Infant Birth Research Articles

The effect of foot reflexology on the volume and composition of breast milk in mothers of premature infants hospitalized in the neonatal intensive care unit: a randomized controlled trial

BackgroundOne of the important problems for mothers after the birth of a premature infant is a decrease in milk production. This study aimed to investigate the effect of foot reflexology on the volume and composition of breast milk in mothers of premature infants hospitalized in the neonatal intensive care unit.MethodsThis randomized clinical trial was conducted on 76 primiparous mothers whose premature infants up to 34 weeks were hospitalized in the neonatal intensive care unit of Ayatollah Rouhani Hospital from February 2023 to November 2023. Mothers in the intervention group received foot reflexology for 20 min on both feet (ten minutes per foot) for seven consecutive days every morning. On the first and seventh days of the study, both groups were compared in terms of milk volume (ml), triglycerides, cholesterol, albumin, total protein, and calcium (mg/dl).ResultsThe mean difference in breast milk characteristics before and after the intervention in the control and intervention groups were as follows: in terms of breast milk volume 12.43 and 23.51 ml, triglyceride 418.37 and 406.21, cholesterol 5.48 and 3.67, albumin 1.02 and 0.35, total protein 1.89 and 4.59, calcium was -3.54 and -1.83 mg/dL; the net difference in breast milk volume in the intervention group compared to the control group increased, which was not statistically significant but was significant in terms of value. No significant difference was observed in other components of breast milk.ConclusionIn this single-center study, foot reflexology massage showed a trend towards increasing the volume of breast milk, total protein and calcium, although it was not statistically significant. Therefore, it needs further investigation.Trial registrationIRCT, IRCT20221220056872N1. Registered 22 January 2023- prospective registered, https://irct.behdasht.gov.ir/trial/67512.

Intimate Partner Violence and Pregnancy and Infant Health Outcomes - Pregnancy Risk Assessment Monitoring System, Nine U.S. Jurisdictions, 2016-2022.

Intimate partner violence (IPV) can include emotional, physical, or sexual violence. IPV during pregnancy is a preventable cause of injury and death with negative short- and long-term impacts for pregnant women, infants, and families. Using data from the 2016-2022 Pregnancy Risk Assessment Monitoring System in nine U.S. jurisdictions, CDC examined associations between IPV during pregnancy among women with a recent live birth and the following outcomes: prenatal care initiation, health conditions during pregnancy (gestational diabetes, pregnancy-related hypertension, and depression), substance use during pregnancy, and infant birth outcomes. Overall, 5.4% of women reported IPV during pregnancy. Emotional IPV was most prevalent (5.2%), followed by physical (1.5%) and sexual (1.0%) IPV. All types were associated with delayed or no prenatal care; depression during pregnancy; cigarette smoking, alcohol use, marijuana or illicit substance use during pregnancy; and having an infant with low birth weight. Physical, sexual, and any IPV were associated with having a preterm birth. Physical IPV was associated with pregnancy-related hypertension. Evidence-based prevention and intervention strategies that address multiple types of IPV are important for supporting healthy parents and families because they might reduce pregnancy complications, depression and substance use during pregnancy, and adverse infant outcomes.

Broad-Spectrum Micronutrients or Antidepressants for Antenatal Depression: Effect on Maternal and Infant Birth Outcomes in an Observational Secondary Analysis of NUTRIMUM.

One-fifth of women experience antenatal depression. Untreated antenatal depression is associated with increased risk of adverse birth outcomes. This study investigated the effect of broad-spectrum micronutrients (BSM; vitamins and minerals), used to treat antenatal depression (NUTRIMUM trial), on birth outcomes. Birth outcomes of 129 mother-infant pairs were obtained from hospital medical records or personal health records for home births. Pairs from NUTRIMUM exposed to ≥8 weeks of BSM antenatally (MN; n = 55) were compared to pairs exposed to antidepressants antenatally (MED; n = 20) and a reference group (REF; n = 54) of pairs not exposed to trial BSM or antidepressants. Groups were comparable on demographic variables. At study entry, MN and MED had depression scores in the moderate range, statistically higher than REF (nonclinical range). MN and REF did not differ significantly for gestational age, preterm births, infant size, or infant resuscitation. There were significantly lower rates of postpartum hemorrhage in MN relative to REF (7.7% vs 30%; RR = 0.26, 95% CI [0.08-0.84]). Gestational age at birth was higher for MN (39.5 weeks) than MED (38.5 weeks; d = 0.67, 95% CI [0.15-1.20], P = 0.03) as well as infant birth length (52.2 vs 50.0 cm; d = 0.77, 95% CI [0.21-1.33], P = 0.02), and rates of infant resuscitation were lower (14.5% vs 45%; RR = 0.33, 95% CI [0.15-0.73]). Days of BSM exposure was positively associated with birth weight (r = 0.32, P = 0.008) and length (r = 0.25, P = 0.04). Micronutrients used to alleviate antenatal depression may mitigate negative effects of depression on birth outcomes and showed more favorable birth outcomes compared with antidepressants.

Exploring Infant Size and Body Composition at 18 Months: An Ambidirectional Peri-Urban South African Cohort Study.

The first 1000 days of life lay the foundations for subsequent growth. This ambidirectional study, including prenatal, perinatal and postnatal factors, aimed to identify exposure variables affecting body size and composition and corresponding Z-score outcomes at age 18 months in infants born to women at low risk of adverse pregnancy outcomes in a peri-urban area of South Africa. Prenatal factors (maternal age, HIV status, anthropometry, parity, food insecurity and umbilical artery resistance index Z-score (UmA-RIAZ) as a measure of placental function, with higher UmA-RIAZ indicating poorer placental function); perinatal factors (infant sex, gestational age and birth anthropometry) and postnatal factors (infant feeding) were included as exposure variables, with infant anthropometry and body composition at 18 months as outcomes. Simple linear regression analysis was used to investigate associations between exposure variables and infant outcomes, and variables with p < 0.10 were included in the subsequent multiple regression analyses. Multiple regression analysis showed that higher UmA-RIAZ predicted lower birthweight [-0.11 kg (95% CI: -0.17, -0.04 kg)], birthweight-for-age Z-score [-0.24 (95% CI: -0.39, -0.09)] and 18-month infant length [-0.9 cm (95% CI: -1.4, -0.4 cm)] and length-for-age Z-score [-0.28 (95% CI: -0.45, -0.11)]. Maternal HIV infection predicted reduced 18-month infant length-for-age Z-score [-0.46 (95% CI: -0.83, -0.09)]. Household food insecurity predicted reduced fat-free mass-for-age Z-score at 18 months [-0.27 (95% CI: -0.51, -0.03)]. Infant anthropometry and body composition outcomes, therefore, are greatly affected by pre- and postnatal nutrition-related factors, such as placental insufficiency in utero and household food insecurity, with long-term consequences including stunting, which impact the individual, future generations and society.

Nonuse of Contraception at Conception Due to Partner Objection and Pregnancy-Related Health Care Utilization, Postpartum Health, and Infant Birth Outcomes.

Objective: Reproductive coercion has been associated with adverse reproductive health experiences. This study examined the relationship between nonuse of contraception due to partner objection, one aspect of reproductive coercion, and selected pregnancy-related outcomes. Methods: We used 2016-2020 data from the Pregnancy Risk Assessment Monitoring System in 22 jurisdictions to assess the prevalence of nonuse of contraception due to a partner objection by select characteristics among individuals with a recent live birth who reported an unintended pregnancy. We calculated adjusted prevalence ratios (aPRs) to understand associations with health care utilization, postpartum behaviors and experiences, postpartum contraceptive use, and infant birth outcomes. Results: Among people with a recent live birth in the study jurisdictions (n = 29,071), approximately 5% reported nonuse of contraception due to a partner objection and unintended pregnancy. This experience was associated with lower prevalence of attending a health care visit before pregnancy (aPR 0.8, 95% confidence interval [CI] 0.7-0.9), first trimester prenatal care, and attending a postpartum checkup (aPR 0.7, 95% CI 0.6-0.9 for both). Higher prevalence was observed for postpartum depressive symptoms (aPR 1.3, 95% CI 1.1-1.6) and partner objecting to using birth control postpartum (aPR 2.8, 95% CI 2.1-3.9). Conclusions: Nonuse of contraception due to a partner objection at conception was associated with poor mental health and lower health care utilization around the time of pregnancy. Prevention efforts may include strategies that ensure provider screening for intimate partner violence, and evidence-based approaches that teach about healthy relationships, enhance self-efficacy, and address underlying drivers of violence.

Adverse birth and obstetric outcomes in the offspring of male adolescent and young adult cancer survivors: A nationwide population-based study.

Background The growing population of male adolescent and young adult (AYA, 15-40 years old) cancer survivors has heightened interest in their reproductive health. However, studies have reported conflicting findings on the potential risks of cancer and its treatments on birth and obstetric outcomes. Methods We utilized encrypted identification numbers for both fathers and mothers to link three nationwide Taiwan datasets from 2004 to 2019, identifying 3,785 births with a paternal history of AYA cancer. For comparison, we included 37,850 matched fathers without a cancer history, matched by paternal age and infant birth year. We employed multivariable logistic regression analysis to identify independent associations between adverse birth outcomes (e.g., preterm labor, low birthweight, and congenital malformations) and obstetric outcomes (e.g., fetal growth restriction, threatened labor, and threatened abortion) and being born to male AYA cancer survivors. Results The offspring of male AYA cancer survivors did not exhibit a significantly increased risk of adverse birth (odds ratio [OR] = 1.0; 95% confidence interval [CI] = 0.9-1.1) or obstetric (OR = 1.1; 95% CI = 1.0-1.1) outcomes compared to offspring born to cancer-free matched fathers. Furthermore, the risk of preterm labor, low birthweight, congenital malformations, fetal growth restriction, and threatened labor or miscarriage was comparable between groups. Conclusions Paternal cancer history during adolescence or young adulthood does not appear to increase offspring's risk of adverse birth or obstetric outcomes. Impact This study reassures about this population's reproductive health, providing valuable insights for oncology and reproductive medicine, potentially influencing patient counseling and guidelines.

Optimal timing for induction of labor in normotensive women: A retrospective cohort study.

Labor induction is offered to reduce the risk of stillbirth at late term (41+0 to 41+6) but earlier induction in normotensive singleton pregnancies is supported by weak evidence. The aim of the present study was to investigate the optimal timing for induction in normotensive women. This was a retrospective cohort study including 70 293 singleton term births in Iceland during 1997-2018. Women with serious pre-gestational comorbidity, hypertension, stillbirth or previous cesarean birth were excluded. The risk of adverse maternal and neonatal outcomes for induction at each week from gestational age 37-41 weeks was compared with expectant management, defined as deliveries at a later gestational age. Risk ratios (RRs) and 95% confidence intervals (95% CI) were calculated using log-binomial regression adjusting for sociodemographics, parity, and pregnancy complications. The risk of cesarean was lower with induction at ≥40+0 than expectant management, especially at late term (RR 0.73, 95% CI: 0.63-0.83). Respiratory distress was diagnosed in 4.4% of infants after induction from 37+0 to 37+6 but 1.3% in the expectant management group (RR 3.08, 95% CI: 1.97-4.81). Induction between 37+0 and 38+6 compared with expectant management was associated with a reduced risk of shoulder dystocia, but this was non-significant in births of infants with normal birthweight. Labor induction from 40+0 compared with expectant management was associated with reduced risk of cesarean birth in Icelandic women without an increase in risk of adverse maternal or neonatal outcomes. No additional benefit appeared to be from inducing at earlier gestations in low-risk pregnancies.

Mercury in saliva, milk, and hair of nursing mothers in southeastern Iranian mothers: levels, distribution and risk assessment.

This research is on lactating mothers in the city of Chah Bahar in Iran. This descriptive-analytical and questionnaire study selected a random sample of 80 mothers to examine mercury levels in their hair, milk, and saliva. The average concentration of mercury in milk, hair and saliva of mothers was 1.23 ± 0.48µg/l, 1.81 ± 0.55µg/g and 1.10 ± 0.63µg/l, respectively. There was a significant correlation between mercury levels in mothers saliva and hair. Still, only a weak correlation was found between mercury levels in milk and hair, and milk and saliva, possibly associated with the high lipid content in milk. The number of children and length of the mother's pregnancy were related to the amount of mercury in the mother's milk. The number of teeth filled with amalgam, consumption of fish and marine products, consumption of fruit, and infant's weight at birth were also associated with the amount of mercury in breast milk. Chewing gum, fish consumption, infant's birth weight, weight, and length of pregnancy were among the factors associated with the amount of mercury in mothers' saliva. The mercury concentration in milk exceeded the WHO (1.4-1.7µg/g) normal level in 8.5%mothers, and hair mercury was found in 12.5% mothers. It should be kept in mind that any amount of mercury can be harmful.

Coagulation assay results at birth in preterm infants: A cohort study highlighting the relevance of local reference values for interpretation.

Routine coagulation screens at birth are still standard in some European neonatal intensive care units (NICUs), although interpretation of these results is complex in preterm infants. It is unclear to what extent local coagulation assay results agree with published reference ranges when using different analysers and reagents. We aimed to assess coagulation assay results on day 1 of life in very preterm infants admitted to the NICU. We included all preterm infants born below 32 weeks gestational age (GA) admitted to the Leiden University Medical Center between 2004 and 2020 in whom coagulation assays (prothrombin time [PT] and activated partial thromboplastin time [APTT]) were obtained during the first 24 h of life. Infants either diagnosed with major intraventricular haemorrhage or who received plasma transfusion before coagulation assay were excluded. We assessed coagulation assay results and compared the results between <28 weeks (extremely preterm) and 28-32 weeks (very preterm) GA groups. Coagulation assays were obtained at birth in 144 infants (144/2577; 5.5%) of whom 104 fulfilled the inclusion criteria. We found similar median PT and APTT values for extremely and very preterm infants (PT: 18.1 vs. 18.7 s [p-value = 0.400]; APTT: 44.2 vs. 47.7 s [p-value = 0.252], respectively). We found similar coagulation assay results at birth for extremely and very preterm infants; however, results deviated considerably from some of the published reference ranges. This may be due to differences between analysers and reagents, underlining the need for reference ranges calibrated to the equipment used per NICU.

Effects of health expenditure, death rate, and infant mortality rate on life expectancy: A case study of the United States

Understanding the factors that influence life expectancy (LEXP) is crucial for promoting economic development, as a nation's prosperity depends on the health of its population. Various socioeconomic, nutritional, lifestyle, genetic, and environmental factors can significantly impact a nation’s health and longevity. Our study investigates these drivers of LEXP, focusing on the United States as a case study. Using quarterly data from 2000 to 2022, we examined the relationship between LEXP and multiple determinants, including environmental degradation, income levels, inflation dynamics, educational attainment, birth and death rates, health expenditure patterns, urbanization trends, and infant mortality rates. Employing advanced analytical methodologies, we accounted for the nonlinear nature of the time series data by utilizing approaches such as quantile-on-quantile Kernel Regression Least Squares and quantile-on-quantile Granger causality. The study revealed that factors such as inflation rate, rapid urbanization, high birth rates, CO2 emissions, death rates, and infant mortality negatively affect LEXP. On the other hand, higher income levels, educational attainment, food production, and health expenditure positively influence LEXP. Based on these findings, we have proposed significant policy recommendations.

Post‐term births as a risk factor for small for gestational age births and infant mortality in Brazil, Mexico, and Palestinian refugees: An analysis of electronic birth records

AbstractBackgroundPost‐term pregnancy, defined as reaching or exceeding 42 + 0 weeks of gestation, is known to be associated with unfavourable birth outcomes. High‐income countries have responded to this risk by widely adopting labour induction protocols in late‐term, but many low‐ and middle‐income countries have not. However, understanding underlying mechanisms linking post‐term births to adverse newborn and infant outcomes remains limited.ObjectiveTo investigate the (a) prevalence of post‐term, (b) the risk factors associated with post‐term (c) the association between post‐term births and the risk of small‐for‐gestational‐age (SGA) neonates and of infant mortality in middle‐income settings.MethodsWe used existing electronic datasets from the general population of Brazil, Mexico, and Palestinian refugees. Regression models were used to explore the associations between post‐term birth and SGA and infant mortality.ResultsWe analysed 21,335,033 live births in Brazil (2011–2018), 23,416,126 in Mexico (2008–2019), and 966,102 in Palestinian refugees (2010–2020) (N = 45,717,261). Post‐term deliveries accounted for 3.1% of births in Brazil, 1.2% in Mexico, and 2.1% in Palestinian refugees. Post‐term births had approximately three times the risk of resulting in SGA neonates compared to term births. Additionally, post‐term neonates exhibited a 15% to 40% increased risk of infant mortality compared to term infants. Notably, post‐term SGA neonates faced a significantly increased risk of infant mortality compared to term appropriate for gestational age neonates.ConclusionsThese findings emphasise the critical significance of implementing induction strategies to prevent post‐term pregnancies and mitigate the associated risks of SGA neonates and subsequent infant mortality. Moreover, the study highlights the importance of accurately determining gestational age and using INTERGROWTH‐21st charts to improve the identification of SGA cases, enabling targeted interventions. This is especially relevant because post‐term SGA neonates may not exhibit low birthweight (a commonly used risk marker) and, therefore, may miss out on required specialised attention.

Evaluation of Maternal Factors Affecting Postpartum Insulin Resistance Markers in Mothers with Gestational Diabetes-A Case-Control Study.

Gestational diabetes mellitus (GDM) is defined by an insufficient insulin response to counteract the insulin resistance (IR) that arises from the physiological adaptations associated with pregnancy. However, the pathophysiology of IR is complex and unclear, as it encompasses elements such as epigenetics, environmental factors, modifiable lifestyle factors, and psychosocial factors. The objective of this study was to evaluate the influence of GDM and other maternal factors on IR markers in comparison to mothers with normal glucose tolerance during pregnancy in the first week postpartum. The study population comprised 70 participants, including mothers with gestational diabetes who were treated with a diet and physical activity (GDM G1), with insulin (GDM G2), and a control group of healthy mothers without gestational diabetes (non-GDM). A series of statistical techniques were employed to facilitate the comparison of data between the study groups, with the objective of identifying potential associations with maternal factors. A taxonomic analysis was conducted using the following factors: classification by study group, a history of hypothyroidism in the maternal medical interview, and maternal gestational weight gain, which were identified as the best-fitting predictors. The analysis resulted in the identification of four clusters of patients. Comparison of the insulin resistance markers between mothers assigned to the abovementioned clusters showed differences in the incidence of excessive weight loss and in the results of glucose screening tests during pregnancy. Also, differences concerning fasting glucose levels in the first and second/third trimesters of pregnancy and glucose levels at 1 h post-OGTT were found. For the clusters, the results of the HOMA-IR and the QUICKI did not show any differences in the first week after delivery (p > 0.05). HbA1c results varied significantly. Degree of glucose metabolism disorders, hypothyroidism, and weight gain in pregnancy influence maternal insulin resistance markers in the first week postpartum. Additionally, gestational weight fluctuation has a significant influence on the outcome of pregnancy, particularly with regard to fetal growth and, consequently, the infant's birth weight and adipose tissue accumulation.

Abstract 4130622: Neonatal Outcomes of Hypertensive Women Across US Races: 2016-2022

Background: Maternal hypertension, a major pregnancy complication, can adversely affect newborn health. We aim to evaluate the racial and ethnic disparities in neonatal outcomes among hypertensive pregnant women in the United States. Methods: Using data from the CDC WONDER Natality database, we conducted a retrospective cohort study focusing on live births to hypertensive mothers from 2016 to 2022. Neonatal outcomes, including NICU admissions, low birth weight, infant mortality, and assisted ventilation, were analyzed by calculating rates [95% CIs] per 1000 live births across maternal racial/ethnic groups and the US Census Bureau's regional classification: Northeast, Midwest, South, and West. Results: We analyzed 2,336,679 live births to hypertensive women (23% pre-pregnancy; 77% gestational). This cohort comprised: 0.2% infants born to Native Hawaiian/other Pacific Islander women (NH/PI), 0.9% to American Indian/Alaska Native women (AI/AN), 3.8% to Asian American women (AA), 19.6% to Hispanic/Latino women (H/L), 20.0% to Black/African American women (BA), and 55.4% to White American women (WA). Infant mortality rates were highest in BA (3.6 [3.5, 3.8]), followed by AA (2.1 [1.8, 2.4]), AI/AN (2.1 [1.6, 2.7]), H/L (1.9 [1.8, 2.0]), NH/PI (1.9 [1.0, 3.3]), and lowest in WA (1.5 [1.4, 1.6]). Similarly, NICU admission rates were highest in BA (217.2 [216.1, 218.4]) and lowest in WA (156 [155.4, 156.6]). Assisted ventilation rates were highest in NH/PI (131.8 [123.4, 140.7]) and lowest in AA (87.8 [86.0, 89.7]). Low birth weight rates were highest in BA (235.1 [233.9, 236.3]) and lowest in WA (121.8 [121.2, 122.4]). The Midwest had the highest rates for NICU admissions in NH/PI (254.2 [217.2, 295.2]), assisted ventilation in AI/AN (143.8 [133.2, 155.1]), and mortality in BA (4.1 [3.7, 4.5]). The South had the highest rate of low birth weight for BA (244.4 [242.9, 246.0]). Conclusion: Significant racial and regional disparities exist in neonatal outcomes among hypertensive women in the US. BA mothers consistently experienced the poorest outcomes, while WA mothers had the best. Further research is crucial to understand the reasons behind these disparities and develop targeted interventions for high-risk populations.

Association of gestational weight gain rate with infant birth weight and cesarean delivery: A prospective cohort study in Nepal.

Gestational weight gain (GWG) is linked to pregnancy outcomes, such as birth weight and delivery mode, though research in low-income countries like Nepal is limited. We examined the association of GWG rate with infant birth weight and cesarean delivery in a prospective cohort of 191 pregnant women in Nepal, using data collected from August 2018 to August 2019 at a peri-urban hospital in Dhulikhel. Participants included women with singleton, full-term live births, with GWG rate calculated from weight gain between the second and late pregnancy stages, divided by the weeks in between. GWG rate categories-adequate, inadequate, or excessive-were defined by pre-pregnancy Body Mass Index (BMI) specific to GWG recommendations from the 2009 Institute of Medicine report. Ethical approval was obtained from Institutional Review Board of Kathmandu University and Rutgers University. Statistical analyses in SPSS and Stata revealed that 52.4% of mothers exceeded the recommended GWG rate, particularly among overweight and obese women (0.4 ± 0.2 kg/week and 0.5 ± 0.2 kg/week, respectively). The average birth weight was 2964.9 ± 407.0 grams, with 12% of infants classified as low-birth-weight. Cesarean delivery was recorded in 45% of the women. After controlling for factors like age, education, ethnicity, occupation, parity and BMI, each 1 kg/week increase in GWG from the second to third trimester correlated with a 392-gram increase in birth weight (β = 391.9, 95%CI = 67.2-716.7, p = 0.01), while excessive GWG rate led to a 148-gram increase over adequate GWG rate (β = 148.1, 95%CI = 8.7-287.5, p = 0.03). However, GWG rate was not significantly linked to cesarean delivery. These findings suggest that maternal GWG rate positively affects infant birth weight but not cesarean delivery, underscoring the need for larger studies to explore GWG rate's effects on maternal and neonatal outcomes.

Investigation of Prognosis and Related Factors of Premature Neonates

The birth of premature infants remains a challenge in many societies. This cross-sectional study investigates prenatal care and influential factors in preterm infants hospitalized in the Neonatal Intensive Care Unit (NICU) of Fatemieh Educational-Medical Center in Hamadan, Iran, from March 2018 to March 2019. We examined premature infants with a gestational age of less than 37 weeks who were admitted to the NICU. Data on demographic and maternal characteristics, length of hospital stay, maternal underlying diseases, probable causes of preterm birth, neonatal complications, treatment types, treatment-related complications, resuscitation needs, ventilation, and mortality rates were extracted from patient records. Among 388 preterm infants studied, 204 (52.6%) were female. The mean gestational age was 31.8±2.8 weeks, birth weight was 1647.4±625.6 grams, and average hospital stay was 10.2±9.3 days. The most common maternal underlying disease was pregnancy-induced hypertension or preeclampsia (22.2%), respiratory distress syndrome, jaundice, and low birth weight were the leading reasons for hospitalization (84%). Neonatal outcomes included 92 (23.7%) deaths, 25 (6.4%) intraventricular hemorrhages, 39 (10.1%) patent ductus arteriosus cases, 20 (5.2%) bronchopulmonary dysplasia cases, and 41 (10.6%) retinopathy of prematurity cases. Regression analysis revealed significant predictors of neonatal mortality, including male gender, maternal underlying diseases, need for cardiopulmonary resuscitation, low Apgar score at one-minute, lower birth weight, shorter gestational age, and NICU stay duration. This study underscores the high neonatal mortality rate among preterm infants. Implementing preventive measures, particularly addressing maternal underlying diseases and low birth weight, can significantly reduce neonatal mortality.

Inflammasome-targeted therapy might prevent adverse perinatal outcomes of recurrent chronic intervillositis of unknown etiology

Chronic histiocytic intervillositis of unknown origin (CHI) is a rare placental disorder associated with adverse pregnancy outcomes, frequent recurrence, and a lack of effective preventive strategies. Recent insights indicate a potential link between CHI-associated inflammatory lesions and the inflammasome pathway, suggesting innovative therapeutic avenues. Here we show a potential role of the inflammasome pathway in CHI through comprehensive transcriptomic analysis of grade 2 or 3 histopathologic CHI samples, paired with placental controls. Additionally, we present case studies of three individuals with recurrent CHI, who have undergone treatment with anakinra and colchicine throughout pregnancy, resulting in improved perinatal outcomes. Notably, all cases are characterized by the birth of healthy, full-term infants, with reduced or absent intervillositis recurrence. Placental assessment unveils heightened activation of the NLRP3-PYCARD inflammasome pathway and IL-1β processing in CHI samples, with downregulation observed in treated pregnancy samples, devoid of intervillositis. Collectively, these findings suggest a potential therapeutic role for targeting the inflammasome pathway in preventing recurrent CHI in pregnant individuals.

Polycystic ovary syndrome and gestational diabetes mellitus association to pregnancy outcomes: A national register-based cohort study.

It is well known that both women with polycystic ovary syndrome (PCOS) and women with gestational diabetes mellitus (GDM) have increased risks of adverse pregnancy outcomes, but little is known whether the combination of these two conditions exacerbates the risks. We explored risk estimates for adverse pregnancy outcomes in women with either PCOS or GDM and the combination of both PCOS and GDM. Nationwide register-based historical cohort study in Sweden including women who gave birth to singleton infants during 1997-2015 (N = 281 806). The risks of adverse pregnancy outcomes were estimated for women exposed for PCOS-only (n = 40 272), GDM-only (n = 2236), both PCOS and GDM (n = 1036) using multivariable logistic regression analyses. Risks were expressed as odds ratios with 95% confidence intervals (CIs) and adjusted for maternal characteristics, including maternal BMI. Women with neither PCOS nor GDM served as control group. Maternal outcomes were gestational hypertension, preeclampsia, postpartum hemorrhage, and obstetric anal sphincter injury. Neonatal outcomes were preterm birth, stillbirth, shoulder dystocia, born small or large for gestational age, macrosomia, low Apgar score, infant birth trauma, cerebral impact of the infant, neonatal hypoglycemia, meconium aspiration syndrome and respiratory distress. Based on non-significant PCOS by GDM interaction analyses, we found no evidence that having PCOS adds any extra risk beyond that of having GDM for maternal and neonatal outcomes. For example, the adjusted odds ratio for preeclampsia in women with PCOS-only were 1.18 (95% CI 1.11-1.26), for GDM-only 1.77 (95% CI 1.45-2.15), and for women with PCOS and GDM 1.86 (95% CI 1.46-2.36). Corresponding adjusted odds ratio for preterm birth in women with PCOS-only were 1.34 (95% CI 1.28-1.41), GDM-only 1.64 (95% CI 1.39-1.93), and for women with PCOS and GDM 2.08 (95% CI 1.67-2.58). Women with PCOS had an increased risk of stillbirth compared with the control group (aOR 1.52, 95% CI 1.29-1.80), whereas no increased risk was noted in women with GDM (aOR 0.58, 95% CI 0.24-1.39). The combination of PCOS and GDM adds no extra risk beyond that of having GDM alone, for a number of maternal and neonatal outcomes. Nevertheless, PCOS is still an unrecognized risk factor in pregnancy, exemplified by the increased risk of stillbirth.

Usefulness of apparent diffusion coefficient values for assessment of MRI abnormality at term equivalent age in low-birth-weight infants weighing less than 1500g.

To determine whether apparent diffusion coefficient (ADC) measurements at term equivalent age (TEA) are useful for assessment of major abnormalities revealed by MRI. Of 405 neonates who underwent MRI during the period 2016-2022, 101 low birth weight (LBW) infants (birth weight < 1500g) were imaged at TEA. ADC values were measured in the thalamus, basal ganglia, anterior and posterior centrum semiovale, pons, and cerebellar hemisphere. The ADC values in LBW infants with and without major abnormalities evident on MRI were compared at the above six sites. Abnormal findings included IVH-3 IVH-4, more than six punctate white matter lesion, white matter injury (cystic or non-cystic), and major cerebellar hemorrhage. LBW infants overall (N = 101) and an extreme LBW (ELBW) group (< 1000g) (N = 55) were compared and area under the curve was calculated using ROC analysis. There were no difference in ADC values between LBW infants with and without major abnormalities. In ELBW infants, ADC values in the cerebellum were higher when major abnormalities were present (p = 0.045). ROC analysis yielded AUC < 0.7 for both LBW cases overall and ELBW cases. For LBW infants overall, ADC measurements alone at TEA are not very useful for differentiation between individuals with and without major abnormalities, but ELBW infants with major abnormalitiesshowed higher ADC values in the cerebellum, suggesting that the normal reduction of ADC occurring with maturation between preterm birth and TEA may be impaired.

Associations of fetal and infant growth patterns with behavior and cognitive outcomes in early adolescence

AbstractBackgroundFetal life and infancy might be critical periods for brain development leading to increased risks of neurocognitive disorders and psychopathology later in life. We examined the associations of fetal and infant weight growth patterns and birth characteristics with behavior and cognitive outcomes at the age of 13 years.MethodsPopulation‐based prospective cohort study from fetal life until adolescence. Pregnant women with a delivery date between April 2002 and January 2006 were eligible. Follow‐up measurements were available for 4716 children. Fetal weight was estimated in the second and third trimesters of pregnancy by ultrasonography. Infant weight was measured at birth and at 6, 12, and 24 months. Fetal and infant weight acceleration or deceleration were defined as a change in SD greater than 0.67 between time points. Total, internalizing and externalizing problems and attention‐deficit hyperactivity disorder (ADHD) symptoms were measured using Child Behavior Checklist (CBCL/6–18), autistic traits by the Social Responsiveness Scale (SRS) and intelligence quotient (IQ) by the Wechsler Intelligence Scale for Children‐Fifth Edition (WISC‐V).ResultsOne week longer gestational age at birth was associated with a −0.03 SDS (95% Confidence Interval (CI): −0.04, −0.01) lower total behavior problems score, a −0.02 SDS (95% CI: −0.04, −0.01) lower ADHD symptoms score. Also an increase in birth weight of 500 g was associated with a lower odds of having high externalizing problems (OR 0.92 (95% CI: 0.86, 0.98) and of having a low IQ score (OR 0.79 (95% CI: 0.71, 0.88). Compared to children with normal fetal and infant growth, those with accelerated fetal and infant growth had a 0.27 SDS higher IQ (95% Confidence Interval 0.11, 0.44).ConclusionsBoth fetal and infant weight development are associated with behavioral and cognitive outcomes in early adolescence. Follow‐up studies are needed to assess whether these associations link to later life mental health outcomes.

Associations of maternal sedentary behavior and physical activity levels in early to mid-pregnancy with infant outcomes: A cohort study.

Physical activity during pregnancy is beneficial for the woman and the fetus. However, non-objective methods are often used to measure physical activity levels during pregnancy. This study aimed to evaluate objectively measured maternal early to mid-pregnancy sedentary behavior and physical activity in relation to infant well-being. This cohort study included 1153 pregnant women and was performed at Uppsala University Hospital, Uppsala, Sweden, between 2016 and 2023. Sedentary behavior and physical activity levels were measured by accelerometers during 4-7 days in early to mid-pregnancy. Outcome measures were infant birthweight standard deviation score, small-for-gestational-age, large-for-gestational-age, preterm birth (<37 weeks' gestation), spontaneous preterm birth, iatrogenic preterm birth, Apgar <7 at 5 min of age, umbilical artery pH ≤7.05, and admission to the neonatal intensive care unit (NICU). There were no associations of sedentary behavior and physical activity levels with infant birthweight standard deviation score, small-for-gestational-age, or large-for-gestational-age. After adjustment for BMI, age, smoking, parity, maternal country of birth, and a composite of pre-pregnancy disease, the most sedentary women had higher odds of preterm birth (adjusted odds ratio (AOR) 2.47, 95% confidence interval (CI) 1.17-5.24, p = 0.018), and NICU admission (AOR 1.93, CI 1.11-3.37, p = 0.021) than the least sedentary women. The most physically active women had lower adjusted odds for NICU admission (AOR 0.45, CI 0.26-0.80, p = 0.006) than the least physically active women. Objectively measured levels of sedentary behavior and physical activity in early to mid-pregnancy were not associated with standardized infant birth size. Sedentary behavior was associated with an increased likelihood of preterm birth and NICU admission, while high level of physical activity was associated with a decreased likelihood of admission to NICU.