Risk Of Adverse Obstetric Outcomes Research Articles

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

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

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

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

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

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

Listen to the Whispers before They Become Screams: Addressing Black Maternal Morbidity and Mortality in the United States.

Black women in the United States (U.S.) disproportionately experience adverse pregnancy outcomes, including maternal mortality, compared to women of other racial and ethnic groups. Historical legacies of institutionalized racism and bias in medicine compound this problem. The disproportionate impact of COVID-19 on communities of color may further worsen existing racial disparities in maternal morbidity and mortality. This paper discusses structural and social determinants of racial disparities with a focus on the Black maternal mortality crisis in the United States. We explore how structural racism contributes to a greater risk of adverse obstetric outcomes among Black women in the U.S. We also propose public health, healthcare systems, and community-engaged approaches to decrease racial disparities in maternal morbidity and mortality.

Demographic trends associated with substance use disorder and risk for adverse obstetric outcomes with cannabis and opioid use disorders

Background Substance use disorders (SUDs) are increasing in the obstetric population, vary with demographic characteristics, and are associated with adverse pregnancy outcomes. Cannabis use disorder and opioid use disorder are two of the most common SUDs during pregnancy. Objective This study had two objectives. The first objective was to assess trends in any SUD diagnosis during delivery hospitalizations from 2000 to 2018 by maternal age, ZIP code income quartile, and hospital location and teaching status. The second objective was to determine risk for adverse pregnancy outcomes during delivery hospitalizations specifically in the presence of cannabis and opioid use disorder diagnoses. Study design We conducted a serial cross-sectional analysis of the 2000–2018 National Inpatient Sample. Delivery hospitalizations to women aged 15–54 years with substance use disorder diagnoses were identified. SUD included (i) cannabis use disorder; (ii) opioid use disorder; (iii) alcohol use disorder; and (iv) other drug use disorder. We used joinpoint regression to estimate the average annual percent change (AAPC) in any substance use disorder diagnoses with 95% confidence intervals (CIs) by (i) ZIP code income quartile, (ii) hospital location and teaching status, and (iii) maternal age. We used unadjusted and adjusted log-linear regression to evaluate the relationship between cannabis use disorder and opioid use disorder several adverse maternal outcomes. We report unadjusted and adjusted risk ratios (aRRs) as measures of effect. Results From 2000 to 2018, trends analyses broadly demonstrated increasing risk for SUD across demographic categories. In trends analyses stratified by ZIP code-income quartile, the proportion of deliveries with any SUD diagnosis increased across each income quartile with significant increases in the lowest income quartile (AAPC 4.6%, 95% CI 0.4%, 8.9%), second lowest quartile (AAPC 6.3%, 95% CI 5.3%, 7.4%), second highest quartile (AAPC 5.4%, 95% CI 4.1%, 6.8%), and highest quartile (AAPC 4.4%, 95% CI 2.1%, 6.8%). A larger increasing AAPC for SUD was present for deliveries in rural hospitals (AAPC 12.3%, 95% CI 9.8%, 14.9%) as compared to teaching (AAPC 5.7%, 95% CI 5.2%, 6.3%) and non-teaching urban hospitals (AAPC 7.0%, 95% CI 5.9%, 8.1%). By maternal age group, there was a significant larger AAPC for SUD for women aged 15–19 years (AAPC 8.5%, 95% CI 6.6%, 10.4%), 20–24 years (AAPC 9.0%, 95% CI 6.9%, 11.1%) and 25–29 years (AAPC 9.8%, 95% CI 9.1%, 10.6%) than women ≥30 years of age. Cannabis use disorder was associated with increased adjusted risk for preterm delivery (aRR 1.44, 95% CI 1.43, 1.45) and abruption and antepartum hemorrhage (aRR 1.77, 95% CI 1.75, 1.80). Opioid use disorder was associated with risk for non-transfusion severe maternal morbidity (aRR 1.73, 95% CI 1.67, 1.79), preterm delivery (aRR 1.75, 95% CI 1.74, 1.77), and abruption and antepartum hemorrhage (aRR 2.15, 95% CI 2.11, 2.19). Conclusion While substance use disorders are increasing in pregnancy across rural and urban settings, age groups, and income quartiles, several populations are associated with higher increased risks and trends. These findings support that SUDs are likely to continue to be of public health significance in diverse geographic and demographic settings.

Trends in delivery hospitalizations with pregestational and gestational diabetes mellitus and associated outcomes: 2000–2019

Pregestational diabetes and associated risks may be increasing in the obstetric population. To characterize trends in delivery hospitalizations with pregestational diabetes, prevalence of chronic diabetes complications, and risk for adverse outcomes. This repeated cross-sectional study used the National Inpatient Sample to identify delivery hospitalizations between 2000 and 2019 with pregestational diabetes. Trends in pregestational diabetes delivery hospitalizations were assessed using Joinpoint regression to determine the average annual percent change (AAPC). Trends in chronic diabetes complications including chronic kidney disease, neuropathy, peripheral vascular disease, and diabetic retinopathy were also analyzed. The risk of adverse obstetric outcomes was compared between patients with and without pregestational diabetes using adjusted logistic regression models accounting for demographic, clinical, and hospital characteristics with adjusted odds ratios (aORs) with 95% CIs as measures of association. Of 76.7 million delivery hospitalizations, 179,885 (0.23%) had type 1 diabetes (T1DM), 430,544 (0.56%) had type 2 diabetes (T2DM), and 99,327 (0.13%) had unspecified diabetes. From 2000 to 2019, the prevalence of diabetes increased from 1.8 to 7.3 per 1,000 deliveries for T2DM (AAPC 8.0%, 95% CI 6.9%, 9.2%), 1.5 to 3.2 for unspecified diabetes (AAPC 3.9%, 95% CI 1.4%, 6.3%), and 2.7 in 2000 to 2.8 (AAPC 0.2% 95% CI -0.8%, 1.3%) for T1DM. The prevalence of chronic diabetes complications increased from 2.7% to 5.6% over the study period (AAPC 5.9%, 95% CI 3.7%, 8.0%). Pregestational diabetes was associated with severe maternal morbidity, cesarean delivery, hypertensive disorders of pregnancy, preterm birth, and shoulder dystocia. Pregestational diabetes increased over the study period, driven by a quadrupling in the prevalence of T2DM. Notably, the prevalence of chronic diabetes complications doubled concomitantly. Pregestational diabetes was associated with a range of adverse outcomes. These findings are further evidence that pregestational diabetes is an important contributor to maternal risk and that optimizing diabetes care in women of childbearing age will continue to be of major public health importance.

Association between cervical disorders and adverse obstetric outcomes: A retrospective cohort study.

The purpose of this study was to explore the association of cervical disorders on obstetric outcomes of singleton pregnancies in China. This hospital-based retrospective cohort study of women with live singleton births included 71,097 Chinese women. We compared the risk of adverse obstetric outcomes in different types of pregnancies with cervical disorders with those with normal cervix. Logistic regression model was used to estimate the association between cervical disorders and adverse obstetric outcomes. Women with cervical disorders had a higher risk of premature delivery (10.98 vs. 4.41%), preterm premature rupture of membranes (PPROM) (3.48 vs. 1.62%), low birth weight (LBW) (7.62 vs. 2.92%) and very low birth weight (VLBW) (2.01 vs. 0.28%) than women with normal cervix. After adjusting for confounding factors, compared with women with normal cervix, women with high-grade abnormal cervical cytology are at greater risk of premature birth (adjusted OR 1.971, 95% CI: 1.302-2.983), premature rupture of membranes (PROM) (adjusted OR 1.379, 95% CI: 1.047-1.815), LBW (adjusted OR 1.790, 95% CI: 1.059-3.025), and VLBW (adjusted OR 4.519, 95% CI: 1.662-12.292) than women with low-grade abnormal cervical cytology, and women with abnormal cervical cytology after treatment had a higher risk of premature birth (adjusted OR 2.060, 95% CI: 1.348-3.147), PROM (adjusted OR 1.381, 95% CI: 1.038-1.839), PPROM (adjusted OR 1.995, 95% CI: 1.022-3.892), LBW (adjusted OR 1.801, 95% CI: 1.046-3.102), and VLBW (adjusted OR 4.868, 95% CI: 1.788-13.255) than untreated women. Our research showed that pregnant women with cervical disorders were more likely to have premature delivery, PPROM, LBW, and VLBW. Moreover, pregnant women with high-grade abnormal cervical cytology and abnormal cervical cytology after treatment had a higher risk of premature birth, PROM, LBW, and VLBW.

Perceived racism or racial discrimination and the risk of adverse obstetric outcomes: a systematic review

ABSTRACTBACKGROUND:Racial disparities are differences among distinct subgroups of the human species; biologically, there are no scientifically proven reasons for them to exist.OBJECTIVE:To assess the impact of racism or racial discrimination on obstetric outcomes.DESIGN AND SETTING:Systematic review conducted at a tertiary/academic hospital.METHODS:The Cochrane Library, SCOPUS/EMBASE, PubMed, Web of Science and ClinicalTrials.gov databases were searched from inception to June 2020. Studies presenting any type of racial discrimination, or any manifestation of racism that was perceived by women of any age in an obstetric scenario were included. Studies that only assessed racial disparities without including direct racism were excluded. The secondary outcomes evaluated included quality of antenatal care, intra and postpartum care, preterm birth and birthweight. The Risk of Bias In Non-randomized Studies - of Interventions (ROBINS-I) scale was used to assess the quality of evidence from non-randomized studies.RESULTS:A total of 508 records were retrieved and 29 were selected for qualitative synthesis. No meta-analysis could be performed due to the high heterogeneity across studies. Perceived racism was associated as a risk factor in 7/10 studies focusing on pregnancy and postpartum maternal outcomes, five studies on preterm birth, one study on small for gestational age and two studies on low birthweight. Overall, among the 29 studies, the risk of bias was classified as moderate.CONCLUSIONS:Perceived racism presented an association with poor obstetric outcomes. Anti-racist measures are needed in order to address the problems that are causing patients to perceive or experience racism.SYSTEMATIC REVIEW REGISTRATION:PROSPERO database, CRD42020194382

The Impact of Malignancy on Assisted Reproductive Outcomes for Cancer Survivors: A Retrospective Case-Control Study.

BackgroundRelated studies have shown that it is safe for cancer patients to undergo assisted reproduction. However, studies on whether a history of cancer affects long-term reproductive outcomes in women who undergo assisted reproductive technology (ART) are scarce. In this study, we evaluated the long-term reproductive outcomes of patients with malignant tumors undergoing ART treatment and explored the impact of malignancy history on ART outcomes.MethodsThis retrospective study analyzed the clinical outcomes of patients with malignant tumors undergoing their first in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles compared with those of age-matched healthy infertile women at Fujian Maternity and Child Health Hospital between January 2003 and October 2020. We evaluated ovarian stimulation outcome, the pregnancy rate, the live birth rate, the risk of adverse obstetric outcomes and birth outcomes.ResultsThis study included 59 patients in the cancer group for data analysis who had a history of malignancy. By matching, a total of 118 healthy infertile women were included in the control group. No statistically significant association was found in terms of age, duration of infertility, BMI, or insemination type between the two groups of patients. Thyroid cancer(45.8%) and gynecologic malignancies (44.07%) were the major cancer types in this study. There were statistically significant differences in the antral follicle count (AFC) (12.00 ± 7.86 vs. 14.90 ± 8.71, P=0.033), length of ovarian stimulation (9.98 ± 2.68 vs. 11.42 ± 2.43, P=0.033) and endometrial thickness on the trigger day (10.16 ± 3.11 vs. 10.84 ± 2.17, P<0.001) between the two groups. The total gonadotropin dose, number of oocytes retrieved, fertilization rate, cleavage rate, high-quality embryo rate, blastocyst rate and first-time embryo-transfer (ET) implantation rate were nonsignificantly lower in the cancer group than in the control group (P>0.05). There were no significant differences in the clinical pregnancy rate per ET cycle (32% vs. 40.39%, P=0.156), live birth rate per ET cycle (27% vs. 35.96%, P=0.119), miscarriage rate per ET cycle (5% vs. 4.43%, P=0.779), or preterm delivery rate per ET cycle (11.11% vs. 17.80%, P=0.547) between the two groups. Additionally, regression analysis showed that a history of malignancy was not a risk factor for reproductive outcomes.ConclusionsOverall, it is feasible for women with a history of cancer to conceive using ART is feasible and their long-term reproductive outcomes are similar to these of healthy infertile women. A history of cancer does not decrease the number of retrieved oocytes, increase the risk of adverse obstetric outcomes or affect birth outcomes.

Polycystic ovary syndrome and risk of adverse obstetric outcomes: a retrospective population-based matched cohort study in England

BackgroundPolycystic ovary syndrome (PCOS) affects up to one in five women of childbearing age. Observational studies assessing the association between maternal PCOS and adverse obstetric outcomes have reported varying results, depending on patient population, diagnostic criteria for PCOS and covariates accounted for in their analyses. We aimed to assess the risk of obstetric outcomes among a population-based representative cohort of women with PCOS compared to an age-matched cohort of women without PCOS.MethodsA retrospective cohort study was conducted of pregnancies of women in England aged 15–49 years identified from the Clinical Practice Research Datalink (CPRD) GOLD pregnancy register and linked Hospital Episodes Statistic (HES) data between March 1997 and March 2020. Pregnancies from the register that had a linked HES delivery record were included. Linked CPRD primary care data was used to ascertain maternal PCOS exposure prior to pregnancy. To improve detection of PCOS, in addition to PCOS diagnostic codes, codes for (1) polycystic ovaries or (2) hyperandrogenism and anovulation together were also considered. Sensitivity analysis was limited to only pregnant women with a diagnostic code for PCOS.Primary outcomes ascertained from linked HES data were (1) preterm delivery (gestation < 37 weeks), (2) mode of delivery, (3) high (> 4000 g) or low birthweight (< 2500 g) and (4) stillbirth. Secondary outcomes were (1) very preterm delivery (< 32 weeks), (2) extremely preterm delivery (< 28 weeks), (3) small and (4) large for gestational age.Conditional logistic regression models were performed adjusting for age, ethnicity, deprivation, dysglycaemia, hypertension, thyroid disorders, number of babies born at index pregnancy, and pre-gravid BMI. Multiple imputation was performed for missing outcome data.Results27,586 deliveries with maternal PCOS were matched for age (± 1 year) to 110,344 deliveries without PCOS. In the fully adjusted models, maternal PCOS was associated with an increased risk of (1) preterm birth [aOR: 1.11 (95% CI 1.06–1.17)], and (2) emergency caesarean, elective caesarean and instrumental vaginal compared to spontaneous delivery [aOR: 1.10 (1.05–1.15), 1.07 (1.03–1.12) and 1.04 (1.00–1.09), respectively]. There was absence of association with low birthweight, high birthweight and stillbirth. In the sensitivity analysis, the association with preterm birth [aOR: 1.31 (95% CI 1.13–1.52)], emergency caesarean [aOR: 1.15 (95% CI 1.02–1.30)], and elective caesarean [aOR: 1.03 (95% CI 1.02–1.03)] remained.While there was no significant association with any of the secondary outcomes in the primary analysis, in the sensitivity analysis maternal PCOS was associated with increased risk of extremely preterm delivery [aOR: 1.86 (95% CI 1.31–2.65)], and lower risk of small for gestational age babies [aOR: 0.74 (95% CI 0.59–0.94)].ConclusionsMaternal PCOS was associated with increased risk of preterm and caesarean delivery. Association with low birthweight may be largely mediated by lower gestational age at birth.

The Relationship between First Trimester 25-Hydroxyvitamin D3 Levels and Second Trimester Femur Length and their Effects on Birth Weight and Length at Birth

Vitamin D is important for fetal development because of its important role during cell proliferation, differentiation, and maturation processes [1,2], also vitamin D is important for placental function, calcium homeostasis, and bone mineralization, which are all important determinants for fetal growth and development [3,4]. Primary source of vitamin D is the exposure to sunlight. Sedentary indoor lifestyles, obesity, and avoiding sunlight each contributes to increased vitamin D deficiency. A pregnant woman needs a daily intake of vitamin D of 800–1000 IU, but the actual need varies according to ethnicity, nutritional factors, and sunlight exposure [5]. Vitamin D deficiency in pregnant women is a great public health problem because of its potential effects on the maternal obstetric outcomes and offspring development [6,7] where vitamin D deficiency may affect early organogenesis and subsequently affect later health and disease [8]. Vitamin D deficiency during pregnancy has been associated with increased risk of adverse obstetric outcomes including increased risk of gestational diabetes, pre-eclampsia, threatened preterm birth, cesarean section, bacterial vaginosis [9-11], also may have adverse effects on fetal development and growth include increase risk of preterm birth and fetal growth restriction resulting in low birthweight and small for-gestational-age neonates [12,13]. It has also been shown that intrauterine bone hypo mineralization is associated with vitamin D deficiency and then a reason for congenital rickets, craniotabes, and osteopenia [14]. 25hydroxy vitamin D is the major storage form of vitamin D in the human, so it can be measured in blood to determine the overall vitamin D status [15], it is the best measure of vitamin D status in human [16]. The main goal of our study was to assess the relationship between maternal circulating 25-hydroxyvitamin D3 [25(OH)D3] concentration and second trimester femur length, infant birthweight and length at birth.

Experiences and outcomes of Gypsy, Roma and Traveller women in pregnancy: a scoping review protocol

IntroductionGypsy, Roma and Traveller communities are subjected to a specific form of racism fuelled by deep-seated prejudice and stereotypes. These groups have historically been the victims of school segregation, forced...

The trend in cesarean myomectomies and the risk of obstetrical complications in Korea

BackgroundTo evaluate pregnancy outcomes and the risk of adverse obstetrical outcomes of cesarean myomectomy (CM) compared with cesarean section (CS) only, and to investigate the trend of surgeons in choosing CM.MethodsA retrospective cohort study was performed on all patients who underwent CS complicated by leiomyoma at two university hospitals between January 2010 and May 2020. All patients were categorized into the CM (341 women) or CS-only (438 women) group. We analyzed the demographic factors, obstetric factors, surgical outcomes, and possible risk factors for adverse outcomes between the two groups.ResultsWomen who underwent CS only were significantly more likely to have a previous myomectomy and multiple leiomyoma history than women who underwent CM. The gestational age at delivery and pregnancy complications were significantly higher in the CS-only group. The mean size of the leiomyomas was larger in the CM group than in the CS-only group (5.8 ± 3.2 cm vs. 5.2 ± 3.1 cm, P = 0.005). The operation time and history of previous CS and preterm labor were higher in the CM group. The leiomyoma types differed between the two groups. The subserosal type was the most common in the CM group (48.7%), and the intramural type was the most common in the CS-only group. Patients in the CM group had fewer than three leiomyomas than those in the CS-only group. Preterm labor and abnormal presentation were relatively higher in the CM group than in the CS-only group, concerning leiomyoma presence. There were no significant differences in the preoperative and postoperative hemoglobin levels. The size of the leiomyoma (odds ratio [OR] = 1.162; 95% confidence interval [CI]: 1.07–1.25; P < 0.001) and operation time > 60 min (OR = 2.461; 95% CI: 1.45–4.15) were significant independent predictors of adverse outcomes after CM.ConclusionsCM should be considered a reliable and safe approach to prevent the need for another surgery for remnant leiomyoma. Herein, surgeons performed CM when uterine leiomyomas were large, of the subserosal type, or few. Standardized treatment guidelines for myomectomy during CSs in pregnant women with uterine fibroids should be established.

Obstetric outcomes during delivery hospitalizations among obese pregnant women in the United States

The rates of both maternal and fetal adverse outcomes increase significantly with higher body mass index. The aim of this study was to calculate national estimates of adverse maternal and fetal outcomes and associated hospitalization cost among obese pregnant women using a national database. This study was a retrospective analysis of data retrieved from Nationwide Inpatient Sample database, collected during 2010–2014. The primary outcomes of this study were adverse maternal and fetal outcomes, hospital length of stay, and hospitalization cost. There was a total of 18,687,217 delivery-related hospitalizations, of which 1,048,323 were among obese women. Obese women were more likely to have cesarean deliveries (aOR 1.70, 95% CI 1.62–1.79) and labor inductions (aOR 1.51, 95% CI 1.42–1.60), greater length of stay after cesarean deliveries (aOR 1.14, 95% CI 1.08–1.36) and vaginal deliveries (aOR 1.48, 95% CI 1.23–1.77). They were also more likely to have pregnancy-related hypertension, preeclampsia, gestational diabetes, premature rupture of membranes, chorioamnionitis, venous thromboembolism, excessive fetal growth, and fetal distress. Obese pregnant women had significantly greater risk for adverse obstetrical outcomes, which substantially increased the hospital and economic burden. Risk stratification of pregnant patients based on obesity could also help obstetricians to make better clinical decisions and improve patient outcomes.

Abstract P137: Maternal Or Parental Outcomes During Delivery Related Hospitalizations Among Pregnant Individuals With Obesity In The United States

Background: The prevalence of obesity among people of reproductive age has steadily increased. The rates of both maternal/parental and fetal adverse outcomes increased significantly with higher BMI. In this study, we examined the national estimates of adverse maternal/parental and fetal outcomes among pregnant individuals with pre-pregnancy obesity using a nationally representative database. Methods: This was a retrospective observational analysis of data retrieved from the Nationwide Inpatient Sample database (2010-2014). The primary outcomes of this study were various adverse maternal/parental and fetal outcomes. Delivery related hospitalizations and all outcomes were identified using the ICD-9 codes. Additionally, propensity-score matching analysis was conducted. Results: There were a total of 18,687,217 delivery-related hospitalizations, of which 1,048,323 were among people with obesity. The mean age of pregnant persons with obesity was 28.5 years while among those without obesity was 28.0 years. Between both groups, most pregnant persons were White, followed by Hispanic and Black. Pregnant persons with obesity were more likely to have labor inductions (AOR: 1.51; 95% CI: 1.42, 1.60), cesarean deliveries (1.70; 1.62, 1.79), and greater length of stay after both cesarean deliveries (1.14; 1.08, 1.36) and vaginal deliveries (1.48; 1.23, 1.77). They were also more likely to have risk factors for adverse obstetrical outcomes such as gestational hypertension (2.17; 2.06, 2.29), preeclampsia (2.06; 1.42, 2.99), gestational diabetes (2.75; 2.60, 2.90), premature rupture of membranes (1.17; 1.08, 1.27), chorioamnionitis (1.39; 1.25, 1.55), and venous thromboembolism (1.63; 1.34, 1.99). Additionally, pregnant persons with obesity were more likely to have adverse fetal outcomes such as excessive fetal growth (3.18; 2.96, 3.43) and fetal distress (1.28; 1.21, 1.35). Conclusion: Pregnant persons with obesity had significantly greater risk for adverse obstetrical outcomes. Risk stratification of pregnant individuals based on obesity can inform obstetrical providers’ clinical decision-making and potentially improve patient outcomes and decrease costs. There is an opportunity to address these risks with pre-conception interventions. Future studies could examine the effect of pre-conception interventions such as counseling on pre-pregnancy weight management, lifestyle modifications addressing nutrition and activity, and pre-pregnancy bariatric surgery.

In-Hospital Complications in Pregnancies Conceived by Assisted Reproductive Technology.

BackgroundAssisted reproductive technology (ART) has emerged as a common treatment option for infertility, a problem that affects an estimated 48 million couples worldwide. Advancing maternal age with increasing prepregnancy cardiovascular risk factors, such as chronic hypertension, obesity, and diabetes, has raised concerns about pregnancy complications associated with ART. However, in‐hospital complications following pregnancies conceived by ART are poorly described.Methods and ResultsTo assess the patient characteristics, obstetric outcomes, vascular complications and temporal trends of pregnancies conceived by ART, we analyzed hospital deliveries conceived with or without ART between January 1, 2008, and December 31, 2016, from the United States National Inpatient Sample database. We included 106 248 deliveries conceived with ART and 34 167 246 deliveries conceived without ART. Women who conceived with ART were older (35 versus 28 years; P<0.0001) and had more comorbidities. ART‐conceived pregnancies were independently associated with vascular complications (acute kidney injury: adjusted odds ratio [aOR], 2.52; 95% CI 1.99–3.19; and arrhythmia: aOR, 1.65; 95% CI, 1.46–1.86), and adverse obstetric outcomes (placental abruption: aOR, 1.57; 95% CI, 1.41–1.74; cesarean delivery: aOR, 1.38; 95% CI, 1.33–1.43; and preterm birth: aOR, 1.26; 95% CI, 1.20–1.32), including in subgroups without cardiovascular disease risk factors or without multifetal pregnancies. Higher hospital charges ($18 705 versus $11 983; P<0.0001) were incurred compared with women who conceived without ART.ConclusionsPregnancies conceived by ART have higher risks of adverse obstetric outcomes and vascular complications compared with spontaneous conception. Clinicians should have detailed discussions on the associated complications of ART in women during prepregnancy counseling.

Crohn’s Disease is associated with a greater risk of adverse obstetric outcome than Ulcerative Colitis

Inflammatory bowel disease (IBD) comprising Crohn’s disease (CD) and ulcerative colitis (UC) affects 3 million people in the US. While it is known that people with IBD have an increased risk of adverse pregnancy outcomes, it is poorly understood what factors predispose patients to this increased risk. The aim of this study was to evaluate whether clinical data could predict the probability of adverse pregnancy outcomes.

Women Aged over 40 with Twin Pregnancies Have a Higher Risk of Adverse Obstetrical Outcomes.

Maternal age is related to a higher risk of adverse maternal, fetal, and neonatal outcomes in twin pregnancies. However, whether this increase in adverse outcomes is due solely to age or due to risk factors that are more common in women over 40 remains unknown. The aim of this study is to assess if maternal age over 40 years old is an independent risk factor for obstetric adverse outcomes in dichorionic diamniotic twin gestations. In this single-center retrospective cohort study, we compared the obstetric outcomes of women with dichorionic diamniotic twin pregnancies below and over 40 years of age. A twin pregnancy cohort enrolled between 2013 and 2019 was included in the study. Maternal, fetal, and labor complications were recorded. A total of 510 women were analyzed in two groups: 266 women below 40 years old and 244 women over 40 years old. Maternal age over 40 increased the odds of maternal (aOR = 1.9 (1.3; 2.9); p-value = 0.002), fetal (aOR = 1.8 (1.0; 3.0); p-value = 0.037), and labor complications (aOR = 2.5 (1.3; 4.6); p-value = 0.004). Maternal age over 40 years was the most important factor increasing the odds of having a caesarean section (C-section). Over 40 years old was an independent risk factor for complications in dichorionic diamniotic twin pregnancies.

Oral Anaerobic Microflora and Pregnancy Complication

Bacterial vaginosis and periodontal diseases share very similar pathogenesis. Each of these diseases occurs when healthy microbiome changes to predominately anaerobic bacterial flora. Bacterial vaginosis is proven factor for adverse pregnancy outcomes. In recent years it has been hypothesized that infection from distant sites of the fetoplacental unit may also elicit an inflammatory response in utero. Aim: The study is designed to determine whether the presence of specific oral anaerobic bacteria in subgingival sulcus of mother increase the risk of adverse obstetric outcomes. Material and Methods: Case-control study. Control group: 50 patients who gave birth to neonate whit normal birth weight at term. Group cases: I group - 40 pregnant women who were hospitalized with signs of preterm labor. II - 20 pregnant women, who have an ultrasound diagnosis of fetal growth retardation. Sub-gingival microbiological paper-point swab was taken in all patients. Results: The total number of isolated oral anaerobic bacteria was statistically significantly higher in the cases group compared to control group p &lt;0.01. In our study, pregnant women who tested positive for Porphyrmonas gingivalis for 6.65 times were more likely to have preterm labor compare with pregnant women with negative oral swabs (95.0% CI: 1.38-32.11 / p &lt;0.05), and for 2,79 times more likely to have fetus with intrauterine growth restriction (95.0% CI: 1.10-7.91 / p &lt;0.05 Conclusions: The study confirmed the hypothesis of a statistically significant association between oral anaerobic infection and adverse pregnancy outcomes. In the future, more studies are needed to investigate the role of the microbial load, maternal immune response, pathophysiological pathway that leads to negative pregnancy outcome.&#x0D;

Obstetric implications of maternal chronic hepatitis B virus infection

Antenatal screening for hepatitis B surface antigen seropositivity is widely adopted to identify pregnant women with chronic hepatitis B virus (HBV) infection in order to target their newborn infants for combined passive-active neonatal immunization to prevent the maternal-to-child transmission of HBV. It is less certain whether the presence of chronic HBV infection in these largely asymptomatic women could impact their pregnancy outcome. There is now gathering information in the literature, though sometimes conflicting, on the obstetric implications of chronic HBV infection. The conflicting data is most probably related to confounding factors such as the immunological phase of chronic HBV infection, viral genotype and activity, presence of hepatic inflammation and other co-existing liver disorders such as non-alcoholic fatty liver disease, and coinfection with other virus such as hepatitis C virus and micro-organisms, which are usually not examined, but which could have made significant influence on the occurrence of many of the pregnancy complications and adverse fetal and neonatal outcome. For pregnancy complications, the evidence suggests association with increased gestational diabetes mellitus, preterm birth, intrahepatic cholestasis of pregnancy, caesarean delivery, and postpartum haemorrhage, probably increased placental abruption and prelabour rupture of the membranes, and no effect or a reduction in the hypertensive disorders of pregnancy, especially preeclampsia. For perinatal outcome, there may be increased miscarriage and fetal malformations, and increase in both low birthweight and large-for-gestational age/macrosomic infants, as well as increased intrauterine fetal demise/stillbirth and fetal distress. However, most studies have not elaborated on the mechanisms or explanations of many of the adverse outcomes. Taken together, maternal chronic HBV infection increases the risk of adverse obstetric outcome overall, but further prospective studies are warranted to elucidate the reasons and mechanisms of, and with a view to mitigate, these adverse obstetric outcomes.