Neonatal Outcomes In Pregnancies Research Articles

Neonatal and Obstetrical Outcomes of Pregnancies Complicated by Alloimmunization.

Despite advances in the prevention of rhesus (Rh)(D) alloimmunization, alloantibodies to Rh(D) and non-Rh(D) red blood cell antigens continue to be detected in ∼4% of US pregnancies and can result in hemolytic disease of the fetus and newborn (HDFN). Recent reports on HDFN lack granularity and are unable to provide antibody-specific outcomes. The objective of this study was to calculate the frequency of alloimmunization in our large hospital system and summarize the outcomes based on antibody specificity, titer, and other clinical factors. We identified all births in a 6-year period after a positive red blood cell antibody screen result during pregnancy and summarized their characteristics and outcomes. A total of 707 neonates were born after a positive maternal antibody screen result (3.0/1000 live births). In 31 (4%), the positive screen result was due to rhesus immune globulin alone. Of the 676 neonates exposed to alloantibodies, the direct antibody test (DAT) result was positive, showing antigen-positivity and evidence of HDFN in 37% of those tested. Neonatal disease was most severe with DAT-positive anti-Rh antibodies (c, C, D, e, E). All neonatal red blood cell transfusions (15) and exchange transfusions (6) were due to anti-Rh alloimmunization. No neonates born to mothers with anti-M, anti-S, anti-Duffy, anti-Kidd A, or anti-Lewis required NICU admission for hyperbilirubinemia or transfusion. Alloimmunization to Rh-group antibodies continues to cause a majority of the severe HDFN cases in our hospital system. In neonates born to alloimmunized mothers, a positive DAT result revealing antigen-positivity is the best predictor of anemia and hyperbilirubinemia.

Adverse obstetric and neonatal outcomes of pregnancy in high-risk women with heart disease

Adverse obstetric and neonatal outcomes of pregnancy in high-risk women with heart disease

Update on diabetic retinopathy during pregnancy.

Diabetes mellitus (DM) leads to several vascular and neurological complications, including diabetic retinopathy (DR). As the population ages, health problems in certain groups, including children and pregnant women, are drawing more and more attention. Pregnancy is one of the independent risk factors for the development and progression of DR. Pregnancy-induced changes may contribute to or worsen DR, which can cause a tremendous burden on public health. It is essential for pregnant women with DR and their offspring to minimize the risk of vision loss from DR in this population and adverse outcomes by understanding the development and processes behind this process. Thus, we have updated the recent situation of epidemiology, evolution characteristics, risk factors, pathophysiology, pregnancy outcomes for a better understanding of the latest status of DR, helping to improve maternal and neonatal pregnancy outcomes, and promoting health for women with DR.

Investigation of health inequities in maternal and neonatal outcomes of patients with placenta accreta spectrum: a multicenter study

BackgroundPlacenta accreta spectrum (PAS) is associated with significant maternal and neonatal morbidity and mortality. There is limited established data on healthcare inequities in outcomes of patients with PAS. ObjectiveTo investigate health inequities in maternal and neonatal outcomes of pregnancies with PAS. Study DesignThis multicentered retrospective cohort study included patients with histopathological diagnosis of PAS at four regional perinatal centers between 1/1/2013 – 6/30/2022. Maternal race and/or ethnicity were categorized as either Hispanic, non-Hispanic Black, non-Hispanic White, or Asian or Pacific Islander. Primary outcome was a composite adverse maternal outcome: transfusion of 4+ units of packed red blood cells, vasopressor use, mechanical ventilation, bowel or bladder injury or mortality. Secondary outcomes were composite adverse neonatal outcome (APGAR < 7 at 1-minute, morbidity, or mortality), gestational age at PAS diagnosis, and planned delivery by a multidisciplinary team. Multivariable logistic regression was used to estimate the associations of race/ethnicity with maternal and neonatal outcomes. Results408 pregnancies with PAS were included. In 218 patients (53%), the diagnosis of PAS was made antenatally. Patients predominantly self-identified as non-Hispanic White (31.6%) or non-Hispanic Black (24.5%). After adjusting for institution, age, BMI, income and parity, there was no difference in composite adverse maternal outcome among racial and ethnic groups. Similarly, adverse neonatal outcomes, gestational age at prenatal diagnosis, rate of planned delivery by a multidisciplinary team and cesarean hysterectomy were similar between groups. ConclusionIn our multicenter PAS cohort, race and/or ethnicity were not associated with inequities in composite maternal or neonatal morbidity, timing of diagnosis and planned multi-disciplinary care. We hypothesize that comparable incidence of individual risk factors for perinatal morbidity as well as geographic proximity reduce potential inequities that may exist in the larger population.

A comprehensive analysis of twin births: clinical characteristics, morbidity trends, and risk determinants

Background: Twin births are often associated with increased risks and complications compared to singleton births. This study aims to analyze the clinical profile, morbidity pattern, and risk factors associated with twin births, focusing on maternal characteristics, neonatal outcomes, and the prevalence of conditions such as low birth weight (LBW) and preterm births. Methods: This hospital-based observational study was conducted at a tertiary care center, involving 25 mothers who had given birth to twins and their 50 neonates. The study assessed maternal age, antenatal care, parity, medical history, and neonatal outcomes including birth weight, gestational age, respiratory and cardiac parameters, and overall health status. Data were collected through medical records and direct observations in the neonatal intensive care unit. Results: The majority of mothers (64%) were aged between 21-30 years, with a mean age of 24.8 years. A significant proportion (92%) had regular antenatal visits, and 96% were multiparous. The majority of neonates (68%) were aged ≤12 hours at assessment, with a near-equal distribution between very low birth weight (VLBW) and LBW. Preterm births were common, affecting 84% of the neonates. Respiratory challenges were evident, with 62% of neonates having SpO2 levels below 94%. The mortality rate among the neonates was 32%. Conclusions: The study highlights the high-risk nature of twin pregnancies, characterized by a significant prevalence of LBW, VLBW, and preterm births. The findings emphasize the need for enhanced prenatal care and specialized neonatal interventions. The high mortality rate among neonates indicates the critical need for targeted strategies to improve neonatal outcomes in twin pregnancies. These insights are crucial for informing clinical practices and developing comprehensive care protocols for managing twin pregnancies and their associated risks.

Analysis of perinatal outcomes for emergency cervical cerclage in singleton pregnancies at 24-28weeks of gestation.

Cervical cerclage is the only effective treatment for cervical insufficiency, effectively preventing late miscarriage and preterm birth. The effectiveness and safety of emergency cervical cerclage (ECC) as an emergency treatment when the cervix is already dilated or when there is protrusion of the fetal membranes into the vagina remain controversial, especially in pregnancies at 24-28weeks when the fetus is viable. There is still no consensus on whether emergency cervical cerclage should be performed in such cases. To investigate the effectiveness and safety of emergency cervical cerclage in singleton pregnant women at 24-28weeks of gestation. This study employed a single-center prospective cohort design, enrolling singleton pregnant women at 24-28weeks of gestation with ultrasound or physical examination indicating cervical dilation or even membrane protrusion. Emergency cervical cerclage was compared with conservative treatment. The primary endpoints included a comprehensive assessment of perinatal pregnancy loss, significant neonatal morbidity, and adverse neonatal outcomes. Secondary endpoints included prolonged gestational age, preterm birth, neonatal hospitalization rate, premature rupture of membranes, and intrauterine infection/chorioamnionitis. From June 2021 to March 2023, a total of 133 pregnant women participated in this study, with 125 completing the trial, and were allocated to either the Emergency Cervical Cerclage (ECC) group (72 cases) or the conservative treatment group (53 cases) based on informed consent from the pregnant women. The rate of adverse neonatal outcomes was 8.33% in the ECC group and 26.42% in the conservative treatment (CT) group, with a statistically significant difference (P = 0.06). There were no significant differences between the two groups in terms of perinatal pregnancy loss and significant neonatal morbidity. The conservative treatment group had a mean prolonged gestational age of 63.0 (23.0, 79.5) days, while the ECC group had 84.0 (72.5, 89.0) days, with a statistically significant difference between the two groups (P < 0.001). Compared with CT group, the ECC group showed a significantly reduced incidence of preterm birth before 28weeks, 32weeks, and 34weeks, with statistical significance (P = 0.046, 0.007, 0.001), as well as a significantly decreased neonatal hospitalization rate (P = 0.013, 0.031). Additionally, ECC treatment did not increase the risk of preterm premature rupture of membranes or intrauterine infection/chorioamnionitis, with no statistically significant differences (P = 0.406, 0.397). In singleton pregnant women with cervical insufficiency at 24-28weeks of gestation, emergency cervical cerclage can reduce adverse neonatal pregnancy outcomes, effectively prolong gestational age, decrease preterm births before 28weeks, 32weeks, and 34weeks, lower neonatal hospitalization rates, and does not increase the risk of preterm premature rupture of membranes or intrauterine infection/chorioamnionitis.

Retracted Article: The effect of maternal gestational diabetes on maternal and neonatal outcomes in twin pregnancies: A systematic review and meta-analysis

Retracted Article: The effect of maternal gestational diabetes on maternal and neonatal outcomes in twin pregnancies: A systematic review and meta-analysis

Is a Higher Amniotic Fluid Viral Load Associated with a Greater Risk of Fetal Injury in Congenital Cytomegalovirus Infection-A Systematic Review and Meta-Analysis.

Background: Numerous studies have aimed to predict prenatal and neonatal outcomes for pregnancies complicated by congenital cytomegalovirus (CMV). Presently, assessing CMV severity prenatally relies largely on fetal imaging. A controversy exists regarding CMV viral load (VL) and its association with fetal and neonatal sequelae. Objective: To perform a systematic review and meta-analysis investigating the association between CMV DNA VL in amniotic fluid and fetal and neonatal outcomes in pregnancies with congenital CMV. Results: All cohort, case-control and observational studies that compared outcomes of fetuses with congenital CMV and provided information on individual patient CMV VL quantified in copies per milliliter (c/mL) from inception to January 2023 were included, with no geographical or language restrictions. A total of 1251 citations were reviewed with eight studies meeting inclusion criteria and included in meta-analysis. Affected pregnancies had a higher VL in the amniotic fluid compared to those unaffected with a mean difference of 2.2e+7 (range 1.5e+7 to 2.8e+7). In subgroup analysis, the VL was significantly higher in the fetuses, with imaging findings related to CMV compared to asymptomatic fetuses with a mean difference of 4.1e+7 (95% CI 2.8e+7-5.4e+7). However, among babies with congenital CMV, the VL was not significantly different between symptomatic and asymptomatic babies. Conclusions: Amniotic fluid CMV VL is associated with fetal sequalae in congenital CMV, with a higher VL conferring a greater risk for prenatal injury.

The Influence of Gestational Diabetes Mellitus on Maternal and Neonatal Outcomes: A Retrospective Study in Rzeszów, Poland.

BACKGROUND Gestational diabetes mellitus (GDM) affects 5.8-12.9% of pregnant women, while pre-gestational diabetes mellitus (PGDM) affects 0.4-1.1%. GDM increases the risk of perinatal complications and long-term health issues. This retrospective study from a single centre in Rzeszów, Poland aimed to evaluate maternal and neonatal outcomes of pregnancy of 65 women with gestational diabetes mellitus. MATERIAL AND METHODS The study group consisted 65 women with GDM. The control group consisted 60 women without. GDM were diagnosed with carbohydrate metabolism disorders during pregnancy based on the results of the oral glucose tolerance test (OGTT). Methods of evaluation of the mothers: age, body mass before pregnancy, body height, body mass index (BMI), gravidity, parity, the number of miscarriages, length of stay (LOS) of mother, gestational weight gain (GWG), duration of pregnancy, type of delivery, treatment of diabetes. Methods of evaluation of the child: LOS, birth weight, Apgar points. RESULTS Women with diabetes stayed in hospital longer than women without, similarly applies the length of stay (LOS) of the child (p<0.001). It turned out that the women with GDM were significantly more likely to deliver by caesarean section (CS) (p=0.024) and these women most often had gestational weight gain (GWG) within the recommended range (p<0.001). Body mass index (BMI) before pregnancy was significantly higher in the women with GDM (p=0.023). CONCLUSIONS The above study confirms that the occurrence of GDM has an undoubted impact on prolonged LOS of the mother and child, more frequent CS delivery and normal GWG.

Pregnancy in women with congenital heart disease: New insights into neonatal risk prediction

BackgroundAdvances in managing adult congenital heart disease (ACHD) have led to an increased number of women with CHD reaching childbearing age. This demographic shift underscores the need for improved understanding and prediction of complications during pregnancy in this specific ACHD population. Despite progress in maternal cardiac risk assessment, the prediction of neonatal outcomes for ACHD pregnancies remains underdeveloped. Therefore, the aims of this study are (1) to assess neonatal outcomes in a CHD women population, (2) to identify their predictive factors and (3) to propose a new risk score for predicting neonatal complications. MethodsThis registry study included all women born between 1975 and 1996 diagnosed with ACHD who underwent at least one cardiology consultation for ACHD in Cliniques Universitaires Saint-Luc. A multivariate analysis was performed to identify predictors of neonatal complications and these were incorporated into a new risk index. Its validity was assessed using bootstrap method. This score was then compared with scores adapted from the ZAHARA and CARPREG studies for offspring events prediction. ResultsAnalysis of 491 pregnancies revealed 31.4% of neonatal complications. Four significant predictors of adverse neonatal outcomes were identified: cardiac treatment during pregnancy (OR 14.8, 95%CI [3.4-66]), hypertensive disorders of pregnancy (OR 11.4, 95%CI [3.4-39.0]), smoking during pregnancy (OR 10.6, 95% CI [2.8-40.6]), and pre-pregnancy BMI < 18.5 kg/m² (OR 6.5, 95% CI [2.5-16.5]). The risk model demonstrated an AUC of 0.70 (95% CI [0.65-0.75), which remained stable after bootstrap validation. This model significantly outperformed the scores adapted from ZAHARA and CARPREG data. Based on the regression coefficients, a risk score was subsequently developed comprising 5 risk categories. ConclusionsOne third of ACHD pregnancies are complicated by poor neonatal outcome. These complications are determined by 4 independent factors relating to the cardiac and non-cardiac status of the patients, which have been incorporated into a risk score. Our study is one of the first to propose a predictive risk score of neonatal outcomes in ACHD pregancies, and paves the way for other validation and confirmation studies.

Pathologic maternal and neonatal outcomes associated with programmed embryo transfer: potential etiologies and strategies for prevention.

In the first of two companion papers, we comprehensively reviewed the recent evidence in the primary literature, which addressed the increased prevalence of hypertensive disorders of pregnancy, late-onset or term preeclampsia, fetal overgrowth, postterm birth, and placenta accreta in women conceiving by in vitro fertilization. The preponderance of evidence implicated frozen embryo transfer cycles and, specifically, those employing programmed endometrial preparations, in the higher risk for these adverse maternal and neonatal pregnancy outcomes. Based upon this critical appraisal of the primary literature, we formulate potential etiologies and suggest strategies for prevention in the second article. Comprehensive review of primary literature. Presupposing significant overlap of these apparently diverse pathological pregnancy outcomes within subjects who conceive by programmed autologous FET cycles, shared etiologies may be at play. One plausible but clearly provocative explanation is that aberrant decidualization arising from suboptimal endometrial preparation causes greater than normal trophoblast invasion and myometrial spiral artery remodeling. Thus, overly robust placentation produces larger placentas and fetuses that, in turn, lead to overcrowding of villi within the confines of the uterine cavity which encroach upon intervillous spaces precipitating placental ischemia, oxidative and syncytiotrophoblast stress, and, ultimately, late-onset or term preeclampsia. The absence of circulating corpus luteal factors like relaxin in most programmed cycles might further compromise decidualization and exacerbate the maternal endothelial response to deleterious circulating placental products like soluble fms-like tyrosine kinase-1 that mediate disease manifestations. An alternative, but not mutually exclusive, determinant might be a thinner endometrium frequently associated with programmed endometrial preparations, which could conspire with dysregulated decidualization to elicit greater than normal trophoblast invasion and myometrial spiral artery remodeling. In extreme cases, placenta accreta could conceivably arise. Though lower uterine artery resistance and pulsatility indices observed during early pregnancy in programmed embryo transfer cycles are consistent with this initiating event, quantitative analyses of trophoblast invasion and myometrial spiral artery remodeling required to validate the hypothesis have not yet been conducted. Endometrial preparation that is not optimal, absent circulating corpus luteal factors, or a combination thereof are attractive etiologies; however, the requisite investigations to prove them have yet to be undertaken. Presuming that in ongoing RCTs, some or all adverse pregnancy outcomes associated with programmed autologous FET are circumvented or mitigated by employing natural or stimulated cycles instead, then for women who can conceive using these regimens, they would be preferable. For the 15% or so of women who require programmed FET, additional research as suggested in this review is needed to elucidate the responsible mechanisms and develop preventative strategies.

Pathologic maternal and neonatal outcomes associated with programmed embryo transfer.

In this first of two companion papers, we critically review the evidence recently published in the primary literature, which addresses adverse maternal and neonatal pregnancy outcomes associated with programmed embryo transfer cycles. We next consider whether these pathological pregnancy outcomes might be attributable to traditional risk factors, unknown parental factors, embryo culture, culture duration, or cryopreservation. Finally, in the second companion article, we explore potential etiologies and suggest strategies for prevention. Comprehensive review of primary literature. The preponderance of retrospective and prospective observational studies suggests that increased risk for hypertensive disorders of pregnancy (HDP) and preeclampsia in assisted reproduction involving autologous embryo transfer is associated with programmed cycles. For autologous frozen embryo transfer (FET) and singleton live births, the risk of developing HDP and preeclampsia, respectively, was less for true or modified natural and stimulated cycles relative to programmed cycles: OR 0.63 [95% CI (0.57-0.070)] and 0.44 [95% CI (0.40-0.50)]. Though data are limited, the classification of preeclampsia associated with programmed autologous FET was predominantly late-onset or term disease. Other adverse pregnancy outcomes associated with autologous FET, especially programmed cycles, included increased prevalence of large for gestational age infants and macrosomia, as well as higher birth weights. In one large registry study, FET was associated with fetal overgrowth of a symmetrical nature. Postterm birth and placenta accreta not associated with prior cesarean section, uterine surgery, or concurrent placenta previa were also associated with autologous FET, particularly programmed cycles. The heightened risk of these pathologic pregnancy outcomes in programmed autologous FET does not appear to be attributable to traditional risk factors, unknown parental factors, embryo culture, culture duration, or cryopreservation, although the latter may contribute a modestdegree of increased risk for fetal overgrowth and perhaps HDP and preeclampsia in FET irrespective of the endometrial preparation. Programmed autologous FET is associated with an increased risk of several, seemingly diverse, pathologic pregnancy outcomes including HDP, preeclampsia, fetal overgrowth, postterm birth, and placenta accreta. Though the greater risk for preeclampsia specifically associated with programmed autologous FET appears to be well established, further research is needed to substantiate the limited data currently available suggesting that the classification of preeclampsia involved is predominately late-onset or term. If substantiated, then this knowledge could provide insight into placental pathogenesis, which has been proposed to differ between early- and late-onset or term preeclampsia (see companion paper for a discussion of potential mechanisms). If a higher prevalence of preeclampsia with severe features as suggested by some studies is corroborated in future investigations, then the danger to maternal and fetal/neonatal health is considerably greater with severe disease, thus increasing the urgency to find preventative measures. Presupposing significant overlap of these diverse pathologic pregnancy outcomes within subjects who conceive by programmed embryo transfer, there may be common etiologies.

Analysis of the Effects of Maternal Body Mass Index and Gestational Weight Gain on Maternal and Neonatal Outcomes in Twin Pregnancy

Objective: To investigate the effects of maternal body mass index (BMI) and gestational weight gain on maternal and neonatal outcomes in twin pregnancies. Methods: Five hundred cases of twin pregnancies were divided into a low body weight group (68 cases), a normal weight group (355 cases), an overweight group (65 cases), and an obesity group (12 cases) according to the World Health Organization (WHO) Body Mass Index (BMI) classification guidelines Results: Comparison of weight gain during different pregnancies revealed that pregnant women were mainly of low weight and average weight. The higher the BMI before pregnancy, the higher the incidence of excessive weight gain during pregnancy. The incidences of gestational diabetes mellitus (GDM) and premature rupture of membranes in women with low weight gain were significantly higher than those in women with average weight gain and high weight gain (P &lt; 0.05). The incidences of gestational hypertension, preeclampsia, and anemia in women with high weight gain were significantly higher than those in women with low weight gain and average weight gain (P &lt; 0.05). The incidence of neonatal birth weight, fetal distress, and macrosomia in the high weight gain group was significantly higher than those in the low weight gain and average weight gain groups (P &lt; 0.05). The birth weight of newborns in low-weight gain mothers was significantly lower than that of normal-weight gain mothers (P &lt; 0.05). Conclusion: Poor maternal and infant outcomes were common in women with insufficient or excessive weight gain during pregnancy. Therefore, for women with twin pregnancies, weight management is crucial to ensure maternal and infant health.

Maternal, Perinatal and Neonatal Outcomes of Triplet Pregnancies According to Chorionicity: Our 15-Year Experience in a Tertiary-Level Center.

Introduction: The goal of this study was to evaluate the effect of chorionicity on maternal, fetal and neonatal morbidity and mortality in triplet pregnancies in our environment. Methods: A retrospective observational study was carried out on triplet pregnancies that were delivered in a tertiary center between 2006 and 2020. A total of 76 pregnant women, 228 fetuses and 226 live newborns were analyzed. Of these triplet pregnancies, half were non-trichorionic. We analyzed maternal characteristics and obstetric, fetal, perinatal and neonatal complications based on their chorionicity, comparing trichorionic vs. non-trichorionic triplet pregnancies. Prematurity was defined as <34 weeks. We measured perinatal and neonatal mortality, composite neonatal morbidity and composite maternal morbidity. Results: Newborns with a monochorionic component had a lower gestational age at birth, presented greater prematurity under 34 weeks, lower birth weight, greater probability of birth weight under 2000 g and an APGAR score below 7 at 5 min after birth, more respiratory distress syndrome and, overall, higher composite neonatal morbidity. The monochorionic component of triple pregnancies may entail the development of complications intrinsic to shared circulation and require premature elective termination. This greater prematurity is also associated with a lower birth weight and to the main neonatal complications observed. These findings are in line with those that were previously published in the meta-analysis by our research group and previous literature. Discussion: Triplet gestations with a monochorionic component present a higher risk of obstetric, fetal and neonatal morbidity and mortality.

The sFlt-1/PlGF Ratio at 12, 24, and 32 Weeks Gestation in Twin Pregnancies as a Predictor of Placental Dysfunction.

Background: This study aims to assess the utility of the sFlt-1/PlGF ratio throughout pregnancy in predicting placental dysfunction and neonatal outcomes in twin pregnancies. Methods: Prospective study at a tertiary hospital. All pregnant women with a twin pregnancy who signed the informed consent were included. The sFlt-1/PlGF ratio was measured at 12, 24, and 32 weeks' gestation. Results: Seventy patients were included, and 30% developed placental dysfunction. Differences were found in the mean sFlt-1/PlGF ratios at week 32 (13.6 vs. 31.8, p = 0.007). Optimal cutoffs at 12, 24, and 32 weeks to identify patients who develop placental dysfunction were 32.5, 8.5, and 30.5, respectively, with ORs of 4.25 (1.13-20.69 95% IC; p = 0.044), 13.5 (3.07-67.90 95% IC; p = 0.001), 14.29 (3.59-66.84 95% IC; p < 0.001). The sFlt-1/PlGF ratio at 32 weeks was associated with gestational age at birth. The sFlt-1/PlGF ratio in weeks 24 and 32 had a statistically significant negative correlation with the birth weight percentile in both twins. Conclusions: The potential of the sFlt-1/PlGF ratio as a predictive tool for placental dysfunction in twin pregnancies is underscored.

Maternal and neonatal outcomes of dichorionic twin pregnancies achieved with assisted reproductive technology: meta-analysis of contemporary data.

Assisted reproductive technology (ART) is commonly used to achieve pregnancy and often results in dichorionic diamniotic (DCDA) twin pregnancies. However, the potential risks of ART on maternal and neonatal outcomes in these pregnancies are not well understood. The objective is to compare the maternal and neonatal outcomes in DCDA twin pregnancies between those achieved through ART and those spontaneously conceived (SC). We carried out a systematic comprehensive search of electronic databases; namely, PubMed, Embase, Scopus, and the Cochrane Library, from inception to March 2023 with a study period of recruitment between 2003 and 2023. We included all studies comparing the maternal and neonatal outcomes of DCDA twin pregnancies between those achieved by ART and those SC. We analyzed data from 18 cohort studies involving 10,485 women with DCDA twin pregnancies. The meta-analysis showed that ART-conceived pregnancies had a significantly higher risk of preeclampsia or gestational hypertension (GH), gestational diabetes mellitus (GDM), placenta previa (PP), placental abruption (PA), postpartum hemorrhage (PPH), and elective and emergency cesarean sections than SC twin pregnancies. The absolute risks of these complications remained relatively low. We also found a slightly higher risk of respiratory distress syndrome (RDS) and congenital malformations in ART-conceived infants compared to the risks in SC infants. Finally, the risk of neonatal intensive care unit (NICU) admissions was significantly higher in ART-conceived infants than in SC infants, but with high heterogeneity. We found associations between DCDA twin pregnancies conceived through ART and increased frequencies of adverse maternal outcomes. However, the absolute risks of these complications remained low, and the benefits of ART for achieving successful pregnancies may well outweigh the potential risks. Additionally, ART-conceived DCDA twin pregnancies may pose higher risks of RDS, congenital malformations and NICU, admissions than SC DCDA twin pregnancies.

Improved neonatal outcomes in pregnancies with coexisting gestational diabetes and preeclampsia in normal birthweight neonates- insights from a retrospective cohort study

IntroductionWe aimed to assess neonatal and maternal outcomes in appropriate-for-gestational-weight (AGA) neonates of mothers with both gestational diabetes mellitus (GDM) and preeclampsia (PET). MethodsMedical records of women diagnosed with GDM or PET were reviewed. Women with AGA neonates were divided into three groups- GDM, PET, and GDM + PET and maternal neonatal and placental outcomes were compared. The primary outcome was a composite of adverse neonatal outcomes, including intensive care unit admission (NICU), neurological morbidity, hypoglycemia, ventilation, respiratory distress syndrome (RDS), phototherapy, sepsis, blood transfusion, and neonatal death. Post-hoc analysis was performed to determine between-group significance. ResultsComposite adverse neonatal outcomes are significantly lower in women with multiple morbidities compared to women with confined PET (p = 0.015), and a similar trend is observed when comparing neonatal outcomes between women with GDM to those with GDM + PET, yet these results are underpowered (18.9 % vs. 12.8 % respectively, p = 0.243). Placentas of women with GDM + PET were larger, with a lower rate of placentas below the 10th percentile as compared to placentas of women with isolated PET (p < 0.001), but with similar rates of MVM lesions. DiscussionWhile maternal and placental outcomes in patients of the GDM + PET group resemble the characteristics of the PET group, surprisingly, the neonatal outcomes in this group are significantly better compared to isolated morbidities. The paradoxical benefit attributed to the coexistence of GDM + PET may be explained by a balance of the opposing trends characterizing these morbidities-the reduced blood and nutrient supply characterizing PET vs. chronic overflow and abundance typical of GDM. Clinical trial registrationapproval of local ethics committee WOMC-19-0152.

Does decreased fetal growth estimation in the appropriate for gestational age range affect delivery outcomes?

To study the effect of decreased estimated fetal weight (EFW) percentiles in appropriate for gestational age fetuses. This retrospective cohort study included women who had second and third trimester ultrasound examinations. Delivery and neonatal outcomes of pregnancies with decreased EFW of ≥ 30 percentiles in EFW between ultrasound examinations (decreased growth group) and those without such a decrease (control group) were compared. Deliveries with EFW or birthweight below the 10th percentile were excluded. Among 1610 deliveries, 57 were in the decreased growth group and 1553 in the control group. Maternal characteristics did not differ between the groups except for higher rate of nulliparity in the decreased growth group. We found similar rates of Category II/III monitoring, cesarean deliveries due to non-reassuring fetal heart rate and adverse neonatal outcomes. Neonatal birthweight was lower in the decreased growth group as compared to controls. This study did not find association between the group of appropriate for gestational age fetuses with decreased growth, with adverse outcomes.

The effect of chorionicity on maternal and neonatal outcomes in triplet pregnancies

ObjectiveTriplet gestations are associated with increased maternal, fetal, and neonatal complications particularly early and extreme preterm delivery. Identifying and interrupting the preterm delivery cascade could prevent the fetal, neonatal, and long-term childhood complications. The shared circulation and placental vascular anastomosis are responsible for the occurrence of twin-to-twin transfusion syndrome, selective fetal growth restriction as well as the higher risk of morbidity and mortality observed in mono and dichorionic compared to trichorionic triplet gestations.Thus, the aim of this study was to determine the effect of chorionicity on maternal, fetal, and neonatal outcomes of triplet pregnancies as it has not been fully ascertained. Study designA retrospective population-based cohort study of 125 parturient with triplets' pregnancy who delivered at a single tertiary hospital. Results98 trichorionic and 27 dichorionic gestations were included. Maternal demographic and obstetric characteristics as well as pregnancy and postpartum complications were similar in the two study groups. The median gestational age at delivery was lower among dichorionic than trichorionic triplet gestations (median 31 vs 33 weeks, p < 0.046). Early (<32 weeks) and extreme preterm delivery (<28 weeks) were more prevalent in the dichorionic than the trichorionic group (early − 56 % vs 34 %, p < 0.038; extreme − 33.3 % vs 8 %, p < 0.002). We found no difference in fetal or newborns' complications and characteristics between the groups. However, the rate of neonatal death was significantly higher in the dichorionic compared to trichorionic triplet gestations (22 % vs 7 %, p < 0.038).A multivariate logistic regression model to determine the variables that contribute to early preterm delivery in triplet gestations showed that women who experienced a past preterm delivery had an independently higher risk for early preterm delivery in the triplet gestation (adj. OR 5.91, 95 % CI 1.16–30.03). Neither maternal age nor chorionicity were found to be independent risk factors for early preterm delivery. ConclusionsDichorionic triplet gestations exhibit a higher rate of early (<32 weeks) and extreme (<28 weeks) preterm delivery and are more prone to neonatal death compared to trichorionic gestations. Past preterm delivery is an independent risk factor for early preterm delivery in a triplet gestation.

Obstetric and neonatal outcomes of pregnancy in advanced maternal age

Obstetric and neonatal outcomes of pregnancy in advanced maternal age