Incidence Of Preterm Delivery Research Articles

Incidence of preterm delivery in gestational diabetes mellitus with and without hypothyroidism

A variety of endocrine disorders complicate pregnancy. Diabetes is reported with increasing prevalence in general and in young people in particular, which has led to increase in the number of Pregnancies complicated with diabetes. Thyroid disorders are one among the common endocrine problems in pregnant women. The present study was done to find out if there is a relationship between the occurrence of these two disorders in pregnancy. The rate of preterm delivery is increased in GDM cases with hypothyroidism compared to the study group and it was statistically significant (p <0.05). The studies also indicate an increased risk of hypothyroidism in women with GDM and maternal thyroid hormone status was related to the degree of metabolic imbalance. The screening for GDM in women during early pregnancy tends to reduce morbidity in fetus and mother through dietary or drug management. Furthermore, the study emphasizes on the importance of evaluation of thyroid function in women with GDM owing to the increase in high perinatal and neonatal morbidity.

Is mid-trimester cervical length screening effective for reduction of threatened preterm labor?

ObjectiveTo assess the incidence of threatened preterm labor and preterm labor admissions and treatment of women with singleton gestations and no prior preterm birth before and after implementation of the universal mid-trimester transvaginal ultrasound cervical length screening. Materials and methodsA retrospective cohort study included of singleton gestations without a history of preterm birth presenting with threatened preterm labor between 24 0/7 and 36 6/7 gestational week in two study periods: before and after the implementation of the universal cervical length screening. Women with cervical length <25 mm were considered being at high risk for preterm birth and were prescribed a treatment with vaginal progesterone daily. The primary outcome was the incidence of threatened preterm labor. Secondary outcomes were the incidence of preterm labor. ResultsWe have found a significant increase in the incidence of threatened preterm labor from 6.42% (410/6378) in 2011 to 11.61% (483/4158) in 2018 (p < 0.0001). Gestational age at triage consult was lower in than in 2011, although the rate of admission for threatened preterm labor was similar in both periods. There was a significant decrease in the incidence of preterm delivery <37 weeks from 25.60% in 2011 to 15.94% in 2018 (p < 0.0004). Although there was a reduction in preterm delivery ≤34 weeks, this reduction was not significant. ConclusionThe universal mid-trimester cervical length screening in asymptomatic women is not associated with a reduction in the frequency of threatened preterm labor or the admission rate for preterm labor, but reduces the rate of preterm births.

Impacto de la suplementación con ácidos grasos omega-3 en el embarazo y la reducción del riesgo de parto pretérmino

Preterm labor accounts for more than 85% of perinatal morbidity, frequently requiring intensive care and presenting complications that can have consequences throughout the individual's life. More than half of preterm delivery cases have unknown causes and therefore no clear preventable etiology. From observation in epidemiological studies that demonstrated longer pregnancies in populations with high consumption of marine oils, attempts have been made to define the benefit of omega-3 polyunsaturated fatty acids (n-3 PUFA) prevention in premature childbirth through randomized clinical trials, as well as its preventive value. This review discusses the relationship between prenatal supplementation of n-3 long chain PUFA during pregnancy and the incidence of preterm delivery.

Pregnancy Complications and Long-Term Mortality in a Diverse Cohort.

Pregnancy complications are associated with increased risk of development of cardiometabolic diseases and earlier mortality. However, much of the previous research has been limited to White pregnant participants. We aimed to investigate pregnancy complications in association with total and cause-specific mortality in a racially diverse cohort and evaluate whether associations differ between Black and White pregnant participants. The Collaborative Perinatal Project was a prospective cohort study of 48 197 pregnant participants at 12 US clinical centers (1959-1966). The Collaborative Perinatal Project Mortality Linkage Study ascertained participants' vital status through 2016 with linkage to the National Death Index and Social Security Death Master File. Adjusted hazard ratios (aHRs) for underlying all-cause and cause-specific mortality were estimated for preterm delivery (PTD), hypertensive disorders of pregnancy, and gestational diabetes/impaired glucose tolerance (GDM/IGT) using Cox models adjusted for age, prepregnancy body mass index, smoking, race and ethnicity, previous pregnancies, marital status, income, education, previous medical conditions, site, and year. Among 46 551 participants, 45% (21 107 of 46 551) were Black, and 46% (21 502 of 46 551) were White. The median time between the index pregnancy and death/censoring was 52 years (interquartile range, 45-54). Mortality was higher among Black (8714 of 21 107 [41%]) compared with White (8019 of 21 502 [37%]) participants. Overall, 15% (6753 of 43 969) of participants had PTD, 5% (2155 of 45 897) had hypertensive disorders of pregnancy, and 1% (540 of 45 890) had GDM/IGT. PTD incidence was higher in Black (4145 of 20 288 [20%]) compared with White (1941 of 19 963 [10%]) participants. The following were associated with all-cause mortality: preterm spontaneous labor (aHR, 1.07 [95% CI, 1.03-1.1]); preterm premature rupture of membranes (aHR, 1.23 [1.05-1.44]); preterm induced labor (aHR, 1.31 [1.03-1.66]); preterm prelabor cesarean delivery (aHR, 2.09 [1.75-2.48]) compared with full-term delivery; gestational hypertension (aHR, 1.09 [0.97-1.22]); preeclampsia or eclampsia (aHR, 1.14 [0.99-1.32]) and superimposed preeclampsia or eclampsia (aHR, 1.32 [1.20-1.46]) compared with normotensive; and GDM/IGT (aHR, 1.14 [1.00-1.30]) compared with normoglycemic. P values for effect modification between Black and White participants for PTD, hypertensive disorders of pregnancy, and GDM/IGT were 0.009, 0.05, and 0.92, respectively. Preterm induced labor was associated with greater mortality risk among Black (aHR, 1.64 [1.10-2.46]) compared with White (aHR, 1.29 [0.97-1.73]) participants, while preterm prelabor cesarean delivery was higher in White (aHR, 2.34 [1.90-2.90]) compared with Black (aHR, 1.40 [1.00-1.96]) participants. In this large, diverse US cohort, pregnancy complications were associated with higher mortality nearly 50 years later. Higher incidence of some complications in Black individuals and differential associations with mortality risk suggest that disparities in pregnancy health may have life-long implications for earlier mortality.

CCR5 contributes to adverse outcomes during malaria in pregnancy.

CCR5 is a chemokine receptor that mediates cell recruitment to sites of inflammation. It has been previously reported that the expression of CCR5 is increased in the placentas of women with malaria, a disease characterized by causing deliveries with low birth weight among other complications. CCR5 has been associated with pathology of protozoan infections during pregnancy but its role during malaria in pregnancy has not been elucidated. In the present work, we assessed the pregnancy outcome, placental structure, and levels of inflammatory markers of pregnant C57BL/6 and CCR5-/- mice infected or not with Plasmodium berghei NK65, with the purpose of determine the role of CCR5 in pregnancy associated malaria complications. We demonstrated that the expression of CCR5 mRNA increases in late pregnancy placentas of C57BL/6 when compared to uninfected controls. Infected pregnant C57BL/6 mice showed preterm birth, decreased fetal weight, placental inefficiency, and reduced placental vascular space. On the other hand, CCR5 deficiency led to increased levels of maternal parasitemia, reduced fetal weight and placental inefficiency compared to C57BL/6 mice. However, the infection did not cause additional changes in these parameters or in the incidence of preterm delivery in infected CCR5-/- mice in relation to C57BL/6 mice, showing that CCR5 may contribute to the adverse effects caused by infection during pregnancy. This improvement in pregnancy outcome, observed in infected CCR5-/- mice, was accompanied by lower placental levels of the inflammatory markers, such as TNF and NAG. Furthermore, it was observed that the placentas of CCR5-/- animals showed structural differences in relation to C57BL/6 mice, which could improve the efficiency of maternal-fetal exchanges, reflecting on fetal weight. Taken together, these results indicate that CCR5 expression contributes to the adverse outcomes caused by malaria in late pregnancy.

Use of Nitroglycerine Patch in the Management of Preterm Labor

Background: Preterm birth is the delivery of the baby before 37 completed weeks of pregnancy. The goal of tocolytic therapy is to reduce neonatal mortality and morbidity by delaying birth, allowing for corticosteroid administration and maternal transfer to the tertiary care center. This study was conducted to observe the tocolytic efficacy of GTN transdermal patches in preterm labor between 28 – 36 weeks of pregnancy. Methods: This cross-sectional study was done in Obstetrics &amp; Gynecology Department at Mufti Mehmood Memorial Hospital, Dera Ismail Khan, from July 2017 to December 2017. Non-probability consecutive samplings of 186 pregnant women with preterm labor were included in the study. Detailed history and examination, routine investigations and ultrasound were performed to confirm viability, gestational age and exclusion of multiple pregnancies, lethal fetal malformation and intrauterine death. Effectiveness of the GTN patch was considered successful if the cessation of uterine contraction occurred within 24 hours of the application of the GTN patch and persisted for 48 hours to achieve the effect of steroids. Results: Tocolytic efficacy of GTN transdermal patch in preterm labor between 28 to 36 weeks of pregnancy was 88.71%. Regarding the parity of the women, 75.8% of women had multipara (parity 2 to 5) and 24.2% had primipara. The average gestational age was 33.15±2.28 weeks. . Two to three uterine contractions per 10 minutes were observed in 75.8% of women while four uterine contractions per 10 minutes were observed in 24.19% of cases. 2cm cervical dilatation was observed in 82 women (44.09%) and 3cm was 75 women (40.32%). Practical implication: The incidence of preterm delivery can be minimized using GTN patch to reduce the uterine contractions and increase the fetal viability inside the womb. Conclusion: There is no better incubator than a mother's womb. The GTN patch appears to be a safe, non-invasive method of suppressing uterine contractions in pre-term labor and also a simple, quicker and cost-effective tocolytic agent. Keywords: Pre-term labor; Tocolytic; Transdermal patch; Uterine contractions.

Beberapa Faktor Risiko Kejadian Persalinan Prematur (Studi Persalinan Prematur di RSUD Hj. Anna Lasmanah Kabupaten Banjarnegara)

Preterm delivery occurs before 37 weeks gestation. One of the causes of high infant mortality rate in Banjarnegara district in 2013 due to preterm birth (36,53%). The purpose of this study was to analyze the risk factors associated with the incidence of preterm delivery. The method used was a quantitative method with case control design. This study consisted of 69 cases and 69 controls. Samples were taken by simple random sampling. Data analysis used chi square test with α= 95%. The results showed correlation between age (OR=2,412 (1,188-4,900)), hemoglobin concentration (OR=3,514 (1,631-7,571)), mid upper arm circumference (OR=2,605 (1,200-5,656)), gestational weight gain (OR= 10,384 (4,524-23,833)), history of preterm delivery (OR=9,750 (2,790-34,071), family income (OR=6,535 (3,100-13,776)), and antenatal care (OR=7,708 (3,310-17,952)) with preterm delivery. There were no correlation between parity, body mass index pre-pregnancy, status of cigaretee smoke exposure and presence concomitant diseases. Advice for Health Service by Midwife to have a personal blood test tool to measure hemoglobin levels of pregrant women, so Midwife can check and monitor status of anemic pregnant women directly and actively provide information about the risk factors for preterm delivery, partiulary weight gain according to the recommendation from Institute of Medicine. To pregnant women should be routine to do antenatal care, so the risk factor of preterm delivery can be known as soon as possible.

Obstetric outcomes after medroxyprogesterone acetate treatment for early stage endometrial cancer or atypical endometrial hyperplasia: a single hospital-based study.

To investigate perinatal outcomes in pregnancy after high-dose medroxyprogesterone acetate (MPA) therapy for early stage endometrial cancer (EC) and atypical endometrial hyperplasia (AEH) and to determine whether pregnancy after MPA therapy is at a higher risk of placenta accreta. Data of 51 pregnancies in 46 women who received MPA therapy for EC or AEH and delivered after 22weeks of gestation at Keio University Hospital were reviewed. A retrospective matched case-control study was performed to determine the risk of placenta accreta in pregnancy after MPA therapy compared with singleton pregnancies without any history of maternal malignancy treatments. The incidence of placenta accreta was higher in the MPA group than in the control group (15.7 vs. 0%, p = 0.0058). However, no differences in other perinatal outcomes were observed between groups. While gestational weeks at delivery in the MPA group were later than those in the control group (p = 0.0058), no difference in the incidence of preterm delivery was recorded between groups. In the MPA therapy group, the number of patients who underwent ≥ 6 dilation and curettage (D&C) was higher in the placenta accreta group than in the non-placenta accreta group (50.0 vs. 14.0%, p = 0.018). Patients with ≥ 6 D&Cs demonstrated a 6.0-fold increased risk of placenta accreta (p = 0.043, 95% CI 1.05-34.1) than those receiving ≤ 3 D&Cs. Pregnancy after MPA therapy is associated with a high risk of placenta accreta. In cases in which the frequency of D&C is high, placenta accreta should be considered.

Neonatal mortality and disparities within the military health system.

Racial disparity exists in U.S. neonatal mortality; Black, non-Hispanic neonates are at higher risk of death. We aim to examine overall and race-specific neonatal mortality within the Military Health System (MHS). Retrospective cohort study of infants delivered within the MHS between 2013-2015. Variables were extracted from the Military Health System Data Repository. There were 320,283 live births within the MHS from 2013-2015; 588 neonates died, a death rate of 1.84/1000. Cohort neonatal mortality and incidence of preterm delivery (7.2%) were lower than concurrent U.S. Black, non-Hispanic neonates had a 2-fold increased risk of death (OR: 2.11; 95% CI 1.73-2.56, p < 0.001) over White, non-Hispanic neonates. Officer versus enlisted rank conferred no difference in neonatal mortality (OR: 0.88; 95% CI 0.74-1.03). Neonatal mortality within the MHS is lower than in the U.S. Despite universal insurance coverage and access to care, racial disparity persists. Risk of death is not modified by socioeconomic status. These findings highlight the need for critical examination of healthcare equity within neonatal-perinatal medicine.

Development and validation of nomogram for the prediction of preterm delivery based on patient characteristics and circulating inflammatory cells in patients with gestational diabetes mellitus.

The incidence of preterm delivery (<37 weeks' gestation) is increased due to gestational diabetes mellitus (GDM). The preterm delivery is the leading cause of death in children. If potential preterm delivery can be diagnosed early and then prevented, adverse pregnancy outcomes can be improved. Therefore, effective methods are needed for early prediction of preterm delivery in women with GDM. Patients with GDM defined as the presence of at least 1 plasma glucose abnormality at 24-28 weeks of pregnancy [fasting plasma glucose ≥5.1 mmol/L, 60-min ≥10.0 mmol/L, 120-min ≥8.5 mmol/L by 75 g oral glucose tolerance test (OGTT)] from the First Affiliated Hospital of Wenzhou Medical University were enrolled. The data (564 patients) recorded from January 2017 to June 2020 were named the training cohort, and the data (242 patients) obtained from patients with GDM, from July 2020 to January 2022, were named the validation cohort. Mann-Whitney U test and chi-square test were used to compare the skewed distributed and categorical data, respectively. According to the results of univariate logistic regression analysis, the multivariate logistic regression model was developed in the training cohort. Then, the nomogram was established. The validation of the nomogram was conducted on the training and validation cohort. No significant differences in baseline characteristics were detected between the 2 cohorts (all P>0.05). The multivariate analysis suggested that maternal age, insulin use, NLR, and monocyte count were the independent predictors of preterm delivery. A nomogram for predicting the probability of preterm delivery was developed. The model suggested good discrimination [areas under the curve (AUC) =0.885, 95% confidence interval (95% CI): 0.855-0.910, sensitivity =83.0%, specificity =83.1% in the training cohort; AUC =0.919, 95% CI: 0.858-0.980, sensitivity =90.6%, specificity =84.8% in the validation cohort] and good calibration [Hosmer-Lemeshow (HL) test: χ2=3.618, P=0.306 in the training cohort; χ2=6.012, P=0.111 in the validation cohort]. The visual nomogram model appears to be a reliable approach for the prediction of preterm delivery, allowing clinicians to take timely measures to prevent the occurrence of preterm delivery in women with GDM at the time of GDM diagnosis, and deserves further investigation.

Https://thejmch.com/index.php?journal=thejmch&amp;page=issue&amp;op=view&amp;path%5B%5D=41

Background: Good antenatal care helps a woman face labour in good health and optimum conditions. The National Institute for Health and Care Excellence (NICE) and WHO guidelines suggest 15 visits in the whole pregnancy. Keeping in view the COVID-19 pandemic to reduce the exposure of pregnant ladies the number of antenatal visits was reduced to 7 milestone visits and outcome was noted. This study aimed to do a comparative study of feto-maternal outcome in antenatal cases at our centre using standard WHO protocol vs. revised antenatal protocol during COVID-19 pandemic. Subjects and Method: This was an observational study done at a tertiary care center of an Armed forces hospital with target population as pregnant ladies attending antenatal care Out patient department of the hospital during COVID19 pandemic Vs Antenatal cases in previous 1 year. A comparative analysis of pregnancy outcome, maternal variables during pregnancy and delivery along with neonatal variables was done. Results: There were lesser deliveries by 41.7% as compared to non-COVID times. There was an increase in the caesarean delivery rate and instrumental delivery rate during COVID times by 11% and 53% respectively. There was increase in Vaginal birth after caesarean (VBAC) by 26.6%. The incidence of fetal growth restriction, placental abruption, maternal anaemia and gestational diabetes mellitus, oligohydramnios and polyhydramnios was low. The incidence of spontaneous abortions was also low in our study. In contrast, the incidence of pre-term deliveries doubled from 7.4% to 13.4%. Neonatal morbidity and mortality indicators like Neonatal Intensive care unit (NICU) admissions showed a rising trend of 1.7% during the COVID (14.6% to 16.3%) with a minimal rise in early neonatal deaths by 0.2%. Conclusion: Our model doesn't show an increase in maternal, neonatal morbidity, and mortality. This model can be used as a standard of care for Antenatal patients during Pandemics. It reduces the risk exposure of the gravid mother without any significant increase in maternal and neonatal morbidity and mortality. Keywords: antenatal care, COVID-19 pandemic, revised antenatal schedule. Correspondence: Dr Vipin Kumar Prajapati, Graded Specialist Department of Obstetrics Gynecology, AFMC, Pune. E Mail: vipinafmc@gmail.com. Contact No: 8811015130. Journal of Maternal and Child Health (2023), 08(01): 125-133 https://doi.org/10.26911/thejmch.2023.08.01.12

Thin endometrial lining: is it more prevalent in patients utilizing preimplantation genetic testing for monogenic disease (PGT-M) and related to prior hormonal contraceptive use?

Is a thin endometrial lining before ovulation triggering more prevalent in patients utilizing preimplantation genetic testing for monogenic disease (PGT-M) compared to the regular IVF/ICSI population and is this associated with prior hormonal contraceptive use? Thin (<8 mm) endometrial lining is more prevalent in PGT-M patients compared to the regular IVF/ICSI population and is associated with both longer prior hormonal contraceptive use and a shorter cessation interval of hormonal contraceptives before IVF/ICSI treatment. Thin endometrial lining has been associated with lower pregnancy rates in IVF/ICSI cycles and increased chances of miscarriage and low birth weight. Endometrial thinning and atrophy occur during hormonal contraceptive use. Patients utilizing PGT-M typically use hormonal contraceptives up until treatment to avoid the risk of conception of a genetically affected child. Whether this could negatively affect endometrial thickness achieved during subsequent IVF/ICSI cycles is not known. A retrospective case control study was performed, including all PGT-M patients attending the University Medical Centre Groningen (cases), between 2009 and 2018. The control group consisted of two non-PGT IVF/ICSI patients for each PGT-M patient, matched for age and treatment period. First cycles of 122 PGT-M patients and 240 controls were included. Cessation interval of hormonal contraceptives was categorized as late cessation (cessation <1 year prior to treatment) or early cessation (>1 year prior to treatment). Endometrial thickness was routinely measured on the day of hCG triggering or 1 day prior. The prevalence of an endometrial lining <8 mm was compared between PGT-M patients and controls. Hormonal contraceptive use (both duration and cessation interval) was compared between both groups. Univariable and multivariable regression analyses were performed to identify risk factors for thin endometrial lining. In addition, cycle and pregnancy outcomes were compared within control/PGT-M groups between patients with endometrial lining > or <8 mm. Thin endometrial lining on the day of hCG triggering was found significantly more often in the PGT-M group, compared to controls: 32% vs 11% (mean difference 21.0%, 95% CI: 11.7, 30.3%). As expected, more patients in the PGT-M group ceased their hormonal contraception late (<1 year): 64% vs 2% in the control group (mean difference 61.9%, 95% CI: 53.0, 70.8%). Average duration of hormonal contraceptive use was 10.6 years in the PGT-M group vs 9.3 years in controls (mean difference 1.3 years, 95% CI: 0.2, 2.3 years). Multivariable logistic regression analysis identified late cessation (OR: 6.0, 95% CI: 1.9-19.2) and duration of prior hormonal contraceptive use (OR per year increase 1.1, 95% CI: 1.0-1.2) as significant independent risk factors for a thin endometrial lining. In relation to outcome, we found a statistically significant increase in miscarriage rate in PGT-M patients with an endometrial lining <8 mm compared to those with an endometrial lining >8 mm (20.0% vs 1.7%, mean difference 18.3%, 95% CI: 2.3, 34.3%). A trend towards lower birth weight and gestation- and gender-adjusted birth weight (z-score) was also found in this group. No statistically significant differences were detected in pregnancy rate, live birth rate, or incidence of preterm delivery or SGA. Within the control group, no statistically significant differences were found in outcomes between patients with an endometrial lining <8 compared to an endometrial lining >8 mm. The study is retrospective. Various types of hormonal contraceptives were reported which possibly exert different effects on the endometrial lining. In relation to pregnancy outcome measures, numbers were very limited; therefore, no firm conclusions should be drawn. This study provides further insight into the role of prior hormonal contraceptive use as a possible contributor to the occurrence of thin endometrial lining during ART treatment. Future studies should provide more information on its clinical relevance, to determine whether PGT-M patients can be reassured, or should be counselled to stop hormonal contraceptive use and change to an alternative contraceptive method prior to PGT treatment. No specific funding was used and no conflicts of interests are declared. N/A.

Sezaryen ile sonuçlanan adolesan gebeliklerde obstetrik sonuçların değerlendirilmesi: Tek merkez deneyimi

Aim: Adolescent pregnancies; defined as pregnancies in women aged 10-19 years old are still an important public health problem and must be considered as high risk pregnancies with increased maternal and fetal mortality and morbidity rates. In this study, we aimed to examine the obstetric and perinatal outcomes in adolescent pregnancies delivered with cesarean section (CS) and compare the outcomes in determined adolescent age groups. Materials and Methods: In this retrospective study, the obstetric and perinatal outcomes in 2665 adolescent patients who delivered with cesarean section were examined in three groups divided according to the age of delivery: group 1 included the patients aged 14-15 years old, group 2 the patients aged 16-17 years old and group 3 the patients aged 18-19 years old. The outcomes were compared between the identified age groups. Results: The incidence of preterm delivery was higher in group 1 compared with group 2 and group 3 (p=0.001) and 52.3% of group 1 patients had delivered between 29-34 gestational weeks. Fetal birth weight and APGAR scores were lower and need for neonatal intensive care unit (NICU) was higher in group 1. In group 3 116 (8.4%) patients had postpartum hemorrhage which was higher than group 1 and group 2 with statistically significant difference (p=0.001). Conclusion: Preterm delivery, low birth weight, low APGAR scores and need for NICU are higher in 15-17 years old adolescents delivered with C/S whereas postpartum hemorrhage and need for blood transfusion is higher in adolescents aged 18-19 years old.

The effect of cold-knife conization on pregnancy outcomes in patients with cervical lesions.

To analyze the pregnancy outcomes of patients with cervical lesions treated by cold-knife conization (CKC). Clinical data of healthy pregnant women and pregnant women who underwent CKC in Dalian Women and Children's Medical Group from March 2010 to December 2019 were retrospectively analyzed. These patients were divided into a CKC group and a control group according to inclusion and exclusion criteria. Statistical methods were used to compare pregnancy and delivery outcomes between the two groups. There were 400 patients in CKC group and control group, with 200 patients in each. There was no significant difference in the mode of delivery, abortion, ectopic pregnancy, in-hospital perinatal management, and cervical cerclage between the CKC group and the control group (P>0.05). The rates of preterm delivery, premature rupture of membranes, cesarean section, and neonatal admission in the CKC group were higher than those in the control group (P<0.05). In the CKC group, the incidence of premature rupture of membranes within six months postoperatively was higher than that after six months (P<0.05). The incidences of preterm delivery and premature rupture of membranes were not completely consistent in different conization ranges (P<0.05). CKC increases the incidence of preterm delivery, premature rupture of membranes, and neonatal adverse outcomes. Conization height can predict the occurrence of preterm delivery. Delaying pregnancy after surgery can reduce the incidence of adverse outcomes during the perinatal period.

Predicting the future of mental health: (how) will in utero COVID-19 infection influence psychiatric illness in future generations?

Objectives: There is limited research on the potential future psychiatric effects of in utero COVID-19 infection. There is evidence that COVID-19 infection can lead to obstetric complications and adverse neonatal outcomes. Obstetric complications and neurodevelopmental insults such as viral infections have been implicated in the development of some mental disorders including schizophrenia (SZ). The aim was to address the possible mechanisms and influences related to in utero infection that could increase the risk of mental illness in the future. &#x0D; Methods: Searches were conducted in the databases PubMed, Embase, and PsycINFO for studies involving COVID-19 infection and pregnancy, obstetric complications, and psychiatric complications. Additionally, any external information outside of these search terms was sourced from these databases. &#x0D; Results: Several studies found evidence of significantly higher incidences of preterm delivery and cesarean section associated with maternal COVID-19 infection. Other noted adverse birth outcomes included fetal distress, stillbirth, low birth weight, neonatal asphyxia, and pre-eclampsia. These birth outcomes tend to occur in the third trimester, a crucial period for neurodevelopment. Additionally, there have been occurrences of vertical transmission of COVID-19. &#x0D; Conclusion: It is plausible that in utero COVID-19 infection could increase the risk of mental illness development in the offspring. The observed implications of COVID-19 along with known neurodevelopmental complications of in utero infection provide multiple processes that could impact the mental health of the offspring in the future. This increased risk could arise from neonatal outcomes associated with COVID-19 infection, the consequences of maternal infection on the fetus, or direct viral infection of the fetus and fetal brain. Due to its novel nature, more evidence is needed to determine the exact prevalence of adverse obstetric outcomes, vertical transmission, effects on neurodevelopment, and development of mental illness due to SARS-CoV-19.

Outcomes in Pregnant HbSS and HbSβ0-Thalassemia Sickle Cell Disease Patients Receiving Scheduled Exchange Transfusions: A Retrospective Study

Introduction: The incidence of feto-maternal complications during pregnancy is high in women with sickle cell disease (SCD) which is the most common inherited hematologic disorder worldwide. Evidence on the impact of transfusions in pregnancy with SCD is lacking with only 12 observational studies and 1 RCT to date that has led to conditional recommendations for transfusional support in pregnant SCD patients. We aim to retrospectively chart review pregnant patients with severe sickle cell disease (HbSS and HbSβ0-thalassemia) and assess if scheduled red cell partial exchanges (RCE) impacted lab values, number of hospital and ED visits, prenatal, perinatal and postnatal outcomes. Methods: We identified 42 adult pregnancies (40 HbSS and 2 HbSβ0-thalassemia) between 04/2012 and 04/2022. HbSC and HbSβ+-thalassemia patients were excluded from the study as most patients did not get RCE due to overall less disease severity. Patients who received RCE had one unit of phlebotomy followed by one unit of packed red cell transfusion every 2 weeks as per the protocol followed at our institution. Collected data included demographics, lab values, number of hospital admissions/ED visits, prenatal, perinatal, and postnatal outcomes. Descriptive statistics as means and percentages, individual samples t-tests for comparison of means, chi-square tests for associations were utilized to report the data. A p value of <0.05 was considered significant. A binary regression model was utilized to adjust for demographics and comorbidities. Results: Mean age in the study group was 24.86±4.28 years. All 42 patients had medicare or medicaid. 11/42 (26.2%) patients received scheduled RCE with 73% compliance rate and no documented evidence of allo-immunization. Only 1/37 (2.7%) patients had venous thromboembolism. Patients who received scheduled RCE had higher hemoglobin (Hb) nadirs (7.80 g/dL vs 6.78 g/dL; p .02), lower number of hospital admissions for painful crises (1.00 vs 3.54; p .02) and higher gestational age in weeks at delivery (37.09 vs 33.64; p .007). The differences in means of other hematological and chemistry lab values were insignificant. Scheduled RCE was associated with lower incidence of preterm deliveries and subsequent NICU admission with unadjusted odds ratios of 0.153 (0.028-0.848) and 0.500 (0.323-0.775) respectively. There was no statistically significant association with respect to other prenatal, perinatal or postnatal outcomes such as preeclampsia, eclampsia, mode of delivery, intrauterine growth restriction or neonatal death. Binary logistic regression did not show any statistically significant associations when adjusted for demographics and comorbidities (Table 1). Conclusions: Pregnant patients with SCD who have had previous pregnancy complications, high hospital admission rates or low Hb nadirs might benefit from scheduled RCE or simple transfusions. Given limited sample size in all 12 reported observational studies, there is a need for multicenter study especially from centers in areas with higher prevalence of SCD. While the TAPS-2 trial was registered in 2019 in the UK and is currently recruiting patients, more trials are necessary to solidify evidence. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

RF18 | PSAT166 Hypercalcemia and hypocalcemia during pregnancy are associated with worse maternal and fetal outcomes

Abstract Background Hypercalcemia during pregnancy is rare. The true incidence, however, is difficult to estimate as routine calcium screening is not recommended. Hypercalcemia is linked with various maternal and fetal outcomes but overall, the literature is conflicting. Aims Aim of this study is to determine the frequency of hypercalcemia in pregnancy and to determine association with early maternal and fetal outcomes. Methods This retrospective cohort study included all confirmed gestations with expected date of delivery (EDD) between 2017-2019 at a large tertiary maternity unit. Baseline demographic, biochemical, and clinical data collected as part of a clinical-administrative dataset was retrieved. Maternal and fetal outcomes studied were incidence of fetal loss (miscarriage/stillbirth), pre-term delivery, emergency C-section, hypertension, blood loss during delivery, neonatal intensive care unit (NICU) admission, and fetal birth weight (for term deliveries). Results Total number of gestations and livebirths recorded between 2017-2019 were 33,118 and 20,969, respectively, with median age of 30.1 [IQR 25.6-34.3] years. Two-thirds of pregnancies were in Caucasian women (65.9%) followed by Asians (9.6%), Afro-Caribbean (5%), and others (19.5%). 15.7% (n=5195) of all gestations had calcium tested in the preceding ten months of EDD. Of these, the hypercalcemia and hypocalcemia were noted in 42 (0.81%) and 499 gestations (9.61%) respectively. The median adjusted calcium in the hypercalcemic group was 2.75 mmol/L [IQR 2.65-2.88] and underlying diagnoses were primary hyperparathyroidism (n=17), transient hypercalcemia (n=12), suspected familial hypocalciuric hypercalcemia (n=2), sarcoidosis (n=1), and unknown (n=10). Of maternal and fetal outcomes, the incidence of pre-term delivery (20.0% v 9.2%; P=0.042), emergency C-section (42.4% v 21.4%; P=0.021), neonatal intensive care unit (NICU) admission (19.4% v 8.2%; P=0.024), and blood loss during delivery (1252 v 526 mL; P&amp;lt;0.001) was higher in the hypercalcemic group. The incidence of fetal loss (22.5% v 18.9%; P=0.560) and hypertension (0% v 1%; P =0.561) was not different between hyper and normocalcemic groups. Interestingly, the hypocalcemic group also demonstrated higher incidence of pre-term delivery (24.2% v 9.2%; P=&amp;lt;0.001), emergency C-section (28.6% v 21.4%; P=0.025), NICU admission (15.9% v 8.2%; P&amp;lt;0.001), and blood loss (627 v 526 mL; P&amp;lt;0.001), but not of fetal loss (21.0% v 18.9%; P=0.281) or hypertension (2.2% v 1.0%; P =0.054) compared to the eucalcemic group. Conclusion The incidence of hypercalcemia in pregnancy is low (0.81%). However, abnormal calcium levels are associated with worse maternal and fetal outcomes. Research needs to focus on whether routine calcium estimations are necessary and if treatment of these conditions improves maternal and fetal outcomes. We recommend that calcium testing should be considered in women who are at risk of worse outcomes during current or previous pregnancies. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m., Sunday, June 12, 2022 12:54 p.m. - 12:59 p.m.

Birth trauma in preterm spontaneous vaginal and cesarean section deliveries: A 10-years retrospective study.

ObjectiveWe compared birth injuries for spontaneous vaginal (VD) and caesarean section (CS) deliveries in preterm and term pregnancies.MethodsA retrospective cohort study was conducted in a single tertiary center, between January 1st, 2007, and December 31st, 2017. The study included 62330 singleton pregnancies delivered after 24 0/7 weeks gestation. Multivariable analyses compared trauma at birth, birth hypoxia and birth asphyxia in term and preterm deliveries, stratified by mode of birth, VD versus CS. Main outcome measure was trauma at birth including intracranial laceration and haemorrhage, injuries to scalp, injuries to central and peripheral nervous system, fractures to skeleton, facial and eye injury.ResultsThe incidence of preterm deliveries was 10.9%. Delivery of preterm babies by CS increased from 37.0% in 2007 to 60.0% in 2017. The overall incidence of all birth trauma was 16.2%. When stratified by mode of delivery, birth trauma was recorded in 23.4% of spontaneous vaginal deliveries and 7.5% of CS deliveries (aOR 3.3, 95%CI 3.1–3.5). When considered all types of birth trauma, incidence of trauma at birth was higher after 28 weeks gestation in VD compared to CS (28–31 weeks, aOR 1.7, 95% CI 1.3–2.3; 32–36 weeks, aOR 4.2, 95% CI 3.6–4.9; >37 weeks, aOR 3.3, 95% CI 3.1–3.5). There was no difference in the incidence of birth trauma before 28 weeks gestation between VD and CS (aOR 0.8, 95% CI 0.5–1.2). Regarding overall life-threatening birth trauma or injuries at birth with severe consequences such as cerebral and intraventricular haemorrhage, cranial and brachial nerve injury, fractures of long bones and clavicle, eye and facial injury, there was no difference in vaginal preterm deliveries compared to CS deliveries (p > 0.05 for all).ConclusionCS is not protective of injury at birth. When all types of birth trauma are considered, these are more common in spontaneous VD, thus favoring CS as preferred method of delivery to avoid trauma at birth. However, when stratified by severity of birth trauma, preterm babies delivered vaginally are not at higher risk of major birth trauma than those delivered by CS.

Characteristics and outcomes of SARS-CoV-2 positivity in neonates born to mothers with COVID-19 in Klang Valley, Malaysia: a retrospective observational study

ObjectiveThe aim of this study was to analyze the clinical characteristics of neonates born to mothers with coronavirus disease 2019 (COVID-19), along with the incidence and outcomes of severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) positivity in Klang Valley, Malaysia. MethodsThe clinical records of all neonates born to mothers with COVID-19 who were admitted to Sungai Buloh Hospital, Selangor, Malaysia from October 1, 2020 to September 30, 2021 were reviewed retrospectively. Data collected included demographic details and the incidence, risk factors, and clinical outcomes of neonates with SARS-CoV-2 positivity. ResultsA total of 766 neonates from 753 mothers with COVID-19 were included. Overall, 23 (3%) neonates tested positive by nasopharyngeal swab SARS-CoV-2 PCR taken within the first 8 days of life. There were three (0.4%) confirmed and four (0.5%) probable neonatal infections acquired intrapartum, seven (0.9%) confirmed neonatal infections acquired postpartum, and nine (1.2%) cases that did not fit within the classification. The rate of preterm delivery was 25% among all neonates born to mothers with COVID-19 and 39.1% among SARS-CoV-2-positive neonates. Of the SARS-CoV-2-positive neonates, 43.5% required ventilatory support. Factors identified to have a significant association with neonate SARS-CoV-2 positivity included maternal antepartum hemorrhage (odds ratio (OR) 7.33, P = 0.014), place of delivery in a non-designated COVID-19 center (OR 7.64, P < 0.001), exposure to the mother post-delivery (OR 4.13, P = 0.014), and a higher 5-minute Apgar score (score 6–10; OR 0.20, P = 0.0037). ConclusionsThis study identified a risk of SARS-CoV-2 transmission from mothers with COVID-19 to their offspring, with infection acquired predominantly postpartum. A higher incidence of preterm delivery and ventilatory support were observed among SARS-CoV-2-positive neonates.

Fetal Growth and Neonatal Outcomes in Pregestational Diabetes Mellitus in a Population with a High Prevalence of Diabetes.

The aim of this retrospective study, conducted in an Italian tertiary care hospital, was to evaluate maternal-fetal and neonatal clinical outcomes in a group of patients with pregestational diabetes mellitus (PGDM), such as diabetes mellitus type 1 (DM1), diabetes mellitus type 2 (DM2), and maturity onset diabetes of the young (MODY). Overall, 174 pregnant women, nulliparous and multiparous, with a single pregnancy were enrolled. Data on pregnancy, childbirth, and newborns were collected from medical records. The selected patients were divided into two groups: the PGDM group (42 with DM1, 14 with DM2, and 2 with MODY), and the control group (116 patients with a negative pathological history of diabetes mellitus). We reported an incidence of preterm delivery of 55.2% in the PGDM group, including 59.5% of those with DM1 and 42.9% of those with DM2, vs. 6% in the controls. Fetal growth disorders, such as intrauterine growth retardation, small for gestational age, and fetal macrosomia were found in 19% and 3.6% in the case and control groups, respectively. A relationship between DM2 and gestational hypertension was found.