Maternal Adverse Effects Research Articles

Severity of pulmonary hypertension and pregnancy outcomes: newer insights from the M-PAC registry

Abstract Background Pregnancy outcomes in women with pulmonary hypertension remain suboptimal. Pregnant women with pulmonary hypertension (PH) are placed in the modified WHO category IV, regardless of the severity or etiology of PH. Earlier studies have indicated that pregnancy outcomes may differ based on the etiology, with more favourable outcomes observed with PH related to left to right shunts. However, it is possible that the pregnancy outcomes may vary based on the severity of PH also. Purpose To analyse pregnancy outcomes in women with PH and investigate differences based on disease severity. Methods M-PAC Registry, is a single center prospective study of pregnancies in women with heart diseases, conducted between July 2016 and December 2019 in a low-and middle-income country from South Asia, whose methodology and outcomes have been published(1). The current study analysed pregnancies with PH enrolled in the M-PAC registry. The tricuspid regurgitation velocity obtained during transthoracic echocardiography, was used to estimate right ventricular systolic pressure (RVSP). Based on the estimated RVSP, PH was classified into three groups; mild (36-45 mm of Hg), moderate (46-64 mm of Hg) and severe (≥ 65 mm of Hg). The differences in the maternal and foetal outcomes among the groups were analysed. Results Of the 1029 pregnancies complicated by heart disease enrolled in the M-PAC registry, 352(34.2%)had PH. Among these 352 pregnancies, 186(52.8%) had mild, 73 (20.7%) had moderate and 93 (26.5%) had severe PH. Adverse maternal cardiac events occurred in 77 pregnancies (21.8%), with heart failure in 53(15.1%) and mortality in 10(2.8%). The composite adverse foetal event rate was 38.6%, foetal loss at 9.7%, low birth weight at 28.9%, and preterm labour at 7.1%. The mean (±standard deviation) RVSP was higher in pregnancies with adverse maternal outcome (58.81±16.9 vs 51.16±15.9; P < 0.001) or adverse foetal outcome (58.10±17.3 vs 49.52±14.9; P < 0.001)compared to those without. When comparing the three groups, pregnancies with mild PH exhibited significantly lower rates of adverse maternal and fetal events compared to those with severe and moderate PH (Fig-1 and Table-1). Mild PH was associated with outcomes similar to those without PH in the M-PAC registry. Conclusion The severity of PH significantly correlated with the adverse pregnancy outcomes. Women with mild PH tend to experience pregnancy outcomes comparable to those without PH, suggesting that pregnancy should not be deemed contraindicated in this subgroup. Therefore, re-evaluation of the placement of PH within the modified World Health Organization (mWHO) classification is warranted, considering the severity of PH.Figure 1:Pregnancy Outcomes & PH SeverityTable-1 PH Severity & Pregnacny Outcomes

Prolonged transcranial magnetic stimulation in a pregnant patient with treatment-resistant depression: a case report

IntroductionPerinatal depression is a serious and highly prevalent medical condition in the USA. Nearly 85% of individuals with perinatal depression go untreated, leading to significant morbidity and mortality. There is an urgent need to develop and advance safe and effective treatments for perinatal depression. Transcranial magnetic stimulation is an established intervention for depression in non-pregnant individuals yet is not well studied in perinatal depression.Case presentationA 33-year-old pregnant Latina female presented with severe, recurrent, treatment-resistant depression and suicidal ideation. The patient had previously trialed psychotherapy, multiple antidepressants, and mood stabilizers and had achieved remission with lithium prior to pregnancy. Due to pregnancy and fetal safety concerns, the patient discontinued lithium and consequently suffered progressive worsening of perinatal depression. At 24 weeks gestation and after additional failed medication trials, a prolonged course of transcranial magnetic stimulation was initiated. Following 46 transcranial magnetic stimulation treatments over 9 weeks using two protocol types (repetitive transcranial magnetic stimulation and intermittent theta burst stimulation), she achieved near-remission of perinatal depression and resolution of suicidal ideation. There were no identified maternal or fetal adverse events at 6 weeks post-delivery.ConclusionTo our knowledge, this is the first published case of a pregnant individual with perinatal depression who received and tolerated a prolonged transcranial magnetic stimulation course with two distinct protocols (repetitive transcranial magnetic stimulation and intermittent theta burst stimulation) with clinically significant response. Transcranial magnetic stimulation is a well-tolerated and effective intervention that warrants further investigation for use in treatment-resistant perinatal depression.

Routine uptake of prenatal iron-folic acid supplementation and associated factors among pregnant women in peri-urban areas of Dodoma City, Tanzania: a cross-sectional study

BackgroundThe physiological requirements for iron and folic acid in pregnancy are a significant challenge to achieve through normal dietary intake, especially in low resource settings. The World Health Organization recommends daily oral iron and folic acid supplementation (IFAS) to prevent maternal anaemia and related adverse effects in community settings where the prevalence of anaemia during pregnancy is > 40%. The objective of this study was to assess the routine uptake of prenatal iron-folic acid supplementation and associated factors among pregnant women at peri-urban areas of Dodoma City, Tanzania.MethodsA cross-sectional study was conducted in peri-urban areas. Data was collected through face-to-face interviews and review of records from maternal clinic card (RCH 4 card). Routine uptake of iron-folic acid supplementation was defined as pregnant woman who reported taking iron-folic acid supplements at least once within the past seven days prior to data collection. Frequency and percentage were used to report respondents’ characteristics and uptake of prenatal iron-folic acid supplementation. Chi-square test and logistic regression were conducted to determine the relationship and association of routine uptake of iron-folic acid supplementation with respondents’ characteristics.ResultsThe total respondents were 452. Overall routine uptake of iron-folic acid supplementation was 35.6% (161). The majority of the respondents (66.5%) initiated iron-folic acid supplementation during the second trimester of pregnancy. Most of the respondents (86.3%) obtained IFA supplements at the health centers where they were receiving antenatal care. The prevalence of routine uptake of iron-folic acid supplementation was significantly higher among women in the third trimester of pregnancy (54.9%), those with more than a five-year interval since last pregnancy (40.6%), those with at least four antenatal care (ANC) visits (73.7%) and women who had undergone haemoglobin testing in the current pregnancy (63.0%). Factors associated with routine uptake of iron-folic acid supplementation were; frequency of ANC visits (AOR = 1.69) and haemoglobin testing (AOR = 3.02).ConclusionApproximately one third of the pregnant women took iron-folic acid supplementation at least once a week. The current frequency for intake of iron-folic acid supplementation can be described as intermittent. This practise is unacceptable for prevention of maternal anaemia and associated adverse pregnant outcomes. Frequency of ANC visits and haemoglobin testing during pregnancy were found to be associated with routine uptake of iron-folic acid supplements. Stakeholders are urged to consider novel systems for provision of prenatal IFAS in community settings with limited access to health-care professionals to ensure a timely and continuous supply of supplements.

Maternal Complications After Laser Surgery for Twin-to-Twin Transfusion Syndrome, a Cohort Study.

To assess maternal complications after fetoscopic laser surgery (FLS) for the twin-to-twin transfusion syndrome (TTTS). All consecutive cases treated with FLS for TTTS between 2008 and 2021 at the Leiden University Medical Center (LUMC) were included. We allocated complications in three timeframes: "Admission for laser surgery," "pregnancy after laser," and "delivery and third stage of labor." Maternal complications were graded according to the Maternal and Fetal Adverse Event Terminology (MFAET) and for intra-abdominal hemorrhage, the Common Terminology Criteria for Adverse Events (CTCAE). In the study period, 637 mothers were treated for TTTS with FLS. There were 1559 occurrences of maternal complications. The rate of severe maternal complications (grade 3 or 4) was 8.0%. Severe complications consisted of six cases of severe intra-abdominal hemorrhage, nine cases of severe hemorrhage in pregnancy, one with severe chorioamnionitis, 10 with severe preeclampsia/HELLP syndrome, and 25 with a severe postpartum hemorrhage. Even though it is the gold standard for treating TTTS, FLS comes at a risk to the mother which should not be neglected. And even though not all complications have serious consequences to the mother, the severe maternal complication rate of 8.0% should be added to the inherent risks for the fetus, and should be discussed with patients eligible for surgery in order to make an informed decision on treatment options.

Safety of contrast-enhanced ultrasound using microbubbles in human pregnancy: A scoping review.

Successful placentation is crucial for fetal development and maintaining a healthy pregnancy. Placental insufficiency can cause a variety of obstetric complications. Despite the many efforts to enhance diagnosing placental insufficiency, no imaging technique has proven satisfactory. A promising imaging technique is contrast-enhanced ultrasound (CEUS) using microbubbles which has proven capable of (micro)vascular imaging. Its use for placental vascularization assessment in human pregnancies remains constrained by limited evidence and safety concerns. This scoping review aims to demonstrate the safety of CEUS used in human pregnancy in the published literature to date. A systematic search using PubMed, Medline, Embase, and Cochrane databases was performed. All studies where contrast-enhanced ultrasound was used in pregnant humans were included. Studies, where there was a planned termination of pregnancy, were excluded. To assess the safety of CEUS during pregnancy, relevant outcomes were divided into the following 3 categories; fetal outcome, maternal outcome, and pregnancy and neonatal outcomes. A total of 13 articles were included, in which 256 women underwent CEUS during pregnancy. No clinically significant maternal or fetal adverse events or negative pregnancy or neonatal outcomes associated with CEUS were described. Based on our findings, we consider expanding the knowledge of this promising diagnostic technique in future larger clinical studies to be safe and relevant.

Management of spinal trauma in pregnant patients: A systematic review of the literature.

Despite the high incidence of spine trauma globally, traumatic spinal cord injury (tSCI) during pregnancy is considered a rare medical emergency. The literature on acute management of these patients is sparse compared with that of mothers with preexisting tSCI. This systematic review aims to evaluate management strategies for tSCI during pregnancy in improving neurologic, obstetric, and neonatal outcomes. A systematic review of PubMed/MEDLINE was performed without language restriction from inception until November 2, 2023 for patients who acquired tSCI during pregnancy. Excluded articles described postpartum trauma, trauma before pregnancy, or SCI of nontraumatic etiology such as neoplastic, vascular, hemorrhagic, or ischemic origin. Primary outcomes investigated were maternal American Spinal Injury Association (ASIA) grade, pregnancy termination, cesarean delivery, prematurity, and neonatal adverse events. Data from 73 patients were extracted from 43 articles from 1955 to 2023. The mothers' median age was 24 years (interquartile range, 23-30 years), and the average gestational age at the time of injury was 21.1 ± 7.7 weeks. The thoracic spine was the most common segment affected (41.1%) and had the greatest proportion of complete tSCI (46.6%). Furthermore, ASIA score improvement was observed in 17 patients with 3 patients experiencing a 2-score improvement and 1 patient experiencing a 3-score improvement. Among these patients, 86% of ASIA B and 100% of ASIA C patients showed neurologic improvement, compared to only 17% of ASIA A patients. Surgically managed patients had a lower rate of neonatal adverse events than conservatively managed patients (11% vs. 34%). Acute tSCI requires a coordinated effort between a multidisciplinary team with careful consideration. While maternal neurologic improvement was observed more often following a better ASIA grade on presentation, the presence of neonatal adverse events was less common in patients treated with surgery than in patients who were managed conservatively. Systematic Review; Level IV.

Associations of multiple risk factors with prenatal depression and anxiety: Evidence from the Tianjin Birth Cohort (TJBC) study

BackgroundAntenatal mental disorders are associated with maternal and fetal adverse events. Previous studies have been focused on the postpartum period, rather than pregnancy, yet the association of risk factors with prenatal depression and anxiety through pregnancy has been rarely reported. This study aimed to identify the risk factors of prenatal depression and anxiety, and access their potential roles in developing mental disorders during pregnancy. MethodsThis is a prospective study in 6470 participants from the Tianjin Birth Cohort in China (TJBC). The degree of prenatal depression and anxiety was evaluated using a questionnaire of Self-Rating Depression scale (SDS) and Self-Rating Anxiety Scale (SAS), which was given to pregnant women at 15–27 (Stage-2), and 28–41 (Stage-3) gestational weeks. The questionnaire also collected demographic, personal, and lifestyle information. The association of different factors with SDS/SAS score was examined by logistic regression analysis. ResultsWe observed an overall depression rate of 12.4 % and an overall anxiety rate of 7.7 % during pregnancy in the TJBC. In the Stage-2, the depression rate was 14.5 % and the anxiety rate was 9.5 %. In the Stage-3, the depression rate dropped to 9.7 % while the anxiety rate dropped to 5.3 %. With univariate analysis, we found that age, education, social support, marriage satisfaction, secondhand smoke (SHS), sleeping time and stress were common factors of prenatal mental health. Working status, family income, gravidity, smoking, electronic using, recreational activities were associated with depression risk, whereas BMI, disease history, changing eating habits, and feeding animal were associated with anxiety risk. Using logistic regression, we found that low education level, low social support, low marriage satisfaction, thyroid disfunction, Stage-2(second trimester), and stress were related to prenatal mental health. ConclusionThe prevalence anxiety and depression in Tianjin is normal as national level. Age appropriateness, a good education level, sufficient social support, marital satisfaction, normal thyroid function, and absence of stress are associated with relieving depression and anxiety during gestation. However, due to individual difference, expectant mothers should seek professional support and guidance to address their mental health needs during gestation.

Preeclampsia and timing of delivery: Disease severity, maternal and perinatal outcomes

ObjectivesThis study aimed to elucidate clinical characteristics, disease severity, and obstetric outcomes in women with pregnancy complicated with preeclampsia stratified by gestational age at delivery. Study designThis retrospective study was conducted at a tertiary care facility from January 2011 to December 2020. Main outcome measuresMaternal characteristics, risk factors, clinical signs and symptoms, laboratory test results, and maternal and perinatal outcomes were compared between early (<34 weeks) versus late (≥34 weeks) and preterm (<37 weeks) versus term (≥37 weeks) preeclampsia. ResultsMore than half of the women (56 %, 612/1094) had preterm preeclampsia. Overall, 30 % (329/1094) delivered before 34 weeks of gestation. Pregnancies with early preeclampsia had the worst maternal signs and symptoms, the highest median blood pressure level, and more abnormal laboratory abnormalities compared to those with late preeclampsia. Additionally, women with co-morbid diseases (chronic hypertension, chronic kidney disease, and systemic lupus erythematosus) were more likely to develop early than late preeclampsia. Of note, although adverse maternal and perinatal events occurred more commonly in early rather than late preeclampsia, 18 % (7/39) of eclampsia and 16 % (8/50) of hemolysis, elevated liver enzymes, and low platelet count syndrome cases occurred after 37 weeks of gestation. ConclusionsEarly preeclampsia posed the highest risk to the mother and infant(s); however, adverse maternal and perinatal events were still present even in cases of preeclampsia at term. Therefore, it is crucial for healthcare practitioners to remain vigilant and manage all cases with great care to prevent adverse outcomes.

Omega-3 reverses the metabolic and epigenetically regulated placental phenotype acquired from preconceptional and peri-conceptional exposure to air pollutants

Air pollution is detrimental to pregnancy adversely affecting maternal and child health. Our objective was to unravel epigenetic mechanisms mediating the effect of preconception, periconception, and gestational exposure to inhaled air pollutants (AP) upon the maternal and placental-fetal phenotype and explore the benefit of an omega-3 rich dietary intervention. To this end, we investigated intranasal instilled AP during 8 weeks of preconception, periconception, and gestation (G; D0 to 18) upon GD16-19 maternal mouse metabolic status, placental nutrient transporters, placental-fetal size, and placental morphology. Prepregnant mice were glucose intolerant and insulin resistant, while pregnant mice were glucose intolerant but displayed no major placental macro-nutrient transporter changes, except for an increase in CD36. Placentas revealed inflammatory cellular infiltration with cellular edema, necrosis, hemorrhage, and an increase in fetal body weight. Upon examination of placental genome-wide epigenetic processes of DNA sequence specific 5′-hydroxymethylation (5′-hmC) and 5′-methylation (5′-mC) upon RNA sequenced gene expression profiles, revealed changes in key metabolic, inflammatory, transcriptional, and cellular processing genes and pathways. An omega-3 rich anti-inflammatory diet from preconception (8 weeks) through periconception and gestation (GD0-18), ameliorated all these maternal and placental-fetal adverse effects. We conclude that preconceptional, periconceptional and gestational exposures to AP incite a maternal inflammatory response resulting in features of pre-existing maternal diabetes mellitus with injury to the placental-fetal unit. DNA 5′-mC more than 5′-hmC mediated AP induced maternal inflammatory and metabolic dysregulation which together alter placental gene expression and phenotype. A dietary intervention partially reversing these adversities provides possibilities for a novel nutrigenomic therapeutic strategy.

Prevalence of and Factors Associated With Adverse Maternal Obstetrical Events Among Teenage Mothers Delivering in a Tertiary Referral Hospital in Southwestern Uganda.

Many female teenagersin low-resource settings conceive, of which half are unplannedand end in many deaths in sub-Saharan Africa, accounting for the majority of the cases. Teenage pregnancy is associated sometimes with poor maternal, newborn, and child deaths. The aim of the study was to determine the prevalence, maternal obstetric outcomes, and factors associated with poor maternal obstetric outcomes among teenage mothers delivering at Mbarara Regional Referral Hospital. This was a cross-sectional study carried out in a maternity ward at Mbarara Regional Referral Hospital, where 9,200 mothers deliver annually. All the women coming in for the delivery of their babies were consecutively approached for inclusion in the study. The women were enrolled in the post-delivery ward after delivery and interviewed with pretested questionnaires to capture the sociodemographic, obstetric, and medical profiles of the mothers. Factors were significant if the p-value was <0.05. Results:Out of the 327 participants, the majority were rural dwellers (68.5%), married (75.8%), attained primary education (69.4%), had not used contraception (89%), and had had a planned pregnancy (63.3%). The prevalence of adverse maternal obstetrical events was 59.9%. The HIV-positive rate was 4.9%, and about half of the participants had delivered by cesarean section (41.6%). The participants' mean age was 18.4 yearsand SD 1.1. The mean number of antenatal care contacts attended was 4.59 and SD 1.9. The adverse maternal outcomes includedepisiotomy (30.9%), perineal tear (18.7%), premature rupture of membranes (10.1%), placenta abruption (5.2%), and pre-eclampsia/eclampsia (4%). Having a cesarean delivery was found to significantly reduce the occurrence of adverse maternal obstetric events among the participants by 97% (adjusted odds ratio (aOR) (95% CI) of 0.03 (0.02-0.06), p-value<0.001). Having a prior history of a miscarriage was significantly associated with the occurrence of adverse maternal obstetrical events among the participants (aOR (95% CI) of 6.55 (1.46-29.42), p-value0.014). Slightly more than half of the teenage mothers had adverse maternal obstetrical outcomes, and a history of a miscarriage in previous pregnancieswas significantly associated with adverse maternal obstetrical outcomes. Having a cesarean delivery was found to significantly reduce the occurrence of adverse maternal obstetric events among the participants. Teenage mothers are at a high risk of adverse maternal obstetrical outcomes, and close antepartum and intrapartum surveillance is recommended.

The significance of different intervertebral spaces in combined spinal epidural anesthesia in cesarean section.

The number of cesarean sections performed is increasing every year, and obstetric anesthesia is of great interest to physicians and research scholars because of its specificity, high risk, and high complication rate. To investigate the effects of combined spinal epidural anesthesia (CSEA) with different intervertebral spaces during cesarean section on anesthesia effect, anesthesia onset time, anesthesia recovery time, maternal adverse reactions, and neonates. Ninety-two women who underwent cesarean section in our hospital from September 2022 to February 2023 were selected as the study subjects and randomly divided them into two groups (group A and group B), 46 women in each group. Group A underwent CSEA via an L2-3 gap and group B underwent CSEA via an L3-4 gap puncture. The anesthesia effect, anesthesia onset time, sensory recovery time, adverse effects, and neonatal Apgar score were compared between the two groups. When CSEA was performed from L2-3, the anesthesia efficiency was higher, but the difference was not statistically significant. When anesthesia was performed by puncture from L2-3, the onset of anesthesia and recovery time was shorter, and the incidence of intraoperative maternal nausea and vomiting, hypotension, respiratory depression, and other adverse reactions was low with a statistically significant difference. However, the Apgar scores of the neonates in the two groups have no difference. When CSEA is induced via L2-3 interspace, anesthesia has a rapid onset of action, shorter recovery time, and few maternal adverse effects, without affecting the final anesthetic outcome.

Is intrathecal bupivacaine plus dexmedetomidine superior to bupivacaine in spinal anesthesia for a cesarean section? A systematic review and meta-analysis.

This study aimed to investigate whether the administration of intrathecal dexmedetomidine as a bupivacaine adjuvant for caesarean section can prolong the duration of analgesia compared with bupivacaine alone. Secondary outcomes included postoperative pain, the time interval to the first analgesic request, the level of sedation, the incidence of adverse effects, and the fetal outcomes. A systematic review and meta-analysis were conducted. The study compared the intrathecal administration of bupivacaine plus dexmedetomidine (group BD) to the intrathecal administration of bupivacaine alone (group B) for cesarean sections. Fourteen publications were included. Among patients who underwent spinal anesthesia for a cesarean section, 514 patients received intrathecal bupivacaine alone, and 533 patients received intrathecal bupivacaine plus dexmedetomidine. The onset of sensory and motor block was essentially the same in both groups; the time for sensory and motor block regression was significantly longer in the BD group. Postoperative Visual Analogue Scale (VAS) values were similar in group BD when compared to group B. Postoperative VAS scores remained consistently low in Group BD compared to Group B, starting from 1 hour after surgery. The level of sedation measured at the end of the cesarean section in both groups was almost similar. No difference in terms of safety, adverse events, and neonatal outcomes was found between the two groups. Use of intrathecal dexmedetomidine for spinal anesthesia in cesarean section significantly prolongs sensory and motor block compared to using bupivacaine alone as an adjuvant. It also improves analgesia after 1 hour with no difference in the incidence of maternal and neonatal adverse effects compared to bupivacaine alone. The optimal dose of dexmedetomidine to use remains to be ingested.

The Effect of Oral Isosorbide Mononitrate Therapy on Umbilical Artery Doppler Resistance Index in Pregnancies with Intrauterine Growth Restriction: A Prospective Randomized Control Trial

Abstract Background Intrauterine growth restriction (IUGR) is associated with impaired placentation. Patients who are at risk of developing IUGR can be identified by abnormal umbilical artery Doppler at mid-trimester pregnancy. Nitric oxide (NO)-donors like isosorbide mononitrate reduce the impedance in the uteroplacental vessels and possess protecting effects on the endothelium. Objective To evaluate the efficacy and tolerability of Isosorbide Mononitrate therapy in reducing umbilical artery Doppler resistance index (RI) in pregnancies with fetal growth restriction. Patients and Methods This prospective randomized control trial was conducted at Obstetric Outpatient Clinic – Obstetrics and Gynaecology Department, Faculty of Medicine, Ain Shams University Maternity Hospitals from February 2021 until February 2022 and performed on women who attended ASUMH ECDU with IUGR. Results Finally, as regard side effects of isosorbide mononitrate therapy, our study reported that headache and overall side effects were statistically significant higher compared with control group. Conclusion Evident from the current study, nitric oxide (NO)-donors like isosorbide mononitrate had no prophylactic or therapeutic effects in management of pregnant cases associated with IUGR. It had no improving effect on umbilical artery Doppler or placental circulation. On the other hand it had unfavorable maternal adverse effects.

Real-World Evidence for Utility of Serum sFlt-1/PlGF Test for Routine Clinical Evaluation of Hospitalized Women with Hypertensive Disorders of Pregnancy

An imbalance of the anti-angiogenic factor, soluble fms-like tyrosine kinase-1 (sFlt-1), and pro-angiogenic factor, placental growth factor (PlGF) in the circulation is a reliable predictor for development of preeclampsia with severe features and related adverse outcomes. In 2023, the United States (US) Food and Drug Administration approved a serum sFlt-1/PlGF test at a cut-off of 40 to aid in the risk assessment of women hospitalized for hypertensive disorders of pregnancy (HDP) for the progression to preeclampsia with severe features between 23 and 35 weeks. The purpose of this study was to generate real-world evidence for clinical utility for serum sFlt-1/PlGF test when made available to clinicians in a timely fashion as an aid in risk stratification of development of preeclampsia with severe features within two weeks of testing among hospitalized patients with HDP. Hospitalized patients with HDP between 23 weeks to 34 weeks and 6 days of gestation were prospectively studied from June 2023 to Jan 2024 following implementation of serum sFlt-1/PlGF testing into routine clinical practice. Serum samples were obtained from patients via venipuncture and analyzed on an automated immunoassay platform (PlGF and sFlt-1 assays; Thermo Fisher Scientific). Before implementation, physicians were educated on appropriate use and management guidelines based on biomarkers but made pragmatic management decisions independently. Results of sFlt-1/PlGF tests were available to clinicians within 24 hours of venipuncture. The association between sFlt-1/PlGF ≥ 40 and progression to preeclampsia with severe features and adverse maternal/perinatal outcomes were assessed. Of the 65 patient encounters, 36 had a sFlt-1/PlGF < 40 (55.4%). The rate of delivery for indications related to HDP within two weeks was significantly lower among encounters with a low ratio versus high ratio (2/36 [5.6%] vs 21/29 [72.4%]) even after controlling for relevant confounders (adjusted HR 7.52, 95% CI: 3.05, 18.54; p < 0.001). A diagnosis of preeclampsia with severe features within two weeks of testing was also less likely among the encounters with sFlt-1/PlGF ratio < 40 when compared to sFlt-1/PlGF ratio ≥ 40 (2/36 [5.6%] versus 23/29 [79.3%], p<0.001; PPV 79% [95% CI: 0.65, 0.94] and NPV 0.94 [95% CI: 0.87, 1.00]). The positive and negative likelihood ratios for the development of preeclampsia with severe features within two weeks of testing were 6.13 and 0.09 respectively. Encounters with an sFlt-1/PlGF ratio <40 were less likely to experience a maternal or fetal adverse event as compared to encounters with sFlt-1/PlGF ratio ≥40 (3/36 [8.3%] vs 10/29 [34.5%], p=0.01). Among 36 encounters involving low sFlt-1/PlGF values, 22 had had equivocal clinical or laboratory criteria resembling preeclampsia at presentation but were expectantly managed based on biomarkers and none developed preeclampsia with severe features or adverse outcomes at two weeks. The median latency defined as days between biomarker measurement and delivery in patients with low biomarker ratio was 33 (IQR 23, 47) versus 7 (IQR 4, 14) days among patients with a high ratio (p<0.001). Corticosteroid use within two weeks was also significantly reduced in the low biomarker group when compared to high biomarker group (8/35 [22.9%] vs 24/29 [82.8%], p<0.001). In this study, incorporation of sFlt-1/PlGF ratio into clinical practice serves as a dependable supplement in assessing risk for progression to preeclampsia with severe features and adverse outcomes in patients with HDP in the US. Among patients with a low ratio, pregnancy may be prolonged which resulted in better neonatal outcomes without harm to the mother.

Absence of association between maternal adverse events and long-term gut microbiome outcomes in the Australian autism biobank

IntroductionMaternal immune activation (MIA) and prenatal maternal stress (MatS) are well-studied risk factors for psychiatric conditions such as autism and schizophrenia. Animal studies have proposed the gut microbiome as a mechanism underlying this association and have found that risk factor-related gut microbiome alterations persist in the adult offspring. In this cross-sectional study, we assessed whether maternal immune activation and prenatal maternal stress were associated with long-term gut microbiome alterations in children using shotgun metagenomics. MethodsThis cross-sectional study included children diagnosed with autism (N = 92), siblings without a diagnosis (N = 42), and unrelated children (N = 40) without a diagnosis who were recruited into the Australian Autism Biobank and provided a faecal sample. MIA exposure was inferred from self-reported data and included asthma/allergies, complications during pregnancy triggering an immune response, auto-immune conditions, and acute inflammation. Maternal stress included any of up to 9 stressful life events during pregnancy, such as divorce, job loss, and money problems. Data were analysed for a total of 174 children, of whom 63 (36%) were born to mothers with MIA and 84 (48%) were born to mothers who experienced maternal stress during pregnancy (where 33 [19%] experienced both). Gut microbiome data was assessed using shotgun metagenomic sequencing of the children's faecal samples. ResultsIn our cohort, MIA, but not MatS, was associated with ASD. Variance component analysis revealed no associations between any of the gut microbiome datasets and neither MIA nor MatS. After adjusting for age, sex, diet and autism diagnosis, there was no significant difference between groups for bacterial richness, α-diversity or β-diversity. We found no significant differences in species abundance in the main analyses. However, when stratifying the cohort by age, we found that Faecalibacterium prausnitzii E was significantly decreased in MIA children aged 11–17. DiscussionConsistent with previous findings, we found that children who were born to mothers with MIA were more likely to be diagnosed with autism. Unlike within animal studies, we found negligible microbiome differences associated with MIA and maternal stress. Given the current interest in the microbiome-gut-brain axis, researchers should exercise caution in translating microbiome findings from animal models to human contexts and the clinical setting.

Risk of Adverse Neonatal Events in Pregnancies Complicated by Severe Maternal Morbidity

To investigate the risk of adverse neonatal events after a pregnancy complicated by severe maternal morbidity. We analyzed a population-based cohort of deliveries in Quebec, Canada, between 2006 and 2021. The main exposure measure was severe maternal morbidity, comprising life-threatening conditions such as severe hemorrhage, cardiac complications, and eclampsia. The outcome included adverse neonatal events such as very preterm birth (gestational age <32weeks), bronchopulmonary dysplasia, hypoxic ischemic encephalopathy, and neonatal death. Using log-binomial regression models, we estimated adjusted relative risks (RRs) and 95% confidence intervals (CIs) for the association between severe maternal morbidity and adverse neonatal events. Among 1 199 112 deliveries, 29 992 (2.5%) were complicated by severe maternal morbidity and 83 367 (7.0%) had adverse neonatal events. Severe maternal morbidity was associated with 2.96 times the risk of adverse neonatal events compared with no morbidity (95% CI 2.90-3.03). Associations were greatest for mothers who required assisted ventilation (RR 5.86, 95% CI 5.34-6.44), experienced uterine rupture (RR 4.54, 95% CI 3.73-5.51), or had cardiac complications (RR 4.39, 95% CI 3.98-4.84). Severe maternal morbidity was associated with ≥3 times the risk of neonatal death and hypoxic-ischemic encephalopathy and ≥10 times the risk of very preterm birth and bronchopulmonary dysplasia. Severe maternal morbidity is associated with an elevated risk of adverse neonatal events. Better prevention of severe maternal morbidity may help reduce burden of severe neonatal morbidity.

Modern Management of Pregnancy in Systemic Lupus Erythematosus: From Prenatal Counseling to Postpartum Support.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that predominantly affects women of childbearing age. Pregnancy in SLE patients poses unique challenges due to the potential impact on maternal and fetal outcomes. We provide an overview of the management of SLE during pregnancy, including preconception risk stratification and counseling, treatment, and disease activity monitoring. These assessments are critical to minimize maternal and fetal adverse events in pregnant patients with SLE. Disease flares, preeclampsia, antiphospholipid syndrome complications, and maternal mortality are the major risks for a woman with SLE during gestation. Timely treatment of SLE relapse, differentiation of preeclampsia from lupus nephritis, and tailored management for antiphospholipid syndrome are essential for a successful pregnancy. Fetal outcomes include neonatal lupus (NL), preterm birth, cesarean delivery, fetal growth restriction (FGR), and small-for-gestational-age (SGA) infants. We focused on NL, linked to maternal anti-Ro/SS-A and anti-La/SS-B antibodies, which can lead to various manifestations, particularly cardiac abnormalities, in newborns. While there is a common consensus regarding the preventive effect of hydroxychloroquine, the role of echocardiographic monitoring and fluorinated steroid treatment is still debated. Finally, close postpartum monitoring and counseling for subsequent pregnancies are crucial aspects of care.

Prevalence of and factors associated with placental malaria in the White Nile State: a cross-sectional study.

Malaria during pregnancy can lead to maternal and perinatal adverse effects. Despite the preventive measures, recent research has shown that malaria during pregnancy is still a threatening health problem, especially in Sub-Saharan African countries. The current study was conducted to determine the prevalence of and factors associated with placental malaria in Rabak Hospital in central Sudan. A cross-sectional study was conducted from September to October 2021. Pregnant women who delivered at the Rabak Maternity Hospital in Central Sudan were included. A questionnaire was used to gather both obstetric and socio-demographic information. Blood films for malaria were prepared using the maternal, placental, and cord blood, and a placental histology was performed. A logistic regression analysis was performed. For the 208 women, the medians (interquartile range) of their age and parity were 25 (21.0 ‒30.0) years and 2 (1‒4), respectively. Twenty-five (12.0%) of the women had used insecticide-treated nets. Active infection, active-chronic infection, and past-chronic infection were detected in four (1.9%), five (2.4%), and 35 (16.8%) placentas, respectively. One hundred and sixty-four (78.8%) placentas showed no signs of infection. Logistic regression analysis showed that none of the examined factors (age, parity, education, antenatal care level, use of insecticide-treated nets, and blood group) was associated with placental malaria. Malaria affects 20% of pregnant women, regardless of their age and parity. Preventative measures should therefore be encouraged in this area.

Association between hospital case volume and maternal adverse events in patients with placental abruption: An analysis using a Japanese national inpatient database.

To clarify the relationship between the prognosis of patients with placental abruption (PA) and the healthcare delivery system using data from a large national inpatient database in Japan. Using the Diagnosis Procedure Combination database, we conducted a retrospective cohort study with the data of patients in almost 1000 hospitals with the primary diagnosis of PA who were hospitalized from April 2014 to March 2021. We divided the hospitals into four groups based on the number of deliveries per month. We performed multilevel logistic regression analysis to analyze the relationship between hospital case volume and maternal end-organ injury (MEOI). Altogether, 8222 patients were included for analysis; among whom, 3575 (44%) were transferred by ambulance. MEOI was noted in 977 patients (12%) with no obvious difference by hospital case volume. Ambulance transfer, age, gestational weeks at admission, delivery on the first day of hospitalization, and history of eclampsia were significantly associated with a higher incidence of MEOI, but the hospital case volume was not. Using a Japanese administrative database, our study shows that hospital case volume was not significantly associated with the severity of maternal illness among patients with PA.

Abstract PS13-03: Safety of taxane chemotherapy for the treatment of breast cancer during pregnancy: an international cohort study

Abstract Introduction: The addition of taxanes to anthracycline-based chemotherapy regimens offers increased odds of survival in breast cancer (BC) patients. However, some clinicians defer their use in pregnant patients due to limited evidence supporting safety during gestation. The aim of this study is to describe the prevalence of maternal and neonatal adverse events in BC patients exposed to taxane-containing regimens during pregnancy. Methods: This is an international cohort study of BC patients treated with taxane chemotherapy during pregnancy. Inclusion criteria were age ≥18 years, treatment in a participating center (n=10), and completion of pregnancy. Results: A total of 103 women with a median age of 34 years (range 21-44) were included, of whom the majority (91/101; 90.1%) were also exposed to anthracyclines. The median gestational age at initiation of any chemotherapy agent was 16 weeks (range 4-34), while that of taxanes was 28 weeks (range 12-37). Paclitaxel was the most frequently used taxane (100/103; 97.1%), most prescribed as an 80 mg/m2 weekly infusion. All cases were singleton pregnancies except for one twin gestation. The overall live birth rate was 98.0% (100/102). Median gestational age at delivery was 37 weeks (range 32 to 40), with 36/83 live births being preterm (gestational age of &amp;lt; 37 weeks; 43.4%). Median birth weight was 2700 grams (range 1440-4000). The prevalence of grade 3 to 4 adverse events, obstetric complications, and neonatal outcomes are shown in the Table. A total of 56/58 (96.6%) of neonates had a 5-minute Apgar score ≥7 and 14/88 (15.9%) were admitted to a neonatal intensive care unit. Follow-up beyond the neonatal period was available for 28 neonates (median 42 months, range 1-228), of which reported adverse events were: cardiac abnormality (n=1), speech disorder (n=1), renal disfunction (n=1), and femoral anteversion (n=1). Conclusion: The use of taxane-containing chemotherapy during pregnancy does not seem to increase the risk of obstetric and neonatal complications. Our findings support the use of taxanes during gestation when clinically indicated. Table 1. Reported adverse events with gestational use of taxane-containing chemotherapy regimens. Citation Format: Ana Ferrigno Guajardo, Bryan Vaca-Cartagena, Erica Mayer, Chayma Bousrih, Oluchi Oke, Cristina Saura, Fedro Alessandro Peccatori, Wendy Muñoz-Montaño, Alvaro Cabrera-Garcia, Matteo Lambertini, Luis Corrales, Andrea Becerril-Gaitan, Tal Sella, Alexandra Newman, Barbara Pistilli, Ashley Martinez, Carolina Ortiz, Laia Joval-Ramentol, Giovanna Scarfone, Barbara Buonomo, Fernando Lara-Medina, Jacqueline Sanchez, Luca Arecco, Allan Ramos-Esquivel, Snezana Susnjar, Gilberto Morgan, Cynthia Villarreal-Garza, Hatem Azim. Safety of taxane chemotherapy for the treatment of breast cancer during pregnancy: an international cohort study [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PS13-03.