Disorders Of Pregnancy Research Articles

Management of Thyroid Disorders in Pregnancy: Green-top Guideline No. 76.

Management of Thyroid Disorders in Pregnancy: Green-top Guideline No. 76.

Maternal exposure to particulate matter and nitrogen oxides during pregnancy and attention deficit hyperactivity disorder in offspring: a systematic review and meta-analysis

Abstract Objectives Attention deficit hyperactivity disorder (ADHD) is the most prevalent neurodevelopmental condition in Australia, with one in 20 children diagnosed. Air pollutants have been associated with poorer child neurodevelopmental outcomes. This systematic review and meta-analysis aims to determine the association between particulate matter (PM2.5, PM10), and nitrogen oxide (NOx) exposure during pregnancy and the development of ADHD in offspring. Content We searched MEDLINE; CINAHL; EMBASE; PsycINFO; The Cochrane Library and Google Scholar (until March 2023), and included English language, human studies if they investigated the association between PM2.5, PM10, and/or NOx (NO and/or NO2) exposure during pregnancy and a clinician-based ADHD diagnosis up to 18 years of age. Three studies met these criteria, with two suitable for meta-analysis due to comparable NOx exposure data. Summary For every 10 μg/m3 increase in maternal NOx exposure during pregnancy, there was a 9 % increased odds of ADHD diagnosis in childhood (adjusted odds ratio 1.09; 95 % confidence interval: 1.01–1.17). Outlook Our findings add to the evidence for an association between air pollution exposure during pregnancy and alterations in offspring neurodevelopment. Since there were only two studies which could be meta-analysed and a very low certainty of the evidence, more research is needed to confirm these findings and inform future interventions and policy.

Increase of augmentation index (AIx@75): a promising tool for screening hypertensive pregnancy disorders

BackgroundScreening tools in the first trimester of pregnancy for hypertensive pregnancy disorders need to be determined.ObjectivesTo compare cardiovascular parameters between pregnant (PG) and non-pregnant women (NPG) and to evaluate the sensitivity and specificity of arterial stiffness indices in screening for hypertensive pregnancy disorders and their possible association with the mean uterine artery pulsatility index (MUA-PI).MethodsThis study included 77 pregnant women (11-13.6 gestational weeks) and 77 age-matched non-pregnant women. Cardiovascular parameters were non-invasively measured using Mobil- O-Graph®, a cuff-based oscillometric device. The Doppler Ultrasonographic was used to evaluate the MUA-PI.ResultsAugmentation index (AIx@75) was significantly higher in PG compared to NPG. ROC curve of AIx@75 showed area under curve (AUC): 0.7303, Sensitivity: 74.03% and Specificity: 64.94% and Cutoff: 22.50%. The systolic volume index was lower and the heart rate was higher in PG compared to NPG. Of the 77 pregnant women, 12 had an unfavorable outcome with hypertensive changes. Central systolic blood pressure (109.1 ± 8.84mmHg) and AIx@75 (31.97 ± 5.47%) were significantly higher in the group of pregnant women with outcome compared to the group without outcome (103.0 ± 8.53mmHg and 26.80 ± 8.71%). ROC curve showed better performance of the AIx@75 [AUC: 0.7179, Sensitivity: 83.33% and Specificity: 60.00%, Cutoff: 27.67%] compared to MUA-PI [AUC: 0.5098, Sensitivity: 8.333% and Specificity 98.44%].ConclusionsAIx@75 was significantly higher in PG compared to NPG. We compared the AIx@75 of PG with and without outcomes. ROC curve analysis showed that this index could discriminate between PG with and without an outcome. Differently, the MUA-PI did not differ between PG with and without outcome, suggesting the superiority of AIx@75 in relation to MUA-PI as a method of screening in the first trimester for hypertensive disease of pregnancy. AIx@75 did not assotiate with MUA-PI. Prospective studies will be needed to confirm these findings.

Genetic Risk and First-Trimester Cardiovascular Health Predict Hypertensive Disorders of Pregnancy inNulliparous Women.

Genetic Risk and First-Trimester Cardiovascular Health Predict Hypertensive Disorders of Pregnancy inNulliparous Women.

Adverse pregnancy outcomes and risk of atrial fibrillation: findings from the HUNT study.

Despite well-studied associations between hypertensive disorders of pregnancy (HDP) and atrial fibrillation (AF), the mechanisms of the excess risk of AF in women with history of HDP are not fully understood. Furthermore, little is known about associations between other adverse pregnancy outcomes (APOs) and AF, including preterm birth, small/large-for-gestational age (SGA/LGA) offspring. By linking the population-based HUNT study with the Medical Birth Registry of Norway (MBRN) and electronic patient administrative systems, 15,104 women ≥45 years with 34,674 births were followed and assessed for validated AF for a median of 12.9 years. Information on APOs was retrieved from the MBRN. We used Cox proportional hazards models to calculate hazard ratios (HR) for associations of APOs with risk of AF. By inverse odds ratio weighting, we assessed modifiable AF risk factors that could explain the associations. Among women aged 45-65, those with HDP had a higher risk of AF [HR 2.03, 95% confidence interval (CI) 1.27-3.24] as women without HDP, but not among women >65 years [HR 0.95, 95% CI 0.57-1.60]. A history of LGA was associated with increased risk of AF [HR 1.38, 95% CI 1.03-1.84], but histories of preterm birth or SGA were not [HR 0.94, 95% CI 0.63-1.41, HR 0.90, 95% CI 0.66-1.23]. Postpregnancy body mass index (BMI) might possibly explain about 45% of the associations between HDP or LGA and AF. Women with history of hypertensive disorders of pregnancy or large-for-gestational age offspring are at higher risk of atrial fibrillation.

Frozen embryo-transfer: a review on the optimal endometrial preparation.

Frozen-thawed embryo transfer (FET) has become a widely adopted method in assisted reproductive technology (ART), thanks to the advancements in vitrification techniques. FET now accounts for a significant proportion of ART cycles, but there is still no clear consensus on the optimal protocol for endometrial preparation. This review aims to evaluate the reproductive outcomes of three commonly used FET protocols: natural cycle (NC), modified natural cycle (mNC), and artificial cycle (AC), with a focus on implantation rates, clinical pregnancy rates (CPR), live birth rates (LBR), and obstetric complications such as hypertensive disorders of pregnancy (HDP) and preeclampsia (PE). Studies published between 2014 and 2024 were reviewed and compared across these protocols. The results show that NC and mNC protocols are associated with higher CPR and LBR compared to AC. AC, on the other hand, is linked to an increased risk of HDP and PE, likely due to the absence of a functional corpus luteum (CL), which plays a vital role in early pregnancy support. The presence of a CL appears to be crucial for minimizing obstetric complications, making NC and mNC preferable options. Future research is needed to refine FET protocols, focusing on personalized approaches to endometrial preparation that optimize both pregnancy outcomes and maternal health.

Prevalence, Incidence, and Temporal Trend of Hypertensive Disorders of Pregnancy and Its Association with Adverse Perinatal Outcomes in High and Low-Middle Income Countries: A Narrative Review

Hypertensive disorders of pregnancy (HDP) are the predominant pregnancy complication in both high and low-middle-income countries. The age-standardized incidence rate and the absolute incidence number of HDP in low-middle-income countries are 2-fold and 4-fold higher than in high-income countries in 2021, respectively. However, the reduction in the age-standardized prevalence rate (-41.1% vs. -8.7%) and incidence rate (-40.8% vs. -7.1%) of HDP is ≈5-fold faster in low-middle income countries compared with high-income countries between 1990 and 2021. Moreover, HDP is significantly associated with the increased risk of adverse perinatal outcomes, including preterm birth, low birth weight, and perinatal mortality in both high and low-middle-income countries. In the current review, we have highlighted the prevalence, incidence, and temporal trend of HDP and its association with adverse perinatal outcomes in high and low-middle-income countries.

Maternal deaths due to hypertensive disorders of pregnancy in Brazil from 2012 until 2023: a cross-sectional populational-based study

ABSTRACT Objective This study evaluated the maternal deaths due to hypertensive disorders in Brazil from 2012 until 2023. Methods We performed a cross-sectional study including public data from Brazilian Ministry of Health, including age group, self-reported skin color, and geographical region. The Maternal Mortality Ratio (MMR) was calculated for each year and for the entire period; we estimated the prevalence ratio (PR), confidence interval (CI) and trend (R2) of MMR according to the variables included. Results We analyzed 3,721 deaths attributed to complications of hypertension (MMR = 11.01/100,000 live births; R2 = 0.03). Those deaths were most prevalent among women aged 30 and older (PR 1.73, CI 1.61–1.85), especially those over 40 (PR 3.77, CI 3.34–4.25). Black (PR 2.75, CI 2.46–3.06), mixed-race (Pardo) (PR 1.27, CI 1.18–1.37), and Indigenous (PR 2.28, CI 1.76–2.97) women had significantly higher MMRs compared to White women. Central-West (PR 1.30, CI 1.13–1.46), North (PR 1.92, CI 1.74–2.13), and Northeast (PR 1.82, CI 1.68–1.97) regions had the highest maternal mortality rates due to hypertension. MMR due to hypertensive disorders of pregnancy in Brazil remained stable. Conclusion Women at higher risk of dying were older, Black, Indigenous, Pardo, and lived in the Central-West, North, and Northeast regions of the country.

History of pre‐eclampsia negatively impacts stroke severity postpartum in rats

AbstractBackgroundPre‐eclampsia (PE) is a serious hypertensive disorder of pregnancy with lifelong deleterious effects including an increased risk of stroke postpartum (PP). In the present study, we aimed to determine whether previous PE exacerbates ischemic injury during PP and investigate the underlying mechanisms.MethodsFemale Sprague‐Dawley rats were studied at 4–9 months PP after either a normal pregnancy postpartum (NormP‐PP, n = 7) or experimental PE (ePE) induced using a high‐cholesterol diet (ePE‐PP, n = 9). The animals underwent transient middle cerebral artery occlusion for 2 h with 1 h of reperfusion. Dual‐site laser Doppler flowmetry was used to measure cerebral blood flow changes in the middle cerebral artery and collateral territories. Ischemic injury was measured using 2,3,5‐triphenyl tetrazolium chloride staining. Circulating 8‐isoprostane, 3‐nitrotyrosine, and oxidized low‐density lipoprotein levels were measured using enzyme‐linked immunosorbent assays. In separate groups of animals, NormP‐PP (n = 10) and ePE‐PP (n = 9) at 3–4 months PP, isolated pial collateral vessels, leptomeningeal anastomoses, and mesenteric arteries were studied using pressure myography.ResultsPrevious ePE worsened stroke outcome in the PP period, significantly increasing infarction and edema in ePE‐PP compared to NormP‐PP animals (40.6 ± 7.6% vs. 13.7 ± 6.5%, p < 0.01; 5.1 ± 2.0% vs. 2.6 ± 0.4%, p < 0.01) despite comparable changes in cerebral blood flow in the middle cerebral artery and pial collateral territories during ischemia and reperfusion. When infarction was analyzed as a function of perfusion deficit, the ePE‐PP animals showed greater sensitivity to ischemia. Pial collaterals had increased pressure‐induced myogenic tone in ePE‐PP compared to NormP‐PP rats. Percentage tone at 80 mmHg for ePE‐PP vs. NormP‐PP was 15.5 ± 1.6% vs. 8.6 ± 1.9% (p < 0.01). ePE‐PP animals showed significantly elevated levels of circulating 8‐isoprostane and 3‐nitrotyrosine but not oxidized low‐density lipoprotein after transient middle cerebral artery occlusion (p < 0.05, and p < 0.01, respectively).ConclusionsWorsened stroke outcomes after ePE pregnancy were related to increased ischemia sensitivity, increased pial collateral tone, and elevated levels of oxidative stress markers. Thus, the pathological effects of ePE persisted PP and negatively affected stroke outcomes.

Thyroid disease as a teratogen.

Thyroid disease as a teratogen.

Effectiveness of Telehealth for Disease Management During the Perinatal Period: A Scoping Review.

Introduction: Many perinatal services to manage chronic diseases transitioned to telehealth following the onset of the coronavirus disease 2019 (COVID-19) pandemic. This study was conducted to review the literature and summarize the effectiveness of telehealth for diabetes, hypertensive disorders of pregnancy (HDP), mental health (anxiety and depression), and opioid use disorder (OUD) management during the perinatal period postonset of COVID-19. Methods: PubMed, CINAHL, Web of Science, and IEEE Xplore databases were searched for articles published between 2020 and 2023 using keywords (COVID-19) and (maternal, maternity, obstetrics, perinatal, pregnancy) and (telemedicine, telehealth). Inclusion criteria were: intervention or change in practice with clinical results, postonset of COVID-19, English language, and addressed disease management (i.e., diabetes, hypertension, mental health, OUD) during pregnancy or postpartum. Exclusion criteria were: commentary, guideline, protocol, or review articles and perspectives. Results: The review included 24 articles, including 7 randomized controlled trials. Articles evaluated diabetes (N = 9), HDP (N = 4), mental health (N = 10), and OUD (N = 1). One-half (N = 12) were conducted in the United States and telehealth interventions (e.g., app, videoconferencing, audio visits) and clinical effectiveness varied by disease state. Most studies reported at least one positive outcome of telehealth (N = 19, 79.2%); however, some also reported negative outcomes (N = 8, 33.3%). Glycemic control was adequately achieved in most studies (N = 8, 88.9%), and the majority of studies (N = 3, 75%) reported positive or neutral results for the management of HDP. Various telehealth interventions resulted in lower anxiety and depression symptoms. Only one study examined OUD and reported negative outcomes. Conclusions: Telehealth offered effective management of diabetes, hypertension, anxiety, and depression in perinatal women and often improved patient outcomes during COVID-19. Therefore, telehealth should continue to be offered to perinatal women with these chronic conditions as appropriate for individual and clinical situations. More research is needed to evaluate the effectiveness of telehealth interventions for OUD management.

Effect of Continuous Positive Airway Pressure or Positional Therapy Compared to Control for Treatment of Obstructive Sleep Apnea on the Development of Gestational Diabetes Mellitus in Pregnancy: Protocol for Feasibility Randomized Controlled Trial.

Obstructive sleep apnea (OSA) is a common sleep disorder, and in pregnancy, it is associated with an increased risk of complications, including gestational diabetes mellitus and preeclampsia. Supine sleep may worsen OSA, and in pregnancy, it is associated with an increased risk of stillbirth due to effects on fetomaternal blood flow. Continuous positive airway pressure (CPAP) therapy is considered the gold-standard treatment for moderate to severe OSA, although compliance is frequently poor; positional therapy (PT) is generally less effective than CPAP in nonpregnant patients but may be better tolerated and more accessible during pregnancy. There is limited data on whether widespread, early screening for sleep disorders in pregnant women with symptoms of sleep-disordered breathing or at high risk of metabolic complications and subsequent early intervention with CPAP or PT attenuates fetomaternal risks. This study aims to determine the feasibility of conducting a randomized controlled trial to assess improved fetomaternal outcomes in a high-risk pregnant population with OSA, using CPAP or PT, initiated by the 16th week of gestation. This study is a randomized, controlled, open-label feasibility study in which pregnant women with an apnea-hypopnea index (AHI) or respiratory disturbance index (RDI) ≥5 are treated with CPAP (auto-titrating and fixed pressure) or positional therapy from early gestation (by 16 weeks) until delivery. The primary outcome is the feasibility of the study protocol and the development of gestational diabetes mellitus by the 28-week gestation period. Secondary outcomes include the development of hypertensive disorders of pregnancy (HDP), maternal weight gain, uterine artery blood flow, glycemic control during pregnancy (in participants who develop gestational diabetes), changes in maternal circulating biomarkers, and neonatal birthweight complications. Polysomnography at 28- to 32-week gestation period, postpartum polysomnography, therapy compliance, and patient acceptability are also assessed. The trial commenced on September 30, 2019. The trial is ongoing as of August 6, 2024. The trial intends to contribute to the growing evidence base to support the need for the identification and treatment of OSA occurring during pregnancy and to assess the feasibility of the study protocol. This will be the first trial to compare the early initiation of CPAP (auto-titrating and fixed pressure) and positional therapy in pregnant women from early gestation, providing alternative therapies for the treatment of OSA in this important population. Australian New Zealand Clinical Trials Registry ACTRN12619001530112; https://tinyurl.com/yctdzs4u. DERR1-10.2196/51434.

Development a nomogram for predicting HELLP syndrome in women complicated with gestational hypertension

ObjectivesThe unpredictability of HELLP syndrome and the severe adverse outcomes for both mother and children make it especially important for us to seek predictive model. This study aimed to develop a clinically accessible prediction model for assessing the risk of HELLP syndrome progression in patients with hypertensive disorders of pregnancy (HDP) and find effective factors that may predict the progression of HELLP within 3 days.MethodsWe used electronic data from Women’s Hospital, Zhejiang University School of Medicine, between January 1,2014 and December 31,2023. A total of 808 patients were included in this study, including 607 patients in the non-HELLP syndrome group and 201 patients in the HELLP syndrome group. We collected clinical and laboratory information, and conducted single- and multiple-factor logistic regression analyses to identify independent factors influencing the occurrence of HELLP syndrome and the onset of HELLP syndrome within 3 days. A nomogram was constructed based on these predictors to provide a visual representation of risk estimation. The model’s performance was evaluated through internal and external validation, with metrics such as the area under the curve(AUC), receiver operating characteristic curve (ROC), precision, recall, and F1 score. Calibration and decision curve analyses were also performed to assess model robustness and clinical utility.ResultsMultiple logistic regression analysis indicated prenatal BMI, neurologic symptoms, other system symptoms, 24-h urine protein, lowest SBP at admission, lowest DBP at admission, prenatal albumin, prenatal platelet and prenatal blood urea nitrogen as independent factors of HELLP syndrome. The prediction model achieved an AUC of 0.975 (95% CI: 0.966–0.985) in the internal validation dataset with a sensitivity of 0.962(95% CI: 0.962–1.000) and specificity of 0.885(95% CI: 0.962–1.000). The AUC of the external validation dataset was 0.838 (95% CI: 0.785–0.892). The optimal cutoff value calculated using Youden’s index was 0.613, with a sensitivity of 0.891(95% CI: 0.473–0.836) and specificity of 0.722(95% CI: 0.667–0.818). In multivariate regression analysis, blood urea nitrogen and the creatinine-to-blood urea nitrogen ratio were significant predictors in predicting HELLP syndrome within 3 days. The sensitivity was found to be 0.68 and 0.65, specificity to be 0.74 and 0.686 respectively.ConclusionsThis study successfully developed and validated a prediction model that can reliably predict the risk of HELLP syndrome in HDP patients. And blood urine nitrogen and the ratio of creatinine over blood urea nitrogen could be efficient predictors of HELLP syndrome occurring within 3 days.

Risk of Adverse Pregnancy Outcomes Among Asian Individuals With Gestational Diabetes Mellitus in the U.S., 2016-2021.

The risk of adverse pregnancy outcomes (APOs) differs among race and ethnic groups with gestational diabetes mellitus (GDM). Heterogeneity in APOs may be masked by aggregating these groups. We assessed whether the frequency and risk of APOs differed among Asian groups with GDM. This is a serial cross-sectional analysis of U.S. birth certificate data (2016-2021) from individuals with a singleton first livebirth. The exposure was self-reported maternal race and ethnicity stratified by Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese versus non-Hispanic White as the reference. Maternal outcomes included: primary cesarean delivery, hypertensive disorders of pregnancy (HDP), intensive care unit admission, and transfusion. Neonatal outcomes included large-for-gestational-age (LGA), small-for-gestational-age (SGA), preterm birth, and neonatal intensive care unit (NICU) admission. The study population included 29,370 Indian, 16,146 Chinese, 9,082 Filipino, 6,497 Vietnamese, 3,754 Korean, and 1,253 Japanese individuals, and 254,433 White individuals. Between 2016 and 2021, the frequency of HDP, but not other APOs, increased among most Asian groups. In multivariable analyses, individuals in all Asian groups had higher likelihood of SGA and lower likelihood of LGA compared with White individuals. Findings for other APOs were heterogeneous. The risk of APOs was generally highest among Filipino individuals, followed by Indian individuals, and lowest among Chinese individuals among Asian groups. There was significant heterogeneity in the frequency and risk of APOs among Asian individuals with GDM in the U.S. Disaggregation of the Asian population in diabetes and pregnancy research and surveillance is necessary to identify opportunities for intervention.

Heat Stress and Placental Abruption: A Space-Time Stratified Case-Crossover Study.

To examine whether heat stress, measured by wet bulb globe temperature (WBGT), a comprehensive heat stress index is associated with placental abruption within 7 days. A space-time-stratified case-crossover design. All 11 regions in Japan during the warm season (June-September) from 2011 to 2020. 6947 cases of placental abruption were registered in the Japan Perinatal Registry Network database. Quasi-Poisson regression with distributed lag linear models assessed the association between heat stress, defined as daily maximum WBGT exceeding the 95th percentile of the regional distribution during the warm season, and daily placental abruption cases over a lag period of 0-7 days. Stratified analyses examined gestational week (preterm vs. term), hypertensive disorders of pregnancy (HDP), and small for gestational age (SGA). Clinical diagnosed placental abruption. Heat stress was associated with an increased risk of placental abruption on lag 1 (relative risk [RR]: 1.23, 95% confidence interval [CI]: 1.11-1.39) and lower risk on lag 2 (RR: 0.84, 95% CI: 0.74-0.95), with negligible cumulative risk over lag 0-7 due to counterbalancing effects. Similar patterns were observed in preterm and term pregnancies. Individuals with HDP showed a higher risk on lag 1 (RR: 1.57, 95% CI: 1.31-1.88), as did those with SGA infants (RR: 1.47, 95% CI: 1.26-1.73). Heat stress during pregnancy may increase the risk of placental abruption on the day after exposure, potentially advancing cases that might have occurred later, particularly in individuals with HDP or SGA infants.

Sedentary Behavior and Light-Intensity Physical Activity During Pregnancy and Cardiovascular Health: A Science Advisory From the American Heart Association.

The Physical Activity Guidelines for Americans supports sitting less and moving more. Growing evidence suggests that a waking behavior profile with less sedentary behavior and more light-intensity physical activity is associated with more favorable cardiovascular health. Remarkably, little is known about how these behaviors relate to cardiovascular health during pregnancy. The purpose of this American Heart Association science advisory is to describe the existing evidence on device-measured sedentary behavior and light-intensity physical activity in relation to cardiovascular health during pregnancy and to make specific calls to action for future research to improve health outcomes and to promote health equity. Outcomes included adverse pregnancy outcomes associated with increased risk of cardiovascular disease and the American Heart Association's Life's Essential 8 health factor components (blood pressure, lipids, glucose, and gestational weight gain). Findings from observational studies are mixed, with preliminary evidence demonstrating an association between high sedentary behavior and increased risk of hypertensive disorders of pregnancy, shorter gestational age at delivery, low or high birth weight, and elevated maternal blood pressure, lipids, glucose, and gestational weight gain. Findings for light-intensity physical activity are limited by fewer studies and are less compelling. Experimental evidence evaluating the impact of decreasing sedentary behavior or increasing light-intensity physical activity on pregnancy cardiovascular health is weak. Future observational studies with rigorous longitudinal designs and larger, diverse samples are needed to characterize associations and to inform the design of adequately powered randomized controlled trials testing the impact of decreasing sedentary behavior and increasing light-intensity physical activity on cardiovascular health during pregnancy.

AI in Hypertensive Disorders of Pregnancy: Review.

Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal and fetal mortality worldwide. Early detection and risk stratification are critical for timely intervention to prevent severe complications such as eclampsia, stroke, and preterm delivery. However, traditional clinical methods often lack the precision needed to identify high-risk individuals effectively. Machine learning (ML) has emerged as a powerful tool, leveraging complex data to enhance prediction, diagnosis, and clinical decision-making in HDP. This review aims to systematically evaluate ML applications in HDP, highlighting trends, methodologies, and gaps to guide future research and improve maternal and fetal outcomes. This study adheres to the PRISMA-ScR guidelines for scoping reviews, focusing on full-text, English-language publications that apply ML models to HDP. A comprehensive search across three databases captured studies involving at-risk patient populations. Data extraction followed the CHARMS checklist, summarizing study characteristics, outcomes, and ML methodologies, while also identifying gaps and opportunities for further research. Most studies targeted preeclampsia (n=70, 75.27%), with limited focus on other HDP phenotypes such as gestational hypertension (n=4, 4.3%) and postpartum hypertension (n=1, 1.07%). Sample sizes ranged from 20 to over 700,000 participants. Studies have been increasing since 2014 emphasizing diagnosis/onset detection (n=58, 62.37%) and risk prediction (n=26, 27.95%). Random Forest, Logistic Regression, Decision Trees, and SVM were the most common ML methods. Geographic analysis revealed concentration in China (n=29, 31.18%) and North America (n=18, 19.35%), with underrepresentation in other regions. Input data predominantly comprised demographics (n=50, 53.76%), patient/family history (n=43, 46.24%), and functional tests (n=43, 46.24%), whereas omics (n=29, 31.18%) and imaging data (n=2, 2.15%) were infrequently used. Outcomes related to time-to-intervenes and readmission were each reported once. Machine learning is increasingly applied to HDP, with significant growth in diagnostic and risk prediction models. However, geographic disparities, limited phenotype representation, and models to help intervene at critical time points throughout the perinatal lifecycle remain barriers. Notably, models addressing time-to-intervene predictions and hospital readmissions are underrepresented, highlighting critical gaps in the current literature. Addressing these limitations-by developing models to help improve the timing of medical interventions, higher risk profiling, and diverse datasets-can advance ML's role in improving maternal and fetal outcomes and reducing mortality globally. Future research should focus on refining ML models to support clinicians and advance care for patients with HDP.

Comparing umbilical cord arterial blood gas findings in pregnancies with and without gestational diabetes mellitus following elective cesarean section: a multicenter retrospective cohort study in Iran

BackgroundGestational diabetes mellitus (GDM) is linked to adverse fetal outcomes like macrosomia and neonatal hypoglycemia, with its global incidence increasing. While prior research indicates GDM may impair placental function and fetal oxygen delivery, direct evidence is limited. This study compares umbilical cord arterial blood gas measurements in pregnancies with and without GDM.MethodsThis retrospective study analyzed medical records from four hospitals in Tehran, Rasht, Ahvaz, and Isfahan in Iran, focusing on term singleton pregnancies (gestational age ≥ 37 weeks) that underwent elective cesarean sections between January and July 2024. Exclusions included maternal age < 18 or > 45 years, pre-existing diabetes, thyroid, hypertensive, malignant, metabolic, or autoimmune disorders, intrauterine growth restriction, hypertensive disorders of pregnancy, and substance use during pregnancy. GDM was diagnosed using a 75-gram oral glucose tolerance test at 24–28 weeks. Primary outcomes included umbilical cord arterial blood gas measures (potential of hydrogen [pH], partial pressure of carbon dioxide [PCO2], partial pressure of oxygen [PO2], bicarbonate [HCO3], and base deficit). The neonatal outcomes were measured as secondary outcomes. Statistical analyses utilized Chi-square, Fisher’s exact, and independent t-tests.ResultsData from 430 pregnancies, including 87 with GDM, were analyzed. Pregnancies with GDM showed significantly lower pH (7.33 ± 0.08 vs. 7.36 ± 0.06, P-value = 0.006) and greater base deficit (-1.82 ± 3.79 vs. -0.50 ± 2.74 mEq/L, P-value = 0.003). However, no significant between-group differences were observed in PCO2, PO2, or HCO3 (P-value > 0.05). Furthermore, we observed no significant differences in the mean birthweight, 1-minute, or 5-minute Apgar scores (P-values > 0.05), while neonates in the GDM group required more resuscitation (28.7% vs. 12.0%, P-value < 0.001) and neonatal intensive care unit admissions (34.5% vs. 16.9%, P-value < 0.001).ConclusionsPregnancies with GDM showed higher umbilical cord blood acidity, indicating impaired placental function and reduced fetal oxygenation. These findings underscore the need for enhanced monitoring, such as regular fetal surveillance and close glycemic control, along with timely interventions like early neonatal resuscitation protocols and preparedness for neonatal intensive care unit admissions, to mitigate impaired fetal oxygenation in GDM.Trial registrationNot applicable.

Oral antihypertensive treatment during pregnancy: a systematic review and network meta-analysis.

Considering safety and effectiveness of oral antihypertensive agents when treating hypertensive disorders of pregnancy, no preference can be stated between the three agents currently available. Therefore, this systematic review and network meta-analysis aims to determine the effects of antenatal treatment with methyldopa, labetalol or nifedipine for hypertensive disorders of pregnancy regarding maternal or fetal/neonatal morbidity and mortality. On August 25th, 2023, an electronic search in PubMed/Medline, Embase and CENTRAL was performed. RCTs reporting on perinatal outcomes in hypertensive pregnancies treated with oral antihypertensive agents of interest (methyldopa, labetalol or nifedipine) or placebo/no treatment were identified. Quality assessment was performed using the Cochrane Risk-of-Bias tool for RCTs and trustworthiness was assessed with the Trustworthiness in RAndomised Controlled Trials Checklist. Data on our predefined outcomes was extracted and relative risks were calculated in network estimates if possible. 23 trials (3989 women) were included in our network meta-analysis with an overall low-to-moderate quality. Compared to placebo/no treatment, labetalol and methyldopa significantly reduced the incidence of severe hypertension (including 8 studies, relative risk 0.20 (95% confidence interval 0.09-0.48); and 0.44 (0.20-0.99); respectively. In the network meta-analysis labetalol versus nifedipine was associated with a reduction in preeclampsia (relative risk 0.50 (0.28-0.87); 15 studies) and preterm birth (relative risk 0.68 (0.52-0.90); 14 studies). No significant differences could be detected for any of the other outcomes of interest. When comparing the oral antihypertensive agents currently available head-to-head no significant differences on the primary outcome severe hypertension could be detected as well as on most of the secondary outcomes of interest. Considering the preference of labetalol over nifedipine regarding the outcomes preeclampsia and preterm birth a modest favor for labetalol could be stated. Included studies however were of low overall quality warranting caution when interpretating results.

Outcomes of pregnancy-related acute kidney injury: A retrospective study in the obstetric critical care unit at Kenyatta National Hospital 2020 to 2023.

Pregnancy-related acute kidney injury (PrAKI) is defined as a rapid decline in kidney function in the pregnancy or puerperal period that can result in life-threatening organ dysfunction. This study aimed to investigatesocio-demographicfeatures of critically ill women with pregnancy-related acute kidney injury as well as their maternal and foetal outcomes. Retrospective analysis of data in patients with pregnancy-related kidney injury in the obstetric critical care unit at a public tertiary referral centre in Kenya between February 2020-2023. Of the 266 patient files reviewed, pregnancy-related acute kidney was found in 203 patients. The main predisposing factors for acute kidney injury were hypertensive disorders in pregnancy (64.1%), obstetric haemorrhage (38.4%) and sepsis (36.5%). According to KDIGO (Kidney Disease Improving Global Outcomes) criteria, 44 patients presented in stage 1 (21.7%), 58 in stage 2 and 101 in stage 3 (49.8%). Patients with KDIGO stage 3 had a higher risk of high SOFA (Sequential Organ Failure Assessment) score (p =< 0.001), longer ICU stay (p = 0.008) and longer duration on ventilation (p = 0.010). Seventy-six patients underwent dialysis (37.4%). Recovery of renal function was complete in 91 patients (44.8%), partial in 41 (20.2%) with dependence on dialysis seen in 23 (23.6%). Forty-eight patients died (23.6%). Risks associated with mortality were mechanical ventilation (p = 0.001) and inotropic support (p =< 0.001) with statistically significant higher mean SOFA scores in those who died versus those who survived (12.6 ± 3.8 p =< 0.001 vs 8.6 ± 3.2). The incidence of PrAKI is still underestimated in the Kenyan setting with the majority of the patients presenting with advanced renal injury. These patients are at higher risk of adverse maternal morbidity and mortality in the critical care setting.