Pregnancy Outcomes For Mother Research Articles

Evaluation of the Effect of Body Mass Index on Labor Progress in Mothers Undergoing Epidural Analgesia: A Double-Blind Randomized Clinical Trial

The present study evaluates the association between epidural analgesia and the duration of the active phase of labor and pregnancy outcomes in mothers with high body mass index (BMI). All term pregnant women undergoing epidural analgesia for pain-free labor entered the study from September 2016 to March 2020. After recruiting 300 subjects into the study, mothers were categorized into six groups based on their BMI levels. Each BMI sub-group was analyzed regarding the duration of the active phase of labor and delivery mode. In addition, the relationship between BMI and labor outcome and characteristics was studied. Overall, 300 laboring women with epidural analgesia were included. 79.3% had a vaginal delivery, and 20.7% undergo cesarean section. Different BMI sub-groups showed no significant difference regarding the duration of the active phase of labor under epidural analgesia. Cox regression analysis revealed that BMI had no significant effect on the length of the active phase of labor (P=0.787). No significant association was found between BMI and the cesarean delivery rate, uterine atony, maternal pyrexia, neonatal Apgar score, and NICU hospitalization rate. However, BMI was significantly associated with the incidence of dystocia and headache. labor with dystocia exhibited a significantly higher Mother’s BMI (P<0.05). The results suggest no significant association between epidural analgesia and the active phase of labor duration in mothers with high BMI.

First trimester maternal tryptophan metabolism and embryonic and fetal growth: the Rotterdam Periconceptional Cohort (Predict Study).

What is the association between first trimester maternal tryptophan (TRP) metabolites and embryonic and fetal growth? Higher 5-hydroxytryptophan (5-HTP) concentrations are associated with reduced embryonic growth and fetal growth and with an increased risk of small-for-gestational age (SGA), while higher kynurenine (KYN) concentrations are associated with a reduced risk of SGA. The maternal TRP metabolism is involved in many critical processes for embryonic and fetal growth, including immune modulation and regulation of vascular tone. Disturbances in TRP metabolism are associated with adverse maternal and fetal outcomes. This study was embedded within the Rotterdam Periconceptional Cohort (Predict Study), an ongoing prospective observational cohort conducted at a tertiary hospital from November 2010 onwards. A total of 1115 women were included before 11 weeks of gestation between November 2010 and December 2020. Maternal serum samples were collected between 7 and 11 weeks of gestation, and TRP metabolites (TRP, KYN, 5-HTP, 5-hydroxytryptamine, and 5-hydroxyindoleacetic acid) were determined using a validated liquid chromatography (tandem) mass spectrometry method. Serial 3D ultrasound scans were performed at 7, 9, and 11 weeks of gestation to accurately assess features of embryonic growth, including crown-rump length (CRL) and embryonic volume (EV) offline using virtual reality systems. Fetal growth parameters were retrieved from medical records and standardized according to Dutch reference curves. Mixed models were used to assess associations between maternal TRP metabolites and CRL and EV trajectories. Linear and logistic regression models were utilized to investigate associations with estimated fetal weight (EFW) and birthweight, and with SGA, respectively. All analyses were adjusted for potential confounders. Maternal 5-HTP concentrations and the maternal 5-HTP/TRP ratio were inversely associated with embryonic growth (5-HTP, √CRL: β = -0.015, 95% CI = -0.028 to -0.001; 5-HTP 3√EV: β = -0.009, 95% CI = -0.016 to -0.003). An increased maternal 5-HTP/TRP ratio was also associated with lower EFW and birthweight, and with an increased risk of SGA (odds ratio (OR) = 1.006, 95% CI = 1.00-1.013). In contrast, higher maternal KYN concentrations were associated with a reduced risk of SGA in the unadjusted models (OR = 0.548, 95% CI = 0.320-0.921). Residual confounding cannot be ruled out because of the observational design of this study. Moreover, this study was conducted in a single tertiary hospital, which assures high internal validity but may limit external validity. The novel finding that maternal 5-HTP concentrations are associated with a smaller embryo and fetus implies that disturbances of the maternal serotonin pathway in the first trimester of pregnancy are potentially involved in the pathophysiology of fetal growth restriction. The association between higher maternal KYN concentrations and a reduced risk of SGA substantiate the evidence that the KYN pathway has an important role in fetal growth. More research is needed to delve deeper into the potential role of the maternal TRP metabolism during the periconception period and pregnancy outcome for mother and offspring. This study was funded by the Department of Obstetrics and Gynecology and the Department of Clinical Chemistry of the Erasmus MC, University Medical Center, Rotterdam, the Netherlands. The authors have no competing interests to disclose. N/A.

Use and Impact of Pessary, Cerclage, and Progesterone for the Secondary Prevention of Preterm Birth: Data from the German Neonatal Network.

To evaluate the use and effect of cervical stitch cerclage, pessary, and progesterone on pregnancy outcome in mothers of very low birth weight infants (VLBWI) born<32 weeks of gestation in the German Neonatal Network (GNN). The GNN is a population-based cohort study enrolling VLBWI since 2009. We included 575 neonates from 424 mothers into our analysis, who were born between 2015 and 2019, after prenatal intervention with cerclage, pessary, progesterone or a combination between 20/0 to 25/0 weeks of gestation to prevent preterm birth. Median intervention-to-birth interval was the primary endpoint. 231 of 424 pregnant women had a cerclage only (54.5%), 76 women a pessary only (17.9%), and 27 were prescribed progesterone only (15.3%). The most common combination treatment (>1 intervention group) was cerclage plus progesterone (n=27), followed by cerclage plus pessary (n=13). The median intervention-to-birth interval for the whole cohort was 24 days (IQR 19.0 days). The earlier the intervention was started, the longer the intervention-to-birth interval lasted: When started at 20 weeks, the interval was 34 days in contrast to 11.5 days, when started at 25 weeks. The >1 group was born at a significantly higher median GA with 27.0 weeks (IQR 2.9 weeks) and a higher median birth weight of 980 g (IQR 394 g) accordingly. We propose that the earliest possible start of intervention leads to the most efficient pregnancy prolongation.

Assessment of Maternal Abdominal Subcutaneous Fat Thickness (Sft) Measured by Ultrasound as an Independent Predictor of Adverse Pregnancy Outcomes

Introduction: Obese pregnant women are at increased risk for a variety of maternal and perinatal complications. The maternal risks related to obesity include Gestational Diabetes mellitus, Preeclampsia, increased caesarean sections. The fetes is at risk of stillbirth, preterm birth and congenital anomalies. This study focuses on the use of Maternal abdominal subcutaneous fat thickness (SFT) as a surrogate measure for central obesity as measured by ultrasound, and determining its efficacy compared to BMI in predicting obesity related pregnancy complications. Objective: To measure mid-trimester SFT in antenatal women and establish SFT as an independent predictor of obesity related adverse pregnancy outcomes Methods: This was a prospective cohort study. 150 pregnant women between 20-40 years of age were recruited. Demographic data of each participant was collected from the OPD. USG for abdominal subcutaneous fat thickness (SFT) was done at 18-22 wks period of gestation. The participants were followed up to labour. Adverse pregnancy outcomes and their correlation with the SFT measured was studied. Results: There was significant positive correlation between BMI and SFT (r=0.591, p&lt;0.001) .A positive correlation was noticed between BMI and adverse pregnancy outcomes such as PIH, GDM , preterm birth , postdates and NICU admissions. SFT independently showed a positive correlation with the above parameters. The mean SFT among women without PIH was 11.45 mm, and with PIH was 16.48 mm[p &lt;0.001].Mean SFT were 11.68mm and 16.24 mm among the ladies without and with GDM respectively[p&lt;0.001]. The mean SFT for term pregnancies was 12.06 mm whereas the mean SFT for preterm births was 14.21 showing positive correlation between SFT and preterm birth. SFT also showed positive correlation with need for NICU admission for neonates [ SFT avg being 11.72mm and 14.94 mm in the 2 groups]. A comparative analysis was done between BMI and SFT regarding their correlation to the various outcomes. SFT showed higher correlation coefficients for these variables than BMI, with lower p values suggesting more statistical significance. Conclusion: BMI showed a positive correlation with adverse pregnancy outcomes in mother as well as fetes, SFT showed greater and more statistically significant correlation for adverse outcomes. Thus it was concluded that SFT is a better independent predictor of obesity related adverse pregnancy outcomes.

The relationship between nutrition adequacy level, physical activity, and pregnancy outcomes in mothers and infants

Pregnancy outcomes are affected by many factors: nutrition and physical activity. This study aims to determine the relationship between physical activity and nutritional adequacy level of pregnant women in the third trimester with pregnancy outcomes, namely maternal fasting blood glucose levels, blood pressure and amniotic fluid volume, and baby's birth weight and length. An observational study on a cohort was conducted on 34 pregnant women in their third trimester and followed until delivery in the Ciampea sub-district, Bogor, Indonesia. The data were processed through descriptive analysis for each variable. Bivariate tests between the predictor and outcome variables were performed using Pearson's correlation and Multiple Regression at 95% CI. Based on multiple regression analysis, we found that the samples' fasting blood glucose in the third trimester was predicted to be 36,9% positively affected by pre-pregnancy body mass index (b= 2,521; p= 0,009) and total physical activity during the third trimester (b= 0,055; p= 0,006). In conclusion, the nutritional adequacy level of macronutrients in the third trimester has not yet significantly affected pregnancy outcomes in this study. It is suggested that pregnant women should avoid prolonged sedentary activity and increase appropriate exercise to achieve maternal health and improve birth outcomes.

Risk of fetal undergrowth in the management of gestational diabetes mellitus in Japan.

In Japan, the increasing frequency of underweight among women of reproductive age and the accompanying increase in the rate of low birth weight (LBW) are social issues. The study aimed to establish a prospective registry system for gestational diabetes mellitus (GDM) in Japan and to clarify the actual status of GDM according to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. Pregnant women with gestational diabetes mellitus and those in the normal glucose tolerance (NGT) group were enrolled in the Diabetes and Pregnancy Outcome for Mother and Baby study from October 2015. Pregnant women with positive glucose screening in early and mid-to-late pregnancy underwent a 75 g oral glucose tolerance test by gestational week 32. Gestational diabetes mellitus was diagnosed according to IADPSG criteria. Women with a positive glucose screening test at mid-to-late pregnancy but NGT were enrolled as references (NGT group). Treatment for gestational diabetes mellitus and maternal and neonatal pregnancy data were prospectively collected on outcomes. In total 1,795 singleton pregnancies (878 women with GDM and 824 NGT women) were analyzed. The risk of LBW and small-for-gestational age in the GDM group was significantly higher than in the NGT group. A similar relationship was found for LBW risk in the non-overweight/obese group but not in the overweight/obese group. We established a prospective GDM registry system in Japan. In the management of GDM in Japan, suppression of maternal weight gain may be associated with reduced fetal growth, especially in non-overweight/obese women with GDM; however, further investigation is required.

The effect of human papilloma virus on women reproductive system, pregnancy outcome of mothers: a review

Human papillomavirus is a type of sexually transmitted virus that is common in people with factors such as multiple sexual partners, a weakened immune system caused by anxiety, or alcohol and tobacco users. This virus (human papilloma) causes negative effects on vaginal and cervical epithelial cells, sperm quality and other fertility parameters. Human papilloma virus can exist in the seminal fluid caused by ejaculation and play a role in the fertility quality of men. Different viruses may directly or indirectly infect male gametes, sperms. Decreased fertility quality is caused by changes in sperm structure, increased sperm DNA fragmentation, and increased sperm aneuploidy. As a result, it causes a decrease in the quality of fertility in women and men and failure of assisted reproductive methods, and pregnancy complications such as frequent miscarriages, premature births and weight loss at birth. HPV causes precancerous cells, low-grade and high-grade cancer (LSIL-HSIL).

Clinical significance of hemostasiological screening for thrombophilia in pregnant women with former thrombosis

Introduction . Pregnancy management in post-thrombotic women is challenging, because women with previous episode of venous thromboembolic complications (VTEC) have a 3–4 times higher risk of its exacerbation during than outside of subsequent pregnancies. Aim : to improve effective prenatal counseling program for women with former venous thrombosis and ischemic stroke to prevent recurrence of arterial and venous complications as well as pregnancy outcomes for mother and fetus. Materials and Methods . A single-center observational study was conducted involving 50 patients with arterial and venous thrombosis and pregnancy complications in anamnesis and 40 patients with a physiological course of pregnancy. To improve existing methods of thrombosis prevention, risk factors such as gene polymorphisms for plasminogen activator inhibitor-1 (PAI-1), coagulation factor II (prothrombin; F2: Thr165Met), coagulation factor I (fibrinogen; FGB I/D) were investigated as potential new candidates of thrombosis risk markers in pregnant women and puerperas. Results . In 24 (48 %) of 50 women with former arterial and venous thrombosis and pregnancy complications, were found to develop thromboembolic complications during pregnancy. Risk assessment performed according to the existing thrombosis risk scales, revealed that only 7 (29.2 %) patients were considered as candidates for thromboprophylaxis and received anticoagulant therapy. The remaining 17 women who subsequently developed thrombosis received no anticoagulant therapy. Unfortunately, most women were not tested for thrombophilia despite a history of pregnancy complications (fetal loss, preeclampsia, fetal growth retardation). The hereditary thrombophilia of high thrombogenic risk occurred in 5 (20.8 %) of 24 women with thrombosis during pregnancy (3 – homozygous forms of factor V Leiden mutation, 1 – reduced protein C and 1 – deficiency of protein S and antithrombin). Circulation of various types of antiphospholipid antibodies was found in 13 (54.2 %) of 24 women. Homozygous polymorphisms of the PAI-1 4G/4G (45.8 %) and prothrombin F2 Thr165Met (20.8 %) genes were significantly more common in women with former thrombosis and obstetric complications compared with the control group (p &lt; 0.001 and p = 0.023, respectively; odds ratio = 6.744; 95 % confidence interval = 1.195–38.056). Conclusion . In all cases examined, 24 women with thrombosis during pregnancy revealed to suffer from hereditary or acquired thrombophilia of high thrombogenic risk. After exclusion of high-risk thrombophilia, a number of gene polymorphisms exist that may be new candidates as a risk factor for thrombosis in pregnant women. More than 50 % of thrombosis cases in our study were associated with the homozygous genotype PAI-1 4G/4G (p &lt; 0.001) and F2 Thr165Met (p &lt; 0.001).

Trends in Maternal Mortality in Tertiary Care Hospital, Peshawar Pakistan- A Follow up study

Objective: To describe the trends in maternal mortality in tertiary care hospitals in the last five years and compare the mortalities in the previous ten years. Methods: All pregnant women from January 2016 to December 2020 were analyzed. The primary outcome of this research was maternal mortality ratios. Various causes of maternal mortality were also evaluated. The correlation between maternal characteristics and maternal mortality was inspected using logistic regression models. Pregnancy outcomes of mothers who died versus mothers who survived were also evaluated. Results: One hundred seventy-three maternal deaths were noted in 49283 pregnant women in 2016-2020. The average maternal mortality ratio in 5 years period was 409 per 100,000 live births. It showed a decreasing curve over the five years, from 539/100,000 live births in 2016 to 295 in 2020. Five year clusters also demonstrated a falling trend, from 856/100,000 live births to 409. Hemorrhage (34.68%), hypertensive disorders of pregnancy (21.38%), suspected cases of thromboembolism (20.80%) were the leading causes of maternal mortality. Pregnancy outcomes in mothers who survived and who expired were evaluated. Almost 33% of maternal deaths had stillbirths as compared to 4.69% in alive mothers (RR 6.87); similarly, unknown outcomes (RR7.56) and ectopic pregnancies (RR 3.01) were more frequent in cases of maternal demise. Conclusion: Trends in maternal mortality show a decreasing curve. Hemorrhage remains the leading cause. Attainment of SDGs requires interventions both at primary and tertiary health care. Keywords: Maternal mortality and Maternal Mortality Ratio (MMR), trends, causes of maternal mortality.

Late-Pregnancy Dysglycemia After Negative Testing for Gestational Diabetes and Risk of the Large-for-Gestational-Age Newborns: A Nest Case-Control Study Based on the Xi'an Longitudinal Mother-Child Cohort Study.

BackgroundThe implications of gestational diabetes mellitus (GDM) on the short- and long-term health outcomes of both mother and child have been extensively studied. However, studies related to negative Oral Glucose Tolerance Test (OGTT) results in the second trimester but dysglycemia in late pregnancy on maternal and infant pregnancy outcomes are rare.MethodsWe conducted a nest case-control study within the Xi'an Longitudinal Mother-Child Cohort study (XAMC) to investigate the risk of adverse pregnancy outcomes in mothers and children with maternal negative mid-pregnancy OGTT results but high glycated hemoglobin (HbA1c) levels (≥5.7%) in late pregnancy. All target women who delivered from January 1st, 2017 to December 31st, 2018 in Northwest Women's and Children's Hospital in Xi'an were enrolled as the case group (HbA1c ≥ 5.7%). Others with HbA1c < 5.7% but without GDM were selected as the control group (HbA1c < 5.7%) by matching with the same delivery period. The logistic regression models were used to find out the risk factors of adverse pregnancy outcomes in the target population.ResultsA total of 2,116 and 1,907 women were finally enrolled in the case and control groups, respectively. Compared to the control group, more newborns with macrosomia (9.2% vs 4.1%, P < 0.001) and large for gestational age (LGA) (23.7% vs. 13.5%, P < 0.001), but less small for gestational age (SGA) (4.4% vs. 6.1%, P = 0.017) were found in the case group. The differences in other outcomes were not statistically significant. The multiple logistic regression analysis showed that gestational age, fetal length, prenatal HbA1c, and total cholesterol (TG) were independent risk factors for newborns with large-for-gestational-age (LGA). The case group had a 2.516-fold (95% CI, 1.692–3.739) risk of delivering LGA newborns compared to the control group.ConclusionThe glycemic management during the late pregnancy of non-GDM women should be given special consideration to reduce the risk of overweight offspring at birth.

A Glyphosate-Based Formulation but Not Glyphosate Alone Alters Human Placental Integrity.

Glyphosate (G)-based herbicidal formulations, such as the most commonly used one, Roundup (R), are major pesticides used worldwide on food and feed. Pregnant women may be frequently exposed to R compounds. These are composed of G, which is declared as the active principle, and other products contained in formulations, named formulants, which have been declared as inerts and diluents by the manufacturers. These formulants have, in fact, been demonstrated to be much more toxic than G, in particular to placental and embryonic human cells. In this work, we thus compared the effect of G and a GT+ formulation named R, using placental perfusion ex vivo. R, but not G alone, was demonstrated to alter the placental permeability of a known small model molecule, antipyrine. Similar results were observed for the fetal venous flow rate. The transfer of G alone increases with time, but is significantly decreased in presence of its formulants. The perfusion of R provokes a destruction of fetal vessels, as demonstrated by immunohistochemistry. Formulants obviously alter the fetal-placental circulation and placental integrity according to time of exposure. Therefore, G does not appear to be the main toxic agent of R. Formulants, although undeclared, include polyoxyethanolamines, PAHs, or heavy metals, and may be responsible for this toxicity. These compounds are also present in other pesticides. The progressive blood flow reduction due to the toxic compounds of formulations may diminish the nutrient supply to the fetus, alter the development, and may enhance the poisoning effects. Although these are preliminary results, they could at least partially explain some adverse pregnancy outcomes in mothers exposed to pesticides or other environmental pollutants. The debate on glyphosate alone is proven insufficient for the understanding of the toxicity.

Investigating the Association between Placental Site in the Second Trimester of Pregnancy and Pregnancy Outcomes in Mother and Infant: A Retrospective Study

Background: The location of placenta is essential for the proper growth of fetus. This study was conducted to assess the relationship between placental location and perinatal and neonatal outcomes. Materials and Methods: The present retrospective cohort study was carried out on 1000 pregnant women who had delivered in Baqiyatallah Hospital, Tehran, Iran, during 2016-2018. We used a researcher-made questionnaire for collection of clinical and demographic information of patients from their medical records. All women had undergone a detailed ultrasound and Doppler examination at 20–23 weeks. We classified placenta position to four types: Lateral, Posterior, Anterior and Fundal. The data were analyzed using SPSS software version 20.0. Results: Placental site location in 44%, 42.1%, 8.2% and 5.7% of cases were anterior, posterior, lateral and fundal, respectively. The mean birth weight in subjects with lateral and posterior placental site location were 2999.3±643.9, and 3269.7±1776.9 gr as lowest and highest, respectively (p <0.001). Among the newborns in lateral group, 4.88% of them were pre-term, which was significantly higher than other groups (P=0.035). The rate of IUGR birth in lateral group was 4.88% which was higher than other groups (P=0.023). Also, among perinatal outcomes the rate of twin pregnancy was higher in lateral group, while the percentage of female birth in this group was lower than other groups (p <0.001). Conclusion: Lateral placental locations are associated with a number of adverse pregnancy, delivery and infant outcomes. Placental implantation and location at 14 to 24 weeks can be used in the evaluation of pregnancies. In other words, knowing the placenta location can help obstetricians and gynecologists in the better diagnosis of pregnancies at higher risk of complications.

ROC Curve Analysis of the Sensitivity and Specificity of Biochemical Detection of Intrahepatic Cholestasis during Pregnancy.

Intrahepatic cholestasis of pregnancy (ICP) is associated with an increased risk of adverse pregnancy outcomes in mothers and infants. The aim was to evaluate the sensitivity and specificity of biochemical detection of ICP by ROC curve and to determine the threshold of more reliable experimental indicators. 305 patients and 305 healthy pregnant women were enrolled in the study. The average levels of TBA, ALT, and AST in the ICP group were much higher than those in the control group (P<0. 001); the area of both CG and TBA under ROC curve was up to 0.99, the sensitivity was 97.7%, and the specificity was 99.3%. This study did not find any single specificity and sensitivity markers that could be used to reliably diagnose ICP. In the future, we will pay more attention to the correlation between sensitive biochemical indicators and adverse pregnancy outcomes.

Abstract 17390: Maternal and Fetal Cardiovascular Adaptations to Pregnancy and Outcomes in Mothers With Cardiac Disease - A Magnetic Resonance Imaging Study

Introduction: Insufficient maternal cardiac output (CO) has been implicated in poor pregnancy outcomes in mothers with heart disease (HD). Simultaneous delineation of vascular flows in the mother and her fetus have not been reported but could contribute to our understanding of the mechanisms of adverse events in this susceptible population. Methods: Pregnant women with moderate or severe HD (n=22; age 32±5 years) were studied using magnetic resonance imaging (MRI) and were compared with healthy controls (n=21; 34±3 years). Each MRI study included maternal and fetal components during the third trimester of pregnancy (corresponding to peak CO) and six months postpartum (surrogate for baseline hemodynamics). Phase contrast (PC) imaging was used to quantify maternal and fetal vascular flows. Fetal vessel T1 and T2 oximetry was used for derivation of fetal oxygen delivery and consumption. Maternal cardiac index (CI) was calculated using CO and pre-pregnancy body surface area. In the HD group, an “adapter” to pregnancy was defined as a woman with peak pregnancy CI measurement which met or exceeded the mean CI in the control population. Maternal and fetal outcomes were recorded. Results: There was no antepartum differences in absolute CO or CI in HD versus controls (CO 7.2±1.5 versus 7.3±1.6 L/min, p=0.79; CI 4.0±0.7 versus 4.3±0.7 L/min/m 2 , p=0.28). The percent increase in CO and CI (antepartum minus postpartum) was greater in women with HD versus controls (CO 46±24% versus 27±16%, p=0.02; CI 51±28% versus 28±17%, p&lt;0.01). Fetal growth and oxygen delivery/consumption were similar between groups. Six adverse maternal cardiovascular events occurred in the HD group (heart failure n=2 and arrhythmia n=4) and there were none in the control group. There were no adverse fetal events in either group. There were 6 HD adapters (30%) and the adverse event rate was lower as compared with non-adapters (0% versus 38%, p=0.03). Conclusions: Maternal and fetal vascular flows can be characterized in pregnancy using MRI. Impaired adaptation to pregnancy in women with HD, as determined by magnitude of change in CO/CI, appears to be associated with adverse outcomes of pregnancy in the mother.

Serum 25-hydroxyvitamin D levels in relation to lipids and clinical outcomes in pregnant women with gestational diabetes mellitus: an observational cohort study

ObjectiveThe aim of the present study was to investigate whether 25-hydroxyvitamin D (25(OH)D) status at 24–28 weeks is associated with blood lipids and pregnancy outcomes in patients with gestational diabetes...

A Meta–Analysis and Systematic Review to Determine the Pregnancy Outcomes in Mothers with inactive Hepatitis B Carrier

Objective: Our goal was to investigate whether asymptomatic maternal hepatitis B &#x0D; (HB) infection affects early membrane rupture (PROM), fetal death, preeclampsia, &#x0D; eclampsia, gestational hypertension, or bleeding before delivery.&#x0D; Materials and Methods: This study was conducted in the Department of Community Medicine and Obstetrics and Gynecology department, KEMU Lahore for one-year duration &#x0D; from May 2017 to April 2018. The electronic literature surveys were conducted &#x0D; using gray literature studies (e.g. conference papers and final reports). (Technicians) and scanned reference lists of attached studies and systematically related studies. &#x0D; We study statistical heterogeneity using statistical tests I2 and tau square (Tau2).&#x0D; Results: 18 studies included. Early membrane ruptures (PROM), fetal death, &#x0D; preeclampsia, eclampsia, gestational hypertension and prenatal bleeding were &#x0D; obtained in this study. The results showed no significant relationship between &#x0D; inactive HB and these complications during pregnancy. Small amounts of P and &#x0D; chi-square and large amounts of I2 have revealed heterogeneity, which we are &#x0D; trying to modify using statistical methods such as subgroup analysis in this chapter.&#x0D; Conclusion: Inactive HB infection did not increase the risk of adverse effects in &#x0D; this study. In addition, well-designed tests should be performed to confirm the &#x0D; results.

Effect of Sjögren’s syndrome on maternal and neonatal outcomes of pregnancy

Background Sjögren's syndrome (SS) is an autoimmune connective tissue disease affecting the body's moisture-producing glands. Some studies have linked SS to adverse maternal/neonatal outcomes, but sample sizes have tended to be small, with few outcomes examined. The purpose of this study was to evaluate the effect of SS on pregnancy outcomes for mother and neonate using a large dataset. Methods We carried out a retrospective cohort study of women who delivered between 1999 and 2014 using data from the Nationwide Inpatient Sample from the United States. SS categorization is based on ICD-9 coding. Baseline characteristics were compared in both groups and multivariate logistic regression was used to compare maternal and fetal outcomes of pregnancies in women with and without SS. Results The prevalence of SS in our population was 1.34 cases/10,000 births, with the rate increasing over the study period. Women with SS tended to be older, Caucasian and to have pre-existing comorbidities. Births to women with SS were at greater risk of pre-eclampsia [odds ratio (OR) 1.63, 95% confidence interval (CI) 1.34-1.99]; premature rupture of membranes (OR 1.28, 95% CI 1.04-1.57); preterm delivery (OR 1.56, 95% CI 1.34-1.81); cesarean delivery (OR 1.29, 95% CI 1.17-1.41); and venous thromboembolic events (OR 3.71, 95% CI 2.57-5.35). Infants of women with SS were more likely to have intrauterine growth restriction (IUGR) (OR 3.00, 95% CI 2.46-3.65); and congenital malformations (OR 3.26, 95% CI 2.30-4.62). Conclusion SS is a high-risk pregnancy condition associated with significant comorbidities and adverse maternal and fetal outcomes. Women with SS may benefit from increased surveillance during their pregnancies.

Pregnancy, Birth, Neonatal, and Postnatal Neurological Outcomes After Pregnancy With Migraine.

Prevalence of migraine is high during the reproductive age. Although migraine often improves during pregnancy, the risk of adverse pregnancy, birth, neonatal, and neurological outcomes in mother and offspring remains poorly understood. To investigate the associations between maternal migraine and risks of adverse pregnancy outcomes in the mother, and birth, neonatal and postnatal outcomes in the offspring. We used Danish population registries to assemble a cohort of pregnancies among women with migraine and an age- and conception year-matched comparison cohort of pregnancies among women without migraine. The study period was 2005-2012. We computed adjusted prevalence ratios (aPRs) for pregnancy and birth outcomes and adjusted risk ratios (aRRs) for neonatal and postnatal outcomes, adjusting for age, preconception medical history, and preconception reproductive history. We identified 22,841 pregnancies among women with migraine and 228,324 matched pregnancies among women without migraine. Migraine was associated with an increased risk of pregnancy-associated hypertension disorders (aPR: 1.50 [95% confidence interval (CI): 1.39-1.61]) and miscarriage (aPR: 1.10 [95% CI: 1.05-1.15]). Migraine was associated with an increased prevalence of low birth weight (aPR: 1.14 [95% CI: 1.06-1.23]), preterm birth (aPR: 1.21 [95% CI: 1.13-1.30]) and cesarean delivery (aPR: 1.20 [95% CI: 1.15-1.25]), but not of small for gestational age offspring (aPR: 0.94 [95% CI: 0.88-0.99]) and birth defects (aPR: 1.01 [95% CI: 0.93-1.09]). Offspring prenatally exposed to maternal migraine had elevated risks of several outcomes in the neonatal and postnatal period, including intensive care unit admission (aRR: 1.22 [95% CI: 1.03-1.45]), hospitalization (aRR: 1.12 [95% CI: 1.06-1.18]), dispensed prescriptions (aRR: 1.34 [95% CI: 1.24-1.45]), respiratory distress syndrome (aRR: 1.20 [95% CI: 1.02-1.42]), and febrile seizures (aRR: 1.27 [95% CI: 1.03-1.57), but not of death (aRR: 0.67 [95% CI: 0.43-1.04]) and cerebral palsy (aRR: 1.00 [95% CI: 0.51-1.94]). Women with migraine and their offspring have greater risks of several adverse pregnancy outcomes than women without migraine.

A Study of Fetomaternal Outcome of Pregnancy in Mothers with Gestational Diabetes

A Study of Fetomaternal Outcome of Pregnancy in Mothers with Gestational Diabetes

Pregnancy outcome in mothers over the age of 35.

The proportion of pregnancies occurring in women of at least 35 years of age has increased from 6.2% in 1980 to 22.3% of births in 2016. This review summarizes recent epidemiological and basic scientific studies investigating the association between older maternal age and adverse pregnancy outcome(s), and clinical studies which investigate the effects of intervention to reduce adverse events. Women of at least 35 years of age have increased risk of maternal and foetal complications in pregnancy including: stillbirth, a small for gestational age baby, preterm birth, preeclampsia and maternal death. These risks increase with increasing age. The reasons for this increased risk are incompletely understood, but likely involve ageing of the maternal cardiovascular and endocrine systems which impacts upon placental function. Intervention, by induction of labour (IOL) at 39-week gestation does not increase operative deliveries or short-term adverse maternal and neonatal outcomes and would reduce perinatal mortality. The additional risks of pregnancy should be discussed with women of at least 35 years of age; additional foetal surveillance may be required in the antenatal period. The benefits and risks of IOL at 39-week gestation should be discussed with women at least 35 years of age.