Risk Of Adverse Pregnancy Outcomes Research Articles

Prevalence of Pregnancy-Induced Hypertension and Pregnancy Outcomes

Background: The most frequent medical comorbidity during pregnancy is hypertension, rendering an elevated menace of unfavorable outcomes for equally mother and infant. It is a substantial public health concern, characterized by eclampsia, chronic hypertension, and preeclampsia. Objectives: The study determined occurrence of pregnancy-induced hypertension (PIH) and pregnancy outcomes, in the locality of Pakistan. Methods: The cross-sectional research appraised 05 districts of Pakistan in 2021-22. The study comprised 1920 patients affected with PIH. The demographic characteristics, laboratory and clinical values and pregnancy outcomes were recorded on the approved questionnaire. Results: Prevalence of PIH in pregnant females in study area was recorded as 13.70%. A significant proportion of PIH-affected females had genetic predisposition (51.14%), followed by abortion history (15.52%), history of hormonal imbalance (9.94%), history of Cesarean section (7.50%) and history of stillbirth (0.88%). Pregnancy outcome revealed that 16 (0.833%) women died of the PIH, 31 suffered from renal failure, 36 from pulmonary edema, 4.06% were affected with abruptio placentae and 103 suffered from HELLP syndrome. Similarly, the neonatal complications revealed that 27 fetuses died to mothers’ PIH, 111 suffered from asphyxia (5.78%) at the time of birth and 13 infants were abnormal and had different congenital anomalies. Practical implication: It emphasized the need for improved prenatal care, early detection of pregnancy-induced hypertension, and meticulous management of the condition in order to improve maternal and neonatal outcomes, especially in high prevalence regions such as Pakistan. Conclusion: The frequency of PIH in Pakistan was high (13.70%) and women had a greater risk of adverse pregnancy outcomes. With good prenatal care and continuous monitoring of the mother and fetus, perinatal outcomes including maternal morbidity and infant mortality can be avoided. Keywords: Asphyxia; Hypertension; Neonatal mortality; Perinatal outcomes.

Association between PM2.5 exposure and the outcomes of ART treatment: A prospective birth cohort study

Exposure to fine particulate matter (PM2.5) has been reported to be adversely associated with reproductive health. However, current evidence on PM2.5 exposure adversely influencing pregnancy outcomes remains inconclusive. Women receiving assisted reproductive technology (ART) treatment are under close monitoring with regards to their treatment process, which make them great study population to assess the impact of PM2.5 in the post-implantation period. Therefore, within a prospective cohort study in Jiangsu, China, we assessed the associations between exposure to ambient PM2.5 and the outcomes of ART treatment, including implantation failure, biochemical pregnancy loss, clinical pregnancy and live birth, in 2431 women who underwent the first fresh embryo transfer or frozen embryo transfer cycle. High-performance machine-learning model was performed to estimate daily PM2.5 exposure concentrations at 1 km spatial revolution. Exposure windows were divided into seven periods according to the process of follicular and embryonic development in ART. Generalized estimation equations (GEE) was used to assess the association between PM2.5 and ART outcomes. Higher PM2.5 exposure was associated with decreased probability of clinical pregnancy (RR: 0.98, 95 % CI: 0.96–1.00). Each 10 μg/m3 increase in PM2.5 exposure in the duration from hCG test to 30 days after embryo transfer (Period 7) was positively associated with the risk of biochemical pregnancy loss (RR: 1.06, 95 % CI: 1.00–1.13), and more prominent effects were observed in women undergoing fresh embryo transfer. Null associations were observed between PM2.5 exposure and implantation failure or live birth at any exposure window. Collectively, our study suggested that exposure to PM2.5 increased the risk of adverse treatment outcomes in the ART population. Thus, for women opting for ART treatment, particularly those who select fresh embryo transfer cycles, additional evaluation of PM2.5 exposure before treatment might be of value in decreasing the risk of adverse pregnancy outcomes.

Counselling on Conceiving: Attitudes and Factors Influencing Advice of Professionals in Transplantation.

Pregnancy after kidney transplantation (KT) conveys risks of adverse pregnancy outcomes (APO). Little is known about performance of pre-pregnancy counselling after KT. This study investigated perceptions of risk, attitudes towards pregnancy and factors influencing advice given at pre-pregnancy counselling after KT. A web-based vignette survey was conducted among nephrologists and gynaecologists between March 2020 and March 2021, consisting of five vignettes containing known risk factors for APO and general questions on pre-pregnancy counselling after KT. Per vignette, attitudes towards pregnancy and estimation of outcomes were examined. In total 52 nephrologists and 25 gynaecologists participated, 56% from university hospitals. One third had no experience with pregnancy after KT. All gave positive pregnancy advice in the vignette with ideal circumstances (V1), versus 83% in V2 (proteinuria), 81% in V3 (hypertension), 71% in V4 (eGFR 40ml/min/1.73m2). Only 2% was positive in V5 (worst-case scenario). Chance of preeclampsia was underestimated by 89% in V1. 63% and 98% overestimated risk for graft loss in V4 and V5. Professionals often incorrectly estimated risk of APO after KT. As experience with pregnancy after KT was limited among professionals, patients should be referred to specialised centres for multidisciplinary pre-pregnancy counselling to build experience and increase consistency in given advice.

Thoracic organ transplantation and pregnancy outcomes: systematic review and meta-analysis.

Pre-conceptual comorbidities, an inherent risk of graft loss, rejection during pregnancy, and the postpartum period in women with thoracic lung transplant may predispose them to increased risk of adverse feto-maternal outcomes. The study aimed to systematically analyze and assess the risk of adverse pregnancy outcomes in women with thoracic organ transplant. MEDLINE, EMBASE, and Cochrane library were searched for publication between January 1990 and June 2020. Risk of bias was assessed using Joanna Briggs critical appraisal tool for case series. The primary outcomes included maternal mortality and pregnancy loss. The secondary outcomes were maternal complications, neonatal complications, and adverse birth outcomes. The analysis was performed using the DerSimonian-Laird random effects model. Eleven studies captured data from 275 parturient with thoracic organ transplant describing 400 pregnancies. The primary outcomes included maternal mortality {pooled incidence (95% confidence interval) 4.2 (2.5-7.1) at 1year and 19.5 (15.3-24.5) during follow-up}. Pooled estimates yielded 10.1% (5.6-17.5) and 21.8% (10.9-38.8) risk of rejection and graft dysfunction during and after pregnancy, respectively. Although 67% (60.2-73.2) of pregnancies resulted in live birth, total pregnancy loss and neonatal death occurred in 33.5% (26.7-40.9) and 2.8% (1.4-5.6), respectively. Prematurity and low birth weight were reported in 45.1% (38.5-51.9) and 42.7% (32.8-53.2), respectively. Despite pregnancies resulting in nearly 2/3rd of live births, high incidence of pregnancy loss, prematurity and low birth weight remain a cause of concern. Focused pre-conceptual counseling to avoid unplanned pregnancy, especially in women with transplant-related organ dysfunctions and complications, is vital to improve pregnancy outcomes. CRD42020164020.

Pregnancy Outcome of Confined Placental Mosaicism: Meta-analysis of Cohort Studies

ABSTRACT Confined placental mosaicism (CPM) is a condition in which there is chromosomal abnormality in the placenta that is not present in the fetus. Confined placental mosaicism has historically been most often identified following a first-trimester chorionic villus sampling (CVS), in which there are 2 different cell lines in the placenta but a normal karyotype in the fetus based on amniocentesis or neonatal blood. As the outcome for CPM pregnancies is still debated, including the potential for adverse pregnancy and postnatal outcomes, this study aimed to evaluate the rates of adverse neonatal and obstetrical outcomes in CPM-diagnosed pregnancies, as compared with unaffected matched controls. This meta-analysis was performed in accordance with an a priori designed protocol and was registered with the PROSPERO (International Prospective Register of Systematic Reviews) database. A search of EMBASE and MEDLINE databases from 1980 to February 2022 was performed. Included articles were published in the English language and were observational studies including singleton CPM-diagnosed pregnancies (whose controls were unaffected and with normal karyotype). Excluded were all reviews, case reports, and congress abstracts. In addition, high-risk or positive cell-free DNA screening (cfDNA) cases followed by diploid amniotic cells were excluded (because of the different methodology, which may have an effect on the analysis). Because of the paucity of data regarding mosaicism in submicroscopic copy number variants, these abnormalities were also excluded from the analysis. Primary outcomes included the occurrence of the following: termination of pregnancy, major fetal defects (as defined by the Centers for Disease Control and Prevention), small for gestational age (SGA) neonate with birth weight (BW) <10th centile and neonatal SGA with BW less than the third centile, preterm birth (PTB), hypertensive disorders, admission to a neonatal intensive care unit, intrauterine fetal demise at <24 weeks' gestation, and >24 weeks' gestation stillbirth. All other abnormal pregnancy outcomes were searched for, including PTB, obstetrical cholestasis, amniotic infection, gestational diabetes, cesarean delivery, amniotic infection, preterm prelabor rupture of membranes, and neonatal mortality or morbidity. Of 310 retrieved articles, 80 studies were assessed for eligibility, and 8 retrospective matched cohort studies were included. The results of the meta-analysis showed that women with CPM had a higher risk of adverse pregnancy outcomes than those without CPM. The most common adverse outcomes were fetal growth restriction (FGR), PTB, and stillbirth. The risk of FGR was significantly higher in women with CPM, with an odds ratio (OR) of 3.60 (95% confidence interval [CI], 2.40–5.39). Similarly, the risk of PTB was higher in women with CPM, with an OR of 2.64 (95% CI, 1.90–3.67), and the risk of stillbirth was also increased, with an OR of 2.58 (95% CI, 1.51–4.42). Scarcity of reporting for other obstetrical neonatal and obstetrical outcomes hindered further conclusions. In subgroup analysis, the risk of delivering an SGA infant was 3-fold higher for CPM when trisomy 16 was excluded and 11-fold higher for trisomy 16 specifically compared with unaffected controls. The authors acknowledge that the meta-analysis has several limitations, including the heterogeneity of the included studies, the lack of information on the specific type and extent of CPM in each case, and the potential for publication bias. Nevertheless, the study provides valuable insights into the pregnancy outcomes of women with CPM and highlights the need for further research to improve our understanding of this condition. Overall, this meta-analysis suggests that women with CPM are at increased risk of adverse pregnancy outcomes, particularly FGR, PTB, and stillbirth. The findings highlight the importance of early detection of CPM and close monitoring of pregnancies in women with this condition. The study also emphasizes the need for further research to better understand the underlying mechanisms of CPM and to identify effective interventions to improve pregnancy outcomes in affected women.

Multicomponent provider–patient intervention to improve glycaemic control in Medicaid-insured pregnant individuals with type 2 diabetes: clinical trial protocol for the ACHIEVE study

IntroductionType 2 diabetes (T2D) is one of the most frequent comorbid medical conditions in pregnancy. Glycaemic control decreases the risk of adverse pregnancy outcomes for the pregnant individual and infant....

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.

Effect of extremely low-frequency electromagnetic radiation on pregnancy outcome: A meta-analysis.

Extremely low-frequency electromagnetic radiation (ELF-EMF) are generated by electrical devices and power systems (1 to 300 Hz). Although several studies have demonstrated that ELF-EMF may beassociated with an increased risk of adverse pregnancy outcomes, other studies have shown no evidence of associations. This meta-analysis was conducted to assess the effect of extremely low frequency electromagnetic radiation on pregnancy outcomes. The following electronic bibliographic databases were searched to identify relevant studies: PubMed, Web Of Science, Cochrane library, Embase, EBSCO. In addition, the manual retrieval of relevant references was conducted as a supplement. Select all eligible studies published from Database construction library to March 10, 2021. Search type for queue research on influence of electromagnetic field radiation on pregnancy results. Data were screened and extracted independently by two researchers. Review Manager 5.3 software was used for the meta-analysis. There was no significant increase in the risk of miscarriage, stillbirth, birth defects and preterm delivery in the pregnant women who lived near the electromagnetic fields compared with the control group. Conclusions: No correlation has been found between maternal ELF-EMF exposure and miscarriage, stillbirth, neonatal birth defects and preterm delivery, while the effects on small gestational age and low birth weight are still uncertain. Related research with high-quality large samples and different regions are still needed for further verification.

ANTENATAL UMBILICAL CORD COILING INDEX AS A PREDICTOR OF PREGNANCY OUTCOME

Introduction: Negative pregnancy outcomes, such as stillbirth, neonatal mortality, premature delivery, low birth weight, and admission to the neonatal intensive care unit (NICU), are linked to anomalies in the umbilical cord, such as the nuchal cord, marginal cord insertion, and aberrant cord coiling. Not many studies throw insight into this topic from South Indian settings. Objective: To investigate the role of the antenatal umbilical cord coiling index (AUCCI) in predicting adverse pregnancy outcomes. Methods: This is a cross-sectional study of 200 pregnant women who underwent antenatal ultrasound scans with ≥ 28 weeks of gestation with singleton live pregnancy who attended the obstetrics department. The AUCCI was measured as the ratio of the total number of coils in the umbilical cord to its length. The primary outcome was to nd the association between AUCCI and adverse pregnancy outcomes, including both maternal and fetal outcomes. Results: The mean AUCCI was 24 ±0.10, we categorised AUCCI <0.42 as hypocoiled, 0.42 – 0.59 as normocoiled and more than equal to 60 as hypercoiled based on distribution. We also observed a signicant association between AUCCI and PPH, PROM, APGAR score, NICU admission, and low birth weight. (p-value <0.05) Conclusion: The antenatal umbilical cord coiling index is a simple and noninvasive tool that can be used to predict adverse pregnancy outcomes. The lower the AUCCI, the higher the risk of adverse pregnancy outcomes

Excessive Gestational Weight Gain and Pregnancy Outcomes.

Adequate weight gain during pregnancy is one of the factors for its proper course. Excessive weight gain during this period of a woman's life is associated with adverse pregnancy outcomes. In this study, we determine the impact of excessive gestational weight gain on pregnancy outcomes. The study is based on the results of a Polish national survey performed between 2011 and 2017 on a group of 10,319 women and 6930 children. Excessive weight gain during pregnancy was associated with higher birthweight and higher prevalence and risk of birthweight over 4500 g (OR 6.92; 95% CI 3.10-15.42), cesarean section/assisted delivery (OR 2.71; 95% CI 1.63-4.49), pregnancy induced hypertension (OR 5.85; 95% CI 3.24-10.57), hospitalization during pregnancy (OR 1.85; 95% CI 1.12-3.04), and the Apgar score in the first minute of neonate's life in the range of 0-7 (OR 2.65; 95% CI 1.36-5.2). We did not observe the significant difference in premature rupture of membranes and labor inductions. Our study indicates that excessive gestational weight gain is associated with higher risk for adverse pregnancy outcomes.

Maternal pre-pregnancy BMI, MTHFR polymorphisms, and the risk of adverse pregnancy outcomes in pregnant women from South China: a retrospective cohort study

BackgroundIncreasing evidence suggests an association between maternal pre-pregnancy body mass index (pre-BMI) and adverse pregnancy outcomes. However, the effects of methylenetetrahydrofolate reductase (MTHFR) polymorphisms on these relationships require further investigation. This study aimed to investigate whether the relationship between pre-BMI and the risk of adverse pregnancy outcomes was influenced by MTHFR gene polymorphisms.MethodsA total of 5614 mother-fetus pairs were included in the study. The odds ratios (OR) of adverse pregnancy complications, including gestational diabetes mellitus (GDM), gestational hypertension (GHT), cesarean delivery (CS), and premature rupture of membranes (PROM), were estimated using adjusted logistic regression models and subgroup analysis.ResultsPregnant women with higher pre-BMI values were positively related to the risk of GDM, GHT, and CS. In the subgroup analysis, underweight BMI was associated with a decreased risk of CS and GDM in pregnant women with the MTHFR A1298C AA or C677T CC genotype, while overweight/obese BMI was associated with an increased risk of GDM and CS in different MTHFR variants. Moreover, pregnant women with MTHFR A1298C AC + CC or C667T CC were found to have an increased risk of GHT in the MTHFR A1298C AA or C667T CT + TT genotype. A remarkable association was observed between the obesity group with MTHFR A1298C AC + CC (OR = 6.49, CI: 2.67–15.79) and the overweight group with the C667T CC genotype (OR = 4.72, CI: 2.13–10.45).ConclusionsMTHFR gene polymorphisms exert a modifying effect on the association between maternal pre-BMI and the risk of GHT, CS, and GDM. Pregnant women with a high pre-BMI with specific MTHFR genotypes should be considered for GHT development.

Pregnancy Outcomes and Disease Course in NMOSD and MOGAD in CANOPTICS (N2.002)

Pregnancy Outcomes and Disease Course in NMOSD and MOGAD in CANOPTICS (N2.002)

Organophosphate Flame Retardants in Pregnant Women: Sources, Occurrence, and Potential Risks to Pregnancy Outcomes

Organophosphate flame retardants (OPFRs) are found in various environmental matrixes and human samples. Exposure to OPFRs during gestation may interfere with pregnancy, for example, inducing maternal oxidative stress and maternal hypertension during pregnancy, interfering maternal and fetal thyroid hormone secretion and fetal neurodevelopment, and causing fetal metabolic abnormalities. However, the consequences of OPFR exposure on pregnant women, impact on mother-to-child transmission of OPFRs, and harmful effects on fetal and pregnancy outcomes have not been evaluated. This review describes the exposure to OPFRs in pregnant women worldwide, based on metabolites of OPFRs (mOPs) in urine for prenatal exposure and OPFRs in breast milk for postnatal exposure. Predictors of maternal exposure to OPFRs and variability of mOPs in urine have been discussed. Mother-to-child transmission pathways of OPFRs have been scrutinized, considering the levels of OPFRs and their metabolites in amniotic fluid, placenta, deciduae, chorionic villi, and cord blood. The results showed that bis(1,3-dichloro-2-propyl) phosphate (BDCIPP) and diphenyl phosphate (DPHP) were the two predominant mOPs in urine, with detection frequencies of >90%. The estimated daily intake (EDIM) indicates low risk when infants are exposed to OPFRs from breast milk. Furthermore, higher exposure levels of OPFRs in pregnant women may increase the risk of adverse pregnancy outcomes and influence the developmental behavior of infants. This review summarizes the knowledge gaps of OPFRs in pregnant women and highlights the crucial steps for assessing health risks in susceptible populations, such as pregnant women and fetuses.

The Effect of 2016 Chinese second-child policy and different maternal age on pregnancy outcomes in Hebei Province, China

ObjectiveTo explore the effect of the 2016 Chinese second child policy and different maternal ages on adverse perinatal outcomes.MethodsClinical data were collected from 22 monitoring hospitals in Hebei Province from January 1, 2013, to December 31, 2021. A total of 413,892 parturient were divided into 3 groups based on delivery age: 20–34, 35–39, and 40–55 years old. The clinical data were analyzed to explore the relationship among the 2016 Chinese second-child policy, maternal age, and various pregnancy risks.ResultsPregnancy complications showed an upward trend from 2013 to 2021.The top 10 incidences of pregnancy complications in Hebei Province were anemia, small for gestational age (SGA), large for gestational age (LGA), macrosomia, gestational diabetes mellitus (GDM), premature delivery, preeclampsia (PE), postpartum hemorrhage (PPH), placenta previa, and placental abruption. The two-child policy was implemented in 2016. The incidence of pregnancy complications, anemia, GDM, PE, placental abruption, cesarean delivery, premature delivery, SGA, LGA, macrosomia in 2016–2021 was significantly higher than that in 2013–2015 (P<0.05), and the proportion of women of advanced maternal age (AMA, ≥ 35 years old) increased from 2013 to 2021. Advanced maternal age was a risk factor for most assessed adverse pregnancy outcomes, including GDM, PE, placenta previa, placenta abruption, cesarean delivery, PPH, premature delivery, SGA, LGA and macrosomia.ConclusionAfter the adjustment of the “second-child” policy, the incidence of pregnancy complications increased. Moreover, the risk of adverse pregnancy outcomes in AMA has increased. Early prevention and intervention should be implemented to cope with the occurrence of adverse perinatal outcomes.

Identifying, understanding and responding to domestic abuse in the perinatal period.

Domestic abuse often begins or escalates during the perinatal period, increasing the risk of adverse pregnancy outcomes and death of the woman and infant. The hidden nature of domestic abuse, compounded by barriers to disclosure, means many clinicians are likely to have unknowingly encountered a patient who is being abused and missed a vital opportunity for intervention. This educational article presents the experience of a woman who was abused during pregnancy. It describes how to facilitate a disclosure and conduct an assessment and illustrates safeguarding duties alongside interventions.

THE PREVALENCE OF MORPHOLOGICAL CHANGES IN OVARIES IN DIFFERENT AGE GROUPS WITH POLYCYSTIC OVARY SYNDROME

Background: Polycystic ovary syndrome (PCOS) is a common endocrinophathy disorder affecting reproductive aged women and frequently manifest during early reproductive age. It is a heterogeneous disorder, with multiple reproductive, cosmetic and metabolic complexities which is characterized by dysfunction in ovulation and clinical or biochemical hyperandrogenism and the presence of polycystic ovarian morphology. It is the most common endocrine cause of infertility, increased risk of adverse pregnancy outcome, metabolic syndrome, type 2 diabetes mellitus, and some carcinoma. For these reasons a correct and early diagnosis of this syndrome is fundamental, as it allows performing the most appropriate treatments and check-ups thus reducing the risk of developing all the complications related to it. Objectives: To measure the ovarian morphology in different age groups of adolescent and adult women with polycystic ovary syndrome. Methods: In this observational crossectional study 150 married or unmarried adolescent and adult women with PCOS were subdivided into three equal age-based groups of 50 each: 12 – 28 years (group 1), 29-36 years (group II) and 37-50 years (group III). The ovarian volume, ovarian area, ovarian stromal area, follicles count and size were determined by trans-abdominal and trans-vaginal scans. All statistical procedures were performed using SPSS 20.0 for Windows (IBM SPSS Statistics, IBM software). Values are expressed as mean ± standard deviation and compared by one-way Anova p&lt;0.05 is considered signicant. Test for normality was done using Kolmogorov-Smirnov test. Bonferroni correction for multiple comparisons was applied. Conclusion: In this study, ovarian area showed a positive correlation with age in women with polycystic ovaries. There were no signicant changes in ovarian volume, ovarian stromal area, and follicle count during reproductive ages until the perimenopause. It was observed a moderate negative correlation of age with follicle size.

Early pregnancy metabolic syndrome and risk for adverse pregnancy outcomes: findings from Rajarata Pregnancy Cohort (RaPCo) in Sri Lanka

BackgroundDespite the intergenerational effects of metabolic disorders, evidence is greatly lacking on early pregnancy metabolic syndrome (MetS) and its effects on pregnancy outcomes from low- and middle-income countries. Thus, this prospective cohort of South Asian pregnant women aimed to evaluate how early pregnancy MetS would affect pregnancy outcomes.MethodsA prospective cohort study was conducted among first-trimester (T1) pregnant women of Anuradhapura district, Sri Lanka recruited to the Rajarata Pregnancy Cohort in 2019. MetS was diagnosed by the Joint Interim Statement criteria before 13 weeks of gestational age (GA). Participants were followed up until their delivery, and the major outcomes measured were large for gestational age (LGA), small for gestational age (SGA), preterm birth (PTB) and miscarriage (MC). Gestational weight gain, gestational age at delivery and neonatal birth weight were used as measurements to define the outcomes. Additionally, outcome measures were re-assessed with adjusting fasting plasma glucose (FPG) thresholds of MetS to be compatible with hyperglycemia in pregnancy (Revised MetS).Results2326 T1 pregnant women with a mean age of 28.1 years (SD-5.4), and a median GA of 8.0 weeks (IQR-2) were included. Baseline MetS prevalence was 5.9% (n = 137, 95%CI-5.0–6.9). Only 2027 (87.1%) women from baseline, had a live singleton birth, while 221(9.5%) had MC and 14(0.6%) had other pregnancy losses. Additionally, 64(2.8%) were lost to follow-up. A higher cumulative incidence of LGA, PTB, and MC was noted among the T1-MetS women. T1-MetS carried significant risk (RR-2.59, 95%CI-1.65–3.93) for LGA, but reduced the risk for SGA (RR-0.41, 95%CI-0.29–0.78). Revised MetS moderately increased the risk for PTB (RR-1.54, 95%CI-1.04–2.21). T1-MetS was not associated (p = 0.48) with MC. Lowered FPG thresholds were significantly associated with risk for all major pregnancy outcomes. After adjusting for sociodemographic and anthropometric confounders, revised MetS remained the only significant risk predictor for LGA.ConclusionPregnant women with T1 MetS in this population are at an increased risk for LGA and PTB and a reduced risk for SGA. We observed that a revised MetS definition with lower threshold for FPG compatible with GDM would provide a better estimation of MetS in pregnancy in relation to predicting LGA.

Effect of Antimicrobial Exposure in Pregnancy on Adverse Pregnancy Outcomes and Admission Rate to the Neonatal Intensive Care Unit: A Multi-Center Cohort Study.

Antimicrobial agents are frequently prescribed during pregnancy. This study aims to explore the association between antimicrobial exposure and pregnancy outcomes. A multi-center retrospective cohort study of pregnant patients (n=370) was conducted in 22 tertiary hospitals in China. Adverse pregnancy outcomes and admission of neonate to neonatal intensive care unit (NICU) were considered as outcomes. The effect of antimicrobial exposure on pregnancy outcomes was assessed using a multivariate logistic regression model. Use of first-generation cephalosporins during pregnancy was associated with a significantly higher risk of adverse pregnancy outcomes (odds ratio [OR]: 3.64 [95% confidence interval, CI: 1.43-9.24], P = 0.007) and admission of neonate to the NICU (OR: 3.41, 95% CI: 1.37-8.53, P=0.009) compared with use of third-generation cephalosporins, after adjusting for gestational age of exposure to antimicrobial agents, cesarean section, and antimicrobial dose. Similarly, a higher risk of adverse pregnancy outcomes (OR: 14.76, 95% CI: 4.43-49.11) and neonatal NICU admission (OR: 11.74, 95% CI: 3.59-38.35) were observed among women with first-generation cephalosporins use compared with mothers with no antimicrobial use. Both first- and third-generation cephalosporins use was associated with an increased risk of adverse pregnancy and neonatal outcomes. In addition, first-generation cephalosporins were associated with an increased risk of those pregnant and neonatal outcomes, when compared with third-generation cephalosporins. We should require to determine the indications and contraindications for use of cephalosporins during pregnancy.

Systems Thinking Approach on Foetal Abnormalities Due to Alpha-Fetoprotein Level

Foetal complications due to abnormal Alpha-Fetoprotein (AFP) levels are becoming a serious matter. The risk of adverse pregnancy outcomes (APOs) is substantially greater in the raised maternal serum-alpha fetoprotein (MS-AFP) group than in the normal MS-AFP groups. The top three APOs in terms of occurrence rate in the increased MS-AFP group were structural foetal abnormalities, spontaneous abortion, and premature delivery. Low levels of AFP in the maternal may indicate a risk of Down syndrome. This is a critical matter that needs to be investigated and dealt with seriously, based on the systems thinking approach. This research aims to investigate screening methods on AFP foetal based on system thinking approach. The main purpose of the study is to provide an analytical and integrated approach to deal with foetal complications due to AFP level. This integrated approach comprises various analytical aspects, including conceptual framework, data analysis, evaluation of the screening methods. How systems thinking can contribute to improve all these aspects of foetal complications will be investigated. The methodology will enable to conduct a detailed explanation to the major problems of AFP in the form of a causal loop diagram based on the holistic view of the systems thinking approach. It is expected that the application of a systems approach could provide an effective method of analysis for understanding and managing the foetal abnormalities by considering all aspects in a holistic manner and clearer methods of intervention to reduce the cases.

The pre-pregnancy fasting blood glucose, glycated hemoglobin and lipid profiles as blood biomarkers for gestational diabetes mellitus: evidence from a multigenerational cohort study

Background Early prevention of gestational diabetes mellitus (GDM) is important to reduce the risk of adverse pregnancy outcomes and post-pregnancy cardiometabolic risk in women and offspring over the life course. This study aimed to investigate some blood biomarkers before pregnancy as GDM predictors. Methods We investigated the prospective association of blood biomarkers before pregnancy and GDM risk among women from the Mater-University of Queensland Study of Pregnancy (MUSP) cohort. A multiple logistic regression model was applied to estimate the odds of experiencing GDM by blood biomarkers. Results Out of 525 women included in this study, the prevalence of GDM was 7.43%. There was an increased risk of experiencing GDM among women who experienced obesity (Odds ratio = OR 2.4; 95% confidence interval = CI 1.6–3.7), had high fasting blood glucose (OR = 2.2; 95% CI = 1.3–3.8), high insulin (OR = 1.1; 95% CI = 1.0–1.2), high insulin resistance (OR = 1.2; 95% CI = 1.0–1.3) and low high-density lipoprotein (OR = 0.2; 95% CI = 0.1–0.7) before pregnancy. Adjustment for potential confounders, such as age, marital status, and BMI did not attenuate these associations substantially. Conclusion The pre-pregnancy fasting blood glucose, insulin, and insulin resistance were independent predictors of GDM. They may be used as early markers for predicting the incidence of GDM.