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PurposeTo determine whether a diagnosis of a perinatal mood and anxiety disorder (PMAD) is associated with adverse perinatal outcomes.MethodsMental health symptom screening and diagnostic data from 82 women with single gestation in the Healthy Babies Before Birth study conducted from 2013 to 2018 were obtained by clinic interview. If a woman scored over 10 on the Patient Health Questionnaire (PHQ-9) or endorsed the suicidality item; or scored over 7 on the Overall Anxiety Severity and Impairment Scale (OASIS), a Structured Clinical Interview for DSM-IV (SCID) Axis I Disorders was administered. An adverse perinatal outcome was operationalized as a diagnosis of gestational diabetes mellitus, intrauterine growth restriction, preeclampsia, chorioamnionitis, hemorrhage, fetal death, preterm birth, or a low birthweight baby, and abstracted from the medical records.ResultsWomen were between 22.0 and 45.0 years old (Mean age = 33.1 ± 4.3). Mean BMI was 24.7 ± 5.6 (Range 16.8 to 47.1). Nineteen percent (16) of the 82 women had a SCID diagnosis of a PMAD. Thirty-seven percent (30) had a diagnosed adverse perinatal outcome. Multiple logistic regression was conducted with these predictors: SCID diagnosis of a PMAD, maternal age, BMI. All predictors were significant with respective odds ratios as follows: OR = 3.58, 95% CI 1.03-12.44, p = .045; OR = 2.30, 95% CI 1.21-4.38, p = .011; OR = 1.69, 95% CI 1.06-2.69, p = .027.ConclusionsA PMAD diagnosis was associated with 3.5 times higher odds of having an adverse perinatal outcome. For every 5 years a woman aged or every five units her BMI increased her odds of having an adverse perinatal outcome increased. Older age and increased BMI are well established adverse perinatal outcome risk factors. These results suggest that mental illness risk should also be consistently assessed in obstetric settings.

Background: Complications during pregnancy frequently result in adverse events impacting both the mother and the fetus. Hemodynamic changes characteristic of pregnancy typically involve a decline in uterine artery flow resistance, accompanied by increased blood flow as gestational age progresses. While these changes are a natural part of pregnancy, pathological alterations marked by high-resistant circulation can pose significant risks for adverse pregnancy outcomes. The uterine artery Doppler has been utilized largely in the first and second trimesters to screen high risk pregnancies in relation to the development of subsequent complications. Second trimester screening can be still of value for late scheduled and those with unplanned pregnancies who require closer antenatal monitoring. The aim of this study was to determine the sensitivity, specificity, positive and negative predictive value of the uterine artery Doppler parameters in the prediction of adverse pregnancy outcomes in our population. Methods: This was a hospital-based, time-bound and prospective study, conducted in the Department of Radiodiagnosis of Mahatma Gandhi Memorial Medical College & M.Y. Hospital, Indore, Madhya Pradesh, India, after getting approval by the Institutional Scientific and Ethical Committee. The duration of this study was from Sept. 2022 to Sept. 2023. A total of 150 pregnant women in 2rd trimester (22-24 weeks), referred to the Department of Radiodiagnosis were included in the study according to the inclusion and exclusion criteria, after enrolling PCPNDT registration and after obtaining written informed consent. Results: In our study, 20.7% women delivered babies before gestational age of 37 weeks, also 15.3% underwent LSCS and 6% had assisted delivery. 28 out of 63 women with high mean PI gave birth to babies with adverse perinatal outcomes, while rest 35 women gave birth to babies with no adverse perinatal outcomes, giving sensitivity of 44.4% and specificity of 81.6%. 23 out of 53 women with high mean RI gave birth to babies with adverse perinatal outcomes, while rest 30 women gave birth to babies with no adverse perinatal outcomes, giving sensitivity of 43.4% and specificity of 77.3%. Conclusion: In second trimester, high mean uterine artery PI has higher specificity for adverse perinatal outcomes than high mean uterine artery RI. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion The aim of this study was to evaluate the clinical characteristics and outcomes of pregnant women with COVID‐19 and to compare with pregnant women without COVID‐19. In addition, in the subgroup of patients who were symptomatic at the time of diagnosis, the persistence of symptoms was assessed.This was a retrospective cohort study. All pregnant women aged ≥18 years, admitted to the maternity ward from March 2020 to September 2023 were included in the study. All patients admitted were routinely screened for SARS‐CoV‐2. Clinical characteristics and outcomes were registered.During the study period, 880 patients met the inclusion and were included in the analysis: 385 were COVID‐19 positive and 495 were COVID‐19 negative. In a multivariate analysis of the outcomes associated with COVID‐19 among pregnant women, hospitalization and the Apgar score at 5 min were independently associated with COVID‐19. Cesarean delivery, preterm birth, Apgar scores at 1 and 5 min <7, and maternal death were more frequent in pregnant women with COVID‐19 admitted to ICU than in those not admitted to ICU. Approximately 30% of patients had persistence of symptoms, for at least 6 months in almost 60%.The findings of the present study suggest that COVID‐19 was associated with increased morbidity and mortality among pregnant women. In addition, pregnant women with SARS‐CoV‐2 infection were at significantly higher risk of adverse perinatal outcomes, especially preterm birth. [ABSTRACT FROM AUTHOR]

Background and Aim: Previously observed associations between interpregnancy interval (IPI) and perinatal outcomes using a between‐individual method may be confounded by unmeasured maternal factors. This study aims to examine the association between IPI and adverse perinatal outcomes using within‐individual comparative analyses. Methods: We studied 10,647 individuals from the National Institute of Child Health and Human Development Consecutive Pregnancies Study in Utah with ≥3 liveborn singleton pregnancies. We matched two IPIs per individual and used conditional logistic regression to examine the association between IPI and adverse perinatal outcomes, including preterm birth (PTB, <37 weeks' gestation), small‐for‐gestational‐age (SGA, <10th percentile of sex‐specific birthweight for gestational age), low birthweight (LBW, <2,500 g), and neonatal intensive care unit (NICU) admission. Point and 95% confidence interval (CI) estimates were adjusted for factors that vary across pregnancies within individuals. Results: CIs did not unequivocally support either an increase or a decrease in the odds of PTB (adjusted odds ratio [aOR]: 1.31, 95% CI: 0.87, 1.96), SGA (aOR: 0.81, 95% CI: 0.51, 1.28), LBW (aOR: 1.59, 95% CI: 0.90, 2.80), or NICU admission (aOR: 0.96, 95% CI: 0.66, 1.40) for an IPI <6 months compared to 18–23‐months IPI (reference), and neither did the CIs for the aOR of IPIs of 6–11 and 12–18 months compared to the reference. In contrast, an IPI ≥24 months was associated with increased odds of LBW (aOR: 1.66, 95% CI: 1.03, 2.66 for 24–29 months; aOR: 2.27, 95% CI: 1.21, 4.29 for 30–35 months; and aOR: 2.09, 95% CI: 1.17, 3.72 for ≥36 months). Conclusions: Using a within‐individual comparative method, we did not find evidence that a short IPI compared to the recommended IPI of 18–23 months was associated with increased odds of PTB, SGA, LBW, and NICU admission. IPI ≥ 24 months was associated with increased odds of delivering an LBW infant. Key points: What is already known Short and long interpregnancy intervals (IPIs) were associated with increased odds of adverse perinatal outcomes using a between‐individual method. What this study adds The within‐individual comparative method showed that a short compared to recommended IPI was not associated with increased odds of small‐for‐gestational‐age, preterm birth, low birthweight (LBW), and neonatal intensive care unit admission. IPI ≥ 24 months was associated with increased odds of delivering an LBW newborn. Clinical implications Previously observed associations between IPI and adverse perinatal outcomes using a between‐individual method may be due to unmeasured confounding. Intervening on a short IPI itself may not be beneficial for decreasing the prevalence of adverse perinatal outcomes. [ABSTRACT FROM AUTHOR]

Background: The association between excessive serum total bile acid (TBA) and adverse perinatal outcomes in individuals with non-intrahepatic cholestasis of pregnancy (non-ICP) hypercholanemia has not been determined, and it is unclear if this link is similar to that observed in patients with ICP. Objective: To examine the adverse perinatal outcomes in two specific subcategories: those with ICP and those with non-ICP, including individuals with liver disease and asymptomatic hypercholanemia of pregnancy (AHP), at different levels of TBA. Investigate the correlation between TBA levels and adverse perinatal outcomes of ICP, liver disease, and AHP. Methods: From 2013 to 2021, pregnant women with excessive TBA levels were taken from the electronic medical record database of our hospital and categorized into three groups: ICP (n=160), liver disease (n=164), and AHP (n=650). This was done as part of a retrospective cohort research project. Multivariable regression and subgroup analyses were performed to examine the association between TBA levels and adverse perinatal outcomes in each group. Results: The study found no significant differences in adverse perinatal outcomes between the ICP and liver disease groups at different TBA levels. However, at moderate TBA levels, both groups had a higher risk of adverse perinatal outcomes than the AHP group (p < 0.017). Among liver disease cases with TBA ≥ 100 µmol/L, three cases of perinatal deaths (6.67%) associated with moderate-to-severe acute hepatitis occurred between 27 and 33 weeks of gestation. A 59% higher chance of perinatal death was found for every 10 µmol/L rise in TBA, even after significant variables and confounders were taken into account (adjusted odds ratio (aOR) = 1.59; 95% confidence interval (CI): 1.06-2.40; p=0.03). Conclusions: If a pregnant woman has moderate-to-severe liver disease and TBA ≥ 100 µmol/L, preterm termination of pregnancy (before 34 weeks) may be considered. [ABSTRACT FROM AUTHOR]

Objective: To analyze prenatal and perinatal stressors associated with molar incisor hypomineralization (MIH) in adolescents. Methods: Prospective cohort study collected prenatal (socioeconomic status, maternal age, number of prenatal visits, smoking, obesity during pregnancy, abortion history, gestational hypertension) and perinatal stressors (type of delivery, gestational age, birth weight, intensive care unit‐ICU at birth). The outcome was MIH at 18–19 years follow‐up (n = 590). MIH was defined according to the Ghanim criteria – Model I. We performed a sensitivity analysis, including opacities demarcated in index tooth, incisive or molars, Model II. Through structural equation modeling, we analyzed direct and mediating pathways between multiple stressors with outcomes. Results: MIH was observed in 15.25% (n = 90), and opacities demarcated in any index tooth were observed in 22.8% of adolescents (n = 135). In Model I, no stressor explained MIH significantly, although we watched high standardized coefficients (SC) for low birth weight (SC = 0.223, p = 0.147), lower gestational age (SC = 0.351; p = 0.254), and ICU admission (SC = 0.447, p = 0.254). In Model II, advanced maternal age (SC = 0.148; p < 0.05) and not undergoing prenatal care (SC = 0.384, p < 0.03) explained opacities demarcated in incisors or molars. Conclusion: Advanced maternal age and not undergoing prenatal care were associated with MIH lesion‐like in incisors or molars. [ABSTRACT FROM AUTHOR]

Objective Our objective was to determine whether maternal blood angiogenic factors in suspected-small-for-gestational-age (sSGA) fetuses can predict critical adverse perinatal outcomes (CAPO) and improve risk assessment. Methods Women with singleton pregnancies diagnosed with sSGA, between 24 and 35 6/7 weeks' gestation, were included. Clinical and sonographic comprehensive evaluations were performed at enrolment. Plasma angiogenic factors, soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF), were obtained at diagnosis. In parallel, three attending maternal-fetal-medicine specialists predicted the risk (1–5 scale) of these pregnancies to develop CAPO, based on the clinical presentation. CAPOs were defined as prolonged neonatal intensive care unit hospitalization, fetal or neonatal death, and major neonatal morbidity. Statistical analysis included sensitivity, specificity, positive and negative predictive values, and receiver-operating characteristic (ROC) curve analyses. Results Of the 79 cases included, 32 were complicated by CAPO (40.5%). In SGA fetuses with CAPO, the sFlt-1/PlGF ratio was higher (p < 0.001) and PlGF was lower (p < 0.001) as compared with uncomplicated pregnancies. The areas under the ROC curves for specialists were 0.913, 0.824, and 0.811 and for PlGF and sFlt-1/PlGF ratio 0.926 and 0.900, respectively. CAPO was more common in pregnancies with absent end-diastolic flow or reversed end-diastolic flow (AEDF or REDF) in the umbilical artery upon enrolment (91.6%). Yet, 65.6% of cases involving CAPO occurred in patients without AEDF or REDF, and 66.6% of these cases were not identified by one or more of the experts. The sFlt-1/PlGF ratio identified 92.9% of the experts' errors in this group and 100% of the errors in cases with AEDF or REDF. Conclusion Among sSGA pregnancies prior to 36 weeks' gestation, angiogenic factors testing can identify most cases later complicated with CAPO. Our data demonstrate for the first time that these markers can reduce clinician judgment errors. Incorporation of these measures into decision-making algorithms could potentially improve management, outcomes, and even health care costs. Key Points Angiogenic factors at diagnosis of sSGA can be used to predict CAPO. The sFlt-1/PlGF ratio can flag sSGA pregnancies at increased risk. The sFlt-1/PlGF ratio at admission of sSGA adds to clinical assessment. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to determine adverse perinatal outcomes related to maternal preconception body mass index (BMI). Study Design This is a retrospective observational cohort study at a single institution of 500 consecutive mothers of normal weight with a preconception BMI of 18.5 to less than 25 and 500 additional obese mothers with a preconception BMI more than or equal to 30. Maternal/newborn metrics were stratified by maternal preconception BMI and trend analysis was performed both by simple univariable and multivariable logistic regression analysis. Results The study included 858 mother/baby dyads after 142 were excluded. Trend analysis demonstrated higher preconception BMI was significantly associated with progressively higher rates of cesarean section (p < 0.001), preeclampsia p < 0.001), gestational diabetes (p < 0.001), preterm birth (p = 0.001), lower 1- and 5 minutes Apgar scores (p < 0.001), and neonatal intensive care unit admission (p = 0.002). These associations remained significant in both simple univariable and multivariable logistic regression models. Conclusion We demonstrated obese women are more likely to have maternal complications and neonatal morbidity when compared with normal weight mothers. Maternal and fetal complications increase with increasing obesity with superobese mothers (BMI ≥ 50) having more perinatal adverse outcomes when compared with other classes of obesity. It is reasonable to counsel weight loss prior to conception of women with BMI more than or equal to 30 in an effort to reduce maternal complications and neonatal morbidity related to pregnancy. Key Points Maternal obesity is associated with adverse outcomes. Complications increase with increasing obesity. Superobese mothers have the most adverse outcomes. [ABSTRACT FROM AUTHOR]

Maternal common mental disorders have broad implications for maternal and child mental and physical health that may have a long-lasting social and economic impact. This study aimed to assess the association between symptoms of antenatal common mental disorders and obstetric and perinatal outcomes in Eastern Ethiopia. A community-based prospective cohort study was conducted and a total of 1011 randomly selected pregnant women were followed up from February 1, 2021, to January 30, 2022. The modified Poisson regression model with a robust variance was fitted to examine the effect of the symptoms of antenatal common mental disorders on obstetric and perinatal outcomes. Antenatal common mental disorders (SRQ ≥ 6) were presented among 390 (38.58 %) pregnant women. In the final multivariate Poisson regression model, women with antenatal common mental disorders symptoms had an increased risk of some pregnancy complications (ARR = 1.65, 95 % CI: 1.59, 1.84). In the current study, symptoms of antenatal common mental disorders increased also the risk of preterm birth (ARR = 1.71; 95 % CI: 1.20, 2.42) and low birth weight (ARR = 1.93; 95 % CI: 1.36, 2.74). The indirect effects of some potential mediators and moderators were not assessed in this study. The study found a high rate of symptoms of antenatal common mental disorders and adverse obstetric and perinatal outcomes. Antenatal common mental disorders symptoms may have considerable effects on individual and combined pregnancy complications and adverse perinatal outcomes. • This study found a high rate of antenatal common mental disorders and adverse obstetric and perinatal outcomes. • The symptoms of antenatal common mental disorders may have considerable effects on obstetric and perinatal outcomes. • It needs to consider the psychological risk factors of adverse obstetric and perinatal outcomes while designing strategies. • It should be a priority to include screening and other detection strategies for mental health conditions in maternal health. [ABSTRACT FROM AUTHOR]

Purpose: Our aim was to investigate the roles of rurality and distance to care on adverse perinatal outcomes and COVID‐19 seroprevalence at the time of delivery over a 1‐year period. Methods: Data were collected from the electronic medical record on all pregnant patients who delivered at a single, large, Midwest academic medical center over 1 year. Rurality was classified using standard Rural‐Urban Commuting Area codes. Geographic Information System tools were used to map outcomes. Data were analyzed with univariate and multivariate models, controlling for Body Mass Index (BMI), insurance status, and parity. Findings: A total of 2,497 patients delivered during the study period; 20% of patients were rural (n = 499), 18.6% were micropolitan (n = 466), and 61.4% were metropolitan (n = 1,532). 10.4% of patients (n = 259) were COVID‐19 seropositive. Rural patients did not experience higher rates of any measured adverse outcomes than metropolitan patients; micropolitan patients had increased odds of preterm labor (OR = 1.41, P =.022) and pre‐eclampsia (OR = 1.78, P<.001). Patients living 30+ miles away from the medical center had increased odds of preterm labor (OR = 1.94, P<.001), pre‐eclampsia (OR = 1.73, P =.002), and infant admission to the neonatal intensive care unit (OR = 2.12, P<.001), as well as lower gestational age at delivery (β = −9.2 days, P<.001) and birth weight (β = −206 grams, P<.001). Conclusion: Distance to care, rather than rurality, was the key predictor of multiple adverse perinatal outcomes in this cohort of deliveries over a 1‐year period. Our study suggests that rurality should not be used as a standalone indicator of access to care without further knowledge of the specific barriers affecting a given population. [ABSTRACT FROM AUTHOR]

Background: Preterm birth impacts 60% of twin pregnancies, with the subsequent risk of complications in both newborns secondary to the immaturity of organs. This study aims to assess the utility of the sFlt-1/PlGF ratio throughout pregnancy in predicting late preterm birth and adverse perinatal outcomes related to prematurity in twin pregnancies. Methods: This is a prospective cohort study developed at a tertiary hospital. All pregnant women with a twin pregnancy who signed the informed consent were included. The sFlt-1/PlGF ratio was measured at 12, 24, and 32 weeks' gestation. Results: Seventy patients were included, from which 54.3% suffered late preterm birth. Results revealed a significant difference in sFlt-1/PlGF ratio at week 32 between term and preterm groups, with a one-unit increase associated with a 1.11-fold increase in the probability of preterm birth. The sFlt-1/PlGF ratio at week 32 alone presented considerable predictive capacities (sensitivity of 71%, specificity of 72%, a PPV of 75%, and an NPV of 68%. Similarly, at week 24, a one-unit increase in sFlt-1/PlGF ratio was associated with a 1.24-fold increase in the probability of adverse perinatal events due to prematurity. Combining parity, maternal age, conception method, BMI, and chorionicity, the model yielded better predictive capacities (sensitivity of 82%, specificity of 80%, PPV of 58%, NPV of 93%). Conclusions: The potential of the sFlt-1/PlGF ratio as a predictive tool for preterm birth and adverse perinatal outcomes secondary to prematurity in twin pregnancies is underscored. [ABSTRACT FROM AUTHOR]

Objective: Mothers whose newborn experiences adversity may neglect their own health to care for their affected infant or following a perinatal death. Weight gain after pregnancy is one measure of maternal self‐care. We measured interpregnancy weight gain among women whose child had an adverse perinatal event. Methods: This population‐based observational study included 192 154 primigravid women with two consecutive singleton births in Ontario, Canada. Outcomes included net weight gain, and adjusted odds ratios (aOR) of moving to a higher body mass index (BMI) category between pregnancies, comparing women whose child did versus did not experience either a perinatal death, prematurity, severe neonatal morbidity, major congenital anomaly, or severe neurologic impairment. Results: Perinatal death was associated with a +3.5 kg (95% confidence interval [CI]: 2.1–4.9) net higher maternal weight gain in the subsequent pregnancy. Relative to term births, preterm birth <32 weeks (+3.2 kg, 95% CI: 1.9–4.6), 32–33 weeks (+1.8 kg, 95% CI: 0.7–2.8) and 34–36 weeks (+0.9 kg, 95% CI: 0.6–1.3) were associated with higher net weight gain. Having an infant with severe neonatal morbidity was associated with a +1.2 kg (95% CI: 0.3–2.1) weight gain. Likewise, the aOR of moving to a higher BMI category was 1.27 (95% CI, 1.14–1.42) following a perinatal death, 1.21 (95% CI: 1.04–1.41) after a preterm birth <32 weeks, and 1.11 (95% CI: 1.02–1.22) with severe neonatal morbidity. Conclusion: Greater interpregnancy weight gain, and movement to a higher BMI category, are each more likely in a woman whose first‐born was affected by certain major adverse perinatal events. Synopsis: Adverse perinatal events in the first pregnancy can lead to higher maternal interpregnancy weight gain and increased BMI in a subsequent pregnancy. [ABSTRACT FROM AUTHOR]

Objectives This study aimed to assess the applicability of the National Academy of Medicine (NAM) interim guidelines for twin pregnancies to the specific population of gestational diabetes mellitus by exploring the relationship between gestational weight gain and adverse pregnancy outcomes in Chinese twin-pregnant women with gestational diabetes mellitus. Study Design This was a retrospective cohort study of women diagnosed with diabetes in pregnancy between July 2017 and December 2020 at the Maternal and Child Health Hospital in Chongqing, China. The primary variable of interest was maternal total gestational weight gain. The primary outcomes were perinatal outcomes, which included: preeclampsia, small for gestational age, large for gestational age, low birth weight, neonatal pneumonia, neonatal respiratory distress syndrome, and neonatal intensive unit admission, etc. The association between inappropriate gestational weight gain and adverse pregnancy outcomes was estimated using multiple logistic regression analysis. Results A total of 455 twin-pregnant women who had gestational diabetes mellitus were analyzed. Women with low gestational weight gain had reduced risk of preeclampsia (adjusted odds ratio [aOR], 0.32; 95% CI or confidence interval, 0.17–0.63; p = 0.001) and their infants had higher risks of small for gestational age (aOR, 1.93; 95% CI, 1.04–3.58; p = 0.037), low birth weight (aOR, 2.27; 95% CI, 1.32–3.90; p = 0.003), neonatal intensive unit admission (aOR, 3.29; 95% CI, 1.10–5.78; p = 0.038), pneumonia (aOR, 2.41; 95% CI, 1.08–5.33; p = 0.031), and neonatal respiratory distress syndrome (aOR, 2.29; 95% CI, 1.10–4.78; p = 0.027); the infants of women with excessive gestational weight gain had a higher risk of large for gestational age (aOR, 3.76; 95% CI, 1.42–9.96; p = 0.008). Conclusion Gestational weight gain controlled within the range recommended by the NAM could reduce the risk of perinatal adverse outcomes. The 2009 NAM gestational weight gain recommendations can be used for Chinese twin-pregnant women with gestational diabetes mellitus. Key Points Inappropriate gestational weight gain can lead to adverse perinatal outcomes in twin pregnancies. Gestational weight gain controlled within recommended range could reduce the risk of poor perinatal outcomes. The National Academy of Medicine recommendations are suitable for Chinese twin-pregnant women with GDM. [ABSTRACT FROM AUTHOR]

BackgroundPreeclampsia is a multisystem disorder that affects pregnant women. Preeclampsia and its complications are the leading causes of maternal and perinatal morbidity and mortality in developing countries. Studies conducted in Ethiopia have primarily concentrated on preeclampsia’s trends and prevalence rather than its obstetrical and perinatal consequences. Thus, this study aimed to determine the risk of adverse obstetric and perinatal outcomes among women with preeclampsia at Woldia Comprehensive Specialized Hospital, Northeast Ethiopia.MethodsA retrospective cohort study was conducted among 140 preeclamptic women and 280 normotensive women who gave birth at Woldia Comprehensive Specialized Hospital between 30 December 2020 and 29 December 2022. Maternal records were retrieved using data-extraction tools. The data were entered into EpiData version 4.6.0.6 and analyzed using SPSS version 26. Binary and multivariable logistic regression models were used to test the associations between independent and outcome variables. The adjusted odds ratio (OR) with a 95% confidence interval (CI) and p-values

Abstract Background and Aim Previously observed associations between interpregnancy interval (IPI) and perinatal outcomes using a between‐individual method may be confounded by unmeasured maternal factors. This study aims to examine the association between IPI and adverse perinatal outcomes using within‐individual comparative analyses. Methods We studied 10,647 individuals from the National Institute of Child Health and Human Development Consecutive Pregnancies Study in Utah with ≥3 liveborn singleton pregnancies. We matched two IPIs per individual and used conditional logistic regression to examine the association between IPI and adverse perinatal outcomes, including preterm birth (PTB,

Objective: To compare the femoral artery and other ultrasonographic Doppler measurements between fetuses with late-onset fetal growth restriction and uncomplicated fetuses. Material and method: This prospective cohort study was conducted with 168 patients, including 83 pregnancies presenting with late-onset fetal growth restriction and 85 uncomplicated control pregnancies at similar gestational weeks. The study group was further divided into two according to the neonatal intensive care unit requirements. Demographic characteristics, obstetric characteristics, femoral artery and other ultrasonographic Doppler measurements, and pregnancy outcomes were compared between the groups. Results: Uterine artery pulsatility index, umbilical artery systolic/diastolic ratio, and peak systolic velocity of the middle cerebral artery were similar between the study and control groups. However, while the middle cerebral artery pulsatility index was significantly lower in the study group, the femoral artery pulsatility index value was significantly higher (p

Abstract Purpose The purpose of this study was to investigate the risk factors for umbilical artery thrombosis (UAT) and the relationship between umbilical artery thrombosis and perinatal outcomes. Methods This was a retrospective study that enrolled singleton pregnant women who were diagnosed with umbilical artery thrombosis. The control group recruited pregnant woman with three umbilical vessels or those with isolated single umbilical artery (iSUA) who were matched with umbilical artery thrombosis group. The risk factors and perinatal outcomes were compared between the groups. Results Preconception BMI (OR [95%CI]: 1.212 [1.038–1.416]), abnormal umbilical cord insertion (OR [95%CI]: 16.695 [1.333-209.177]) and thrombophilia (OR [95%CI]: 15.840 [1.112-223.699]) were statistically significant risk factors for umbilical artery thrombosis. An elongated prothrombin time (OR [95%CI]: 2.069[1.091–3.924]) was strongly associated with the occurrence of UAT. The risks of cesarean delivery, preterm birth, fetal growth restriction, neonatal asphyxia, and intraamniotic infection were higher in pregnancies with UAT than in pregnancies with three umbilical vessels or isolated single umbilical artery (P

• There is an association between maternal and fetal Doppler in early labour with the occurrence of labour complications. • A predictive model including early labour CPR and mean UtA Doppler allows the identification of over three out of four women at low-risk of intrapartum hypoxia that are submitted to obstetric intervention due to suspected intrapartum fetal compromise. • The predictive model has a good capacity to rule out and a moderate capacity to rule in OI due to IFC, albeit with poor predictive value. • The predictive model including antenatal and intrapartum characteristics combined with abnormal CPR and mean UtA PI may be used as a screening tool for subclinical uteroplacental insufficiency manifesting during active labor. The evidence-based management of human labor includes the antepartum identification of patients at risk for intrapartum hypoxia. However, available evidence has shown that most of the hypoxic-related complications occur among pregnancies classified at low-risk for intrapartum hypoxia, thus suggesting that the current strategy to identify the pregnancies at risk for intrapartum fetal hypoxia has limited accuracy. To evaluate the role of the combined assessment of the cerebroplacental ratio (CPR) and uterine arteries (UtA) Doppler in the prediction of obstetric intervention (OI) for suspected intrapartum fetal compromise (IFC) within a cohort of low-risk singleton term pregnancies in early labor. Prospective multicentre observational study conducted across four tertiary Maternity Units between January 2016 and September 2019. Low-risk term pregnancies with spontaneous onset of labor were included. A two-step multivariable model was developed to assess the risk of OI for suspected IFC. The baseline model included antenatal and intrapartum characteristics, while the combined model included antenatal and intrapartum characteristics plus Doppler anomalies such as CPR MoM < 10th percentile and mean UtA Doppler PI MoM ≥ 95th percentile. Predictive performance was determined by receiver–operating characteristics curve analysis. 804 women were included. At logistic regression analysis, CPR MoM < 10th percentile (aOR 1.269, 95 % CI 1.188–1.356, P < 0.001), mean UtA PI MoM ≥ 95th percentile (aOR 1.012, 95 % CI 1.001–1.022, P = 0.04) were independently associated with OI for suspected IFC. At ROC curve analysis, the combined model including antenatal characteristics plus abnormal CPR and mean UtA PI yielded an AUC of 0.78, 95 %CI(0.71–0.85), p < 0.001, which was significantly higher than the baseline model (AUC 0.61, 95 %CI(0.54–0.69), p = 0.007) (p < 0.001). The combined model was associated with a 0.78 (95 % CI 0.67–0.89) sensitivity, 0.68 (95 % CI 0.65–0.72) specificity, 0.15 (95 % CI 0.11–0.19) PPV, and 0.98 (0.96–0.99) NPV, 2.48 (95 % CI 2.07–2.97) LR + and 0.32 (95 % CI 0.19–0.53) LR- for OI due to suspected IFC. A predictive model including antenatal and intrapartum characteristics combined with abnormal CPR and mean UtA PI has a good capacity to rule out and a moderate capacity to rule in OI due to IFC, albeit with poor predictive value. [ABSTRACT FROM AUTHOR]

Since the world's first in vitro fertilization baby was born in 1978, there have been more than 8 million children conceived through assisted reproductive technologies (ART) worldwide, and a significant proportion of them have reached puberty or young adulthood. Many studies have found that ART increases the risk of adverse perinatal outcomes, including preterm birth, low birth weight, small size for gestational age, perinatal mortality, and congenital anomalies. However, data regarding the long-term outcomes of ART offspring are limited. According to the developmental origins of health and disease theory, adverse environments during early life stages may induce adaptive changes and subsequently result in an increased risk of diseases in later life. Increasing evidence also suggests that ART offspring are predisposed to an increased risk of non-communicable diseases, such as malignancies, asthma, obesity, metabolic syndrome, diabetes, cardiovascular diseases, and neurodevelopmental and psychiatric disorders. In this review, we summarize the risks for long-term health in ART offspring, discuss the underlying mechanisms, including underlying parental infertility, epigenetic alterations, non-physiological hormone levels, and placental dysfunction, and propose potential strategies to optimize the management of ART and health care of parents and children to eliminate the associated risks. Further ongoing follow-up and research are warranted to determine the effects of ART on the long-term health of ART offspring in later life. [ABSTRACT FROM AUTHOR]

MicroRNA is associated with angiogenesis, invasion, proliferation, and vascular endothelial remodeling of various diseases. We aimed to investigate serum MicroRNA (miRNA) levels in preeclampsia (PE) and to determine whether any changes in miRNA levels are useful in predicting early onset preeclampsia (EOPE) and adverse perinatal outcomes. A total of 89 pregnant patients were enrolled in this prospective case–control study (55 PE and 34 healthy controls). miR-17, miR-20a, miR-20b, miR126, miR155, miR-200, miR-222, and miR-210 levels were studied in maternal serum in preeclamptic pregnant women. Multiple logistic regression analyses analyzed the risk factors which are associated with EOPE and adverse maternal outcomes. The Real-time RT-PCR method was used to determine maternal serum miRNA levels. Serum miR-17, miR-20a, miR-20b, miR126, and miR-210 levels were significantly higher in PE than the control group (p <.001, p <.001, p <.001, p <.001 and p =.047 respectively). Increased miR-17, miR-20a, and miR-20b levels were independently associated with PE (OR: 0.642, 95%Cl: 0.486–0.846, p =.002; OR: 0.899, 95%Cl: 0.811–0.996, p =.042 and OR: 0.817, 95%Cl: 0.689–0.970, p =.021). Increased miR-17 and miR-126 levels were negatively correlated with serum EOPE in PE (r = -.313, p =.020), and increased miR-210 levels were significantly positively correlated with EOPE in PE (r =.285, p =.005). Increased expression of serum miR-17, miR-20a, miR-20b, miR126, and miR-210 were found to be associated with PE, also increased expression of miR-17, miR-20a, and miR-20b were to be predicted with PE, also increased maternal serum miR-17 and miR-126 expressions were negatively correlated and increased miR-210 expression was positively correlated with EOPE in PE women. [ABSTRACT FROM AUTHOR]

Birthweight has increased in the UK and abroad over the last 30 years, partly attributed to the increasing prevalence of maternal obesity and gestational diabetes. The aim of this review is to provide better understanding of definition, epidemiology, detection and management of the large fetus. Many definitions of large infants, or fetal overgrowth, have been described in the literature including macrosomia (weight above 4 kg) or large for gestational age (LGA, defined as weight above the 90th centile by population, customised or international growth charts). Errors in estimation of fetal weight by ultrasound reduce the accuracy of predicting the actual birthweight. Although no single definition is currently universally accepted, the terminology LGA has the advantage of identifying the large fetus even when macrosomia has not yet occurred. Irrespective of definition, fetal overgrowth is associated with an increased risk of adverse perinatal outcomes including need for caesarean delivery, postpartum haemorrhage, third and fourth perineal tears, shoulder dystocia, low Apgar score, admission to neonatal intensive care unit, and increased neonatal morbidity and perinatal mortality. Major risk factors for LGA are maternal obesity, diabetes and increased gestational weight gain but these are not highly predictive of LGA. Previous efforts to prevent fetal overgrowth have had limited success which explain the current focus on improving management once an LGA fetus is identified by ultrasound. Management of LGA has changed substantially in the last decade in response to the ruling Montgomery v Lanarkshire Health Board [2015], national reports from the Healthcare Safety Investigation Branch (HSIB), and international literature. Induction of labour for large for gestational age at early term seems to reduce the incidence of shoulder dystocia but may increase the rate of the third and fourth degree tears. Caesarean section seems to be associated with a reduced risk of LGA related adverse neonatal outcomes, mainly birth trauma, however the number needed to treat is high, being mostly recommended for estimated fetal weight above 4.5 kg in women with diabetes. NICE currently recommends that women with estimated fetal weight above the 95th centile should have a comprehensive discussion regarding birth options including expectant management, induction of labour and elective caesarean; choice should be offered due to the lack of clear evidence of benefit of one strategy over another. Observational evidence suggests that an estimated fetal weight between the 90th and the 95th centile have a much weaker association with adverse neonatal outcomes and is not associated with increased perinatal mortality compared to an estimated fetal weight above the 95th centile, suggesting discussion regarding mode and timing of birth may not be of benefit between the 90th and the 95th centile. There is an ongoing UK randomised controlled trial of induction of labour at early term compared to expectant management for LGA fetuses, which will report soon, and this may help inform the best practice for management of LGA. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to investigate the risk factors for umbilical artery thrombosis (UAT) and the relationship between umbilical artery thrombosis and perinatal outcomes. Methods: This was a retrospective study that enrolled singleton pregnant women who were diagnosed with umbilical artery thrombosis. The control group recruited pregnant woman with three umbilical vessels or those with isolated single umbilical artery (iSUA) who were matched with umbilical artery thrombosis group. The risk factors and perinatal outcomes were compared between the groups. Results: Preconception BMI (OR [95%CI]: 1.212 [1.038–1.416]), abnormal umbilical cord insertion (OR [95%CI]: 16.695 [1.333-209.177]) and thrombophilia (OR [95%CI]: 15.840 [1.112-223.699]) were statistically significant risk factors for umbilical artery thrombosis. An elongated prothrombin time (OR [95%CI]: 2.069[1.091–3.924]) was strongly associated with the occurrence of UAT. The risks of cesarean delivery, preterm birth, fetal growth restriction, neonatal asphyxia, and intraamniotic infection were higher in pregnancies with UAT than in pregnancies with three umbilical vessels or isolated single umbilical artery (P<0.05). Additionally, the incidence of thrombophilia was higher in pregnant women with umbilical artery thrombosis than those with isolated single umbilical artery (P = 0.032). Abnormal umbilical cord insertion was also found to be associated with an elevated risk of iSUA (OR [95%CI]: 15.043[1.750-129.334]). Conclusions: Abnormal umbilical cord insertion was the risk factor for both umbilical artery thrombosis and isolated single umbilical artery. The pregnancies with umbilical artery thrombosis had a higher risk of the adverse perinatal outcomes. [ABSTRACT FROM AUTHOR]

Objective: To compare the femoral artery and other ultrasonographic Doppler measurements between fetuses with late-onset fetal growth restriction and uncomplicated fetuses. Material and Method: This prospective cohort study was conducted with 168 patients, including 83 pregnancies presenting with late-onset fetal growth restriction and 85 uncomplicated control pregnancies at similar gestational weeks. The study group was further divided into two according to the neonatal intensive care unit requirements. Demographic characteristics, obstetric characteristics, femoral artery and other ultrasonographic Doppler measurements, and pregnancy outcomes were compared between the groups. Results: Uterine artery pulsatility index, umbilical artery systolic/diastolic ratio, and peak systolic velocity of the middle cerebral artery were similar between the study and control groups. However, while the middle cerebral artery pulsatility index was significantly lower in the study group, the femoral artery pulsatility index value was significantly higher (p<0.001 and p=0.002, respectively). When the two subgroups of the study group were compared according to the neonatal intensive care unit requirements, their femoral artery and other Doppler measurements were similar. Estimated fetal weight was statistically lower in the group requiring neonatal intensive care unit (p=0.033). Conclusion: The femoral artery pulsatility index measurement was higher in the late-onset fetal growth restriction cases than in the healthy controls. The Doppler examination of the femoral artery was not found to be effective in demonstrating adverse perinatal outcomes. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the aspartate aminotransferase to platelet ratio (APRI) score as a predictive and prognostic test in intrahepatic cholestasis of pregnancy (ICP). Methods: This study was conducted in 198 patients diagnosed with ICP and 204 healthy pregnant women who presented to a tertiary center between 2019 and 2022. APRI scores; laboratory findings in the first, second, and third trimesters; and perinatal outcomes were compared between the two groups. The ICP group was evaluated for correlation between APRI scores and composite adverse outcomes. Two different receiver operating characteristic analyses were performed to determine optimal cutoff values of predictive APRI score of ICP and composite adverse outcomes in patients with ICP. Results: Aspartate aminotransferase values and APRI scores were significantly higher in the ICP group in all trimesters (P < 0.001). The optimal cutoff values of APRI scores to predict ICP for the first, second, and third trimesters were 0.101 (79.7% sensitivity, 79.6% specificity), 0.103 (78.4% sensitivity, 76.3% specificity), and 0.098 (72.5% sensitivity, 72% specificity), respectively. APRI scores were statistically higher in patients with ICP with composite adverse outcomes in all trimesters (P values of 0.03, 0.04, and 0.01, respectively). Conclusion: APRI score was found to be a valuable predictor of ICP and its adverse outcomes during the entire pregnancy. Synopsis: The aspartate aminotransferase to platelet ratio score was found to be statistically higher in patients with intrahepatic cholestasis of pregnancy than in the control group. [ABSTRACT FROM AUTHOR]

Background: The prevalence of childhood and adult obesity is rising exponentially worldwide. Class IV obesity (body mass index, BMI ≥50 kg/m2) is associated with a higher risk of adverse perinatal outcomes. This study compared these outcomes between women with class IV obesity and women in the normal or overweight categories during pregnancy. Methods: A retrospective cohort study was performed in Qatar, including women having singleton live births beyond 24 weeks of gestation, classified into two class IV obesity and normal/overweight (BMI between 18.5 and 30.0 kg/m2). The outcome measures included the mode of delivery, development of gestational diabetes and hypertension, fetal macrosomia, small for date baby, preterm birth and neonatal morbidity. Adjusted odds ratios (aOR) with 95% confidence intervals (95% CI) were determined using multivariable logistic regression models. Results: A total of 247 women with class IV obesity were compared with 6797 normal/overweight women. Adjusted analysis showed that women with class IV obesity had 3.2 times higher odds of cesarean delivery (aOR: 3.19, CI: 2.26–4.50), 3.4 times higher odds of gestational diabetes (aOR: 3.39, CI: 2.55–4.50), 4.2 times higher odds of gestational hypertension (aOR: 4.18, CI: 2.45–7.13) and neonatal morbidity (aOR: 4.27, CI: 3.01–6.05), and 6.5 times higher odds of macrosomia (aOR 6.48, CI 4.22–9.99). Conclusions: Class IV obesity is associated with more adverse perinatal outcomes compared with the normal or overweight BMI categories. The study results emphasized the need for specialized antenatal obesity clinics to address the associated risks and reduce complications. [ABSTRACT FROM AUTHOR]

Abstract Objective To evaluate the appropriateness, timeliness and perinatal outcomes of obstetric referrals compared to nonreferrals managed by caesarean section (CS) at a tertiary hospital. Methods Research assistants observed and recorded every delivery prospectively. Neonates were followed to discharge or up to 7 days, and outcomes were recorded. Proportions were used to describe baseline characteristics of the groups, and logistic regression was used to determine factors associated with CS in the referral group. Results A total of 10 353 deliveries occurred during the study period: 7.4% (768) were referrals and 92.6% (9585) were nonreferrals. The proportion of CS among referrals was 41.5% (319), nonreferrals 22.5% (2152) and overall 23.8% (2471). Compared to nonreferrals, referred women arrived at the second stage of labour with complications, ending up with emergency CS (p

Massive perivillous fibrin deposition (MPVFD) is a potentially devastating complication of pregnancy that occurs in 0.03–0.5% of deliveries and is associated with severe fetal growth restriction, stillbirth, and neurologic injury due to uteroplacental insufficiency. The management of patients with recurrent pregnancy loss secondary to MPVFD has not been widely studied. We describe the case of a healthy 19-year-old with a history of two prior intrauterine fetal demises at 35w6d and 36w6d secondary to MPVFD of the placenta who subsequently delivered a healthy infant at 33w6d after she had been treated in the prenatal period with aspirin and prophylactic enoxaparin. Antenatal treatment with daily aspirin and prophylactic enoxaparin as well as close antenatal follow-up may be an option for patients with recurrent pregnancy loss due to MPVFD.

Abstract Background Despite efforts, Uganda has not met the World Health Organization target of

Background: Despite efforts, Uganda has not met the World Health Organization target of < 12 newborn deaths per 1,000 live births. Severe maternal morbidity or 'near miss' is a major contributor to adverse perinatal outcomes, particularly in low-resource settings. However, the specific impact of maternal near miss on perinatal outcomes in Uganda remains insufficiently investigated. We examined the association between maternal near miss and adverse perinatal outcomes at Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda. Methods: We conducted a prospective cohort study among women admitted for delivery at MRRH's maternity ward from April 2022 to August 2022. We included mothers at ≥ 28 weeks of gestation with singleton pregnancies, while intrauterine fetal death cases were excluded. For the near-miss group, we consecutively included mothers with any one of the following: antepartum hemorrhage with shock, uterine rupture, hypertensive disorders, coma, and cardiac arrest; those without these complications constituted the non-near-miss group. We followed the mothers until delivery, and their infants until seven days postpartum or death. Adverse perinatal outcomes considered were low birth weight (< 2,500 g), low Apgar score (< 7 at five minutes), intrapartum stillbirths, early neonatal death, or admission to neonatal intensive care unit. Multivariable log-binomial regression was used to determine predictors of adverse perinatal outcomes. Results: We enrolled 220 participants (55 maternal near misses and 165 non-near misses) with a mean age of 27 ± 5.8 years. Most of the near misses were pregnancies with hypertensive disorders (49%). Maternal near misses had a four-fold (adjusted risk ratio [aRR] = 4.02, 95% CI: 2.32–6.98) increased risk of adverse perinatal outcomes compared to non-near misses. Other predictors of adverse perinatal outcomes were primigravidity (aRR = 1.53, 95%CI: 1.01–2.31), and gestational age < 34 weeks (aRR = 1.81, 95%CI: 1.19–2.77). Conclusion: Maternal near misses, primigravidity, and preterm pregnancies were independent predictors of adverse perinatal outcomes in this study. We recommend implementing maternal near-miss surveillance as an integral component of comprehensive perinatal care protocols, to improve perinatal outcomes in Uganda and similar low-resource settings. Targeted interventions, including specialized care for women with maternal near misses, particularly primigravidas and those with preterm pregnancies, could mitigate the burden of adverse perinatal outcomes. [ABSTRACT FROM AUTHOR]

Background Anaemia in pregnancy is one of the most frequent complications related to pregnancy and is a public health concern. This article examines the prevalence of anaemia in the third trimester of pregnancy and the associations between anaemia and adverse perinatal outcomes in Hebei Province, China. Methods We used SPSS software to describe the incidence of anaemia in the third trimester of pregnancy in Hebei Province and analysed the clinical characteristics in anaemic patients and the relationship between anaemia and adverse pregnancy outcomes. Results The overall prevalence of anaemia in the third trimester of pregnancy was 35.0% in Hebei Province. The prevalence of anaemia in the population with a high education level was lower than that in the population with a low education level. The incidence rate in rural areas was higher than that in urban areas. After adjustment for confounding factors, anaemia in the third trimester of pregnancy is an independent risk factor in terms of placenta previa, placental abruption, uterine atony, pre-eclampsia, gestational diabetes mellitus, heart disease, postpartum haemorrhage, premature birth, laceration of birth canal, puerperal infection, caesarean section and large for gestational age. Conclusions The prevalence of anaemia in the third trimester of pregnancy is associated with an increased risk of adverse perinatal outcomes. A comprehensive approach to prevent anaemia is needed to improve maternal and child health outcomes. [ABSTRACT FROM AUTHOR]

Abnormal body mass index (BMI) during pregnancy, a growing public health concern, increases maternal and neonatal complications. This study aimed to investigate the impact of abnormal BMI on perinatal outcomes compared to normal BMI. A total of 14,624 women having singleton births were categorized as underweight (BMI<18.5 kg/m2), overweight (25.0–29.9 kg/m2), obesity class I (30.0–34.9 kg/m2), obesity class II (35.0–39.9 kg/m2), and obesity class III (≥40.0 kg/m2) and compared to those with normal BMI (18.5–24.9 kg/m2). Outcomes included gestational diabetes (GDM), gestational hypertension (GHT), postpartum haemorrhage (PPH), cesarean delivery (CD), preterm birth (PTB), low birth weight (LBW), congenital anomalies and neonatal intensive care unit admission. Women with increasing BMI had increasingly higher odds of developing specific adverse outcomes, the highest being in the class III obesity group (GDM-aOR 2.71, 95 % CI 2.25–3.27, p<0.001, GHT-aOR 5.32 95 % CI 3.49–8.11, p<0.001, CD-aOR 2.33 95 % CI 1.85–2.94, p<0.001, PPH-aOR 1.77 95 % CI 1.35–2.33, p<0.001). On the other hand, being underweight during pregnancy was associated with increased odds of PTB (aOR 2.09, 95 % CI 1.37–3.20, p=0.001), LBW (OR 1.88, 95 % CI 1.27–2.79, p=0.002) and congenital anomalies (aOR 2.52 95 % CI 1.12–5.64, p=0.025). Majority in the underweight category gained less than expected gestational weight gain during the pregnancy. The findings of this study have important implications for the clinical management of pregnant women with abnormal BMI. Interventions to improve maternal and neonatal outcomes must focus on enhancing pre-pregnancy BMI and maintaining adequate gestational weight gain. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to investigate the association of the epithelial and lymphoid immune markers with the adverse perinatal conditions such as early-onset preeclampsia (EOPE), fetal growth restriction (FGR) and intrauterine fetal death (IUFD) in preeclampsia in the placentae of preeclamptic patients. Material and methods: A total of 60 pregnant patients were included in this study. The immunohistochemistry method was used to determine the expression levels of CD4, CD8, CD4 / CD8, CD68, P53, MDM2, CK18, CK19, E-cadherin, and β-catenin. Results: In our study, the increase in E-cadherin expression in the preeclamptic fetal-maternal placental region was associated with EOPE and FGR development preeclampsia and the decrease in the expression of CD4 and CD8, which are involved in the local immunomodulation, was associated with IUFD. Conclusions:Our data reveal that the increase in the expression of CK18, CK19, E-cadherin, and β-catenin and the decrease in CD4 and CD8 play a role in the pathogenesis of preeclampsia. [ABSTRACT FROM AUTHOR]

Abstract Background The prevalence of childhood and adult obesity is rising exponentially worldwide. Class IV obesity (body mass index, BMI ≥50 kg/m2) is associated with a higher risk of adverse perinatal outcomes. This study compared these outcomes between women with class IV obesity and women in the normal or overweight categories during pregnancy. Methods A retrospective cohort study was performed in Qatar, including women having singleton live births beyond 24 weeks of gestation, classified into two class IV obesity and normal/overweight (BMI between 18.5 and 30.0 kg/m2). The outcome measures included the mode of delivery, development of gestational diabetes and hypertension, fetal macrosomia, small for date baby, preterm birth and neonatal morbidity. Adjusted odds ratios (aOR) with 95% confidence intervals (95% CI) were determined using multivariable logistic regression models. Results A total of 247 women with class IV obesity were compared with 6797 normal/overweight women. Adjusted analysis showed that women with class IV obesity had 3.2 times higher odds of cesarean delivery (aOR: 3.19, CI: 2.26–4.50), 3.4 times higher odds of gestational diabetes (aOR: 3.39, CI: 2.55–4.50), 4.2 times higher odds of gestational hypertension (aOR: 4.18, CI: 2.45–7.13) and neonatal morbidity (aOR: 4.27, CI: 3.01–6.05), and 6.5 times higher odds of macrosomia (aOR 6.48, CI 4.22–9.99). Conclusions Class IV obesity is associated with more adverse perinatal outcomes compared with the normal or overweight BMI categories. The study results emphasized the need for specialized antenatal obesity clinics to address the associated risks and reduce complications.

BACKGROUND: Globally, various studies have reported that most adverse perinatal outcomes were associated with maternal near-misses. In Ethiopia, studies on adverse perinatal outcomes from maternal near-miss are scarce. OBJECTIVE: This study aimed to assess the incidence, determinants, and maternal near-miss effects on perinatal outcomes among women at public hospitals in the South Gondar zone in 2021. STUDY DESIGN: A facility-based prospective cohort study was conducted from January 10, 2021, to May 10, 2021. The chi-square test, multivariable logistic regression methods, and SPSS software were used. The strength of associations and significance level were examined using P values and odds ratios with 95% confidence intervals, respectively. In addition, multicollinearity and model fitness were checked. RESULTS: A total of 304 respondents (76 exposed and 228 unexposed) were included in the study with a response rate of 100.0%. The incidence rates of adverse perinatal outcomes among exposed and unexposed groups were 71.1% (95% confidence interval, 60.0–73.8) and 21.1% (95% confidence interval, 15.8–28.8), respectively. Multivariable logistic regression showed that short interbirth interval (adjusted odds ratio, 8.39; 95% confidence interval, 5.36–16.08), lower household income (adjusted odds ratio, 3.61; 95% confidence interval, 1.12–6.54), rural residence (adjusted odds ratio, 2.54; 95% confidence interval, 1.21–4.07), previous stillbirth (adjusted odds ratio, 4.24; 95% confidence interval, 1.04–17.31), absence of antenatal care (adjusted odds ratio, 9.84; 95% confidence interval, 4.89–17.51), and anemia (adjusted odds ratio, 4.19; 95% confidence interval, 1.01–17.46) were significantly associated with increased odds of adverse perinatal outcomes CONCLUSION: This study revealed that the incidence of adverse perinatal outcomes was significantly higher among exposed groups than unexposed groups. The result signified the need for improving the health of mothers by all stakeholders to improve perinatal outcomes.

Introduction and aim. To evaluate the clinical features of women at =40 weeks of pregnancy and the utility of obstetric Doppler indices in predicting adverse perinatal outcomes in these pregnancies. Material and methods. This prospective study was conducted at a single academic medical center between 2020 and 2022. Women aged 18 years and older with no risk factors who were at =40 weeks of pregnancy and delivered their babies in our hospital were included in the study. The fetal biometry, placental maturity grading, and doppler velocytometry indices of the pregnant women were evaluated. The cases were divided into two groups according to the development of adverse perinatal outcomes. The relationship between clinical features and adverse perinatal outcomes was evaluated. Results. Adverse perinatal outcomes developed in 19.6% (42) of the 214 cases. The multiple logistic regression analysis was performed to identify factors affecting perinatal outcomes. Accordingly, a maternal age of =35 years (odds ratio [OR]: 1.74, 95% confidence interval [CI]: 1.29-3.96, p=0.038), nulliparity (OR: 1.42, 95% CI: 1.13-4.63, p=0.040), and grade 3 placental calcification (OR: 1.98, 95% CI: 1.11-4.53, p=0.029) were independent predictors of adverse perinatal outcomes. Conclusion. Care should be taken in terms of adverse perinatal outcomes in the presence of nulliparity, a maternal age of =35 years, and grade 3 placental calcification in =40 week pregnancies. [ABSTRACT FROM AUTHOR]

Background: (1) The aim of this article is to describe the physiopathology underlying umbilical cord diseases and their relationship with obstetric and perinatal outcomes. (2) Methods: Multicenter case series of umbilical cord diseases with illustrations from contributing institutions are presented. (3) Results: Clinical presentations of prenatal ultrasound findings, clinical prenatal features and postnatal outcomes are described. (4) Conclusions: Analysis of our series presents and discusses how umbilical cord diseases are associated with a wide variety of obstetric complications leading to a higher risk of poor perinatal outcomes in pregnancies. Knowing the physiopathology, prenatal clinical presentations and outcomes related to umbilical diseases allow for better prenatal counseling and management to potentially avoid severe obstetric and perinatal complications. [ABSTRACT FROM AUTHOR]

Background: While a male infant is usually born with a higher birthweight than his female counterpart, he is more at risk of variety of adverse perinatal outcomes. Indeed, throughout life, females exhibit a marked survival advantage compared to males. The aetiology for such pertinent sex disparity remains unclear and is likely multifactorial. Aims: The aim of this study was to investigate obstetric and perinatal outcomes by infant sex from 28 weeks in a contemporary, large Australian birth cohort. Materials and Methods: A 14‐year retrospective cohort study of 130 133 births over 28 weeks gestation from a single tertiary centre. Results: Male infants had overall higher rates of neonatal mortality (0.12% vs 0.06%, P < 0.001) and severe neonatal morbidity (12% vs 9.1%, P < 0.001) (adjusted odds ratio (aOR) 1.41, 95% CI 1.35–1.47). The odds of overall perinatal mortality (stillbirth and neonatal death) were higher for male infants (aOR 1.30, 95% CI 1.08–1.56). The difference in severe neonatal morbidity when stratified by gestational age at birth only remained significant from >35 weeks gestation. Regardless of infant sex, rates of neonatal mortality and morbidity were lowest at 39 weeks gestation. Rates of preterm birth and operative birth were also higher for male infants. Conclusions: Our study demonstrates significant disparities in clinical outcomes by infant sex with males at a disadvantage to female infants. [ABSTRACT FROM AUTHOR]

Abstract Background Vulvovaginal yeast infections in pregnancy are common and can cause extensive inflammation, which could contribute to adverse pregnancy outcomes. Symptomatic yeast infections are likely to cause more inflammation than asymptomatic. The objective of this study was to investigate associations between symptomatic and asymptomatic vulvovaginal yeast infections in pregnancy and perinatal outcomes. Methods We did a systematic review and searched eight databases until 01 July 2022. We included studies reporting on pregnant women with and without laboratory confirmed vulvovaginal yeast infection and preterm birth or eight other perinatal outcomes. We used random effects meta-analysis to calculate summary odds ratios (OR), 95% confidence intervals (CI) and prediction intervals for the association between yeast infection and outcomes. We described findings from studies with multivariable analyses. We assessed the risk of bias using published tools. Results We screened 3909 references and included 57 studies. Only 22/57 studies reported information about participant vulvovaginal symptoms. Preterm birth was an outcome in 35/57 studies (49,161 women). In 32/35 studies with available data, the summary OR from univariable analyses was 1.01 (95% CI 0.84–1.21, I 2 60%, prediction interval 0.45–2.23). In analyses stratified by symptom status, we found ORs of 1.44 (95% CI 0.92–2.26) in two studies with ≥ 50% symptomatic participants, 0.84 (95% CI 0.45–1.58) in seven studies with

Introduction: Machine learning (ML) corresponds to a wide variety of methods that use mathematics, statistics and computational science to learn from multiple variables simultaneously. By means of pattern recognition, ML methods are able to find hidden correlations and accomplish accurate predictions regarding different conditions. ML has been successfully used to solve varied problems in different areas of science, such as psychology, economics, biology and chemistry. Therefore, we wondered how far it has penetrated into the field of obstetrics and gynecology. Aim: To describe the state of art regarding the use of ML in the context of pregnancy diseases and complications. Methodology: Publications were searched in PubMed, Web of Science and Google Scholar. Seven subjects of interest were considered: gestational diabetes mellitus, preeclampsia, perinatal death, spontaneous abortion, preterm birth, cesarean section, and fetal malformations. Current state: ML has been widely applied in all the included subjects. Its uses are varied, the most common being the prediction of perinatal disorders. Other ML applications include (but are not restricted to) biomarker discovery, risk estimation, correlation assessment, pharmacological treatment prediction, drug screening, data acquisition and data extraction. Most of the reviewed articles were published in the last five years. The most employed ML methods in the field are non-linear. Except for logistic regression, linear methods are rarely used. Future challenges: To improve data recording, storage and update in medical and research settings from different realities. To develop more accurate and understandable ML models using data from cutting-edge instruments. To carry out validation and impact analysis studies of currently existing high-accuracy ML models. Conclusion: The use of ML in pregnancy diseases and complications is quite recent, and has increased over the last few years. The applications are varied and point not only to the diagnosis, but also to the management, treatment, and pathophysiological understanding of perinatal alterations. Facing the challenges that come with working with different types of data, the handling of increasingly large amounts of information, the development of emerging technologies, and the need of translational studies, it is expected that the use of ML continue growing in the field of obstetrics and gynecology. [ABSTRACT FROM AUTHOR]

Objective: To determine the relative burdens of maternal and perinatal complications for preterm and term pre‐eclampsia. Design: Prospective observational cohort study. Setting: Two English maternity units. Population: Unselected women with singleton pregnancies who developed pre‐eclampsia (International Society for the Study of Hypertension in Pregnancy definition). Methods: Outcomes were ascertained by health record review and compared between pregnancies with preterm (versus term) pre‐eclampsia. Main outcome measures: Severe maternal hypertension, maternal mortality or major maternal morbidity, perinatal mortality or major neonatal morbidity, neonatal unit (NNU) admission ≥48 hours, and birthweight <3rd percentile. Results: Among 40 241 singleton pregnancies, 298 (0.7%, 95% confidence interval [CI] 0.66–0.83) and 1194 (3.0%, 95% CI 2.8–3.1) developed preterm and term pre‐eclampsia, respectively. Women with preterm (versus term) pre‐eclampsia more commonly experienced adverse maternal or perinatal events: severe hypertension 18.5% (95% CI 14.5–23.3) versus 13.6% (95% CI 11.7–15.6); maternal mortality/major morbidity 7.4% (95% CI 4.9–10.9) versus 2.2% (95% CI 1.5–3.2); perinatal mortality/major neonatal morbidity 29.5% (95% CI 24.6–34.9) versus 2.2% (95% CI 1.5–3.2); and birthweight <3rd percentile 54.4% (95% CI 48.7–59.9) versus 14.2% (95% CI 12.4–16.3). However, in absolute terms, most maternal complications occurred in women with term pre‐eclampsia, as did a large proportion of perinatal complications: severe hypertension 74.7% (95% CI 68.5–80.0); maternal mortality/major morbidity 54.2% (95% CI 40.3–67.4); perinatal mortality/major neonatal morbidity 22.8% (95% CI 16.1–31.3); NNU admission ≥48 hours 38.1% (95% CI 32.4–44.1); and birthweight <3rd percentile 51.2% (95% CI 45.8–56.5). Conclusions: Although adverse event risks are greater with preterm (versus term) pre‐eclampsia, term disease is associated with at least equivalent total numbers of maternal, and a significant proportion of perinatal, adverse events. Increased efforts should be made to decrease the incidence of term pre‐eclampsia. This article includes Author Insights, a video abstract presented by Laura A. Magee available at: https://vimeo.com/790715868 [ABSTRACT FROM AUTHOR]

OBJECTIVE: The COVID-19 pandemic brought about many social, psychological, and economic changes. We sought to compare pregnancy and birth outcomes immediately preceding the COVID-19 lockdown to those 12 months later. STUDY DESIGN: This was a retrospective cohort study of people giving birth at a large-volume tertiary medical center in Rhode Island. We compared those who gave birth in February 2020 to those in February 2021. RESULTS: Fewer people delivered in 2021 than 2020 (562 vs. 655). There was a non-significant decrease in the number of primary cesarean deliveries from 2020 to 2021. Insurance status modified this effect as there was a significant decrease in the number of patients with private insurance undergoing primary cesarean (63.6 vs 36.4%, p=0.004). Neonatal complications significantly decreased (55.4% vs 47.4%, p=0.006). CONCLUSION: There were differences in sociodemographic characteristics and outcomes of birthing people between 2020 and 2021. The socioeconomic and healthcare landscape caused by COVID-19 altered statewide birthing patterns. [ABSTRACT FROM AUTHOR]

Objective: To compare adverse perinatal outcome among coronavirus disease 2019 (COVID‐19)–vaccinated and –unvaccinated pregnant women. Method: Retrospective equivalence cohort study comparing 930 women who received at least one BNT162b2 (Pfizer/BioNTech) COVID‐19 vaccine during the second or third trimester of pregnancy and 964 unvaccinated women. The primary outcome was a composite adverse perinatal outcome including at least one of the following: preterm delivery <35 weeks of gestation, intrauterine fetal death >23 weeks of gestation, intrauterine growth restriction defined as birth weight < 10th percentile, 5‐min APGAR score ≤ 7, and neonatal care unit admission. Results: The authors found no effect of the COVID‐19 vaccine on the rate of the individual adverse perinatal outcomes. At least one adverse perinatal outcome was found in 108 (11.25%) of unvaccinated women versus 82 (8.82%) of vaccinated pregnant women (P = 0.080). The observed proportion difference (unvaccinated minus vaccinated) was 0.024. In the equivalence analysis with a margin of 0.05, the 90% confidence interval (0.01–0.05) was entirely within the equivalence zone (−0.05 to 0.05) with a P value of 0.032. Conclusion: The present study demonstrated an equivalent rate of adverse perinatal outcomes among vaccinated and unvaccinated women, thus supporting vaccine safety during the second and third trimesters of pregnancy. The authors believe this information is useful in counseling pregnant women regarding COVID‐19 vaccination during pregnancy. Synopsis: The rate of the composite adverse perinatal outcome following COVID‐19 vaccination during pregnancy was equivalent between vaccinated and unvaccinated pregnant women. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to evaluate a new ratio of amniotic fluid volume (AFV) to Doppler measurements, and compare its association with adverse perinatal outcomes (APOs) in fetal growth restriction (FGR). Methods: This prospective study included pregnant women with singleton fetal growth–restricted fetuses. Each participant underwent a detailed ultrasonographic examination. Uterine artery pulsatility index, umbilical artery pulsatility index (UA PI), middle cerebral artery pulsatility index (MCA PI), cerebroplacental ratio (CPR), and umbilical‐to‐cerebral ratio (UCR) were calculated, and the single deepest pocket (SDP) technique was used to estimate AFV. Amniotic‐umbilical‐to‐cerebral ratio (AUCR) was calculated as the ratio of SDP to UCR: AUCR = SDP / (UA PI/MCA PI). APO was defined as umbilical venous cord blood pH <7.10, 5‐minute APGAR score <7, and neonatal intensive care unit admission. Results: We compared the fetal ultrasonographic and demographic features between the APO and the non‐APO groups. The mean UA PI and UCR were significantly higher in the APO group. The mean SDP, CPR, and AUCR were significantly lower in the APO group. Receiver operating characteristic curve analyses demonstrated the highest area under the curve value (0.882; P < 0.001) for AUCR to APOs. Conclusion: The current study suggests that AUCR is the best predictor for APOs in FGR. Synopsis: The currrent study suggests that umbilical‐to‐cerebral ratio is superior to cerebroplacental ratio and the amniotic‐umbilical‐to‐cerebral ratio is the best predictor of adverse perinatal outcomes in fetal growth restriction. [ABSTRACT FROM AUTHOR]

Background: Vulvovaginal yeast infections in pregnancy are common and can cause extensive inflammation, which could contribute to adverse pregnancy outcomes. Symptomatic yeast infections are likely to cause more inflammation than asymptomatic. The objective of this study was to investigate associations between symptomatic and asymptomatic vulvovaginal yeast infections in pregnancy and perinatal outcomes. Methods: We did a systematic review and searched eight databases until 01 July 2022. We included studies reporting on pregnant women with and without laboratory confirmed vulvovaginal yeast infection and preterm birth or eight other perinatal outcomes. We used random effects meta-analysis to calculate summary odds ratios (OR), 95% confidence intervals (CI) and prediction intervals for the association between yeast infection and outcomes. We described findings from studies with multivariable analyses. We assessed the risk of bias using published tools. Results: We screened 3909 references and included 57 studies. Only 22/57 studies reported information about participant vulvovaginal symptoms. Preterm birth was an outcome in 35/57 studies (49,161 women). In 32/35 studies with available data, the summary OR from univariable analyses was 1.01 (95% CI 0.84–1.21, I2 60%, prediction interval 0.45–2.23). In analyses stratified by symptom status, we found ORs of 1.44 (95% CI 0.92–2.26) in two studies with ≥ 50% symptomatic participants, 0.84 (95% CI 0.45–1.58) in seven studies with < 50% symptomatic participants, and 1.12 (95% CI 0.94–1.35) in four studies with asymptomatic participants. In three studies with multivariable analysis, adjusted ORs were greater than one but CIs were compatible with there being no association. We did not find associations between vulvovaginal yeast infection and any secondary outcome. Most studies were at high risk of bias in at least one domain and only three studies controlled for confounding. Conclusions: We did not find strong statistical evidence of an increased risk for preterm birth or eight other adverse perinatal outcomes, in pregnant women with either symptomatic or asymptomatic vulvovaginal yeast infection. The available evidence is insufficient to make recommendations about testing and treatment of vulvovaginal yeast infection in pregnancy. Future studies should assess vulvovaginal symptoms, yeast organism loads, concomitant vaginal or cervical infections, and microbiota using state-of-the-art diagnostics. Systematic review registration: PROSPERO CRD42020197564 [ABSTRACT FROM AUTHOR]

Aim: To investigate the association of systemic immune‐inflammation index (SII) and systemic immune‐response index (SIRI) with adverse perinatal outcomes in pregnant women with coronavirus disease 2019 (COVID‐19). Methods: The cases were divided into (1) the Mild–moderate COVID‐19 group (n = 2437) and (2) the Severe–critical COVID‐19 group (n = 212). Clinical characteristics, perinatal outcomes, SII (neutrophilXplatelet/lymphocyte), and SIRI (neutrophilXmonocyte/lymphocyte) were compared between the groups. Afterward, SII and SIRI values were compared between subgroups based on pregnancy complications, neonatal intensive care unit (NICU) admission, and maternal mortality. A receiver operator characteristic analysis was performed for the determination of optimal cutoff values for SII and SIRI in the prediction of COVID‐19 severity, pregnancy complications, NICU admission, and maternal mortality. Results: Both SII and SIRI were significantly higher in complicated cases (p < 0.05). Cutoff values in the prediction of severe–critical COVID‐19 were 1309.8 for SII, and 2.3 for SIRI. For pregnancy complications, optimal cutoff values were 973.2 and 1.6. Cutoff values of 1045.4 and 1.8 were calculated for the prediction of NICU admission. Finally, cut‐off values of 1224.2 and 2.4 were found in the prediction of maternal mortality. Conclusion: SII and SIRI might be used in combination with other clinical findings in the prediction of poor perinatal outcomes. [ABSTRACT FROM AUTHOR]

IntroductionMachine learning (ML) corresponds to a wide variety of methods that use mathematics, statistics and computational science to learn from multiple variables simultaneously. By means of pattern recognition, ML methods are able to find hidden correlations and accomplish accurate predictions regarding different conditions. ML has been successfully used to solve varied problems in different areas of science, such as psychology, economics, biology and chemistry. Therefore, we wondered how far it has penetrated into the field of obstetrics and gynecology.AimTo describe the state of art regarding the use of ML in the context of pregnancy diseases and complications.MethodologyPublications were searched in PubMed, Web of Science and Google Scholar. Seven subjects of interest were considered: gestational diabetes mellitus, preeclampsia, perinatal death, spontaneous abortion, preterm birth, cesarean section, and fetal malformations.Current stateML has been widely applied in all the included subjects. Its uses are varied, the most common being the prediction of perinatal disorders. Other ML applications include (but are not restricted to) biomarker discovery, risk estimation, correlation assessment, pharmacological treatment prediction, drug screening, data acquisition and data extraction. Most of the reviewed articles were published in the last five years. The most employed ML methods in the field are non-linear. Except for logistic regression, linear methods are rarely used.Future challengesTo improve data recording, storage and update in medical and research settings from different realities. To develop more accurate and understandable ML models using data from cutting-edge instruments. To carry out validation and impact analysis studies of currently existing high-accuracy ML models.ConclusionThe use of ML in pregnancy diseases and complications is quite recent, and has increased over the last few years. The applications are varied and point not only to the diagnosis, but also to the management, treatment, and pathophysiological understanding of perinatal alterations. Facing the challenges that come with working with different types of data, the handling of increasingly large amounts of information, the development of emerging technologies, and the need of translational studies, it is expected that the use of ML continue growing in the field of obstetrics and gynecology.

Abstract Background Due to the advancement of modern societies, the proportion of women who delay childbearing until or beyond 30 years has dramatically increased in the last three decades and has been linked with adverse maternal-neonatal outcomes. Objective To determine the trend in delayed childbearing and its negative impact on pregnancy outcomes. Material and methods A tertiary hospital-based retrospective study was conducted in Wuhan University Renmin Hospital, Hubei Province, China, during the years 2011–2019. The joinpoint regression analysis was used to find a trend in the delayed childbearing and the multiple binary logistic regression model was used to estimate the association between maternal age and pregnancy outcomes. Results Between 2011 and 2019, the trend in advanced maternal age (AMA ≥35 years) increased by 75% [AAPC 7.5% (95% CI: − 10.3, 28.9)]. Based on maternal education and occupation, trend in AMA increased by 130% [AAPC 11.8% (95% CI: 1.1, 23.7)] in women of higher education level, and 112.5% [AAPC 10.1% (95% CI: 9.4, 10.9)] in women of professional services. After adjusting for confounding factors, AMA was significantly associated with increased risk of gestational hypertension (aOR 1.5; 95% CI: 1.2, 2.1), preeclampsia (aOR 1.6; 95% CI: 1.4, 1.9), sever preeclampsia (aOR 1.7; 95% CI: 1.1, 2.6), placenta previa (aOR 1.8; 95% CI: 1.5, 2.2), gestational diabetes mellitus (aOR 2.5; 95% CI: 2.3, 2.9), preterm births (aOR 1.6; 95% CI: 1.4, 1.7), perinatal mortality (aOR 1.8; 95% CI: 1.3, 2.3), and low birth weight (aOR 1.3; 95% CI: 1.2, 1.4) compared with women aged