Adverse Obstetric Outcomes In Women Research Articles

Microbiome Review: Ethnicity, Diet, and Lifestyle in Bad Obstetric History

This systematic review explores the intricate relationship between the maternal microbiome and adverse obstetric outcomes in women with a history of recurrent miscarriages, preterm birth, or stillbirth, collectively known as Bad Obstetric History (BOH). The microbiome, encompassing bacteria, viruses, and fungi, within the reproductive tract is increasingly recognized as a crucial factor in pregnancy maintenance and complications. The study explores BOH's multifactorial causes—genetic, anatomical, endocrine, thrombophilic, immunological, and environmental. Despite one-third of cases being unexplained, it underscores the importance of evaluating uterine macro and microenvironments. Emerging evidence challenges prior beliefs by supporting the existence of an endometrial microbiome, hinting at its impact on pregnancy outcomes. The methodology follows a systematic approach adhering to PRISMA guidelines, incorporating electronic database searches yielding 125 relevant articles, with 47 meeting inclusion criteria. The selected studies focus on human samples from stool, oral, or vaginal swabs, including randomized clinical trials, systematic reviews, and meta-analyses. In conclusion, the review emphasizes the significance of understanding the microbial changes in pregnant females and their potential impact on obstetric outcomes. The findings propose a connection between altered microbiota and maternal complications, highlighting the potential for personalized medicine interventions. Additionally, the study delves into the nuanced relationship between ethnicity, dietary patterns, and the microbiome, underscoring the importance of personalized and culturally sensitive healthcare interventions. Overall, this comprehensive review provides valuable insights into the role of the microbiome in obstetric outcomes, paving the way for future research and targeted interventions to optimize pregnancy outcomes globally.

Effect of type III female genital mutilation on obstetric outcomes: A systematic review and meta-analysis

BackgroundControversial evidence suggests a potential association between female genital mutilation (FGM/C) and adverse obstetric outcomes, with type III FGM/C (infibulation) carrying the greatest risk. The aim of this systematic review and meta-analysis was to assess current rate of adverse obstetric outcomes in women with type III female genital mutilation and cutting (FGM/C; infibulation) delivering across different settings worldwide. MethodsWe searched PubMed, Scopus, Embase, and ClinicalTrials.gov databases from inception to Jan 1, 2023. Studies were selected if they included the main outcome of postpartum haemorrhage (PPH) or secondary outcomes, which included major conditions affecting maternal-neonatal health during labour and delivery. DerSimonian-Laird random effects meta-analysis including pooled effect estimates with corresponding 95 % confidence intervals was performed. Heterogeneity was assessed using the I2 statistic. Meta regression for relevant covariates was performed when data on relevant confounders were available. The Newcastle-Ottawa scale (NOS) was used to assess quality of observational studies. The level of evidence was assessed with the GRADE method. Results14 observational studies including 15,320 type III FGM/C women and 59,347 controls were eligible. The risk for postpartum haemorrhage was significantly increased in type III FGM/C, in the main analysis (OR 1.83, 95 % CI 1.03 to 3.24, I2 = 93 %), in pooling of data adjusted for confounders (aOR 1.76, CI 1.42 to 2.17, I2 = 0 %), and in sensitivity analysis of higher quality studies with NOS≥7 (OR 2.76, CI 1.38 to 5.51, I2 = 95 %). Meta-regression showed that nulliparity was significantly and positively associated with postpartum haemorrhage. Similarly, analysis of data adjusted for confounders showed an increased risk of episiotomy in type III FGM/C (aOR 1.56, CI 1.03 to 2.35, I2 = 52 %). Sensitivity analysis of studies with NOS≥7 revealed a significant increase for episiotomy (OR 7.53, CI 1.19 to 47.54, I2 = 96 %), perineal tears (OR 4.24, CI 1.09 to 16.46, I2 = 66 %), prolonged second stage of labour (OR 5.19, 95 % CI 1.00 to 26.85, I2 = 66 %), and Apgar score less than 7 (OR 4.19, CI 1.64 to 10.70, I2 = 0 %). No difference was found regarding obstetric anal sphincter injuries and mode of delivery in these women. Deinfibulation achieved similar obstetric and neonatal outcomes to women who never had type III FGM. The overall quality of the studies was adequate (median NOS score: 7; IQR: 6–8), the level of evidence, according to the GRADE assessment, was low. ConclusionsThese results consistently show an increased risk of adverse obstetric outcomes in women with FGM/C type III. Infibulation substantially increases the risk for PPH, particularly in nulliparae. Systematic Review registration: PROSPERO CRD42023421993.

Abstract 12902: Supraventricular Tachycardia During Pregnancy is Independently Associated With Adverse Obstetrical Outcomes

Introduction: Supraventricular tachycardias (SVT) are the most frequently encountered arrhythmias in pregnancy, however, their clinical significance is unclear. Hypothesis: We report the prevalence, describe the management and explore the association between SVT and adverse obstetric outcomes in women with structurally normal hearts. Methods: This is a case-control study of primiparous and multiparous women without history of cesarean section (CS), and no known cardiac diagnosis admitted in labor to one of 8 Northwell Health hospitals between January 2015 and August 2022. The study group consisted of women with at least one SVT episode during pregnancy and the control group was randomly selected in a 4:1 ratio. Multivariate analysis was used to examine the association between occurrence of SVT during pregnancy and incidence of cesarean section (CS), preterm labor (PTL), and length of stay (LOS). Results: Of 141,769 women meeting the inclusion criteria, SVT diagnosis was confirmed in 122. Of those, 76 (age 33.2±4.8 years) had at least 1 symptomatic episode during pregnancy. For the women with known SVT diagnosis prior to pregnancy, medical therapy with any antiarrhythmic agent was not associated with reduction of SVT recurrence during pregnancy (OR 1.07, 95% CI 0.41-2.80 p=0.89). On the contrary, catheter ablation prior to pregnancy was associated with significant reduction of SVT recurrence (OR 0.09, 95% CI 0.04-0.23, p<0.0001). Women with SVT during pregnancy had a higher incidence of CS (39.5% vs 27.0%. p=0.03), and PLT (30.3% vs 8.6%, p<0.001) compared to the control group. After adjusting for age and parity, SVT during pregnancy was independent predictor of CS, particularly elective CS (OR 2.89 95% CI 1.06-7.89) and PTL (OR 4.37 95%CI 2.30-8.31). Conclusions: SVT occurs in about 1 in every 1,000 women during pregnancy and is associated with higher rates of CS, particularly scheduled, and PLT. Any history of SVT should be sought and addressed during preconception counselling and SVT episodes during pregnancy should be approached in a multidisciplinary way to mitigate the risk of CS and associated complications.

P-601 Comparison of adverse obstetric outcomes in women with the hyperandrogenic syndromes, polycystic ovary syndrome and Cushing’s syndrome: an evaluation of a population database

Abstract Study question How does the risk for adverse obstetric outcomes differ among women with polycystic ovary syndrome (PCOS) and women with Cushing’s syndrome (CUS)? Summary answer PCOS increased the risk of gestational diabetes and cesarean section relative to CUS, whereas CUS increased the prevalence of operative vaginal delivery and blood transfusions. What is known already PCOS and CUS are hyperandrogenic disorders that have previously been associated with unique adverse obstetric outcomes. Despite there being similarities in the hyperandrogenism and insulin resistance of these disorders, there is a lack of knowledge when comparing their specific risks of pregnancy complications. Study design, size, duration A retrospective population-based study utilizing data from the Healthcare Cost and Utilization Project—Nationwide Inpatient Sample (HCUP-NIS), was performed. A dataset of all deliveries between 2004 and 2014 inclusively, was created. 14 881 deliveries to women with PCOS and 134 deliveries to women with CUS were identified. The HCUP-NIS presents information on approximately 20% of admissions to US hospitals. Data was not continued into 2015 when ICD-10 codes were used, which are not comparable. Participants/materials, setting, methods Descriptive analyses were performed to compare the demographic features among both groups using chi-squared tests. Multivariate logistic regression analysis was performed to calculate unadjusted and adjusted odds ratios (aORs) and corresponding 95% confidence intervals (CI). According to Tri-Council Policy statement (2018), IRB approval was not required, given data was anonymous and publicly available. Main results and the role of chance At baseline, CUS was associated with a higher risk of chronic hypertension (P < 0.001), pregestational diabetes mellitus (P = 0.01), thyroid disease (P = 0.004), and higher rates of smoking during pregnancy (P = 0.02) whereas PCOS was associated with higher rates of obesity (P = 0.01). In terms of obstetric outcomes, PCOS increased the prevalence of gestational diabetes mellitus (P = 0.002, adjusted[a] OR 2.73; 95% CI 1.46 to 5.12), and cesarean section (P < 0.001, aOR 2.63; 95% CI 1.81-3.83) in comparison to CUS. CUS increased the prevalence of operative vaginal delivery (P < 0.001, aOR 0.10; 95% CI 0.06-0.14), and transfusion (P = 0.002, aOR 0.25; 95% CI 0.11-0.59) in comparison to deliveries to women with PCOS. No significant differences were found in terms of pregnancy-induced hypertension (P = 0.78), gestational hypertension (P = 0.86), preeclampsia (P = 0.25), preeclampsia or eclampsia superimposed on pre-existing hypertension (P = 0.13), premature rupture of membranes (P = 0.99), preterm delivery (P = 0.17), placental abruption (P = 0.82), chorioamnionitis (P = 0.16), spontaneous vaginal delivery (P = 0.35), postpartum hemorrhage (P = 0.29), and maternal infection (P = 0.11). In terms of neonatal outcomes, both deliveries to women with PCOS and women with CUS had similar outcomes for small for gestational age infants (P = 0.52), intrauterine fetal demise (P = 0.94), and congenital anomalies (P = 0.53). Limitations, reasons for caution The data within this retrospective cohort study relies on the accuracy of the individuals collecting the data. Data on medication use and compliance was unavailable. Wider implications of the findings Pregnant women with PCOS and CUS are at risk for certain specific obstetric complications, with most risks being similar. The magnitude of the insulin resistance in PCOS may be greater than in CUS due to the increased risk of gestational diabetes in PCOS when controlling for obesity and confounding effects. Trial registration number Not applicable

Risk of adverse obstetric outcomes in patients with a history of endometrial cancer: A nationwide population-based cohort study.

To evaluate adverse obstetric outcomes in women with a history of endometrial cancer (EC). Population-based cohort study. The Korean National Health Insurance (KNHI) claims database. Women who gave birth between 2009 and 2016, with a history of EC prior to pregnancy. The KNHI database was used to compare obstetric outcomes of women with and without a history of EC, using the ICD-10 codes. Multivariable logistic regression models were used to determine the associations between a history of EC and adverse obstetric outcomes. Adverse obstetric outcomes. Overall, 248 and 3 335 359 women with and without a history of EC, respectively, gave birth. When adjusted for age, primiparity and comorbidities, an increased risk of multiple gestations (odds ratio [OR] 4.925, 95% confidence interval [CI] 3.394-7.147), caesarean delivery (OR 2.005, 95% CI 1.535-2.62) and preterm birth (OR 1.941, 95% CI 1.107-3.404) was observed among women with a history of EC. We were unable to demonstrate significant differences in the risk of pre-eclampsia, gestational diabetes, vacuum delivery, placenta praevia, placenta accreta spectrum, placental abruption and postpartum haemorrhage between the groups. In the sensitivity analyses excluding multiple gestations, an increased risk of preterm birth was not observed among women with a history of EC (OR 1.276, 95% CI 0.565-2.881). There is no convincing evidence of an increased risk of adverse obstetric outcomes among women with a history of EC. Our findings would be useful in counselling of patients with EC who are undergoing fertility-sparing treatment.

Adverse obstetric outcomes in women with PCOS and multiple gestations

Research question: Does multiple gestation alter the risks for adverse obstetric outcomes in women with polycystic ovary syndrome (PCOS)?Design: Retrospective population-based cohort study using data from the HCUP-NIS from 2004 to 2014. A total of 14,882 women with PCOS, who delivered within that time period, were identified. The study group comprised women with PCOS who had had a multiple gestation (n = 880); the reference group was comprised of the remaining women with PCOS and singleton gestation (n = 14,002).Results: In women with PCOS, multiple gestation increased the risks of pregnancy complications including pregnancy-induced hypertension (adjusted odds ratio [aOR] 2.030; 95% confidence interval [CI] 1.676–2.460), pre-eclampsia (aOR 2.879; 95% CI 2.277–3.639), pre-eclampsia and eclampsia superimposed on pre-existing hypertension (aOR 1.917; 95% CI 1.266–2.903) and gestational diabetes (aOR 1.358; 95% CI 1.114–1.656). Multiple gestation increases the risk of preterm premature rupture of membranes (aOR 5.807; 95% CI 4.153–8.119), preterm delivery (aOR 8.466; 95% CI 7.071–10.135), Caesarean section (aOR 5.146; 95% CI 4.184–6.329), post-partum haemorrhage (aOR 1.540; 95% CI 1.065–2.228) and the need for transfusion (aOR 3.268; 95% CI 2.010–5.314), as well as wound complications (aOR 3.089; 95% CI 1.647–5.794). Neonates born to mothers with PCOS and having multiple gestations are more likely to be small for gestational age when compared to singleton neonates born to mothers with PCOS (aOR 4.606; 95% CI 3.480–6.095). Among PCOS women with multiple gestations, obesity increased the risks of developing pregnancy-induced hypertension (P < 0.001), pre-eclampsia (P < 0.001) and wound complications (P = 0.045).Conclusion: These results highlight the importance of single embryo transfer and ovulation induction to develop a single follicle in women with PCOS. Obesity further increases obstetrical complications.

Association between obesity in women with polycystic ovary syndrome and adverse obstetric outcomes

Research questionHow does the presence of obesity modify the risks for adverse obstetric outcomes in women with polycystic ovary syndrome (PCOS)? DesignRetrospective population-based cohort study using data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample, 2004–2014. A total of 14,855 women with PCOS were identified (study group: obese women with PCOS [BMI ≥30 kg/m2] [n = 3286]; reference group: remaining women with PCOS [n =11 569]). Logistic regression analysis was used to explore the associations between obesity, pregnancy, delivery and neonatal outcomes. ResultsObesity was associated with a higher prevalence of chronic hypertension (P < 0.001), pregestational diabetes (P < 0.001) and a previous caesarean delivery (P < 0.001). Obesity increased the risk of gestational diabetes (adjusted [a]OR 1.745; 95% CI 1.473 to 2.067), pregnancy-induced hypertension (aOR1.889; 95% CI 1.589 to 2.246), gestational hypertension (aOR 1.555; 95% CI 1.219 to 1.983) and preeclampsia (aOR 2.170; 95% CI 1.683 to 2.798). Maternal obesity in PCOS increased the risk of chorioamnionitis (aOR 1.548; 95% CI 1.072 to 2.235) and caesarean delivery (aOR 1.414; 95% CI 1.210 to 1.653) and decreased the likelihood of a spontaneous vaginal delivery (aOR 0.751; 95% CI 0.644 to 0.876). Infants born to obese mothers with PCOS were not more likely to be SGA (aOR 0.775; 95% CI 0.511 to 1.175) or to have congenital anomalies (aOR 0.849; 95% CI 0.483 to 1.490). ConclusionIn women with PCOS, obesity increases the risk of specific pregnancy and delivery complications.

Analysis of in vitro fertilization/intracytoplasmic sperm injection outcomes in infertile women with a history of thyroid cancer: a retrospective study

BackgroundRecent studies have revealed that women with infertility have a higher risk of thyroid cancer (TC) than fertile women. However, studies on whether a history of thyroid cancer affects clinical outcomes in women who conceive using in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) are scarce. We investigate whether a history of thyroid cancer (TC) affects the in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) outcomes and increases the risk of adverse obstetric outcomes in women with infertility.MethodsThis retrospective study enrolled 384 women with infertility who underwent their first IVF/ICSI treatment at the Peking University Third Hospital between 2010 and 2019. Participants were divided into the TC (64 women with TC history) and control (320 women matched from 85,272 women without thyroid diseases) groups. Controls were individually matched to the TC group according to age, body mass index, concomitant infertility factors, first IVF/ICSI dates, and controlled ovarian stimulation and embryo transfer procedure protocols. IVF/ICSI outcomes, including the numbers of retrieved oocytes and high-grade embryos, clinical pregnancy, miscarriage, preterm delivery, and live birth rates, and adverse obstetric outcome risk were assessed.ResultsThe TC group had significantly higher thyroid hormone and lower thyroid-stimulating hormone (TSH) levels than the control group. Despite similar gonadotropin treatment dosage, the TC group had a significantly lower numbers of retrieved oocytes and high-grade embryos than the control group. The occurrence rates of clinical pregnancy, miscarriage, preterm delivery, live births, and adverse obstetric outcomes, including multiple gestation, preterm delivery, gestational diabetes mellitus, gestational hypertension, low birth weight, and large-for-gestational-age infants, were not significantly different between the two groups.ConclusionsTC history did not affect the pregnancy outcomes or increase the risk of adverse obstetric outcomes after the first IVF/ICSI, but it may decrease the number of retrieved oocytes and high-grade embryos.

High prevalence and resistance rates of Mycoplasma genitalium among patients visiting two sexually transmitted infection clinics in the Netherlands.

Mycoplasma genitalium is a well-known cause of urethritis in men and has been associated with cervicitis, pelvic inflammatory disease, and adverse obstetric outcomes in women. In this cross-sectional study, we determined the current prevalence of M. genitalium infection and the rate of macrolide resistance in M. genitalium isolates, in patients visiting two large Dutch sexually transmitted infection (STI) clinics, to evaluate whether the recommendations in Dutch guidelines should be revised. In addition, risk factors for M. genitalium were identified. In total, 3225 patients were included. M. genitalium prevalence rates were 13.8% for all patients; 20.1% for men who have sex with men, 8.2% for men who have sex with women, and 12.6% for women. Macrolide resistance-associated mutations were detected in 66% of the patients infected with M. genitalium. Age, educational level, country of origin, number of sexual partners, HIV-positivity, infection with Neisseria gonorrhoeae, and urethral symptoms in men were independently associated with M. genitalium infection. In conclusion, we found very high prevalence rates and macrolide resistance rates of M. genitalium in patients visiting STI clinics.

The presence of lupus nephritis additionally increases the risk of preeclampsia among pregnant women with systemic lupus erythematosus.

IntroductionPregnant women with systematic lupus erythematosus (SLE) have an increased risk of obstetric complications, such as preeclampsia and premature births. Previous studies have suggested that renal involvement could further increase the risk for adverse obstetric outcomes. Aims: The aim of this study was to compare the obstetric outcomes in a Swedish cohort of patients with SLE with and without lupus nephritis (LN).Patients and methodsThe study was conducted as a retrospective observational study on 103 women with SLE, who gave birth at the Karolinska University Hospital between the years 2000-2017. Thirty-five women had previous or active LN and 68 women had non-renal lupus. Data was collected from digital medical records. The outcomes that were analysed included infants born small for gestational age (SGA), premature birth, preeclampsia, SLE- or nephritis flare and caesarean section.ResultsWomen with LN, both with previous and with renal flare during pregnancy suffered from pre-eclampsia more often compared to women with non-renal lupus (25.7% vs 2.9%, p = 0.001) and this complication was associated with premature birth (p = 0.021) and caesarean section (p = 0.035).ConclusionsLupus nephritis is a significant risk factor for adverse obstetric outcomes in women with SLE, including preeclampsia. Those patients could benefit from more frequent antenatal controls and more vigorous follow-up.

Is there an association between Chlamydia trachomatis load and in situ expression of cyclooxygenase/inflammatory cytokines in first trimester aborters

Background: Colonization of Chlamydia trachomatis genital tract infection during pregnancy is associated with adverse obstetric outcomes in women; however, despite clear association between C. trachomatis and spontaneous abortion (SA), study on C. trachomatis load in first trimester abortion remains meagre. The reported occurrence of sporadic/recurrent SA (SSA/RSA) in C. trachomatis-positive women emphasize the need to identify chlamydial load and possible immunomolecular pathway in early SSA/RSA. The study aims to find whether there is association between C. trachomatis load and in situ expression of cyclooxygenase (cox)-2/pro-inflammatory cytokines in C. trachomatis-positive SSA/RSA. Methods and materials: 150 women experiencing SA, viz.: SSA (n = 70) and RSA (n = 80) during first trimester were enrolled from Gynecology Receiving Room (GRR), Department of Obstetrics and Gynecology, Safdarjung hospital, New Delhi (India) after obtaining hospital ethical permission and prior informed written consent from each patient. Endometrial curettage tissue (ECT) was collected for detection of C. trachomatis load and in situ expression of cox-2 and pro-inflammatory cytokines, viz.: IFN-γ/TGF-b1 in each patient by quantitative real time (qRT) PCR. Data was statistically analyzed. Results: C. trachomatis plasmid gene (200 bp) was found in 12.8% and 15% of SSA and RSA respectively; while 1–4/4–12 copies of C. trachomatis were detected in SSA/RSA respectively. Significant upregulation of cox-2/IFN-γ/TGF-b1 gene was found in C. trachomatis-positive RSA versus SSA (‘p’ < 0.0001). After controlling for confounding variables, linear regression analysis showed that C. trachomatis copy load in SSA/RSA was significantly associated with cox-2/IFN-γ/TGF-b1. Significant positive correlation was observed between C. trachomatis copy load and cox-2/IFN-γ/TGF-b1 gene (‘p’ < 0.0001) in SSA/RSA. Conclusion: Findings delineated that C. trachomatis load during early pregnancy is clearly associated with elevated cytokines and cox-2 in SSA/RSA, thereby accelerating endometrial contractions and ultimately resulting in SA. Hence, it is suggested that investigation of C. trachomatis load in SSA/RSA should be undertaken in first trimester of pregnancy for better clinical management of SA.

Effectiveness of real-time continuous glucose monitoring to improve glycaemic control and pregnancy outcome in patients with gestational diabetes mellitus: a study protocol for a randomised controlled trial

IntroductionReal-time continuous glucose monitoring (rt-CGM) informs users about current interstitial glucose levels and allows early detection of glycaemic excursions and timely adaptation by behavioural change or pharmacological intervention. Randomised controlled...

Adverse obstetric outcomes in public hospitals of southern Ethiopia: the role of parity

Purpose Direct obstetric causes have a significant contribution for severe maternal morbidities and mortalities, although the effect of grand multiparity on adverse obstetric outcomes remains controversial across studies. This study aimed to compare obstetric outcomes in grand multiparous and low multiparous women in two hospitals of southern Ethiopia. Materials and methods A comparative cross-sectional study was conducted in one general and one comprehensive specialized hospitals in 2018. Four hundred and sixty-one mothers were included in the study. Data were collected by structured questionnaire and extraction sheets from clinical documents, and were analyzed using STATA version 14 (StataCorp, College Station, TX, USA). Results About 39% of the included mothers had at least one adverse obstetric outcome. Hypertensive disorders of pregnancy, antepartum hemorrhage, and premature rupture of membrane and were higher in the grand multiparous mothers. However, obstructed labor and risk of cesarean delivery were higher in low multiparous women. History of medical illnesses, previous cesarean delivery, and high birth weight were independent predictors of adverse maternal outcomes regardless of parity. However, parity did not show statistically significant difference in obstetric outcomes. Conclusion Parity did not show statistically significant difference in experiencing adverse obstetric outcomes in women. Early identification and treatment of high-risk mothers is recommended regardless of parity.

Repeat measurements of uterine artery pulsatility index, mean arterial pressure and serum placental growth factor at 12, 22 and 32 weeks in prediction of pre‐eclampsia

To investigate the potential value of repeat measurements of uterine artery pulsatility index (UtA-PI), mean arterial pressure (MAP) and serum placental growth factor (PlGF) at 12, 22 and 32 weeks' gestation in the prediction of pre-eclampsia (PE) developing after 32 weeks. Data were derived from prospective screening for adverse obstetric outcomes in women attending their routine hospital visit at 11-13, 19-24 and/or 30-34 weeks' gestation in two maternity hospitals in England. UtA-PI, MAP and PlGF were measured. Bayes' theorem was used to combine the a-priori risk from maternal factors with UtA-PI, MAP and PlGF multiples of the median values. The performance of screening for PE developing after the 30-34-week visit by UtA-PI, MAP and PlGF measured at 11-13, 19-24 and 30-34 weeks and their combinations was examined. Screening at 30-34 weeks by UtA-PI, MAP and PlGF detected, at a 10% false-positive rate, 79%, 86% and 92% of preterm PE and 42%, 50% and 56% of term PE. The addition of biomarker values at 11-13 and/or 19-24 weeks was not associated with any improvement in the detection rate of preterm PE; in the case of term PE, there was a marginal (< 2%) improvement in detection for UtA-PI and MAP and a modest improvement of about 5% for PlGF. Measurements of UtA-PI, MAP and PlGF in the first and/or second trimester have a small or no effect on improving the prediction of PE provided by screening in the early third trimester. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Pregnancy-specific stress, fetoplacental haemodynamics, and neonatal outcomes in women with small for gestational age pregnancies: a secondary analysis of the multicentre Prospective Observational Trial to Optimise Paediatric Health in Intrauterine Growth Restriction

ObjectivesTo examine associations between maternal pregnancy-specific stress and umbilical (UA PI) and middle cerebral artery pulsatility indices (MCA PI), cerebroplacental ratio, absent end diastolic flow (AEDF), birthweight, prematurity, neonatal intensive...

Relationship Between Excessive Gestational Weight Gain and Neonatal Adiposity in Women With Mild Gestational Diabetes Mellitus.

To evaluate the relationships among excessive gestational weight gain, neonatal adiposity, and adverse obstetric outcomes in women with mild gestational diabetes mellitus. This is a secondary analysis of a multicenter randomized clinical trial of women with mild gestational diabetes mellitus. Based on self-reported prepregnancy body weight, gestational weight gain was categorized as excessive if it was greater than 2009 Institute of Medicine guidelines. Maternal outcomes and neonatal anthropomorphic characteristics were compared between women with excessive weight gain and those without excessive weight gain. Multiple linear and logistic regression analyses were performed to adjust for confounding factors. We studied 841 women who participated in the main trial and had prepregnancy body mass index (BMI) and delivery information available (n=431 treatment group, n=410 no treatment). After adjustment for factors including treatment and prepregnancy BMI, excessive weight gain remained associated with large for gestational age (adjusted odds ratio [OR] 2.94, 95% confidence interval [CI] 1.81-4.93), birth weight greater than 4,000 g (adjusted OR 2.56, 95% CI 1.54-4.40), preeclampsia (adjusted OR 2.96, 95% CI 1.35-7.03), and cesarean delivery for labor arrest (adjusted OR 2.37, 95% CI 1.30-4.44). In addition, excessive weight gain was independently associated with increased total neonatal fat (P<.001) and birth weight (P<.001). In women with both treated and untreated mild gestational diabetes mellitus, excessive gestational weight gain was independently associated with both greater birth weight and adiposity.

Maternal serum soluble fms-like tyrosine kinase-1 at 22 and 32 weeks in the prediction of pre-eclampsia.

To investigate the potential value of repeat measurements of maternal serum concentration of soluble fms-like tyrosine kinase-1 (sFlt-1) at 22 and 32 weeks' gestation in the prediction of pre-eclampsia (PE) in women delivering after 32 weeks. The data were derived from prospective screening for adverse obstetric outcomes in women attending their routine hospital visit at 19-24 and/or 30-34 weeks' gestation in one of two maternity hospitals in England. Serum sFlt-1 was measured in 7565 and 8264 singleton pregnancies at 19-24 and 30-34 weeks, respectively. Bayes' theorem was used to combine the a-priori risk from maternal factors with sFlt-1 multiples of the median (MoM) values. The performance of screening for PE developing after the 30-34-week visit by sFlt-1, measured at 19-24, 30-34 and at both 19-24 and 30-34 weeks was examined. In pregnancies with PE, sFlt-1 in both the second and third trimesters was increased and the deviation from normal was inversely related to the gestational age at which delivery became necessary for maternal or fetal indications. Serum sFlt-1 at 19-24 weeks was not useful in predicting PE beyond the 30-34-week visit, but the addition of sFlt-1 at 19-24 weeks improved the prediction of PE provided by sFlt-1 at 30-34 weeks. Screening by maternal factors and sFlt-1 at 30-34 weeks predicted 94% of preterm PE and 54% of term PE, at a false-positive rate of 10%; this was improved to 99% and 64%, respectively, by the additional measurement of sFlt-1 at 19-24 weeks. Measurement of sFlt-1 in the second trimester improves the prediction of PE provided by screening in the early third-trimester. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Competing-risks model in screening for pre-eclampsia by maternal factors and biomarkers at 35-37 weeks' gestation

To develop a model for prediction of term pre-eclampsia (PE) based on a combination of maternal factors and late third-trimester biomarkers. Data were derived from prospective screening for adverse obstetric outcomes in women attending their routine hospital visit at 35-37 weeks' gestation in two maternity hospitals in the UK. Uterine artery pulsatility index (UtA-PI) was measured in 5362 pregnancies, mean arterial pressure (MAP) in 5386 and serum placental growth factor (PlGF) and serum soluble fms-like tyrosine kinase-1 (sFlt-1) in 3920. Bayes' theorem was used to combine the a-priori risk of PE from maternal factors with various combinations of biomarkers, expressed as multiples of the median (MoM). Five-fold cross-validation was used to estimate the performance of screening for PE, requiring delivery at some stage after assessment. The empirical performance of screening was compared to model predictions. In pregnancies that developed PE, the values of MAP, UtA-PI and sFlt-1 were increased and PlGF was decreased compared to unaffected pregnancies. For all biomarkers evaluated, the deviation from normal was inversely related to the gestational age at which delivery became necessary for maternal or fetal indications. Screening by maternal factors and by a combination of maternal factors with all biomarkers predicted 35% and 84% of PE, respectively, at a 10% false-positive rate. A combination of maternal factors and biomarkers at 35-37 weeks' gestation can provide effective screening for term PE. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

Contingent screening for preterm pre-eclampsia.

Effective screening for pre-eclampsia resulting in delivery < 37 weeks' gestation (preterm PE) is provided by assessment of a combination of maternal factors, mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI) and serum placental growth factor (PlGF) at 11-13 or 19-24 weeks' gestation. This study explores the possibility of carrying out routine screening for preterm PE by maternal factors and MAP in all pregnancies and reserving measurements of UtA-PI and PlGF for a subgroup of the population, selected on the basis of the risk derived from screening by maternal factors and MAP alone. Study data were derived from prospective screening for adverse obstetric outcomes in women attending their routine hospital visit at 11-13 and/or 19-24 weeks' gestation. Bayes' theorem was used to derive the a-priori risk for preterm PE from maternal factors and MAP. The posterior risk was obtained by the addition of UtA-PI and PlGF. We estimated the detection rate (DR) of preterm PE, at an overall false-positive rate (FPR) of 10%, from a policy in which first-stage screening by a combination of maternal factors and MAP defines screen-positive, screen-negative and intermediate-risk groups, with the latter undergoing second-stage screening by UtA-PI and PlGF. At 11-13 weeks' gestation, the model-based DR of preterm PE, at a 10% FPR, when screening the whole population by maternal factors, MAP, UtA-PI and PlGF was 74%. A similar DR was achieved by two-stage screening, with screening by maternal factors and MAP in the first stage and reserving measurement of UtA-PI and PlGF for the second stage and for only 50% of the population. If second-stage screening was offered to 30% of the population, there would be only a small reduction in DR from 74% to 71%. At 19-24 weeks, the model-based DR of preterm PE, at a 10% FPR, when screening the whole population by maternal factors, MAP, UtA-PI and PlGF was 84%. A similar DR was achieved by two-stage screening with measurements of UtA-PI and PlGF in only 70% of the population; if second-stage screening was offered to 40% of the population, the DR would be reduced from 84% to 81%. High DR of preterm PE can be achieved by two-stage screening in the first and second trimesters with maternal factors and MAP in the whole population and measurements of UtA-PI and PlGF in only some of the pregnancies. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

HYPOTHYROXINAEMIA AND BRAIN DEVELOPMENT.

The aim of this review is to indicate the current position on the role of thyroxine (T4) and fetal brain development with particular relevance to the human situation. Adequate maternal iodine nutrition and maternal circulating thyroxine (T4) concentrations are essential to ensure optimum T4 placental passage which in turn will ensure transport of T4 into fetal brain cells. These processes are discussed and the role of thyroid hormone transporters is considered. The emphasis on isolated maternal hypothyroxinaemia (IH) as an important factor affecting brain development is discussed from the animal experimental point of view as well as in the clinical setting. There is evidence of neurocognitive impairment as assessed by different modalities in children up to the age of 8 years and some suggestion of increased psychiatric disorder in older persons whose mothers had IH during gestation. Although international guidelines have not in general recommended thyroxine therapy for IH the recent demonstration of adverse obstetric outcomes in women with isolated maternal hypothyroxinaemia may warrant a revision of this strategy.