Perinatal Outcomes Research Articles

Family poverty, neighbourhood greenspace and perinatal outcomes.

The relationship between low income and adverse perinatal outcomes, such as low birth weight and developmental delays, is well established making the search for protective factors important. One such factor may be neighbourhood greenspace. This study elucidates the role of urban neighbourhood greenspace in the relationship between income and perinatal outcomes in a nationally representative birth cohort from the UK. Data on 14 050 infants participating in the initial wave at age 9 months of the Millennium Cohort Study were used (51% male, 20% non-white, 52% living in disadvantaged areas). We tested whether the association between income and perinatal outcomes is moderated by urban greenspace (measured in deciles) before and after adjustments for confounding. The perinatal outcomes included birth weight, gestational age (in days), communication and motor delays. The models were adjusted for the infant's sex and ethnicity, mother's age, education, substance use and mental health as well as area disadvantage and air pollution. Neighbourhood greenspace moderated the association between income and gestational age, even after adjustment for all confounders, b=-0.11, 95% CI (-0.215, -0.004). For births in low-income households, in particular, it was associated with an increase in gestational age by an average of approximately 3 days. However, after adjustment, greenspace was not found to influence birth weight, communication or motor delays at age 9 months. The biophilic design of urban environments is a modifiable factor for improving perinatal outcomes in the UK as urban greenspaces appear to be mitigating the risk of preterm birth associated with family poverty.

Weight Bias in the Perinatal Period: An Integrative Review

ABSTRACTBackgroundWeight bias toward individuals with higher body weights in healthcare settings is associated with adverse health behaviors, reduced healthcare utilization, and poor health outcomes. The purpose of this integrative review was to explore: (1) What has been measured and described regarding perinatal care providers' and students' weight bias toward pregnant, birthing, and postpartum individuals with higher body weights? (2) What has been measured and described regarding pregnant, birthing, and postpartum individuals' experiences of weight bias? (3) What is the association of experiences of weight bias with perinatal and mental health outcomes among pregnant, birthing, and postpartum individuals?MethodsWe conducted a systematic search in CINAHL, PubMed, and PsycINFO databases to identify relevant research publications related to the Medical Subject Headings (MeSH) terms weight prejudice (and related terms) and pregnancy (and related terms). The review was guided by the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA), Johns Hopkins Nursing Evidence‐Based Practice model for study quality determination, and the Whittemore and Knafl integrative review framework for data extraction and analyses.ResultsTwenty‐two publications met inclusion criteria, representing six countries and varying study designs. This review found pervasive sources of explicit weight bias in the perinatal period, including care providers and close relationships. Experiences of weight bias among pregnant and postpartum individuals are associated with adverse perinatal and mental health outcomes.DiscussionThe findings address a knowledge gap regarding a summary of literature on weight bias in the perinatal period and elucidate its prevalence as well as its negative influence on perinatal and mental health outcomes. Future research efforts on this topic must examine the nature and extent of perinatal care providers' weight bias by demographic factors and explore its association with clinical decision‐making and perinatal and mental health outcomes.

The Implications of a "Flat" Oral Glucose Tolerance Test Curve in Pregnancy.

To determine whether pregnant women with "flat" oral glucose tolerance test (OGTT) curves are at increased risk of adverse perinatal outcomes. We conducted a retrospective cohort study comparing the perinatal outcomes of pregnant women whose 100g OGTT curve was "flat" (fasting serum glucose below 95 mg/dl and the remaining values below 100 mg/dl) to those of women whose OGTT curve was "normal". Primary outcomes compared were the prevalence of macrosomic and small for gestational age (SGA) neonates. Secondary outcomes included hypertensive disorders of pregnancy (HDP), intrauterine fetal demise, placental abruption, induction of labor, meconium-stained amniotic fluid (MSAF), mode of delivery, postpartum hemorrhage (PPH), blood product transfusion, postpartum readmission, umbilical artery pH <7.1, Apgar score <7 at 5 minutes, neonatal intensive care unit (NICU) admission, neonatal respiratory and infectious morbidity, and hypoglycemia. Composite adverse maternal and neonatal outcomes were also evaluated. There were 1,060 patients in the study group and 10,591 patients in the control group. Patients with a flat OGTT had a reduced risk of delivering a macrosomic neonate (11.4% vs. 15.1% OR 0.7 [0.58-0.89] p=0.001) and having an unplanned cesarean delivery (7.5% vs 10.2% OR 0.8 [0.58-0.96] p=0.002). There was no difference in the rate of composite adverse maternal (14.0% vs 15.4% OR 0.9 [0.7-1.0] p=0.1) or neonatal outcome (5.3% vs. 4.5% OR 1.2 [0.9-1.5] p=0.15). Neonates had a slightly lower mean birthweight (3474g vs. 3505g, p=0.04), but the rate of SGA was similar in the two groups (2.5% vs.1.8% OR 1.3[0.9-2.0] p=0.08). Conclusions Pregnant women whose OGTT curve is flat have a lower risk of delivering macrosomic neonates and undergoing unplanned cesarean delivery and are not at increased risk of adverse maternal or neonatal outcomes. More research is required to evaluate the relationship between different OGTT curves and th.

Safety of the Seasonal Influenza Vaccine in 2 Successive Pregnancies

ImportanceAlthough influenza vaccination has been found to be safe in pregnancy, few studies have assessed repeated influenza vaccination over successive pregnancies, including 2 vaccinations in a year, in terms of adverse perinatal outcomes.ObjectiveTo examine the association of seasonal influenza vaccination across successive pregnancies with adverse perinatal outcomes and whether the association varies by interpregnancy interval (IPI) and vaccine type (quadrivalent or trivalent).Design, Setting, and ParticipantsThis retrospective cohort study included individuals with at least 2 successive singleton live-birth pregnancies between January 1, 2004, and December 31, 2018. Data were collected from the Vaccine Safety Datalink, a collaboration between the Centers for Disease Control and Prevention and integrated health care organizations. Data analysis was performed between January 8, 2021, and July 17, 2024.ExposuresInfluenza vaccination was identified using vaccine administration codes. The vaccinated cohort consisted of people who received influenza vaccines during the influenza season (August 1 through April 30) in 2 successive pregnancies. The comparator cohort consisted of people identified as unvaccinated during both pregnancies.Main Outcomes and MeasuresMain outcomes were risk of preeclampsia or eclampsia, placental abruption, fever, preterm birth, preterm premature rupture of membranes, chorioamnionitis, and small for gestational age among individuals with and without vaccination in both pregnancies. Adjusted relative risks (RRs) from Poisson regression were used to assess the magnitude of associations. The associations with adverse outcomes by IPI and vaccine type were evaluated.ResultsOf 82 055 people with 2 singleton pregnancies between 2004 and 2018, 44 879 (54.7%) had influenza vaccination in successive pregnancies. Mean (SD) age at the start of the second pregnancy was 32.2 (4.6) years for vaccinated individuals and 31.2 (5.0) years for unvaccinated individuals. Compared with individuals not vaccinated in both pregnancies, vaccination in successive pregnancies was not associated with increased risk of preeclampsia or eclampsia (adjusted RR, 1.10; 95% CI, 0.99-1.21), placental abruption (adjusted RR, 1.01; 95% CI, 0.84-1.21), fever (adjusted RR, 0.87; 95% CI, 0.47-1.59), preterm birth (adjusted RR, 0.83; 95% CI, 0.78-0.89), preterm premature rupture of membranes (RR, 1.00; 95% CI, 0.94-1.06), chorioamnionitis (adjusted RR, 1.03; 95% CI, 0.90-1.18), or small for gestational age birth (adjusted RR, 0.99; 95% CI, 0.93-1.05). IPI and vaccine type did not modify the observed associations.Conclusions and RelevanceIn this large cohort study of successive pregnancies, influenza vaccination was not associated with increased risk of adverse perinatal outcomes, irrespective of IPI and vaccine type. Findings support recommendations to vaccinate pregnant people or those who might be pregnant during the influenza season.

Obstetrical and perinatal outcomes of women with preeclampsia at Woldia Comprehensive Specialized Hospital, Northeast Ethiopia.

Preeclampsia is a multisystem disorder that affects pregnant women. Preeclampsia and its complications are the leading causes of maternal and perinatal morbidity and mortality in developing countries. Studies conducted in Ethiopia have primarily concentrated on preeclampsia's trends and prevalence rather than its obstetrical and perinatal consequences. Thus, this study aimed to determine the risk of adverse obstetric and perinatal outcomes among women with preeclampsia at Woldia Comprehensive Specialized Hospital, Northeast Ethiopia. A retrospective cohort study was conducted among 140 preeclamptic women and 280 normotensive women who gave birth at Woldia Comprehensive Specialized Hospital between 30 December 2020 and 29 December 2022. Maternal records were retrieved using data-extraction tools. The data were entered into EpiData version 4.6.0.6 and analyzed using SPSS version 26. Binary and multivariable logistic regression models were used to test the associations between independent and outcome variables. The adjusted odds ratio (OR) with a 95% confidence interval (CI) and p-values <0.05 were used to measure the strength of the association and declare the level of statistical significance. The odds of at least one adverse obstetric outcome among preeclamptic women were 2.25 times higher than those among normotensive women [AOR: 2.25, 95% CI: (1.06, 4.77)]. In addition, babies born to preeclamptic women were at a higher risk of perinatal death [AOR: 2.90, 95% CI: (1.10, 8.17)], low birth weight [AOR: 3.11, 95% CI: (1.43, 6.7)], birth asphyxia [AOR: 2.53, 95% CI: (1.15, 5.5)], and preterm birth [AOR: 2.21, 95% CI: (1.02, 4.8)] than babies born to normotensive women. More adverse obstetric and perinatal outcomes were observed in women with preeclampsia than those in normotensive women. This study highlights the significantly elevated level of at least one adverse obstetric outcome associated with preeclampsia, low hemoglobin level, and rural residents. Moreover, perinatal death, low birth weight, asphyxia, and preterm birth were significantly associated with preeclampsia.

The Negative Impact of Maternal HIV Infection on Birth Outcomes-Myth or Reality?

Human Immunodeficiency Virus (HIV) infection during pregnancy poses significant risks to both maternal and child health, with potential adverse effects on perinatal outcomes. This study aimed to compare perinatal outcomes, including birth weight, length, Apgar scores, and prematurity rates, between HIV-exposed, uninfected (HEU) children and HIV-unexposed, uninfected (HUU) children. A total of 204 neonates were included in the study, comprising 102 born to HIV-positive mothers and 102 born to uninfected mothers. Our findings revealed significant differences in birth weight (p < 0.001), length (p < 0.001), and Apgar scores at both 1 min (p = 0.003) and 5 min (p < 0.001) between HIV-exposed and -unexposed children. The HIV-exposed group exhibited lower birth weights and lengths, along with lower Apgar scores, indicating potential neonatal health challenges. No significant disparities were observed in the prematurity risk between the two groups (OR = 2.58, p = 0.126), but the risk of being born small for gestational age (SGA) in the case of HEU newborns was significantly high (OR = 17.41, p < 0.001). The significant differences in birth weight, length, and Apgar scores underscore the need for tailored healthcare interventions and support for neonates born to HIV-positive mothers. These findings contribute to our understanding of the complex interplay between maternal HIV infection and perinatal outcomes, guiding healthcare professionals in delivering targeted care for this vulnerable population.

The TLI system can help day-3 single cleavage embryo transfer to obtain comparative clinical outcomes to day-4 or day-5.

The aim was to explore whether the time-lapse imaging system can help day-3 single cleavage embryo transfer to obtain comparative clinical outcomes to day-4 or 5. The data of 1237 patients who underwent single embryo transfer from January 1, 2018, to September 30, 2020, in our reproductive medicine centre were retrospectively analysed. They were divided into the day-3 single cleavage-stage embryo transfer (SCT) group (n = 357), day-4 single morula transfer (SMT) group (n = 129) and day-5 single blastocyst transfer (SBT) group (n = 751) according to the different embryo transfer stage. The clinical and perinatal outcomes of the three groups were analysed and compared. The clinical pregnancy rates of the patients in the day-3 SCT group, day-4 SMT group and day-5 SBT group were 68.07, 70.54 and 72.04%, respectively. The live birth rates were 56.86, 61.24 and 60.99%, respectively. The monozygotic twin (MZT) rate in the day-3 SCT group was significantly lower than that in the day-5 SBT group (P = 0.049). Regarding perinatal outcomes, only the secondary sex ratio had a significant difference (P < 0.05). After age stratification, no improvement was found in the pregnancy outcomes of patients >35 years of age receiving blastocyst transfer. Our findings suggest that for patients with multiple high-quality embryos on day-3, prolonging the culture time can improve the pregnancy outcome to some extent, but it will bring risks. For centres that have established morphodynamic models, day-3 SCT can also achieve an ideal pregnancy outcome and reduce the rate of monozygotic twins and sex ratio.

Early life epigenetics and childhood outcomes: a scoping review.

Epigenetics is the study of changes in gene expression, without a change in the DNA sequence that are potentially heritable. Epigenetic mechanisms such as DNA methylation, histone modifications, and small non-coding RNA (sncRNA) changes have been studied in various childhood disorders. Causal links to maternal health and toxin exposures can introduce epigenetic modifications to the fetal DNA, which can be detected in the cord blood. Cord blood epigenetic modifications provide evidence of in-utero stressors and immediate postnatal changes, which can impact both short and long-term outcomes in children. The mechanisms of these epigenetic changes can be leveraged for prevention, early detection, and intervention, and to discover novel therapeutic modalities in childhood diseases. We report a scoping review of early life epigenetics, the influence of maternal health, maternal toxin, and drug exposures on the fetus, and its impact on perinatal, neonatal, and childhood outcomes. IMPACT STATEMENT: Epigenetic changes such as DNA methylation, histone modification, and non-coding RNA have been implicated in the pathophysiology of various disease processes. The fundamental changes to an offspring's epigenome can begin in utero, impacting the immediate postnatal period, childhood, adolescence, and adulthood. This scoping review summarizes current literature on the impact of early life epigenetics, especially DNA methylation on childhood health outcomes.

Maternal-Fetal Complications in Renal Colic during Pregnancy: A Scoping Review.

Renal colic is one of the most common non-obstetric causes of hospitalization in pregnant women. Its management is often a challenge for obstetricians/gynecologists, urologists and neonatologists due to the complexity of the problem. The aim of this study was to analyze the possible maternal-fetal complications in renal colic during pregnancy. The authors performed a scoping review of the current literature regarding the analyzed issues. The review was conducted using the PubMed/MEDLINE and Web of Science databases. The search generated a total of 237 articles, out of which 7 original studies were ultimately included in the scoping review. In the women affected by renal colic, the incidence of perinatal complications such as urinary tract infections (UTIs), premature rupture of membranes (pPROM), and preterm birth is markedly higher than reported in the general population of pregnant women. Data regarding the recurrence of other perinatal complications such as gestational diabetes mellitus (GDM), pregnancy-induced hypertension (PIH), preeclampsia (PE), and intrauterine growth restriction (IUGR) are scarce and ambiguous. Further research on these issues is needed to improve the perinatal outcomes of the affected pregnancies.

Using Doppler ultrasound to assess fetal cardiac function and pregnancy outcomes in obstetric antiphospholipid syndrome pregnancies: a case-control study.

This study aimed to evaluate fetal left ventricular function (LVF) in pregnant women with obstetric antiphospholipid syndrome (OAPS) by Doppler ultrasound and developed a clinical nomogram to predict adverse perinatal outcomes. In this prospective observational study, 105 pregnant women were enrolled and divided into the OAPS cohort (n = 60) and the control cohort (n = 45). Fetal cardiac function parameters were collected and compared between two cohorts. Univariate and multivariate analysis was conducted to select the risk factors associated with adverse perinatal outcomes, and a clinical nomogram was developed based on these selected risk factors. The predictive performance of corresponding indicators for adverse perinatal outcomes was evaluated using receiver operating characteristic (ROC) curve analysis. The OAPS cohort revealed an increase in the isovolumic relaxation time (IVRT) and myocardial performance index (MPI), a decrease in the ejection time (ET), middle cerebral artery pulsatility index (MCA-PI) and cerebroplacental ratio (CPR) compared to the control cohort. Through univariate and multivariate analysis, gravidity, CPR, and MPI were the risk factors associated with adverse perinatal outcomes. A model predicting adverse perinatal outcomes in OAPS pregnant women was constructed based on these three factors and visualized as a nomogram. The nomogram could accurately predict adverse perinatal outcomes with an area under the curve of 0.923 (95% CI: 0.858-0.982). This performance was better than evaluating individual factors such as MPI (0.825, 95% CI: 0.739-0.911) and CPR (0.816, 95% CI: 0.705-0.927) for efficacy. MPI can be used to assess fetal LVF and predict adverse perinatal outcomes. We developed a nomogram to predict adverse perinatal outcomes in OAPS women. This imaging-based evidence can provide timely clinical intervention, enabling personalized clinical decision-making.

Severe novel coronavirus infection in late pregnancy: a case report.

This study reported the diagnosis, treatment and perinatal outcome of a novel coronavirus infection patient at 29+6 weeks pregnancy. The patient case came to the hospital with persistent fever and cough for 6 days. Patient's chest CT diagnosis showed double pneumonia, and viral infection was considered. Blood gas analysis revealed type I respiratory failure, and a throat swab nucleic acid test confirmed the novel coronavirus infection (critical type). After 13 days of isolation and supportive treatment, the patient recovered and was discharged from hospital after two consecutive negative nucleic acid tests. After discharge, the patient delivered a baby girl successfully by cesarean section on March 16, 2023. The newborn weighing 2050 g, with an Apgar score of 9-10 points /1-5 minutes. The newborn was transferred to the neonatology department for hospitalization and discharged 10 days later. The patient and her baby were followed up for nearly 1 year. Both mother and daughter were in good health.

A comparison of the effects of nifedipine and indomethacin used in preterm labor tocolytic treatment on feto-maternal Doppler ultrasonography flow.

To compare the effects of nifedipine and indomethacin, used for tocolytic purposes in the treatment of preterm labor (PTL), on fetal-maternal Doppler blood flows and perinatal outcomes. Eighty pregnant women between weeks 24 and 32 of gestation who used nifedipine (n = 40) and indomethacin (n = 40) as tocolytic treatments due to PTL were prospectively and consecutively included in the study. Sociodemographic, obstetric, and laboratory and Doppler flow parameters were compared between the groups. Statistically significant differences were observed between the groups in terms of gestational age at delivery and birth weight, Doppler flows (umbilical artery (UA) Pulsatility Index (PI), and UA Resistance Index (RI)) at 12, 24, and 48 h, middle cerebral artery RI at 12 h, and ductus venosus (DV) PI and DV-RI at 12, 24, and 48 h (p < 0.05). The findings of this study showed that nifedipine and indomethacin used in the treatment of PTL had significant effects on UA-PI and UA-RI Doppler flows at 12, 24, and 24 h, MCA-RI Doppler flows at 12 h, and DV-PI and DV-RI Doppler flows at 12, 24, and 48 h. Further studies involving larger numbers of participants are now needed to support these results.

Impact of isolated fetal congenital heart disease on pregnancy and perinatal outcomes.

The aim of the present study was to evaluate the obstetric complications associated with isolated fetal congenital heart disease (CHD) by comparing pregnancies with and without this condition. In this retrospective matched comparative study at Siriraj Hospital, Thailand, we included 233 postnatally confirmed fetal CHD cases and 466 unaffected fetuses. Controls were selected at a 2:1 ratio, ensuring that they matched the cases in terms of maternal age, parity, and history of preterm deliveries. Fetal CHD was significantly associated with an increased risk of spontaneous preterm labor (30% vs 9.7%; adjusted odds ratio [aOR] 2.42; 95% confidence interval [CI]: 1.35-4.36; P = 0.003), delivery before 34 gestational weeks (11.6% vs 0.6%; aOR 12.33; 95% CI: 3.32-45.78; P < 0.001), and pre-eclampsia (11.6% vs 2.8%; aOR 2.19; 95% CI: 1.01-4.76; P = 0.047). Newborns with CHD were significantly more likely to be small for gestational age (10.7% vs 5.2%; aOR 2.09; 95% CI: 1.11-3.94; P = 0.022). Intriguingly, a prenatal diagnosis of CHD was associated with a reduced risk of preterm delivery in affected pregnancies (P = 0.002). Pregnancies affected by isolated fetal CHD demonstrated a higher propensity for several adverse outcomes. These findings underscore the importance of prenatal CHD detection and tailored perinatal care to potentially improve both pregnancy outcomes and neonatal health.

Associations between non-registered ultrasound examination in pregnancy and adverse perinatal outcomes in immigrant and non-immigrant women: a Norwegian population-based study 1999-2016.

Prenatal ultrasound examinations are important to detect placental dysfunction. Several ultrasound-detected abnormalities can be managed during pregnancy or childbirth, thus improve health outcomes. Maternal birth country is known to influence the risk of placental dysfunction, but little is known about the possible mechanisms of this relation. (a) To estimate the proportion of non-registered prenatal ultrasound examinations; (b) to examine associations between non-registered ultrasound examinations and adverse perinatal outcomes, by migrant-related factors, in women giving birth in Norway. Individually linked data from the Medical Birth Registry of Norway and Statistics Norway, 1999-2016, comprising 999,760 singleton pregnancies to immigrants (n=196,220) and non-immigrants (n=803,540). Crude and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were estimated using logistic regression with robust standard error estimations, adjusted for year of childbirth, maternal age, parity, maternal smoking, educational level and Norwegian health region at birth. Compared with non-immigrants, immigrant women had a higher proportion of non-registered ultrasound examinations (2.3% vs. 4.3%; aOR 2.0 (95% CI 1.9, 2.0)). Compared with women with ultrasound examination, the aOR for perinatal mortality for women with non-registered ultrasound was 2.27 (95% CI 1.85, 2.79) for immigrants and 3.61 (3.21, 4.07) for non-immigrants. Non-registered ultrasound examination was also associated with placental abruption (aOR 1.32 (1.08, 1.63)) for non-immigrant women, but it was not associated with preeclampsia.

Cohort profile: The Camden Study - a pregnancy cohort study of pregnancy complications and birth outcomes in Camden, New Jersey, USA.

Pregnancy is a unique stage of the life course characterized by trade-offs between the nutritional, immune, and metabolic needs of the mother and fetus. The Camden Study was originally initiated to examine nutritional status, growth, and birth outcomes in adolescent pregnancies and expanded to study dietary and molecular predictors of pregnancy complications and birth outcomes in young women. From 1985-2006, 4765 pregnant participants aged 12 years and older were recruited from Camden, NJ, one of the poorest cities in the U.S. The cohort reflects a population under-represented in perinatal cohort studies (45% Hispanic, 38% non-Hispanic Black, 17% White participants; 98% using Medicaid in pregnancy). Study visits, including questionnaires, dietary assessments, and biospecimen collection, occurred in early and late pregnancy as well as at delivery. Medical records were abstracted, and a subset of mothers and infants participated in a six-week postpartum visit. Over the last five decades, the Camden Study has provided data toward the publication of numerous peer-reviewed papers. Results show that adolescent linear growth in pregnancy is associated with smaller birth size, possibly due to impaired hemodynamics. In the context of preterm birth and other perinatal outcomes, analyses of nutritional data have demonstrated the importance of micronutrients (e.g., folate, iron, zinc), as well as glucose/insulin dynamics and prenatal supplement use. More recent analyses have begun to unpack the biochemical pathways in pregnancy that may be shaped by race as an indicator for systemic racism. The Camden Study data and biorepositories are well-positioned to support future research aimed at better understanding perinatal health in under-represented women and infants. Linkages to subsequent health and administrative records and the potential for recontacting participants over 18-39 years after initial participation may provide key insights into the trajectories of maternal and child health across the life course.

Maternal and Perinatal Outcomes in Twins conceived Spontaneously Versus by Art –A Prospective Observational Study

Background: Multifetal pregnancies are on the rise due to advanced treatment modalities for infertility and assisted reproductive techniques (ART). These pregnancies are associated with more maternal and fetal morbidities as compared to singleton gestations. Even among twin pregnancies, those conceived by ART have been shown to be associated with adverse outcomes as compared to their spontaneously conceived counterparts. Objectives: The primary objective was to examine whether DCDA twin pregnancies conceived after ART were at a higher risk of adverse outcomes as compared to their spontaneously conceived counterparts. The secondary objective was to assess the maternal and fetal complications in the twin pregnancies.

Myoinositol and Metformin in the Prevention of Gestational Diabetes in High-Risk Patients: A Narrative Review.

Our hypothesis is that myoinositol and metformin in pregnant women with high-risk factors for glucose intolerance would reduce insulin resistance and consequently lower the incidence of gestational diabetes mellitus (GDM), a metabolic disorder of pregnancy characterized by maternal hyperglycemia due to deficient response to physiological insulin resistance, which may have a negative impact on perinatal outcome and long-term sequelae. In recent years, this pathology has become increasingly important given the global obesity epidemic and the delay in becoming pregnant, especially in industrialized countries. For this reason, the attempt to prevent, rather than cure, gestational diabetes is particularly important. In addition to lifestyle changes (especially diet and doing more exercise), myoinositol and metformin are the most promising factors at the moment, although not all RCTs published so far agree on their real effectiveness. A review of the articles published so far allows us to assume, albeit with some distinctions, that they can play a positive role.

Mortality of very low birth weight infants by neonatal intensive care unit workload and regional group status.

Very low birth weight infants (VLBWIs) continue to face high mortality risk influenced by the care quality of neonatal intensive care units (NICUs). Understanding the impact of workload and regional differences on these rates is crucial for improving outcomes. This study aimed to assess how the structural and staffing attributes of NICUs influence the mortality rates of VLBWIs, emphasizing the significance of the availability of medical personnel and the regional distribution of care facilities. Data from 69 Korean NICUs collected by the Korean Neonatal Network between January 2015 and December 2016 were retrospectively analyzed. The NICUs were classified by various parameters: capacity (small, medium, large), nurse-to-bed ratio (1-4), and regional location (A, B, C). Pediatrician staffing was also analyzed and NICUs categorized by beds per pediatrician into low (≤10), medium (11-15), and high (≥16). The NICUs were classified by mortality rates into high-performance (1st and 2nd quartiles) and low-performance (3rd and 4th quartiles). Demographic, perinatal, and neonatal outcomes were analyzed using multivariate logistic regression to explore the association between NICU characteristics and mortality rates. This study included 4,745 VLBWIs (mean gestational age, 28.4 weeks; mean birth weight, 1,088 g; 55.4% male) and found significant variations in survival rates across NICUs linked to performance and staffing levels. High-performing NICUs, often with lower bed-to-staff ratios and advanced care levels, had higher survival rates. Notably, NICUs with two rather than one neonatologist were associated with reduced mortality rates. The study also underscored regional disparities, with NICUs in certain areas showing less favorable survival rates. Adequate NICU staffing and proper facility location are key to lowering the number of VLBWI deaths. Enhancing staffing and regional healthcare equity is crucial for improving the survival of this population.

Induction of Labor Using Castor Oil Cocktail - an Analysis of Real-world Data.

Induction of labor is indicated when benefits of delivery outweigh benefits of prolonged pregnancy, which is not always welcomed by women. Castor oil is accepted as an "old household remedy" for labor induction but is not yet part of the official guidelines. Nevertheless, it is often used, mostly even before the women are admitted to the hospital. Data on its actual benefits and safety are missing. Upon accepting the real-world practice of applying castor oil cocktail for labor induction we added castor oil as one option of labor induction in our clinical routine for multiparous women at term, with a history of at least one vaginal delivery. Here we aimed to generate data on the effectivity and safety of castor oil in labor induction by analyzing the real-world data generated in our cohort. In our retrospective analysis we included data of a cohort of 148 multiparous women induced by castor oil cocktail and of 286 matched controls receiving established methods according to the current guidelines for labor induction. The castor oil cocktail was prepared following a standardized recipe with quality-tested castor oil. Statistical analysis was performed with SPSS27.0. Perinatal outcome data including the rate of vaginal deliveries did not differ between groups, except significantly more neonates were admitted to the neonatal intensive care unit in the group receiving established methods for induction of labor (p=0.01). In 39 women (26%), administration of castor oil cocktail alone failed to induce labor. The time from initiation of labor induction until delivery was significantly shorter in the castor oil cocktail group (p=0.04). Our study demonstrates the safety and effectivity of a castor oil cocktail induction in multiparous women at term in a hospital-based setting using quality-controlled castor oil in a standardized recipe.

The Effect of Folic Acid Supplementation in the First Trimester of Pregnancy on Perinatal Outcomes: A Retrospective Cohort Study

Background: The purpose of this study is to compare the perinatal outcomes of pregnant women who received folic acid (FA) supplements to those who did not, using a large sample size. Methods: This study was conducted retrospectively at Konya Training and Research Hospital between 2016 and 2020. The study included pregnant women who took FA and those who did not. We obtained sociodemographic data and perinatal outcomes of all pregnant women from the electronic record system. We learned about folic acid usage from the e-prescription tracking system. Results: Out of the total sample size of 2393 patients, n = 861 (35.97%) received FA supplements during pregnancy, while n = 1532 (64.02%) did not. The gestational age at birth in the group receiving FA was higher than in the group not receiving FA (271.59 ± 13.83 days vs. 270.09 ± 15.27 days, p = 0.005). The group that did not take FA had more neonatal intensive care unit (NICU) admissions than the group that did (5.09% vs. 2.90%, p = 0.011). In the group that took FA, there were n = 17 (1.97%) patients with gestational diabetes (GDM), whereas in the group that did not use FA, there were n = 15 (0.98%) patients with GDM (p &lt; 0.001). Conclusions: The group taking FA supplements had a higher gestational age at birth and GDM, while admission to the NICU were lower compared to the group not taking FA supplements.