Weeks Of Gestation Research Articles

Feasibility Study for a Randomized Controlled Trial of Aromatherapy Footbath for Stimulating Onset of Labor in Term Pregnant Women.

We evaluated the feasibility of a new research methodology designed for conducting a future, large-scale randomized controlled trial (RCT). This future RCT is aimed at evaluating the effects of repeated aromatherapy footbaths on stimulating the onset of labor. Herein, we conducted a pilot RCT with two arms among low-risk pregnant women at or beyond 39 weeks of gestation before labor onset. These two arms consisted of a treatment group performing aromatherapy footbaths twice a day (n = 7) and a usual care group (n = 8). This study was prospectively registered in the Clinical Trials Registry of the University Hospital Medical Information Network in Japan (UMIN000037398). Feasibility was assessed across the domains of acceptability, demand, implementation, practicality, process, resources, and management using questionnaires, researcher records, and semi-structured interviews with the treatment group and midwives at the setting facility. The new research methodology was found to be feasible, although challenges were identified in the process and implementation. For process, the research participation rate was 55.5%. For implementation, the adherence rate among the multiparous participants in the treatment group ranged from 50% to 94%. An imbalance between both groups was found. Areas that need careful planning and methodological improvements include random allocation, treatment method, and participation criteria.

'VACTERL-H in newborn: A rare case report'.

BackgroundVACTERL association is a mnemonically useful acronym for a condition characterized by the sporadic, non-random association of specific birth defects in multiple organ systems. Described in the early 1970s, it is typically defined by the presence of three or more of these congenital malformations: vertebral defects, anal atresia, cardiac defects, tracheoesophageal fistulas, renal anomalies, and limb abnormalities. In addition to these core components, patients may also have other congenital anomalies. VACTERL association does not involve neuro-cognitive impairment unless; associated with hydrocephalus, known as VACTERL-H syndrome. VACTERL with hydrocephalus is an extremely rare disorder that affects males and females' children equally.Case descriptionThis report describes the case of a preterm 32weeks gestation, Asian, male infant who was diagnosed with VACTERL associated with hydrocephalus (VACTERL-H).ConclusionVACTERL syndrome cases are seen very rarely. The diagnosis of VACTERL-H syndrome is primarily based upon a complete physical examination and a few specialized tests to ascertain the features of the syndrome. The treatment of VACTERL-H is directed towards the specific symptoms that are apparent in each individual, which often vary greatly. This case highlights the challenges in managing VACTERL-H syndrome in preterm, who presented with the most serious features of VACTERL. Hence, early diagnosis and early interventions are needed to prevent morbidity and mortality.

The Predictive Role of Fetal Growth for Placental Invasion Anomalies in Placenta Previa.

To evaluate the predictive role of fetal percentile for placental invasion anomalies in placenta previa cases. Study Design: Retrospective studyPlace & Duration of the Study: Training and Research Hospital, January 2018 and December 2023A total of 298 placenta previa cases was divided into two groups: PAS (placenta accreta spectrum)-positive placenta previa (n=98) and PAS-negative placenta previa (n=200). Then PAS-positive placenta previa cases were divided into two subgroups: placenta increta-accreta (n=59) and placenta percreta (n=39). Sociodemographic findings, obstetric features, fetal percentile measurements between 22 and 28 gestational weeks and perioperative characteristics of patients were recorded and compared between groups.Fetal percentile was significantly lower in PAS-positive placenta previa cases as compared to PAS-negative placenta previa cases (p<0.001). Moreover, fetal percentile≤52.5 discriminated PAS-positive placenta previa cases from PAS-negative placenta previa cases with 75.51% sensitivity and 51.5% specificity (p<0.001, AUC=0.654). In multivariate analysis, a fetal percentile of 52.5 and below increased the risk of PAS by approximately 4 times (Hosmer-Lemeshow p=0.101, model p<0.001). No significant difference was detected between placenta percreta and placenta accreta-increta groups in terms of fetal percentile (p=0.224). Fetal percentiles calculated between 22 and 28 gestational weeks could discriminate PAS-positive placenta previa cases from PAS-negative placenta previa cases, although it had no role in discriminating placenta percreta from accreta and increta cases. Therefore, the evaluation of fetal percentile in placenta previa cases can be considered as a supportive finding in the prediction of invasion anomaly although it does not determine the depth of invasion.

Ultrasound-Estimated Index Versus Measured Volume of Amniotic Fluid at Caesarean Delivery: Accuracy and Perinatal Outcomes

Objective: To assess the reliability of ultrasound-based amniotic fluid index (AFI) in estimating amniotic fluid volume by comparing it with intraoperative findings during caesarean section, and to evaluate its association with neonatal clinical outcomes in low-risk term pregnancies. Methodology: This prospective observational study was conducted at the Department of Obstetrics and Gynaecology, Shalamar Hospital, Lahore, from January to June 2024. A total of 100 pregnant women between 37 and 40 weeks of gestation who underwent caesarean section, were enrolled. Participants were divided into two groups based on AFI measured by ultrasound: Group 1 with low AFI (&lt;5 cm) and Group 2 with normal AFI (5–25 cm). Intraoperative amniotic fluid volume was estimated using a suction apparatus. Neonatal outcomes, including Apgar scores at 1 and 5 minutes and NICU admissions, were recorded and compared. Results: In the low AFI group, 74% of patients had low amniotic fluid volume confirmed during surgery, while 26% had normal levels. In the normal AFI group, 80% had normal intraoperative fluid volume, and 20% showed reduced levels. Poor Apgar scores at 1 minute were seen in 62% of neonates in the low AFI group versus 16% in the normal group. At 5 minutes, 12% in the low AFI group and 2% in the normal group had low scores. NICU admission was required in 34% of neonates in the low AFI group compared to 8% in the normal group (p &lt; 0.05). Conclusion: There is a moderate correlation between AFI and intraoperative fluid volume. Low AFI is associated with adverse neonatal outcomes, supporting its role in antenatal risk assessment.

Modeling and Exploring Stillbirth Risks in Northern Pakistan

Background: The World Health Organization (WHO) defines stillbirth as the loss of a fetus after 28 weeks of gestation. Annually, approximately 2 million stillbirths occur worldwide. Projections indicate that by 2030, this figure could rise to nearly 15.9 million, with half of these stillbirths expected to take place in Sub-Saharan Africa. In the global literature, causes include placental complications, birth defects, and maternal health issues, though often the cause is unknown. Stillbirths have significant emotional and financial impacts on families. Methods: The process involves using chi-square tests to identify candidate covariates for model building. The relative risk (RR) measures the association between variables using the sample data of 1435 mothers collected retrospectively. Since these tests are independent, covariates might be interrelated. The unadjusted RR from the bivariate analysis is then refined using stepwise logistic regression, guided by the Akaike Information Criterion (AIC), to select the best subset of covariates among the candidate variables. The logistic model’s regression coefficients provide the adjusted RR (aRR), indicating the strength of the association between a factor and stillbirth. Results: The model fit results reveal that heavy bleeding in the second or third trimester increases stillbirth risk by 4.69 times. Other factors, such as water breaking early in the third trimester (aRR = 3.22), severe back pain (aRR = 2.61), and conditions like anemia (aRR = 2.45) and malaria (aRR = 2.74), also heightened the risk. Further, mothers with a history of hypertension faced a 3.89-times-greater risk, while multifetal pregnancies increased risk by over 6 times. Conversely, proper mental and physical relaxation could reduce stillbirth risk by over 60%. Additionally, mothers aged 20 to 35 had a 40% lower risk than younger or older mothers. Conclusions: This research study identifies the significant predictors for forecasting stillbirth in pregnant women, and the results could help in the development of health monitoring strategies during pregnancy to reduce stillbirth risks. The research findings further support the importance of targeted interventions for high-risk groups.

Maternal thyroid function during pregnancy and early adolescent regional differences in cerebral gray matter morphology.

Thyroid hormone regulates fetal brain development. Both low and high maternal thyroid function during early pregnancy has been associated with smaller offspring total gray matter and cortex volume. However, it remains unknown whether regional gray matter differences underlie global brain morphology findings. To assess the association of gestational thyroid function with regional gray matter morphology through detailed vertex-wise analysis of cortical surface area and thickness, and volumetric analyses of subcortical gray matter. We enrolled 2,426 women of the population-based prospective cohort Generation R with TSH and/or FT4 assessment before 18 weeks of gestation and offspring brain MRI scans at age 10 and/or 14 years. We studied the association of gestational TSH, FT4 and (sub)clinical thyroid disease entities with local cortical surface area, thickness and subcortical volumes. There was an inverse J-shaped association of TSH with cortical surface area in the rostral middle frontal region (β[SE] for quadratic TSH: -0.005[0.001] mm2, linear TSH 0.009[0.004]). FT4 was not associated with cortical measures. Post-hoc analyses revealed an inverse J-shaped association of TSH with gyrification in a similar region and children of hyperthyroid women had less gyrification in three cortical regions, mainly frontal (-0.082[0.022], -0.077[0.020], -0.069[0.020]). Moreover, there was an inverse U-shaped association of FT4 with caudate volume (β[SE] for quadratic FT4: -0.004[0.001] SD, linear FT4 0.010[0.010]). TSH and FT4 were not associated with other subcortical volumes. Maternal thyroid function during early pregnancy is associated with offspring cerebral gray matter morphology in certain brain regions, specifically the frontal lobe. These findings expand on global brain morphology associations and support previous associations with behavioral outcomes.

Maternal Vascular Adaptation in High-Risk Pregnancies: Effects of Early Smoking Cessation on Hemodynamic and Endothelial Function

Cardiovascular adaptation is vital for a healthy pregnancy but may be impaired in women at high risk for preeclampsia (PE), a condition marked by endothelial dysfunction. Smoking may lower the PE risk but harms vessels, and the effects of early cessation remain unclear. This prospective cohort study assessed vascular changes in high-risk pregnancies and the potential influence of early smoking cessation. Of 110 women screened for PE in the first trimester, 43 were classified as high-risk: 18 former smokers and 25 lifelong non-smokers. Vascular assessments were performed at 11–16, 24–28, and 34–37 weeks of gestation. Parameters included the carotid–femoral pulse wave velocity (cfPWV), asymmetric dimethylarginine (ADMA), mean arterial pressure (MAP), systolic and diastolic blood pressure (SBP, DBP), heart rate (HR), and retinal vessel calibers (central retinal arteriolar and venular equivalents (CRAE, CRVE)). Serum cotinine confirmed abstinence in former smokers. Across gestation, ADMA (p = 0.034), MAP (p = 0.001), SBP (p = 0.033), DBP (p = 0.004), and HR (p = 0.004) increased, while CRAE (p = 0.016) and CRVE (p = 0.004) narrowed in late pregnancy; cfPWV remained stable (p = 0.783). Non-smokers showed increases in their ADMA (p = 0.020), MAP (p = 0.001), and DBP (p = 0.0001) with no differences between groups. High-risk pregnancies showed vascular changes with similar profiles in former and non-smokers, underscoring the need for broader studies.

"Severe transient hypertrophic cardiomyopathy in an extremely preterm infant receiving early low-dose hydrocortisone for bronchopulmonary dysplasia prevention".

We present a case of a 24-week gestation neonate who developed severe, reversible hypertrophic cardiomyopathy (HCM) with mid-cavity obstruction within the first 14days of life. This occurred while the infant was receiving early low-dose hydrocortisone therapy according to the PREMILOC protocol. The patent ductus arteriosus (PDA) was small and functionally restricted following concurrent medical management with paracetamol at the time of diagnosis of HCM. Genetic, endocrine, and metabolic causes were ruled out, and the infant was not receiving any other pharmacological therapy associated with HCM. Our case highlights the need for clinical awareness of the potential association between HCM and low-dose hydrocortisone. This is a rare occurrence and may represent a multifactorial response involving heightened myocardial stress induced by hydrocortisone and increased left ventricular afterload following PDA restriction. The resulting rise in hemodynamic burden could contribute to cardiac remodeling, highlighting the need for clinical caution, close cardiac monitoring, and further research in this vulnerable population.

Comparison of Misoprostol and Dinoprostone for Induction of Labour in Full Term Pregnancy

Background: Labor induction is a common obstetrical practice, and a number of agents are effective in facilitating the process. Misoprostol and dinoprostone are two common medications, and their comparative effectiveness regarding labor length and success rate is a subject of continued investigation. Objective: To compare the efficacy of misoprostol and dinoprostone for labor induction at term. Study Design: Randomized controlled trial. Duration and Place of Study: The study was conducted from September 2024 to March 2025 at the Department of Obstetrics and Gynaecology, MTI-D.I. Khan. Methodology: 152 pregnant women were randomized into either the dinoprostone (Group B) or misoprostol (Group A) group, with an even split of participants in both groups of 76 each. Inclusion in the study was women presenting between the ages of 18 and 40 years, having a singleton gestation at term (39 weeks of gestation), intact amniotic membrane, and Bishop score ≤6. Induction of labor using either dinoprostone or misoprostol was conducted, and labor duration and success rate of vaginal delivery were noted. Results: Misoprostol demonstrated superior performance with a 75.0% success rate, compared to dinoprostone's 47.4% (p&lt;0.001). Additionally, labor duration was significantly shorter in the misoprostol group, with an average of 10.66 ± 2.81 hours, compared to 13.84 ± 2.37 hours for dinoprostone. Stratified analysis revealed that misoprostol was particularly more effective in younger patients (≤30 years), as well as in those with fewer previous births and lower socioeconomic status. Conclusion: Misoprostol is a more effective and time-efficient agent for labor induction compared to dinoprostone.

Long-term risk of diabetes following hypertensive disorders of pregnancy: A retrospective cohort study.

The impact of varying degrees of pregnancy-induced hypertension (PIH) on the risk of developing diabetes later in life is currently unknown. To assess the long-term risks of type 2 diabetes mellitus (T2DM), prediabetes, and mortality that are associated with hypertensive disorders of pregnancy. This retrospective cohort study used the TriNetX United States Collaborative Network to examine outcomes, especially T2DM, prediabetes and mortality, related to hypertensive disorders of pregnancy in females aged 21-45. Participants had no history of hypertension or diabetes before pregnancy or before 20 weeks of gestation. Propensity score matching was applied to balance covariates such as gestational diabetes, polycystic ovarian syndrome, chronic kidney disease, hyperlipidemia, overweight/obesity, nicotine dependence, alcohol abuse, and healthcare utilization. This ensured comparability between groups and reduced potential confounding in outcome evaluation. This study included 318544 females aged 21-45 with and without PIH. Females with PIH had higher risks of T2DM [hazard ratio (HR): 1.907, 95% confidence interval (CI): 1.821-1.998), prediabetes (HR: 1.610, 95%CI: 1.537-1.687), and mortality (HR: 1.501, 95%CI: 1.361-1.655) over a follow-up of up to 18 years. Incidence rates for T2DM, prediabetes, and mortality were 3.2%, 2.7%, and 0.6%, respectively. Subgroup analyses showed that the presence of gestational hypertension, preeclampsia, and eclampsia increased risks across all outcomes. Persistent hypertension beyond 12 weeks postpartum was linked to more than a 3-fold increase in mortality. Preventative aspirin use during pregnancy did not reduce the risks of T2DM, prediabetes, or mortality among those with PIH. PIH significantly increases the long-term risks of T2DM, prediabetes, and mortality, highlighting the urgent need for improved long-term management strategies to enhance overall health in such individuals.

Correlation between serum advanced glycation end-products and their receptor-mediated oxidative stress and perinatal outcomes in gestational diabetes mellitus.

Gestational diabetes mellitus (GDM) is one of the most prevalent metabolic disorders of pregnancy. Advanced glycation end-products (AGEs) are a complex and highly heterogeneous group of compounds formed from amino acids and reducing sugars. High-AGE diet exposure during pregnancy may cause adverse effects. To investigate the expression levels of AGE and AGE receptor (RAGE) in the serum and placenta of pregnant women with GDM and to assess the association of their mediated oxidative stress response with perinatal outcomes. This study retrospectively analyzed the clinical data of 126 pregnant women with GDM who gave birth in the Obstetrics Department of Obstetrics and Gynecology Hospital of Fudan University from January 2023 to January 2024. A total of 85 pregnant women of similar age without GDM during the same period were selected as the control group. Fasting blood glucose, glycated hemoglobin, AGEs, soluble RAGE (sRAGE), and oxidative stress were compared in both groups. Postpartum placental tissue was collected to identify RAGE protein expression. Participants with GDM were categorized based on perinatal outcomes into normal (n = 89) and adverse perinatal outcome groups (n = 37), and differences in serum AGE-RAGE levels and oxidative stress were analyzed. The influencing factors of adverse perinatal outcomes were analyzed using logistic regression. The GDM group demonstrated notably higher serum AGE (t = 8.955) and malondialdehyde (MDA) levels (t = 14.14) and lower sRAGE (t = 16.37) and superoxide dismutase (SOD) levels (t = 18.50) than the control group at 24-28 weeks of gestation and before delivery (P < 0.0001). Serum AGE levels were positively correlated with MDA and negatively related to SOD at 24-28 weeks of pregnancy (SOD: r = 0.393, MDA: r = 0.424, P < 0.0001) and before delivery (SOD: r = 0.443, MDA: r = 0.492, P < 0.0001), whereas AGE was inversely associated with sRAGE in the GDM group (r = -0.495, P < 0.0001). Serum AGE levels were significantly higher (t = 9.225, P < 0.0001) and the sRAGE level (r = 3.563, P < 0.0001) was significantly lower in participants with adverse perinatal outcomes than those with normal perinatal outcomes in the GDM group. Logistic regression analysis revealed AGE level as a risk factor (OR = 1.056, P < 0.0001) and sRAGE level (OR = 0.949, P < 0.0001) as a protective factor for adverse perinatal outcomes in GDM. High serum AGE level is a risk factor for adverse perinatal outcomes in GDM, whereas high sRAGE levels are protective. AGEs and RAGE may be associated with oxidative stress in pregnant women with GDM.

Use of Prenasal Thickness, Nasal Bone Length and Their Ratio in Diagnosing Down Syndrome at 16‐25 weeks' of gestation in India: A Retrospective, Observational, Case Control Study

ABSTRACTBackgroundIt is found to have association of facial parameters with trisomy 21 fetuses (T 21). We have compared prenasal thickness (PNT), nasal bone length (NBL), and the PNT:NBL ratio of normal fetuses with fetuses with trisomy 21 (T 21) between 16 and 25 weeks of gestation as a diagnostic tool for T 21.MethodsFacial profile images in the two dimensional (2D) gray scale were assessed to measure fetal NBL and PNT between 16 and 25 weeks of gestation. The PNT:NBL ratio of the fetuses was calculated. Nomograms were constructed from the data of morphologically normal fetuses at live birth. The PNT, NBL, and PNT:NBL ratio of fetuses with confirmed T 21 (n = 31) and morphologically normal fetuses at live birth (controls, n = 3485) were compared.ResultsNomograms for PNT, NBL, and the PNT:NBL ratio were constructed. In T 21 fetuses, PNT (&gt; 95th percentile), NBL (&lt; 5th percentile), and the PNT:NBL ratio (&gt; 95th percentile) showed a sensitivity of 25%, 29%, and 45% for PNT, NBL, and PNT:NBL, respectively, and specificity of 95%, 96%, and 94%, for PNT, NBL, and PNT:NBL, respectively. All of these markers showed a negative predictive value of 99%.ConclusionPNT, NBL, and the PNT:NBL ratio have high diagnostic value for fetuses with Down syndrome and can be incorporated easily in the current second trimester screening protocol for T 21. PNT, NBL, and the PNT:NBL ratio are more specific markers for Down syndrome than those used in previous studies.

Multiple micronutrient supplementation for maternal anemia prevention (MMS-MAP): an individually randomized trial of higher-dose iron (60 mg, 45 mg) compared to low-dose iron (30 mg) in multiple micronutrient supplements in pregnancy

BackgroundAntenatal multiple micronutrient supplementation (MMS) has been shown to be more effective than iron-folic acid (IFA) alone in reducing adverse pregnancy and birth outcomes. However, there is a concern that MMS containing 30 mg of iron may be less effective in reducing maternal anemia compared to IFA supplements containing 60 mg of iron. This poses a clinical and programmatic dilemma for countries with a high burden of maternal anemia (> 40% prevalence) where the World Health Organization (WHO) recommends using IFA with 60 mg of iron.Methods/designWe will conduct an individually randomized, quadruple-blind superiority trial of daily antenatal MMS in Dar es Salaam, Tanzania (n = 6381 pregnant women). Participants will be randomized to receive a daily MMS regimen during pregnancy containing 60 mg iron, 45 mg iron, or 30 mg iron at a ratio of 1:1:1. The trial participants, outcome assessors (research staff and care providers), investigators, trial statistician, and data analysts will be blinded. Pregnant women will be enrolled in the trial before 20 weeks of gestation and will receive the randomized MMS regimen from enrollment until the time of pregnancy outcome/delivery.The primary outcome is maternal third-trimester moderate or severe anemia (Hb < 10.0 g/dL). The proportion of women who have moderate or severe anemia at 32 weeks of gestation will be compared between MMS containing 60 mg iron versus MMS containing 30 mg iron, as well as MMS containing 45 mg iron versus MMS containing 30 mg iron. Secondary outcomes include maternal hemoglobin concentration, anemia, maternal iron deficiency, and maternal iron deficiency anemia at 32 weeks gestation and 6 weeks postpartum; preeclampsia, antepartum bleeding, postpartum hemorrhage, maternal peripartum infection, pregnancy-related death, symptoms consistent with depression, fatigue, and maternal malaria during pregnancy and 42 days following; fetal death, stillbirth, birth weight, low birthweight, gestational age at birth, preterm birth, birthweight for gestational age, and small-for-gestational age birth; infant hemoglobin concentrations, infant iron status, neonatal death, and infant death at 6 weeks of age; and maternal side effects. Relative risks for binomial outcomes and mean differences for continuous outcomes and their 95% confidence intervals will be calculated for all the primary and secondary outcomes.DiscussionThis study will produce causal evidence on whether MMS containing 60 or 45 mg of iron is superior to MMS containing 30 mg of iron in reducing maternal anemia and improving other important maternal and infant health outcomes. The findings of this study will inform Tanzania and similar contexts on the optimal formulation of MMS as many countries begin transitioning from IFA to MMS.Trial registrationClinicalTrials.gov NCT06079918. Registered on 2023–10-06.Trial statusThe trial is recruiting. We report protocol version 1.7 dated March 2, 2025. Recruitment started with the first patient enrolled on March 3, 2025. At the submission of this manuscript on April 10, 2025, 111 participants have been randomized. Recruitment is ongoing and should be completed by December 2026.

Association between the ferritin level and risk of gestational diabetes mellitus: A prospective cohort study.

Iron is increasingly recognized to influence glucose metabolism. However, evidence about the linkage between body iron stores and the risk of developing gestational diabetes mellitus (GDM) is still inconclusive. We aimed to prospectively investigate the association of serum ferritin concentrations with GDM. We studied 847 women from Peking University International Hospital from December 2017 to March 2019. Serum ferritin concentrations were measured three times during pregnancy (gestational weeks 6-12, 24-28 and 32-34). GDM was diagnosed by a 75-g oral-glucose-tolerance test (OGTT) at 24-28 weeks' gestation. Logistic regression analyses were carried out to determine the influence of serum ferritin at the first and second trimester on the risk of developing GDM. Among 847 participants, 73 women (8.6%) developed GDM. The median (IQR) of serum ferritin concentrations were 50.6 (32.4-75.5) ng/mL at gestational weeks 6-12, 19.7 (12.0-28.4) ng/mL at gestational weeks 24-28 and 19.4 (11.4-27.2) ng/mL at gestational weeks 32-34. The median serum ferritin concentrations were all significantly higher in women with GDM than those without GDM at the first, second and third trimester. Ferritin concentrations were positively correlated with the risk of GDM; the adjusted OR (95% CI) for highest vs lowest quartile was 2.97 (1.36, 6.51) at the first trimester and 2.64 (1.26, 5.54) at the second trimester. Elevated serum ferritin concentrations in the first and second trimester during pregnancy are both independently associated with increased risk of GDM.

Early pregnancy maternal lipid profile, acute phase responders, and the association with preterm delivery and selected pregnancy outcomes

Abstract IntroductionIt is estimated that 30%–50% of spontaneous preterm deliveries (PTDs) are caused by infectious states. Acute‐phase responders (APRs) accompany chronic as well as acute inflammatory states. In addition, hyperlipidemia is considered as a precursor of inflammation and oxidative stress. This study aimed to examine the associations between maternal serum levels of lipids and APRs in the 1st trimester of pregnancy and pregnancy outcomes.MethodsA prospective cohort study was conducted among multipara individuals with singleton pregnancies. Recruitment took place between 11 and 13 gestational weeks. The exposures were serum levels of the following APRs: C‐ reactive protein, albumin, triglyceride, total cholesterol, low density lipoprotein calculated (LDL‐c), and high density lipoprotein. The outcomes were gestational diabetes mellitus, preeclampsia, gestational age at delivery, PTD (&lt; 37 gestational weeks + 0 days), low birthweight, and macrosomia. Participants with the lowest or highest levels for each APR were identified based on clinical cut points. Multivariable analyses were performed to evaluate the independent association between the APRs and the studied outcomes, including linear models for gestational age at delivery or birthweight, and logistic models for PTD and other outcomes.ResultA total of 201 participants were included in the study. Mean birthweight was higher among individuals with high total cholesterol (3392.710 ± 426 g vs. 3220.782 ± 448 g, p value = 0.01). Similarly, mean birthweight was higher among individuals with high LDL‐c (3414.520 ± 407 g vs. 3237.324 ± 453 g, p value = 0.018). In multivariable linear models for the association between total cholesterol or LDL‐c and birthweight, which adjusted for newborn sex, gestational age at delivery, gestational diabetes mellitus or pregestational diabetes mellitus, and maternal body mass index (BMI), an increase in one unit of total cholesterol was significantly related with higher birthweight (2.796 g per unit, 95% CI = 0.682–3.956), and an increase in one unit of LDL‐c was significantly related with higher birthweight (2.463 g per unit, 95% CI = 0.152–4.773). No associations were found between early pregnancy APRs and PTD, gestational age at delivery, and the other outcomes of interest.ConclusionsHigher birthweight was found among individuals with high early pregnancy total cholesterol and LDL‐c levels, even after controlling for maternal BMI. Early monitoring of maternal lipid profile may serve as a useful predictor of excessive fetal growth, providing a potential tool for identifying pregnancies and individuals at higher risk for this complication, and which could benefit from closer observation. Levels of APRs were not associated with other pregnancy outcomes of interest.

Brain volumes are related with motor skills at late childhood in children born extremely preterm.

This study had three aims. First, we wanted to explore if there was difference in motor performance at 12 years of age in children born extremely preterm (EPT < 28 weeks of gestation) and at term. Our second aim was to study whether the volumes of motor networks and regions differed between those groups when they underwent brain scans at 10 years of age. Third, we investigated whether there were differences in the motor networks and regions of the brain in children born EPT who did or did not have motor impairment at 12 years of age. In a Swedish national study, a subgroup of 42 children born before 27 weeks and 25 term-born controls underwent MRI at age 10. A neuroradiologist performed MRI acquisitions, and analyses focused on brain regions associated with motor function. At age 12, motor function was assessed using the Movement Assessment Battery for Children - Second Edition (MABC-2), conducted by a licensed physiotherapist. Examiners were blinded to group status. Motor function and motor-related brain volumes were compared between the EPT and control group, and between children born EPT with and without motor impairments. Findings revealed significantly reduced motor performance and smaller motor region volumes in EPT children compared to controls (p < 0.001). Among EPT children, those with motor impairment especially in aiming and catching, had notably smaller brain volume in the basal ganglia (mean difference:1.2 cm3, p = 0.049), cerebellum (mean difference:14.4 cm3, p < 0.001), motor execution (mean difference:3.7 cm3, p = 0.049) network and motor imagery network (mean difference 5.6 cm3, p = 0.049) than their EPT peers without such impairments. Cerebellar volume remained significant different between the groups when adjusting for birth weight and sex in a linear regression model, p = 0.02 (η2 = 0.17). The results underscore the impact of extreme prematurity on motor function and brain structure, highlighting a specific link between reduced motor area volumes and impaired ball skills.

Moderate-To-Late Preterm Infants Benefit From the Early Collaborative Intervention: Primary Outcomes of an RCT.

This study aimed to determine the longitudinal impact of the EArly Collaborative Intervention (EACI), a three-session early intervention designed to enhance parent-infant interaction, on the developmental outcomes of preterm infants born between 30 + 0 and 35 + 6 weeks of gestation. This randomised controlled blinded study recruited families in two neonatal intensive care units in Sweden. In this one-year follow-up, 87 infants (standard care = 37, standard care with EACI = 50) were included in the intention-to-treat analysis. The primary study outcomes were cognition, receptive and expressive communication, and fine and gross motor development measured with the Bayley-III. At one year of age (mean age 13.1 months SD = 0.64), there was a statistically significant effect in the intention-to-treat analysis on receptive communication F(1, 85) = 4.61, p = 0.035, η2 = 0.051. No statistically significant effects were found on the other Bayley-III outcome measures. There were no significant differences between the groups regarding gestational age, birth weight, gender, parents' education, or age at assessment. This new intervention indicates a small positive effect on moderate-to-late preterm infants' communication ability at one year of age. Though the attrition rate was relatively large, results are encouraging since clinical interventions supporting moderate-to-late preterm infants and parents are lacking. ClinicalTrials.gov: NCT02034617.

Confidential Audit of Perinatal Mortality in the Republic of Kazakhstan: A Pilot Study

Introduction: Perinatal mortality is labeled as the loss of fetuses at or beyond 22 weeks of gestation, deaths during labor and delivery, as well as early neonatal deaths. Appropriate medical care provided in the perinatal period is an integral indicator of high-quality medical care. Although developed countries managed to decrease perinatal mortality, it remains high in the developing world. This study aims to perform a confidential audit of perinatal mortality (CAPM) across Kazakhstani maternity hospitals. Methods: A descriptive, observational cross-sectional study was conducted from January 2024 to December 2024. The structure of the underlying causes of mortality in the antenatal, intranatal, and early neonatal periods among different maternity hospitals of the Republic of Kazakhstan was analyzed. Results: A total of 116 cases were assessed: 34 antenatal deaths, 6 intranatal, and 76 early neonatal. Most deaths occurred on the second day post-delivery. The analysis revealed that 93% of cases fell into categories indicating substandard or potentially inadequate care (categories 2 and 3). Intraventricular hemorrhage and sepsis emerged as leading causes of neonatal death. Among antenatal and intranatal deaths, significant proportions were associated with comorbid maternal conditions, insufficient antenatal visits, and inadequate perinatal support. Conclusions: CAPM proves to be a critical tool for identifying systemic gaps and guiding improvements in maternity services without attributing blame to health professionals. Findings underscore that many perinatal deaths could have been avoided with timely, evidence-based interventions across antenatal and neonatal care. Broader implementation and institutionalization of CAPM in Kazakhstan could lead to measurable reductions in perinatal mortality and improvements in maternal/newborn care outcomes. Factors such as preconception planning, improving the health of reproductive-age women, administration of folic acid, and reducing primary cesarean sections could assist in achieving the reduction in the perinatal mortality rate.

Ileal Atresia Mimicking Hirschsprung Disease on Contrast Study: A Case Report and Diagnostic Re-evaluation

The differentiation between congenital causes of neonatal bowel obstruction, such as ileal atresia and Hirschsprung disease, is paramount for appropriate surgical planning. While clinically similar, their radiological findings can overlap, creating significant diagnostic challenges. Ileal atresia is a congenital anomaly characterized by the incomplete development of the ileum, resulting in intestinal obstruction. The aim of this study is to highlight the limitations of contrast studies in neonatal bowel obstruction and to reinforce the principle that in the face of discordant clinical and radiological evidence. We present the case of a full-term female neonate, born at 39 weeks of gestation, who developed symptoms of green vomiting and delayed bowel movements on her second day of life. An initial colon in loop contrast study at eight days of age was suggestive of short-segment Hirschsprung disease, showing a narrowed rectal lumen and a transition zone in the rectosigmoid region. However, due to persistent signs of distal bowel obstruction, surgical exploration was performed on the ninth day of life. Intraoperatively, the diagnosis was revised to Type 3A ileal atresia located 20 cm from the ileocecal junction, with significant adhesions. The management involved adhesiolysis, resection of the atretic ileal segment, and a primary ileo-ascending anastomosis. The postoperative course was complicated by hypovolemic shock and suspected sepsis neonatorum, which were managed successfully with intensive care support, including intravenous antibiotics and parenteral nutrition. The patient showed significant improvement by the fifth postoperative day and was discharged with normal gastrointestinal function. In conclusion, this case underscores a critical diagnostic pitfall where the 'microcolon of disuse' in distal ileal atresia radiologically mimicked the transition zone of Hirschsprung disease. It highlights that while contrast studies are invaluable, a high index of clinical suspicion and readiness for surgical exploration are essential for accurate diagnosis and timely intervention in complex cases of neonatal bowel obstruction.

Effect of active follow-up of women with previous cesarean delivery on uptake of timely safe obstetric and surgical care: Comparison between pre-intervention and intervention cohorts in Rwanda.

The rate of cesarean delivery (CD) in Rwanda has increased significantly from 2.2% in 2000 to 15.6% in 2020. Given increasing risks in subsequent pregnancy following CD it is important that women who have had a prior cesarean section plan and schedule CD in later pregnancies. This study assessed the effectiveness of the USAID MOMENTUM Safe Surgery in Family Planning and Obstetrics intervention in reducing emergency CDs among women with previous CDs. We conducted a cohort study in four public hospitals and 64 health centers across Rwanda, comparing two non-parallel cohorts: a pre-intervention cohort (December 2021-February 2022) and an intervention cohort (November 2022-May 2023). Exploratory data analysis and logistic regression were conducted to analyze the emergency CD rate and any associated factors. The pre-intervention group comprised 212 women, whereas the intervention group involved 283 women, of whom 189 were included in the analysis. Among the 189 women in the intervention group, 87.3% reported to the hospital within five days post-referral when they were first called. The percentage of women who consulted for a delivery plan within 36-38 weeks of gestation increased from 37.6% in the pre-intervention group to 62.4% in the intervention group. Consequently, in the adjusted logistic regression model, there was still a significant association between the intervention and reduced odds of emergency CD, with a 81% reduction in the odds of delivery by emergency CD (0.187; 95% CI: [0.115; 0.298]) compared to pre-intervention. This study demonstrates the effectiveness of an active follow-up intervention in promoting delivery planning and reducing emergency CD rates among pregnant women with previous CD scars. The comprehensive intervention, including tailored education and personalized phone conversations around the delivery period, appears to have contributed to increased awareness and motivation for women to seek timely care at the hospital for delivery planning.