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Introduction: Antenatal corticosteroids (ACS) administration before anticipated preterm birth is one of the most important interventions available to improve neonatal outcomes. Nevertheless, this treatment is associated with an increased risk of neonatal hypoglycemia. The aim of this study was to determine whether preterm twins who receive ACS are at increased risk for developing neonatal hypoglycemia. Methods: This was a retrospective cohort study of indicated and spontaneous preterm births of twins at a single center between 2011 and 2018. The study population included 3 groups matched for gestational age at delivery and birth weight: (1) Twin neonates who received a course of ACS 1–7 days before birth (n = 532); (2) twins who did not receive ACS at that time interval (n = 532); and (3) singletons receiving ACS 1–7 days before birth (n = 266). The primary outcome was neonatal hypoglycemia (<40 mg/dL/2.2 mmol/L) within the first 24 h and 48 h of life. Results: The rate of neonatal hypoglycemia during the first 24 h of life was significantly higher in singletons exposed to ACS compared to twins not exposed to ACS (p = 0.019) and in twins exposed to ACS compared to twins not exposed to ACS (p = 0.047). The rate of neonatal hypoglycemia was almost identical between twins and singletons exposed to ACS (p = 0.72). Regression analysis revealed that exposure to ACS and birth weight were independently associated with neonatal hypoglycemia after adjustment for maternal age, body mass index, gravidity, gestational diabetes mellitus, and gestational age at delivery. Conclusion: Exposure to ACS, rather than plurality, is associated with short-lived neonatal hypoglycemia. [ABSTRACT FROM AUTHOR]

Objective: In recent years antiphospholipid syndrome (APS) as well as antiphospholipid antibodies (aPL) prevalence has demonstrated an upward trend in women during reproductive age. There is a lack of data concerning its effects on women with grand multiparity (GMP) (parity ≥5). Hence, this study aimed to assess pregnancy outcomes among GMP aPL/APS patients. Study Design: We retrospectively assembled the births of GMP women with aPL/APS, between 2017 and 2022 in the Sheba Medical Center. We compared their deliveries with those of two control groups: (1) the "aPL/APS‐controls"—of pregnant women with aPL/APS and parity <5. (2) The "GMP‐controls"‐ parity ≥5 without aPL/APS. We examined demographics, aPL characteristics, pregnancy, and neonatal outcomes between the groups. Results: In total, 42 deliveries in the study group were compared to 461 deliveries in the "aPL/APS‐controls" group and 84 deliveries of the "GMP‐controls." Most parameters were similar across groups. However, the study group had a higher rate of obstetric APS diagnosis (64.64% vs. 83.33%, p < 0.01) and showed significant differences such as older maternal age, higher BMI, more polyhydramnios cases, and larger babies compared to controls (33.91 vs. 36.19, p = 0.05; 23.2 vs. 28.89, p = 0.02; 3.68 vs. 11.9, p = 0.01; and 2.17 vs. 14.28, p < 0.01, respectively). Conclusions: Our findings reveal that perinatal outcomes in aPL/APS GMP women are comparable and not inferior to those in aPL/APS women with <5 pregnancies or in comparison to the general GMP population. The minor differences observed may all be related to GMP women's older age and higher BMI. [ABSTRACT FROM AUTHOR]

Introduction: Insulin requirement in women with Type 1 diabetes (T1DM) changes throughout pregnancy. The aim of this study was to determine the total change in insulin requirements and the effect of gestational weight gain (GWG) and pre‐gestational BMI on insulin requirements during pregnancy in women with T1DM treated with continuous subcutaneous insulin infusion and continuous glucose monitoring. Methods: This historical cohort study included all consecutive women with T1DM who were monitored during pregnancy at the high‐risk pregnancy clinic at a tertiary medical center during April 2011–April 2019. One Way Repeated Measures ANOVA with Bonferroni adjustment was conducted to compare the effects of gestational age on insulin requirements and a Two Way Repeated Measures ANOVA was employed to test for the interaction between gestational age intervals and maternal BMI and GWG. Results: Data regarding insulin requirements of 185 pregnancies were included in the analyses. There was a significant effect of gestational age on total insulin (Wilks' Lambda = 0.34, F(6,14) = 4.52, p = 0.009), basal insulin (Wilks' Lambda = 0.41, F(6,14) = 3.30, p = 0.031) and bolus insulin (Wilks' Lambda = 0.43, F(6,14) = 3.02, p = 0.041). Total insulin/kg requirements increased by 5.5% from 13–20 weeks to 20–26 weeks, 19% from 20–26 weeks to 26–33 weeks, and 17.4% from 26 to 33 weeks to delivery (p for trend = 0.009). Overall, insulin requirements increased by 42.1% from conception to delivery (p < 0.01). There was no significant main effect of maternal BMI or GWG on insulin requirements. Conclusions: There is a significant increase in insulin requirements per kg during pregnancy in women with T1DM who were treated with an insulin pump. [ABSTRACT FROM AUTHOR]

Introduction: Neonates of individuals with type 1 diabetes (T1D) are at increased risk of neonatal hypoglycaemia. It is hypothesised that this is a result of birthing‐individual hyperglycaemia and subsequent foetal hyperinsulinemia. Aims: To test for association between clinically significant neonatal hypoglycaemia (requiring intravenous glucose treatment) and cord‐blood c‐peptide (CBCP) concentrations in birthing‐individuals with T1D. Materials and Methods: This is a prospective cohort study of individuals with T1D followed at a single tertiary centre. Clinical variables and glucose control during pregnancy were recorded. Cord‐blood was collected and CBCP concentrations determined. The correlation between clinically significant neonatal hypoglycaemia and CBCP concentrations was determined. Results: Fifty‐four pregnant individuals and their newborns were included in the study. Individuals to neonates who experienced hypoglycaemia had longer diabetes duration (19 vs. 13 years, respectively, p = 0.023), higher HbA1c at conception (7.3 [6.3–8.8] vs. 6.5 [6.0–7.0], respectively, p = 0.042) and higher rates of caesarian section (73.3% vs. 28.2%, respectively, p = 0.005) than individuals to those who did not. CBCP levels were significantly higher in neonates with clinically significant neonatal hypoglycaemia as compared to those who did not experience hypoglycaemia (3.3 mcg/L vs. 1.9 mcg/L, respectively, p = 0.002). After adjustment for possible confounders, every 1 unit higher in CBCP level was associated with a 1.46 (1.02–2.09, p = 0.035)—fold greater risk for neonatal hypoglycaemia. No significant differences were observed in either birthing individual complications or glucose control indices during pregnancy between the two groups. Conclusions: In neonates of individuals with T1D, higher CBCP levels are an independent risk factor for clinically significant neonatal hypoglycaemia. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine the association between glucose control indices of parturient with type 1 diabetes (T1DM), treated with an insulin pump and utilizing continuous glucose monitoring (CGM), and clinically significant neonatal hypoglycemia. This was a retrospective cohort study which included 37 pregnant women with T1DM. All women were followed at a single tertiary center and had available CGM data. The association between maternal glucose indices before delivery and the risk for neonatal hypoglycemia requiring IV glucose (clinically significant hypoglycemia) was assessed using logistic regression. Mothers to neonates that experienced clinically significant hypoglycemia had a higher glucose standard deviation (SD) before delivery than did mothers to neonates who did not (25.5 ± 13 mg/dL vs. 14.7 ± 6.7 mg/dl respectively; p =.008). This association persisted after adjustment for maternal age, maternal pregestational body mass index (BMI), gestational age at delivery, neonatal birth weight, large for gestational age (LGA) and gender. This study demonstrates an association between high maternal glucose standard deviation before delivery and the risk for clinically significant neonatal hypoglycemia. Larger studies are needed to confirm these results and further explore the role of intrapartum glucose variability in the prediction and prevention of significant neonatal hypoglycemia. [ABSTRACT FROM AUTHOR]

Objective: Though amnioinfusion decreases the rate of uterine atony, its effect on postpartum hemorrhage (PPH) is uncertain. This study aimed to assess whether amnioinfusion reduces the risk of PPH in laboring individuals., Study Design: A retrospective study of all laboring singletons at a tertiary center between 01/2013 and 12/2022 at ≥ 34 weeks. Individuals with known major fetal anomalies, stillbirths, or missing delivery records were excluded. The primary outcome was PPH. Neonatal and secondary maternal outcomes were also explored. Adjusted odds ratios (aOR) were estimated using multivariable regression models., Results: Out of 113,816 deliveries during the study period, 83,152 (77.1%) met inclusion criteria, and among them 4,597 (4.03%) had amnioinfusion. Laboring individuals with amnioinfusion were more commonly nulliparous, had more polyhydramnios, oligohydramnios, preeclampsia, gestational diabetes, and fetal growth restriction. Furthermore, individuals with amnioinfusion had a higher rate of labor induction (54.54% vs. 27.8%; P<0.01) and a higher cesarean rate (36.9% vs. 9.5%; P<0.01). Following multivariable regression, there was no significant difference in the rate of PPH among individuals who had an amnioinfusion (2.6%) versus those who did not (3.1%; aOR 0.95, 95% CI 0.87, 1.27). The rates of endometritis (aOR 1.4; 95% CI 1.04-1.89) and postpartum fever (aOR 1.70; 95% CI 1.36-2.12), were higher in those who had amnioinfusion compared to those that did not., Conclusion: Among laboring individuals ≥ 34 weeks, intrapartum amnioinfusion was not associated with a reduction in the rate of postpartum hemorrhage and was associated with a higher likelihood of infectious morbidity., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)