Birth Outcomes Research Articles

Development and validation of a risk score to predict adverse birth outcomes using maternal characteristics in northwest Ethiopia: a retrospective follow-up study

BackgroundAdverse birth outcomes are unfavorable outcomes of pregnancy that are particularly common in low- and middle-income countries. At least one ultrasound is recommended to predict adverse birth outcomes in early pregnancy. However, in low-income countries, imaging equipment and trained manpower are scarce. According to our search of the literature, there is no validated risk prediction model for predicting adverse birth outcomes in Ethiopia. Hence, we developed and validated a model and risk score to predict adverse birth outcomes using maternal characteristics during pregnancy for use in resource-limited settings.MethodsA retrospective follow-up study was conducted from 1 January 2016 to 31 May 2021, and a total of 910 pregnant women were included in this study. Participants were selected using a simple random sampling technique. Stepwise, backward multivariable analysis was conducted. The model's accuracy was assessed using density plots, discrimination, and calibration. The developed model was assessed for internal validity using bootstrapping techniques and evaluated for clinical utility using decision curve analysis across various threshold probabilities.ResultsPremature rupture of Membrane, number of fetuses, residence, pregnancy-induced hypertension, antepartum hemorrhage, hemoglobin level, and labor onset remained in the final multivariable prediction model. The area under the curve of the model was 0.77 (95% confidence interval: 0.73–0.812). The developed risk prediction model had a good performance and was well-calibrated and valid. The decision curve analysis indicated the model provides a higher net benefit across the ranges of threshold probabilities.ConclusionIn general, this study showed the possibility of predicting adverse birth outcomes using maternal characteristics during pregnancy. The risk prediction model using a simplified risk score helps identify high-risk pregnant women for specific interventions. A feasible score would reduce neonatal morbidity and mortality and improve maternal and child health in low-resource settings.

Association of air purifier usage during pregnancy with adverse birth outcomes: the Japan Environment and Children’s Study

ObjectivePrevious studies have reported that ambient air pollutants such as PM2.5 can increase the risk of adverse birth outcomes. The objective of this study was to ascertain whether air purifier usage during pregnancy is associated with a lower risk of adverse birth outcomes in a large Japanese birth cohort.MethodsWe conducted a prospective cohort analysis using data from the Japan Environment and Children’s Study. Use of air purifiers during pregnancy was assessed using a self-administered questionnaire. Primary outcomes were the prevalence of preterm birth (PTB), small for gestational age (SGA), and low birth weight (LBW). Logistic regression analysis was performed to estimate odds ratios (ORs) and 95% confidence intervals (CIs).ResultsThe prevalence of outcomes was 4.5% for PTB, 7.4% for SGA, and 8.1% for LBW. The crude model analysis revealed that PTB, SGA, and LBW showed lower ORs in the group that used an air purifier, although the association disappeared in the adjusted model except for SGA (OR: 0.94; 95% CI: 0.89, 1.00, p = 0.048) and LBW (OR: 0.93; 95% CI: 0.88, 0.98, p = 0.003). Subgroup analysis stratified by infant sex revealed that the lower OR for LBW was observed only in male infants.ConclusionsOur results suggest that avoiding maternal air pollution exposure during pregnancy may be useful in preventing adverse birth outcomes. These findings provide evidence supporting the development of protective measures against air pollutants in the gestational period by relevant health agencies.

Effects of Microplastic Exposure on Human Digestive, Reproductive, and Respiratory Health: A Rapid Systematic Review.

Microplastics are ubiquitous environmental contaminants for which there are documented human exposures, but there is a paucity of research evaluating their impacts on human health. We conducted a rapid systematic review using the "Navigation Guide" systematic review method. We searched four databases in July 2022 and April 2024 with no restriction on the date. We included studies using predefined eligibility criteria that quantitatively examined the association of microplastic exposure with any health outcomes. We amended the eligibility criteria after screening studies and prioritized digestive, reproductive, and respiratory outcomes for further evaluation. We included three human observational studies examining reproductive (n = 2) and respiratory (n = 1) outcomes and 28 animal studies examining reproductive (n = 11), respiratory (n = 7), and digestive (n = 10) outcomes. For reproductive outcomes (sperm quality) and digestive outcomes (immunosuppresion) we rated overall body evidence as "high" quality and concluded microplastic exposure is "suspected" to adversely impact them. For reproductive outcomes (female follicles and reproductive hormones), digestive outcomes (gross or microanatomic colon/small intestine effects, alters cell proliferation and cell death, and chronic inflammation), and respiratory outcomes (pulmonary function, lung injury, chronic inflammation, and oxidative stress) we rated the overall body of evidence as "moderate" quality and concluded microplastic exposure is "suspected" to adversely impact them. We concluded that exposure to microplastics is "unclassifiable" for birth outcomes and gestational age in humans on the basis of the "low" and "very low" quality of the evidence. We concluded that microplastics are "suspected" to harm human reproductive, digestive, and respiratory health, with a suggested link to colon and lung cancer. Future research on microplastics should investigate additional health outcomes impacted by microplastic exposure and identify strategies to reduce exposure.

Double-J Ureteral Stenting in Obstetrics and Gynecology: Pivotal or Problematic?

Background and Objectives: Double-J stents are urinary catheters that are frequently used in urology. They are now also used in other specialist areas such as obstetrics and gynecology. However, the use of double-J stents is not without side effects. The aim of this review was to highlight the indications and possible adverse effects of the use of these stents in obstetrics and gynecology. Materials and Methods: We analyzed works published after 1995 in the PUBMED, SCOPUS, and Web of Science databases related to the use of double-J stents in obstetrics and gynecology, as well as reported adverse events. We carried out a narrative review of the available literature on this topic. Results: We identified 69 relevant publications that we included in the review. In obstetrics, indications include the treatment of gestational hydronephrosis, some urological conditions during pregnancy, such as obstructive urinary calculi, with or without superinfection, or intraoperative use for cesarean section or hysterectomy after cesarean section, to protect from, or to solve, ureteral lesions. In gynecology, they are used preoperatively or intraoperatively to protect the ureter during gynecological operations in the pelvic area or postoperatively to repair some ureteral injuries. They are also indicated for ureteral obstructions that occur after pelvic radiotherapy for gynecological neoplasms. Complications associated with the use of double-J stents include more frequent urinary tract infections, lower urinary tract symptoms, calcifications and misplacements. Conclusions: Double-J stents are widely used in obstetrics and gynecology and are characterized by good efficiency and safety, although some side effects may occur (lower urinary tract symptoms, hematuria, complications in birth outcomes), which do not limit their use. Summary of evidence: In this review, we analyzed the indications and complications of double-J ureteral stenting in obstetric and gynecologic patients. We found that the procedure is safe, both in the treatment of ureteral obstruction and in the resolution of postoperative complications. No serious complications of ureteral stenting have been noted that would constitute a contraindication to its use. Future prospective studies in large patient cohorts are necessary to validate our data.

Identifying child growth effects of elevated pollution levels during pregnancy

Abstract Poor air quality is known to be one of the leading contributors to poor child health globally, and a wealth of evidence has linked pollution exposure during pregnancy to adverse birth and early-life outcomes. While there is some evidence pollution exposure during pregnancy is associated with slowed child growth, this evidence is largely limited to empirical settings in which it is difficult to disentangle the role of pollution from other co-varying factors. Here we rely on quasi-random variation in pollution conditions induced by thermal inversions to estimate the impact of pollution spikes during pregnancy on childhood stunting. We find that thermal inversions during pregnancy worsen air quality and increase the likelihood of childhood stunting, but only in places with poor baseline air quality and particularly for younger children and in lower-wealth communities. Our estimates imply that a 1 ugm-3 increase in average PM2.5 concentration during pregnancy increases the probability of stunting by an average of 4.1 percentage points (95% CI: 0.2-8.0). This translates to an 11.2% increase (95% CI: 0.6-21.9%) in stunting risk from the sample baseline of 37% children stunted. Our results suggest that policies that limit baseline daily PM2.5 levels, particularly during seasons when thermal inversions are more frequent, have potential to generate meaningful improvements in long-run child outcomes.

Placental expression and methylation of angiogenic factors in assisted reproductive technology pregnancies from India.

This study aims to examine the gene expression and DNA methylation patterns of angiogenic factors in the placentae of Indian women who underwent assisted reproductive technology (ART) procedures and their association with maternal one-carbon metabolites and birth outcome. Placental gene expression and DNA methylation of angiogenic factors (VEGF, PlGF, FLT-1, KDR) in Indian women who underwent ART procedures (n = 64) and women who conceived naturally (Non-ART) (n = 93) was investigated using RT-qPCR and Epitect Methyl-II PCR assay kits. Maternal plasma one-carbon metabolites were assessed by CMIA technology. Gene expression of FLT-1 and KDR was higher (p < 0.05) in the ART placentae. Placental global DNA methylation levels were higher (p < 0.01) and DNA methylation levels of VEGF promoter were lower (p < 0.05) in ART compared to non-ART women. Maternal plasma folate and vitamin B12 levels were higher (p < 0.01) in the ART group. Gene expression of PlGF was negatively associated with maternal plasma folate (p < 0.05) whereas KDR was positively associated with maternal plasma homocysteine (p < 0.05). Gene expression of KDR was positively associated with chest circumference of the baby (p < 0.05). Hypomethylation of VEGF and increased expression of FLT-1 and KDR was observed in the placentae of women who underwent ART procedure.

Characteristics of the pregnancy and labour course in women who underwent COVID-19 during pregnancy.

This study aims to analyze the impact of COVID-19 on pregnancy and labor, focusing on its effects on maternal and child health. The research explores the relationships between coronavirus infection and clinical and laboratory parameters, as well as the risks of pregnancy complications and adverse birth outcomes. The study involved 60 pregnant women diagnosed with COVID-19. A comprehensive evaluation of clinical and laboratory indicators was conducted, employing correlation, regression, logistic analyses to determine risk factors. There was a strong inverse correlation between carbon dioxide levels and haematocrit (-0.76), and a direct correlation between blood pH and partial pressure of oxygen (0.73). COVID-19 was associated with increased risks of preterm labor (OR=1.82), stillbirth (OR=2.11), pre-eclampsia (OR=1.46), and foetal distress. Multivariate analysis revealed a 200 g reduction in neonatal birth weight and higher risks of hospitalisation (OR=1.8), postpartum hemorrhage (OR=2.3), and preterm delivery (OR=2.5). Comorbid conditions such as cardiovascular abnormalities, diabetes, obesity, thrombophilias exacerbated the risks of complications, including pre-eclampsia, neonatal respiratory distress syndrome, venous thromboembolism. COVID-19 infection increases the likelihood of pregnancy complications and adverse outcomes, especially in women with comorbidities. These findings highlight the need for preventive strategies and risk management protocols for pregnant women during future outbreaks, emphasizing the importance of further research in this field.

Effects of pretreatment strategies on fertility outcomes in patients with adenomyosis

Adenomyosis is a commonly encountered pathology in women of reproductive age and frequently coexists with infertility. The effect of adenomyosis on fertility, particularly on in vitro fertilisation and intracytoplasmic sperm injection outcomes, is not well understood. Various pretreatment modalities have been used to improve pregnancy rates and live birth outcomes; however, because of a lack of high-quality evidence, there is no clear consensus on the best pretreatment option. This review was conducted through a PubMed search aiming to highlight the relationship between pretreatment and fertility in women with adenomyosis. Medical, ablative surgical, and non-surgical therapies were reviewed. According to the current literature, gonadotropin-releasing hormone agonist therapy and placement of a levonorgestrel intrauterine system are two suitable medical pretreatment strategies that can improve the clinical pregnancy rates of patients with adenomyosis. Surgical ablation of adenomyosis can also be beneficial, although surgical management can be challenging. Non-surgical thermal techniques, including high-intensity focused ultrasound ablation, percutaneous microwave ablation, and radiofrequency ablation, are much less invasive techniques that have shown effectiveness in improving fertility. Although evidence remains limited, all these procedures have demonstrated a favourable safety profile. Further studies are needed to better develop these techniques and demonstrate their effectiveness.

Voting Restrictions and Increased Odds of Adverse Birth Outcomes in the US.

Disparities persist in adverse birth outcomes - preterm birth and small-for-gestational age (SGA) among racialized populations. Previous studies have indicated that voting restrictions are associated with health outcomes, such as access to health insurance and teenage birth rates. This paper examines whether the association between voting restrictions and adverse birth outcomes varies according to birthing individuals' race/ethnicity. These analyses merged individual-level 2019-2020 Pregnancy Risk Assessment Monitoring System (PRAMS, 8th edition) data with state-level exposure information. The exposure, the Cost of Voting Index (COVI), is a 2020 state-level measure of voting restrictions, and the outcomes were preterm birth and SGA. Multilevel logistic regression, survey-weighted models adjusted for sociodemographic and geographically-based characteristics. Subanalyses examined if the association differed by race (non-Hispanic White, non-Hispanic Black, Hispanic, API, Other). In the unadjusted model, a standard deviation increase in COVI was associated with increased odds of preterm birth (OR = 1.11, 95% CI = 0.98, 1.25) and SGA (OR = 1.12, 95% CI = 1.02, 1.22). The association for SGA was still significant in the fully adjusted models. Results differed by race/ethnicity with the largest effects among API (OR = 1.20, 95% CI = 0.95, 1.52) for preterm birth and OR = 1.27, 95% CI = 1.01, 1.59) for SGA respectively). Our results suggest structural voting barriers disproportionately increase the odds of adverse birth outcomes, especially for API-birthing individuals. Increasing voting restrictions may amplify existing birth inequities.

The Causal Effect of Increasing Area-Level Income on Birth Outcomes and Pregnancy-Related Health: Estimates From the Marcellus Shale Boom Economy.

Income is positively correlated with pregnancy health and birth outcomes, but the causal evidence for this association is limited. Leveraging a natural experiment based on the Pennsylvania boom economy created by the extraction of natural gas from the Marcellus Shale geological formation, we test whether area-level income gains impact birth outcomes (birth weight, gestational length, and preterm birth) and pregnancy health (prepregnancy and prenatal smoking, prepregnancy weight status, gestational weight gain, and the timing and adequacy of prenatal care). We append tax data to birth certificate data and compare health outcomes before and after the boom for births occurring in school districts above the Marcellus Shale. We also explore income effects with a subsample of siblings and test for nonlinear income effects by considering preboom district poverty rates. Using instrumented difference-in-differences models, we find that plausibly exogenous income gains increase the likelihood of having adequate prenatal care in the full sample. In the sibling sample, income gains decrease the likelihood of low birth weight but increase the likelihood of prepregnancy underweight among birthing parents. Results are statistically significant in initially high-poverty districts. We thus affirm prior findings of a causal effect of income on birth weight and prenatal care use but find minimal area-level income effects on other pregnancy-related health behaviors and birth outcomes.

Reduce Prenatal Maternal Stress to Improve Pregnancy and Birth Outcomes: Recommendations for U.S. Policy

Reduce Prenatal Maternal Stress to Improve Pregnancy and Birth Outcomes: Recommendations for U.S. Policy

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.

Intrapartum maternal risks of group B streptococcus carriage in premature rupture of membranes

BACKGROUND: Group B streptococcal infection remains the epicenter of attention for maternal and child health services around the world. Premature rupture of membranes requires adaptation of obstetric tactics and intrapartum antibiotic prophylaxis. AIM: The aim of this study was to identify maternal intrapartum risks of group B streptococcus colonization of the birth canal and the lack of antepartum screening for group B streptococcus in cases of premature rupture of membranes in full-term pregnancy. MATERIALS AND METHODS: This retrospective cohort study was conducted in the Perinatal Center of City Clinical Hospital No. 31 named after Academician G.M. Savelyeva (Moscow, Russia) in 2023–2024. We selected women with premature rupture of membranes at full-term pregnancy, whose birth canals were subsequently divided into those colonized by group B streptococcus and those not colonized and who underwent antenatal group B streptococcus screening at 35–37 weeks of pregnancy or not. In the absence of group B streptococcus screening upon admission to the hospital, vaginal discharge was collected and sent off for bacteriological testing. Two tactics for labor management were selected: expectant, and active. Intrapartum antibiotic prophylaxis was performed in case of group B streptococcus isolation during screening. RESULTS: With premature rupture of membranes in full-term pregnancy, only 57.14% of group B streptococcus carriers have prenatal group B streptococcus screening; therefore, in 42.86% of group B streptococcus carriers, intrapartum antibiotic prophylaxis was delayed by 18 hours. Group B streptococcus carriage is not associated with the gestational age of premature rupture of membranes, but has intrapartum features such as a trend of younger age (less than 30 years) and attendance at the hospital earlier than six hours after premature rupture of membranes with the opportunity for induction or effective pre-induction of labor with a single dose of an antigestagen (in more than 70% of women). These women had a blood leukocyte count of ≥12.5 × 109/l and higher C-reactive protein levels. They were most often delivered by cesarean section, with characteristic indications for chorioamnionitis and fetal distress. The absence of prenatal group B streptococcus screening distinguishes the age of women under 30 years old, the threshold C-reactive protein level being 19.5 g/l, with a tendency towards a less frequent spontaneous onset of labor and a higher frequency of its induction, hypotonic hemorrhage, and chorioamnionitis. CONCLUSIONS: There are intrapartum maternal risks of group B streptococcus carriage and the presence of group B streptococcus screening, which are conditionally controlled in the Moscow. Intrapartum antibiotic prophylaxis and the metropolis resource “equalize” the outcome of births in cases of group B streptococcus carriage and absence, with the presence and absence of group B streptococcus screening. Modern medicine allows for minimizing the risks of chorioamnionitis and hypotonic hemorrhage in group B streptococcus carriers after premature rupture of membranes, even in the absence of group B streptococcus screening in more than half of women or deferment of intrapartum antibiotic prophylaxis for 18 hours.

A new perspective on the causal pathway between maternal mental health and neonatal adversity.

Substantial evidence suggests a downstream impact of maternal mental health on birth outcomes. The roles of comorbid maternal physical health and familial confounding underlying this association remain unclear. This cohort study included a random sample of children born 1997-2008 within a health maintenance organization (HMO) in Israel, their parents, and siblings. Outcomes were ICD-9 diagnoses of neonatal adversities (birth complications and congenital anomalies) and exposures were maternal diagnoses of mental health disorders. Odds ratios (ORs) and their 95% confidence intervals for the associations between maternal mental health diagnoses and measures of neonatal adversity were calculated using logistic regression, adjusting for maternal age, child's year of birth, socioeconomic status, and maternal physical morbidity burden. We examined potential familial confounding using a negative control approach based on paternal exposure. In our sample of 74,533 children, 6,674 (9.1%) were born after birth complications and 14,569 (19.9%) with a congenital anomaly. Maternal mental health diagnosis around pregnancy was significantly associated with these measures of neonatal adversity after adjustment for potential confounders (birth complications: OR = 1.3 (1.2-1.4), p < 0.001; congenital anomalies: OR = 1.2 (1.1-1.3), p < 0.001). These associations became attenuated and non-significant after further adjustment for maternal physical morbidity burden. In a joint model, maternal and paternal diagnosis of a mental health disorder were independently associated with neonatal adversity (birth complications: ORmat=1.3 (1.1-1.4), p < 0.001; ORpat=1.2 (1.1-1.3), p = 0.004; congenital anomalies: ORmat=1.2 (1.1-1.3), p < 0.001; ORpat=1.1 (1.0-1.2), p = 0.01). Physical health and familial factors play a role in the associations between maternal mental health and neonatal adversity.

Association of Dietary Patterns and Pre-pregnancy Body Mass Indices With Gestational and Birth Outcomes in Pregnant Emirati Women: A Cross-Sectional Study

Association of Dietary Patterns and Pre-pregnancy Body Mass Indices With Gestational and Birth Outcomes in Pregnant Emirati Women: A Cross-Sectional Study

Prenatal Maternal Psychological Stress (PMPS) and Its Effect on the Maternal and Neonatal Outcome: A Retrospective Cohort Study.

Prenatal psychology studies show that stress, depression, and psychological stress during pregnancy can have a significant impact on maternal and fetal health and are highly prevalent. The aim of the study was to compare maternal and neonatal short-term outcomes in pregnant women* (the asterisk (*) is used at the appropriate places in this text to indicate that all genders are included) with a history of prenatal maternal psychological stress (PMPS) with those of pregnant women* not exposed to PMPS to determine differences and identify risk factors. Statistical tests for differences and relative risks between the groups were carried out with the perinatal data of University Hospital Tübingen from 2022 using IBM SPSS. The study shows that PMPS has significant negative effects on various parameters, including the rate of premature births, preeclampsia, induction of birth, birth duration, and fetal asphyxia, as well as the birth weight of the children and their Apgar values (an assessment of newborn health scored shortly after birth). In addition, the risk of PMPS increases in women* with stillbirths and two or more previous miscarriages. However, the practical relevance must be critically scrutinized and confirmed by bigger studies. PMPS has a significant impact on the maternal and neonatal birth outcomes and must be identified as a risk factor in pregnancy. There is still a need for further research with larger samples, more balanced groups, and multivariate regression models to generate detailed, more transferable results and a deeper insight into the significant effects of PMPS and the role midwives can play in helping it.

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.

Maternal exposure to fine particulate matter before and during pregnancy, and the risk of birth defects: A population-based study

Although epidemiological evidence has linked maternal exposure to air pollution with adverse birth outcomes, the association between exposure to fine particulate matter (PM2.5) and the risk of total birth defects in highly polluted developing regions remains limited. The objective of this study was to assess the relationship between maternal exposure to PM2.5 before and during pregnancy and the occurrence of birth defects. This study included 16,080 births with birth defects and 567,483 controls born between 2014 and 2019 in 14 cities in Liaoning Province, China. The assessment of exposure was conducted using satellite-based PM2.5 data at a spatial resolution of 1 km. Participants were classified into four subgroups based on their exposure to PM2.5 before and during pregnancy. The association between maternal exposure to PM2.5, and the risk of birth defects, was estimated using logistic regression models. For each 10 μg/m³ increase in PM2.5, the odds ratios of birth defects were 1.68 (95% CI: 1.65, 1.70) and 2.41 (95% CI: 2.36, 2.45) during the preconception period and pregnancy, respectively. We observed a J-shaped association between maternal PM2.5 exposure during both the preconception period and pregnancy and the risk of total birth defects. Mothers exposed to elevated levels of PM2.5 during both the preconception period and pregnancy exhibited the highest risk of total birth defects (odds ratio: 4.43, 95% CI: 4.17, 4.71). Our findings illustrated that maternal exposure to PM2.5 before and during pregnancy was associated with increased risks of birth defects and underscored the potential health benefits of reducing air pollution exposure during the preconception period and pregnancy.

Association between adverse birth outcomes and long-term risk of premature cardiovascular disease and mortality in a contemporary population-based cohort of 502,383 pregnant women.

Relatively few studies have examined the association between the entire spectrum of adverse birth outcomes [stillbirth, preterm birth (PTB), term births that are low birth weight (LBW) or high birth weight (HBW)] and long-term risk of CVD in the mother. Our objective was to examine the association between birth outcomes and risk of premature CVD or death in a contemporary cohort of pregnant women. We conducted a retrospective population-based cohort study of women in Alberta, Canada, between 01/01/2005 and 01/01/2023. The primary endpoint was a composite of CVD-related hospitalization, CVD-related emergency department visit, or death. Cox proportional hazard modelling was used to examine the independent association between birth outcomes and the risk of CVD or death in the mother, after accounting for other socio-demographic, clinical and pregnancy-related complications. Among 502,383 mothers, 0.51% had stillbirth, 7.11% had PTB, 86.11% had normal birth weight (NBW), 2.11% had LBW, and 4.15% had HBW. During a median follow-up of 3612 days (∼10 years), compared the NBW group, the adjusted hazard ratio (aHR) and 95% confidence interval (CI) for maternal CVD or death associated with stillbirth was 1.63 (1.33, 1.99); 1.45 (1.36, 1.55) for PTB; 1.22 (1.06, 1.41) for LBW, and 1.13 (1.03, 1.23) for HBW. In addition to birth outcomes, pre-existing diabetes (aHR: 1.61, 95% CI: 1.47, 1.76), gestational hypertension (aHR: 1.47, 95% CI: 1.38, 1.57), and pre-existing hypertension (aHR: 3.28, 95% CI: 2.66, 4.04) carried a higher risk for premature CVD and death in the mother. Adverse birth outcomes of stillbirth and preterm birth, and to a lesser degree term births that result in LBW or HBW, are markers of increased risk of premature CVD and death in the mother. Coordinated effort between obstetricians, family physicians, and cardiologists are needed to design and implement effective risk reduction programs tailored for these high-risk women.

Impact of corpus luteum number on maternal pregnancy and birth outcomes: the Rotterdam Periconception Cohort.

To investigate associations between assisted reproductive technology (ART) -induced alterations in corpus luteum (CL) number during implantation, and maternal pregnancy and birth outcomes. Pregnancies conceived through ART are associated with increased risks of adverse obstetric and perinatal outcomes, with discrepancies in outcomes between different ART treatment protocols. We hypothesize this is due to the periconceptional hormonal environment regulated by the CL. ART protocols affect CL quantity at conception resulting in CL absence or a supraphysiological number of CL. This study is embedded in the Rotterdam Periconceptional Cohort, an ongoing tertiary center prospective cohort at the Erasmus University Medical Center in Rotterdam, the Netherlands. Women with a singleton pregnancy with data on CL. The number of CL, based on mode of conception: 0 CL (artificial cycle frozen embryo transfer (AC-FET), n=72); >1 CL (ovarian stimulated fresh embryo transfer, n=462) and 1 CL (natural cycle frozen embryo transfer (NC-FET) and natural conceptions, n=1327). Hypertensive disorders of pregnancy, gestational diabetes, gestational age at birth and birthweight, derived from medical records. We included 1,861 pregnancies. The results were adjusted for maternal age, maternal body mass index, nulliparity and obstetric history. In comparison with natural conceptions (1 CL), a pregnancy with CL absence (0 CL) was associated with a higher risk of gestational diabetes (aOR 2.59 [95% CI 1.31;5.15]), and a higher risk of preeclampsia, albeit non-significantly (aOR 2.02 [95% CI 0.91;4.51]). In comparison with pregnancies with >1 CL the risk of preeclampsia was significantly lower (aOR 0.36 [95% CI 0.18;0.72]). Post hoc analyses revealed that in male neonates, >1 CL was associated with a lower birthweight percentile (aβ -6.18 [95% CI -11.16;-1.20]). In contrast, female neonates showed no association with >1 CL, whereas CL absence was associated with a higher birthweight percentile (aβ 12.93 [95% CI 2.52;23.34]). Risks of hypertensive disorders of pregnancy, gestational diabetes and relative birthweight differ between CL groups. These findings support the hypothesis that an aberrant number of CL impacts maternal pregnancy and or birth outcomes. Additional studies need to be conducted to investigate causes and underlying pathophysiology.