Trimester Pregnancy Outcome Research Articles

812: The relationship of second trimester serum progesterone, cytokine levels, and pregnancy outcome

Progesterone (P4) is an important anti-inflammatory agent during pregnancy. Serum cytokine values have been associated with adverse pregnancy outcome. Our goal was to assess the interrelationship between serum P4 concentration and serum cytokine levels.

The association between low PAPP-A levels at first trimester and poor pregnancy outcomes

The association between low PAPP-A levels at first trimester and poor pregnancy outcomes

PPO.45 Low maternal serum PAPP-A in the first trimester and adverse pregnancy outcome: An experience over one year from a University Hospital

IntroductionMaternal serum pregnancy associated plasma protein A (PAPP-A) is derived from the placenta and is a component of combined screening. When combined with maternal age, fetal nuchal translucency and maternal...

Fetal isolated short femur in the second trimester and adverse pregnancy outcomes

This study aims to evaluate the association of isolated short femur (ISF) in the second trimester ultrasound with adverse pregnancy outcomes. All obstetric scans between 16 and 24 weeks of gestation from 1 January 2006 to 1 June 2012 were retrospectively evaluated. Multiple pregnancies, major congenital or chromosomal anomalies and subjects with incomplete outcome data were excluded. Femur length (FL) measurement from the earliest scan of singleton pregnancies was selected. An ISF was defined as a FL less than the tenth percentile in a fetus with an abdominal circumference greater than or equal to the tenth percentile. The primary outcomes were small for gestational age (SGA), birth weight below the third and fifth percentiles, low birth weight (LBW), preterm birth (PTB) and preeclampsia (PE). A 5-min Apgar score of less than 7 and a neonatal intensive care unit admission were secondary outcomes. Of the 4992 eligible fetuses, 312 (6%) had an ISF. Mothers in the short femur group were shorter and had a lower prepregnancy and delivery weight than the group with normal FL (p < 0.05). Multiple logistic regression revealed a significant increase in birth weight below fifth percentile, SGA, LBW infants and PTB (<32, <34 and <37 weeks) in the ISF group (p < 0.05). The incidence of PE was similar in both groups. Isolated short femur in the second trimester increases the risk of LBW, SGA and PTB, but not of PE.

Association and Predictive Accuracy of High TSH Serum Levels in First Trimester and Adverse Pregnancy Outcomes

High serum levels of TSH have been associated with adverse pregnancy outcomes by some studies, and not by others. The aim of the study was to assess the association between high levels of TSH in the first trimester of pregnancy and adverse pregnancy outcomes; and to examine the predictive accuracy as a screening test. Serum levels of TSH were measured in a cohort of 2801 women with a singleton pregnancy attending first trimester Down syndrome screening. Information on maternal and infant outcomes was obtained through record linkage to population-based birth and hospital data. Association between high TSH (>95th and >97.5th centiles) multiple of the median levels, and risk of adverse pregnancy outcomes was evaluated using multivariable logistic regression, and the predictive accuracy of models was assessed. Rates of infants being small for gestational age (SGA), preterm birth, preeclampsia, miscarriage, and stillbirth were investigated. High TSH multiple of the median levels were associated with SGA (<10th centile) [adjusted odds ratio (aOR), 1.71; 95% confidence interval (CI), 0.99-2.94]; preterm birth at less than 37 wk gestation (aOR, 2.59; 95% CI, 1.21-5.53); miscarriage (aOR, 3.66; 95% CI, 1.59-8.44); and a composite measure of any study outcome (aOR, 2.10; 95% CI, 1.23-3.59). The area under the receiver operator characteristic curves were 0.69 (95% CI, 0.65-0.73) for SGA; 0.56 (95% CI, 0.51-0.61) for preterm birth; 0.70 (95% CI, 0.61-0.79) for miscarriage; and 0.63 (95% CI, 0.60-0.65) for any adverse pregnancy outcome. High TSH serum levels during the first trimester of pregnancy were associated with adverse pregnancy outcomes; however, the predictive accuracy was poor. Screening for high TSH levels in the first trimester would be of no benefit to identify women at risk.

Effect of maternal body mass index on pregnancy outcome and newborn weight

BackgroundMaternal obesity has been associated with adverse pregnancy outcomes, such as pre-eclampsia, eclampsia, pre- and post-term delivery, induction of labor, macrosomia, increased rate of caesarean section, and post-partum hemorrhage. The objective of this study was to determine the effect of maternal Body Mass Index (BMI) on pregnancy outcomes.Methods1000 pregnant women were enrolled in the study. In order to explore the relationship between maternal first trimester Body Mass Index and pregnancy outcomes, participants were categorized into five groups based on their first trimester Body Mass Index. The data were analyzed using Pearson Chi-square tests in SPSS 18. Differences were considered significant if p < 0.05.ResultsWomen with an above-normal Body Mass Index had a higher incidence of pre-eclampsia, induction of labor, caesarean section, pre-term labor, and macrosomia than women with a normal Body Mass Index (controls). There was no significant difference in the incidence of post-term delivery between the control group and other groups.ConclusionIncreased BMI increases the incidence of induction of labor, caesarean section, pre-term labor and macrosomia. The BMI of women in the first trimester of pregnancy is associated with the risk of adverse pregnancy outcome.

Antidepressants Linked to Shorter Gestation and Neonatal Seizures

Fetal exposure to selective serotonin reuptake inhibitors (SSRIs) has been connected to preterm birth, lower birth weight, cardiac defects, and a neonatal adaptation syndrome, in some cases including seizures. These researchers retrospectively examined associations between antidepressant prescriptions in each trimester and adverse pregnancy outcomes in a large Tennessee Medicaid population. Of 228,876 women with singleton pregnancies (age range, 15–44), …

Second trimester biparietal diameter size and the risk of adverse pregnancy outcomes

To identify the relationship between biparietal diameter (BPD) in the second trimester and adverse pregnancy outcomes in low-risk pregnancies. This prospective cohort study was performed on 2219 singleton pregnant women from August 2008 to March 2010. The gestational age-specific percentiles of BPD at 17 to 24 weeks of gestation were established to categorize participants into three groups: a BPD < 10th percentile as small BPD, between 10th and 90th percentile as normal BPD and > 90th percentile as large BPD. Using logistic regression analysis, the association between BPD < 10th and > 90th percentile with pregnancy outcomes was evaluated after controlling for confounding factors. There was a significantly increased risk of macrosomia [odds ratio (OR(adj)) = 2.1; 95% confidence intervals (CI), 1.23-3.78] and preterm labor (PTL) (OR(adj) = 1.9; 95% CI, 1.19-3.05) in fetuses with a BPD > 90th percentile compared with fetuses with a normal BPD, and there was a significant relationship between small for gestational age (SGA) at delivery and a BPD < 10th percentile at the second trimester (OR(adj) = 2.4; 95% CI, 1.77-3.52). No association was present between preeclampsia and second trimester BPD. BPD in the first half of pregnancy is related to fetal size at term and risk of PTL.

Levels of soluble fms-like tyrosine kinase one in first trimester and outcomes of pregnancy: a systematic review

Angiogenic factors are involved in formation of new blood vessels required for placental development and function; and critical for fetal growth and development. Soluble fms-like tyrosine kinase 1(sFlt-1) is an anti-angiogenic protein that inhibits formation of new blood vessels resulting in potential pregnancy complications. The objective of this study was to undertake a systematic review to assess levels of sFlt-1 in early pregnancy and association with adverse pregnancy outcomes. PubMed and Medline databases and reference lists were searched up to July 2010. Inclusion criteria were pregnant women, blood sample taken during first trimester and assessment/reporting of sFlt-1 concentrations and subsequent pregnancy complications. Twelve relevant studies were identified of 71 to 668 women. No pooling of results was undertaken due to variation in sFlt-1 concentrations (range, 166-6,349 pg/ml amongst controls), samples used (serum, plasma), different summary statistics (mean, median, odds ratio) and outcome definitions applied. Levels of sFlt-1 were generally higher among women who developed preeclampsia (11 studies) or gestational hypertension (two studies), but not significantly different to normotensive women in most studies. There was no consistent pattern in association between sFlt-1 concentrations and fetal growth restriction (4 studies); and levels were non-significantly higher for women with postpartum bleeding (1 study) and significantly lower for stillbirths (1 study).This review found no clear evidence of an association between sFlt-1 levels in first trimester and adverse pregnancy outcomes. However, findings were affected by methodological, biological and testing variations between studies; highlighting the need for consistent testing of new biomarkers and reporting of outcome measures.

First trimester diclofenac exposure and pregnancy outcome

First trimester diclofenac exposure and pregnancy outcome

First trimester diclofenac exposure and pregnancy outcome

Objective To assess the safety of diclofenac during pregnancy. Methods A prospective observational cohort study, evaluating follow-up data of women who contacted Teratology Information Services to get counseling. The exposed group included 145 pregnant women who were exposed to diclofenac between the 5th and the 14th gestational week. A contemporary control group (501 women) was randomly selected from among patients who contacted Teratology Information Services with regard to exposures to agents known not to be teratogenic during a similar period of pregnancy. Results Major birth malformations were not more common in the study group than in the control group ( p = 0.07). Conclusion Our study suggests that the use of diclofenac is relatively safe during the first trimester of pregnancy and the studied sample size makes it possible to exclude a risk of congenital malformation higher than 3.3, with a power of 80%.

Fetal growth between the first and second trimesters and the risk of adverse pregnancy outcome

To relate growth rate of the biparietal diameter (BPD) between the first and second trimesters to the risk of perinatal death, intrauterine growth restriction (IUGR), macrosomia, preterm/post-term delivery and pre-eclampsia. In this retrospective study, we analyzed sonographic BPD measurements at 11-14 and 17-21 weeks from 8215 singleton pregnancies in the Copenhagen First Trimester Study. Growth rate was defined as millimeters of growth per day between the two measurements and was dichotomized into growth rates < 2.5(th) vs. 2.5(th)-97.5(th) centiles, and > 97.5(th) vs. 2.5(th)-97.5(th) centiles. Odds ratios (OR) and 95% CIs for adverse outcome were calculated. Fetuses with growth rates < 2.5(th) centile had an OR of 4.79 (95% CI, 1.43-15.99) for perinatal death and an OR of 2.64 (95% CI, 1.51-4.62) for birth weight < sonographically estimated mean fetal weight (adjusted for gestational age) - 2 SD. Fetuses with growth rates > 97.5(th) centile had an OR of 2.83 (95% CI, 1.58-5.06) for birth weight > mean + 2 SD and an OR of 2.30 (95% CI, 1.15-4.59) for delivery in weeks 34-36. Growth rate showed no association with pre-eclampsia. There is a significant relationship between the growth rate of BPD from the first to the second trimester and adverse pregnancy outcome. Low growth rates are associated with an increased OR for perinatal death and IUGR, while high growth rates are associated with an increased OR for macrosomia and preterm delivery.

First trimester bleeding and pregnancy outcome in gravidas with normal and low folate levels.

The purpose of this study was to examine whether women with first trimester uterine bleeding and low serum folate have a higher incidence of spontaneous abortions and adverse perinatal outcome compared with women whose folate levels are normal. Serum folate and vitamin B12 levels were obtained on 225 women who presented with first trimester vaginal bleeding; pregnancy outcomes of those whose folate or vitamin B12 levels were low were compared with those with normal levels using the chi-square test. Of the 151 women included, 52 had low folate levels (less than 4.0 ng/ml). Their spontaneous abortion rate and perinatal outcomes were similar to those whose folate levels were normal. We concluded that in pregnancies complicated by first trimester vaginal bleeding, low folate levels do not appear to be associated with an increased risk of pregnancy loss and adverse outcome.

Yolk sac size and embryonic heart rate as prognostic factors of first trimester pregnancy outcome

Objectives To investigate embryonic heart rate (EHR) and yolk sac diameter (YSD) during the first trimester and their role as prognostic markers of first trimester pregnancy outcome. Study design Prospective cohort study involving 219 women conducted in the 4th Academic Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Greece. Gestational age (GA) was determined ultrasonographically based on gestational sac diameter and crown-rump length. EHR and YSD were evaluated during the first 12 weeks and subsequently compared between the pregnancies that continued beyond the first trimester and those that resulted in spontaneous abortion. Receiver-operating characteristic (ROC) curves were used for the evaluation of the prognostic value of the combination of gestational age with embryonic heart rate and yolk sac diameter. Results The EHR and YSD were significantly correlated to advancing gestational age ( p < 0.001) in pregnancies continuing beyond 12 weeks. Pregnancies that resulted in spontaneous abortion exhibited a statistically significant lower EHR ( p < 0.001), smaller YSD ( p = 0.001) or absent yolk sac. ROC curve analysis demonstrated the predictive value of the combination of GA with EHR (area under the ROC curve: 0.971, p < 0.001) and GA with YSD (area under the ROC curve: 0.858, p < 0.001) for first trimester pregnancy outcome. Conclusions EHR and YSD progressively increase in healthy pregnancies during the first trimester. Embryonic bradycardia and absence of yolk sac or even a smaller yolk sac diameter than expected for any gestational age are predictors of poor pregnancy outcome during the first 12 weeks.

Cervical fetal fibronectin as a predictor of first trimester pregnancy outcome in unexplained recurrent miscarriage

Objective To determine whether cervical fetal fibronectin is a reliable predictor of first trimester pregnancy outcome in patients with unexplained recurrent miscarriage. Study design A prospective observational study was carried out on 49 pregnant women with a history of unexplained recurrent miscarriage. In all participants the presence of fetal fibronectin in the cervical secretion was determined with a qualitative rapid immunoassay. The outcome of the first trimester pregnancy was recorded a successful outcome was a pregnancy that progressed beyond 12 weeks of gestation; a miscarriage referred to a pregnancy loss in the first 12 weeks. Results Of the 49 subjects screened, fetal fibronectin was positive in 17 and negative in 32. Overall, 14 pregnancies resulted in fetal loss before the 12th week of gestation. Fetal cervical fibronectin was positive in 6 of the 14 patients who miscarried and in 11 of the 35 in whom outcome was successful. As predictor of first trimester pregnancy outcome the test had a sensitivity and a specificity of 43% and 69% and positive and negative predictive values of 35%, and 75%, respectively. Subgroup analysis by number of previous miscarriages and maternal age gave similar values. Conclusion This study examines the possible value of cervical fetal fibronectin in predicting first trimester pregnancy outcome. We conclude that the occurrence of positive or negative fetal cervical fibronectin test has only limited predictive value and therefore its use cannot be considered for clinical application.

Decreased Ovarian Reserve: Is it an Independent Predictor of Adverse Obstetric Outcomes?

To examine the impact of decreased ovarian reserve on adverse pregnancy outcomes. Retrospective cohort study in a tertiary care hospital. The medical records of all patients tested for ovarian reserve who achieved pregnancy through our infertility program between January 1 2000 and December 31 2004 were reviewed. Infertility history and treatment protocol was obtained through review of our infertility charts. Pregnancy and neonatal outcomes information was collected through medical records. Data collected included clomid challenge test results, first, second and third trimester pregnancy outcomes, antepartum complications and mode of delivery. Ovarian reserve testing was defined as a clomid challenge test with day 3 and day 10 FSH values available. Patients were classified as having normal ovarian reserve if both their day 3 and day 10 FSH values were less than 10 mIU/ml. Patients were classified as having abnormal ovarian reserve testing if either of their values was equal to or exceeded 10 mIU/ml. 35 patients with ovarian reserve testing had complete pregnancy outcomes information available. 22 patients had normal ovarian reserve testing and 13 patients had abnormal ovarian reserve testing. The average age of patients in the normal ovarian reserve testing group was 34.1 (range 28 to 40) versus 34.9 (range 32 to 39) for the abnormal ovarian reserve testing group. Significant past medical history was comparable between both groups (28.6 versus 33.3 %). No patients had previous pregnancy complications. The average day 3 FSH was 6.84 mIU/ml in the normal ovarian reserve group versus 9.33 mIU/ml in the abnormal group. The average day 10 FSH was 6.35 mIU/ml in the normal ovarian reserve group versus 12.46 in the abnormal ovarian reserve group. Estradiol levels were comparable between both groups (39.5 pg/ml and 38.6 pg/ml respectively).Pregnancy outcomes in the normal ovarian reserve group were as follows: 2 biochemical pregnancies (5.7%), 9 spontaneous abortions (25.7%), 1 ectopic pregnancy (2.9%), 1 second trimester loss (2.9%) and 22 live births (62.9%). Pregnancy outcomes in the decreased ovarian reserve group were 0 biochemical pregnancies, 5 spontaneous abortions (27.8%), 0 ectopic pregnancies or second trimester losses and 13 live births (72.2%) (P=NS). The number of twins and triplets was comparable between the two groups (8.6 versus 16.7%) and (2.9 versus 5.6 %) respectively (P=NS). The number of abnormal quadruple screen tests was comparable (2 versus 1) and so was the number of abnormal glucose tolerance tests (4 versus 2). There were 2 intrauterine growth restricted babies in the normal ovarian reserve group versus none in the abnormal ovarian reserve group as well as 2 versus 1 cases of oligohydramnios. In the normal ovarian reserve group versus the abnormal ovarian reserve group, there were 3 cases of preterm labor (13.6%) versus 4 (31%), 2 cases of hypertension (9.1%) versus 1 (8%), 1 case of diabetes (4.5%) versus 0 and 2 cases of other medical complications (9.1%) versus 0 (P=NS). 45.5% versus 46.2 % of patients delivered by cesarean section. The average birth weight was 2716 g in the normal ovarian reserve group versus 2452 g in the abnormal ovarian reserve group (P=NS). Ovarian reserve does not appear to negatively impact pregnancy outcomes in this group of patients.

P08.04: Association of second trimester uterine artery Doppler, thrombophilia and pregnancy outcome

P08.04: Association of second trimester uterine artery Doppler, thrombophilia and pregnancy outcome

Gestational diabetes diagnosed in third trimester pregnancy and pregnancy outcome

The clinical significance of gestational diabetes diagnosed in the third trimester is unclear. A prospective observational study was performed on a cohort of women without pre-existing gestational diabetes or other medical disorders to examine the effect of gestational diabetes on pregnancy complications and infant outcome. Four hundred and eighty-nine consecutive women were assessed at 28-30 weeks by random glucose screening and/or a 75 g oral glucose tolerance test. The subsequent management was according to established departmental protocols. The outcome of pregnancy was compared among the groups with negative screening, positive screening but normal glucose tolerance, and gestational diabetes which was controlled with diet therapy. Women with gestational diabetes (n=67 or 13.7%) had significantly increased maternal age, pre-pregnancy weight and body mass index, hemoglobin levels at booking and at 36-38 weeks, and incidences of parity >1, pre-eclampsia, and female infants, while the gestational age was shorter and there was no significant difference in the birthweight outcome or neonatal morbidity. Despite diet treatment, gestational diabetes diagnosed in the last trimester is associated with increased risk of pre-eclampsia and shorter length of gestation, and this is likely to reflect a pathological process rather than the physiological effect of pregnancy on maternal glucose tolerance.

Gestational diabetes diagnosed in third trimester pregnancy and pregnancy outcome

Gestational diabetes diagnosed in third trimester pregnancy and pregnancy outcome

Endometrial Thickness and Endometrial Patterns as Predictors of First Trimester Spontaneous Abortion (SpAb) in Pregnancies Achieved Through Intra-Uterine Insemination (IUI)

Objective: To assess whether endometrial thickness and or endometrial patterns on day of hCG injection is predictive of SpAb during the first trimester in pregnancies achieved with IUI.Design: A retrospective chart review of all IUI pregnancies from 1998 through 1999. Excluded were ectopic pregnancies and chemical pregnancies with hCG levels less than 50 mIU/ml.Materials and Methods: Measurement of endometrial thickness in millimeters and assessment of endometrial pattern categorized as hypoechoic, echoic, or hyperechoic in relation to the myometrium via transvaginal ultrasound on day of hCG administration.Results: Of the sixty-five pregnancies reviewed, fourteen were SpAb’s (22%) during the first trimester. The SpAb group had endometrial thickness ranging from 7 mm–14 mm; the mean thickness was 10 mm ± 3.8. (P=0.5). Seven of the fourteen SpAb’s were attributed to genetic abnormalities confirmed by genetic karyotype on the products of conception; the remaining seven SpAb’s had no identifiable cause. Five of the seven SpAb’s (71%) that did not have evidence of genetic abnormalities had a hyperechoic pattern of the endometrial lining in comparison to the myometrium. Fifty-one pregnancies were carried successfully through the first trimester. The pregnancy group endometrial thickness ranged 4 mm–15 mm; the mean was 9 mm ± 3.22 (P=0.5). Six of the fifty-one (12%) successful pregnancies had hyperechoic endometrial patterns, and three (6%) had echoic endometrial patterns. The remaining forty-two (82%) had hypoechoic endometrial patterns.Conclusion: Once pregnancy was achieved, the endometrial thickness on day of HCG administration had no predictive value for determining a successful first trimester pregnancy outcome. Although genetic abnormalities account for 50% of SpAb’s in this retrospective study, endometrial patterns may be predictive in assessing the risk of SpAb in first trimester pregnancies. Objective: To assess whether endometrial thickness and or endometrial patterns on day of hCG injection is predictive of SpAb during the first trimester in pregnancies achieved with IUI. Design: A retrospective chart review of all IUI pregnancies from 1998 through 1999. Excluded were ectopic pregnancies and chemical pregnancies with hCG levels less than 50 mIU/ml. Materials and Methods: Measurement of endometrial thickness in millimeters and assessment of endometrial pattern categorized as hypoechoic, echoic, or hyperechoic in relation to the myometrium via transvaginal ultrasound on day of hCG administration. Results: Of the sixty-five pregnancies reviewed, fourteen were SpAb’s (22%) during the first trimester. The SpAb group had endometrial thickness ranging from 7 mm–14 mm; the mean thickness was 10 mm ± 3.8. (P=0.5). Seven of the fourteen SpAb’s were attributed to genetic abnormalities confirmed by genetic karyotype on the products of conception; the remaining seven SpAb’s had no identifiable cause. Five of the seven SpAb’s (71%) that did not have evidence of genetic abnormalities had a hyperechoic pattern of the endometrial lining in comparison to the myometrium. Fifty-one pregnancies were carried successfully through the first trimester. The pregnancy group endometrial thickness ranged 4 mm–15 mm; the mean was 9 mm ± 3.22 (P=0.5). Six of the fifty-one (12%) successful pregnancies had hyperechoic endometrial patterns, and three (6%) had echoic endometrial patterns. The remaining forty-two (82%) had hypoechoic endometrial patterns. Conclusion: Once pregnancy was achieved, the endometrial thickness on day of HCG administration had no predictive value for determining a successful first trimester pregnancy outcome. Although genetic abnormalities account for 50% of SpAb’s in this retrospective study, endometrial patterns may be predictive in assessing the risk of SpAb in first trimester pregnancies.