrenal gland of intrauterine growth‐restricted fetuses is relatively larger compared with controls and its function is enhanced. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion To compare circulating levels of vascular endothelial growth factor receptor 3 (VEGFR‐3) in women with pregnancy‐induced hypertension (PIH) and in non‐pregnant (NP) and healthy pregnant (HP) women.We conducted a case–control study including PIH (n = 135), HP (n = 68), and NP (n = 49) women from southeastern Brazil. PIH were diagnosed according to international guidelines, and defined as gestational hypertension (GH, n = 61) or pre‐eclampsia (n = 74). VEGFR‐3 was measured in plasma using ELISA.Plasma VEGFR‐3 was increased in HP (1207 pg/mL) compared with NP (133 pg/mL) women; however, PIH (729 pg/mL) patients exhibited lower levels than HP women (both p < 0.05). In addition, plasma VEGFR‐3 was decreased in pre‐eclampsia compared with GH (537 versus 980 pg/mL; p < 0.05). When pre‐eclampsia was classified according to different clinical presentations, plasma VEGFR‐3 was further decreased in the cases identified as pre‐eclampsia with severe features, preterm pre‐eclampsia, and pre‐eclampsia accompanied by small for gestational age (all p < 0.05).Our data indicate reduced circulating VEGFR‐3 levels in patients with PIH, specifically in those diagnosed with pre‐eclampsia. Moreover, decreased VEGFR‐3 was associated with adverse clinical outcomes in pre‐eclampsia. These findings expand previous evidence of reduced VEGFR‐3 expression in pre‐eclampsia. Future studies should investigate whether it can be used as a predictive biomarker and/or therapeutic target for pre‐eclampsia. [ABSTRACT FROM AUTHOR]

Objective: To assess which fetal growth charts best describe intrauterine growth in France defined as the ability to classify 10% of fetuses below the 10th percentile (small for gestational age [SGA]) and above the 90th percentile (large for gestational age [LGA]) in the second and third trimesters. Methods: We analyzed five studies on fetal ultrasound measurements using three French data sources. Two studies used second and third trimester ultrasound data from a nationwide birth cohort in 2011 (the ELFE study, N = 13 197 and N = 7747); one study used third trimester ultrasound data from on a nationwide cross‐sectional study (the 2016 French National Perinatal Survey, N = 9940); and the last two studies were from the "Flash study" 2014 which prospectively collected ultrasound data from routine visits in the second and third trimesters (N = 4858 and N = 3522). For each study, we reported the percentage of measurements below the 10th percentile or above the 90th percentile, using French, Hadlock's, WHO and Intergrowth (IG) charts. Results: WHO classified 4.7% and 16.3% of fetuses as having an estimated fetal weight (EFW) <10th and >90th percentiles in the second trimester compared to 3.3% and 34.7% with IG. The percentage of fetuses in the third trimester with an EFW <10th and >90th percentiles, ranged from 9.1% to 9.4% and from 8.0% to 11.1%, respectively, for WHO, and from 3.9% to 4.1% and from 17.3% to 21.6%, respectively, for IG. The WHO and IG charts for head circumference were very similar and performed well. Compared to the WHO charts, the French and Hadlock's charts deviated more frequently from the target percentiles values for EFW and biometric measures. Conclusion: It is recommended to use the WHO charts for the assessment of EFW and ultrasound biometric measurements in France (strong recommendation; low quality of evidence). Synopsis: Our data highlight the importance of validating fetal growth charts prior to their use in a local setting, as has also been suggested by FIGO and WHO. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion To investigate the association between infant mortality and birth weight using estimated fetal weight (EFW) versus birth‐weight charts, by gestational age (GA).This nationwide population‐based study used data from the Finnish Medical Birth Register from 2006 to 2016 on non‐malformed singleton live births at 24–41+6 weeks of gestation (N = 563 630). The outcome was death in the first year of life. Mortality risks by birth‐weight z score, defined as a continuous variable using Maršál's EFW and Sankilampi's birth‐weight charts, were assessed using generalized additive models by GA (24–27+6, 28–31+6, 32–36+6, 37–38+6, 39–41+6 weeks). We calculated z score thresholds associated with a two‐ and three‐fold increased risk of infant death compared with newborns with a birth weight between 0 and 0.675 standard deviations.The z score thresholds (with corresponding centiles in parentheses) associated with a two‐fold increase in infant mortality were: −3.43 (<0.1) at 24–27+6 weeks, −3.46 (<0.1) at 28–31+6 weeks, −1.29 (9.9) at 32–36+6 weeks, −1.18 (11.9) at 37–38+6 weeks, and − 1.34 (9.0) at 39–41+6 weeks according to the EFW chart. These values were − 2.43 (0.8), −2.62 (0.4), −1.34 (9.0), −1.37 (8.5), and − 1.43 (7.6) according to the birth‐weight chart.The association between birth weight and infant mortality varies by GA whichever chart is used, suggesting that different thresholds for the screening of growth anomalies could be used across GA to identify high‐risk newborns. [ABSTRACT FROM AUTHOR]

Objective: The present study aimed to evaluate the association between syphilis in pregnancy and low birth weight, small for gestational age, and preterm birth. Methods: This longitudinal study used Brazilian National Information System for livebirths (SINASC) linked to the gestational syphilis cases from Notifiable Diseases Information System (SINAN) from 2011 to 2017. Descriptive statistics and logistic regression were used to compare the birth outcomes of pregnant women with and without syphilis. The study protocol was approved by the Research Ethics Committee of the Institute of Collective Health of the Federal University of Bahia (CAAE: registration no. 18022319.4.0000.5030). Results: A total of 17 930 817 live births were included in the study. Of these, 155 214 (8.7/1000) were exposed to syphilis during pregnancy. Maternal syphilis increased the odds of low birth weight (aOR 1.88, 95% CI: 1.85–1.91), small for gestational age (aOR 1.53, 95% CI: 1.51–1.56), and preterm birth (aOR 1.35, 95% CI: 1.33–1.37). Higher odds were observed for pregnant women with VDRL titer ≥64 and untreated maternal syphilis when compared to mothers without syphilis. Analysis stratified by prenatal care showed higher odds for all adverse birth outcomes for mothers attending ≤6 prenatal appointments. Conclusion: Our findings showed a strong association between gestational syphilis and adverse birth outcomes with increased odds observed among women with higher VDRL titers, lack of treatment, and fewer prenatal appointments. These results highlight the need for adequate screening and treatment for gestational syphilis during pregnancy to mitigate the risk of adverse birth outcomes. Synopsis: Gestational syphilis, lack of treatment, high VDRL titer, inadequate prenatal care increased the risk for low birth weight, small for gestational age, and preterm birth. [ABSTRACT FROM AUTHOR]

Background: Maternal HIV infection remains a significant global health concern with potential repercussions on perinatal outcomes. Emphasis on early intervention to improve peri‐ and postnatal outcomes in infected mothers and infants is a valid therapeutic concern. Objectives: To comprehensively analyze perinatal outcomes associated with maternal HIV infection and evaluate adverse effects associated with the HIV infection in the existing literature. Search Strategy: A comprehensive search of PubMed, MEDLINE, and Google Scholar was conducted from 2013 to September 2023, using relevant MeSH terms. Selection Criteria: The included studies encompassed original studies, cross‐sectional, prospective, retrospective studies and observational studies focused on perinatal outcomes in the context of maternal HIV infection. Data Collection and Analysis: The selected studies underwent rigorous data collection and comprehensive quality checks and adhered to the PRISMA guidelines. Main Results: Nine eligible studies from Brazil, China, India, Malawi, Nigeria, Tanzania, the USA, and Canada were included. These studies have consistently demonstrated that maternal HIV infection is associated with adverse perinatal outcomes. The analysis revealed a higher risk of preterm birth (OR 1.57, 95% CI: 1.39–1.78), low birth weight (OR 1.33, 95% CI: 1.18–1.49), and small for gestational age (OR 1.38, 95% CI: 1.24–1.53) among infants born to mothers living with HIV. Notably, the impact of antiretroviral treatment (ART) on these outcomes varied, but maternal HIV infection remained a significant risk factor regardless of income level and geographic region. Conclusion: Maternal HIV infection is consistently associated with adverse perinatal outcomes, emphasizing the need for targeted interventions and improved prenatal care in pregnant women with HIV infection. Synopsis: Maternal HIV infection is linked to adverse perinatal outcomes such as increased perinatal mortality, preterm birth, and low birth weight. [ABSTRACT FROM AUTHOR]

Background: Evidence for the association between earthquakes and adverse perinatal outcomes is limited. Objectives: To evaluate the association between earthquakes and perinatal outcomes including preterm birth and low birth weight. Search Strategy: We searched studies using MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, World Health Organization International Clinical Trials Platform Search Portal, and ClinicalTrials.gov on February 9, 2023. Selection Criteria: We included before‐and‐after studies that evaluated the associations between earthquakes and perinatal outcomes in women living in affected areas. Data Collection and Analysis: Two independent reviewers extracted data. We calculated the pooled odds ratio (OR) with the random‐effects model. We analyzed outcomes in subgroups of Asians and others. We evaluated the certainty of evidence with the Grading of Recommendations Assessment, Development and Evaluation system. Main Results: We included 2 607 405 women in 13 studies. Earthquakes may not increase preterm birth (nine studies, 1 761 760 participants: OR 1.10, 95% confidence interval [CI] 0.98–1.24, low certainty of evidence) or low birth weight (seven studies, 1 753 891 participants: OR 1.10, 95% CI 0.94–1.28, low certainty of evidence). Subgroup analyses showed that earthquakes may be associated with an increase of preterm birth among populations in Asia (OR 1.44, 95% CI 1.07–1.95), but this was not evident in others (OR 0.93, 95% CI 0.83–1.05). Conclusions: Perinatal outcomes might not change after earthquakes. Further research on the association between earthquakes and perinatal outcomes, combined with an assessment of the characteristics of the region, is needed. Synopsis: Preterm birth and low birth weight might not change after earthquakes. However, earthquakes may be associated with an increase of preterm birth in Asia. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusions With inconsistencies regarding the possible effect of hyperemesis gravidarum on the course of pregnancy, this research aimed to study the association between hyperemesis gravidarum and pregnancy outcomes, while also addressing the trimester of diagnosis and severity.A retrospective cohort study was performed, including all singleton deliveries of mothers from the largest health maintenance organization in the country, in a single tertiary hospital between 1991 and 2021. The incidence of adverse pregnancy outcomes was compared between pregnancies with and without hyperemesis gravidarum diagnosis. Multivariable generalized estimation equation binary models were used to study the association between maternal hyperemesis gravidarum, trimester of diagnosis and hyperemesis gravidarum severity and the studied outcomes.The study population included 232 476 pregnancies, of which 3227 (1.4%) were complicated with hyperemesis gravidarum. Women with hyperemesis gravidarum were more likely to deliver preterm (adj. OR = 1.33, 95% CI: 1.18–1.50), a newborn with low birthweight (adj. OR = 1.52, 95% CI: 1.16–1.98, only if diagnosed in the second trimester), and to have a cesarean delivery (adj. OR = 1.20, 95% CI: 1.09–1.32). They were less likely to deliver small gestational age newborn (adj. OR = 0.82, 95% CI: 0.69–0.99) and their offspring to experience perinatal mortality (adj. OR = 0.54, 95% CI: 0.31–0.93, among mild cases only). A dose–response association was observed between preterm birth and hyperemesis gravidarum (adj. OR = 1.26; 95% CI: 1.11–1.44, for mild cases and adj. OR = 2.04; 95% CI: 1.31–3.19, for severe cases).Hyperemesis gravidarum is associated with an increased risk for adverse pregnancy outcomes including mainly preterm delivery in a dose–response manner and when diagnosed during the second trimester. [ABSTRACT FROM AUTHOR]

Objective: To construct a simple term small‐for‐gestational‐age (SGA) neonate prediction model that is clinically practical. Methods: This analysis was based on the Born in Guangzhou Cohort Study (BIGCS). Mothers who had a singleton pregnancy, delivered a term neonate, and had an ultrasonography within 30 + 0 to 32 + 6 weeks of gestation were included. Term SGA was defined with customized population percentiles. Prediction models were constructed with backward selection logistic regression in a four‐step approach, where model 1 contained fetal biometrics only, models 2 and 3 included maternal features and a time factor (weeks between ultrasonography and delivery), respectively; and model 4 contained all features mentioned. The prediction performance of individual models was evaluated based on area under the curve (AUC) and a calibration test was performed. Results: The prevalence of SGA in the study population of 21 346 women was 11.5%. With a complete‐case analysis approach, data of 19 954 women were used for model construction and validation. The AUC of the four models were 0.781, 0.793, 0.823, and 0.834, respectively, and all were well‐calibrated. Model 3 consisted of fetal biometrics and corrected for time to delivery was chosen as the final model to build risk prediction graphs for clinical use. Conclusion: A prediction model derived from fetal biometrics in early third trimester is satisfactory to predict SGA. Synopsis: A simple SGA prediction model based on fetal biometrics that requires no additional tests and no prior knowledge of the patient is clinically useful. [ABSTRACT FROM AUTHOR]

Objective: To estimate the prevalence and risk of stillbirths by biologic vulnerability phenotypes in a cohort of pregnant women in the municipality of São Paulo, Brazil, 2017–2019. Methods: Retrospective population‐based cohort study. Fetuses were assessed as small for gestational age (SGA), large for gestational age (LGA), adequate for gestational age (AGA), preterm (PT) as less than 37 weeks of gestation, non‐PT (NPT) as 37 weeks of gestation or more, low birth weight (LBW) as less than 2500 g, and non‐LBW (NLBW) as 2500 g or more. Relative risks (RR) with robust variance were estimated using Poisson regression. Results: In all 442 782 pregnancies, including 2321 (0.5%) stillbirths, were included. About 85% (n = 1983) of stillbirths had at least one characteristic of vulnerability, compared with 21% (n = 92524) of live births. Fetuses with all three markers of vulnerability had the highest adjusted RR of stillbirth—SGA + LBW + PT (RR 155.00; 95% confidence interval [CI] 136.29–176.30) and LGA + LBW + PT (RR 262.04; 95% CI 206.10–333.16) when compared with AGA + NLBW + NPT. Conclusion: Our findings show that the simultaneous presence of prematurity, low birth weight, and abnormal intrauterine growth presented a higher risk of stillbirths. To accelerate progress towards reducing preventable stillbirths, one must identify the circumstances of greatest biologic vulnerability. Synopsis: The simultaneous presence of prematurity, low birth weight, and abnormal intrauterine growth demonstrated an increased risk of stillbirth. [ABSTRACT FROM AUTHOR]

Objective: To assess the impact of treatment of subclinical hypothyroidism (SCH) on short‐term pregnancy outcomes. Method: Data from 4526 consecutive women with singleton pregnancies who delivered between January 2015 and December 2017 were analyzed. SCH was defined as a thyroid‐stimulating hormone (TSH) level between 2.5 and 10 mU/mL with normal free thyroxine. Of those with SCH, some were treated but others were not. These two groups were compared using χ2 and Student t tests for categorical and continuous variables, respectively. Multiple logistic regression models, adjusted for maternal age, body mass index, parity, gestation at TSH measurement, and gestational diabetes mellitus status, were used to investigate the effect of treatment on pregnancy and neonatal outcomes. Results: In all, 1227 (27.1%) of 4526 women had SCH, of whom 393 (32.0%) were treated. The mean age and body mass index were similar in both groups. The mean gestation at measuring of TSH was 11.7 ± 6.5 weeks. There was no significant difference in pregnancy or neonatal outcomes between the two groups. A sub‐group analysis when SCH was defined as TSH 4.0 mU/mL or greater showed a higher rate of large for gestational age and lower rates of low birth weight and small for gestational age in the treated group. Conclusions: The prevalence of SCH based on the international guidelines threshold is high in India. Treatment of SCH did not show any difference in pregnancy and neonatal outcomes in this study. Synopsis: The prevalence of subclinical hypothyroidism in India is high. However, treatment did not show any difference in pregnancy and neonatal outcomes in this study. [ABSTRACT FROM AUTHOR]

Objective: Poor intrauterine growth has negative impacts for child growth and development and disproportionately affects children living in low‐resource settings. In the present study, we investigated relationships between placental pathologies and indicators of poor intrauterine growth. Methods: We enrolled a longitudinal cohort of 279 mother–infant pairs from Leyte, the Philippines. Placental measures included characteristics, pathological findings, and immunohistochemistry. At birth, intrauterine growth was assessed using anthropometric measures, weight‐for‐gestational age, and the clinical assessment of nutritional status score (CANSCORE) for determining fetal malnutrition. Multivariate linear regression and log‐binomial regression models were applied, controlling for potential confounding factors. Results: Maternal vascular malperfusion (MVM) was related to reduced birthweight (P < 0.0001), birth length (P = 0.002), head circumference (P = 0.001), and weight‐to‐length ratio (P = 0.016). MVM increased the risk for preterm delivery (P = 0.0005) and small for gestational age (SGA) (P = 0.016). Acute chorioamnionitis (P = 0.013) and MVM (P = 0.021) both led to an increased risk for fetal malnutrition defined by CANSORE<25. Villous tissue activated caspase‐3 was associated with lower birth length (P = 0.0006), higher weight‐to‐length ratio (P = 0.004), reduced risks for SGA (P = 0.011) and low weight‐to‐length ratio for gestational age (P = 0.004). Conclusion: The present study applied comprehensive measures for intrauterine growth and demonstrates that low placental weight and placental pathology, chiefly MVM, contribute to poor intrauterine growth. A better understanding of the mechanistic role of specific placental pathologies on adverse newborn outcomes will provide opportunities for reducing incidence of poor intrauterine growth and associated long‐term morbidities. Synopsis: Among 279 mother–infant pairs from the Philippines, low placental weight and maternal vascular malperfusion were associated with increased risk for measures of poor intrauterine growth. [ABSTRACT FROM AUTHOR]

Objective: To evaluate perinatal effects of umbilical cord entanglement (UCE) of different body parts. Methods: The database of a tertiary medical center was retrospectively searched for women who gave birth to a liveborn singleton newborn in 2014–2018. Those diagnosed postpartum with UCE were matched 1:10 with women who were not and compared for adverse obstetric and neonatal outcomes, overall and by site of entanglement. Results: A total of 14 299 women were evaluated, of whom 1243 were diagnosed with UCE: 78.7% neck, 26% trunk, 6.7% limb. UCE was associated with lower birth weight percentile and higher rate of small for gestational age, but findings were significant only for neck and trunk UCE. On multivariate regression analysis adjusted for maternal age, parity, gestational age at birth, and history of cesarean delivery, UCE was an independent risk factor for nonreassuring fetal heart rate, labor induction, operative vaginal delivery, cesarean delivery, and meconium‐stained amniotic fluid, but not for lower absolute birth weight/birth weight percentile, small for gestational age, low 1‐min Apgar score, or neonatal asphyxia. Conclusion: While fetuses with UCE might be more compromised during labor, they apparently recover shortly after birth. The impact on perinatal outcomes was similar for UCE of the neck and trunk and lower for UCE of the limb. Synopsis: Umbilical cord entanglement, especially of the neck or trunk relative to the limb, may complicate labor and delivery but does not adversely affect neonatal outcomes. [ABSTRACT FROM AUTHOR]

Background: There have been few studies reporting on maternal and neonatal events in high‐risk pregnant women receiving medications for preventing hypertensive disorders of pregnancy (HDP). Objective: To identify placental abruption, postpartum hemorrhage, neonatal intraventricular hemorrhage, and neonates with small for gestational age (SGA) or growth restriction resulting from medications for preventing HDP in high‐risk pregnant women using a network meta‐analysis. Search strategy: All randomized controlled trials comparing the most commonly used medications (antiplatelet agents, anticoagulants, antioxidants, nitric oxide, and calcium) for preventing HDP in high‐risk pregnant women were searched from the Cochrane Pregnancy and Childbirth's Specialized Register of Controlled Trials until July 31, 2020, without language restriction. Selection criteria: Two of the authors independently selected the eligible trials. Data collection and analysis: Two authors independently extracted the data and assessed the methodological quality of the included trials. Pairwise and network meta‐analyses were used to determine comparative risk ratios and 95% confidence intervals. Main results: The 51 included trials involved 69 669 pregnant women. Compared with placebo/no treatment, antioxidants slightly reduced placental abruption with high‐certainty evidence. Antiplatelet agents probably reduced SGA with low‐certainty evidence and slightly increased neonatal intraventricular hemorrhage with moderate‐certainty evidence. Conclusion: Antiplatelet agents probably reduce SGA, but neonatal intraventricular hemorrhage should be monitored. Systematic review registration: PROSPERO, CRD42018096276. Synopsis: Antiplatelet agents administered for preventing hypertengefosive disorders of pregnancy probably reduce small for gestational age in neonates, but the women should be closely monitored for neonatal intraventricular hemorrhage. [ABSTRACT FROM AUTHOR]

Objective: Scarce data exist regarding obstetric complications of short‐stature patients. This study aimed to investigate obstetric and perinatal outcomes in women with short stature; specifically, to investigate whether short‐stature patients are at an increased risk for cesarean delivery. Methods: A population‐based cohort study was conducted, including all singletons born between the years 1991 and 2021 at a tertiary medical center. Obstetric and perinatal outcomes of short‐stature patients were compared with those of non‐short patients. A generalized estimation equation binary logistic model was constructed to adjust for confounders and maternal recurrence in the cohort. Results: The study population included 356 356 parturient; among them, 14 035 (3.9%) were short‐stature patients. Short‐stature patients had significantly higher rates of cesarean delivery (20.7% vs 13.7%, odds ratio = 1.64, 95% confidence interval 1.57–1.71, P < 0.001), induction of labor, pathologic presentations, prolonged second stage of labor, non‐reassuring fetal monitoring, and meconium‐stained amniotic fluid. Newborns of short‐stature patients had a significantly higher risk of being small for gestational age as compared with those of non‐short patients. In the generalized estimation equation models, the association between short stature and risk of cesarean delivery remained significant (adjusted odds ratio = 1.32, 95% confidence interval 1.27–1.38, P < 0.001), as well as the risk of small for gestational age newborns (adjusted odds ratio = 1.51, 95% confidence interval 1.40–1.63, P < 0.001), but not for the other adverse outcomes. Conclusions: Maternal short stature is an independent risk factor for cesarean delivery and is associated with small for gestational age newborns. Synopsis: Maternal short stature is an independent risk factor of cesarean delivery and is associated with a higher risk of small for gestational age newborns. [ABSTRACT FROM AUTHOR]

Objective: To analyze the associations between gestational weight gain (GWG) and perinatal outcomes based on the GWG guidelines of the Chinese Nutrition Society (CNS) and the Institute of Medicine (IOM). Methods: This was a retrospective study with 9075 low‐risk singleton pregnant women. Logistic regression model was used to analyze associations between GWG categories and perinatal outcomes. Sensitivity analyses were performed based on pre‐pregnancy body mass index (calculated as weight in kilograms divided by the square of height in meters). Results: Excessive GWG as defined by the two guidelines was associated with a higher risk of adverse perinatal outcomes. Inadequate GWG was associated with higher risks of small for gestational age (adjusted odds ratio [aOR] 1.34, 95% confidence interval [CI] 1.10–1.64) and preterm birth (aOR 1.70, 95% CI 1.22–2.36), but a lower risk of large for gestational age (LGA) (aOR 0.77, 95% CI 0.63–0.95) according to the IOM guidelines. When using the CNS guidelines, inadequate GWG was associated with only a lower risk of preterm birth (aOR 1.80, 95% CI 1.19–2.70). Sensitivity analyses suggested that excessive GWG was associated with a higher risk of LGA in underweight women. Conclusions: Both guidelines could demonstrate the relationship between GWG and adverse perinatal outcomes. The CNS guidelines were more suitable for the Chinese population with underweight or normal weight before pregnancy, whereas IOM was more suitable for pregnant women with inadequate GWG. Synopsis: Chinese Nutrition Society guidelines were generally better for Chinese woman, but IOM guidelines were more appropriate for pregnant women with inadequate gestational weight gain. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the impact of type and timing of antiretroviral therapy (ART) on the risk of preterm delivery (PTD) and small‐for‐gestational age (SGA) birth among pregnant women and people living with HIV in Canada. Methods: Data for this retrospective cohort study were analyzed from the Canadian Perinatal HIV Surveillance Program from 1990 to 2020. The association between ART and risk of PTD (<37 weeks) and SGA birth (<10th percentile) was explored using mixed effects logistic regression and time‐dependent Cox proportional hazards models. Results: Overall, there were 14.9% (654 of 4379) PTD and 18.5% (732 of 3947) SGA cases. A higher risk of PTD was observed with nonnucleoside reverse transcriptase inhibitor–(adjusted hazard ratio [aHR], 1.73; P = 0.019) and boosted protease inhibitor– (aHR, 186; P = 0.007) based regimens compared with integrase strand transfer inhibitor (INSTI)–based regimens. ART initiation prior to conception was associated with a lower risk of SGA birth compared with ART initiation after conception at 1 to 14 weeks (adjusted odds ratio [aOR], 0.69; P = 0.024) and > 14 weeks (aOR, 0.70; P = 0.005). Conclusion: INSTI‐based ART regimens were associated with lower risk of PTD compared with other regimens, and ART initiation before conception was associated with a lower risk of SGA birth. These findings, with overall safety data, should be considered when providing pregnancy counseling to people living with HIV. Synopsis: The type and timing of antiretroviral therapy during pregnancy influence perinatal complications, including preterm delivery and small for gestational age birth, in Canada. [ABSTRACT FROM AUTHOR]

Objectives: To synthesize the evidence from randomized controlled trials (RCTs) of antihypertensive treatment for mild pregnancy hypertension. Methods: We searched various databases from inception to June 2022, using keywords including hypertension; pregnancy; therapy; treatment; pregnancy outcomes; maternal outcomes; and perinatal outcomes. Only RCTs of antihypertensive treatment for mild hypertension in pregnancy comparing placebo/no therapy were included. We used Review Manager version 5.3 for statistical analyses. Results: In all, eight studies were eligible, with a total of 4211 participants. Compared with control, the active treatment significantly prevented preeclampsia (OR 0.55; 95%CI, 0.39–0.78), placental abruption (OR 0.39; 95%CI, 0.17–0.91), severe hypertension (OR 0.35; 95%CI, 0.17–0.71), end–organ dysfunction (OR 0.34; 95%CI, 0.19–0.62) and preterm birth (OR 0.69; 95%CI, 0.59–0.82), with no increased risk of small for gestational age (SGA) (OR 1.25; 95%CI, 0.78–2.00), or admission to the NICU (OR 0.83; 95%CI, 0.54–1.28). Subgroup analyses demonstrated that the tight control group did not show an advantage over the less‐tight control group in improving pregnancy outcomes. Conclusion: In pregnant women with mild pregnancy‐induced hypertension or chronic hypertension, antihypertensive treatment still provided precise benefits of improving pregnancy outcomes without increased risk in fetal outcomes. Synopsis: Antihypertensive treatment provided precise benefits of improving pregnancy outcomes without increased risk in fetal outcomes for pregnant women with mild hypertension. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the performance of INTERGROWTH‐21st (IG‐21st) and World Health Organization (WHO) fetal growth charts to identify small‐for‐gestational‐age (SGA) and fetal growth restriction (FGR) neonates, as well as their specific risks for adverse neonatal outcomes. Methods: Multicenter cross‐sectional study including 67 968 live births from 10 maternity units across four Latin American countries. According to each standard, neonates were classified as SGA and FGR (birth weight <10th and less than third centiles, respectively). The relative risk (RR) and diagnostic performance for a low APGAR score and low ponderal index were calculated for each standard. Results: WHO charts identified more neonates as SGA than IG‐21st (13.9% vs 7%, respectively). Neonates classified as having FGR by both standards had the highest RR for a low APGAR (RR, 5.57 [95% confidence interval (CI), 3.99–7.78]), followed by those who were SGA by both curves (RR, 3.27 [95% CI, 2.52–4.24]), while neonates with SGA identified by WHO alone did not have an additional risk (RR, 0.87 [95% CI, 0.55–1.39]). Furthermore, the diagnostic odds ratio for a low APGAR was higher when IG‐21st was used. Conclusion: In a population from Latin America, the WHO charts seem to identify more SGA neonates, but the diagnostic performance of the IG‐21st charts for low APGAR score and low ponderal index is better. Synopsis: Diagnostic performance of fetal growth charts in Latin America. Although using the World Health Organization standard increases the detection of small for gestational age and fetal growth restriction neonates in Latin America, the INTERGROWTH‐21st standards have better diagnostic performance in ruling in and out adverse neonatal outcomes. [ABSTRACT FROM AUTHOR]

Objective: To compare the performance of mid upper arm circumference (MUAC) and body mass index (BMI) for prediction of small for gestational age (SGA) in Zambia. Methods: This is a secondary analysis of an ongoing clinical cohort that included women with a single gestation and MUAC measured before 24 weeks of pregnancy. We assessed relationships between maternal MUAC and birth weight centile using regression. The performance of MUAC and BMI to predict SGA was compared using receiver operating characteristic curves and the effect of maternal HIV was investigated in sub‐group analyses. Results: Of 1117 participants, 847 (75%) were HIV‐negative (HIV−) and 270 (24%) were HIV‐positive (HIV+). Seventy‐four (7%) delivered severe SGA infants (<3rd centile), of whom 56 (76%) were HIV− and 18 (24%) were HIV+ (odds ratio [OR] 1.01, 95% confidence interval [CI] 0.58–1.75). MUAC was associated with higher birth weight centile (+1.2 centile points, 95% CI 0.7–1.6; P < 0.001); this relationship was stronger among HIV+ women (+1.7 centile points, 95% CI 0.8–2.6; P < 0.001) than HIV− women (+0.9 centile points, 95% CI 0.4–1.4; P = 0.001). The discriminatory power was similar, albeit poor (area under the curve [AUC] < 0.7), between MUAC and BMI for the prediction of SGA. In stratified analysis, MUAC and BMI showed excellent discrimination predicting severe SGA among HIV+ (AUC 0.83 and 0.81, respectively) but not among HIV− women (AUC 0.64 and 0.63, respectively). Conclusion: Maternal HIV infection increased the discrimination of both early pregnancy MUAC and BMI for prediction of severe SGA in Zambia. Clinical Trial Number: ClinicalTrials.gov (NCT02738892). Synopsis: Maternal mid‐upper arm circumference measured early in pregnancy is associated with small for gestational age with predictive performance similar to body mass index. [ABSTRACT FROM AUTHOR]

Objective: To identify first pregnancy risk factors for placental abruption in subsequent pregnancy. Methods: In a population‐based nested case–control study, cases were defined as women with placental abruption in their second pregnancy, and controls as women without abruption. A total of 43 328 women were included in the study, 0.4% (n = 186) of second pregnancies had placental abruption. Multivariable logistic models were used to study the association between first pregnancy complications and placental abruption in subsequent pregnancy. Results: Having either small for gestational age, preterm delivery, pre‐eclampsia or cesarean delivery during first pregnancy were independently associated with increased risk for placental abruption, and the risk was higher with any additional complication (age adjusted odds ratio [aOR] 2.00, 95% confidence interval [CI] 1.46–2.74; aOR 3.61, 95% CI 2.23–5.86; and aOR 3.86, 95% CI 1.56–9.56, for one, two, and three or more complications, respectively). Conclusion: First pregnancy may serve as a window of opportunity to identify women at risk for future placental abruption. Synopsis: The first pregnancy may serve as a window of opportunity to identify women at risk for future placental abruption. [ABSTRACT FROM AUTHOR]

Objective: to evaluate fetal growth in pregnancies complicated by placenta accreta spectrum (PAS) and to compare fetal growth between cases stratified by ultrasound stage of PAS. Methods: This was a prospective multicenter cohort study of women diagnosed with PAS between January 2018 and December 2021. We grouped participants into cases by ultrasound stage (PAS stage 1–3) and controls (PAS0). Fetal growth centiles at three timepoints with median gestational ages of 21 ± 1 weeks (interquartile range [IQR], 20 ± 1–22 ± 0 weeks), 28 ± 0 weeks (IQR, 27 ± 0–28 ± 5 weeks), and 33 ± 0 weeks (IQR, 32 ± 1–34 ± 0 weeks) and birth weight centiles were compared between cases and controls and between those with PAS stratified by ultrasound stage. Results: A total of 53 women met inclusion criteria, with a mean age of 37 years (standard deviation, ±4.0 years) and body mass index of 27 kg/m2 (standard deviation, ±5.8 kg/m2). Median (IQR) fetal weight centiles were around the 50th centile at each timepoint, with no difference between groups. The incidence of small for gestational age (birth weight ≤ 10th percentile) and large for gestational age (birth weight ≥ 90th percentile) was 11.3% (n = 6) and 15.1% (n = 8), respectively, with no differences by ultrasound stage. The median birth weight centile was 64 (IQR, 26–85), with no differences between cases and controls or by ultrasound stage. Conclusions: In our cohort, a diagnosis of PAS was not associated with fetal growth restriction. Synopsis: Placenta accreta spectrum does not seem to result in placental insufficiency and fetal growth abnormalities, with normal growth seen across all stages of ultrasound severity in our cohort. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the use of UmbiFlow™ in field settings to assess the impact of heat stress on umbilical artery resistance index (RI). Methods: This feasibility study was conducted in West Kiang, The Gambia, West Africa; a rural area with increasing exposure to extreme heat. We recruited women with singleton fetuses who performed manual tasks (such as farming) during pregnancy to an observational cohort study. The umbilical artery RI was measured at rest, and during and at the end of a typical working shift in women at 28 weeks or more of pregnancy. Adverse pregnancy outcomes (APO) were classified as stillbirth, preterm birth, low birth weight, or small for gestational age, and all other outcomes as normal. Results: A total of 40 participants were included; 23 normal births and 17 APO. Umbilical artery RI demonstrated a nonlinear relationship to heat stress, with indication of a potential threshold value for placental insufficiency at 32°C by universal thermal climate index and 30°C by wet bulb globe temperature. Conclusions: The Umbiflow device proved to be an effective field method for assessing placental function. Dynamic changes in RI may begin to explain the association between extreme heat and APO with an identified threshold of effect. Synopsis: Extreme heat exposure is increasing and a low‐cost umbilical artery Doppler device, UmbiFlow™, can aid understanding of fetoplacental function under heat stress conditions. [ABSTRACT FROM AUTHOR]

Objective: To assess the association between maternal asthma and adverse perinatal outcomes in an Australian Indigenous population. Methods: This prospective cohort study included all Indigenous mother and baby dyads for births from 2001 to 2013 in Western Australia (n = 25 484). Data were linked from Western Australia Births, Deaths, Midwives, Hospital, and Emergency Department collections. Maternal asthma was defined as a self‐reported diagnosis at an antenatal visit or hospitalization or emergency visit for asthma during pregnancy or less than 3 years before pregnancy. Associations with birth, labor, and pregnancy outcomes were assessed using generalized estimating equations. Asthma exacerbation during pregnancy and stratification by remoteness was also assessed. Results: Maternal asthma was associated with placental abruption (adjusted odds ratio [aOR], 1.59 [95% confidence interval (CI), 1.07–2.35]), threatened preterm labor (aOR, 1.58 [95% CI, 1.39–1.79]), and emergency cesarean sections (aOR, 1.27 [95% CI, 1.13–1.44]). These risks increased further with an asthma exacerbation during pregnancy or if the mother was from a remote area. No associations were found for low birth weight, preterm birth, small for gestational age, or perinatal mortality. Conclusion: Maternal asthma in Indigenous women is associated with an increased risk of emergency cesarean sections, placental abruption, and threatened preterm labor. These risks may be mitigated by improved management of asthma exacerbations during pregnancy. Synopsis: Maternal asthma in Australian Indigenous women is associated with an increased risk in emergency cesarean sections, placental abruption, and threatened preterm labor. [ABSTRACT FROM AUTHOR]

In women, it has been epidemiologically associated with cervicitis, pelvic inflammatory disease, and infertility[[1]]; however, most infections are asymptomatic.[3] Routine MG screening is not currently recommended[4] because of a lack of consistent evidence of reproductive sequelae from asymptomatic infection. Keywords: macrolide; Mycoplasma genitalium; pregnancy; resistance; sexually transmitted infection EN macrolide Mycoplasma genitalium pregnancy resistance sexually transmitted infection 341 344 4 12/16/22 20230101 NES 230101 I Mycoplasma genitalium i (MG) infection is an emerging sexually transmitted infection (STI). [Extracted from the article]

Objective: Pre‐eclampsia (PE) and small for gestational age (SGA) can be predicted from the first trimester. The most widely used algorithm worldwide is the Fetal Medicine Foundation (FMF) algorithm. The recently described Gaussian algorithm has reported excellent results although it is unlikely to be externally validated. Therefore, as an alternative approach, we compared the predictive accuracy for PE and SGA of the Gaussian and FMF algorithms. Methods: Secondary analysis of a prospective cohort study was conducted at Vall d'Hebron University Hospital (Barcelona) with 2641 singleton pregnancies. The areas under the curve for the predictive performance for early‐onset and preterm PE and early‐onset and preterm SGA were calculated with the Gaussian and FMF algorithms and subsequently compared. Results: The FMF and Gaussian algorithms showed a similar predictive performance for most outcomes and marker combinations. Nevertheless, significant differences for early‐onset PE prediction favored the Gaussian algorithm in the following combinations: mean arterial blood pressure (MAP) with pregnancy‐associated plasma protein A, MAP with placental growth factor, and MAP alone. Conclusions: The first‐trimester Gaussian and FMF algorithms have similar performances for PE and SGA prediction when applied with all markers within a routine care setting in a Spanish population, adding evidence to the external validity of the FMF algorithm. Synopsis: The first‐trimester Gaussian and Fetal Medicine Foundation algorithms have similar predictive performances for pre‐eclampsia and small‐for‐gestational‐age fetuses. [ABSTRACT FROM AUTHOR]

Objectives: To explore perinatal outcomes in severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2)‐vaccinated pregnant women compared with unvaccinated counterparts. Methods: Search was conducted using Web of Science, Scopus, ClinicalTrial.gov, MEDLINE, Embase, OVID, and Cochrane Library as electronic databases. We included observational studies evaluating pregnant women undergoing SARS‐CoV‐2 vaccination and compared pregnancy and perinatal outcomes with those in unvaccinated women. Categorical variables were assessed using odds ratio (OR) with 95% confidence interval (CI), whereas for continuous variables, the results were expressed as mean difference with their 95% CI. All analyses were performed by adopting the random effect model of DerSimonian and Laird. Results: There was no difference in the probability of having a small‐for‐gestational‐age fetus (OR 0.97, 95% CI 0.85–1.09; P = 0.570), but we observed a reduced probability of a non‐reassuring fetal monitoring, a reduced gestational age at delivery, and a reduced probability of premature delivery in vaccinated pregnant women versus unvaccinated ones. Conclusion: The probability of small for gestational age is similar between vaccinated and unvaccinated pregnant women, and the former also had a slightly reduced rate of premature delivery. Synopsis: Probability of small for gestational age and other adverse perinatal outcomes is similar between SARS‐CoV‐2‐vaccinated and unvaccinated pregnant women. [ABSTRACT FROM AUTHOR]

Objective: To assess obstetric, perinatal, and placental histologic findings in small‐for‐gestational‐age (SGA) neonates according to different growth charts. Methods: A retrospective cohort of singleton deliveries from 2008 to 2019 were divided into SGA neonates according to the local population‐based chart, SGA according to universal standard growth charts (but appropriate for gestational age [AGA] according to local charts) and AGA deliveries according to both charts. Results: A total of 626 local population SGA deliveries, 132 universal SGA and 468 AGA deliveries were compared. The local population SGA group had a significantly higher rate of preterm and cesarean deliveries. An adverse neonatal outcome occurred in 27.2% of the local population SGA group, 9.8% of the universal SGA group and 6.7% of the AGA group (P < 0.001). In the local population SGA group, placental weight was lower, birth weight to placental weight ratio was highest, and the rate of maternal malperfusion lesions was highest—55.4% versus 45.4% in the universal SGA group and 39.1% in the AGA group (P < 0.001). Villitis of unknown etiology was significantly more common and histologic chorioamnionitis was significantly less common in the local population SGA group. Conclusions: Our findings support the use of a local population‐based growth chart for the diagnosis of fetal growth restriction. Synopsis: The contents of this page will be used as part of issue TOC only. It will not be published as part of main article. Diagnosis of fetal growth restriction according to local population‐based growth curves best correlates with neonatal outcomes and placental histology. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether pre‐eclampsia is a single clinical entity or whether de novo pre‐eclampsia and superimposed pre‐eclampsia are distinct entities, with respect to baseline maternal characteristics, obstetrical complications, and perinatal outcomes. Methods: A retrospective cohort study comparing singleton pregnancies complicated with de novo pre‐eclampsia (n = 10 979, 93%) and superimposed pre‐eclampsia (n = 804, 7%). Maternal baseline characteristics, pregnancy and labor complications, and neonatal outcomes were evaluated in the univariate analysis. Multivariable logistic regression models were performed for the prediction of different pregnancy outcomes while controlling for confounders. Results: In the multivariate regression models controlling for confounders, superimposed pre‐eclampsia was found to be a significant risk factor for placental dysfunction, a composite outcome composed of severe pre‐eclampsia (rather than mild), placental abruption, oligohydramnios, and small‐for‐gestational‐age neonate (odds ratio [OR] 2.23, 95% confidence interval [CI] 1.90–2.62, P < 0.001), preterm delivery (OR 2.79, 95% CI 2.39–3.26, P < 0.001), and perinatal mortality (OR 1.79, 95% CI 1.11–2.88, P = 0.02). Conclusion: De novo and superimposed pre‐eclampsia demonstrated significant differences in most studied variables, suggesting that these may be two distinct clinical syndromes. In our population, superimposed pre‐eclampsia was found to be significantly associated with adverse pregnancy outcomes such as placental dysfunction, preterm delivery, and perinatal mortality compared with de novo pre‐eclampsia. A retrospective cohort study demonstrating that superimposed pre‐eclampsia is a major risk factor for adverse maternal and perinatal outcomes, when compared with de novo pre‐eclampsia. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the relationships of pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) trajectory with adverse perinatal outcomes (APOs). Methods: A retrospective cohort study was conducted in China, and 12 855 women who had a singleton birth were included. The WHO classification categorized prepregnancy BMI, and five GWG trajectories were identified using the latent class growth model. Results: The adjusted odds ratios for the risks of cesarean delivery, preterm birth, and large-for-gestational-age (LGA) infant were significantly higher in women with whoe were overweight or obese pre-pregnancy, but were lower in underweight (except preterm birth) than in normal weight women. Five GWG trajectories were identified: (1) retaining GWG (6.6 kg), (2) moderately slow GWG (10.5 kg), (3) moderate GWG (13.7 kg), (4) moderately fast GWG (16.3 kg), and (5) rapid GWG (19.8 kg). Compared with women in trajectory 3, the risks of cesarean delivery and LGA increase by about 35%–96% for the women in trajectory 4 or 5, whereas the women in trajectory 1 or 2 are inclined to have a higher risk of small for gestational age, but lower risk of LGA. Association of GWG trajectory with APOs varies across pre-pregnancy BMI subgroups. Conclusion: This study highlights the influence of inappropriate pre-pregnancy maternal weight and GWG trajectories on the risk of APOs. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether angiogenic biomarker concentrations differ between women who deliver small-for-gestational-age (SGA) infants (<10th centile birth weight for gestational age) compared with controls, because identifying SGA risk early could improve outcomes. Methods: This case-control study compared serum concentrations of angiogenic biomarkers before 24 weeks of pregnancy from 62 women who delivered SGA infants (cases) and 62 control women from an urban Zambian cohort. Odds of delivering an SGA infant were calculated using conditional logistic regression. Results: Placental growth factor (PlGF), soluble fms-like tyrosine kinase (sFLT-1) and soluble endoglin (sEng) in controls were 37.74 pg/mL (interquartile range [IQR] 23.12– 63.15), 2525.18 pg/mL (IQR 1502.21–4265.54) and 2408.18 pg/mL (IQR 1854.87– 3017.94), respectively. SGA cases had higher PlGF (40.50 pg/mL, IQR 22.81–67.94) and sFLT-1 (2613.06 pg/mL, IQR 1720.58–3722.50), and lower sEng (2038.06 pg/mL, IQR 1445.25–3372.26). Participants with sEng concentration below and concomitant sFLT-1 concentration above their respective thresholds (n = 40) had five-fold higher odds of SGA (adjusted odds ratio 4.77, 95% confidence interval 1.61–14.1; P = 0.005). Conclusion: Biomarker concentrations were similar between cases and controls. Participants with concomitant low sEng and high sFLT-1 had the highest odds of SGA, suggesting that a combination of biomarkers may better for predicting SGA than single biomarkers. [ABSTRACT FROM AUTHOR]

Objective: To understand the relationship between birth weight and altitude to improve health outcomes in high-altitude populations, to systematically assess the impact of altitude on the likelihood of low birth weight (LBW), small for gestational age (SGA), and spontaneous preterm birth (sPTB), and to estimate the magnitude of reduced birth weight associated with altitude. Methods: PubMed, OvidEMBASE, Cochrane Library, Medline, Web of Science, and clinicaltrials.gov were searched (from inception to November 11, 2020). Observational, cohort, or case-control studies were included if they reported a high altitude (>2500 m) and appropriate control population. Results: Of 2524 studies identified, 59 were included (n = 1 604 770 pregnancies). Data were abstracted according to PRISMA guidelines, and were pooled using random-effects models. There are greater odds of LBW (odds ratio [OR] 1.47, 95% confidence interval [CI] 1.33-1.62, P < 0.001), SGA (OR 1.88, 95% CI 1.08-3.28, P = 0.026), and sPTB (OR 1.23, 95% CI 1.04-1.47, P = 0.016) in high-versus low-altitude pregnancies. Birth weight decreases by 54.7 g (±13.0 g, P < 0.0001) per 1000 m increase in altitude. Average gestational age at delivery was not significantly different. Conclusion: Globally, the likelihood of adverse perinatal outcomes, including LBW, SGA, and sPTB, increases in high-altitude pregnancies. There is an inverse relationship between birth weight and altitude. These findings have important implications for the increasing global population living at altitudes above 2500 m. [ABSTRACT FROM AUTHOR]

Objective: The fetal risks and benefits of antihypertensives to treat gestational hypertension in pregnancy are understudied, particularly in low‐ and middle‐income countries. Methods: We performed a nested case‐control study within a retrospective cohort of obstetrical patients in Botswana from 2014 to 2019. We included women carrying singletons who developed new onset non‐severe hypertension (140–159 mm Hg systolic or 90–109 mm Hg diastolic blood pressure) after 20 weeks of pregnancy. Cases were defined as women with either small‐for‐gestational‐age (SGA) infants or stillbirth, analyzed separately; controls were otherwise similar women without the adverse outcome in each analysis. Results: We identified 1932 cases of SGA (7925 controls) and 316 cases of stillbirth (9619 controls). Cases with SGA were more likely to have used an anti‐hypertensive than controls (33% vs 29%, adjusted odds ratio [aOR] 1.28, 95% confidence interval [CI] 1.15–1.43). Cases with stillbirth were more likely to have used an anti‐hypertensive than controls (42% versus 29%, aOR 1.45, 95% CI 1.14–1.83). Conclusion: Anti‐hypertensive use for new‐onset gestational hypertension was associated with an increased risk of having an SGA infant or a stillbirth among women who never developed severe hypertension. These data support conduct of a randomized clinical trial to determine the appropriate use of anti‐hypertensives in non‐severe gestational hypertension. In an observational study of new‐onset, non‐severe hypertension in pregnancy in Botswana, anti‐hypertensive use was associated with small‐for‐gestational‐age infants and stillbirth. [ABSTRACT FROM AUTHOR]

Objective: To identify risk factors in first pregnancy for perinatal mortality in the subsequent pregnancy. Methods: A retrospective population‐based nested case‐control study was conducted, including all women with two first singleton consecutive deliveries. Women with perinatal mortality in their first pregnancy were excluded, and cases with perinatal mortality in the second pregnancy were compared with controls who delivered a live birth. Characteristics and complications of the first pregnancy were compared between the groups using multivariable logistic models. Results: A total of 43 043 women were included in the study, 385 (0.9%) were cases. Cases, as compared with controls (live births), were younger (22.62 ± 4.0 vs 23.22 ± 4.0 years), with shorter inter‐pregnancy interval (1.38 ± 1.55 vs 1.56 ± 1.53 years), and were more likely to have the following complications in their first pregnancy: severe pre‐eclampsia (3.4% vs 1.7%), small for gestational age (12.5% vs 8.0%), preterm delivery (17.7% vs 7.8%), and congenital or chromosomal malformations (9.6% vs 5.9%). In multivariable analysis the risk for perinatal mortality was greater with each additional complication (adjused odds ratio [aOR] 1.64, 95% confidence interval [CI] 1.30–2.07, P < 0.001; aOR 2.55, 95% CI 1.61–4.04, P < 0.001; aOR 7.88, 95% CI 3.81–16.29, P < 0.001 for one, two, and three or more complications, compared with no complications, respectively). Conclusion: Complications in first pregnancy ending with live birth are associated with increased risk for perinatal mortality in a subsequent pregnancy. First pregnancy complications are associated with an increased risk for perinatal mortality in a subsequent pregnancy of women with no history of perinatal mortality. [ABSTRACT FROM AUTHOR]

Objective: Pre-eclampsia and delivery of small-for-gestational-age (SGA) neonates can be predicted from the first trimester. A Gaussian model for prediction of PE has recently been described, although its capacity to predict SGA is still unknown.Methods: This was a secondary analysis of a prospective cohort study conducted at Vall d'Hebron University Hospital (Barcelona) in 2483 single pregnancies from October 2015 to September 2017. Mean arterial blood pressure and mean uterine artery pulsatility index were recorded at the first-trimester scan. Serum concentrations of placental growth factor and pregnancy-associated plasma protein-A were assessed between 8+0 and 13+6  weeks. The predictive capacities of early (<32 weeks) and preterm (<37 weeks) SGA were tested.Results: For SGA without pre-eclampsia, detection rates of 25.0% (95% confidence interval [CI] 0-75.0) for early SGA and 14.3% (95% CI 3.6-28.6) for preterm SGA were achieved. For SGA with pre-eclampsia, the algorithm showed detection rates of 100.0% (95% CI 25.0-100.0) for early SGA and 56.3% (95% CI 31.3-81.3) for preterm SGA.Conclusion: This algorithm identifies 62.5% of early SGA and 27.3% of preterm SGA. Combined screening for predicting both pre-eclampsia and SGA by using the Gaussian algorithm is feasible and would simplify clinical practice. [ABSTRACT FROM AUTHOR]

Objective: To establish trimester‐specific reference intervals (TSRIs) for blood lipid profiles in Chinese women and explore their associations with pregnancy outcomes. Methods: Participants were women with singleton pregnancies aged 18–45 years without pre‐existing chronic diseases who delivered from January 2018 to December 2018 from an ongoing cohort in Beijing, China. Baseline information and pregnancy outcomes were from the medical records. Blood lipid levels were measured at 7–13, 24–28, and 32–34 weeks of pregnancy. We estimated TSRIs for lipid profiles using an indirect Hoffmann method and evaluated their associations with pregnancy outcomes, including gestational diabetes, pregnancy‐induced hypertension, macrosomia, low birth weight, large or small for gestational age, and preterm delivery. Results: The established TSRIs were 3.21–5.38, 4.64–7.56, and 4.86–8.20 mmol/L for total cholesterol; 0.37–1.81, 1.14–3.49, and 1.61–4.63 mmol/L for triglycerides; 1.12–2.19, 1.33–2.49, and 1.24 2.31 mmol/L for high‐density lipoprotein cholesterol; 1.33–2.98,1.97–4.36, and 2.02–4.92 mmol/L for low‐density lipoprotein cholesterol from first trimeseter to third trimester, respectively. Both higher and lower levels of lipid profiles than TSRIs were associated with adverse pregnancy outcomes. Conclusion: We suggested TSRIs for blood lipid levels in a Chinese population. Inappropriate lipid levels were associated with adverse pregnancy outcomes. Synopsis: We established trimester‐specific reference intervals for blood lipids in a Chinese population. Both higher and lower blood lipid levels were associated with adverse pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the association between neonatal weight centile and neonatal and maternal morbidity following vacuum‐assisted delivery (VAD) among term nulliparous women. Methods: A retrospective cohort study of all nulliparous women who delivered at term by VAD between 2011 and 2019. Deliveries were allocated into two groups and compared: (1) delivery of an small‐for‐gestational‐age (SGA) neonate, and (2) delivery of an appropriate‐for‐gestational‐age (AGA) neonate. Results: Overall, 3116 women were included in the study; 2878 (92.4%) were AGA and 163 (5.2%) were SGA and comprised the study groups. Neonatal and maternal adverse outcomes did not vary between groups. Rates of composite neonatal adverse outcome for SGA and AGA neonates were 26 (16.0%) versus 462 (16.1%), respectively (P = 0.972). Duration of the second stage of labor and rate of prolonged second stage were significantly lower among the SGA group compared with the AGA group (P < 0.001 for both comparisons). Maternal rates of anal sphincter injury and postpartum hemorrhage did not differ between groups. Conclusion: Neonatal outcomes among SGA neonates delivered by VAD at term did not differ from those of AGA neonates. Maternal outcome did not differ. These data provide reassurance for practitioners to perform VAD in SGA neonates at term. Synopsis: Neonatal and maternal outcomes among SGA neonates delivered by vacuum at term do not differ from those of AGA neonates. [ABSTRACT FROM AUTHOR]

Objective: To explore the associations of duration and quality of sleep during pregnancy with preterm birth and small for gestational age (SGA).Methods: A prospective study was carried out on 1082 healthy women with singleton pregnancies from Chengdu, China. Self-report questionnaires, including duration and quality of sleep and other information, were administered at 8-12, 24-28, and 32-36 weeks of pregnancy. Data on gestational age and weight and length of the neonates were recorded after delivery. After controlling the potential confounders, a multivariable logistic regression model was performed to evaluate whether duration and quality of sleep were associated with preterm birth and SGA.Results: Participants with short duration of sleep during the third trimester were more likely to report preterm birth (odds ratio [OR] 2.16, 95% confidence interval [CI] 1.26-4.81) and SGA (OR 2.67, 95% CI 1.18-6.54). Participants with poor quality of sleep during the third trimester were at high risk for preterm birth (OR 2.26, 95% CI 1.29-5.84) and SGA (OR 2.08, 95% CI 1.19-5.38).Conclusion: Short duration and poor quality of sleep during pregnancy are associated with an increased risk of preterm birth and SGA. Sleep characteristics should be assessed during prenatal evaluations to decrease adverse maternal and fetal outcomes. [ABSTRACT FROM AUTHOR]

Objective: To explore preterm birth among Māori indigenous peoples through Kaupapa Māori research of preterm birth in Aotearoa New Zealand. Methods: Linked maternity, mortality, and hospital data were analyzed for women and their infants born between January 1, 2010 and December 31, 2014. Relative risks (RR) were calculated for each ethnic group for preterm birth, small for gestational age (SGA), and mortality. Results: Adjusted rates showed that compared with Māori women, European women were at significantly less risk of having extremely and very preterm infants (RR 0.86, 95% confidence interval [CI] 0.76–0.95). Preterm infants of European women had a significantly lower adjusted RR of early neonatal death (RR 0.65, 95% CI 0.45–0.93) or post‐neonatal death (RR 0.41, 95% CI 0.26–0.64). In addition to ethnicity, preterm rates were influenced by maternal age, body mass index, smoking status, and SGA status. Conclusion: This study demonstrates that the Aotearoa New Zealand maternity system privileges whiteness, suggesting that clinical pathways for evidence‐based medical care are not delivered systemically and equitably for all. Health pathways that focus on equity as a fundamental right will enhance health outcomes for Māori women and their infants. Synopsis: The Aotearoa maternity system consistently advantages privileged populations, primarily European women. Health providers should support initiatives to ensure equitable outcomes for indigenous women and infants. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effects of low‐molecular‐weight heparin (LMWH) combined with low‐dose aspirin (LDA) in pregnant women with a history of pregnancy‐related hypertensive disorders. Methods: In the current retrospective stratified cohort study, 33 women with previous hypertensive disorders of pregnancy treated with LMWH and LDA were compared with 37 control women who did not undergo LMWH or LDA treatment. Rates of pre‐eclampsia recurrence, placental abruption, and other adverse outcomes for the fetuses and pregnant women were compared in the two groups. Results: The pre‐eclampsia recurrence rates were 12/33 (36.4%) in the LMWH + LDA group and 28/37 (75.7%) in the control group (P < 0.01). In stratified cohort analysis, pregnant women with a history of early‐onset pre‐eclampsia, a body mass index of at least 24 (calculated as weight in kilograms divided by the square of height in meters), and aged less than 35 years benefited from LMWH + LDA treatment. In women with chronic hypertension or a history of placental abruption there was no protective effect. There were no significant differences in other adverse outcomes such as placental abruption and small size for gestational age in fetuses or pregnant women in the two groups. Conclusion: Administration of LMWH + LDA only lowered the risk of pre‐eclampsia recurrence in subgroups of pregnant women with a history of pregnancy‐associated hypertensive disorders. Synopsis: Administration of low‐molecular‐weight heparin and aspirin lowered the risk of recurrent pre‐eclampsia only in certain subgroups of pregnant women with a history of pregnancy‐related hypertensive disorders. [ABSTRACT FROM AUTHOR]

Objective: To establish reference ranges for aortic isthmus Doppler indices in appropriate‐for‐gestational‐age (AGA) fetusesand to evaluate its association with perinatal outcome in small‐for‐gestational‐age (SGA) fetuses. Methods: Prospective cohort observational study in which 30 pregnant women with SGA fetuses and 60 women with AGA fetuses were recruited from the prenatal clinic of the hospital. The AGA group was eventually followed from 24 weeks by 4‐weekly Doppler assessment, and the SGA group was examined as per institutional protocol. We analyzed the data using STATA version 14.0 statistical software. Continuous variables were examined for normality assumption using the Kolmogorov‐Smirnov test. To develop a nomogram for appropriate gestational age, we adopted a mixed linear model analysis. For each of the variables Ao pulsatility index (PI), Ao peak systolic velocity (PSV), Ao systolic nadir (Ns), and Ao isthmic systolic index (ISI) mean predicted values, 3rd centile and 97th centile were calculated based on the parameter estimation of mixed model. Observed data for each of the variables in the SGA group were plotted in the nomogram developed for the AGA group to show the trend of SGA data in comparison to AGA data. Results: The total number of observations made on 60 AGA and 30 SGA fetuses were 240 and 67, respectively. Nomograms for the 3rd and 97th centiles were derived for Ao PI, Ao PSV, Ao Ns, and Ao ISI. Mean Ao PI values were significantly higher in SGA group (2.37 vs 2.22; P <.05); mean Ao PSV was significantly lower in the SGA group (67.1 vs 76.3; P <.05), but mean Ao Ns and mean Ao ISI values were significantly higher in the SGA group (–5.24 vs 2.0 and –0.04 vs –0.01; P <.05). Conclusions: Aortic Doppler assessment seems to provide beneficial information for monitoring small fetuses. Ao PI and Ao ISI, which were raised in fetuses with SGA, can be used in prognosis. Synopsis: Aortic isthmus Doppler seems to provide beneficial information for monitoring small fetuses. Aortic pulsatility index and aortic isthmic systolic index are elevated in fetuses with small‐for‐gestational‐age. [ABSTRACT FROM AUTHOR]

Objective: To evaluate whether neutrophil-to-lymphocyte ratio (NLR), a well-established inflammatory marker, can be used as an early predictor for small-for-gestational-age (SGA) neonates and other adverse pregnancy outcomes.Methods: A case-control study compared first-trimester hematological biomarkers in pregnancies of patients with and without SGA (n=149, n=151, respectively). Demographic, clinical, and obstetrical characteristics and first-trimester complete blood count were retrieved. Woman with singleton pregnancies who delivered at Soroka University Medical Center between January 2015 and December 2016 were included. Patients with known maternal infections, relevant medications, hematological conditions, and chronic diseases that may alter the blood count, those with multiple pregnancies, and those with congenital or chromosomal abnormalities were excluded. After univariate analysis, a linear regression model was constructed to assess the association between hematological indices and SGA. Receiver operating curves were constructed to evaluate the sensitivity and specificity of NLR.Results: First-trimester NLR values of the SGA group were significantly higher compared to controls (3.03 ± 1.68 vs 2.63 ± 1.2, P=0.016). Significantly higher levels of NLR were noted among the severely (<3%) SGA neonates (3.12 ± 1.62 vs 2.62 ± 1.2; P=0.034).Conclusion: NLR may be an early, clinically useful marker in the prediction of SGA. As blood samples are routinely collected, correct implication of this result may serve as a valuable non-invasive, low-cost, readily available predicting tool. [ABSTRACT FROM AUTHOR]

Placental dysfunction has a deleterious influence on fetal size and is associated with higher rates of perinatal morbidity and mortality. This association underpins the strategy of fetal size evaluation as a mechanism to identify placental dysfunction and prevent stillbirth. The optimal method of routine detection of small for gestational age (SGA) remains to be clarified with choices between estimation of symphyseal-fundal height versus routine third-trimester ultrasound, various formulae for fetal weight estimation by ultrasound, and the variable use of national, customized, or international fetal growth references. In addition to these controversies, the strategy for detecting SGA is further undermined by data demonstrating that the relationship between fetal size and adverse outcome weakens significantly with advancing gestation such that near term, the majority of stillbirths and adverse perinatal outcomes occur in normally sized fetuses. The use of maternal serum biochemical and Doppler parameters near term appears to be superior to fetal size in the identification of fetuses compromised by placental dysfunction and at increased risk of damage or demise. Multiparameter models and predictive algorithms using maternal risk factors, and biochemical and Doppler parameters have been developed, but need to be prospectively validated to demonstrate their effectiveness. [ABSTRACT FROM AUTHOR]

Objectives: To assess the role of the cerebro-placental ratio (CPR) in predicting adverse fetal outcomes among women with sickle cell disease (SCD).Methods: A prospective cohort study at Korle-Bu Teaching Hospital, Accra, Ghana, between January and June 2016. Pregnant women with SCD at 34 gestational weeks or more underwent weekly fetal umbilical and middle cerebral artery Doppler assessment until delivery. Participants were categorized into two study arms based on CPR (<1.1 or ≥1.1). The primary outcome, a composite of adverse perinatal outcomes including intrauterine growth restriction, stillbirth, low birthweight, and neonatal intensive care unit admission, was compared between groups.Results: Overall, 48 pregnant women with SCD were enrolled, and 5 had a fetus with CPR less than 1.1. Low CPR (<1.1) had a sensitivity and specificity of 29.4% and 100%, respectively, for predicting composite adverse perinatal outcomes. Sensitivity and specificity were, respectively, 100% and 93.5% for predicting stillbirth, and 40.2% and 97.4% for predicting low birthweight. Perinatal outcomes did not differ between the two major sickle cell genotypes (hemoglobin SS and hemoglobin SC).Conclusions: Among women with SCD, CPR less than 1.1 was associated with adverse perinatal outcomes, particularly low birthweight and stillbirth. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of low-dose aspirin, which was administered at or before the 16th week of pregnancy due to maternal characteristics and history of a pre-existing medical condition, on prevention of pre-eclampsia, and on the birth of a small-for-gestational-age (SGA) neonate without pre-eclampsia in nulliparas in primary settings.Methods: We performed a case-control study using population-based data on 47 271 nulliparas with a singleton pregnancy who delivered in Slovenia from 2013 to 2017. The treated group received low-dose aspirin. For the untreated group, propensity score matching was used to perform a 1:1 matching. In the matched sample, we calculated the odds ratios (OR) with a 95% confidence interval (95% CI) with a two-way test for pre-eclampsia, as well as SGA neonates.Results: In the treated group (n=584), the odds for an SGA neonate were significantly increased by 42.7% (OR 1.427, 95% CI 1.001-2.034). However, we found no significant effect on the odds for pre-eclampsia (OR 1.308, 95% CI 0.847-2.022).Conclusions: In anticipation of more substantial population-based data studies, in the Slovenian population, preventive treatment with low-dose aspirin due to maternal characteristics and history of a pre-existing medical condition is not beneficial for the prevention of pre-eclampsia and can harm fetal growth. [ABSTRACT FROM AUTHOR]

Objective: To investigate the placental staining pattern of fibronectin, an extracellular matrix protein essential for trophoblastic invasion, in pre-eclampsia and fetal growth restriction.Methods: This was a retrospective study conducted at the University of Udine, including the placentas of women with pre-eclampsia and fetal growth restriction collected between January 1, 2001, and December 31, 2010. Fibronectin was evaluated in placental tissue micro-array by immunohistochemistry, describing localization and intensity of staining.Results: The study included the placentas of 36 women with early-onset (delivery <34 weeks of gestation) pre-eclampsia; 6 with early-onset HELLP syndrome; 17 with early-onset intrauterine growth restriction (IUGR); 14 with late-onset (delivery ≥34 weeks of gestation) pre-eclampsia; 35 with late-onset IUGR; 18 with small for gestational age (SGA) fetuses (birth weight <10th percentile); and 64 controls. Fibronectin was present both at the cell surface and in the cytoplasm. Cytoplasm staining intensity resulted higher in early forms of pregnancy-related complications compared to controls, although this was statistically significant (P<0.05) only for early-onset pre-eclampsia (P=0.085 for HELLP syndrome; P=0.091 for IUGR). Also, late-onset forms of pre-eclampsia had stronger cytoplasmic and pericellular staining compared to controls (P<0.05). Interestingly, staining of both late-onset IUGR and SGA was comparable to controls.Conclusion: Fibronectin appeared to be unaffected in women with late-onset IUGR and SGA fetuses, suggesting a peculiar common pathogenetic pattern in these conditions. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the association between sleep patterns (sleep duration or timing) in late pregnancy and adverse birth outcomes (preterm delivery or small for gestational age, SGA).Methods: An analysis of data from a prospective cohort study of pregnant women in Wuhan city, Hubei Province, China, between 2012 and 2014. Preterm delivery was defined as delivery before 37 gestational weeks. SGA was defined as neonatal birthweight below the 10th percentile of the predicted birthweight distribution.Results: In total, 11 192 women were included in the analysis. After adjustment for potential confounders, 9.1-10 hours of nocturnal sleep was associated with a lower likelihood of SGA (odds ratio [OR], 0.81; 95% confidence interval [CI], 0.66-0.99) as compared with 7.1-9 hours. As compared with intermediate mid-sleep time (between 02:46 and 04:00), early mid-sleep time (at or earlier than 02:45) was associated with a higher likelihood of preterm delivery (OR, 1.64; 95% CI, 1.28-2.10).Conclusion: Among a large cohort of pregnant Chinese women, 9.1-10 hours of nocturnal sleep was associated with a lower risk of SGA, whereas early mid-sleep time was associated with a higher risk of preterm delivery. [ABSTRACT FROM AUTHOR]

Background: Studies on the impact of adenomyosis and its pregnancy complications have yielded conflicting results.Objective: To determine the likelihood of adverse pregnancy outcomes among women with adenomyosis relative to women without adenomyosis.Search Strategy: PubMed, Embase, Scopus, and Web of Science were searched for studies published up to June 15, 2018.Selection Criteria: Observational studies with medically confirmed pregnancy outcomes as endpoints.Data Collection and Analysis: Two researchers independently screened and selected relevant studies. Dichotomous data for all adverse pregnancy outcomes were expressed as an odds ratio (OR) with 95% confidence interval (CI), and combined in a meta-analysis by using a random-effects model.Main Results: Six studies (322 cases and 9420 controls) were eligible for inclusion in the meta-analysis. Women with adenomyosis had an increased likelihood of preterm birth (OR, 3.05; 95% CI, 2.08-4.47; P˂0.001), small for gestational age (OR, 3.22; 95% CI, 1.71-6.08; P˂0.001), and pre-eclampsia (OR, 4.35; 95% CI, 1.07-17.72; P=0.042).Conclusion: Adenomyosis seems to have a detrimental impact on pregnancy outcomes, resulting in a higher likelihood of preterm birth, small for gestational age, and pre-eclampsia. [ABSTRACT FROM AUTHOR]