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Objective: To investigate the prevalence and longitudinal trend of severe maternal morbidity (SMM) at nationwide level in Taiwan. The associated maternal factors contributing to SMM were also analyzed. Materials and methods: A population-based secondary analysis using administrative datasets released by Ministry of Health and Welfare of Taiwan from 2011 to 2021 was carried out. SMM was defined from ICD-9 or10-CM diagnosis and procedure codes previously released by CDC. The existence of any SMM indicators identified by delivery and postpartum hospitalizations between≧20 weeks of gestational age and within 42 days after childbirth was retrieved for analysis. Kendall Tau-b correlation was applied for trend test. Logistic regression was used to investigate the associated maternal factors for SMM. All the data were analyzed using SAS statistical software version 9.4. Statistical significance was defined as P value

Introduction: Neonatal mortality remains a critical concern, particularly in developing countries. The advent of machine learning offers a promising avenue for predicting the survival of at-risk neonates. Further research is required to effectively deploy this approach within distinct clinical contexts. Objective: This study aimed to assess the applicability of machine learning models in predicting neonatal mortality, drawing from maternal and clinical characteristics of pregnant women within an intensive care unit (ICU). Methods: Conducted as an observational cross-sectional study, the research enrolled pregnant women receiving care in a level III national hospital's ICU in Peru. Detailed data encompassing maternal diagnosis, maternal characteristics, obstetric characteristics, and newborn outcomes (survival or demise) were meticulously collected. Employing machine learning, predictive models were developed for neonatal mortality. Estimations of beta coefficients in the training dataset informed the model application to the validation dataset. Results: A cohort of 280 pregnant women in the ICU were included in this study. The Gradient Boosting approach was selected following rigorous experimentation with diverse model types due to its superior F1-score, ROC curve performance, computational efficiency, and learning rate. The final model incorporated variables deemed pertinent to its efficacy, including gestational age, eclampsia, kidney infection, maternal age, previous placenta complications accompanied by hemorrhage, severe preeclampsia, number of prenatal checkups, and history of miscarriages. By incorporating optimized hyperparameter values, the model exhibited an impressive area under the curve (AUC) of 0.98 (95 % CI: 0.95–1), along with a sensitivity of 0.98 (95 % CI: 0.94–1) and specificity of 0.98 (95 % CI: 0.93–1). Conclusion: The findings underscore the utility of machine learning models, specifically Gradient Boosting, in foreseeing neonatal mortality among pregnant women admitted to the ICU, even when confronted with maternal morbidities. This insight can enhance clinical decision-making and ultimately reduce neonatal mortality rates.

Resumen: La hipertensión afecta entre en 5 y 10% de los embarazos. Su prevalencia ha ido en ascenso debido al aumento de enfermedades cardiometabólicas en mujeres en edad fértil. Es la segunda causa de mortalidad materna y un importante factor de morbilidad materna y fetal por lo que es un tema de gran relevancia en nuestra especialidad.En la siguiente revisión de la literatura se abordará la clasificación de los trastornos hipertensivos, las nuevas estrategias de predicción, prevención de la preeclampsia, y manejo de esta patología en base a la mejor evidencia disponible. Abstract: Hypertension affects between 5 and 10% of pregnancies. Its prevalence has been increasing due to the increase in cardiometabolic diseases in women of childbearing age. It is the second cause of maternal mortality and an important factor of maternal and fetal morbidity, making it a topic of great relevance in maternal-fetal medicine.The following review of the literature will address the classification of hypertensive disorders, new strategies for prediction, prevention of preeclampsia, and management of this pathology based on the best available evidence.

Exposure to organophosphate esters (OPEs) during pregnancy has been suggested to be associated with adverse pregnancy and birth outcomes. However, relevant investigations are scarce, and the findings are inconsistent. We aimed to conduct a scoping review to provide an overview of these associations. Electronic databases, including MEDLINE (through PubMed), Web of Science, and CNKI (China National Knowledge Infrastructure), were searched from inception to March 2022 and updated in July 2022. A total of 8 studies (1860 participants) were included. Limited evidence indicates that OPE exposure during pregnancy may be negatively associated with both maternal and neonatal triiodothyronine and tetraiodothyronine concentrations but positively associated with thyroid-stimulating hormone concentrations. OPE exposure during pregnancy may be associated with lower insulin concentrations. OPE exposure during pregnancy was associated with gestational age in a sex-specific manner. Intrauterine OPE exposure might increase the risk of preterm birth in female infants but decrease the risk of preterm birth in male infants. Prenatal OPE exposure might be associated with an increased risk of low birth weight. The current scoping review suggests that OPE exposure during pregnancy may disturb pregnancy and birth health, including adverse thyroid function and birth size. Because of the limited evidence obtained for most associations, additional studies followed by a traditional systematic review are needed to confirm these findings.

Objective: To investigate the prevalence and longitudinal trend of severe maternal morbidity (SMM) at nationwide level in Taiwan. The associated maternal factors contributing to SMM were also analyzed., Materials and Methods: A population-based secondary analysis using administrative datasets released by Ministry of Health and Welfare of Taiwan from 2011 to 2021 was carried out. SMM was defined from ICD-9 or10-CM diagnosis and procedure codes previously released by CDC. The existence of any SMM indicators identified by delivery and postpartum hospitalizations between≧20 weeks of gestational age and within 42 days after childbirth was retrieved for analysis. Kendall Tau-b correlation was applied for trend test. Logistic regression was used to investigate the associated maternal factors for SMM. All the data were analyzed using SAS statistical software version 9.4. Statistical significance was defined as P value < 0.05., Results: A total of 2,054,010 delivery hospitalization records were identified during the study period. 6961 subjects met the SMM indicators, yielding an average SMM rate of 3.4 per 1000 deliveries. The pure transfusion rate was 2.33%. The overall SMM rate including transfusion reached 26.7 per thousand deliveries. The trend of SMM including and excluding transfusion demonstrated significantly increasing. Extreme maternal age and cesarean delivery were two main maternal associated factors for SMM., Conclusion: Our findings demonstrated the steadily increasing trend of SMM in the past decade from nationwide study in Taiwan. The sharply growing rates of blood transfusion made the prevention of obstetric hemorrhage imperative. Health policies should be focused on the encourage of early childbearing and avoidance of unnecessary cesarean delivery to reduce the maternal risks associated with SMM. Continuous surveillance of SMM is required to improve obstetric care and reduce severe maternal complications., Competing Interests: Conflicts of interest The authors have no conflicts of interest., (Copyright © 2024. Published by Elsevier B.V.)

Objective: A supportive environment for women with Hyperemesis Gravidarum is crucial but not always provided. There is a lack of research regarding Hyperemesis Gravidarum, its impact on the family, and the partner's perception of supporting their spouse. Thus, this study aims to explore partners' experiences of Hyperemesis Gravidarum during their spousés pregnancy., Methods: Data were gathered through 13 individual, semi-structured, in-depth, digital interviews with partners of women who had experienced Hyperemesis Gravidarum and analysed with Qualitative Content Analysis. The partners were recruited through advertisement on a social media platform and were exclusively males, representing 8 of 21 Swedish regions. The mean age was 34, and they had, on average, 1 previous child. The mean time from the experience to the interview was 12 months., Findings: The main theme, "Navigating in a maze without a map", explains partners' situation as stressful and demanding when their spouse suffers from Hyperemesis Gravidarum, with insufficient support and guidance from healthcare providers. The analysis resulted in three themes: "Standing alone with a demanding responsibility", "Being in a lottery when facing healthcare", and "Climbing the mountain together." The themes display challenges within everyday life and healthcare, as well as strained relations within the family., Conclusion: Partners experience a need to support their spouse in every aspect of daily life and advocate for adequate healthcare. Healthcare professionals must support and acknowledge the partners' struggles during the demanding situation with Hyperemesis Gravidarum., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Introduction: Preeclampsia (PE) is a severe pregnancy complication due to placental dysfunction. Thrombomodulin (TM), a glycoprotein expressed on the trophoblast cell membrane, plays an organ-protective role in the placenta by regulating coagulation and inflammation. TM-mediated regulation of High Mobility Group Box1(HMGB1) is an essential mechanism that contributes to placental homeostasis and prevents pregnancy complications in mice. Here, we aimed to clarify the role of placental TM and HMGB1 in the pathophysiology of human PE., Methods and Results: In this study, maternal blood serum and placental tissue were obtained from 72 PE patients and 110 normal controls. Soluble TM(sTM) and HMGB1 levels in the maternal serum were assessed. The placental TM and HMGB1 expression levels were evaluated using immunohistochemistry and qPCR. Serum sTM and HMGB1 levels gradually increased with gestational age in normal pregnancies; however, both circulating sTM and HMGB1 levels were significantly higher in the PE group. Serum HMGB1/sTM ratio was elevated in PE patients compared to that in normal controls, which correlated positively with the clinical severity of PE. The immunohistochemistry analysis revealed the loss of TM and the increase in extranuclear HMGB1. TM mRNA expression was diminished in PE placentas, which negatively correlated with soluble fms-like tyrosine kinase-1 (sFlt-1) expression., Discussion: The increase in circulating sTM and HMGB1 could be attributed to the enhanced placental TM shedding in PE patients. The molecular events mediated by the imbalance in the placental TM and HMGB1 levels could be an underlying feature of PE; maternal serum HMGB1/sTM ratio could reflect this status., Competing Interests: Declaration of competing interest None, (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Obstetrical hemorrhage is a relatively frequent obstetrical complication and a common cause of maternal morbidity and mortality worldwide. The majority of maternal deaths attributable to hemorrhage are preventable, thus, developing rapid and effective means of treating postpartum hemorrhage is of critical public health importance. Intrauterine devices are one option for managing refractory hemorrhage, with rapid expansion of available devices in recent years. Intrauterine packing was historically used for this purpose, with historical cohorts documenting high rates of success. Modern packing materials, including chitosan-covered gauze, have recently been explored with success rates comparable to uterine balloon tamponade in small trials. There are a variety of balloon tamponade devices, both commercial and improvised, available for use. Efficacy of 85.9% was cited in a recent meta-analysis in resolution of hemorrhage with the use of uterine balloon devices, with greatest success in the setting of atony. However, recent randomized trials have demonstrated potential harm associated with improvised balloon tamponade use In low resource settings and the World Health Organization recommends use be restricted to settings where monitoring is available and care escalation is possible. Recently, intrauterine vacuum devices have been introduced, which offer a new mechanism for achieving hemorrhage control by mechanically restoring uterine tone via vacuum suction. The Jada device, which is is FDA-cleared and commercially available in the US, found successful bleeding control in 94% of cases in an initial single-arm trial, with recent post marketing registry study described treatment success following hemorrhage in 95.8% of vaginal and 88.2% of cesarean births. Successful use of improvised vacuum devices has been described in several studies, including suction tube uterine tamponade via Levin tubing, and use of a modified Bakri balloon. Further research is needed with head-to-head comparisons of efficacy of devices and assessment of cost within the context of both device pricing and overall healthcare resource utilization., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Although adverse pregnancy outcomes are associated with an increased risk of cardiovascular disease, studies on timing and subtypes of heart failure after a hypertensive pregnancy are lacking., Objectives: The goal of this study was to assess the association between pregnancy-induced hypertensive disorder and risk of heart failure, according to ischemic and nonischemic subtypes, and the impact of disease characteristics and the timing of heart failure risks., Methods: This was a population-based matched cohort study, comprising all primiparous women without a history of cardiovascular disease included in the Swedish Medical Birth Register between 1988 and 2019. Women with pregnancy-induced hypertensive disorder were matched with women with normotensive pregnancies. Through linkage with health care registers, all women were followed up for incident heart failure, classified as ischemic or nonischemic., Results: In total, 79,334 women with pregnancy-induced hypertensive disorder were matched with 396,531 women with normotensive pregnancies. During a median follow-up of 13 years, rates of all heart failure subtypes were more common among women with pregnancy-induced hypertensive disorder. Compared with women with normotensive pregnancies, adjusted HRs (aHRs) with 95% CIs were as follows: heart failure overall, aHR: 1.70 (95% CI: 1.51-1.91); ischemic heart failure, aHR: 2.28 (95% CI: 1.74-2.98); and nonischemic heart failure, aHR: 1.60 (95% CI: 1.40-1.83). Disease characteristics indicating severe hypertensive disorder were associated with higher heart failure rates, and rates were highest within the first years after the hypertensive pregnancy but remained significantly increased thereafter., Conclusions: Pregnancy-induced hypertensive disorder is associated with an increased short-term and long-term risk of incident ischemic and nonischemic heart failure. Disease characteristics indicating more severe forms of pregnancy-induced hypertensive disorder amplify the heart failure risks., Competing Interests: Funding Support and Author Disclosures This study was supported by Region Stockholm; the Swedish Research Council for Health, Working Life and Welfare; and the Swedish Heart and Lung Foundation. The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Exposure to organophosphate esters (OPEs) during pregnancy has been suggested to be associated with adverse pregnancy and birth outcomes. However, relevant investigations are scarce, and the findings are inconsistent. We aimed to conduct a scoping review to provide an overview of these associations. Electronic databases, including MEDLINE (through PubMed), Web of Science, and CNKI (China National Knowledge Infrastructure), were searched from inception to March 2022 and updated in July 2022. A total of 8 studies (1860 participants) were included. Limited evidence indicates that OPE exposure during pregnancy may be negatively associated with both maternal and neonatal triiodothyronine and tetraiodothyronine concentrations but positively associated with thyroid-stimulating hormone concentrations. OPE exposure during pregnancy may be associated with lower insulin concentrations. OPE exposure during pregnancy was associated with gestational age in a sex-specific manner. Intrauterine OPE exposure might increase the risk of preterm birth in female infants but decrease the risk of preterm birth in male infants. Prenatal OPE exposure might be associated with an increased risk of low birth weight. The current scoping review suggests that OPE exposure during pregnancy may disturb pregnancy and birth health, including adverse thyroid function and birth size. Because of the limited evidence obtained for most associations, additional studies followed by a traditional systematic review are needed to confirm these findings., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: Gastric bypass is a surgical procedure that is popularly used to treat morbid obesity. Herein, we report a woman who had a rare gastrointestinal complication during the subsequent antepartum period following a gastric bypass surgery. Case Report: After a Roux-en-Y gastric bypass surgery, a 32-year-old woman had unrelenting epigastria for one week at 36 weeks' gestation. An emergency cesarean delivery, followed by laparotomy, was performed. A female neonate was delivered with Apgar scores of 8 and 9 at 1 and 5 minutes, respectively. Strangulation and gangrene of the upper jejunum caused by a fibrous band at the site of the Roux anastomosis were revealed. Segmental resection of the nonviable bowel was performed. The patient experienced a smooth postoperative course. Conclusion: The awareness of internal hernias and small bowel strangulation should be addressed when unrelenting epigastric pain is present in women after Roux-en-Y gastric bypass surgery, during their first subsequent pregnancy.

Background: Several studies have indicated that prenatal exposure to ambient air pollution is associated with an increased risk of gestational diabetes mellitus, hypertensive disorder during pregnancy, preterm birth, and stillbirth. However, no previous study has focused on the association between the number of pregnancy complications and exposure to ambient air pollution., Objectives: To investigate the association between prenatal exposure to ambient air pollutants and the number of pregnancy complications in high-risk pregnancies., Methods: We collected data on gestational diabetes mellitus, hypertensive disorder during pregnancy, preterm birth, and stillbirth from the National Health Information Databases, provided by the Korean National Health Insurance Service.R To assess individual-level exposure to air pollutants, a spatial prediction model and area-averaging approach were used., Results: From 2015 to 2018, data of 789,595 high-risk pregnancies were analyzed. The ratio of gestational diabetes mellitus in the country was the highest, followed by preterm birth, hypertensive disorder during pregnancy, and stillbirth. Approximately 71.7% of pregnant women (566,143) presented with one pregnancy complication in identical pregnancies, 27.5% (216,714) presented with two, and 0.9% (6738) presented with three or more. Multiple logistic regression models with adjustments for age, residence, and income variables indicated that the risk of having two or more pregnancy complications was positively associated with the exposure to higher levels of PM 10 (odds ratio [OR], 1.11; 95% confidence interval [CI], 1.09-1.12) and PM 2.5 (OR, 1.14; 95% CI, 1.12-1.15). The highest quartile presented higher odds of two or more pregnancy complications compared with the lower three quartiles of PM 10 , PM 2.5 , CO, NO 2 , and SO 2 exposures (p < 0.001)., Conclusion: The results indicate that the risk of pregnancy complications is positively associated with the exposure to the high concentrations of PM 10 , PM 2.5 , CO, NO 2 , and SO 2 ., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objectives: Considering the burden of preeclampsia (PE), it is important to understand better the underlying risk factors involved in its etiology. We studied the association of background factors with PE with an emphasis on socioeconomic factors, reproductive factors and health history enclosing the parents of pregnant women., Study Design: The Finnish Genetics of Pre-eclampsia Consortium (FINNPEC) cohort participants filled in a questionnaire on background information. The questionnaire data was available from 708 women with PE and 724 control women. Two different control groups, healthy controls with uncomplicated pregnancies (n = 498) and all controls (n = 724, including controls with uncomplicated pregnancies and pregnancy complications other than PE), were established., Results: PE women had similar socioeconomic status and more often non-communicable diseases including type 1 diabetes, chronic hypertension and hyperlipidemia than the two control groups (p < 0.05 for all). Depression and subfertility were more common among PE women and they had earlier menarche (p < 0.05 for all). Hypertension was more common in both parents of PE women, stroke in fathers and diabetes in mothers (p < 0.05 for all). Mental disorders including depression were more common in mothers of PE women compared to controls (PE women 7.2%, healthy controls 3.7% (p = 0.013) and all controls 3.9% (p = 0.007))., Conclusions: In the FINNPEC cohort, PE women had similar socioeconomic status, more non-communicable diseases and depression, earlier menarche, more subfertility and more parental non-communicable diseases compared to controls. As a novel finding we found more mental disorders including depression in mothers of PE women., (Copyright © 2020 International Society for the Study of Hypertension in Pregnancy. Published by Elsevier B.V. All rights reserved.)

Background: The aim of this study was to retrospectively analyze the prevalence of severe preeclampsia and low sodium (PALS) among the pregnant population admitted at the University Hospital of Udine in the past 4 years and to compare these data with the current literature., Methods: Only women with a diagnosis of preeclampsia were included. According to the lowest sodium level measured either 5 days before or 5 days after delivery, patients were divided in two groups: women with hyponatremia (<135 mmol/L; severe <120 mmol/L) and women with normonatremia (>135 mmol/L). Moreover, a search literature was performed., Results: Of 59 patients with preeclampsia, 20 (34%) had hyponatremia. Only one case (1.6%) of severe maternal hyponatremia (sodium level 117 mmol/L) in the setting of preeclampsia was identified. After literature search, a total of 22 manuscripts including 60 case reports of PALS were identified. The lowest sodium level was 113 mmol/L, at 25 weeks of gestation. In most cases hyponatremia was treated with fluid restriction. In only 5 cases hyponatremia was treated with a saline hypertonic solution. Hyponatremia resolution, when reported, occurred in about 48 h. Sodium level in neonates ranged from 118 and 128 mmol/L., Conclusions: PALS may occur in about a third of women with severe preeclampsia. Severe maternal hyponatremia should be treated with fluid restriction and with hypertonic saline solution. Moreover neonatologists should be alerted in order to treat the neonate for the best outcome., (Copyright © 2020 International Society for the Study of Hypertension in Pregnancy. Published by Elsevier B.V. All rights reserved.)

Purpose: This matched cohort study aims to determine whether teenagers with a history of childhood sexual abuse (CSA) are at greater risk of consulting for a pregnancy and related complications than teenagers from the general population. It also aims to compare provoked abortion, live births, and fetal losses of participants who were sexually abused in childhood and those of the general population., Methods: A total of 661 girls (aged 13-18 years) with a corroborated by Child Protection Services CSA report between 2001 and 2010 were matched to 661 girls from the general population upon age, biological sex, urban Child Protection Services area, and public drug insurance admissibility at reporting date. Pregnancy consultations and complications during pregnancy and delivery were documented using diagnoses from public health insurance administrative databases from January 1996 to March 2013. Socioeconomic status was controlled., Results: Results indicate that compared with participants from the general population, those with a history of CSA were 4.6 times more likely to consult for at least one pregnancy, 5.3 times more likely to consult for at least one complication during pregnancy or delivery, and on average 5.2 and 3.3 times more likely to consult for at least one live birth and provoked abortion, respectively. There were too few observations to compare fetal losses between groups., Conclusions: Medical interventions for teenage pregnancies and related complications should take into consideration a possible history of CSA to reinforce gynecological follow-up and treatment for girls who were sexually abused and to prevent unfavorable outcomes., (Copyright © 2019 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Women at risk of preterm birth before 32 weeks gestation are routinely transferred to facilitate birth at a hospital that has Neonatal Intensive Care. The clinical outcomes of being 'in-born" improves newborn and neonatal outcomes is well documented. However little is known about the women's experiences when such a complication occurs., Method: Using the NSW Agency for Clinical Innovation Patient and Carer stories method, 10 women were purposively invited and consented to tell their stories. Semi-structured interviews were undertaken during their inpatient stay and then again, by telephone in the months following their baby's due date. Themes were identified, illustrated by exemplars., Results: All women were multiparous. Without exception, the women said that having the support of their family was the most important factor in coping with their unexpected hospitalisation and the anxiety of having to deal with the uncertainty of their pregnancy outcome. The most difficult aspect of their experience was the distress of being separated from their children and families and undue stress and distress from their partners. Other issues they identified were: physical difficulties during transfer; information overload as they sought to understand their changing circumstances; accommodation issues; and financial stress resulting from their relocation., Conclusions: All women perceived their midwifery, obstetric and neonatal care to be exceptional and their neonatal outcomes were positive. Improvements may be made by facilitating family contact allowing flexible visiting, assisting with partner/family accommodation, providing women with their basic needs during transport and providing assistance to relieve financial strain., (Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

Introduction: The etiology of preeclampsia is unclear. Fetal DNA is present in higher concentrations in the plasma of pregnant women suffering from preeclampsia than in the plasma of healthy pregnant women. A previously published study has shown that human fetal DNA injected into pregnant mice induces preeclampsia-like symptoms when administered between gestation days 10-14. The aim of our experiment was to determine whether or not similar effects would be induced by administration of human and mouse fetal DNA, as well as mouse adult DNA and lipopolysaccharide during late pregnancy in the mouse., Methods: Experimental animals were injected daily intraperitoneally during gestation days 14-18 with either saline - negative control, lipopolysaccharide - positive control, or various types of DNA. On gestation day 19, blood pressure and proteinuria were measured, and placental and fetal weights were recorded., Results: Fetal and placental hypotrophy were induced only by lipopolysaccharide (p < 0.001). Neither fetal nor adult DNA induced changes in fetal/placental weight. None of the experimental groups had higher blood pressure or urinary protein in comparison to saline treated animals., Discussion: In our experiment, we found that there was no effect from intraperitoneally injected human fetal DNA, mouse fetal DNA, or mouse adult DNA on pregnant mice. Additionally, relatively high doses of various types of DNA did not induce preeclampsia-like symptoms in mice when administered in late pregnancy. Our negative results support the hypothesis that the increase of fetal DNA circulating in maternal circulation during the third trimester is rather a consequence than a cause of preeclampsia., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: Health disparities begin early in life and persist across the life course. Despite current efforts, black women exhibit greater risk for pregnancy complications and negative perinatal outcomes compared with white women. The placenta, which is a complex multi-tissue organ, serves as the primary transducer of bidirectional information between the mother and fetus. Altered placental function is linked to multiple racially disparate pregnancy complications; however, little is known about racial differences in molecular factors within the placenta. Several pregnancy complications, which include preeclampsia and fetal growth restriction, exhibit racial disparities and are associated with shorter placental telomere length, which is an indicator of cellular stress and aging. Cellular senescence and telomere dynamics are linked to the molecular mechanisms that are associated with the onset of labor and parturition. Further, racial differences in telomere length are found in a range of different peripheral tissues. Together these factors suggest that exploration of racial differences in telomere length of the placenta may provide novel mechanistic insight into racial disparities in birth outcomes., Objective: This study examined whether telomere length measured in 4 distinct fetally derived tissues were significantly different between black and white women. The study had 2 hypotheses: (1) that telomere length that is measured in different placental tissue types would be correlated and (2) that across all sampled tissues telomere length would differ by race., Study Design: In a prospective study, placental tissue samples were collected from the amnion, chorion, villus, and umbilical cord from black and white singleton pregnancies (N=46). Telomere length was determined with the use of monochrome multiplex quantitative real-time polymerase chain reaction in each placental tissue. Demographic and pregnancy-related data were also collected. Descriptive statistics characterized the sample overall and among black and white women separately. The overall impact of race was assessed by multilevel mixed-effects linear regression models that included empirically relevant covariates., Results: Telomere length was correlated significantly across all placental tissues. Pairwise analyses of placental tissue telomere length revealed significantly longer telomere length in the amnion compared with the chorion (t=-2.06; P=.043). Overall telomere length measured in placenta samples from black mothers were significantly shorter than those from white mothers (β=-0.09; P=.04). Controlling for relevant maternal and infant characteristics strengthened the significance of the observed racial differences (β=-0.12; P=.02). Within tissue analyses revealed that the greatest difference by race was found in chorionic telomere length (t=-2.81; P=.007)., Conclusion: These findings provide the first evidence of racial differences in placental telomere length. Telomere length was significantly shorter in placental samples from black mothers compared with white mothers. Given previous studies that have reported that telomere length, cellular senescence, and telomere dynamics are molecular factors that contribute to the rupture of the amniotic sac, onset of labor, and parturition, our findings of shorter telomere length in placentas from black mothers suggest that accelerated cellular aging across placental tissues may be relevant to the increased risk of preterm delivery in black pregnancies. Our results suggest that racial differences in cellular aging in the placenta contribute to the earliest roots of health disparities., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Obesity in pregnancy has an impact on both the mother and the fetus. To date, no universal protocol has been established to guide the management of pregnancy in obese woman. In April 2011, the Geisinger Maternal-Fetal Medicine Department implemented an obesity protocol in which women meeting the following criteria were delivered by their estimated due dates: (1) class III obese or (2) class II obese with additional diagnoses of a large-for-gestational-age fetus or pregnancy complicated by gestational diabetes or (3) class I obese with large-for-gestational-age and gestational diabetes., Objective: We sought to assess the impact of this protocol on the rate of cesarean deliveries in obese women., Study Design: We performed a retrospective cohort study of 5000 randomly selected women who delivered at Geisinger between January 2009 and September 2013, excluding those who delivered in 2011. The data were stratified into obese and nonobese and divided into before protocol and after protocol. Comparison across all groups was accomplished using Wilcoxon rank sum and Pearson's χ(2) tests. Potential confounders were controlled for using logistic regression., Results: The cesarean delivery rate in the obese/after protocol group was 10.8% lower than in the obese/before protocol group (42.4% vs 31.6%, respectively; P < .0001). In addition, when controlling for age, race, smoking status, preeclampsia, gestational diabetes, and intrauterine growth restriction, obese women were 37% less likely to have a cesarean delivery after the protocol than they were before (odds ratio, 0.63; 95% confidence interval, 0.52, 0.76, P < .0001)., Conclusion: Implementation of a maternal-fetal medicine obesity protocol did not increase the rate of cesarean deliveries in obese women. On the contrary, obese women were less likely to have a cesarean delivery after implementation of the protocol., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objectives: To update the epidemiologic data of pregnant women with type 2 diabetes and to assess obstetrical outcomes., Patients and Methods: The pregnant women with type 2 diabetes who delivered between 2002 and 2010 were systematically involved in an observational study. Maternal and fetal outcomes were reviewed, as well as the potential impact of preconceptional management. The presented data were compared with those from the 2010 French perinatal study., Results: A rise in the incidence of type 2 diabetes was observed during the study period (from 0.19% to 0.35% between 2002 and 2010). Women with diabetes (n=97) were older and had a higher BMI than the general population (>35years: 49% vs 19%, P<0.00001, BMI>25: 86% vs 27.2, P<0.00001). The delivery mode was, for half of these women with diabetes, a C-section. Pregnancy was scheduled in only 4% of cases. Compared to the general population, prematurity rate was multiplied by 6 (28.7% vs 4.7%, P<0.0001) and the malformation rate by 3.2 (7.22% vs 2.2%, P<0.00001)., Conclusion: Obstetrical complications were more frequent than in the general population. Preconception care was almost inexistent, despite its potential benefits for the mother and child., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

In this study, the clinical significance of first-trimester intrauterine haematomas (IUH) detected in pregnancies achieved by IVF-embryo transfer (IVF-ET) was evaluated. A retrospective case-control study was designed to compare obstetric and perinatal outcomes of 350 pregnancies with IUH and 350 matched controls without IUH. The incidence of first-trimester IUH detected in the IVF-ET pregnancies was 13.5%. In women who delivered after 28 weeks' gestation, the incidence of gestational hypertension (OR 2.6; 95% CI 1.5 to 4.6), preeclampsia (OR 2.8; 95% CI 1.5 to 5.0) and postpartum haemorrhage (OR 3.1; 95% CI 1.8 to 5.3) was significantly higher in the IUH group. Compared with controls, placenta previa (OR, 8.7 95%; CI 3.4 to 22.2) and oligohydramninos (OR 5.8; 95% CI 2.4 to 14.0) were more common in the IUH group. The incidence of preterm delivery (<37 weeks' gestation) was significantly higher in the IUH group (OR 2.1; 95% CI 1.4 to 3.0), although the incidence of preterm delivery before 34 weeks' gestation was not. No differences were observed in the incidence of gestational diabetes mellitus, premature rupture of membranes and low birth weight. The presence of first-trimester IUH in IVF-ET pregnancies was associated with a higher risk of several pregnancy complications., (Copyright © 2014 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.)

Objective: The purpose of this study was to examine the association between labor induction and gestational age-specific severe maternal morbidity., Study Design: Our study was restricted to women who delivered singletons at 37-42 weeks' gestation who had no pregnancy complications from 2003-2010 (n = 1,601,253) in Canada (excluding Quebec). Using a pregnancies-at-risk approach, the week-specific rates of specific morbidity after induction were contrasted with rates among ongoing pregnancies. Logistic regression was used to adjust for confounders., Results: Induction increased the rate of postpartum hemorrhage that required blood transfusion at 38 weeks' gestation (adjusted rate ratio, 1.28; 95% confidence interval, 1.11-1.49) and 39 weeks' gestation (adjusted rate ratio, 1.21; 95% confidence interval, 1.06-1.38). Induction was also associated with higher rates of pueperal sepsis at 38 and 39 weeks' gestation and venous thromboembolism at 38 weeks' gestation. The absolute increase in morbidity rates was small; the number needed to harm was large (eg, 1270 for postpartum hemorrhage with blood transfusion at 38 weeks' gestation)., Conclusion: Among women without pregnancy complications, induction at earlier term is associated with higher rates of specific severe maternal morbidity, although absolute risks are low., (Copyright © 2013 Mosby, Inc. All rights reserved.)

Objective: To assess adverse fetal outcomes and short-term prognoses of infants exposed to oseltamivir or zanamivir in utero during pandemic (H1N1) 2009 in Japan., Study Design: Case series study. We asked the 2611 obstetric facilities in Japan that are members of the Japan Society of Obstetrics and Gynecology to participate, and data were provided from 157 facilities. We evaluated the numbers of pregnancy complications and neonatal abnormalities., Results: We evaluated 624 infants born to 619 women given oseltamivir and 50 infants born to 50 women given zanamivir. Of patients given oseltamivir before gestational week 22, 3 experienced miscarriage and 1 experienced induced abortion. The overall rate of congenital malformations was 2.1% (14/670). In infants exposed during the first trimester, the rate of malformations was 1.3% (2/156) with oseltamivir and 0.0% (0/15) with zanamivir, although in infants exposed during the second and third trimesters, this rate was 2.6% (12/464) with oseltamivir and 0.0% (0/35) with zanamivir. Increased rates of miscarriage in women given antiviral drugs before gestational week 22 (0.9% [3/322]), preterm delivery in women given antiviral drugs before gestational week 37 (5.5% [33/600]), stillbirth (0% [0/670]), neonatal death (0.15% [1/670]), birthweight <2500 g (8.7% [58/670]), small-for-gestational-age infants (8.4% [56/670]), necrotizing enterocolitis (0.0%), intraventricular hemorrhage (0.0%), seizures (0.15% [1/670]), and other transient abnormalities in the neonatal period (4.3% [29/670]) were not observed in those exposed to antiviral drugs before the corresponding episodes or complications., Conclusion: Short-term prognoses of infants exposed to oseltamivir or zanamivir in utero were not adversely affected., (Copyright © 2013 Mosby, Inc. All rights reserved.)