Risk Of Adverse Obstetric Outcomes Research Articles

Placental SARS-CoV-2 infection and its implications for increased risk of adverse pregnancy outcomes.

Pregnant women are at increased risk of COVID-19. This could be explained through the prism of physiologic and immunologic changes in pregnancy. In addition, certain immunological reactions originate in the placenta in response to viral infections. This study aimed to investigate whether SARS-CoV-2 can infect the human placenta and discuss its implications in the pathogenesis of adverse pregnancy outcomes. We conducted a retrospective cohort study in which we collected placental specimens from pregnant women who had a laboratory-confirmed SARS-CoV-2 infection. We performed RNA in situ hybridization (RNA-ISH) assay on formalin-fixed paraffin-embedded (FFPE) tissues to establish the in vivo evidence for placental infectivity by this corona virus. In addition, we infected trophoblast isolated from uninfected term human placenta with SARS-CoV-2 variants to further provide in vitro evidence for such an infectivity. There was a total of 21 cases enrolled, which included five cases of spontaneous preterm birth (SPTB) and two intrauterine fetal demises (IUFDs). Positive staining of positive-sense strand (PSS) of SARS-CoV-2 virions was detected in 15 placentas including four SPTB and both IUFDs. In vitro infection assay demonstrated that SARS-CoV-2 virions were highly capable of infecting both cytotrophoblast and syncytiotrophoblast. This study implies that placental SARS-CoV-2 infection may be associated with an increased risk of adverse obstetrical outcomes.

External cephalic version - single-center experience.

External cephalic version (ECV) is an alternative to caesarean section for abnormal fetal position. ECV is recommended by the most important scientific committees in the world. ECV complications are rare and occur in 6.1% of cases, however severe complications requiring urgent caesarean section are found in less than 0.4%. Our aim was to demonstrate the effectiveness and safety of ECV and to present our own experience with the procedure of ECV. ECV was performed on 62 patients (32 nulliparas and 30 multiparas). Qualification criteria included: singleton gestation, gestational age > 36 + 6, longitudinal pelvic lie, no uterine contractions, intact membranes. Indications for immediate cesarean section within 24 hours of ECV were considered a procedural complication. In patients with complications, the condition of the newborn was checked according to the APGAR score and the day of discharge of the mother and child from the maternity ward was analyzed. ECV finished successfully in 66.1% (nulliparas 56.2% and multiparas 76.7%). Patients with a successful ECV were significantly older and had higher median gestational age. ECV was more often successful when placenta was located on the posteriori wall. In our patients, there were 4 cases of complications requiring delivery at the time of ECV. No serious consequences associated with increased maternal or neonatal morbidity or mortality were reported. ECV seems to be a safe alternative for women wishing to deliver vaginally, as this procedure does not increase the risk of adverse obstetric outcomes.

Clinical outcomes of screen-positive genome-wide cfDNA cases for trisomy 20: results from the global expanded NIPT Consortium.

Trisomy 20 has been shown to be one of the most frequent rare autosomal trisomies in patients that undergo genome-wide noninvasive prenatal testing. Here, we describe the clinical outcomes of cases that screened positive for trisomy 20 following prenatal genome-wide cell-free (cf.) DNA screening. These cases are part of a larger cohort of previously published cases. Members of the Global Expanded NIPT Consortium were invited to submit details on their cases with a single rare autosomal aneuploidy following genome-wide cfDNA screening for retrospective analysis. Clinical details including patient demographics, test indications, diagnostic testing, and obstetric pregnancy outcomes were collected. Genome-wide cfDNA screening was conducted following site-specific laboratory procedures. Cases which screened positive for trisomy 20 (n = 10) were reviewed. Clinical outcome information was available for 90% (9/10) of our screen-positive trisomy 20 cases; the case without diagnostic testing ended in a fetal demise. Of the nine cases with outcome information, one was found to have a mosaic partial duplication (duplication at 20p13), rather than a full trisomy 20. Only one case in the study cohort had placental testing; therefore, confined placental mosaicism could not be ruled out in most cases. Adverse pregnancy outcomes were seen in half of the cases, which could suggest the presence of underlying confined placental mosaicism or mosaic/full fetal trisomy 20. Based on our limited series, the likelihood of true fetal aneuploidy is low but pregnancies may be at increased risk for adverse obstetric outcomes and may benefit from additional surveillance.

Effect of type III female genital mutilation on obstetric outcomes: A systematic review and meta-analysis

BackgroundControversial evidence suggests a potential association between female genital mutilation (FGM/C) and adverse obstetric outcomes, with type III FGM/C (infibulation) carrying the greatest risk. The aim of this systematic review and meta-analysis was to assess current rate of adverse obstetric outcomes in women with type III female genital mutilation and cutting (FGM/C; infibulation) delivering across different settings worldwide. MethodsWe searched PubMed, Scopus, Embase, and ClinicalTrials.gov databases from inception to Jan 1, 2023. Studies were selected if they included the main outcome of postpartum haemorrhage (PPH) or secondary outcomes, which included major conditions affecting maternal-neonatal health during labour and delivery. DerSimonian-Laird random effects meta-analysis including pooled effect estimates with corresponding 95 % confidence intervals was performed. Heterogeneity was assessed using the I2 statistic. Meta regression for relevant covariates was performed when data on relevant confounders were available. The Newcastle-Ottawa scale (NOS) was used to assess quality of observational studies. The level of evidence was assessed with the GRADE method. Results14 observational studies including 15,320 type III FGM/C women and 59,347 controls were eligible. The risk for postpartum haemorrhage was significantly increased in type III FGM/C, in the main analysis (OR 1.83, 95 % CI 1.03 to 3.24, I2 = 93 %), in pooling of data adjusted for confounders (aOR 1.76, CI 1.42 to 2.17, I2 = 0 %), and in sensitivity analysis of higher quality studies with NOS≥7 (OR 2.76, CI 1.38 to 5.51, I2 = 95 %). Meta-regression showed that nulliparity was significantly and positively associated with postpartum haemorrhage. Similarly, analysis of data adjusted for confounders showed an increased risk of episiotomy in type III FGM/C (aOR 1.56, CI 1.03 to 2.35, I2 = 52 %). Sensitivity analysis of studies with NOS≥7 revealed a significant increase for episiotomy (OR 7.53, CI 1.19 to 47.54, I2 = 96 %), perineal tears (OR 4.24, CI 1.09 to 16.46, I2 = 66 %), prolonged second stage of labour (OR 5.19, 95 % CI 1.00 to 26.85, I2 = 66 %), and Apgar score less than 7 (OR 4.19, CI 1.64 to 10.70, I2 = 0 %). No difference was found regarding obstetric anal sphincter injuries and mode of delivery in these women. Deinfibulation achieved similar obstetric and neonatal outcomes to women who never had type III FGM. The overall quality of the studies was adequate (median NOS score: 7; IQR: 6–8), the level of evidence, according to the GRADE assessment, was low. ConclusionsThese results consistently show an increased risk of adverse obstetric outcomes in women with FGM/C type III. Infibulation substantially increases the risk for PPH, particularly in nulliparae. Systematic Review registration: PROSPERO CRD42023421993.

Outcomes of pregnancies complicated by cirrhosis: a retrospective cohort study

BackgroundAlthough pregnancy complicated by liver cirrhosis is rare, women with cirrhosis experience increased adverse pregnancy outcomes. This study aimed to evaluate pregnancy outcomes in women with liver cirrhosis and develop a predictive model using maternal factors for preterm birth in such pregnancies.MethodsA retrospective analysis was conducted on pregnancy outcomes of a cirrhosis group (n = 43) and a non-cirrhosis group (n = 172) in a university hospital between 2010 and 2022. Logistic regression evaluated pregnancy outcomes, and a forward stepwise logistic regression model was designed to predict preterm birth in pregnant women with cirrhosis. The model's predictive performance was evaluated using the receiver operating characteristic (ROC) curve and the area under the ROC curve (AUC).ResultsThe incidence of cirrhosis during pregnancy was 0.06% (50/81,554). Pregnant women with cirrhosis faced increased risks of cesarean section, preterm birth, intrahepatic cholestasis of pregnancy, thrombocytopenia, and postpartum hemorrhage. In pregnant women with cirrhosis, preterm birth risk significantly increased at an incidence rate of 46.51% (20/43). According to the prediction model, the key predictors of preterm birth in pregnant women with cirrhosis were intrahepatic cholestasis of pregnancy and total bilirubin. The model demonstrated accurate prediction, with an AUC of 0.847, yielding a model accuracy of 81.4%.ConclusionsPregnant women with cirrhosis face a heightened risk of adverse obstetric outcomes, particularly an increased incidence of preterm birth. The preliminary evidence shows that the regression model established in our study can use the identified key predictors to predict preterm birth in pregnant women with cirrhosis, with high accuracy.

Obstetric and perinatal outcomes in women with previous breast cancer: a nationwide study of singleton births 1973-2017.

What are the obstetric and perinatal outcomes in births to breast cancer survivors compared to women without previous breast cancer? Women who conceived during the first 2 years following a breast cancer diagnosis had a higher risk for preterm birth, induced delivery, and cesarean section, while no increased risks were observed in births conceived later than 2 years after a breast cancer diagnosis. A recent meta-analysis found higher risks of cesarean section, preterm birth, low birthweight, and small for gestational age in pregnancies among breast cancer survivors. Less is known about rarer outcomes such as pre-eclampsia or congenital malformations. We conducted a population-based matched cohort study including all breast cancer survivors who gave birth to singletons 1973-2017 in Sweden, identified through linkage between the Swedish Cancer Register, the Medical Birth Register, and the National Quality Register for Breast Cancer. Each birth following breast cancer (n = 926) was matched by maternal age at delivery, parity, and calendar year at delivery to 100 births in a comparator cohort of women (n = 92 490). Conditional logistic and multinomial regression models estimated relative risks (RR) with 95% CI. Subgroup analyses by time since diagnosis and type of treatment were performed. Previous breast cancer was associated with higher risks of induced delivery (RR; 1.3, 1.0-1.6), very preterm birth (RR; 1.8, 1.1-3.0), and planned preterm birth (RR; 1.6, 1.0-2.4). Women who conceived within 1 year after breast cancer diagnosis had higher risks of cesarean section (RR; 1.7, 1.0-2.7), very preterm birth (RR; 5.3, 1.9-14.8), and low birthweight (RR; 2.7, 1.4-5.2), while the risks of induced delivery (RR; 1.8, 1.1-2.9), moderately preterm birth (RR; 2.1, 1.2-3.7), and planned preterm birth (RR; 2.5, 1.1-5.7) were higher in women who conceived during the second year after diagnosis. Women who conceived later than 2 years after breast cancer diagnosis had similar obstetric risks to their comparators. As information on the end date of treatment was unavailable, the time between the date of diagnosis and conception was used as a proxy, which does not fully capture the effect of time since end of treatment. In addition, treatments and clinical recommendations have changed over the long study period, which may impact childbearing patterns in breast cancer survivors. Risks of adverse obstetric outcomes in breast cancer survivors were confined to births conceived within 2 years of diagnosis. As family building holds significance for numerous young breast cancer patients, these findings are particularly important to inform both breast cancer survivors and clinicians about future reproductive outcomes. This work was supported by the Swedish Cancer Society (grant number 22-2044 Pj A.L.V.J.), Karolinska Institutet Foundations (grant number: 2022-01696 F.E.L., 2022-01559 A.L.V.J.), and the Swedish Research Council (grant number: 2021-01657 A.L.V.J.). K.A.R.-W. is supported by grants from the Swedish Cancer Society (20 0170 F) and the Radiumhemmets Research Foundations for clinical researchers 2020-2026. The authors declare that they have no conflicts of interest. N/A.

Insights on obstetric outcomes in pregnant individuals with Marfan Syndrome: evidence from the National Inpatient Sample.

We investigated the potential association between Marfan Syndrome (MFS) and adverse obstetric outcomes using the National Inpatient Sample (NIS) database. We utilized the International Classification of Diseases (ICD-10) system to identify relevant codes and extracted data from the NIS database covering the period 2016-2019. Descriptive statistics and χ2 tests were employed to summarize and compare baseline characteristics. Univariate and multivariate regression analyses (adjusted for age, race, hospital region, smoking status, and alcohol misuse) were conducted to evaluate association between MFS and adverse obstetric outcomes. The regression analyses were summarized as Odds Ratios (OR) with 95% confidence intervals (CI). Among the 2,854,149 pregnant individuals, 179 had MFS. Baseline characteristics revealed significant associations between MFS and age, race, and hospital location. Univariate analysis showed MFS individuals had significantly increased risks of amniotic fluid/membrane abnormalities (AFAs, OR=1.64, 95% CI: 1.01-2.68, P=0.045) and postpartum hemorrhage (PPH, OR=3.73, 95% CI: 2.41-5.78, P<0.001). Several obstetric outcomes showed some trends towards increased (multiple gestation, placenta previa, and preterm labor) and decreased (premature rupture of membrane, gestational diabetes, and preeclampsia) obstetric risks with MFS; however, they were not statistically significant. Multivariate analysis showed MFS was significantly associated with increased risks of AFAs (adjusted OR=1.68, 95% CI: 1.03-2.74, P=0.037) and PPH (adjusted OR=3.62, 95% CI: 2.31-5.68, P<0.001). MFS is associated with increased risks of adverse obstetric outcomes, specifically AFAs and PPH. These results highlight the importance of monitoring these specific pregnancy outcomes in MFS individuals to ensure optimal maternal-fetal health.

Intrauterine adhesions treated with hysteroscopic adhesiolysis and subsequent obstetric outcome: A retrospective matched cohort study.

To examine whether a history of hysteroscopic adhesiolysis (HA)-treated intrauterine adhesions (IUAs) was associated with an increased risk of adverse obstetrical outcomes in subsequent pregnancies. Retrospective cohort study. A tertiary-care hospital in Shanghai, China. A cohort of 114 142 pregnant women who were issued an antenatal card and received routine antenatal care in Shanghai First Maternity and Infant Hospital, between January 2016 and October 2021. From the cohort of 114 142 pregnant women, each woman with a history of HA-treated IUA prior to the current pregnancy (n = 780) was matched with four women without a history of IUAs (n = 3010) using propensity score matching. The matching variables were maternal age and parity, mode of conception, pre-pregnancy body mass index and prior history of abortion. Pregnancy complications, placental abnormalities, postpartum haemorrhage and adverse birth outcomes. Compared with women with no history of IUAs, women with a history of HA-treated IUAs were at higher risk of pre-eclampsia (RR 1.69, 95% CI 1.23-2.33), placenta accreta spectrum (RR 4.72, 95% CI 3.9-5.73), placenta praevia (RR 4.23, 95% CI 2.85-6.30), postpartum haemorrhage (RR 2.86, 95% CI 1.94-4.23), preterm premature rupture of membranes (RR 3.02, 95% CI 1.97-4.64) and iatrogenic preterm birth (RR 2.86, 95% CI 2.14-3.81). Those women were also more likely to receive cervical cerclage (RR 5.63, 95% CI 3.95-8.02) during pregnancy and haemostatic therapies after delivery (RR 2.17, 95% CI 1.75-2.69). Moreover, we observed that the RRs of those adverse obstetrical outcomes increased with the increasing number of hysteroscopic surgeries. This study found that a history of HA-treated IUAs, especially a history of repeated HAs, was associated with an increased risk of adverse obstetrical outcomes.

Adverse delivery hospitalisation outcomes in 2020 during the COVID-19 pandemic.

To evaluate risk for adverse obstetric outcomes associated with the coronavirus disease 2019 (COVID-19) pandemic period and with COVID-19 diagnoses. Serial cross-sectional study. A national sample of US delivery hospitalisations before (1/2016 to 2/2020) and during the first 10 months of (3/2020 to 12/2020) the COVID-19 pandemic. All 2016-2020 US delivery hospitalisations in the National Inpatient Sample. Delivery hospitalisations were identified and stratified into pre-pandemic and pandemic periods and the likelihood of adverse obstetric outcomes was compared using logistic regression models with adjusted odds ratios (aOR) with 95% confidence intervals (CI) as measures of association. Risk for adverse outcomes was also analysed specifically for 2020 deliveries with a COVID-19 diagnosis. Adverse maternal outcomes including respiratory complications and cardiac morbidity. Of an estimated 18.2 million deliveries, 2.9 million occurred during the pandemic. The proportion of delivery hospitalisations with a COVID-19 diagnosis increased from 0.1% in March 2020 to 3.1% in December. Comparing the pandemic period to the pre-pandemic period, there were higher adjusted odds of transfusion (aOR 1.12, 95% CI 1.05-1.19), a respiratory complication composite (aOR 1.37, 95% CI 1.29-1.46), cardiac severe maternal morbidity (aOR 1.30, 95% 1.20-1.39), postpartum haemorrhage (aOR 1.19, 95% CI 1.15-1.24), placental abruption/antepartum haemorrhage (OR 1.04, 95% CI 1.00-1.08), and hypertensive disorders of pregnancy (OR 1.23, 95% CI 1.21-1.26). These associations were similar to unadjusted analysis. Risk for these outcomes during the pandemic period was significantly higher in the presence of a COVID-19 diagnosis. In a national estimate of delivery hospitalisations, the odds of cardiac and respiratory outcomes were higher in 2020 compared with 2016-2019. COVID-19 diagnoses were specifically associated with a range of serious complications.

A Comparison of Pregnancy and Neonatal Outcomes in Women with the Hyperandrogenic Disorders Polycystic Ovary syndrome and Cushing’s Syndrome

Research Question: How does the risk for adverse obstetric outcomes differ among women with polycystic ovary syndrome (PCOS) and women with Cushing’s syndrome (CUS)? Design: A retrospective population-based study utilizing data from the Healthcare Cost and Utilization Project—Nationwide Inpatient Sample (HCUP-NIS), 2004-2014. 14, 881 deliveries to women with PCOS and 134 deliveries to women with CUS were identified. Associations between PCOS, CUS, pregnancy, delivery, and neonatal outcomes were analyzed with multivariate logistic regression analysis. Results: At baseline, CUS was associated with a higher risk of chronic hypertension (P&lt;0.001), pregestational diabetes mellitus (P=0.01), thyroid disease (P=0.004), and higher rates of smoking during pregnancy (P=0.02) whereas PCOS was associated with higher rates of obesity (P=0.01). In terms of obstetric outcomes, PCOS increased the prevalence of gestational diabetes mellitus (P=0.002, adjusted[a] OR 2.73; 95% CI 1.46 to 5.12), and cesarean section (P&lt;0.001, aOR 2.63; 95% CI 1.81-3.83) in comparison to CUS. CUS increased the prevalence of operative vaginal delivery (P&lt;0.001, aOR 0.10; 95% CI 0.06-0.14), and transfusion (P=0.002, aOR 0.25; 95% CI 0.11-0.59) in comparison to deliveries to women with PCOS. No significant differences were found in terms of pregnancy-induced hypertension (P=0.78), gestational hypertension (P=0.86), preeclampsia (P=0.25), preeclampsia or eclampsia superimposed on pre-existing hypertension (P=0.13). Conclusion: PCOS increases the risk of gestational diabetes and cesarean section relative to CUS, whereas CUS increases the prevalence of operative vaginal delivery and blood transfusions.

O-009 The Role of Ethnicity and Polycystic Ovary Syndrome on Pregnancy Complications. An Analysis of a Population Database

Abstract Study question The goal of this study was to determine the independent effect of ethnicity on adverse obstetrical outcomes in women with Polycystic Ovary Syndrome (PCOS). Summary answer Among women with PCOS, African Americans, Hispanic and Asians are at an increased risk of certain adverse obstetrics outcomes, whereas Caucasians have fewer pregnancy complications. What is known already Polycystic ovarian syndrome is associated with an increased risk of pregnancy complications possibly due to the insulin resistance inherent in this syndrome. Variable ethnicities demonstrate different magnitudes of insulin resistance and in non-PCOS populations are known to be at modified pregnancy complication risks. Different ethnicities may have different phenotypes of PCOS, possibly further modifying outcomes. The role of ethnicity in women with PCOS and its effect on pregnancy complications has not been well studied. Study design, size, duration This retrospective population-based study utilized data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS), over 11 years from 2004 to 2014. The data are representative of 20% of admissions to US hospitals and geographically represent over 96% of the American population. Clinical modification ICD9-CM codes were used to identify women with PCOS and group them according to maternal ethnicity. In 2015 codes were changed to ICD-10 which are not comparable. Participants/materials, setting, methods All women with PCOS(n = 12782) were grouped according to maternal ethnicity: Caucasian(9107), African American(1098), Hispanic(1288), Asian(741), and other. Pregnancy, delivery, and neonatal outcomes were collected per group and compared to the rest. Chi-square tests were used to compare the baseline characteristics between the cohorts. Logistic regression analyses were conducted to explore associations between ethnicity and pregnancy outcomes through the estimation of odds ratio (OR) and 95% confidence intervals (CI) while controlling for confounding effects. Main results and the role of chance PCOS was found in 12,782 patients with included ethnicity results. Asian women had a higher prevalence of gestational diabetes(GDM) (aOR1.96, 95%CI 1.49-2.58, p &amp;lt; 0.001), chorioamnionitis (aOR3.41, 95%CI 2.12-5.47, p &amp;lt; 0.0001), operative vaginal delivery (aOR2.42, 95%CI 1.65-3.56, p &amp;lt; 0.001), postpartum hemorrhage(PPH) (aOR2.07, 95%CI 1.25-3.43, p = 0.004) and maternal infection (aOR2.84, 95%CI 1.80-4.49, p &amp;lt; 0.001). African Americans had a higher risk of pregnancy-induced hypertension (aOR1.38, 95% CI 1.06-1.80, p = 0.02), preeclampsia (aOR1.68, 95% CI 1.15-2.45, p = 0.007), preterm premature rupture of membrane (aOR2.75, 95%CI 1.58-4.78, p &amp;lt; 0.001), chorioamnionitis (aOR1.83, 95%CI 1.12-2.98, p = 0.016) and cesarean sections (aOR1.69, 95%CI 1.32-2.15, p &amp;lt; 0.001) and lower risk of operative vaginal delivery (aOR0.53, 95%CI 0.31-0.93, p = 0.03), spontaneous vaginal delivery (aOR0.67, 95%CI 0.52-0.85, p &amp;lt; 0.001), and maternal infection (aOR1.91, 95%CI 1.21-3.00, p = 0.005). The risk of GDM (aOR1.36, 95%CI 1.06-1.73, p &amp;lt; 0.014) and PPH (aOR1.58, 95%CI 1.01-2.47, p = 0.045) was increased among Hispanic patients. Caucasian patients were at lower risk of GDM(aOR0.67, 95%CI 0.57-0.79, p &amp;lt; 0.0001), chorioamnionitis (aOR0.39, 95%CI 0.28-0.55, p &amp;lt; 0.0001), casarean section (aOR0.83, 95%CI 0.73-0.95, p &amp;lt; 0.008), spontaneous vaginal deliveries (aOR1.25, 95% CI1.10-1.43, p &amp;lt; 0.001), PPH (aOR0.70, 95% CI0.50-0.98, p &amp;lt; 0.035), blood transfusion (aOR0.49, 95%CI 0.29-0.83, p &amp;lt; 0.007), maternal infection (aOR0.34, 95% CI 0.27-0.51, p &amp;lt; 0.0001) and small for gestational age infants (aOR0.64, 95%CI 0.44-0.93, p &amp;lt; 0.018). Rates of other pregnancy outcomes were similar for the groups. Limitations, reasons for caution This is a retrospective analysis utilizing an administrative database that relied on the accuracy and consistency of the individuals coding the data. There are known limitations to how accurately hospital coding is able to capture perinatal conditions and complications. Wider implications of the findings Our study demonstrated that among women with PCOS, specific ethnicities are at an increased risk of adverse obstetric outcomes. This underlines the importance of screening for certain pregnancy complications in PCOS women of African American, Hispanic, and Asian ethnicity. Studies should evaluate the role of insulin resistance in these outcomes. Trial registration number not applicable - This study used publicly accessible, anonymized data; therefore, according to articles 2.2, 2.4 of Tri-Council Policy Statement (2010), institutional review board approval was not required.

P-601 Comparison of adverse obstetric outcomes in women with the hyperandrogenic syndromes, polycystic ovary syndrome and Cushing’s syndrome: an evaluation of a population database

Abstract Study question How does the risk for adverse obstetric outcomes differ among women with polycystic ovary syndrome (PCOS) and women with Cushing’s syndrome (CUS)? Summary answer PCOS increased the risk of gestational diabetes and cesarean section relative to CUS, whereas CUS increased the prevalence of operative vaginal delivery and blood transfusions. What is known already PCOS and CUS are hyperandrogenic disorders that have previously been associated with unique adverse obstetric outcomes. Despite there being similarities in the hyperandrogenism and insulin resistance of these disorders, there is a lack of knowledge when comparing their specific risks of pregnancy complications. Study design, size, duration A retrospective population-based study utilizing data from the Healthcare Cost and Utilization Project—Nationwide Inpatient Sample (HCUP-NIS), was performed. A dataset of all deliveries between 2004 and 2014 inclusively, was created. 14 881 deliveries to women with PCOS and 134 deliveries to women with CUS were identified. The HCUP-NIS presents information on approximately 20% of admissions to US hospitals. Data was not continued into 2015 when ICD-10 codes were used, which are not comparable. Participants/materials, setting, methods Descriptive analyses were performed to compare the demographic features among both groups using chi-squared tests. Multivariate logistic regression analysis was performed to calculate unadjusted and adjusted odds ratios (aORs) and corresponding 95% confidence intervals (CI). According to Tri-Council Policy statement (2018), IRB approval was not required, given data was anonymous and publicly available. Main results and the role of chance At baseline, CUS was associated with a higher risk of chronic hypertension (P &amp;lt; 0.001), pregestational diabetes mellitus (P = 0.01), thyroid disease (P = 0.004), and higher rates of smoking during pregnancy (P = 0.02) whereas PCOS was associated with higher rates of obesity (P = 0.01). In terms of obstetric outcomes, PCOS increased the prevalence of gestational diabetes mellitus (P = 0.002, adjusted[a] OR 2.73; 95% CI 1.46 to 5.12), and cesarean section (P &amp;lt; 0.001, aOR 2.63; 95% CI 1.81-3.83) in comparison to CUS. CUS increased the prevalence of operative vaginal delivery (P &amp;lt; 0.001, aOR 0.10; 95% CI 0.06-0.14), and transfusion (P = 0.002, aOR 0.25; 95% CI 0.11-0.59) in comparison to deliveries to women with PCOS. No significant differences were found in terms of pregnancy-induced hypertension (P = 0.78), gestational hypertension (P = 0.86), preeclampsia (P = 0.25), preeclampsia or eclampsia superimposed on pre-existing hypertension (P = 0.13), premature rupture of membranes (P = 0.99), preterm delivery (P = 0.17), placental abruption (P = 0.82), chorioamnionitis (P = 0.16), spontaneous vaginal delivery (P = 0.35), postpartum hemorrhage (P = 0.29), and maternal infection (P = 0.11). In terms of neonatal outcomes, both deliveries to women with PCOS and women with CUS had similar outcomes for small for gestational age infants (P = 0.52), intrauterine fetal demise (P = 0.94), and congenital anomalies (P = 0.53). Limitations, reasons for caution The data within this retrospective cohort study relies on the accuracy of the individuals collecting the data. Data on medication use and compliance was unavailable. Wider implications of the findings Pregnant women with PCOS and CUS are at risk for certain specific obstetric complications, with most risks being similar. The magnitude of the insulin resistance in PCOS may be greater than in CUS due to the increased risk of gestational diabetes in PCOS when controlling for obesity and confounding effects. Trial registration number Not applicable

Knowledge Gaps and Current Evidence Regarding Breastfeeding Issues in Mothers with Chronic Diseases.

The prevalence of chronic maternal disease is rising in the last decades in the developed world. Recent evidence indicated that the incidence of chronic maternal disease ranges from 10 to 30% of pregnancies worldwide. Several epidemiological studies in mothers with chronic diseases have mainly focused on the risk for adverse obstetric outcomes. Evidence from these studies supports a correlation between maternal chronic conditions and adverse perinatal outcomes, including increased risk for preeclampsia, cesarean section, preterm birth, and admission in the Neonatal Intensive Care Unit (NICU). However, there is a knowledge gap pertaining to the management of these women during lactation. This review aimed at summarizing the available research literature regarding breastfeeding in mothers with chronic diseases. Adjusted and evidence-based support may be required to promote breastfeeding in women with chronic diseases; however, our comprehension of breastfeeding in this subpopulation is still unclear. The literature related to breastfeeding extends in various scientific areas and multidisciplinary effort is necessary to compile an overview of current evidence and knowledge regarding breastfeeding issues in mothers with chronic diseases.

Obstetric Outcomes Among Women With a History of Intimate Partner Violence in the United States.

To evaluate the association between exposure to intimate partner violence (IPV) and delivery method in a U.S. obstetric cohort. The study population included U.S. women with a history of recent live birth, drawn from the 2009-2018 PRAMS (Pregnancy Risk Assessment Monitoring System) cohort. The primary exposure was self-reported IPV. The primary outcome of interest was method of delivery (vaginal or cesarean). Secondary outcomes included preterm birth, small for gestational age (SGA), and admission to the neonatal intensive care unit (NICU). Bivariate associations between the primary exposure (ie, self-report of IPV vs no self-report of IPV) and each covariate of interest were assessed with weighted quasibinomial logistic regression. Weighted multivariable logistic regression was conducted to evaluate the association between IPV and delivery method controlling for confounders. A total of 130,000 women were included in this secondary analysis of a cross-sectional sample, representing 7,500,000 women nationwide based on PRAMS sampling design. Of these, 0.8% reported abuse in the 12 months before their current pregnancy and 1.3% reported abuse during pregnancy; 1.6% of the study population reported abuse both before and during pregnancy. After adjusting for maternal sociodemographic characteristics, IPV exposure at any time was not significantly associated with cesarean delivery, compared with no IPV exposure (odds ratio [OR] 0.98, 95% CI 0.86-1.11). Of secondary outcomes, 9.4% of women experienced preterm birth and 15.1% had neonates admitted to the NICU. Exposure to IPV was associated with a 21.0% increased risk of preterm birth, compared with women without exposure (OR 1.21, 95% CI 1.05-1.40), and a 33.3% increased risk of NICU admission (OR 1.33, 95% CI 1.17-1.52) after controlling for confounders. There was no difference in the risk of delivering a neonate who was SGA. Intimate partner violence was not associated with an increased risk of cesarean delivery. Intimate partner violence before or during pregnancy was associated with increased risk of adverse obstetric outcomes, such as preterm birth and NICU admission, corroborating previous research findings.

The Therapeutic Potential of Multipotent Mesenchymal Stromal Cell-Derived Extracellular Vesicles in Endometrial Regeneration.

Disruption of endometrial regeneration, fibrosis formation, and intrauterine adhesions underlie the development of "thin" endometrium and/or Asherman's syndrome (AS) and are a common cause of infertility and a high risk for adverse obstetric outcomes. The methods used (surgical adhesiolysis, anti-adhesive agents, and hormonal therapy) do not allow restoration of the regenerative properties of the endometrium. The experience gained today with cell therapy using multipotent mesenchymal stromal cells (MMSCs) proves their high regenerative and proliferative properties in tissue damage. Their contribution to regenerative processes is still poorly understood. One of these mechanisms is based on the paracrine effects of MMSCs associated with the stimulation of cells of the microenvironment by secreting extracellular vesicles (EVs) into the extracellular space. EVs, whose source is MMSCs, are able to stimulate progenitor cells and stem cells in damaged tissues and exert cytoprotective, antiapoptotic, and angiogenic effects. This review described the regulatory mechanisms of endometrial regeneration, pathological conditions associated with a decrease in endometrial regeneration, and it presented the available data from studies on the effect of MMSCs and their EVs on endometrial repair processes, and the involvement of EVs in human reproductive processes at the level of implantation and embryogenesis.

Risk of adverse obstetric outcomes in patients with a history of endometrial cancer: A nationwide population-based cohort study.

To evaluate adverse obstetric outcomes in women with a history of endometrial cancer (EC). Population-based cohort study. The Korean National Health Insurance (KNHI) claims database. Women who gave birth between 2009 and 2016, with a history of EC prior to pregnancy. The KNHI database was used to compare obstetric outcomes of women with and without a history of EC, using the ICD-10 codes. Multivariable logistic regression models were used to determine the associations between a history of EC and adverse obstetric outcomes. Adverse obstetric outcomes. Overall, 248 and 3 335 359 women with and without a history of EC, respectively, gave birth. When adjusted for age, primiparity and comorbidities, an increased risk of multiple gestations (odds ratio [OR] 4.925, 95% confidence interval [CI] 3.394-7.147), caesarean delivery (OR 2.005, 95% CI 1.535-2.62) and preterm birth (OR 1.941, 95% CI 1.107-3.404) was observed among women with a history of EC. We were unable to demonstrate significant differences in the risk of pre-eclampsia, gestational diabetes, vacuum delivery, placenta praevia, placenta accreta spectrum, placental abruption and postpartum haemorrhage between the groups. In the sensitivity analyses excluding multiple gestations, an increased risk of preterm birth was not observed among women with a history of EC (OR 1.276, 95% CI 0.565-2.881). There is no convincing evidence of an increased risk of adverse obstetric outcomes among women with a history of EC. Our findings would be useful in counselling of patients with EC who are undergoing fertility-sparing treatment.

Obstetrical complications in hereditary fibrinogen disorders: the Fibrinogest study

BackgroundWomen with hereditary fibrinogen disorders (HFDs) seem to be at an increased risk of adverse obstetrical outcomes, but epidemiologic data are limited. ObjectivesWe aimed to determine the prevalence of pregnancy complications; the modalities and management of delivery; and the postpartum events in women with hypofibrinogenemia, dysfibrinogenemia, and hypodysfibrinogenemia. MethodsWe conducted a retrospective and prospective multicentric international study. ResultsA total of 425 pregnancies were investigated from 159 women (49, 95, and 15 cases of hypofibrinogenemia, dysfibrinogenemia, and hypodysfibrinogenemia, respectively). Overall, only 55 (12.9%) pregnancies resulted in an early miscarriage, 3 (0.7%) resulted in a late miscarriage, and 4 (0.9%) resulted in an intrauterine fetal death. The prevalence of live birth was similar among the types of HFDs (P = .31). Obstetrical complications were observed in 54 (17.3%) live birth pregnancies, including vaginal bleeding (14, 4.4%), retroplacental hematoma (13, 4.1%), and thrombosis (4, 1.3%). Most deliveries were spontaneous (218, 74.1%) with a vaginal noninstrumental delivery (195, 63.3%). A neuraxial anesthesia was performed in 116 (40.4%) pregnancies, whereas general or no anesthesia was performed in 71 (16.6%) and 129 (44.9%) pregnancies, respectively. A fibrinogen infusion was administered in 28 (8.9%) deliveries. Postpartum hemorrhages were observed in 62 (19.9%) pregnancies. Postpartum venous thrombotic events occurred in 5 (1.6%) pregnancies. Women with hypofibrinogenemia were at an increased risk of bleeding during the pregnancy (P = .04). ConclusionCompared with European epidemiologic data, we did not observe a greater frequency of miscarriage, while retroplacental hematoma, postpartum hemorrhage, and thrombosis were more frequent. Delivery was often performed without locoregional anesthesia. Our findings highlight the urgent need for guidance on the management of pregnancy in HFDs.

Comparison of Obstetric Outcomes Between Unassisted Pregnancies and Non-IVF Fertility Treatment Pregnancies in Infertile Patients [ID: 1365555

INTRODUCTION: Prior studies suggest that pregnancies conceived with non-IVF fertility treatment (NIFT) have an increased risk of adverse obstetric outcomes compared to unassisted pregnancies. However, recent population-based studies suggest that infertility independently contributes to elevated perinatal risks. It is unclear whether underlying infertility or NIFT itself contributes to obstetric risks. To understand the effects of NIFT on pregnancy, we compare obstetric outcomes between NIFT and unassisted pregnancies in infertile patients. METHODS: The Developmental Epidemiological Study of Children Born Through Reproductive Technology (DESCRT) recruited an IRB-approved prospective cohort of women with infertility who delivered between 2018 and 2022 (funded under R01-HD084380). We compared maternal serum analyte levels and obstetric outcomes between infertile patients who conceived spontaneously and those who utilized NIFT (ovulation induction, superovulation, and/or intrauterine insemination). Serum analytes were compared using the Mann-Whitney test. Obstetric outcomes regarding placental insufficiency were reviewed by two ob-gyns and compared using χ2 tests. RESULTS: We analyzed 101 unassisted pregnancies and 141 NIFT pregnancies. There were no significant differences in mean maternal age (36.6 and 35.6, P=.08). There were no significant differences in maternal serum analytes or in adverse obstetric outcomes, including hypertensive disorders of pregnancy (P=.35), fetal growth restriction (P=.12), abnormal placentation (P=.79), spontaneous preterm birth (P=.97), and gestational diabetes (P=.30). CONCLUSION: Among infertile patients, there were no significant differences in maternal serum analytes or adverse obstetric outcomes between unassisted and NIFT pregnancies. This suggests that the previously demonstrated risk of adverse pregnancy outcomes associated with NIFT could be attributed to underlying infertility rather than the utilization of NIFT.

Risk Factors for Discharge Against Medical Advice at Antepartum Hospitalizations [ID: 1373372

INTRODUCTION: Antepartum obstetrical admissions are often unplanned. Despite counseling, some patients may choose to be discharged against medical advice (DAMA). This study examined patterns of DAMA at antepartum hospitalizations and associated patient characteristics. METHODS: Using 2019 National Inpatient Sample (NIS) data, we identified pregnant patients aged 12–50 years with antepartum admissions. The primary outcome was DAMA determined based on patients' discharge disposition status. Patients' sociodemographic and clinical characteristics were measured based on hospital discharge records and diagnosis/procedure codes. Characteristics of DAMA and non-DAMA patients were compared using chi-square tests and multivariable logistic regression, while accounting for NIS complex sample design to generate nationally representative estimates. RESULTS: Among 214,935 patients in the sample, 8,495 (4.0%) were DAMA. The risk of DAMA was significantly higher among Black than White patients (5.4% versus 3.8%, P&lt;.001, adjusted odds ratio [OR] 1.25, 95% CI 1.09–1.43), Medicaid than privately insured patients (5.4% versus 1.7%, P&lt;.001, adjusted OR 2.49, 95% CI 2.12–2.93), and patients with (versus without) obstetrical/comorbid conditions, such as substance use disorders (11.3% versus 2.7%, P&lt;.001, adjusted OR 3.30, 95% CI 2.76–3.96), prior preterm birth (8.1% versus 3.9%, P&lt;.001, adjusted OR 2.04, CI 1.44–2.89), hypertensive disorders of pregnancy (5.4% versus 3.8%, P&lt;.001, adjusted OR 1.70, 95% CI 1.43–2.03), and chronic hypertension (6.2% versus 3.8%, P&lt;.001, adjusted OR 1.51, 95% CI 1.28–1.79). CONCLUSION: Patients who are DAMA in the antepartum period have certain sociodemographic and clinical characteristics that may place them at higher risk of adverse obstetrical outcomes. Risk-stratified, targeted patient support during admission may be beneficial.

Migrant mothers' experiences of Caesarean section: a transcultural qualitative study.

Migrant women face an increased risk of adverse obstetrical outcome and Caesarean section. The psychological experience of Caesarean section combines physiological, social, and cultural dimensions. This qualitative study explores the subjective experiences of first-generation migrant women who gave birth by Caesarean section. Seven qualitative, semi-directed interviews were conducted from January to March 2022 in a Paris maternity hospital, with women in their postpartum period who had had a scheduled or emergency Caesarean section and straightforward obstetrical outcomes. The presence of an interpreter-mediator was systematically offered. Thematic analysis of the interviews was carried out following the Interpretative Phenomenological Analysis (IPA) methodology. Four themes were identified in the thematic analysis relating to the women's experiences of Caesarean section: (1) The shock of the intervention combines disappointment, fear and early separation from the baby, (2) Pregnancy and delivery far from one's family aggravates the psychological suffering caused by isolation and loneliness related to migration, (3) The lack of cultural representations of Caesarean section leads to negative preconceptions and hinders mental preparation, in contrast with traditional or medicalised childbirth, and (4) The women's experiences of the medical follow-up highlights the importance of the continuity of care. Caesarean section, which is a physical break, re-enacts the symbolic break (cultural, social, familial) that follows on from emigration. Improvements in care include the need for a better preparation for Caesarean section, active efforts for care continuity, and the development of early prevention interviews and groups in maternity units.