Maternal Parameters Research Articles

Exploration of Teratogenic Effects of Bambusa vulgaris on Wistar Rats by Evaluating Morphological and Skeletal Parameters

AbstractBambusa vulgaris is a commonly consumable plant, which is widely utilized by indigenous peoples as a source of food. Consumption of these plant products in various forms is typically acceptable due to their distinct tastes, and aromatic flavor. However, there is little information on the plant's safety and toxicity profile. Although toxicity information on B. vulgaris is readily available, the impact of plants during pregnancy has yet to be fully explored. To determine the possible mechanism behind teratogenicity, pregnant albino Wistar rats are administered aqueous extracts of B. vulgaris in a dose‐dependent manner. For determining the structural malformations, Teratogenicity indices include maternal common physiological parameters, number of implantations and fetal indices, number of live, resorpsed, and dead somites, morphological malformations, and skeletal malformations of different organs are evaluated by comparing different test groups with control groups. Most developmental indices, including implantation and fetalindices, vertebral, organ, and skeletal structures are significantly altered by the crude extract at higher dosages in treated as compared to control animals. The administration of aqueous extract of B. vulgaris during the organogenesis phase in rats has a considerable deleterious effect on embryonic and fetal developmental indices. It ruthlessly impacts the embryo's numerous organs as well as their typical physiological processes in a dose‐dependent way. The present investigation validates the capacity of B. vulgaris to cause developmental toxicity in Wistar rats, as evidenced by significant alterations in their gestational morphological, structural, and skeletal anatomy and physiology. It is recommended that further scientific studies be conducted to evaluate the more advanced mechanisms of teratogenicity associated with B. vulgaris.

Retrospective Study Comparing Treatment Outcomes in Obstetric Patients With Iron Deficiency Anemia Treated With and Without Intravenous Ferric Carboxymaltose.

Introduction Iron deficiency anemia is associated with an increased risk of adverse maternal and perinatal outcomes. Intravenous iron preparation containing ferric carboxymaltose has been shown to be a safe and effective way of increasing hemoglobin (Hb) and mean corpuscular volume (MCV) levels and reducing the need for blood transfusion. In our center, it used to be given as an inpatient procedure because of the risks of potential drug reactions. In 2021, we initiated the administration of intravenous ferric carboxymaltose as an outpatient procedure. We compared the outcomes of patients between 2021 and 2023 after the initiation of outpatient administration of intravenous ferric carboxymaltose in 127 obstetric patients with iron deficiency anemia in the second and third trimesters. Methods In this study conducted in a large maternity unit in Singapore between 2021 to 2023, we compared the changes in maternal hematological parameters among obstetric patients with iron deficiency anemia presenting to the day care unit in the second or third trimester with a Hb level of <8 g/dl treated with a single dose of ferric carboxymaltose injection (Ferinject) against a control group who were referred for treatment but defaulted on and declined treatment. Results Ferric carboxymaltose significantly increased the Hb and MCV levels at delivery in obstetric patients with iron deficiency. The mean Hb at delivery was 10.8 g/dL in the case group compared to 8.8 g/dL in the control group. The percentage of patients with Hb ≥10.0 g/dL was 73.4% in the case group compared to 27.8% in the control group. The incidence of adverse side effects was low and mild (2/127; 1.6%). None of the patients received were hospitalized because of ferric carboxymaltose. Conclusion A single injection dose of ferric carboxymaltose as an outpatient antenatal procedure was easily administered and well tolerated. Obstetric patients with iron deficiency anemia who received intravenous ferric carboxymaltose had a significantly higher level of Hb than those who did not.

Blastocyst telomere length predicts successful implantation after frozen-thawed embryo transfer.

Do embryos with longer telomere length (TL) at the blastocyst stage have a higher capacity to survive after frozen-thawed embryo transfer (FET)? Digitally estimated TL using low-pass whole genome sequencing (WGS) data from the preimplantation genetic testing for aneuploidy (PGT-A) process demonstrates that blastocyst TL is the most essential factor associated with likelihood of implantation. The lifetime TL is established in the early cleavage cycles following fertilization through a recombination-based lengthening mechanism and starts erosion beyond the blastocyst stage. In addition, a telomerase-mediated slow erosion of TL in human fetuses has been observed from a gestational age of 6-11 weeks. Finally, an abnormal shortening of telomeres is likely involved in embryo loss during early development. Blastocyst samples were obtained from patients who underwent PGT-A and FET in an IVF center from March 2015 to May 2018. Digitally estimated mitochondrial copy number (mtCN) and TL were used to study associations with the implantation potential of each embryo. In total, 965 blastocysts from 232 cycles (164 patients) were available to investigate the biological and clinical relevance of TL. A WGS-based workflow was applied to determine the ploidy of each embryo. Data from low-pass WGS-PGT-A were used to estimate the mtCN and TL for each embryo. Single-variant and multi-variant logistic regression, decision tree, and random forest models were applied to study various factors in association with the implantation potential of each embryo. Of the 965 blastocysts originally available, only 216 underwent FET. While mtCN from the transferred embryos is significantly associated with the ploidy call of each embryo, mtCN has no role in impacting IVF outcomes after an embryo transfer in these women. The results indicate that mtCN is a marker of embryo aneuploidy. On the other hand, digitally estimated TL is the most prominent univariant factor and showed a significant positive association with pregnancy outcomes (P < 0.01, odds ratio 79.1). We combined several maternal and embryo parameters to study the joint effects on successful implantation. The machine learning models, namely decision tree and random forest, were trained and yielded classification accuracy of 0.82 and 0.91, respectively. Taken together, these results support the vital role of TL in governing implantation potential, perhaps through the ability to control embryo survival after transfer. The small sample size limits our study as only 216 blastocysts were transferred. The number was further reduced to 153 blastocysts, where pregnancy outcomes could be accurately traced. The other limitation of this study is that all data were collected from a single IVF center. The uniform and controlled operation of IVF cycles in a single center may cause selection bias. We present novel findings to show that digitally estimated TL at the blastocyst stage is a predictor of pregnancy capacity after a FET cycle. As elective single-embryo transfer has become the mainstream direction in reproductive medicine, prioritizing embryos based on their implantation potential is crucial for clinical infertility treatment in order to reduce twin pregnancy rate and the time to pregnancy in an IVF center. The AI-powered, random forest prediction model established in this study thus provides a way to improve clinical practice and optimize the chances for people with fertility problems to achieve parenthood. This study was supported by a grant from the National Science and Technology Council, Taiwan (MOST 108-2321-B-006-013 -). There were no competing interests. N/A.

PREDICTORS AND OUTCOMES OF NEONATAL SEPSIS IN TERTIARY CARE SETTING: A RETROSPECTIVE STUDY

Neonatal sepsis represents a critical challenge in healthcare, particularly in tertiary care settings. A comprehensive understanding of the predictors and consequences is pivotal for enhancing clinical practice and patient outcomes. A retrospective study was conducted on a sample size of 120 neonates to explore the predictors and outcomes of neonatal sepsis. The analysis encompassed a wide range of variables, including maternal characteristics (e.g., age, religion, education), obstetric factors (e.g., PROM, UTI/STI history), neonatal demographics (e.g., age, sex, birth weight), healthcare facilities (e.g., place of delivery, length of stay), and clinical care parameters (e.g., invasive procedures, mode of delivery). Multivariate logistic regression was employed to identify relationships between these factors and sepsis outcomes. Maternal and obstetric factors showed significant correlations with neonatal sepsis. Neonatal characteristics revealed a mean age of 3.1 days, equal gender distribution, and a mean birth weight of 2.6 kg. Health facility indicators pointed to balanced utilization and transport means. Clinical care variables illustrated a balance in delivery modes and attendance. The logistic regression model (Nagelkerke R²: 0.52) identified specific coefficients indicating relationships between variables and sepsis. The mortality rate among neonates with sepsis was 27.8%, with an average stay of 15 days and 38.9% complications rate. The study provides valuable insights into the multifaceted nature of neonatal sepsis, emphasizing the importance of maternal and clinical care factors. The results underscore the necessity for early identification, targeted interventions, and comprehensive care strategies to reduce the incidence and adverse outcomes of neonatal sepsis in tertiary care settings.

In premature rupture of membranes, maternal serum delta neutrophil index may be a predictive factor for histological chorioamnionitis and affect fetal inflammatory markers: A retrospective cross-sectional study.

We aimed to investigate the predictive value of delta neutrophil index (DNI) for histological choriomanionitis (HCAM) and the effect of maternal inflammatory markers on neonatal outcomes and fetal inflammatory parameters. In this retrospective cross-sectional study, 68 pregnant women without HCAM (group 1) and 46 pregnant women diagnosed with HCAM (group 2) were divided into two groups. Demographic stories of the groups; maternal hematological parameters; maternal DNI and systemic inflammatory index (SII) values; outcomes of newborns; fetal inflammatory markers were recorded and compared between groups. Maternal DNI, and SII levels were significantly higher in group 2 (p value<.05 for all). Admission to the neonatal unit (NICU) was higher in group 2 than in group 1 (p=.0001). We found that fetal inflammatory markers were significantly higher in group 2 (p values .001 for CRP, .0001 for DNI, and .002 for leukocyte). Maternal DNI was determined to be significantly diagnostic at a value of ≥1.3 in HCAM (p=.001). We observed that SII had a significant predictive value of 953036.6 (p=.019) for NICU admission. There is also a positive correlation between fetal inflammatory markers and maternal inflammatory markers. We found that maternal inflammatory markers are high in HCAM, maternal DNI can predict patients who will develop HCAM, maternal SII value can predict NICU admission, fetal inflammatory markers are high in HCAM, and these markers are affected by maternal inflammatory markers.

Respiratory distress in SARS-CoV-2 exposed uninfected neonates followed in the COVID Outcomes in Mother-Infant Pairs (COMP) Study

Respiratory distress (RD) has been reported in SARS-CoV-2 exposed uninfected (SEU) term neonates. Prior studies suggest that prenatal exposure to Coronavirus Disease 19 (COVID-19) may activate an inflammatory cascade in the newborn airway. In this study, we examine the relationship between maternal COVID-19 vaccination and neonatal RD using a longitudinal cohort of mother-infant pairs in Los Angeles, CA. Two-hundred and twenty-one mothers with laboratory confirmed SARS-CoV-2 during pregnancy and 227 exposed fetuses are enrolled in our study. Maternal disease severity and neonatal RD variables were defined based on current accepted clinical criteria. To explore the multifactorial associations between maternal COVID-19 parameters and infant RD, we utilize a multivariable logistic regression model and a proteomic sub-analysis to propose a pathway for the development of RD following in utero exposure to SARS-CoV-2. Unusually high rates of RD are observed in SEU infants (17%). The odds ratio of RD is 3.06 (95% CI:1.08-10.21) in term neonates born to unvaccinated individuals versus those born to individuals vaccinated prior to maternal infection. Proteomic analysis reveals a robust inflammatory response associated with ciliary dysregulation and enhanced IgE production among SEU neonates with RD. Maternal vaccination against COVID-19 reduces the frequency of neonatal RD.

Association of Altered Ratio of Maternal Folic Acid and Vitamin B12 during Pregnancy with Newborn Birth Weight, Head Circumference, and Chest Circumference

Objective This study evaluated the effect of an altered ratio of maternal RBC folate (MRF) to serum vitamin B12 (MB12) on pregnancy and newborn outcomes. Methods Blood samples were collected from pregnant women and the umbilical cord at the time of delivery. Estimations of RBC folate and serum vitamin B12 from maternal and cord blood samples and total homocysteine (HCY) were performed. Maternal and newborn anthropometric parameters like placental weight (PW), head circumference (HC), chest circumference (CC), and body weight (BW) were measured in offsprings after birth. We stratified the pregnant women into six groups (a) vitamin B12 normal and folic acid normal (BNFN)-control group, (b) vitamin B12 normal and folic acid elevated (BNFE), (c) vitamin B12 normal and folic acid deficient (BNFD), (d) vitamin B12 deficient and folic acid normal (BDFN), (e) vitamin B12 deficient and folic acid elevated (BDFE) and (f) vitamin B12 deficient and folic acid deficient (BDFD) based on their levels of RBC folate (MRF) and vitamin B12 (MB12). The expression of the one-carbon metabolism genes (methionine synthase (MS), glycine N-methyltransferase (GNMT), and cystathionine β-synthase (CBS) was also studied in placental tissue by using real-time PCR. Results Cord blood RBC folate was significantly reduced in groups BDFE and BDFD as compared to the control group (BNFN). The cord blood vitamin B12 levels were also reduced in the BDFE group as compared to the BDFD. All the newborn parameters viz. PW, HC, CC, and BW, were reduced in the altered MRF/MB12 ratio (low & high vs. normal ratio). Total HCY was significantly elevated in the groups with (BDFE & BDFN) an imbalance of maternal RBC folate and serum vitamin B12 as compared to the control group. Downregulation of one-carbon metabolism genes like MS (p < 0.001), GNMT (p < 0.05), and CBS (p < 0.01) in placental tissue was observed in the high MRF/MB12 ratio group as compared to the normal ratio group. A strong positive correlation was also observed between MRF, MB12, and newborn parameters. Conclusions The altered ratio of folate to vitamin B12 in the maternal blood is associated with adverse growth and development of the newborn.

Intravenous ondansetron for the prevention of supine hypotensive syndrome during spinal anesthesia for cesarean section: a randomized controlled trial.

Background: Supine hypotensive syndrome is a common complication in late pregnancy. This study aims to explore the effects of ondansetron on the prevention of supine hypotensive syndrome during spinal anesthesia for cesarean section. Methods: A total of 80 women undergoing elective cesarean delivery were randomly assigned to two groups (the ondansetron group and the control group), with 40 cases in each group. The ondansetron group received 0.075mg/kg of ondansetron intravenously 5min before the induction of spinal anesthesia; the control group was given the same volume of saline solution. The blood pressure and heart rate were measured. Umbilical artery pH was analyzed, and the incidence of nausea and vomiting and vasoconstrictor drug usage were noted. Results: The incidence of supine hypotensive syndrome, nausea and vomiting, and vasoconstrictor drug use were significantly lower in the ondansetron group than the control group (2.5% vs. 20%, p = 0.029; 2.5% vs. 22.5%, p = 0.007; and 5% vs. 22.5%, p = 0.012, respectively). Umbilical artery pH was higher in the ondansetron group than the control group, and statistical significance was observed (7.31 ± 0.03 vs. 7.28 ± 0.04, p = 0.002). The maternal hemodynamic parameters and the neonatal Apgar score were similar between the two groups. Conclusion: Ondansetron can effectively prevent supine hypotensive syndrome, reduce the incidence of nausea, vomiting, and vasoconstrictor drug use, and improve neonatal umbilical arterial pH during spinal anesthesia for cesarean section. Clinical Trial Registration: https://www.chictr.org.cn/, identifier ChiCTR180018756.

Changes in the shape and function of the fetal heart of pre- and gestational diabetes mothers

BackgroundHyperglycemia during pregnancy can affect fetal heart in many ways, including causing cardiac malformation, leading to hypertrophic cardiomyopathy and cardiac dysfunction. Echocardiographic evaluation can assist identify alterations in heart structure, morphology and function, enabling prompt monitoring and management. However, according to earlier research, the cardiac alterations are modest in hyperglycemic mothers’ fetuses, and might not be detectable using conventional methods and it is also unclear whether these changes are related to the metabolism of mothers. Fetal Heart Quantification (Fetal HQ) can assess ventricular geometry and function more sensitively and thoroughly, and identify sub-clinical cardiac dysfunction. The purpose of this study was to evaluate fetal heart by Fetal HQ in fetuses of hyperglycemic mothers who either had pre-gestational or gestational diabetes and to correlate them with maternal metabolic indices.MethodsThe fetuses of 25 gestational age-matched control mothers, 48 women with gestational diabetes mellitus (GDM), and 11 women with diabetes mellitus (DM) were included in the prospective case-control research. Using fetal echocardiography and speckle tracking echocardiography (STE), the heart of the fetus was evaluated. Differences in the groups’ anthropometric, metabolic, and cardiac parameters were examined. It was assessed whether maternal features, prenatal glucose, lipids, and maternal hemoglobin A1c (HbA1c) correlated with fetal cardiac parameters.ResultsThe LV EDV and ESV were significantly higher in the GDM group as compared to the DM group (p < 0.05). The GSI% was significantly lower in the GDM group compared with the control (p < 0.05). The LV SV and CO of the GDM group were both significantly higher compared with the DM group (p < 0.05). There was a significant decrease in RV FS for segments 1–7 in GDM fetuses compared to the control (p < 0.05) and for segments 5–10 compared to DM (p < 0.05). Fetal cardiac morphology and function indices correlate with maternal pregestational weight, BMI, early pregnancy fast glucose, lipids, and glycemic control levels.ConclusionsFetuses exposed to gestational diabetes have altered heart morphology and function that is linked to maternal metabolic parameters, which presents a special indication for performing geometry and function cardiac assessment. Fetal HQ can be employed to evaluate the fetal cardiac shape and function in fetuses exposed to gestational diabetes.

Fetal cardiovascular changes during open and fetoscopic in-utero spina bifida closure.

Fetoscopic closure of spina bifida using heated and humidified carbon dioxide gas (hhCO2) has been associated with lower maternal morbidity compared with open closure. Fetal cardiovascular changes during these surgical interventions are poorly defined. Our objective was to compare fetal bradycardia (defined as fetal heart rate (FHR) < 110 bpm for 10 min) and changes in umbilical artery (UA) Doppler parameters during open vs fetoscopic closure. This was a prospective cohort study of 22 open and 46 fetoscopic consecutive in-utero closures conducted between 2019 and 2023. Both cohorts had similar preoperative counseling and clinical management. FHR and UA Doppler velocimetry were obtained systematically during preoperative assessment, every 5 min during the intraoperative period, and during the postoperative assessment. FHR, UA pulsatility index (PI) and UA end-diastolic flow (EDF) were segmented into hourly periods during surgery, and the lowest values were averaged for analysis. Umbilical vein maximum velocity was measured in the fetoscopic cohort. At each timepoint at which FHR was recorded, maternal heart rate and systolic and diastolic blood pressure were measured. Fetal bradycardia occurred in 4/22 (18.2%) cases of open closure and 21/46 (45.7%) cases of fetoscopic closure (P = 0.03). FHR decreased gradually in both cohorts after administration of general anesthesia and decreased further during surgery. FHR was significantly lower during hour 2 of surgery in the fetoscopic-repair cohort compared with the open-repair cohort. The change in FHR from baseline in the final stage of fetal surgery was significantly more pronounced in the fetoscopic-repair cohort compared with the open-repair cohort (mean, -32.4 (95% CI, -35.7 to -29.1) bpm vs -23.5 (95% CI, -28.1 to -18.8) bpm; P = 0.002). Abnormal UA-EDF (defined as absent or reversed EDF) occurred in 3/22 (13.6%) cases in the open-repair cohort and 23/46 (50.0%) cases in the fetoscopic-repair cohort (P = 0.004). There were no differences in UA-EDF or UA-PI between closure techniques at the individual stages of assessment. We observed a decrease in FHR and abnormalities in UA Doppler parameters during both open and fetoscopic spina bifida closure. Fetal bradycardia was more prominent during fetoscopic closure following hhCO2 insufflation, but FHR recovered after cessation of hhCO2. Changes in FHR and UA Doppler parameters during in-utero spina bifida closure were transient, no cases required emergency delivery and no fetoscopic closure was converted to open closure. These observations should inform algorithms for the perioperative management of fetal bradycardia associated with in-utero spina bifida closure. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

Methylation of serotonin regulating genes in cord blood cells: association with maternal metabolic parameters and correlation with methylation in peripheral blood cells during childhood and adolescence

BackgroundSerotonin (5-hydroxytryptamine, 5-HT) signaling is involved in neurodevelopment, mood regulation, energy metabolism, and other physiological processes. DNA methylation plays a significant role in modulating the expression of genes responsible for maintaining 5-HT balance, such as 5-HT transporter (SLC6A4), monoamine oxidase A (MAOA), and 5-HT receptor type 2A (HTR2A). Maternal metabolic health can influence long-term outcomes in offspring, with DNA methylation mediating these effects. We investigated associations between maternal metabolic parameters—pre-pregnancy body mass index (pBMI), gestational weight gain (GWG), and glucose tolerance status (GTS), i.e., gestational diabetes mellitus (GDM) versus normal glucose tolerance (NGT)—and cord blood methylation of SLC6A4, MAOA, and HTR2A in participants from our PlaNS birth cohort. CpG sites (15, 9, and 2 in each gene, respectively) were selected based on literature and in silico data. Methylation levels were quantified by bisulfite pyrosequencing. We also examined the stability of methylation patterns in these genes in circulating blood cells from birth to adolescence using longitudinal DNA methylation data from the ARIES database.ResultsNone of the 203 PlaNS mothers included in this study had preexisting diabetes, 99 were diagnosed with GDM, and 104 had NGT; all neonates were born at full term by planned Cesarean section. Methylation at most CpG sites differed between male and female newborns. SLC6A4 methylation correlated inversely with maternal pBMI and GWG, while methylation at HTR2A site -1665 correlated positively with GWG. None of the maternal metabolic parameters statistically associated with MAOA methylation. DNA methylation data in cord blood and peripheral blood at ages 7 and 15 years were available for 808 participants from the ARIES database; 4 CpG sites (2 in SLC6A4 and 2 in HTR2A) overlapped between the PlaNS and ARIES cohorts. A positive correlation between methylation levels in cord blood and peripheral blood at 7 and 15 years of age was observed for both SLC6A4 and HTR2A CpG sites.ConclusionsMethylation of 5-HT regulating genes in cord blood cells is influenced by neonatal sex, with maternal metabolism playing an additional role. Inter-individual variations present in circulating blood cells at birth are still pronounced in childhood and adolescence.

Fetal sexual dimorphism of maternal thyroid function parameters during pregnancy, a single center retrospective real-world study.

Thyroid function during pregnancy fluctuates with gestational weeks, seasons and other factors. However, it is currently unknown whether there is a fetal sex-specific thyroid function in pregnant women. The purpose of this study was to investigate the fetal sex differences of maternal thyroid-stimulating hormone (TSH) and free thyroxine (FT4) in pregnant women. This single-center retrospective real-world study was performed by reviewing the medical records of pregnant women who received regular antenatal health care and delivered liveborn infants in Shanghai First Maternity and Infant Hospital (Pudong branch), from Aug. 18, 2013 to Jul. 18, 2020. Quantile regression was used to evaluate the relationship between various variables and TSH and FT4 concentrations. The quantile regression also evaluated the sex impact of different gestational weeks on the median of TSH and FT4. A total of 69,243 pregnant women with a mean age of 30.36 years were included. 36197 (52.28%) deliveries were boys. In the three different trimesters, the median levels (interquartile range) of TSH were 1.18 (0.66, 1.82) mIU/L and 1.39 (0.85, 2.05) mIU/L, 1.70 (1.19, 2.40) mIU/L; and the median levels (interquartile range) of FT4 were 16.63 (15.16, 18.31) pmol/L, 14.09 (12.30, 16.20) pmol/L and 13.40 (11.52, 14.71) pmol/L, respectively. The maternal TSH upper limit of reference ranges was decreased more in mothers with female fetuses during gestational weeks 7 to 12, while their FT4 upper limit of the reference ranges was increased more than those with male fetuses. After model adjustment, the median TSH level was 0.11 mIU/L lower (P <0.001), and FT4 level was 0.14 pmol/L higher (P <0.001) for mothers with female fetuses than those with male fetuses during gestational weeks 9 to 12. We identified sexual dimorphism in maternal thyroid function parameters, especially during 9-12 weeks of pregnancy. Based on previous research, we speculated that it may be related to the higher HCG levels of mothers who were pregnant with girls during this period. However, longitudinal studies are needed to determine if fetal sex differences impact the maternal thyroid function across pregnancy.

Low Platelet Count Analysis as a Prognostic Indicator in Pregnancy-induced Hypertension

Introduction: Hypertension is one of the serious complications of pregnancy which virtually affects all maternal organs such as the liver, kidney, brain, and placenta. Changes in the hemostatic system are observed in normal and hypertensive patients. The frequency and intensity of maternal thrombocytopenia vary and are dependent on the intensity of the disease process and duration of pregnancy-induced hypertension (PIH) syndrome. In general, the lower the platelet counts, the higher the maternal and fetal morbidity and mortality. Aims and Objectives: The aims and objectives of the study were to study the platelet counts in cases of PIH, compare the values with normotensive pregnant participants, and study the association between thrombocytopenia and fetomaternal outcome. Materials and Methods: A total of 226 patients were included in the study and were evaluated for their platelet count and fetomaternal outcome. The patients were divided into two groups, with each group comprising 113 patients, namely, Group I which included controls and Group II which included patients with PIH (subgroups: gestational hypertension, preeclampsia, and eclampsia). Platelet counts in all groups were charted, compared, and correlated with various maternal parameters such as age, gravidity, severity of hypertension, gestational age of termination, maternal complications, and hospital stay. Fetal parameters studied were intrauterine growth restriction, stillbirth, neonatal intensive care unit care, and intrauterine fetal demise. Results: Our study found that the mean platelet count decreases with the severity of gestational hypertension. Thus, the highest platelet count was seen in the control group (D), i.e., 1.67 lakh/mm3 and the lowest platelet count was seen in the eclamptic group, (C) i.e., 0.75 lakh/mm3. Pregnancies complicated by thrombocytopenia were terminated at an earlier gestation (35–37 weeks). Maternal complications such as postpartum hemorrhage (56.5%) and stitch line ooze (27.5%) were found to occur more in the thrombocytopenic group. The association between birth weight and thrombocytopenia was statistically significant in our study. Conclusion: Thrombocytopenia associated with PIH is a reliable prognostic indicator for the severity of hypertension as well as the associated maternal and fetal morbidity.

Hemolysis in Pregnancy: Considerations for Sickle Cell Anemia Patients

Hemolysis in pregnancy represents a complex and multifaceted challenge, particularly for individuals grappling with sickle cell anemia. This review delves into the intricate interplay between the physiological changes induced by pregnancy and the underlying pathophysiology of sickle cell anemia. It provides a comprehensive examination of the clinical implications, management strategies, and recent research advances pertaining to hemolysis in pregnant women with sickle cell anemia. The physiological adaptations inherent in pregnancy, including alterations in the cardiovascular and hematologic systems, create a dynamic environment that may exacerbate hemolysis in individuals with sickle cell anemia. This review elucidates the intricacies of these changes, establishing a foundation for understanding the heightened risks and challenges faced by pregnant women with this inherited blood disorder. Effective management strategies are crucial for optimizing outcomes in pregnant women with sickle cell anemia experiencing hemolysis. This review provides an in-depth analysis of various approaches, including the role of hydroxyurea therapy, blood transfusions, and meticulous monitoring of maternal and fetal parameters. By evaluating the potential benefits and risks of each strategy, clinicians are equipped with valuable insights to tailor interventions to individual patient needs. In conclusion, this comprehensive review offers a synthesized perspective on the considerations surrounding hemolysis in pregnancy for individuals with sickle cell anemia. Bridging the realms of physiology, clinical practice, and research, it provides a valuable resource for healthcare professionals, researchers, and policymakers seeking to enhance the care and outcomes of pregnant women grappling with sickle cell anemia and heightened hemolytic challenges.

Risk factors and prediction model for new-onset hypertensive disorders of pregnancy: a retrospective cohort study.

Hypertensive disorders of pregnancy (HDP) is a significant cause of maternal and neonatal mortality. This study aims to identify risk factors for new-onset HDP and to develop a prediction model for assessing the risk of new-onset hypertension during pregnancy. We included 446 pregnant women without baseline hypertension from Liyang People's Hospital at the first inspection, and they were followed up until delivery. We collected maternal clinical parameters and biomarkers between 16th and 20th weeks of gestation. Logistic regression was used to determine the effect of the risk factors on HDP. For model development, a backward selection algorithm was applied to choose pertinent biomarkers, and predictive models were created based on multiple machine learning methods (generalised linear model, multivariate adaptive regression splines, random forest, and k-nearest neighbours). Model performance was evaluated using the area under the curve. Out of the 446 participants, 153 developed new-onset HDP. The HDP group exhibited significantly higher baseline body mass index (BMI), weight change, baseline systolic/diastolic blood pressure, and platelet counts than the control group. The increase in baseline BMI, weight change, and baseline systolic and diastolic blood pressure significantly elevated the risk of HDP, with odds ratios and 95% confidence intervals of 1.10 (1.03-1.17), 1.10 (1.05-1.16), 1.04 (1.01-1.08), and 1.10 (1.05-1.14) respectively. Restricted cubic spline showed a linear dose-dependent association of baseline BMI and weight change with the risk of HDP. The random forest-based prediction model showed robust performance with the area under the curve of 0.85 in the training set. This study establishes a prediction model to evaluate the risk of new-onset HDP, which might facilitate the early diagnosis and management of HDP.

Risk factors and etiology of early-onset neonatal sepsis in Northeastern part of India: Case-control study.

Sepsis, the second most common cause of neonatal mortality, causes more than one million deaths annually. India has the highest incidence of clinical sepsis (17000/100000 live birth). This study aimed to determine the risk factors and organisms of early-onset neonatal sepsis (EONS) in a tertiary care hospital in Northeast India. It was a case-control study conducted in the neonatal unit of MGM Medical College, Kishanganj, Bihar, from January 2022 to April 2023. All neonates admitted to the neonatal intensive care unit (NICU) within 72 hours of life constituted the study population. Neonates diagnosed as EONS by clinical and laboratory parameters were considered as cases and those not diagnosed for EONS as controls. Maternal and newborn information and laboratory parameters were collected and analyzed. For risk factor identification, the bivariate logistic regression was used. An equal number of cases (78) and control (78) were enrolled in the study. Maternal age >30 years (adjusted odds ratio [aOR] = 3.017, confidence interval [CI]: 1.238 to 7.352; P < 0.015), maternal urinary tract infection (UTI) in the third trimester (aOR = 5.435, CI: 2.647 to 11.158; P < 0.0001), and premature rupture of membranes (PROM) (aOR = 2.918, CI: 4.61 to 33.73, P < 0.004) were significant predictors of EONS. Pseudomonas (41.02%), Klebsiella (16.66%), and coagulase-negative Staphylococcus aureus (20.51%) were commonly isolated organisms, which were highly resistant to cephalosporin, meropenem, aminoglycosides, and quinolones. Proper and adequate antenatal screening for diagnosis and treatment of maternal infection and high-risk pregnancies for perinatal management of newborn is recommended to prevent neonatal sepsis-related morbidity and mortality. Rational use of antibiotics may minimize the hazard of antibiotic resistance.

Validity of the current anti-D immunoglobulin doses for the prevention of hemolytic disease of the newborn in Duhok/Iraq

Abstract: BACKGROUND: The current study was initiated to evaluate the comparability of fetomaternal hemorrhage (FMH) measurement using flow cytometry (FCM) and Kleihauer–Betke test (KBT) and also to evaluate the validity of the current anti-D immunoglobulin doses for the prevention of hemolytic disease of the newborn in Duhok/Iraq. MATERIALS AND METHODS: The current study included 101 pregnant women with Rh(D)-negative blood group who had Rh (D)-positive husbands. Their blood was tested for blood groping, FMH by FCM and KBT, and indirect Coombs test, 1 h following sensitizing events and 72 h after giving anti-D. Furthermore, blood from newborns was examined for blood group and direct Coombs test. RESULTS: The main sensitizing event was parturition (62.4%) followed by cesarean section (32.7%). The indirect Coombs was positive in 32 cases while the direct Coombs test was positive in 19 cases. In 63.4% of cases, the ABO blood groups were incompatible between mothers and their babies. When FMH was checked by KBT method, it was found that 16 (15.8%) participants had FMH ranging 1.2–51 mL (median 4.35 mL), while FMH was positive in 27 (26.7%) participants by FCM method ranging 1.2–54.4 ml (median 9.5 mL). About 4–5 patients had FMH (measured by KBT and FCM, respectively) of &gt;12 mL and only 1% had a volume of &gt;30 mL. The difference between KBT and FCM for FMH measurement was statistically significant with P &lt; 0.001 when assessed by paired t-test and has a highly significant positive correlation with each other. The correlation of FMH was statistically significant with maternal gravidity, number of anti-D received before (moderate positive correlation), gestational age, and newborn hemoglobin (negative correlation). However, the correlation was not significant between FMH and the following factors: maternal parity, maternal hematological parameters, and ABO compatibility of mother and their babies with P &gt; 0.05. CONCLUSION: Inadequate doses of anti-D had been given previously that resulted in sensitization in at least one-quarter of the cases, and this necessitated proper measurement of FMH in all Rh (D) mothers following sensitizing events.

İlk Trimesterde Monosit Sayısı ve Monosit Bazlı Kan Hücre İndekslerinin Gebeliğin İntrahepatik Kolestazı Gelişimi, Şiddeti ve Prognozunu Öngörmedeki Rolü

Abstract&#x0D; Aim: To evaluate the effect of monocyte count and monocyte-based whole blood cell indices in the prediction of intrahepatic cholestasis of pregnancy (ICP) in the first trimester.&#x0D; Materials and Method: The clinical data of patients who presented to the Perinatology Clinic of the Turkish Ministry of Health ----xxxxxxx--- ICP between January 1, 2021, and October 1, 2022, were evaluated retrospectively. Maternal demographic parameters, gestational age at birth, fetal birth weight, first-trimester white blood cell, neutrophil, platelet, monocyte, lymphocyte, and basophil counts, lymphocyte-to-monocyte ratio (LMR), platelet-to-monocyte ratio (PMR), neutrophil-to-monocyte ratio (NMR), and basophil-to-monocyte ratio (BMR) were recorded. These parameters were compared between the ICP and control groups. The relationship between monocyte count, monocyte-based blood cell indices, and fasting bile acid levels was evaluated in the ICP group. The cut-off values of the first-trimester monocyte count and monocyte-based blood cell indices for the prediction of ICP were determined.&#x0D; Results: Gestational week at birth and fetal birth weight were significantly lower, and the neonatal intensive care requirement was significantly higher in the ICP group (p

Associations between artificial reproductive technologies (ART) and newborn size, as well as perinatal risk factors among singleton births in Vienna, Austria.

Background: The use of ssisted reproductive technologies (ART) such as fertilization (IVF) and intracytoplasmic sperm injection (ICSI) has increased markedly during the last four decades. ART, however, is still discussed critically, as there is no consensus on whether these treatments have a negative effect on fetal growth or increase the risk of preterm birth, low birth weight, and perinatal complications. Objectives: The aim of this study is the analysis of association patterns between ART (IVF or ICSI) and newborn size, preterm birth rate, and the mode of delivery. Sample and Methods: In this single-center medical record-based study data concerning the conception mode (spontaneous versus IVF or ICSI), preterm birth, newborn sex and size, child presentation, delivery mode, labor induction as well as parity, maternal age, body height, weight, and gestational weight gain of 5867 singleton-term births taking place in Vienna from 2015 to 2023 were included. 178 newborns (3.0%) were conceived by IVF or ICSI. Results: ART (IVF or ICSI) increased the risk of preterm birth by a factor of 3.4, and the risk of emergency cesarean section by a factor 2.3. ART was not independently associated with newborn size as well as breech presentation. The most important factor for newborn size was the gestational week of delivery, but also maternal parameters such as body height, gestational weight gain, and age. Conclusion: Preterm birth is a major cause of small newborn size and complications at birth. Therefore, ART can also be interpreted with caution as an indirect risk factor for small newborn size with all its long-term consequences.

Impact of maternal age and body mass index on the structure and function of the heart in newborns: a Copenhagen Baby Heart Study

BackgroundMaternal obesity and advanced age have been associated with an increased risk of structural congenital heart defects in the offspring. Whether these factors may also cause abnormalities in infant cardiac dimension and function is unknown. This study investigates whether maternal body mass index (BMI) and maternal age are associated with changes in left ventricular (LV) dimensions and function in the newborn.MethodsInfants enrolled in the Copenhagen Baby Heart Study (CBHS), who were born at term, and contributed with a transthoracic echocardiography (TTE) within 60 days of birth were included. The exposure variables were prepregnancy maternal BMI (kg/m2) < 18.5; 18.5–24.9 (reference); 25–29.9; 30–34.9 and ≥ 35 and maternal age (years) < 25; 25–29; 30–34 (reference); 35–39 and ≥ 40. Outcomes were LV parameters ascertained by 2D-echocardiography. Associations between each maternal factor and infant LV parameters were analysed with either a linear model adjusted for the child’s weight and length at birth, gestational age, sex, age at TTE, and maternal smoking, or a linear mixed model, further adjusted for random effects of analyst and month of analysis. Analyses investigating impact of maternal BMI were adjusted for maternal age, and vice versa.ResultsThe study cohort included 24,294 infants. Compared with infants in the BMI reference group, infants born to women with a BMI ≥ 25 kg/m2 generally had smaller measures of LV internal diameters in end-diastole, reaching statistical significance for BMI 30–34.9 kg/m2 [-0.11 ± 0.04 mm, p = 0.01]. All groups of infants born to women with a BMI ≥ 25 kg/m2 had significantly smaller LV internal diameters in end-systole: BMI 25–29.9 kg/m2 [-0.04 ± 0.02 mm, p = 0.04], BMI 30–34.9 kg/m2 [-0.12 ± 0.03 mm, p = 0.001] and BMI ≥ 35 kg/m2 [-0.11 ± 0.05 mm, p = 0.03].Compared with infants in the age reference group, infants born to women ≥ 40 years had significantly smaller LV internal diameters in end-diastole [-0.15 ± 0.04 mm, p = 0.001] and end-systole [-0.09 ± 0.04 mm, p = 0.009].ConclusionsSystematic population-based echocardiography of infants showed that a maternal prepregnancy BMI ≥ 25 kg/m2 and maternal age ≥ 40 years were associated with smaller systolic and diastolic LV diameters. The long-term effects are unknown.Clinical trial registrationApril 2016, Copenhagen Baby Heart, NCT02753348.