Weeks Of Gestation Research Articles

Attention-Deficit/Hyperactivity Disorder Medication Use in Pregnancy and Risk of Preterm Birth: A Population-Based Cohort Study.

Medication use during pregnancy for attention-deficit/hyperactivity disorder (ADHD) is increasing, but evidence on its safety in pregnancy for foetal health is limited, with little attention to time-related biases in observational research. To determine the association between ADHD medication use in early and late pregnancy and the risk of preterm birth. This population-based cohort study utilised data from national registers, including records on births, prescription medications, specialist healthcare visits, hospitalisations and educational attainment, to account for relevant potential confounders. We included singleton births delivered between 22 and 44 gestational weeks among pregnant individuals with ADHD medication use in the year before conception from Norway (2009-2020) and Sweden (2007-2019). ADHD medications (amphetamine, dexamphetamine, methylphenidate, atomoxetine, lisdexamfetamine and guanfacine) were assessed during early (conception to 21 gestational weeks) and late pregnancy (22-36 gestational weeks). The main outcome was preterm birth, defined as a live birth before 37 completed weeks of pregnancy. Risk ratios (RR) and hazard ratios (HR) with 95% confidence intervals (CI) were estimated using log-binomial regression and flexible parametric survival modelling to determine the risk of preterm birth in early and late pregnancy, respectively. Among 11,075 pregnancies, early pregnancy ADHD medication use was associated with higher preterm birth risk with ≥ 2 filled prescriptions (aRR 1.29, 95% CI 1.08, 1.53), but not as ≥ 1 prescription (aRR 1.08, 95% CI 0.93, 1.25). Any medication use in late pregnancy increased preterm birth risk (aHR 1.15, 95% CI 0.95, 1.39). For every 30 days of cumulative exposure to ADHD medication, the risk of preterm birth increased in late pregnancy (aHR 1.07, 95% CI 1.02, 1.12), but not in early pregnancy (aHR 1.01, 95% CI 0.97, 1.05). ADHD medication may modestly increase the risk of preterm birth, especially with atomoxetine early and methylphenidate late in pregnancy, and with longer durations of use.

Impact of Aspirin on Timing of Birth in Pregnancies With Clinical Manifestations of Placental Dysfunction: Evidence From a Multicentre Randomised Clinical Trial.

To examine whether aspirin delays gestational age at delivery (GAD) in pregnancies with placental dysfunction (PD) phenotypes (preeclampsia [PE], small-for-gestational-age [SGA], placental abruption and/or stillbirth). A secondary analysis of a multicentre stepped-wedge cluster randomised trial. 18 maternity/diagnostic units in Asia. Singleton pregnancies examined at 11-13+6 weeks. A model in which the effect of aspirin is to delay the GAD in pregnancies with PD was developed. GAD in pregnancies with PD. Aspirin administration was associated with a significant reduction in PD < 32 weeks (adjusted relative risk 0.543, 95% CI: 0.330-0.864), with a trend for an increase of PD ≥ 32 weeks (test for trend, p-value = 0.0018). Similar findings were observed individually for PE, SGA and/or placental abruption. At 24 weeks, the aspirin-induced prolongation of pregnancies with PD was 2.85 weeks (95% CI: 0.44-5.40), and this effect was decreased by -0.19 weeks (95% CI: -0.33 to -0.05) for each week of gestation; therefore, at 28 and 32 weeks' gestation, the aspirin-induced prolongation was 2.09 and 1.33 weeks, respectively. In this secondary analysis of a cluster randomised trial, women at high risk of PE who are destined to develop a clinical spectrum of PD may benefit from longer pregnancy duration through aspirin administration in early pregnancy. Aspirin may delay the GAD due to PD, particularly benefiting those deliveries that would occur at earlier gestations without aspirin administration.

Umbilical Venous Flow Volume and Fetal Combined Cardiac Output in Twin Pregnancies.

This study aimed to establish normal reference ranges of combined cardiac output (CCO) and umbilical venous flow volume (UVFV) in twin fetuses at 20 to 28 weeks of gestation and to evaluate the differences between monochorionic and dichorionic twins. CCO and UVFV were prospectively measured by ultrasound at two centers. The following exclusion criteria were applied: age <18 years or >45 years, first hospital visit at >16 weeks of gestation, monochorionic monoamniotic twin pregnancy, fetal structural or chromosomal abnormality, fetal growth restriction, twin-twin transfusion syndrome, twin anemia polycythemia sequence, and severe hypertension or renal disease were excluded. The period was divided into three groups: 20-22 weeks of gestation, 23-25 weeks of gestation, and 26-28 weeks of gestation. The CCO and UVFV were measured at least once during each period. CCO and UVFV were collected from 274 and 269 fetuses and were measured 412 and 424 times, respectively. UVFV and CCO levels increased as gestation progressed. The weight-corrected UVFV (UVFV/kg) and CCO (CCO/kg) remained stable. UVFV and CCO did not differ between monochorionic and dichorionic twin fetuses. The mean ± SD of UVFV/kg and CCO/kg were determined as 127.8 ± 31.8 and 439.4 ± 80.1 mL/kg/min, respectively. The UVFV-to-CCO ratio also remained stable from 20 to 28 weeks of gestation, ranging from 27.7% to 31.8%. The values and ranges of UVFV/kg and mean CCO/kg in twins were similar to those in singletons.

Prenatal ultrasound prediction of coarctation of the aorta: a nomogram for risk stratification.

Coarctation of the aorta is one of the most common congenital heart malformations, accounting for approximately 7% of all live births with congenital heart disease. It is crucial to make a definitive prenatal diagnosis as it can inform clinical treatment decisions. The diagnostic criteria for coarctation of the aorta are still controversial, and there is currently no risk nomogram available to assess the probability of coarctation of the aorta using routine ultrasound parameters. We explored the prenatal diagnostic efficacy of ultrasound parameters and established a nomogram for coarctation of the aorta. A total of 101 fetuses with suspected coarctation of the aorta diagnosed by prenatal ultrasound from July 2015 to June 2023 were collected retrospectively. The patients were divided into two groups according to the diagnostic results: a normal group (n=42; gestational weeks, 28.5±6.0) and a coarctation of the aorta group (n=59; gestational weeks, 26.7±5.1). Univariate and multivariate logistic regression analyses were used to identify echocardiographic predictors of coarctation of the aorta. Moreover, the patients were divided into a training set and a validation set in a ratio of 8:2, and a nomogram for the prenatal diagnosis of coarctation of the aorta was established using R. (1) Aortic isthmus, aortic isthmus z-score, ascending aorta, ascending aorta z-score, pulmonary artery, pulmonary artery z-score, pulmonary artery/ascending aorta ratio, persistent left superior vena cava, and aortic arch dysplasia were the predictive markers of coarctation of the aorta in the univariate logistic regression analysis (P<0.05). (2) Aortic isthmus z-score, ascending aorta z-score, pulmonary artery/ascending aorta ratio, persistent left superior vena cava, and aortic arch dysplasia were identified as the final predictors after multivariate logistic regression analysis (P<0.05). (3) The combined model, which included aortic isthmus z-score, ascending aorta z-score, pulmonary artery/ascending aorta ratio, persistent left superior vena cava, and aortic arch dysplasia, demonstrated a larger area under the receiver operating characteristic curve (AUC) (AUC=0.96, sensitivity=93.22%, specificity=88.10%) than aortic isthmus z-score alone (AUC=0.77, sensitivity=77.97%, specificity=71.43%), ascending aorta z-score alone (AUC=0.78, sensitivity=54.24%, specificity=90.48%), pulmonary artery/ascending aorta ratio alone (AUC=0.68, sensitivity=72.88%, specificity=54.76%), aortic arch dysplasia alone (AUC=0.70, sensitivity=66.10%, specificity=73.81%), and persistent left superior vena cava alone (AUC=0.72, sensitivity=79.66%, specificity=64.29%). The nomogram, which was constructed with these parameters, also exhibited excellent calibration curves and a good decision curve analysis curve. The nomogram established by aortic isthmus z-score, ascending aorta z-score, pulmonary artery/ascending aorta ratio, persistent left superior vena cava, and aortic arch dysplasia demonstrated excellent efficacy in the prenatal diagnosis of coarctation of the aorta.

Neighborhood Threat of Eviction over Time and Risk of Preterm Birth in Black American Women.

Black communities are disproportionately impacted by dual crises: residential evictions and adverse birth outcomes. A growing literature has documented the spill-over effects of neighborhood evictions on adverse birth outcomes, but none have examined associations between these exposures over time and risk of preterm birth (PTB) among Black women. We linked survey data from the Life-course Influences on Fetal Environments Study (n = 807) and publicly available block group-level eviction filing rate data. Addresses from the preconception (from 2007 to 2009) and during pregnancy neighborhoods (from 2009 to 2011) were linked to data from the Eviction Lab. Eviction filing rate trajectories included (1) steady low (referent), (2) steady high, (3) decreasing, and (4) increasing categories. PTB was defined as birth before 37 completed weeks of gestation and was abstracted from participant medical records. Modified Poisson regression with robust error variance estimated relative risk and 95% confidence intervals. Models were adjusted for predictors of residential selection (income, education, marital/cohabiting status, andage), as well asduration of residence in current neighborhood, current neighborhood sociodemographic disadvantage, and residential movefrom the before pregnancy to during pregnancy neighborhood. Preterm birth was experienced in 16.2% of the sample (n = 131), and the mean age of participants was 27years. In adjusted models, PTB risk was strongly associated with increasing eviction filing rates (compared to steady low) (relative risk: 1.68, 95% CI: 1.05, 2.68). Our results provide new evidence about the spillover effects of increased neighborhood threat of eviction over time, on risk of PTB among Black women. Future interventions, including policy solutions aimed at addressing the eviction and PTB crises, are warranted.

Exposure to Extreme Heat Increases Preterm Birth Risk: Hypothetical Pathophysiological Mechanisms.

Preterm birth (PTB), delivery before 37 weeks of gestation, is the leading cause of neonatal mortality globally, accounting for nearly half of all neonatal deaths. While numerous established risk factors for PTB have been identified, ongoing research continues to elucidate additional contributing factors. Epidemiological studies increasingly demonstrate that elevated ambient temperature is an environmental risk factor for PTB, with odds increasing 16% during heat waves and 5% per 1°C temperature rise. This is particularly concerning given escalating global warming trends. While maternal heat susceptibility during pregnancy may be linked to compromised thermoregulation from gestational adaptations, the exact pathophysiological mechanisms leading to heat-associated PTB remain unclear, hindering therapeutic development. This review proposes multitudes potential pathophysiologic mechanisms leading to PTB that can be induced by heat. They include but are not limited to metabolic derangement, mitochondria dysfunction, inflammation, endothelial dysfunction, oxidative stress, and change in cell fate. These mechanisms are derived from integrated knowledge of pregnancy physiology, parturition processes, and temperature effects on physiological pathways. We also outline future experimental approaches to test these hypotheses.

Evaluation of a novel liquid-solid biphasic differential medium for screening of group B streptococcus in perinatal women.

This study explored the capabilities of the commonly used blood agar plate in Chinese clinical microbiology laboratories and a novel liquid-solid biphasic differential medium (L-S StrepB) for detecting group B streptococcus (GBS) in peripartum women in China. A total of 11.2% (65/582) of pregnant women at 35-37 weeks of gestation were found to carry GBS. The sensitivity and specificity of L-S StrepB were 96.9% and 100%, respectively. Additionally, 87.3% (55/63) of GBS cases were detected within 15-24 h using L-S StrepB, demonstrating rapid processing time. This method is user-friendly, cost-effective, and requires no specialized equipment, making it suitable for use in primary healthcare settings.IMPORTANCEThe clinical application methods for group B streptococcus (GBS) detection among peripartum women in medical institutions in China are influenced by various factors, such as cost and personnel availability, leading to a lack of standardization. In this study, we evaluated a novel liquid-solid biphasic differential medium (L-S StrepB) that integrates liquid enrichment with solid agar for the detection of GBS. This is the first reported study in China to utilize biphasic medium for GBS detection. L-S StrepB demonstrates good sensitivity and specificity, with simple operations and low costs, while adhering to guidelines recommending initial enrichment followed by culturing.

Effect of artificial intelligence driven therapeutic lifestyle changes (AI-TLC) intervention on health behavior and health among obesity pregnant women in China: a randomized controlled trial protocol

IntroductionObesity has reached epidemic proportions globally, posing significant challenges to public health and economic stability. In China, the prevalence of obesity is increasing rapidly, particularly among pregnant women, who face unique risks due to the complex interplay between obesity and pregnancy outcomes. This study aims to evaluate the effectiveness of an Artificial Intelligence-driven Therapeutic Lifestyle Change (AI-TLC) intervention in improving health behaviors and outcomes among obese pregnant women in China.Methods and analysisThis randomized controlled trial will recruit pregnant women aged 18 years or older with a singleton pregnancy between 8 and 12 weeks of gestation and a pre-pregnancy BMI of ≥30.0 kg/m2. Participants will be randomly assigned to one of three groups: a manual intervention group, an AI intervention group, and a combined AI and manual intervention group. The intervention will focus on therapeutic lifestyle changes, including behavioral modifications, dietary adjustments, and physical activity promotion, supported by a multidisciplinary team. Primary outcomes will include maternal BMI, weight, and adverse pregnancy outcomes, while secondary outcomes will assess physiological indicators, quality of life, mental health, and lifestyle factors.ResultsThe study will evaluate the effects of health interventions on obese pregnant women through primary outcomes (e.g., BMI, weight, adverse pregnancy outcomes) and secondary outcomes (e.g., physiological indicators, quality of life, mental health) using various statistical methods. The results will provide insights into the intervention's effectiveness and cost-effectiveness across different socioeconomic groups.DiscussionThe anticipated findings are expected to demonstrate the efficacy of AI-TLC interventions in managing obesity during pregnancy. This study will contribute valuable evidence to the limited research on AI-based interventions for obese pregnant women, offering potential implications for the development of personalized, efficient, and innovative health strategies. The findings may also inform public health initiatives aimed at improving maternal and child health outcomes in the context of obesity.

Beyond the Scar: A Case Report on the Clinical Presentation, Diagnostic Nuances, and Surgical Management of Type I Cesarean Scar Pregnancy

Background: Cesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy where the gestational sac implants within the fibrous tissue of a previous cesarean section scar. Its incidence is rising in parallel with increasing cesarean delivery rates, posing significant risks of maternal morbidity, including uterine rupture and severe hemorrhage. Type I CSP, or endogenic CSP, involves implantation on a healed scar with growth primarily towards the uterine cavity. Early and accurate diagnosis, relying heavily on ultrasonographic nuances, is crucial for appropriate management and fertility preservation. Case presentation: We present the case of a 36-year-old woman, G7P3033, with a history of two prior cesarean sections, who presented at 6-7 weeks of gestation with vaginal discharge. Transabdominal ultrasonography revealed a gestational sac implanted on the anterior uterine wall within the cesarean scar area, with a thin myometrium between the sac and the bladder, consistent with a Type I (endogenic, COS-1, Grade II) Cesarean Scar Pregnancy. The patient also had Stage II hypertension. After thorough evaluation and counseling, the patient underwent a laparotomy with wedge resection of the CSP and scar revision, along with bilateral fimbriectomy as per her request for sterilization. Conclusion: This case highlights the importance of high clinical suspicion for CSP in pregnant women with previous cesarean sections presenting with early pregnancy symptoms. Detailed ultrasonography is paramount for accurate diagnosis, classification, and guiding management. Surgical management, specifically laparotomy with wedge resection and scar repair, proved to be an effective treatment for this Type I CSP, allowing for removal of the ectopic pregnancy and reinforcement of the uterine wall, while addressing the patient's desire for permanent contraception. Timely intervention is key to preventing life-threatening complications and preserving future reproductive options if desired.

Quantitative Approach to Quality Review of Prenatal Ultrasound Examinations: Incomplete Detailed Fetal Anatomy Exams

Background/Objectives: It is challenging to obtain all the required views for a fetal anatomy ultrasound examination, so exams are often incomplete. Our objective was to develop and demonstrate quantitative methods to assess the overall rate of incomplete exams for an ultrasound practice and for individual examiners. Methods: We performed a retrospective quality review of all detailed fetal anatomy exams at seven maternal–fetal medicine practices in 2024 with singleton pregnancies and cardiac activity present. The exams were considered incomplete if any of the 36 required anatomy views were reported as inadequate. The analysis focused on exams at a gestational age (GA) of 18.0 to 23.9 weeks. The rates of incomplete exams were tabulated across practices and for individual sonographers and physicians. Multivariable logistic regression was used to adjust for known covariates. Results: In total, 15,723 detailed fetal anatomy exams were performed at 18.0–23.9 weeks of gestation. Incomplete exams were significantly more common with maternal obesity, prior cesarean, maternal age &lt; 35 years and GA &lt; 19 weeks. There were significant between-practice differences in the rate of incomplete exams, varying from 1% to 53%. Incomplete exams had a median of four inadequate views (interquartile range 2–7). Practices also varied significantly in the rate of missing measurements for nuchal fold (0 to 9%) and nose bone length (11–100%). There were significant between-individual differences in the rate of incomplete exams. The tabulation of specific views showed some individuals with very high rates of inadequate views of certain elements. Conclusions: For some practices, there is a need for practice-wide quality improvement to increase the rate of measurement of the nuchal fold and nose bone. For selected individuals, the tabulation of which anatomy elements were inadequate can identify areas for targeted education or mentorship. We suggest strategies and software enhancements that may reduce the rate of incomplete exams. Sample data and statistical analysis scripts are provided for those who wish to adopt these methods to review their own data.

Use of Artificial Intelligence in Recognition of Fetal Open Neural Tube Defect on Prenatal Ultrasound.

To compare the axial cranial ultrasound images of normal and open neural tube defect (NTD) fetuses using a deep learning (DL) model and to assess its predictive accuracy in identifying open NTD.It was a prospective case-control study. Axial trans-thalamic fetal ultrasound images of participants with open fetal NTD and normal controls between 14 and 28 weeks of gestation were taken after consent. The images were divided into training, testing, and validation datasets randomly in the ratio of 70:15:15. The images were further processed and classified using DL convolutional neural network (CNN) transfer learning (TL) models. The TL models were trained for 50 epochs. The data was analyzed in terms of Cohen kappa score, accuracy score, area under receiver operating curve (AUROC) score, F1 score validity, sensitivity, and specificity of the test.A total of 59 cases and 116 controls were fully followed. Efficient net B0, Visual Geometry Group (VGG), and Inception V3 TL models were used. Both Efficient net B0 and VGG16 models gave similar high training and validation accuracy (100 and 95.83%, respectively). Using inception V3, the training and validation accuracy was 98.28 and 95.83%, respectively. The sensitivity and specificity of Efficient NetB0 was 100 and 89%, respectively, and was the best.The analysis of the changes in axial images of the fetal cranium using the DL model, Efficient Net B0 proved to be an effective model to be used in clinical application for the identification of open NTD. · Open spina bifida is often missed due to the nonrecognition of the lemon sign on ultrasound.. · Image classification using DL identified open spina bifida with excellent accuracy.. · The research is clinically relevant in low- and middle-income countries..

Migration of Placenta Previa in Patients Presenting in A Tertiary Care Hospital and Feto-maternal Outcome

Objective: To investigate the migration of placenta previa and its feto-maternal outcomes in patients presenting at a tertiary care hospital. Material and Methods: The study was conducted at the Obstetrics and Gynaecology Department of Ghurki Trust Teaching Hospital over a two-year period, from March 2021 till March 2023, following the approval from the Institutional Review Board. This study included 50 patients who met the specified inclusion criteria. Using a pre-designed proforma, data was collected on placental location (low-lying or previa, anterior or posterior) at both 20 and 32 weeks of gestation to assess migration. Additionally, demographic and clinical information, including maternal age, gravidity, parity, obstetric history, fetal gender, fetal presentation, delivery mode, and neonatal outcomes were recorded. The data was analyzed using SPSS software (version 22) and the results were presented as frequencies, percentages, and tables. The chi-square test was used to evaluate associations (95% confidence interval) considering p-values &lt; 0.05 statistically significant. Results: The migration of placenta previa was 38%. Posterior placenta previa was more common (62%) and migrated more frequently (63%) than anterior placenta previa. Primigravida women placenta previa. Placenta previa was associated with male fetuses (59%) and breech presentation (22%). Moreover, the study revealed that 42% women needed blood transfusions during childbirth and 6% experienced anemia related complications, underscoring maternal risks. Conclusion: Understanding placenta previa migration and its associated factors helps to better plan the mode and timing of delivery, improving maternal and fetal outcomes. Keywords: Placenta previa, migration, Cesarean section, feto-maternal outcome

Effect of gestational age on special education: a population-based matched cohort analysis.

To investigate the effect of gestational age on special education use at primary school age, and to examine specific groups with elevated risk. Population-based matched cohort study linking data from the Dutch national perinatal registry (PERINED) of all singleton surviving children without major congenital abnormalities, born between 25+0 and 42+6 weeks of gestation between 1999 and 2009, with data of the mandatory special education registry of Statistics Netherlands. Use of special education at primary school age. 1 814 540 children were included. Overall prevalence of special education was 6.6%, with highest rates in children born at 25 weeks (34.7%) and lowest at 40 weeks (5.7%). Elevated adjusted ORs for special education compared with the reference of 40 weeks were found in all gestational age groups (25-29 weeks, 30-31 weeks, 32-36 weeks, 37-39 weeks and 41-42 weeks), with the highest adjusted OR (3.50 (95% CI, 3.26 to 3.77)) in children born at 25-29 weeks. Comparable ORs were obtained after 1 to 1 exact matching with controls born at 40 weeks. Low maternal education, male sex, small for gestational age and 5-min Apgar score<7 increased special education use at week 25 and above. There is a strong inverse effect of gestational age on special education use in this complete nationwide, decennium birth cohort. Increased risk of special education use is still present in late preterms and those born at early-term or post-term.

Clinical manifestation and management in a resource-limited setting of Ballantyne syndrome (Mirror syndrome) associated with preeclampsia, a case report

Introduction and importance: Ballantyne syndrome, also known as triple edema or maternal mirror syndrome, is an extremely rare clinical condition characterized by maternal edema, placentomegaly, and fetal hydrops. Its rarity and overlapping symptoms often lead to misdiagnosis, particularly in resource-limited settings. Management is primarily etiological and focuses on addressing the underlying cause. This case highlights the challenges encountered in managing Ballantyne syndrome associated with preeclampsia in a resource-limited setting. Case presentation: A 21-year-old woman, blood group AB Rh-positive, was hospitalized at 24 weeks of gestation with generalized edema and absent fetal movements. She had limited antenatal care, with only one prenatal visit and two ultrasounds, both showing placentomegaly that obscured optimal visualization of fetal structures. Clinical assessment confirmed severe preeclampsia complicated by fetal-maternal hydrops. Given the maternal risks and the poor fetal prognosis, pregnancy termination was performed. Induction of labor resulted in the delivery of a hydropic fetus, who succumbed shortly after birth. The patient recovered without complications following symptomatic management of preeclampsia. Clinical discussion: Ballantyne syndrome, although rare, poses a significant maternal risk and requires prompt recognition and intervention. In this case, severe preeclampsia and fetal hydrops contributed to the worsening maternal condition, necessitating urgent pregnancy termination to prevent further complications. The patient’s limited access to antenatal care may have delayed diagnosis, underscoring the importance of early screening and multidisciplinary management in high-risk pregnancies. Conclusion: This case highlights the critical need for early diagnosis and timely intervention in managing Ballantyne syndrome and preeclampsia, particularly in resource-limited settings. Strengthening antenatal care, comprehensive patient counseling, and evidence-based management is essential to improving maternal and perinatal outcomes in such complex cases.

EV-microRNA signatures in pregnant women with idiopathic recurrent pregnancy loss: deciphering microRNAome pathway networks at feto-maternal interface

BackgroundDespite extensive research in the past decade, the exact pathogenesis of recurrent pregnancy loss (RPL) remains unknown. At the time of pregnancy, human placenta releases microRNAs (miRNAs) enclosed in extracellular vesicles (EVs), which enter into maternal circulation and play an important role at feto-maternal interface to sustain a successful pregnancy. Aberrant expression of these miRNAs often results in adverse pregnancy complications. Therefore, studying the expression of these EV-miRNAs in maternal circulation could provide insights into the pathogenesis of RPL.MethodsThe present study included idiopathic currently pregnant (&amp;lt;22 weeks of gestation) RPL women (n=10) and gestational-age-matched healthy pregnant women as control (n=5). EVs were isolated from plasma samples and characterized for their morphology and cell-surface marker. Total RNA was isolated and subjected to miRNA sequencing on Illumina NovaSeq 6000 platform. Differentially expressed (DE) miRNAs were identified using DESeq package. Target prediction and pathway analysis were done using TargetScan, miRDB, miRTarBase, and DIANA-miRPath v3.0 online tool. Protein–protein interaction was done using STRING, and hub genes were identified using Cytoscape software.ResultsmiRNA sequencing revealed 66 (44 known and 22 novel) significantly DE miRNAs between RPL and healthy pregnant women. Among these, 37 were downregulated and 29 were upregulated, log2|FC| ≥ 1. Network-based analysis showed highest degree for nine miRNAs (hsa-miR-155-5p, hsa-miR-26a-5p, hsa-miR-204-5p, hsa-miR-140-5p, hsa-miR-139-5p, hsa-let-7e-5p, hsa-miR-149-5p, hsa-miR-374a-5p, and hsa-miR-190a-5p). Gene Ontology (GO) and KEGG pathway analysis of target genes showed significant involvement of Hippo, FoxO, TGF-β, and p53 signaling pathways, which play a crucial role in RPL. Top 10 identified hub genes (NFKB1, IL6, JUN, FOS, CXCL8, PTGS2, TGFB1, MMP9, STAT1, and CD4) were significantly enriched in immunological pathways—Th1/Th2/Th17 differentiation, NF-κB pathway, TNF-α signaling, IL-17 signaling pathway, and vascular endothelial growth factor (VEGF) pathway.ConclusionThese results suggest that circulating EV-miRNAs in maternal blood could provide clinical insights into the pathogenesis of RPL and dysregulated immunological and molecular pathways at feto-maternal interface.

Effect of FSL-CGM on Maternal and Neonatal Outcomes in GDM: A Propensity Score Matching Study in Hangzhou, China.

This study aims to evaluate the impact of using FreeStyle Libre continuous glucose monitoring (FSL-CGM) on maternal glucose control and obstetric and neonatal outcomes among women with gestational diabetes mellitus (GDM). A total of 3062 women with GDM in gestational weeks 24-28 were enrolled in this study and divided into FSL-CGM and self-monitoring of blood glucose (SMBG) groups according to the method of monitoring blood glucose. Nearest-neighbor matching propensity score matching (PSM) was used to balance covariates at a ratio of 1:2. Compared with the first 6days during the study period, the index of glycemic variability, such as the mean largest amplitude of glycemic excursions (LAGE), average daily risk range (ADRR) and glucose management indicators (GMI) during the last 6days were improved (all p < 0.05). The fasting blood glucose before delivery in the FSL-CGM group was lower than that in the SMBG group (p < 0.05). In the normal weight subgroup, the FSL-CGM group had a lower gestational weight gain (GWG) than the SMBG group (p < 0.05). The incidence of neonatal hypoglycemia was higher in the SMBG group than in the FSL-CGM group (p < 0.05). This study demonstrated that FSL-CGM helps reduce maternal glycemic variability and the incidence of neonatal hypoglycemia. Additionally, FSL-CGM may contribute to appropriate gestational weight gain during pregnancy. ClinicalTrials.gov identifier, NCT05003154.

Maternal plasma extracellular vesicles tsRNA as potential biomarkers for assessing preterm labor risk

BackgroundSpontaneous preterm labor (PTL) accounts for approximately 70% of preterm births, posing significant risks to both maternal and neonatal health. Current predictive biomarkers lack sufficient reliability, underscoring the need for non-invasive and dependable indicators. Emerging research indicates that tRNA-derived small RNAs (tsRNAs) are involved in various diseases; however, their potential association with PTL remains underexplored.MethodsBioinformatics analyses of public GEO datasets (PRJNA415953 and PRJNA428989) were conducted to identify tsRNAs associated with PTL. Validation was performed using plasma extracellular vesicles samples collected at 12 weeks of gestation from PTL patients (n = 45) and healthy controls (n = 38). Functional assays were used to assess the impact of tsRNA1 (tRNA-Gly-GCC-5p-tRF-921) on extravillous trophoblast (EVT) function, including apoptosis, migration, invasion, and endothelial-like tube formation in HTR8/SVneo cells. Transcriptomic sequencing was conducted to identify tsRNA1-mediated pathways, and DNA methylation patterns were predicted based on the transcriptomic data. Statistical significance was determined using Student’s t-test.ResultsTwo tsRNAs, tsRNA1 and tsRNA3 (tRNA-Gly-GCC-5p-tR-half-368), were significantly upregulated in PTL patient samples compared to controls. Overexpression of tsRNA1 impaired EVT function, increased apoptosis, and altered DNA methylation profiles, implicating its critical role in PTL mechanisms.ConclusionsThis study identifies tsRNA1 as a key regulator of EVT dysfunction and placental pathology in PTL. The findings provide novel insights into the mechanistic role of tsRNAs in PTL and highlight tsRNA1 as a promising biomarker for early risk stratification and prediction of the condition.Clinical trial numberNot applicable.

Bidirectional relationships between mindfulness and symptoms of depression and anxiety during pregnancy and postpartum

ABSTRACT Background Perinatal anxiety and depression are significant public health concerns with the potential to affect maternal and infant well-being; therefore, it is crucial to identify protective factors. This study explores the reciprocal relationship between dispositional mindfulness and symptoms of anxiety and depression throughout pregnancy and the postpartum period. Methods In a sample of 347 women, mindfulness traits were evaluated at 26 weeks of gestation and two weeks postpartum, while anxiety and depression symptoms were evaluated at 26 weeks of gestation and at two and six weeks postpartum. Results The results indicate that higher levels of non-judging mindfulness during pregnancy predicted reduced depression symptoms at two weeks postpartum, and similarly, higher levels of non-judging mindfulness at two weeks postpartum predicted lessened depression symptoms at six weeks postpartum. Moreover, depressive symptoms during pregnancy predicted reduced mindfulness capacities (non-judging of and non-reactivity to inner experience) in the postpartum period. Conclusion These findings underscore the importance of promoting mindfulness during pregnancy as a means to prevent and manage postpartum mood disorders, highlighting the dynamic interplay between mental health symptoms and mindfulness traits.

Mild-to-moderate iodine deficiency among pregnant women in Ireland: data from a large prospective pregnancy cohort

PurposeAdequate maternal iodine status is essential for healthy foetal brain development. There are no current data on maternal iodine status in Ireland. The aim of this study was to conduct the first large-scale assessment of maternal iodine status in Ireland and identify its sociodemographic determinants using data from a large prospective pregnancy cohort.MethodsParticipants were nulliparous females (n = 1509) recruited at Cork University Maternity Hospital, Cork, Ireland. Clinical and questionnaire-based assessments were carried out and spot urine samples were collected throughout pregnancy. Urinary iodine concentration (UIC) at 11 and 15 weeks of gestation was quantified using the Sandell–Kolthoff colorimetric method. UIC was corrected for urinary creatinine (measured via Jaffe assay), expressed as I: Cr ratio. Linear and logistic regression were performed to identify non-dietary determinants of iodine status in early pregnancy.ResultsMedian (IQR) UIC at 11 and 15 weeks of gestation were 128 (76, 201) and 125 (74, 208) µg/L, respectively, indicating mild-to-moderate iodine deficiency during pregnancy at both timepoints. Iodine-containing supplement use, winter season, BMI, age and education were predictors of I: Cr < 150 µg/g.ConclusionThis first large-scale investigation of maternal iodine status in Ireland highlighted sub-optimal status in pregnancy.

Measuring ENAP interventions for small and/or sick newborns in routine health information systems: indicators and considerations from a WHO expert consultation.

Current trends indicate 63 low- and middle-income countries (LMICs) are not on track to achieve the 2030 Sustainable Development Goal 3.2 target of a neonatal mortality rate ≤12 per 1000 live births. The Every Newborn Action Plan (ENAP) prioritised four life-saving interventions for small and/or sick newborns (SSN) in health facilities: neonatal resuscitation, kangaroo mother care, antibiotic treatment of possible serious bacterial infections, and antenatal corticosteroids for women at risk of preterm birth at <34 weeks of gestation. Limited indicator reporting on the use of these interventions in routine health information systems (RHIS) is a barrier to scaling up SSN care. The World Health Organization (WHO) led a multi-step process to agree coverage indicators for the four SSN interventions, which included a rapid review of existing research and programme reports; expert consultation to review available evidence, deliberate and propose coverage indicators, assess feasibility in RHIS, and identify research gaps. Expert working groups discussed and recommended definitions for each of the four coverage indicators. After considering feasibility and challenges, potential sources of data for each indicator were appraised. Data for these indicators is not always routinely collected in registers, requiring information from clinical case records, which can be challenging in resource-constrained health systems. The proposed indicators were also assessed against established indicator assessment criteria. The need for testing the indicators was emphasised and other research gaps were also identified. Reporting and monitoring the life-saving SSN interventions in routine health information systems (RHIS) is crucial for improving newborn care in LMICs. Urgent consideration must be given to how this data can be collected from health facilities and subsequently reported in RHIS. Improved RHIS measures for these interventions will enable programme managers and policy makers to scale up their use, accelerating reductions in preventable neonatal morbidity and mortality.