Gestational Diabetes Research Articles

Adverse perinatal outcomes related to pregestational obesity or excessive weight gain in pregnancy.

To evaluate outcomes related to pregestational obesity and excessive weight gain during pregnancy. This retrospective cohort was conducted from August to December 2020. Participants were divided into four groups: non-obese with non-excessive weight gain (n=765, 45.9 %), obese with non-excessive weight gain (n=190, 11.4 %), non-obese with excessive weight gain (n=532, 31.9 %), and obese with excessive weight gain (n=179, 10.7 %). The outcomes were evaluated for gestational diabetes (GDM), pregnancy-induced hypertension (PIH), newborn large for gestational age (LGA) and cesarean delivery. A p-value of <0.05 was considered significant. The odds of GDM were significant in groups 2 (CR, 3.6; 95 %CI, 2.5-5.2) and 4 (CR,1.9; 95 %CI, 1.3-2.9). The odds of PIH in groups 3 (CR, 1.7; 95 %CI, 1-2.6) and 4 (CR,3.1; 95 %CI, 1.9-5.2) and those of LGA newborns in groups 2 (CR, 2.0; 95 %CI, 1.2-3.3), 3 (CR, 2.6; 95 %CI, 1.9-3.7), and 4 (CR, 3.2; 95 %CI, 2-5) were high. The odds of GDM were higher in participants with pregestational obesity, while the odds of PIH were higher in participants with excessive weight gain. All groups analyzed, except the reference group, had greater chances of lga newborns. the form of delivery was not affected.

The inflammatory and oxidative phenotype of gestational diabetes is epigenetically transmitted to the offspring: role of methyltransferase MLL1-induced H3K4me3

Abstract Background and Aims Hyperglycaemia during gestational diabetes (GD) predisposes women and their offspring to later cardiometabolic disease. The hyperglycaemia-mediated epigenetic changes remain to be elucidated. Methyltransferase MLL1-induced trimethylation of histone 3 at lysine 4 (H3K4me3) activates inflammatory and oxidative phenotype. This epigenetic mark in GD women and its transmission to the offspring were investigated. Methods Peripheral blood mononuclear cells (PBMC) were collected from GD and control (C) women and also from adolescents born to women of both groups. Endothelial human umbilical vein endothelial cells (HUVEC) and cord blood mononuclear cells (CBMC) were from umbilical cords. The NF-κBp65 and NOX4 expressions were investigated by reverse transcription quantitative polymerase chain reaction and immunofluorescence (IF). MLL1 and H3K4me3 were investigated by immunoblotting and IF. H3K4me3 on NF-κBp65 and NOX4 promoters was studied by chromatin immunoprecipitation. Superoxide anion generation was measured by electron spin resonance spectroscopy. Plasma cytokines were measured by enzyme-linked immunosorbent assay. To investigate the role of MLL1, HUVEC were exposed to inhibitor MM102 or siRNA transfection. Results PBMC, CBMC, and HUVEC showed an increase of NF-κBp65, IL-6, ICAM-1, MCP-1, and VCAM-1 mRNAs. These findings were associated with H3K4me3 enrichment in the promoter of NF-κBp65. Elevated H3K4me3 and cytokine levels were observed in GD adolescents. MLL1 drives H3K4me3 not only on NF-kB p65, but also on NOX4 promoter. Inhibition of MLL1 blunted NF-κBp65 and NOX4 by modulating inflammatory and oxidative phenotype. Conclusions Such proof-of-concept study shows persistence of MLL1-dependent H3K4me3 in offspring born to GD women, suggesting an epigenetic-driven transmission of maternal phenotype. These findings may pave the way for pharmacological reprogramming of adverse histone modifications to mitigate abnormal phenotypes underlying early ASCVD.

The relationship between coronary flow reserve and the TyG index in patients with gestational diabetes mellitus

Abstract Gestational diabetes mellitus (GDM) is a prevalent metabolic disorder characterized by glucose intolerance during pregnancy. The triglyceride glucose (TyG) index, a marker of insulin resistance, and coronary flow reserve (CFR), a measure of coronary microvascular function, are emerging as potential indicators of cardiovascular risk. This study aims to investigate the association between CFR and the TyG index in GDM patients. This cross-sectional study of 87 GDM patients and 36 healthy controls was conducted. The participants underwent clinical assessments, blood tests, and echocardiographic evaluations. The TyG index was calculated as ln(triglycerides × fasting glucose/2). CFR was measured using Doppler echocardiography during rest and hyperemia induced by dipyridamole. The study included 87 individuals in the GDM group and 36 individuals in the control group. There was no significant difference in age between the two groups (34.1 ± 5.3 years for GDM vs. 33.1 ± 4.9 years for the control, p = 0.364). The TyG index was significantly higher in the GDM group compared to the controls (p &amp;lt; 0.001) and CFR was lower in the GDM group (p &amp;lt; 0.001) as shown in Figure 1a and 1b. A negative and significant correlation between the TyG index and CFR was observed, which was demonstrated in Figure 2 (r = −0.624, p &amp;lt; 0.001). Linear regression revealed the TyG index as an independent predictor of reduced CFR. The study findings reveal a significant association between the TyG index and CFR in GDM patients, suggesting their potential role in assessing cardiovascular risk.TyG index and CFR of the groupsTyG and CFR correlation analysis

Comparison of cord blood alarin levels of full-term infants according to birth weight.

To compare the cord blood alarin levels of infants in different birth weight groups with those of infantsborn to mothers diagnosed with gestational diabetes mellitus (GDM) who were not subgrouped according to birth weight. This prospective study was conducted between September 2023 and January 2024. Healthy term babies whose families agreed to participate in the study were divided into four groups according to their birth weight (small for gestational age (SGA), appropriate for gestational age (AGA) and large for gestational age (LGA)) and whether their mothers had GDM. There was a significant difference between the cord blood alarin levels of the AGA and SGA groups (p=0.014). There was also a significant difference between the cord blood alarin levels of the AGA and GDM groups (p=0.012). However, the cord blood alarin levels of the LGA group (whose mothers did not have GDM) were similar to those of the AGA group (p=0.394). We found evidence that alarin levels in umbilical cord blood are associated with low birth weight and GDM.

A Comparative Study on Anemia, Gestational Diabetes and Gestational Hypertension during pregnancy in Rural, Semi Urban and Urban Hospitals in Bangladesh

Most of the women in developing countries undergo health problems in full or part of the pregnancy period. Major complications of pregnancy are anemia, gestational hypertension, and Gestational Diabetes. The objective of this study was to compare the prevalence of anemia, gestational hypertension, and Gestational Diabetes among antenatal women in rural, semi-urban, and urban hospitals. The study was conducted among 384 pregnant mothers who attended for ANC in OPD of Gonosashasthaya Samaj Vittik Medical College Hospital (Savar) , Gonosasthaya Nogor Hospital, (Dhanmondi), Sub-center of Gonosasthaya Kendro (Shimulia, Panisail, Barobaria, Delduwar, Shripur ) from December 2021 to November 2022 by consecutive sampling. The age range of the patients was 18 to 40 years. Mean age was 24.74 years. In this study majority of population 169 (44%) were in age group 18 - 22 years. Most of the pregnant women 291(76%) were housewives, lived in Nuclear families 253(66%) and the maximum population were from lower middle 134 (35%) socio-economic condition. A significant number of pregnant mother ,98(26%) were anemic, 38(10%) had GDM and only 34(9%) were gestational hypertension. Anemia is comparatively more in rural and semi-urban than urban. GDM and gestational hypertension is more in urban areas than rural and semi urban followed by 14(11%) and 20(16%) respectively. Special attention of policy makers, health professional, public health researchers, and the community is required on this regards. So early diagnosis and treatment is required to avoid long-term health problems of the mother and her offspring. EWMCJ Vol. 12, No. 1&amp;2, January-July 2024: 9-13

Diabetes, hypertension, and hospitalizations during pregnancy: a multivariate analysis

Abstract Introduction The study analyzes the correlation between socio-demographic variables and pathologies encountered by women during pregnancy. The presence of these pathologies is recorded at the time of compiling the CAP (Certificate of Assistance for Birth). Methods Data analysis pertains to the Certificate of Assistance for Birth (CAP) concerning residents in the territory of AUSL South-East Tuscany in the years 2021 and 2022. The number of women of childbearing age in Tuscany in 2022 is 150,959, while the number of births analyzed in the study is 9,053. The study conducts multivariate analysis between socio-demographic variables and pathological outcomes. Results Controlling for age, citizenship and other factors, the risk of gestational diabetes is significantly higher (p &amp;lt; 0.05) among mothers: over 40 years old (OR = 1.56), with citizenship in PFPM countries (OR = 1.60) and particularly, compared to Italians, among women from Indian subcontinent (OR = 3.73) and the Maghreb (OR = 2.04), with lower educational levels (OR = 1.28) compared to graduates, obese (OR = 2.43). The risk of gestational hypertension is significantly higher (p &amp;lt; 0.05) among mothers: over 40 years old (OR = 1.71), obese (OR = 2.50), nulliparous (OR = 1.60). The risk of one or more hospitalizations during pregnancy is significantly higher (p &amp;lt; 0.05) among mothers: not employed (OR = 1.31) and homemakers (OR = 1.32) compared to employed, from Indian subcontinent (OR = 1.82) and the Maghreb (OR = 1.75) compared to Italians, with gestational hypertension (OR = 2.06). Conclusions Unlike gestational diabetes and hospitalizations during pregnancy, gestational hypertension does not show significant associations with the mother’s socio-demographic characteristics. However, gestational diabetes and hospitalizations during pregnancy are correlated with different variables: they are more common among women over 40, foreigners, homemakers, with lower educational levels, obese, and with low family economic status. Key messages • It has been observed that some variables are also risk factors for adult age pathologies, such as diabetes and hypertension. • The importance of Early Childhood Development and early interventions can improve children’s health and well-being.

Gestational diabetes and pregnancy outcome in Kurdish, Somali and general population in Finland

Abstract Gestational diabetes (GDM) increases the risk of type II diabetes and cardiovascular morbidity later in life but GDM incidence in women from different cultural backgrounds varies. This study aims to examine treatment of GDM and pregnancy outcomes in Somali, Kurdish and general population women. Patient data of 312 Kurdish, 254 Somali and 508 general population women was collected from Turku University Hospital records from 2008 to 2019. The general population was selected by randomization with matching year, BMI, age, and parity. Singleton deliveries after 34th gestational week with no prior diabetes mellitus were included. Descriptive and comparison analyses (SPSS, version 29.0) were used to identify associations between ethnic background and pregnancy outcomes in women with GDM. The incidence of GDM was 22 % (CI 95 % 17-27) in Somali, 36 % (CI 95 % 31-42) in Kurdish, and 16 % (CI 95 % 13-19) in the general population women. Kurdish women had medication for GDM more often (43 % CI 95 % 34-53) than the Somali (22 % CI 95 % 11-33) and general population women (18 % CI 95 % 9-26). Metformin was more commonly used among Kurdish (30 % CI 95 % 22-39) compared to the general population (12 % CI 95 % 4-18) and Somali women (13 % CI 95 % 4-22). There was no difference in insulin or combined metformin and insulin treatment between the groups. In GDM group, vaginal deliveries were more common in general population (89 % CI % 81-95) than in Somali women (67 % CI % 64-81). Induction of labour (indication GDM or other) and instrumental vaginal delivery rates were similar between the groups. Newborns of all Somali women had a lower weight (SD -0.3 CI 95 % -0.7 - -0.2) compared to the general population (SD 0 CI 95 % -0.1 - 0.3). The prevalence of GDM was increased and dietary treatment decreased in Kurdish women compared to the general population in Finland. In the future, the treatment of GDM should be adjusted to better optimize the care for different cultural background women. Key messages • Kurdish women have increased incidence of GDM and less dietary treatment compared to the general population with similar risk factors. The pregnancy outcomes remain good in all groups. • With Somali women, the birth weight of the child is lower despite GDM status. This might direct clinicians to underestimate the effect of GDM when considering individual treatment.

Maternal pre-gestational and gestational diabetes and risk of offspring epilepsy: A cohort study

Abstract Background Despite growing evidence linking maternal diabetes to impaired brain physiology and neurodevelopment in offspring, evidence on its effect on epilepsy remains scarce. This study aims to determine if intrauterine exposure to maternal pre-existing and gestational diabetes mellitus is associated with risk of offspring epilepsy. Methods We studied &amp;gt;2.3 million singletons live-born in Sweden between 1998 and 2021, with final follow up until October 31, 2023. The Swedish Medical Birth Register was linked to the National Patient Register to identify gestational diabetes (GDM), maternal pre-gestational type 1 (T1DM) and type 2 diabetes (T2DM), and offspring epilepsy. The incidence of epilepsy, comparing offspring of mothers with versus without diabetes, was calculated as hazard ratios (HR), adjusting for maternal education, smoking, body mass index, hypertension, epilepsy and other important confounders. Paternal T1DM and T2DM were additionally analysed as negative control exposures to assess genetic confounding. Results Of the 2,335,245 offspring analysed (48.9% female), 13,883 (0.6%) were exposed to maternal T1DM, 4477 (0.2%) to T2DM, and 37,253 (1.6%) to GDM. During a median follow up of 13 years (range 0-26 years), 18,732 offspring were diagnosed with epilepsy. Maternal T1DM (HR 1.27, 95% confidence intervals [CI] 1.08-1.49) and T2DM (HR 1.34, 95% CI 1.00-1.49) were associated with higher hazards of epilepsy in offspring, compared with no exposure to maternal diabetes. Preterm birth and birth-asphyxia jointly mediated 63% and 39% of these associations, respectively. No association was found between maternal GDM and epilepsy. Paternal T1DM and T2DM did not show association with epilepsy. Conclusions In this nationwide population-based cohort study, children of mothers with T1DM or T2DM showed an elevated risk of epilepsy. The results from paternal comparison and mediation analyses suggest a key role of the intrauterine environment in the aetiology of epilepsy. Key messages • Maternal pre-existing T1DM and T2DM might be risk factors for epilepsy in offspring and are likely to influence the risk through the intrauterine environment independent of genetic mechanisms. • In the context of a globally rising prevalence of diabetes in women who get pregnant, it is crucial that the diabetes is well-regulated and birth complications associated with diabetes are prevented.

Associations between maternal health literacy and prenatal micronutrient intake in Hungarian women

Abstract Background Adequate level of health literacy (HL) is an important factor in pregnancy. Low HL may increase the risk of maternal and fetal complications (e.g., gestational diabetes mellitus, low birth weight). This study aimed to measure the levels of maternal HL and its associations with the consumption of folic acid (FoA), vitamin D (VD), and omega-3 fatty acids (FAs) during pregnancy in Hungarian women. Methods The questionnaire-based study was conducted at the Department of Obstetrics and Gynecology, University of Szeged among women who gave birth between June and September 2023 (N = 294). Sociodemographic, lifestyle, conception and pregnancy related questions were asked. HL was measured by the Maternal Health Literacy Inventory in Pregnancy (MHELIP) questionnaire (after the Hungarian adaptation); it contains 48 items representing four subscales (maternal health knowledge, search for maternal health information, assessment of maternal health information, and maternal health decision making and behavior). Data analysis was performed by SPSS 29.0. (Ethical permission: 5351) Results The mean age of women was 31.53 +-4.75 years. During pregnancy 84.5% of women consumed FoA, 61.8% VD and 41.8% omega-3 FAs. The total mean score of MHELIP on a scale 0-100 was 78.93 (95%CI: 77.77-80.08); the score of “search for maternal health information” subscale was the lowest [57.68 (95%CI: 56.20-59.16)], and the score of “maternal health decision making and behavior” was the highest [86.75 (95%CI: 85.62-87.87)]. Omega-3 FAs and VD consumption was significantly higher in women with higher total and subscales mean scores (except “search for maternal health information”), while FoA consumption was significant in case of “assessment of maternal health information”. (The results are preliminary.) Conclusions The association between micronutrient consumption and HL supports that using this tool during pregnancy the mothers who needs more support and health information can be identified. Key messages • The Maternal Health Literacy Inventory in Pregnancy questionnaire is a reliable tool for measuring health literacy in Hungarian pregnant women. • Maternal health literacy plays an important role in the healthier lifestyle, including prenatal vitamin/micronutrient consumption.

Impact of cardiovascular risk factors in cardiac (reverse) remodelling induced by pregnancy

Abstract Introduction Haemodynamic overload during pregnancy induces cardiac remodelling, characterised by cardiac hypertrophy and chamber enlargement, associated with deterioration of diastolic function, despite preservation of the systolic function. After delivery, the woman's heart undergoes reverse remodelling(RR), and myocardial function and structure normalise to their pre-gravid state. The impact of cardiovascular risk factors(CRF) in cardiac remodelling and RR, namely, on cardiac function and structure, is variable and remains to be clarified. Purpose To characterise cardiac remodelling and RR during pregnancy and postpartum, respectively, and to investigate CRF's impact in these processes. Methods This prospective cohort study included volunteer pregnant women (healthy [H group] or obese and/or hypertensive and/or with gestational diabetes [CRF group]) recruited in two tertiary centres between 2019 and 2022. Women were evaluated by transthoracic echocardiography at the 1st trimester [1T,10-15 weeks, baseline], 3rd trimester [3T,30-35 weeks, peak of cardiac remodelling] of pregnancy as well as at the 1st, 6th and 12th month after delivery (during RR). Blood samples were collected in each evaluation moment to quantify plasma troponin I (cTnI), procollagen I COOH-terminal propeptide (PICP), ST2/IL33-receptor, C-reactive protein (CRP) and relaxin-2 by ELISA. Generalised linear mixed-effects models were used to evaluate the extent of RR and its potential predictors. Results We included 130 pregnant women with a median age of 33 [30,36] years, 41.5% with at least one CRF. As shown in Table 1, pregnant women developed cardiac hypertrophy with significant atrial and ventricular enlargement from 1T to 3T in both groups. A significant rise in filling pressures was also documented. During postpartum, a significant regression of cardiac hypertrophy and dilation was verified in the two study groups, accompanied by a significant decrease of E/e’ as soon as 1 month after delivery. These cardiac anatomical and functional adaptations induced by pregnancy were accompanied by a significant reduction in plasma cTnI, PICP, ST2/IL33-receptor, CRP and relaxin-2 levels from 3T to 6-months after delivery. Compared to the healthy pregnant women, the CRF group showed higher relative wall thickness (RWT) for all time points of the follow-up period, with similar values of indexed cardiac mass and volumes. Pregnant women with CRF revealed higher E/e’, contrasting with lower ejection fraction and worse global longitudinal strain. Conclusion The significant cardiac reverse remodelling occurred as soon as 1 month after delivery, returning to basal values 6 months postpartum, supported by a significant reduction of levels of plasma biomarkers related to myocardial injury, repair, fibrosis, and inflammation. Pregnant women with CRF showed higher RWT, impaired relaxation and subclinical LV dysfunction when compared with healthy women at all time points of the study.

A review of the risk factors for Autism

Abstract Background Autism Spectrum Disorder (or Autism) is a neurodevelopmental and neurological condition, with prevalence of 1 in 100 children globally. This review examines the most common factors associated with Autism. Methods We conducted a scoping review of factors associated with an increased risk of developing Autism. These included genetic predisposition, parental age, gender, birth complications and morbidities due to other medical conditions. Results Evidence from twin studies shows a 90% genetic predisposition towards Autism - with 102 genes strongly associated with Autism, including SCN1A and SLC6A1. There are also genetic syndromes and chromosomal disorders associated with Autism, including Fragile X syndrome and Tuberous Sclerosis complex (TSC). Several studies have demonstrated an increased risk with advanced parental age (&amp;gt;35 years) (e.g., fathers &amp;gt;50 years are 2.2 times more likely to have a child with Autism than those &amp;lt;30 years). Other factors include infections during pregnancy (e.g. immune dysfunction) and gestational diabetes. Prematurity, such as low birth weight (&amp;lt;1500g) and low gestational age (&amp;lt;32 weeks) are also associated with an increased risk of Autism. With regard to gender, boys are more likely to be diagnosed with Autism - gender ratio of 3:1 and 4:1 has been reported in different populations. Abnormalities in brain development during early prenatal or postnatal periods may increase the risk of Autism. These abnormalities can lead to social, communication, and behavioural challenges characteristic of Autism. Conclusions Autism is a complex and heterogeneous condition that likely arises from a combination of factors such as genetic susceptibility and pre- and postnatal factors. An understanding of these factors is important for early detection, intervention, and support for children to improve their quality of life and reduce morbidity. Key messages • Risk factors associated with an increased risk of developing Autism include genetic predisposition, parental age, gender, birth complications and other comorbidities. • There is need to increase awareness of the risk factors of Autism to improve quality of life.

Characterization of left atrial function during cardiac (reverse) remodeling induced by pregnancy

Abstract Introduction The hemodynamic overload in pregnancy leads to cardiovascular remodeling, characterized by enlargement of left atrial (LA) and ventricular (LV) volumes associated with impaired LV relaxation, maintaining preserved systolic function. These changes are reversible during postpartum. Few scientific evidence has been published about LA function yet. Purpose To assess the changes in LA function through two-dimensional speckle tracking echocardiography analysis during pregnancy and its recovery up to 1 year after delivery and to determine potential predictors of its progression. Methods This prospective cohort study included volunteer pregnant women (healthy, obese and/or hypertensive and/or with gestational diabetes) recruited in two tertiary centers between 2019 and 2021. Women were evaluated by transthoracic echocardiography at the 1st trimester [1T, 10-15 weeks, baseline], 3rd trimester [3T, 30-35 weeks, peak of cardiac remodeling] of pregnancy as well as at the 1st, 6th and 12th month after delivery (during RR). Generalized linear mixed-effects models evaluated the extent of RR, including the variation of left atrial strain and its potential predictors. Results We included 130 pregnant women with a median age of 33 [30,36] years, 39,2% multiparas. Fifty-four (41.5%) were diagnosed with at least one cardiovascular risk factor. A significant enlargement of LA volume (24 [22, 28]mL/m2 to 29 [25, 33]mL/m2, p&amp;lt;0.001) associated with the increase of E/e’ (5.85 [5.08, 6.36] to 6.70 [5.67, 7.82], p&amp;lt;0.001) was observed from 1T to 3T, both recovering as soon as 1 month after delivery (LA volume: 29 [25, 33]mL/m2 to 24 [20, 27] mL/m2, p&amp;lt;0.001; E/e’: 6.70 [5.67, 7.82] to 5.70 [4.82, 6.47], p&amp;lt;0.001). Regarding LA function, a significant reduction of LA strain was verified from 1T to 3T (35 [31, 41]% to 31 [29, 36]%, p&amp;lt;0.001), recovering 6 months postpartum (31 [29, 36]% to 33 [30, 38]%, p=0.035). Systemic vascular resistance seemed to be an independent predictor of lower LA strain (-3.83 [-6.40, -1.25], p=0.004). The presence of cardiovascular risk factors (-0.80 [-2.28, 0.68], p=0.287), smoking habits (-1.26 [-2.82, 0.30], p=0.112), parity (-0.33 [-1.93, 1.27], p=0.684) and age (-0.11 [-0.29, 0.08], p=0.257) showed a non-significant impact in LA strain. Conclusion Despite the recovery in diastolic function and LA volume 1 month after delivery, the LA function only significantly improved 6 months later. Systemic vascular resistance was revealed as an independent predictor of LA strain.

Cardiovascular (reverse) remodelling induced by pregnancy: looking at the right side of the heart

Abstract Introduction Many studies have focused on pregnancy-induced left ventricular remodelling, overlooking the changes in right cardiac chambers. Purpose To characterize the right cardiovascular (CV) remodelling and reverse remodelling (RR) induced by pregnancy and postpartum, respectively, and the impact of CV risk (CVR) factors on these processes. Methods This prospective cohort was recruited at two tertiary centers from 2019 to 2022, including 51 healthy and 79 obese and/or hypertensive and/or with gestational diabetes and/or smoking habits pregnant women (cardiovascular risk [CVR] group). Women were evaluated by transthoracic echocardiography at the 1st trimester (1T) and 3rd trimester (3T) of pregnancy, as well as one-month (PP1), six-months (PP2), and one-year postpartum (PP3). Generalized linear mixed-effects models were used for the analysis of right CV remodelling and RR and to evaluate the impact of CVR factors on these processes. Results This study included 130 pregnant women, 60.8% primiparous, with a median age of 33 years. Despite all echocardiographic results being within the normality range, we describe the progression of right heart adaptations throughout pregnancy and postpartum (Table 1), namely: 1) Similar enlargement of the right atrium (RA) and right ventricle (RV) dimensions throughout pregnancy, recovering at PP2 except for RA in the CVR group; 2) Preserved RV systolic function throughout pregnancy in both groups, while the postpartum hemodynamic normalization triggers a reduction of (TAPSE) and tricuspid S' wave velocity; 3) Reduced RA strain in both groups during pregnancy, more evident in CVR group, which had a slower postpartum recovery; 4) Preserved RV global longitudinal strain (GLS) throughout follow-up time, being significantly reduced in 3T of CVR group and recovering at PP2; 5) Reduction of tricuspid E/A ratio from 1T to 3T in both groups with an early recovery at PP1, being these values significantly higher in the healthy group, and 6) Steady pulmonary artery systolic pressure (PASP) values throughout follow-up time, showing consistently higher values in the CVR group. Conclusion This study describes the subclinical right cardiac functional and structural changes within the physiological range, which recover 6 months after delivery. CVR factors impact the magnitude of the subclinical RV diastolic function changes, PASP and myocardial deformation (strain) without any impact on classic RV systolic function.

Pregnancy and inherited cardiomyopathies: insights from specialized care

Abstract Background Pregnancy and postpartum represent periods of increased risk of cardiovascular complications. Management of women with modified World Health Organization (mWHO) class II–III, III, and IV during pregnancy and around delivery should be conducted at an expert centre by a multidisciplinary team. Purpose Our objective was to analyze the impact of pregnancy on cardiomyopathy outcomes in a centre specialized in inherited cardiovascular conditions in the United Kingdom. Methods All women with cardiomyopathy referred due to pregnancy to our centre between 2016 and 2023 were retrospectively analyzed. Demographic, clinical, obstetric, genetic, electrocardiographic, and multimodal imaging variables were collected. Results Between 2016 and 2023, follow-up and delivery planning were initiated for 86 pregnancies in women with cardiomyopathies referred to our centre, resulting in 81 live births and 5 miscarriages, all in the first trimester. Among the full-term pregnancies, 17 (21%) were in patients in mWHO class I or II, 22 (27.2%) in II-III, 34 (42%) in III, and 8 (9.8%) in IV. The distribution of cardiomyopathy types among different mWHO classification is represented in Table 1. Women in mWHO class ≥ II-III had more pregnancy-related events than patients in mWHO I or II [28 (34.6%) vs 1 (1.2%); p = 0.004]. The most common complication in the first group was supraventricular tachycardia in 11 pregnancies (13.6%), followed by gestational diabetes in 9 (11.1%), left ventricular ejection fraction impairment in 4 (4.9%), preeclampsia in 3 (3.7%), and 1 (1.2%) ventricular tachycardia. One patient in the second group developed gestational diabetes. The distribution of the type of delivery among different mWHO classification is represented in Table 2. Only one patient with hypertrophic cardiomyopathy in mWHO II-III who underwent a caesarean section presented a post-delivery complication related to retroperitoneal haematoma, with no statistical significative differences between the groups (p = 0.604). 100% of the patients survived pregnancy and postpartum period. Conclusions Pregnant women with cardiomyopathy face an increased risk of adverse events. Despite the presence of cardiovascular and obstetric complications, careful monitoring at a specialized centre leads to favourable outcomes particularly concerning mortality rates for both the mother and fetus. This highlights the importance of a comprehensive risk assessment and meticulous pregnancy and delivery planning to ensure optimal maternal and fetal health.Table 1.Cardiomyopathy and mWHOTable 2.Type of delivery and mWHO

Determinants of health and pregnancy and birth outcomes: an overview

Abstract Introduction This study examines the influence of health determinants on pregnancy and birth outcomes. The aim is to provide a clear and updated view of the overall framework characterizing the birth experience, with crucial implications for clinical practice, research, and health policy. Methods Data analysis pertains to the Certificate of Assistance for Birth (CAP) concerning residents in the territory of AUSL South-East Tuscany in the years 2021 and 2022. The number of women of childbearing age in Tuscany in 2022 is 150,959, while the number of births analyzed in the study is 9,053. The study conducts multivariate analysis between factors and pregnancy-related outcomes. Results Controlling for age, citizenship and others factors, the risk of cesarean section is significantly higher (p &amp;lt; 0.05) among mothers: over 40 years old (OR = 2.09), with education levels of lower secondary (OR = 1.21) and upper secondary (OR = 1.23) compared to a degree, not employed (OR = 1.25) and homemakers (OR = 1.45) compared to employed, overweight/obese (OR = 1.41), with gestational diabetes (OR = 1.16), smoking during pregnancy (OR = 1.27), with gestational hypertension (OR = 2.81). Controlling for age, citizenship and others factors, the risk of term low birth weight is significantly higher (p &amp;lt; 0.05) among mothers: over 40 years old (OR = 1.76), not employed (OR = 1.76) and homemakers (OR = 1.34) compared to employed, smoking more than 3 cigarettes daily during pregnancy (OR = 1.31) not significant, with gestational hypertension (OR = 5.57), nulliparous (OR = 1.42). Controlling for age, citizenship and other factors, the risk of premature birth is significantly higher (p &amp;lt; 0.05) among mothers: with gestational hypertension (OR = 5.22), nulliparous (OR = 1.89), smoking during pregnancy (OR = 1.59). Conclusions The results underscore the importance of carefully monitoring and managing these risk factors during pregnancy to improve outcomes for both mother and baby. Key messages • Understanding the determinants that influence birth outcomes plays a fundamental role. • The importance of Early Childhood Development and early interventions can improve children’s health and well-being.

Are novel ASCVD risk factors more prevalent in young middle eastern women who have classical risk factors

Abstract Introduction Urbanization is an important contributor to atherosclerotic cardiovascular disease (ASCVD) in the Middle East, especially in the younger age groups. There is a scarcity of data on clinical profiles and cardiovascular risk factors (RFs) in urban young women compared with those who reside in rural areas in this region. Purpose To study the demographic and clinical profiles and prevalence of traditional and novel CV RFs in a cohort study of young urban Middle Eastern women compared with those in rural areas. Methods The prevalence of 19 traditional and novel cardiovascular RFs were compared in urban vs. rural young women residents (18-50 years of age), who were enrolled in 12 centers (August 2020 to October 2023). Results Of 627 young women enrolled (mean age 44.2 ± 5.1 years old), 463 (74%) were urban residents and 164 (26%) were rural residents. ASCVD was diagnosed in 32% of urban and 37.3% of rural young women. Table shows the prevalence of traditional and novel, sex-specific RFs with significant differences in the 2 groups. Other RFs with no significant differences included hypertension, diabetes and gestational diabetes, preterm delivery, persistent weight gain after delivery, radiation for breast cancer, and polycystic ovary syndrome. Conclusion In this cohort of Middle Eastern young women, despite heterogeneity, those who were urban residents had worse clinical profiles with higher prevalence of certain classical and sex-specific risk factors.

Determinants of appetite in the first year of life: Results from a prospective study of infants

Abstract Childhood obesity, a growing public health problem, was shown to be associated with appetite traits (ATs) in infancy but little research exists on the determinants of early appetite. We aimed to examine the association between parental, pregnancy and infant variables on ATs during the first year of life. We followed up 450 healthy term infants assessing Enjoyment of Food (EF), Food Responsiveness (FR), Satiety Responsiveness (SR) and Slowness in Eating (SE), using the Baby (at 2-4 weeks (wk) &amp; 6m) and the Child (at 12m) Eating Behaviour Questionnaires. Associations between parental sociodemographic and lifestyle, pregnancy, infant feeding and anthropometric factors, and these ATs were investigated. Multivariable linear regression models were built for each AT, incorporating statistically significant variables from minimally adjusted models (sex, gestational age, and ethnicity). Results primarily focus on ATs at 2-4wks, as later ATs were largely influenced by these values. Higher father’s BMI (β = 0.013, p = 0.022) was associated with increased EF at 2-4wks. Later gestational age (β = 0.106, p = 0.032), and gestational diabetes (β = 0.538, p = 0.002) were associated with higher FR 2-4wk while mixed feeding compared to exclusively breast feeding (β =-0.281, p = 0.013) with lower FR 2-4wk. Female sex (β = 0.174, p = 0.009) was positively, while gestational age (β=-0.076, 0.022), father’s educational attainment (β=-0.199, p = 0.003), father habitual smoking (β=-0.167, p = 0.020) and 4wk WFA z-score (β = 0.087, p = 0.037) were negatively associated with SR 2-4wk. Lastly, higher 4wk WFA z-score (β=-0.151, p = 0.012) and bottle feeding (β=-0.378, p = 0.003) were associated with decreased SE 2-4wk. Acknowledging that a causal association cannot be established in an observational study, this data suggests that parental lifestyle and pregnancy factors could influence infant ATs and hence risk of later obesity, highlighting the importance of preconception health in mitigating the problem of childhood obesity. Key messages • Appetite traits in early infancy are influenced by infant feeding and anthropometric variables, but also by parental and pregnancy characteristics. • The importance of preconception health is paramount in mitigating the problem of childhood obesity.

Preliminary data on short-term outcomes within the cardio-obstetrics registry

Abstract Background Pregnancy leads to physiological changes within the cardiovascular system such as increased plasma volume and cardiac output or hypercoagulability. These changes can be challenging for women with pre-existing cardiovascular disease with higher risks of complications. The guidelines of the European Society of Cardiology recommend treating high-risk patients in specialized centres by an interdisciplinary pregnancy heart team. In a team-based approach, the Pregnancy Heart Team was founded at our university hospital, in order to establish specific structures of communication and responsibility. Methods A prospective registry of all patients treated by the Pregnancy Heart Team between November 2022 and March 2024 was established. Patients consisted of women with pre-existing cardiovascular disease undergoing pregnancy as well as women who developed pregnancy-associated cardiovascular disease. Patients were evaluated throughout pregnancy by lab work and echocardiography during each trimester as well as in the postpartum period. Results In total 39 women (mean age 34±5 years) were prospectively included in the registry. 17 patients (43.5%) were classified as mWHO ≥ III. 17 patients (43.5 %) with pre-existing (pregnancy-associated) cardiovascular disease were managed throughout pregnancy and delivery. 9 patients (18.4 %) developed pregnancy-associated cardiovascular diseases such as peripartum cardiomyopathy or spontaneous coronary artery dissection. Preliminary data shows that mean left-ventricular ejection fraction remained stable during pregnancy with a non-significant trend towards lower values postpartum. Cardiac biomarkers such as high-sensitivity troponin T and NT-pro-BNP showed a non-significant trend towards increased values in the third trimester and postpartum. Adverse maternal outcomes occurred in 14 patients (35.9 %), including preterm premature rupture of membranes (12.2%), gestational hypertension (7.6%), gestational diabetes (5.1%), preeclampsia/eclampsia (7.6%) and delivery-associated complications (10.2%). Fetal complications included macrosomia (10.2%) or intrauterine growth retardation (5.1%). Discussion These preliminary data of a real-world patient collectivedemonstrate that a significant number of patients experienced adverse pregnancy outcomes which was associated with a trend towards increased cardiac biomarkers throughout pregnancy and postpartum. As recent studies have shown, interpretation of standard parameters such as cardiac biomarkers is not fully understood during pregnancy, especially in women with pre-existing cardiovascular disease. Our data may aid to understand prognostic implications of cardiac biomarkers during pregnancy.

Neonatal screening for hearing loss and its associated factors: A pediatric hospital experience

Abstract Introduction Hearing impairment affects 0.6% of children worldwide, with 60% of cases being preventable. Identifying risk factors for hearing impairment would facilitate early detection and better patient prognosis. Objectives To identify factors associated with abnormalities in auditory screening in a pediatric hospital. Methods A cross-sectional study was conducted on patients assessed in the early hearing detection program at the Pediatric Tower of the High Specialty Hospital of Veracruz, Mexico, between June 2022 and 2023. Screening was performed using otoacoustic emissions initially. Those with abnormalities underwent two retests, and those positive in all three evaluations underwent confirmatory testing. Newborn screening was conducted at discharge for healthy neonates and after reaching a weight of over 1.8 kg and more than 34 gestational weeks for preterm infants. For term and low-birth-weight babies, screening occurred when they reached 2 kg, considering positive results in any of the three tests indicative of altered screening and probable hearing impairment. Results A total of 2731 patients were fully evaluated, with 1416 (51.8%) being male, and a median Apgar score of 9 at 5 minutes. The incidence of hearing impairment was 0.7%, comprising 19 patients. Evaluation of sex, 5-minute Apgar score, weight, gestational age, congenital malformations, history of neonatal asphyxia, hyperbilirubinemia, sepsis, TORCH infections, family history of hearing impairment, maternal exposure to ototoxic drugs, substances, COVID-19, gestational diabetes, or maternal hypertension obtaining values of p &amp;gt; 0.05 in each of them. Conclusions The prevalence of hearing loss is similar to that reported in the literature. In our population, auditory screening abnormalities are not associated with classic perinatal factors, indicating the complexity of contributors to neonatal hearing impairment. Key messages • The neonatal screening program plays a fundamental role in identifying patients with hearing loss even without any clinical factor that arouses suspicion of hearing loss. • Early diagnosis will favor timely care for patients with hearing loss, favoring their development with adequate care to improve their quality of life.

Worse ischemic symptoms and cardiac function in women with suspected ischemia with no obstructive coronary artery disease and adverse pregnancy outcomes history

Abstract Background Adverse pregnancy outcomes (APO) are associated with increased maternal risk of cardiovascular disease (CVD) and mortality. Ischemia with no obstructive coronary artery disease (INOCA) is predominant in women, however the association of APO history with INOCA is poorly understood. Purpose To compare clinical characteristics, symptoms, cardiac structure and function and coronary microvascular dysfunction in women suspected to have INOCA with or without a history of APO. Methods Women’s Ischemia Syndrome Evaluation (WISE) CVD (NCT00832702) and WISE pre-HFpEF (NCT02582021) prospective cohorts of women with suspected INOCA were merged and utilized to determine among women with at least 1 prior pregnancy whether a history of APO was associated with ischemic symptoms, and to characterize CMRI measured left ventricle (LV) structure and function, myocardial deformation (systolic and diastolic strain) and coronary microvascular dysfunction on invasive coronary functional testing (CFT). Self-reported APO was defined as hypertensive disorder of pregnancy (HDP), gestational diabetes, preterm birth (&amp;lt;37-week gestation), low birth weight (&amp;lt;5lbs). Results In a cohort of 469 women with suspected INOCA, (mean average age 55 [SD 10.2] years) and at least 1 prior pregnancy, 138 (29%) had history of at least 1 APO. Among women with history of APO, 78 reported HDP, 50 gestational diabetes, 27 pre-term birth, 8 low birth weight. Women with a history of APO were younger, had higher rates of hypertension and diabetes, higher BMI and lower SAQ and DASI scores compared to those with no history of APO (Table). LV ejection fraction (EF) was lower and early diastolic strain rate/LVEDP was higher in women with APO history compared to those without APO history. Conclusion(s) In cohort of women with INOCA, history of APO was highly prevalent. Despite younger age, women with history of APO had higher rates of CVD risk factors, worse ischemic symptoms and functional capacity, lower EF, and higher filling pressures. Our findings suggest a potential for APO history to better identify women with worse prognosis that warrants further investigation and aggressive management.