Did the COVID-19 pandemic have an impact on pregnant women's participation in routine antenatal care and on pregnancy and neonatal outcomes?

Introduction Gestational diabetes mellitus (GDM) is a major contributor to adverse pregnancy outcomes both in the United States and globally. As the prevalence of obesity continues to rise, the incidence of GDM is anticipated to increase as well. Despite the significant impact of GDM on maternal and neonatal health, research examining the independent associations between GDM and adverse outcomes remains limited in the U.S. context. Objective This study aims to address this knowledge gap and further elucidate the relationship between GDM and maternal and neonatal health outcomes. Method We performed a retrospective study using data from the United States Vital Statistics Records, encompassing deliveries that occurred between January 2015 and December 2019. Our analysis aimed to establish the independent association between GDM and various adverse maternal and neonatal outcomes. The multivariate analysis incorporated factors such as maternal socioeconomic demographics, preexisting comorbidities, and conditions during pregnancy to account for potential confounders and elucidate the relationship between GDM and the outcomes of interest. Result Between 2015 and 2019, there were 1,212,589 GDM-related deliveries, accounting for 6.3% of the 19,249,237 total deliveries during the study period. Among women with GDM, 46.4% were Non-Hispanic Whites, 11.4% were Non-Hispanic Blacks, 25.7% were Hispanics, and 16.5% belonged to other racial/ethnic groups. The median age of women with GDM was 31 years, with an interquartile range of 27-35 years. The cesarean section rate among these women was 46.5%. GDM was identified as an independent predictor of adverse maternal and neonatal outcomes, including cesarean section (OR=1.40; 95% CI: 1.39-1.40), maternal blood transfusion (OR=1.15; 95% CI: 1.12-1.18), intensive care unit admission (OR=1.16; 95% CI: 1.10-1.21), neonatal intensive care unit admission (OR=1.53; 95% CI: 1.52-1.54), assisted ventilation (OR=1.37; 95% CI: 1.35-1.39), and low 5-minute Apgar score (OR=1.01; 95% CI: 1.00-1.03). Conclusion GDM serves as an independent risk factor for adverse maternal and neonatal outcomes, emphasizing the importance of early detection and management in pregnant women.

To estimate the incidence of gestational diabetes mellitus (GDM) according to The International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria and the pregnancy complications in women fulfilling these criteria but who are not considered diabetic according to the Canadian Diabetes Association criteria. We estimated the rate of GDM according to the IADPSG criteria from November 2008 to October 2010. Then, we conducted a chart review to compare maternal and neonatal outcomes between women classified as GDM according to the IADPSG criteria but not by the Canadian Diabetes Association criteria (group 1; n=186) and nondiabetic women according to both criteria (group 2; n=372). Results were expressed as crude (odds ratio [OR]) or adjusted OR and 95% confidence interval (CI). The study has a statistical power of 80% to detect a difference between 16% and 8% in large for gestational age newborns (α level of 0.05; two-tailed). The rate of GDM using the IADPSG criteria was 27.51% (95% CI 25.92-29.11). Group 1 presented similar rates of large-for-gestational-age newborns (9.1% compared with 5.9%, adjusted OR 1.58, 95% CI 0.79-3.13; P=.19), delivery complications (37.1% compared with 30.1%, OR 1.37, 95% CI 0.95-1.98; P=.10), preeclampsia (6.5% compared with 2.7%, adjusted OR 2.40, 95% CI 0.92-6.27; P=.07), prematurity (6.5% compared with 2.7%, OR 1.10, 95% CI 0.53-2.27; P=.85), neonatal complications at delivery (13.4% compared with 9.7%, OR 1.45, 95% CI 0.84-2.49; P=.20), and metabolic complications (10.8% compared with 14.2%, OR 0.73, 95% CI 0.42-1.26; P=.29) compared with group 2. Women classified as nondiabetic by the Canadian Diabetes Association Criteria but considered GDM according to the IADPSG criteria have similar pregnancy outcomes as women without GDM. More randomized studies with cost-effectiveness analyses are needed before implementation of these criteria. II.

Introduction. Gestational diabetes mellitus (GDM) approximately affects 14% of pregnant women in the Philippines. It has been linked to several maternal and neonatal adverse outcomes. Objective. This study aimed at determining the association of the clinical profile of patients with GDM to maternal and neonatal outcomes. Methodology. This single-center, retrospective, descriptive, cross-sectional chart review was conducted in a tertiary hospital in Cebu City to 229 patients with GDM admitted from January 2021 to December 2022. Results. The study revealed several significant associations. Hypertension was strongly linked with primary cesarean section (OR: 4.32, P-value 0.004); and severe pre-eclampsia (OR: 16.97, P-value: 0.000). Gravidity showed significant correlations with Ballard’s score (P-value: 0.013), birthweight (P-value: 0.045) and 5-minute APGAR score (P-value: 0.001). Parity was associated with birthweight (P-value: 0.011) and 5-minute APGAR score (P-value: 0.001). Weight gain during pregnancy was linked to birthweight (P-value: 0.004) and occurrence of congenital anomalies (OR: 1.26, P-Value: 0.032). Additionally, prenatal smoking was associated with 5-minute APGAR score (P-value: 0.006). Moreover, having a Small for Gestational Age (SGA) fetal growth status is associated with insulin-requiring mothers, (OR: 4.79, P-Value: 0.049); and a family history of diabetes was significantly associated with insulin therapy (OR: 5.38, P-value: 0.021). Conclusion. Patients' clinical profile affect maternal and neonatal outcomes among patients with GDM. Careful consideration of these factors during the perinatal period may help reduce maternal and fetal risks. Keywords. Gestational Diabetes Mellitus, association, clinical profile, outcome, pregnancy, maternal health

Background and Objectives: ABO and Rh blood types are known to have associations with health and disease, but studies on their relationship to pregnancy outcomes have been largely inconclusive. We aimed to examine the associations between ABO and Rh blood groups in pregnant women with maternal–neonatal characteristics and outcomes including hypertensive disorders of pregnancy, gestational diabetes, cesarean section rate, preterm birth, postpartum quantitative blood loss, birth weight, and appearance, pulse, grimace, activity, and respiration scores. Methods: At the time of delivery, 2497 consecutive patients were tested for ABO and Rh blood groups. Only those who delivered singleton infants were included in the analysis (2392 patients, 95.8%). Demographic and clinical data were obtained from the electronic medical record. Associations between blood groups and maternal–neonatal characteristics and outcomes were assessed using logistic regression models. A significance threshold of 0.05 was used for all comparisons. Results: Of the 2392 delivering patients, 46.9% were blood group O, 37.5% were blood group A, 12.2% were blood group B, and 3.4% were blood group AB. In addition, 85.9% were Rh-positive and 14.1% Rh-negative. A total of 2127 (88.9%) women delivered at term. The cesarean section rate was 32.4%, 183 (7.7%) had chronic hypertension, 275 (11.5%) had gestational diabetes, and 396 (16.6%) had a postpartum hemorrhage. The median birth weight was 3330 g (interquartile range 2940–3640). No blood groups were significantly associated with these characteristic and outcome measures. Conclusion: At the time of delivery, no significant associations were identified between ABO and Rh blood groups and maternal–neonatal characteristics and outcomes in this delivery cohort of over 2000 women.

Improved neonatal outcomes in pregnancies with coexisting gestational diabetes and preeclampsia in normal birthweight neonates- insights from a retrospective cohort study

Gestational diabetes mellitus and COVID-19: results from the COVID-19–Related Obstetric and Neonatal Outcome Study (CRONOS)

265: Induction at term for women with gestational diabetes mellitus (GDM): safe for the mother but questionable for the neonate

IntroductionConflicting reports of increases and decreases in rates of preterm birth (PTB) and stillbirth in the general population during the COVID‐19 pandemic have surfaced. The objective of our study was to conduct a living systematic review and meta‐analyses of studies reporting pregnancy and neonatal outcomes by comparing the pandemic and pre‐pandemic periods.Material and methodsWe searched PubMed and Embase databases, reference lists of articles published up until 14 May 2021 and included English language studies that compared outcomes between the COVID‐19 pandemic time period and pre‐pandemic time periods. Risk of bias was assessed using the Newcastle–Ottawa scale. We conducted random‐effects meta‐analysis using the inverse variance method.ResultsThirty‐seven studies with low‐to‐moderate risk of bias, reporting on 1 677 858 pregnancies during the pandemic period and 21 028 650 pregnancies during the pre‐pandemic period, were included. There was a significant reduction in unadjusted estimates of PTB (28 studies, unadjusted odds ratio [uaOR] 0.94, 95% confidence [CI] 0.91–0.98) but not in adjusted estimates (six studies, adjusted OR [aOR] 0.95, 95% CI 0.80–1.13). The reduction was noted in studies from single centers/health areas (uaOR 0.90, 95% CI 0.86–0.94) but not in regional/national studies (uaOR 0.99, 95% CI 0.95–1.03). There was reduction in spontaneous PTB (five studies, uaOR 0.89, 95% CI 0.82–0.98) and induced PTB (four studies, uaOR 0.90, 95% CI 0.81–1.00). There was no reduction in PTB when stratified by gestational age <34, <32 or <28 weeks. There was no difference in stillbirths between the pandemic and pre‐pandemic time periods (21 studies, uaOR 1.08, 95% CI 0.94–1.23; four studies, aOR 1.06, 95% CI 0.81–1.38). There was an increase in birthweight (six studies, mean difference 17 g, 95% CI 7–28 g) during the pandemic period. There was an increase in maternal mortality (four studies, uaOR 1.15, 95% CI 1.05–1.26), which was mostly influenced by one study from Mexico. There was significant publication bias for the outcome of PTB.ConclusionsThe COVID‐19 pandemic time period may be associated with a reduction in PTB; however, referral bias cannot be excluded. There was no difference in stillbirth between the pandemic and pre‐pandemic period.

The role of religion in decision-making on antenatal screening of congenital anomalies: A qualitative study amongst Muslim Turkish origin immigrants

Aim: To reveal the preventable complications related to fetal loss more clearly by hypothesizing that the negative effects of the pandemic on antenatal follow-up and daily habits in pregnancies resulting in fetal loss may increase compared to the pre-pandemic period. Methods: In this question-based study, 80 pregnant women who were diagnosed with fetal death during the pre-pandemic period(September 1, 2019- February 28, 2020) were compared with 80 pregnant women diagnosed with fetal death during the pandemic period (March 1,2020-September 1,2020). Antenatal screening tests, dietary, exercise, smoking, medications, low-income status, fetal anomalies, coexisting medical disorders and, adverse outcomes have been comparatively analyzed between the groups. Results: There was no statistical difference between the periods in terms of the number of antenatal visits (p =0.52). However dietary modification and physical exercise rates were lower during the pandemic (p=0.03, and p&lt;0.01 ), respectively. The use of vitamin D has increased during the pandemic period (p = 0.02). Maternal complication rates in women diagnosed with stillbirth were 20% in the pre-pandemic period and 30% in the pandemic. The stillbirth rates were 1.4%(87/6277) and 1.3%(87/6936), in pre-pandemic and pandemic periods, respectively (p&gt;0.05). Conclusion: In particular, we demonstrated that the pandemic process negatively affected the daily routine such as physical exercise and dietary in women diagnosed with fetal loss. However, we found the stillbirth rates similar between the periods.

BackgroundRising national cesarean section rates (CSRs) and unexplained inter-hospital differences in CSRs, led national and international bodies to select CSR as a quality indicator. Using hospital discharge abstracts, we aimed to document in Belgium (1) inter-hospital differences in CSRs among low risk deliveries, (2) a national upward CSR trend, (3) lack of better neonatal outcomes in hospitals with high CSRs, and (4) possible under-use of CS.MethodsWe defined a population of low risk deliveries (singleton, vertex, full-term, live born, <4500 g, >2499 g). Using multivariable logistic regression techniques, we provided degrees of evidence regarding the observed departure ([relative risk-1]*100) of each hospital (N = 107) from the national CSR and its trend. To determine a benchmark, we defined three CSR groups (high, average and low) and compared them regarding 1 minute Apgar scores and other neonatal endpoints. An anonymous feedback is provided to the hospitals, the College of Physicians (with voluntary disclosure of the outlying hospitals for quality improvement purposes) and to the policy makers.ResultsCompared with available information, the completeness and accuracy of the data, regarding the variables selected to determine our study population, showed adequate. Important inter-hospital differences were found. Departures ranged from -65% up to +75%, and 9 "high CSR" and 13 "low CSR" outlying hospitals were identified. We observed a national increasing trend of 1.019 (95%CI [1.015; 1.022]) per semester, adjusted for age groups. In the "high CSR" group 1 minute Apgar scores < 4 were over-represented in the subgroup of vaginal deliveries, suggesting CSs not carried out for medical reasons. Under-use of CS was also observed. Given their questionable completeness, except Apgar scores, our neonatal results, showing a significant association of CS with adverse neonatal endpoints, are to be cautiously interpreted. Taking the available evidence into account, the "Average CSR" group seemed to be the best benchmark candidate.ConclusionRather than firm statements about quality of care, our results are to be considered a useful screening. The inter-hospital differences in CSR, the national CS upward trend, the indications of over-use and under-use, the geographically different obstetric patterns and the admission day-related concentration of deliveries, whether or not by CS, may trigger initiatives aiming at improving quality of care.

The Affordable Care Act (ACA) aims to broaden health care access and significantly impacts obstetric practices. Yet, its effect on maternal and neonatal outcomes among women with gestational diabetes across diverse demographics is underexplored. This study examines the impact of the implementation of the ACA on maternal and neonatal health in Maryland with ACA implementation and Georgia without ACA implementation. We used data from the Maryland State Inpatient Database and US Vital Statistics System to assess the ACA's influence on maternal and neonatal outcomes in Maryland, with Georgia serving as a nonexpansion control state. Outcomes compared include cesarean section (CS) rates, low Apgar scores, neonatal intensive care unit (NICU) admissions, and assisted ventilation 7 h postdelivery. We adjusted for factors including women's age, race, insurance type, preexisting conditions, prior CS, prepregnancy obesity, weight gain during pregnancy, birth weight, labor events, and antenatal practices. The study included 52 479 women: 55.8% from Georgia and 44.2% from Maryland. Post-ACA, CS rates were 45.1% in Maryland versus 48.2% in Georgia (P = 0.000). Maryland demonstrated better outcomes, including lower rates of low Agar scores (odds ratio [OR], 0.74 [95% confidence interval (CI), 0.63-0.86]), assisted ventilation (OR, 0.79 [95% CI, 0.71-0.82]), and NICU admissions (OR, 0.76 [95% CI, 0.71-0.82]), but no significant change in CS rates (OR, 0.96 [95% CI, 0.92-1.01]). After ACA implementation, Maryland showed improved maternal and neonatal outcomes compared with Georgia, a nonexpansion state.

Association Between Interpregnancy Interval and Adverse Neonatal and Maternal Outcomes Stratified by Gestational Age in Previous Pregnancy in China

Background: Gestational diabetes mellitus (GDM) is a common metabolic disorder of pregnancy and is associated with significant adverse maternal and neonatal outcomes. With the rising prevalence of GDM in India and limited region-specific data from Northeast India, evaluating fetomaternal outcomes in this population is essential. Aim and Objectives: To assess and compare maternal and neonatal outcomes in pregnancies complicated by gestational diabetes mellitus with those in normoglycaemic pregnancies, and to evaluate the association between glycaemic control and pregnancy outcomes. Materials and Methods: This hospital-based observational comparative study was conducted at a tertiary care hospital in Northeast Tezpur, Assam, from August 2021 to July 2024. A total of 120 pregnant women were enrolled, comprising 60 women diagnosed with GDM and 60 normoglycaemic controls. Participants were followed from diagnosis until delivery and the early neonatal period. Maternal demographic characteristics, antenatal complications, mode of delivery, and neonatal outcomes were recorded. Results: Women with GDM were significantly older and had higher body mass index compared to controls. Gestational hypertension and polyhydramnios were more common in the GDM group. Caesarean section rates were substantially higher among women with GDM. Neonates born to mothers with GDM had significantly higher birth weight, increased incidence of macrosomia, neonatal hypoglycaemia, and higher rates of NICU admission. Poor glycaemic control within the GDM group was significantly associated with increased operative delivery and adverse neonatal outcomes. Conclusion: Pregnancies complicated by gestational diabetes mellitus are associated with increased risk of adverse fetomaternal outcomes. Effective glycaemic control plays a crucial role in improving maternal and neonatal prognosis. Early screening, timely diagnosis, and appropriate management of GDM are essential to reduce pregnancy-related complications, particularly in high-risk populations.

Background: Gestational diabetes mellitus (GDM) is a common metabolic disorder of pregnancy and is associated with significant adverse maternal and neonatal outcomes. With the rising prevalence of GDM in India and limited region-specific data from Northeast India, evaluating fetomaternal outcomes in this population is essential. Aim and Objectives: To assess and compare maternal and neonatal outcomes in pregnancies complicated by gestational diabetes mellitus with those in normoglycaemic pregnancies, and to evaluate the association between glycaemic control and pregnancy outcomes. Materials and Methods: This hospital-based observational comparative study was conducted at a tertiary care hospital in Northeast Tezpur, Assam, from August 2021 to July 2024. A total of 120 pregnant women were enrolled, comprising 60 women diagnosed with GDM and 60 normoglycaemic controls. Participants were followed from diagnosis until delivery and the early neonatal period. Maternal demographic characteristics, antenatal complications, mode of delivery, and neonatal outcomes were recorded. Results: Women with GDM were significantly older and had higher body mass index compared to controls. Gestational hypertension and polyhydramnios were more common in the GDM group. Caesarean section rates were substantially higher among women with GDM. Neonates born to mothers with GDM had significantly higher birth weight, increased incidence of macrosomia, neonatal hypoglycaemia, and higher rates of NICU admission. Poor glycaemic control within the GDM group was significantly associated with increased operative delivery and adverse neonatal outcomes. Conclusion: Pregnancies complicated by gestational diabetes mellitus are associated with increased risk of adverse fetomaternal outcomes. Effective glycaemic control plays a crucial role in improving maternal and neonatal prognosis. Early screening, timely diagnosis, and appropriate management of GDM are essential to reduce pregnancy-related complications, particularly in high-risk populations.