Adverse Pregnancy Outcomes Research Articles

Association between maternal glucose levels in pregnancy and offspring's metabolism and adiposity: an 18-year birth cohort study.

The study aimed to explore the association between maternal glucose levels in pregnancy and offspring's metabolism and adiposity at approximately 18 years of age. Pregnant women from the Hong Kong Field Centre enrolled in the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study underwent a 75 g OGTT at 24-32 gestational weeks. Offspring's metabolic and adiposity traits were assessed at 18 years postpartum. Associations were evaluated using multiple linear regression and logistic regression. Among the 506 mother-child pairs followed up to 18 years, maternal fasting plasma glucose (FPG) in pregnancy was positively associated with offspring's FPG (β = 0.06 [95% CI 0.02, 0.09]), while maternal 1 h plasma glucose (PG) showed a positive association with offspring's FPG (β = 0.05), 30 min PG (β = 0.21) and 2 h PG (β = 0.14). All maternal glycaemic levels were associated with an increased risk of offspring being overweight/obese, particularly maternal 1 h PG (OR 1.50 [95% CI 1.17, 1.93]). Offspring of mothers with gestational diabetes mellitus showed a higher prevalence of abnormal glucose tolerance (11.86% vs 7.97%), impaired fasting glucose (1.89% vs 0.49%) and impaired glucose tolerance (10.34% vs 7.13%) than offspring of mothers with normal glucose tolerance, although these associations did not reach statistical significance in fully adjusted models, underscoring the benefit of considering maternal glucose as a continuous trait. Maternal glucose levels in pregnancy showed a long-term association with offspring's metabolic health into young adulthood, with continuous associations across the full maternal glucose spectrum, suggesting a graded effect of maternal hyperglycaemia on offspring's metabolic risk.

Distinct response to treatment and characteristics of bile acid composition of early- and late-onset intrahepatic cholestasis of pregnancy: A prospective pilot study.

Distinct response to treatment and characteristics of bile acid composition of early- and late-onset intrahepatic cholestasis of pregnancy: A prospective pilot study.

Reproductive patterns and birth rates in acute leukaemia survivors: A Danish population-based cohort study.

Treatment-related infertility is of great concern to younger long-term survivors of acute leukaemia (AL). This study aimed to assess birth rates and cumulative incidences of first live birth, use of assisted reproduction technology (ART) and pregnancy outcomes in AL survivors compared to the Danish general population. Patients aged 18-45 years at AL diagnosis, alive and in remission 3 years after the date of diagnosis (index date), were included and matched 1:10 with leukaemia-free comparators on sex, age and parenthood status. A total of 401 AL survivors (183 females; 218 males) and 4010 matched comparators were followed for a median of 9.9 years. The median age at index was 37 years in females and 36 years in males. AL survivors had lower birth rates (incidence rate ratio: 0.77, 95% confidence interval: 0.61-0.99), lower 10-year cumulative incidences (females: 20.1% vs. 27.8%; males: 22.3% vs. 29.9%), a higher use of ART (females: 25.5% vs. 14.1%; males: 55.9% vs. 12.2%), but no higher degree of adverse pregnancy outcomes. This underscores the importance of informing patients of fertility-preservation options as well as of the risk of treatment-related infertility.

Placental Abnormalities in Systemic Lupus Erythematosus: Novel Markers of Adverse Pregnancy Outcomes

ObjectivesPlacenta-mediated adverse pregnancy outcomes (APO) are a huge concern in SLE. Recent efforts to understand APO include the establishment of the 2016 Amsterdam classification criteria,[1] developed to standardize placental pathology evaluation. No study to date evaluated the Amsterdam criteria in SLE. Using the prospective “Lupus prEGnAnCY (LEGACY)” biobank, we assessed the relationship between placental abnormalities, lupus anticoagulant (LAC), and APO, applying the Amsterdam criteria.MethodsLEGACY is a prospective cohort enrolling SLE pregnancies (before the 17th gestational week). Relevant information is collected at each trimester and/or end-of-pregnancy visits. We evaluated pregnancies delivered beyond 17 weeks at the Montreal site. Placental pathology was defined as abnormal if fulfilling at least 1of the 4 main Amsterdam classification subtypes: (1) maternal vascular malperfusion, (2) fetal vascular malperfusion, (3) acute chorioamnionitis, and/or (4) villitis of unknown etiology. Pregnancies with and without abnormal pathology were further characterized based on presence of LAC and APO (ie, stillbirth, placental insufficiency, gestational hypertension, preeclampsia, small-for-gestational age neonate <5%).ResultsOf 44 LEGACY pregnancies delivered (beyond 17 weeks), 32 (73%) had placental pathology available. Among these 32, 15 (47%) had abnormal pathology. Of those with abnormal pathology, 6/15 (40%) had maternal vascular malperfusion, 5/15 (33%) acute chorioamnionitis, 4/15 (27%) villitis of unknown etiology, and 1/15 (7%) fetal vascular malperfusion. Mean gestational age at delivery was substantially lower in pregnancies with abnormal pathology [mean 33.7 weeks, standard deviation (SD) 6.8] versus those with normal pathology (mean 37.8 weeks, SD 1.7), with a difference in mean gestational age of −4.1 weeks (95% CI −0.6, −7.6). LAC was more frequent in pregnancies with abnormal pathology (4/15; 27%) as opposed to pregnancies with normal pathology (2/17; 12%). APO occurred in 8/15 (53%) pregnancies with abnormal pathology (including 3 with early preterm preeclampsia <34 weeks) as opposed to 7/17 (41%) pregnancies with normal pathology (none with early preterm preeclampsia). Maternal vascular malperfusion was strongly associated with APO (odds ratio 8.1; 95% CI 0.8, 83.7), although the CI included the null.ConclusionIn this cross-sectional analysis, SLE pregnancies with abnormal placenta pathology, particularly maternal vascular malperfusion, experienced shorter gestation and more severe placenta-mediated APO, including early preterm preeclampsia. Future studies will aim to expand the sample and investigate if placental abnormalities in 1 pregnancy helps predict APO in subsequent pregnancies. [1.] Khong T. Arch Pathol Lab Med 2016;140(7):698-713.Best Abstract on Basic Science Research by a Trainee Award. Supported by a CIORA grant

Overweight and Obesity Are Key Modifiable Risk Factors for Adverse Outcomes in Systemic Lupus Erythematosus Pregnancies

ObjectivesTo determine if overweight (25-29.9 kg/m2) or obese (≥30 kg/m2) baseline body mass index (BMI) conferred higher adverse pregnancy outcomes (APO) risk compared to BMI <25 kg/m2 in a prospective systemic lupus erythematosus (SLE) pregnancy cohort.MethodsWe enrolled pregnant SLE women at <17 weeks gestation at 5 Systemic Lupus International Collaborating Clinics centers in Canada and South Korea. We collected data on demographics, obstetrical history, SLE characteristics, baseline comorbidities, and APO at each of the 2nd trimester, 3rd trimester, and end-of-pregnancy (8-12 weeks) visits. APO included: (1) fetal death >20 weeks’ gestation, (2) neonatal death due to preterm birth and/or placental insufficiency, (3) preterm delivery or termination <36 weeks due to placental insufficiency, gestational hypertension, preeclampsia, and/or eclampsia, and (4) small for gestational age (<5th percentile). We assessed the proportion of APO across the different BMI groups. We conducted a multivariate analysis using the Korean BMI classification for pregnancies from Asian mothers [obese (BMI ≥25 kg/m2), overweight (BMI 23-24.9 kg/m2), and normal weight (BMI <23 kg/m2)].ResultsWe analyzed 80 completed pregnancies, with a mean maternal age of 33.9 years (standard deviation, SD 4.1) and BMI of 26.0 kg/m2 (SD 6.7). Almost half (40%) of pregnancies had a maternal BMI ≥25 kg/m2. Non-Hispanic Whites made up 40% of the pregnancies and more than half (56%) of pregnancies with a maternal BMI ≥30 kg/m2 (Table 1). Overall, APO occurred in 8 (10%) pregnancies. The proportion of APO was 19% [95% CI 0, 38%] in both the BMI 25-29.9 kg/m2 and BMI ≥30 kg/m2 groups and 4% (95% CI 1, 12%) in the BMI <25 kg/m2 group. In univariate analysis, there was more than a 5-fold increased risk of APO in pregnancies with maternal BMI ≥25 kg/m2 versus those with BMI <25 kg/m2 [odds ratio (OR) 5.31; 95% CI 1.00, 28.24]. In multivariate analysis, using the Korean BMI classification for all Asian mothers and adjusting for race and antiphospholipid antibody status, overweight and obese pregnancies had a substantially increased risk of APO compared to those with normal weight (OR 6.32; 95% CI 1.25, 32.0).Table 1.SLE Pregnancy Characteristics by Body Mass Index (BMI, kg/m2)ConclusionOverweight and obese SLE women had higher APO risk compared to those with normal weight. High BMI may be a modifiable risk factor for APO in women with SLE.Supported by a CIORA grant

Oleanolic acid derivative OA17 inhibits trophoblast apoptosis by suppressing HIF-1α nuclear translocation in SLE-associated adverse pregnancy outcomes.

Oleanolic acid derivative OA17 inhibits trophoblast apoptosis by suppressing HIF-1α nuclear translocation in SLE-associated adverse pregnancy outcomes.

Adverse maternal outcomes in pregnancies with life-limiting fetal conditions managed expectantly: a cross-sectional study from a single tertiary fetal medicine centre in UK.

Adverse maternal outcomes in pregnancies with life-limiting fetal conditions managed expectantly: a cross-sectional study from a single tertiary fetal medicine centre in UK.

Pregnancy, risk behaviors and adverse reproductive outcomes: Is preconception care working in Italy?

Pregnancy, risk behaviors and adverse reproductive outcomes: Is preconception care working in Italy?

Fatty Acid Signatures in People With HIV: Association With Adverse Pregnancy Outcomes and Offspring Anthropometrics

Background: We assessed the association of polyunsaturated fatty acids in pregnant people with HIV (PWH) with pregnancy outcomes and offspring anthropometrics. Setting: This is a cohort of 264 pregnant PWH, and their HIV-exposed uninfected children, enrolled in the Pediatric HIV/AIDS Cohort Study Nutrition sub-study from 2009 to 2011. Methods: We measured third-trimester plasma omega-6 and omega-3 polyunsaturated fatty acid content, each as a percentage of total fatty acid content, through esterification and gas chromatography. Omega-6:omega-3 ratios were calculated. Pregnancy outcomes were hypertensive disorders of pregnancy, preterm birth (<37 weeks' gestation), and small-for-gestational age (birthweight <10th percentile). Childhood anthropometrics outcomes were Z-scores for age and sex: (1) weight and length/height (birth to 5 years of age), (2) head circumference (1–2 years), and (3) triceps skinfold thickness (2–5 years). Log-binomial regression models estimated pregnancy outcome prevalence ratios by omega-6:omega-3 ratios as a continuous variable. Linear regression models using generalized estimating equations assessed childhood anthropometric outcomes in those with omega-6:omega-3 ratios >25th versus ≤25th percentile. Results: Each 1% increase in the omega-6:omega-3 ratio was associated with a 25% [95% confidence interval (CI): 8 to 43] and 10% (95% CI: 3 to 18) higher prevalence of hypertensive disorders of pregnancy and preterm birth, respectively, and 13% (95% CI: 1 to 23) lower prevalence of small-for-gestational age. A difference in childhood anthropometric outcomes was not identified at any time point between exposure groups. Conclusions: Higher omega-6:omega-3 ratios in pregnant PWH were positively associated with hypertensive disorders of pregnancy and preterm birth, inversely associated with small-for-gestational age birth, and not associated with childhood anthropometric trajectories.

Single and joint associations of exposure to polycyclic aromatic hydrocarbons with hypertensive disorders of pregnancy: A nested case-control study.

Single and joint associations of exposure to polycyclic aromatic hydrocarbons with hypertensive disorders of pregnancy: A nested case-control study.

MiR-27a-3p, miR-222-3p and miR-340-5p as indicators of the antioxidant response activation in gestational diabetes.

Gestational diabetes (GDM) is the most common pregnancy-related metabolic disorder and a major risk factor for both mother and a child, during pregnancy and after delivery. Impairment of the anti-oxidative system acts as the driving force of the devastating consequences in GDM, while microRNA molecules are affected by disturbances related to (glyco)oxidative stress ((g)OS) and emerged as potential sensors and effectors of (g)OS-associated mechanisms. The aim of the present study was to evaluate the potential of OS-related microRNAs miR-27a, miR-222 and miR-340 from peripheral blood mononuclear cells (PBMCs) to serve as OS indicators of in GDM. MicroRNA quantification was conducted in samples of patients with GDM and normoglycemic controls (n = 45 each). Levels of expression were tested for correlations with the activities of glutathione reductase (GR), superoxide dismutase (SOD) and catalase (CAT) and serum thiol content. MiR-27a demonstrated correlation with the expression of other two microRNAs. GR activity during pregnancy weeks 24-28 was increased in GDM, while thiol content showed an opposite direction of change. Similar results were acquired when comparing GDM patients with and without adverse pregnancy outcomes. The expression of tested microRNAs was positively correlated with the activity of GR in GDM group, while the correlation of the expression of miR-27a-3p and miR-340-5p with SOD activity and blood thiol content was negative. Our findings support the relevance of redox dysregulation in mid-pregnancy for developing obstetric and neonatal complications. The results also qualify miR-27a-3p, miR-222-3p and miR-340-5p for redox status indicators in GDM.

Trends in the prevalence of autoimmune diseases during pregnancy in the UK, 2000-21: a retrospective cohort study.

Trends in the prevalence of autoimmune diseases during pregnancy in the UK, 2000-21: a retrospective cohort study.

Impact of second trimester iron deficiency on maternal and infant outcomes: A Danish cohort study.

Iron is a fundamental component during pregnancy; however, there is a lack of understanding of how iron deficiency (ID) during the second trimester affects maternal and infant outcomes. We aimed to investigate the prevalence of ID among pregnant women during the second trimester of pregnancy and to evaluate the associations with adverse maternal and infant outcomes. This was an exploratory analysis of data from a longitudinal cohort study including singleton pregnant women at a single center, where P-ferritin was analyzed in blood samples drawn between 24 and 28weeks gestation. Multivariable regression analyses with Bonferroni corrections were used to evaluate the association between ID (P-ferritin <15µg/L) in the second trimester and maternal and infant outcomes. Second trimester ID was found in 182 of the 449 included women (40.5%), among whom anemia was present in 4.4%. Women with ID were more often multiparous (73.1% vs. 52.4%) and subsequently treated with intravenous iron infusion (5.5% vs. 1.1%). Infants born to women with ID had a significantly higher placental weight (700g vs. 630g), higher birth weight (3713g vs. 3522g), birth weight z-score (0.3 vs. -0.1), and significantly lower prevalence of small for gestational age (2.7% vs. 9.8%) compared to women with normal iron levels. ID in the second trimester of pregnancy was not associated with adverse maternal or infant outcomes such as emergency cesarean section, induction of labor, preterm birth, or fetal acidosis. Despite recommended iron supplements from 10weeks gestation, ID was frequent among pregnant Danish women in the second trimester and associated with accelerated placental and infant growth, but not adverse pregnancy outcomes. This study indicates that the clinical relevance of the current cut-off level for ID in the second trimester of pregnancy among pregnant Danish women needs further investigation.

Safety of biologics in patients with autoimmune rheumatic diseases during pregnancy: Systematic review and meta-analysis.

Safety of biologics in patients with autoimmune rheumatic diseases during pregnancy: Systematic review and meta-analysis.

Longitudinal twin growth discordance patterns and adverse perinatal outcomes.

Longitudinal twin growth discordance patterns and adverse perinatal outcomes.

Childhood-Onset Systemic Lupus Erythematosus: Pregnancy and Birth Outcomes in Ontario

ObjectivesChildhood-onset systemic lupus erythematosus (cSLE) is a chronic, multisystem, autoimmune disease. Pregnancy and birth outcomes of cSLE are not well understood. Our objectives were to describe and evaluate pregnancy, neonatal, and maternal outcomes among female cSLE patients in Ontario, and to identify demographic and disease characteristics associated with adverse outcomes.MethodsA population-based retrospective cohort study linked clinical data for eligible female cSLE patients diagnosed between 1985 and 2011 and followed for ≥1 year from date of diagnosis to March 31, 2023, with multiple health administrative datasets housed at the Institute for Clinical Evaluative Sciences. Descriptive statistics, adjusted, and univariate analyses were used to determine significant associations between risk factors (including demographic and early disease characteristics) and adverse outcomes.Results489 female cSLE patients were diagnosed between 1985-2011 and followed for 16.8±7.2 years. A total of 423 pregnancies occurred in 175 women. 131 women had at least 1 live birth while 44 had no live births. 46.1% pregnancies resulted in fetal death (including still birth, miscarriage or abortion), 32% of live births were preterm, and 33.3% of neonates were admitted to neonatal intensive care (Table 1). Our adjusted analysis shows that patients who were older at time of cSLE diagnosis have lower odds of fetal death [OR= 0.87, 95% CI (0.78-0.97)], after controlling for years since cSLE diagnosis, ethnicity, income, anti-dsDNA antibodies, and biopsy-proven lupus nephritis. Our univariate analyses show that odds of preterm birth are higher for patients with non-white ethnicity [OR=2.43, 95% CI (1.22-4.85)], anti-Sm antibodies [OR=2.82, 95% CI (1.43-5.56)], and biopsy-proven lupus nephritis [OR=2.51, 95% CI (1.27-4.98)].Table 1:Pregnancy, neonatal, and maternal outcomes among female cSLE patientsConclusionInvestigating pregnancy, neonatal, and maternal outcomes is crucial for providing targeted health care for cSLE patients and their newborns. Factors such as age at diagnosis, non-white ethnicity, and early disease characteristics like anti-Sm antibodies, and biopsy-proven lupus nephritis are significantly associated with adverse pregnancy and birth outcomes. Understanding these associations will enhance patient care and improve health resource management.

Case Series of Six Patients with Inflammatory Myositis Seen at a Specialized Pregnancy and Rheumatic Diseases Clinic

BackgroundDermatomyositis (DM) is a systemic autoimmune disease which can present with proximal muscle weakness, cutaneous eruptions, and interstitial lung disease. There is limited data on the impact of pregnancy on DM. A few studies have suggested increased rates of adverse pregnancy outcomes in this population, but this has not been firmly established. In this case series, we describe 6 pregnancies in women with DM who were followed at a specialized pregnancy and rheumatic diseases clinic (PReDICT).CaseWe used a prospective registry of patients seen at PReDICT and identified those with dermatomyositis or polymyositis between 2021-2024. Six patients with DM, who were managed at PReDICT throughout the 3 trimesters of pregnancies and 6 weeks postpartum, were included in the study. Five of the patients had a pre-existing diagnosis of DM prior to pregnancy. One patient presented with a new diagnosis of DM in the 1st trimester of pregnancy. Patients who had pre-pregnancy counseling had low disease activity at conception and conceived on pregnancy-compatible medications. One patient (Patient 2) experienced a possible flare during pregnancy during the 2nd trimester, manifesting as dyspnea, hoarseness of voice, and dysphagia, and requiring an increase in dose of prednisone from 5 mg to 10 mg. One patient (Patient 3) experienced a postpartum flare involving both the skin and muscles which required initiation of Tacrolimus and IVIG. All other patients remained in remission (Patients 1 and 5) or stable low disease activity (Patients 4 and 6); postpartum information for patient 2 is not available. All pregnancies resulted in live births. Infant 2 was born prematurely (34+3 weeks) and admitted to NICU for blood glucose monitoring and feeding support. Infant 4 experienced severe combined immunodeficiency due to in-utero azathioprine exposure. Pregnancy outcomes are summarized in Table 1.Table 1:Pregnancy Outcomes and Management in Pregnant Women Diagnosed with DermatomyositisConclusionIn our case series of 6 pregnant patients with DM, all resulted in live births, although pregnancy complications were noted. Further studies on the effect of inflammatory myositis on pregnancy and vice versa are needed.

Obstetric and neonatal outcomes in pregnant women with left-sided valvular stenosis in a tertiary medical center in Taiwan.

Obstetric and neonatal outcomes in pregnant women with left-sided valvular stenosis in a tertiary medical center in Taiwan.

Transgenerational transmission of prenatal maternal stress across three generations of male progeny alters inflammatory stress markers in reproductive tissues.

Transgenerational transmission of prenatal maternal stress across three generations of male progeny alters inflammatory stress markers in reproductive tissues.

Seasonal Influenza in Pregnancy.

Influenza presents as respiratory illnesses that range in severity and can lead to adverse maternal health outcomes and pregnancy complications, particularly in pregnant individuals who are considered high-risk for severe disease. To highlight the significance of seasonal influenza in pregnant people and emphasize the importance of early testing, antiviral treatment, and vaccination. A literature review identified relevant research, review articles, textbook chapters, databases, and societal guidelines. Pregnant individuals face higher risks of severe respiratory illness from seasonal influenza due to physiological changes in pregnancy. Seasonal influenza infection in pregnancy is linked to adverse pregnancy outcomes, which correspond to illness severity. Recognizing the pregnant population as a high-risk group, national and global public health agencies, such as the Centers for Disease Control and Prevention and the World Health Organization, recommend influenza vaccination in pregnancy. Early testing with available commercial tests and prompt antiviral treatment are critical interventions to decreasing morbidity and mortality.