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Background: Fear of childbirth can develop due to the concerns or adverse maternal or foetal outcomes experienced in a previous pregnancy. The aim of this study was to examine the main risk factors associated with the development of fear of childbirth during subsequent pregnancies and deliveries. Methods: In this case–control study, data from the National Medical Birth Register were used to evaluate the events in previous pregnancies that were potential risk factors for fear of childbirth in subsequent pregnancies. The first and second pregnancies of women registered during our study period (2004–2018) were included. The exposure variable was delivery mode, obstetric challenge or adverse neonatal outcomes during the first pregnancy. The outcome was the development of FOC during the second pregnancy. Adjusted odds ratios with 95% CIs were used for comparison. Results: A total of 13 064 pregnancies were included in the case group and 195 351 in the control group. Previous emergency caesarean section was the strongest risk factor for the development of FOC in the second pregnancy (adjusted odds ratio 5.27, CIs 4.83–5.75). In addition, unplanned CS (adjusted odds ratio 3.93, CIs 3.77–4.10) and vacuum delivery (adjusted odds ratio 1.69, CIs 1.61–1.77) also increased the odds of fear of childbirth. Of the obstetric complications, third- or fourth-degree tear of the perineum was the strongest risk factor (adjusted odds ratio 2.99, CIs 2.69–3.31), followed by shoulder dystocia (adjusted odds ratio 2.82, CIs 2.16–3.62). Neonatal mortality also increased the odds for the development of FOC (adjusted odds ratio 2.17, CIs 1.77–2.64). Conclusion: The main risk factors for the development of fear of childbirth in the second pregnancy were previous fear of childbirth, unplanned CS, vacuum delivery, perineal tear or shoulder dystocia. The results of this study can be used in a clinical setting to improve the prevention of fear of childbirth. [ABSTRACT FROM AUTHOR]

Aims The aim of this study was to explore the association of pregnancy loss (PL) with the incidence of cardiovascular disease (CVD) and examine the extent to which this relation is mediated by subsequent metabolic disorders. Methods and results We followed 95 465 ever-gravid women participating in the Nurses' Health Study II between 1993 and 2017. Cox proportional hazards models were used to estimate the hazard ratios (HRs) of CVD, including coronary heart disease (CHD), and stroke, according to the occurrence of PL. A mediation analysis was conducted to explore the intermediating effect of subsequent type 2 diabetes, hypertension, or hypercholesterolaemia. During 2 205 392 person-years of follow-up (mean 23.10 years), 2225 (2.3%) incident CVD cases were documented. After adjusting for confounding factors, PL was associated with an HR of 1.21 [95% confidence interval (CI) 1.10–1.33] for CVD during follow-up. A similar association was observed for CHD (HR 1.20; 95% CI 1.07–1.35) and stroke (HR 1.23; 95% CI 1.04–1.44). The risk of CVD increased with the number of PLs [HR 1.18 (95% CI 1.06–1.31) for 1 and 1.34 (95% CI 1.13–1.59) for ≥2 times] and was greater for PL occurring early in reproductive lifespan [HR 1.40 (95% CI 1.21–1.62) for age ≤23 years, 1.25 (95% CI 1.09–1.43) for age 24–29 years, and 1.03 (95% CI 0.88–1.19) for age ≥30 years]. Hypertension, hypercholesterolaemia, and type 2 diabetes all explained <1.80% of the association between PL and CVD. Conclusion PL was associated with a greater CVD risk, independently of subsequent development of metabolic disorders. [ABSTRACT FROM AUTHOR]

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Objective: The correlation between periodontal status and systemic conditions, among them pregnancy, is widely described in the scientific literature. The aim of the present systematic review of the literature was to evaluate periodontal diseases as an independent risk factor for adverse pregnancy outcomes. Data: Case-control studies reporting pregnancy outcomes and periodontal status of the subjects were included. Risk of bias evaluation was performed using a tool developed by the Cochrane Bias Methods Group. After risk of bias evaluation of included studies, a meta-analysis was performed computing the Risk Ratio (RR) for each pregnancy outcome. Sources: Electronic databases (MedLine, Embase, Cochrane Central) were searched after preparation of an appropriate search string. Study selection: The search resulted in 422 entries that were screened. After application of inclusion and exclusion criteria, a total of 22 studies were included in the review accounting for a total of 17,053 subjects. The computed RR for periodontitis was 1.61 for preterm birth evaluated in 16 studies (P < .001), 1.65 for low birthweight evaluated in 10 studies (P < .001), and 3.44 for preterm low birthweight evaluated in four studies. Conclusion: The present systematic review reported a low but existing association between periodontitis and adverse pregnancy outcomes. This assumption is the result of proper corrections of biased methodologies and of heterogeneity of studies. [ABSTRACT FROM AUTHOR]

Pregnant women may be at higher risk of severe complications associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which may lead to obstetrical complications. We performed a case control study comparing pregnant women with severe coronavirus disease 19 (cases) to pregnant women with a milder form (controls) enrolled in the COVI-Preg international registry cohort between March 24 and July 26, 2020. Risk factors for severity, obstetrical and immediate neonatal outcomes were assessed. A total of 926 pregnant women with a positive test for SARS-CoV-2 were included, among which 92 (9.9%) presented with severe COVID-19 disease. Risk factors for severe maternal outcomes were pulmonary comorbidities [aOR 4.3, 95% CI 1.9–9.5], hypertensive disorders [aOR 2.7, 95% CI 1.0–7.0] and diabetes [aOR2.2, 95% CI 1.1–4.5]. Pregnant women with severe maternal outcomes were at higher risk of caesarean section [70.7% (n = 53/75)], preterm delivery [62.7% (n = 32/51)] and newborns requiring admission to the neonatal intensive care unit [41.3% (n = 31/75)]. In this study, several risk factors for developing severe complications of SARS-CoV-2 infection among pregnant women were identified including pulmonary comorbidities, hypertensive disorders and diabetes. Obstetrical and neonatal outcomes appear to be influenced by the severity of maternal disease. [ABSTRACT FROM AUTHOR]

Background: Pregnancy is a risk factor for coronavirus disease 2019 (COVID-19). Pregnant women suffer from varying levels of pregnancy-related anxiety (PRA) which can negatively affect pregnancy outcomes. The aim of this study was to assess PRA and its associated factors during the COVID-19 pandemic.Methods: This web-based cross-sectional study was conducted in 2020 on 318 pregnant women purposively recruited from primary healthcare centers in Sari and Amol, Iran. Data were collected using questionnaires (PRAQ, Edinburg, KAP of COVID-19, CDA-Q and Demographic questionnaire), which were provided to participants through the social media or were completed for them over telephone. Data were analyzed with the linear regression and the logistic regression analysis, at the significance level of 0.05 using the SPSS software (v. 21).Results: Around 21% of participants had PRA, 42.1% had depression, and 4.4% had COVID-19 anxiety. The significant predictors of PRA were number of pregnancies (P = 0.008), practice regarding COVID-19 (P < 0.001), COVID-19 anxiety (P < 0.001), depression (P < 0.001), and social support (P = 0.025) which explained 19% of the total variance. Depression and COVID-19 anxiety increased the odds of PRA by respectively four times and 13%, while good practice regarding COVID-19 decreased the odds by 62%.Conclusion: Around 21% of pregnant women suffer from PRA during the COVID-19 pandemic and the significant predictors of PRA during the pandemic include number of pregnancies, practice regarding COVID-19, COVID-19 anxiety, depression, and social support. These findings can be used to develop appropriate strategies for the management of mental health problems during pregnancy in the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Background: Pregnancy loss is common and several factors (e.g. chromosomal anomalies, parental age) are known to increase the risk of occurrence. However, much existing research focuses on recurrent loss; comparatively little is known about the predictors of a first miscarriage. Our objective was to estimate the population-level prevalence of miscarriages and to assess the contributions of clinical, social, and health care use factors as predictors of the first detected occurrence of these losses.Methods: In this population-based cohort study, we used linked administrative health data to estimate annual rates of miscarriage in the Manitoba population from 2003 to 2014, as a share of identified pregnancies. We compared the unadjusted associations between clinical, social, and health care use factors and first detected miscarriage compared with a live birth. We estimated multivariable generalized linear models to assess whether risk factors were associated with first detected miscarriage controlling for other predictors.Results: We estimated an average annual miscarriage rate of 11.3%. In our final sample (n = 79,978 women), the fully-adjusted model indicated that use of infertility drugs was associated with a 4 percentage point higher risk of miscarriage (95% CI 0.02, 0.06) and a past suicide attempt with a 3 percentage point higher risk (95% CI -0.002, 0.07). Women with high morbidity were twice as likely to experience a miscarriage compared to women with low morbidity (RD = 0.12, 95% CI 0.09, 0.15). Women on income assistance had a 3 percentage point lower risk (95% CI -0.04, -0.02).Conclusions: We estimate that 1 in 9 pregnant women in Manitoba experience and seek care for a miscarriage. After adjusting for clinical factors, past health care use and morbidity contribute important additional information about the risk of first detected miscarriage. Social factors may also be informative. [ABSTRACT FROM AUTHOR]

Background: For every neonate who dies, many others experience a near miss event that could have but did not result in death. Neonatal near miss is three to eight times more frequent than neonatal deaths and, therefore, is more useful for assessing the determinants of adverse neonatal outcomes. The aim of this study was to assess the incidence and determinants of neonatal near miss in south Ethiopia.Methods: A facility-based prospective study was conducted among 2704 neonates between 12 July to 26 November 2018. The neonates were followed from the time of admission to hospital discharge or seven postpartum days if the newborn stayed in the hospital. The data were collected by interviewer-administered questionnaire and medical record review. Logistic regression was employed to identify the distant, intermediate and proximal factors associated with neonatal near miss. The independent variables were analysed in three hierarchical blocks. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were used to determine the strength of the associations.Results: The incidences of neonatal near miss and neonatal death were 45.1 (95% CI = 37.7-53.8) and 17.4 (95% CI = 13.0-23.3) per 1000 live births, respectively. Of those newborns who experienced neonatal near miss, more than half (59.8%) of their mothers were referred from other health facilities. After adjusting for potential confounders, the odds of neonatal near miss were significantly higher among neonates with a low monthly income (< 79 USD monthly), a birth interval of less than 24 months and where severe maternal complications had occurred.Conclusion: Strategies to improve neonatal survival need a multifaceted approach that includes socio-economic and health-related factors. The findings of this study highlight important implications for policymakers with regard to neonatal near miss. In particular, addressing inequalities by increasing women's income, promoting an optimal birth interval of 24 months or above through postpartum family planning, and preventing maternal complications may improve newborn survival. [ABSTRACT FROM AUTHOR]

Background: Approximately 10% of all Graves' disease cases are triiodothyronine (T3)-predominant. T3-predominance is characterized by higher T3 levels than thyroxine (T4) levels. Thyroid stimulating hormone receptor autoantibody (TRAb) levels are higher in T3-predominant Graves' disease cases than in non-T3-predominant Graves' disease cases. Treatment with oral drugs is difficult. Here, we report a case of fetal goiter in a pregnant woman with T3-predominant Graves' disease.Case Presentation: A 31-year-old woman had unstable thyroid function during the third trimester of pregnancy, making it impossible to reduce her dosage of antithyroid medication. She was admitted to our hospital at 34 weeks of gestation owing to hydramnios and signs of threatened premature labor, and fetal goiter (thyromegaly) was detected. The dose of her antithyroid medication was reduced, based on the assumption that it had migrated to the fetus. Subsequently, the fetal goiter decreased in size, and the hydramnios improved. The patient underwent elective cesarean delivery at 36 weeks and 5 days of gestation. The infant presented with temporary symptoms of hyperthyroidism that improved over time.Conclusions: The recommended perinatal management of Graves' disease is to adjust free T4 within a range from the upper limit of normal to a slightly elevated level in order to maintain the thyroid function of the fetus. However, in T3-predominant cases, free T4 levels may drop during the long-term course of the pregnancy owing to attempts to control the mother's symptoms of thyrotoxicosis. Little is known about the perinatal management and appropriate therapeutic strategy for T3-predominant cases and fetal goiter. Therefore, further investigation is necessary. [ABSTRACT FROM AUTHOR]

Background: In women with singleton pregnancies, maternal adaptation is considered a stress test for later life cardiovascular disease. The aim of this study was to assess maternal adaptation in women with twin pregnancies compared to women carrying singletons during and after pregnancy.Methods: This was a population based prospective cohort study of 91 women with twin pregnancies and 8107 women carrying singletons. The association of twin pregnancy and maternal adaptation was examined using regression analyses. In pregnancy, we measured soluble fms-like tyrosine kinase-1 (sFLT-1), placental growth (PGF) factor, systolic (SBP) and diastolic blood pressure (DBP), and the occurrence of pre-eclampsia (PE). After pregnancy, measurements were obtained on SBP and DBP, cardiac function, retinal calibres, intima media thickness and distensibility of the common carotid artery.Results: sFLT-1 and PGF concentrations were higher in early (13.4 weeks) and mid-pregnancy (20.4 weeks) in women with twin pregnancies compared to women with singleton pregnancies. Women with twin pregnancies had a different DBP pattern in pregnancy. Women with twin pregnancies were more likely to have PE (odds ratio 3.63; 95% CI [1.76 to 7.48]). Six and ten years after pregnancy, no differences in maternal adaptation were observed.Conclusions: Women with twin pregnancies show an altered adaptation during pregnancy compared to women with singleton pregnancies. This is associated with a substantially increased incidence of PE, but does not lead to persistent altered maternal adaptation years after pregnancy. [ABSTRACT FROM AUTHOR]

Vascular complications in pregnancy (e.g. preeclampsia) are a major source of maternal and foetal morbidity and mortality, and may be due to excessive release of placental syncytiotrophoblast-derived extracellular vesicles (STBEVs) into the maternal circulation. Increased activity of the multi-ligand scavenger receptor Lectin-like Oxidized LDL Receptor-1 (LOX-1) is associated with vascular dysfunction, and LOX-1 has been shown to interact with angiotensin II receptor type 1 (AT1). We hypothesized that STBEVs contribute to vascular dysfunction via LOX-1 and AT1 receptors during pregnancy. Uterine arteries from late pregnant wildtype and LOX-1 overexpressing mice were incubated overnight with or without STBEVs and vascular function was assessed using wire myography. STBEV-incubation decreased angiotensin II responsiveness only in wildtype mice, which coincided with decreased AT1 contribution and expression. Thus, STBEVs reduced angiotensin II responsiveness in normal pregnancy, but not in conditions of increased LOX-1 expression, suggesting that STBEVs (via LOX-1) play a role in normal adaptations to pregnancy. Oxidized LDL (a LOX-1 ligand) increased angiotensin II-induced vasoconstriction in STBEV-incubated arteries from both mouse strains, suggesting that the LOX-1 pathway may be involved in complicated pregnancies with elevated STBEVs and oxidized LDL levels (such as preeclampsia). These data increase our understanding of vascular complications during pregnancy. [ABSTRACT FROM AUTHOR]

Introduction: Isolated single umbilical artery (iSUA) refers to single umbilical artery cords with no other fetal malformations. The association of iSUA to adverse outcome of pregnancy has not been consistently reported, and whether iSUA carries increased risk of third stage of labor complications has not been studied. We aimed to investigate the risk of adverse perinatal outcome, third stage of labor complications, and associated placental and cord characteristics in pregnancies with iSUA. A further aim was to assess the risk of recurrence of iSUA and anomalous cord or placenta characteristics in Norway.Material and Methods: This was a population-based study of all singleton pregnancies with gestational age >16 weeks at birth using data from the Medical Birth Registry of Norway from 1999 to 2014 (n = 918 933). Odds ratios (OR) with 95% confidence intervals were calculated for adverse perinatal outcome (preterm birth, perinatal and intrauterine death, low Apgar score, transferral to neonatal intensive care ward, placental and cord characteristics [placental weight, cord length and knots, anomalous cord insertion, placental abruption and previa]), and third stage of labor complications (postpartum hemorrhage and the need for manual placental removal or curettage) in pregnancies with iSUA, and recurrence of iSUA using generalized estimating equations and logistic regression.Results: Pregnancies with iSUA carried increased risk of adverse perinatal outcome (OR 5.06, 95% confidence interval [CI] 4.26-6.02) and perinatal and intrauterine death (OR 5.62, 95% CI 4.69-6.73), and a 73% and 55% increased risk of preterm birth and small-for-gestational-age neonate, respectively. The presence of iSUA also carried increased risk of a small placenta, placenta previa and abruption, anomalous cord insertion, long cord, cord knot and third stage of labor complications. Women with iSUA, long cord or anomalous cord insertion in one pregnancy carried increased risk of iSUA in the subsequent pregnancy.Conclusions: The presence of ISUA was associated with a more than five times increased risk of intrauterine and perinatal death and with placental and cord complications. The high associated risk of adverse outcome justifies follow up with assessment of fetal wellbeing in the third trimester, intrapartum surveillance and preparedness for third stage of labor complications. [ABSTRACT FROM AUTHOR]

Background: Sedentary behavior (SED) is a potential risk factor for poor pregnancy outcomes. We evaluated the validity of several common and one new method to assess SED across three trimesters of pregnancy.Methods: This cohort study of pregnant women measured objective and self-reported SED each trimester via thigh-worn activPAL3 micro (criterion), waist-worn Actigraph GT3X, and self-report from the Pregnancy Physical Activity Questionnaire (PPAQ) and the de novo Sedentary Behavior Two Domain Questionnaire (SB2D). SED (hours per day) and percent time in SED (SED%) from activPAL were compared to GT3X, SB2D, and PPAQ using Pearson's r, ICC, Bland-Altman analysis, and comparison of criterion SED and SED% across tertiles of alternative methods.Results: Fifty-eight women (mean age 31.5 ± 4.8 years; pre-pregnancy BMI 25.1 ± 5.6 kg/m2; 76% white) provided three trimesters of valid activPAL data. Compared to activPAL, GT3X had agreement ranging from r = 0.54-0.66 and ICC = 0.52-0.65. Bland-Altman plots revealed small mean differences and unpatterned errors, but wide limits of agreement (greater than ±2 h and ± 15%). The SB2D and PPAQ had r < 0.5 and ICC < 0.3 vs. activPAL SED, with lower agreement during the 2nd and 3rd trimesters, and performed poorly in Bland-Altman analyses. SED% from the modified SB2D performed best of the self-reported instruments with modest mean differences, r ranging from 0.55 to 0.60, and ICCs from 0.31-0.33; though, limits of agreement were greater than ±35%. Significant trends in activPAL SED were observed across increasing tertiles of SB2D SED in the 1st and 3rd trimesters (both p ≤ 0.001), but not the 2nd trimester (p = 0.425); and for PPAQ SED in the 1st and 2nd trimesters (both p < 0.05), but not the 3rd trimester (p = 0.158). AcitvPAL SED and SED% increased significantly across tertiles of GT3X SED and SED% as well as SB2D SED% (all p-for-trend ≤ 0.001).Conclusions: Compared to activPAL, waist-worn GT3X produced moderate agreement, though similar mean estimates of SED across pregnancy. Self-report questionnaires had large absolute error and wide limits of agreement for SED hr./day; SB2D measurement of SED% was the best self-report method. These data suggest activPAL be used to measure SED when possible, followed by GT3X, and - when necessary - SB2D assessing SED% in pregnancy.Trial Registration: www.clinicaltrials.gov NCT03084302 on 3/20/2017. [ABSTRACT FROM AUTHOR]

Background: Maternal behaviours during pregnancy have short- and long-term consequences for maternal and infant health. Pregnancy is an ideal opportunity to encourage positive behaviour change. Despite this, limited information exists about the nature and content of lifestyle advice provided by healthcare professionals during antenatal care. Pregnancy Risk Assessment Monitoring System (PRAMS) Ireland is based on the Centers for Disease Control and Prevention (CDC) developed PRAMS that monitors maternal behaviours and experiences before, during and after pregnancy. The aim of the study was to assess the prevalence of preventive health counselling during pregnancy.Methods: Secondary data analysis of the PRAMS Ireland study. Using hospital discharge records, a sampling frame of 2424 mother-infant pairs was used to alternately sample 1212 women whom had recently given birth. Preventive health counselling was defined as advice during antenatal care on smoking, alcohol, infant feeding and weight gain. Self-reported maternal behaviours (smoking/alcohol cessation, gestational weight gain, infant feeding). Univariate and multivariable analyses were conducted, adjusting for maternal characteristics.Results: Among 718 women (61% response rate), the reported counselling rates were 84.8% for breastfeeding (n = 592), 48.4% for alcohol (n = 338), 47.6% for smoking (n = 333) and 31.5% for weight gain (n = 218). Women who smoked pre-pregnancy (23.7%, n = 170) were more likely to receive counselling on its effects compared to non-smokers (Adjusted Odds Ratio (AOR) 2.72 (95% Confidence Interval (CI), 1.84-4.02)). In contrast, women who did not breastfeed (AOR 0.74, 95%CI 0.44-1.26) and those who reported alcohol consumption pre-pregnancy (AOR 0.94, 95%CI 0.64-1.37) were not more likely to receive counselling on these topics.Conclusion: Pregnancy is an ideal opportunity to encourage positive behaviour change. Preventive health counselling during pregnancy is not routinely provided and rates vary widely depending on the health behaviour. This study suggests that additional strategies are needed to promote positive behaviour before and during the unique opportunity provided by pregnancy. [ABSTRACT FROM AUTHOR]

Background: Birth Preparedness and Complication Readiness interventions have a significant role in the reduction of maternal and neonatal mortality risk. Inadequacy of birth and emergency preparedness were depicted as one of the major reasons for high maternal deaths in sub-Saharan Africa. The main objective of this study was to assess birth preparedness, complication readiness and associated factors among pregnant women.Methods: A community based comparative cross-sectional study design was conducted among 411 urban and 209 rural respondents who were selected using multi-stage stratified random sampling technique. Quantitative data were collected by interviewer administered questionnaire while qualitative data were collected from purposely selected 54 members of the community by using guiding checklist and analyzed by thematic areas. Birth preparedness and complication readiness was measured using five birth preparedness and complication readiness items then women who scored at least three were considered as well prepared. Bivariate and multivariable logistic regressions were used to examine the association between independent variables and birth preparedness and complication readiness. The result were presented as Odds Ratio at 95% CI. P < 0.05 ware used to dictate statistical significance.Results: A total response rate of the study was 97.3%. The prevalence of birth preparedness and complication readiness was significantly higher among urban respondents (P = 25.8%; p < 0.05). Factors such as history of obstetric complication, knowledge of key danger signs, having favourable attitude towards birth preparedness and complication readiness, starting antenatal care visit within 3 months age of pregnancy, completing at least four antenatal care visits, urban residence, having occupation of government employee or merchant and being in the higher wealth quintile were variables positively associated with birth preparedness and complication readiness.Conclusions: Prevalence of birth preparedness and complication readiness was low in this study, though significantly higher in urban area. Three-fourth of women planned to attend 4+ antenatal care visits indicating opportunity to counsel them on birth preparedness and complication readiness which increases its prevalence. Health workers should counsel every woman on birth preparedness and complication readiness components during her first antenatal care visit and subsequent visits. [ABSTRACT FROM AUTHOR]

Background: Gestational diabetes mellitus is a leading medical condition woman encounter during pregnancy with serious short- and long-term consequences for maternal morbidity. However, limited evidence was available on potential impacts of gestational diabetes mellitus using updated international diagnostic criteria on adverse maternal outcomes. Therefore, this study aimed to assess the effects of gestational diabetes mellitus on the risk of adverse maternal outcomes in Northwest Ethiopia.Methods: A prospective cohort study was conducted among pregnant women followed from pregnancy to delivery. Gestational diabetes mellitus status was determined by using a two-hour 75 g oral glucose tolerance test and based on updated international diagnostic criteria. Multivariable log-binomial model was used to examine the effects of gestational diabetes mellitus on the risk of adverse maternal outcomes.Results: A total of 694 women completed the follow-up and included in the analysis. Women with gestational diabetes mellitus had a higher risk of composite adverse maternal outcome (ARR=1.58, 95% CI: 1.22, 2.04), caesarean delivery (ARR=1.67; 95%: 1.15, 2.44), pregnancy induced hypertension (ARR= 3.32; 95%: 1.55, 7.11), premature rupture of membranes (ARR= 1.83; 95%: 1.02, 3.27), antepartum hemorrhage (ARR= 2.10; 95%: 1.11, 3.98) and postpartum hemorrhage (ARR= 4.85; 95%:2.28, 10.30) compared to women without gestational diabetes mellitus.Conclusions: Gestational diabetes mellitus increased the risk of adverse maternal outcomes. This implies that maternal care and intervention strategies relating to women with gestational diabetes mellitus should be strengthened. [ABSTRACT FROM AUTHOR]

Background: Overweight and gestational diabetes are risk factors for pregnancy complications. We hypothesized that the metabolic impact of overweight on pregnancy outcome, would be different if it was combined with a predisposition for diabetes. The aim of this study was to compare the outcome of pregnancies in women with diabetes diagnosed later in life, to the outcome of pregnancies of women who did not develop diabetes.Methods: Women in a population-based cohort who also were registered in the Swedish Medical Birth Registry (n = 4738) were included. A predisposition for diabetes (GDM or diabetes after pregnancy) was found in 455 pregnancies. The number of pregnancies with maternal BMI ≥ 25 kg/m2 and without diabetes were 2466, and in 10,405 pregnancies the mother had a BMI < 25 kg/m2 without diabetes at any time. Maternal BMI, gestational length, gestational weight gain, frequency of caesarean section, infant birth weight, frequency of large for gestational age (LGA) and Apgar score were retrospectively compared.Results: Pregnancies with normal maternal BMI ≤25 kg/m2, with predisposition for diabetes had a higher frequency of LGA (11.6% vs. 2.9%; p < 0.001), a higher frequency of macrosomia (28.6% vs. 17.6%; p < 0.001), and a shorter gestational length (39.7 vs. 40 weeks; p = 0.08) when compared to pregnancies in women without a predisposition for diabetes. In addition, pregnancies with both maternal predisposition for diabetes and BMI ≥ 25 kg/m2 there was a higher frequency of LGA (23.3% vs. 7.1%; p < 0.001), caesarean section (24.0% vs. 14.9%, p = 0.031) compared to pregnancies in women who were only overweight. A predisposition for diabetes significantly increases the risk of macrosomia (OR1.5; 95% CI 1.07-2.15; p = 0.02).Conclusions: In pregnancy, there is an increased frequency of LGA, macrosomia and caesarean section if the woman has a predisposition for diabetes. The frequency of overweight young women is increasing, and it is urgent to identify pregnant women with a predisposition to diabetes. How to distinguish the women with the highest risk for adverse pregnancy outcome and the highest risk of future disease, remains to be studied. [ABSTRACT FROM AUTHOR]

Background: In 2010, the recommended diagnostic thresholds for gestational diabetes mellitus (GDM) were amended, which has increased GDM diagnoses, as well as pressure on the services involved in GDM management, specifically impacting dietetic workloads. The present study examined the associations between dietetic intervention in women with GDM and maternal and neonatal health outcomes. Methods: The present study involved 1233 adult women with GDM who delivered at The Royal Women's Hospital (RWH), Melbourne, Australia, between July 2015 and May 2017. Retrospective data assessing GDM‐care (therapy type, diagnosis time and model of care, maternal and neonatal health outcomes, and outpatient dietetic consultations) were retrieved from patient medical records. Unadjusted and adjusted linear and logistic regression were used to assess associations of GDM care dietetic intervention and GDM care and dietetic intervention with maternal and neonatal health outcomes. Results: Women receiving dietetic intervention had a decreased likelihood of infant admission to the neonatal intensive care unit or special care nursery than women who not receiving dietetic intervention [adjusted odds ratio (OR) = 0.41, 95% confidence interval (CI) = 0.22–0.75; P = 0.004). Women requiring pharmacotherapy were more likely to experience maternal complications (adjusted OR = 3.13, 95% CI = 2.23–4.41; P < 0.001) and had a greater number of dietetic consultations (β‐coefficient = 0.28, 95% CI = 0.17–0.39; P < 0.001) compared to women managed through diet. Conclusions: Dietetic intervention plays a key role in optimising maternal and neonatal health outcomes for women with GDM. Exploring further the impact of dietetic intervention in women diagnosed with GDM is key with respect to understanding the optimal delivery of care for these women. The type and number of consultations included in a dietetic intervention should be investigated further. [ABSTRACT FROM AUTHOR]

Background: The DASH (Dietary Approaches to Stop Hypertension) diet serves as a dietary pattern for the prevention and control of hypertension. The present study aimed to investigate whether the DASH diet can improve the outcomes of pregnancy with gestational hypertension (GH) and chronic hypertension. Methods: The current randomised controlled clinical trial was performed in 85 pregnant women diagnosed with GH and chronic hypertension between July 2015 and December 2017. The women were categorised into a control group (41 cases) and a DASH group (44 cases). Participants were followed until delivery. The clinical outcomes of mothers included gestational weeks of birth, delivery mode, postpartum haemorrhage and GH, as well as the incidence of pre‐eclampsia during the second and third trimesters. Newborn measurements were collected by evaluating prematurity, birth weight, body length and neonatal Apgar score. Results: The incidence of pre‐eclampsia, prematurity and low birth weight in the DASH group was lower than that in the control group (P < 0.05). Significant differences were also observed in gestational age at delivery and the newborn body length between the two groups (P < 0.05). We failed to find a significant difference in changes of delivery mode, postpartum haemorrhage, postpartum GH, mean birth weight and Apgar score (P > 0.05) between the two diets. Conclusions: A DASH diet might comprise a potential strategy for improving the clinical outcomes in pregnant women with GH and chronic hypertension. Future robust clinical trials are warranted to corroborate these findings. [ABSTRACT FROM AUTHOR]

Introduction: To improve reproductive, maternal, and child health, preconception health (PCH) care that is innovative and generationally relevant is essential. In response, Wellington-Dufferin-Guelph Public Health (WDGPH) developed and tested an evidence-based PCH electronic intervention delivered in a primary care setting. The purpose of this study was to: (1) identify the prevalence of PCH risks among women of reproductive age, (2) determine the impact of the PCH intervention on knowledge and behaviour, and (3) assess the implementation of the intervention. Methods: The PCH intervention was designed as a cohort study using a mixed method approach. 300 women aged 15–49 years participated across seven primary care sites. The intervention was implemented using a three-part model. Participants: (1) completed a Risk Assessment (RA) on tablet with results sent to their electronic medical record, (2) discussed results with primary care providers (PCPs), (3) received handout with results and key messages. Data were collected from participants (RA and two surveys), and PCPs (interviews). Results: The RA screened for 34 PCH risk factors. The number of risks identified per participant ranged from 4 to 24, averaging 15. The majority reported a positive experience using the RA and would recommend the intervention. PCPs reported many practice benefits. The study highlights the positive influence that PCPs have around PCH. Discussion: The PCH intervention is the first of its kind in Canada. The intervention is an evidence-based population health approach that may help to improve reproductive, maternal and child health. Further research, evaluation and promotion is needed. [ABSTRACT FROM AUTHOR]

Introduction: Asymptomatic mild primary hyperparathyroidism is increasingly being identified during pregnancy. Recent studies have demonstrated inconsistent findings with regard to pregnancy complications and the need for surgical intervention during pregnancy. Method: A retrospective audit of outcomes of pregnancies complicated by hypercalcaemia over a 15-year period was performed. Results: Twenty-nine pregnancies to 26 women with hypercalcaemia were identified, corresponding to 37 cases per 100,000 deliveries. Hypercalcaemia was due to primary hyperparathyroidism in 90% of cases, with mean serum calcium of 2.89 mmol/l and mean ionised calcium 1.43 mmol/l. Four women underwent successful neck exploration during pregnancy. Pregnancy complications were limited to three cases of pre-eclampsia and one case of symptomatic neonatal hypoparathyroidism. Conclusion: Close observation without surgical intervention would seem reasonable in women with mild hypercalcaemia during pregnancy. [ABSTRACT FROM AUTHOR]

Introduction. In literature, it is well documented that migration is associated with adverse perinatal outcomes in many countries over the world. But in Turkey, health care providers and obstetricians had to face the effects of migration for the first time after civil war in Syria. Hence, this situation motivated us to conduct the current research in Turkey. Also we aimed to evaluate the effect of immigration on adverse perinatal outcomes, comparing the obstetric results of a native population and an immigrant population, and focusing on relevant indicators of perinatal health. Methods. Information from the hospital database of pregnant women who had vaginal or cesarean delivery was evaluated. The patients were divided into two groups, native women and immigrant women, according to their ethnic origin. Adverse perinatal outcomes were compared between groups using multivariate regression models. Adjusted odds ratio (aOR) and 95% confidence interval (CI) were calculated. Results. A total of 6311 patients were evaluated, of which 4271 were classified as native and 2040 were classified as immigrants. Mean hemoglobin level before delivery was significantly lower in the immigrant group. Preterm delivery (aOR: 1.41; 95% CI: 1.19–1.65), stillbirth (aOR: 1.88; 95% CI: 1.09–3.23), red blood cell transfusion requirement (aOR: 3.12; 95% CI: 2.02–3.98), unplanned birth rates before hospital arrival (aOR: 2.25; 95% CI: 1.53–3.31), and postpartum infection rates (aOR:2.12; 95% CI: 1.48–3.08) were significantly increased in the immigrant group compared with native group, even considering adjustment for potential confounders. Conclusion. The immigration may be an important and independent risk factor for some adverse maternal and neonatal outcomes. [ABSTRACT FROM AUTHOR]

Objective Despite heterogeneity among Pacific Islanders, most studies aggregate them regardless of origin. Thus, limited information is available about perinatal outcomes among various subgroups of Pacific Islanders in the United States, including immigrants from the Republic of the Marshall Islands. We sought to evaluate perinatal outcomes among Marshallese women. Methods We conducted a cross-sectional study of women with at least one singleton live birth between 1997 and 2013 in two Arkansas counties using birth certificate data from the Arkansas Department of Health. Unadjusted and adjusted prevalence ratios (PR) and 95% confidence intervals (CI) were calculated from modified Poisson regression models. Results Of the 91,662 singleton births in both counties during the study period, 2488 were to Marshallese women. In adjusted analyses, Marshallese women had higher prevalence of "other medical risk factors" (PR = 1.47; 95% CI 1.30, 1.65) than NH White women. Marshallese women had higher rates of precipitous labor and fetal distress during labor compared to NH White women (PR = 2.65; 95% CI 2.22, 3.17 and 1.89; 95% CI 1.62, 2.21, respectively). Marshallese were also more likely to have tocolysis (PR = 1.43; 95% CI 1.16, 1.76), forceps (PR = 1.68; 95% CI 1.16, 2.43) or vacuum (PR = 1.89; 95% CI 1.60, 2.22) used in delivery and cesarean section (PR = 1.13; 95% CI 1.01, 1.27). Marshallese infants had higher rates of anemia (PR = 3.10; 95% CI 2.01, 4.77), birth injury (PR = 2.13; 95% CI 1.50, 3.03), assisted ventilation < 30 min (PR = 2.11; 95% CI 1.64, 2.71), preterm birth (PR = 1.67; 95% CI 1.50, 1.83), and small-for-gestational age (PR = 1.25; 95% CI 1.12, 1.39) than NH White infants. Conclusions Marshallese women and infants had higher rates of adverse perinatal outcomes compared to their NH White counterparts. Additional studies are needed to determine if perinatal outcomes among the Marshallese differed from other Pacific Islander subgroups. [ABSTRACT FROM AUTHOR]

Objectives In this study we aimed to investigate foetal and maternal pregnancy outcomes from a large multicentre cohort of women diagnosed with MCTD and anti-U1RNP antibodies. Methods This multicentre retrospective cohort study describes the outcomes of 203 pregnancies in 94 consecutive women ever pregnant who fulfilled the established criteria for MCTD with confirmed U1RNP positivity. Results The foetal outcomes in 203 pregnancies were as follows: 146 (71.9%) live births, 38 (18.7%) miscarriages (first trimester pregnancy loss of <12 weeks gestation), 18 (8.9%) stillbirths (pregnancy loss after 20 weeks gestation) and 11 (5.4%) cases with intrauterine growth restriction. Maternal pregnancy outcomes were as follows: 8 (3.9%) developed pre-eclampsia, 2 (0.9%) developed eclampsia, 31 (15.3%) developed gestational hypertension and 3 (1.5%) developed gestational diabetes. Women with MCTD and aPL and pulmonary or muscular involvement had worse foetal outcomes compared with those without. Moreover, we report a case of complete congenital heart block (0.45%) and a case of cutaneous neonatal lupus, both born to a mother with positive isolated anti-U1RNP and negative anti-Ro/SSA antibodies. Conclusion In our multicentre cohort, women with MCTD had a live birth rate of 72%. While the true frequency of heart block associated with anti-U1RNP remains to be determined, this study might raise the consideration of echocardiographic surveillance in this setting. Pregnancy counselling should be considered in women with MCTD. [ABSTRACT FROM AUTHOR]

Background Data on the relationship between bariatric surgery and risk of birth defects are conflicting. Objectives We studied the association of bariatric surgery with birth defects in future pregnancies in a large cohort of women. Methods We carried out a retrospective cohort study of 2,194,348 pregnancies that occurred between 1989 and 2016 in Quebec, Canada. We identified women who had bariatric surgery before pregnancy, and included nonobese women with no surgery as a comparison group. We estimated risk ratios (RRs) and 95% CIs for the associations between bariatric surgery and the risk of birth defects, using log-binomial regression models adjusted for maternal age, comorbidities, parity, whether there was a multiple birth, socioeconomic deprivation, and the presence of folic acid food fortification. Results In this study, 1845 deliveries were among women who had bariatric surgery before pregnancy (0.08%). Having bariatric surgery was associated with 1.20 times the risk of birth defects in later pregnancies (95% CI: 1.01, 1.43), compared with having no surgery or obesity. Obesity without having bariatric surgery was, in contrast, more weakly associated with birth defects (RR: 1.09; 95% CI: 1.07, 1.12). The association with bariatric surgery was greater for heart (RR: 1.47; 95% CI: 1.02, 2.12) and musculoskeletal defects (RR: 1.32; 95% CI: 1.02, 1.71). Associations were primarily present before folic acid food fortification was implemented (RR: 2.03; 95% CI: 1.41, 2.92), but not after (RR: 1.05; 95% CI: 0.86, 1.28). Conclusions Having bariatric surgery was a risk factor for birth defects, and particularly heart and musculoskeletal defects. After fortification, however, an association was no longer present. Future studies are needed to determine whether micronutrient supplementation underpins the difference in the changing results pre- and postfortification. [ABSTRACT FROM AUTHOR]

Background In sub-Saharan Africa, malaria in the first half of pregnancy is harmful for both the mother and her fetus. However, malaria in the first trimester of pregnancy, when women are usually not protected against malaria, has been little investigated. For the first time, we assessed the effects of malaria in the first trimester on maternal and birth outcomes using a preconceptional study design. Methods From June 2014 to March 2017, 1214 women of reproductive age were recruited and followed monthly until 411 became pregnant. The pregnant women were then followed from 5–6 weeks of gestation until delivery. Path analysis was used to assess the direct effect (ie, not mediated by malaria in the second or third trimester) of malaria in the first trimester on maternal anemia and poor birth outcomes. The cumulative effect of infections during pregnancy on the same outcomes was also evaluated. Results The prevalence of malaria infections in the first trimester was 21.8%. Malaria in the first trimester was significantly associated with maternal anemia in the third trimester (adjusted odds ratio 2.25, 95% confidence interval 1.11–4.55). While we did not find evidence of any direct effect of first trimester malaria infections on birth outcomes, their association with infections later in pregnancy tended to increase the risk of low birth weights. Conclusions Malaria infections in the first trimester were highly prevalent and have deleterious effects on maternal anemia. They highlight the need for additional preventive measures, starting in early pregnancy or even before conception. [ABSTRACT FROM AUTHOR]

Maternal mental health problems in the perinatal period incur significant human and economic costs attributable to adverse child outcomes. In response, governments invest in screening for perinatal depressive symptoms. Mother–infant relationship quality (MIRQ) is a key mechanism linking maternal perinatal mental health to child outcomes. Perinatal depressive symptoms are typically transient while personality style, including interpersonal sensitivity, is a more stable construct. We have demonstrated that antenatal interpersonal sensitivity independently predicted MIRQ at 12 months postpartum. Building on our previous work, the objective of this study was to examine the associations of antenatal interpersonal sensitivity and depressive symptoms with MIRQ 1 year postnatal. A sample of 73 women attending routine antenatal care, 61 (84%) from ethnically diverse populations, were studied across the perinatal period. At ⩽26 weeks, gestation interpersonal sensitivity and depressive symptoms were measured. At 12 months, postnatal mental health and MIRQ was assessed in 35 of the mother–infant dyads. We found no significant statistical association between antenatal interpersonal sensitivity and depressive symptoms with postnatal MIRQ. Interpersonal sensitivity (r = –.24) showed weak association with MIRQ. Depressive symptom scores were not associated (r =–.01). Maternal sensitivity assessment (MIRQ) using the CARE-Index identified low mean scores signifying low levels of maternal sensitivity (potential range 0–14; mean score = 6.3). We cautiously suggest that the findings raise questions about the presentation and assessment of perinatal mental health status among ethnically diverse populations and scoping of parenting support needs within this population. [ABSTRACT FROM AUTHOR]

Many countries have adopted abstinence guidelines for pregnant women, due to uncertainty around the risk of harm caused by small amounts of alcohol. There is a lack of research exploring frontline midwives' attitudes towards alcohol use during pregnancy and comparisons of practices in different countries. Sixteen semi-structured interviews were conducted with midwives working in Liverpool, England (n = 7) and Örebro County, Sweden (n = 9). Data were analysed inductively, using thematic analysis with thematic networks. The findings show that all midwives believed pregnant women should be advised not to consume any alcohol during pregnancy and there is a need to tailor their approach to the individual. A key concern among midwives in both countries was how to advise about alcohol exposure that occurs before the pregnancy is known to the woman. English midwives discussed the uncertainty around the risk of consuming small amounts of alcohol, whereas Swedish midwives believed any amount of alcohol was associated with risk. Discussing alcohol was viewed as part of the health professional's role, but routine questions for all women were perceived to aid discussions about alcohol. Future research should further explore the impact of wider social and political environment on midwives' attitudes around risks with prenatal alcohol use. [ABSTRACT FROM AUTHOR]

Women make choices throughout pregnancy and childbirth and interactions with healthcare providers are integral to the journey. Healthcare providers have the potential to advise, influence and support women in their choices as to where to give birth. The aim of this study was to examine Northern Ireland healthcare providers' attitudes and experiences of women choosing place of birth, independent of risk profile. A qualitative study design was used to undertake key informant interviews with healthcare providers who were involved in caring for women antenatally, intrapartum and postnatally. Seven midwives and five obstetricians were interviewed. These interviews were transcribed, coded and presented in themes. Emerging themes included: informed decision-making among pregnant women; understanding and judgement of risk; autonomy and choice; culture of control and fear; and human rights. Interviewees highlighted barriers to women being able to access their chosen place of birth because of legal concerns, cultural perception of birth, and lack of senior managerial support for those providing clinical care to women who are considered at risk of complications during pregnancy or birth. Proposed solutions include developing a human rights-based approach which is about health and not isolated pathologies and focuses on empowering women, and not merely avoiding maternal morbidity or mortality. [ABSTRACT FROM AUTHOR]

Background: Placental elasticity varies in different diseases. Our objective was to evaluate placental elasticity using point shear wave elastography (pSWE) in pregnancies with intrauterine growth restriction (IUGR). Methods: A total of 66 pregnant women with IUGR and 81 healthy pregnant women were enrolled. Placental elasticity was measured using the transabdominal pSWE method. Ten measurements were made, and the mean was accepted as the mean placental elasticity value in each case. The results for IUGR pregnancies and controls were compared. Results: The mean pSWE values were significantly higher in pregnancies with IUGR, which means that women with IUGR have stiffer placentas (P < 0.001). Furthermore, the pSWE values were significantly and positively correlated with Doppler indices and adverse perinatal outcomes. Conclusion: The pregnancies with IUGR had stiffer placentas than the healthy controls. The utilization of pSWE for placental elasticity may be useful in the diagnosis and management of IUGR as a supplement to the existing ultrasonography methods. [ABSTRACT FROM AUTHOR]

Complications of preterm birth (PTB) are the global leading cause of death in children younger than 5 years of age. Almost 15 million children are born prematurely in the world each year. Increasing evidence suggests that labor and delivery have many hallmarks of an inflammatory reaction, where complement activation has an active participation. As one of the most important components of inflammation, the role of complement during labor and PTB is becoming an attractive research target. The complement components C1q and C5b-9 are deposited on fetal membranes and release inflammatory mediators that contribute to uterine contractions, cervical ripening, cell chemotaxis, metalloproteinases production, membrane awaking and rupture, and it participates as a co-adjuvant in the onset and progress of labor. This article reviews a basic description of the complement system, its role in preterm birth and current concepts regarding its contribution in novel therapy strategies and new biomarkers. [ABSTRACT FROM AUTHOR]

Background: Recognizing the pervasive impact of popular media on reproductive-aged women, we sought to characterize the depiction of age-related fertility decline in widely consumed media. Materials and Methods: We performed a quantitative and qualitative analysis of top read print magazines targeting reproductive-aged women. Primary outcome measures include celebrity age at time of pregnancy, content related to assisted reproductive technology (ART) and donor gametes, and mention of risks related to pregnancy at advanced maternal age (AMA). Results: Four hundred sixteen magazine issues published between January 2010 and January 2014 included 1,894 headlines, photos, or text passages related to fertility. Fertility was highlighted on one-third of all magazine covers. Two hundred forty celebrities received at least one fertility-related depiction. The majority (56%) were of AMA; only two mentions of AMA-related obstetrical risks were included. Three of 240 subjects (1.25%) were reported as having used ART. Forty-five celebrities (33%) were at least 40 years old at the time of mention; 7 subjects >44 years were depicted as pregnant or having delivered a healthy infant, without mention of ART. Donor gametes received no mention. All 416 magazines (100%) contained at least 1 reference to contraception; only 10 magazines (2.4%) mentioned any form of ART. Conclusions: Widely consumed popular media downplays the impact of age on fertility. Magazines promote contraception contrasted with easily reachable fertility goals at advanced reproductive ages, with rare or no mention of ART, donor gametes, or AMA-related health risks. Magazine content may be a contributing source to the public's misconceptions about age-related fertility decline. [ABSTRACT FROM AUTHOR]

Although the cesarean section (C-section) is known as a lifesaving procedure, it can also increase the risk of maternal mortality and morbidity. This study was conducted to achieve two objectives: (1) determination of maternal near miss (MNM) indicators and pregnancy outcomes among women with a history of C-section and (2) investigation of the women's experience of near miss events during childbirth to provide a deeper understanding of the weaknesses of care delivery process. The present study was conducted using a prospective cross-sectional study using the World Health Organization (organ system dysfunction–based) criteria. All subjects were women at more than 22 weeks of gestation who gave birth in Ali ibn Abi Talib Hospital, Zahedan, Iran, and were referred to this hospital for childbirth or those within 42 days of pregnancy termination. Logistic regression was used to predict the risk factors for severe maternal outcomes (SMOs). Nearly 58% of all MNM cases were related to women with a history of C-section. The MNM ratio was estimated at 8.04 per 1000 live births. Moreover, the frequent causes of SMOs were reported as severe hemorrhage (58.3%), severe pre-eclampsia/eclampsia (27.8%), medical condition (8.3%), and sepsis or severe systemic infection (5.6%). Abnormally invasive placenta (61%) was the most common cause of severe hemorrhage. After adjustment for potential confounder variables, the hemoglobin level of <11 g/dl (odds ratio [OR] = 0.18, 95% confidence interval [CI] = 0.09–0.36) and place of residence (OR = 0.41, 95% CI = 0.19–0.90) remained as independent risk factors for SMOs in the final model of multivariate analysis. A risk assessment system is needed to diagnose and manage the risk factors for SMOs during prenatal care. In addition, there should be a continuous audit of the indication and number of C-sections performed across health facilities. • Fifty-eight percent of all maternal near miss (MNM) cases were related to women with a history of cesarean section. • Abnormally invasive placenta was the most common cause of sever hemorrhage. • Anemia and living in rural areas were the determinants of severe maternal outcomes. • Delay in providing care and harmful practices were contributed to MNM incidence. [ABSTRACT FROM AUTHOR]

Complement activation is essential for select physiologic processes during pregnancy; however, excess activation has been associated with an increased risk for preterm birth (PTB). African American (AA) women experience disproportionately higher rates of inflammation-associated PTB than other groups of women; thus, the purpose of this study was to explore the relationship between complement activation and perinatal outcomes among AA women. A plasma sample was collected between 8 and 14 weeks' gestation from a cohort of healthy AA women (N= 144) enrolled in a larger PTB cohort study. Medical record review was conducted to collect information on clinical factors (cervical length, health behaviors, gestational age at delivery). Multiple regression analysis was used to explore the relationships between complement marker (C3a/Bb) concentrations and the outcomes of interest after adjusting for baseline characteristics. C3a/Bb concentrations were not significant predictors of the gestational age at delivery, cervical length, or behavioral risk factors for PTB in this sample. Complement markers may not influence pregnancy outcomes among AA women in the same way as in predominantly white populations; however, more studies are needed to define complement dysregulation and the relationship with outcomes among AA women. [ABSTRACT FROM AUTHOR]

Aim: To describe changed epidemiological features of advanced maternal age (AMA) and to examine the effect of AMA on the risk for Cesarean section (CS) in a Chinese pregnant population. Methods: This retrospective single‐center cohort study investigated the changes of epidemiological features of AMA parturients with respect to the revised reproductive policy in China in 43 702 singleton deliveries with live birth at ≥28 weeks managed from January 2005 to December 2016. We also evaluated the pregnancy outcomes in different age groups and risk factors of CS with multivariate analysis. Results: In this 12‐year study period, the average maternal age increased from 28.5 to 30.2 years, and the proportion of AMA raised from 6.5% to 17.2%. AMA was significantly associated with increased risk of adverse pregnancy outcomes, and after adjustment for confounding factors, AMA remained a significant independent risk factor for CS. Furthermore, the effect of AMA in nulliparous women on the risk of CS was more significant than in multiparous women, while the history of previous CS (adjusted odds ratio 39.85) and interdelivery interval ≥10 years (adjusted odds ratio 1.52) also increased the risk of CS in multiparous women. Conclusion: AMA increased the risk of a number of adverse pregnancy outcomes, and was independently associated with increased risk for CS. The increasing number of AMA parturients with risk factors is likely to increase CS rate in China in the near future, thus it is imperative to reduce the rate of primary CS as a matter of policy. [ABSTRACT FROM AUTHOR]

Diabetes is one of the most common medical conditions complicating pregnancy. Both pre-existing diabetes and gestational diabetes are associated with increased risks to the mother and fetus. These risks can be reduced by improving pre-conception and antenatal care. Pre-conception planning and care is important to ensure women are taking high dose folic acid, to optimise glucose control, to review medications and to screen for and manage any complications. All women with either pre-existing diabetes or gestational diabetes should be reviewed by the antenatal team every 1-2 weeks throughout pregnancy. This is to optimise glucose control and to monitor fetal growth and development. Women with diabetes in pregnancy should receive an individualised care plan for delivery. The exact timing of delivery will depend on maternal glucose control, fetal growth and any other complications. Women diagnosed with gestational diabetes in pregnancy are at high risk of developing both gestational diabetes and type 2 diabetes in the future. After delivery, they should be offered a fasting plasma glucose at 6 weeks or a glycated haemoglobin (HbA1c) at 13 weeks to ensure that the gestational diabetes has resolved and an annual HbA1c. [ABSTRACT FROM AUTHOR]

Background: It is unclear that how prepregnancy body mass index (BMI), gestational weight gain (GWG), and gestational diabetes mellitus (GDM) affect pregnancy outcomes in -China. Thus, we explored how BMI, GWG, and GDM affect the risks of adverse pregnancy outcomes. Methods: We performed a retrospective, population-based study included all births in Xiamen, China, 2011–2018. Demographic data and pregnancy outcomes of 73,498 women were acquired from the Medical Birth Registry of Xiamen. Women were categorized into groups on prepregnancy BMI and GWG in order to assess the risk of pregnancy outcomes. Multivariable logistic regression was performed to evaluate risk factors. Results: Overall, 6,982 (9.37%) women were obese, and 8,874 (12.07%) women were overweight. Obese women are more vulnerable to cesarean delivery, preterm birth, large-for-gestational age (LGA), and macrosomia (crude OR [cOR] 2.00, 1.89–2.12; 1.35, 1.20–1.51; 2.12, 1.99–2.26; 2.53, 2.25–2.86, respectively, adjusted ORs 1.73, 1.62–1.84; 1.25, 1.10–1.42; 2.03, 1.90–2.18; 2.77, 2.44–3.16, respectively). Similar results were observed in overweight women (cORs 1.49, 1.42–1.57; 1.02, 0.91–1.15; 1.60, 1.50–1.70; 2.01, 1.78–2.26, respectively). Furthermore, women who gain weight in excessive group were 1.43, 2.06, and 2.16 times to deliver cesarean, LGA, and macrosomia, respectively. Additionally, GDM women were easily subjected to cesarean section, preterm birth, LGA, low birth weight, and macrosamia (cORs 1.52, 1.55, 1.52, 1.37, 1.27, respectively). Conclusions: Obesity prior to pregnancy, excessive GWG, and GDM were all associated with increased odds of cesarean, LGA, and macrosomia. Blood glucose and weight control before and during pregnancy are needed that may reduce the complications of pregnancy. [ABSTRACT FROM AUTHOR]

Background: To assess the influence of the time interval between pregnancy and the Roux-en-Y gastric bypass (RYGB) on maternal-infant complications. Methods: This is an analytical, longitudinal and retrospective study comprising 42 pregnant women who had previously undergone RYGB, subdivided according to the time interval between pregnancy and bariatric surgery: ≤12 months (G1), >12 and <24 months (G2) and ≥24 months (G3). Anthropometric variables of mothers, newborns and information on pregnancy complications were collected. Results: G1 was the group more likely to develop urinary tract infection, dumping syndrome and inadequacy of birth weight than G2. Pregnancy complications were similar and >80.0% both in the first 12 months and after 24 months of the RYGB and the smallest percentages occurred in the time interval of 12–24 months after it. In addition, the percentage of neonatal complications was the highest in G1 when compared to the other times studied. Conclusion: Our findings indicate less predisposition to maternal-infant complications in pregnancies occurring in the time interval of >12 and <24 months and suggest that pregnancy after 24 months can be as harmful as pregnancies occurring before the first 12 postoperative months, since a great catabolism occurs at this time as it has been shown in the literature. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to assess maternal and perinatal outcomes of twin pregnancies with single fetal demise in terms of chorionicity and fetal death time. Material and Methods: All deliveries between January 2008 and July 2015 were reviewed retrospectively and 85 twin pregnancies with single fetal demise were included. These cases were grouped according to chorionicity and fetal death time. Results: The incidence of single fetal demise was 4.7%. The mean delivery week was later in the dichorionic group (34.16±4.65) than in the monochorionic group (31.1±3.83). The ratios of deliveries before the 34th gestational week were 71.4% in monochorionics and 35% in dichorionics. Monochorionics had a 13 times greater risk for having delivery before the 37th gestational week and a 4 times greater risk for having delivery before the 34th gestational week compared with dichorionics. Furthermore, monochorionics had a 7 times greater risk for having abruptio placenta compared with dichorionics. The newborn intensive care unit admission ratios were 61.3% in dichorionics and 85.7% in monochorionics. Also, monochorionics had a 3.7 times greater risk for admission to newborn intensive care unit compared with dichorionics. Conclusion: We recommend follow-up of twin pregnancies with single fetal demise in terms of premature birth, regardless of chorionicity. Also, close monitoring is recommended for monochorionic twin pregnancies with single fetal demise in terms of premature birth before 34 weeks of gestation, abruptio placenta, the need for neonatal intensive care, and respiratory distress syndrome. [ABSTRACT FROM AUTHOR]

Traffic-related air pollution has been linked to higher risks of infertility and miscarriage. We evaluated whether folate intake modified the relationship between air pollution and livebirth among women using assisted reproductive technology (ART). Our study included 304 women (513 cycles) presenting to a fertility center in Boston, Massachusetts (2005–2015). Diet and supplements were assessed by food frequency questionnaire. Spatiotemporal models estimated residence-based daily nitrogen dioxide (NO2), ozone, fine particulate, and black carbon concentrations in the 3 months before ART. We used generalized linear mixed models with interaction terms to evaluate whether the associations between air pollutants and livebirth were modified by folate intake, adjusting for age, body mass index, race, smoking, education, infertility diagnosis, and ART cycle year. Supplemental folate intake significantly modified the association of NO2 exposure and livebirth (P = 0.01). Among women with supplemental folate intakes of <800 μg/day, the odds of livebirth were 24% (95% confidence interval: 2, 42) lower for every 20-parts-per-billion increase in NO2 exposure. There was no association among women with intakes of ≥800 μg/day. There was no effect modification of folate on the associations between other air pollutants and livebirth. High supplemental folate intake might protect against the adverse reproductive consequences of traffic-related air pollution. [ABSTRACT FROM AUTHOR]

Objective  Excessive gestational weight gain (GWG) has been associated with adverse pregnancy outcomes, including increased risk of cesarean delivery (CD). Data are limited on associations between GWG and outcomes in women undergoing trial of labor after cesarean (TOLAC). We aimed to investigate whether appropriate GWG impacts TOLAC outcomes. Study Design  We performed a retrospective cohort study of women undergoing TOLAC at a single institution from May 2007 to April 2016. Women were divided into three groups based on GWG as compared with the Institute of Medicine recommendations. The primary outcome was successful vaginal birth after cesarean (VBAC). Secondary outcomes included various perinatal morbidity markers. Results  A total of 614 women underwent TOLAC, of whom 444 (72.3%) had successful VBACs. When grouped by GWG in accordance with the Institute of Medicine guidelines, 149 (24.3%) women had GWG below guidelines, 224 (36.5%) met guidelines, and 241(39.3%) exceeded guidelines. There was no difference in the rate of VBAC success among the three groups. We also found no differences in secondary perinatal morbidity markers. Conclusion  We found no difference in TOLAC success rates with excess GWG. Providers should not consider excess GWG a risk factor for failed TOLAC, even in obese patients. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Both inadequate and excessive gestational weight gain (GWG) have been shown to increase the risk of adverse pregnancy outcomes, but the risk profiles of GWG rate are unclear. We aimed to examine the associations between GWG rate in the second/third trimester and a spectrum of pregnancy outcomes. This study consisted of 14 219 Chinese rural nulliparous women who participated in a randomised controlled trial of prenatal micronutrient supplementation during 2006–2009. The outcomes included stillbirth, neonatal and infant death, preterm birth, macrosomia, low birth weight (LBW) and large and small for gestational age (LGA and SGA, respectively). GWG rate was divided into quintiles within each BMI category. Compared with women in the middle quintile, those in the lowest quintile had higher risks of neonatal death (adjusted OR 2·27; 95 % CI 1·03, 5·02), infant death (adjusted OR 1·85; 95 % CI 1·02, 3·37) and early preterm birth (adjusted OR 2·33; 95 % CI 1·13, 4·77), while those in the highest quintile had higher risks of overall preterm birth (adjusted OR 1·28; 95 % CI 1·04, 1·59), late preterm birth (adjusted OR 1·25; 95 % CI 1·00, 1·56), LBW (adjusted OR 1·48; 95 % CI 1·02, 2·15), macrosomia (adjusted OR 1·89; 95 % CI 1·46, 2·45) and LGA (adjusted OR 1·56; 95 % CI 1·31, 1·85). In conclusion, very low and very high GWG rates in the second/third trimester appear to be associated with adverse pregnancy outcomes in Chinese nulliparous women, indicating that an appropriate GWG rate during pregnancy is necessary for neonatal health. [ABSTRACT FROM AUTHOR]

INTRODUCTION This paper provides an up-to-date summary of the effects of smoking in pregnancy as well as challenges and best practices for supporting smoking cessation in maternity care settings. METHODS We conducted a qualitative review of published peer reviewed and grey literature. RESULTS There is strong evidence of the effects of maternal tobacco use and secondhand smoke exposure on adverse pregnancy outcomes. Tobacco use is the leading preventable cause of miscarriage, stillbirth and neonatal deaths, and evidence has shown that health effects extend into childhood. Women who smoke should be supported with quitting as early as possible in pregnancy and there are benefits of quitting before the 15th week of pregnancy. There are a variety of factors that are associated with tobacco use in pregnancy (socioeconomic status, nicotine addiction, unsupportive partner, stress, mental health illness etc.). Clinical-trial evidence has found counseling, when delivered in sufficient intensity, significantly increases cessation rates among pregnant women. There is evidence that the use of nicotine replacement therapy (NRT) may increase cessation rates, and, relative to continued smoking, the use of NRT is considered safer than continued smoking. The majority of women who smoke during pregnancy will require support throughout their pregnancy, delivered either by a trained maternity care provider or via referral to a specialized hospital or community quitsmoking service. The 5As (Ask, Advise, Assess, Assist, Arrange) approach is recommended for organizing screening and treatment in maternity care settings. Additionally, supporting smoking cessation in the postpartum period should also be a priority as relapse rates are high. CONCLUSIONS There have been several recent updates to clinical practice regarding the treatment of tobacco use in pregnancy. It is important for the latest guidance to be put into practice, in all maternity care settings, in order to decrease rates of smoking in pregnancy and improve pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Background: Sjögren's syndrome (SS) is an autoimmune connective tissue disease affecting the body's moisture-producing glands. Some studies have linked SS to adverse maternal/neonatal outcomes, but sample sizes have tended to be small, with few outcomes examined. The purpose of this study was to evaluate the effect of SS on pregnancy outcomes for mother and neonate using a large dataset. Methods: We carried out a retrospective cohort study of women who delivered between 1999 and 2014 using data from the Nationwide Inpatient Sample from the United States. SS categorization is based on ICD-9 coding. Baseline characteristics were compared in both groups and multivariate logistic regression was used to compare maternal and fetal outcomes of pregnancies in women with and without SS. Results: The prevalence of SS in our population was 1.34 cases/10,000 births, with the rate increasing over the study period. Women with SS tended to be older, Caucasian and to have pre-existing comorbidities. Births to women with SS were at greater risk of pre-eclampsia [odds ratio (OR) 1.63, 95% confidence interval (CI) 1.34–1.99]; premature rupture of membranes (OR 1.28, 95% CI 1.04–1.57); preterm delivery (OR 1.56, 95% CI 1.34–1.81); cesarean delivery (OR 1.29, 95% CI 1.17–1.41); and venous thromboembolic events (OR 3.71, 95% CI 2.57–5.35). Infants of women with SS were more likely to have intrauterine growth restriction (IUGR) (OR 3.00, 95% CI 2.46–3.65); and congenital malformations (OR 3.26, 95% CI 2.30–4.62). Conclusion: SS is a high-risk pregnancy condition associated with significant comorbidities and adverse maternal and fetal outcomes. Women with SS may benefit from increased surveillance during their pregnancies. [ABSTRACT FROM AUTHOR]

Background: The association between bacteriuria and adverse pregnancy outcomes has been extensively described. The current practice of screening all pregnant women for bacteriuria is challenged by recent studies. We aimed to evaluate pregnancy outcomes among women with a positive urine culture, to assess the significance of positive urinary nitrites in this setting. Methods: This was a retrospective cohort study at the emergency department (ED) of the Helen Schneider Hospital for Women, Israel, during 2014–2018. This included all gravida women >18 years old within the 20th week of pregnancy or above, admitted to the ED with diverse complains, who had urinalysis collected and subsequently had a positive urine culture. Clinical and obstetric characteristics were stratified by positive vs. negative nitrites in urinalysis. The primary outcome was premature delivery, and the secondary outcomes were a composite outcome of all recorded pregnancy complications and the significance of urinalysis in predicting urinary tract infection (UTI). Results: Overall, 874 pregnant women with a positive urine culture were included. Of them, 721 (79%) patients had a negative nitrite in their urine exam (NNU-group) and 153 (21%) had a positive nitrite in their urine exam (PNU-group). Escherichia coli was the most common pathogen, with significantly higher rates of growth in the PNU-group vs. NNU-group [129 (84.3%) vs. 227 (38.4%), P < 0.001]. Premature delivery was recorded with no association of symptomaticity or nitrite status. Among symptomatic women with classic symptoms of UTI, PNU was significantly associated with decreased risk for major peripartum complications [odds ratio (OR) with 95% confidence interval (CI) of 0.22 (0.05–0.94)]. Conclusion: Our findings support that PNU among symptomatic pregnant women with UTI-related symptoms was associated with lower risk of developing major adverse obstetrical outcomes. [ABSTRACT FROM AUTHOR]

Background Asylum seekers (AS) and undocumented migrants (UM) are at risk of adverse pregnancy outcomes due to adverse health determinants and compromised maternal healthcare access and service quality. Considering recent migratory patterns and the absence of a robust overview, a systematic review was conducted on maternal and perinatal outcomes in AS and UM in Europe. Methods Systematic literature searches were performed in MEDLINE and EMBASE (until 1 May 2017), complemented by a grey literature search (until 1 June 2017). Primary research articles reporting on any maternal or perinatal outcome, published between 2007 and 2017 in English/Dutch were eligible for inclusion. Review protocols were registered on Prospero: CRD42017062375 and CRD42017062477. Due to heterogeneity in study populations and outcomes, results were synthesized narratively. Results Of 4652 peer-reviewed articles and 145 grey literature sources screened, 11 were included from 4 European countries. Several studies reported adverse outcomes including higher maternal mortality (AS), severe acute maternal morbidity (AS), preterm birth (UM) and low birthweight (UM). Risk of bias was generally acceptable, although the limited number and quality of some studies preclude definite conclusions. Conclusion Limited evidence is available on pregnancy outcomes in AS and UM in Europe. The adverse outcomes reported imply that removing barriers to high-quality maternal care should be a priority. More research focussing on migrant subpopulations, considering potential risk factors such as ethnicity and legal status, is needed to guide policy and optimize care. [ABSTRACT FROM AUTHOR]