Optimal Pregnancy Outcomes Research Articles

P0577 Influence of Pregnancy on Outcomes of Inflammatory Bowel Disease and Medication Adherence

Abstract Background Treatment of inflammatory bowel disease (IBD) is challenging due to the maintenance of remission and associated fetal safety concerns during pregnancy. While existing literature emphasizes the importance of achieving remission prior to conception, optimal management of IBD during pregnancy remains underexplored, especially regarding medication continuation and efficacy. Methods This cross-sectional study was performed in pregnant patients with IBD between March 2019 and June 2023. Clinical features, treatment details, disease activation and outcomes were collected and analyzed. Results A total of 57 pregnant were included, of those 37 (64.9%) had UC, and 20 (35.1%) had CD. The overall median disease duration was 9.1 (6-12.8) years (8.2 years for UC and 9.9 years for CD). The disease location was 19 (51.4%) left-sided colitis, 15 (40.5%) extensive, and 3 (8.1%) proctitis in UC, while in CD 8 (40%) patients were ileal involvement, 8 (40%) ileocolonic and 4 (20%) colonic. 4 (20%) had stricturing disease and 4 (20%) had penetrating disease in CD. Before pregnancy, medical treatments for UC patients were mesalazine in 29 (78.4%) patients, thiopurine in 20 (54.1%), biologic therapy in 6 (16.2%), while it was 13 (65%) patients biologic therapy and 7 (35%) thiopurine in CD patients. The most prescribed biologic agent was infliximab in both diseases. During pregnancy, 16 (28.1%) patients [6 (18.8%) with UC and 10 (50%) with CD] had a history of drug withdrawal. 13 (%81) medications were withdrawn by the patient's wish. Disease activation occurred in 25 (43.9%) patients, 10 (50%) with CD, and 15 (40.5%) with UC. 12 (48%) patients required steroids due to activation. There were 54 (94.7%) live births when compared based on whether disease activation developed or not, there was no statistically significant difference in live birth rate 23, 92% vs. 31, 96.9%, p=0.576. There was no statistically significant difference between normal birth and cesarean section rates with activation development. 3 (5%) abortions occurred. Abortion rate was not associated with disease activation (p>0.05). No serious infection occurred during the first month following birth. Conclusion In this study, the disease activation was seen in 43.9% of pregnant patients with IBD. Consistent medication management of IBD during pregnancy enhances patient adherence, reduces risks, and promotes positive maternal outcomes. Proactive counseling and careful selection of medications are crucial for disease control and optimizing pregnancy outcomes in IBD patients.

Controversies in thyroid disease management in pregnancy.

Adequate control of thyroid function is crucial for optimal pregnancy outcomes and neurodevelopment of the offspring, and testing for thyroid function is ideally performed using manufacturer- and gestation-specific reference ranges. While universal screening for thyroid dysfunction is not recommended, targeted case finding of women at risk of thyroid disease during pregnancy is advised. A number of controversies continue to fuel debate including: (i) the target range for thyroid stimulating hormone (TSH) in women with subfertility planning pregnancy, (ii) management of mild thyroid hypofunction before and during pregnancy, (iii) the treatment of thyroid peroxidase (TPO) antibody-positive euthyroid women with levothyroxine, (iv) the optimal choice of antithyroid treatment in women with hyperthyroidism. A significant body of evidence has accumulated in recent years, including large systematic reviews and meta-analyses of observational studies determining effects of thyroid dysfunction on pregnancy and fetal outcomes. In addition, outcomes from important randomised trials continue to inform current guidance on how to best care for women with thyroid dysfunction before and during pregnancy.

Optimizing Pregnancy Outcomes: The Importance of Pre-Marital and Preconception Care

Premarital and preconception care are essential components in improving maternal and newborn health outcomes. This community service aims to evaluate the importance of premarital and preconception counseling, with a focus on its role in reducing the risks associated with unplanned pregnancy, complications during pregnancy, and adverse neonatal outcomes. Although the benefits of premarital and preconception care are clear, access and awareness are still limited in Indonesia, especially among couples planning to marry. This community service was carried out through a national webinar attended by midwifery students, midwives and midwifery/health lecturers. The number of participants was 815 people. Based on the questionnaire that we gave to the midwives, only a few received preconception visits even though the implementation of premarital and preconception care can significantly improve reproductive health outcomes, reduce maternal and infant mortality, and help prospective couples plan a healthy pregnancy. The results of this activity identified barriers to accessing these services, including lack of awareness and education. The hope from this activity is that midwives can expand health education programs aimed at increasing community awareness of the benefits of premarital and preconception care in creating healthier family planning outcomes

Predictive modeling of gestational weight gain: a machine learning multiclass classification study

BackgroundGestational weight gain (GWG) is a critical factor influencing maternal and fetal health. Excessive or insufficient GWG can lead to various complications, including gestational diabetes, hypertension, cesarean delivery, low birth weight, and preterm birth. This study aims to develop and evaluate machine learning models to predict GWG categories: below, within, or above recommended guidelines.MethodsWe analyzed data from the Araraquara Cohort, Brazil, which comprised 1557 pregnant women with a gestational age of 19 weeks or less. Predictors included socioeconomic, demographic, lifestyle, morbidity, and anthropometric factors. Five machine learning algorithms (Random Forest, LightGBM, AdaBoost, CatBoost, and XGBoost) were employed for model development. The models were trained and evaluated using a multiclass classification approach. Model performance was assessed using metrics such as area under the ROC curve (AUC-ROC), F1 score and Matthew’s correlation coefficient (MCC).ResultsThe outcomes were categorized as follows: GWG within recommendations (28.7%), GWG below (32.5%), and GWG above recommendations (38.7%). The XGBoost presented the best overall model, achieving an AUC-ROC of 0.79 for GWG within, 0.76 for GWG below, and 0.65 for GWG above. The LightGBM also performed well with an AUC-ROC of 0.79 for predicting GWG within recommendations, 0.76 for GWG below, and 0.624 for GWG above. The most important predictors of GWG were pre-gestational BMI, maternal age, glycemic profile, hemoglobin levels, and arm circumference.ConclusionMachine learning models can effectively predict GWG categories, offering a valuable tool for early identification of at-risk pregnancies. This approach can enhance personalized prenatal care and interventions to promote optimal pregnancy outcomes.

MAGNETIC RESONANCE IMAGING IN DIAGNOSIS AND CLASSIFICATION OF MULLERIAN DUCT ANOMALIES: CASE SERIES

Objectives: Mullerian duct anomalies (MDAs) arise from the aberrant development of the uterus, cervix, and vagina, impacting the potential for successful conception and full-term pregnancy. This category encompasses a diverse range of developmental defects, leading to a spectrum of clinical presentations such as amenorrhea, infertility, recurrent miscarriages, intrauterine growth retardation, malposition of the fetus, preterm labor, and retained placenta. Case(s): In this study, we present 17 cases of MDA with a wide array of clinical manifestations. The varied symptoms included amenorrhea, infertility, repeated miscarriages, intrauterine growth retardation, malposition of the fetus, preterm labor, and retained placenta. Accurate categorization of these cases is crucial for determining the appropriate surgical intervention. While ultrasonography aids in the initial diagnosis of MDA, our focus on accurate classification necessitates the use of magnetic resonance imaging (MRI). Conclusion: Our findings underscore the significance of MRI in precisely categorizing MDA, and facilitating effective management strategies. The 17 cases presented demonstrate the diverse spectrum of MDA manifestations, emphasizing the need for tailored surgical interventions for successful conception and optimal pregnancy outcomes. The use of MRI proves instrumental in guiding clinical decisions, offering a comprehensive understanding of MDA, and informing targeted interventions to enhance reproductive success.

Maternal vitamin D status, fetal growth patterns, and adverse pregnancy outcomes in a multisite prospective pregnancy cohort

BackgroundFew studies have examined maternal vitamin D status and fetal growth patterns across gestation. Furthermore, time points in pregnancy at which maternal vitamin D status is most critical for optimal fetal growth and pregnancy outcomes are uncertain. ObjectivesOur objective was to examine whether first and second trimester maternal vitamin D status are associated with fetal growth patterns and pregnancy outcomes. MethodsWe conducted a secondary analysis using data and samples from a multisite prospective cohort study of nulliparous pregnant females in the United States. We measured serum 25-hydroxyvitamin D (25(OH)D) for 351 participants at 6–13 and 16–21 weeks of gestation. Fetal growth was measured by ultrasound at 16–21 and 22–29 weeks of gestation, and neonatal anthropometric measures at birth. We constructed fetal growth curves using length, weight, and head circumference z-scores, and calculated risk of preterm birth (<37 wk) and small for gestational age (SGA). We examined outcomes across 25(OH)D concentrations assessed continuously, using Institute of Medicine (IOM) cutoffs (<50 compared with ≥50 nmol/L), and using exploratory cutoffs (<40, 40–59.9, 60–79.9, ≥80 nmol/L). ResultsVitamin D insufficiency (25(OH)D <50 nmol/L) was prevalent in 20% of participants in the first trimester. Each 10 nmol/L increase in first trimester 25(OH)D was associated with a 0.05 [95% confidence interval (CI): 0.01, 0.10] increase in length-for-age z-score but was not associated with weight or head circumference. There were no differences in risk of preterm birth or SGA using IOM cutoffs; participants with first trimester 25(OH)D <40 compared with ≥80 nmol/L had 4.35 (95% CI: 1.14, 16.55) times risk of preterm birth. Second trimester 25(OH)D was not associated with fetal growth patterns or with pregnancy outcomes. ConclusionsFirst trimester 25(OH)D is positively associated with linear growth. Low first trimester 25(OH)D (<40 nmol/L) is associated with a higher risk of preterm birth. Second trimester 25(OH)D is not associated with fetal growth or pregnancy outcomes assessed.

Extra-Hepatic Portal Venous Obstruction in Pregnant Women of South-Asian Descent: A Case Series

Liver diseases complicate approximately 3% of pregnancies worldwide, and require specialized care to ensure optimal pregnancy outcomes. Extra-hepatic portal venous obstruction (EHPVO), even though asymptomatic in a majority of the cases, has a higher risk of variceal bleeding in pregnancy and adverse pregnancy outcomes. In this series, we describe five cases of EHPVO presenting during pregnancy at our tertiary care hospital, their antenatal management, and delivery outcomes. In our case series on EHPVO in pregnancy, a majority of the women were diagnosed during childhood and adequately asymptomatic before pregnancy. Two women underwent Endoscopic band ligation for esophageal varices and one woman underwent splenectomy before pregnancy for disease control. One woman was Anti-nuclear antibody (ANA) positive and another was Anti-phospholipid antibody (APLA) positive, while the other three did not have pre-existing thrombotic tendencies. One patient required Endoscopic band ligation during pregnancy. Pregnancy complicated by hypertension was noted in two of the five women (40%). Four of the five women (80%) had thrombocytopenia requiring blood products during delivery. Two women underwent preterm vaginal delivery, and one woman underwent preterm Caesarean section because of placental abruption. Three women had a post-partum hemorrhage, which was effectively managed with uterotonics and blood products. All five women and their neonates were discharged in good health. Multi-disciplinary approach with standardized antenatal care can give positive pregnancy outcomes in women with EHPVO.

Multidisciplinary care to optimise pregnancy outcomes among Jehovah’s Witness: Case series over fifteen years in a tertiary teaching hospital

ObjectiveTo assess the obstetric and neonatal outcomes of Jehovah’s Witness (JW) mothers and the willingness to accept blood products after multidisciplinary management. Study DesignA retrospective case-control study was conducted at Queen Mary Hospital from 2005 to 2020. Delivery records of pregnant women who identified themselves as JW were reviewed. The immediate next age-matched non-JW patient in the booking register was assigned as control. ResultsA total of 96 subjects were identified within the study period (48 JW and 48 non-JW age-matched patients). The haemoglobin levels of JW and non-JW were similar at booking, 28 weeks of gestation, pre-delivery and postnatal day 2. JW mothers were more likely to receive iron supplements in the antenatal period than the control group (27.1 % vs. 6.3 %, p = 0.01) despite the similar rate of antenatal anemia in both groups (4.2 % vs. 4.2 %, p = 1.00). There were no differences in mode of delivery, total blood loss at delivery, rate of primary postpartum haemorrhage, gestational age at delivery, birth weight, and Apgar score at 1 and 5 min between JW and non-JW. There were no maternal deaths, hysterectomy or admissions to the adult intensive care unit in either group. Six JW women accepted packed cell transfusion at the initial consultation and did not receive multidisciplinary care. The remaining 42 JW women had consultant obstetric and anesthesiologist review before delivery. After multidisciplinary consultation, two (4.8 %, 2/42) accepted blood transmission and 11 (26.2 %, 11/42) accepted some components of blood. The remaining 29 (69 %, 29/42) women refused all blood products. ConclusionJW patients who received multidisciplinary care achieved comparable pregnancy and neonatal outcomes to the normal population. Antenatal iron supplement was more common among pregnant JW despite the similar rate of antenatal anemia compared with the non-JW women. 12.5% of JW women agreed packed cell transfusion at the initial consultation and a further 27.1% of JW women agreed to some forms of blood products after multidisciplinary counseling.

Advances in Understanding and Managing Gestational Diabetes Mellitus: A Comprehensive Review

Gestational Diabetes Mellitus (GDM) is a significant and growing concern in prenatal care, impacting maternal and neonatal health. This comprehensive review highlights recent advancements in the understanding and management of GDM. The pathophysiology of GDM involves complex interactions between genetic, environmental, and hormonal factors that disrupt glucose homeostasis during pregnancy. Improved screening techniques and diagnostic criteria have led to earlier and more accurate detection. Management strategies have evolved to include not only traditional lifestyle interventions such as diet and exercise but also novel pharmacological treatments and continuous glucose monitoring technologies. The role of multidisciplinary care teams in optimizing pregnancy outcomes is emphasized, ensuring tailored care that addresses the unique needs of each patient. Additionally, the review explores emerging research on the long-term implications of GDM for both mother and child, underscoring the importance of postpartum follow-up and preventive measures. These advancements collectively aim to enhance maternal and fetal outcomes, reduce complications, and provide a framework for future research and clinical practice in GDM.

Subclinical Hypothyroidism and Placenta Abruption: A Dangerous Relationship During Pregnancy

This case report explores the intricate link between subclinical hypothyroidism and placenta abruption during pregnancy, emphasising the potential risks and clinical implications, through a detailed case study of a 28-year-old woman with a history of hyperthyroidism, non-compliance, and subsequent subclinical hypothyroidism, causing placenta abruption leading to intrauterine death. The report highlights the challenges in managing thyroid disorders during pregnancy. Limited Malaysian data on this association prompts a broader discussion of international findings, suggesting a correlation between subclinical hypothyroidism and adverse pregnancy outcomes. The study delves into potential mechanisms, including thyroid hormone impact on placental vascular function and the complexity added by autoimmune thyroiditis. Personalised treatments, thyroid function monitoring, and comprehensive antenatal care are emphasised for optimal pregnancy outcomes. This case underscores the need for increased awareness, proactive management, and preconception counselling to safeguard maternal and foetal well-being.

Increasing dominant follicular proportion was associated with adverse IVF/ICSI outcomes in low-prognosis women undergoing GnRH antagonist protocol: a retrospective cohort study

PurposeThis study aimed to examine the correlation between different dominant follicle proportions (DFPs) and outcomes of in-vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI) among patients classified under POSEIDON Groups 3 and 4, who underwent gonadotropin-releasing hormone antagonist (GnRH-ant) protocols. Additionally, it sought to determine the optimal DFP threshold for trigger timing.MethodsA retrospective analysis was performed on patients classified under POSEIDON Groups 3 (n = 593) and 4 (n = 563) who underwent GnRH-ant protocols for controlled ovarian hyperstimulation (COH) between 2016 and 2022. These patients were categorized into two groups based on their DFPs, defined as the ratio of ≥ 18-mm dominant follicles to ≥ 12-mm follicles on the trigger day (DFP ≤ 40% and DFP ≥ 40%). Statistical analyses, including restricted cubic spline (RCS) and multivariate logistic regression, were employed to assess the relationship between DFP and IVF/ICSI outcomes.ResultsDemographic characteristics of patients were similar across groups. In POSEIDON Groups 3 and 4, DFP > 40 was associated with a significant decrease in the number (No.) of oocytes retrieved, cleaved embryos, and available embryos. Moreover, following the GnRH-ant cycle, the clinical pregnancy and live birth rates in fresh embryo transfer (ET) were notably reduced in the DFP > 40 group compared with the DFP ≤ 40 group, whereas no significant differences were observed in the pregnancy outcomes of the first frozen-thawed embryo transfer (FET) between the groups. In POSEIDON Group 3, the cumulative clinical pregnancy rate (CCPR) and cumulative live birth rate (CLRB) were significantly higher in the DFP ≤ 40 subgroup than in the DFP > 40 subgroup, with a notable decrease in CLRB observed with increasing DFP levels. However, in POSEIDON Group 4, no significant differences in CCPR and CLRB were found between the groups. Logistic regression analysis identified age and the No. of oocytes retrieved as pivotal factors influencing CLRB in Group 4.ConclusionFor patients in POSEIDON Group 3, maintaining a DFP ≤ 40 mm is crucial to achieve optimal laboratory and pregnancy outcomes by avoiding delayed triggering. However, for patients in POSEIDON Group 4, age remains a critical factor influencing CLRB regardless of DFP, although a higher No. of oocytes retrieved and available embryos with DFP ≤ 40 is beneficial.

A Comparative Study of Fetal and Maternal Outcomes in Registered and Unregistered Antenatal Cases in a Tertiary Care Center.

Background Antenatal care plays a crucial role in ensuring optimal maternal and neonatal health outcomes. However, disparities in access to prenatal care persist, with a subset of pregnant women failing to register for antenatal care, referred to as "unbooked" or "unregistered" pregnancies. This study aims to investigate the impact of registration status on pregnancy outcomes, considering various demographic, clinical, and socioeconomic factors. Understanding the factors influencing registration status and its implications on maternal and fetal health outcomes is essential for developing targeted interventions to improve prenatal care access and enhance overall pregnancy outcomes. Objective To see the difference in obstetrical complications along with feto-maternal outcomes in both registered and unregistered antenatal cases and to determine the correlation of maternal and fetal outcomes with antenatal care. Materials and methods This two-year observational study at Dr. D.Y. Patil Medical College's Obstetrics and Gynecology IPD in Pimpri, Pune, examined maternal and fetal outcomes in registered and unregistered pregnancies. Consent was obtained, and patients were categorized as registered and unregistered based on the number of antenatal visits. This was an observational prospective cohort study. Data on socioeconomic factors like income and education were analyzed to assess their association with registration status. Maternal outcomes included preterm delivery and complications such as preeclampsia, gestational diabetes, oligohydramnios, premature rupture of membranes, anemia, and postpartum complications. Fetal outcomes included birth weight and NICU admissions. Statistical analyses, including Chi-square tests, Fisher's exact test, and logistic regression, were used to examine relationships between variables and registration status. Results This study analyzed 502 cases, comprising 251 registered and 251 unregistered pregnancies, to investigate the impact of antenatal registration on maternal and fetal outcomes. Significant associations were observed between socioeconomic factors, such as lower income and education levels in unregistered pregnancies.Specifically, 46 (18.3%) unregistered cases were in the lowest income bracket, while 103 (41.0%) were in the lower-middle bracket, and the majority (132, 52.2%) had only completed secondary education. Unregistered pregnancies were linked to a higher prevalence of adverse outcomes, including preterm delivery (101, 40.23%), anemia (178, 70.9%), hypertensive disorders (30, 11.9%), gestational diabetes mellitus (16, 6.37%), fetal growth restriction (39, 15.3%), low birth weight (181, 72.1%), and NICU admissions (112, 44.6%), compared to registered pregnancies. Conclusion In conclusion, this study highlights the significant impact of registration status on pregnancy outcomes, emphasizing the need for comprehensive interventions to improve prenatal care access and to promote maternal and neonatal health equity. By addressing socioeconomic barriers and implementing targeted interventions, healthcare systems can strive towardensuring optimal pregnancy outcomes for all expectant mothers. This is done by ensuring that all antenatal patients are registered for prenatal care by involving a combination of strategies focused on support, education, and accessibility.

Preparing the Heart for a New Baby: Management of Pregnancy in Heart Transplant Recipients.

Heart transplant (HT) recipients are more frequently reaching childbearing age given improvement in median survival and outcomes after HT. Although most pregnancies in HT recipients have favorable outcomes, poor fetal outcomes and maternal complications such as hypertensive disorders of pregnancy are more common in HT recipients than in the general population. In this review, we summarize the current evidence to guide the management of pregnancy in HT recipients. Preconception counseling, focused on risk stratification and optimal timing of conception, is the first important step to optimize pregnancy outcomes. During pregnancy and in the postpartum period, frequent monitoring of graft function and immunosuppressive levels is recommended. Calcineurin inhibitors and corticosteroids should be the mainstay of treatment for both prevention and treatment of graft rejection. Delivery planning should follow usual obstetric indications, preferably with vaginal delivery at term using regional anesthesia. A multidisciplinary care team should be involved in management through all stages of pregnancy to ensure success.

The prevalence of gestational diabetes among underweight and normal weight women worldwide: a scoping review.

Gestational diabetes (GDM) affects nearly 15% of pregnancies worldwide and is increasing globally. While this growth is thought to be primarily from overweight and obesity, normal and underweight women are affected as well, particularly in low and middle-income countries. However, GDM in non-overweight women remains understudied. Thus, we examined the prevalence among normal and underweight women globally. A comprehensive literature search was performed in Ovid MEDLINE, Ovid EMBASE, and The Cochrane Library. Studies retrieved were screened for eligibility against predefined inclusion/exclusion criteria. Prevalence of GDM among women with normal and underweight body mass index (BMI) was extracted, and average prevalence was calculated globally, by World Health Organization region, and by country. Pregnancy outcomes were described when available. A total of 145 studies were included. The average global prevalence of GDM among non-overweight women (BMI <25 kg/m2) was 7.3% and among underweight women (BMI <18.5 kg/m2) was 5.0%. GDM prevalence in non-overweight women was highest in Asia (average 12.1%) and lowest in the African region (0.7%). The countries with the highest prevalence were Vietnam (21.1%), Finland (19.8%), Poland (19.3%), Bangladesh (18.65%), and China (17.7%). The average global prevalence of large for gestational age infants (LGA) born to non-overweight women with GDM was 9.9%, which is lower than the average prevalence in the general population with GDM (14%). GDM is more common than previously recognized in non-overweight women, particularly in Asia, but also in European countries. Non-overweight women with GDM had lower prevalence of LGA babies compared to prior reported prevalence in all women with GDM, though data on pregnancy outcomes was limited. These findings challenge guidelines that recommend restriction of weight gain for GDM management. Further research on the pathophysiology and complications of GDM in women who are not overweight should be urgently conducted to inform appropriate management guidelines and support optimal pregnancy outcomes.

P-572 Circadian serum progesterone variations on the day of frozen embryo transfer in a modified natural cycle protocol

Abstract Study question Does a circadian variation of serum progesterone (P) on the frozen embryo transfer (FET) day in a modified natural cycle (mNC) exist? Summary answer A statistically significant diurnal variation of serum P on the day of a FET in a mNC protocol exists. What is known already In recent years, the proportion of FET cycles has increased dramatically. To further optimize pregnancy outcomes after FET, recent studies have focused on serum luteal P levels in both natural and artificially prepared FET cycles. Despite the different cut-off values proposed to define low serum P in the natural cycle, it is generally accepted that lower serum P values (&amp;lt;10ng/ml) around the day of FET are associated with negative reproductive outcomes. However, a single serum P measurement on the day of FET is not reliable given that P levels are prone to diurnal fluctuations and are impacted by patients’ characteristics. Study design, size, duration A prospective cohort study was conducted in a single fertility center including 22 patients performing a single blastocyst mNC-FET from August 2022 to August 2023.Serum P levels were measured on the day of transfer at 08:00h,12:00h,16:00h and 20:00h.Differences between P levels were compared using the Wilcoxon signed-rank test.The sample size was calculated to detect a difference of 15% between the first and last P measurements with a 5% false-positive rate and a 95% confidence interval. Participants/materials, setting, methods Patients with a normal BMI, between 18 and 40 years old, without uterine diseases were eligible. Patients utilizing donated oocytes were excluded. The mNC-FET protocol implied monitoring the normal ovarian cycle and triggering ovulation with an injection of 250 mcg of choriogonadotropin alfa when a pre-ovulatory follicle (16-20 mm diameter)was visualized. The blastocyst was transferred seven days later. The patients were not supplemented with exogenous P at any moment before the day of the FET. Main results and the role of chance The mean age and BMI of the study population were 33.6 ± 3.8 years and 22.7 ± 1.8 kg/m2, respectively. Mean P values at 08:00h,12:00h,16:00h, and 20:00h were 14.6 ± 4.5ng/ml, 14.7 ± 4.1ng/ml, 12.9 ± 3.5ng/ml, and 14.6 ± 4.3ng/ml, respectively. The mean P levels at 16:00h were statistically significantly lower compared to all other time points (p &amp;lt; 0.05:p= 0.007 between P at 8:00h and 16:00h;p = 0.003 between P at 12:00h and 16:00h;p=0.007 between P at 16:00h and 20:00h). Absence of a statistically significant fluctuation was observed between P values at the other time points (p = 0.88 between P at 8:00h and 12:00h;p=0.96 between P at 8:00h and 20:00h;p=0.83 between P at 12:00h and 20:00h). This study confirms the existence of an intra-day variation of serum P on the day of mNC-FET, with lower values at 16:00h. This highlights the importance of standardizing P measurement on the day of FET; we propose this should always be assessed in the morning to be more reliable and to allow the time to prescribe additional exogenous progesterone if lower P values (&amp;lt;10ng/ml) are detected. This standardization would allow fertility clinics around the world to compare their results and develop internationally recognized treatment protocols. Limitations, reasons for caution The study’s main limitation include the small sample size that may cause a bias when results are extrapolated to a larger subfertile population undergoing mNC-FET. Ideally, larger prospective trials including a more heterogeneous patient population would be necessary to validate our findings. Wider implications of the findings This study demonstrates the existence of a diurnal fluctuation of serum P on the mNC-FET day highlighting the importance of a standardized time point for its measurement.This is important when clinical actions, like additional exogenous P supplementation, are considered when encountering P values lower than 10ng/ml on the FET day. Trial registration number NCT05511272

Comparison of pregnancy outcomes between 4th day morula and 5th day blastocyst after embryo transfer: a retrospective cohort study

BackgroundThis study was designed to evaluate pregnancy outcomes between morulae transferred on day 4 (D4) and blastocysts transferred on day 5 (D5).MethodsFrom September 2017 to September 2020, 1963 fresh transfer cycles underwent early follicular phase extra-long protocol for assisted conception in our fertility center were divided into D4 (324 cases) and D5 (1639 cases) groups, and the general situation and other differences of patients in both groups were compared. To compare the differences in pregnancy outcomes, the D4 and D5 groups were further divided into groups A and B based on single and double embryo transfers. Furthermore, the cohort was divided into two groups: those with live births (1116 cases) and those without (847 cases), enabling a deeper evaluation of the effects of D4 or D5 transplantation on assisted reproductive outcomes.ResultsIn single embryo transfer, there was no significant difference between groups D4A and D5A (P > 0.05). In double embryo transfer, group D4B had a lower newborn birthweight and a larger proportion of low birthweight infants (P < 0.05). The preterm delivery rate, twin delivery rate, cesarean delivery rate, and percentage of low birthweight infants were lower in the D5A group than in the D5B group (P < 0.05). Analysis of factors influencing live birth outcomes further confirmed the absence of a significant difference between D4 and D5 transplantation in achieving live birth (P > 0.05).ConclusionWhen factors such as working life and hospital holidays are being considered, D4 morula transfer may be a good alternative to D5 blastocyst transfer. Given the in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) success rate and risk of twin pregnancy, D4 morula transfer requires an adapted decision between single and double embryo transfer, although a single blastocyst transfer is recommended for the D5 transfer in order to decrease the twin pregnancy rate. In addition, age, endometrial thickness and other factors need to be taken into account to personalize the IVF program and optimize pregnancy outcomes.

O-091 Severe maternal and neonatal morbidity among gestational carriers: a population-based cohort study

Abstract Study question Are gestational carriers at higher risk of severe maternal (SMM) or neonatal (SNM) morbidity, compared to patients using unassisted conception or in vitro fertilization (IVF)? Summary answer A higher risk of SMM and adverse pregnancy outcomes is seen among gestational carriers, without evident neonatal morbidity. What is known already The use of gestational carriers (GC) also known as “surrogate pregnancy” is increasing. Gestational carriage may be associated with adverse outcomes linked to both IVF techniques and exposure to foreign fetal antigens. Adverse outcomes of GC pregnancies are largely unknown. Study design, size, duration Retrospective population-based cohort study of 937,938 births, derived from existing administrative health datasets. Data were linked using unique for birthing woman and child identifiers and analyzed at ICES Ontario. The study excluded participants with untreated infertility, those utilizing ovulation induction or intrauterine insemination, and those with multifetal gestation. Participants/materials, setting, methods Singleton births at &amp;gt; 20 weeks gestation in Ontario, 2012-2021. Pregnancy characteristics were obtained from the Ontario Birth Registry database. Exposure groups were i) unassisted conception (comparison group 1), ii) IVF (comparison group 2), or iii) GC. Primary outcomes included validated composite outcomes of i) SMM and ii) SNM. Secondary outcomes included hypertensive disorders of pregnancy, cesarean delivery, preterm birth, and postpartum hemorrhage. Modified Poisson regression models generated relative risks adjusted for birthing woman’s characteristics (aRR). Main results and the role of chance Of all singleton births, 937,938 (97.7%) were from unassisted conception, 20,958 (2.2%) from IVF, and 956 (0.1%) from GC. GC were more likely to be parous, reside in a lower-income area, and have higher rates of chronic hypertension. GC were more likely than unassisted conception women to be older and be non-smokers, with some opposite trends when compared to IVF recipients. Respective rates of SMM were 2.4%, 4.6% and 7.1%. The aRR were 3.07 (95% CI 2.44-3.87) comparing GC to unassisted conception, and 1.88 (95% CI 1.46-2.42) comparing GC to IVF. Respective rates of SNM were 6.0%, 9.1% and 6.5%, generating aRR of 1.21 (95% CI 0.95-1.54) for GC vs. unassisted conception, and 0.78 (95% CI 0.60-1.00) for GC vs. IVF. Respective rates of hypertensive disorders were 6.6%, 11.6% and 13.9%. The aRR were 1.89 (1.61 - 2.21) comparing GC to unassisted conception, 1.42 (1.19 - 1.69) comparing GC to IVF. Respective rates of postpartum hemorrhage were 5.7%, 10.5% and 13.9%, generating aRR of 2.87 (2.43 - 3.38) for GC vs. unassisted conception, and 1.40 (1.17 - 1.67) for GC vs. IVF. Limitations, reasons for caution The databases did not include certain baseline details, including the reasons for opting for a GC and the sources of gametes. There is a chance that the measured association may be distorted or confounded by the unmeasured variables. Wider implications of the findings GC appear to be at an elevated risk of maternal morbidity, without evident risk of neonatal morbidity. Further studies are needed to understand the mechanisms involved. Eligibility for GC should be determined using consistent selection criteria, and consideration should be given to specialized obstetrical care to promote optimal pregnancy outcomes. Trial registration number Not applicable

Inteleukin-6 secretion during pathophysiological events of pregnancy – preterm birth, preeclampsia, fetal growth restriction, gestational diabetes mellitus

Cytokines play a role in nearly all reproductive and pregnancy processes. These proteins are expressed in various body fluids and tissues related to reproduction. Interleukin-6 (IL-6) stands out as one of the best-characterized members of the cytokine family. This protein has an immense and imperfectly understood impact on both normal and pathological aspects of human pregnancy. IL-6 exerts a wide range of effects on the immune system, and it plays crucial roles in regulating inflammation processes and homeostasis. Herein, we summarize current knowledge on IL-6 secretion during pathophysiological events of pregnancy: preterm birth, preeclampsia, fetal growth restriction and gestational diabetes mellitus. Cytokines, particularly interleukin-6, play crucial roles in regulating pregnancy physiology. Maintaining IL-6 homeostasis is essential for the health of both the mother and fetus. IL-6 supports pregnancy by influencing uterine receptivity, trophoblast function, and immune interactions at the feto–maternal interface. Disrupted IL-6 expression may contribute to various pregnancy complications. A deeper understanding of IL-6 regulation can help detect dysregulation and potentially optimizing pregnancy outcomes. Addressing knowledge gaps identified in this review is vital for improving current practices and enhancing pregnancy outcomes.

Analyzing Protein and Glucose Levels in Pregnant Women Attending Antenatal Care at Health Centers in Port Harcourt, Rivers State

Protein and glucose serve as crucial indicators of potential maternal health complications and fetal outcomes during pregnancy. This study aimed to investigate protein and glucose level of pregnant women attending antenatal care in some health centre, in Port Harcourt, Nigeria. A total of sixty pregnant women between ages 16-45 who attended antenatal care in the selected health centres were randomly selected and their urine samples were collected and analyzed for protein and glucose levels using urinometre (combi 2). The result obtained for protein level ranged between 200± 14.0mg/dl to 350± 16.2 mg/dl while the glucose level ranged between 180± 11.0mg/dl to 200± 12.0mg/dl. The least protein level of 200± 14.0mg/dl were recorded among 7-9 months (3rd trimester) pregnancy, while the highest protein level of 350± 16.0mg/dl were recorded between 0-3 months (1st trimester). The least glucose value of 180± 11.0mg/dl was recorded among pregnant women that are in their 1st trimester, while the highest value of 200± 12.0mg/dl was recorded among pregnant women in their 2nd trimester. The result indicates significant fluctuations in protein and glucose levels across trimesters, reflecting dynamic metabolic changes during pregnancy.Factors like advanced maternal age, knowledge gaps, misconceptions, symptoms, and treatment-seeking behaviour highlighted in the questionnaire data can be considered as potential risk factors or indicators concerning protein and glucose levels during pregnancy. Addressing these factors through targeted education, early detection, and appropriate medical intervention is recommended in the study area to ensure an optimal pregnancy outcome

Metformin Plus Insulin for Preexisting Diabetes or Gestational Diabetes in Early Pregnancy: The MOMPOD Randomized Clinical Trial

(Abstracted from JAMA 2023;330(22):2182–2190) Preexisting type 2 diabetes in pregnant people increases the risk for adverse pregnancy outcomes, intrapartum complications, and neonatal hypoglycemia at birth. To achieve normal maternal glucose levels and optimize pregnancy outcomes, management includes maternal blood glucose monitoring, dietary management, and insulin therapy.