Fetal Risk Research Articles

The causal effects of placental weight on atherosclerotic cardiovascular disease: a Mendelian randomization and mediation analysis

IntroductionPrevious studies have linked placental weight (PW) to cardiovascular diseases, but the causality and potential mediators underlying this relationship are still unknown.Material and methodsWe conducted Mendelian randomization (MR) analysis via summary statistics from genome-wide association studies (GWAS), including PW adjusted for sex, 21 candidate mediators and atherosclerotic cardiovascular disease (ASCVD), which includes coronary heart disease (CHD) and ischemic stroke (IS).Two-step MR was employed to identify and assess the mediation proportion of potential mediators in the association between PW and ASCVD. Additionally, we conducted a repeated analysis using PW adjusted for gestational age and sex.ResultsUnivariable MR (UVMR) analysis revealed that for each 1-SD decrease in fetal genotype-determined PW adjusted for sex only, the risk of CHD increased by 24% (95% CI: 1.05–1.46) and the risk of large artery stroke (LAS) increased by 46% (95% CI: 1.13–1.89). Similar results were obtained in repeated analyses. The mediation MR analysis revealed that the causal relationship between fetal genotype-determined PW and CHD risk was primarily mediated by birthweight, type 2 diabetes, and education, each mediating 3.66% to 40.80% of the total effect. The causal relationship between fetal genotype-determined PW and LAS risk was mediated mainly by type 2 diabetes, which accounted for 22.11% of the total effect.ConclusionsThis study elucidated a unidirectional causal relationship between lower PW and a greater ASCVD risk, with factors such as birthweight, type 2 diabetes, and education mediating the association between PW and ASCVD.

Pregnancy and delivery after functional hemispherectomy for Rasmussen’s encephalitis: a case report

BackgroundRasmussen’s encephalitis (RE) is a rare neurologic disorder characterized by progressive seizures and unilateral cerebral atrophy with onset during childhood and unknown etiology. When medical therapy appears refractory, surgical disconnection of the affected hemisphere is indicated. Quality of life after functional hemispherectomy is largely good, affected females may therefore pursue pregnancy. However, data on pregnancy and delivery in RE post hemispherectomy is extremely rare.Case presentationWe present the case of a patient with left functional hemispherectomy for RE at the age of seven, who experienced two successful pregnancies. In both pregnancies, her post-surgical symptoms including right-sided spasticity, cephalgia, dizziness, and impairment of vision and speech deteriorated but improved to pre-pregnancy level after delivery. Neurologic sequelae post-hemispherectomy overlapped with clinical signs of preeclampsia and required close diagnostic surveillance during both pregnancies.ConclusionThere are no data on the interaction between RE, hemispherectomy and pregnancy, making maternal and fetal risk assessment difficult. Due to the complexity of the condition and symptoms, management of RE in pregnancy remains highly challenging and requires an interdisciplinary approach. This is the first case description of two successful pregnancies in a woman with RE and status post-hemispherectomy. Further evidence is urgently required to improve counseling and management of affected women.

Lupus activity and pregnancy outcomes in systemic lupus erythematosus patients undergoing assisted reproductive therapy: A systematic review and meta-analysis.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease primarily impacting women of childbearing age. While pregnancy and hormonal stress can trigger SLE flare-ups, the effects of assisted reproductive therapies (ARTs) on SLE patients are not well defined. We conducted a search of PubMed/Medline, Embase, and CENTRAL until March 20, 2024, to find observational studies assessing the prevalence of SLE flares and pregnancy outcomes following ARTs. Our analysis included random-effects meta-analysis and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach for evaluating evidence quality. Five studies involving 237 SLE women who underwent ARTs were eligible. The meta-analysis indicated a prevalence of SLE flares at 17% (95% CI: 10-25%) with moderate-quality evidence. The pooled prevalence of arthritis flares was 7% (95% CI: 0-25%) with low-quality evidence. Successful pregnancy rates were 58% (95% CI: 43-72%), and live birth rates were 96% (95% CI: 83-100%), both with low-quality evidence. Moderate-quality evidence showed pregnancy complications, including preterm premature rupture of membranes (PPROM) at 8% (95% CI: 3-16%), miscarriages at 2% (95% CI: 0-9%), intrauterine fetal demise (IUFD) at 4% (95% CI: 0-11%), and preeclampsia at 7% (95% CI: 1-17%). Low-quality evidence showed preterm labor at 10% (95% CI: 0-32%) and ovarian hyperstimulation syndrome (OHSS) at 2% (95% CI: 0-11%). SLE flares, as well as pregnancy complications such as IUFD, miscarriage, PPROM, and preeclampsia in ART recipients, are equivalent to those in spontaneous conception. This indicates that ART is relatively safe for SLE patients with meticulous pregnancy planning. Key Points •Systemic lupus erythematosus (SLE) is a chronic autoimmune disease primarily impacting women of childbearing age. • Pregnancy in women with SLE poses elevated maternal and fetal risks compared to healthy women. • SLE flares and pregnancy complications while receiving ART are equivalent to those in spontaneous conception and ART is relatively safe for SLE patients.

Study of Some Apoptotic Protein Expration in Human Mesenchymal Stem Cells During Toxoplasma Gondii Infection

Background: Toxoplasma gondii (T. gondii) infection is a significant health concern, particularly during pregnancy, as it can lead to fetal harm and birth abnormalities. Specific Background: The role of apoptosis in managing T. gondii infection remains poorly understood, particularly regarding its molecular mechanisms. Knowledge Gap: The impact of T. gondii infection on apoptosis in mesenchymal stem cells (MSCs) derived from human umbilical cords has not been thoroughly studied in existing literature. Aims: This study aimed to investigate the activation of apoptosis and its regulatory mechanisms in human Wharton’s Jelly mesenchymal stem cells (WJ-MSCs) during T. gondii infection. Results: Using non-enzymatic techniques, we isolated T. gondii from infected and aborted phase-specific placentas. Our findings demonstrated a significant increase in the expression of apoptosis-activating genes (CASP2, CASP3, Bak1) in WJ-MSCs following infection, with a marked decrease in cell viability observed within 2 to 4 hours of exposure to the parasite (P≤0.05). Novelty: This study provides novel insights into the relationship between T. gondii infection and apoptosis in WJ-MSCs, highlighting the specific gene expression changes that occur in response to infection. Implications: Research on T. gondii's apoptotic pathways is crucial for developing therapeutic strategies to mitigate pregnancy-related adverse effects and improve maternal and fetal health outcomes. Highlights: Increased Apoptosis: T. gondii enhances apoptosis in mesenchymal stem cells. Cell Viability Impact: Significant decrease in WJ-MSC viability after infection. Clinical Relevance: Insights can inform strategies to reduce fetal infection risks. Keywords: Toxoplasma gondii, apoptosis, Wharton’s Jelly mesenchymal stem cells, pregnancy, gene expression

7752 Navigating Hypercalcemia in Pregnancy: A Case Report

Abstract Disclosure: J. Gabbay: None. S. Steinmetz-Wood: None. Introduction: Primary hyperparathyroidism (PHPT) in pregnancy is rare but presents many diagnostic and therapeutic challenges. Prompt diagnosis and treatment are important due to associated maternal and fetal risks, however evaluation of urine calcium to differentiate from Familial Hypocalciuric Hypercalcemia (FHH) becomes less reliable due to physiologic changes in pregnancy, sestamibi scans. CT scans require radiation, parathyroidectomy introduces surgical risk, and medical alternatives like bisphosphonates can interfere with fetal skeletal development. Clinical Case: A 24-year-old woman who presented to the emergency room for progressive nausea and abdominal pain was found to be pregnant with elevated serum calculated calcium to 11.4 mg/dL (2.84 mmol/L). She had a history of renal stones, longstanding hypercalcemia of unknown etiology and a remote family history of parathyroid “issues”. Follow up laboratory work showed a PTH of 75.8 pg/ml (8.04 pmol/L) with an elevated 24-hour urine calcium and a low 25OH vitamin D. Given her history of kidney stones and overt symptoms it was our clinical judgement that this was not a case of FHH. She was started on IV fluids twice weekly. After an unrevealing neck ultrasound, an MRI neck showed a 7 mm lesion along the posterior aspect of the left thyroid suggestive of a parathyroid adenoma. Sestamibi scan was avoided due to the risks of radiation to the developing fetus. Given the presumptive diagnosis of parathyroid adenoma, the lack of response to aggressive hydration, and the maternal and fetal risks of hypercalcemia during pregnancy, parathyroidectomy was pursued in her second trimester. Intra-operative inspection and biopsy showed the lesion to be only a lymph node. She underwent 4-gland exploration and the left inferior parathyroid gland, which appeared abnormal and enlarged, was removed. The intra-operative PTH dropped only from 98 to 80 (10.4 to 8.5 pmol/L). She otherwise had an unremarkable hospital course and at discharge her calcium was normal with an undetectable PTH, which can be an expected finding in pregnancy. On follow up she was feeling well with sustained normocalcemia and low PTH levels. Given the age at which her hyperparathyroidism started, she was referred to genetics for further evaluation. Clinical Lessons/Conclusion: There were significant biochemical and radiological limitations in the management of this case. Normally an inappropriately normal PTH with elevated serum calcium and normal urine calcium/creatinine clearance ratio confirms the diagnosis of PHPT, however in pregnancy it should be noted that FHH could also present with normal or elevated urine calcium due to absorptive hypercalciuria in pregnancy. Additional clinical history and reasoning was needed for management as well as a skilled surgeon, where preoperative localization was limited and was not ultimately helpful. Presentation: 6/2/2024

8640 Thyroid Orbitopathy in Pregnancy

Abstract Disclosure: Z. Maisonet -Feliciano: None. M. Alvarado: None. L.A. Gonzalez-Rodriguez: None. M. Ramirez: None. L. El Musa Penna: None. J. Segarra-Villafane: None. I.C. Arroyo: None. W. Medina-Torres: None. L.R. Sepulveda-Garcia: None. Thyroid orbitopathy, often associated with Graves' disease, is characterized by the inflammation and swelling of ocular tissues. Its occurrence or exacerbation during pregnancy is infrequent, primarily due to the immunosuppressive state inherent in pregnancy. In most instances, the immunosuppression associated with pregnancy leads to a reduction in TRAb levels, although they continue to be present in women who have an active form of the disease. The course and severity of ocular manifestation do not always correlate with thyroid hormone levels. Strict control of thyroid function is crucial in patients with thyroid eye disease. This report sheds light on the rare occurrence of thyroid orbitopathy during pregnancy, a condition that complicates treatment due to potential risks to both the mother and the child. In this case, a 35-year-old pregnant woman with no prior history of thyroid issues exhibited symptoms of hyperthyroidism in her first trimester, including unintended weight loss, anxiety, and tremors in the upper limbs. She also presented with ocular discomfort, diplopia, and eyelid lag. Thyroid tests confirmed Graves Disease, with a significant elevation in Thyroid Stimulating Immunoglobulin (TSI): 243 %, Free thyroxine (T4): 1.08 ng/dl and Triiodothyronine (T3): >1.89 units and decreased Thyroid Stimulation Hormone (TSH): 0.001 uIU/ml. Ophthalmic examination revealed mild Graves orbitopathy due to bilateral exophthalmos (measured by Hertel’s exophthalmometer) 21mm on both sides, Marginal reflex distance (MDR) 1: right eye 9 mm and left 7mm. MDR 2: right eye 6mm and left eye 7mm. Right upper eyelid retraction, lagophthalmos of the right eye, limitation in the upward movement of the left eye, and vertical diplopia on extreme gazes without signs of orbital compression. Considering her normal FT4 levels and the mild nature of her hyperthyroidism, the decision was made to prioritize the mother's treatment while minimizing fetal risk, thus opting not to initiate antithyroid medication but to closely monitor her thyroid function. Symptomatic management of her orbitopathy was provided including lubricating eye drops and an eye patch. Throughout the progression of her pregnancy, her TSI levels exhibited a decreasing trend while FT4 remained within normal limits. Following delivery, there was a notable improvement in her ocular symptoms, and her TSH started increasing up to normal values of 1.29 uIU/ml and FT4 remained in range. This report underscores the importance of recognizing uncommon presentations of autoimmune thyroid conditions, such as thyroid orbitopathy, during pregnancy. It emphasizes the complexities and necessary considerations in treating these cases. A collaborative approach involving endocrinology, ophthalmology, and obstetrics is essential to safeguard the health of both the mother and the fetus. Presentation: 6/1/2024

Emergency cerclage: Neonatal outcomes and evaluation of prognostic scores − A decade of experience at a tertiary center

ObjectivesEmergency cervical cerclage is a high-risk surgical procedure associated with maternal and fetal risks, including preterm birth. Authors have developed scores to try to predict the probability of success following emergency cerclage, but these tools have yet to be externally validated.Our main objective was to assess the preterm birth rate before 32 weeks following emergency cerclage. Secondary objectives included assessing perinatal outcomes and the predictive validity of two published scores in our setting. We hypothesized that predictive scores, such as Fuchs and Kokia scores, may not perform optimally in our population due to variability in clinical and biological characteristics that influence eligibility for cerclage across different settings. Study designWe conducted a retrospective, monocentric study in a tertiary maternity hospital. All patients who underwent emergency cerclage between January 1st, 2010, and December 31st, 2021, were included. The main outcome was preterm birth rate before 32 weeks. Secondary outcomes were need for maternal hospitalization after initial hospitalization for cerclage, preterm premature rupture of membrane, and perinatal death. The rate of preterm birth before 32 weeks and adverse perinatal outcomes were estimated. To assess the predictive validity of Fuchs’ score in our population, we performed a multivariable logistic regression model including the score’s variables and constructed receiver operating characteristic (ROC) curve. To assess the validity of Kokia’s score in our population, we studied the correlation between the initial score and gestational age at delivery using Pearson’s correlation coefficient. ResultsOur population was composed of 64 women who underwent an emergency cerclage. The median gestational age at delivery was 30.6 weeks (IQR (24.2; 37.6)). The preterm birth rate before 32 weeks was 54.7 %. The rate of perinatal death was 30.7 %. There were no statistical differences between the patients delivered before and after 32 weeks. The multivariable logistic regression model showed that none of the variables of Fuchs’s score were significantly associated with preterm birth risk in our population. The AUC of the ROC curve using Fuchs’ score was 0.63. There was a minor yet significant correlation between Kokia’s score and gestational age at delivery (r = 0.26 – p = 0.04). ConclusionsOur study underscores the persistent risks associated with cervical insufficiency, including very preterm birth. It highlights the variability in performance of predictive scores across different populations, underscoring the need for external validation in diverse clinical settings.

COVID-19 Vaccine mRNA Biodistribution: Maternal and Fetal Exposure Risks.

SARS-CoV-2 infection during pregnancy has severe consequences on maternal and neonatal health. Presently, vaccination stands as a critical preventive measure for mitigating infection-related risks. Although the initial clinical trials for the COVID-19 vaccines excluded pregnant women, subsequent investigations have indicated mRNA vaccinations' effectiveness and short-term safety during pregnancy. However, there is a lack of information regarding the potential biodistribution of the vaccine mRNA during pregnancy and lactation. Recent findings indicate that COVID-19 vaccine mRNA has been detected in breast milk, suggesting that its presence is not confined to the injection site and raises the possibility of similar distribution to the placenta and the fetus. Furthermore, the potential effects and responses of the placenta and fetus to the vaccine mRNA are still unknown. While potential risks might exist with the exposure of the placenta and fetus to the COVID-19 mRNA vaccine, the application of mRNA therapies for maternal and fetal conditions offers a groundbreaking prospect. Future research should leverage the unique opportunity provided by the first-ever application of mRNA vaccines in humans to understand their biodistribution and impact on the placenta and fetus in pregnant women. Such insights could substantially advance the development of safer and more effective future mRNA-based therapies during pregnancy.

Study protocol for Early Tracking of Childhood Health determinants (ETCHED): A longitudinal observational life course study

BackgroundThe prevalence of childhood obesity and diabetes continues to rise in the United States (US), especially among minority populations. The objective of the Early Tracking of Childhood Health Determinants (ETCHED) study is to investigate the role of adverse fetal and early-life risk exposures that contribute to the development of childhood obesity and metabolic risk.MethodsETCHED is a longitudinal observational study of American Indian/Alaska Native (AI/AN) and Hispanic pregnant woman and their offspring. Pregnant mothers ≥ 18 years old are enrolled at a large public hospital system in the southwestern US. Enrolled mothers are followed through pregnancy, delivery, and the maternal/offspring dyad will be followed until the child’s 18th birthday. At each maternal visit, questionnaires assessing medical history, diet, physical activity, sleep, perceived stress, and socioeconomic and sociocultural information are obtained. Standard laboratory tests during maternal visits include glycemic measures, lipids, and renal function. Additional bio samples obtained include venous blood samples and cord blood for obesity/metabolic biomarkers and genetic/epigenetic testing, urinalysis, placental tissue for examining functional pathways, breast milk for metabolomics, and stool for metabolites and microbiome analysis. The offspring will have 6 infant/toddler visits at 6–12 weeks, 4 months, 6 months, 18 months, 2 and 3 years respectively. Thereafter, they will undergo comprehensive research visits (major visits) at 4–5 years, 6–9 years, 10–13 years, and 14–17 years. The major visits in children include detailed medical history, anthropometry, developmental assessment, socioeconomic and environmental assessments (food insecurity, family structure, and childcare), feeding and activity, biochemical tests, genetics/epigenetic testing, and ultrasound elastography. Electronic health records will be reviewed for additional clinical information. The primary analysis will constitute estimation of correlation coefficients between continuous variables. The planned study duration in this ongoing study is 23-years.DiscussionThis is a life course study that that will examine biological and environmental risk factors for obesity and cardiometabolic risk from the intrauterine period to early childhood and adolescence in a population with high-risk of obesity and type 2 diabetes in the United States. The ETCHED study would also provide a unique opportunity to combine multi-omics and clinical data to create novel integrative models to predict the cardiometabolic risk associated with childhood obesity and possibly identify etiopathogenetic mechanisms and future targets of intervention.Trial registration numberClinicalTrials.gov identifier: NCT03481829. Updated July 19, 2024, https://clinicaltrials.gov/study/NCT03481829?cond=ETCHED&rank=1.

The risk tolerance and decision-making processes of Australian women regarding medication trials in pregnancy.

Pregnant women have historically been excluded from participation in medication trials, in part due to the perceived risks of drug exposure to mothers and fetuses. However, little is known about pregnant women's attitudes toward risk and participation in such trials. To address this knowledge gap and to identify factors that influence trial participation. Australian women over the age of 18, currently pregnant or within six months of delivery, were recruited to participate in an online survey (n = 623) and follow-up interviews (n = 11). The survey investigated willingness to participate in five hypothetical drug trial scenarios of varying risk. Demographic and obstetric information, including COVID-19 vaccination status, was also collected. The impact of these factors on trial participation was analysed using ordinal regression. Interviews were subjected to thematic framework analysis using a priori and emergent themes. Nearly half of the respondents (48%) indicated a willingness to participate in at least one of the hypothetical trials. As trial risk increased participation likelihood decreased, especially if the risk was to the fetus, regardless of benefits to the mother. COVID-19 vaccination status and medication hesitancy were predictors of an unwillingness to participate. Three broad themes emerged from the qualitative data: risk-benefit analysis, quality of evidence, and trust. Overall, participants expressed a positive attitude toward research and medication trials during pregnancy, but were concerned about fetal risk. The findings of this study may help enhance trial design and the participation of pregnant women in medication trials.

Maternal and fetal risk factors for congenital anomalies of the kidney and urinary tract: a birth cohort study in urban China

Maternal and fetal risk factors for congenital anomalies of the kidney and urinary tract: a birth cohort study in urban China

Perioperative Considerations for ASD Device Closure in the First Trimester: A Case of Secundum ASD with Bidirectional Shunt

Introduction: Atrial septal defect (ASD) closure during pregnancy is a complex procedure requiring careful consideration of maternal and fetal risks. This case report highlights the perioperative management of a secundum ASD with a bidirectional shunt in a patient during her first trimester. Case presentation: A 31-year-old woman, G3P2A0, presented at approximately 10-11 weeks gestation with a recently diagnosed large secundum ASD and pulmonary hypertension. She was on Sildenafil and Bisoprolol. Due to the potential risks associated with an unrepaired ASD during pregnancy, the decision was made to proceed with percutaneous ASD closure. General anesthesia was administered with meticulous hemodynamic monitoring. The procedure was successful, and the patient recovered without complications. Conclusion: ASD closure during the first trimester can be safely performed with careful planning and execution. Multidisciplinary collaboration and vigilant monitoring are crucial for optimal maternal and fetal outcomes.

Dilated Cardiomyopathy in Pregnancy: A Review of ACEI Exposure and Fetal Risks

Dilated Cardiomyopathy in Pregnancy: A Review of ACEI Exposure and Fetal Risks

WP7.1 - MRI for suspected acute appendicitis in pregnant females: What is the best imaging modality?

Abstract Introduction/Aims Acute appendicitis (AA) in pregnancy is the commonest non-obstetric cause of acute abdominal pain, but controversy surrounds the most appropriate imaging modality in this group. Ultrasound (USS) and Magnetic Resonance Imaging (MRI) have no known fetal risks. Hence, The World Society of Emergency Surgeons (WSES) recommends MRI in pregnant patients with suspected appendicitis, if available, but emphasises the preferred initial use of USS. This project explored the use of both imaging modalities in pregnant patients with suspected AA. Method Data was collected for all pregnant patients undergoing an MRI for suspected AA between 2015 and 2023. Results Of the 29 patients identified, the mean gestation was 23 weeks (range 2-36), and over half (15, 52%) of MRI scans were performed in 2022/3. Intra-abdominal pathology was seen in 17 (59%) patients, with 8 (47%) having MRI features of AA. 63% of those diagnosed with AA had an USS pre-MRI, and 40% identified the appendix as "normal." Other intra-abdominal pathologies picked up on MRI included pyelonephritis(1), small bowel obstruction(1), stercoral perforation(1), and ovarian torsion(2). Of the 8 patients with MRI-proven AA, all underwent appendicectomy: 3 laparoscopic, 2 open, and 3 with simultaneous Caesarean section, of whom 2 required ileocaecal resection. Conclusions Diagnosis of abdominal pain in pregnancy is a challenge. USS may be reasonably sensitive and specific in dedicated hands, but pathology may still be missed. In this patient group, for which appendicectomy for AA is associated with better outcomes than non-operative management, MRI should be obtained for accurate diagnosis.

Pregnancy outcomes in patients with systemic lupus erythematosus compared to a high-risk tertiary cohort andtostandard population from the Austrian birth registry.

Women with systemic lupus erythematosus (SLE) have a higher risk for fetal and maternal complications. We aimed to investigate maternal and fetal complications in pregnant women with SLE compared to a high-risk pregnancy cohort (HR) from a tertiary university center and a standard-risk general population (SR) from the Austrian Birth Registry. In this retrospective data analysis, we compared the incidence of fetal/neonatal and maternal complications of pregnancies and deliveries of women with SLE to age, body mass index and delivery date-matched high-risk pregnancies from the same department, a progressive tertiary obstetric center and to a group of women, who represent pregnancies with standard obstetric risk from the Austrian Birth Registry. One hundred women with SLE were compared to 300 women with high-risk pregnancies and 207 039 women with standard-risk pregnancies. The incidence of composite maternal complications (preeclampsia, Hemolysis, Elevated Liver enzymes and Low Platelets [HELLP] syndrome, pregnancy-related hypertension, gestational diabetes mellitus, maternal death, thromboembolic events) was significantly higher in the SLE as compared to the SR group (28% vs. 6.28% SLE vs. SR, p = 0.001). There was no difference between the SLE and the HR groups (28% vs. 29.6% SLE vs. HR group, p = 0.80). The incidence of composite fetal complications (preterm birth before 37 weeks of gestation, stillbirths, birthweight less than 2500 g, fetal growth restriction, large for gestational age, admission to neonatal intensive care unit, 5-min Apgar <7) was also higher in the SLE than in the SR group (55% vs. 25.54% SLE vs. SR p < 0.001) while the higher incidence of adverse fetal outcome was detected in the HR than in the SLE group (55% vs. 75% SLE vs. HR group, p = 0.0005). Although composite fetal risk is higher in the SLE group than in the general population, it is still significantly lower as compared to high-risk pregnant women at a tertiary obstetric center. Prepregnancy counseling of women with SLE should put fetal and maternal risk in perspective, not only in relation to healthy, low risk cohorts, but also compared to mixed HR populations.

Maternal and Fetal Health Risks Among Female Military Aviation Officers.

INTRODUCTION: Military aviation poses unique occupational risks, including exposures to intermittent hypoxia, high gravitational force, and toxic materials, in addition to circadian disruption, cosmic radiation, and ergonomic stressors also present in commercial flight. We sought to investigate whether a military aviation officer's career is associated with adverse maternal or fetal health outcomes.METHODS: We conducted a retrospective cohort study of female aviation and nonaviation officers in the Military Health System from October 2002 to December 2019. Exposure was identified as assignment of an aviation occupation code. Maternal and fetal health outcomes were identified by International Classification of Diseases codes from medical records. Regression analysis was used to estimate adjusted relative risks (aRR).RESULTS: Included in the study were 25,929 active-duty female officers, with 46,323 recorded pregnancies and 32,853 recorded deliveries; 2131 pregnancies were diagnosed in aviation officers. Pregnant aviation officers had a decreased risk of composite adverse pregnancy outcomes [aRR 0.82 (0.73-0.92)], including gestational diabetes [aRR 0.69 (0.57-0.85)] and gestational hypertension [aRR 0.84 (0.71-0.99)]. Pregnant aviation officers had a decreased risk of depression prior to delivery [aRR 0.43 (0.35-0.53)] and hyperemesis gravidarum [aRR 0.74 (0.57-0.96)], but an increased risk of placental complications [aRR 1.15 (1.02-1.30)] and fetal growth restriction [aRR 1.36 (1.16-1.60)].DISCUSSION: Pregnant military aviation officers have an increased risk of placental complications and fetal growth restriction in spite of a lower risk of gestational diabetes and gestational hypertension. Further research is needed to determine how flight-related occupations impact pregnancy.Stark CM, Sorensen IS, Royall M, Dorr M, Brown J, Dobson N, Salzman S, Susi A, Hisle-Gorman E, Huggins BH, Nylund CM. Maternal and fetal health risks among female military aviation officers. Aerosp Med Hum Perform. 2024; 95(9):675-682.

Characteristics, Physiopathology and Management of Dyslipidemias in Pregnancy: A Narrative Review.

Dyslipidemia is a significant risk factor for atherosclerotic cardiovascular disease (ASCVD). During pregnancy, physiological changes elevate cholesterol and triglyceride levels to support fetal development, which can exacerbate pre-existing conditions and lead to complications such as pre-eclampsia, gestational diabetes, and increased ASCVD risk for both mother and child. Effective management strategies are necessary, especially for pregnant women with inherited forms of dyslipidemia (i.e., familial hypertriglyceridemia, hyperchylomicronemia), where personalized dietary adjustments are crucial for successful pregnancy outcomes. Pharmacological interventions and lipoprotein apheresis may be necessary for severe cases, though their use is often limited by factors such as cost, availability, and potential fetal risks. Despite the promise of advanced therapies, their widespread application remains constrained by limited studies and high costs. Thus, a personalized, multidisciplinary approach is essential for optimizing outcomes. This review provides a comprehensive overview of current strategies and evidence-based practices for managing dyslipidemia during pregnancy, emphasizing the balance of maternal and fetal health. Additionally, it discusses the physiological changes in lipid metabolism during pregnancy and their implications, particularly for women with inherited forms of dyslipidemia.

Fetal exposure to toxic metals (mercury, cadmium, lead, and arsenic) via intrauterine blood transfusions.

Intrauterine blood transfusions (IUBTs) are critical for treating fetal anemia but may expose fetuses to toxic metals. This study assessed mercury (Hg), cadmium (Cd), lead (Pb), and arsenic (As) levels in red blood cell (RBC) transfusion bags used during pregnancy, examined metal exposure in maternal and cord blood, and evaluated fetal health risks. Thirty pregnant women who underwent intrauterine blood IUBTs were enrolled in this study. Metal concentrations were measured in one to nine transfusion bags for each participant. These bags contained 8-103 mL volumes and were administered between gestational weeks 18 and 35. We also tested the mothers' blood for metal levels in the final stages of pregnancy and the umbilical cord blood at birth. The assessment utilized the intravenous reference dose (IVRfD) and the hazard index (HI) to evaluate the non-carcinogenic health risks these metals might pose to the fetus. Metals were detectable in almost all transfusion bags. The IVRfD was exceeded for Hg in 16 fetuses, Cd in 8 fetuses, Pb in 30 fetuses, and As in 1 fetus. Significant correlations were found between the concentrations of Hg, Cd, and As in transfused RBCs and cord blood. No correlations were observed between these concentrations and maternal blood levels, except for Cd. The influence of multiple IUBTs was positively associated only with Cd levels in the cord (ß = 0.529, 95% confidence intervals (CI) between 0.180 and 0.879). The HI exceeded 1, indicating significant health risks, predominantly from Pb, followed by Hg and Cd. The findings of this study highlight the significant risk of fetal exposure to toxic metals, mainly Pb, through IUBTs. This underscores the critical need for prescreening blood donors for toxic metals to minimize the potential for long-term adverse effects on the fetus. The research stresses the necessity of balancing the immediate benefits of IUBTs against the risks of toxic metal exposure, underscoring the importance of safeguarding fetal health through improved screening practices. This study highlights the risk of toxic metal exposure through IUBTs, a treatment for fetal anemia. Hg, Cd, Pb, and As levels were measured in transfusion bags and linked to fetal exposure through maternal and umbilical cord blood analysis. The HI indicates significant Pb exposure risks, underscoring the need for mandatory blood donor screening. Recommendations include shifting toward safer practices in managing fetal anemia to protect fetal health.

First reported case of Acute Disseminated Encephalomyelitis in pregnancy in Sri Lanka

Acute Disseminated Encephalomyelitis (ADEM) complicating pregnancy is a rare occurrence, posing challenges to the management due to maternal and fetal risks including fetal loss, fetal anomalies, intrauterine fetal growth restriction (FGR) and preterm labour. We report a case of a 21-year-old primiparous woman who was diagnosed with ADEM during the second trimester. She was treated with high dose intravenous (IV) steroids as well as IV immunoglobulin. She made complete neurological recovery within two months, but there were fetal complications including oligohydramnios, intrauterine growth restriction and low birth weight. The baby was delivered via elective caesarean section due to suspicious cardiotocograph and abnormal fetal doppler studies indicative of compromised fetal circulation. The baby was given special baby care unit (SBCU) care. However, both the mother and baby were safely discharged following six days of special neonatal care. This is the first reported case of ADEM in pregnancy in Sri Lanka, and highlights the challenges in management.

Clinical Manifestations and Health Impact of Malaria in Pregnant Women

Malaria during pregnancy poses significant health risks, both to mothers and their unborn children, due to the unique physiological and immunological changes occurring during this period. This review provides a comprehensive examination of the clinical manifestations and health impacts of malaria in pregnant women, highlighting the severity of the disease across different trimesters and its implications for maternal and fetal health. Malaria during pregnancy can cause symptoms like fever, anemia, headaches, fatigue, and nausea, with complications varying by trimester. In the first trimester, malaria can lead to early pregnancy loss and congenital anomalies, while in the second trimester, it can exacerbate maternal anemia and affect fetal growth. The third trimester is associated with an increased risk of preterm labor and adverse fetal outcomes. Placental malaria, characterized by parasite accumulation in the placenta, impairs nutrient and oxygen transfer to the fetus, leading to intrauterine growth restriction, low birth weight, and increased stillbirth risk. Maternal complications include severe anemia, acute respiratory distress syndrome, and potential long-term health effects. HIV infection further complicates malaria during pregnancy, increasing risks for both mother and fetus. Age-related variations and socioeconomic factors also impact malaria severity and management. Effective management strategies include intermittent preventive treatment, insecticide-treated nets, and indoor residual spraying. Addressing malaria during pregnancy requires a multifaceted approach, including enhancing diagnostic tools, improving preventive measures, and ensuring equitable healthcare access. Keywords: Clinical Manifestations, Health, Malaria, Pregnant Women