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OBJECTIVES: Up to a quarter of pregnant individuals with SLE have small for gestational age (SGA) infants. We aimed to characterize placental pathology associated with SGA infants in SLE. METHODS: We retrospectively analysed SLE deliveries with placental analysis at UCSD from November 2018 to October 2023, comparing SLE pregnancies resulting in SGA to those that did not, and additionally, to matched pregnancies with SGA but without SLE. RESULTS: Placental analysis was available only for 28/70 (40%) SLE deliveries, which had high rates of adverse outcomes (75%). All exhibited at least one histopathologic abnormality. Key findings distinguishing 12 SLE placentas resulting in SGA infants (vs.16 without) included small placental disc for gestational age (100% vs 56%, P = 0.01), placental disc infarct (50% vs 6%, P = 0.02) and increased perivillous fibrin deposition (PVFD, 58% vs 0%, P = 0.001). All seven SLE placentas with increased PVFD resulted in SGA infants. Compared with matched non-SLE pregnancies with SGA (n = 36), the only distinguishing placental lesion was a higher prevalence of increased PVFD in SLE-associated SGA (58% vs 22%, P = 0.03). CONCLUSION: The higher prevalence of increased PVFD in placentas of SLE-associated SGA may indicate a specific mechanism of placental injury leading to SGA in this context. Thus, its presence, particularly in context of SGA, should prompt providers to screen for an underlying autoimmune disease, including SLE. Systematic placental examination in context of SLE and associated autoimmune diseases could help evaluate responses to existing therapies, comparative studies of novel therapies and correlation to adverse outcomes.

Evidence has documented the effects of place on perinatal outcomes, but less is known about the sociopolitical mechanisms, such as gentrification, that shape neighborhood context and produce spatialized inequities in adverse birth outcomes. Leveraging a diverse sample in California, we assessed the associations between gentrification and birth outcomes: preterm birth, small-for-gestational-age, and low birth weight. Gentrification was measured using the Freeman method and the Displacement and Gentrification Typology. Descriptive analysis assessed outcome prevalence and race and ethnicity distribution by exposure and participant characteristics. Overall and race and ethnicity-stratified mixed effects logistic models examined associations between gentrification and birth outcomes, sequentially adjusting for sociodemographic status and pregnancy factors, with a random intercept to account for clustering by census tract. In a sample of 5,116,131 births, outcome prevalence ranged from 1.0% for very preterm birth, 5.0% for low birth weight, 7.9% for preterm birth, and 9.4% for small-for-gestational-age. Adjusting for individual-level factors, gentrification was associated with increased odds of preterm birth (Freeman OR = 1.09, 95% CI 1.07-1.10; Displacement and Gentrification Typology OR = 1.11, 95% CI 1.09-1.13). While Displacement and Gentrification Typology-measured gentrification was consistently associated with greater odds of adverse outcomes, Freeman-measured gentrification was associated with slightly lower odds of small-for-gestational-age and low birth weight. Furthermore, gentrification was associated with birth outcome odds across multiple racial and ethnic groups, but the directions and magnitudes of the associations varied depending on the gentrification assessment methodology and the outcome assessed. Results demonstrate that gentrification plays a role in shaping adverse birth outcomes in California.

BackgroundThere is a lack of research on the relationship between water fluoridation and pregnancy outcomes.ObjectivesWe assessed whether hypothetical interventions to reduce fluoride levels would improve birth outcomes in California.MethodsWe linked California birth records from 2000 to 2018 to annual average fluoride levels by community water system. Fluoride levels were collected from consumer confidence reports using publicly available data and public record requests. We estimated the effects of a hypothetical intervention reducing water fluoride levels to 0.7 ppm (the current level recommended by the US Department of Health and Human Services) and 0.5 ppm (below the current recommendation) on birth weight, birth-weight-for-gestational age z-scores, gestational age, preterm birth, small-for-gestational age, large-for-gestational age, and macrosomia using linear regression with natural cubic splines and G-computation. Inference was calculated using a clustered bootstrap with Wald-type confidence intervals. We evaluated race/ethnicity, health insurance type, fetal sex, and arsenic levels as potential effect modifiers.ResultsFluoride levels ranged from 0 to 2.5 ppm, with a median of 0.51 ppm. There was a small negative association on birth weight with the hypothetical intervention to reduce fluoride levels to 0.7 ppm [-2.2g; 95% confidence interval (CI): -4.4, 0.0] and to 0.5 ppm (-5.8g; 95% CI: -10.0, -1.6). There were small negative associations with birth-weight-for-gestational-age z-scores for both hypothetical interventions (0.7 ppm: -0.004; 95% CI: -0.007, 0.000 and 0.5 ppm: -0.006; 95% CI: -0.013, 0.000). We also observed small negative associations for risk of large-for-gestational age for both the hypothetical interventions to 0.7 ppm [risk difference (RD)=-0.001; 95% CI: -0.002, 0.000 and 0.5 ppm (-0.001; 95% CI: -0.003, 0.000)]. We did not observe any associations with preterm birth or with being small for gestational age for either hypothetical intervention. We did not observe any associations with risk of preterm birth or small-for-gestational age for either hypothetical intervention.ConclusionWe estimated that a reduction in water fluoride levels would modestly decrease birth weight and birth-weight-for-gestational-age z-scores in California. https://doi.org/10.1289/EHP13732.

OBJECTIVE:  The aim of Placental Assessment in Response to Environmental Pollution Study (PARENTs) was to determine whether imaging of the placenta by novel multiparametric magnetic resonance imaging (MRI) techniques in early pregnancy could help predict adverse pregnancy outcomes (APOs) due to ischemic placental disease (IPD). Additionally, we sought to determine maternal characteristics and environmental risk factors that contribute to IPD and secondary APOs. STUDY DESIGN:  Potential patients in their first trimester of pregnancy, who agreed to MRI of the placenta and measures of assessment of environmental pollution, were recruited into PARENTs, a prospective population-based cohort study. Participants were seen at three study visits during pregnancy and again at their delivery from 2015 to 2019. We collected data from interviews, chart abstractions, and imaging. Maternal biospecimens (serum, plasma, and urine) at antepartum study visits and delivery specimens (placenta, cord, and maternal blood) were collected, processed, and stored. The primary outcome was a composite of IPD, which included any of the following: placental abruption, hypertensive disease of pregnancy, fetal growth restriction, or a newborn of small for gestational age. RESULTS:  In this pilot cohort, of the 190 patients who completed pregnancy to viable delivery, 50 (26%) developed IPD. Among demographic characteristics, having a history of prior IPD in multiparous women was associated with the development of IPD. In the multiple novel perfusion measurements taken of the in vivo placenta using MRI, decreased high placental blood flow (mL/100 g/min) in early pregnancy (between 14 and 16 weeks) was found to be significantly associated with the later development of IPD. CONCLUSION:  Successful recruitment of the PARENTs prospective cohort demonstrated the feasibility and acceptability of the use of MRI in human pregnancy to study the placenta in vivo and at the same time collect environmental exposure data. Analysis is ongoing and we hope these methods will assist researchers in the design of prospective imaging studies of pregnancy. KEY POINTS: · MRI was acceptable and feasible for the study of the human placenta in vivo.. · Functional imaging of the placenta by MRI showed a significant decrease in high placental blood flow.. · Measures of environmental exposures are further being analyzed to predict IPD..

Plain language summary: Cytomegalovirus (CMV) is the most common cause of viral infection in newborn babies, and affects 1 in 200 of all live born infants in high‐income countries; and 1 in 71 in low‐ and middle‐income countries. It is a major cause of hearing loss and brain damage. Women may get CMV infection for the first time during pregnancy (primary infection) or may experience 'non‐primary' infection, either by reactivation of previous CMV infection or by a new infection with a different strain of the virus. The most common source of infection to pregnant women is the saliva and urine of young children. Therefore, all pregnant women, especially those in regular contact with young children, should be informed about hygiene‐based measures to reduce the risks, e.g. handwashing. The UK National Screening Committee recommends against universal antenatal or newborn screening for CMV. Testing for CMV is usually offered only to women who develop symptoms of influenza, glandular fever or hepatitis (liver inflammation) during pregnancy, or for those whom a routine ultrasound scan detects fetal anomalies that suggests possible CMV infection. The risk of harm to the fetus is greatest following primary CMV infection of the woman in early pregnancy, and appears to be very low following infection after 12 weeks of pregnancy. Babies with CMV infection at birth may have jaundice, a rash, enlarged liver or spleen, a small brain, or be small for their gestational age. Around 1 in 8 babies born with CMV infection will have clinically detectable signs at birth. The rest will not have any features detectable by clinical examination alone. Therefore, all infants with CMV infection at birth should be followed up at a minimum of up to 2 years of age or later, depending upon the disease status, to check hearing and brain development. Following primary CMV infection in the first 12 weeks of pregnancy, if the woman starts taking the antiviral medicine valaciclovir (valacyclovir) it reduces the risk of the baby becoming infected. Where CMV infection of the fetus in the womb has been confirmed (by amniocentesis, for example), regular ultrasound scans should be offered every 2–3 weeks until birth. Detailed assessment of the fetal brain is an essential part of these scans. Where maternal CMV infection occurs, but fetal infection is not confirmed, repeated ultrasound scans of the fetus should be offered every 2–3 weeks until birth. In infected fetuses, as well as ultrasound scans, an MRI scan of the brain should be offered at 28–32 weeks of gestation (and sometimes repeated 3–4 weeks later) to assess for any signs of harm to the fetal brain. All babies born to women with confirmed or suspected CMV infection should be tested for CMV with a urine or saliva sample within the first 21 days of life. In newborns with symptomatic CMV infection at birth, treatment with antiviral medicine (valganciclovir or ganciclovir) can reduce hearing loss in 5 out of 6 babies, and improve long‐term brain development outcomes in some. There is no licensed vaccine for CMV. [ABSTRACT FROM AUTHOR]

Background: Maternal stress is a potential factor affecting fetal growth, but it is unknown whether it directly affects fetal growth restriction. This study aims to investigate the association between pre-pregnancy maternal stress with small for gestational age (SGA). Methods: This study used a population-based retrospective cohort analysis to examine the association between pre-pregnancy maternal stress and SGA in offspring. Data were extracted from the National Preconception Health Care Project (NPHCP), conducted between 2010 and 2012, which encompassed preconception health-related information from 572,989 individuals across various regions in China. Logistic regression models were used to assess the associations between pre-pregnancy maternal stress variables and the risk of SGA. In addition, Synthetic Minority Over-sampling Technique (SMOTE) and Propensity Scores (PS) methods were used to enhance the model's ability to the associations between pre-pregnancy maternal stress and SGA. Results: Pre-pregnancy maternal stress was significantly associated with an increased the risk of SGA in offspring (OR 1.35, 95% CI 1.20 to 1.51, P < 0.001). Stress related to life and economic factors notably increased the risk of SGA across different socio-economic conditions, whereas stress related to friends did not show a statistically significant association (P > 0.05). Specially, individuals with lower socio-economic status that characterized by below high school education levels (OR = 1.45, 95% CI: 1.23 to 1.70), farmer occupation (OR = 1.33, 95% CI: 1.15 to 1.55, P = 0.002), rural residence (OR = 1.38, 95% CI: 1.22 to 1.56, P < 0.001), and younger age (under 35 years: OR = 1.35, 95% CI: 1.20 to 1.52, P < 0.001) were more susceptible to pre-pregnancy maternal stress, increasing their risk of SGA. Conclusions: Pre-pregnancy maternal stress was positively associated with an increased risk of SGA in offspring. Individuals with lower socio-economic status were more likely to experience pre-pregnancy maternal stress related to life and economic factors, which in turn contributed to a higher risk of SGA. [ABSTRACT FROM AUTHOR]

AbstractAflatoxin B1 (AFB1) and fumonisin B1 (FB1) are toxic secondary products of fungi that frequently contaminate staple crops in resource-limited settings. Antenatal AFB1 and FB1 exposure may cause adverse birth outcomes. We conducted a retrospective substudy nested in a case-control cohort of HIV-infected and HIV-uninfected women ≥20 weeks gestation from Harare, Zimbabwe. Urinary aflatoxin M1 (AFM1) and FB1, biomarkers of AFB1 and FB1 exposure, respectively, were quantified in random antenatal urine via ELISA and grouped into tertiles. The adverse birth outcomes considered were low birth weight, preterm birth (PTB), small for gestational age, stillbirth, birth defects, neonatal death, neonatal jaundice and perinatal death (PD). We evaluated any associations between adverse birth outcomes and exposure to AFB1, FB1, or the AFB1-FB1 combination via a multivariable logistic regression controlled for potential confounders. We enrolled 94 HIV-infected and 81 HIV-uninfected women. In HIV-infected, AFM1 was detected in 46/94 (49%), and FB1 was detected in 86/94 (91%). In HIV-uninfected, AFM1 was detected in 48/81 (59%), and FB1 was detected in 74/81 (91%). Among all women, AFM1 tertile 3 was associated with PD (OR: 6.95; 95% CI: 1.21-39.78). In the same population, AFM1 tertiles 2 (OR: 13.46; 95% CI: 1.20-150.11) and 3 (OR: 7.92; 95% CI: 1.08-58.19) were associated with PTB. In HIV-infected, AFM1 tertile 2 was associated with PTB (OR: 64.73; 95% CI: 2.37-177.93). Our results revealed an association between AFB1 exposure and PD and PTB in women, including those infected with HIV. Public health and nutrition measures are necessary to mitigate mycotoxins. [ABSTRACT FROM AUTHOR]

Background: Over one-third of the global stillbirth burden occurs in countries affected by conflict or a humanitarian crisis, including Afghanistan. Stillbirth rates in Afghanistan remained high in 2021 at over 26 per 1000 births. Stillbirths have devastating physical, psycho-social and economic impacts on women, families and healthcare providers. Data on the risks and causes of stillbirths are critical to target prevention measures and are currently lacking. This study aimed to use routine health facility data to examine the socio-demographic, maternal, fetal, and obstetric characteristics associated with stillbirth. Methods: This was a hospital-based case-control study of births at the maternity units of the three tertiary care referral hospitals in Kabul, Afghanistan between March-September 2021. Cases were defined as stillbirths that occurred at 22 weeks or later in pregnancy while live births occurring after each case were selected as controls. Multivariable logistic regression was used to explore factors associated with stillbirth after performing multiple imputation to impute missing data for independent variables. Results: A total of 497 cases (stillbirths) and 1069 controls (live births) were included in the analysis. Factors independently associated with stillbirth while adjusting for maternal age and baby's sex were: being referred from another facility which increased the odds of stillbirth by over three times (aOR 3.24; 95% CI 1.17, 8.85) compared to those who were not referred; being born extremely preterm (< 28 weeks) (aOR 13.98; 95% CI 7.44, 26.27), very preterm (28–31 weeks) (aOR 3.91; 95% CI 2.73, 5.62), and moderate to late preterm (32–36 weeks) (aOR 2.32; 95% CI 1.60, 3.37) compared to term babies; and being small-for-gestational age (aOR 1.70; 95% CI 1.10, 2.64) compared to those that were average size for gestational age. Placental abruption also increased the odds of stillbirth by two times (aOR 2.07; 95% CI 1.37–3.11). Conclusions: Improving the detection and management of preterm births, and small-for-gestational age babies through improvements in antenatal care attendance and quality will be important for future stillbirth prevention in Afghanistan. More research is needed to understand referral delays and contributing factors to increased risk among referrals. Strengthening routine data quality for stillbirths is imperative for improved understanding and prevention of stillbirths. Plain English summary: A stillbirth refers to the death of a baby before or during childbirth, at or after 22 weeks of pregnancy. Stillbirth can have devastating mental, social, and economic impacts on women and families yet many of these deaths can be prevented. Understanding stillbirth and its risk factors is important to design public health interventions to prevent these deaths in the future. There is currently very little publicly available information to understand stillbirth risk factors in Afghanistan. We used routine hospital data to examine factors associated with having a stillbirth among women that gave birth in three health facilities in urban Kabul, Afghanistan between March- September 2021. We compared the characteristics of stillborn babies (497 cases) to live born babies (1069 controls) to identify the factors that increased the odds of having a stillbirth. Our findings showed that being referred from another health facility; being born extremely preterm, very preterm, and moderate to late preterm, being small for gestational age and placental abruption increased the likelihood of stillbirth. In Afghanistan, more research is needed to understand referral and what is contributing to increased stillbirths among women who are referred. It will also be important to improve the quality of antenatal care to ensure appropriate management of preterm and small babies. Further, strengthening the quality of data recorded at health facilities will be critical for more accurate understanding of why these deaths occur. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusion The aim was to investigate feeding type at discharge; exclusively breastfeeding (EBF), mixed breastfeeding (MBF), and formula milk feeding (FMF), factors associated with feeding type, and changes in weight‐for‐age z‐score (ΔWAZ) in infants admitted to Danish neonatal units.Using data from the Danish National Quality Database for Births and the Danish Newborn Quality Database, we included 8639 mother‐infant dyads admitted ≥5 days between February 2019 and December 2021. We used logistic regression to investigate associations between maternal and infant factors and feeding type, and descriptive statistics to describe ΔWAZ and feeding type at discharge.Of all infants 59.1% were EBF, 16.9% MBF and 24.0% FMF at discharge. Gestational age <37 weeks, caesarean section, multiple births, small for gestational age, weeks at hospital, ≥6 h before skin‐to‐skin contact, and few weeks at hospital were associated with failure to EBF at discharge. Median (min–max) ΔWAZ in EBF, MBF and FMF infants was −0.44 (−4.78 to 4.88), −0.43 (−3.47 to 4.42) and −0.39 (−3.54 to 4.03), respectively. ΔWAZ was higher in EBF compared to FMF infants, p‐value 0.01, but no significant difference in ΔWAZ between MBF and FMF infants, p‐value 0.06.Danish newborn infants demonstrated satisfactory growth during admission to the neonatal unit, independent of feeding type at discharge. Rates of exclusively breastfeeding need improvement. [ABSTRACT FROM AUTHOR]

BACKGROUND: With increasing use of diazoxide for hyperinsulinemic hypoglycemia (HH), reporting of serious side effects of diazoxide such as pulmonary hypertension (PHT) increased. METHODS: Charts of all children diagnosed with HH during the study period and evaluated by Pediatric Endocrinology division of the Hasbro Children's Hospital were reviewed. We analyzed diazoxide use among infants with HH with focus on infants born small for gestational age (SGA) and preterm infants. RESULTS: Average timing of diazoxide initiation was later after 6/2017 compared to prior in preterm infants (45 days versus 4 days, p < 0.001) and in SGA infants (28 days versus 13 days, p < 0.001). Prescribing patterns changed further over time, corresponding with development of diazoxide-associated PHT in three infants between 10/2018-5/2020. Delays in diazoxide initiation were observed after 5/2020 compared to prior in fullterm, non-SGA infants: 18 days versus12 days (p = 0.01). The proportion of SGA infants who received diazoxide was lower after 5/2020 compared to prior (23% versus 65%, p = 0.03). PHT developed in 12.5% of infants treated with diazoxide in this cohort, 75% of whom were preterm and/or SGA, and 75% were born to mothers with preeclampsia. CONCLUSIONS: Patterns of diazoxide use changed over time, with delayed use in preterm and/or SGA infants observed after 6/2017, reduced use in SGA infants, and delayed initiation in all infants after 5/2020. PHT was not rare in our cohort, and was more likely in infants born SGA, preterm, or to a mother with preeclampsia. [ABSTRACT FROM AUTHOR]

Aims/Introduction: The relationship between economic disadvantages and the risk of developing gestational diabetes mellitus (GDM), as well as its impact on birth outcomes, remains uncertain. Materials and Methods: From the Taiwan Maternal and Child Health Database, we identified 984,712 pregnant women between 1 January 2007 and 31 December 2018. Using propensity score matching, we selected 5,068 pairs of women across four income levels: very low, low, middle and high. We used a multivariable Cox regression model to assess the risk of GDM in these pregnant women and analyzed the birth outcomes. Results: The mean age of the pregnant women was 30.89 years. We found no significant difference in GDM risk among pregnant women with different family income. However, newborns of women with GDM and very low‐income were at higher risk for several adverse conditions, such as small for gestational age (adjusted odds ratio (aOR) 1.17, 95% confidence interval (CI) 1.04–1.31), large for gestational age (aOR 1.27, 95% CI 1.08–1.51), hypoxic–ischemic encephalopathy (aOR 3.19, 95% CI 1.15–8.86), respiratory distress (aOR 1.58, 95% CI 1.14–2. 19), congenital anomalies (aOR 1.32, 95% CI 1.08–1.62), jaundice requiring phototherapy or exchange transfusion (aOR 1.14, 95% CI 1.05–1.24) and so on. Conclusions: This study found that low family income alone was not associated with GDM development. However, for a GDM pregnancy, pregnant women with lower income had worse birth outcomes. Improving maternal health and nutrition among low‐income pregnant women with GDM might be critical to improving birth outcomes. [ABSTRACT FROM AUTHOR]

Introduction: It is well known that both women with polycystic ovary syndrome (PCOS) and women with gestational diabetes mellitus (GDM) have increased risks of adverse pregnancy outcomes, but little is known whether the combination of these two conditions exacerbates the risks. We explored risk estimates for adverse pregnancy outcomes in women with either PCOS or GDM and the combination of both PCOS and GDM. Material and Methods: Nationwide register‐based historical cohort study in Sweden including women who gave birth to singleton infants during 1997–2015 (N = 281 806). The risks of adverse pregnancy outcomes were estimated for women exposed for PCOS‐only (n = 40 272), GDM‐only (n = 2236), both PCOS and GDM (n = 1036) using multivariable logistic regression analyses. Risks were expressed as odds ratios with 95% confidence intervals (CIs) and adjusted for maternal characteristics, including maternal BMI. Women with neither PCOS nor GDM served as control group. Maternal outcomes were gestational hypertension, preeclampsia, postpartum hemorrhage, and obstetric anal sphincter injury. Neonatal outcomes were preterm birth, stillbirth, shoulder dystocia, born small or large for gestational age, macrosomia, low Apgar score, infant birth trauma, cerebral impact of the infant, neonatal hypoglycemia, meconium aspiration syndrome and respiratory distress. Results: Based on non‐significant PCOS by GDM interaction analyses, we found no evidence that having PCOS adds any extra risk beyond that of having GDM for maternal and neonatal outcomes. For example, the adjusted odds ratio for preeclampsia in women with PCOS‐only were 1.18 (95% CI 1.11–1.26), for GDM‐only 1.77 (95% CI 1.45–2.15), and for women with PCOS and GDM 1.86 (95% CI 1.46–2.36). Corresponding adjusted odds ratio for preterm birth in women with PCOS‐only were 1.34 (95% CI 1.28–1.41), GDM‐only 1.64 (95% CI 1.39–1.93), and for women with PCOS and GDM 2.08 (95% CI 1.67–2.58). Women with PCOS had an increased risk of stillbirth compared with the control group (aOR 1.52, 95% CI 1.29–1.80), whereas no increased risk was noted in women with GDM (aOR 0.58, 95% CI 0.24–1.39). Conclusions: The combination of PCOS and GDM adds no extra risk beyond that of having GDM alone, for a number of maternal and neonatal outcomes. Nevertheless, PCOS is still an unrecognized risk factor in pregnancy, exemplified by the increased risk of stillbirth. [ABSTRACT FROM AUTHOR]

To evaluate population characteristics and obstetric complications after abdominal myomectomy vs. laparoscopic myomectomy. Retrospective cohort study. A total of 13,868 and 338 pregnancies after abdominal or laparoscopic myomectomy, respectively. Obstetrics outcomes following abdominal and laparoscopic myomectomy were collected. Obstetric outcomes after abdominal or laparoscopic myomectomies were collected using hospital discharges from 2004 to 2014 inclusively, and adjusted using multiple and binomial logistic regression in different models for age, obesity, chronic hypertension, and pregestational diabetes mellitus. Pregnancy, delivery, and neonatal outcomes were analyzed. Abdominal myomectomy were characterized by younger patients, lower rates of Caucasian, chronic hypertension, pregestational diabetes, active smoking, illicit drug use, and higher rates of previous cesarean delivery, and multiple gestations when compared with laparoscopic myomectomy. Pregnant women with laparoscopic myomectomy had decreased rates of pregnancy-induced hypertension (adjusted risk ratios [aRR], 0.12; 95% confidence intervals [CI], 0.006–0.24]), gestational hypertension (aRR, 0.24; 95% CI, 0.08–0.76), pre-eclampsia (aRR, 0.18; 95% CI, 0.07–0.48), and pre-eclampsia or eclampsia superimposed on chronic hypertension (aRR, 0.03; 95% CI, 0.005–0.3), gestational diabetes mellitus (aRR, 0.14; 95% CI, 0.06–0.34), preterm premature rupture of membranes (aRR, 0.14; 95% CI, 0.02–0.96), preterm delivery (aRR, 0.36; 95% CI, 0.23–0.55), and cesarean delivery (aRR, 0.01; 95% CI, 0.007–0.01) and small for gestational age (aRR, 0.15; 95% CI, 0.005–0.04), compared with abdominal myomectomy group. Laparoscopic myomectomy group had a higher rate of spontaneous (aRR, 35.57; 95% CI, 22.53–62.66), and operative vaginal delivery (aRR, 10.2; 95% CI, 8.3–12.56), uterine rupture (aRR, 6.1; 95% CI, 3.2–11.63), postpartum hemorrhage (aRR, 3.54; 95% CI, 2.62–4.8), hysterectomy (aRR, 7.74; 95% CI, 5.27–11.4), transfusion (aRR, 3.34; 95% CI, 2.54–4.4), pulmonary embolism (aRR, 7.44; 95% CI, 2.44–22.71), disseminated intravascular coagulation (aRR, 2.77; 95% CI, 1.47–5.21), maternal infection (aRR, 1.66; 95% CI, 1.1–2.5), death (aRR, 2.04; 95% CI, 1.31–3.2), and intrauterine fetal death (aRR, 2.99; 95% CI, 1.72–5.2) compared with the abdominal myomectomy group. Women who had a previous abdominal myomectomy have underlying risk factors for hypertension disorders of pregnancy and gestational diabetes. Women who underwent laparoscopic myomectomies have higher risks of bleeding, uterine rupture, resultant complications, and death, and should be monitored as high-risk patients, like abdominal myomectomies. [ABSTRACT FROM AUTHOR]

To study the association between sperm deoxyribonucleic acid fragmentation index (DFI) and the odds of preeclampsia and other adverse perinatal outcomes after in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) treatment. A prospective cohort study including infertile couples undergoing conventional IVF or ICSI treatment and their children. Data regarding preeclampsia and perinatal outcomes were derived from the Swedish National Birth Register. A total of 1,594 infertile couples undergoing IVF or ICSI treatment and their 1,660 children conceived by assisted reproduction. Sperm DFI measured by Sperm Chromatin Structure Assay. The primary outcome was preeclampsia. The secondary outcomes were preterm birth (PTB), low birth weight, low Apgar score, and small for gestational age. With a DFI level of <20% as a reference, the odds ratio (OR) of preeclampsia statistically significantly increased in the group with a DFI level of ≥20% when IVF was used as the fertilization method (OR, 2.2; 95% confidence interval, 1.1–4.4). Already at the DFI levels of ≥10%, in IVF pregnancies, the OR of preeclampsia increased in a dose-response manner, from a prevalence of 3.1% in the reference group to >10% among those with a DFI level of ≥30%. The DFI was not associated with the OR of preeclampsia in the ICSI group. In the entire cohort, a DFI level of ≥20% was associated with an increased OR of PTB (OR, 1.4; 95% confidence interval, 1.0–2.0). High DFI level was associated with increased odds of PTB and, in IVF pregnancies, also increased odds of preeclampsia. [ABSTRACT FROM AUTHOR]

The objective of this study is to evaluate whether early hypoglycemia is an independent risk factor for 2-year cognitive (COG) impairment in small for gestational age (SGA) preterm infants with gestational age (GA) < 32 weeks. We retrospectively reviewed data of 1364 preterm infants with a GA 24+0/7–31+6/7 weeks. Infants were classified based on blood glucose concentrations within the first 6 h of life (HOL) as < or ≥ 40 mg/dL (Glyc < 40[Birth−6HOL] and Glyc ≥ 40[Birth−6HOL], respectively) and subsequently by birth weight z-score as SGA or appropriate for gestational age (AGA). Propensity score matching analyses were conducted for each comparison. Multiple logistic regression was used to evaluate the association of Glyc < 40[Birth−6HOL] with 2-year COG impairment, defined as a Bayley-III score < 85, in SGA infants. Out of the 747 preterm infants who met the inclusion criteria, 173 (23.2%) were classified as Glyc < 40[Birth−6HOL], and 574 (76.8%) as Glyc ≥ 40[Birth−6HOL]. The proportion of SGA infants was significantly higher in Glyc < 40[Birth−6HOL] than in Glyc ≥ 40[Birth−6HOL] (25.4 vs 18.3%, p = 0.039). The incidence of 2-year COG impairment was significantly higher in SGA infants compared to matched AGA counterparts both in Glyc < 40[Birth−6HOL] (+ 20%, p = 0.040) and Glyc ≥ 40[Birth−6HOL] (+ 17%, p = 0.029). Neither in the entire cohort nor in the SGA infants, Glyc < 40[Birth−6HOL] was significantly associated with 2-year COG impairment (aOR: 1.077, p = 0.768; 0.993, p = 0.935; respectively) after the adjustment for GA, sex, Apgar score at 5 min < 7, SGA status, complications of prematurity, duration of mechanical ventilator support > 7 days, cumulative energy intakes from birth to 36 weeks, and maternal university level. Conclusion: Among SGA preterm infants with GA between 24+0/7 and 31+6/7 weeks/days, hypoglycemia within the first 6 HOL was not an independent risk factor for 2-year COG impairment. What is Known: • Hypoglycemia is associated with poor neurodevelopmental outcomes in preterm infants. • Small for gestational age (SGA) preterm infants are more prone to cognitive (COG) impairment compared to AGA counterparts. What is New: • In a large cohort of preterm infants < 32 weeks, the incidence of hypoglycemia within the first 6 hours of life (HOL) was higher in SGA compared to AGA. • Hypoglycemia within the first 6 HOL was not an independent risk factor for 2-year COG impairment in SGA preterm infants. [ABSTRACT FROM AUTHOR]

Objective: To compare circulating levels of vascular endothelial growth factor receptor 3 (VEGFR‐3) in women with pregnancy‐induced hypertension (PIH) and in non‐pregnant (NP) and healthy pregnant (HP) women. Methods: We conducted a case–control study including PIH (n = 135), HP (n = 68), and NP (n = 49) women from southeastern Brazil. PIH were diagnosed according to international guidelines, and defined as gestational hypertension (GH, n = 61) or pre‐eclampsia (n = 74). VEGFR‐3 was measured in plasma using ELISA. Results: Plasma VEGFR‐3 was increased in HP (1207 pg/mL) compared with NP (133 pg/mL) women; however, PIH (729 pg/mL) patients exhibited lower levels than HP women (both p < 0.05). In addition, plasma VEGFR‐3 was decreased in pre‐eclampsia compared with GH (537 versus 980 pg/mL; p < 0.05). When pre‐eclampsia was classified according to different clinical presentations, plasma VEGFR‐3 was further decreased in the cases identified as pre‐eclampsia with severe features, preterm pre‐eclampsia, and pre‐eclampsia accompanied by small for gestational age (all p < 0.05). Conclusion: Our data indicate reduced circulating VEGFR‐3 levels in patients with PIH, specifically in those diagnosed with pre‐eclampsia. Moreover, decreased VEGFR‐3 was associated with adverse clinical outcomes in pre‐eclampsia. These findings expand previous evidence of reduced VEGFR‐3 expression in pre‐eclampsia. Future studies should investigate whether it can be used as a predictive biomarker and/or therapeutic target for pre‐eclampsia. Synopsis: Circulating VEGFR‐3 levels were decreased in patients with pregnancy‐induced hypertension, specifically in those with pre‐eclampsia. Decreased VEGFR‐3 was associated with adverse clinical outcomes in pre‐eclampsia. [ABSTRACT FROM AUTHOR]

An integrated care pathway to manage small and nutritionally at‐risk infants under 6 months (u6m) and their mothers (MAMI Care Pathway) is consistent with 2023 WHO malnutrition guidelines and is being tested in a randomised controlled trial (RCT) in Ethiopia. To optimise trial implementation, we investigated contextual fit with key local stakeholders. We used scenario‐based interviews with 17 health workers and four district managers to explore perceived feasibility. Eighteen policymakers were also surveyed to explore policy coherence, demand, acceptability, evidence needs, opportunities and risks. The Bowen feasibility framework and an access to health care framework were adapted and applied. Health workers perceived the MAMI Care Pathway as feasible to implement with support to access services and provide care. The approach is acceptable, given consistency with national policies, local protocols and potential to improve routine care quality. Demand for more comprehensive, preventive and person‐centred outpatient care was driven by concerns about unmet, hidden and costly care burden for health services and families. Inpatient care only for severe wasting treatment is inaccessible and unacceptable. Support for routine and expanded components, especially maternal mental health, is needed for successful implementation. Wider contextual factors may affect implementation fidelity and strength. Policymakers cautiously welcomed the approach, which resonates with national commitments, policies and plans but need evidence on how it can work within varied, complex contexts without further system overstretch. A responsive, pragmatic randomised controlled trial will generate the most useful evidence for policymakers. Findings have informed trial preparation and implementation, including a realist evaluation to contextualise outcomes. Key messages: The MAMI Care Pathway integrated approach is perceived as acceptable, needed and possible to implement during a randomised control trial in outpatient clinics in Ethiopia.Contextualised inputs (training, staffing, space and supplies) will be needed to strengthen implementation of existing activities and for new components.Breastfeeding counselling skills and maternal care provision, especially maternal mental health, are varied and often limited in routine services.National policymakers need trial implementation evidence to contextualise RCT outcomes for policy development. [ABSTRACT FROM AUTHOR]

Background and aim: Paternal use of analgesics during the time of conception and adverse birth outcomes are poorly studied. We investigated the association between paternal exposure to non‐steroid anti‐inflammatory drugs and opioids within 3 months before the date of conception and the risk of adverse birth outcomes (preterm birth, small for gestational age, low Apgar score, and major congenital malformations). Methods: We used nationwide data from the Danish health registers. We included information on all singleton live births, and their fathers and mothers from 1997 to 2018. We created two exposed cohorts, children with preconception paternal exposure to (1) non‐steroid anti‐inflammatory drugs and (2) opioids. The unexposed cohort was children without preconception paternal exposure to non‐steroid anti‐inflammatory drugs or opioids, and we performed a sub‐analysis against paternal use of acetaminophen (paracetamol). We used logistic regression models to estimate the odds ratios of adverse birth outcomes including 95% confidence intervals. Results: We identified 1,260,934 children, 45,667 children with paternal exposure to non‐steroid anti‐inflammatory drugs, 10,086 children with paternal exposure to opioids, and 1,205,181 unexposed children. The adjusted odds ratio for preterm birth was 1.08 (95% confidence interval, 1.03–1.13) after paternal exposure to non‐steroid anti‐inflammatory drugs and 1.21 (95% confidence interval, 1.08–1.35) after paternal exposure to opioids. The adjusted odds ratio for small for gestational age was 1.09 (95% confidence interval, 1.03–1.17) after paternal exposure to non‐steroid anti‐inflammatory drugs, and 1.03 (95% confidence interval, 0.88–1.21) after paternal exposure to opioids. We found null‐associations for a low Apgar score and major congenital malformations. Estimates were attenuated when compared against paternal paracetamol exposure. Conclusions: Overall, we found null‐associations across the comparisons made. Weak associations were found for paternal exposure to non‐steroid anti‐inflammatory drugs or opioids and preterm birth and small for gestational age, but not with low Apgar score or major congenital malformation. All associations were attenuated when compared against an active comparator of paternal paracetamol exposure. The effect sizes were small and less likely to be of clinical relevance. [ABSTRACT FROM AUTHOR]

• Women with PCOS and pre-gestational DM are more likely to develop pregnancy complications. • These complications include pregnancy induced hypertension, preeclampsia, and placenta previa. • Women with PCOS who had pregestational diabetes were also at increased risk of preterm delivery and delivery by cesarean section. • The impact of pre-existing DM on the relationship between PCOS and pregnancy outcomes should be considered when planning care for these patients. To evaluate the effect of pregestational diabetes mellitus (DM) on the likelihood of experiencing adverse pregnancy, delivery, and neonatal outcomes in pregnant women with polycystic ovary syndrome (PCOS). A retrospective population-based study using data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS) database was performed. All deliveries between 2004 and 2014, inclusively, were studied using ICD-9 codes. Within the study period, 14,882 women had a diagnosis of PCOS, of which 673 (4.7%) had a diagnosis of pregestational diabetes. Chi-squared tests were used for comparison of demographics. Multivariate logistic regression analysis was performed to calculate unadjusted and adjusted odds ratios (aORs) and corresponding 95% confidence intervals (CI), controlling for confounding effects. IRB approval was not required, given data was anonymous and publicly available. Women with PCOS and pre-gestational DM were more likely to develop pregnancy complications, including pregnancy induced hypertension (aOR 1.55; CI 1.25–1.92), preeclampsia (aOR 1.45; CI 1.04–2.02), preeclampsia or eclampsia superimposed on pre-existing hypertension (aOR 1.85; CI 1.29–2.66), and placenta previa (aOR 2.53; CI 1.06–6.01), after controlling for confounding demographics. Women with PCOS who had pregestational diabetes were at increased risk of preterm delivery (aOR 1.40; CI 1.09–1.80), and delivery by cesarean section (aOR 1.50; CI 1.23–1.84). Results demonstrated no difference in the rate of women who gave birth to small for gestational age (SGA) infants, the rate of intrauterine fetal demises (IUFD), and the rate of infants with congenital anomalies between the two groups. The impact of pre-existing DM on the relationship between PCOS and pregnancy outcomes should be considered when counselling and planning care for pregnant women affected by these conditions. This emphasizes the importance of optimal perinatal care in diabetic women with PCOS as they are at higher risk of obstetric complications. [ABSTRACT FROM AUTHOR]

The short-term respiratory consequences of small for gestational (SGA) are only partially known. Our aim was to compare the early respiratory features between SGA and appropriate for gestational age (AGA) in very preterm infants. We conducted a secondary analysis of the French prospective EPIPAGE-2 cohort. Eligible children were those born alive before 32 weeks’ gestation. The exposed group consisted of children with SGA. The unexposed group consisted of AGA children. SGA and AGA children were randomly matched in a ratio of 1:1 on the same gestational age and sex. Primary outcomes were age at final extubation and age at weaning from any respiratory support. Among 3.964 very preterm from the EPIPAGE2 cohort, 1123 SGA and 1123 AGA very preterm children were included in the study. The median gestational age was 30.0 weeks (interquartile range 28.0–31.0) in both groups. The median birthweight was 1440 g (1138–1680) in the AGA group and 1000 g (780–1184) in the SGA group. Invasive mechanical ventilation was less common in the SGA than in the AGA group: 68.6% (770/1123) versus 72.0% (808/1062), odds ratio 0.85 (95% CI [0.72–1.00]). In cases of mechanical ventilation, median age at final extubation was 4 days (1–23) and 2 days (1–9) in the SGA and AGA groups. Median postmenstrual age at weaning from any respiratory support was 33.4 weeks (31.7–35.9) in the SGA group and 32.4 weeks (31.4–34.3) in the AGA group. Conclusion: SGA is associated with delayed extubation and respiratory support weaning. What is Known: • Small for gestational age concerns more than 30% of very preterm children. • The condition is strongly associated with increased neonatal mortality and morbidity, including bronchopulmonary dysplasia. What is New: • Small for gestational age is associated with delayed extubation and respiratory support weaning in very preterm children. • Shortening invasive mechanical ventilation as much as possible is a crucial issue in this population to try to reduce the risk of bronchopulmonary dysplasia. [ABSTRACT FROM AUTHOR]

Objective To examine the effect of underweight maternal body mass index (BMI) on pregnancy complications and neonatal outcomes. Design Cohort study. Setting Tertiary academic center. Patients A total of 16 361 mothers who delivered a singleton between 2015-2021 with either a BMI <18.5 kg/m2 (n = 732) or normal BMI (18.5 ≥ BMI <23 or 25 kg/m2, n = 15 629) at the initial prenatal visit or within 6 months of the initial visit. Main Outcome Measures Birthweight, gestational age, neonatal intensive care unit admission, preterm birth, and fetal death; obstetrical complications including preeclampsia/eclampsia, premature rupture of membranes, preterm premature rupture of membranes, and postpartum hemorrhage. Results Underweight women were younger and less likely to have private insurance (P <.01 for both) than normal-weight women. Approximately 23% of infants born to underweight mothers were small for gestational age and 15% were low birth weight vs 13.5% and 9% of infants of normal-weight mothers, respectively (P <.01 for both). These differences remained significant after adjusting for potential confounders. In adjusted logistic regression models, underweight women had a decreased risk of premature rupture of membranes and postpartum hemorrhage compared to normal-weight women. Conclusion Underweight BMI during pregnancy is associated with an increased risk of small for gestational age and low birth weight infants and a decreased risk of premature rupture of membranes and postpartum hemorrhage. These findings suggest underweight BMI during pregnancy increases the risk of adverse neonatal outcomes, while maternal-related pregnancy outcomes are less affected. [ABSTRACT FROM AUTHOR]

We identified individuals born in Norway between 1970 and 2019 with transverse reduction deficiency at or above the wrist (TRDAW) from the Medical Birth Registry of Norway and from the CULA (congenital upper limb anomaly) North Oslo Registry. Infant outcomes and parental factors were compared for 202 individuals with TRDAW to 2,741,013 living individuals without TRDAW born during the same period. We found an overall TRDAW prevalence of 0.74/10,000. Infants with TRDAW had a higher risk for being small for gestational age, an Apgar score <7 and transfer to neonatal intensive care units after delivery. Nine of the infants with TRDAW had associated anomalies, most commonly in the lower limb, and at a higher proportion than the reference population. Other than twin pregnancies, we are unable to identify with certainty any other risk factors for TRDAW. Level of evidence: I [ABSTRACT FROM AUTHOR]

Context Long-term data regarding health-related quality of life (HRQoL) and problem behavior in adults born small for gestational age (SGA) who were treated with GH during childhood are lacking. Objective To investigate longitudinal changes in HRQoL and problem behavior in adults born SGA during 12 years after cessation of childhood GH treatment (SGA-GH) and compare these with 3 control groups at age around 30 years. Participants One hundred seventy-six SGA-GH adults and 3 untreated age-matched control groups: 50 born SGA with short stature (SGA-S), 77 born SGA with spontaneous catch-up growth to normal height (SGA-CU), and 99 born appropriate-for-gestational-age with normal height (AGA). Main Outcome Measures HRQoL and problem behavior were assessed using the TNO-AZL Adults Quality of Life questionnaire and Adolescent Behavior Check List at 6 months and 2, 5, and 12 years after GH cessation. Data at 12 years after GH cessation were compared with 3 control groups. Results During 12 years after GH cessation, HRQoL remained similar on 9 subscales in SGA-GH adults but decreased on 3 subscales (gross motor functioning, pain, sleep). Externalizing problem behavior decreased significantly, and internalizing problem behavior tended to decrease. SGA-GH and SGA-S adults had similar HRQoL and problem behavior. SGA-GH adults had, compared to AGA adults, similar HRQoL on 7 subscales, lower HRQoL on 5 subscales, and more internalizing and externalizing problem behavior. All SGA adults had lower HRQoL and more internalizing problem behavior than AGA adults. Adult height associated negatively with externalizing problem behavior, but the influence was small. Conclusion During 12 years after GH cessation, HRQoL remained mostly similar and problem behavior decreased in SGA-GH adults. SGA-GH and SGA-S adults had similar HRQoL and problem behavior. All SGA adults had lower HRQoL and more internalizing problem behavior than AGA adults. [ABSTRACT FROM AUTHOR]

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

Background: The blastocyst-stage embryo has been considered more advantageous for increasing the cumulative live birth rate (CLBR) at fresh embryo transfer (ET) compared to the cleavage-stage embryo. However, it remains uncertain whether this advantage extends to specialized subpopulations, such as women with thin endometrium (TE), who are characteristic of impaired endometrial receptivity. Thus, this study aims to evaluate the difference in the CLBR between cleavage-stage and blastocyst-stage embryos at fresh ET specifically in women with TE. Methods: A retrospective cohort comprising 1089 women from three centers, ranging from September 2017 to January 2022, was established. These women were diagnosed with TE (defined as endometrium thickness <= 8 mm) and underwent their first fresh ET. To create a comparable cohort between the cleavage and blastocyst groups while adjusting for key covariates, the propensity score matching (PSM) method was employed. The primary outcome assessed was the CLBR per woman. Both cohorts underwent Kaplan-Meier analysis, Cox proportional hazard models, cumulative incidence function (CIF) curve analysis, and Fine-Grey competing risk models to ascertain the impact of embryo stage at fresh ET on CLBR. Additionally, a sensitivity analysis was conducted within a subgroup defining thin endometrium as an endometrium thickness (EMT) < 7 mm. Results: In the matched cohort after PSM, the CLBR was comparable between groups (p=0.331). However, the cleavage-stage fresh ET was associated with an elevated risk of low birth weight (LBW) (p=0.005) and small for gestational age (SGA) (p=0.037). Kaplan-Meier analysis showed that the median number of embryo transfer cycles was 2 in the cleavage group and 3 in the blastocyst group. The CLBR for the cleavage group reached 78.1%, while the blastocyst group reached 60.0% after 5 cycles of embryo transfers (log-rank test, p=0.09). A multivariable Cox proportional hazard model indicated no significant association between the embryo stage at fresh ET and CLBR (HR=0.80, 95% CI=0.60-1.07). The CIF curve and Fine-Grey competing risk models demonstrated similar results. These analyses were repeated in the original cohort before PSM and in the subgroup with EMT < 7 mm, and the results remained robust. Conclusion: For TE women receiving fresh ET, the choice between the cleavage-stage embryo and the blastocyst-stage embryo yields comparable CLBR. However, selecting the cleavage-stage embryo is associated with increased risks of LBW and SGA births. [ABSTRACT FROM AUTHOR]

Background: Adverse birth outcomes (preterm birth, low birth weight, small for gestational age, and stillbirth) seem to persist in infants born to people with HIV, even in the context of maternal antiretroviral therapy. However, findings have been disparate, inconclusive, and difficult to compare directly across settings, partly owing to variable outcome definitions. We aimed to collate, compare, and map existing adverse birth outcome definitions to inform a harmonized approach to universally measure these outcomes in studies including pregnant people with HIV. Methods: We conducted a scoping review of studies that reported adverse birth outcomes associated with maternal HIV and antiretroviral use in pregnancy, specifically those that included definitions of 'preterm birth', 'low birth weight', 'small for gestational age', and 'stillbirth'. Five databases were searched from 01 January 2011 to 15 August 2022. Title, abstract and full-text screening was conducted independently in duplicate. A comparative quantitative analysis was conducted to compare study characteristics by period of study (< 2013; 2013–2015; > 2016) and country income group. A qualitative content analysis was conducted to compare and map deviations from the WHO definitions as a reference. Results: Of the 294 articles that included at least one adverse birth outcome, 214 (73%) studies started before 2013, 268 (91%) were published as primary research articles, and 137 (47%) were conducted in Eastern and Southern Africa. Among the 283 studies included in the country income group analysis, 178 (63%) were conducted in low- and middle-income countries. Studies reporting low birth weight, preterm birth, small for gestational age and stillbirth deviated from the WHO definitions in n = 11/169 (7%), n = 93/246 (39%), n = 40/112 (36%) and n = 85/108 (79%) instances, respectively. The variations included the use of different thresholds and the addition of new terminology. Conclusion: The current WHO definitions are valuable tools for population-level monitoring; however, through consensus, these definitions need to be optimized for research data collection, analysis, and presentation. In conjunction with good reporting, variation in adverse birth outcome definitions can be decreased to facilitate comparability of studies as well as pooling of data for enhanced evidence synthesis. [ABSTRACT FROM AUTHOR]

Birth weight is an important indicator of fetal development, which directly influencing the health and safety of both mother and child. However, accurately predicting fetal growth remains a challenging task due to complex influencing factors. To overcome this issue, this paper proposes a new framework called Multidirectional Perception Generative Adversarial Network with Rat Swarm Optimizer for Fetal Growth Prediction (MPGAN-RSO-FGP) to enhance birth weight predictions. The model integrates the capabilities of the Multidirectional Perception Generative Adversarial Network (MPGAN) with the Rat Swarm Optimizer (RSO) to optimize prediction accuracy. Input parameters, including gestational age and birth weight are categorized into three sets: (i) Small for Gestational Age (SGA), (ii) Appropriate for Gestational Age (AGA), (iii) Large for Gestational Age (LGA). In general, the MPGAN does not adopt any optimization strategy to determine the optimal parameters. That’s why, RSO is used to optimize the MPGAN for accurate fetal growth prediction. The proposed MPGAN-RSO-FGP is evaluated using performance metrics, such as Accuracy, Mean Relative Error (MRE), F-score, Precision, Sensitivity, Specificity, ROC, Computational time. The experimental results exemplify that the MPGAN-RSO-FGP outperforms existing models. The MPGAN-RSO-FGP attains 20.78%, 23.67%, and 17.98% higher accuracy, and 21.98%, 23.56%, and 30.78% higher precision compared to the existing LSTM-FBWP, SVM-PSGA, and RF-PLBW models. These findings demonstrate the model’s significant impact on decision-making systems, providing more reliable and efficient fetal growth predictions, which can aid in timely clinical interventions and improve maternal-infant outcomes. [ABSTRACT FROM AUTHOR]

Inappropriate birth weight for gestational age (IBWGA) is linked with obstetric complications like birth asphyxia, hypothermia, and postpartum hemorrhage. This study was aimed at determining the prevalence of IBWGA with factors associated with newborns born at Dessie Referral Hospital, northeast of Ethiopia. We used a retrospective cohort study design and systematic random sampling method to select charts of women giving birth at the hospital from January 2013 to December 2017. Binary logistic regression analysis was used to check the association of selected variables with the outcome variable IBWGA. The prevalence of IBWGA was found to be 145 (34.36%), with 52 (12.32%) and 93 (22.04%) for large for gestational age (LGA) and small for gestational age (SGA), respectively. A higher prevalence of IBWGA was found among women who use substances during pregnancy, such as chewing chat (43, 49.4%), smoking (14, 53.8%), and those with a history of giving birth to an infant with IBWGA (31, 50.0%). Furthermore, maternal age less than 35 years old (p < 0.05), antenatal care initiation at or before the second trimester (p < 0.05), gestational age less than 37 weeks (p < 0.05), and chewing chat during pregnancy (p < 0.05) were found to be statistically significantly associated with IBWGA. The high prevalence of IBWGA revealed by this study suggests a need for interventions focusing on its predicting factors: maternal age, prenatal care, gestational age, and substance use during pregnancy. [ABSTRACT FROM AUTHOR]

Objective: Previous studies have reported that ambient air pollutants such as PM2.5 can increase the risk of adverse birth outcomes. The objective of this study was to ascertain whether air purifier usage during pregnancy is associated with a lower risk of adverse birth outcomes in a large Japanese birth cohort. Methods: We conducted a prospective cohort analysis using data from the Japan Environment and Children's Study. Use of air purifiers during pregnancy was assessed using a self-administered questionnaire. Primary outcomes were the prevalence of preterm birth (PTB), small for gestational age (SGA), and low birth weight (LBW). Logistic regression analysis was performed to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results: The prevalence of outcomes was 4.5% for PTB, 7.4% for SGA, and 8.1% for LBW. The crude model analysis revealed that PTB, SGA, and LBW showed lower ORs in the group that used an air purifier, although the association disappeared in the adjusted model except for SGA (OR: 0.94; 95% CI: 0.89, 1.00, p = 0.048) and LBW (OR: 0.93; 95% CI: 0.88, 0.98, p = 0.003). Subgroup analysis stratified by infant sex revealed that the lower OR for LBW was observed only in male infants. Conclusions: Our results suggest that avoiding maternal air pollution exposure during pregnancy may be useful in preventing adverse birth outcomes. These findings provide evidence supporting the development of protective measures against air pollutants in the gestational period by relevant health agencies. [ABSTRACT FROM AUTHOR]

Manganese is essential for adequate feto-maternal health; however, an inverted U-shaped relation has been found between maternal manganese status and pregnancy complications. This systematic review summarizes the effect of maternal manganese exposure and perinatal health. We adopted a systematic approach to retrieve the recent literature. After applying the inclusion/exclusion criterion, a total of 20 studies were included in this review. Results found a non-significant relationship between maternal manganese exposure and risk of gestational diabetes mellitus (GDM), while only three studies reported the association between higher manganese levels and risk of preterm birth. Also, inconsistent results were found regarding higher manganese status and risk of low birth weight. This review reported no association between higher maternal manganese status andrisk of GDM. Nevertheless, the paucity of literature related to small for gestational age and pre-eclampsia prohibits a conclusion. Further studies are required for evaluation of environmental manganese exposure and maternal manganese status. [ABSTRACT FROM AUTHOR]

Background: Pregnant women with gestational diabetes mellitus (GDM) are at an increased risk of adverse pregnancy outcomes (APO). Early understanding of risk factors affecting these outcomes may facilitate preventive interventions for women at high risk. Blood samples from GDM and control pregnant women were collected for Free fatty acid (FFA) profiling to determine the relationship with the occurrence of APO in GDM pregnant women. Methods: The study comprised 144 women diagnosed with GDM and 52 normal control pregnancy (NC). Venous fasting serum samples were collected during the second trimester. The serum FFA levels were detected by liquid chromatography-mass spectrometry (LC-MS). The primary outcome consisted of serious maternal and neonatal adverse events (hypertensive disorder complicating pregnancy (HDCP), emergency cesarean section, large for gestational age (LGA), small for gestational age (SGA), macrosomia, low birth weight (LBW), preterm birth, and stillbirth). The association of metrics with outcomes was assessed, and receiver operating characteristic (ROC) curve analysis was employed to evaluate clinical utility. Results: Differences in fatty acid profiles were observed between GDM patients and controls. Stearic acid (C18:0) levels differed between the normal pregnancy outcome (NPO) and APO groups, potentially correlating with fetal sex. Logistic regression models indicated that moderate and high levels of C18:0 were negatively associated with APO relative to the NPO group. ROC analysis demonstrated that C18:0 had a certain predictive ability for APO, and predictive efficiency was enhanced when combined with general clinical data. Conclusion: The level of C18:0 was associated with the occurrence of APO in pregnant women with GDM and exhibited a certain predictive value. When C18:0 was combined with general clinical data, the predictive power for APO was improved. [ABSTRACT FROM AUTHOR]

Background/Objectives: A-kinase-interacting protein 1 (AKIP1) has been discovered to be a pivotal signaling adaptor in the regulation of human labor and associated with preterm birth, but its effect on fetal growth was still unclear. Meanwhile, the regulation role of DNA methylation (DNAm) on placental and fetal development has been demonstrated. Therefore, we aimed to investigate the association of AKIP1 DNAm in maternal peripheral blood with placental development and full-term small for gestational age (FT-SGA) neonates, and to explore whether placenta mediate the association between AKIP1 DNAm and FT-SGA; Methods: This study was a case–control study including 84 FT-SGAs and 84 FT-AGAs derived from the Shenzhen Birth Cohort Study. The DNA methylation analysis of CpG in the target region of the AKIP1 gene was measured by the Sequenom MassARRAY EpiTYPER approach. Multiple-variable logistic and linear regression analyses were used to estimate the association between the DNAm of three validated CpG sites in the AKIP1 gene, placental thickness, and FT-SGA. Mediation analysis was used to examine the mediation effect of placental development on the association between the DNAm of AKIP1 and FT-SGA. Results: For every increment in standard deviation in the DNAm of CpG4 (cg00061907) at AKIP1, the risk of FT-SGA elevated by 2.01-fold (aOR = 2.01, 95%CI = 1.39~3.01), and the thickness of the placenta significantly decreased by a 0.19 standard deviation (β = −0.19, 95%CI = −0.32~ −0.06). Placental thickness mediated the 22.96% of the effect of the DNAm of CpG4 at AKIP1 on the risk of FT-SGA with statistical significance. Conclusions: The findings in the present study suggested the mediating effect of placental thickness on the association of the DNAm of AKIP1 in maternal peripheral blood and the risk of FT-SGA, providing new evidence for the mechanism of maternal epigenetics in placental and fetal development. [ABSTRACT FROM AUTHOR]

Objective: To assess the impact of low-dose aspirin (LDA) on obstetrical outcomes through a meta-analysis of placebo-controlled randomized controlled trials (RCTs). Methods: A systematic search of the PubMed, Cochrane Library, Web of Science and Embase databases from inception to January 2024 was conducted to identify studies exploring the role of aspirin on pregnancy, reporting obstetrical-related outcomes, including preterm birth (PTB, gestational age <37 weeks), small for gestational age (SGA), low birth weight (LBW, birthweight < 2500g), perinatal death (PND), admission to the neonatal intensive care unit (NICU), 5-min Apgar score < 7 and placental abruption. Relative risks (RRs) were estimated for the combined outcomes. Subgroup analyses were performed by risk for preeclampsia (PE), LDA dosage (<100 mg vs. ≥100 mg) and timing of onset (≤20 weeks vs. >20 weeks). Results: Forty-seven studies involving 59,124 participants were included. Compared with placebo, LDA had a more significant effect on low-risk events such as SGA, PTB and LBW. Specifically, LDA significantly reduced the risk of SGA (RR = 0.91, 95% CI: 0.87–0.95), PTB (RR = 0.93, 95% CI: 0.89–0.97) and LBW (RR = 0.94, 95% CI: 0.89–0.99). For high-risk events, LDA significantly lowered the risk of NICU admission (RR = 0.93, 95% CI: 0.87–0.99). On the other hand, LDA can significantly increase the risk of placental abruption (RR = 1.72, 95% CI: 1.23–2.43). Subgroup analyses showed that LDA significantly reduced the risk of SGA (RR = 0.86, 95% CI: 0.77–0.97), PTB (RR = 0.93, 95% CI: 0.88–0.98) and PND (RR = 0.65, 95% CI: 0.48–0.88) in pregnant women at high risk of PE, whereas in healthy pregnant women LDA did not significantly improve obstetrical outcomes, but instead significantly increased the risk of placental abruption (RR = 5.56, 95% CI: 1.92–16.11). In pregnant women at high risk of PE, LDA administered at doses ≥100 mg significantly reduced the risk of SGA (RR = 0.77, 95% CI: 0.66–0.91) and PTB (RR = 0.56, 95% CI: 0.32–0.97), but did not have a statistically significant effect on reducing the risk of NICU, PND and LBW. LDA started at ≤20 weeks significantly reduced the risk of SGA (RR = 0.76, 95% CI: 0.65–0.89) and PTB (RR = 0.56, 95% CI: 0.32–0.97). Conclusions: To sum up, LDA significantly improved neonatal outcomes in pregnant women at high risk of PE without elevating the risk of placental abruption. These findings support LDA's clinical application in pregnant women, although further research is needed to refine dosage and timing recommendations. [ABSTRACT FROM AUTHOR]

Hugely concerning changes to health outcomes have been observed in the UK since the early 2010s, including reductions in life expectancy and widening of inequalities. These have been attributed to UK Government 'austerity' policies which have profoundly affected poorer populations. Studies in mainland Europe have shown associations between austerity and increases in adverse birth outcomes such as low birthweight (LBW). The aim here was to establish whether the period of UK austerity was also associated with higher risks of such outcomes. We analysed all live births in Scotland between 1981 and 2019 (n  = 2.3 million), examining outcomes of LBW, preterm birth (PB) and small-for-gestational-age (SGA). Descriptive trend analyses, segmented regression (to identify changes in trends) and logistic regression modelling (to compare risk of outcomes between time periods) were undertaken, stratified by infant sex and quintiles of socioeconomic deprivation. There were marked increases in LBW and PB rates in the austerity period, particularly in the most deprived areas. However, rates of SGA decreased, suggesting prematurity as the main driver of LBW rather than intrauterine growth restriction. The regression analyses confirmed these results: trends in LBW and PB changed within 1–3 years of the period in which austerity was first implemented, and that period was associated with higher risk of such outcomes in adjusted models. The results add to the European evidence base of worsening birth outcomes associated with austerity-related economic adversity. The newly elected UK government needs to understand the causes of these changes, and the future implications for child and adult health. [ABSTRACT FROM AUTHOR]

The combination of hypertension with systemic inflammation during pregnancy is a hallmark of preeclampsia, but both processes also convey dynamic information about its antecedents and correlates (e.g., fetal growth restriction) and potentially related offspring sequelae. Causal inferences are further complicated by the increasingly frequent overlap of preeclampsia, fetal growth restriction, and multiple indicators of acute and chronic inflammation, with decreased gestational length and its correlates (e.g., social vulnerability). This complexity prompted our group to summarize information from mechanistic studies, integrated with key clinical evidence, to discuss the possibility that sustained or intermittent systemic inflammation-related phenomena offer hints about viable therapeutic targets, not only for the prevention of preeclampsia, but also the neurobehavioral and other developmental deficits that appear to be overrepresented in surviving offspring. Importantly, we feel that carefully designed hypothesis-driven observational studies are necessary if we are to translate the mechanistic evidence into child health benefits, namely because multiple pregnancy disorders might contribute to heightened risks of neuroinflammation, arrested brain development, or dysconnectivity in survivors who exhibit developmental problems later in life. [ABSTRACT FROM AUTHOR]

Temple syndrome is a rare imprinting disorder, caused by alterations in the critical imprinted region 14q32 of chromosome 14. It is characterized by pre- and postnatal growth retardation, truncal hypotonia and facial dysmorphism in the neonatal period. We report an 18-year-old girl with a late diagnosis of Temple syndrome presenting with all typical signs and symptoms including small for gestational age at birth, feeding difficulties, muscle hypotonia and delayed developmental milestones, central precocious puberty, truncal obesity and reduced growth. The patient is the second reported in the literature with signs of clinical and biochemical hyperandrogenism and the first treated with Dehydrocortisone®, with a good response. The clinical diagnosis of this patient was made after long-term follow up at a single center for rare endocrine diseases, and a molecular genetics diagnosis of complete hypomethylation of 14q32 chromosome imprinting center (DLK/GTL2) was recently established. Growth hormone treatment was not given and although precocious puberty was treated in line with standard protocols, her final height remained below the target range. Increased awareness of Temple syndrome and timely molecular diagnosis enables improvement of clinical care of these patients as well as prevention of inherent metabolic consequences. [ABSTRACT FROM AUTHOR]

Background: Polycystic ovary syndrome (PCOS) is a metabolic and reproductive disorder. Current research findings present conflicting views on the effects of different PCOS phenotypes on outcomes in pregnancy and for newborns. Methods: This research study followed the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). A thorough search of literature was carried out using the Cochrane Menstrual Disorders and Subfertility Group trials register, Web of Science, and EMBASE databases from their start to December 2023. The search focused on studies examining the links between hyperandrogenic and non-hyperandrogenic PCOS phenotypes and risks in pregnancy and neonatology. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed using either a fixed-effects or random-effects model. Results: Our analysis incorporated 10 research studies. Expectant mothers with a hyperandrogenic PCOS subtype had increased ORs for gestational diabetes mellitus (GDM) and preeclampsia (PE) compared to those with a non-hyperandrogenic PCOS subtype, with respective values of 2.14 (95% CI, 1.18–3.88, I2 = 0%) and 2.04 (95% CI, 1.02–4.08, I2 = 53%). Nevertheless, no notable differences were detected in ORs for outcomes like preterm birth, live birth, miscarriage, cesarean delivery, pregnancy-induced hypertension, small for gestational age babies, large for gestational age newborns, and neonatal intensive care unit admissions between pregnant women with hyperandrogenic PCOS phenotype and those without. Conclusions: This meta-analysis highlights that the presence of hyperandrogenism heightens the risks of GDM and PE within the PCOS population. Healthcare providers ought to be aware of this connection for improved patient management. [ABSTRACT FROM AUTHOR]