Multiple Pregnancy Complications Research Articles

Fetal magnetic resonance imaging, ultrasound, and echocardiography findings in twin reversed arterial perfusion sequence.

Twin reversed arterial perfusion (TRAP) sequence is a rare complication of monochorionic multiple gestation pregnancies, in which the pump twin provides hemodynamic support to a nonviable co-twin (acardius). Fetal magnetic resonance imaging (MRI) is used to detect pump twin abnormalities, particularly brain ischemia, prior to fetal intervention to interrupt umbilical blood flow to the acardius. To summarize the imaging findings of TRAP sequence pregnancies in a large series. A single-center retrospective review was performed of all TRAP sequence pregnancies referred for fetal MRI (2004-2021). Fetal MRI, ultrasound, and echocardiography data were collected. Eighty-eight TRAP sequence pregnancies with MRI were included (mean gestational age, 19.8±2.8 weeks). Demise of the pump twin was noted in two pregnancies at the time of MRI. By MRI, 12% (10/86) of live pump twins had abnormalities, including 3% (3/86) with brain abnormalities and 9% (8/86) with extra-cranial abnormalities. By echocardiography, 7% (6/86) of pump twins had structural cardiac abnormalities. Three acardius morphological subtypes were identified by MRI: acephalus (55%, 48/88), anceps (39%, 34/88), and amorphous (7%, 6/88). The mean ultrasound acardiustopump twin ratioA/Pratio, calculated for each twin pair as the ratio of the acardius trunk (and head, if present) plus limb volume to the pump twin estimated fetal weight) differed among the three acardius subtypes (P=.03). The mean A/P ratio moderately correlated with pump twin cardiothoracic ratio and combined cardiac output (Pearson's r=0.45 and 0.48, respectively, both P<.001). Fetal MRI of TRAP sequence pregnancies found anomalies in a substantial number of pump twins. The three acardius subtypes differed in A/P ratio, which moderately correlated with the pump twin cardiothoracic ratio and combined cardiac output.

SFlt-1 Levels as a Predicting Tool in Placental Dysfunction Complications in Multiple Pregnancies.

several studies have demonstrated that angiogenic markers can improve the clinical management of hypertensive disorders (HDs) and fetal growth restriction (FGR) in singleton pregnancies, but few studies have evaluated the performance of these tests in multiple pregnancies. Our aim was to investigate the role of soluble fms-like tyrosine kinase 1 (sFlt-1) in predicting adverse obstetric outcomes in hospitalized multiple pregnancies with HD (preeclampsia/gestational hypertension/uncontrolled chronic hypertension) and/or FGR in one or more fetuses. A retrospective analysis of multiple pregnancies with HD/FGR occurring after the 20th gestational week. Pregnant women were divided into two groups: women with high levels of sFlt-1 and those with low levels of sFlt-1. A value of sFlt-1 greater than or equal to 15,802 pg/mL was considered arbitrarily high, as it is equivalent to two times the 90th percentile expected in an uncomplicated full-term singleton pregnancy based on data from a prospective multicenter study (7901 pg/mL). The cohort included 39 multiple pregnancies. There were no cases of birth <34 weeks, HELLP syndrome, ICU admission, and urgent cesarean sections for HD/FGR complications reported among women with low levels of sFlt-1. A cut-off value of sFlt-1 ≥ 15,802 pg/mL could represent a valuable tool for predicting adverse obstetric outcomes in multiple pregnancies hospitalized for HD/FGR disorders, regardless of gestational age and chorionicity.

Demystifying the impact of prenatal tobacco exposure on the placental immune microenvironment: Avoiding the tragedy of mending the fold after death.

Prenatal tobacco exposure (PTE) correlates significantly with a surge in adverse pregnancy outcomes, yet its pathological mechanisms remain partially unexplored. This study aims to meticulously examine the repercussions of PTE on placental immune landscapes, employing a coordinated research methodology encompassing bioinformatics, machine learning and animal studies. Concurrently, it aims to screen biomarkers and potential compounds that could sensitively indicate and mitigate placental immune disorders. In the course of this research, two gene expression omnibus (GEO) microarrays, namely GSE27272 and GSE7434, were included. Gene set enrichment analysis (GSEA) and immune enrichment investigations on differentially expressed genes (DEGs) indicated that PTE might perturb numerous innate or adaptive immune-related biological processes. A cohort of 52 immune-associated DEGs was acquired by cross-referencing the DEGs with gene sets derived from the ImmPort database. A protein-protein interaction (PPI) network was subsequently established, from which 10 hub genes were extracted using the maximal clique centrality (MCC) algorithm (JUN, NPY, SST, FLT4, FGF13, HBEGF, NR0B2, AREG, NR1I2, SEMA5B). Moreover, we substantiated the elevated affinity of tobacco reproductive toxicants, specifically nicotine and nitrosamine, with hub genes through molecular docking (JUN, FGF13 and NR1I2). This suggested that these genes could potentially serve as crucial loci for tobacco's influence on the placental immune microenvironment. To further elucidate the immune microenvironment landscape, consistent clustering analysis was conducted, yielding three subtypes, where the abundance of follicular helper T cells (p < 0.05) in subtype A, M2 macrophages (p < 0.01), neutrophils (p < 0.05) in subtype B and CD8+ T cells (p < 0.05), resting NK cells (p < 0.05), M2 macrophages (p < 0.05) in subtype C were significantly different from the control group. Additionally, three pivotal modules, designated as red, blue and green, were identified, each bearing a close association with differentially infiltrated immunocytes, as discerned by the weighted gene co-expression network analysis (WGCNA). Functional enrichment analysis was subsequently conducted on these modules. To further probe into the mechanisms by which immune-associated DEGs are implicated in intercellular communication, 20 genes serving as ligands or receptors and connected to differentially infiltrating immunocytes were isolated. Employing a variety of machine learning techniques, including one-way logistic regression, LASSO regression, random forest and artificial neural networks, we screened 11 signature genes from the intersection of immune-associated DEGs and secretory protein-encoding genes derived from the Human Protein Atlas. Notably, CCL18 and IFNA4 emerged as prospective peripheral blood markers capable of identifying PTE-induced immune disorders. These markers demonstrated impressive predictive power, as indicated by the area under the curve (AUC) of 0.713 (0.548-0.857) and 0.780 (0.618-0.914), respectively. Furthermore, we predicted 34 potential compounds, including cyclosporine, oestrogen and so on, which may engage with hub genes and attenuate immune disorders instigated by PTE. The diagnostic performance of these biomarkers, alongside the interventional effect of cyclosporine, was further corroborated in animal studies via ELISA, Western blot and immunofluorescence assays. In summary, this study identifies a disturbance in the placental immune landscape, a secondary effect of PTE, which may underlie multiple pregnancy complications. Importantly, our research contributes to the noninvasive and timely detection of PTE-induced placental immune disorders, while also offering innovative therapeutic strategies for their treatment.

Study of How Adiposity in Pregnancy has an Effect on outcomeS (SHAPES): protocol for a prospective cohort study

IntroductionMaternal obesity increases the risk of multiple maternal and infant pregnancy complications, such as gestational diabetes and pre-eclampsia. Current UK guidelines use body mass index (BMI) to identify which women...

Clinical Utility of sFlt-1 and PlGF in Screening, Prediction, Diagnosis and Monitoring of Pre-eclampsia and Fetal Growth Restriction

ABSTRACT Preeclampsia is a serious hypertensive disorder of pregnancy that can deteriorate into eclampsia or HELLP syndrome and ultimately result in severe maternal morbidity or mortality. In addition to possible complications for the mother, preeclampsia and its additional complications can lead to adverse outcomes for infants, both before and after birth. Because of the serious consequences associated with preeclampsia, current practice guidelines recommend the screening of all pregnant patients for risk of preeclampsia in the first trimester and consistent monitoring for the development of preeclampsia later in pregnancy. Recommendations also include that women who are diagnosed with preeclampsia are closely monitored to prevent further complications such as preterm birth, as well as monitoring for fetal growth restriction (FGR). There are serum markers that are known to be related to preeclampsia, such as proangiogenic placental growth factor (PlGF) and antiangiogenic soluble fms-like tyrosine kinase-1 (sFlt-1). This article is a review aiming to summarize current knowledge about PlGF and sFlt-1, their performance, and potential alteration in diagnosis and monitoring of preeclampsia. Factors such as these have trends that occur in normal pregnancy and different trends that tend to occur in a pregnancy that is abnormal. In a healthy pregnancy, sFlt-1 increases in the third trimester, but in patients who later develop preeclampsia or FGR, it tends to increase sooner. Recent studies have shown that the interaction between sFlt-1 and PlGF reduces the amount of PlGF in circulating in the blood, causing a cascade of other effects. In addition, a decrease in PlGF is known to be associated with the development of preeclampsia. Because of this interaction, the ratio of sFlt-1 to PlGF can be used as a diagnostic tool; an increasing ratio can indicate development of preeclampsia. In addition to predicting preeclampsia, sFlt-1 and PlGF have been shown to be helpful in managing preeclampsia that has already been diagnosed. Monitoring the ratio of sFlt-1 to PlGF has shown a correlation between a higher ratio and imminent preterm delivery due to preeclampsia. It has also proven to be a predictor of other adverse outcomes such as preterm delivery and FGR, as well as stillbirth and complications of multiple pregnancies. Recent data show robust enough associations between sFlt-1 and PlGF that it can reasonably be used for predicting short-term development of preeclampsia, monitoring preeclampsia that has been previously diagnosed and predicting other disorders of the placenta. These factors can be particularly useful in guiding treatment of those whose symptoms are not a clear enough indicator on their own for preeclampsia, but who may be in danger of complications if left untreated. In particular, the most impactful clinical outcome comes when both sFlt-1 and PlGF levels are monitored, as the interaction between the 2 gives the most relevant information, whereas one or the other alone has not been shown to have practical value. Understanding the clinical utility of these levels indicates that there could be many benefits to integrating testing of the sFlt-1/PlGF ratio into preeclampsia screening and testing regimens; it could help clarify the need for treatment and predict the development of complications, which in turn could help clinicians prevent or treat complications for better outcomes for both mother and child.

A case of observing cardiac twins

Introduction. Reverse twin arterial perfusions, also known as cardiac malformation, is a uniquely rare complication of monochorionic multiple pregnancy due to the presence of a large arterio-arterial anastomosis, the formation of a rudimentary heart or its absence in one of the fetuses. The heart of a morphologically normal twin (fetus-pump, fetus-donor) provides blood circulation for both fetuses.The aim of the work was to determine a possible way to reduce perinatal mortality using the clinical example of monochorionic multiple pregnancy with the presence of cardiac twins.Materials and methods. Materials for clinical case analysis were the exchangenotification card of the pregnant and parenting woman, labor history, the results of functional and laboratory tests. Methods: analysis of anamnesis, results of functional and laboratory tests, peculiarities of pregnancy and delivery.Results. The analysis successfully demonstrates the possibility of improving perinatal outcomes in monochorionic twins complicated by the presence of acardia syndrome in the case of timely diagnosis of the complication, close dynamic monitoring of pregnancy and timely delivery in the case of functionally confirmed deterioration of the living fetus.Discussion. Monochorial type of placentation is recognized as a high risk factor for adverse perinatal outcomes (fetal-fetal hemotransfusion syndrome, the formation of discordant growth andfetal growth retardation, cardiac twins, increase frequency of preterm birth, perinatal morbidity and death). The presence of cardiac twins is the highest risk factor for antenatal death of a second fetus in the absence of timely surgical treatment and delivery. The presented clinical case demonstrates the possibility of improving perinatal outcomes by prolonging a multiple pregnancy complicated by cardiac malformation up to 33 weeks of gestation and delivery at decompensation of the placental complex.Conclusion. In the vector of reducing the incidence of perinatal mortality, individual management of pregnant women with monochorionic multiple pregnancy is necessary to enable timely diagnosis of its complicated course by cardiac malformation of one of the fetuses, dynamic functional examination of the placental complex, determination of indications for surgical correction and choice of term of delivery.

Regional distribution of the MTHFR C677T polymorphism in Chinese females.

Objective: For analyzing the distribution characteristics of MTHFR C677T polymorphism in Chinese females in order to provide information for reducing birth defects and formulating public health policies to prevent congenital malformations. Methods: Literature search in the last 6 years on "MTHFR C677T," "polymorphism" and "methylene tetrahydrofolate reductase." The included literature provides the MTHFR C677T frequency in healthy females in the corresponding regions. The data were grouped by the national administrative region as a unit to obtain the distribution information of the MTHFR C677T and alleles in the female population in every province, municipality or autonomous region. This was done for analyzing the overall distribution of the MTHFR C677T allele and the geographical distribution of pregnancy complications. Results: A total of 126 studies were included, covering five autonomous areas, four municipalities directly under the Central Government, as well as 22 provinces (except Taiwan Province) in China. MTHFR C677T polymorphism data of 27 groups of Chinese Han women and 31 groups of other Chinese females were obtained, and the chi-square test revealed notable inter-group differences (p = 0.000). The TT genotype and T allele of MTHFR C677T accounted for 18.2% (4.7%-38.3%) and 40.3% (19.7%-61.4%) of the Chinese female population, respectively, with a significant north-south difference. Chinese females had a consistent frequency of the T allele with the geographical distribution of pregnancy complications such as recurrent abortion and preeclampsia. Conclusion: With a obvious geographical gradient, the MTHFR C677T polymorphism distribution in Chinese females is consistent with the geographical distribution of multiple pregnancy complications, and the risk assessment for it might be included in primary prevention for birth defects.

A Compendium on Perinatal Autopsy in Neonats.

Professionals who work in perinatal care must understand the advantages and disadvantages of perinatal autopsy since they are an essential tool for determining fetal and neonatal mortality. Perinatal is the period five months before one month after birth, while prenatal is before birth. The traditional prenatal autopsy is still the gold standard for establishing the cause of death and providing an accurate report, notwithstanding the development of new technology. The ideal locations for a prenatal autopsy are tertiary institutes that offer these procedures. It emphasizes the need for systematic histopathologic sampling, rigorous record-keeping, technological adaptation, and wise laboratory test use. When a laboratory does a microbiologic examination with a focus on the genital tract and neonatal problems, it is very beneficial. Karyotyping needs to be selective and works best when there are many aberrations if resources are to be saved. A perinatal autopsy is insufficient without examining the placenta, and severe lesions should be distinguished from deformities and abnormalities brought on by fetal death. In addition to providing epidemiology teams and auditing committees with high-quality data, the pathologist's role in perinatal medicine also includes participating in the multidisciplinary management of fetal abnormalities identified during pregnancy, monitoring the patterns of iatrogenic disease, and aiding the perinatal grief management process. Investigations into complicated multiple pregnancies, hydrops, bone dysplasias, and unexpected intrauterine fetal deaths provide unique obstacles and diagnostic difficulties. There hasn't been any research that contrasts postmortem computed tomography with postmortem x-rays in pregnant women, as far as we know. Histological analysis of many perinatal autopsies revealed healthy developing tissues. Only a tiny percentage of histological abnormalities can be expected in fetal anomaly terminations. On prenatal imaging, many organ abnormalities are commonly anticipated. A thorough database search was done in Pubmed, Medline, and Scopus using the phrases "fetal abnormalities," "karyotyping," "fetal abnormality," "postmortem," and "perinatal autopsy."

Fetal reduction for everyone?

Infertility treatments have benefited millions of couples to have their own children; however, the complication of multiple pregnancies with their increased morbidity and mortality has created significant problems. Fetal reduction (FR) was developed to ameliorate these issues. Over 30 years of publications show that FR has been highly successful in substantially reducing both mortality and morbidity. As with most radically new techniques, initial cases were in the "nothing to lose" category. With experience, indications liberalize, and quality of life issues increase as a proportion of cases. Overall risks for twins are not twice as those for singletons, but they are approximately 4- to 5-fold higher. In experienced hands, the combination of genetic testing by CVS followed by FR has made most multiples behave statistically as if they were originally the lower number. The use of microarray analysis to better determine fetal genetic health before deciding on which fetus(es) to keep or reduce further improves pediatric outcomes. With increasing experience and lower average starting numbers, the proportion of FRs to a singleton has increased considerably. Twins to a singleton FR now constitute an increasing proportion of cases performed. Data on such cases show improved outcomes, and we believe FR should be at least discussed and offered to all patients with a dichorionic twin pregnancy or higher. eSET is not a panacea because of the resultant monochorionic twins.

Role of multiple- and single-pregnancy complications with incident cardiovascular diseases: a nationwide data linkage study in Wales

Abstract Background Prior evidence has suggested that pregnancy complications are associated with a higher risk of cardiovascular disease in women. However, associations between coexisting multiple pregnancy complications and incident cardiovascular disease remains unclear. Purpose To examine the risk of ischemic heart disease (IHD), stroke, atrial fibrillation or heart failure among women after their first pregnancy with a history of multiple pregnancy complications and women with a history of single-pregnancy complications, compared to women without pregnancy complications. Methods This retrospective cohort included women aged 16–45 years who had their first pregnancy between 2000 and 2018 in Wales using the Secure Anonymised Information Linkage (SAIL) Databank. Data were extracted from various sources such as Office for National Statistics (ONS) birth and death extracts, hospital admission, outpatient, emergency department and General Practice data sources, and pregnancy related data such as maternal indicators and national community child health. Cox proportional hazard regression was used to evaluate the association between multiple or specific single pregnancy complications and incidence of cardiovascular disease. Results A total of 298,515 women were included in the study, of which 64,794 (21.7%) women experienced a single pregnancy complication, and 10,038 (3.38%) women experienced more than one complication during their first pregnancy. During the a median of 9.7 years of follow-up, 2,484 women developed incident cardiovascular disease. IHD had the highest incidence rate among women with multiple pregnancy complications at 9.06 (7.36–11.15) per 10,000 person-years, compared to 4.24 (3.77–4.78) among women with a single pregnancy complication and 2.40 (2.20–2.61) among women without any pregnancy complications. After adjusting for potential confounding factors, compared to no previous pregnancy complications, a history of multiple pregnancy complications was associated with a higher risk of heart failure [hazard ratio (HR) 3.18 (95% confidence interval (CI) 2.34–4.32)], IHD [HR 2.88 (95% CI 2.27–3.67)], stroke [HR 2.03 (95% CI 1.55–2.65)] and atrial fibrillation [HR 1.80 (95% CI 1.20–2.72)]. There was also a consistent trend for a higher risk of all outcomes in women with a history of single-pregnancy complications compared to women without complications during the first pregnancy (Figure 1). Conclusion This population-scale study used anonymised individual-level linked data from multiple routinely collected data sources. In almost 300,000 women with a previous pregnancy, multiple pregnancy complications were associated with a higher risk of incident cardiovascular disease, including heart failure, ischaemic heart disease, stroke and atrial fibrillation. Women who experience multiple pregnancy complications may benefit from targeted intervention strategies to reduce their risk of incident cardiovascular disease. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): Saudi Arabia governmental PhD studentship

Twin Reversed Arterial Perfusion Sequence: Prenatal Diagnosis and Treatment

Abstract Twin reversed arterial perfusion sequence, a severe and unique complication of monochorionic multiple pregnancy, is characterized by vascular anastomosis and abnormal or absent cardiac development in the twins. This article reviewed its pathogenesis, prenatal ultrasound diagnosis, and management. The pump twin’s chances for survival can be maximized by proper management. The optimal timing of the interventions remains a debate, although the latest studies encourage early intervention, i.e., in the first trimester. The most preferred approach is to interrupt the vascular supply to the acardius, such as through ultrasound-guided laser coagulation and radiofrequency ablation of the intrafetal vessels.

Introduction to the immunology of pregnancy.

Introduction to the immunology of pregnancy.

Early detection of ischemic brain injuries by diffusion-weighted imaging after radiofrequency ablation for fetal reduction in monochorionic pregnancies.

This study aimedto investigate the additional advantages of magnetic resonance imaging (MRI), particularly diffusion-weighted imaging (DWI) over fetal ultrasound in the detection of acute ischemic cerebral injuries in complicated monochorionic (MC) pregnancies that underwent selective reduction by radiofrequency ablation (RFA). This prospective cohort study was conducted on 40 women with complicated MC pregnancies who were treated by RFA. Fetal brain imaging by DWI and conventional MRI was performed either in the early (within 10 days after RFA) or late phase (after 3-6 weeks) in the surviving fetuses to detect both acute and chronic ischemic injuries. The presence of anemia after RFA was also evaluated by Doppler ultrasound. Overall, 13 of the total 43 fetuses (30.23%) demonstrated MRI abnormalities with normal brain ultrasound results including germinal matrix hemorrhage (GMH), extensive cerebral ischemia, and mild ventriculomegaly. Although seven fetuses with GMH eventually survived, fetuses that demonstrated ischemic lesions and ventriculomegaly on MRI died in the uterus. The absence of abnormal cerebral lesions or anemia on ultrasound and Doppler exams does not necessarily rule out fetal brain ischemia. Performing early MRI, particularly DWI seems to be a reasonable option for detection of early intracranial ischemic changes and better management of complicated multiple pregnancies which were treated by RFA.

Perinatal complications in multiple pregnancies

Perinatal complications in multiple pregnancies

The psychological portrait of pregnant women with several complications of multiple pregnancy

BACKGROUND: Multiple pregnancies are high-risk pregnancies from both an obstetric and a psychological point of view.&#x0D; AIM: The aim of this study was to identify the features of prenatal experiences of women carrying multiple pregnancies and to determine the influence of several complications of multiple pregnancy on prenatal experience.&#x0D; MATERIALS AND METHODS: The study involved 80 individuals aged 19 to 43 years, at a gestational age of 21 to 39 weeks, carrying twins. The patients were divided into five groups by clinical diagnosis and were asked to complete psychodiagnostic questionnaire. The answers to the questions suggested both a quantitative assessment and a qualitative description of their experiences.&#x0D; RESULTS: We revealed some differences between the study groups in the frequency of manifestations of different psychological elements of the mothers gestational dominant. Some trends were also found for differences between the groups in terms of prenatal attachment rates. An analysis of pregnant womens descriptions of their ideas about the unborn children and communication with them showed that there were qualitative differences between the groups in the following: ideas about the characters of the unborn children, actual thoughts about them and thoughts about them after delivery, and features of the mothers communication with them in several emotional conditions. The data obtained allowed for describing the psychological portrait of pregnant women with several complications of multiple pregnancy.&#x0D; CONCLUSIONS: Depending on the type of multiple pregnancy complications, there are specific psychological experiences associated with pregnancy, future maternity and an emotional bond with the unborn children. Moreover, these experiences influence the behavior of pregnant women and their communication with other people and medical staff.

Prevalence of obstetric complications in multiple pregnancies treated at Hospital José Carrasco Arteaga - IESS, Cuenca-Ecuador from JUne 2014 to June 2019

BACKGROUND: Multiple pregnancy is the development of two or more fetuses simultaneously; but being the human species uniparous par excellence, MP is sensitive to the appearance of complications that affect both the mother and the fetuses, due to the high metabolic demand, hyperplacentation, and uterine distention. Among the most common obstetric and metabolic complications in women with MP are: premature delivery, hypertensive disorders of pregnancy, intrauterine growth restriction, premature rupture of membranes, gestational diabetes, anemia, urinary tract infection, hypothyroidism, and postpartum hemorrhage. The aim of this study is to identify the prevalence and risk factors related to obstetric and metabolic complications in multiple pregnancies. METHODS: An observational, descriptive and correlational cross-sectional study was carried out in the city of Cuenca, at Hospital José Carrasco Arteaga –IESS, during the period of June 2014 to June 201, in the department of obstetrics and gynecology (OBGYN), with a sample of 64 patients with multiple pregnancies. RESULTS: The results showed that 71.42% of the patients presented some of the studied complications. Preterm delivery was the most common obstetric complication, occurring in 79.7% of the patients, followed by preeclampsia, which occurred in 23.5%; while the most frequent metabolic complication was urinary tract infection ( in 37.5% of the patients), followed by anemia, which occurred in 25% of the patients. A statistically significant association (p&lt;0.05) was found between the patient`s age and the presence of premature rupture of membranes. CONCLUSION: 71.42% of women with multiple pregnancy had obstetric or other type of complications. Preterm delivery was the most frequent complication, followed by urinary tract infections, anemia, and preeclampsia. A significant association was found between the age of the mother and the occurrence of premature rupture of membranes.

Goals for Reaching Optimal Wellness (GROWell): A clinical trial protocol of a digital dietary intervention for pregnant and postpartum people with prenatal overweight or obesity

BackgroundExcess gestational weight gain (EGWG) is associated with multiple pregnancy complications and health risks for birthing people and their infants. Likewise, postpartum weight retention (PPWR), or not losing all pregnancy weight, has long-term health consequences. EGWG among people who enter pregnancy with overweight or obesity have worse obstetric outcomes and increased PPWR compared to women who gain within Institute of Medicine guidelines. MethodsThis study protocol describes the details of a blinded, randomized clinical trial of GROWell: Goals for Reaching Optimal Wellness, a mHealth tool designed to improve diet quality among people who enter pregnancy with overweight or obese BMIs to help them achieve appropriate GWG and safe postpartum pregnancy weight loss. Individuals with overweight and obesity will be randomly assigned to an attention control or intervention arm. The intervention group will receive personalized, goal-oriented text messages regarding dietary choices, while the attention control group will receive text messages about healthy pregnancy, labor, delivery, and early infancy. Both groups will complete online surveys at baseline, follow up, 3 and 6 months postpartum. Results and discussionCurrently, 162 subjects have been enrolled. Outcomes associated with GWG and pregnancy are expected in late 2023, while outcomes on postpartum weight retention GROWell adherence are expected in late 2024. The results of this trial will support the use of an evidence-based mHealth tool to be integrated into clinical practice to reduce EGWG and PPWR among pregnant people with overweight and obese BMIs, a resource that is currently lacking. Trial registrationClinicalTrials.gov identifier: NCT04449432. Registered on June 26, 2020.

Relationship between Physical Activity and Physical and Mental Health Status in Pregnant Women: A Prospective Cohort Study of the Japan Environment and Children's Study.

To discuss appropriate physical activity (PA) levels during pregnancy, this prospective cohort study examined the relationships between PA levels before and during pregnancy and physical and mental health status. Fixed data for 104,102 pregnant women were used from the Japan Environment and Children’s Study, of which data for 82,919 women were analyzed after excluding women with multiple birth and pregnancy complications. PA levels were measured using the International Physical Activity Questionnaire-Short Form. The 8-Item Short Form Health Survey was used to measure outcomes. Logistic regression with multiple imputations showed that moderate PA for over 720 min/wk and vigorous PA before pregnancy were associated with poorer mental health in the first trimester (adjusted odds ratio (AOR): 1.087–1.376. Walking in the second and third trimesters was associated with better physical and mental health (AOR: 0.855–0.932). Moderate PA over 1080 min/wk and vigorous PA in the second and third trimesters were associated with poorer mental health (AOR: 1.223–1.873). Increases over 4135.4 MET–min/wk and decreases in PA levels were associated with poorer mental and physical health (AOR: 1.070–1.333). Namely, pregnant women receiving health benefits prefer continuous walking in addition to avoiding vigorous PA and excessive changes in PA levels during pregnancy.

The Effects of Autologous Platelet-Rich Plasma on Pregnancy Outcomes in Repeated Implantation Failure Patients Undergoing Frozen Embryo Transfer: A Randomized Controlled Trial.

Repeated implantation failure (RIF) is a disorder in which good-quality embryos fail to implant in the endometrium following several in vitro fertilization (IVF) cycles. This study aimed to evaluate the efficiency and safety of intrauterine infusion of platelet-rich plasma (PRP) in improvement of pregnancy outcomes in RIF patients undergoing frozen embryo transfer (FET). A total of 438 women with a history of RIF undergoing FET were assessed for eligibility to enter the study. Patients were randomly assigned to the intervention (PRP) and control groups. The intervention group received an intrauterine infusion of 0.5 ml PRP 48 h before embryo transfer while the control group received standard treatment. The rates of chemical and clinical pregnancy were defined as the primary outcome values. All women were followed up until the study endpoints that included the number of neonates born and pregnancy-related complications. Three hundred and ninety-three participants accomplished the study and their data were analyzed. The chemical pregnancy, clinical pregnancy, and live birth rates were higher in the PRP group than control group (p value: <0.0001; p value: <0.0001; p value: <0.0001 respectively). However, there were no significant differences between the two groups in terms of multiple pregnancies and pregnancy complications except for spontaneous abortion. The spontaneous abortion rate was significantly higher in the control group compared to the PRP group (p value = 0.0262). These results suggest that intrauterine infusion of PRP is an effective and safe route to improve pregnancy outcomes in RIF patients undergoing FET.

EARLY PREGNANCY OUTCOMES AFTER IVF AND SLEEP DISORDERED BREATHING

While sleep disordered breath (SDB) is associated with multiple medical comorbidities and adverse late stage pregnancy complications such as preeclampsia and gestational diabetes, there is little understanding of its impact on early pregnancy outcomes after IVF. Patients between 18 to 45 years old undergoing autologous IVF and anticipating an embryo transfer were eligible for participation in this single-arm prospective observational study. Women with current treatment of obstructive sleep apnea were excluded. Demographics, medical history, and sleep surveys including the STOP-BANG Questionnaire, Epworth Sleepiness Survey, Pittsburgh Sleep Quality Index, and the Insomnia Severity Index were collected. Participants completed a single night of home sleep monitoring prior to IVF with a novel sensor system composed of two wireless patches located at the suprasternal notch and the index finger (ANNE Sleep, Sibel Health), which collected continuous measurements of heart rate, respiratory rate, peripheral arterial tonometry, temperature, blood pressure, and pulse oxygenation. Sleep nights were reviewed for SDB determined by an apnea hypopnea index (AHI), defined as the average number of apneic events per hour based on American Academy of Sleep Medicine scoring guidelines. IVF cycle and early pregnancy outcomes were followed to at least 12 weeks. The primary exposure was SDB (AHI 5 events/hr) and the primary outcome was rate of clinical pregnancy (defined as intrauterine gestational sac with a yolk sac) after IVF. Continuous variables were compared using Student’s t-test or Mann–Whitney U test based on normality, while χ2 or Fisher’s exact tests were used to compare categorical variables by SDB exposure. Logistic regression assessed predictors of clinical pregnancy after adjusting for confounders. A total of 30 subjects were recruited from an academic fertility center. The overall rate of SDB was 58%. Participants with SDB had a mean AHI of 13.4 compared to 2.7 events/hr (p<0.01), were younger, and more likely to have ovulatory dysfunction. There were otherwise no significant differences in body mass index (BMI), parity, IVF cycle stimulation parameters, embryological yield, or sleep survey results. Clinical pregnancy occurred in only 38% of women with SDB vs 64% in those without (p=0.18). After adjusting for age, BMI, and ovulatory dysfunction, SDB was an independent risk factor for reduced clinical pregnancy rates (aOR 0.13, 95% CI: 0.02-0.83, p=0.03). Though SDB occurred more frequently among women with ovulatory dysfunction (88% vs 46%, p=0.04), SDB remained a risk factor for unsuccessful pregnancy after IVF, independent of underlying infertility diagnosis. Sleep disordered breathing of any severity is associated with an 87% (95% CI: 0.02-0.83) lower likelihood of clinical pregnancy after IVF.