Risk Of Pregnancy Complications Research Articles

Associations between Historical Redlining and the Risk of Pregnancy Complications and Adverse Birth Outcomes in Massachusetts, 1995-2015.

Objective: To assess the impact of historical redlining on the risk of pregnancy complications and adverse birth outcomes in Massachusetts (MA) from 1995 to 2015. Methods: In total, 288,787 pregnant people from the MA Birth Registry had information on parental characteristics, pregnancy factors, and redlining data at parental residences at the time of delivery. Historic redlining data were based on MA Home Owners' Loan Corporation (HOLC) security maps, with grades assigned (A "best," B "still desirable," C "definitely declining," and D "hazardous"). We used covariate-adjusted binomial regression models to examine associations between HOLC grade and each chronic condition and pregnancy/birth outcome. Results: Living in HOLC grades B through D compared with A was associated with an increased risk of entering pregnancy with chronic conditions and adverse pregnancy/birth outcomes. The strongest associations were seen with pregestational diabetes (adjusted risk ratio [RR] Grade D: 1.7, 95% confidence interval [CI]: 1.3, 2.4) and chronic hypertension (adjusted RR Grade D: 1.5, 95% CI: 1.1, 1.9). Conclusions: Historical redlining policies from the 1930s were associated with adverse pregnancy outcomes and chronic conditions; associations were strongest for chronic conditions in pregnancy.

Practical weight management to minimize pregnancy complications and promote women's health: the possibility of interpregnancy care.

Pregnancy is an excellent opportunity to provide medical interventions to women. It is also a stress test used to predict health. Numerous studies have demonstrated that the pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) are critical factors for pregnancy complications such as hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), large or small gestational age infants, and spontaneous preterm birth (sPTB). These complications are associated with an increased risk of cardiovascular disease (CVD), which is a leading cause of mortality in women. In addition, complications adversely affect the short- and long-term prognoses of children. Optimal GWG to reduce complications is recommended based on pre-pregnancy BMI; however, racial differences should also be noted. The values in the Japanese guidelines are lower than those in the American Institute of Medicine guidelines. The Asian BMI thresholds for CVD risk are also lower than those in Europe. Therefore, weight management should be based on racial/genetic background. Interpregnancy weight gain or loss has also been reported to be associated with the risk of pregnancy complications; however, few studies have been conducted in Asian populations. Our previous reports suggested that avoiding an excess of 0.6 kg/m2/year of annual BMI gain may reduce the risk of HDP or GDM, and insufficient gain of < 0.25 kg/m2/year may increase sPTB recurrence. Annual BMI is useful for practical weight control during interpregnancy. Based on these findings, effective approaches should be established to improve the health of women and their offspring.

Ovulation induction and subfertile untreated conception groups offer improved options for interpreting risks associated with ART

PurposeTo identify and characterise appropriate comparison groups for population studies of health outcomes in ART-conceived births: ovulation induction (OI), subfertile untreated and fertile natural conceptions. Our secondary objective was to examine whether known risks of pregnancy complications and adverse birth outcomes in ART births are elevated in comparison with subfertile (untreated and OI) conception groups.MethodsWe linked State and Commonwealth datasets to identify all live and stillbirths (≥ 20 weeks) in Western Australia from 2003 to 2014 by method of conception. Demographic characteristics, maternal pre-existing conditions, adverse obstetric history and pregnancy complications were compared across conception groups. Generalised estimating equations were used to estimate adjusted risk ratios (aRRs) and 95% confidence intervals (CI) for pregnancy complications and birth outcomes in singletons.ResultsWe identified 9456 ART, 3870 OI, 11,484 subfertile untreated and 303,921 fertile naturally conceived deliveries. OI and subfertile untreated groups more closely resembled the ART group than the fertile group; however, some differences remained across parity, maternal age, pre-existing conditions and obstetric history. In multivariate analyses, ART singletons had greater risks of placental problems (e.g. placenta praevia aRR 2.42 (95% CI 1.82–3.20)) and adverse birth outcomes (e.g. preterm birth aRR 1.38 (95% CI 1.25–1.52)) than the subfertile untreated group, while OI singletons were more similar to the subfertile group with higher risk of preeclampsia and gestational diabetes.ConclusionOI and subfertile untreated conception groups offer improved options for interpreting health outcomes in ART births. Pregnancy complications (particularly placental disorders) and adverse outcomes at delivery are more common following ART.

Maternal Hemodynamics from Preconception to Delivery: Research and Potential Diagnostic and Therapeutic Implications: Position Statement by Italian Association of Pre-Eclampsia and Italian Society of Perinatal Medicine.

The Italian Association of Preeclampsia (AIPE) and the Italian Society of Perinatal Medicine (SIMP) developed clinical questions on maternal hemodynamics state of the art. AIPE and SIMP experts were divided in small groups and were invited to propose an overview of the existing literature on specific topics related to the clinical questions proposed, developing, wherever possible, clinical and/or research recommendations based on available evidence, expert opinion, and clinical importance. Draft recommendations with a clinical rationale were submitted to 8th AIPE and SIMP Consensus Expert Panel for consideration and approval, with at least 75% agreement required for individual recommendations to be included in the final version. More and more evidence in literature underlines the relationship between maternal and fetal hemodynamics, as well as the relationship between maternal cardiovascular profile and fetal-maternal adverse outcomes such as fetal growth restriction and hypertensive disorders of pregnancy. Experts agreed on proposing a classification of pregnancy hypertension, complications, and cardiovascular states based on three different hemodynamic profiles depending on total peripheral vascular resistance values: hypodynamic (>1,300 dynes·s·cm-5), normo-dynamic, and hyperdynamic (<800 dynes·s·cm-5) circulation. This differentiation implies different therapeutical strategies, based drugs' characteristics, and maternal cardiovascular profile. Finally, the cardiovascular characteristics of the women may be useful for a rational approach to an appropriate follow-up, due to the increased cardiovascular risk later in life. Although the evidence might not be conclusive, given the lack of large randomized trials, maternal hemodynamics might have great importance in helping clinicians in understanding the pathophysiology and chose a rational treatment of patients with or at risk for pregnancy complications. · Altered maternal hemodynamics is associated to fetal growth restriction.. · Altered maternal hemodynamics is associated to complicated hypertensive disorders of pregnancy.. · Maternal hemodynamics might help choosing a rational treatment during hypertensive disorders..

Pregnant women's attitudes and knowledge about oral health

Background: Good oral health of pregnant women is important for their own health and the health of the fetus and can reduce the risk of complications in pregnancy. The development of early childhood caries is associated with the transfer of bacteria from the mother's oral cavity, and there is a need to promote oral health during pregnancy and the perinatal period. Aim: This cross-sectional study aimed to evaluate attitudes and knowledge regarding oral health and infant oral health among pregnant women. Materials and methods: The study involved 130 pregnant women in the Republic of North Macedonia who completed an anonymous online questionnaire (Google Forms) from January to June 2022. The questionnaire was divided into three parts. The first part contained questions about the general demographic data of the respondents and their own experience with oral health in pregnancy. The second part was related to the knowledge of the relationship between oral health and pregnancy. The third section consisted of questions related to knowledge about the oral health of children at the earliest age. The results were analyzed with descriptive statistics. Results: The study involved 130 pregnant 19 to 42-year-old women. The women are most informed about oral health in pregnancy from their dentists (30.8 %), but least from doctors of family medicine (3.1%). In pregnancy, gingival bleeding was observed by 60.8 % of respondents, and tooth mobility by 22.3 %. The chi-square test found that there was a difference in attitude regarding the age at which they should stop breastfeeding between respondents who had their first pregnancy and those who already had children (Chi-square value =13.216, p = 0.004, p &lt; 0.05). Only 20.5 % of respondents are aware that breastfeeding can cause tooth decay. Linear regression analysis showed that pregnant women's knowledge about the association between pregnancy and periodontal diseases is statistically significantly positively associated with their gynecologist's advice to visit a dentist (β = 1.282, p ≤ 0.001). In addition, pregnant women's knowledge about children's oral health is statistically significantly negatively associated with women already having children (β = -0.693, p = 0.043). Conclusion: Pregnant women in the Republic of North Macedonia do not have sufficient knowledge, and they are neither aware of the importance of oral health during pregnancy nor infant oral health.

Continuous glucose monitoring in pregnancies with type 1 diabetes: small increases in time-in-range improve maternal and perinatal outcomes

BackgroundContinuous glucose monitors (CGM) provide detailed information regarding glycemic control in pregnant patients with type 1 diabetes (T1D). Little data have been published examining the association between CGM parameters and perinatal outcomes among gravidas with T1D using CGM. ObjectiveTo examine the association between perinatal outcomes and time-in-range (TIR) as assessed by CGM used in pregnant individuals with T1D. We hypothesized that higher TIR would be associated with lower risk of adverse perinatal outcomes. Study designThis multicenter retrospective cohort study included all gravidas with T1D using CGM who delivered in 2020-2022 at 5 University of California sites. Only those with CGM target range set to 70-140 mg/dL (±10 mg/dL) were included. TIR (%) was recorded at 12, 16, 20, 24, 28, and 32 weeks. The primary maternal and neonatal outcomes were preeclampsia and large for gestational age (LGA), defined as birthweight (BW) ≥ 95th percentile. Kruskal-Wallis tests were used to compared median TIR in those with and without the primary outcomes. Log-binomial regression was used to obtain risk ratios, with adjustment for microvascular disease and years with T1D. ResultsA total of 91 patients were included. Most used an insulin pump (81%) and did not have diabetic microvascular disease (72%). Median time since diagnosis of T1D was 16 years, and median periconception A1c was 6.7%. Compared to those with preeclampsia, normotensive gravidas had significantly higher TIR at nearly every time point. A similar pattern was seen for those with normal BW infants compared to LGA infants. On adjusted analyses, every 5-unit increase in TIR at 12 weeks was associated with a 45% and 46% reduction in the risk of preeclampsia and LGA, respectively (ARR 0.55, 95% CI 0.30-0.99 for preeclampsia; ARR 0.54, 95% CI 0.29-0.99 for LGA). ConclusionsHigher TIR is associated with lower risk of preeclampsia and LGA. This association is seen early in gestation, when each 5-unit increase in TIR is associated with ∼50% reduction in the risk of these complications. These findings can be used to counsel patients regarding risk of pregnancy complications at specific TIR values and to encourage patients that even small improvements in TIR can have significant impact on pregnancy outcomes. Larger studies are needed to further explore these findings and to identify optimal TIR to reduce perinatal complication rates.

Severe Maternal Morbidity According to Mode of Delivery Among Pregnant Patients With Cardiomyopathies

BackgroundWomen with cardiomyopathies are at risk for pregnancy complications. The optimal mode of delivery in these patients is guided by expert opinion and limited small studies. ObjectivesThe objective of this study is to examine the association of delivery mode with severe maternal morbidity events during delivery hospitalization and readmissions among patients with cardiomyopathies. MethodsThe Premier inpatient administrative database was used to conduct a retrospective cohort study of pregnant patients with a diagnosis of a cardiomyopathy. Utilizing a target trial emulation strategy, the primary analysis compared outcomes among patients exposed to intended vaginal delivery vs intended cesarean delivery (intention to treat). A secondary analysis compared outcomes among patients who delivered vaginally vs by cesarean (as-treated). Outcomes examined were nontransfusion severe maternal morbidity during the delivery hospitalization, blood transfusion, and readmission. ResultsThe cohort consisted of 2,921 deliveries. In the primary analysis (intention to treat), there was no difference in nontransfusion morbidity (adjusted OR [aOR]: 1.17; 95% CI: 0.91-1.51), blood transfusion (aOR: 1.27; 95% CI: 0.81-1.98), or readmission (aOR: 1.03; 95% CI: 0.73-1.44) between intended vaginal delivery and intended cesarean delivery. In the as-treated analysis, cesarean delivery was associated with a 2-fold higher risk of nontransfusion morbidity (aOR: 2.44; 95% CI: 1.85-3.22) and blood transfusion (aOR: 2.26; 95% CI: 1.34-3.81) when compared with vaginal delivery. ConclusionsIn patients with cardiomyopathies, a trial of labor does not confer a higher risk of maternal morbidity, blood transfusion, or readmission compared with planned cesarean delivery.

Clinical Factors for Predicting Pharmacotherapy in Twin Pregnancies Complicated by Gestational Diabetes Mellitus.

Controlling blood glucose levels is the main target in pregnant women with gestational diabetes mellitus (GDM). Twin pregnancies are offered the same screening selection and have the same diagnostic criteria as well as treatment of gestational diabetes as singleton pregnancies, even though the risks for pregnancy complications are increased. The aim of this study was to assess the association between predicting factors, OGTT glucose levels and pharmacotherapy requirements in twin pregnancies with GDM. This retrospective cohort study included 446 GDM patients with twin pregnancies (246 managed with lifestyle modifications and 200 requiring pharmacotherapy) over a time period of 18 years. An evaluation of maternal characteristics and a standardized 75 g oral glucose test (OGGT) for glucose concentrations at fasting, 1 h and 2 h were conduced. OGTT glucose levels at fasting (=0 min, p < 0.01) and 1 h (p < 0.01) were significantly associated with the later requirement of pharmacotherapy. Also, clinical risk factors (pre-pregnancy BMI p < 0.01, multiparity p < 0.05, GDM in previous pregnancy p < 0.01, assisted reproduction p < 0.05) showed a predictive accuracy for insulin therapy in twin pregnancies complicated by GDM, whereas age and chorionicity had no effect. OGTT glucose measures in addition to clinical risk factors are promising variables for risk stratification in mothers with GDM and twin pregnancy.

Navigation of Knowledge: the Impact of COVID-19 on Pregnancy-a Bibliometric Analysis.

Since the outbreak of COVID-19, countries around the world have faced huge economic and social burdens. SARS-COV-2 may exist in nature for a long time due to the diversity of its different variants. Pregnant women and newborns as vulnerable groups will suffer serious health threats. Bibliometrics as a method of summarizing publications can be used to extract important achievements and hot topics in this field. We search the target publications from the Web of Science Core collection database, and then use Microsoft Office Excel, CiteSpace, R, Scimago, and VOSviewer for visual analysis. Finally, we included 1709 publications from 2998 institutions in 104 countries. The number of publications has exploded since the COVID-19 pandemic in 2019. Among them, the USA, China, Britain, and Italy have higher quantity and quality. We identified important journals, authors, keywords, and references in this field. Anxiety, stress, risk of pregnancy complications, and vaccine safety and acceptance have received extensive attention from scholars during the COVID-19 pandemic and will continue to be urgent issues to be addressed in the future. Most of the current studies fall into the category of case reports and clinical data analysis. COVID-19 has been linked to serious pregnancy complications and mental illness, and vaccination during pregnancy is recommended to protect both mother and fetus. Further large-scale cohort studies and discovery of molecular mechanisms are needed in this field.

Cancer survivorship and risk of pregnancy complications, adverse obstetric outcomes, and maternal morbidities in female adolescents and young adults: a nationwide population-based study from Taiwan.

Cancer treatment in female adolescent and young adult (AYA) cancer survivors (i.e., those diagnosed between 15 and 39 years of age) may adversely affect multiple bodily functions, including the reproductive system. We initially assembled a retrospective, nationwide population-based cohort study by linking data from two nationwide Taiwanese data sets. We subsequently identified first pregnancies and singleton births to AYA cancer survivors (2004-2018) and select AYA without a previous cancer diagnosis matched to AYA cancer survivors for maternal age and infant birth year. The study cohort consisted of 5151 and 51,503 births to AYA cancer survivors and matched AYA without a previous cancer diagnosis, respectively. The odds for overall pregnancy complications (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.01-1.18) and overall adverse obstetric outcomes (OR, 1.07; 95% CI, 1.01-1.13) were significantly increased in survivors compared with matched AYA without a previous cancer diagnosis. Specifically, cancer survivorship was associated with an increased risk of preterm labour, labour induction, and threatened abortion or threatened labour requiring hospitalisation. AYA cancer survivors are at increased risk for pregnancy complications and adverse obstetric outcomes. Efforts to integrate individualised care into clinical guidelines for preconception and prenatal care should be thoroughly explored.

597-P: Effects of Exercise Interventions on Blood HbA1c and Lipid Concentrations in Healthy Pregnant Women—The FitMum RCT

Concentrations of maternal glucose and lipid during pregnancy affect both fetal growth and the risk of pregnancy complications. The aim of this study was to investigate the effect of two different exercise interventions on maternal blood HbA1c and lipid concentrations. Healthy pregnant women (n=219) were enrolled in the study at gestational age ≤15+0 weeks and randomized 2:2:1 to supervised exercise sessions three times per week, to a motivational group having seven counselling sessions on physical activity, or to standard care. Venous blood samples were drawn at 6+4 to 15+0 weeks, at 28+0-6 weeks, at 34+0-6 weeks and at delivery. HbA1c, total cholesterol, LDL-C and triglyceride concentrations were measured by standard biochemical methods and compared within and between groups using constrained linear mixed models. No differences in HbA1c or lipid concentrations between the groups were detected (Figure 1). Overall, HbA1c decreased from ≤15+0 to 28+0-6 weeks (p&amp;lt;0.001) and increased from ≤15+0 to 34+0-6 weeks (p=0.032). Overall, total cholesterol, LDL-C and triglyceride concentrations increased throughout pregnancy (all p&amp;lt;0.001 for ≤15+0 weeks vs. 28+0-6 weeks, 34+0-6 weeks and delivery). Exercise interventions did not affect maternal HbA1c or lipid concentrations during pregnancy. The overall pattern of changes during pregnancy resembled findings from previous studies. Disclosure I.K.B.Jensen: None. B.Stallknecht: None. T.D.Clausen: None. E.Løkkegaard: None. C.B.Roland: None. S.P.Knudsen: None. A.D.Jessen: None. S.A.Alomairah: None. O.H.Mortensen: None. L.J.Friis-hansen: None. J.M.Bendix: None. S.Molsted: None.

Platelet counts affect the association between hyperhomocysteinemia and pregnancy complications

BackgroundThe joint effect of platelet and other modifiers on the risk of pregnancy complications is unknown. This study investigated whether platelet count (PC) and total homocysteine (tHcy) level have a synergistic effect on the incidence of pregnancy complications in a Chinese population.MethodsTotal 11,553 consecutive pregnant women who received whole blood cell and biochemical tests at the time of admission for labor in Changzhou Maternal and Child Health Care Hospital were analyzed. The primary outcome was the prevalence of pregnancy complications: gestational diabetes mellitus (GDM), intrahepatic cholestasis of pregnancy (ICP), pre-eclampsia (PE), and pregnancy induced hypertension (PIH).ResultsThe prevalence of GDM, ICP, PE, and PIH was 8.4%, 6.2%, 3.4%, and 2.1%, respectively. The highest rate of ICP (28.6%) was observed in women with high tHcy (> 15 μmol/L) and low PC (quartile 1); and the lowest rate of GDM (0.6%) was found in women with high tHcy and high PC (quartiles 2 to 4). In low PC group, the prevalence of ICP in women with high tHcy was significantly higher than that in women with low tHcy (≤ 15 μmol/L) (28.6% vs. 8.4%), representing an absolute risk increment of 20.2% and a relative risk increment of 3.3-fold (OR: 3.34; 95% CI: 1.55, 7.17; P = 0.002), whereas no joint effect was observed among high PC group.ConclusionsAmong Chinese pregnant women, one subgroup (high tHcy and low PC) has the highest risk of ICP and another (high tHcy and high PC) has the lowest risk of GDM; tHcy and platelet could be used as indicators to identify the women with high risk of ICP or low risk of GDM.

Determination of distress, emotional eating and internalized weight bias levels of Turkish pregnant women

This study was conducted to determine the stress, emotional eating and weight bias levels of Turkish pregnant women. The study sample was composed of 210 pregnant women, who met the research inclusion criteria and admitted to the obstetrics and gynaecology outpatient clinics of Bingol Hospital for Obstetrics and Gynaecology. Research data were collected between December 2018 and June 2019, using face-to-face interview technique. Personal Information Form, Tilburg Pregnancy Distress Scale (TPDS), Internalised Weight Bias Scale (IWBS), and Emotional Eating sub-scale items of the Netherlands Eating Behaviour Questionnaire used to collect data. In our study, 47.9% of pregnant women were found to be overweight or obese according to the pre-pregnancy body mass index (BMI) average. Pregnant women experience a moderate level of stress, emotional eating and weight bias. It was found that there was a statistically significant relationship between the weight bias score averages and the emotional eating and stress score averages of the pregnant women (p < .05). In our study, stress, emotional eating and weight bias score averages of pregnant women in the 3rd trimester were found to be higher than that of the pregnant women in the 2nd trimester (p < .05). It has been determined that nearly 1in 2 pregnant women was overweight or obese, when BMI level of the women increased, weight stigma and emotional eating of them also increased. IMPACT STATEMENT What is already known on this subject? To be overweight or obese pre-pregnancy is risk for pregnancy complications and adverse birth outcomes. What do the results of this study add? It is important to inform nurses about the relationship between stress, weight bias, eating disorders, and obesity; moreover, care should be providing with the awareness that pregnant women with obesity are at greater risk in terms of these factors. It is of great importance to provide the necessary training and counselling by nurses to ensure the psychological adaptation of pregnant women to childbirth and the postpartum period. Besides, any disadvantage or disparity between overweight and obese pregnant women in the care process should be eliminated, and all pregnant women, regardless of their body size, should have equal access to supportive prenatal and postnatal care. What are the implications of these findings for clinical practice and/or further research? It is of great importance to providing training and consultation by nurses on coping with stress and stigma and eating during pregnancy in order to ensure psychological adjustment of the pregnant women to childbirth and the postpartum period, which are at risk in terms of stress, emotional eating and weight bias factors.

The Study on Stress and Related Factors Among Pregnant Women During the COVID-19 Pandemic in Tertiary Teaching Hospital

Covid 19 is one of the causes of stress among pregnant women. Stress increases the risk of complications in pregnancy and birth. The objectives were to assess the stress level among pregnant women attending Obstetrics and Gynecology Clinic at Hospital Sains Malaysia and find an association between stress levels during the COVID-19 pandemic and related factors (employment status, education level, and physical activity). The research design used in this study is cross-sectional - a self-administered questionnaire involving 207 pregnant mothers using simple random sampling methods. Most respondents had mild stress, 60.4%, followed by 39.6%, moderate and non-having high stress. There was a statistically significant association between stress level and employment status (p=0.003). Thus, early detection can prevent complications and enable mothers to go through pregnancy happily.

Open Questions on Gestational Diabetes Mellitus in Twin Pregnancies.

The concurrent, recent increase in prevalence of Gestational Diabetes Mellitus (GDM) and twin pregnancy, in combination with the shared risk factors, has led to speculation that multiples are a risk factor for GDM and, GDM may contribute to twin complications. Twin pregnancies have different physiology and greater obstetric risks compared to singletons, including prematurity and growth restriction. However, in twins methods of GDM screening, thresholds for diagnosis and treatment, as well as glycaemic control targets, have been predominantly extrapolated from singletons. Studies investigating the impact of GDM on pregnancy outcomes in twin pregnancies are conflicting. To provide a comprehensive, critical overview of evidence on GDM in twin pregnancies with an emphasis on prevalence, methods of screening, thresholds for diagnosis, risk of pregnancy complications and the impact of treatment on perinatal outcomes. Review of retrospective and prospective cohort, case-control, and case-series studies on twin pregnancies with GDM published between 1980 and 2021. Glucose tolerance in twin pregnancies is poorly studied. Specific guidance for screening, diagnosis, and treatment of GDM in twins is lacking. Studies evaluating pregnancy outcomes in twins with GDM are few and heterogeneous. The absolute risk of maternal complications is greater in twins with GDM compared to singletons; conversely, differences in risks between twins with and without GDM may be due to maternal confounders rather than to GDM. Most studies agree on a positive effect of GDM on neonatal outcomes in twins, likely mediated by the hyperglycaemia improving fetal growth. The impact of lifestyle-measures versus medical management on pregnancy outcomes in twins with GDM is unknown. Larger longitudinal studies evaluating glucose tolerance, pregnancy outcomes and the impact of treatment both in mono and di-chorionic twins with GDM are warranted to gain further insight into the pathophysiology of this condition and guide optimal management.

Nutritional status among pregnant adolescents at maternity teaching hospital

Background: Adolescent pregnancy increases nutritional requirements and the risk of pregnancy complications. There are few studies about anthropometric measurements as predictors of the nutritional status of pregnancy. Objective: The study consisted of an assessment of nutritional status by studying the association of anthropometric index and biochemical tests with adolescent pregnancy outcomes. Materials and Methods: A descriptive study included 116 convenient samples of pregnant adolescents. An interview questionnaire was used for collecting the following data: socio-demographic, body mass index (BMI), height, mid-upper arm circumference (MUAC), hemoglobin levels, and proteinuria. Pregnancy complications included; anemia, urinary tract infection, mode of delivery, preterm birth, and low birth weight. Descriptive statistics, Pearson's R test chi-square, and logistic regression were all used in statistical analysis. Results: The majority of study subjects were of late age of adolescence (≥ 17 years), housewives with primary education, and had normal obstetric history. Multigravida was only in late age of adolescence. Most 46.9% were overweight. Primigravida decrease in overweight subjects (odds ratio [OR] 0.2*; 95% confidence interval [CI] 0.03-0.88). The highest percentage had normal stature, 12.1% had short stature, 46.6 % had MUAC ˃28cm, and 3.4 % had undernutrition. Short stature increased at age 17 years and the risk of multipara increased in short stature (OR 4.2*; 95% CI 1.2-14.4). The majority had normal pregnancy outcomes. Anemia risk decreased in the normal height group (OR=0.08*: 95% CI 0.01-0.73), and in MUAC ≥ 28 cm (OR 0.77*; 95% CI 0.64-0,93). The risk of low birth weight increased not significantly in late age, among MUAC 24-28 cm, and significantly in anemia (OR=2.5*, 95% 1.1-5.5). Conclusion: This study concluded that the majority of the adolescents with primigravid/para status had normal nutritional status and pregnancy outcomes, as a result of growth in height, MUAC, and weight gain. malnutrition among overweight older adolescents with multigravida status affects growth, causes shorter stature, and anemia consequently increases the risk of low birth weight, preterm birth, and cesarian section. Because its effects manifest as teenage age increases in multigravida, this study supports the prevention of adolescent pregnancy. MUAC can be used to assess adolescent pregnancy complications.

Approach to the Patient: Management of Parathyroid Diseases Across Pregnancy.

Taking care of patients with parathyroid disorders during pregnancy requires consideration of the physiological fundamental changes in bone and mineral metabolism occurring in these women. Diagnostic and therapeutic procedures regarding primary hyperparathyroidism (PHPT) and hypoparathyroidism significantly differ from the nonpregnant population. PHPT should preferably be cured by parathyroidectomy before pregnancy since in women with hypercalcemic PHPT, maternal and fetal pregnancy complications seem to increase according to the degree of hypercalcemia. Parathyroidectomy, if needed during pregnancy, is preferentially performed in the second trimester. Conservative treatment is recommended for milder cases and is mainly restricted to hydration, with only limited evidence regarding drug treatment. Women with hypoparathyroidism can be informed that there are no major concerns regarding disease-associated infertility and that the risk of pregnancy complications is low if the disease is properly managed. Regular active surveillance is recommended, as requirements for calcium and active vitamin D may change during the course of pregnancy in either direction, with an overall trend for rather reduced doses. Any woman suffering from parathyroid disorders during pregnancy requires further surveillance in the postpartum period and during lactation, as there is an increased risk of hypercalcemia after delivery. Newborns of mothers with parathyroid diseases should, depending on disease severity, be carefully monitored for calcium levels in the first days (to weeks) after delivery since intrauterine exposure to hyper- or hypocalcemia may impact their postnatal regulation of calcium metabolism.

Perception of the impact of maternal weight on pregnancy outcomes in overweight and obese women

Objective The purpose of this study was to assess and compare knowledge, self-awareness, and accuracy of perceived risks and weight status among overweight and obese women. Methods This study was a secondary analysis of a cross-sectional questionnaire study of overweight and obese pregnant women who sought a routine first-trimester screening ultrasound. Those with a pre-pregnancy body mass index (BMI) ≥25 kg/m2 (calculated using self-reported height and weight) were included. Perceived associations between estimated weight category and risk of pregnancy complications were assessed and compared in the overweight and obese groups. The perceived weight category was compared to an estimated weight category. A logistic regression identified the demographic and medical factors associated with correct identification of risk factors. Results A total of 169 participants (88 overweight; 81 obese) were included. Most participants believed their weight did not impact the ultrasound detection of a fetal malformation (92.1% overweight vs. 55.6% obese, p < .01). Few participants associated their weight with pregnancy-related problems (6.8% overweight vs. 24.7% obese, p < .01). Most participants did not associate their weight with specific maternal complications (72.7% overweight vs. 45.7% obese, p < .01) and fetal complications (83.0% overweight vs. 71.6% obese, p = .08). More obese than overweight women underestimated their weight category (64.4% vs 41.3% overweight, p = .01). Women who correctly estimated their weight status, non-Hispanic participants, and those with a history of depression or at least one maternal co-morbidity were more likely to associate their weight with increased risk for pregnancy-related problems. Conclusion Although more obese than overweight women associated excess weight with pregnancy complications, both groups underestimated the impact on their pregnancies. Targeted educational programs are needed to improve the risk perception of these populations prior to pregnancy with the goal of improving their weight statuses and pregnancy outcomes.

Low Rates of Reproductive Counseling Documentation in Women With Interstitial Pneumonia With Autoimmune Features.

Women with interstitial pneumonia with autoimmune features (IPAFs), a subset of interstitial lung disease (ILD), are at risk for pregnancy complications. Family planning discussions improve pregnancy outcomes in women with ILD. The objective of this study was to evaluate the documentation of reproductive counseling in IPAF female patients of childbearing age by pulmonary and rheumatology providers at an academic medical center. We conducted a medical record review study of pulmonary and rheumatology encounters in reproductive-aged women with IPAF to evaluate documentation of family planning discussions and contraceptive use. We used nonparametric measures of association and logistic regression to evaluate the relationship between patient characteristics and the presence of reproductive counseling documentation by providers. Thirty-one women met IPAF classification and were ≤50 years at initial ILD clinic visit. Twenty-five (81%) of these women had risk factors for adverse pregnancy outcomes. Ten women (32%) had a record of reproductive counseling during any visit with their pulmonary provider. Of the 21 patients who also saw a rheumatology provider, 12 (57%) women had a record of reproductive counseling during any visit with their rheumatology provider. No baseline characteristics were associated with odds of reproductive counseling documentation. Neither pulmonary nor rheumatology providers consistently discussed family planning/contraceptive use with reproductive-aged women with IPAF. There was a trend for rheumatology providers to discuss reproductive issues with IPAF patients more frequently than pulmonary providers. Efforts should focus on educating providers about the need for reproductive counseling in women with IPAF of childbearing age.

Impact of prepregnancy body mass index on adverse pregnancy outcomes: analysis from the Longitudinal Indian Family hEalth cohort study

BACKGROUNDBoth high and low maternal prepregnancy body mass index can lead to suboptimal fetal growth and risk of pregnancy complications. In developed countries, nearly half of all women of childbearing age are either overweight or obese, and most data linking maternal body mass index and adverse pregnancy complications are limited to these populations. OBJECTIVEThis study aimed to prospectively evaluate the relationships between prepregnancy body mass index and adverse pregnancy outcomes using the Longitudinal Indian Family hEalth (LIFE) study. STUDY DESIGNWe modeled the relationships between prepregnancy body mass index and adverse pregnancy outcomes such as low birthweight, preterm birth, cesarean delivery, intrauterine growth restriction, miscarriage, and fetal death among 675 women aged 15 to 35 years with singleton pregnancies in the Longitudinal Indian Family hEalth study, a population-based prospective pregnancy cohort study conducted in Telangana, India. Prepregnancy body mass index was calculated as weight in kilograms divided by height in meters squared and was classified into 4 categories using the World Health Organization recommendations for Asian adults. Prepregnancy body mass index was assessed at a mean of 12.3 months before pregnancy. Odds ratios and 95% confidence intervals of adverse pregnancy outcomes were modeled and adjusted for confounders. RESULTSObese women had a 3-fold increased risk of cesarean delivery (odds ratio, 3.13; 95% confidence interval, 1.56–6.29) compared with normal-weight women. Those who were overweight also had a marginally increased risk of cesarean delivery, albeit not statistically significant (odds ratio, 1.17; 95% confidence interval, 0.61–2.24). Underweight women had a modestly increased risk of low birthweight, compared with normal-weight women (odds ratio, 1.12; 95% confidence interval, 0.71–1.77), although results were not significant. Conversely, obese (odds ratio, 0.71; 95% confidence interval, 0.28–1.77) and overweight (odds ratio, 0.61; 95% confidence interval, 0.24–1.51) women had a marginally decreased risk of low birthweight. CONCLUSIONOur data suggest that women with elevated prepregnancy body mass index may have a higher risk of adverse pregnancy outcomes, especially cesarean delivery. Although this study has limited generalizability, our findings are generalizable to rural to periurban regions of India. Further studies exploring the translatability of these findings to other populations are needed. In addition, targeted prepregnancy intervention studies and programs that include counseling on optimization of preconception health and lifestyle modification for improvement of subsequent pregnancy outcomes among overweight and obese women are needed.