To evaluate the association of vaginal versus caesarean birth with neonatal and maternal outcomes for breech, singleton deliveries at 22 0/7 to 25 6/7 weeks of gestation. Retrospective cohort study. Hospital births in the United States. This study analysed non-anomalous, singleton, breech live births at 22 0/7 to 25 6/7 weeks of gestation identified in the linked birth-infant death records data from 2016 to 2021. A propensity score analysis was conducted to establish pseudo-randomization based on the mode of delivery, matching vaginal to caesarean deliveries at a ratio of 1:2 using greedy nearest-neighbour matching. The propensity score estimation included year of delivery, maternal age, race/ethnicity, pre-pregnancy body mass index, parity, marital status, maternal education, insurance status, attendant at delivery, smoking status, hypertensive disorders, diabetes mellitus, gestational age, induction of labour and whether a trial of labour was attempted. We estimated the risk differences (RD) and odds ratios (OR) and associated 95% CIs, taking the matching into consideration. Multiple imputation was used to account for missing data. Composite adverse neonatal and maternal outcomes. Of 21,461 periviable breech singleton births, 34.0% (n = 7289) were delivered vaginally. The median gestational age was 24 (IQR: 23-25) and 23 (IQR: 22-24) weeks in the vaginal and caesarean delivery groups, respectively. Earlier gestational age was associated with vaginal birth, while later gestational age was associated with caesarean births. After propensity score matching, the distributions of baseline factors, except for gestational age, were balanced between the vaginal and caesarean delivery groups. A composite of adverse neonatal outcomes occurred among 99.0% (n = 7213) of vaginal and 96.8% (n = 13,716) of caesarean breech births (aRD 1.8%, 95% CI 1.3 to 2.4; aOR 2.25, 95% CI 1.59 to 3.17). Neonatal mortality rates were higher among vaginal compared to caesarean breech births (72.6% versus 36.2%; aRD 26.8%, 95% CI 25.0 to 28.6; aOR 3.15, 95% CI 2.85 to 3.48). A composite of adverse maternal outcomes occurred in 1.6% of vaginal breech and 3.1% of caesarean births (aRD -1.7%, 95% CI -2.2 to -1.1; aOR 0.47, 95% CI 0.35 to 0.63). Vaginal breech birth between 22 0/7 and 25 6/7 weeks of gestation is associated with a lower risk of adverse maternal outcomes but a higher risk of neonatal adverse outcomes and mortality.

Design and evaluation of an oral health booklet during pregnancy

Women with familial hypercholesterolaemia (FH) lose substantial treatment time during their reproductive years as most lipid-lowering therapies are contraindicated from the preconception through the end of breastfeeding. We examined the duration of real-life pregnancy-related off-treatment time in 27 women with FH in Norway. Women with FH in Norway who had completed the ongoing FH-FEMINA study (ClinicalTrials.gov ID NCT05367310) were included. Women were followed from 36th week of gestation and until one year after delivery or until end of breastfeeding. Information on use of medication before, during and after the current and previous pregnancies was collected. Pregnancy-related off-treatment time was calculated from discontinuation of lipid-lowering therapy when planning pregnancy, throughout pregnancy, and after delivery. The total duration of pregnancy-related off-treatment time after all childbirths (median 1, range 1-3) per woman was a median of 2.9 years (25th-75th percentile; 1.6-4.0), ranging from 0.8 to 12 years. The pregnancy itself accounted for median of 42.1% of the pregnancy-related off-treatment time, whereas the time before and after pregnancy accounted for a median of 57.9% (range 11.4% to 91.2%). When including untreated years in childhood and/or prior to diagnosis, the lifelong off-treatment time represented a median of 66.3% (range 41.9 to 100%) of lifetime without treatment. Early diagnosis and initiation of treatment is essential in girls with FH to compensate for pregnancy-related off-treatment time later in life. To minimize these pregnancy-related off-treatment periods, healthcare professionals should support women with FH to resume lipid-lowering therapy immediately after breastfeeding and between pregnancies. In addition, more knowledge on the potential effects of statin use during pregnancy and breastfeeding on maternal and offspring health is urgently needed.

Lateral flow assays are widely used for rapid diagnostics at the point of care. However, their dependence on biological receptors limits their stability, scalability, and cost-effectiveness. This work demonstrates the use of biotin-specific molecularly imprinted polymers (biotin-MIPs) as synthetic recognition elements in nucleic acid lateral flow (NALF) assays. The biotin-MIPs were synthesized, structurally characterized, and integrated into the nitrocellulose membrane as a test line. Their selective binding affinity was first validated using biotinylated horseradish peroxidase as a model analyte. The platform was then evaluated for the detection of double-tagged PCR amplicons from Escherichia coli labeled with biotin and digoxigenin, achieving a visual detection limit of 2ngmL-1 and a limit of detection of 1.8ngmL-1, with no detectable signal in negative controls. Clinical feasibility was further assessed retrospectively using swab specimens collected during routine third-trimester screening (35-37 weeks of gestation) for Group B Streptococcus, a major cause of neonatal sepsis. In this proof-of-concept study, the MIP-based NALF assay showed complete qualitative agreement with the qPCR reference classification and the gold standard microbiological culture, demonstrating the compatibility of this approach with battery-operated portable PCR amplification. Unlike biological receptors, MIPs offer robustness, long-term stability at room temperature, and animal-free scalable production. These features position the MIP-based NALF platform as a cost-effective alternative to antibody-based tests and a promising foundation for next-generation lateral flow diagnostics for the detection of communicable diseases at the point of care.

Malignant ovarian tumours during pregnancy are rare, and the proportion is also too small. Mixed Germ Cell Tumours (MGCTs) are rare yet very aggressive ovarian cancers that generally afflict women of young age and consist of at least two different germ cell tumour components. Their presence during pregnancy poses distinct clinical and ethical dilemmas, and intervention must be undertaken early enough to maximise survival of the mother, considering the viability of the foetus. In this case, a 28-year-old primigravida with 16+4 weeks of gestation presented with acute pain in the right lower abdomen. Ultrasound was found to have a viable intrauterine pregnancy and a complex right adnexal mass with haemoperitoneum, which was indicative of a ruptured ovarian cyst. Emergency exploratory laparotomy showed a ruptured right ovarian mass, which was actively bleeding, and right salpingooophorectomy was done. Histopathological analysis revealed a malignant mixed germ cell tumour composed of yolk sac tumour and immature teratoma. Postoperatively, tumour markers were significantly high. The multidisciplinary tumour board discussed the case and advised termination of pregnancy and subsequent systemic chemotherapy due to the aggressive tumour behaviour and an urgent need for treatment. The patient was subjected to Medical Termination of Pregnancy (MTP) after counselling; later, she was treated with Bleomycin, Etoposide, and Cisplatin (BEP) chemotherapy. The patient responded well to treatment, experiencing a drop in tumour markers and showing no signs of residual disease. The case highlights the role of early detection and timely surgical intervention of ovarian malignancy identified in pregnancy. It also highlights the importance of multidisciplinary decisionmaking and the need to balance maternal prognosis and fetal considerations. Aggressive MGCTs need emergent management, and, in some cases, a pregnancy may have to be terminated to administer immediate chemotherapy

The relationship between neonatal hyperglycemia, neonatal illness, and 3-year outcomes in extremely preterm infants.

Insights from over a million births on maternal exposure to multiple pollutants and the risk of isolated ventricular septal defects.

To evaluate fetal brain midline structures, cortical structures, and brain volume using sonography in cases of fetal growth restriction (FGR) and to compare these findings with those of fetuses demonstrating normal growth. This prospective case-control study included 80 FGR cases and 80 fetuses with normal growth curves between 24 and 37 weeks of gestation. Multiplanar neurosonography was performed in all cases according to the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) guidelines. The corpus callosum (CC; length, thickness, and fastigium distance), cavum septi pellucidi (CSP), sylvian fissure (SF), parieto-occipital fissure (POF), calcarine fissure (CF), insula, olfactory sulcus (OS), and brain volume were evaluated. Measurements were made using the ultrasound device's electronic calipers, and brain volume was calculated using the Virtual Organ Computer-aided Analysis (VOCAL) application. In the FGR group, CSP width, CC length, and thickness were significantly increased, while CCFL and POF depths were decreased (p<0.05, for all). Mean brain volumes were similar in the FGR and control groups (349.30±61.77 vs. 368.42±68.51, p=0.066). In FGR group, middle cerebral artery peak systolic velocity (MCA PSV) was positively correlated with most brain structures but negatively correlated with CC thickness. There was no relationship between cerebroplacental ratio (CPR) and brain volume or fetal brain structures. Our findings showed that FGR affects the fetal brain through neuroanatomical structures such as the CC, CSP, CCFL, and POF during the prenatal period. In our cohort, fetal brain volume did not differ significantly in FGR. Furthermore, there was no association between CPR and fetal brain structures.

Pesticide exposures disrupt biological functions in humans, raising concerns about potential effects on newborn health and development. To analyze associations of preconception and prenatal exposures to carbamate, organophosphate, and pyrethroid pesticide classes and 25 individual active ingredients with newborn Apgar scores to evaluate the relationship between these exposures and neonatal health. We used pesticide use registry and birth certificate data from 2006 to 2020, linked as part of the Arizona Pregnant Women's Environmental and Reproductive Outcomes Study (Az-PEARS). Exposures were measured as binary variables and defined as living within 500 m of an agricultural pesticide application during preconception (T0, 90 days before conception) and each trimester (T1-T3). Five-minute Apgar scores (low: <8, high: ≥8) were analyzed using log-binomial regression and a meta-analytic approach to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI), adjusting for newborn and maternal demographics. Approximately half of the newborns were male, and the majority were born at ≥38 weeks of gestation. Mothers were predominantly 20-35 years old and non-Hispanic white. Exposure to several pesticide active ingredients at any point during preconception and/or pregnancy were associated with increased odds of low Apgar scores (aOR [95% CI]): the carbamates carbaryl (2.07 [1.45, 2.96]) and formetanate hydrochloride (3.50 [1.55, 7.89]); the organophosphates diazinon (1.67 [1.25, 2.22]) and tribufos (1.39 [1.02, 1.90]); and the pyrethroid cypermethrin (1.49 [1.03, 2.15]). Consistent effect estimates were seen across trimesters. Additional positive associations included ethephon, phorate, and beta-cyfluthrin during T0, methomyl during T1, and esfenvalerate and fenpropathrin during T2. Prenatal exposure to certain carbamates, organophosphates, and pyrethroids had increased odds of low Apgar scores. We identified the preconception period as a possible sensitive exposure window for additional ingredients. These findings suggest that interventions aimed at mitigating maternal agricultural pesticide exposures may improve newborn health. Few studies have investigated how ambient preconception and prenatal exposures to pesticide active ingredients affect neonatal health, despite the importance of studying sensitive windows of exposure. Using pesticide use registry and birth certificate data from the state of Arizona, we report that residential proximity to agricultural pesticide exposures of several pesticide active ingredients belonging to the carbamate, organophosphate, and pyrethroid classes during the preconception period and throughout pregnancy is associated with low Apgar scores. This research suggests that maternal pesticide exposures may adversely impact newborn health and emphasizes the importance of mitigating these exposures.

Understanding maternal-obstetric determinants is key to stillbirth prevention. The Robson classification system enables monitoring and identification of high-risk groups. This study examined the prevalence and distribution of antepartum and intrapartum stillbirths by maternal-obstetric characteristics and Robson groups in district hospitals of Bangladesh. We conducted a cross-sectional analysis using prospectively collected data from Phases 4 and 5 (August 2022-June 2023) of a multi-phase implementation research study on the Robson classification system in eight district hospitals. All deliveries at ≥ 28 weeks of gestation were included, classified as live births, antepartum stillbirths (death before onset of labour), and intrapartum stillbirths (death after onset of labour). Descriptive analyses estimated stillbirth prevalence by timing, maternal and obstetric factors, and Robson groups. Associations were assessed using χ2 tests. Out of 15 529 deliveries, 3.9% were stillbirths (56.6% intrapartum and 43.4% antepartum). Stillbirth prevalence varied across facilities (0.9-6.6%). A higher stillbirth burden was significantly associated (P < 0.05) with advanced maternal age (>34 years), preterm birth, lack of antenatal care, non-use of the partograph, and low birthweight. Breech presentation, induced labour, and vaginal delivery had the highest stillbirth percentage. Timing of stillbirth differed significantly by foetal presentation, onset of labour, and mode of delivery (P < 0.05). Stillbirth prevalence varied across Robson groups (0-17.5%). Intrapartum stillbirths predominated in Groups 1, 3, 6 and 8, while Group 10 was largely antepartum-dominated. Stillbirth remains a substantial burden in district-level hospitals in Bangladesh, with most deaths occurring during the intrapartum period and marked variation across facilities and Robson groups. The findings highlight preventable gaps in antenatal screening, labour monitoring, and timely emergency obstetric care. Application of the Robson classification system enables precise identification of high-risk obstetric groups for targeted quality-improvement interventions to reduce preventable stillbirths and accelerate progress toward national and global stillbirth reduction targets.

Examine relationships between quantitative measures of language and sound exposure in the NICU and infant neurobehavior. Sixty-four preterm infants (≤28 weeks of gestation) had language and sound exposure measured across four time points: within two weeks of birth and at 30, 34, and 35-41 weeks postmenstrual age (PMA). Neurobehavior was assessed at 35-41 weeks PMA using the NICU Network Neurobehavioral Scales. Higher average decibel levels in the NICU environment were associated with lower infant orientation scores (p = 0.04, β = -0.33). Higher peak decibel levels were associated with greater hypertonia (p = 0.01, β = 0.37). More electronic sound exposure was associated with less infant hypotonia (p = 0.047; β = -0.003). Increased silence was associated with greater infant hypertonia (p = 0.01; β = 0.001). Higher adult word counts were related to lower infant stress (p = 0.045, β = -1.37). NICU sound exposures were related to neonatal neurobehavior near term age, highlighting the neurological impact of the auditory environment on preterm infants.

Red blood cell (RBC) transfusions have been associated with retinopathy of prematurity (ROP) and adverse long-term neurodevelopmental outcomes in very preterm infants. Although lower transfusion thresholds reduce the incidence of ROP, they have not improved neurological outcome. Periventricular leukomalacia (PVL) is a major cause of long-term neurodevelopmental impairment in very preterm infants. The objective of this study was to determine whether exposure to RBC transfusions is an independent, dose-dependent risk factor for PVL. A retrospective cohort study was conducted. Infants born at 32 weeks of gestation or less or with a birth weight <1500 g were eligible. Infants transferred from other hospitals, managed with palliative care or who died before cranial imaging were excluded. Exposure was defined as the cumulative number of RBC transfusions during neonatal intensive care. Outcomes were PVL and severe ROP. Multivariable logistic regression analyses were performed and stratified by birth weight <750 g and ≥750 g. RBC transfusions were independently associated with PVL and ROP. The adjusted odds ratio was 1.10 and 1.09, respectively, in infants weighing <750 g, and 1.26 and 1.15 in infants weighing 750 g or more, respectively, with statistically significant confidence intervals. RBC transfusions were independently associated with PVL in preterm infants. As lowering transfusion thresholds has not been associated with improved neurological outcomes, consideration of cord blood products may be warranted.

Long chain polyunsaturated fatty acids are an important determinant of the birth weight of the baby. Studies have reported altered fatty acid desaturase indices (Δ5 and Δ6 desaturases) from early pregnancy in women with pregnancy complications. However, it remains unclear if these alterations are also observed in women who have no complications, yet delivering low birth weight (LBW) infants (birth weight below 2500 g regardless of gestational age). This study aims to longitudinally examine the maternal erythrocyte fatty acids levels in women delivering LBW babies (in women with pregnancy complications and without complications) and in women delivering normal birth weight babies (NBW). This study includes 1096 singleton pregnant women, out of which 181 delivered LBW babies. Maternal erythrocyte fatty acids were measured at 11-14 weeks, 18-22 weeks, and 26-28 weeks and at delivery using gas chromatography. Product-precursor ratios were used to represent enzyme indices: Δ5D index = arachidonic acid/dihomo-y-linolenic acid (DGLA), Δ6D index = DGLA/linoleic acid. Maternal age at the time of delivery was: NBW group: 28.74 ± 4.65; LBW group: 28.14 ± 4.61 and LBW without complications group: 26.99 ± 4.20. Birth weight of the baby was: NBW: 2978.69 ± 340.37; LBW: 2404.47 ± 262.85; LBW without complications group: 2308.02 ± 202.06. Higher Δ5 desaturase and lower Δ6 desaturase indices at 11-14 weeks of gestation were associated with higher risk of having LBW babies (p < 0.01 for both). This study reports that disrupted fatty acid metabolism in early pregnancy regardless of pregnancy complications is a risk factor for having LBW babies.

Levels of plasma branched-chain and aromatic amino acids in pregnancy have been associated with gestational diabetes mellitus (GDM), but the metabolic role of serum amino acid (AA) profiles in its pathogenesis remains insufficiently elucidated. This study evaluated the diagnostic potential of second-trimester serum AA profiles, including Cys, Met, Val, Lys, Cit, Tau, Asp, Ile and Ala, for distinguishing GDM patients from healthy controls. A total of 189 women with GDM and 189 healthy women at 24-28 weeks of gestation were enrolled in the study, recruited from 2019 to 2022. Serum levels of 21 amino acids were precisely measured using automatic amino acid analyzer. Three machine learning methods were employed to select the most significant variables. Generalized linear models (GLMs) were established to evaluate the association between Serum AAs and GDM. Serum cysteine (Cys) and lysine (Lys) were inversely associated with GDM risk, whereas methionine (Met) and citrulline (Cit) showed positive associations. Notably, Met demonstrated an inverted U-shaped relationship, with an inflection at 239.9 µmol/L. The adjusted model achieved higher discrimination than the crude model. Sensitivity and subgroup analyses confirmed robust associations for Cys, while associations for Met, Lys, and Cit varied by pre-pregnancy body mass index (BMI). Mid-pregnancy serum AAs, particularly Cys, Lys, Met, and Cit, were associated with GDM risk. These findings highlighted the heterogeneity of GDM metabolic signatures and support AAs as potential biomarkers for diagnosis of GDM.

Reactive thrombocytosis is defined as an increase in megakaryocyte count and production secondary to inflammation, malignancy, or anemia. Although cases of reactive thrombocytosis are frequently encountered in newborns admitted to the neonatal intensive care unit (NICU), neonatal thrombocytosis has not yet been fully elucidated. This study aimed to evaluate the maternal and neonatal medical characteristics of neonates diagnosed with reactive thrombocytosis in the NICU. This retrospective, cross-sectional study included neonates with thrombocytosis (platelet count >450 × 109/L) who were admitted to our institution's NICU between January 1, 2021, and December 31, 2022. Children with suspected primary thrombocytosis were excluded from the study. Maternal and neonatal medical data were retrospectively analyzed using patient files. The cases were divided into 3 groups: platelet counts >450 and <700 × 109/L, 700 and <900 × 109/L, and 900 and <1000 × 109/L; gestational age was divided into 2 groups: <37 gestational weeks (GH) (preterm) and ≥37 to 42 GH (term); maternal age was divided into 3 groups: 20 years or younger, 20 to 34 years old, and 35 years or older; and birth weight was divided into 3 groups: <2500g, 2500 to 3999g, and ≥4000g. The groups were then compared. Statistical significance was set at P<0.05. A negative correlation was observed between mean platelet volume (MPV) and hemoglobin (Hb) levels at admission, as well as between MPV and platelet counts. The mean platelet count at the time of thrombocytosis was significantly higher in term cases than in preterm cases. Platelet counts were higher in the macrosomic group than in the nonmacrosomic group. Decreased Hb levels and increased C-reactive protein (CRP) levels were associated with severe thrombocytosis. Reactive thrombocytosis resolved spontaneously without complications and did not require any clinical intervention.

The superficial subplate forms the interface between the cortical plate and the deeper subplate, as a transient sublamina prominent during midfetal development of the human brains when many cortical malformations originate, and prenatal counselling is needed. Our aim was to assess the visibility of the superficial subplate throughout development using in vivo 3 Tesla fetal MR images in the human brain. In this retrospective observational study, 51 human fetuses (19- 36 gestational weeks, GW) medically assessed as neurotypical were imaged on a 3 Tesla MR scanner in vivo, using single shot, fast spin-echo T2-weighted sequences (T2-weighted SSFSE) and images in three planes were selected. Three readers twice assessed the visibility of the sSP on the selected images in the region of frontal, parietal, temporal, and occipital lobes. To explore the relationship between the visibility of the superficial subplate (sSP) and gestational age, regression analysis was used. A quadratic model was applied to investigate the non-linear association between visibility scores and fetal age. The inter-observer agreement on the visibility of sSP was scrutinized both pairwise and among all three raters. Weighted kappa statistics determined inter- and intra-rater agreement. The visualization of the sSP on in vivo fetal 3T MRI was possible between the 19th and 27th weeks of gestation, in one or more lobes, (the frontal, parietal, temporal, occipital), with optimal visibility between 20 and 27 gestational weeks coinciding with the peaks in glycosaminoglycan expression in the sSP. Inter-rater agreement ranged from moderate to excellent (weighted κ = 0.57-0.93), with a mean κ of 0.81 ± 0.10 on first assessment, improving to 0.88 ± 0.03 on second assessment. Intra-rater agreement was good to excellent (κ = 0.75-0.90). The superficial subplate is visible on T2-w in vivo fetal MRI at 3T. A deeper understanding of the in vivo appearance of the laminar organization of the human fetal brain, including the superficial subplate, is required to accurately interpret altered fetal brain development, thereby improving early diagnostic accuracy, reducing false-positive assessments, and supporting prenatal counselling in cases of suspected cortical malformations.

Introduction: Gestational diabetes mellitus (GDM) is one of the most prevalent metabolic complications of pregnancy, posing significant risks to both maternal and neonatal health. Multiple maternal factors, including pre-pregnancy body mass index (BMI), gestational weight gain (GWG), height, and metabolic status, have been implicated in the development of macrosomia in GDM pregnancies. In recent years, novel inflammation-based hematological indices such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and neutrophil-to-HDL cholesterol ratio (NHR) have emerged as cost-effective biomarkers reflecting systemic inflammatory and metabolic alterations. However, their potential role in predicting macrosomia in GDM remains insufficiently explored. Thus, the purpose of our study was to asses the association between maternal risk factors, blood parameters, novel inflammatory markers, and macrosomia in patients with GDM. In addition, we aimed to develop and validate new predictive models for macrosomia in pregnancies complicated by GDM.Methods: A total of 200 patients diagnosed with GDM using a 75-gram oral glucose tolerance test (OGTT) between the 24th and 28th weeks of gestation were included in the study. Macrosomia was identified if birth weight exceeded 4,000 grams or the 90th percentile for gestational age. Patients were divided into two groups: 42 GDM patients with macrosomic offspring (GDM-M) and 158 GDM patients without macrosomia (GDM-N). Maternal characteristics, blood parameters, and novel inflammatory markers were compared between the GDM-M and GDM-N groups using statistical analyses. Point-biserial (Pearson-equivalent) correlation analysis was used to examine the relationships between various maternal, metabolic, and inflammatory parameters and macrosomia. Independent associations were then evaluated using multivariable logistic regression, with calibration and explained variance assessed. Discrimination was examined using receiver operating characteristic (ROC) curves for single predictors and a combined model; optimal cut-offs were derived by the Youden index.Results: GWG (p = 0.028), pre-pregnancy BMI (p = 0.023), maternal height (p &amp;lt; 0.001), fasting plasma glucose (FPG) (p &amp;lt; 0.001), glycated hemoglobin (HbA1c) (p &amp;lt; 0.001), triglyceride (TG) (p = 0.034), NLR (p = 0.012), and NHR (p = 0.018) levels were significantly higher in the GDM-M group than in the GDM-N group. In contrast, insulin (p &amp;lt; 0.001) and high-density lipoprotein cholesterol (HDL-C) (p = 0.022) levels were significantly lower in the GDM-M group compared with the GDM-N group. In adjusted analyses, higher pre-pregnancy BMI, maternal height, GWG, FPG, HbA1c, NLR, and NHR were associated with increased odds of macrosomia, whereas insulin and HDL-C were inversely associated. ROC analyses showed the highest single-marker area under curve (AUC)’s for maternal height (0.78; cut-off ≥162 cm), NHR (0.76; cut-off ≥3.2), and HbA1c (0.75; cut-off ≥7.4%), with NLR (0.74), GWG (0.73), FPG (0.72), and HDL-C (0.71; cut-off ≤42 mg/dL) performing similarly; the combined model achieved AUC 0.85 (95% CI 0.77–0.92), sensitivity 80.9%, specificity 78.5%, positive predictive value (PPV) 63.2%, and negative predictive value (NPV) 90.4%.Conclusion: There is an association between higher GWG, pre-pregnancy BMI, maternal height, FPG, and HbA1c levels, as well as lower insulin and HDL-C levels, and the occurrence of macrosomia in patients with GDM. These findings suggest that GWG, pre-pregnancy BMI, maternal height, FPG, HbA1c, insulin, HDL-C, NLR, and NHR may be useful in predicting macrosomia in pregnancies complicated by GDM. A compact multivariable model combining these routine measures demonstrated good discrimination with a high NPV, supporting potential use for early risk stratification.

This narrative review critically examines the potential association between paracetamol (acetaminophen) use during pregnancy and autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) in children. Paracetamol remains the most widely used analgesic-antipyretic agent during pregnancy, used by approximately 60% of pregnant women. It is considered the first-line therapeutic option because non-steroidal anti-inflammatory drugs, particularly when used after 20 weeks of gestation, have been associated with adverse neonatal outcomes, including fetal renal dysfunction, oligohydramnios, and, rarely, neonatal renal failure, while their third-trimester use has also been linked to premature closure of the ductus arteriosus. In this context, unsubstantiated risk claims surrounding paracetamol create an important dilemma for clinicians and patients in clinical decision-making.The review evaluated large birth cohorts, sibling-controlled analyses, and meta-analyses from the literature, with a predominant focus on large-scale studies from Scandinavian countries (Norway, Denmark, Sweden). While several studies have reported small-to-moderate increases in risk between prenatal paracetamol exposure and ASD and ADHD, these associations lose significance in some sibling-controlled analyses, which are methodologically more rigorous.Current evidence suffers from substantial methodological limitations, including unmeasured confounding factors (particularly genetic susceptibility, familial characteristics, and maternal illnesses), validation problems in outcome measures, the absence of a demonstrable dose-response relationship, and confounding by indication. Furthermore, no valid, reproducible animal model specific to ASD exists.In conclusion, the available data do not support a causal relationship between paracetamol use during pregnancy and ASD or ADHD in offspring, and the reported associations remain questionable. Exaggerating unproven risks regarding medication use in pregnancy may unnecessarily amplify public concerns, discourage pregnant patients from receiving necessary treatment, and disrupt the balance between benefits and risks. Therefore, risk assessments should be conducted using an objective, evidence-based, cautious, and balanced approach.

Objective To explore the association between pre-pregnancy BMI (PPBMI) and preterm birth (PTB) across the Chinese population. Methods A total of 72,827 singleton pregnancies were included in this retrospective cohort study. Women were divided into 4 groups according to PPBMI (kg/m2): underweight (<18.5), normal weight (18.5-23.9), overweight (24-27.9) and obesity (≥28); Underweight was further categorized into severe (<16.5), moderate (16.5-17.4) and mild (17.5-18.4) underweight. PTB was grouped as spontaneous and medically indicated PTB based on clinical presentation, or grouped as 24-27, 28-31 and 32-36 weeks based on gestational age. Binary logistic regression was applied to estimate odds ratios for PTB, adjusted for potential confounders. Restricted cubic spline was used to assess potential nonlinear relationships between PPBMI and PTB. Results The overall PTB rate was 4.8% (n = 3, 478). Compared with the normal weight group, the risks of PTB were similar across underweight categories: aOR = 1.10(95% CI 0.97-1.24) in mild, aOR = 0.96 (95% CI 0.79-1.18) in moderate and aOR = 1.16 (95% CI 0.85-1.60) in the severe underweight group; The risks of PTB were higher both in the overweight (aOR, 1.32; 95% CI, 1.20-1.45) and obesity (aOR, 1.47; 95% CI, 1.24-1.74) group; the trends associated with PPBMI in the risks for medically indicated PTB, spontaneous PTB and PTB at different weeks of gestation were generally consistent with those observed in overall PTB. The association between PPBMI and PTB in the study population exhibited a J-shaped curve, and the nadir of PTB risk corresponded to a PPBMI of approximately 18.5–21.5 kg/m2, with a potential risk threshold around 24.5 kg/m2. Conclusions In Chinese population, pre-pregnancy underweight and severity of underweight were not significantly associated with the risk of PTB; while overweight and obesity increased the risk of PTB. The nadir of PTB risk corresponded to a PPBMI of approximately 18.5–21.5 kg/m2, with a potential risk threshold around 24.5 kg/m2.

Very preterm infants born before 32 weeks of gestation remain vulnerable to postnatal growth impairment. However, longitudinal data focusing on appropriate-for-gestational-age (AGA) infants are limited. Standard growth references may inadequately reflect the developmental trajectories of this population. We constructed sex-specific growth curves for height, weight, body mass index, and head circumference from term-equivalent age to 6 years postmenstrual age in AGA infants born at <32 weeks of gestation without neurodevelopmental impairments. These trajectories were compared with Japanese national growth standards. Infants born before 28 weeks of gestation demonstrated significantly reduced growth relative to national standards, with the greatest deviation occurring between 40 and 60 weeks postmenstrual age. While gradual catch-up growth was observed thereafter, full alignment with standard curves was not achieved. Lower gestational age correlated with more pronounced deficits across all anthropometric parameters. Head circumference remained notably reduced among infants born before 25 weeks, raising concern for potential neurodevelopmental implications. Extremely preterm AGA infants experience persistent growth deficits through early childhood. These findings underscore the importance of long-term growth surveillance and early intervention strategies to support optimal physical and neurological outcomes in this high-risk population. Many extremely preterm infants grow more slowly than expected well into early childhood. Babies born earlier in pregnancy show more delayed physical growth across all measures. Infants born before 25 weeks may have a smaller head size, raising concerns for brain development.