Maternal Parameters Research Articles

Subclinical Hypothyroidism and Gestational Hypertensive Disorders in a Cohort of Romanian Pregnant Women with Gestational Diabetes Mellitus: A Pilot Study

Objective: This study aimed to explore whether subclinical hypothyroidism (SCH) treated with levothyroxine in pregnancy complicated by gestational diabetes mellitus (GDM) is associated with an increased risk of gestational hypertensive disorders (GHDs) (gestational hypertension and preeclampsia). Methods: 96 pregnant women with GDM were enrolled in this study and grouped as per the European Thyroid Association criteria into the SCH (n = 21) and euthyroid groups (n = 75). All subjects were tested for anthropometric parameters, maternal glucose homeostasis parameters, lipid levels, thyroid function tests, and blood pressure. All GDM pregnant women received nutritional and insulin therapy where needed, and the SCH group received levothyroxine treatment. Then, the maternal and newborn outcomes were compared. Data were analyzed using Student’s t-test, Mann–Whitney U, and Chi-square tests wherever applicable. p values of <0.05 were considered significant. Results: Patients with GDM and SCH had a pre-pregnancy BMI and BMI at inclusion in the study smaller than those of the euthyroid group (p = 0.0004, p = 0.0009). There were no significant differences between groups regarding the incidence of GHD, preterm prelabor rupture of membranes (PPROMs), macrosomia, low birth weight, and fetal distress (p > 0.05). Patients with GDM and SCH treated with levothyroxine had more premature delivery than the euthyroid group (p = 0.03). Conclusions: Subclinical hypothyroidism treated with levothyroxine in women with GDM does not increase the risk of gestational hypertensive disorders, but is associated with increased risk for prematurity.

Association between duration of urinary catheterization and post-operative mobilization following elective cesarean section: A retrospective case-control study in Espoo, Finland.

Cesarean section is the most common surgery performed on women. The enhanced recovery recommendations are early urinary catheter removal and early mobilization, as essential elements of post-operative care. This study aimed to analyze the association between these elements and whether limiting the catheter treatment duration affects the timing of post-operative mobilization. This retrospective case-control study compared the mobilization of healthy elective cesarean patients under different instructions on urinary catheter removal: cases with a preset catheter removal time (8-12 hours) and controls with catheter removal based on midwife considerations. Apart from the preset time of catheter removal, the routine post-operative care was given by the same personnel without any advice on patient mobilization. Data on patient demographics, surgery details, post-operative medication, first upright mobilization, the length of hospital stay, and patient satisfaction were analyzed. The study comprised 52 cases and one control for each case (N=104). The mean duration of urinary catheterization was 20.15 ± 6.59 and 11.30 ± 4.20 hours in the control and intervention groups, respectively (p<0.001). A linear regression analysis showed a significant association between the catheter removal time and patient mobilization, when adjusted for maternal background parameters (age, BMI, fear of childbirth diagnosis, prior uterine scar), duration and timing of the surgery, bleeding and post-operative analgesic use (R2=0.444, p<0.001). No difference was detected in the length of hospital stay, or patient satisfaction. Limiting the duration of urinary catheter therapy is associated with shorter time to post-operative mobilization. A prospective randomized trial would provide more detailed information.

Development of a quantitative prediction algorithm for human cord blood-derived CD34+ hematopoietic stem-progenitor cells using parametric and non-parametric machine learning models

The transplantation of CD34+ hematopoietic stem-progenitor cells (HSPCs) derived from cord blood serves as the standard treatment for selected hematological, oncological, metabolic, and immunodeficiency disorders, of which the dose is pivotal to the clinical outcome. Based on numerous maternal and neonatal parameters, we evaluated the predictive power of mathematical pipelines to the proportion of CD34+ cells in the final cryopreserved cord blood product adopting both parametric and non-parametric algorithms. Twenty-four predictor variables associated with the cord blood processing of 802 processed cord blood units randomly sampled in 2020–2022 were retrieved and analyzed. Prediction models were developed by adopting the parametric (multivariate linear regression) and non-parametric (random forest and back propagation neural network) statistical models to investigate the data patterns for determining the single outcome (i.e., the proportion of CD34+ cells). The multivariate linear regression model produced the lowest root-mean-square deviation (0.0982). However, the model created by the back propagation neural network produced the highest median absolute deviation (0.0689) and predictive power (56.99%) in comparison to the random forest and multivariate linear regression. The predictive model depending on a combination of continuous and discrete maternal with neonatal parameters associated with cord blood processing can predict the CD34+ dose in the final product for clinical utilization. The back propagation neural network algorithm produces a model with the highest predictive power which can be widely applied to assisting cell banks for optimal cord blood unit selection to ensure the highest chance of transplantation success.

Effects of Maternal Obesity on Oxidative Parameters in Maternal and Cord Blood Samples.

Aim The purpose of this study was to analyze oxidative stress parameters in maternal and cord blood samples from both obese and nonobese women. Methods Our study included 30 obese and 35 nonobese pregnant women aged 18-40. We analyzed and compared oxidative stress parameters, including thiol/disulfide balance markers (native thiol, total thiol, and disulfide), albumin, ischemia-modified albumin (IMA), myeloperoxidase (MPO), catalase, ceruloplasmin, and intracellular glutathione levels. Results The comparison of maternal blood oxidative stress parameters between obese and nonobese pregnant women showed significantly higher levels of disulfide, catalase (kU/L), and ceruloplasmin (U/L) in the obese group (p = 0.005, p = 0.001, p < 0.001, respectively). Similarly, in cord blood, disulfide (µmol/L), IMA, catalase (kU/L), and (U/L) levels were significantly higher in the obese group (p < 0.001, p = 0.049, p < 0.001, p = 0.023, respectively), while albumin levels were significantly higher in the nonobese group (p = 0.003). Conclusions Our results suggest a strong association between maternal obesity and increased oxidative stress in both mothers and their offspring. Elevated oxidative stress levels may contribute to adverse maternal and fetal clinical outcomes. Therefore, we conclude that maintaining healthy weight control during reproductive age is crucial for ensuring maternal and fetal well-being.

Risk factors associated with late-onset hearing loss in children with congenital cytomegalovirus: a systematic review.

To search for existing evidence of prognostic factors related to the development of late-onset hearing loss (LOHL) in infants with congenital cytomegalovirus (cCMV). A PRISMA systematic review was performed, with the PubMed, Embase, and Web of Science databases searched from inception through to December 2023; after the application of inclusion and exclusion criteria a total of 9 papers were included in this review. PROSPERO registration number CRD42024492244. 9 studies encompassing a total of 292 children with late-onset hearing loss were included. A total of 12 risk factors were identified in the literature, with 6 found to be statistically significant. Late-onset hearing loss was more frequently reported in children with symptomatic than asymptomatic cCMV. Moreover, in asymptomatic cCMV cases, elevated DNAemia and salivary viral load were associated with late-onset hearing loss. Additionally, first-trimester seroconversion was identified as a risk factor for late- onset hearing loss. Further, gestational age < 37weeks and low birth weight were found to correlate with late-onset hearing loss. Remarkably, only one study documented a relationship between late-onset hearing loss and ultrasonographic abnormalities. Although six statistically significant risk factors have been identified, the available evidence is limited and inconsistent, preventing the establishment of reliable neonatal and maternal parameters to predict the development of LOHL in patients with CMV. There are few studies addressing this topic, and those available exhibit a low level of evidence and heterogeneous designs. More studies should be done.

Maternal vascular indices and hemodynamic parameters at 36 weeks' gestation in gestational and pre-existing diabetes mellitus.

To compare maternal vascular indices and hemodynamic parameters at 35-37 weeks' gestation in pregnancies complicated by gestational diabetes mellitus (GDM), those with pre-existing diabetes mellitus (DM) and those without GDM or pre-existing DM. This was a prospective observational study in women with a singleton pregnancy attending for a routine hospital visit at 35 + 0 to 36 + 6 weeks' gestation. The visit included recording of maternal demographic characteristics and medical history, and measurement of vascular indices and hemodynamic parameters using a non-invasive operator-independent device. These included carotid-to-femoral pulse-wave velocity, augmentation index, cardiac output, stroke volume, central systolic and diastolic blood pressure, total peripheral resistance and heart rate. The values in the GDM and pre-existing DM groups were compared to those in the unaffected group. We examined 6746 women, of whom 396 were excluded because they had chronic hypertension or developed pre-eclampsia or gestational hypertension. The study population of 6350 pregnancies contained 99 (1.6%) with pre-existing Type-I or Type-II DM and 617 (9.7%) that developed GDM, including 261 (42.3%) that were treated with diet alone, 239 (38.7%) treated with metformin alone and 117 (19.0%) treated with insulin with or without metformin. Among women with GDM and those with pre-existing DM, compared to those without GDM or pre-existing DM, there was a higher median cardiac output and heart rate, central systolic and diastolic blood pressure and pulse-wave velocity, but there was no significant difference in stroke volume and total peripheral resistance. There were no significant differences within the GDM group according to treatment type, except for higher heart rate in women treated with metformin alone compared to the group treated with diet alone. Women with GDM and those with pre-existing DM have evidence of early vascular disease in the third trimester, and this may contribute to their increased long-term cardiovascular risk. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

Effects of abdominal touch, music, and virtual reality video during the non-stress test on maternal anxiety and fetal parameters: A randomized controlled clinical trial

This randomized control trial compared the effects of abdominal touch, music, and virtual reality video on maternal anxiety and fetal parameters. 120 pregnant women were randomly assigned to one of three experimental arms (abdominal touch, music, virtual reality video) or the control group (30 pregnant women in each group). Data were collected through the Participant Information Form, and outcomes were assesssed using the Non-stress test (NST) Findings Registry Form, and the State Anxiety Scale. This trial showed that abdominal touch and virtual reality videos were superior to music in increasing fetal heart rate (p=0.001), and music and virtual reality videos were superior to abdominal touch in decreasing maternal anxiety (p=0.001). Abdominal touch and virtual reality video were effective in increasing fetal heart rate, and music and virtual reality video were effective in decreasing maternal anxiety. It is recommended to provide pregnant women access to abdominal touch, music, and virtual reality videos to reduce maternal stress and anxiety and to increase fetal heart rate.

Effect of the WHEY protein on pregnancyneonatal outcomes and prophylactic effect on fetal growth restriction cases: A randomized clinical trial

Background: WHEY protein is a high-quality protein source that is easily absorbed and utilized by the body. It has a beneficial effect on pregnancy and neonatal outcomes. Aim: To evaluate the impact of WHEY protein on pregnancy-neonatal outcomes and its prophylactic effect on Fetal growth restriction (FGR) cases. Patients and methods: This study was a prospective randomized, controlled clinical trial conducted on 300 pregnant females from attendees of obstetrics and gynecology clinics of Al Azhar University Hospitals. They were randomly divided into two groups: Case group: The intervention group (150 cases) received a daily WHEY protein supplement containing 25 grams of protein, and the Control Group: 150 cases received a placebo supplement. Results: There was no statistically significant difference between the studied groups regarding demographic criteria (P&gt;0.01), and the prevalence of FGR was (20% vs 18.75) in the studied groups. According to fetal biometry at birth, there was no statistically significant difference regarding sonographic parameters between the appropriate gestational age (AGA) in the studied groups (P&gt;0.01). There was no statistically significant difference between the two groups regarding complete blood parameters, platelets, or PTT (P&gt;0.01). There was a highly statistically significant difference regarding PT between the studied groups (P&lt;0.001). There was no statistically significant difference between the two groups regarding liver and kidney function tests (P&gt;0.01). There was a highly statistically significant difference regarding total proteins and serum calcium between the studied groups (P&lt;0.001). Conclusion: WHEY protein supplementation did not affect fetal growth, but it improved some maternal parameters, such as total protein and PT.

Characterization of Amniotic Fluid Ureaplasma Species from Pregnancies Complicated by Preterm Prelabor Rupture of Membranes.

The main aim of this study was to determine expanded sequence types (eSTs) of Ureaplasma species (U. spp.). DNA isolated from the amniotic fluid of pregnancies complicated by preterm prelabor rupture of membranes (PPROM) using an expanded multilocus sequence typing scheme. Additionally, the study sought to examine whether phylogenetic subgroups of U. spp. DNA differ with respect to maternal demographic and clinical parameters and selected aspects of short-term neonatal morbidity. This retrospective cohort study was focused on singleton pregnancies complicated by PPROM occurring between the gestational ages of 24+0 and 36+6 weeks, where amniocentesis was conducted to assess the intra-amniotic environment and the presence of U. spp. DNA in the amniotic fluid samples was confirmed. The stored aliquots of U. spp. DNA were used to assess differences in nucleotide sequences in six U. spp. genes (ftsH, rpL22, valS, thrS,ureG, and mba-np1) using the eMLST scheme. The expanded multilocus sequence typing scheme was performed in 73 samples of U. spp. DNA isolated from pregnancies complicated by PPROM. In total, 33 different U. spp. DNA eSTs were revealed, 21 (#20, 233-244, 248-251, 253, 255, 259, and 262) of which were novel. The most frequently identified eST was #41, identified in 18% (13/73) of the aliquots. Based on their genetic relationships, the U. spp. DNA was divided into two clusters and four subgroups [cluster I (U. parvum): A, 43% (n = 31); B, 15% (n = 11); and C, 26% (n = 19); cluster II (U. urealyticum): 1; 16% (n = 12)]. Cluster II had a higher rate of polymicrobial findings than cluster I (58% vs 16%; p = 0.005), while subgroup A had the highest rate of concomitant Mycoplasma hominis in the amniotic fluid samples (66%; p = 0.04). In conclusion, Ureaplasma spp. DNA obtained from PPROM consisted of 33 different eSTs of U. spp. DNA. No differences in maternal and neonatal characteristics were found among the phylogenetical subgroups of U. spp. DNA, except for a higher rate of polymicrobial amniotic fluid findings in those with U. urealyticumand the concomitant presence of M. hominis in the amniotic fluid in those with the presence of U. parvum.

Maternal vascular indices at 36 weeks' gestation in pregnancy with small or growth-restricted fetus.

To compare maternal vascular indices and hemodynamic parameters at 35-37 weeks' gestation in pregnancies complicated by delivery of a small-for-gestational-age (SGA) or growth-restricted (FGR) neonate. This was a prospective observational study of women with a singleton pregnancy attending for a routine hospital visit at 35 + 0 to 36 + 6 weeks' gestation. The visit included recording of maternal demographic characteristics, medical history, vascular indices and hemodynamic parameters, which were obtained using a non-invasive operator-independent device and included pulse-wave velocity, augmentation index, cardiac output, stroke volume, central systolic and diastolic blood pressure, total peripheral resistance and heart rate. Women with hypertensive disorders of pregnancy were excluded. SGA was diagnosed if birth weight was < 10th percentile. FGR was diagnosed if, in addition to birth weight < 10th percentile, at the 35-37-week scan, uterine artery or umbilical artery pulsatility index (PI) was > 95th percentile or fetal middle cerebral artery PI was < 5th percentile. Among the 6413 women included in the study, there were 605 (9.4%) cases of SGA, 133 (2.1%) cases of FGR and 5675 (88.5%) cases that were unaffected by SGA or FGR. Women with SGA or FGR, compared to unaffected pregnancies, had increased peripheral vascular resistance and reduced cardiac output. Central systolic and diastolic blood pressure were increased in the FGR group compared with the unaffected group. Aortic stiffness, as assessed by pulse-wave velocity, and augmentation index did not differ between affected and unaffected pregnancies. In the FGR group, compared with the SGA group, central systolic and diastolic blood pressure were higher, whereas heart rate was lower. SGA and FGR pregnancies exhibit deranged maternal hemodynamic responses compared with unaffected pregnancies. Pregnancies with FGR have higher central blood pressure compared to those with SGA, but it remains unclear whether these differences are driven by the size of the fetus or pathological fetal growth. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

PSIX-22 Maternal methane, carbon dioxide, and oxygen flux compared with progeny gas flux

Abstract Red Angus heifers [n = 19; body weight (BW) = 370 ± 8.1 kg) and their paired offspring (BW = 283 ± 4.2 kg; 18 heifers, 1 steer) were used to compare the respiration gas parameters between dams and their progeny over 2 calving cycles (8 pairs in the 1st cycle, 11 in the 2nd). The methane (CH4), carbon dioxide (CO2) emissions and oxygen (O2) consumption of the dams were measured at 14 mo of age over a 70-d period using an automated head-chamber system (AHCS) that measured the flux of these 3 gases. Dams grazed native mixed-grass prairie and were offered a daily supplement of alfalfa (Medicago sativa L.) pellets (1.0 kg) via the AHCS. Dams were artificially inseminated using sexed semen (female) from a single Black Angus sire. The gas fluxes of the progeny were measured, beginning at 11 mo of age, over a 70-d period. Like the dams, during their measurement period, the progeny grazed native mixed-grass prairie and were offered a daily supplement (1.0 kg) of alfalfa pellets via the AHCS. Pearson correlations were developed between the 70-d means of daily CH4 and CO2 emissions, O2 consumption, CH4:CO2 ratio, respiratory quotient (RQ), and heat of production estimates for the dams and their progeny by regressing maternal parameters on the parameters of the progeny, using beginning dam and progeny BW as covariates, and year as an indicator variable. A dam’s CH4 emission was very strongly correlated with that of their offspring (ρ = 0.86). The CO2 emission and O2 consumption of the dams were both also very strongly (ρ = 0.92 and ρ = 0.97, respectively) correlated, with that of their progeny. The heat production and CH4:CO2 ratio of the dams were very strongly (ρ = 0.96) and fairly (ρ = 0.50) correlated, respectively, with that of their progeny. Lastly, the RQ of the dam was also very strongly correlated (ρ = 0.87) with the RQ of the progeny. These results indicate that CH4 and CO2 emissions, O2 consumption, CH4:CO2 ratio, and heat of production of the dam are fairly to very strongly correlated to the gas flux parameters of their progeny. Hence, even with this small dataset, there is evidence that beef cattle traits related to greenhouse gas emissions are somewhat heritable and could potentially be selected in breeding animals to decrease greenhouse gas emission intensity.

Determination of the Normative Value of Fetal Left Brachiocephalic Vein Diameter Using Ultrasound in a Tertiary Care Hospital in Eastern India.

Fetal ultrasound plays a vital role in prenatal care by offering key insights into fetal growth and facilitating the early identification of congenital abnormalities. Among various anatomical structures, the fetal left brachiocephalic vein (FLBCV) plays a significant role in fetal circulation, yet normative data for FLBCV dimensions are limited, particularly in diverse populations. This study aims to establish normative values for FLBCV diameter in fetuses between 18 and 23 weeks of gestation in a tertiary care hospital in Eastern India. Such data are essential for accurate clinical assessment and early diagnosis of potential congenital anomalies. This descriptive study was conducted at the College of Medicine and Sagore Dutta Hospital, Kolkata, India, from January to December 2022. The study included 287 singleton pregnancies between 18 and 23 weeks of gestation, excluding cases with maternal or fetal conditions that could affect the measurements. LBCV diameter was measured using transabdominal ultrasound, and the normative values were established using percentile charts. Correlation analyses were performed to assess the relationship between FLBCV diameter and various fetal and maternal parameters. Linear regression analysis was done to identify significant predictors of FLBCV diameter. FLBCV diameter showed a consistent increase with gestational age, ranging from a median of 1.87 mm at 18 completed weeks to 2.27 mm at 22 completed weeks. The 95th percentile values exhibited more pronounced growth, particularly between 18 and 20 weeks. Significant positive correlations were observed between FLBCV diameter and fetal biometric parameters such as biparietal diameter, head circumference, abdominal circumference, and femur length. Head circumference emerged as the most significant predictor (p=0.007) of FLBCV diameter in the linear regression model. This study provides essential normative data on FLBCV diameter for the Indian population, offering a valuable reference for clinicians in prenatal diagnostics. The incorporation of FLBCV measurement in basic fetal echocardiography, which is a part of the second-trimester fetal anomaly scan, could enhance the detection of congenital anomalies, contributing to improved prenatal care.

Effects of prenatal stress on reproductive function of male offspring through the KISS1 system.

Prenatal stress can lead to the programming of the neuroendocrine system in male offspring, disrupting the hypothalamic testicular axis and adversely affecting the reproductive health of male offspring. This study aimed to determine the long-term effects of prenatal stress on the KISS1 system in male offspring and the effects on reproductive function in male offspring. Sixteen pregnant females were divided into a prenatal control group (PC, n = 8) and a prenatal stress group (PS, n = 8). The PS group was modeled with chronic unpredictable mild stress (CUMS) from day 1 of gestation to full-term delivery. Differences between the two groups in various maternal parameters, including glucocorticoid secretion, litter size, and the effects of male offspring birth weight, the KISS1 system, and reproductive function, were determined. Male offspring of PS dams had lower birth weights compared to prenatal controls.KISS1 gene expression is reduced at birth and in adult PS offspring, and its receptor KISS1-R protein is similarly reduced in PS offspring at birth and adulthood. In adulthood, PS male offspring show significantly reduced sex hormone production, altered testicular morphology, reduced maturation of their supporting cells, and decreased expression of connexin 43 (CX43), leading to an altered sperm microenvironment and reduced sperm quality. In conclusion, prenatal stress leads to adverse changes in the KISS1 system in male offspring and decreased reproductive function.

Baicalin ameliorates heat stress-induced hepatic injury and intestinal microecology dysbiosis in late gestational mice

Heat stress (HS) disrupts intestinal microbiota, glycolipid metabolism, and hepatic mitochondrial function in late gestational mice. Baicalin (BAI), a Chinese herbal medicine known for its heat-clearing and anti-inflammatory properties, has shown promise in modulating intestinal microecology and mitigating inflammation in various organs. This study investigates whether baicalin attenuates HS-induced intestinal microbial dysbiosis and liver damage in pregnant mice during late gestation. Twenty-four pregnant mice were randomly assigned to four groups, including thermoneutral (TN) (24 ± 1 ℃), HS (35 ± 1 ℃), HS+BAI200 (oral gavaged with 200 mg/kg BW of BAI), and HS+BAI400 (oral gavaged with 400 mg/kg BW of BAI). 400 mg/kg BAI treatment markedly decreased the rectal temperature and increased fetal weight in HS pregnant mice. Furthermore, 400 mg/kg BAI administration effectively ameliorated HS-induced hepatic damage and lipid disorders, reducing HSP70, AST, and ALT levels while increasing TG concentration. Notably, it activated a network of genes involved in lipid synthesis, including fatty acid synthase (FAS), acetyl-CoA carboxylase (ACC), and oxidation, such as peroxisome proliferator-activated receptor alpha (PPARα), carnitine palmityl transferase 1 beta (CPT1β). Moreover, BAI intervention restored the intestinal morphology and barrier function, evidenced by increased intestinal villus height, the ratio of villus height to crypt depth, and colonic goblet cells numbers. 400 mg/kg of BAI treatment up-regulated the expression of tight junction proteins, such as claudin-1 and Zonula Occludens-1 (ZO-1), in the jejunum and ileum, counteracting HS-induced downregulation. High-throughput sequencing showed that BAI treatment altered cecal microbial composition, increasing the relative abundance of beneficial Bacteroidota and decreasing Deferribacterota, Turicibacter, and Akkermansia. Spearman’s correlation analysis highlighted significant correlations between differential cecal microbiota and physiological indexes. In conclusion, BAI administration alleviated adverse impacts in heat-exposed mice during late gestation, improving maternal physiological parameters, and ameliorating hepatic damage with altered cecal microbial composition. The findings suggest that BAI may regulate the gut-liver axis by modulating intestinal morphology, microecology, and hepatic function.

Alterations in maternal cardiovascular parameters and their impact on uterine and fetal circulation in hypertensive pregnancies and fetal growth restriction

ObjectiveTo examine potential alterations in maternal cardiovascular parameters in hypertensive pregnancies with or without fetal growth restriction (FGR) in comparison to uncomplicated normotensive pregnancies, and to determine the correlation between maternal cardiovascular parameters and changes in umbilical and uterine artery circulation. Materials and methodsThis study enrolled 73 pregnant women starting from the 20th week of gestation, categorized into three groups: hypertensive conditions (pregnancy-induced hypertension, preeclampsia or eclampsia, n = 30), hypertensive conditions with FGR (n = 8) and a control group of healthy normotensive pregnant women (n = 35). All participants underwent echocardiography to assess cardiac output and calculate peripheral vascular resistance. Additionally, fetal biometric measurements and Doppler ultrasound examinations of the uterine and umbilical artery were performed. The results were standardized into gestational age-adjusted z-scores. ResultsThe mean pulsatility index (PI) of the uterine artery (1.36, p < 0.001) and umbilical artery PI z-scores (1.32, p < 0.001) showed significant increases in the hypertensive conditions + FGR group. Maternal cardiac output z-scores were notably lower in both the hypertensive + FGR group (−2.62, p = 0.001) and the hypertensive group (−2.49, p < 0.001). Peripheral vascular resistance was significantly elevated in the hypertensive + FGR group (7.43, p < 0.001) and the hypertensive group (6.06, p < 0.001). There was a positive correlation between maternal peripheral vascular resistance and uterine artery PI (R2 = 0.172; p = 0.0004), and a negative correlation between cardiac output and uterine artery PI (R2 = 0.067; p = 0.031). However, significant correlation between maternal cardiovascular parameters and umbilical artery PI was not identified. ConclusionsMaternal cardiac output exhibits a significant decrease whereas peripheral vascular resistance increases in hypertensive pregnancies, irrespective of the presence of FGR. Both uterine and umbilical artery PI notably increase when hypertensive pregnancies are accompanied by FGR. A positive correlation exists between maternal peripheral vascular resistance and uterine artery PI, as well as a negative correlation between maternal cardiac output and uterine artery PI. However, changes in maternal cardiovascular parameters do not exhibit significant correlations with umbilical artery PI.

Hematological and Coagulation Factors in Term and Preterm Newborns of Mothers with Pre-eclampsia

Objective: Pre-eclampsia (preE) is pregnancy-induced hypertension affecting a significant proportion of pregnant women worldwide and can cause detrimental effects on the mother and newborn. Recognition of contributing factors of health in neonates with pre-eclamptic mothers is important to reduce the burden of the problem. The aim of the study was to determine the hematologic and coagulation factors in term and preterm neonates born to mothers with pre-eclampsia. Method and Materials: In this observational cross-sectional comparative study, 104 neonates born to mothers with pre-eclampsia in Imam-Hossein Hospital from 2018 to 2021 were enrolled. The neonates were divided into term and preterm groups according to the gestational age of the mothers. Maternal and fetal parameters of neonates were collected. The hematologic and coagulation factors were recorded and compared. Results: The finding of the study demonstrated that the mean leukocyte (P=0.030), hemoglobin (P=0.0001), and platelet (P=0.0001) were significantly higher in term neonates. The mean PT (P=0.003), PPT (P=0.001), and INR (P=0.003) were significantly higher in preterm cases. Conclusion: Totally, according to the obtained results it may be concluded that CBC indexes and coagulopathy in term and preterm neonates born to mothers with pre-eclampsia are significantly different.

Associations between maternal nutritional status, haemodynamic parameters and delivery outcomes in low-risk pregnancies: a prospective observational study

Associations between maternal nutritional status, haemodynamic parameters and delivery outcomes in low-risk pregnancies: a prospective observational study

Fetal bradycardia in open versus fetoscopic prenatal repair of spina bifida.

To compare the occurrence of fetal bradycardia in open versus fetoscopic fetal spina bifida surgery. This is a single-institution retrospective cohort study of patients undergoing open (n=25) or fetoscopic (n=26) spina bifida repair between 2017 and 2022. From October 2017 to June 2020, spina bifida repairs were performed via an open classical hysterotomy, and from November 2020 to June 2022 fetoscopic repairs were performed following transition to this technique. Fetal heart rate (FHR) in beats per minute (bpm) was recorded via echocardiography every 15min during the procedure. Cohort characteristics, fetal bradycardia and maternal physiologic parameters were compared between the groups. Fetuses undergoing an open repair more frequently developed bradycardia defined as <110 bpm (32% vs. 3.8%, p=0.008), and a trend was observed for FHR decreases more than 25 bpm from baseline (20% vs. 3.8%, p=0.073). Profound bradycardia less than 80 bpm was rare, occurring in only three operations (two in open, one in fetoscopic repair) with two fetuses (one in each group) requiring emergency cesarean delivery. When compared to open fetal surgery, fetal bradycardia occurred less frequently in fetoscopic surgery despite a significantly greater anesthetic exposure and the use of the intraamniotic carbon dioxide insufflation.

Correlation between Obesity and Pregnancy Outcomes, Miscarriage, and Mode of Delivery

&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;The obesity pandemic is a source of problems in both developed countries. The obesity is associated with complications before and during pregnancy and even infant death. The study aims to find out the issue of obesity among women of reproductive age, particularly concerning its impact on maternal and fetal outcomes during pregnancy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This is a cross-sectional observational study using secondary data with medical records taken at Sebelas Maret University Hospital (UNS Hospital). Subjects were obese pregnant women who gave birth at UNS Hospital. Data from 284 single births were added maternal parameters, obstetric parameters, and newborn parameters were taken and then analyzed univariately, and bivariate analysis was carried out using the Kruskall-Wallis test and the Spearman test for comparison and correlation of each variable.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;This study finds lower incidences of postdate pregnancy and instrumental deliveries among obese mothers, but a higher rate of emergency cesarean sections. Newborn anthropometric measurements increase with maternal BMI, indicating a direct association between maternal obesity and newborn health (p = 0.001), while APGAR scores show no significant differences among maternal BMI groups. The findings underscore the importance of addressing maternal obesity to improve both maternal and newborn health outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The research indicates a correlation between maternal BMI, maternal obstetric characteristics, newborn anthropometric measurements, and APGAR scores. This suggests that interventions aimed at promoting healthy maternal BMI, beginning before conception, continuing throughout pregnancy, and extending into the post-pregnancy period, could potentially improve newborn health outcomes and give long-term health benefits.&lt;/p&gt;

Serum Levels of Adipolin and Adiponectin and Their Correlation with Perinatal Outcomes in Gestational Diabetes Mellitus.

Objectives: This study aimed to investigate the serum level of adipolin and adiponectin in healthy pregnant women and pregnant women with gestational diabetes mellitus (GDM) during the second trimester, the prepartum period, and in the newborns of these patients. Methods: A total of 55 women diagnosed with GDM and 110 healthy pregnant women were included in this study. Pearson's and Spearman's correlation coefficients were calculated to determine the association of adipolin and adiponectin with anthropometric markers of obesity (body mass index (BMI), mid-upper arm circumference (MUAC), tricipital skinfold thickness (TST)), inflammation markers (neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP)), and maternal glucose homeostasis parameters (fasting glucose, insulin, C peptide, glycosylated hemoglobin A1c (HbA1c), Insulin Resistance-Homeostatic Model Assessment (IR HOMA)). Results: There were no statistical differences between the adipolin value in patients with GDM compared to healthy patients (p = 0.65 at diagnosis and p = 0.50 prepartum) and in newborns from mothers with GDM compared to healthy mothers (p = 0.24). Adipolin levels are significantly higher in patients with GDM who gave birth via cesarean section (p = 0.01). In patients with GDM, the adipolin level correlates positively with HgA1c in the prepartum period. We found a positive correlation between the maternal adipolin values at diagnosis and prepartum and neonatal adipolin (respectively: r = 0.556, p = 0.001; r = 0.332, p = 0.013). Adiponectin levels were significantly lower in patients with GDM at diagnosis and prepartum (p = 0.0009 and p = 0.02), but their levels increased prepartum (5267 ± 2114 ng/mL vs. 6312 ± 3150 ng/mL p = 0.0006). Newborns of mothers with GDM had lower adiponectin levels than newborns of healthy mothers (p < 0.0001). The maternal adiponectin value correlates negatively with maternal BMI, MUAC, and IR HOMA in both groups at diagnosis and prepartum. There were no differences between the groups in terms of cesarean rate (p > 0.99). The relative risk of occurrence of adverse events in patients with GDM compared to healthy ones was 2.15 (95% CI 1.416 to 3.182), and the odds ratio for macrosomia was 4.66 (95% CI 1.591 to 12.69). Conclusions: There was no difference in adipolin levels between mothers with GDM and healthy mothers during the second trimester and the prepartum period. Adipolin is known to enhance insulin sensitivity and reduce inflammation, but unlike adiponectin, it does not appear to contribute to the development of GDM.