Risk Of Intrauterine Growth Restriction Research Articles

The Association between Maternal Dietary Iron Intake during the First Trimester of Pregnancy with Pregnancy Outcomes and Pregnancy-Related Complications.

In this study, we investigated the associations of maternal dietary iron intake during the first trimester of pregnancy and pregnancy outcomes and related complications in pregnant women of Isfahan, Iran. In this prospective study, 812 healthy first-trimester singleton pregnant women were selected randomly from 20 various health centers across Isfahan city during 2015–2016. The maternal dietary iron classified into 2 groups, including heme and non-heme iron. Factors including pre-eclampsia, gestational hypertension, gestational diabetes mellitus, intrauterine growth restriction (IUGR), and nausea and vomiting in pregnancy considered as the pregnancy-related complications. Infant's birth weight, birth height, and birth head circumference were also determined as the pregnancy-outcomes. There was a significant association between total iron consumption and infant head circumference (p = 0.01). Total maternal iron (the sum of heme and non-heme iron) was negatively associated with both infant's birth height (p = 0.006) and birth weight (p = 0.02). Non-heme iron consumption is positively associated with high-risk of IUGR (p = 0.004). Heme intake was associated with an increased risk of maternal fasting blood sugar (FBS) (p = 0.04). Higher heme, non-heme, and total iron intake were associated with lower risk of pre-eclampsia (heme: crude p = 0.05; non-heme iron: adjusted p = 0.02; total iron: adjusted p = 0.05). Maternal total iron intake was directly associated with infant head circumference, whereas, negatively associated with both birth weight and birth height. High non-heme iron intake may increase the risk of IUGR, and a high intake of heme iron may increase FBS.

An Overview of Prophylactic Acetylsalicylic Acid for the Prevention of Intra-uterine Growth Restriction (IUGR) in Women at Risk for Preeclampsia

Background: Preeclampsia is a major global cause of maternal, neonatal and perinatal mortality. The aim of this review was to summarize all reviews on Acetylsalicylic Acid for the prevention of Intra-uterine Growth Restriction (IUGR) in women at risk for Preeclampsia. Materials and Methods: In this overview we searched databases following Medline, Scopus, EMBASE, Central Records Central Register Cochrane and the Web of Science databases for finding related articles regarding Acetylsalicylic Acid on the prevention of IUGR in women at high risk for Preeclampsia. Search was conducted from 1996 to 5 April 2019 with English keywords. Any meta-analysis (published or unpublished), was eligible for inclusion. No language restriction was imposed. Results: Finally eight meta-analysis were included in the review. Acetylsalicylic acid begun at 16≤weeks significantly reduced IUGR in women; but it was not effective in the subgroups of women who took acetylsalicylic acid when they had gestational age of more than 16 weeks. One meta-analysis showed that acetylsalicylic acid was superior to control group in decreasing of IUGR in East Asians (OR=0.36); while no significant effectiveness was observed in non-East Asians (OR = 0.85). According to one meta-analysis, a dose-response effect of acetylsalicylic acid (p=0.04) on IUGR was observed if it was begun at 16≤ weeks. However, a dose-response effect (p= 0.95) was not seen if women started acetylsalicylic acid when they were in gestational age more than 16 weeks. Conclusion: Acetylsalicylic acid has decreased the incidence of IUGR if administrated before or at 16 weeks. Acetylsalicylic acid was superior to control group in decreasing IUGR risk in East Asians but not in non-East Asians.

Pregnancy outcomes in women with primary systemic vasculitis: a retrospective study

Background/aims Pregnancies in women with systemic vasculitis constitute high-risk pregnancies, and outcomes vary based on the size of the affected blood vessels. Currently, there is limited data describing pregnancy outcomes in these women. The aim of this paper is to evaluate pregnancy outcomes in women with large, medium, or small vessel vasculitis to aid preconceptional counseling and inform antepartum and intrapartum care. Methods We included all women with large-, medium-, or small-vessel vasculitis and documented pregnancies attending high-risk pregnancy clinics at Mount Sinai Hospital, Toronto, Canada between 2001 and 2016. Pregnancy characteristics and outcomes were reported as proportions. Maternal, fetal/neonatal, and obstetric outcomes, stratified by type of vasculitis, were the main outcomes measured. Results We identified 60 pregnancies in 50 women with systemic vasculitis. These included large-vessel (n = 10), medium-vessel (n = 5), small-vessel [n = 30, of which 16 were AntiNeutrophil Cytoplasmic Autoantibody (ANCA)-associated and 14 were immune-complex mediated], central nervous system (n = 3), and retinal (n = 2). Although vasculitis flares occurred with large-vessel (3/12), small-vessel (13/36), and retinal (2/3) vasculitis, only one was severe and involved hemoptysis requiring blood transfusion in a woman with ANCA-associated vasculitis. Preeclampsia complicated two pregnancies each with large- (25%) and small- (6%) vessel vasculitis. Intrauterine growth restriction (IUGR) only occurred with small-vessel vasculitis (10, 29.4%). Although seven (26.4%) viable pregnancies resulted in preterm birth, the mean gestational age was over 35 weeks. Conclusion Although women with systemic vasculitis can have successful pregnancies, they are at increased risk for late preterm birth. In addition, those with small-vessel vasculitis are at increased risk for IUGR and vasculitis flares.

Renal Disease

Renal disease can lead to significant complications during pregnancy, both for mother and child, and must be managed appropriately and efficiently. Recommended intervention depends on the severity and the underlying cause, as well as the acute versus chronic nature of the disease, and should involve optimization both prior to and during pregnancy. With suboptimal treatment, chronic kidney disease can progress to end-stage renal disease necessitating dialysis. Furthermore, renal disease has a negative effect on the fetus including an increase in the risk of intrauterine growth restriction, preterm delivery, and fetal loss. Urolithiasis and pyelonephritis are not uncommon in pregnancy and require special attention. The diagnosis of urolithiasis is complicated, as ultrasonography is the safest modality for the developing fetus but is also associated with a substantial false-negative rate. Although the majority of stones will pass without intervention, some may require the placement of ureteral stents or manual extraction. It is unclear whether urolithiasis itself has a negative impact on pregnancy, as the data are conflicting; however, pyelonephritis has been shown to cause an increase in delivering a fetus with low birth weight and spontaneous preterm birth. Therefore, all urinary tract infections are treated aggressively during pregnancy. This review contains 5 figures, 6 tables, and 43 references. Key Words: acute kidney injury, chronic kidney disease, dialysis, end-stage renal disease, lupus nephritis, pyelonephritis, renal transplant, urolithiasis

Umbilical arterial Doppler ultrasonography predicts late pregnancy outcomes in patients with lupus nephritis: a multicenter study from southern China.

To investigate the fetal adverse pregnancy outcomes (APOs) and the predictive value of umbilical arterial Doppler ultrasonography in the third trimester in pregnant women with lupus nephritis (LN). A retrospective cohort study enrolling 203 LN patients from 2007 to 2017 was performed. Ultrasonic parameters were recorded. Fetal APOs occurred in 103 patients (103/203, 50.7%). Sixty-six pregnancies (66/203, 32.5%) ended with preterm births. The incidence rate of intrauterine growth restriction (IUGR) was 18.2% (37/203). Fetal distress was noted in 23 pregnancies (23/203, 11.3%). All the Doppler parameters elevated in patients with IUGR, fetal distress, and composite conditions. Resistance index (RI) indicated the highest risk of IUGR and composite APOs. The cutoff values were 0.66 and 0.67, respectively. Sensitivities were 51.4% and 33.7%, and specificities were 87.4% and 92.1%. Peak velocity of the umbilical arteries at end-systole (Vmax, abbreviated as S) to that at end-diastole (Vmin, abbreviated as D) (S/D) ratio was also a best predictor for IUGR, with the optimal cutoff value of 2.88. Sensitivity and specificity were comparable with RI. Pulsatility index (PI) over 0.84 was an ideal indicator for fetal distress with an optimal combination of sensitivity (89.5%) and specificity (51.6%). Fetal complications were frequent in patients with LN. Umbilical arterial Doppler ultrasonography was a useful measure to predict late IUGR, fetal distress, and the composite APOs.

Placenta previa and the risk of intrauterine growth restriction (IUGR): a systematic review and meta-analysis

Background Whether placental location confers specific neonatal risks is controversial. In particular, whether placenta previa is associated with intra-uterine growth restriction (IUGR)/small for gestational age (SGA) remains a matter of debate. Methods We searched Medline, EMBASE, Google Scholar, Scopus, ISI Web of Science and Cochrane database search, as well as PubMed (www.pubmed.gov) until the end of December 2018 to conduct a systematic review and meta-analysis to determine the risk of IUGR/SGA in cases of placenta previa. We defined IUGR/SGA as birth weight below the 10th percentile, regardless of the terminology used in individual studies. Risk of bias was assessed using the Cochrane Handbook for Systematic Reviews of Interventions. We used odds ratios (OR) and a fixed effects (FE) model to calculate weighted estimates in a forest plot. Statistical homogeneity was checked with the I2 statistic using Review Manager 5.3.5 (The Cochrane Collaboration, 2014). Results We obtained 357 records, of which 13 met the inclusion criteria. All study designs were retrospective in nature, and included 11 cohort and two case-control studies. A total of 1,593,226 singleton pregnancies were included, of which 10,575 had a placenta previa. The incidence of growth abnormalities was 8.7/100 births in cases of placenta previa vs. 5.8/100 births among controls. Relative to cases with alternative placental location, pregnancies with placenta previa were associated with a mild increase in the risk of IUGR/SGA, with a pooled OR [95% confidence interval (CI)] of 1.19 (1.10-1.27). Statistical heterogeneity was high with an I2 = 94%. Conclusion Neonates from pregnancies with placenta previa have a mild increase in the risk of IUGR/SGA.

Comparative analyses of umbilical cord lead concentration in term and IUGR complicated neonates

Background Lead as a toxic heavy metal can readily transfer through the placenta; this condition may increase the risk of lead toxicity for a developing fetus. Therefore, we undertook this study to evaluate the association between umbilical cord blood lead levels and the risk of intrauterine growth restriction (IUGR) occurrence. Methods A cross-sectional study was done at an academic hospital (Tehran, Iran, 2017). The population study was term and IUGR complicated neonates. Immediately after birth, 3-ml umbilical cord blood was collected in some tubes and sent to a laboratory to assay plasma lead levels. Demographic data related neonates and their mothers were gathered from the medical record. All recorded data were analyzed to compare the cord blood lead levels among normal term and IUGR neonates as the primary outcome. Results Totally 152 neonates, 76 in each group with inclusion criteria entered the study. Of all neonates, 71 subjects (47%) were male. The mean (±SD) cord blood lead levels was 6.5 ± 4.2 µg/l. Of all neonates, 102 (67.1%) had high cord blood lead levels (≥5 µg/dl) and 50 subjects (32.8%) had low cord blood lead levels (<5 µg/dl). The mean gestational age, birth weight and head circumference of term neonates were significantly higher than IUGR complicated neonates (p-value = .0001). On the other hand, no significant difference was observed between two groups regarding the mean cord blood lead concentrations (6.2 ± 2.2 and 6.8 ± 5.6 µg/dl; p-value = .855). ANOVA analyses showed no relationships between cord blood lead levels and all assessed qualitative variables except from mother’s educational status (in IUGR group; p-value = .048 and in term group; p-value = .010). Conclusion Our results highlighted that IUGR occurrence was not associated with fetal blood lead levels alone. Moreover, highly educated mothers had neonates with low blood lead levels, showing that maternal education may be a potentially protective factor against this toxin exposure in newborns. The majority of neonates in the present study had high blood lead concentrations that show a necessity for more efforts and strategies regarding protection against potential deleterious effects of lead toxicity.

The effects of zinc supplementation on clinical response and metabolic profiles in pregnant women at risk for intrauterine growth restriction: a randomized, double-blind, placebo-controlled trial

Objective This investigation was conducted to assess the effects of zinc supplementation on clinical response and metabolic status among pregnant women at risk for intrauterine growth restriction (IUGR). Methods This randomized, double-blind, placebo-controlled, clinical trial was conducted among 52 women at risk for IUGR according to abnormal uterine artery Doppler waveform. Participants were randomly assigned to take either 233 mg zinc gluconate (containing 30 mg zinc) supplements (n = 26) or placebo (n = 26) for 10 weeks from 17 to 27 weeks of gestation. Fasting blood samples were taken at baseline and after the 10-week treatment to quantify related variables. Results After the 10-week intervention, taking zinc led to a significant reduction in serum high-sensitivity C-reactive protein (hs-CRP) (β ‒1.17 mg/L; 95% CI, −1.77, −0.57; p < .001) and plasma malondialdehyde (MDA) levels (β −0.23 µmol/L; 95% CI, −0.45, −0.02; p = .03); also a significant rise in total antioxidant capacity (TAC) (β 59.22 mmol/L; 95% CI, 25.07, 93.36; p = .001) was observed in comparison to placebo. In addition, zinc supplementation significantly reduced serum insulin (β –1.33 µIU/mL; 95% CI, −2.00, −0.67; p < .001) and insulin resistance (β –0.30; 95% CI, −0.44, −0.15; p < .001), and significantly increased insulin sensitivity (β 0.008; 95% CI, 0.003, 0.01; p < .001) compared with the placebo. Zinc supplementation did not influence pulsatility index (PI) and other metabolic parameters. Conclusions Overall, zinc supplementation in pregnant women at risk for IUGR had beneficial effects on TAC, MDA, hs-CRP, and insulin metabolism, but did not affect PI and other metabolic profiles.

Pharmacological activation of peroxisome proliferator-activated receptor γ (PPAR-γ) protects against hypoxia-associated fetal growth restriction.

The hypoxia of high-altitude (HA) residence increases the risk of intrauterine growth restriction (IUGR) and preeclampsia 3-fold, augmenting perinatal morbidity and mortality and the risk for childhood and adult disease. Currently, no effective therapies exist to prevent these vascular disorders of pregnancy. The peroxisome proliferator-activated receptor γ (PPAR-γ) is an important regulator of uteroplacental vascular development and function and has been implicated in the pathogenesis of IUGR and preeclampsia. Here, we used a model of HA pregnancy in mice to determine whether hypoxia-induced fetal growth restriction reduces placental PPAR-γ protein expression and placental vascularization and, if so, to evaluate the effectiveness of the selective PPAR-γ agonist pioglitazone (PIO) for preventing hypoxia-induced IUGR. Hypoxia resulted in asymmetric IUGR, placental insufficiency, and reduced placental PPAR-γ expression; PIO prevented approximately half of the fetal growth restriction and attenuated placental insufficiency. PIO did not affect fetal growth under normoxia. Although PIO was beneficial for fetal growth, PIO treatment reduced placental vascular density of the labrynthine zone in normoxic and hypoxic (Hx) conditions, and mean vascular area was reduced in the Hx group. Our results suggest that pharmacological PPAR-γ activation is a potential strategy for preventing IUGR in pregnancies complicated by hypoxia, although further studies are needed to identify its likely metabolic or vascular mechanisms.-Lane, S. L., Dodson, R. B., Doyle, A. S., Park, H., Rathi, H., Matarrazo, C. J., Moore, L. G., Lorca, R. A., Wolfson, G. H., Julian, C. G. Pharmacological activation of peroxisome proliferator-activated receptor γ (PPAR-γ) protects against hypoxia-associated fetal growth restriction.

A comparison of obstetric outcomes in adolescent pregnancies and adult pregnancies

Introduction: Adolescent pregnancies are associated with adverse maternal and fetal outcomes including preeclampsia, preterm birth, and fetal growth restriction compared to adult pregnancies. The purpose of our study is to compare the incidents of obstetric outcomes between the adolescent pregnancies and adult pregnancies.Materials and methods: This retrospective case-control study was conducted between January 2013 and January 2018 at Kanuni Sultan Suleyman Research and Training Hospital, Istanbul, Turkey. The institutions’ medical records were screened for women with pregnancies after 24 weeks of gestation. Women under 19 years of age were included as the adolescent group and women between the ages of 20 and 29 were included as the control group. Obstetric outcomes were compared between the groups.Results: There were 3875 adolescent pregnancies in the case group and 3875 adult pregnancies in the control group. Even after adjusting for confounders in our adolescent pregnant cohort, the odds of intrauterine growth restriction, preterm birth and premature rupture of membranes were higher than in our adult pregnant cohort. On the other hand, we found low incidents of preeclampsia and gestational diabetes mellitus in pregnant women younger than 19 years of age.Conclusions: Adolescent pregnancies should be closely followed up as they have higher preterm birth rates as well as the risk of intrauterine growth restriction.

Prenatal exposure to particulate matter and ozone: Bulky DNA adducts, plasma isoprostanes, allele risk variants, and neonate susceptibility in the Mexico City Metropolitan Area

Mexico City's Metropolitan Area (MCMA) includes Mexico City and 60 municipalities of the neighbor states. Inhabitants are exposed to emissions from over five million vehicles and stationary sources of air pollutants such as particulate matter (PM) and ozone. MCMA PM contains elemental carbon and organic carbon (OC). OCs include polycyclic aromatic hydrocarbons (PAHs), many of which induce mutagenic and carcinogenic DNA adducts. Gestational exposure to air pollution has been associated with increased risk of intrauterine growth restriction, preterm birth or low birth weight risk, and PAH-DNA adducts. These effects also depend on the presence of risk alleles. We investigated the presence of bulky PAH-DNA adducts, plasma 8-iso-PGF2α (8-iso-prostaglandin F2α ) and risk allele variants in neonates cord blood and their non-smoking mothers' leucocytes from families that were living in a highly polluted area during 2014-2015. The presence of adducts was significantly associated with both PM2.5 and PM10 levels, mainly during the last trimester of gestation in both neonates and mothers, while the last month of pregnancy was significant for the association between ozone levels and maternal plasma 8-iso-PGF2α . Fetal CYP1B1*3 risk allele was associated with increased adduct levels in neonates while the presence of the maternal allele significantly reduced the levels of fetal adducts. Maternal NQO1*2 was associated with lower maternal levels of adducts. Our findings suggest the need to reduce actual PM limits in MCMA. We did not observe a clear association between PM and/or adduct levels and neonate weight, length, body mass index, Apgar or Capurro score. Environ. Mol. Mutagen. 60:428-442, 2019. © 2019 Wiley Periodicals, Inc.

Inadequate maternal weight gain in the third trimester increases the risk of intrauterine growth restriction in rural Bangladesh.

ObjectiveTo estimate the effect of inadequate maternal weight gain in the third trimester on the risk of intrauterine growth restriction (IUGR) in rural Bangladesh.MethodsThis study analyzed data from 1,463 mother-infant pairs in Matlab, Bangladesh which were available through the electronic databases of Matlab Health and Demographic Surveillance System and Matlab hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). All the mothers were admitted to Matlab hospital for childbirth from January 2012 to December 2014, and they had singleton live births at term. Third-trimester weight gain (kg) was calculated by subtracting the estimated weight at the end of the second trimester from the weight taken before childbirth. Inadequate third-trimester weight gain was defined as 4 kg or less irrespective of pre-gravid nutritional status. IUGR was defined as a birth weight below 2500 g in full-term newborns (LBW-Term), and a birth weight for gestational age and infant sex less than the 10th percentile (SGA-10th) and 2 standard deviations below the mean birth weight (SGA-2SD) based on the international newborn standards from the INTERGROWTH-21st project. Multivariable logistic regression models were fitted to determine the independent effect of inadequate weight gain in the third trimester on the risk of IUGR.ResultsA total of 824 (56.3%) women experienced inadequate weight gain in the third trimester of pregnancy. In this study, 215 (14.7%), 573 (39.2%) and 220 (15.0%) infants were born as LBW-Term, SGA-10th and SGA-2SD, respectively. In the multivariable logistic regression models, compared to adequate weight gain in the third-trimester, the odds ratios (OR) for LBW-Term, SGA-10th and SGA-2SD for inadequate weight gain were 1.8 (95% CI: 1.3, 2.5; p < 0.001), 1.4 (95% CI: 1.1, 1.8; p = 0.002) and 1.8 (95% CI: 1.3, 2.4; p = 0.001), respectively.ConclusionsBoth inadequate third-trimester weight gain and IUGR are prevailing public health concerns in rural Bangladesh. Inadequate weight gain in the third trimester substantially increased the risk of IUGR. Public health programs focusing on the promotion of adequate weight gain in the third trimester of pregnancy with an ultimate aim to decrease IUGR should be implemented.

Obstetrical complications of thin endometrium in assisted reproductive technologies: a systematic review.

The aim of the systematic review is to describe the obstetrical complications associated with pregnancies in the context of a thin endometrial lining. Systematic review of the literature. Patients who conceive in the setting of a thin endometrium have a significantly increased risk of early pregnancy loss, namely miscarriage and ectopic pregnancy. These patients also have a twofold increase in low birth weight and preterm delivery, as well as a significantly higher risk of intrauterine growth restriction and composite adverse perinatal outcomes. In addition to the lower probability of conception, a thin endometrium in assisted reproductive technologies appears to be associated with both early and late pregnancy complications. These pregnancies thus warrant special attention and close follow-up from obstetricians.

The effect of placenta abruption on the risk of intrauterine growth restriction: A meta-analysis

There is a contradict findings on the effect of placenta abruption on the risk of intrauterine growth restriction (IUGR). Therefore, the objective of present meta-analysis was to identify all the eligible studies to assess the effect of placenta abruption on the risk of IUGR. The major electronic databases, including PubMed, Scopus and Web of Science, were searched to identify relevant published studies. The literature search included 551 articles until January 2018 with 35,201 participants. In the end, a total of seven references were remained for this meta-analysis. Two independent authors reviewed the retrieved the studies and extracted data. I2 statistics was used to assess of heterogeneity. The random effects model was conducted to assess pooled effects size. the results of study showed that placenta abruption has a significant effect on the risk of IUGR based on odds ratio results (2.06; 95% confidence interval: 1.57, 2.55). The result reported of the measure of effect was homogeneous (I2 = 0.0%). we presented based on reports in epidemiological studies that placenta abruption is a risk factor for IUGR.

Comparative Analysis of Automated Applications using Fetal Ultrasound Images

Computer-assisted technology plays an important role in helping to reduce risk during pregnancy, particularly serious risks associated with intra-uterine growth restriction (IUGR). Fetal gestational age estimation and fetal weight estimation are two crucial factors in evaluating fetal growth and detecting any abnormality of growth, in order to identify IUGR risk to the fetus. The estimation is made through serial measurement of fetal anatomy comprising the length, diameter and circumference of multiple segments in the fetus scanned through an ultrasound machine. The computing method helps to overcome human subjectivity in assessment that is prone to variability in measurement. Automatic measurement methods carried out by the computer can help in producing fast, accurate and reproducible measurement and assessment of the fetal anatomy. This study presents an analysis of techniques attempted by researchers in conducting automated fetal biometric anatomy measurements using ultrasound images. Chronological comparative analysis presented in this paper will aid other researchers who are keen to explore on computer-assisted technology especially in the field of fetal ultrasound imaging.

Should Women with Sickle Cell Disease be Administered Prophylactic Transfusions to Avoid Complications during Pregnancy?

BACKGROUNDIncreasing numbers of women with sickle cell disease (SCD) are reaching reproductive age. There is an array of possible pregnancy outcomes that women with SCD may experience. Many have described adverse maternal and fetal outcomes in pregnant patients with SCD including increased risk of pre-eclampsia, infections, painful vaso-occlusive crises as well as increased risk of intrauterine growth restriction, pre-term delivery and pregnancy loss. Not all women with SCD have complicated pregnancies, however. Limited data are available to categorize the proportion of patients who have uncomplicated pregnancies and protective characteristics for good pregnancy outcomes. Identifying these features potentially informs practice and reduces exposure to blood products as red blood cell (RBC) transfusion is associated with an increased risk of alloimmunization, particularly in pregnancy. OBJECTIVETo determine the proportion and characteristics of pregnant patients with SCD who have uncomplicated pregnancies. METHODSWe retrospectively reviewed medical records of pregnant women with SCD from 1980 to 2018 at Mount Sinai Hospital, a university affiliated tertiary care centre in Toronto, Canada. We defined a pregnancy to be uncomplicated if the pregnancy was not associated with a hospitalization, RBC transfusion was not administered peripartum and/or the delivery was at term (37 or more weeks gestation). RESULTSA total of 179 pregnancies were included (Figure 1). Preliminary results show that 57% of pregnancies had hemoglobin SS disease. The median maternal age was 27 years (range 16-43 years) (n=179). Median hemoglobin concentration, platelet count and leukocyte count were 91g/L (n=141), 304 x 10(9)/L (n=140) and 11 x 10(9)/L (n=140), respectively. Hospital admission was required in 61% of pregnancies (n=171) and RBC transfusion in 49% of pregnancies (n=173). The median hemoglobin F level was 0.05 (range 0.01-0.87). Nineteen percent had coexisting alpha gene deletion (s). The median birth weight was 2863 grams (n=155). Analysis is ongoing to determine characteristics associated with the pre-defined pregnancy outcomes. CONCLUSIONSWomen with SCD frequently have adverse maternal and fetal outcomes with pregnancy. However, 39% of pregnancies with SCD in this study did not require hospitalization and 51% did not require RBC transfusion. Additional analysis will attempt to identify protective features so as not to expose all patients to RBC transfusion unless it is required. These initial results suggest that risk scores should be developed for pregnant patients with sickle cell disease to identify who may benefit from RBC transfusion. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

History of periodontal treatment and risk for intrauterine growth restriction (IUGR)

BackgroundTo explore the hypothesis that maternal periodontitis is associated with increased risk for Intrauterine Growth Restriction (IUGR), we examined the risk of IUGR in relation to periodontal treatment before, during and after pregnancy.MethodsWe conducted a retrospective cohort analysis of insurance claims data from 2009 to 2012 for women who delivered a singleton live birth (n = 32,168). IUGR was examined as a function of type and timing of dental treatment, adjusting for potential confounders in logistic regression. Sensitivity analysis evaluated the potential effects of unmeasured confounding.ResultsWomen who received periodontal treatment after delivery, indicating the presence of untreated periodontal disease during pregnancy, had significantly higher odds of IUGR compared to women who received no periodontal treatment (adjusted OR 1.5, 95% CI 1.2, 1.8).ConclusionsPeriodontal treatment provided in the immediate postpartum period, a proxy for periodontitis during gestation, was associated with increased risk of IUGR.

Interpregnancy Body Mass Index Changes: Distribution and Impact on Adverse Pregnancy Outcomes in the Subsequent Pregnancy.

To examine the change in body mass index (BMI) categories between pregnancies and its effect on adverse pregnancy outcomes. We performed a retrospective cohort study of women with two consecutive deliveries from 2005 to 2010. Analysis was limited to women with BMI recorded at <24 weeks for both pregnancies. Standard BMI categories were used. Adverse pregnancy outcomes included preterm birth at <37 weeks, intrauterine growth restriction (IUGR), pregnancy-related hypertension, and gestational diabetes mellitus (GDM). Women with increased BMI category between pregnancies were compared with those who remained in the same BMI category. In total, 537 women were included, of whom 125 (23%) increased BMI category. There was no association between increase in BMI category and risk of preterm birth, IUGR, or pregnancy-related hypertension. Women who increased BMI category had an increased odds of GDM compared with women who remained in the same BMI category (6.4 vs. 2.2%; p = 0.018). The increased risk remained after controlling for age, history of GDM, and starting BMI (adjusted odds ratio: 8.2; 95% confidence interval: 2.1-32.7; p = 0.003). Almost one-quarter of women increased BMI categories between pregnancies. This modifiable risk factor has a significant impact on the risk of GDM.

Pregnancy induced hypertension and outcomes in early and moderate preterm infants.

To identify the effect of pregnancy induced hypertension on neonatal outcomes in early and moderate preterm infants of gestational age less than 34 weeks. Prospectively collected data in 773 premature deliveries less than 34 weeks from 10 centers in China between July 2014 and July 2016 were analyzed in this cohort study. Univariate and Multivariate regression analyses were conducted to exam the effect of pregnancy induced hypertension on neonatal outcomes, including mortality to discharge, intrauterine growth restriction, severe brain injury, neonatal respiratory distress syndrome, bronchopulmonary dysplasia, necrotizing enterocolitis, early onset of sepsis and retinopathy of prematurity. The incidence of PIH in this cohort was 18.4%. Women with PIH tended to have a higher cesarean delivery rate (78.2% vs 40.9%, P < 0.001). More tocolytics and magnesium sulfate were used in PIH women (72.5% vs 48.7%, P < 0.001; 59.2% vs 34.7%, P < 0.001). Mean birth weight was lower in infants of PIH mothers than infants of non-PIH mothers (1522.1 ± 348.8 g vs 1683.4 ± 345.3, P < 0.001). In multivariate regression models, PIH was associated with increased risk of IUGR (OR 8.402; 95% CI 4.350-16.227) and lower odds of NRDS (OR 0.526; 95% CI 0.332-0.853). Preterm infants less than 34 weeks born to PIH women had a higher risk of intrauterine growth restriction and lower birth weight. PIH warrants more intensive interventions to prevent relevant infant morbidities.

Polymorphism of genes of hemostasis system, endothelial dysfunction and regulation of blood pressure in pregnant woman with preeclampsia and fetal growth retardation

Objective: To study the distribution and effect of blood clotting, endothelial dysfunction, and blood pressure regulator gene polymorphisms on the development of fetal growth retardation in women with preeclampsia (PE). Materials and methods: a prospective cohort study that included 36 women with PE and FGR and 97 with PE without FGR was conducted. A determinations of genes polymorphisms in factor V Leiden 1691 G → A (FVL), prothrombin 20210 G → A, plasminogen activator inhibitor 1 type 675 5G / 4G (PAI-1), fibrinogen β 455 G → A, paraoxonasae 1 192 Q → R (PON-1), methylentetrahydrofolatereductase 677 C → T (MTHFR), angiotensinogen II 235 M → T (AGT II) were performed. Results: it was found that the early onset of preeclampsia (up to 34 weeks), the duration of hypertension more than 4 weeks increase the relative risk of developing FGR in PE by 3.77 (95 % CI 1.85-7.66) and by 2.1 (95 % DI 1,2-3,6) times respectively. The severity of PE increases the risk of FGR almost by 2 times (RR = 1.98, 95 % CI 1.07-3.69). It was found that the frequency of abnormal polymorphisms was equally high between groups (80.5 % vs. 68.0 %). It was revealed that two or more abnormal polymorphisms were observed more often in pregnant women with PE and FGR (OR = 2.17, 95 % CI 1.26-3.72, p<0.01). Conclusions: Pre-eclampsia is independently associated with the development of FGR. Our findings do not indicate that there are associations between studied maternal polymorphisms and an increased risk of intrauterine growth restriction in pregnant woman with preeclampsia