Pregnancy-related Outcomes Research Articles

Pregnancy Outcomes: Effects of Metformin (POEM) study: a protocol for a long-term, multicentre, open-label, randomised controlled trial in gestational diabetes mellitus

IntroductionGestational diabetes mellitus (GDM) is a common disorder of pregnancy with health risks for mother and child during pregnancy, delivery and further lifetime, possibly leading to type 2 diabetes mellitus...

A178 BIOLOGIC THERAPY DURING PREGNANCY AS PER GUIDELINE RECOMMENDATIONS REDUCES ADVERSE PREGNANCY RELATED OUTCOMES

BackgroundInflammatory bowel disease (IBD) disease activity during pregnancy is associated with adverse neonatal and pregnancy-related outcomes. Biologics are used to suppress disease activity but crosses the placenta in the third trimester. Conflicting studies and guidelines on the timing of biologic dosing in pregnancy persist as we try to balance the risk of disease flare and possible adverse drug effects. The American Gastroenterology Association (AGA) recommends timing the final dose according to the half-life and dosing regimen of each biologic agent.AimsTo compare neonatal and pregnancy-related outcomes in early versus late dosing of biologics.MethodsThis was a single-center retrospective cohort study conducted at Mount Sinai Hospital from 2016–2021. We included patients with an established diagnosis of IBD before pregnancy who were at least 18 years of age at the time of conception. All patients must have been treated with an IBD-specific biologic agent and had a documented final dose during the pregnancy. The early group received their last biologic dose earlier than the AGA recommendations and the late group received it within the recommended interval. A patient was considered to have a flare based on the overall clinical impression of their gastroenterologist informed by reported symptoms, investigations (fecal calprotectin, endoscopy), and response to treatment. Neonatal and pregnancy-related outcomes were compared amongst the two groups using the student’s t-test (for continuous variables) and Fischer’s exact test (for categorical variables) using SPSS Version 27.ResultsOf 322 patients who had a completed pregnancy at Mount Sinai Hospital, 107 were included in this study. 67 (62.6%) were in the early and 40 (37.4%) were in the late groups. Baseline characteristics including age, comorbidities, IBD phenotype and disease activity were similar between the two groups. The late group had significantly later gestational ages (37.4 vs 38.7 weeks, p=0.006), higher 5-minute Apgar scores (8.7 vs. 9.0, p=0.042), fewer NICU admissions (25.4% vs 5.0%, p=0.036), and fewer IBD flares (28.3% vs 11.1%, p=0.039) in the 6-month post-partum period. There were no significant differences in the rates of premature birth, caesarian sections, infections, and congenital abnormalities. Results are displayed in figure 1.ConclusionsOur study suggests that late dosing of biologics according to the AGA guidelines was associated with favourable outcomes. However, this is an unadjusted analysis based on retrospective data and findings should be confirmed in a prospective manner to account for confounders. Funding AgenciesNone

Survey of Raspberry Leaf Tea in pregnancy.

Raspberry leaf tea (RLT) is a traditional herb purported to help with many pregnancy-related outcomes including reducing the duration of labour. No experimental data exist to support these claims. This study aims to determine how common use and knowledge of RLT are during pregnancy. It also aims to explore whether it would be possible to recruit women for a trial of raspberry leaf in the future. Postnatal women were asked to fill in a survey about their use of RLT during pregnancy, and their knowledge of its purported benefits. They were asked whether they would consider being part of a randomised controlled trial of raspberry leaf in the future. One hundred and twenty-one women completed the survey. Of these, 88 (73%) were aware of herbal tea use in pregnancy and 46 (38%) reported using raspberry leaf during pregnancy. Of all women surveyed, 79% indicated they would be happy to participate in a trial of RLT in pregnancy if they were asked. Despite no scientific evidence of the efficacy of RLT in pregnancy, 38% of women surveyed used it during pregnancy. Further studies are required to determine whether the claims made about RLT are correct. Clinicians should base their advice on available evidence.

Analysis of pregnancy-related adverse outcomes in patients with severe hypothyroidism during pregnancy

Objective: To analyze the pregnancy-related adverse outcomes in patients with severe hypothyroidism during pregnancy. Methods: Using cross-sectional study, a total of 47 pregnant women with severe hypothyroidism in the Peking University First Hospital from January 2007 to December 2020 were retrospectively collected by electronic case system. According to the occurrence of adverse pregnancy events (defined as any pregnancy complication or adverse maternal-fetal/neonatal outcomes), the patients were divided into pregnancy-related adverse outcomes group (n=33) and no pregnancy-related adverse outcomes group (n=15). The demographic data, thyroid function and thyroid autoantibody levels during pregnancy, pregnancy complications and maternal-fetal/neonatal outcomes of the two groups were recorded and analyzed. Results: The age of severe hypothyroidism women was (30.5±4.1) years. The median of gestational week at delivery was 38.6 (36.3, 39.9) weeks, the median of gestational week for diagnosis was 7.0 (6.0, 8.8) weeks, the median of the highest TSH level was 32.7(23.1,60.2)mU/L and the period of reaching the target TSH level for the first time was 6.0(4.0, 10.0)weeks. Most cases (82.5%, 33/40) had thyroid autoimmunity. All women were treated with levothyroxine (L-T4) during pregnancy. A total of 37 cases (77.1%, 37/48) of them obtained the recommended target values. Fourty cases (83.3%, 40/48) gave birth. The birth weight of newborns was (3 041±452) g, the body length was (49.4±2.1) cm, and the head circumference was (33.6±0.7) cm. The period of reaching to target TSH level for the first time in patients without pregnancy-related adverse outcomes was shorter [5.0 (3.0, 9.0) vs 8.0 (4.5, 12.5) weeks) ] (P=0.033), and the times of thyroid function monitoring were more frequent [ (8.2±3.5) vs (6.0±3.6) times] (P=0.049) than the group with pregnancy-related adverse outcomes. Conclusions: The incidence of pregnancy complications and adverse maternal-fetal/neonatal outcomes is high in patients with severe hypothyroidism during pregnancy. Intense follow-up, treatment and restoration of euthyroidism as prompt as possible may improve pregnant outcomes.

Complexities in Assessing Pregnancy-related Outcomes Among Patients Receiving Interdisciplinary Treatment for an Opioid Use Disorder.

Complexities in Assessing Pregnancy-related Outcomes Among Patients Receiving Interdisciplinary Treatment for an Opioid Use Disorder.

Immunogenicity Following Administration of BNT162b2 and Ad26.COV2.S COVID-19 Vaccines in the Pregnant Population during the Third Trimester.

Globally, COVID-19 vaccines are currently being used to prevent transmission and to reduce morbidity and death associated with SARS-CoV-2 infection. Current research reveals that vaccines such as BNT162b2 and Ad26.COV2.S are highly immunogenic and have high short-term effectiveness for most of the known viral variants. Clinical trials showed satisfying results in the general population, but the reluctance in testing and vaccinating pregnant women left this category with little evidence regarding the safety, efficacy, and immunogenicity following COVID-19 vaccination. With the worldwide incidence of COVID-19 remaining high and the possibility of new transmissible SARS-CoV-2 mutations, data on vaccination effectiveness and antibody dynamics in pregnant patients are critical for determining the need for special care or further booster doses. An observational study was developed to evaluate pregnant women receiving the complete COVID-19 vaccination scheme using the BNT162b2 and Ad26.COV2.S, and determine pregnancy-related outcomes in the mothers and their newborns, as well as determining adverse events after vaccination and immunogenicity of vaccines during four months. There were no abnormal findings in pregnancy and newborn characteristics comparing vaccinated versus unvaccinated pregnant women. COVID-19 seropositive pregnant women had significantly higher spike antibody titers than seronegative patients with similar characteristics, although they were more likely to develop fever and lymphadenopathy following vaccination. The same group of pregnant women showed no statistically significant differences in antibody titers during a 4-month period when compared with case-matched non-pregnant women. The BNT162b2 and Ad26.COV2.S vaccines are safe to administer during the third trimester of pregnancy, while their safety, efficacy, and immunogenicity remain similar to those of the general population.

How a Public Health Crisis Created an Impetus for Change: The Robert Wood Johnson Foundation's National Commission to Transform Public Health Data Systems: Expert Roundtable.

How a Public Health Crisis Created an Impetus for Change: The Robert Wood Johnson Foundation's National Commission to Transform Public Health Data Systems: Expert Roundtable.

Pregnancy Complications and Outcomes Among Women With Congenital Heart Disease in Beijing, China.

ObjectiveTo conduct a comparative analysis of the complications and outcomes in pregnant women with and without congenital heart disease (CHD) in Beijing, China.MethodsWe compared pregnancy-related complications and outcomes experienced by women with and without CHD throughout 19,424 deliveries in Beijing Anzhen Hospital between 2010 and 2019, including cardiovascular and obstetric factors, fetal events, delivery methods, and other complications over a mean 5-years post-delivery follow-up period.ResultsThere were 1,040 women with CHD (5.35% of all deliveries). Compared to women without CHD, these women had longer hospital stays (7.83 ± 4.65 vs. 4.93 ± 3.26 days) and a higher death rate (1.92 vs. 0.02%). They also had a greater risk of comorbidities, including pre-term delivery (odds ratio: 13.65 vs. 6.71), heart failure (odds ratio: 4.90 vs. 0.40), and arrhythmia (odds ratio 12.69 vs. 4.69). Pulmonary hypertension, New York Heart Association functional class III~IV, and no congenital heart disease surgery prior to pregnancy were associated with adverse events such as cesarean section, pre-term delivery, and heart failure. The fetuses of mothers with CHD were more likely to be born pre-term (odds ratio: 13.65 vs. 6.71) and have low birth weight (odds ratio: 8.56 vs. 4.36). Eleven infants (1.82%) born to mothers with CHD and four infants (0.64%) born to mothers without CHD were diagnosed with CHD.ConclusionsWomen with CHD generally increase maternal and infant risk during pregnancy and the perinatal period. Pulmonary hypertension, decrease in cardiac function, and no previous CHD surgery increase the risk in women with CHD. Greater attention should be paid to pregnant women with CHD and their fetuses, newborns.

Infant Mortality and Maternal Risk Factors in Texas: Highlighting Zip Code Variations in 2 At-Risk Counties, 2011-2015.

IntroductionStark differences in the infant mortality rate (IMR) exist by geography in Texas. The Healthy Families initiative sought to understand how evidence-informed practices implemented in the community can improve pregnancy-related outcomes in 2 counties in Texas with a high prevalence of maternal chronic conditions. The objective of this study was to examine associations between maternal risk factors and infant deaths to inform strategies to improve outcomes.MethodsTwo counties with high prevalence of maternal chronic conditions were selected as Healthy Families sites: one with lower prenatal care usage than other counties in the state but an IMR lower than Texas, and the other with a higher IMR among minority racial and ethnic groups compared with other women in the county and Texas overall. Cohort-linked birth and infant death records from 2011 through 2015 provided by the Texas Department of State Health Services were analyzed by using logistic regression to examine associations of maternal sociodemographic and pregnancy risk factors with infant death. The data were mapped at the zip code level. Analyses were limited to births to women aged 15 to 49 years who resided in Texas from 2011 through 2015 (n = 1,942,899 births).ResultsThe Texas IMR was 5.4 per 1,000 live births, compared with 4.6 and 7.5 per 1,000 live births for Hidalgo and Smith counties, respectively. Congenital malformations were the leading cause of infant death in both counties for infants born in 2015, which was similar to Texas overall. In both counties, maternal marital status, education, multiple gestation, and cesarean delivery were significantly associated with infant mortality. Wide zip code–level variations in IMR and maternal risk factors were observed in both counties.ConclusionVariations in IMR and key maternal risk factors observed at the zip code level helped drive local strategies to maximize outreach of services to disproportionately affected communities.

Frequency of early initiation of breastfeeding among women in Thatta, Sindh and factors associated with it: A secondary data analysis.

To determine the early breastfeeding initiation prevalence and factors associated with it in a rural seting. The cross-sectional study was conducted at Eight areas of Thatta registed in MNHR from May 2019 to July 2019, and comprised data obtained from a larger survey related to exclusive breastfeeding among women in Thatta, Pakistan, in 2019. The survey had been conducted in areas registered with the Maternal and Neonatal Health Registry, which is a population-based study for developing countries to assess pregnancy-related outcomes. Data was analysed using Stata 16. There were 397 women with a mean age of 27.71±4.92 years. Of them, 305(76.8%) had not received any formal education, 45(11.3%) women had attended primary school, 278(70.1%) were unemployed, and 313(78.8%) had a monthly household income <7,500 rupees. Breastfeeding within the first hour of birth was initiated by 95(20.4%) mothers. Factors associated with early initiation were adequate knowledge, place of delivery, gestational age of the baby and the age of the mother (p<0.05). Providing counseling and health education to mothers before, during and after the pregnancy are important for motivating them to initiate breastfeeding early and continue exclusive breastfeeding for the recommended period of a minimum of 6 months.

The Psychobehavioral Responses of Pregnant Women towards the COVID-19 Pandemic

Psychological distress during pregnancy can have adverse effects on both maternal and fetal wellbeing. It is a well-known fact that it increases risk of preterm deliveries and low birth weight babies. The objective of this study is to determine the psychological responses of pregnant women towards the COVID-19 outbreak, by assessing the degree of stress, anxiety, and depression among these pregnant women. This study is a cross-sectional study, utilizing a five-part questionnaire exploring patients’ sociodemographic background, level of knowledge and psychological impact of the COVID-19 pandemic utilizing the Depression Anxiety Stress Scale (DASS-21). In addition, the study also aims to evaluate the rate of vaccination among pregnant women attending antenatal care in our center. Respondents are recruited from the Antenatal Clinic, Patient Assessment Center (PAC), and maternity wards of the University Malaya Medical Center, Malaysia. The result shows that the percentage of pregnant mothers with significant psychological distress is low at 1%, further scrutiny showed that the level of anxiety as a result of the COVID-19 pandemic is substantial, whereby half of them reported an abnormal score, 5.4 % and 7.9 % of them reported to be having severe and extremely severe levels of anxiety respectively. Risk factors for anxiety include higher education level, being a first time mothers and having significant complications in the current pregnancy. Good stress management, family support and vaccination may have resulted in a lower degree of stress among pregnant women; however the level of anxiety is significantly higher. The result should help maternity care providers to strategize and implement appropriate screening and interventions to prevent significant deterioration in maternal mental health which subsequently could translate into poor pregnancy and fetal related outcomes.

Maternal nutritional knowledge, practice and their associated factors during pregnancy in Addis sub city health centers, Addis Ababa, Ethiopia

IntroductionMaternal dietary knowledge and practice is an essential element in ensuring positive pregnancy-related outcomes, optimal gestational weight gain, reduce complications and positive birth outcomes, and the overall health of mothers. 3.5 million mothers dead annually due to undernutrition; which resulted from a deficit in nutritional knowledge and practices in third world countries, especially in Ethiopia, so it needs further investigation. ObjectiveTo assess maternal nutritional knowledge, practice, and their associated factors during pregnancy in Addis Sub-city health centers, Addis Ababa, Ethiopia, 2021. Method and MaterialsA cross-sectional study design was conducted in the Addis sub-city from April 1 to May 30, 2021. A total of 363 pregnant mothers attending ANC clinics participated in the study. Eligible pregnant mothers were selected using a systematic random sampling method from three health centers proportionally. Data were collected using an interviewer-administered questionnaire prepared in English and translated into the national language, Amharic. The data were entered into Epi-data version 3.1 and exported to SPSS version 26. Bivariate and multivariate logistics regression analyses were employed to identify factors associated with dietary knowledge and practices. ResultsMaternal dietary knowledge was 73.9 % and dietary practices 63.9 % during pregnancy. Being daily laborer (AOR = 0.2, 95 %CI:(0.1–0.9)), husband’s educational level (AOR = 4.3, 95 % CI: (1.1–6.3)), family size (AOR = 1.6, 95 % CI: (2.9–4.6)). Monthly income (AOR = 0.2, 95 % CI: (0.0–0.9)), having chronic illness (AOR = 3.3, 95 % CI, (1.3–8.1)), BMI (AOR = 3.6, 95 %CI: (1.2–5.4)), pregnancy interval (AOR = 0.1, 95 %CI: (0.0–0.4)), ANC visit (AOR = 2.2, 95 % CI:(1.6–2.7)), were significantly associated with dietary knowledge. Being employed (AOR = 1.7, 95 % CI:(1.1–3.9)), husband’s educational level (AOR = 5.3, 95 % CI: (1.3–7.9)), husband’s occupation (AOR = 2.4, 95 %CI: (1.0–5.7)), family size (AOR = 8.7, 95 % CI: (3.2–12.5)) and BMI (AOR = 6.2, 95 % CI: (1.9–14.9) were statistical associated with dietary practice. Conclusion and RecommendationThe overall maternal dietary knowledge was good and dietary practices were poor. Women’s occupational status, husband’s education, family size, and BMI were associated with both knowledge and practices while monthly income, having chronic illness and pregnancy interval and ANC visit was only associated with knowledge. Therefore enhancing maternal educational status increases their dietary knowledge and practices.

Clinical Characteristics and Pregnancy-Related Outcomes of Pregnant Women Hospitalized with COVID-19 During the Delta Wave: A Single-Center Observational Study.

BackgroundCoronavirus disease 2019 (COVID-19) during pregnancy is associated with increased disease severity and an increased risk of perinatal complications. However, few studies of pregnant women with COVID-19 have been conducted in Korea. The purpose of this study was to describe the clinical course and pregnancy outcomes of pregnant women admitted to our hospital with COVID-19 according to the severity.Materials and MethodsThis retrospective cohort study included women aged 18 years of age or older who were hospitalized in the Gachon University Gil Medical Center with COVID-19 during pregnancy between July 1, 2021 and January 31, 2022. COVID-19 severity was classified according to the “Criteria for severity classification by symptoms of COVID-19” presented by the Korea Disease Control and Prevention Agency. Severe cases were defined as those who required oxygen treatment administered via a high-flow nasal cannula or invasive mechanical ventilation or should be applied extracorporeal membrane oxygenation (ECMO) or continuous renal replacement therapy.ResultsA total of 103 pregnant women were hospitalized with COVID-19 during the study period. Their mean age was 33 (± 4.14) years, and 4 (3.9%) had been vaccinated against COVID-19. At the time of diagnosis of COVID-19, 3 (2.9%), 33 (32.0%), and 67 (65.1%) patients were in the first, second, and third trimester, respectively. The most common symptoms were cough (99 patients, 96.1%) and fever (85 patients, 82.5%). There was 1 (1.0%) asymptomatic patient. Forty patients (38.8%) required supplemental oxygen and 19 patients (18.4%) had severe disease. Of the 19 severe cases, 7 were in the 2nd trimester and 12 were in the 3rd trimester. Forty-one (39.8%) patients delivered, including two twin deliveries. Of the 41 cases of delivery, 14 were premature, 4 out of 21 (19.0%) in mild, 4 out of 12 (25.0%) in moderate, and 6 out of 8 (75.0%) in severe. Severe disease was associated with an increased rate of preterm birth (P = 0.012). Four of the 43 neonates (9.1%) received oxygen treatment.ConclusionPregnant women with COVID-19 had a high rate of severe disease and a high preterm delivery rate, especially among those with severe disease.

Pregnancy safety of COVID-19 vaccines is validated by the Vaccine Adverse Event Reporting System

Healthcare providers, vaccine manufacturers, and the public can submit reports to the CDC's Vaccine Adverse Event Reporting System (VAERS) which was created to collect reports of adverse events and reactions that occur following vaccination. Our objective was to assess the safety of COVID-19 vaccines for pregnancy-related events as reported by VAERS. This is a retrospective cohort study utilizing the United States VAERS. We included reproductive age (18-49 years old) females in this study who reported pregnancy-related events as of July 23, 2021 for the three COVID-19 vaccines available in the United States. Overall there were 1,146,536 VAERS events, of which 435,077 were COVID-19 vaccines related, 143,934 of these were reported in reproductive age women with 5,537 different symptoms. 2.7% of events (3,915/143,934) were pregnancy-related. Spontaneous abortion constituted the largest number of adverse events (0.47%: 678/143,934) There were no serious maternal sequelae reported after COVID-19 vaccinations nor was there an increase in other pregnancy-related adverse outcomes. The table shows the top 30 pregnancy-related symptoms reported. There were no significant differences in pregnancy-related issues among the 3 different COVID-19 vaccines. Our study of VAERS confirms the safety in pregnancy after COVID-19 vaccinations for each of the three different vaccines. Only 3,915 events after COVID-19 vaccines were pregnancy-related out of a total of 143,934 events among reproductive age women. The number of spontaneous abortions were in line with expected numbers, and there was no significant difference between the three vaccine manufactures. The strength of VAERS is that it is national in scope, can quickly provide an early warning of a safety problem with a vaccine, and is designed to rapidly detect unusual or unexpected patterns of adverse events, also known as “safety signals.” There were no “safety signals” for pregnancy-related events after COVID-19 vaccinations.

Dietary diversity and diet quality with gestational weight gain and adverse birth outcomes, results from a prospective pregnancy cohort study in urban Tanzania.

Healthy maternal diets during pregnancy are an important protective factor for pregnancy‐related outcomes, including gestational weight gain (GWG) and birth outcomes. We prospectively examined the associations of maternal dietary diversity and diet quality, using Minimum Dietary Diversity for Women (MDD‐W) and Prime Diet Quality Score (PDQS), with GWG and birth outcomes among women enrolled in a trial in Tanzania (n = 1190). MDD‐W and PDQS were derived from a baseline food frequency questionnaire. Women were monthly followed until delivery, during which weight was measured. GWG was classified based on the 2009 Institute of Medicine guidelines. Adverse birth outcomes were classified as low birth weight (LBW), small for gestational age, large for gestational age, and preterm birth. 46.2% participants had MDD‐W ≥ 5. Mean score of PDQS was 23.3. Maternal intakes of nuts, poultry, and eggs were low, whereas intakes of sugar‐sweetened beverages and refined grains were high. MDD‐W was not associated with GWG or birth outcomes. For PDQS, compared to the lowest tertile, women in the highest tertile had lower risk of inappropriate GWG (risk ratio [RR] = 0.93, 95% confidence interval [CI]: 0.87–1.00). Women in the middle tertile group of PDQS (RR = 0.72, 95% CI: 0.51–1.00) had lower risk of preterm birth. After excluding women with prior complications, higher PDQS was associated with lower risk of LBW (middle tertile: RR = 0.55, 95% CI: 0.31–0.99, highest tertile: RR = 0.52, 95% CI: 0.29–0.94; continuous per SD: RR = 0.77, 95% CI: 0.60–0.99). Our findings support continuing efforts to improve maternal diet quality for optimal GWG and infant outcomes among Tanzanian women.

Pregnancy Outcomes During the COVID-19 Pandemic in Canada, March to August 2020.

Several studies have documented changes in the rates preterm birth and stillbirth during the COVID-19 pandemic. We carried out a study to examine obstetric intervention, preterm birth, and stillbirth rates in Canada from March to August 2020. The study included all singleton hospital deliveries in Canada (excluding Québec) from March to August 2020 (and March to August for the years 2015-2019) with information obtained from the Canadian Institute for Health Information. Data for Ontario were examined separately because this province had the highest rates of COVID-19 in the study population. Rates and odds ratios with 95% confidence intervals (CIs) were used to quantify pregnancy-related outcomes. There were 136,445 and 717,905 singleton hospital deliveries in Canada (excluding Quebéc) in from March to August 2020 and between March and August 2015-2019, respectively. Rates of obstetric intervention declined in early gestation in 2020. Odds ratios for labour induction and cesarean delivery at <32 weeks gestation for March-August 2020 versus March-August in 2015 to 2019 were 0.84 (95% CI 0.74-0.95) and 0.92 (95% CI 0.85-1.00), respectively. Preterm birth rates increased in Canada (excluding Québec) from 6.42% in March-August 2015 to 6.74% in March-August 2019 but were unchanged in March-August 2020 (6.74%). Stillbirth rates were stable between March-August 2015 and March-August 2020. However, stillbirth rates peaked in Ontario in April 2020 due to higher rates of stillbirths at 20-27 and 37-41 weeks gestation. Changes in labour induction and cesarean delivery at early gestation and other perinatal outcomes during the period of March to August 2020 highlight the need to reconsider the use and impact of obstetric services in pandemics as well as the need for timely perinatal surveillance.

First Trimester Anticoagulant Exposure and Adverse Pregnancy Outcomes in Women with Preconception Venous Thromboembolism: A Nationwide Cohort Study

ObjectiveThe purpose of this study was to investigate first trimester anticoagulant exposure and risks of adverse pregnancy-related and fetal outcomes. MethodsUsing Danish nationwide registries, we identified all pregnant women with preconception venous thromboembolism, 2000-2017, and linked data on exposure to low-molecular-weight heparin (LMWH), vitamin K antagonist (VKA), or non-VKA oral anticoagulant (NOAC) during pregnancy. We assessed pregnancy-related and fetal outcomes associated with first trimester anticoagulant exposure. ResultsAmong 4490 pregnancies in women with preconception venous thromboembolism (mean age 31 years, 40% nulliparous) during the first trimester, 63.1% were unexposed, 25.9% were exposed to LMWH, 10.4% VKA, and 0.6% NOAC. Adverse outcomes were lowest in unexposed and LMWH exposed. Compared with unexposed, VKA was associated with higher risks of preterm (adjusted odds ratio [OR] 2.26; 95% confidence interval [CI], 1.70-2.99) and very preterm birth (adjusted OR 3.78; 95% CI, 1.91-7.49), shorter mean gestational age was associated with VKA (−7.5 days; 95% CI, −9.1 to −5.9 days) or NOAC (−2.3 days; 95% CI, −8.4-3.8), and lower mean birthweight with VKA (−55 g; 95% CI, −103.1 to −8.5) or NOAC (−190 g; 95% CI, −364.1 to −16.4). Adjusted ORs for small-for-gestational-age infants were 1.07 (95% CI, 0.77-1.50) with VKA, and 3.29 (95% CI, 1.26-7.95) with NOAC. Mean 5-minute Apgar score (9.8) and congenital defect prevalence (8.4%-10%) varied little across exposure groups. ConclusionsFetal risk was lowest in unexposed and LMWH-exposed pregnancies, supporting the recommendation of LMWH during pregnancy. NOAC safety during pregnancy is unclear due to the rarity of NOAC exposure.

Influence of Obstructive Sleep Apnea on Systemic Inflammation in Pregnancy.

Background: Obstructive sleep apnea (OSA) is prevalent in pregnancy and it is associated with adverse pregnancy-related outcomes such as gestational diabetes, pre-eclampsia, and low birth weight. Maternal systemic inflammation is proposed to be one of the main intermediate mechanisms. However, the effects of OSA on systemic inflammation are unknown in normal pregnancy.Methods: Women in the 3rd trimester underwent hospital polysomnography to evaluate whether OSA increases systemic inflammation in normal pregnancy and its potential association with adverse fetal outcomes. OSA was defined as an apnea–hypopnea index (AHI) of ≥ 5 h−1. Plasma cytokines levels (TNF-α, IL-1β, IL-6, IL-8, and IL-10) were determined by multiple immunoassays.Results: We included 11 patients with OSA and 22 women with AHI < 5 h−1, who were homogeneous in age, and body mass index (BMI). Women with OSA had significant higher levels of TNF-α, IL-1β, IL-8, and IL-10. We found significant correlations between AHI during REM and TNF-α (r = 0.40), IL-1β (r = 0.36), IL-6 (r = 0.52), IL-8 (r = 0.43), between obstructive apnea index and TNF-α (r = 0.46) and between AHI and IL-1β (r = 0.43). We also found that CT90% was related to IL-8 (r = 0.37). There were no significant differences in neonatal characteristics; however, we found inverse correlations between TNF-α and IL-8 with birth weight (both r = −0.48), while IL-8 showed a significant inverse relationship with neonatal gestational age (r = −0.48).Conclusions: OSA in our normal pregnancy population was associated with higher systemic inflammation, which was related to obstructive events, especially during REM sleep. Moreover, systemic inflammation was inversely correlated with neonatal birth weight and age.

"My 9 to 5 Job Is Birth Work": A Case Study of Two Compensation Approaches for Community Doula Care.

With the increased policy emphasis on promoting doula care to advance birth equity in the United States, there is a vital need to identify sustainable and equitable approaches for compensation of community doulas, who serve clients experiencing the greatest barriers to optimal pregnancy-related outcomes. This case study explores two different approaches for compensating doulas (contractor versus hourly employment with benefits) utilized by SisterWeb San Francisco Community Doula Network in San Francisco, California. We conducted qualitative interviews with SisterWeb doulas in 2020 and 2021 and organizational leaders in 2020. Overall, leaders and doulas reported that the contractor approach, in which doulas were paid a flat fee per client, did not adequately compensate doulas, who regularly attend trainings and provide additional support for their clients (e.g., referrals to promote housing and food security). Additionally, this approach did not provide doulas with healthcare benefits, which was especially concerning during the COVID-19 pandemic. As hourly, benefited employees, doulas experienced a greater sense of financial security and wellbeing from receiving consistent pay, compensation for all time worked, and benefits such as health insurance and sick leave, allowing some to dedicate themselves to birth work. Our study suggests that efforts to promote community doula care must integrate structural solutions to provide appropriate compensation and benefits to doulas, simultaneously advancing birth equity and equitable labor conditions for community doulas.

Gestational diabetes mellitus: Major risk factors and pregnancy-related outcomes: A cohort study.

BackgroundGestational diabetes mellitus (GDM) is a major pregnancy endocrine problem that has several confirmed risk factors and is associated with adverse pregnancy-related outcomes (PRO).ObjectiveTo evaluate the relationship between GDM diagnosis and the associated risk factors of PRO (maternal, intrapartum, perinatal, and neonatal) in accordance with International Association of Diabetes and Pregnancy Study Groups criteria.Materials and MethodsThis prospective cohort study was performed with 531 singleton parturient (265 GDM and 266 non-GDM). They were selected consecutively from referral hospitals, and the maternal, intrapartum, perinatal, and neonatal outcomes were assessed.ResultsThe major risk factors influencing the GDM diagnosis were maternal age, obesity, family history of diabetes, previous history of GDM, and previous history of macrosomia. In the comparison of PRO between the groups, significant associations were detected for emergency cesarean delivery, preeclampsia, polyhydramnios, premature rupture of membrane, preterm delivery, and neonatal hyperbilirubinemia in the GDM group. In the multivariate logistic regression analysis, a previous history of stillbirth was significantly associated with maternal and perinatal outcomes. The odds ratios (CI 95%) of the PRO in the women with a GDM diagnosis were: maternal = 2.43 (1.51-3.90), intrapartum = 2.05 (1.35-3.11), perinatal = 2.00 (1.29-3.10), and neonatal = 1.68 (1.08-2.62). The PRO was significantly correlated with GDM diagnosis, but not with the risk factors.Conclusion The adverse pregnancy outcomes were significantly correlated with GDM diagnosis, and the outcomes were not directly affected by the risk factors. Given the related adverse outcomes for mothers and offspring, early screening and management of GDM is necessary especially in Asians and in low-/middle-income countries.