Rate Of Intrauterine Growth Restriction Research Articles

Late selective termination in dichorionic twins: comparing late second and third trimester procedures

Research questionDo perinatal outcomes of selective termination performed in the late second versus third trimester differ and what risk factors are associated with subsequent preterm birth? DesignThis is a retrospective cohort study of late selective terminations performed in dichorionic twins between 2009 and 2021. Perinatal outcomes were compared between two groups: group A, late second trimester (20.2 to 24.2 weeks, n = 26), and group B, third trimester (≥28.2 weeks, n = 55) selective terminations. Univariate and multivariate analyses were conducted to identify factors associated with post-procedure preterm birth. ResultsIn total, 81 dichorionic twin pregnancies were included. There were no pregnancy losses but 16% (13/81) of cases experienced complications. Group A had a higher median birthweight centile (36.5th versus 15th centile, P = 0.002) and lower rates of intrauterine growth restriction (IUGR) and Caesarean delivery (11.5% versus 32.7%, P = 0.04; and 26.9% versus 61.8%, P = 0.003) than group B. Preterm birth rates were similar (46.2% versus 63.6%, P = 0.15). Multiple regression revealed that reduction of the presenting twin and cervical length ≤35 mm were independently associated with post-procedure preterm birth (odds ratio [OR] 8.7, P = 0.001, 95% confidence interval [CI] 2.5–29.8; OR 3.8, P = 0.015, 95% CI 1.3–11). ConclusionsLate second trimester selective termination is associated with a higher birthweight centile and lower rates of IUGR and Caesarean delivery, compared with third trimester selective termination. Cervical length 35 mm or less and reduction of the presenting twin are independent risk factors for post-procedural preterm birth. These findings may help determine the optimal time to perform a late selective termination.

Correlation between PAPP-A serum levels in the first trimester of pregnancy with the occurrence of gestational diabetes, a multicenter cohort study

ObjectiveThis study aimed to investigate the association between first-trimester Pregnancy-associated plasma protein A (PAPP-A) levels and subsequent gestational diabetes mellitus (GDM) development.MethodThe study was conducted on 5854 pregnant women who attended routine prenatal care. Maternal biomarkers, including PAPP-A and free beta hCG, were measured for all women in a referral laboratory and converted to MoM values. Pregnant women were divided into two groups, based on the serum concentration of PAPP-A, (PAPP-A > 0.4 (normal) and PAPP-A < 0.4 (low)). Data on the screening test for GDM and pregnancy outcomes were collected and analyzed with appropriate tests.ResultOf the 5854 pregnant women, 889 (15.19%) developed GDM. The maternal PAPP-A MoM concentrations were significantly lower in GDM cases compared to controls. Indeed, gestational age at delivery and birth weight were significantly lower (p < 0.001) in PAPP-A MoM < 0.4, and the rate of intrauterine growth restriction (IUGR) was significantly higher (p < 0.001). ROC analysis revealed that the sensitivity and specificity of MoM concentration for predicting GDM were 53.3% and 51.9%, respectively.ConclusionLower maternal PAPP-A in early pregnancy can lead to glucose intolerance and increase the risk of subsequent GDM development. In addition, decreased serum concentration of PAPP-A is significantly correlated to lower birth weight and IUGR.

Parir después de los 50 años. Estudio piloto observacional

ObjectivesTo assess whether there is a higher rate of adverse obstetric outcomes, postpartum urinary incontinence, and sexual problems among women who give birth over 50. Material and methodsA single-center ambispective observational study. Rate of cesarean birth, gestational diabetes, preeclampsia, intrauterine growth restriction (IUGR), prematurity, urinary incontinence (Incontinence Questionnaire Short Form [ICIQ-SF]), and sexual dysfunction (Female Sexual Function Index [FSFI-6]) were recorded. ResultsTwenty-five (0.06%) of 38,510 births occurred in women over 50 during the study period. There were 16 (64%) cesarean births. Seven (28%) women had gestational diabetes. Preeclampsia was diagnosed in 3 (12%) women. There were 5 (20%) cases of IUGR. There were 5 (20%) preterm births. The differences in the rate of cesarean birth, gestational diabetes, and IUGR between the study group and the total population were statistically significant. The results of the ICIQ-SF and FSFI-6 questionnaires were obtained from 17 women. Some degree of urinary incontinence was found in 7 (41.1%) and sexual dysfunction in 9 (52.9%) women. ConclusionsPregnancies in women over 50 may be associated with a higher rate of gestational diabetes, IUGR, and preeclampsia. There is a high prevalence of urinary incontinence and sexual problems among these women.

Comparison of maternal, fetal, obstetric and neonatal outcomes for 234 triplet pregnancies conceived in vivo versus IVF and ICSI conceptions

Research questionTriplet pregnancies have increased due to the rise in assisted reproductive techniques (ART). The objective of this study is to compare the results of natural versus ART triplet pregnancies. DesignThis is a single-center, retrospective cohort study that includes all triplet pregnancies followed up on at the La Paz University Hospital between 2000 and 2022. The characteristics of the pregnant women, maternal, fetal, obstetric, and perinatal outcomes were examined. Univariate and multivariate statistical analyses were performed. Results234 triplet pregnancies were analyzed: 92 triplet pregnancies in the spontaneous and artificial insemination conception group (natural conception) and 142 triplet pregnancies in the in vitro fertilization and intracytoplasmic sperm injection conception group (ART conception). Between 2000 and 2010, ART pregnancies were more frequent (p<0.01). The monochorionic triamniotic percentage was significantly higher (p<0.01) in the spontaneous group and the dichorionic triamniotic percentage (p=0.02) was higher in the ART group. After adjusting for confounders, the intrauterine growth restriction (IUGR) (p=0.01) result remained statistically significant with OR=8.65(1.66-45-03), being more frequent in the ART group. Maternal age (p=0.61; OR=1.08(0.99-1.18)) threatened preterm labor (p=0.10), Apgar test ≤5 at 5-minutes (p=0.99), pH<7.20 (p=0.99) and fetal death (p=0.99) differences disappearing upon adjustment for confounders. ConclusionTriplet pregnancies by ART had a higher rate of IUGR than natural triplet pregnancies. This could be related to the higher maternal age and the higher rates of lower Apgar test scores at 5-minutes and umbilical cord pH <7.20 in these pregnancies. In these cases, placental examination could provide valuable information.

Dietary Supplementation with Different Types of Potassium and Magnesium during Late Gestation and Lactation Modulates the Reproductive Performance, Antioxidant Capacity, and Immune Function of Sows

The objective of this study was to investigate the effects of dietary supplementation with different types of potassium and magnesium on the reproductive performance, antioxidant capacity, and immunity of sows. Forty-five Landrace × Yorkshire sows at the late gestation stage (85 d) were randomly assigned to three groups (n = 15). Sows in the control group (CON), potassium chloride and magnesium sulfate group (PM), and potassium-magnesium sulfate group (PMS) were fed with a basal diet, a basal diet supplemented with magnesium sulfate (0.20%) and potassium chloride (0.15%), or a basal diet supplemented with potassium-magnesium sulfate (0.45%), respectively. The results showed that dietary supplementation with PMS did not yield significant effects on the reproductive performance compared with the CON group (p &gt; 0.05). However, it significantly elevated the level of insulin-like growth factor 1 (IGF-1) in plasma and immunoglobulin A (IgA) in colostrum (p &lt; 0.05). Furthermore, PMS significantly augmented the activities of catalase (CAT) and superoxide dismutase (SOD) while reducing the levels of malondialdehyde (MDA) in comparison to the CON group (p &lt; 0.05). Compared with the PM group, the PMS group significantly reduced the incidence rate of intrauterine growth restriction (IUGR) (p &lt; 0.05) and significantly decreased the concentration of the proinflammatory cytokine (TNF-α) level in plasma (p &lt; 0.05). These results indicated that dietary supplementation with PMS during late gestation could enhance sows’ antioxidant capacity and the IgA level in colostrum. These findings will provide a theoretical reference for the use of magnesium and potassium in sow production to improve sows’ health.

P-502 Higher progesterone levels on the day of frozen embryo transfer is associated to better reproductive outcomes and higher obstetric complications: a retrospective cohort study

Abstract Study question Can serum progesterone (P) levels on the day of frozen embryo transfer (ET) compromise reproductive outcomes and/or obstetric complications? Summary answer Serum P levels was related to higher clinical pregnancy rate on frozen ET cycles. However, women with P level≥8.8 ng/ml presented higher obstetric complications. What is known already P levels &amp;lt;9.2 ng/ml on the day of ET significantly decreased ongoing pregnancy rate (OPR) in 211 donated oocyte cycles. In another study of the same group, serum P levels &amp;lt;8.8 ng/ml on the day of ET presented lower OPR in both own or donated oocyte cycles. Another study shown that low serum P4 the day prior to euploid FET can benefit from association of injectable P and achieve similar reproductive outcomes compared to those with initial higher P levels. Study design, size, duration This is a retrospective cohort study that included 509 women who have undergone frozen embryo transfer. In this study was included only first cycle of each patient. The women were divided into two groups according P levels: 1) P level &amp;lt;8.8 ng/ml (n = 388) and 2) P level≥8.8 ng/ml (n = 121). The analysis included the period between 01 January 2020 to 31 December 2021. Participants/materials, setting, methods All participants of study who underwent frozen ET after an artificial endometrial preparation cycle with estradiol valerate or 17βestradiol and vaginal micronized progesterone(600 mg/day). Age, body mass index(BMI), cause of infertility, and reproductive outcomes(clinical pregnancy, miscarriage, twin pregnancy, live birth rates) and obstetric complications (prematurity, ectopic pregnancy, acretism, hypertensive syndrome in pregnancy, gestational diabetes, intrauterine growth restriction rates) were analyzed. Only women without uterine abnormalities and with endometrium≥6.5 mm were included in this study. Main results and the role of chance Clinical pregnancy rate did not significant statistical between the 1 and 2 groups. Live birth rate (p = 0.01) was significantly higher in group 2. Other reproductive outcomes were similar between the groups. In relation to obstetric complications, miscarriage rate was significantly higher in group 1 (p &amp;lt; 0.01) and prematurity (&amp;gt;0.01), acretism (&amp;gt; 0.01), and gestational diabetes (p = 0.01) rates were higher in group 2. The P level did not present relation to cause of infertility. The logistic regression analysis shown that only good embryo quality was predictor to clinical pregnancy rates. Limitations, reasons for caution These outcomes were shown only in women without uterus abnormality and that used vaginal progesterone. It is necessary caution to considerer these results to general population. Furthermore, serum P level was analyzed in single moment without definition of interval between last vaginal P dose administration and blood sample collected. Wider implications of the findings Monitoring P levels on FET day should be performed routinely on artificial cycles because it can be related to higher live birth rate. However, new studies can confirm if higher P levels on FET day or adjust of P level according P value will be related to better reproductive outcomes. Trial registration number not applicable

A Retrospective Cohort Study to Determine Whether the Previous Route of Delivery Affects the Uterine Artery Blood Flow.

In our study, we aimed to investigate the effect of the previous delivery route on uterine artery pulsatility index (PI) and obstetric outcome.We aim to assess the effects of previous cesarean delivery (CD) and placental location on first- and second-trimester uterine artery Doppler indices as well as first-trimester pregnancy-associated plasma protein-A (PAPP-A)multiples of the median (MoM) levels in the subsequent pregnancy. We designed a retrospective cohort study to collect the participants' clinical and uterine artery Doppler.Data regarding pregnant women's first- and second-trimester exams, who were referred to our maternal-fetal medicine unit, were collected from hospital records between June 2015 and December 2019. Uterine artery PI MoM values were not different between the cases with the anterior and non-anterior placental locations. No significant difference was found in the first- and second-trimester uterine artery PI MoMvalues by delivery route (p = 0.57). However, the intrauterine growth restriction rate was higher in the CD group (p < 0.001). In this study, we compared the uterine blood flow indices between the previous cesarean and vaginal delivery groups. We observed no significant difference between the patients with different delivery routes.

Incidence and Antibiogram of Uropathogens Isolated from Pregnant Women Attending Antenatal Clinic in a Public Hospitalin Yola, Adamawa State, Nigeria

Urinary tract infection during pregnancy including asymptomatic bacteriuria has been associated with some adverse outcomes for the mother and foetus. Studies have shown that pregnant women with urinary tract infections have a significantly higher rate of intra-uterine growth restriction, pre-eclampsia, caesarean and pre-term deliveries. This study was undertaken to determine the occurrence, distribution and antibacterial susceptibility pattern of uropathogens among pregnant women attending antenatal clinic in a public hospital in Yola. A total of 200 clean catch mid-stream urine samples were collected from pregnant women and inoculated on cysteine lactose electrolyte deficient agar for bacterial count and isolation of uropathogens. The isolates were also screened for ability to form biofilms using Congo Red Agar method and antibiotic susceptibility test was done on the isolates using agar disk diffusion method. The incidence of UTI among the pregnant women was found to be 90%. The predominant uropathogens were E. coli (46.0%), S. aureus (20.0%) and Klebsiella pneumoniae (17.0%) while the least occurring uropathogen was Proteus sp. (2.0%). Women in the third and first trimester of pregnancy had the highest occurrence of UTI. A total of 47.0% of the isolates produced biofilm in vitro with the highest biofilm production observed among Proteus sp. (75.0%) and Pseudomonas aeruginosa (60.0%) isolates. The occurrence of antibiotic resistance among the isolates was high, with greater susceptibility observed to quinolone and third generation cephalosporin. The E. coli isolates demonstrated varying levels of resistance to all the antibiotics tested. Because of the gravity of problems of UTI in pregnancy and that 9 in 10 pregnant women from this study have symptomatic or asymptomatic infection, it is concluded that pregnant women should be screened for urinary tract infection during antenatal visits especially during the first and third trimesters of pregnancy.

Contemporary maternal and fetal outcomes in the treatment of LQTS during pregnancy: Is nadolol bad for the fetus?

β-Blocker therapy, specifically nadolol, is the recommended treatment for long QT syndrome (LQTS). Previous studies assessing maternal and fetal outcomes were published before the nadolol era. The purpose of this study was to examine contemporary maternal and fetal outcomes in the treatment of LQTS during pregnancy. We queried the Inherited Arrhythmia Database at Cleveland Clinic and identified all pregnant patients with LQTS from January 2001 through January 2020. Collected data included use and timing of β-blockers, maternal arrhythmic events, fetal growth restriction, neonatal hypoglycemia, and bradycardia. Among 68 live-birth pregnancies in 31 women with LQTS (mean age 29 ± 5.9 years; mean corrected QT interval 468 ± 39 ms), there were 5 arrhythmic events in 4 mothers. All arrhythmic events occurred in the postpartum period, and there were no arrhythmic events in patients taking β-blockers. In patients diagnosed with LQTS and treated with β-blockers (n = 27 [41%]), nadolol was the most commonly prescribed agent throughout pregnancy and the postpartum period (n = 16 [60%]). The rate of intrauterine growth restriction was not significantly different in fetuses exposed to β-blockers vs unexposed (P = .08). In the postnatal period, hypoglycemia was not seen and 1 patient in the exposure group had bradycardia. Arrhythmic events were only seen in the postpartum period in those not treated with β-blockers. Events occurred as late as 9 months postpartum. β-Blocker therapy, specifically nadolol, was not associated with a higher incidence of intrauterine growth restriction. Moreover, neonatal bradycardia was rare and hypoglycemia was not observed.

Burden of disease and survival rate amongst hospitalized newborns in Himalayan region in North India.

ABSTRACTObjective:To describe the patient population, priority diseases, and outcomes in neonates admitted to neonatal unit in the Himalayan region of North India.Study Design:The retrospective study was conducted at a University teaching hospital in Himachal Pradesh, and captured anonymized data on all admissions in newborn unit over 6-year period.Results:Total 12449 newborns were admitted, 4669 were outborn, M:F of 1.35:1 and 81% of them were discharged successfully. Overall admissions surged by 76 percent in six years, preterm admissions increased by 41%. During the same period delivery load grew by 24.7%. Majority 64.9% were full-term; 50.4% (6279/12449) of neonates were low birthweight (LBW; <2.5 kg) and 3.8% were Extreme LBW (ELBW; <1.0 kg). Among intramural, out of 20.2% preterm, 1.8% were <28 week; compared to 1.5% <28 week and 14.1% preterm in extramural. The intrauterine growth restriction rate was 17.6% for intramural and 19.3% for extramural, respectively. The most common morbidities were prematurity (40.2% & 27%), jaundice (32.6% & 27.5%), RDS and respiratory problems (19.2% & 9.8%), sepsis (11.3% & 23.5%), and perinatal asphyxia (6.2% and 7.5%) among inborn and outborn respectively. Total 798 (6.4%) newborns died, 10.5% of all deaths happened within 24 hours; mortality was very high amongst ELBW (110/205, 53.7%) and very preterm infants <28 weeks (81/135,60%). Only 993 inborn and 18 outborn received antenatal corticosteroids, with only 383 inborn and 4 outborn receiving four doses of Dexamethasone. Low gestational age, LBW, less of antenatal corticosteroids, outborns, male sex, and congenital deformity were all found to have a significant association with death (P < 0.001).Conclusion:Preterm accounts for a considerable majority of our total admissions. Greater efforts and investment in better prenatal care, infrastructure, therapeutic facilities, manpower, and periodic training and review of staff nurses are all urgently needed to address the extremely high burden of illnesses and mortality among hospitalized newborns; otherwise, lowering the NMR will remain an unattainable goal.

Effect of Maternal Catalase Supplementation on Reproductive Performance, Antioxidant Activity and Mineral Transport in Sows and Piglets.

This experiment was conducted to investigate the effects of maternal catalase (CAT) supplementation on reproductive performance, antioxidant enzyme activities, mineral transport, and mRNA expression of related genes in sows and offspring. A total of 40 pregnant sows at 95 days of gestation with similar parity (3-5 parities) and back-fat thickness were assigned randomly and equally into the control (CON) group (fed a basal diet) and CAT group (fed a basal diet supplemented with 660 mg/kg CAT; CAT activity, 280 U/g). The reproductive performance was recorded, and the placenta and blood samples of sows and neonatal piglets, as well as the jejunum and ileum samples from neonatal boars (eight replicates per group), were collected. Results showed that dietary supplementation with CAT significantly decreased the intrauterine growth restriction (IUGR) rate and increased the activity of serum CAT in neonatal piglets and umbilical cords (p &lt; 0.05). In addition, CAT supplementation tended to improve total antioxidant capacity (T-AOC) levels in the maternal serum (p = 0.089) and umbilical cords of piglets (p = 0.051). The serum calcium (Ca), manganese (Mn), and zinc (Zn) of farrowing sows and Mn concentration in the umbilical cord, and serum Ca, magnesium (Mg), copper (Cu), and Mn of neonatal piglets were significantly increased (p &lt; 0.05) in the CAT group. CAT supplementation downregulated mRNA expression of TRPV6 and CTR1 (p &lt; 0.05), Cu/Zn SOD (p = 0.086) in the placenta and tended to increase the mRNA expression of the glutathione peroxidase 1 (GPX1) (p = 0.084), glutathione peroxidase 4 (GPX4) (p = 0.063), and CAT (p = 0.052) genes in the ileum of piglets. These results showed that the maternal CAT supplementation improved fetal growth by decreasing the IUGR rate, and modulated antioxidant activity, as well as mineral elements in the pregnant sows and their piglets.

Prediction of Pregnancy Complications With Maternal Biochemical Markers Used in Down Syndrome Screening.

Objective: To determine whether first- and second-trimester maternal serum biomarkers are useful for the prediction of pregnancy complications like preterm birth, intrauterine growth restriction (IUGR), and macrosomia.Methods: We conducted a retrospective analysis of 353 women having first- or second-trimester combined test for Down syndrome screening who delivered at our institution between January 2018 and December 2020. Associations between first- and second-trimester serum markers and adverse pregnancy outcomes among those who underwent prenatal screening for Down syndrome in our clinic were studied. The adverse pregnancy outcomes, serum levels of pregnancy-associated plasma protein-A (PAPP-A), β-human chorionic gonadotropin (β-hCG), and maternal serum alpha-fetoprotein (ms-AFP) were recorded and analyzed. Correlation analyses of PAPP-A, free βhCG, and ms-AFP with pregnancy outcomes were studied. We sought to predict the risks of preterm delivery (PTD, <37 weeks gestational age), low birth weight (LBW, <2500 grams) and macrosomia (>4000 grams).Results: A total of 353 women who had first- and second-trimester screening test for Down syndrome were included. Two hundred fifty (70.08%) of them had first-trimester and 103 (41.2%) had second-trimester test. Mean age of the patients who underwent screening test for Down syndrome was 29.3±5.9, mean maternal weight was 67.3±13.6, mean gestational weeks at birth was 38.6±2.1 weeks and mean birth weight was 3260.9±511.1, preterm birth rate was 40/353 (11.3%), IUGR rate was 21/353 (5.9%), macrosomia rate was 17/353 (4.8%), stillbirth rate was 3/353 (0.8%). When laboratory and clinical parameters affecting birth weight and birth weeks were analysed in correlation analysis, both birth week and birth weight were found to be positively correlated with maternal weight. Of first-trimester markers Papp-A MoM (Multiples of Median) was found to be positively correlated with fetal birth weight (p = 0.044). Of second-trimester biochemical parameters ms-AFP was found to be negatively correlated with fetal birth weight (p = 0.039).Conclusion: The study concluded that there is a relationship between serum markers and adverse pregnancy outcomes. Significant associations were found between the levels of first- and second-trimester serum markers PAPP-A, AFP and IUGR, macromia and additionally significant association was found between maternal weight and both delivery week and fetal weight. These results can highlight the pregnancies at risk and follow-up intervals may be arranged according to risk scala which may help at antenatal follow-up of high-risk patients.

Assisted Reproductive Technology Required to Achieve High Conception Rates, Despite a Low Incidence of Hypogonadotrophic Hypogonadism in Thalassemia and Sickle Cell Disease Patients

BackgroundEarly and effective iron chelation has improved life expectancy and decreased disease complications for people with transfusion dependent thalassemia (TDT) and Sickle Cell Disease (SCD). Fertility challenges and pregnancy complications have historically limited reproductive options in this group, however improved disease management has made subfertility a chronic disease complication requiring attention. Despite this, there are very few reports on rates of conception and pregnancy outcomes in this population.MethodsA 20 year retrospective analysis (1997 - 2017) was performed to evaluate fertility outcomes in women with TDT and SCD at an Australian referral centre. Patients with TDT and SCD who tried to conceive during the study period were included. Use of assisted reproductive technologies (ART), as well as pregnancy outcomes and neonatal and maternal complications were assessed.ResultsEleven women with TDT and 3 with SCD tried to conceive during the study period. Median age at conception was 28 years (range 21-35). A total of 28 pregnancies and 25 live births were reported, including 2 spontaneous early pregnancy losses, a termination for anencephaly and a reduction of triplets. There was 1 multiple gestation in the cohort. At least 1 live birth occurred in 13 of the 14 women (93%). Spontaneous conception was reported in 9 women, of whom 8 had at least one resulting live birth, with a total of 15 live births from spontaneous conception. Of 5 women who were unable to conceive spontaneously, four had a diagnosis of hypogonadotrophic hypogonadism (HH) - two conceived following ovarian stimulation (OS), one required in vitro fertilization (IVF), and one did not pursue IVF following unsuccessful OS. The cause of subfertility was unknown in one patient, who conceived with IVF following failed OS. Three women who had an initial spontaneous conception required assisted reproductive technology (ART) for subsequent pregnancies, with no cause for subfertility identified.Mean ferritin at conception was 2911 mmol/L (range 164 to 8697mmol/L), and there was no association between ferritin at conception and need for ART. A trend was observed between increasing age and use of ART. Nine of the thirteen (69%) women who achieved pregnancy underwent Cesarean section for their first delivery. Prematurity (birth prior to 37 weeks' gestation) occurred in 5 (20%) of live births. Intrauterine growth restriction (IUGR) evidenced by birth weight <10 th centile for gestational age at birth was observed in 7 of 25 births (28%). This included one very low birth weight neonate delivered following induction for suspected IUGR. Respiratory distress syndrome occurred in two neonates in the setting of prematurity (delivered at 31 and 33 weeks gestation), both from women with TDT. Post partum hemorrhage (PPH) occurred after four deliveries in three women with TDT. There were no neonatal or maternal deaths.ConclusionsOur data is the first analysis of fertility and pregnancy outcomes in Australian patients with TDT or SCD. Publications in this area are limited, and primarily report on pregnancy outcomes without capturing failure to conceive. Our findings are encouraging, with high conception rates achieved, with the use of ART where needed. Ferritin level did not predict difficulty with spontaneous conception and few of the women (29%) had HH, despite many having significant hyperferritinemia. Overall, 48% of live births resulted from ART, despite 58% of these patients not having a diagnosis of HH. This indicates that pituitary iron deposition with resultant HH alone does not adequately explain subfertility in this population. Our data also highlight the importance of affordable ART access for this patient population despite the clinical gains achieved with effective chelation therapy.Pregnancies were largely uncomplicated with excellent maternal and foetal outcomes. A high rate of IUGR was observed, supporting classification of pregnancy in this population as high risk. Rates of Cesarean section for first delivery were more than double the Australian average, likely in part due to high IUGR rates. Neonatal complications and PPH occurred at general population rates. Guidelines around pregnancy management in this population abound, however large prospective studies are needed to identify those at risk of sub- and infertility, even in the era of effective chelation. DisclosuresNo relevant conflicts of interest to declare.

Incidence of childhood hearing loss after in utero exposure to platinum agents.

When treated for childhood cancers, at least 50% of children exposed to platinum agents have permanent hearing loss. We determined the relative risk of childhood hearing loss after in utero exposure to platinum chemotherapy in our registry cohort. After exposure to platinum chemotherapy in utero, all children undergo routine newborn hearing screening. This consists of Otoacoustic Emissions. Children who failed this screen were evaluated by audiologists. For those children with hearing loss by Automated Auditory Brainstem Response, prenatal and postnatal treatment details were compared to platinum exposed children without hearing loss. Three hundred and seven children were exposed to chemotherapy in utero. Four children were diagnosed with hearing loss, all exposed to platinum agents. Chemotherapy exposures included: Cisplatin/Paclitaxel (2), Etoposide/Cisplatin/Bleomycin (1), Carboplatin/Paclitaxel (1) to treat ovarian (2), or cervical cancer (2). Of the 39 platinum exposed without hearing loss: 11 children were exposed to oxaliplatin, 16 were exposed to cisplatin and 12 to carboplatin in utero. Two hundred and sixty four women received non-platinum based chemotherapy for various cancers during pregnancy. Among these, there were no cases of hearing loss. There was a significant difference in hearing loss based on exposure to platinum agents in utero compared to non-platinum-containing chemotherapy regimens, 4/43 versus 0/264, p=0.0003. There were no statistical differences in prenatal and postnatal treatment details, including: gestational age at diagnosis, at first chemotherapy treatment, at first platinum treatment, at delivery (<32weeks, <35weeks, <37weeks), gender, birthweight, birthweight percentile, rates of intrauterine growth restriction, neonatal complications or use of postnatal antibiotics between the platinum exposed children with and without hearing loss. The only children in the registry exposed to chemotherapy who were diagnosed with hearing loss had been exposed to cisplatin or carboplatin in utero. No hearing loss occurred in children exposed to oxaliplatin, or non-platinum agents. Due to a concern for cisplatin ototoxicity, carboplatin is the preferred platinum agent for use in pregnancy when equivalent maternal survival can be expected for the particular cancer type. For newborns exposed to platinum agents in utero, newborn screening with an auditory emissions test at birth (OES) may not detect sensorineural hearing loss and auditory brainstem response testing is recommended, regardless of the newborn screening result.

Rheumatic heart disease in pregnancy and neonatal outcomes: A systematic review and meta-analysis.

PurposeAssociations between rheumatic heart disease (RHD) in pregnancy and fetal outcomes are relatively unknown. This study aimed to review rates and predictors of major adverse fetal outcomes of RHD in pregnancy.MethodsMedline (Ovid), Pubmed, EMcare, Scopus, CINAHL, Informit, and WHOICTRP databases were searched for studies that reported rates of adverse perinatal events in women with RHD during pregnancy. Outcomes included preterm birth, intra-uterine growth restriction (IUGR), low-birth weight (LBW), perinatal death and percutaneous balloon mitral valvuloplasty intervention. Meta-analysis of fetal events by the New-York Heart Association (NYHA) heart failure classification, and the Mitral-valve Area (MVA) severity score was performed with unadjusted random effects models and heterogeneity of risk ratios (RR) was assessed with the I2 statistic. Quality of evidence was evaluated using the GRADE approach. The study was registered in PROSPERO (CRD42020161529).FindingsThe search identified 5949 non-duplicate records of which 136 full-text articles were assessed for eligibility and 22 studies included, 11 studies were eligible for meta-analyses. In 3928 pregnancies, high rates of preterm birth (9.35%-42.97%), LBW (12.98%-39.70%), IUGR (6.76%-22.40%) and perinatal death (0.00%-9.41%) were reported. NYHA III/IV pre-pregnancy was associated with higher rates of preterm birth (5 studies, RR 2.86, 95%CI 1.54–5.33), and perinatal death (6 studies, RR 3.23, 1.92–5.44). Moderate /severe mitral stenosis (MS) was associated with higher rates of preterm birth (3 studies, RR 2.05, 95%CI 1.02–4.11) and IUGR (3 studies, RR 2.46, 95%CI 1.02–5.95).InterpretationRHD during pregnancy is associated with adverse fetal outcomes. Maternal NYHA III/IV and moderate/severe MS in particular may predict poor prognosis.

Outcomes of pregnancies diagnosed with circumvallate placenta, and use of uterine artery pulsatility index and maternal serum alpha-fetoprotein for prediction of adverse outcomes

ObjectivesTo evaluate the outcomes, and predictive value of uterine artery pulsatility index (UtA-PI) and second-trimester maternal serum alpha-fetoprotein (MSAFP) for adverse obstetric outcomes in cases with morphologically confirmed circumvallate placenta by comparison with normal pregnancies. Study designThis prospective study was conducted in a tertiary referral hospital between January 2017 and December 2019. During the study period, 77 patients with a circumvallate placenta and 77 patients without any placental or feto-maternal diseases or abnormalities were evaluated. The final diagnosis was made based on macroscopic examination of the placenta soon after birth. Demographic characteristics, MSAFP, obstetric complications, haemoglobin after delivery, gestational week of birth, fetal sex, 1- and 5-min Apgar scores, postnatal complications and type of delivery were retrieved from hospital records. Bilateral mean transabdominal UtA-PI and MSAFP were evaluated for the prediction of adverse outcomes. SPSS Version 21.0 for Windows was used for statistical analysis, and receiver operating characteristic (ROC) curves were used for the prediction model of adverse outcomes. ResultsSmoking rate, MSAFP, preterm birth and intrauterine growth restriction (IUGR) were higher in the patients with a circumvallate placenta (p = 0.005, 0.00, 0.025 and 0.027, respectively). The cut-off value of MSAFP was 1.41 (0.60–3.32) and the cut-off value of UtA-PI was 1.2 using the ROC curves, and had sensitivity of 73.7 % and specificity of 71.9 %, and sensitivity of 73.7 % and specificity of 76.3 %, respectively (p < 0.05). ConclusionsCircumvallate placenta was associated with a higher rate of IUGR, preterm birth and bleeding at the time of delivery. In patients with a circumvallate placenta, UtA-PI and MSAFP may be valuable as predictors of IUGR.

Maternal yeast-based nucleotide supplementation decreased stillbirth by regulating nutrient metabolism.

As an enzymatic product of yeast, yeast-based nucleotide (YN) is rich in nucleotides. To test the effects of maternal dietary supplementation with YN during late pregnancy on placental nutrient transport and nutrient metabolism in neonatal piglets, 64 pregnant sows (day 85 ± 3) were assigned into two groups: (i) control (CON) and (ii) treatment (YN; 4g kg-1 ). Blood, placenta and liver samples of neonates during delivery were collected. The results showed that maternal YN supplementation decreased stillbirth rate and intra-uterine growth restriction rate (P < 0.05). In addition, maternal YN supplementation increased total serum protein, albumin and total cholesterol (P < 0.05). Furthermore, in neonatal piglets in the YN group, both serum amino acidand nucleotide profiles were affected, as well as liver amino acid, and fatty acid profiles were regulated (P < 0.05). Moreover, maternal YN supplementation increased liver mRNA expression of SLC28A3, SLC29A1, SLC29A2, PC, PCK1, FBP1, SREBP1c, HSL and CYP7a1 of neonatal piglets (P < 0.05). Meanwhile, there was a decrease in placental gene expression of EAAT2, EAAT3, LAT1 and PAT1, as well as lower protein expression of peroxisome proliferator-activated receptor (PPAR)γ, AKT, phosphorylated-AKT, phosphorylated-mammalian target of rapamycin (mTOR) and Raptor, in the YN group (P < 0.05). Taken together, these results indicate that maternal YN supplementation regulates placental nutrient transport by regulating the mTOR complex 1-PPAR pathway, and affects the liver metabolism of nucleotides, amino acids and fatty acids in neonatal piglets, thereby improving the reproductive performance of sow to a certain extent. © 2020 Society of Chemical Industry.

Low incidence of intrauterine growth restriction in pregnant patients with systemic lupus erythematosus taking hydroxychloroquine

Systemic lupus erythematosus (SLE) preferentially affects women of childbearing age. Miscarriages or fetal death, intrauterine growth restriction (IUGR), preterm delivery, preeclampsia and disease flares complicate pregnancy in SLE patients. Treatment is challenging due to the need to prevent disease exacerbations and limit obstetrical complications, while showing an acceptable safety profile for both the mother and the fetus. We collected data from 74 pregnancies in 53 SLE patients prospectively followed in a dedicated ‘Pregnancy at risk’ outpatient clinic from 2003 to 2019. Out of 74, 45 pregnancies patients were treated with hydroxychloroquine (HCQ). Mothers under HCQ therapy (HCQ+ patients) and those who did not receive HCQ (HCQ−) were homogeneous in terms of age and comorbidities. Disease activity prior to conception was slightly higher in HCQ+ patients. No significant difference was observed in terms of obstetrical history. In patients achieving a viable pregnancy, the rate of IUGR (4/39, 10% in HCQ+ vs 8/25, 32%, in HCQ− patients, p < .05) was significantly lower in HCQ+ patients. Conversely, HCQ+ patients displayed a significantly longer time to delivery (37.8 ± 1.72 vs. 36.3 ± 4.11 in HCQ− patients, p < .05). HCQ is safe in pregnant patients with SLE and protects against obstetrical complications.

The effect of aspirin on preeclampsia, intrauterine growth restriction and preterm delivery among healthy pregnancies with a history of preeclampsia.

Background:Due to the significance of preeclampsia (PE) and its adverse outcomes in the health of both mother and newborn, the present study was carried out to investigate the effect of aspirin on preventing the occurrence of PE, intrauterine growth restriction (IUGR), and preterm delivery in women with a previous history of PE.Methods:The present clinical trial was conducted on 90 pregnant women with a previous history of PE referred to the Khalij Fars Hospital in Bandar Abbas, Hormozgan Province Iran from April 2017 to August 2018. The subjects of the study were randomly assigned into two groups of intervention and control to receive either 80 mg of aspirin or placebo daily during the pregnancy. Patients’ information was obtained and recorded upon entering the study, follow-up visits, and childbirth.Results:Among participants who entered the clinical trial, 86 patients (95.6%) completed the study. During the pregnancy, systolic blood pressure increased by 8.25 ± 14.83 and 19.06 ± 18.33 mmHg in aspirin and placebo groups, respectively (p = 0.001). Also, the same happened with diastolic blood pressure (6.12 ± 11.46 vs 13.48 ± 13.95 mmHg, p = 0.010). The rate of PE was equal to 27 (62.8%) and 38 (88.4%) in the aspirin and placebo groups, respectively (aOR = 0.23, p = 0.013). In the aspirin group, the rate of IUGR was equal to 27.9% compared with 25.6% of newborns in the control group (aOR = 1.18, p = 0.750). Similarly, there was no significant difference in the rate of preterm delivery between the two groups (p = 0.061).Conclusion:The findings of the present study conducted exclusively on women with previous documented PE revealed that taking aspirin may have a preventive effect on PE in the current pregnancy.

Maternal and Microorganism Characteristics Cannot Predict Adverse Outcome in Pregnancies Complicated With Urinary Tract Infection

Background Previous studies revealed different results on the impact of urinary tract infection on pregnancy outcomes. Inconsistent data on adverse outcomes such as preterm delivery, low birth weight, and intrauterine growth restriction (IUGR) are reported in several studies. Methods Microorganisms were classified into 4 groups; Enterobacteriaceae, gram-positive cocci, fungi and others. Adverse pregnancy outcome was defined in the presence of IUGR, preterm delivery, low birth weight, and low appearance, pulse, grimace, activity, and respiration score. Adverse and no adverse outcome groups were compared. Results The total number of women with a positive urinary culture was 186. The most common isolated microorganism was Escherichia coli (n = 111, 59.7%). Among E. coli isolates, resistance was most common to ampicillin and trimethoprim sulfamethoxazole. The mean gestational week was 23.3 ± 1.12 for the urinary tract infection onset time and recurrence rate was 11.8% (n = 22). Oral antibiotics were prescribed to 164 outpatient women and hospitalization was required in 22 cases (11.8%). The rates of IUGR, low birth weight, low appearance, pulse, grimace, activity, and respiration, and preterm delivery were 11.8%, 11.3%, 6.9%, and 17.7%, respectively. There were 137 women (73.7%) in no adverse outcome group, whereas 49 women (26.3%) were in adverse outcome group. There was no significant difference in terms of bacteria group and maternal characteristics between 2 groups (P &lt; 0.05 for all). Conclusions Maternal and microorganism characteristics are similar in pregnancies complicated with urinary infections in terms of adverse outcome. It is not possible to predict the ongoing pregnancy course by identifying maternal and microbiological features.