High Risk Of Preterm Delivery Research Articles

Association between hemoglobin A1c trajectory during pregnancy and adverse birth outcomes among non-gestational diabetic women.

Previous studies have shown that higher hemoglobin A1c (HbA1c) levels within the normal range during pregnancy can increase the risk of adverse birth outcomes. However, the effects of the longitudinal HbA1c trajectory during pregnancy on adverse birth outcomes among non-gestational diabetic women are poorly characterized. We aimed to identify HbA1c trajectory during pregnancy among non-gestational diabetic women and to estimate their associations with adverse birth outcomes. Data was extracted from the Information System of Guangdong Women and Children Hospital, China, from January 2017 to July 2022. This study involved 13,979 women who did not have gestational diabetes mellitus and underwent repeated HbA1c measurements during pregnancy. Latent mixture modeling was used to identify HbA1c trajectory groups. Logistic regression was applied to explore the associations between HbA1c trajectory groups and adverse birth outcomes, including preterm delivery, low birth weight, macrosomia, small for gestational age, and large for gestational age (LGA). Three HbA1c trajectory groups were identified: low-stable (range 4.0% [20mmol/mol]-4.4% [25mmol/mol]), moderate-stable (range 4.6% [27mmol/mol]-5.1% [32mmol/mol]), and elevated-increasing (range 5.0% [31mmol/mol]-5.6% [38mmol/mol]). Compared with the low-stable HbA1c group, the elevated-increasing group had a higher risk of preterm delivery and LGA. The adjusted OR (95% CIs) were 1.67 (1.13, 2.49) and 1.47 (1.01, 2.12) for preterm delivery and LGA, respectively. Among non-gestational diabetic women, the elevated-increasing HbA1c trajectory group was associated with a higher risk of preterm delivery and LGA. This finding emphasizes the importance of maintaining optimal HbA1c levels throughout pregnancy.

Pregnancy After Bariatric Surgery—Experience from a Tertiary Center

IntroductionIt is estimated that most people undergoing bariatric surgery are women of reproductive age; nonetheless, its effects on pregnancy outcomes are not yet fully understood.MethodsRetrospective observational study, conducted in a tertiary center in Portugal, included participants in two groups: (1) pregnant women with a history of bariatric surgery (n = 89) and (2) pregnant women with a BMI ≥ 35 kg/m2, without previous bariatric surgery (n = 176). Data was collected from the medical files. Multivariate analysis was conducted to adjust for confounders.ResultsPregnancy after bariatric surgery was associated with lower risk of gestational diabetes (15.7% vs. 30.1%, p = 0.002) and cesarean delivery (20.7% vs. 33.5%, p = 0.007), and a higher gestational weight gain (10.58 ± 9.95 vs. 7.33 ± 6.00 kg, p < 0.001). Participants in the bariatric surgery who experienced a gestational weight gain ≤ 10.0 kg had a higher risk of preterm delivery (16.7% vs. 2.5%, p = 0.031). No significant differences were found regarding hypertensive diseases of pregnancy between groups (4.5% vs 11.4%, p = 0.147).Pregnancy after bariatric surgery was associated with lower neonate weight percentile (34.24 ± 21.09 vs. 48.77 ± 27.94, p < 0.001), higher risk of fetal growth restriction (5.6% vs. 0.6%, p = 0.018), and lower risk of fetal macrosomia (0.0% vs. 7.5%, p = 0.005). There were no significant differences in the risk of SGA (12.5% vs. 7.0%, p = 0.127) or LGA neonates (2.3% vs. 6.4%, p = 0.069).ConclusionPregnancy after bariatric surgery is associated with both risks and benefits, which should be considered by healthcare providers. Pregnancy after bariatric surgery requires individualized care, to ensure adequate gestational weight and avoid micronutrient deficiencies.Graphical

A Pregnant Patient with Sjögren’s Syndrome and non-Hodgkin Lymphoma: A Case Report

Background: Sjögren's syndrome is an autoimmune disease primarily affecting women around the age of 50, but can also occur in women of reproductive age, leading to serious maternal-fetal complications during pregnancy. The exact cause of this condition is not entirely understood, however, it is assumed to attack the exocrine glands, leading to impairment of their function. Additionally, an increased risk of developing lymphomas, particularly non-Hodgkin lymphoma is recognized among affected patients. Objective: To illustrate the management of pregnancy in a patient with Sjögren's syndrome and non-Hodgkin's lymphoma and the achievement of obstetric success without maternal-fetal complications. Case report: In the article, a 36-year-old pregnant patient with Sjögren's syndrome history, two miscarriages, and non-Hodgkin's lymphoma is presented. Due to unexpected pregnancy, the patient discontinued lymphoma treatment. Through the pregnancy, fetal well-being, blood flow, and maternal health were meticulously monitored, showcasing successful obstetric management. Due to Sjögren's syndrome, fetal atrioventricular conduction was monitored weekly from the 16th to the 30th week, showing no abnormalities. Additionally, during the course of pregnancy gestational diabetes, cervical insufficiency treated with pessary insertion, anemia and thyroid insufficiency were diagnosed. Multidisciplinary care addressed these issues, allowing our patient to give birth to a healthy child at 37 weeks via cesarean section. Conclusion: Pregnancies in Sjögren's syndrome patients pose elevated risks due to the presence of antibodies causing tissue damage and complications. These antibodies contribute to fetal myocardial issues and congenital heart conditions. Regular fetal heart ultrasounds, especially for those positive for Ro/SS-A antibodies, are crucial between the 16th and 31st weeks. Maternal-fetal complications include a higher risk of preterm delivery and lower birth weight of the offspring, often due to fetal growth restriction. Additionally, considering the potential for oncohematologic disorders in adults, comprehensive obstetric care is essential for minimizing complications risk.

Functional assessment of brain development in fetuses that subsequently deliver very preterm: An MRI pilot study.

To evaluate changes occurring in the fetal brain prior to very preterm delivery using MRI T2* relaxometry, an indirect assessment of tissue perfusion. Fetuses that subsequently delivered spontaneously <32weeks gestation and a control cohort were identified from pre-existing datasets. Participants had undergone a 3T MRI assessment including T2* relaxometry of the fetal brain using a 2D multi-slice gradient echo single shot echo planar imaging sequence. T2* maps were generated, supratentorial brain tissue was manually segmented and mean T2* values were generated. Groups were compared using quadratic regression. Twenty five fetuses that subsequently delivered <32weeks and 67 that delivered at term were included. Mean gestation at MRI was 24.5weeks (SD 3.3) and 25.4weeks (SD 3.1) and gestation at delivery 25.5weeks (SD 3.4) and 39.7weeks (SD 1.2) in the preterm and term cohorts respectively. Brain mean T2* values were significantly lower in fetuses that subsequently delivered before 32weeks gestation (p<0.001). Alterations in brain maturation appear to occur prior to preterm delivery. Further work is required to explore these associations, but these findings suggest a potential window for therapeutic neuroprotective agents in fetuses at high risk of preterm delivery in the future.

Prediction of spontaneous preterm birth using CCL2 and CXCL10 in maternal serum of symptomatic high-risk pregnant women: a prospective cohort study

IntroductionCCL2 and CXCL10 are putative biomarkers for the prediction of spontaneous preterm birth. This study evaluates these markers in a cohort of pregnant high-risk women.Material and methodsIn our prospective study, we included 109 women with signs of preterm labor between 20 + 0 and 31 + 6 weeks of gestation. Inclusion criteria were regular (< 3/30 min) or painful contractions, cervical length < 25 mm or a history of previous preterm birth (PTB). Blood samples were obtained upon first admission to our clinic. Biomarker concentrations were measured using pre-coated sandwich immunoassays (ELISA). Primary study outcome was spontaneous preterm birth < 34 weeks, secondary outcome was delivery < 37 weeks or within seven days after study inclusion.ResultsSixteen women (14.7%) delivered < 34 weeks and twenty women between 34 + 0 and 36 + 6 weeks (18.4%). Six patients (5.5%) gave birth within seven days after study admission. CXCL10 showed higher medium serum levels in women with PTB < 34 weeks (115 pg/ml compared to 61 pg/ml ≥ 34 weeks; p < 0.001) and < 37 weeks (103 pg/ml vs. 53 pg/ml; p < 0.001). In contrary, lower CCL2 serum levels were associated with PTB < 34 weeks (46 pg/ml vs. 73 pg/ml; p = 0.032) and birth within 7 days (25 pg/ml vs. 73 pg/ml; p = 0.008). The CXCL10/CCL2-ratio further improved the predictive model with a ROC-AUC of 0.83 (95% CI 0.73–0.93, p < 0.001) for delivery < 34 weeks. These corresponds to a sensitivity, specificity and positive predictive value of 0.67, 0.86 and 0.43 at a cut-off of 2.2.ConclusionLow maternal serum CCL2 levels are associated with a higher risk of preterm delivery within seven days. High CXCL10 serum levels are more associated with a high risk for preterm birth < 34 weeks. Elevated CXCL10/CCL2-ratio is showing the best predictive performance.Trial registration number (DRKS-ID)DRKS00010763, Registration date: September 02, 2016.

Different subtypes of gestational diabetes mellitus are associated with distinct perinatal outcomes in twin pregnancies

AimsTo determine whether different gestational diabetes mellitus (GDM) subtypes are associated with distinct perinatal outcomes in twin pregnancies. MaterialsThis retrospective cohort study enrolled women with twin pregnancies who gave birth at a tertiary hospital between January 2017 and December 2022. GDM was diagnosed by the IADPSG diagnostic criteria. Three subtypes of GDM were defined as only abnormal fasting glucose (OAFG) values, only abnormal post-load glucose (OAPG) values and abnormal combined fasting and post-load glucose (ACFPG) values. Logistic regression or generalized estimation equation models were used to test the correlation of subtypes of GDM and perinatal outcomes. ResultsGDM with OAPG had a slightly higher risk for preterm delivery (PTD) at <37 gestational weeks (aOR 1.22, 95 %CI 1.01–1.47) and neonatalintensivecareunit (NICU) admission (aOR 1.31, 95 %CI 1.09–1.57). GDM with ACFPG were associated with PTD at <37 gestational weeks (aOR 1.42, 95 %CI 1.06–1.89) and PTD at <34 gestational weeks (aOR 1.65, 95 % CI 1.14–2.39). GDM with OAFG had a lower risk of being small-for-gestational age (SGA) (aOR 0.48, 95 % CI 0.26–0.92). ConclusionsDifferent subtypes of GDM are associated with distinct perinatal outcomes. Only abnormal fasting glucose levels may be responsible for reduced the risk of SGA neonates.

Pregnancies in women with antineutrophil cytoplasmatic antibody associated vasculitis.

Antineutrophil cytoplasmatic antibody associated vasculitis (AAV) usually manifests after age fifty, thus making it very rare during reproductive age. Although rare, AAV, particularly eosinophilic granulomatosis with polyangiitis, can manifest at a younger age. AAV can also appear for the first time during pregnancy. Data from pregnant patients with AAV mostly derive from case reports or retrospective studies, with an absolute number of <100 published cases. Therefore, numbers of results of pregnancy outcome vary widely. As with other chronic autoimmune diseases, patients and infants seem to be at a higher risk for preterm delivery, intrauterine growth retardation and preeclampsia. Possible treatment for AAV in pregnancy depends upon gestational age and include glucocorticosteroids, azathioprine, intravenous immunoglobulins, and in severe cases rituximab and even cyclophosphamide. Plasma exchange might be an option in selected patients. Aside from cyclophosphamide these medications can also be used during breastfeeding. Acetylsalicylic-acid 100-150 mg/day reduces the risk of preeclampsia, also in this population. Patients should be counseled prior to conception and medication that is suitable for pregnancy should be established early on. During pregnancy, we recommend close monitoring of disease activity, blood pressure and ideally to co-consult with a gynecologist in an interdisciplinary approach.

Failed vacuum and preterm delivery risk in the subsequent pregnancy: a multicenter retrospective cohort study

Second-stage cesarean delivery is associated with subsequent preterm delivery. Failed vacuum-assisted delivery is a subgroup of second-stage cesarean delivery in which the fetal head is engaged deeper in the pelvis and, thus, is associated with an increased risk of short-term maternal complications. This study aimed to investigate the maternal and neonatal outcomes of women at their subsequent delivery after a second-stage cesarean delivery with failed vacuum-assisted extraction vs after a second-stage cesarean delivery without a trial of vacuum-assisted extraction. This was a multicenter retrospective cohort study. The study population included all women in their subsequent pregnancy after a second-stage cesarean delivery who delivered in all university-affiliated obstetrical centers (n=4) in a single geographic area between 2003 and 2021. Maternal and neonatal outcomes of women who had second-stage cesarean delivery after a failed vacuum-assisted delivery were compared with women who had second-stage cesarean delivery without a trial of vacuum-assisted delivery. The primary outcome of this study was preterm delivery at <37 weeks of gestation. The secondary outcomes were vaginal birth rate and other adverse maternal and neonatal outcomes. Univariate analysis was followed by multiple logistic regression modeling. During the study period, 1313 women met the inclusion criteria, of whom 215 (16.4%) had a history of failed vacuum-assisted delivery at the previous delivery and 1098 (83.6%) did not. In univariate analysis, women with previously failed vacuum-assisted delivery had similar preterm delivery rates (<37, <34, <32, and <28 weeks of gestation), a successful trial of labor after cesarean delivery rates, uterine rupture, and hysterectomy. However, multivariable analyses controlling for confounders showed that a history of failed vacuum-assisted delivery is associated with a higher risk of preterm delivery at <37 weeks of gestation (adjusted odds ratio, 2.05; 95% confidence interval, 1.11-3.79; P=.02), but not with preterm delivery at <34 or <32 weeks of gestation. Among women with a previous second-stage cesarean delivery, previously failed vacuum-assisted delivery was associated with an increased risk of preterm delivery at <37 weeks of gestation in the subsequent birth.

Contribution of Preterm Birth to Mortality Among Neonates With Birth Defects

ABSTRACT Birth defects are an important cause of death among infants who die within their first year. Among other complications associated with birth defects, mothers are at higher risk for preterm delivery, which is also associated with infant mortality. Some previous research has shown that in a population of infants with birth defects, those born at term are 3 to 4 times more likely to survive as their preterm peers. This study aimed to clarify the relationship between birth defects, infant mortality, and preterm birth using the population attributable fraction (PAF), examining the mortality risk attributable to preterm birth in infants with birth defects. Data for this study came from the Texas Birth Defects Registry, which includes live births, still births, and pregnancy terminations with a structural birth defect or chromosomal abnormality. The sample included live-born infants with 1 or more major birth defects between January 1, 1999 and December 31, 2014. Exclusion criteria were infants with a chromosomal abnormality or diagnosed syndrome, infants missing data on gestational age or with a gestational age less than 24 weeks, and anencephaly. The final sample included 169,148 infants; of these, 40,872 were preterm (&lt;37 weeks), 128,276 were term, and 2715 died as neonates. Distributions of maternal and infant characteristics were significantly different between the 2 groups (P &lt; 0.01), with more mothers of preterm infants experiencing diabetes, hypertension, multiple gestation pregnancies, or cesarean delivery. In addition, more preterm infants had multiple birth defects or congenital heart defects than their term peers. Analysis of the data included estimates of PAF for infant mortality risk attributed to 31 different birth defects, with results ranging from 12.5% to 71.9%. Highest PAF estimates were observed for anotia or microtia (71.9%; CI, 41.1–86.6), hypospadias (69.4%; CI, 53.9–79.7), talipes equinovarus (69.4%; CI, 60.0–76.6), and stenosis or atresia of the large intestine, rectum, or anal canal (69.1%; CI, 56.3–78.1). On the other hand, lowest PAF estimates included hypoplastic left heart syndrome (12.5%; CI, 8.7–16.1), coarctation of the aorta (19.7%; CI, 9.8–28.4), diaphragmatic hernia (23.8%; CI, 19.2–28.2), and holoprosencephaly (26.0%; CI, 14.5–35.9). For each defect associated with a higher PAF, a large percentage of infant deaths were those born preterm. Infants with defects that had a high PAF estimate were 11.4–17.8 times more likely to die if born preterm than term, and those with a low PAF estimate were only 1.9–2.3 times more likely to die if born preterm as opposed to full term. Overall, analysis showed that 51.7% of neonatal mortality in infants with birth defects is attributable to preterm birth. Stratified analyses performed to reduce confounders showed similar results. The relationship between birth defects and other factors contributing to preterm delivery and infant mortality is complex, and thus this study is unable to fully characterize these relationships. The associations revealed in this analysis indicate that preterm birth is a significant contributor to infant mortality in infants with birth defects, and further research can more fully characterize this association by attempting interventions both to mitigate preterm birth and to reduce infant mortality after preterm birth. Further research might also focus on particular types of birth defects and how rates of preterm birth might be reduced in specific cases of either infant or maternal risks.

Neonatal outcomes in pregnant women with pulmonary arterial hypertension associated with heart disease.

As an increasing number of women with pulmonary arterial hypertension (PAH) choose to become pregnant, outcomes in newborns have become a priority. The main purpose of this study was to compare the neonatal outcomes in pregnant women with PAH associated with heart disease. A single-center retrospective study was performed. Pregnancy with heart disease is divided into three groups: no PAH, mild PAH and severe PAH. Neonatal outcomes of pregnant women were compared among groups. Meanwhile, multivariable analyses were used to investigate the association between maternal PAH and adverse neonatal events. A total of 127 pregnant women with heart disease were enrolled. Of these, 82 (64.6%) had no PAH, 19 (15%) had mild PAH and 26 (20.4%) had severe PAH. The offspring of women with severe PAH had a higher risk of preterm delivery, low birth weight, neonatal respiratory distress syndrome (NRDS), neonatal intensive care unit (NICU) admission and recurrence of congenital heart disease (CHD). Compared to the women without PAH, only the risk of preterm delivery (32-36 weeks) and NICU admission were slightly higher in mothers with mild PAH; other neonatal events were similar. Multivariate regression analyses showed that the risk of preterm delivery (<37 weeks) increased with the increasing severity of maternal PAH, with an OR of 3.1 (95% CI, 1.1-8.8) for mild and 21.9 (95%CI, 4.8-99.4) for severe PAH. The same pattern was observed for NICU admission. Mothers with severe PAH were independently associated with low birth weight (OR 13, 95%CI 4.3-39, P<0.001), NRDS (OR 17.9, 95%CI 5.5-58.9, P<0.001) and recurrence of CHD (OR 4.47, 95%CI 1.7-11.6, P=0.002). Pregnancy in women with severe PAH can significantly increase the risks of neonatal events. While neonatal outcomes in pregnant women with mild PAH were considered optimistic in the present study, a multidisciplinary management of PAH in pregnancy would be necessary to have consistently good outcomes.

Development of risk prediction models for preterm delivery in a rural setting in Ethiopia

Preterm birth complications are the leading causes of death among children under five years. However, the inability to accurately identify pregnancies at high risk of preterm delivery is a key practical challenge, especially in resource-constrained settings with limited availability of biomarkers assessment. We evaluated whether risk of preterm delivery can be predicted using available data from a pregnancy and birth cohort in Amhara region, Ethiopia. All participants were enrolled in the cohort between December 2018 and March 2020. The study outcome was preterm delivery, defined as any delivery occurring before week 37 of gestation regardless of vital status of the foetus or neonate. A range of sociodemographic, clinical, environmental, and pregnancy-related factors were considered as potential inputs. We used Cox and accelerated failure time models, alongside decision tree ensembles to predict risk of preterm delivery. We estimated model discrimination using the area-under-the-curve (AUC) and simulated the conditional distributions of cervical length (CL) and foetal fibronectin (FFN) to ascertain whether they could improve model performance. We included 2493 pregnancies; among them, 138 women were censored due to loss-to-follow-up before delivery. Overall, predictive performance of models was poor. The AUC was highest for the tree ensemble classifier (0.60, 95% confidence interval = 0.57-0.63). When models were calibrated so that 90% of women who experienced a preterm delivery were classified as high risk, at least 75% of those classified as high risk did not experience the outcome. The simulation of CL and FFN distributions did not significantly improve models' performance. Prediction of preterm delivery remains a major challenge. In resource-limited settings, predicting high-risk deliveries would not only save lives, but also inform resource allocation. It may not be possible to accurately predict risk of preterm delivery without investing in novel technologies to identify genetic factors, immunological biomarkers, or the expression of specific proteins.

Nomogram for predicting the risk of preterm delivery after IVF/ICSI treatment: an analysis of 11513 singleton births.

There is a higher risk of preterm delivery (PTD) in singleton live births conceived after in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) compared with spontaneously conceived pregnancies. The objective of our study was to build a predictive nomogram model to suggest the possibility of PTD in singleton pregnancies after IVF/ICSI treatment. 11513 IVF/ICSI cycles with singleton live births were enrolled retrospectively. These cycles were randomly allocated into a training group (80%) and a validation group (20%). We used the multivariate logistics regression analysis to determine prognostic factors for PTD in the training group. A nomogram based on the above factors was further established for predicting PTD. Receiver operating characteristic curves (ROC), areas under the ROC curves (AUC), concordance index (C-index), and calibration plots were analyzed for assessing the performance of this nomogram in the training and validation group. There were fourteen risk factors significantly related to PTD in IVF/ICSI singleton live births, including maternal body mass index (BMI) > 24 kg/m2, smoking, uterine factors, cervical factors, ovulatory factors, double embryo transferred (DET), blastocyst transfer, FET, vanishing twin syndrome (VTS), obstetric complications (placenta previa, placenta abruption, hypertensive of pregnancies, and premature rupture of membrane), and a male fetus. These factors were further incorporated to construct a nomogram prediction model. The AUC, C-index, and calibration curves indicated that this nomogram exhibited fair performance and good calibration. We found that the occurrence of PTD increased when women with obesity, smoking, uterine factors, cervical factors, ovulatory factors, DET, VTS, and obstetric complications, and a male fetus. Furthermore, a nomogram was constructed based on the above factors and it might have great value for clinic use.

Adverse Pregnancy Outcomes Associated with Endometriosis and Its Influencing Factors.

To investigate the adverse pregnancy outcomes associated with endometriosis and its influencing factors. A total of 188 endometriosis patients who gave birth at our hospital between June 2018 and January 2021 were screened for eligibility and included in the research group, while a control group of 188 nonendometriosis women who delivered at our hospital during the same period were also included as healthy controls. Pregnancy outcomes were the key outcome measure, and the relationship between endometriosis and unfavorable pregnancy outcomes, as well as the influencing factors, were explored. There was no significant difference in the risk of adverse pregnancy events such as miscarriage, ectopic pregnancy, termination of pregnancy, and fetal death between the two groups (P > 0.05). The differences in hypertensive disorder in pregnancy, gestational diabetes, placental abruption, fetal growth restriction, and luteal support between the two groups also failed to reach the statistical standard (P > 0.05). The two groups significantly differed in terms of cesarean delivery, preterm delivery, and placenta previa (1.92 (95% CI 1.33-2.85), 2.43 (95% CI 1.05-5.58), and 4.51 (95% CI 1.23-16.50)) (P < 0.05). Endometriosis is an influential factor in adverse pregnancy outcomes and results in a high risk of preterm delivery, placenta previa, and cesarean delivery in patients. Mutual interactions exist among adverse pregnancy outcomes and thus require appropriate management.

Type and timing of antiretroviral therapy during pregnancy: Impact on risk of preterm delivery and small-for-gestational age births in Canada, a retrospective cohort study.

To evaluate the impact of type and timing of antiretroviral therapy (ART) on the risk of preterm delivery (PTD) and small-for-gestational age (SGA) birth among pregnant women and people living with HIV in Canada. Data for this retrospective cohort study were analyzed from the Canadian Perinatal HIV Surveillance Program from 1990 to 2020. The association between ART and risk of PTD (<37 weeks) and SGA birth(<10th percentile)was explored using mixed effects logistic regression and time-dependent Cox proportional hazards models. Overall, there were 14.9% (654 of 4379) PTD and 18.5% (732 of 3947) SGA cases. A higher risk of PTD was observed with nonnucleoside reverse transcriptase inhibitor-(adjusted hazard ratio [aHR], 1.73; P=0.019) and boosted protease inhibitor-(aHR,186;P=0.007)based regimenscompared with integrase strand transfer inhibitor (INSTI)-based regimens. ART initiation prior to conception was associated with a lower risk of SGA birthcompared with ART initiation after conception at 1 to 14 weeks (adjusted odds ratio [aOR], 0.69; P=0.024) and > 14 weeks (aOR, 0.70; P=0.005). INSTI-based ART regimens were associated with lower risk of PTD compared with other regimens, and ART initiation before conception was associated with a lower risk of SGAbirth. These findings, with overall safety data, should be considered when providing pregnancy counseling to people living with HIV.

Pregnancy Outcomes Associated With Biologic Agent Exposure in Patients With Several Rheumatic Diseases and Inflammatory Bowel Diseases.

This study aimed to analyze pregnancy outcomes based on biologic agents use in women using the nationwide population-based database. The study used the claims database to identify women of childbearing age with several rheumatic (rheumatoid arthritis, juvenile idiopathic arthritis, ankylosing spondylitis, psoriatic arthritis) and inflammatory bowel diseases (Crohn's disease and ulcerative colitis) who had pregnancy-related codes between January 2010 and December 2019. We analyzed live births and adverse pregnancy outcomes based on the previous use of biologics. We also stratified the patients according to duration of biologic agent exposure before pregnancy and the use of biologics during pregnancy to analyze the pregnancy outcomes by subgroups. We identified 4,787 patients with pregnancy events. Among them, 1,034 (21.6%) used biologics before pregnancy. Live birth rate was not different between the biologics group and biologics naïve group (75.0% vs. 75.2%). Multivariate analyses showed that biologics use was associated with higher risk of intrauterine growth retardation (odds ratio [OR], 1.780) and lower risk of gestational diabetes mellitus (OR, 0.776) compared with biologics naïve. Biologics use during pregnancy was associated with higher risk of preterm delivery (OR, 1.859), preeclampsia/eclampsia (OR, 1.762), intrauterine growth retardation (OR, 3.487), and cesarean section (OR, 1.831), but lower risk of fetal loss (OR, 0.274) compared with biologics naïve. Although there was no difference in live birth rate between the biologics group and biologics naïve group, biologics use seems to be associated with several adverse pregnancy outcomes, especially in patients with biologics during pregnancy. Therefore, patients with biologics during pregnancy need to be carefully observed for adverse pregnancy outcomes.

Operator Sex and Experience Do Not Influence Conization Outcomes in Terms of Cone Volume, Depth or Resection Margins.

Conization in patients with cervical intraepithelial neoplasia is associated with longer time required to conceive, a higher risk of preterm delivery, and a myriad of obstetric complications. This study assessed whether operator sex and experience correlate with cone volume, depth, and resection margins in patients wishing to conceive and the general patient population. This retrospective single center cohort study included 141 women who had undergone conization for cervical dysplasia in 2020 and 2021. Loop size selection was guided by the preoperative colposcopy report and intraoperative diluted Lugol staining. The hemiellipsoid cone volume was compared for subgroups in three categories: patients operated on by residents vs. board-certified gynecologists; patients operated on by female vs. male surgeons; patients who wished to pursue future pregnancy after conization vs. those who did not. Female surgeons excised insignificantly less cervical tissue compared with their male counterparts (p=0.08). In the subgroup of patients without the wish to conceive, male surgeons tended to excise significantly bigger volumes during conization (p=0.008). No significant difference (p=0.74) regarding volume of resected tissue was evidenced when comparing residents to board-certified surgeons, both in patient subgroups with (p=0.58) and without (p=0.36) a wish to conceive. Male surgeons tended to resect higher volumes (p=0.012) if board-certified compared to their board-certified female colleagues. There were insignificant differences regarding cone depth and volume or incomplete resection when stratified by operator experience and sex. However, male gynecologists removed significantly larger cone volumes in the subgroup of patients who did not pursue future pregnancy.

Ultrasound-Indicated Cerclage in Twin Pregnancies: A Cohort Study.

To report the pregnancy and neonatal outcomes in patients with twin pregnancies who underwent ultrasound-indicated cerclage (UIC) and to compare them to patients with singleton pregnancies undergoing the same procedures. Patients who underwent UIC between January 2010 and December 2020 at Kangnam Sacred Heart Hospital were reviewed. We compared characteristics, pregnancy, and neonatal outcomes between patients with singleton and twin pregnancies. A total of 94 women (56 singleton and 38 twin pregnancies) underwent UIC were included. The mean gestational age (GA) at cerclage and preoperative cervical length (CL) were not significantly different. Twin pregnancies were more likely to deliver at earlier median gestations than singletons (singleton, 36 + 1 weeks vs twin, 32 + 6 weeks, and p = 0.004). The frequency of preterm delivery <34 weeks in twin group was higher than in singleton group (15 (26.8%) vs 20 (52.6%) and p =0.016). However, the frequency of preterm delivery <32, <28, and <24 weeks was not significantly different between two groups. Although neonatal weights in singleton pregnancies were heavier than twin pregnancies, neonatal mortality and morbidities were not significantly different between two groups. Among various factors contributing to preterm birth, preoperative CL ≤ 15 mm was independently associated with a higher risk of preterm delivery before 34 weeks. Furthermore, pregnancy and neonatal outcomes of twin pregnancies with cervical length ≤ 15 mm are comparable with those of singleton pregnancies (GA at delivery, singleton, 35 + 1 weeks vs twin, 32 + 5 weeks, and p = 0.24; neonatal mortality, singleton, 3.4% vs twin, 4.8%, and p = 0.64). The pregnancy and neonatal outcomes of UIC in twin pregnancies were comparable to those in singleton pregnancies, especially when CL is ≤15 mm. UIC might be considered a safe procedure for twin pregnancies.

Prevalence, maternal characteristics, and birth outcomes of preeclampsia: A cross-sectional study in a single tertiary healthcare center in greater Kuala Lumpur Malaysia.

Preeclampsia is associated with an increased risk of adverse maternal and perinatal outcomes. This study aimed to assess preeclampsia prevalence in a Malaysian referral maternity hospital and the association between preeclampsia and maternal characteristics and outcomes. A cross-sectional study was conducted between January 2010 and December 2020 using secondary data from a single tertiary healthcare center in Greater Kuala Lumpur, Malaysia. A total of 40,212 deliveries were included for analysis to investigate the association between conditions (maternal characteristics and adverse birth outcomes) and preeclampsia. Multivariable logistic regression was conducted to assess the association between multiple independent variables and the outcome variable (preeclampsia). The reported prevalence of preeclampsia was 1.6%. Pregnant women with preeclampsia had a higher risk of preterm delivery (67.7%), instrumental and cesarean delivery (74.7%), neonatal low birth weight (48.5%), neonatal 5-min Apgar score <7 (18.1%), and neonatal intensive care unit (NICU) admission (19.8%). There were significantly higher odds of developing preeclampsia among nullipara [adjusted odd ratio (adjOR) 1.792, 95% CI: 1.518-2.115], women with a previous history of preeclampsia (adjOR 5.345, 95% CI: 2.670-10.698) and women with multiple pregnancies (adjOR 1.658, 95% CI: 1.071-2.566). However, there is a significant association between maternal characteristic variables. There was a significant association when a combination of variables for risk assessment: the presence of anemia and gestational hypertension effect on preeclampsia (OR 26.344, 95% CI: 9.775-70.993, p < 0.002) and gestational hypertension without anemia on preeclampsia (OR 3.084, 95% CI: 2.240-4.245, p < 0.001). Similarly, an association was seen between chronic hypertension and younger age (<35 years old) on preeclampsia (OR 14.490, 95% CI: 9.988-21.021, p < 0.001), and having chronic hypertension with advanced maternal age (≥35 years old) on preeclampsia (OR 5.174, 95% CI: 3.267-8.195, p < 0.001). Both conditions had increased odds of preeclampsia, in varying magnitudes. Overall, the significant interaction effects suggest that a history of chronic or gestational hypertension has a different relationship to the incidence of preeclampsia depending on the maternal age and anemia status. Pregnant women with preeclampsia had significantly higher odds for preterm delivery (adjOR 6.214, 95% CI: 5.244-7.364), instrumental and cesarean delivery (adjOR 4.320, 95% CI: 3.587-5.202), neonatal low birth weight (adjOR 7.873, 95% CI: 6.687-9.271), 5-min Apgar score <7 (adjOR 3.158, 95% CI: 2.130-4.683), and NICU admission (adjOR 8.778, 95% CI: 7.115-10.830). Nulliparity, previous history of preeclampsia, and multiple pregnancies were associated with an increased risk of preeclampsia. The presence of different underlying conditions, such as chronic hypertension, anemia, and extremes of maternal age played an important role in increasing preeclampsia risk in the considered study. Larger samples are needed to validate such findings.

Point: Antenatal corticosteroid treatment in the late preterm period-Are the benefits worth the potential risks?

Point: Antenatal corticosteroid treatment in the late preterm period-Are the benefits worth the potential risks?

Complete blood count during the first trimester predicting spontaneous preterm birth.

This work aimed at assessing the peripheral complete blood count during the first trimester of pregnancy in women with spontaneous preterm birth (sPTB) compared with age-matched controls who are women with healthy pregnancies. This was a cross-sectional case-control study, with 175 sPTB and 175 age-matched healthy controls, carried out between January 2019 and December 2019. Baseline data and the complete blood count parameters examined during the first trimester of all the participants were recorded. The receiver operator characteristic curve (ROC) was used to evaluate cut-off point and diagnostic characteristics and area under the curve predicting sPTB. White blood count, platelet, lymphocyte, monocyte, and lymphocyte-monocyte ratio values were significantly higher, and platelet-lymphocyte ratio and neutrophil-lymphocyte ratio values were lower in sPTB group than healthy control group in the first trimester of pregnancy. Receiver-operator curve analysis suggested that lymphocyte, white blood count, platelet-lymphocyte ratio, neutrophil-lymphocyte ratio, lymphocyte-monocyte ratio, monocyte, and platelet in the first trimester of pregnancy had predictive value for sPTB. The greatest predictive was lymphocyte, and the areas under the receiver operator characteristic curve (AUROCs) reached 0.853. Lymphocyte values during the first trimester of pregnancy were the most predictive spontaneous preterm delivery. Therefore, in the management of the higher risk of preterm delivery, lymphocyte values could be a more cost-effective method during the first trimester of pregnancy because it does not need any kit.