Fetal Pregnancy Outcomes Research Articles

Outcome of subsequent pregnancies in women with complete uterine rupture: A population-based case-control study.

In the attempt of a trial of labor after a cesarean section approximately one in 200 women experience a complete uterine rupture. As a complete uterine rupture is associated with an adverse perinatal outcome, data regarding subsequent pregnancies are needed to provide proper care and guidance to women with a complete uterine rupture when informing them of future possibilities. The objective of this study was to investigate the fetal and maternal outcomes in subsequent pregnancies after a complete uterine rupture. Retrospective population-based case-control study. Denmark 1997-2017. A total of 175 women with complete uterine rupture during an attempted trial of labor after cesarean (TOLAC) at term (cases) and a corresponding group of 272 women with no uterine rupture during an attempted TOLAC at term (controls) were labeled as index deliveries. Index deliveries were included from January 1, 1997 to December 31, 2008. From the date of the index delivery to December 31, 2017 the information on subsequent pregnancies and deliveries, and on referral to hospital with any obstetric or gynecological diagnosis were retrieved from the Danish Medical Birth Registry and National Patient Registry. Main outcome measures were miscarriage, perinatal death, neonatal morbidity, preterm birth, and recurrence of uterine rupture. Outcome measures were compared between cases and controls. After the index deliveries; there were 109 pregnancies and 70 deliveries after gestational age 22+0 weeks in the population of cases. In the population of controls, there were 183 pregnancies and 126 deliveries after 22+0 weeks. Cases had a significantly higher risk of miscarriage (odds ratio [OR] 3.99; 95% confidence interval [CI] 1.36-13.17). The incidence of uterine rupture was 8.6% among cases and 0.8% among controls (OR 11.7; 95% CI 1.36-543.1). Among cases, 98.6% had live-born infants, and none of these had severe neonatal morbidity. No significant association was found between previous complete uterine rupture and preterm delivery, placenta previa, hysterectomy in relation to subsequent births, diagnosis such as meno/metrorrhagia, dysmenorrhea, or procedures such as hysteroscopy or hysterectomy. In pregnancies following complete uterine rupture continuing after 22+0 weeks, maternal and fetal outcomes are good when managed promptly with cesarean delivery.

OP050: Cell-free DNA fetal fraction and adverse obstetric outcomes in twin pregnancy

Both decreased and increased cell-free (cf) DNA fetal fractions are associated with adverse obstetric outcomes in singleton pregnancies. The aim of this study was to evaluate the association between cfDNA fetal fraction and adverse obstetric outcomes in twin pregnancies in a large geographically diverse population.

Fetal outcome of adolescent pregnancy in a tertiary care center in western Nepal: A case control study

Fetal outcome of adolescent pregnancy in a tertiary care center in western Nepal: A case control study

Tight control of blood pressure in pregnant women with nonsevere hypertension: expectations for decreasing adverse maternal and fetal pregnancy outcomes

Tight control of blood pressure in pregnant women with nonsevere hypertension: expectations for decreasing adverse maternal and fetal pregnancy outcomes

Maternal fetal outcome in multiple versus singleton pregnancies delivered in a teaching hospital

To compare the maternal and fetal outcome in multiple versus singleton pregnancies in a private teaching hospital in India. Prospectively collected data on 50 twin deliveries from July 2018 to November 2021 were studied to determine its incidence; the maternal and foetal outcome, and compared with 50 singleton deliveries conducted on same day following the twin delivery who served as controls, the twins were also analysed on the basis of chorionicity. A total of 3415 deliveries were conducted during the study period, of which 50 were twin deliveries, giving an incidence of 14 per 1000 births or 1.4:100 deliveries. Six among 50 twins resulted following ovulation induction. Women with twin gestation had a mean maternal age of 24.7±3.71, same for the singleton mothers was 24.26±3.7years; mean gestational age at delivery for twins and singletons were 35.38±2.6 and 38.63±1.19 weeks; mean birth weight for twins and singletons were 2.193kgs and 2.85±0.46kgs, mean parity were 2.04± 1.0 and 1.72±0.7 respectively. Parity, gestational age, NICU stay characteristics showed p value < 0.05. Compared with singletons, women with twin gestations had a positive risk association with odds >1 for anaemia, preeclampsia, preterm labour, malpresentation and caesarean delivery. Twin Neonates suffered prematurity, low birth weight, congenital anomaly, prolonged NICU care and increased perinatal death. Neonatal risk was more among monochorionic twins than dichorionic twins. There were 3 cases with single fetal demise, and both fetuses IUD in another case, (total IUDs-5), one twin was still born, two had early neonatal death and there were two late neonatal (>7 Days) deaths. One twin mother threw fits on the 6th postpartum day. Another mother received 20 units of blood and component replacement and subtotal hysterectomy for PPH. Despite improvement in antenatal and neonatal care, twins pose a higher threat to MCH outcome. Hence, thorough counselling, patient awareness, more vigilance at interpretation of antenatal tests, intrapartum monitoring and bridging the gap between demand and supply at NICU facility can improve maternal and neonatal outcome; as well as can help parents cope with the psychological stress.

Assessment of Maternal and Fetal Outcomes in Pregnancy Complicated by Fibroid Uterus.

BackgroundThe study aims to assess maternal and fetal outcomes in pregnancy complicated by a fibroid uterus.Materials and methodsSixty-four adult women patients with fibroids in age range of 25-45 years were selected. Fetal and maternal outcomes were recorded.ResultsThirty-four patients were in the age group of 25-35 years, and 50 were aged 35-45 years of age. Primigravida was seen in 52 and multigravida in 32. The common types were intramural in 40, submucosal in 16, pedunculated in seven, and subserosal in 21 cases. Size >5 cm was seen in 38 and 2 cm-5 cm in 46 patients. Common symptoms were preterm labor pain in 50, abdominal pain in 12, and urinary tract infection (UTI) in 22 cases. The common sites were the anterior wall fibroid in 42, posterior wall in 22, and lateral wall in 20 cases. Complications reported in our study were premature rupture of membranes (PROMs) in 12, threatened preterm in 11, associated infertility in five, intrauterine growth retardation (IUGR) in two, malpresentation in seven, postpartum hemorrhage (PPH) in four, preterm labor in six, and abruption in eight cases. The difference was observed to be significant (P<0.05). ConclusionCommon complications were PROM, threatened preterm, associated infertility, IUGR, malpresentation, PPH, preterm labor, and abruption.

Frequency of Teenage Pregnancy and Frequency of its Complications

Objectives: To determine the frequency of fetomaternal complications among teenage pregnant women. Study design: Descriptive study, cross-sectional study. Settings: Department of Obstetrics &amp; Gynecology, Civil Hospital Karachi Study duration: 4th February 2019 to 3rd August 2020. Materials &amp; Methods: A total of 126 pregnant women with teenage pregnancies of 13-19 years of age were included. Patients with known medical disorders i.e. PIH, DM were excluded. All teenagers were questioned for demographic particulars like age, parity, ethnicity, antenatal care, qualification, and their height and weight were taken. Clinical details regarding maternal and fetal outcomes of pregnancy were acquired. The data regarding the demographic characteristics of pregnant teenagers and details about fetal and maternal outcomes were documented. Results: In this study, the age span ranges between 13 and 19 years with a mean age of 17.44 ± 1.63 years. A majority of these patients 100 (79.87%) were between theage group of 17 to 19 years. In this study, the frequency of fetomaternal outcome in teenage pregnancy was as follows; anemia was found in 41 (32.54%), miscarriage in 23 (18.25%) patients, and preterm birth in 45 (35.71%) patients. Conclusion: This study concluded that teenage pregnancy is associated with adverse fetomaternal outcomes so it is recommended that public awareness should be arranged on national and regional levels regarding this major public health issue and to avoid teenage marriages. Keywords: Teenage pregnancy, anemia, preterm birth.

Influence of Pre-Pregnancy Underweight Body Mass Index on Fetal Abdominal Circumference, Estimated Weight, and Pregnancy Outcomes in Gestational Diabetes Mellitus.

This study aimed to determine the influence of pre-pregnancy body mass index on pregnancy outcomes in gestational diabetes mellitus (GDM), comparing underweight patients with GDM with normal weight patients with GDM. Maternal baseline characteristics, ultrasonographic results, and pregnancy and neonatal outcomes were reviewed in 946 women with GDM with singleton pregnancies. Underweight patients with GDM showed a benign course in most aspects during pregnancy, except for developing a higher risk of giving birth to small for gestational age neonates. Underweight women with GDM required less insulin treatment, had a higher rate of vaginal delivery, and had a lower rate of cesarean delivery. In addition, their neonates were more likely to have fetal abdominal circumference and estimated fetal weight below the 10th percentile both at the time of GDM diagnosis and before delivery. Notably, their risk for preeclampsia and macrosomia were lower. Collectively, our data suggest that underweight women with GDM may require a different approach in terms of diagnosis and management throughout their pregnancy.

Maternal and Fetal Outcome of Pregnancy with COVID- 19 in A Tertiary Level Hospital, Bangladesh

Introduction: Pregnant women have long been recognized as a vulnerable population during infectious disease pandemics due to physiological changes in the immune, pulmonary, cardiac and coagulation systems. It is essential to acquire knowledge of pregnancy outcomes, potential complications and neonatal health conditions born to an infected mother with COVID-19. Material and methods: This cross-sectional observational study was conducted in Combined Military Hospital (CMH), Jashore from June 2020 to July 2021 among 100 hospitalized laboratory-confirmed COVID-19 positive pregnant women, patients who had clinical symptoms of COVID but RT PCR negative were excluded. The aim of the study was to evaluate the clinical profile and maternal and fetal outcome of pregnancy. Relevant data were recorded in a preformed data collection sheet and analyzed by SPSS version 20. Results: Among 100 COVID-19 positive hospitalized pregnant women, the mean age of participants was 27years (range 19-40 years), Maximum infection rate observed during 12 to 28 weeks of gestation among the participants, 21% got infected at 37 to 40 weeks of gestation and 20% got infected at 32 to 36 weeks. Seventy-four percent patients underwent delivery during the study &amp; 23% of them continued with ongoing pregnancy; 67 of the participants underwent LUCS and 7 vaginal deliveries were done, 3% had abortion and IUFD 1% ,61% were multipara and 39% were Primipara, associated co-morbidities were subclinical hypothyroidism(15%), pregnancy induced HTN(12%) and GDM(8%); 36% participants were asymptomatic and 44% had mild symptoms, rate of LUCS was higher than (90.64%) vaginal delivery. Among the 73 live births, 80.82% were term and 10.18% were preterm of neonates, small for gestational was seen in the case of 20.55% neonates. Testing for SARS-CoV-2 was performed in all neonatal throat swabs and found positive in one case only. Eighty-six percent neonates were well-baby and 9.58% neonates required NICU admission. There were 2 neonatal deaths due to severe prematurity and 2 babies were found to have congenital cardiac anomaly and cleft lip, cleft palate. Though 36% of patients were asymptomatic but 10% were severe and in the critical stage. HDU support needed for 8% of patients and ICU support for 6%. Conclusion: This cross-sectional study supports that pregnant women with COVID-19 infection are at increased risk of adverse pregnancy and birth outcomes and a low risk of congenital transmission. Availability of ICU in critical conditions is needed for better pregnancy outcomes. J Bangladesh Coll Phys Surg 2022; 40: 10-16

Maternal anthropometric measurements and correlation to maternal and fetal outcomes in late pregnancy.

Background:Body mass index does not distinguish between lean and fat body mass; therefore, its utility defining body composition is limited in pregnancy. Anthropometric measurements may better represent variation in body composition among women who are overweight or obese. We sought to examine body fat composition using maternal anthropometric measurements in late pregnancy and correlate with mode of delivery.Methods:A prospective study of pregnant patients who were overweight (body mass index: 25–29.9 kg/m2) or obese (body mass index ⩾ 30 kg/m2) with singleton pregnancies who underwent anthropometric measurements between 27 weeks, 0 days to 34 weeks, 6 days gestation. Maternal skinfold thicknesses from eight sites were used to estimate body fat mass. Correlation of skinfold thickness, anthroprometric measurements, and estimated body fat percentage on mode of delivery were analyzed with p < .05 as significant.Results:A total of 41 women with overweight (34.1%) or obese (65.9%) body habitus were included. Mean age was 29.9 years, and the majority (43.9%) were Black and 31.7% identified Hispanic/Latinx. The average gestational age at recruitment was 30 weeks, 2 days and 38 weeks, 6 days at delivery. A greater weight at recruitment (94.2 vs 81.8 kg, p = .023), waist circumference (47.1 vs 43.5 inches, p = .010), Huston–Presley body fat percentage (36.4% vs 31.8%, p = .030), triceps skinfold thickness (20.1 vs 15.7 mm, p = .030), biceps skinfold thickness (18.6 vs 15.0 mm, p = .042), and skinfold thickness, as well as sum of skinfold sites (83.3 vs 68.8 mm, p = .049) were associated with cesarean delivery compared to vaginal delivery on univariate analysis.Conclusion:Third-trimester anthropometric measurements may help predict increased risk for c-section in women with obesity. Further research may elucidate utility in nutritional counseling and delivery planning.

Fetal and maternal outcome of higher-order multiple pregnancies in a tertiary hospital: A 5-year single-center observational study from Nigeria.

Objective:The aim of this study was to determine the pattern and outcomes of higher-order multiple pregnancies in a tertiary hospital in NigeriaMethods:This is a retrospective review of all cases of higher-order multiple pregnancies that were managed between 1 January 2012 and 31 December 2016 in Alex Ekwueme Federal University Teaching Hospital Abakaliki, Nigeria. Data obtained were represented with frequency tables, percentages, bar charts, and odds ratio.Results:There were 22 higher-order multiple pregnancies over the study period and 12,002 deliveries, giving a higher-order multiple prevalence rate of 0.2%. Five of the mothers (four triplets and one quadruplet) had in vitro fertilization (0.4 per 1000 deliveries), while other mothers conceived naturally. Many of the women (12, 54.6%) were in the 30–34 years age group, and more than half (16, 72.7%) were multiparas. More than half of the neonates were delivered preterm (13, 59.1%). Being booked is associated with better neonatal outcomes although not significant (odds ratio = 3.06. 95% confidence interval: 0.55–16.83, p = 0.197). Anemia was common in the antepartum and postpartum periods. Half of the women (11, 50%) were delivered by elective cesarean section and 7 (31.8%) by emergency cesarean section (C/S), while 4 (18.2%) had a spontaneous vaginal delivery. The neonates had a mean birth weight of 2.14 ± 0.35 kg. Overall, 61 neonates (91.0%) were born alive and 6 (9.0%) suffered perinatal deaths, giving a perinatal mortality rate of 89.8 neonates per 1000 live births.Conclusion:Our study shows that higher-order multiple pregnancies are high-risk pregnancies that are associated with fetal and maternal complications. Anemia is the commonest complication seen in our study. The majority had preterm delivery. Proper antenatal care and close feto-maternal monitoring are important in reducing adverse outcomes associated with these pregnancies.

Clinical Analysis of Fetal Lung Development Index and Pregnancy Outcome in Pregnant Women with Gestational Diabetes Mellitus with Satisfactory Blood Glucose Control.

Objective To explore the regularity of fetal lung development of pregnant women with gestational diabetes mellitus (GDM) with satisfactory blood glucose control and the clinical analysis with pregnancy outcome. Methods 120 GDM pregnant women with satisfactory blood glucose control (GDM group) and 200 normal pregnant women undergoing prenatal examination (Control group) from 31 to 38 + 6 weeks of gestation were included. The two groups of pregnant women were divided into 8 time periods according to the gestational age, respectively. The parameters of Doppler flow velocity curve of fetal main pulmonary artery, diameter lines of fetal lung development, mode of delivery, neonatal weight, neonatal asphyxia, neonatal respiratory distress syndrome (NRDS), and neonatal pneumonia were, respectively, compared and analyzed between the two groups. Results Acceleration time (AT) and AT/ejection time (AT/ET) were positively correlated with gestational age, and AT/ET showed stronger correlation than AT, while no significant difference in AT and AT/ET between the two groups (P > 0.05). There was a positive correlation between the diameter of fetal lung development and gestational age, but there was no significant difference between the two groups (P > 0.05). In addition, there was no significant difference between the two groups in fetal delivery mode, neonatal weight, neonatal asphyxia, NRDS, and neonatal pneumonia (P > 0.05). Conclusion AT/ET may be a potential index to evaluate fetal lung maturity. There was no difference in fetal lung development and neonatal birth outcome between pregnant women with satisfactory GDM blood glucose control and the normal pregnant women. The pregnancy of GDM pregnant women lasts until the end of 37∼38 weeks, and the neonatal incidence rate is decreased. The key is to manipulate the blood glucose in the normal range.

Perinatal Outcome in Term Pregnancy with Isolated Oligohydramnios: Retrospective Observational Study

Introduction: Isolated Oligohydramnios complicates 3 to 5% of pregnancy at term both in terms of fetal outcome and mode of delivery.&#x0D; Aims: To study the perinatal outcome in isolated oligohydramnios (Amniotic Fluid Index≤8) and compare the outcome between Borderline (Amniotic Fluid Index=5.1-8 cm) and Severe (&lt;5 cm) oligohydramnios.&#x0D; Methods: Retrospective observational study of pregnancy outcome with isolated oligohydramnios (Amniotic Fluid Index≤8 cm) at term was carried out in Gandaki Medical College Teaching Hospital, Pokhara for one year from January 2019 to December 2019. Patients were divided into Borderline Oligohydramnios (Amniotic Fluid Index=5.1 to 8 cm) and Severe Oligohydramnios (Amniotic Fluid Index ≤5 cm). The two groups were compared in terms of fetal outcome like: meconium passage, low birth weight, low APGAR (Appearance, Pulse, Grimace, Activity and Respiration) score at 1 and 5 min, Neonatal Intensive Care Unit (NICU) admission and neonatal death. Similarly mode of delivery was also compared.&#x0D; Results: There were total of 100 patients with isolated oligohydramnios. Of which 51(51%) were with Borderline Oligohydramnios and 49(49%) with Severe Oligohydramnios. The incidence of adverse perinatal outcome and caesarean delivery was high in patients with isolated oligohydramnios. When compared with the two groups there was significant difference in terms of meconium passage (11% vs 48.9%), low birth weight (5.8% vs 18%), low APGAR (Appearance, Pulse, Grimace, Activity and Respiration) score at 1 min (1.9% vs 14%), NICU (Neonatal Intensive Care Unit) admission (11% vs 67%) and Caesarean delivery (39% vs 79.5%).&#x0D; Conclusion: Isolated oligohydramnios at term has been associated with an increased risk for caesarean delivery for fetal distress and adverse perinatal outcomes. Severe oligohydramnios is a sensitive predictor for the adverse perinatal outcome both in terms of fetal outcome and termination of pregnancy.

Assessment of Correlation between Amniotic Fluid Index (AFI) and Feto-maternal Outcomes of In-term Pregnancies

Background: Amniotic fluid plays a crucial role in providing basic life support to the fetus. This clear, slightly yellowish liquid that surrounds the fetus is helpful in the development of fetal systems by providing thermally controlled and a non-restricted sterile environment for fetal growth. During labour, amniotic fluid helps in providing an adequate cushion for umbilical cord. It is this mechanical function of the cushion which aids in preventing compression of cord in-between fetus and uterine wall during uterine contractions and fetal movements. Therefore, helps to prevent fetal distress. It protects fetus from any kind of injury and helps in preventing infection by its bacteriostatic properties. This study aims to estimate the effect of decreased amniotic fluid index (AFI) on maternal and fetal outcomes in term pregnancy.&#x0D; Materials and Methods: This will be a Prospective cross sectional observational study conducted in OBGY dept. of AVBRH, Wardha. Pregnant women will be enrolled and divided into 3 groups as per Amniotic Fluid Index. Group A with low amniotic fluid index (AFI&lt; 5 cm) Group B with borderline amniotic fluid index (AFI&gt;5cm and &lt;8cm)and Group C with normal amniotic fluid index (AFI 8cm-24cm). Data will be collected, analysed and compared between the groups in terms of the ultrasonographic findings and feto-maternal outcomes of in term pregnancy.&#x0D; Expected Results: Significant correlation is expected between AFI and feto-maternal outcomes.&#x0D; Conclusion: Unexpected adverse outcomes can be minimized by estimation of AFI and timely antepartum treatment in mothers with decreased AFI.

Is maternal sickle cell trait associated with small for gestational age neonates?

There is conflicting data regarding the impact of sickle cell trait (SCT) on maternal and fetal outcomes in pregnancy. We explored whether pregnant patients with SCT (Hgb AS) are more likely to have small for gestational age (SGA) neonates and other pregnancy complications than patients with a normal hemoglobin electrophoresis (Hgb AA).

Maternal and Fetal Outcome in Pregnancy with Sickle Cell Disease in the Third Trimester in Central India: A Retrospective Study

Introduction: Sickle cell disease is an uncommon cause of anemia and jaundice during pregnancy. However, SCD is expected in Maharashtra, especially the Vidarbha region. SCD in pregnancy can cause various maternal and fetal complications. This study was conducted to know maternal and fetal outcomes in pregnancy with sickle cell disease in the third trimester.&#x0D; Methodology: This retrospective data were collected from hospital records of medical colleges located in central India for one and a half years, from November 2019 to January 2021. Forty-two women were admitted with pregnancy with sickle cell disease in the third trimester during the study period. The baseline characteristics, frequency of sickle hemoglobin variants, and maternal and fetal pregnancy outcomes were collected.&#x0D; Results: Compiled data were analyzed by simple descriptive statistics and frequency tables. Majority were primigravida (59.52%). Type of sickle cell was determined based on HB electrophoresis; out of 42 patients, 36 had AS pattern, 5 had SS pattern SCD, and 1 had As+b thal minor. The most common medical complication was anemia [73.80%] and UTI 26.19%. The most common adverse obstetric outcomes observed were IUGR/Oligohydramnios 42.85% and pre-eclampsia 21.42%. Majority of patients delivered by LSCS 42.85%. An adverse outcome in the fetus was fetal distress 45.23% and meconium-stained amniotic fluid 42.86%.&#x0D; Discussion: Due to hematological changes, extra demands, and sickle crisis, complications in both mother and fetus are more common in sickle cell anemia.&#x0D; Conclusions: Early detection and management of sickle cell anemia during pregnancy can reduce the adverse outcome in both mother and baby.

Pregnancy outcomes of fetuses with congenital heart disease after a prenatal diagnosis with chromosome microarray.

To evaluate the pregnancy outcomes of fetuses with congenital heart disease (CHD) after chromosome microarray (CMA)-based prenatal diagnosis. Amniocentesis was performed in 1035 pregnant women carrying fetuses with CHD between September 2014 and December 2019. Chromosomal aberrations in fetuses with CHD were evaluated using CMA. The pregnancy outcomes were followed up from 6months to 5years. The overall CHD detection rate by CMA was 10.1% (105/1035; 50 fetuses: aneuploidy, 55 fetuses: pathogenic or likely pathogenic copy number variations). Among 1003 fetuses who were followed up, 4, 236, 763, and 18 cases were of miscarriages, pregnancy termination, live births, and postnatal deaths, respectively. Self-healed CHD was observed in 401 (52.6%) fetuses. The pregnancy termination rate of fetuses with chromosomal anomalies was significantly higher than that of fetuses without chromosomal anomalies (93.1% vs. 15.5%, p<0.001). However, other pregnancy outcomes, including mortality, preterm labor, and low-weight birth rate, were similar between the two groups. The outcome of CMA is an important factor influencing parents' choice of whether to continue the pregnancy. Self-healing rate of prenatal diagnosed CHD is high. The mortality and morbidity of fetuses with CHD following prenatal CMA testing are relatively low.

Women Aged over 40 with Twin Pregnancies Have a Higher Risk of Adverse Obstetrical Outcomes.

Maternal age is related to a higher risk of adverse maternal, fetal, and neonatal outcomes in twin pregnancies. However, whether this increase in adverse outcomes is due solely to age or due to risk factors that are more common in women over 40 remains unknown. The aim of this study is to assess if maternal age over 40 years old is an independent risk factor for obstetric adverse outcomes in dichorionic diamniotic twin gestations. In this single-center retrospective cohort study, we compared the obstetric outcomes of women with dichorionic diamniotic twin pregnancies below and over 40 years of age. A twin pregnancy cohort enrolled between 2013 and 2019 was included in the study. Maternal, fetal, and labor complications were recorded. A total of 510 women were analyzed in two groups: 266 women below 40 years old and 244 women over 40 years old. Maternal age over 40 increased the odds of maternal (aOR = 1.9 (1.3; 2.9); p-value = 0.002), fetal (aOR = 1.8 (1.0; 3.0); p-value = 0.037), and labor complications (aOR = 2.5 (1.3; 4.6); p-value = 0.004). Maternal age over 40 years was the most important factor increasing the odds of having a caesarean section (C-section). Over 40 years old was an independent risk factor for complications in dichorionic diamniotic twin pregnancies.

Correlation of fetal ventriculomegaly with copy number variations and pregnancy outcome

To assess the correlation of borderline fetal ventriculomegaly with genomic copy number variations (CNVs) and outcome of pregnancy. For 84 singleton pregnancies diagnosed with VM, chromosomal microarray analysis (CMA) was carried out to detect the CNVs of the fetal genome. Outcome of the pregnancy and neonatal development were analyzed. The pregnant women were divided into mild group (10-12 mm), moderate group (12-15 mm) and severe group (>= 15 mm) based on the severity of fetal ventriculomegaly. The detection rate of pathogenic CNVs and pregnancy outcome were compared. Multivariate logistic regression was carried out to analyze the predictors for pregnancy outcome. Respectively, 24, 28 and 32 fetuses were assigned into the mild, moderate and severe groups. CMA has detected 15 cases of chromosomal abnormalities, including 11 pathogenic CNVs and 4 abnormal karyotypes. Abnormal pregnancy outcomes were found in 20 fetuses, including 12 with hydrocephalus and 8 with chromosomal microdeletion syndromes. A significant difference was found in the detection rate of fetal pathogenic CNVs and abnormal pregnancy outcome among the three groups (P<0.05). Multivariate logistic regression analysis showed that the largest change of lateral ventricle width (OR = 1.868, 95%CI = 1.120-3.116) and the extent of lateral ventricle widening (OR = 1.571, 95%CI = 1.120-2.206) were the key factors affecting the outcome of pregnancy (P<0.05). Borderline fetal VM is associated with the risk of pathogenic CNVs and adverse pregnancy outcome. A comprehensive examination is required after prenatal ultrasound diagnosis, which is conducive to prenatal consultation and prognostic evaluation of the fetus.

Effects of Mediterranean Diet or Mindfulness-Based Stress Reduction on Prevention of Small-for-Gestational Age Birth Weights in Newborns Born to At-Risk Pregnant Individuals

Being born small for gestational age (SGA) is a leading cause of perinatal morbidity and mortality with no effective prevention or therapy. Maternal suboptimal nutrition and high stress levels have been associated with poor fetal growth and adverse pregnancy outcomes. To investigate whether structured interventions based on a Mediterranean diet or mindfulness-based stress reduction (stress reduction) in high-risk pregnancies can reduce the percentage of newborns who were born SGA and other adverse pregnancy outcomes. Parallel-group randomized clinical trial conducted at a university hospital in Barcelona, Spain, including 1221 individuals with singleton pregnancies (19-23 weeks' gestation) at high risk for SGA. Enrollment took place from February 1, 2017, to October 10, 2019, with follow-up until delivery (final follow-up on March 1, 2020). Participants in the Mediterranean diet group (n = 407) received 2 hours monthly of individual and group educational sessions and free provision of extra-virgin olive oil and walnuts. Individuals in the stress reduction group (n = 407) underwent an 8-week stress reduction program adapted for pregnancy, consisting of weekly 2.5-hour sessions and 1 full-day session. Individuals in the usual care group (n = 407) received pregnancy care per institutional protocols. The primary end point was the percentage of newborns who were SGA at delivery, defined as birth weight below the 10th percentile. The secondary end point was a composite adverse perinatal outcome (at least 1 of the following: preterm birth, preeclampsia, perinatal mortality, severe SGA, neonatal acidosis, low Apgar score, or presence of any major neonatal morbidity). Among the 1221 randomized individuals (median [IQR] age, 37 [34-40] years), 1184 (97%) completed the trial (392 individuals assigned to the Mediterranean diet group, 391 to the stress reduction group, and 401 to the usual care group). SGA occurred in 88 newborns (21.9%) in the control group, 55 (14.0%) in the Mediterranean diet group (odds ratio [OR], 0.58 [95% CI, 0.40-0.84]; risk difference [RD], -7.9 [95% CI, -13.6 to -2.6]; P = .004), and 61 (15.6%) in the stress reduction group (OR, 0.66 [95% CI, 0.46-0.94]; RD, -6.3 [95% CI, -11.8 to -0.9]; P = .02). The composite adverse perinatal outcome occurred in 105 newborns (26.2%) in the control group, 73 (18.6%) in the Mediterranean diet group (OR, 0.64 [95% CI, 0.46-0.90]; RD, -7.6 [95% CI, -13.4 to -1.8]; P = .01), and 76 (19.5%) in the stress reduction group (OR, 0.68 [95% CI, 0.49-0.95]; RD, -6.8 [95% CI, -12.6 to -0.3]; P = .02). In this randomized trial conducted at a single institution in Spain, treating pregnant individuals at high risk for SGA with a structured Mediterranean diet or with mindfulness-based stress reduction, compared with usual care, significantly reduced the percentage of newborns with birth weight below the 10th percentile. Due to important study limitations, these findings should be considered preliminary and require replication, as well as assessment in additional patient populations, before concluding that these treatments should be recommended to patients. ClinicalTrials.gov Identifier: NCT03166332.