Birth Outcomes In Pregnant Women Research Articles

Syphilis in pregnancy and adverse birth outcomes: Anationwide longitudinal study in Brazil.

The present study aimed to evaluate the association between syphilis in pregnancy and low birth weight, small for gestational age, and preterm birth. This longitudinal study used Brazilian National Information System for livebirths (SINASC) linked to the gestational syphilis cases from Notifiable Diseases Information System (SINAN) from 2011 to 2017. Descriptive statistics and logistic regression were used to compare the birth outcomes of pregnant women with and without syphilis. The study protocol was approved by the Research Ethics Committee of the Institute of Collective Health of the Federal University of Bahia (CAAE: registration no. 18022319.4.0000.5030). A total of 17 930 817 live births were included in the study. Of these, 155 214 (8.7/1000) were exposed to syphilis during pregnancy. Maternal syphilis increased the odds of low birth weight (aOR 1.88, 95% CI: 1.85-1.91), small for gestational age (aOR 1.53, 95% CI: 1.51-1.56), and preterm birth (aOR 1.35, 95% CI: 1.33-1.37). Higher odds were observed for pregnant women with VDRL titer ≥64 and untreated maternal syphilis when compared to mothers without syphilis. Analysis stratified by prenatal care showed higher odds for all adverse birth outcomes for mothers attending ≤6 prenatal appointments. Our findings showed a strong association between gestational syphilis and adverse birth outcomes with increased odds observed among women with higher VDRL titers, lack of treatment, and fewer prenatal appointments. These results highlight the need for adequate screening and treatment for gestational syphilis during pregnancy to mitigate the risk of adverse birth outcomes.

Safety surveillance for PrEP in pregnant and breastfeeding women.

The risk of HIV acquisition is higher during pregnancy and postpartum than other times. Newly acquired maternal HIV infection associated with high primary viraemia, substantially increases the risk of vertical HIV transmission. Pre-exposure prophylaxis (PrEP) reduces the risk of HIV acquisition. Currently available products include oral tenofovir/emtricitabine (TDF/FTC) and tenofovir alafenamide (TAF)/FTC), long-acting cabotegravir (CAB-LA) and the dapivirine ring (DVR). All except oral TDF/FTC have limited safety data available for use in pregnant and breastfeeding women. The safety of new PrEP agents for pregnant women and the fetus, infant and child, either exposed in utero or during breastfeeding is an ongoing concern for health care workers and pregnant and breastfeeding women, particularly as the safety risk appetite for antiretroviral (ARV) agents used as PrEP is lower in pregnant and breastfeeding women who are HIV-uninfected, compared to women living with HIV taking ARVs as treatment. With the widespread rollout of TDF/FTC among pregnant women in South Africa and other low-middle income countries (LMIC) and the potential introduction of new PrEP agents for pregnant women, there is a need for safety surveillance systems to identify potential signals of risk to either the mother or fetus, measure the burden of such a risk, and where appropriate, provide specific reassurance to PrEP users. Safety data needs to be collected across the continuum of the product life cycle from pre-licensure into the post-marketing period, building a safety profile through both passive and active surveillance systems, recognising the strengths and limitations of each, and the potential for bias and confounding. Pharmacovigilance systems that aim to assess the risk of adverse birth outcomes in pregnant women exposed to PrEP and other agents need to consider the special requirements of pregnancy epidemiology to ensure that the data derived from surveillance are sufficiently robust to inform treatment policies. Here we review the known safety profiles of currently available PrEP candidates in women of child-bearing potential, pregnancy and breastfeeding and discuss pragmatic approaches for such surveillance in HIV-endemic LMICs.

Effects of the COVID-19 early pandemic on delivery outcomes among women with and without COVID-19 at birth.

The COVID-19 pandemic may influence delivery outcomes through direct effects of infection or indirect effects of disruptions in prenatal care. We examined early pandemic-related changes in birth outcomes for pregnant women with and without a COVID-19 diagnosis at delivery. We compared four delivery outcomes-preterm delivery (PTD), severe maternal morbidity (SMM), stillbirth, and cesarean birth-between 2017 and 2019 (prepandemic) and between April and December 2020 (early-pandemic) using interrupted time series models on 11.8 million deliveries, stratified by COVID-19 infection status at birth with entropy weighting for historical controls, from the Healthcare Cost and Utilization Project across 43 states and the District of Columbia. Relative to 2017-2019, women without COVID-19 at delivery in 2020 had lower odds of PTD (OR = 0.93; 95% CI = 0.92-0.94) and SMM (OR = 0.88; 95% CI = 0.85-0.91) but increased odds of stillbirth (OR = 1.04; 95% CI = 1.01-1.08). Absolute effects were small across race/ethnicity groups. Deliveries with COVID-19 had an excess of each outcome, by factors of 1.07-1.46 for outcomes except SMM at 4.21. The effect for SMM was more pronounced for Asian/Pacific Islander non-Hispanic (API; OR = 10.51; 95% CI = 5.49-20.14) and Hispanic (OR = 5.09; 95% CI = 4.29-6.03) pregnant women than for White non-Hispanic (OR = 3.28; 95% CI = 2.65-4.06) women. Decreasing rates of PTD and SMM and increasing rates of stillbirth among deliveries without COVID-19 were small but suggest indirect effects of the pandemic on maternal outcomes. Among pregnant women with COVID-19 at delivery, adverse effects, particularly SMM for API and Hispanic women, underscore the importance of addressing health disparities.

Birth Outcomes in Pregnant Women with Epilepsy: a Nationwide Multicenter Study from Türkiye.

The present study was aimed at investigating the effects of anti-seizure medications (ASMs), patient demographic characteristics, and the seizure type and frequency on the development of congenital malformation (CM) in infants of pregnant women with epilepsy (PWWE). PWWE followed-up at the neurology outpatient clinic of 21 centers between 2014 and 2019 were included in this prospective study. The follow-up of PWWE was conducted using structured, general pregnant follow-up forms prepared by the Pregnancy and Epilepsy Study Committee. The newborns were examined by a neonatologist at 1. and 3. months postpartum. Of the infants of 759 PWWE , 7.2% had CMs, with 5.6% having major CMs. Polytherapy, monotherapy, and no medications were received by 145 (19.1%), 517 (68.1%), and 42 patients, respectively. CMs were detected at an incidence of 2.3% in infants of those who did not receive medication, 5.7% in infants of those who received monotherapy, and 13.7% in infants of those who received polytherapy. The risk of malformation was 2.31-folds (95% confidence interval: 1.48-4.61, p < 0.001) higher in infants of PWWE who received polytherapy. Levetiracetam was the most frequently used seizure medication as monotherapy, with the highest incidence of CMs occurring with valproic acid (VPA) use (8.5%) and the lowest with lamotrigine use (2.1%). The incidence of CMs was 5% at a carbamazepine dose <700 mg, 10% at a carbamazepine dose ≥700 mg, 5.5% at a VPA dose <750 mg, and 14.8% at a VPA dose ≥750 mg. Thus, the risk of malformation increased 2.33 times ( p = 0.041) in infants of those receiving high-dose ASMs. Birth outcomes of PWWE receiving and not receiving ASMs were evaluated. The risk of CMs occurrence was higher, particularly in infants of PWWE using VPA and receiving polytherapy. The incidence of CMs was found to be lower in infants of PWWE receiving lamotrigine.

Biomarkers of environmental enteric dysfunction and adverse birth outcomes: An observational study among pregnant women living with HIV in Tanzania.

SummaryBackgroundEnvironmental enteric dysfunction (EED) may contribute to adverse birth outcomes in low-resource settings. We examined the associations of EED biomarkers with birth outcomes in pregnant women living with human immunodeficiency virus in Dar es Salaam, Tanzania.MethodsWe performed a cohort study of 706 HIV-infected pregnant women. Maternal serum samples collected at 32 weeks gestation were analyzed for markers of EED (anti-flagellin and anti-LPS immunoglobulins, intestinal fatty acid-binding protein [I-FABP] and soluble CD14), systemic inflammation (C-reactive protein and α1-acid glycoprotein [AGP]), and growth hormone resistance (insulin-like growth factor 1 [IGF-1] and fibroblast growth factor 21 [FGF21]. Associations of biomarkers categorized into quartiles with birth outcomes (birthweight, gestational duration, birthweight-for-gestational age, and stillbirth) were assessed using linear and log-binomial regression models adjusted for multiple sociodemographic and clinical variables.FindingsMaternal EED biomarkers were not significantly associated with birthweight, gestation duration, or birthweight-for-gestational age. However, higher quintiles of I-FABP concentrations were associated with greater risk of stillbirth (ptrend=0·02). Higher AGP was associated with lower birthweight and was associated with increased risk of small-for-gestational age births. Higher IGF-1 was associated with higher birthweight and birthweight-for-gestational age while higher FGF21 was associated with shorter gestation and higher risk of preterm birth.InterpretationMaternal biomarkers of EED, systemic inflammation, and growth hormones were differentially associated with birth outcomes. Biomarkers of EED may be useful to identify pregnant women at risk of adverse birth outcomes, but further research is needed to confirm these findings and elucidate biological mechanisms.Funding10.13039/100000002National Institutes of Health.

Prenatal Exposure to Mercury and Adverse Birth Outcomes in Rio de Janeiro, Brazil: Rio Birth Cohort Study (PIPA Project)

Background: Mercury (Hg) is a highly toxic environmental pollutant, with studies of its prenatal exposure indicating adverse birth outcomes such as low birth weight, preterm delivery, and micro- cephaly. Therefore, we analyzed prenatal Hg exposure levels and their relationship with birth outcomes in pregnant women living in an urban area in the city of Rio de Janeiro. Subjects and Method: A cross-sectional study nested in the prospective birth cohort (PIPA Project) was conducted at the Federal University of Rio de Janeiro Maternity School from October to November 2017. A total of 117 mother-infant pairs were evaluated. The sampling technique used convenience sampling. The independent variables encompassed maternal and cord blood Hg levels, while the dependent variables were birth weight, birth length, head circumference (neonatal anthropometrics), and Apgar score at 1 and 5 minutes. The Hg levels were analyzed using induc- tively coupled plasma-mass spectrometry, and dependent variable data were obtained through medical records. Multiple regression models were applied using the SPSS. Results: The detection rate of maternal and cord blood was 100%, with medians of 0.76 and 0.91 µg/L, respectively. A strong correlation between maternal and cord blood Hg levels was observed (r= 0.70; p&lt;0.010), as well as an inverse association between cord blood Hg and Apgar score at 1 and 5 minutes (b=−0.47; p&lt;0.010; b=−0.34; p&lt;0.010) after adjusting for covariates. Conclusion: Our study provided preliminary evidence that Hg exposure was associated with a worse Apgar score at 1 and 5 minutes. However, the relevance of this finding requires further evaluations due to its potential clinical implications concerning newborn health. Keywords: Mercury, Maternal exposure, Apgar Score, Anthropometry Correspondence: Angelica dos Santos Vianna. Federal University of Rio de Janeiro (UFRJ). Avenida Horacio Macedo sem numero – Proximo a Prefeitura Universitária da UFRJ. Ilha do Fundao – Cidade Universitária. ZIP Code: 21941-598, Rio de Janeiro, RJ, Brazil. Email address: angelica- @iesc.ufrj.br

O-139 COVID-19 in pregnant women: a living systematic review and meta-analysis on the risk and prevalence of pregnancy loss

Study questionWhat is the risk and prevalence of pregnancy loss (PL) in women with COVID-19 compared to women without COVID-19?Summary answerPregnant women with COVID-19 do not appear to be at increased risk of miscarriage.What is known alreadyPregnant women with COVID-19 have an increased risk to deliver preterm and to deliver a stillborn child in comparison to pregnant women without the disease. Currently, many studies have evaluated birth outcomes in pregnant women with COVID-19, however few regard the risk of PL as most data were available on pregnancies infected during the third trimester. Based on the data currently available, there is no evidence to suggest that an infection with SARS-CoV-2 poses an increased risk of miscarriage.Study design, size, durationOur living systematic review is based on a prospectively registered protocol (PROSPERO CRD42020178076; registered 22 April 2020). For this project a short separate protocol was developed (https://osf.io/e8dhr/). The literature search was performed up until the 8th of December 2021 and an update has been planned.Participants/materials, setting, methodsWe included retrospective and prospective cohort studies of pregnant women with COVID-19, provided that they contained information on PL. We calculated odds ratios (OR) and risk differences with corresponding 95% confidence intervals (CI) and pooled the data using random effects meta-analysis. To estimate risk prevalence, we performed meta-analysis on proportions. Heterogeneity was assessed by I2.Main results and the role of chanceWe included 75 studies comprising a total of 39826 pregnant women, of which 32663 pregnant women with COVID-19 and 2610 controls. 1423 pregnant women with COVID-19 were in their first trimester and 2700 were in their second trimester. Evidence level was considered to be of low certainty. The overall proportion of pregnancy loss in all COVID-19 pregnancies including third trimester pregnancies was 1.2% (95% CI 0.7% to 1.8%; I2=79%). Selecting on first and second trimester pregnancies the proportion of pregnancy loss was 4.7% (95% CI 3.0% to 6.7%; I2=71%).When comparing pregnancy loss in cohorts of pregnant women with COVID-19 to pregnant women without the disease the odds ratio was 1.26 (95% CI 0.74 to 2.18, I2=0%; RD 0.12%, 95% CI -0.62 to 0.85, I2=0%). Selecting on only first and second trimester pregnancies, the odds ratio for pregnancy loss was 1.35 (95% CI 0.46 to 3.93, I2=0%; RD 0.35%, 95% CI -1.44 to 2.15, I2=0%;).The overall proportion of ectopic pregnancy in all COVID-19 pregnancies cohorts including third trimester pregnancies was 0.61% (95% CI 0.1% to 1.4%; I2=49.8%). Selecting on first and second trimester pregnancies the proportion of ectopic pregnancy was 2.0% (95% CI 0.3% to 5.9%; I2=40%).Limitations, reasons for cautionMost included studies were hospital-based studies such that selection bias towards more severe infections seems likely. A minority of studies reported on first and second trimester pregnancies.Wider implications of the findingsAt this moment there are no indications that COVID-19 increases the risk of miscarriages. In view of the wide insecurities around the risk estimates further well-designed studies are required, that consider the clinical manifestation of COVID-19 and include first and second trimester pregnancies.Trial registration numberNot applicable

Biomarkers of Environmental Enteric Dysfunction in Pregnancy and Adverse Birth Outcomes: An Observational Study Among Women Living With HIV in Tanzania

ObjectivesEnvironmental enteric dysfunction (EED), a subclinical state of intestinal inflammation, may contribute to poor fetal growth in low-resource settings. Pregnant women living with HIV may be particularly susceptible to effects of EED, given their increased risk of infections and adverse birth outcomes. We sought to explore the associations of biomarkers of EED, inflammation and growth hormones with birth outcomes in pregnant women living with HIV in Dar es Salaam, Tanzania.MethodsWe performed a sub-study of 706 HIV-infected pregnant women participating in a randomized, double-blind, placebo-controlled trial assessing the effect of vitamin D3 supplementation. Maternal serum samples collected at 32 weeks gestation were analyzed for anti-flagellin and anti-LPS IgA and IgG via ELISA as well as using an 11-plex Micronutrient and EED Assessment Tool, which includes markers of EED [intestinal fatty acid-binding protein (I-FABP) and soluble CD14], systemic inflammation [C-reactive protein and α1-acid glycoprotein (AGP)], insulin-like growth factor 1 (IGF-1) and fibroblast growth factor 21 (FGF21). Biomarkers were categorized as quartiles. Associations with birth outcomes were assessed using linear regression analyses.ResultsPregnant women in the highest quartile of I-FABP had more than twice the risk of stillbirth compared to those in the lowest quartile (RR 2.43, 95% CI 0.98–6.03, ptrend = 0.02). Compared to women in the lowest quartile of AGP, those in the highest quartile gave birth to infants weighing 176g less (95% CI -280 to -71g, ptrend = 0.005). Maternal AGP was associated with increased risk of small-for-gestational age births; those in the highest quartile had a 70% greater risk compared to the lowest (RR 1.70, 95% CI 1.08–2.69, ptrend = 0.03). IGF1 was positively associated with birthweight and birthweight-for-age z-score; FGF21 was negatively associated with gestation duration and risk of preterm birth.ConclusionsMaternal biomarkers of EED, systemic inflammation, and the growth hormone axis were associated with birth outcomes. Further studies are needed to confirm these results and study the biologic mechanisms involved.Funding SourcesNational Institutes of Health (NICHD, NIDDK).

The Effect of Pumpkin Seed Biscuits and Moringa Capsules on (Malondialdehyde) Levels and Birth Outcomes of Pregnant Women

BACKGROUND: Maternal and infant mortality is a global health problem, the direct cause of which is malnutrition. Dietary supplements and vegetables are mandatory to support the nutritional needs of pregnant women. Moringa oleifera and pumpkin seeds contain many nutrients, and the price is relatively cheap; therefore, they are very good for consumption by pregnant women. The aim of the study was to find literature on the effect of pumpkin seed biscuits and moringa capsules on the effects of malondialdehyde (MDA) levels and birth outcomes of pregnant women. AIM: The objective of the study was to review journals related to the effect of pumpkin seed biscuits and moringa capsules on (MDA) levels and birth outcomes of pregnant women. METHODS: Study literature by collecting relevant journal data based on PubMed, ScienceDirect, and ProQuest. RESULTS: supplementary food that is cheap and easily available to pregnant women by giving pumpkin seeds and moringa leaf extract has an impact on improving nutritional status and preventing such as low birth weight (LBW). Moreover, the result found that food ingredients from pumpkin seeds and moringa have high nutritional value and are very beneficial for pregnant and lactating women. CONCLUSION: The screened articles with inclusion and exclusion criteria support and recommend additional nutrients such as Moringa oleifera and pumpkin seeds to pregnant women. These two foods directly contribute to the prevention of MDA which causes stress, preeclampsia, LBW babies, severe anemia, babies growth and development, as well as maternal and babies mortality.

Prospective significance of the placenta accreta index and pregnancy outcomes in pregnant women with placenta previa at Hue Central Hospital

ABSTRACT Objectives: This study aims to explore the predictive value of placenta accreta scoring system (PASS) in diagnosing placenta accreta spectrum and the birth outcomes in pregnant women with placenta previa at Obstetrics Department of Hue Central Hospital. Method: A cross-sectional descriptive study was conducted on 42 pregnant women who were diagnosed with placenta previa at Obstetrics Department of Hue Central Hospital from January 2021 to December 2021. On ultrasound, PASS was used to assess the potential of placenta accreta spectrum. Results: Pregnant women with placenta previa had at least 1 previous cesarean section accounted for 66.7%. The high-risk group of placenta accreta (PASS ≥ 8 points) was 89 times more likely to predict placenta accreta than the group low-risk and mediumrisk group (&lt; 8 points) (OR= 89.2; 95%CI: 11.4-901.4; p&lt;0.001). The area under the ROC curve (AUC) of the PASS showed a very- high level (AUC: 0.977; p&lt;0.001) to predict the placenta accreta spectrum. The optimal cut-off point was 8 points with a sensitivity of 89.5% and specificity of 91.3%. The PASS was relevant to the hysterectomy, and blood transfusion happened in operation (p&lt;0.001). The proportion of pregnant women with placenta accreta was 45.2%, underwent hysterectomy was 33.3%, needed blood transfusion accounted for 52.4% and had complications during surgery was 23.8%. Gestational age at birth in the group ≥ 38 weeks accounted for the majority, with 69.0%. Newborns weighing 2500 - 3500 grams accounted for 73.8% in the majority. The first minute Apgar &gt; 7 points is 69%, the 5th minute Apgar &gt; 7 points is 95.2%. Conclusion: PASS is strongly recommended to use in predicting of placenta accreta spectrum in pregnant women with placenta previa. PASS is easily and widely applied in clinical practice, suitable for the current situation of almost obstetricians and ultrasound practitioners that are occupied on clinical systems.

Effects of Smoking Reduction and Cessation on Birth Outcomes in a Scheduled Gradual Reduction Cessation Trial.

Smoking during pregnancy can affect infant birthweight. We tested whether an intervention that promoted scheduled gradual reduction improved birth outcomes among pregnant women who smoked. We also examined race differences in birth outcomes. We conducted a 2-arm randomized controlled trial where pregnant women who smoked received either SMS text-delivered scheduled gradual smoking reduction (SGR) program plus support texts or support messages only throughout their pregnancy. The outcomes for this paper were birth outcomes including birth weight and gestational age obtained from chart review. Analyses were conducted using chi-square and t-tests in SAS. We approached 2201 pregnant women with smoking history. Of the 314 women recruited into the study, 290 completed a medical release form (92%). We did not find any significant differences in birth outcomes by arm or race. The majority of participants reduced smoking by the 80%. Women who reduced more than 50% of their baseline cigarettes per day had a birth weight increase of 335g compared to those that did not (p = 0.05). The presence of alcohol/drug use in prenatal visit notes was associated with low infant birth weight (p = 0.05). The scheduled gradual reduction intervention did not improve birth outcomes. Additional research is needed to help improve birth outcomes for pregnant women who engage in tobacco and illicit substance use. CLINICAL TRIAL #: NCT01995097.

Female Relatives as Lay Doulas and Birth Outcomes: A Systematic Review.

Continuous labor support provided by professional doulas is associated with improved birth outcomes for pregnant women and their infants. However, there is limited data on the impact of using female relatives as lay doulas. This systematic review included nine published studies that examined the association between use of female relatives as lay doulas with childbirth outcomes. In some study populations, there was a decrease in the number of cesarean births and length of labor, and in all studies, there was improved maternal birth satisfaction. However, the woman's chosen female relative often did not receive education regarding labor support skills before providing continuous support. Educational programs designed to teach labor support skills to female relatives are needed.

The relationship between preoperative anxiety level, ABO blood types and birth outcomes in cesarean sections

Objective: There is a relationship between ABO blood groups, which are part of the genetic phenotype, and various psychiatric diseases. Our primer aim in this study is to examine the relationship between ABO blood groups and preoperative anxiety (POA) levels in patients undergoing elective cesarean section. The secondary aim is to determine the relationship between POA levels and birth outcomes in pregnant women.&#x0D; Material and Method: A total of 132 patients with different ABO blood groups who were scheduled for elective cesarean section under spinal anesthesia between August 2020 and July 2021 at the Medical Faculty Hospital were included in this prospective observational study. State Anxiety Inventory scores (SAI) were used to assess preoperative anxiety in groups A, B, AB, and O. Birth outcomes (fetal birth weight, birth sex and APGAR scores at the 1st and 5th minutes) were recorded.&#x0D; Results: There were 55 people (41.7%) in the A blood group, 43 people (32.6%) in the O blood group, 25 people (18.9%) in the B blood group, 9 people (6.8%) in the AB blood group. A total of 73/132 (55.3%) patients with SAI score &gt;40 were identified. There was no significant difference in mean SAI scores in A, B, AB and O blood groups (p=0.531). Fetal birth weight was found to be lower in patients with high SAI scores (p=0.044). &#x0D; Conclusion: There was no relationship between ABO blood groups and preoperative anxiety and birth outcomes in elective cesarean sections under spinal anesthesia, but low fetal birth weight was found in pregnant women with high anxiety. More studies with larger sample sizes in the future are needed to confirm the results of our study.

Trichomoniasis and adverse birth outcomes: a systematic review and meta-analysis.

Trichomoniasis commonly affects women of childbearing age and has been linked to several adverse birth outcomes. To elucidate the association between trichomoniasis in pregnant women and adverse birth outcomes, including preterm delivery, prelabour rupture of membranes and low birthweight. MEDLINE, EMBASE and ClinicalTrials.gov were systematically searched in December 2020 without time or language restrictions. Original research studies were included if they assessed at least one of the specified adverse birth outcomes in pregnant women with laboratory-diagnosed trichomoniasis. Estimates from included articles were either extracted or calculated and then pooled to produce a combined estimate of the association of trichomoniasis with each adverse birth outcome using the random effects model. Heterogeneity was assessed using the I2 statistic and Cochran's Q test. Literature search produced 1658 publications after removal of duplicates (n=770), with five additional publications identified by hand search. After screening titles and abstracts for relevance, full text of 84 studies was reviewed and 19 met inclusion criteria for meta-analysis. Significant associations were found between trichomoniasis and preterm delivery (OR 1.27; 95% CI 1.08-1.50), prelabour rupture of membranes (OR 1.87; 95% CI 1.53-2.29) and low birthweight (OR 2.12; 95% CI 1.15-3.91). Trichomoniasis in pregnant women is associated with preterm delivery, prelabour rupture of membranes and low birthweight. Rigorous studies are needed to determine the impact of universal trichomoniasis screening and treatment during pregnancy on reducing perinatal morbidity. This systematic review and meta-analysis found that in the setting of pregnancy, trichomoniasis is significantly associated with multiple adverse birth outcomes, including preterm delivery, low birthweight, and prelabour rupture of membranes.

PM2.5 exposure exaggerates the risk of adverse birth outcomes in pregnant women with pre-existing hyperlipidemia: Modulation role of adipokines and lipidome

The in-utero environmental exposure to fine particulate matter (PM2.5) might lead to adverse birth outcomes, such as low birth weight (LBW) and preterm birth (PTB), thereby increasing susceptibility to diseases in later life. However, no studies have examined the underlying mechanism through cross-omics of lipidome and adipokines profiling, as well as the possible effect modification by maternal hyperlipidemia. In total, 203 mother-newborn pairs were recruited in the birth cohort study ongoing since February 2017 in Beijing, China. Individual-level of PM2.5 exposure was estimated using a satellite data based random forest model. Cord blood lipidome and adipokines were assessed through the lipidomic approaches and antibody-based array. Multivariable logistic/linear regression models and moderation analysis were employed in this study. We observed a significantly increased risk of PTB associated with PM2.5 exposure during the second trimester, especially in pregnant women with pre-existing hyperlipidemia. 9 lipid classes and 21 adipokines were associated with PM2.5 exposure independently or significantly influenced by the interaction of maternal PM2.5 exposure and hyperlipidemia. In addition, 4 adipokines (ANGPTL4, IGFBP-2, IL-12p40, and TNF-RII) and 3 lipid classes [phosphatidylcholines (PCs), phosphatidylinositols (PIs), and triglycerides (TGs)] were related to the increased risk of PTB, indicating that inflammation, IGF/IGFBP axis, and lipolysis induced lipid homeostasis disorder of PCs, TGs, and PIs might be the possible mediators for the PM2.5-induced adverse birth outcomes. Our results substantiated the need for reducing exposure in susceptible populations.

Birth Outcomes of Maternal Morbid Obesity

Background: The prevalence of pregnancy with morbid obesity has increased in the last decade which caused complications for both the mother and fetus. The aim of this study was to find out the birth outcomes of pregnant women with morbid obesity who gave birth at Dr. Soetomo General Hospital, Surabaya from 2013 to 2015. Methods: This was a descriptive study on pregnant women with morbid obesity (BMI ≥40 kg /m2) who gave birth in the delivery room of Dr. Soetomo General Hospital, Surabaya from January 2013 to June 2015. Results: There were 3986 deliveries during the study period with 297 (7.4%) deliveries with obese mothers. The births with morbid obesity were in 42 mothers (14%). The range of BMI was 40.17-59 kg/m2 with median of 45.86 kg/m2. Caesarean section was the most mode of delivery in mothers with morbid obesity as many as 36 mothers (85%). The options of anesthesy in mother with morbid obesity were general anesthesia and subarachnoid block, 9 (25%) and 27 (75%), respectively. The childbirth in mother with morbid obesity spend an average of 69.60 minutes for cesarean delivery with the average time of incision until the birth of a baby 8.67 minutes. Most Apgar score group of infants was in 7-10 group. Conclusion: The birth outcomes of morbidly-obese pregnant women were caesarean section delivery, long duration in delivery, and normal birth weight.

Pregnancy and Birth Outcomes Among Women on Antiretroviral Therapy: A Long-term Retrospective Analysis of Data from a Major Tertiary Hospital in North Central Nigeria.

Background and Objective:Antiretroviral therapy (ART) has transformed human immune deficiency virus (HIV) infection from a death sentence to a chronic syndrome, allowing infected individuals to lead near-normal lives, including achieving pregnancy and bearing children. Notwithstanding, concerns remain about the effects of ART in pregnancy. Previous studies suggested contradictory associations between ART and pregnancy. This study determined birth outcomes in pregnant women who accessed ART between 2004 and 2017 at a major tertiary hospital in North Central Nigeria.Methods:This was a retrospective study of 5,080 participants. Ethical clearance was obtained from the Institutional Review Board of the Harvard T. H. Chan School of Public Health Boston. A pro forma for data abstraction was designed and used to collect data. ed data were sorted and managed using SPSS® version 22. The Chi-square test was used to calculate the proportions of pregnancy outcomes. One-way analysis of variance was used to test the effect of antiretroviral drug regimens on mean birth weight and gestational age at delivery. All levels of significance were set at p 0.05.Results:Pregnancy outcomes were recorded as live birth (99.8%), stillbirth (0.2%), preterm delivery (6.6%), and low birth weight (23%). There was a statistically significant association between ART in pregnancy and low birth weight {χ2 [(5, n = 3439) = 11.99, p = 0.04]}. The highest mean birth weights were recorded in participants who received drug combinations with protease inhibitors or efavirenz, in contrast to participants who received Nevirapine, stavudine and Emtricitabine/Tenofovirbased regimens. However, there was no significant difference in the gestational age of babies at birth for the six ART regimens in the study.Conclusion and Global Health Implications:Findings support the benefits of ART in pregnancy, which is in line with the testing and treatment policies of the 90-90-90 targets for ending HIV by the year 2030.

The effect of dental problems on pregnancy and birth outcomes in pregnant women registered in family health centers in a city center: A prospective study

The researchers aimed to determine the effects of oral–dental health of pregnant women on their pregnancy and fetus health. In this descriptive observational study, the researchers prospectively followed up 64 pregnant women three times, who were registered in two family health centers that were selected by using a simple random sampling method. As the follow-ups progressed, an increase was determined in the DMF-S (Decayed-Missing-Filled-Surface) index and DEBRIS (Caries Surface Distribution Form) scores in the areas observed (p < 0.05). No significant relationship was found between the increased scores and the infant’s birth length, weight, and birth week.

Lifetime Psychosocial Stress Exposure Associated with Hypertensive Disorders of Pregnancy.

Hypertensive disorders of pregnancy (HDP) complicate 5 to 10% of all pregnancies and are a major cause of pregnancy-related morbidity. Exposure to psychosocial stress has been associated with systemic inflammation and adverse birth outcomes in pregnant women. Thus, it is probable that psychosocial stress and inflammation play a role in the development of HDP. The primary objective of this analysis was to determine if a woman's lifetime psychosocial stress exposure was associated with an increased risk of HDP. Additionally, we examined whether serum inflammation was an underlying biological mediator for this relationship. A multisite prospective study was conducted in a sociodemographically diverse cohort of 647 pregnant women. At a study visit between 12 and 206/7 weeks' gestation, maternal psychosocial stress was assessed with six validated assessments and inflammation was measured via log-transformed serum concentrations of interferon-γ, interleukin (IL)-10, IL-13, IL-6, IL-8, and tumor necrosis factor-α. A composite stress score was calculated for each participant from the six stress assessments. The diagnosis of HDP was abstracted from the medical record and was defined as the presence of gestational hypertension after 20 weeks of pregnancy and/or preeclampsia. The association between composite stress and HDP was determined using binary logistic regression. Inflammation, using the six inflammatory biomarkers, was tested as a potential mediator between stress and HDP. Participants with higher composite stress scores were more likely to develop HDP (odds ratio [OR]: 1.50, 95% confidence interval [CI]: 1.06-2.12). When adjusted for known risk modifiers, including maternal age, race/ethnicity, parity, pre-pregnancy body mass index, diabetes, chronic hypertension, and smoking during pregnancy, the risk remained unchanged (OR: 1.50, 95% CI: 1.03-2.20). No mediation effect by inflammation was observed. Independent of known risk factors, women exposed to greater composite stress burden across the life course are at increased risk of developing HDP. · This study was conducted to determine if women with high levels of psychosocial stress have differences in risk for hypertensive disorders of pregnancy (HDP).. · Independent of known risk factors, women with increased lifetime psychosocial burden are at higher risk for HDP.. · A model that captures multiple domains of life stress may better predict HDP than a unimodal stress assessment..

Characteristics and Birth Outcomes of Pregnant Women Treated with Corticosteroid After Fetal Reduction

Background and Purpose: Compared with singleton births, twin pregnancies are at increased risk of significant child morbidity, particularly cerebral palsy, after high-order fetal reduction. This is termed the vanishing-twin syndrome, and is an important etiology of cerebral palsy. Antenatal corticosteroid therapy (CCT) is widely used during preterm labor to enhance lung maturity. The use of dexamethasone, however, increases the risk for detrimental long-term neurodevelopmental effects. Thus, in this study we assess the effect of CCT on neurological disability and congenital abnormality in twins over 2 years of age after fetal reduction. Methods: The CCT (38 sets of twins) and control (56 sets) groups were compared for the incidences of cerebral palsy and congenital abnormalities, as well as mean birth weight, maternal age, and mean gestational age at delivery and at fetal reduction using records from Shin-Kong Memorial Hospital for the period 1992~2000. Results: There were 94 quadruplet-reduced sets of twins in our study. All of these twins were alive and aged over 2 years at the time of this writing. The gestational age at the time of delivery was 32.4±2.7 weeks for the CCT group vs. 36±2.9 weeks for the controls, with mean birth weights of 2099±555 vs. 2405±519g, respectively (p＜0.01). All 94 sets of twins were delivered by cesarean section, with only 1 case of cerebral palsy in the CCT group, while the others had developed normally by the age of 2 years. Only mean birth weight and gestational age at delivery showed significant differences in comparisons of the 2 groups of twins. Conclusion: Limiting the number of embryo transfers is essential for preventing adverse effects of the vanishing-twin syndrome. When reduction has been performed, a prolonged gestational age at delivery is mandatory for twin babies.