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Intrahepatic cholestasis during pregnancy is associated with a higher risk of prenatal and maternal complications. There are several new publications and guidelines on the detection and thresholds of intrahepatic cholestasis during pregnancy. However, the genetic background of this disease has rarely been investigated. This is a comprehensive review of the roles of genes in intrahepatic cholestasis during pregnancy. [ABSTRACT FROM AUTHOR]

Emergency cesarean section is one of the most critical methods in the treatment of high-risk emergency obstetric cases. The aim of this study was to explore the clinical effect of constructing a Rapid Response Team (RRT) in emergency cesarean section. This is a pre- and post-implementation study. The patients who underwent emergency cesarean section were retrospectively analyzed and divided into an experimental group and a control group. There were 52 patients (June–December 2020) in the control group who underwent routine emergency cesarean section without an RRT, and 51 patients (January–June 2021) in the experimental group who underwent emergency cesarean section with an RRT. The operation time indexes (DOI, decision-to-operating room interval; O-I, operating room-to-incision interval; DII, decision-to-incision interval; I-D, incision-to-delivery interval; DDI, decision-to-delivery interval), DDI pass rate, neonatal Apgar score and maternal complications in the two groups were compared. Moreover, the management time trends (DOI, DII, and DDI) in the experimental group were analyzed. The DDI, DII, DOI, and O-I of the experimental group were shorter than those of the control group, and the differences were significant (p < 0.05). The DDI pass rate in the experimental group was higher than that in the control group, and the difference was significant (p < 0.01). The 1-min Apgar score of the experimental group was higher than that of the control group (p < 0.05). The key intervals of emergency cesarean section in the experimental group leveled off after approximately 3 to 4 months. In the face of emergency situations, the implementation of an emergency cesarean section RRT can improve delivery intervals for emergency cesarean and would be conducive to maternal and infant safety. [ABSTRACT FROM AUTHOR]

Maternal nutrition can have a profound effect on fetal growth, development, and subsequent infant birth weight. However, little is known regarding the influence of prepregnancy dietary patterns. This study aimed to explore the effects between prepregnancy dietary patterns on birth weight. This study included 911 singleton live-born infants from the Taicang and Wuqiang Mother–Child Cohort Study (TAWS). Baseline information and prepregnancy diet data were collected during early pregnancy. Newborn birth information was obtained from the Wuqiang County Hospital. Macrosomia, defined as a birth weight of ≥4000 g, and large for gestational age (LGA), defined as a birth weight higher than the 90th percentile for the same sex and gestational age, were the outcomes of interest. The dietary patterns were extracted using principal component analysis. Logistic regression models were used to investigate the association between prepregnancy dietary patterns (in tertiles) and macrosomia and LGA, and subgroup analysis was further explored by pre-pregnancy body mass index (BMI). Four dietary patterns were identified based on 15 food groups. These patterns were named as "cereals–vegetables–fruits," "vegetables–poultry–aquatic products," "milk–meat–eggs," and "nuts–aquatic products–snacks." After adjusting for sociodemographic characteristics, pregnancy complications, and other dietary patterns, greater adherence to the "cereals–vegetables–fruits" pattern before pregnancy was associated with a higher risk of macrosomia (adjusted OR = 2.220, 95% CI: 1.018, 4.843), while greater adherence to the "nuts–aquatic products–snacks" pattern was associated with a lower risk of macrosomia (adjusted OR = 0.357, 95% CI: 0.175, 0.725) compared to the lowest tertile. No significant association was observed between prepregnancy dietary patterns and LGA. However, after subgroup analysis of pre-pregnancy BMI, "cereals–vegetables–fruits" pattern was associated with an increased risk of LGA in overweight and obese mothers (adjusted OR = 2.353, 95% CI: 1.010, 5.480). An unbalanced pre-pregnancy diet increases the risk of macrosomia and LGA, especially in overweight or obese women before pre-pregnancy. [ABSTRACT FROM AUTHOR]

In pregnancies complicated by maternal obesity and diabetes, a disruption in inflammatory mediators occurs, resulting in endothelial microvascular dysfunction, oxidative stress, tissue damage, and maternal and feto-neonatal complications. To outline this proinflammatory status, an innovative approach is represented by the measurement of proinflammatory cytokines. Among these biomarkers, B-cell-activating factor (BAFF) and platelet-activating factor (PAF) play a key role in metabolic regulation, immune response to infections, tissue homeostasis, and "food-related inflammation." The aim of the present study is to investigate the blood expression of BAFF and PAF in a cohort of pregnant women affected by obesity and diabetes compared with a control group of healthy pregnant women. A prospective longitudinal cohort study has been conducted on pregnant women referred to Fondazione Policlinico Universitario Gemelli IRCCS in Rome. For each pregnant woman, a capillary sample was collected with a swab in three different consecutive evaluations carried out in the three trimesters of pregnancy. A total of 77 pregnant women have been enrolled. No significant differences in BAFF and PAF levels were longitudinally observed between groups. Focusing on the exposed group, in the third trimester of pregnancy, both PAF and BAFF levels were lower than the basal time. Among the selected group of patients who developed Gestational Diabetes, only PAF values were longitudinally lower when compared to other groups. The multivariate analysis showed that BAFF levels were positively correlated with thyroid-stimulating hormone levels. No macrosomia, no shoulder dystocia, no major perineal lacerations at birth, and no intrauterine growth restriction were observed in the whole population. This study supports the involvement of metabolic and proinflammatory biomarkers in the mechanisms related to pregnancy complications. Improving a good metabolic environment for obese and diabetic pregnant women could break the vicious cycle connecting inflammation, oxidative stress, and metabolic disorders. [ABSTRACT FROM AUTHOR]

The widespread use of assisted reproductive technology (ART) has led to an increased twin pregnancy rate and increased risk of pregnancy complications. Pre-pregnancy body mass index (BMI) and maternal age are both risk factors for pregnancy complications. This study aimed to explore whether there is an interaction effect between pre-pregnancy BMI and maternal age on pregnancy complications in women with twin pregnancies after ART. Data of 445,750 women with twin pregnancies after ART were extracted from the National Vital Statistics System (NVSS) database in 2016-2021 in this retrospective cohort study. Univariate and multivariate logistic regression analyses were used to explore (1) the associations between pre-pregnancy BMI, maternal age, and total pregnancy complications; (2) interaction effect between pre-pregnancy BMI and maternal age on total pregnancy complications; and (3) this interaction effect in parity, race, gestational weight gain (GWG), and preterm birth subgroups. The evaluation indexes were odds ratios (ORs), relative excess risk of interaction (RERI), attributable proportions of interaction (AP), and synergy index (S) with 95% confidence intervals (CIs). A total of 6,827 women had pregnancy complications. After adjusting for the covariates, compared with women had non-AMA and pre-pregnancy BMI <25 kg/m2, higher maternal age combined with higher pre-pregnancy BMI was associated with higher odds of total pregnancy complications [OR = 2.16, 95%CI: (1.98-2.36)]. The RERI (95% CI) was 0.22 (0.04-0.41), AP (95% CI) was 0.10 (0.02-0.19), and S (95% CI) was 1.24 (1.03-1.49). Subgroup analysis results indicated that the potential additive effect between pre-pregnancy BMI and maternal age on total pregnancy complications was also found in women with different race, multipara/unipara, GWG levels, or preterm births/non-preterm births (all p < 0.05). Pre-pregnancy BMI and maternal age may have an additive effect on the odds of pregnancy-related complications in women with twin pregnancy after ART. [ABSTRACT FROM AUTHOR]

Some of obstetrical complications such as unexplained pregnancy loss and preeclampsia (PE) are associated with maternal-fetal immune abnormalities, leading to uteroplacental dysfunction, insufficient fetal immune tolerance, or fetal rejection. Immunosuppressants with calcineurin inhibitors could be useful for the prevention of these complications by modulating the cellular immune balance by directly inhibiting activated T-helper (Th) 1 and natural killer (NK)/NKT cells. We present our experience with the immunosuppressant tacrolimus in five pregnant women who had a previous pregnancy history of unexplained or preeclamptic stillbirth. Th1 and Th2 cell populations and NK cell activities in peripheral blood were measured as clinical parameters during pregnancy. Case 1–3 achieved suppressions of predominant Th1 immunity and live births without pregnancy-related complications. In case 4, increased tacrolimus dose after a miscarriage resulted in her first live birth; however, she developed PE and severe fetal growth restriction with elevated Th1/Th2 cell ratios at 26 weeks of gestation. Case 5 had a previous history of early onset PE and the hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome, and an emergency cesarean section was needed for maternal safety at 20 weeks of gestation. The course of the next pregnancy was stable under tacrolimus treatment; however, the HELLP syndrome recurred after PE at 33 weeks of gestation. Although an imbalance in the Th1/Th2 cell ratio was not observed during pregnancy, NK cell activity was markedly elevated before delivery. In conclusion, tacrolimus is a potential drug candidate for the prevention of unexplained or preeclamptic stillbirth with Th1-dominant immune states. [ABSTRACT FROM AUTHOR]

Objective: This study aims to characterize changes in serum lipid levels throughout twin pregnancies and explore the relationship between lipid levels and gestational diabetes mellitus (GDM) and hypertensive disorders complicating pregnancy (HDCP). Methods: We retrospectively studied 297 twin pregnancies of women who received regular prenatal care and delivered at the Beijing Obstetrics and Gynecology Hospital over a period of two years. Demographic and medical data of the participants were collected by questionnaires and medical records review. Serum lipid levels were measured in the first trimester (6–13 weeks), second trimester (24–28 weeks), and third trimester (34–37 weeks). A multivariate regression model was constructed to examine the association between lipid levels and pregnancy complications. A decision tree was used to explore the relationship between early serum lipid glucose levels and GDM and HDCP in twin pregnancies. Results: Triglyceride (TG), total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels increased significantly from the first trimester to the third trimester, with the exception of high-density lipoprotein cholesterol (HDL-C), which decreased in the third trimester in twin pregnancies (p < 0.001). The levels of TC in the GDM and HDCP group were significantly elevated compared to those in the normal group in early pregnancies (p < 0.05, p < 0.05). In the second trimester, TG in the HDCP group was substantially higher than that in the normal group (p = 0.01). In the third trimester, LDL-C and HDL-C levels in the GDM group are significantly lower than that in the normal group (p < 0.05, p < 0.05). After adjusting for confounders, body mass index (BMI) is independently associated with GDM (odds ratio [OR] = 1.129, 95% confidence interval [CI]: 1.007–1.266) and HDCP(odds ratio [OR] = 1.170, 95% confidence interval [CI]: 1.031–1.329). The variation amplitude of HDL-C in the third trimester is related to the occurrence of GDM and HDCP(GDM:OR = 0.271, 95%CI: 0.095–0.778; HDCP: OR =0.249, 95% CI: 0.075–0.823). TG and TC levels in DCDA twins were significantly higher than that in MCDA twins in the first trimester(TG: p < 0.05, TC: p < 0.05). In the decision tree model for GDM, fasting blood glucose in the first trimester (FBG), TC, and pre-pregnancy BMI were identified as important nodes, while in the HDCP model, pre-pregnancy BMI, TC, and TG were key nodes. Conclusion: Serum lipid levels in twin pregnancies increase gradually during pregnancy. BMI is independently associated with the occurrence of GDM and HDCP. HDL-C may serve as a protective factor for GDM and HDCP. The predictive effect of early blood lipid on GDM and HDCP in twin pregnancy needs further study. [ABSTRACT FROM AUTHOR]

Aim: The optimal drug management strategy for severe hypertension during pregnancy remains inconclusive. Some randomized controlled trials found that oral nifedipine was more effective than intravenous labetalol in hypertensive emergencies during pregnancy, while others found otherwise. As a result, we conducted a meta-analysis to assess the effectiveness of oral nifedipine versus intravenous labetalol for hypertensive emergencies during pregnancy. Methods: We searched PubMed, Embase, and the Cochrane Library for randomized controlled trials that compared oral nifedipine versus IV labetalol in hypertensive emergencies during pregnancy. Results: 12 RCTs enrolling 1151 participants (573 in the labetalol group and 578 in the nifedipine group) were included in the meta-analysis. Patients who received oral nifedipine reached their target blood pressure more rapidly than those who received intravenous labetalol (MD 7.64, 95%CI 4.08–11.20, p <.0001). The nifedipine group required fewer doses to achieve the target blood pressure (MD 0.62, 95%CI 0.36 to 0.88, p <.00001). There were no meaningful differences on the maternal complications between the two groups, mainly including eclampsia (OR 1.51; 95% CI, 0.75–3.05; p =.25), headache (OR 0.86; 95% CI, 0.52–1.44; p =.57), nausea/vomiting (OR 1.50; 95% CI, 0.76–2.93; p =.24), hypotension (OR 0.49; 95% CI, 0.12–1.99; p =.32), dizziness (OR 2.01; 95% CI, 0.77–5.25; p =.16), HELLP (OR 0.27; 95% CI, 0.05–1.64; p =.16), palpitations (OR 0.63; 95% CI, 0.32–1.27; p =.20), flushing (OR 0.77; 95%CI, 0.18–3.22; p =.72). There were no significant difference in the neonatal complications, including NICU admission (OR 1.24; 95% CI, 0.87–1.77; p =.23), 5 min Apgar score < 7 (OR 1.07; 95% CI, 0.82–1.39; p =.63), neonatal deaths (OR 1.08; 95%CI, 0.66–1.76; p =.77), FHR abnormality (OR 0.94; 95%CI, 0.47–1.88; p =.86). Conclusion: In conclusion, oral nifedipine could achieve target blood pressure more rapidly and required fewer doses than intravenous labetalol in the management of hypertensive emergencies during pregnancy. [ABSTRACT FROM AUTHOR]

To explore the association between abnormal uterine artery Dopplers (combined PI > 2.5) - with normal PAPP-A - and adverse obstetric/neonatal outcomes. This was a retrospective cohort study of 800 patients between 1 March 2019 − 23 November 2021 in a tertiary UK hospital, where it is routine to measure uterine artery Dopplers of all pregnancies during their anomaly scans. 400 nulliparous women/birthing people with complete data were included. 400 nulliparous controls scanned in the same time frame (1.5 years) with normal PAPP-A and uterine artery Dopplers were matched for age and BMI. Outcomes included: mode of birth, postpartum complications, birth weight/centile, Apgar score, gestational age at delivery, neonatal unit admission, and clinical neonatal hypoglycemia. Multivariable analysis was used. Compared to controls, pregnancies with abnormal uterine artery Dopplers and normal PAPP-A were at increased risk of induction (46.5% vs 35.5%, p =.042), cesarean section (46.0% vs 38.0%, p =.002), emergency cesarean section (35.0% vs 26.5%, p =.009), and pre-eclampsia 5.8% vs 2.5%, p =.021). Their babies were more likely to be admitted to the neonatal unit – mostly for prematurity (15.3% vs 6.3%, p =.0004), hypoglycemia (4.0% vs 1.0%, p =.007), be small for gestational age (26.5% vs 11.5%, p =.0001), had intrauterine growth restriction (10.8% vs 1.3%, p =.0001), and be born prematurely (10.0% vs 3.5%, p =.002). Routine measurement of uterine artery Dopplers increased the detection rate of small for gestational age fetuses by 15.1%. Over half of the babies admitted with neonatal hypoglycemia in pregnancies with abnormal uterine artery Dopplers had an unexplained cause. Pregnancies with abnormal uterine Dopplers are not only at increased risk of pre-eclampsia and small for gestational age fetuses/intrauterine growth restriction, but are also at increased risk of emergency cesarean section and adverse neonatal outcomes. The increased incidence of neonatal hypoglycemia is likely driven to some degree by prematurity and placental complications, but possibly also by undiagnosed glucose dysmetabolism. This may warrant routine measurement of uterine artery Dopplers in all pregnancies (regardless of risk), where feasible, to aid antenatal management and counseling. What are the novel findings of this work? Pregnancies with abnormal uterine artery Dopplers at the time of the anomaly scan and normal PAPP-A are at increased risk of having pre-eclampsia, small for gestational age fetuses, emergency cesarean, neonatal unit admission (including but not limited to prematurity), and neonatal hypoglycemia. What are the clinical implications of this work? Due to the significantly increased risk of adverse maternal and neonatal outcomes in first time mothers with increased uterine artery Dopplers despite normal PAPP-A, ultrasound assessment of placental function should be offered to all during their anomaly scans, subject to resources, to aid antenatal management and counseling. Further research is needed into undiagnosed diabetes. [ABSTRACT FROM AUTHOR]

To review the usefulness of the sFlt-1/PlGF ratio to detect adverse pregnancy outcomes related to placental dysfunction in twin pregnancies. A systematic review in Pubmed-Medline, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Web of Science, and National Guideline was performed. Studies were selected if they were published in the last 10 years, included a sample size equal to or greater than 10 twin gestations, determined the sFlt-1/PIGF ratio, and revealed the pregnancy outcome of the included patients. A total of 11 studies were selected. Outcomes related to the association between sFlt-1/PlGF ratio throughout pregnancy and perinatal outcome, particularly related to placental dysfunction (early and late-onset preeclampsia and FGR), were collected. The vast majority of studies showed an increased sFlt-1/PlGF ratio in twin pregnancies complicated with preeclampsia or other adverse perinatal outcomes compared with uneventful pregnancies. The included articles revealed promising results when evaluating the usefulness of the sFlt-1/PlGF ratio to rule out preeclampsia. The scarce available data regarding FGR suggests that the sFlt-1/PlGF ratio is a promising tool for detecting this pregnancy complication. Data concerning other aspects of the sFlt-1/PlGF ratio, such as its evolution during healthy twin pregnancies or variations according to chorionicity, is limited. The sFlt-1/PlGF ratio in twin pregnancies is useful to detect, and particularly to rule out adverse pregnancy outcomes related to placental dysfunction, such as preeclampsia or FGR. [ABSTRACT FROM AUTHOR]

This meta-analysis aimed to investigate the relationship between hyperuricemia and maternal and neonatal complications in pregnant women. We searched PubMed, Embase, Web of Science, and the Cochrane Library from the databases' inception to August 12, 2022. We included studies that reported results on the association between hyperuricemia and maternal and fetal outcomes among pregnant women. Using the random-effects model, the pooled odds ratio (OR) with 95% confidence intervals (CIs) was calculated for each outcome analysis. A total of 7 studies, including 8104 participants, were included. The pooled OR for pregnancy-induced hypertension (PIH) was 2.61 [0.26, 26.56] (z = 0.81, p =.4165; I2 = 96.3%). The pooled OR for preterm birth was 2.52 [1.92, 3.30] (z = 6.64, p <.0001; I2 = 0%). The pooled OR for low birth weight (LBW) was 3.44 [2.52, 4.70] (z = 7.77, p <.0001; I2 = 0%). The pooled OR for small gestational age (SGA) was 1.81 [0.60, 5.46] (z = 1.06, p =.2912; I2 = 88.6%). Results of this meta-analysis indicate a positive relationship between hyperuricemia and PIH, preterm birth, LBW, and SGA in pregnant women. [ABSTRACT FROM AUTHOR]

Doppler velocimetry has been widely used throughout the years as a valuable tool in the follow-up and prognosis of various pregnancy complications. Numerous Doppler indices have been introduced to qualitatively describe fetal blood flow. Currently, the Pulsatility index (PI) is the most widely used index for this purpose. In current clinical practice, middle cerebral artery (MCA) PI measurement is commonly used to assess fetal well-being, especially in late-onset fetal growth restriction (FGR). However, existing evidence suggests that MCA PI alone is inferior to the ratio between MCA and umbilical artery (UA) pulsatility indices in predicting adverse perinatal and neonatal outcomes. When comparing normal and abnormal MCA Doppler waveforms, it is evident that most changes appear in the diastolic part of the heart cycle. Therefore, the PI, which contains elements from both systole (peak systolic velocity–PSV) and diastole (end-diastolic velocity), may not be the most effective tool for quantifying fetal brain sparing (BS). We hypothesize that another measurement modality that focuses predominantly on the diastole could be more efficient for evaluating the amount of vasodilatation. In ultrasound velocimetry of larger blood vessels, there is a well-known phenomenon called "dicrotic notch" (DN), which appears on the declining part of each Doppler waveform and can be used to precisely pinpoint the end of systole and the start of diastole. We hypothesized that the extent of cerebral vasodilation can be more accurately assessed by measuring the area between the dicrotic notch (DN) and the end-diastolic velocity (which we refer to as the "diastolic deceleration area–DDA"). In this study, we introduced a new Doppler parameter along with a rationale for DDA measurement in the fetal MCA. We also defined third-trimester nomograms and provided a preliminary assessment of the correlation between DDA and fetal oxygen deficiency. Our findings suggest that the DDA may serve as an independent instrument for identifying hypoxia during late pregnancy, either on its own or in conjunction with other Doppler and cardiotocography modalities. However, before incorporating DDA into clinical practice, it is crucial to conduct further research and validation studies with larger sample sizes and more diverse populations. This would help assess the generalizability of the results and establish optimal cutoff points for DDA in various clinical settings. It is also important to prospectively study the role of DDA in early- and late-onset fetal growth restriction (FGR), Rh-isoimmunization/anemia, preeclampsia, gestational diabetes, and other pregnancy complications. In fact, we believe that the concept of measuring specific areas in arterial Doppler velocimetry indices could have significant implications not only in fetal medicine and obstetrics, but also in other areas of human and veterinary medicine. [ABSTRACT FROM AUTHOR]

To define the natural course and complications, and develop a model for predicting persistency when low-lying placenta (LLP) is detected early in pregnancy. This retrospective cohort study included women with LLP detected during an early anatomic scan performed at 13–16 weeks gestation. Additional transvaginal ultrasound exams were assessed for resolution at 22–24 weeks and 36–39 weeks. Patients were categorized as: Group 1–LLP resolved by the second-trimester scan, Group 2–LLP resolved by the third trimester, or Group 3–LLP persisted to delivery. Clinical and laboratory parameters, as well as maternal and neonatal complications, were compared. A linear support vector machine classification was used to define a prediction model for persistent LLP. Among 236 pregnancies with LLP, 189 (80%) resolved by 22–24 weeks, 25 (10.5%) resolved by 36–39 weeks and 22 (9.5%) persisted until delivery. Second trimester hCG levels were higher the longer the LLP persisted (0.8 ± 0.7MoM vs. 1.13 + 0.4 MoM vs. 1.7 ± 1.5 MoM, adjusted p =.03, respectively) and cervical length (mm) was shorter (first trimester: 4.3 ± 0.7 vs. 4.1 ± 0.5 vs. 3.6 ± 1; adjusted p =.008; Second trimester: 4.4 ± 0.1 vs. 4.1 ± 1.2 vs. 3.8 ± 0.8; adjusted p =.02). The predictive accuracy of the linear support vector machine classification model, calculated based on these parameters, was 90.3%. Persistent LLP has unique clinical characteristics and more complications compared to cases that resolved. Persistency can be predicted with 90.3% accuracy, as early as the beginning of the second trimester by using a linear support vector machine classification model. [ABSTRACT FROM AUTHOR]

To identify risk factors, maternal and neonatal adverse outcomes related to unintended lower segment uterine extension during cesarean delivery (CD). A retrospective cohort analysis in a single, university-affiliated medical center between 1 January 2018 and 31 December 2019. All singleton pregnancies delivered by CD were included. Univariate and multivariate analyses were performed to identify maternal and obstetrical predictors for uterine extension during CD. For secondary outcomes, we assessed the correlation between uterine extension and any adverse maternal or neonatal outcome. Risk factors were analyzed using ROC statistics to measure their prediction performance for a uterine extension. Overall, 1746 (19.3%) CDs were performed during the study period. Of them, 121 (6.9%) CDs were complicated by unintended uterine extension. There was no difference in maternal demographics and clinical data stratified by uterine extension at CD. Uterine extensions were significantly more common following induction of labor, intrapartum fever, premature rupture of membranes, a trial of labor after cesarean, advanced gestational age, emergent CD, and in particular CD during the second stage of labor (37.2% vs. 6.5%) and after failed vacuum extraction (6.6% vs. 1.1%), p <.05 for all. The incidence of postpartum hemorrhage and re-laparotomy did not differ between the groups. Most of the extensions were caudal-directed (40.4%), and were closed by a two-layer closure (92%). Mean extension size was 4.5 ± 1.7 cm. Using multivariable analysis, the only factor that remained significant was CD at the second stage of labor (adjusted odds ratio (aOR) 54.2, 95% CI 4.5–648.9, p =.002), with an area under the ROC curve 0.653 (95% CI 0.595–0.712, p <.001). Emergent CD, body mass index, birth weight, failed vacuum attempt, and trial of labor after cesarean were not significant. For secondary outcomes, an unintended uterine extension was associated with longer operation time, higher estimated blood loss, greater pre- to post-CD hemoglobin difference, increased blood products transfusion, puerperal fever, and longer hospital stay. No clinically significant neonatal adverse outcomes were observed. In our cohort, second-stage CD was the strongest predictor for an unintended uterine extension. Following uterine extension, women had increased infectious and blood-loss morbidity. [ABSTRACT FROM AUTHOR]

Strong evidence imply that delayed cord clamping (DCC) provides significant benefits for singleton neonates. However, there is little information about the safety or efficacy of DCC in twins to recommend for or against DCC in twins in guidelines. We aimed to determine the effect of DCC on dichorionic twins born at <32 weeks of gestation. This is a retrospective cohort study comparing the neonatal and maternal outcomes of immediate cord clamping (ICC) [<15 second (s)] versus DCC (at 60 s). Generalized estimating equations models were performed accounting for twin correlation. A total of 82 pairs of twins (DCC: 41; ICC: 41) were included in analysis. The primary outcome of death before discharge occurred in 3.66% of twins in the DCC group and 7.32% in the ICC group, without a significant difference between the groups. Compared to ICC group, DCC was associated with increased hemoglobin levels [β1 coefficient 6.51; 95% confidence interval (CI) 0.69–12.32. β2 coefficient 5.80; 95% CI 0.07–11.54] at 12–24 h of life. There were no significant differences between the groups in neonatal death, neonatal major morbidities and maternal bleeding complications, although DCC was associated with higher estimated maternal blood loss in the cesarean section group (p =.005). DCC for 60 s in dichorionic twins born at <32 weeks of gestation was associated with increased neonatal hemoglobin levels, when compared with ICC. The finding of a higher estimated maternal blood loss by cesarean section in the DCC group calls for further trials to assess maternal safety of this procedure in this patient population. [ABSTRACT FROM AUTHOR]

This retrospective, single-center case series was designed to characterize the effects of perinatal COVID-19 diagnosis on obstetric and neonatal outcomes in a predominantly high-risk, urban Black population. Data were collected via retrospective chart review on all COVID-19-positive obstetric patients and their neonates who presented to the University of Chicago Medical Center between March 2020 and November 2020, before the availability of the COVID-19 vaccine. Patient demographics, delivery outcomes, COVID-19 symptoms, treatment, and outcomes were analyzed. A total of 56 COVID-19-positive obstetric patients were included in the study, of which four were lost to follow-up before delivery. The median age of patients was 27 years (IQR 23, 32), with 73.2% publicly insured and 66.1% Black. Patients had a median body mass index (BMI) of 31.6 kg/m2 (IQR 25.9, 35.5). 3.6% of patients had chronic hypertension, 12.5% had diabetes, and 16.1% had asthma. Perinatal complications were common. Twenty-six patients (50.0%) had a diagnosis of a hypertensive disorder of pregnancy (HDP). 28.8% had gestational hypertension, and 21.2% had preeclampsia (with and without severe features). The rate of maternal ICU admission was 3.6%. Furthermore, 23.5% of patients delivered preterm (<37 weeks gestation), and 50.9% of infants were admitted to the Neonatal Intensive Care Unit (NICU). In our study of a predominantly Black, publicly-insured, unvaccinated group of COVID-19-positive pregnant patients, we found high rates of hypertensive disorders of pregnancy, preterm delivery, and NICU admission compared to rates reported in existing literature before widespread vaccine availability. Our findings suggest that SARS-CoV-2 infection during pregnancy, irrespective of maternal disease severity, may exacerbate existing obstetric health disparities by disproportionately impacting Black, publicly insured patients. Larger comparative studies are needed to better characterize possible racial and socioeconomic disparities in obstetric outcomes in the setting of SARS-CoV-2 infection during pregnancy. These studies should examine the pathophysiology of SARS-CoV-2 infection during pregnancy, as well as potential associations between adverse perinatal outcomes and disparities in access to care, COVID-19 vaccination, and other social determinants of health amongst more vulnerable populations infected with SARS-CoV-2 during pregnancy. [ABSTRACT FROM AUTHOR]

The European Society of Cardiology (ESC) guidelines (GL) provide indications on the mode of delivery in women with heart disease. However available data suggests that the rate of Cesarean Delivery (CD) is high and widely variable among such patients. In this study, we aimed to investigate the degree of adherence to the ESC recommendations among women delivering in four tertiary maternity services in Italy and how this affects the maternal and neonatal outcomes. Retrospective multicenter cohort study including pregnant women with heart disease who gave birth between January 2014 and July 2020. Composite adverse maternal outcome (CAM) was defined by the occurrence of one or more of the following: major postpartum hemorrhage, thrombo-embolic or ischemic event, de novo arrhythmia, heart failure, endocarditis, aortic dissection, need for re-surgery, sepsis, maternal death. Composite Adverse Neonatal outcome (CAN) was defined as cord arterial pH <7.00, APGAR <7 at 5 min, admission to the intensive care unit, and neonatal death. We compared the incidence of CAM and CAN between the cases with planned delivery in accordance (group "ESC consistent") or in disagreement (group "ESC not consistent") with the ESC GL. Overall, 175 women and 181 liveborn were included. A higher frequency of CAN was found when delivery was not planned accordingly to the ESC guidelines [("ESC consistent" 9/124 (7.2%) vs "ESC not consistent" 13/57 (22.8%) p = 0.002 OR 3.74 (CI 95% 1.49–9.74) , while the occurrence of CAM was comparable between the two groups. At logistic regression analysis, the gestational age at delivery was the only parameter independently associated with the occurrence of CAN (p = 0.006). Among pregnant women with heart disease, deviating from the ESC guidelines scheduling cesarean delivery does not seem to improve maternal outcomes and it is associated with worse perinatal outcomes, mainly due to lower gestational age at birth. [ABSTRACT FROM AUTHOR]

To explore the impact of IVF on pregnancy complications and birth outcomes in women of advanced maternal age. In this retrospective study, 3325 women were divided into the ART pregnancy group (n = 241) and the natural pregnancy group (n = 3086). The differences in maternal general conditions, pregnancy complications and birth outcomes were compared between the two groups. The ART group had higher rates of primiparity (78.4% vs 20.4%), cesarean section (90.5% vs 76.2%) and twin births (28.6% vs 2.1%). The risk of gestational hypertension (5.8% vs 2.9%), preeclampsia (5.0% vs 2.3%) and preterm birth [28 ∼ 31 + 6 weeks (2.9% vs 1.1%), 32 ∼ 33 + 6 weeks (5.0% vs 1.4%), 34 ∼ 36 + 6 weeks (15.8% vs 9.4%)] was significantly higher in the ART group than in the natural pregnancy group. Neonates in the ART group had lower birth weights (2882.61 ± 657.70 vs 3223.05 ± 534.28). However, in the singleton-only comparison, only gestational hypertension still showed a statistically significant difference. For women of advanced maternal age, IVF-ET pregnancies may result in higher rates of pregnancy complications and adverse birth outcomes, but this is likely to be due to increased rates of multiple pregnancies. [ABSTRACT FROM AUTHOR]

Even through the fact that pregnant women are more and more severely infected with COVID-19 disease, there are still doubts about vaccinating these people due to the lack of sufficient evidence base information. So in this systematic review, we decided to study vaccinated and unvaccinated pregnant women regarding maternal, fetal and neonatal complications and outcomes. Between 30 December 2019 and 15 October 2021, electronic searches were performed on the databases of PubMed, Scopus, Google Scholar, and Cochrane library by searching in English and free full text. Keywords searched included these: maternal outcome, neonatal outcome, pregnancy, and COVID-19 vaccination. Among 451 articles, finally, seven studies were included to study pregnancy outcomes in vaccinated women compared to unvaccinated for systematic review purposes In this study 30257 vaccinated women in their third trimester compared to 132339 unvaccinated women in terms of age, the root of delivery, neonatal adverse outcomes. There were no significant differences between two groups in terms of: IUFD, and 1 min Apgar score, C/S rate, and NICU admission between the two groups, however, the rate of SGA, IUFD, and also neonatal jaundice, asphyxia, and hypoglycemia was more significant in the unvaccinated group comparing to the vaccinated group as a result. Among them, the chance of preterm labor pain was reported more among vaccinated patients. Emphasizing that, except 7.3% of the case population, everyone in the second and third trimesters had been vaccinated with mRNA COVID-19 vaccines COVID-19 vaccination during the second and third trimesters appears to be the right choice due to the immediate impact of COVID-19 antibodies on the developing fetus and formation of neonatal prophylaxis, as well as the absence of adverse outcomes for both the fetus and mothers. [ABSTRACT FROM AUTHOR]

To evaluate the risk of recurrence of severe placenta-mediated pregnancy complications and compare the efficacy of two different anti-thrombotic regimens in women with a history of late fetal loss without thrombophilia. We performed a 10-year retrospective observational study (2008–2018) analyzing a cohort of 128 women who suffered from pregnancy fetal loss (>20 weeks of gestational age) with histological evidence of placental infarction. All the women tested negative for congenital and/or acquired thrombophilia. In their subsequent pregnancies, 55 received prophylaxis with acetylsalicylic acid (ASA) only and 73 received ASA plus low molecular weight heparin (LMWH). Overall, one-third of all pregnancies (31%) had adverse outcomes related to placental dysfunction: pre-term births (25% <37 weeks, 5.6% <34 weeks), newborns with birth weight <2500 g (17%), and newborns small for gestational age (5%). The prevalence of placental abruption, early and/or severe preeclampsia, and fetal loss >20 weeks were 6%, 5%, and 4% respectively. We found a risk reduction for combination therapy (ASA plus LMWH) compared with ASA alone for delivery <34 weeks (RR 0.11, 95% CI: 0.01–0.95 p = 0.045) and a trend for the prevention of early/severe preeclampsia (RR 0.14, 95% CI: 0.01–1.18, p = 0.0715), while no statistically significant difference was observed for composite outcomes (RR 0.51, 95%CI: 0.22–1.19, p = 0.1242). An absolute risk reduction of 5.31% was observed for the ASA plus LMWH group. Multivariate analysis confirmed a risk reduction for delivery <34 weeks (RR 0.32, 95% CI 0.16–0.96 p = 0.041). In our study population, the risk of recurrence of placenta-mediated pregnancy complications is substantial, even in the absence of maternal thrombophilic conditions. A reduction of the risk of delivery <34 weeks was detected in the ASA plus LMWH group. [ABSTRACT FROM AUTHOR]

To compare the fetal thymic thoracic ratio in preeclamptic pregnant women and healthy pregnant women. Fetal thymic thoracic ratio was evaluated in 240 pregnant women in the third trimester. Patients were examined in two groups. They included 120 preeclamptic pregnant women (study group) women and 120 healthy pregnant women (control group). The fetal thymic thoracic ratio was found to be statistically significantly lower in preeclamptic cases compared to that in the control group (p =.001). When the fetal thymic thoracic ratio was evaluated between the mild preeclampsia group (0.399 (0.388–0.413)), severe preeclampsia group (0.385 (0.350–0.394)), and the control group (0.43 (0.324–0.462)), it was found statistically significant differences between the groups (p =.001). The fetal thymic thoracic ratio decreased in preeclamptic pregnant women and this decrease was more pronounced in the severe preeclampsia group. The measurement of fetal thymic thoracic ratio was seen to be beneficial in determining the severity of the disease in preeclamptic pregnant women. [ABSTRACT FROM AUTHOR]

Appendicitis is the most common acute abdominal complication during pregnancy. If appendix perforation occurs there is an increasing risk of preterm delivery and other pregnancy complications. To assess the outcome of pregnancy after appendectomy, the mode of surgery used, appendectomy rates, and complications. A prospective cohort study of pregnant women with, or without, appendectomy at South Stockholm General Hospital, December 2015 to February 2021 in a setting where pregnant women are prioritized for surgery and laparoscopic surgery was standard of care in first half of pregnancy. Data on preoperative imaging, surgical method, intraoperative findings, microscopic findings, hospital stay, pregnancy, and 30-day complications were prospectively recorded in a local appendectomy register. A non-pregnant control group was gathered comprising women of fertile age in the same study interval. During the study period 50 pregnant women, of whom 44 gave birth, underwent appendectomy of 38 199 women giving birth. There were no differences between women with or without appendectomy in proportion of preterm delivery (4.5% vs. 5.6%), small-for-gestational age (2.3% vs. 6.2%), or Cesarean delivery (18.2% vs. 20.4%). The rate of appendix perforation was 19% in non-pregnant control group compared to 12% among pregnancy. There was no case of perforated appendix in the second half of pregnancy. However, women with gestational age > 20 weeks more frequently had an unaffected appendix compared to those operated ≤ 20 gestational weeks (4/11 vs. 2/39, p =.005). Laparoscopic surgery was used in 97% of non-pregnant control group, 92% of appendectomies ≤ 20 weeks gestation, and in 27% >20 weeks. As compared to first half, the appendectomy rate was three times lower during the second half of pregnancy. Pregnant women had priority for surgery < 6 h compared to < 24 h among non-pregnant women, this resulted in a shorter time-to-surgery among pregnant women (p <.001) Routine laparoscopic surgery and time priority for pregnant surgery is associated with a low risk of perforation, preterm birth and other complications. However, a low threshold for surgery may increase the risk of a negative exploration. [ABSTRACT FROM AUTHOR]

Congenital hemangiomas are rare benign vascular tumors but can lead to serious adverse pregnancy outcomes. Its prenatal diagnosis is a challenge. We explored the clinical applications of prenatal ultrasound for evaluating fetal cutaneous hemangioma and associated complications. A retrospective observational study was conducted comprising a population of pregnant women with fetal cutaneous hemangioma, the latter diagnosed by prenatal ultrasound, between January 2016 and December 2020. The clinical characteristics, sonographic images, complications, and pregnancy outcomes were documented and analyzed. We identified 20 cases of fetal cutaneous hemangioma diagnosed by prenatal ultrasound and confirmed by postpartum examinations. Most hemangiomas were in the head and neck (55%), with either solid isoechoicity (25%) or solid mildly hyperechoic (25%), and well-circumscribed (80%) mass. Eight (40%) fetuses experienced complications, which often occurred in fetuses with large hemangiomas (67% with maximum diameter ≥5 cm; 100% with a volume ≥40 cm3). The most common complications were cardiac-related (88%), including elevated cardiothoracic area ratio, atrioventricular valve regurgitation, and fetal hydrops. A large hemangioma was usually associated with advanced gestational age and a fast hemangioma growth rate. In five (25%) cases, the pregnancy was terminated; these involved hemangioma of the head or neck. One newborn developed Kasabach–Merritt phenomenon, pulmonary hemorrhage and respiratory distress, and died 3 days after birth. Among the 14 (70%) fetuses that survived birth, all hemangiomas disappeared or regressed after treatments with propranolol, interventional surgery, or observed routinely. Prenatal ultrasound examination can accurately diagnose fetal cutaneous hemangioma and related complications to facilitate appropriate management during the pregnancy. Prenatal diagnosis of cutaneous hemangiomas is a clinical challenge. Prenatal ultrasound examination could be a method to accurately diagnose and monitor these hemangiomas. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess and compare knowledge, self-awareness, and accuracy of perceived risks and weight status among overweight and obese women. This study was a secondary analysis of a cross-sectional questionnaire study of overweight and obese pregnant women who sought a routine first-trimester screening ultrasound. Those with a pre-pregnancy body mass index (BMI) ≥25 kg/m2 (calculated using self-reported height and weight) were included. Perceived associations between estimated weight category and risk of pregnancy complications were assessed and compared in the overweight and obese groups. The perceived weight category was compared to an estimated weight category. A logistic regression identified the demographic and medical factors associated with correct identification of risk factors. A total of 169 participants (88 overweight; 81 obese) were included. Most participants believed their weight did not impact the ultrasound detection of a fetal malformation (92.1% overweight vs. 55.6% obese, p <.01). Few participants associated their weight with pregnancy-related problems (6.8% overweight vs. 24.7% obese, p <.01). Most participants did not associate their weight with specific maternal complications (72.7% overweight vs. 45.7% obese, p <.01) and fetal complications (83.0% overweight vs. 71.6% obese, p =.08). More obese than overweight women underestimated their weight category (64.4% vs 41.3% overweight, p =.01). Women who correctly estimated their weight status, non-Hispanic participants, and those with a history of depression or at least one maternal co-morbidity were more likely to associate their weight with increased risk for pregnancy-related problems. Although more obese than overweight women associated excess weight with pregnancy complications, both groups underestimated the impact on their pregnancies. Targeted educational programs are needed to improve the risk perception of these populations prior to pregnancy with the goal of improving their weight statuses and pregnancy outcomes. [ABSTRACT FROM AUTHOR]

The vaginal birth after cesarean (VBAC) calculator developed by the Maternal-Fetal Medicine Units Network (MFMU) helps to identify the likelihood of VBAC. We sought to compare adverse maternal and neonatal outcomes of trial of labor after cesarean (TOLAC) to those of elective cesarean delivery after stratifying by VBAC likelihood. This was a retrospective cohort study of all women whose primary low transverse segment cesarean delivery and subsequent singleton term delivery with vertex presentation occurred at an academic center from January 2009 to June 2018. Only data from the second pregnancy were analyzed. The final analysis included 835 women. The MFMU VBAC calculator was used to assess the likelihood of VBAC. The two primary outcomes were composite adverse maternal (death or severe maternal complications) and neonatal outcomes (perinatal death or severe neonatal complications). The analyses were stratified based on the VBAC likelihood (less than 60% and 60–100%). Multivariable logistic regression was used to calculate adjusted odds ratio (OR) and 95% confidence interval (CI), controlling for predefined covariates. Among women with VBAC likelihood less than 60%, TOLAC compared with elective cesarean was associated with increased odds of the primary adverse maternal outcome (16.4% vs. 4.2%; adjusted OR 4.60 [95%CI 1.48–14.35]) and the primary adverse neonatal outcome (17.8% vs. 6.3%; adjusted OR 3.93 [95%CI 1.31–11.75]). Among women with VBAC likelihood of 60–100%, TOLAC compared with elective cesarean was associated with decreased odds of the primary adverse maternal outcome (6.4% vs. 11%; adjusted OR 0.47 [95%CI 0.25–0.89]) and similar odds of the primary adverse neonatal outcome (6.7% vs. 8.3%; adjusted OR 0.98 [95%CI 0.52–1.84]). Among women with a history of a primary low transverse cesarean delivery, those who underwent TOLAC compared to those who had elective cesarean had increased odds of adverse maternal and neonatal outcomes when VBAC likelihood was less than 60%. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate maternal and perinatal outcomes in pregnancies after kidney transplant (KT) and the impact of pregnancy on graft function. A descriptive and retrospective case-control study included 43 pregnancies in women after KT, followed in our institution, from January 1991 to December 2019. The control group included 200 non-transplanted pregnant women. Statistical analysis used SPSS 25.0 (SPSS Inc., Chicago, IL), and a p value of.05 was considered statistically significant. We studied 43 pregnancies in 37 KT women. The live birth rate of KT pregnant was 81.4%. The mean interval between transplantation and pregnancy was 4.6 years (range 1–16). We found a higher rate of obstetric complications in pregnancies after KT: miscarriage (14.0%, OR 6.7 (2.0–22.1), p <.001), preeclampsia (31.4%, OR 25.7 (7.7–85.3), p <.001), and fetal growth restriction (37.1%, OR 37.6 (9.9–142.3), p <.001). The rate of urogenital infections and anemia during pregnancy was higher in the KT group (p <.001). The gestational age at delivery was 35.0 ± 2.8 weeks and premature delivery was observed in 24 (68.6%) cases. The cesarean rate was higher in the KT group (p <.001). In the KT group, there were two neonatal deaths due to prematurity complications. Renal function deterioration, measured by serum creatinine levels, was observed in two pregnancies. Immunosuppressive therapy was used in all pregnancies after KT, and dosage escalation of immunosuppressive therapy was necessary for 69.8%. A higher rate of adverse obstetric outcomes was found in KT pregnant. Kidney function remained stable in most pregnancies. An antenatal and postpartum multidisciplinary approach is essential to improve outcomes and minimization of complications. [ABSTRACT FROM AUTHOR]

Rates of pregestational (PGDM) and gestational diabetes (GDM), and their associated pregnancy complications, are rising. Pregnancies complicated by diabetes have increased cesarean delivery (CD) rates; however, there are limited data regarding the current rates of, and contributing factors to, these deliveries. The Robson Ten Group Classification System (TGCS) is a clinically relevant, standardized framework that can be used to evaluate and analyze cesarean rates. The objective of this study was to evaluate rates of, and indications for, intrapartum, unplanned CD among pregnancies complicated by diabetes, compared to normoglycemic (NG) pregnancies, in a large United States birth cohort. This retrospective cohort study used chart-abstracted data on births between 24 and 42 weeks' gestation at 17 hospitals that contributed to the Obstetrical Care Outcome Assessment Program database between 01/2016 and 03/2019. The CD rate for NG pregnancies, and pregnancies complicated by gestational and PGDM was calculated and compared using the Robson TGCS. The indications for intrapartum CD in patients with term, singleton, vertex gestations without a prior cesarean were then analyzed. Univariate and multivariate logistic regression models were used to compare the cesarean rate and indications for CD, between the diabetic groups and the NG group. Results were adjusted for maternal age, BMI, neonatal birth weight, and insurance status, as well as clustering by hospital. A total of 86,381 pregnant people were included in the study cohort. Of these 76,272 (88.3%) were NG, 8591 (9.9%) had GDM, and 1518 (1.8%) had PGDM. Compared to NG patients, overall cesarean rates were higher in patients with GDM (40.3% vs. 29.7%; aOR 1.25, 95%CI 1.18–1.31) and PGDM (60.0% vs. 29.7%; aOR 2.53, 95%CI 2.04–3.13). This finding remained true when the cohort was restricted to term, singleton, vertex laboring patients without a prior cesarean; compared to NG patients, the cesarean rate was higher in patients with GDM (17.4% vs. 12.2%, aOR 1.37, 95%CI 1.29–1.45) and PGDM (26.0% vs. 12.2%, aOR 2.55, 95%CI 2.00–3.25). The cesarean rate for fetal indications was similar in the GDM (5.7%) and NG (4.4%) groups, while those patients with PGDM had a significantly higher rate (10.4%; aOR 2.01, 95%CI 1.43–2.83). Similarly, the rate of cesarean for labor dystocia in patients with PGDM was significantly higher than in NG patients (16.9% vs. 7.0%, and aOR 2.28, 95%CI 1.66–3.13) while patients with GDM had an intermediate rate (10.6% vs. 7.0%, aOR 1.49, 95%CI 1.40–1.57). The CD rate is significantly higher in pregnancies complicated by diabetes, particularly pregestational, compared to NG pregnancies. Despite controlling for maternal factors and birth weight, pregnancies complicated by diabetes are more likely to undergo an unplanned intrapartum cesarean secondary to labor dystocia than their NG counterparts, but only pregnancies complicated by PGDM have an increased risk of cesarean for fetal indications. More research is needed to understand whether this higher cesarean rate is due to factors intrinsic to diabetes in laboring patients or is due to a difference in the way clinicians manage diabetics in labor. [ABSTRACT FROM AUTHOR]

Cervical artery dissection (CeAD) is responsible of one fifth of cases of ischemic stroke, but is uncommon during pregnancy or the early postpartum period and evidence is derived from published case reports and case series. This systematic review with a prospectively registered protocol was conducted to study the clinical presentation, management and prognosis of this condition. Ovid-Medline, PubMed Central, and CINAHL were searched without language restriction. Fifty-seven articles (50 case reports and seven case series) reporting on 77 patients were included. The mean age was 33.7 years. The main possible risk factors identified were migraine, hyperlipidemia, connective tissue disorders, preeclampsia and eclampsia, HELLP syndrome and prolonged second stage of labor. Headache was the most frequent symptom, followed by neck pain. Acute medical treatments included anticoagulation, antiplatelets, and endovascular therapy. No patients received thrombolysis. The overall prognosis was good with 77.8% of patients making full clinical recovery. Cervical artery dissection is a rare, but an important complication of pregnancy and puerperium. Diagnosis requires a high index of suspicion. The strong association with hypertensive and connective tissue disorders requires further research [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study to evaluate the risk of Cushing’s syndrome (CS) and maternal and fetal complications using the American Nationwide Inpatient Sample database. Materials and methods: This is a retrospective study using the Health Care Cost and Utilization Project-Nationwide Inpatient Sample database from 2004 to 2014. We compared pregnancies with CS versus non-CS regarding pregnancy, delivery, and neonatal outcomes using multivariate logistic regression. Results: We identified 9,096,788 pregnancies during the study period. Cushing’s syndrome complicated 135 pregnancies at a rate of 1–2 cases per 100,000 births. Cushing’s syndrome subjects were more likely to be older, obese, have private insurance, chronic hypertension, and pre-gestational diabetes (p<.001). The maternal mortality rate was 0.7 and 0.007% in Cushing’s syndrome and control groups, respectively, although due to small numbers of cases, this should be interpreted with caution. Preeclampsia was higher in CS compared to controls after controlling for confounding variables, aOR 2.20. Operative vaginal delivery and blood transfusion rates were higher in CS patients than controls after controlling for confounding factors, aOR 6.49 and 3.09, respectively. The rates of preterm delivery (8.9 versus 7.2%) and gestational diabetes (8.1 versus 5.8%) were not statistically different between CS and control groups. Conclusion: Cushing’s syndrome patients begin pregnancies often with maladies making them more at risk for complications including, preeclampsia, blood transfusion, and operative vaginal delivery. These patients might benefit from prevention methods for preeclampsia, and increased surveillance to decrease maternal morbidity and mortality. However, the nature of the database and its limitations, including the lack of information about CS activity and treatments received by patients, warrant careful interpretation of these results. [ABSTRACT FROM AUTHOR]

Introduction: Women with high levels of physical activity have improved pregnancy, labor, and delivery outcomes related to cardiovascular health. Hyperhomocysteinemia, which predicts cardiovascular disease risk, is associated with maternal vascular complications during pregnancy, such as placental abruption and preeclampsia. However, studies are lacking on whether physical activity impacts homocysteine in pregnant women, pointing to a potential mechanism behind the improved cardiovascular health in women who exercise during pregnancy. The purpose of this study was to examine if women with high levels of physical activity have lower levels of homocysteine compared to women with low levels of physical activity. Methods: This study was a secondary analysis using data from the 2003 to 2006 National Health and Nutrition Examination Survey. A total of 257 pregnant women were included. Physical activity was assessed objectively over seven days with accelerometers. High and low groups based on moderate-to-vigorous physical activity (MVPA) and steps/day were defined. Homocysteine and related laboratory biomarkers (vitamin B12, folate, pyridoxal 50 -phosphate) were assessed through blood draws. Data assembly was performed using SAS and analysis via SPSS Complex Samples. Results: Only an estimated 17.7 ± 4.7% of women met guidelines to achieve at least 150 min per week of MVPA. Plasma homocysteine was not different between pregnant women with high and low levels of moderate-to-vigorous physical activity (4.39 ± 0.21 and 4.44 ± 0.17 μmol/L; p > .05) or between those with high and low levels of steps (3.95 ± 0.26 and 4.62 ± 0.27 μmol/L; p > .05) when the data was split into two quantiles by the median. These results were similar when using log-transformed values for homocysteine to normalize the distribution of data. Pregnant women in the group of the high steps tended to have higher vitamin B12, folate, and pyridoxal 50 -phosphate than those in the group of the low steps. Sensitivity analyses revealed that homocysteine was not different between the upper 25% (4.04 ± 0.22 μmol/L) and lower 25% (4.17 ± 0.26 μmol/L) MVPA (p = .716) but that it was statistically higher in the low (<5000 steps/day) (4.99 ± 0.20 μmol/L) steps/day group compared to high (>7500 steps/day) steps/day (3.99 ± 0.23 μmol/L) (p = .003) after excluding individuals with hypertension and thyroid/kidney issues. Conclusion: Maternal steps/day, but not MVPA, appear to be associated with homocysteine (albeit weakly) in the present study after excluding potential factors which impact homocysteine. The volume of physical activity appears to be an important indicator as this difference was not revealed until the physical activity was more distinctly separated. [ABSTRACT FROM AUTHOR]

Introduction: In singleton pregnancies, maternal complications, such as preeclampsia and thyroid dysfunction are associated with small for gestational age (SGA). However, data on the association between SGA and maternal complications in twin pregnancies are limited and conflicting. Small sample size and the application of singleton birth weight reference (SBWR) to define SGA in twins may be reasons for the inconsistent conclusions. Purpose of this study was to define SGA in dichorionic diamniotic (DCDA) and monochorionic diamniotic (MCDA) twin pregnancies using both SBWR and twin birth weight reference (TBWR) and to determine whether certain maternal complications are associated with SGA in twin pregnancies. Materials and methods: This retrospective cohort study included all twins delivered in a single tertiary center between 2013 and 2018. SGA was defined as a twin with birth weight <10th centile for gestational age using either SBWR or TBWR. The association between SGA and maternal complications was analyzed separately for DCDA and MCDA twin pregnancies, expressed as odds ratio (OR) and adjusted odds ratio (aOR) with 95% confidence interval (95%-CI). Results: A total of 2005 DCDA and 467 MCDA twin pregnancies were enrolled. In DCDA pregnancies, SGA was significantly associated with PE according to TBWR (22.73 vs. 14.56%, aOR 1.823, 95%-CI 1.137–2.922). This association was even more pronounced between SGA and severe PE (9.09 vs. 4.54%, aOR 2.234, 95%-CI 1.115–4.479). In turn, PE was associated with higher risk of SGA defined according to TBWR (8.31 vs. 4.99%, aOR 1.825, 95%-CI 1.139–2.925). No association was detected between SGA and other maternal complications. Using SBWR, no association was found between preeclampsia and SGA. In MCDA pregnancies, according to TBWR, SGA was associated only with severe PE (12.5 vs. 4.06%, aOR 3.470, 95%-CI 1.256–9.587) and lower risk of PROM (aOR 0.067, 95%-CI 0.014–0.322). Conclusion: PE was associated with SGA in DCDA pregnancies only when TBWR was used, suggesting that DCDA pregnancies complicated with PE should be closely monitored for signs of SGA and vice versa. In MCDA pregnancies, SGA defined according to TBWR was associated with only severe PE (but not with all PE) and lower risk of PROM. More basic experiments are needed to investigate the mechanisms underlying PE and SGA in DCDA and MCDA twin pregnancies respectively. [ABSTRACT FROM AUTHOR]

Objective: To determine whether abdominal (open) vs. laparoscopic myomectomy affects the obstetrical outcomes of subsequent pregnancies. Methods: A retrospective cohort study was conducted at a tertiary university medical center. The study population included women who had a documented birth following a myomectomy at our institution between the years 1997 and 2018. The obstetrical characteristics and immediate perinatal outcomes of the subsequent pregnancy following open vs. laparoscopic myomectomy were collected and compared. Data were retrieved from patients’ medical records via the institutional computerized database. Cases that lacked detailed surgery and delivery reports were excluded. Data were analyzed using a chi-square test for categorical variables and one-way ANOVA for continuous variables. A p-value <.05 was considered statistically significant. Results: During the study period, 57 women met the inclusion criteria, of whom 66.6% (38/57) had an open and 33.3% (19/57) had a laparoscopic myomectomy. Women who underwent an open myomectomy had a higher rate of cesarean birth than those in the laparoscopic group (89.5 vs. 42.1%, p < .001). No cases of severe maternal or perinatal complications, uterine ruptures, or placental abruptions were identified in either study group. No other significant differences were noted between the two types of myomectomy. Conclusion: Open myomectomy is associated with a higher rate of cesarean delivery than laparoscopic. No severe adverse maternal or neonatal outcomes were detected in either study group. [ABSTRACT FROM AUTHOR]

Introduction: The prevalence of diabetes mellitus has increased tremendously in the last two decades among women of reproductive age and this is mainly due to the pandemic of obesity. Diabetes mellitus is a well-known cause of maternal and neonatal complications in pregnancy. Diabetic nephropathy is a marker of severe diabetes and results in organ damage. However, only a small number of studies have evaluated the implications of diabetic nephropathy on pregnancy complications, with most having 50 to 100 nephropathy subjects. Our study aims to compare pregnant women with diabetes mellitus complicated by nephropathy or not and evaluate the relationship with obstetrical and perinatal morbidity and mortality, on a larger population. Methods: This was a population-based study using data from the Healthcare Cost and Utilization Project—Nationwide Inpatient Sample (HCUP-NIS) including women who delivered between 2004 and 2014. Multivariate logistic regression was used to control for confounding effects. Results: Among 86,615 pregnancies that were complicated by diabetes mellitus, 1,241 (1.4%) had diabetic nephropathy. Diabetic nephropathy was strongly associated with preeclampsia (aOR 2.3, 95% CI 1.90–2.68), as well as chronic hypertension with superimposed preeclampsia or eclampsia (aOR 4.2, 95% CI 3.53–5.01), preterm birth (aOR 1.8, 95% CI 1.59–2.1), and blood transfusion (aOR 3.6 95% CI 2.82–4.46). Both groups were similar in age and income. Conclusion: Diabetic nephropathy is associated with increased obstetrical and perinatal morbidity compared to diabetes mellitus alone. These patients may benefit from a high dose of folic acid, more vigilant antenatal surveillance, delivery in a tertiary care center, and more rigorous screening and prevention methods for pregnancy-induced hypertension diseases at antenatal care visits. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the studies which have reported the prevalence of maternal complications and outcomes for women with SCA/SCD. Healthy populations make a healthy community and improve the future for mankind. Pregnant women are an essential segment of humanity as they bear the fetus and supply nutrition for their development throughout the gestational period. Their health status and disease conditions also play a vital role in deciding the future of the offspring. Materials and methods: The Mesh terms: “Haemoglobinopathies” + “Sickle cell anemia” + “Sickle cell disease” + “Ethnic tribes” + “Pregnancy outcomes” + “India” were used to search the literature available from public databases such as “PubMed”, “PubMed Central” “Google Scholar”, “Science Direct” and “Scopus” and the same is checked for removing repetitions. The data was extracted and collected literature was thoroughly analysed. SCD/SCA is a commonly prevalent hereditary hemoglobinopathy disease and is related to augmented risk factors and premature mortality. Results: SCD severely affects pregnancy, which leads to the elevated occurrence of perinatal and maternal outcomes such as pre-eclampsia, eclampsia, abortions, intrauterine growth retardation (IUGR), etc., and sufficient care during the pregnancy guarantees an improved outcome. Due to the best health care conveniences, availability of drugs such as hydroxyurea, antibiotic prophylaxis, and vaccination, the life expectancy of SCD patients has greatly improved in recent times though directly related to the access and services available at the healthcare facilities for the needy and poor. Moreover, the latest innovations in the fields of prenatal screening and preimplantation genetic diagnosis (PGD), facilitate partners suffering from SCA/SCD to have a healthy child. There are no available studies on the prevalence of SCA/SCD in pregnant women among ethnic tribal populations from India. Conclusion: This review article is focused on the effects of SCA/SCD on pregnancy outcomes, the consistent follow-up, routine check-ups and successful management of complications throughout pregnancy, the various diagnostic methods toward preventive methods, curative and management therapeutic strategies and also defines the perinatal and maternal outcomes in the ethnic tribal populations of India. [ABSTRACT FROM AUTHOR]

Objective: To quantify the frequency of serious maternal complications associated with cerclage use during pregnancy. Study design: We performed a retrospective population-based cohort study of all live births in Ohio from 2006 to 2015. Maternal sociodemographic, medical, and obstetric characteristics were compared for births in which cerclage was utilized during the pregnancy versus those without cerclage. The primary outcome for the study was a composite of adverse outcome including maternal intensive care unit (ICU) admission, blood product transfusion, uterine rupture and unplanned hysterectomy in all births. Secondary outcomes included each of the individual adverse outcomes as well as maternal hospital transfer to a tertiary facility, unplanned operation after delivery and chorioamnionitis. Each outcome was also analyzed separately in singleton and twin births. Generalized linear modeling was used to estimate the relative risk of adverse maternal outcomes associated with cerclage placement after adjustment for coexisting risk factors. Results: Of the 1,428,655 singleton and twin live births in Ohio from 2006 to 2015, 4595 [0.3%] were recorded on the birth certificate as having cerclage during pregnancy. Of those, 11.7% experienced a serious adverse maternal outcome, compared to 3.7% without cerclage, adjRR 2.7 [95% CI 2.5, 3.0]. The rate of the composite maternal adverse outcome was significantly increased for pregnancies with cerclage versus those without overall, and in singleton and twin pregnancies when measured individually [all p ≤ .001]. Even after adjustment for coexisting risk factors, cerclage remained significantly associated with composite adverse outcome in each of these groups. Conclusions: Over 1 in 10 women with cerclage experience an adverse maternal outcome. Even after adjusting for gestational age at delivery and other risk factors, maternal risk for serious adverse event remains over twofold increased for pregnancies with cerclage. This information may be helpful in counseling women regarding potential maternal risk when considering neonatal benefit of cerclage in pregnancies at high risk of preterm birth. [ABSTRACT FROM AUTHOR]

Background Moderate to severe intrauterine adhesions (IUAs) may greatly impact fertility, predisposing to pregnancy and obstetric complications. The impact of mild IUAs on reproductive performance remains unclear. A systematic review and meta-analysis was performed to examine the long-term reproductive outcomes in women with hysteroscopic identified and treated mild IUAs mild intrauterine adhesions (IUAs) Methods An electronic literature search was conducted using MEDLINE and EMBASE from inception to June 2019. All prospective cohort, cross-sectional studies or randomized controlled trials Clinical trials in which reproductive outcomes of women with mild IUAs, were reported were included. Results Five studies, reporting on reproductive outcomes of 229 women with hysteroscopic identified and treated mild IUAs, were included. The pregnancy rate was 62.3% (142 of 228; 95% CI: 0.55–0.72, I² 25%, p = .21) and in 86.6% (123 of 142) a live birth was encountered (95% CI: 0.71–0.97) with 83.1% (108 out of 130) term deliveries (95% CI: 0.53–0.95). A miscarriage was reported in 10% (13 of 130; 95% CI: 0.02–0.26). Due to the lack of a control group, reproductive outcomes were compared to a general population. Pregnancy and live birth rates were significantly lower in women with identified and treated mild IUAs, 90% versus 62.3% and respectively 99.5% versus 86.6%. The miscarriage rate was similar. Data on obstetric and neonatal outcomes are lacking. Conclusions Women with hysteroscopic identified and treated mild IUAs seem to have lower pregnancy and live birth rate compared to the general population. Future studies consisting of a large cohort of women with hysteroscopic identified and treated IUAs with structural follow-up and a control group are needed to confirm our findings. [ABSTRACT FROM AUTHOR]

Objective: Enhanced first trimester aneuploidy screening (eFTS) combines serum biomarkers and ultrasound. Abnormal biomarkers are associated with placental complications, such as fetal growth restriction (FGR). We aimed to evaluate whether a Midtrimester placental scan can provide reassurance regarding FGR in women with abnormal eFTS biomarkers. Methods: We conducted a retrospective cohort study of women who had eFTS and delivered at a single referral center. Women with abnormal biomarkers had a mid-trimester scan of the placenta (morphologic assessment, fetal biometry and uterine artery pulsatility index). We compared pregnancies with abnormal eFTS biomarkers and normal placental scans (study group) with those who had normal eFTS biomarkers (control group). Results: A total of 6,514 women were included, of whom 343 (5.3%) comprised the study group. Women in the study group had an increased risk of hypertensive disorders of pregnancy [(aOR)1.96(95%CI 1.21–3.16)], and preterm birth <37 weeks [aOR1.98(95%CI 1.33–2.95)] compared to the control group. Yet, their neonates were not at higher risk for FGR <3rd, 5th, or 10th percentile [aOR1.16(95%CI 0.83–1.63), 1.14(95%CI 0.70–1.87), and 0.47(95%CI 0.17–1.27), respectively]. Conclusion: A normal second trimester placental scan provided reassurance regarding the risk of FGR in women at high risk based on abnormal eFTS biomarkers. [ABSTRACT FROM AUTHOR]

Background Because obese women are at increased risk for insulin resistance and development gestational diabetes (GDM), the American College of Obstetricians and Gynecologists (ACOG) recommends early GDM screening in this population. For obese women with a normal early 1-hour 50 g oral glucose challenge test (eGCT), the risk of developing GDM later in the pregnancy is unknown. Thus, we aimed to assess the risk of developing gestational diabetes based on the value of a normal eGCT. Study Design Retrospective cohort of non-anomalous singleton pregnancies with maternal body mass index (BMI) ≥40 at the time of entry to prenatal care at a single institution from 2013 to 2017. Pregnancies with abnormal early 1-hour 50 g glucose challenge test (eGCT), multiple gestation, late entry to care, type 1 or 2 diabetes, and missing diabetes-screening information are excluded. Primary outcome was development of GDM. Secondary outcomes include fetal growth restriction, macrosomia, gestational age at delivery, large for gestational age, delivery BMI, total weight gain in pregnancy, induction of labor, shoulder dystocia, and cesarean delivery. Bivariate statistics compare demographics, pregnancy complications and delivery characteristics of women who had an eGCT≤ 100 mg/dL (low-normal eGCT) and women who had an eGCT of 101–134 mg/dL (high-normal eGCT). Regression models used to estimate odds of primary outcome. Results Of 169 women, 66(39%) had a low-normal eGCT, and 103(61%) had a high-normal eGCT. Women in the low-normal eGCT group were more likely to use recreational drugs (p = 0.03), other baseline demographics did not differ. The rate of GDM was low in this population (5.3%), with no difference in the rate of GDM between with a low-normal eGCT (1.5%) and high-normal eGCT (7.7%) (p = 0.09). The median neonatal birthweight was higher in the high-normal GCT group (3405 g) as compared to the low-no GCT (3285 g) (p = 0.03). Conclusions Among women with class 3 obesity, the specific value of an early normal GCT was not associated with developing gestational diabetes mellitus later in the pregnancy. Larger studies are needed confirm these findings. [ABSTRACT FROM AUTHOR]

Background/Objective SARS-CoV-2 continues to spread widely in the US and worldwide. Pregnant women are more likely to develop severe or critical illness than their non-pregnant counterparts. Known risk factors for severe and critical disease outside of pregnancy, such as asthma, diabetes, and obesity have not been well-studied in pregnancy. We aimed to determine which clinical and pregnancy-related factors were associated with severe and critical COVID illness in pregnancy. Study design This was a retrospective cohort study of women with confirmed intrauterine pregnancy and positive nasopharyngeal swab for SARS-CoV-2 who presented to an academic medical center in New York City from 1 March 2020 to 1 July 2020. Severe and critical COVID-19 disease was defined by World Health Organization criteria. Women with severe/critical disease were compared to women with asymptomatic/mild disease. Continuous variables were compared with Mann–Whitney or t-test and categorical variables were compared using chi-square and Fisher’s exact. Statistical significance was set at p < .05. Multivariable logistic regression was performed including variables that were significantly different between groups. Results Two hundred and thirty-three patients were included, 186 (79.8%) with asymptomatic/mild disease and 47 (20.2%) with severe/critical disease. Women with asymptomatic/mild disease were compared to those with severe/critical disease. Women with severe/critical disease were more likely to have a history of current or former smoking (19.6 vs. 5.4%, p = .004), COVID-19 diagnosis in the 2nd trimester (42.6 vs. 11.8%, p = .001), and asthma or other respiratory condition (21.3 vs. 7.0%, p = .01). Women with severe/critical disease were more likely to have cesarean delivery (35.5 vs. 15.6%, p < .01) and preterm delivery <37 weeks (25.8 vs. 3.8%, p < .01). After adjustment, history of smoking remained significantly predictive of severe/critical disease [aOR 3.84 (95% CI, 1.25–11.82)]. [ABSTRACT FROM AUTHOR]

Aim Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-specific liver disease associated with a significant risk of fetal complications including pre-term delivery and fetal death. Typically, it was diagnosed in the third trimester of pregnancy. This study utilized characteristics from routine maternal examinations in the first 20 weeks’ gestation to predict ICP in pregnant women. Methods This is a retrospective case-control study. 13,329 medical records were collected on pregnant women presenting to the West China Second University Hospital between December 2017 and December 2018. After screening according to strict criteria, a total of 487 patients, 250 intrahepatic cholestasis of pregnancy cases, and 237 controls were selected for this study. We collected seven maternal characteristics indices for analysis and forty-three routine blood examination indices were obtained from routine hepatic, renal, and coagulation function examinations. The least absolute shrinkage and selection operator regression was applied for variable selection. Classification and regression trees, logistic regression, random forests, and light gradient boosting machines were fit for predictive modeling. We randomly divided 25% of the original data as testing set to conduct internal validation of the performance of the prediction model. The area under the receiver operating characteristic curves (AUC) was used to compare methods. Results Eight variables were selected out as potentially significant predictors that could reliably predict ICP. The sensitivity, specificity, accuracy, and AUC of the final prediction model obtained by light gradient boosting machines were 72.41, 79.69, 76.23, and 79.77%, respectively. Significantly higher platelet large cell ratio, alanine aminotransferase, glutamyl transpeptidase, and fibrinogen levels were found in cases as compared to healthy controls, while activated partial thromboplastin time and mean corpuscular hemoglobin concentration levels were significantly lower (p < .001). Conclusions The combination of alanine aminotransferase, glutamyl transpeptidase, fibrinogen, platelet large cell ratio, activated partial thromboplastin time, lactate dehydrogenase, creatinine, and mean corpuscular hemoglobin concentration levels can effectively predict ICP in the first 20 weeks of gestation. These could help provide direction for earlier detection and prevention of ICP. [ABSTRACT FROM AUTHOR]

Background Preeclampsia with severe features and other severe placenta-mediated complications may be life threatening to mother and fetus, especially when they are recurrent. Recurrence of pregnancy complications is common, however, when combined treatment with low molecular weight heparin and low dose aspirin fails, there are not any proven therapeutic options for prevention of recurrence of obstetrical complications. Objective We aimed to determine the impact of adding pravastatin to low molecular weight heparin and low dose aspirin for improving pregnancy outcome in women with severe recurrent placenta-mediated complications. Design A retrospective study of 32 women with severe recurrent placenta-mediated complications (preeclampsia with severe features, placental abruption, severe intrauterine growth retardation or intra uterine fetal death) in spite of treatment with low molecular weight heparin and low dose aspirin in previous pregnancy. All women were treated in the index pregnancy with 20 mg pravastatin starting at 12 weeks, with low molecular weight heparin and low dose aspirin. Antiphospholipid syndrome was evident for 10 of the 32 women. Results In the index pregnancy, only one woman had recurrence of severe placenta-mediated complications. Gestational age at delivery in the index pregnancy compared to previous pregnancy when women were treated with low molecular weight heparin and low dose aspirin was 36.5 ± 1.7 vs. 32 ± 3.6 weeks, and mean birth weight 2691 ± 462 vs. 1436 ± 559 grams, compared to previous pregnancy when women were treated with low molecular weight heparin and low dose aspirin (p < .001 for both). Of the 17 women with previous preeclampsia with severe features, 15 had no recurrence of preeclampsia and 2 women had mild preeclampsia at term. Of the 8 women with previous severe intrauterine growth retardation, all delivered at significant higher gestational age compare to previous pregnancy, [37.0 ± 1 vs. 34 ± 3 weeks, (p < .05)] with higher mean birth-weight [2648 ± 212 vs. 1347 ± 465 grams, (p = .05)]. Of the 3 women with previous placental abruption, one delivered at 32 weeks due to non-reassuring fetal heart monitoring, one woman was delivered at 36 weeks due to mild preeclampsia, and one woman underwent elective induction of labor at 37 weeks with no intrauterine growth retardation. Of the 4 women with previous recurrent intrauterine fetal death, 3 women delivered at 37 weeks after elective induction, and one woman at 30 weeks with a birthweight of 960 grams due to severe intrauterine growth retardation. [ABSTRACT FROM AUTHOR]

Objective: Maternal age, maternal obesity and neonatal sex dimorphism are known to affect pregnancy and neonatal outcome. However, the effects of these factors on specific placental pathology are less well-documented. Study design: Clinical information, placental pathology and neonatal data from singleton delivery were collected at our hospital in March 2020 to October 2021 and correlation studies were performed. Results: A total 3,119 singleton placentas were examined between March 2020 and October 2021 in conjunction with clinical information and neonatal birth data. Advanced maternal age (>35) was significantly associated with a variety of pregnancy complications and placental pathology including preeclampsia/pregnancy induced hypertension (Pre/PIH), gestational diabetes mellitus (GDM2), intrauterine growth restriction (IUGR), and increased maternal body mass index (BMI) at delivery. Maternal obesity (BMI >30 at the time of delivery) was significantly associated with a variety of clinical features and placental pathology including PRE/PIH, GDM2 and decidual vasculopathy (mural arterial hypertrophy). No specific placental pathology was associated with neonatal sex except for more maternal inflammatory response (MIR, chronic deciduitis) in neonates of male sex. Conclusion: Maternal age and maternal obesity were associated with not only clinical complications of pregnancy and neonatal birth weight but also specific placental pathology. Understanding the effects of maternal and environmental factors will help improve pregnancy outcome. [ABSTRACT FROM AUTHOR]

Background: Complete atrioventricular block (CAVB) is a complication of maternal antibody positivity and treatment of fetal disease is controversial in terms of efficacy and safety. We hypothesized that dexamethasone treatment for fetal anti-Ro/SSA antibody-mediated cardiac disease leads to better pregnancy outcomes than expectant management. Methods: A retrospective multi-center cohort study of anti-Ro/SSA antibody positive pregnancies with fetal conduction disease reported by participating North American Fetal Therapy Network (NAFTNet) centers between January 2010 and December 2018. The primary outcomes included: fetal death, oligohydramnios, growth restriction, preterm delivery, and new maternal comorbidities. Secondary outcomes included: pacemaker prior to 28 days, transplantation, and neonatal death in maternal/fetal dyads treated with dexamethasone versus not. Results: In 127 anti-Ro/SSA positive pregnancies, 98 were treated with dexamethasone and 29 were not. Of those treated, 61/96 (63.5%) met the primary outcome including 45/91 (49.4%) premature deliveries; 20 mothers developed comorbidities during treatment (fetal death 5, 10 growth restriction, 14 oligohydramnios, two new/worsening gestational diabetes). In the untreated group, 15/25 (60%) met the primary outcome including 11/22 (50%) premature deliveries and four mothers developing comorbidities during their pregnancy (fetal death 3, one growth restriction, one new onset maternal hypertension). Regarding secondary outcomes, 37/ 96 (43%) treated fetuses required a pacemaker or died by 28 days, while untreated 13/25 (52%) required pacemaker placement, died prior to 28 days or required listing for transplantation. Excluding terminations, survival without transplant was 17 (68%) in untreated and 85 (89%) in treated patients (p<.01). Conclusions: While the use of dexamethasone in anti-Ro/SSA positive pregnancies is associated with a high rate of poor pregnancy outcomes, there was an unexpected similarly high rate in untreated positive pregnancies. This suggests that the maternal disease itself is influencing pregnancy complications independent of dexamethasone. Our data, which show that treatment decreases neonatal morbidity and overall mortality without increasing overall pregnancy complications, warrant further study. [ABSTRACT FROM AUTHOR]

Background: The importance of nutrition in reproductive health is widely acknowledged with special emphasis given to periconceptional maternal diet and its implications on embryo-fetal development, pregnancy complications, and the health of the offspring. Methods: Following the PRISMA guidelines, we searched for literature in PubMed, CINAHL, and WoS to gather newer information on how diet composition influences the concepts from the very early stages of pregnancy and how maternal health may be affected as well. Fifty-six studies published up to June 2020 met the inclusion criteria. Results: With its proportioned and diversified macronutrient composition, the Mediterranean Diet prevents congenital anomalies, preterm birth, hypertensive disorders, and gestational diabetes. Similar dietary patterns rich in vegetables, nuts, fish, and cereals increase the likelihood of conception and have a protective action, mediated by their antioxidant properties, against orofacial clefts, congenital heart and limb defects in the progeny. Conversely, the pro-inflammatory features of western diets, rich in processed foods and low in fruit content, diminish fertility, increase miscarriage rates, and enhance the risk of neural tube defects regardless of folate supplementation. Conclusions: It may be concluded that within the multiple dietary options, some of them are soundly associated with beneficial effects for the mother and the newborn. [ABSTRACT FROM AUTHOR]

Purpose: Several studies link maternal cardiovascular disease (CVD) to maternal and fetal morbidity and mortality. This study describes the profile of maternal, obstetric, and neonatal outcomes among pregnant women with CVD in a tertiary hospital in the Philippines. It identifies the clinical and sociodemographic variables associated with these outcomes. Materials and Methods: A single-center, retrospective analysis of pregnant women admitted for delivery at the Philippine General Hospital from 2015 to 2019 was performed. Of these patients, pregnant women with CVD were identified as the cohort for this study. Data on clinical and sociodemographic factors, maternal major adverse cardiovascular events, neonatal adverse clinical events, and obstetric complications were collected. Logistic regression analysis was performed to determine the odds ratio for the risk factors for small-for-gestational-age (SGA) babies and preterm birth. Results: Among 30,053 delivery admissions in the Philippine General Hospital from 2015 to 2019, 293 (0.98%) pregnant women had CVD. Of the CVDs present in this cohort, congenital heart diseases (n = 119, 40.6%) were the most common, followed by rheumatic heart disease (n = 109, 37.2%). Maternal adverse events were rarely observed. Four women experienced symptomatic arrhythmias, two presented with worsening heart failure, three experienced thromboembolic events, and one had cerebrovascular infarction. There was no reported maternal death, cardiac arrest, shock, or acute renal failure. The majority (69.3%) of the women included in the study were delivered by spontaneous vaginal delivery and assisted vaginal delivery by vacuum or forceps; however, a significant portion of these women had undergone cesarean section. Almost all the study cohort delivered live births, with most neonates being delivered at 37–38 weeks gestational age (83.6%) and only 16.0% born preterm. However, a significant portion, a third of the neonates, were classified as having low birth weight. Around 17.4% of neonates born from gravidocardiac mothers were admitted neonatal intensive care unit. Conditions associated with preterm birth were low educational attainment, previous history of early neonatal death, maternal low ejection fraction, and abnormal maternal left ventricular geometry. The conditions associated with SGA babies were high gravidity and parity, a history of abortion/ stillbirth, a history of previous cesarean section delivery, low ejection fraction, a history of multiple gestations, and higher BMI. Conclusion: In this cohort study, adverse maternal outcomes were rarely observed. CVD in pregnancy is associated with an increased risk of preterm birth and SGA babies. We identified certain maternal conditions and sociodemographic factors associated with these outcomes. Despite having CVD, our study cohort had no mortality from the pregnancy. [ABSTRACT FROM AUTHOR]

Introduction: There are conflicting reports on the effect of pregnancy on liver transaminase (aspartate aminotransferase [AST] and alanine aminotransferase [ALT]) levels. In this study, we sought to investigate the trajectories of AST and ALT levels during normal pregnancy and to compare them with AST and ALT levels of matched nonpregnant controls. Materials and Methods: Our multicenter retrospective study included 34,396 women who delivered at term at 12 primary maternity care units between January 2011 and December 2018 and 57,152 nonpregnant women younger than 45 years who received a medical checkup between 2016 and 2019. After matching at a ratio of 1:1 for adjustment of several factors (age, weight, and height), a total of 30,460 normal pregnant women and 30,460 nonpregnant women were selected for this study. We measured serum AST and ALT levels during each trimester and the postpartum period to compare with those of the nonpregnant women. Results: The ALT level began to decrease in the first half of the third trimester and was lowest in the second half of third trimester and at postpartum day 1 (median [interquartile range]: 8 [6–11] U/L, 8 [6–10] U/L, respectively). The decline reversed and returned to the level of a nonpregnant state by postpartum days 2–7. The AST level remained unchanged regardless of pregnancy. The prevalence of abnormal liver transaminases (AST >40 U/L and ALT >40 U/L) was <1% at third trimester; however, it increased to 3–5% on postpartum days 2–7. Conclusions: The ALT level was lower during pregnancy compared with nonpregnant women matched for several factors, whereas the AST level remained unchanged during pregnancy. Understanding the trajectories of AST and ALT levels during pregnancy may facilitate early recognition and diagnosis of impaired liver function, including liver disease and pregnancy complications that affect liver transaminases, such as pre-eclampsia and HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. [ABSTRACT FROM AUTHOR]

Aim The biology of recurrent pregnancy loss and recurrent implantation failure (RPL-RIF) is complex with multi-factorial etiology, with defective thrombosis being one of the most important and highly prevalent causes. The role of several thrombophilia related genes and variants associated with RPL-RIF is widely reported, and this study aimed to identify the risk associated with these genes in the Indian population. Methods Next generation sequencing (NGS) was employed for the current study. NGS enables sequencing of multiple genes, identification of new variants, and establishment of genetic correlations with reproductive failure in diverse population groups. The present NGS based study evaluates association of twenty-nine genotypes of ten coagulation pathway genes (F2, F5, F13, MTR, MTRR, MTHFR, ANXA5, PROZ, SERPINE1 and VEGFA) with RPL-RIF in 540 female subjects − 474 patients with early recurrent pregnancy loss, late pregnancy loss, pregnancy complications in late gestation and recurrent implantation failure, with 66 controls. Results The results emphasize inclusion of genotypes of seven thrombophilia genes (MTHFR, MTRR, MTR, ANXA5, PROZ, SERPINE1, VEGFA) for diagnosis of inherited thrombophilia risk for RPL-RIF in Indian population, as against the common practice of testing limited to F2, F5 and MTHFR genes. Conclusion Deriving risk magnitude from Combined Risk Analysis and interpretation of high-risk haplotypes are crucial components for evidence based personalized management such as selection of drugs and dosage, and prenatal or pre-implantation recommendations, for high-risk patients in fertility and obstetric clinics. [ABSTRACT FROM AUTHOR]

Purpose Treatment for post-partum anemia frequently entails oral iron supplementation, but questions remain regarding optimal dosing, frequency, and efficacy. The objective of this study was to describe oral iron prescribing practices in post-partum women delivered via Cesarean section, and identify factors associated with iron supplementation. Methods A retrospective review of Cesarean section deliveries at a single tertiary center between May 2019 and April 2020 was undertaken. Patient demographics, hematological indices, indication for Cesarean section and discharge prescriptions were collected. Univariate and multivariable analyses were performed to identify factors associated with oral iron prescription at discharge. Results During the study period, 1470 women were eligible for inclusion. The mean age at delivery was 34.4 ± 4.9 years and mean gestational age was 37.2 ± 3.6 weeks. Most pregnancies (92%) were singleton. Ninety-six total patients (6.5%) received intravenous iron post-partum. Fourteen percent of women (210/1470) received prescriptions for oral iron at discharge, most commonly ferrous fumarate (61.9%, 130/210). The most common dose provided was 300 mg (145/210). Ante-partum ferritin was available for most patients (64.3%, 945/1470), but only for 17 post-partum patients (1.2%). Factors significantly associated with oral iron prescription were earlier gestational age at birth (aOR 0.93, 95% CI 0.89–0.97), history of complications during pregnancy or labor (aOR 1.92, 95% CI 1.26–2.98), higher blood loss (aOR 2.66, 95% CI 1.36–5.44), post-partum anemia (aOR 6.28, 95%-CI 4.41–8.96), blood transfusion (aOR 5.43, 95%-CI 1.81–18.19) and antenatal iron supplementation (aOR 5.70, 95%-CI 4.02–8.17). Conclusions In summary, a relatively small proportion of women following Cesarean section were prescribed oral iron at discharge. We identified several factors associated with post-partum iron supplementation. This information will inform future prospective studies investigating the efficacy of iron supplementation in the treatment of post-partum anemia. [ABSTRACT FROM AUTHOR]

Introduction Post-partum depression (PPD) affects up to 19.1% of pregnancies and is associated with increased levels of proinflammatory cytokines, inflammation, and reductions in brain-derived neurotrophic factor (BDNF). Previous work by our team suggests that environmental toxins such as polybrominated diphenyl ethers (PBDEs) enhance placental inflammation and reduce BDNF production. Nearly, 100% of studied women in California have some level of exposure to these compounds due to extensive use of the flame retardants. High levels of exposure to PBDEs has been linked to increased risk of adverse pregnancy complications associated with placental inflammation such as preterm birth and gestational diabetes but their effects on risk of PPD is unclear. Objective To determine if PPD is associated with higher levels of PBDE-47, the most common PBDE congener in maternal plasma. Methods PBDE-47 was quantified in first trimester plasma samples collected from a cohort of 367 asymptomatic pregnant women that were routinely screened for depressive symptoms for 1 year post-partum. Data were analyzed using general linear models and multivariable logistic regression to determine if higher levels of PBDE-47 in the first trimester are associated with development of PPD. Results Women who developed PPD (n = 22) had significantly higher PBDE-47 levels in their plasma (p=.031) relative to those in which PPD was not diagnosed. Logistic regression analysis suggested that each two-fold increase in PBDE-47 concentrations increased the risk of PPD by 22% (OR = 1.22, 95% CI: 1.03, 1.47). Groups were similar regarding PTB rate, race-ethnicity, parity, child’s sex, maternal pre-pregnancy obesity status, maternal age, family income, and study center. Results remained significant after adjustment for these possible confounding factors. Conclusions These results suggest that PBDE-47 exposure in the first trimester is associated with increased risk of PPD. [ABSTRACT FROM AUTHOR]

Background Protracted labor is associated with an elevated risk of maternal and fetal complications. Results of randomized controlled trials on the efficacy in labor of phloroglucinol (PHL), a pure antispasmodic drug, are uncertain. Objectives To evaluate whether PHL is effective in shortening the first stage of labor. Search strategy MEDLINE, EMBASE, LILACS, Scopus, ClinicalTrials.gov, and the Cochrane Library were searched from inception to July 2020. Selection criteria Randomized controlled trials (RCTs) concerning women with a singleton vertex pregnancy at term who were treated with PHL. Data collection and analysis Relevant data were extracted and tabulated. Review Manager 5.3 was used for data analysis. Primary outcome evaluated was the mean reduction of the first stage of labor. Main results Five RCTs, including 487 pregnant women, were analyzed. The first stage of labor duration was significantly shorter in the treatment arm compared to the control group [MD−113.21 min (95% CI−119.63,–106.79)]. A significant shortening of the second stage was achieved in the PHL group [MD−11.12 min (95% CI−12.64,–9.75)] while no differences were reported for the third stage. Conclusions PHL might represent an effective treatment to shorten the duration of the first and second stage of labor. [ABSTRACT FROM AUTHOR]