Neonatal Outcomes In Women Research Articles

Neonatal Outcomes in Women with Pre-Eclampsia in a Tertiary Care Hospital

Objective: To determine the frequency of adverse neonatal outcomes in women with pre-eclampsia. Methods: This case series containing 100 patients with diagnosis of pre-eclampsia was conducted in Saidu teaching hospital Swat from April-2022 to January-2023. The women were followed till delivery of baby. The primary study endpoint was neonatal outcomes, which were labelled in-terms of pre-mature birth, birth status, APGAR score at 5 minutes, NICU admission, and in-hospital death. Results: Mean age was 31.2±3.5 years, majority of patients; 44% were multiparous. Cesarean section was performed in 66% patients. Regarding neonatal outcomes, pre-term birth rate was 53%, still birth occurred in 12% patients. 46% neonates had normal birthweight, 35% were of low birthweight and 19% were of very low birthweight. NICU admission was needed in 58% neonates and 16% neonates died before discharge. Conclusion: There is a high frequency of adverse neonatal outcomes in women with pre-eclampsia. Optimizing obstetric and neonatal care can help to reduce these adverse outcomes. Keywords: pre-eclampsia, still birth, low birthweight, APGAR score, mortality.

Neonatal Outcomes for Women at Risk of Preterm Delivery Given Half Dose Versus Full Dose of Antenatal Betamethasone: A Randomized, Multicenter, Double-blind, Placebo-controlled, Noninferiority Trial

(Lancet. 2022;400:592–604) Antenatal corticosteroids are recommended worldwide to help premature fetus lung maturity. However, the current recommended dose may be too high, based on some neurological, mental, and behavioral side effects. This study compared a half-dose (12 mg) of antenatal betamethasone to the typical full dose (24 mg) to determine if a half-dose can be as effective as a full dose, as well as to ultimately determine if a half-dose should be recommended in order to lessen side effects.

Association of chorioamnionitis with infertility treatment and subsequent neonatal outcomes in the US: a population-based cohort study

BackgroundChorioamnionitis (CAM) is a common risk factor for preterm births, resulting in several adverse outcomes. The association between infertility treatment and CAM is unclear. Therefore, this study examined the association between infertility treatment and CAM and described subsequent neonatal outcomes.MethodsThis population-based cohort study used data from the National Vital Statistics System Database. We included women who had a singleton live birth from January 1, 2016 to December 31, 2018. Women-infant pairs were stratified by infertility treatment, and the main outcome was a reported diagnosis of CAM in a checkbox format: clinical CAM or maternal temperature of > 38 °C. Multivariate logistic regression was used to examine the association between infertility treatment and CAM and the effect of infertility treatment on neonatal outcomes in women diagnosed with CAM.ResultsThe final sample comprised 10,900,495 woman-infant pairs, and 1.4% received infertility treatment. Compared with the natural conception group, women receiving infertility treatment had a significantly higher risk of CAM (adjusted odds ratio [aOR] 1.772 [95% confidence interval {CI}, 1.718–1.827]). Furthermore, newborns exposed to CAM had a higher risk of very low birth weight (VLBW) (aOR, 2.083 [95% CI, 1.664–2.606], P < .001), preterm birth (aOR, 1.497 [95% CI, 1.324–1.693]; P < .001), neonatal intensive care unit admission (aOR, 1.234 [95% CI, 1.156–1.317]; P < .001), and other adverse neonatal outcomes in the infertility treatment group compared with ones conceived naturally.ConclusionsThis study found that women who received infertility treatment had a higher risk of CAM. And CAM deteriorated neonatal outcomes in the infertility treatment group.

Provider and client perspectives on the use of maternity waiting homes in rural Rwanda

ABSTRACT Background The World Health Organization recommends the implementation of maternity waiting homes (MWH) to reduce delays in access to obstetric care, particularly for high-risk pregnancies and mothers living far from health facilities, and as a result, several countries have rolled out MWHs. However, Rwanda has not implemented this recommendation on a large scale. There is only one MWH in the country, hence a gap in knowledge regarding the potential utilisation and benefits of MWHs. Objective To explore providers’ and clients’ perspectives on facilitators and barriers to the use of MWH in rural Rwanda. Methods We conducted a qualitative study to explore health providers’ and clients’ perspectives on facilitators and barriers to the use of MWH in Rwanda, between December 2020 and January 2021. We used key informant interviews and focus group discussions to collect data. Data were analysed using NVivo qualitative analysis software version 11. Results Facilitators included perceptions that the MWH offered either a peaceful and home-like environment, good-quality services, or timely obstetric services, and was associated with good maternal and neonatal outcomes. Barriers included limited awareness of the MWH among pregnant women, fear of health providers to operate the MWH at full capacity, women’s lack of autonomy, uncertainty over funding for the MWH, and perceived high user fees. Conclusion The Ruli MWH offers a peaceful environment for pregnant women while providing quality and timely obstetric care, resulting in positive maternal and neonatal outcomes for women. However, its existence and benefits are not widely known, and its use is limited due to inadequate resources. There is a need for increased awareness of the MWH among healthcare providers and the community, and lessons from this MWH could inform the scale up of MWHs in Rwanda.

Pregnancy in Complement-Mediated Thrombotic Microangiopathy: Maternal and Neonatal Outcomes

Pregnancy, delivery, and neonatal outcomes in women with complement-mediated thrombotic microangiopathy (cTMA) have not been well described. A better understanding of these outcomes is necessary to provide women with competent pregnancy counseling. Cohort study. Women with a history of cTMA and pregnancies enrolled into the Vienna thrombotic microangiopathy cohort. New onset or relapses of cTMA. Pregnancy, delivery, and neonatal outcomes of pregnancies in women (a) before cTMA manifestation, (b) complicated by pregnancy-associated cTMA (P-cTMA), and (c) after first manifestation of cTMA or P-cTMA. Mixed models were used to adjust the comparison of pregnancy, delivery, and neonatal outcomes between conditions (before, with, and after cTMA) for repeated pregnancies using the mother's ID as random factor. In addition, the fixed factors, mother's age and neonate's sex, were used for adjustment. For (sex-adjusted and age-adjusted) centile outcomes, only the mother's age was used. Adjusted odds ratios were derived from a generalized linear mixed model with live birth as the outcome. Least squares means and pairwise differences between them were derived from the linear mixed models for the remaining outcomes. 28 women reported 74 pregnancies. Despite higher rates of fetal loss before the diagnosis of P-cTMA and preterm births with P-cTMA, most of the women were able to conceive successfully. Neonatal development in all 3 conditions of pregnancies was excellent. Pregnancy and neonatal outcomes were better in women with a pregnancy after the diagnosis of cTMA. Although our data set comprises a considerable number of 74 pregnancies, the effective sample size is lower because only 28 mothers with multiple pregnancies were observed. The statistical power for detecting clinically relevant effects was probably low. A recall bias for miscarriages cannot be ruled out. Prepregnancy counseling of women with a history of cTMA can be supportive of their desire to become pregnant.

Pregnancy and neonatal outcomes of women with coronavirus disease 2019: hospitals registry based study

Background Coronavirus disease (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome. Several reports highlighted the risk of infection with COVID-19 in pregnant women and neonate. Aim The aim of this study was of two folds: to identify the maternal, perinatal and neonatal outcomes for pregnant women with COVID-19 in study sample and explore the experience of women who were infected by COVID-19 during pregnancy about the illness process as well as maternal fears and concerns about their condition and the wellbeing of their unborn/newborn babies. Design Methodological triangulation approach was carried out to achieve the purpose of this study. Sample A total of 100 pregnant women were recruited from medical health records throughout one year. Setting The current study was conducted in isolation hospitals and home visits at Beni Suef governorate. Tools Two tools were utilized; (A) case record tool; (b) unstructured interview of open ended questions. Results The study findings reported that, preterm labor occurred in 41% of pregnant women, ICU admission and poor placental perfusion occurred in 26%, premature rupture of membrane occurred in 19% of pregnant women, respiratory failure and maternal death occurred in 16.1% of pregnant women. For neonatal outcomes; gestational age less than 37 weeks was showed in 52% of neonates, low birth weight was showed in 39% of neonates, 30% of neonates admitted to NICU, only one newborn experienced with COVID-19 infection, neonatal death occurred in 13% of neonates. As a result of the content analysis of the interviews with recovered women, the major themes that were emerged; Response to diagnosis with COVID-19 such as denial of the diagnosis, uncertainty, and some participant accepted the diagnosis. The experience of isolation such sadness, extreme longlines and fear, Challenges of the disease in health care delivery system such as scant medical supplies and overcrowding in the hospitals. Conclusion COVID-19 is associated with a high prevalence of adverse maternal and neonatal outcomes also COVID-19 infection has a negative emotional effect on pregnant women. Recommendation Developing COVID-19 treatment guidelines to provide clinicians with guidance on caring for pregnant women with COVID-19.

Obstetrical and Neonatal Outcomes in Women With Gestational Lyme Disease [ID: 1354384

INTRODUCTION: The incidence of Lyme disease (LD) infections has risen in recent decades. Gestational LD has been associated with adverse pregnancy outcomes; however, the results have been contradictory. The objective of this study was to examine the effects of gestational LD on obstetrical and neonatal outcomes. METHODS: Using the Healthcare Cost and Utilization Project–National Inpatient Sample database from the United States, we conducted a retrospective cohort study of pregnant women who were admitted to hospital between 2016 and 2019. The exposed group consisted of pregnant women with gestational LD infection (ICD-10 code of A692x), whereas the comparison group consisted of pregnant women without gestational LD. Descriptive statistics and multivariate logistic regression models, adjusted for baseline maternal characteristics, were used to determine the associations between gestational LD and obstetrical and neonatal outcomes. RESULTS: Our cohort included 2,943,575 women, 226 of whom were diagnosed with LD during pregnancy. The overall incidence of gestational LD was 7.67 per 100,000 pregnancy admissions. The incidence of gestational LD was stable during the study period. Women with gestational LD were more likely to be Caucasian, older, have private health insurance, and earn higher incomes than the comparison group. Gestational LD was associated with an increased risk of placental abruption (adjusted odds ratio [aOR] 3.45, 95% CI 1.53–7.80) and preterm birth (aOR 1.58, 95% CI 1.03–2.42). CONCLUSION: Gestational LD is associated with a higher risk of placental abruption and preterm birth. Pregnancies complicated by LD may benefit from being closely monitored in tertiary care settings.

Study of maternal and neonatal outcomes of placenta accreta spectrum in a tertiary care hospital

Background: Placenta accreta produces significant maternal morbidity and mortality. A detailed knowledge of outcome is needed to develop a standardized risk appropriate maternal care system. Aims and Objectives: The aim of the study was to study the maternal and neonatal outcome of women with placenta accreta spectrum (PAS) in a tertiary care hospital. Materials and Methods: A hospital-based prospective observational study was conducted among the 40 women with PAS during a period of 3 years. Exposure factors such as previous caesarean sections, previous uterine procedures, and present or previous placenta previa; maternal outcome factors include obstetric hysterectomy, massive blood transfusion, bowel and bladder injury, and death; neonatal outcome factors include prematurity, newborn intensive care unit (NICU) admissions, APGAR scores, and birth weight. The data were analyzed by calculating frequency and percentage. Results: Of the 40 cases studied, 25 were known cases of PAS, and the remaining was diagnosed intraoperatively. About 90% (36 cases) underwent an obstetric hysterectomy. In 62.5% of patients, large vessel ligation and a clamp were applied. About 32.5% of patients required massive blood transfusions, 20% sustained bladder injuries, and there was 1 maternal death. About 76% of babies born to mothers with PAS were preterm, 43% required NICU admission, and there were 5 neonatal deaths (12%). Conclusion: The PAS is associated with significant maternal morbidity in the form of severe postpartum hemorrhage requiring massive blood transfusions and bladder injury. There is also increased neonatal morbidity and mortality. Hence, there is a need for early termination in anticipation of grave complications.

Obstetrical and neonatal outcomes in women with gestational Lyme disease

The incidence of Lyme disease (LD) infections has risen in recent decades. Gestational LD has been associated with adverse pregnancy outcomes; however, the results have been contradictory. The objectives of this study was to examine the effects of gestational LD on obstetrical and neonatal outcomes.

A Systematic Review and Meta-Analysis Examining the Risk of Adverse Pregnancy and Neonatal Outcomes in Women with Isolated Hypothyroxinemia in Pregnancy.

Background: The relationship between isolated hypothyroxinemia (IH) in pregnancy and adverse pregnancy outcomes is controversial, with no consensus on the need for treatment. Summary: We conducted a systematic review and meta-analysis examining adverse pregnancy and neonatal outcomes in women with IH in pregnancy. We searched PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials for publications from inception to December 2022. Randomized clinical trials and cohort studies were included. Random-effects meta-analyses were used to estimate pooled relative risks (RRs) for each outcome. We included 21 articles, of which 19 investigated the relationship between IH and maternal and neonatal outcomes and 4 investigated the efficacy of levothyroxine (LT4) treatment. Compared with euthyroid pregnancies, IH pregnancies were associated with an increased risk of preterm birth (RR 1.35 [confidence interval, CI, 1.16-1.56]; I2 = 9%), premature rupture of membranes (RR 1.41 [CI 1.08-1.84]; I2 = 0%), gestational diabetes (RR 1.34 [CI 1.07-1.67]; I2 = 76%), macrosomia (RR 1.62 [CI 1.31-2.02]; I2 = 42%), and fetal distress (RR 1.72 [CI 1.15-2.56]; I2 = 0%). However, no statistically significant differences were noted in adverse outcomes according to LT4 treatment status. Conclusions: There is evidence suggesting that IH in pregnancy may be associated with an increased risk of adverse pregnancy and neonatal outcomes. However, it is unclear whether LT4 may mitigate the risk of these adverse outcomes.

The impact of cerclage placement on gestational length in women with premature cervical shortening.

Cervical insufficiency (CI) is a condition consistent with painless cervical dilatation that can lead to preterm delivery. Cervical cerclage is a procedure in which cervical suture is performed for preventing preterm labor in several indications. Late emergency cerclage is technically more challenging compared to elective cerclage, performed earlier during pregnancy, prior to cervical changes. Pregnancy outcomes with emergency cerclage were found to be improved in previous reports, but there is still inconclusive data. To assess the effectiveness and safety of emergency cerclage vs. conservative management with progesterone and/or bed resting, in preventing preterm birth and improving neonatal outcomes in women with clinically evident cervical insufficiency. This is a retrospective cohort study conducted on all women diagnosed with cervical insufficiency between the 16th and 24th gestational week who met the inclusion criteria, from January 2012 to December 2018. Obstetric and neonatal outcomes: time from diagnosis to delivery, duration of pregnancy, birth weight and Apgar score, were compared between women who underwent cerclage and those who treated conservatively. Twenty eight women underwent emergency cerclage (cerclage group) and 194 managed with a conservative therapy, progesterone and/or bed rest (control group). Time from diagnosis to delivery 13 weeks vs. 8weeks and birth weight 2,418 g vs. 1914 g were significantly higher in the first cohort. Average pregnancy duration was three weeks longer in the cerclage group, but that was not significant. No complications occurred in the cerclage group and no difference in mode of delivery were found. Emergency cerclage is an effective and safe procedure in preventing preterm birth and prolongation of pregnancy, in women with cervical insufficiency in the late second trimester.

Effect of serum progesterone on human chorionic gonadotropin trigger day / metaphase II oocyte ratio on pregnancy and neonatal outcomes in women undergoing ICSI cycle

BackgroundThe serum progesterone on human chorionic gonadotropin trigger day / metaphase II oocyte (P/MII) ratio might be a more predictable indicator of pregnancy and neonatal outcomes as compare to P/estradiol (E2) or P alone. Hence, we conducted a larger population study to compare the pregnancy and neonatal outcomes in the low and high P/MII ratio.MethodsA retrospective, single-center, larger population cohort study between January 2015 and August 2021. Calculate the threshold effect of P/MII ratio on clinical pregnancy rate according to the construct smooth curve fitting. Divide data into two groups by threshold for comparison.Results3566 fresh ICSI-ET cycles were included, in which 929 singleton delivery and 676 twin deliveries. Compare to P/MII ≤ 0.367 group, it indicated that the P/MII > 0.367 group had a lower clinical pregnancy rate and live birth rate, furthermore, a significantly higher rate of LBW and SGA were observed in the singleton and twin deliveries. No deleterious impact of high P/MII ratio on embryo quality and undesirable pregnancy outcomes was shown.ConclusionsWhen P/MII is higher than 0.367, may have adverse impacts on pregnancy and neonatal outcomes for ICSI cycle.

Perinatal outcomes in nulliparous women with a history of multiple pregnancy losses according to number of previous pregnancy losses

While it is widely acknowledged that pregnancy losses can lead to negative outcomes for both mothers and fetuses, there is limited information available on the specific levels of risk associated with each additional pregnancy loss. This study aimed to investigate the effect of number of previous pregnancy losses among nulliparous women on maternal and neonatal adverse outcomes. This was a multicenter retrospective cohort study. The study population included all nulliparous women with singleton pregnancies who delivered in all university-affiliated obstetrical centers in a single geographic area between 2003 and 2021. Maternal and neonatal outcomes of women who delivered at our medical centers and had varying numbers of previous pregnancy losses were compared with women who had no previous pregnancy loss. The primary outcome of this study was preterm delivery rate at <37 weeks of gestation. The secondary outcomes were adverse maternal and neonatal outcomes. Univariate analysis was performed using multiple logistic regression modeling. During the study period, 97,904 nulliparous women met the inclusion and exclusion criteria. Of those women, 84,245 (86%) had no previous pregnancy losses (reference group), 10,724 (11%) had 1 previous pregnancy loss, 2150 (2.2%) had 2 previous pregnancy losses, 516 (0.5%) had 3 previous pregnancy losses, 160 (0.2%) had 4 previous pregnancy losses, and 99 (0.1%) had ≥5 previous pregnancy losses. Women who had previous pregnancy losses had significantly higher rates of preterm delivery, hypertensive disorders of pregnancy, diabetes mellitus (pregestational and gestational), unplanned cesarean delivery, perinatal death, neonatal intensive care unit admissions, and neonatal hypoglycemia. The risks of preterm delivery and most other adverse obstetrical outcomes correlated with the number of previous pregnancy losses. Multivariate analyses showed that each previous pregnancy loss was associated with an additional, significant, increased risk of preterm delivery of 14% at <37 weeks of gestation, 37% at <34 weeks of gestation, 45% at <32 weeks of gestation, and 77% at <28 weeks of gestation. A history of previous pregnancy losses increased the risk of preterm delivery and other perinatal outcomes in a dose-dependent manner. To minimize perinatal complications, obstetricians should be aware of the risks and complications in this unique population, consider close monitoring of the cervical length, and maintain high vigilance in case of complications with special attention to other potentially modifiable risks.

Short Interpregnancy Interval Following a Multifetal Pregnancy: Maternal and Neonatal Outcomes

To evaluate the maternal and neonatal outcomes of women with short interpregnancy intervals (IPI < 6 months) following a multifetal pregnancy. A multicenter retrospective cohort study of women with an index multifetal delivery and a subsequent singleton gestation between 2005 and 2021. The obstetrical outcomes of pregnancies following short IPI (<6 months) were compared to those with an IPI of 18-48 months. Additional analyses were also conducted for the other IPI groups: 7-17 months, and longer than 49 months, while women with an IPI of 18-48 months served as the reference group. The primary outcome was preterm birth (<37 weeks) rate. Secondary outcomes were other adverse maternal and neonatal outcomes. Univariate and multiple logistic regression analyses were performed. Overall, 2514 women had a primary multifetal delivery with a subsequent singleton gestation at our medical centers; 160 (6.4%) had a short IPI, and 1142 (45.4%) had an optimal IPI. Women with a singleton gestation following a short IPI were younger, with lower rates of previous cesarean and fertility treatments. Women in the short IPI group had significantly higher rates of preterm birth <37 weeks, anemia (Hb < 11 gr%) on admission to the delivery room, and placental abruption. Multivariable logistic regression analysis demonstrated that short IPI is associated with an increased risk for preterm birth (aOR 2.39, 95% CI 1.12-5.11, p = 0.03). Short IPI following a multifetal gestation is associated with an increased risk for preterm birth in subsequent singleton pregnancy.

A meta-analysis of obstetric and neonatal outcomes in patients after treatment of hysteroscopic adhesiolysis.

Hysteroscopic adhesiolysis is widely performed in women with intrauterine adhesions. Small observational studies have reported the obstetric and neonatal outcomes, but studies with larger sample sizes are few. The aim of this study is to evaluate the obstetric and neonatal outcomes in women after hysteroscopic adhesiolysis. We conducted a literature search in July 2022 using the PubMed, Embase, the Cochrane Library, and Web of Science databases, and finally, 32 studies (N = 3812) were included. We did a meta-analysis to estimate the prevalence of placenta-related disorders, including placenta previa, placental abruption, placenta accreta, placenta increta, and retained placenta. We also included other obstetric and neonatal outcomes like postpartum hemorrhage, ectopic pregnancy, oligohydramnios, gestational hypertension, gestational diabetes mellitus, and intrauterine growth restriction. The results were presented as odds ratios (ORs) with 95% confidence intervals (CIs) in studies with a control group, but otherwise as prevalence (%) with 95% confidence intervals (CIs). The overall pregnancy and live birth rates were 58.97% and 45.56%, respectively. The prevalence of placenta previa differed in pregnant women who underwent hysteroscopic adhesiolysis compared with those who did not (OR, 3.27; 95% CI, 1.28-8.36). In studies without a comparative group, the pooled rate of placenta accreta was 7% (95% CI, 4-11) in 20 studies; placenta increta was 1% (95% CI, 0-4) in 5 studies; a retained placenta was 11% (95% CI, 5-24) in 5 studies; postpartum hemorrhage was 12% (95% CI, 8-18) in 12 studies; ectopic pregnancy was 1% (95% CI, 0-2) in 13 studies; oligohydramnios was 3% (95% CI, 1-6) in 3 studies; intrauterine growth restriction was 3% (95% CI, 1-8) in 3 studies; gestational hypertension was 5% (95% CI, 2-11) in 4 studies; and diabetes mellitus was 4% (95% CI, 2-7) in 3 studies. Due to the paucity of good quality comparative data, the question of whether there is an increased prevalence of obstetric and neonatal complications in women after hysteroscopic adhesiolysis compared with the general population remains unanswered. The findings from this review will provide a basis for more well-designed studies in the future. https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=364021, identifier [CRD42022364021].

Association between foetal sex and adverse neonatal outcomes in women with gestational diabetes.

Foetal male sex is associated with adverse perinatal outcomes. However, studies evaluating the impact of foetal sex on perinatal outcomes in women with gestational diabetes (GDM) are scarce. We studied whether male new-born sex is associated with neonatal outcomes, in women with GDM. This is a retrospective study based on the national Portuguese register of GDM. All women with live-born singleton pregnancies between 2012 and 2017 were eligible for study inclusion. Primary endpoints under analysis were neonatal hypoglycaemia, neonatal macrosomia, respiratory distress syndrome (RDS) and neonatal intensive care unit (NICU) admission. We excluded women with missing data on the primary endpoint. Pregnancy data and neonatal outcomes between female and male new-borns were compared. Multivariate logistic regression models were built. We studied 10,768 new-borns in mothers with GDM, 5635 (52.3%) male, 438 (4.1%) had neonatal hypoglycaemia, 406 (3.8%) were macrosomic, 671 (6.2%) had RDS, and 671 (6.2%) needed NICU admission. Male new-borns were more frequently small or large for gestational age. No differences were observed on maternal age, body mass index, glycated haemoglobin, anti-hyperglycaemic treatment, pregnancy complications or gestational age at delivery. In the multivariate regression analysis, male sex was independently associated with neonatal hypoglycaemia [OR 1.26 (IC 95%: 1.04-1.54), p = 0.02], neonatal macrosomia [1.94 (1.56-2.41), p < 0.001], NICU admission [1.29 (1.07-1.56), p = 0.009], and RDS [1.35 (1.05-1.73, p = 0.02]. Male new-borns have an independent 26% higher risk of neonatal hypoglycaemia, 29% higher risk of NICU admission, 35% higher risk of RDS, and almost twofold higher risk of macrosomia, compared to female new-borns.

The effectiveness of vaginal progesterone in reducing preterm birth in high-risk patients diagnosed with short cervical length after 24 weeks: A retrospective cohort study.

To assess the impact of progesterone treatment on maternal and neonatal outcomes in women with a history of preterm birth and short cervical length diagnosed after 24 weeks of gestation. A retrospective cohort study included women with a history of preterm birth and a transvaginal sonographic cervical length measurement of ≤ 25 mm, diagnosed between 24+0 and 33+6 weeks of gestation. Exclusion criteria included prior progesterone treatment, cervical cerclage, or pessary. The study population was divided into the progesterone treatment group and the non-treatment group. The study included 104 women, with 46.2% (48/104) receiving progesterone treatment and 53.8% (56/104) not receiving treatment. The rate of spontaneous preterm birth before 37 weeks of gestation was 43% (24/56) in the non-treatment group and 31% (15/48) in the progesterone treatment group (P = 0.14); the rate of spontaneous preterm birth before 34 weeks was 7% (4/56) in the non-treatment group and 0% (0/48) in the progesterone treatment group (P = 0.05). Progesterone treatment was associated with a significant decrease in neonatal intensive care unit admissions (OR 0.20, 95% CI 0.05-0.74) and in the neonatal hospitalization period (mean difference in days 2.43, 95% CI 0.44-4.42). The risk of recurrent spontaneous preterm birth was highest (71%) among women with two or more previous preterm deliveries who did not receive progesterone treatment, and lowest (24%) among women with one previous preterm delivery who received progesterone treatment. Progesterone treatment was associated with a reduction in rates of spontaneous preterm birth before 34 weeks of gestation, neonatal intensive care unit admission, and neonatal length of stay in high-risk patients, even when initiated after 24 weeks of gestation.

IDF2022-0437 Maternal and neonatal outcomes of women with type 1 diabetes; study from a resource constrained country Karachi Pakistan

IDF2022-0437 Maternal and neonatal outcomes of women with type 1 diabetes; study from a resource constrained country Karachi Pakistan

Association of Low Placental Growth Factor Gene Expression with Maternal and Neonatal Outcomes in Type 1 Diabetes: A Single Center, Cross-Sectional Study

Objective : The placental growth factor (PlGF) plays a crucial role in early and late pregnancy placental development. Pregestational type 1 diabetes (T1D) is a pregnancy complication that may lead to serious fetomaternal complications. Our study analyzed the association between placental PlGF mRNA expression and metabolic control, fetal weight and development in women with T1D. Materials and methods : A cross-sectional study on 65 pregnant women with T1D in singleton pregnancies admitted to the tertiary-level perinatal care unit. The study examined associations between the placental mRNA-PlGF gene expression measured with quantitative real-time PC and markers of maternal metabolism in the third trimester. The expression was also compared across maternal subgroups stratified according to the birth weight (small- vs. appropriate- vs. large-for-gestational age; SGA, AGA, LGA, respectively) and the following neonatal outcomes: mode of delivery, Apgar score and pH in the umbilical vessels. Results : Placental PlGF mRNA expression was significantly lower in SGA than in AGA and LGA patients (0.60 ± 0.34 vs. 0.63 ± 0.54 vs. 1.02 ± 0.15, respectively, p &lt; 0.05). In the SGA group, the expression of the PlGF-mRNA correlated positively with maternal 3 rd trimester BMI (r = 0.49, p = 0.04), pH and BE cord blood values, and maternal 3 rd trimester mean BP. There was no correlation between 3 rd -trimester glycated hemoglobin and mean blood glucose levels (MBG) and PlGF expression. Conclusions : Our data suggest that lower PlGF mRNA expression may predict neonatal outcomes in women with T1D giving birth to SGA newborns.

Obesity and gestational diabetes independently and collectively induce specific effects on placental structure, inflammation and endocrine function in a cohort of South African women.

Maternal obesity and gestational diabetes mellitus (GDM) are associated with insulin resistance and health risks for mother and offspring. Obesity is also characterized by low-grade inflammation, which in turn, impacts insulin sensitivity. The placenta secretes inflammatory cytokines and hormones that influence maternal glucose and insulin handling. However, little is known about the effect of maternal obesity, GDM and their interaction, on placental morphology, hormones and inflammatory cytokines. In a South African cohort of non-obese and obese pregnant women with and without GDM, this study examined placental morphology using stereology, placental hormone and cytokine expression using real-time PCR, western blotting and immunohistochemistry, and circulating TNFα and IL-6 concentrations using ELISA. Placental expression of endocrine and growth factor genes was not altered by obesity or GDM. However, LEPTIN gene expression was diminished, syncytiotrophoblast TNFα immunostaining elevated and stromal and fetal vessel IL-6 staining reduced in the placenta of obese women in a manner that was partly influenced by GDM status. Placental TNFα protein abundance and maternal circulating TNFα concentrations were reduced in GDM. Both maternal obesity and, to a lesser extent, GDM were accompanied by specific changes in placental morphometry. Maternal blood pressure and weight gain and infant ponderal index were also modified by obesity and/or GDM. Thus, obesity and GDM have specific impacts on placental morphology and endocrine and inflammatory states that may relate to pregnancy outcomes. These findings may contribute to developing placenta-targeted treatments that improve mother and offspring outcomes, which is particularly relevant given increasing rates of obesity and GDM worldwide. KEY POINTS: Rates of maternal obesity and gestational diabetes (GDM) are increasing worldwide, including in low-middle income countries (LMIC). Despite this, much of the work in the field is conducted in higher-income countries. In a well-characterised cohort of South African women, this study shows that obesity and GDM have specific impacts on placental structure, hormone production and inflammatory profile. Moreover, such placental changes were associated with pregnancy and neonatal outcomes in women who were obese and/or with GDM. The identification of specific changes in the placenta may help in the design of diagnostic and therapeutic approaches to improve pregnancy and neonatal outcomes with particular significant benefit in LMICs.