Preterm Low Birth Weight Research Articles

Risk factors associated with cesarean section and adverse fetal outcomes in intrahepatic cholestasis of pregnancy.

To determine the risk factors for cesarean section (CS) and adverse fetal outcomes (AFOs) in patients with intrahepatic cholestasis of pregnancy (ICP) based on the severity of maternal hypercholanemia. A hospital-based retrospective cohort study was performed between January 1, 2015, and December 31, 2019. A total of 227 nulliparous women with a singleton fetus complicated by ICP were included. The patients were divided into two groups according to the levels of total bile acids, that is, mild (10 μmol/L < total bile acids < 40 μmol/L) and severe (≥40 μmol/L). The patients' clinical characteristics and fetal outcomes were assessed. Among the 227 eligible women, 177 (78.0%) were allocated to the mild group and 50 (22.0%) were in the severe group. Women with severe ICP also had a significantly higher incidence of planned and unplanned CS compared with mild ICP subjects (52.0% vs. 23.7% and 22.0% vs. 6.8%, respectively; p < 0.001). The indications for CS showed that fetal intolerance (65.4% vs. 14.3%) was higher in severe ICP compared with mild ICP (p < 0.001). Severe ICP was associated with an increased risk of preterm delivery (p < 0.001), low birthweight (p = 0.001), and neonatal intensive care unit (NICU) admission (p < 0.001). Women with severe ICP (OR 6.397, 95%CI 3.041-13.455, p < 0.001) or preeclampsia (OR 12.434, 95%CI 5.166-29.928, p < 0.001) had increased risks of AFOs compared to controls. Severe ICP and preeclampsia are associated with a higher incidence of AFOs.

Demographic and clinical status of the neonates admitted to an intensive care unit in Bangladesh

Background: The neonatal intensive care unit is a fundamental sector for the survival of high-risk newborns. Such a unit involves high-complexity assistance with teams trained in newborn care, reconciling technological advances with proper approaches to humanized care practices. Usually, the outcomes of neonatal intensive care unit patients depend upon the demographic and clinical status of the patients. In Bangladesh, we have very limited research-based information regarding this issue. This study aimed to assess the demographic and clinical status of neonates admitted to an intensive care unit in Bangladesh. Methods: This was an observational cohort study that was conducted in the Neonatal Intensive Care Unit (I.C.U.) of Dhaka Shishu Hospital, Dhaka, Bangladesh during the period from October 2009 to September 2010. In total 230 neonates admitted to the Neonatal Intensive Care Unit, after fulfilling the inclusion criteria were enrolled in this study as study subjects. Properly written consent was taken in favour of all the participants before data collection. All data were processed, analysed and disseminated by using MS Excel and SPSS version 15.0 program as per necessity. Results: Among the total of 230 participants, the male-female ratio was 1.7:1 and gestational age was found as &gt;37 weeks in 60% of neonates. The age of the majority of the neonates (53%) was &lt;7 days. The diaphragmatic hernia was present in the highest number (n=17) of cases as a single congenital anomaly. As the disease pattern, perinatal asphyxia with complications, preterm low birth weight with sepsis and congenital anomalies were found in 24.8%, 20.4% and 23% of cases respectively. Among the total of our patients, in 55% of cases, acid-base derangements were present. Conclusions: The higher frequency of ICU admission of male neonates is alarming for the neonatal care system. The first week of neonatal ICU may be considered the most critical period, especially for preterm babies. Neonates with perinatal asphyxia, preterm low birth weight with sepsis and congenital anomalies are some common features among neonatal ICU care patients.

P-115 Clinical prognosis of abnormally cleaved embryos: time-lapse evidence of self-correction before blastulation

Abstract Study question What is the clinical prognosis of embryos displaying abnormal cleavage (ABNCL) observed via time-lapse videography (TLV) and the role of blastulation in embryo self-correction? Summary answer ABNCL leads to reduced blastulation rate, but not live birth rates and neonatal outcomes once blastulation has been achieved. What is known already It is widely accepted that ABNCL is associated with reduced viability in cleavage stage human embryos. However, evidence is scarce in literature reporting birth outcomes from blastocysts arising from such embryos, mostly because they are ranked low priority for transfer. Knowledge is also limited regarding the potential self-correction mechanism in those leading to live births. In this study, using a large dataset of blastocysts with known live birth outcomes, we aimed to explore the role of blastulation in the self-correction process of ABNCL embryos, and their subsequent live birth rates as well as neonatal outcomes following intrauterine transfer. Study design, size, duration This retrospective study involved 1562 consecutive autologous in vitro fertilization cycles (maternal age 35.1 ± 4.7 years) performed at Fertility North between January 2017 and June 2022. Fresh transfers were routinely performed on Day 3 with remaining embryos cultured up to Day 6. A total of 9451 embryos were subject to blastocyst culture, with a subset of 664 resulting blastocysts (following single frozen transfers up to August 2021) included for live birth and neonatal outcome analysis. Participants/materials, setting, methods A total of 6019 out of 9451 embryos were annotated for ABNCL up to Day 3, including direct cleavage (DC), reverse cleavage (RC) and &amp;lt;4 intercellular contact points at 4-cell stage (&amp;lt;4ICCP). The remaining 3432 embryos were excluded from TLV annotation due to poor quality as per the 2011 Istanbul consensus. For DC and RC, the number of affected blastomeres was also recorded for the 1st (1-cell), 2nd (2-3-cell), and 3rd cleavage cycles (4-8-cell), respectively. Main results and the role of chance Embryos showing DC (19.5%), RC (41.7%), &amp;lt;6ICCP (58.8%), and Mixed (affected by 2 or 3 ABNCL types, 26.4%) had lower blastulation rates than those without ABNCL (67.2%, P &amp;lt; 0.01 respectively). Subgroup analysis showed increasing blastulation rates along cleavage cycles of DC/RC occurrence, from 1st through 2nd to 3rd cleavage cycles (DC 6.3%, 20.7% and 41.0%, P &amp;lt; 0.001; and RC 10.0%, 32.3% and 45.8%, P &amp;lt; 0.05). Negative correlation (P &amp;lt; 0.05 respectively) was also identified between the number of blastomeres affected by DC/RC and subsequent blastulation. However, once blastulation was achieved, clinical results were comparable between blastocysts with DC, RC, &amp;lt;6ICCP and No ABNCL; including live birth rates (25.9%, 33.0%, 36.0% vs 30.8%, P &amp;gt; 0.05 respectively), gestational age (38.7 ± 1.6, 38.5 ± 1.2, 38.3 ± 3.5 vs 38.5 ± 1.8 weeks, P &amp;gt; 0.05 respectively) and birthweight (3343.0 ± 649.1, 3378.2 ± 538.4, 3352.6 ± 841.3 vs 3313.9 ± 509.6 grams, respectively). Above findings held true following multivariate regression (logistic or linear as appropriate); adjusting for maternal age and BMI, vitrification day, blastocyst expansion stage, ICM/TE grades, insemination methods and sperm types. Also, no difference was detected using either Z-score as endpoint combining birthweight, baby sex and gestational age; or preterm delivery (&amp;lt;37 weeks) or low birthweight (&amp;lt;2500 grams) incidences as endpoints. Live-birth embryo TLV indicated self-correction mechanisms by excluding/extruding DC/RC cells before blastulation. Limitations, reasons for caution Our study is limited by its retrospective nature, making it impossible to control all known/unknown confounders. Embryos in our dataset, being surplus after selection for those with no or minimum ABNCL for fresh transfer on Day 3, may not represent the full embryo cohort. Wider implications of the findings Our findings further support the embryo self-correction mechanism where DC/RC affected blastomere is excluding/extruded at blastulation, which is evidenced by TLV of live-birth embryos. The assuring live birth rates and neonatal outcomes in ABNCL blastocysts provide valuable guidance to clinical practice and patient counselling. Trial registration number not applicable

Association between preterm birth and low birth weight and maternal chronic periodontitis: A hospital-based case-control study.

Periodontal diseases (PDs) are one of the most common chronic diseases affecting overall oral functions, and their association with adverse pregnancy outcomes (APOs) has been an area of interest since the late 90s. The present hospital-based case-control study aimed to find any association between maternal chronic periodontitis (CP) and preterm birth (PTB) and low birth weight (LBW) by comparing the periodontal parameters in patients with normal birth, PTB and LBW. The participants of the study were females that had delivered a live baby (n = 1,200). They were classified as either cases or controls. The cases were defined as PTB if the delivery was before 37 weeks of gestation, and as LBW if the infant weighed <2,500 g. The others were controls. The intraoral examination, which included recording the periodontal status, was conducted within 3 days of delivery. Detailed medical history and demographic data were recorded for the determination of the confounding factors. The multivariable dependence of PTB and LBW on both the categorical and continuous data was analyzed using a multivariate logistic regression analysis. Adjusted odds ratios (AORs) with a 95% confidence interval (CI) for the risk of PTB and LBW were calculated. A strong association with PTB was found for a high plaque index (PI) score (AOR = 1.61; p < 0.001; 95% CI: 1.26-2.07) and a mean pocket probing depth (PPD) ≥4 mm (AOR: 4.32; p < 0.001; 95% CI: 3.09-6.02). A strong association with LBW was found for a high PI score (AOR = 2.02; p < 0.001; 95% CI: 1.43-2.83) and a mean PPD ≥4 mm (AOR: 8.70; p < 0.001; 95% CI: 6.01-12.59). A high PI score and a mean PPD ≥4 mm were independent risk factors for PTB and LBW. The presence of deep pockets and inadequate plaque control in pregnant females increased the risk of APOs.

#4482 PREGNANCY AND RENAL OUTCOMES IN WOMEN WITH CHRONIC KIDNEY DISEASE: A POPULATION STUDY

Abstract Background and Aims Women with CKD stages 3-5 are at higher risk of adverse pregnancy outcomes, including preterm delivery and low birthweight and progression of kidney disease. However, data describing outcomes of women with less severe kidney disease are limited, and few compare with women normal renal function. Furthermore, most studies report cohorts recruited from specialist clinics and may not be representative. This study aimed to describe pregnancy outcomes in a UK population cohort according to pre-conception eGFR &amp;lt;90 ml/min/1.73 m2 compared with women with eGFR ≥90 ml/min/1.73 m2. Method Routinely collected pregnancy data from three NHS Trust hospitals in Kent (UK) between 2010 and 2020 were extracted with Research Ethics Committee approval (19/LO/1242 and 18/SC/0158). Local laboratory and clinical data were linked to identify women with eGFR measured within two years of conception. Women without preconception creatinine were excluded from analysis. Baseline characteristics were described and comparisons between eGFR and adverse pregnancy and renal outcomes were tested. Results A total of 14,243 pregnancies with confirmed pre-pregnancy creatinine were included, of which 1,405/14,243 (9.9%) had CKD stages 1-4 (stage 1: 221/14,243 (1.6%), stage 2: 1,170/14,243 (8.2%), stage 3: 12/14,243 (0.1%), stage 4: 2/14,243 (0.01%) (Table 1). Women with pre-pregnancy eGFR 60-89 ml/min/1.73 m2 (stage 2) were significantly older at conception than women without CKD (eGFR ≥90 ml/min/1.73 m2) but there were no significant differences in live birth rates, small for gestational age, gestation at delivery, and preterm birth. In pregnancies with CKD (1,405, stages 1-4), pre-pregnancy eGFR was weakly correlated with birthweight (rs = 0.05, p = 0.05), and gestational age (rs = 0.06, p = 0.05). Conclusion To our knowledge, this is the largest population cohort to describe pregnancy outcomes between women with eGFR 60-89 ml/min/1.73 m2 compared with eGFR ≥90 ml/min/1.73 m2. Women with eGFR 60-89 ml/min/1.73 m2 did not have worse renal or pregnancy outcomes compared to eGFR ≥90 ml/min/1.73 m2. Limitations include lack of proteinuria data and details of structural CKD (Class 1 CKD), and only one eGFR measurement prior to pregnancy may have led to some women with temporary reduction in function being included in the cohort. Overall, the findings suggest that women with eGFR 60-89 ml/min/1.73 m2 should not be discouraged from pregnancy.

Cycle Biodynamics of Women's Microbiome in the Urinary and Reproductive Systems.

The genitourinary microbiome plays a crucial role in the establishment and maintenance of urinary and reproductive health in women throughout their lives. Particularly during the reproductive stage, resident microorganisms contribute to implantation and protect against perinatal complications, including preterm birth, stillbirth, and low birth weight, while also serving as the first line of defense against pathogens that can cause infections, such as urinary tract infections and bacterial vaginosis. This review aimed to elucidate the relationship between a healthy microbiome environment and women's overall health. We examine the variability and dynamics of the microbiome during different developmental stages, ranging from the prepubertal to the postmenopausal stage. Furthermore, we explore the significance of a healthy microbiota in successful implantation and pregnancy development and investigate potential differences between women experiencing infertility. In addition, we analyze the local and systemic inflammatory responses associated with the establishment of a dysbiotic state and compare it to a condition where a healthy microbiome was established. Lastly, we present the most recent evidence regarding preventive measures, such as dietary interventions and the use of probiotics to promote and maintain a healthy microbiome, thereby ensuring comprehensive women's health. By highlighting the importance of the genitourinary microbiome in reproductive health, this review aimed to enhance this microbiome's visibility and significance in the field.

Linking Adverse Experiences to Pregnancy and Birth Outcomes: A Life Course Analysis of Racial and Ethnic Disparities Among Low-Income Women.

Racial and ethnic disparities in birth outcomes have persisted in the United States for decades, though the causes remain poorly understood. The life course perspective posits that poorer outcomes of Black birthing people stem from heightened exposure to stressors early in life and cumulative exposure to stressors over time. Despite its prominence, this perspective has seldom been investigated empirically. We analyzed longitudinal data gathered from 1319 women in low-income households in Wisconsin who received perinatal home visiting services. Variable- and person-centered analyses were performed to assess whether 15 adverse childhood experiences (ACEs) and 10 adverse adult experiences (AAEs) were associated, alone and in combination, with pregnancy loss, preterm birth, and low birth weight among Hispanic (i.e., Latinx) and non-Hispanic Black and White participants. As expected, there were disparities in preterm birth and low birth weight, and both ACEs and AAEs were linked to poorer pregnancy and birth outcomes. Unexpectedly, bivariate and multivariate analyses showed that the associated effects of ACEs and AAEs were most robust for non-Hispanic White women. A latent class analysis produced four patterns of life course adversity, and multigroup latent class analyses confirmed that, compared to White women, higher-adversity class assignments were associated with less robust effects for Hispanic women, and even less robust effects for Black women. We discuss interpretations of the paradoxical findings, including the possibility that alternative sources of stress such as interpersonal and structural racism may better account for the reproductive disparities that disproportionately affect Black birthing people.

Changes in conception rates, not in pregnancy-related behaviour, likely caused decline in preterm births during the first year of the COVID-19 pandemic.

Changes in conception rates, not in pregnancy-related behaviour, likely caused decline in preterm births during the first year of the COVID-19 pandemic.

Profile and predictors of babies admitted to SNCUs of two tribal districts of Chhattisgarh.

The neonatal period is the crucial and vulnerable period of the human life cycle. Various research has been conducted worldwide that provide the baseline data on clinical profiles and predictors of outcomes of babies admitted to sick newborn care units (SNCUs). Nonetheless, studies on tribal areas and community outreach areas are rare. In the present study, predictors and profiles of patients admitted to SNCU, in the Dantewada and Bijapur districts of Chhattisgarh, India, were evaluated which shall help prioritize patient care and preventive approaches. This retrospective study was undertaken from January 2019 to December 2020 in the SNCUs of Dantewada and Bijapur. Neonatal and maternal characteristics, course during labor, treatment given to the neonates, and outcome data were obtained and analysed. In total, 1,531 neonates were enrolled in the study. Mothers had a mean age of 25.6 years (standard deviation [SD] ±4.9) with birth spacing less than 2 years (60.3%) and antenatal care (ANC) visits less than 4 (50.4%). Neonates were low birth weight (43.75%) and were home-delivered (15.8%). One hundred forty-nine neonates died. In the multivariate regression model, extremely low birth weight babies, less than 1 kg (odds ratio [OR]: 11.59 confidence interval [CI] 4.625-31.58), gestational age less than 34 weeks (OR: 2.13 CI 1.291-3.532), central cyanosis (OR: 10.40 CI: 3.269-32.35), duration of IV fluid > 3 days (OR: 2.16 CI 0.793-0.880), duration of antibiotic >3 days (OR 0.63 CI 0.408-0.979) were found to be independent predictors of mortality among neonates. The prevalence of newborns aged less than 12 h is higher among the study population. Birth asphyxia, prematurity, neonatal jaundice, and sepsis were fundamental and leading causes of morbidity. Preterm birth and low birth weight babies had significantly high mortality. The government needs to focus on marginalized communities with target-based interventions and policies.

Group vs Traditional Prenatal Care for Improving Racial Equity in Preterm Birth and Low Birthweight: The Centering and Racial Disparities Randomized Clinical Trial Study

(Abstracted from Am J Obstet Gynecol 2022;227:893.e1–893.e15 Preterm birth (PTB) is far too common in the United States and disproportionately affects Black individuals. To address these differences, a group care model was proposed that would provide health care with family and peer support and provider-led patient-centered health education.

Maternal periodontitis: A risk factor for preterm labour and low birth weight

Purpose: Preterm delivery and low birth weight is becoming the foremost crunch in India and is the most prevailing public health issue in developed and developing countries. To prove the confederacy between preterm labour (PTL) or low birth weight (LBW) and maternal periodontitis, a case control study was conducted among 30 puerpera women in rural population. Methods: The study sample was grouped into cases and controls based on the pregnancy outcomes, cases include 15 mothers with preterm birth and low birth weight babies and controls includes 15 mothers with normal term (greater than or equal to 37 weeks) gestation and normal birth weight babies (more than or equal to 2500 grams), in accordance with postnatal records regarding the gestation weeks and baby weight. Within 48 hours of parturition, periodontal status of the puerperal was examined by Community Periodontal Index. Statistical analysis used: Epi Info 7 Software. Results: Pregnant women with periodontal disease are 56 times risk of preterm labour and low birth weight babies and Chi-square value = 16.425 (p =0.000). Conclusions: This study shows that there is a strong statistical association between the preterm labour and birth type of babies with maternal periodontitis. Maternal periodontitis are 56 times risk of preterm labour and low birth weight. Hence, pregnant mothers should be educated about the risk of periodontal disease and motivated to maintain the oral hygiene by proper oral hygiene instruction measures with periodic dental visits.

Association of preterm birth and low birthweight with bone fractures during childhood.

Preterm birth and low birthweight have been associated with increased fracture risk in children. Our aim was to analyze bone fractures during childhood in preterm, and low-birthweight newborns compared to full term and normal birthweight newborns. We conducted a nationwide register-based cohort study in Finland from 1998 to 2017 and utilized the Medical Birth Register and Care Register for Healthcare. All newborns alive 28 days after birth were included and data on all fracture visits in specialized healthcare units were gathered. Incidences per 100,000 person-years with 95% confidence intervals (CI) were calculated, and comparisons were made by incidence rate ratios (IRR). Kaplan-Meier analysis was used to analyze the timing of fractures during childhood (0-20 years). We included a total of 997,468 newborns and 95,869 fractures, the mean follow-up was 10.0 years and the overall incidence of fractures 963 per 100,000 person-years. Very preterm (<32 gestational weeks) newborns had 23% lower fracture incidence than term newborns (IRR 0.77; CI 0.70-0.85). Preterm newborns (32 to 36 gestational weeks) had similar fracture rate (IRR 0.98; CI 0.95-1.01) to term newborns. Birthweight showed linear increase in the fracture rates as newborns with birthweight less than 1000 g had the lowest fracture incidence 773 per 100,000 person-years and the highest incidence (966 per 100,000 person-years) was among newborns with birthweight 2500 g or more. Children born very preterm or with extremely low birth weight have in general a lower fracture incidence during childhood compared to children born full term and with normal birthweight. These findings possibly reflect, in addition to improvements of neonatal intensive care and early nutrition, the fact that childhood fracture incidences are more dependent on other issues than early life events.

Adverse birth outcomes among offspring born to women diagnosed with cancer: a population-based cohort study

With increasing cancer incidence and survival rates, the prevalence of maternal cancer and its effect on adverse birth outcomes are important for prenatal care and oncology management. However, the effects of different types of cancer at different gestational stages have not been widely reported. To describe the epidemiological characteristics of pregnancy-associated cancers (during and one year after pregnancy) and evaluate the association between adverse birth outcomes and maternal cancers. Of 983,162 children, a history of maternal cancer, including pregestational cancer, pregnancy-associated cancer and subsequent cancer, was identified in 16,475 cases using a health information network. The incidence and 95% confidence interval (CI) of pregnancy-associated cancer were calculated with the Poisson distribution. The adjusted risk ratio (RRadj) with 95%CI of the association between adverse birth outcomes and maternal cancer were estimated using the multilevel log binomial model. A total of 38,295 offspring were born to mothers with a cancer history. Of these, 2,583 (6.75%) were exposed to pregnancy-associated cancer, 30,706 (80.18%) had a subsequent cancer diagnosis, and 5006 (13.07%) were exposed to pregestational cancer. The incidence of pregnancy-associated cancer was 2.63/1000 pregnancies (95%CI: 2.53-2.73‰), with cancer of the thyroid (1.15‰), breast (0.25‰), and female reproductive organs (0.23‰) being the most common cancer types. The increased risks of preterm birth and low birth weight were significantly associated with cancer diagnosed during the second and third trimester of pregnancy, while increased risks of birth defects (RRadj=1.48, 95%CI: 1.08-2.04) were associated with cancer diagnosed in the first trimester. An increased risk of preterm birth (RRadj=1.16, 95%CI: 1.02-1.32), low birth weight (RRadj=1.24, 95%CI: 1.07-1.44), and birth defects (RRadj=1.22, 95%CI: 1.10-1.35) was observed in thyroid cancer survivors. Careful monitoring of fetal growth should be implemented for women diagnosed with cancer in the second and third trimester, to ensure timely delivery and balance the benefits of neonatal health and cancer treatment. The higher incidence of thyroid cancer and increased risk of adverse birth outcomes among thyroid cancer survivors suggested that the regular thyroid function monitoring and regulation of thyroid hormone levels are important in maintaining pregnancy and promoting foetal development among thyroid cancer survivors before and during pregnancy.

Perinatal Outcome of Singletons Born after Using a Simplified Low-Cost IVF Culture System and All Singletons Born in Flanders (Belgium) between 2012 and 2020.

We developed a simplified IVF culture system (SCS) which has proven to be effective and safe in a selected IVF cohort. Preterm birth (PTB) and low birth weight (LBW) of 175 singletons born after using the SCS, 104 after fresh embryo transfer (ET), and 71 after frozen embryo transfer, were compared with all singletons born in Flanders between 2012 and 2020 conceived after natural conception, ovarian stimulation (OS), and assisted reproduction (IVF/ICSI). The proportion of preterm (<37 weeks) births was significantly higher in the case of IVF or ICSI, followed by hormonal treatment, compared to spontaneous pregnancies. There was no significant difference in PTB between SCS and any of the other groups. Concerning the average birth weight we found no significant difference between singletons born after natural conception and SCS. However, a significant difference in average birth weight was found between SCS singletons and singletons born after IVF, ICSI and hormonal treatment, with a significantly higher birth weight in the SCS group. This difference was also observed in the proportion of babies weighing less than 2500 g, with significantly more LBW babies in the IVF and ICSI group compared to the SCS newborns. Taking into account the small series, PTB and LBW rates in SCS singletons were found to be comparable with singletons born after natural conception. Compared to babies born after ovarian stimulation and IVF/ICSI, SCS singletons had a lower PTB and LBW rates, although the differences were not significant for PTB. Our results confirm previous reports on reassuring perinatal outcomes after using the SCS technology.

A Case of Necrotizing enterocolitis caused by &lt;i&gt;Clostridium perfringens&lt;/i&gt; type C in the Absence of a History of Animal Exposure in a Neonate Admitted to the NICU, in which Gram Staining of the Stool was Helpful for Diagnosis

Neonatal necrotizing enterocolitis is a fatal neonatal disease that accounts for a large proportion of deaths in the NICU. Preterm birth and low birth weight are among the most important risk factors, but the disease is multifactorial, with multiple other factors involved, including intestinal immaturity, ischemia, continued enteral feeding in place of breastfeeding, long-term exposure to antimicrobial agents, and an abnormal microbiota in the intestinal tract. In regard to the causative microorganism, the disease has been reported to be caused by Enterobacteriaceae such as Klebsiella pneumoniae and Clostridium perfringens type A.

Immunological disease activity parameters at conception are risk factors for preterm birth and low birth weight in patients with systemic lupus erythematosus.

This study aimed to identify which disease activity parameters may be risk factors for preterm birth (PB) and low birth weight (LBW) in patients with systemic lupus erythematosus (SLE). We also analyzed the extent to which these parameters affected PB and LBW. We collected the SLE Disease Activity Index (SLEDAI), the rate of lupus low disease activity state (LLDAS) attainment, complement levels, and the titer of anti-double stranded DNA (dsDNA) antibody as disease activity parameters. We retrospectively analyzed the associations of these parameters with PB and LBW. Sixty pregnancies were included in this study. C3 levels and anti-dsDNA antibody titers at conception were strongly associated with PB (p = 0.03 and p = 0.01, respectively), whereas C3 and CH50 levels were associated with LBW (p = 0.02 and p = 0.03, respectively). A logistic regression analysis showed that the cutoff values of C3 and anti-dsDNA antibody for PB were 62.0mg/dl and 5.4IU/ml, respectively. The cutoff values of C3 and CH50 for LBW were 87.0mg/dl and 41.8U/ml, respectively. The risk of PB or LBW was increased when divided by the cutoff value, and the combination of these cutoff values showed a significantly higher risk of PB and LBW (p = 0.01 and p < 0.01, respectively). PB and LBW are strongly associated with disease activity parameters in patients with SLE. Therefore, strictly monitoring and controlling these disease activity parameters, with or without clinical manifestation, is important for women who want to become mothers.

Continuous subcutaneous insulin infusion via an insulin pump in extremely premature neonates—a case series

Extremely preterm infants are prone to hyperglycemia which is associated with increased mortality and morbidity. Insulin sensitivity is variable in extreme prematurity, and its monitoring, prevention, and treatment are a significant challenge in the NICU. Frequent changes in fluid composition and volumes, as well as large growth and adaptational nutrient requirements are limited by difficult vascular access and blood sampling and risk of drug incompatibilities. Insulin treatment requires specific access and significantly increases fluid intake and sampling. Clinicians, therefore, often compromise by reducing glucose intake and accepting higher glycemia. We report a case series of 11 extremely low birth weight (ELBW) preterms, born between 23 5/7 and 27 6/7 weeks of gestation, treated for transient hyperglycemia during the first 2 weeks of life by continuous subcutaneous insulin infusion (CSII). Insulin concentration was 10 IU/ml, administered via 13 mm Accu-Chek® Tenderlink catheters and a commercial insulin pump (Accu-Chek® Combo, Roche Diabetes Care). Insulin treatment was initiated when glycemia was > 252 mg/dL (14 mmol/l) in two consecutive blood glucose determinations, except for one case when glycemia was 234 mg/dL (13 mmol/l), despite a previous decrease in glucose infusion rate. The starting dose for the CSII was between 0.01 and 0.08 IU/kg/h. The average duration of the CSII was 5 days (1–16 days). CSII in extreme preterm neonates with hyperglycemia was clinically feasible and practical by sparing IV lines and volume and appeared as more rapidly effective than continuous IV administration. No adverse events like hypoglycemia or skin infection were recorded.

Neurodevelopmental outcomes of very low birth weight preterms in preschool childhood: a prospective cohort study

BackgroundPreterm birth is a risk factor for a child’s neurological development. Preterm children have unusual neurodevelopmental profiles with executive, visual-motor functions, fine and gross motor skills, language and behavior that affect learning. In this study, we analyzed the neurodevelopmental outcomes of a cohort of very low birth weight infants admitted to the Treviso Neonatal Intensive Care Unit (NICU) between 2014 and 2016 and followed up to preschool childhood.MethodThis is a prospective cohort study. Infants were followed at birth and after NICU discharge at two- and four-year follow-ups. The two-year assessment was conducted with Bayley III, and at four years with the Wechsler Preschool and Primary Scale of Intelligence - III scales and Movement Assessment Battery for Children − 2.ResultsThe cohort consisted of 207 subjects with a mean gestational age of 28.9 weeks, and a mean birth weight of 1097.2 g. At two years of age, children without disabilities were 90 (59.6%), those with minor disabilities 47 (31.1%), and those with major disabilities 14 (9.3%); at four years, 58.4% of children without previous disabilities, presented problems with verbal tests and manual dexterity: aiming, grasping and balance at movement assessment. There was significant alteration in processing speed (p < 0.001). Furthermore, there was a strong correlation between processing speed and manual dexterity (p < 0.001) and between processing speed and aiming and grasping (p = 0.0059).ConclusionsWe found that more than half the children free of disability at two years, at four years had deficit often involving the oculo-motor coordination and processing speed. These motor profile alterations limit the expression of cognitive abilities and the achievement of expected school performance, thus resulting in behavioral disorders, typical of preterm children. Early professional follow-up could improve the expected educational outcomes.

Influence of ovarian reserves on assisted reproductive and perinatal outcomes in patients with endometriosis: a retrospective study.

To investigate the association between different ovarian reserves and reproductive and adverse perinatal outcomes in patients with endometriosis. Retrospective study. Reproductive Medicine Center in a hospital. Patients surgically diagnosed with endometriosis were divided into three groups according to their ovarian reserve: diminished ovarian reserve (DOR) group (n=66), normal ovarian reserve (NOR) group (n=160), and high ovarian reserve (HOR) group (n=141). None. Live birth rate (LBR), cumulative live birth rate (CLBR), and adverse perinatal outcome for singleton live births. There were significantly higher live birth and cumulative live birth rates in endometriosis patients with NOR or HOR than in those with DOR. For adverse perinatal outcomes, patients with NOR or HOR had no significant association with preterm birth, gestational hypertension, placenta previa, fetal malformation, abruptio placentae, macrosomia, or low birth weight, except for a decreased risk of gestational diabetes mellitus. Our study revealed that although patients with endometriosis with NOR and HOR had increased reproductive outcomes, patients with endometriosis with DOR had still an acceptable live birth rate and a similar cumulative live birth rate with available oocytes. Moreover, patients with NOR and HOR might not exhibit a decreased risk of abnormal perinatal outcomes, except for gestational diabetes mellitus. Multicenter prospective studies are needed to further clarify the relationship.

Autoimmune diseases of the digestive system during pregnancy

Kamilė Piesliakaitė1, Živilė Sabonytė – Balšaitienė2, 3, Diana Ramašauskaitė2, 3, Virginija Paliulytė2, 3 1Vilnius University, Faculty of Medicine, Vilnius, Lithuania 2Vilnius University, Faculty of Medicine, Clinic of Obstetrics and Gynecology, Vilnius, Lithuania 3Vilnius University Hospital Santaros Clinics, Center of Obstetrics and Gynecology, Vilnius, Lithuania Abstract Background. Autoimmune diseases of the digestive tract are more prevalent in women and have a negative impact on maternal or fetal health. Most common of these diseases are celiac disease, inflammatory bowel disease, autoimmune hepatitis, primary sclerosing cholangitis, and primary biliary cholangitis. Even though they usually tend to go into remission, the underlying pathological pathways may cause complications. Most frequent pregnancy risks include preterm birth, miscarriage, cesarian section, or low birth weight newborn. Aim: the aim of the study is to analyze and review the evidence-based scientific literature describing the relationship between autoimmune diseases and pregnancy, maternal or fetal complications. Methods. International databases PubMed and Google Scholar were used for literature review. 53 scientific articles were selected for this literature review. Results. Celiac disease poses a risk of cesarean section, recurrent miscarriages, low birth weight and preterm delivery, especially for untreated women. Inflammatory bowel disease may cause hemostatic complications in women, preterm birth, small for gestational age birth weight, or stillbirth. Autoimmune hepatitis could lead to fetal loss premature delivery. Primary sclerosing cholangitis and primary biliary cirrhosis increase the risk of cesarean section and preterm birth. Conclusions. Autoimmune diseases of the digestive tract are not common in pregnancy and most cases will be in remission. Preterm birth, caesarean section or small for gestational age fetus are most common complications. Careful multidiscipline follow-up of obstetrician-gynecologist and gastroenterologist is crucial for reducing pregnancy, maternal, or fetal risks. Keywords: pregnancy; celiac disease; inflammatory bowel disease; autoimmune hepatitis; primary sclerosing cholangitis; primary biliary cholangitis Full article https://doi.org/10.53453/ms.2023.5.4