Risk Of Adverse Neonatal Outcomes Research Articles

Pregnancy Outcome in Pregnancies Complicated by Fetal Growth Restriction and Severe Preeclampsia

Abstract Background common pathophysiological feature favors parallel occurrence of severe pre-eclampsia (PET) and fetal growth restriction. Objective To identify pregnancy and neonatal outcome differences between early-onset and late-onset preeclampsia, in relation to fetal growth restriction (FGR) Methods this retrospective study included 50 singleton pregnancies with FGR and severe PET who were admitted in Ain Shams University Maternity Hospital. Fetal growth restriction was defined as EFW and/or AC < 10th percentile. Preeclampsia with severe features included patients with systolic BP ≥ 160 mmHg, diastolic BP ≥ 110 mmHg, elevated liver transaminases twice the normal values, elevated serum creatinine twice the normal levels, or > 1.1mg/dl, HELLP syndrome, features of impending eclampsia, pulmonary edema, and/or thrombocytopenia with platelets level < 100 x 109/L. obstetric and neonatal outcomes were compared in early and late onset PET. Results The current study revealed that there was no difference between early and late onset PET in fetal and pregnancy outcomes while there was significant difference in neonatal outcomes. Conclusion the current study showed that risk of adverse neonatal outcomes as respiratory distress syndrome and neonatal death were higher in cases with early onset PET.

Is the sFlt-1/PlGF ratio efficient in predicting adverse neonatal outcomes in small-for-gestational-age newborns? A prospective observational multicenter cohort study.

Fetuses with growth abnormalities are at an increased risk of adverse neonatal outcomes. The aim of this study was to investigate if placental growth factor (PlGF), soluble fms-like tyrosine kinase-1 (sFlt-1), or the sFlt-1/PlGF ratio were efficient predictive factors of adverse neonatal outcomes in small-for-gestational-age (SGA) newborns. A prospective observational multicenter cohort study was performed between 2020 and 2023. At the time of the SGA fetus diagnosis, serum angiogenic biomarker measurements were performed. The primary outcome was an adverse neonatal outcome, diagnosed in the case of any of the following: <34 weeks of gestation: mechanical ventilation, sepsis, necrotizing enterocolitis, intraventricular hemorrhage grade III or IV, and neonatal death before discharge; ≥34 weeks of gestation: Neonatal Intensive Care Unit hospitalization, mechanical ventilation, continuous positive airway pressure, sepsis, necrotizing enterocolitis, intraventricular hemorrhage grade III or IV, and neonatal death before discharge. In total, 192 women who delivered SGA newborns were included in the study. The serum concentrations of PlGF were lower, leading to a higher sFlt-1/PlGF ratio in the adverse outcome group. No significant differences in sFlt-1 levels were observed between the groups. Both PlGF and sFlt-1 had a moderate correlation with adverse neonatal outcomes (PlGF: R - 0.5, p < 0.001; sFlt-1: 0.5, p < 0.001). The sFlt-1/PlGF ratio showed a correlation of 0.6 (p < 0.001) with adverse outcomes. The uterine artery pulsatility index (PI) and the sFlt-1/PlGF ratio were identified as the only independent risk factors for adverse outcomes. An sFlt-1/PlGF ratio of 19.1 exhibited high sensitivity (85.1%) but low specificity (35.9%) in predicting adverse outcomes and had the strongest correlation with them. This ratio allowed the risk of adverse outcomes to be assessed as low with approximately 80% certainty. The sFlt-1/PlGF ratio seems to be an efficient predictive tool in adverse outcome risk assessment. More studies on large cohorts of SGA-complicated pregnancies with and without preeclampsia are needed to develop an optimal and detailed formula for the risk assessment of adverse outcomes in SGA newborns.

Incidence and Determinants of Adverse Neonatal Outcomes among HIV-Positive Pregnant Women: A Prospective Cohort Study at Regional Referral Hospitals in Uganda

HIV infection remains a significant global health challenge, affecting over 37.9 million people worldwide. Despite widespread access to antiretroviral therapy (ART), adverse neonatal outcomes are prevalent among pregnant women living with HIV. This prospective cohort study aimed to determine the incidence and factors associated with early adverse neonatal outcomes among HIV-positive mothers at Mubende and Fort Portal Regional Referral Hospitals (MRRH and FRRH), compared to HIV-negative mothers. The study excluded mothers with known risks for adverse neonatal outcomes. Neonates were monitored from birth to discharge within 7 days for adverse outcomes. Among 203 participants, 135 were HIV-negative and 68 were HIV-positive. Adverse neonatal outcomes were more frequent in the HIV-positive group (39.7% vs. 28.1%), although the difference was not statistically significant (P=0.096). Prematurity (20.6% vs. 8.1%, P=0.031) and low birth weight (25.0% vs. 12.6%, P=0.047) were significantly higher among HIV-positive mothers. Multivariate analysis identified detectable viral load as a significant risk factor for early neonatal adverse outcomes (aRR=4.036, CI=1.428-11.406, P=0.008). These findings underscore the importance of close monitoring and viral load suppression in HIV-positive mothers. Further research is needed to understand the causes of detectable viral loads in mothers on ART and to capture neonatal adverse outcomes beyond 7 days post-delivery. Keywords: HIV, Adverse neonatal outcomes, Antiretroviral therapy (ART), Viral load, Prematurity, Low birth weight, public health and Maternal health

Neonatal outcomes in women with diabetes mellitus — analysis of DAPSY data

BACKGROUND: Hyperglycemia in pregnancy is associated with short- and long-term implications for children. Nevertheless, the effects of different types of diabetes mellitus and treatment methods on the neonatal outcomes are to be investigated. AIM: The aim of this study was to evaluate the contribution of different types of maternal diabetes mellitus to the risk of adverse neonatal outcomes. MATERIALS AND METHODS: This retrospective cohort study included women (n = 3261) who delivered at the Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott, Saint Petersburg, Russia in 2008–2017. The following comparison groups were used: type 1 diabetes mellitus (n = 506; 1a, continuous subcutaneous insulin injections; 1b, multiple daily insulin injections), type 2 diabetes mellitus (n = 229; 2a, diet; 2b, insulin therapy), gestational diabetes mellitus (n = 2387; 3a, diet; 3b, insulin therapy), and control (n = 139). The main birth outcomes assessed included weight and length of newborns, Apgar score at birth and at 5 minutes after birth, and pathological conditions such as fetal macrosomia, syndrome of infant of mother with gestational diabetes mellitus or diabetic mother (P70.0–P70.1), light (P05.0) or small for gestational age (P05.1), intrauterine growth restriction, prematurity (P07), neonatal hypoglycemia (P70.4), and neonatal respiratory distress syndrome (P22). The secondary birth outcomes assessed included birth trauma (P10–P15), stillbirth (P95), disturbances of cerebral status of newborn (P91), and congenital malformations, deformations and chromosomal abnormalities (Q00–Q99). RESULTS: Pregestational diabetes mellitus is strongly associated with adverse neonatal outcomes. Type 1 diabetes mellitus women had the highest risks for fetal macrosomia and diabetic fetopathy, neonatal hypoglycemia, prematurity, and congenital malformations (odds ratio 3.54, 20.2, 5.59, 4.24 and 3.92 respectively). In type 2 diabetes mellitus patients, the risks of low birth weight, intrauterine growth restriction and birth trauma (odds 9.14, 5.42 and 6.3 respectively) were higher. For women with gestational diabetes mellitus, these risks were lower. CONCLUSIONS: This study provides a comprehensive analysis of the major neonatal pathology in patients with different types of diabetes mellitus, taking into account the treatment method. Preconception care and optimal glycemic control are necessary to reduce the risk of obstetric and perinatal complications in women with pregestational types of diabetes mellitus. Further research into the health status of this cohort of children at a later age is required.

Risk of Adverse Neonatal Outcomes After Combined Prenatal Cannabis and Nicotine Exposure

The prevalence of cannabis use in pregnancy is rising and is associated with adverse perinatal outcomes. In parallel, combined prenatal use of cannabis and nicotine is also increasing, but little is known about the combined impact of both substances on pregnancy and offspring outcomes compared with each substance alone. To assess the perinatal outcomes associated with combined cannabis and nicotine exposure compared with each substance alone during pregnancy. This retrospective population-based cohort study included linked hospital discharge data (obtained from the California Department of Health Care Access and Information) and vital statistics (obtained from the California Department of Public Health) from January 1, 2012, through December 31, 2019. Pregnant individuals with singleton gestations and gestational ages of 23 to 42 weeks were included. Data were analyzed from October 14, 2023, to March 4, 2024. Cannabis-related diagnosis and prenatal nicotine product use were captured using codes from International Classification of Diseases, Ninth Revision, Clinical Modification, and International Statistical Classification of Diseases, Tenth Revision, Clinical Modification. The main outcomes were infant and neonatal death, infants small for gestational age, and preterm delivery. Results were analyzed by multivariable Poisson regression models. A total of 3 129 259 pregnant individuals were included (mean [SD] maternal age 29.3 [6.0] years), of whom 23 007 (0.7%) had a cannabis-related diagnosis, 56 811 (1.8%) had a nicotine-use diagnosis, and 10 312 (0.3%) had both in pregnancy. Compared with nonusers, those with cannabis or nicotine use diagnoses alone had increased rates of infant (0.7% for both) and neonatal (0.3% for both) death, small for gestational age (14.3% and 13.7%, respectively), and preterm delivery (<37 weeks) (12.2% and 12.0%, respectively). Moreover, risks in those with both cannabis and nicotine use were higher for infant death (1.2%; adjusted risk ratio [ARR], 2.18 [95% CI, 1.82-2.62]), neonatal death (0.6%; ARR, 1.76 [95% CI, 1.36-2.28]), small for gestational age (18.0%; ARR, 1.94 [95% CI, 1.86-2.02]), and preterm delivery (17.5%; ARR, 1.83 [95% CI, 1.75-1.91]). These findings suggest that co-occurring maternal use of cannabis and nicotine products in pregnancy is associated with an increased risk of infant and neonatal death and maternal and neonatal morbidity compared with use of either substance alone. Given the increasing prevalence of combined cannabis and nicotine use in pregnancy, these findings can help guide health care practitioners with preconception and prenatal counseling, especially regarding the benefits of cessation.

Outcome of induction of labour at 41 weeks with foley catheter in midwifery-led care

ObjectiveAssess the outcome of induction of labour (IOL) with a Foley catheter in pregnancies at 41 weeks in midwifery-led care setting compared to consultant-led care setting. DesignMixed-methods cohort study at a midwifery – hospital partnership in Amsterdam, the Netherlands. Setting and participantsProspectively, women undergoing IOL in midwifery-led care were recruited at a secondary hospital. This group was compared to a retrospective cohort, in which IOL was exclusively performed under consultant-led care. Measurements and findingsWe compared 320 women whose induction started in midwifery-led care to a historical cohort of 320 women induced for the same reason under consultant-led care. Both groups exhibited similar rates of spontaneous vaginal births (64.2 %vs62.5 %). Caesarean section and assisted vaginal birth rates did not significantly differ. Maternal adverse outcomes were comparable, while neonatal adverse outcomes were significantly higher in the midwifery-led care group (8.1 %vs3.8 %; OR 2.27, 95 % CI 1.12–4.58). The use of pain relief was significantly lower in midwife-led care (65.3 %vs75.3 %; OR 0.62, 95 % CI 0.44–0.87). 20.6 % of births occurred in midwife-led care. Key conclusions and implications for practiceIn this single-centre study, spontaneous vaginal birth rates following IOL with a Foley catheter were similar between midwife- and consultant-led care. However, the midwife-led group showed a higher risk of adverse neonatal outcomes, mainly early onset neonatal sepsis, with a minority eventually delivering under midwife-led care. Implications highlight the need for broader research, validation across diverse settings and exploration of patient and healthcare worker perspectives to refine the evolving midwifery-led care model.

Assessing Adverse Neonatal Outcomes Associated With Intrapartum Narcotic Administration [ID 2683477

INTRODUCTION: Approximately 83% of U.S. deliveries include pain control, with 67% incorporating epidural analgesia, and 16% utilizing narcotics. Research suggests intrapartum fentanyl predicts poor neonatal suckling, and thus impaired breastfeeding. Unclear are potential effects of other narcotics. We examined whether use of intrapartum narcotics increases risk of adverse neonatal outcomes. METHODS: Charts of patients admitted for delivery at a single academic institution were reviewed for drugs administered in the intrapartum period and neonatal outcomes. Institutional review board approval was obtained with a waiver of informed consent. Data were summarized using logistic regression, controlling for confounders. RESULTS: Of the 519 participants, 286 (55.1%) received at least one narcotic in the intrapartum period. Compared to the control group, those who received narcotics were significantly younger, had greater pregnancy weight gain, were less likely to deliver via cesarean section, were less likely to have had preeclampsia, had greater gestational age at delivery, and gave birth to babies that weighed more. Tylenol III predicted a three times higher adjusted risk of neonatal intensive care unit admission (odds ratio [OR] 3.03 [1.06–8.62]). Norco predicted greater than 2.5 times higher risk of 1-minute (OR 2.66 [1.26–5.60]) and 5-minute Apgar scores below 7 (OR 2.61 [1.08–6.31]), and requiring oxygen at birth (OR 2.68 [1.21–5.93]). Morphine predicted a three times higher risk of 5-minute Apgar scores below 7 (OR 3.00 [1.26–7.17]). When adjusting for receipt of epidural analgesia, epidural did not significantly increase risk of any study outcomes. CONCLUSION: Adverse neonatal outcomes were observed following intrapartum Norco, morphine, and Tylenol III, and were unrelated to use of epidural analgesia. Findings support growing evidence that intrapartum narcotics pose risk to neonates, and further research is needed to elucidate potential longer-term effects.

Effect of active-duty military service on neonatal birth outcomes: a systematic review.

Increasing numbers of women serve in the armed forces in countries worldwide. Stress experienced during pregnancy is associated with adverse birth outcomes including preterm delivery (PTD) and low birth weight (LBW). Several characteristics of military employment and lifestyle can increase stress acting on active-duty servicewomen (ADSW) and hence may increase the risk of adverse neonatal outcomes. This paper reviews the prevalence of PTD, preterm labour (PTL), LBW and stillbirth in babies born to ADSW in the armed forces. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. Medline, EMBASE, Web of Science, Global Health and CINAHL Plus databases were searched from inception to July 2021 (November 2023, EMBASE) using subject heading and keyword searches for English language journal articles on babies born to ADSW in any military branch and any country. The Joanna Briggs Institute prevalence critical appraisal tool assessed risk of bias in included papers. Studies were paired with a comparator non-active-duty population to generate a prevalence ratio as the effect measure. A narrative synthesis was conducted. 21 observational studies fulfilled the eligibility criteria. They were all conducted in the US military, involved a total of 650 628 participants, and were published between 1979 and 2023. Their results indicate increased LBW in ADSW compared with non-service women. There was insufficient evidence to conclude or rule out whether ADSW have increased rates of PTD or PTL. ADSW may be at increased risk of having an LBW baby. However, caution is needed if seeking to generalise the findings beyond the US context. This review highlights a growing need for female-specific research in other armed forces and, specifically, into reproductive health. Such research is necessary to inform military maternity pathways and policies in ways that safeguard mothers and their babies while enhancing military readiness.

Maternal Diabetes Mellitus and Neonatal Outcomes in Bisha: A Retrospective Cohort Study

Background: Maternal diabetes mellitus (MDM) is associated with increased risks for adverse neonatal outcomes. However, the impact of MDM on neonatal outcomes in Bisha, a city in Saudi Arabia, is not well documented. This study aims to investigate the impact of MDM on neonatal outcomes in the Maternity and Children’s Hospital (MCH), Bisha, Saudi Arabia. Methods: A retrospective cohort study was conducted on 181 pregnant women with diabetes and their neonates who were diagnosed at the Maternity and Children’s Hospital (MCH), Bisha, Saudi Arabia, between 5 October 2020 and 5 November 2022. The primary outcome was a composite of adverse neonatal outcomes, including stillbirth, neonatal death, macrosomia, preterm birth, respiratory distress syndrome, hypoglycemia, and congenital anomalies. Logistic regression analyses were used to adjust for potential confounders. Results: The total sample size was 181. The average age of patients was 34 years (SD = 6.45). The majority of the patients were diagnosed with GDM, 147 (81.2%), and pre-GDM, 34 (18.8%). Neonates born to mothers with MDM had a higher risk of adverse neonatal outcomes compared to those born to mothers without MDM (adjusted odds ratio [aOR] = 1.46, 95% confidence interval [CI]: 1.25–1.70). The risks of macrosomia (aOR = 1.74, 95% CI: 1.38–2.19), LBW (aOR = 1.32, 95% CI: 1.06–1.66), and RDS (aOR = 1.57, 95% CI: 1.28–1.93) were significantly higher among neonates born to mothers with MDM. The types of DM were statistically significant in terms of their correlation with the following neonatal outcomes: hypoglycemia (p-value = 0.017), macrosomia (p-value = 0.050), and neonatal death (p-value = 0.017). Conclusions: MDM is associated with an increased risk of adverse neonatal outcomes in Bisha. The early identification and management of MDM may improve neonatal outcomes and reduce the burden of neonatal morbidity and mortality in this population.

Neonatal outcomes according to different glucose threshold values in gestational diabetes: a register-based study

BackgroundMild hyperglycaemia is associated with increased birth weight but association with other neonatal outcomes is controversial. We aimed to study neonatal outcomes in untreated mild hyperglycaemia using different oral glucose tolerance test (OGTT) thresholds.MethodsThis register-based study included all (n = 4,939) singleton pregnant women participating a 75 g 2-h OGTT in six delivery hospitals in Finland in 2009. Finnish diagnostic cut-offs for GDM were fasting ≥ 5.3, 1 h ≥ 10.0 or 2-h glucose ≥ 8.6 mmol/L. Women who did not meet these criteria but met the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria (fasting 5.1–5.2 mmol/L and/or 2-h glucose 8.5 mmol/L, n = 509) or the National Institute for Health and Clinical Excellence (NICE) criteria (2-h glucose 7.8–8.5 mmol/L, n = 166) were considered as mild untreated hyperglycaemia. Women who met both the Finnish criteria and the IADPSG or the NICE criteria were considered as treated GDM groups (n = 1292 and n = 612, respectively). Controls were normoglycaemic according to all criteria (fasting glucose < 5.1 mmol/L, 1-h glucose < 10.0 mmol/L and 2-h glucose < 8.5 mmol/L, n = 3031). Untreated mild hyperglycemia groups were compared to controls and treated GDM groups. The primary outcome – a composite of adverse neonatal outcomes, including neonatal hypoglycaemia, hyperbilirubinaemia, birth trauma or perinatal mortality – was analysed using multivariate logistic regression.ResultsThe risk for the adverse neonatal outcome in untreated mild hyperglycemia was not increased compared to controls (adjusted odds ratio [aOR]: 1.01, 95% confidence interval [CI]: 0.71–1.44, using the IADPSG criteria; aOR: 1.05, 95% CI: 0.60–1.85, using the NICE criteria). The risk was lower compared to the treated IADPSG (aOR 0.38, 95% CI 0.27–0.53) or the treated NICE group (aOR 0.32, 95% CI 0.18–0.57).DiscussionThe risk of adverse neonatal outcomes was not increased in mild untreated hyperglycaemia compared to normoglycaemic controls and was lower than in the treated GDM groups. The OGTT cut-offs of 5.3 mmol/L at fasting and 8.6 mmol/L at 2 h seem to sufficiently identify clinically relevant GDM, without excluding neonates with a risk of adverse outcomes.

Neonatal outcomes in women with Multiple Sclerosis – Influence of disease activity: A Danish nationwide cohort study

BackgroundMaternal Multiple Sclerosis (MS) has been associated with an increased risk of adverse birth outcomes. We hypothesized that active disease during conception and pregnancy plays an important role in this context, which this study aims to address. MethodsWe used the Danish registers to conduct a nationwide cohort study. Information on maternal disease activity during pregnancy was retrieved using proxies from the linked registers (hospitalization, magnetic resonance imaging of the brain, and use of systemic corticosteroids during pregnancy). Neonates, exposed in utero to maternal disease activity constituted the exposed cohort and the unexposed cohort constituted neonates without in utero exposure to maternal disease activity. The examined outcomes were preterm birth, small for gestational age, low 5-minute Apgar score, and major congenital anomalies. In logistic regression models we estimated the odds ratios (OR) with adjustment for confounders such as maternal age, comorbidities, parity, smoking, calendar year of birth, and disease-modifying treatment. ResultsAmong the study population of 2492 children of mothers with MS we identified 273 (11 %) neonates exposed to maternal disease activity during pregnancy, and 2219 (89 %) neonates without exposure to disease activity. The adjusted odds ratios (aOR) for preterm birth, small for gestational age, low 5-minute Apgar score, and major congenital anomalies among children born to women with disease activity during pregnancy were 0.92 (95 % confidence interval (95 % CI) 0.53–1.60), aOR 1.19 (95 % CI 0.62–2.26), aOR 2.57 (95 % CI 0.93–7.15) and aOR 0.93 (95 % CI 0.48–1.83), respectively. ConclusionsWomen with MS having disease activity during pregnancy did not have a statistically significantly increased risk of adverse neonatal outcomes compared to women with MS without disease activity, which is overall reassuring results. We believe, that this will be useful knowledge for patients and clinicians in planning a pregnancy and preparing a birth plan.

Is Parity a Risk Factor for Late Preterm Birth? Results from a Large Cohort Study.

Most preterm births occur in the late preterm period. While prematurity-related adverse outcomes are significantly diminished when birth occurs during this period, these infants are still at increased risk of complications. Parity affects the incidence of obstetric complications. The purpose of this study was to determine whether parity impacts the risk of spontaneous late preterm birth (SLPTB) and associated complications. A retrospective observational cohort study was conducted. Patients were divided into three study groups according to parity. The primary outcome was the rate of SLPTB in each group. Secondary outcomes were unplanned cesarean delivery (UCD), prolonged third stage of labor respiratory distress syndrome (RDS), transient tachypnea of the newborn (TTN), intraventricular hemorrhage (IVH), neonatal hypoglycemia, duration of NICU admission, neonatal death, and composite adverse neonatal outcome (CANO). Primiparas were more likely to have SLPTB, UCD, and CANO compared to multiparas (2.6% vs. 1.9% OR 1.5 [1.3-1.7] p < 0.01) (4.1% vs. 1.3% OR 2.7 [1.2, 5.9] p < 0.01) (8.5% vs. 4.2 OR 2.1 [1.3-3.5] p = 0.002) and grandmultiparas (2.6% vs. 1.7% OR 1.4 [1.2-1.5] p < 0.001) 8.5% vs. 4.4% OR 2.0 [1.1, 3.8], p = 0.01) but no difference in UCD compared to grandmultiparas (4.1% vs. 3.3% OR 1.2 [0.6-2.7] p = 0.28). Primiparas are at increased risk of SLPTB and UCD, and this is accompanied by an increased risk of adverse neonatal outcomes.

Unveiling sex bias and adverse neonatal outcomes in ultrasound estimation of gestational age: A population-based cohort study.

Gestational age estimation by second-trimester ultrasound biometry introduces systematic errors due to sex differences in early foetal growth, consequently increasing the risk of adverse neonatal outcomes. Ultrasound estimation earlier in pregnancy may reduce this bias. To investigate the distribution of sex ratio by gestational age and estimate the risk of adverse outcomes in male foetuses born early-term and female foetuses born post-term by first- and second-trimester ultrasound estimations. This population-based study compared two cohorts of births with gestational age based on first- and second-trimester ultrasound in the Medical Birth Registry of Norway between 2016 and 2020. We used a log-binomial regression model to estimate adjusted relative risk (RR) with 95% confidence interval (CI) for Apgar score <7 at 5 min, umbilical artery pH <7.05, neonatal intensive care unit (NICU) admission and respiratory morbidity in relation to foetal sex. The sex ratio at birth in gestational weeks 36-43 showed less male predominance in pregnancies estimated in first compared to second trimester. Any adverse outcome was registered in 627 of 4470 male infants born in gestational weeks 37-38 and 618 of 6406 females born ≥41 weeks. Male infants born in weeks 37-38 had lower risk of NICU admission (RR 0.76, 95% CI 0.58, 0.99), Apgar score <7 at 5 min (RR 0.63, 95% CI 0.28, 1.41) and respiratory morbidity (RR 0.68, 95% CI 0.37, 1.25) in first- compared to second-trimester estimations. Female infants estimated in first trimester born ≥41 weeks had lower risk of umbilical artery pH <7.05, NICU admissions and respiratory morbidity; however, CIs were wide. Early ultrasound estimation of gestational age may reduce the excess risk of adverse neonatal outcomes and highlight the role of foetal sex and the timing of ultrasound assessment in the clinical evaluation of preterm and post-term pregnancies.

Impact of fetal inflammatory response on the severity of necrotizing enterocolitis in preterm infants.

Neonates born with fetal inflammatory response (FIR) are at increased risk for adverse neonatal outcomes. Our objective was to determine whether FIR and its severity is associated with severity of necrotizing enterocolitis (NEC) in preterm infants. A case-control retrospective study of infants <33 weeks gestational age or <1500 g birthweight, including 260 with stage I-III NEC and 520 controls matched for gestational age. Placental pathology was evaluated, and FIR progression and its severity were defined according to Amsterdam classification. In this study, mild FIR (i.e., stage 1 FIR) was present in 52 controls (10.0%) and 22 infants with stage I-III NEC (8.5%), while moderate to severe FIR (i.e., ≥stage 2 FIR) was present in 16 controls (3.1%) and 47 infants with stage I-III NEC (18.1%). Both stage and grade of FIR were associated with stage of NEC (P < 0.001). On multinomial logistic regression, stage III NEC was associated with stage of FIR (P < 0.001). This is the first report demonstrating the association between progression and increasing severity of FIR and stage of NEC. Fetal Inflammatory Response (FIR) and its progression and severity are associated with the stages of necrotizing enterocolitis (NEC). This is the first study demonstrating the impact of progression and severity of FIR on stage III NEC. These observations provide additional insight into understanding the impact of intrauterine exposure to inflammation on the severity of NEC in preterm infants.

The mediating role of pregnancy-induced hypertension on pre-pregnancy body mass index and adverse neonatal outcomes in women with assisted reproductive technology

ObjectiveTo explore whether pregnancy-induced hypertension (PIH) mediates the association between pre-pregnancy body mass index (BMI) and adverse neonatal outcomes in women undergoing assisted reproductive technology (ART) for singleton pregnancies.MethodsThis cohort study collected 79437 maternal data from the National Vital Statistics System (NVSS) between 2020 and 2021. Univariable and multivariable logistic regression models were applied to estimate the association between pre-pregnancy BMI and PIH in women receiving ART as well as the associations between pre-pregnancy BMI and PIH and adverse neonatal outcomes. The mediation effect of PIH on the association between pre-pregnancy BMI and adverse neonatal outcomes was estimated according to the total effect, natural direct effect, natural indirect effect, and percentage of mediation.ResultsThere were 25769 participants had adverse neonatal outcomes at the end of the follow-up. After adjusting for confounding factors, an increased risk of PIH in women receiving ART was identified in those with pre-pregnancy BMI ≥25 kg/m2 [odds ratio (OR)=1.92, 95% confidence interval (CI):1.84–2.01]. Pre-pregnancy BMI ≥25 kg/m2 was associated with an increased risk of adverse neonatal outcomes (OR = 1.26, 95%CI:1.22–1.30). Women with PIH had an increased risk of adverse neonatal outcomes (OR = 1.79, 95%CI:1.71–1.87). The percentage mediated by PIH in the association between pre-pregnancy BMI and adverse neonatal outcomes was 21.30%.ConclusionPIH partially mediated the association between pre-pregnancy BMI and adverse neonatal outcomes in women receiving ART, which recommends that women control weight before receiving ART.

Grandparental income and adverse neonatal outcomes in Finland in 2000 − 2015

Abstract Background Pre-term births and other adverse neonatal outcomes are a major burden to healthcare systems, and they also contribute to long-term health problems. Socioeconomic inequalities in these outcomes are well-documented, but whether grandparental characteristics influence them over and above parental characteristics remains unclear. Methods We used population register data on all singleton children of non-migrant origin, born in Finland in 2000 − 2015 (n = 341,715), linked to their both biological parents and all four grandparents, including an indicator for deceased kin members. We examined whether grandparental income predicted grandchildren's neonatal outcomes (preterm birth, low birth weight, small for gestational age, congenital malformations) in addition to parental income, once accounting for sociodemographic family characteristics such as parental age, parity, education, family structure, and maternal smoking. Results We found a consistent association between lower income and adverse neonatal outcomes, for both mothers and fathers, as well as maternal and paternal grandparents. The gradient was stronger among young mothers (under age 25), e.g., the prevalence of being born small for gestational age was 11% for the highest parental or grandparental income quintile, while for the lowest it ranged from 13 to 15%. Overall, the income gradients clearly attenuated in adjusted models, but remained. Preliminary results suggest grandparental characteristics mainly influence grandchild outcomes through the middle generation, but depending on the outcome, partly independent associations remain. Conclusions Even in the context of a Nordic welfare state, offspring of lower income grandparents are at higher risk of adverse neonatal outcomes, particularly when born to young mothers. This influence mainly, but not fully, passes through the parental generation, suggesting more support should be offered to expecting parents with low income and from disadvantaged backgrounds. Key messages • Lower grandparental income predicts higher risk of adverse neonatal outcomes, particularly when born to young mothers. • Expecting parents with low income and disadvantaged family background should be supported to reduce adverse neonatal outcomes.

Early age at menarche is associated with an increased risk of preeclampsia and adverse neonatal outcomes: a 6‑year retrospective study.

Preeclampsia affects between 2 to 8% of pregnancies worldwide and is associated with significant adverse outcomes for both mothers and their offspring. The present study aims to investigate whether there is a correlation between early age at menarche and an increased risk of developing preeclampsia and experiencing adverse neonatal outcomes. The study involved a review of medical records of 4227 pregnant women who gave birth at The First Affiliated Hospital of Chengdu Medical College between January 2017 and December 2022. The collected data included demographic characteristics, clinical manifestations of preeclampsia, laboratory indicators, gestational complications, and neonatal outcomes. Pregnant women were categorized into four groups based on their age at menarche (≤ 12, 13, 14, and ≥ 15years). Logistic regression analysis was conducted to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) for the association between different menarche age groups and the risk of preeclampsia and adverse neonatal outcomes. Pregnant women who had an age at menarche of ≤ 12years had a higher risk of preeclampsia than women who had their menarche at 13, 14, and ≥ 15years of age, with adjusted ORs (95% CIs) for preeclampsia of 1.00 (reference), 0.78 (0.45-0.91), 0.76 (0.59-0.88), and 0.73 (0.56-0.94), respectively. The predictive efficacy of age at menarche for preeclampsia was assessed with a sensitivity and specificity of 85.2% and 76.4%, respectively, and an AUC of 0.82. Moreover, infants born to women with an age at menarche of ≤ 12years had a higher risk of adverse neonatal outcomes, including small for gestational age, preterm birth, low birth weight, neonatal respiratory distress syndrome, and neonatal intensive care unit admission. Our findings suggest that an early age at menarche is associated with an increased risk of preeclampsia and adverse neonatal outcomes. This information could be useful for obstetricians to identify women at risk for preeclampsia early on and implement timely interventions to reduce the incidence of preeclampsia and associated adverse neonatal outcomes.

Suboptimal gestational weight gain and neonatal outcomes in low and middle income countries: individual participant data meta-analysis

ObjectiveTo estimate the associations between gestational weight gain (GWG) during pregnancy and neonatal outcomes in low and middle income countries.DesignIndividual participant data meta-analysis.SettingProspective pregnancy studies from 24 low and middle...

Associations of maternal motor vehicle crashes during pregnancy with offspring's neonatal birth outcomes.

Adverse events in fetuses are well researched but studies on the follow-up health outcomes of infants exposed to maternal motor vehicle crashes (MVCs) during pregnancy have yielded inconsistent results. This study aimed to investigate the association of maternal exposure to MVCs during pregnancy with the risk of adverse neonatal outcomes. This population-based cohort study used data from birth notifications in Taiwan. A total of 19277 offspring with maternal exposure to MVCs during pregnancy and 76015 randomly selected comparison offspring without such exposure were selected. Neonatal adverse outcomes were identified from National Health Insurance medical claims data. Conditional logistic regression was used to estimate the unadjusted and adjusted odds ratios (aORs) of neonatal adverse outcomes. Offspring exposed to maternal MVCs during pregnancy had a higher risk of birth defects (aOR, 1.21; 95% CI, 1.04-1.41) than offspring without such exposure. This positive association was sustained with exposure to an MVC during the first or second trimester. A dose-response relationship (P = 0.0023) was observed between the level of injury severity and the risk of birth defects. In the early stages of pregnancy, maternal exposure to MVCs may entail a risk of birth defects in the offspring. The potential mechanisms for the associations of maternal exposure to MVCs with birth defects need further investigation.

The Association between Grand Multiparity and Adverse Neonatal Outcomes: A Retrospective Cohort Study from Ha'il, Saudi Arabia.

Inconsistent evidence exists regarding the association of grand multiparity with adverse neonatal outcomes. This study aims to compare specific adverse outcomes in grand multiparas (those with five or more births at twenty or more weeks of gestation, regardless of fetal outcome) compared to those with lower parity (those with less than five births at twenty or more weeks of gestation, regardless of fetal outcome). A retrospective cohort study was undertaken at the Maternity and Children Hospital in Ha'il region, Saudi Arabia. After calculating the required sample size, data were collected from consenting participants with a viable singleton delivery. Socio-demographic variables, select maternal characteristics, and adverse neonatal outcomes (admission to the neonatal intensive care unit, low birth weight, prematurity, and APGAR score less than 7 in the first 5 min) were compared between grand multiparas and women with lower parity. Two hundred ninety-four participants were recruited (ninety-eight grand multiparas and one hundred ninety-six of lower parity). There was a statistically significant difference between the two groups in relation to age, level of education, body mass index, and the occurrence of gestational diabetes. Out of the studied adverse neonatal outcomes after the adjustment for maternal age between the two groups, no statistically significant difference in the adverse neonatal outcomes was found between the two groups. Grand multiparity does not incur an additional risk of adverse neonatal outcomes compared to women of lower parity. Furthermore, increasing maternal age and comorbid conditions might have a more detrimental effect on neonatal outcomes than grand multiparity per se.