Prediction Of Adverse Pregnancy Outcomes Research Articles

Maternal disease activity and serological activity as predictors of adverse pregnancy outcomes in women with systemic lupus erythematosus: a retrospective chart review.

To evaluate the association between disease activity, serological activity, and adverse pregnancy outcomes (APOs) in women with systemic lupus erythematosus (SLE) and determine the cut-off values of complements to predict APOs in live birth cases. This retrospective chart review included pregnant women with SLE who had singleton live births after 22weeks between 2006 and 2020. First trimester maternal disease activity was assessed for SLE onset during pregnancy, antiphospholipid syndrome, SLE pregnancy disease activity index (SLEPDAI), disease flare-ups, lupus nephritis, pancytopenia, and daily prednisolone dosage. Serological activity was assessed for autoantibodies and complements. APOs included preterm birth (PTB), low birth weight infants, small-for-gestational age infants, preterm premature rupture of membranes, and preeclampsia (PE). Chi-square and Fisher's exact tests were used to compare categorical variables; a receiver-operating characteristic analysis was performed to calculate the cut-off values of complements to predict APOs. Fifty-two participants met the inclusion criteria. The incidence of PTB and PE was associated with a high SLEPDAI (p < 0.001, p = 0.001), disease flare-ups (p = 0.007, p < 0.001), lupus nephritis (p = 0.020, p = 0.012), anti-dsDNA antibodies (p = 0.047, p = 0.016), anti-SSA antibodies (p = 0.003, p = 0.004), low CH 50 (p < 0.001, p < 0.001), low C3 (p < 0.001, p < 0.001), and low C4 (p < 0.001, p = 0.001), respectively. The cut-off values of C4 to predict PTB and PE were 13.0mg/dL (higher than the normal lowest limit). High maternal disease activity and high serological activity in the first trimester in women with SLE are significantly associated with APOs. Proper disease control and close management for hypocomplementemia are required for better perinatal outcomes.

Prediction of Adverse Pregnancy Outcomes Using Crown-Rump Length at 11 to 13 + 6 Weeks of Gestation.

To assess the risk of a fetus with a smaller or larger than expected crown-rump length (CRL) for adverse pregnancy outcomes. The data of 960 healthy singleton pregnancies conceived via in vitro fertilization were retrospectively collected. Fetal CRL was measured between 11 and 13 + 6 weeks of gestation, and small and large fetal CRLs were defined as fetuses below the 10th and above the 90th centiles, respectively. Multiple logistic regression analysis was performed to assess the risk for adverse pregnancy outcomes. The mean birth weights of fetuses with small, normal, and large CRLs were 3002 g, 3205 g, and 3378 g, respectively. A small fetal CRL was associated with an increased risk of smaller-than-gestational-age neonates (adjusted odds ratio [aOR], 2.79; 95% confidence interval [CI], 1.53-5.08; P < .001) and preterm delivery before 34 gestational weeks (aOR, 6.48; 95% CI, 1.36-30.79; P=.019). A large fetal CRL was associated with an increased risk of large-for-gestational-age (LGA) neonates, and the risk persisted even after adjustment for well-known risk factors of macrosomia, such as pre-pregnancy body mass index, gestational diabetes, and excessive gestational weight gain (aOR, 3.67; 95% CI, 2.04-6.59; P < .001). However, a large fetal CRL was associated with a decreased risk of gestational diabetes (aOR, 0.10; 95% CI, 0.01-0.76; P=.026). Fetal CRL measured at 11 to 13 + 6 weeks gestation is worth using as a predictor of LGA as well as small for gestational age or preterm delivery.

Biochemical and clinical predictors in pregnant women with antiphospholipid syndrome and systemic lupus erythematosus: comprehensive update.

Autoimmune diseases as antiphospholipid syndrome (APS) and systemic lupus erythematosus (SLE) could cause many maternal complications. The most common maternal complications of autoimmune diseases are lupus flare, hypertension, nephritis, preeclampsia (PE), eclampsia, and poor pregnancy outcomes which including preterm delivery and pregnancy loss. Only the lupus anticoagulant in the greatest prospective multicenter study has been associated with adverse pregnancy outcomes of the APS. This review aims to provide a comprehensive update for predictors in pregnant women with APS/SLE. These data have been collected from clinical and pathological studies, systematic reviews, and meta-analysis. In recent years the SLE and APS demonstrated to have different and valuable clinical and biomarker predictors for the pregnancy outcome. Treatment of pregnant women with APS is low molecular weight heparin (LMWH) and aspirin; however, around 75% of this management is considered successful. This review summarizes recent research that focuses on biochemical and clinical predictors of adverse pregnancy outcomes (APOs) of pregnant women with SLE and APS. Furthermore, we have collected more evidence that confirms the safety and efficacy of hydroxychloroquine (HCQ) preventing APOs.

Prediction of Adverse Pregnancy Outcome Related to Placental Dysfunction Using the sFlt-1/PlGF Ratio: A Narrative Review.

The sFlt-1 (soluble fms-like tyrosine kinase-1)/PlGF (placental growth factor) ratio is a helpful tool for the prediction and diagnosis of preeclampsia (PE). Current data even show that the ratio has the potential to predict adverse pregnancy outcomes (APO) caused by placental pathologies. The aim of this article is to give a brief overview of recent findings on APO predictions based on the sFlt-1/PlGF ratio. The focus is on obstetric pathologies related to placental dysfunction (PD) such as PE and/or fetal growth restriction (FGR). New uses of the sFlt-1/PlGF ratio as a predictor of APO demonstrate its potential with regard to planning hospitalization and corticosteroid administration and the optimal timing of delivery. However, prospective interventional studies are warranted to define the exact role of the sFlt-1/PlGF ratio as a predictor of adverse pregnancy outcomes caused by placental pathologies.

Quadruple Screening in the Age of Cell-Free DNA: What are We Losing?

Cell-free DNA has emerged as the most reliable, non-invasive prenatal screening tool for fetal aneuploidies. It has come to replace the previously widely used quadruple screen offered in the second trimester of pregnancy. This change comes with improved detection for aneuploidy but also presents potential gaps in prenatal diagnosis including detection of open fetal defects and emerging data on prediction of adverse pregnancy outcomes. This review article provides a historical summary of the quadruple marker screen and evaluates the intersection of this screen with cell-free DNA. Furthermore, it discusses points to consider as providers trend toward cell-free DNA testing alone and reviews potential options to remedy any disparities.

Maternal bile acid profile and subtype analysis of intrahepatic cholestasis of pregnancy

BackgroundICP pregnant women have a unique profile of serum bile acid metabolism, thus the early and accurate identification of ICP patients is beneficial to early appropriate treatment and improvement of pregnancy outcomes. In this study, ultra-high performance liquid chromatography-mass spectrometry/mass spectrometry (UPLC-MS/MS) was used to analyze the 15 types of serum bile acid profiles among patients with ICP in third trimester, patients with cholelithiasis, and patients with hepatitis B virus. The ICP diagnostic model established by partial least squares-discriminant analysis (PLS-DA) was used to screen the differential bile acids for clinical subtypes of ICP. 144 cases of ICP patients were involved in this study, and divided into four subgroups according to serum level of TBA, DBIL, and ALT.Results(1) The differential serum bile acid profiles of ICP group and normal pregnant women were DCA, TDCA, TCA, GDCA and GLCA. (2) The differential serum bile acid profiles of the ICP1 group (ICP with jaundice) and normal pregnant women were TCDCA, TCA, GCA, GCDCA, TUDCA and GUDCA. (3) The differential serum bile acid profiles of the ICP3 group (Hyperchoicemia of pregnancy) and normal pregnant group was GUDCA, LCA, GLCA, UDCA, TUDCA, CDCA, and TLCA (P < 0.05). (4) The differential serum bile acid profiles of ICP4 group (idiopathic aminotransferase abnormality during pregnancy) and normal pregnant group was UDCA, GUDCA, TUDCA, GCA and GLCA (P < 0.05). (5) The occurrence of meconium-stained amniotic fluid, premature delivery and cesarean section in ICP1 group was significantly higher than normal group, ICP2 group, ICP3 group, and ICP4 group (P < 0.05); The occurrence of meconium-stained amniotic fluid, premature delivery and cesarean section in ICP2 group, ICP3 group, and ICP4 group was significantly higher than normal group (P < 0.05), but no difference was found among ICP2 group, ICP3 group, and ICP4 group (P > 0.05).ConclusionMaternal serum bile acid profiles are useful to differentiate the four subtypes of ICP. ICP with jaundice could be an important predictor of adverse pregnancy outcomes of ICP.

The cardio-ankle vascular index as a predictor of adverse pregnancy outcomes

To assess the association between maternal hemodynamic parameters; cardio-ankle vascular index (CAVI), representing arterial stiffness; mean arterial pressure (MAP), uterine artery pulsatility index (Ut-PI), and adverse pregnancy outcomes including preeclampsia (PE), fetal growth restriction (FGR), and gestational diabetes mellitus (GDM). A prospective cohort study was conducted on low-risk pregnancies. All were serially measured for the mean CAVI, MAP, and Ut-PI for four times at gestational age (GA) 11-14, 18-22, 28-32, and after 36 weeks. Also, the women were followed up for pregnancy outcomes, focusing on PE, FGR, and GDM. Of 335 recruited cases meeting the inclusion criteria, 16 cases developed PE, 24 cases had FGR, and 83 cases had GDM. Compared to the non-PE group, women developing PE had a significant increase in CAVI at 18-22, 28-32, and after 36 weeks (P-value = 0.021, 0.003, and <0.001, respectively), a significant increase in MAP at all of the four periods (P-value < 0.001, for all periods), and a significant increase in Ut-PI during GA 18-22 weeks (P-value = 0.021). In pregnancies with FGR, there was a significant increase of CAVI at GA 18-22, 28-32 and after 36 weeks (P-value = 0.012, 0.015, and 0.004, respectively), an increase in Ut-PI in all gestational periods (P-value < 0.05) but no changes of MAP throughout pregnancy. In GDM, the three parameters were not significantly different from those in the non-GDM group in all of the four periods. CAVI could predict PE and FGR with AUC of 0.655-0.835 and 0.673-0.760, respectively. CAVI added predictive values when combined with MAP or Ut-PI. Increased CAVI, like MAP and Ut-PI, can be used as a predictor of PE and FGR but not GDM. Also, it has an added predictive value when combined with MAP or Ut-PI.

954-P: In Gestational Diabetes, Patient-Led Insulin Titration Is Rapidly Effective without Detrimental Hypoglycaemia

Introduction: Elevated fasting blood glucose in gestational diabetes (GDM) is the strongest predictor of adverse pregnancy outcomes but is difficult to treat. We assessed the effectiveness and safety of a novel patient-led insulin dose titration algorithm, targeting rapid reduction in fasting glucose. Research Design and Methods: In women with GDM commenced on insulin, we initiated a patient-led approach to basal dose titration. Women were asked to increase their basal insulin dose by 4 units after every elevated fasting blood glucose (&amp;gt;90 mg/dL). We retrospectively reviewed the records of 50 women with GDM, after initiating this approach. Daily fasting capillary glucose measurements and insulin dose were collected from GDM diagnosis to delivery. Results: Basal insulin was commenced at a median 30+4 weeks gestation in 28 (56%) women. At insulin initiation median fasting glucose was 104.4 mg/dL. Fasting glucose control (defined as the first of three consecutive readings &amp;lt;95 mg/dL) was achieved by all women after a median 4 days (IQR: 1-13). This was successfully maintained for the remainder of pregnancy with additional patient-led titrations. Basal insulin dose at delivery (median 38+2 weeks gestation) was a median 34 units (IQR 18-62; 0.31 units/kg; IQR 0.23-0.71) with a birthweight less than half a standard deviation above normal (birthweight z-score 0.47 vs. 0.81 [n=34 insulin treated prior to implementation]). Hypoglycaemia &amp;lt;63 mg/dL was uncommon in those on basal insulin (1.86% of all fasting glucose readings) with just five values &amp;lt;54 mg/dL (0.34% of all readings). By comparison, in women never started on basal insulin (n=22), 0.45% of fasting readings were &amp;lt;63 mg/dL with just one value &amp;lt;54 mg/dL (0.09% of all readings). No patients experienced hypoglycaemia requiring assistance. Conclusions: In GDM, fasting glycaemic control is achieved within a week by using intensive patient-led insulin titration and is not at the expense of detrimental hypoglycaemia. Disclosure I. K. Mayne: None. N. Thomas: None. A. T. Hattersley: None. A. P. Mcgovern: Advisory Panel; Self; Boehringer Ingelheim Pharmaceuticals, Inc.

Dietary Fat and Fatty Acid Intake in Nulliparous Women: Associations with Preterm Birth and Distinctions by Maternal BMI.

ABSTRACTBackgroundEvidence documenting whether diet quality, particularly dietary fatty acids, is associated with preterm birth (PTB) is limited.ObjectiveThe aim was to measure associations between dietary fatty acid intake prior to pregnancy, specifically n–3 (ɷ-3) PUFAs and odds of PTB in US women and determine if associations differed by prepregnancy BMI.MethodsWe designed a secondary analysis of dietary intake in nulliparous women enrolled in a longitudinal cohort (NCT01322529). Participants completed an FFQ, modified to assess detailed PUFA intake, during the 3 mo preceding pregnancy. Inclusion in this analytic cohort required total energy intake within 2 SDs of the group mean. Prepregnancy BMI was categorized as underweight, normal, overweight, or obese. The primary exposure was estimated intake of EPA and DHA (combined EPA+DHA), in the context of a recommended intake of 250 mg. The primary outcome was PTB (<37 wk). Adjusted regression models controlled for maternal factors relevant to PTB and evaluated associations with PUFAs. Interaction terms estimated effect modification of BMI. A false discovery rate (FDR) correction accounted for multiple comparisons.ResultsMedian daily intake of combined EPA+DHA in 7365 women was 70 mg (IQR: 32, 145 mg). A significant interaction term indicated the effects of EPA+DHA on odds of PTB were different for different BMI categories (P < 0.01). Specifically, higher intake of combined EPA+DHA was nominally associated with reduced odds of PTB in women with underweight (OR: 0.67; 95% CI: 0.46–0.98) and normal BMI (OR: 0.87; 95% CI: 0.78–0.96), yet was associated with increased odds of overweight BMI (OR: 1.21; 95% CI: 1.02–1.44). Associations remained significant after FDR correction.ConclusionsBased on a cohort of US women designed to identify predictors of adverse pregnancy outcomes, dietary intake of combined EPA+DHA was considerably lower than recommended. Associations between intake of these recommended n–3 fatty acids and risk of PTB differ by maternal BMI.

Combination of three-dimensional placental vascular indices and volume and uterine artery pulsatility index at 10-13 weeks of gestation could improve the prediction of adverse pregnancy outcomes.

To evaluate whether three-dimensional (3D) placental vascular indices and volumes during the first trimester of pregnancy can be used as predictors of subsequent adverse outcomes. This was a prospective cohort study including women with singleton pregnancies between 10 and 13 weeks. 3D placental volume and vascular indices and uterine artery pulsatility index (UtA-PI) were measured. Adverse outcomes were defined whether there was any of the following complications: small for gestational age pregnancy, preterm delivery, and preeclampsia. The serum pregnancy-associated plasma protein-A (PAPP-A) and free beta-human chorionic gonadotropin (β-hCG) levels were also compared. We analyzed the screening performances of these parameters for prediction of any of adverse outcomes. Of 348 women screened, 300 women were completed follow-up. Overall, 57 (19.0%) of 300 women developed any of adverse pregnancy outcomes. Multiple logistic regression analysis demonstrated that gestational age-adjusted z-scores of log10 placental volume (odds ratio [OR], 0.572; 95% confidence interval [CI], 0.416-0.788), log10 placental vascularization flow index (VFI; OR, 0.676; 95% CI, 0.496-0.921), and log10 UtA-PI (OR, 1.910; 95% CI, 1.335-2.731) were significantly associated adverse pregnancy outcomes. The multivariate model combining placental VFI, placental volume, UtA-PI, and underweight or obese body mass index exhibited the highest screening performances (AUC=0.77) and PAPP-A and β-hCG did not add any significance to multivariate model. Placental volume and vascular indices at 10-13 weeks of gestation are significantly associated with adverse pregnancy outcomes. Combination of these placental indices and UtA-PI could improve the screening performance for adverse outcomes.

Evaluation of the value of fasting plasma glucose in the first trimester for the prediction of adverse pregnancy outcomes

AimsTo evaluate the importance and usefulness of fasting plasma glucose (FPG) in the first trimester in predicting adverse pregnancy outcomes. MethodsA retrospective study of 22,398 singleton pregnancies was conducted. Participants were divided into subgroups according to first-trimester FPG (low FPG, FPG < 5.1 mmol/L; medium FPG, 5.1 mmol/L ≤ FPG < 5.6 mmol/L; high FPG, 5.6 ≤ FPG < 7.0 mmol/L) and oral glucose tolerance test(OGTT) results (normal and abnormal) during pregnancy. Patient characteristics and risk of adverse pregnancy outcomes were compared. Then, the whole population of women with abnormal OGTT served as a reference, and the relative risks of maternal and neonatal complications in normal OGTT women were analyzed by categorical analyses and logistic regression. Subgroup analyses were performed according to pre-pregnancy body mass index (BMI). ResultsThe frequency of adverse pregnancy outcomes increased with increasing FPG levels during the first trimester, regardless of OGTT results. High FPG + Abnormal OGTT had the worst outcome. Compared to the whole population of women with abnormal OGTT, Normal OGTT + Medium FPG showed the same risk of PIH and macrosomia. Normal OGTT + High FPG showed the same risk of PIH, macrosomia as well as LGA and preterm birth. Additionally, Normal OGTT + Medium FPG + BMI ≥ 24 kg/m2 showed significantly higher risk of PIH (OR = 1.867, 1.245–2.800), macrosomia (OR = 1.748, 1.304–2.344) and LGA (OR = 1.274, 1.019–1.593). Furthermore, the OR value for PIH was 3.759 (1.680–8.412) in Normal OGTT + High FPG + BMI ≥ 24 kg/m2 compared to women with abnormal OGTT. ConclusionsFirst-trimester FPG values can help identify women at increased risk for adverse pregnancy outcomes. Increased attention and management should be given to women with early pregnancy FPG ≥ 5.10 mmol/L despite a normal OGTT, especially if their BMI ≥ 24 kg/m2.

Predictors of adverse pregnancy outcome at Hospitals in South Gondar Zone, North-central Ethiopia: A multicenter facility-based unmatched case-control study

BackgroundAdverse pregnancy outcomes are the most significant public health problem which leads to serious short and long-term health consequences to the mother and the newborn baby. Adverse pregnancy outcomes, especially prematurity and low birth weights are the major cause of neonatal morbidity and mortality in Ethiopia, particularly in the study area. Therefore, this study was aimed to determine predictors of adverse pregnancy outcome among mothers who gave birth at Hospitals in South Gondar zone, North-central Ethiopia. MethodsHospital-based unmatched case-control study was conducted. A total of 441 study participants with 147 cases and 294 controls were included. The study participants were selected by multi-stage sampling technique. A combination of chart review and interview were used. Data entry and analysis were done by using Epi data version 3.1 and SPSS version 23 respectively. Descriptive & analytical statistics were computed. In the binary logistic regression, both bivariable and multivariable analysis was computed. Statistical significance was considered at P < 0.05 and the strength of association were assessed by using the adjusted odds ratio with their 95%confidence interval. ResultA total of 147 cases and 294 controls were included. The mean age (±SD) of study participants was 26.8 ± 5.5 years. History of adverse birth outcome (AOR = 6.39, 95%CI = 2.55, 15.99), did not receive dietary counseling during pregnancy (AOR = 5.17, 95%CI = 2.09, 12.84), pregnancy induced hypertension (AOR = 3.74, 95%CI = 1.20, 11.62), history of hyperemesis gravidarum in the recent pregnancy (AOR = 4.01, 95%CI = 1.58, 10.21) and inter-pregnancy interval less than 24 months (AOR = 2.02, 95%CI = 1.04, 3.91) were significantly associated with adverse pregnancy outcome. ConclusionThis study showed that history of adverse pregnancy outcome, pregnancy induced hypertension, did not receive dietary counseling, history of hyperemesis gravidarum, and inter-pregnancy interval less than 24 months were significantly associated with adverse pregnancy outcome. This study implies the need to improve dietary counseling for pregnant mothers during antenatal care visits. Beside to this, counseling on birth spacing should be given to improve inter-pregnancy intervals.

First and Second-Trimester Maternal Serum Analytes for the Prediction of Adverse Pregnancy Outcomes

First and Second-Trimester Maternal Serum Analytes for the Prediction of Adverse Pregnancy Outcomes

Incidence and associated predictors of adverse pregnancy outcomes of maternal syphilis in China, 2016-19: a Cox regression analysis.

This study aimed to investigate the incidence and associated predictors of adverse pregnancy outcomes (APOs) among pregnant women infected with syphilis. Cox regression analysis. China. Pregnant women who were tested for and diagnosed with syphilis during the index pregnancy and delivered at a gestational age ≥28weeks between 2016 and 2019. Data were extracted from China's Information System of Prevention of Mother-to-Child Transmission of Syphilis Management. Descriptive analysis provided profiles and pregnancy outcomes of maternal syphilis, as well as the incidence of APOs. Log-rank tests and Cox proportional hazard models were used to investigate factors influencing APOs in infected mothers with singleton births. The incidence of APOs and the hazard ratios of associated predictors using Cox proportional hazard model. Syphilis treatment data were available from 83.86% of diagnosed women. Including deliveries from the total study population, 13.33% experienced APOs. Cox regression indicated that APOs were more likely in women tested and diagnosed in the late trimester, at delivery or postpartum. Women who accepted non-standardised treatment and who received standardised treatment had less risk of APOs. China has made huge progress over the last decades in the prevention of mother-to-child transmission of syphilis, but the incidence of APOs among pregnant women infected with syphilis remains high. It is essential to further strengthen access to early detection and standardised treatment of infected women to reduce the risk of APOs. Access to early detection and standardised treatment reduces the risk of APOs due to maternal syphilis.

Correlation between Oral Glucose Tolerance Test Abnormalities and Adverse Pregnancy Outcomes in Gestational Diabetes: A Cross-Sectional Study.

Gestational diabetes mellitus (GDM) is associated with maternal and neonatal complications. We aimed to evaluate the relationship between the abnormalities of the oral glucose tolerance test (OGTT) and adverse pregnancy outcomes. This was a retrospective study of GDM patients over a five-year period in a Malaysian tertiary center. The diagnosis of GDM was based on the National Institute for Health and Care Excellence (NICE) guideline. The data on patients’ demographics, OGTT results, GDM treatment, and pregnancy outcomes were analyzed. A total of 1105 women were included in the final analysis. The percentage of women with isolated abnormal fasting glucose, isolated two-hour abnormality, and both abnormal values were 4.8%, 87.1%, and 8.1%, respectively. Women with both OGTT abnormalities had a higher risk of preeclampsia (odds ratio (OR) 4.73; 95% confidence interval (CI) 1.45–15.41) and neonatal hypoglycemia (OR 8.78; 95% CI 1.93–39.88). Isolated postprandial abnormality was associated with an 80% lesser risk of neonatal hypoglycemia (OR 0.19; 95% CI 0.04–0.87). Both isolated fasting and multiple OGTT abnormalities were associated with insulin therapy. Multiple OGTT abnormalities were a positive predictor of adverse pregnancy outcomes, while isolated postprandial abnormality was associated with a lesser risk of neonatal complication. Further prospective study is essential to validate these findings.

Minimization of bias in measures of gestational weight gain.

Gestational weight gain (GWG) is an important predictor of adverse pregnancy outcomes including gestational diabetes, preterm birth, delivery by caesarean and post-partum weight retention. The Institute of Medicine guidelines on GWG are widely adopted, and GWG is widely researched as an outcome of interest in lifestyle interventions during pregnancy. However, estimation of prepregnancy weight and measurement of weight prior to delivery introduce bias into measures of GWG. This review discusses the sources of bias in measures of GWG and the potential effect of bias on the relationship between adverse pregnancy outcomes associated with GWG. Bias in measures of GWG can be minimized by using measured weight at the first antenatal appointment in early pregnancy rather than self-reported prepregnancy weight and by adjusting for gestational age when the last weight is collected earlier than the delivery date. Bias owing to gestational age is an important potential confounder in the relationship between GWG and adverse pregnancy outcomes.

Are serum levels of inhibin A in second trimester predictors of adverse pregnancy outcome?

ObjectiveDuring pregnancy, inhibin A is mainly derived from the placenta and regulates the implantation and differentiation of embryos. Our aim was to assess whether second trimester serum inhibin A was associated with an increased risk of adverse pregnancy outcomes.MethodsWe investigated the serum levels of Inhibin A during the second trimester in pregnancy, and analyzed associations between the Inhibin A and the risk of adverse pregnancy outcome. 12,124 pregnant women were enrolled in this study between January 2017 and July 2019 at the Obstetrics & Gynecology Hospital of Fudan University. Multivariate logistic regression analysis was conducted to estimate the relative risk between Inhibin A and adverse pregnancy outcome.ResultsCompared with the group without adverse pregnancy outcome, during the second trimester of pregnancy, age and Inhibin A were risk factors for pre-eclampsia, gestational diabetes mellitus and preterm delivery; Inhibin A was risk factors for low birth weight. Gravidity and Inhibin A were risk factors for macrosomia; while parity was a protective factor against pre-eclampsia, gestational hypertension and low birth weight.ConclusionElevated Inhibin A levels in pregnancy are significantly associated with pre-eclampsia, GDM, macrosomia, low birth weight and preterm delivery.

Falling Insulin Requirements and Adverse Pregnancy Outcomes in Women With Pre-pregnancy Diabetes [10D

INTRODUCTION: A subset of women with pre-gestational diabetes experience a third-trimester fall in insulin requirements (IR). There is no consensus on whether this fall represents placental dysfunction or is a variant of normal third-trimester physiology. Our study sought to determine whether a third-trimester drop in IR is associated with adverse pregnancy outcomes. METHODS: This is a retrospective cohort study of women with type 1 and 2 diabetes. We compared outcomes in those with and without a ≥15% drop in basal IR. The primary outcome was a composite of stillbirth, spontaneous preterm birth, preterm premature rupture of membranes and iatrogenic preterm birth or emergency caesarean delivery for fetal wellbeing concerns. The results were adjusted for the effect of maternal BMI, presence of microvascular disease, and pre-pregnancy hemoglobin A1c &gt;7. The study was approved by the research ethics board at Mount Sinai Hospital. RESULTS: We included 350 women (146 type 1, 204 type 2), of which 15% had a drop of ≥15% in third-trimester basal insulin requirements. There was no difference in the primary outcome between groups (aOR 0.75 [0.27, 1.81]). In isolation the sensitivity and specificity of a ≥15% drop in basal IR as a diagnostic test for the primary outcome was 13% and 85%, respectively. CONCLUSION: A ≥15% drop in third-trimester basal IR is not associated with and is a poor predictor of adverse pregnancy outcomes in women with pre-pregnancy diabetes. It should not be used in isolation as a sole indication for delivery.

The Impact of Posttraumatic Stress Disorder and Moral Injury on Women Veterans' Perinatal Outcomes Following Separation From Military Service.

Posttraumatic stress disorder (PTSD) has been found to lead to several adverse perinatal outcomes in the general population. Preliminary research has found that women veterans with PTSD have an increased prevalence of preterm birth, gestational diabetes, and preeclampsia. Less research has examined the role of moral injury (MI) in perinatal outcomes. This longitudinal survey study examined the impact of PTSD symptoms and MI on prospectively assessed adverse perinatal outcomes among women who became pregnant in the first 3 years after separating from U.S. military service (N = 318). The Moral Injury Events Scale was used to assess the degree to which individuals experienced distress related to transgressions of deeply held moral beliefs, and the Primary Care PTSD Screen for DSM-5 (PC-PTSD) was used to assess PTSD symptoms. Perinatal outcomes included experiencing an adverse pregnancy outcome (e.g., preterm birth, gestational diabetes), postpartum depression and/or anxiety, and perceived difficult pregnancy. Although both PTSD symptoms, adjusted odds ratio (aOR) = 1.16, 95% CI [1.00, 1.35]; and MI, aOR = 1.27, 95% CI [1.06, 1.41], emerged as significant predictors of adverse pregnancy outcomes, only PTSD symptoms were a significant predictor of postpartum depression and/or anxiety, aOR = 1.43, 95% CI [1.22, 1.68], and perception of a difficult pregnancy, β = .31, when controlling for lifetime trauma exposure, age, socioeconomic status, and ethnic/racial minority status. The results indicate that both PTSD symptoms and MI are associated with adverse perinatal outcomes, supporting the potential need to screen for both PTSD and MI during the perinatal period.

Pregnancy with lupus erythematosus-an update

Current research in the field of systemic lupus erythematosus (SLE) and pregnancy focuses on predictors of adverse pregnancy outcomes, the safety and efficacy of hydroxychloroquine (HCQ) in pregnancy and the importance of preconception counselling. In particular, the prospective predictors of pregnancy outcome: biomarkers in antiphospholipid antibody syndrome and SLE (PROMISSE) study adds to the understanding of risk factors for adverse outcomes. There is increasing evidence of the numerous benefits associated with continuing HCQ treatment in pregnancy and for the use of low-dose acetylsalicylic acid in the prevention of preeclampsia. The European League Against Rheumatism (EULAR) has published evidence-based recommendations for the treatment of women with SLE and/or antiphospholipid syndrome before, during and after pregnancy. Rheumatologists caring for women with SLE should be familiar with the current state of knowledge in order to help optimize the management and thus the outcome of pregnancy in their patients.