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Backgrounds: Many pregnant women suffer from more than one pregnancy complication. However, whether those women experienced a higher risk of adverse birth outcomes is unclear. This study aims to assess the association between the comorbidity of gestational diabetes mellitus (GDM) and hypertension disorders of pregnancy (HDP) and adverse birth outcomes. Methods: The data was from the Zhoushan Maternal and Child Health Hospital electronic medical recorder system (EMRS) between 2015 and 2022. Multivariate linear regression model was used to analyze the association of GDM, HDP, and comorbidity with birth weight and gestational age, respectively. Multiple logistic regression model was used to analyze the association of GDM, HDP, and comorbidity with adverse birth outcomes. Results: 13645 pregnant women were included. GDM+HDP was significantly associated with a higher risk of composite adverse neonatal outcomes (OR=1.82, 95%CI: 1.02-3.04), including preterm birth, placenta previa, and/or neonatal jaundice, a higher risk of small for gestational age (SGA) (OR=2.2, 95% CI: 1.24 3.92) and large for gestational age (LGA) (OR=2.33, 95% CI: 1.64 3.31) compared with the normal group. Further analysis showed that HDP diagnosed in the 21-27th week comorbid with GDM had the lowest gestational age at delivery (β= -1.57, P =0.0002) and birth weight (β= -189.57, P =0.0138). Moreover, combined hyperglycemia (CH) comorbid with HDP had the strongest association with reduced gestational age (β= -0.83, P =0.0021). Conclusion: Pregnant women suffering from both GDM and HDP had a higher risk of adverse neonatal outcomes; hence, the prevent and treatment of GDM and HDP, especially their comorbidity, are very important for pregnant women. [ABSTRACT FROM AUTHOR]

Particulate matter (PM) is considered an intrauterine toxin that can cross the blood-placental barrier and circulate in fetal blood, affecting fetal development, and implicating placental and intrauterine inflammation, and oxidative damage. However, the relationship between PM exposure and adverse pregnancy outcomes is still unclear and our aim was to systematically review toxicological evidence on the link between PM exposure during pregnancy and the development of gestational diabetes mellitus or hypertensive disorders of pregnancy, including gestational hypertension and pre-eclampsia. PubMed and Science Direct were searched until January 2022. Of the 204 studies identified, 168 were excluded. The remaining articles were assessed in full-text, and after evaluation, 27 were included in the review. Most of the studies showed an association between PM exposure and gestational hypertension, systolic and diastolic blood pressure, pre-eclampsia, and gestational diabetes mellitus. These results should be interpreted with caution due to the heterogeneity of baseline concentrations, which ranged from 3.3 μg/m3 to 85.9 μg/m3 and from 21.8 μg/m3 to 92.2 μg/m3, respectively for PM2.5 and PM10. Moreover, critical exposure periods were not consistent among studies, with five out of ten observational studies reporting the second trimester as the critical period for hypertensive disorders of pregnancy, and ten out of twelve observational studies reporting the first or second trimester as the critical period for gestational diabetes mellitus. Overall, the findings support an association between PM exposure during pregnancy and adverse pregnancy outcomes, highlighting the need for further research to identify the critical exposure periods and underlying mechanisms. [ABSTRACT FROM AUTHOR]

BackgroundsMany pregnant women suffer from more than one pregnancy complication. However, whether those women experienced a higher risk of adverse birth outcomes is unclear. This study aims to assess the association between the comorbidity of gestational diabetes mellitus (GDM) and hypertension disorders of pregnancy (HDP) and adverse birth outcomes.MethodsThe data was from the Zhoushan Maternal and Child Health Hospital electronic medical recorder system (EMRS) between 2015 and 2022. Multivariate linear regression model was used to analyze the association of GDM, HDP, and comorbidity with birth weight and gestational age, respectively. Multiple logistic regression model was used to analyze the association of GDM, HDP, and comorbidity with adverse birth outcomes.Results13645 pregnant women were included. GDM+HDP was significantly associated with a higher risk of composite adverse neonatal outcomes (OR=1.82, 95%CI: 1.02-3.04), including preterm birth, placenta previa, and/or neonatal jaundice, a higher risk of small for gestational age (SGA) (OR=2.2, 95% CI: 1.24 3.92) and large for gestational age (LGA) (OR=2.33, 95% CI: 1.64 3.31) compared with the normal group. Further analysis showed that HDP diagnosed in the 21-27th week comorbid with GDM had the lowest gestational age at delivery (β= -1.57, P=0.0002) and birth weight (β= -189.57, P=0.0138). Moreover, combined hyperglycemia (CH) comorbid with HDP had the strongest association with reduced gestational age (β= -0.83, P=0.0021).ConclusionPregnant women suffering from both GDM and HDP had a higher risk of adverse neonatal outcomes; hence, the prevent and treatment of GDM and HDP, especially their comorbidity, are very important for pregnant women.

Hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM) are the most common medical complications in pregnancy. Physical exercise is considered to be safe and beneficial during pregnancy. Moreover, pregnancy could be considered as an opportunity for healthcare providers to promote positive lifestyle behavior and optimize the well-being of pregnant women. Since there are few up-to-date reviews evaluating the role of exercise and the risks of developing obstetrical complications, we performed a review to investigate the effects of physical activity and exercise during pregnancy compared to a control group, focusing on the risk of development of HDP and GDM. We searched Medline and Web of Science, including only randomized controlled trials (RCTs) and systematic reviews. This review supports a beneficial effect of exercise and provides evidence that it significantly decreases the risk of HDP and GDM. [ABSTRACT FROM AUTHOR]

Objective: To discuss the points that still challenge low‐ and middle‐income countries (LMICs) and strategies that have been studied to help them overcome these issues. Methods: Narrative review addressing 20 years of articles concerning pre‐eclampsia morbidity and mortality in LMICs. We summarized evidence‐based strategies to overcome the challenges in order to reduce the pre‐eclampsia impact on perinatal outcomes. Results: Pre‐eclampsia is the first or second leading cause in the ranking of avoidable causes of maternal death, and approximately 16% of all maternal deaths are attributable to eclampsia and pre‐eclampsia. Considering the social and economic contexts, it represents a major public health concern, and prevention and early detection of pre‐eclampsia seem to be a major challenge. Reducing maternal mortality related to hypertensive disturbances depends on public policies to manage these preventable conditions. Early and continuous recognition of signs of severity related to hypertensive disorders during pregnancy and childbirth, self‐monitoring of symptoms and blood pressure, as well as preventive approaches such as aspirin and calcium, and magnesium sulfate, are lifesaving procedures that have not yet reached a universal scale. Conclusion: This review provides a vision of relevant points to support pregnant women in overcoming the constraints to healthcare access in LMICs, and strategies that can be applied in primary prenatal care units. Synopsis: Relevant points to support pregnant women in overcoming the constraints of access to healthcare in LMICs and strategies that can be applied in primary antenatal care units. [ABSTRACT FROM AUTHOR]

Objective. This study aims to investigate the risk factors associated with hypertension in pregnant women through a comprehensive literature review. Methodology. A retrospective bibliographic investigation was conducted by searching for relevant information in both Spanish and English languages using databases such as PubMed, Scielo, Medline, NIH, and Elsevier. Results. A total of 33 articles were included in this research, covering various aspects including definitions, etiology, classification, risk factors, and laboratory examinations related to hypertension during pregnancy. Conclusions. Hypertension during pregnancy is a pathological condition that not only affects the mother but also poses risks to the fetus. The mortality rate among pregnant women with hypertension is estimated at 35%. Failure to timely detect and diagnose hypertension can result in complications such as hemorrhages, early placental detachment, spontaneous abortions, or preterm births, which may lead to maternal and fetal mortality. Biochemical markers and regular blood chemistry or urine analysis tests can aid in the diagnosis of this condition. [ABSTRACT FROM AUTHOR]

One of the hallmarks of twin pregnancies is the slower rate of fetal growth when compared with singleton pregnancies during the third trimester. The mechanisms underlying this phenomenon and whether it represents pathology or benign physiological adaptation are currently unclear. One important implication of these questions relates to the type growth charts that should be used by care providers to monitor growth of twin fetuses. If the slower growth represents pathology (ie, intrauterine growth restriction caused uteroplacental insufficiency), it would be preferable to use a singleton growth chart to identify a small twin fetus that is at risk for perinatal mortality and morbidity. If, however, the relative smallness of twins is the result of benign adaptive mechanisms, it is likely preferable to use a twin-based charts to avoid overdiagnosis of intrauterine growth restriction in twin pregnancies. In the current review, we addressed this question by describing the differences in fetal growth between twin and singleton pregnancies, reviewing the current knowledge regarding the mechanisms responsible for slower fetal growth in twins, summarizing available empirical evidence on the diagnostic accuracy of the 2 types of charts for intrauterine growth restriction in twin pregnancies, and addressing the question of whether uncomplicated dichorionic twins are at an increased risk for fetal death when compared with singleton fetuses. We identified a growing body of evidence that shows that the use of twin charts can reduce the proportion of twin fetuses identified with suspected intrauterine growth restriction by up to 8-fold and can lead to a diagnosis of intrauterine growth restriction that is more strongly associated with adverse perinatal outcomes and hypertensive disorders than a diagnosis of intrauterine growth restriction based on a singleton-based chart without compromising the detection of twin fetuses at risk for adverse outcomes caused by uteroplacental insufficiency. We further found that small for gestational age twins are less likely to experience adverse perinatal outcomes or to have evidence of uteroplacental insufficiency than small for gestational age singletons and that recent data question the longstanding view that uncomplicated dichorionic twins are at an increased risk for fetal death caused by placental insufficiency. Overall, it seems that, based on existing evidence, the of use twin charts is reasonable and may be preferred over the use of singleton charts when monitoring the growth of twin fetuses. Still, it is important to note that the available data have considerable limitations and are primarily derived from observational studies. Therefore, adequately-powered trials are likely needed to confirm the benefit of twin charts before their use is adopted by professional societies. [ABSTRACT FROM AUTHOR]

Particulate matter (PM) is considered an intrauterine toxin that can cross the blood-placental barrier and circulate in fetal blood, affecting fetal development, and implicating placental and intrauterine inflammation, and oxidative damage. However, the relationship between PM exposure and adverse pregnancy outcomes is still unclear and our aim was to systematically review toxicological evidence on the link between PM exposure during pregnancy and the development of gestational diabetes mellitus or hypertensive disorders of pregnancy, including gestational hypertension and pre-eclampsia. PubMed and Science Direct were searched until January 2022. Of the 204 studies identified, 168 were excluded. The remaining articles were assessed in full-text, and after evaluation, 27 were included in the review. Most of the studies showed an association between PM exposure and gestational hypertension, systolic and diastolic blood pressure, pre-eclampsia, and gestational diabetes mellitus. These results should be interpreted with caution due to the heterogeneity of baseline concentrations, which ranged from 3.3 μg/m 3 to 85.9 μg/m 3 and from 21.8 μg/m 3 to 92.2 μg/m 3 , respectively for PM2.5 and PM10. Moreover, critical exposure periods were not consistent among studies, with five out of ten observational studies reporting the second trimester as the critical period for hypertensive disorders of pregnancy, and ten out of twelve observational studies reporting the first or second trimester as the critical period for gestational diabetes mellitus. Overall, the findings support an association between PM exposure during pregnancy and adverse pregnancy outcomes, highlighting the need for further research to identify the critical exposure periods and underlying mechanisms., (© 2023 the author(s), published by De Gruyter, Berlin/Boston.)