Risk Of Miscarriage Research Articles

Characteristics of the pregnancy and labour course in women who underwent COVID-19 during pregnancy.

This study aims to analyze the impact of COVID-19 on pregnancy and labor, focusing on its effects on maternal and child health. The research explores the relationships between coronavirus infection and clinical and laboratory parameters, as well as the risks of pregnancy complications and adverse birth outcomes. The study involved 60 pregnant women diagnosed with COVID-19. A comprehensive evaluation of clinical and laboratory indicators was conducted, employing correlation, regression, logistic analyses to determine risk factors. There was a strong inverse correlation between carbon dioxide levels and haematocrit (-0.76), and a direct correlation between blood pH and partial pressure of oxygen (0.73). COVID-19 was associated with increased risks of preterm labor (OR=1.82), stillbirth (OR=2.11), pre-eclampsia (OR=1.46), and foetal distress. Multivariate analysis revealed a 200 g reduction in neonatal birth weight and higher risks of hospitalisation (OR=1.8), postpartum hemorrhage (OR=2.3), and preterm delivery (OR=2.5). Comorbid conditions such as cardiovascular abnormalities, diabetes, obesity, thrombophilias exacerbated the risks of complications, including pre-eclampsia, neonatal respiratory distress syndrome, venous thromboembolism. COVID-19 infection increases the likelihood of pregnancy complications and adverse outcomes, especially in women with comorbidities. These findings highlight the need for preventive strategies and risk management protocols for pregnant women during future outbreaks, emphasizing the importance of further research in this field.

Genetic Causal Association Between 15 Micronutrients and 12 Obstetric-Related Diseases: A Mendelian Randomization Study.

Micronutrients, namely vitamins and minerals, are associated with pregnancy outcomes. However, the effects reported in previous observational studies and randomized controlled trials have been inconsistent. Using publicly available genetic data, we conducted a two-sample MR analysis to estimate the causal association between 15 micronutrient levels and 12 obstetric-related diseases. Sensitivity analysis was performed to assess the robustness of the results, detect heterogeneity, and examine the potential existence of horizontal pleiotropy. Iron was protective against gestational diabetes mellitus (GDM) (OR = 0.597, 95% CI 0.438-0.814, P = 0.001), while zinc increased the risk of pregnancy hypertension (OR = 1.064, 95% CI 1.004-1.128, P = 0.035). Vitamin B6 was associated with increased risk of spontaneous abortion (OR = 1.222, 95% CI 1.001-1.490, P = 0.047), and vitamin D was linked to poor fetal growth (OR = 1.612, 95% CI 1.018-2.552, P = 0.041). Conversely, vitamin B12 showed protective effects against preterm birth (OR = 0.686, 95% CI 0.482-0.976, P = 0.036). Selenium and vitamin E were protective against polyhydramnios (OR = 0.828, 95% CI 0.698-0.981, P = 0.030; OR = 0.441, 95% CI 0.213-0.910, P = 0.026), whereas selenium increased the risk of premature rupture of membranes (OR = 1.083, 95% CI 1.007-1.164, P = 0.030).However, no causal links were found between the other micronutrients analyzed and obstetric-related diseases. Sensitivity analyses revealed no significant heterogeneity or pleiotropy. Our research has clarified the causal link between micronutrients and obstetric-related diseases, assisting clinicians in offering personalized guidance on the appropriate intake of micronutrients for women preparing for pregnancy and those who are pregnant. These findings are essential for screening and preventing pregnancy complications, and they also provide new insights and evidence for improving pregnancy outcomes through nutritional interventions.

Impact of Human Papillomavirus (HPV) on Male and Female Fertility

Human papillomaviruses (HPVs) are responsible for the majority of sexually transmitted infections (STIs), some of which are oncogenic and can cause oropharyngeal or genital cancers. The HPV prevalence at the genital level varies according to the population studied but is higher in the seminal fluid of men suffering from idiopathic infertility than in the general population. The involvement of HPV in male infertility is supported by several studies suggesting that this virus can affect sperm quality by altering sperm DNA integrity, motility, number, viability, and morphology, and by inducing the production of anti-sperm antibodies (ASAs). HPVs may also have an impact on female fertility, mainly by increasing the risk of miscarriage and premature delivery and by altering the implantation of endometrial trophoblastic cells. In addition, an association with vaginal bacterial dysbiosis, notably involving Gardnerella vaginalis, or co-infection with an STI agent, serves as an aggravating factor. The aim of this review is to present current data on the potential role of HPVs in male and female infertility, along with data on infertility prevention and treatment strategies and the impact of vaccination in this context.

The effect of coronavirus disease 2019 vaccination on pregnant women: A scoping review

Background: Globally, reports have shown that pregnant women refuse to receive the coronavirus disease 2019 (COVID-19) vaccine. This has posed a significant concern given the global impact of the COVID-19 pandemic.Aim: This study aims to explore the current evidence on the effect of COVID-19 vaccination on pregnant women.Method: A scoping review was conducted using Levac et al.’s five-stage framework. Relevant articles were searched in the Web of Science, PubMed, Scopus and EBSCOhost (CINAHL) databases. The identified articles were screened based on predetermined inclusion and exclusion criteria. Data from the selected articles were charted and summarised into meaningful units.Results: Twelve articles from developed countries were included in the review. Studies have reported that COVID-19 vaccination during pregnancy is generally safe and does not increase the risk of pregnancy complications. There was no significant difference in delivery outcomes between vaccinated and unvaccinated women. Neonatal outcomes were not affected by the vaccination. However, one study identified a potential risk of spontaneous abortion between 6 and 9 weeks of gestation among vaccinated women.Conclusion: Coronavirus disease 2019 vaccination is considered safe during pregnancy. While some studies have identified potential associations with certain conditions, the overall benefits of vaccination outweigh the risks. Continued monitoring of the safety and effectiveness of COVID-19 vaccines during pregnancy is recommended. Pregnant women should consult healthcare providers to make informed decisions regarding vaccination.Contribution: The findings of this review may assist in alleviating anxiety and reducing vaccine hesitancy among pregnant women.

Simplifying management of cholestasis: a proposal for a classification system.

Given the stillbirth risk associated with intrahepatic cholestasis of pregnancy, management to reduce this adverse outcome has primarily involved planned delivery as early as 36-weeks' gestation. While earlier planned delivery has decreased the incidence of stillbirth in this population, recently, there have been multiple published retrospective studies to better correlate the association of adverse outcomes with cholestasis severity. Despite this new data, uptake of individualized management for cholestasis have been varied from provider to provider. In this perspective, we briefly review the current literature and evidence regarding cholestasis and adverse outcomes and propose a cholestasis classification system with subsequent algorithm for management.

Association between first-trimester subchorionic hematoma and pregnancy loss before 20 weeks of gestation in singleton pregnancies

To evaluate the association between a first-trimester subchorionic hematoma (SCH) and pregnancy loss before 20 weeks of gestation in singleton pregnancies. We conducted a retrospective cohort study of singleton pregnancies from January to December 2021. All patients had routine first-trimester ultrasound scans and were followed up for pregnancy outcomes. We compared pregnancy loss rates before 20 weeks in women with and without SCH and analyzed risk factors using logistic regression. Out of 1,144 singleton pregnancies, 559 (48.9%) had SCH. Women with SCH had higher rates of vaginal bleeding (38.1 vs. 23.2%, P < 0.001). SCH was independently associated with miscarriage before 20 weeks (adjusted OR 1.94, 95% CI 1.19–3.15). Earlier SCH diagnosis increased miscarriage risk (adjusted OR 2.71 for diagnosis before 7 weeks, 95% CI 1.45–5.07). SCH size was not linked to pregnancy loss, but “large” SCH increased placental abruption risk (adjusted OR 5.03, 95% CI 1.20–21.11). Dydrogesterone use appeared protective against miscarriage (adjusted OR 0.28, 95% CI 0.15–0.52). First-trimester SCH is associated with an increased risk of miscarriage before 20 weeks. Large SCHs increase the risk of placental abruption, while dydrogesterone use may reduce miscarriage risk.

Association between maternal physiological and pathological factors and the risk of stillbirth and perinatal mortality

Association between maternal physiological and pathological factors and the risk of stillbirth and perinatal mortality

Bushen Zhuyun Decoction Enhances Endometrial Receptivity via the IL-6/STAT3 Signaling Pathway in Rats

Background: Reproductive endocrine disorder can impair endometrial receptivity, preventing embryo implantation and increasing miscarriage risk. Impaired endometrial receptivity contributes significantly to female infertility. Inflammatory signaling pathways including the IL-6/STAT3 pathway help embryos implant. Therefore, it is crucial to explore the relationship between the IL-6/STAT3 signaling pathway and endometrial receptivity. Objective: To investigate the mechanism by which Bushen Zhuyun decoction (BSZY) enhances endometrial receptivity in rats through the IL-6/STAT3 signaling pathway. Methods: Mifepristone-induced poor endometrial receptivity models of female SD rats were established, followed by histopathological observation. ELISA was used to measure serum sex hormones and VEGF. Western blotting or IHC was used to measure steroid receptors, IGFBP1, and IL-6/STAT3 pathway activation in the uterus during each estrus cycle and early gestation of normal rats. The Treg/Th17 balance was assessed using flow cytometry. Results: Significant differences were found in the protein expressions of steroid receptors, IL6, STAT3, and p-STAT3 during each estrus cycle and early gestation of normal rats. The protein expressions of STAT3 and PR were strongly correlated with each other. BSZY notably improved uterine morphology increased the expression of implantation markers and raised the serum concentrations of sex hormones and VEGF. BSZY enhanced the expressions of IL-6 and its receptors and restored the expressions of STAT3 and p-STAT3 in the uterus of pregnant rats. In addition, BSZY effectively restored the Treg/Th17 balance in the peripheral blood of pregnant rats. Conclusion: BSZY enhances endometrial receptivity and promotes decidualization in SD rats via the IL-6/STAT3 signaling pathway.

Hypoglycemia in Pregnant Women with Type 1 Diabetes: Is It Inevitable?

The human body has abundant mechanisms to counteract hypoglycemia and prevent neuroglycopenia primarily involving the secretion of glucagon and adrenalin. Within several years from the onset of diabetes, people with type 1 diabetes lose their ability to mount a counterregulatory response to hypoglycemia and develop hypoglycemia unawareness, thus being at risk for deteriorating to a state of severe hypoglycemia and neuroglycopenia. Pregnant individuals with type 1 diabetes are particularly prone to experience severe hypoglycemia during the first half of pregnancy. This may be not only due to the institution of strict glycemic control and the nausea and vomiting prevalent during the early months of pregnancy, but also because the counterregulatory responses are further diminished during pregnancy. Severe hypoglycemia during early pregnancy does not appear to increase the risks of spontaneous abortion or congenital fetal malformations, but the potential long-term effects on the fetus are unknown. Recent technological advances have contributed to improved glycemic control and time in range as well as decreased risk of hypoglycemia in people with diabetes. These advances include treatment with insulin analogs, use of continuous glucose monitors, and closed-loop systems for administration of insulin. Limited studies have demonstrated that pregnant individuals with type 1 diabetes may also benefit from these modalities. While ongoing research continues to explore the adjustment of closed-loop systems for optimal use during pregnancy, more effort is needed to explore the optimal use of these modalities in pregnancy. KEY POINTS: · People with type 1 diabetes have diminished counterregulatory responses to hypoglycemia and frequently develop hypoglycemia unawareness.. · Pregnant individuals with type 1 diabetes are at increased risk for severe hypoglycemia particularly during the first half of pregnancy.. · Use of insulin analogs and newer technologies for insulin administration may lower the risk of hypoglycemia in pregnant individuals with type 1 diabetes..

The Association Between Periconceptual Maternal Dietary Patterns and Miscarriage Risk in Women With Recurrent Miscarriages: A Multicentre Cohort Study.

To examine the association between periconceptual maternal diet and miscarriage risk among women with recurrent miscarriages. Prospective multicentre cohort study (Tommy's Net). Three university hospital research centres in the United Kingdom. 1035 women with a baseline history of two or more miscarriages. We analysed baseline dietary data from a 10-item Food Frequency Questionnaire (FFQ). For individual food category analyses, we used multivariable Poisson regression following adjustment for maternal confounders and paternal dietary patterns. For whole diet analyses, ordinal principal component analysis (PCA) was used to identify common dietary patterns. Results were presented as relative risks (RR) with 95% confidence intervals (CI) and accompanying p-values. Miscarriage rate, defined as the rate of spontaneous pregnancy loss (< 24 weeks of gestation) relative to the total number of pregnancies (miscarriages and live births). High consumption of fruit and nuts (almonds and walnuts) was associated with lower miscarriage risk (fruit 226/662 (34.1%) vs. 38/77 (49.4%), RR 0.66, 95% CI 0.51 to 0.85, p = 0.001; nuts 47/152 (30.9%) vs. 220/613 (35.9%), RR 0.73, 95% CI 0.54 to 0.98, p = 0.039). High red meat intake was associated with a possible increase in miscarriage risk (6/12 (50.0%) vs. 165/469 (35.2%), RR 1.86, 95% CI 1.10 to 3.16, p = 0.022). The association with miscarriage risk was unclear for other food groups, including fresh vegetables, white meat, fish, dairy, eggs, soya and chocolate, due to imprecise point estimates. Through PCA, we identified three data-derived dietary patterns. Yet, no distinct relationship emerged between these dietary patterns and miscarriage risk. A maternal diet rich in fresh fruits and nuts is associated with a lower miscarriage risk among women with a history of recurrent miscarriage. Tommy's Net (ISRCTN17732518) https://www.isrctn.com/ISRCTN17732518. Analysis plan (OSF zp7cs) https://osf.io/zp7cs.

Perinatal outcomes after selective third‐trimester ultrasound screening for small‐for‐gestational age: prospective cohort study nested within DESiGN randomized controlled trial

ABSTRACTObjectiveIn screening for small‐for‐gestational age (SGA) using third‐trimester antenatal ultrasound, there are concerns about the low detection rates and potential for harm caused by both false‐negative and false‐positive screening results. Using a selective third‐trimester ultrasound screening program, this study aimed to investigate the incidence of adverse perinatal outcomes among cases with (i) false‐negative compared with true‐positive SGA diagnosis and (ii) false‐positive compared with true‐negative SGA diagnosis.MethodsThis prospective cohort study was nested within the UK‐based DESiGN trial, a prospective multicenter cohort study of singleton pregnancies without antenatally detected fetal anomalies, born at &gt; 24 + 0 to &lt; 43 + 0 weeks' gestation. We included women recruited to the baseline period, or control arm, of the trial who were not exposed to the Growth Assessment Protocol (GAP) intervention and whose birth outcomes were known. Stillbirth and major neonatal morbidity were the two primary outcomes. Minor neonatal morbidity was considered a secondary outcome. Suspected SGA was defined as an estimated fetal weight (EFW) &lt; 10th percentile, based on the Hadlock formula and fetal growth charts. Similarly, SGA at birth was defined as birth weight (BW) &lt; 10th percentile, based on UK population references. Maternal and pregnancy characteristics and perinatal outcomes were reported according to whether SGA was suspected antenatally or not. Unadjusted and adjusted logistic regression models were used to quantify the differences in adverse perinatal outcomes between the screening results (false negative vs true positive and false positive vs true negative).ResultsIn total, 165 321 pregnancies were included in the analysis. Fetuses with a false‐negative SGA screening result, compared to those with a true‐positive result, were at a significantly higher risk of stillbirth (adjusted OR (aOR), 1.18 (95% CI, 1.07–1.31)), but at lower risk of major (aOR, 0.87 (95% CI, 0.83–0.91)) and minor (aOR, 0.56, (95% CI, 0.54–0.59)) neonatal morbidity. Compared with a true‐negative screening result, a false‐positive result was associated with a lower BW percentile (median, 18.1 (interquartile range (IQR), 13.3–26.9)) vs 49.9 (IQR, 30.3–71.7)). A false‐positive result was also associated with a significantly increased risk of stillbirth (aOR, 2.24 (95% CI, 1.88–2.68)) and minor neonatal morbidity (aOR, 1.60 (95% CI, 1.51–1.71)), but not major neonatal morbidity (aOR, 1.04 (95% CI, 0.98–1.09)).ConclusionsIn selective third‐trimester ultrasound screening for SGA, both false‐negative and false‐positive results were associated with a significantly higher risk of stillbirth, when compared with true‐positive and true‐negative results, respectively. Improved SGA detection is needed to address false‐negative results. It should be acknowledged that cases with a false‐positive SGA screening result also constitute a high‐risk population of small fetuses that warrant surveillance and timely birth. © 2024 The Author(s). Ultrasound in Obstetrics &amp; Gynecology published by John Wiley &amp; Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Miscarriage, stillbirth, and mortality risk from stroke in women: findings from the PLCO study.

Existing evidence suggests that miscarriage and stillbirth are associated with an increased risk of stroke in women. However, the impact of these events on stroke mortality remains unclear. This study aimed to elucidate the potential association between miscarriage and stillbirth and stroke mortality in women. We employed a competing risk model using data from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial to assess the relationship between miscarriage/stillbirth and stroke death. Death from other causes was considered as a competing risk, and we conducted a subgroup analysis to explore the potential impact. Our study included 68,629 women for miscarriage and 65,343 women for stillbirth. No significant association was observed between miscarriage and stroke mortality (hazard ratio [HR]=0.96; 95% confidence interval [CI], 0.84-1.10; p=0.58). While a single stillbirth did not show a significant association (HR=1.07; 95% CI, 0.81-1.41, p=0.63), recurrent stillbirth (≥2) was associated with a significantly increased risk of stroke mortality compared to women with no stillbirths (HR=2.24; 95% CI, 1.45-3.46, p<0.001). Our findings suggest that recurrent stillbirth, but not single events, is associated with an elevated risk of stroke mortality in women. Further research is warranted to clarify the underlying mechanisms and potential long-term health implications of recurrent pregnancy loss.

Optimal timing for induction of labor in normotensive women: A retrospective cohort study.

Labor induction is offered to reduce the risk of stillbirth at late term (41+0 to 41+6) but earlier induction in normotensive singleton pregnancies is supported by weak evidence. The aim of the present study was to investigate the optimal timing for induction in normotensive women. This was a retrospective cohort study including 70 293 singleton term births in Iceland during 1997-2018. Women with serious pre-gestational comorbidity, hypertension, stillbirth or previous cesarean birth were excluded. The risk of adverse maternal and neonatal outcomes for induction at each week from gestational age 37-41 weeks was compared with expectant management, defined as deliveries at a later gestational age. Risk ratios (RRs) and 95% confidence intervals (95% CI) were calculated using log-binomial regression adjusting for sociodemographics, parity, and pregnancy complications. The risk of cesarean was lower with induction at ≥40+0 than expectant management, especially at late term (RR 0.73, 95% CI: 0.63-0.83). Respiratory distress was diagnosed in 4.4% of infants after induction from 37+0 to 37+6 but 1.3% in the expectant management group (RR 3.08, 95% CI: 1.97-4.81). Induction between 37+0 and 38+6 compared with expectant management was associated with a reduced risk of shoulder dystocia, but this was non-significant in births of infants with normal birthweight. Labor induction from 40+0 compared with expectant management was associated with reduced risk of cesarean birth in Icelandic women without an increase in risk of adverse maternal or neonatal outcomes. No additional benefit appeared to be from inducing at earlier gestations in low-risk pregnancies.

Tuberculosis Preventive Treatment for Pregnant People With Human Immunodeficiency Virus in South Africa: A Modeling Analysis of Clinical Benefits and Risks.

Although prior studies of tuberculosis-preventive treatment (TPT) for pregnant people with human immunodeficiency virus (PPWH) report conflicting adverse pregnancy outcome (APO) risks, international guidelines recommend TPT for PPWH. We used a microsimulation model to evaluate 5 TPT strategies among PPWH receiving antiretroviral therapy in South Africa: No TPT; 6 months of isoniazid (6H) or 3 months of isoniazid-rifapentine (3HP) during pregnancy (Immediate 6H or Immediate 3HP) or post partum (Deferred 6H or Deferred 3HP). The primary outcomes were maternal, fetal/infant, and combined deaths from causes potentially influenced by TPT (maternal tuberculosis, maternal hepatotoxicity, stillbirth, low birth weight [LBW], and infant tuberculosis). Tuberculosis during pregnancy confers 250% and 81% higher modeled risks of stillbirth and LBW, respectively. In lower-risk or higher-risk scenarios, immediate TPT confers 38% lower or 92% higher risks of stillbirth and 16% lower or 35% higher risks of LBW. Immediate TPT would minimize deaths among PPWH. When TPT confers higher stillbirth and LBW risks, immediate TPT would produce the most combined maternal and fetal/infant deaths, even with low maternal CD4 cell count and high tuberculosis incidence. If immediate TPT yields a <4% or <20% increase in stillbirth or LBW, immediate TPT would produce fewer combined deaths than deferred TPT (sensitivity analysis range, <2%-22% and <11%-120%, respectively). If APO risks are below identifiable thresholds, TPT during pregnancy could decrease combined maternal and fetal/infant deaths. Given uncertainty around isoniazid's risks, and the low threshold at which APO risks could outweigh benefits from tuberculosis deaths averted, studies of newer TPT regimens among PPWH are warranted to inform guidelines.

Analysis of single-cell RNA sequencing in human oocytes with diminished ovarian reserve uncovers mitochondrial dysregulation and translation deficiency

BackgroundDiminished ovarian reserve (DOR) is clinically characterized by a decrease in the number of available ovarian follicles and a decline in the quality of oocytes, accompanied by hormonal changes. Low quality of DOR oocyte leads to impaired embryo development, an increased risk of aneuploid pregnancies and miscarriages. However, the specific pathogenic mechanism remains unclear, posing a significant challenge for assisted reproductive technology.MethodsFor the first time, our study employed single-cell RNA sequencing to reveal the altered transcriptomic landscape of DOR oocytes at GV stage after ovarian stimulation. Differentially expressed genes analysis (DEGs), functional enrichment analysis, weighted gene co-expression network analysis (WGCNA) and protein-protein interactions network analysis were performed.ResultsWe found 132 up-regulated genes and 466 down-regulated genes in DOR oocytes, with the down-regulated genes primarily enriched in mitochondrial function and translation. Hub genes, identified through integrated analysis of WGCNA and DEGs, were further validated in DOR and control oocytes using RT-qPCR. By utilizing hub genes and employing transcription factor enrichment tools, it had been predicted that pleomorphic adenoma gene 1 (PLAG1) played a crucial role as a transcriptional regulatory factor in DOR oocytes. Additionally, we conformed the PLAG1-IGF2 axis was dysregulated in DOR oocytes.ConclusionsTranscriptome analysis revealed that DOR oocytes exhibited mitochondrial dysfunction and translational defects, and the PLAG1-IGF2 axis might be a potential contributor for the low quality of DOR oocytes.

Effect of vitamin D adjuvant therapy on the proportion of regulatory T cells in peripheral blood and pregnancy outcome of patients with recurrent miscarriage.

Recurrent miscarriage (RM) is influenced by immune factors, particularly regulatory T cells, which can impact immune function and miscarriage risk. Vitamin D (VD) is known to regulate the immune system, potentially improving pregnancy outcomes in RM patients. This study aims to assess the effect of VD adjuvant therapy on regulatory T cells and pregnancy outcomes in RM patients. Clinical data from 104 individuals with RM admitted to our hospital between March 2022 and February 2023 were allocated at random to either the VD group (VDG) or the control group (CG), with 52 patients in each group. Both groups received standard treatment; the CG was treated with aspirin, while the VDG received additional VD therapy. Outcomes measured included regulatory T cell proportion, metabolic factors, immune inflammatory markers, and pregnancy outcomes. After treatment, the proportion of regulatory T cells in VDG was considerably higher (p < 0.05). Additionally, triglyceride levels, leptin, fasting blood glucose, and fasting insulin were lower in the VDG, whereas adiponectin levels were higher (p < 0.05). Levels of progesterone, luteinizing hormone, and 25-hydroxy VD were also higher in the VDG (p < 0.05). Furthermore, interleukin-17, gamma interferon, tumor necrosis factor-α, and C-reactive protein were lower in the VDG (p < 0.05). The pregnancy success rate in the VDG was higher, and the preterm birth rate was lower (p < 0.05). Adjuvant treatment with VD can increase the proportion of regulatory T cells in peripheral blood of individuals with recurrent abortion, regulate metabolic disorder, alleviate immune inflammation, and improve pregnancy outcome.

The prevalence of threatened miscarriage in Malta

A retrospective cohort study was conducted in Malta to assess the prevalence of threatened miscarriage. The study focuses on cases managed at a local state hospital over a 12-month period. Currently, data on pregnancies prior to 22 weeks’ gestation are not publicly available, which hampers understanding of the frequency and impact of threatened miscarriage. This research provides the basis for a potential prospective study which analysis the epidemiology and outcomes of threatened miscarriage and advocates for early intervention and appropriate patient counselling. The study included females who visited the Accident and Emergency Department in a local state hospital in 2019 with first trimester vaginal bleeding. It excluded patients with incomplete medical records. Data from various hospital departments were collected, anonymised and analysed to track outcomes such as miscarriage, ongoing pregnancy, ectopic or molar pregnancy. The research aimed to create a comprehensive local registry of pregnancy outcomes following threatened miscarriage, reflecting the national situation. In 2019, 711 pregnant women in Malta experienced first-trimester vaginal bleeding. Of these, 241 had successful births beyond 22 weeks’ gestation, while 412 experienced miscarriages, with other outcomes including ectopic and molar pregnancies and 58 women had an unknown pregnancy outcome. A significant association was found between maternal age and risk of miscarriage, particularly higher for women aged 35–46 and those under 19. Birthweight data revealed that threatened miscarriage complications likely led to low birthweights in a significant proportion of newborns. This study analysed pregnancy outcomes which were preceded by first trimester vaginal bleeding in pregnant women in Malta. Establishing a local register of pregnancy outcomes following first trimester vaginal bleeding provides clinicians with enhanced insights into the current local context. This resource may improve patient counselling and informed policy decisions and lay the groundwork for future research in the field.

Assessing the Link between Vitamin D Levels and Miscarriage Risk in Women

Background: The issue of miscarriage, sometimes known as missed abortion, is a contemporary concern in the field of obstetrics and gynecology. This condition is characterized by a cluster of clinical symptoms, one of which is the inability of the embryo to survive. Through the process of its metabolism of 1.25(OH) vitamin D, vitamin D has a significant role in promoting the reproductive health of women. Aim of the Study: This study aims to investigate the correlation between Vitamin D deficiency and idiopathic miscarriage in women. Materials and Methods: There were 180 miscarriage survivors who took part in this study.; and only forty-three women with idiopathic miscarriage included in this study. They were attended to private clinics in Karbala Province from the period of May-August/ 2024, and their ages range between (17- 43) years. The confident diagnosis was confirmed according to examination by gynaecologists. Results: The female patients with miscarriage were evaluated to exclude all other potential reasons of miscarriage, including age, body mass index, hypertension, endometrial abnormalities, and smoking. Out of 180 women who experienced miscarriage, only 43 were included in the current study. The study assessed infectious agents and other autoimmune disorders in all participating women to eliminate those with Toxoplasma gondii, Rubella, Chlamydia, Herpes (TORCH), and autoimmune diseases. The findings revealed that only 43 women experienced idiopathic miscarriage, and no women exhibited a significant correlation or positive outcomes for any of the aforementioned characteristics. The study revealed a strong association between the trimester of pregnancy and miscarriage among the patients, indicating notable fetal losses In the first and second trimesters, a substantial association was identified; however, no such relationship was evident in the third trimester. The findings indicated that Vitamin D insufficiency was substantially correlated with miscarriage in all women experiencing miscarriage in the research. In conclusion: The role of Vitamin D deficiency significantly affected the losses of pregnancy in women with idiopathic miscarriage.

Solid fuel combustion and adverse pregnancy outcomes: A nationwide study on stillbirth in India

ObjectivesStillbirth is a significant public health challenge in India, accounting for a substantial portion of the global burden. Exposure to household air pollution from solid fuel combustion during pregnancy has been associated with adverse pregnancy outcomes, including stillbirth. This study aimed to investigate the association between solid fuel use and stillbirth risk in India, utilizing data from the National Family Health Survey 5 (NFHS-5). Study designNationwide cross-sectional study. MethodsThe study employed data from the NFHS-5, a nationally representative cross-sectional survey conducted in India from 2019 to 2021. The study sample consisted of 204,723 women aged 15–49 years who had a pregnancy in the past 5 years preceding the survey. Stillbirth was calculated using calendar data, providing robust estimates. Logistic regression analysis was performed to assess the relationship between solid fuel use and stillbirth, adjusting for various sociodemographic and maternal factors. ResultsThe use of unclean cooking fuels was significantly associated with an increased risk of stillbirth (OR = 1.34, 95 % CI: 1.13–1.58, p < 0.001) compared to clean fuels. Other factors associated with higher stillbirth risk included rural residence, lower maternal education, belongingness to certain social categories, delivering at private healthcare facilities, limited antenatal visits, and undergoing caesarean delivery. ConclusionsThe findings highlight the detrimental impact of solid fuel use on stillbirth rates in India, underscoring the need for targeted interventions to promote cleaner cooking technologies and address socioeconomic disparities. Efforts to transition households towards cleaner energy sources and improve access to quality maternal healthcare services are crucial for reducing the burden of stillbirth in India.

Building a machine learning-based risk prediction model for second-trimester miscarriage

BackgroundSecond-trimester miscarriage is a common adverse pregnancy outcome that imposes substantial economic and psychological pressures on both the physical and mental well-being of patients and their families. Currently, there is a scarcity of research on predictive models for the risk of second-trimester miscarriage.MethodsClinical data were retrospectively collected from patients who were in the second trimester of pregnancy (between 14+0 and 27+6 weeks gestation), whose main diagnosis was “threatened abortion” and who were hospitalized at the Women and Children’s Hospital of Ningbo University from January 2020 to October 2023. Following preliminary data processing, the patient cohort was randomly stratified into a training cohort and a validation cohort at proportions of 70% and 30%, respectively. The Boruta algorithm and multifactor analysis were used to refine feature factors and determine the optimal features linked to second-trimester miscarriages. The imbalanced dataset from the training cohort was rectified by applying the SMOTE oversampling approach. Seven machine-learning models were built and subjected to a comprehensive analysis to validate and evaluate their predictive capabilities. Through this rigorous assessment, the optimal model was selected. Shapley additive explanations (SHAP) were generated to provide insights into the model’s predictions, and a visual representation of the predictive model was built.ResultsA total of 2006 patients were included in the study; 395 (19.69%) of them had second-trimester miscarriages. XGBoost was shown to be the optimal model after a comparison of seven different models utilizing metrics such as accuracy, precision, recall, the F1 score, precision-recall average precision, the receiver operating characteristic-area under the curve, decision curve analysis, and the calibration curve. The most significant feature was cervical length, and the top ten features of second-trimester miscarriage were found using the SHAP technique based on relevance rankings.ConclusionThe risk of a second-trimester miscarriage can be accurately predicted by the visual risk prediction model, which is based on the machine learning mentioned above.