Maternal Pregnancy Complications Research Articles

Changes in Maternal Heart Rate Variability and Photoplethysmography Morphology after Corticosteroid Administration: A Prospective, Observational Study.

Background: Owing to the association between dysfunctional maternal autonomic regulation and pregnancy complications, assessing non-invasive features reflecting autonomic activity-e.g., heart rate variability (HRV) and the morphology of the photoplethysmography (PPG) pulse wave-may aid in tracking maternal health. However, women with early pregnancy complications typically receive medication, such as corticosteroids, and the effect of corticosteroids on maternal HRV and PPG pulse wave morphology is not well-researched. Methods: We performed a prospective, observational study assessing the effect of betamethasone (a commonly used corticosteroid) on non-invasively assessed features of autonomic regulation. Sixty-one women with an indication for betamethasone were enrolled and wore a wrist-worn PPG device for at least four days, from which five-minute measurements were selected for analysis. A baseline measurement was selected either before betamethasone administration or sufficiently thereafter (i.e., three days after the last injection). Furthermore, measurements were selected 24, 48, and 72 h after betamethasone administration. HRV features in the time domain and frequency domain and describing heart rate (HR) complexity were calculated, along with PPG morphology features. These features were compared between the different days. Results: Maternal HR was significantly higher and HRV features linked to parasympathetic activity were significantly lower 24 h after betamethasone administration. Features linked to sympathetic activity remained stable. Furthermore, based on the PPG morphology features, betamethasone appears to have a vasoconstrictive effect. Conclusions: Our results suggest that administering betamethasone affects maternal autonomic regulation and cardiovasculature. Researchers assessing maternal HRV in complicated pregnancies should schedule measurements before or sufficiently after corticosteroid administration.

Twin Pregnancy Complicated by Gestational Diabetes Mellitus: Maternal and Neonatal Outcomes.

The risk of gestational diabetes mellitus (GDM) in twin pregnancies is more than double that of singleton pregnancies. Although twin pregnancies present unique challenges for fetal growth and prenatal management, the approach to GDM diagnosis and treatment is the same regardless of plurality. Data on pregnancy outcomes for individuals with GDM and a twin pregnancy are limited and conflicting. To describe the maternal characteristics associated with GDM in twin pregnancies and to assess the associated pregnancy outcomes compared to twin pregnancies unaffected by GDM. A retrospective cohort study was conducted at Mayo Clinic, Rochester, Minnesota, USA, and included predominantly Causasian women aged 18 to 45 years who received prenatal care for a twin pregnancy from 2017-2022. Maternal characteristics and a broad spectrum of pregnancy outcomes were evaluated. Universal GDM screening involved a 50 g oral glucose challenge test +/- a 100 g oral glucose tolerance test. GDM was diagnosed in 23% pregnancies (n = 104/452). Compared to those without, women with GDM had known risk factors including a higher prepregnancy body mass index (31.1vs 26.3 kg/m2; P < .01) and a prior history of GDM (21.7 vs 5.9%; P < .01). There were no differences in maternal pregnancy complications or neonatal outcomes between groups. Attendance at postpartum glucose testing among women with GDM was poor at 27.9% (29/104). These data suggest that women with twin pregnancies share a similar GDM risk profile to those with singleton pregnancies and provide reassuring evidence that current management for GDM twin pregnancies produces similar outcomes to twin pregnancies without GDM.

Association between maternal hemoglobin concentration and educational attainment in mid-childhood in a high-resource obstetric setting: a prospective cohort study

BackgroundAlthough maternal Hb levels during pregnancy are commonly associated with perinatal outcomes, their link to childhood neurodevelopment remains uncertain. ObjectiveThis study aimed to examine the associations between maternal hemoglobin (Hb) in early and late pregnancy with offspring mid-childhood educational attainment in a high-resource obstetric setting. Study DesignPregnancy data from a prospective birth cohort (Pregnancy Outcome Prediction Study, Cambridge, UK, 2008-2012, N=3285) were linked to mid-childhood educational outcomes (Department for Education, UK). Regression models adjusted for maternal, child, and socioeconomic factors were used to determine associations between maternal Hb, pregnancy complications, and offspring educational outcomes (ages 5-7). ResultsNo association was observed between maternal Hb at 12 weeks and the likelihood of either adverse pregnancy outcomes or children meeting expected educational standards between ages 5-7. Higher maternal Hb at 28 weeks was associated with an increased risk of small-for-gestational age infants (aOR1.26, 95%CI 1.11-1.59; p=0.002) and preterm birth (aOR1.38, 95%CI 1.11-1.81; p=0.005). There were no adverse birth outcomes associated with anemia. However children of mothers who were anaemic at 28 weeks had ∼40% increased risk of not attaining expected educational standards at age 5 (aOR1.42, 95%CI 1.03-1.95; p=0.03). There was no association between maternal anemia at 28 weeks and educational performance at ages 6-7. No associations were found between high maternal Hb concentrations (top decile) or change Hb concentrations between 12-28 weeks and childhood educational attainment. ConclusionsMaternal anemia at 28 weeks of pregnancy is associated with reduced educational attainment aged 5, but not at older ages (6-7 years). A proactive approach to increasing maternal hemoglobin in high-resource settings is unlikely to impact on long-term childhood educational attainment.

Epigenetic associations in HPA axis genes related to bronchopulmonary dysplasia and antenatal steroids.

Bronchopulmonary dysplasia (BPD), a common morbidity among very preterm infants, is associated with chronic disease and neurodevelopmental impairments. A hypothesized mechanism for these outcomes lies in altered glucocorticoid (GC) activity. We hypothesized that BPD and its treatments may result in epigenetic differences in the hypothalamic-pituitary-adrenal (HPA) axis, which is modulated by GC, and could be ascertained using an established GC risk score and DNA methylation (DNAm) of HPA axis genes. DNAm was quantified from buccal tissue (ECHO-NOVI) and from neonatal blood spots (ELGAN ECHO) via the EPIC microarray. Prenatal maternal characteristics, pregnancy complication, and neonatal medical complication data were collected from medical record review and maternal interviews. The GC score was not associated with steroid exposure or BPD. However, six HPA genes involved in stress response regulation demonstrated differential methylation with antenatal steroid exposure; two CpGs within FKBP5 and POMC were differentially methylated with BPD severity. These findings were sex-specific in both cohorts; males had greater magnitude of differential methylation within these genes. These findings suggest that BPD severity and antenatal steroids are associated with DNAm at some HPA genes in very preterm infants and the effects appear to be sex-, tissue-, and age-specific. This study addresses bronchopulmonary dysplasia (BPD), an important health outcome among preterm neonates, and interrogates a commonly studied pathway, the hypothalamic-pituitary-adrenal (HPA) axis. The combination of BPD, the HPA axis, and epigenetic markers has not been previously reported. In this study, we found that BPD itself was not associated with epigenetic responses in the HPA axis in infants born very preterm; however, antenatal treatment with steroids was associated with epigenetic responses.

Maternal cardiovascular function at mid-gestation is related to placental angiogenesis.

To investigate whether placental function, reflected in the levels of angiogenic factors, is associated with maternal cardiac function and hemodynamic responses at 19 to 24 weeks' gestation after adjustment for maternal risk factors and pregnancy complications. Prospective study on women with singleton pregnancies attending Kings' College Hospital, London, UK for a routine hospital visit at 19-24 weeks' gestation. We recorded maternal characteristics and measured mean arterial pressure, maternal heart rate, serum placental growth factor and soluble fms-like tyrosine kinase 1 (sFLT-1).We also performed maternal echocardiogram to assess cardiac output and peripheral vascular resistance as well as indices of diastolic and systolic function. Our cohort included 4006 women.Lower placental growth factor (PlGF) values were significantly associated with higher mean arterial pressure (MAP) (p<0.001), lower maternal heart rate (p<0.001), lower mitral valve s' velocity (p= 0.027) and higher left atrial volume (p=0.022) after adjustment for maternal characteristics and pregnancy complications. sFLT-1 was positively related to relative wall thickness (p= 0.012), whereas sFLT-1/ PlGF ratio was negatively associated with mitral valve A (p= 0.006) and positively associated with left atrial volume (p= 0.015) and MAP (p= 0.004). The magnitude of these associations was similar in the subgroup of women without any risk factors from their obstetric and medical history. A continuous link of moderate strength between angiogenic factors and subclinical maternal cardiac function alterations is present at mid-gestation, independently of preexisting maternal risk factors and pregnancy complications. Impaired placental function appears to be related to a mild systolic and diastolic dysfunction and cardiac remodeling. This article is protected by copyright. All rights reserved.

Newborn Hospitalizations Before and During COVID-19 Pandemic in Poland: A Comparative Study Based on a National Hospital Registry.

Objectives: There are limited data on the impact of the COVID-19 outbreak in Poland on newborn health. The aim of the study is to show recent information on hospitalizations of newborns in Poland in the pre-pandemic and COVID-19 pandemic era. Methods: A retrospective, population-based study was conducted using data from hospital discharge records of patients hospitalized in 2017-2021. Results: The data on which the study was based consisted of a substantial number of 104,450 hospitalization records. Annual hospitalization rate was estimated to be 50.3-51.9 per 1,000 in 2017-2019, 56 per 1,000 in 2020 and it rose to 77.7 per 1,000 in 2021. In comparison to the pre-pandemic period, in the COVID-19 era, we observed significantly more hospitalization cases of newborns affected by maternal renal and urinary tract diseases (p < 0.001), syndrome of infant of mother with gestational diabetes (p < 0.001), maternal complications of pregnancy (p < 0.001). In the COVID-19 era, the prevalence of COVID-19 among newborns was 4.5 cases per 1,000 newborn hospitalizations. Conclusion: The COVID-19 pandemic outbreak could significantly contribute to qualitative and quantitative changes in hospitalizations among newborns.

Associations of polymetabolic risk of high maternal pre-pregnancy body mass index with pregnancy complications, birth outcomes, and early childhood neurodevelopment: findings from two pregnancy cohorts

BackgroundA substantial proportion of maternal pregnancy complications, adverse birth outcomes and neurodevelopmental delay in children may be attributable to high maternal pre-pregnancy Body Mass Index (BMI). However, BMI alone is insufficient for the identification of all at-risk mothers and children as many women with non-obesity(< 30 kg/m2) or normal weight(18.5–24.99 kg/m2) and their children may suffer from adversities. Evidence suggests that BMI-related metabolic changes during pregnancy may predict adverse mother–child outcomes better than maternal anthropometric BMI.MethodsIn a cohort of 425 mother–child dyads, we identified maternal BMI-defined metabolome based on associations of 95 metabolic measures measured three times during pregnancy with maternal pre-pregnancy BMI. We then examined whether maternal BMI-defined metabolome performed better than anthropometric BMI in predicting gestational diabetes, hypertensive disorders, gestational weight gain (GWG), Caesarian section delivery, child gestational age and weight at birth, preterm birth, admission to neonatal intensive care unit (NICU), and childhood neurodevelopment. Based on metabolic measures with the highest contributions to BMI-defined metabolome, including inflammatory and glycolysis-related measures, fatty acids, fluid balance, ketone bodies, lipids and amino acids, we created a set of maternal high BMI-related polymetabolic risk scores (PMRSs), and in an independent replication cohort of 489 mother–child dyads tested their performance in predicting the same set of mother–child outcomes in comparison to anthropometric BMI.ResultsBMI-defined metabolome predicted all of the studied mother–child outcomes and improved their prediction over anthropometric BMI, except for gestational hypertension and GWG. BMI-related PMRSs predicted gestational diabetes, preeclampsia, Caesarian section delivery, admission to NICU, lower gestational age at birth, lower cognitive development score of the child, and improved their prediction over anthropometric BMI. BMI-related PMRSs predicted gestational diabetes, preeclampsia, Caesarean section delivery, NICU admission and child’s lower gestational age at birth even at the levels of maternal non-obesity and normal weight.ConclusionsMaternal BMI-defined metabolome improves the prediction of pregnancy complications, birth outcomes, and neurodevelopment in children over anthropometric BMI. The novel, BMI-related PMRSs generated based on the BMI-defined metabolome have the potential to become biomarkers identifying at-risk mothers and their children for timely targeted interventions even at the level of maternal non-obesity and normal weight.

ПЕРИНАТАЛЬНЫЕ ИСХОДЫ У ЖЕНЩИН С ВАРИКОЗНОЙ БОЛЕЗНЬЮ В УСЛОВИЯХ ПАНДЕМИИ COVID-19

Objective. To evaluate pregnancy and labor outcomes in women with varicose veins in a COVID-19 pandemic. Material and methods. Sixty-eight pregnant women were included in the study, 38 of whom used compression stockings (main group), and 30 patients were included in the comparison group. During follow-up, 8/38 (21%) patients from the main group and 9/30 (30%) patients from the comparison group had COVID-19 infection. All patients underwent clinical, laboratory, gynecologic, and ultrasound examinations. The primary endpoints of the study were maternal complications of pregnancy and labor. Secondary endpoints were pathologic conditions and perinatal parameters related to the fetus. Results. The number of cases of preterm labor, utero-placental blood flow disorders, preeclampsia, and gestational diabetes mellitus was higher in the control group compared to the comparison group (p&gt;0.99). Fetal distress developed in 2/30 (6.7%) observations from the comparison group of laboring women (p=0.605). The highest number of infants (70-75%) who scored 9 Apgar score at the 5th minute of life was recorded in the main group. Comparative analysis of pregnant women with mild COVID-19 and without COVID-19 found no significant effect of coronavirus infection on obstetric and perinatal outcomes. Conclusion. The results of this study confirm the information about the adverse effect of concomitant varicose veins on the outcomes of pregnancy and childbirth. These findings support the rationale for the combined use of compression and phlebotropic pharmacological therapy in pregnant women with varicose veins.

A real-life prospective blinded evaluation of placental biometry and macroscopic morphology from 1008 unselected consecutive pregnancies

IntroductionThe study of the macroscopic appearance of the placenta may represent a useful tool to understand the pathophysiology of adverse pregnancy outcomes. The aim of this study was to evaluate biometry and morphology of placentas in relation to maternal, neonatal and pregnancy course characteristics. MethodsClinical and placental data (biometry and macroscopic features of chorionic disk and adnexa) from unselected consecutive singleton pregnancies were recorded at the same Institution. Placental efficiency was approximated as ratio between fetal and placental weight (FPR). The total population was grouped according to the presence of any maternal comorbidity or pregnancy complication (group 1), neonatal complications diagnosed only at birth (2) and absence of any comorbidity (3). Multi-adjusted general linear and logistic regression models were performed to analyze associations between groups and placental biometry and morphology. ResultsThe study population counted 1008 pregnancies: 576 (57.2 %) classified as group 1, 76 (7.5 %) as group 2 and 356 (35.3 %) uncomplicated controls (group 3). In multivariate models adjusted for confounding factors, no significant differences in placental biometry and macroscopic features were observed among the three groups. Maternal BMI was significantly associated with higher placental and birth weight and lower FPR; moreover FPR was significantly higher in pregnancies carrying males compared to female neonates. DiscussionMaternal comorbidity or pregnancy disease was not associated with significant changes in placental macroscopic biometry and morphology. Conversely, maternal pregestational BMI and fetal sex impact on placental biometry and efficiency, suggesting different intrauterine adaptations in obese mothers and in male and female fetuses.

Incidence, clinical features, management and outcomes of ANCA-associated vasculitis in pregnancy- a systematic literature review.

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) are rare multi-system conditions, usually presenting in older age groups. However, younger individuals are also affected. The average increase of childbearing age and lack of studies in pregnancy necessitates this comprehensive review of data to guide the management of AAV in pregnancy.This systematic review (SR) aimed to summarise the incidence, clinical features, management and maternal and foetal outcomes in female patients with AAV. The protocol was registered on PROSPERO (CRD42023437482). Articles published in Medline, Embase and Cochrane Databases from 1946 until June 2023 were included. Single case reports, reviews and conference abstracts were excluded. Articles meeting inclusion criteria were examined by two authors. Data on demographics, treatment, clinical features, flares during pregnancy and maternal and foetal outcomes were extracted. Eight studies were included, detailing 82 pregnancies in 64 women. The most common drugs used for remission induction pre-conception were cyclophosphamide, rituximab, prednisolone and azathioprine. Serious maternal complications in pregnancy included progressive tracheal/subglottic stenosis (n=5), renal disease (n=2), preeclampsia (n=10) and miscarriages (n=5). Foetal anomalies were rare (n=5). The mean birth weight was 3.37kgs and mean gestation age was 38.26 weeks. No maternal deaths or vasculitis in newborns were reported. Conclusions: Patients can have positive maternal and foetal outcomes following strong induction therapy, vigorous monitoring and prompt treatment of flares during pregnancy. Serious complications and flares are not associated with worse outcomes for newborns.

Relationship between Maternal ABO Blood group and pregnancy complications of adichunchanagiri hospital B.G Nagara -A cross sectional study

ABO blood group has been divulged as a risk factor for perceptible diseased states. The ABO blood group differences may put a patient at specific risk according to their inherited antigens among the obstetrical syndromes like Intrauterine growth restriction, Pre-eclampsia and pre-term labour. Studies conducted have shown Group O individuals had lowest plasma von Willebrand factor and non O group had elevated level of this factor which showed increased thrombotic risk among these individuals. The earlier studies conducted have focused only on preeclampsia but not on other complications of pregnancy and the data available is scarce. The study aims to determine whether maternal ABO blood groups contribute to adverse pregnancy outcomes especially in this part of the country.The study was conducted on 50 pregnant women who were having complications of pregnancy including preeclampsia (PE), cases of Pregnancy induced hypertension (PIH), Gestational Diabetes mellitus (GDM) were considered as study cases and 50 pregnant women with normal pregnancy without any complications were categorized as controls. The study was conducted for a period of 6 months among patients attending Obstetrics and Gynecology department of Adichunchanagiri hospital selected based on convenience sampling procedure. Maternal ABO Blood group of the subjects were determined by Haemagglutination technique.Relationship between maternal ABO Blood group and Pregnancy complications (PE, PIH.GDM) was estimated by calculating odds ratio from logistic regression models using Blood Group O as a reference group and p – value of &amp;#60; 0.05 was considered as statistically significant. The results of the present study have found that maternal AB blood group was highest among preeclampsia and PIH category of cases.The present study conducted have found maternal AB blood group was highest among PIH and preeclampsia category of casesFrom the study conducted we want to conclude non-O blood group had the highest risk compared to O Blood group among pregnancy complications.

The impact of healthy pregnancy on features of heart rate variability and pulse wave morphology derived from wrist-worn photoplethysmography

Due to the association between dysfunctional maternal autonomic regulation and pregnancy complications, tracking non-invasive features of autonomic regulation derived from wrist-worn photoplethysmography (PPG) measurements may allow for the early detection of deteriorations in maternal health. However, even though a plethora of these features—specifically, features describing heart rate variability (HRV) and the morphology of the PPG waveform (morphological features)—exist in the literature, it is unclear which of these may be valuable for tracking maternal health. As an initial step towards clarity, we compute comprehensive sets of HRV and morphological features from nighttime PPG measurements. From these, using logistic regression and stepwise forward feature elimination, we identify the features that best differentiate healthy pregnant women from non-pregnant women, since these likely capture physiological adaptations necessary for sustaining healthy pregnancy. Overall, morphological features were more valuable for discriminating between pregnant and non-pregnant women than HRV features (area under the receiver operating characteristics curve of 0.825 and 0.74, respectively), with the systolic pulse wave deterioration being the most valuable single feature, followed by mean heart rate (HR). Additionally, we stratified the analysis by sleep stages and found that using features calculated only from periods of deep sleep enhanced the differences between the two groups. In conclusion, we postulate that in addition to HRV features, morphological features may also be useful in tracking maternal health and suggest specific features to be included in future research concerning maternal health.

Direct Effect of Iron Deficiency Independent of Anemia on Adverse Perinatal Outcomes- a Scoping Review

Introduction Iron is required throughout pregnancy by both the pregnant individual and the fetus. Iron stores can be depleted during pregnancy resulting in iron deficiency (ID), which is the most common cause of anemia in pregnancy. Iron deficiency anemia (IDA) is associated with an approximately two-fold increase in adverse perinatal outcomes (APO) such as low birth weight (LBW), preterm delivery, and stillbirth. It is uncertain whether depleted iron store in a non-anemic pregnant individual affects fetal growth and well-being. The effect of ID per se on these outcomes, independent of anemia, is the central focus of this scoping review. If an independent association between iron deficiency without anemia (IDWA) and these APO is established and given the potential for non-anemic iron deficiency to progress to IDA, early screening, and intervention before the development of IDA may be important in preventing these morbidities and mortality. Our objective is to determine the current state of existing knowledge concerning IDWA and APO. The specific aims are to determine the prevalence of IDWA in pregnant individuals, assess predictors and determine types of APO associated with IDWA. Methods We performed a comprehensive systematic scoping review of the independent effect of IDWA on APO. The search for relevant studies involved Ovid Medline, Cochrane Database of Systematic Reviews, Cochrane Control Register of Controlled Trials, and hand search of citations of relevant articles for cohort and cross-sectional studies, randomized controlled trials, systematic reviews, and meta-analyses, scoping and narrative reviews from the inception of the databases. We used all relevant Medical Subject Headings terms and subheadings with no language restrictions. Two reviewers independently screened titles, abstracts, and full text based on the outlined inclusion and exclusion criteria. The inclusion criteria include relevant studies reporting on IDWA in pregnancy and APO. Exclusion criteria include studies not reporting IDWA and APO, and the presence of medical conditions such as hemoglobinopathies, polycythemia, iron overload, autoimmune and inflammatory conditions. Discrepancies were resolved through discussion and consensus. Covidence ® systematic review software was used for screening, automatically eliminating duplicates and data extraction. PRISMA for Scoping Reviews reporting guidelines was used. The selection process and results of included and excluded studies were presented with a PRISMA flow chart. A narrative summary was conducted to descriptively summarize the findings. Results A total of 4389 articles were identified from the searched databases after all duplicates were removed. Two studies conducted between 2005-2008 and 2017-2018 respectively met the inclusion criteria and were eligible for data extraction. A total of 5684 participants made up of 5479 Danish and 205 Spanish cohorts were included. The prevalence of IDWA in Denmark was 14.2% based on serum ferritin of &amp;lt;30μg/L and hemoglobin ≥110g/L and 20% in Spain using thresholds of SF &amp;lt;12μg/L and Hb≥110g/L. The mean (standard deviation, SD) age of participants was 31.8 ± 5.0 years in Denmark, and the mean (95% CI) was 31.0 (29.4-32.6) years in Spain. In the Danish study, the babies had a mean (SD) birth weight of 3508±523g and were on average 192g smaller (p=0.028). The mean (SD) gestational age (GA) at delivery was 39.8±1.7 weeks, adjusted odds ratio (95%CI) of LBW was 0.6 (0.4-1.0), stillbirth 4.0(1.0-14.3) and gestational diabetes mellitus 1.1 (0.7-1.7) in the IDWA group. The Spanish study reported a mean (95% CI) infant birth weight (IBW) of 3140 (3067-3213) g, reduction in adjusted IBW of -192.4 (-363.6, -21.2)g, p=0.028, R 2c.100 = 35.4, F 194,11 =9.3, p&amp;lt;0.001 in IDWA. Both studies reported the covariates and predictors of APO including parity, race, body mass index, and socioeconomic status. Conclusion Overall, there is limited research on this important obstetric hematology topic. The few available studies identified higher odds of non-causal association between IDWA, stillbirth, and smaller birth weight. Similarly, there was a non-significant causal association with most predictors and maternal medical complications of pregnancy. These findings will motivate further research work by our team. The study will involve the use of large population-based data to establish a potential causal association between IDWA and APO.

Perinatal Outcomes at Rural Hospitals That Participated in the Rural Surgical and Obstetrical Networks (RSON) of British Columbia (2016–2021)

BackgroundThe goal of the Rural Surgical and Obstetrical Networks (RSON) of British Columbia was to support safe and appropriate surgery, operative birth, and perinatal care closer to home for rural communities. Family physicians with enhanced obstetrical and/or surgical skills provide cesarean delivery and family practice anesthetists manage anesthesia for labour pain and operative births at RSON-supported hospitals, with the involvement of a local specialist at one site. ObjectivesThe objectives of the study were to: (1) compare perinatal outcomes at hospitals participating in the RSON initiative with outcomes at referral hospitals and (2) examine temporal changes in the proportion of childbearing people who resided in RSON communities and gave birth locally. MethodsPoisson regression analysis was used to model the effect of hospital type (RSON vs. referral) on perinatal outcomes. We restricted the analysis to singleton births and controlled for differences in maternal characteristics, obstetric history, and pregnancy complications. ResultsChildbearing people who gave birth at RSON-supported hospitals (n = 3498) had a 10% lower incidence of adverse maternal–newborn outcomes compared to those who gave birth at referral hospitals (n = 14 772), after controlling for referral bias. We found a small increase (3.2 %) in the proportion of local births over the study period. ConclusionFindings provide evidence that childbearing people can safely give birth at smaller rural hospitals in British Columbia and that investments in rural hospitals contribute to service stability. Stabilizing local birth services in rural communities benefits the whole region because it reduces surgical overload in regional referral centres.

Pregnancy and Inflammatory Rheumatological Diseases: A Single-Center Retrospective Cohort Study.

Background Rheumatic diseases pose risks to pregnant women, leading to complications like preterm birth, congenital heart block, and pregnancy loss. These diseases are expected to deteriorate during pregnancy and further in the postpartum period. The impact of these diseases on the pregnancy will add further burden on the patient, fetus, physician, and healthcare system. Advances in diagnosis and treatment have improved outcomes making them similar to that of healthy women, but close follow-up in a multidisciplinary clinic is essential. The objective of this study is to study the outcome of pregnancy in women with rheumatological disease and the behavior of the disease during pregnancy. Methods A retrospective cohort study was conducted in King Abdulaziz Medical City (KAMC) in Riyadh, Saudi Arabia, to compare the outcomes of pregnancy across three rheumatological diseases: Sjogren syndrome (SS), systemic lupus erythematosus (SLE), and rheumatoid arthritis (RA) from 2016 to 2021. A total of 128 pregnancies in 107 women with rheumatological diseases were included in this study. Pregnancy measures and outcomes were investigated by assessing maternal health, fetal health, and pregnancy complications, specifically maternal disease activity, medications to control the disease, infection, preterm birth, birth weight, abortions/stillbirths, mode of delivery, bleeding, preeclampsia, congenital heart block, and neonatal lupus. Results There were 55 patients with RA (63 RA pregnancies), 44 with SLE (54 SLE pregnancies), and eight with primary SS (11 SS pregnancies). In most of the pregnancies (n= 108; 95.58%), the patients were in clinical remission before pregnancy. Lupus nephritis, which was in remission before pregnancy, has been reported in nine (16.67%) out of 54 SLE pregnancies. Vaginal delivery was the most common mode of delivery (n=87; 67.97%). On the other hand, there were 38 cesarean sections (29.69%). Rheumatological disease flares occurred in 10 pregnancies (7.87%). One hundred and twenty-two live births were delivered. Preterm infants were born in 25 pregnancies (20.16%), and 16 (13.22%) of the newborns needed neonatal intensive care unit (NICU) care. Interestingly, congenital heart block (CHB) was found in five (12.2%) neonates out of 41 anti-SS-related antigen A (anti-SSA) positive mothers; one of those five died from heart block. Eleven neonates were delivered with positive serology, and five were diagnosed with neonatal lupus. Conclusion The outcome of pregnancy in patients with rheumatological disease is favorable. A multidisciplinary team approach and close clinical follow-up are the cornerstone for such success. A small dose of prednisolone (5 mg or less) is safe and will not have a negative impact on maternal or fetal health. CHB is a concern for pregnant women with positive anti-SSA.

Preconception and Pregnancy Nutrition Support for Women with a History of Bariatric Surgery: A Mixed-Methods Survey of Healthcare Professionals in the UK.

Preconception bariatric surgery improves obesity-related maternal pregnancy complications but may reduce the absorption of nutrients required for healthy fetal growth and development. Women who receive preconception nutritional support after bariatric surgery are less likely to have adverse pregnancy outcomes. This study aimed to investigate the provision of preconception and pregnancy-specific nutritional support for women having bariatric surgery in the UK. A mixed-methods survey was distributed to healthcare professionals working in obesity or maternity services between December 2018 and October 2019. We collected both quantitative and qualitative data which were analysed using a mixed-methods approach. We received 135 responses from online (n = 99) and postal (n = 36) questionnaires. Only 45% of participants reported being 'very familiar' with the preconception/pregnancy nutritional needs of this population. Barriers to providing nutritional support included: a lack of resources and time; poor communication both across services and with women; not having contact with women preconception; and a lack of information and guidance. Respondents felt that dietitians have the expertise in nutrition necessary to provide support; however, GPs and midwives have the most frequent patient access post-surgery, both before and during pregnancy. Optimal preconception and pregnancy-related nutritional support requires multidisciplinary care pre- and post-surgery, and healthcare professionals require training and guidance to inform practice.

Excessive Pregestational Weight and Maternal Obstetric Complications: The Role of Adipokines.

There is a high frequency of overweight and obesity in women of reproductive age. Women who start pregnancy with overweight or obesity have an increased risk of developing maternal obstetric complications such as gestational hypertension, pre-eclampsia, gestational diabetes mellitus, postpartum hemorrhage, and requiring C-section to resolve the pregnancy with a higher risk of C-section surgical site infection. Excessive weight in pregnancy is characterized by dysregulation of adipokines, the functions of which partly explain the predisposition of pregnant women with overweight or obesity to these maternal obstetric complications. This review compiles, organizes, and analyzes the most recent studies on adipokines in pregnant women with excess weight and the potential pathophysiological mechanisms favoring the development of maternal pregnancy complications.

An observational association study between maternal homocysteine and pregnancy complications or perinatal outcomes with established trimester-specific reference intervals in pregnant women.

Elevated homocysteine (Hcy) level during pregnancy is positively associated with various gestational-specific diseases. However, there is no uniform standard for the reference interval (RI) of Hcy in pregnancy. From January 2017 to January 2019, 14,530 singleton pregnant women registered at our institute were included for the establishment of trimester-specific RIs of Hcy with both the nonparametric approach and the indirect Hoffmann method, followed by pregnancy outcome association analysis conducted with logistic regression. The serum Hcy level in the nonpregnant group was significantly higher than that of pregnant women. A relatively decreased Hcy concentration was observed in the second trimester when compared with that of the first or third trimester. The direct RIs of Hcy in the first or third, and second trimesters were 4.6 to 8.0 mmol/L (merged) and 4.0 to 6.4 mmol/L, respectively, which showed no significant difference compared with the RI derived from the indirect Hoffmann method. In the subsequent risk analysis, the first trimester Hcy was found to be negatively associated with GDM development; whereas the third trimester Hcy conferred increased risk of postpartum hemorrhage after delivery. Having established trimester-specific RIs, our study sheds light on the complicated roles of Hcy in pregnancy-related complications.

Hypertensive pregnancy complications and maternal characteristics as predictors of cardiovascular health within ten years after delivery

ObjectiveTo identify the combination of maternal characteristics in women with hypertensive disorders of pregnancy (HDP) associated with hypertensive and other cardiovascular diseases (CVDs) within ten years following delivery. The aim is to understand who should receive the most intensive primary cardiovascular disease prevention. Study designA prospective cohort study. Main outcomeThe population was the FINNPEC cohort (2008–2011), including women with (n = 1837) and without (n = 847) HDP. The main exposures were maternal hypertensive pregnancy complications linked with maternal pregnancy data from hospital records. The outcomes were hypertensive diseases and other CVDs (International Classification of Diseases, Tenth Revision). ResultsWomen with de novo pre-eclampsia (PE) had an elevated risk for hypertensive diseases within ten years following delivery. The risk of CVD was increased in women with superimposed PE and chronic hypertension (CHT) only. Women with de novo PE and hypertensive diseases were more often primiparous (41.4% vs. 23.0%, p = 0.020), had gestational diabetes (GDM) (31.0% vs. 11.7%, p = 0.002), and higher pre-pregnancy body mass index (BMI) (28.7 ± 5.8 vs. 24.6 ± 4.8 kg/m2, p = 0.001), compared with women who remained normotensive. Women with superimposed PE with CVD had more likely early-onset PE, preterm delivery and were older than women without later CVD. ConclusionsHealthcare professionals should target early prevention of CVDs in women with chronic hypertension during pregnancy; of those who developed superimposed PE prior to 34th weeks of gestation and who delivered preterm. Women with de novo PE who are overweight/obese, primiparous, and with concurrent GDM need regular blood pressure monitoring.

Biogenesis and function of exosome lncRNAs and their role in female pathological pregnancy.

Preeclampsia, gestational diabetes mellitus, and recurrent spontaneous abortion are common maternal pregnancy complications that seriously endanger women's lives and health, and their occurrence is increasing year after year with a rejuvenation trend. In contrast to biomarkers found freely in tissues or body fluids, exosomes exist in a relatively independent environment and provide a higher level of stability. As backbone molecules, guidance molecules, and signaling molecules in the nucleus, lncRNAs can regulate gene expression. In the cytoplasm, lncRNAs can influence gene expression levels by modifying mRNA stability, acting as competitive endogenous RNAs to bind miRNAs, and so on. Exosomal lncRNAs can exist indefinitely and are important in intercellular communication and signal transduction. Changes in maternal serum exosome lncRNA expression can accurately and timely reflect the progression and regression of pregnancy-related diseases. The purpose of this paper is to provide a reference for clinical research on the pathogenesis, diagnosis, and treatment methods of pregnancy-related diseases by reviewing the role of exosome lncRNAs in female pathological pregnancy and related molecular mechanisms.