Reduce Pregnancy Complications Research Articles

Ensemble machine learning framework for predicting maternal health risk during pregnancy

Maternal health risks can cause a range of complications for women during pregnancy. High blood pressure, abnormal glucose levels, depression, anxiety, and other maternal health conditions can all lead to pregnancy complications. Proper identification and monitoring of risk factors can assist to reduce pregnancy complications. The primary goal of this research is to use real-world datasets to identify and predict Maternal Health Risk (MHR) factors. As a result, we developed and implemented the Quad-Ensemble Machine Learning framework to predict Maternal Health Risk Classification (QEML-MHRC). The methodology used a vacxsriety of Machine Learning (ML) models, which then integrated with four ensemble ML techniques to improve prediction. The dataset collected from various maternity hospitals and clinics subjected to nineteen training and testing tests. According to the exploratory data analysis, the most significant risk factors for pregnant women include high blood pressure, low blood pressure, and high blood sugar levels. The study proposed a novel approach to dealing with high-risk factors linked to maternal health. Dealing with class-specific performance elaborated further to properly understand the distinction between high, low, and medium risks. All tests yielded outstanding results when predicting the amount of risk during pregnancy. In terms of class performance, the dataset associated with the “HR” class outperformed the others, predicting 90% correctly. GBT with ensemble stacking outperformed and demonstrated remarkable performance for all evaluation measure (0.86) across all classes in the dataset. The key success of the models used in this work is the ability to measure model performance using a class-wise distribution. The proposed approach can help medical experts assess maternal health risks, saving lives and preventing complications throughout pregnancy. The prediction approach presented in this study can detect high-risk pregnancies early on, allowing for timely intervention and treatment. This study’s development and findings have the potential to raise public awareness of maternal health issues.

Quantification of the size of subchorionic hematoma causing pregnancy-related complications: a retrospective cohort study.

This study aimed to establish criteria for defining "large" subchorionic hematoma (SCH) and assess its association with pregnancy complications. This was a retrospective cohort study conducted at our institution between 2019 and 2020. We compared the size of SCH between the pregnancy-related complication and non-complication groups, using two measurement methods. Receiver operating characteristic (ROC) curve analysis determined cutoff values. Additionally, we compared the occurrence of pregnancy complications among three groups: large SCH group (above the cutoff value), non-large SCH group (below the cutoff value), and non-SCH group. Of 1305 singleton pregnancies managed during the study, 80 cases were diagnosed with SCH. Pregnancy complications occurred in 15 patients. The patients with pregnancy complications had significantly larger SCH sizes with both measurement methods. For each method, the cutoff values calculated from the ROC curve analysis were as follows: Method 1, 25% (area under the ROC curve [AUC], 0.662); Method 2, 30% (AUC, 0.624). In Method 1, we found a significantly higher occurrence of preterm delivery in the large SCH group (24.1%) than in the non-large SCH (4.2%) and non-SCH groups (5.3%; all p < 0.01). In Method 2, there was a significantly higher occurrence of preterm delivery in the large SCH group (33.3%) than in the non-large SCH (6.5%) and non-SCH groups (5.3%; all p < 0.01). Large SCHs may indicate a high risk of pregnancy-related complications. Among these, recognizing and managing cases that exceed the aforementioned cutoff value as high-risk cases may be beneficial for reducing pregnancy complications.

Prevention of Pregnancy Complications Using a Multimodal Lifestyle, Screening, and Medical Model.

Prevention of pregnancy complications related to the "great obstetrical syndromes" (preeclampsia, fetal growth restriction, spontaneous preterm labor, and stillbirth) is a global research and clinical management priority. These syndromes share many common pathophysiological mechanisms that may contribute to altered placental development and function. The resulting adverse pregnancy outcomes are associated with increased maternal and perinatal morbidity and mortality and increased post-partum risk of cardiometabolic disease. Maternal nutritional and environmental factors are known to play a significant role in altering bidirectional communication between fetal-derived trophoblast cells and maternal decidual cells and contribute to abnormal placentation. As a result, lifestyle-based interventions have increasingly been recommended before, during, and after pregnancy, in order to reduce maternal and perinatal morbidity and mortality and decrease long-term risk. Antenatal screening strategies have been developed following extensive studies in diverse populations. Multivariate preeclampsia screening using a combination of maternal, biophysical, and serum biochemical markers is recommended at 11-14 weeks' gestation and can be performed at the same time as the first-trimester ultrasound and blood tests. Women identified as high-risk can be offered prophylactic low dose aspirin and monitored with angiogenic factor assessment from 22 weeks' gestation, in combination with clinical assessment, serum biochemistry, and ultrasound. Lifestyle factors can be reassessed during counseling related to antenatal screening interventions. The integration of lifestyle interventions, pregnancy screening, and medical management represents a conceptual advance in pregnancy care that has the potential to significantly reduce pregnancy complications and associated later life cardiometabolic adverse outcomes.

Analysis of the Application Effectiveness of the Pregnancy Dietary Compliance Index Scoring Tool

This study aims to conduct a dietary index score assessment for individuals with high-risk factors for gestational hyperglycemia (such as overweight, obesity, family history of diabetes, history of macrosomia, and gestational diabetes mellitus), starting from early pregnancy, and to provide personalized nutrition management based on the score to reduce pregnancy complications and adverse pregnancy outcomes. A total of 194 pregnant women who underwent routine prenatal examinations at our hospital from September 2022 to September 2023 were selected. They were randomly divided into a study group and a control group, with 97 cases in each group. The control group received simple nutritional guidance, mainly focusing on the requirements for various nutrients and nutritional supplements during each trimester. The study group received nutrition guidance based on the dietary index score, as well as personalized guidance on health education, weight management, pregnancy exercise, and lifestyle. The incidence of gestational diabetes mellitus in the intervention group was significantly lower than that in the control group, and the difference was statistically significant (P &lt; 0.05). The incidence of macrosomia was 1.03% in the intervention group and 8.25% in the control group, with a statistically significant difference (P &lt; 0.05). The incidence of small-for-gestational-age infants was 2.06% in the intervention group and 10.31% in the control group, with a statistically significant difference (P &lt; 0.05). For pregnant women with high-risk factors, early pregnancy nutrition management based on the dietary compliance index score can quickly screen for nutritional risks and provide targeted personalized nutrition management, thereby reducing the risk of pregnancy complications and adverse pregnancy outcomes and promoting the health of mothers and infants during pregnancy.

Continuous Glucose Monitoring for Diabetes Management During Pregnancy: Evidence, Practical Tips, and Common Pitfalls.

Continuous glucose monitoring (CGM) has the potential to revolutionize diabetes management during pregnancy by providing detailed and real-time data to patients and clinicians, overcoming many of the limitations of self-monitoring of blood glucose. Although there are limited data on the role of CGM to improve pregnancy outcomes in patients with type 2 diabetes or gestational diabetes, CGM has been shown to reduce pregnancy complications in patients with type 1 diabetes. Despite the limited data in some populations, given its ease of use and recent U.S. Food and Drug Administration approval with expanding insurance coverage, CGM has gained widespread popularity among pregnant patients with all types of diabetes. It is critical for obstetric clinicians to understand how CGM can be successfully integrated into clinical practice. We present a practical, step-wise approach to CGM data interpretation that can be incorporated into diabetes management during pregnancy and common CGM pitfalls and solutions. Although technology will continue to advance with newer-generation CGM devices and diabetes technology such as automated insulin delivery (not covered here), these key principles form a basic foundation for understanding CGM technology and its utility for pregnant people.

Artificial Intelligence: Introducing to the Field of Infertility on Patient Having Ovarian Cancer

Artificial intelligence (AI) is a human-invented technology that is supposed to perform specific tasks more quickly and with fewer resources. Machine data base or machine calculation is much accurate, which shows a positive point towards patient safety.AI is a discipline of computer science that focuses on developing intelligent machines that can accomplish tasks that would normally need human intelligence. Ovarian cancer is such a widespread disease that it is observed all over the world. It may cause infertility since it has a direct effect on the reproductive organs.AI will play a critical role in future IVF facilities, boosting outcomes and reducing pregnancy complications. This review article looks at how artificial intelligence (AI) can help infertile ovarian cancer patients. In the field of infertility, Artificial intelligence (AI) is a well-developed platform. Patients with ovarian cancer may experience infertility.If a patient is able to conceive following ovarian cancer, there is a higher risk of disease transmission from parent to offspring through gene.Through gene mapping, AI can read the gene coding and alert to the impact of diseases, reducing the danger of disease transmission. It may also reduce the pregnancy complication.

Interaction of semen with female reproductive tract tissues: what we know, what we guess and what we need to do.

For nearly 100 years the postcoital inflammatory response has been described in the female reproductive tract of rodents. Since the 1950's this observation has been made in a number of animals including humans and domestic species. Yet pregnancy can be initiated and maintained by using embryo transfer which bypasses insemination and the related postcoital inflammatory response. Thus, the role of semen exposure beyond sperm transport and subsequent postcoital inflammatory response in female reproductive tissues has yet to be given a true physiological purpose. Historically the postcoital inflammatory response of female tissues was suggested to remove spermatozoa and male derived pathogens from the female reproductive tract. More recently, semen exposure and the postcoital inflammatory response have been suggested to play a role in long-term preparation of the maternal immune system to the semi-allogeneic pregnancy, ancillary support of the preimplantation embryo, and potentially fetal programing that improves pregnancy outcomes, while the absence or inappropriate postcoital inflammation has been suggested to contribute to pregnancy complications. Although the postcoital inflammatory response has been robustly characterized, the evidence for its role in promoting positive pregnancy outcomes or reducing pregnancy complications remains tenuous. This manuscript is designed to balance the information we know regarding semen exposure and postcoital inflammation in various animal systems, with the information we perceive to be factual but perhaps not yet fully tested, along with the data we have yet to generate if we intend to postulate a physiological purpose of the postcoital inflammatory response to pregnancy outcomes.

Impact of Bifidobacterium longum1714® on maternal cytokine response in peripheral blood mononuclear cells

PurposeThe maternal immune system is implicated in adverse pregnancy outcomes. Manipulation of maternal immune response by probiotics holds potential to reduce pregnancy complications. The MicrobeMom2 study investigates the impact of probiotic supplementation on maternal immune responses to pathogen associated molecular patterns (PAMPs) in peripheral blood mononuclear cells (PBMCs) during pregnancy. MethodsThis double-blinded randomised-controlled trial involved oral supplementation of Bifidobacterium longum subsp. longum 1714® (B. longum 1714; daily ingestion of a minimum of 1x109 colony forming units) or placebo from 16 to 20-weeks’ gestation until delivery in healthy pregnant women. The primary outcome was a change in IL-10 production, after stimulation with Lipopolysaccharide (LPS) or anti-CD3/28/2, in PBMCs isolated from blood samples taken at baseline (11–15 weeks’ gestation) and late pregnancy (28–32 weeks’ gestation) after 48 h incubation. 68 subjects were needed (34ineachgroup) for 80 % power at an alpha significance of 0.05 to detect differences in IL10. Results72 women (mean ± SD age 33.17 ± 4.53 years and median (25th, 75th centile) body mass index 24.93 (21.93, 27.57 kg/m2)) were recruited with primary outcome data. Using LPS, late pregnancy fold change in IL-10 in PBMCs after 48 h incubation was median (25th, 75th centile) 88.45 (4.88, 488.78) in the intervention, 24.18 (6.36, 141.17) in the control group, p = 0.183. Using anti-CD3/28/2, values were 189.69 (425.96, 866.57),148.74 (31.67, 887.03) in intervention and control groups, respectively, p = 0.506. No significant differences were observed between the two groups. ConclusionMaternal antenatal supplementation with B. longum 1714 did not alter cytokine production by maternal PBMCs in response to PAMPs or anti-CD3/28/2.Trial registration number: ISRCTN registry ISRCTN43013285.

P-612 Comparison the effectiveness and safety of letrozole-stimulated and hormone replacement treatment in endometrial preparation for frozen embryo transfer in patients with polycystic ovary syndrome

Abstract Study question Whether letrozole-stimulated protocol has advantages over hormone replacement therapy (HRT) in frozen embryo transfer in patients with polycystic ovary syndrome (PCOS)? Summary answer Letrozole-stimulated protocol is more suitable for endometrial preparation than HRT in patients with PCOS, which can increase the live birth rate and reduce pregnancy complications. What is known already The current routine endometrial preparation protocol for women with PCOS is HRT. However, HRT is expensive, and recent studies have found HRT may increase the risk of adverse maternal and neonatal complications such as hypertensive disorders of pregnancy. Letrozole induces mono-ovulatory and has no antiestrogenic effect, and has been found to increase live birth rate compared with clomiphene in fresh embryo cycles. However, Letrozole is rarely used in frozen embryo cycles. Whether letrozole-stimulated protocol is suitable for frozen embryo transfer in patients with PCOS and for whom is suitable is still lack of evidence. Study design, size, duration This is a retrospective cohort study involving all frozen embryo transfer cycles with letrozole-stimulated and HRT for PCOS during the period from August 2018 to December 2020 at a tertiary care center. Participants/materials, setting, methods A total of 2011 letrozole-stimulated cycles and 2211 HRT cycles were included in the analysis. Multivariate Logistic regression was used to analyze the differences in clinical pregnancy rate, live birth rate, miscarriage rate, the incidence of other pregnancy and obstetric outcomes between letrozole-stimulated protocol and HRT after adjusting for possible confounding factors. Subgroup analysis was used to explore the population for which letrozole-stimulated protocol was suitable. Main results and the role of chance After adjusting for confounding, letrozole-stimulated protocol increased the clinical pregnancy rate (OR,1.44; 95%CI,1.21-1.70), live birth rate (OR,1.49; 95%CI,1.27-1.74) and reduced the incidence of miscarriage (OR, 0.71; 95%CI,0.55-0.92), hypertensive disorders of pregnancy (OR, 0.66; 95%CI,0.45,0.98), gestational diabetes mellitus (OR,0.75; 95%CI,0.57,0.98) and cesarean section (OR,0.78; 95%CI,0.61,0.99) than HRT. There were no significant differences in other outcomes such as preterm birth, small for gestational age, and large for gestational age between the two endometrial preparation protocols. Subgroup analysis according to maternal age, BMI, insulin resistance and PCOS classification showed that the live birth rate of letrozole-stimulated protocol was significantly higher than that of HRT in all subgroups. Limitations, reasons for caution This study is a retrospective study, the population characteristics of the two endometrial preparation protocols existed differences. Although multivariate logistic regression was used to adjust some factors, the interference of known and unknown factors on the outcomes cannot be completely avoided. Wider implications of the findings This retrospective study found letrozole-stimulated protocol has more advantages than HRT, which can improve the live birth rate and reduce the incidence of hypertensive disorders of pregnancy, gestational diabetes mellitus in patients with PCOS. High-quality well-powered randomised clinical trials and possible mechanistic studies are needed to further validate this conclusion. Trial registration number NA

Pregnancy Outcome After Selective Fetal Reduction in Dichorionic Twin Pregnancies.

This study was conducted for determining pregnancy outcome after selective fetal reduction in twin pregnancies based on the gestational age at the time of the procedure in a referral academic center between 2017 and 2021. This retrospective cohort study included all women with twin pregnancies who were diagnosed with a genetic or structural anomaly of one fetus or a desire to reduce the number of fetuses in order to reduce pregnancy complications visited in the period of 2017-2021. Reduction was performed due to an abdominal approach at 11 to 23 weeks of pregnancy. Maternal and pregnancy information were recorded. A total of 159 cases of twin dichorionic pregnancies were included. The highest frequency of reduction was performed at the gestational age of 18-20 weeks, and the most common cause of reduction was major structural anomalies in the fetus. The results showed the average gestational age (GA) at the time of delivery to be 37.6 weeks, the average birth weight of 2,999 grams, the incidence of miscarriage (loss before 22 weeks) to be 9.4% and a rate of preterm birth (delivery before 37weeks) of 33.3%. There is not a statistically significant relationship between the gestational age at the time of reduction and preterm birth, the birth weight, the incidence of RDS and the incidence of SGA. Fetal reduction of twins to singleton pregnancy is associated with lower risk of preterm birth (delivery before37 weeks reduction of twins to singleton pregnancy is associated with lower risk of preterm birth (delivery before37 weeks). It causes an increase in birth weight and perinatal outcome in remaining co-twin so we recommend fetal reduction after counselling with patients for their unique situation to improve pregnancy outcome.

Noninvasive preeclampsia prediction using plasma cell–free RNA signatures

Preeclampsia, especially preterm preeclampsia and early-onset preeclampsia, is a life-threating pregnancy disorder, and the heterogeneity and complexity of preeclampsia make it difficult to predict risk and to develop treatments. Plasma cell-free RNA carries unique information from human tissue and may be useful for noninvasive monitoring of maternal, placental, and fetal dynamics during pregnancy. This study aimed to investigate various RNA biotypes associated with preeclampsia in plasma and to develop classifiers to predict preterm preeclampsia and early-onset preeclampsia before diagnosis. We performed a novel, cell-free RNA sequencing method termed polyadenylation ligation-mediated sequencing to investigate the cell-free RNA characteristics of 715 healthy pregnancies and 202 pregnancies affected by preeclampsia before symptom onset. We explored differences in the abundance of different RNA biotypes in plasma between healthy and preeclampsia samples and built preterm preeclampsia and early-onset preeclampsia prediction classifiers using machine learning methods. Furthermore, we validated the performance of the classifiers using the external and internal validation cohorts and assessed the area under the curve and positive predictive value. We detected 77 genes, including messenger RNA (44%) and microRNA (26%), that were differentially expressed in healthy mothers and mothers with preterm preeclampsia before symptom onset, which could separate participants with preterm preeclampsia from healthy samples and that played critical functional roles in preeclampsia physiology. We developed 2 classifiers for predicting preterm preeclampsia and early-onset preeclampsia before diagnosis based on 13 cell-free RNA signatures and 2 clinical features (invitro fertilization and mean arterial pressure), respectively. Notably, both classifiers showed enhanced performance when compared with the existing methods. The preterm preeclampsia prediction model achieved 81% area under the curve and 68% positive predictive value in an independent validation cohort (preterm, n=46; control, n=151); the early-onset preeclampsia prediction model had an area under the curve of 88% and a positive predictive value of 73% in an external validation cohort (early-onset preeclampsia, n=28; control, n=234). Furthermore, we demonstrated that downregulation of microRNAs may play vital roles in preeclampsia through the upregulation of preeclampsia-relevant target genes. In this cohort study, a comprehensive transcriptomic landscape of different RNA biotypes in preeclampsia was presented and 2 advanced classifiers with substantial clinical importance for preterm preeclampsia and early-onset preeclampsia prediction before symptom onset were developed. We demonstrated that messenger RNA, microRNA, and long noncoding RNA can simultaneously serve as potential biomarkers of preeclampsia, holding the promise of prevention of preeclampsia in the future. Abnormal cell-free messenger RNA, microRNA, and long noncoding RNA molecular changes may help to elucidate the pathogenic determinants of preeclampsia and open new therapeutic windows to effectively reduce pregnancy complications and fetal morbidity.

Nutrition Based on the Traditional Chinese Medicine and Complications of Subclinical Gestational Hypothyroidism

We have explored the effect of nutrition management based on the principles of traditional Chinese medicine nutrition on the complications of subclinical gestational hypothyroidism. A total of 228 pregnant women from the Affiliated Hospital of Jiangnan University and the Wuxi Xishan People’s Hospital who were diagnosed with subclinical hypothyroidism between June 2020 and April 2022 were recruited. The patients were divided into the control group (n = 120) and intervention group (n = 108) using the historical control method. The intervention group adopted the traditional Chinese medicine nutrition management model, while the control group was given conventional gestational nutrition management. Iodine nutritional status, maternal and neonatal outcomes, pregnancy complications, pregnancy stress, and social support were compared between the two groups before intervention, at 20 weeks of pregnancy, and before labor. The intervention group had significantly lower iodine nutritional status, better postpartum nutritional status, better pregnancy outcome, lower incidences of pregnancy complications, and better pregnancy stress and social support than in the control group (P &lt; 0.05). In conclusion, traditional Chinese medicine-based nutrition management can effectively control iodine nutritional status, improve maternal and neonatal outcomes, reduce pregnancy complications, and decrease pregnancy stress in postpartum women.

Towards an explainable clinical decision support system for large-for-gestational-age births.

A myriad of maternal and neonatal complications can result from delivery of a large-for-gestational-age (LGA) infant. LGA birth rates have increased in many countries since the late 20th century, partially due to a rise in maternal body mass index, which is associated with LGA risk. The objective of the current study was to develop LGA prediction models for women with overweight and obesity for the purpose of clinical decision support in a clinical setting. Maternal characteristics, serum biomarkers and fetal anatomy scan measurements for 465 pregnant women with overweight and obesity before and at approximately 21 weeks gestation were obtained from the PEARS (Pregnancy Exercise and Nutrition with smart phone application support) study data. Random forest, support vector machine, adaptive boosting and extreme gradient boosting algorithms were applied with synthetic minority over-sampling technique to develop probabilistic prediction models. Two models were developed for use in different settings: a clinical setting for white women (AUC-ROC of 0.75); and a clinical setting for women of all ethnicity and regions (AUC-ROC of 0.57). Maternal age, mid upper arm circumference, white cell count at the first antenatal visit, fetal biometry and gestational age at fetal anatomy scan were found to be important predictors of LGA. Pobal HP deprivation index and fetal biometry centiles, which are population-specific, are also important. Moreover, we explained our models with Local Interpretable Model-agnostic Explanations (LIME) to improve explainability, which was proven effective by case studies. Our explainable models can effectively predict the probability of an LGA birth for women with overweight and obesity, and are anticipated to be useful to support clinical decision-making and for the development of early pregnancy intervention strategies to reduce pregnancy complications related to LGA.

AWARENESS AMONG GYNECOLOGISTS IN JAMNAGAR DISTRICT ABOUT PERIODONTAL HEALTH AND ITS CORRELATION TO ADVERSE PREGNANCY OUTCOMES - A CROSS –SECTIONAL QUESTIONNAIRE SURVEY.

Introduction: Periodontitis is an inammatory disease of the soft and hard support tissues of tooth in response to the supra and subgingival microorganisms. In women with periodontitis, the infected periodontal tissues may act as reservoirs of bacteria and their products that can disseminate to the foetus-placental unit causing adverse pregnancy outcomes like preterm birth. This is a cross sectional survey carried out to Aim: access the level of knowledge, attitude, practice and awareness of Gynecologists in Jamnagar district regarding periodontal health and its correlation with adverse pregnancy outcomes. An online structured questionnaire had bee Materials and method: n made and was distributed through social media, responses were collected for a period of 3 months and the collected data were then subjected to statistical analysis. Result: Out of 64 participants, 44.88% of the gynecologists answered that regular screening of pregnant patients for periodontal disease is needed and 43.75% agree that dental treatment during pregnancy can reduce pregnancy complications. Only 65.63% were aware of the association between APO (adverse pregnancy outcomes) and periodontal disease. Collaborative treatment Conclusion: by gynaecologists and dentists help to improve the maternal oral health, reduce the postnatal complications and increases awareness among pregnant women regarding oral hygiene and regular dental check-up during pregnancy.

Folate and vitamin D during pregnancy: association for reducing pregnancy complications

Folate and vitamin D during pregnancy: association for reducing pregnancy complications

Iron deficiency in women: ways to reduce prevalence

Iron deficiency states (IDSs) are common disorders at the nexus of various fields. The etiology and pathogenesis of IDSs have been well studied in recent decades, but their prevalence is still high. The highest incidence of IDSs is reported in women of reproductive age. The timely correction of iron deficiency improves women's quality of life and reduces pregnancy complications and infant morbidity. To achieve and maintain the improvement, caution in risk groups, early diagnosis, physiology-based therapy, and follow-up are necessary. Iron sulfate agents are well known as an effective way to treat iron deficiency anemia. However, the high rate of previously reported side effects posed significant challenges to the complete course of therapy. The development of a new molecule with prolonged iron release minimizes the complications of therapy, providing new prospects for iron deficiency treatment. The combination of folic acid to iron sulfate in one tablet simplifies prevention regimens and therapy for pregnant women and those planning to become pregnant and reduces the time to improve.

Influence of pre-gravid preparation on the course and outcomes of the pregnancy in genital herpes

Introduction. According to researchers from different countries, the incidence of neonatal herpes varies noticeably. Objective. Optimization of pre-gravid preparation of women with chronic recurrent genital herpes to reduce pregnancy complications and improve perinatal outcomes. Мaterials and methods. The study included 58 women with confirmed chronic recurrent genital herpes. Two groups were formed, the main group included 30 women receiving pre-gravid preparation, complex treatment with antiviral and immunomodulatory drugs, the comparison group was represented by 28 women receiving pre-gravid preparation and only antiviral drug. Evaluation of the effectiveness of the treatment of chronic genital herpes and the benefits of pre-gravid preparation were carried out by assessing clinical manifestations, determining the immune status, analyzing the characteristics of the course of pregnancy, childbirth, and perinatal outcomes. Results. As a result of the study, the available data confirm the feasibility of using complex therapy in the treatment of chronic recurrent genital herpes in combination with pre-gravid preparation. Conclusion. Pre-gravid preparation and specific treatment of women with chronic recurrent genital herpes improve the clinical status of patients, increase the interrecurrent period, reduce the severity of prodromal symptoms, the duration and intensity of relapses of the disease, and contribute more favorable course of pregnancy and improvement perinatal outcomes.

A Big Role for microRNAs in Gestational Diabetes Mellitus.

Maternal diabetes is associated with pregnancy complications and poses a serious health risk to both mother and child. Growing evidence suggests that pregnancy complications are more frequent and severe in pregnant women with pregestational type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) compared to women with gestational diabetes mellitus (GDM). Elucidating the pathophysiological mechanisms that underlie the different types of maternal diabetes may lead to targeted strategies to prevent or reduce pregnancy complications. In recent years, microRNAs (miRNAs), one of the most common epigenetic mechanisms, have emerged as key players in the pathophysiology of pregnancy-related disorders including diabetes. This review aims to provide an update on the status of miRNA profiling in pregnancies complicated by maternal diabetes. Four databases, Pubmed, Web of Science, EBSCOhost, and Scopus were searched to identify studies that profiled miRNAs during maternal diabetes. A total of 1800 articles were identified, of which 53 are included in this review. All studies profiled miRNAs during GDM, with no studies on miRNA profiling during pregestational T1DM and T2DM identified. Studies on GDM were mainly focused on the potential of miRNAs to serve as predictive or diagnostic biomarkers. This review highlights the lack of miRNA profiling in pregnancies complicated by T1DM and T2DM and identifies the need for miRNA profiling in all types of maternal diabetes. Such studies could contribute to our understanding of the mechanisms that link maternal diabetes type with pregnancy complications.

P-770 Is there an association between blood hCG elevation rate in very early IVF pregnancy and adverse pregnancy outcomes?

Abstract Study question Is a slow elevation rate between the first and second hCG values following a successful fresh IVF cycle associated with long-term pregnancy outcomes? Summary answer A slow rate of hCG elevation in early IVF pregnancies is associated with an increased risk for low birth weight neonates. What is known already IVF pregnancies are associated with higher prevalence of late obstetrical complications such as preterm birth, preeclampsia and small for gestational age. Different baseline characteristics and treatment parameters are associated with obstetrical complications. Abnormal, mostly slow, hCG elevation patterns have been strongly associated with short-term adverse pregnancy outcomes such as non-viability, miscarriage, early fetal demise and ectopic pregnancies. However, the long-term impact of slow hCG elevation rate on pregnancies that do continue to term is unknown. Study design, size, duration Single center cohort study between 2008-2019 including 703 fresh cycles resulting in live singleton birth. Full obstetrical data for these pregnancies was available. Participants/materials, setting, methods The first blood hCG measurement was performed 14±1.4 days after ovum pick-up (OPU), and the second one 48-72h later. The slope between the two measurements was calculated and adjusted per day. Slow hCG elevation was defined as a slope value below the 10th percentile. Maternal and short-term neonatal outcomes were compared between cycles with a slow elevation (n = 71) and a “normal” elevation (n = 632) in hCG values. Multivariate analysis was used to control for potential confounders. Main results and the role of chance There were no differences between the slow and normal hCG elevation groups in maternal age, numbers of retrieved oocytes, ICSI rates, number of transferred and usable embryos, and gestational age at delivery. Neonates from cycles with a slow hCG elevation weighed significantly less (2876±619 gr vs. 3083±553 gr, p &amp;lt; 0.005) and were at a higher risk (21% vs. 12%, OR = 1.96, 95% CI 1.06-3.64) of having low birth weight (LBW) (below 2500 grams). Women with slow hCG elevation rate had more hypertension-preeclampsia related complications (11% vs. 6%, p &amp;lt; 0.05), although barely reaching statistical significance in the multivariate analysis (OR = 1.76, 95% CI 1.0-3.6). Limitations, reasons for caution Retrospective design, single center, applicability to fresh cycles only. Wider implications of the findings Very early (5th week) initial blood hCG elevation slope, measured only in IVF gestations, might be a novel marker for identifying patients at risk for hypertensive complications during pregnancy and low birth-weight neonates. Tighter prenatal care for these patients could potentially reduce pregnancy complications and improve long-term outcome. Trial registration number not applicable

560-P: Medical Nutrition Therapy Treatment for Gestational Diabetes

Objective: Gestational Diabetes Mellitus (GDM) is a controversial disorder that can be defined as glucose intolerance or obesity in offspring or unfortunate perinatal complications and outcomes. Inadequate treatment of GDM might lead to foetal complications. This study will aim at assessing the effects of Medical Nutritional Therapy (MNT) as a treatment therapy for pregnant women with gestational diabetes. Methods: This study was conducted in two center between March to July 2021. A total of 76 patients had been evaluated among whom 20 women had been diagnosed with GDM while the other 56 women had normal tolerance for glucose. Women diagnosed with GDM had received medical nutrition therapy with recommended nuts and olive oil intake. Results: The HbA1C level of the GDW women (5.1% ± 0.3% (32 ± 0.9 mmol/mol) was higher as opposed to those with Normal tolerance for glucose (NGT) (4.9% ± 0.3% (30 ± 0.9 mmol/mol) , p = 0.001) . In a similar manner, the insulin resistance among the GDM women (24-28 GWs, p = 0.001) was higher. The total weight gain during the pregnancy period was lesser in comparison with the NGT women. Along with these, occurrences of adverse events during pregnancy were lesser among GDW women. Conclusion: With the help of Medical Nutrition therapy during gestational diabetes management, the outcomes of pregnancies among GDW women can be made similar to those with NGT. MNT is an effective treatment since it reduces pregnancy complications and enhances outcomes. Disclosure A.Shankar: None.