Subsequent Pregnancy In Women Research Articles

Risk Stratification for Subsequent Pregnancy After Prior Peripartum Cardiomyopathy

Peripartum cardiomyopathy (PPCM) is a rare but serious cardiac complication of pregnancy. Patients with PPCM may not have completed their reproductive years and may desire future pregnancies. This review summarizes the epidemiology and pathophysiology of PPCM and gives an overview of the current knowledge of risk factors that can be used to assess the risk of pregnancy after PPCM. An increasing body of work has been reported on pregnancy outcomes in women with a history of PPCM. The most dominant determinate of poor outcome in subsequent pregnancies (SSP) is left ventricular ejection fraction (LVEF), where persistently impaired LVEF pertains significant morbidity and mortality associated with future pregnancies. Major society guidelines recommend against SSP in women with PPCM who do not recover their LVEF. However, some experts discourage SSP even among women who normalized their LVEF due to reports of recurrence of heart failure. At present, limited data exists to allow risk stratification in this population; therefore, assessment for the lack of subclinical cardiac dysfunction may provide some reassurance. The care of women with PPCM and reproductive health for women after PPCM can be challenging. Robust data highlights the increased risk for women with persistently depressed LVEF; however, evidence to risk stratify those with normalized cardiac function is limited. Going forward, further studies investigating factors predicting pregnancy outcome will hopefully provide data to allow more accurate understanding of risks and optimal management in this population.

Preeclampsia before 26 weeks of gestation: Obstetrical prognosis for the subsequent pregnancy

IntroductionGestational age at delivery seems to be a risk factor of recurrence of preeclampsia. The objective of this study was to analyze adverse pregnancy outcomes and recurrence of preeclampsia during the subsequent pregnancy in women with a history of pre-eclampsia delivered before 26 weeks of gestation. Material and MethodWe performed a retrospective study in two French tertiary care hospitals between 2000 and 2018. Patients with a history of pre-eclampsia delivered before 26 weeks of gestation were analyzed. Information on the immediate subsequent pregnancy was collected. Adverse composite outcome was defined as recurrent preeclampsia, HELLP syndrome, placental abruption, fetal growth restriction <3rd percentile or <10e percentile with Doppler abnormalities, maternal death and fetal death. ResultsAmong the 107 patients who met the criteria, 48 were analyzed for a subsequent pregnancy. Seventeen women (35.4 %) developed an adverse composite outcome, occurring for 15 women (31.2 %) before 34 weeks. Ten women (20.8 %) developed a recurrent preeclampsia occurring for 5 women (10.4 %) before 34 weeks. We related 3 HELLP syndromes, 1 placental abruption, 9 fetal growth restrictions, 3 fetal deaths and no maternal death. Compared to baseline normotensive women, chronic hypertension was significantly associated with an increased risk of adverse composite outcome (19.3 vs 58.8 %, p-value 0.014). ConclusionIn our population, preeclampsia with delivery before 26 weeks is associated with 35.4 % of adverse composite outcomes and 20.8 % of recurrent preeclampsia during the immediate subsequent pregnancy. These results justify the importance of an ongoing monitoring of these patients during subsequent pregnancy.

Is Hysteroscopy a Good Option to Manage Severe Cesarean Scar Defect?

To compare the outcomes of hysteroscopic management in women with a severe or nonsevere symptomatic cesarean scar defect (residual myometrium ≤3-mm vs >3-mm, respectively). Retrospective cohort study. Gynecology department of a teaching hospital. Seventy-one women with an operative hysteroscopy for a symptomatic defect (49 with severe defects and 22 with nonsevere ones). Operative hysteroscopy for cesarean scar defect in women with a severe defect (residual myometrium ≤3-mm) and with nonsevere defect (residual myometrium >3-mm). The main objective was to compare success rates between the 2 groups. The secondary objectives were the comparisons of (1) the number of women who required more than 1 procedure, (2) the rate of complications, (3) the number of subsequent pregnancies, and (4) the evolution of residual myometrium thickness between the groups. The success rates were not significantly different between the groups (73.5% in the severe group and 63.6% in the nonsevere group [p = .40]). The number of women requiring more than 1 procedure was also similar, as were the rate of complications and the mean increase of myometrium thickness. The rate of subsequent pregnancies in women who were infertile was significantly higher in women with a severe defect (p = .04). The hysteroscopic approach seems to be a good way to manage cesarean scar defects even when the residual myometrium is thin. A prospective study is, however, necessary to confirm these findings.

The Effect of Prolonged Antenatal IVIG Treatment on the Development of Gestational Alloimmune Liver Disease in the Neonate

Introduction: Gestational Alloimmune Liver Disease (GALD) is a rare disease characterized by subacute fetal liver injury and often accompanied by hepatic and extrahepatic iron deposition. Findings include hypoglycemia, coagulopathy, hypoalbuminemia, elevated serum ferritin, elevated alpha-fetoprotein, and ascites. Extrahepatic hemosiderin deposition is often seen in salivary glands. Previously, the mortality rate was close to 80% with all patients needing liver transplantation. With maternal IVIG treatment and changes in neonatal treatment, there is now less than 20% mortality with infrequent need for liver transplantation. Diagnosis of GALD is typically done on a postmortem analysis. Case Description: A term female infant was born via scheduled c-section to a 32 year old G2P1000 mother who had been receiving weekly IVIG during this pregnancy due to the death of her first child at 4 days of life. Autopsy of that female baby demonstrated extensive neuropathological changes, liver steatosis, iron depletion, and ascites, consistent with GALD. Following delivery of our current patient, there was an elevated alpha-fetoprotein (greater than 80,000), decreased fibrinogen, and coagulopathy with peak international normalized ratio of 1.6. The patient received fresh frozen plasma and IVIG on day of life 1 with improvement of these levels. Complete blood count, liver function tests, and ammonia were within normal limits. An MRI of the liver demonstrated normal size, morphology, and normal iron levels based on T2 relaxometry. A buccal biopsy did not demonstrate extrahepatic iron deposition. MRI of the brain showed significant stenosis of the right transverse and sigmoid sinus relating to dural venous sinus thrombosis. There was no evidence of parenchymal infarction and no evidence of iron deposition. At this time, enoxaparin was initiated. The patient was discharged home on day of life nine on enoxaparin therapy. Discussion: There are few reported cases of patients with GALD, especially after maternal IVIG treatment. This case report exemplifies the effect of antenatal IVIG infusions during subsequent pregnancies in women with a history of GALD in prior children. This effect is protective, evidenced by lack of liver injury noted in this patient. This supports the use of immunotherapy during pregnancy to prevent recurrence of alloimmune injury.

Disease flare at prior pregnancy and disease activity at conception are important determinants of disease relapse at subsequent pregnancy in women with inflammatory bowel diseases.

Disease flare throughout gestation are not uncommon among women with inflammatory bowel diseases (IBD), and can substantially affect pregnancy outcomes. We aimed to evaluate the effect of prior pregnancy outcome on the risk of disease flare at subsequent pregnancy in women with IBD. Women with IBD attending a multidisciplinary clinic for the preconception, antenatal and postnatal treatment were prospectively recruited during 2011-2018. Overall, 476 IBD women were followed during the study period. Of them, 69 (14.5%) had two pregnancies throughout follow-up period and constituted the study cohort. Among these 69 women, 48 (69.6%) had Crohn's disease and 21 (30.4%) ulcerative colitis. The median interpregnancy interval was 20 [11-32] months. Overall, 34 (49.3%) women experienced disease flare at the subsequent pregnancy. In multivariate analysis, active disease at conception (odds ratio [95% CI]: 25.65 (3.05, 25.52), P < 0.001) and history of disease flare at the previous pregnancy (odds ratio [95% CI]: 4.21 (1.10, 16.58), P < 0.001) were the only independent predictors of disease relapse in current gestation. Rates of hospitalization during pregnancy (14.7% vs. 0, P = 0.02) and preterm delivery (32.4% vs. 5.7%, P = 0.006) were higher, and neonatal birth weight was lower (median 3039 vs. 3300g, P = 0.03), in those with disease flare as compared to those with maintained remission. History of disease relapse at previous gestation and periconception disease activity were found as important predictors of disease flare among IBD women. These data would facilitate adequate counseling and informed management decisions among reproductive-aged IBD women and their treating physicians.

Management of subsequent pregnancies following fourth-degree obstetric anal sphincter injuries (OASIS)

ObjectivesThe management of subsequent pregnancy in women who sustained OASIS remains an enigma. Nearly all studies include all grades of OASIS including fourth-degree tears. In addition, most protocols require endoanal ultrasound and anal manometric assessment to provide advice regarding mode of delivery. In reality, most women who sustain an OASI do not undergo these investigations. The aims of our study were firstly to evaluate outcomes of fourth-degree OASIS in terms of sphincter defects, anal manometry and anal incontinence symptoms. Secondly, we wished to review recommendations made regarding subsequent mode of delivery after fourth-degree OASIS according to different published protocols. Study designAn observational study of all women who had undergone a primary repair of a fourth-degree tear and seen in the perineal clinic of a tertiary urogynaecology unit between January 2006 and December 2017. Three-dimensional endoanal ultrasound and anal manometry were performed on all women, and symptoms assessed using the validated modified St Mark’s Score for anal incontinence. Diagnostic test accuracy analysis was performed for use of symptoms in predicting abnormal investigations. Results74 fourth-degree tears were identified (mean follow-up 5.9 months; SD 11.5). Endoanal scan showed an internal anal sphincter defect in 77 % and an external anal sphincter defect in 49 %. Only 18 % had no defect. The mean incremental pressure rise was 12.6 mmHg (SD 15.5). 61 % were asymptomatic with a mean St Mark’s Score of 3.8 (SD 5.4). The presence of symptoms alone had poor accuracy in predicting abnormal investigations. Based on Royal College of Obstetricians and Gynaecologists guidance, only 7% would not be offered a caesarean section as they are asymptomatic women with normal scan and manometry findings and would be counselled for a vaginal delivery. ConclusionsGiven that only a few units offer these specialist investigations to their OASI population, it would be reasonable to offer caesarean section to all women who have sustained a fourth-degree tear. However, in centres where endoanal ultrasound and anal manometry are available, individualised counselling can be offered.

Pregnancy in Women With Prior Treatments for Pelvic Floor Disorders.

Although the peak incidence of surgery for pelvic floor disorders does not occur until after menopause, an increasing number of younger women are seeking treatment for these problems. Whereas most surgeons would recommend delaying surgery until the completion of childbearing, published cases and case series address outcomes after subsequent pregnancies in women who have been treated for urinary incontinence and pelvic organ prolapse. This document synthesizes the available evidence on the impact of pregnancy on women with prior treatment for pelvic floor disorders and on the impact of these prior treatments on subsequent pregnancy. Pregnancy after the repair of obstetrical anal sphincter laceration is also discussed. Consensus recommendations are presented based on available literature review and expert involvement.

26-Year-Old Woman With Shortness of Breath and Chest Pain

26-Year-Old Woman With Shortness of Breath and Chest Pain

P242 Prior pregnancy outcome is an important determinant of subsequent pregnancy outcome in women with inflammatory bowel diseases

Abstract Background Inflammatory bowel diseases (IBD) are commonly diagnosed in women of childbearing age. As such, pregnancy is often encountered in this subset of patients. Disease flare throughout gestation are not uncommon and can substantially affect pregnancy outcomes. We aimed at the effect of prior pregnancy outcome on the risk of disease flare at subsequent pregnancy in women with IBD. Methods Women with IBD attending a multidisciplinary clinic for the preconception, antenatal and postnatal treatment were prospectively recruited during 2011–2018. Results Overall, 476 IBD women were followed during the study period. Of them, 69 (14.5%) had two pregnancies throughout the follow-up period and constituted the study cohort. Among these 69 women, 48 (69.6%) had Crohn’s disease and 21 (30.4%) ulcerative colitis. The median interpregnancy interval was 20 [11–32] months. Overall, 34 (49.3%) women experienced disease flare at the subsequent pregnancy. In multivariate analysis, active disease at conception (odds ratio [95% CI]: 25.65 (3.05, 215.52), p &amp;lt; 0.001) and history of disease flare at the previous pregnancy (odds ratio [95% CI]: 4.21 (1.10, 16.58), p &amp;lt; 0.001) were the only independent predictors of disease relapse in current gestation. Rates of hospitalisation during pregnancy (14.7% vs. 0, p = 0.02) and preterm delivery (32.4% vs. 5.7%, p = 0.006) were higher, and neonatal birth weight was lower (median 3039 vs. 3300 grams, p = 0.03), in those with disease flare as compared with those with maintained remission. Conclusion History of disease relapse at previous gestation and periconception disease activity were found as an important predictor of disease flare among IBD women. These data would facilitate adequate counselling and informed management decisions among reproductive-aged IBD women and their treating physicians.

Adverse Outcomes of Preeclampsia in Previous and Subsequent Pregnancies and the Risk of Recurrence.

Objectives:We evaluated the fetal and maternal outcomes of pregnant women with preeclampsia who gave birth in our hospital; we also evaluated preeclampsia recurrence rates in these patients and their fetal and maternal outcomes in their subsequent pregnancy.Methods:In this retrospective cohort study, 126 patients whose medical records were accessed completely and who got pregnant again and gave birth in our hospital were analyzed. The primary aim was to show the recurrence rate of preeclampsia, while the secondary aim was to evaluate the maternal and fetal results of the first pregnancy in which preeclampsia developed and the subsequent pregnancy.Results:The incidence of preeclampsia was found to be 2.1% in our clinic. The first pregnancy in which preeclampsia developed; 111 (80.2%) pregnancies resulted in a live birth, 7 (5.6%) resulted in termination, and 8 (6.3%) resulted in stillbirth. Neonatal death occurred in 10 (7.9%) pregnancies. While 105 of the subsequent pregnancies resulted in a live birth, 10 (7.9%) resulted in abortion, 9 (7.1%) resulted in stillbirth, and 2 (1.6%) resulted in termination due to preeclampsia. Neonatal death developed in 3 (2.6%) pregnancies. In the subsequent pregnancy, preeclampsia developed in 70 (55.5%) patients and 39 (55.7%) of these had preeclampsia with severe features.Conclusion:The present study guides us on the risk factors related to preeclampsia and the rate of fetomaternal adverse outcomes and emphasizes the need for strict and regular antenatal follow-up in the subsequent pregnancies of women who have a history preeclampsia. Improvement of maternal and fetal morbidity and mortality in this way is the utmost goal.

298: Assessing the need for subsequent pregnancy education at time of spontaneous preterm delivery

The strongest risk factor for preterm birth (PTB) is history of prior PTB. Despite interventions such as cerclage and 17 alpha-hydroxyprogesterone caproate (17 OHP-C), the rate of PTB has not significantly decreased. Lack of follow up postpartum (PP) visits and preconception counseling may be attributing to limited familiarity of PTB prevention. We sought to assess the knowledge of treatments and management for subsequent pregnancies in women with history of PTB. We conducted a qualitative study using a confidential telephone survey of women who had a PTB between July 2016-March 2018 at a tertiary care center. Maternal and fetal indications that prompted iatrogenic preterm delivery were excluded. Recorded data was analyzed to assess the following: 1) knowledge of cerclage and/or 17 OHP-C, 2) PTB prevention counseling in immediate PP period, 3) contraceptive counseling in immediate PP period, and 4) interest in receiving education on PTB prevention. Of 525 women who had spontaneous PTB, 70 agreed to participate in the survey. Twenty-three (33%) women had heard about 17 OHP-C and cerclage, though 11 (48%) of those women had already had a subsequent pregnancy with one or both of their use. Fifty-six (80%) women received immediate PP contraceptive counseling, however, only 19 (27%) women received immediate PP PTB prevention counseling. Fifty-two (74%) women reported they would have liked to receive PTB prevention counseling at time of their delivery. Forty-nine (70%) women reported they would be interested in receiving educational material if such become available. The most common reason provided for not wanting education or PTB prevention counseling was no longer desiring future pregnancy. The majority of women with history of PTB are not aware of existing interventions to prevent PTB. Counseling in the immediate PP period after PTB is not frequently provided but is sought after by women. These findings suggest that there is a need to provide counseling and educational resources in the immediate PP period to women who have PTB and desire subsequent pregnancies.

SELECTED PSYCHOLOGICAL ASPECTS OF FUNCTIONING OF A PATIENT AFTER REPEATED MISCARRIAGES − CASE STUDY

The purpose of our case study was to identify psychological and medical dependencies affecting subsequent pregnancies of women after early pregnancy loss. The patient miscarried three times, gave birth to two children. The case study describes her state of health, emotional reactions and social support in these situations. Based on medical information, psychological interview and questionnaires (STAI, CISS, BHI-R, ISEL) are described factors influencing the patient’s coping with such a difficult situation as the loss of pregnancy.

Laparoscopic Transabdominal Cerclage and Subsequent Pregnancy Outcomes When Left In Situ

To evaluate obstetric outcomes of subsequent pregnancies in women who had a laparoscopic transabdominal cerclage. A prospective observational study of consecutive women who became pregnant a second or third time after a laparoscopic transabdominal cerclage. Eligible women were considered not suitable for a transvaginal cerclage or had previously failed a transvaginal cerclage. The primary outcome was neonatal survival and the secondary outcome was delivery at 34 weeks of gestation or more. During the study period (2007-2018), 22 women who had undergone a laparoscopic transabdominal cerclage and completed one pregnancy with the cerclage in situ became pregnant a second or third time. In the first pregnancies with the cerclage in situ, the neonatal survival rate was 100% (22/22) and 86% (19/22) of women delivered after 34 weeks of gestation. In the second pregnancies, the neonatal survival rate was 95% (21/22) and 86% (19/22) of women delivered after 34 weeks of gestation. In the third pregnancies, the neonatal survival rate was 100% (3/3) and 100% (3/3) of women delivered after 34 weeks of gestation. When left in situ for subsequent pregnancies, laparoscopic transabdominal cerclage is associated with a high rate of neonatal survival.

Predictors of subsequent pregnancy in women who underwent laparoscopic cornuostomy or laparoscopic wedge resection for interstitial pregnancy.

The ideal surgical procedure for interstitial pregnancy remains undetermined. The aim of this study was to assess whether surgical method is a factor in predicting subsequent pregnancy in women with interstitial pregnancy who underwent laparoscopic cornuostomy or laparoscopic wedge resection. Medical records of all women with interstitial pregnancy who underwent laparoscopic cornuostomy or laparoscopic wedge resection between March 2008 and October 2017 in a medical center were reviewed. Cox regression analysis was performed to identify factors predicting subsequent pregnancy. Forty patients underwent laparoscopic cornuostomy (n = 14) or laparoscopic wedge resection (n = 26) for the treatment of interstitial pregnancy. Twelve women become pregnant during follow-up. Laparoscopic cornuostomy was associated with shorter operation time (coefficient = -19.1 minutes, 95% CI = -36.9 to -1.3 minutes, p = 0.04, multivariable analysis) than that of laparoscopic wedge resection. Furthermore, laparoscopic cornuostomy (hazard ratio = 6.3, p = 0.03), parity (hazard ratio = 0.18, p = 0.008), and preoperative rupture of the cornus (hazard ratio = 13.3, p = 0.005) were independent predictors of subsequent pregnancy. Laparoscopic cornuostomy was associated with a higher probability of subsequent pregnancy and a shorter operation time. Thus, compared with laparoscopic wedge resection, laparoscopic cornuostomy might be a better surgical procedure for women with interstitial pregnancy, particularly for women who wish to become pregnant later. However, because of the retrospective nature and small sample size of this study, some well-defined/designed prospective studies including more patients are needed to verify our results.

460: Prior spontaneous preterm birth is not associated with maternal morbidity in subsequent pregnancies

Emerging data suggests that placental malperfusion and subsequent placental dysfunction may play a significant role in the pathophysiology of spontaneous preterm birth (PTB). The placental response to malperfusion is thought to lead to a pro-inflammatory state. We hypothesized that PTB patients with a history of prior spontaneous preterm birth (pSPB) may prone to recurrent placental dysfunction and in subsequent pregnancies and not only at increased risk of recurrent PTB but to maternal morbidity as well. This study aimed to determine if history of pSPB is associated with maternal morbidity in subsequent pregnancies. This was a retrospective cohort study of all women with two pregnancies at an academic tertiary care institution from 2004 to 2014. Pregnancy outcomes, and maternal morbidity rates were compared between women with a history of pSPB and with a history of prior spontaneous term birth. The primary outcome was composite morbidity, comprised of postpartum hemorrhage (PPH), transfusion, wound infection, fever, & endomyometritis. T-tests & Mann- Whitney U tests were used for continuous variables and chi-square/Fisher’s exact tests for categorical variables. 3,202 patients had at least two pregnancies in the study period, and 695 (21.7%) patients had a history of a prior spontaneous preterm birth. Patients with pSPB were more likely to be African-American, and develop a hypertensive disorder. The current pregnancies of patients with pSPB were more likely to result in vaginal delivery at earlier gestation, and have lower birth weights. The composite maternal morbidity rate, PPH, transfusion and infection rates were similar. In this study, patients with a pSPB do not appear to be at an increased risk of maternal morbidity in subsequent pregnancies. Further pursuit with a larger population evaluating not only maternal morbidity but neonatal outcomes as well may be helpful to determine the overall risk of morbidity in subsequent pregnancies of women with history of prior SPB.

Identifying risk factors for preeclampsia in subsequent pregnancies in women with a history of preeclampsia

Preeclampsia (PE) is a prevalent hypertensive disorder of pregnancy that causes significant maternal-fetal mortality. It has been reported that 60% of maternal mortality can be prevented. Studies have demonstrated that nursing has the ability to influence the mortality rates by providing proactive and competent care. Part of proactive, competent care is to identify those women at the highest risk for PE. Multiple studies have identified a history of PE as a significant risk factor for PE in future gestations. We conducted a nested case control study with our Rule Out Pre-Eclampsia (ROPE) cohort to identify comorbidities most likely to lead to recurrent PE.

Association between first caesarean delivery and adverse outcomes in subsequent pregnancy: a retrospective cohort study

BackgroundFew studies have explored the association between a previous caesarean section (CS) and adverse perinatal outcomes in a subsequent pregnancy, especially in women who underwent a non-indicated CS in their first delivery. We designed this study to compare the perinatal outcomes of a subsequent pregnancy in women who underwent spontaneous vaginal delivery (SVD) or CS in their first delivery.MethodsThis retrospective cohort study included women who underwent singleton deliveries at the International Peace Maternity and Child Health Hospital from January 2013 to December 2016. Data on the perinatal outcomes of all the women were extracted from the medical records. Multivariate logistic regression was conducted to assessed the association between CS in the first delivery and adverse perinatal outcomes in the subsequent pregnancy.ResultsCS delivery in the subsequent pregnancy was more likely for women who underwent CS in their first birth than for women with previous SVD (97.3% versus 13.2%). CS in the first birth was also associated with a significantly increased risk of adverse outcomes in the subsequent pregnancy, especially in women who underwent a non-indicated CS. Adverse perinatal outcomes included pregnancy-induced hypertension [adjusted odds ratio (OR), 95% confidence interval (CI): 2.20, 1.59–3.05], gestational diabetes mellitus (1.82, 1.57–2.11), gestational anaemia (1.27, 1.05–1.55), placenta previa (3.18, 2.15–4.71), placenta accreta (2.75, 1.75–4.31), and polyhydramnios (2.60, 1.57–4.31) in the mother and preterm delivery (1.37, 1.06–1.78), low birth weight (3.78, 2.07–6.90), macrosomia (5.04, 3.95–6.44), and neonatal jaundice (1.72, 1.39–2.14) in the baby.ConclusionsCS in the first delivery markedly increases the risk of repeated CS and maternal-fetal complications in the subsequent pregnancy, especially in women with a non-indicated CS.

Time course of changes in maternal left ventricular function during subsequent pregnancy in women with a history of gestational hypertensive disorders.

Women with a history of gestational hypertensive disorders (GHD) are at increased risk for developing perinatal cardiovascular complications (e.g., gestational hypertension, preeclampsia, etc.) in subsequent pregnancies. The underlying mechanisms remain uncertain, but impaired maternal left ventricular function may be one contributing factor for these complications. We evaluated the time course of changes in left ventricular function before, during, and after pregnancy in women with prior GHD. Sixteen women with a history of GHD (the high-risk group) and 25 women without such a history (controls) were enrolled. Resting hemodynamic and echocardiographic measurements were longitudinally performed before pregnancy, during early pregnancy (4-8 wk of gestation), during late pregnancy (32-36 wk of gestation), and postpartum (6-10 wk after delivery). Pregnancy outcomes were obtained after delivery. At prepregnancy, there was no difference in blood pressure and heart rate between the groups. Corrected isovolumic relaxation time was longer, E/ e' was larger, and Tei index was greater in the high-risk group than controls. Moreover, the rate of GHD during the study was significantly greater in the high-risk group than controls [odds ratio = 8.94 (95% confidence interval: 1.55-51.5), P = 0.007]. Multiple logistic regression analysis adjusted for age demonstrated that prepregnancy E/ e' was an independent predictor for GHD ( P = 0.017). Thus, women with a history of GHD have modestly impaired cardiac function prepregnancy compared with controls, which identifies an increased susceptibility to developing cardiovascular complications during a subsequent pregnancy.

Recurrent Risk of Preterm Birth in the Third Pregnancy in Korea.

BackgroundAlthough preterm delivery is the most common cause of infant morbidity and mortality, an obvious cause cannot be found in most cases. Preterm delivery is known to be the most important risk factor for preterm birth in a subsequent pregnancy. We aimed to evaluate the recurrence rate of premature births for subsequent pregnancies in women with a history of a preterm birth.MethodsStudy data were collected from the Korea National Health Insurance (KNHI) claims database and data from a national health-screening program for infants and children. We enrolled women who had their first delivery between January 1, 2007 and December 31, 2007 and a subsequent delivery before 2014.ResultsPreterm delivery had a significant higher risk of preterm birth in a subsequent singleton pregnancy. The risk of preterm birth at second pregnancy was 2.2% in women whose first delivery at ≥ 37 weeks and 18.6% in women whose first delivery at < 37 weeks (relative risks [RR], 8.64; 95% confidence interval [CI], 7.94–9.40). In the analysis of the third pregnancy, we compared women with an initial term birth followed by preterm birth and women with an initial preterm birth followed by a subsequent term birth. A history of a just preceding preterm birth at < 37 weeks was the most relevant factor for recurrence of preterm delivery in a subsequent pregnancy (26.6%, RR, 4.01; 95% CI, 2.45–6.58).ConclusionWe found that the prognosis of a third pregnancy was more closely related to the outcome of the second pregnancy to that of the first pregnancy.

Impact of borderline–subclinical hypothyroidism on subsequent pregnancy outcome in women with unexplained recurrent pregnancy loss

Because subclinical hypothyroidism (thyroid-stimulating hormone [TSH] > 4.5 IU/mL) is associated with adverse pregnancy outcome, including early pregnancy loss, TSH is recommended to be titrated to ≤2.5 mIU/L in levothyroxine-treated women before pregnancy. The purpose of this study was to determine whether borderline-subclinical hypothyroidism (borderline-SCH; 2.5 < TSH ≤ 4.5 IU/mL) affects the outcome of subsequent pregnancies in women with unexplained recurrent pregnancy loss (uRPL). After workup for antinuclear antibody (ANA), anti-phospholipid syndrome, thrombophilia, uterine abnormalities, hormone disorders, and/or chromosomal abnormalities, 317 women with a history of uRPL were enrolled. The women were classified into two groups: borderline-SCH, and euthyroidism (0.3 ≤ TSH ≤ 2.5 IU/mL). All women had normal serum free thyroxine (T4) and did not receive levothyroxine before or during the subsequent pregnancy. There were no significant differences in age, number of previous pregnancy losses, number of live births, or body mass index between the borderline-SCH (n = 56) and the euthyroid (n = 261) groups, but the rate of ANA positivity differed significantly (53.6% vs 33.7%, respectively; P = 0.005). The subsequent pregnancy rate did not differ between the two groups (55.4%, 31/56 vs 51.3%, 134/261, respectively). The pregnancy loss rate (<22 weeks of gestation) tended to be higher in the borderline-SCH than the euthyroid group (29.0%, 9/31 vs 17.9%, 24/134), although not significantly so (P = 0.16). Although some subset of uRPL is though to be due to as-yet-unidentified cause(s), borderline-SCH is unlikely to be involved in uRPL.