Neonates Of Women Research Articles

Postpartum Hemorrhage after Vaginal Delivery Is Associated with a Decrease in Immediate Breastfeeding Success.

This study aimed to identify the impact of postpartum hemorrhage (PPH) after vaginal delivery on immediate breastfeeding success. This is a retrospective cohort study examining the impact of PPH on breastfeeding for nulliparous patients after term, singleton, vaginal deliveries at a large academic institution from 2017 to 2018. Indicators of successful breastfeeding in the immediate postpartum period were measured by the presence of breastfeeding, the need for formula supplementation, the average number of breastfeeding sessions per day, the average amount of time spent at each breastfeeding session, the average number of newborn stools and wet diapers produced daily, and the neonatal percentage in weight loss over the first 2 to 3 days of life. A total of 1,904 women met inclusion criteria during the study period, 262 (13.8%) of whom experienced PPH, defined as an estimated blood loss of 500 mL or greater after vaginal delivery. Women who had a PPH had significantly fewer breastfeeding sessions on average (β = -0.06, p-value 0.01) and required more time at each breastfeeding session (β = 0.08, p-value <0.002). Neonates of women with PPH had a larger percentage in weight loss over the first 2 to 3 days of life compared with those without PPH (β = 0.06, p = 0.008). Women who experience PPH after vaginal delivery have a decreased number of breastfeeding sessions despite spending more time trying to breastfeed, and an increased percentage in neonatal weight loss over the first 2 to 3 days of life. Further work is needed to elicit the mechanism behind this association; however, it is possible that PPH results in decreased secretion of endogenous oxytocin from the hypothalamic-pituitary axis as a result of hypovolemia. These women may therefore require additional breastfeeding support for successful breastfeeding initiation in the immediate postpartum period. · Women who experience PPH after vaginal delivery have decreased breastfeeding success.. · Further work is needed to elicit the mechanism behind this association.. · These women may require additional support for successful breastfeeding initiation postpartum..

Common mental disorders and perinatal outcomes in Victoria, Australia: A population-based retrospective cohort study

PurposeCommon mental disorders (non-psychotic mental health conditions which impact on day-to-day functioning) are increasingly common in childbearing women and may impact significantly on both maternal and neonatal outcomes. Our study examines the associations between common mental disorders and perinatal outcomes. MethodsWe used routinely collected perinatal data (2009–2016) for this population-based retrospective cohort study (n = 597,522 singleton births). We undertook multiple logistic regression adjusting for key maternal medical conditions and sociodemographic factors to determine associations between maternal common mental disorders and adverse perinatal outcomes with confidence intervals set at 95%. ResultsWomen with common mental disorders were more likely to have an induction of labour and caesarean birth, have a postpartum haemorrhage (PPH), and be admitted to the Intensive Care Unit (ICU) than women without common mental disorders. Neonates of women with common mental disorders were more likely to have an Apgar score at five minutes of less than seven (a measure of neonatal wellbeing at birth), be born preterm and low birthweight, be admitted to the Special Care Nursery or Neonatal Intensive Care Unit (SCN/NICU) and have a congenital anomaly than neonates of women without common mental disorders. ConclusionCommon mental disorders during the perinatal period were associated with poorer perinatal outcomes for mothers and their neonates. Strategies that enable early recognition and response to maternal common mental disorders should be developed to mitigate the consequential impact on maternal and infant wellbeing.

De Novo ITP Diagnosed during Pregnancy : Outcome for the Mothers and the Neonates and Prospective Comparative Study with Chronic ITP Pregnant Women

Background and Objective : Outcome, severity and transition to chronic illness of de novo ITP diagnosed during pregnancy and incidence of neonatal ITP (NITP) in this subset of patients have never been prospectively described. We conducted a prospective multicentric study in France to evaluate the outcome of patients with ITP during pregnancy (Clinical Trials.gov ID NCT02892630). One of the aims of this study was to investigate the evolution of ITP in patients with known ITP prior to pregnancy (« chronic group »). The results of this first part of the study have been recently published (Guillet et al, Blood ; 141 :11-21). Another aim was also to prospectively study the outcome of patients with ITP appeared and diagnosed during pregnancy (“ de novo group”) and to compare them with the previous group. We report the results here. Methods: De novo ITP was defined by a normal platelet count before pregnancy and a nadir &amp;lt; 50x10 9/L during pregnancy without any other clinical or biological abnormalities in particular no sign of pregnancy-specific causes of thrombocytopenia. We used a stringent platelet count threshold &amp;lt;50x10 9/L to avoid misdiagnosis with gestational thrombocytopenia. Patients were followed during pregnancy and 6 months after delivery. We compared ITP outcome in both groups (“ chronic” and “ de novo” groups) including episodes of bleeding events, severe thrombocytopenia (&amp;lt;30x10 9/L) and ITP treatment modification. We also studied obstetrical complications and NITP incidences in both groups. Results: 34 “ de novo” ITP women diagnosed during pregnancy were included and compared with 61 chronic ITP pregnant women. De novo ITP was diagnosed equally during the first, second and third trimester, in respectively 29.4% (10/34), 32.4% (11/34) and 38.2% (13/34). Among these 34 women, 29.4% (10/34) were primiparous. De novo ITP pregnant women experienced during follow-up, severe thrombocytopenia in 50% [35.5-91.9], bleeding events in 41.2% [26.8-59.4] including 11.8% [4.6%-28.4%] severe bleeding events with a French bleeding score &amp;gt; 8 and ITP therapeutic interventions in 76.5% [61.4-88.9]. Episodes of severe thrombocytopenia and bleeding events including severe bleeding event were similarly observed in “ de novo” and “ chronic” groups (data not shown). However, chronic ITP pregnant women underwent less ITP therapeutic interventions 50.8% [39.1-63.8], p=0.039. Obstetrical complications including preterm delivery, postpartum hemorrhage and cesarean delivery rates were similar in both groups (data not shown). NITP &amp;lt;50x10 9/L was observed in 6/31 (19.3%) neonates of women with de novo ITP and was similar to those observed in neonates of chronic ITP women 9/53 (17%). With a median follow-up of 6 months [5-7] after delivery, de novo ITP remained active for 25/34 women (73.5%). Conclusion: The severity of de novo ITP diagnosed during pregnancy and the risk of NITP are closely similar to those observed in chronic ITP pregnant women. Non-fatal severe bleeding events occur in around 10% of patients. De novo ITP remains active 6 months after delivery in a large majority of patients. Our study is still in progress to better assess the risk of chronic evolution (more than one year of duration) of de novo ITP after delivery.

Maternal ethnicity and gestational age at birth predict hypoglycaemia among neonates of mothers with gestational diabetes.

Hypoglycaemia is common in neonates born to mothers with gestational diabetes mellitus (GDM). We aimed to determine predictors of hypoglycaemia among neonates of women with GDM and association with short-term outcomes. We conducted a secondary cohort analysis of data from a multi-centre randomised trial (the TARGET trial) conducted across ten maternity hospitals in New Zealand between May 2015 and November 2017. Data were analysed using univariate analysis and multivariable forward stepwise logistic regression. Among 1085 neonates, those born to Asian mothers had reduced odds of hypoglycaemia (OR [95% CI]: 0.54 [0.38, 0.75], p = 0.001), as did those born at higher gestational ages (0.76 [0.68, 0.85], p < 0.001). Neonates born to Pacific mothers had increased odds of hypoglycaemia (OR [95% CI]: 1.57 [1.04, 2.39], p = 0.034). Neonates who experienced hypoglycaemia were more likely to experience neonatal intensive care unit admission (8.3% vs. 2.1%; p ≤ 0.001), hyperbilirubinaemia (8.6% vs. 3.3%; p ≤ 0.001) and receive respiratory support (11.4% vs. 4.8%; p ≤ 0.001) and less likely to be breastfed at discharge (92.4% vs. 96.2%; p = 0.009). Among neonates of women with GDM, maternal ethnicity and gestation at birth are independent predictors of hypoglycaemia, and hypoglycaemia is associated with short-term comorbidities. Additional surveillance may be appropriate for neonates in these high-risk groups.

Effects of neuraxial labor analgesia on intrapartum maternal fever in full-term pregnancy and its influence on birth outcomes.

This study aimed to explore the relationship between neuraxial labor analgesia and intrapartum fever and to demonstrate the influence of maternal fever on perinatal outcomes within 6 weeks after birth. This was a secondary analysis of a multicenter prospective cohort study that enrolled women with single- and full-term cephalic pregnancy in northern China. Intrapartum maternal fever was defined as the highest axillary temperature during labor ≥37.5°C. Data on baseline characteristics, maternal variables, and neonatal outcomes were all collected. The association between neuraxial labor analgesia and intrapartum maternal fever was analyzed with logistic regression models, and the cutoff point was identified by the receiver operating characteristic curve. Of 577 parturients, 74 (12.8%) developed intrapartum fever. Neuraxial analgesia was associated with an increased risk of maternal intrapartum fever with or without adjusting for confounding factors (adjusted OR = 2.68; 95% CI: 1.32-5.47; p = 0.007). Further analysis showed that neuraxial analgesia of <5 h did not increase the risk of intrapartum fever compared with no analgesia (OR = 1.52; 95% CI: 0.63-3.64; p = 0.35), and longer neuraxial labor analgesia time (over 5 h) significantly increased the risk of fever (OR = 3.38; 95% CI: 1.63-7.01; p = 0.001). Parturients with intrapartum fever suffered more maternal adverse outcomes compared with those without fever (p < 0.001). Neonates of women with intrapartum fever had slightly higher rates of composite adverse neonatal outcomes compared with those without fever; however, the difference was not statistically significant (p = 0.098). In women with low-risk pregnancies, a longer time of neuraxial labor analgesia was associated with an increased risk of intrapartum maternal fever. Intrapartum fever was related to adverse maternal outcomes but did not significantly affect neonatal outcomes within 6 weeks after delivery.

Risk of adverse neonatal outcomes among pregnant women with disabilities.

To compare risk of neonatal morbidities between women with and without documented disability and to evaluate mediation of these associations by pre-term birth and caesarean delivery. Using data from the Consortium on Safe Labor (2002-2008; n = 223 385), we evaluated risk of 22 neonatal outcomes among singleton deliveries using ICD-9 codes to define physical (n = 1733), sensory (n = 250) and intellectual disability (n = 91). Adjusted relative risk (aRR) was estimated for each outcome among each category of disability, and among women with any disability using Poisson regression models with robust variance. Causal mediation methods evaluated pre-term birth and caesarean delivery as mediators. Compared with no disability, neonates of women with any disability had higher risk of nearly all neonatal outcomes, including pre-term birth (aRR = 1.77; 95% CI 1.62-1.94), small for gestational age (SGA) (aRR = 1.25; CI 1.11-1.41), neonatal intensive care unit (NICU) admission (aRR = 1.70; CI 1.54-1.87), seizures (aRR = 2.81; CI 1.54-5.14), cardiomyopathy (aRR = 4.92; CI 1.15-20.95), respiratory morbidities (aRR ranged from 1.33-2.08) and death (aRR = 2.31; CI 1.38-3.87). Women with disabilities were more likely to have a maternal indication for pre-term delivery, including pre-pregnancy diabetes (aRR = 3.80; CI 2.84-5.08), chronic hypertension (aRR = 1.46; CI 0.95-2.25) and severe pre-eclampsia/eclampsia (aRR = 1.47; CI 1.19-1.81). Increased risk varied but was generally consistent across all disability categories. Most outcomes were partially mediated by pre-term birth, except SGA, and heightened risk remained for NICU admissions, respiratory distress syndrome, anaemia and a composite of any adverse outcome (aRR = 1.21; CI 1.10-1.32). Neonates of women with disabilities were at higher risk of a broad range of adverse neonatal outcomes, including death. Risks were not fully explained by pre-term birth.

Combined Anticoagulant Therapy for Prevention of Preeclampsia and Small for Gestational Age Neonates: A Systematic Review and Meta-analysis.

This systematic review and meta-analysis (SRMA) aims to compare the efficacy of combining low molecular weight heparin (LMWH) and aspirin against aspirin alone in preventing preeclampsia (PE) and small for gestational age (SGA) neonates in women at moderate and high risks. The included studies were nonrandomized and randomized clinical trials (RCTs) enrolling women at moderate and high risks for developing preeclampsia. PubMed/Medline, Cochrane Library, Embase, and Grey literature (including ClinicalTrials.gov) were searched. Out of 4,762 records, 7 nonrandomized studies and 12 RCTs (enrolling 545 and 1,677 women, respectively) were selected. Although the studies were clinically heterogeneous, the conduction of quantitative analysis was feasible. Regarding RCTs, the odds of early-onset preeclampsia was reduced by 89% (pooled odds ratio [OR] = 0.11, 95% confidence interval [CI]: 0.01-0.93, p = 0.04) in women with thrombophilia, the incidence of SGA neonates below the 5th percentile by 48% (pooled OR = 0.52, 95% CI: 0.28-0.96, p = 0.04) in women with a history of preeclampsia and/or SGA neonates, and the incidence of SGA neonates below the 10th percentile by 31% (pooled OR = 0.69, 95% CI: 0.50-0.96, p = 0.03) in the whole population. Concerning the whole studied population, combined anticoagulant therapy is not superior to aspirin alone. However, it may be more effective in preventing early-onset preeclampsia regarding women with thrombophilia, SGA neonates below the 5th percentile regarding women with a history of preeclampsia and/or SGA, and SGA neonates below the 10th percentile in moderate- or high-risk women. The above mixed but promising results need to be envisaged with caution due to the clinical heterogeneity of the included studies which is the main limitation of our research. Nevertheless, the strict and narrow inclusion search criteria, and the appropriate subgroup analysis are its main strengths. More RCTs with homogeneous populations and stricter inclusion criteria are needed to confirm these results. · Combined therapy is not superior to aspirin alone.. · Combined therapy in women with thrombophilia may protect against early-onset preeclampsia.. · Combined therapy in moderate/high-risk women may protect against SGA <10th percentile neonates..

Fetal Outcomes in Preterm Cesarean Sections

IntroductionNeonatal mortality is a major challenge in low-middle-income countries. The current study was conducted to assess the association between preterm cesarean delivery and fetal outcomes.MethodsA prospective study was conducted at the Combined Military Hospital in Peshawar, Pakistan, from October 1, 2020, to March 31, 2021. All women reporting to the hospital with a cephalic presentation and singleton pregnancies between the 27th and 34th weeks of gestation were included in the study. Pregnancies with an abnormal presentation, those diagnosed with a congenital abnormality, and those with indications for growth restriction or preterm delivery were excluded from the study. We also excluded infants delivered via vacuum or forceps. The outcomes of interest in this study included neonatal death prior to discharge, neonatal respiratory distress, sepsis, intraventricular hemorrhage (IVH), seizure, subdural hemorrhage (SDH), or appearance, pulse, grimace, activity, and respiration (APGAR) test score of less than 7 at five minutes. Maternal features including diabetes, hypertension and gestational age of delivery, parity, previous cesarean sections (CS), and last pregnancy outcomes were documented in a predefined pro forma.ResultsOur sample size consisted of 288 women, who were classified into two groups. Group A comprised 144 women who gave birth vaginally and group B consisted of 144 women who underwent CS. It was observed that women who underwent cesareans had a higher likelihood of a history of hypertension and related pathologies. It was also observed that these women had a greater likelihood of being of higher age compared to women who underwent vaginal deliveries. Neonates of women who had CS were at a greater risk of presenting with respiratory distress than those who had spontaneous vaginal deliveries.ConclusionBased on our findings, respiratory distress was significantly more common in babies of women who delivered via CS. However, there was no difference in neonatal outcomes in terms of IVH, seizures, SDH, and APGAR score of <7.

P280 Maternal use of hydroxychloroquine with anti-Ro and or anti-La during pregnancy: a systematic review

Abstract Background/Aims Anti-Ro antibody and, to a lesser extent, anti-La antibody have been associated with fetal heart block during pregnancy. Use of hydroxychloroquine has previously been shown to reduce this risk in pregnancy. According to ACR 2020, all women with positive anti-Ro and or anti-La antibodies are conditionally advised to commence HCQ during pregnancy, but this is based on limited data. We performed a systematic review to evaluate the prevalence of hydroxychloroquine prescription in women with anti-Ro or La antibodies and examine the prevalence of congenital heart block. Methods This was a systematic review of case controlled and observational studies. A PICO model was used to design the research question. Literature searches were initiated based on five keywords: hydroxychloroquine, pregnancy(antenatal), maternal, anti-Ro(SSA), anti-La(SSB). Studies were retrieved from Pubmed, MEDLINE, Mendeley, Cochrane, University College Dublin Library using relevant search strategies from inception to May 2021. The search was restricted to English language articles only. Data were extracted and cross-checked by two reviewers. Results Sixteen studies involving 1,706 anti-Ro and 454 anti-La positive females, resulting in 2,279 pregnancies, were eligible for inclusion in this review. Mean age was 30.7 years at gestation. The prevalence of HCQ prescription in pregnancy in Ro+ women was 32.7%. The most common diagnoses were systemic lupus erythematosus (n = 990) and Sjögren’s syndrome (n = 452), while the remaining women had rheumatoid arthritis, antiphospholipid syndrome, undifferentiated connective tissue disease, scleroderma, autoimmune thyroiditis, dermatomyositis, polychondritis and overlap conditions. Eight studies included asymptomatic antibody carriers (n = 192). The prevalence of congenital heart block in neonates of women on HCQ in pregnancy was 1.8%. Due to issues with data reporting in the included studies, it was not possible to separate out Ro+ women on HCQ from those not on HCQ. For this reason, we could not compare and draw conclusions on the prevalence of CHB in pregnancies of Ro+ women. Conclusion This systematic review highlights the need for additional studies to examine use of HCQ in women positive for Ro or La antibodies. While these antibodies are commonly encountered in SLE and Sjögren’s syndrome, they can occur in other rheumatic diseases and should be screened for to limit risk of CHB. Disclosure S.A. Al Nokhatha: None. S. Maguire: None. R. Harrington: None.

Gestational Diabetes Mellitus in Pregnant Women with Beta-Thalassemia Minor: A Matched Case-Control Study.

Pregnancy in women with thalassemia minor is considered safe. However, a higher incidence of maternal and neonatal complications in women with the disorder has been reported in the literature. This study aimed to determine whether there is an increased risk of gestational diabetes mellitus (GDM) in pregnant women with beta-thalassemia minor. We conducted a retrospective matched case-control study of 230 pregnant women who delivered at the Department of Obstetrics and Feto-Maternal Medicine at the Medical University of Vienna between the years 2008 and 2020, whereof 115 women had beta-thalassemia minor. We found no significant difference in the occurrence of GDM between the case group and control group of age and BMI-matched healthy women. However, we observed a significantly lower hemoglobin (Hb) and hematocrit (Ht) level during the first, the second, and the third trimesters of pregnancy, and postpartum (all: p < 0.001) among women with beta-thalassemia minor compared to the healthy controls. Neonates of women with beta-thalassemia were more likely to experience post-natal jaundice and excessive weight loss (p < 0.001). We conclude that GDM is not more likely to occur in pregnant women with beta-thalassemia minor. However, clinicians should be made aware of the risk of adverse maternal and neonatal outcomes. Furthermore, women with beta-thalassemia minor should undergo regular laboratory screening and multidisciplinary pregnancy care.

Severe birth injuries in neonates and associated risk factors for injury in mothers with different types of diabetes in Finland.

ObjectiveTo examine severe birth‐related injuries in neonates among mothers with different types of diabetes.MethodsRetrospective cohort study based on Finnish Medical Birth Register data from 2004 to 2017. The study included singleton neonates born vaginally with cephalic presentation (n = 623 649) after 35+0 weeks of gestation. The primary outcome variable was severe birth injury. Incidences, crude and adjusted odds ratios, and probabilities in regression analysis were calculated for different types of diabetes.ResultsThere were 1952/623 649 (0.3%) severe birth injuries of which brachial plexus injury occurred most frequently. The injury incidence was highest in neonates of women with type 1 or type 2 diabetes, 42/1659 (2.5%) and 10/548 (1.8%), respectively. For gestational diabetes, the injury incidence was comparable to non‐diabetic women: 422/77 810 (0.5%) and 1478/543 632 (0.3%), respectively. Shoulder dystocia, high birthweight, and vacuum‐assisted delivery were associated with the highest probability for injury. Birthweight and obesity had a stronger impact on injury risk in women with pregestational diabetes compared to other pregnancies.ConclusionNeonates of women with pregestational diabetes have a higher risk for severe birth injury than other neonates. The injury risk in neonates delivered by women with gestational diabetes or non‐diabetic women is generally low.

Early pregnancy hyperglycaemia as a significant predictor of large for gestational age neonates

AimsWe aimed to determine the effect of early pregnancy hyperglycaemia on having a large for gestational age (LGA) neonate.MethodsA prospective cohort study was conducted among pregnant women in their first trimester. One-step plasma glucose (PG) evaluation procedure was performed to assess gestational diabetes mellitus (GDM) and diabetes mellitus (DM) in pregnancy as defined by the World Health Organization (WHO) criteria with International Association of Diabetes in Pregnancy Study Group (IADPSG) thresholds. The main outcome studied was large for gestational age neonates (LGA).ResultsA total of 2,709 participants were recruited with a mean age of 28 years (SD = 5.4) and a median gestational age (GA) of eight weeks (interquartile range [IQR] = 2). The prevalence of GDM in first trimester (T1) was 15.0% (95% confidence interval [CI] = 13.7–16.4). Previously undiagnosed DM was detected among 2.5% of the participants. Out of 2,285 live births with a median delivery GA of 38 weeks (IQR = 3), 7.0% were LGA neonates. The cumulative incidence of LGA neonates in women with GDM and DM was 11.1 and 15.5 per 100 women, respectively. The relative risk of having an LGA neonate among women with DM and GDM was 2.30 (95% CI = 1.23–4.28) and 1.80 (95% CI = 1.27–2.53), respectively. The attributable risk percentage of a LGA neonate for hyperglycaemia was 15.01%. T1 fasting PG was significantly correlated with both neonatal birth weight and birth weight centile.ConclusionsThe proposed WHO criteria for hyperglycaemia in pregnancy are valid, even in T1, for predicting LGA neonates. The use of IADPSG threshold for Fasting PG, for risk assessment in early pregnancy in high-risk populations is recommended.

Hydrolytic enzymes in therapy of gestosis

The clinical effectiveness o f complex enzymotherapy with preparation Vobenzim in treatment o f gestosis was studied in comparison with traditional therapy. The author analyzes the course оf gestation and delivery, and the state оf neonates in women with nephropathy o f I degree, who got common treatment (28 patients) and complex treatment including Vobenzim (17patients). Positive clinical effect o f complex enzymotherapy in case o f nephropathy is displayed in decreasing of edematic syndrome, eliminating or decreasing o f proteinuria, lowering o f blood pressure and impairment o f fetalhypoxia in labors. It goes along with the reduction o f immune complexes fixed in placenta.

Midwife-led continuity of care improved maternal and neonatal health outcomes in north Shoa zone, Amhara regional state, Ethiopia: A quasi-experimental study

BackgroundIn a low-resource setting, information on the effect of midwife-led continuity of care (MLCC) is limited. Therefore, this study aimed to determine the effect of MLCC on maternal and neonatal health outcomes in the Ethiopian context. MethodA study with a quasi-experimental design was conducted from August 2019 to September 2020 in four primary hospitals of the north Shoa zone, Amhara regional state, Ethiopia. A total of 1178 low risk women were allocated to one of two groups; the midwife-led continuity of care (MLCC or intervention group) (received all antenatal, labour, birth, and immediate postnatal care from a single midwife or backup midwife) (n = 589) and the Shared model of care (SMC or comparison group) (received care from different staff members at different times) (n = 589). The two outcomes studied were Spontaneous vaginal birth and preterm birth. Outcome variables were compared using multivariate generalized linear models (GLMs) and reported using adjusted risk ratios (aRR) with 95% confidence intervals. FindingsWomen in MLCC were, in comparison with women in the SMC group more likely to have spontaneous vaginal birth (aRR of 1.198 (95% CI 1.101–1.303)). Neonates of women in MLCC were in comparison with those in SMC less likely to be preterm (aRR of 0.394; 95% CI (0.227–0.683)). ConclusionIn this study, use of the MLCC model improved maternal and neonatal health outcomes. To scale up and further investigate the effect and feasibility of this model in a low resource setting could be of considerable importance in Ethiopia and other Sub-Saharan Africa countries.

NEONATAL OUTCOMES IN POSTPARUM PSYCHOSIS

We aimed to examine neonatal behaviour and cortisol reactivity in neonates born to women at risk of postpartum psychosis (AR) who had a psychiatric relapse within 4 weeks post-delivery (AR-unwell), compared with neonates of women at risk who stayed well (AR-well) and those born to healthy women (HC). We assessed neonatal behaviour using the Neonatal Behavioral Assessment Scale (NBAS), performed on 105 neonates (AR-unwell=17; AR-well=27; HC=61). Neonatal cortisol was measured pre-, immediately post- and 30-minutes post-NBAS. Neonates born to AR women did not differ from those born to HCs in behaviour or cortisol reactivity. There was also no difference in behaviour between neonates born to AR-unwell women and those born to AR-well women. However, neonates born to AR-unwell women had significantly lower pre-NBAS cortisol compared with neonates of AR-well women (t(38)=2.3, p=.02). Neonates of AR-unwell women also had a greater increase in cortisol from pre- to post-NBAS, though the difference did not reach statistical significance (p=.12), and a greater increase from pre- to 30 minutes post-NBAS (t(32)=2.7, p=.01). Maternal postpartum symptoms appear to disrupt the stress response of neonates whose mothers are at risk of postpartum psychosis.

Efficacy of Antenatal Corticosteroid Injection in the Prevention of Neonatal Respiratory Distress Syndrome after C-Section

Aim: To determine the efficacy of antenatal corticosteroid in the prevention of respiratory distress syndrome of the neonates in women undergoing elective cesarean section at term pregnancy. Study design: Descriptive case series Place and duration of study: Department of Obstetrics and Gynecology, Lady Reading Hospital, Peshawar from 6th December 2018 to 6th May 2019. Methodology: One hundred and seventy five women were enrolled. The women after taking complete history with obstetrical examination and antenatal corticosteroid administration i.e. 12 mg dexamethasone IM (two doses 12 hours apart) were observed. The caesarean section was performed by experienced obstetrician having minimum of five years of experience after 24 hours and within seven days of the second dose of dexamethasone. All the neonates were carefully examined in NICU for the detection of respiratory distress syndrome. All these observations were done under supervision of an expert pediatrician having minimum of five years of experience. Results: The mean age was 28±11.34 years. Thirty five percent patients had POG range 37+ weeks while 65% patients had POG range 38+ weeks. Mean POG was 37±1.12 weeks. More over antenatal corticosteroid was effective in 97% patients and was not effective in 3% patients. Conclusion: The antenatal corticosteroid was 97% effective in the prevention of respiratory distress syndrome of the neonates, in women undergoing ELSC at term after elective caesarean section for term pregnancy. Keywords: Efficacy, Antenatal corticosteroid, Respiratory distress syndrome, Neonates, Elective C- section,

Abstract P171: A Longitudinal Study Of Maternal Thyroid Hormone Trajectories And Neonatal Anthropometric Measures

Introduction: Maternal thyroid hormones (TH) are essential for fetal growth and development. While prior studies have examined associations of TH with birthweight (BW), data on other neonatal anthropometric measures are scarce. Here we aimed to examine relations between TH and its trajectory across pregnancy with neonatal anthropometrics in a multi-racial pregnancy cohort. Hypothesis: We hypothesized that distinct TH trajectories across gestation would explain differences in neonatal anthropometrics including BW, length and sum of skinfolds (SSF). Methods: We used longitudinal data from 321 women who were included in a gestational diabetes (GDM) case-control study nested within the NICHD Fetal Growth Studies-Singletons Cohort (n=2802). Plasma free triiodothyronine (fT3), free thyroxine (fT4) and thyroid-stimulating hormone (TSH) were measured, and fT3/fT4 ratio was derived, using blood samples collected at gestational weeks (GW) 10-14, 15-26, 23-31 and 33-39. TH trajectories were identified using a latent class trajectory approach. BW was abstracted from medical records. Neonatal length and SSF were measured. To examine associations between TH levels and neonatal outcomes, we used weighted linear regression models, adjusted for maternal age, race/ethnicity, GW at blood collection, pre-pregnancy BMI, education, parity, infant sex, GDM diagnosis (33-39 GW only) and number of days post-delivery (length and SSF only). Results: Overall, neonates of women in the highest fT3 tertile at 33-39 GW had marginally higher BW (β: 205.5 g, 95% CI -23.4, 434.4) and BW z-score (β: 0.4, 95% CI 0.0, 0.8) than neonates of women in the lowest tertile. Significant interactions were observed by infant sex for associations of fT4 and BW, BW z-score and neonatal length (all p for interactions &lt;0.05). Specifically, female neonates of women in the highest fT4 tertile had lower BW, BW z-score and length than those in the lowest tertile at 15-26 (β BW -416.3 g, 95% CI -753.7, -79.0; β BW zscore -0.5, 95% CI -0.9, -0.1; β length -1.5 cm, 95% CI -2.8, -0.1, respectively) and 23-31 GW (β BW -357.0 g, 95% CI -635.6, -78.4; β BW zscore -0.7, 95% CI -1.3, -0.1; β length -1.8 cm, 95% CI -3.3, -0.2, respectively). Across gestation, a low fT3 trajectory (class size 5.5%) was associated with lower neonatal SSF (β: -3.2 mm, 95% CI -6.0, -0.5) than an intermediate/referent trajectory (60.1%). A high fT3/fT4 ratio trajectory (16.2%) was associated with higher BW (β: 300.5 g, 95% CI 41.7, 559.4), BW z-score (β: 0.6, 95% CI 0.3, 0.8), and neonatal SSF (β: 3.3 mm, 95% CI 0.7, 5.9) than an intermediate/referent trajectory (44.3%). Conclusions: Our study suggests that both overall TH trajectory across gestation and TH levels at specific timepoints in pregnancy may be related to neonatal anthropometrics, with associations varying by infant sex. These novel data support the significance of monitoring thyroid hormones longitudinally in pregnancy.

Third trimester HbA1c and the association with large-for-gestational-age neonates in women with gestational diabetes.

To evaluate the association between HbA1c levels measured in the third trimester and the risk for large for gestational age (LGA) in neonates of mothers affected by gestational diabetes mellitus (GDM). Secondarily, we aimed to identify an ideal cut-off for increased risk of LGA amongst pregnant women with GDM. Observational retrospective review of singleton pregnant women with GDM evaluated in a diabetes and pregnancy clinic of a tertiary and academic hospital. From January/2011 to December/2017, 1,085 pregnant women underwent evaluation due to GDM, of which 665 had an HbA1c test in the third trimester. A logistic regression model was performed to evaluate predictors of LGA. A receiver-operating-characteristic (ROC) curve was used to evaluate the predictive ability of third trimester HbA1c for LGA identification. A total of 1,085 singleton pregnant women were evaluated during the study period, with a mean age of 32.9 ± 5.3 years. In the multivariate analysis, OGTT at 0 minutes (OR: 1.040; CI 95% 1.006-1.076, p = 0.022) and third trimester HbA1c (OR: 4.680; CI 95% 1.210-18.107, p = 0.025) were associated with LGA newborns. Using a ROC curve to evaluate the predictive ability of third trimester HbA1c for LGA identification, the optimal HbA1c cut-off point was 5.4% where the sensitivity was 77.4% and the specificity was 71.7% (AUC 0.782; p < 0.001). Few studies in the Mediterranean population have evaluated the role of HbA1c in predicting neonatal complications in women with GDM. A third trimester HbA1c > 5.4% was found to have good sensitivity and specificity for identifying the risk of LGA.

Maternal and neonatal outcomes in the following delivery after previous preterm caesarean breech birth: a national cohort study

The objective of this retrospective, nationwide Finnish population-based cohort study was to determine whether there is an association between preterm caesarean breech delivery in the first pregnancy and maternal and neonatal morbidity in the subsequent pregnancy and delivery. We identified all singleton preterm breech birth in Finland from 2000 to 2017 (n = 1259) and constructed a data set of the first two deliveries for these women. We compared outcomes of the following pregnancy and delivery among women with a previous preterm caesarean breech section with the outcomes of women with one previous vaginal preterm breech birth. p Value, odds ratio, and adjusted odds ratio were calculated. Neonates of women with a previous caesarean preterm breech delivery had an increased risk for arterial umbilical cord pH below seven (1.2% versus 0%; p value .024) and a higher rate of neonatal intensive care unit admission [22.9% versus 15% adjusted OR 1.57 (1.13–2.18); p value <.001]. The women with a previous caesarean section had a higher rate of uterine rupture (2.3% versus 0%; p value .001). They were also more likely in the subsequent pregnancy to have a planned caesarean section [19.9% versus 4% adjusted OR 8.55 (4.58–15.95), an emergency caesarean section [21.5% versus 9.7% adjusted OR 2.16 (1.28–2.18)], or an instrumental vaginal delivery [9.3% versus 3.8% adjusted OR 2.38 (1.08–5.23)]. IMPACT STATEMENT What is already known on this subject? Vaginal birth after caesarean section is generally known to be associated with a higher risk of maternal and neonatal morbidity. What do the results of this study add? The following birth after previous caesarean preterm breech section is associated with a higher rate of uterine rupture and with a higher rate neonatal admission to the neonatal intensive care unit and more often an arterial umbilical cord pH below seven regardless of the mode of the following delivery, compared to women with a subsequent delivery after a previous vaginal preterm breech birth. What are the implications of these findings for clinical practice and/or further research? Our results must be considered when counselling patients regarding their first preterm breech delivery, as the selected method of delivery also affects the outcomes of subsequent pregnancies and deliveries.

Prevalence and perinatal outcomes of non-communicable diseases in pregnancy in a regional hospital in Haiti: A prospective cohort study.

BackgroundThe prevalence of non-communicable diseases (NCDs) is rising in low and middle-income countries (LMIC). We aimed to report on the prevalence of NCDs in pregnancy and their associated perinatal outcomes in a regional hospital in Haiti.MethodsWe conducted the “Diabète et hYpertension Artéerielle et leurs issues MAternelles et Néonatales” (DYAMAN) prospective cohort study in a regional hospital in Haiti. Pregnant women presenting to care at 24-28 weeks were screened and treated for diabetes (DM) and hypertensive disorders of pregnancy (HDP) using setting-adapted protocols. Prevalence of NCDs and associated maternal-neonatal outcomes were described.Results715 women were included, of which 51 (7.1%) had DM, 90 (12.6%) had HDP, and 30 (4.2%) had both DM and HDP (DM/HDP). Of 422 (59%) women delivered in hospital, 58 (13.7%) had preeclampsia, including 5 (8.6%) with eclampsia. Preterm birth <32 weeks was more common in the HDP than the control, DM, and DM/HDP groups. More low birth weight babies (n = 20, 25.6%) were born to the HDP group than to the control (n = 20, 7.1%), DM (n = 1, 2.7%), and DM/HDP (n = 3, 12%) groups (P < 0.001). Macrosomia and hypoglycemia affected 5 (8%) neonates of women with DM. Perinatal mortality, affecting 36/1000 births, was mainly driven by maternal NCDs.ConclusionsNCDs in pregnancy led to adverse maternal and perinatal outcomes. This study will help to prepare future refinements aimed at optimizing the management of NCDs in pregnancy in LMIC. Research is required to understand barriers to patient attendance at antenatal follow-up, treatment escalation for hyperglycemia, and in-hospital delivery.