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Objective Fetal growth restriction (FGR) is defined as an estimated fetal weight (EFW) or abdominal circumference (AC) <10th percentile (%ile) for gestational age (GA). An EFW <3rd %ile for GA is considered severe FGR (sFGR). It remains unknown if fetuses with isolated AC <3rd %ile should be considered sFGR. Our primary objective was to assess composite neonatal outcomes in fetuses with an AC <3 rd %ile and overall EFW 3rd to 9th %ile compared with those with an EFW <3rd %ile. Study Design This retrospective cohort study was undertaken at a tertiary academic center from January 2016 to December 2021. Inclusion criteria were singleton fetuses with an EFW <3rd %ile (Group 1) or AC <3rd %ile with EFW 3rd to 9th %ile (Group 2) at 28 weeks' gestation or greater. Exclusion criteria were multiple gestations, presence of a major fetal anomaly, resolution of FGR, genetic syndrome, or infection. Composite neonatal outcome was defined by any of the following: neonatal intensive care unit admission >48 hours, necrotizing enterocolitis, sepsis, respiratory distress syndrome, mechanical ventilation, retinopathy of prematurity, seizures, intraventricular hemorrhage, stillbirth, or death before discharge. Small for gestational age (SGA) was defined as birth weight <10th %ile for GA. Results A total of 743 patients fulfilled our study criteria, with 489 in Group 1 and 254 in Group 2. The composite neonatal outcome occurred in 281 (57.5%) neonates in Group 1 and 53 (20.9%) in Group 2 (p < 0.01). The rates of SGA at birth were 94.9 and 75.6% for Group 1 and Group 2, respectively (OR 5.99, 95% confidence interval 3.65–9.82). Conclusion Although AC <3rd %ile with EFW 3rd to 9th %ile is associated with a lower frequency of SGA and neonatal morbidity than EFW <3 %ile, fetuses with AC <3 %ile still exhibited moderate rates of these adverse perinatal outcomes. Consideration should be given to inclusion of an AC <3rd %ile with EFW 3rd to 9th %ile as a criterion for sFGR. However, prospective studies comparing delivery at 37 versus 38 to 39 weeks' gestation are needed to ensure improved outcomes before widespread adaptation in clinical practice. Key Points The composite neonatal outcome occurred in 57.5% of fetuses with an overall EFW <3rd %ile and 20.9% of fetuses with an AC <3rd %ile but EFW 3rd to 9th %ile. Both groups demonstrated a high positive predictive value for SGA birth weight. Consideration should be given to inclusion of an AC <3rd %ile as a criterion for sFGR. [ABSTRACT FROM AUTHOR]

Icaraí beach, located in the municipality of Niterói, in the metropolitan region of Rio de Janeiro, Brazil, plays an important role in the social context, since it is very popular among the local population. However, it has been suffering negative impacts due to anthropic activities, which are enhanced by increasing urbanization. Ecotoxicological tests using the microcrustaceans Artemia salina as test organism are an important alternative in the evaluation of the toxic state of the water due to their sensitivity to chemical and toxic components of the environment. The present work aimed to evaluate the acute toxicity at two sampling sections (P1 and P2) using low cost methodology, technically simpler and with some adaptations. For this purpose, a number of physico-chemical parameters (temperature, pH, dissolved oxygen, salinity, biochemical oxygen demand (BOD), chemical oxygen demand (COD), total coliforms and fecal coliforms) were analyzed, compared to the values established by CONAMA Resolution 357 of 2005, besides the performance of the acute ecotoxicological test with samples of water from the Icaraí beach and with the use of Artemia salina for the evaluation of the lethal dose (LD50). The samples showed a change in toxicity, because in some sample concentrations of the second collection, Section 2 presented a toxic effect. Therefore, the results were satisfactory, since the two ecotoxicological tests presented good answers, associated with their simplicity of execution and economic feasibility. [ABSTRACT FROM AUTHOR]

Objective:  This study aimed to develop machine learning (ML) models for predicting preterm preeclampsia using the information available before 23 weeks gestation., Study Design:  This was a secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) cohort. We considered 131 features available before 23 weeks including maternal demographics, obstetrics and family history, social determinants of health, physical activity, nutrition, and early second-trimester ultrasound. Our primary outcome was preterm preeclampsia before 37 weeks. The dataset was randomly split into a training set (70%) and a validation set (30%). ML models using glmnet, multilayer perceptron, random forest, XGBoost (extreme gradient boosting), and LightGBM models were developed. Using the ML approach that achieved the best area under the curve (AUC), we developed the final model. Further feature selection was conducted from the top 25 important features based on SHapley Additive exPlanations (SHAP) values. The performance of the final model was assessed using the validation dataset., Results:  Of 9,467 individuals, 219 (2.3%) had preterm preeclampsia. The AUC of the XGBoost model was the highest (AUC = 0.749 [95% confidence interval (95% CI), 0.736-0.762]) compared with other models. Therefore, XGBoost was used to develop models using fewer variables. The XGBoost model with the eight features (in order of importance: mean uterine artery pulsatility index in the early second trimester, chronic hypertension, pregestational diabetes, uterine artery notch, systolic and diastolic blood pressure in the first trimester, body mass index, and maternal age) was chosen as the final model as it had an AUC of 0.741 (95% CI, 0.730-0.752) which was not inferior to the original model ( p  = 0.58). The final model in the validation dataset had an AUC of 0.779 (95% CI, 0.722-0.831). An online application of the final model was developed ( https://kawakita.shinyapps.io/Preterm&#95;preeclampsia/ )., Conclusion:  ML algorithms using information available before 23 weeks can accurately predict preterm preeclampsia before 37 weeks., Key Points: · Prediction models using uterine artery Doppler have not been adopted in the US.. · We developed a model using an ML algorithm.. · An online application of the final model was developed.. · ML algorithms using information available before 23 weeks can accurately predict preterm preeclampsia before 37 weeks.., Competing Interests: None declared., (Thieme. All rights reserved.)

Objective:  This study aimed to examine the impact of maternal obesity on fetal growth abnormalities including fetal growth restriction (FGR) and large for gestational age (LGA) fetuses., Study Design:  Secondary analysis from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b). The study excluded individuals with pregestational or gestational diabetes, chronic hypertension, and other major maternal medical conditions. First-trimester ultrasound was performed to establish accurate dating criteria. Ultrasound assessments were performed at 16 to 21 and 22 to 29 weeks of gestation. Our exposure was the presence of pre-pregnancy obesity. Our primary outcome was rates of fetal growth abnormalities identified by ultrasound, defined as FGR (estimated fetal weight [EFW] or abdominal circumference <10th percentile) or LGA (EFW >90th percentile) among obese compared with nonobese women. A secondary analysis was performed after limiting ultrasound performed from 28 to 29 weeks. To estimate adjusted relative risks (aRRs) with 95% confidence intervals (95% CIs), we used generalized linear models with Poisson distribution and log link using robust error variance, adjusting for the predefined covariates., Results:  Of 7,354 participants, 1,443 (19.6%) had pre-pregnancy obesity while 5,911 (80.4%) did not. Pre-pregnancy obesity compared with normal weight was associated with an increased risk of fetal growth abnormalities both at 16 to 21 weeks (16.0% vs. 13.2%; aRR 1.23; 95% CI 1.06-1.42) and 22 to 29 weeks (16.0% vs. 12.1%; aRR 1.33; 95% CI 1.14-1.54). Furthermore, pre-pregnancy obesity compared with normal weight was associated with an increased risk of LGA both at 16 to 21 weeks (12.5% vs. 10.3%; aRR 1.24; 95% CI 1.05-1.47) and 22 to 29 weeks (10.6% vs. 6.9%; aRR 1.66; 95% CI 1.38-2.01). In a secondary analysis limited to the ultrasound at 28 to 29 weeks, both fetal growth abnormalities and LGA were associated with the presence of obesity. In any of the analyses, pre-pregnancy obesity was not associated with FGR compared with normal weight., Conclusion:  Maternal obesity is associated with an increased risk of fetal growth abnormalities and LGA fetuses., Key Points: · Obesity is associated with increased LGA risk.. · Association between obesity and FGR remains unclear.. · Ultrasound is effective in obese women to detect fetal growth abnormalities.. · Future research is needed to assess the association between obesity and FGR.., Competing Interests: None declared., (Thieme. All rights reserved.)

Objective: This study aimed to compare adverse maternal outcomes between pregnancies complicated by fetal growth restriction (FGR) and those without FGR., Study Design: This was a secondary analysis of the data from the Consortium on Safe Labor, which was conducted from 2002 to 2008 in 12 clinical centers with 19 hospitals across 9 American College of Obstetricians and Gynecologists districts. We included singleton pregnancies without any maternal comorbidities or placenta abnormalities. We compared the outcomes of individuals with FGR with individuals without FGR. Our primary outcome was severe maternal morbidity. Our secondary outcome included various adverse maternal and neonatal outcomes. Multivariable logistic regression was performed to obtain adjusted odds ratios (aOR) and 95% confidence intervals (95% CI), adjusting for confounders. Missing values for maternal age and body mass index were imputed., Results: Of 199,611 individuals, 4,554 (2.3%) had FGR and 195,057 (97.7%) did not have FGR. Compared with the individuals without FGR, individuals with FGR had increased odds of severe maternal morbidity (0.6 vs. 1.3%; aOR: 1.97 [95% CI: 1.51-2.57]), cesarean delivery (27.7 vs. 41.2%; aOR: 2.31 [95% CI: 2.16-2.48]), pregnancy-associated hypertension (8.3 vs. 19.2%; aOR: 2.76 [95% CI: 2.55-2.99]), preeclampsia without severe features (3.2 vs. 4.7%; aOR: 1.45 [95% CI: 1.26-1.68]), preeclampsia with severe features (1.4 vs. 8.6%; aOR: 6.04 [95% CI: 5.39-6.76]), superimposed preeclampsia (18.3 vs. 30.2%; aOR: 1.99 [95% CI: 1.53-2.59]), neonatal intensive care unit admission (9.7 vs. 28.4%; aOR: 3.53 [95% CI: 3.28-3.8]), respiratory distress syndrome (2.2 vs. 7.7%; aOR: 3.57 [95% CI: 3.15-4.04]), transient tachypnea of the newborn (3.3 vs. 5.4%; aOR: 1.62 [95% CI: 1.40-1.87]), and neonatal sepsis (2.1 vs. 5.5%; aOR: 2.43 [95% CI: 2.10-2.80])., Conclusion: FGR was associated with increased odds of severe maternal outcomes in addition to adverse neonatal outcomes., Key Points: · FGR is associated with cesarean section.. · FGR is not associated with severe maternal morbidity.. · FGR is related to pregnancy-associated hypertension.. · FGR is associated with neonatal morbidity.., Competing Interests: None declared., (Thieme. All rights reserved.)