Outcomes In Low-risk Pregnancies Research Articles

The effect of continuous electronic fetal monitoring on mode of delivery and neonatal outcome among low-risk laboring mothers at Debre Markos comprehensive specialized hospital, Northwest Ethiopia.

Electronic fetal heart rate monitoring (EFM) has been widely used in obstetric practice for over 40 years to improve perinatal outcomes. Its popularity is growing in Ethiopia and other sub-Saharan African countries to reduce high perinatal morbidity and mortality rates. However, its impact on delivery mode and perinatal outcomes in low-risk pregnancies remains controversial. This study aimed to assess the effect of continuous EFM on delivery mode and neonatal outcomes among low-risk laboring mothers at Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia. A prospective follow-up study was conducted from November 20, 2023, to January 10, 2024. All low-risk laboring mothers meeting the inclusion criteria were included. Data were collected via pretested structured questionnaires and observation, then analyzed using Epi-data 4.6 and SPSS. The incidences of cesarean delivery and continuous EFM were compared using the chi-squared test and Fisher's exact test. The study found higher rates of instrumental-assisted vaginal delivery (7% vs. 2.4%) and cesarean sections (16% vs. 2%) due to unsettling fetal heart rate patterns in the continuous EFM group compared to the intermittent auscultation group. However, there were no differences in immediate neonatal outcomes between the groups. When compared to intermittent auscultation with a Pinard fetoscope, the routine use of continuous EFM among low-risk laboring mothers was associated with an increased risk of cesarean sections and instrumental vaginal deliveries, without significantly improving immediate newborn outcomes. However, it is important to note that our study faced significant logistical constraints due to the limited availability of EFM devices, which influenced our ability to use EFM comprehensively. Given these limitations, we recommend avoiding the routine use of continuous EFM for low-risk laboring mothers to help reduce the rising number of operative deliveries, particularly cesarean sections. Our findings should be interpreted with caution, and further research with adequate resources is needed to draw definitive conclusions.

The Association Between Unintended Pregnancy and Perinatal Outcomes in Low-Risk Pregnancies: A Retrospective Registry Study in the Netherlands.

People with unintended pregnancies might be at increased risk of adverse perinatal outcomes due to structural factors, distress, or delayed prenatal care. Existing studies addressing this association yielded inconsistent findings. Using contemporary data from a large Dutch midwifery care registry, we investigated the association between unintended pregnancy ending in birth and neonatal outcomes, parental morbidity, and obstetric interventions. We extend previous research by exploring whether delayed initiation of prenatal care mediates these associations. This study used data (N = 9803) from a Dutch nationally representative registry of people with low-risk pregnancies receiving primary midwife-led care in the Netherlands between 2012 and 2020. Using logistic (mediation) regression analyses adjusted for potential confounders we investigated associations between unintended pregnancy and neonatal outcomes (low Apgar score, small for gestational age, and prematurity), parental morbidity (hypertension and gestational diabetes mellitus), and obstetric interventions (induction of labor, pain medication, assisted vaginal birth, and cesarean birth) and whether delayed initiation of prenatal care mediated these associations. Unintended pregnancies were associated with increased odds of low Apgar scores (odds ratio [OR], 1.68; 95% CI, 1.09 -2.59), preterm birth (OR, 1.27; 95% CI, 1.02-1.58), small for gestational age (OR, 1.19; 95% CI, 1.00-1.41), and induction of labor (OR, 1.14; 95% CI, 1.01-1.28). Conversely, unintended pregnancy was associated with a decreased odds of cesarean birth (OR, 0.83; 95% CI, 0.71-0.97). The timing of prenatal care initiation did not mediate any of these associations. Our findings suggest that people in primary midwifery-led care with unintended pregnancies ending in birth are at increased risk for adverse perinatal health outcomes and that structural factors might underlie this link. Health care professionals and policy makers should attend to their own biases and offer nonjudgmental, tailored preventive preconception care and antenatal care strategies for people with higher vulnerabilities.

Comparison Of Maternal And Perinatal Outcome Of Isolated Borderline Amniotic Fluid Index Versus Normal Amniotic Fluid In Low-Risk Pregnancies At Term

Objective: The objective of the study was to compare the maternal and perinatal outcomes in low-risk pregnancies having borderline Amniotic fluid index with normal amniotic fluid index at term. Methods: This prospective observational study, included 540 low-risk pregnant women admitted at POF Hospital Wah Cantt between 1st June 2020-31st Dec 2022. Group A had 180 women with borderline AFI having normal umbilical artery Doppler and group B had 360 women with normal AFI between 37-40 weeks, who fulfilled the inclusion criteria. The data regarding baseline characteristics and fetomaternal outcome was collected on an already designed proforma and analysis was done by using SPSS version 23. Results: The difference in overall cesarean section rate (p=0.071) and cesarean section for fetal distress (p=0.076) was not statistically significant between the two groups. The borderline AFI did not increase the risk of meconium-stained liquor (p=0.116), 5minute APGAR score <7 (p=0.218), admission to NICU (p=0.064) and low birth weight (mean birth weights p=0.278) compared to normal AFI. Conclusion: Borderline oligohydramnios does not increase the risk of cesarean section and cesarean section for fetal distress. There is no increase in the risk of meconium-stained liquor, 5-minute APGAR score<7, admission to NICU and low birth weight. Keywords: Amniotic fluid index, borderline oligohydramnios, cesarean section, fetal distress, meconium-stained liquor.

Induction of labour at 39 weeks and adverse outcomes in low-risk pregnancies according to ethnicity, socioeconomic deprivation, and parity: A national cohort study in England.

Ethnic and socioeconomic inequalities in obstetric outcomes are well established. However, the role of induction of labour (IOL) to reduce these inequalities is controversial, in part due to insufficient evidence. This national cohort study aimed to identify adverse perinatal outcomes associated with IOL with birth at 39 weeks of gestation ("IOL group") compared to expectant management ("expectant management group") according to maternal characteristics in women with low-risk pregnancies. All English National Health Service (NHS) hospital births between January 2018 and March 2021 were examined. Using the Hospital Episode Statistics (HES) dataset, maternal and neonatal data (demographic, diagnoses, procedures, labour, and birth details) were linked, with neonatal mortality data from the Office for National Statistics (ONS). Women with a low-risk pregnancy were identified by excluding pregnancies with preexisting comorbidities, previous cesarean section, breech presentation, placenta previa, gestational diabetes, or a baby with congenital abnormalities. Women with premature rupture of membranes, placental abruption, hypertensive disorders of pregnancy, amniotic fluid abnormalities, or antepartum stillbirth were excluded only from the IOL group. Adverse perinatal outcome was defined as stillbirth, neonatal death, or neonatal morbidity, the latter identified using the English composite neonatal outcome indicator (E-NAOI). Binomial regression models estimated risk differences (with 95% confidence intervals (CIs)) between the IOL group and the expectant management group, adjusting for ethnicity, socioeconomic background, maternal age, parity, year of birth, and birthweight centile. Interaction tests examined risk differences according to ethnicity, socioeconomic background, and parity. Of the 1 567 004 women with singleton pregnancies, 501 072 women with low-risk pregnancies and with sufficient data quality were included in the analysis. Approximately 3.3% of births in the IOL group (1 555/47 352) and 3.6% in the expectant management group (16 525/453 720) had an adverse perinatal outcome. After adjustment, a lower risk of adverse perinatal outcomes was found in the IOL group (risk difference -0.28%; 95% CI -0.43%, -0.12%; p = 0.001). This risk difference varied according to socioeconomic background from 0.38% (-0.08%, 0.83%) in the least deprived to -0.48% (-0.76%, -0.20%) in the most deprived national quintile (p-value for interaction = 0.01) and by parity with risk difference of -0.54% (-0.80%, -0.27%) in nulliparous women and -0.15% (-0.35%, 0.04%) in multiparous women (p-value for interaction = 0.02). There was no statistically significant evidence that risk differences varied according to ethnicity (p = 0.19). Key limitations included absence of additional confounding factors such as smoking, BMI, and the indication for induction in the HES datasets, which may mean some higher risk pregnancies were included. IOL with birth at 39 weeks was associated with a small reduction in the risk of adverse perinatal outcomes, with 360 inductions in low-risk pregnancies needed to avoid 1 adverse outcome. The risk reduction was mainly present in women from more socioeconomically deprived areas and in nulliparous women. There was no significant risk difference found by ethnicity. Increased uptake of IOL at 39 weeks, especially in women from more socioeconomically deprived areas, may help reduce inequalities in adverse perinatal outcomes.

Management of late-onset fetal growth restriction: pragmatic approach.

There is limited prospective evidence to guide the management of late-onset fetal growth restriction (FGR) and its differentiation from small-for-gestational age. The aim of this study was to assess prospectively a novel protocol in which ultrasound criteria were used to classify women with suspected late FGR into two groups: those at low risk, who were managed expectantly until the anticipated date of delivery, and those at high risk, who were delivered soon after 37 weeks of gestation. We also compared the outcome of this prospective cohort with that of a historical cohort of women presenting similarly with suspected late FGR, in order to evaluate the impact of the new protocol. This was a prospective study of women with a non-anomalous singleton pregnancy at ≥ 32 weeks' gestation attending a tertiary hospital in London, UK, between February 2018 and September 2019, with estimated fetal weight (EFW) ≤ 10th centile, or EFW > 10th centile in addition to a decrease in fetal abdominal circumference of ≥ 50 centiles compared with a previous scan, umbilical artery Doppler pulsatility index > 95th centile or cerebroplacental ratio < 5th centile. Women were classified as low or high risk based on ultrasound and Doppler criteria. Women in the low-risk group were delivered by 41 weeks of gestation, unless they subsequently met high-risk criteria, whereas women in the high-risk group (EFW < 3rd centile, umbilical artery Doppler pulsatility index > 95th centile or EFW between 3rd and 10th centiles (inclusive) with abdominal circumference drop or abnormal Dopplers) were delivered at or soon after 37 weeks. The primary outcome was adverse neonatal outcome and included hypothermia, hypoglycemia, neonatal unit admission, jaundice requiring treatment, suspected infection, feeding difficulties, 1-min Apgar score < 7, hospital readmission and any severe adverse neonatal outcome (perinatal death, resuscitation using inotropes or mechanical ventilation, 5-min Apgar score < 7, metabolic acidosis, sepsis, and cerebral, cardiac or respiratory morbidity). Secondary outcomes were adverse maternal outcome (operative delivery for abnormal fetal heart rate) and severe adverse neonatal outcome. Women managed according to the new protocol were compared with a historical cohort of 323 women delivered prior to the implementation of the new protocol, for whom management was guided by individual clinician expertise. Over 18 months, 321 women were recruited to the prospective cohort, of whom 156 were classified as low risk and 165 were high risk. Adverse neonatal outcome was significantly less common in the low-risk compared with the high-risk group (45% vs 58%; adjusted odds ratio (aOR), 0.6 (95% CI, 0.4-0.9); P = 0.022). There was no significant difference in the rate of adverse maternal outcome (18% vs 24%; aOR, 0.7 (95% CI, 0.4-1.2); P = 0.142) or severe adverse neonatal outcome (3.8% vs 8.5%; aOR, 0.5 (95% CI, 0.2-1.3); P = 0.153) between the low- and high-risk groups. Compared with women in the historical cohort classified retrospectively as low risk, low-risk women managed under the new protocol had a lower rate of adverse neonatal outcome (45% vs 58%; aOR, 0.6 (95% CI, 0.4-0.9); P = 0.026). Appropriate risk stratification to guide management of late FGR was associated with a reduced rate of adverse neonatal outcome in low-risk pregnancies. In clinical practice, a policy of expectantly managing women with a low-risk late-onset FGR pregnancy at term could improve neonatal and long-term development. Randomized controlled trials are needed to assess the effect of an evidence-based conservative management protocol for late FGR on perinatal morbidity and mortality and long-term neurodevelopment. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

The Rate of Spontaneous Preterm Birth and Associated Neonatal Adverse Outcomes in Low-Risk Pregnancies Conceived Spontaneously Versus Intrauterine Insemination or Infertility Medications

The objective of this work is to compare the rate of spontaneous preterm birth and associated neonatal morbidity among low-risk pregnancies conceived spontaneously versus pregnancies conceived using infertility medications/intrauterine insemination (IFM/IUI). This population-based retrospective cohort study utilized the US Vital Statistics data set from 2015 to 2019. Low-risk pregnancies, resulting in a live birth, of individuals who conceived either spontaneously or with the assistance of IFM/IUI were examined. The primary measured outcome was the rate of spontaneous preterm delivery, defined as delivery before 37 weeks’ gestation without induction of labor. Of the 19,382,574 deliveries during the study period, 7,876,515 (40.6%) met the inclusion criteria. While 7,843,328 (99.6%) conceived spontaneously, 33,187 (0.4%) conceived using IFM/IUI. The rate of spontaneous preterm delivery was significantly higher for patients who conceived using IFM/IUI (71.0 per 1,000 live births) compared to patients who conceived spontaneously (60.3 per 1,000 live births; adjusted relative risk, 1.40; 95% confidence interval, 1.35–1.46). While the rate of spontaneous preterm births and associated composite of neonatal adverse outcomes are significantly higher in pregnancies conceived using IFM/IUI than spontaneous conception, the mortality is similar.

Racial and Ethnic Disparities in Primary Cesarean Birth and Adverse Outcomes Among Low-Risk Nulliparous People.

To compare trend of primary cesarean delivery rate and composite neonatal and maternal adverse outcomes in low-risk pregnancies among racial and ethnic groups: non-Hispanic White, non-Hispanic Black, and Hispanic. This population-based cohort study used U.S. vital statistics data (2015-2019) to evaluate low-risk, nulliparous patients with nonanomalous singletons who labored and delivered at 37-41 weeks of gestation. The primary outcome was the primary cesarean delivery rate. Secondary outcomes included composite neonatal adverse outcome (Apgar score less than 5 at 5 minutes, assisted ventilation for more than 6 hours, seizure, or death), and composite maternal adverse outcome (intensive care unit admission, blood transfusion, uterine rupture, or unplanned hysterectomy), as well as infant death. Multivariable Poisson regression models were used to estimate adjusted relative risks (aRR) and 95% CIs. Among 4.3 million births, 60.6% identified as non-Hispanic White, 14.6% identified as non-Hispanic Black, and 24.8% identified as Hispanic. The rate of primary cesarean delivery was 18.5% (n=804,155). An increased risk for cesarean delivery was found in non-Hispanic Black (21.7%, aRR 1.24, 95% CI 1.23-1.25) and Hispanic (17.3%, aRR 1.09, 95% CI 1.09-1.10) individuals, compared with non-Hispanic White individuals (18.1%) after multivariable adjustment. There was an upward trend in the rate of primary cesarean delivery in all racial and ethnic groups ( P for linear trend&lt;0.001 for all groups). However, the racial and ethnic disparity in the rate of primary cesarean delivery remained stable during the study period. The composite neonatal adverse outcome was lower in Hispanic individuals in all newborns (10.7 vs 8.3 per 1,000 live births, aRR 0.74, 95% CI 0.72-0.75), and in newborns delivered by primary cesarean delivery (18.5 vs 15.0 per 1,000 live births, aRR 0.73, 95% CI 0.70-0.76), compared with non-Hispanic White individuals. Using a nationally representative sample in the United States, we found racial and ethnic disparities in the primary cesarean delivery rate in low-risk nulliparous patients, which persisted throughout the study period.

Effect of Amniotic Fluid Results on Perinatal Outcomes in Low-risk Pregnancies

Effect of Amniotic Fluid Results on Perinatal Outcomes in Low-risk Pregnancies

Role of the cerebro-placental-uterine ratio in predicting adverse perinatal outcome in low-risk pregnancies at term

PurposeThe cerebroplacental ratio (CPR) is associated with adverse perinatal outcome (APO) in low-risk pregnancies near term. A Doppler parameter, which also includes information from the uterine vessels could potentially improve detection of subclinical placental dysfunction. The aim of this study is to investigate the performance of cerebro-placental-uterine ratio (CPUR) related to APO prediction in low-risk term pregnancies in > 40 + 0 weeks.MethodsThis is a retrospective cohort study. All low-risk pregnancies in which feto-maternal Doppler was examined from 40 + 0 weeks and an appropriate for gestational age fetus was present were included. ROC (receiver operating characteristic curves) analyses were performed to assess the predictive value of CPUR. The presence of at least one of the following outcome parameters was defined as composite APO (CAPO): operative delivery (OD) due to intrapartum fetal compromise (IFC), admission to the neonatal intensive care unit, umbilical cord arterial pH ≤ 7.15, 5 min APGAR ≤ 7.ResultsA total of n = 114 cases were included. Mean gestational age at examination and delivery were 40 + 3 weeks and 40 + 6 weeks, respectively. Overall, CAPO occurred in 38 of 114 cases (33.3%). ROC analyses showed a significant association of CPUR (AUC = 0.67, p = 0.004) and CPR (AUC = 0.68, p = 0.002) with CAPO. Additionally, CPUR (AUC = 0.64, p = 0.040) showed a predictive value for OD due to IFC.ConclusionThe CPUR in > 40 + 0 weeks showed a predictive value for CAPO and OD due to IFC in low-risk pregnancies. However, the extent to which CPUR can be used to optimize delivery management warrants further investigations in prospective interventional studies.

Travel Time to Delivery, Antenatal Care, and Birth Outcomes: A Population-Based Cohort of Uncomplicated Pregnancies in British Columbia, 2012–2019

ObjectiveHealth policy and system leaders need to know whether long travel time to a delivery facility adversely affects birth outcomes. In this study, we estimated associations between travel time to delivery and outcomes in low-risk pregnancies. MethodsThis population-based cohort included all singleton births without obstetric comorbidities or intrapartum facility transfers in British Columbia, Canada, from 2012 to 2019. Travel time was measured from maternal residential postal code to delivery facility using road network analysis. We estimated associations between travel time and severe maternal morbidity, stillbirth, pre-term birth, and small-for-gestational age (SGA) and large-for-gestational age (LGA) status using logistic regression, adjusted for confounders (adjusted odds ratios [aORs]). To examine variations in associations between travel time and outcomes by antenatal care utilization, we stratified models by antenatal care categories. ResultsOf 232 698 births, 3.8% occurred at a facility ≥60 minutes from the maternal residence. Obesity, adolescent age, substance use, inadequate prenatal care, and low socioeconomic status were more frequent among those traveling farther for delivery. Travel time ≥120 minutes was associated with increased risk of stillbirth (aOR 1.8; 95% CI 1.2–2.8), pre-term birth (aOR 2.3; 95% CI 2.1–2.5), LGA (aOR 1.5; 95% CI 1.4–1.6), and severe maternal morbidity (aOR 1.5; 95% CI 1.2–1.8), but not SGA (aOR 1.0; 95% CI 0.8–1.1), when compared with a travel time of 1–29 minutes. Risk of stillbirth was greatest with inadequate and intensive (adequate plus) antenatal care but persisted for severe maternal morbidity, pre-term birth, and LGA across categories. ConclusionLonger travel time to delivery was associated with increased risk of adverse outcomes in low-risk pregnancies after adjusting for confounding factors. Associations were stronger among those with inadequate antenatal care.

Cerebroplacental ratio and neonatal outcome in low-risk pregnancies with reduced fetal movement: A prospective study.

ObjectiveTo evaluate the effectiveness of the cerebroplacental ratio (CPR) in predicting poor outcomes in low-risk pregnancies with reduced fetal movements (RFMs).Study DesignThis prospective study included singleton pregnancies at 28–40 weeks, presenting with RFM but no additional risk factors. Sub analysis was performed for pregnancies between 36 and 40 weeks. Umbilical artery (UA) and middle cerebral artery (MCA) pulsatility indices (PIs) were measured, and the MCA-PI to UA-PI ratio (CPR) was calculated. Mode of delivery, gestational age, fetal monitoring category, Apgar score at 1 and 5 min, birth weight, presence of meconium, umbilical artery pH, and neonatal intensive care unit (NICU) admission were recorded. Women with good and poor outcomes were compared with doppler indices and pregnancy characteristics.ResultsOf 96 women, 86 had good outcomes. There was no significant difference in UA-PI (0.871 ± 0.171 vs. 0.815 ± 0.179, P = 0.446), MCA-PI (1.778 ± 0.343 vs. 1.685 ± 0.373, P = 0.309), or CPR (2.107 ± 0.635 vs. 2.09 ± 0.597, P = 0.993) between the poor and good outcome groups. No difference was found in the location of the placenta, biophysical profile (BPP) score, fetal sex, or amniotic fluid index (AFI) at the time of presentation. The proportion of nulliparous patients in the poor outcome group was higher than that of multiparous patients. Sub analysis for 36–40 weeks revealed the same results; no significant difference in UA-PI (0.840 ± 0.184 Vs 0.815 ± 0.195, P = 0.599), MCA-PI (1.724 ± 0.403 vs. 1.626 ± 0.382, P = 0.523), or CPR (2.14 ± 0.762 vs. 2.08 ± 0.655, P = 0.931) between poor and good outcome groups.ConclusionsCPR is not predictive of neonatal outcome in low-risk pregnancies with RFM. However, a higher proportion of poor outcomes in nulliparous women warrants further investigation.

The relationship between umbilical cord measurements and newborn outcomes

Objective This study investigated the relationship between umbilical vein diameter and cord length and fetal outcome in low-risk pregnancies (fetuses appropriate for gestational age [AGA]). Methods A prospective cohort study of 39 singleton pregnant women aged 19–44 years at between 38+0 and 41+6 weeks of gestation was conducted. Case demographics, umbilical vein diameter measured by prenatal ultrasound, postnatal birth weight, gender, 1- and 5-minute Apgar scores, blood gas analysis, and umbilical cord length were recorded. Fetuses with a fetal weight in the 10–90th percentile according to week of gestation were accepted as AGA. Results The mean age of the pregnant women was 27.5±5.3 years. 33% (13/39) of the pregnant women were nulliparous. There was no statistically significant correlation between umbilical vein diameter and other variables in correlation analysis (p&gt;0.050). Umbilical cord length and umbilical vein lactate level were found to have a statistically negative and significant correlation (r=-0.418; p=0.015); however, no other pregnancy outcomes were found to have a significant correlation. There was no statistically significant difference between the median values of umbilical vein diameter and cord length by gender (p=0.076 and 0.181, respectively). Conclusion In conclusion, this study found no relationship between umbilical vein diameter and cord length and fetal weight and pregnancy outcome in low-risk 38.0–41.6-week pregnancies (AGA fetuses). However, the obtained results still need to be confirmed by larger series.

Chorioamnionitis and adverse outcomes in low-risk pregnancies: a population-based study

Objective To compare the composite neonatal and maternal adverse outcomes among low-risk pregnancies with versus without chorioamnionitis. Methods We conducted a retrospective cohort study using U.S. Vital Statistics Data. The study population was restricted to full term, low-risk, singleton pregnancies. Pregnancies were categorized into those affected and unaffected by chorioamnionitis. The primary outcome was composite neonatal adverse outcome and the secondary outcome was composite maternal adverse outcome. Multivariable Poisson regression models with robust error variance were used to examine the factors associated with chorioamnionitis and to evaluate the association between chorioamnionitis and adverse outcomes [using adjusted relative risk (aRR) and 95% confidence interval (CI)]. Results Of 19.7 million live births, 59.4% met inclusion criteria; among them, 1.7% were complicated by chorioamnionitis. The risk of composite neonatal adverse outcome was higher in newborns delivered by women with chorioamnionitis (aRR = 3.40; 95% CI = 3.30–3.49). Compared to women without chorioamnionitis, those with chorioamnionitis had a higher risk of composite maternal adverse outcome (aRR = 2.42; 95% CI = 2.31–2.55). Infant mortality was also higher in affected pregnancies (aRR = 1.23; 95% CI = 1.09–1.38). Conclusion Among low-risk pregnancies, chorioamnionitis is associated with a higher risk of composite neonatal and maternal adverse outcomes. Infant death is also increased.

745 Cross-sectional analysis of mid-trimester maternal uterine artery blood flow, maternal pre-eclampsia and childhood neurodevelopmental outcomes

Resistance to blood flow in the maternal uterine artery (UtA) has been associated with both pre-eclampsia and fetal growth restriction. Our objective was to assess the association between increases in mid-trimester maternal UtA Pulsitility Index (PI), pre-eclampsia and child neurodevelopmental outcomes in low-risk pregnancies. Serial ultrasound exams were prospectively performed in 2,334 racially/ethnically diverse, healthy women with low-risk singleton pregnancies (July 2009-Jan 2013) as part of the NICHD- Fetal Growth Studies (NICHD-FGS). Maternal UtA PI measures were obtained between 18w0d and 25w6d. Maternal outcomes were collected at delivery. Mother-child pairs from the NICHD-FGS were re-recruited to the Environmental Influences on Child Health Outcomes (ECHO) Study (May 2017-April 2019). Cross-sectional analysis of ND was performed using the NIH Toolbox for children aged 3-7 and 8-11years. Executive function domains included Inhibitory Control/Attention, Cognitive Flexibility and Working Memory. Motor domains included Dexterity, Grip Strength and Standing Balance. Multivariable adjusted general linear and logistic regression models were used to assess continuous and dichotomous variables. The study group is described in Table 1. A 1-unit increase in the mid-trimester UtA PI was significantly associated with reduced Cognitive Flexibility in children aged 3-7 and improved Inhibitory Control/Attention in children 8-11. For each of these executive domains the results were in opposite directions for children 3-7 and 8-11 years, respectively (Table 2). Incremental change in UtA PI had no impact on any measure of motor function. A 1-unit increase in UtA PI was significantly associated with an increased risk of pre-eclampsia. A 1-unit increase in mid-trimester UtA PI was associated with maternal pre-eclampsia and childhood executive function. Executive effects are variable and different in younger compared to older children. Cognitive Flexibility at 3-7 years and Inhibitory Control/Attention at 8-11 years were negatively and positively influenced, respectively.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

741 Cross-sectional analysis of association between late pregnancy umbilical artery blood flow and childhood neurodevelopmental outcomes

Reduced placental perfusion has been associated with adverse child neurodevelopmental (ND) outcomes. These studies were performed primarily in pregnancies complicated by fetal growth restriction. Our objective was to assess the association between incremental increases in umbilical artery Doppler measurements and ND outcomes in low-risk pregnancies. Serial ultrasound (US) exams were prospectively performed in 2,334 racially/ethnically diverse, healthy women with low-risk singleton pregnancies (July 2009-Jan 2013) as part of the NICHD- Fetal Growth Studies (NICHD-FGS). Umbilical artery Systolic/Diastolic ratio (UAS/D) and Pulsitility Index (UAPI) were recorded at the last US (mean 17.6 days prior to delivery). Mother-child pairs from the NICHD-FGS were re-recruited to the Environmental Influences on Child Health Outcomes (ECHO) Study (May 2017-April 2019). Cross-sectional analysis of ND was performed using the NIH Toolbox. Executive function domains included Inhibitory Control/Attention, Cognitive Flexibility and Working Memory. Motor domains included Dexterity, Grip Strength and Standing Balance. Multivariable adjusted general linear regression model was used to assess continuous relationships for children 3-7 and 8-11 years. The study group is described in Table 1. A 1-unit increase in the UAS/D was associated with significantly reduced Inhibitory Control/Attention and Cognitive Flexibility and improved Working Memory in children 8-11 years. Children age 3-7 had non-significant opposite effects compared to the older children. UAPI findings were similar to UAS/D in both direction and age-specificity and significant only for improved Working Memory. Neither UAS/D or UAPI had any impact on motor function. In late pregnancy a 1-unit rise in UAS/D or UAPI affected ND differently in younger compared to older children. Opposite effects between age groups were seen in each test of executive function. Cognitive Flexibility at 3-7 years and Inhibitory Control/Attention at 8-11 years were most negatively impacted. Working Memory was enhanced in older children.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Maternal and neonatal anthropometric analyses: Determining birth outcomes in low-risk pregnancies at Alex Ekwueme Federal University Teaching Hospital, Abakaliki.

To assess the input of maternal and neonatal body physique anthropometries to birth outcomes. A prospective study of 177 full-term births at Alex Ekwueme Federal Teaching Hospital Abakaliki from July to December, 2019. Maternal and neonatal anthropometric parameters and birth outcomes: mode of delivery and Apgar score were considered in this study. The measurements followed the guidelines outlined by the Institute of Medicine. The prevalence of low birth weight (6.21%), cesarean delivery (14.12%), and abnormal Apgar score (9.04%) was relatively low in the study. Birth weight was dependent on maternal age, weight, body mass index, percentage body fat, and waist and hip circumference (P<0.05). Normal Apgar score at 1min after birth of male neonates was dependent on maternal BMI and neonatal head circumference whereas abnormal Apgar score in male and female neonates was dependent on maternal age and waist:hip ratio, respectively (P<0.05). Maternal and neonatal body physique anthropometries can be used to identify mothers and neonates at risk of having birth complications. This provided a practical alternative means to know the possible risk of undesirable birth outcomes with spontaneous vaginal delivery in low-risk pregnancies.

The relation between second-trimester placental elasticity and poor obstetric outcomes in low-risk pregnancies.

Increased placental stiffness is associated with various pathological conditions. Our objective was to evaluate the relation between the second-trimester placental elasticity value in low-risk pregnant women and poor obstetric outcomes. A total of 143 pregnant women were enrolled. Placental elasticity values were measured using the transabdominal point shear wave elastography method. 10 random measurements were obtained from different areas of the placenta. The mean was accepted as the mean placental elasticity value. Logistic regression analyses were performed to identify independent variables associated with obstetric outcomes. Second-trimester placental elasticity value was significantly and positively associated with the poor obstetric outcomes (p=0.038). We could predict a poor outcome with 69.2% sensitivity and 60.7% specificity if we defined the placental elasticity cut-off as 3.19kPa. Furthermore, in the multiple regression model, the placental elasticity value added significantly to the prediction of birth weight (p=0.043). Our results showed that the pregnancies with a stiffer placenta in the second trimester were associated with an increased likelihood of exhibiting poor obstetric outcomes. Also, placental elasticity was independently associated with birth weight.

Effect of micronutrient supplements on low-risk pregnancies in high-income countries: a systematic quantitative literature review.

To assess the quantity and focus of recent empirical research regarding the effect of micronutrient supplementation on live birth outcomes in low-risk pregnancies from high-income countries. A systematic quantitative literature review. Low-risk pregnancies in World Bank-classified high-income countries, 2019. Using carefully selected search criteria, a total of 2475 publications were identified, of which seventeen papers met the inclusion criteria for this review. Data contributing to nine of the studies were sourced from four cohorts; research originated from ten countries. These cohorts exhibited a large number of participants, stable data and a low probability of bias. The most recent empirical data offered by these studies was 2011; the most historical was 1980. In total, fifty-five categorical outcome/supplement combinations were examined; 67·3 % reported no evidence of micronutrient supplementation influencing selected outcomes. A coordinated, cohesive and uniform empirical approach to future studies is required to determine what constitutes appropriate, effective and safe micronutrient supplementation in contemporary cohorts from high-income countries, and how this might influence pregnancy outcomes.

367: Chorioamnionitis and adverse outcomes in low-risk pregnancies: A population based study

367: Chorioamnionitis and adverse outcomes in low-risk pregnancies: A population based study

Local cerebroplacental ratio reference ranges are better predictors for adverse delivery outcomes in normal weight fetuses during pregnancy

Objective To evaluate the predictive value of local versus external cerebroplacental ratio (CPR) reference ranges for delivery outcomes in low-risk pregnancies. Methods A retrospective analysis of all feto-maternal demographic and biometric data in fetuses with normal estimated fetal weight (EFW) and a CPR examination between the years 2014–2019, in a university medical center. The study group included healthy singleton pregnancies from 32-week gestation, with an examination-to-delivery interval of <31 days. The three models compared two thresholds: <5th percentile (CPR 1, CPR 3) and <10th percentile (CPR2). The CPR1 and CPR2 models both use local CPR reference ranges, while the CPR3 model uses an external CPR reference range. The main outcome was predictive accuracy for urgent cesarean delivery (CD), operative delivery (OD), and composite outcome (CO), defined as an Apgar score of <7, fetal blood pH < 7.1 or admission to the neonatal intensive care unit (NICU). Results Overall, 410 low-risk pregnancies with normal weight fetuses were enrolled in the study. All three CPR models turned out to be significant predictors of CD, with an odds ratio (OR) of 9, 95% CI (2.7–27), p < .001 for CPR1, and an OR of 2.9, 95% CI (1.1–7.4), p < .04 for CPR2, and an OR of 3.4, 95% CI (1.7–6.8), p < .001 for CPR3. All the three models were also found to be predictors of OD, and an OR of 6.9, 95% CI (2.1–22) p < .04 for CPR1, and an OR of 2.8, 95% CI (1.2–6.7), p < .04 for CPR2, and an OR of 2.8, 95% CI (1.4–5.3) p < .01 for CPR3. The positive predictive values (PPV) for CD and OD were both 50% for CPR1, versus 28% and 26% in CPR2, and 24% and 25% in CPR3. The negative predictive value (NPV) was similar, around 88% in all three models. None of the models were found to be significant predictors for CO. Conclusions A CPR model based on local reference ranges and <5th percentile cutoffs showed the highest PPV for CD and OD. The calculation of local references for CPR should be encouraged.