Search

Infertility is a condition where a male or female is unable to achieve pregnancy through at least 1 year of regular, unprotected sexual intercourse. There are several known causes and risk factors associated with infertility. The gut microbiota is a complex community of trillions of microorganisms living in the gut. Due to modern lifestyle changes, such as dietary habits, physical inactivity, and increasing antibiotic use, the diversity and composition of these microbes may change in a detrimental manner. Dysbiosis or an imbalance of the gut microbiota compared to a normal composition can lead to various abnormalities, such as obesity, Alzheimer's, metabolic disorders, and infertility. This review will cover the factors influencing gut microbiota composition, the mechanisms by which gut microbiota contributes to infertility in men and women, the effects of gut microbiota on problems that may arise during pregnancy, and therapeutic methods for diseases caused by dysbiosis of the gut microbiota. [ABSTRACT FROM AUTHOR]

Background: Given the high prevalence of gestational diabetes mellitus and its significant impact on maternal and neonatal health, identifying reliable biomarkers for prediction and diagnosis is essential. The increased incidence of gestational diabetes mellitus among patients with intrahepatic cholestasis of pregnancy suggests a possible association between serum total bile acid levels and gestational diabetes mellitus. This study evaluated the relationship between total bile acid levels and gestational diabetes mellitus incidence. Methods: A systematic search was performed on February 19, 2024, for studies examining the association between total bile acid levels and gestational diabetes mellitus incidence in both the general pregnant population and patients diagnosed with intrahepatic cholestasis of pregnancy. Meta-analyses were conducted to compare pooled total bile acid levels between patients with and without gestational diabetes mellitus, as well as to assess gestational diabetes mellitus prevalence in patients with mild (10 ≤ total bile acid < 40 µmol/L) vs. moderate-to-severe intrahepatic cholestasis of pregnancy (total bile acid ≥ 40 µmol/L). Results: 15 observational studies involving 7,238 pregnant women were systematically reviewed. Our meta-analysis found significantly higher serum total bile acid levels in women diagnosed with gestational diabetes mellitus compared to controls in the general population (Hedge's g = 0.29 [0.03,0.54]). However, subgroup analysis indicated that total bile acid levels were only significantly higher in patients measured earlier in pregnancy, before the gestational diabetes mellitus diagnosis, compared to healthy controls (Hedge's g = 0.48 [0.33,0.64]), while no significant difference in total bile acid levels was observed when measurements were taken after the gestational diabetes mellitus diagnosis (Hedge's g = 0.00 [-0.26,0.27]). Additionally, we found that the prevalence of gestational diabetes mellitus was significantly lower in patients with mild intrahepatic cholestasis of pregnancy compared to those with moderate-to-severe intrahepatic cholestasis of pregnancy (Log odds ratio=-0.56 [-0.95,-0.17]). Conclusions: This study highlights a complex relationship between serum total bile acid levels and gestational diabetes mellitus incidence, influenced by the timing of measurement. Elevated total bile acid levels early in pregnancy may predict gestational diabetes mellitus, but its diagnostic value may decline later in pregnancy. Trial registration: The review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) on 3/3/2024 under CRD42024516164. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to evaluate the relationship of thin endometrial thickness (EMT) on the maternal and child health outcome of frozen-thawed embryo transfer (FET) cycles with singletons. Methods: The retrospective cohort study included 1,771 live singleton deliveries, with 273 in the thin endometrium group (EMT ≤ 7.5 mm) and 1,498 in the control group (EMT > 7.5 mm). Pregnancy, perinatal complications and neonatal outcomes were compared between the two groups. Results: Women in the thinner endometrium group had higher rates of preeclampsia (7.69% vs. 7.00%), placenta previa (4.39% vs. 2.43%), postpartum haemorrhage (15.38% vs. 11.42%) than the control groups, although they were not significantly different. Significant difference was observed in the rates of placental abruption (1.09% vs. 0.07%, P = 0.001), abnormal placental cord insertion (3.66% vs. 1.74%, P = 0.011), placental adherence (15.38% vs. 7.14%, P < 0.001) between the two groups. No significant difference could be found regarding preterm labour, macrosomia, Apgar ≤ 7, large for gestational age (LGA) and appropriate for gestational age (AGA), and singletons from the thinner endometrium group had a significantly lower birthweight than those from the controls. Then after adjusting for confounders, thinner endometrium was still statistically significantly associated with placental adherence, postpartum haemorrhage and low birthweight (LBW). Conclusion: These findings highlight the important role of endometrial thickness in influencing perinatal and obstetric-neonatal outcomes in FET cycles. The study contributes to the growing body of evidence supporting the clinical relevance of endometrial thickness in FET cycles and underscores the need for close monitoring and management of pregnancies in women with a thin endometrium. Future research should focus on elucidating the underlying mechanisms and identifying effective interventions to improve endometrial thickness and pregnancy outcomes in this patient population. [ABSTRACT FROM AUTHOR]

Background: Risk factors for influenza complications in women are poorly understood. We examined the association between pregnancy outcomes and risk of influenza hospitalization up to three decades later. Methods: We analyzed a cohort of 1,421,531 pregnant women who delivered in Quebec, Canada between 1989 and 2021. Patients were followed over time beginning at the first delivery. The main exposure measures included obstetric complications such as preeclampsia, gestational diabetes, and preterm birth. The main outcome was influenza hospitalization up to 32 years later. We used adjusted Cox regression models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between obstetric complications and risk of influenza hospitalization following pregnancy. Results: A total of 4,016 women were hospitalized for influenza during 32 years of follow-up. Influenza hospitalization was more frequent among women with pregnancy complications than women without complications (18.0 vs 14.1 per 100,000 person-years). Compared with no pregnancy complication, women with gestational diabetes (HR 1.48, 95% CI 1.30–1.69), preeclampsia (HR 1.45, 95% CI 1.28–1.65), placental abruption (HR 1.36, 95% CI 1.12–1.66), preterm birth (HR 1.40, 95% CI 1.27–1.55), cesarean section (HR 1.22, 95% CI 1.13–1.31), and severe maternal morbidity (HR 1.43, 95% CI 1.22–1.68) had a greater risk of influenza hospitalization later in life. These pregnancy outcomes were associated with severe influenza infections requiring critical care. Conclusions: Women with pregnancy complications have an elevated risk of severe influenza complications later in life and have potential to benefit from seasonal vaccination to prevent influenza hospitalization. [ABSTRACT FROM AUTHOR]

Background: Perinatal mental health conditions are the most common complication of pregnancy and childbirth (1 in 8 women). When left untreated, perinatal depression and anxiety adversely affects the entire family with pregnancy complications and negative outcomes including preterm birth, impaired mother-infant bonding, impaired lactation, substance abuse, divorce, suicide, and infanticide. Significant disparities persist in the diagnosis and treatment of perinatal depression and anxiety and these inequities are often intersectional. Preliminary research with stakeholders including community advisory boards, underrepresented and minority birthing people, and state departments of health, demonstrates the importance of social support as a mechanism for reducing disparities in perinatal depression, particularly in rural geographies. Home visiting programs (HVPs) can provide the social support needed to improve mental health outcomes in pregnant and postpartum women. Our project aims to explore the impact of context on the implementation of a mental health intervention, focusing on the lived experiences of diverse populations served by HVPs to reduce disparities in adverse maternal outcomes. Methods: Using implementation facilitation, our study will engage multilevel stakeholders (e.g., policymakers, front-line implementers, and intervention recipients) to adapt facilitation to integrate a maternal mental health intervention (i.e., Mothers and Babies) across two midwestern, rural states (Iowa and Indiana) with multiple HVP models. Given the complexity and heterogeneity of the contexts in which Mothers and Babies will be integrated, a three variable hybrid implementation-effectiveness-context trial will test the adapted facilitation strategy compared with implementation as usual (i.e., standard education) and will assess contextual factors related to the outcomes. Using an evidence-based implementation strategy that tailors implementation delivery to the needs of the specific populations and context may improve fidelity and adoption, particularly in rural states where residents have limited access to care. Discussion: The immediate impact of this research will be to show whether adapted facilitation can improve the uptake and fidelity of Mothers and Babies across multiple HVP models and thus positively affect depressive symptoms and perceived stress of recipients. Our implementation protocol may be used by researchers, practitioners, and policy makers to better integrate evidence-based interventions into diverse contexts, leading to more equitable implementation and improved health outcomes. Trial registration: ClinicalTrials.gov Identifier: NCT06575894, registered on August 29, 2024 https://clinicaltrials.gov/study/NCT06575894?id=NCT06575894&rank=1. [ABSTRACT FROM AUTHOR]

Background: There is critical need to strengthen the global nursing and midwifery workforce. This is especially true in Malawi where they are the primary providers of obstetric and neonatal care. In Neno district, Malawi, in 2017, we implemented an intensive training and longitudinal bedside mentorship intervention for nurses and midwives. From inception, there was a pre-planned project target completion after 5 years, including a staged handover to local ownership after 3 years. The objective of this study was to assess differences in reported maternal and neonatal complications following project completion and handover to local leadership. Methods: The project was a partnership between an academic institution and local nongovernmental organization. In October 2020, the intervention was handed over and maintained by the local organization with limited support from the academic institution. Data from January 2019 to May 2023 were extracted from the Malawi District Health Information Software 2. Bivariate analyses explored differences in the pre- and post-handover periods for all government-collected, birth-related variables. The "pre-handover" period encompassed January 2019 to September 2020 and "post-handover" from October 2020 to May 2023. Multivariate linear regression explored outcomes while controlling for health facility. Results: Data were collected from 10 health facilities in the district and included a total of 23,259 births. Overall, there were few significant changes between periods. Exceptions were in reporting of antepartum hemorrhage (p < 0.01), maternal sepsis (p = 0.01), and manual removal of the placenta (p < 0.01), where we observed decreases in reporting. There was a significant decrease in the reporting of neonatal sepsis (p = 0.01) in the bivariate analysis, which remained only borderline significant in the multivariate model (p = 0.05). Where differences occurred, they were associated with improvements in reported identification of complications and provision of associated emergency care. Conclusions: Few differences in reported maternal and neonatal complications between the periods suggest positive impact of the intervention was sustained following project handover and transition of activities to local leadership. These findings strengthen support for longitudinal mentorship as a pivotal component for skill retention after training. Transparent partnerships which include pre-determined end points and time for handover of activities to local ownership are crucial components for sustainability. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusions The study aimed to describe the incidence of pregnancy‐associated colorectal cancer (PACRC) in New South Wales (NSW), Australia, and to examine the perinatal outcomes of women with PACRC and their babies.A population‐based cohort study was conducted using linked data from NSW. The study group comprised all women diagnosed with colorectal cancer during pregnancy (gestational CRC) or postpartum (postpartum CRC). Women who gave birth without cancer during pregnancy or postpartum formed the comparison group (no‐cancer group).A total of 123 women were diagnosed with PACRC (22 gestational, 101 postpartum), and 1 786 078 women were in the no‐cancer group. The incidence of PACRC was 6.9/100 000 women giving birth. From 1994 to 2013, the incidence significantly increased even when adjusting for maternal age (adjusted increase of 5.8% per year). Women with gestational CRC had significantly higher odds of severe maternal complications (AOR 29.27, 95% CI: 11.18–76.63) and were more likely to give birth by labor induction or no‐labor caesarean section (AOR 4.39, 95% CI: 1.50–12.84) than women in the no‐cancer group. Although babies born to women with gestational CRC did not experience congenital anomalies, they had higher odds of planned preterm birth (AOR 9.91, 95% CI: 1.99–49.21) and severe neonatal adverse outcomes (AOR 8.65, CI: 3.65–20.5) than babies of women without cancer.The study found a significant increase in PACRC incidence in NSW over the study period, independent of maternal age. Increased interventions during gestational CRC births reflect management challenges with higher maternal and neonatal morbidities. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted the health of pregnant women and their unborn babies. Objective: To explore the impact of COVID-19 on intrapartum care in Ethiopia. Design: A concurrent mixed-methods design was employed. Methods: An interrupted time series analysis was implemented using a Poisson regression model to estimate monthly changes in the incidence rates of institutional childbirth, instrumental vaginal birth, caesarean section, stillbirth, institutional neonatal death, institutional maternal death and availability of essential medical supplies before and during COVID-19. The dataset included data from all women who gave birth in 15 public hospitals, and the total number of childbirths in the cohort study before COVID-19 (12 months of data from March 2019 to February 2020) was 24,478, while during COVID-19 (6 months of data from March to August 2020), the total number of childbirths in the cohort study was 11,966, forming a combined final dataset of 36,444. Simultaneously, a descriptive qualitative study using a purposive sampling technique was conducted through in-depth interviews until data saturation was reached, with data were collected from 14 February to 10 May 2022. Data from the interviews were imported into NVivo 12 Plus to perform an inductive thematic analysis. Quantitative and qualitative data were integrated using joint display methods to identify corroboration or contradiction between the different forms of evidence. Results: Our findings indicate that the incidence rates of caesarean sections and instrumental vaginal births significantly increased in the first 6 months of COVID-19. Three themes were identified: ' Barriers to providing intrapartum care during COVID-19 ', ' Delays to provision of intrapartum care during COVID-19 ' and ' Inadequate COVID-19 preventive measures '. Conclusion: In combination, the three themes contributed to a considerable increase in neonatal and maternal deaths. Interventions such as fully equipped labour wards and obstetric triage systems are needed to restore disrupted maternal and perinatal care during the ongoing and future pandemics. In addition, stakeholders should inform the public that blood donations can help the community recover from recent shocks in emergency health and future pandemics. Further research should investigate the long-term impact of COVID-19 on maternity care and maternal and infant outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Congenital transmission is one of the most significant forms of Trypanosoma cruzi transmission worldwide. Migrant women, in particular, often face barriers to accessing the healthcare system; one such barrier being that their health rights are not recognised. The situation in Chile is a reality that can be extrapolated to historical territories affected by Chagas disease and that is characterized by migrant populations. This article explores the healthcare experiences of pregnant and women living with Chagas disease, both nationals and migrants, and residents of three regions of Chile. Methodology: The qualitative research study analyzed the experiences and meanings around the problem of Chagas based on 54 in-depth interviews with women in pregnancy and women who were diagnosed with the disease. The information was processed following the Grounded Theory tenets through the constant encoding feedback procedure, which allowed us to describe and comprehensively understand the phenomenon. Results: The findings indicate that managing information is a sensitive aspect in evaluating healthcare experiences, with the potential to either positively or negatively impact the acceptance of diagnosis and treatment planning. The negative impact is determined by the communicative dimension and how healthcare teams deliver information. Poor attention, poor treatment, and lack of empathy lead patients to reject or distance themseves from the healthcare system. The positive aspects are related to a sensitive, personalized, and highly empathetic treatment. In historically endemic areas, these factors are essential for ensuring continuity in healthcare processes. There is an evident need to understand and value the settings, means, and contents within Chagas´s healthcare contexts. Conclusion: Communication is crucial during diagnostic processes as it determines the assessment, credibility, and trust in the health system, thereby influencing the continuity of treatment, especially in highly sensitive moments such as pregnancy. Therefore, it is necessary to articulate strategies considering information magement with greater empathy and emotional support. [ABSTRACT FROM AUTHOR]

Objective: To investigate pregnant women's preferences for risks of vaginal and caesarean birth, including possible impacts on future fertility. Methods: In this discrete choice experiment, low-risk nulliparous pregnant women recruited after 28 weeks of gestation evaluated eight choice sets, each between two different hypothetical births scenarios which intermixed the risks of planned caesarean or vaginal birth. Scenarios consisted of six attributes: pain, maternal health, neonatal health, risk of unplanned intervention, impact on fertility and risk of complications in the next pregnancy. All scenarios contained risks to neonatal health as neither vaginal nor caesarean birth guarantee an ideal outcome. Choice data were analysed using a conditional logistic regression model. Results: Between June and September 2023, 211 participants, including 34 from pilot interviews, completed the questionnaire. Influential attributes were maternal health (conditional odds ratio [COR] 1.29, 95% CI 1.17 to 1.42, p<0.001) and risk of unplanned intervention (COR 1.37, 95% CI 1.24 to 1.51, p<0.001), favouring caesarean birth. Conversely, impact on fertility (COR 0.75, 95% CI 0.68 to 0.83, p<0.001) and complications in the next pregnancy favoured vaginal birth (COR 0.90, 95% CI 0.82 to 1.00, p = 0.045). Conclusions: Participants weighed the included morbidity risks of planned caesarean and vaginal birth in a low-risk pregnancy approximately equally. To facilitate an informed birth decision, clinicians should, apart from neonatal outcomes, particularly consider discussing impacts on fertility, maternal health and the risks of unplanned intervention or future pregnancy complications. [ABSTRACT FROM AUTHOR]

Background: The association between serum triglyceride to high density lipoprotein cholesterol ratio (THR) in late pregnancy and adverse birth outcomes (ABO) remains controversial because of inconsistent results. The present study assessed the association between maternal serum THR and incidence of ABO [preterm birth (PTB), small and large for gestational age (SGA/LGA), low birth weight (LBW) and macrosomia] in a Chinese population. Methods: A total of 11,553 consecutive participants from a real-world database with data on lipid profiles and birth outcomes were included. Logistic regression models were applied to assess the association between THR and incident ABO. Mediation analysis was performed to investigate the contribution of pregnancy complications [gestational diabetes mellitus (GDM), intrahepatic cholestasis of pregnancy (ICP) and pre-eclampsia (PE)] to this association. Results: Approximately 6.6% (762/11,553), 8.9% (1023/11,553), 15.5% (1792/11,553), 4.3% (494/11,553), and 7.4% (851/11,553) of individuals developed PTB, SGA, LGA, LBW and macrosomia, respectively. Significant trends across the quintiles of THR toward decreasing incidence of SGA and LBW and increasing incidence of LGA and macrosomia were observed. The multivariate-adjusted odds ratios (OR) in the top quintile of serum THR (> 3.16) versus the bottom quintile (< 1.44) were 0.52 for PTB, 0.48 for SGA, 0.64 for LBW, 2.80 for LGA and 3.80 for macrosomia, respectively. A 1-standard deviation (SD) increase in serum THR was associated with decreased risk of PTB [OR = 0.84, 95% confidence interval (CI): 0.76–0.93), SGA (OR = 0.71, 95% CI:0.65–0.78) and LBW (OR = 0.76, 95% CI:0.65–0.90) and increased risk of LGA (OR = 1.40, 95% CI:1.32–1.49) and macrosomia (OR = 1.49, 95% CI:1.38–1.62). In mediation analyses, PE mediated − 19.8%, -10.6% and − 24.6% of THR-associated PTB, SGA and LBW, respectively, GDM accounted for − 3.7%, 6.8% and 4.3% of THR-associated PTB, LGA and macrosomia, respectively, and ICP explained − 1.9% and − 2.1% of THR-associated PTB and LBW, respectively. In addition, incorporating THR to ABO predictive models significantly improved the area under the curve for SGA (0.743 vs. 0.753, P < 0.001), LGA (0.734 vs. 0.745, P < 0.001) and macrosomia (0.786 vs. 0.800, P < 0.001). Conclusion: Real-world data showed an association between serum THR in late pregnancy and ABO risk, and this association may be partially mediated by prevalent pregnancy complications (PE/GDM/ICP), suggesting a potential role of THR in predicting ABO (SGA/LGA/macrosomia). [ABSTRACT FROM AUTHOR]

Background Aims Materials and methods Results Conclusions Anticoagulant therapy prevents thrombosis and thromboembolic events in patients with mechanical heart valves. Bridging anticoagulation around the time of birth represents a unique challenge. Few retrospective reviews or case series exist examining peripartum outcomes with bridging anticoagulation.Review of peripartum and postpartum anticoagulation management, with a focus on postpartum complications.Design: case series, single centre. Setting: Royal Brisbane and Women's Hospital, Australia between 1 January, 2000, and 1 August, 2022. Population: all pregnant women with mechanical heart valves (any type) who birthed. Main outcome measures: intrapartum and postpartum haemorrhage, thrombosis, thromboembolic complications, cardiac events, readmission, and maternal death.There were 18 women, with 23 births. Sixteen births were via caesarean section (70%). Fourteen women (61%) experienced at least one significant haemorrhagic complication, one woman required a peripartum hysterectomy, one woman experienced atrial fibrillation, and one had a valvular thromboembolic complication. No maternal cerebral thromboses or maternal deaths were recorded.Women with mechanical heart valves who undergo bridging anticoagulation are associated with significant maternal morbidity. Most postpartum haemorrhagic complications were associated with bridging unfractionated heparin infusions in the first postnatal week. Bridging anticoagulation practices varied widely. Ongoing pooled data are required to inform evidence‐based guidelines for postpartum anticoagulation management. [ABSTRACT FROM AUTHOR]

Background: Gestational diabetes mellitus (GDM) is a common pregnancy complication characterized by insulin resistance. A link has been suggested between insulin resistance and breast cancer, which is the most common cancer in women. Hence, women with previous GDM may be at increased risk of developing breast cancer, yet, the existing evidence is conflicting. This study explored the association between GDM and incident breast cancer, including age at cancer diagnosis. Additionally, we investigated the potential impact of severity of insulin resistance during pregnancy and of subsequent diabetes development on the breast cancer risk. Methods: We conducted a nationwide, register-based cohort study including all women giving birth in Denmark from 1997 to 2018. We defined GDM and breast cancer based on ICD-10 codes. Premenopausal and postmenopausal breast cancer was pragmatically defined as age at outcome < 50 years and ≥ 50 years, respectively. A proxy for severity of insulin resistance during pregnancy was based on insulin treatment; subsequent diabetes was defined as presence of ICD-10 codes and/or antidiabetic medication after pregnancy. The statistical analyses included Cox regression, logistic regression and t-test. Results: Of 708,121 women, 3.4% had GDM. The median follow-up period was 11.9 years (range 0-21.9). The overall breast cancer risk was comparable in women with and without previous GDM (adjusted hazard ratio 0.96 [95% CI 0.83–1.12]). Premenopausal and postmenopausal breast cancer risk also did not differ; however, women with previous GDM had a breast cancer diagnosis at younger age (42.6 vs. 43.5 years, p-value 0.01). All-cause mortality was similar regardless of GDM history. Severity of insulin resistance during pregnancy and subsequent diabetes did not affect breast cancer risk. Conclusions: This large, population-based cohort study showed no higher risk of incident breast cancer in women with previous GDM compared to women without previous GDM after a median of almost 12 years of follow-up. This was evident irrespective of menopausal state. The breast cancer risk was not influenced by the severity of insulin resistance during pregnancy and by subsequent diabetes development. Regardless of GDM history, attention towards prevention, early detection and treatment of breast cancer should be prioritized. [ABSTRACT FROM AUTHOR]

Vasa previa is a condition where unprotected fetal vessels cross the cervix within the membranes, posing a considerable risk of fetal death or severe morbidity if the membranes rupture before or during delivery. There has not been a definitive in utero treatment for this condition. Patients are typically closely monitored and hospitalized in the early third trimester and scheduled for cesarean delivery before term. This approach poses considerable physical, social, psychological, and financial challenges for pregnant patients and their families. Furthermore, fetal vessel rupture may lead to severe hypoxic-ischemic injury and consequent neurodevelopmental impairment. Finally, babies delivered early due to vasa previa may face both the short- and long-term consequences of prematurity. Recently, fetoscopic laser photocoagulation using a single-port fetoscope has emerged as a potential therapeutic option for patients with types II and III vasa previa. This innovative approach aims to reduce hospital stays, increases the chance of successful vaginal delivery, and potentially allows pregnancies to reach full term, providing lifelong benefits for the infant. Preliminary clinical studies on human subjects have demonstrated promising results concerning the feasibility, safety, and efficacy of this intervention for a subset of patients with types II and III vasa previa. After reviewing the current state of the art, we argued that offering fetoscopic laser photocoagulation in specialized centers under IRB supervision meets the ethical obligations of beneficence and non-maleficence for both pregnant and fetal patients, as well as the autonomy-based obligations for pregnant patients. [ABSTRACT FROM AUTHOR]

To estimate the number of pregnancies complicated by vasa previa annually in nine developed countries, and the potential preventable stillbirths associated with undiagnosed cases. We also assessed the potential impact of universal screening for vasa previa on reducing stillbirth rates. We utilized nationally-reported birth and stillbirth data from public databases in the United States, United Kingdom, Canada, Germany, Ireland, Greece, Sweden, Portugal, and Australia. Using the annual number of births and the number and rate of stillbirths in each country, and the published incidence of vasa previa and stillbirth rates associated with the condition, we estimated the expected annual number of cases of vasa previa, those that would result in a livebirth, and the potential preventable stillbirths with and without prenatal diagnosis. There were 6,099,118 total annual births with 32,550 stillbirths, corresponding to a summary stillbirth rate of 5.34 per 1,000 pregnancies. The total expected vasa previa cases was estimated to be 5,007 (95 % CI: 3,208–7,201). The estimated number of livebirths would be 4,937 (95 % CI: 3,163–7,100) and 3,610 (95 % CI: 2,313–5,192) in pregnancies with and without a prenatal diagnosis of VP. This implies that prenatal diagnosis would potentially prevent 1,327 (95 % CI: 850–1,908) stillbirths in these countries, corresponding to a potential reduction in stillbirth rate by 4.72 % (95 % CI: 3.80–5.74) if routine screening for vasa previa was performed. Our study highlights the importance of universal screening for vasa previa and suggests that prenatal diagnosis of prevention could potentially reduce 4–5 % of stillbirths. [ABSTRACT FROM AUTHOR]

To develop prediction models for intrapartum caesarean section in vaginal breech birth. This single-center cohort-study included 262 nulliparous and 230 multiparous women attempting vaginal breech birth. For both groups, we developed and (internally) validated three models for the prediction of intrapartum cesarean section. The prediction model for nulliparous women (AUC: 0.67) included epidural analgesia (aOR 2.14; p=0.01), maternal height (aOR 0.64 per 10 cm; p=0.08), birthweight ≥3.8 kg (aOR 2.45; p=0.03) and an interaction term describing the effect of OC if birthweight is ≥3.8 kg (aOR 0.24; p=0.04). An alternative model for nulliparous women which, instead of birthweight, included fetal abdominal circumference with a cut-off at 34 cm (aOR 1.93; p=0.04), showed similar performance (AUC: 0.68). The prediction model for multiparous women (AUC: 0.77) included prelabor rupture of membranes (aOR 0.31; p=0.03), epidural analgesia (aOR 2.42; p=0.07), maternal BMI (aOR 2.92 per 10 kg/m2; p=0.01) and maternal age (aOR 3.17 per decade; p=0.06). Our prediction models show the most relevant risk factors associated with intrapartum cesarean section in vaginal breech birth for both nulliparous and multiparous women. Importantly, this study clarifies the role of the OC by showing that this parameter is only associated with intrapartum cesarean section if birthweight is above 3.8 kg (or abdominal circumference is above 34 cm). Conversely, knowing the OC when the birthweight is less than 3.8 kg (or abdominal circumference is less than 34 cm) did not improve prediction of this surgical outcome. [ABSTRACT FROM AUTHOR]

Complementary and Alternative Medicine (CAM) is a group of diverse medical and healthcare systems, practices, and products that are not generally considered part of conventional medicine. Pregnant women are vulnerable to adverse effects of medicines, especially during the first trimester. Though it is advised to avoid unnecessary intake of medicine during pregnancy, CAM use is widespread. A cross-sectional questionnaire-based study was conducted on 120 pregnant women attending the antenatal clinic of a tertiary-care teaching hospital in Udaipur district of Southern Rajasthan, India. Women of age 18 years and above were surveyed between July 2022 to December 2023 by convenient sampling strategy and data were entered in a pretested and pre-validated questionnaire. The data were analyzed using descriptive statistics, the Chi-square test was applied to compare CAM use among different demographic categories and a p-value less than 0.05 was considered statistically significant. Out of 120 participants, 58 (48.33 %) were using CAM therapy. Out of 58 users, 44 (75.86 %) were using herbal & traditional medicines. Twenty (34.48 %) were using CAM for a healthy baby, 18 (31.03 %) for easy delivery and 17 (29.31 %) for boosting immunity. Forty (68.96 %) participants started CAM on the advice of a relative/friend. Fifty six (46.67 %) participants believe that CAM therapy cannot cause adverse effects on the in utero child, while 32 (26.67 %) believe that CAM and modern medicines don't interact. CAM use among pregnant women is substantial. There is a need to raise awareness among the healthcare professionals and pregnant women regarding possible adverse effects and drug-drug interactions with CAM use. [ABSTRACT FROM AUTHOR]

Gestational diabetes mellitus (GDM) is a common complication during pregnancy with an increasing prevalence worldwide. Early prediction of GDM and its associated adverse outcomes is crucial for timely intervention and improved maternal and fetal health. The objective of this review is to provide a comprehensive summary of contemporary evidence on biomarkers, focusing on their potential to predict the development of GDM and serve as predictors of maternal, fetal, and neonatal outcomes in women with GDM. A literature search was conducted in the PubMed database using relevant terms. Original research articles published in English between 1 January 2015, and 30 June 2024, were included. A two-stage screening process was employed to identify studies on biomarkers for GDM diagnosis and prognosis and to evaluate the evidence for each biomarker's diagnostic performance and its potential prognostic correlation with GDM. Various biochemical markers, including adipokines, inflammatory markers, insulin resistance markers, glycemic markers, lipid profile markers, placenta-derived markers, and other related markers, have shown promise in identifying women at risk of developing GDM and predicting adverse pregnancy outcomes. Several promising markers with high predictive performance were identified. However, no single biomarker has demonstrated sufficient accuracy to replace the current diagnostic criteria for GDM. The complexity of multiple pathways in GDM pathogenesis highlights the need for a multi-marker approach to improve risk stratification and guide personalized management strategies. While significant progress has been made in GDM biomarker research, further studies are required to refine and validate these markers for clinical use and to develop a comprehensive, evidence-based approach to GDM prediction and management that can improve maternal and child health outcomes. [ABSTRACT FROM AUTHOR]

Reciprocal in vitro fertilization (IVF) and intravaginal culture (IVC) are two technologies that allow same-sex female couples to jointly contribute biologically to a pregnancy. This systematic review aimed to synthesize the clinical outcomes of each method including live birth rate, clinical pregnancy rate, embryo quality, and perinatal complications. A dual-reviewer protocol identified eight studies on reciprocal IVF and ten studies on IVC. In retrospective studies reporting on a total of 1,405 reciprocal IVF cycles, reciprocal IVF has demonstrated similar cycle and pregnancy outcomes to autologous IVF. One study that reported on pregnancy complications found a comparable rate of hypertensive disease in pregnancy between patients undergoing reciprocal IVF and intrauterine insemination. However, a lack of prospective studies on reciprocal IVF limits the generalizability of these results. Overall, small prospective and retrospective studies reporting on a total of 776 IVC cycles show that IVC offers good cycle and pregnancy outcomes, comparable to IVF. However, randomized prospective studies reported that the rate of quality embryo creation in IVC may be lower than in IVF. Although both reciprocal IVF and IVC show promise for same-sex female couples and the larger lesbian, gay, bisexual, transgender, intersex, asexual, and other sexual or gender minorities community, this review has highlighted the need for larger, prospective, more diverse studies on methods of shared biological contribution for family building. [ABSTRACT FROM AUTHOR]

The human placenta is a vital organ, encompassing many distinct cell types, that maintains the growth and development of the fetus and is essential for substance exchange, defense, synthesis, and immunity. Abnormalities in placental cells can lead to various pregnancy complications, but the mechanisms remain largely unclear. Single‐cell and spatial transcriptomics technologies have been developed in recent years to demonstrate placental cell heterogeneity and spatial molecular localization. Here, we review and summarize the current literature, demonstrating these technologies and showing the heterogeneity of various placenta cells and cell–cell communication of normal human placenta, as well as placenta‐related diseases, such as preeclampsia, gestational diabetes mellitus, advanced maternal age, recurrent pregnancy loss, and placenta accreta spectrum disorders. Meanwhile, current weaknesses and future direction were discussed. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To examine the association between neighborhood socioeconomic disadvantage and birth outcomes among refugee women in Denmark, leveraging a natural experiment. METHODS: This register-based study included 15 118 infants born to women who arrived in Denmark as refugees during 1986 to 1998, when a dispersal policy was in place that quasirandomly assigned newcomers to neighborhoods with varying degrees of socioeconomic disadvantage. Neighborhood disadvantage was measured using a composite index representing neighborhood-level income, education, unemployment, and welfare assistance. These data were linked to individual-level birth register data. Outcomes included low birth weight, preterm birth, and small-for-gestational-age infants. Associations between neighborhood disadvantage at resettlement and birth outcomes up to 20 years after resettlement were examined using multivariable regressions adjusting for characteristics of the women at resettlement. RESULTS: Each SD of increase in neighborhood disadvantage was associated with an 18% increase in low birth weight risk (0.61 percentage points [pp], 95% confidence interval [CI]: 0.19-1.02), 15% increase in preterm birth risk (0.64 pp, 95% CI: 0.22-1.07), and 7% increase in small-for-gestational-age risk (0.78 pp, 95% CI: 0.01-1.54) 5 years after resettlement. Results did not differ after adjusting for urbanicity and conational density, but associations were attenuated after adjusting for municipality-level fixed effects, suggesting that local government characteristics may partially explain the associations. CONCLUSIONS: Resettling in a disadvantaged neighborhood is associated with higher risk of adverse birth outcomes among refugee women. This highlights how policy decisions affecting settlement of refugees can have long-term consequences, including on the health of the next generation. [ABSTRACT FROM AUTHOR]

Introduction: Most pregnancies are low-risk. However, sometimes women develop pre-eclampsia. The incidence varies based on different studies (Havers-Borgersen et al., 2023, 10.1136/jech-2023-220829).Pre-eclampsia is characterized by elevated blood pressure, protein in the urine, and excessive swelling and occurs after 20 weeks of pregnancy though in the case of severe symptoms, all may not be required for diagnosis (Bajpai et al., 2023). Many strategies exist to identify women with pre-eclampsia and to treat it. There are known immediate risks to both the mother and fetus. Some of these risks extend beyond the immediate postpartum period. Much less is known regarding the long-term risks. Therefore, the purpose of our study was to conduct a systematic review of the long-term complications related to pre-eclampsia. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were used to guide this systematic review. PubMed, CINAHL, Medline, Scopus, PschINFO, and Google Scholar were used to identify relevant articles. We focused on articles published within the last 5 years. Search terms were pre-eclampsia and complications, pregnancy-induced hypertension and complications, long-term complications of pre-eclampsia, and long-term follow-up of pre-eclampsia. Results: Two hundred and fifty-eight articles were identified; further analysis identified 91 that seemed relevant. After a thorough review, 19 articles were deemed relevant to identify complications women experience following pre-eclampsia. Discussion: Cardiovascular disease is a major long-term risk. Early-onset pre-eclampsia contributes the greatest risk. Health promotion interventions that target women following a diagnosis of pre-eclampsia are needed. Inadequate knowledge exists to guide efforts to prevent long-term sequelae from pre-eclampsia. Significance: Women who experience pre-eclampsia have significant health risks following the diagnosis. Some risks are immediate (elevated blood pressure) and some risks can take longer to develop (heart disease, diabetes, kidney disease). Because of these risks, it is critical to develop treatment strategies to prevent these risks if possible. There are also risks to the fetus/newborn and these may be amendable to intervention as well. [ABSTRACT FROM AUTHOR]

BACKGROUND Women with endometriosis may constitute a group at a particularly increased risk of pregnancy-related complications. Furthermore, women selected for assisted reproductive technology (ART) are exposed to additional endocrinological and embryological factors that have been associated with adverse pregnancy outcomes. OBJECTIVE AND RATIONALE This study aimed to investigate the independent effect of endometriosis, adenomyosis, and various ART-related factors on adverse maternal, placental, fetal, and neonatal outcomes. SEARCH METHODS Published randomized controlled trials, cohort studies, and case–control studies were considered eligible. PubMed, MEDLINE, ClinicalTrials.gov, Embase, and Scopus were systematically searched up to 1 March 2024. This systematic review and meta-analysis was performed in line with the PRISMA and the MOOSE reporting guidelines. To thoroughly investigate the association between endometriosis/adenomyosis and adverse pregnancy outcomes, sub-analyses were conducted, whenever possible, according to: the method of conception (i.e. ART and non-ART conception), the endometriosis stage/phenotype, the coexistence of endometriosis and adenomyosis, any pre-pregnancy surgical treatment of endometriosis, and the form of adenomyosis. The odds ratio (OR) with 95% CI was used as effect measure. The quality of evidence was assessed using the GRADE approach. OUTCOMES We showed a higher risk of placenta previa in women with endometriosis compared to controls (34 studies, OR 2.84; 95% CI: 2.47, 3.26; I 2 = 83%, moderate quality). The association was observed regardless of the method of conception and was particularly strong in the most severe forms of endometriosis (i.e. rASRM stage III–IV endometriosis and deep endometriosis (DE)) (OR 6.61; 95% CI: 2.08, 20.98; I 2 = 66% and OR 14.54; 95% CI: 3.67, 57.67; I 2 = 54%, respectively). We also showed an association, regardless of the method of conception, between endometriosis and: (i) preterm birth (PTB) (43 studies, OR 1.43; 95% CI: 1.32, 1.56; I 2 = 89%, low quality) and (ii) cesarean section (29 studies, OR 1.52; 95% CI: 1.41, 1.63; I 2 = 93%, low quality). The most severe forms of endometriosis were strongly associated with PTB. Two outcomes were associated with adenomyosis both in the main analysis and in the sub-analysis that included only ART pregnancies: (i) miscarriage (14 studies, OR 1.83; 95% CI: 1.53, 2.18; I 2 = 72%, low quality) and (ii) pre-eclampsia (7 studies, OR 1.70; 95% CI: 1.16, 2.48; I 2 = 77%, low quality). Regarding ART-related factors, the following associations were observed in the main analysis and confirmed in all sub-analyses conducted by pooling only risk estimates adjusted for covariates: (i) blastocyst stage embryo transfer (ET) and monozygotic twinning (28 studies, OR 2.05; 95% CI, 1.72, 2.45; I 2 = 72%, low quality), (ii) frozen embryo transfer (FET) and (reduced risk of) small for gestational age (21 studies, OR 0.59; 95% CI, 0.57, 0.61; P  < 0.00001; I 2 = 17%, very low quality) and (increased risk of) large for gestational age (16 studies, OR 1.70; 95% CI, 1.60, 1.80; P  < 0.00001; I 2 = 55%, very low quality), (iii) artificial cycle (AC)-FET and pre-eclampsia (12 studies, OR 2.14; 95% CI: 1.91–2.39; I 2 = 9%, low quality), PTB (21 studies, OR 1.24; 95% CI 1.15, 1.34; P  < 0.0001; I 2 = 50%, low quality), cesarean section (15 studies, OR 1.59; 95% CI 1.49, 1.70; P  < 0.00001; I 2 = 67%, very low quality) and post-partum hemorrhage (6 studies, OR 2.43; 95% CI 2.11, 2.81; P  < 0.00001; I 2 = 15%, very low quality). WIDER IMPLICATIONS Severe endometriosis (i.e. rASRM stage III–IV endometriosis, DE) constitutes a considerable risk factor for placenta previa and PTB. Herein, we recommend against superimposing on this condition other exposure factors that have a strong association with the same obstetric adverse outcome or with different outcomes which, if coexisting, could determine the onset of an ominous obstetric syndrome. Specifically, we strongly discourage the use of AC regimens for FET in ovulatory women with rASRM stage III–IV endometriosis or DE. We also recommend single ET at the blastocyst stage in this high-risk population. REGISTRATION NUMBER CRD42023401428. [ABSTRACT FROM AUTHOR]

STUDY QUESTION Is the degree of maternal vulnerability positively associated with stress biomarkers (stress hormones, C-reactive protein, tryptophan metabolites, and one-carbon metabolites), and does long-term exposure to stress hormones reduce first-trimester growth? SUMMARY ANSWER The maternal vulnerability risk score is positively associated with concentrations of hair cortisol and cortisone and negatively with tryptophan, while higher hair cortisol concentrations are associated with reduced first-trimester growth without mediation of tryptophan. WHAT IS KNOWN ALREADY A high degree of maternal vulnerability during the periconception period is associated with impaired first-trimester growth and pregnancy complications, with consequences for long-term health of the child and future life course. However, due to the challenges of early identification of vulnerable women, the uptake of periconception care is low in this target group. STUDY DESIGN, SIZE, DURATION Between June 2022 and June 2023, this study was conducted in a sub-cohort of 160 pregnant women participating in the Rotterdam Periconceptional Cohort (Predict Study), an ongoing prospective tertiary hospital-based cohort. PARTICIPANTS/MATERIALS, SETTING, METHODS One hundred and thirty-two women with ongoing pregnancies and available stress biomarker data were included in the analysis. Data on periconceptional social, lifestyle, and medical risk factors were collected via self-administered questionnaires, and these factors were used for the development of a composite maternal vulnerability risk score. Stress biomarkers, including stress hormones (hair cortisol and cortisone) and inflammatory and oxidative stress biomarkers (C-reactive protein, total homocysteine, and tryptophan metabolites) were determined in the first trimester of pregnancy. First-trimester growth was assessed by crown–rump length (CRL) and embryonic volume (EV) measurements at 7, 9, and 11 weeks gestation by making use of an artificial intelligence algorithm and virtual reality techniques using 3D ultrasound data sets. The associations between the maternal vulnerability risk score and stress biomarkers were identified using linear regression models, and between stress hormones and CRL- and EV-trajectories using mixed models. A mediation analysis was performed to assess the contribution of tryptophan. All associations were adjusted for potential confounders, which were identified using a data-driven approach. Several sensitivity analyses were performed to check the robustness of the findings. MAIN RESULTS AND THE ROLE OF CHANCE The maternal vulnerability risk score was positively associated with concentrations of hair cortisol and cortisone (pg/mg) (β = 0.366, 95% CI = 0.010–0.722; β = 0.897, 95% CI = 0.102–1.691, respectively), and negatively with tryptophan concentrations (µmol/L) (β = –1.637, 95% CI = –2.693 to –0.582). No associations revealed for C-reactive protein and total homocysteine. Higher hair cortisol concentrations were associated with reduced EV-trajectories (3√EV: β = –0.010, 95% CI = –0.017 to –0.002), while no associations were found with CRL-trajectories. Mediation by tryptophan was not shown. LIMITATIONS, REASONS FOR CAUTION Residual confounding cannot be ruled out, and the external validity may be limited due to the study's single-center observational design in a tertiary hospital. WIDER IMPLICATIONS OF THE FINDINGS There is mounting evidence that a high degree of maternal vulnerability negatively affects maternal and perinatal health, and that of the future life course. The results of our study emphasize the need to identify highly vulnerable women as early as possible, at least before conception. Our findings suggest that the chronic stress response and alterations of the maternal tryptophan metabolism are involved in maternal vulnerability, affecting first-trimester growth, with potential impact on the long-term health of the offspring. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by the Departments of Obstetrics and Gynecology and Clinical Chemistry of the Erasmus MC, University Medical Center, Rotterdam, the Netherlands, and the Junior Award granted by the De Snoo—van 't Hoogerhuijs Foundation in March 2022. There are no conflicts of interest. TRIAL REGISTRATION NUMBER N/A. [ABSTRACT FROM AUTHOR]

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

Background: Systemic lupus erythematosus (SLE) affects women, with the onset of disease typically around the childbearing years. Aims: This study examines the frequency and risk factors for adverse pregnancy outcomes (APOs) in an Australian cohort, and any disease flares during pregnancy and post partum. Methods: Female patients with SLE enrolled in the Australian Lupus Registry and Biobank (ALRB) between January 2007 and June 2019 were studied. Self‐reported pregnancy history, including adverse foetal or maternal outcomes, was collected at the time of enrolment and updated as appropriate. Baseline demographics, clinical parameters, medication exposure and disease activity were collected. Factors associated with APO were examined using univariate and multivariate logistic regression analyses. Results: Pregnancy history was available in 278 patients; 30% were nulliparous. Most pregnancies occurred before the diagnosis of SLE. Patients who had pregnancies after SLE diagnosis had an earlier age of diagnosis, and had fewer pregnancies. The APO rate was 44.3% in the overall cohort, with most presenting as prematurity with or without foetal growth restriction. Women with APO were also diagnosed with SLE at a younger age and had a higher prevalence of anti‐cardiolipin antibodies and hypocomplementemia. Early age of SLE diagnosis was a significant independent risk factor for APO. No increase in disease flare was observed in those who experienced APO during the observation period of ALRB. Conclusion: This study shows a considerable incidence of APO in patients with SLE, emphasising the need for pre‐pregnancy counselling and collaboration between maternal‐foetal medicine specialists and rheumatologists, especially for women diagnosed with SLE at a younger age. [ABSTRACT FROM AUTHOR]

The article discusses the case of a 42-year-old pregnant woman with type 2 diabetes who was treated with dulaglutide until the 34th week of pregnancy. Despite concerns about the use of GLP-1 RAs in pregnancy, the woman did not experience fetal malformations or neonatal complications. The case highlights the need for improved clinical education for women with type 2 diabetes regarding pregnancy planning and the potential risks associated with certain medications. [Extracted from the article]

Objective: To investigate the correlation between lipid levels during gestation and the incidence rate of gestational diabetes mellitus (GDM) and macrosomia. Method: Clinical records of 607 pregnant women with GDM (GDM group) who delivered in the Obstetrics Department of Fujian Maternal and Child Health Hospital from May to December 2018 and of 833 women with uncomplicated pregnancies (control group) were retrospectively analyzed. After delivery, the entire cohort was further grouped based on the weight of the neonates: women who delivered newborns with body mass <4 kg comprised the normal group (n = 1367), and pregnancies that resulted in delivery of neonates with body mass >4 kg were classified as the macrosomia group (n = 73). Fasting serum levels of triglycerides (TG), total cholesterol (TC), high‐density lipoprotein cholesterol (HDL‐C), low‐density lipoprotein cholesterol (LDL‐C), and TG/HDL‐C ratio were compared between the groups at the early (10–12 weeks), middle (24–28 weeks), and late (28 weeks‐delivery) stages of pregnancy, and the correlation between the lipid indices and the rates of GDM and macrosomia were analyzed. Results: There was a gradual increase in TC, TG, LDL‐C, and TG/HDL‐C levels with increasing gestational weeks in pregnant women. TG and TG/HDL‐C levels were markedly higher, while HDL‐C was lower in women with GDM compared with women of the same gestational age with uncomplicated pregnancies (p < 0.05). Conclusion: Lipid metabolism disorders exist in pregnant women with GDM at different gestational stages and are closely related to the higher incidence of macrosomia. TG, TG/HDL‐C, and HDL‐C in early and late pregnancy are independent risk factors for macrosomia in all trimesters, and TG/HDL‐C ratio at different gestational stages has a good predictive value for macrosomia. [ABSTRACT FROM AUTHOR]

Aim: Prenatal maternal depression is known to affect the neurodevelopment of offspring. This study aimed to investigate the profile of umbilical cord serum in mothers with major depressive disorder (MDD). Methods: Liquid chromatography–tandem mass spectrometry (LC–MS) was conducted using umbilical cord serum from mothers with MDD (n = 5) and controls (control, n = 5). The levels of several differentially expressed proteins in umbilical cord serum were compared between the MDD (n = 10) and control groups (n = 10) by enzyme‐linked immunosorbent assay. Results: The proteomic profiles in the umbilical cord serum were different between the MDD and control groups, including the pathways of regulation of plasma lipoprotein particle levels, and synapse organization. Only apolipoprotein A4 (APOA4) was significantly higher in the cord blood of MDD group. APOA4 levels in maternal serum were also significantly higher in the MDD group than those in the control group. The APOA4 levels in the umbilical cord serum were higher than that in the maternal serum. Conclusions: The levels of APOA4, a biomarker of depression, in the umbilical cord serum at birth were elevated in the neonates of MDD mothers. It is, therefore, likely that fetuses of MDD mothers were exposed to higher APOA4 levels in utero and this could have developmental and mental health implications for the offspring. [ABSTRACT FROM AUTHOR]

Background: Previous studies provided inconsistent associations between diabetes mellitus (DM) and miscarriage, recurrent miscarriage (RM). Therefore, this study aims to evaluate the association between DM and miscarriage, specifically RM, through a meta‐analysis approach. Methods: We searched for articles published before July 2023 in PubMed and Web of Science databases. STATA 12.0 software was used to compute all the results collected from included studies. Results: DM was associated with a higher risk of miscarriage, RM (miscarriage: odds ratio [OR]/relative risk [RR] = 1.23, 95% confidence interval [CI] 1.13 to 1.34; RM: OR/RR = 1.73, 95% CI 1.55 to 1.94). T1DM was associated with a higher risk of miscarriage (OR/RR = 1.16, 95% CI 1.07 to 1.26). Similarly, T2DM showed a higher risk of miscarriage (OR/RR = 1.44, 95% CI 1.23 to 1.68). Miscarriage, RM were associated with a higher risk of DM (miscarriage: OR/RR = 1.14, 95% CI 1.08 to 1.19; RM: OR/RR = 1.14, 95% CI 1.08 to 1.20). Furthermore, miscarriage was found to be associated with a higher risk of T2DM (OR/RR = 1.08, 95% CI 1.05 to 1.11). Conclusion: In conclusion, our meta‐analysis findings indicate a significant association between DM and miscarriages as well as RM. As a result, women with a history of miscarriage should consider regular monitoring of their metabolic health as a potential benefit. Nevertheless, it is important to note that further research is needed to validate the results of our study and shed light on the biological mechanisms underlying these associations. [ABSTRACT FROM AUTHOR]

Maternal asthma is associated with increased rates of neonatal lung disease, and fetuses from asthmatic ewes have fewer surfactant‐producing cells and lower surfactant‐protein B gene (SFTPB) expression than controls. Antenatal betamethasone increases lung surfactant production in preterm babies, and we therefore tested this therapy in experimental maternal asthma. Ewes were sensitised to house dust mite allergen, and an asthmatic phenotype induced by fortnightly allergen lung challenges; controls received saline. Pregnant asthmatic ewes were randomised to receive antenatal saline (asthma) or 12 mg intramuscular betamethasone (asthma+beta) at 138 and 139 days of gestation (term = 150 days). Lambs were delivered by Caesarean section at 140 days of gestation and ventilated for 45 min before tissue collection. Lung function and structure were similar in control lambs (n = 16, 11 ewes) and lambs from asthma ewes (n = 14, 9 ewes). Dynamic lung compliance was higher in lambs from asthma+beta ewes (n = 12, 8 ewes) compared to those from controls (P = 0.003) or asthma ewes (P = 0.008). Lung expression of surfactant protein genes SFTPA (P = 0.048) and SFTPB (P < 0.001), but not SFTPC (P = 0.177) or SFTPD (P = 0.285), was higher in lambs from asthma+beta than those from asthma ewes. Female lambs had higher tidal volume (P = 0.007), dynamic lung compliance (P < 0.001), and SFTPA (P = 0.037) and SFTPB gene expression (P = 0.030) than males. These data suggest that betamethasone stimulates lung maturation and function of near‐term neonates, even in the absence of impairment by maternal asthma. What is the central question of this study?Does antenatal betamethasone before near‐term delivery mitigate the increased risk of neonatal lung disease in a sheep model of maternal asthma?What is the main finding and its importance?Maternal asthma did not impair neonatal lung function or reduce surfactant gene expression, likely reflecting a mild maternal and fetal phenotype in this cohort. Nevertheless, antenatal maternal betamethasone treatment in asthmatic pregnancies increased dynamic lung compliance and surfactant protein A and B mRNA expression in newborn lambs. These data suggest potential benefits of betamethasone on lung maturation when mothers have asthma. [ABSTRACT FROM AUTHOR]

Objective: To assess the association between adenomyosis volume, as a reflection of its severity, and the risk of adverse perinatal outcomes. Methods: This multicenter retrospective cohort study was conducted at a comprehensive tertiary care institution and a tertiary maternal and child healthcare hospital, which are the main types of hospital providing maternal medical care in China. The study included pregnant women without adenomyosis (non‐AD cohort) who delivered between 1 January 2021 and 31 December 2021, and women with pregnancy complicated by adenomyosis (AD cohort) who delivered between 1 January 2020 and 31 December 2022. Adenomyosis was diagnosed and measured using transvaginal or transabdominal ultrasound up to 14 weeks of gestation. The adenomyosis volume (V) was calculated based on the sonographic measurement of three dimensions, using the formula V = (length × width × thickness) × 4/3π. Univariate and multivariate logistic regression analyses were conducted to assess the association between adenomyosis and the risk of pregnancy complications. We also performed a sensitivity analysis among 226 pregnancies complicated by adenomyosis that had volume measurements available and 10 507 pregnancies without adenomyosis, using as a threshold for severe adenomyosis the 3rd quartile of adenomyosis volume. Results: The study group included 10 507 pregnant women in the non‐AD cohort and 321 in the AD cohort. Pregnancies complicated by adenomyosis had an increased risk of preterm birth < 37 weeks of gestation (adjusted odds ratio (aOR), 2.39 (95% CI, 1.65–3.48)), spontaneous preterm birth < 37 weeks of gestation (aOR, 2.57 (95% CI, 1.54–4.28)), placenta previa (aOR, 2.57 (95% CI, 1.41–4.67)), cervical incompetence (aOR, 9.70 (95% CI, 4.00–23.55)) and abnormal fetal presentation (aOR, 2.04 (95% CI, 1.39–3.00)), and there was also a non‐significant trend toward increased risk of pre‐eclampsia (aOR, 1.64 (95% CI, 0.94–2.85)). Sensitivity analysis revealed there was a greater risk in pregnancies with severe (≥ 757.5 cm3) vs mild adenomyosis of preterm birth < 37 weeks of gestation (aOR, 5.50 (95% CI, 2.80–10.82) vs aOR, 1.73 (95% CI, 0.98–3.05)), pre‐eclampsia (aOR, 4.94 (95% CI, 2.11–11.58) vs aOR, 1.03 (95% CI, 0.41–2.58)), placenta previa (aOR, 6.37 (95% CI, 2.39–17.04) vs aOR, 1.58 (95% CI, 0.60–4.19)) and cervical incompetence (aOR, 12.79 (95% CI, 2.87–56.93) vs aOR, 4.97 (95% CI, 1.25–19.77)) compared to pregnancies without adenomyosis. The risk of spontaneous preterm birth < 37 weeks and the risk of abnormal fetal presentation was similar between the two subgroups. Conclusion: Pregnancies complicated by adenomyosis, particularly those with severe adenomyosis, have an increased risk of pregnancy complications, including preterm birth, spontaneous preterm birth, placenta previa, cervical incompetence and abnormal fetal presentation. © 2024 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To examine long-term diabetes risk after preterm delivery or hypertensive disorders of pregnancy in a large population-based cohort. METHODS: This retrospective cohort study included all women with a singleton delivery in Sweden during 1973-2015 and no preexisting diabetes mellitus. Participants were followed up for development of type 2 diabetes identified from nationwide outpatient and inpatient diagnoses through 2018. Cox regression was used to compute hazard ratios (HRs) for the association between preterm delivery or hypertensive disorders of pregnancy and type 2 diabetes with adjustment for gestational diabetes and other maternal factors. Co-sibling analyses assessed for confounding by shared familial (genetic or environmental) factors. RESULTS: Overall, 2,184,417 women were included. Within 10 years after delivery, adjusted HRs for type 2 diabetes associated with specific pregnancy outcomes were as follows: any preterm delivery (before 37 weeks of gestation), 1.96 (95% CI, 1.83-2.09); extremely preterm delivery (22-27 weeks), 2.53 (95% CI, 2.03-3.16); and hypertensive disorders of pregnancy, 1.52 (95% CI, 1.43-1.63). All HRs remained significantly elevated (1.1-1.7-fold) 30-46 years after delivery. These findings were largely unexplained by shared familial factors. CONCLUSION: In this large national cohort, preterm delivery and hypertensive disorders of pregnancy were associated with increased risk for type 2 diabetes up to 46 years later. Women with these pregnancy complications are candidates for early preventive actions and long-term monitoring for type 2 diabetes. [ABSTRACT FROM AUTHOR]

Objective: Primary antiphospholipid syndrome (PAPS) is a rare autoimmune disease characterized by the presence of antiphospholipid antibodies and the occurrence of thrombotic events and pregnancy complications. Our study aimed to identify novel genetic susceptibility loci associated with PAPS. Methods: We performed a genome‐wide association study comprising 5,485 individuals (482 affected individuals) of European ancestry. Significant and suggestive independent variants from a meta‐analysis of approximately 7 million variants were evaluated for functional and biological process enrichment. The genetic risk variability for PAPS in different populations was also assessed. Hierarchical clustering, Mahalanobis distance, and Dirichlet Process Mixtures with uncertainty clustering methods were used to assess genetic similarities between PAPS and other immune‐mediated diseases. Results: We revealed genetic associations with PAPS in a regulatory locus within the HLA class II region near HLA‐DRA and in STAT1‐STAT4 with a genome‐wide level of significance; 34 additional suggestive genetic susceptibility loci for PAPS were also identified. The disease risk allele near HLA‐DRA is associated with overexpression of HLA‐DRB6, HLA‐DRB9, HLA‐DQA2, and HLA‐DQB2 in immune cells, vascular tissue, and nervous tissue. This association is independent of the association between PAPS and HLA‐DRB1*1302. Functional analyses highlighted immune‐related pathways in PAPS‐associated loci. The comparison with other immune‐mediated diseases revealed a close genetic relatedness to neuromyelitis optica, systemic sclerosis, and Sjögren syndrome, suggesting co‐localized causal variations close to STAT1‐STAT4, TNPO3, and BLK. Conclusion: This study represents a comprehensive large‐scale genetic analysis for PAPS and provides new insights into the genetic basis and pathophysiology of this rare disease. [ABSTRACT FROM AUTHOR]

Introduction: To compare neonatal, obstetrical, and maternal outcomes associated with outpatient vs inpatient management of pregnancies with preterm prelabor rupture of membranes (PPROM). Material and Methods: A search of MEDLINE, EMBASE, the Cochrane Database and Central Register from January 1, 1990 to July 31, 2023 identified randomized controlled trials (RCTs) and cohort studies comparing outpatient with inpatient management for pregnant persons diagnosed with PPROM before 37 weeks' gestation. No language restriction was applied. We applied a random effects model for meta‐analysis. Trustworthiness was assessed using recently published guidance and Risk of bias using the RoB 2.0 tool for RCTs and ROBINS‐I tool for cohort studies. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach was used to assess the certainty of evidence (COE). Outcomes of interest included perinatal mortality, neonatal morbidities, latency and gestational age at delivery, and maternal morbidities. RCTs and cohort studies were analyzed separately. This study was registered in the International Prospective Register of Systematic Reviewsr: CRD42022295275. Results: From 2825 records, two RCTs and 10 cohort studies involving 1876 patients were included in the review and meta‐analysis. Outpatient management protocols varied but generally included brief initial hospitalization, strict eligibility criteria, and surveillance with laboratory and ultrasound investigations. Outpatient management showed lower rates of neonatal respiratory distress syndrome (cohort: RR 0.63 [0.52–0.77, very low COE]), longer latency to delivery (RCT: MD 7.43 days [1.14–13.72 days, moderate COE], cohort: MD 8.78 days [2.29–15.26 days, low COE]), higher gestational age at birth (cohort: MD 7.70 days [2.02–13.38 days, low COE]), lower rates of Apgar scores <7 at 5 min of life (cohort: RR 0.66 [0.50–0.89, very low COE]), and lower rates of histological chorioamnionitis (cohort: RR 0.74 [0.62–0.89, low COE]) without increased risks of adverse neonatal, obstetrical, or maternal outcomes. Conclusions: Meta‐analysis of data from RCTs and cohort studies with very low‐to‐moderate certainty of evidence indicates that further high‐quality research is needed to evaluate the safety and potential benefits of outpatient management for selected PPROM cases, given the moderate‐to‐high risk of bias in the included studies. [ABSTRACT FROM AUTHOR]

Objective: This study aims to investigate the prevalence of depression, anxiety and insomnia in pregnant Chinese women, and to explore the related risk factors across multiple fields. Method: The participants were 2120 women (Mage = 30.24 years, range = 19–47) from 12 provinces in China. Bivariate correlation and logistic regression analyses were used to explore the risk factors. Chi-square tests and t tests were used to examine whether there were significant differences in mental health status between pregnant women in different periods of gestation. Results: The overall prevalence rates of depression, anxiety and insomnia among pregnant Chinese women were 10.0%, 3.8% and 3.3%, respectively. Risk factors for the mental health of pregnant women were identified across demographic, maternal, physiological, and psychological domains. Among these, severe mobility restrictions and fear of childbirth were found to be the strongest predictors. Conclusions: The prevalence of depression, anxiety and insomnia among pregnant women is low. Pregnant women with a seriously impaired ability to move and fear of childbirth are more likely to experience mental health problems. KEY POINTS: What is already known about this topic: Depression, anxiety, and insomnia are common mental health problems among pregnant women. Prevalence rates vary significantly across different countries and regions. Particularly in a large country like China, prevalence rates differ substantially among different regions. While risk factors for mental health of pregnant women span multiple domains, such as physiological and demographic domains, the most influential factors remain unclear. What this topic adds: A large-scale study from 12 provinces in China showed relatively low prevalence rates of depression, anxiety, and insomnia among pregnant women. Among the numerous factors influencing mental health, severe mobility restrictions and fear of childbirth emerged as the most robust predictors. [ABSTRACT FROM AUTHOR]

The article discusses the critical need to address maternal sepsis as a prominent cause of maternal morbidity and mortality worldwide. Topics include the background of maternal sepsis, detailing its impact on pregnant and postpartum women; diagnostic approaches to improve early detection and outcomes; and management strategies within obstetric critical care, emphasizing timely intervention and multidisciplinary care.

Objective To decrease the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on the Mount Sinai Hospital's obstetric service, additional contact and respiratory precautions for patients and staff were implemented. Patients were allowed only one support person, SARS-CoV-2 tested on admission, and required to mask during hospitalization. Staff were required to wear masks and eye shields, gloves for all patient care, and gowns for care with SARS-CoV-2-infected patients. This study determined if the risk of endometritis/intra-amniotic infection (IAI) changed under the new pandemic precautions. Study Design A single-center, historical cohort study via electronic medical record review compared singleton deliveries among patients who labored during the "pandemic period" (from March 1 through May 31, 2020) with those who labored during the "prepandemic period" (March 1 through May 31, 2019) to determine if the risk of endometritis/IAI differed. The analysis was done using logistic regression with inverse probability of treatment weighting (IPTW) to adjust for possible differences in obstetric practice and patient population between the two periods. Results Four percent (53/1,318) of patients in the pandemic period and 5.1% (82/1,596) of patients in the prepandemic period were diagnosed with endometritis/IAI (p = 0.15). Compared with patients who delivered in the prepandemic period, those who delivered during the pandemic period had a higher body mass index at delivery (median: 28.36 [interquartile range, IQR: 25.70, 32.07] vs. 28.00 [IQR: 25.23, 31.50], p = 0.01) and experienced fewer digital exams (median: 4 [range: 1, 10] vs. 4 (range: 1, 19], p = 0.004), a practice not included in the SARS-CoV-2 prevention strategy. In multivariable logistic regression with IPTW adjusting for risk factors for endometritis/IAI, period of delivery was not associated with endometritis/IAI (odds ratio = 0.76, 95% confidence interval [0.52, 1.11], p = 0.15). Conclusion The use of respiratory and contact precautions to limit the spread of SARS-CoV-2 was not associated with risk of endometritis/IAI. Key Points Pandemic infection control precautions were not associated with a decrease in endometritis/IAIs. The early months of the pandemic were associated with the performance of fewer digital cervical exams. The early months of the pandemic were associated with a higher BMI at delivery. [ABSTRACT FROM AUTHOR]

Objective We evaluated if venous thromboembolism (VTE) prophylaxis in the inpatient antepartum period was associated with wound hematomas, VTE occurrence, and other adverse outcomes. Study Design This study is a secondary analysis of a retrospective cohort of patients who delivered at University of Alabama at Birmingham (UAB). Patients receiving outpatient anticoagulation (AC) were excluded. We grouped patients into those who received inpatient antepartum prophylactic AC and those who did not. The primary outcome was wound hematomas from delivery to 6 weeks postpartum (PP). Secondary outcomes included VTE occurrence and select adverse outcomes, including other wound complications, unplanned procedures, mode of anesthesia, and intensive care unit (ICU) admission. Analyses were performed with no AC group as the reference. A sensitivity analysis excluding those who received inpatient PP AC was performed. Results Of 1,035 included patients, only 169 patients received inpatient prophylactic AC. They were older, had higher body mass indices, and more comorbidities. Patients receiving inpatient antepartum AC had higher wound hematomas (adjusted odds ratio [aOR] 23.81; 95% confidence interval [CI] 7.04–80.47). They had similar risk for developing VTE as the control group (aOR 2.68; 95% CI 0.19–37.49) but were more likely to have wound complications (aOR 2.36; 95% CI 1.24–4.47), maternal deaths (p < 0.05), and require PP ICU admission (aOR 13.38; 95% CI 4.79–37.35). When excluding those receiving any PP AC, there was no difference in bleeding complications between the two groups and VTE rates remained unchanged. Rates of maternal deaths and PP ICU admissions remained higher in those who received inpatient antepartum AC prophylaxis. Conclusion In this small cohort study, increased wound hematomas were found in those who received inpatient antepartum AC prophylaxis with no difference in VTE occurrence. While adverse events were increased in the inpatient AC group, this was mostly associated with PP AC prophylaxis. Larger studies should be conducted to describe the true benefits and risks of antepartum AC prophylaxis and determine efficacy of this widely used practice. Key Points Peripartum chemoprophylaxis is associated with increased wound hematomas. VTE is rare, despite its association with significant peripartum morbidity/mortality. Large studies are needed to guide practices that optimize the risk/benefit ratio of chemoprophylaxis. [ABSTRACT FROM AUTHOR]

Objective The ductus arteriosus normally closes after birth. Histamine 2 receptor antagonist (H 2 RA) has been associated with patent ductus arteriosus (PDA). We aimed to study the characteristics of term infants with PDA and their possible association with prenatal exposure to antacids—proton pump inhibitors (PPIs) and H 2 RA. Study Design This was a population-based matched case–control study of mothers registered at "Clalit" Health Maintenance Organization (HMO) and their infants born at "Soroka" University Medical Center (SUMC) between 2001 and 2018. Cases are defined as term infants born with PDA diagnosed by echocardiography and registered in the postdelivery discharge form. Each case was matched with four term newborns without PDA diagnosis. Exposure window was defined by the timing of first purchase of H 2 RA or PPI during pregnancy and based on information from a computerized medication database (Clalit HMO, SUMC). Results PDA was diagnosed in 1,884 term infants (4.9%). Characteristics included a significantly higher percentage of lack of prenatal care, cesarean section, in vitro fertilization, polyhydramnios, oligohydramnios, Apgar 1 minute <5, and prenatal exposure to H 2 RA (odds ratio [OR] 4.18) and PPIs (OR 3.50; all p < 0.001). PDA association with exposure window was similar in each trimester (1.5–2%) for both H 2 RA and PPI. Conclusion PDA incidence in term infants in our population was greater than previously reported. PPI and H 2 RA are both antiacids with different mechanisms of action. The similar OR for exposure to one as well as the other, and the lack of influence of the initial exposure period, are compatible with bias. Key Points Term newborns with PDA have different characteristics than newborns without PDA. Prenatal exposure to PPIs or H 2 RA is associated with greater risk of PDA in term newborns. The possible effect mechanism of PPIs on the ductus is unclear and understudied. [ABSTRACT FROM AUTHOR]

Objective Non-Hispanic Black people (NHBP) have a three-fold higher rate of maternal mortality compared to other racial groups. Racial disparities in maternal morbidity are well-described; however, there are substantial differences in cultural, economic, and social determinants of health among racial groups. We thus sought to study the at-risk, non-Hispanic Black population as its own cohort to identify factors most associated with severe maternal morbidity (SMM). Study Design This is a population-based retrospective case–control study of all live births in the United States between 2017 and 2019 using birth records obtained from the National Center for Health Statistics. The primary outcome for this study was to determine demographic, social, medical, and obstetric factors associated with maternal morbidity among NHBP who did and did not experience an SMM event. Multivariable logistic regression was used to estimate the adjusted odds ratio between each individual factor and the outcome of SMM among NHBP. Results Of the 1,624,744 NHBP who delivered between 2017 and 2019, 1.1% experienced an SMM event defined as a composite of blood product transfusion, eclamptic seizure, intensive care unit admission, unplanned hysterectomy, and uterine rupture. The rates of these individual SMM events per 10,000 deliveries were 50, 40, 20, 5, and 4 among NHBP, respectively. Among NHBP, factors associated in multivariable regression analysis with SMM in order of strength of association included cesarean delivery, earlier gestational age at delivery, preeclampsia, induction of labor, chronic hypertension, prior preterm birth, lower educational attainment, multifetal gestation, advanced maternal age, pregestational diabetes, and cigarette smoking. The population attributable fraction for cesarean delivery, preterm birth, and pregnancy-induced hypertensive disease for the outcome of SMM were 0.46, 0.23, and 0.07, respectively. Conclusion The three factors most associated with SMM among NHBP are potentially avoidable or modifiable by aggressive screening, prevention, and treatment of preeclampsia and preterm birth as well as reducing cesarean rates in this population. Key Points The rate of SMM in NHBP may be modifiable. NHBP have a three-fold higher rate of maternal mortality. Preeclampsia, preterm birth, and cesarean sections are most associated with maternal morbidity. [ABSTRACT FROM AUTHOR]

Background: Within Europe, Roma, Gypsy, and Traveller groups have been marginalized and discriminated against by larger society. Persecution and displacement have resulted in high rates of unemployment, reduced access to education, and poorer health, with significantly increased risk of poverty compared with the general population. In pregnancy, there appears to be a gap in the literature surrounding the experiences and outcomes of pregnant people within these ethnic groups. Objectives: The aim of this study was therefore to scope published research, specifically questioning "What is the experience of Roma Gypsy and Traveller pregnant people who access maternity care?" and "What are the obstetric outcomes within these groups?" Search Strategy: This review followed frameworks proposed by Arksey and O'Malley, Levac, and the Joanna Brigg's Institute. The PRISMA extension for Scoping Reviews (PRISMA‐ScR) tool was used. The search strategy and specific terms were chosen using the population–concepts–context framework. Selection Criteria: Titles and abstracts were reviewed independently by two reviewers. Inclusion and exclusion criteria were defined to set clear guidance for reviewers to identify appropriate studies. Data Collection and Analysis: Five electronic databases were searched (CINAHL, EMBASE, MEDLINE [OVID] Web of Science and SCOPUS). A charting form was developed to record key characteristics systematically and uniformly from the studies. Main Results: Five themes were identified: systemic issues, antenatal care, complications of pregnancy, birth experience, and postnatal care. Systemic issues included racism, barriers to care, and adapted antenatal care. Antenatal issues included teenage pregnancy, smoking, risk of venous thrombus embolism, dietary issues, risk of communicable diseases, domestic violence, and mental health concerns. Increased risks of congenital abnormalities, growth restriction, premature labor, and perinatal and early childhood mortality were identified. For Roma women, negative birth experiences were reported, whereas the experiences of Traveller women varied. Conclusions: The findings identified in this study serve to create a framework upon which healthcare providers can tailor the way in which pregnant people from a Roma, Gypsy, or Irish Traveller background are cared for. Using such a framework would hopefully begin to reduce the systematic marginalization and discrimination of these minorities. Synopsis: Gypsy, Roma, and Traveller pregnant people suffer poor outcomes in pregnancy. The true extent of this is not known as they are underrepresented in research. [ABSTRACT FROM AUTHOR]

Objective: To investigate the relationship between maternal blood pressure (BP) and neonatal cord blood telomere length (TL) during pregnancy, and to clarify the sensitive period. Methods: We conducted a prospective cohort study with 621 mother‐newborn pairs from the Guangxi Zhuang Birth Cohort (GZBC) in China. Multiple informant models, restricted cubic spline regression (RCS) models, and quantile regression models were conducted to analyze the correlation between maternal BP and neonatal TL. Results: Maternal diastolic blood pressure (DBP) was inversely related to neonatal cord blood TL in the second trimester (P = 0.015) and the third trimester (P = 0.011). There was a male‐specific relationship between maternal BP and neonatal TL. A 1 mmHg increment in maternal systolic blood pressure (SBP) and DBP during the second trimester was related with 0.42% (95% CI: −0.80%, −0.04%) and 0.61% (95% CI: −1.13%, −0.09%) shorter TL in male newborns, respectively. Per unit increase of maternal DBP during the third trimester was related with 0.54% (95% CI: −1.03%, −0.05%) shorter TL in male newborns. Pregnant women with hypertensive disease of pregnancy (HDP) had male offspring with shorter TL (P = 0.003). However, no significant relationships were found in female newborns (P = 0.570). Conclusion: Maternal BP during pregnancy is inversely correlated with male neonatal TL and the second and third trimesters are sensitive windows. Synopsis: Maternal blood pressure during pregnancy is inversely correlated with male neonatal telomere length and the second and third trimesters are sensitive windows. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to develop and validate a prenatal nomogram to predict the risk of placenta accreta spectrum (PAS) in women with one previous cesarean delivery. Methods: This retrospective study enrolled 5157 pregnant women with one previous cesarean delivery in China from January 2021 to January 2023. The nomogram was developed from a training cohort of 3612 pregnant women and tested on a validation cohort of 1545 pregnant women. Multivariate regression analysis was performed using the minimum value of the Akaike information criterion to select prognostic factors that can be included in the nomogram. We evaluated the nomogram by the area under the receiver operating characteristic (ROC) curve, calibration curves, and the decision curve analysis (DCA). Results: PAS occurred in 199 (5.51%) and 80 (5.18%) patients in the training and validation cohorts, respectively. Backward stepwise algorithms in the multivariable logistic regression model determined abortion, hypertensive disorders complicating pregnancy, fetal position, and placenta previa as relevant PAS predictors. The area under the ROC curve for the nomogram was 0.770 (95% confidence interval [CI] 0.733–0.807) and 0.791 (95% CI 0.730–0.853) for the training and validation cohorts, respectively. The calibration curves indicated that the nomogram's prediction probability was consistent with the actual probability. The DCA curve revealed that the nomogram has potential clinical benefit. Conclusion: A prenatal nomogram was developed for PAS in our study, which helped obstetricians determine potential patients with PAS and make sufficient preoperative preparation to reduce maternal and neonatal complications. Synopsis: This study developed and validated a nomogram to predict the risk of PAS in women with one previous cesarean delivery. [ABSTRACT FROM AUTHOR]

Objective: To investigate the associations between time interval from myomectomy to pregnancy (TIMP) and subsequent pregnancy and obstetric complications, and to explore whether these associations vary according to maternal age at birth. Methods: A retrospective population‐based cohort study was conducted from 2008 to 2017. Data were extracted from the National Health Insurance Research Database and the Taiwan Maternal and Child Health Database, comprising 2024 379 births from 1 391 856 pregnancies. Eligible cases were identified using diagnostic and procedure codes; 4006 first singleton births in 4006 women after their first laparotomic myomectomy were identified. We estimated the risks of pregnancy and obstetric outcomes according to TIMP (<6, 6–11, and ≥12 months). Subgroup analysis was performed by further dividing according to maternal age at birth (18–34 vs ≥35 years old). Results: We observed higher risks of gestational hypertensive disorders (adjusted odds ratio [aOR] 1.97, 95% confidence interval [CI] 1.22–3.18, P = 0.005) and neonatal death (aOR 4.59, 95% CI 1.49–14.18, P = 0.008) for TIMP of <6 months versus TIMP of 6–11 months. Likewise, a TIMP ≥12 months was associated with increased risks of gestational hypertensive disorders (aOR 1.72, 95% CI 1.14–2.58, P = 0.010), and neonatal death (aOR 3.27, 95% CI 1.16–9.24, P = 0.025) versus a TIMP of 6–11 months. In subgroup analysis, women over 35 years old still had higher risks of gestational hypertensive disorders when TIMP was <6 months (aOR 2.26, 95% CI 1.17–4.37, P = 0.015) or ≥12 months (aOR 2.04, 95% CI 1.17–3.54, P = 0.012), and a higher risk of neonatal death when TIMP was <6 months (aOR 4.05, 95% CI 1.06–15.53, P = 0.041); whereas women aged 18–34 years old did not. Conclusions: This study suggests that a TIMP between 6 and 11 months is associated with lower risks of gestational hypertensive disorders and neonatal death compared with a TIMP <6 months or ≥12 months, especially for women over 35 years old. Synopsis: A population‐based cohort study to investigate the association between myomectomy‐to‐pregnancy interval and obstetric outcomes. [ABSTRACT FROM AUTHOR]

Background and aims: Stimulant‐related disorders (SRD), or the continued misuse of illicit or prescribed stimulants, during pregnancy can have adverse health effects for mothers and infants. This study aimed to measure prevalence and trends of SRD diagnosis in pregnancy, and associations between SRD diagnosis and adverse maternal and infant health outcomes, among pregnant individuals in California. Design: Retrospective cohort study. Setting: California, USA. Participants: Pregnant individuals from the Study of Outcomes in Mothers and Infants (SOMI) with singleton live births between 2012 and 2020 (n = 3 740 079). Measurements: SRD diagnosis (excluding cocaine) and maternal (gestational diabetes, gestational hypertension [gHTN], severe maternal morbidity [SMM]) and infant (very preterm birth [gestational age <32 weeks], preterm birth [gestational age 32–37 weeks], neonatal intensive care unit [NICU] admission, small for gestational age [SGA]) outcomes were classified using International Classification of Disease (ICD) codes and vital statistics. Risk ratios were estimated with modified Poisson log linear regression that accounted for sibling pregnancies. Covariates included maternal sociodemographic characteristics, mental and physical health problems, nicotine use and co‐occurrence of other diagnosed substance use disorders. Bias analyses were conducted to address unmeasured confounding and exposure misclassification. Findings SRD diagnosis among pregnant individuals increased from 2012 to 2020 (554 to 748 per 100 000 births). SRD diagnosis was associated with an increased risk of SMM (adjusted risk ratio [aRR] = 2.3; 95% confidence interval [CI] = 2.2–2.5), gHTN (aRR = 1.8; 95% CI = 1.7–1.9), very preterm birth (aRR = 2.2, 95% CI = 2.0–2.5), preterm birth (aRR = 2.1, 95% CI = 2.1–2.2) and NICU admission (aRR = 2.0, 95%CI = 1.9–2.0), and a decreased risk of gestational diabetes (aRR = 0.8; 95% CI = 0.8–0.9). SRD diagnosis was not associated with infants born SGA. Findings were generally robust to unmeasured confounding and misclassification of diagnosis. Conclusions: Stimulant‐related disorder diagnosis during pregnancy appears to be associated with an increased risk for select adverse maternal and infant health outcomes including severe maternal morbidity, gestational hypertension, very preterm birth, preterm birth and neonatal intensive care unit admission. [ABSTRACT FROM AUTHOR]

Limb-girdle muscular dystrophy (LGMD) poses unique challenges for women during pregnancy, necessitating comprehensive care and tailored management strategies. The present narrative review aims to examine the unique challenges and management strategies required for women with LGMD during pregnancy. With over 30 genetic subtypes identified and the potential for additional discoveries through advanced diagnostic techniques, preconception counseling plays a crucial role in informing prospective parents about reproductive risks and available options. Baseline assessments, including cardiac and pulmonary evaluations, are essential to guide antenatal care, alongside genetic testing for precise diagnosis and counseling. Optimizing maternal health through respiratory exercises, cardiac monitoring, and individualized exercise and nutrition plans is paramount to avoid potential complications. During pregnancy, close monitoring of maternal and fetal well-being is important, with collaborative care between obstetricians and specialists. An individualized approach to delivery mode considering factors such as muscle strength, pelvic size, and fetal presentation is crucial. While vaginal delivery has been proven to be possible, the need for an emergency cesarean delivery should always be kept in mind. Regional anesthesia is preferred, with proactive planning for potential respiratory support. Bupivacaine has been shown to be effective with epidural catheters that may be used for prolonged relief with opioids like morphine and fentanyl, while also evaluating the patients' respiratory function. Postpartum considerations include pain management, mobility support, breastfeeding assistance, and emotional support. Early mobilization and tailored physiotherapy regimens may promote optimal recovery, while comprehensive breastfeeding guidance is needed to address challenges related to muscle weakness. Access to mental health resources and support networks is essential to helping individuals cope with the emotional demands of parenthood alongside managing LGMD. By addressing the unique needs of pregnant individuals with LGMD, healthcare providers can optimize maternal and fetal outcomes while supporting individuals in their journey to parenthood. [ABSTRACT FROM AUTHOR]

Purpose: The present systematic review aimed to assess the fecundity of women with congenital uterine anomalies (CUAs) undergoing assisted reproductive technology (ART). Methods: The present systematic review of the literature was reported according to the PRISMA guidelines. We systematically searched PubMed, MEDLINE, Embase and Scopus, from database inception to 17th October 2023. Studies were deemed eligible only if they included women with CUAs clearly fitting into one of the categories of the ASRM Müllerian anomalies classification 2021. Results: Data relevant to the reproductive outcomes of women with CUAs who underwent ART were extracted from 55 studies. Regarding Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome, studies on gestational surrogacy reported a live birth rate (LBR) ranging from 37 to 54%. Uterus transplant, although still experimental, showed promising results. Most studies reported a negative impact of unicornuate uterus and partial or complete septate uterus on both the miscarriage rate (MR) and the live birth rate (LBR). The reproductive prognosis of women with unicornuate uterus was shown to be particularly poor in case of twin pregnancy. Uterus didelphys, bicornuate and arcuate uterus seem not to negatively impact the ART reproductive outcomes. Uterus didelphys was associated with an increased risk of preterm birth (PTB), cesarean section and low birth weight (LBW). Conclusion: Women with CUAs should be informed regarding the impact (if any) of their congenital anomaly on both the chances of success of ART and on pregnancy-related complications. Elective single embryo transfer (eSET) should always be the first choice in patients with an increased baseline obstetric risk. [ABSTRACT FROM AUTHOR]

The article focuses on the implications of placenta accreta spectrum (PAS) among patients seeking abortion, highlighting the importance of preprocedural planning to improve outcomes and minimize complications. It discusses the rising incidence of PAS, its associated risk factors, and the critical role of ultrasound in diagnosis, particularly for patients with a history of cesarean delivery and placenta previa.

Purpose: To comprehensively evaluate and compare all the available reference guides for the safe use of drugs during pregnancy, with the goal of determining the scientificity and reliability of these reference guides. Methods: We searched PubMed, EMbase, CNKI, Wanfang Database, and VIP database to comprehensively identify the available reference guides. Moreover, we selected 103 drugs based on relevant literatures, and compared the recommendations of each drug from different reference guides. Results: A total of 14 available reference guides were identified. However, none of these reference guides assessed the risk of bias of original studies or the quality of current evidence. Seven reference guides adopted expert consensus method to formulate pregnancy recommendations, while the rest reference guides did not report the formation method. Moreover, 77.7% of the selected drugs had inconsistent recommendations among different reference guides. In addition, the referenced human and animal studies for the same drug differed among different reference guides. Conclusion: Our results indicate that current reference guides for the safe use of drugs during pregnancy are less scientific and reliable, and there are considerable discrepancies in recommendations from different reference guides concerning drug use during pregnancy. The reasons for the discrepancies in recommendations include ① the literature search in most reference guides was not comprehensive, ② none of the available reference guides assessed the risk of bias of original studies or the quality of current evidence, and ③ the method adopted by current reference guides to formulate recommendations had obvious subjectivity and lacked of scientificity. [ABSTRACT FROM AUTHOR]