Adverse Pregnancy Outcomes In Women Research Articles

Follicular fluid leptin as a marker for pregnancy outcomes in women undergoing IVF treatment: a systematic review and meta-analysis

Leptin is a hormone secreted mainly by the adipocytes with an essential role in the regulation of body weight. It acts on the reproductive axis at different sites, with stimulatory effects at the hypothalamus and pituitary and inhibitory interactions at the gonads. To investigate the influence of leptin on pregnancy outcomes in women undergoing IVF, we undertook a systematic review. A search of PubMed from 1966 to 2018 identified ten studies meeting the inclusion criteria. Outcomes were BMI, serum leptin level at hCG injection, serum and follicular fluid leptin level at the oocyte pick up, and serum 17β-oestradiol level at oocyte pick up time, oocytes retrieved and embryo transfer number. Results indicated that follicular fluid leptin concentrations at the oocyte pick up were significantly lower in women who became pregnant compared to those who did not (MD = −4.53 (ng/ml); 95% CI: −7.78, −1.78; p value < 0.006). In conclusion, elevated leptin concentrations in follicular fluid at oocyte pick up time is significantly associated with an adverse pregnancy outcome in women undergoing an IVF programme.

Increasing insulin resistance predicts adverse pregnancy outcomes in women with gestational diabetes mellitus.

This study aimed to investigate the association between maternal insulin resistance (IR) in the late second trimester and pregnancy outcomes, as well as to identify risk factors of IR among women with gestational diabetes mellitus (GDM). A retrospective study was conducted among 2647 women diagnosed with GDM. IR was evaluated using the homeostasis model assessment method for IR (HOMA-IR) in the late second trimester (between 24 and 28 weeks), and the lipid profiles were measured at the same time. Patients were divided into groups based on quartiles of HOMA-IR. The information on pregnancy outcomes and risk factors was extracted from the medical records of all participants and entered electronically. Logistic regression models were used to analyze the associations between HOMA-IR and pregnancy outcomes, as well as the associations between risk factors and HOMA-IR. Greater IR was associated with cesarean delivery, preterm delivery, macrosomia, and large for gestational age newborns, but only significantly associated with preterm delivery after adjustment for potential confounders (P < .001). Prepregnancy body mass index (BMI), weight gain before diagnosis of GDM, and triglycerides were significantly related with IR in the late second trimester (P < .001). Besides, the total area under the curve of the diagnostic 75-g oral glucose tolerance test and glycosylated hemoglobin A1c increased from the lowest to the highest HOMA-IR groups. Increasing IR in the late second trimester predicts adverse pregnancy outcomes especially for preterm delivery in women with GDM. Additionally, prepregnancy BMI and weight gain before diagnosis of GDM are independent risk factors for the development of IR.

Shared Molecular Features Linking Endometriosis and Obstetric Complications

Recent epidemiological research has shown the increased risk of adverse pregnancy outcomes in women with endometriosis compared with the general population. The aim of this review is to explore common pathophysiologic mechanisms between endometriosis and obstetric complications. A computerized literature search was performed to identify relevant studies. The search covered the period between January 2008 and October 2018. One of the potential mechanisms driving the initiation and progression of endometriosis is the accumulation of a variety of epigenetic changes in endometrial cells. Epigenetic control of gene expression which is considered to be responsible for the development of endometriosis is commonly seen in patients with preeclampsia, small for gestational age (SGA), or preterm birth. DLX5 and GATA3, paternally imprinted genes, and CDKN1C, a maternally imprinted gene, were aberrantly expressed in placenta tissues of the preeclampsia; CDKN1C, the growth inhibitor gene, was upregulated in human SGA placentas; and hypomethylation of PTGER2 would be associated with preterm birth. Preeclampsia, SGA, or preterm birth may share common epigenetic alterations with endometriosis, which raises the possibility that the occurrence of two conditions might be nonrandom. To date, however, there is a lack of evidence that links endometriosis and other obstetric complications, such as postpartum hemorrhage or placental abruption, at the epigenetic level. In conclusion, epigenetic changes may be a common hallmark of two conditions: endometriosis and obstetrical complications, such as preeclampsia, SGA, or preterm birth.

Forced air-warming blanket versus pethidine for the prevention of shivering during and after caesarean section

Background Spinal anaesthesia significantly impairs thermoregulation by inhibiting vasomotor and shivering responses and by redistributing heat from the core of body to peripheral tissues. Core hypothermia may be associated with a number of adverse outcomes in pregnant women, including shivering, wound infection, coagulopathy, increased blood loss and transfusion requirements. Several pharmacological and mechanical methods have been used in an attempt to maintain normothermia and prevent intra-anaesthetic and postanaesthetic shivering. Therefore, the aim of the present study was to compare the efficacy of prophylactic use of forced air-warming blanket with pethidine for the prevention of shivering during and after spinal anaesthesia in elective caesarean section. Patients and methods The present study included 96 pregnant women with ASA I and II, admitted to Al Shatby Maternity Hospital. Patients were randomly assigned into three equal groups of 32 patients each. Group I patients were covered with forced air-warming blanket over the upper limbs and chest, group II patients received a single bolus of 0.5 mg/kg pethidine intravenously and group III patients did not receive anything, and they were regarded as control. Results Heart rate and mean arterial blood pressure decreased significantly in all the three studied groups after spinal anaesthesia. The decrease in the mean arterial blood pressure required ephedrine boluses, which ranged between 0 and 4 boluses, with no significance between the three studied groups. The core body temperature decreased significantly 15 min after spinal anaesthesia and thereafter in all patients of the three studied groups. However, the decrease in core temperature was significantly more in groups II and III. The shivering score increased significantly 10 min after spinal anaesthesia and thereafter intraoperatively. The shivering scores were significantly lower in groups I and II when compared with group III. There was a negative correlation between core body temperature and shivering scores in all the three studied groups. The mean core body temperature for shivering patients was significantly less in group II patients compared with groups I and III patients. The three groups were matched as regard to APGAR score at 1 and 5 min. No significant changes were observed as regard to hypotension, nausea, vomiting and feeling cold extremities. Conclusion Forced air-warming blanket decreased the shivering incidence by preserving core body temperature, whereas pethidine can prevent and treat shivering.

Maternal Serum Uric Acid Levels and Adverse Pregnancy Outcomes in Women with Hypertensive Disorders of Pregnancy

Introduction: Hypertensive Disorders of Pregnancy (HDP) are the major cause of maternal morbidity and mortality worldwide. The maximum burden of maternal mortality and morbidity is due to HDP and its related complications which is further followed by obstetric haemorrhage, pre-existing medical diseases, infections and abortions. Aim: To study the association between the serum uric acid level in hypertensive pregnant women and their association with maternal and foetal morbidity and mortality. Materials and Methods: It was a prospective observational study conducted at BLDE (Deemed to be) University, Shri BM Patil Medical College Hospital and Research Centre, Vijayapura, Karnataka, India from January to June 2019. A total of 165 pregnant women with HDP were included (44 (27%) had Gestational Hypertension (GH); 86 (52%), Pre-eclampsia (PE) and 35 (21%) eclampsia) in each group in the study and they were subjected for obstetric history, examination and laboratory evaluation. The laboratory evaluation included complete blood count, liver function test, renal function test, serum uric acid level and urine albumin, sugars and microscopy. The maternal and foetal outcomes were measured, which included mode of delivery, Neonatal Intensive Care Unit (NICU) admission, neonatal outcomes in terms of preterm or term delivery, intrauterine death, fresh still born, neonatal deaths. Results: A total of 165 cases with HDP were enrolled in the study. Mean serum uric acid level in GH, PE and eclampsia group was 5.13±1.32, 5.34±1.4, 6.05±1.67, respectively. A total of 118 participants presented at term and 47 were preterm (11 in GH, 20 in PE and 16 in eclampsia group). About 103 (62.42%) had vaginal delivery and 62 (31.51%) underwent caesarean section (14 in GH, 28 in PE and 20 in eclampsia group). All the perinatal deaths occurred were in women with PE (n=5) and eclampsia (n=2) and was not statistically analysed. Conclusion: Present study shows that increased levels of maternal serum uric acid levels were associated with PE and eclampsia compared to GH patients and were associated with adverse foetal outcomes and increase in the instrumental and operative interventions.

976: Risk of adverse pregnancy outcomes in women with maximum blood pressure 130-139/80-89 after 20 weeks

Hypertensive disorders of pregnancy have historically been based on the American Heart Association/American College of Cardiology’s definition of abnormal blood pressure, previously >140/90 mmHg. With the recent redefinition of hypertension (HTN), blood pressures 130-139/80-89 are now classified as abnormal. We sought to explore if new-onset blood pressure elevations of 130-139/80-89 mmHg after 20 weeks are associated with increased risk of adverse pregnancy outcomes. We performed a retrospective cohort study from a single tertiary care center who delivered singleton gestations after 20 weeks from January 1, 2014 to December 31, 2015. Normotensive patients were defined as having maximum BP < 130/80 prior to 20 weeks gestation. Patients that remained normotensive were then compared to patients who developed new blood pressure elevations 130-139/80-89 after twenty weeks but prior to admission for delivery. Clinical outcomes were assessed using χ2and logistic regression with multivariable logistic regression to control for confounders. Of 1,702 normotensive women, 1,014 (59.6%) remained normotensive for their entire antenatal course prior to admission, 518 (30.4%) had new-onset blood pressure elevations between 130-139/80-89, and 170 (10.0%) were excluded for overt HTN >140/90 prior to admission for delivery. Women with BP 130-139/80-89 after 20 weeks have a significantly increased risk of developing a hypertensive disorder of pregnancy during their delivery admission (OR 3.82, 95%CI 2.9-5.0) including a 5-fold increased risk for preeclampsia with severe features even after adjusting for confounders. There were no differences in median gestational age at time of diagnosis, rates of readmission for postpartum hypertensive disorders of pregnancy, or preterm birth < 34 weeks. Normotensive women with newly elevated blood pressures between130-139/80-89 mmHg after 20 weeks gestation are more likely to develop hypertensive disorders of pregnancy during their delivery hospitalization. These blood pressure elevations may be an early indicator of disease.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Subchorionic Hematomas and Adverse Pregnancy Outcomes among Twin Pregnancies.

This study estimates the association of a first trimester finding of subchorionic hematoma (SCH) with third trimester adverse pregnancy outcomes in women with twin pregnancies. Retrospective cohort study of twin pregnancies prior to 14 weeks at a single institution from 2005 to 2019, all of whom had a first trimester ultrasound. We excluded monoamniotic twins, fetal anomalies, history of fetal reduction or spontaneous reduction, and twin-to-twin transfusion syndrome. Ultrasound data were reviewed, and we compared pregnancy outcomes after 24 weeks in women with and without a SCH at their initial ultrasound 60/7 to 136/7 weeks. Regression analysis was used to control for any differences in baseline characteristics. A total of 760 women with twin pregnancies met inclusion criteria for the study, 68 (8.9%) of whom had a SCH. Women with SCH were more likely to have vaginal bleeding and had their initial ultrasound at earlier gestational ages. On univariate analysis, SCH was not significantly associated with gestational age at delivery, preterm birth, birthweight of either twin, low birthweight percentiles of either twin, fetal demise, or preeclampsia. SCH was associated with placental abruption on univariate analysis, but not after controlling for vaginal bleeding and gestational age at the time of the initial ultrasound (adjusted odds ratio: 2.00, 95% confidence interval: 0.63-6.42). Among women with SCH, SCH size was not associated with adverse pregnancy outcomes. In women with twin pregnancies, the finding of a first trimester SCH is not associated with adverse pregnancy outcomes >24 weeks.

Pregnancy outcomes among women with American College of Cardiology- American Heart Association defined hypertension

Objective To compare the rate of adverse pregnancy outcomes of women with hypertension defined by the ACC-AHA guidelines, women with hypertension defined by ACOG guidelines, and normotensive women. Methods A historical cohort study of women with singleton, nonanomalous pregnancies who presented before 20 weeks for their first prenatal visit between 1 January 2014 and 31 January 2016 with (a) hypertension defined by ACC-AHA (systolic blood pressure 130 mmHg and/or diastolic blood pressure of 80 mmHg documented), (b) hypertension defined by ACOG (systolic blood pressure of 140 mmHg and/or diastolic blood pressure of 90 mmHg documented) and (c) women documented to be normotensive. Primary outcomes were preeclampsia and small for gestational age. Fisher’s exact test was used to compare demographics and risk factors between the groups. Multivariable logistic regression analysis was used to predict the association of preeclampsia within the groups adjusting for additional risk factors. Results A total of 252 women were included. Of these, 92 (36.5%) had hypertension by ACC-AHA, 34 (13.5%) by ACOG and 126 (50%) were normotensive. Sixty percent of women with the ACOG definition developed preeclampsia compared to 45.1% of women with the ACC-AHA definition and 17.1% in the control group (p < .001). The rate of preeclampsia among women with hypertension by ACC-AHA criteria was not significantly different from the rate among women with hypertension by ACOG criteria (p = .288). Differences in small for gestational age among the groups were not significant (ACOG: 20%, ACC-AHA: 11.1%, normotensive: 9.8%, p = .423). Conclusion Women with hypertension defined by ACC-AHA have a rate of developing preeclampsia that is similar to that of women with hypertension defined by ACOG.

Adverse Pregnancy Outcomes Are Associated with Reduced Coronary Flow Reserve in Women With Signs and Symptoms of Ischemia Without Obstructive Coronary Artery Disease: A Report from the Women's Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction Study.

Background: We assessed history of adverse pregnancy outcomes (APOs) and coronary microvascular dysfunction (CMD) in the Women's Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction (WISE-CVD) cohort of women with signs and symptoms of ischemia without obstructive coronary artery disease (CAD). We hypothesized that women with CMD with symptoms and signs of ischemia, without obstructive CAD, are more likely to have a history of APO. Materials and Methods: WISE-CVD recruited women with suspected ischemia found to have no obstructive CAD (n = 324). A subset of these women underwent coronary reactivity testing, including coronary flow reserve (CFR) (n = 185). Relationship between history of any APO and CMD was assessed by multivariable linear regression analyses. APOs included any of the following: hypertension during pregnancy, preeclampsia, eclampsia, gestational diabetes, or intrauterine growth restriction (low-birth-weight child). Results: Overall, 79/324 (24%) women reported at least one APO. Women with APOs were younger (52 vs. 56 years, p = 0.001), were more likely obese (body mass index 32 vs. 29 kg/m2, p = 0.004), and had a history of hypertension (56% vs 36%, p = 0.002), but otherwise had no additional differences in cardiac risk variables versus women without APOs. Among the subgroup who underwent invasive CFR testing (n = 185), those with an APO had lower CFR (2.53 vs. 2.76, p = 0.016) versus those without APO. Conclusions: History of APOs in women with signs and symptoms of ischemia without obstructive CAD is associated with lower CFR indicative of CMD. Whether common pathways involving diffuse microvascular dysfunction may account for this suggested association remains unclear. Further investigation is needed to expand on these exploratory findings.

Limited presence of Waddlia chondrophila in drinking water systems in the Netherlands.

Waddlia chondrophila is an emerging pathogen belonging to the order of Chlamydiales. This obligate intracellular bacterium was initially isolated from an aborted bovine fetus and is associated with adverse pregnancy outcomes in women. The ability of W. chondrophila to reside and replicate within a range of free-living amoebae implies a possible widespread environmental presence. Potential hosts of W. chondrophila are present in Dutch drinking water. This study therefore investigated the presence of W. chondrophila DNA in drinking water by analysing 59 samples from ten drinking water systems throughout the Netherlands. Samples were taken at three distances from the treatment plant, during both summer and winter. Twelve of the samples were positive, originating from two of the treatment plants, of which three samples were quantifiable.

The efficiency of treatment of vaginal infections in women with a history of miscarriage

Hypothesis/aims of study. The problem of vaginal infections during pregnancy is of high importance in obstetric practice. To predict the risks and reduce the frequency of pregnancy and childbirth complications, it is necessary to dynamically assess the vaginal microflora and treat its disorders. The aim of the study was to investigate the vaginal microflora and evaluate the effectiveness of treating vaginal infections in pregnant women with a history of miscarriage.&#x0D; Study design, materials and methods. The study included 153 pregnant women in the first trimester. The main group (group I) consisted of 99 women with a history of miscarriage, 35 of whom had signs of threatened abortion (subgroup IA) and 64 did not (subgroup IB). The control group (group II) comprised 54 women without a history of miscarriage and signs of threatened abortion. The vaginal microflora was examined using microscopic, bacteriological and quantitative real-time PCR methods. All patients with an established vaginal infection (bacterial vaginosis, aerobic vaginitis, and vulvovaginal candidiasis) received etiotropic therapy, depending on the microorganisms identified and their sensitivity to antimicrobial drugs. After treatment, in order to assess the effectiveness of the therapy, the vaginal microflora was examined in the second trimester and the outcomes and complications of present pregnancy were evaluated.&#x0D; Results. In women of subgroup IA, vulvovaginitis and bacterial vaginosis were detected 3.5 times more often compared to the control group, and 1.6 times more often compared to subgroup IB (66% and 19%, respectively, p 0.001; 66% and 42%, respectively, p 0.05). Aerobic vaginitis was the most frequent vaginal infection in the first trimester of pregnancy in women of the main group (p 0.05). After treatment, the frequency of the vaginal infections in the second trimester in women of the main group significantly decreased: by 1.9 times in subgroup IA and by 1.5 times in subgroup IB (p 0.05). There were no significant differences in the frequency of adverse pregnancy outcomes in women with bacterial vaginosis or vulvovaginitis as compared to women with normal vaginal microflora. Nevertheless, pregnancy and childbirth complications were diagnosed 4 times more frequently in the main group (23% and 6%, respectively, p 0.05), with the complications occurring significantly more often in the cases of vulvovaginitis or bacterial vaginosis and signs of threatened abortion in the first trimester (p 0.05).&#x0D; Conclusion. Etiotropic therapy of vaginal infections diagnosed in the first trimester of pregnancy in women with a history of miscarriage was highly effective. In 40% of women, vaginal microbiocenosis normalized, and the clinical symptoms of vaginosis/vaginitis disappeared. Differences in the frequency of adverse pregnancy outcomes in women with vulvovaginitis or bacterial vaginosis in the first trimester and in women with normal vaginal microbiocenosis were not significant. However, the treatment of vaginal infections in the group of pregnant women with a history of miscarriage did not significantly affect the frequency of pregnancy and childbirth complications.

Potentially modifiable predictors of adverse neonatal and maternal outcomes in pregnancies with gestational diabetes\xa0mellitus: can they help for future risk stratification and risk-adapted patient care?

BackgroundGestational diabetes mellitus (GDM) exposes mothers and their offspring to short and long-term complications. The objective of this study was to identify the importance of potentially modifiable predictors of adverse outcomes in pregnancies with GDM. We also aimed to assess the relationship between maternal predictors and pregnancy outcomes depending on HbA1c values and to provide a risk stratification for adverse pregnancy outcomes according to the prepregnancy BMI (Body mass index) and HbA1c at the 1st booking.MethodsThis prospective study included 576 patients with GDM. Predictors were prepregnancy BMI, gestational weight gain (GWG), excessive weight gain, fasting, 1 and 2-h glucose values after the 75 g oral glucose challenge test (oGTT), HbA1c at the 1st GDM booking and at the end of pregnancy and maternal treatment requirement. Maternal and neonatal outcomes such as cesarean section, macrosomia, large and small for gestational age (LGA, SGA), neonatal hypoglycemia, prematurity, hospitalization in the neonatal unit and Apgar score at 5 min < 7 were evaluated. Univariate and multivariate regression analyses and probability analyses were performed.ResultsOne-hour glucose after oGTT and prepregnancy BMI were correlated with cesarean section. GWG and HbA1c at the end pregnancy were associated with macrosomia and LGA, while prepregnancy BMI was inversely associated with SGA. The requirement for maternal treatment was correlated with neonatal hypoglycemia, and HbA1c at the end of pregnancy with prematurity (all p < 0.05). The correlations between predictors and pregnancy complications were exclusively observed when HbA1c was ≥5.5% (37 mmol/mol). In women with prepregnancy BMI ≥ 25 kg/m2 and HbA1c ≥ 5.5% (37 mmol/mol) at the 1st booking, the risk for cesarean section and LGA was nearly doubled compared to women with BMI with < 25 kg/m2 and HbA1c < 5.5% (37 mmol/mol).ConclusionsPrepregnancy BMI, GWG, maternal treatment requirement and HbA1c at the end of pregnancy can predict adverse pregnancy outcomes in women with GDM, particularly when HbA1c is ≥5.5% (37 mmol/mol). Stratification based on prepregnancy BMI and HbA1c at the 1st booking may allow for future risk-adapted care in these patients.

Prediction of Risk for Adverse Pregnancy Outcomes in Women with Sickle Cell Disease

Introduction: Pregnancies in women with Sickle Cell Disease (SCD) are at risk of adverse maternal and fetal outcomes. There are no studies characterizing features predictive of pregnancy-related complications that would enable targeted interventions towards those at high-risk, whilst avoiding exposure of those at low risk to the potential intervention-associated complications. Objective: To explore risk factors associated with adverse pregnancy outcomes in women with SCD and to develop a prediction rule identifying women at different levels of risk for adverse pregnancy outcomes. Methods: Retrospective cohort study of pregnant women with SCD at a tertiary care center. Maternal composite outcome (MCO) includes any of the following: severe, complicated anemia, multi-organ failure, venous thromboembolism, vaso-occlusive episodes requiring admission, blood transfusion, maternal mortality, hypertensive disorder of pregnancy (HDP), cardiac, pulmonary, hepatobiliary, MSK/skin, splenic, neurologic, or renal complication. Fetal composite outcome (FCO) includes any of the following: perinatal mortality, preterm birth, or small for gestational age size. Both composite outcomes were defined a priori. SCD-associated MCO were defined based on a published classification of SCD manifestations. HDP were divided to include gestational hypertension or pre-eclampsia, as noted in the health record. For twin pregnancies, the FCO was considered present if either infant met criteria. Predictor variables included SCD-related and non-SCD related maternal factors, which have been shown in the literature and through clinical experience to potentially result in adverse pregnancy outcomes. For a variable to be interpreted as a potential cause of an adverse outcome, it must have been present before the outcome and must not have been part of the outcome definition. Regression models for MCO and FCO were constructed using generalized estimation equation (GEE) logistic regression with clustering by woman to account for non-independence of outcomes in women with several pregnancies during the study period. From a set of 21 potential predictors for MCO and 26 potential predictors for FCO, those with univariate p-values &lt;0.2 in GEE were included in a multivariable GEE regression model. Using cross-validation, predictive performance of the fitted model was evaluated using the concordance statistic and accuracy of prediction using a calibration curve; for each of 10 90%:10% splits of the dataset, a model was fitted on the 90% and used to obtain predicted probabilities on the 10%. Results: Of 199 pregnancies in 131 women between 1990 and 2016, MCO and FCO occurred in 71% and 45% of pregnancies, respectively. Risk for MCO was predicted by low maternal BMI, low first-trimester hemoglobin, VOE in the year preceding pregnancy, high LDH in pregnancy, history of multiple transfusions, and history of cardiac complications (heart failure, cardiomyopathy, or cardiomegaly). While presence of MCO was not part of the model given the inability to include it in a prediction rule for primiparous women, its manifestation was a risk factor for recurrence in subsequent pregnancies. FCO risk was predicted by older maternal age, high LDH in pregnancy, and maternal composite outcome during pregnancy. The model was discriminative for (a) MCO with a concordance statistic of 0.84 (se=0.03) on the observed data, and a cross-validated value of 0.80 (se=0.03), and (b) FCO with a concordance statistic of 0.72 (se=0.04) on the observed data, and a cross-validated value of 0.69 (se=0.04). Except at the extremes, predicted risk agreed well with observed risk for both the MCO and the FCO (Figure 1). Predicted risk of the MCO, separated pregnancies into groups having as low as a 35% to as high as a 95% chance, while predicted risk of FCO separated pregnancies into groups as low as 10% to as high as 70% (Figure 1). Conclusions: Our study shows that readily available clinical and laboratory variables can predict the degree of risk for an adverse pregnancy outcome in women with SCD. In our models, SCD genotype itself does not predict adverse maternal or fetal outcome, while presence of MCO or FCO are important predictors alongside other prespecified variables. The prediction rules will enable identification of sub-groups of women at higher risk of adverse events, allowing for consideration of targeted interventions such as prophylactic transfusion. Disclosures Malinowski: Alexion: Consultancy, Honoraria. Kuo:Agios: Consultancy; Alexion: Consultancy, Honoraria; Apellis: Consultancy; Bioverativ: Other: Data Safety Monitoring Board; Pfizer: Consultancy; Bluebird Bio: Consultancy; Celgene: Consultancy; Novartis: Consultancy, Honoraria.

The Association of Gestational Weight Gain and Adverse Pregnancy Outcomes in Women with Gestational Diabetes Mellitus

Objective: To explore the association of excessive gestational weight gain (GWG) defined by the Institute of Medicine (IOM) targets and adverse perinatal outcomes in gestational diabetes mellitus (GDM) pregnancies, and whether a modified target might be related to a lower rate of adverse perinatal outcomes for GDM. Methods: This retrospective cohort study involved 1,138 women of normal glucose tolerance (NGT) and 1,200 women with GDM. Based on the IOM target, pregnancies were classified to appropriate GWG (aGWG), inadequate GWG, and excessive GWG (eGWG). Modified GWG targets included: upper limit of IOM target minus 1 kg (IOM-1) or 2 kg (IOM-2), both upper and lower targets minus 1 kg (IOM-1-1) or 2 kg (IOM-2-2). Results: The proportions of women achieving eGWG were 26.3% in NGT and 31.2% in GDM (P = .036); in comparison, for aGWG NGT, the risks of large for gestational age (LGA) were significantly higher in eGWG NGT (adjusted odds ratio [OR] 1.47; 95% confidence interval [CI] 1.02 to 2.13), aGWG GDM (adjusted OR 1.42; 95% CI 1.03 to 1.95), and eGWG GDM (adjusted OR 2.70; 95% CI 1.92 to 3.70). GDM pregnancies gaining aGWG based on the modified GWG targets (IOM-2, IOM-1-1, and IOM-2-2) had a lower prevalence of LGA and macrosomia delivery than that for similar pregnancies using the original IOM target (all P<.05). Conclusion: For aGWG GDM according to the IOM target, adhering to a more stringent weight control was associated with decreased adverse outcomes. A tighter IOM target might help to reduce the prevalence of adverse pregnancy outcomes. Abbreviations: aGWG = appropriate gestational weight gain; BG = blood glucose; BMI = body mass index; CI = confidence interval; eGWG = excessive gestational weight gain; GDM = gestational diabetes mellitus; GW = gestational weeks; GWG = gestational weight gain; HbA1c = hemoglobin A1c; iGWG = inadequate gestational weight gain; IOM = Institute of Medicine; LGA = large for gestational age; NGT = normal glucose tolerance; NICU = neonatal intensive care unit; OGTT = oral glucose tolerance test; OR = odds ratio; PARp = partial population attributable risks; SGA = small for gestational age.

Risk factors during pregnancy and birth-related complications in HIV-positive versus HIV-negative women in Denmark, 2002-2014.

We aimed to compare risk factors for adverse pregnancy outcomes in women living with HIV (WLWH) with those in women of the general population (WGP) in Denmark. Further, we estimated risk of pregnancy- or birth-related complications. A retrospective cohort study including all WLWH who delivered a live-born child from 2002 to 2014 and WGP, matched by origin, age, year and parity, was carried out. We compared risk factors during pregnancy and estimated risk of pregnancy- and birth-related complications using multivariate logistic regression. A total of 2334 pregnancies in 304 WLWH and 1945 WGP were included in the study. WLWH had more risk factors present than WGP during pregnancy: previous caesarean section (CS) (24.7% versus 16.3%, respectively; P=0.0001), smoking (14.2% versus 7.5%, respectively; P=0.0001) and previous perinatal/neonatal death (2.3% versus 0.9%, respectively; P=0.03). We found no difference between groups regarding gestational diabetes, hypertensive disorders, low birth weights or premature delivery. More children of WLWH had intrauterine growth retardation (IUGR) [adjusted odds ratio (aOR) 1.9; 95% confidence interval (CI) 1.1-3.2; P=0.02]. Median gestational age and birth weight were lower in children born to WLWH. WLWH had a higher risk of emergency CS (EmCS) (aOR 1.6; 95% CI 1.2-2.1; P=0.0005) and postpartum haemorrhage (aOR 1.4; 95% CI 1.0-1.9; P=0.02) but not infection, amniotomy, failure to progress, low activity-pulse-grimace-appearance-respiration (APGAR) score or signs of asphyxia. WLWH had more risk factors present during pregnancy, similar risks of most pregnancy- and birth-related complications but a higher risk of postpartum haemorrhage and EmCS compared with WGP. Children born to WLWH had lower median birth weights and gestational ages and were at higher risk of IUGR.

Predicting adverse outcomes of hypertensive disorders in pregnancy: validation of fullPIERS model in Chinese population

Purpose of Investigation: The fullPIERS model is an effective tool to predict the adverse outcomes of pre-eclampsia. This study aimed to validate the effectiveness of fullPIERS model, and discover the variables that may be useful to predict the adverse outcomes of hypertensive disorders in pregnancy (HDPs) in Chinese population. Materials and Methods: The authors retrospectively collected the data of 1,430 HDPs patients within 48 hours of adverse outcomes in two tertiary hospitals in China. Calculated the risk probability value of every patient using fullPIERS model and validated the predictive efficiency by area under curve of operating characteristic curve (AUC ROC). To assess the factors particularly useful to predict adverse outcomes of HDPs for Chinese population, the authors conducted the independent sample t-test and multivariate regression analysis to the following factors: age, platelet count, gestational age, creatinine, AST, total bilirubin, direct bilirubin, indirect bilirubin, hemoglobin, albumin, globulin, ALT, alkaline phosphatase, lactic dehydrogenase, urea, and uric acid. Results: The AUC ROC was 0.768 calculated by fullPIERS model within 48 hours of adverse outcomes, and the cut-off probability value was 0.045. In patients with a probability value ≥ 0.045, 53.53% experienced adverse outcomes, and the false positive rate was 10.70%. Lactic dehydrogenase was a promising variable for predicting the risk of adverse outcome of HDPs. The AUC ROC calculated based on lactic dehydrogenase alone was 0.615 with a cut-off value of 243.5 U/L. Conclusions: The fullPIERS model was effective for Chinese population to predict adverse outcomes in pregnant women complicating HDPs. Lactic dehydrogenase was a promising variable to predict the adverse outcomes of HDPs.

Erratum: Erratum: Adverse Pregnancy Outcomes in Women with Sickle Cell Trait.

[This corrects the article DOI: 10.1055/s-0039-1695743.].

Adverse Pregnancy Outcomes in Women with Sickle Cell Trait.

Objective To compare adverse pregnancy outcomes between women with sickle cell trait (SCT) and women with normal hemoglobin. Study Design A retrospective cohort study of women who delivered within Kaiser Permanente Northern California between 2006 and 2013. Using hemoglobin electrophoretic profiles, we defined women with hemoglobin AS (HbAS) as having SCT and those with hemoglobin AA (HbAA) as having normal hemoglobin. Outcomes were pregnancy-induced hypertension (PIH), small for gestational age (SGA), gestational diabetes (GDM), and preterm delivery (PTD). Demographic and pregnancy outcome variations were assessed in bivariate analyses. Multivariable logistic regression modeling was used to estimate odds ratios for the association between primary outcomes and selected characteristics. Results Of 31,840 eligible women, 868 (2.7%) had SCT. Women with SCT were more likely to have PIH (15.6% vs. 12.2%, p value = 0.003) and SGA (8.3% vs. 6.1%, p value = 0.008), less likely to have GDM (6.8% vs. 9.8%, p value = 0.003) and had similar PTD prevalence (8.1% vs. 7.6%, p value = 0.600). In multivariable analyses, SCT was not an independent predictor of these outcomes. Racial/ethnic minorities had higher adjusted odds of PIH, SGA, and GDM. Conclusion SCT alone does not appear to be associated with adverse pregnancy outcomes. Race/ethnicity is a risk factor for adverse pregnancy outcomes.

P19.01: The cervical elastography change after progesterone treatment is associated with adverse pregnancy outcome in women with short cervix

P19.01: The cervical elastography change after progesterone treatment is associated with adverse pregnancy outcome in women with short cervix

Prediction of Adverse Pregnancy Outcomes in Women with Systemic Lupus Erythematosus.

Systemic lupus erythematosus (SLE) is a chronic, autoimmune disease associated with major obstetrical complications such as gestational loss, preterm delivery, fetal growth restriction (FGR) and preeclampsia. Published literature is not consensual regarding the main risk factors for each of these outcomes. Our goal with this study was to determine the most important predictors for each of the main adverse pregnancy outcomes in this population. We conducted a retrospective cohort study of unifetal pregnancies of women with the diagnosis of SLE followed in our unit between January 1994 and December 2016. We excluded elective terminations of pregnancy and cases lost to follow-up and we analyzed 157 pregnancies (128 women). Multiple logistic regression models for the outcomes gestational loss, preterm delivery, fetal growth restriction, and preeclampsia were built. Two-sided p-values of < 0.05 were used to determine statistical significance, and two-sided confidence intervals of 95% are reported. In our cohort, the main risk factors for gestational loss were maternal age and the presence of antiphospholipid antibodies. Lupic nephritis was predictive of a preterm delivery and preeclampsia. Renal involvement and lupus flares during pregnancy were risk factors for FGR. Overall, the main risk factor for an adverse pregnancy outcome were lupus flares during pregnancy. Despite optimal pregnancy monitoring, women with SLE are still at risk for adverse pregnancy outcomes. Risk stratification for each of these outcomes is crucial for an effective counselling and tailored monitoring.