Factors Of Adverse Pregnancy Outcomes Research Articles

Impact of advanced maternal age on maternal and neonatal outcomes in preterm birth.

The aim of this study was to investigate the influence of advanced maternal age on the maternal and neonatal outcomes of preterm pregnancies. The characteristics of patients admitted to the Department of Obstetrics and Gynecology, The First Affiliated Hospital of Fujian Medical University between January 2015 and March, 2019 were retrospectively reviewed. The maternal and neonatal outcomes were compared between advanced maternal age group (≥ 35 years) and younger age group (18-34 years). Statistical analysis was performed by applying the SPSS software. The study population consisted of 986 pregnancies with preterm delivery and 1094 liveborn preterm infants. Multivariate analyses demonstrated that mothers of advanced age were more likely to suffer iatrogenic preterm birth, placenta previa, preeclampsia, gestational diabetes mellitus and postpartum hemorrhage, but less likely to suffer multiple gestation. In terms of neonatal outcomes, advanced maternal age was associated with a decreased rate of low birthweight in an adjusted model without multiple gestation. However, with multiple gestation included in the adjusted model, advanced maternal age was only associated with an increased rate of hyperbilirubinemia. Advanced maternal age was a risk factor for adverse pregnancy outcomes including iatrogenic preterm birth, placenta previa, preeclampsia, gestational diabetes mellitus, postpartum hemorrhage, and a protective factor for multiple gestation. Regarding neonatal outcomes, advanced maternal age was related to a decreased rate of low birthweight or an increased rate of hyperbilirubinemia depending on the adjustment for multiple gestation.

EFFECT OF MATERNAL BODY MASS INDEX ON THE MODE OF DELIVERY AND NEONATAL OUTCOME: A TERTIARY CARE HOSPITAL BASED STUDY IN SOLAN, HIMACHAL PRADESH.

INTRODUCTION: Obesity is a global health problem characterised as a pandemic issue by the World Health Organization (WHO), with a higher prevalence in females than males. During pregnancy, it is considered a high-risk state because it is associated with maternal complications like preeclampsia, gestational diabetes, obstetric interventions like caesarean delivery, postpartum haemorrhage; and fetal complications like macrosomia, poor apgar scores. BMI is a commonly used indicator which can be used to classify subjects on the basis of weight.AIM: This study aims to find the prevalence of normal weight, overweight and obese pregnant women defined by body mass index (BMI) according to the WHO classification and to study the associations between maternal BMI, the mode of delivery and neonatal outcome.MATERIAL AND METHODS: 200 pregnant women admitted for delivery in the department of Obstetrics & Gynaecology were studied, height and weight were recorded from reliable antenatal records (recorded within two months of gestation). The Body Mass Index was calculated and patients were divided into four categories: Category I: underweight; Category II: normal BMI; Category III: Overweight; Category IV: Obese. The feto-maternal outcomes were studied.RESULTS: On evaluation of 200 nulliparous antenatal women with singleton term gestation, 1.5% were underweight, 33% had normal BMI, 56% were overweight and 9.5% were obese. The prolongation of labour was seen in subjects with BMI more than 25 kg/m2. Overweight patients had more instrumental deliveries and obese patients had a higher tendency for prolonged labour and caesarean deliveries. Neonatal outcomes were poor for obese and overweight patients as compared to normal BMI because more neonates required resuscitation at birth, had low Apgar scores and were small for gestational age. Maternal complications like Hypothyroidism, preeclampsia and gestational diabetes occurred more commonly in the obese category.CONCLUSION: In our institution, majority of patients were found to be overweight. Adverse perinatal outcomes were seen more often in the obese patients. Hence, obesity must be identified as a risk factor for adverse pregnancy outcomes.

Burden of sleep disturbance in non-Hispanic Black pregnant women.

Non-Hispanic Black pregnant women disproportionately experience poor perinatal outcomes compared to other racial/ethnic groups. Sleep disruption has emerged as a risk factor for adverse pregnancy outcomes, but there are limited data in minority pregnant women. We examined the prevalence of habitual snoring and its timing of onset with several key sleep-wake disturbances and their associations with perinatal outcomes in a cohort of non-Hispanic Black pregnant women. Non-Hispanic Black pregnant women in their third trimester were recruited from a large academic medical center and screened for habitual snoring and its timing relative to pregnancy, along with sleep quality, symptoms of insomnia, excessive daytime sleepiness, and daytime function. Clinical diagnoses of hypertensive disorders of pregnancy were obtained along with delivery outcomes. In 235 women, the vast majority (80%) reported 3 or more sleep-wake disturbances, and almost half had at least 5 disturbances. Sixteen percent reported prepregnancy snoring and 20% reported pregnancy-onset snoring. Women with pregnancy-onset snoring had significantly increased odds of poor sleep quality (adjusted odds ratio [aOR] = 8.2), trouble staying asleep (aOR = 3.6), waking up too early (aOR = 2.7), excessive daytime sleepiness (aOR = 2.3), and poor daytime function (aOR = 8.7) but no relationship with perinatal outcomes. In contrast, prepregnancy snoring was related to chronic hypertension, preterm delivery, and fetal growth restriction (aOR = 2.6, aOR = 2.8, and aOR = 5.1, respectively). Sleep-wake disturbances confer a significant burden to pregnant non-Hispanic Black women, an infrequently studied yet disproportionately affected population. Contributions of maternal sleep to racial disparities in perinatal health should be a priority for public health research. White KM, Dunietz GL, Pitts DS, Kalmbach DA, Lucchini M, O'Brien LM. Burden of sleep disturbance in non-Hispanic Black pregnant women. J Clin Sleep Med. 2022;18(5):1319-1325.

Oral Anaerobic Microflora and Pregnancy Complication

Bacterial vaginosis and periodontal diseases share very similar pathogenesis. Each of these diseases occurs when healthy microbiome changes to predominately anaerobic bacterial flora. Bacterial vaginosis is proven factor for adverse pregnancy outcomes. In recent years it has been hypothesized that infection from distant sites of the fetoplacental unit may also elicit an inflammatory response in utero. Aim: The study is designed to determine whether the presence of specific oral anaerobic bacteria in subgingival sulcus of mother increase the risk of adverse obstetric outcomes. Material and Methods: Case-control study. Control group: 50 patients who gave birth to neonate whit normal birth weight at term. Group cases: I group - 40 pregnant women who were hospitalized with signs of preterm labor. II - 20 pregnant women, who have an ultrasound diagnosis of fetal growth retardation. Sub-gingival microbiological paper-point swab was taken in all patients. Results: The total number of isolated oral anaerobic bacteria was statistically significantly higher in the cases group compared to control group p <0.01. In our study, pregnant women who tested positive for Porphyrmonas gingivalis for 6.65 times were more likely to have preterm labor compare with pregnant women with negative oral swabs (95.0% CI: 1.38-32.11 / p <0.05), and for 2,79 times more likely to have fetus with intrauterine growth restriction (95.0% CI: 1.10-7.91 / p <0.05 Conclusions: The study confirmed the hypothesis of a statistically significant association between oral anaerobic infection and adverse pregnancy outcomes. In the future, more studies are needed to investigate the role of the microbial load, maternal immune response, pathophysiological pathway that leads to negative pregnancy outcome.

Arcuate Uterus as an Independent Risk Factor for Adverse Pregnancy Outcomes.

The aim of the study is to estimate the association between arcuate uterus and pregnancy outcomes using controls selected from a similarly high-risk cohort. This is a retrospective cohort study of women with an arcuate uterus cared for by a single maternal-fetal medicine practice from 2005 to 2020. We included all women with a singleton pregnancy ≥20 weeks and diagnosis of arcuate uterus and randomly selected (3:1) patients with a singleton pregnancy and no uterine anomaly from the same practice as controls. Baseline characteristics and pregnancy outcomes were compared between the two groups. Chi-square, Fisher's exact, and independent samples t-test were used for data analysis, as indicated. A total of 37 women with an arcuate uterus (55 independent singleton pregnancies) and 165 controls were included. There were no differences in baseline characteristics. Women with an arcuate uterus had a significantly higher rate of spontaneous preterm birth less than 37 weeks (10.9 vs. 3.0%, p = 0.031) and were more likely to require vaginal progesterone (5.5 vs. 0.6%, p = 0.049) and administration of antenatal corticosteroids (16.4 vs. 5.5%, p = 0.020). Arcuate uterus was also associated with lower birthweight (3,028.1 ± 528.0 vs. 3257.2 ± 579.9 g, p = 0.010) and higher incidence of intrauterine fetal growth restriction (20.0 vs. 7.3%, p = 0.008), despite similar starting body mass index (BMI) and weight gain throughout pregnancy. There were no differences in preeclampsia, malpresentation, cesarean delivery, blood transfusion, retained placenta, or morbidly adherent placenta. Arcuate uterus is associated with a significantly increased risk of spontaneous preterm birth (<37 weeks), need for vaginal progesterone for short cervix and antenatal corticosteroids, fetal growth restriction, and lower mean birthweight. These findings suggest that arcuate uterus is not just a normal variant of uterine anatomy but rather a risk factor for poor fetal growth, short cervix, and a higher risk pregnancy. · Arcuate uterus is associated with increased risk of preterm birth and fetal growth restriction.. · Women with arcuate uteri had higher rates of vaginal progesterone use during pregnancy.. · Arcuate uterus should be treated as a true finding rather than a normal anatomical variant..

Expression and clinical significance of lncRNA TCL6 in serum of patients with preeclampsia.

Preeclampsia is a common syndrome in pregnancy and a leading cause of mortality of pregnant females and their infants. To investigate the diagnostic and prognostic utility of lncRNA T-cell leukemia/lymphoma 6 (TCL6) in patients with preeclampsia, 120 singleton pregnant females with preeclampsia and another 100 healthy pregnant control subjects were analyzed in the present study. The expression of lncRNA TCL6 in the serum of the included patients was detected. Receiver operating characteristic curve analysis was applied to evaluate the efficiency of lncRNA TCL6 in terms of preeclampsia diagnosis and grading. Kaplan-Meier analysis was adopted to assess the effect of lncRNA TCL6 expression on the rate of adverse pregnancy. Multivariate logistic regression was used to determine high-risk factors of adverse pregnancy. The results indicated that lncRNA TCL6 was significantly increased in the serum of patients with preeclampsia. Furthermore, TCL6 was elevated in subgroups of patients with early-onset or severe preeclampsia and with Haemolysis, Elevated Liver enzymes and Low Platelet count syndrome in comparison with other patients with preeclampsia. High expression of TCL6 in pregnant females corresponded to a higher rate of adverse pregnancy outcomes. Severe preeclampsia, early-onset preeclampsia and high TCL6 expression were identified as independent risk factors for adverse pregnancy outcomes. For each unit increase in TCL6 expression, a 9.5-fold increase of the risk of adverse maternal and fetal outcomes was determined. Collectively, high expression of lncRNA TCL6 may assist the diagnosis and grading of preeclampsia and may be adopted as an independent risk factor for adverse pregnancy outcomes.

High-risk factors for adverse pregnancy outcomes in systemic lupus erythaematosus: a retrospective study of a Chinese population

ObjectiveTo clarify high-risk factors for adverse pregnancy outcomes (APOs) in systemic lupus erythaematosus (SLE).DesignA retrospective chart review study.SettingData were collected in a tertiary medical centre, Shanghai, China, from November 2010...

Adverse pregnancy outcomes attributable to socioeconomic and ethnic inequalities in England: a national cohort study

Socioeconomic deprivation and minority ethnic background are risk factors for adverse pregnancy outcomes. We aimed to quantify the magnitude of these socioeconomic and ethnic inequalities at the population level in England. In this cohort study, we used data compiled by the National Maternity and Perinatal Audit, based on birth records from maternity information systems used by 132 National Health Service hospitals in England, linked to administrative hospital data. We included women who gave birth to a singleton baby with a recorded gestation between 24 and 42 completed weeks. Terminations of pregnancy were excluded. We analysed data on stillbirth, preterm birth (<37 weeks of gestation), and fetal growth restriction (FGR; liveborn with birthweight <3rd centile by the UK definition) in England, and compared these outcomes by socioeconomic deprivation quintile and ethnic group. We calculated attributable fractions for the entire population and specific groups compared with least deprived groups or White women, both unadjusted and with adjustment for smoking, body-mass index (BMI), and other maternal risk factors. We identified 1 233 184 women with a singleton birth between April 1, 2015, and March 31, 2017, of whom 1 155 981 women were eligible and included in the analysis. 4505 (0·4%) of 1 155 981 births were stillbirths. Of 1 151 476 livebirths, 69 175 (6·0%) were preterm births and 22 679 (2·0%) were births with FGR. Risk of stillbirth was 0·3% in the least socioeconomically deprived group and 0·5% in the most deprived group (p<0·0001), risk of a preterm birth was 4·9% in the least deprived group and 7·2% in the most deprived group (p<0·0001), and risk of FGR was 1·2% in the least deprived group and 2·2% in the most deprived group (p<0·0001). Population attributable fractions indicated that 23·6% (95% CI 16·7-29·8) of stillbirths, 18·5% (16·9-20·2) of preterm births, and 31·1% (28·3-33·8) of births with FGR could be attributed to socioeconomic inequality, and these fractions were substantially reduced when adjusted for ethnic group, smoking, and BMI (11·6% for stillbirths, 11·9% for preterm births, and 16·4% for births with FGR). Risk of stillbirth ranged from 0·3% in White women to 0·7% in Black women (p<0·0001); risk of preterm birth was 6·0% in White women, 6·5% in South Asian women, and 6·6% in Black women (p<0·0001); and risk of FGR ranged from 1·4% in White women to 3·5% in South Asian women (p<0·0001). 11·7% of stillbirths (95% CI 9·8-13·5), 1·2% of preterm births (0·8-1·6), and 16·9% of FGR (16·1-17·8) could be attributed to ethnic inequality. Adjustment for socioeconomic deprivation, smoking, and BMI only had a small effect on these ethnic group attributable fractions (13·0% for stillbirths, 2·6% for preterm births, and 19·2% for births with FGR). Group-specific attributable fractions were especially high in the most socioeconomically deprived South Asian women and Black women for stillbirth (53·5% in South Asian women and 63·7% in Black women) and FGR (71·7% in South Asian women and 55·0% in Black women). Our results indicate that socioeconomic and ethnic inequalities were responsible for a substantial proportion of stillbirths, preterm births, and births with FGR in England. The largest inequalities were seen in Black and South Asian women in the most socioeconomically deprived quintile. Prevention should target the entire population as well as specific minority ethnic groups at high risk of adverse pregnancy outcomes, to address risk factors and wider determinants of health. Healthcare Quality Improvement Partnership.

Short Interpregnancy Interval and Low Birth Weight

Objective: To determine the frequency of Low Birth Weight among women with short interpregnancy interval. Study Design: Descriptive case series. Study Setting: Study was conducted at Department of Gynecology and Obstetrics Unit 1, Civil Hospital, Karachi. Duration of Study: Six months after approval of synopsis from 22-12-15 till 22-06-16. Subjects and Methods: Data was prospectively collected from patients after taking a verbal consent. 384 women with short interval pregnancy were included. Quantitative data was presented as simple descriptive statistics giving mean and standard deviation and qualitative variables was presented as frequency and percentages. Effect modifiers were controlled through stratification to see the effect of these on the outcome variable. Post stratification chi square test was applied taking p-value of ≤0.05 as significant. Results: Out of 384 patients mean age and BMI in our study was 29.56±3.91 years and 30.72±1.34 kg/m2 respectively. 135 (35.2%) and 249 (64.8%) had and did not have low birth weight respectively. Conclusion: Our study confirmed that short IPI is an independent risk factors for adverse pregnancy outcomes like low birth weight. These finding emphasize the importance of providing support for family planning programs which will support optimal IPI and improve pregnancy outcomes. Keywords: Short interpregnancy interval and low birth weight.

O22 Pregnancy planning in non-criteria antiphospholipid syndrome

Case report - IntroductionAntiphospholipid Syndrome (APS) is an autoimmune condition manifested by vascular thrombosis with or without pregnancy related morbidities. APS classification criteria require detection of persistent antibodies: Anti-Cardiolipin Antibody (aCL), Anti-Beta Glycoprotein I (ab2GPI) and circulating Lupus Anticoagulant (LAC).Criteria for the diagnosis of obstetric antiphospholipid syndrome allow for optimal treatment planning in pregnancy and reduction of foetal and maternal morbidity. There are, however, several “non-criteria” features of APS, including late pre-eclampsia, which may also infer adverse obstetric outcomes.We highlight a treatment dilemma in a young female with lupus and APS with history of previous pregnancy that was complicated by pre-eclampsia.Case report - Case descriptionWe describe a case of a 26-year-old female with systemic lupus erythematosus (SLE), “triple positive” APS markers (aPL) and non-criteria APS obstetric morbidity.During her first pregnancy she presented at 22 weeks with severe and frequent migraine episodes. She had no other active clinical manifestations of SLE. There was no prior history of pregnancy and therefore no previous obstetric morbidity nor had she had any vascular thrombotic episodes. She had been commenced on low-dose aspirin (LDA) at the start of her pregnancy and was already taking hydroxychloroquine (HCQ). The dose of HCQ was increased to 400mg daily leading to improvement in the headaches. She had persistent strong ACL antibodies, positive LAC and ab2GPI antibodies. ANA was positive with hypocomplementemia and neutropenia but normal range double-stranded DNA antibodies.After discussion with a tertiary centre, it was recommended to continue HCQ and LDA. Low molecular weight heparin (LMWH) was not proposed as she did not fulfil criteria for obstetric APS. Her pregnancy was subsequently complicated by pre-eclampsia and post-partum sepsis.Two years later she sought advice to plan her second pregnancy, raising important questions as to whether the same treatment strategy should be followed or if alternative approaches should be considered, given the history of pre-eclampsia and its association with APS. Again, she did not meet the international consensus (revised Sapporo) criteria for diagnosis of obstetric APS.After further discussion with the tertiary centre, she commenced high-dose aspirin 150mg/day alone. Uterine artery dopplers were recommended and LMWH proposed if bilateral notching was noted. Dopplers were normal.Her blood pressure (BP) fluctuates between 130-145mmHg systolic. She has occasional crops of mouth ulcers but no other SLE features. Migraines continue every 2—3 weeks although severe attacks are infrequent. C4 is persistently low with normal Ds DNA and urine protein/creatinine ratio.Case report - DiscussionOur case raises questions on how pregnancy should be safely managed in patients without a prior history of APS-related pregnancy complications but who nevertheless have risk factors, in the form of APS antibody positivity and non-criteria obstetric manifestations of APS. Her previous pregnancy was treated with LDA and HCQ which had proved insufficient in avoiding the outcome of pre-eclampsia.The objective of prophylactic treatments is to prevent adverse outcomes such as miscarriage, which carry significant maternal morbidity including psychological manifestations such as depression and anxiety. In first pregnancies, mothers have no existing obstetric history, such that current treatment guidance provides few recommendations for preventative interventions, even where other risk factors are apparent. Furthermore, non-criteria manifestations of obstetric APS are now well recognised, which may further highlight potential risk for obstetric morbidity but fail to trigger interventions as they are not included within the current international criteria. These manifestations include late pre-eclampsia, placental abruption and late pregnancy loss, unexplained in vitro fertilisation failures, two unexplained miscarriages and three non-consecutive miscarriages. Low positive antibody titres and intermittent aPL are also included.Studies suggest that women with non-criteria APS may benefit from standard treatment for obstetric APS which includes LMWH in addition to aspirin, with good pregnancy outcomes.HCQ has a dose-dependent effect in preventing thrombosis through inhibition of platelet aggregation and aPL Ab-related thrombosis. However, pregnancy itself is a prothrombotic condition and in the presence of persistent triple positive aPL is a risk factor for adverse pregnancy outcomes.Further studies are needed to define the risk of non-criteria APS on pregnancy outcomes and define optimal treatment strategies.Case report - Key learning pointsObstetric APS carries significant risk for maternal foetal morbidity including miscarriage and pre-term birth.Significant maternal psychological effects are recognised even following a single miscarriage.The international consensus (revised Sapporo) criteria for diagnosis of obstetric antiphospholipid syndrome exclude certain non-criteria clinical and laboratory manifestations that may confer adverse pregnancy outcomes.First pregnancies are challenging to risk stratify in patients with identified aPL as there will be no prior pregnancy history to reference.Ultrasound doppler velocimetry is a useful non-invasive tool to diagnose poor placental perfusion, a predictor of obstetric complications, hence identifying high-risk pregnancies.Further research is required to establish the diagnostic validity, predictive value, and treatment implications of non-criteria manifestations of obstetric APS.

Good pregnancy outcomes in lupus nephritis patients with complete renal remission.

The aim of this study was to investigate pregnancy outcomes and risk factors in patients with lupus nephritis (LN). A total of 158 pregnancies in 155 women with LN were divided into a remission group and a control group according to whether they achieved complete renal remission (CRR) prior to pregnancy. The adverse pregnancy outcomes and risk factors were retrospectively analyzed. In the remission group, 130 LN patients with 133 pregnancies (two twin pregnancies) delivered 127 live births; 25 LN patients with 25 pregnancies delivered 19 live births in the control group. Compared with the control group, the remission group had significantly lower incidence of LN relapse, fetal loss and premature birth. For LN patients in the remission group, a CRR duration <18 months [odds ratio (OR) 11.24, 95% confidence interval (CI) 2.95-42.80, P <0.001] and anti-C1q antibody positivity before pregnancy (OR 7.2, 95% CI 1.38-37.41, P=0.019) were independent risk factors for LN relapse; anti-phospholipid antibody positivity (OR 9.32, 95% CI 1.27-68.27, P=0.028) and prednisone dosage during pregnancy≥12.5mg/day (OR 3.88, 95% CI 1.37-10.99, P=0.011) were independent risk factors for fetal loss and premature birth, respectively; and age >30 years was an independent risk factor for preeclampsia and premature birth. LN patients with a CRR duration greater than 18 months were associated with good pregnancy outcomes and lower LN relapse. Age, anti-C1q and anti-phospholipid antibodies, and prednisone dosage during pregnancy were risk factors for adverse pregnancy outcomes.

Prevention Starts in the Womb: Opportunities for Addressing Cardiovascular Risk Factors During Pregnancy and Beyond.

Early identification and mitigation of sex-specific cardiovascular disease risk factors is a potential trajectory-changing strategy to improve lifelong cardiovascular health in women. These sex-specific risk factors include adverse pregnancy outcomes, polycystic ovarian syndrome, and premature menopause. We start by discussing the impact and management of risk factors for adverse pregnancy outcomes as an upstream intervention for cardiovascular disease risk reduction and then address the long-term effect and mitigation of sex-specific risk factors for cardiovascular disease.

Increased Risk of Stillbirth among Women whose Partner Has Tuberculosis.

Background The relationship between tuberculosis (TB) and adverse pregnancy outcomes remains unclear. The aim of our study was to investigate whether TB is a risk factor for adverse pregnancy outcomes including premature birth, low birth weight, and stillbirth. Method We conducted a population-based retrospective cohort study in mainland China. A total of 3,668,004 Chinese women, along with their partners, were included in this study, within the National Free Pre-Pregnancy Checkups Project, during 2015–2018. Propensity score matching was used to balance the two groups (cases: women or partners with TB; controls: women and partners without TB). Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results Multivariate logistic regression showed that the OR of stillbirth for cases was 1.89 (95% CI: 1.09–3.16), in comparison with the control group. In the subgroup analysis, women whose partner had TB had a higher risk of stillbirth (OR: 2.13, 95% CI: 1.10–3.86) than women whose partner did not have TB. There was no significant difference in adverse pregnancy outcomes, including preterm birth, low birth weight, and stillbirth, between women with and without TB. Conclusions Women whose partner had TB were more likely to have stillbirth than women whose partners did not have TB.

Effects of individual dietary intervention on blood glucose level and pregnancy outcomes in patients with gestational diabetes mellitus: a retrospective cohort study.

Gestational diabetes mellitus (GDM) increases the incidence of adverse outcomes in pregnant women. Individual diet intervention (IDI) was developed in our center through collaboration with nutritionists to treat GDM and prevent further complications. We then aimed to analyze the effects of IDI on the level of blood glucose and pregnancy outcomes in pregnant women with GDM. We retrospectively enrolled pregnant women with GDM between April 2016 and March 2020. Participants in the control group received routine GDM care, and those in the study group received extra IDI on the basis of routine GDM care. Demographic and clinical characteristics of participating pregnant women were retrospectively collected. The study outcomes were the status of blood glucose control after 6 weeks of IDI or conventional intervention and pregnancy outcomes. Univariable and multivariable logistic regression analyses were sequentially performed to determine the predictors of proper blood glucose control and risk factors of adverse pregnancy outcomes in the study population. A total of 817 pregnant women who had been diagnosed as GDM were enrolled in this study, including 435 admitted between April 2016 to March 2018 who received conventional medication and 382 who were admitted between April 2018 to March 2020 and received IDI. Generally, there was no significant difference in baseline characteristics between study and control groups. Glycated hemoglobin (HbA1c) level after intervention was statistically lower in the study group than in the control group (5.6±0.9 vs. 5.5±0.7, P=0.006). Multivariable logistic regression analysis revealed that IDI was a predictor of proper blood glucose control in GDM participants (P=0.003). There were more cesarean sections and cases of macrosomia in the control group than the study group, showing statistical difference (35.9% vs. 28.5%, P=0.026; 8.7% vs. 4.7%, P=0.023, respectively). According to multivariable logistic regression analysis, IDI was identified as playing a protective role against cesarean section in GDM participants (P=0.034) and it could reduce the incidence of macrosomia in GDM participants (P=0.028). This novel pattern of IDI may not only help stabilize blood glucose levels in pregnant women with GDM, but also reduce the incidence of adverse outcomes to a certain extent.

Evaluation of the diagnosis and treatment of cesarean scar pregnancy induced in the second trimester: a national multicenter retrospective study

Objective: To study the risk factors of adverse pregnancy outcomes for induced abortion of cesarean scar pregnancy in midtrimester. Methods: A national multicenter retrospective study was conducted. A total of 154 singletons pregnant women with cesarean scar pregnancy during the second trimester induced abortion by various reasons in 12 tertiary A hospitals were selected, their pregnant outcomes were observed and the risk factors of serious adverse outcomes were analyzed with univariate and multivariate logstic regression; the role of ultrasound and MRI in predicting placenta accreta and severe adverse outcomes was evaluated, the effectiveness of uterine artery embolization (UAE) in preventing hemorrhage in pregnant women with and without placenta accreta was compared. Results: Among 154 subjects, the rate of placenta accreta was 42.2% (65/154), the rate of postpartum hemorrhage≥1 000 ml was 39.0% (60/154), the rate of hysterectomy was 14.9% (23/154), the rate of uterine rupture was 0.6% (1/154). The risk factor of postpartum hemorrhage≥1 000 ml and hysterectomy was placenta accreta (P<0.01). For each increase in the number of parity, the risk of placenta accreta increased 2.385 times (95%CI: 1.046-5.439; P=0.039); and the risk of placenta accreta decreased with increasing ultrasound measurement of scar myometrium thickness (OR=0.033, 95%CI: 0.001-0.762; P=0.033). The amount of postpartum hemorrhage and hysterectomy rate in the group with placenta accreta diagnosed by ultrasound combined with MRI were not significantly different from those in the group with placenta accreta diagnosed by ultrasound only or MRI only (all P>0.05). For pregnant women with placenta accreta, there were no significant difference in the amount of bleeding and hysterectomy rate between the UAE group [median: 1 300 ml; 34% (16/47)] and the non-embolization group (all P>0.05); in pregnant women without placenta accreta, the amount of bleeding in the UAE group was lower than that in the non-embolization group (median: 100 vs 600 ml; P<0.01), but there was no significant difference in hysterectomy rate [2% (1/56) vs 9% (3/33); P>0.05]. Conclusions: (1) Placenta accreta is the only risk factor of postpartum hemorrhage≥1 000 ml with hysterectomy for induced abortion of cesarean scar pregnancy in midtrimester; multi-parity and ultrasound measurement of scar myometrium thickness are risk factors for placenta accreta. (2) The technique of using ultrasound and MRI in predicting placenta accreta of cesarean scar pregnancy needs to be improved. (3) It is necessary to discuss of UAE in preventing postpartum hemorrhage for induced abortion of cesarean scar pregnancy in midtrimester.

Low Preconception Complement Levels Are Associated with Adverse Pregnancy Outcomes in a Multicenter Study of 260 Pregnancies in 197 Women with Antiphospholipid Syndrome or Carriers of Antiphospholipid Antibodies

Antiphospholipid antibodies (aPL) can induce fetal loss in experimental animal models. Human studies did find hypocomplementemia associated with pregnancy complications in patients with antiphospholipid syndrome (APS), but these results are not unanimously confirmed. To investigate if the detection of low C3/C4 could be considered a risk factor for adverse pregnancy outcomes (APO) in APS and aPL carriers’ pregnancies we performed a multicenter study including 503 pregnancies from 11 Italian and 1 Russian centers. Data in women with APS and asymptomatic carriers with persistently positive aPL and preconception complement levels were available for 260 pregnancies. In pregnancies with low preconception C3/C4, a significantly higher prevalence of pregnancy losses was observed (p = 0.008). A subgroup analysis focusing on triple aPL-positive patients found that preconception low C3 and/or C4 levels were associated with an increased rate of pregnancy loss (p = 0.05). Our findings confirm that decreased complement levels before pregnancy are associated with increased risk of APO. This has been seen only in women with triple aPL positivity, indeed single or double positivity does not show this trend. Complement levels are cheap and easy to be measured therefore they could represent a useful aid to identify patients at increased risk of pregnancy loss.

Fetal Growth Disorders and Influence of Maternal Adiposity

Introduction: Infant birth weight is recognized as the leading indicator of health among infants and affects a wide range of subsequent outcomes later in life. The incidence of neonates with high birth weight has increased in recent years. Many studies in the past have revealed that high birth weight is associated with neonatal morbidity and mortality and associated with complications in later life. These complications include shoulder dystocia, birth trauma, asphyxia, and neonatal deaths. In the later life these neonates have high risk for obesity, hypertension, diabetes mellitus and cancer. High pre-pregnancy body mass index (BMI) has been reported as a well-established risk factors for adverse pregnancy outcomes. Despite the high prevalence of maternal obesity in the gulf region, only a few studies in this regard have been published. Methods: A retrospective service evaluation was conducted at a secondary hospital to evaluate the effect of pre-pregnancy BMI on neonatal birth weight. 950 women were randomly selected from women delivered at or more than 37 weeks gestation and grouped on the basis of pregnancy BMI as group A-BMI 18.5–24.9 kg/m2, group-B- BMI 25–29.9 kg/m2 and group C-BMI >30 kg/m2. Infants were grouped according to birth weight as low birth weight(<2500 g), normal birth weight (2500–3999 g), and high birth weight >4000g and correlation was studied with maternal body mass index. Chi square test was used for statistical evaluation using Medcal online software. Results: In the study group, 34.43% women had normal body mass index, 37.21 % women were overweight and 28.36 % were obese. In group A, 6.50% and 4.64 % infants were with low and high birth weight, respectively. In group B, 4.3% and 5.73 % were with low and high birth weight, respectively. In group C, 4.51% and 20.33 % infants were with low and high birth weight, respectively. In comparison to women with normal BMI, low birth weight infants in group B (OR-0.922, 95% CI- 0.327–1.275) and group C (OR- 0.679, 95% CI-0.682–1.572) were not statistically significant. High birth weight infants in group B (OR- 1.2482, 95% CI- 0.3270 to 1.2756, p = 0.2080) and group C (OR-5.230, 95% CI-2.875–9.512, p= < 0.0001) were positively correlated with pre-pregnancy BMI. Pre-pregnancy overweight and obesity increased the risk of high birth weight (OR- 1.248 and 5.230 respectively). The results were statistically significant in obese women (p=< 0.0001). Conclusion: Women with pre-pregnancy overweight and obesity have higher likelihood of high birth weight in infants. Pre-pregnancy weight loss is the key to reduce maternal and fetal complications. Early pregnancy booking and antenatal fetal surveillance is recommended for all women with high body mass index.

The correlation between serum uric acid levels in the third trimester of pregnancy and adverse pregnancy outcomes

Objective: To investigate the associations between serum uric acid levels during the third trimester of pregnancy and risks of adverse pregnancy outcomes. Methods: In this retrospective study, a cohort of 7 995 pregnant women who were hospitalized for childbirth from January 2014 to January 2019 were collected to compare pregnancy outcomes between subjects with or without hyperuricemia (HUA). A smooth curve analysis was used to evaluate the relationship between uric acid levels and preterm delivery, low birth weight and smaller than gestational age. Logistic regression analyses were performed to identify risk factors for adverse pregnancy outcomes, and the interaction of the factors. Results: During the third trimester of pregnancy, the uric acid levels of about 10% pregnant women were over 420 μmol/L. In those with HUA, the median neonatal birth weight was 2 590 (1 790, 3 410) g, the probability of premature birth was 49.81%, and the incidence of small than gestational age was 20.41%. These were significantly different from the women without HUA (the median neonatal birth weight: 3300 (2850, 3640) g; the probability of premature birth 23.09%; the incidence of small than gestational age 6.55%, respectively) (All P<0.001). Maternal uric acid levels were negatively correlated with neonatal birth weight, and positively correlated with the risk of smaller than gestational age. It has a U-shaped association with the probability of premature birth, and the lowest probability of premature birth was at 200-400 μmol/L of the uric acid. Risks of low birth weight (adjusted β=-5.22, 95%CI-6.46--3.99) and smaller than gestational age (adjusted OR=1.03, 95%CI 1.02-1.04) were increased in the function of uric acid levels. High uric acid, hypertension, oligoamnios and preeclampsia were important risk factors for the adverse pregnancy outcomes. The risk of preterm delivery and low birth weight enhanced when hyperuricemia combined with hypertension and preeclampsia. Conclusions: Serum uric acid level can be used as one of reliable markers for predicting adverse pregnancy outcomes, which might provide theoretical basis for clinical intervention in practice.

Risk Factors for Adverse Pregnancy Outcomes among Zhuang Ethnic Pregnant Women: A Cohort Study in Guangxi, China

SummaryRisk factors for adverse pregnancy outcomes among Zhuang ethnic pregnant women are unclear. This study analyzed the incidence and risk factors related to preterm birth (PB), low birth weight (LBW) and macrosomia in Zhuang population. We conducted a prospective cohort study of 9965 Zhuang pregnancy women in Guangxi, China. Information on mothers and newborns was obtained by using questionnaires and referring to medical records. Multivariate logistic regression analyses were used to evaluate the association between related factors and adverse pregnancy outcomes. Our results showed that the incidence of PB, LBW and macrosomia in Zhuang people was 5.55%, 5.64% and 2.19%, respectively. Maternal age ≥36 years (OR=2.22, 95% CI: 1.51–3.27) was related to a higher incidence of PB. Those with pre-pregnancy body mass index (BMI) <18.5 kg/m2 (OR=1.91, 95% CI: 1.45–2.51), and had a female fetus (OR=1.74, 95% CI: 1.36–2.23) were more likely to have LBW infants. Maternal age between 31 and 35 years (OR=1.76, 95% CI: 1.03–2.99) and pre-pregnancy overweight or obesity (OR=1.79, 95% CI: 1.15–2.80) were associated with a higher risk of macrosomia. The protective factors of macrosomia were maternal pre-pregnancy BMI <18.5 kg/m2 (OR=0.30, 95% CI: 0.15–0.60) and female fetus (OR=0.41, 95% CI: 0.28–0.59). Our study provided a reference for maternal and childcare administration among Zhuang population.

Subclinical thyroid diseases and isolated hypothyroxinemia during pregnancy.

Thyroid diseases in pregnancy are common. While data on management of overt diseases are clear, there is no consensus regarding subclinical thyroid disease. Many studies have tried to clarify the impact of subclinical thyroid disease on pregnancy outcomes without reaching universal conclusions. As several studies are present in literature, but no univocal indication is present to manage each condition, the present review tries to summarize the recent indications for such disease. The most updated guidelines are 2017 American thyroid association for thyroid disease during pregnancy, which at present represent the most accurate and reliable guide. Subclinical hyperthyroidism during pregnancy has not been associated with adverse outcomes and only needs follow up. Subclinical hypothyroidism is associated with adverse obstetric and offspring outcomes. At present thyroxine treatment is recommended in selected cases, as beneficial effects are not clear for all these patients. Data regarding the association between isolated hypothyroxinemia and adverse maternofetal outcome are controversial but treatment is not indicated. Autoimmune thyroid disease represents the main thyroid risk factor for adverse pregnancy outcomes. If patients have normal TSH values, treatment is not indicated. A possible thyroxine treatment can be evaluated on a case-by-case basis in euthyroid patients with history of abortion/infertility. In the last years, risks of subclinical thyroid dysfunction on the outcome of gestation and new-born have been scaled back. Further prospective studies are necessary to better understand thyroid dysfunction in pregnancy to perfectly target treatment in appropriate settings.