Factors Of Adverse Pregnancy Outcomes Research Articles

Expression and clinical significance of lncRNA PART1 in patients with unexplained recurrent pregnancy loss

Purpose Previous studies have reported the involvement of long noncoding RNAs (lncRNAs) in reproductive diseases via the regulation of target genes. This study aimed to determine whether lnc-prostate androgen-regulated transcript 1 (lnc-PART1)could be used as a biomarker of unexplained recurrent pregnancy loss (URPL) and a possible predictor of poor pregnancy outcomes in women with URPL. Materials and methods Sixty patients with URPL and 15 healthy women were included in this study. PART1 expression was detected in plasma and endometrial tissues using a quantitative reverse transcription polymerase chain reaction. Logistic regression and receiver operating characteristic curve analyses were performed to analyze the association between PART1 expression and pregnancy outcomes in women with URPL. Results The expression of PART1transcript variant 2 was significantly up-regulated in the endometrial specimens from patients with URPL compared to control tissues. High tissue expression levels of PART1transcript variant 2 were associated with poor pregnancy outcomes in women with URPL, indicating that it could serve as a potential risk factor. Additionally, PART1 could serve as a potential risk factor for adverse pregnancy outcomes in patients with URPL (OR = 4.374; 95% CI = 1.052–18.189; p = .042). Conclusion lncRNA PART1 transcript variant 2 was highly expressed in patients with URPL. Therefore, it is important to conduct in-depth studies on the relationship between PART1 expression and URPL.

Lifetime Violence and Perinatal Sleep Quality: A Scoping Review

Abstract Introduction In-utero experience of violence through maternal experience of intimate partner violence (IPV) is a risk factor for adverse pregnancy outcomes via ‘biological programming,’ whose effect can be mediated by sleep. We conducted a scoping review to synthesize the current evidence of the association between experiences of violence and sleep in women. Methods Between August and October 2023, we conducted a search in four databases (PubMed, APA PsycInfo, Embase, and Web of Science) for peer-reviewed articles, using 11 inclusion and exclusion criteria. Any study published in English in peer-reviewed journals that conducted original research on the association between exposure to violence (lifetime IPV, IPV during the previous year, during and 1 year after pregnancy, as well as adverse childhood experiences) and poor sleep outcomes (sleep disturbances, insomnia, poor sleep quality, and longer time to fall asleep) in the perinatal population were included. Results The synthesis of the 12 included studies revealed a positive association between exposure to violence and poor sleep, and between adverse childhood experiences and sleep disturbances or poor sleep during pregnancy. Moreover, IPV in the postpartum period was associated with poor sleep. Conclusion Most of the evidence synthesized comprises data from high-income countries, resulting in lack of cultural context. However, it is evident that the experience of violence throughout life is a risk for poor perinatal sleep quality. Thus, there is a growing need to study this association, especially in resource-limited settings, where data on sleep health is largely absent, inform pregnancy care and maternal and child health policies.

Air pollution exposure during pregnancy and preterm birth in Brazil

Ambient air pollution is a significant environmental risk factor for adverse pregnancy outcomes, including preterm birth. However, the impact of different pollutants across various regions and trimesters of pregnancy has not been fully investigated in Brazil. This study aimed to examine the associations between exposure to PM2.5, NO2, and O3 during different trimesters of pregnancy and the risk of preterm birth across five regions of Brazil. We used logistic regression models to estimate the odds ratios (OR) of preterm birth associated with PM2.5, NO2, and O3 adjusting for potential confounders such as maternal age, education, and socioeconomic status. Our study included over 9.9 million live births from 2001 to 2018, with data obtained from the Ministry of Health in Brazil. On average, for each 1-μg/m3 increase in PM2.5, we estimated a 0.26 % (95 % CI: 0.08–0.44 %) increase in the risk of preterm birth nationally in the first trimester. For NO2, each 1ppb increase was associated with a percentage increase in preterm birth risk of 7.26 % (95 % CI: 4.77–9.74 %) in the first trimester, 8.05 % (95 % CI: 5.73–10.38 %) in the second trimester, and 7.48 % (95 % CI: 5.25–9.72 %) in the third trimester. For O3, each 1ppb increase was associated with a percentage increase in preterm birth risk of 1.24 % (95 % CI: 0.29–2.18 %) in the first trimester, 1.51 % (95 % CI: 0.60–2.41 %) in the second trimester, and 0.72 % (95 % CI: −0.18–1.62 %) in the third trimester. This study highlights the significant impact of ambient air pollution on preterm birth risk in Brazil, with significant regional variations. Our findings underscore the need for targeted public health interventions to mitigate the effects of air pollution on pregnancy outcomes, particularly in the most affected regions.

Cohen versus Pfannenstiel Cesarean Skin Incision for BMI =35 kg/m2: a Randomized Controlled Trial

Background: Maternal obesity is recognized as a significant risk factor for adverse pregnancy outcomes, including increased cesarean delivery rates and heightened surgical complications. It is unclear if the Cohen or Pfannenstiel skin incisions at cesarean delivery are associated with different outcomes. Objective: To evaluate the impact of either Cohen or Pfannenstiel cesarean skin incision type on maternal morbidity. Study Design: Pregnant individuals with a BMI of ≥35 kg/m2, carrying either singleton or multiple gestations, were consented prenatally and in labor. Eligible participants who underwent a cesarean delivery between 24 and 41 weeks of gestation were randomized to either Pfannenstiel or Cohen skin incisions at Thomas Jefferson University Hospital from October 2016 to March 2020. The study aimed to recruit 284 participants based on a sample size calculation assuming a 50% reduction in wound complications with Cohen versus Pfannenstiel incisions (80% power, α=0.05), but recruitment was terminated early after 72 participants were randomized. The primary outcome was a composite maternal morbidity within six weeks, which consisted of the following: wound infection, hematoma, seroma, separation of skin ≥1 cm, readmission for wound complications, endometritis, and postpartum hemorrhage. Statistical analyses included bivariate tests, t-tests, and non-parametric analyses. Results: Of 331 pregnant individuals consented prenatally and in labor, 72 eventually underwent cesarean delivery and were randomized, 34 to Cohen and 38 to Pfannenstiel skin incisions. The mean BMI was >42 kg/m2, about two thirds of the patients had a pannus, 56% were Black, 47% had diabetes, and 56% hypertensive disorders. The primary outcome of composite maternal morbidity occurred in 47.1% in the Cohen and 36.8% in the Pfannenstiel groups (RR 1.24, 95% CI 0.71-2.08), and was also similar regardless of the presence of a pannus, or by degree of obesity. Surgical site infection, hematoma, seroma, wound separation/dehiscence, endometritis, and postpartum hemorrhage were each similar between Cohen and Pfannenstiel participants. Neonatal outcomes were also similar between the Cohen and Pfannenstiel groups, except that the Cohen group was found to have statistically significant lower Apgar score at 5 minutes and higher need for respiratory support compared to the Pfannenstiel group, possibly related to the trend for a longer time from skin incision to delivery. Physicians were found to be significantly less satisfied with the Cohen compared to the Pfannenstiel incision. Conclusion: In pregnant patients with BMI of ≥35 kg/m2, obstetrical providers can chose from either a Cohen or an Pfannenstiel skin incision, as they are associated in general with similar outcomes, except for lower Apgar scores and lower physician satisfaction associated with the Cohen incision. The findings of this study are limited by its early cessation for logistical reasons, leading to an underpowered analysis. It is crucial to acknowledge that these results must be interpreted cautiously due to the reduced sample size and the circumstances surrounding the study's termination. These data can inform future trial design and implementation as well as fuel individual patient level meta-analyses on this topic.

Gestational Outcomes Related to the Occurrence of Gestational Diabetes Mellitus: A Cohort Study

Background: Gestational diabetes mellitus (GDM) is the main cause of hyperglycemia in pregnancy and is related to complications throughout the gestational and post-partum period. Objectives: To analyze the pregnancy outcomes related to the occurrence of GDM in women and their offspring. Methods: Third-trimester pregnant women were interviewed and monitored until childbirth. The diagnosis of GDM, blood glucose ≥ 92 mg/dL, was defined by the criteria of the International Association of the Diabetes and Pregnancy Study Groups (IADPSG). Results: A total of 138 women participated, and there were 136 births (due to 2 fetal losses); 23 (16.7%) were diagnosed with GDM. The risk of complications during childbirth was higher among pregnant women with GDM (RR 3.40; 95%CI 1.65–7.00), as was the occurrence of cesarean birth (RR 1.9; 95%CI 1.46–2.59). The occurrence of preterm birth did not show a significant difference between GDM/non-GDM groups. There was a non-significant association in adjusted analyses of macrosomia (birth weight ≥ 4000 g) among newborns born to mothers with GDM (RR 1.27; 95%CI 0.67–2.38). For newborns born to pregnant women with GDM, there was a higher risk for the following outcomes: large for gestational age (LGA) (3.29 95%CI 1.62–6.64), low Apgar (4.98 95%CI 2.32–10.69), and birth asphyxia (9.51 95%CI 3.42–26.48). Conclusions: The findings reinforce that GDM is an important risk factor for adverse pregnancy outcomes for women and their offspring.

Maternal, Fetal and Infant outcomes Associated with Bariatric Surgery

Objective: The purpose of this study was to determine the association between bariatric surgery and maternal, fetal and infant outcomes. Summary Background Data: Obesity during pregnancy is a risk factor for adverse pregnancy outcomes. Bariatric surgery is the most effective weight loss treatment but the impact of bariatric surgery on pregnancy outcomes remains poorly characterised. Methods: This was a population-based, matched cohort study of prospective databases in Ontario, Canada. Patients with obesity who received bariatric surgery from 2010 to 2016 and subsequently became pregnant matched on multiple factors to non-surgical pregnant patients with obesity. The primary outcomes of interest were the incidence included of gestational diabetes, preeclampsia/HELLP syndrome, small for gestational age (SGA), large for gestational age (LGA), and a composite of severe fetal/infant morbidity/mortality. Multivariable regression evaluated outcomes. Results: 680 patients who underwent bariatric surgery and later became pregnant were matched to 2002 pregnant patients with obesity. Gestational diabetes occurred in 8.7% of the surgery group and 18.8% of the non-surgical group (adjusted OR (aOR) 0.29, 95%CI 0.21-0.40, P<0.001). A lower incidence of preeclampsia/HELLP was observed post-surgery (aOR 0.20, 95%CI 0.13-0.31, P<0.001). Bariatric surgery impacted SGA (aOR 2.74, 95%CI 2.04–3.70, P<0.001) and LGA (aOR 0.25, 95%CI 0.18-0.36, P<0.001). There were no observed associations between bariatric surgery and any adverse fetal or infant outcomes. A lower composite severe fetal/infant morbidity/mortality was observed post-surgery (aOR 0.73, 95%CI 0.54-0.97, P<0.05). Conclusions: Pregnancy after bariatric surgery appears safe and was associated with a reduced risk of several obesity related adverse pregnancy outcomes.

Pregnancy outcomes among patients with complex congenital heart disease

Patients with complex congenital heart disease (CCHD) may pose a serious threat to the mother-infant safety. This study intends to explore the influencing factors for adverse pregnancy outcomes in the CCHD population. Totally 108 CCHD patients who terminated pregnancy from January 2013 to January 2023 were recruited. We collected clinical data during the pregnancy from electronic medical records. Among them, 45 patients had adverse pregnancy outcomes (41.7%) and no patient died. 5 patients with no newborn. The incidence rate of adverse pregnancy outcomes was significantly higher in patients with brain natriuretic peptide (BNP) > 100 pg/mL (OR: 2.736; 95%CI: 1.001–7.481, p = 0.049) and hypoxemia (OR: 15.46; 95%CI: 1.689–141.512, p = 0.015) and without undergoing cardiac surgical correction (OR: 3.226; 95%CI: 1.121–9.259, p = 0.03). It was confirmed by propensity score matching that no cardiac surgical correction was an independent risk factor. Maternal patients without undergoing cardiac surgical correction had poorer NYHA cardiac function (p = 0.000) and were more prone to heart failure (p = 0.027), hypoxemia (p = 0.042), pulmonary arterial hypertension (p = 0.038) and postpartum hemorrhage (p = 0.016). Moreover, these patients had prolonged Surgical Intensive Care Unit (SICU) stay (p = 0.000) and significantly higher risk of premature delivery (p = 0.005), low birth weight (p = 0.018), infection and asphyxia (p = 0.043). Corrective cardiac surgery in patients with CCHD before pregnancy significantly reduces the incidence of adverse pregnancy outcomes.

Pregnancy outcomes in Australian patients with systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) affects women, with the onset of disease typically around the childbearing years. This study examines the frequency and risk factors for adverse pregnancy outcomes (APOs) in an Australian cohort, and any disease flares during pregnancy and post partum. Female patients with SLE enrolled in the Australian Lupus Registry and Biobank (ALRB) between January 2007 and June 2019 were studied. Self-reported pregnancy history, including adverse foetal or maternal outcomes, was collected at the time of enrolment and updated as appropriate. Baseline demographics, clinical parameters, medication exposure and disease activity were collected. Factors associated with APO were examined using univariate and multivariate logistic regression analyses. Pregnancy history was available in 278 patients; 30% were nulliparous. Most pregnancies occurred before the diagnosis of SLE. Patients who had pregnancies after SLE diagnosis had an earlier age of diagnosis, and had fewer pregnancies. The APO rate was 44.3% in the overall cohort, with most presenting as prematurity with or without foetal growth restriction. Women with APO were also diagnosed with SLE at a younger age and had a higher prevalence of anti-cardiolipin antibodies and hypocomplementemia. Early age of SLE diagnosis was a significant independent risk factor for APO. No increase in disease flare was observed in those who experienced APO during the observation period of ALRB. This study shows a considerable incidence of APO in patients with SLE, emphasising the need for pre-pregnancy counselling and collaboration between maternal-foetal medicine specialists and rheumatologists, especially for women diagnosed with SLE at a younger age.

The risk factor for adverse pregnancy outcomes and its impact on clinical effect in IgA nephropathy: A retrospective observational study.

IgA nephropathy (IgAN) is the most common primary glomerular disease worldwide. Pregnant IgAN patients are more susceptible to adverse pregnancy outcomes (APO). However, the risk factor for APO and its effects on the long-term renal outcome of pregnant IgAN patients remained unclear. We performed a retrospective observational study covering 2003-2019 that included 44 female IgAN patients with pregnancy history to investigate the risk factor for APO and its impact on clinical outcome in IgAN. Renal function outcome and proteinuria remission were evaluated in pregnant IgAN women with and without APO. In this retrospective and observational study, we found that patients with APO exhibited higher levels of serum creatinine and IgM, and lower haemoglobin levels while other clinical characteristics, pathological characteristics and therapy protocol had no significant difference. We found that anaemia and a higher level of serum IgM were independent risk factors for APO. IgAN pregnant women without APO experienced a higher proportion of proteinuria remission than those with APO, but there is no difference in the renal function outcome. Pregnant IgAN patients with higher risks, including lower haemoglobin levels and higher IgM levels deserve intensive monitoring, and aggressive therapy to reduce proteinuria should be carried out in pregnant IgAN patients with APO.

Clinical assessment of the respiratory system in pregnant women on the background of nicotine addiction

Smoking is not only a modifiable risk factor for adverse pregnancy outcomes, it is primarily a risk factor for the development of pathology of the respiratory system, eventually turning into chronic obstructive pulmonary disease (COPD). The high prevalence of tobacco smoking among pregnant women, confirmed by numerous studies, demonstrates the underestimation of the high risks of COPD development. The present study substantiates the relevance of timely detection of pathological changes in the bronchi in smokers in primary care and the formation of motivations to quit smoking. It is the desired pregnancy that can cause complete cessation of smoking, thereby reducing the risks of developing not only the pathology of the smoker's lungs, but also the pathology of the fetus.

Clinical Features Between Primary Obstetric Antiphospholipid Syndrome and Non-Criteria Obstetric Antiphospholipid Syndrome and Risk Factors of Adverse Pregnancy Outcomes: A Retrospective Study of 1006 Cases.

To compare the clinical characteristics and pregnancy outcomes between patients with primary obstetric antiphospholipid syndrome (OAPS) and those with primary non-criteria obstetric antiphospholipid syndrome (NC-OAPS), and to identify the risk factors of adverse pregnancy outcomes in both groups. A retrospective single-center study was performed in a university hospital of western China, including 141 patients with OAPS and 865 patients with NC-OAPS. The clinical characteristics, pregnancy complications, and obstetric outcomes of the cohorts were collected from the hospital system and were compared by univariable analysis, and the independent risk factors for adverse pregnancy outcomes (APO) were investigated by logistic regression analysis in these two populations. The OAPS patients had a significantly higher risk for stillbirths compared to the NC-OAPS patients, while the NC-OAPS group had a significantly higher risk for preterm birth and overall APO. Double aPL positivity, triple aPL positivity, and gestational hypertension were the independent risk factors for APO in OAPS patients, whereas two of the double aPL positivity subtypes, triple aPL positivity and placenta previa were independent risk factors for APO in NC-OAPS patients. This study identified different rates in different APOs among OAPS and NC-OAPS patients. Additionally, this study revealed different risk factors for the development of APO between the two populations. These findings indicated that OAPS and NC-OAPS are two distinct entities of the same disease, providing new insights into the individualized management for patients with OAPS and NC-OAPS.

Development and validation of a prognostic model to predict birth weight: individual participant data meta-analysis

ObjectiveTo predict birth weight at various potential gestational ages of delivery based on data routinely available at the first antenatal visit.DesignIndividual participant data meta-analysis.Data sourcesIndividual participant data of four cohorts...

#2130 Pregnancy in patients with chronic kidney disease stage 3 to 5: what to expect?

Abstract Background and Aims Chronic Kidney disease (CKD) has long been recognized as a risk factor for adverse pregnancy outcomes. Advanced CKD is also associated with decrease fertility, raising the importance of an early approach of pre- menopausal CKD women to discuss pregnancy planning and avoid long term kidney function deterioration or prematurity sequelae in their child-to-be. Method Retrospective analysis of maternal, obstetric and perinatal outcomes of patients with CKD stage 3 to 5, followed by the Nephro-obstetric clinical team between 2011 until 2023. Results We evaluated 31 gestations in 28 patients, with mean age of 32 years [19-43], 21 Caucasian and 7 African, 15 nulliparous, 21/28 with hypertension (HTN), 6/28 diabetic, 2/28 with HIV and 3/28 with systemic lupus erythematosus (SLE). CKD diagnosis occurred during pregnancy in 4/28 patients. Mean pre-pregnancy SCr was 2,1 ± 1 mg/dL [1,1-4,3] and mean proteinuria was 1535 ± 1874 mg/day [5 - 6000], and 11 patients had proteinuria >1 g/day. At gestation baseline, patients evaluated in each pregnancy were in CKD stage 3a (9/31), 3b (10/31), 4 (8/31) and 5 (4/31). CKD etiologies were heterogenous, with most common diagnosis being hereditary nephropathies (7/28), Diabetic nephropathy (6/28) and lupus nephritis (3/28). Exposure to teratogenic therapy occurred in 10/31 gestations (mean time of 11 weeks; 2 - 15), generally ACE/ARBs. Medical termination of pregnancy occurred in 3 gestations due to active SLE and severe growth restriction, 1 abortion at 16 weeks and 1 stillbirth due to cervical insufficiency. HTN aggravation occurred in 16/31 (52%) gestations and de novo proteinuria or proteinuria increase occurred in 7/31(22,5%) and 20/31 (64.5%) gestations, respectively due to pregnancy hyperfiltration, active lupus nephritis and preeclampsia. Considering pregnancies that progressed, renal function (RF) deterioration occurred 10/19 (53%) patients in CKD stage 3 with 20%/60%/20% with full/partial and no RF recovery, respectively. In CKD4 6/7 patients (86%) had RF aggravation with 17% and 83% with partial or no RF recovery. Of the 2 Patients in CKD stage 5 with gestation >20 weeks, 1 started dialysis during pregnancy and the other 4 months postpartum. Dialysis was initiated in 3 patients during pregnancy (2 CKD stage 4 and 1 CKD stage 5) due to urea level >100 mg/dL. RF deterioration was mainly due to pregnancy hyperfiltration and preeclampsia (11/26 gestations; 42%). Mean gestation age at delivery was 34 ± 4 weeks (28-41), with 73% and 53,8% pregnancies with gestational age <37 and 34 weeks, respectively. Mean birth weight was 1866 ± 707 g (555–3095 g), with 73% low birth weight (<2500 g). Mean Apgar 1/5/10 was 9/10/10, respectively. Cesarean was performed in 53,8% gestations and 61,5% newborns were admitted to the neonate care unit (NICU) due to prematurity Conclusion CKD patients with stage 3 to 5 are at increased risk of worse maternal outcomes, namely HTN aggravation (52%), de novo or increase proteinuria (87%) and RF deterioration (53% stage 3 and 86% stage 4) with significant permanent loss of kidney function. Obstetric and perinatal results were also significantly worse with a high incidence of preeclampsia (42%), prematurity (73%), low birth weight (73%) and the need of NICU (61.5%). It is of sum importance, that advanced CKD patients are previously counseled about those risks and are managed in a multidisciplinary feto- maternal clinic experienced in CKD pregnancy care that has a dialysis unit.

Identifying the Risk Factors of Adverse Pregnancy Outcomes among Women with COVID-19: A Population-Based Case-Control Study in Southern Iran.

Pregnant women and their fetuses are considered as high-risk groups during the COVID-19 pandemic. The aim of this study was to identify the risk factors of adverse pregnancy outcomes among women with COVID-19. This case-control study was conducted among pregnant women who delivered live infants at least 60 days before data collection in Hormozgan Province, south of Iran, 2021. The case and control groups included women with and without the history of COVID-19, respectively. A 47-item checklist including demographic information of the mothers, maternal current and past medical history, maternal and fetal prenatal and post-natal outcomes; and other COVID-19 related outcomes was used. The logistic regression analysis was used for data analysis. A total of 1337 women (668 in case and 669 in control groups) participated in this study. The mean (SD) gestational age in the case and control groups were 32.83 (84.64) and 23.75 (6.93) weeks respectively. Maternal age and the incidence of abortion, obesity, and multiple pregnancies was higher in the COVID-19 group compared with the control group. The most common COVID-19 symptoms were myalgia (24.8%), cough (19.3%), fever (17.5%) and olfactory disorder (14.3%). The preventive factors against COVID-19 adverse pregnancy outcomes were low and normal body mass index, influenza vaccination history, and multivitamin consumption, while the risk factors were multiple pregnancies, abortion and preterm labor. This study showed that pregnant women were to COVID-19. The identified risk factors for COVID-19 adverse pregnancy outcomes can be used to prioritized pregnant women in receiving COVID-19 related health services.

Risk Factors for Adverse Pregnancy Outcomes in Patients with Antiphospholipid Syndrome

Risk Factors for Adverse Pregnancy Outcomes in Patients with Antiphospholipid Syndrome

Adverse pregnancy outcomes and pharyngeal flow limitation during sleep: Nulliparous Pregnancy Outcomes Study Monitoring Mothers-to-be (nuMoM2b).

Pharyngeal flow limitation during pregnancy may be a risk factor for adverse pregnancy outcomes but was previously challenging to quantify. Our objective was to determine whether a novel objective measure of flow limitation identifies an increased risk of pre-eclampsia (primary outcome) and other adverse outcomes in a prospective cohort: Nulliparous Pregnancy Outcomes Study Monitoring Mothers-to-be (nuMoM2b). Flow limitation severity scores (0%=fully obstructed, 100%=open airway), quantified from breath-by-breath airflow shape, were obtained from home sleep tests during early (6-15 weeks) and mid (22-31 weeks) pregnancy. Multivariable logistic regression quantified associations between flow limitation (median overnight severity, both time-points averaged) and pre-eclampsia, adjusting for maternal age, body mass index (BMI), race, ethnicity, chronic hypertension and flow limitation during wakefulness. Secondary outcomes were hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM) and infant birthweight. Of 1939 participants with flow limitation data at both time-points (mean±sd age 27.0±5.4 years and BMI 27.7±6.1 kg·m-2), 5.8% developed pre-eclampsia, 12.7% developed HDP and 4.5% developed GDM. Greater flow limitation was associated with increased pre-eclampsia risk: adjusted OR 2.49 (95% CI 1.69-3.69) per 2sd increase in severity. Findings persisted in women without sleep apnoea (apnoea-hypopnoea index <5 events·h-1). Flow limitation was associated with HDP (OR 1.77 (95% CI 1.33-2.38)) and reduced infant birthweight (83.7 (95% CI 31.8-135.6) g), but not GDM. Greater flow limitation is associated with increased risk of pre-eclampsia, HDP and lower infant birthweight. Flow limitation may provide an early target for mitigating the consequences of sleep disordered breathing during pregnancy.

Hemodynamic changes and perinatal outcome associated with umbilical artery thrombosis: a retrospective study

ObjectivePoor fetal and perinatal outcomes in fetuses associated with umbilical artery thrombosis (UAT), such as severe intrauterine growth restriction (IUGR) and intrauterine asphyxia have been reported by some case series. Its hemodynamic impact remains unclear. The aim of this study was to evaluate the hemodynamic changes and perinatal outcome in UAT fetuses with a relatively large sample.MethodsWe included singleton fetuses diagnosed with UAT and with at least one available Doppler evaluation before the end of pregnancy in our center from 2016 to 2023. Fetuses with structural abnormalities and with no follow-up results were excluded. Doppler waveforms from the Umbilical artery (UA), middle cerebral artery (MCA), ductus venosus (DV) and uterine artery (UtA) were routinely evaluated according to ISUOG Practice Guidelines from diagnosis. The same sample of GA-matched normal fetuses with Doppler measurements during the same period were randomly selected as control group.ResultsEighty-nine singleton fetuses with UAT with at least one Doppler evaluation before the end of pregnancy were identified, 13 fetuses with no follow-up results were excluded. After comprehensive prenatal counseling, 14 cases received urgent cesarean section, the remaining 55 cases received expectant management, the median day between GA at diagnosis and end of pregnancy was 13 (5–53) days (range, 2-159). 7 (7/76, 9.2%) cases occurred stillbirth, and the incidence of IUGR and Neonatal Intensive Care Unit (NICU) admission were 18.4% (14/76) and 13.2% (10/76) respectively. 49 fetuses (49/76, 64.5%) combined with Doppler abnormalities. UA abnormalities (35/76, 46.1%) and MCA abnormalities (34/76, 44.7%) were the most changes at presentation. Compared to control group, UA-EDV was significantly increased in UAT fetuses [21.84 (15.59–26.64) vs. 16.40 (12.43–20.70) cm/s, p < 0.001], UA-PI and UA-RI significantly decreased [0.68 (0.57–0.84) vs. 0.92 (0.79–1.11), p<0.001; 0.51 (0.44–0.59) vs. 0.62 (0.55–0.68), p < 0.001, respectively]. Both the MCA-PSV and MCA-EDV were significantly higher in UAT fetuses [54.60 (48.00-61.34) vs. 44.47 (29.66–57.60) cm/s, p < 0.001; 11.19 (7.84–17.60) vs. 8.22 (5.21-12.00) cm/s, p < 0.001, respectively], this led to a lower MCA-PI and MCA-RI. Meanwhile, DV-PIV was significantly higher in UAT fetuses [0.6 (0.47–0.87) vs. 0.45 (0.37–0.55), p < 0.001], CPR and UtA-PI were no significant difference between these two groups. Multivariate logistic regression analysis showed that DV-PIV was an independent risk factor for adverse pregnancy outcomes (OR 161.922, p<0.001), the area under the ROC curve (AUC) was 0.792 (95% CI 0.668–0.917; p < 0.001).ConclusionOur data showed serious adverse pregnancy consequences are combined with UAT fetuses. Hemodynamic changes in UAT fetuses showed the remaining artery for compensation and brain perfusion derangement. With a comprehensive and standardized Doppler evaluation, progression of fetal deterioration may be detailed presented.

Pregnancy Concerns as Predictors of Sleep Quality in Primigravid Women: A Cross-Sectional Study.

Introduction Poor sleep quality may be a risk factor for adverse pregnancy outcomes. Identifying the predictors of sleep disorders can help design effective interventions. The present study aimed to evaluate the impact of pregnancy concerns on the sleep quality of primigravid women. Methods This cross-sectional study was conducted on 220 primigravid women referred to health centers in Hamadan, Iran. In addition to completing the demographic characteristics questionnaire, the Parkinson's Disease Questionnaire (PDQ) questionnaire was completed to determine the level of pregnancy concerns, and the Pittsburgh Sleep Quality Index (PSQI) questionnaire was completed to determine the quality of sleep by pregnant women. Data were analyzed using descriptive statistics, the Pearson correlation coefficient, independent t-test, and univariate and multivariate logistic regression models with a backward method at a 95% confidence level. Results Pregnant women's total PSQI score was 13.8 ± 3.08, and with a PSQI ≥ 5 as a cut-off point, 76.3% of the study's participants had poor sleep quality. There was a significant direct correlation between the total score of PDQ and its subscales with the total PSQI score (P < 0.05). The adjusted regression logistic model showed a significant relationship between the PDQ scores, women'seducational level (adjusted odds ratio (AOR) 1.19; confidence interval (CI) 95%: 0.19-2.18), and their spouse's educational level (AOR 1.03; CI 95%: 0.02-2.03) with sleep quality scores. Conclusion Pregnancy concerns, including concerns about birth and the baby, concerns about physical symptoms and body image, and concerns about emotions and relationships, can reduce the sleep quality of primigravid women. Designing and implementing effective interventions to reduce or modify these common concerns can improve the sleep quality of pregnant women and prevent the adverse effects of poor sleep quality on pregnancy outcomes.

Genetic Factors Associated With Adverse Pregnancy Outcomes in Chronic Pancreatitis.

The effects of genetic factors on pregnancy outcomes in chronic pancreatitis (CP) patients remain unclear. We evaluated the impacts of clinical features and mutations in main CP-susceptibility genes ( SPINK1 , PRSS1 , CTRC , and CFTR ) on pregnancy outcomes in Chinese CP patients. This was a prospective cohort study with 14-year follow-up. The sample comprised female CP patients with documented pregnancy and known genetic backgrounds. Adverse pregnancy outcomes were compared between patients with and without gene mutations. Univariate and multivariate analyses were performed to determine the impact factors for adverse pregnancy outcomes. Totally, 160 female CP patients with a pregnancy history were enrolled; 59.4% of patients carried pathogenic mutations in CP-susceptibility genes. Adverse pregnancy outcomes occurred in 38 patients (23.8%); the prevalence of adverse outcomes was significantly higher in those harboring gene mutations than those without (30.5% vs 13.8%, P = 0.015). Notably, the rates of preterm delivery (12.6% vs 3.1%, P = 0.036) and abortion (17.9% vs 4.6%, P = 0.013) were remarkably higher in patients with gene mutations (especially SPINK1 mutations) than those without. In multivariate analyses, both CP-susceptibility gene mutations (odds ratio, 2.52; P = 0.033) and SPINK1 mutations (odds ratio, 2.60; P = 0.037) significantly increased the risk of adverse pregnancy outcomes. Acute pain attack during pregnancy was another risk factor for adverse pregnancy outcomes. Pathogenic mutations in CP-susceptibility genes, especially SPINK1 , were independently related to adverse pregnancy outcomes in CP patients. Significant attention should be paid to pregnant females harboring CP-susceptibility gene mutations (ClinicalTrials.gov: NCT06055595).

Effects of glycated serum protein, homocysteine, and cystatin-C levels on pregnancy outcomes in patients with gestational diabetes mellitus.

To explore the effects of serum glycated serum protein (GSP), homocysteine (Hcy) and cystatin-C (Cys-C) levels on pregnancy outcomes in patients with gestational diabetes mellitus (GDM). Retrospective selection of 247 pregnant women who underwent normal prenatal examinations in The Yan'an People's Hospital from January 2020 to May 2022 were included in this retrospective study. Among them, 119 were pregnant women with diabetes (GDM-group) and 128 were pregnant women with normal blood glucose (Normal-group). The levels of serum GSP, HCY, CYS-C, and incidence of adverse pregnancy outcomes were compared between the two groups. The clinical value of levels of serum GSP, Hcy, and Cys-C in predicting adverse pregnancy outcomes were analyzed. Compared with the Normal-group, the overall incidence of adverse pregnancy outcomes, serum GSP, Hcy, and Cys-C levels in the GDM-group were significantly higher (p<0.05). Logistic regression analysis showed that the levels of GSP, Hcy, and Cys-C were independent risk factors for adverse pregnancy outcomes in the GDM-group (p<0.05). Receiver operating characteristic (ROC) curve showed that the area under the curve (AUC) for diagnosing adverse pregnancy outcomes in pregnant women with GDM using serum GSP, Hcy, and CysC levels alone were 0.817, 0.843, and 0.775, respectively. The AUC of the three indicators combined was 0.921, indicating that this combination has a good predictive value for diagnosing adverse outcomes in GDM-complicated pregnancies. GDM is associated with a high risk of adverse pregnancy outcomes. Levels of serum GSP, Hcy, and Cys-C are higher in patients with GDM. The higher the levels of GSP, Hcy, and Cys-C, the greater the risk of adverse pregnancy outcomes. Combining these three indicators can effectively predict maternal pregnancy outcomes.