Incidence Of Low Birth Weight Babies Research Articles

HUBUNGAN ANEMIA DALAM KEHAMILAN IBU DENGAN KEJADIAN BAYI BERAT LAHIR RENDAH

Anemia is a common medical problem in pregnancy. So far, whether maternal anemia affects the health of mother and baby is still uncertain. Maternal anemia is generally considered a risk factor for low birth weight (LBW) babies. The aim of this study was to determine the relationship between anemia in maternal pregnancy and the incidence of LBW babies at Hajja Andi Depu Regional Hospital. This research is a quantitative analysis research with a cross sectional design. The research was carried out by taking medical record data from pregnant women who gave birth to low birth weight babies at Hajja Andi Depu Hospital, Polewali Mandar Regency. The sampling method is consecutive sampling of 20 samples. Bivariate analysis used using chi-square obtained a significant value, namely ???? 0.000 < 0.05. There is a relationship between maternal pregnancy and the incidence of LBW at Hajja Andi Depu Regional Hospital.

Impact of Severe Preeclampsia on the Incidence of Low-Birth-Weight Babies

Infant birth weight is an important indicator of survival, growth potential, and developmental capacity. Maternal health plays an important role in determining the well-being of newborns. A complicated pregnancy, inclusive of conditions such as preeclampsia, elevates the risk of giving birth to a low birth weight (LBW) baby. This study aimed to compare the impact of severe preeclampsia on the incidence of LBW babies in Dr. Dradjat Prawiranegara General Hospital Serang, Indonesia. This case-control analysis included 148 parturients recruited randomly from June to October 2022. Logistic regression was used as the analytical tool, with P=0.000 considered as demonstrating a significant association. The incidence rates of LBW and severe preeclampsia in 2018 were 19.84% and 14.15%, respectively. The case group recorded LBW within the weight range of 1,000-2,450 g, with 38% of them were Small for Gestation Age (SGA), while 50% and 12% were Appropriate for Gestational Age (AGA), and Large for Gestational Age (LGA), respectively. In contrast, the control group, with birth weights ranging from 2,600-4,500 g, 13.50% were SGA, while 77% and 9.50% were AGA and LGA, respectively. Parity was a confounding factor influencing the incidence of LBW, while maternal age did not present a significant correlation. Pregnancies with severe preeclampsia were found to have a 29-fold increased likelihood of delivering LBW babies compared to the control group when controlling for parity (P=0.000, CI 95%). Hence, women with severe preeclampsia pregnancies have a higher risk for delivering LBW babies of 29 times higher than the control.

Iron supplements in pregnant women with normal iron status: A systematic review and meta-analysis.

Effects of daily iron supplementation in iron replete pregnancy are unclear. This systematic review aimed to assess benefits and harms of oral iron supplements in pregnant women without anemia and iron deficiency. We predefined and registered a protocol in PROSPERO (CRD42020186210) and performed the review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. We searched for randomized clinical trials (RCTs) and observational studies comparing daily oral iron supplementation with no iron supplements in non-anemic iron replete pregnant women. Searches were conducted in MEDLINE (by PubMed), EMBASE (by OVID), Cochrane Library, and ClinicalTrials.gov from inception to September 2022 without language restrictions. Two authors independently screened records, extracted data, and assessed risk of bias using the revised Cochrane risk of bias tool (RoB2). One author read full-texts, assessed certainty of evidence by GRADE and conducted meta-analyses using a random-effects model. Primary outcomes included iron deficiency anemia, iron deficiency, hemoglobin >130 g/L, elevated iron status, small for gestational age newborns, low birthweight newborns, preterm birth, and congenital anomalies. Eight RCTs (2822 women) but no observational studies were eligible for inclusion. Daily oral iron supplementation in pregnancy probably reduces iron deficiency anemia at term (risk ratio [RR]: 0.51, 95% confidence interval [CI]: 0.38-0.70; 4 RCTs, 1670 women; I2 = 13%; moderate-certainty evidence) and the incidence of low birthweight babies (RR: 0.30, 95% CI: 0.13-0.68; 2 RCTs, 361 infants; I2 = 0%; moderate-certainty evidence). In addition, it may reduce iron deficiency at term (RR: 0.74, 95% CI: 0.60-0.92; 4 RCTs, 1663 women; I2 = 58%; low-certainty evidence) and the incidence of small for gestational age babies (RR: 0.39, 95% CI: 0.17-0.86; 1 RCT, 213 infants; I2 not estimable; low-certainty evidence). Daily iron supplementation in iron replete non-anemic pregnant women probably reduces the risk of maternal iron deficiency anemia at term and low birthweight.

Analysis of the causes of low birth weight infants in terms of nutritional status and maternal health history

Introduction: The incidence of low-birth-weight infants is still high and requires serious attention to prevent infant mortality. This study aimed to analyze the causes of low-birth-weight infants' nutritional status and maternal health history. Methods: This cross-sectional study was conducted in May to July 2021 at two hospitals in Surabaya. The study involved 498 mothers who had newborns within three years from 2019 and were recruited using simple random sampling. The inferential test was conducted using logistics regression with a significance level of 0.05. Results: According to the adjusted model, variables that were significantly associated with the incidence of low-birthweight infants were the husband's job as private worker (OR=0.021; 95% CI = 0.023-0.123), child number as one (OR=0.214; 95% CI = 0.114-3.428), parity as prime (OR=0.749; 95% CI = 0.197-3.652) and history of low-birth-weight infants in previous births (OR=0.015; 95% CI = 0.004-0.006). Conclusions: Individual and family factors remand an essential variable in low-birth-weight prevalence. Nurses are responsible for providing socialization to mothers and fathers who are having and planning to have children. Cultural factors in the family and community where the mother lives also need to be carried out in further research.

Nutritional Status of Pregnant Women Aged Less Than 20 Years is a Risk Factor For The Incidence of Babies With Low Birth Weight (LBW)

Low birth weight (LBW) is influenced by various factors, such as maternal education, gestational age, maternal nutritional status, and economic level. The high pregnancy rate in adolescent mothers is in line with pregnancy complications experienced, one of which is giving birth to LBW babies. The aim of this study was to analyze the risk factors most associated with the incidence of LBW babies in mothers aged less than 20 years old in Wagir District, Malang Regency. The data collection method was used cross-sectional. The inclusion criteria in this study were mothers who were less than 20 years old, had given birth to a baby with LBW, and were domiciled in Wagir District. The data was analysed by logistic regression test. A total of 106 respondents participated in this study. The results showed that the factors that were significantly related were nutritional status (p-value 0.012), economic level (p-value 0.030), and gestational age (p-value 0.046). The dominant factor was nutritional status (p-value 0,012; OR 0,666). Nutritional status is the most influential thing for the health of both mother and baby, so the role of health workers in educating women during the preconception period regarding nutrition and the risk of pregnancy is essential.

The Relationship Of Anemia In Pregnancy With The Event Of LBW Babies (Low Birth Weight) at Supiori Hospital

Background: Anaemia is a common medical problem in pregnancy. The extent up to which, maternal anaemia effects maternal and neonatal health is still uncertain. Maternal anaemia is commonly considered a risk factor for low birth weight (LBW) babies. The purpose of this study was to determine the relationship between anemia in pregnancy and the incidence of LBW infants in Supiori Hospital.
 This research method used an analytical survey with a cross sectional approach by looking at the medical record data at the Supiori Hospital in Januari-May 2021 who giving birth as many as 80 responden. Sampling technique with total sampling. Bivariate analysis used chi-square.
 Results: Bivariate analysis showed statistical test results using chi-square obtained a significant value, namely 0.000 <0.05.
 Conclusion: There was a relationship between pregnancy and anemia with the incidence of LBW infants in Supiori Hospital.

Study to Assess the Maternal and Perinatal Outcome in Teenage Pregnancy

Background: A pregnant teenager ‘’A child in child”as to meet the growing demands of fetus in additionto her own growing needs, thus putting her in a stressful situation. Teenage pregnancy is dangerous forthe mother, child and the community. Medical complications such as preterm labor, pregnancy-inducedhypertension, anemia and low birth weight babies are strongly associated with adolescent pregnancy. Suchpregnancies are seen mostly amongst the poorer and less educated sections of the society.Aim: To evaluate the maternal and perinatal outcome in teenage pregnancy in a tertiary care center.Objectives: To compare the maternal and perinatal outcome in teenage and adult pregnanciesDesign: A prospective studySetting: Department of Obstetrics and Gynecology, Sri Siddhartha medical college, Tumkur.Materials and Method: This study was undertaken at Sri Siddhartha medical college and hospital researchcentre tumakuru between October 2018 to October 2020, among the married pregnant women visiting toantenatal OPD and inpatients in the department of the OBG between 18 to 19 yrs as per the inclusion andexclusion criteria.Results: Teenage pregnancy may cause a significant obstetric complication Anaemia, preterm delivery,prom, pph, low birth weight babies, NICU admissions, respiratory distress syndrome were found to behigher among teenage mothers when compared to adult mothers.Conclusion: Teenage pregnancy was associated with increased incidence of anaemia and contract ed pelvis.Consequently there were higher incidence of lscs and PPH. There was in creased incidence of low birthweight babies, RDS, NICU admissions among the ba bies born to teenage mothers. Teenage pregnancy isassociated with increased mater nal and perinatal morbidity

Correlation between Parity, Birth Interval, and the Frequency of Antenatal Care towards the Incidence of Low Birth Weight Babies in RSUD Dr. Mohammad Soewandhie Surabaya

Low Birth Weight (LBW) contributes to 60% to 80% of all neonatal and infant deaths in Indonesia whilst globally, prevalence of LBW is 15.5%, amounting to approximately 20 million LBW infants born each year. According to several previous studies, factors closely related with the incidence of LBW are high birth rates, shorter birth intervals, and low frequency of Antenatal Care (ANC) examinations. The objective of this study was to determine the correlation between parity, birth interval, and the frequency of ANC towards the incidence of LBW babies. This retrospective cross-sectional study using simple random sampling involved 95 mothers in RSUD Dr. Mohammad Soewandhie Surabaya between January and July 2016. Data was collected using medical records and analyzed using logistic regression test with p < 0.05. The result of this research showed there was no correlations between parity and incidence of LBW babies (p=0.162) nor between birth interval and incidence of LBW babies (p=0.574). There was a correlation between frequency of ANC and incidence of LBW babies (p=0.006). The physician should further improve early detection for LBW babies by monitoring high-risk pregnancy mothers routinely.

Trends in Birth Weight and the Incidence of Low Birth Weight and Advanced Maternal Age in Korea between 1993 and 2016.

BackgroundAs the aging society progresses, the average age of mothers is also increasing. Advanced maternal age has been known to be associated with perinatal outcomes, as well as birth weight (BW). In this study, we aimed to investigate the perinatal factors associated with low birth weight infants (LBWIs) using birth statistics of the Korean population.MethodsBirth statistics between 1993 and 2016 from the Korean Statistical Information Service were reviewed. We investigated 12,856,614 data points, which included the number of births, BWs, percentage of preterm births and LBWIs, multiple pregnancies, and maternal age.ResultsThe proportion of LBWIs delivered by mothers of advanced maternal age has gradually increased since 1993. In addition, the proportion of older mothers (≥ 35 years old) giving birth to LBWIs has increased over the years. Average BW has a negative correlation with the ratio of preterm births, LBW, multiple births, and advanced maternal age. The mean BW also has a negative correlation with maternal age.ConclusionThis study shows that the average BW continues to decline, and the incidence of LBWIs is increasing in Korea since 1993. This study also revealed that several perinatal factors, including percentage of preterm births, LBWIs, multiple births, and maternal age influence the mean BW. Although this study did not investigate the effects of decreasing mean BW on perinatal health, future research is worth discussing.

The Correlation of Maternal Factors and The Quality of Antenatal Care Services With Low Birth Weight Babies In Health Facilities Level I

Infant Mortality Rate in West Sumatra still increased from 96 cases in 2015 becomes 111 cases in 2016. One of the contributors to this was the case of Low Birth Weight Babies (LBWB), wich is birth weight < 2500 grams. Causative factors of LBWB are derived from maternal factors because it is related to fetal growth, starting from the moment of conception until the baby is born. Maternal health is very influential towards the growth and development of the fetus. In addition, Antenatal Care is also require to monitor maternal health. Antenatal service care quality can detect the occurrence of risk in pregnancy. This study aims to determine the relationship of maternal factors based on maternal age, parity, distance of pregnancy, complications of pregnancy, economic status, nutritional status, anemia status, antenatal care implementation and the quality of antenatal care services with LBWB incidence on health facilities level 1 in Padang City.This study used a comparative cross-sectional design totalling 72 respondents consisting of a group of mothers who gave birth to babies with birth weight < 2500 grams and ≥ 2500 grams using consecutive sampling technique. Then conducted interviews and observations by using questionnaires as well as data processing were carried out using SPSS. The results showed there was a correlation between pregnancy complications (p = 0.033), anemia status (p = 0.016) and the implementation of antenatal care (p = 0.000) with the incidence of LBWB, while the unrelated were maternal age (p = 0.405), parity (p = 1,000), pregnancy distance (p = 1,000), economic status (p = 0.637), nutritional status (p = 0.326), and quality of antenatal care services (p = 0.812).The conclusion of this study is that there is no correlation between the quality of antenatal care services and the incidence of LBWB, and the implementation of antenatal care is the dominant factor related with the incidence of LBWB in Padang City.

Racial disparities in cervical length for prediction of preterm birth in a low risk population

Purpose: Racial minorities experience higher rates of spontaneous preterm birth (sPTB). Our objective was to evaluate whether there are racial discrepancies in the incidence of second trimester short cervical length (≤25 mm).Materials and methods: Retrospective cohort of women with singleton gestations without prior sPTB undergoing universal second trimester transvaginal ultrasound cervical length (CL) screening between January 2012 and December 2013. Black women were compared to non-Hispanic white women. Our primary outcome was the incidence of CL ≤25 mm. Secondary outcomes were incidence of PTB ≤37 weeks, delivery mode, birth weight and neonatal intensive care unit (NICU) admission.Results: Black women (n = 1092) differed from non-Hispanic white women (n = 659) with respect to maternal age (26.0 versus 30.7 years), gravidity (3.1 versus 2.1), prepregnancy BMI (29.6 versus 25.0 kg/m2), and smoking status (9.8% versus 16%), respectively (p < 0.001). Black women had higher incidence of CL ≤25 mm (1.9% versus 0.6%; OR: 3.21 [1.1–9.4]), rates of sPTB (8.5% versus 4.4%; aOR: 1.95 [1.1–3.4]), incidence of low birthweight infants (<2500 g, 8.3% versus 5.6%; aOR 1.80 [1.1–3.0]) and were more likely to have their infants admitted to the NICU (16% versus 11%; OR: 1.52 [1.0–2.3]).Conclusions: Black women had a 2.8-fold increased risk of CL ≤25 mm compared non-Hispanic white women in a low-risk population.

Combination of parity and pre-pregnancy BMI and low birth weight infants among Japanese women of reproductive age.

This study aimed to examine the effects of parity and pre-pregnancy body mass index (BMI) on low birth weight (LBW) infants among Japanese women. Participants included 1,518 mothers (mean age 34.0 years) of singleton full-term infants in 2011. The incidence of LBW infants was 7.5% in primiparous women with BMI<18.5 (Group A; n=239), 4.0% in multiparous women with BMI<18.5 (Group B; n=124), 6.0% in primiparous women with 18.5≤BMI<25 (Group C; n=715), and 1.8% in multiparous women with 18.5≤BMI<25 (Group D; n=440). A multivariable logistic regression model revealed that mothers in Group A were more likely to deliver a LBW infant [odds ratio (OR) 6.41, 95% confidence interval (CI), 2.65–15.49] than were mothers in Group D. Being both underweight (OR 1.8, 95% CI: 1.05–3.11) and primiparous (OR 3.41, 95% CI: 1.82–6.44) were independently associated with LBW infants. This study demonstrated that the characteristics of primiparous and underweight in mothers are additively associated with LBW infants.

Influencing factors of low birth weight infants in China

Objective To investigate the influencing factors of low birth weight infants (LBWI) in China in order to provide evidence for lowering the incidence of LBWI and improving the perinatal outcomes. Methods Clinical data were obtained from 14 different provinces, municipalities or autonomous regions in Northeastern, Northwestern, Northern, Central, Eastern, Southern and Southwestern of China, covering 39 hospitals of different levels. A total of 112 441 newborns were collected from January 1 to December 31 in 2011. After exclusion of those cases with incomplete information, miscarriage before 28 weeks of gestation, induction due to fetal malformation or intrauterine fetal death, 103 678 cases were restrospectively analyzed. Questionnaires were filled out and all data were recorded in computer network databases. Clinical data included maternal age, education background, height, weight, parity, histories of abnormal pregancy and comorbidities and complication. Independent sample t-test, Chi-square test, unvariate and ultivariate unconditional Logistics regression analysis were performed. Results The incidence of LBWI in mainland China was 7.21% (7 474/103 678), 61.43% (5 260/8 562) for preterm babies, and 2.33% (2 214/95 116) for full-term babies. Univariate analysis showed that LBWI were associated with maternal age, education background, height, pregestational body mass index (BMI), weight gain during pregnancy, cord length, smoking, parity, histories of abnormal pregancy, gestational diabetes mellitus (GDM), preterm birth, hypertensive disorders in pregnancy, anemia, premature rupture of membranes and abnormal amniotic fluid volume. The following unconditional binary logistic regression analysis for those factors with P<0.3 in unvariate analysis showed that preterm birth (OR=46.246, 95%CI: 41.484-51.555), hypertensive disorders during pregnancy (OR=5.031, 95%CI: 4.325-5.853), histories of intrauterine fetal death ≥1 times (OR=2.446, 95%CI: 1.479-4.044), oligohydramnios (OR=2.068, 95%CI:1.659-2.578), pregestational BMI<18.5 (OR=1.637, 95%CI: 1.415-1.893), spontaneous abortion ≥1 times (OR=1.362, 95%CI: 1.043-1.777), age≤20 (OR=1.332, 95%CI: 1.046-1.695), anemia (OR=1.230, 95%CI: 1.017-1.488) and premature rupture of membranes (OR=1.154, 95%CI: 1.016-1.311) were risk factors for LBWI. The higher the maternal education level, weight gain, BMI and height, the lower the LBWI incidence. The risk factors of LBWI in premature small for gestational age (SGA) infants were hypertensive disorders during pregnancy and histories of intrauterine fetal death ≥1 times. The higher the maternal height and weight gain during pregnancy, the lower the incidence of LBWI in premature SGA infants. Conclusions The main influencing factors for LBWI are preterm birth and hypertensive disorders during pregnancy. In addition, LBWI is also associated with socioeconomic and genetic factors. Key words: Infant, low birth weight; Incidence; Risk factors

Antibiotics for asymptomatic bacteriuria in pregnancy.

Asymptomatic bacteriuria occurs in 2% to 10% of pregnancies and, if not treated, up to 30% of mothers will develop acute pyelonephritis. Asymptomatic bacteriuria has been associated with low birthweight and preterm birth. To assess the effect of antibiotic treatment for asymptomatic bacteriuria on the development of pyelonephritis and the risk of low birthweight and preterm birth. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (19 March 2015) and reference lists of retrieved studies. Randomized trials comparing antibiotic treatment with placebo or no treatment in pregnant women with asymptomatic bacteriuria found on antenatal screening. Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. Fourteen studies, involving almost 2000 women, were included. Antibiotic treatment compared with placebo or no treatment reduced the incidence of pyelonephritis (average risk ratio (RR) 0.23, 95% confidence interval (CI) 0.13 to 0.41; 11 studies, 1932 women; very low quality evidence). Antibiotic treatment was also associated with a reduction in the incidence of low birthweight babies (average RR 0.64, 95% CI 0.45 to 0.93; six studies, 1437 babies; low quality evidence) and preterm birth (RR 0.27, 95% CI 0.11 to 0.62; two studies, 242 women; low quality evidence). A reduction in persistent bacteriuria at the time of delivery was seen (average RR 0.30, 95% CI 0.18 to 0.53; four studies; 596 women). There were very limited data on which to estimate the effect of antibiotics on other infant outcomes and maternal adverse effects were rarely described.Overall, all 14 studies were assessed as being at high or unclear risk of bias. While many studies lacked an adequate description of methods and the risk of bias could only be assessed as unclear, in almost all studies there was at least one domain where the risk of bias was judged as high. The three primary outcomes were assessed with GRADE software and given a quality rating. Evidence for pyelonephritis, preterm birth and birthweight less than 2500 g was assessed as of low or very low quality. While antibiotic treatment is effective in reducing the risk of pyelonephritis in pregnancy, the estimate of the effect is very uncertain because of the very low quality of the evidence. The reduction in low birthweight and preterm birth with antibiotic treatment is consistent with theories about the role of infection in adverse pregnancy outcomes, but this association should be interpreted with caution given the very poor quality of the included studies.

English

S: The Low Birth Weight (LBW) is important factor affecting maternal and child health. This study was conducted to assess the morbidity and mortality patterns of LBW neonates at a tertiary care hospital in Jaipur, Rajasthan. 200 low birth weight babies out of 957 neonates born at our institute were included. Incidence of LBW babies was 20.9%. Hyperbilirubinemia (30.5%) was the commonest morbidity followed by respiratory distress (28.5%) and sepsis (23.5%). Preterm SGA babies had maximum morbidities. Mortality among LBW babies was 12.5% during hospital stay. There was significant decline in mortality with increasing gestational age. Mortality was maximum in initial 72 hours of life. Among the various causes of deaths sepsis accounted for 36% followed by respiratory distress 32%. Among maternal factors extremes of maternal age, parity and bad obstetric history had significant relationship with incidence of LBS babies, morbidity and mortality among LBW babies.

Association between maternal periodontal disease and preterm delivery and low birth weight

ObjectiveIt has been suggested that periodontal disease is an important risk factor for preterm low birth weight (PLBW). The purpose of this study was to determine the association of maternal periodontitis with low birth weight (LBW) and preterm birth (PB). Materials and MethodsPregnant women (n = 211) aged 22–40 years were enrolled while receiving prenatal care. Dental plaque, probing depth, bleeding on probing, and clinical attachment level were used as criteria to classify three groups: a healthy group (HG; n = 82), a gingivitis group (GG; n = 67), and a periodontitis group (PG; n = 62). At delivery, birth weight was recorded. ResultsMean infant weight at delivery was 3084.9 g. The total incidence of preterm birth and LBW infants was 10.4% and 8.1%, respectively. The incidence of LBW infants was 4.2% for term and 40.9% for preterm gestations. Maternal height was not correlated with infant birth weight (p = 0.245). Significant differences in mean infant birth weight were observed among the HG, GG, and PG groups (p = 0.030). No significant relationship was found between periodontal disease and PB, but the association between periodontal disease and LBW was significant. ConclusionAfter appropriately controlling for confounding variables, our results do not support the hypothesis of an association that was observed in previous studies of maternal periodontal disease and infant PB, but the association between periodontal disease and LBW is significant.

Parental age and child growth and development: Child health check‐up data

The aim of the present study was to determine whether parental age has any influence on child health. Well-baby check-up data at 1 month and at 12 months of age were used. The trends of parental age in association with growth measurements, incidence of physical and developmental abnormalities, occurrence of low birthweight, and maternal history of spontaneous abortion were analyzed. Associations between increasing paternal age and incidence of psychomotor developmental delay at 12 months, increasing paternal and maternal age and increasing birthweight, and increasing parental age and higher incidence of history of spontaneous abortion were found. The incidence of low-birthweight infants was significantly decreased with increasing paternal age. Not only increasing maternal age but also increasing paternal age have influences on child development and growth in the general population.

P1-546 Malaria infection in pregnancy as a risk factor for low birth weight in the District of Bangka Belitung, Indonesia, 2010

BackgroundMalaria is a major health problem in Indonesia. The District of Bangka is one of 338 malaria endemic areas with a clinical malaria rate of 51.87% and positive malaria rate...

P2-57 Does reduced placental nutrient transport contribute to the high incidence of low birthweight infants in teenage pregnancies?

P2-57 Does reduced placental nutrient transport contribute to the high incidence of low birthweight infants in teenage pregnancies?

Are we coming to terms with tumor necrosis factor inhibition in pregnancy?

Rheumatic diseases commonly affect women of childbearing age, who often receive immunosuppressive treatments that pose risks to the mother and/or fetus during pregnancy. Due to the benefits of early and aggressive treatment of inflammatory arthritis, rheumatologists prescribe tumor necrosis factor (TNF ) inhibitors early in disease and to a large number of patients. According to a recent survey, 44.2% of practicing US rheumatologists prescribe TNF inhibitors for at least half of their patients with rheumatoid arthritis (RA) (1). All commercially available TNF inhibitors are classified by the Food and Drug Administration as pregnancy risk category B: no adverse pregnancy effects have been observed in animal studies, but there have been insufficient controlled human studies. Given the lack of data in humans, it remains unclear how the practicing rheumatologist should manage TNF inhibitor therapy in women of childbearing age. Underscoring this uncertainty, 38–47% of practicing US rheumatologists recently surveyed believe that the TNF inhibitors etanercept and infliximab are contraindicated during pregnancy (2). However, many women taking TNF inhibitors become pregnant. According to an online survey of 1,023 practicing US rheumatologists, 454 patients with RA became pregnant while receiving anti-TNF therapy. Surprisingly, 31.3% of these patients continued taking TNF inhibitors throughout pregnancy (1). Despite the fact that disease severity tends to decrease in roughly three-fourths of pregnant patients with RA (3), rheumatologists may be reluctant to discontinue a medication that has proven effective. The published experience with TNF inhibition during pregnancy consists of a limited number of case reports, series, and ongoing registry data. Most reported exposures to TNF inhibitor therapy occurred prior to or at the time of conception or during the first trimester of pregnancy. In a retrospective study from the Infliximab Safety Database of 96 pregnancies in women (85% with Crohn’s disease) exposed to infliximab prior to or early in pregnancy, 67% resulted in a live birth, 15% in a miscarriage, and 19% in an elective termination (4). This finding is comparable with historical pregnancy outcomes in the general white population of the US reported by the National Center for Health Statistics (5). An interim data analysis by the Organization of Teratology Information Services compared pregnancy outcomes in 32 patients with RA exposed to etanercept or infliximab with outcomes in 74 patients with RA not exposed to anti-TNF therapy, and with 49 nondisease controls. Rates of miscarriage and fetal malformation did not differ significantly among these 3 groups, but there was a significant increase in the rates of preterm delivery and low-birth-weight infants in all patients with RA compared with controls (6), suggesting that the RA disease state rather than TNF inhibitor therapy predisposes patients to these adverse fetal outcomes. Whereas additional studies have also shown increased rates of adverse pregnancy outcomes among women with RA (7,8), including an increased incidence of low-birthweight infants (9), other investigators have failed to confirm these findings (3). In this issue of Arthritis & Rheumatism, Hyrich et al report data from the British Society for Rheumatology Biologics Register on pregnancy outcomes in a series of 32 women with rheumatic diseases (91% with RA) exposed to anti-TNF therapy (10). Of these women, 23 were exposed to TNF inhibitor therapy (74% to etanercept) at the time of conception, and 11 were also receiving either methotrexate or leflunomide. Overall, 69% of these 32 pregnancies resulted in a live birth, 22% in a miscarriage, and 9% in an elective termination, outcomes comparable with previously reJane E. Salmon, MD, Deborah Alpert, MD, PhD: Hospital for Special Surgery–Weill Medical College, Cornell University, New York, New York. Dr. Salmon has received consulting fees (less than $10,000 each) from Amgen and Genentech and owns stock in Amgen, Johnson and Johnson, and Biogen/Idec. Address correspondence and reprint requests to Jane E. Salmon, MD, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail: salmonj@hss.edu. Submitted for publication March 21, 2006; accepted in revised form May 8, 2006.