Adverse Maternal Outcomes Research Articles

Serum Uric Acid in Women with Preeclampsia and its Relation to Perinatal and Maternal Outcomes

Background and objective: Preeclampsia is a dangerous, progressive condition that is linked to maternal and neonatal death and morbidity. The purpose of this study was to determine the association between serum uric acid levels in preeclampsia with maternal and fetal outcomes. Method: A case-control study was conducted on 300 women delivered at the labour room of Duhok Obstetrics and Gynecology Hospital, from 1st of April 2021 to 1st of April 2022. The study participants were divided into two groups, pregnant women with preeclampsia and normotensive women. The serum uric acid levels of these women were estimated with the impact on fetal and mother outcomes. Results: There was a highly significant association between preeclamptic and normotensive women in relation to mean serum uric acid (5.862 ±1.416) mg/dL and (3.570 ±0.982) mg/dL respectively. A highly significant association was seen between uric acid test levels and maternal eclamptic fit, HELLP syndrome and admission to intensive care unit. A highly significant association also seen with newborn birth weight, APGAR scores and admission to neonatal intensive care unit. Conclusion: The current study demonstrates a significant raise in serum uric acid level in preeclamptic women and associated with adverse perinatal and maternal outcomes.

Transperineal sonographic assessment of the angle of progression before the onset of labour: how well does it predict the mode of delivery in late-term pregnancy.

Predicting the success of vaginal delivery is an important issue in preventing adverse maternal and neonatal outcomes. This study sought to examine whether measurement of the angle of progression (AoP) can predict asuccessful vaginal delivery following induction of labour (IoL) among late term nulliparous women with a low (4>) Bishop score. This prospective study included consecutive nulliparous pregnant women whose gestational age was 41weeks and 1-6days (late-term). The AoP was measured atleast three times and their means were calculated. During the study period, data of 150 women wereincluded in the final analysis. Thirty-eight women underwent CS due to failure to progress (n=30) or NRGHR (n=8), while the remaining 112 women underwent NVD, with four women requiring vacuum extraction. The two groups were similar with respect to age, gestational age, BMI, estimated foetal weight, and birth weight. Women undergoing NVD differed significantly from those undergoing CS with respect to a greater ultrasonographic AoP (113.8±11.9° vs. 98.1±10.9°, p=0.0001), a shorter duration of dinoprostone use, shorter time to labour contraction, and a shorter duration oflabour. In ROC analysis, the cut-off value for AoP was 100° for the prediction of successful IoL for NVD, with a sensitivity of 96 % and a specificity of 63 %. AoP may be a useful sonographic parameter for predicting successful vaginal delivery among nulliparous women at late term undergoing IoL; an AOP wider than 100°is associated with a high rate of vaginal delivery.

Health system barriers and predictors of prenatal care utilization at a large academic medical center

IntroductionThis retrospective cohort study recognizes a profound need to address rising rates of maternal morbidity and mortality, especially its disproportionate impact on ethnic and racial minorities. Timely access to high-quality prenatal care is essential, the absence of which is associated with increased risk of adverse maternal and fetal outcomes. The persistence of racial and ethnic disparities in pregnancy outcomes, despite accounting for income and education level, suggests that barriers to care are also significantly limited by psychosocial and health system barriers.MethodsThis retrospective cohort study analyzed several potential barriers to prenatal care among postpartum patients who delivered at Loyola University Medical Center in Maywood, Illinois, such as transportation, parking, childcare, clinic wait times, scheduling difficulties, and knowledge about the impact of COVID-19 on pregnancy. Participants were screened daily for eligibility and consented to participate from February to May 2022, a total of three months. Eligible patients were given a 10-question paper survey that also assessed out-of-pocket costs and suggestions to improve prenatal care attendance and satisfaction. During the study period, there were 251 eligible deliveries. 197 patients (77.3%) were consented and participated in the survey. 194 (98.4%) were eligible for post-chart review; 21 patients (10.6%) declined to participate, 33 patients (16.8%) did not complete the survey, and 3 surveys (1.5%) were lost. Retrospective chart reviews were conducted for PNC utilization, pregnancy comorbidities and outcomes, and demographic information. Data underwent Fischer analyses, chi-squared analyses, and ANOVAs. Institutional Review Board-approved, participants consented for research and quality improvement, including medical record data use.ResultsAmong 194 patients, average reported barriers to PNC were 2.14, with “difficulty scheduling appointments” (39.6%) and “couldn’t leave work or school” (30.2%) most common. Despite most patients reporting a similar number of barriers, timing disparities based race and ethnicity, education, and income were observed. Hispanic patients initiated PNC later than non-Hispanic White patients (13w6d vs. 10w5d; p = 0.009). Twelfth-grade education or less initiated PNC bachelor's degree holders (16w vs. 11w; p < 0.001). Patients who made < 45 k annually initiated later than > 140 k (13w3d vs. 9w1d; p = 0.02). Patients who reported “long wait times” initiated prenatal care an average of 2w2d later than patients not facing this barrier, at 14w1d vs. 12w0d, respectively (p = 0.01).ConclusionsLower socioeconomic status and ethnic minority patients exhibit delayed PNC start that are linked to adverse outcomes. Noteworthy discrepancies within the surveyed cohorts, despite comparable reported barriers, hint at the existence of supplementary, interconnected obstacles specific to these patients. Future efforts should tackle common issues specific to various sociodemographic groups to address disparities in pregnancy outcomes.

Preterm birth, low birth weight, and their co-occurrence among women with preexisting chronic diseases prior to conception: a cross-sectional analysis of postpartum women in a low-resource setting in Ghana

BackgroundThe incidence of chronic diseases, which are significant contributors to maternal deaths and adverse new-born outcomes, is increasing among women of reproductive age in northern Ghana. This emerging health issue raises serious concerns about the potential exacerbation of adverse birth outcomes in this setting, given that it is one of the regions in the country with a high incidence of such outcomes. We investigated the risks of preterm birth (PTB), low birth weight (LBW), and concurrent PTB and LBW among women with preexisting chronic conditions prior to conception in the Tamale Metropolis of northern Ghana.MethodsA facility-based cross-sectional study was conducted among 420 postpartum women randomly selected from five public health facilities. Information was collected electronically on participants’ self-reported experience of chronic conditions, namely, hypertension, diabetes, asthma, heart disease, and sickle cell disease, prior to their most recent pregnancy. Information on gestational age at delivery and birth weight was also collected. Regression modeling was used to quantify the risk of adverse newborn outcomes among women who reported preexisting chronic conditions prior to pregnancy.ResultsChronic diseases affected 31.2% of our sample. Of these, 28.6% had a single chronic condition, while 2.6% had comorbid chronic conditions. The prevalence of PTB was 24.0% (95% CI: 20.2, 28.4), 27.6% (95% CI: 23.5, 32.1) of the newborns were born LBW, and 17.4% (95% CI: 14.0, 21.3) of the pregnancies resulted in both PTB and LBW. Compared with those without chronic conditions, women with chronic conditions prior to conception had a greater risk of PTB (aOR = 6.78, 95% CI: 3.36, 13.68), LBW (aOR = 5.75, 95% CI: 2.96, 11.18), and the co-occurrence of PTB and LBW (aOR = 7.55, 95% CI: 3.32, 17.18).ConclusionsWe observed significant rates of PTB, LBW, and the co-occurrence of PTB and LBW among women who were already aware that they had preexisting chronic conditions prior to conception. Our findings highlight a potential gap in the quality of prenatal care provided to these women before delivery. Preconception care may offer an opportunity to address preexisting chronic conditions in women before pregnancy and potentially improve maternal and newborn health outcomes.

Impact of anaemia in pregnancy on maternal and fetal wellbeing in Oman: a retrospective study

Background/Aims Anaemia is associated with negative outcomes for both mothers and infants. Better understanding of its consequences could lead to improved guidelines for screening and treatment. The aim of this study was to investigate anaemia in pregnancy and adverse maternal and fetal outcomes among pregnant women in Oman. Methods This retrospective study examined the medical records of women who gave birth at a university hospital in Oman over a 3-year period. Chi-squared tests were used for data analysis. Results A total of 723 pregnant women were included, with 62.8% diagnosed with anaemia. Anaemia was significantly associated with preterm birth (P=0.037), low birth weight (P=0.009), intrauterine growth restriction (P=0.002) and postpartum heamorrhage (P=0.019). Conclusions Anaemia is a significant health concern for pregnant women in Oman. Further research will provide more data on its effects, informing targeted interventions and policy enhancements. Implications for practice Early antenatal screening, targeted iron supplementation, nutritional education, appropriate treatment and active management during birth would help address this issue.

The safety of a dolutegravir (DTG)-based antiretroviral treatment (ART) regimen for pregnancy and birth outcomes in Ethiopia: evidence from multicenter cohort study

BackgroundA dolutegravir (DTG)-based antiretroviral regimen has been rolled out for pregnant women in low- and middle-income countries since 2020. However, available safety data are limited to a few clinical trials and observational studies. Hence, we present real-world pregnancy and birth outcome safety data from a large sample multicenter cohort study in Ethiopia.MethodsA retrospective cohort study was conducted in fourteen hospitals across Ethiopia from 2017 to 2022. HIV-infected pregnant women were followed from the date of prevention of mother-to-child transmission (PMTCT) care enrolment until the infant was 6–8 weeks old. The primary safety outcome was a composite of adverse pregnancy events comprising spontaneous abortion, intrauterine fetal death (IUFD) before onset of labor, preterm birth, and maternal death. Additionally, a composite adverse birth outcome was assessed, comprising intrapartum fetal demise, low birth weight, and neonatal death. Finally, a composite of adverse pregnancy or birth outcome was also investigated. The exposure of interest was the antiretroviral treatment (ART) regimen used during pregnancy for PMTCT of HIV.ResultsDuring the study period, 2643 women were enrolled in routine PMTCT care. However, 2490 (92.2%) participants were eligible for the study. A total of 136/1724 (7.9%, 95% CI: 6.7–9.3%) women experienced adverse pregnancy outcomes. Fewer women in the DTG-based group (5.4%, 95% CI: 3.7–7.5%) had adverse pregnancy outcomes than in the Efavirenz (EFV)-based group (8.3%, 95% CI: 6.6–10.3%), P = 0.004. After controlling for baseline differences, the DTG group had a 43% lower risk of adverse pregnancy outcomes (adjusted odd ratio (AOR), 0.57; 95% CI, 0.32–0.96%) and a 53% lower risk of preterm birth (AOR, 0.47; 95% CI, 0.22–0.98%) compared to the EFV group. A total of 103/1616 (6.4%, 95% CI: 5.2–7.7%) women had adverse birth outcomes. Although the difference was not statistically significant, fewer women in the DTG group (30/548; 5.5%, 95% CI: 3.7–7.7%) than in the EFV group (57/830; 6.9%, 95% CI: 5.2–8.8%) had adverse birth outcomes.ConclusionsIn this study, we observed that DTG-based regimens were associated with better pregnancy and birth outcome safety profiles, reaffirming the WHO recommendation. However, a prospective study is recommended to assess uncaptured maternal and perinatal adverse outcomes, such as congenital abnormalities, and infant growth and neurocognitive development.

Bromocriptine treatment and outcomes in peripartum cardiomyopathy: the EORP PPCM registry.

Peripartum cardiomyopathy (PPCM) remains a serious threat to maternal health around the world. While bromocriptine, in addition to standard treatment for heart failure, presents a promising pathophysiology-based disease-specific treatment option in PPCM, the evidence regarding its efficacy remains limited. This study aimed to determine whether bromocriptine treatment is associated with improved maternal outcomes in PPCM. PPCM patients from the EORP PPCM registry with available follow-up were included. The main exposure of this exploratory non-randomized analysis was bromocriptine treatment, and the main outcome was a composite endpoint of maternal outcome (death or hospital readmission within the first 6 months after diagnosis, or persistent severe left ventricular dysfunction [left ventricular ejection fraction <35%] at 6-month follow-up). Inverse probability weighting was used to minimize the effects of confounding by indication. Multiple imputation was used to account for missing data. Among 552 patients with PPCM, 85 were treated with bromocriptine (15%). The primary endpoint was available in 491 patients (89%) and occurred in 18 out of 82 patients treated with bromocriptine in addition to standard of care (22%) and in 136 out of 409 patients treated with standard of care (33%) (p=0.044). In complete case analysis, bromocriptine treatment was associated with reduced adverse maternal outcome (odds ratio [OR] 0.29, 95% confidence interval [CI] 0.10-0.83, p=0.021). This association remained after applying multiple imputation and methods to correct for confounding by indication (inverse probability weighted model on imputed data OR 0.39, 95% CI 0.19-0.81, p=0.011). Thrombo-embolic events were observed in 5.9% of the patients in the bromocriptine group versus 5.6% in the standard of care group (p=0.900). Among women with PPCM, bromocriptine treatment in addition to standard of care was associated with better maternal outcomes after 6 months.

Decision and economic evaluation of abortion availability in the United States military

BackgroundActive-duty service women rely on the civilian sector for most abortion care due to limits on federal funding for abortion. Abortion is now banned in many states with large military presences. The Department of Defense has implemented policies to assist active-duty service women in accessing abortion, but there is debate to reverse this support. ObjectiveOur goal was to compare the cost-effectiveness and incidence of adverse maternal and neonatal outcomes of a hypothetical cohort of active-duty service women living in abortion-restricted states comparing restricted abortion access (abortion not available cohort) to abortion available with Department of Defense travel support (abortion available cohort). Study DesignWe developed a decision tree model to compare abortion not available and abortion available cohorts for active-duty service women living in abortion-restricted states. Our cohorts were subdivided into normal pregnancies and those with a major fetal anomaly. Cost estimates, probabilities, and disability weights of various health conditions associated with abortion and pregnancy were obtained and derived from the literature. Effectiveness was expressed in disability-adjusted life years and the willingness to pay threshold was set to $100,000 per disability-adjusted life year gained or averted. We completed probabilistic sensitivity analyses with 10,000 simulations to test the robustness of our results. Secondary outcomes included numbers of stillbirths, neonatal deaths, neonatal intensive care unit admissions, maternal deaths, severe maternal morbidities, and first and second trimester abortions. ResultsThe abortion not available cohort had a higher annual cost to the military ($299.1 million, 95% CI 239.2 – 386.6, vs. $226.0 million, 95% CI 181.9 – 288.5) and was associated with 203 more disability-adjusted life years compared to the abortion available cohort. The incremental cost effectiveness ratio was dominant for abortion available. Abortion not available resulted in an annual additional 7 stillbirths, 1 neonatal death, 112 neonatal intensive care unit admissions, 0.016 maternal deaths, 24 severe maternal morbidities, 27 less second trimester abortions, and 602 less first trimester abortions. Probabilistic sensitivity analysis revealed that the chance of the abortion available cohort being the more cost-effective strategy was greater than 95%. ConclusionLimiting active-duty service women’s access to abortion care increases costs to the military, even with costs of travel support, and increases adverse maternal and neonatal outcomes. This analysis provides important information for policymakers about economic and health burdens associated with barriers to abortion care in the military.

Maternal and Neonatal Outcomes after Vaccination with SARS-CoV-2: A Systematic Review and Meta-analysis of Cohort Studies

: SARS-CoV-2 infection among pregnant women causes maternal and neonatal complications. Professional societies endorse the vaccination among pregnant women. This review of the cohort studies aims to assess the short-term maternal and neonatal outcomes among vaccinated vs. non-vaccinated pregnant women with SARS-CoV-2 vaccination. We searched Cochrane Central Registry of Controlled Trials, Scopus, Google Scholar, and PubMed databases. The observational cohort studies published from July 2021 to December 2022 were included. The eligibility criteria were assessed. The studies documenting maternal and neonatal outcomes and the relative risk, and 95% confidence interval were considered. Joanna Briggs Institute data extraction form was used, and the quality assessment of the included study was conducted using the Newcastle-Ottawa quality assessment scale. The quality of the grading was summarised with GradePro software. Data from the five cohort studies are considered. 56% of the un-vaccinated pregnant women experience composite adverse maternal outcomes (RR: 3.97; 95% CI:0.73,21.49; p-value: ˂0.11). There was a reduced risk of occurrence of the meconium-stained amniotic fluid who are vaccinated (RR: 0.89; 95% CI:0.71, 1.12; p value=0.33). The unvaccinated group is 3.16 times more likely to take infertility treatment (RR: 3.54; 95% CI:2.04, 6.12; p-value: ˂0.00001). There was no significant difference concerning neonatal outcomes between both groups. The pregnant women who were not vaccinated against SARS-CoV had an increased risk for a composite adverse maternal outcome and meconium-stained amniotic fluid. The vaccine has effectively prevented the disease in the first six months. Additional studies are needed to understand the safety of the SARS-CoV vaccine.

Pregnancy-Associated Mortality During the Pandemic: Disparities by Rurality

IntroductionIn the US, rural areas experience higher rates of adverse maternal health outcomes, but little data exists on rural/urban differences in pregnancy-associated deaths (PAD, all deaths during pregnancy and postpartum) or rural/urban differences in those deaths during the COVID-19 pandemic. MethodsCross-sectional US vital statistics mortality data from 2018 to 2021 was used to identify PAD (analyzed in 2024). PAD ratios (deaths per 100,000 live births) and 95% confidence intervals (CIs) were calculated by year, cause, and rurality (urban, suburban, rural). The percent change in PAD ratios between the pre-pandemic (2018 and 2019) and pandemic (2020 and 2021) time periods was calculated by rurality. ResultsDuring the pandemic, rural—compared to suburban and urban—areas had the highest pregnancy-associated death ratios due to obstetric causes (53.9 deaths/100,000 live births, 95%CI: 48.8, 59.4), drug-related causes (19.0, 95%CI: 16.0, 22.4), suicide (4.4., 95%CI: 3.0, 6.2), and other causes (the majority of which are motor vehicle accidents, 16.4, 95%CI: 14.0, 19.6). Rural areas experienced increases in all causes of pregnancy-associated death from pre-pandemic (2018 and 2019) to pandemic (2020 and 2021) with increases of 48.1% in obstetric deaths, 115.9% in drug-related deaths, 17.8% in homicide, 25.7% in suicide, and 11.6% in other causes. Rural areas experienced the largest (compared to urban and suburban) increase in drug-related deaths, and only rural areas experienced an increase in suicide during the pandemic. ConclusionsRural areas experience a high burden of pregnancy-associated death, and this inequity was exacerbated during the COVID-19 pandemic.

O22 MATERNAL AND FETAL OUTCOMES OF VARIOUS ANTIHYPERTENSIVE TREATMENT REGIMENS DURING PREGNANCY: INSIGHTS FROM THE CZECH NATIONAL REGISTRY 2012-2022

Introduction: Arterial hypertension affects about 5-10% of pregnancies and has detrimental effects on pregnancy outcomes in both the mother and fetus. This study aimed to analyze the outcomes of pregnancy in women treated with different antihypertensive drugs. Methodology: Nationwide data on all births and abortions in the period 2012-2022 in the Czech Republic were obtained from the National Registry of Reproductive Health (NRRZ) and the National Registry of Reimbursable Health Services (NRHZS). Women who had the diagnosis I10 within one year before pregnancy and were prescribed any antihypertensive drug from selected ATC groups (C02, C03, C07, C08, C09) were classified as pre-existing hypertension. Women diagnosed with O13 or I10 during pregnancy were classified as pregnancy-induced hypertension. Hypoxia in the newborn was defined as pH &lt;7.1 or Apgar score &lt;8 present after delivery. For all factors, univariate logistic regression was used to calculate the odds ratios (OR) of adverse outcomes. Results: There were a total of 1,154,648 deliveries in the 11-year period. 95,215 women (8.2%) had hypertension in pregnancy, out of these 21,094 (22.2%) were treated with antihypertensive drugs. Odds ratios for caesarean section, pre-term delivery, low birth weight, newborn hypoxia, and pre-eclampsia in women using different antihypertensive classes and drugs are shown in the Figure. The risk of maternal and fetal complications was higher with calcium channel blockers (mainly amlodipine) compared to methyldopa and beta-blockers. Among beta-blockers, bisoprolol had the most favorable safety profile. Although used in limited numbers, diuretics, verapamil, ACE-inhibitors and angiotensin receptor blockers (ARBs) appeared to be comparably safe to methyldopa. A combination of multiple antihypertensive drugs was associated with a higher risk of adverse outcomes. Conclusion: Bisoprolol, verapamil, and diuretics seem to have a risk of adverse maternal and fetal outcomes comparable to methyldopa. Amlodipine and multiple antihypertensive drug combinations are associated with increased risk.

Fetal Outcome Evaluation in High-risk Term Pregnancy Using Biophysical Profile at a Tertiary Hospital in Anambra State, Nigeria

Introduction: A high-risk pregnancy is defined as a pregnancy in which there is a significant probability of an adverse maternal or fetal outcome that is more than the incidence of that outcome in the general population. Aim: To determine the usefulness of biophysical profile evaluation in women with high-risk term pregnancies. Methods: Biophysical profile (BPP) parameters were used to evaluate 160 high-risk women with term pregnancies. Results: All the participants had normal amniotic fluid index values [AFI] of 8.1-24.0cm. Most of the participants 115 (71.9%) showed good BPP scores. Outcome at delivery was as follows; fetal distress [presence 8.9%, absence 91.1%], stillbirth = none, admission into the intensive care unit (ICU) [Yes 2.0%, No 88%], meconium staining [Yes 8.2%, Clear 91.8%], birth weight [&lt; 2.5kg = 5.7%, &gt; 2.5kg = 94.3%]. APGAR score at 1 minute [&lt;7 = 5.1%, &gt;7 = 94.9%] while at 5 minutes [&lt;7 = 3.2%, &gt; 7= 96.8%]. The commonest mode of delivery was vaginal 84 (52.8%). The association between gross body movement, fetal breathing movement, and fetal outcome was not statistically significant p &gt; 0.05. Conclusion: BPP parameters were found to be associated with fetal outcomes.

A Survey of Lithuanian Pregnant Women's Knowledge about Periodontal Disease, Its Prevalence and Possible Influence on Pregnancy Outcomes.

Background: This study aimed to subjectively assess the changes in the oral health status of pregnant women, to find out their attitudes and knowledge about possible changes in the oral cavity that occurred during pregnancy, and their influence on the outcomes of pregnancy. Methods: 112 pregnant women who visited the Republican Siauliai Hospital during their pregnancy participated in the study. An anonymous self-administered questionnaire was used to conduct the research, surveying their demographic characteristics, oral health changes and habits during pregnancy, and awareness of possible negative pregnancy outcomes. Results: The study involved 112 pregnant women, with 35 in the first trimester, 28 in the second, and 48 in the third trimester. The findings revealed that pregnant women do not take sufficient care of their oral health: more than half of the respondents did not visit an oral care specialist during pregnancy; 22.3% of women reported brushing their teeth only once a day or less; and 35.7% did not clean interdental surfaces at all. Statistically, significantly more urban women believed there is a relationship between maternal oral health and adverse pregnancy outcomes than women living in rural areas (p = 0.013). While significant oral health changes were not observed in the first trimester, more women in the second and third trimesters reported issues such as bleeding gums, swelling, plaque accumulation, tartar, and caries (p < 0.001). Conclusions: The attitude of women towards oral health during pregnancy and their understanding of the possible risks for unfavorable pregnancy outcomes are insufficient. Notably, oral health issues become more prominent in the second and third trimesters, necessitating appropriate oral care to reduce the incidence of oral and dental diseases during pregnancy. This underscores the importance of educational and preventive public health policies focused on oral care for pregnant women, aimed at increasing awareness and promoting practices that safeguard both maternal and fetal health.

Pregnancy and Postpartum Experiences in Chicago Neighborhoods With Increased Adverse Maternal Outcomes: A Qualitative Study

Abstract: Background: Black birthing people are three to four times more likely to die from pregnancy-related causes than White birthing people. Objective: We aimed to better understand the pregnancy and postpartum experiences with health care, support, and maternal morbidity and mortality (MMM) of Black pregnant and parenting people living in neighborhoods with increased rates of MMM in Chicago, Illinois. Methods: This was a rapid qualitative analysis in Chicago, Illinois based on principles of community-based participa-tory research. Community partners recruited Black pregnant and parenting individuals living in neighborhoods with higher rates of MMM. Four focus groups from February 2021 to October 2021 were led by community health workers and covered pregnancy and postpartum experiences. Transcripts were deductively and inductively coded by paired-analyst teams and thematically analyzed. Results: This study included 31 participants from eight neighborhoods. Key themes related to pregnancy and the postpartum period included the: (1) a need for social and mental health support during and after pregnancy, (2) a preference for multiple sources of health information, (3) a need for strengthened connection with medical providers and health care systems, (4) a lack of clarity regarding MMM and the postpartum period, and (5) a difference in language between patients and health care providers. Conclusions: Further research and interventions are needed to evaluate how to best support pregnant and postpartum people, to implement patient-centered language when communicating about pregnancy and postpartum complications, and to demonstrate investment by health care workers in Black birthing people. Crucial to further research and interventions is communication with and input from communities most affected by MMM.

Pregnancy and Postpartum Experiences in Chicago Neighborhoods With Increased Adverse Maternal Outcomes: A Qualitative Study

Pregnancy and Postpartum Experiences in Chicago Neighborhoods With Increased Adverse Maternal Outcomes: A Qualitative Study

Duration of Induction of Labor for Second-Trimester Medication Abortion and Adverse Outcomes.

To evaluate the relationship between duration of labor during second-trimester medication abortion and adverse outcomes. We conducted a retrospective cohort study including all individuals with a singleton gestation undergoing second-trimester medication abortion without evidence of advanced cervical dilation, rupture of membranes, or preterm labor at four centers. The primary exposure was duration of labor (ie, hours spent from receiving misoprostol to fetal expulsion). The primary outcome was composite morbidity , defined as uterine rupture, need for blood transfusion, clinical chorioamnionitis, intensive care unit admission, or need for readmission. We performed bivariate and multivariate negative binomial analyses. A post hoc subgroup analysis was performed to assess for the risk of the primary outcome by gestational age. We performed tests of homogeneity based on history of uterine scarring and parity. Six hundred eighty-one individuals were included. The median duration of labor was 11 hours (interquartile range 8-17 hours). One hundred thirty-one (19.2%) experienced the primary outcome. When duration of labor was evaluated continuously, a longer duration of labor was associated with an increased frequency of morbidity (adjusted β=0.68, 95% CI, 0.32-1.04). When duration of labor was evaluated categorically, those experiencing the highest quartile of duration (ie, 17 hours or more) had a statistically higher risk for experiencing morbidity compared with individuals in all other quartiles (adjusted relative risk 1.99, 95% CI, 1.34-2.96). When we focused on components of the composite outcome, clinical chorioamnionitis was significantly different between those experiencing a longer duration and those experiencing a shorter duration of labor (26.2% vs 10.6%, P <.001). On subgroup analysis, gestational age was not associated with the risk of composite morbidity. Tests of homogeneity demonstrated no significant difference in the risk for morbidity among individuals with a history of uterine scarring or based on parity. Duration of labor was independently associated with risks for adverse maternal outcomes during second-trimester medication abortion, specifically clinical chorioamnionitis.

Effects of pre-pregnancy maternal underweight on pregnancy and perinatal outcomes of the foetus

Background: Maternal underweight, defined as a body mass index (BMI) less than 18.5 kg/m², poses significant challenges in maternal and fetal health. Despite being prevalent worldwide, particularly in low- and middle-income countries, the effects of pre-pregnancy underweight on pregnancy and perinatal outcomes remain under-researched compared to maternal obesity. This study aims to explore the complex interactions between pre-pregnancy maternal underweight and adverse pregnancy outcomes such as low birth weight (LBW), preterm birth (PTB), and intrauterine growth restriction (IUGR), with a focus on Nigeria's diverse socioeconomic landscape. Materials and Methods: This study employed a retrospective analysis method, leveraging data from national health surveys, birth registries, and healthcare databases across six Nigerian states (Lagos, Osun, Anambra, Imo, Kano, and Kaduna). The study examined pre-pregnancy BMI, maternal demographics, socioeconomic factors, and pregnancy outcomes. The analysis included the systematisation setback technique to assess the relationship between pre-pregnancy underweight and pregnancy outcomes, considering regional nutritional disparities. Results: The findings indicated a significant association between maternal underweight before pregnancy and adverse pregnancy outcomes. Underweight mothers were more likely to experience LBW, PTB, and SGA infants. Socioeconomic and demographic factors, such as low educational attainment and rural residence, were identified as significant predictors of maternal underweight. The study highlighted regional differences, with higher rates of underweight mothers in economically disadvantaged areas. Conclusion: Addressing pre-pregnancy maternal underweight is crucial for improving perinatal outcomes. The study underscores the need for targeted public health interventions, including nutritional support, education, and enhanced healthcare access, particularly in low-resource settings. By mitigating the risks associated with maternal underweight, healthcare professionals can promote healthier pregnancies and better developmental trajectories for infants.

Hypertension subtypes and adverse maternal and perinatal outcomes - a retrospective population-based cohort study

BackgroundThis study aims to examine risk of adverse pregnancy outcomes and mothers’ characteristics in patients with chronic hypertension, gestational hypertension and preeclampsia.MethodsThe study included all births born from women aged 15–45 years, in Lleida, Spain from 2012 to 2018. Pregnancy outcomes were retrieved by regional administrative databases. Logistic regression analysis was used to calculate adjusted odds ratios (OR) (OR 95% CI) for maternal characteristics or neonatal outcomes.ResultsAmong 17,177 pregnant women, different types of hypertension present varying risks for both the mother and fetus. There is an increased risk of cesarean section in patients with preeclampsia (OR 2.04, 95% CI: 1.43–2.88). For the newborn, a higher risk of preterm birth is associated with maternal chronic hypertension (OR 3.09, 95% CI: 1.91–4.83) and preeclampsia (OR 5.07, 95% CI: 3.28–7.65). Additionally, there is a higher risk of low birth weight in cases of maternal chronic hypertension (OR 3.2, 95% CI: 2.04–4.88), preeclampsia (OR 5.07, 95% CI: 3.34–7.52), and gestational hypertension (OR 2.72, 95% CI: 1.49–4.68). Furthermore, only newborns of patients with preeclampsia had a higher risk of an Apgar score lower than 7 in the first minute (OR 2.95, 95% CI: 1.45–5.38).ConclusionsIn the study population adjusted for body weight, the different types of hypertension represent different risks in the mother and foetus. These complications were mostly associated with preeclampsia.

Trial of labor after caesarean section in low risk pregnancies: is it risky?

To evaluate the influence of a previous caesarean section on adverse composite maternal and perinatal outcome in women who attempted a trial of labor. This historical cohort study analyzed maternal and perinatal outcome in women with otherwise low risk pregnancies at term who underwent a trial of labor after a caesarean section (TOLAC). The primary outcome measure was the adverse composite outcome. Secondary outcome measures were amongst others the caesarean section rate and the mode of vaginal delivery. The adverse composite outcome was more frequently in the previous caesarean section group compared to women with no previous caesarean Sect.(22.3% vs. 15.6%, p < 0.0001). The percentage of caesarean Sect.(15.4% vs. 8.2%, p < 0,0001), uterine rupture (1.0% vs. 0.02%, p < 0.0001), placental abruption (1.1% vs. 0.3%, p = 0.0014), vaginal operative delivery (16.0% vs. 8.6%, p < 0.0001), pH < 7.10 (3.7% vs. 2.5%, p = 0.0151), base excess < -12 (3.2% vs. 2.2%, p = 0.0297), abnormal cardiotocography (22.5% vs. 13.9%, p < 0,0001) and fetal blood analysis (6.2% vs. 2.6%, p < 0.0001) was significantly higher in women with a previous caesarean section. Taking the parity into account, these differences could only been seen in women without a previous vaginal delivery. In parous women with a previous vaginal delivery and a caesarean section in history, the adverse composite did not differ between the groups. Only the rate of pH < 7.1 was higher in women after a caesarean Sect.(4.5% vs. 1.8%, p = 0.0436). Trial of labor after caesarean in otherwise low risk pregnancies is associated with a higher rate of complications especially if there is no history of vaginal delivery.

Gestational weight gain trajectories in patients with gestational diabetes mellitus: a retrospective cohort study.

Aims/Background Gestational diabetes mellitus is a common pregnancy complication that affects approximately 14% of pregnancies worldwide and can lead to adverse maternal and neonatal outcomes. This study aimed to investigate the trajectories of gestational weight gain among gestational diabetes mellitus patients and to inform the development of effective weight management strategies. Methods Demographic and antenatal examination data from 1421 pregnant women diagnosed with gestational diabetes mellitus were retrospectively analysed. Quantitative data comparisons were performed using Chi-square tests, Fisher's exact test, t-tests, and one-way analysis of variance. Group-based trajectory modelling was employed to identify the trajectories of gestational weight gain among patients with gestational diabetes mellitus. Results This study revealed that pre-pregnancy body mass index and types of gestational diabetes mellitus significantly influence gestational weight gain (p < 0.05). Group-based trajectory modelling identified three distinct gestational weight gain trajectories. Patients with gestational diabetes mellitus demonstrated a continuous weight gain throughout pregnancy, while women who were overweight or obese before pregnancy were more likely to follow a low-speed growth trajectory. Women in the rapid growth trajectory group were more inclined to deliver by caesarean section and were more likely to give birth to macrosomic infants. Conclusion Our research underscores the importance of identifying and distinguishing between different gestational weight gain trajectories in pregnant women, thereby identifying high-risk groups, which is crucial for improving the health conditions of both mothers and newborns.