Prediction Of Adverse Pregnancy Outcomes Research Articles

Assessment of Obstetric Doppler Ultrasound in High-Risk Pregnancy and Its Perinatal Outcome

Background: Intrauterine growth restriction (IUGR) is associated with an increased risk of perinatal mortality & morbidity. It accounts for a sizeable number of future unhealthy children, which is a significant burden to parents and society. IUGR can be minimized to some extent by timely & accurate detection of IUGR. Aims and objectives: To evaluate various waveforms of the umbilical artery, middle cerebral artery, ductus venosus, and cerebroplacental ratio as a predictor of adverse pregnancy outcomes in high-risk pregnancies. Materials and Methods: Eightywomen with a gestational age of 24 to 36 weeks were studied in the department of Radiodiagnosis of SAMC & PGI, Indore, Madhya Pradesh, from April 2021 to September 2022. Subjects were divided into non-complicated pregnancy [Appropriate for gestational age (AGA); n=40) and high-risk pregnancy [Small for gestational age (SGA); n=40; ≥18 years of age, with or without risk factors]. All underwent Doppler interrogation of the uterine arteries, umbilical artery, middle cerebral artery, and ductus venosus between 24-36 weeks of gestation. Results: Elevated head circumference (HC)/ abdominal circumference (AC) ratio, elevated femur length (FL)/AC ratio, presence of oligohydramnios without ruptured membrane, and advanced placental grade was more frequently observed among SGA babies. In this series, among the various risk factors, hypertension was a significant risk factor for IUGR, which other workers also accepted. Pulsatility index (PI), resistive index (RI) and systolic/diastolic (SD) ratio of uterine & umbilical arteries was significantly raised in SGA babies compared to AGA babies. In contrast, middle cerebral artery (MCA)'s PI, RI, and SD ratios were significantly lower in SGA babies than in AGA babies. Uterine artery early Diastolic Notch was seen in 11 cases & all of them delivered SGA babies. Hypertension was present in 8 of these 11 cases. Absent Diastolic Flow was detected in only one case, and the foetus ......

Early Prediction of Adverse Pregnancy Outcome in Women with Systemic Lupus Erythematosus, Antiphospholipid Syndrome, or Non-Criteria Obstetric Antiphospholipid Syndrome.

A prospectively study of pregnant women with systemic lupus erythematosus (SLE), antiphospholipid syndrome, or non-criteria obstetric antiphospholipid syndrome was conducted to describe the characteristics of women followed in a referral unit and to derive a predictive tool for adverse pregnancy outcome (APO). Demographic characteristics, treatments, SLE activity, and flares were recorded. Laboratory data included a complete blood cell count, protein-to-creatinine urinary ratio (Pr/Cr ratio), complement, anti dsDNA, anti-SSA/Ro, anti-SSB/La, and antiphospholipid antibodies status. A stepwise regression was used to identify baseline characteristics available before pregnancy and during the 1st trimester that were most predictive of APO and to create the predictive model. A total of 217 pregnancies were included. One or more APO occurred in 45 (20.7%) women. A baseline model including non-Caucasian ethnicity (OR 2.78; 95% CI [1.16-6.62]), smoking (OR 4.43; 95% CI [1.74-11.29]), pregestational hypertension (OR 16.13; 95% CI [4.06-64.02]), and pregestational corticosteroids treatment OR 2.98; 95% CI [1.30-6.87]) yielded an AUC of 0.78 (95% CI, [0.70-0.86]). Among first-trimester parameters, only Pr/Cr ratio improved the model fit, but the predictive performance was not significantly improved (AUC of 0.78 vs. 0.81; p = 0.16). Better biomarkers need to be developed to efficiently stratify pregnant women with the most common autoimmune diseases.

Nationwide Pregnancy Outcomes After Kidney Transplantation and Prediction of Adverse Pregnancy Outcomes: A Dutch Cohort Study

Nationwide Pregnancy Outcomes After Kidney Transplantation and Prediction of Adverse Pregnancy Outcomes: A Dutch Cohort Study

Dietary behavior of obese pregnant women attending an antenatal clinic at El Manial University Hospital

Background The poor quality of maternal diet among obese pregnant women was considered one of the most significant predictors of adverse pregnancy outcomes. The aim of this study was to assess the dietary behavior among obese pregnant women. Design A descriptive research design was adopted to reach the stated aim. Sample A purposive sample of 125 obese pregnant women through a period of 6 months was recruited from the antenatal care at El Manial Maternity Hospital. Tools Three tools were used: (a) structured interviewing questionnaire tool, (b) anthropometric assessment tool, and (c) nutritional assessment tools. Results Only 61.6% of the study sample never ate fast food, 32% either drink beverage regularly or always. Moreover, 46.4% from the study sample always added sugar in large quantities, 40% consume fruits, 35.2% either use fat or oil during cooking, and ate snacks between meals. Also, 83.2% from the study sample had unsatisfactory dietary behavior for certain nutrients. Conclusion Carbohydrate, diary product, fruits, vegetables, and grains were the main nutrients used by the study sample. Craving for unhealthy foods such as beverages, sweets, and fats was noted among the study sample. Moreover, the overall intake of food in the form of nutrients was found above the limits of the recommended dietary allowances for most of the nutrients among the study sample during pregnancy. Recommendation Counseling for proper dietary intake and dietary behavior for obese pregnant women was strongly recommended.

Ultrasound assessment of twin reversed arterial perfusion sequence for the prediction of adverse pregnancy outcomes in the first trimester.

To investigate twin reversed arterial perfusion (TRAP) sequence for the prediction of TRAP-related adverse pregnancy outcomes at the gestational age of 11-14weeks. Pregnant women in the first trimester diagnosed with TRAP were recruited at West China Second University Hospital from January 2015 to June 2018. Systematic screening for the pump twin's crown-rump length (CRL) and acardiac twin's upper pole-rump length (URL) was conducted using ultrasonic detection. The (CRL- URL)/CRL and URL/CRL ratios were used to assess the pregnancy outcomes for the pump twin. Twenty-one pregnant women aged 21-39years with a gestation of 11-14weeks were recruited. TRAP was diagnosed on average(±standard deviation (SD)) at pregnancy week 13.1±0.18. The pump twins' mean(±SD) CRL was 6.65±1.1cm. The incidence of intrauterine death for the pump twins was 19.0% (n=4), the miscarriage rate was 14.3% (n=3), and the live birth rate was 66.7% (n=14). The (CRL- URL)/CRL ratios between the nonsurvival (intrauterine death and miscarriage) and survival groups significantly differed (0.33±0.08vs. 0.58±0.08, p<0.05). Similarly, the URL/CRL ratios between the nonsurvival and survival groups significantly differed (0.67±0.08vs. 0.42±0.08, p<0.05). The (CRL- URL)/CRL and URL/CRL ratios were valuable indicators for determining pregnancy outcomes of pump twins with TRAP at an early gestational age.

Cell-Free RNA Transcriptome and Prediction of Adverse Pregnancy Outcomes.

Pregnancy is a complex condition with maternal, placental, and fetal factors all contributing to outcomes. Comprehensive profiling of biological pathways underlying both healthy and adverse pregnancy outcomes is in its infancy, and tools to predict obstetric complications remain limited. Minimally invasive methods to monitor pregnancy health through sampling of the maternal blood, also known as liquid biopsies, could significantly advance pregnancy care. Whole-blood transcriptome profiling involves the sequencing of circulating gene transcripts—referred to as cell-free RNA (cfRNA)—and allows minimally invasive assessment of human tissues. Utilization of cfRNA has lagged behind other minimally invasive assessments (such as cell-free DNA [cfDNA]) due to concerns that circulating RNA would be highly unstable and fragmented. However, with optimized collection and extraction, most of the cfRNA in blood is protected from degradation (1). cfRNA consists primarily of ribosomal RNA (rRNA; >95% of transcripts) and mitochondrial RNA (mtRNA), with about 2% messenger RNA (mRNA) reflecting the composition in most cell types (1). A few high abundance transcripts dominate the mRNA signature, including hemoglobin subunits, major histocompatibility complex components, and red blood cell markers. Thus, to optimize detection of transcripts with lower levels of expression, these high abundance transcripts are best removed during RNA sequencing (RNA-seq) library preparation.

Assessment of the adverse pregnancy outcomes and its associated factors among deliveries at Debre Berhan Comprehensive Specialized Hospital, Northeast Ethiopia.

BackgroundAdverse pregnancy outcomes are the main causes of maternal and neonatal morbidity and mortality and long-term physical and psychological sequels in low- and middle-income countries, particularly in Africa and Asia. In Ethiopia, maternal mortality remained high despite the country’s maximum effort. This study aimed to assess adverse pregnancy outcomes and associated factors among deliveries at Debre Berhan Comprehensive Specialized Hospital, Northeast Ethiopia.MethodsA retrospective cross-sectional study was done among deliveries at Debre Berhan Comprehensive Specialized Hospital from January 1, 2017, to December 31, 2018. The data was collected using a structured and pre-tested questionnaire by reviewing labor and delivery service log books and admission or discharge registration books. The data were entered into a Microsoft Excel spreadsheet and analyzed using SPSS version 25. Logistic regression analysis was computed to identify independent predictors of pregnancy complications.ResultIn this study, the magnitude of adverse pregnancy outcomes was 28.3%, 95% CI (25.7–30.9). The most frequently recorded obstetric complications were obstructed labor (7.4%), retained placenta (5.3%), and hypertensive disorders of pregnancy (2.4%). Whereas stillbirths (10%), malpresentation (3%), and prematurity (2.3%) frequently occurred fetal/neonatal complications. There were 29 maternal deaths and the possible causes of death were obstructed labor (51.7%), hemorrhage (44.7%), eclampsia (24.1%), and sepsis (6.9%). Home delivery (AOR (CI = 4.12 (2.30–7.15) and low birth weight (AOR (CI = 1.63 (1.36–1.96) were significant associates of adverse pregnancy outcomes.ConclusionThe magnitude of adverse pregnancy outcomes was high. Obstructed labor, retained placenta, hypertension in pregnancy, malpresentation, prematurity, and stillbirth are the commonest adverse pregnancy outcomes. Place of delivery and birth weight were independent predictors of adverse pregnancy outcomes. Institutional delivery, early detection and management of complications, and adequate nutrition and weight gain during pregnancy should be encouraged to minimize the risk of adverse pregnancy outcomes.

Evaluation of red blood cell distribution width-platelet ratio as a predictor of adverse pregnancy outcomes and disease severity in systemic lupus erythematosus.

The red blood cell distribution width to platelet ratio (RPR) is known to reflect systemic inflammation. This study aimed to explore the predictive value of RPR for disease activity and adverse pregnancy outcomes (APOs) in pregnant women with systemic lupus erythematosus (SLE). We retrospectively evaluated case data of all pregnant women with SLE managed at the First Affiliated Hospital of Zhengzhou University from January 2014 to March 2017. Correlations between RPR and SLE clinical disease activity, organ involvement, and maternal complications were analysed. Changes in the RPR and erythrocyte sedimentation rate (ESR) were observed before and after treatment. A receiver operating characteristic (ROC) curve was used to predict disease activity and APOs based on RPR. A total of 118 patients were enrolled, including 77 in the disease-active group and 41 in the disease-inactive group. The live birth rate was significantly higher in the disease-inactive group than in the disease-active group (P < 0.001). Compared to the disease-inactive group, the number of patients with elevated RPR, anti-dsDNA antibody level, and ESR was significantly higher in the disease-active group, whereas their platelet-lymphocyte ratios and complement 3 and 4 levels were significantly lower. The disease-active group was more likely to experience APOs (P < 0.001), mainly due to premature birth, low birth weight, and pregnancy loss. The ROC curve indicated that RPR had an effect on disease activity and APOs. RPR can be used as a predictor of disease severity and APOs in pregnant women with SLE. Key Points • RPR positively correlated with SLEDAI; patients with elevated RPR have higher disease activity, more organ, and more maternal complications. • Monitoring RPR could better predict disease activity in pregnant patients with SLE and reduce the incidence of maternal complications and APOs.

In gestational diabetes, patient‐led insulin titration is rapidly effective, safe and is associated with reduced birthweight

AbstractBackground: Elevated fasting glucose in gestational diabetes (GDM) is the strongest predictor of adverse pregnancy outcomes but is difficult to treat. We assessed the effectiveness, safety, and patient acceptability of a simple patient‐led insulin dose titration algorithm in GDM, targeting rapid reduction in fasting glucose.Methods: Once initiated on basal insulin, women were asked to increase their dose by 4 units daily, following every fasting glucose ≥5.0mmol/L. We evaluated pregnancy outcomes, rates of hypoglycaemia and time taken to achieve target readings (&lt;5.3mmol/L) before and after this practice change. We undertook patient interviews and questionnaires to capture the patient perspective.Results: Insulin was commenced at a median 30+4 weeks with fasting glucose control (defined as the first of three consecutive readings &lt;5.3mmol/L) achieved after a median 4 days (IQR: 1–11) and maintained throughout pregnancy with further patient‐led titrations. Hypoglycaemia was uncommon; 1.7% of all fasting glucose readings were &lt;3.5mmol/L and 0.3% were &lt;3.0mmol/L. No patients experienced hypoglycaemia requiring assistance. At delivery, patient‐led titration achieved higher final insulin doses (53 vs 36 units/day; p=0.027), improved fasting glucose (4.6 vs 5.1mmol/L; p=0.031), and significantly lower birthweight (Z‐scores 0.34 vs 0.92; p=0.005) compared to our previous routine practice. Women liked the intervention and having increased responsibility for their own management.Conclusions: In GDM significant reduction in birthweight is achieved with patient‐led insulin dose titration. Following insulin initiation glycaemic control is achieved rapidly and maintained without detrimental hypoglycaemia. Copyright © 2022 John Wiley &amp; Sons.

Fatty Liver Index is a valid predictor of non-alcoholic fatty liver disease (NAFLD) in pregnancy

BackgroundDespite the evidence for adverse pregnancy outcomes, non-alcoholic fatty liver disease (NAFLD) is not routinely addressed in early pregnancy. The Fatty Liver Index (FLI) has been proposed as a screening...

Cerebro placental ratio at 30–34 weeks’ gestation in the prediction of perinatal outcome in low-risk and high-risk pregnancy

Doppler ultrasound velocimetry of umbilical and fetal vessels has become an established method of antenatal monitoring, allowing the non-invasive assessment of neonatal circulation. Cerebro placental ratio (CPR) is emerging as a significant predictor of adverse pregnancy outcome. To predict perinatal outcome in low and high-risk pregnancy in early and late-onset FGR using CPR. The study group comprised 410 pregnant women at 30-34 weeks, evaluated with ultrasound Doppler study, and other routine investigations and CPR were calculated. Women were categorized into high-risk and low-risk pregnancies and followed up until delivery, and fetal outcome was noted. Period of prolongation of pregnancy was significantly lower with high-risk patients than low-risk patients (31.09 ± 13.9 vs 37.79 ± 15.1, p=0.0003). NICU admissions significantly increased with high-risk patients than low-risk patients (22.22% vs 9.4%, p=0.002). Low-risk patients underwent significantly more vaginal deliveries as compared to high-risk patients (74.22% vs 44.87%, p &amp;#60; 0.0001). Birth weight, period of prolongation of pregnancy, and gestation period were significantly lower in patients with abnormal CPR than normal CPR group (2.82 Kg vs 1.94 Kg, 37.56 weeks vs 14.64 weeks, 266.47 days vs 245.41 days, respectively). Doppler velocimetry becomes an important tool for high-risk cases and late-onset mild FGR(after 32 weeks). CPR is helpful in high-risk pregnancies and also to predict peripartum fetal distress.

Placental Size and Uterine Artery Doppler for Prediction of Adverse Pregnancy Outcomes in Women with Low Pregnancy-Associated Plasma Protein-A

Background: Patients with a low level of pregnancy-associated plasma protein-A (PAPP-A) experience more placental disorders in the second trimester. Objectives: We aimed to assess UtA-Doppler and placental size to predict adverse pregnancy outcomes in a woman with placental insufficiency and low PAPP-A. Methods: Following a cross-sectional design, 83 singleton pregnant women with normal chromosomes and PAPP-A ≤ 0.5 were examined at 11 - 13 + 6 weeks of gestation. All participants with PAPP-A ≤ 0.5 were tested in the Nilo laboratory of Tehran from 2018 to 2019. The placental size and Doppler uterine artery were assessed at 18 - 20 weeks. Three cases were excluded due to abortion and aneuploidy. All participants were assigned to placenta lengths of &lt; 10 cm and &gt; 10 cm. All comparisons between two groups were assayed by the independent t-test, Mann-Whitney U test, χ2-test or Fisher exact test, and Logistic regression model. Results: Of 80 women, 48 (60%) had placenta length of &lt; 10 cm and 32(40%) had placenta length of &gt; 10 cm. Fourteen (17.5%) were preterm (&lt; 32 weeks), and 36(45%) were IUGR. According to the logistic regression model, in participants with a placenta length of &lt; 10 cm, the risk of IUGR was higher by 9-time than those with placenta length of &gt; 10 cm (OR = 9, CI95% = 3.20 - 25.29). Also, the risk of preterm labor was 3.47 fold higher in the group with placenta length of &lt; 10 cm, OR: 3.47;( CI95% = 1.27 - 9.44). Sensitivity of placenta length of &lt; 10 cm for predicting IUGR was 75% (CI95% = 56.60 - 88.54). Conclusions: Placental length measurement in the second trimester can help predict adverse pregnancy outcomes in pregnant women with low PAPP-A. Placenta evaluation can assist in planning future pregnancy care to detect the pathology of fetal growth restriction.

Genomics and Epigenomics of Gestational Diabetes Mellitus: Understanding the Molecular Pathways of the Disease Pathogenesis.

One of the most common complications during pregnancy is gestational diabetes mellitus (GDM), hyperglycemia that occurs for the first time during pregnancy. The condition is multifactorial, caused by an interaction between genetic, epigenetic, and environmental factors. However, the underlying mechanisms responsible for its pathogenesis remain elusive. Moreover, in contrast to several common metabolic disorders, molecular research in GDM is lagging. It is important to recognize that GDM is still commonly diagnosed during the second trimester of pregnancy using the oral glucose tolerance test (OGGT), at a time when both a fetal and maternal pathophysiology is already present, demonstrating the increased blood glucose levels associated with exacerbated insulin resistance. Therefore, early detection of metabolic changes and associated epigenetic and genetic factors that can lead to an improved prediction of adverse pregnancy outcomes and future cardio-metabolic pathologies in GDM women and their children is imperative. Several genomic and epigenetic approaches have been used to identify the genes, genetic variants, metabolic pathways, and epigenetic modifications involved in GDM to determine its etiology. In this article, we explore these factors as well as how their functional effects may contribute to immediate and future pathologies in women with GDM and their offspring from birth to adulthood. We also discuss how these approaches contribute to the changes in different molecular pathways that contribute to the GDM pathogenesis, with a special focus on the development of insulin resistance.

Predictors of adverse pregnancy outcomes among Kenyan women with HIV on antiretroviral treatment in pregnancy.

The aim of this study was to understand predictors of adverse pregnancy outcomes (APOs) among women on antiretroviral treatment (ART). A longitudinal cohort. Participants from the Mobile WAChX trial were evaluated for APOs, including stillbirth (fetal death at ≥20 weeks' gestation), preterm birth (PTB, livebirth at <37 weeks' gestation,) and neonatal death (NND, ≤28 days after live birth). Predictors were determined by univariable and multivariable Cox proportional hazards and log-binomial models. Among 774 women included, median age was 27 years and 29.0% had unsuppressed HIV viral load (>1000 copies/ml) at enrollment. Half (55.1%) started ART prepregnancy, 89.1% on tenofovir-based regimens. Women with depression had a higher risk of stillbirth (adjusted hazard ratio [aHR] 2.93, 95% confidence interval (95% CI) 1.04-8.23), and women with lower social support score had higher risk of late stillbirth (aHR 11.74, 2.47-55.86). Among 740 livebirths, 201 (27.2%) were preterm and 22 (3.0%) experienced NND. PTB was associated with unsuppressed maternal viral load (adjusted prevalence ratio [aPR] 1.28, 95% CI 1.02-1.61), intimate partner violence (IPV) in pregnancy (aPR 1.94, 95% CI 1.28-2.94), and history of any sexually transmitted infection (STI) (aPR 1.63, 95% CI 1.06-2.51). NND was associated with PTB (aPR 2.53, 95% CI 1.10-5.78) and STI history (aPR 4.25, 95% CI 1.39-13.06). Most associations retained significance in the subgroup of women with viral suppression. Maternal viremia during pregnancy predicted PTB as did IPV, lower education, and STI history, while psychosocial stressors predicted stillbirth. Implementing mental health services, ART adherence, partner support, and routine STI screening and treatment could reduce APOs among women with HIV in sub-Saharan Africa settings.

Longitudinal assessment of spiral artery and intravillous arteriole blood flow and adverse pregnancy outcome.

Superb microvascular imaging (SMI) has been shown to improve visualization of small vessels by suppressing global motions while preserving low-flow components, such as the microvessels in the placenta. We sought to determine if SMI-aided visualization of flow velocity waveforms in the spiral arteries (SA) and intravillous fetal arterioles (IVA) could predict fetal growth restriction (FGR), gestational hypertension (GH) and/or pre-eclampsia (PE). This was a prospective longitudinal study of singleton pregnancies without fetal anomaly, receiving prenatal care in one of two medical centers over a 5-year period. Using SMI-aided color Doppler, SA and IVA flow velocity was measured at three timepoints: 11 + 0 to 14 + 0, 18 + 0 to 22 + 6 and 28 + 0 to 34 + 6 weeks of gestation. SA and IVA flow velocity waveforms were reported as resistance indices (RI). RI values were analyzed using multilevel modeling; individual regression curves were estimated and combined to obtain the reference intervals for SA-RI and IVA-RI in uncomplicated pregnancies. The primary clinical outcome was FGR and secondary outcomes were PE and GH. FGR was defined as estimated fetal weight < 10th percentile. Student's t-test was used to compare deviation from expected RI between normal and complicated pregnancies. Among 540 pregnancies included in the analysis, 18 (3.3%) had FGR, 31 (5.7%) PE and 61 (11.3%) GH. In uncomplicated pregnancies, the SA-RI decreased progressively with advancing gestation, whereas the IVA-RI increased with gestational age. In the third trimester, the mean SA-RI and IVA-RI values were significantly higher in the FGR group compared with pregnancies that did not develop FGR, while the mean SA-RI was significantly higher in PE compared with non-PE pregnancies. There was no significant difference in mean SA-RI or IVA-RI between pregnancies with vs those without GH at any gestational age. When all three adverse outcomes were combined, SA-RI was significantly higher in pregnancies with these outcomes when compared to uncomplicated pregnancies in the third trimester (mean ± SD, 0.29 ± 0.12 vs 0.26 ± 0.12; P = 0.02). In screening for FGR using SA-RI, the areas under the receiver-operating-characteristics curves (AUC) were 0.68, 0.73 and 0.73 in the first, second and third trimesters, respectively. The respective AUCs for IVA-RI were 0.72, 0.72 and 0.73 for each trimester. SA-RI and IVA-RI, measured using SMI technology, were significantly higher in pregnancies at risk for FGR in late gestation. Larger studies are needed to determine if SA and IVA flow are reliable predictors of adverse pregnancy outcome. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Predictors of Adverse Pregnancy Outcomes in Pregnant Women Living with Obesity: A Systematic Review.

Obesity is a well-recognized risk factor for pregnancy complications. Most studies to date are in large cohorts, with results presented in a way that assumes all women living with obesity are at equal risk. This study investigates which women living with obesity are at higher risk of specific pregnancy complications. A systematic search of MEDLINE and Embase identified 7894 prospective or retrospective cohort studies exploring predictors of adverse outcomes among pregnant women living with obesity. Following screening, 61 studies were deemed eligible. Studies were selected if the effects of exposure to any predictor amongst pregnant women living with obesity could be collected. Maternal characteristics assessed for association with adverse outcomes included maternal age, race/ethnicity, maternal height, mode of conception, complement activation factors, and history of various comorbidities/procedures. Gestational diabetes mellitus was the most studied outcome (n = 32), followed by preterm birth (n = 29), preeclampsia (n = 27), low birthweight infants (n = 20), small for gestational age newborns (n = 12), and stillbirth (n = 7). This review identified important characteristics that should be considered during the screening and follow-up sessions of pregnant women living with obesity, including pre-existing type 1 diabetes, maternal age < 20 years or ≥35 years, non-White ethnicity, abdominal adiposity obesity, and history of bariatric surgery.

The intersection of race and socioeconomic status is associated with inflammation patterns during pregnancy and adverse pregnancy outcomes.

Preterm birth rates are higher among individuals of lower socioeconomic status and non-White race, which is possibly related to life-course stressors. It is important to understand the underlying mechanisms of these health disparities, and inflammation is a possible pathway to explain the disparities in birth outcomes. In this study, we aimed to determine whether patterns of inflammation differed by maternal race and socioeconomic status. Seven hundred and forty-four participants in a multi-site, prospective study of pregnancy and birth outcomes provided biological and psychological data between 12'0-20'6 weeks gestation. Participants with recent infection, fever, antibiotics or steroid treatment were excluded. Cytokines including INFɣ, IL-10, IL-13, IL-6, IL-8, and TNFα, and the acute phase protein CRP were measured in serum and values and were log-transformed for normality when appropriate, and a non-orthogonal rotation (Oblimid) was performed to allow the extracted factor to inter-correlate. IFNγ, IL-8, IL-10, IL-6, TNF-a, and IL-13 loaded onto Inflammatory Factor 1 (IF-1), while CRP and IL-6 loaded onto Inflammatory Factor 2 (IF-2). Race and education were collected via self-report during an in-person study visit. Multivariable models were used to determine the association of race and SES with IF-1 and IF-2 during the second trimester, and a mediation model was used to examine if inflammation is on the causal pathway. Models were adjusted for study site, prenatal age, pre-pregnancy BMI, smoking during pregnancy, and gestational age at the time of blood collection. Six hundred and five participants were included in our final analysis, with 61.2% of low or moderate SES, and 35.5% identifying as a person of color (POC). Identifying as a POC, being of low and moderate SES, and being both low-SES and POC or moderate-SES and POC were associated with higher odds of preterm birth and lower birth weight percentile infants. Low SES POC participants had significantly higher IF-1 and IF-2 scores when compared to high-SES White participants. Additionally, higher IF-1 and IF-2 were associated with shorter gestation. In the mediation analysis, we observed a significant direct effect of race/SES on preterm birth; however, the results did not support an indirect pathway where IF-1 or IF-2 acted as mediators. Maternal race and SES are significantly associated with inflammatory biomarkers during pregnancy, and when race and SES are considered in combination, they are stronger predictors of adverse pregnancy outcomes than when evaluated separately.

Evaluation of lupus anticoagulant, damage, and remission as predictors of pregnancy complications in systemic lupus erythematosus: the French GR2 study.

ObjectivesThe specific roles of remission status, lupus low disease activity state (LLDAS), and damage accrual on the prognosis of pregnancies in women with SLE are unknown. We analysed their impact on maternal flares and adverse pregnancy outcomes (APOs).MethodsWe evaluated all women (≥18 years) with SLE enrolled in the prospective GR2 study with an ongoing singleton pregnancy at 12 weeks (one pregnancy/woman). Several sets of criteria were used to define remission, disease activity and damage. APOs included: foetal/neonatal death, placental insufficiency with preterm delivery and small-for-gestational-age birth weight. First trimester maternal and disease features were tested as predictors of maternal flares and APOs.ResultsThe study included 238 women (98.3% on hydroxychloroquine (HCQ)) with 230 live births. Thirty-five (14.7%) patients had at least one flare during the second/third trimester. At least one APOs occurred in 34 (14.3%) women. Hypocomplementemia in the first trimester was the only factor associated with maternal flares later in pregnancy (P=0.02), while several factors were associated with APOs. In the logistic regression models, damage by SLICC-Damage Index [odds ratio (OR) 1.8, 95% CI: 1.1, 2.9 for model 1 and OR 1.7, 95% CI: 1.1, 2.8 for model 2] and lupus anticoagulant (LA, OR 4.2, 95% CI: 1.8, 9.7 for model 1; OR 3.7, 95% CI: 1.6, 8.7 for model 2) were significantly associated with APOs.ConclusionLA and damage at conception were predictors of APOs, and hypocomplementemia in the first trimester was associated with maternal flares later in pregnancy in this cohort of pregnant patients mostly with well-controlled SLE treated with HCQ.Trial registrationClinicalTrials.gov, https://clinicaltrials.gov, NCT02450396.

Patterns of antiseizure medication prescription in pregnancy and maternal complications in women with epilepsy: A retrospective study in Saudi Arabia

AimTo evaluate patterns of antiseizure medication (ASM) prescription in pregnancy and changes over a 16-year period: 2005–2020, and to investigate maternal complications in pregnant women with epilepsy (WWE). MethodData of pregnant WWE was retrospectively reviewed at the King Faisal Specialist Hospital and Research Centre, Riyadh and Jeddah, Saudi Arabia. ResultsOut of 162 pregnancies, 81.5% were prescribed ASMs. During the study period, the prescription rate increased from 68.8% to 93.5%. Between 2005 and 2020, the use of new ASMs increased from 15.4% to 75.5% (p < 0.0001). Furthermore, valproate use markedly decreased from 23.08% to 2.04%. The rate of maternal and delivery complications was 29.6%; the most frequent was gestational diabetes (5.6%), followed by bleeding during pregnancy (4.9%). Furthermore, preeclampsia and eclampsia were documented in 3.7% and 1.8%, respectively. ASMs use and other factors were not found to be associated with maternal complications (p > 0.05). However, first generation ASMs, i.e. carbamazepine (38.71%) and valproate (41.67%), were associated with higher maternal complication rates than new ASMs, i.e. levetiracetam (25%) and lamotrigine (20%), but the difference was not statistically significant (p = 0.4403). ConclusionASM prescription in pregnancy is increasing as is the use of new ASMs. The rate of maternal and delivery complications was relatively low, particularly preeclampsia and eclampsia. ASMs use was not found to associated with these complications. However, exposure to first generation ASMs seemed to be a predictor of adverse pregnancy outcomes.

Serum Growth Differentiation Factor 15 Might Be an Early Predictor of Adverse Pregnancy Outcomes in Chinese Pregnant Women

Serum Growth Differentiation Factor 15 Might Be an Early Predictor of Adverse Pregnancy Outcomes in Chinese Pregnant Women