Worse Pregnancy Outcomes Research Articles

Low Reproductivity of Giant Pandas May Be Associated with Increased Vaginal Escherichia-Shigella

The poor reproductive capacity of giant pandas significantly hinders the development of captive populations, with 80.88% of adult individuals being unable to successfully become pregnant and deliver offspring. The disturbance of vaginal microbiota has been proven to potentially lead to miscarriage, abortion, and stillbirth in mammals. To elucidate the potential relationship between the vaginal microbiota and the reproductive capacity of giant pandas, we performed high-throughput sequencing of vaginal microbiota at the time of fertilization and conducted comparative analyses based on different pregnancy outcomes. We found that the microbial diversity in the delivery (D) group exceeded that in the non-delivery (ND) group and the vaginal microbial community structure was statistically different between the two groups. The vaginal microbiota in the delivery pandas consisted of unclassified Pseudomonadaceae which was gradually replaced by the Escherichia-Shigella type of vaginal microbiota in the ND group. A function predictions analysis showed that infectious disease, glycan biosynthesis, and metabolism were significantly enriched in the ND group. Additionally, an analysis of the microbial community phenotypic categories indicated that the ND group exhibited a significantly higher abundance of Gram-negative bacteria, facultative anaerobes, potential pathogens, and stress-tolerant species compared to the D group, predominantly driven by the elevated abundance of Escherichia-Shigella. Escherichia-Shigella can be used within LDA and ROC analyses to diagnostically distinguish the vaginal microflora associated with bad pregnancy outcomes during estrus. Our results will help to identify potential pathogens causing reproductive tract diseases, reduce the number of reproductive tract disease infections in pandas, and increase the birth rate of giant pandas in conservation breeding programs.

Pregnancy in Dystonia or Tourette's Patients with DBS. Fourteen News Cases and a Review of the Literature.

Deep Brain Stimulation (DBS) has been demonstrated to improve quality of life in patients with refractory dystonia and Tourette's syndrome (TS). Because of the young age at onset of these disorders, and the marked benefit from DBS, pregnancy in patients who have received DBS is becoming a more frequent clinical occurrence, although clear management guidelines are lacking. We report 14 new pregnancies in patients with dystonia or TS and DBS. Upon review of the literature, 23 pregnancies in patients with dystonia or TS were previously reported in seven articles. Based on the available data from a total of 37 pregnancies, DBS does not seem associated with worse pregnancy outcome. However, careful planning and communication between neurologist, anesthesiologist and obstetrician are key. A registry on pregnancy outcome in patients with DBS should be generated to facilitate the development of guidelines.

The impact of prior levonorgestrel intrauterine device use at the time of embryo transfer.

To investigate whether infertile women with a history of levonorgestrel intrauterine device (LNG IUD) use have impaired pre-transfer endometrial thickness and pregnancy rates after embryo transfer. Retrospective cohort study at a single academic medical center of infertile women ages 18-44 with a history of LNG IUD use undergoing their first embryo transfer cycle between January 2019 and January 2021 compared to controls with a history of no prior birth control use (NONE) or only prior oral contraceptive use (OCP). The primary outcome is endometrial thickness prior to embryo transfer. Secondary outcomes include embryo transfer results. We analyzed data from a total of 616 patients (197 NONE, 357 OCP, 62 LNG IUD). Women with a history of LNG IUD use had thinner endometrial stripes than women with a history of no prior birth control use (LNG IUD 8.93mm, NONE 10.32mm [aRR 0.88, 95% CI 0.80-0.97]), but not when compared to women with a history of OCP use (OCP 9.61mm [aRR 0.92, 95% CI 0.84-1.01]). Women with a history of LNG IUD use had slightly higher implantation rates than those with no birth control use history (LNG IUD 43.37%, NONE 24.17% [RR 1.79, 95% CI 1.21-2.45]), though not when compared to prior OCP users (OCP 38.72% [RR 1.12, 95% CI 0.86-1.47]). The remainder of the embryo transfer outcomes were similar between the three groups. Prior LNG IUD users have reduced endometrial thickness at the time of embryo transfer but do not have worse pregnancy outcomes.

The Impact of Pregnancy Readiness on Lupus Activity, Maternal Mental Health, and Pregnancy Outcomes.

Among individuals with systemic lupus erythematosus (SLE) who became pregnant, we explored the impact of medical readiness for pregnancy and personal readiness for pregnancy on the following aspects of maternal health: (1) provider-reported disease activity, (2) patient-perceived disease activity, (3) mood symptoms, (4) pregnancy-related health behaviors, and (5) pregnancy outcomes. All study participants were enrolled in a prospective registry, met Systemic Lupus Collaborating Clinics (SLICC) criteria for SLE, and had at least one pregnancy. Patient-reported outcomes were collected at the first rheumatology visit during pregnancy. "Medically ready" for pregnancy was defined as (1) <1 g of proteinuria, (2) no rheumatic teratogens at conception, and (3) continuing pregnancy-compatible SLE medications after conception. "Personally ready" was defined as planned pregnancy based on a London Measure of Unplanned Pregnancy score ≥10. Multivariable logistic regression models estimated the association of pregnancy readiness with each outcome of interest. Among the 111 individuals enrolled, lack of medical readiness for pregnancy was associated with significantly higher rates of active disease and worse pregnancy outcomes; however, these patients did not perceive themselves as having higher disease activity. Lack of personal readiness for pregnancy was associated with significantly higher patient-perceived disease activity. Although medical readiness did not impact depressive symptoms substantially, lack of personal readiness for pregnancy was associated with much higher maternal depressive symptoms. To improve pregnancy outcomes among individuals with SLE, greater focus is needed on improving medical optimization before conception. For maternal mental health and quality of life, greater focus is needed on decreasing the incidence of unplanned pregnancy.

Factors Associated with The Utilization of Immediate Postpartum Family Planning Among Women Attending Kibogora Health Center, Nyamasheke District, Rwanda

Although the main purpose of Postpartum Family Planning (PPFP) is to address problem of unmet need of the existing Family Planning (FP), decrease pregnancies and its bad outcomes, the PPFP uptake is still low in developing countries. Little is known about factors associated with acceptance of PPFP among delivered women at health center level. This study sought to assess factors (Socio-demographic, cultural, and healthcare system related) associated with the use of FP methods among postpartum mothers at Kibogora Health Center in order to fill the literature gap. The study used a cross-sectional design with quantitative approach to collect data from 196 postpartum mothers attending the Health Center. Data was collected using questionnaires, entered into Microsoft Excel, and exported in SPSS for analysis. Of 196 women recruited in our study, 180 (91.8%) are using PPFP contraceptives methods. Factors associated with the use of PPFP methods at health center level include: mothers’ communication with partners about PPFP, which is likely to increase by almost three times the chance of using PPFP (cOR 2.7, 95% CI, 0.26, 0.33; P=0.03) compared with those who never communicate with their partners, and mothers delivered by caesarean section are by seven times more likely to accept PPFP (cOR 7.05, 95% CI, 0.08, 0.10); P=0.008) compared with those who undergo vaginal delivery. Therefore, strengthen a comprehensive education program aiming at scaling up communication between mothers and their partners about PPFP, and the role of PPFP on decreasing spontaneous pregnancies and bad pregnancy outcomes regardless the mode of delivery are recommended.

Variability in COVID-19 symptom presentation during pregnancy and its impact on maternal and infant outcomes across the pandemic

BackgroundWith the dominance of different SARS-CoV-2 variants, the severity of COVID-19 has evolved. We aimed to investigate the difference in symptom prevalence and the association between symptoms and adverse pregnancy outcomes during the dominance of Wild-type/Alpha, Delta, and Omicron. MethodsCOVID-19 related symptom prevalence, maternal and specific neonatal outcomes of 5431 pregnant women registered in this prospective study were compared considering the dominant virus variant. Logistic regression models analyzed the association between specific symptoms and intensive care unit (ICU) admission or preterm birth. ResultsInfection with the Delta variant led to an increase in the symptom burden compared to the Wild-type/Alpha variant and the highest risk for respiratory tract symptoms, feeling of sickness, headache, and dizziness/drowsiness. An infection with the Omicron variant was associated with the lowest risk of dyspnea and changes in smell/taste but the highest risk for nasal obstruction, expectoration, headaches, myalgia, and fatigue compared to the Wild-type/Alpha and Delta variant dominant periods. With the progression of the Wild-type/Alpha to the Delta variant neonatal outcomes worsened. Dyspnea and fever were strong predictors for maternal ICU admission and preterm birth independent of vaccination status or trimester of infection onset. ConclusionThe symptom burden increased during the Delta period and was associated with worse pregnancy outcomes than in the Wild-type/Alpha area. During the Omicron dominance there still was a high prevalence of less severe symptoms. Dyspnea and fever can predict a severe maternal illness.

A Study of Frequency of Anemia in Pregnant Females in Tertiary Care Hospital, Islamabad

Background: Anemia is among the most public hematological disorders, especially in pregnancy. It is a nutritional deficiency disorder that affects pregnant women, mainly in underdeveloped countries. Pregnant women who suffer from anemia often have bad pregnancy outcomes and may lead to difficulties that endanger both the mother's and the fetus's health. This study aimed was to determine the frequency of anemia among pregnant women in tertiary care hospitals in Islamabad. Material and Methods: This cross-sectional investigation was carried out in the Dr. Akbar Niazi Teaching Hospital's pathology and gynecology department in Islamabad. All the pregnant women who visited for antenatal check-ups from January 2021 to December 2021 were involved in the study. Data was taken through a specially designed proforma and statistical analysis was accomplished using SPSS version 21. Results: A total number of 93 pregnant females were enrolled in the study. The average age of pregnant women was 30.6 ± 6.0 (20-43). The average hemoglobin in our study population was 11.1± 1.4 (8-13 g/dL). The mean range of WBC counts was 11,304/mm3 ±7722 (4100/mm3 - 81000/mm3), the mean value of RBC count was 4.1 mil/mm3 ± 0.6 (2-5 mil/mm3). The overall prevalence of anemia in pregnant females was 45% (n=42). Out of 42 pregnant anemic women, 25 (59%) had normocytic normochromic type of anemia, 15 (36%) had microcytic type of anemia, and 2 (5%) had macrocytic type of anemia. Mild anemia was recorded in 26 (30%) of the pregnant females, while moderate anemia was recorded in 16 (17%) of the pregnant females, and 51 (55%) of the pregnant females had no anemia. Conclusion: Anemia was found in the majority of pregnant females visiting tertiary care teaching hospitals. The frequency of mild anemia was high and also according to severity. The most common morphological type of anemia was normocytic normochromic. The overall prevalence of anemia in pregnancy was 45% (n=42).55% of pregnant women were non-anemic and new severe anemia was detected.

Insight into Maternal Health and Nutrition throughout Pregnancy

Nutrition is crucial throughout pregnancy to ensure optimal mother health. Pregnant women are advised to follow a diet that is abundant in vegetables, fruits, and whole grains. Additionally, it is recommended that they take a daily vitamin and mineral supplement to ensure sufficient consumption of iron and folic acid. Maternal weight gain is an essential physiological alteration that occurs during pregnancy. Curiously, the combined weight of the fetus, placenta, and amniotic fluid constitutes less than 50% of the overall weight gained. Pregnancy is a phase characterized by fast development and cellular specialization, occurring in both the mother and the developing child. Maternal micronutrient deficiency increases the likelihood of a woman experiencing negative health effects, such as infection, preeclampsia/eclampsia, and bad pregnancy outcomes like premature birth and intrauterine development retardation.

Myths Pertaining to COVID-19 Vaccination in Pregnant Women Attending a Rural Tertiary Care Hospital.

Background The outbreak of the COVID-19 pandemic led to the rise of various social issues apart from medical ones. Several myths regarding COVID-19 vaccination were found worldwide, and some of the common ones identified were abortions, birth defects, bad pregnancy outcomes such as abortions, ectopic pregnancy, risk of infertility, and irregular menstrual cycles. Although no scientific theories or data backed those myths, pregnancy was still omitted from trials for a long time as any drug/vaccine given during pregnancy may affect the fetus. Objective The objective of this study was to evaluate the vaccination status of pregnant women (PW) regarding COVID-19 and explore the factors influencing those who chose not to get the initial dose, second dose, or booster dose. Methodology A total of 747 PW were enrolled in the current study. Information related to sociodemographic data, clinical data, COVID-19 vaccine status, and rationale for choosing not to receive the COVID-19 vaccination was analyzed using a prestructured and validated Performa. Results The mean age and gestational age of the women enrolled for the study was 27.39 ± 3.75 years and 30.21 ± 7.30 weeks, respectively. The first dose of the COVID-19 vaccine was not receivedby 40 (5.4%) subjects, and the second dose was pending in 142 (19%) women, and none of them received booster dose. The prevalent cause for abstaining from receiving the COVID-19 vaccination was the fear of abortion in 179 (24%) subjects, followed by the fear of vaccine-related side effects in 142 (19%) subjects. There was a significant correlation between acceptance of COVID-19 vaccination and education and employment. Conclusion The present study indicated that most women have taken the COVID-19 vaccine before conception and that none received the first, second, or booster dose during pregnancy, even if it was due. Women need to be educated about the benefits of vaccination to enhance the compliance rate of COVID-19 vaccination and reduce COVID-19-related morbidity and mortality during pregnancy.

Do women living in a deprived neighborhood have higher maternity care costs and worse pregnancy outcomes? A retrospective population-based study.

Living in a deprived neighborhood is associated with poorer health, due to factors such as lower socio-economic status and an adverse lifestyle. There is little insight into whether living in deprived neighborhood is associated with adverse maternity care outcomes and maternity health care costs. We expect women in a deprived neighborhood to experience a more complicated pregnancy, with more secondary obstetric care (as opposed to primary midwifery care) and higher maternity care costs. This study aimed to answer the following research question: to what extent are moment of referral from primary to secondary care, mode of delivery, (extreme or very) preterm delivery and maternity care costs associated with neighborhood deprivation? This retrospective cohort study used a national Dutch database with healthcare claims processed by health insurers. All pregnancies that started in 2018 were included. The moment of referral from primary to secondary care, mode of delivery, (extreme or very) preterm delivery and maternity care costs were compared between women in deprived and non-deprived neighborhoods. We reported descriptive statistics, and results of ordinal logistic, multinomial and linear regressions to assess whether differences between the two groups exist. Women in deprived neighborhoods had higher odds of being referred from primary to secondary care during pregnancy (adjusted OR 1.49, 95%CI 1.41-1.57) and to start their pregnancy in secondary care (adjusted OR 1.55, 95%CI 1.44-1.66). Furthermore, women in deprived neighborhoods had lower odds of assisted delivery than women in non-deprived neighborhoods (adjusted OR 0.73, 95%CI 0.66-0.80), and they had higher odds of a cesarean section (adjusted OR 1.19, 95%CI 1.13-1.25). On average, women in a deprived neighborhood had higher maternity care costs worth 156 euros (95%CI 104-208). This study showed that living in a deprived neighborhood is associated with more intensive maternal care and higher maternal care costs in the Netherlands. These findings support the needs for greater attention to socio-economic factors in maternity care in the Netherlands.

Pregnancy Care Utilization, Experiences, and Outcomes Among Undocumented Immigrants in the United States: A Scoping Review

BackgroundUndocumented immigrants face many barriers in accessing pregnancy care, including language differences, implicit and explicit bias, limited or no insurance coverage, and fear about accessing services. With the national spotlight on maternal health inequities, the current literature on undocumented immigrants during pregnancy requires synthesis. ObjectiveWe aimed to describe the literature on pregnancy care utilization, experiences, and outcomes of undocumented individuals in the United States. MethodsWe performed a scoping review of original research studies in the United States that described the undocumented population specifically and examined pregnancy care utilization, experiences, and outcomes. Studies underwent title, abstract, and full-text review by two investigators. Data were extracted and synthesized using descriptive statistics and content analysis. ResultsA total of 5,940 articles were retrieved and 3,949 remained after de-duplication. After two investigators screened and reviewed the articles, 29 studies met inclusion criteria. The definition of undocumented individuals varied widely across studies. Of the 29 articles, 24 showed that undocumented status and anti-immigrant policies and rhetoric are associated with lower care utilization and worse pregnancy outcomes, while inclusive health care and immigration policies are associated with higher levels of prenatal and postnatal care utilization as well as better pregnancy outcomes. ConclusionsThe small, heterogeneous literature on undocumented immigrants and pregnancy care is fraught with inconsistent definitions, precluding comparisons across studies. Despite areas in need of further research, the signal among published studies is that undocumented individuals experience variable access to pregnancy care, heightened fear and stress regarding their status during pregnancy, and worse outcomes compared with other groups, including documented immigrants.

The impact of first-trimester subchorionic hematomas on pregnancy outcomes after euploid embryo transfer: a retrospective cohort study

BackgroundThe aim of the retrospective cohort study was to investigate the prognostic effect of subchorionic hematomas (SCH) in the first trimester on pregnancy outcomes after euploid embryo transfer.MethodsWe retrospectively analyzed women achieving singleton pregnancy by PGT-A or PGT-SR from January 2017 to January 2022. Patients were enrolled in the study if they had a viable intrauterine pregnancy at ultrasound between 6 0/7 and 8 0/7 weeks of gestation. Pregnancy outcomes as well as the incidence of maternal complications were compared between patients with and without SCH. Logistic regression was used for adjusting for potential confounding factors.ResultsA total of 1539 women were included, of which 298 with SCH and 1241 with non-SCH. The early miscarriage rate in SCH group was significantly higher than that in the non-SCH group (10.1% vs. 5.6%, adjusted odds ratio [aOR] 1.99, 95% confidence interval [CI] 1.25–3.16, P = 0.003). The live birth rate in SCH group was significantly lower than that in the non-SCH group. (85.6% vs. 91.2%, aOR 0.57, 95% CI 0.39–0.84, P = 0.005). In addition, SCH group had an increased risk of hypertensive disorder of pregnancy (HDP) (8.9% vs. 5.2%, P = 0.022), especially in hematoma with bleeding (19.3% vs. 6.0%, P = 0.002). The incidence of gestational diabetes mellitus (GDM), major congenital abnormalities rate, normal birth weight rate and low birth weight rate were similar between the two groups.ConclusionsThe presence of SCH in the first trimester was associated with worse pregnancy outcomes after euploid embryo transfer, including an increased risk of early miscarriage and hypertensive disorder of pregnancy, along with a reduced live birth rate.

Recurrent miscarriage and low-titer antiphospholipid antibodies

ObjectiveTo evaluate the clinical features and pregnancy outcomes in patients experiencing recurrent miscarriage (RM) with either low-titer or medium-high titer positivity of antiphospholipid antibodies (aPL).MethodsA retrospective review of medical records was conducted for patients with aPL positivity and recurrent miscarriage between 2018 and 2022. The clinical features, treatment strategies, outcomes were compared between the patients with low (n = 92) and medium (n = 32) titer of aPL.ResultsA total of 118 patients, resulting in 124 obstetric episodes (pregnancies), with a mean age of 33. 15 ± 4.56 and 31.47 ± 4.41 years between the two groups. The low-titer group exhibited a higher frequency of anti-cardiolipin antibodies IgM (P < 0.001), whereas the medium-high titer group demonstrated a higher frequency of anti-β2-glycoprotein 1 antibodies IgG (P < 0.001) and IgM (P = 0.032). Moreover, the medium-high titer group displayed a significantly elevated erythrocyte sedimentation rate compared to the low-titer group (P < 0.05). In the low-titer group, 71 patients (77.2%) received appropriate treatment, resulting in 48 live births (67.6%) and 23 repeat abortions (32.4%). In the medium-high titer group, 29 patients (90.6%) received relevant treatment, leading to 23 live births (79.3%) and 6 repeat abortions (20.7%). No significant differences were observed in live births or maternal-fetal complications between the two groups (all P > 0.05).ConclusionNoteworthy distinctions in laboratory parameters were identified between the low-titer and medium-high titer groups. However, when appropriately treated, the fetal-maternal outcomes were comparable in both groups. Timely intervention by clinicians is imperative to enhance pregnancy outcomes in patients experiencing recurrent miscarriage with low levels of aPL.Key Points• This study challenges the conventional belief that only the higher antiphospholipid antibodies (aPL) titers directly correlated with worse pregnancy outcomes, which emphasized the importance of patients with low titer positive aPL-positive RM.• The results underscore the need for timely intervention in women with low titer aPL-positive RM, as it leads to favorable maternal–fetal outcomes.

Fertility issues in hypopituitarism.

Women with hypopituitarism have lower fertility rates and worse pregnancy outcomes than women with normal pituitary function. These disparities exist despite the use of assisted reproductive technologies and hormone replacement. In women with hypogonadotropic hypogonadism, administration of exogenous gonadotropins can be used to successfully induce ovulation. Growth hormone replacement in the setting of growth hormone deficiency has been suggested to potentiate reproductive function, but its routine use in hypopituitary women remains unclear and warrants further study. In this review, we will discuss the clinical approach to fertility in a woman with hypopituitarism.

Adverse effects of type 2 diabetes mellitus on ovarian reserve and pregnancy outcomes during the assisted reproductive technology process.

To study the effect of type 2 diabetes mellitus(T2DM)on overall ovarian reserve and pregnancy outcomes during assisted reproductive technology (ART) among childbearing infertile women. Retrospective cohort study. The Reproductive Medicine Special Hospital, The First Hospital of Lanzhou University, between January 2019 and December 2022. A total of 265 infertile female patients aged 20-45 years who underwent in vitro fertilization-embryo transfer (IVF-ET), intracytoplasmic sperm injection-embryo transfer (ICSI-ET), or rescue intracytoplasmic sperm injection-embryo transfer (RICSI-ET) in the first fresh cycle. None. Serum Anti-Müllerian Hormone (AMH) levels, clinical pregnancy rate (CPR), live birth rate (LBR), and abortion rate (AR) in the T2DM group and non-T2DM group. Patients with T2DM showed statistically decreased levels of AMH compared to the non-T2DM group. During ovarian stimulation, those with T2DM required significantly higher total and initial doses of gonadotropin (GN), although they had fewer retrieved oocytes and worse pregnancy outcomes than the non-T2DM group. Multivariate logistic regression analysis adjusting for confounding factors showed that T2DM alone was an independent risk factor for CPR and LBR (adjusted odds ratio [a OR], 0.458, adjusted 95% confidence interval [CI], 0.235-0.891, P = 0.022; a OR, 0.227, 95% CI, 0.101-0.513, P<0.001; respectively), and the abortion rate in the T2DM group was 3.316 times higher than the non-T2DM group(a OR, 3.316, 95%CI, 1.248-8.811, P = 0.016). Infertile patients with T2DM have decreased ovarian reserve, and T2DM has a deleterious impact on clinical pregnancy outcomes during the ART process compared with non-T2DM infertile women. Infertile women with T2DM have decreased ovarian reserve and pregnancy outcomes during the assisted reproductive technology process compared with non-T2DM infertile women.

Effect of successful bariatric surgery on maternal cardiovascular outcomes

Abstract Background Obesity is a common comorbidity and is prevalent in at least 20% of pregnant women. Its prevalence is increasing at an alarming rate and is associated with worse pregnancy outcomes. With increasing obesity, more females are considering bariatric surgery (BS) as a form of weight-loss. Purpose The purpose of the study is to evaluate the effect of successful bariatric surgery (sBS) on maternal cardiovascular outcomes. Methods Pregnant females were sampled from the National Inpatient Sample Database (2016-2018). Demographics and comorbidities were collected using ICD-10 and DRG codes. Pregnant patients were stratified into three groups – morbidly obese, overweight/obese, and sBS. Individuals with a history of BS and not currently morbidly obese or overweight/obese were included in the sBS group. The primary outcome was a composite and was defined as major adverse cardiovascular events (MACE; Table 1). Secondary outcomes included pre-eclampsia (preE), gestational diabetes (GDM), and length of hospital stay (LOS). Patients with concurrent history of BS and overweight/obese/morbidly obese were excluded. To address confounding factors, sBS patients were matched 1:1 with morbidly obese and overweight/obese patients by 15 variables (Table 1). Binary logistic regression analyses were performed to assess for association between sBS and cardiac outcomes. Results Out of 207,511 patients included, 5,517 were sBS, 132,483 were overweight/obese, and 69,511 were morbidly obese. Compared to the sBS group (0.1%), MACE was higher in morbidly obese (0.7%) and overweight/obese patients (0.3%). Additionally, morbidly obese patients had higher acute heart failure, peripartum cardiomyopathy, acute pulmonary edema, preE, GDM, and longer LOS than sBS patients. Overweight/obese had more preE and GDM than the sBS cohort (Table 1). After 1:1 matching, MACE was more prevalent in morbidly obese patients (OR:6.69 [1.99-22.52]; p=0.002) and overweight/obese patients (OR:6.5 [1.5-28.9; p=0.01) when compared to sBS group. Both morbidly obese and overweight/obese groups were associated with increased preE (OR:3.0 and 2.1 respectively), GDM (OR:3.2 and 2.3 respectively), LOS (Coefficient:3.4 and 3.3 respectively; Figure 1). Conclusion Despite longstanding effects of obesity, sBS patients had better cardiovascular outcomes, even after matching for pre-existing cardiac conditions. A reduction in weight leads to decreased circulatory volume and improved cardiac output, resulting in lower risk of acute pulmonary edema, peripartum cardiomyopathy, and acute heart failure. The decrease in systemic inflammation and endothelial dysfunction likely led to a reduction in preE. Although pregnancy after bariatric surgery requires multidisciplinary management due to specific nutritional needs, the significant reduction in MACE highlights the importance of considering it as an option if conventional weight loss measures fail.Table 1Figure 1

The Effect of Latent Tuberculosis Infection on Ovarian Reserve and Pregnancy Outcomes among Infertile Women Undergoing Intrauterine Insemination: A Retrospective Cohort Study with Propensity Score Matching.

Latent tuberculosis infection (LTBI) widely exists in patients with unexplained infertility, and whether LTBI would affect the ovarian reserve and pregnancy outcome of infertile women undergoing intrauterine insemination (IUI) is still unknown. A single-center, retrospective, cohort study was designed that included infertile women undergoing IUI at the Department of Reproductive Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology in Wuhan, China, from January 2018 to December 2020. The primary outcomes of this study were ovarian reserve and live birth rate. Secondary outcomes included pregnancy outcomes and maternal and neonatal complications. As a result, 3066 IUI cycles were eventually enrolled in this study. Of these women, 9.6% (295/3066) had LTBI evidence. After propensity score matching (PSM), there was no significant difference in the baseline between the LTBI and non-LTBI groups. The data showed that women who had LTBI had trends toward lower biochemical pregnancy rates (12.9% vs. 17.7%, p-value 0.068), lower clinical pregnancy rates (10.8% vs. 15.1%, p-value 0.082) and lower live birth rates (8.1% vs. 12.1%, p-value 0.076), with no significant differences. There were also no significant differences in ovarian reserve and other secondary outcomes between the two groups. In conclusion, there were no significant differences in ovarian reserve, perinatal or neonatal complications between women with and without LTBI. Women with LTBI tended to have worse pregnancy outcomes after receiving IUI, but the difference was not significant.

Clinical Features of Severe Ovarian Hyperstimulation Syndrome with Hydrothorax.

Does the presence of hydrothorax suggest that severe ovarian hyperstimulation syndrome (OHSS) is associated with more severe conditions and worse pregnancy outcomes? The clinical data for 868 hospital patients with severe OHSS following IVF-ET at Peking University Third Hospital between 1 January 2016 and 21 July 2021 were retrospectively analysed. The patients were divided into two groups, the ascites alone group (n = 417) and the ascites combined with hydrothorax group (n = 451), to investigate the clinical features and pregnancy outcomes of patients with severe ovarian hyperstimulation syndrome (OHSS) combined with hydrothorax plus ascites. The clinical data for 868 hospital patients with severe OHSS following IVF-ET were included. A total of 51.96% of patients with severe OHSS had hydrothorax plus ascites, mainly bilateral and moderate hydrothorax. Most cases with hydrothorax could be monitored and observed, and only 2.66% of the cases required thoracentesis and pleural drainage. Clinically, the time to visit due to worsening symptoms was longer; the hospital stay was shorter; and the OHSS-related laboratory tests, such as white blood cells (WBC), haematocrit (HCT), and ovarian diameter, were less severe in the ascites combined with hydrothorax group than in the ascites alone group. For live-birth outcomes of IVF-ET, the presence and the volume of hydrothorax were not independent risk factors, while the late onset of OHSS (odds ratio [OR]: 0.857 95% confidence interval [CI]: 0.795, 0.925) and a history of foetal reduction (OR: 13.796 95% CI: 1.808, 105.288) were independent protective factors for live birth. Patients with severe OHSS combined with hydrothorax plus ascites have less severe clinical manifestations and laboratory tests than those with ascites alone. The presence and the volume of hydrothorax are unrelated to live-birth outcomes following in vitro fertilization and embryo transfer (IVF-ET).

Trends in the incidence and in-patient outcomes of acute myocardial infarction in pregnancy: Insights from the national inpatient sample

Study objectivePregnancy-related morbidity and mortality rates in the United States are rising despite advances in knowledge, technology, and healthcare delivery. Cardiovascular disease is the leading cause of adverse pregnancy outcomes, with acute myocardial infarction (AMI) being a potential contributor to the worse outcomes in pregnancy. Design/settingWe analyzed data from the national inpatient sample database to examine trends in the incidence and in-hospital outcomes of myocardial infarction in pregnancy from 2016 to 2020. ParticipantsUsing ICD-10-CM codes, we identified all admissions from a pregnancy-related encounter with a diagnosis of type 1 AMI. Main outcomeUsing the marginal effect of years, we assessed the trends in the incidence of AMI and utilized a multivariate logistic regression model to compare our secondary outcomes. ResultsOf the 19,524,846 patients with an obstetric-related admission, 3605 (0.02 %) had a diagnosis of type 1 AMI. Overall, we observed an approximately 2-fold increase in the trend of AMI from 1.4 to 2.5 per 10,000 obstetric admissions, with the highest incidence trend of 2.5 to 5.2 per 10,000 obstetric admissions seen in Black patients. Among patients diagnosed with AMI, we found significantly higher rates of in-hospital mortality (Adjusted Odds Ratio (AOR): 22.9, 12.2–42.8), cardiogenic shock (AOR:54.3, 33.9–86.6), preeclampsia (AOR: 2.2, 1.65–2.94) and spontaneous abortion (AOR:6.3, 3.71–10.6). ConclusionOver the 5-year period, we found increasing trends in the incidence of AMI in pregnancy, especially among Black patients. Incident AMI was also associated with worse pregnancy outcomes.

Rational use of drugs to alleviate adverse outcomes caused by COVID-19 quarantine in women with intrahepatic cholestasis of pregnancy.

This study aimed to investigate the impacts of home quarantine on pregnancy outcomes of women with intrahepatic cholestasis of pregnancy (ICP) during the COVID-19 outbreak and whether the rational use of drugs will change these impacts. This multi-center study was conducted to compare the pregnancy outcomes in women with ICP between the home quarantine group and the non-home quarantine group in southwest China. Propensity score matching was performed to confirm the pregnancy outcomes of the medication group and the non-medication group in women with ICP during the epidemic period. A total of 3,161 women with ICP were enrolled in this study, including 816 in the home quarantine group and 2,345 in the non-home quarantine group. Women with ICP in the home quarantine group had worse pregnancy outcomes, such as a growing risk of gestational diabetes mellitus A1, fetal growth restriction, pre-eclampsia, preterm delivery, and even stillbirth. Drug therapy could alleviate some adverse pregnancy outcomes caused by home quarantine, including pre-eclampsia, preterm delivery, and meconium-stained amniotic fluid. COVID-19 quarantine would increase the incidence of ICP and lead to adverse pregnancy outcomes in women with ICP. The rational use of drugs reduced some obstetrical complications and improved partial pregnancy outcomes. Our findings suggested that the government and hospitals should enhance their management and life guidance for women with ICP and speed up developing home quarantine guidelines.