Risk Of Intrauterine Growth Retardation Research Articles

Energy Dense Feeding in Premature Infants and Its’ Associated Outcomes

COVID-19 infection in pregnant mothers is associated with higher risk of intrauterine growth retardation and premature births. Very low birth weight infants are more susceptible to neurodevelopmental and chronic respiratory problems. An infant delivered at 33 weeks via caesarean section to a COVID-19 Stage 5A positive mother, weighing 1.43kg at birth. She was kept nil by mouth with parenteral nutrition (PN) support since day five of life until referred to dietitian on day 22 of life for enteral nutrition (EN) establishment. Feeding was administered intermittently via oro-gastric Ryle’s Tube. She was kept under non-invasive ventilation (NIV) mode and had difficulty in weaning from ventilation, leading to slow feeding progress. Initially, enteral trophic feeding was administered using premature infant formula fortified with modular products. In the later stage of feeding, modular products were tapered off and the formula was concentrated. Frequency of bowel output when using fortified formula is lesser compared to when using concentrated and supplemented formula. There is no significant difference in renal profile observed in both stages of feeding. Increasing energy intake using easily digestible sources is preferable as opposed to concentrating feeds even further due to concerns about osmolality and excess administration of other solutes. Intermittent bolus feeding mode may have an effect on dependency on oxygen since intermittent feeds can decrease tidal volume, minute ventilation and dynamic compliance. Additional research is necessary to establish optimal caloric density and nutritional compositions of feedings, feeding mechanisms and its’ effect on feeding tolerance.

A prospective interventional study to observe the effectiveness of parenteral iron infusion of iron isomaltoside 1000 (Fur – IV) in obstetrics and gynecology patients suffering from moderate to severe iron deficiency anaemia

Anaemia during pregnancy is allied with maternal and foetal complications like increased risk of intrauterine growth retardation, prematurity, low birth weight, and maternal and infant mortality. The agent iron isomaltose 1000 (Fur-IV) combines iron and isomaltose 1000 for slow, controlled release to reduce the risk of free iron toxicity and provide flexibility and convenience for high dose administration. Iron isomaltoside has been shown to be effective in the treatment of IDA in many treatment groups compared to intravenous iron sucrose and FCM. : It is a prospective interventional study which is conducted to observe an increase in hemoglobin levels in obstetric and gynecological department patients suffering from IDA in whom oral iron preparation was ineffective or in case of clinical need to supply iron rapidly via single infusion of iron isomaltoside 1000. Each patient in the study received 500 mg single intravenous infusion. After this, patient was followed up and haemogram was repeated after 15 and 30 days of infusion while investigation for serum ferritin and serum iron was repeated after 30 days. Average Hb concentration in increased by 30.86% to 9.88 g/dL after 30 days of infusion. There is statistically significant difference between baseline values and post infusion 30 days values for serum ferritin and serum iron (p-value <0.0001 for both).IV iron isomaltoside administration was well tolerated in patients with gynecological IDA who were intolerant or unresponsive to oral iron therapy or who required rapid iron administration.

MATERNALAND FETAL OUTCOME IN TERM PREGNANCY IN OLIGOHYDRAMNIOS

Decrease in amniotic uid volume or Oligohydramnios has been correlated with increased risk of intrauterine growth retardation, meconium aspiration syndrome, severe birth asphyxia, low APGAR scores and congenital abnormities. Early detection of oligohydramnios and its management may help in reduction of perinatal morbidity and mortality one side and decreased caesarean deliveries on the other side. Aim of was present study was to study maternal and fetal outcome in term pregnancy in oligohydramnios in tertiary care center. A prospective observational Study was conducted on 100 patients with oligohydramnios with AFI <= 5cm at Tertiary Care Center, studied between 2019-2021 to observe outcome of labour in form of perinatal morbidity and maternal outcome in form of induction and deliveries. It was observed that AFI measurement of less than 5 cm detected after 37 completed weeks of gestation with a low-risk pregnancy is found to be an indicator of adverse pregnancy outcome with higher cesarean section rate.

Value of noninvasive prenatal testing in the detection of rare fetal autosomal abnormalities

ObjectivesTo evaluate the value of noninvasive prenatal testing (NIPT) in the screening of rare autosomal abnormalities and provide further support for the clinical application of NIPT. Study designA total of 81,518 pregnant women who underwent NIPT at the Anhui Maternal and Child Health Hospital between May 2018 and March 2022 were selected. The high-risk samples were analyzed using amniotic fluid karyotype and chromosome microarray analysis (CMA), and the pregnancy outcomes were followed up. ResultsNIPT detected 292 cases (0.36%) with rare autosomal abnormalities among the 81,518 cases sampled. Of these, 140 (0.17%) showed rare autosomal trisomies (RATs), and 102 of these patients agreed to undergo invasive testing. Five cases were true positives, with a positive predictive value (PPV) of 4.90%. Copy number variants (CNV) were detected in 152 samples of the total cases (0.19%), and 95 of the patients involved agreed to the use of CMA. Twenty-nine of these cases were confirmed to be true positive, with a PPV of 30.53%. Detailed follow-up information was obtained in 81 cases from 97 patients with false-positive results for RATs. Thirty-seven of these cases (45.68%) had adverse perinatal outcomes, with a higher incidence of small for gestational age (SGA), intrauterine growth retardation (IUGR), and preterm birth (PTB). ConclusionsNIPT is not recommended for screening for RATs. However, considering that positive results are associated with an increased risk of IUGR and PTB, additional fetal ultrasound examination should be performed to monitor fetal growth. In addition, NIPT has a reference value in screening for CNVs, especially pathogenic CNVs, but a comprehensive analysis of prenatal diagnosis combined with ultrasound and family history is still needed.

Pregnancy Outcomes Associated With Biologic Agent Exposure in Patients With Several Rheumatic Diseases and Inflammatory Bowel Diseases.

This study aimed to analyze pregnancy outcomes based on biologic agents use in women using the nationwide population-based database. The study used the claims database to identify women of childbearing age with several rheumatic (rheumatoid arthritis, juvenile idiopathic arthritis, ankylosing spondylitis, psoriatic arthritis) and inflammatory bowel diseases (Crohn's disease and ulcerative colitis) who had pregnancy-related codes between January 2010 and December 2019. We analyzed live births and adverse pregnancy outcomes based on the previous use of biologics. We also stratified the patients according to duration of biologic agent exposure before pregnancy and the use of biologics during pregnancy to analyze the pregnancy outcomes by subgroups. We identified 4,787 patients with pregnancy events. Among them, 1,034 (21.6%) used biologics before pregnancy. Live birth rate was not different between the biologics group and biologics naïve group (75.0% vs. 75.2%). Multivariate analyses showed that biologics use was associated with higher risk of intrauterine growth retardation (odds ratio [OR], 1.780) and lower risk of gestational diabetes mellitus (OR, 0.776) compared with biologics naïve. Biologics use during pregnancy was associated with higher risk of preterm delivery (OR, 1.859), preeclampsia/eclampsia (OR, 1.762), intrauterine growth retardation (OR, 3.487), and cesarean section (OR, 1.831), but lower risk of fetal loss (OR, 0.274) compared with biologics naïve. Although there was no difference in live birth rate between the biologics group and biologics naïve group, biologics use seems to be associated with several adverse pregnancy outcomes, especially in patients with biologics during pregnancy. Therefore, patients with biologics during pregnancy need to be carefully observed for adverse pregnancy outcomes.

Association of maternal dietary patterns with child birth weight and size in India: Evidence from National Family Health Survey, 2005 to 2016

Background: Maternal dietary diversity during pregnancy is a major determinant of birth weight and birth size of infant. During pregnancy, mother diet is highly dependent on their topographical, cultural, and sociodemographic circumstances. Objective: The objective of the study was to assess the association between the maternal dietary intake with child birth weight and birth size along with the sociodemographic factors in India. Materials and Methods: The data for this study were drawn from the National Family Health Survey (NFHS), 2005 to 2006 and 2015 to 2016 held in India. Inferential statistical analysis Chi-square was built to test was used to examine the association between maternal dietary patterns, and logistic regression model was used to analyze the effect of mother’s dietary patterns on child birth weight and size by controlling the sociodemographic factors. Results: Mother’s daily intake of fish, meat, green leafy vegetables, and fruits was associated with higher birth weight or size and lower risk of intrauterine growth retardation. Women with ?2 dietary diversity categories had significantly higher proportion of low birth weight (LBW) and size of babies comparatively to those in the ?2 dietary diversity categories, there were lesser chance of LBW and small size of babies with women’s dietary diversity 3 (odds ranges from 1.09 to 1.44) or ?4 (odds ranges from 1.15 to 1.59). Furthermore, low birth order, mother’s underweight status, low maternal education, and wealth status significantly have positive association with the poor birth outcomes. Conclusion: The birth weight and size of newborns were found positively associated with the mother’s dietary intake. To meet the aim of maternal dietary diversity and to achieve the double bonus, the government should focus more on supplementation and food security programs during pregnancy that also include nutritional education as well as behavioral and social change interventions strategies.

The femur too short? 1373 fetuses with short femur during second-trimester screening

PurposeA short fetal femur in prenatal diagnosis might be an indicator for intrauterine growth retardation (IUGR), a genetically determined small child (SGA) with or without associated fetal malformations and/or an adverse fetal outcome.Methods1373 singleton pregnancies with a femoral length < 5th percentile detected between 1999 and 2015 during second-trimester screening in a tertiary prenatal diagnostic center were subjected to a descriptive retrospective analysis with regard to fetal characteristics as well as pregnancy outcome.Results685 (49.9%) fetuses presented an isolated short femur, while 688 (50.1%) showed additional abnormalities. 293 (42.6%) of those were SGA babies without any malformation, while 395 (57.4%) had one or more severe anomaly of the following organ systems: 157 (11.5%) cardiovascular, 101 (7.4%) musculoskeletal, 82 (6.0%) urogenital, 72 (5.2%) cerebrocephalic, 50 (3.6%) gastrointestinal, and 5 (0.4%) thoracic. 75 (5.5%) of the fetuses showed chromosomal aberrations of which Trisomy 13, 18 and 21 were found in 2, 13 and 27 of the cases, respectively. Fetuses with associated malformations had a significantly lower live birth rate than those without (64.2% vs. 98.1%, p < 0.001); in addition, a higher rate of preterm births 36.6% vs. 11.3%, p < 0.001) and SGA babies (51.4% vs. 30.4%, p < 0.001) were observed in the first collective.ConclusionDiagnosis of a short fetal femur should lead to an extended organ screening; in the case of associated abnormalities, additional genetic testing has to be offered, as well as intensified pregnancy monitoring in pregnancies at risk for IUGR and/or preterm birth.

Вплив екзогенних факторів на геномний імпринтинг. 2. Вплив шкідливих звичок батьків на геномний імпринтинг нащадків

У статті наведені наукові дані, які свідчать про те, що зловживання алкоголем 3і тютюнопаління батьків несприятливо впливають на розвиток плода і стан здоров’я дитини. Дані фактори порушують процеси метилювання ДНК імпринтованих генів, обумовлюючи збільшення ризику затримки внутрішньоутробного розвитку та виникнення патологічних відхилень у нейрогенезі плода.

Impact of preimplantation genetic testing on obstetric and neonatal outcomes: a systematic review and meta-analysis

To investigate whether preimplantation genetic testing (PGT) increases the risk of adverse obstetric and neonatal outcomes. Systematic review and meta-analysis. Not applicable. Pregnancies achieved after PGT or invitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). Systematic search of databases until December 2020 with cross-checking of references from relevant articles in English. Obstetric and neonatal outcomes after PGT and IVF/ICSI, including mean birth weight, low birth weight, very low birth weight (VLBW), mean gestational age at birth, preterm birth, very preterm birth, birth defects, intrauterine growth retardation (IUGR), sex ratio, cesarean section, hypertensive disorders of pregnancy, gestational diabetes mellitus, placenta disorder (placenta previa, placenta abruption, placenta accreta), and preterm premature rupture of membranes. Ultimately, a total of 785,445 participants were enrolled in this meta-analysis, and these participants were divided into a PGT group (n = 54,294) and an IVF/ICSI group (n = 731,151). The PGT pregnancies had lower rates of low birth weight (risk ratio [RR] 0.85, 95% confidence interval [CI] 0.75 to 0.98), VLBW (RR 0.52, 95% CI 0.33 to 0.81), and very preterm births (RR 0.55, 95% CI 0.42 to 0.70) than those of IVF/ICSI pregnancies. However, the PGT group had a higher rate of the obstetric outcome of hypertensive disorders of pregnancy (RR 1.30, 95% CI 1.08 to 1.57). The PGT did not increase the risk of other adverse obstetric and neonatal outcomes, such as those associated with mean birth weight, mean gestational age at birth, birth defects, IUGR, sex ratio, cesarean section, gestational diabetes mellitus, placental disorder (placenta previa, placenta abruption, placenta accreta), or preterm premature rupture of membranes. We performed subgroup analysis with only blastocyst biopsies and found that PGT with blastocyst biopsies was associated with a lower rate of VLBW (RR 0.55, 95% CI 0.31 to 0.95). The PGT with blastocyst biopsies did not increase the risk of other adverse obstetric and neonatal outcomes. Additionally, we performed subgroup analysis with only frozen-thawed embryo transfer cycles, and we found that PGT pregnancies were associated with a lower rate of VLBW (RR 0.55, 95% CI 0.31 to 0.97), a lower rate of cesarean birth (RR 0.90, 95% CI 0.82 to 0.99), a higher rate of preterm birth (RR 1.10, 95% CI 1.02 to 1.18), and a higher rate of IUGR (RR 1.21, 95% CI 1.06 to 1.38) than those of IVF/ICSI pregnancies. The PGT with frozen-thawed embryo transfer did not increase the risk of other adverse obstetric and neonatal outcomes. The pooled analysis suggested that PGT did not increase the risk of adverse obstetric outcomes. The association between PGT and a higher risk of IUGR requires further investigation.

The Danish HIV Birth Cohort (DHBC) - a nationwide, prospective cohort

PurposeThe purpose of the Danish HIV Birth Cohort (DHBC) is to investigate the significance of HIV-1 infection in pregnancy and after delivery in women living with HIV (WLWH) in Denmark...

Intrauterine growth retardation after laparoscopic Roux-en-Y gastric bypass — clinical presentation and literature review

Bariatric surgery is associated with a higher risk of intrauterine growth retardation (IUGR) and small for gestational age neonates. We present two examples of IUGR after laparoscopic Roux-en-Y gastric bypass, both associated with excessive restriction in patients caloric intake, one due to obstetrician's indications and the other resulting from patient's anxiety of weight gain in pregnancy. IUGR was observed accordingly in the 35th and 28th week of pregnancy. The first patient had an urgent cesarean section due to pathological cardiotocography tracings in the 35th week of pregnancy, with the newborn's weight of 1690 g (< 1st percentile). The second patient, admitted in the 28th week with suspected IUGR, had an elective cesarean section in the 36th week, with the newborn's weight of 2095 g (5th percentile). Although malabsorptive mechanisms are known to be involved in the impaired fetal growth after bariatric surgery, patients' and obstetricians' adherence to nutrition and supplementation regimen are of utmost importance. The problem of optimum daily caloric intake, vitamin and micronutrients supplementation in pregnancies after bariatric surgery is presently discussed in the literature. Optimum care and advice for bariatric patients have to be diversified as malabsorptive and restrictive operations lead to changes in metabolism, nutrition and hormonal balance.

State of the dentoalveolar system in children from mothers with gestational hypertension

&#x0D; Development of diagnostic and practical criteria for arterial hypertension and complications in children from mothers with gestational hypertension against the background of the use of calcium channel inhibitors.&#x0D; In 2018, new European recommendations on cardiovascular diseases during pregnancy and European recommendations on arterial hypertension were published, which have special sections on hypertension in pregnant women. The recommendations draw attention to the fact that hypertensive disorders during pregnancy are the most common medical complications affecting 5-10% of pregnancies worldwide, and remain the main cause of maternal, fetal and neonatal morbidity and mortality. The fetus is at high risk of intrauterine growth retardation (25% of cases in preeclampsia (PE), prematurity (27% of cases in PE), and intrauterine death (4% of cases in PE). Women with a high or moderate risk of developing PE are recommended to take 100-150 mg of acetylsalicylic acid daily between 12 and 36-37 weeks of pregnancy (recommendation class 1, evidence level A). In addition, to prevent PE in women with low calcium intake (&lt;600 mg/day), it is recommended to introduce calcium into the diet (1.5-2 g/day, orally), which should begin after the first visit to the women's consultation. The recommendations specifically draw attention to the fact that vitamins C and E do not reduce the risk of PE.

Impact of maternal underweight on obstetric and neonatal prognosis: A retrospective study

IntroductionMaternal underweight (BMI < 18.5) is an uncommon situation with potentially serious obstetric consequences, though data in the literature are scarce. ObjectiveTo compare the obstetrical prognosis of patients with normal BMI and BMI < 18.5. Study designWe performed a retrospective study in France (Normandy). ResultsWe included 14,246 patients between January 2011 and November 2017, among whom 12,648 (88.8 %) had normal BMI, 1269 were considered mild underweight (17 ≤ BMI < 18.5 kg/m²) and 329 (2.3 %) were considered severe to moderate underweight (BMI < 17 kg/m²). The risk of preterm birth was all the greater as the thinness was severe (ORa: 1.34 [1.12−1.60] and ORa 1.77 [1.31−2.34]) and the risk of intrauterine growth retardation also increased with severe thinness (ORa: 1.63 [1.35−1.96] and ORa 2.28 [1.69−3.07]). The risk of a caesarean section or scheduled labour was no different. Neonatal parameters were comparable between the groups. ConclusionOur study confirms an increased risk of preterm delivery and intrauterine growth retardation with increased thinness after adjusting for confounding factors. This link had only been shown previously in 2 studies Neither the type of prematurity (induced or spontaneous) nor the severity of prematurity is influenced by the severity of thinness; however, the low prevalence of thinness limits the power of these data. It would be interesting to study the medico-economic relevance of a policy of close maternal-foetal surveillance in this target population.

Oligohydramnios and fetal outcome in term pregnancy

Background and objective: Oligohydramnios is defined as an amniotic fluid index less than 5th centile for gestation. It presents a threat to the fetus and has been correlated with increased risk of intrauterine growth retardation, meconium aspiration syndrome, severe birth asphyxia, low APGAR scores, and congenital abnormalities. It is associated with perinatal morbidity and mortality and maternal morbidity in a significant number of cases. Therefore, early detection of oligohydramnios and its management is important. This study aimed to determine the perinatal and maternal outcomes in oligohydramnios. Methods: This retrospective cohort study was carried out at the Maternity Teaching Hospital in Erbil from March 2018 to March 2019. A total of 300 patients were recruited, including 150 pregnant women with oligohydramnios and 150 with normal amniotic fluid index. Results: There was a significant difference between the oligohydramnios group and the comparison group in relation to parity and gestational age. Oligohydramnios was more among primigravids. The rate of cesarean section was higher in oligohydramnios group compared to the comparison group. Intrauterine growth retardation among oligohydramnios group was 13%. Oligohydramnios was associated with birth weight &lt;2500 gm (21.3%). Conclusion: Antepartum diagnosis of severe oligohydramnios at term was associated with an increased cesarean section rate, a higher rate of admission of neonatal care unit, and low birth weight. Therefore, antepartum oligohydramnios is associated with increased perinatal morbidity and mortality. Keywords: Amniotic fluid index; Maternal outcome; Fetal outcome; Oligohydramnios.

Relationship of Vitamin D Serum Level With Intrauterine Growth Retardation in Pregnant Women

Objectives: Intrauterine growth retardation (IUGR) is a major problem in midwifery medicine for which no effective treatment has been established. This problem has been associated with significant morbidity and mortality, as well as perinatal mortality. IUGR could be prevented when the treatment is administered before the occurance of irreversible changes. Hence appropriate methods for early detection and successful treatment deem necessary. The purpose of this study was to investigate the relationship of vitamin D serum level with IUGR in pregnant women. Materials and Methods: This nested case-control study was conducted on pregnant women who had referred to Fatemieh hospital during 2016. Each of case and control groups included 130 pregnant women. Serum levels of vitamin D were tested in the blood samples obtained from the participants. At the end of the study, all data were analyzed in SPSS software version 16, and χ2 , Fisher exact and t tests were utilized for data analyses. Level of 0.05 was considered statistically significant. Results: Our results showed that the average age, body mass index at the beginning of the pregnancy, blood group, employment status, and education level were not significantly different between the two groups. Moreover, average serum levels of vitamin D were about 14.74 ng/L and 25.34 ng/L in the case and control groups, respectively. In those with vitamin D deficiency, the chance of IUGR was higher compared to those who had sufficient levels of vitamin D (6.27 times). Therefore, women who had vitamin D deficiency, had almost 6 times more chance of IUGR incidence compared to the women with adequate levels of vitamin D (P&lt;0.05). Conclusions: The results verified that serum levels of vitamin D can affect the risk of IUGR; therefore, the incidence of IUGR in babies whose mothers have enough vitamin D level during pregnancy is lower than that in other babies.

Pregnancy and lupus nephritis in developing countries: A systematic review

Systemic lupus erythematosus (SLE) and lupus nephritis (LN) have a significant impact on the course of pregnancy, as well as on maternal and fetal outcomes. LN in pregnancy can increase the maternal risks of SLE flare, acute kidney injury, preeclampsia, and even death. It also affects fetal outcomes by the increased risk of intrauterine growth retardation, premature delivery, and fetal loss. Successful pregnancy outcomes have been well documented in the developed world, but less is known about patients in developing nations. We searched PubMed and Google scholar for all articles published from 1999 to 2016 in developing countries. Twelve of 13 studies were included excluding only one. All studies were independently reviewed. Most of the studies reported a significant association between high flare rates of LN and higher rates of disease flare. Higher rates of active disease at conception were associated with lower live birth rates. Similarly, high flare rates of LN were associated with higher rates of fetal loss. With regard to geographic trends, Indian studies reported lower overall live birth rates and higher rates of active disease at conception. Interestingly, lower rates of preeclampsia were also noted in Indian studies. Higher rates of flare were observed in other Asian studies, but not the Indian studies. Although LN and active SLE at conception are associated with poor fetal outcomes, better outcomes are possible with proper management, even in low-resource settings. More research is necessary to fully understand the relationships between active disease at conception or LN and flare rates, live birth rates, and fetal loss rates in developing countries.

Risk factors during pregnancy and birth-related complications in HIV-positive versus HIV-negative women in Denmark, 2002-2014.

We aimed to compare risk factors for adverse pregnancy outcomes in women living with HIV (WLWH) with those in women of the general population (WGP) in Denmark. Further, we estimated risk of pregnancy- or birth-related complications. A retrospective cohort study including all WLWH who delivered a live-born child from 2002 to 2014 and WGP, matched by origin, age, year and parity, was carried out. We compared risk factors during pregnancy and estimated risk of pregnancy- and birth-related complications using multivariate logistic regression. A total of 2334 pregnancies in 304 WLWH and 1945 WGP were included in the study. WLWH had more risk factors present than WGP during pregnancy: previous caesarean section (CS) (24.7% versus 16.3%, respectively; P=0.0001), smoking (14.2% versus 7.5%, respectively; P=0.0001) and previous perinatal/neonatal death (2.3% versus 0.9%, respectively; P=0.03). We found no difference between groups regarding gestational diabetes, hypertensive disorders, low birth weights or premature delivery. More children of WLWH had intrauterine growth retardation (IUGR) [adjusted odds ratio (aOR) 1.9; 95% confidence interval (CI) 1.1-3.2; P=0.02]. Median gestational age and birth weight were lower in children born to WLWH. WLWH had a higher risk of emergency CS (EmCS) (aOR 1.6; 95% CI 1.2-2.1; P=0.0005) and postpartum haemorrhage (aOR 1.4; 95% CI 1.0-1.9; P=0.02) but not infection, amniotomy, failure to progress, low activity-pulse-grimace-appearance-respiration (APGAR) score or signs of asphyxia. WLWH had more risk factors present during pregnancy, similar risks of most pregnancy- and birth-related complications but a higher risk of postpartum haemorrhage and EmCS compared with WGP. Children born to WLWH had lower median birth weights and gestational ages and were at higher risk of IUGR.

Survival analysis of a cohort of extremely preterm infants born in Finland during 2005–2013

Objective This study aimed to analyze the mortality of extremely preterm infants (ELGA born alive before 28 weeks) until the postconceptional age of 42 weeks, death, or home discharge, whichever came first. It was focused especially on studying the relationship between antenatal risk factors, the time of death, and the postnatal morbidities associated with mortality. Study design The original data obtained from the nationwide Finnish medical birth register of extremely preterm and low birthweight infants born during 2005–2013 were analyzed. The total population consisted of 1353 ELGA infants after the exclusion of 18 infants born with lethal congenital anomalies or genetic defects. Mortality risks were adjusted according to the length of gestation, the administration of antenatal steroids, and the delivery hospital. Results During the first 48 hours, extreme immaturity was seen to be the prominent cause of death, and intrauterine growth did not influence mortality. The ELGA population surviving for at least 48 hours (N = 1135) was submitted for mortality risk analysis. After the adjustments, small-for-gestational-age (SGA) (birth weight below −2 SD) was found to be the factor with the highest risk for demise [OR 6.2; 95% CI (3.9–10.0) p < .001]. Multiple deliveries were associated with increased risk for death [OR 1.5; 95% CI (1.0–2.1), p = .048] to a lesser extent. The main neonatal morbidities associated with the risk of mortality after 48 postnatal hours of life were severe intraventricular hemorrhage (IVH) [OR 4.4; 95% CI (3.0–6.7), p < .001], respiratory distress syndrome (RDS) [OR 2.6; 95% CI (1.3–5.0), p = .006], and necrotizing enterocolitis (NEC) [OR 2.3; 95% CI (1.5–3.4), p < .001]. The major morbidities associated with deaths among non-SGA infants were severe IVH (32.1% of all deaths), NEC (19.1%), and sepsis (8.4%). In SGA infants, severe respiratory disease (RDS, severe bronchopulmonary dysplasia, pulmonary hemorrhage, or pulmonary hypertension) was the main cause of death (60.9% of all deaths). Medical or surgical PDA treatment was not found to be associated with increased risk of death [OR 0.4; 95% CI (0.2–0.5), p < .001] compared to infants who had survived for more than 2 days. Severe preeclampsia was found to be associated with 42% of all ELGA-SGA births. After the adjustments, ELGA infants from pregnancies complicated by preeclampsia of the mother exhibited a significantly lower risk of severe IVH [OR 0.3; 95% CI (0.2–0.5), p < .001] compared to the non-preeclamptic mothers’ infants. The low incidence of severe IVH was evident regardless of fetal growth in this patient group. Conclusions SGA infants with less than 28 gestational weeks, who had survived for at least 2 days, had excessively high mortality due to severe pulmonary disease. Intrauterine growth had no influence on the risk of death, other than pulmonary causes. The infants of preeclamptic mothers exhibited an increased risk of intrauterine growth retardation; however, despite this serious complication, these infants exhibited a significant decrease in the risk for severe IVH.

2. Pregnancy and myositis

2. Pregnancy and myositis

12. WHAT TO DO WHEN THERE IS NO EUPLOID EMBRYOS? TRANSFER MOSAIC EMBRYOS OR PROPOSE ANOTHER PGT-A CYCLE?

Introduction Embryonic mosaicism is defined as the presence of karyotypically distinct cell lines within an embryo and can be detected with Next Generation Sequencing (NGS) at a rate between 20-80%. High incidence of mosaicism has been reported in preimplantation embryos, with the blastocyst mosaicism being between 4-24% (Harton et al., 2017). Although mosaic embryos have a chance to implant (Munne et al., 2017; Spinella et al., 2018), their pregnancy rate is lower, with an increased miscarriage rate, possible risk of intrauterine growth retardation and uniparental disomy. Therefore, low-level mosaics are preferentially selected for transfer if no euploid embryos are found. Material and Methods This retrospective study was based on 1958 preimplantation genetic testing for aneuploidy (PGT-A) cycles initiated between January 2017 and December 2018 in Istanbul Memorial Hospital. At least one euploid embryo was found for 1066 cycles (54.4%) and in 892 PGT-A cycles either full aneuploid or euploid/ mosaic embryos were diagnosed. PGT-A was done by NGS ReproSeq on Ion Torrent S5 (Thermo Fisher Scientific) following trophectoderm biopsy. Among 168 cycles at least one mosaic embryo was found, and 37 mosaic embryo transfer cycles were achieved (mean female age: 36.0). 42 patients refused the transfer of mosaic embryos and went through another PGT-A cycle (mean female age: 37.1). Student's t-test and Mann-Whitney U test were applied for continuous variables and Chi-square test for categorical group comparisons. Results Among the 42 patients who have chosen to go for a second PGT-A cycle, 31 had at least one euploid embryo diagnosed (73.6%) and 28 couples came for a frozen-thawed embryo transfer cycle at the time the abstract was written. The mean mosaicism rate of the transferred embryos was 29% with a range of 20% to 40%. The biochemical pregnancy rate was 64.8% and 78.5% in the mosaic embryo transfer group and in the second PGT-A cycle group, respectively (p=0.23). The biochemical miscarriage rate was similar for both groups (16.7% vs. 13.6%, respectively). The clinical pregnancy rate was 54.1% and 67.9% for mosaic embryos and for the transfer of euploid embryos found in a second PGT-A cycle, respectively (p=0.26). The clinical miscarriage rate was 10% and 15.8% in the mosaic embryo transfer group and in the second PGT-A cycle group, respectively (p=0.71). The ongoing pregnancy rate was 48.6% and 57.1% for mosaics and second cycle's euploids, respectively (p=0.50). Conclusions As no statistically significant differences were found and considering the high rate of at least one euploid embryo in the second PGT-A cycle (73.6%), couples should be encouraged to start a new PGT-A cycle. For advanced maternal age patients (≥42) and/ or patients with a diminished ovarian reserve a second PGT-A cycle may not be a realistic option, thus mosaic embryo transfers may still be feasible. The limitations of our study include the fact that this was a retrospective analysis. Cohort sizes are undeniably small which prevents us to obtain statistically significant results and draw strong conclusions. Prospective studies are warranted.