Pregnancy Outcomes In Women Research Articles

High anti-Müllerian hormone level as a predictor of poor pregnancy outcomes in women with polycystic ovary syndrome undergoing in vitro fertilization/intracytoplasmic sperm injection: a retrospective cohort study

ObjectiveTo study the correlation between anti-Müllerian hormone levels and pregnancy outcomes after in vitro fertilization/intracytoplasmic sperm injection in women with polycystic ovary syndrome, which remains controversial.MethodsThis retrospective cohort study recruited 4,719 women with infertility and polycystic ovary syndrome aged 20–40 years who underwent treatment at the Reproductive Center of Peking University Third Hospital between February 2017 and June 2023. We divided the participants into three groups according to the 25th and 75th percentile cutoffs of serum anti-Müllerian hormone: low (≤ 4.98 ng/mL, n = 1,198), average (4.98 − 10.65 ng/mL, n = 2,346), and high (≥ 10.65 ng/mL, n = 1,175). Pregnancy outcomes included live birth rate, miscarriage rate, clinical pregnancy rate, and cumulative live birth rate.ResultsThe live birth rate for fresh embryo transfer was 39.8%, 35.9%, and 30.4% in the low, average, and high anti-Müllerian hormone groups, respectively. The miscarriage rate was 11.3%, 17.1%, and 21.8% in the low, average, and high anti-Müllerian hormone groups, respectively. Significant intergroup differences were observed in the live birth rate (P = 0.017) and miscarriage rate (P = 0.018). No significant intergroup difference was observed in the clinical pregnancy rate (P = 0.204) or cumulative live birth rate (P = 0.423). After adjusting the confounders by multivariable logistic regression analysis, anti-Müllerian hormone was associated with decreased live birth rate in the high anti-Müllerian hormone group compared with that in the low anti-Müllerian hormone group (odds ratio: 0.629, 95% confidence interval: 0.460–0.860). Anti-Müllerian hormone was associated with increased miscarriage rate in the average and high anti-Müllerian hormone groups compared with that in the low anti-Müllerian hormone group (average vs. low: odds ratio: 1.592, 95% confidence interval: 1.017–2.490); high vs. low: odds ratio: 2.045, 95% confidence interval: 1.152–3.633).ConclusionHigh anti-Müllerian hormone is a prognostic factor for reduced live birth rate after fresh embryo transfer in women with polycystic ovary syndrome aged 20–40 years undergoing in vitro fertilization/intracytoplasmic sperm injection, and is associated with increased miscarriage rate in these patients.

Retrospective Analysis of the Correlation between Umbilical Blood Flow Index and Maternal and Fetal Outcomes in Pregnant Women with Gestational Diabetes.

Aims/Background Gestational diabetes mellitus (GDM) is a common complication during pregnancy. This retrospective study investigates the correlation between umbilical blood flow index and maternal-fetal outcomes in pregnant women with GDM, aiming to contribute to evidence-based risk assessment and management strategy in this high-risk obstetric population. Methods This retrospective study recruited 119 pregnant women with GDM who were admitted to the Yichang Central People's Hospital, between January 2022 and January 2024. Based on the umbilical blood flow index, the study participants were divided into a normal umbilical blood flow (UBF) index group (n = 56) and a high UBF index group (n = 63). Colour Doppler ultrasound was used to assess umbilical blood flow, and relevant data on maternal, fetal, and neonatal outcomes were obtained from the hospital's electronic medical records. Results We observed that, compared to the normal UBF index group, the high UBF index group exhibited significantly higher rates of adverse pregnancy outcomes, including the cesarean section (p = 0.022), preterm delivery (p = 0.020), gestational hypertension (p = 0.019), neonatal hypoglycemia (p = 0.015), as well as increased incidence of neonatal complications such as respiratory distress syndrome (p = 0.009), neonatal jaundice (p = 0.022), neonatal intensive care unit (NICU) admission (p = 0.015), lower 5-minute Apgar scores (p = 0.013), and neonatal sepsis (p = 0.005). Furthermore, significant differences were observed in fetal biometric parameters and placental morphology between the two groups (fetal weight: p = 0.003; estimated fetal weight percentile: p = 0.017; femur length: p = 0.018; placental weight: p = 0.019; placental volume: p = 0.021). Additionally, correlation analyses indicated significant associations between umbilical blood flow index and maternal and fetal outcomes (p < 0.05). Conclusion We observed a significant correlation between umbilical blood flow indices and maternal and fetal outcomes in pregnant women with gestational diabetes mellitus, implying its utility as a non-invasive parameter for risk stratification and personalized management in this high-risk obstetric population.

Pregnancy Outcomes in Women with Low and Ultra-Low Ejection Fraction: A Retrospective Study in a Tertiary Care Center

The data about pregnancy while having a low ejection fraction are scarce, since pregnancy is not recommended for women with an ejection fraction of less than 30%. There is an increased risk of obstetrical complications and adverse maternal-fetal outcomes. Pregnancy is a rough journey for this group of patients. However, a successful pregnancy can be achieved when cardiac complications are managed during pregnancy. The early recognition of women at risk of cardiovascular events and early referral can optimize the maternal and neonatal outcomes with close collaboration between the maternal-fetal medicine specialist and the cardiologist. The study’s aim was to assess the experience of our tertiary center with regard to the adverse maternal outcome for women with an ejection fraction ≤ 30% compared to those with an EF &gt; 30% in our tertiary center. The fetal and obstetric outcome for pregnancies with an EF ≤ 30% was compared to that for pregnancies with an EF &gt; 30%. Methodology: After receiving the approval of the local Ethical Board Review, a retrospective study was conducted at King Faisal Specialist Hospital and Research Center (KFSHRC) in the city of Riyadh, Kingdom of Saudi Arabia. Our study population included women with cardiomyopathy (acquired or congenital) who were followed up or delivered in KFSHRC from the period of January 2004 till March 2020. Cases were identified by reviewing the database from the Cardiac Center Echocardiograph and maternal fetal medicine unit. The data on the maternal and fetal outcome were gathered from the hospital medical records. An adverse maternal outcome included: death, hospitalization due to decompensated heart failure, and worsening cardiovascular status during pregnancy. Adverse fetal outcomes included: miscarriages, termination of pregnancy, FGR, and placental insufficiency. Obstetrics complications included: complications related to the mode of delivery, antepartum hemorrhage, postpartum hemorrhage, or preeclampsia. Results: Our study included 44 subjects, examining the differences between those with an ejection fraction greater than 30 (n = 21 subjects) and those with an ejection fraction less than or equal to 30 (n = 23) with respect to demographics, co-morbidities, and outcomes (maternal, pregnancy, fetal, ultrasound, and baby). There was no evidence of any differences in the demographics. From among the co-morbidities, there was a statistically higher rate of dilated cardiomyopathy and lower rate of rheumatic heart disease in those with a lower ejection fraction. Also, women with a lower ejection fraction tended to deliver through a means other than simple vaginal delivery. There was a significant association (p = 0.0296) indicating that individuals with a lower ejection fraction tended to have a lower gestational age at delivery. The information on whether the pregnancy resulted in a live birth was available for all but one of the mothers. Across all the mothers, 32 (74%) resulted in a live birth and 11 did not. The percentage of pregnancies resulting in a live birth in the group for which the ejection fraction was greater than 30 was 90% and that in the group for which the ejection fraction was less than or equal to 30 was 59% (p = 0.0339). From among the ultrasound and baby outcomes, only the rate of the babies being discharged alive differed statistically between the two ejection fraction groups, with those mothers having a lower ejection fraction experiencing fewer babies being discharged alive (p = 0.0310). Conclusions: In conclusion, women with a low ejection fraction are at an increased risk of maternal-fetal complications. In our study, the lower the EF (≤30) the worse were the fetal and neonatal outcomes; however, in terms of the maternal outcomes, it was the same whether the EF was low or ultra-low. Yet, these groups of patients need to be counseled about the facts of poor obstetrical outcomes with an emphasis on preconceptual counseling.

Serum Neuropeptide FFR2 is increased in pregnant women with pre-eclampsia and associated with pregnancy outcomes

Objectives: NPFFR2 is a biomarker produced by the placenta during pregnancy and is thought to be associated with in various physiological processes, including pain modulation, opioid receptor regulation, and cardiovascular function. Pre-eclampsia (PE) is a major public health concern due to its links with cardiovascular disease (CVD), stroke and neonatal morbidity and mortality. Consequently, timely diagnosis and efficient management of PE are essential for both maternal and neonatal health. This study aimed to conduct a comparative analysis of neuropeptide FFR2 (NPFFR2), echocardiographic evaluation results, and pregnancy outcomes in pregnant women with and without PE. Methods: This is a prospective case-control study. It included 94 pregnant participants who applied to Manisa City Hospital between October 2021 to January 2023 and were grouped into women with PE (n = 47) and those without PE (n = 47). Biochemical and NPFFR2 analyses were performed using the blood samples collected from all participants, along with echocardiography and 24 hours. Ambulatory blood pressure monitoring (ABPM). A p-value &lt;0.05 was considered statistically significant Results: The study group comprised 94 pregnant women with a mean age of 29.2 years and mean gestational age of 27.6 weeks. The preeclampsia group had a significantly higher NPFFR2 levels, lower gestational age at birth and higher all 24-hours ABPM findings. The left atrial-to-aortic ratio and right ventricle myocardial performance index were significantly higher and EA ratio was significantly lower in the preeclampsia group than in the control group. NPFFR2, gestational age at birth, LDL cholesterol, and body mass index were found to be independently associated with neonatal intensive care unit admission. Conclusions: The women with PE presented with increased serum NPFFR2 levels and the prognosis of pregnancy was associated with NPFFR2 levels. doi: https://doi.org/10.12669/pjms.41.2.10591 How to cite this: Tas U, Tas S, Kume T, Yilmaz O. Serum Neuropeptide FFR2 is increased in pregnant women with pre-eclampsia and associated with pregnancy outcomes. Pak J Med Sci. 2025;41(2):378-383. doi: https://doi.org/10.12669/pjms.41.2.10591 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

P0223 In Vitro Fertilization in Women with Inflammatory Bowel Disease – Clinical Characteristics and Outcomes

Abstract Background Inflammatory Bowel Disease (IBD) most commonly affects women of reproductive age. While considered effective, there are limited data concerning IBD and pregnancy-related outcomes in patients receiving in vitro fertilization (IVF). This study compares the characteristics and outcomes of pregnant women with IBD who conceived spontaneously with those who required IVF. Methods This retrospective study included pregnant women with IBD who visited the IBD Mom Clinic at the Tel Aviv Sourasky Medical Center (TLVMC). The cohort consists of two groups - women who conceived spontaneously (IBD-spon) or through IVF therapy (IBD-IVF). Demographics, clinical characteristics, as well as pregnancy and IBD-related outcomes were collected from electronic medical records. Results A total of 269 IBD pregnancies from September 2017 to December 2023 were reviewed; 53 women (19.7%) conceived via IVF. Among the IBD-IVF group, there was a lower rate of Crohn’s disease (54.7% vs 67%, P=0.02), similar rate of ulcerative colitis (35.8% vs 31%, p=0.347) and lower rate of patients with pouch (9.4% vs 1.9%, p=0.005). Disease duration was longer in IBD-IVF (10.5 ± 6.9 vs. 8.3 ± 6.0 years, p&amp;lt;0.05) and the IBD-IVF group was significantly older (mean 34.5 ± 5.4 years vs. 31.6 ± 4.4 years, p&amp;lt;0.001) and independently associated with a 10% increase in IVF conception likelihood per additional year of age (OR=1.10, p&amp;lt;0.001). Patients with CD who received IVF had higher rates of peri-anal involvement compared to those who conceived spontaneously (37.9% vs. 19.5% p&amp;lt;0.05). Table 1 summarizes these findings. First-trimester fecal calprotectin levels were elevated in the IBD-IVF group (684.1 ± 1003.5 vs. 373.8 ± 529.6 μg/g, p&amp;lt;0.001). Despite that, no significant differences in IBD exacerbations, advanced therapy adjustments, or hospitalizations were observed. Adverse pregnancy outcomes were more frequent in the IBD-IVF group. These includes lower mean fetal weight (2999.7 ± 493 vs. 3185.6 ± 524.6 g, p=0.05), spontaneous abortions (9.4% vs. 1.9%, p=0.03), and pregnancy losses before 20 weeks (7.5% vs. 1.5%, p=0.03), as detailed in Table 2. Conclusion In this study, significantly higher rates of adverse pregnancy outcomes were observed in patients conceiving through IVF. Older age was independently associated with IVF conception. No increased adverse IBD-related outcomes were observed. These data suggest that the complications in the IVF group, are more related to underlying maternal risk factors and emphasize the importance of close monitoring and follow-up in this population.

DOP044 Active disease on intestinal ultrasound in pregnancy is associated with an increased risk of adverse obstetric and neonatal outcomes: an international multi-centre prospective cohort study.

Abstract Background Clinically active inflammatory bowel disease (IBD) impacts 30-50% of women antenatally1,2. Such clinically active disease is associated with an increased risk of adverse pregnancy outcomes, including preterm delivery2. However, the validity of clinical scores to assess antenatal disease activity has been questioned, whilst both faecal calprotectin (FCP) and intestinal ultrasound (IUS) are feasible and accurate in pregnancy3,4. We aimed to assess whether active disease defined by IUS may predict adverse obstetric outcomes in pregnant women with IBD. Methods This international multi-centre prospective cohort study recruited both preconception and pregnant individuals with IBD in Australia and the USA from 2017-2023. Participants underwent clinical assessments and FCP testing six months before conception, in each trimester (T1, T2, and T3), and, when feasible, six weeks postpartum. IUS was performed preconception and in T1 and T2. Clinically active disease in pregnancy was defined by a PGA&amp;gt;1, or a HBI&amp;gt;5 or SCCAI &amp;gt;3. A FCP&amp;gt;100μg/g was considered elevated, and IUS remission was defined as a bowel wall thickness of &amp;lt;3mm in all bowel segments, with normal bowel wall stratification, a lack of extra-mural complications, and an absence of mesenteric fat hypertrophy or hyperaemia. Univariable and multivariable binary logistic regression analyses including relevant confounders were used to determine the independent impact of IUS disease activity on obstetric outcomes. Cohen κ coefficients were used to determine agreement between FCP, IUS and clinical disease activity. Results 379 participants, 200 with Crohn’s Disease (CD), were recruited. Overall, rates of adverse obstetric outcomes were comparable to the general population (Figure 1). Maximal bowel wall thickness (BWT) &amp;gt;6mm in T1 was associated with a three-fold increased risk of neonatal intensive or special care unit admission (RR 3.10;1.27-7.54, p=0.013) and in T2 was associated with a four-fold increased risk of prematurity (4.51; 1.45-14.04, p=0.009). IUS hyperaemia in T2 was associated with a three-fold increase in preeclampsia risk (3.61; 1.07-12.15, p=0.038). FCP &amp;gt;100μg/g in T2 was associated with an increased risk of preterm delivery after adjusting for clinical disease activity (RR 2.90; 1.22-7.50, p=0.028). Agreement between clinical (HBI or SCCAI) and IUS/FCP activity during pregnancy was weak (Figure 2). Conclusion Sub-clinical disease activity identified on IUS in pregnancy is associated with an increased risk of pre-term delivery, with poor agreement between clinical symptoms and objective biomarkers of disease activity during pregnancy. IUS monitoring should be performed as part of routine antenatal IBD care and IUS remission targeted.

Monocyte and Macrophage in Follicular Liquid: Predictive Markers of Embryo Quality in Women with Obesity and Infertility.

Over the past five years, the pregnancy rate in assisted reproductive technology (ART) programs in Russia has remained relatively stable. The aim of this study was to assess the distribution of monocyte and macrophage subsets in the blood and follicular fluid of infertile women undergoing assisted reproductive technology. The study involved 45 women with a mean age of 35 ± 4.66 years. Monocytes and macrophages were identified using flow cytometry. We observed a decrease in the CD68+CD163+CD206+ and the CD68+CD163-CD206+ cells in patients with a body mass index (BMI) >25 by 0.19 times and 6.56 times, respectively, compared to the group with a BMI <25 (p = 0.031). Patients with fair oocyte quality had 3.6 times more oocytes than those with poor quality (p = 0.010). The relative content of CD14+163-206+ monocytes was found to be 24.15 times higher in the follicular fluid of women with poor embryo quality compared to the group with good embryos (p = 0.010). We also noted that the number of oocytes increased in women with male factor infertility (p = 0.020) and those with unspecified infertility when compared to tubal infertility. An increase in the relative content of CD14+163+206+ in the blood was higher in women with other causes of female infertility compared to those with male factor infertility (p = 0.010). The relative content of M2-monocytes (CD14+163+206-) in the blood was 4.38 times higher in women with male factor infertility than in women with unexplained infertility (p = 0.010). A critical component of the inflammatory reaction in patients undergoing in vitro fertilization (IVF) involves more than just the activation of pro-inflammatory cells in response to ovarian stimulation. Our research shows that changes in the distribution of monocytes and macrophages can influence embryo implantation success and pregnancy outcomes in women. These processes are influenced by various infertility-related factors, including those mentioned above. However, these findings are preliminary and require further investigation.

Association of pregnancy diet with metabolic adverse outcomes in pregnant women and their children: A Systematic Review and Meta-Analysis.

The diet during pregnancy has long-term effects on the health outcomes of both mothers and their children. Study aimed to undertake a systematic review to explore the association of high-fiber diet, DASH diet, and Mediterranean diet with metabolic outcomes among mothers and their children. We searched for relevant articles published from Jan 2012 to Nov 2022 through PubMed, MEDLINE and Embase. Randomized trials and observational studies that considered high-fibre diet, DASH diet, Mediterranean diet during pregnancy and metabolic outcomes in pregnant women and their children were included in the systematic review. Thirty studies were included involving 41,424 pregnant women and children. A high-fibre diet was associated with reduced risk of gestational diabetes mellitus (GDM) (OR: 0.22; 95%CI: 0.11-0.42), pregnancy hypertensive disorders (OR: 0.45; 95% CI: 0.25-0.81) and lower birth weight (-109.54g; 95%CI: -204.84 to -14.24). The adherences to Mediterranean diet and DASH diet were associated with reduced risk of GDM (OR: 0.60; 95%CI: 0.45-0.80; OR: 0.36; 95%CI: 0.26-0.51), and lower risk of excessive gestational weight gain (OR: 0.41; 95%CI: 0.18-0.93; OR: 0.3, 95%CI: 0.16-0.57). Adherence to Mediterranean diet was associated with a lower risk of small for gestational age, fetal growth restriction and childhood overweight in the progeny (OR: 0.83, 95%CI: 0.73-0.95; OR: 0.50; 95%CI: 0.28-0.89; OR: 0.85; 95%CI: 0.74-0.97). During pregnancy, high-fibre diet and adherences to Mediterranean diet and DASH diet were associated with lower risk of adverse metabolic outcomes in pregnant women and their children.

Association of nucleoside reverse transcriptase inhibitors with adverse perinatal outcomes in pregnant women living with HIV: systematic review and meta-analysis.

The World Health Organization (WHO) recommends antiretroviral therapy (ART) containing two nucleoside reverse transcriptase inhibitors (NRTIs) as backbone. WHO recommends tenofovir disoproxil fumarate combined with lamivudine or emtricitabine as first line in pregnancy, and zidovudine, abacavir or tenofovir alafenamide, combined with lamivudine or emtricitabine, as alternatives. Evaluate risk of adverse perinatal outcomes in pregnant women living with HIV (WLHIV) receiving different NRTIs. Medline, CINAHL, Global Health, EMBASE. Cohort studies. Pregnant WLHIV. ART regimes containing different NRTI drugs. Newcastle-Ottawa Scale and GRADE. Random-effects meta-analysis. 22 cohort studies including 124,478 WLHIV met the eligibility criteria. ART containing tenofovir disoproxil fumarate was associated with lower risk of preterm birth (Risk Ratio 0.89; 95% confidence interval 0.81-0.97), very preterm birth (0.58; 0.40-0.86), small for gestational age (0.76; 0.59-0.98), very small for gestational age (0.60; 0.48-0.73), stillbirth (0.49; 0.31-0.78), and neonatal death (0.61; 0.40-0.93), compared to ART not containing tenofovir disoproxil fumarate. ART containing zidovudine was associated with increased risk of very preterm birth (1.59; 1.01-2.49), small for gestational age (1.33; 1.03-1.70), very small for gestational age (1.63; 1.25-2.13), stillbirth (2.23; 1.10-4.55), and neonatal death (1.65; 1.08-2.52), compared to ART not containing zidovudine. For ART regimens also containing either lamivudine or emtricitabine, zidovudine was associated with increased risk of very preterm birth (1.62; 1.04-2.52), small for gestational age (1.52; 1.28-1.82), very small for gestational age (1.68; 1.36-2.06), stillbirth (2.19; 1.03-4.67), and neonatal death (1.65; 1.08-2.52), compared to ART containing tenofovir disoproxil fumarate. Abacavir was not associated with adverse perinatal outcomes. Tenofovir alafenamide was not associated with low birth weight compared to tenofovir disoproxil fumarate. Tenofovir disoproxil fumarate is associated with a lower risk of adverse perinatal outcomes, whereas zidovudine is associated with an increased risk of perinatal outcomes. Abacavir is not associated with adverse perinatal outcomes. Our findings support current WHO guidelines.

Prevalence, risk factors, and adverse outcomes of bacterial vaginosis among pregnant women: a systematic review

IntroductionBacterial vaginosis (BV) is one of the most common genital tract infections among women of reproductive age. The existence of BV among pregnant women has momentously attracted the attention of both clinicians and the scientific community due to its potential link with adverse clinical outcomes in pregnancy.MethodsTo evaluate the prevalence, risk factors, and adverse outcomes of bacterial vaginosis among pregnant women, a comprehensive systematic review was conducted based on the preferred reporting items for systematic review and meta-analyses (PRISMA) criteria. PubMed, ScienceDirect, ClinicalTrials.gov and Cochrane database searches were conducted independently by two authors until May 13th, 2023.ResultsThe search strategies yielded a total of 2237 records; among them, 12 studies met the inclusion criteria and were included in the qualitative synthesis. Majority of the included studies demonstrated a high prevalence of BV among African women. The risk of developing BV during pregnancy was highest among women with multiple sexual partners. Additionally, factors including age, socioeconomic status, unhygienic practices, ethnicity, 2nd trimester, spontaneous abortion, vaginal douching, symptoms, and history of sexually transmitted infections (STIs) were also associated with a higher prevalence of BV. Overall, 7 studies reported adverse outcomes during pregnancy which was directly associated with BV. Based on the review, it was found that PROM, PTB, and LBW were the most frequently reported adverse outcomes in pregnant women with BV.ConclusionIn summary, the high prevalence of bacterial vaginosis necessitates a global surveillance approach to delineate the health risks imposed on both mother and child, and promote cost-effective strategic measures to alleviate the undesired consequences of BV during pregnancy.

A Review of Immunological Evaluation of Patients with Recurrent Spontaneous Abortion (RSA).

In approximately half of the recurrent spontaneous abortion (RSA) cases, the underlying cause is unknown. However, most unexplained miscarriages are thought to be linked to immune dysfunction. This review summarizes the current evidence regarding the immunological evaluations of patients with RSA, with potential implications for clinical research. The immune system plays a crucial role in the successful outcome of pregnancy, as it tolerates the semi-allogeneic fetus while offering protection to both the mother and fetus from pathogens. The maternal-fetal interface is the place where the crosstalk between various immune cells such as macrophages, dendritic cells, natural killer (NK) cells, and T cells takes place. An adequate balance is required between these immune cells for pregnancy to progress. In RSA, a dysregulation between these immune players is witnessed. For example, in RSA, NK cells are not increased but also undergo a change in their activity, manifested as cytotoxic decidual NK. Similarly, regulatory T cells, which are crucial for fostering a tolerant immune environment, are decreased in RSA women. Similarly, imbalances between T-helper (Th1, Th2, Th17) cell subsets have been implicated in RSA. Furthermore, the imbalance between pro-inflammatory M1 and anti-inflammatory M2 macrophage phenotypes has been documented, with studies indicating a predominance of M1 macrophages in RSA patients. Targeting immune imbalances with therapies such as immunoglobulin administration, TNF inhibitors, and anticoagulants may improve pregnancy outcomes in women with RSA.

Association between iron deficiency and fertility.

This retrospective, observational cohort study investigated the association between treatment of iron deficiency with conception results and pregnancy outcomes in women with infertility and iron deficiency, before and after intravenous ferric carboxymaltose infusion. Data were collected from electronic health records from the Dextra Fertility Clinic (Helsinki, Finland) between 2015 and 2020. The cohort included 292 women (<43 years) with infertility and iron deficiency (s-ferritin ≤30 μg/L), treated with a ferric carboxymaltose infusion (Ferinject®, 500 mg i.v.). The main outcomes were live birth and miscarriage rates before and after treatment of iron deficiency. The main explanatory variable studied was the administered iron infusion. Mean s-ferritin levels increased from 16.2 ± 7.0 μg/L before to 81.5 ± 49.8 μg/L after iron infusion. The proportion of patients who conceived increased from 65% before to 77% after treatment of iron deficiency (p < 0.001). Of the study population, 28% of patients experienced miscarriages and 26% gave a live birth before iron infusion, and 13% and 51% after treatment of iron deficiency (p < 0.001). In the model adjusted for age, use of preimplantation genetic testing for aneuploidy, and repeated iron infusions, treatment of iron deficiency with iron infusion was associated with a higher live birth rate (OR = 3.19; 95% CI = 2.21-4.66; p < 0.001). In the model adjusted for age, reason for infertility, and total number of pregnancies, treatment of iron deficiency was associated with lower miscarriage rates (OR = 0.32; 95% Cl = 0.20-0.52; p < 0.001). Filling of depleted iron stores was positively associated with conception results (higher number of pregnancies) and pregnancy outcomes (higher live birth rates and lower miscarriage rates), regardless of the assisted reproductive technology method used. Screening of iron status seems to be important in patients seeking help for infertility problems.

Impacts of Lifestyle Intervention by a Nurse-Led Smartphone Application on Blood Pressure, Weight, and Pregnancy Outcomes in Pregnant Women With Gestational Hypertension: A Randomized Controlled Trial.

High blood pressure and excess weight during pregnancy can have adverse outcomes. This randomized controlled trial evaluated the effects of a nurse-led smartphone application-based lifestyle intervention on blood pressure, body weight, and pregnancy outcomes in pregnant women with gestational hypertension between August and December 2023. Pregnant women, between 20 and 28 weeks of gestation, were allocated to the intervention or control group. Control group (n = 99) received standard high-risk pregnancy management, while intervention group (n = 96) also received lifestyle guidance via a nurse-led smartphone application. Intervention group experienced longer gestations (p = 0.007), higher neonatal weights (p = 0.028), and lower incidences of pre-eclampsia (p < 0.001), small for gestational age infants (p = 0.003), and preterm births (p = 0.023) compared to control group. The mixed-effect models for repeated measures showed that the nurse-led smartphone application intervention had no impact on body mass index, while significantly reducing systolic and diastolic blood pressure measurements (β = -1.666, 95% confidence interval, CI: -2.814 to -0.519, p = 0.005 and β = -2.247, 95% CI: -3.349 to -1.145, p < 0.001, respectively). Both systolic and diastolic blood pressures showed a downward trend from 28 weeks (p < 0.05). The nurse-led smartphone application-based lifestyle intervention significantly reduced adverse pregnancy outcomes and positively influenced blood pressure management in pregnant women with gestational hypertension.

Association of insulin resistance surrogates with live birth outcomes in women with polycystic ovary syndrome undergoing in vitro fertilization

BackgroundInsulin resistance (IR) is a common pathophysiologic feature in patients with polycystic ovary syndrome (PCOS). However, there have been no studies investigating the association of IR surrogates with pregnancy outcomes in women with PCOS undergoing in vitro fertilization (IVF). Therefore, we explored the association between these factors among PCOS patients.MethodsWe conducted a retrospective study that included patients with PCOS who underwent IVF at a university-affiliated hospital. Blood samples and physical examinations are collected at reproductive center on fasting in the morning of the 2nd to 4th day of the menstrual cycle prior to medication. We categorized participants into “Non-IR group” (HOMA-IR < 2.2) and “IR group” (HOMA-IR ≥ 2.2). The association of IR surrogates [triglyceride-glucose-body mass index (TyG-BMI), triglyceride-glucose (TyG) and homeostasis model assessment (HOMA-IR)] with IVF outcomes was evaluated by regression model analysis. Moreover, we also performed sensitivity analyses with stratification and interaction tests. The primary outcome variable was the live birth rate.ResultsA total of 543 PCOS patients were finally included in the study. In all three regression models for the fresh embryo transfer (ET) cycles, all three IR surrogates showed stable negative correlations with live birth rate (in Model III: TyG-BMI OR = 0.99, 95% CI: 0.98 ~ 0.99; TyG OR = 0.47, 95% CI: 0.27 ~ 0.82; HOMA-IR OR = 0.84, 95% CI: 0.72 ~ 0.97; all P < 0.05), and this association was stable across all subgroups of the population (all P-interaction > 0.05). However, this relationship did not exist in frozen-thawed embryo transfer (FET) cycles. Furthermore, our study found that TyG-BMI was superior to TyG and HOMA-IR in predicting the rate of live birth in fresh ET cycles [TyG-BMI: 0.64 (95% CI: 0.58, 0.69) vs. TyG: 0.61 (95% CI: 0.55, 0.67) vs. HOMA-IR: 0.60 (95% CI: 0.55, 0.67)].ConclusionsOur study revealed that the three IR surrogates (TyG-BMI, TyG and HOMA-IR) were negatively associated with the live birth rates in fresh ET cycles. However, this relationship did not exist in FET cycles. Furthermore, our study found that TyG-BMI was superior to TyG and HOMA-IR in predicting the rate of live birth in fresh ET cycles.

Pregnancy Outcomes in Women with Complete Heart Block: Experience from a Tertiary Care Hospital

Pregnancy Outcomes in Women with Complete Heart Block: Experience from a Tertiary Care Hospital

Effect of pre-conception serum vitamin D level on pregnancy outcomes in women undergoing in vitro fertilization with fresh embryo transfer: a retrospective analysis

BackgroundThis study aims to investigate the association of pre-conception vitamin D levels on adverse pregnancy outcomes in women undergoing in vitro fertilization with fresh embryo transfer.MethodsThis was a retrospective cohort study using archived serum 25-hydroxyvitamin D measured in the pre-conception period before ovarian stimulation in patients undergoing in vitro fertilization with fresh autologous embryo transfer. A total of 306 women were included and adverse pregnancy outcomes in their resulting pregnancy were recorded. Patients who were vitamin D deficient (< 20ng/ml) were compared with those who were non-deficient (≥20ng/ml) and analysed for any association with adverse pregnancy outcomes.ResultsA total of 16/306 (5.3%) patients had hypertensive disorders of pregnancy (gestational hypertension and/or pre-eclampsia). The adjusted odds ratio for hypertensive disorders of pregnancy using vitamin D deficiency as a reference was 0.190 (95% CI 0.042–0.852) (p = 0.030). Other pregnancy complications were not significantly different with regards to pre-conception vitamin D status.ConclusionsPre-conception vitamin D deficiency is associated with an increased risk of hypertensive disorders in pregnancy in women undergoing in vitro fertilization with fresh embryo transfer.Trial registrationHKUCTR 2361 (9th March 2018).

Vaginal colonization and vertical transmission of Candida species: prevalence and associated factors among pregnant women and their neonates at public health facilities of Northeast Ethiopia

BackgroundVaginal colonization by Candida can lead to vulvovaginal candidiasis, which is the second most prevalent vaginal condition globally. It is frequently associated with sepsis and adverse neonatal outcomes in pregnant women. This issue is worsening in Sub-Saharan Africa, including Ethiopia. However, evidence of the existing problem is very scarce yet crucial. Thus, this study aimed to determine the vaginal colonization and vertical transmission of Candida species and their associated factors among pregnant women and their neonates in public health facilities of northeast Ethiopia.MethodsA facility-based cross-sectional study was conducted at selected public health facilities in Dessie town from April 1 to June 30, 2023, among 348 pregnant women and their newborns, using convenience sampling techniques. Socio-demographic, and clinical-related data were collected using a pre-tested, semi-structured questionnaire. Vaginal swab samples from pregnant women and pooled swabs from the external ear, nasal area, and umbilical areas of the newborns were collected and transported using Amies transport media. The samples were inoculated into Sabouraud Dextrose Agar for isolation, followed by inoculation onto a standard CHROM agar Candida plate for species identification, and a germ-tube test confirmed pseudophyphae of C.albicans. Data was entered into Epi Data version 4.6.0 software and exported and analyzed by SPSS version 25.0. A stepwise logistic regression model was used to identify the associated factors. Variables with p < 0.05 and their 95% confidence interval were considered statistically significant.ResultA total of 348 pregnant women attending vaginal delivery were included in the study. The maternal and neonatal colonization rates of Candida species were 14.1% (49/348) and 6.3% (22/348), respectively. The overall proportion of vertical transmission of Candida species was 44.9% (22/49, 95% CI: 41.2, 49.7). Among Candida isolates, 63.3% (31/49) were C. albicans and 36.7% (18/49) were C. krusei. Gestational diabetes mellitus (AOR: 4.2, 95% CI: 1.23–38.6, P = 0.047) and HIV (AOR: 1.58, 95% CI: 1.11–6.12, P = 0.049) were independently associated with maternal colonization of Candida species. Moreover, rural residence (AOR = 3.6, 95% CI: 1.37–9.5, P = 0.010) and maternal age above 28 years (AOR = 2.39, 95% CI: 1.97–5.89, P = 0.048) were independently associated with vertical transmission of Candida species.ConclusionThe findings of this study highlight the need for effective screening and treatment of Candida colonization during antenatal care.

Trends, characteristics, and outcomes of pregnancy in women with attention-deficit hyperactivity disorder: A nationwide analysis.

To assess clinical and obstetric characteristics associated with pregnant patients with a diagnosis of attention-deficit hyperactivity disorder (ADHD). This serial cross-sectional study queried the Agency of Healthcare Research and Quality's Healthcare Cost and Utilization Project National Inpatient Sample. The study population was 16,759,786 hospital deliveries from 2016 to 2020. Patients with a diagnosis of another mental health condition (anxiety disorder, depressive disorder, bipolar disorder, and schizophrenia disorder) were excluded. A multivariable binary logistic regression model was created to assess clinical and obstetric characteristics associated with ADHD. A 1-to-1 propensity score matching was performed to assess severe maternal morbidity. A total of 33,415 patients with ADHD were identified (prevalence rate: 19.9 per 10,000 deliveries, 95% confidence interval [CI] 19.8-20.2). During the study period, the prevalence of pregnant patients with a diagnosis of ADHD increased 39.4% from 16.5 to 23.0 per 10,000 (P-trend<0.001). Younger patients were more likely to have the diagnosis of ADHD (P<0.001), including one in 373 patients aged <25years and one in 227 patients in aged <20years. In a multivariable analysis, age <25years (adjusted-prevalence rate ratio [aRR] 2.80, 95%CI 2.57-3.04), White race (adjusted-RR 2.13, 95%CI 1.83-2.47), asthma (adjusted-RR 3.68, 95%CI 3.58-3.79), tobacco use disorder (adjusted-RR 2.04, 95%CI 1.97-2.12), alcohol use disorder (adjusted-RR 2.48, 95%CI 2.13-2.89), and illicit drug use disorder (adjusted-RR 2.19, 95%CI 2.09-2.29) were associated with ADHD. A classification-tree identified that White, asthmatic patients aged ≤21years had the highest ADHD prevalence rate (209 per 10,000 or one in 48 patients). Rates of early-term, late-preterm, and early-preterm, peri-viable deliveries and cesarean delivery were only modestly increased. In a propensity score matched model, the measured severe maternal morbidity was overall similar between the ADHD and non-ADHD groups (19.5 versus 18.1 per 1,000 deliveries, incidence rate ratio 1.08, 95%CI 0.96-1.20). This nationwide assessment suggests the prevalence of ADHD in pregnancy is gradually increasing in the United States. Observed associations with younger age, asthma, and substance use could possibly provide useful insights in perinatal care for screening, support, and treatment.

Improving neonatal outcome by studying the incidence of maternal group B streptococcus colonization among pregnant women: A prospective observational study

ABSTRACT Aims and Objectives: Group B streptococcus (GBS) colonization during pregnancy can lead to invasive infections in neonates including meningitis or sepsis. The major risk factor for neonatal disease is the rectovaginal colonization of GBS during pregnancy and delivery. The objectives of this study were as follows: 1) to screen antenatal patients at 35–37 weeks of gestation for GBS colonization, 2) to determine the prevalence of GBS among pregnant women, 3) to formulate an antibiotic policy with respect to antepartum antibiotic prophylaxis and empiric choice of antibiotics for early onset neonatal sepsis, and 4) to ascertain the maternal and neonatal outcomes in pregnant women with positive GBS colonization. Material and Methods: A prospective observational study was conducted among 50 obstetric patients at 35–37 weeks of gestation attending the outpatient and inpatient departments of a tertiary care hospital. High vaginal and rectal swabs were collected and immediately transported to the microbiology lab and were sent for culture and sensitivity testing using the standard culture methods. The incidence of positive cultures was noted and was taken up as a reference for statistical calculations. Results: Out of the 50 vaginal samples, one sample showed GBS positivity having a prevalence of 2%. Rectal swabs did not grow GBS for all samples. Neither the pregnant woman nor the newborn showed any symptoms or signs due to GBS. GBS grown in vaginal culture was highly sensitive to benzyl penicillin and other penicillins, cephalosporins, clindamycin, daptomycin, vancomycin, meropenem, and linezolid. Conclusion: Based on our findings, screening the patients with routine rectovaginal swabs may not be necessary in our population. Also, empiric treatment with antibiotics for GBS in symptomatic mothers cannot be justified, and hence, GBS should be considered as an insignificant pathogen.

Comparative Study of Follicular Fluid Inflammatory Cytokines and Post-IVF Pregnancy Outcomes in Women with Polycystic Ovary Syndrome (PCOS)

Comparative Study of Follicular Fluid Inflammatory Cytokines and Post-IVF Pregnancy Outcomes in Women with Polycystic Ovary Syndrome (PCOS)