Rate Of Preterm Delivery Research Articles

Association of Neighborhood Income with Clinical Outcomes Among Pregnant Patients with Cardiac Disease

Cardiovascular disease is the leading cause of pregnancy mortality. Socioeconomic and racial disparities in pregnancy are well established. Despite this, little is known about the impact of social determinants of health in pregnant patients with heart disease. This study aims to determine whether pregnant patients with heart disease living in lower income neighborhoods and managed at cardio-obstetrics programs have higher rates of cardiac events or preterm deliveries compared with those living in higher income neighborhoods. This is a retrospective cohort study of 206 patients between 2010 and 2020 at a quaternary care hospital in Northern California. The exposure was household income level based on neighborhood defined by the US Census data. Patients in lower income neighborhoods (N = 103) were 45% Hispanic, 34% White, and 14% Asian versus upper income neighborhoods (N = 103), which were 48% White, 31% Asian, and 12% Hispanic (p < 0.001). There was no significant difference in the rates of intrapartum cardiac events (10% vs. 4%; p = 0.16), postpartum cardiac events (14% vs. 17%; p = 0.7), and preterm delivery (24% vs. 17%; p = 0.23). The rates of antepartum hospitalization were higher for lower income neighborhoods (42% vs 22%; p = 0.004). While there is no significant difference in cardiac events and preterm delivery rates between patients from low versus high income neighborhoods, patients from lower income neighborhoods have higher antepartum hospitalization rates. Earlier identification of clinical deterioration provided by a cardio-obstetrics team may contribute to increased hospitalizations, which might mitigate socioeconomic disparities in outcomes for these pregnant patients with heart disease.

P-754 Perinatal outcomes and congenital anomalies after clomiphene citrate based minimal ovarian stimulation in vitro fertilisation stratified by embryo transfer method: a 10-year cohort study

Abstract Study question Is the embryo transfer method associated with perinatal outcomes and congenital anomalies after minimal ovarian stimulation in vitro fertilisation (IVF) with clomiphene citrate (CC)? Summary answer Single vitrified-warmed blastocyst transfers in natural cycles had a lower incidence of pregnancy complications compared to single fresh cleaved embryo transfers after CC-based ovarian stimulation. What is known already Pregnancies resulting from IVF are associated with a higher risk of adverse perinatal outcomes compared to spontaneous conception; therefore, the next focus in reproductive medicine is to assess whether the increased risks are attributable to the IVF. Perinatal outcomes and congenital anomalies should be considered in addition to pregnancy outcomes in selecting the embryo transfer method. However, studies describing the influence of transfer methods on perinatal and maternal outcomes are limited. Study design, size, duration This study retrospectively analysed a single centre 10-year cohort. A total of 82,491 clinical records of women who underwent oocyte retrieval during a CC-based minimal stimulation cycle followed by single fresh cleaved embryo transfer (SFCT), single vitrified-warmed cleaved embryo transfer (SVCT), or single vitrified-warmed blastocyst transfer (SVBT) at the Kato Ladies Clinic between January 2008 and December 2017 were retrospectively analysed. Participants/materials, setting, methods The oocyte retrievals were performed in CC-based minimal ovarian stimulation. The embryos were transferred 2–3 days after retrieval, or vitrified at the cleavage or blastocyst stages. The vitrified embryos were warmed and transferred within the natural cycles. Perinatal outcomes and congenital anomalies were stratified by the transfer method. Multivariate logistic regression analysis was performed to evaluate the effect of transfer methods on pregnancy complications and congenital anomalies. Main results and the role of chance The perinatal outcomes and congenital anomalies in 19,069 singleton pregnancies were analysed. Multivariate logistic regression analysis revealed that the incidence of hypertensive disorders of pregnancy was significantly lower in the SVBT group compared with the SFCT group (adjusted odds ratio [AOR], 0.628; P &amp;lt; 0.0001). The incidence of low-lying placenta (AOR 0.359 P = 0.0483; AOR 0.452 P &amp;lt; 0.0001, respectively) and placenta previa (AOR 0.300 P = 0.0021; AOR 0.542 P &amp;lt; 0.0001, respectively) were lower in the SVCT and SVBT groups than in the SFCT group. The rate of preterm delivery was lower in SVBT compared with SFCT (AOR 0.732 P &amp;lt; 0.0001). The rate of low birth weight was significantly lower after SVCT and SVBT, compared with the SFCT group (AOR 0.751; P = 0.0261: AOR, 0.560; P &amp;lt; 0.0001: respectively). A lower incidence of small for gestational age (AOR 0.720 P = 0.0436; AOR 0.494 P &amp;lt; 0.0001, respectively) and higher incidence of large for gestational age (AOR 1.287 P = 0.0332; AOR 1.706 P &amp;lt; 0.0001, respectively) were observed in the SVCT and SVBT groups compared to the SFCT group. The incidence of each congenital anomaly was similar among the groups. Limitations, reasons for caution The data was collected through self-reported parental questionnaires on neonatal outcomes and congenital malformations. Furthermore, this study was retrospective in nature; further studies are necessary to ascertain the generalisability of these findings to other clinics with different protocols and/or patient demographics. Wider implications of the findings This study demonstrated reassuring outcomes for SVBT, in terms of a lower incidence of pregnancy complications compared with SFCT. Our findings provide valuable knowledge to improve perinatal outcomes in CC-based stimulation and to inform couples of the possible benefits and harms of each type of embryo transfer method. Trial registration number not applicable

Fetal Reduction Could Improve but Not Completely Reverse the Pregnancy Outcomes of Multiple Pregnancies: Experience From a Single Center.

ObjectiveTo investigate the effectiveness and limitations of multifetal pregnancy reduction (MFPR) on the improvement of pregnancy outcomes of triplet or twin pregnancies conceived by in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI).MethodsWe performed a cohort study of women undergoing IVF or ICSI from 2002–2016 in reproductive center, women’s hospital, Zhejiang University School of Medicine. The cohort included 502 women who underwent MFPR and 9641 non-reduced women. Pregnancy outcomes were gestational age (GA) at delivery, pregnancy loss, preterm delivery, low birth weight (LBW), very low birth weight (VLBW), and small for gestational age (SGA). Multiple linear regression and logistic regression models were used to compare pregnancy outcomes between groups.ResultsTriplets reduced to singletons had a longer median GA (39.07 vs 37.00, P<0.001), and lower rates of LBW (8.9% vs 53.2%, P<0.001) and SGA (17.8% vs 44.7%, P=0.001) than triplets reduced to twins, with a similar pregnancy loss rate (6.7% vs 6.6%, P=0.701). Twins reduced to singletons had a comparable pregnancy loss rate (4.8% vs. 6.5%, P=0.40), a longer median GA (38.79 vs. 37.00, P<0.001), and lower rates of LBW (13.5% vs. 47.0%, P<0.001) and SGA (13.5% vs. 39.6%, P<0.001) than primary twins. Triplets reduced to twins had higher rates of LBW (53.2% vs. 47.0%, P=0.028) and SGA (44.7% vs. 39.6%, P=0.040) than primary twins, with a similar pregnancy loss rate (6.6% vs. 6.5%, P=0.877). Singletons reduced from triplets/twins had higher rates of preterm delivery (15.8% vs. 7.3%, P<0.001), LBW (12.3% vs. 4.32%, P<0.001), VLBW (2.3% vs. 0.4%, P=0.002), and SGA (14.6% vs.6.6%, P<0.001) than primary singletons, with a comparable pregnancy loss rate (5.3% vs. 5.4%, P=0.671).ConclusionsThis study suggests that the pregnancy loss rate is similar between reduction and non-reduction groups. MFPR improves pregnancy outcomes, including the risk of preterm delivery, LBW, and SGA, but still could not completely reverse the adverse pregnancy outcomes of multiple pregnancies.

Nonobstetric surgery during pregnancy in Finland during a 21‐year period: A register‐based study

AbstractObjectiveTo assess how much and on which specialities nonobstetric surgery was performed for pregnant women in Finland during a 21‐year period, between 1997 and 2017 and the effect of Finnish guideline about preoperative evaluation affected the amount of surgery during pregnancy.DesignRegister‐based observational study.SettingFinnish Medical Birth Register.Population1 175 677 pregnancies ending with a singleton birth 1997−2017.MethodsAmount of nonobstetric surgeries, and pregnancy foetal and maternal outcomes in Finland between 1997 and 2017 were searched.Main Outcome MeasuresThe prevalence of nonobstetric surgery, and proportions of elective and emergency nonobstetric surgery performed during the three trimesters.ResultsThe prevalence of nonobstetric surgery before the guideline was 0.39%, after the guideline 0.28% and after the first revision 0.39%. The prevalence of elective surgery decreased after the guideline (before 0.15%, after the guideline 0.10% and 0.07% after the first revision), but the prevalence of emergency surgery was highest after the first revision (0.24%, 0.21% and 0.29%). The guideline and the first revision had no impact on the timing of elective surgery; 35% of elective surgery was performed during the second trimester before the guideline, 36% after it and 36% after its first revision. The preterm delivery rate, 9.1%−9.4% of pregnancies with nonobstetric surgery was twofold higher than that of pregnancies without surgery.ConclusionThe prevalence of nonobstetric surgery during pregnancy is low in Finland. The national guideline decreases the prevalence of elective surgery during pregnancy but does not impact the timing of nonobstetric surgery.

Pregnancy (Maternal and Fetal) Outcome in Women Who Used Smokeless Tobacco: A Cross-sectional Study

Aim: To assess the pregnancy (maternal and fetal) outcome in pregnant women who used smokeless tobacco in tertiary care hospital.&#x0D; Study Design: A cross-sectional study.&#x0D; Place and Duration: Department of Obstetrics and Gynecology, LUMHS, Jamshoro/Hyderabad from August 2016 to February 2017.&#x0D; Methodology: Total 169 pregnant women who used smokeless tobacco (gutka, paan, naswar, mainpuri) were included. General examination was performed. Laboratory investigations were ordered for complete blood counts. Ultrasonography was performed for gestational age and fetal weight. We calculated descriptive statistics. The stratification was completed. After stratification, the Chi-square test was used.&#x0D; Results: Mean gestational age was 29.15±8.80 weeks. Mean birth weight was 1.96±0.81Kg. Among smokeless tobacco, 24.3% used Paan, 18.9% used Gutka, 23.7% used naswar and 47.3% used mainpuri. Mean duration of use of smokeless tobacco was 32.94±17.63 months. 62.1% have low weight birth and 34.3% have still birth. 28.4% had spontaneous abortion, 58% had anemia and 34.9% had premature delivery.&#x0D; Conclusion: This study concludes that mothers who used smokeless tobacco had a higher rate of abortion, preterm delivery, stillbirth, and delivery of low birth weight newborns.

Systemic Lupus Erythematosus Delivery Outcomes Are Unchanged Across Three Decades.

ObjectiveUsing a large, de‐identified electronic health record database with over 3.2 million patients, we aimed to identify trends of systemic lupus erythematosus (SLE) medication use during pregnancy and birth outcomes from 1989 to 2020.MethodsUsing a previously validated algorithm for SLE deliveries, we identified 255 pregnancies in patients with SLE and 604 pregnancies in controls with no known autoimmune diseases. We examined demographics, medications, SLE comorbidities, and maternal and fetal outcomes in SLE and control deliveries.ResultsCompared with control deliveries, SLE deliveries were more likely to be complicated by preterm delivery (odds ratio [OR]: 6.71; 95% confidence interval [CI]: 4.31‐10.55; P < 0.001) and preeclampsia (OR: 3.22; 95% CI: 1.83‐5.66; P < 0.001) after adjusting for age at delivery, race, and parity. In a longitudinal analysis, medication use during SLE pregnancies remained relatively stable, with some increased use of hydroxychloroquine over time but no increase in aspirin use. For SLE deliveries, preterm delivery and preeclampsia rates remained stable.ConclusionWe observed rates of preeclampsia and preterm delivery in SLE that were five times higher than the general population and higher compared with other prospective SLE cohorts. Furthermore, we did not observe improved outcomes over time with preeclampsia and preterm delivery. Despite increasing evidence for universal use of hydroxychloroquine and aspirin, we did not observe substantially higher use of these medications over time, particularly for aspirin. Our results demonstrate the continued need to prioritize educational and implementation efforts to improve adverse pregnancy outcomes in SLE.

Decreased Adiponectin Levels in Early Pregnancy Are Associated with High Risk of Prematurity for African American Women.

The relationship of low maternal serum adiponectin levels with preterm delivery among a multi-ethnic group has not been extensively investigated. We examined ethnic differences in cytokine/adipokine profiles and whether they contribute to several adverse pregnancy outcomes, particularly preterm delivery. Data and samples were from a large prospective observational cohort (n = 1776) of young, generally healthy pregnant women (African American 36.4%, Hispanic 48.0%, Caucasian 15.6%). Serum cytokine/adipokine concentrations were measured at entry (mean gestational age of 16.83 weeks) using the Liminex xMap Technology. Multivariable analyses were performed. A significant difference in adiponectin level was observed among ethnic groups. African Americans had a decreased adiponectin and increased resistin levels compared to Hispanics and Caucasians (p < 0.05 to p < 0.0001 for each). Decreased adiponectin (lowest quartile) was positively associated with preterm delivery independent of usual risk factors (adjusted odds ratio (AOR) 1.46, 95% confidence interval (CI) 1.05, 2.04 for all preterm and AOR 1.84, 95% CI 1.07, 3.17 for early preterm births). The results were unchanged when women with preeclampsia were excluded. Similar results were observed in African Americans. Decreased adiponectin levels were not related to preterm birth in either Hispanics or Caucasians. Lower adiponectin levels were also significantly associated with an increased risk of developing gestational diabetes (AOR 1.72, 95% CI 1.05, 2.84) and preeclampsia (AOR 1.45, 95% CI 1.00, 2.14) in the whole cohort and in Caucasians. We did not find any consistent relationships between the other markers with outcome variables. Dysregulation in maternal adiponectin at early gestation is associated with an increased risk of preterm delivery. An ethnic difference in adiponectin levels may contribute to a higher preterm delivery rate in African American women.

Pregnancy and neonatal outcomes in women receiving calcineurin inhibitors: A systematic review and meta-analysis.

Calcineurin inhibitors (CNIs) are often used for solid organ transplantation recipients or patients with immune-mediated diseases. This systematic review and meta-analysis aims to understand how CNIs affect pregnancy and neonatal outcomes. Electronic databases were searched for observational studies assessing pregnancy and neonatal outcomes in CNI-treated patients. The pooled rate of each outcome was determined. Metaregression was conducted to identify contributing factors to the outcomes. We analysed 98 studies with a total of 5355 pregnancies in 4450 CNI-treated patients. The pooled rates of live birth and spontaneous abortion were 82.1% (95% confidence interval [CI] 76.7-86.4%) and 11.7% (95% CI 8.7-15.5%), respectively. The rates of preterm delivery (33.2%, 95% CI 29.2-37.5%), low birth weight (35.8%, 95% CI 27.7-44.8%) and preeclampsia (13.5%, 95% CI 9.4-19.2%) were 3-4 times higher than the rates of general population. Nearly half of the CNI-treated patients required caesarean delivery (43.5%, 95% CI 36.9-50.3%). The rates of stillbirth, neonatal and maternal death were 4.2% (95% CI 2.8-6.2%), 2.9% (95% CI 1.8-4.8%) and 2.3% (95% CI 1.3-4.1%), respectively. Metaregression showed that preeclampsia was significantly associated with the risks of preterm delivery and low birth weight. Older maternal age, prepregnancy hypertension and cyclosporine use increased the risk of preeclampsia. Given the higher mortalities in CNI-treated patients and their children than the general averages, their pregnancy is considered high risk. The risks of preterm delivery and low birth weight were primarily attributed to preeclampsia. Since prepregnancy hypertension increased its risk, an appropriate preconception blood pressure management may improve their outcomes.

Perinatal outcomes and placental histology in small-for-gestational-age pregnancies-A comparison of population-based and universal growth charts.

To assess obstetric, perinatal, and placental histologic findings in small-for-gestational-age (SGA) neonates according to different growth charts. A retrospective cohort of singleton deliveries from 2008 to 2019 were divided into SGA neonates according to the local population-based chart, SGA according to universal standard growth charts (but appropriate for gestational age [AGA] according to local charts) and AGA deliveries according to both charts. A total of 626 local population SGA deliveries, 132 universal SGA and 468 AGA deliveries were compared. The local population SGA group had a significantly higher rate of preterm and cesarean deliveries. An adverse neonatal outcome occurred in 27.2% of the local population SGA group, 9.8% of the universal SGA group and 6.7% of the AGA group (P< 0.001). In the local population SGA group, placental weight was lower, birth weight to placental weight ratio was highest, and the rate of maternal malperfusion lesions was highest-55.4% versus 45.4% in the universal SGA group and 39.1% in the AGA group (P< 0.001). Villitis of unknown etiology was significantly more common and histologic chorioamnionitis was significantly less common in the local population SGA group. Our findings support the use of a local population-based growth chart for the diagnosis of fetal growth restriction.

Adrenal insufficiency and pregnancy.

Adrenal insufficiency is a disorder characterized by the failure of adrenocortical function because of distorted function of hypothalamic-pituitary- adrenal (HPA) axis. Pregnancy is a state of a physiological glucocorticoid excess as the HPA axis is functioning at a higher level. The aim of the present review was to shed light on current evidence of adrenal insufficiency management during pregnancy, along with maternal and neonatal outcomes. A recent multicenter study under the auspices of the European Network for the Study of Adrenal Tumours (ENSAT) presented real-life data of pregnant women with adrenal insufficiency documenting an increased use of hydrocortisone (or mineralocorticoids when needed according to the level of disorder) replacement treatment, increased rates of caesarean section, preterm delivery and adrenal crises along with peripartum and postpartum complications but no maternal or neonatal fatality. These data were in agreement with those obtained from previously published studies. The limited published evidence is in line with the present guidelines as real-life data did not document any increased fatality among pregnant women or newborns. Prospective data with prolonged follow-up are needed to shed more light on appropriate dose adjustments to avoid the risks of under-replacement or over-replacement of glucocorticoid and/or mineralocorticoid drugs and their sequelae. A recent multicenter study by ENSAT presented real-life data of pregnant women with adrenal insufficiency documenting an increased use of hydrocortisone as replacement treatment during pregnancy, along with an increased rate of caesarean section and preterm delivery, adrenal crises, peripartum and postpartum complications but no maternal or neonatal fatality. These data are in agreement with those of a previously published study and also confirm the statements made by the recent guidelines. Prospective data are needed aiming to develop precise therapeutic protocols during each trimester of pregnancy according to the different causes of adrenal insufficiency.

Correlation analysis of adverse outcomes for the selective reduction of twin pregnancies

BackgroundDue to the extensive development of assisted reproductive technology, the number of twin pregnancies has increased significantly over recent decades. Twin pregnancy is the most representative type of multiple pregnancies and is associated with high infant morbidity and mortality. Perinatal complications of twin pregnancy are also markedly increased compared with those of single pregnancy. Transabdominal selective reduction (SR) is a remedial intervention. This study aimed to research the adverse outcomes of transabdominal selective reduction of twin pregnancy and the correlation between the reduction week and pregnancy outcomes.ObjectiveThe purpose of this study was to examine the adverse outcomes of the transabdominal selective reduction of twin pregnancy and the correlation between the reduction week and pregnancy outcomes.MethodsA retrospective cohort study of the transabdominal reduction of twin pregnancy was conducted in a single prenatal diagnosis medical centre from September 2012 to October 2020. According to chorionicity, women with twin pregnancies were divided into 2 groups: dichorionic (DC) twin pregnancies and monochorionic (MC) twin pregnancies. Women with DC twin pregnancies underwent potassium chloride reduction, and those with MC twin pregnancies underwent radiofrequency ablation (RFA). The reduction indications included pregnancy complications, foetal abnormalities, and maternal factors. The perinatal outcomes of different chorionic twins after reduction were analysed. Each foetus with an adverse outcome was included. The relative relationship between the reduction weeks and delivery weeks of twins was examined by correlation analysis.ResultsA total of 161 women were included in this study. A total of 112 women had DC twin pregnancies, and 49 women had MC twin pregnancies. Preterm delivery rates were significantly higher in the MC twin reduction group than in the DC twin reduction group prior to 37 weeks (53.1% vs. 29.5%, P = 0.004). The mean gestational age at delivery of the foetuses in the DC twin group that underwent SR was significantly older than that of those in the MC twin group that underwent SR (36.9 ± 4.0 vs. 33.5 ± 6.6 weeks, P = 0.001). The number of DC twins that underwent SR and were delivered after 37 weeks was obviously greater than that of the MC twins that underwent SR (70.5% vs. 46.9%, P = 0.004). The foetal survival rate was 95.5% in the DC twin reduction group and 77.6% in the MC twin reduction group. If the indication of TTTS was not included, there was no significant difference in the foetal survival rate of the DC and MC twin reduction groups (95.5% vs. 86.2%, P = 0.160). Cotwin death 1 week after reduction was greater in the MC group (6.1% vs. 0%, P = 0.027). Compared to other indications, this finding indicated that a significantly lower proportion of women remained undelivered after selective reduction with the indication of TTTS. There was a significant negative correlation between the reduction weeks and delivery weeks of the two groups (P < 0.01), and the best opportunity for reduction was before 22 weeks of gestation.ConclusionThese findings highlighted an obviously negative correlation between the reduction week and delivery week. The transabdominal selective reduction of twin pregnancy should be considered for a lower rate of miscarriage or premature delivery if the reduction week takes place earlier in pregnancy. The rate of preterm delivery was the lowest when transabdominal selective reduction was completed before 22 weeks of gestation. Compared with other RFA indications, a higher rate of premature delivery was shown for MC twins with a reduction indication of TTTS. TTTS with sIUGR might be one of the reasons for the adverse outcomes of reduction for MC twin pregnancy.

Impact of Preoperative Cervical Length on Pregnancy Outcome in Twin-Twin Transfusion Syndrome.

To evaluate the impact of preoperative cervical length on pregnancy outcome in monochorionic diamniotic twin pregnancies complicated by twin-twin transfusion syndrome that underwent laser surgery or cord occlusion. Retrospective study of 330 patients stratified by preoperative cervical length (≥25 mm, 16-24 mm,≤15 mm). Maternal characteristics, operative data, and pregnancy outcomes were compared between the cervical length groups as well as between the subgroups of patients with a cervical length≤15 mm according to management (expectant vs. cerclage). A preoperative cervical length≥25 mm was observed in 82% (n=271) of cases, 16-24 mm in 9% (n=29), and≤15 mm in 9% (n=30). Patients with a preoperative cervical length≤15 mm showed shorter median procedure-to-delivery interval (5.5 weeks vs. 11.6 (16-24 mm) vs. 13.0 (≥25 mm); p<0.001); lower median gestational age at delivery (29.5 weeks vs. 34.3 (16-24 mm) vs. 33.4 (≥25 mm); p<0.001); higher rate of preterm delivery<32 weeks (78 vs. 20% (16-24 mm) vs. 31% (≥25 mm); p<0.001); and lower neonatal survival rate of at least one twin (70 vs. 88% (16-24 mm) vs. 93% (≥25 mm); p<0.001). Outcome of patients with a preoperative cervical length≤15 mm was similar regardless of management. Monochorionic diamniotic twin pregnancies complicated by twin-twin transfusion syndrome with a preoperative cervical length≤15 mm showed a higher rate of preterm delivery<32 weeks and lower neonatal survival. The role of a cervical cerclage remains unclear.

Maternal and perinatal outcome of pre-eclampsia in patients with gestational diabetes mellitus

Background: Pre-eclampsia is a leading cause of maternal mortality in Bangladesh. The most common problem of the gestational diabetic mother is increased incidence of pre-eclampsia. The aim of the study was to compare the maternal and perinatal outcome of diabetic pregnancy complicated with pre-eclampsia and without preeclampsia.&#x0D; Methods: This was a prospective observational study including 70 gestational diabetes mellitus (GDM) cases with pre-eclampsia and 70 patients with GDM without pre-eclampsia admitted in Obstetrics and Gynaecology Department of BIRDEM General Hospital-2. A detailed history was taken, and relevant data were collected through interview in a structured questionnaire and analyses were done according to objectives of the study.&#x0D; Results: In this study, 82% patients were delivered by Caesarean section in the study group (pre-eclampsia) and 72% patients were delivered by Caesarean section in the control group (p value 0.158). Rate of pre-term delivery was 55% in the studygroup and 32% in the control group (p value &lt;0.001). In the study group percentage of intrauterine growth retardation (IUGR) was 11.4% and in control group proportion of percentage of IUGR was 1.4%. There was oligo-hydramnios in 32% subjects of the study group and 22% of control group (p value 3.32). In the study group 44% babies were low birth weight whereas in control group 8% were low birth weight (p value &lt;0.001).&#x0D; Conclusion: The rates of pre-maturity and low birth weight were significantly higher among patients of GDM with pre-eclampsia in comparison to patients with GDM without pre-eclampsia.&#x0D; BIRDEM Med J 2022; 12(2): 106-110

MO170: Systematic Review of Patients with Chronic Kidney Disease Undergoing Fertility Treatment

Abstract BACKGROUND AND AIMS The prevalence of chronic kidney disease (CKD) in women of reproductive age continues to rise and reduced fertility is recognized even with mild disease. A greater proportion of women with CKD are seeking assisted reproductive technology (ART) treatment; however, our understanding of treatment success and adverse outcomes is limited. Our aim was to perform a systematic review to describe pregnancy and kidney outcomes and complications of pregnancies in women with CKD following ART. METHOD The systematic review was performed with reference to the Cochrane Handbook for Systematic Reviews of Interventions and reported with reference to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The following databases were searched from 1946 to May 2021: (1) Cochrane Central Register of Controlled Trials (CENTRAL), (2) Cumulative Index to Nursing and Allied Health Literature (CINAHL), (3) Embase and (4) MEDLINE. Relevant review articles were also searched for additional studies. RESULTS The database search identified 3520 records, of which 35 publications were suitable for analysis. A total of 95 fertility treatment cycles were analysed in 74 women with CKD who had ART. The median age of women with CKD at the time of pregnancy was 32.0 years (IQR 29.0, 34.0 years). The majority of women had in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) (56/74; 75.7%). One woman had an autotransplant of cryopreserved ovarian tissue which led to a spontaneous pregnancy, one woman had a medicated frozen embryo transfer cycle, one woman used donor eggs and five women used gestational surrogates. Of the 95 cycles, 11 women (15%) did not have a clinical pregnancy; there were 66 clinical pregnancies from 63 women (69%). There were 81 live births in total, with 21 multifetal live births (26%). There was 1 ectopic pregnancy, 13 miscarriages and 2 still births. Seven cycles in seven women were complicated by ovarian hyperstimulation syndrome (OHSS) (7%) which were all associated with AKI. Full recovery of kidney function occurred in six women; one woman had progression of her CKD. Hypertensive disorders of pregnancy including pre-eclampsia complicated 27 pregnancies (41%). The most common mode of delivery was caesarean section (42/74, 57%). Preterm delivery (&amp;lt;37 weeks’ gestation) occurred in 25 (34%) births. Low birth weight (&amp;lt;2500 g) was present in 46 (79%) of live births and 6 (20%) of birthweights were under the 10th centile. Twelve (15%) neonates required admission to a neonatal intensive care unit (NICU). A total of 7/12 children had normal development at up to 10 years of follow-up. When comparing women with CKD requiring ART to those with natural conception, rates of preterm delivery and caesarean section were similar; however, rates of pre-eclampsia (P = .001) and multifetal deliveries were significantly higher (P &amp;lt; .001) in the ART cohort. CONCLUSION To our knowledge, this systematic review represents the most comprehensive assessment of fertility outcomes in patients with CKD who have assisted conception. Limitations include reporting bias due to a high reported live birth rate. Patient selection for fertility treatment and identification of risk factors remains crucial in order to maximize patient safety, screen for adverse events and optimise fertility outcomes.

Preterm delivery rate in China: a systematic review and meta-analysis

BackgroundPreterm delivery rate is a crucial public health indicator, yet reliable statistic is currently not available in China. In this systematic review and meta-analysis, we aimed to review studies on preterm delivery rate in China, explore sources of heterogeneity, and estimate the preterm delivery rate in China.MethodsPublished studies on preterm delivery rate in China since 2010 were electronically searched from PubMed, Embase, Web of Science, China National Knowledge Infrastructure, China Science and Technology Journal Database, and Wanfang Database, and complemented by manual search. Study selection, data extraction, and quality and bias assessment (using the Joanna Briggs Institute Critical Appraisal Checklist) were conducted by two reviewers independently. Random-effects meta-analysis was performed to estimate the pooled preterm delivery rate, and prespecified stratified analysis was conducted to explore sources of heterogeneity.ResultsThe database search returned 4494 articles and manual search identified 10 additional studies. In total, 162 studies were eligible, of which 124 were hospital-based and 38 population-based. The pooled preterm delivery rate of hospital-based studies (7.2%; 95% CI: 6.9% to 7.6%) was significantly higher than that of population-based studies (4.9%; 95% CI: 4.5% to 5.4%) (P for subgroup difference < 0.001). Among population-based studies, the rate tended to differ by geography (P for subgroup difference = 0.07): 5.3% for Eastern, 4.6% for Central, and 3.8% for Western.ConclusionsAccording to population-based studies, the preterm delivery rate in China is around 5%. This rate is substantially lower than estimates from hospital-based studies or estimates from a combination of both hospital-based and population-based studies as having been done in previous studies.

Preeclampsia and Its Maternal and Perinatal Outcomes in Pregnant Women Managed in Bahrain's Tertiary Care Hospital.

Objective: Hypertensive disorders during pregnancy being the leading causes of maternal and fetal morbidity and mortality remains a serious health issue worldwide due to the high rate of adverse maternal outcomes and close association with neonatal morbidity and mortality. The purpose of our study was to ascertain the perinatal outcomes of preeclampsia (PE) in a tertiary care hospital in Bahrain.Methods: A retrospective cohort study was conducted from January 2018 to December 2019 in the department of Gynecology and Obstetrics in Bahrain Defense Hospital. The process of data collection included a baseline review of all women who had delivered during the study period in order to identify those with PE. Additionally, the postdelivery records of the mothers and newborns were reviewed to identify relevant maternal and neonatal outcomes.Results: During the research period, records revealed 142 patients with PE with a rate of 1.95%. The mean gestational age at diagnosis was 35.61 (± 3.69) weeks, ranging between 20 and 42 weeks. The mean birth weight was 2.64 ± 0.79 kg, ranging from 0.5-4.5 kg. Furthermore, most babies had an Apgar score of 9 at 5 minutes. The preterm delivery rate was (16.3%) and intrauterine growth restriction (IUGR) was seen in 19 patients (13.5%) and it was significantly higher in patients who presented between 30 and 34 gestational weeks P < 0.001. Twenty-one infants were admitted to the NICU primarily for prematurity and low birth weight.There was only one early neonatal death of a hydrops baby. One infant was stillborn with extreme prematurity at 24 weeks+4 days. Maternal complications included five abruption placentae (3.5%) cases, five HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count) cases (3.5%), four eclampsia (2.8%) cases, and four patients had ICU admission. Other maternal complications included acute renal failure (ARF) in two patients (1.4%), pulmonary edema in one patient, and peripartum cardiomyopathy in one patient. Data showed that adverse pregnancy outcomes were significantly more common in those with PE as compared to other pregnant populations.Conclusion: Preeclampsia causes a remarkable increase in adverse maternal and perinatal outcomes as compared to the normotensive pregnant population. A regular goal-oriented clinical audit into perinatal morbidity and mortality associated with this condition and an active multidisciplinary approach to the management of pre-eclampsia patients in the hospital might improve the clinical outcomes.

Gestational Weight Gain in Patients With Obesity and Diabetes: A Comparison of 2009 Institute of Medicine Versus 2019 JAMA Recommendations [A270

INTRODUCTION: Excessive gestational weight gain (GWG) is associated with adverse maternal and neonatal outcomes. Current guidelines established by the United States' Institute of Medicine (IOM) in 2009 recommend GWG of 11–20 lb for all obese patients. In 2019, a JAMA meta-analysis proposed recommending less weight gain in obesity (0–13 lb), not accounting for pre-existing maternal co-morbidities. We aim to ascertain whether, in obese diabetic pregnancies, GWG within the updated JAMA guidelines is associated with better outcomes. METHODS: IRB approval was obtained. Using a large urban hospital's de-identified obstetric database, obese diabetic patients from 2011 to 2020 were categorized into two groups: IOM and JAMA, depending on their GWG. Diagnosis codes were used to assess outcomes. Chi-square test, independent samples T-test, and Wilcoxon rank-sum test were used. RESULTS: Of 240 patients with obesity and diabetes, 135 fell within IOM weight gain guidelines and 65 within JAMA. The groups were not significantly different in age, BMI, A1C, or proportion with prior cesarean delivery. For maternal outcomes, chronic hypertension was independently associated with weight gain within the JAMA guidelines versus IOM (55% vs. 36%, P=.0082). There were no significant differences in rates of cesarean delivery (P=.73) or pre-eclampsia (P=.92). For neonatal outcomes, no differences were noted in NICU admission (P=.73), macrosomia (P=.72), or preterm delivery (P=.21) rates. CONCLUSION: For women with obesity and diabetes, chronic hypertension was associated with marginally less weight gain. Further research may be needed before clinicians advise the stricter GWG recommendations in the new JAMA guidelines rather than the current standard of IOM guidelines.

Systemic sclerosis and pregnancy outcomes: a retrospective study from a single center

BackgroundPregnancy in systemic sclerosis (SSc) patients is no more an infrequent event as it used to be, but literature data on pregnancy outcomes in women with SSc are scarce. The rate of preterm deliveries and intrauterine growth restriction (IUGR) seems to be increased, while the risk of miscarriages is controversial. Moreover, no study compared pregnancy outcomes in SSc with antiphospholipid syndrome (APS) and systemic lupus erythematosus (SLE). We performed a retrospective study to compare the pregnancy and disease outcomes of women with SSc with a cohort of age-matched women with systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS), and healthy controls (HC).MethodsA total of 154 pregnancies from SSc, SLE, APS patients, and HC were prospectively followed at the High-Risk Pregnancy Unit of our center from 2008 to 2019. The primary outcome was a composite endpoint of miscarriages, fetal deaths, intrauterine growth restriction (IUGR), preeclampsia, neonatal deaths, preterm birth, and small-for-gestational-age (SGA) newborns. Single adverse pregnancy outcomes (APO) represented secondary endpoints. SSc activity variations in relation to pregnancy were assessed.ResultsThe risk of APO was significantly higher in SSc patients compared to HC (60.6% vs 10.0%; OR = 14.42; 95% CI 3.70–56.18, p = 0.001) and SLE patients (60.6% vs 37.5%; OR = 3.56; 95% CI 1.29–9.83, p = 0.014). Compared to HC, women with SSc had an increased frequency of first trimester miscarriage (15% vs 0 %; p = 0.016), preeclampsia (12% vs 0%, p = 0.038), and SGA newborns (21.2% vs 0%; p = 0.003). Preterm deliveries were more frequent in SSc pregnancies in comparison with HC (24.2% vs 5%; OR = 6.08; 95% CI 1.19–31.02, p = 0.036) and SLE patients (24.2% vs 7.5%, OR = 5.68; 95% CI 1.1–29.38, p = 0.038). Disease remained stable in all SSc patients during pregnancy and up to 1 year after delivery.ConclusionsWe found an increased risk of APO in our SSc cohort in comparison with HC (with higher rates of miscarriages, preeclampsia, SGA newborns, and preterm deliveries) and SLE patients (presenting a higher rate of preterm deliveries). High-risk multidisciplinary management of SSc pregnant women is highly recommended.

A case series to examine the perinatal outcomes of infants conceived by intravaginal culture (IVC).

In vitro fertilization (IVF) has been a well-established method for treating infertility for over four decades. The mainstay method of culture of oocytes and embryos has been in gas incubators. More recently, the novel use of a gas-permeable closed vessel to culture oocytes and embryos in the vagina, intravaginal culture (IVC), has been introduced as a viable lower-cost option for infertility patients. Several studies have studied the efficacy of IVC; however, there is no data on the perinatal outcomes of the babies born using this newer technology. Our study is a retrospective case series (n = 66) from a single center, uniquely examining the perinatal outcomes of infants born after IVC. There were 50 singleton and 16 twin gestations in this case series. For singleton infants conceived via IVC (n = 50), the mean gestational age at delivery was 38weeks and 4days, and the mean birth weight was 3159.1 + / - 501.5g. Four infants were born with low birth weight, three were born preterm, and one was born macrosomic. The twin pregnancies had a mean gestational age at delivery of 33weeks 4days and a mean birth weight of 1992.9 + / - 620.7g. Twenty-seven infants met the criteria for low birthweight, and twenty-four infants delivered preterm. No twin infants met the criteria for macrosomia. This case series provides an initial description of the perinatal outcomes of IVC conceived infants, which shows no concerning trends in adverse birth outcomes for singleton infants. As expected, IVC twin gestations had a high rate of low birth weight and preterm delivery. Continued larger studies are essential to provide more comprehensive data on perinatal outcomes of infants conceived by this new technology.

The role of oligohydramnios and fetal growth restriction in adverse pregnancy outcomes in preeclamptic patients.

We aimed to compare perinatal outcomes of oligohydramnios or fetal growth restriction with normal amniotic fluid index and fetal growth in preeclampsia and to compare the outcomes of only oligohydramnios, only fetal growth restriction and oligohydramnios with fetal growth restriction preeclamptic groups. A total of 743 preeclamptic patients were evaluated between June 2016 and 2020. Patients were divided into two groups: preeclampsia with oligohydramnios or fetal growth restriction (n = 237) and preeclampsia with normal amniotic fluid index and fetal growth (n = 506). Then, the first group was divided subgroups as only oligohydramnios (n = 55), only fetal growth restriction (n = 125) and oligohydramnios with fetal growth restriction (n = 57). Demographic characteristics and perinatal outcomes were recorded. Gestational age at delivery (p < 0.001), birth weight (p < 0.001), Apgar scores (p < 0.001) and eclampsia (p < 0.001) were lower whereas impaired doppler findings (p < 0.001), cesarean rates (p < 0.001), preterm delivery (p < 0.001), abruptio placenta (p < 0.001), acute fetal distress (p < 0.001), RDS (p < 0.001), NICU requirement (p < 0.001) and neonatal death (p < 0.001) were higher in oligohydramnios or fetal growth restriction preeclamptic group. In subgroup analysis, there were differences between three groups according to the gestational age (p < 0.001), cesarean rates (p = 0.002), preterm delivery (p < 0.001), intensive care unit requirement (p = 0.039), birth weight (p < 0.001), Apgar scores (p < 0.001), RDS (p < 0.001) and NICU requirement (p < 0.001). In pairwise comparison, there was significant difference between only oligohydramnios and only fetal growth restriction group and between only oligohydramnios and oligohydramnios with fetal growth restriction group according to birth weight, Apgar scores, preterm delivery and cesarean rates, presence of RDS, maternal and neonatal intensive care unit requirement. No significant difference was detected between only fetal growth restriction group and oligohydramnios with fetal growth restriction group in terms of all parameters. We suggest that patients with only oligohydramniosis have more favorable pregnancy outcomes than pregnants with only fetal growth restriction and coexistence of two conditions in preeclamptic patients. We claim that it could be appropriate to recommend close monitorization in preeclamptic patients with only fetal growth restriction and oligohydramniosis and fetal growth restriction.