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Abstract: Objective: To determine the time interval from decision to result for fetal blood sampling (FBS) and the time from an abnormal pH result to delivery of the neonate. Study design: A prospective study of 107 consecutive attempts at FBS on 72 out of 1450 patients in labour from 1st April 2006 to 1st August 2006 at St James University Hospital in Leeds, England. Statistical analysis was performed by using nonparametric tests. Results: 107 attempts at FBS on 72 cases were reviewed. Overall the median time from decision to the result of FBS was 17min (interquartile range: 11–22min). 27% (19/70) of fetuses had abnormal results and the median time from result to delivery was 21min (interquartile range: 16–25min) in these cases. The median time from decision to perform FBS to delivery was 37min in cases where acidaemia was present. Body mass index (BMI) cervical dilatation and grade of operator were the factors which affected median time from decision to the result of FBS. Conclusion: The time from decision to the result of FBS should be considered in the delivery decision-making process in cases complicated by suspected fetal compromise. [Copyright &y& Elsevier]

Widespread legalisation of marijuana raises safety concerns for its use in pregnancy. This study investigated the association of marijuana use prior to and during pregnancy with pregnancy outcomes in a prospective cohort of 5588 nulliparous women from the international SCOPE study. Women were assessed at 15 ± 1 and 20 ± 1 weeks’ gestation. Cases [278 Preeclampsia, 470 gestational hypertension, 633 small-for-gestational-age, 236 spontaneous preterm births (SPTB), 143 gestational diabetes] were compared separately with 4114 non-cases. Although the numbers are small, continued maternal marijuana use at 20 weeks’ gestation was associated with SPTB independent of cigarette smoking status [adj OR 2.28 (95% CI:1.45–3.59)] and socioeconomic index (SEI) [adj OR 2.17 (95% CI:1.41–3.34)]. When adjusted for maternal age, cigarette smoking, alcohol and SEI, continued maternal marijuana use at 20 weeks’ gestation had a greater effect size [adj OR 5.44 (95% CI 2.44–12.11)]. Our data indicate that increasing use of marijuana among young women of reproductive age is a major public health concern. [ABSTRACT FROM AUTHOR]

Objective: To investigate compliance with risk-based screening for Gestational Diabetes Mellitus (GDM) in a nulliparous cohort. Design: A retrospective analysis of nulliparous women recruited to a prospective cohort, the Screening for Pregnancy Endpoints (SCOPE) study, was performed. Population included 2428 healthy nulliparous women with singleton pregnancies, recruited within Cork, Ireland; and Manchester, Leeds and London, United Kingdom. Compliance with risk factor screening for GDM was assessed in relation to the following risk factors: obesity, family history of diabetes and increased ethnic risk. GDM was diagnosed using an oral Glucose Tolerance Test (GTT) with locally employed diagnostic criteria. Statistical analysis was performed using Statistical Packages for Social Sciences (SPSS V22). Descriptive statistics are presented for the various baseline characteristics using numbers and percentages. Cross tabulation was used to compare relevant groups. When comparing group distributions Chi-square test was used. p-value <0.05 was considered statistically significant. Results: In the entire cohort of 2432 women, 27% (650 Women) had one or more identifiable risk factors as defined by National Institute of Health and Care Excellence (NICE) for GDM. Of those that had identifiable GDM risk factors according to the NICE guidelines, 395(60.8%) were appropriately screened. 253 (38.9%) had risk factors but were not screened. 261 (14.6%) had no GDM NICE risk factors but were screened with an oral GTT. Women with a risk factor that were screened with a GTT had an 8.9% (n=34) prevalence of GDM. Of those that were screened but did not have a risk factor 7.7% (n=20) were diagnosed with GDM. Overall, 2% (54 women) of the cohort had a diagnosis of GDM. Ethnicity was the risk factor most likely to be missed (n=55, 66.3%). The GTT test was completed within the recommended gestational window (24-28 weeks) 56.6% (n=371) of the time. Conclusion: This study highlights poor compliance with risk factor screening for GDM in nulliparous women. Further investigation into the underlying reasons is warranted as well as the implications for pregnancy outcome. Trial Registration Number: ACTRN12607000551493. [ABSTRACT FROM AUTHOR]

Background: Small-for-gestational-age (SGA) is a significant cause of morbidity and mortality, and there are currently few preventive strategies.Aim: The aim of this study was to investigate the relationship between maternal folic acid supplement (FAS) use pre-conception through to the second trimester, and small-for-gestational age (SGA) and birth size parameters.Study Design: Women were recruited as part of the Screening for Pregnancy Endpoints (SCOPE) international prospective multi-centre cohort study: New Zealand, Australia, United Kingdom and Ireland. Information on FAS use pre-conception, during the first trimester and at 15 ± 1 weeks' gestation was collected via interview administered questionnaire. Participants were followed through to delivery. Pregnancy outcome data and birth measurements were collected within 72 h of birth. Multivariable regression analysis was used to investigate relationships between FAS and outcomes, adjusting for maternal sociodemographic and lifestyle factors.Subjects: Nulliparous women with singleton pregnancies.Outcome Measures: SGA (<10th customised birthweight centile).Results: 5606 women were included. SGA prevalence was 11.3%. Pre-conception FAS was associated with a significantly lower risk of SGA: aOR = 0.82 (95% CI: 0.67-01.00 p = 0.047). Although the association between FAS at 15 weeks' gestation and SGA did not reach significance, FAS at 15 weeks was associated with a significantly higher customised birthweight centile (β 2.56 (95% CI: 0.87-4.26; p = 0.003). There was no significant effect of FAS on large-for-gestational-age births or head circumference.Conclusions: In this international cohort, FAS was positively associated with fetal growth, without increasing risks associated with LGA. Further studies are required to confirm whether continuing FAS beyond the first trimester might lower the risk of SGA. [ABSTRACT FROM AUTHOR]