Severe maternal morbidity and risk of adverse pregnancy, delivery, and neonatal outcomes in the subsequent delivery.

Preeclampsia affects between 2 to 8% of pregnancies worldwide and is associated with significant adverse outcomes for both mothers and their offspring. The present study aims to investigate whether there is a correlation between early age at menarche and an increased risk of developing preeclampsia and experiencing adverse neonatal outcomes. The study involved a review of medical records of 4227 pregnant women who gave birth at The First Affiliated Hospital of Chengdu Medical College between January 2017 and December 2022. The collected data included demographic characteristics, clinical manifestations of preeclampsia, laboratory indicators, gestational complications, and neonatal outcomes. Pregnant women were categorized into four groups based on their age at menarche (≤ 12, 13, 14, and ≥ 15years). Logistic regression analysis was conducted to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) for the association between different menarche age groups and the risk of preeclampsia and adverse neonatal outcomes. Pregnant women who had an age at menarche of ≤ 12years had a higher risk of preeclampsia than women who had their menarche at 13, 14, and ≥ 15years of age, with adjusted ORs (95% CIs) for preeclampsia of 1.00 (reference), 0.78 (0.45-0.91), 0.76 (0.59-0.88), and 0.73 (0.56-0.94), respectively. The predictive efficacy of age at menarche for preeclampsia was assessed with a sensitivity and specificity of 85.2% and 76.4%, respectively, and an AUC of 0.82. Moreover, infants born to women with an age at menarche of ≤ 12years had a higher risk of adverse neonatal outcomes, including small for gestational age, preterm birth, low birth weight, neonatal respiratory distress syndrome, and neonatal intensive care unit admission. Our findings suggest that an early age at menarche is associated with an increased risk of preeclampsia and adverse neonatal outcomes. This information could be useful for obstetricians to identify women at risk for preeclampsia early on and implement timely interventions to reduce the incidence of preeclampsia and associated adverse neonatal outcomes.

Adverse pregnancy and neonatal outcomes in women with Tourette syndrome or chronic tic disorder (TS/CTD) have not been systematically studied. This Swedish population-based study investigated associations between maternal TS/CTD and pregnancy, delivery, and neonatal outcomes. We included all singleton births at ≥22 weeks between 2001 and 2021. Each pregnancy with TS/CTD was matched on mother's age and delivery year with up to 10 pregnancies without TS/CTD. Crude and adjusted relative risks were estimated using Poisson log-linear regressions. We compared 581 pregnancies in women with TS/CTD to 5777 matched unexposed pregnancies. Maternal TS/CTD was associated with significantly increased risks of gestational diabetes, and elective and emergency cesarean section. Neonates of women with TS/CTD showed no increased risks of adverse neonatal outcomes. Maternal TS/CTD is associated with increased risk of some adverse pregnancy and delivery outcomes, but not with adverse neonatal outcomes. Enhanced maternal care for women with TS/CTD is warranted. © 2025 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

ABSTRACTObjectiveTo evaluate the use of twin vs singleton growth charts for detecting small‐for‐gestational‐age (SGA) twins at risk of adverse neonatal outcomes.MethodsMEDLINE, EMBASE, CINAHL, Cochrane and Scopus databases were searched electronically from inception to May 2024. The primary outcome of this meta‐analysis was the risk of composite adverse neonatal outcome in SGA fetuses in a twin pregnancy diagnosed using twin or singleton charts. The secondary outcomes included: neonatal intensive care unit (NICU) admission, oxygen supplementation or continuous positive airway pressure, mechanical ventilation, respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, neonatal sepsis and neonatal mortality. Prospective and retrospective studies on neonatal outcomes of monochorionic or diamniotic twins diagnosed with SGA using both singleton and twin charts based on estimated fetal weight or birth weight were considered suitable for inclusion. Quality assessment of the included studies was performed using the Newcastle–Ottawa Scale for cohort studies. Random‐effects head‐to‐head meta‐analyses were used to analyze the data.ResultsSix studies were included in the systematic review and five studies, including 10 554 twin pregnancies, were included in the meta‐analysis. The risk of composite adverse neonatal outcome (OR, 3.11 (95% CI, 1.83–5.26)) and that of most secondary outcomes was significantly higher in SGA fetuses diagnosed using twin charts compared with those diagnosed using singleton charts. Conversely, the risk of composite adverse neonatal outcome (OR, 1.22 (95% CI, 0.73–2.04)) and most secondary outcomes was similar when comparing SGA fetuses diagnosed using singleton charts vs non‐SGA fetuses diagnosed using twin charts, except for the risk of NICU admission, which was significantly higher in SGA fetuses diagnosed using singleton charts. When comparing non‐SGA fetuses diagnosed using twin charts vs non‐SGA fetuses diagnosed using singleton charts, the risk of composite adverse neonatal outcome was significantly lower when using twin charts (OR, 0.90 (95% CI, 0.83–0.97)). Finally, when comparing SGA vs non‐SGA fetuses diagnosed using singleton charts, there was no significant difference for the primary or secondary outcomes, except for a higher risk of NICU admission in the SGA group (OR, 1.54 (95% CI, 1.11–2.12)). Twin charts had lower sensitivity than singleton charts in predicting adverse neonatal outcome (14% (95% CI, 7–26%) vs 32% (95% CI, 24–41%)), but higher specificity (95% (95% CI, 86–98%) vs 71% (95% CI, 63–77%)).ConclusionsTwin charts increase the specificity but reduce the sensitivity for the detection of SGA compared with singleton charts. Nevertheless, twin charts detect cases at higher risk of adverse neonatal outcome, which may be the cases that require intervention. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Background/Objectives: The objective of this study is to investigate pregnancy and neonatal outcomes in women with pre-gestational diabetes (PGDM) in the Korean population and compare outcomes according to glycosylated hemoglobin (HbA1c) levels in the third trimester. Methods: Singleton pregnant women with PGDM, with follow-up data, and who delivered at 16 Korean tertiary institutions between 2010 and 2023 were included for analysis. Eligible patients were divided into two groups according to HbA1c levels (47.5 mmol/mol, 6.5%) in the third trimester (well-controlled and poorly controlled group). Adverse pregnancy and neonatal outcomes between the two groups were compared. The primary outcome was the composite neonatal adverse outcome and the secondary outcome was pregnancy-related hypertension. Results: In 416 pregnancies, the mean HbA1c in the third trimester was 45 mmol/mol (6.26%). Of these, 296 (71.2%) women were included in the well-controlled group and 120 (28.8%) in the poorly controlled group. Between these, the poorly controlled group showed a significantly higher risk of composite neonatal adverse outcome (57.8% vs. 79.2%, p < 0.001) and pregnancy-related hypertension (14.5% vs. 24.2%, p = 0.022). In multivariate analysis, HbA1c > 6.5% in the third trimester was associated with higher risk of composite neonatal adverse outcome and pregnancy-related hypertension. HbA1c ROC curves for the third trimester that predicted composite neonatal adverse outcomes had an AUC of 0.66; HbA1c of 43.7 mmol/mol (6.15%) had a sensitivity of 52.3% and specificity of 73.5% (p < 0.001). Conclusions: In PGDM, HbA1c > 47.5 mmol/mol (6.5%) in the third trimester was significantly associated with a higher risk of adverse neonatal and pregnancy outcomes and could be a predictive factor for composite neonatal adverse outcomes and pregnancy-related hypertension. Maintenance of HbA1c levels below 43.7 mmol/mol (6.15%) in the third trimester might decrease the risk of adverse neonatal outcomes.

Objective To evaluate the possible effects of exposure to neuraminidase inhibitors during embryo-fetal life with respect to adverse neonatal outcomes and congenital malformations.Design Population based multinational observational cohort study and...

Obsessive-compulsive disorder (OCD) is associated with adverse health-related outcomes. However, pregnancy and neonatal outcomes among women with OCD have been sparsely studied. To evaluate associations of maternal OCD with pregnancy, delivery, and neonatal outcomes. Two register-based cohort studies in Sweden and British Columbia (BC), Canada, included all singleton births at 22 weeks or more of gestation between January 1, 1999 (Sweden), or April 1, 2000 (BC), and December 31, 2019. Statistical analyses were conducted between August 1, 2022, and February 14, 2023. Maternal OCD diagnosis recorded before childbirth and use of serotonin reuptake inhibitors (SRIs) during pregnancy. Pregnancy and delivery outcomes examined were gestational diabetes, preeclampsia, maternal infection, antepartum hemorrhage or placental abruption, premature rupture of membranes, induction of labor, mode of delivery, and postpartum hemorrhage. Neonatal outcomes included perinatal death, preterm birth, small for gestational age, low birth weight (<2500 g), low 5-minute Apgar score, neonatal hypoglycemia, neonatal jaundice, neonatal respiratory distress, neonatal infections, and congenital malformations. Multivariable Poisson log-linear regressions estimated crude and adjusted risk ratios (aRRs). In the Swedish cohort, sister and cousin analyses were performed to account for familial confounding. In the Swedish cohort, 8312 pregnancies in women with OCD (mean [SD] age at delivery, 30.2 [5.1] years) were compared with 2 137 348 pregnancies in unexposed women (mean [SD] age at delivery, 30.2 [5.1] years). In the BC cohort, 2341 pregnancies in women with OCD (mean [SD] age at delivery, 31.0 [5.4] years) were compared with 821 759 pregnancies in unexposed women (mean [SD] age at delivery, 31.3 [5.5] years). In Sweden, maternal OCD was associated with increased risks of gestational diabetes (aRR, 1.40; 95% CI, 1.19-1.65) and elective cesarean delivery (aRR, 1.39; 95% CI, 1.30-1.49), as well as preeclampsia (aRR, 1.14; 95% CI, 1.01-1.29), induction of labor (aRR, 1.12; 95% CI, 1.06-1.18), emergency cesarean delivery (aRR, 1.16; 95% CI, 1.08-1.25), and postpartum hemorrhage (aRR, 1.13; 95% CI, 1.04-1.22). In BC, only emergency cesarean delivery (aRR, 1.15; 95% CI, 1.01-1.31) and antepartum hemorrhage or placental abruption (aRR, 1.48; 95% CI, 1.03-2.14) were associated with significantly higher risk. In both cohorts, offspring of women with OCD were at elevated risk of low Apgar score at 5 minutes (Sweden: aRR, 1.62; 95% CI, 1.42-1.85; BC: aRR, 2.30; 95% CI, 1.74-3.04), as well as preterm birth (Sweden: aRR, 1.33; 95% CI, 1.21-1.45; BC: aRR, 1.58; 95% CI, 1.32-1.87), low birth weight (Sweden: aRR, 1.28; 95% CI, 1.14-1.44; BC: aRR, 1.40; 95% CI, 1.07-1.82), and neonatal respiratory distress (Sweden: aRR, 1.63; 95% CI, 1.49-1.79; BC: aRR, 1.47; 95% CI, 1.20-1.80). Women with OCD taking SRIs during pregnancy had an overall increased risk of these outcomes, compared with those not taking SRIs. However, women with OCD not taking SRIs still had increased risks compared with women without OCD. Sister and cousin analyses showed that at least some of the associations were not influenced by familial confounding. These cohort studies suggest that maternal OCD was associated with an increased risk of adverse pregnancy, delivery, and neonatal outcomes. Improved collaboration between psychiatry and obstetric services and improved maternal and neonatal care for women with OCD and their children is warranted.

Gestational hypertension/preeclampsia is the most common obstetric complication of pregnancy. Management in the near term and early term periods remains controversial; the 2 options are induction of labor versus expectant management. Induction at an earlier gestational age presents risks of cesarean delivery (CD) and increased rates of neonatal morbidities. Maternal risks of expectant management include progression to severe gestational hypertension, eclampsia, or placental abruption. The Hypertension and Pre-eclampsia Intervention Trial at Term (HYPITAT) compared labor induction with expectant management and showed that induction reduced the occurrence of high-risk situations and was not associated with an increase in CDs or adverse neonatal outcomes. This post hoc analysis of the HYPITAT trial data was performed to evaluate the association between ripeness of the cervix and outcomes of labor induction and expectant management. The HYPITAT trial included 756 women with a singleton pregnancy at 36 to 41 weeks’ gestation and complicated by gestational hypertension or mild preeclampsia; they were allocated to either labor induction or expectant management. In the induction group, labor was induced within 48 hours of randomization. Women in the expectant management group were monitored until the onset of spontaneous labor. The primary outcome was a composite of high-risk situations (ie, maternal mortality, maternal morbidity, progression to severe disease, and major postpartum hemorrhage). Secondary outcomes were CD and a composite of adverse neonatal outcomes. Before labor, the cervix was assessed by cervical length measurement and Bishop score calculation. The predictors in each model were treatment, cervical length, and an interaction between these factors. The HYPITAT trial found that labor induction reduced the occurrence of high-risk situations without increasing the risk of CD or adverse neonatal outcomes. The median cervical length was 30 mm (range, 0–64 mm), and median Bishop score was 3 (range, 0–9). For the expectant management group, each centimeter of increase in cervical length was associated with a 32% increase in the likelihood of high-risk situations. For the induced women, each centimeter increase in baseline cervical length carried a 3% risk reduction for maternal high-risk situations (P = 0.03 for interaction between the treatment options). Fifty-one (13.5%) of 377 women who were induced developed an indication for CD compared with 68 (17.9%) of 379 women monitored expectantly. In both groups, the probability of CD was lower when the cervix was more favorable. For each centimeter increase in the length of cervix, the risk of CD was 31% and 14% higher for expectant management and labor induction, respectively (P = 0.48 for interaction). No association was found between cervical length and risk of adverse neonatal outcomes. Analyses using the Bishop score found similar, but not statistically significant, associations between cervical favorability and high-risk maternal situations, CD, and adverse neonatal outcomes. The women were categorized into those with a favorable or unfavorable cervix at baseline. In the induction group, the average times to delivery with a favorable or unfavorable cervix were 1.9 and 2.6 days, respectively. In women managed expectantly, the respective times to delivery were 7.7 and 9.1 days. In the induction group, 33% and 32% of women with a favorable or unfavorable cervix, respectively, had high-risk situations. In the expectant management group, 39% and 49%, respectively, experienced high-risk situations. The risk of CD was comparable after induction for women with (14.6%) and without (14.8%) a favorable cervix. In women managed expectantly, the risks of CD were 18.2% and 21.1%, respectively, for women with a favorable or unfavorable cervix. No increase was found in risks of adverse neonatal outcomes when women with and without a favorable cervix in each treatment group were compared. This post hoc analysis showed that the likelihood of developing high-risk situations depends on the level of cervical ripeness only when women are managed expectantly. If labor is induced, the development of high-risk situations is not associated with cervical ripeness. A comparable risk of CD after labor induction occurs in women with a favorable or unfavorable cervix. Women with an unripe cervix are at increased risk for CD with expectant management. Despite more monitoring and earlier detection of deterioration in the induction of labor group, more women developed high-risk situations in the expectant management group.

Risk of adverse pregnancy, delivery and neonatal outcomes associated with bipolar disorder and prenatal use of mood stabilizers: A population-based cohort study

Adverse pregnancy, delivery and neonatal outcomes across different advanced maternal ages: A population-based retrospective cohort study.

Descriptive population-based birthweight standards possess low sensitivity in detecting infants with growth impairment. A prescriptive birthweight standard based on a 'healthy' subpopulation without risk factors for intrauterine growth restriction might be superior. We created two birthweight standards based on live born, singleton infants with gestational age 24-42weeks and born in The Netherlands between 2000 and 2007. Inclusion criteria for the prescriptive birthweight standard were restricted to infants without congenital malformations, born to healthy mothers after uncomplicated pregnancies. We defined small-for-gestational-age (SGA) as birthweight <10th percentile and assessed the ability of both standards to predict adverse neonatal outcomes. The prescriptive birthweight standard identified significantly more infants as SGA, up to 38.0% at 29weeks gestation. SGA infants classified according to both standards as well as those classified according to the prescriptive birthweight standard only, were at increased risk of both major and minor adverse neonatal outcomes. The prescriptive birthweight standard was both more sensitive and less specific, with a maximum increase in sensitivity predicting bronchopulmonary dysplasia (+42.6%) and a maximum decrease in specificity predicting intraventricular haemorrhage (-26.9%) in infants aged 28-31weeks. Prescriptive birthweight standards could improve identification of infants born SGA and at risk of adverse neonatal outcomes. • Descriptive birthweight standards possess low sensitivity in detecting growth restricted infants at risk of adverse neonatal outcomes. • Prescriptive standards could improve identification of very preterm small-for-gestational-age (SGA) infants at risk of intraventricular haemorrhage. What is New: • Prescriptive standards identify more preterm and term SGA infants at risk of major adverse neonatal outcomes. • Late preterm and term SGA infants classified according to the prescriptive standard are at increased risk of minor adverse neonatal outcomes with potentially harmful implications.

ObjectiveTo determine (1) whether the risk of adverse neonatal and delivery outcomes differs between mothers with and without multiple sclerosis (MS) and (2) whether risk is differentially associated with clinical factors of MS.MethodsThis retrospective cohort study analyzed data from the British Columbia (BC) MS Clinics' database and the BC Perinatal Database Registry. Comparisons were made between births to women with MS (n = 432) and to a frequency-matched sample of women without MS (n = 2,975) from 1998 to 2009. Outcomes included gestational age, birth weight, assisted vaginal delivery, and Caesarean section. Clinical factors examined included age at MS onset, disease duration, and disability. Multivariate regression models adjusting for confounding factors were built for each outcome.ResultsBabies born to MS mothers did not have a significantly different mean gestational age or birth weight compared to babies born to mothers without MS. MS was not significantly associated with assisted vaginal delivery (odds ratio [OR], 0.78; 95% confidence interval [CI], 0.50–1.16; p = 0.20) or Caesarean section (OR, 0.94; 95% CI, 0.69–1.28; p = 0.69). There was a slightly elevated risk of adverse delivery outcomes among MS mothers with greater levels of disability, although findings were not statistically significant. Disease duration and age at MS onset were not significantly associated with adverse outcomes.InterpretationThis study provides reassurance to MS patients that maternal MS is generally not associated with adverse neonatal and delivery outcomes. However, the suggestion of an increased risk with greater disability warrants further investigation; these women may require closer monitoring during pregnancy. ANN NEUROL 2011;

Type-III selective intrauterine growth restriction (sIUGR) is associated with a high and unpredictable risk of fetal death and fetal brain injury. The objective of this study was to describe the prospective risk of fetal death and the risk of adverse neonatal outcome in a cohort of twin pregnancies complicated by Type-III sIUGR and treated according to up-to-date guidelines. We reviewed retrospectively all monochorionic diamniotic twin pregnancies complicated by Type-III sIUGR managed at nine fetal centers over a 12-year period. Higher-order multiple gestations and pregnancies with major fetal anomalies or other monochorionicity-related complications at initial presentation were excluded. Data on fetal and neonatal outcomes were collected and management strategies reviewed. Composite adverse neonatal outcome was defined as neonatal death, invasive ventilation beyond the resuscitation period, culture-proven sepsis, necrotizing enterocolitis requiring treatment, intraventricular hemorrhage Grade > I, retinopathy of prematurity Stage > II or cystic periventricular leukomalacia. The prospective risk of intrauterine death (IUD) and the risk of neonatal complications according to gestational age were evaluated. We collected data on 328 pregnancies (656 fetuses). After exclusion of pregnancies that underwent selective reduction (n=18 (5.5%)), there were 51/620 (8.2%) non-iatrogenic IUDs in 35/310 (11.3%) pregnancies. Single IUD occurred in 19/328 (5.8%) pregnancies and double IUD in 16/328 (4.9%). The prospective risk of non-iatrogenic IUD per fetus declined from 8.1% (95% CI, 5.95-10.26%) at 16 weeks, to less than 2% (95% CI, 0.59-2.79%) after 28.4 weeks and to less than 1% (95% CI, -0.30 to 1.89%) beyond 32.6 weeks. In otherwise uncomplicated pregnancies with Type-III sIUGR, delivery was generally planned at 32 weeks, at which time the risk of composite adverse neonatal outcome was 29.0% (31/107 neonates). In twin pregnancies that continued to 34 weeks, there was a very low risk of IUD (0.7%) and a low risk of composite adverse neonatal outcome (11%). In this cohort of twin pregnancies complicated by Type-III sIUGR and treated at several tertiary fetal centers, the risk of fetal death was lower than that reported previously. Further efforts should be directed at identifying predictors of fetal death and optimal antenatal surveillance strategies to select a cohort of pregnancies that can continue safely beyond 33 weeks' gestation. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Adverse live-born pregnancy outcomes among pregnant people with anorexia nervosa

A comparison of criteria for defining metabolic acidemia in live-born neonates and its effect on predicting serious adverse neonatal outcomes

Gestational diabetes mellitus increased the risk of adverse neonatal outcomes: A prospective cohort study in Northwest Ethiopia