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Hyperreactio luteinalis is a benign, pregnancy-related condition with cystic enlargement of the ovaries and elevated androgen. However, only one-third of patients manifest as maternal virilisation and rarely does it cause fetal virilisation. Here, we report a virilised baby girl born to a virilised mother because of hyperreactio luteinalis. This case illustrates our management to maternal and fetal virilisation.

Interstitial pregnancies present a diagnostic and management challenge and are associated with significant bleeding risk. We present a case of an interstitial ectopic pregnancy where there was a diagnostic delay due to the presence of uterine fibroids and where a laparoscopic myomectomy was required in order to perform laparoscopic resection of the ruptured interstitial pregnancy.This case demonstrates the possibilities at laparoscopy for ectopic pregnancy, highlights the benefit of a structured ‘buddy’ system between gynaecology surgeons and brings attention to the paucity of literature on the unique management challenges of ectopic pregnancy in the presence of leiomyoma.

Spontaneous adrenal haemorrhage (SAH) is a rare condition. The incidence of adrenal haemorrhage in pregnancy is currently not known; however, an association with pregnancy has been reported.An acute presentation with severe back or flank pain should raise suspicion of this condition. Diagnosis is based on imaging. An ultrasound scan is a basic and readily available investigation in pregnancy to rule out renal and suprarenal pathology while CT or MRI scan can help to confirm the diagnosis. A multidisciplinary team (MDT) approach, involving the obstetric, anaesthetic, medical and endocrine team, is essential in management of this condition.We present a case of an SAH; managed conservatively, in an otherwise healthy and low-risk pregnant woman and describe the literature review on this rare condition, including pathophysiology and management.

Objective: This article aims to review the literature regarding the use of technologies to promote mental health for pregnant women. We seek to: understand the strategies that pregnant women use for mental health care. Also, we investigate the existence of scientific evidence that validates such practices. Methods: This study follows the PRISMA guidelines for systematic reviews. We analyze 27 studies published between 2012 and 2019. We include publications in Portuguese, English, and Spanish. Results: The results revealed several different possibilities to use technology, including the use of text messages and mobile applications on smartphones. Mobile applications are the most commonly used approaches (22.5%). Regarding the strategies used, cognitive-behavioral approaches, including mood checks, relaxation exercises, and psychoeducation comprised 44.12% of the content. Conclusion: There is a need for further investigation and research and development efforts in this field to better understand the possibilities of intervention in mental health in the digital age. Resumo Objetivo: Este artigo objetiva revisar a literatura quanto ao uso das tecnologias como promotoras de saúde mental de gestantes. Desta forma, compreender quais são as estratégias utilizadas no cuidado da saúde mental dessas mulheres, assim como verificar se há evidências científicas que justifiquem a implementação dessas práticas. Métodos: Este estudo segue o protocolo PRISMA para revisões sistemáticas de 27 estudos publicados em 2012-2019, incluindo publicações em português, inglês e espanhol. Resultados: Os resultados revelaram diferentes possibilidades de utilização da tecnologia, sendo o uso de mensagens de texto e de aplicativos em smartphones mais os utilizados (22,5%). No que se refere às ferramentas utilizadas, estratégias cognitivo-comportamentais, tais como verificação do humor, exercícios de relaxamento e psicoeducação compreenderam 44,12% do conteúdo. Conclusão: Verifica-se a necessidade de mais investimentos nessa área para que se possa compreender as possibilidades de intervenção em saúde mental na era digital.

Most children born to women with epilepsy (WWE) are normal, but have increased risks for malformations and poor neuropsychological outcomes. Antiseizure medications (ASMs) are among the most commonly prescribed teratogenic medications in women of childbearing age. However, WWE typically cannot avoid using ASMs during pregnancy. Teratogenic risks vary across ASMs. Valproate poses a special risk for anatomic and behavioral teratogenic risks compared with other ASMs. The risks for many ASMs remain uncertain. Women of childbearing potential taking ASMs should be taking folic acid. Breastfeeding while taking ASMs seems safe. WWE should receive informed consent outlining risks before conception.

The study aims to identify specific determinants of dental care utilization during the perinatal period (prenatal and 1-year postnatal) among underserved US women residing in Upstate New York.The prospective cohort study included 186 low-income US pregnant women. Demographic-socioeconomic parameters and medical-dental conditions were obtained from questionnaires, electronic medical-dental records, and dental examinations. Multivariate regression analyses were used to assess factors associated with perinatal dental care utilization. As an exploratory effort, a separate logistic model assessed factors associated with adverse birth outcomes.The results demonstrated unmet oral health needs among the underserved US pregnant women residing in Upstate New York. Despite an average of 2.7 ± 3.6 untreated decayed teeth per person during pregnancy, only 39.3% and 19.9% utilized prenatal and 1-year postnatal dental care, respectively. Previous dental care utilization was a notable factor contributing to a higher uptake of perinatal dental care at a subsequent period. Prenatal dental care utilization was significantly lower among African American women (odds ratio 0.43 [95% CI 0.19, 0.98], P = .04) and positively associated with dental caries severity (OR 2.40 [1.09, 5.12], P = .03). Postnatal utilization was associated with caries severity (OR 4.70 [1.73, 12.74], P = .002) and prevalent medical conditions (hypertension, diabetes mellitus, and emotional conditions). Pregnant women who achieved prenatal caries-free status had a lower odds of experiencing adverse birth outcomes; however, this was an insignificant finding due to limited adverse birth cases.Racial and oral health disparity is associated with perinatal oral health care utilization among underserved US pregnant women in New York. While both prenatal and postnatal dental care utilization was positively associated with oral health status, specifically, postnatal utilization was driven by existing medical conditions such as emotional condition, hypertension, and diabetes mellitus. The results add to existing information on inherent barriers and postulated needs to improve access to perinatal oral care, thereby informing statewide recommendations to maximize utilization. Considering this is a geographically restricted population, the findings are particularly true to this cohort of underserved pregnant women. However, future more robust studies are warranted to assess effective strategies to further improve perinatal dental care utilization among underserved pregnant women.

Objectives. To estimate use of medication for opioid use disorder (MOUD) and prescription opioids in pregnancy among mothers of infants with neonatal opioid withdrawal syndrome (NOWS). Methods. We used linked 2016–2018 North Carolina birth certificate and newborn and maternal Medicaid claims data to identify infants with an NOWS diagnosis and maternal claims for MOUD and prescription opioids in pregnancy (n = 3395). Results. Among mothers of infants with NOWS, 38.6% had a claim for MOUD only, 14.3% had a claim for prescription opioids only, 8.1% had a claim for both MOUD and prescription opioids, and 39.1% did not have a claim for MOUD or prescription opioids in pregnancy. Non-Hispanic Black women were less likely to have a claim for MOUD than non-Hispanic White women. The percentage of infants born full term and normal birth weight was highest among women with MOUD or both MOUD and prescription opioid claims. Conclusions. In the 2016–2018 NC Medicaid population, 60% of mothers of infants with NOWS had MOUD or prescription opioid claims in pregnancy, underscoring the extent to which cases of NOWS may be a result of medically appropriate opioid use in pregnancy.

Poorly controlled asthma can affect neonatal outcomes including congenital anomalies, which can be reduced with appropriate asthma care during pregnancy. Although there is a concern regarding the safety of asthma medication use during pregnancy and congenital anomalies, the risk of uncontrolled asthma outweighs any potential risks of controller and reliever medication use. Patient education before and during pregnancy is critical to ensure good compliance to therapy and reduce the risk of poor asthma control.

Poor prenatal sleep quality is associated with increased risk for depressive symptoms but may go undetected in brief, busy prenatal care visits. Among non-depressed pregnant participants, we evaluated whether 1) the endorsement of sleep disturbance on a depression questionnaire predicted postpartum depressive symptoms, 2) the strength of these associations was higher than other somatic symptoms of pregnancy and depression (i.e., fatigue, appetite disturbance), and 3) the endorsement of prenatal sleep disturbance varied by participant characteristics. In this retrospective cohort study, participants had a live birth and completed Patient Health Questionnaire (PHQ-9) during pregnancy and within 8 weeks postpartum between 2012 and 2017. Participants who were non-depressed during pregnancy (PHQ-9 < 10) were included (n = 3619). We operationalized sleep disturbance, fatigue, and appetite disturbance as endorsement of item 3, 4, and 5 on the PHQ-9, respectively, and postpartum depressive symptoms as PHQ-9 total score ≥ 10. Participant characteristic variables included age, race, ethnicity, parity, gestational age at delivery, and preterm birth. Prenatal sleep disturbance was associated with higher odds of postpartum depressive symptoms (aORs 1.9, 95% CI 1.2–3.1 for first trimester; 3.7, 95% CI 1.5–11.5 for second trimester; 3.4, 95% CI 1.9–6.8 for third trimester). Fatigue and appetite disturbance in the first and third trimesters were associated with higher odds of postpartum depressive symptoms. Sleep disturbance varied by race during the first and second trimesters (p < 0.05) and was highest among Black or African American participants (61.8–65.1%). A routinely administered single-item measure of sleep disturbance could identify otherwise lower-risk pregnant individuals who may benefit from depression prevention efforts.

To evaluate whether prolonged storage of vitrified blastocysts negatively impacts pregnancy and neonatal outcomes.A retrospective cohort study.University hospital.A total of 6,900 patients who desired to transfer vitrified blastocysts from the same oocyte retrieval cycle as their last live birth met the inclusion criteria and were grouped according to the storage duration (1,890 patients in group 1 with storage duration3 years, 2,693 patients in group 2 with storage duration between 3 and 4 years, 1,344 patients in group 3 with storage duration between 4 and 5 years, 578 patients in group 4 with storage duration between 5 and 6 years and 395 patients in group 5 with storage duration ≥ 6 years but ≤ 10.5 years).None.Rates of blastocyst survival, biochemical pregnancy, clinical pregnancy, miscarriage, ectopic pregnancy, and live birth and neonatal outcomes.The survival rates of the vitrified blastocysts significantly decreased with prolonged storage from group 1 to the subsequent groups 2, 3, 4, and 5. After adjusting for potential confounding factors, the rates of biochemical pregnancy, clinical pregnancy, and live birth were significantly decreased when the vitrified blastocysts were stored for more than 6 years (group 5) compared with these for less than 3 years (group 1) but no distinct differences were found in these above-mentioned indicators among group 1, 2, 3, and group 4 (group 1 as reference). However, no significant differences were noted in the rates of miscarriage and ectopic pregnancy and neonatal outcomes on prolonged storage of vitrified blastocysts.Long-term blastocyst vitrification for more than 6 years can negatively affect the rates of biochemical pregnancy, clinical pregnancy, and live birth but does not impact neonatal outcomes.

Pregnancy has an important impact on the thyroid gland and its function. Thyroid activity changes as a consequence of the novel physiological state of pregnancy and requires a complex hormonal and metabolic adaptation, which is possible only in the presence of a perfectly functioning thyroid gland. In fact, thyroid function is crucial for the success of the implantation and the progression of pregnancy. Abnormal thyroid function is very common among childbearing age women, explaining the high incidence of thyroid diseases that occur during pregnancy. Aim of this work is to analyze the adaptive events that characterize the thyroid function during pregnancy, exploring their hormonal, metabolic and molecular mechanisms. Moreover, the interpretation of the laboratory data necessary to monitor the thyroid functioning during normal pregnancy or in the presence of thyroid abnormalities will be discussed.

Neonatal lupus (NLE) is a rare acquired autoimmune disorder caused by transplacental passage of maternal autoantibodies to Sjogren’s Syndrome A or B (SSA-SSB) autoantigens (Vanoni et al. in Clin Rev Allerg Immunol 53:469–476, 2017) which target fetal and neonatal tissues for immune destruction. The cardiac trademark of NLE is autoimmune heart block, which accounts for more than 80% of cases of complete atrioventricular heart block (AVB) in newborns with a structurally normal heart (Martin in Cardiol Young 24: 41–46, 2014). NLE presenting with cardiac alterations not involving rhythm disturbances are described in the literature, but they are rare. Here, we report a case of a neonate with high anti-SSA antibodies who developed severe ventricular dysfunction in the absence of rhythm abnormalities, endocardial fibroelastosis, and dilated cardiomyopathy (Trucco et al. in J Am Coll Cardiol 57:715–723, https://doi.org/10.1016/j.jacc.2010.09.044, 2011), the most common cardiac presentations of NLE. The patient developed severe multiorgan dysfunction syndrome that required prolonged critical care support but fully recovered and was discharged home. We highlight the unusual clinical features of this NLE case and the importance of timely treatment of NLE allowing complete recovery of a critically ill neonate.

Asthma is the most prevalent chronic disease in pregnancy, and as symptoms can change with pregnancy, and exacerbations of asthma are common, regular review of asthma symptoms, the provision of self-management education, and appropriate medication use are the hallmarks of management. Co-morbidities are also prevalent among pregnant women with asthma, with obesity, gestational diabetes, hypertension, rhinitis, depression, and anxiety, more common among women with asthma than women without asthma. Less is known about reflux, obstructive sleep apnoea and vocal cord dysfunction, along with nutritional deficiencies to iron and vitamin D. Maternal asthma impacts the offspring's long-term health, particularly in increasing the risk of early life wheeze and asthma in childhood. While breastfeeding may modify the risk of infant wheeze, less is known about the mechanisms involved. More research is needed to further understand the relationship between asthma in pregnancy and the risk of poor neurodevelopmental outcomes, such as autism.

Investigate an association between severe tropical cyclones (TCs) and birth outcomes in an Australian population.We analysed over 600,000 singleton livebirths collected through the Queensland Perinatal Data Collection between 2008 and 2018. We estimated the odds ratios (ORs) of adverse birth outcomes using logistic multi-level modelling.Exposure to TCs in early pregnancy was associated with significantly higher odds of preterm births in affected compared to unaffected areas during the TC year [OR=1.28, 95%CI=1.11, 1.49, p=0.001] and slightly significant higher odds in affected areas during TC years compared to non-TC years. Significantly higher odds of low birthweight births were associated with mid-pregnancy exposure to cyclone Marcia [OR=1.62, 95%CI=1.00, 2.40, p=0.016] .Findings aligned with studies demonstrating an association between exposure to environmental stressors in early to mid-pregnancy and adverse birth outcomes.There is limited research into TCs and perinatal health in Australia despite most of the population residing along coastlines and TCs presenting one of the nation's most devastating weather events. This study will inform public health practice and contribute to further research into mitigating environmental risks faced by pregnant women.

Optimal care during the antenatal and postnatal phases of the life cycle is a potentially positive determinant of health elsewhere in the continuum. A successful transition from the antenatal to the postnatal period requires early detection, optimal management, and prevention of disease; health promotion; birth preparedness; and complication readiness. Women, their babies, and families need appropriate evidence-based care based on their dignity and human rights before, during, and after birth. In this review, we present an overview of the components of antenatal and postnatal care needed to provide women a culturally sensitive and positive pregnancy and postnatal experience. The challenge of antenatal and postnatal care is determining their core components and underpinning them with evidence without overmedicalizing their practice.

Despite a 38% decrease in global maternal mortality during the last decade, rates remain unacceptably high with greater than 800 maternal deaths occurring each day. There exists significant regional variation among rates and causes of maternal mortality, and the vast majority occurs in low-income and middle-income countries. The leading causes of direct maternal mortality are hemorrhage, hypertensive disorders of pregnancy, sepsis, complications of abortion, and thromboembolism. Eliminating preventable maternal mortality hinges on improving clinical management of these life-threatening obstetric conditions, as well as addressing the complex social and economic barriers that pregnant women face to access quality care.

The world has been experiencing an opioid epidemic for over 20 years, and rates of use and overdose among women, including during pregnancy, have risen markedly. Women receive more prescriptions for opioids compared to men. Data suggest that 20% of women filled at least one prescription for an opioid during their pregnancy, and the prevalence of prenatal exposure averaged 14%. Opioid use by women, especially during pregnancy and while breastfeeding, and management and treatment is complex for healthcare providers, especially related to methadone treatment, pain management during labour, neonatal opioid withdrawal syndrome, nutritional issues and maternal withdrawal. Opioid use during pregnancy has been associated with maternal, foetal and infant complications, and overdose has become a leading cause of death in post-partum women in some countries. Universal screening for opioid use disorder (OUD) is recommended in pregnancy, and prevention and treatment programs that meet the specific needs of women are important to understand and consider as the world continues to try to anticipate and respond to the realities of the opioid epidemic.

Obesity is a worldwide epidemic and is associated with an increased risk of hypertension, diabetes, and obstructive sleep apnea. Pregnant patients with obesity experience a higher risk of maternal and fetal complications. Anesthesia also poses higher risks for obese parturients and may be more technically challenging due to body habitus. Safe anesthesia practice for these patients must take into consideration the unique challenges associated with the combination of pregnancy and obesity.

Pregnancy in women with sickle cell disease (SCD) has been identified as high risk owing to increased incidence of materno-fetal complications across various studies and reports. These complications include consequences related to the underlying hemoglobinopathy; chronic anemia/associated inflammation, and pregnancy related including the risk for thromboembolism, bleeding and maternal mortality. Outcomes of neonates born to women with SCD has been suboptimal over the years with recent improvement due to strict monitoring, preventive and therapeutic measures. Much is yet to be unraveled regarding the optimal management of women with SCD during pregnancy, identifying target hemoglobin, delivery mode or timing among others.This review includes a summary of available data of the maternal and fetal outcomes; in addition to current recommendations for monitoring and management of women with SCD during pregnancy.To have a successful pregnancy, women should be closely monitored, and interventions provided as needed to guarantee adequate management of anemia, as well as prevention, diagnosis and management of disease. They should also be educated regarding their reproductive health, emphasizing that pregnancy is possible, and achieving optimal results depends on providing adequate care in a health care facility with expertise in high-risk pregnancies and SCD.

Previous coronavirus epidemics were associated with increased maternal morbidity, mortality, and adverse obstetric outcomes. Reports for SARS-CoV-2 indicate that the obstetric population is at increased risk for severe illness, although there are still limited data on mild COVID-19 infection during pregnancy. To determine the association between mild COVID-19 infection during pregnancy, and maternal and neonatal outcomes, we performed a prospective cohort study among pregnant women with COVID-19 and a control group. Postnatal depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale. We recruited 84 pregnant women with mild COVID-19 and 88 pregnant women without COVID-19. All participants were unvaccinated. The most common acute COVID-19 symptoms were headache (82.1%), loss of smell (81%), and asthenia (77.4%). The median duration of long COVID symptoms was 60 days (interquartile range, 130). Pregnant women with a COVID-19 diagnosis were at greater risk for obstetric ultrasound abnormalities—mainly, fetal growth restriction (relative risk [RR], 12.40; 95% CI, 1.66–92.5), premature birth (RR, 2.62; 95% CI, 1.07–6.43), and postpartum depression (RR, 2.28; 95% CI, 1.24–4.21). Our results alert clinicians to the consequences of COVID-19 during pregnancy, even in mild cases, given the increased risk of ultrasound abnormalities, premature birth, long COVID symptoms, and postpartum depression. National guidelines on preventive measures and treatments should be based on scientific evidence, including attention to the impact on health and family needs during and after the COVID-19 pandemic.

The aim of the study is to develop a method for early diagnosis of intrauterine infection (IUI). A study of markers of inflammation in the venous blood of 60 pregnant women was conducted. The study was followed by a retrospective assessment of the outcomes of pregnancies and childbirth. Of these, 33 patients with a gestation period of more than 37 weeks (full-term pregnancy) and, accordingly, 27 patients from whom the blood sample was taken at a period of less than 37 weeks - patients with the threat of premature birth (PB). PB is the main factor contributing to the development of IUI. 27 patients were diagnosed with premature rupture of the membranes (PROM). Of these, 15 are with the threat of PB. 8 of them had a diagnosed IUI. In all cases of diagnosed PROM, including those with IUI, the concentration of nitrite and nontiolate nitroso compounds (NO2-+RNO) in the mother’s blood plasma was 2.3±1.2 µM, while normally it does not exceed 0.1 µM (p0.1). Since the concentration index (NO2-+RNO) increased in almost all cases of PREM, unlike all other clinical and biochemical indicators used in modern medicine, there is an obvious sense of its use for the current monitoring of the health of pregnant women. But it is still impossible to say unequivocally about the possibility of monitoring the fetal health by concentration (NO2-+RNO) in the mother’s blood.

The literature reports that teenage pregnancy is considered a risk factor for anxiety disorders (ADs). However, research on this topic is limited. This study aimed to investigate if pregnant adolescents presented a greater likelihood of having ADs by comparing two samples of pregnant women in a southern city of Brazil. We also observed the prevalence rates of antenatal ADs among adolescents and adult women.In this cross-sectional study, we evaluated 1852 women from two different studies: 995 pregnant adolescents attending prenatal care in the public health system (convenience sample) and 857 pregnant women from a population-based study. We used the Mini International Neuropsychiatric Interview (MINI Plus) to assess antenatal ADs, using the Social Anxiety Disorder (SAD) and Generalized Anxiety Disorder (GAD) modules. The primary aim of this study was tested through multivariate analysis using Poisson regression.The prevalence of ADs was 11.0 % among pregnant adolescents and 13.8 % among adult pregnant women. Both samples presented similar rates of ADs (p = 0.065). In the adjusted analysis, maternal age did not predict antenatal ADs (PR = 0.97; p = 0.853).Considering the particularities of each study where the samples came from, it was not possible to include other ADs such as panic disorder or phobias.Our findings suggest that pregnancy in adolescence does not increase the likelihood of antenatal ADs. However, we emphasize the importance of an adequate psychological screening and care in pregnancy in order to prevent possible psychiatric disorders.

Pelvic floor muscle exercises (PFME) are recommended for treatment of urinary incontinence with less evidence available about the effect on female sexual function (FSF) and childbirth.To investigate the effect of antenatal PFME on FSF during pregnancy and the first three months following birth as a primary outcome, and on labour and birth outcomes as a secondary outcome.200 nulliparous women were randomised to control (n = 100) and intervention (n = 100) groups. The women in the intervention group (IG) undertook PFME from 20 weeks gestation until birth and had routine antenatal care, while those in the control group (CG) received routine antenatal care only. The Female Sexual Function Index (FSFI) was used to measure FSF at 36 weeks gestation and three months postnatal. Baseline characteristics and childbirth data were also collected and analysed using SPSS.There were no statistically significant differences between the two groups in terms of FSF scores during pregnancy and on childbirth outcomes. Sexual satisfaction was slightly higher in the CG [Mean ± SD, CG: 4.35 ± 1.45 vs. IG: 3.70 ± 1.50, (P = 0.03)] at three months after birth. However, 50% of women adhered to the PFME, and 40% of women did not resume sex by three months after the birth.Though some trends were observed, the results showed no effect of PFME on sexual function or labour and birth outcomes. This needs to be interpreted considering the 50% adherence to PFME. More research is recommended.

Idiopathic intracranial hypertension (IIH) is a neurological condition characterized by raised intracranial pressure of unknown etiology with normal cerebrospinal fluid (CSF) composition and no brain lesions. It occurs in pregnant patients at approximately the same frequency as in general population, but obstetric and anesthetic management of the pregnancy and labor remains controversial. In this article we provide a multidisciplinary review of the main aspects of IIH in pregnancy including treatment options, mode of delivery and anesthetic techniques. Additionally, we report three cases of pregnant women diagnosed with IIH between 2012 and 2019 in our institution.

Pregnancy and lactation-associated osteoporosis (PLO) is a rare disease that occurs in late pregnancy or early postpartum and is associated with multiple vertebral fractures. We present a case of a 34-year-old woman with a history of Systemic Lupus Erythematosus and Antiphospholipid Syndrome, who started postpartum back pain. After an ineffective response to analgesic escalation, she performed imaging exams with evidence of multiple dorsal and lumbar vertebral fractures. After an exhaustive etiological study, PLO represented the most likely diagnosis. Early diagnosis, interruption of breastfeeding, and initiation of targeted anti-osteoporotic therapy are essential for symptomatic control, increase the quality of life of these patients, and prevent new fractures in the future.

Background/Objectives Obesity in pregnancy has been associated with increased childhood cardiometabolic risk and reduced life expectancy. The UK UPBEAT multicentre randomised control trial was a lifestyle intervention of diet and physical activity in pregnant women with obesity. We hypothesised that the 3-year-old children of women with obesity would have heightened cardiovascular risk compared to children of normal BMI women, and that the UPBEAT intervention would mitigate this risk. Subjects/Methods Children were recruited from one UPBEAT trial centre. Cardiovascular measures included blood pressure, echocardiographic assessment of cardiac function and dimensions, carotid intima-media thickness and heart rate variability (HRV) by electrocardiogram. Results Compared to offspring of normal BMI women (n = 51), children of women with obesity from the trial standard care arm (n = 39) had evidence of cardiac remodelling including increased interventricular septum (IVS; mean difference 0.04 cm; 95% CI: 0.018 to 0.067), posterior wall (PW; 0.03 cm; 0.006 to 0.062) and relative wall thicknesses (RWT; 0.03 cm; 0.01 to 0.05) following adjustment. Randomisation of women with obesity to the intervention arm (n = 31) prevented this cardiac remodelling (intervention effect; mean difference IVS −0.03 cm (−0.05 to −0.008); PW −0.03 cm (−0.05 to −0.01); RWT −0.02 cm (−0.04 to −0.005)). Children of women with obesity (standard care arm) compared to women of normal BMI also had elevated minimum heart rate (7 bpm; 1.41 to 13.34) evidence of early diastolic dysfunction (e prime) and increased sympathetic nerve activity index by HRV analysis. Conclusions Maternal obesity was associated with left ventricular concentric remodelling in 3-year-old offspring. Absence of remodelling following the maternal intervention infers in utero origins of cardiac remodelling. Clinical trial registry name and registration number The UPBEAT trial is registered with Current Controlled Trials, ISRCTN89971375.

Understanding and communicating the risk of pregnancy complications post-living kidney donation is imperative as the majority of living kidney donors (LKD) are women of childbearing age. We aimed to identify all original research articles examining complications in post-donation pregnancies and compared the quality and consistency of related guidelines. We searched Embase, MEDLINE, PubMed, society webpages, and guideline registries for English-language publications published up until December 18, 2020. Ninety-three articles were screened from which 16 studies were identified, with a total of 1399 post-donation pregnancies. The outcome of interest, post-donation pregnancy complications, was not calculable, and only a narrative synthesis of the evidence was possible. The absolute risk of pre-eclampsia increased from similar to 1%-3% pre-donation (lower than the general population) to similar to 4%-10% post-donation (comparable to the general population). The risks of adverse fetal and neonatal outcomes were no different between post-donation and pre-donation pregnancies. Guidelines and consensus statements were consistent in stating the need to inform LKDs of their post-donation pregnancy risk, however, the depth and scope of this guidance were variable. While the absolute risk of pregnancy complications remains low post-donation, a concerted effort is required to better identify and individualize risk in these women, such that consent to donation is truly informed.

To examine the outcome of gestational blood pressure and birth weight in women with normal pre-pregnancy BMI (18.5-25 kg/m2) who are at the lower and upper limits of this range, i.e., slightly underweight or slightly overweight. Overall, 2,038 Japanese women with low -risk who had delivered during January 2014–December 2016 were classified according to their pre-pregnancy BMI: underweight (< 18.5 kg/m2), slightly underweight (18.5≤BMI

Introduction: Gestational Diabetes is a group of metabolic disorders that result in glucose intolerance during pregnancy. Among the range of treatments are diet, continuous use of medication, and psychological monitoring. Since it is a multidisciplinary treatment, a proper protocol is vital for a favorable outcome. In addition, there are questions about the benefits of physical activity as a complementary therapy. Objective: To verify the impact of adding exercise to the hospital protocol for patients with gestational diabetes, both on the risks of type 2 diabetes in pregnant women and on the obesity of their offspring. Methods: Sixty pregnant women diagnosed with Gestational Diabetes were randomly divided into control and intervention groups. Both groups received specific treatment and intervention, and the experimental group practiced controlled moderate-intensity physical activity (125-146bpm). Morning blood samples were collected from both groups to check fasting glucose and insulin levels, indicators of lipid metabolism, low and high-density lipoprotein cholesterol, apolipoprotein B. The Brog scale measured the fatigue level. In addition, the premature rupture of membranes, postpartum hemorrhage, neonatal asphyxia, macrosomia, and others was checked. Results: The peripheral blood total cholesterol levels were 5.93, 5. 38, low-density lipoprotein cholesterol levels were 2.95 before versus 2.64 after, and apolipoprotein B levels were 1.84 versus 1.59 in the control group, high-density lipoprotein cholesterol content increased from 1.74 to 1.88, blood cholesterol, and apolipoprotein B levels after the intervention in the experimental group were lower than those in the control group, with an elevation of high-density lipoprotein cholesterol. Conclusion: Aerobic exercise proved to be more appropriate for patients with gestational diabetes in the later stages of pregnancy and may also be adapted for bedridden patients refractory to traditional drugs. Evidence Level II; Therapeutic Studies - Investigating the result. RESUMO Introdução: O Diabetes Gestacional é um grupo de desordens metabólicas que resultam na intolerância à glicose durante a gravidez, dentre o leque de tratamentos está a dieta, o uso continuo de medicamentos, e acompanhamento psicológico. Por ser um tratamento multidisciplinar, é importante que haja um protocolo adequado para um desfecho favorável. Há questionamentos quanto aos benefícios de atividades físicas como terapia complementar. Objetivo: Verificar o impacto da adição de exercícios ao protocolo hospitalar para pacientes com diabetes gestacional, tanto nos riscos de diabetes tipo 2 em grávidas quanto na obesidade de seus descendentes. Métodos: Sessenta mulheres grávidas que foram diagnosticadas com Diabetes Gestacional foram aleatoriamente divididas em grupos controle e intervenção. Ambos grupos receberam tratamento e intervenção específicos e o grupo experimental praticou atividade física de intensidade moderada controlada (125-146bpm). Amostras de sangue em jejum matinal foram coletados em ambos os grupos para verificar níveis de glicose e insulina em jejum, indicadores de metabolismo lipídico, colesterol lipoproteico de baixa e alta densidade, apolipoproteína B. Verificou-se também o nível de fadiga pela escala Brog, ruptura prematura de bolsa, hemorragia pós-parto, asfixia neo-natal, macrossomia entre outros. Resultados: Os níveis de colesterol total no sangue periférico foram de 5,93, 5.38, os níveis de colesterol lipoproteico de baixa densidade foram 2,95 antes contra 2,64 depois e os níveis de apolipoproteína B foram 1,84 contra 1,59 no grupo controle, o conteúdo de colesterol lipoproteico de alta densidade aumentou de 1,74 para 1,88, os níveis de colesterol, e apolipoproteína B sanguíneos depois da intervenção no grupo experimental foram menores que os do grupo controle, com elevação do colesterol lipoprotéico de alta densidade. Conclusão: O exercício aeróbico mostrou-se mais adequado para pacientes com diabetes gestacional nos estágios posteriores da gravidez, podendo ser adaptado inclusive para as pacientes acamadas refratárias aos fármacos tradicionais. Nível de evidência II; Estudos Terapêuticos - Investigação de Resultados. Resumen Introducción: La diabetes gestacional es un grupo de trastornos metabólicos que dan lugar a una intolerancia a la glucosa durante el embarazo. Entre la gama de tratamientos se encuentra la dieta, el uso continuado de medicamentos y el seguimiento psicológico. Al tratarse de un tratamiento multidisciplinar, es importante contar con un protocolo adecuado para obtener un resultado favorable. Existen dudas sobre los beneficios de la actividad física como terapia complementaria. Objetivo: Comprobar el impacto de añadir el ejercicio al protocolo hospitalario para pacientes con diabetes gestacional, tanto en los riesgos de diabetes tipo 2 en las mujeres embarazadas como en la obesidad de su descendencia. Métodos: Sesenta mujeres embarazadas a las que se les diagnosticó diabetes gestacional fueron divididas aleatoriamente en grupos de control y de intervención. Ambos grupos recibieron un tratamiento y una intervención específicos y el grupo experimental practicó una actividad física controlada de intensidad moderada (125-146bpm). Se tomaron muestras de sangre en ayunas por la mañana de ambos grupos para comprobar los niveles de glucosa e insulina en ayunas, los indicadores del metabolismo de los lípidos, el colesterol de lipoproteínas de baja y alta densidad, la apolipoproteína B. También se comprobó el nivel de fatiga según la escala de Brog, la rotura prematura de bolsa, la hemorragia posparto, la asfixia neonatal y la macrosomía, entre otros. Resultados: Los niveles de colesterol total en sangre periférica fueron de 5,93, 5. 38, los niveles de colesterol de lipoproteínas de baja densidad eran de 2,95 antes frente a 2,64 después y los niveles de apolipoproteína B eran de 1,84 frente a 1,59 en el grupo de control, el contenido de colesterol de lipoproteínas de alta densidad aumentó de 1,74 a 1,88, el colesterol en sangre y los niveles de apolipoproteína B después de la intervención en el grupo experimental fueron inferiores a los del grupo de control, con una elevación del colesterol de lipoproteínas de alta densidad. Conclusión: El ejercicio aeróbico resultó ser más apropiado para las pacientes con diabetes gestacional en las últimas fases del embarazo, y puede adaptarse incluso a las pacientes encamadas y refractarias a los fármacos tradicionales. Nivel de evidencia II; Estudios terapéuticos - Investigación de resultados.

To delineate obstetric complications and neonatal outcomes by maternal age in singleton pregnancies with previous caesarean section (CS).A retrospective study involved 7715 singleton gestations with previous CS was conducted in a single centre. Statistical methods were used to describe and analyse the incidence of various complications and adverse outcomes classified by maternal ages. After selecting the reference group (30-34 years), multivariate logistic-binomial regression model was used to investigate the outcomes using SPSS.From 2013 to 2017, the proportion of advanced maternal age (AMA, ≥35 years) women with a history of CS increased yearly, especially in the 35-39 years age group. AMA women accounted for 39.4% of all pregnancies and has a high incidence of in vitro fertilization(IVF), progesterone therapy in early pregnancy, pregnancy-induced hypertension (PIH), gestational diabetes mellitus (GDM), placenta previa, premature rupture of membranes (PROM) and postpartum haemorrhage (PPH). Compared to the 30-34 years group, the risks of PIH, GDM, placenta previa, PROM and PPH increased in AMA pregnancies. Very advanced age (≥40 years) may be associated with placenta accreta while young mothers (20-24 years) have a higher prevalence of premature birth. Vaginal bleeding during pregnancy is a risk factor for maternal complications, maternal and neonatal morbidity.AMA is associated with increased risk of PIH, GDM, placenta previa, PROM and PPH. Vaginal bleeding may be a predictor during pregnancy.

Rising maternal morbidity and mortality rates, widening healthcare disparities, and increasing focus on cardiometabolic risk modification in at-risk patients have together catalyzed a shift in the postpartum care paradigm. What was once a single office visit in the 6 weeks after delivery is now being reimagined as a continuum of care that transitions patients from pregnancy to lifelong health optimization. However, this shift in postpartum care also comes with increased visit complexity and additional provider burden, particularly when patients have had significant pregnancy complications or have chronic diseases. To ensure that the comprehensive needs of both healthy and medically complex people are consistently met under this revised postpartum care paradigm, a postpartum visit checklist for uncomplicated postpartum patients and another checklist for those with major medical or obstetrical morbidities are presented. These checklists are designed to ensure that essential elements of physical and mental well-being are routinely considered, that adequate follow-up or specialty referrals are made, and that relevant future health risks are appropriately reviewed and discussed.

To summarize our experience in the application of radiofrequency ablation (RFA) and microwave ablation (MWA) for selective fetal reduction in complicated monochorionic pregnancies and compare the perinatal outcome of the two techniques.This was a retrospective study of data from a consecutive cohort of all monochorionic twin pregnancies that underwent selective fetal reduction with RFA or MWA at Peking University Third Hospital, Beijing, China from January 2012 to December 2018. All surviving cotwins were followed up to assess their neurodevelopment using the Ageamp; Stage Questionnaire, Chinese version. Perinatal and neurodevelopmental outcomes were compared between the RFA and MWA groups. We also fitted multivariable models to test the association between procedure-related factors and the main perinatal outcomes, including preterm birth (PTB)lt; 37 weeks' gestation, intrauterine fetal death (IUFD) of the cotwin, adverse outcome (defined as occurrence of IUFD of the cotwin, termination of pregnancy or PTBlt; 28 weeks) and overall survival.In total, 45 cases (42 twin and three triplet pregnancies) underwent RFA and 126 cases (105 twin and 21 triplet pregnancies) underwent MWA. The overall survival rates in monochorionic diamniotic twin pregnancies were similar between the RFA and MWA groups (61.0% vs 67.0%; P = 0.494). However, pregnancies whose indication for fetal reduction was selective intrauterine growth restriction or twin reversed arterial perfusion had higher overall survival rates (75.5% and 82.6%, respectively) compared with those in other indication groups. A total of 104 children were followed up (20 in the RFA group and 84 in the MWA group); four (20.0%) and eight (9.5%) children were assessed as having overall developmental delay in the RFA and MWA groups, respectively, with no significant difference between the two groups. Multivariable analyses showed that procedure indication, number of ablation cycles and gestational age at procedure were associated significantly with the main perinatal outcomes.RFA and MWA for selective fetal reduction in complicated monochorionic pregnancies can achieve similar overall survival rate and neurodevelopmental outcome, but MWA is associated with a lower risk of preterm birth. Moreover, procedure-related factors are associated significantly with perinatal outcome. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Abnormalities of the airway smooth muscle (ASM) layer in asthma may develop before birth. We hypothesize that antenatal inflammation causes physiological abnormalities of the ASM that predisposes asthma. This study determined the short-term effects of antenatal inflammation on the developing ASM. Fourteen pregnant ewes were randomly assigned to one of three groups. Fetal lambs were exposed to intra-amniotic injections of lipopolysaccharide (LPS

To describe our experience with outpatient hysteroscopy for removal of intrauterine devices (IUDs) in pregnant patients, along with the pregnancy-related outcomes.Retrospectively and prospectively collected data between January 2015 and April 2021.Hysteroscopic outpatient clinic (See and Treat Clinic) at a university affiliated, tertiary medical center.Forty-one patients with an inadvertent but desired pregnancy up to 12 weeks + 6 days gestational age with an IUD in situ, with documented failed attempts of IUD removal.After ultrasonographic confirmation of IUD location, gestational age, and viability, a small-caliber hysteroscope was introduced via a vaginoscopic approach. The uterus was distended using 0.9% normal saline until a clear view was achieved. On visualization, the IUD was grasped by its strings, tail, or lateral arm using a semirigid hysteroscopic grasper. Oral antibiotic prophylaxis was prescribed in all cases.The primary outcome of interest was term delivery, from 37 weeks of gestation. Secondary outcomes included patient-reported tolerability and satisfaction, and procedure-related and pregnancy related complications.The procedure was completed successfully in all 41 patients. Thirty-three patients continued their pregnancies, resulting in 32 full-term singleton deliveries and 1 singleton preterm delivery at 33 + 4 weeks. Median gestational age at delivery was 39 weeks, with a median birthweight of 3,450 grams. Eight patients (19.5%) miscarried, 4 of these within a week of the procedure.In cases of desired pregnancy with an IUD, outpatient hysteroscopic removal of the IUD is a safe and effective management option. Broader uptake of outpatient hysteroscopy and development of hysteroscopic skills will allow more clinicians to offer patients this effective solution.

STUDY QUESTION Do women with polycystic ovary syndrome (PCOS) have a greater risk of adverse pregnancy complications (gestational diabetes, preeclampsia, cesarean section, placental abnormalities) and neonatal outcomes (preterm birth, small for gestational age, prolonged delivery hospitalization) compared to women without a PCOS diagnosis and does this risk vary by BMI, subfertility and fertility treatment utilization? SUMMARY ANSWER Deliveries to women with a history of PCOS were at greater risk of complications associated with cardiometabolic function, including gestational diabetes and preeclampsia, as well as preterm birth and prolonged length of delivery hospitalization. WHAT IS KNOWN ALREADY Prior research has suggested that women with PCOS may be at increased risk of adverse pregnancy outcomes. However, findings have been inconsistent possibly due to lack of consistent adjustment for confounding factors, small samples size and other sources of bias. STUDY DESIGN, SIZE, DURATION Massachusetts deliveries among women ≥18 years old during 2013–2017 from state vital records linked to hospital discharges, observational stays and emergency department visits were linked to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) and the Massachusetts All-Payers Claims Database (APCD). PARTICIPANTS/MATERIALS, SETTING, METHODS PCOS was identified by ICD9 and ICD10 codes in APCD prior to index delivery. Relative risks (RRs) and 95% CI for pregnancy and delivery complications were modeled using generalized estimating equations with a log link and a Poisson distribution to take multiple cycles into account and were adjusted a priori for maternal age, BMI, race/ethnicity, education, plurality, birth year, chronic hypertension and chronic diabetes. Tests for homogeneity investigated differences between maternal pre-pregnancy BMI categories ( MAIN RESULTS AND THE ROLE OF CHANCE Among 91 825 deliveries, 3.9% had a history of PCOS. Women with a history of PCOS had a 51% greater risk of gestational diabetes (CI: 1.38–1.65) and a 25% greater risk of preeclampsia (CI: 1.15–1.35) compared to women without a diagnosis of PCOS. Neonates born to women with a history of PCOS were more likely to be born preterm (RR: 1.17, CI: 1.06–1.29) and more likely to have a prolonged delivery hospitalization after additionally adjusting for gestational age (RR: 1.23, CI: 1.09–1.40) compared to those of women without a diagnosis of PCOS. The risk for gestational diabetes for women with PCOS was greater among women with a pre-pregnancy BMI LIMITATIONS, REASONS FOR CAUTION PCOS was defined by ICD documentation prior to delivery so there may be women with undiagnosed PCOS or PCOS diagnosed after delivery included in the unexposed group. The study population is limited to deliveries within Massachusetts among most private insurance payers and inpatient or observational hospitalization in Massachusetts during the follow-up window, therefore there may be diagnoses and or deliveries outside of the state or outside of our sample that were not captured. WIDER IMPLICATIONS OF THE FINDINGS In this population-based study, women with a history of PCOS were at greater risk of pregnancy complications associated with cardiometabolic function and preterm birth. Obstetricians should be aware of patients’ PCOS status and closely monitor for potential pregnancy complications to improve maternal and infant perinatal health outcomes. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by the NIH (R01HD067270). S.A.M. receives grant funding from NIH, AbbVie and the Marriot Family Foundation; payment/honoraria from the University of British Columbia, World Endometriosis Research Foundation and Huilun Shanghai; travel support for attending meetings for ESHRE 2019, IASP 2019, National Endometriosis Network UK meeting 2019; SRI 2022, ESHRE 2022; participates on the data safety monitoring board/advisory board for AbbVie, Roche, Frontiers in Reproductive Health; and has a leadership role in the Society for Women’s Health Research, World Endometriosis Research Foundation, World Endometriosis Society, American Society for Reproductive Medicine and ESHRE. The other authors have no conflicts of interest. TRIAL REGISTRATION NUMBER N/A.

We aimed to identify the complications of gestational diabetes mellitus (GDM) associated with poor control of fasting plasma glucose (FPG) and postload plasma glucose (PPG) on the 75-g oral glucose tolerance test (OGTT). This retrospective study included 997 singleton pregnancy GDM patients who were assigned to poor or good glycaemic control groups. Multivariate analysis indicated that poor FPG control and poor PPG control were both independent predictors of hypertensive disorder complicating pregnancy (HDCP) (odd ratio (OR) of 2.551 (95% CI [1.146-5.682]

Bariatric surgery is associated with elevated risks for adverse birth outcomes, such as small-for-gestational-age infants (SGA). Maternal mental health is a critical regulator of fetal growth, but it is largely overlooked in pregnant women post-surgery. This study aimed to examine the associations between maternal mental health and birth outcomes in pregnant women post-bariatric surgery.This was a retrospective analysis of medical records of women who had a singleton delivery following Roux-en-Y gastric bypass or sleeve gastrectomy. Mental health measures included depression/anxiety and substance use (cigarettes, alcohol, opioids, and marijuana). Birth outcomes were fetal growth restriction, SGA, low birthweight, and preterm birth. Logistic regressions were used to assess the associations between maternal mental health and each of the birth outcomes. A post hoc logistic regression was conducted to assess factors that influenced maternal marijuana use.Participants (N = 179) were mostly white (64.6%), non-Hispanic (84.5%), with a mean age of 32.7 ± 4.6 years, and mean body mass index of 37.2 ± 8.4 kg/mThis analysis identified marijuana and cigarette use as risk factors for adverse birth outcomes post-bariatric surgery. Future studies with larger sample sizes are needed to confirm study findings.

Recent evidence on perceived stress during the COVID-19 pandemic shows that birthing people experienced stress from pandemic-related stressors. While psychosocial stress is a significant predictor of adverse birth outcomes, social support can reduce stress levels during pregnancy. This study examined social support moderation of relationships between COVID-19-related stressors and perceived stress during pregnancy. The analysis included data from publicly insured pregnant participants who were enrolled in a randomized control trial of two enhanced prenatal care models in Fresno, California, and completed a third-trimester questionnaire between April and August 2020 (n = 77). Multivariate linear regression was used to estimate the associations between perceived stress and COVID-19-related stressors and social support moderation. COVID-19-related stressors related to childcare and tension at home remained significantly associated with perceived stress adjusting for sociodemographic characteristics and other COVID-19-related stressors. Social support moderated the relationship between perceived stress and loss of childcare (β = 2.4, 95 percent CI = 0.5-4.3, p = .014). Overall, social support moderated the association between COVID-19 stressors and perceived stress. While social support is commonly conceptualized as protective, the finding of greater stress around childcare among individuals reporting greater social support suggests complexity for leveraging these support networks during the pandemic.

Aim. A retrospective study of the occurrence of liver damage and obstetric outcomes in pregnant women diagnosed with pruritus. Methods. The following parameters were monitored in patients: aspartate aminotransferase (AST), alanine aminotransferase, gamma-glutamyl transferase, bilirubin (direct and total), hemoglobin, platelets, serum bile acid level, age of pregnant women, parity, pregnancy weight gain, birth weight, and gestational age at delivery. A total of 107 patients were included during a five-year period (2016–2020) and classified into three groups. Group A included 17 pregnant women with pruritus without elevated liver enzymes and bilirubin. Group B included 50 pregnant women with pruritus, elevated liver enzymes, and bilirubin. Group C included 40 pregnant women with pruritus and elevated bile acids (regardless of liver enzyme levels). Results. The groups did not significantly differ in patients’ age and parity, but there was a statistically significant between-group difference in weight gain during pregnancy. The values of AST, ALT, GGT, LDH, and direct bilirubin were the highest in group B, and serum bile acids were expectedly the highest in group C. There was no statistically significant variation in the onset of labor and mode of delivery between groups. However, groups significantly differed in gestational age at delivery, newborn birthweight, and pregnancy prolongation from the onset of pruritus to delivery. Conclusion. Further study is needed to assess the pathophysiologic mechanisms underlying intrahepatic cholestasis of pregnancy as well as any significant liver damage associated with pregnancy.

To report fertility treatment use and outcomes among patients who use donor sperm for intrauterine insemination (IUI), in vitro fertilization (IVF), and reciprocal IVF (co-IVF).This is a retrospective review of patients who used donor sperm at an urban, southeastern academic reproductive center between 2014 and 2020.Among the 374 patients presenting for care, 88 (23.5%) were single, 188 (50.3%) were in a same-sex female partnership, and 98 (26.2%) had a male partner with a diagnosis of male factor infertility. Most patients did not have infertility (73.2%). A total of 1106 cycles were completed, of which there were 931 IUI cycles, 146 traditional IVF cycles, and 31 co-IVF cycles. Live birth rates per cycle were 11% in IUI, 42% in IVF, and 61% in co-IVF. Of all resulting pregnancies, hypertensive disorders were most commonly experienced (18.0%), followed by preterm delivery (15.3%), neonatal complications (9.5%), gestational diabetes (4.8%), and fetal growth restriction (4.8%). Of the 198 infants born, fifteen (8.3%) required admission to the neonatal intensive care unit and three (1.7%) demised. Pregnancy and neonatal complications were more likely to occur in older patients and patients with elevated body mass index.The use of donor sperm for fertility treatment is increasing. These data show reassuring live birth rates; however, they also highlight the risks of subsequent pregnancy complications. With the expansion of fertility treatment options for patients, these data assist provider counseling of patients regarding anticipated cycle success rates and possible pregnancy complications.

Pregnancy dermatoses are inflammatory skin disorders that occur during pregnancy or immediately postpartum. This heterogenous group of disorders includes pemphigoid gestationis, polymorphic eruption of pregnancy, intrahepatic cholestasis of pregnancy, atopic eruption of pregnancy, and pustular psoriasis of pregnancy. In this article, we provide a comprehensive literature review of each condition focusing on nomenclature, epidemiology, pathogenesis, clinical presentation, diagnosis, differential diagnosis, maternal risk, fetal risk, and treatment. We aim to increase awareness and help clinicians recognize, diagnose, and manage these unique conditions.

Previous work identified three subgroups of children with ASD based upon co-occurring conditions (COCs) diagnosed during the first 5 years of life. This work examines prenatal risk factors, given by maternal medical claims, for each of the three subgroups: children with a High-Prevalence of COCs, children with mainly developmental delay and seizures (DD/Seizure COCs), and children with a Low-Prevalence of COCs. While some risk factors are shared by all three subgroups, the majority of the factors identified for each subgroup were unique; infections, anti-inflammatory and other complex medications were associated with the High-Prevalence COCs group; immune deregulatory conditions such as asthma and joint disorders were associated with the DD/Seizure COCs group; and overall pregnancy complications were associated with the Low-Prevalence COCs group. Thus, we have found that the previously identified subgroups of children with ASD have distinct associated prenatal risk factors. As such, this work supports subgrouping children with ASD based upon COCs, which may provide a framework for elucidating some of the heterogeneity associated with ASD.

Purpose: Post-hemithyroidectomy women are at increased risk for gestational subclinical hypothyroidism. Therefore, the American Thyroid Association (ATA) recommends increased thyroid function surveillance for this subgroup of pregnant women. The Purpose of this study was to evaluate the frequency of thyroid function surveillance during pregnancy in post-hemithyroidectomy women, and to evaluate the adherence to the 2017 ATA guidelines and its possible impact since being published, on thyroid function surveillance rates.Materials and Methods: A retrospective study including all pregnancies conceived by post-hemithyroidectomy women operated at Kaplan Medical Center between the years 1997-2020. The study cohort was subdivided by pregnancy date prior to 2018 and 2018 and onwards to evaluate the impact of the 2017 ATA guidelines. Adherence to the guidelines was defined as at least one TSH test in each trimester. Results: After exclusions, a total of 120 pregnancies conceived by 66 women who underwent hemithyroidectomy surgeries were included in this study. Overall, serum TSH examinations were performed during the first, second and third pregnancy trimesters in 86.6%, 40% and 16.6% of pregnancies (PConclusions: Adherence to the latest ATA guidelines is low and its publication in 2017 did not increase the thyroid function surveillance rate in post-hemithyroidectomy women. Better patient education regarding the risks of gestational hypothyroidism following hemithyroidectomy and improved communications between treating surgeons, obstetricians, and endocrinologists may improve these rates.

The mechanisms underlying pregnancy complications caused by advanced maternal age (AMA) remain unclear. We analyzed the cellular signature and transcriptomes of human placentas in AMA women to elucidate these mechanisms. Placental tissues from two AMA women and two controls were used for single-cell RNA-sequencing (scRNA-seq). Controls consisted of AMA women who did not experience any pregnancy complications and pregnant women below the age of 35 years without pregnancy complications. Trophoblast cells were obtained from the placentas of another six pregnant women (three AMA women and three controls), and in-vitro transwell assays were conducted to observe the cell invasion ability. Thirty additional samples (from 15 AMA women and 15 controls) were analyzed to verify the specific expression of serine protease inhibitor clade E member 1 (SERPINE1). Preliminary study of the role of SERPINE1 in cell invasion was carried out with HTR8-S/Vneo cells. High-quality transcriptomes of 27 ‍607 cells were detected. Three types of trophoblast cells were detected, which were further classified into eight subtypes according to differences in gene expression and Gene Ontology (GO) function. We identified 110 differentially expressed genes (DEGs) in trophoblast cells between the AMA and control groups, and the DEGs were enriched in multiple pathways related to cell invasion. In-vitro transwell assays suggested that the invading trophoblast cells in AMA women were reduced. SERPINE1 was specifically expressed in the trophoblast, and its expression was higher in AMA women (P

Trophectoderm (TE) cells are the first differentiating cells in embryo development and have epithelial features. TE cells, which associate with implantation of the blastocyst into the uterine endometrium, contribute to the formation of the placenta. Inner cells mass (ICM) together with TE cells are used for determining embryo quality. The aim of this study was to investigate the role of TE and ICM cells on pregnancy outcome in 5This was a retrospective study using data from all patients who applied for blastocyst transfer IVF between January 2015 and March 2019 at the Reproductive Endocrinology and Infertility Center of Akdeniz University Faculty of Medicine, Department of Obstetrics and Gynecology. ALPHA İstanbul consensus evaluation system was used for grading of the blastocyst. The embryo quality, expansion, ICM and TE morphology of the 5There was a significantly increased risk of preeclampsia (PE) (7.8% vs 1.1%; p=0.041), preterm delivery (PD) (36% vs 17.7%; p=0.037), and antenatal bleeding rates (13.6% vs 5%; p=0.021) in TE-C compared to the TE-A + TE-B blastocysts. Furthermore, a higher rate of obstetric complications was observed in ICM-C compared to ICM-A and B (p=0.003). There was a significant correlation between TE morphology and implantation success, ongoing pregnancy rate, and abortion incidence.These results suggest that TE cell morphology is related to implantation success and pregnancy outcomes, especially in terms of the risk of abortion, PE, PD, and antenatal bleeding. It may be advisable to counsel women concerning possible poor obstetric outcome due to poor ICM quality. Future prospective and controlled studies are needed to clarify this association.