Weeks Of Gestation In Pregnancies Research Articles

Association of prothrombin time, thrombin time and activated partial thromboplastin time levels with preeclampsia: a systematic review and meta-analysis

BackgroundPreeclampsia (PE), an obstetric disorder, remains one of the leading causes of maternal and infant mortality worldwide. In individuals with PE, the coagulation-fibrinolytic system is believed to be among the most significantly impacted systems due to maternal inflammatory responses and immune dysfunction. Therefore, this systematic review and meta-analysis aimed to assess the association of prothrombin time (PT), thrombin time (TT) and activated partial thromboplastin time (APTT) levels with preeclampsia.MethodsThis systematic review and meta-analysis was conducted in accordance with the PRISMA guidelines. Articles relevant to the study, published from July 26, 2013, to July 26, 2023, were systematically searched across various databases including PubMed, Scopus, Embase, and Hinari. The methodological quality of the articles was evaluated using the Joanna Briggs Institute critical appraisal checklist. Utilizing Stata version 14.0, a random-effects model was employed to estimate the pooled standardized mean difference (SMD) along with the respective 95% CIs. The I2 statistics and Cochrane Q test were utilized to assess heterogeneity, while subgroup analyses were performed to explore its sources. Furthermore, Egger’s regression test and funnel plot were employed to assess publication bias among the included studies.ResultsA total of 30 articles, involving 5,964 individuals (2,883 with PE and 3,081 as normotensive pregnant mothers), were included in this study. The overall pooled SMD for PT, APTT, and TT between PE and normotensive pregnant mothers were 0.97 (95% CI: 0.65–1.29, p < 0.001), 1.05 (95% CI: 0.74–1.36, p < 0.001), and 0.30 (95% CI: -0.08-0.69, p = 0.11), respectively. The pooled SMD indicates a significant increase in PT and APTT levels among PE patients compared to normotensive pregnant mothers, while the increase in TT levels among PE patients was not statistically significant.ConclusionsThe meta-analysis underscores the association between PE and prolonged PT and APTT. This suggests that evaluating coagulation parameters like PT, APTT, and TT in pregnant women could offer easily accessible and cost-effective clinical indicators for assessing PE. However, multicenter longitudinal studies are needed to evaluate their effectiveness across various gestational weeks of pregnancy.

The perinatal outcomes of women treated for Asherman syndrome: a propensity score-matched cohort study.

Do the perinatal outcomes of patients following hysteroscopic treatment for Asherman syndrome (AS) differ from that of a control population? Perinatal complications including placental issues, high blood loss, and prematurity in women after treatment for AS should be considered as moderate to high risk, especially in patients who have undergone more than one hysteroscopy (HS) or repeated postpartum instrumental revisions of the uterine cavity (Dilation and Curettage; D&C). The detrimental impact of AS on obstetrics outcomes is commonly recognized. However, prospective studies evaluating perinatal/neonatal outcomes in women with AS history are sparse, and the characteristics accounting for the respective morbidity of AS patients remain to be elucidated. We conducted a prospective cohort study utilizing data from patients who underwent HS treatment for moderate to severe AS in a single tertiary University-affiliated hospital (enrolled between 01 January 2009 and March 2021), and who consequently conceived and progressed to at least 22nd gestational week of pregnancy. Perinatal outcomes were compared to a control population without an AS history, retrospectively enrolled concomitantly at the time of delivery for each patient with AS. Maternal and neonatal morbidity was assessed as well as the characteristics-related risk factors of AS patients. Our analytic cohort included a total of 198 patients, 66 prospectively enrolled patients with moderate to severe AS and 132 controls. We used multivariable logistic regression to calculate a propensity score to match 1-1 women with and without AS history based on demographic and clinical factors. After matching, 60 pairs of patients were analysed. Chi-square test was used to compare perinatal outcomes between the pairs. Spearman's correlation analysis was utilized to investigate the correlation between perinatal/neonatal morbidity and the characteristics-related factors of AS patients. The odds ratio (OR) for the associations was calculated by logistic regression. Among the 60 propensity matched pairs, the AS group more frequently experienced overall perinatal morbidity, including abnormally invasive placenta (41.7% vs 0%; P < 0.001), retained placenta requiring manual or surgical removal (46.7% vs 6.7%; P < 0.001), and peripartum haemorrhage occurrence (31.7% vs 3.3%; P < 0.001). Premature delivery (<37 gestational weeks) was reported more frequently also for patients with AS (28.3% vs 5.0%; P < 0.001). However, no increased frequency of intra-uterine growth restriction or worsened neonatal outcomes were observed in AS group. Univariable analysis of risk factors for AS group morbidity outcomes revealed that the main factor related to abnormally invasive placenta was two or more HS procedures (OR 11.0; 95% CI: 1.33-91.23), followed by two or more D&Cs preceding AS treatment (OR 5.11; 95% CI: 1.69-15.45), and D&C performed postpartum as compared to post abortion (OR 3.0; 95% CI: 1.03-8.71). Similarly, two or more HS procedures were observed as the most important factor for retained placenta (OR 13.75; 95% CI: 1.66-114.14), followed by two or more preceding D&Cs (OR 5.16; 95% CI: 1.67-15.9). Premature birth was significantly associated with the number of preceding D&Cs (OR for two or more, 4.29; 95% CI: 1.12-14.91). Although the cohort of patients with AS was enrolled prospectively, a baseline imbalance was intrinsically involved in the retrospective enrolment of the control group. However, to reduce the risk of bias, confounding factors were adjusted for using propensity score matching. The limitation to the generalization of our reported results is the single institution design in which all patients were treated for AS in one tertiary medical centre. Within our search scope, our study represents one of the first and largest prospective studies of perinatal and neonatal outcomes in moderate to severe AS patients with a prospectively analysis of the risks factors of characteristics significantly influencing reported morbidities among patients with AS. The study was supported by the Charles University in Prague [UNCE 204065] and by the institutional grant of The General Faculty Hospital in Prague [00064165]. No competing interests were declared. N/A.

Development and validation of risk prediction models for large for gestational age infants using logistic regression and two machine learning algorithms.

Large for gestational age (LGA) is one of the adverse outcomes during pregnancy that endangers the life and health of mothers and offspring. We aimed to establish prediction models for LGA at late pregnancy. Data were obtained from an established Chinese pregnant women cohort of 1285 pregnant women. LGA was diagnosed as >90th percentile of birth weight distribution of Chinese corresponding to gestational age of the same-sex newborns. Women with gestational diabetes mellitus (GDM) were classified into three subtypes according to the indexes of insulin sensitivity and insulin secretion. Models were established by logistic regression and decision tree/random forest algorithms, and validated by the data. A total of 139 newborns were diagnosed as LGA after birth. The area under the curve (AUC) for the training set is 0.760 (95% confidence interval [CI] 0.706-0.815), and 0.748 (95% CI 0.659-0.837) for the internal validation set of the logistic regression model, which consisted of eight commonly used clinical indicators (including lipid profile) and GDM subtypes. For the prediction models established by the two machine learning algorithms, which included all the variables, the training set and the internal validation set had AUCs of 0.813 (95% CI 0.786-0.839) and 0.779 (95% CI 0.735-0.824) for the decision tree model, and 0.854 (95% CI 0.831-0.877) and 0.808 (95% CI 0.766-0.850) for the random forest model. We established and validated three LGA risk prediction models to screen out the pregnant women with high risk of LGA at the early stage of the third trimester, which showed good prediction power and could guide early prevention strategies.

Prone Positioning: A Safe and Effective Procedure in Pregnant Women Presenting with Severe Acute Respiratory Distress Syndrome.

Prone positioning (PP) improves oxygenation and survival in patients with severe acute respiratory distress syndrome (ARDS). Data regarding feasibility and effectiveness of PP in pregnancy are lacking. This subgroup analysis of a cohort study that included mechanically ventilated pregnant women presenting with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-induced ARDS who underwent PP aims to assess the efficacy and safety of PP. Ventilatory and gasometric parameters were evaluated at baseline (T0) and in prone (T1) and supine (T2) positions. Obstetric outcomes were also assessed. Sixteen cases at an average of 27.0 (22.0-31.1) gestational weeks of pregnancy were included. Obesity and hypertension were frequent comorbidities. PP was associated with a &gt;20% increase in PaO2 levels and in PaO2/FiO2 ratios in 50% and 100% of cases, respectively. The PaO2/FiO2 ratio increased 76.7% (20.5-292.4%) at T1 and 76.9% (0-182.7%) at T2. PP produced sustained improvements in mean PaO2/FiO2 ratio (p &lt; 0.001) and PaCO2 level (p = 0.028). There were no cases of emergency delivery or suspected fetal distress in pregnancies ≥25 weeks during the 24 h period following PP. PP is safe and feasible during pregnancy, improving PaO2/FiO2 ratios and helping to delay preterm delivery in severe ARDS.

Comparison of the Mean Uterine Artery Pulsatility Index Global Reference with an Asian Indian Population of Pregnant Women in the Samrakshan Program-Differences and Implications.

Doppler ultrasound assessments are used more often to screen and prognosticate for adverse maternal and perinatal outcomes.[1] [2] [3] [4] [5] [6] Ultrasound examination of the uterine artery (UA) helps to assess uteroplacental circulation from early gestation through the course of pregnancy. The mean UAPI is among the most common UA indices that are currently assessed. The mean UAPI is used to screen and prognosticate for the development of pre-eclampsia (PE), fetal growth restriction (FGR), still birth, placental abruption, and other adverse perinatal outcomes.[1] [2] [3] [4] [5] [6] Gómez et al[7] have published global reference ranges for the mean UAPI for 11 to 41 gestational weeks of pregnancy; however, population reference ranges for pregnant Asian Indian women are not available.

Amniopatch Treatment in Spontaneous Previable Preterm Rupture of Membranes with Neonatal Outcomes

Objective: To evaluate the efficiency of amniopatch application in previable preterm rupture of membranes (pPPROM) between 17-23 gestational weeks of pregnancy. Methods: 30 pregnants with previable preterm rupture of membranes were given amniopatch as therapy option instead of termination.After one week of antibiotics and bed rest the volunteers were applied amniopatch under sonographic guidance by infusion of 100 mL of 0.9% Isotonic solution alternate infusions of platelets, normal saline and FFP with a total of 100cc of each maximally were given into amniotic cavity. During infusion, in the event of bradycardia, the infusion was stopped. Results: 38 amniopatches were applied to 30 pPPROM patients. 7 aborted, 17 gave an immature birth and 6 gave preterm birth None reached to term. Alive birth rate was %23, All of them were born prematurely with changing durations in Neonatal Intensive Care Unite (NICU). In the 7 alive newborns duration of NICU differed (10 days-91 days) with a mean of 44,5 days. Deepest vertical pocket normalized in only 4 of the 30 patients (13,3%) after one week. There were 2 ablatio plasenta cases, none born alive. Cesarean section rate was 6/30 (%20). Maternal complications were endometritis (5/30, 16%), chorioamnionitis 4/30 (13%) all cured with antbiotic regimens in one week, none had sepsis. Conclusion: Results of amniopatch treatment in pPPROM are not convincing, although you restore the amnion a little bit, the etiopathogenesis and underlying factors still exist and cause premature birth, resulting in neonatal complications.

Predicting miscarriage using systemic immune-inflammation index.

To evaluate the clinical significance of the systemic immune-inflammation index (SII) for patients who had miscarriages. The retrospective study included 709 pregnant women who had a miscarriage (nonviable intrauterine pregnancy up to 20 weeks of gestation) and 676 women who carried a viable intrauterine pregnancy up to 20 weeks of gestation-serving as the control group. The study and the control group were compared in terms of demographic characteristics, laboratory test results, and SII values. Furthermore, laboratory test results and SII values were compared between patients in the study group and the control group with a history of genital bleeding (threatened abortion). The mean gestational week of pregnancy was 9.5 ± 3 for the control group and 8.3 ± 2.5 for the study group (p=0.150). The SII values were higher in the study group than in the control group (p=0.030). In all participants with a clinical history of genital bleeding, the leukocyte count, neutrophil count, neutrophil-to-lymphocyte ratio (NLR), and SII values were higher in the miscarriage group than the group with viable fetus (p=0.031, p=0.003, p=0.002, p < 0.001). Based on a receiver operating characteristic (ROC) curve analysis, the SII cutoff value for miscarriage was 883.95 (109 /L) (62.6% sensitivity, 62% specificity) in patients with a clinical history of threatened abortion. High SII values in early pregnancy may be used as an additional marker for the prediction of miscarriage, in pregnant women with threatened abortion. Further prediction models including maternal risk factors and multiple markers may be more valuable for clinical practice.

Pertussis antibody levels in infants and their mothers receiving combined tetanus-diphtheria toxoid and acellular pertussis vaccine during pregnancy in Turkey

ObjectivePertussis is an important cause of morbidity and mortality in infants under two months of age and these high risk babies are dependent on maternally derived antibodies until completion of their first immunization series. This study aimed to evaluate the vaccine response of late preterm and term newborns as well as their mothers who underwent combined tetanus-diphtheria toxoid and acellular pertussis (Tdap) vaccination during pregnancy. Study designA total of 70 pregnant women were administered Tdap vaccine (Boostrix®, GSK) between 27 and 33 gestational weeks of pregnancy. The IgG antibodies against pertussis toxin (PT) and filamentous hemagglutinin (FHA) in maternal blood before vaccination and in both maternal and umbilical cord blood after vaccination were evaluated using the in-house ELISA method. The geometric mean concentrations (GMC) and placental transfer ratios of antibodies were measured. ResultsParticipants’ with a mean age of 29.59 ± 4.70 years received Tdap vaccine at an average 28.6 ± 1.31 gestational weeks. Average pre and post vaccination levels of anti-PT IgG GMCs and anti-FHA IgG GMCs were 8.01 IU/ml vs 39.48 IU/ml (p = 0.001) and 122.24 IU/ml vs 183.97 IU/ml (p < 0.001), respectively. The anti-PT and anti-FHA IgG GMCs of cord blood after vaccination was 25.15 IU/ml and 118.77 IU/ml, respectively (p < 0.001 and p = 0.064). Placental transfer ratios of anti-PT ve anti-FHA IgG antibodies were detected as 0.65 and 0.62, respectively. ConclusionImmunization of pregnant women with Tdap at the third trimester results in high maternal and infant antibody levels. Maternal immunization during each pregnancy seems to be the best strategy in revealing the highest maternal and infant antibodies and in narrowing the gap between birth and immune system maturation in infants. Pregnant women in our country should also get the Tdap vaccine during pregnancy especially in the early third trimester.

381 Evening Chronotype Predicts Subjective Sleep Symptom Severity in Pregnant Women with Insomnia Disorder

Abstract Introduction Evening chronotype is associated with greater reports of insufficient sleep and sleep-related distress. Little research has examined this relationship within the context of pregnancy. This study investigated whether eveningness predicts insomnia severity, sleep effort, dysfunctional sleep beliefs, and sleep reactivity to stress in pregnant women with insomnia disorder. Methods Pregnant women with insomnia disorder who spoke English or Spanish enrolled in a clinical trial of cognitive behavioral therapy for insomnia (N = 178; M age = 32.6 years). Before beginning treatment, participants completed the Composite Scale of Morningness (CSM), Insomnia Severity Index (ISI), Glasgow Sleep Effort Scale (GSS), Dysfunctional Beliefs and Attitudes about Stress Scale (DBAS), and Ford Insomnia Response to Stress Test (FIRST). Participants were categorized into evening, intermediate, or morning chronotypes (bottom 25%, middle 50%, or top 25% of CSM scores, respectively). MANCOVA examined whether chronotype predicted higher baseline ISI, GSS, DBAS, and FIRST scores after adjusting for age, gestational week of pregnancy, and language. Results Sleep measures collectively differed by chronotype, F(8, 336) = 4.05, p &amp;lt; .001; Wilk’s Λ = .83, partial η-sqd = .09. Follow-up ANOVAs testing individual dependent variables were all significant (partial η-sqd = .04 – .10, p &amp;lt; .05). Pairwise comparisons (Bonferroni-adjusted; p &amp;lt; .05) found that evening types had higher ISI scores than intermediate (M difference = 2.21) and morning types (M difference = 2.30), and higher DBAS scores than morning types (M difference = .95). Morning types had lower FIRST scores than evening (M difference = 5.44) and intermediate types (M difference = 3.89). Conclusion Evening chronotype was associated with greater insomnia severity and maladaptive sleep-related cognition than other chronotypes among pregnant women with insomnia disorder. Future research may examine whether differences in chronotype have implications for insomnia treatment outcome during pregnancy, and whether greater morningness confers protection against sleep challenges during the early postpartum period. Support (if any) NIH R01 NR013662

ACUTE PANCREATITIS: AS A REASON FOR PRETERM DELIVERY

Acute pancreatitis which is the rare reason for acute abdomen during pregnancy could cause morbidity or mortality. Physiologic changes of pregnancy affect the gall bladder and bile ingredients which play a crucial role in acute pancreatitis. Damage in the pancreas initiates local inammation and damage in the pancreas however, systemic inammatory response and multi-organ dysfunction are not rare. Additionally, acute pancreatitis during pregnancy could be a reason for preterm delivery as we aimed to present two cases in the last trimester of the pregnancy. Case 1: rd A 19-year-old woman in her 33 gestational week of pregnancy was admitted to the emergency room with acute abdominal pain and vomiting for 4 hours. She had a rm cervix on vaginal examination and ultrasonographic evaluation revealed a live fetus with a 2620 gr of estimated fetal weight, normal amniotic uid index, and placenta. Laboratory tests presented as elevated serum amylase and lipase. A hydropic gallbladder with multiple gall stones was detected in the abdominal ultrasound. The patient was hospitalized with an acute pancreatitis diagnosis. During the hospital stay, uterine th contractions had initiated and cervical dilation has progressed. The patient was delivered a live baby and discharged on the 7 hospital stay. She was performed laparoscopic cholecystectomy 4 weeks after the delivery. Case 2: th A 28-year-old woman in her 35 gestational week was admitted to the emergency department with right upper quadrant pain. Abdominal and obstetric ultrasounds were uneventful. Laboratory examination revealed an elevated serum amylase and lipase. She was hospitalized. During the hospital stay; despite the medical treatments and prevention of oral intake, the levels of amylase and lipase and the abdominal pain have progressed. The patient was delivered via cesarean section. The levels of amylase and lipase decreased progressively, and the upper quadrant abdominal pain gradually decreased. The patient was discharged on day 7. Discussion: Acute pancreatitis could cause a systemic inammatory response which could lead to preterm delivery. Upper abdominal pain is the essential symptom and elevated serum amylase and lipase about 3-fold are the most common nding. Ultrasonographic evaluation of the gall-bladder and pancreas is crucial. Magnetic resonance cholangiopancreatography without contrast medium can also be used for diagnosis. A multidisciplinary approach is essential for treatment and follow-up. Obstetricians should evaluate fetal well being, and consider acute pancreatitis as a reason for threatened preterm labor.

Periodontal status of women with excessive gestational weight gain and the association with their newborns’ health

The aim of this study was to assess the association between high gestational weight gain and systemic and periodontal status of women between the 32nd and 36th gestational weeks of pregnancy (T1) and after delivery (T2), and the association of these factors with newborns' health. The sample was divided into excessive gestational weight gain (GE=25) and normal gestational weight gain (GN=25) and was evaluated regarding: (i) socio-economic status; (ii) systemic and periodontal status; and (iii) newborns' health. The results were analysed using the Mann-Whitney U-test, the t-test, the Friedman test, analysis of variance (ANOVA) and Cochran's Q test (P<0.05). Women with GE had lower household income (P=0.010) and higher body mass index (BMI) at both T1 and T2. The prevalence of hypertension at T1 was higher in women with GE, but the condition resolved post-delivery (P=0.001). Worsening in oral hygiene was observed at T2 in both groups (P<0.001). Sixty-eight percent of women with GE and 16% of women with GN had periodontitis at T1, and 52% and 12%, respectively, had periodontitis at T2. In women with GE, the BMI of newborns was higher (P=0.031). Women with high gestational weight gain also showed a high prevalence of hypertension and periodontitis during pregnancy, and persistent periodontitis after delivery. High gestational weight gain was related to high BMI of newborns.

The effect of prenatal yoga on the anxiety level of pregnant women

This study was to determine the effect of prenatal yoga on the anxiety level of third trimesters pregnant women in the Singgani Health Center before and after being given yoga pregnancy. The method in this study is a type of pre-experimental research that uses the one group pre-test - post-test approach. The samples in this study were 48 subjects using a purposive sampling technique. Prenatal yoga was given to third trimesters pregnancy gestational weeks 30-37 age; the level of anxiety of pregnant women was measured by Interviews using questionnaires. Analysis in the study used the Wilcoxon test. Before the intervention of yoga, pregnancy has severe anxiety that is equal to 58.3%, mothers who are not anxious 2.1%, mild anxiety levels 2.1%, mothers who have moderate anxiety levels of 37.5%. After pregnancy yoga, most mothers had a mild anxiety level of 54.1%, mothers who did not have the anxiety of 16.7%, and mothers who had moderate and severe anxiety levels of 14.6% each. Wilcoxon test showed significant statistics. This study indicated that prenatal yoga could influence the anxiety level of pregnant women.

Reference range for C1-esterase inhibitor (C1 INH) in the third trimester of pregnancy

The objectives of this study were to (i)establish the reference range and mean value for normal levels of C1-esterase inhibitor (C1 INH) during pregnancy, and (ii) investigate the association between C1 INH and uterine atony, as measured by blood loss at delivery. We prospectively studied 200 healthy pregnant women who were registered. We studied C1 INH levels in 188 women at 34 and 35 gestational weeks of pregnancy. The reference range for C1 INH during the third trimester of pregnancy was calculated using the value of C1 INH that was determined at registration. The mean value of C1 INH was determined to be 70.3% (95% confidence interval, 68.7-71.9). While the C1 INH levels in four women were determined to be 40% lower than the calculated mean value, amniotic fluid embolism (AFE) did not occur in any of the women studied. This study successfully demonstrated that a reference value for C1 INH activity can be established using the methods described herein. Further research is needed to determine whether C1 INH is involved in obstetric coagulopathy syndrome such as amniotic fluid embolism.

Tracking evoked responses to auditory and visual stimuli in fetuses exposed to maternal high-risk conditions.

Magnetoencephalography (MEG) has been successfully applied to record fetal auditory (auditory evoked response [AER]) and visual evoked responses (VER). In this study, we report the AER and VER development trajectory by tracking the evoked response detectability and latency from recordings starting at 27weeks of gestation in pregnancies classified as high risk. Fetal MEG and ultrasound recordings were performed on 158 pregnant women, and the total number of fetal auditory and visual tests conducted was 321 and 237, respectively. The overall evoked response analysis showed 237 AER (73.8%) and 164 VER detections (69.2%). The mean AER latency was 290.7 (SD 125.5) ms and the mean VER latency was 293.7 (SD 114.5) ms. The rate of decrease (95% confidence limits) in average AER and VER first-peak latency between 100-350ms was 1.97 (-1.86, +5.81) ms/week and 1.35 (-3.83, +6.53) ms/week, respectively. This trend in high-risk fetuses conforms to the general trajectory of decrease in latency with gestational age progression, even though this decrease was non-significant, as reported in the case of normal growing fetuses. Although there was a significant difference in detection rates between male and female fetuses, this was not reflected in either latency values or the sensory modality applied. Furthermore, the main factors that had the most significant effect on response detectability included the presence of intervening layers of adipose tissue between the fetal head and stimulus source and an increase in the maternal body mass index.

Prevalence of inadequate and excessive iodine intake in a US pregnancy cohort

US iodine intake, estimated from the median urinary iodine concentration of population representative data, has declined by half since the 1970s, which is problematic because maternal iodine intake is critical for fetal neurodevelopment. Relying on median urinary concentrations to assess iodine intake of populations is standard practice but does not describe the number of individuals with insufficient intake. Prevalence estimates of inadequate and excessive intake are better for informing public health applications but require multiple urine samples per person; such estimates have been generated in pediatric populations but not yet among pregnant women. Our aims were as follows: (1) to assess median urinary iodine concentrations across pregnancy for comparison with national data and (2) to estimate the prevalence of inadequate and excessive iodine intake among pregnant women in mid-Michigan. Data were collected from 2008 to 2015 as part of a prospective pregnancy cohort in which women were enrolled at their first prenatal clinic visit. Few exclusion criteria (<18 years or non-English speaking) resulted in a sample of women generally representative of the local community, unselected for any specific health conditions. Urine specimens were obtained as close as practicable to at least 1 specimen per trimester during routine prenatal care throughout pregnancy (n=1-6 specimens per woman) and stored at -80°C until urinary iodine was measured to estimate the iodine intake (n=1014 specimens from 464 women). We assessed urinary iodine across pregnancy by each gestational week of pregnancy and by trimester. We used multiple urine specimens per woman, accounted for within-person variability, performed data transformation to approximate normality, and estimated the prevalence of inadequate and excessive iodine intake using a method commonly employed for assessment of nutrient status. Maternal characteristics reflected the local population in racial and ethnic diversity and socioeconomic status as follows: 53% non-Hispanic white, 22% non-Hispanic black, and 16% Hispanic; 48% had less than or equal to high school education and 71% had an annual income of <$25,000. Median urinary iodine concentrations in the first, second, and third trimester-including some women contributing more than 1 specimen per trimester-were 171 μg/L (n=305 specimens), 181 μg/L (n=366 specimens), and 179 μg/L (n=343 specimens), respectively, with no significant difference by trimester (P=.50, Kruskal-Wallis test for equality of medians). The estimated prevalence of inadequate and excessive iodine intake was 23% and <1%, respectively. Median urinary iodine concentrations in each trimester were above the World Health Organization cutoff of 150 μg/L, indicating iodine sufficiency at the group level across pregnancy. However, the estimated prevalence of inadequate iodine intake was substantial at 23%, whereas prevalence of excessive intake was <1%, indicating a need for at least some women to increase consumption of iodine during pregnancy. The American Thyroid Association, the Endocrine Society, and the American Academy of Pediatrics recommend that all pregnant and lactating women receive a daily multivitamin or mineral supplement that contains 150 μg of iodine. The data presented here should encourage the collection of similar data from additional US population samples for the purpose of informing the American College of Obstetricians and Gynecologists' own potential recommendations for prenatal iodine supplementation.

Uterine fibroids and preterm birth risk: A systematic review and meta-analysis.

This study explored the association between the presence of uterine fibroids (UF), as determined by ultrasound, and preterm birth (PB) risk. Medline, Embase, Cochrane, Scopus and Web of Science databases. Studies reporting women with and without UF demonstrated by an ultrasound exam. The primary outcome was the risk of PB < 37 weeks of gestation in pregnancies with UF diagnosed by an obstetric ultrasound exam. Effects for dichotomous and continuous outcomes are, respectively, reported as risk ratios (RR) or mean differences and their 95% confidence intervals (CI). Eighteen studies were included comprising 276 172 pregnancies to whom obstetric ultrasound assessment was performed for the presence/absence of UF. Women with UF were older (mean difference = 2.40 years, 95% CI 0.94-3.85) and were at higher risk of PB before 37 (RR = 1.43, 95% CI 1.27-1.60), 34 (RR = 1.79, 95% CI 1.32-2.42), 32 (RR = 1.94, 95% CI 1.33-2.85) and 28 (RR = 2.17, 95% CI 1.48-3.17) weeks as compared to those without UF (P < 0.01). In addition, women with UF were at higher risk of threatened preterm labor, preterm premature rupture of membranes, fetal malpresentation, placental abruption, lower gestational age and birthweight at delivery and a higher cesarean delivery rate. Pregnant women with UF are at increased risk of PB and other adverse obstetric outcomes.

Role of first‐trimester umbilical vein blood flow in predicting large‐for‐gestational age at birth

To describe umbilical vein (UV) hemodynamics at 11 + 0 to 13 + 6 weeks of gestation in pregnancies delivering a large-for-gestational-age (LGA) neonate, and to build a multiparametric model, including pregnancy and ultrasound characteristics in the first trimester, that is able to predict LGA at birth. This was a matched case-control study, of singleton pregnancies that underwent ultrasound examination at 11 + 0 to 13 + 6 weeks for aneuploidy screening, at a single center over a 4-year period. Cases were women who delivered a neonate with birth weight (BW) > 90th centile for gestational age and sex, according to local birth-weight standards, while controls were those who delivered a neonate with BW ranging between the 10th and 90th centiles, matched for maternal and gestational age, at a ratio of 1:3. Each included case underwent Doppler assessment of the uterine arteries and UV, including measurement of its diameter, time-averaged maximum velocity (TAMXV) and UV blood flow (UVBF). UVBF and its components were expressed as Z-scores. Fisher's exact test and Mann-Whitney U-test were used to compare differences in maternal biomarkers and ultrasound characteristics between pregnancies complicated by LGA and controls. Logistic regression and receiver-operating-characteristics (ROC) curve analyses were carried out to identify independent predictors of LGA and to build a multiparametric prediction model integrating different maternal, pregnancy and ultrasound characteristics. Subgroup analysis was also performed, considering women who delivered a neonate with BW > 4000 g. In total, 964 pregnancies (241 with LGA at birth and 723 without) were included in the study. In LGA pregnancies compared with controls, UV-TAMXV Z-score (0.8 (interquartile range (IQR), 0.4-1.5) vs 0.0 (IQR, -0.3 to 0.5); P ≤ 0.001) and UVBF Z-score (1.3 (IQR, 0.8-1.9) vs 0.1 (IQR, -0.4 to 0.4); P ≤ 0.001) were higher, while there was no difference in median UV diameter Z-score (P = 0.56). Median uterine artery pulsatility index multiples of the median (MoM; 0.94 (IQR, 0.78-1.12) vs 1.02 (IQR, 0.84-1.19); P = 0.04) was significantly lower in LGA pregnancies. On multivariate logistic regression analysis, maternal body mass index (BMI; adjusted odds ratio (aOR), 1.2 (95% CI, 1.1-1.7); P < 0.001), parity (aOR, 1.4 (95% CI, 1.2-1.6); P < 0.001), pregnancy-associated plasma protein-A (PAPP-A) MoM (aOR, 1.1 (95% CI, 1.0-1.6); P = 0.04) and UVBF Z-score (aOR, 1.6 (95% CI, 1.1-1.9); P < 0.001) were associated independently with LGA. A multiparametric model integrating parity, BMI and PAPP-A MoM provided an area under the ROC curve (AUC) of 0.72 (95% CI, 0.67-0.76) for the prediction of LGA. The addition of UVBF Z-score to this model significantly improved the prediction of LGA provided by maternal and biochemical factors, with an AUC of 0.79 (95% CI, 0.75-0.83; P = 0.03). Similarly, the model incorporating UVBF Z-score predicted BW > 4000 g with an AUC of 0.83 (95% CI, 0.75-0.93). UVBF measured at the time of the 11-14-week scan is associated independently with, and is predictive of, LGA and BW > 4000 g. Adding measurement of UVBF to a multiparametric model that includes maternal (parity and BMI) and biochemical (PAPP-A) parameters improves the diagnostic accuracy of prenatal screening for LGA at birth. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Early Detection of Structural Anomalies in a Primary Care Setting in the Netherlands

Objective: This study assessed the percentage and type of congenital anomalies diagnosed at first-trimester ultrasound (US) scan in a primary care setting without following a standardized protocol for fetal anatomical assessment. Materials and Methods: US scans performed between 11⁺⁰ and 13⁺⁶ weeks of gestation in pregnancies with estimated date of delivery between January 1, 2012 and January 1, 2016 were searched. Data were supplemented with results of 20-week scans and pregnancy outcome. Results: Of all scans, 38.6% were dating scans and 61.4% were part of first-trimester screening. Anomalies were diagnosed prenatally in 200 (1.8%) fetuses; 81 (0.7%) were chromosomal and 119 (1.1%) were structural. Of all prenatally detected anomalies, 27% (n = 32) were detected at first-trimester scan, with a false-positive rate of 0.04%. All cases of anencephaly (n = 4), encephalocele (n = 2), exomphalos (n = 9), megacystis (n = 4), and limb reduction (n = 1) were diagnosed. First-trimester detection of gastroschisis and congenital heart defects was 67 and 19%, respectively. Conclusion: In a primary care setting, global fetal anatomical assessment at first-trimester scan without following a standardized protocol detects about 30% of all structural anomalies and most of the severe anomalies, with an extremely low false-positive rate. We hypothesize that additional training and use of a systematic protocol would improve early detection of structural anomalies.

Influenza A H1N1 virus infection among pregnant women in a tertiary hospital in Belgrade, Serbia.

Pregnant women are at higher risk of developing severe influenza. Our aim was to analyze clinical course and risk factors for fatal outcome in pregnant women with influenza (H1N1) infection. This retrospective study enrolled eleven pregnant women with confirmed Influenza A (H1N1) infection treated in the Clinic for Infectious and Tropical Diseases, Belgrade, Serbia in a 6-years period. The mean age of pregnant women was 28.9 ± 5.2 years, and mean gestational age was 23.1 ± 7.0 weeks. Nine (81.8%) pregnant women had pneumonia (six had interstitial and three had bacterial pneumonia). Pregnant women developed pneumonia more often than other women in the reproductive period, but without statistical significance (81.8% vs. 65.7%, p = 0.330, OR (95% CI) 2.35 (0.47-11.80)). Nine (81.8%) pregnant women recovered. None of them experienced preterm delivery or abortion. Two women (18.2%) died due to acute respiratory distress syndrome. In one of them fetal death occurred one day before she died. The other one was performed caesarean section three days before death. Her newborn and children of all recovered women were healthy at birth. Prolonged time to initiation of oseltamivir and higher body mass index were statistically significantly associated with fatal outcome (p = 0.002, and p = 0.007, respectively). Gestational week of pregnancy, the etiology of pneumonia and comorbidity were not found to be risk factors for death (p = 0.128, p = 0.499 and p = 1.000, respectively). Pregnant women with H1N1 infection are at higher risk of pneumonia and death than other women in the reproductive period. Early antiviral therapy reduces the risk of unfavorable outcome.

THE ROLE OF BIOCHEMICAL MARKERS OF FIRST TRIMESTER TRISOMY SCREENING TEST IN THE PREDICTION OF GESTATIONAL DIABETES MELLITUS

Objective: To investigate the potential advantage of routinely examined biochemical markers; PAPP-A (pregnancy related plasma protein A) and ßHCG values, in the first trimester screening test for the screening and early diagnosis of gestational diabetes mellitus (GDM) disease that occured in the following weeks of pregnancy without bringing any additional cost.Material and Method: This study was designed as a retrospective cohort study. In this study singleton pregnancies were included whose first trimester trisomy screening tests were examined in our hospital and also deliviries of them took place in our hospital with the routine pregnancy follow up between January 2014 – December 2016. The pregnancies were divided into two groups as GDM and control group. The functional role of biochemical markers ( PAPP-A (MoM), ßhcg (MoM)) in the first trimester screening test were investigated for early diagnosis of GDM which appeared in the later gestational weeks of pregnancy. Results: In the GDM group; maternal age, the number of pregnancies, parity, abort and living children were found significantly high, according to the control group (p&amp;lt;0.05). Statistically significant difference was not observed between PAPP-A (MoM), ßhcg (MoM), NT (mm) ve NT (MoM), gestational week of delivery, birth infant weight, APGAR 1.minute and APGAR 5.minute in the GDM group.Conclusion: No statistically significant relationship was established between biochemical markers of first trimester screening test and GDM in this study. However, more patients and carefully planned prospective studies are needed in this subject.