Prenatal Intervention Research Articles

Outcomes of Intrauterine Interventions in Twin Reversed Arterial Perfusion (TRAP) Sequence: A Systematic Review of the Literature Over the Past 35Years.

Twin reversed arterial perfusion (TRAP) sequence is an uncommon disease affecting monochorionic twin pregnancies. The diagnosis can be made by ultrasound allowing to plan optimal antenatal management. An electronic search was conducted from inception to July 2024 to systematically evaluate and compare the outcomes of different intrauterine interventions in this condition. Eighty-two studies were included, and 859 women with a prenatal ultrasound diagnosis of TRAP sequence with a total of 1763 fetuses were studied. The mean maternal age was 24.2years (range 19-40) and the mean gestational age at diagnosis was 19.6weeks (range 10-32). A total of 792 pregnancies were reported in which a fetal intervention was performed over the past 35years. The mean gestational age at fetal intervention was 22.1weeks (range 11-32). The two most frequent fetal interventions were radiofrequency ablation, performed in 293 cases and laser umbilical cord coagulation in 140 cases. Overall, 684 out of 828 non-acardiac fetuses following fetal intervention survived (82.6%) compared with 49 out of 76 (64.5%) non-acardiac fetuses in pregnancies managed expectantly (p=0.0001). A higher survival rate was seen in fetuses undergoing umbilical cord ligation (100%) although this procedure was performed in only 8 women. Survival rates were 88.9%, 79.9%, 78.9% and 77.9% for monopolar coagulation of the umbilical cord, laser coagulation of the umbilical cord, fetoscopic laser ablation of placental anastomoses and radiofrequency ablation, respectively. Our results show that the survival rate is higher in patients with TRAP who have a prenatal intervention compared with those who have prenatal expectant management. The survival rate varies depending on the modality used for the prenatal intervention. Future studies are necessary to investigate the impact of the gestational age at the time of the procedure on the survival rate depending on the prenatal therapeutic modality.

Examination of the Feelings and Experiences of Postpartum Mothers Engaging with Social Media: A Qualitative Study.

Purpose: This study examined how postpartum mothers experience social media within the context of mothering and their postpartum body.Methods: A subsample of 20 mothers (age 23-42) of infants aged 0-6 months who were exposed to body-focused social media posts as part of an experimental study designed to test social media's impact on body dissatisfaction took part in semi-structured interviews. We used thematic analysis to identify themes and subthemes generated from the data.Results: We identified three themes in the study: (i) Social media provides a sense of connection with family and friends as a source of support, and connecting with others to gather information related to mothering and child-rearing; (ii) social media led mothers to engage in comparison regarding their bodies, lifestyles, and baby's development; and: (iii) mothers do not always recognize the influence of social media on their feelings.Conclusions: Findings can help guide prenatal and postpartum interventions and equip healthcare professionals with the information needed to support postpartum mothers in maintaining a positive body image and mothering experience when engaging online.

Prenatal gene editing for neurodevelopmental diseases: Ethical considerations.

Neurodevelopmental diseases (NDDs) are notoriously difficult to treat because clinical symptoms stem from developmental processes that begin before birth. Prenatal gene editing could fill the treatment gap for NDDs by targeting and permanently correcting the genetic variants that underlie these pathogenic developmental processes. At the same time, there is a risk of unintended edits to the fetus or the pregnant person that could result in serious adverse consequences that are difficult, if not impossible, to undo. This raises ethical concerns that make the development of prenatal gene editing especially challenging. To date, there are no frameworks for considering the steps necessary for an ethical path forward for prenatal gene editing specifically. The 60-year history of in utero therapy has included the development of frameworks for other therapies that can provide starting points for addressing the unique issues of prenatal gene editing. We identified 12 themes from 17 ethical frameworks, literature, consensus statements, and government reports on prenatal interventions that could set precedents for prenatal gene editing interventions. In considering these alongside current criteria for postnatal gene therapies for NDDs, we discuss a path forward for prenatal gene editing interventions of NDDs.

The Childbirth Experience: A Systematic Review on Prenatal and Intrapartum Supportive Interventions

Background: The incidence of challenging delivering experiences varies among societies and is impacted by various factors. The primary goal of this review was to assess the effect of supportive interventions pre- and during delivery on the likelihood of a positive childbirth experience. Methods: This study reviewed articles related to childbirth experience in international databases, such as PubMed, Cochrane, and ScienceDirect. A total of 1433 articles were found using the PRISMA guideline. Review research emphasized the supporting interventions during labor and women's subjective experience. Quality assessment was conducted using the modified Jadad scale. Results: Overall, fifteen studies passed the eligibility criteria. The effective approaches to develop a favorable understanding of the whole birthing process encompassed the following supportive interventions: yoga exercise during pregnancy, antenatal hypnosis program, continuous supportive care during labor, family companion during labor, massage during labor, therapeutic touch program, acupressure during labor, birth ball exercise during labor, warm showers during the first stage, and dancing with music during the active phase of labor. Conclusion: Various supportive interventions related to childbirth may reduce pain and anxiety, build confidence, encourage, and serve as valuable psychosocial interventions for childbirth. Becoming a mother is not a frequent occurrence for all women, contributing to an overall experience in childbirth. Our study recommends interventions, such as yoga exercises during pregnancy, an antenatal hypnosis program, continuous supportive care during labor, a family companion during labor, massage during labor, a therapeutic touch program, acupressure during labor, birth ball exercise during labor, warm showers during the first stage, and dancing with music during the active phase of labor.

Effectiveness of prenatal intervention on neonatal hyperbilirubinemia management in rural Bangladesh: Results from a cluster-randomized trial.

Nearly 80% of severe neonatal hyperbilirubinemia cases are identified too late for medical treatment in lower-middle-income countries. Parents' understanding of neonatal jaundice is crucial for early detection and effective treatment. This study evaluated the effectiveness of prenatal sensitization in improving maternal knowledge and attitude toward neonatal hyperbilirubinemia management in Bangladesh. Cluster-randomized trial. Between September 2019 and March 2021, a prospective home-based intervention trial on neonatal hyperbilirubinemia was conducted in 20 interventions and comparison clusters through community health workers (CHW). Participants were pregnant women in their second or third trimester of pregnancy. Proportion-based difference-in-difference (DID) was calculated to determine changes in the mother's knowledge and attitude towards newborn jaundice. A total of 539 pregnant women were enrolled, 273 in the intervention, and 266 in the comparison arm. Following the intervention, participant's overall knowledge level about neonatal hyperbilirubinemia increased significantly (DID: 24.9, 95%CI: 19.2, 30.7) from baseline (33.2%) to endline (70.5%). Knowledge of newborn jaundice management showed the most improvement (DID: 60), followed by danger signs detection (DID: 40.0). The intervention also enhanced participants' positive attitudes regarding neonatal hyperbilirubinemia (DID: 13.1, 95%CI: 8.1, 18.0). Mothers with improved knowledge of neonatal hyperbilirubinemia were nearly five times more likely to have a favorable attitude toward it than those with counterparts. CHW-led home-based prenatal sensitization interventions substantially improved mothers' awareness and attitudes toward neonatal hyperbilirubinemia detection and management. Integrating such sensitization into prenatal care of the existing health system could be a practical approach to improve neonatal health outcomes in Bangladesh.

Exploring the impact of hepatitis B immunoglobulin and antiviral interventions to reduce vertical transmission of hepatitis B virus.

Hepatitis B virus (HBV) infection is a major public health burden. In HBV endemic regions, high prevalence is also correlated with the infections acquired in infancy through perinatal transmission or early childhood exposure to HBV, the so-called mother-to-child transmission (MTCT). Children who are infected with HBV at a young age are at higher risk of developing chronic HBV infection than those infected as adults, which may lead to worse clinical outcome. To reduce the incidence of HBV MTCT, several interventions for the infants or the mothers, or both, are already carried out. This review explores the newest information and approaches available in literature regarding HBV MTCT prevalence and its challenges, especially in high HBV endemic countries. This covers HBV screening in pregnant women, prenatal intervention, infant immunoprophylaxis, and post-vaccination serological testing for children.

Fetal Tracheal Occlusion Corelates with Normalized YAP Expression and Alveolar Epithelial Differentiation in CDH.

Congenital diaphragmatic hernia (CDH) is characterized by incomplete closure of the diaphragm. While the ensuing compression to the fetal lung causes lung hypoplasia, specific cellular phenotypes and developmental signaling defects in the alveolar epithelium in CDH are not fully understood. Employing lung samples from human CDH, a surgical lamb model and a nitrogen rat model, we investigate whether lung compression impairs alveolar epithelial differentiation and Yes-associated protein (YAP)-mediated mechanosensing. We showed that CDH in humans and lambs caused defective alveolar epithelial differentiation manifested by more abundant ATII cells, fewer ATI cells, and the emergence of cells expressing both ATI and ATII markers. Associated with the alveolar epithelial defects, we found a decrease in the level and nuclear localization of YAP. Reduced nuclear YAP and abnormal distal lung development were evident as early as 21 weeks in gestation in human CDH. In addition, rat fetuses with CDH also showed diminished nuclear YAP and mor abundant ATII cells. In contrast, the littermates without the hernia had no such alveolar phenotypes. Furthermore, fetal tracheal occlusion (TO) in the surgical lamb model of CDH fully normalized nuclear YAP and rescued alveolar epithelial defects in a gestational age-dependent manner. Taken together, our findings across species indicate that lung compression in CDH is sufficient to disrupt alveolar epithelial differentiation and impair YAP signaling. TO can restore nuclear YAP and rescue the alveolar defects in CDH, depending on the timing and the duration of this prenatal surgical intervention. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Amniotic fluid-derived stem cells: potential factories of natural and mimetic strategies for congenital malformations

Background:Mesenchymal stem cells (MSCs) derived from gestational tissues offer a promising avenue for prenatal intervention in congenital malformations although their application is hampered by concerns related to cellular plasticity and the need for invasive, high-risk surgical procedures. Here, we present naturally occurring exosomes (EXOs) isolated from amniotic fluid-derived MSCs (AF-MSCs) and their mimetic analogs (MIMs) as viable, reproducible, and stable alternatives. These nanovesicles present a minimally invasive therapeutic option, addressing the limitations of MSC-based treatments while retaining therapeutic efficacy.Methods:MIMs were generated from AF-MSCs by combining sequential filtration steps through filter membranes with different porosity and size exclusion chromatography columns. A physicochemical, structural, and molecular comparison was conducted with exosomes (EXOs) released from the same batch of cells. Additionally, their distribution patterns in female mice were evaluated following in vivo administration, along with an assessment of their safety profile throughout gestation in a mouse strain predisposed to neural tube defects (NTDs). The possibility to exploit both formulations as mRNA-therapeutics was explored by evaluating cell uptake in two different cell types(fibroblasts, and macrophages) and mRNA functionality overtime in an in vitro experimental setting as well as in an ex vivo, whole embryo culture using pregnant C57BL6 dams.Results:Molecular and physiochemical characterization showed no differences between EXOs and MIMs, with MIMs determining a threefold greater yield. Biodistribution patterns following intraperitoneal administration were comparable between the two particle types, with the uterus being among targeted organs. No toxic effects were observed in the dams during gestation, nor were there any malformations or significant differences in the number of viable versus dead fetuses detected. MIMs delivered a more intense and prolonged expression of mRNA encoding for green fluorescent protein in macrophages and fibroblasts. An ex-vivo whole embryo culture demonstrated that MIMs mainly accumulate at the level of the yolk sac, while EXOs reach the embryo.Conclusions:The present data confirms the potential application of EXOs and MIMs as suitable tools for prevention and treatment of NTDs and proposes MIMs as prospective vehicles to prevent congenital malformations caused by in utero exposure to drugs.

The Impact of Customized Interventions on Antenatal Mothers’ Body Mass Index

ABSTRACT Introduction: Antenatal exercise andYoga improves strength, balance and flexibility and reduces maternal stress and yield better outcome of pregnancy. Aim: To assess and compare effect of yoga nad exercise on maternal Body mass Index Material and methods Sample size 132 and each group 33 samples one control and 3 experimental group. The YG and EG groups received prenatal exercise 40 minutes and yoga 20 minutes intervention 2 days per week consecutively 16 weeks provided. At 20th week the Pre test BMI and 36 week post test Measured. Results: Control group gradually improved BMI comparing to all Experimental groups, Significantly at P.0.001 level. The mean difference is significant at the 0.05 level. Conclusion: Customized yoga and prenatal exercise interventions will be more helpful in bringing BMI back to normal.

Predictive modeling of gestational weight gain: a machine learning multiclass classification study

BackgroundGestational weight gain (GWG) is a critical factor influencing maternal and fetal health. Excessive or insufficient GWG can lead to various complications, including gestational diabetes, hypertension, cesarean delivery, low birth weight, and preterm birth. This study aims to develop and evaluate machine learning models to predict GWG categories: below, within, or above recommended guidelines.MethodsWe analyzed data from the Araraquara Cohort, Brazil, which comprised 1557 pregnant women with a gestational age of 19 weeks or less. Predictors included socioeconomic, demographic, lifestyle, morbidity, and anthropometric factors. Five machine learning algorithms (Random Forest, LightGBM, AdaBoost, CatBoost, and XGBoost) were employed for model development. The models were trained and evaluated using a multiclass classification approach. Model performance was assessed using metrics such as area under the ROC curve (AUC-ROC), F1 score and Matthew’s correlation coefficient (MCC).ResultsThe outcomes were categorized as follows: GWG within recommendations (28.7%), GWG below (32.5%), and GWG above recommendations (38.7%). The XGBoost presented the best overall model, achieving an AUC-ROC of 0.79 for GWG within, 0.76 for GWG below, and 0.65 for GWG above. The LightGBM also performed well with an AUC-ROC of 0.79 for predicting GWG within recommendations, 0.76 for GWG below, and 0.624 for GWG above. The most important predictors of GWG were pre-gestational BMI, maternal age, glycemic profile, hemoglobin levels, and arm circumference.ConclusionMachine learning models can effectively predict GWG categories, offering a valuable tool for early identification of at-risk pregnancies. This approach can enhance personalized prenatal care and interventions to promote optimal pregnancy outcomes.

Sex-Specific Metabolic Effects of Gestational Chronodisruption and Maternal Melatonin Supplementation in Rat Offspring.

Gestational chronodisruption, increasingly common due to irregular light exposure, disrupts maternal-fetal circadian signaling, leading to long-term health issues in offspring. We utilized a chronic photoperiod shifting model (CPS) in pregnant rats to induce chronodisruption and investigated the potential mitigating effects of maternal melatonin supplementation (CPS + Mel). Male and female offspring were evaluated at 3 ages (90, 200, and 400 days of age) for metabolic profiles, hormonal responses, cytokine levels, and adipose tissue activity. Our findings indicate that gestational chronodisruption leads to increased birth weight by approximately 15% in male and female offspring and increased obesity prevalence in male offspring, accompanied by a 30% reduction in nocturnal melatonin levels and a significant disruption in corticosterone rhythms. Male CPS offspring also exhibited decreased lipolytic activity in white adipose tissue, with a 25% reduction in glycerol release compared to controls, indicating impaired metabolic flexibility. In contrast, female offspring, while less affected metabolically, showed a 25% increase in adipose tissue lipolytic activity and higher levels of pro-inflammatory cytokines such as IL-6 (increased by 40%). Scheduled melatonin supplementation in chronodisrupted mothers, administered throughout gestation, effectively normalized birth weights in both sexes, reduced obesity prevalence in males by 18%, and improved lipolytic activity in male offspring, bringing it closer to control levels. In females, melatonin supplementation moderated cytokine levels, reducing IL-6 by 35% and restoring IL-10 levels to near-control values. These results highlight the importance of sex-specific prenatal interventions, particularly the role of melatonin in preventing disruptions to fetal metabolic and inflammatory pathways caused by gestational chronodisruption. Melatonin treatment would prevent maternal circadian rhythm misalignment, thereby supporting healthy fetal development. This study opens new avenues for developing targeted prenatal care strategies that align maternal and fetal circadian rhythms, mitigating the long-term health risks associated with chronodisruption during pregnancy.

Socio-economic disparities in prenatal prognosis and intervention accessibility

Socio-economic disparities in prenatal prognosis and intervention accessibility

Evaluating Maternal Risk Factors Impacting Fetal Intima-Media Thickness of the Abdominal Aorta Measured at 28 Weeks of Gestation.

Background and Objectives: Cardiovascular disease risk can exist in utero, influenced by maternal health factors. This study evaluates maternal characteristics and biochemical markers that correlate with the fetal intima-media thickness (IMT), aiming to identify interventions that could minimize prenatal influences on later cardiovascular disease. Methods: In this observational study approved by the Institutional Review Board at The Obstetrics and Gynecology Clinic of the Timisoara Municipal Emergency Hospital, we recruited pregnant women aged 15-40 years, divided into groups based on their lipid profiles and gestational diabetes risk. The data collection had, as its main focus, ultrasound measurements, along with demographic, clinical, and biochemical parameters. The IMT of the fetal abdominal aorta was measured at 28 weeks of gestation. Results: Notable differences were observed in the TNF-alpha levels (8.66 ± 3.87 pg/mL vs. 4.96 ± 3.37 pg/mL), hsCRP levels (0.94 ± 0.46 mg/L vs. 0.60 ± 0.52 mg/L), and the area under the curve (AUC) for hsCRP at 0.738 with a sensitivity of 84.41% and specificity of 79.01%. Compound score 2, integrating inflammatory markers and lipid profiles, exhibited a good diagnostic accuracy (AUC = 0.789) with a sensitivity of 86.35% and specificity of 81.42%. A regression analysis indicated strong associations of TNF-alpha and hsCRP with an increased fetal IMT, suggesting potential early markers of cardiovascular risk, presenting hazard ratios (HRs) of 2.21 (95% CI: 1.15-5.28) and 2.87 (95% CI: 1.11-4.23), respectively, both with p-values of less than 0.0001. Compound score 2 further indicated an increased risk (HR = 4.27; 95% CI: 1.19-8.32). Conclusions: Statistically significant correlations were found between an increased fetal IMT and elevated maternal inflammatory markers (TNF-alpha and hsCRP), suggesting that these could serve as early indicators of cardiovascular risk. This study supports the potential for targeted prenatal interventions to reduce cardiovascular risk factors from the fetal stage, emphasizing the importance of monitoring inflammatory markers in pregnant women at risk.

Implementing a prenatal health screening intervention for future fathers in Montreuil, France: most users are immigrants facing hardship

BackgroundPrenatal care provides pregnant women with repeated opportunities for prevention, screening and diagnosis that have no current extension to future fathers. It also contributes to women’s general better access to health. The goal of PARTAGE study was to evaluate the level and determinants of adherence to a prenatal prevention consultation dedicated to men.MethodsBetween January 2021 and April 2022, we conducted a monocentric interventional study in Montreuil hospital. We assessed the acceptance of a prenatal prevention consultation newly offered to every future father, through their pregnant partner’s prior consent to provide their contact details.ResultsThree thousand thirty-eight women provided contact information used to reach the fathers; effective contact was established with 2,516 men, of whom 1,333 (53%) came for prenatal prevention consultation. Immigrant men were more likely to come than French-born men (56% versus 49%, p < 0·001), and the more they faced social hardship, the more likely they were to accept the offer. In multivariate analysis, men born in Subsaharan Africa and Asia were twice as likely to attend the consultation as those born in Europe or North America.ConclusionAcceptance of this new offer was high. Moreover, this consultation was perceived by vulnerable immigrant men as an opportunity to integrate a healthcare system they would have otherwise remained deprived of.Trial registrationRegistry: ClinicalTrials.gov, US National Library of Medicine https://classic.clinicaltrials.gov/ct2/show/NCT05085717Clinical Trial number: NCT05085717.Date of registration: 20/10/2021.

Maternal adiposity and perinatal and offspring outcomes: an umbrella review.

Maternal adiposity deleteriously affects obstetrical health and has been associated with long-term adverse consequences in offspring. Here we conducted an umbrella review encompassing 194 observational meta-analyses, 10 Mendelian randomization studies and 748 interventional meta-analyses to appraise the published evidence on the associations between maternal adiposity and perinatal and offspring outcomes. Evidence grading suggested that 17 (8.8%) observational meta-analyses were supported by convincing evidence for 12 outcomes: maternal adiposity was associated with an increased risk of caesarean delivery following labour induction, infant mortality, Apgar score <7 at 1 min, antenatal depression, offspring overweight and obesity, early timing of puberty onset in daughters, attention deficit hyperactivity disorder, cerebral palsy, congenital heart disease and spina bifida (OR/RR ranging from 1.14 to 2.31), as well as increased offspring body fat percent and fat mass (SMD 0.31 and 0.35, respectively). Among these outcomes, interventional meta-analyses supported that maternal weight loss interventions significantly reduced the risk of antenatal depression but not low Apgar scores; these interventions also could not reduce offspring fat mass or body fat percent. Evidence from Mendelian randomization studies supported a causal relationship between maternal adiposity and gestational diabetes mellitus, preeclampsia, birth size and offspring adiposity. Our findings highlight that while observational meta-analyses reveal associations between maternal adiposity and various adverse perinatal and offspring outcomes, convincing, unbiased evidence or support from Mendelian randomization studies is limited. Maternal pre-conceptional and prenatal weight loss interventions can reduce some, but not all, of these adverse effects.

Pelvic floor status during pregnancy as a predictor of pelvic dysfunction and birth outcome

This literature review presents an analysis of a number of studies that examined the association between pelvic floor health during pregnancy and the development of pelvic dysfunction and birth outcomes. These studies consistently demonstrated that changes in pelvic floor structure and function during pregnancy are associated with an increased risk of developing pelvic disorders such as urinary incontinence and pelvic organ prolapse. Besides, certain pelvic floor characteristics, such as muscle strength, tone, and stretching ability, have been identified as potential predictors of pelvic floor dysfunction during pregnancy and prolonged second-stage labor. The data collected suggest that pelvic floor assessment during pregnancy may provide valuable prognostic information about birth outcomes. Understanding these relationships may lead to improved prenatal care strategies and interventions to optimize pelvic floor function and reduce the incidence of adverse birth outcomes. Further research is required to clarify the specific parameters for evaluating pelvic floor changes that are most indicative of pelvic organ dysfunction and adverse birth outcomes, as well as to assess the efficacy of preventive interventions.

Prenatal and postnatal antiviral therapies for the prevention and treatment of congenital cytomegalovirus infections.

Congenital cytomegalovirus infection (cCMV) is the leading infectious cause of sensorineural hearing loss and lifelong neurodevelopmental disabilities. Studies suggest antiviral therapy can prevent fetal infection after maternal primary infection, as well as halt the progression of hearing loss and neurodevelopmental disabilities in newborns with symptomatic cCMV. With growing worldwide momentum on early detection and diagnosis of cCMV, this review describes the exciting recent advances in antiviral therapies in CMV infected pregnant mothers and babies, as well as emerging evidence on anti-CMV vaccines. New opportunities for prenatal and neonatal interventions have driven a rising interest in screening and identification of asymptomatic CMV infection. Routine screening of pregnant women to identify primary infection in first trimester is now advocated in Western Europe but has yet to be examined from a public health perspective in other regions. Evidence is emerging for maternal valaciclovir therapy to prevent fetal infection after a maternal primary CMV infection in the first trimester of pregnancy. For those infants who are born with symptomatic cCMV, a 6-month course of valganciclovir, started within the first 4 weeks of life, and possibly up to 13 weeks of life, is the current recommended therapy. However, there is unclear evidence for the benefit of treatment for asymptomatic cCMV and cCMV with isolated hearing loss. Research to identify more effective antivirals and an effective CMV vaccine continues. More research is needed to determine the region-specific applicability of the new European recommendations for routine CMV screening in pregnancy. Areas of uncertainty in postnatal management include timing of initiation, duration of treatment and identifying pediatric subgroups that benefit from modification of the standard treatment recommendations.

A group prenatal care intervention reduces gestational weight gain and gestational diabetes in American Samoan women.

The objective of this study was to determine the preliminary effectiveness of an intervention to mitigate adverse pregnancy outcomes associated with pre-pregnancy obesity in American Samoa. We enrolled n = 80 low-risk pregnant women at <14 weeks' gestation. A complete case analysis was conducted with randomized group assignment (group prenatal care-delivered intervention vs. one-on-one usual care) as the independent variable. Primary outcomes were gestational weight gain and postpartum weight change. Secondary outcomes included gestational diabetes screening and exclusive breastfeeding at 6 weeks post partum. Other outcomes reported include gestational diabetes incidence, preterm birth, mode of birth, infant birth weight, and macrosomia. Gestational weight gain was lower among group versus usual care participants (mean [SD], 9.46 [7.24] kg vs. 14.40 [8.23] kg; p = 0.10); postpartum weight change did not differ between groups. Although the proportion of women who received adequate gestational diabetes screening (78.4% group; 65.6% usual care) was similar, there were clinically important between-group differences in exclusive breastfeeding (44.4% group; 25% usual care), incidence of gestational diabetes (27.3% group; 40.0% usual care), and macrosomia (8.3% group; 29.0% usual care). It may be possible to address multiple risk factors related to intergenerational transmission of obesity in this high-risk setting using a group care-delivered intervention.

Comparative Study between the Accuracy of Transcerebellar Diameter versus Femur Length and Biparietal Diameter Measurements in Estimation of Gestational Age during Third Trimester

Abstract Background Knowledge of accurate gestational age is of great importance in obstetric practice. Pregnancy complications as low birth weight, preterm labor are very common in pregnancies with unknown and inaccurate estimated gestational age, gestational age estimation is essential for proper prenatal care and determining whether the fetal size is appropriate-for- gestational age. Moreover, it is essential for many prenatal interventions, such as fetal lung maturation, use of magnesium for neuroprophylaxis in preterm infants, induction of delivery and neonatal resuscitation. Optimal assessment requires good judgment by the obstetrician caring for the patient. Objective To compare the accuracy of transcerebellar diameter versus the current fetal biometrics including (femur length and biparietal diameter) in estimation of the gestational age during the third trimester according to last menstrual period. Patients and Methods The study was conducted in clinic of Obstetrics and Gynaecology Department- MUST University Hospital. This study included 120 pregnant females. They were divided equally into three equal groups each contained 40 patients; Group I: Biparietal diameter measured group, Group II: Femur Length measured group, and Group III: Transcerebellar measured group. Results The comparison in 1 week proved that the TCD gave correct assessment of gestational age in 107 patients (89.17%), the BPD gave correct assessment of gestational age in 73 patients (60.83%) and the FL gave correct assessment of gestational age in 97 patients (80.83%). Conclusion Transcerebellar diameter is the most accurate and reliable method for assessment of gestational age in third trimester followed by FL and the least accurate is the BPD.

Adaptive changes in multiple aspects of emotion regulation in the offspring of pregnant persons receiving a diet-and-exercise intervention relative to usual pregnancy care: a randomized controlled trial

BackgroundHuman studies examining the influence of prenatal diet and/or exercise interventions on offspring neurodevelopment are mixed. Interventions that include the provision of whole foods, nutritional counseling, address exercise behaviors, and that utilize multimethod assessments of offspring emotion regulation (ER) may better reveal the impact of these interventions on neurodevelopment. ObjectivesTo explore whether the Be Healthy in Pregnancy (BHIP) prenatal diet-and-exercise intervention improves ER in 22-mo-old offspring. MethodsPregnant persons (>18 y, singleton pregnancy) were recruited between 12 and 17 wk gestation and randomly assigned to the intervention [high protein energy-controlled diet via the provision of cottage cheese, Greek yogurt, low-fat milk, individualized biweekly nutritional counseling, a controlled walking program, and usual pregnancy care (UPC)] or control (UPC alone) groups. ER in offspring [mage = 22.2 (SD = 4.04); 50.9% female; intervention: n = 29, control: n = 28] was assessed using reports from pregnant persons and their partners on the Child Behavior Checklist, and the Behavior Rating Inventory of Executive Function-Preschool Version, laboratory observational tasks examining inhibitory control, attention, and empathy, and high-frequency heart rate variability (HF-HRV). ResultsChildren exposed to the BHIP intervention exhibited medium to large effect size reductions in pregnant person and partner reported externalizing [effect size ƞ2pmother = 0.08, 95% confidence interval of the difference (0.05, 7.14); ƞ2ppartner = 0.17 (1.68, 9.65)], internalizing [ƞ2pmother = 0.08 (0.09, 5.32); ƞ2ppartner = 0.13 (0.84, 8.88)], and total behavior problems [ƞ2pmother = 0.09 (0.72, 11.87); ƞ2ppartner = 0.17 (3.17, 17.88)] relative to control participants’ children. Pregnant persons, but not partners, reported fewer problems with inhibitory control [ƞ2p = 0.13 (1.40, 8.55)], cognitive flexibility [ƞ2p = 0.08 (0.18, 4.85)], emergent metacognition [ƞ2p = 0.14 (2.00, 11.59)], and global executive function [ƞ2p = 0.14 (3.37, 20.12)]. Intervention children displayed fewer impulsive behaviors [ƞ2p = 0.11 (0.16, 1.77)] and a longer attention span [ƞ2p = 0.08 (0.30, 13.34)]. Finally, intervention children exhibited greater baseline HF-HRV [ƞ2p = 0.10 (0.16, 2.01)], and adaptive HF-HRV reactivity during the impulsivity [ƞ2p = 0.12 (0.20, 2.19)], and attention tasks [ƞ2p = 0.21 (0.74, 2.77)]. ConclusionsThis intervention was associated with medium/large effect size improvements in offspring ER. Larger trials are needed to confirm the potential of these interventions on offspring neurodevelopment. Trial registration numberThis trial was registered at www.clinicaltrials.gov as NCT01689961 (21 September, 2012).