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In recent decades, global rates of overweight and obesity have surged, posing significant health challenges, Maternal obesity is particularly concerning because of its potential adverse effects on women, foetuses, and children. The intrauterine environment plays a crucial role in shaping long-term health outcomes, with maternal factors significantly influencing childhood obesity and related health markers. This review synthesises current evidence on the associations between macrosomia, maternal weight, pregnancy weight gain, and offspring obesity risk. It explores how maternal weight status during pregnancy may impact a child’s susceptibility to obesity later in life, examining potential underlying mechanisms. By consolidating these findings, the review aims to deepen our understanding of the complex relationships between maternal health, prenatal factors, and childhood obesity. This knowledge can inform future research and public health strategies aimed at addressing this global health issue effectively. [ABSTRACT FROM AUTHOR]

This study reports the spectrum of discharge diagnoses in a national cohort of newborns admitted during a 3-month period to hospitals across Jamaica. The data were analyzed using measures of central tendency and risk assessed using odds ratio. Data on 1607 admissions were used to describe the spectrum of morbidity in hospitalized infants. Eight hundred and seven (50%) male and 754 (48%) female neonates were admitted. There was a 15% (240) readmission rate during the neonatal period. Infants of diabetic mothers were almost three times as likely to be admitted as infants whose mothers were not diabetic OR 2.89 (CI 1.96 − 4.13). Infants of women who were hypertensive were 1.5 times more likely to be admitted than infants of non-hypertensive women OR 1.56 (CI 1.56–1.9). The odds ratio for admission of an infant born to a woman delivere d by caesarean section was 2.1 (CI: 1.67–2.38). Premature infants constituted 50% of admissions. The most prevalent discharge diagnosis included presumed sepsis, respiratory distress and neonatal jaundice in both preterm and term neonates. In the extreme preterm infant respiratory distress syndrome was the most predominant discharge diagnosis. Multiple gestation was a significant risk for admission OR 2.7 (CI 1.8 to 3.9). Prematurity, multiple gestation, macrosomia, maternal diabetes, maternal hypertension and low 5 minute Apgar score < 7 were all found to be independent predictors of neonatal admission in a logistic regression model (p < 0.001). The recognition of the discharge morbidity is useful for future health planning for the most vulnerable in our population. [ABSTRACT FROM AUTHOR]

The heterogeneity of oral glucose tolerance test (OGTT) patterns during pregnancy remains unclear. This study aims to identify latent OGTT patterns in pregnant women and investigate the high-risk population for late-onset gestational diabetes mellitus (GDM). This study including 17,723 participants was conducted from 2018 to 2021. Latent mixture modeling was used to identify subgroups. Modified Poisson regression was performed to explore the relationship between OGTT patterns and late-onset GDM or adverse perinatal outcomes. Three distinct glucose patterns, high, medium, and low glucose levels (HG, MG, and LG patterns) were identified. The HG pattern represented 28.5% of the participants and 5.5% of them developed late-onset GDM. A five-fold higher risk of late-onset GDM was found in HG pattern than in LG pattern (relative risk [RR]: 5.17, 95% confidence interval [CI]: 3.38-7.92) after adjustment. Participants in HG pattern were more likely to have macrosomia, large for gestational age, preterm birth, and cesarean deliveries, with RRs of 1.59 (1.31-1.93), 1.55 (1.33-1.82), 1.30 (1.02-1.64) and 1.15 (1.08-1.23), respectively. Three distinct OGTT patterns presented different risks of late-onset GDM and adverse perinatal outcomes, indicating that timely monitoring of glucose levels after OGTT should be performed in pregnant women with HG pattern. [ABSTRACT FROM AUTHOR]

The effect of hepatitis B virus (HBV) replication during pregnancy on the outcomes of pregnancies remains to be elucidated. This study aimed to investigate the association between HBV replication and adverse maternal and infant outcomes. We retrospectively analysed the clinical data of 836 pregnant inpatients with hepatitis B surface antigen positivity who delivered at two provincial tertiary grade A hospitals in the Fujian province between June 2016 and October 2020. The incidence of intrahepatic cholestasis of pregnancy, hypertensive syndrome complicating pregnancy, gestational diabetes mellitus, preterm birth, macrosomia, growth restriction, and vaginal infections did not differ in the HBV replication and non-replication groups (p > 0.05); however, the rates of caesarean section (p = 0.017; OR, 1.423; 95% CI, 1.065–1.902) and neonatal jaundice (p < 0.001; OR, 2.361; 95% CI, 1.498–3.721) were higher in the replication group than that in the non-replication group. After using propensity score analysis to adjust for alanine transaminase and aspartate aminotransferase levels in both groups, the replication group was still found to have an increased risk for caesarean section (p < 0.001; OR, 2.367; 95% CI, 1.668–3.359) and their infants had higher rates of neonatal jaundice (p < 0.001; OR, 12.605; 95% CI, 4.456–35.656). Our findings contribute to a better understanding of the association between maternal HBV replication status and perinatal outcomes. Pregnant women with HBV replication face an increased risk of caesarean section, and their infants appear to have a higher risk for neonatal jaundice. [ABSTRACT FROM AUTHOR]

To analyze pregnancy outcomes of women with one abnormal value (OAV) during oral glucose tolerance test (OGTT) or OGTT-intolerance, compared with gestational diabetes mellitus (GDM) and normal glucose tolerance (NGT) pregnant women, according to whether they received any health intervention or not. An observational retrospective study was designed including pregnant women who gave birth at Hospital del Mar, Barcelona (Spain) during December/2014–July/2018. Baseline characteristics, pregnancy outcomes and health interventions were obtained from a database collected previously for other study. Inclusion criteria were singleton pregnancies with OAV or OGTT-intolerants who gave birth at the Hospital. GDM screening followed a two-step approach: 50 g O'Sullivan test and 100 g 3-hour OGTT if the former was abnormal. From a total of 2,662 pregnancies, 326 (12.2%) had GDM, 87 OAV (3.3%), 65 OGTT intolerance (2.4%) and 2,184 were NGT women. First trimester HbA1c in both OAV and OGTT-intolerant women was significantly higher than in NGT group, and significantly lower than in GDM pregnants. No differences in obstetric outcomes were found between OGTT-intolerants and NGT/GDM groups. Treated OGTT-intolerants had greater gestational age at delivery than non-treated ones (weeks, 39.6 ± 1.2 vs 38.0 ± 4.0, respectively). In OAV women, significant differences were observed in newborns' birthweight (g, 3227.3 ± 500.8 vs 3351.1 ± 436.7, vs GDM) and gestational age at birth (weeks, 38.7 ± 1.8 vs 39.3 ± 1.9, vs NGT), but not in macrosomia/pre-eclampsia. No differences were found according to treatment in OAV. OAV and OGTT-intolerants account for a third of pregnant women referred to Diabetes Unit. Their rates of preterm birth, pre-eclampsia and macrosomia were not different from NGT or GDM women. [ABSTRACT FROM AUTHOR]

To establish and verify a model for labour dystocia occurring in the active phase, this study retrospectively analysed the clinical data of primiparas with singleton cephalic full-term foetuses, who had delivered after a trial of labour. The Chi-square test, t-test, Mann–Whitney U test and multivariate logistic regression analysis were used for statistical analysis. Based on the model a nomogram was established using the R programming language. Multivariate logistic regression analysis showed that the foetal abdominal circumference, premature rupture of membranes (PROM), prolonged latent phase, foetal station and foetal position at the early stage of the active phase were independent factors influencing labour dystocia occurring in the active phase. The established model could effectively and accurately support clinicians in the early identification of labour dystocia to improve maternal and infant outcomes. What is already known on this subject? Labour dystocia occurring during the active phase of the first stage, is the most commonly diagnosed as labour aberration. Previous studies have suggested that maternal age, body mass index, macrosomia and abnormal foetal position are the independent risk factors for labour dystocia. However, only the risk factors were reported, and few prediction models were established. What do the results of this study add? This study uses data in the real world to establish a prediction model of full-term singleton primipara with labour dystocia occurring in the active phase by logistic regression analysis. Foetal abdomen circumference, PROM, prolonged latent phase, the foetal station and foetal position at the early stage of the active phase are independent factors influencing labour dystocia that occurs in the active phase. In addition, a nomogram is established as a visual graph to predict the probability of it. What are the implications of these findings for clinical practice and/or further research? The nomogram based on the predictive model discarded complicated calculations and presented an easy visual graph-based method to predict the probability of labour dystocia occurring in the active phase. It helps to introduce interventions that could reduce the CS rate and occurrence of adverse maternal and foetal outcomes to ensure the safety of mothers and infants. [ABSTRACT FROM AUTHOR]

This study explored the effect of individualised nutritional intervention on the postpartum nutritional status of patients with the growth and development of their offspring. This study included pregnant women with gestational diabetes mellitus (GDM) at Hangzhou Women's Hospital in 2019. At 42 days after childbirth, the HbA1c (95% CI: 0.44-0.56%, p < 0.001), the FPG (95% CI: 0.01–0.26 mmol/L, p < 0.05), 2HPG (95% CI: −0.01–0.73 mmol/L, p < 0.05) and TCH (95% CI: −0.34–0.00 mmol/L, p < 0.05) level of the control group were 0.14, 0.36, and 0.17 mmol/L higher than in the intervention group. There were no differences in TG and HGB between the two groups (all p > 0.05). There were significant differences in the number of macrosomia and neonatal weight between the two groups (both p < 0.05). Differences in WHZ after childbirth were not statistically significant between the two groups (all p > 0.05). Individualised nutritional intervention could improve blood glucose levels 42 days after childbirth and reduce macrosomia incidence in pregnant women with GDM. What is already known on this subject? Individualised nutrition intervention can improve blood glucose status and complications during pregnancy, thus improving pregnancy outcomes. What the results of this study add? Individual nutrition intervention improved the blood glucose and nutritional status of patients at 42 days postpartum, but there was no difference in the growth and development indicators of their offspring at 0–24 months. What the implications are of these findings for clinical practice and/or further research? Improve nutritional intervention programs for gestational diabetes, improve blood glucose during pregnancy and postpartum, to improve pregnancy outcomes and reduce the occurrence of type 2 diabetes and other metabolic diseases; Extend the monitoring range of the growth and development of the offspring of gestational diabetes, find the problems and timely carry out the nutritional intervention, to improve the development of the offspring. [ABSTRACT FROM AUTHOR]

Background: Macrosomia is a common disorder that occurs during pregnancy. We investigated the comprehensive metabolite profiles of pregnant maternal and fetal sera in normoglycemic macrosomia in a Chinese population. Methods: Forty pregnant women and their fetuses were included in the study (twenty macrosomia patients and twenty normal-weight controls). Maternal and umbilical cord serum metabolites were identified using ultra-performance liquid chromatography coupled with tandem mass spectrometry. Results: In total, 203 metabolites were identified. Lipids and lipid-like molecules were the predominant metabolites. Fifty-three metabolites with significant differences were obtained in the maternal samples. In the macrosomia group, the levels of docosahexaenoic acid, eicosapentaenoic acid, and arachidonic acid were significantly higher than those in the control group. Umbilical cord serum samples were obtained for 24 different metabolites. The maternal-fetal gradient of polyunsaturated fatty acids was decreased in the macrosomia group. Aconitic acid, citric acid, isocitric acid, 2-methylhexanoic acid, and 12-hydroxystearic acid were the common differential metabolites in the maternal and umbilical cord serum samples. Conclusion: There were obvious metabolic abnormalities in the sera of pregnant women and fetuses with macrosomia. Lipids and lipid-like molecules were the predominant differential metabolites but had different classifications in the maternal and umbilical cord serum. These results may provide new insights into the long-term metabolic disorders associated with macrosomia. [ABSTRACT FROM AUTHOR]

To establish and verify a nomogram model that can predict the risk of macrosomia in patients with gestational diabetes mellitus (GDM). Data of patients with GDM who delivered their babies in Shanxi Bethune Hospital between November 2020 and February 2022 were analyzed. Multifactor logistic regression analysis was used to screen the independent risk factors for macrosomia. The model was constructed by R software. The area under the receiver operating characteristic curve (AUC) and goodness-of-fit analysis were used to evaluate its efficiency and accuracy. The clinical application value was evaluated using the decision curve analysis (DCA). A total of 991 patients with GDM were enrolled for modeling. Multigravida, pre-pregnancy body mass index, family history of hypertension, abdominal circumference, and biparietal diameter were independent risk factors for macrosomia, and the prediction model was established. The AUC in the training and test set were 0.93 (0.89–0.97) and 0.90 (0.84–0.96), respectively, and the difference was not statistically significant. The DCA suggested that the model has a high clinical application value. The nomogram model for predicting macrosomia in patients with GDM was established. The model has certain accuracy and is expected to be a quantitative tool to guide clinical decision of delivery timing, individualized labor monitoring, and delivery mode. [ABSTRACT FROM AUTHOR]

In an effort to prevent the spread of coronavirus disease 2019 (COVID-19), governments restricted outdoor activities and imposed lockdown quarantine. This change in lifestyle probably affected individuals' eating habits and physical activity. To examine the effect of lockdown due to the COVID-19 pandemic on maternal antenatal weight gain, neonatal macrosomia, and other maternal and neonatal outcomes of women delivering at an academic medical center in Israel. A retrospective, two-period cohort study conducted at a university teaching medical center in Afula, Israel. The study period was between April and September 2020. This period signifies worsening in pandemic situations, during which citizens experienced strict prolonged lockdown measures. The parallel unexposed period (control period) was between April and September 2019. Singleton pregnancies delivered at >24 weeks were eligible. Primary outcome was incidence of macrosomia. Secondary outcomes included gestational weight gain, body mass index (BMI) at delivery, rates of gestational diabetes mellitus (GDM), mode of delivery, postpartum hemorrhage (PPH), and neonatal outcomes reflecting neonatal birth weight and condition at delivery. A total of 4,765 women were included, 2,442 in the study group and 2,323 in the control group. The incidence of macrosomia was significantly higher in 2020 (6.2%) than in 2019 (4.9%), (p =.048; OR: 1.29; 95% CI: 1.002– 1.65). Women gained significantly more weight (median 1 kg more), weighed more at delivery (median 1 kg), and had higher BMI at delivery in 2020 compared with those in 2019 (p <.01). The incidence of GDM was 9.5% and 8.5% in the study and control groups respectively (p =.26; OR: 1.12; 95% CI: 0.92–1.37). Greater percentage of women did not perform the glucose challenge test in 2020 (9.9%) compared with those in 2019 (7.5%) (p =.003, OR: 1.36; 95% CI: 1.11–1.67). The incidence of any hypertension related to pregnancy was significantly higher in 2020 compared to 2019 (5.8% vs 4.4% respectively, (p =.042; OR: 1.32; 95% CI: 1.02–1.71). The proportion of women who smoked during pregnancy was also significantly higher in 2020 than in 2019 (5.1% vs 3.7%, respectively, p =.02; OR: 1.40; 95% CI: 1.06–1.86). Delivery mode did not differ, while the incidence of PPH was significantly higher in 2020 than in 2019 (5.6% vs 3.4%, respectively, p =.001; OR: 1.65; 95% CI: 1.25–2.19). Neonatal condition at delivery was comparable. COVID-19-related lockdown was associated with the increased rate of macrosomic infants. This indirect effect of the pandemic is probably related to poorer maternal antenatal metabolic health status. Long-term consequences should be further examined. [ABSTRACT FROM AUTHOR]

The literature on the incidence of traumatic brain injury (TBI) during pregnancy is lacking. Furthermore, only studies with small sample size have analyzed the impact of TBI during pregnancy to maternal and fetal outcomes. Thus, we aim to report the incidence of TBIs during pregnancy and study the pregnancy outcomes using nationwide high-quality registers. This nationwide retrospective register-based matched cohort study utilized two national registers. All fertile-aged (15–49 years) women with a TBI hospitalization period during pregnancy were retrieved the Care Register for Health Care. Data were then linked with the data from the National Medical Birth Register (MBR). Propensity score matching was conducted according to maternal age during pregnancy, previous cesarean section (CS), maternal smoking status, maternal body mass index, and maternal gestational diabetes. The matching was conducted using the nearest neighbor methods with a caliber width if 0.15, and with a ratio 1:3 (patients/references). Adverse maternal and fetal outcomes were compared between patient group and reference group using Chi-squared tests. A total of 392 women having a TBI during pregnancy were found. The control group consisted of 722,497 women without TBI during pregnancy. Of the TBIs occurring during pregnancy, the most common types of TBIs were concussion (S06.0) (n = 359, 91.6%), diffuse traumatic brain injury (S06.2) (n = 11, 2.8%), traumatic subdural hemorrhage (n = 7, 1.8%), and unspecified intracranial injury S06.9 (n = 6, 1.5%). The incidence rates of pregnancies with a TBI have remained similar during pregnancy in Finland, peaking at 0.8 per 1000 pregnancies in 2016. The Chi-squared test showed higher rate for CS among women with TBI than for their matched references (21.4% vs. 15.5%, p =.008). Especially, women with TBI during 3rd trimester had higher rate for CS (29.0 vs. 15.0%, p =.016). The main findings of this study were that the incidence rates for TBI during pregnancy have remained similar during our study period (2004–2018). TBI during pregnancy, even a mild one, is associated with an increased rate for CS. Especially, TBI during the 3rd trimester was associated with high rate for CS, but the etiology behind this remains unknown. In addition, we found no evidence of difference in fetal outcomes, such as preterm birth, low birth weight, or need for intensive care unit. Future studies should focus on the indications for elective CS, and reasons for unplanned CS among women with TBI during pregnancy, as these could possibly provide important information on the effects of TBI on the course of childbirth. [ABSTRACT FROM AUTHOR]

To compare several maternal-fetal morbidities comparing the Institute of Medicine IOM 2009 recommendations (IOMR: 5–9 kg in all obese women) between women with adequate gestational weight gain (GWG) and Inadequate (less than 5 kg), and excessive those gaining more than 9 kg among obese women class I (30–34.9 kg/m2) and class II (35–39.9 kg/m2). South-Reunion University's maternity (Reunion Island, Indian Ocean). 21-Year-observational cohort study (2001–2021). Epidemiological perinatal database with information on obstetrical and neonatal risk factors. Cesarean sections, preeclampsia, means birthweight, rate of small (SGA) or large (LGA) for gestational age newborns and macrosomic babies (≥4 kg). Among the singleton term live births (37 weeks onward) we could define the pre-pregnancy body mass index and GWG in 85.9% of cases. The final study population focused on 10,296 obese women (7138 obesity class I − 30–34.9 kg/m2, 3158 obesity class II – 35–39.9 kg/m2). Concerning inadequate GWG (less than 5 kg), respectively for obese I and II, IOMR babies were heavier (plus 90 and 104 g, p <.001), were more prone to be LGA OR 1.61 and 1.69, p <.001, macrosomic OR 1.49 and 2.21, p <.0001, IOMR women had more cesarean sections OR 1.33, OR 1.45, p =.001, and for obese II a tendency for more term preeclampsia OR 1.83, p =.06. This study demonstrates that for obese women these IOMR (5–9 kg) are mildly but significantly too high if we consider obesity class I and obviously too high for obesity class II (35–39.9 kg/m2). [ABSTRACT FROM AUTHOR]

Fetal macrosomia may have serious effects on both mother and newborn, so it is important to correctly evaluate the fetal weight before delivery. Fetal routine biometry, height of the fundus of uterus, interventricular septal thickness seems to be very good but still not perfect. In our study the relation between fetal biventricular (AP) diameter and fetal foot length was elaborated in the 2nd and 3rd trimester of pregnancy. The analyzed group (n = 423 fetuses) was divided into 2 subgroups: a control group (n = 109 fetuses) with normal biometry, normal heart anatomy and normal cardiac function, no extracardiac malformation, no extracardiac anomalies, gestational age ranged from 17.5 to 37.1 weeks of gestation, born at term with birth weight 3000–3600 g, and a study group (n = 314 fetuses) with gestational age 17.5–39.5 weeks. Among the study group there were 20 patients (n = 20 fetuses) with macrosomia defined as a neonatal birth weight of greater than or equal to 4000 g. The control group was used to generate normograms on fetal AP, foot length and AP/Foot Index. The Statistica 13.3 and Excel 365 software were used to calculate the sensitivity, specificity, positive predictive value and negative predictive values. In control group, the mean biventricular fetal heart (AP) measurement was 23 mm (12.9 mm–38 mm), the mean foot length was 43 mm (24 mm–71 mm), and the mean AP/Foot Index was 0.52 (0.40–0.65). The value of the AP/Foot Index in the second trimester of the control group was 0.53, whereas the AP/Foot Index in the third trimester of pregnancy was 0.51. The use of standard fetal biometry resulted in the prediction of macrosomia in 20%, whereas the AP/Foot index in addition to standard fetal biometry enabled the detection of 65% of macrosomia. The AP/Foot Index higher than 0.52 has greater sensitivity and negative predictive value to detect macrosomia compared to standard ultrasound fetal biometry. [ABSTRACT FROM AUTHOR]

Background: Screening strategies for gestational diabetes mellitus (GDM), particularly early GDM, have traditionally relied upon the use of clinical risk factors (CRFs). Although commonly used in nonpregnant patients, HbA1c screening is not widely used despite reports of abnormal HbA1c values being predictive of GDM development. The aims of this study are to assess the utility of universal HbA1c screening in predicting GDM and to compare universal screening to targeted CRF-based screening for the diagnosis of GDM. Study design: This is a retrospective cohort study of patients undergoing universal HbA1c screening at <16 completed weeks gestation with a singleton pregnancy between December 2016 and April 2018 at a single urban tertiary care center. Patients with preexisting diabetes (HbA1c 6.5%) or patients who did not have glucose tolerance testing were excluded. Patients with HbA1c 5.7-6.4% underwent early two-step GDM screening. Positive screens were diagnosed with early GDM. Normal early screeners underwent repeat 3rd trimester screening. Clinical risk factors for early GDM screening at our institution prior to universal screening were history of GDM, body mass index (BMI) 40 kg/m², prior macrosomia (birth weight 4000 g) or stillbirth, and polycystic ovary syndrome. Multivariable regression was performed to assess the relationship between HbA1c and GDM. The predictive ability of universal HbA1c screening compared to that of CRFs was evaluated by testing for differences in the area under the curve (AUC) of receiver operating curves (ROCs). Results: One thousand nine hundred and fifteen patients met inclusion criteria. Two hundred and thirty-one (12.1%) patients had an elevated HbA1c 5.7%. Patients with elevated HbA1c were more likely to be older, Black, or obese compared with patients with normal HbA1c values. After adjusting for Black race, BMI, age, and public insurance, the odds of GDM development are 3.50 (95%CI 2.26-5.39) times higher among patients with HbA1c 5.7% compared to those with a normal HbA1c. Clinical risk factors for early glucose screening were present in 33% of patients with an elevated HbA1c. The AUC of CRF screening and HbA1c 5.7% was 0.72 and 0.75, respectively (p= .07), after controlling for Black race, BMI, maternal age, and insurance. Conclusions: An elevated HbA1c is associated with an increased risk of GDM. Universal HbA1c screening performs as favorably as CRF based screening for the prediction of GDM. [ABSTRACT FROM AUTHOR]

Aim: The early detection of small-for-gestational age (SGA) fetuses and newborns is pivotal in the prevention of perinatal mortality. Objectives: To compare the predictive capability of performing ultrasound-based estimated fetal weight (EFW) at 32 versus 36 weeks’ gestation on the detection rate of SGA fetuses and SGA newborns at delivery, and to find a better cutoff level to consider a fetus at risk of being born small. Material and methods: Nine hundred fifteen low-risk pregnant women were assessed at both 32 and 36 weeks’ gestation. EFW centile was calculated in both occasions. The rate of SGA fetuses was compared. SGA fetuses were considered when both abdominal circumference (AC) and EFW were below the 10th centile from a total of 488 delivered at our Hospital. Paired comparisons between ultrasound at 32 and 36 weeks’ gestation were done to predict SGA at delivery. Percentages of SGA fetuses were compared by chi-squared test. ANOVA test was used for comparing centiles among groups. Receiver operating characteristic (ROC) curve was used to find the best cutoff ultrasound centile to predict SGA at delivery. Statistical significance was previously set at 95% level (p < .05). Results: Ultrasound-based EFW at 32 weeks showed 23 cases of SGA (2.5%) while at 36 weeks this rate increased up to 4% (37/915) (p < .000001). When comparing both outcomes, 2.8% of those catalogued as adequate-for-gestational age (AGA) at 32 weeks were cases of SGA at 36 weeks. In addition, 47.8% of those diagnosed as SGA were not confirmed at 36 weeks. Only 12.3% of SGA neonates were identified at 32 weeks’ gestation ultrasound, while using the 36 weeks’ gestation approach this rate increased up to 30.9%. So, only a low proportion of SGA neonates were SGA fetuses at any of these two gestational ages. However, the area under the curve (AUC) at 36 weeks was as high as 0.86. Being a matter of cutoff rather than a matter of choosing the correct variable, ROC analysis showed that the best cutoff for prediction having the best sensitivity (0.80) with the best specificity (0.77) was 28th centile of EFW. This represents 24.9% of the studied women (228/915). Conclusions: In general, ultrasound at 36 weeks has better performance detecting SGA fetuses than ultrasound at 32 weeks and we suggest to definitively change from 32 to 36 weeks in order to increase the detection rate of SGA fetuses. Moreover, in order to detect those fetuses who will grow below the lower level of the normal range in the last month of pregnancy, we suggest that those with EFW below the 28th centile at 36 weeks should be rescanned later in pregnancy to identify prenatally as many cases as we can of SGA newborns. [ABSTRACT FROM AUTHOR]

Purpose: The association between maternal vitamin D concentrations and birth weight is controversial. We conducted a large-scale retrospective cohort study in southern China to explore this relationship. Methods: From July 2017 to April 2019, we enrolled 10,586 pregnant women and measured serum vitamin D [via 25-hydroxyvitamin D, 25(OH)D] in the second trimester using electrochemiluminescence immunoassays. The association between macrosomia and 25(OH)D was analyzed using logistic regression and ROC curve. Results: Average vitamin D concentration was 61.1 ± 20.2 nmol/L. Additionally, 31.1% participants had 25(OH)D concentrations <50.0 nmol/L, while 68.9% exhibited concentrations ≥50.0 nmol/L. Of the subjects, 3.2% of women delivered macrosomic infants (neonatal birth weight ≥4000 g) and 96.8% did not. The macrosomia group had lower vitamin D concentrations than the non-macrosomia group (59.5 ± 22.3 vs. 61.2 ± 20.1, p < .05). Approximately a third of each group had vitamin D < 50.0 nmol/L (non-macrosomia, 31.3%; macrosomia, 35.9%; p = .055). After adjusting for confounding variables, women with 25(OH)D ≥ 50.0 nmol/L had 24.3% lower macrosomia risk than women with 25(OH)D < 50.0 nmol/L (adjusted OR = 0.757, 95% CI = 0.599–0.956, p = .0193). The predictive accuracy of vitamin D concentrations for evaluating macrosomia risk was 0.667 area under the ROC curve. Conclusion: Maternal vitamin D levels are negatively correlated with macrosomia. Elevating vitamin D above 50.0 nmol/L may reduce macrosomia incidence. [ABSTRACT FROM AUTHOR]

Introduction Maternal obesity has been linked to adverse outcomes for mothers and their offspring, including, but not limited to gestational hypertension (gHTN), gestational diabetes (GDM), pre-eclampsia, fetal macrosomia, and emergency cesarean section. Recent investigations have also shown that obesity, as defined by a body mass index (BMI) ≥ 30, especially severe obesity (BMI ≥ 40), is a risk factor for both hospitalization and death from COVID-19. Objectives The objective of this study is to determine the prevalence and association of maternal obesity at delivery with adverse antenatal, intrapartum, and neonatal outcomes in a cohort of consecutive delivering patients at a tertiary care center in Iowa from May to September 2020. A secondary objective is to determine if maternal obesity has any relationship to past or current COVID-19 infection status at the time of delivery. This is a secondary analysis of a prospective cohort study to analyze obstetric outcomes among COVID-19 infected and uninfected patients. Methods We conducted a prospective cohort study using demographic and clinical data obtained from the electronic medical record. Excess plasma was collected from routine blood samples obtained at delivery admission to determine the seroprevalence of COVID-19 antibody using the DiaSorin and Roche antibody assays. Frequency variables were each calculated separately, and a comparison of maternal and neonatal outcomes was conducted using the generalized linear mixed modeling (GLMM) framework to account for varying distributions (normal and binary). Results 1001 women delivered during the study period and 89.7% met criteria for being overweight or obese; 17.9% met criteria for severe obesity. Women with obesity had 49.8% lower odds of possessing private insurance, and women with severe obesity were less than half as likely to plan to breastfeed at the time of discharge. Women with obesity of any kind had a significantly increased odds of GDM and gHTN, and an increased risk of an infant with macrosomia, hypoglycemia, and NICU admission. No significant association was found between BMI and COVID-19 infection or disease severity. Conclusion This study provides insight into obstetric complications facing women with obesity, especially those with severe obesity. This report serves to highlight potential challenges, such as insurance status and labor complications, that impact women of high BMI to a greater degree when compared to their normal-weight counterparts. [ABSTRACT FROM AUTHOR]

Background and aim Macrosomia is used to describe an infant born with excessively high weight, and it brings lots of unexpected risks in clinical work. Macrosomia causes considerable challenges for both physicians and pregnant women. Our objectives were to identify factors in gravida to be associated with the risk of macrosomia, to guide clinical prevention and treatment. Methods The study assessed risk factors of macrosomia by comparison with normal birth weight neonates, and a case-control study was conducted at Shandong Provincial Maternity and Child Healthcare Hospital. We followed and selected the relevant indicators of gravida who gave birth to macrosomia or normal infants, and applied statistical analysis to identify clinical indicators related to macrosomia. Results Maternal blood glucose (OR 3.88 (1.07, 14.15)), history of abnormal conception (OR 18.44 (1.05, 322.89)), situation of menarche (OR 13.53 (1.28, 142.66)), and menstrual cycle of gravida (OR 13.24 (1.17, 150.24)) were significant influencing factors of macrosomia, but did not appear in the univariate analysis. Adding gestational age at delivery (OR 4.00 (1.45, 11.09)), triglyceride (OR 0.01 (<0.01, 0.40)), and MBI (OR 46.35 (2.08, >99.99)) of pregnant women, the area under the curve (AUC) curve was drawn for forecasting the risk of macrosomia, and the value of AUC was 0.9174. The triglyceride blood index of pregnant women was the only one that was inversely proportional to the probability of giving birth to macrosomic infants. The low-density lipoprotein (LDL) (OR 0.29 (0.12, 0.72)) and total cholesterol (OR 0.39 (0.20, 0.75)) were important factors in univariate analysis, and both of them were negative correlation factors of macrosomia. All influencing factors in multivariate analysis were selected for drawing a receiver operating characteristic (ROC) curve, and the value of the AUC was 0.9174. Conclusions This analysis could therefore accurately predict the risk of pregnant women who would deliver macrosomic infants. [ABSTRACT FROM AUTHOR]

Purpose: To investigate and compare the causes of macrosomia and FGR fetuses, their ultrasound characteristics and the importance of their similar metabolic profile in intrauterine and extrauterine life. Materials and methods: We searched Pubmed/Google Scholar database up until 15 December 2020 using keywords. Out of the 70 matching results we selected 50 most representative and matching papers. Results: We found similar causes and metabolic profiles and in both conditions offspring are at increased risk of developing metabolic and cardiovascular diseases in the extrauterine life. Conclusion: Despite similarities of the maternal factors and fetal metabolic profile it is still unknown which of them has worse metabolic status during intrauterine and extrauterine life. [ABSTRACT FROM AUTHOR]

Objective: Small for gestational age (SGA) fetuses and neonates are of great interest, while those who are too big are much less studied. The aim was to analyze the classifiers described by ACOG “Fetal macrosomia” practice bulletin as predictors of adverse perinatal outcomes for overgrown fetuses and their mothers. Materials: From a database of 53,586 singleton term births, appropriate-for-gestational-age (AGA), large for gestational age (LGA), and macrosomic deliveries were selected. AGA served as a control. The crude and adjusted odds ratios (aORs) were calculated for large-for-gestationalage >90th centile, and macrosomia >4000 g, >4250 g, and >4500 g. Patients with and without diabetes were analyzed separately. Results: Macrosomia >4000 g performed poorer than other classifiers. LGA performed comparably to other definitions of macrosomia. Diabetes carries a severe risk of complications for overgrown neonates, but those non-diabetic also have increased risk. Conclusions: Definition of macrosomia as weight >4000 g should be reconsidered. LGA >90th centile should be used as a definition of fetal overgrowth along with other definitions of macrosomia. [ABSTRACT FROM AUTHOR]

Background Randomized trials reported no difference whether induction or expectant management is performed in non-diabetic women with large for gestational age babies but no tool has been validated for the prediction of high risk cases. Aim Assessing the performance of different growth curves in the prediction of complications. Methods Data from 1066 consecutive non-diabetic women who delivered babies ≥4000 g were collected. Logistic regression analysis was used to analyze the impact of the maternal variables on: instrumental delivery, shoulder dystocia (SD), perineal tears, cesarean section (CS), and postpartum hemorrhage. Intergrowth21 curves and customized Gardosi’s curves were compared in terms of prediction of adverse outcomes. Findings Induction of labor was performed in 23.1% cases. The rate of CS was 17%. Hemorrhage, fetal distress, and SD occurred in 2%, 1.3%, and 2.7% of cases, respectively. Induction was significantly associated with instrumental delivery (p < .001), CS (p = .001), third and fourth degree perineal tears (p = .031), and post-partum hemorrhage (p = .02). The cutoff of 90th percentile according to Intergrowth21 did not show significant performance in predicting CS, while the same cutoff according to the Gardosi curves showed an OR 1.92 (CI 1.30–2.84) (p = .0009). Discussion Gardosi curves showed a better performance in predicting the risk of CS versus Intergrowth curves. Induction is significantly associated with adverse outcome in non-diabetic women with LGA babies. [ABSTRACT FROM AUTHOR]

Purpose To derive a prescriptive sex-specific fetal growth standard and assess clinical management and outcomes according to sex-specific growth status. Materials and methods This was a secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b), a prospective observational study of 10,038 nulliparas from eight U.S. centers who underwent ultrasounds at 14–20 and 22–29 weeks with outcomes ascertained after delivery. From these, we selected a nested cohort of lower risk participants (excluded those with chronic hypertension, pre-gestational diabetes, suspected aneuploidy, and preterm delivery) to derive a sex-specific equation for expected fetal growth using fetal weights by ultrasound and at birth. We compared the male-female discrepancy in the rate of weight <10th (small for gestational age [SGA]) and >90th (large for gestational age [LGA]) percentiles between the sex-specific and sex-neutral (Hadlock) standards. Using the full unselected cohort, we then assessed outcomes and clinical management according to sex-specific SGA and LGA status. Results Overall, 7280 infants in the lower risk nested cohort were used to derive a sex-specific equation with fetal sex included as an equation intercept. The sex-neutral standard diagnosed SGA more often in female newborns (21% vs. 13%, p < .001) and LGA more often in male newborns (5% vs. 3%, p < .001). The sex-specific standard resolved these disparities (SGA: 9% vs. 10%, p = .23; LGA: 13% vs. 13%, p = .58). To approximate an unselected population, 1059 participants initially excluded for risk factors for abnormal growth were then included for our secondary objective (N = 8339). In this unselected cohort, 39% (95% CI 37.0–42.0%) of the 1498 newborns classified as SGA by the sex-neutral standard were reclassified as appropriate for gestational age (AGA) by the sex-specific standard. These reclassified newborns were more likely to be delivered for growth restriction despite having lower risk of morbidity (females) or comparable risk of morbidity (males) compared to newborns considered AGA by both methods. Of the 6485 newborns considered AGA by the sex-neutral standard, 737 (11.4%, 95% CI 10.6–12.2%) were reclassified as LGA by the sex-specific standard. These reclassified newborns had higher rates of cesarean for arrest of descent, cesarean for arrest of dilation, and shoulder dystocia than newborns considered AGA by both methods. None were reclassified from LGA to AGA by the sex-specific standard. Conclusion The Hadlock sex-neutral standard generates sex disparities in SGA and LGA at birth. Our sex-specific standard resolves these disparities and has the potential to improve accuracy of growth pathology risk stratification. [ABSTRACT FROM AUTHOR]

Aims Higher rates of fetal macrosomia may occur in infants of women with pre-gestational diabetes compared with non-diabetic controls. Antenatal predication of fetal macrosomia remains challenging. Ultrasound over-estimated fetal weight could result in over-classification of fetuses as macrosomic with corresponding inappropriate clinical interventions. Previously we had studied a measurement – the anterior abdominal wall measurement (AAW) – to predict fetal macrosomia in fetal estimation of weight. The purpose of the study was to study whether specific third trimester ultrasound measurements with measures of glycaemic control (HbA1c) predicted macrosomia in babies born to women with pre-gestational diabetes. In particular, a new variant of this measurement (fetal anterior abdominal wall thickness (AAW), abdominal circumference (AC) ratio: AAW:AC) was investigated. Methods This was a prospective cohort study in a tertiary referral maternity hospital. Serial growth scans including measurement of AAW and AC: AAW ratio was performed at 30, 33- and 36-weeks’ gestation. Birth-weight data was collected, and macrosomia was defined as >90th centile based on gestational age and gender of the baby. Serial HbA1c as measured at the first antenatal visit, 14, 20- and 36-weeks’ gestation were reported for this study. Results Of the 416 pregnancies analyzed, mean maternal age was 33.3 years. One in five women were primigravida’s. The mean birthweight was 3548 g (+/− 581 g), of which 142 (34%) babies were classified as macrosomic. The median gestational age at delivery was 383 weeks (314 − 402 weeks). There were 37 (9%) babies born preterm at <37 weeks’ gestation. Mean AC measurements in fetuses that would be born with macrosomia compared with those with a non-macrosomic birth weight were 282 mm vs. 266 mm at 30 weeks, 318.3 mm vs. 297 mm at 33 weeks and 350 mm vs. 325 mm at 36 weeks’ gestation (all p < .001). Mean AAW measurements in macrosomic fetuses compared with normal size fetuses were 3.7 mm vs. 3.3 mm at 30 weeks, 4.9 mm vs 4.3 mm at 33 weeks and 5.9 mm vs. 5.3 mm at 36 weeks’ gestation (all p < .001). The mean AC: AAW was 0.01 for both normal and macrosomic fetuses at 30 weeks. There was no clinical or statistical difference in AC:AAW ratios between non-macrosomic and macrosomic infants. Binary logistic regression showed that AC at 36 weeks was most predictive of macrosomia (76.5%), followed by AAW at 30 weeks (68.5%). Using a combination of HbA1c booking, 14, 20, 36 weeks and AAW 30, 33, 36 weeks and AC 30, 33, 36 weeks predicted macrosomia in 80.9%. The ratio of AC: AAW did not act as a useful antenatal clinical predictor of macrosomia at birth. Conclusions Abdominal circumference at 36 weeks was the single best predictor of fetal macrosomia. A combined model of HbA1c, AC and AAW was the best antenatal predictor of macrosomia, with intriguing clinical possibilities in the possible prevention of maternal and fetal complications of macrosomia. [ABSTRACT FROM AUTHOR]

Nutrition is the most important environmental factor in the development and progression of childhood obesity, which is very common in Arabic countries. Study of associated factors and nutritional status of childhood obesity. This was a comparative study of 50 obese children recruited from the outpatient department of the children's hospital, as well as 35 controls. The two groups were matched for gender and age. Anthropometric measurements have been undertaken. A food history as well as a frequency of consumption of certain foods were performed. There were 32 girls in obese group. Breastfeeding was more common in the control group (p = 0.04) but gestational diabetes, pregnancy weight gain, and macrosomia were greater in obese people (p = 0.002; 0.0001 and 0.004). Food diversification was early in the obese (p = 0.05). Mobile phone use was higher among obese people (p = 0.001) but time spent watching TV was not significant (p = 0.06). There was no significant difference between the two groups regarding: the number of hours of sleep, and the practice of sport. Sedentary lifestyle concerned 34% of obese versus 8.57% controls. Intense physical activity was practiced by 14.29% of the controls against any obese (p = 0.0001). The anthropometric parameters of the parents of the obese were more important than those of the controls. The average BMI of the obese was 25.63 Kg/m2.The frequency of consumption showed a more caloric and fat diet in obese group.The diet of the controls was richer in proteins and lipids but better distributed in MUFA and PUFA, but the energy intake of the obese was significantly higher (10,612 versus 4097 Kcal/d). The mineral and vitamin intakes of the obese were correct. The fight against childhood obesity essentially involves prevention and promotion of a good lifestyle. [ABSTRACT FROM AUTHOR]

To identify risk factors for postpartum hemorrhage (PPH) following cesarean delivery (CD). A retrospective study of all women who underwent CD in a university-affiliated tertiary hospital (2014–15). PPH was defined as any of the following: clinical PPH (≥1000 ml estimated blood loss), hemoglobin (Hb) drop ≥3 g/dl (the difference between pre-CD Hb level within a 24 h prior to the delivery) and post-CD (nadir level during the first 72 h after CD)) or the need for blood products transfusion. The characteristics of women with PPH following CD were compared to a control group of those with CD without PPH. Of the 15,564 deliveries during the study period, 3208 (20.6%) women met inclusion criteria, of them, 307 (9.6%) had PPH and 2901 (90.4%) served as controls. Women in the PPH group were younger (32.6 ± 5.3 vs. 33.5 ± 5.4, p =.006) and more often nulliparous (45.9% vs. 33.3%, p<.001) compared to the controls. However, there were no differences between the groups regarding the rate of multiple gestations, maternal diabetes mellitus, hypertensive disorders, polyhydramnios, and macrosomia. The rates of induction of labor (16.3% vs. 8.6%, p<.001) and urgent CD (47.9% vs. 32.0%, p<.001) were higher in the PPH group compared to the controls. In multivariate logistic regression, predictors for PPH following CD were (odds ratio, 95% confidence interval) urgent CS (1.57, 1.78–2.11, p =.002), CD duration (1.02, 1.01–1.03, p<.001), and the number of previous CDs (0.74, 0.62–0.90, p =.003). In women undergoing cesarean section, urgent CD, the duration of the surgery, and the number of the previous CD are associated with the risk of PPH and should be taken into consideration during the postpartum assessment. [ABSTRACT FROM AUTHOR]

To evaluate the performance of a local fetal weight curve based on the prediction for large gestational age (LGA) newborns in diabetic pregnant women and to compare it to reference curves established for other populations. A reference model for estimated fetal weight was created from a local sample of 2211 singleton low-risk pregnancies. The estimated fetal weight from 194 women with gestational diabetes mellitus was then plotted on this curve, and the results were compared to those obtained by Intergrowth 21st and Hadlock curves. The sensitivity of the proposed model to predict LGA fetuses was 55.6%, the specificity was 82.1%, and the accuracy was 74.7%. The sensitivity, specificity, and accuracy for the Intergrowth 21st curve were 46.3%, 87.9%, and 76.3%, respectively, and no statistically significant difference was observed compared to the proposed model. Conversely, significant differences were observed for the Hadlock curve, which presented a lower sensitivity (24.1%), higher specificity (97.1%), and similar accuracy (76.8%). The sensitivity of the proposed model was higher compared to the Hadlock curve for the screening of LGA newborns in diabetic pregnant women. However, no significant differences were observed in comparison to the Intergrowth 21st curve. [ABSTRACT FROM AUTHOR]

To investigate clinical and sonographic features associated with sonographic accuracy for the prediction of small for gestational age (SGA) and macrosomia at birth. The database of a tertiary medical center was retrospectively searched for women who gave birth at term to a singleton healthy neonate in 2007–2014 and underwent sonographic estimated fetal weight (sEFW) evaluation within 3 d before delivery. Fetal growth restriction (FGR) and SGA were defined as sEFW or birth weight <10th percentile for gestational age; macrosomia was defined as birth weight >4000 grams. Data on maternal age, parity, gestational age, fetal gender, presentation, placental location, diabetes, hypertension, and oligo/polyhydramnios were compared between pregnancies with a false-negative and false-positive diagnosis of SGA or macrosomia. Of the 5425 fetal weight evaluations, 254 (4.7%) deviated by >15% from the actual birth weight. Nulliparity, absence of diabetes, neonatal female gender, anterior placenta, lower birth weight, and oligohydramnios were associated with a high deviation. We identified 482 SGA neonates (8.9%) and 633 macrosomic neonates (11.7%). A false-positive diagnosis of FGR was associated with oligohydramnios, absence of diabetes, and posterior placenta, and a false-negative diagnosis, with older maternal age, nulliparity, and male gender. A false-positive diagnosis of macrosomia was associated with older maternal age, multiparity, polyhydramnios, anterior placenta, and lack of hypertensive complications, and a false-negative diagnosis, with diabetes, hypertension, oligohydramnios, and vertex presentation. The accuracy of sEFW is affected by clinical and sonographic pregnancy characteristics. Further analyses should focus on improving accuracy especially at the fetal weight extremes. [ABSTRACT FROM AUTHOR]

In the present study, we aimed to compare postprandial 90 minute measurements and postprandial 1 hour (PP1-HR) measurements for prediction of foetal growth disturbances and pregnancy complications. This was a prospective study conducted in Acıbadem Mehmet Ali Aydınlar University Altunizade Hospital in Department of Perinatology. The study group consisted of patients diagnosed with gestational diabetes. In each antepartum visit, the patients fasting plasma glucose as well as PP1-HR and 90 minute measurements were made. Perinatal and neonatal data were obtained from each patient. The rate of large for gestational age infants was increased in patients when either PP1-HR measurement above 140 mg/dl or postprandial 90 minute measurement above 165 mg/dl compared to patients with normal PP1-HR or postprandial 90 minute measurement. Preterm delivery rate was increased in patients with postprandial 90 minute measurement above 165 mg/dl but not in patients with PP1-HR measurement above 140 mg/dl. The optimal cut-off for postprandial 90 minute measurement was 165 mg/dl based on receiver operating characteristics curve. Our preliminary data show that postprandial 90 minute measurements are superior to PP1-HR measurements in predicting large for gestational age infants. What is already known on this subject? Gestational diabetes (GDM) is defined as any degree of glucose intolerance with onset or first recognition in pregnancy. Maternal hyperglycaemia has been linked to metabolic alterations in the foetus and thus brings about foetal macrosomia as well as other pregnancy complications such as preterm delivery and preeclampsia. What the results of this study add? The findings of the present study suggest that postprandial 90 minute predicted more cases of LGA infants than postprandial 1-hour (PP1-HR) measurements. In addition, the rate of preterm deliveries was found to be increased in patients with mean postprandial 90 minute measurements above 165 mg/dl compared to patients with postprandial 90 minute measurements below 165 mg/dl. However, the rate of preterm deliveries was similar in patients with elevated PP1-HR measurements and patients with normal PP1-HR measurements. What the implications are of these findings for clinical practice and/or further research? Our study is the first to investigate the usefulness of postprandial 90 minute in a prospective design. Our preliminary data show that postprandial 90 minute measurements are superior to PP 1 measurements in predicting LGA babies. It also correlates better with preterm deliveries. [ABSTRACT FROM AUTHOR]

This study investigated the effectiveness of maternal Body Roundness Index (BRI), Body Shape Index (ASBI), and Visceral Adiposity Index (VAI) in predicting foetal macrosomia and small for gestational age (SFGA) babies in obese and non-obese pregnant women. This prospective trial included 168 pregnant women (99 obese and 69 non-obese). A logistic regression model was used to identify the independent risk factors of foetal macrosomia and SFGA. BRI, waist/hip ratio, HbA1c and HOMA-IR were found to be significantly associated with increased macrosomia risk in obese women (OR = 1.469, % CI: 1.126–1.917, p =.005; OR = 4.289, % CI: 0.178–1.030, p =.012, OR = 6.277, %Cl: 1.233–31.948, p =.027, and OR = 1.393, %Cl: 1.060–1.832, p =.017). The present study indicates that first-trimester BRI and waist/hip ratio may be powerful determinants in predicting foetal macrosomia in obese pregnant women. What is already known on this subject? Obesity is a major risk factor for maternal and foetal morbidity and mortality. The rate of obesity continues to increase rapidly around the world. The accuracy of ultrasound in estimated foetal weight is reduced in obese pregnant women. The Body Roundness Index (BRI) is a new anthropometric index that shows body fat distribution. What do the results of this study add? Our results show that the BRI was an independent risk factor associated with foetal macrosomia in obese pregnant women. What are the implications of these findings for future clinical practice and/or further research? BRI measurements should be taken before pregnancy to help predict shoulder dystocia, GDM, FGR and foetal macrosomia in obese women. [ABSTRACT FROM AUTHOR]

To evaluate maternal and fetal outcomes in women with Gitelman syndrome (GS). Retrospective analysis of the clinical data of five patients with the clinical diagnosis of GS during pregnancy, who were admitted to Beijing Shijitan Hospital, Capital Medical University between 2013 and 2019, was conducted. Five women with GS during pregnancy who finally gave birth to a total of eight newborns have been included. Three cases were primiparas and two cases were multiparas. Two cases were diagnosed before pregnancy and three cases were diagnosed in first or second trimester. The primary treatment was oral or intravenous electrolytes supplement. Three patients delivered through the vagina, and shoulder dystocia occurred in one patient. Two patients delivered by cesarean section, with one because of symptom of limb weakness during the course of labor and the other owing to gestational diabetes with fetal macrosomia. Postpartum hemorrhage and urinary retention were not reported in these cases. In perinatal period all the infants had good outcome. The children, aged between six months and five years, were healthy and well-developed during follow-up. The maternal and perinatal outcome is usually favorable. We should pay attention to electrolyte examination in the first trimester in order to diagnose and manage the GS efficiently. Well-controlled patients with Gitelman syndrome can deliver through the vagina. [ABSTRACT FROM AUTHOR]

To assess the association between an abnormal 1-h 50-g glucose challenge test (GCT) followed by a normal 3-h 100-g glucose tolerance test (GTT) on fetal macrosomia and other adverse outcomes. MEDLINE, Cochrane, clinicaltrials.gov, and Google Scholar were searched from inception to March 2019. Any studies reporting adverse perinatal and/or maternal outcomes in women with an abnormal 50-g 1-h glucose challenge test (GCT) followed by a normal 3-h, 100-g glucose tolerance test (GTT) were included. Studies were critically appraised by three independent reviewers. Outcomes included fetal macrosomia, cesarean delivery, preeclampsia, birth weight, neonatal hypoglycemia, shoulder dystocia, NICU admission, respiratory morbidity, and low Apgar score. A random-effects model was employed to calculate pooled odds ratios (OR) for each outcome with their 95% confidence intervals (CI) and 95% predictive intervals (PI). We identified 30 studies comprising 18,067 patients with a normal 3-h GTT after an abnormal 1-h GCT (study group) and 117,091 patients with a normal 1-h, 50-g GCT (comparison group). Patients in the study group had an increased risk of macrosomia (OR 1.68, 95% CI 1.48–1.91, 27 studies, 132,027 patients), cesarean delivery (OR 1.39, 95% CI 1.30–1.48, 24 studies, 128,495 women), preeclampsia (OR 1.48, 95% CI 1.15–1.91, 17 studies, 110,930 patients), hypoglycemia (OR 1.43, CI 1.07–1.91) and shoulder dystocia (OR 1.52, 95% CI 1.09–2.12, 9 studies, 41,229 patients). Neonatal birth weight was significantly higher in the study group. The incidence of NICU admission, low Apgar score, and respiratory morbidity was similar in the two groups. Controlling for body mass index and 1-h glucose screen cut off did not alter these results. Even in the absence of gestational diabetes, patients who fail the GCT test are at mildly increased risk of maternal and neonatal morbidity including macrosomia, cesarean delivery, preeclampsia, and shoulder dystocia. [ABSTRACT FROM AUTHOR]

Introduction: One of the approaches to diagnose Gestational Diabetes Mellitus (GDM) is to detect two or more elevated values in 3-h Glucose Tolerance Test (OGTT) after an abnormal 50 gr Glucose Challenge Test (GCT). Patients with single elevated OGTT generally postulated as healthy; however, these patients could experience adverse perinatal and maternal issues more frequently. We aimed to investigate the maternal and neonatal outcomes of women with single abnormal OGTT primarily by comparing these women with healthy controls and GDM patients. Secondarily; Mean Platelet Volume (MPV), Platelet Distribution Width (PDW), Neutrophil to Lymphocyte Ratio (NLR) and Platelet to Lymphocyte Ratio (PLR) which were defined as novel inflammatory markers recently, were evaluated among these women within the first trimester and before delivery values whether these markers could use as a predictive marker of GDM.Materials and Methods: A retrospective cohort study was achieved in Bursa Yuksek Ihtisas Education and Training Hospital between January 2016 and April 2020. Patients who had GCT and OGTT at 24th-28th weeks of gestation were reviewed. Patients with GDM, women with single elevated OGTT value, and women with normal OCT values were recruited at the study as groups 1, 2, and 3 respectively. Maternal-neonatal outcomes and postpartum complications were reviewed from hospital registry system. Each complication were accumulated in a group entitled peripartum complication (a patient who had more than 1 complication for example preeclampsia and acute fetal distress was added in the peripartum complication group as one patient).The novel inflammatory markers were evaluated as NLR and PLR, and thrombocyte parameters as MPV and PDW were compared within the groups, and between the groups individually in the time period of first trimester and before delivery.Results: A total of 10,579 patients were screened with OCT, of these a total of 1718 patients' results were between 140 mg/dl and 199 mg/dl. The numbers of the women who diagnosed GDM and who had single elevated OGTT were 508 and 469 respectively. Numbers of the patients who gave birth in our hospital and whose data were reviewed adequately were 464 in groups 1, 406 in group 2, and 768 in group 3.Patients with single elevated OGTT had increased rates of peripartum complication, acute fetal distress (AFD), IUGR, preterm delivery, cesarean delivery rate, macrosomia, labor arrest, blood component transfusion, post-partum complication and stillbirth than healthy controls. Statistical analysis of comparison between group 2 and 3 has revealed that; patients with single elevated OGTT had more peripartum complication (p = .032; odds ratio [OR] = 1.2, 95% CI: 1.02-1.54), had more babies with macrosomia (p < .001; [OR] = 1.7, 95% CI: 1.2-2.4), had more postpartum complication (p = .040; [OR] = 3, 95% CI: 0.997-9.1), and had higher cesarean rates (p < .001; [OR] = 1.29, 95% CI: 1.1-1.4).Evaluating the first trimester CBC parameters between groups; only PLR differed statistically significant in GDM patients. These parameters before delivery were also analyzed PLR and NLR values did not differ between all groups, on the other hand; MPV values were higher and PDW values were lower in healthy controls comparing GDM and single elevated OGTT group.Conclusion: Patients with single elevated OGTT had a higher risk of maternal and neonatal consequences than women with normal OCT, which was comparable levels to patients with GDM. These patients should not be underestimated and could be classified as an individual diagnose such as "Borderline GDM." To intervene in these patients with dietary advice and lifestyle changes like exercise could decrease neonatal and maternal adverse outcomes. [ABSTRACT FROM AUTHOR]

To establish a feasible prediction model for gestational diabetes mellitus (GDM) with macrosomia based on risk factors analysis. A total of 1981 GDM pregnant women with macrosomia were enrolled in this retrospective study. The potential risk factors were revealed between the GDM women with and without macrosomia based on questionnaire and clinical data analysis. Then, prediction models including logistic regression (LR), decision tree (DT), support vector machine (SVM) and artificial neural networks (ANN) were constructed using these risk factors. Effect evaluation was performed based on model forecasting ability and model practicability such as accuracy, true positive (TP) rate, false positive (FP) rate, recall, F-measure, and receiver operating characteristic curve (ROC). The risk factors analysis showed that factors such as triglyceride (TG), high-density lipoprotein-cholesterol (HDL-c) and ketone body were risk factors for GDM with macrosomia. Then, the forecasting model was constructed, respectively. Based on these risk factors as variables, the overall classification accuracy of the four forecasting models was 86%. DT model had the highest overall classification accuracy. SVM model had advantages over the other three models in terms of TP rate. Among the comparison parameters including overall ROC curve, ANN model was the highest, followed by LR model. Among four forecasting models, ANN might be the optimal predication model, which had a certain practical value for the clinical screening of GDM women combined with macrosomia. Furthermore, HDL-c, TG, and ketone body might be potential risk factors for GDM with macrosomia. [ABSTRACT FROM AUTHOR]

Goals: Our aim in this study was to determine if the maternal neck and waist circumference measured in the first three months of pregnancy were effective in prediction of fetal macrosomia. Material and methods In this retrospective cohort study; body mass index, neck circumference (NC) and waist circumference (WC) was measured in low risk pregnant women at 11–13+6th weeks of pregnancy. Results Among the 361 women, 8% of newborns were over 4000 grams. The rate of fetal macrosomia increased with the increased NC and WC. In ROC analysis, optimum cutoff value of NC was >36.5 cm to predict fetal macrosomia with 68.97% sensitivity and 66.97% specifity and for WC it was >88 cm with 62.07% sensitivity and 61.26% specifity. Conclusion Risk of fetal macrosomia increased with the increased maternal NC and WC. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate thiol/disulfide homeostasis in both maternal and fetal compartment in the presence of fetal growth restriction (FGR).Materials and Methods: A prospective case-control study was carried out in women with FGR (n: 40) or normally growing fetus (n: 40). FGR was defined as estimated fetal weight below the 10th percentile for the gestational age. Maternal serum and fetal cord blood samples were collected from all participants and native thiol-disulfide exchanges were examined with automated method enabling the measurement of both sides of thiol-disulfide balance.Results: Native thiol, total thiol and disulfide amounts were decreased in the maternal serum and fetal cord blood of babies born to women with FGR (p < .05). The most sensitive marker was maternal native thiol (82.5, 95% confidence interval, 67.22-92.66%), while the maternal total thiol had highest specificity value (77.5, 95% confidence interval, 61.55-89.16%).Conclusions: Maternal and fetal serum thiol/disulfide profiles may use prediction of FGR severity and its neonatal outcome. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to detect the role of G protein-associated estrogen receptor (GPER) 1, corin, raftlin and estrogen in etiopathogenesis of intrauterine growth retardation (IUGR). Materials and methods: The present study was designed prospectively between January 2017 and May 2018. The study group included 32 patients with unexplained IUGR and 32 healthy pregnant women who gave birth at term among the patients who referred to obstetrics clinic of a tertiary reference hospital. Intrauterine growth retardation (IUGR) was accepted as birth weight below 10th percentile according to the estimated fetal weight. Exclusion criteria were as follows: the patients with renal or hepatic dysfunction, presence of any chronic disease, smoker patients, preeclampsia, acute or chronic inflammatory diseases, body mass index as <18 kg/m2 and >25 kg/m2, structural or chromosomal abnormality in fetus Estradiol (E2), estriol (E3), GPER, corin, and raftlin levels were analyzed in maternal serum and placental tissue homogenate through ELISA method. Results: Serum levels of GPER-1, raftlin, and E3 were significantly lower in IUGR group when compared with the control group (p <.05 for all). Serum corin and E2 levels were similar between two groups. GPER-1, E2, E3, raftlin, and corin levels in placental homogenate were found significantly higher in the control group (p <.05 for all). Conclusion: Although maternal, fetal, and placental causes take place in etiopathogenesis of IUGR, exact etiological factor is not revealed in majority of the IUGR cases. The present study serves as the first study revealing the role of the decrease in GPER-1 and raftlin in maternal serum and placental levels on the etiopathogenesis of IUGR. Furthermore, the decrease in placental corin expression of the cases with IUGR was detected first in the literature. The present study reveals a potential therapeutic use of GPER-1, corin, and raftlin for IUGR. [ABSTRACT FROM AUTHOR]

Foetuses with Sotos syndrome may manifest with increased NT, macrocephaly, polyhydramnios, foetal overgrowth, renal abnormalities, and central nervous system abnormalities (Thomas and Lemire 2008). In this study, we report on the identification of polyhydramnios and macrosomia on ultrasound in an euglycemic pregnancy, which leads to the prenatal diagnosis of Costello syndrome by using whole exome sequencing (WES). Prenatal overgrowth syndromes include relatively few conditions, that is, Sotos syndrome, Simpson-Golabi-Behmel syndrome, Beckwith-Wiedemann syndrome, and Costello syndrome. [Extracted from the article]

Background: Macrosomia at birth is associated with maternal hyperglycemia and leads to subsequent susceptibility to obesity, abnormal glucose metabolism, hypertension, and dyslipidemia in offspring. Epigenetic reprogramming has been reported to be involved in the development of human diseases caused by suboptimal environmental or nutritional factors. The study was aiming to explore epigenetic mechanism influences on macrosomic infants exposed to intrauterine hyperglycemia. We performed a genome-wide analysis of DNA methylation in cord blood from macrosomic infants born to women with gestational diabetes in order to identify genes related to fetal growth or early adipose tissue development.Methods: To analyze the epigenetic patterns in umbilical cord blood in gestational diabetes mellitus (GDM), we collected umbilical cord blood from women with GDM (mean pregestational BMI of 24.4 kg/m2 and mean neonatal birth weight of 4366 g) and normal glucose-tolerant women (mean pregestational BMI of 19.8 kg/m2 and mean neonatal birth weight of 3166 g). Differentially methylated genes in the GDM group were identified using the Infinium HumanMethylation450 BeadChip array.Results: A total of 1251 genes were differentially methylated compared to the controls (p < .01). The methylation microarray data showed that two specific CpG sites (cg12604331 and cg08480098) in the gene body of ARHGEF11 were significantly hypomethylated in the cord blood in macrosomic infants. Altered DNA methylation levels of ARHGEF11 were negatively correlated with glucose levels and neonatal birth weight.Conclusions: Exposure to adverse intrauterine environments can alter fetal development, such as by affecting the nutritional status of the fetus. Such exposure can also result in significant epigenetic modifications, including DNA methylation, which could serve as a potential marker for nutrition and metabolic conditions at the neonatal stage or even in the adult. [ABSTRACT FROM AUTHOR]

This cohort study aimed to determine the association between false-positive 50-g GCT and incidence of LGA and to evaluate predictive roles of third-trimester ultrasonographic examination. A total of 200 women with false-positive 50-g GCT and 188 women without GDM risks were enrolled. Third-trimester ultrasonographic examinations were offered. Rate of LGA during third trimester and at birth were compared between groups. Factors associated with LGA and diagnostic properties of third-trimester ultrasonography were evaluated. Incidence of LGA by third-trimester ultrasound and at birth were significantly higher in women with false-positive GCT (19.0% vs. 10.6%, p = .03 and 22% vs. 13.8%; p = .04). Factors associated with LGA included multiparity (adjusted OR 2.32, p = .01), excessive weight gain (adjusted OR 2.57, p = .01) and LGA by ultrasound (adjusted OR 9.79, p < .001). Third-trimester ultrasonography had 47.1% sensitivity, 92.1% specificity and LR + and LR- of 5.96 and 0.57 in identifying LGA infants.Impact statementWhat is already known on this subject? Women with abnormal GCT but normal OGTT (false positive GCT) might have some degree of glucose intolerance so that GDM-related outcomes could develop, including LGA, macrosomia, shoulder dystocia, and caesarean delivery. Roles of ultrasonography in the prediction of LGA and macrosomia has been reported with mixed results.What do the results of this study add? The results showed that the incidence of LGA, by third-trimester ultrasound and at birth, were significantly increased in women with false-positive GCT. Multiparity, excessive weight gain and LGA by third-trimester ultrasound significantly increased the risk of LGA. Third-trimester ultrasonography had 47.1% sensitivity, 92.1% specificity and LR + and LR- of 5.96 and 0.57 in identifying LGA infants.What are the implications of these findings for clinical practice and/or further research? More intensive behavioural and dietary interventions, together with weight gain control and monitoring, may be needed in women with false-positive GCT to minimise the risk of LGA. Third trimester ultrasonographic examination might be helpful to detect and predict LGA at birth and should be included into routine clinical practice. Further studies that are more widely generalisable are needed to elucidate the relationship between false-positive GCT and adverse pregnancy outcomes and to investigate the benefits of ultrasonographic examination in the prediction of LGA and macrosomia. [ABSTRACT FROM AUTHOR]

Objective: The results of the study on the relationship between obesity and cord blood irisin were far apart. The aim of this study was to explore the relationship between cord blood irisin levels and neonatal growth in China.Methods: A cross-sectional study of 400 neonates and their mothers was conducted in the obstetrics department of Shandong provincial hospital in China. Neonates were divided into a fetal macrosomia group and a normal birth weight group based on customized birth-weight standards and divided into non-high-ponderal index group and high ponderal index group based on ponderal index. Levels of irisin in umbilical cord blood were measured by enzyme-linked immunosorbent assay.Results: Irisin concentrations in the fetal macrosomia group were significantly higher than in the normal birth weight group (p = .032). Irisin levels in the high ponderal index group were significantly higher compared with the non-high-ponderal index group (p = .032). After adjustment for confounding variables, logistic regression analysis identified macrosomia affected factors include weight gained during pregnancy (OR = 1.15, p = .028), infant's sex (OR = 9.73, p = .001) and found that affected factors of high ponderal index include weight gained during pregnancy (OR = 1.08, p = .025), maternal age (OR = 1.10, p = .018). Compared with the reference category (<108.62 ng/ml), infants with a cord blood irisin level above 241.44 ng/ml had significantly elevated risk of macrosomia (OR = 8.57, p = .010) and had significantly elevated risk of high birth ponderal index (PI) (OR = 3.15, p = .002). A nonlinear relationship was observed between irisin levels and fetal macrosomia. The higher the concentration of irisin, the greater the risk of fetal macrosomia.Conclusions: We found that as the cord blood irisin increased, the risk of having fetal macrosomia was greater. Weight gained during pregnancy and high cord blood irisin levels were independent predictors of fetal adiposity. [ABSTRACT FROM AUTHOR]

The review presents some renewed data on the problem of optimal time and modes of delivery for women with various types of diabetes mellitus (DM 1 and 2, gestational diabetes). The necessity of making the universal delivery strategy algorithm for women with DM comes out of adverse outcomes high frequency, where the main cases are fetal macrosomia, fetal shoulder dystocia and perinatal mortality. Despite significant interest for this issue, there is still no common delivery tactics in the world for pregnant women with carbohydrate metabolism disorders. The main obstacle is evidence-based tests and meta-analysis insufficiency. So far, further studies are necessary to obtain high quality data concerning optimal terms and modes of delivery for women with DM. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to investigate the independent influence of maternal age on the risk of emergency cesarean section (CS) due to nonreassuring fetal heart rate or arrest disorder. Methods: This was a cross-sectional study on women with nulliparous pregnancies, who are attempting vaginal delivery at term and have a cephalic presentation without the indication of elective CS at the onset of labor. The primary outcome was the rate of emergency CS. Independent risk factors were elucidated using multivariate logistic regression analysis. Results: Of 3513 women, 541 (15.4%) delivered by emergency CS during a trial of vaginal delivery, with theses being due to nonreassuring fetal heart rate (N = 150) or arrest disorder (N = 391). In univariate analysis, both individual CS rate due to nonreassuring fetal heart rate or arrest disorder and total emergent CS rate increased with maternal age. The risk of emergency CS was also significantly higher when labor induction was performed (odds ratio (OR) 2.489, 95% confidence interval (CI) 2.043–3.033), while fetal weight was heavier (neonatal weight ≥3.5 kg; OR 2.396, 95% CI 1.956–2.934), and maternal BMI was higher (before pregnancy ≥25 kg/m2; OR 2.751, 95% CI 1.980–3.823, at delivery ≥28 kg/m2; OR 2.375 95% CI 1.915–2.946). Multivariate stepwise regression analysis showed a statistically significant increase in the risk of total emergency CS in mothers over 35 years of age, compared to that in women less than 30 years old (35–39 years group; adjusted OR 1.805 95% CI 1.347–2.418, ≥40 years group; adjusted OR 4.659 95% CI 2.709–8.013). CS due to nonreassuring fetal heart rate increased in mothers over 40 years of age (adjusted OR 5.354, 95% CI 2.386–12.017) and CS due to arrest disorder was also increased in mothers over 30 years of age (30–34 years group; adjusted OR 1.343, 95% CI 1.010–1.785, 35–39 years group; adjusted OR 1.906, 95% CI 1.357–2.679, ≥40 years group; adjusted OR 4.663, 95% CI 2.480–8.768). Similar to the result of univariate analysis, labor induction increased the risk of emergency CS (adjusted OR 2.241, 95% CI 1.828–2.747). Conclusions: Advanced maternal age is an independent risk factor of emergency CS due to nonreassuring fetal heart rate or arrest disorder during the trial of vaginal delivery. The risk of emergency CS was also increased when labor induction was performed. Therefore, the risk of emergency CS needs to be considered, especially when the labor induction is planned, in women aged 40 or more. [ABSTRACT FROM AUTHOR]

Objective: This study aims to estimate the prevalence and risk factors of macrosomia and LGA (large for gestational age) in non-GDM (gestational diabetes mellitus) pregnant women in Fuyang, Anhui Province of China.Methods: A large population-based cohort study was conducted among non-GDM pregnant women aged 18-45 years. Maternal sociodemographic data prior to pregnancy were collected using interviewer-administered standardized questionnaire. Maternal obstetrical delivery records and newborn hospital records were extracted from antenatal care booklets and hospital discharge abstracts. Logistic regression analysis was used to identify the predictors of macrosomia and LGA.Results: The incidence of macrosomia and LGA was 9.2 and 15.9%, respectively. Mothers ≥35 years of age (aOR 2.75, 95% CI 1.98, 3.80), male neonates (aOR 1.68, 95% CI 1.51, 1.89), overweight and obese (aOR 1.61, 95% CI 1.34, 1.92 and aOR 3.05, 95% CI 2.05, 4.56, respectively) were associated with increased risk of macrosomia. Compared with the less educated mothers, the educated mothers were more likely to have increased risk of macrosomia. IFA (iron and folic acid) supplements intake during pregnancy was more likely to deliver macrosomia or LGA (aOR1.32, 95% CI 1.08, 1.49 and aOR1.42, 95% CI 1.24, 1.61, respectively) as compared with no IFA supplements intake. SCr (serum creatinine concentration) >80 µmol/L was related to decreased risk of macrosomia (aOR 0.73, 95% CI 0.61, 0.86) and LGA (aOR 0.67, 95% CI 0.59, 0.77) as compared with normal range (44-80 µmol/L).Conclusions: There was a high prevalence of macrosomia and LGA in non-GDM pregnant women in China. Healthcare educations and reasonable body weight are necessary for pregnant women to prevent macrosomia and LGA. Pregnant women should be checked regularly and have the first prenatal visit as soon as possible. [ABSTRACT FROM AUTHOR]

Objective: To investigate the diagnostic value of glycated hemoglobin A1c (HbA1c) in detecting gestational diabetes mellitus (GDM).Methods: Pregnant women at gestational age 24 weeks or more, who had abnormal GDM screening test, were enrolled in this prospective study. A HbA1c assessment was performed at the same time of 3-h 100 g oral glucose tolerance test (OGTT). GDM was diagnosed according to the National Diabetes Data Group for a 3-h 100 g OGTT. Sensitivity and specificity of HbA1c were evaluated and pregnancy outcome were recorded in aspects of gestational age at delivery, preeclampsia, primary cesarean section rate, birth weight, fetal macrosomia, and neonatal intensive care unit admission.Results: One hundred fourteen women were enrolled. There were 35 women with GDM using NDDG criteria. The area under the curve of the receiver operating characteristic curve for HbA1c detection of GDM was 0.725 (95% confidence interval 0.621-0.829). Cut-off value of HbA1c was 5.8%. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 17.1, 100, 100, 73.2, and 74.6%, respectively. Pregnancy outcome in both groups in this study has no statistical significance.Conclusions: HbA1c values cannot replace OGTT for the diagnosis of GDM. However, HbA1c might be a useful tool to reduce the number of OGTT, associated costs and patient inconvenience. [ABSTRACT FROM AUTHOR]

Bivariate diagnostic meta-analysis was performed to evaluate the diagnostic value of symphysis-fundal height (SFH) for identifying large-for-gestational- age (LGA) (i.e. birth weight >90th centile according to gestational age) and macrosomia (i.e. birth weight >4000 g). Ten databases, e.g. PubMed (MEDLINE), were searched to include English-language studies providing true- and false-positive and true- and false-negative results for this identification. Study quality was assessed using the revised Quality Assessment of Diagnostic Accuracy Studies tool. Synthetic evidence from good quality studies suggested that SFH to identify LGA and macrosomia (n = 23 and 3, respectively) provided a low sensitivity (0.76 and 0.30, respectively), specificity (0.67 and 0.80, respectively) and diagnostic odds ratio (6 and 4, respectively) and 'neither exclusion nor confirmation' strategy (positive and negative likelihood ratios <10 and >0.1, respectively). In conclusion, there is no evidence that SFH is useful to identify LGA or macrosomia.Impact StatementWhat is already known on this subject? Synthetic evidence has shown that symphysis-fundal height (SFH) is not useful for the detection of low birth weight and small-for-gestational-age babies mainly in developing countries. In the present study bivariate diagnostic meta-analysis was carried out to evaluate the diagnostic value of SFH for identifying large-for-gestational age (LGA) and macrosomia.What the results of this study add? SFH to identify LGA and macrosomia provided a low sensitivity (0.76 and 0.30, respectively), specificity (0.67 and 0.80, respectively) and diagnostic odds ratio (6 and 4, respectively) and 'neither exclusion nor confirmation' strategy (positive and negative likelihood ratios <10 and >0.1, respectively).What the implications are of these findings for clinical practice and/or further research?There is no evidence that SFH is useful to identify LGA or macrosomia. Further studies are required to provide more generalisable findings to evaluate the identification of LGA or macrosomia and whether the results can be extrapolated toward the subpopulations that subgroup analysis did not evaluate in this meta-analysis. [ABSTRACT FROM AUTHOR]

Background: The diagnosis of gestational diabetes (GDM) has undergone several revisions. The broad adoption of the 2013 WHO criteria for hyperglycemia in pregnancy has increased the prevalence of GDM with no apparent benefit on pregnancy outcomes. The study aims to investigate the pregnancy outcomes in women with GDM diagnosed based on the WHO criteria compared to a control group; the impact of other confounders; and the difference in outcomes between GDM women who needed pharmacotherapy (GDM-T) and those who did not (GDM-D).Methods: This is a retrospective cohort study that included GDM women compared to normoglycemic controls between March 2015 and December 2016 in the Women's Hospital, Qatar.Results: The study included 2221 women; of which 1420 were normoglycemic, and 801 were GDM (358 GDM-D and 443 GDM-T). At conception, GDM women were older (mean age 32.5 ± 5.4 versus 29.6 ± 5.6 years, p<.001) and had higher prepregnancy BMI (mean BMI 32.2 ± 6.2 versus 28.2 ± 6.1 kg/m2, p<.01) compared to the controls, respectively. After correction for age, prepregnancy weight, and gestational weight gain (GWG); women with GDM had a higher risk of preterm labor (OR: 1.72; 95% CI: 1.32-2.23), large for gestational age (GA) (OR: 1.67; 95% CI: 1.22-2.29), neonatal ICU admission (OR: 1.57; 95% CI: 1.15-2.13), and neonatal hypoglycemia (OR: 3.22; 95% CI: 2.06-5.03). At conception, GDM-T women were older (mean age 33.3 ± 5.0 versus 31.5 ± 5.7 years, p<.001) and had higher BMI (mean BMI 32.9 ± 6.3 versus 231.2 ± 6.0 kg/m2, p=.01) compared to GDM-D, respectively. Metformin was used in 90.7% of the GDM-T women. Women in the GDM-T group had lower GWG/week compared to GDM-D (-0.01 ± 0.7 versus 0.21 ± 0.5 kg/week; p<.001). After correcting for age, prepregnancy weight and GWG; GDM-T had a higher risk of preterm labor (OR: 1.66; 95% CI: 1.20-2.22), and C-section (OR: 1.37, 95% CI: 1.02-1.85) and reduced risk of macrosomia (OR: 0.56; 95% CI: 0.32-0.96) and neonatal hypoglycemia (OR: 0.49; 95% CI: 0.28-0.82).Conclusion: In addition to hyperglycemia, the adverse effects of GDM on pregnancy outcomes are multifactorial and includes maternal age, maternal obesity, and gestational weight gain. Treatment with metformin reduces maternal weight gain, the risk of macrosomia and neonatal hypoglycemia compared to diet alone. [ABSTRACT FROM AUTHOR]

Objective: To determine key demographic and intrapartum antecedents predisposing to severe adverse neonatal outcome at term.Methods: This was a retrospective cohort study of severe adverse neonatal outcomes of nonanomalous singleton term births at an Australian tertiary maternity unit between January 2007 and April 2017. Serious neonatal outcome (SNO) was defined as any of the following: Apgar score ≤3 at 5 min, severe respiratory distress syndrome, severe acidosis, admission into neonatal intensive care unit (NICU), stillbirth, or neonatal death. Multivariable generalized estimating equations were used to identify key demographic and intrapartum risk factors predisposing to poor neonatal outcomes.Results: There were 77 888 births with SNO occurring in 7247 (9.3%) cases. Young maternal age, raised BMI, indigenous ethnicity, nulliparity, smoking, illicit drug use, and diabetes mellitus were more common in the SANO cohort. Instrumental birth (aOR 3.24, 95%CI 3.02-3.47, p < .001), emergency cesarean section (aOR 1.61, 95%CI 1.49-1.73, p < .001), emergency cesarean for nonreassuring fetal status (aOR 3.45, 95%CI 3.04-3.92, p < .001), cord accidents (aOR 4.98, 95%CI 2.81-8.83, p < .001) and intrapartum hemorrhage (aOR 1.42, 95%CI 1.08-1.87, p = .01) were major antecedents. Induction of labor (aOR 1.08, 95%CI 1.01-1.15, p = .03), prolonged second stage (aOR 1.76, 95%CI 1.55-2.00, p < .001) and use of intramuscular opioids/narcotics (aOR 1.41, 95%CI 1.30-1.52, p < .001) were also associated with adverse neonatal outcome. Low birth weight (< 5th and <10th centiles) and macrosomia (> 90th and >95th centiles) and delivery at 37 weeks and >41 weeks were additional risk factors.Conclusion: There are multiple maternal and intrapartum risk factors which can predispose to severe outcomes in the neonate. [ABSTRACT FROM AUTHOR]

Objective: To explore the relevant influencing factors of neonatal respiratory distress syndrome (NRDS) in southern China and provide scientific basis for improving the quality of life for neonates.Methods: A retrospective analysis of 320 cases with NRDS neonates admitted from January 2015 to December 2017 in a neonatal department of a Maternal and Child Health Hospital in South China was conducted. Three hundred twenty non-NRDS patients admitted to the same hospital during the same period were also included as control. The basic characteristics were compared and the risk and protective factors for NRDS were evaluated by logistic regression analysis.Results: Univariate analysis showed that the difference in age, gestational age, fetal sex, mode of delivery, asphyxia, intrauterine distress, and gestational diabetes in the case group and the control group were significantly different (p < .05). The multivariate logistic regression analysis revealed that the age of pregnant women (OR ± 1.539, 95% CI ± 1.427-1.660), intrauterine distress (OR ± 2.427, 95% CI ± 1.079-5.458), and gestational diabetes (OR ± 2.881, 95% CI ± 1.271-6.532) were independent risk factors for NRDS. Meanwhile, gestational age (OR ± 0.588, 95% CI ± 0.508-0.681) was an independent protective factor for NRDS.Conclusions: The age of pregnant women, intrauterine distress, and gestational diabetes can increase the risk of NRDS, while long gestational age can reduce the risk of NRDS. Early detection, early diagnosis and early treatment of children with NRDS have achieved the purpose of improving the quality of life of children. [ABSTRACT FROM AUTHOR]

Aim: Prolonged oxytocin infusion during labor results in receptor desensitization and increases the risk of obstetric hemorrhage. We aimed to examine the association between recovery time (RT) and intraoperative severe blood loss in women who underwent a cesarean section after oxytocin pretreatment.Methods: We retrospectively assessed 103 Japanese women who underwent cesarean section after oxytocin pretreatment. RT (time from cessation of oxytocin infusion during labor to delivery) and intraoperative severe blood loss (active bleeding exceeding 1000 mL) were measured. Confounding factors were controlled, and RT cut-off value associated with severe blood loss and association between RT and intraoperative severe blood loss were assessed.Results: The mean maternal age was 34 years, and 100 (97.1%) women delivered at term. Mean RT was 121.6 min. The overall incidence of intraoperative severe blood loss was 22.3% (23/103). The cut-off point to predict intraoperative severe blood loss was 96 min (sensitivity, 65.2%; specificity, 81.3%). On multivariate analysis, an RT of ≤96 min [adjusted odds ratio (OR), 11.9; 95% confidence interval (CI), 3.32-42.7] and macrosomia (adjusted OR, 3.91; 95% CI, 1.10-13.8) were associated with intraoperative severe blood loss.Conclusions: Consideration of RT is helpful in the management of women undergoing cesarean section after oxytocin pretreatment. [ABSTRACT FROM AUTHOR]

Objective: Worldwide controversy exists regarding the best approach and criteria for gestational diabetes mellitus (GDM) screening and diagnosis. The aim of this systematic review and meta-analysis of randomized trials was to assess the incidence of maternal and neonatal outcomes comparing the one step with the two step approach for the diagnosis of GDM.Methods: Electronic databases were searched from their inception until June 2018. We included all the randomized trials comparing the one step versus the two step method for screening and diagnosis of GDM. The primary outcome was the incidence of large for gestational age (LGA), defined as birth weight >90th percentile. Meta-analysis was performed using the random effects model of DerSimonian and Laird, to produce summary treatment effects in terms of relative risk (RR) with 95% confidence interval (CI).Results: Four randomized clinical trials (RCTs) (n = 2582 participants) were identified as relevant and included in the meta-analysis. Women screened with the one step approach had a significantly lower risk of adverse perinatal outcomes, including LGA (RR 0.46, 95% CI 0.25-0.83), admission to neonatal intensive care unit (NICU) (RR 0.49, 95% CI 0.29-0.84) and neonatal hypoglycemia (RR 0.52, 95% CI 0.28-0.95), compared to those randomized to the screening with the two step approach. The one step approach was also associated with lower mean birth weight (mean difference -112.91 grams, 95% CI -190.48 to -35.33). No significant difference in the incidence of GDM was found comparing the one step versus the two step approach (8.3 versus 4.4%; RR 1.60, 95% CI 0.93-2.75).Conclusions: This study provides high quality evidence that the diagnosis of GDM by the one step approach is associated with better perinatal outcomes, including lower incidences of LGA, NICU admission and neonatal hypoglycemia, compared to the two step approach. Based on these findings, we recommend screening of GDM using the one-step approach. [ABSTRACT FROM AUTHOR]