Higher Risk Of Perinatal Complications Research Articles

THU317 Study Of Risk Factors For The Development Of Various Subtypes Of Gestational Diabetes Mellitus

Abstract Disclosure: N.I. Volkova: None. I. Davidenko: None. J. Sorokina: None. J. Degtyareva: None. V. Kovalenko: None. Abstract: Gestational diabetes mellitus (GDM) poses a threat to the health of the mother and a high risk of perinatal complications, however, achieving normoglycemia will significantly improve the prognosis in such pregnant women. One of the factors determining the most optimal management tactics is based on the pathophysiological mechanism of GDM formation. According to modern concepts, the processes associated with pancreatic β-cell dysfunction, insulin resistance (IR) or a combination of these factors may prevail in the basis of the formation of GDM, forming various subtypes of GDM. Identification of risk factors for the development of various subtypes of GDM in pregnant women may be important for timely verification and selection of therapy. In order to study risk factors for the development of various subtypes of GDM 130 pregnant women were examined without a history of carbohydrate metabolism disorders. The subjects were divided into: group I - 45 pregnant women with GDM and β-cell dysfunction, group II - 43 pregnant women with GDM and IR, group III - 42 pregnant women without GDM (control). The risk factors, whose contribution to the development of GDM is already well known, and the factors that, in our opinion, can influence the development of GDM, were studied. We conducted a full clinical examination. Carbohydrate metabolism was assessed according to fasting venous plasma glucose, oral glucose tolerance test with 75 g of glucose. The function of β-cells was evaluated and IR was detected. According to the Matsuda index, subtypes of GDM were identified. Statistical processing was carried out using comparative analysis. The data are presented in the form of medians and interquartile intervals of quantitative indicators in the groups, the data were considered reliable at p<0.05. Pregnant women with GDM and IR are characterized by an older age at the onset of pregnancy [32 (29; 35) y.o, p = 0.009], a large body weight [84 (76; 91) kg, p <0.001], signs of acanthosis nigricans (14%, p=0.03), weight of 1 child at birth (p= 0.047), rarer intake of folic acid (p< 0.001), low physical activity before pregnancy (p<0.001). Patients with GDM and β-cell dysfunction are characterized by a younger age [29 (27; 31) y.o.; p= 0.02], lower body weight [59.8 (55.9; 76.4) kg, p <0.001] and BMI [21.9 (20.7; 26.6) kg/m2, p <0.001], absence of regular MC before pregnancy (93%, p=0.02) and more frequent use of folic acid (p=0.048). Both groups of patients were characterized by the absence of pre-gravidar preparation (p=0.03).Thus, we have studied known risk factors for GDM, as well as factors that could potentially cause the development of hyperglycemia during pregnancy. And it turned out that in addition to the influence of the patient's age and body weight before pregnancy, an important contribution to the development of various subtypes of GDM is provided by low physical activity and lack of pregravidar preparation. Presentation: Thursday, June 15, 2023

Severe Smallness as Predictor of Adverse Perinatal Outcome in Suspected Late Small-for-Gestational-Age Fetuses: Systematic Review and Meta-analysis

ABSTRACT Various adverse perinatal outcomes, such as neonatal morbidity, fetal death, suboptimal neurodevelopment, and delayed effects as an adolescent and adult, are associated with fetal growth restriction (FGR). Failure to detect this condition prenatally is recognized as a contributor to avoidable perinatal death. This systematic review and meta-analysis assessed the evidence regarding the use of severe smallness (eg, birth weight <3%ile) for prediction of adverse perinatal outcome in fetuses with suspected late-onset small for gestational age (SGA) birth. Study eligibility included third-trimester singleton pregnancies with suspected SGA fetuses, based on an estimated fetal weight (EFW) or abdominal circumference <10th percentile, diagnosed at or after 32 weeks' gestation. Included studies were both retrospective cohort studies and randomized controlled trials and reported on the following outcomes: (1) admission to the neonatal intensive care unit (NICU); (2) neonatal acidosis; (3) cesarean delivery for intrapartum fetal compromise; (4) Apgar score <7 at 5 minutes; (5) perinatal death (including stillbirth and neonatal death within 48 hours after birth); and (6) composite adverse perinatal outcome. The analysis identified a total of 6541 articles via database search, and 1 additional study was identified manually. A final review resulted in the inclusion of 12 cohort studies. The studies included 3639 fetuses with suspected late-onset SGA, of which 1246 had severe SGA <3%ile. Significant associations were found between suspected severe SGA and the composite adverse perinatal outcome, with an odds ratio (OR) of 1.97 (95% confidence interval [CI], 1.33–2.92), NICU admission (OR, 2.87; 95% CI, 1.84–4.47), and perinatal death (OR, 4.26; 95% CI, 1.07–16.93). However, the analysis found limited performance of suspected severe SGA to predict perinatal outcomes, with an area under the curve of 60.9% for the composite adverse perinatal outcome. The meta-analysis results indicate that the performance of severe SGA in the study was poorer than that reported for uterine artery Doppler and cerebroplacental ratio. The current analysis found a positive and negative likelihood ratio of 1.53 and 0.76, respectively, for composite adverse perinatal outcome associated with severe smallness. Despite its association with a higher risk of perinatal complications, suspected severe SGA failed to perform as a standalone parameter for the prediction of adverse perinatal outcome.

Perinatal Outcome in Maternal COVID-19 infection at a Tertiary care Institute- A cross Sectional Study.

COVID 19 pandemic is one of the biggest challenge to health system of developing as well as developed countries. Because of the novelty of the virus, limited data were available regarding perinatal outcome. The objective of this study is to find out the perinatal outcome in COVID-19 infected mothers who delivered during COVID Pandemic. A cross sectional study was carried out at PCMC'S Post-Graduate Institute and YCM Hospital Pune (Maharashtra) from 1 May 2020 to 31 October 2021 which was a dedicated COVID hospital during COVID pandemic. A total of 362 maternity patients (including 5 twin pregnancies) having COVID 19 infection who gave birth to 367 Newborns were studied. Maternal COVID -19 infection was diagnosed either by RTPCR test or Rapid Antigen test. Demographic variables, maternal symptoms, labour and neonatal outcome were recorded. RT PCR of neonates at birth was performed. Data was analyzed statistically by using Epi Info Software. To analyze the perinatal outcome among COVID-19 infected mothers who delivered during Covid pandemic. Study was conducted with the primary objective to analyze the labour outcome, maternal symptoms and secondarily to study maternal demographic profile and to compare disease severity during 1st and 2nd wave of COVID and to detect possibility of vertical transmission of COVID-19 in neonates of covid positive mothers. 74.2% patients from young reproductive age (21-30 years age) were affected. All socioeconomic classes were affected. 61% patients were multigravida. Normal BMI was noted in 49.8%. 28.2% deliveries were preterm. Caesarean section rate was 50.5%. Following obstetric high risk factors were noted-anaemia in 34.2% followed by previous LSCS in 26.2% cases and preeclampsia in 18.7%Overall 54.6% patients were asymptomatic while 45.4% were symptomatic. Symptomatology between 1st and 2nd wave showed statistical significance (p value < .05%) for mild, moderate and severe symptoms. Myalgia, cough, fever and fatigue were common presenting symptoms. 14% patients required ICU/HDU care. HDU/ICU requirement showed statistical significance (p value < .05) between 1st and 2nd wave. Overall maternal mortality was 1.1% (4 maternal deaths in 2nd wave) with no mortality in 1st wave.96.4% were live births. Birth weight was more than 2.5kg in 62% cases and 21.3% cases required NICU. Vertical transmission of COVID was seen in 1.1% cases. Pregnant patients with moderate and severe disease are at higher risk of perinatal complications. ICU/HDU management with multidisciplinary management may reduce morbidity and mortality. Neonatal affection due to COVID may not be severe but may increase prematurity due to iatrogenic intervention.

Severe smallness as predictor of adverse perinatal outcome in suspected late small-for-gestational-age fetuses: systematic review and meta-analysis.

To investigate the performance of severe smallness in the prediction of adverse perinatal outcome among fetuses with suspected late-onset small-for-gestational age (SGA). A systematic search was performed to identify relevant studies in PubMed, Web of Science and Scopus. Late-onset SGA was defined as estimated fetal weight (EFW) or abdominal circumference (AC) < 10th percentile diagnosed at or after 32 weeks' gestation, while severe SGA was defined as EFW or AC < 3rd percentile or < 2 SD. Random-effects modeling was used to generate hierarchical summary receiver-operating-characteristics (HSROC) curves. The performance of severe SGA (as a presumptive diagnosis) in predicting adverse perinatal outcome among singleton pregnancies with suspected late-onset SGA was expressed as area under the HSROC curve (AUC), sensitivity, specificity and positive/negative likelihood ratios. The association between suspected severe SGA and adverse perinatal outcome was also assessed by random-effects modeling using the Mantel-Haenszel method and presented as odds ratio (OR). The non-exposed group was defined as non-severe SGA (EFW ≥ 3rd centile). Twelve cohort studies were included in this systematic review and meta-analysis. The studies included a total of 3639 fetuses with suspected late-onset SGA, of which 1246 had suspected severe SGA. Significant associations were found between suspected severe SGA and composite adverse perinatal outcome (OR, 1.97 (95% CI, 1.33-2.92)), neonatal intensive care unit admission (OR, 2.87 (95% CI, 1.84-4.47)) and perinatal death (OR, 4.26 (95% CI, 1.07-16.93)). However, summary ROC curves showed limited performance of suspected severe SGA in predicting perinatal outcomes, with AUCs of 60.9%, 66.9%, 53.6%, 57.2%, 54.6% and 64.9% for composite adverse perinatal outcome, neonatal intensive care unit admission, neonatal acidosis, Cesarean section for intrapartum fetal compromise, low Apgar score and perinatal death, respectively. Although suspected severe SGA was associated with a higher risk of perinatal complications, it performed poorly as a standalone parameter in predicting adverse perinatal outcome. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

A Web-Based mHealth Intervention With Telephone Support to Increase Physical Activity Among Pregnant Patients With Overweight or Obesity: Feasibility Randomized Controlled Trial.

BackgroundPregnant patients with overweight or obesity are at high risk for perinatal complications. Excess gestational weight gain (GWG) further exacerbates this risk. Mobile health (mHealth) lifestyle interventions that leverage technology to facilitate self-monitoring and provide just-in-time feedback may motivate behavior change to reduce excess GWG, reduce intervention costs, and increase scalability by improving access.ObjectiveThis study aimed to test the acceptability and feasibility of a pilot mHealth lifestyle intervention for pregnant patients with overweight or obesity to promote moderate intensity physical activity (PA), encourage guideline-concordant GWG, and inform the design of a larger pragmatic cluster randomized controlled trial.MethodsWe conducted a mixed methods acceptability and feasibility randomized controlled trial among pregnant patients with a prepregnancy BMI of 25 to 40 kg/m2. Patients with singletons at 8 to 15 weeks of gestation who were aged ≥21 years and had Wi-Fi access were recruited via email from 2 clinics within Kaiser Permanente Northern California and randomized to receive usual prenatal care or an mHealth lifestyle intervention. Participants in the intervention arm received wireless scales, access to an intervention website, activity trackers to receive automated feedback on weight gain and activity goals, and monthly calls from a lifestyle coach. Surveys and focus groups with intervention participants assessed intervention satisfaction and ways to improve the intervention. PA outcomes were self-assessed using the Pregnancy Physical Activity Questionnaire, and GWG was assessed using electronic health record data for both arms.ResultsOverall, 33 patients were randomly assigned to the intervention arm, and 35 patients were randomly assigned to the usual care arm. All participants in the intervention arm weighed themselves at least once a week, compared with 20% (7/35) of the participants in the usual care arm. Participants in the intervention arm wore the activity tracker 6.4 days per week and weighed themselves 5.3 times per week, and 88% (29/33) of them rated the program “good to excellent.” Focus groups found that participants desired more nutrition-related support to help them manage GWG and would have preferred an app instead of a website. Participants in the intervention arm had a 23.46 metabolic equivalent of task hours greater change in total PA per week and a 247.2-minute greater change in moderate intensity PA per week in unadjusted models, but these effects were attenuated in adjusted models (change in total PA: 15.55 metabolic equivalent of task hours per week; change in moderate intensity PA: 199.6 minutes per week). We found no difference in total GWG (mean difference 1.14 kg) compared with usual care.ConclusionsThe pilot mHealth lifestyle intervention was feasible, highly acceptable, and promoted self-monitoring. Refined interventions are needed to effectively affect PA and GWG among pregnant patients with overweight or obesity.Trial RegistrationClinicalTrials.gov NCT03936283; https://clinicaltrials.gov/ct2/show/NCT03936283

Methods for assessing insulin resistance in gestational diabetes mellitus

Among all endocrine diseases complicating pregnancy, gestational diabetes mellitus (GSD) is the most common. Th is violation of carbohydrate metabolism poses a serious threat to the health of the mother and fetus, associated with a high risk of perinatal complications. At the same time, the eff ective achievement of normoglycemia in a woman suff ering from GSD can signifi cantly improve the prognosis. Th e choice of GSD therapy depends on a number of factors and is decided individually in each case. One of the factors determining the eff ectiveness of non-drug therapy and the need for pharmacological correction may be related to the pathophysiological aspects of the formation of hyperglycemia during pregnancy. Currently, they talk about the heterogeneity of GSD and distinguish its various subtypes depending on the predominance of pancreatic beta-cell dysfunction, insulin resistance (IR) or a combination of these factors in the pathogenesis. Since the prevailing criterion for the verifi cation of GSD subtypes is the presence and severity of IR, various methods of its verifi cation are considered in this review. It is shown that the currently available methods for detecting IR have a number of disadvantages, consisting both in the complexity and complexity of implementation (hyperinsulinemic euglycemic clamp) and in the absence of clear reference intervals (mathematical models). It is necessary to continue research aimed at studying IR methods for the subsequent identifi cation of GSD subtypes.

Child mortality of twins and singletons among late preterm and term birth: a study of national linked birth and under-five mortality data of Korea.

Twins involve a higher risk of perinatal complications compared to singletons. We compared the risk of under five mortality between twins and singletons among late preterm and term births. The national birth data of South Korea pertaining to the years 2010-2014 linked with the mortality record of children aged under 5 years in 2010-2019 was analyzed. The final study population was 2,199,632 singletons and 62,351 twins. We conducted a survival analysis of under-five mortality with adjustment for neonatal and familial factors. Overall under-five mortality rates during the study period were 3.6 and 2.0 for twins and singletons, respectively. Although the unadjusted overall under-five mortality was higher in twins (hazard ratio [HR] = 1.80, 95% confidence interval [CI]: 1.57, 2.06, overall risk), twin birth was associated with comparable or lower risk (HR = 0.70, 95% CI: 0.58, 0.85, overall; 0.70, 95% CI: 0.56, 0.87, excluding neonatal mortality; 0.59, 95% CI: 0.40, 0.86, excluding infant mortality) after controlling for both neonatal and familial factors. Twins born at a gestational age of 34-35 weeks showed a generally lower risk of under-five mortality than their singleton counterparts, regardless of model specification.Conclusion: Among late preterm and term birth, under-5-year mortalities for twins were lower than singleton births when adjusted for neonatal and familial risk factors. This highlights the differential implication of gestational age at birth between twin and singleton in the child mortality.

ATYPICALPRESENTATION OF PREECLAMPSIA. ABOUT A CASE

3 to 5% of pregnancies are complicated by pre-eclampsia, which remains one of the main causes of fetal-maternal mortality and morbidity worldwide. The rate is higher in Morocco where the lack of prenatal consultation explains why pre-eclampsia is diagnosed at advanced stages. It is also responsible for 10 to 15% of maternal deaths in the Western world, and it remains the second leading cause of maternal death in France after the hemorrhage during delivery. Severe early pre-eclampsia (before 32 weeks of pregnancy) is associated with a risk of maternal mortality 20 times higher than after 37 weeks, and a higher risk of perinatal complications: prematurity, intrauterine growth retardation, premature detachment of the normoinsere placenta and perinatal mortality [3].Its pathophysiology is complex and multifactorial. The identification of biochemical and biophysical markers that point to placental and endothelial dysfunction allows us to improve our practices through new screening tests (4), which make it possible to target at-risk pregnancies, and to initiate treatment early. Currently, the coexistence of arterial hypertension, proteinuria and edema is arbitrary and inconstant. Preeclampsia can occurwithout the clinical data mentioned above or appear before the second half of pregnancy. Its symptoms are variable and reflect multisystem dysfunction [3]. Its development is unpredictable and can be overwhelming. The objective of this article is to report a case of atypical preeclampsia (before week 20 of gestation) associated with a HELLP Syndrome then to analyze the clinical features of atypical forms, differential diagnosis and progress in biochemical markers and biophysics that can aid in diagnosis.

COMPARATIVE ANALYSIS OF THE NEONATE BIRTH WEIGHT IN DIFFERENT TYPES OF TIN PREGNANCY

The relevance of the study lies in the significant increase in multiple pregnancies connected with the higher risk of perinatal complications, the controversy over the effects of chorionicity and sex of the babies on their birth weight, the need for timely diagnosis of fetal growth restriction, and associated morbidity.&#x0D; The objective of this study was to compare fetal weights at the birth of different variants of twins depending on chorionicity, gestational age, and sex.&#x0D; Materials and methods. During 2016-2020, 440 pairs of twins were examined: 375 dichorionic diamniotic and 65 monochorionic diamniotic (38 – boys, 27 – girls). Among dichorionic couples there were 186 (49.6%) opposite-sex, 98 (26.1%) same-sex males and 91 (24.3%) same-sex females. Fetal weight was measured at birth, and its relationship to chorionicity, fetal sex, a combination of same-sex or opposite-sex co-twins, and gestational age was assessed.&#x0D; Results. The average weight of 750 fetuses from dichorionic pairs (2570.0 ± 506.43 g) significantly exceeded the weight of 130 fetuses from monochorionic pairs (2333.4 ± 567.24 g, p &lt; 0.0001). The same-sex male (2603.8 ± 532.29 g) and opposite-sex dichorionic diamniotic (2595.6 ± 490.17 g). twins’ masses significantly surpassed the mass of all other twins (p &lt;0.05). In the group of dichorionic twins, the weight of boys exceeded the weight of girls (2638.1 ± 525.96 g vs. 2499.4 ± 475.84 g, p = 0.0002). This pattern was observed both inside the opposite-sex pairs (2674.2 ± 518.17 g vs. 2517.1 ± 448.24 g, p = 0.0019), and same-sex couples of boys compared to same-sex couples of girls (2603.8 ± 532.29 g and 2481.4 ± 503.08 g, respectively, p = 0.0224). No significant difference in the weight of girls of opposite-sex twins compared to same-sex couples was seen. In monochorionic pairs, the weight of male and female fetuses did not differ significantly. Birth weight discordance was found in all types of twins, the highest percentage of discordance was registered in monochorionic boys – 23.7%, second place in frequency took male dichorionic twins – 20.4%. Among the 30 discordant dichorionic opposite-sex twins in 19 (63.3%) cases, the male fetus was heavier. There was no significant difference in fetal weight when women were fertilized naturally and using assisted reproductive technologies. The average weight of children born by surrogate mothers exceeded the weight of children born by non-surrogate mothers (p = 0.0466). In the first pregnancy, children were born with a lower body weight compared to children born as a result of repeated pregnancies and in women who had a history of childbirth.&#x0D; Conclusion. The average weight of the fetuses of dichorionic twins was higher than the weight of the neonates f monochorionic pairs. The prevalence of the weight of boys over the weight of girls from dichorionic pairs and the absence of sex difference in fetal weight in monochorionic twins indicates the possibility of different functional activity of the placenta in fetuses of different sexes. Small for gestational age newborns were most often found in the group of female monochorionic twins and opposite-sex dichorionic pairs. Discordance of fetal mass was most common in monochorionic same-sex male twins. In discordant opposite-sex couples, the male fetus more often was heavier. There was no significant difference in newborn weight when women were fertilized naturally and with the use of assisted reproductive technologies. The average weight of surrogate-born children exceeded the weight of children born by non-surrogate mothers. In the first pregnancy, children were born with a lower body weight compared to children of multiparous and multigravida women.

Pregnancy and childbirth in patients with endometriosis

Aim. To review the current publication highlighting the features of pregnancy and childbirth outcomes in patients with endometriosis.&#x0D; Materials and methods. The analysis of 45 foreign and domestic publications on this topic has been carried out.&#x0D; Results. Patients with endometriosis have fertility problems, and when pregnancy occurs, it was characterized by a higher risk of preeclampsia, placenta previa, gestational diabetes, miscarriage and preterm labor, as well as delivery by caesarean section. Newborns in women with endometriosis have an increased risk of prematurity and small for gestational age. Probably, in addition to the presence of endometriosis, the risk of obstetric and neonatal complications is influenced by the localization and severity of the disease, as well as the use of assisted reproductive technologies.&#x0D; Conclusion. The results obtained indicate that patients with endometriosis have a high risk of perinatal complications and require additional antenatal monitoring and care.

Impact of familial and perinatal risk factors in children with attention deficit hyperactivity disorders: an Egyptian sample

Introduction Attention-deficit hyperactivity disorders (ADHD) are reported in children who have a higher risk of perinatal complications, reaching up to 35–50% of children born with low birth weight, or preterm, and other natal and neonatal complications.Objective To study the patterns and extent of familial and perinatal risk factors in children with ADHD.Patients and methods The sample was 456 ADHD cases out of 3152 children who were attending a Neurodevelopmental Child Psychiatry Clinic in Cairo, Egypt, from April 2010 to October 2018. The control group was 274 apparently normal children attending the Neurodevelopmental Child Psychiatry Clinic for parental consultations and counseling.Results The most prominent significant risk factors were the existence of attacks of skin allergy and cerclage prenatally, while asphyxia and neonatal ICU admission were significant risk factors postnatally. There was a significant correlation between the cerclage and in-vitro fertilization with no significant correlation with previous abortion. There is a significant correlation with threatened abortion, using drug treatment for threatened abortion, infection, and inflammation during pregnancy, also the placenta was not nutritive, kidney, lung, cardiac problems postnatally, and cesarean section were significantly correlated with cerclage as a risk factor.Conclusions There was a complex interaction of familial and other antenatal risk factors of ADHD, the role of an inadequate maternal and child healthcare delivery system was also evident.

Perinatal outcome in cases of borderline oligohydramnios

Introduction: Oligohydramnios is associated with intrauterine growth restriction, congenital anomaly, neonatal and maternal morbidities. The outcome in cases of borderline oligohydramnios is less clear. This study was performed to document fetal, neonatal and maternal outcome in cases of borderline oligohydramnios among those women who delivered in our unit. Materials and Methods: The duration of the study was July 2013-June 2016 and a total of 66 women who were more than 37 weeks gestation were included. The data was compared with 66 control women from the same institution. Results: Overall 45.4%% cases were delivered normally while 62.5% of the control group had a vaginal delivery (p=0.02). Emergency caesarean section cases were due to fetal distress in 35.29% of cases compared to 8.6%in the control group (p=0.02).The fetal and neonatal outcome was far better in the control group as there was 45 versus 8 cases where there was a neonatal problem (p< 0> Conclusions: Cases of borderline oligohydramnios at term have a higher risk of perinatal complications and operative delivery and should be monitored during labour. Delivery should preferably be in a unit where excellent neonatal facilities are available. Keywords: Oligohydramnios, Caesarean section, Intrauterine growth restriction, Meconium.

Phenotyping stress exposures related to perinatal health disparities.

Black American women living in low-resource environments are exposed to multiple stressors and are at high risk for perinatal complications. Stress exposure likely impacts pregnancy and birth complications via alterations in health systems that are engaged in regulating the stress response. Stressors may vary in terms of magnitude and pattern of effect on such health systems. In the present study, we test associations between three types of stress exposure: perceived stress, negative life events, and discrimination stress on neuroendocrine and cardiac response to a controlled laboratory stressor during the first trimester of pregnancy. In all, 100 pregnant Black women with Medicaid insurance completed a laboratory assessment during which salivary cortisol and heart rate variability (HRV) were used to measure stress response to the Trier Social Stress Test (TSST). Results revealed that only discrimination stress was significantly associated with cortisol and HRV in response to the TSST. High levels of discrimination stress were associated with lower levels of cortisol reactivity and higher levels of HRV across the visit. These results highlight the differential impact of domains of stress exposure on stress regulation during pregnancy and provide further evidence of the impact of discrimination stress on Black American women's health.

The effect of donor and recipient race on outcomes of assisted reproduction

A growing literature suggests that minority races, particularly Black women, have a lower probability of live birth and higher risk of perinatal complications after autologous assisted reproductive technology. However, questions still remain as to whether these racial disparities have arisen because of associations between race and oocyte/embryo quality, the uterine environment, or a combination of the two. Oocyte donation assisted reproductive technology represents a unique approach to examine this question. This study aimed to evaluate the associations between the race of female oocyte donors and recipients and live birth rates following vitrified donor oocyte assisted reproductive technologies. This was a retrospective study conducted at a single, private fertility clinic that included 327 oocyte donors and 899 recipients who underwent 1601 embryo transfer cycles (2008-2015). Self-reported race of the donor and recipient were abstracted from medical records. Live birth was defined as the delivery of at least 1 live-born neonate. We used multivariable cluster weighted generalized estimating equations with binomial distribution and log link function to estimate the adjusted risk ratios of live birth, adjusting for donor age and body mass index, recipient age and body mass index, tubal and uterine factor infertility, and year of oocyte retrieval. The racial profile of our donors and recipients were similar: 73% white, 13% Black, 4% Hispanic, 8% Asian, and 2% other. Women who received oocytes from Hispanic donors had a significantly higher probability of live birth (adjusted risk ratio, 1.20; 95% confidence interval, 1.05-1.36) than women who received oocytes from white donors. Among Hispanic recipients, however, there was no significant difference in probability of live birth compared with white recipients (adjusted risk ratio, 1.07; 95% confidence interval, 0.90-1.26). Embryo transfer cycles using oocytes from Black donors (adjusted risk ratio, 0.86; 95% confidence interval, 0.72-1.03) and Black recipients (adjusted risk ratio, 0.84; 95% confidence interval, 0.71-0.99) had a lower probability of live birth than white donors and white recipients, respectively. There were no significant differences in the probability of live birth among Hispanic, Asian, and other race recipients compared with white recipients. Black female recipients had a lower probability of live birth following assisted reproductive technology, even when using vitrified oocytes from healthy donors. Female recipients who used vitrified oocytes from Hispanic donors had a higher probability of live birth regardless of their own race.

Perinatal mortality and morbidity, timing and route of delivery in monoamniotic twin pregnancies: a retrospective cohort study.

Monoamniotic twin pregnancies are at high risk of perinatal complications and fetal loss. The objective of this study is to describe the management and outcomes of monoamniotic twin pregnancies in a French university obstetrics department. Retrospective review of all consecutive monoamniotic twin pregnancies managed between 1992 and 2018 in a level-3 university hospital maternity unit. Antenatal variables, gestational age and other neonatal characteristics at delivery, mode of delivery, and its reason were recorded, together with outcomes, including a composite adverse neonatal outcome. Overall, 46 monoamniotic twin pregnancies (92 fetuses) were identified during the study period. Among them, 27 fetal losses and 2 early neonatal deaths were reported. Congenital abnormalities accounted for 33.3% of the 27 fetal losses, and unexpected fetal deaths for 29.6%. Among the 37 women who gave birth to 65 live infants at 23 or more weeks of gestation, 17 had cesarean and 19 vaginal deliveries. Overall and composite adverse neonatal outcomes did not differ significantly for the 33 children born vaginally and the 31 by cesarean deliveries. The prospective risk of intrauterine death in all 92 fetuses reached its nadir of 1.8% at 336/7weeks. This series confirms the still high risk of fetal and neonatal death of these twins and shows that congenital abnormalities but also unexpected fetal deaths account for the majority of pre- and postnatal mortality. Our data suggest that vaginal delivery of monoamniotic twins is safe and that delivery for uncomplicated monoamniotic twins should be considered around 33weeks of gestation, but not later than 35weeks.

THE EFFECT OF DONOR AND RECIPIENT RACE ON OUTCOMES OF ASSISTED REPRODUCTION USING DATA FROM A VITRIFIED DONOR OOCYTE BANK

A growing literature suggest that minority races, particularly Black women, have a lower probability of live birth and a higher risk of perinatal complications after autologous assisted reproductive technology (ART); however, questions still remain as to whether racial disparities are associated with differences in oocyte/embryo quality, an impaired uterine environment, or a combination of the two. To investigate this question further, we evaluated how oocyte donor and recipient race is associated with ART outcomes using data from a large, racially diverse vitrified donor oocyte bank.

Obstetric outcomes of twin pregnancies presenting with a complete hydatidiform mole and coexistent normal fetus: a systematic review and meta-analysis.

Epidemiological data on obstetric and oncologic complications in twin pregnancies combining a complete hydatidiform mole (CHM) coexisting with a normal fetus and placenta are limited. To evaluate perinatal and obstetric outcomes for mother and fetus and risk of gestational trophoblastic neoplasia (GTN) in twin pregnancies including a CHM. PubMed, MEDLINE and EMBASE and the grey literature were searched for articles published between May 1980 and May 2019 using a protocol designed a priori and registered on PROSPERO (CRD42018112524). Observational cohort studies of four or more cases confirmed by histopathology and providing data on pregnancy outcomes and GTN. Two reviewers independently reviewed abstracts and full-text articles. The quality of the studies was assessed with the Newcastle-Ottawa scale and a meta-analysis was performed. Of the 344 abstracts identified, 14 studies (244 cases) met the eligibility criteria. The incidence of maternal complication in ongoing pregnancies was 80.8% and included vaginal bleeding, hyperthyroidism and pre-eclampsia. There were overall 91 (50%) live births in ongoing pregnancies and 83 (34%) of the total cases were subsequently diagnosed with GTN. Substantial and significant (P<0.001) heterogeneity was found for the incidence of preeclampsia indicating variability in reporting the incidence of some obstetric complications between studies. Patients diagnosed with a twin pregnancy combining a CHM and an apparently normal fetus have a high risk of perinatal complications, low live-birth rates and around a third of them will develop a GTN and should be managed by specialised multidisciplinary teams. Our study indicates a high rate of obstetric and oncologic complications in patients presenting with a complete hydatidiform mole and coexistent normal fetus.

Perinatal Cultural Aspects of African Refugee Women Resettled in Greece: Providing Culturally-sensitive Midwifery Care.

Introduction:African refugee women constitute a growing group of maternity service users in Greece. Being a refugee is considered a risk factor in itself for poorer maternal and neonatal health outcomes. These women additionally, are at high risk of perinatal complications, often due to misconceptions or absence of interpretation between providers and patients through different cultural concepts. Consequently, midwives may feel uncertainly experienced when provide perinatal care for a culturally diverse patient population.Aim:The aim of the study was to investigate perinatal cultural aspects and practices of African refugee pregnant women in Greece, in order to increase cultural awareness and improve midwifery care in a culturally-sensitive way.Methods:Forty-two (n=42) African pregnant women who lived in a “Reception and Identification Center” on a greek island named “Samos”, were included in the study. Women were selected by “simple random sampling” and asked to complete anonymously, with assistance of interpreters, a questionnaire that was devised by the authors with open-ended and closed-ended questions.Results:Women were aged between 19-38 years old. The 50% (n=21) of them were from the Democratic Republic of the Congo, 28.6% (n=12) from Ghana and 21.4% (n=9) from Cameroon. Major themes emerging from the data analysis were: presence of antenatal care in African countries, potentiality of abortions, complications in previous pregnancy, supplement receipt in previous pregnancy after healthcarers’ consultation, decision of birth place, support of traditional birth attendants’ during pregnancy and birth, consumption of culturally acceptable food during pregnancy and birth, culturally accepted disposal of placenta, postpartum ceremonies for the baby and newborn’s navel care.Conclusion:Increased understanding of the pluralistic African perinatal cultural aspects is essential. Inclusion of cultural insight and/or family members in decision making and implementation of training programmes culturally-oriented for midwives, can fulfil women’s health, social needs and expectations.

Labor Induction in Late-Onset Fetal Growth Restriction: Foley Balloon Versus Vaginal Dinoprostone

(Abstracted from Fetal Diagn Ther 2019;46(1):67–74) Fetal growth restriction (FGR) is associated with a higher risk of perinatal complications and death, as well as neurodevelopmental delay. Once FGR is diagnosed, delivery is the main therapeutic measure.

The impact of interpregnancy weight change on perinatal outcomes in women and their children: A systematic review and meta-analysis.

SummaryPrepregnancy overweight and obesity are associated with higher risk of perinatal complications. However, the effect of weight change prior to pregnancy on perinatal outcome is largely unknown. Therefore, it is aimed to examine the impact on perinatal outcomes of interpregnancy BMI change in women of different BMI categories. The MEDLINE, EMBASE, LILACS, and CINAHL databases were searched (1990‐August 2019). Observational studies on interpregnancy BMI change were selected. Outcomes evaluated were gestational diabetes mellitus (GDM), preeclampsia, gestational hypertension (GH), cesarean section, preterm birth, and newborns being large (LGA) or small (SGA) for gestational age. Meta‐analyses and meta‐regression analyses were executed. Thirty studies were included (n > 1 million). Interpregnancy BMI gain was associated with a higher risk of GDM (for BMI gain ≥3 kg/m2: OR 2.21; [95%CI 1.53‐3.19]), preeclampsia (1.77 [1.53‐2.04]), GH (1.78 [1.61‐1.97]), cesarean section (1.32 [1.24‐1.39]), and LGA (1.54 [1.28‐1.86]). The effects of BMI gain were most pronounced in women with BMI <25 kg/m2 before the first pregnancy regarding GDM, GH, and cesarean section. Except for LGA, interpregnancy BMI loss did not result in a decreased risk of perinatal complications. In this study, women of normal weight who gain weight before pregnancy were identified as a high‐risk population for perinatal complications. This emphasizes that weight management is important for women of all BMI categories and a pregnancy wish.