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Importance: Body mass index (BMI) and gestational weight gain are increasing globally. In 2009, the Institute of Medicine (IOM) provided specific recommendations regarding the ideal gestational weight gain. However, the association between gestational weight gain consistent with theIOM guidelines and pregnancy outcomes is unclear., Objective: To perform a systematic review, meta-analysis, and metaregression to evaluate associations between gestational weight gain above or below the IOM guidelines (gain of 12.5-18 kg for underweight women [BMI <18.5]; 11.5-16 kg for normal-weight women [BMI 18.5-24.9]; 7-11 kg for overweight women [BMI 25-29.9]; and 5-9 kg for obese women [BMI ≥30]) and maternal and infant outcomes., Data Sources and Study Selection: Search of EMBASE, Evidence-Based Medicine Reviews, MEDLINE, and MEDLINE In-Process between January 1, 1999, and February 7, 2017, for observational studies stratified by prepregnancy BMI category and total gestational weight gain., Data Extraction and Synthesis: Data were extracted by 2 independent reviewers. Odds ratios (ORs) and absolute risk differences (ARDs) per live birth were calculated using a random-effects model based on a subset of studies with available data., Main Outcomes and Measures: Primary outcomes were small for gestational age (SGA), preterm birth, and large for gestational age (LGA). Secondary outcomes were macrosomia, cesarean delivery, and gestational diabetes mellitus., Results: Of 5354 identified studies, 23 (n = 1 309 136 women) met inclusion criteria. Gestational weight gain was below or above guidelines in 23% and 47% of pregnancies, respectively. Gestational weight gain below the recommendations was associated with higher risk of SGA (OR, 1.53 [95% CI, 1.44-1.64]; ARD, 5% [95% CI, 4%-6%]) and preterm birth (OR, 1.70 [1.32-2.20]; ARD, 5% [3%-8%]) and lower risk of LGA (OR, 0.59 [0.55-0.64]; ARD, -2% [-10% to -6%]) and macrosomia (OR, 0.60 [0.52-0.68]; ARD, -2% [-3% to -1%]); cesarean delivery showed no significant difference (OR, 0.98 [0.96-1.02]; ARD, 0% [-2% to 1%]). Gestational weight gain above the recommendations was associated with lower risk of SGA (OR, 0.66 [0.63-0.69]; ARD, -3%; [-4% to -2%]) and preterm birth (OR, 0.77 [0.69-0.86]; ARD, -2% [-2% to -1%]) and higher risk of LGA (OR, 1.85 [1.76-1.95]; ARD, 4% [2%-5%]), macrosomia (OR, 1.95 [1.79-2.11]; ARD, 6% [4%-9%]), and cesarean delivery (OR, 1.30 [1.25-1.35]; ARD, 4% [3%-6%]). Gestational diabetes mellitus could not be evaluated because of the nature of available data., Conclusions and Relevance: In this systematic review and meta-analysis of more than 1 million pregnant women, 47% had gestational weight gain greater than IOM recommendations and 23% had gestational weight gain less than IOM recommendations. Gestational weight gain greater than or less than guideline recommendations, compared with weight gain within recommended levels, was associated with higher risk of adverse maternal and infant outcomes.

Objective: Excessive weight gain during pregnancy has an important influence on fetal growth and on weight development in future generations., Design and Methods: A prospective cohort study of 325 obese and nonobese Caucasian women with naturally conceived, singleton pregnancies was performed. They were followed up until delivery for maternal weight gain and for fetal growth with ultrasound-based weight estimations and final birth weight. Using cluster analysis distinct profiles of maternal weight gain during pregnancy were obtained. Longitudinal regression analysis was performed to investigate the relationship of the maternal weight gain profile and BMI on fetal growth and final birth weight., Results: Cluster analysis revealed four discernable maternal weight gain profiles: 12 cases (3.7%) ended up at their starting weight or decreased in weight (cluster 1), 16 cases (4.9%) who slightly increased in weight (maximum 4 kg) as compared to their initial weight (cluster 2), 114 cases (35.1%) who gained between 4 and 12 kg in weight (cluster 3), and 183 cases (56.3%) who showed the largest weight gain: more than 12 kg (cluster 4). There were statistically significant differences in fetal growth associated with weight gain cluster, which became apparent late in the second trimester and increased toward the end of pregnancy. Maternal BMI and maternal weight gain profile were independent predictors of fetal growth and birth weight., Conclusions: Therefore, the conclusion is that the cluster analysis permits to discern four gestational weight gain (GWG) patterns in obese and nonobese subjects and that both maternal BMI and maternal weight gain pattern during pregnancy positively influence fetal growth and birth weight., (Copyright © 2013 The Obesity Society.)

Aim: To generate reference charts for weight gain during pregnancy for the different BMI categories (underweight, normal weight, overweight, obesity), based on recent data in a homogeneous, Caucasian, low-risk obstetric population., Methods: Weight gain and prepregnancy BMI were retrospectively gathered from 605 pregnant Belgian women with accurately dateable, uncomplicated singleton pregnancies. Percentile curves for the different BMI categories were constructed using the linear mixed model, based on absolute weight gain. The effect of parity on weight gain was examined., Results: Overall mean weight gain was 14.8 kg (+/-4.7). Weight gain differed significantly between underweight (15.4 +/- 4.1 kg) and obese patients (12.0 +/- 5.9 kg), between patients with normal weight (15.1 +/- 4.5 kg) and overweight patients (13.7 +/- 5.3 kg), and between normal-weight and obese patients. Parity had a statistical, but no clinically significant, influence on amount and evolution of weight gain., Conclusion: By using strict inclusion criteria, BMI-category-specific reference charts were generated representing, in terms of outcome, the optimal weight gain during pregnancy rather than the mean observed weight gain. This enables the weight charts to be used as a clinical tool during the counseling of pregnant women., (Copyright 2009 S. Karger AG, Basel.)

Objective: To study cefazolin pharmacokinetics in maternal plasma and amniotic fluid during pregnancy., Study Design: Newly collected time-concentrations profiles and reported studies investigating cefazolin disposition (plasma, amniotic fluid) were pooled. Nonlinear mixed effect modeling was applied. A 2-compartment linear disposition model was used to fit cefazolin plasma observations. A third compartment was used to model amniotic fluid concentration., Results: One hundred eighty-seven plasma and 96 amniotic fluid samples were collected in 82 pregnancies (17-40 weeks gestational age). Cefazolin clearance and distribution estimates were 7.44 L/h and 12.04 L without gestational age-dependent trends in maternal plasma. The equilibration half-life (T(eq)) between plasma and amniotic fluid at term gestational age was 4.4 hours, increased with decreasing gestational age, and was 9.09 times longer in patients with polyhydramnios., Conclusion: Cefazolin clearance and distribution volume are increased during pregnancy. The cefazolin T(eq) depends on gestational age and polyhydramnios. On the basis of these observations, dosing regimes to attain higher amniotic fluid concentrations were formulated.

Outcome of monochorionic twin pregnancy with selective fetal growth restriction at 16, 20 or 30 weeks according to new Delphi consensus definition Keywords: definition; discordance; growth restriction; monochorionic twin pregnancy; outcome EN definition discordance growth restriction monochorionic twin pregnancy outcome 821 830 10 12/03/20 20201201 NES 201201 CONTRIBUTION B What are the novel findings of this work? More specifically, a pregnancy with sFGR complicated by TTTS at 19 weeks was included in the 16-week analysis but not in the 20- or 30-week analysis, as this pregnancy would no longer be diagnosed with isolated sFGR. In 44/177 (25%) sFGR pregnancies, the smaller twin had continuous or intermittent absent or reversed end-diastolic umbilical artery flow, which was classified as sFGR Type II in 11 and Type III in 33 pregnancies, with survival rates of 55% (12/22) and 83% (55/66), respectively ( I P i = 0.006). [Extracted from the article]

Background: Labour is a period of significant physical activity. The importance of carbohydrate intake to improve outcome has been recognised in sports medicine and general surgery.Objectives: To assess the effect of oral carbohydrate supplementation on labour outcomes.Search Strategy: MEDLINE (1966-2014), Embase, the Cochrane Library and clinical trial registries.Selection Criteria: Randomised controlled trials (RCT) of women randomised to receive oral carbohydrate in labour (<6 cm dilated), versus placebo or standard care.Data Collection and Analysis: Authors were contacted to provide data. Individual patient data meta-analyses were performed to calculate pooled risk ratios (RR) and 95% confidence intervals (CI).Main Results: Eight RCTs met the inclusion criteria. Six authors responded, four supplied data (n = 691). Three studies used isotonic drinks (one placebo-controlled, two compared with standard care), and one an advice booklet regarding carbohydrate intake. The mean difference in energy intake between the intervention and control groups was small [three studies, 195 kilocalories (kcal), 95% CI 118-273]. There was no difference in the risk of caesarean section (RR 1.15, 95% CI 0.83- 1.61), instrumental birth (RR 1.26, 95% CI 0.96-1.66) or syntocinon augmentation (RR 0.99, 95% CI 0.86-1.13). Length of labour was similar (mean difference -3.15 minutes, 95% CI -35.14 to 41.95). Restricting the analysis to primigravid women did not affect the result. Oral carbohydrates did not increase the risk of vomiting (RR 1.09, 95% CI 0.78-1.52) or 1-minute Apgar score <7 (RR 1.23, 95% CI 0.82-1.83).Authors' Conclusion: Oral carbohydrate supplements in small quantities did not alter labour outcome.Tweetable Abstract: Oral carbohydrate does not affect labour. But the difference between intervention and control equals 10 teaspoons sugar. [ABSTRACT FROM AUTHOR]

Objective: To develop maternal, fetal, and neonatal composite outcomes relevant to the evaluation of diet and lifestyle interventions in pregnancy by individual patient data (IPD) meta-analysis.Design: Delphi survey.Setting: The International Weight Management in Pregnancy (i-WIP) collaborative network. Sample Twenty-six researchers from the i-WIP collaborative network from 11 countries.Methods: A two-generational Delphi survey involving members of the i-WIP collaborative network (26 members in 11 countries) was undertaken to prioritise the individual outcomes for their importance in clinical care. The final components of the composite outcomes were identified using pre-specified criteria.Main Outcome Measures: Composite outcomes considered to be important for the evaluation of the effect of diet and lifestyle in pregnancy.Results: Of the 36 maternal outcomes, nine were prioritised and the following were included in the final composite: pre-eclampsia or pregnancy-induced hypertension, gestational diabetes mellitus (GDM), elective or emergency caesarean section, and preterm delivery. Of the 27 fetal and neonatal outcomes, nine were further evaluated, with the final composite consisting of intrauterine death, small for gestational age, large for gestational age, and admission to a neonatal intensive care unit (NICU).Conclusions: Our work has identified the components of maternal, fetal, and neonatal composite outcomes required for the assessment of diet and lifestyle interventions in pregnancy by IPD meta-analysis. [ABSTRACT FROM AUTHOR]

Pregnancy is a complex period of human growth, development, and imprinting. Nutrition and metabolism play a crucial role for the health and well-being of both mother and fetus, as well as for the long-term health of the offspring. Nevertheless, several biological and physiological mechanisms related to nutritive requirements together with their transfer and utilization across the placenta are still poorly understood. In February 2009, the Child Health Foundation invited leading experts of this field to a workshop to critically review and discuss current knowledge, with the aim to highlight priorities for future research. This paper summarizes our main conclusions with regards to maternal preconceptional body mass index, gestational weight gain, placental and fetal requirements in relation to adverse pregnancy and long-term outcomes of the fetus (nutritional programming). We conclude that there is an urgent need to develop further human investigations aimed at better understanding of the basis of biochemical mechanisms and pathophysiological events related to maternal-fetal nutrition and offspring health. An improved knowledge would help to optimize nutritional recommendations for pregnancy. [ABSTRACT FROM PUBLISHER]

Linked article: This is a mini commentary on K Johansson et al., pp. 461–471 in this issue. To view this article visit https://doi.org/10.1111/1471-0528.16871 [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives To evaluate the application of a pocket-sized ultrasound machine ( PUM) in a routine antenatal third-trimester scan compared with a high-specification ultrasound machine ( HSUM). Methods This was an observational cohort study of 53 unselected women who came for their routine third-trimester ultrasound scan. The first scan was performed by an experienced ultrasonographer on an HSUM for fetal growth, fetal wellbeing and placental location. A second experienced operator performed the measurements on the PUM. Both operators were blinded to the other's findings and measurement results. Results Fifty-one patients were eligible and scanned at a median gestational age of 31 + 1 (range, 27 + 2 to 36 + 0) weeks. Mean pregestational body mass index was 22.9 ± 3.1 (range, 17.6-35.7) kg/m2. In the comparison between measurements made using the PUM and HSUM, perfect agreement was found for fetal position, fetal bladder and stomach visualization (all κ 1.0) and very good agreement was found for placental position (κ 0.86). Measurements of deepest vertical pocket correlated moderately (intraclass correlation coefficient ( ICC) 0.38 (95% CI, 0.12-0.59); Bland-Altman bias, 2.43 (95% limits of agreement ( LoA), −22.65 to 27.51)). For fetal growth measurements there was very good agreement for biparietal diameter ( ICC, 0.93 (95% CI, 0.88-0.96), Bland-Altman bias, −1.06 (95% LoA, −5.07 to 2.95)), and good agreement for femur length ( ICC, 0.66 (95% CI, 0.48-0.79), Bland-Altman bias 0.56 (95% LoA, −5.97 to 7.08)) and transcerebellar diameter ( ICC, 0.65 (95% CI, 0.46-0.78), Bland-Altman bias, −0.84 (95% LoA, −7.77 to 6.09)). Conclusion A battery-driven PUM can be used in third-trimester obstetrics for routine assessment of fetal growth (biparietal diameter, transcerebellar diameter and femur length) and for assessment of fetal wellbeing. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Abstract: Background: The postpartum period affects drug disposition, but data of intravenous paracetamol loading dose pharmacokinetics immediately following caesarean delivery have not yet been reported. Methods: Immediately following caesarean delivery, women received a 2-g loading dose of intravenous paracetamol. Plasma samples were collected at 1, 2, 4 and 6h. Individual pharmacokinetics were calculated assuming a linear one-compartment model with instantaneous input and first-order output. Data were reported using median and range. Results: Twenty-eight patients undergoing caesarean delivery were recruited (age 31.5 [20–42] years, weight 79 [57–110] kg, body surface area 1.9 [1.5–2.4]m2). Median paracetamol plasma concentrations after 1, 2, 4 and 6h were 22.5, 15.25, 7.9, and 3.9mg/L respectively. Paracetamol clearance was 20.3 (11.8–62.8) L/h or 10.9 (7–23.8)L/hm2, distribution volume 58.3 (42.9–156) L or 0.72 (0.52–1.56) L/kg. Conclusion: Pharmacokinetics of intravenous paracetamol have been estimated following caesarean delivery. Although limited to a loading dose shortly after surgery, the results are clinically relevant since this is the first description in this patient population. These data provide evidence on which to base further integrated pharmacokinetic/pharmacodynamic studies in peripartum analgesia. [Copyright &y& Elsevier]

Background: Spontaneous liver rupture during pregnancy is extremely rare, and often associated with hypertensive disorders. Maternal outcomes are poor and morbidity is high. Case: A 27-year-old women (G1P0), pregnant with monochorionic-monoamniotic twins, developed extensive abdominal pain while she was electively admitted at 32 weeks for fetal pulmonary maturation. Diagnosed with preterm labor, a caesarean section was performed. Postoperatively, our patient deteriorated and a second laparotomy revealed an extensive liver rupture. There was no evidence of hypertensive disorders or hepatic tumors. After perihepatic packing and embolization, our patient required long-term treatment in our intensive care unit. She survived, and both mother and children are healthy after 6 months. Conclusion: Despite being rare, spontaneous liver rupture in absence of hypertensive disorders during pregnancy is associated with high maternal morbidity and mortality. Adequate treatment requires a multidisciplinary approach. [ABSTRACT FROM AUTHOR]

The obesity epidemic affects all, including women of reproductive age. One in five women attending prenatal care in the UK is obese. Prepregnancy obesity is associated with serious short- and long-term complications for mother and child. Furthermore, gestational weight gain (GWG) of obese pregnant women generally exceeds the Institute of Medicine recommended ranges. This observation can partially be explained by an unbalanced diet and lack of daily physical activity. Despite this, few lifestyle intervention trials in obese pregnant women are available. Two out of seven intervention trials focusing on GWG, nutrition and physical activity, reached a significant decrease in GWG. Developing guidelines to promote appropriated weight gain and healthy lifestyle in overweight and obese pregnant women remains a challenge. This review aims to summarize the complications associated with maternal prepregnancy overweight and obesity and to discuss possible strategies to improve the lifestyle habits of pregnant women. [ABSTRACT FROM AUTHOR]

Since the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, Belgium has reported a proportionally high number of COVID-19-related deaths (Table S1, Figure S1)[1]. According to the classification system of Wu I et al i . for severity of COVID-19 symptoms, 37 (86.0%) patients had mild symptoms and four (9.3%) had severe symptoms, and two (4.7%) were admitted to the intensive care unit (ICU)[3]. No patients developed severe symptoms and there were therefore no ICU admissions or deaths, and no patients developed symptoms during hospitalization. [Extracted from the article]

In view of the important protective role of the fetal membranes, wound sealing, tissue regeneration, or wound healing could be life saving in cases of preterm premature rupture of the membranes. Although many investigators are studying the causes of preterm premature rupture of membranes, the emphasis has not been on the wound healing capacity of the fetal membranes. In this review, the relevant literature on the pathophysiologic condition that leads to preterm premature rupture of membranes will be summarized to emphasize a continuum of events between rupture and repair. We will present the current knowledge on fetal membrane wound healing and discuss the clinical implications of these findings. We will critically discuss recent experimental interventions in women to seal or heal the fetal membranes after preterm premature rupture of membranes. [ABSTRACT FROM AUTHOR]

An abstract of the conference paper "The influence of pre-pregnancy BMI and maternal weight gain in pregnancy on fetal size at 12 weeks: a cross sectional analysis," by J. Luts and colleagues is presented.