Pregnancy Outcomes In Pregnant Women Research Articles

How does subchorionic hematoma in the first trimester affect pregnancy outcomes?

IntroductionSubchorionic hematoma (SCH) in pregnancy has been associated with increased risk of adverse pregnancy outcomes. We aimed to investigate the association of SCH with adverse pregnancy outcomes in pregnant women in relation to size of hematoma and control subjects.Material and methodsThis study included 178 pregnant women with sono-graphically detected SCH in the 1st trimester, and 350 pregnant controls without SCH. Data on maternal age, smoking status, gestational week at diagnosis, location of SCH, medications before diagnosis, gestational week at delivery, delivery route and pregnancy outcomes (first trimester vaginal bleeding, pre-eclampsia, gestational diabetes, intrauterine growth restriction (IUGR), placental abruption, preterm delivery < 37 weeks, early pregnancy loss and intrauterine death) were retrieved retrospectively from hospital records. Pregnant women with SCH were divided into 3 groups according to the size of hematoma including small SCH (SCH-I group, n = 47), medium-size SCH (SCH-II group, n = 110) and large SCH (SCH-III group, n = 21) groups.ResultsSubchorionic hematoma was associated with significantly lower gestational age at delivery (p < 0.001) and higher rate of first trimester bleeding (p < 0.001) compared with the control group, regardless of the size of the hematoma. Placental abruption (p = 0.002) and early pregnancy loss (p < 0.001) were significantly more common in SCH-II and -III groups than in the control group. SCH-III group was associated with a significantly higher rate of < 37 gestational weeks at delivery (p < 0.001), first trimester vaginal bleeding (p < 0.001), early pregnancy loss (p < 0.001), IUGR (p = 0.003) and preterm delivery (p < 0.001) compared to both lesser size hematoma and control groups.ConclusionsOur findings suggest that large SCH might indicate an increased risk of adverse pregnancy outcomes such as 1st trimester vaginal bleeding, early pregnancy loss, IUGR, placental abruption or preterm delivery. These findings are important to guide the patients with SCH for detailed clinical evaluation.

A Comparative Study on Adverse Pregnancy Outcomes in Pregnant Women with Different Age

Introduction: Delayed childbearing is increasing. Increased maternal age has been associated with increased risk of pregnancy complications. On the other hand, the adolescent pregnancy has traditionally been considered high-risk, especially in developing countries. Objective: This study aimed to compare the adverse pregnancy outcomes in different age groups of pregnant women. Materials and Methods: The analytical study with cross-sectional design was conducted on 345 pregnant women referred to one of the maternity hospitals in Rasht, Iran in 2018 who were selected by sequential sampling method. They were followed from gestational age &gt;37 weeks until delivery in 3 groups: &lt;19 years, 19-35 years and &gt;35 years. The data collection tool was a two-part researcher-made questionnaire which surveys demographic, fertility, and socioeconomic information and adverse maternal and neonatal outcomes. The collected data were analyzed using descriptive and inferential statistics (Chi-square test, Fisher’s exact test, Kruskal-Wallis test, ANOVA, Bonfrroni test, Spearman correlation test, and multiple linear regression analysis). Results: The highest prevalence of maternal diabetes mellitus (29.7%) and cesarean section (72.46%) were reported in the age group &gt;35 years. The highest frequency of premature rupture of membranes (18.8%) and abnormal fetal presentation (13.8 %) were reported in age groups &lt;19 years and 19-35 years, respectively. Among maternal outcomes, maternal diabetes, abnormal fetal presentation, premature rupture of membranes and delivery by cesarean section were significantly different between three groups (P&lt;0.05). There was a significant difference between maternal age and neonatal outcomes in ages groups &lt;19 years and 19-35 years (P&lt;0.05). Multiple linear regression model showed that the maternal age &lt;19 years was a predictor of adverse neonatal outcomes. The group &lt;19 years reported more adverse outcomes than the age group 19-35 years (β=0.282, 95% CL: 0.002-0.561, P=0.049). Conclusion: All age groups of pregnant women faced some pregnancy outcomes. Due to Iran’s new plan to encourage childbearing, prenatal screening, and receiving more prenatal care, we recommend pregnant women to participate in childbirth preparation training courses.

The effect of caring intervention (physical activity, diet and counseling) on gestational diabetes for pregnant women with metabolic syndrome

Objective Metabolic syndrome and its indexes is one of the critical health problems during pregnancy. This study aimed to examine the effects of a care intervention program on pregnancy outcome in pregnant women with Metabolic Syndrome during 2017–2018. Methods This randomized clinical trial study was conducted in 120 singleton pregnant women with metabolic syndrome. The participants were selected using purposive sampling method from pregnant women referred to two health centers of Babol. They were randomly divided in two control and intervention groups (60 samples in each group). Intervention group received one motivational interview session for 120 min, two consultation sessions with expert for nutritional recommendations based on Nutrition Guidelines of Ministry of Health for Pregnant Women. They were also theoretically and practically provided by three training sessions for physical activity and pregnancy exercises combining pelvic floor muscles, bodybuilding, muscle strengthening, stretching, and relaxation and walking activities. To follow up on the intervention, the researcher made a phone call with the participants in intervention group every 10 days to two weeks. Pregnancy outcomes were assessed using SPSS software. Results The obtained results showed that there was a significant difference between the two groups in maternal complications including gestational diabetes, hospitalization due to gestational diabetes, nutritional diet for gestational diabetes, pregnancy weight gain and 2-hour post-prandial blood glucose test (p ≤ .01). There was no significant difference in terms of demographic, midwifery and metabolic syndrome indices between the intervention and control groups. Conclusion The results of the study indicated that intervention program improved the maternal pregnancy outcome such as gestational diabetes and weight gain during the pregnancy in the intervention group. This program had no adverse effects for the mother who is consistent with pregnancy health objectives.

Clinical characteristics and pregnancy outcome of 14 pregnant women with history of atherosclerotic cardiovascular disease

Objective: To summarize the clinical characters and pregnancy outcome in pregnant women with history of atherosclerotic cardiovascular disease (ASCVD). Methods: A total of 14 pregnant women with pre-existing ASCVD admitted to Beijing Anzhen Hospital from October 2013 to May 2020 were enrolled as subjects, whose ASCVD disease status, clinical manifestations, treatment and pregnancy outcomes were collected and retrospectively analyzed. Results: The age of subjects at diagnosis of ASCVD was (31±7) years old. The main intervention before pregnancy was revascularization (10 cases), and the rest 4 cases were treated with medicine. The age of subjects at pregnancy was (36±5) years old. A total of 12 cases had risk factors of ASCVD. In early stages of pregnancy, there were 1 case with cardiac function level Ⅲ and 1 with cardiac function level Ⅳ. Abnormal ventricular wall motion and ventricular aneurysm formation were determined in 3 cases by echocardiography, one of which was complicated with moderate left ventricular ejection fraction impairment. Abnormal ST segment in 4 cases and sinus tachycardia in 1 case were found by electrocardiogram. Troponin (TNI) increased in 1 case. The serum low density lipoprotein cholesterol level (LDL-C) of these pregnant women at early stages of pregnancy was (2.3±1.0) mmol/L. A total of 9 pregnant women entered later stages of pregnancy, 1 of whom had chest tightness after slight activity. There were 4 cases with excessive weight gain and 2 cases with insufficient weight gain during pregnancy, and there were 1 case with cardiac function level Ⅲ and 1 case with mild impaired left heart function. The average level of LDL-C was (2.6±0.6) mmol/L in 5 pregnant women at their later stages of pregnancy. The main treat measures included anti-platelet therapy (aspirin, 75-100 mg/d) and healthy lifestyle interventions. Five pregnant women terminated their pregnancy at the early stage of pregnancy, and 9 full-term pregnant women underwent hysterotomy with intraoperative blood loss of 180-800 ml. Adverse cardiac events occurred in 2 cases and gestational diabetes was diagnosed in 3 cases during pregnancy, among which 2 cases were complicated with chronic hypertension and preeclampsia. The weight of 9 live newborns was (3 102±647) g, among which 2 were smaller than gestational age and 1 was of low birth weight. Conclusions: Women with established ASCVD before preynancy have risk of adverse cardiac events in pregnancy. Strengthening the management of high risk factors in pregnancy is conducive to achieving a good pregnancy outcome.

Selected Micronutrients: An Option to Boost Immunity against COVID-19 and Prevent Adverse Pregnancy Outcomes in Pregnant Women: A Narrative Review.

The coronavirus disease-19 (COVID-19) negatively affects immune system. It is linked with adverse pregnancy outcomes. These complications may be linked with the infections mediated deficiency of micronutrients in pregnant women. COVID-19 cause’s malabsorption of micronutrients thereby increases the risk of their deficiency. Both micronutrients deficiencies and poor micronutrients intake can compromise immune function and may increase the risk of pregnancy complications associated with COVID-19 infection. Vita-min A, C, D, E, and selected minerals iron (Fe), selenium (Se), and zinc (Zn) are the micronutrients essential for immuno-competency and play a significant role in the prevention of adverse pregnancy outcomes. Immune function and pregnancy outcomes can be improved by adequate intake of micronutrients in diet or in supplements form. Based on regulatory links between viral infection, micronutrients, immunity, and pregnancy outcomes, this review highlights the role of micronutrients in boosting immunity to reduce or prevent pregnancy complications in COVID-19 infected women.

Oral and intestinal microbial features in pregnant women with hypothyroidism and their correlations with pregnancy outcomes

The purpose of this study was to explore the characteristics of oral and intestinal microbiota of pregnant women with hypothyroidism during pregnancy, and to find the correlations between the changes of flora and pregnancy outcome of pregnant women with hypothyroidism during pregnancy. In this study, oral and intestinal microbial composition was surveyed by using the 16S rRNA sequencing approach in 61 pregnant women (30 with hypothyroidism and 31 normal controls). Sequentially, we validated the differential microbial features by using the quantitative real-time PCR (qPCR) approach in 10 randomly selected pregnant women (5 with hypothyroidism and 5 normal controls). Furthermore, general clinical data and serological indices were added to the analysis to examine the links between oral and intestinal microbiota and pregnancy outcomes. The 16S rRNA results showed that the relative abundances of Gammaproteobacteria were higher in pregnant women in the hypothyroidism group than in those in the control group, whereas the levels of Firmicutes were higher in the control group than in the hypothyroidism group. The serum C-reactive protein level, the weight gain during pregnancy, and the incidence of fetal distress were higher in the hypothyroidism group than in the control group. The QPCR results also showed the same changes of the intestinal microbiota in the two groups. There were significant differences in the oral and intestinal microbiota between pregnant women with hypothyroidism and normal pregnant women. The changes of microbiota is one of the factors influencing the occurrence and development of hypothyroidism during pregnancy.

Prevalence and association of adverse pregnancy outcomes in pregnant women with abnormal levels of serum markers in the first trimester of pregnancy at Tehran Nasl-Omid Center in 2012-2016

Prevalence and association of adverse pregnancy outcomes in pregnant women with abnormal levels of serum markers in the first trimester of pregnancy at Tehran Nasl-Omid Center in 2012-2016

Adverse pregnancy outcomes associated with first-trimester exposure to angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers: A systematic review and meta-analysis.

This study aimed to determine the effects of prenatal exposure to angiotensin‐converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs), particularly when exposure is limited to the first trimester of pregnancy, on adverse maternal and neonatal outcomes. A systematic search was performed on four databases, that is, PubMed, Scopus, Web of Science, and Cochrane Library, to identify relevant articles published up to December 31, 2019. Included studies were limited to original investigations assessing the association between prenatal exposure to ACEIs/ARBs and adverse pregnancy outcomes. Odds ratios were used as a summary effect measure. Pooled‐effect estimates of each outcome were calculated by the random‐effects meta‐analysis. The main outcomes included overall and specific congenital malformations, low birth weight, miscarriage, elective termination of pregnancy, stillbirth, and preterm delivery. Of 19 included articles involving a total of 4 163 753 pregnant women, 13 studies reported an increased risk of, at least, one adverse pregnancy outcome in pregnant women who were exposed to ACEIs/ARBs. Meta‐analysis revealed a significant association between overall congenital malformations and first trimester‐only exposure to ACEIs/ARBs (OR = 1.94, 95% CI = 1.71‐2.21, P < .0001). Cardiovascular malformations, miscarriage, and stillbirth also provided a significant relation with ACEI/ARB exposure. In conclusion, prenatal exposure to ACEIs/ARBs in the first trimester of pregnancy was found to be associated with an increased risk of adverse pregnancy outcomes. Women of reproductive age should be aware of the potential teratogenic risks of these drugs if they become pregnant.

“Optimal Physical Activity Cut-off Value” For Preventing Gdm Among Pregnant Women In Beijing

The prevalence of gestational diabetes mellitus (GDM) has rapidly risen during the past decade, and it is considered that GDM contributes to the increasing risk of adverse perinatal outcomes. Physical activity has been reported to be beneficial in improving pregnancy outcomes in pregnant women with GDM, however, there is a lack of evidence-based recommended amounts of physical activity specific for preventing GDM among Chinese pregnant women. PURPOSE: The study aims to explore the “optimal physical activity cut-off value” for preventing GDM among pregnant women in Beijing, preparing to provide scientific basis for future research of personalized exercise prescription. METHODS: A total of 321 pregnant women who took regular prenatal examination in outpatient clinics were finally chosen into the study, including 59 patients with GDM and 262 controls. General information and clinical data of each participant was collected through electronic medical record system, physical activity data was investigated using the short form of International Physical Activity Questionnaires (IPAQ), and physical activity level was calculated bases on the standard methods. Difference in means for continuous variables were compared using t-test, and differences in proportions were tested by chi-square test, ROC curve analysis was conducted to screen the “optimal physical activity cut-off value.” RESULTS: Compared with control group, average age (31.62 ± 2.95 vs 29.90 ± 3.34 yrs,t=3.63, P<0.05) , the proportion of participants with low education level (25.42% vs 8.78%, χ2=19.31, P<0.05) and overweight or obese before pregnancy (38.98% vs 24.05%, χ2=7.19, P<0.05) in GDM group are significantly higher. The area under the ROC curve is 0.82(0.77~0.86)(P<0.05), and the “optimal physical activiry cut-off value” is 834 MET*min per week. CONCLUSIONS: Older age, lower education level and overweight or obese before pregnancy contributes to the risk of GDM. It is recommended that physical activity level of more than 834 MET*min per week, accordingly walking no less than 36 minutes per day is beneficial to reduce the risk of GDM.

New corona virus and pregnancy; What should obstetricians know?

COVID-19, the disease caused by a new coronavirus, has quickly raised the world concern by spreading globally at an accelerated rate and is now a pandemic, according to the World Health Organization. But limited data are available for pregnant women with COVID-19 infection. The pregnant women present a unique challenge during the COVID-19 pandemic and several questions remain about pregnant women and their newborns. whether they will develop distinct symptoms from non-pregnant adults and whether COVID-19 could spread vertically pose risks to the fetus and neonate. Information on adverse pregnancy outcomes in pregnant women with COVID-19 is lacking. Previous reports on pregnant women with SARS and MERS show higher case fatality rate, while, COVID-19 appears less-lethal Compared with SARS and MERS,In this study we aim to highlight COVID-19 infection during pregnancy, bringing together the various factors integral to the understanding of clinical manifestations, diagnostic challenge and susceptibleness with the virus, intrauterine infection and maternal-fetal complications, therapeutic controversies,

1376-P: Association of Continuous Glucose Monitoring (CGM)-Derived Parameters with Adverse Pregnancy Outcomes in Pregnant Women with Type 1 Diabetes

Background: The relation of CGM derived parameters and adverse pregnancy outcomes (APOs) in pregnant women with type 1 diabetes (T1D) is not completely clear. Methods: During 2015 - 2018, data were prospectively collected from pregnancies of women with pregestational T1D receiving intermittent CGM in 11 centers in China. Characteristics and CGM derived parameters were compared between the women who had severe APOs and those who did not. Severe APOs were defined as maternal death, neonatal death, congenital anomaly, pregnancy loss in 2nd/3rd trimester and neonatal admission to intensive care unit. Results: Data of 84 pregnant women with pregestational T1D were collected. Among them, 56 had received CGM in the 1st trimester, 55 in the 2nd trimester, and 59 in the 3rd trimester. 30 of these 84 women had severe APOs. Compared with women without severe APOs, women who had severe APOs had lower age at diagnosis, longer diabetes duration at conception. For CGM derived parameters, women who had severe APOs had significantly higher mean glucose (MG), MG at wake, MG at night, and time above range (TAR, &amp;gt;7.8mmol/L) throughout all 3 trimesters, compared with women who did not have. Details see Table. Conclusions: Higher MG, MG at wake, MG at night, and TAR throughout pregnancy were associated with the presence of severe APOs in women with T1D. These parameters should be closely monitored. Disclosure S. Luo: None. P. Ling: None. Y. Ding: None. X. Zheng: None. D. Yang: None. Y. Zhou: None. J. Yan: None. J. Weng: None. Funding National Health and Family Planning Commission of the People’s Republic of China; Foundation for Public Welfare Industry Research Project (201502011)

1374-P: Association between Number of Abnormal Glucose Values and Severity of Fasting Plasma Glucose in IADPSG Criteria and Pregnancy Outcomes in Pregnant Women in South India

Background: International Association for Diabetes in Pregnancy Study Group (IADPSG) criteria recommends single step OGTT for diagnosis of gestational diabetes mellitus (GDM). The main concerns with IADPSG criteria are i) only one abnormal value is required and ii) fasting plasma glucose (FPG) cut point is too low. We report on association between number of abnormal glucose values and levels of FPG with pregnancy outcomes. Methods: Pregnant women (n=1,044) were screened for GDM using IADPSG criteria. OGTT’s were classified based on the number of abnormal glucose values (any one value vs. more than one value), and FPG values (&amp;lt;92mg/dl,92-100mg/dl,&amp;gt;100mg/dl) and correlated with pregnancy outcomes. Odds Ratios were adjusted for age, BMI, family history of diabetes, history of GDM, birth weight, gestational week at diagnosis and delivery. For macrosomia, birth weight was not included. Results: For caesarean sections, risk was higher in women with any one abnormal glucose value (OR:1.53;95%CI:1.08-2.16) and it increased further in those with more than one abnormal value (OR:1.58;95%CI:0.99-2.52), compared to women with normal glucose tolerance (NGT). Risk of caesarean section was also higher in women with FPG (92-100mg/dl) (OR:1.36;95%CI:0.86-2.15) and even higher in women with FPG &amp;gt;100mg/dl (OR:1.88;95%CI:1.08-3.29) when compared to FPG &amp;lt;92mg/dl. For macrosomia, women with any one abnormal value (OR:1.49;95%CI:0.96-2.33) and with more than one abnormal value (OR:1.07;95%CI:0.57-2.03) had higher risk compared to women with NGT. Risk of macrosomia was also higher in women who had FPG 92-100mg/dl (OR:1.04;95%CI:0.56-1.95) and FPG &amp;gt;100mg/dl (OR:1.61;95%CI:0.83-3.10) compared to FPG&amp;lt;92mg/dl. Conclusion: The risk for poor pregnancy outcomes starts in those with one abnormal value in the OGTT or with FPG &amp;gt;92mg/dl and the risk further increases with higher abnormal values. Disclosure B. Balaji: None. R. Anjana: None. M. Deepa: None. P. Rajendra: None. U. Ram: None. P. Saravanan: None. V. Mohan: None.

Effectiveness of telemedicine for pregnant women with gestational diabetes mellitus: an updated meta-analysis of 32 randomized controlled trials with trial sequential analysis

BackgroundGestational diabetes mellitus (GDM) is now a global health problem. Poor blood glucose control during pregnancy may lead to maternal and neonatal/foetal complications. Recently, the development of information and communication technology has resulted in new technical support for the clinical care of GDM. Telemedicine is defined as health services and medical activities provided by healthcare professionals through remote communication technologies. This study aimed to update the systematic review of the effectiveness of telemedicine interventions on glycaemic control and pregnancy outcomes in pregnant women with GDM.MethodsWe searched the Web of Science, PubMed, Scopus, Cochrane Central Register of Controlled Trials, Chinese National Knowledge Infrastructure, Wan-fang Database, China Biology Medicine and VIP Database for randomized controlled trials (RCTs) related to the effectiveness of telemedicine interventions for GDM from database inception to July 31st, 2019. Languages were limited to English and Chinese. Literature screening, data extraction and assessment of the risk of bias were completed independently by two reviewers. Meta-analysis and trial sequential analysis were conducted in Stata 14.0 and TSA v0.9.5.10 beta, respectively.ResultsA total of 32 RCTs were identified, with a total of 5108 patients. The meta-analysis showed that telemedicine group had significant improvements in controlling glycated haemoglobin (HbA1c) [mean difference (MD) = − 0.70, P < 0.01], fasting blood glucose (FBG) (MD = -0.52, P < 0.01) and 2-h postprandial blood glucose (2hBG) (MD = -1.03, P = 0.01) compared to the corresponding parameters in the standard care group. In the telemedicine group, lower incidences of caesarean section [relative risk (RR) = 0.82, P = 0.02], neonatal hypoglycaemia (RR = 0.67, P < 0.01), premature rupture of membranes (RR = 0.61, P < 0.01), macrosomia (RR = 0.49, P < 0.01), pregnancy-induced hypertension or preeclampsia (RR = 0.48, P < 0.01), preterm birth (RR = 0.27, P < 0.01), neonatal asphyxia (RR = 0.17, P < 0.01), and polyhydramnios (RR = 0.16, P < 0.01) were found. The trial sequential analyses conclusively demonstrated that the meta-analytic results of the change in HbA1c, the change in 2hBG, the change in FBG, the incidence rates of caesarean section, pregnancy-induced hypertension or preeclampsia, premature rupture of membranes, premature birth, neonatal asphyxia, and polyhydramnios were stable.ConclusionsCompared to standard care, telemedicine interventions can decrease the glycaemic levels of patients with GDM more effectively and reduce the risk of maternal and neonatal/foetal complications.

Kidney function, blood pressure and proteinuria were associated with pregnancy outcomes of pregnant women with chronic kidney disease: a single-center, retrospective study in the Asian population.

Studies among pregnant Asian women with chronic kidney disease (CKD) have not been widely performed; therefore, clinical criteria for these patients have not been well established. We conducted a retrospective study among pregnant women with CKD who received prenatal care at our institution for 8 consecutive years. Primary outcome was the development of severe adverse events (SAEs). We analyzed correlations between primary outcome and CKD parameters [age, body mass index (BMI), estimated glomerular filtration rate (eGFR), urinary protein-creatinine ratio (UP), systolic blood pressure (SBP), diastolic blood pressure (DBP), and not normal blood pressure (non-NBP)] at the time of referral. Secondary outcomes were low birth weight (LBW), preterm delivery (PreD), and small for gestational age (SGA). We divided into two categories, CKD stage G1, and G2 or higher according to eGFR, and proteinuria negative and proteinuria positive according to UP, respectively. We observed 89 pregnancies. SAE was observed in 28 pregnancies. In live birth cases, there were 28 PreD, 28 LBW and 13 SGA. Major SAEs included preeclampsia, superimposed preeclampsia, unscheduled cesarean section, neonatal intensive care unit admission, and fetal death. Stepwise logistic regression analysis selected eGFR (OR = 0.847, p = 0.026), SBP (OR = 1.897, p = 0.006) and proteinuria positive (OR = 2.96, p = 0.046) as the significant predictors of SAEs. There were no significant differences among the baseline characteristics stratified by SGA. This is the first study to report pregnancy outcomes among Japanese non-disease-oriented patients with CKD. In Asians, especially in the Japanese population, kidney function, blood pressure and proteinuria might affect pregnancy outcomes.

Atrial septal aneurysm in pregnancy: echocardiography and obstetric outcomes.

Background Atrial septal aneurysm (ASA) is an uncommon cardiac anomaly that increases maternal morbidity during pregnancy. ASA is related to atrial arrhythmia thromboembolism and it may accompany congenital anomalies such as an atrial septal defect (ASD) or patent foramen ovale (PFO). There are no studies examining pregnancy outcomes in pregnant women with ASA. We aimed to investigate the cardiologic parameters and obstetric outcomes of pregnant women diagnosed with ASA. Methods This prospective cohort study analyzed 45 pregnant women diagnosed with ASA, who continued their follow-ups in an obstetric tertiary care center. Results A total of 45 pregnant women were recruited; seven pregnancies ended before the 20th gestational week (six spontaneous abortion, one fetal anomaly), 38 women gave birth. In total, there were 32 term births (≥37 weeks), six preterm births (<37 weeks), two extremely preterm births <28 weeks). Among 38 babies delivered, several obstetrical complications such as oligohydramnios, spontaneous preterm labor, intrauterine growth restriction (IUGR), preeclampsia and gestational diabetes mellitus (GDM) developed in 16 patients, while 22 women ended with term pregnancy without any complications. Deep venous thrombosis (DVT) developed in one patient. Conclusion ASA may have an increased risk for cardiac complications during pregnancy and may also be associated with poor pregnancy outcomes. Increased attention to these entities with more studies is needed in order to determine a potential risk for pregnant women.

Pregnancy outcomes for pregnant women with chronic hepatitis B exposing to entecavir or adefovir dipivoxil therapy before or in early pregnancy

Background Entecavir (ETV) or adefovir dipivoxil (ADV) are not recommended during pregnancy because of embryotoxicity or teratogenicity found in animal studies; however, information on the safety of ETV or ADV in humans is limited. Aims The aim of this study was to investigate the safety of ETV or ADV in women with chronic hepatitis B (CHB). Methods We retrospectively enrolled 152 pregnant women with CHB who exposed to ETV or ADV in the first trimester of pregnancy. All the mothers were followed until postpartum 7 months. All newborns received immunoprophylaxis. The primary endpoint was the safety of mothers and infants. The secondary endpoint was the rate of mother-to-child transmission (MTCT) of hepatitis B virus (HBV). Results The pregnant women were divided into two groups. Group 1 included 20 pregnant women who became unplanned pregnancy with ETV or ADV treatment. All of them switched to TDF before 7 weeks of gestation. There were 20 women with 20 pregnancies and 18 live births. Group 2 included 132 with TDF before conception. There were 132 women with 141 pregnancies and 125 live births. The abortion rate of Group 1 was not higher than that in Group 2 (10.0 versus 10.6%, p = 1.000). The birth defect rate in Group 1 did not statistically differ from Group 2 (5.6 versus 4.8%, p = 1.000). There were no significant differences of gestational complications between the two groups. The rate of MTCT of HBV is 0%. Conclusions Among infants exposed to ETV or ADV before conception, ETV or ADV was not associated with a higher risk for adverse birth outcomes.

Pulmonary Hypertension and Pregnancy Outcomes: Systematic Review and Meta-Analysis

Background: Traditionally, pulmonary hypertension during pregnancy has been associated with increased risk of adverse maternal and fetal outcomes. Therefore, the aim of this systematic review was to assess the risk of adverse pregnancy outcomes in pregnant women with pulmonary hypertension in recent decades. Methods: Electronic literature search of Medline, EMBASE and Cochrane library to find studies published in English literature from 1 Jan 1990 to 31st May 2018. Two authors independently extracted data from the eligible studies. Observational studies and case series describing adverse pregnancy outcomes in at least 4 pregnant women with pulmonary hypertension were included. The primary outcomes were maternal mortality and any pregnancy loss. The analysis included absolute risks and 95% confidence intervals (CI) for adverse outcomes using the DerSimonian-Laird random effects model. Heterogeneity was assessed by I2 statistic and visual plot. Results: Twenty studies captured data from 589 parturient describing 610 pregnancies. The majority (84.2%) of parturient had WHO Class I pulmonary hypertension. Pooled unadjusted data yielded maternal mortality of 11.5 (95% CI; 7.6-17.2) and total pregnancy loss of 22.8 (95% CI; 16.2-31.1). Prematurity and IUGR/SGA were reported by 7 and 8 studies and had pooled estimates of 51.7 (95% CI; 37.6-65.7) and 29.3 (95% CI; 20.9-39.5), respectively. The pooled estimates of cesarean delivery and general anesthesia were 72.1 (95% CI; 60.6-81.93) and 40.1 (95% CI; 26.4-55.5), respectively. Conclusions: Fetomaternal outcomes have improved in recent decades in pregnant women with moderate to severe grades of pulmonary hypertension. Though pregnancy should be discouraged, early pregnancy termination and planned early delivery with pulmonary artery pressure directed treatment appear to improve the fetomaternal outcome further. Funding Statement: The authors stated: None. Declaration of Interests: None of authors reported any conflicts of interest. Ethics Approval Statement: PROSPERO, number: CRD42018099974.

Importance of diagnosis time on pregnancy outcomes in pregnant women with pre-gestational diabetes mellitus

Objective: To analyze the characteristics of pregnant women with pre-gestational diabetes mellitus (PGDM) who had missed diagnosis prior to pregnancy, and to evaluate the effects of diagnosis time on pregnancy outcomes in pregnant women with PGDM. Materials and Methods: A total of 822 pregnant women who were diagnosed with PGDM were conducted in this study. They were divided into two groups, including pre-pregnancy diagnosis group and pregnancy diagnosis group based on the initial diagnosis time. Then in the pregnancy diagnosis group, the cases diagnosed before 24 gestational weeks were defined as group A, and those diagnosed at or after 24 gestational weeks were defined as Group B. Maternal and pregnancy variables, as well as pregnancy outcomes, including delivery age of pregnant women, the rate of pregnancy loss, delivery gestational weeks, neonatal birth weight, the proportion of insulin treatment, the rate of pre-term, macrosomia, newborns transferred to pediatrics, the average of HbA1c level, and preeclampsia, were analyzed among groups by paired Student’s t-test. Results: The rate of missed diagnosis before pregnancy was 68.1%. The proportion of insulin treatment and the rate of the cesarean section had a significant difference between pre-pregnancy diagnosis group and pregnancy diagnosis group. The characteristics and pregnancy outcomes in pregnancy diagnosis group A were not significantly different from those in the pre-pregnancy diagnosis group. However, in the pregnancy diagnosis group B, the proportion of pregnant women using insulin treatment and the average HbA1c level had a statistically significant difference, compared to pregnancy diagnosis group A, as well as the pre-pregnancy group. Conclusions: The rate of undiagnosed PGDM was high, and PGDM was significantly associated with multiple adverse pregnancy outcomes. Fasting plasma glucose should be used as a screening test to identify PGDM at pre-pregnancy or first antenatal care.

COVID-19 &amp; Pregnancy Complication During Early Pandemic: A Narrative Review

Background: Coronaviruses have caused 3 outbreaks in the past 2 decades. The novel one is SARS-COV-2, which causes COVID-19. Pregnant women have somewhat altered immune state, which may make them more vulnerable to COVID-19 and its complications. Extensive research is needed to better understand the clinical course of COVID-19 in this population. Objective: This review article discusses the comparison of previous coronaviruses’ outbreaks, clinical presentations, and complications in pregnant women and newborns. Study Design: We conducted literature search for case series and case reports about pregnancy outcomes in pregnant women with COVID-19 during the early phase of pandemic. Results: In case series, 37 of 129(28.6%) pregnant women with COVID-19 disease had preterm delivery and 14 of 67 pregnant women had fetal distress. The rate of preterm labor in normal pregnant women who are healthy and not infected with any virus worldwide is approximately 11%. Conclusion: Based on the articles reviewed, preterm delivery appears to be the most common complication in COVID-19 pregnant patients. Other complications include fetal distress, stillbirth, ICU admission and severe disease leading to fetal demise and maternal mortality. Pregnancy outcomes seem to be better with Covid-19 compared to SARs and MERS. However, most of these publications are from the early part of the pandemic when protocols for care for pregnant women were being worked out and comprehensive knowledge of the disease process in pregnant women was still in developing stage.

Are anemia, gastrointestinal disorders, and pregnancy outcome associated with pica behavior?

This study was conducted to determine the relationship between pica and anemia, gastrointestinal disorders, as well as pregnancy outcomes in pregnant women. This study was a prospective study carried out between January 2016 and June 2017 and was performed on 226 pregnant women who attended four different health care centers to receive routine prenatal care. Sampling was done considering the inclusion criteria, in two steps: cluster sampling and random sampling. Data collection was done using a researcher-made checklist. The significance level was set at p = 0.05. The average age of the participants was 26.10±6.27. The prevalence of pica in pregnant women in the first, second, and third trimesters was 9.3, 8, and 2.1%, respectively. The most common pica craving among pregnant women was for ice and frozen materials (68.2%). There was a statistically significant relationship between gastrointestinal disorders and anemia with pica (p < 0.001). There was also a significant relationship between birth weights of babies born to mothers with pica and those without pica (p = 0.005). Pica in pregnant women had a significant relationship with gastrointestinal disorders and anemia during pregnancy and pregnancy outcomes. Thus, in addition to providing healthcare services, health care professionals should consider patients' pica practices and make the necessary interventions.