Miscarriage Research Articles

Risk Factors of Thrombophilia-Related Mutations for Early and Late Pregnancy Loss.

Background and Objectives: This retrospective cohort study investigates the role of genetic thrombophilia in pregnant women experiencing early pregnancy loss compared to those with late pregnancy loss. Materials and Methods: Participants were categorized into early and late pregnancy loss groups based on gestational age. A total of 156 patients were included, out of which 103 had early-trimester pregnancy losses and 96 had multiple miscarriages. Results: The study revealed a synergistic effect of Factor V Leiden (FVL G1691A) and Methylenetetrahydrofolate Reductase (MTHFR C677T) mutations (coefficient 3.42). Prothrombin (PT) G20210A and β-Fibrinogen 455 G>A mutations exhibited a significant interaction (coefficient 1.98). Additionally, MTHFR A1298C and Plasminogen Activator Inhibitor-1 (PAI-1 4G/5G) mutations showed a significant interaction (coefficient 1.65). FVL G1691A and Endothelial Protein C Receptor (EPCR) allele A1/A2 mutations also demonstrated a significant association (coefficient 2.10). Lastly, MTHFR C677T and Glycoprotein IIb/IIIa T1565C mutations interacted significantly (coefficient 1.77). Risk factor analysis identified several mutations associated with early pregnancy loss, including PAI-1 4G/5G homozygous (OR 3.01), FVL G1691A heterozygous (OR 1.85), and MTHFR A1298C heterozygous (OR 1.55). Both homozygous and heterozygous MTHFR C677T mutations were significant risk factors (OR 2.38; OR 2.06), as was PT G20210A homozygous mutation (OR 1.92). The PAI-1 4G/4G homozygous variant posed a risk (OR 1.36). Late pregnancy loss was associated with MTHFR A1298C homozygous mutation (OR 3.79), β-Fibrinogen 455 G>A heterozygous mutation (OR 2.20), and MTHFR A1298C heterozygous mutation (OR 2.65). Factor XIII G1002T heterozygous mutation (OR 1.18) and PAI-1 4G/5G homozygous mutation (OR 2.85) were also significant risk factors. EPCR allele A1/A2 (OR 1.60) and A2/A3 (OR 1.73) mutations were identified as significant risk factors for late pregnancy loss. Furthermore, FVL G1691A homozygous mutation, PT G20210A homozygous mutation, MTHFR C677T heterozygous mutation, MTHFR A1298C heterozygous mutation, and EPCR allele A1/A2 were identified as significant risk factors for multiple miscarriage. Conclusions: This study highlights significant interactions and risk factors related to genetic thrombophilia mutations in different types of pregnancy loss, contributing valuable insights for miscarriage management guidelines.

Real-world safety of Levetiracetam: Mining and analysis of its adverse drug reactions based on FAERS database

Levetiracetam is a relatively new and widely utilized anti-seizure medication; however, limited information is available regarding its adverse effects. This study aims to thoroughly investigate, evaluate, and present evidence on the safety profile of Levetiracetam, relying on data from the FDA Adverse Event Reporting System (FAERS) database to facilitate informed clinical decision-making. We employed various statistical measures, including Reporting Odds Ratio (ROR), Proportionate Reporting Ratio (PRR), and analysis by the Medicines and Healthcare Products Regulatory Agency (MHRA), to identify signals of adverse reactions associated with Levetiracetam. Positive signals consistent with Designated Medical Event (DME) were singled out for focused comparison and discussion. The analysis of 26,182 adverse events linked to Levetiracetam as the primary suspected drug revealed 692 positive signals spanning 22 System Organ Classes (SOCs). Nervous system disorders were the most frequently reported, followed by psychiatric disorders, and general disorders and administration site conditions. 11 positive signals consistent with Preferred Terms (PTs) in DME were identified, predominantly concentrated in 6 SOCs. Among these, rhabdomyolysis, Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), drug reaction with eosinophilia and systemic symptoms (DRESS) exhibited relatively large values of A, ROR, and Chi-squared. Additionally, PTs related to spontaneous abortion, drug interaction, urethral atresia, ventricular septal defect, and atrial septal defect showed significant strength. The study indicates that Levetiracetam carries a potential risk of causing rhabdomyolysis, SJS, TEN, DRESS as well as spontaneous abortion. Signals related to drug interaction, urethral atresia, ventricular septal defect, and atrial septal defect warrant heightened attention in clinical use.

Sub-Septate Uterus: An Incidental Radiological Finding in a Woman with History of Recurrent Miscarriage. A Case Report

Background: The septate uterus, which is the most common Mullerian duct anomaly, results from the abnormal fusion of the Mullerian duct during embryonic life, and it is usually associated with poor obstetric outcomes such as recurrent spontaneous abortions, subfertility, preterm labour, and reproductive failure. A large proportion of the patients that are affected remain asymptomatic owing to lack of indication for abdominal ultrasound before conception, and the problems are mainly detected after several pregnancy losses. The exact aetiology of the septate uterus is unknown but is caused by incomplete resorption of the uterovaginal septum after fusion of the Mullerian duct during embryogenesis. Case Presentation: We present a 32-year-old Para 0+3 woman referred to the radiology department for ultrasonography and hysterosalpingography (HSG) on account of recurrent miscarriage, which occurs within the first trimester of gestation. She has had three (3) consecutive miscarriages within the last 4 years, of pregnancies which were achieved spontaneously and were lost between the gestational ages of 9-12 weeks. She was investigated with ultrasonography, which demonstrated a bulky uterine appearance with two endometrial cavities that is connected to one cervical canal. Hysterosalpingography (HSG) showed a contrast-filled partly divided uterus with inter-cornual angles of 34º and intercornual distance of 1.92cm. The patient had hysteroscopic septum resection with a satisfactory outcome given addressing other medical problems that could militate against conception and has been on monthly follow-up. Conclusion: Radiological investigation of patients with recurrent miscarriages is indispensable for optimal evaluation to achieve accurate diagnosis and identify women whose problems are amenable to specialized treatments.

Association between previous surgical termination of pregnancy and pregnancy outcomes in frozen-thawed embryo transfer cycles of IVF/ICSI: a retrospective cohort study

This study aimed to evaluate the effect of previous surgical termination of pregnancy (STP) on pregnancy outcomes in women undergoing FET cycles of IVF/ICSI. Retrospective cohort study. Reproductive Center of Maternal and Child Health Care Hospital in Lianyungang city. Data were selected from all IVF/ICSI FET cycles performed between January 2014 and December 2020. A total of 761 cycles met the criteria were included in this study. The primary outcome measures were clinical pregnancy and live birth rates. Secondary outcome measures were biochemical pregnancy rate, spontaneous abortion rate, and preterm birth rate. After adjustments for a series of potential confounding factors, the previous STP was an influential factor in reducing FET cycle clinical pregnancy rate compared with women who had not previously undergone STP (OR = 0.614, 95% CI 0.413–0.911, P = 0.016). The effect of the previous STP on the live birth rate was not statistically significant. (OR = 0.745, 95% CI 0.495–1.122, P = 0.159). Also, an increase in the number of previous STPs relative to only 1-time abortion was an independent risk factor in reducing clinical pregnancy rate and live birth rate (OR = 0.399,95% CI 0.162–0.982, p = 0.046; OR = 0.32,95% CI 0.119–0.857, p = 0.023). Previous STP was an independent factor contributing to the decline in FET cycle clinical pregnancy rates.

Pregnancy in myeloproliferative neoplasms.

Myeloproliferative neoplasms (MPN) are associated with a significant risk of thrombosis and the hypercoagulable environment of pregnancy increases this risk. The most frequent gestational complications consist of spontaneous abortion, thrombosis, bleeding, and hypertensive disease of pregnancy. Treatment depends on thrombotic risk, gestational trimester, and myeloproliferative neoplasm.

Trends in Syphilis in Pregnant Women in Japan in 2016 and 2022.

Since 2012, the rate of syphilis infection has increased dramatically in high-income countries including Japan. In this study, we examined the rate of syphilis infection among pregnant women and perinatal outcomes in the syphilis-infected pregnancy in 2022 in Japan, and compared the results with those in 2016. We requested 2,005 obstetric institutes to provide information on syphilis infection in pregnant women who delivered in 2022. A total of 1,346 obstetrical facilities responded with valid information. We compared the results with those in our previous study. The prevalence of syphilis-infected pregnant women was 1/1,215. The incidence of preterm delivery, intrauterine fetal demise and congenital syphilis in surviving neonates in the syphilis-infected pregnancy were 9%, 2% and 7%, respectively. The prevalence of syphilis-infected pregnant women has increased significantly, while the incidence of congenital syphilis seems to have decreased clinically.

Anaesthetic challenges in a patient with eisenmenger syndrome: A case report

The term Eisenmenger syndrome describe a large left-to-right cardiac shunt. Occur in 8% of patients with congenital heart disease. Pregnancies carries very high risk of mortality and premature delivery. 20-30% pregnancies result in spontaneous abortion and premature delivery. Pulmonary microembolism and macroembolism have caused peripartum maternal death even after delivery. Anaesthetic management is challenging due to the patho-physiology of the shunt. Our case report is a 27-year-old female known case of Eisenmenger syndrome with chronic thromboembolism presented with inevitable abortion scheduled to undergo emergency evacuation under general anaesthesia.

Socio-demographic and reproductive determinants of spontaneous abortion- A cross-sectional comparative research at a tertiary care hospital in North Karnataka, India

The current study aims to explore the relationship between Spontaneous Abortion and socioeconomic and reproductive factors. Cross-sectional comparative research was conducted. The study collected data from 200 women aged 19 to 35, consisting of 2 groups. Group 1mothers who had undergone spontaneous and group 2 mothers who continued pregnancy with the same gestational week and the socio-demographic and reproductive factors were compared. Participants were interviewed using a structured questionnaire on socio-demographics, and reproductive factors were collected. Risk of abortion with an unadjusted odds ratio 1.87 times more in the age group of 19 to 20 years, parity primi mother with an unadjusted odds ratio 1.16 times had more risk of abortion, Area of residence the mother who stayed in a rural area with unadjusted ratio 1.47 times more risk of abortion, occupation the mothers who were self-workers with unadjusted odds ratio 1.50 times more risk of abortion, when looking into the education of mother illiterate mother with unadjusted odds ratio 0.50 times had a risk of abortion, in view with Religion muslins with unadjusted odds ratio 0.38 times more risk of abortion considering the type of family the mother who belong to a nuclear family with unadjusted odds ratio 1.04 times had more risk of abortion, consanguineous marriage with unadjusted odds ratio 3.95 had times more risk of abortionConclusion: Our study shed light on clarifying whether certain socio-demographic and reproductive determinants do increase miscarriage risk or whether screening of pregnant women for treatable determinants would improve the rate of pregnancy loss

History of Cholestasis Is Not Associated with Worsening Outcomes in Subsequent Pregnancy with Cholestasis.

Intrahepatic cholestasis of pregnancy is associated with adverse pregnancy outcomes including intrauterine fetal demise, spontaneous preterm labor, and meconium-stained amniotic fluid. Studies have yet to determine if patients with a history of pregnancy complicated by cholestasis had an association with more severe adverse outcomes in a subsequent pregnancy complicated by cholestasis. Retrospective cohort study of multiparous, singleton, nonanomalous live gestations complicated by cholestasis at Elmhurst Hospital Center from 2005 to 2019. We compared rates of adverse outcomes in multiparous pregnancies complicated by cholestasis with versus without prior cholestasis. Our primary outcome was rates of spontaneous preterm labor. Our secondary outcomes included rates of iatrogenic preterm birth, meconium-stained amniotic fluid, cesarean delivery for nonreassuring fetal heart tracing. Chi-square and multivariate regression tests were used to determine the strength of association. In all analyses, a p-value less than 0.05 and 95% confidence interval not crossing 1.00 indicated statistical significance. Mount Sinai Icahn School of Medicine Institutional Review Board approval was obtained for this project. Of the 795 multiparous pregnancies complicated by cholestasis, 618 (77.7%) had no prior history of cholestasis and 177 (23.3%) had prior history of cholestasis. Multiparous pregnancies with history of cholestasis had higher rates of prior preterm birth, earlier gestational age at diagnosis and delivery, and were more likely to receive ursodeoxycholic acid therapy. Pregnancies with history of cholestasis were not associated with spontaneous preterm labor in subsequent pregnancies with cholestasis, but history of cholestasis was associated with iatrogenic preterm birth and neonatal intensive care unit (NICU) admission. After adjusting for confounders, the association with iatrogenic preterm birth and NICU admission were no longer statistically significant. There was no significant association between history of cholestasis and other adverse obstetric outcomes. Findings suggests that history of prior cholestasis is not associated with worsening outcomes in subsequent pregnancies complicated by cholestasis. · Prior cholestasis may not alter risk in subsequent pregnancies.. · Unclear relationship between cholestasis and hepatobiliary disease.. · Studies needed to develop cholestasis screening protocol..

Placental pathology and neonatal morbidity: exploring the impact of gestational age at birth

AimTo evaluate placental pathology in term and post-term births, investigate differences in clinical characteristics, and assess the risk of adverse neonatal outcome.MethodsThis prospective observational study included 315 singleton births with gestational age (GA) > 36 weeks + 6 days meeting the local criteria for referral to placental histopathologic examination. We applied the Amsterdam criteria to classify the placentas. Births were categorized according to GA; early-term (37 weeks + 0 days to 38 weeks + 6 days), term (39 weeks + 0 days to 40 weeks + 6 days), late-term (41 weeks + 0 days to 41 weeks + 6 days), and post-term births (≥ 42 weeks + 0 days). The groups were compared regarding placental pathology findings and clinical characteristics. Adverse neonatal outcomes were defined as 5-minute Apgar score < 7, umbilical cord artery pH < 7.0, admission to the neonatal intensive care unit or intrauterine death. A composite adverse outcome included one or more adverse outcomes. The associations between placental pathology, adverse neonatal outcomes, maternal and pregnancy characteristics were evaluated by logistic regression analysis.ResultsLate-term and post-term births exhibited significantly higher rates of histologic chorioamnionitis (HCA), fetal inflammatory response, clinical chorioamnionitis (CCA) and transfer to neonatal intensive care unit (NICU) compared to early-term and term births. HCA and maternal smoking in pregnancy were associated with adverse outcomes in an adjusted analysis. Nulliparity, CCA, emergency section and increasing GA were all significantly associated with HCA.ConclusionsHCA was more prevalent in late and post-term births and was the only factor, along with maternal smoking, that was associated with adverse neonatal outcomes. Since nulliparity, CCA and GA beyond term are associated with HCA, this should alert the clinician and elicit continuous intrapartum monitoring for timely intervention.

Exploring Risk Factors for Early Pregnancy Loss: A Retrospective Hysteroscopy Study in a Single Institution

Exploring Risk Factors for Early Pregnancy Loss: A Retrospective Hysteroscopy Study in a Single Institution

Right ventricular outflow tract obstruction in twin-to-twin transfusion syndrome undergoing laser surgery: A systematic review and meta-analysis.

We aimed to investigate the incidence, prenatal factors and outcomes of twin-to-twin transfusion (TTTS) with right ventricular outflow tract obstruction (RVOTO). A systematic search was conducted to identify relevant studies published until February 2023 in English using the databases PubMed, Scopus and Web of Science. Studies reporting on pregnancies with TTTS and RVOTO were included. The random-effect model pooled the mean differences or odds ratios (OR) and the corresponding 95% confidence intervals. Heterogeneity was assessed using the I2 value. A total of 17 studies encompassing 4332 TTTS pregnancies, of which 225 cases had RVOTO, were included. Incidence of RVOTO at time of TTTS diagnosis was 6%. In all, 134/197 (68%) had functional pulmonary stenosis and 62/197 (32%) had functional pulmonary atresia. Of these, 27% resolved following laser and 55% persisted after birth. Of those persisting, 27% required cardiac valve procedures. Prenatal associations were TTTS stage III (53% vs 39% in no-RVOTO), stage IV TTTS (28% in RVOTO vs 12% in no-RVOTO) and ductus venosus reversed a-wave (60% in RVOTO vs 19% in no-RVOTO). Gestational age at laser and gestational age at delivery were comparable between groups. Survival outcomes were also comparable between groups, including fetal demise of 26%, neonatal death of 12% and 6-month survival of 82% in RVOTO group. Findings were similar when subgroup analysis was done for studies including head-to-head analysis. RVOT occurs in about 6% of the recipient twins with TTTS, especially in stages III and IV and those with reversed ductus venosus a-wave. The findings from this systematic review support the need for a thorough cardiac assessment of pregnancies complicated by TTTS, both before and after laser, to maximize perinatal outcome, and the importance of early diagnosis of TTTS and timely management.

Role of Medical Treatment in Abortion-An Observational Study

Background: Medical treatment of abortion has been identified as safe and effective Method of evacuation of uterus and is more amenable to provision through primary care facilities, ever where providers may not have the skills to perform a surgical evacuation. Medical treatment of abortion care encompasses the management of various clinical conditions including incomplete abortion missed abortion, blighted ovum, as well as post-abortion contraception. Medical management of abortion generally involves misoprostol. Objective: To assess the role of medical treatment in abortion in pregnant women-an observational study. Methods: This is an observational study done at Uttara Adhunik Medical College Hospital, Dhaka, Bangladesh from July 2021 to July 2023. 101 patients fulfilling the inclusion criteria were enrolled. This is an attempt to study incomplete abortion after medical treatment of abortion and to observe the success read of this method of taking it among patients, with prescriptions or without it. Questionnaires were prepared and women were interviewed. Questions pertaining to women knowledge, attitude, perception and use of medicine for treatment of abortion, use of emergency contraception were asked. Study was carried out by using responses in the preform given. Results: This study was done in duration of two years and 101 patients fulfilling the inclusion criteria were enrolled. Women who had ectopic pregnancy, threatened abortion &amp; excessive P/V bleeding were excluded. In our study, most of the women interviewed, were between 25-34 years of age (51.5%). Out of the 101 women, 99 women (98.01%) were married and 2 (1.99%) were unmarried. 76 women (75.2%) belonged to urban residence. 16 women (15.9%) were working women. 81 women (80.2%) were housewives. 4 (3.9%) interviewed were students. 41 women interviewed were illiterate (40.6%) while only 9 women (8.9%) were graduates. In our study, majority of women 76 (75.2%) had taken abortifacient or spontaneous abortion occur at &lt;12 weeks of gestation. However, 05 (4.9%) women did not know about their gestational age. Main complication after taking medicine for abortion was moderate bleeding mentioned by 60 women (59.4%), incomplete abortion by 10 women (9.90%), Repeat prescription after 1 week 05 women (4.95%), pain by 27 women (26.7%) and need MVA or D&amp;C by 07 women (6.93%). Among the 101 women who used misoprostol with known outcome, 90.09% had complete abortions, 10 (9.90%) had incomplete abortions. The rates of incomplete abortion and surgical intervention were not significantly different among the women with administration of misoprostol. Among blighted ovum after treatment, complete abortion 69.3% and 30.7% incomplete abortion. Conclusion: Medical treatment of abortion is safe and effective but complications can occur if not used in accordance. However, the awareness about medical treatment of abortion is increasing. It is therefore of utmost importance to increase the awareness about medical treatment of abortion not only among doctors but also among general population.

Common mental disorders and risk of spontaneous abortion or recurrent spontaneous abortion: A two-sample Mendelian randomization study

BackgroundThe direct causal relationships between common mental disorders (anxiety disorders, broad depression, major depressive disorder (MDD), bipolar disorder, and insomnia) and miscarriage or recurrent spontaneous abortion (RSA) are unclear. Therefore, this study aimed to explore these, using Mendelian randomization. MethodsGenome-wide association studies (GWAS) meta-analyses with the largest sample size possible and selected independent single individuals of European ancestry were selected. Inverse variance weighted (IVW) was the main analysis method. The heterogeneity of the instrumental variables (IVs) was assessed using IVW and MR-Egger, and the horizontal pleiotropy of the IVs was assessed using MR-Egger and MR-PRESSO. ResultsBased on IVW results, the four mental disorders were found to be causally associated with spontaneous abortion (anxiety disorder: OR (95%CI), 1.230 (1.063–1.420), P = 0.0050; major depressive disorder: 1.690 (1.239–2.307), P = 0.0009; bipolar disorder: 1.110 (1.052–1.170), P = 0.0001; insomnia: 1.292 (1.076–1.552), P = 0.0060). Furthermore, no causal relationship was observed between broad depression and spontaneous abortion. Five common mental disorders were not causally associated with the RSA. Limitations(1) Our analysis was limited to the European population; (2) the duration of mental disorders was not analyzed, as no information was available; and (3) it was difficult to completely detect genetic pleiotropy. ConclusionsAnxiety disorders, MDD, bipolar disorder, and insomnia may contribute to spontaneous abortion. Therefore, we should focus on the mental and sleep health of pregnant women. Future studies may be required on whether mental disorders directly lead to RSA, especially unexplained RSA.

Medical treatment for early pregnancy loss following in vitro fertilization compared to spontaneous pregnancies.

Misoprostol is a well-studied medical treatment for early pregnancy loss (EPL), with success rates ranging between 70 and 90%. However, treatment failure is associated with major patient discomfort, including the need for surgical intervention to evacuate the uterus. It was previously reported that medical treatment was especially successful among women who conceived after in vitro fertilization (IVF). We aimed to study if there is a difference in rates of medical treatment failures for EPL between pregnancies conceived by IVF and spontaneous pregnancies. In this retrospective cohort study, we included all women who underwent medical treatment for EPL at our institute between 07/2015 and 12/2020. Treatment outcome was compared between IVF and spontaneous pregnancies. Treatment failure was defined as a need for surgical intervention, namely, dilation & curettage (D&C) and/or hysteroscopy, due to retained products of conception, which was defined as a gestational sac or endometrial thickness greater than 15 mm in a TVS scan. Overall, 775 patients were included, of which 195 (169/775 = 25.1%) ultimately required surgical intervention. There was no difference between the study groups in the rate of treatment failure. However, among IVF pregnancies, the rate of emergency D&C was lower (3.6% vs. 9.8%, p = 0.001), compared to spontaneous group. In cases of medical treatment for EPL, IVF pregnancies had no differences in rates of treatment failure compared to spontaneous pregnancies. That being said, IVF pregnancies have lower chances to undergo emergency D&C, compared to spontaneous pregnancies.

Epidemiologic and genetic associations of female reproductive disorders with depression or dysthymia: a Mendelian randomization study

Observational studies have previously reported an association between depression and certain female reproductive disorders. However, the causal relationships between depression and different types of female reproductive disorders remain unclear in terms of direction and magnitude. We conducted a comprehensive investigation using a two-sample bi-directional Mendelian randomization analysis, incorporating publicly available GWAS summary statistics. Our aim was to establish a causal relationship between genetically predicted depression and the risk of various female reproductive pathological conditions, such as ovarian dysfunction, polycystic ovary syndrome(PCOS), ovarian cysts, abnormal uterine and vaginal bleeding(AUB), endometriosis, leiomyoma of the uterus, female infertility, spontaneous abortion, eclampsia, pregnancy hypertension, gestational diabetes, excessive vomiting in pregnancy, cervical cancer, and uterine/endometrial cancer. We analyzed a substantial sample size, ranging from 111,831 to 210,870 individuals, and employed robust statistical methods, including inverse variance weighted, MR-Egger, weighted median, and MR-PRESSO, to estimate causal effects. Sensitivity analyses, such as Cochran's Q test, MR-Egger intercept test, MR-PRESSO, leave-one-out analysis, and funnel plots, were also conducted to ensure the validity of our results. Furthermore, risk factor analyses were performed to investigate potential mediators associated with these observed relationships. Our results demonstrated that genetic predisposition to depression or dysthymia was associated with an increased risk of developing PCOS (OR = 1.43, 95% CI 1.28–1.59; P = 6.66 × 10–11), ovarian cysts (OR = 1.36, 95% CI 1.20–1.55; P = 1.57 × 10–6), AUB (OR = 1.41, 95% CI 1.20–1.66; P = 3.01 × 10–5), and endometriosis (OR = 1.43, 95% CI 1.27–1.70; P = 2.21 × 10–7) after Bonferroni correction, but no evidence for reverse causality. Our study did not find any evidence supporting a causal or reverse causal relationship between depression/dysthymia and other types of female reproductive disorders. In summary, our study provides evidence for a causal relationship between genetically predicted depression and specific types of female reproductive disorders. Our findings emphasize the importance of depression management in the prevention and treatment of female reproductive disorders, notably including PCOS, ovarian cysts, AUB, and endometriosis.

Safety monitoring of bivalent mRNA COVID-19 vaccine among pregnant persons in the vaccine adverse event reporting System – United States, September 1, 2022 – March 31, 2023

BackgroundPregnant persons are at increased risk of severe COVID-19 illness. Bivalent mRNA COVID-19 vaccination is recommended for everyone, including pregnant persons. However, data are limited on the safety of bivalent mRNA COVID-19 vaccination during pregnancy. ObjectiveTo evaluate and summarize reports to the Vaccine Adverse Event Reporting System (VAERS), a national spontaneous reporting system, among pregnant persons who received bivalent mRNA COVID-19 vaccine. MethodsVAERS U.S. reports of adverse events (AEs) in pregnant persons who received the bivalent mRNA COVID-19 vaccine from 9/1/2022–03/31/2023 were identified. Clinicians reviewed all reports and available medical records. AEs of these reports were compared with AEs reported to VAERS following monovalent mRNA COVID-19 booster vaccination in pregnancy. ResultsVAERS received 136 reports for pregnant persons who received bivalent mRNA COVID-19 vaccine; 87 (64 %) after BNT162b2 (Pfizer-BioNTech), and 48 (35 %) after mRNA-1273 (Moderna); 28 (20.6 %) reports were classified as serious. The most common pregnancy-specific outcomes reported included 12 (8.8 %) spontaneous abortions (<20 weeks gestation), 6 (4.4 %) episodes of preterm delivery, and 5 (3.7 %) reports of preeclampsia. One stillbirth (≥20 weeks gestation) was reported. No maternal or infant deaths were reported. There were 6 reports of AEs in infants, which included 3 reports of admissions to the neonatal intensive care unit: two infants with low birth weight, and one infant with a patent ductus arteriosus and patent foramen ovale. Non-pregnancy-specific adverse events were mostly COVID-19 infection and systemic reactions (e.g., headache, fatigue). Pregnancy-specific conditions were reported less frequently after bivalent mRNA COVID-19 vaccination compared to monovalent mRNA COVID-19 booster vaccination (3rd and 4th dose). ConclusionsBased on this review of reports to VAERS, the safety profile of bivalent mRNA COVID-19 vaccination in pregnant persons was comparable to that observed for monovalent mRNA COVID-19 booster vaccination (3rd and 4th dose) in pregnant persons.

FETO/Maternal Complications in Iron Deficiency Anemia during Pregnancy and Labor

Background: Iron deficiency anemia (IDA) is a prevalent nutritional disorder globally, especially in developing countries, impacting both maternal and fetal health. The condition exacerbates the risk of adverse pregnancy outcomes, including increased morbidity and mortality rates. Objective: This study aimed to examine the prevalence and impact of IDA on feto-maternal health during pregnancy and labor, as well as to evaluate the efficacy of antenatal care programs in managing this condition. Methods: A six-month cross-sectional study was conducted at Shaikh Zayad Hospital, Larkana, from October 2021 to March 2022. Fifty pregnant women, ranging from primigravida to multigravida, were recruited through emergency and outpatient departments. Comprehensive data collection included demographic information, clinical history, and a full spectrum of laboratory tests for IDA. The severity of anemia and related complications were assessed, and the collected data were analyzed using SPSS version 25. Results: Of the participants, 74% suffered from moderate anemia, while 12% and 14% had mild and severe anemia, respectively. Serum ferritin levels indicated iron deficiency in 40% of the women, with an elevated total iron-binding capacity (TIBC) in 60% of cases. Maternal complications were prevalent, with 52% encountering unspecified emergency conditions and 16% experiencing postpartum hemorrhage. Fetal complications included intrauterine growth restriction (30%), intrauterine death (18%), and neonatal death (10%). Conclusion: IDA presents a significant health risk during pregnancy, correlated with a high incidence of maternal and fetal complications. This study emphasizes the importance of proactive management and monitoring of iron levels throughout pregnancy. Establishing comprehensive antenatal care that includes nutritional education and iron supplementation is crucial for preventing IDA and improving pregnancy outcomes.

Serum Ferritin Level and Total Iron Binding Capacity Relationship with Iron Deficiency Anemia During Pregnancy and Labour

Background: Iron deficiency anemia (IDA) is a prevalent condition globally, impacting maternal and fetal health outcomes significantly. The condition is especially concerning during pregnancy, given its association with complications such as preterm labor and increased maternal and neonatal morbidity and mortality rates. Objective: The study aimed to assess the prevalence of IDA among pregnant women and its correlation with fetal-maternal complications, as well as to evaluate the effectiveness of current healthcare interventions in managing the condition. Methods: A cross-sectional study was conducted at Shikhzayad Women Hospital, Larkana, over six months from January 1, 2022, to July 1, 2022. Fifty pregnant women with IDA at various gestational stages were selected and evaluated for serum ferritin and total iron-binding capacity (TIBC). The severity of anemia and its correlation with feto-maternal complications were analyzed using SPSS version 25. Results: Out of the 50 women studied, 6 had mild anemia, 37 had moderate anemia, and 7 had severe anemia. Serum ferritin levels showed that 10 participants had levels between 5-10 mg/L, 20 had levels between 10-50 mg/L, 10 had levels between 50-150 mg/L, and 10 had normal levels (150-300 mg/L). Elevated TIBC levels (400-600 ug/ml) were observed in 30 women. Feto-maternal complications included emergency cesarean sections (28 cases), postpartum hemorrhage (8 cases), disseminated intravascular coagulation (6 cases), cardiac failure (4 cases), and maternal death (4 cases). Pregnancy outcomes were reported as 5 first-trimester abortions, 2 second-trimester abortions, 4 preterm deliveries, 15 cases of intrauterine growth restriction (IUGR), 9 intrauterine deaths (IUD), and 5 neonatal deaths (NND). Conclusion: IDA remains a significant determinant of adverse maternal and neonatal outcomes. This study underscores the urgent need for enhanced preventive strategies, including iron supplementation and dietary education. Further large-scale research is required for a comprehensive understanding of IDA's impact and the development of targeted interventions.

Exposure of Pregnancy to Pregestational Diabetes, Gestational Diabetes, and Antidiabetic Medications With Especial Focus on Major Congenital and Cardiac Malformations in Offspring.

The global prevalence of type 2 diabetes mellitus (T2DM) is increasing. T2DM is more common in patients with psychiatric disorders and those who take certain psychotropic drugs. T2DM occurs in 2%-7% of women of reproductive age. The prevalence of pregestational diabetes is 0.5%-2.4%, and that of gestational diabetes is 7%-28%, depending on geographical region. About 20%-50% of pregnancies, across the world, are unplanned; this figure is higher, at about 65%, in women with psychiatric disorders. As a result, many women of reproductive age who have diabetes, including women who do not know that they have diabetes, may unintentionally become pregnant, thus unknowingly exposing their pregnancy to diabetes and its treatment. Exposure of pregnancy to pregestational and gestational diabetes is associated with risks to the mother as well as risks to the child. Risks to the mother include obesity, hypertension, and preeclampsia. Risks to the child include spontaneous abortion, fetal death, macrosomia, major congenital malformations (MCMs), preterm delivery, neonatal hypoglycemia, neonatal hyperbilirubinemia, and neonatal respiratory distress syndrome. A recent large retrospective cohort study with data from 6 countries in Europe, Asia, and North America found that, in about 51,000 women with pregestational T2DM, neither MCMs nor cardiac malformations were more prevalent in offspring of children periconceptionally exposed to second-line antidiabetic treatments relative to exposure to insulin. These findings are reassuring but have limitations that are discussed. A reasonable conclusion from a reading of the reviewed literature is that pregestational and gestational diabetes are best treated during pregnancy, that insulin is a first-line treatment, that metformin is an increasingly accepted alternative, and that safety data on second-line antidiabetic treatments are, so far, reassuring.