Unfavorable Pregnancy Outcomes Research Articles

#1616 Pregnancy and fetal outcome in women with Alport syndrome

Abstract Background and Aims Pregnancy in patients with CKD is associated with maternal and fetal risks. The data about pregnancy outcome in Alport syndrome (AS) is limited. The aim was to evaluate the fetal and maternal pregnancy outcome in women with AS. Method One center retrospective study included 88 women with AS (86 with COL4A5, 2 with COL4A4 variants). Data at conception (age, arterial hypertension (HP), proteinuria (Pr), GFR), course of pregnancy (HP, Pr, GFR, pre-eclampsia (PE)), delivery (preterm (PD): < 37 weeks; early preterm (EPD): < 34 weeks), fetus characteristics (intrauterine fetal growth restriction (IUGR): L < 2 z-score for gestational age; small for gestational age (SGA): m < 2 z-score (SGA)) were obtained from medical charts and a cross-sectional survey. Results Information of 88 women, 133 term pregnancies (2 in 25 pts, 3 in 2 pts) were analyzed. Only 16 (q = 0,18) from 85 (q = 0,96) women with hematuria had diagnosis of AS before pregnancy; one of them had HP, 13 pts had Pr. HP, Pr, decreased GFR were revealed in 11 (q = 0,13), 27 (q = 0,2) and 9 (q = 0,06) pregnant, respectively. PE occurred in 8 cases (q = 0,06); PD was seen in 24 (q = 0,18) and EPD in 1 (q = 0,01) cases; cesarean section was performed in 8 cases (q = 0,07). IUGR and SGA were recorded in 8 (q = 0,06) and 11 (q = 0,08) neonates, respectively; 6 babies (q = 0,05) required a neonatal intensive care unit stay. Pr was the risk factor for PE (CI 14,86 ± 0,85, p < 0,001), PD (CI 6,267 ± 0,49; p < 0,001), IUGR (CI 14,86 ± 0,85, p < 0,001), SGA (CI 8,93 ± 0,67, p < 0,001). Conclusion The risk of pre-eclampsia and slowing of fetal growth in women with AS and normal kidney function appears comparable to that in the general population. But AS should be considered as a potential risk factor for preterm delivery. Proteinuria is associated with unfavorable pregnancy and fetal outcome in AS.

OA22 Pregnancy in connective tissue diseases: a 30 year follow-up study of 465 pregnancies from a Spanish monocentric registry

Abstract Background/Aims Pregnancy in patients with connective tissue diseases (CTDs) are known to be at high risk for the occurrence of adverse pregnancy outcomes. We aimed to evaluate pregnancy outcomes in patients with systemic lupus erythematosus (SLE), systemic sclerosis (SSc), primary Sjögren’s syndrome (pSS) and undifferentiated connective tissue disease (UCTD). Methods A retrospective and descriptive study was conducted from 1990 to 2020. All data were collected from the medical records of women of childbearing age with SLE, SSc, SS and UTCD enrolled in our clinic at the time of their pregnancy and childbirth. The obstetric, maternal and fetal outcomes were collected and compared regarding diagnosis and adverse outcomes. Results The study group included 295 patients: 125 patients (42%) with SLE; 50 patients (17%) with SSc; 80 patients (27%) with pSS; 40 patients (14%) with UCTD. A total of 465 pregnancies were registered. The mean age at delivery was 31.5±8.5 years and the mean duration of disease was 7.2±5.6 years. Pregnancy loss occurred in 21% of patients, live births in 66% of pregnancies, preterm delivery in 8%, postpartum haemorrhage in 6%, preeclampsia in 5%, placental abnormalities in 4%, ectopic pregnancy in 3%, and premature rupture of membranes in 2%. Treatment with hydroxychloroquine (HCQ) was received in 115 pregnancies in SLE (59%), 21 pregnancies in SSc (24%) 62 pregnancies in pSS (52%) and 32 pregnancies in UCTD (49%). Exposure to corticosteroids and biologics during pregnancy was 23 (18.4%), 6 (12%), 15 (19%) and 3 (7.5%), respectively. Patients with SLE had a higher risk of fetal morbidity, including abortion (p = 0.03), mean abortion rate (p = 0.03), preeclampsia (p = 0.04), ectopic pregnancy (p = 0.03), preterm delivery (p = 0.02) and postpartum haemorrhage (p = 0.01) than patients without SLE. The multivariate model found an association between unfavourable pregnancy outcomes and disease activity (OR 2.4; 95% CI 1.3-7.2; p 0.003), whilst HCQ during pregnancy (OR 0.23; 95% CI 0.03-0.82) had a protective effect. Conclusion 66% of pregnancies in patients with autoimmune diseases resulted in live births. Patients with SLE had higher rates of fetal and maternal morbidity than SSc, pSS and UCTD. Disease activity was associated with unfavourable pregnancy outcomes. Exposure to HCQ had a protective effect during pregnancy. Disclosure C. Sieiro Santos: None. P. Pérez García: None. J. Ordas Martínez: None. C. Álvarez Castro: None. E. Díez Álvarez: None.

Impact of dehydroepiandrosterone sulfate and free androgen index on pregnancy and neonatal outcomes in PCOS patients

BackgroundPolycystic ovary syndrome (PCOS) is a prevalent endocrine disorder associated with infertility and pregnancy complications. The pathogenesis of PCOS and its impact on reproductive function may be influenced by the source of androgens, including testosterone, free androgen, dehydroepiandrosterone sulfate (DHEAS). However, the differential effects of these androgen on pregnancy and neonatal outcomes and the cut-off value of East Asian population with PCOS remain unclear.MethodsA retrospective cohort study was conducted at the Reproductive Medicine Center of the First Affiliated Hospital of Sun Yat-sen University from January 2015 to November 2022, involving 636 cycles of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). Subgroup analyses were performed using cut-off values of 6.4 for free androgen index (FAI), 9.5 µmol/L for DHEAS. Pregnancy and neonatal outcomes were compared between groups. Restricted cubic spline (RCS) was used to identify significant cut-off values affecting pregnancy.ResultsHigher FAI levels (> 6.4) were associated with decrease in clinical pregnancy rate (PR) (50.61% vs. 41.66%, p = 0.024), live birth rate (LBR) (42.42% vs. 32.35%, p = 0.011). When DHEAS levels exceeded 9.5 µmol/L, there was a significant decrease in clinical PR (51.27% vs. 42.73%, P = 0.039), LBR (42.73% vs. 32.73%, P = 0.012). Negative correlations were also observed between DHEAS levels and cumulative pregnancy rate (70.57% vs 56.62% p = 0.002) and cumulative live birth rate (CLBR) (59.35% vs 43.37%, p = 0.0007). Both FAI and DHEAS elevated is associated with the lowest clinical pregnancy rate (37.84%). Conversely, when solely FAI is elevated, the pregnancy rate increases to 52.38%, while an elevation in DHEAS alone is associated with a pregnancy rate of, both of which are lower than when neither FAI nor DHEAS are elevated (60.68%). The live birth rates exhibit a similar trend (30.00% vs 40.00% vs 41.83% vs 44.48%). RCS revealed a significant decrease in CPR and CLBR when DHEA levels exceeded 7.69 umol/L, while the cut-off value of FAI was 6.36 for CPR and CLBR.ConclusionIn conclusion, PCOS patients with biochemical hyperandrogenism show unsatisfactory clinical PR and CLBR when undergoing assisted reproductive technology (ART). This may be attributed to the influence of both adrenal-derived DHEAS and ovarian-derived FAI on the unfavorable pregnancy outcomes.

MUC16 can Predict the Pregnancy Outcomes in Human and Intraperitoneal Administration of MUC16 can Rescue Pregnancy Losses in Mouse Models.

Mucin 16 (MUC16) participates in the process of embryo implantation, but few studies have examined the association between MUC16 and pregnancy loss. To investigate this association, the expression of MUC16 in serum and decidua was compared between women with pregnancy loss and ongoing pregnancies. In vitro experiments and animal models were used to explore the role and underlying mechanisms of MUC16 in pregnancy loss. In human study, the expression of MUC16 in serum and decidua was both consistently lower in the women with pregnancy loss compared with those in women with ongoing pregnancies. In vitro experiments revealed the interaction of MUC16 with peripheral blood natural killer (pNK) cells. MUC16 changed the phenotype and reduced the pro-inflammation ability of pNK cells. MUC16 also inhibited the cytotoxicity of pNK cells through the Src homology region 2 domain-containing phosphatase-1/extracellular signal-regulated kinase (SHP-ERK) pathway. Furthermore, MUC16 promoted the migration, invasion and tube formation of trophoblast cells by co-culturing together with pNK cells. In vivo experiments, the mouse model of abortion was used to further confirm that intraperitoneal administration of MUC16 could rescue the pregnancy loss. This study reveals the still-unknown connection between MUC16 and pNK cells and indicates that MUC16 provides a novel method for future prediction and treatment of unfavorable pregnancy outcomes.

The Impact of High BMI on Pregnancy Outcomes and Complications in Women with PCOS Undergoing IVF-A Systematic Review and Meta-Analysis.

(1) Background: Current evidence indicates that women with polycystic ovarian syndrome (PCOS) undergoing in vitro fertilization (IVF) have an increased likelihood of adverse pregnancy outcomes. The objective of this systematic review was to clarify the role of a PCOS-related high body mass index (BMI) in these unfavourable pregnancy outcomes. (2) Methods: A comprehensive search of electronic databases was conducted to identify studies investigating the impact of high BMI on pregnancy outcomes in women with PCOS undergoing IVF. RevMan software (v5.4) was used to calculate the odds ratio (OR) and 95% confidence interval (CI). (3) Results: Nineteen eligible studies (n = 7680) were identified, including 16 retrospective cohort studies (n = 6934), two prospective cohort studies (n = 525), and one cross-sectional study (n = 221). Pooled analysis showed significantly higher odds of clinical pregnancy (OR, 1.16 [95% CI, 1.04-1.29]; z = 2.73; p = 0.006; I2 = 30%) and livebirths (OR, 1.88 [95% CI, 1.56-2.27]; z = 6.54; p < 0.0001; I2 = 55%) in women with PCOS with a normal versus a high BMI. Meta-analysis showed significantly increased odds of miscarriages in women with PCOS with a high versus a normal BMI (OR, 0.76 [95% CI, 0.60-0.95]; z = 2.42; p = 0.02; I2 = 53%). Pooled analysis of three studies (n = 993) showed significantly higher ORs of gestational diabetes mellitus (OR 3.96 [95% CI 1.62-9.68]; z = 3.01; p = 0.003; I2 = 58%) and gestational hypertension (OR 2.16 [95% CI 1.32-3.54]; z = 3.05; p = 0.002; I2 = 68%) in women with PCOS with a high versus a normal BMI. Meta-analysis of three studies reported significantly greater odds of a caesarean section for women with PCOS with a high versus a normal BMI (OR 0.45 [95% CI 0.29-0.69]; z = 3.66; p = 0.0003; I2 = 0%). (4) Conclusions: The increased likelihood of adverse pregnancy outcomes observed in women with PCOS undergoing IVF seems to be attributable to a PCOS-related high BMI.

Role of gut microbiota derived short chain fatty acid metabolites in modulating female reproductive health

Short chain fatty acids (SCFA) have been linked to women's reproductive health, though to a lesser extent, alteration in the production of SCFA and SCFA-producing bacteria has been associated significantly with pregnancy-related complications, unfavourable pregnancy outcomes, menstrual anomalies, and gynaecological cancer.The female reproductive system is a delicate, intricate, hormone-dependent group of tissues required for the continuity of life and the species' survival. Reproductive health impacts the ovarian function to implantation and foetal development. Several environmental and physiological factors contribute to mammalian infertility concerns caused by a change in reproductive health status. Several lifestyle factors have been demonstrated to affect reproductive health, including age, body weight, smoking, alcohol consumption, work stress, exercise, diet, and nutrition. Nutrition influences puberty, the menstrual cycle, ovulation, conception, implantation and early foetal development. This review provides an overview of how intestinal derived SCFAs maintains female reproductive health summarizing the current knowledge and future perspectives. Microbial SCFAs improve human metabolism by interfering with, glucose homeostasis, appetite regulation and lipid metabolism. Also affect host immunity and intestinal barrier integrity via primary by inhibition of Histone deacetylases (HDAC) mechanism. Therefore, SCFAs exhibit anti-inflammatory, anti-obesity, immunoregulatory, anti-diabetes, anti-cancer, hepatoprotective, cardiovascular protective and neuroprotective properties.This review highlights recent findings on SCFA and gynaecological pathologies such as preeclampsia, gestational diabetes, pregnancy complications, polycystic ovary syndrome, bacterial vaginosis, and endometriosis to describe current knowledge of the relationship between SCFA and reproductive health and disease in women.

Awareness and Utilization of Antenatal Care Services among Women in Northern Nigeria

Background: Utilization of antenatal care is paramount in achieving the MDG goal, and is a resultant effect of knowledge, and attitude of the women to the services [20-25]. There are expedient factors that have been reported in literatures as affecting the utilization of ANC such as religion, education, cultures and traditions of the people, cost etc. Lack of antenatal care and its underuse can result in a variety of unfavorable pregnancy outcomes, including intrauterine growth restriction, low birth weight, and mother and infant death. This study was done to determine the awareness and utilization of ANC in Sokoto State, Nigeria as part of an effort to achieving the millennium development goal. Materials and Methods: This was a descriptive cross-sectional study, adopting the simple random sampling technique and an interviewer administered semi-structured questionnaire. Results and Discussions: The study finds, after assessment, the percentage of Good utilization, Good knowledge and Good Attitude towards ANC services as 52.3%, 72.6% and 67.0% respectively. Crude percentage of utilization of ANC services was 87.0%. Factors influencing utilization identified were marital status and income, with odds ratio of 6.2 (95%CI: 0.88 – 43.39) and 5.4 (95%CI: 1.60 – 18.30) respectively and having p-values of 0.068 and 0.007. Although the women in Sokoto have knowledge of ANC services, their utilization of ANC services is relatively poor. Conclusion: Out of the 87.0% of uptake of ANC, only 52.3% were assessed to have Good utilization score. There is need for interventions to improve utilization of ANC services among women in Sokoto.

Role of Cerebroplacental Ratio in Predicting Perinatal Outcome.

Objective Doppler velocimetry provides a sensitive, non-invasive, and safe method of surveillance of fetal hemodynamics and fetomaternal circulation. Cerebroplacental ratio (CPR) is an indicator of placental function and fetal maladaptation to placental insufficiency. Cerebroplacental ratio (CPR) is becoming a significant indicator of unfavorable pregnancy outcomes, which has implications for the assessment of fetal well-being. This study aimedto determine the cut-off value of the cerebroplacental ratio (CPR) in appropriate for gestational age (AGA) fetuses in high-risk mothers to predict adverse perinatal outcomes. We also compared the efficacy of CPR, umbilical artery pulsatility index (UmA PI), and middle cerebral artery pulsatility index (MCA PI) for predicting adverse perinatal outcomes. Design and setting This was a prospective observational study conducted at the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. Methods A total of 100 women with singleton high-risk pregnancies were included in this prospective observational study. Obstetric ultrasound was performed at the time of recruitment, and fetal weight and CPR were noted. Based on fetal weight, patients were divided into AGA and fetal growth restriction (FGR) groups; CPR was measured; patients were followed up fortnightly; and outcomes were noted. Main outcome The effectiveness of CPR, UmA PI, and MCA PI for predicting poor perinatal outcomes and identifying the cut-off value of CPR in appropriate for gestational age (AGA) fetuses in high-risk mothers was assessed. Result The values of MCA PI, UmA PI, and CPR were statistically significant between AGA and FGR (p-value =.023, .002 and .0001), respectively. The cut-off value for CPR-detecting adverse outcomes in AGA was 1.49. It has sensitivity, specificity, positive predictive value, and negative predictive value of 67.5%, 68%, 71.69%, and 70.21%, respectively. Conclusion Cerebroplacental ratio (CPR) reflects both circulatory insufficiency of the placenta and adaptive changes of the middle cerebral artery, indicating an important non-invasive surveillance modality.

The role of the cerebroplacental ratio in predicting pregnancy outcomes at 40-42 gestational weeks: a prospective observational trial.

The cerebroplacental ratio is a sonographic tool used to predict poor pregnancy outcomes. Data are insufficient regarding its use in postdate pregnancy. We evaluated the cerebroplacental ratio's prediction of unfavorable pregnancy outcomes in women at 40-42 weeks gestation with normal amniotic fluid index. This prospective observational study included 101 women with low-risk singleton pregnancy and gestational age > 40 weeks who delivered in a university affiliated hospital during 2020-2021. The middle cerebral artery pulsatility index, the umbilical artery pulsatility index, and the cerebroplacental ratio, which is their quotient, were compared between women with favorable and unfavorable pregnancy outcomes. The latter included: meconium-stained amniotic fluid, cesarean or vacuum-assisted delivery due to pathological cardiotocography (category 2 or 3), 5-min Apgar score < 7, umbilical cord pH < 7.1, neonatal intensive care unit admission, and neonatal death. Fetal Doppler, performed at a median gestational age of 40.3 (40.0-41.6), did not differ between 75 (74.3%) women with favorable obstetrical outcomes and 26 (25.7%) with unfavorable outcomes. In multivariate analysis, advanced maternal age and a history of a cesarean section were correlated with unfavorable outcomes, while Doppler indices were not found to be predictive. Among women at 41-42 weeks' gestation, for those with intrapartum fetal monitor category 2-3 vs. category 1, the mean umbilical artery pulsatility index was higher: 0.92±0.34 vs. 0.71±0.11 (p = 0.044). According to the study results, fetal Doppler indices, including the cerebroplacental ratio, are not predictive of unfavorable outcome in women with pregnancies exceeding 40 weeks. Larger prospective studies are needed.

The effect of limited access to antenatal care on pregnancy experiences and outcomes among undocumented migrant women in Europe: a systematic review.

Women who are undocumented migrants in Europe encounter a variety of challenges while trying to access health services, including restricted access to antenatal care (ANC) despite the importance of ANC to the well-being of mothers and their infants. This study's aim was to examine the effect that limited access to antenatal care has on the pregnancy experiences and outcomes of undocumented migrant (UM) women in Europe. Systematic searches were done on PubMed, Ovid MEDLINE, Ovid EMBASE, EBSCO CINAHL Plus, and BioMed Central. From the search results, only primary research articles that reported on the pregnancy outcomes and experiences of undocumented migrants were selected. A meta-analysis was not possible because this review included information from both qualitative and quantitative studies. The data that was taken from the included publications was organised, analysed, using the Microsoft Excel programme, and then meta-synthesised. Twelve papers from seven different European nations-Belgium, France, Sweden, Denmark, Norway, Finland, and England-were included in this systematic review. Eight of the studies aimed to explore the access to and utilization of ANC by undocumented migrant women and the related pregnancy outcomes. Two of the included studies examined the pregnancy experiences of UMs and two examined the perinatal risks associated with living as a migrant with no legal status. Although heterogeneous in their specific findings most of the studies showed undocumented immigrants are more likely to experience unfavourable pregnancy outcomes and experience greater anxiety and worries due to a variety of factors than documented migrants and registered citizens. This review's conclusions demonstrate the pressing need for policy modifications and healthcare reforms in Europe to address the problems associated with undocumented migrants' restricted access to antenatal care. It also highlights the urgent need for structural changes that will give this vulnerable population's health and well-being a higher priority. It is not just an issue of health equality but also a humanitarian obligation to address the many obstacles and difficulties undocumented migrant women endure during pregnancy.

Adverse Impact of Systemic Lupus Erythematosus on Pregnancy Outcomes: A Saudi Arabia Retrospective Multi-Center Study.

The current study aimed to determine the pregnancy outcomes complications in patients with SLE and its association with clinical, laboratory variables, disease activity, and medication use in the Saudi population, as well as pregnancy effect on disease activity. A multicenter study included pregnant female patients with Systemic Lupus Erythematosus (SLE) from three tertiary centers in Saudi Arabia. The demographics, clinical, and laboratory variables, SLE disease activity index (SLEDAI), medication before, during, and after pregnancy, planned pregnancy, pregnancy-related outcomes, and complications in comparison to age-matched healthy female controls were noted. A total of 66 pregnant patients with SLE and 93 healthy age-matched pregnant controls were included in the study. A total of 77.3% had SLEDAI-2K ≤ 4 before conception, and 84.85% of pregnancies were planned. Age of conception, cesarean section, miscarriage, and low birth weight were statistically significant (p <0.05) higher in SLE patients than in healthy controls. Among all clinical and laboratory variables, SLEDAI-2K > 4 and active lupus nephritis during pregnancy were statistically associated with adverse outcomes (p <0.05), history of lupus nephritis was not associated with statistically adverse pregnancy outcomes. Higher SLEDAI-2K > 4 was an independent risk at least 4.87 times higher association with adverse pregnancy outcomes. (p <0.05). SLE is intricately connected with unfavorable pregnancy outcomes. The preconception of high disease activity stands as a pivotal risk factor for adverse outcomes. Despite the disease remission and meticulous planning, SLE patients frequently grapple with disease exacerbations during pregnancy, culminating in unexpected and unfavorable pregnancy-related outcomes. This underscores the intricate and multifaceted nature of managing SLE during gestation.

ПРЕЖДЕВРЕМЕННЫЙ РАЗРЫВ ПЛОДНЫХ ОБОЛОЧЕК ПРИ ДОНОШЕННОЙ БЕРЕМЕННОСТИ КАК ФАКТОР РИСКА РАЗРЫВА ШЕЙКИ МАТКИ В РОДАХ

Abstract. Introduction. Premature rupture of membranes continues to be one of the urgent problems in modern obstetrics, since it is exactly the pathology a high frequency of unfavorable pregnancy outcomes is associated with. At the same time, an equally important task in obstetrics and gynecology remains the problem of maternal birth injuries, including cervical ruptures, the frequency of which ranges 6 to 15 %. Aim. To study how premature ruptures of membranes in full-term pregnancies affect the frequency of cervical ruptures in childbirth and to identify the risk factors of cervical injuries in at-term labor complicated by premature rupture of membranes. Materials and Methods. A retrospective analysis of birth histories for the years 2019-2020 was carried out according to the data of the perinatal center at Saratov City Clinical Hospital No. 8. The study group included 894 histories of single at-term vaginal deliveries complicated by premature rupture of membranes, while the control group included 6,735 birth histories of women whose vaginal deliveries were performed with timely ruptures of membranes. Later, we identified subgroups within the study group: Subgroup 1 (n=101) included patients with premature rupture of membranes at full-term gestation, whose at-term labors were complicated by uterine cervix ruptures, while Subgroup 2 (n=336) included women with premature ruptures of membranes during at-term labors without any maternal birth traumas. When analyzing medical records, special attention was paid to the anamnesis details and to the special aspects of birth courses and outcomes. Statistical data processing was performed using the MS Excel and Statistica 7.0 software programs. Differences in indications were considered statistically significant at p&lt;0.05. Results and Discussion. Probability of premature ruptures of membranes during full-term pregnancy increases in patients expecting their first childbirth by 1.6 times (χ2 = 173.49; p &lt;0.001), those with a burdened obstetric/gynecological history, such as abortions, miscarriages, and genital pathology, and those with concomitant extragenital diseases (85.9%). In the study group, we identified an increase in the incidence of labor anomalies (by 3 times) and acute fetal distress (by 1.9 times), which increased the proportion of using surgical aids in childbirth (by 2.7 times) and the risk of obstetric injuries to the mother (by up to 63.4%), including uterine cervix ruptures by up to 11.3%. Conclusions. Premature rupture of membranes at full-term gestation increases the risk of uterine cervix ruptures in childbirth by 10.3 times. In this obstetric context, the uterine cervix rupture risk factors should include the first birth (57.4%; p= 0.003) in the absence of biological readiness of the birth canal (“unripe” or “insufficiently ripe” uterine cervix, 76.2%), development of ineffective uterine contractions (12.9%), and the use of surgical aids in delivery (vacuum-assisted deliveries and episiotomies, 32.7%).

Relationship between parity and history of hypertension with MEOWS score in early onset severe preeclampsia patients

Introduction: Parity and a history of hypertension are some of the highest risk factors for severe preeclampsia, especially early onset. The severity of recurrent preeclampsia will increase compared to preeclampsia in the first pregnancy. Although there is a correlation between chronic hypertension and unfavorable pregnancy outcomes, several case-control studies have consistently shown that chronic hypertension is the most often acknowledged risk factor for adverse events affecting both the mother and the fetus. Women with the risk factors above can potentially fall into bad conditions, so close monitoring must be carried out. Modified Early Obstetric Warning System (MEOWS) is used for early detection, care, treatment, and referral of changes in obstetric patient parameters that are leading to worsening. Objective: Analyze the relationship between parity and history of hypertension with MEOWS scores in early-onset severe preeclampsia patients. Methods: A cross-sectional approach was used in this study by involving 63 patients. The population was early-onset severe preeclampsia patients treated at Dr. Soetomo Regional Public Hospital Surabaya Indonesia 2022; the sampling technique used was total sampling. This data was collected using secondary data from medical records and analyzed statistically using bivariate test, specifically the chi-square test using SPSS software. Results: The majority of patients were of reproductive age (73%), the gestational age was predominantly in the very preterm (28-&lt;32 weeks) category (49.2%), the most obstetric status was multigravida (77.8 ), and most patients had no history of hypertension (66.7%). The average MEOWS score in early-onset PEB patients was 8.11. Parity vs MEOWS score (p&gt;0.05), while the history of hypertension vs MEOWS score (p&lt;0.05). Conclusion: Parity and MEOWS score did not have a significant relationship, while the history of hypertension had a significant relationship with MEOWS score.

ASSESSMENT OF SEVERITY OF IRON DEFICIENCY AND ASSOCIATED RISK FACTORS AMONG PREGNANT WOMEN

Introduction: Iron deficiency (ID) is a common problem in pregnant women. The primary drivers of anemia in pregnancy are ID, aplastic anemia, a lack of vitamin B12, and vitamin B9. ID is the most widely recognized and can lead to unfavorable pregnancy outcomes. Both ID and iron deficiency anemia (IDA) are normal clinical illnesses in pregnant women. Anemia can cause a compromised immune system during pregnancy, leading to negative outcomes including premature birth and premature rupture of membranes. Objective: The objectives of this research are to determine the severity of ID among pregnant women and to check the associated risk factors for ID. Methodology: It is a cross-sectional study in government hospitals in Lahore. The data was collected through a self-administered questionnaire. Simple random sampling techniques are used, and SPSS is used for data analysis. Results: According to this study, the prevalence of IDA is high. Out of 385 women, 96 are normal, 102 are mild, 129 are moderate, and 58 are anemic. All associated risk factors—level of education, trimester, gravidity, family planning, and animal source food values—were significantly positive. Conclusion: The iron deficiency anemia (IDA) prevalence is high, and risk factors are high among pregnant women: living in rural areas, high gravidity, no family planning, and poor food from animal sources.

Postpartum quality of life and mental health in women with heart disease: Integrated clinical communication and treatment.

Postpartum quality of life (QoL) in women with heart disease has been neglected. To improve clinical communication and treatment, we integrated medical data and subjective characteristics to study postpartum QoL concerns. The study assessed QoL 6 wk after birth using the 12-Item Short-Form Health Survey. The Edinburgh Postnatal Depression Scale, Cardiac Anxiety Questionnaire, European Heart Failure Self-Care Behavior Scale, and a self-designed questionnaire based on earlier research were also used to assess patient characteristics. Patient data were collected. Prediction models were created using multiple linear regression. This retrospective study examined postpartum QoL in 105 cardiac patients. Postpartum QoL scores were lower (90.69 ± 13.82) than those of women without heart disease, with physical component scores (41.09 ± 9.91) lower than mental component scores (49.60 ± 14.87). Postpartum depression (33.3%), moderate anxiety (37.14%), pregnancy concerns (57.14%), offspring heart problems (57.14%), and life expectancy worries (48.6%) were all prevalent. No previous cardiac surgery, multiparity, higher sadness and cardiac anxiety, and fear of unfavorable pregnancy outcomes were strongly related to lower QoL (R2 = 0.525). Postpartum QoL is linked to physical and mental health in women with heart disease. Our study emphasizes the need for healthcare workers to recognize the unique characteristics of these women while developing and implementing comprehensive management approaches during their maternity care.

THE SYSTEMATIC REVIEW OF THE ASSOCIATION OF PREGNANCY OUTCOMES AND CHRONIC KIDNEY DISEASE

Background: Pregnancy as a metabolic stress test that might reveal underlying endothelial dysfunction and vascular illness. Maternal cardiovascular disease risk is heightened in cases of adverse pregnancy outcomes, including hypertensive disorders of pregnancy, gestational diabetes, and premature birth. Aims : This systematic review is to review the association of chronic kidney disease to its outcomes at pregnant women. Methods: By comparing itself to the standards set by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, this study was able to show that it met all of the requirements. So, the experts were able to make sure that the study was as up-to-date as it was possible to be. For this search approach, publications that came out between 2014 and 2024 were taken into account. Several different online reference sources, like Pubmed and SCIENCE DIRECT, were used to do this. It was decided not to take into account review pieces, works that had already been published, or works that were only half done. Result: In the PubMed database, the results of our search brought up 661 articles, whereas the results of our search on SCIENCE DIRECT brought up 3.6314 articles. The results of the search conducted for the last year of 2014 yielded a total 12 articles for PubMed and 96 articles for SCIENCE DIRECT. In the end, we compiled a total of 5 papers, 4 of which came from PubMed and 1 of which came from SCIENCE DIRECT. We included five research that met the criteria. Conclusion: In summary, an increased risk of chronic kidney disease was linked to exposure to unfavorable pregnancy outcomes, such as hypertensive disorders of pregnancy, gestational diabetes, and premature birth. Preeclamptic women had the highest chance of developing ESKD. To identify women who are more likely to develop kidney disease, especially following hypertensive disorders during pregnancy, a systematic strategy may be necessary to maximize the patients' long-term follow-up.

Anxiety and associated factors in Northwest Ethiopian pregnant women: a broad public health concern.

Pregnancy-related anxiety is a prevalent mental health issue that mostly affects women in low-income countries such as Ethiopia. It has been linked to unfavorable pregnancy outcomes, such as miscarriage, prematurity, and low birth weight. However, it has often received less attention, and community-based evidence lacks its prevalence and associated factors. Thus, the purpose of this study was to assess the prevalence and associated factors of anxiety in Northwest Ethiopian pregnant women in Gondar city. A community-based cross-sectional study was conducted from 1 July to 30 August 2021 in Gondar city. A cluster sampling technique was used to select a sample of 872 pregnant women, and in-person interviews were conducted to gather data. Descriptive and analytical statistical procedures were carried out. Of the participants, pregnancy-related anxiety was reported in 29.4% (95% CI: 26.3, 32.4) of women. The likelihood of having anxiety was higher among women who had known medical illness (AOR = 3.16; 95% CI: 1.8, 5.35), loneliness (AOR = 2.52; 95% CI: 1.34, 4.73), depression (AOR = 2.38; 95% CI: 1.48, 3.85), poor social support (AOR = 1.93; 95% CI: 1.21, 3.07), and intimate partner violence (AOR = 2.87; 95% CI: 2.04, 4.04). In this study, three out of ten women have suffered from anxiety. It is strongly advised to identify and treat known medical illnesses early in pregnancy, enhance social support, diagnose and treat depression, and limit intimate partner violence through multimodal and integrative activities with concerned bodies.

Blood lead levels in pregnant women and their newborn infants at an Indian teaching hospital.

With the growth of the world's economy and industrialization, lead (Pb) contamination in the environment has become a major issue on a global scale. Lead is typically linked to unfavorable pregnancy outcomes such as stillbirth, low birth weight preterm, and spontaneous abortion. In this study, we evaluated the blood lead levels of pregnant women and their birth outcomes attending an Indian tertiary care teaching hospital, those who were not exposed to any lead-associated industry or shops. A descriptive study was undertaken to evaluate blood lead estimation in pregnant women and umbilical blood lead levels in a community hospital. Blood samples from 104 mothers during the 1st trimester, 90 mothers during 3rd trimester, and from the umbilical cord were collected. Self-administered questionnaires were used to collect information on demographics, medical history, and concerns linked to pregnancy. Following acid digestion, the levels of lead in whole blood were determined by an atomic absorption spectrometer. The DNA damage in high blood lead-concentrated pregnant women was evaluated by comet assay methods. Among 194 blood samples of pregnant women, 31 (15.98%) samples revealed ≥5 μg/dL blood lead levels. High lead concentration (≥5 µg/dL) in 1st trimester pregnant women, end of 3rd trimester and cord blood were detected 20.19%, 11.11% and 1.11% respectively. The mean blood lead levels in 1st trimester, 3rd trimester, and cord blood were 3.88 ± 3.19, 2.66 ± 1.82, and 1.53 ± 1.06 mg/dL, respectively. The blood lead concentrations were significantly higher in the 1st trimester of pregnancy than in the 3rd trimester of pregnancy (P < 0.0017). A positive correlation between maternal and infant blood lead levels was revealed (P < 0.0001). When the comet assay was used to assess the genotoxic consequences of elevated blood lead levels during pregnancy, higher amounts of DNA damage were found in the samples (P < 0.01). In this descriptive study, there was a significant amount of lead transferred from mother to baby through the placenta. All mothers were not exposed to lead-associated industry and most were housewives. This article may be viewed as an eye-opener for understanding the blood lead concentration during pregnancy to avoid abnormal birth outcomes. To minimize exposure to environmental lead, all possible measures should be undertaken.

Enhancing pregnancy outcomes: the role of antioxidants in obstetrics

The physiological process of pregnancy is intricate and fraught with difficulties and potential problems that may affect the health of the mother and the fetus. Owing to its capacity to counteract oxidative stress, antioxidants have drawn a lot of interest from obstetricians as possible partners in enhancing pregnancy outcomes. This study examines the body of research on the function of antioxidants in obstetrics and how they affect different elements of pregnancy. Reactive oxygen species (ROS) and the body's antioxidant defense mechanisms are out of balance, and this imbalance can lead to oxidative stress, which has been linked to harmful pregnancy outcomes such as preterm birth, preeclampsia, and intrauterine growth restriction. One vital organ for fetal development, the placenta, is especially vulnerable to oxidative damage, which could result in difficulties. This review focuses on the many endogenous and exogenous sources of antioxidants as well as their methods of action in reducing oxidative stress in pregnancy. Selenium, polyphenols from fruits and vegetables, vitamins C and E, and other well researched antioxidants have demonstrated the potential to lower the risk of unfavorable pregnancy outcomes. The review also investigates the possible synergistic benefits of mixing several antioxidants for improved defense.

Risk for fetal malformations and unfavorable neonatal outcomes in early-onset gestational diabetes mellitus.

Early-onset gestational diabetes mellitus (GDM) is diagnosed before the 24th gestational week. Since early GDM is associated with first trimester hyperglycemia, many clinicians treat these women as having pre-GDM. However, whether early GDM increases the risk for unfavorable pregnancy outcomes and particularly for fetal malformations to a greater extent than late-onset GDM were not studied sufficiently. We aimed to examine the effect of early-onset GDM on unfavorable pregnancy outcomes. A retrospective cohort study of women with GDM delivering singletons during 2005-2018 was conducted. Women were divided into GDM diagnosed at the first (Trimester1; up to 13.6weeks; N = 117), the second (Trimester2; up to 23.6weeks; N = 126), and the third trimester (Trimester3; N = 2334). The primary outcomes were neonatal malformations and a composite of large-for-age newborns, hypoglycemia and hyperbilirubinemia treated with phototherapy. Comparisons were made between early- (Trimester1 + Trimester2-groups) and late-onset GDM (Trimester3-group), and between the three trimesters. Fetal malformations were low and comparable between the trimester1, trimester2, trimester3 groups (2 (1.7%), 3 (2.4%), and 110 (4.7%), respectively).The composite neonatal complications was similar between the groups (68 (58%), 58 (46%), and 1087 (47%), respectively). In early-onset, the rates of neonatal hypoglycemia and shoulder dystocia were higher than in the late-onset GDM group (OR 95% CI 3.5 [2.0-6.1] and 10.3 [2.4-44.6], respectively). Macrosomia was higher in trimester1 compared with trimester2 and trimester3 cohorts (OR 95% CI 5.3 [1.7-16.9] and 2.8 [1.5-5.2], respectively). The risk for fetal malformations was low and comparable between the first, second and third trimester GDM. Since the risks for macrosomia, shoulder dystocia, and neonatal hypoglycemia are higher in early-onset GDM, these women should undergo strict glycemic control, intensive monitoring, and careful neonatal evaluation.