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Household food insecurity (HFI) has been related to adverse maternal‐child health outcomes and mental health worsening during pregnancy. Few studies evaluated the temporal association between HFI and anxiety and depressive symptoms in pregnant women, and this association remains not completely understood. This study aimed to systematically review the association between HFI and symptoms of depression and anxiety in pregnant individuals. The systematic review protocol was registered in the International Prospective Register of Systematic Reviews (CRD42022373615). Systematic searches were conducted on 10 electronic databases and grey literature. Two researchers independently conducted the study selection, data extraction process, and the risk of bias assessment. Random‐effects meta‐analysis models were used, and I2 > 40% indicated high heterogeneity across studies. Eighteen articles were included for the systematic review, comprising n = 27,882, and a total of 18,987 pregnant individuals aged between 14 and 45 years were included in the meta‐analysis. The prevalence of HFI reported in studies ranged from 12.6% to 62.1% (n = 17). The prevalence of depressive and anxiety symptoms ranged from 18% to 49% (n = 11) and 23% to 34% (n = 2), respectively. HFI during pregnancy was associated with increased odds of experiencing symptoms of depression [(OR: 2.52; 95% CI: 2.11–3.02), I2 = 73.23%]. The quality of evidence was very low due to high heterogeneity. Our findings highlighted the association between HFI and depression symptoms during pregnancy. Findings from this study suggest the importance of assessing HFI and mental health during pregnancy. [ABSTRACT FROM AUTHOR]

Objectives Methods Results Conclusion To investigate the fetal heart using pulsed wave Doppler, M‐mode, and tissue Doppler imaging (TDI) in cases of intrahepatic cholestasis of pregnancy (ICP).This prospective study was conducted at a single tertiary center and included 35 patients with ICP and 70 healthy pregnant women at 28–36 weeks of pregnancy. Among the patients with ICP, 26 had serum bile acid (SBA) levels less than 40 μmol/L and nine had SBA levels of 40 μmol/L or greater. Pulsed wave Doppler, M‐mode, and TDI evaluations were performed on the patients to assess fetal cardiac function.The ICP group exhibited significantly higher myocardial performance index (MPI) and isovolumetric relaxation time (IRT), but similar isovolumetric contraction time (ICT). The tricuspid and mitral valve E, A, and E/A ratios were significantly reduced in the ICP group. The TDI parameters showed significantly reduced tricuspid and mitral valve E′/A′ ratios in the ICP group compared with the control group (P < 0.001). The E/E′ ratio was significantly increased in the ICP group (P < 0.001). According to the M‐mode Doppler findings, tricuspid and mitral annular plane systolic excursion values were significantly decreased in the ICP group (P = 0.005 and P = 0.001, respectively). In the subgroup analysis, MPI and IRT were significantly higher in the severe ICP group.ICP might induce changes in the fetal heart during the early systolic and diastolic phases. The detection of these early changes using M‐mode and TDI during the antenatal period can provide valuable insights into the condition of the fetus. [ABSTRACT FROM AUTHOR]

Introduction Material and Methods Results Conclusions While 10% of pregnant individuals report a penicillin allergy, there is no established best practice for penicillin allergy delabeling in pregnancy. To better understand options for penicillin delabeling, we aimed to evaluate two penicillin allergy delabeling protocols in pregnancy regarding efficacy, adverse events, and patient satisfaction.From July 2019 to December 2022, we completed a two‐center prospective cohort study, where each site recruited pregnant patients over 24 weeks gestational age with a reported penicillin allergy. One center offered antepartum amoxicillin oral challenges, either directly or after negative skin testing (i.e., antepartum oral challenge site). Our other centers completed a two‐step approach with antepartum penicillin skin testing only and deferred oral challenges to the postpartum period (i.e., postpartum oral challenge site). Our primary outcome was the rate of penicillin allergy delabeling, defined as tolerating an antibiotic challenge with penicillin or amoxicillin. Univariate analyses were completed using chi‐squared, Fisher's exact, and Wilcoxon rank tests.During the study period, 276 pregnant patients were assessed, with 207 in the antepartum oral challenge site and 69 in the postpartum oral challenge site. Among the 204 patients who completed antepartum oral challenges, 201 (98%) passed without reactions. Deferring oral challenges to the postpartum period led to a loss of follow‐up for 37/53 (70%) of eligible individuals. Overall, 97% (201/207) of patients at the antepartum oral challenge site were delabeled from their penicillin allergy—compared to 38% (26/69) of patients referred to the postpartum oral challenge site (p < 0.0001). Three antepartum oral challenge reactions were noted, including two mild cutaneous reactions and a case of transient abdominal discomfort.Antepartum amoxicillin oral challenge is a more effective method to delabel pregnant patients from their penicillin allergy. Deferral of oral challenges to the postpartum period introduces a significant barrier for penicillin allergy delabeling. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusion IgA nephropathy (IgAN) is the most common primary glomerular disease worldwide. Pregnant IgAN patients are more susceptible to adverse pregnancy outcomes (APO). However, the risk factor for APO and its effects on the long‐term renal outcome of pregnant IgAN patients remained unclear.We performed a retrospective observational study covering 2003–2019 that included 44 female IgAN patients with pregnancy history to investigate the risk factor for APO and its impact on clinical outcome in IgAN. Renal function outcome and proteinuria remission were evaluated in pregnant IgAN women with and without APO.In this retrospective and observational study, we found that patients with APO exhibited higher levels of serum creatinine and IgM, and lower haemoglobin levels while other clinical characteristics, pathological characteristics and therapy protocol had no significant difference. We found that anaemia and a higher level of serum IgM were independent risk factors for APO. IgAN pregnant women without APO experienced a higher proportion of proteinuria remission than those with APO, but there is no difference in the renal function outcome.Pregnant IgAN patients with higher risks, including lower haemoglobin levels and higher IgM levels deserve intensive monitoring, and aggressive therapy to reduce proteinuria should be carried out in pregnant IgAN patients with APO. [ABSTRACT FROM AUTHOR]

Background Methods Results Discussion Hemolytic disease of the fetus and newborn (HDFN) is caused by maternal alloantibody‐mediated destruction of fetal/neonatal red blood cells (RBCs). While the pathophysiology has been well‐characterized, the clinical and laboratory monitoring practices are inconsistent.We surveyed 103 US institutions to characterize laboratory testing practices for individuals with fetuses at risk of HDFN. Questions included antibody testing and titration methodologies, the use of critical titers, paternal and cell‐free fetal DNA testing, and result reporting and documentation practices.The response rate was 44% (45/103). Most respondents (96%, 43/45) assess maternal antibody titers, primarily using conventional tube‐based methods only (79%, 34/43). Among respondents, 51% (23/45) rescreen all individuals for antibodies in the third trimester, and 60% (27/45) perform paternal RBC antigen testing. A minority (27%, 12/45) utilize cell‐free fetal DNA (cffDNA) testing to predict fetal antigen status. Maternal antibody titers are performed even when the fetus is not considered to be at risk of HDFN based on cffDNA or paternal RBC antigen testing at 23% (10/43) of sites that assess titers.There is heterogeneity across US institutions regarding the testing, monitoring, and reporting practices for pregnant individuals with fetuses at risk of HDFN, including the use of antibody titers in screening and monitoring programs, the use of paternal RBC antigen testing and cffDNA, and documentation of fetal antigen results. Standardization of laboratory testing protocols and closer collaboration between the blood bank and transfusion medicine service and the obstetric/maternal‐fetal medicine service are needed. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion Excessive weight gain, obesity, or insufficient weight gain during pregnancy can adversely affect both the mother and her offspring. This study aims to investigate the relationship between pregnant women's self‐perception and beliefs and their body weight management during pregnancy.A cross‐sectional survey involving 350 pregnant women in Changsha City was conducted from July to September 2023. Instruments included a sociodemographic data sheet, protective motivation questionnaire for pregnancy body quality management, and scales measuring body image, anxiety, self‐efficacy, and social support. Univariate analysis and multiple linear regression were employed to identify factors influencing protective motivation for body quality management during pregnancy.The average score of the protective motivation questionnaire was 124 (SD = 13.07), suggesting a need for enhanced weight management. Key factors influencing protective motivation included household income, cooperation with healthcare workers, sources of pregnancy information, midnight snacking habits, prepregnancy exercise, body image, and self‐efficacy (P < 0.05).The study highlights significant factors influencing pregnant women's motivation for body quality management. These include economic status, healthcare collaboration, information accessibility, lifestyle habits, and psychological factors. The findings underscore the need for healthcare professionals to integrate these factors into pregnancy care programs to improve body quality management. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion To assess variations in the presentation and clinical implications of pre‐eclampsia between Iranian and Afghan mothers at a maternity center in Tehran.We conducted a cross‐sectional study of Iranian and Afghan mothers diagnosed with pre‐eclampsia. Data were collected from March 2021 to February 2023 at a maternity center in Tehran, Iran. Demographic information, clinical characteristics, and laboratory findings were extracted from medical records. Statistical analyses were employed to compare differences between Iranian and Afghan mothers, including Mann–Whitney U, Pearson χ2 tests, and logistic regression models.We included 822 pregnant women with pre‐eclampsia, predominantly Iranian (75.5%) and Afghan (24.5%). Regarding the multivariate logistic regression model, Iranian mothers were older, with a higher proportion over 35 years. Although Afghan mothers showed higher gravidity counts and greater gestational ages at delivery, they had lower rates of hypothyroidism. Iranian women were more often categorized as obese than Afghan women, and the difference was statistically significant. Serum levels of alkaline phosphatase were significantly greater in Afghan women.Pre‐eclampsia poses significant maternal health risks, especially among Afghan refugees in Iran. Variances in age, gravidity, and hypothyroidism prevalence highlight the need for tailored healthcare strategies. Addressing cultural barriers and implementing targeted interventions can improve maternal and fetal outcomes in these populations. [ABSTRACT FROM AUTHOR]

COVID‐19 infection among pregnant women results in more severe symptoms and higher mortality rates. No comprehensive health literacy for protection against COVID‐19 among pregnant women has been available for general use in Thailand. This cross‐sectional study aimed to develop and examine an instrument for measuring health literacy of prevention COVID‐19 infection among pregnant women (HLS‐P). A total of 321 pregnant women aged older than 20 years were participated in this study, Selected through multistage cluster sampling, between September 2021 and January 2022. Data were collected using structured questions that included sociodemographic characteristics and the health literacy scale for protecting against COVID‐19 (HLS‐P) developed by the researchers. The content and construct validity of the health literacy scale were examined. Exploratory factor analysis performed with principal component analysis and Varimax rotation. Confirmatory factor analysis was conducted using IBM SPSS AMOS 26. The model fitting was evaluated using several indices namely root mean square error of approximation, normed fit index, comparative fit index, and goodness‐of‐fit index. The reliability of the scale was evaluated using Cronbach's alpha and item total correlation. As a results of exploratory factor analysis of the scale, 31 items were loaded which indicated a 6‐factors for the scale that collectively explained 62.59% of total variance. Confirmatory factor analysis also indicated a good fit to the six latent structures with root mean square error of approximation 0.03, normed fit index 0.94, comparative fit index 0.97, and goodness‐of‐fit index 0.91. Internal consistency reliability was satisfactory with Cronbach's alpha coefficient of 0.94 and the item‐total correlation between 0.34 and 0.86. The overall scale was sufficiently reliable. As a result, the HLS‐P is a reliable and relevant measure for assessing health literacy in pregnant women. Thus, this scale is profoundly used as an evaluation tool for measuring health literacy among pregnant women, providing critical information for healthcare professionals and policymakers about the health literacy needs and capacity of service receivers. [ABSTRACT FROM AUTHOR]

Background and Objectives Methods Results Discussion and Conclusions Scientific Significance Prenatal cannabis use prevalence in the United States has increased. Relaxation of state‐level cannabis policy may be contributing to the diminished risk perception of using cannabis. The main psychoactive constituent of cannabis, delta‐9‐tetrahydrocannabinol, crosses the placenta, interacting with functional cannabinoid receptors in the fetus. Here, we assess the association between prenatal cannabis exposure (PCE) and a set of birth outcomes.Using the Michigan Archive for Research on Child Health, a prospective pregnancy cohort, we linked prenatal survey data with neonatal data from state‐archived birth records. Recruitment occurred in 23 clinics across Michigan. Pregnant participants with live birth records between October 2017 and January 2022, after exclusion for missing data on cannabis use, birth outcomes, and covariates, were included in the final analytic sample (n = 584). Analyses involved generalized linear models.An estimated 15% (95% confidence interval [CI]: 12%, 18%) of participants reported using cannabis during pregnancy. Covariate‐adjusted models revealed an association between PCE and birth size (ß = −0.3; 95% CI: −0.5, −0.003).Findings suggest a relationship between PCE and smaller birth size. Clinicians should follow guidelines outlined by the American College of Obstetricians and Gynecologists when counseling pregnant patients on cannabis use.We detected a significant association between PCE and birth size. Most studies focus only on the extremes of birth size, however, use of z‐scores allow for assessment of the sex‐specific birth weight‐for‐gestational age distribution, increasing the accuracy of detecting an effect of cannabis exposure on birth size. [ABSTRACT FROM AUTHOR]

Background Aim Design Results Conclusion Status epilepticus (SE) is defined as 5 min or more of seizure activity or two recurrent seizures without a return to baseline. Healthcare providers encounter a challenge when a patient with SE is pregnant. SE is not only detrimental to the mother but can also put the baby at risk of severe harm. SE must be treated rapidly and therefore healthcare providers have very little time to thoroughly review the risk and benefits of available antiseizure medication in this population.To evaluate the current available evidence related to the management of SE in pregnancy.A literature search of PubMed, CINAHL, ProQuest Nursing & Allied Health Source, and Web of Science databases was conducted (2012–2022) using the following search terms: ‘pregnancy’, ‘pregnant women’ OR ‘gestation’ AND ‘status epilepticus’, ‘generalized status epilepticus’, ‘generalized convulsive status epilepticus’, ‘non convulsive status epilepticus’ OR ‘non‐convulsive status epilepticus’. Full‐text randomised controlled trials, clinical trials, observational studies, and case reports published in English were included. Data were extracted and the quality of the studies was evaluated using the Mixed Methods Appraisal Tool.The literature described 29 pregnancies and 30 total foetuses. Intravenous benzodiazepine use for emergent control was reported in 45% of patients. Phenytoin and levetiracetam were primarily utilised for urgent control, with a variety of agents used for refractory SE. Ninety‐seven percent of maternal outcomes were reported as positive. The most common outcome was the birth of a healthy term infant. There were seven cases of pregnancy loss.Publications pertaining to the treatment of SE in pregnancy are limited to case reports and small observational studies. Use of a benzodiazepine followed by levetiracetam or phenytoin is appropriate, whereas valproic acid should be utilised only when necessary due to the risk of major congenital malformation. [ABSTRACT FROM AUTHOR]

Artemisinin‐based combination therapy (ACT) is the first‐line recommended treatment for uncomplicated malaria. Pharmacokinetic (PK) properties in pregnant women are often based on small studies and need to be confirmed and validated in larger pregnant patient populations. This study aimed to evaluate the PK properties of amodiaquine and its active metabolite, desethylamodiaquine, and piperaquine in women in their second and third trimester of pregnancy with uncomplicated P. falciparum infections. Eligible pregnant women received either artesunate‐amodiaquine (200/540 mg daily, n = 771) or dihydroartemisinin‐piperaquine (40/960 mg daily, n = 755) for 3 days (NCT00852423). Population PK properties were evaluated using nonlinear mixed‐effects modeling, and effect of gestational age and trimester was evaluated as covariates. 1071 amodiaquine and 1087 desethylamodiaquine plasma concentrations, and 976 piperaquine plasma concentrations, were included in the population PK analysis. Amodiaquine concentrations were described accurately with a one‐compartment disposition model followed by a two‐compartment disposition model of desethylamodiaquine. The relative bioavailability of amodiaquine increased with gestational age (1.25% per week). The predicted exposure to desethylamodiaquine was 2.8%–32.2% higher in pregnant women than that reported in non‐pregnant women, while day 7 concentrations were comparable. Piperaquine concentrations were adequately described by a three‐compartment disposition model. Neither gestational age nor trimester had significant impact on the PK of piperaquine. The predicted exposure and day 7 concentrations of piperaquine were similar to that reported in non‐pregnant women. In conclusion, the exposure to desethylamodiaquine and piperaquine was similar to that in non‐pregnant women. Dose adjustment is not warranted for women in their second and their trimester of pregnancy. [ABSTRACT FROM AUTHOR]

Issues Approach Key Findings Implications and Conclusion Health policy makers worldwide have adopted evidence‐based legislation, largely directed at consumers, to reduce tobacco‐related harm. It is suggested that limiting supply by decreasing retail availability can also reduce cigarette smoking. To inform policy makers this systematic literature review assesses whether reducing availability is associated with smoking behaviours.Systematic literature searches of five databases were carried out up to January 2023. Included studies had at least one exposure (tobacco retail density, proximity or mixed measures thereof) and outcomes of smoking behaviour. Meta‐analysis of effect estimates were undertaken if there were at least three studies with similar population, exposure and outcome measures.Sixty‐two studies were included, and positive associations were found between tobacco outlet density and cigarette smoking in pregnancy, youth, adults and cessation. Meta‐analyses were undertaken for retail density and ever smoking (odds ratio [OR] 1.20; 95% confidence interval [CI] 1.04, 1.37; I2 = 87.3%), and current youth smoking (OR 1.23; 95% CI 1.08, 1.40; I2 = 0.0%), adult smoking (OR 1.11; 95% CI 1.01, 1.22; I2 = 74.8%); and mixed measures of retail availability near schools and current youth smoking (OR 1.03; 95% CI 1.01, 1.05; I2 = 0.0%).There is evidence higher tobacco retail density is consistently associated with cigarette smoking in pregnant women, young people and adults when ecological studies are included in meta‐analysis. Meanwhile, evidence synthesis reveals restrictive tobacco retail laws based on proximity or mixed measures near home or very near school may not reduce smoking except in men who smoke heavily. Mechanisms to reduce retailer density should be thus considered part of tobacco control strategies. [ABSTRACT FROM AUTHOR]

Background Objective Methods Results Conclusions Suboptimal pre‐pregnancy health, including substance use and cardiovascular risk factors, is associated with higher risks of maternal‐foetal morbidity and mortality.To determine if pre‐pregnancy substance use is associated with early pregnancy cardiovascular health (CVH). It is hypothesised that pre‐pregnancy use of substances is associated with worse CVH in the first trimester of pregnancy.This is a secondary analysis from the 2010–2015 United States nuMoM2b cohort (n = 9895). Pre‐pregnancy alcohol, tobacco, marijuana, and illicit substance use were assessed through questionnaires. Latent class analysis categorised participants based on their 3‐month pre‐pregnancy or ever(*) substance use: (1) Illicit substances*, marijuana*, and alcohol use (n = 1234); (2) marijuana* and alcohol use (n = 2066); (3) tobacco and alcohol use (n = 636); and (4) alcohol only use (n = 3194). The referent group reported no pre‐pregnancy substance use (n = 2765). First trimester CVH score from 0 (least healthy) to 100 (most healthy) was calculated using a modified American Heart Association Life's Essential 8 framework and included body mass index (BMI), blood pressure, blood glucose, non‐HDL cholesterol, diet, sleep, and physical activity. Multiple linear regression evaluated the relationship between pre‐pregnancy substance use classes and CVH scores.CVH score varied by class: No substance use (mean: 65, SD: ±1.3), illicit substances*, marijuana*, and alcohol use (68 ± 1.3), marijuana* and alcohol use (67 ± 1.3), tobacco and alcohol use (62 ± 1.4), and alcohol only use (67 ± 1.3). In adjusted models, those who used tobacco and alcohol compared to the no substance use class had a lower CVH score (−2.82); other classes had scores ranging from 1.81 to 2.44 points higher than the no substance use class. Individual CVH component scores followed similar patterns.All groups, but most markedly those who used tobacco and alcohol prior to pregnancy, began pregnancy with only moderate CVH and may benefit from CVH promotion efforts along with substance use treatment. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Study Design Results Conclusion To determine maternal and neonatal outcomes in individuals with iron deficiency receiving antepartum intravenous (IV) iron supplementation, stratified by the degree of anemia.Retrospective cohort study of iron‐deficient pregnant patients who received at least one IV infusion of iron (iron sucrose, low molecular weight iron dextran [LMWID], or ferric carboxymaltose) during their pregnancy from January 1, 2011 through June 16, 2022. Our primary outcomes included both neonatal composite morbidity and maternal composite morbidity in the context of maternal anemia.Patients who received LMWID had fewer infusion visits, received higher total doses of iron and had a more substantial correction of hemoglobin compared to those who received iron sucrose (p < 0.01). Maternal anemia at the time of admission was not associated with neonatal composite morbidity. However, there was a significant association between anemia status and maternal composite outcome (p = 0.05). Anemia at time of delivery was associated with the likelihood of requiring a blood transfusion (p = 0.01).This study reinforces previous findings emphasizing the adverse effects of iron deficiency on maternal health and the role of IV iron in reducing these risks. [ABSTRACT FROM AUTHOR]

Objective: To assess the capacity of fetal pancreatic size, before standard blood glucose testing for screening and diagnosis, to predict maternal gestational diabetes mellitus (GDM). Methods: This was a retrospective cohort study of low‐risk pregnant women recruited during routine second‐trimester fetal anatomical screening at 20–25 weeks' gestation at two ultrasound units in Israel between 2017 and 2020. The predictive performance of fetal pancreatic circumference ≥ 80th and ≥ 90th centiles and glucose challenge test (GCT) was examined for the outcome of GDM. The independent‐samples t‐test was used to compare mean pancreatic circumference centile between pregnancies with GDM and those without GDM. Diagnostic performance was evaluated with 2 × 2 contingency tables and receiver‐operating‐characteristics (ROC) curves. Results: Overall, 195 women were selected for statistical analysis. Twenty‐four (12.3%) women were diagnosed subsequently with GDM. The mean ± SD fetal pancreatic circumference centile was significantly higher in the GDM group compared with the non‐GDM group (82.4 ± 14.6 vs 62.8 ± 27.6; P < 0.001). The pancreatic circumference centile was correlated positively with the estimated fetal weight centile (Pearson's coefficient, 0.243; P = 0.001). The 80th centile cut‐off for pancreatic circumference had the highest sensitivity (70.8%) and positive predictive value (23.3%) for future maternal GDM, with the best trade‐off between sensitivity and specificity achieved at the 75th centile cut‐off (sensitivity, 79%; specificity, 60%). The GCT had better specificity (90.2%) and negative predictive value (97.9%) compared with both cut‐offs in pancreatic circumference. The area under the ROC curve was higher for pancreatic circumference compared with GCT (0.71 vs 0.64) and only the former was statistically significant (P = 0.001). Conclusions: Fetal pancreatic circumference has a higher positive predictive capacity compared with GCT. Measuring pancreatic circumference can identify pregnancies at high risk for maternal GDM, thereby promoting earlier diagnosis and treatment, decreasing the time period during which the fetus is exposed to high maternal glucose levels and improving infant outcome. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objective: To investigate the trimester‐specific associations between maternal total physical activity level vs moderate‐to‐vigorous exercise and fetal growth disorders. Methods: We analyzed 2062 mother–neonate pairs participating in the longitudinal China Medical University Birth Cohort Study. The Pregnancy Physical Activity Questionnaire was used to assess the physical activity level of women during the three trimesters. A higher level of total physical activity was defined as meeting or exceeding the cohort‐specific 75th percentile, and a higher level of exercise was defined according to the Physical Activity Guidelines for Americans. Fetal growth disorder was defined as small‐for‐gestational age (SGA) or large‐for‐gestational age (LGA) at birth. Results: Of the neonates included in this study, 7.1% were SGA and 15.5% were LGA. A higher level of total physical activity during the first trimester (adjusted relative risk (aRR), 0.62 (95% CI, 0.42–0.91)) and second trimester (aRR, 0.62 (95% CI, 0.41–0.95)) was associated with a lower risk of SGA, and a higher level of total physical activity during the third trimester was associated with a lower risk of LGA (aRR, 0.73 (95% CI, 0.54–0.97)). When analyzing physical activity by subtype, a higher level of occupational physical activity during the first and second trimesters was associated negatively with SGA risk, and higher levels of occupational and low‐intensity physical activity during the first trimester were associated negatively with LGA risk. No significant association was found between maternal adherence to the Physical Activity Guidelines for Americans and risk of fetal growth disorders. Conclusions: A higher total physical activity level during the first and second trimesters was associated with a decreased risk of SGA, whereas a higher total physical activity level in the third trimester was associated with a decreased risk of LGA. Pregnant women should be advised to increase their total physical activity levels instead of focusing on engaging in only moderate‐to‐vigorous exercise. © 2024 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Opioid use disorder (OUD) among pregnant people has increased dramatically during the opioid epidemic, affecting a significant number of families with young children. Parents with OUD commonly face significant challenges as they are often balancing the stress of caring for young children with maintaining recovery and co‐occurring psychosocial challenges (e.g., mental health, low social support). Toward designing interventions to address parenting needs among parents with OUD, we conducted a mixed‐methods study to understand the acceptability of receiving parenting support prenatally among pregnant people with OUD residing in the United States. Semi‐structured interviews were conducted among 18 pregnant and early postpartum people recruited from a substance use treatment program specializing in the care of pregnant and parenting populations. Among all participants, a prenatal parenting program that comprehensively addresses recovery, parenting, and wellbeing was found to be widely acceptable. Regarding content most desirable within a parenting intervention, participants indicated an interest in breastfeeding, caring for newborns with in‐utero opioid exposure, parent‐infant bonding, infant soothing techniques, their own wellbeing/mental health, and parenting skills. We introduce a prenatal adaptation of the well‐established Family Check‐up parenting intervention as a novel, prenatal intervention to prevent negative outcomes for caregivers in recovery and their children. [ABSTRACT FROM AUTHOR]

This study examined the associations between maternal depression and oxytocin in pregnancy, caregiving sensitivity and adult attachment style, and infant temperament. One hundred and six women recruited from a public hospital antenatal clinic in Australia, and their infants completed assessments at three time points (Time 1: pregnancy; Time 2: 3‐month postpartum; Time 3: 12‐month postpartum). Mothers completed self‐report questionnaires assessing maternal depression symptom severity at Time 1–3, adult attachment style at Time 2, and infant temperament at Time 3. At Time 1, they also provided a blood sample to assess peripheral oxytocin levels, and at Time 2, participated in a parent–child interaction session, which was later coded for caregiving behavior (sensitivity). Neither maternal depression nor lower levels of oxytocin during pregnancy predicted difficult infant temperament; rather, it was predicted by non‐Caucasian ethnicity. When all other variables were free to vary, adult attachment avoidance mediated an association between maternal depression during pregnancy and difficult infant temperament. Results highlight the potential value of interventions focusing on adult attachment insecurity for pregnant women and raise questions about associations between culture/ethnicity and infant temperament. [ABSTRACT FROM AUTHOR]

Background: Research exploring the relationship between prenatal infection and child behavioural outcomes would benefit from further studies utilising full‐population samples with the scale to investigate specific infections and to employ robust designs. We tested the association among several common infections requiring inpatient admission during and after pregnancy with a range of childhood behavioural outcomes, to determine whether any negative impact was specific to the period of foetal development. Methods: The sample included all mother–offspring pairs from the Australian state of New South Wales (NSW) for whom the child commenced their first year of full‐time schooling in 2009 (~age 5 years; n = 77,302 offspring), with records linked across four health administrative data sets including the NSW perinatal data collection (PDC), the NSW admitted patient data collection (APDC) and the NSW component of the 2009 Australian Early Development Census (AEDC). Multivariable linear regression was used to test associations between a number of infections requiring inpatient admission during and after pregnancy with a range of teacher assessed behavioural outcomes. Results: Associations specific to the prenatal period were only found for streptococcus A although this would need to be reproduced in external samples given the low prevalence. Otherwise, 12 out of 15 selected infections either showed no association prenatally or also demonstrated associations in the 12 months after pregnancy. For example, prenatal hepatitis C, influenza and urinary E. coli infections were associated with lower scores of several domains of childhood behaviour, but even stronger associations were found when these same maternal infections occurred after pregnancy. Conclusions: The prenatal infections we tested appeared not to impact childhood behaviour by altering foetal neurodevelopment. Rather, the strong associations we found among infections occurring during and after pregnancy point to either residual socioeconomic/lifestyle factors or a shared familial/genetic liability between infections and behavioural problems. [ABSTRACT FROM AUTHOR]

Background: It is estimated that 78% of children experience the death of a close friend or family member by 16 years of age, yet longitudinal research examining the mental health outcomes of wider experiences of bereavement is scarce. We conducted a longitudinal investigation of the association between maternal experienced bereavement before the age of 11 years and offspring depressive and anxiety disorders at age 18 and examined moderation of this association by modifiable parental factors. Methods: We analysed data from the Avon Longitudinal Study of Parents and Children, a UK‐based birth cohort, including 9,088 child participants with data available on bereavement. Bereavement was measured via maternal report at eight timepoints until children were 11 years. Offspring depressive and anxiety‐related disorders were self‐reported at 18 years old using the Clinical Interview Schedule‐Revised (CIS‐R). The potential moderating roles of maternal anxiety, maternal depression, parental monitoring, positive parenting and negative parenting practices were examined. Results: Maternal experienced bereavement was not associated with depression or anxiety‐related disorders in early adulthood among offspring. In addition, no support was found for negative parenting practices, parental monitoring or maternal anxiety and depression as moderators of the relationship between maternal experienced bereavement and offspring mental health problems at 18 years old. Findings in relation to the moderating role of positive parenting practices were inconsistent. Conclusions: Findings suggest that a large number of children are exposed to maternal experienced bereavement. We found no evidence that maternal experienced bereavement during childhood increases the risk for offspring psychiatric disorders in early adulthood. Several methodological considerations prudent to bereavement research are discussed. [ABSTRACT FROM AUTHOR]

Aim: We investigated the relationship between the complexity of the glucose time series index (CGI) during pregnancy and adverse pregnancy outcomes in women with gestational diabetes mellitus (GDM). Materials and Methods: In this retrospective cohort study, 388 singleton pregnant women with GDM underwent continuous glucose monitoring (CGM) at a median of 26.86 gestational weeks. CGI was calculated using refined composite multiscale entropy based on CGM data. The participants were categorized into tertiles according to their baseline CGI (CGI <2.32, 2.32‐3.10, ≥3.10). Logistic regression was used to assess the association between CGI and composite adverse outcomes or large for gestational age (LGA). The discrimination performance of CGI was estimated using receiver operating characteristic analysis. Results: Of the 388 participants, 71 (18.3%) had LGA infants and 63 (16.2%) had composite adverse outcomes. After adjustments were made for confounders, compared with those with a high CGI (CGI ≥3.10), participants with a low CGI (CGI <2.32) had a higher risk of composite adverse outcomes (odds ratio: 12.10, 95% confidence interval: 4.41‐33.18) and LGA (odds ratio: 12.68, 95% confidence interval: 4.04‐39.75). According to the receiver operating characteristic analysis, CGI was significantly better than glycated haemoglobin and conventional CGM indicators for the prediction of adverse pregnancy outcomes (all p <.05). Conclusion: A lower CGI during pregnancy was associated with composite adverse outcomes and LGA. CGI, a novel glucose homeostasis predictor, seems to be superior to conventional glucose indicators for the prediction of adverse pregnancy outcomes in women with GDM. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to explore the experiences of women with moderate‐to‐severe mental health difficulties during pregnancy, with a focus on establishing their psychological needs. Psychological distress caused by mental health difficulties during pregnancy is common and can significantly impact women and their babies. However, women's subjective experiences of difficulties with their mental health throughout pregnancy, alongside their experiences of staff, services and treatments are less well understood. Design: In this qualitative study, an Interpretive Phenomenological Analysis (IPA) approach was used. Methods: Semi‐structured interviews were conducted with participants recruited via a regional Perinatal Mental Health Service. Interviews were transcribed and analysed following the IPA methodology. Results: Five superordinate themes were identified which represented the lived experiences of the 11 participants on their journey through pregnancy whilst living with mental health difficulties and subsequent psychological distress: (i) Feeling the 'wrong' feelings, (ii) Societal pressures and a desire for greater acceptance, (iii) Searching for answers despite a lack of resources, (iv) What made a difference and (v) Experiences and expectations of service provision. Within these themes, 13 subordinate themes were also identified. Conclusions: These themes highlight the need for greater awareness and acceptance of mental health difficulties during pregnancy as well as postnatally. While perinatal mental health services are evolving, there is still an urgent requirement for services to continue to develop to meet women's needs, as well as to develop the role of clinicians as facilitators of engagement with needs‐matched care. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the disparity of the expectations and basic knowledge of prenatal ultrasound (US) screening among pregnant women and make a comparison with the current scientific knowledge and national recommendations. We hypothesize that sociodemographic factors, including age, education, and professional occupation, may be associated with different levels of knowledge. Methods: This was a cross‐sectional study performed in 2021 of 336 women aged 18 to 46 years in a maternity facility in a tertiary hospital in Portugal. The main outcome measures were questionnaire data from questions divided into four categories (sociodemographic, expectations, knowledge, and final considerations/suggestions). The data were grouped according to the sociodemographic factors (age, educational level, and professional occupation) and analyzed and compared as a function of the social groups as well as overall tendencies. Results: Our data confirmed a significant discrepancy between the expectations and general knowledge of pregnant women regarding prenatal US when compared with the current scientific knowledge. Importantly, we found that both depended greatly on sociodemographic factors, particularly educational level. This reiterated the importance of conducting effective dissemination actions of current scientific knowledge, focusing on the main objectives of US screening as well as the limitations of the existing technology. Conclusion: This study will help in defining strategies for future dissemination actions aiming to improve current practice and lead to a higher synchrony of expectations towards US between couples and practitioners. Synopsis: Our results highlight a direct relationship between general knowledge about prenatal ultrasound and sociodemographic characteristics. This study will help future efficient and accurate dissemination actions. [ABSTRACT FROM AUTHOR]

Objective: To investigate the relationship between anti‐Müllerian hormone (AMH) level and early pregnancy loss in patients who underwent their first embryo transfer by hormone replacement therapy–frozen–thawed embryo transfer (HRT‐FET) and analyze the threshold effect. Methods: A retrospective cohort analysis was performed on pregnant women undergoing HRT‐FET at the Reproductive Medical Center of Henan Provincial People's Hospital from January 2016 to December 2021. The patients were divided into four groups based on AMH concentration according to the Poseidon criteria: group A (≤1 μg/L), group B (1–≤2 μg/L), group C (2–≤6 μg/L), and group D (>6 μg/L). Univariate analysis, multivariate logistic regression analysis, smooth curve fitting, and threshold effect analysis were applied to investigate the influence of AMH on the outcome of early pregnancy loss in in vitro fertilization/intracytoplasmic sperm injection and HRT‐FET cycles. Results: Of the 6597 pregnant women, early pregnancy loss occurred in 893, giving an early pregnancy loss rate of 13.54%. Univariate regression analysis demonstrated that age, female body mass index, AMH, antral follicle count, endometrial thickness at endometrial transformation day, total retrieved oocyte number, number of pregnancies, duration of infertility, type of infertility, and the number of embryos transferred were all factors influencing the early pregnancy loss rate (P < 0.050). Multivariate logistic regression analysis, after adjusting for confounders, further stratified the analysis of patients of different ages. With group A as the control group, the results showed that when age was younger than 35 years, the pregnancy loss rates in groups B, C, and D were lower than that in group A, with statistical significance (P < 0.050); when age was 35 years or older, there was no statistically significant difference in outcome indicators between the groups (P > 0.050). A threshold effect analysis revealed that the AMH threshold was 2.83 μg/L. When the AMH concentration was less than 2.83 μg/L, the early pregnancy loss rate decreased significantly with increasing AMH concentration; the early pregnancy loss rate decreased by 21% for each unit increase in AMH (odds ratio 0.79; 95% confidence interval 0.71–0.88; P < 0.001); when the AMH concentration was 2.83 μg/L or more, there was no statistical difference in the change in early pregnancy loss rate (odds ratio 1.01; 95% confidence interval 0.99–1.03; P = 0.383). Conclusion: For pregnant women after their first embryo transfer, there is a curvilinear relationship between the influences of AMH levels on early pregnancy loss rates in patients younger than 35 years. When the AMH level was less than 2.83 μg/L, the early pregnancy loss rate declined significantly with increasing AMH levels. Synopsis: We revealed the quantitative and curvilinear relationship between AMH and early pregnancy loss after IVF, for which the threshold value of low AMH was found. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to assess the predictors of acceptance and hesitancy of additional doses of any SARS‐CoV‐2 (COVID‐19) vaccine among pregnant or recently pregnant and non‐pregnant people of reproductive age and partners in Brazil. Methods: We conducted an online cross‐sectional study from June 2022 to April 2023 and invited women and partners between 18 and 49 years old to participate. We employed a snowball strategy to reach all potential eligible participants. Our primary outcome was the acceptance rate of the COVID‐19 booster vaccine. We estimated the frequency and percentage for the three groups and compared categorical variables using the Chi‐square test. Moreover, bivariate, backward stepwise regression, and subgroup analyses were performed to evaluate risk factors and predictors of COVID‐19 vaccine booster hesitancy. We reported the effect size as OR with a 95% CI. Results: We included 1487 participants, and among them, 334 (22.5%) were pregnant or recently pregnant people, 905 (60.8%) were non‐pregnant people, and 247 (16.6%) were male partners. Pregnant and recently pregnant people showed greater hesitancy for the COVID‐19 vaccine booster than non‐pregnant people (28% vs 15%, P < 0.001) and male partners (28% vs 16%, P < 0.001). Non‐pregnant women accepted the COVID‐19 vaccine more often than pregnant or recently pregnant people (OR 1.75; 95% CI: 1.13–2.70). The associated factors to the reduced COVID‐19 vaccine booster acceptance were family income between US$ 566–945.00 (54%), evangelic religion (65%), concern about vaccine safety (80%) and perceived common vaccine importance (93%). Conclusion: Pregnant people were more hesitant than non‐pregnant people to accept the COVID‐19 booster vaccine. Family income, religious beliefs, vaccine safety concerns, and perceived common vaccine importance were significant barriers to accepting COVID‐19 booster vaccines. The impact of these factors was more evident among pregnant or recently pregnant people, emphasizing the harmful effect of misinformation among this vulnerable population. Synopsis: Pregnant people are more hesitant about COVID‐19 vaccine uptake compared to their counterparts, with social determinants and vaccine safety concerns being the key barriers. [ABSTRACT FROM AUTHOR]

Objective: To determine the reliability of the Carousel simulator in medical education for obstetric examinations. Cervical dilation examination training in pregnant women exposes patients to additional uncomfortable and health‐risk procedures, a gold standard, and does not objectively evaluate the medical student's competence. Method: We studied the reliability of training internship medical students in obstetrics. Participating students were assigned to take the examination of digital assessment of the cervical dilation on the simulator. Classes performed 12 consecutive randomly blind predetermined cervical dilation examinations using the Carousel simulator. The exact answer and the answer with certainty within ±1 cm were registered and analyzed. Incorrect or outlier answers were considered with a cutoff of ≥2 cm from the dilation. A dispersion graph for each centimeter of dilation simulation was constructed. Results: Sixty‐six medical obstetricians took part, performing 396 examinations. Thus, we observed 49 outliers (12.37%) in simulated assessments. According to the analysis, we did not observe outliers from dilation 1 to 4 cm; dilation 7 to 9 cm had a higher index of outlier measurements. We did not consider any dilation simulation dispersion graphic as a null correlation. A strong correlation was seen in the dilation 1 to 6 cm and the dilation 10 cm. The dilations 7, 8, and 9 cm showed a weak correlation. Conclusion: The Carousel simulator model is a reliable method for student learning. The simulator is an essential study tool capable of reducing the embarrassment and possible harm caused by the excessive and repetitive number of in vivo digital vaginal examinations. Novel studies are proposed to improve the simulator device and method, mainly to estimate the adequate repetitions and training needed before in vivo practice. Synopsis: We demonstrated the reliability of a novel simulator device used for digital vaginal examination of cervical dilation during labor for medical education. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the quality of ChatGPT responses to common issues in obstetrics and assess its ability to provide reliable responses to pregnant individuals. The study aimed to examine the responses based on expert opinions using predetermined criteria, including "accuracy," "completeness," and "safety." Methods: We curated 15 common and potentially clinically significant questions that pregnant women are asking. Two native English‐speaking women were asked to reframe the questions in their own words, and we employed the ChatGPT language model to generate responses to the questions. To evaluate the accuracy, completeness, and safety of the ChatGPT's generated responses, we developed a questionnaire with a scale of 1 to 5 that obstetrics and gynecology experts from different countries were invited to rate accordingly. The ratings were analyzed to evaluate the average level of agreement and percentage of positive ratings (≥4) for each criterion. Results: Of the 42 experts invited, 20 responded to the questionnaire. The combined score for all responses yielded a mean rating of 4, with 75% of responses receiving a positive rating (≥4). While examining specific criteria, the ChatGPT responses were better for the accuracy criterion, with a mean rating of 4.2 and 80% of the questions received a positive rating. The responses scored less for the completeness criterion, with a mean rating of 3.8 and 46.7% of questions received a positive rating. For safety, the mean rating was 3.9 and 53.3% of questions received a positive rating. There was no response with an average negative rating below three. Conclusion: This study demonstrates promising results regarding potential use of ChatGPT's in providing accurate responses to obstetric clinical questions posed by pregnant women. However, it is crucial to exercise caution when addressing inquiries concerning the safety of the fetus or the mother. Synopsis: ChatGPT demonstrated the ability to provide accurate and comprehensive responses to common obstetric questions. [ABSTRACT FROM AUTHOR]

Objective: In the Netherlands, antenatal cardiotocography (aCTG) to assess fetal well‐being is performed in obstetrician‐led care. An innovative initiative was started to evaluate whether aCTG for specific indications—reduced fetal movements, external cephalic version, or postdate pregnancy—is feasible in non‐obstetrician‐led care settings by independent primary care midwives. Quality assessment is essential when reorganizing and shifting tasks and responsibilities. Therefore, we aimed to assess the inter‐ and intraobserver agreement for aCTG assessments between and within four professional groups involved in Dutch maternity care regarding the overall classification and assessment of the various components of aCTG. Method: This was a prospective study among 47 Dutch primary care midwives, hospital‐based midwives, residents, and obstetricians. Ten aCTG traces were assessed twice at a 1 month interval. To ensure a representative sample, we used two different sets of 10 aCTG traces each. We calculated the degree of agreement using the proportions of agreement. Results: The proportions of agreement for interobserver agreement on the classification of aCTG between and within the four professional groups varied from 0.82 to 0.94. The proportions of agreement for each professional group were slightly higher for intraobserver (0.86–0.94) than for interobserver agreement. For the various aCTG components, the proportions of agreement for interobserver agreement varied from 0.64 (presence of contractions) to 0.98 (baseline heart frequency). Conclusion: The proportion of agreement levels between and within the maternity care professionals in the classification of aCTG traces among healthy women were comparable. This means that these professional groups are equally well able to classify aCTGs in healthy pregnant women. Synopsis: The proportion of agreement levels between and within professionals in midwife‐led and obstetrician‐led care in the classification of antenatal cardiotocography traces among healthy women are comparable. [ABSTRACT FROM AUTHOR]

Objective: Unlike other types of acute pain, labor pain is considered physiological. Due to the heterogeneous management during labor, there is a lack of intention to define quality of care of peripartal analgesia. This study presents the first results of the national register for this evaluation. Methods: This prospective cross‐sectional study, conducted in five different German level‐three hospitals, included women after vaginal childbirth between January 2020 and January 2022. A validated questionnaire was completed 24 h postpartum, including information about labor pain, satisfaction, and expectations regarding analgesia. Data were centrally recorded with obstetric records using the database of the QUIPS (Quality Improvement in Postoperative Pain Management) Project. Results: A total of 514 women were included. On an 11‐point Numerical Rating Scale, pain intensity during labor was severe (8.68 ± 1.8) while postpartal pain was 3.9 (±2.1). The second stage of labor was considered the most painful period. Only 62.6% of the parturients obtained pharmacological support, with epidural being the most effective (reduction of 3.8 ± 2.8 points). Only epidural (odds ratio [OR] 0.22) and inhalation of nitrous oxide (OR 0.33) were protective for severe pain. In benchmarking, a relation between satisfaction, pain intensity, and the use of epidural was found; 40.7% of the women wished they had received more analgesic support during labor. Conclusion: This study highlights deficiencies in analgesic management in high‐level perinatal centers, with more than 40% of parturients considering actual practices as insufficient and wishing they had received more analgesic support, despite the availability of analgesic options. Using patient‐reported outcomes can guarantee qualitative tailored analgesic care in women. Synopsis: This study exposes relevant analgesic shortcomings for parturients in perinatal centers, highlighting the need for tools to monitor and improve the quality of obstetric analgesic care. [ABSTRACT FROM AUTHOR]

Objective: Idiopathic intracranial hypertension (IIH), also known as pseudotumor cerebri, is a common pathology in reproductive‐aged women, although data regarding pregnancy outcomes are scarce. In the present study, we aimed to compare pregnancy and perinatal outcomes between women who suffered from IIH to those who did not. Methods: A retrospective cohort study using the Healthcare Cost and Utilization Project, Nationwide Inpatient Sample. All pregnant women who delivered or had a maternal death in the US (2004–2014) were included. Women with an ICD‐9 diagnosis of IIH before or during pregnancy were matched to controls without IIH according to age, race, insurance type, and income quartile, in a 1:20 ratio. Pregnancy, delivery, and neonatal outcomes were compared between the two groups. Results: Overall, 9 096 788 deliveries were identified. Of these, 1454 women (0.016%) had a diagnosis of IIH (study group) and were compared to 29 080 women without IIH (control group). Women with IIH, compared to those without, were more likely to be obese (body mass index >30 kg/m2) and suffer from pregestational diabetes mellitus and chronic hypertension (P < 0.001, all). After adjusting for confounders, patients in the IIH group, compared to those without, had a higher rate of pregnancy‐induced hypertension (aOR 1.82, 95% CI: 1.57–2.1, P < 0.001), pre‐eclampsia (aOR 1.98, 95% CI: 1.61–2.45, P < 0.001), preterm delivery (aOR 1.88, 95% CI: 1.59–2.23, P < 0.001), CD (aOR 2.41, 95% CI: 2.12–2.73, P < 0.001), wound complications (aOR 3.2, 95% CI: 1.89–5.42, P < 0.001), and congenital anomalies (aOR 2.18, 95% CI: 1.4–3.4, P < 0.001). Conclusion: Women with IIH had a higher incidence of obstetrical complications, including preterm deliveries, hypertensive disorders of pregnancy, and congenital anomalies. Synopsis: Women with IIH had a higher incidence of obstetrical complications, including preterm deliveries, hypertensive disorders of pregnancy, and congenital anomalies. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to report the screening performance of cell‐free DNA (cfDNA) testing for chromosomal abnormalities in twins, triplets, and vanishing twin pregnancies. Material and Methods: Data were obtained from pregnant women with a multiple pregnancy or a vanishing twin pregnancy at ≥10 weeks' gestation who requested self‐financed cfDNA testing between May 2015 and December 2021. Those that had positive screening results had diagnostic confirmatory procedures after counseling and consent. The performance of screening of the cfDNA test was determined by calculating confirmation rate and combined false‐positive rate (cFPR). Results: Data from 292 women were included after exclusion of those lost to follow‐up, with no‐result on cfDNA testing, or had reductions. Of the 292 pregnancies, 10 (3.4%) were triplets, including no cases of trisomy 21 and trisomy 18; 249 (85.3%) were twins, including 3 cases of trisomy 21 and no cases of trisomy 18 and 13; and 33 (11.3%) were vanishing twins, including 3 cases of trisomy 21 and 1 case of trisomy 18. The median (IQR) maternal age was 34 years (31–37). For triplet pregnancies, the initial no‐result rate was 10.3% (95% confidence interval [CI] 3.6–26.4), all with results after redraw. For twin pregnancies, the initial no‐result rate was 12.9% (95% CI 9.6–17.0), and the no‐result rate after redraw was 1.6% (95% CI 0.7–3.6). For vanishing twins, there were no cases with no‐result. All triplets had low‐risk cfDNA results. The confirmation rate for trisomy 21 was 100% with a FPR at 0% due to the small number of positive cases for twins. For vanishing twins, one high‐risk case for trisomy 21 and the only high‐risk case for trisomy 18 were confirmed with a cFPR of 8.3% (n = 2/24; 95% CI 2.3–25.9). Conclusions: cfDNA testing in twin pregnancies has sufficient screening performance for trisomy 21 but the number of affected cases for other conditions is limited to draw any meaningful conclusion. The use of cfDNA testing in triplet pregnancies and vanishing twins remains an area for further research. [ABSTRACT FROM AUTHOR]

Introduction: Clinical practice guidelines provide inconsistent recommendations regarding progestogen supplementation for threatened and recurrent miscarriage. We conducted a systematic review and meta‐analysis to assess the effectiveness and safety of progestogens for these patients. Material and methods: We searched Medline, Embase, and Cochrane Central Registry of Controlled Trials up to October 6, 2023 for randomized control trials (RCTs) comparing progestogen supplementation to placebo or no treatment for pregnant women with threatened or recurrent miscarriage. We assessed the risk of bias using a modified version of the Cochrane risk‐of‐bias tool and the certainty of evidence using the GRADE approach. Results: Of 15 RCTs (6616 pregnancies) reporting on threatened or recurrent miscarriage, 12 (5610 pregnancies) reported on threatened miscarriage with or without a prior history of miscarriage. Results indicated that progesterone probably increases live births (relative risk (RR) 1.04, 95% confidence interval (CI) 0.99–1.10, absolute increase 3.1%, moderate certainty). Of these RCTs, three (1973 pregnancies) reporting on threatened miscarriage with a prior history of miscarriage indicated that progesterone possibly increases live births (RR 1.06, 95% CI: 0.97–1.16, absolute increase 4.4%; low certainty), while four (2540 pregnancies) reporting on threatened miscarriage and no prior miscarriage left the effect very uncertain (RR 1.02, 95% CI: 0.96–1.10, absolute increase 1.7%; very low certainty). Three trials reporting on 1006 patients with a history of two or more prior miscarriages indicated progesterone probably increases live births (RR 1.08, 95% CI: 0.98–1.19, absolute increase 5.7%, moderate certainty). Six RCTs that reported on 2979 patients with at least one prior miscarriage indicated that progesterone probably increases live births (RR 1.07, 95% CI: 1.01–1.13, absolute increase 5.0%; moderate certainty). Progesterone probably has little or no effect on congenital anomalies (RR 1.06, 95% CI: 0.76–1.48, absolute increase 0.1%; moderate certainty), and other serious adverse pregnancy events (RR 1.07, 95% CI: 0.83–1.40, absolute increase 0.2%, moderate certainty). Conclusions: In women at increased risk of pregnancy loss, progestogens probably increase live births without increasing adverse maternal and neonatal events. It remains possible that the benefit is restricted to those with prior miscarriages. [ABSTRACT FROM AUTHOR]

Studies have shown cerebrovascular dysfunction in offspring with full‐gestational electronic cigarette (Ecig) exposure, but little is known about how individual trimester exposure impacts offspring health. This study aimed to determine if there is a critical window during gestation that contributes to vascular and anxiety‐like behavioural changes seen with full‐term exposure. To test this, rats were time‐mated, and the pregnant dams were randomly assigned to Ecig exposure during first trimester (gestational day, GD2–7), second trimester (GD8–14), third trimester (GD15–21) or full‐term gestation (GD2–21). We also assessed the effect of maternal preconception exposure. Both male and female offspring from all maternal exposure conditions were compared to offspring from dams under ambient air (control) conditions. Ecig exposure consisted of 60‐puffs/day (5 days/week) using either 5 or 30 watts for each respective exposure group. We found that maternal exposure to Ecig in the second and third trimesters resulted in a decrease (23–38%) in vascular reactivity of the middle cerebral artery (MCA) reactivity in 3‐ and 6‐month‐old offspring compared to Air offspring. Further, the severity of impairment was comparable to the full‐term exposure (31–46%). Offspring also displayed changes in body composition, body mass, anxiety‐like behaviour and locomotor activity, indicating that Ecigs influence neurodevelopment and metabolism. Maternal preconception exposure showed no impact on offspring body mass, anxiety‐like behaviour, or vascular function. Thus, the critical exposure window where Ecig affects vascular development in offspring occurs during mid‐ to late‐gestation in pregnancy, and both 5 W and 30 W exposure produce significant vascular dysfunction compared to Air. Key points: Exposure to electronic cigarettes (Ecigs) is known to increase risk factors for cardiovascular disease in both animals and humans.Maternal Ecig use during pregnancy in rodents is found to impair the vascular health of adolescent and adult offspring, but the critical gestation window for Ecig‐induced vascular impairment is not known.This study demonstrates Ecig exposure during mid‐ and late‐gestation (i.e. second or third trimester) results in impaired endothelial cell‐mediated dilatation (i.e. middle cerebral artery reactivity) and alters anxiety‐like behaviour in offspring.Maternal exposure prior to conception did not impact offspring's vascular or anxiety‐like behavioural outcomes.Rodent models have been a reliable and useful predictor of inhalation‐induced harm to humans. These data indicate maternal use of Ecigs during pregnancy should not be considered safe, and begin to inform clinicians and women about potential long‐term harm to their offspring. [ABSTRACT FROM AUTHOR]

Becoming pregnant as an academic is risky. Many who want to become or find themselves pregnant structure their lives and careers to try to mitigate the potential negative effects of pregnancy on their future careers. Yet research continues to suggest that having been pregnant or being a mother significantly reduces the likelihood of career success compared to either being child‐free or a father. While in some cases success is defined as research productivity, in many cases, it is defined as simply remaining in academia. Governments, societies, and institutions bemoan the resulting "leaky pipelines" and speculate as to the causes of seemingly reinforced glass ceilings. Yet, underlying so many of the formal and informal conversations, norms, and policies surrounding pregnancy and academia is an implicit assumption that pregnancy and pregnant people are the problem to be solved and solutions thus require repairing some deficit created in the individual by pregnancy. In this article, I argue that pregnancy discrimination in academia is in large part a problem resulting from power and how it is wielded against pregnant people, both by institutions and by individuals. Using both a personal narrative account of the process, experience, and outcomes of pregnancy in the academy resulting in filing a formal Title IX complaint and a review of contemporary research on power, discrimination, and pregnancy, I explore how academic structures and systems nominally tasked with supporting equity can instead serve to exaggerate power differences and foster discrimination. [ABSTRACT FROM AUTHOR]

Background and objectives: The provider–patient relationship is integral to medical practice and health outcomes, particularly among vulnerable patient populations. This study compared the provider–patient relationship among pregnant patients with opioid‐use disorder (OUD), who did or did not have a history of moderate to severe trauma. Methods: This was an exploratory data analysis of 119 patients enrolled in the Support Models for Addiction Related Treatment trial. Probable posttraumatic stress disorder (PTSD) was determined by a score ≥ 31 on the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. The provider–patient relationship was assessed at 26 ± 4 weeks of pregnancy using the Kim Alliance Scale (KAS). Multivariable regression was used to examine the association of KAS with probable PTSD among pregnant people with OUD. Results: The mean KAS score for pregnant participants without probable PTSD (N = 88) was 61.4 (SD ± 2.8) and for pregnant participants with probable PTSD (N = 31) was 59.6 (SD ± 3.7). Results demonstrated significant differences in KAS scores between those with and without probable PTSD after adjusting for demographic variables. Adjusted mean total KAS scores and scores on Empowerment and Communication subscales were significantly lower among those with probable PTSD compared to those without (p =.04 and 0.02, respectively) but did not differ significantly on Collaboration and Integration subscales. Conclusions and scientific significance: Analyses show an association between probable PTSD and provider–patient relationship among pregnant patients with OUD, with those with probable PTSD having a worse alliance with obstetric providers. This novel finding helps characterize the provider–patient relationship among a uniquely vulnerable population and can inform efforts to integrate trauma‐informed practices into prenatal care. [ABSTRACT FROM AUTHOR]

Background: There is limited epidemiological evidence on outcomes associated with dupilumab exposure during pregnancy; monitoring pregnancy outcomes in large populations is required. Objective: To investigate the potential association between exposure to dupilumab in pregnant women with atopic dermatitis and any adverse pregnancy, neonatal, congenital and post‐partum outcomes. Methods: We performed a multicentre retrospective cohort study across 19 Italian tertiary referral hospital. Childbearing women were eligible if aged 18–49 years and carried out the pregnancy between 1 October 2018 and 1 September 2022. Results: We retrospectively screened records of 5062 patients receiving dupilumab regardless of age and gender, identifying 951 female atopic dermatitis patients of childbearing age, 29 of whom had been exposed to the drug during pregnancy (3%). The median duration of dupilumab treatment prior to conception was 22.5 weeks (range: 3–118). The median time of exposure to the drug during pregnancy was 6 weeks (range: 2–24). All the documented pregnancies were unplanned, and the drug was discontinued in all cases once pregnancy status was reported. The comparison of the study cohort and the control group found no significant drug‐associated risk for adverse pregnancy, congenital, neonatal or post‐partum outcomes. The absence of a statistically significant effect of exposure on the event was confirmed by bivariate analysis and multivariate analysis adjusted for other confounding factors. Conclusions: This cohort of pregnant patients exposed to dupilumab adds to the existing evidence concerning the safety of biologic agents in pregnancy. No safety issues were identified regarding the primary outcome assessed. In clinical practice, these data provide reassurance in case of dupilumab exposure during the first trimester. However, the continuous use of dupilumab throughout pregnancy warrants further research. [ABSTRACT FROM AUTHOR]

Certolizumab pegol (CZP; CIMZIA™) is the only Fc‐free tumor necrosis factor inhibitor with data from a clinical study demonstrating no to minimal placental transfer. The pharmacokinetics (PK) of certolizumab pegol during pregnancy and postpartum in women with chronic inflammatory diseases were assessed using a population PK model based on data from the CHERISH study (NCT04163016), a longitudinal, prospective, open‐label PK phase IB study. Model development was performed in NONMEM using a frequentist prior approach, with prior information based on a population PK model for certolizumab pegol in non‐pregnant adult patients (NCT04740814). A one‐compartment model with first‐order absorption (Ka = 0.236 1/day) and linear elimination (CL/F = 0.416 L/day) from the central compartment (V/F = 7.86 L) best described certolizumab pegol PK in the CHERISH study. The structural model parameters were estimated with good precision (RSE < 25%). Baseline BW was included as a covariate on CL/F and V/F. Pregnancy trimester and time‐varying log‐transformed anti‐drug antibody (ADA) titer were identified as the only significant covariates for CL/F with a comparable influence on CL/F. Individuals with higher ADA titer (75th percentile) during pregnancy exhibited CL/F up to 1.43‐fold higher relative to individuals postpartum that showed median levels of ADA titer. However, the confidence interval for the combined effect of pregnancy stage and ADA titer effects on CL/F overlapped with the CL/F range of the typical individual postpartum. In addition, simulations showed a large overlap in certolizumab pegol concentrations between pregnant and non‐pregnant adults. The findings of this population PK analysis support the maintenance of established certolizumab pegol dosing regimens throughout pregnancy. [ABSTRACT FROM AUTHOR]

Background: Pregnant women involved in decisions about their care report better health outcomes for themselves and their children. Shared decision‐making (SDM) is a priority for health services; however, there is limited research on factors that help and hinder SDM in hospital‐based maternity settings. The purpose of this study was to explore barriers and facilitators to SDM in a large tertiary maternity care service from the perspectives of multiple stakeholders. Methods: Qualitative semi‐structured interviews were undertaken with 39 participants including women, clinicians, health service administrators and decision‐makers, and government policymakers. The interview guide and thematic analysis were based on the Theoretical Domains Framework to identify barriers and facilitators to SDM. Results: Women expect to be included in decisions about their care. Health service administrators and decision‐makers, government policymakers, and most clinicians want to include them in decisions. Key barriers to SDM included lack of care continuity, knowledge, and clinician skills, as well as professional role and decision‐making factors. Key facilitators pertained to policy and guideline changes, increased knowledge, professional role factors, and social influences. Conclusion: This study revealed common barriers and facilitators to SDM and highlighted the need to consider perspectives outside the patient–clinician dyad. It adds to the limited literature on barriers and facilitators to SDM in hospital care settings. Organizational‐ and system‐wide changes to service delivery are necessary to facilitate SDM. These changes may be enabled by education and training, changes to policies and guidelines to include and support SDM, and adequately timed information provision to enable SDM conversations. [ABSTRACT FROM AUTHOR]

Background: Implementation of shared decision‐making in antenatal care has had limited exploration. Objective: To assess what is known about shared decision‐making in antenatal care. Search Strategy: Five databases were searched (1997–2022) limited to English language studies from OECD countries. Data Collection and Analysis: A data collection table was constructed with findings from 32 papers. A narrative synthesis was conducted with subsequent thematic analysis of included papers. Main Results: Four areas of decision‐making were identified with six themes revealing enablers and barriers to shared decision‐making in antenatal care. Conclusion: Implementation of shared decision‐making requires continuity, time and personalisation of care. [ABSTRACT FROM AUTHOR]

Background: Standardization of health systems often hinders client‐centered care. This study investigates whether allowing more flexibility in the planning range of the Dutch home‐based postpartum care service improves its quality of care, as innovative approach to client‐centered care. Methods: A randomized controlled trial was conducted (2017–2019), in which pregnant women who intended to breastfeed were assigned into two groups (1:1). The intervention group was allowed to receive care up to the 14th‐day postpartum, instead of the first 8–10 consecutive days ("usual care"). Primary outcome measure was the proportion of newborns still receiving exclusively breastmilk on final caring day of the service. This so‐called successful breastfeeding rate is currently used by the Dutch health sector to measure the quality of care. Secondary outcome measures were self‐care experience, overall care experience, and exclusive breastfeeding duration rate. Results: Based on data from 1275 participants, there was no difference in exclusive breastfeeding on final caring day (86,7% intervention group vs. 88,9% control group, RR: 1.03, 95% CI: 0.98–1.07). Both groups showed similar self‐care experiences. Women in the intervention group had slightly poorer overall care experience and lower exclusive breastfeeding duration rates. Conclusions: This study found no effect on the quality of care when allowing more flexibility in the planning range of home‐based postpartum care. Women can, therefore, be offered more flexibility to suit them. Given the confusion in interpreting the sector's current main quality indicator, we call for an inclusive dialogue on how to best measure the quality of home‐based postpartum care. [ABSTRACT FROM AUTHOR]

Background: To prevent the spread of SARS‐CoV‐2, hospitals around the world adopted protocols that, in varying ways, resulted in the exclusion of partners from hospital postnatal care wards. The objective of this study was to examine the effect this exclusion had on partners' satisfaction with postnatal care. Methods: An online survey (the Swedish Pregnancy Panel) including free‐text comments was conducted before and during the first wave of the COVID‐19 pandemic; partners of pregnant women were recruited at an early ultrasound appointment and followed until 2 months after childbirth. Data were linked to the Swedish Pregnancy Register. Results: The survey was completed by 524 partners of women who gave birth during the pandemic and 203 partners of women who gave birth before. Partners' satisfaction with hospital postnatal care dropped 29.8 percent (−0.94 OLS, 95% CI = −1.17 to −0.72). The drop was largest for partners of first‐time mothers (−1.40 OLS, 95% CI = −1.69 to −1.11), but unrelated to clinical outcomes such as mode of birth and most social backgrounds, except higher income. The qualitative analysis showed that partners (1) felt excluded as partners and parents, (2) thought the strain on staff led to deficiencies in the care provided, and (3) perceived the decision about partner restrictions as illogical. Conclusions: The exclusion of partners from the hospital postnatal wards clearly impaired satisfaction with care, and partners of first‐time mothers were particularly affected. Planning for future restrictions on partners from hospital wards should factor in these consequences. [ABSTRACT FROM AUTHOR]

Given the paucity of safety data on fluoroquinolone antibiotics in pregnancy, a prospective observational cohort study was conducted in pregnant women who sought help and advice on drug use at two teratology information institutes in Japan. The primary endpoint of the study was the incidence of major congenital anomalies. The study population included pregnant women exposed to (i) fluoroquinolones (fluoroquinolone group), (ii) β‐lactams (infectious control group), or (iii) other agents considered to be nonteratogenic in humans (nonteratogenic control group) during the first trimester. The frequency of major congenital anomalies was compared across groups using a logistic regression model that adjusted for maternal age, smoking status, drinking status, facility consulted, and time of consultation. The fluoroquinolone group consisted of 411 women who had 383 children born alive. The infectious control and nonteratogenic control groups consisted of 1416 and 1482 women who had 1322 and 1401 children born alive, respectively. The incidence of major congenital anomalies was 1.5%, 2.0%, and 1.6% in the fluoroquinolone group, infectious control, and nonteratogenic control groups, respectively. Logistic regression showed that fluoroquinolone exposure is not a significant risk factor for major congenital anomalies. In conclusion, first‐trimester exposure to fluoroquinolone antibiotics was not associated with increased maternal or fetal risks. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion The aim of this study was to evaluate the clinical characteristics and outcomes of pregnant women with COVID‐19 and to compare with pregnant women without COVID‐19. In addition, in the subgroup of patients who were symptomatic at the time of diagnosis, the persistence of symptoms was assessed.This was a retrospective cohort study. All pregnant women aged ≥18 years, admitted to the maternity ward from March 2020 to September 2023 were included in the study. All patients admitted were routinely screened for SARS‐CoV‐2. Clinical characteristics and outcomes were registered.During the study period, 880 patients met the inclusion and were included in the analysis: 385 were COVID‐19 positive and 495 were COVID‐19 negative. In a multivariate analysis of the outcomes associated with COVID‐19 among pregnant women, hospitalization and the Apgar score at 5 min were independently associated with COVID‐19. Cesarean delivery, preterm birth, Apgar scores at 1 and 5 min <7, and maternal death were more frequent in pregnant women with COVID‐19 admitted to ICU than in those not admitted to ICU. Approximately 30% of patients had persistence of symptoms, for at least 6 months in almost 60%.The findings of the present study suggest that COVID‐19 was associated with increased morbidity and mortality among pregnant women. In addition, pregnant women with SARS‐CoV‐2 infection were at significantly higher risk of adverse perinatal outcomes, especially preterm birth. [ABSTRACT FROM AUTHOR]

Background and Aims Methods Results Conclusions Wilson disease (WD) is a rare disorder of copper metabolism, leading to liver and neurological disease. Existing literature on WD in pregnancy is scarce, limiting preconception and obstetrical counselling. In this systematic review with meta‐analysis, we determine the prevalence of various adverse pregnancy and neonatal outcomes in WD, as well as evaluate the impact of WD treatment on these outcomes.Scopus, MEDLINE and EMBASE were searched until 12 May 2023, for studies of pregnant individuals with WD and at least one pregnancy or neonatal outcome of interest. Meta‐analysis of single proportions was conducted to pool prevalence data for each outcome. Outcome rates were compared between treated and untreated groups in a meta‐analysis of dichotomous events.Sixteen studies, published from 1975 to 2022, were included in the systematic review. Thirty‐seven percent of pregnancies reported at least one adverse pregnancy outcome. Spontaneous abortions (20%), liver diseases of pregnancy (4.5%) and preterm births (2%) were the most frequent adverse pregnancy outcomes in patients with WD. The prevalence of spontaneous abortions was significantly lower in pregnant individuals with WD who received treatment during pregnancy (OR: .47, 95% CI: 35%–63%). The prevalence of any adverse pregnancy outcome was also significantly lower with treatment (OR: .53, 95% CI: .37–.76), which appears to be mostly driven by the reduction of spontaneous abortions.There is low to moderate quality evidence to suggest that preconception and obstetrical counselling for patients with WD should include a discussion on the potentially high frequency of adverse pregnancy outcomes in this population, as well as the importance of continuing WD treatment during pregnancy to ensure satisfactory pregnancy course and potentially minimize the risk of spontaneous abortions. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion To develop a model based on maternal serum liquid chromatography tandem mass spectrometry (LC–MS/MS) proteins to predict spontaneous preterm birth (sPTB).This nested case–control study used the data from a cohort of 2053 women in China from July 1, 2018, to January 31, 2019. In total, 110 singleton pregnancies at 11–13+6 weeks of pregnancy were used for model development and internal validation. A total of 72 pregnancies at 20–32 weeks from an additional cohort of 2167 women were used to evaluate the scalability of the model. Maternal serum samples were analyzed by LC–MS/MS, and a predictive model was developed using machine learning algorithms.A novel predictive panel with four proteins, including soluble fms‐like tyrosine kinase‐1, matrix metalloproteinase 8, ceruloplasmin, and sex‐hormone‐binding globulin, was developed. The optimal model of logistic regression had an AUC of 0.934, with additional prediction of sPTB in second and third trimester (AUC = 0.868).First‐trimester modeling based on maternal serum LC–MS/MS identifies pregnant women at risk of sPTB, which may provide utility in identifying women at risk at an early stage of pregnancy before clinical presentation to allow for earlier intervention. [ABSTRACT FROM AUTHOR]

Granulomatous mastitis (GM), a benign inflammatory disease of the breast, often mimics breast cancer on presentation. We present a case of GM during pregnancy manifesting as a breast mass, sudden onset of plantar pain, and erythema nodosum (EN). A 31‐year‐old pregnant Japanese woman, gravida 2, para 1, was referred to our hospital with severe plantar pain on both soles, causing difficulty walking. This pain worsened and EN appeared on both lower legs, followed by a left breast mass. Ultrasound findings suggested malignancy; however, aspiration biopsy confirmed GM. Her arthritis and EN resolved 2 days after commencing oral prednisolone and her walking improved. EN with/without arthritis is commonly associated with GM, especially during pregnancy. The described manifestations with a breast mass are suggestive of this diagnosis. [ABSTRACT FROM AUTHOR]

Introduction Material and Methods Results Conclusions This study aims to evaluate the safety of discontinuing aspirin treatment at 24–28 weeks in women at high risk after first‐trimester combined screening for preeclampsia (PE) and normal placental growth factor (PlGF) levels at 24–28 weeks of gestation.This is a post hoc analysis of the StopPRE trial, conducted at nine Spanish maternity hospitals from September 2019 to September 2021. In the StopPRE trial, all high‐risk single pregnancies identified during first‐trimester screening for PE were treated with 150 mg of daily aspirin. Out of 1604 eligible women with a soluble fms‐like tyrosine kinase‐1 to PlGF ratio (sFlt‐1/PlGF) ≤38 at 24–28 weeks, 968 were randomly assigned in a 1:1 ratio to either continue aspirin until 36 weeks (control group) or discontinue it (intervention group). In this secondary analysis, only women with PlGF ≥100 pg/mL at 24–28 weeks were included. As in the StopPRE trial, the non‐inferiority margin was set at a 1.9% difference in preterm PE incidence between the groups.Among the 13 983 screened pregnant women, 1984 (14.2%) were deemed high‐risk for preterm PE, of which 397 (20.0%) were ineligible, 636 declined participation, and 32 were excluded. Ultimately, 919 women with PlGF >100 pg/mL were randomized and included in this analysis. Preterm PE occurred in 0.9% of the intervention group (4 out of 465) and 1.5% of the control group (7 out of 454), indicating non‐inferiority of aspirin discontinuation. There were no significant differences between the groups in adverse pregnancy outcomes before 37 weeks, at <34 weeks, or ≥37 weeks. Minor antepartum hemorrhage incidence was significantly lower in the intervention group (absolute difference, −5.96; 95% CI, −10.10 to −1.82).Discontinuation of aspirin treatment at 24–28 weeks in women with PlGF levels ≥100 pg/mL was non‐inferior to continuing until 36 weeks for preventing preterm PE. However, these findings should be interpreted with caution, as they originate from a subanalysis of the StopPRE trial. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Discussion and Conclusions Little is known about reasons pregnant people self‐treat health conditions and pregnancy‐related symptoms with cannabis.We administered a cross‐sectional survey to 3571 pregnant and recently pregnant people from US population‐based panels. Participants who used cannabis at some point during pregnancy were asked which health conditions or symptoms they used cannabis to treat and reasons they used cannabis for self‐treatment. We explored differences in reasons for self‐treatment by sociodemographics.Nine‐hundred forty‐six participants indicated they used cannabis during pregnancy. Fifty‐seven percent (n = 578) of those who used cannabis during pregnancy indicated they used cannabis exclusively for health purposes; 39% (n = 347) indicated they used cannabis for health and recreation. The most common reasons for self‐treatment were believing cannabis was safer and more effective than other medications or treatments. Some participants reported not having health insurance or a health care provider as reasons for self‐treatment. Black and Hispanic people, and people with household income under $25,000, were more likely than White people and people with household income between $25,000–$49,999 to report barriers to other medications or treatments as reasons for self‐treatment. People with high school education were more likely than people with more education to report viewing cannabis as safe and effective for self‐treatment.Most pregnant people self‐treating health conditions or symptoms with cannabis are doing so because they consider it safer and more effective than other medications or treatments. Some people, particularly people of colour and low‐income people, may also self‐treat because they face barriers to other treatments. [ABSTRACT FROM AUTHOR]

Objective Design Setting Population Methods Main Outcome Measures Results Conclusions To assess whether procedural‐induced abortion or provider‐initiated preterm delivery are associated with improved survival in pregnant people with cancer.Retrospective population‐based cohort study.Provinces of Alberta and Ontario, Canada, 2003–2016.Females aged 18–50 years diagnosed with cancer at <20 weeks' (for the assessment of procedural‐induced abortion) or <37 weeks' gestation (for the assessment of provider‐initiated delivery).Cox proportional hazard models assessed all‐cause mortality in relation to procedural‐induced abortion and provider‐initiated preterm delivery, adjusting for cancer site, stage at diagnosis and age. Meta‐analysis pooled the results across both provinces.All cause mortality.There were 512 pregnant people diagnosed with cancer at <20 weeks' gestation and 782 diagnosed with cancer at <37 weeks' gestation. Neither procedural‐induced abortion (adjusted hazard ratio [aHR] = 1.39, 95% CI: 0.32–6.17) nor provider‐initiated preterm delivery (aHR = 1.17, 95% CI: 0.76–1.81) were associated with improved survival following adjustment for age, stage at diagnosis and cancer site.Neither procedural‐induced abortion nor provider‐initiated preterm birth was associated with improved survival in pregnant people diagnosed with cancer; however, these obstetric interventions are highly personal decisions best decided by the pregnant person in consultation with their care providers. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion Synopsis To determine the value of the Aggregate index of systemic inflammation (AISI) in predicting admission to neonatal intensive care unit (NICU) and chorioamnionitis.The present retrospective cohort study with pregnant women who were diagnosed with preterm premature rupture of membranes (PPROM) in the Department of Perinatology, Ministry of Health Ankara City Hospital between January 1, 2021, and June 1, 2023 (n = 357). The patients were categorized into subgroups: (1) cases with (n = 27) or without (n = 330) chorioamnionitis, (2) admission (n = 182) or no admission (n = 175) to NICU; (3) gestational age at birth <28 weeks or 28 weeks or longer; and (4) gestational age at birth <34 weeks or 34 weeks or longer. AISI values were compared between the subgroups, and cut‐off values for AISI were determined to predict adverse outcomes.AISI values were significantly higher in the admission to NICU group compared with the no admission to NICU group (707.0 vs 551.2) (P < 0.05). AISI values were also significantly higher in the chorioamnionitis group compared with those without chorioamnionitis (850.3 vs 609.4) (P < 0.05). AISI levels were significantly higher in cases delivered before 28 weeks of gestation compared with the cases delivered at 28 weeks of gestation or later (945.6 vs 604.9) (P < 0.05), and were also significantly higher in cases delivered before 34 weeks of gestation compared with the cases delivered at 34 weeks of gestation or later (715.5 vs 550.1) (P < 0.05). Optimal cut‐off values of AISI were found to be 626.19 (74.1% sensitivity, 52.8% specificity), 506.09 (68.9% sensitivity and, 47.7% specificity), and 555.1 (69.8% sensitivity, 48.1% specificity) in predicting NICU admission, chorioamnionitis, and delivery before 28 weeks, respectively.The novel inflammatory marker AISI may be used in the prediction of chorioamnionitis and NICU admission in PPROM cases.Aggregate index of systemic inflammation may be used as a novel marker in predicting high‐risk for chorioamnionitis and neonatal intensive care unit admission in women with preterm premature rupture of membranes. [ABSTRACT FROM AUTHOR]