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In the United States, cytomegalovirus is the most common congenital viral infection and the number 1 cause of nonhereditary sensorineural hearing loss. The vast majority of infants may be asymptomatic, especially if cytomegalovirus is contracted later in the pregnancy, and some symptoms may have a delayed onset. Therefore, it is important for the pathologist to identify the common histologic findings to help confirm the diagnosis so the child can be followed for late sequelae. Histologic examination of the placenta is important in live births and in cases of intrauterine fetal demise. Chronic lymphoplasmacytic villitis and fibrotic, avascular villi are the most common findings. When present, Cowdry A intranuclear and basophilic intracytoplasmic inclusions are characteristic. Immunohistochemistry for cytomegalovirus can highlight these inclusions as well as the associated eosinophilic debris. In addition, polymerase chain reaction or viral culture on placental or fetal samples can be performed for confirmation. [ABSTRACT FROM AUTHOR]

Objective  To determine if patients with a history of low pregnancy-associated plasma protein A (PAPP-A) in an initial pregnancy are at higher risk for adverse obstetric outcomes in a subsequent pregnancy. Study Design  This was a retrospective cohort study in patients who underwent first trimester screening for PAPP-A in two consecutive pregnancies. Two groups were examined: patients who had low PAPP-A in the first pregnancy followed by normal PAPP-A in the second pregnancy and patients who had recurrent low PAPP-A. Maternal and neonatal outcomes were compared between the groups, with the primary outcome being intrauterine growth restriction (IUGR) or preeclampsia. Results  A total of 124 patients were included, representing 248 pregnancies. Ninety-two (74.2%) patients had normal PAPP-A in the second pregnancy, and 32 (12.9%) patients had recurrent low PAPP-A. Patients with recurrent low PAPP-A had a higher rate of IUGR or preeclampsia compared with patients with normal PAPP-A in the second pregnancy but this was not significantly different (12.5 vs. 10.9%, p  = 0.51). There were no significant differences for all other outcomes. Conclusion  Among patients with a history of low PAPP-A, patients with normal PAPP-A in the subsequent pregnancy have a similar risk of adverse neonatal outcomes compared with patients with recurrent low PAPP-A. [ABSTRACT FROM AUTHOR]

Objective  To test the hypothesis that maternal height is associated with adverse perinatal outcomes, controlling for and stratified by maternal body mass index (BMI). Study Design  This was a retrospective cohort study of all births in California between 2007 and 2010 (n  = 1,775,984). Maternal height was categorized into quintiles, with lowest quintile (≤20%) representing shorter stature and the uppermost quintile (≥80%) representing taller stature. Outcomes included gestational diabetes mellitus (GDM), preeclampsia, cesarean, preterm birth (PTB), macrosomia, and low birth weight (LBW). We calculated height/outcome associations among BMI categories, and BMI/outcome associations among height categories, using various multivariable logistic regression models. Results  Taller women were less likely to have GDM, nulliparous cesarean, PTB, and LBW; these associations were similar across maternal BMI categories and persisted after multivariable adjustment. In contrast, when stratified by maternal height, the associations between maternal BMI and birth outcomes varied by specific outcomes, for example, the association between morbid obesity (compared with normal or overweight) and the risk of GDM was weaker among shorter women (adjusted odds ratio [aOR], 95% confidence interval [CI]: 3.48, 3.28–3.69) than taller women (aOR, 95% CI: 4.42, 4.19–4.66). Conclusion  Maternal height is strongly associated with altered perinatal risk even after accounting for variations in complications by BMI. [ABSTRACT FROM AUTHOR]

Objectives  To estimate the prevalence of gestational weight gain (GWG) adequacy according to the 2009 guidelines, and to examine the association between GWG adequacy and the adverse outcomes, stratified by prepregnancy body mass index (BMI). Study Design  A retrospective cohort study, using the 2011 to 2013 U.S. linked birth/infant death datasets, restricted to nonanomalous singleton live births at 37 to 41 weeks. The adverse outcomes included composite maternal morbidity (CMM), composite neonatal morbidity (CNM), and neonatal and infant mortalities. We used multivariable Poisson's regression models with robust error variance to examine the association between GWG adequacy and adverse outcomes. Results  Of 8,656,791 singleton live births, 20, 32, and 48% had inadequate, adequate, and excessive GWG, respectively. After multivariable regression adjustment, compared with adequate GWG, excessive GWG had 1.10 (1.08–1.13) and 1.12 (1.10–1.14) times higher risk of CMM and CNM, respectively; similar findings were observed in BMI subgroups. Compared with adequate GWG, inadequate GWG had 1.14 (1.03–1.26) and 1.12 (1.07–1.18) times higher risk of neonatal and infant mortalities, respectively. Similar results were noted among women with normal weight. Conclusion  Excessive GWG was associated with an increased risk of CMM and CNM, while inadequate GWG was associated with a higher risk of neonatal and infant mortalities. [ABSTRACT FROM AUTHOR]

Introduction: To determine whether maternal human papillomavirus (HPV) infection is associated with preterm premature rupture of membranes (PPROM). Materials and Methods: We conducted a retrospective cohort study of singleton deliveries at our institution from 2010 to 2015. Women, ages 16–49, with HPV genotyping or cervical cytology results 3 years before delivery were included. Chi-squared and logistic regression analyses were used. Results: In our cohort of 2153 women, 38.5% were HPV positive. PPROM was observed in 2.88% of women. HPV infection (p = 0.02), history of PPROM (p < 0.001), history of cervical conization or loop electrical excision procedure (LEEP) (p < 0.05), parity (p = 0.001), maternal body mass index at delivery (p < 0.001), drug use or smoking (p < 0.001), and ethnicity (p = 0.01) were associated with PPROM. HPV infection (odds ratio [OR] = 2.07, 95% confidence interval [CI]: 1.03–4.14) remained associated with PPROM when adjusting for history of PPROM, cervical conization, drug use or smoking, parity, ethnicity, and insurance. PPROM was associated with preterm delivery (OR = 105.50, 95% CI: 29.49–377.46) when adjusting for HPV infection, pregnancy-related hypertension, diabetes, placenta previa and abruption, cervical conization, smoking or drug use, ethnicity, and history of PPROM. HPV infection was associated with preterm delivery (p = 0.04) in univariate analysis, but not after adjusting for PPROM (p = 0.13). HPV infection had a univariate association with newborn septicemia (p = 0.02), respiratory distress syndrome (RDS) (p = 0.01), neonatal intensive care unit (NICU) admission (p = 0.001), and low birthweight (p = 0.03). Conclusions: HPV infection was associated with an increased risk of PPROM in this cohort. However, maternal HPV infection does not increase the risk of preterm delivery beyond those caused by PPROM. The observed association between maternal HPV infection and neonatal morbidity is likely due to the relationship between PPROM and preterm delivery. [ABSTRACT FROM AUTHOR]

Epidemiological studies report conflicting findings regarding association between maternal immigration status and pregnancy outcomes. In this study we compared risk factors and prevalence of adverse pregnancy outcomes in native Portuguese and migrants. Cross-sectional analysis was conducted using information collected at delivery from the participants of Generation XXI birth cohort. Logistic regression models were fitted to assess the association between migrant status and adverse pregnancy outcomes. Prevalence of risk factors for adverse pregnancy outcomes varied between native Portuguese and migrants: teenage mothers (5.6 and 2.0%), primiparae (57.1 and 63.9%), smoking during pregnancy (23.0 and 19.1%), twins (3.2 and 8.0%), and caesarean section (35.2 and 45.7%). Among singleton births, prevalence of low birthweight, preterm birth and small for gestational age were 7.3 and 3.9%, 7.5 and 6.2%, and 15.1 and 7.6%, respectively for native Portuguese and migrants. The native Portuguese had an adjusted significantly higher risk of low birthweight (OR 2.67, 95% CI 1.30, 5.48) and small for gestational age (OR 2.01, 95% CI 1.26, 3.21), but a similar risk for preterm birth (OR 1.38, 95% CI 0.81, 2, 34). Migrant mothers presented a lower risk of low birthweight and small for gestation and data suggest a healthy immigrant effect. [ABSTRACT FROM AUTHOR]

Objective  To examine the change in body mass index (BMI) categories between pregnancies and its effect on adverse pregnancy outcomes. Study Design  We performed a retrospective cohort study of women with two consecutive deliveries from 2005 to 2010. Analysis was limited to women with BMI recorded at <24 weeks for both pregnancies. Standard BMI categories were used. Adverse pregnancy outcomes included preterm birth at <37 weeks, intrauterine growth restriction (IUGR), pregnancy-related hypertension, and gestational diabetes mellitus (GDM). Women with increased BMI category between pregnancies were compared with those who remained in the same BMI category. Results  In total, 537 women were included, of whom 125 (23%) increased BMI category. There was no association between increase in BMI category and risk of preterm birth, IUGR, or pregnancy-related hypertension. Women who increased BMI category had an increased odds of GDM compared with women who remained in the same BMI category (6.4 vs. 2.2%; p  = 0.018). The increased risk remained after controlling for age, history of GDM, and starting BMI (adjusted odds ratio: 8.2; 95% confidence interval: 2.1–32.7; p  = 0.003). Conclusion  Almost one-quarter of women increased BMI categories between pregnancies. This modifiable risk factor has a significant impact on the risk of GDM. [ABSTRACT FROM AUTHOR]

CONTEXT: Advancing gestational age can increase the cost of an abortion and is a significant risk factor for complications. While obesity is not associated with increased risks, anecdotal evidence suggests that obese women seeking services at freestanding abortion clinics are often referred for hospital‐based care, which can lead to delays. METHODS: In 2016, a cross‐sectional survey collected data on the experiences of 201 women who had obtained abortions at a hospital‐based clinic in Philadelphia; rates of medical complications were determined from hospital records. Multivariable logistic regression analysis was used to assess if obesity was associated with whether patients had been referred from freestanding abortion clinics or reported other paths to care. Differences in wait time and up‐front out‐of‐pocket costs were examined by women's referral status. RESULTS: No difference in rates of abortion complications was found between patient groups. Women who were severely obese (body mass index of at least 40 kg/m2) were more likely than normal‐weight individuals to have been referred from a freestanding abortion clinic (odds ratio, 7.5). The median wait time to get an abortion was 28 days for referred patients and 12 days for others. Multivariable analysis confirmed that referred patients waited twice as long as other patients (rate ratio, 2.0) and paid 66% more in up‐front costs. CONCLUSIONS: Future research is needed to determine whether obese women seeking abortions are being referred despite evidence that they do not require hospital‐based care. If obese women are suffering delays because of referral, strategies to help overcome delay should also be explored. [ABSTRACT FROM AUTHOR]

Aim: To obtain the incidence of preterm premature rupture of membranes (PPROM) at Siriraj Hospital during 2012–2016 and to identify its possible risk factors in singleton pregnancies. Methods: This study was a retrospective case–control study. The institutional ethical committee has approved the study. The medical records of eligible cases were reviewed. To assess the risk factors of PPROM, the data of the cases with PPROM in 2016 were compared with the data of pregnant women who did not have PPROM and delivered at term. Fifteen variables of interest were studied. Results: During the 5‐year period, there were 43 727 deliveries at Siriraj Hospital and 1280 (2.93%) cases had PPROM. In 2016, 252 pregnant women were diagnosed PPROM and data of 199 cases were compared with the data of 199 control cases. Mean latency period was 2 days and mean gestational age at birth was 34.7 weeks in PPROM group. Logistic regression analysis showed that diabetes mellitus, poor weight gain and history of previous preterm birth were the factors that significantly associated with PPROM, with adjusted odds ratio (OR) 3.22 (95% confidence interval [CI] 1.47–7.05), 2.58 (95% CI 1.63–4.07) and 8.81 (95% CI 2.81–28.69), respectively (P < 0.05), while multiparity decreased the risk of PPROM (adjusted OR = 0.36, 95% CI 0.23–0.57) (P < 0.001). Conclusion: The incidence of PPROM during 5‐year period was 2.93%. Diabetes mellitus, poor maternal weight gain and history of previous preterm birth significantly increased risk of PPROM while multigravida reduced the risk. [ABSTRACT FROM AUTHOR]

Objective To investigate the impact of medical and obstetric complications associated with mixed connective tissue disease (MCTD) in pregnancy. Method We analyzed 68 pregnancies from a systematic literature review and 12 pregnancies affected by MCTD at our centre between 1986 and 2015 for medical and obstetric complications. Results During pregnancy 37.1% had active MCTD and 26.7% had relapsed. Maternal complications included caesarean section (31.1%, n = 19), preeclampsia (17.6%, n = 13), thromboembolism events, and death (2.5%, n = 2 for each). Fetal complications included prematurity (48.1%, n = 25), intrauterine growth restriction (38.3%, n = 19), and neonatal lupus (28.6%, n = 18, including chondrodysplasia punctata). More than half (n = 10) of the neonatal lupus cases were explained by anti-U1RNP only. The perinatal mortality rate was 17.7% (n = 14). Pregnant women with active disease had higher rates of prematurity (OR = 7.60; 95%CI [1.93; 29.95]) and perinatal death (OR = 16.83; 95%CI [1.90; 147.70]). Conclusion MCTD in pregnancy puts women at risk of medical and obstetric complications, and disease activity probably increases this risk. [ABSTRACT FROM AUTHOR]

Objectives Severe maternal morbidity (SMM) is an important indicator for identifying and monitoring efforts to improve maternal health. Studies have identified independent risk factors, including race/ethnicity; however, there has been limited investigation of the modifying effect of socioeconomic factors. Study aims were to quantify SMM risk factors and to determine if socioeconomic status modifies the effect of race/ethnicity on SMM risk. Methods We used 2008-2012 NYC birth certificates matched with hospital discharge records for maternal deliveries. SMM was defined using an algorithm developed by the Centers for Disease Control and Prevention. Mixed-effects logistic regression models estimated SMM risk by demographic, socioeconomic, and health characteristics. The final model was stratified by Medicaid status (as a proxy for income), education, and neighborhood poverty. Results Of 588,232 matched hospital deliveries, 13,505 (229.6 per 10,000) had SMM. SMM rates varied by maternal age, birthplace, education, income, pre-existing chronic conditions, pre-pregnancy weight status, trimester of prenatal care entry, plurality, and parity. Race/ethnicity was consistently and significantly associated with SMM. While racial differences in SMM risk persisted across all socioeconomic groupings, the risk was exacerbated among Latinas and Asian-Pacific Islanders with lower income when compared to white non-Latinas. Similarly, living in the poorest neighborhoods exacerbated SMM risk among both black non-Latinas and Latinas. Conclusions for Practice SMM determinants in NYC mirror national trends, including racial/ethnic disparities. However, these disparities persisted even in the highest income and educational groups suggesting other pathways are needed to explain racial/ethnic differences. [ABSTRACT FROM AUTHOR]

Women who have eating disorders represent up to 8% of pregnant women today. The risks to both a mother and her baby are significant if an eating disorder is present. It is important that midwives have the knowledge, skills and confidence to enquire about eating disorders with women early in the pregnancy, and are also aware of the clinical signs of eating disorders, in order to recognise these situations. Midwives should use sensitive and compassionate communication skills when caring for women who have eating disorders, who have complex psychological feelings that may affect their behaviour. The symptoms of eating disorders may improve during pregnancy but midwives should be aware of the effects of childbirth. The postnatal phase is an important period for a mother who has an eating disorder, as her symptoms may recur, and midwives should therefore work in partnership with key members of the multidisciplinary team. [ABSTRACT FROM AUTHOR]

Background: Peripartal hysterectomy (PH) is a challenging surgical procedure with elevated maternal morbidity. Methods: From 2004 to 2016, 41 emergency PHs were performed at the tertiary care center of the Department of Gynecology and Obstetrics at University Hospital Ulm. In our retrospective analysis, the incidence of PH in our hospital was 12.8 per 10,000 deliveries with a maternal mortality of 2.4%. PH followed in 80.5% after cesarean section (c-section). Underlying causes/indications for PH were abnormal placentation (53.7%; n=22), uterine atony (26.8%; n=11), uterine lacerations (14.6%; n=6) and in rare cases uterine infection (4.9%; n=2). The median number of transfused products was 11 packed red blood cells (range 0–55 products), 10 fresh frozen plasma units (range 1–43) and two platelet concentrates (0–16). Results: Loss of blood as estimated by surgeons was significantly correlated with actual transfused blood volume (P<0.001). Clinically relevant intra- and/or postoperative complications occurred in 53.7% of patients (n=22). Abnormal placentation was the leading cause for PH with an increased incidence during the last 10 years presumptively representing the elevated rate of c-sections. Conclusion: PH goes along with increased rates of blood product transfusions independently of indication for surgery and has a high morbidity with a major complication rate of more than 50%. Prepartal assessment of risk factors like abnormal invasive placenta are crucial for reducing maternal morbidity. [ABSTRACT FROM AUTHOR]

Rationale: The extent of pregnancy in adolescents and young adults, especially in low and middle‐income countries, is a source of increasing concern given its social and economic impact. Aims and Objective: We hypothesized that there would be correlations between female patients becoming pregnant at a young age and practices such as harmful alcohol misuse, cigarette smoking, and drug use, the use of toxic substances, low educational attainment, and an essential absence of health care seeking about the outcome of adolescent pregnancies. Methods: We performed a prospective cross‐sectional study of patients who gave birth between August and November 2017 at St. Pantelimon Emergency Hospital in Bucharest, Romania. Seventy‐four patients aged 14 to 20 years, with a mean maternal age of 18.07 years, were enrolled in the study and answered a 15‐item questionnaire about their social, educational, and medical background. Results: Fifty‐three patients (71.6%) gave birth by caesarean section and 21 (28.3%) by vaginal delivery. Notably, patients aged 14 to 16 years had a lower rate of caesarean delivery compared with those aged 17 to 20 years. Moreover, 83.0% of the caesarean sections and 76.1% of the vaginal deliveries were at term. With reference to age and type of delivery, women are more likely to give birth by caesarean section at any age group (the association is not statistically significant at P < .05), except for the age of 15 years (five out of six patients in our sample had a spontaneous birth). Smoking was the most common risk behavior in the sample (45.9%, n = 34), followed by alcohol consumption (17.5%, n = 13) and drug use (5.40%, n = 4). Conclusions: A high percentage of caesarean delivery was reported, particularly in patients aged >17 years. The percentage of female participants who underwent a caesarean delivery for their second pregnancy was significantly higher than compared with primipara participants. Patients receiving consistent antenatal care visits compared with those who did not monitor their pregnancy did not differ in the likelihood of undergoing a caesarean section. [ABSTRACT FROM AUTHOR]

Chronic hypertension in pregnancy is traditionally classified according to degree of blood pressure (BP) elevation. Alternatively, stratifying women as high or low risk based on the etiology of hypertension, baseline work-up, and comorbid medical conditions will better inform clinicians about thresholds to initiate antihypertensive therapy, target BPs, frequency of antepartum visits, and timing of delivery. Women classified as high-risk chronic hypertension as described here require stricter BP management and more frequent follow-up visits as their associated rates of adverse maternal and/or fetal/neonatal outcomes appear higher than women classified as low-risk chronic hypertension. The latter group can in most cases be managed similarly to the general obstetric population. [ABSTRACT FROM AUTHOR]

Objective  The aim of this study was to evaluate obstetric outcomes in relation to the extent of donor sperm exposure with and without egg donation. Materials and Methods  This is a retrospective cohort study in a single tertiary care center. All women with a singleton pregnancy who conceived following sperm donation (SD) were included. Obstetrics and neonatal outcomes for pregnancies following single SD were compared with pregnancies following repeat SD from the same donor. In a secondary analysis, we compared pregnancy outcomes among three modes of assisted reproductive technology (intrauterine insemination [IUI-SD], in vitro fertilization [IVF-SD], and IVF sperm + egg donation [IVF-SD + ED]). Results  A total of 706 pregnant women met the inclusion criteria, 243 (34.4%) following the first SD and 463 (65.6%) following repeat donations. Compared with repeat SDs, single donation was not associated with higher rates of preterm delivery (12.8 vs. 12.7%, respectively, p  = 0.99), preeclampsia (7.0 vs. 6.9%, p  = 0.999), and intrauterine growth restriction (4.1 vs. 3.9%, p  = 0.88). Pregnancies following IVF-SD + ED had increased risk for preeclampsia (adjusted odds ratio [AOR], 3.1; 95% confidence interval [CI], 1.5–6.6), preterm labor (AOR, 2.4; 95% CI, 1.1–5.4), and cesarean section (AOR, 2.1; 95% CI, 1.0–4.3) compared with IUI-SD and IVF-SD. Conclusion  The extent of donor sperm exposure did not correlate with obstetrics complications, but double gamete donation was associated with increased risk for preeclampsia, preterm labor, and cesarean section. [ABSTRACT FROM AUTHOR]

Background: The incidence of pregnancy-associated cancer (PAC) is expected to increase as more women delay childbearing until later ages. However, information on frequency and incidence of PAC is scarce in the United States. Methods: We identified pregnancies among women aged 10–54 years during 2001–2013 from five U.S. health plans participating in the Cancer Research Network (CRN) and the Medication Exposure in Pregnancy Risk Evaluation Program (MEPREP). We extracted information from the health plans' administrative claims and electronic health record databases, tumor registries, and infants' birth certificate files to estimate the frequency and incidence of PAC, defined as cancer diagnosed during pregnancy and up to 1 year postpartum. Results: We identified 846 PAC events among 775,709 pregnancies from 2001 to 2013. The overall incidence estimate was 109.1 (95% confidence interval [CI] = 101.8–116.7) per 100,000 pregnancies. There was an increase in the incidence between 2002 and 2012 (the period during which complete data were available), from 75.0 (95% CI = 54.9–100.0) per 100,000 pregnancies in 2002 to 138.5 (95% CI = 109.1–173.3) per 100,000 pregnancies in 2012. The most common invasive cancers diagnosed were breast (n = 208, 24.6%), thyroid (n = 168, 19.9%), melanoma (n = 93, 11.0%), hematologic (n = 87, 10.3%), and cervix/uterus (n = 74, 8.7%). Conclusions: Our study provides contemporary incidence estimates of PAC from a population-based cohort of U.S. women. These estimates provide the data needed to help develop clinical and public health policies aimed at diagnosing PAC at an early stage and initiating appropriate therapeutic interventions in a timely manner. [ABSTRACT FROM AUTHOR]

Objective: To investigate the variability in the prevalences of selected birth risks in women of different heights and weights. Methods: Data from the German Perinatal Survey of 1998–2000 were analyzed: 503,468 cases contributed to our analysis of the prevalences of selected birth risks specified according to maternal weight groups, 502,562 cases contributed to our analysis according to maternal height groups and 43,928 cases contributed to our analysis of birth risks in women with a body mass index (BMI) of 21–23 kg/m2 but different heights and weights. Data analysis was performed using SPSS version 22. Results: Some birth risks varied substantially by maternal height in women with a "normal" BMI of 21–23 kg/m2: the prevalence of post-term birth increased from 8.7% in women with a height of 150 cm to 13.5% in 185 cm tall women, the prevalence of preterm birth decreased from 5.9% (150 cm tall women) to 3.1% (185 cm tall women), a pathologic cardiotocography (CTG) or poor fetal heart sounds on auscultation occurred in 19.4% of the 150 cm tall women but only in 9.2% of 185 cm tall women and cephalopelvic disproportion decreased from 12.3% (150 cm tall women) to 1.2% (185 cm tall women). Analyses of women in different body height and weight groups (without restriction of BMI) likewise showed differences in the prevalences of some birth risks. Conclusion: Birth risks may vary by height and weight in women with the same, "normal" BMI. BMI should not be the only way by which the impact of maternal height and weight is assessed with regard to perinatal outcomes such as birth risks. [ABSTRACT FROM AUTHOR]

From last decade of the 20th century, numerous epidemiological studies and intervention trials have attempted to prove the relationships between maternal periodontal diseases and adverse pregnancy outcomes (APO). Periodontal diseases are considered a risk factor for APO, including preterm birth, fetal growth restriction, low birthweight, pre‐eclampsia and gestational diabetes. However, the efficacy of periodontal treatment during pregnancy is controversial. Two pathogenic mechanisms might explain the potential effect of periodontal diseases on pregnancy outcomes. First, periodontal bacteria originating in the gingival biofilm directly affect the feto‐placental unit subsequent to bacteremia. Second, inflammatory mediators secreted by the subgingival inflammatory site are carried to the feto‐placental unit, where they then cause an inflammatory response. To elucidate these mechanisms, many researchers have been investigating the use of experimental animal models and in vitro models. In the present review, we summarize the current literature on the relationship between periodontal diseases and APO from epidemiological studies, animal models studies and in vitro studies, and speculate on the possible mechanism of periodontal diseases affecting pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Background: The placenta is a soft organ with vital importance. Increased placental stiffness was reported in pathological conditions emerging during pregnancy, such as diabetes mellitus and hypertension. Nowadays, placental stiffness can be quantitatively measured using the shear wave elastography (SWE) technique. Objectives: We aimed to assess the factors affecting elasticity by finding the normal elastogram values of healthy pregnancy placentas using the SWE technique due to the importance of early diagnosis in ris^cy pregnancies. Patients and Methods: In total, 288 healthy pregnant women in the second or third trimester were included in our prospective study. The pregnant women who had pathology in their fetus and its appendices or a posteriorly located placenta were excluded from the study. Obstetric ultrasonography and a placental elasticity assessment were performed in all the pregnant women. Speed values were obtained from five different locations of the placenta, including the central S1, S2, S3, S4 and peripheral P regions. The elasticity of the regions were compared, and the factors affecting elasticity were investigated. Results: There were significant differences among the velocity values obtained from five different areas of the placenta. The mean velocity values obtained from the central region were higherthan those of the peripheral region (P< 0.001). There was also a significant difference in the mean velocity measurements obtained from the central region (P < 0.001). The hardest region of the placenta was the maternal surface, while the softest region was the peripheral surface. The elastographic velocity values of the placenta were found to correlate with maternal age, body mass index, placental localization, thickness, and grade, whereas it did not correlate with gravidity, parity, gestational week, and amniotic fluid index. Conclusion: The elasticity of the placenta varied according to the region and surface, whereas it did not change according to gestational week. It may be convenient to use the elasticity values obtained by SWE from specified regions in the follow-up of placentas in high-risk pregnancies. However, considering the affecting factors and contradictory study results, a large number of large-scale studies is required to strengthen the efficiency of SWE in the placental assessment. [ABSTRACT FROM AUTHOR]

Introduction Rheumatologists are essential partners in planning and managing pregnancies in women with lupus. Whether they know the essentials of contraceptive and medical treatment in pregnancy, however, is unknown. Method Anonymous in-lecture surveys were completed by 270 rheumatologists to assess knowledge of contraceptive effectiveness, emergency contraception, medication teratogenicity, and lupus pregnancy risk assessment. Results Rheumatologists knew the high effectiveness of the intrauterine device, but over-estimated the effectiveness of injectable medroxyprogesterone and condoms. Almost all identified methotrexate as a teratogen, but only 69% identified cyclophosphamide and 37% mycophenolate. Most rheumatologists knew that lupus activity in pregnancy is the main predictor of pregnancy outcomes, but underestimated the risks of hypertension and race. Conclusion To improve lupus pregnancy planning and management, rheumatologists would benefit from improved knowledge about contraceptive effectiveness, teratogens, and the risks from non-lupus factors for pregnancy complications. [ABSTRACT FROM AUTHOR]

Background: Self‐injurious behaviours (SIB) are concerning, maladaptive behaviours that commonly occur in people with neurodevelopmental conditions and delays but seem to be particularly prevalent in children and adults with autism spectrum disorder (ASD). There has been increasing research examining the risk markers associated with the presence of SIB in people with ASD. Some of the factors associated with SIB have included cognitive abilities, adaptive functioning deficits and behaviour regulation impairments (e.g. impulsivity and repetitive behaviours). However, many of the findings in the literature are mixed and only explain a small proportion of the variance contributing to SIB. Limitations in the previous literature have centred on lack of availability of large and diverse samples, restricted age ranges and constraints of measurement. Method: This study characterises a clinic‐referred sample of children and adults currently presenting with and without SIB using a range of standardised and parent‐report measures. The sample includes 144 individuals with ASD between the ages of 2.5 and 60.1 years. Results: After adjusting for multiple tests, none of the variables maintained statistical significance between the group of individuals with and without SIB, but medium to large effect sizes were noted. These variables include parent‐reported early motor and toileting delays and perinatal risk, and current cognitive and social impairment. The remaining variables, including current autism severity levels, early ASD symptomatology, impulsivity, executive functioning impairments, adaptive functioning, mood and anxiety, did not differ between those with and without current engagement in SIB. Conclusions: Utilising a diverse clinic‐referred sample and standardised diagnostic tools, this study explored retrospective and current correlate risk markers of SIB in individuals with ASD. In addition to impairments in current functioning, specific early developmental delays and perinatal risk factors were preliminarily associated with the presence of SIB in individuals with ASD. Together these findings suggest that a set of specific characteristics may be related to both early risk and concurrent manifestation of SIB. Identifying this set of characteristics in early development may lead to faster identification and better intervention services, but future work utilising longitudinal design and multivariate analysis is warranted. [ABSTRACT FROM AUTHOR]

Objectives: Preterm premature rupture of membranes (PPROM) is a major contributor to overall preterm birth (PTB) rates. A short interpregnancy interval (IPI) is a well-known risk factor for PTB. It is unknown if a short IPI specifically affects the risk of developing PPROM in a subsequent pregnancy. We sought to determine the association between IPI and the risk of PPROM in a subsequent pregnancy.Methods: A retrospective cohort study using the Missouri birth certificate database of singleton births from 2003 to 2013 was conducted. A short IPI (delivery of the prior pregnancy to conception of the index pregnancy) was defined as ≤6 months. IPI >6 months was categorized into two groups: IPI 7-23 months and IPI ≥24 months. PPROM was defined as premature rupture of membranes between 160 and 366 weeks. Multivariable logistic regression was conducted to determine the association between IPI and PPROM while controlling for maternal age, race, body mass index (BMI), education level, use of social services (Medicaid insurance, food stamps, or participation in the WIC [Women, Infants, and Children] program), tobacco use, and history of PTB. Secondary outcome included the gestational age at delivery, categorized into five subgroups (≤240, 241-280, 281-320, 321-340, and 341-366 weeks).Results: 474,957 subjects with singleton gestations had data available to calculate the IPI. Of these, 1.4% (n = 6797) experienced PPROM. IPI ≤6 months was significantly associated with an increased risk of developing PPROM compared with patients with IPI ≥24 months (odds ratio (OR) 1.80, 95% CI 1.70-1.90, p < .001). A higher proportion of women with IPI ≤6 months delivered between 281 and 320 weeks compared to the other two IPI groups (27.0 versus 15.0 and 16.4%, p < .001). Individual maternal factors associated with an increased risk of PPROM included advanced maternal age, African American race, BMI <18.5 kg/m2, BMI ≥30 kg/m2, use of social services, tobacco use, and a prior PTB.Conclusion: Our data demonstrate that an IPI of ≤6 months is significantly associated with an increased risk of developing PPROM in the subsequent pregnancy. Of greater clinical relevance is that these women were more likely to deliver between 281 and 320 weeks as compared with women with a longer IPI. Novel to this study is the establishment of a specific link between a short IPI and PPROM with subsequent early delivery. Several maternal demographic factors known to be associated with PTB risk were also found to be associated with an increased risk of PPROM. Further studies are necessary to elucidate plausible biologic mechanisms ultimately leading to the development and implementation of preventive and therapeutic strategies for this high-risk cohort. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to investigate the effect of maternal obesity on fetal size in first- and second-trimester pregnancies and to determine duration of pregnancy as estimated by a variety of methods.Methods: Between 2006 and 2011, a cohort study included (n = 9055) singleton pregnancies that resulted in live birth at Holbaek Hospital in Denmark. This study recorded first- and second-trimester fetal measurements and maternal anthropometry. Characteristics considered included mother's age, parity, height, body mass index (BMI), smoking habits, and sex of child. The correlation between BMI and duration of pregnancy was analyzed by time-to-event analysis and accounted for medical intervention by censoring while correlation of BMI on fetal size was evaluated by multiple regression analysis.Results: Adjusting for maternal and fetal characteristics, BMI was associated with prolonged pregnancy duration (0.20-0.22 d per kg/m2 (standard error (SE) 0.02)) when using ultrasound and 0.26 d per kg/m2 (SE: 0.03) when using last menstrual period. With increasing BMI, fetal biometries in first and second trimester were significantly smaller than expected (0.08 mm per kg/m2 when measured by crown rump length (SE 0.02)).Conclusions: Maternal BMI is correlated to smaller fetal size in early pregnancy and prolongs duration of pregnancy. [ABSTRACT FROM AUTHOR]

Although essential for a successful pregnancy, a growing body of evidence suggests that maternal inflammation, when dysregulated, may represent a risk factor for both maternal and neonatal outcomes. Here, we assessed the accuracy of maternal C-reactive protein (CRP) concentrations at the middle phase of pregnancy in the identification of maternal adverse outcomes (MAO) until delivery. A correlation between CRP and a complicated pregnancy including both maternal and neonatal adverse outcomes has been investigated, too. In this retrospective study, conducted at the Diabetology Unit of IRCCS Ospedale Policlinico San Martino, Genoa (Italy), 380 outpatient pregnant women have been enrolled at the prenatal visit before performing a 75 g oral glucose tolerance test at 24th-26th gestational week for gestational diabetes mellitus (GDM) screening. Demographic, medical, and reproductive history has been obtained by verbal interview. Data about pregnancy and delivery have been retrieved from medical records. The median value of maternal baseline serum CRP was 3.25 μg/mL. Women experiencing MAO were older, more frequently suffering from hypertension, and showed higher CRP concentrations, with a cutoff value >1.86 μg/mL found by a ROC curve analysis to be accurately predictive for MAO. By a logistic regression analysis, serum CRP levels >1.86 μg/mL have been found to predict MAO also considering maternal age, hypertension, and GDM. Maternal CRP levels have been positively associated with overall pregnancy adverse outcomes (maternal and neonatal), too. In conclusion, in pregnant women serum levels of CRP can early recognize subjects at higher risk for maternal and neonatal complications needing a more stringent follow-up. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to evaluate the maternal outcome in women with very advanced maternal age (VAMA) at childbirth (>45 years) compared to advanced maternal age (35–39 and 40–44 years). Methods: Retrospective cohort study using the Texas Public Use Data File, years 2013–2014. Maternal age was a three-level variable: 35–39 (referent), 40–44, and 45–59 years (VAMA). Adjusted risk ratios (aRRs) for the two older age groups for various obstetrical and nonobstetrical complications were calculated from log-binomial regression models. Results: The sample consisted of 96,879 deliveries. In univariate analyses, a higher frequency (p < 0.05) of gestational diabetes, pregestational diabetes, chronic hypertension, pregnancy related hypertensive disorders, multiple gestation, oligohydramnios, polyhydramnios, placenta previa, postpartum hemorrhage, small for gestational age, intrauterine fetal death, and length of stay were noted in the two older maternal age groups compared to the youngest maternal age group. Multiple gestations were noted to be more frequent in the two older groups: the VAMA group had a 336% increase in their risk (aRR = 4.36, 95% CI: 3.68–5.17), while women 40–44 years of age experienced a 17% increase in their risk (aRR = 1.17, 95% CI: 1.07–1.29) compared to women in the 35–39 year group. The risk of the following outcomes was approximately doubled in VAMA women compared to the referent (all statistically significant): small for gestational age (aRR = 1.92), stillbirth (aRR = 2.12), and intrauterine fetal death (aRR = 1.96). Conclusions: This population-based study detected a dose–response association between maternal age and the risk of multiple maternal and fetal complications. [ABSTRACT FROM AUTHOR]

Objectives Providing counseling on danger signs of pregnancy complications as part of visits for antenatal care (ANC) can raise expecting women’s awareness so that if danger signs occur they can seek assistance in time. The study examines the level of agreement in counseling on danger signs between observation of the provider during the ANC visit and the client’s report in the exit interview, and the association of this agreement with the client’s level of knowledge on danger signs. Methods The analysis used data from service provision and assessment (SPA) surveys in Haiti, Malawi, and Senegal. Agreement between the observation and client’s report was measured by Cohen’s kappa and percent agreement. Regressions were performed on the number of danger signs the client knew, with the level of agreement on the counseling on danger signs as the main independent variable. Results The study found little agreement between the observation of counseling and the client’s report that the counseling occurred, despite the fact that the exit interview with the client was performed immediately following the ANC visit with the provider. The level of positive agreement between observation and client’s report was 17% in Haiti, 33% in Malawi, and 23% in Senegal. Clients’ overall knowledge of danger signs was low; in all three countries the mean number of danger signs known was 1.5 or less. The regression analysis found that, in order to show a significant increase in knowledge of danger signs, it was important for the client to report that it took place. Conclusions Ideally, there should be 100% positive agreement that counseling occurred. To achieve this level requires raising both the level of counseling on danger signs of pregnancy complications and its quality. While challenges exist, providing counseling that is more client-centered and focuses on the client’s needs could improve quality and thus could increase the client’s knowledge of danger signs. [ABSTRACT FROM AUTHOR]

Objective: Pregnancies in women affected by a muscular dystrophy are at an increased risk of adverse maternal and neonatal outcomes due to the effect of the disease on the muscular, cardiac and respiratory systems. We sought to evaluate the risk of adverse outcomes within a large population-based cohort study. Methods: We used the data extracted from the Nationwide Inpatient Sample (NIS) to conduct a retrospective population-based cohort study consisting of over 12 million births that occurred in the United States between 1999 and 2013. Births to mothers with muscular dystrophy were identified using the International Classification of Diseases, Ninth Revision (ICD-9) codes and were compared with births to mothers with no maternal muscular dystrophy. Unconditional logistic regression analysis was used to evaluate the adjusted effect of muscular dystrophy on maternal and neonatal outcomes. Results: During the 14-year study period, there was an increasing trend in the incidence of muscular dystrophy, with a cumulative incidence of 7.26 in 100,000 births. Women with muscular dystrophy and their neonates were at a significantly increased risk of adverse pregnancy outcomes: specifically, an increased risk of preeclampsia, preterm premature rupture of membranes, preterm labor, venous thromboembolism, cardiac dysrhythmia, requiring a blood transfusion and giving birth by cesarean section. Neonates born to affected mothers were at a significantly higher risk of being born preterm, with a congenital malformation and suffering intrauterine growth restriction. Conclusion: The risk of several adverse maternal and neonatal outcomes is increased in pregnant women with muscular dystrophy. As such, additional surveillance in order to mitigate the risk of adverse outcomes is warranted in these pregnancies. [ABSTRACT FROM AUTHOR]

Patients with SLE are often young females of childbearing age and a pregnancy wish in this patient group is common. However, SLE patients are at high risk for adverse pregnancy outcomes that require adequate guidance. It is widely acknowledged that pre-pregnancy counselling is the pivotal first step in the management of SLE patients with a wish to become pregnant. Next, management of these patients is usually multidisciplinary and often requires specific expertise from the different physicians involved. Very recently a EULAR recommendation was published emphasizing the need for adequate preconception counselling and risk stratification. Therefore the present review specifically addresses the issue of pre-pregnancy counselling for SLE patients with an evidence-based approach. The review summarizes data retrieved from recently published, high-quality cohort studies that have contributed to a better understanding and estimation of pregnancy-related risks for SLE patients. The present review categorizes risks from a patient-oriented point of view, that is, the influence of pregnancy on SLE, of SLE on pregnancy, of SLE on the foetus/neonate and of SLE-related medication. Lastly, pre-pregnancy counselling of SLE patients with additional secondary APS is reviewed. Collectively these data can guide clinicians to formulate appropriate preventive strategies and patient-tailored monitoring plans during pre-pregnancy counselling of SLE patients. [ABSTRACT FROM AUTHOR]

Infertility, may be a harbinger for future health risk in women, including early mortality. Fertility status itself could serve as an early biomarker, (present in a woman's reproductive years) for risk stratification later in life. The relationship between infertility and early mortality involves the impact of nulliparity on future adverse health events, potential sequelae from the underlying cause(s) of infertility, the risks of fertility treatments, as well as the potential for risk reduction from a healthy pregnancy. This complex interplay coupled with difficulties ascertaining infertility on a population level has presented unique challenges to assessing infertility and early mortality risk. With further study, a better understanding the role of fertility status in health at various stages of life may provide unique opportunities for surveillance and risk reduction. [ABSTRACT FROM AUTHOR]

Women with polycystic ovary syndrome (PCOS) have compromised cardiovascular health profiles and an increased risk of pregnancy complications. In order to evaluate potential consequences, we aim to compare the cardiovascular and metabolic health of the children from women with PCOS with a population-based reference cohort. We included children from women with PCOS between the age of 2.5 to 4 years (n = 42) and 6 to 8 years (n = 32). The reference groups consisted of 168 (3-4 years old) and 130 children (7-8 years old). In an extensive cardiovascular screening program, we measured anthropometrics and blood pressure (all children), heart function and vascular rigidity (young children), metabolic laboratory assessment and carotid intima thickness (old age-group). Results showed that young PCOS offspring have a significantly lower diastolic blood pressure (β = 2.3 [95% confidence interval, CI: 0.5-4.0]) and higher aortic pulse pressure (β = −1.4 [95% CI: −2.5 to −0.2]), compared to the reference population. Furthermore, a higher left ventricle internal diameter but a lower tissue Doppler imaging of the right wall in systole compared to the reference group was found. Older offspring of women with PCOS presented with a significantly lower breast and abdominal circumference, but higher triglycerides (β = −0.1 [95% CI: −0.2 to −0.1]), LDL-cholesterol (β = −0.4 [95% CI: −0.6 to −0.1]), and higher carotid intima-media thickness (β = −31.7 [95% CI: −46.6 to −16.9]) compared to the reference group. In conclusion, we observe subtle but distinct cardiovascular and metabolic abnormalities already at an early age in PCOS offspring compared to a population-based reference group, despite a lower diastolic blood pressure, breast, and abdominal circumference. These preliminary findings require confirmation in independent data sets. [ABSTRACT FROM AUTHOR]

Complications during pregnancy are not frequent, but may occur abruptly. Point-of-care ultrasound is a non-invasive, non-ionising diagnostic tool that is available at the bed-side when complications occur. This review covers the use of ultrasound in various clinical situations. Gastric ultrasound can identify stomach contents that put the woman at risk for pulmonary aspiration. In the future, this tool will probably be used routinely before induction of anaesthesia to determine the presence of stomach contents above a particular risk threshold. Difficult tracheal intubation, and the potential for 'can't intubate, can't oxygenate', is more frequent in pregnant women. Point-of-care ultrasound of the airway allows accurate identification of the cricothyroid membrane, permitting rapid and safer establishment of front-of-neck airway access. Combined cardiac and lung ultrasound can determine the potential risk:benefit of fluid administration in the pregnant patient. Such prediction is of critical importance, given the tendency of pregnant women to develop pulmonary oedema. Combined echocardiography and lung ultrasound can be combined with ultrasound of the leg veins to differentiate between the various causes of acute respiratory failure, and guide treatment in this situation. Finally, as shown in the general population, multi-organ point-of-care ultrasound allows early diagnosis of the main causes of circulatory failure and cardiac arrest at the bed-side. As the importance of point-of-care ultrasound in critical patients is increasingly recognised, it is emerging as an important tool in the therapeutic armoury of obstetric anaesthetists. [ABSTRACT FROM AUTHOR]

Prenatal vitamin D deficiency and prenatal depression are both separately associated with adverse perinatal outcomes; however, to our knowledge no studies have investigated the effects of having both risk factors. Our objective was to determine to what extent vitamin D deficiency predicts adverse perinatal outcomes and whether elevated depressive symptoms in pregnancy places women at additional increased risk. This study was a secondary data analysis of prospective data collected from a cohort of pregnant women (N = 101) in an obstetric clinic of a large medical center. Maternal vitamin D deficiency (serum 25(OH)D ≤ 20 ng/ml) and depressive symptoms (Edinburgh Postnatal Depression Scale, EPDS) were assessed in early pregnancy. A composite of four adverse perinatal outcomes (low birth weight, preterm birth, small-for-gestational age, and preeclampsia) were abstracted from medical charts. Nineteen of the 101 women had one or more adverse perinatal outcome and 84% with an adverse outcome (16/19) were not White. Both prenatal and time of delivery vitamin D deficiency were associated with developing an adverse outcome compared to those vitamin D sufficient (prenatal relative risk 3.43; 95% CI 1.60-7.34, p = 0.004; delivery time relative risk 5.14, 95% CI 2.68-9.86, p = 0.004). These both remained significant after adjusting for BMI. A higher rate of adverse outcome was found when women had both prenatal vitamin D deficiency and elevated depressive symptoms (EPDS ≥ 10). Sixty percent with both risk factors had an adverse perinatal outcome versus 17% with only one or neither risk factor (relative risk 3.60; 95% CI 1.55-8.38, p = 0.045), worthy of investigation with larger samples. Together, prenatal vitamin D deficiency and elevated depressive symptoms in pregnancy may increase risk for adverse perinatal outcomes, especially in racial minorities. Obstetric providers should consider routine prenatal depression screening. The impact of vitamin D supplementation to reduce risk for adverse perinatal outcomes should be studied in prospective trials. Our results suggest that supplementation early in pregnancy might be especially beneficial for depressed women. [ABSTRACT FROM AUTHOR]

Objective: Current evidence from clinical studies suggests that having an active eating disorder (ED) during pregnancy is associated with unfavorable obstetric outcomes. However, the role of a lifetime diagnosis of ED is not fully understood. Variations in findings suggest a need for additional studies of maternal ED. This study aims to identify associations between a lifetime ED and obstetric outcomes. Method: Data from a hospital patient register and a population‐based study (The HUNT Study) were linked to the Medical Birth Registry in Norway. Register based information of obstetric complications (preeclampsia, preterm birth, perinatal deaths, small for gestational age (SGA), large for gestational age (LGA), Caesarean sections, and 5‐min Apgar score) were acquired for 532 births of women with ED and 43,657 births of non‐ED women. Multivariable regression in generalized estimating equations was used to account for clusters within women as they contributed multiple births to the dataset. Results: After adjusting for parity, maternal age, marital status, and year of delivery, lifetime history of anorexia nervosa was associated with increased odds of having offspring who were SGA (Odds ratio (OR) 2.7, 95% Confidence Interval (CI) 1.4–5.2). Women with a lifetime history of bulimia nervosa had higher odds of having a Caesarian section (OR 1.7 95% CI 1.1–2.5). Women with EDNOS/sub‐threshold ED had a higher likelihood of having a low Apgar score at 5 min (OR 3.1, 95% CI 1.1–8.8). Conclusion: Our study corroborates available evidence on the associations between maternal ED and adverse obstetric outcomes. [ABSTRACT FROM AUTHOR]

Highlights • E-cigarette use is increasing rapidly yet there is limited data available regarding its effects during pregnancy. • E-cigarette conditioned-media impaired placental trophoblast function. • The impaired trophoblast function does not appear to be dependent on the presence of nicotine. • E-cigarette exposure may cause placental dysfunction which is consistent with adverse pregnancy outcomes. Abstract Despite evidence that maternal smoking is associated with numerous adverse outcomes, 10–35% of women still smoke during pregnancy. Recently, many smokers have turned to electronic cigarettes (e-cigarettes) as a smoking cessation tool. However, there is considerable uncertainty regarding their safety for use during pregnancy. The goal of this study was to examine the effects of e-cigarette vapour on placental trophoblast function. HTR-8/SVneo cells were exposed to unflavored e-cigarette vapour-conditioned media with and without nicotine to assess cell viability, proliferation, migration (wound healing assay), invasion (transwell extracellular matrix invasion assay), and tube formation, a surrogate for angiogenesis. While there was no effect on cell viability, proliferation or migration (all p > 0.05), e-cigarette conditioned media significantly reduced trophoblast invasion and tube formation; these effects could not be solely attributed to the presence of nicotine. These results suggest that an evaluation of the safety of e-cigarette use during pregnancy is urgently required. [ABSTRACT FROM AUTHOR]

Highlights • largest monocentric cohort study on metformin safety during the first trimester. • 336 pregnancies with metformin exposure and 1011 matched controls. • no increase in major birth defects and spontaneous abortions. • no distinct pattern of major birth defects. Abstract The aim of this study was to evaluate the risk of major birth defects and spontaneous abortion after metformin use during the first trimester of pregnancy. We conducted an observational cohort study comparing pregnancies with metformin treatment during the first trimester with non-exposed women matched for BMI and year of enrolment. Pregnancies were prospectively ascertained in the German Embryotox pharmacovigilance database between 2004 and 2014. The study sample included 336 pregnancies with metformin exposure for PCOS and fertility disorders (56.8%), diabetes (25.9%) and insulin resistance (14.9%) and 1011 matched controls. Independent of the treatment indication, neither the rate of major birth defects (OR adjusted 0.58, 95% CI 0.3–1.3) nor of spontaneous abortions (HR adjusted 0.95, 95% CI 0.6–1.5) was significantly increased among metformin exposed. Our study supports the evidence that metformin does not carry a developmental risk for the fetus when used during the first trimester. [ABSTRACT FROM AUTHOR]

Background: Aripiprazole is a second generation antipsychotic medication that has been a useful addition to the treatment of severe mental illness due to its low metabolic and sedation risk profile. Pregnancy is a time of high risk of metabolic complications such as gestational diabetes and the postpartum period is often a time when sedation can compromise infant care. To date there is limited data in pregnancy on the safety of aripiprazole use. While available data do not suggest an elevated malformation risk in pregnancy, there is less information available on pregnancy and neonatal complications.Methods: This study presents preliminary data on pregnancy and neonatal complications on 26 women who took aripiprazole in pregnancy. These women attended at antenatal clinics for women with severe mental illness at two hospitals in Australia.Results: Overall aripiprazole was not associated with an increased risk of gestational diabetes. However, use of aripiprazole in pregnancy was associated with an increased risk of pregnancy hypertension, lower birth weight, shorter gestation at birth and higher rates of admission of the neonate than the expected population rates.Limitations: These findings need to be replicated in a larger, well-designed study to ensure they do not reflect confounding factors.Conclusions: Findings demonstrate that aripiprazole is unlikely to pose a metabolic risk in pregnancy but other pregnancy complications including hypertension, need to be examined in further studies. [ABSTRACT FROM AUTHOR]

Aims During pregnancy, there is a significant increase in heart rate (HR) potentially associated with an increased risk of arrhythmias or exacerbation of pre-existing cardiac conditions endangering both mother and foetus. Calcium homeostasis plays an important role in regulating automaticity of the sinoatrial node (SAN); however, its contribution to the accelerated HR during pregnancy remains unknown. Methods and results Using murine SAN cells, we showed that pregnancy increased L-type Ca2+ current (I CaL) and CaV1.3 mRNA expression, whereas T-type Ca2+ current (I CaT) and its underlying channel were unchanged. Analysis of SAN intra-cellular Ca2+ oscillations showed that the rate of spontaneous Ca2+ transients was significantly higher in pregnant mice along with a higher mRNA expression of ryanodine receptor. Assessment of supra-ventricular arrhythmias using programmed electrical stimulation protocols on anaesthetized mice revealed higher susceptibility in pregnancy. Of note, the modifications associated with pregnancy were reversible following delivery. Furthermore, chronic administration of 17β-estradiol (E2) to nodal-like human-induced pluripotent stem cell-derived cardiomyocytes (N-hiPSC-CM), control mice, oestrogen-receptor-β knockout (ERKOβ) but not ERKOα mice, accelerated cardiac automaticity, recapitulating the pregnancy phenotype in both mouse and human SAN cell models. Conclusion Together, these results indicate that pregnancy considerably alters intra-cellular Ca2+ homeostasis sustaining faster HR during pregnancy. Importantly, these changes were dependent on an oestrogen receptor α (ERα) mechanism that resulted in increased I CaL and spontaneous Ca2+ release from the sarcoplasmic reticulum, highlighting a novel role for oestrogen in regulating HR. [ABSTRACT FROM AUTHOR]

Background: Most pregnancy-related complications are associated with increased risks of adverse outcomes for mother and her infant. Although, relations between diet and pregnancy's complications indicate that there may be some benefits of nutritional factors to prevent such disorders, there are rare studies regarding the associations of dietary patterns and mentioned complications. So, the aim of the present study was to determine the relationship between dietary patterns and risk of pregnancy-related complications. Methods: The current prospective observational study was based on the data collected from 812 pregnant women. Dietary data was collected using a validated semi-quantitative food frequency questionnaire. Results: Three major dietary patterns identified according to the results from the factor loading matrix were: (i) 'western dietary pattern'; (ii) 'traditional dietary pattern'; (iii) 'healthy dietary pattern'. Overall, this study demonstrated a marginal significant inverse association between high adherence to healthy dietary pattern and chance of having pre-eclampsia. Also, a high chance of pre-eclampsia was observed among women with the most adherence to western dietary pattern. Conclusion: We found that dietary patterns might be associated with the risk of pregnancy-related complications. Further studies are required to confirm these findings. [ABSTRACT FROM AUTHOR]

Background While anti-β2 glycoprotein 1 (anti-β2GP1) antibody positivity is included in the diagnostic criteria for antiphospholipid syndrome (APS), the association between anti-β2GP1 and the obstetrical complications of APS has been inconsistently reported and remains unclear. Objective We completed a case-control study nested within the Canadian Ottawa and Kingston (OaK) Birth Cohort to evaluate the association between anti-β2GP1 antibody positivity and placenta-mediated pregnancy complications. Study Design Five hundred cases were randomly selected among pregnant women who experienced any of the following independently adjudicated placenta-mediated pregnancy complications: preeclampsia, placental abruption, late pregnancy loss (≥ 12 weeks' gestation), and birth of a small-for-gestational age (SGA) infant < 10th percentile. Five hundred pregnant women without any placenta-mediated pregnancy complications were selected as controls. Stored blood samples were analyzed for the presence of anti-β2GP1 antibodies by enzyme-linked immunosorbent assay. Results Anti-β2GP1 immunoglobulin G (IgG) and/or immunoglobulin M (IgM) antibodies in titers ≥ 20 G/M units (> 99th percentile) were present in 24 of 497 (4.8%) of controls and 33 of 503 (6.6%) of cases. There was no significant difference between cases and controls for the composite outcome of any placenta-mediated pregnancy complications (odds ratio, 1.38, 95% confidence interval [CI], 0.8-2.37, p = 0.25). Conclusion Our results call into question the association between anti-β2GP1 antibodies and placenta-mediated pregnancy complications, with further research needed. [ABSTRACT FROM AUTHOR]

Unrealized maternal and child health goals continue to challenge Kenya where adverse outcomes remain high and diagnostic services are limited. The acute shortage of doctors and radiographers requires alternate human resources for health (HRH) with the ability to identify risk factors in pregnancy through Point-Of-Care Ultrasound (POCUS). A specialist radiologist and ultrasonography team partnered with midwives to adopt interprofessional task sharing and capacity building. Faculty from the Radiology Department of our hospital designed and implemented the project which was carried out at three outreach health service centres. Designing and implementing a training model to skill midwife sonographers with the capacity to accurately identify risk factors in pregnancy is an effective model to increase POCUS access. A collaborative task sharing model focused on training quality, validation of results, tracking of errors and specialist level clinical supervision yielded a safe and scalable model of HRH capacity building. Programme evaluation, verification of outcomes and dissemination of results were all monitored. The project was a successful HRH task sharing and interprofessional learning initiative involving task sharing a clearly defined suite of sonographer competencies with participating midwives. The programme increased POCUS accessibility at the three outreach clinics with proven outcomes in the early detection and referral of risk factors in pregnancy. [ABSTRACT FROM AUTHOR]

Objectives This study measures the prevalence of risk factors among pregnant women and young children aged 12-24 months in a rural community in West Bengal, India. Methods Community health workers (CHWs) enrolled women and children into this 2015 cross-sectional study. Pregnant women were evaluated for underweight, anemia, and abnormal blood pressure. Children were evaluated for underweight, abnormal head and upper arm circumferences, and low scores from the Ages and Stages Questionnaire (ASQ). Data were collected on smartphones and tablets or by paper. Results More than half of the 279 women (59.9%) had a risk factor during pregnancy: 48.7% were anemic, 35.1% had low blood pressure, and 7.5% were underweight. Among the 366 children, 59.3% had a risk factor, including 24.0% with low ASQ scores and 49.7% who had abnormal anthropometric measures. Conclusions for Practice Vulnerable populations, such as pregnant women and young children, needed a greater connection to doctors in this rural community. This study demonstrated the feasibility of CHWs to listen to health concerns and connect underserved populations with health care services. [ABSTRACT FROM AUTHOR]

Perinatal depression is associated with serious risks for the mother, baby, and family. When considering treating perinatal depression with a drug indicated for the treatment of depression, the major concerns are whether the drug increases the risks of teratogenicity, pregnancy complications, poor neonatal adaptation, or neurodevelopmental disorders. Although different studies have produced different results, the majority have not shown increases in risk for selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, tricyclic antidepressants, or the noradrenergic/dopaminergic drug bupropion. In this review we will discuss the reproductive safety data for these medications as well as monoamine oxidase inhibitors and benzodiazepines. [ABSTRACT FROM AUTHOR]

To counsel women about risks and benefits of depression treatment during pregnancy, clinicians must appreciate the potential consequences of untreated depression on the mother and her unborn child. Many studies have demonstrated associations between untreated depression during pregnancy and a range of adverse outcomes, including low birth weight, preterm delivery, preeclampsia, emergent operative delivery, postpartum depression, and both cognitive and behavioral deficits in the child. Although most of these associations are marked by low odds ratios and a host of potential confounding issues, they collectively provide considerable rationale for identifying depression in pregnancy and offering treatment for mothers at risk. [ABSTRACT FROM AUTHOR]

Abstract: This paper explores racial disparities and risk factors of adverse pregnancy outcomes in Black and White pregnant women in the US. The study uses a cross‐sectional approach to explore Black and White disparities using data from the 2012 National Survey on Drug Use and Health (NSDUH), which collects interview data from approximately 70,000 randomly selected participants. We included several self‐reported conditions that we categorised as individual and social stressors (e.g. measures of institutionalised racism, individual health behaviours, access to quality care and social context factors). We used descriptive statistics, univariate and multivariate analyses in risk factors of adverse pregnancy outcomes between Black and White women. Black women who were pregnant had a lower socioeconomic status and experienced more measures of institutionalised racism compared to White women who were pregnant. More white women who were pregnant were married, had higher levels of educational attainment, higher income levels, and greater employment opportunities. White pregnant women also had higher levels of private health insurance and less dependency on government programmes for access to healthcare. Results from the regressions indicated that Black pregnant women were less likely to be married (OR = 0.01), less likely to have higher income levels (OR = 0.31) and less likely to be employed (OR = 0.52). However, Black pregnant women were more likely to be younger (OR = 1.82). For the health‐eroding behaviours, Black pregnant women were less likely to smoke (OR = 0.53) and use alcohol (0.52). After assessing the SES Household‐level stressors (access to healthcare), Black pregnant women were more likely to have Medicaid/CHIP (OR = 3.21) and health coverage through government assistant programmes (OR = 3.80); however, less likely to have private health insurance (OR = 0.38). There are differences in risk factors of adverse pregnancy outcomes between White and Black pregnant women based on measures of individual level/social stressors, institutionalised racism, health behaviours and access to care. [ABSTRACT FROM AUTHOR]

Background: Transplacental passage of IgGs is impaired in HIV + pregnant women, possibly determining an inadequate immunological protection in their children. We aimed to determine the impact of maternal immunological IgG profile and immunoactivation status on the efficiency of transplacental passage of IgG subclasses in HIV + mothers.Methods: 16 mother/infants pairs were studied in Malawi. Mothers received antiretroviral therapy (ART) from the third trimester of pregnancy. Determinations of pre-ART levels of maternal sCD14, of IgG subclasses in mothers at delivery and in their 1-month-old infants, were performed using commercial ELISA kits.Results: At delivery, after a median of 10 weeks of ART, 12/16 mothers were hypergammaglobulinemic, with IgG levels (20.5 mg/ml, 95% CI:18.8-26.8) directly correlated to the plasmatic levels of sCD14 (r = 0.640, p = 0.014). IgG1 levels (17.9 mg/ml) accounted for 82% of IgG, IgG3 and IgG4 levels were in the normal range. A profound deficit of IgG2 was observed both in mothers (0.60 mg/ml) and in infants (0.14 mg/ml). Placental transfer ratio (range 0.16-0.42) did not show a selective impairment between the different IgG subclasses. The transplacental passage of all IgG subclasses was decreased in the presence of maternal IgG over 16 mg/ml (significantly for IgG1, p = 0.031) and of high levels of sCD14 (p = 0.063).Conclusions: Transplacental passage was reduced for all IgG subclasses and inversely correlated to high levels of maternal IgGs and to the degree of immunoactivation. The profound depression of IgG2 in mothers suggests that IgG2 neonatal levels mostly reflect the maternal deficit rather than a selective impairment of IgG2 transfer. [ABSTRACT FROM AUTHOR]

Objective: This study evaluates associations of maternal eating disorders (bulimia nervosa, anorexia nervosa, and purging behaviors) with infant wheezing and examines the effects of eating disorders on several wheezing determinants. Method: We studied 5,150 singletons from the NINFEA birth cohort. Maternal bulimia nervosa and anorexia nervosa diagnoses were ascertained from the questionnaires completed in pregnancy and 6 months after delivery, and were analyzed as: ever diagnosis, only before pregnancy, and during pregnancy. Purging behaviors were assessed for 12 months before or during pregnancy. The associations with wheezing between 6 and 18 months of age were assessed in models adjusted for a priori selected confounders. Results: Children born to mothers with lifetime eating disorders were at an increased risk of developing wheezing (adjusted OR 1.68; [95% CI: 1.08, 2.60]), and this risk further increased when the disorders were active during pregnancy (2.52 [1.23, 5.19]). Increased risk of offspring wheezing was observed also for purging behaviors without history of eating disorder diagnosis (1.50 [1.10, 2.04]). The observed associations were not explained by comorbid depression and/or anxiety. Bulimia nervosa and/or anorexia nervosa during pregnancy were also associated with several risk factors for wheezing, including maternal smoking, adverse pregnancy outcomes, shorter breastfeeding duration, and day‐care attendance. Discussion: The associations of maternal eating disorders with offspring wheezing suggest long‐term adverse respiratory outcomes in children of mothers with eating disorders. A better understanding of mechanisms implicated is necessary to help reduce the respiratory disease burden in these children. [ABSTRACT FROM AUTHOR]

HIV infection may increase risk of postpartum infection and infection-related mortality. We hypothesized that postpartum infection incidence and attributable mortality in Mbarara, Uganda would be higher in HIV-infected than HIV-uninfected women. We performed a prospective cohort study of 4231 women presenting to a regional referral hospital in 2015 for delivery or postpartum care. All febrile or hypothermic women, and a subset of randomly selected normothermic women were followed during hospitalization and with 6-week postpartum phone interviews. The primary outcome was in-hospital postpartum infection. Secondary outcomes included in-hospital complications (mortality, re-operation, intensive care unit transfer, need for imaging or blood transfusion) and 6-week mortality. We performed multivariable regression analyses to estimate adjusted differences in each outcome by HIV serostatus. Mean age was 25.2 years and 481 participants (11%) were HIV-infected. Median CD4+ count was 487 (IQR 325, 696) cells/mm3, and 90% of HIV-infected women (193/215 selected for in-depth survey) were on antiretroviral therapy. Overall, 5% (205/4231) of women developed fever or hypothermia. Cumulative in-hospital postpartum infection incidence was 2.0% and did not differ by HIV status (aOR 1.4, 95% CI 0.6-3.3, P = 0.49). However, more HIV-infected women developed postpartum complications (4.4% vs. 1.2%, P = 0.001). In-hospital mortality was rare (2/1768, 0.1%), and remained so at 6 weeks (4/1526, 0.3%), without differences by HIV serostatus (P = 1.0 and 0.31, respectively). For women in rural Uganda with high rates of antiretroviral therapy coverage, HIV infection did not predict postpartum infection or mortality, but was associated with increased risk of postpartum complications. [ABSTRACT FROM AUTHOR]

Following a restructuring of Swedish healthcare in the 1990s - moving from a welfare model to one inspired by New Public Management - maternity care in Sweden is increasingly centralised to bigger towns. This has led to several units being relocated or forced to close, and to a bigger distance to maternity care for women living in smaller towns and rural areas. In the present article, I analyse the media reporting on the recent closure of the maternity ward in Sollefteå, a small town in Sweden’s northern region. Using intersectional risk theory, I explore how pregnancy-related risks are articulated in Swedish newspapers, and how such articulations relate to power and ideology. Articles from three Swedish newspapers, published during a 4-month period, have been analysed using critical discourse analysis. I conclude that the newspaper articles were most likely to stress the family as the main ‘risk victim’, while the pregnant woman was rarely the focus of risk articulations. When she was, risks were described as ‘worry’ or ‘unworthiness’, and never in medical terms. When such articulations appeared within an individualist ideological discourse, they were naturalised and as such, disconnected from the political decision to close the maternity ward. My contention is that a feminist perspective is largely missing in the media articles and that a bigger focus on the effect that maternity ward closures have for women living outside urban centres is needed. [ABSTRACT FROM AUTHOR]