Vanishing twin syndrome among ART singletons and pregnancy outcomes.

PubMed

Magnus, Maria C; Ghaderi, Sara; Morken, Nils-Halvdan; Magnus, Per; Bente Romundstad, Liv; Skjærven, Rolv; Wilcox, Allen J; Eldevik Håberg, Siri

2017-11-01

Among babies born by ART, do singleton survivors of a vanishing twin have lower birth weight than other singletons? Vanishing twin syndrome (VTS) was associated with lower birth weight among ART singletons; a sibship analysis indicated that the association was not confounded by maternal characteristics that remain stable between deliveries. Previous studies indicate that ART singletons with VTS have increased risk of adverse pregnancy outcomes, compared with other ART singletons. The potential contribution of unmeasured maternal background characteristics has been unclear. This was a Norwegian population-based registry study, including 17 368 mothers with 20 410 ART singleton deliveries between January 1984 and December 2013. The study population included 17 291 ART singletons without VTS, 638 ART singletons with VTS and 2418 ART singletons with uncertain vanishing twin status. We estimated differences in birth weight and gestational age comparing ART singletons with VTS first to all ART singletons without VTS, and subsequently to their ART siblings without VTS, using random- and fixed-effects linear regression, respectively. The corresponding comparisons for the associations with preterm birth and small for gestational age (SGA) were conducted using random-and fixed-effects logistic regression. The sibling analysis of preterm birth included 587 discordant siblings, while the sibling analysis of SGA included 674 discordant siblings. ART singletons with VTS had lower birth weight when compared to all ART singletons without VTS, with an adjusted mean difference (95% CI) of -116 g (-165, -67). When we compared ART singletons with VTS to their ART singletons sibling without VTS, the adjusted mean difference was -112 g (-209, -15). ART singletons with VTS also had increased risk of being born SGA, with an adjusted odds ratio (OR) (95% CI) of 1.48 (1.07, 2.03) compared to all ART singletons without VTS, and 2.79 (1.12, 6.91) in the sibship analyses. ART singletons with VTS were also more likely to be born preterm, although this difference did not reach statistical significance. We did not have information on maternal socio-economic status, but this factor is accounted for in the sibship analyses. We also had no information on whether fresh or frozen embryos were replaced. The reduction in birth weight and increased risk of SGA in ART singletons with VTS may suggest the presence of harmful intrauterine factors with long-term health impact. While vanishing twins are not routinely observed in naturally conceived pregnancies, loss of a twin is potentially a risk factor for the surviving foetus in any pregnancy. This could be further explored in large samples of naturally conceived pregnancies with the necessary information. The authors of this study are supported in part by the UK Medical Research Council, US National Institute of Environmental Health Sciences and the Norwegian Research Council. The authors have no conflicts of interest. N/A. © The Author 2017. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology.

Recent Declines in Induction of Labor by Gestational Age

MedlinePlus

... Individual live birth in a singleton (one fetus) pregnancy. Singleton induction rate : Number of labor inductions for singleton births per 100 singleton births. Gestational age categories : Early preterm: Births prior to 34 completed weeks of ...

Nuchal translucency in pregnancies conceived after assisted reproduction technology.

PubMed

Hui, Pui Wah; Lee, Chin Peng; Tang, Mary Hoi Yin; Ho, Pak Chung

2006-06-01

Nuchal translucency is one of the important markers in the first trimester during antenatal screening for fetal Down's syndrome. With the observation of alterations in biochemical markers in pregnancies conceived after assisted reproduction, this review presents current information related to the thickness of nuchal translucency in these pregnancies. Early small studies did not demonstrate any discrepancy in the thickness of nuchal translucency in fetuses from assisted reproduction and from spontaneous pregnancies, but there has been recent evidence to suggest an increased level of nuchal translucency in singletons from various modes of assisted-reproduction technology. Nuchal translucency in twins following assisted reproduction did not, however, show a similar increase. Although the effect of chorionicity was not specifically addressed, nuchal translucency thickness in twins born after assisted reproduction was reported to be comparable to that in spontaneous singletons. It is possible that singletons and twins after assisted reproduction exhibit different antenatal behavior and pregnancy courses. Similar to other biochemical markers of fetal Down's syndrome, nuchal translucency is increased in singletons after assisted-reproduction technology. Further studies on twin pregnancies, in particular dichorionic twins, are necessary before conclusive evidence can be drawn for multiple pregnancies.

Sonographic Measurement of Fetal Ear Length in Turkish Women with a Normal Pregnancy

PubMed Central

Özdemir, Mucize Eriç; Uzun, Işıl; Karahasanoğlu, Ayşe; Aygün, Mehmet; Akın, Hale; Yazıcıoğlu, Fehmi

2014-01-01

Background: Abnormal fetal ear length is a feature of chromosomal disorders. Fetal ear length measurement is a simple measurement that can be obtained during ultrasonographic examinations. Aims: To develop a nomogram for fetal ear length measurements in our population and investigate the correlation between fetal ear length, gestational age, and other standard fetal biometric measurements. Study Design: Cohort study. Methods: Ear lengths of the fetuses were measured in normal singleton pregnancies. The relationship between gestational age and fetal ear length in millimetres was analysed by simple linear regression. In addition, the correlation of fetal ear length measurements with biparietal diameter, head circumference, abdominal circumference, and femur length were evaluated.Ear length measurements were obtained from fetuses in 389 normal singleton pregnancies ranging between 16 and 28 weeks of gestation. Results: A nomogram was developed by linear regression analysis of the parameters ear length and gestational age. Fetal ear length (mm) = y = (1.348 X gestational age)−12.265), where gestational ages is in weeks. A high correlation was found between fetal ear length and gestational age, and a significant correlation was also found between fetal ear length and the biparietal diameter (r=0.962; p<0.001). Similar correlations were found between fetal ear length and head circumference, and fetal ear length and femur length. Conclusion: The results of this study provide a nomogram for fetal ear length. The study also demonstrates the relationship between ear length and other biometric measurements. PMID:25667783

First trimester PAPP-A levels correlate with sFlt-1 levels longitudinally in pregnant women with and without preeclampsia.

PubMed

Saxena, Aditi R; Seely, Ellen W; Rich-Edwards, Janet W; Wilkins-Haug, Louise E; Karumanchi, S Ananth; McElrath, Thomas F

2013-04-04

First trimester Pregnancy Associated Plasma Protein A (PAPP-A) levels, routinely measured for aneuploidy screening, may predict development of preeclampsia. This study tests the hypothesis that first trimester PAPP-A levels correlate with soluble fms-like tyrosine kinase-1 (sFlt-1) levels, an angiogenic marker associated with preeclampsia, throughout pregnancy. sFlt-1 levels were measured longitudinally in 427 women with singleton pregnancies in all three trimesters. First trimester PAPP-A and PAPP-A Multiples of Median (MOM) were measured. Student's T and Wilcoxon tests compared preeclamptic and normal pregnancies. A linear mixed model assessed the relationship between log PAPP-A and serial log sFlt-1 levels. PAPP-A and PAPP-A MOM levels were significantly lower in preeclamptic (n = 19), versus normal pregnancies (p = 0.02). Although mean third trimester sFlt-1 levels were significantly higher in preeclampsia (p = 0.002), first trimester sFlt-1 levels were lower in women who developed preeclampsia, compared with normal pregnancies (p = 0.03). PAPP-A levels correlated significantly with serial sFlt-1 levels. Importantly, low first trimester PAPP-A MOM predicted decreased odds of normal pregnancy (OR 0.2, p = 0.002). Low first trimester PAPP-A levels suggests increased future risk of preeclampsia and correlate with serial sFlt-1 levels throughout pregnancy. Furthermore, low first trimester PAPP-A status significantly predicted decreased odds of normal pregnancy.

[Singleton and twin pregnancies of PKU patients - individual variability of phenylalanine tolerance: experience of a single treatment center (Preliminary report)].

PubMed

Żółkowska, Joanna; Hozyasz, Kamil K; Nowacka, Maria

2017-01-01

Phenylketonuria (PKU) is the autosomal recessive deficiency of phenylalanine hydroxylase resulting in the accumulation of phenylalanine (Phe) in blood and in the brain. Phe restriction in a patient's diet is determined depending on the amount of Phe intake which allows for stable blood Phe levels within the therapeutic range of 120-360µmol/L. In clinical practice the empirical determination of Phe tolerance relies on frequent assessment of blood Phe concentrations in relation to Phe intake from food records. Untreated maternal PKU may lead to maternal PKU syndrome in offspring. The objective of the study was to compare Phe tolerance during the course of singleton and multiple pregnancies of PKU patients. Case subjects and methods: The cases reviewed included three sets of classical PKU-affected Polish women on a low-phenylalanine diet during the course of singleton and twin pregnancies and their PKU-unaffected newborns. All the patients were under regular supervision of a metabolic dietitian to stabilize blood Phe levels and determine Phe tolerance. Data on pregnancy weight gain, the gestational age when the diet initiated, the percent of Phe assessments < 120 µmol/L and > 360 µmol/L, as well as offspring birth measurements were analyzed. The total increase in Phe tolerance and its pattern during the course of singleton and twin pregnancies differed remarkably in each patient. Three PKU women (Q383X/R408W, EX3DEL/EX3DEL, R281L/R408W) increased their Phe tolerance in singleton and twin pregnancies by 579%/468%, 674%/261%, and 427%/236%, respectively. During the last 10 weeks of singleton and twin pregnancy Phe tolerance showed an increase by 62%/149%, 33%/64%, and 37%/40%, respectively. The analysis of predictors for Phe tolerance showed that an individual's weight gain and the fetal weight gain as estimated from liveborn birth-weight data had no predictive capacity. Individual Phe tolerance in singleton pregnancies of PKU patients does not predict tolerance in twin pregnancy. Further research on the growing population of multiple pregnancy PKU patients is necessary to provide evidence-based guidelines to optimize the treatment of PKU in females of childbearing age.

Prospective first-trimester screening for trisomies by cell-free DNA testing of maternal blood in twin pregnancy.

PubMed

Sarno, L; Revello, R; Hanson, E; Akolekar, R; Nicolaides, K H

2016-06-01

First, to examine in twin pregnancies the performance of first-trimester screening for fetal trisomies 21, 18 and 13 by cell-free (cf) DNA testing of maternal blood and, second, to compare twin and singleton pregnancies regarding the distribution of fetal fraction of cfDNA and rate of failure to obtain a result. This was a prospective study in 438 twin and 10 698 singleton pregnancies undergoing screening for fetal trisomies by cfDNA testing at 10 + 0 to 13 + 6 weeks' gestation. Chromosome-selective sequencing of cfDNA was used and, in twin pregnancies, an algorithm was applied that relies on the lower fetal fraction contributed by the two fetuses. Multivariate regression analysis was used to determine significant predictors of fetal fraction and a failed result. In twin pregnancies, the median fetal fraction was lower (8.0% (interquartile range (IQR), 6.0-10.4%) vs 11.0% (IQR, 8.3-14.4%); P < 0.0001) and failure rate after first sampling was higher (9.4% vs 2.9%; P < 0.0001) compared to in singletons. Multivariate logistic regression analysis demonstrated that the risk of test failure increased with increasing maternal age and body mass index and decreased with fetal crown-rump length. The risk was increased in women of South Asian racial origin and in pregnancies conceived by in-vitro fertilization (IVF). The main contributor to the higher rate of failure in twins was conception by IVF which was observed in 9.5% of singletons and 56.2% of twins. In the 417 twin pregnancies with a cfDNA result after first or second sampling, the detection rate was 100% (8/8) for trisomy 21 and 60% (3/5) for trisomies 18 or 13, at a false-positive rate (FPR) of 0.25% (1/404). In the 10 530 singleton pregnancies with a cfDNA result after first or second sampling, the detection rate was 98.7% (156/158) for trisomy 21 and 80.3% (49/61) for trisomies 18 or 13, at a FPR of 0.22% (23/10 311). In twin pregnancies undergoing first-trimester screening for trisomies by cfDNA testing, the fetal fraction is lower and failure rate higher compared to in singletons. The number of trisomic twin pregnancies examined was too small for an accurate assessment of performance of screening, but it may be similar to that in singleton pregnancies. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Vanishing twin syndrome among ART singletons and pregnancy outcomes

PubMed Central

Magnus, Maria C; Ghaderi, Sara; Morken, Nils-Halvdan; Magnus, Per; Bente Romundstad, Liv; Skjærven, Rolv; Wilcox, Allen J; Eldevik Håberg, Siri

2017-01-01

Abstract STUDY QUESTION Among babies born by ART, do singleton survivors of a vanishing twin have lower birth weight than other singletons? SUMMARY ANSWER Vanishing twin syndrome (VTS) was associated with lower birth weight among ART singletons; a sibship analysis indicated that the association was not confounded by maternal characteristics that remain stable between deliveries. WHAT IS KNOWN ALREADY Previous studies indicate that ART singletons with VTS have increased risk of adverse pregnancy outcomes, compared with other ART singletons. The potential contribution of unmeasured maternal background characteristics has been unclear. STUDY DESIGN, SIZE AND DURATION This was a Norwegian population-based registry study, including 17 368 mothers with 20 410 ART singleton deliveries between January 1984 and December 2013. PARTICIPANTS/MATERIALS, SETTING, METHODS The study population included 17 291 ART singletons without VTS, 638 ART singletons with VTS and 2418 ART singletons with uncertain vanishing twin status. We estimated differences in birth weight and gestational age comparing ART singletons with VTS first to all ART singletons without VTS, and subsequently to their ART siblings without VTS, using random- and fixed-effects linear regression, respectively. The corresponding comparisons for the associations with preterm birth and small for gestational age (SGA) were conducted using random-and fixed-effects logistic regression. The sibling analysis of preterm birth included 587 discordant siblings, while the sibling analysis of SGA included 674 discordant siblings. MAIN RESULTS AND THE ROLE OF CHANCE ART singletons with VTS had lower birth weight when compared to all ART singletons without VTS, with an adjusted mean difference (95% CI) of −116 g (−165, −67). When we compared ART singletons with VTS to their ART singletons sibling without VTS, the adjusted mean difference was −112 g (−209, −15). ART singletons with VTS also had increased risk of being born SGA, with an adjusted odds ratio (OR) (95% CI) of 1.48 (1.07, 2.03) compared to all ART singletons without VTS, and 2.79 (1.12, 6.91) in the sibship analyses. ART singletons with VTS were also more likely to be born preterm, although this difference did not reach statistical significance. LIMITATIONS REASONS FOR CAUTION We did not have information on maternal socio-economic status, but this factor is accounted for in the sibship analyses. We also had no information on whether fresh or frozen embryos were replaced. WIDER IMPLICATIONS OF THE FINDINGS The reduction in birth weight and increased risk of SGA in ART singletons with VTS may suggest the presence of harmful intrauterine factors with long-term health impact. While vanishing twins are not routinely observed in naturally conceived pregnancies, loss of a twin is potentially a risk factor for the surviving foetus in any pregnancy. This could be further explored in large samples of naturally conceived pregnancies with the necessary information. STUDY FUNDING/COMPETING INTEREST(S) The authors of this study are supported in part by the UK Medical Research Council, US National Institute of Environmental Health Sciences and the Norwegian Research Council. The authors have no conflicts of interest. TRIAL REGISTRATION NUMBER N/A. PMID:29025107

Assessing the Risk of Having Small for Gestational Age Newborns Among Lebanese Underweight and Normal Pre-pregnancy Weight Women.

PubMed

Rafei, Rym El; Abbas, Hussein A; Alameddine, Hind; Bizri, Ayah Al; Melki, Imad; Yunis, Khalid A

2018-01-01

Introduction It has been established that underweight women with low gestational weight gain (GWG) are at a higher risk of having Small for Gestational Age (SGA) newborns. However, the association remains poorly studied in Middle Eastern societies exhibiting different ethnic groups, genetic predisposing factors along with differences in nutritional food intake during pregnancy. The aim of this study is to assess the risk of having a SGA newborn among underweight and normal weight BMI women while studying the role of GWG in this association. Methods This is a retrospective cross-sectional study of 62,351 singleton pregnancies from the National Collaborative Perinatal Neonatal Network between 2001 and 2009 from 27 hospitals across Lebanon. Women who had underweight and normal pre-pregnancy BMI were included. Results A total of 8.6% newborns were SGA and 6.6% of women were underweight. Among women with normal and underweight pre-pregnancy BMI, 8.6 and 12.4% had SGA births respectively. Overall, the adjusted OR of having SGA newborns was significantly higher among underweight women (OR = 1.448; 95%CI = 1.287-1.630) compared to normal pre-pregnancy BMI. Below normal weight gain significantly increased the odds of SGA for both normal and underweight pre-pregnancy BMI women, with adjusted ORs of 1.535 (95% CI = 1.418-1.661) and 1.970 (95%CI = 1.515-2.560) respectively. Discussion Higher risks of SGA newborns in underweight and normal BMI women with low GWG were observed. In addition, normal weight gain couldn't protect underweight women of having risk for SGA newborns. Hence, all pregnant women should be encouraged to maintain healthy BMI before pregnancy and attain adequate GWG.

Gender impact on first trimester markers in Down syndrome screening.

PubMed

Larsen, Severin Olesen; Wøjdemann, Karen R; Shalmi, Anne-Cathrine; Sundberg, Karin; Christiansen, Michael; Tabor, Ann

2002-12-01

The influence of fetal gender on the level in the first trimester of the serological markers alpha-fetoprotein (AFP), pregnancy-associated plasma protein-A (PAPP-A) and free beta human chorionic gonadotropin (betahCG) and on nuchal translucency is described for 2637 singleton pregnancies with normal outcome. Mean log MoM values for pregnancies with female and male fetuses were calculated using regression of log marker values on gestational age expressed as crown rump length and on maternal weight. A pronounced gender impact was found for free betahCG, being 16% higher for female than for male fetuses. Copyright 2002 John Wiley & Sons, Ltd.

The costs to the NHS of multiple births after IVF treatment in the UK.

PubMed

Ledger, William L; Anumba, Dilly; Marlow, Neil; Thomas, Christine M; Wilson, Edward C F

2006-01-01

To determine the cost to the NHS resulting from multiple pregnancies arising from IVF treatment in the UK, and to compare those costs with the cost to the NHS due to singleton pregnancies resulting from IVF treatment. A modelling study using data from published literature and cost data from national sources in the public domain, calculating direct costs from the diagnosis of a clinical pregnancy until the end of the first year after birth. Academic Unit of Reproductive and Developmental Medicine. Theoretic core modelling study using data from published literature. The analysis was based on the total annual number of births resulting from an IVF treatment in the UK. Main outcome measures total direct costs to the NHS per IVF singleton, twin or triplet family. Cost of singleton, twin and triplet IVF pregnancies in the UK. Total direct costs to the NHS per IVF twin or triplet family (maternal + infant costs) are substantially higher than per IVF singleton family (singleton: pounds 3313; twin: pounds 9122; and triplet: pounds 32,354). Multiple pregnancies after IVF are associated with 56% of the direct cost of IVF pregnancies, although they represent less than 1/3 of the total annual number of maternities in the UK. Multiple pregnancies after IVF are associated with high direct costs to the NHS. Redirection of money saved by implementation of a mandatory 'two embryo transfer' policy into increased provision of IVF treatment could double the number of NHS-funded IVF treatment cycles at no extra cost. Further savings could be made if a selective 'single embryo transfer' policy were to be adopted.

First trimester β-hCG and estradiol levels in singleton and twin pregnancies after assisted reproduction.

PubMed

Póvoa, Ana; Xavier, Pedro; Matias, Alexandra; Blicksttein, Isaac

2017-07-28

To compare levels of β-hCG and estradiol collected during the first trimester in singleton and twin pregnancies following assisted reproduction technologies (ART). We prospectively evaluated 50 singleton and 47 dichorionic twin pregnancies that eventually ended in live births. Patients were recruited from a single ART center with standard treatment protocols followed by fresh embryo transfers. Hormone measurements were performed within a narrow gestational age range and analyzed in a single laboratory thus minimizing inter- and intra-assay variability. We measured serum β-hCG at 13 days after embryo transfer as well as samples of β-hCG and estradiol at 8-9 weeks+6 days. No significant differences existed between singletons and twins in respect to demographic and cycle characteristics. β-hCG and estradiol were all significantly higher in twins (P<0.05). The data confirms the higher levels of β-hCG and estradiol in twins, pointing to the potential role of these placental hormones in early support of a twin pregnancy.

Risk of fetal death associated with maternal drug dependence and placental abruption: a population-based study.

PubMed

McDonald, Sarah D; Vermeulen, Marian J; Ray, Joel G

2007-07-01

Substance use in pregnancy is associated with placental abruption, but the risk of fetal death independent of abruption remains undetermined. Our objective was to examine the effect of maternal drug dependence on placental abruption and on fetal death in association with abruption and independent of it. To examine placental abruption and fetal death, we performed a retrospective population-based study of 1 854 463 consecutive deliveries of liveborn and stillborn infants occurring between January 1, 1995 and March 31, 2001, using the Canadian Institute for Health Information Discharge Abstract Database. Maternal drug dependence was associated with a tripling of the risk of placental abruption in singleton pregnancies (adjusted odds ratio [OR] 3.1; 95% confidence intervals [CI] 2.6-3.7), but not in multiple gestations (adjusted OR 0.88; 95% CI 0.12-6.4). Maternal drug dependence was associated with an increased risk of fetal death independent of abruption (adjusted OR 1.6: 95% CI 1.1-2.2) in singleton pregnancies, but not in multiples. Risk of fetal death was increased with placental abruption in both singleton and multiple gestations, even after controlling for drug dependence (adjusted OR 11.4 in singleton pregnancy; 95% CI 10.6-12.2, and 3.4 in multiple pregnancy; 95% CI 2.4-4.9). Maternal drug use is associated with an increased risk of intrauterine fetal death independent of placental abruption. In singleton pregnancies, maternal drug dependence is associated with an increased risk of placental abruption.

Parents' anxiety and depression symptoms after successful infertility treatment and spontaneous conception: does singleton/twin pregnancy matter?

PubMed

Tendais, I; Figueiredo, B

2016-10-01

Does mode of conception [spontaneous/after infertility treatment (IT)], type of pregnancy (singleton/twin) and parent gender have an effect on anxiety and depression levels and trajectories during pregnancy and the post-partum period? Conception after IT was associated with a transitory increase in anxiety during the perinatal period for parents of singletons, while for IT parents of twins higher levels of psychopathological symptoms tended to persist during pregnancy and the post-partum period. Most previous studies have shown that successful IT is not associated with poor psychological well-being during pregnancy and the post-partum period, but there is also some evidence for heightened pregnancy-related anxiety, lower self-esteem and lower self-efficacy. Parents of twins experience increased postnatal anxiety and depression. This prospective longitudinal study assessed 267 couples (N = 534) at each trimester of pregnancy, after childbirth and at 3 months post-partum. The sample comprised 36 couples who had conceived after IT (19 twin pairs and 17 singletons) and 231 couples who had conceived spontaneously (SC; 28 twin pairs and 203 singletons). Couples were recruited at four public hospitals in Portugal, and self-report measures of anxiety and depression symptoms were administered. IT parents reported higher anxiety after childbirth than parents who SC, regardless of pregnancy type. IT parents of twins showed higher anxiety at mid-pregnancy, as well as higher anxiety and depression at 3 months post-partum than IT parents of singletons. Among IT mothers, those who had twins exhibited higher depression after childbirth than those who had singletons. Differences according to mode of conception, pregnancy type and parents gender over time were also noted. During pregnancy, IT parents of twins showed no significant change in depression scores, while the other groups depression scores statistically significantly decreased over time. From pregnancy to the post-partum period, (i) IT parents showed an increase in anxiety scores, whereas SC parents exhibited no changes in anxiety scores; (ii) IT women exhibited an increase in depression scores, while SC women depression scores decreased. During the post-partum period, IT and SC parents of twins showed no changes in anxiety scores, while IT and SC parents of singletons anxiety scores declined. Due to the small number of IT couples, the interpretation and generalization of the results should be done with caution. The adverse impact of IT on psychopathological symptoms depends mostly on time and type of pregnancy, and is greater for twin pregnancies. These findings are important for tailoring interventions that address parents' specific needs at different moments. This work was supported by a grant (SFRH/BD/40146/2007) to the first author from the FCT, Foundation for Science and Technology (Portuguese Ministry of Education and Science), by the Operational Program Science and Innovation 2010 (POCI 2010) of the Community Support Board III, by FEDER Funds through the Operational Competitiveness Programme, COMPETE, and through national funding from the FCT under the projects: POCI/SAU-ESP/ 56397/2004 and PTDC/SAU/SAP/116738/2010. The authors have no conflicts of interest. © The Author 2016. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Effects of mares' age and day of gestation on efficacy of transvaginal ultrasound-guided twin reduction.

PubMed

Rau, Janina; Tiedemann, Daniela; Sielhorst, Jutta; Tönissen, Anna; Burger, Dominik; Martinsson, Gunilla; Rohn, Karl; Oldenhof, Harriette; Sieme, Harald

2018-06-01

Transvaginal ultrasound-guided aspiration (TUA) is a procedure which can be used for the reduction of twins post-fixation in the mare. The aim of this study was to evaluate the effect of the age of mares and the day of gestation on the outcome of TUA treatment. In 88 mares, diagnosed pregnant with twins, TUA of the yolk sac or allantoic fluid was performed between day 30 and 62 of gestation. Mares were aged 3-22 years. Ultrasonographic examination for a viable singleton pregnancy was performed by referring veterinarians 5-7 days and 4 weeks after TUA. Based on reported findings, effects of age and day of gestation on pregnancy rates were evaluated. Four weeks after TUA, 67% of the cases resulted in a viable singleton pregnancy. Five to 7 days after TUA treatment, the success rate was 74%. The gestational period did not affect the outcome, irrespective of the age of the mare. In contrast, success rates decreased with increasing age of the mares (84% ≤ 7 years vs. 67% 8-14 years vs. 57% ≥ 15 years). In mares aged 8-14 years, a decrease in singleton pregnancies was observed, if TUA was performed after day 35 of gestation. Success rates were slightly higher, if twin vesicles were localized within separate uterine horns (73%) as compared to the same horn (66%). Differences in singleton pregnancy rates were not statistically significant (p > 0.05). TUA was found to be an effective procedure for reduction of twin pregnancies performed at days 30-62 of gestation. Success rates for singleton pregnancies were high for young mares ≤ 7 years old (84%) and middle aged mares treated before day 36 of pregnancy (74%). Duration of pregnancy at the time of TUA did not have a major impact on the outcome. Nevertheless, the procedure should optimally be performed around days 32-35 of pregnancy to allow for the possibility of natural reduction before treatment and rebreeding in case of a total pregnancy loss after TUA. Schattauer GmbH.

The Normal Fetal Pancreas.

PubMed

Kivilevitch, Zvi; Achiron, Reuven; Perlman, Sharon; Gilboa, Yinon

2017-10-01

The aim of the study was to assess the sonographic feasibility of measuring the fetal pancreas and its normal development throughout pregnancy. We conducted a cross-sectional prospective study between 19 and 36 weeks' gestation. The study included singleton pregnancies with normal pregnancy follow-up. The pancreas circumference was measured. The first 90 cases were tested to assess feasibility. Two hundred ninety-seven fetuses of nondiabetic mothers were recruited during a 3-year period. The overall satisfactory visualization rate was 61.6%. The intraobserver and interobserver variability had high interclass correlation coefficients of of 0.964 and 0.967, respectively. A cubic polynomial regression described best the correlation of pancreas circumference with gestational age (r = 0.744; P < .001) and significant correlations also with abdominal circumference and estimated fetal weight (Pearson r = 0.829 and 0.812, respectively; P < .001). Modeled pancreas circumference percentiles for each week of gestation were calculated. During the study period, we detected 2 cases with overgrowth syndrome and 1 case with an annular pancreas. In this study, we assessed the feasibility of sonography for measuring the fetal pancreas and established a normal reference range for the fetal pancreas circumference throughout pregnancy. This database can be helpful when investigating fetomaternal disorders that can involve its normal development. © 2017 by the American Institute of Ultrasound in Medicine.

The cost-effectiveness of targeted or universal screening for vasa praevia at 18-20 weeks of gestation in Ontario.

PubMed

Cipriano, L E; Barth, W H; Zaric, G S

2010-08-01

To estimate the cost-effectiveness of targeted and universal screening for vasa praevia at 18-20 weeks of gestation in singleton and twin pregnancies. Cost-utility analysis based on a decision-analytic model comparing relevant strategies and life-long outcomes for mother and infant(s). Ontario, Canada. A cohort of pregnant women in 1 year. We constructed a decision-analytic model to estimate the lifetime incremental costs and benefits of screening for vasa praevia. Inputs were estimated from the literature. Costs were collected from the London Health Sciences Centre, the Ontario Health Insurance Program, and other sources. We used one-way, scenario and probabilistic sensitivity analysis to determine the robustness of the results. Incremental costs, life expectancy, quality-adjusted life-years (QALY) and incremental cost-effectiveness ratio (ICER). Universal transvaginal ultrasound screening of twin pregnancies has an ICER of $5488 per QALY-gained. Screening all singleton pregnancies with the risk factors low-lying placentas, in vitro fertilisation (IVF) conception, accessory placental lobes, or velamentous cord insertion has an ICER of $15,764 per QALY-gained even though identifying some of these risk factors requires routine use of colour Doppler during transabdominal examinations. Screening women with a marginal cord insertion costs an additional $27,603 per QALY-gained. Universal transvaginal screening for vasa praevia in singleton pregnancies costs $579,164 per QALY compared with targeted screening. Compared with current practice, screening all twin pregnancies for vasa praevia with transvaginal ultrasound is cost-effective. Among the alternatives considered, the use of colour Doppler at all transabdominal ultrasound examinations of singleton pregnancies and targeted use of transvaginal ultrasound for IVF pregnancies or when the placenta has been found to be associated with one or more risk factors is cost-effective. Universal screening of singleton pregnancies is not cost-effective compared with targeted screening.

In vitro fertilization-induced pregnancies predispose to gastroesophageal reflux disease

PubMed Central

Kitapcioglu, Gul; Tavmergen Goker, Ege; Sahin, Gulnaz; Bor, Serhat

2015-01-01

Background Women conceiving following in vitro fertilization (IVF) likely have a variety of risk factors that predispose them to gastroesophageal reflux disease (GERD) in the future. Objective We aimed to investigate whether pregnancy through IVF may predispose to subsequent GERD compared with pregnancies without IVF. We also evaluate whether twin IVF pregnancies lead to additional risk for having GERD compared with singleton IVF pregnancies. Methods A validated reflux questionnaire was administered to 156 women with singleton (n = 102) or twin (n = 54) IVF birth (IVF group) and 111 women with a naturally conceived singleton birth (control group). All women included in the study were primiparas who had given birth at least 1 year prior to data collection. The diagnosis of GERD was based on the occurrence of typical symptoms (heartburn, regurgitation, or both) at least once a week. Results The prevalence of GERD was 13.5% and 4.5% in IVF and control groups (p = 0.015); in the IVF group, this was slightly higher, but not statistically significant, in women with twin compared with singleton pregnancies (14.8% vs. 12.7%, p = 0.749). Logistic regression analysis showed that IVF was strongly associated with subsequent GERD (OR, 3.30; 95% CI 1.20–9.04; p = 0.02). Conclusion The risk of developing GERD at least 1 year after delivery increased following IVF. Long-term follow-up studies are required to determine whether therapy during pregnancy can prevent this risk. PMID:27087950

Trends in preterm birth: singleton and multiple pregnancies in the Netherlands, 2000-2007.

PubMed

Schaaf, J M; Mol, B W J; Abu-Hanna, A; Ravelli, A C J

2011-09-01

Several studies have reported increasing trends in preterm birth in developed countries, mainly attributable to an increase in medically indicated preterm births. Our aim was to describe trends in preterm birth among singleton and multiple pregnancies in the Netherlands. Prospective cohort study. Nationwide study. We studied 1,451,246 pregnant women from 2000 to 2007. We assessed trends in preterm birth. We subdivided preterm birth into spontaneous preterm birth after premature prelabour rupture of membranes (pPROM), medically indicated preterm birth and spontaneous preterm birth without pPROM. We performed analyses separately for singletons and multiples. The primary outcome was preterm birth, defined as birth before 37 weeks of gestation, with very preterm birth (<32 weeks of gestation) being a secondary outcome. The risk of preterm birth was 7.7% and the risk of very preterm birth was 1.3%. In singleton pregnancies, the preterm birth risk decreased significantly from 6.4% to 6.0% (P < 0.0001), mainly as a result of the decrease in spontaneous preterm birth without pPROM (3.6-3.1%, P < 0.0001). In multiple pregnancies, the preterm birth risk increased significantly (47.3-47.7%, P = 0.047), mainly as a result of medically indicated preterm birth, which increased from 15.0% to 17.9% (P < 0.0001). In the Netherlands, the preterm birth risk in singleton pregnancies decreased significantly over the years. The trend of increasing preterm birth risk reported in other countries was only observed in (medically indicated) preterm birth in multiple pregnancies. © 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG.

Use of the partial farm budget technique to predict the economic impact of the flock management decision to use B-mode ultrasonographic pregnancy diagnosis.

PubMed

Sprecher, D J; Ley, W B; Whittier, W D; Bowen, J M; Thatcher, C D; Pelzer, K D; Moore, J M

1989-07-15

A computer spreadsheet was developed to predict the economic impact of a management decision to use B-mode ultrasonographic ovine pregnancy diagnosis. The spreadsheet design and spreadsheet cell formulas are provided. The program used the partial farm budget technique to calculate net return (NR) or cash flow changes that resulted from the decision to use ultrasonography. Using the program, either simple pregnancy diagnosis or pregnancy diagnosis with the ability to determine singleton or multiple pregnancies may be compared with no flock ultrasonographic pregnancy diagnosis. A wide range of user-selected regional variables are used to calculate the cash flow changes associated with the ultrasonography decisions. A variable may be altered through a range of values to conduct a sensitivity analysis of predicted NR. Example sensitivity analyses are included for flock conception rate, veterinary ultrasound fee, and the price of corn. Variables that influence the number of cull animals and the cost of ultrasonography have the greatest impact on predicted NR. Because the determination of singleton or multiple pregnancies is more time consuming, its economic practicality in comparison with simple pregnancy diagnosis is questionable. The value of feed saved by identifying and separately feeding ewes with singleton pregnancies is not offset by the increased ultrasonography cost.

Unconscious dynamics in twin pregnancy emerging from the Lüscher color test.

PubMed

Savio, Francesca; Zanardo, Vincenzo

2015-01-01

To investigate unconscious dynamics in women pregnant with twins, using Lüscher's color test to objectively measure subjective color preferences, and compare them with women with singleton pregnancies. The color test was administered to 50 Italian women with twin pregnancies and 100 women with singleton pregnancies. Both the twin and singleton pregnancy groups said that violet was their favorite color (50 versus 49%) and brown was their least favorite color (52 versus 44%), indicating that they idealized being pregnant, but also found it physically stressful. The twin pregnancy group chose yellow as their second favorite (28 versus 17%) and were most likely to combine it with their first choice of violet (44 versus 19%, p=0.0006), indicating that they were worried about their relationships with their new babies and wanted to give birth soon. In addition, both groups preferred form 6, the sine curve on a dark background, but rejected the associated brown color 6, revealing that the women felt the need to look after themselves. Both groups idealized being pregnant, but also found it physically stressful. However, the twin pregnancy group was afraid of building relationships with their babies and wanted to give birth soon.

Perineal Distensibility Using Epi-no in Twin Pregnancies: Comparative Study with Singleton Pregnancies

PubMed Central

Kubotani, Juliana Sayuri; Moron, Antonio Fernandes; Zanetti, Miriam Raquel Diniz; Soares, Vanessa Cardoso Marques; Elito Júnior, Julio

2014-01-01

The aims of this study were to compare perineal distensibility between women with twin and singleton pregnancies and to correlate these women's perineal distensibility with anthropometric data. This prospective cross-sectional case-control study was conducted among nulliparous women, of whom 20 were pregnant with twins and 23 with a single fetus. Perineal distensibility was evaluated in the third trimester by means of Epi-no, which was introduced into the vagina and inflated up to the maximum tolerable limit. It was then withdrawn while inflated and its circumference was measured. The unpaired Student's t-test was used to compare perineal distensibility in the two groups and Pearson's correlation coefficient (r) was used to correlate the pregnant women's perineal distensibility with their anthropometric data. There was no difference in perineal distensibility between the twin group (16.51 ± 2.05 cm) and singleton group (16.13 ± 1.67 cm) (P = 0.50). There was a positive correlation between perineal distensibility and abdominal circumference (r = 0.36; P = 0.01). The greater the abdominal circumference was, the greater the perineal distensibility was, regardless of whether the pregnancy was twin or singleton. PMID:25006476

Pregnancy and childhood health and developmental outcomes with the use of posthumous human sperm.

PubMed

Robson, Stephen J; Campbell, Simone; McDonald, Janelle; Tremellen, Kelton; Carlin, Emily; Maybury, Genevieve

2015-10-01

Although there is now considerable experience in obtaining sperm from a cadaver, there is little or no published data regarding pregnancy, birth and long-term childhood health and development outcomes when posthumous sperm is used in in vitro fertilisation (IVF). We report the results from treatment of four women undergoing IVF treatment using posthumously acquired human sperm from their deceased partners. In all cases, testicular tissue was obtained in a mortuary setting, and the duration from death to posthumous sperm retrieval ranged from 12 to 48 h. The age of women treated ranged from 31 to 41 years. Fertilization rates ranged from 40 to 100%. Singleton pregnancies were obtained for each of the four women. One pregnancy was complicated by preterm birth at 31 weeks; the other three delivered at term. One baby was growth restricted but morphologically normal; the other children had term birthweights in the normal range. All four children were have shown normal health and developmental outcomes, with the follow-up ranging from 1 to 7 years. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Watchful waiting or induction of labour--a matter of informed choice: identification, analysis and critical appraisal of decision aids and patient information regarding care options for women with uncomplicated singleton late and post term pregnancies: a review.

PubMed

Berger, Bettina; Schwarz, Christiane; Heusser, Peter

2015-05-07

Decision-making during pregnancy regarding different options of care can be difficult, particularly when risks of intervention versus no intervention for mother and baby are unclear. Unbiased information and support for decision making may be beneficial in these situations. The management of normal pregnancies at and beyond term is an example of such a situation. In order to determine the need to develop an evidence-based decision aid this paper searches, analyses and appraises patient decision aids and patient information leaflets regarding care options in cases of late term and post-term pregnancies, including complementary and alternative medicine (CAM). A literature search was carried out in a variety of lay and medical databases. written information related to uncomplicated singleton pregnancies and targeted at lay people. Analysis and appraisal of included material by means of quality criteria was set up based on the International Patient Decision Aid Standards accounting for evidence-basing of CAM options. Inclusion of two decision aids and eleven leaflets from four decision aids and sixteen leaflets. One decision aid met the quality criteria almost completely, the other one only insufficiently despite providing some helpful information. Only one leaflet is of good quality, but cannot substitute a decision aid. There is an urgent need for the design of an evidence-based decision aid of good quality for late-term or post-term pregnancy, particularly in German language.

Obstetric and neonatal outcome in women aged 50 years and up: A collaborative, Nordic population-based study.

PubMed

Khatibi, Ali; Nybo Andersen, Anne-Marie; Gissler, Mika; Morken, Nils-Halvdan; Jacobsson, Bo

2018-05-01

Childbearing at extremely advanced maternal age is a globally increasing trend, but only a few studies have described the outcomes of these pregnancies. The aim of this study was to describe the occurrence of childbearing at age 50 and up in the Nordic countries, as well as to examine the frequency of adverse obstetric and neonatal outcomes. A descriptive population-based study was designed. Data from 1991 to 2013 were collected from the Medical Birth Registries in Denmark, Finland, Norway and Sweden. We investigated the occurrence of antepartum, delivery and neonatal outcomes. A total of 170 deliveries, in 141 singleton and 29 multiple pregnancies, were identified in mothers aged 50 and up. The highest frequency during this period was 6 per 100,000 deliveries. The prevalence for selected adverse outcomes in singleton pregnancies were: intrauterine fetal death (IUFD) 6%, preeclampsia 4%, preterm delivery 14%, gestational diabetes 8% and cesarean delivery 50%. In multiple pregnancies, the respective prevalence were: IUFD 2%, preeclampsia 22%, preterm delivery 57%, gestational diabetes 10% and cesarean delivery 79%. Pregnancy after assisted reproductive technologies was frequent (29% of singleton and 50% of multiple pregnancies). This study found high frequency of obstetric and neonatal complications at extremely advanced maternal age. Despite a high prevalence of stillbirth in singleton pregnancies in the studied Nordic countries, other complications were less frequent than those previously reported in different populations. Adequate preconception consultation concerning maternal and neonatal hazards is highly recommended in this group of women. Copyright © 2018. Published by Elsevier B.V.

The placental component and neonatal outcome in singleton vs. twin pregnancies complicated by gestational diabetes mellitus.

PubMed

Weiner, Eran; Barber, Elad; Feldstein, Ohad; Schreiber, Letizia; Dekalo, Ann; Mizrachi, Yossi; Bar, Jacob; Kovo, Michal

2018-03-01

We aimed to compare placental histopathological lesions and neonatal outcome in singleton vs. twin pregnancies complicated by gestational diabetes mellitus (GDM). Maternal characteristics, neonatal outcomes, and placental histopathology reports of pregnancies complicated by GDM, between 1/2008-10/2016, were reviewed. Results were compared between singletons (singleton group) and dichorionic-diamniotic twins (twin group). Placental lesions were classified as placental weight abnormalities, maternal and fetal vascular malperfusion lesions (MVM, FVM), inflammatory lesions, and lesions associated with chronic villitis. LGA was defined as birth-weight ≥90th percentile. Composite adverse neonatal outcome was defined as one or more early neonatal complications. Compared with the twin group (n = 57), the singleton group (n = 228) was characterized by higher gestational-age (38.6 ± 0.9 vs. 35.1 ± 1.8 weeks, p < 0.001) and a higher rate of insulin treatment (32.9% vs. 17.5%, p = 0.023). Placentas from the singleton group were characterized by higher rates of MVM lesions (54.4% vs. 30.7%, p < 0.001), villitis of unknown etiology (VUE, 5.7% vs. 0.9%, p = 0.040), villous immaturity (10.1% vs. 0.9%, p = 0.001), and placental weight <10th percentile (16.7% vs. 8.8%, respectively, p = 0.049). Using multivariable regression analysis, MVM (aOR = 2.2, 95% CI = 1.6-4.1), VUE (aOR = 1.2, 95% CI = 1.1-2.1), villous immaturity (aOR = 2.3, 95% CI 1.8-7.6), and placental weight <10th percentile (aOR = 1.1, 95% CI = 1.02-1.6), were the only lesions associated with singleton pregnancies. Composite adverse neonatal outcome was more common in the twin group (54.3% vs. 14.0%, p < 0.001) and it was associated only with lower GA (aOR = 3.7, 95% CI 2.1-7.3). Higher rate of placental weight <10th percentile, MVM lesions, villous immaturity, and VUE characterize GDM singleton pregnancy as compared to twins GDM gestation, suggesting different placental alterations in the diabetic environment. Copyright © 2018 Elsevier Ltd. All rights reserved.

Post-partum recovery course in patients with gestational hypertension and pre-eclampsia.

PubMed

Mikami, Yukiko; Takagi, Kenjiro; Itaya, Yukiko; Ono, Yoshihisa; Matsumura, Hideyoshi; Takai, Yasushi; Seki, Hiroyuki

2014-04-01

We examined the post-partum recovery course in patients with pre-eclampsia (PE) and gestational hypertension (GH) and evaluated the associated factors. In a retrospective review of 145 patients with GH or PE who gave birth between 1 January 2008 and 30 October 2011 at our institution, there were 125 PE and 20 GH cases. Data collected included the gestational age at initial examination and delivery, delivery mode, time for normalization of blood pressure (BP), and time until resolution of proteinuria in PE patients. Comparisons were made between singleton and multiple pregnancies, onset (early, <32 weeks; late, ≥ 32 weeks) and fetal growth restriction in singleton pregnancies. The mean interval for normalization of BP was 41.8 ± 29.4 days (median, 31.5). The mean interval for resolution of proteinuria was 30.0 ± 39.6 days (median, 27.0). Ninety percent of patients required 77 and 60 days to recover from hypertension and proteinuria, respectively. The time for BP normalization was longer in the early-onset group. The time for resolution of proteinuria was not affected by any factor examined. A post-partum observation period of 12 weeks is acceptable for differentiating PE and GH from chronic hypertension or renal disease. GH severity did not affect the recovery period, but proteinuria severity did. Onset time was a factor influencing the recovery from PE and GH. © 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.

Increased risk of congenital heart disease in twins in the North of England between 1998 and 2010

PubMed Central

Best, K E; Rankin, J

2015-01-01

Objective To examine the relative risk (RR) of congenital heart disease (CHD) in twins compared with singletons, according to chorionicity. Methods Twins and singletons with CHD notified to the Northern Congenital Abnormality Survey between 1998 and 2010 were included in this population-based study. Information on chorionicity was obtained from the Northern Survey of Twins and Multiple Pregnancy. Prevalence was calculated as the number of cases occurring in live births, late miscarriages (20–23 weeks), stillbirths (≥24 weeks) and terminations of pregnancy for fetal anomaly, per 10 000 total births. The risk of CHD in twins compared with singletons was estimated using Poisson regression. Results There were 399 414 singleton births of which 2984 (0.7%) had CHD. Among 11 871 twin births, 154 (1.3%) had CHD; one twin was affected by CHD in 2.5% of twin pregnancies. Of 8605 dichorionic (DC) births and 2317 monochorionic (MC) births, 96 (1.1%) and 47 (2.0%) were associated with CHD. Compared with singletons, twins were at significantly increased risk of CHD (RR=1.73, 95% CI 1.48 to 2.04; p<0.001). MC twins were at 82% significantly increased risk of CHD compared with DC twins (RR=1.82, 95% CI 1.29 to 2.57; p<0.001). The RR of severe and mild CHD was particularly high in MC twins compared with singletons (292% increased risk, RR=3.92, 95% CI 1.25 to 12.30, p=0.02 and 207% increased risk, RR=3.07, 95% CI 2.20 to 4.28; p<0.001). Conclusions Compared with singletons, twins were at increased risk of CHD, the risk being substantially higher among MC twins. This information is important for health professionals when counselling women with twin pregnancies. PMID:26412859

Blood pressure changes during pregnancy: impact of race, body mass index, and weight gain.

PubMed

Magriples, Urania; Boynton, Marcella H; Kershaw, Trace S; Duffany, Kathleen O; Rising, Sharon Schindler; Ickovics, Jeannette R

2013-05-01

To investigate the effect of race, body mass index (BMI), and weight gain on blood pressure in pregnancy and postpartum. Secondary analysis of pregnant women aged 14 to 25 who received prenatal care at a university-affiliated public clinic in New Haven, Connecticut and delivered singleton term infants (n = 418). Longitudinal multivariate analysis was used to evaluate blood pressure trajectories from pregnancy through 12 weeks postpartum. Obese and overweight women had significantly higher blood pressure readings as compared with women with normal BMI (all p < 0.05). African American women who had high pregnancy weight gain had the greatest increase in mean arterial and diastolic blood pressures in pregnancy and postpartum. Blood pressure trajectories in pregnancy and postpartum are significantly affected by race, BMI, and weight gain. Given the young age of this cohort, targeted efforts must be made for postpartum weight reduction to reduce cardiovascular risk. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The effects of gestational transient thyrotoxicosis on the perinatal outcomes: a case-control study.

PubMed

Kinomoto-Kondo, Satoko; Umehara, Nagayoshi; Sato, Shiori; Ogawa, Kohei; Fujiwara, Takeo; Arata, Naoko; Sago, Haruhiko

2017-01-01

To study the effects of gestational transient thyrotoxicosis (GTT) on pregnancy outcomes. This case-control study retrospectively analyzed 7976 women with singleton pregnancies whose thyroid function was measured before 16 weeks of gestation and who delivered at ≥22 weeks of pregnancy. GTT was defined as hyperthyroidism (free thyroxine [FT4] level: ≥95th percentile) in the early pregnancy, which normalized in mid-pregnancy without thyroid-stimulating hormone receptor antibodies. Using data extracted from electronic records, we examined the association between GTT and the pregnancy outcomes (preterm delivery, gestational age at delivery, pregnancy induced hypertension (PIH), preeclampsia, placental abruption, caesarian section, birth weight, low birth weight, Apgar score, cord pH, stillbirth at gestational week ≥22, and neonatal death). We classified the cases into quartiles according to their FT4 values during the early pregnancy and investigated the association with the gestational age at delivery. Two hundred and eight cases of GTT and 6317 cases with normal thyroid assessments were reviewed. GTT was associated with hyperemesis gravidarum, but not with stillbirth, preterm delivery, PIH, preeclampsia, placental abruption, or low birth weight. The gestation period was shorter in patients with GTT than in those with a normal thyroid function (38.69 ± 1.79 vs. 39.07 ± 1.64 weeks, p < 0.01). Higher FT4 levels during the early pregnancy were associated with earlier delivery (p = 0.02). GTT was associated with a lower gestational age at delivery but not with adverse pregnancy outcomes. There was a negative correlation between the FT4 values in the early pregnancy and the gestational period.

Live-born diploid fetus complicated with partial molar pregnancy presenting with pre-eclampsia, maternal anemia, and seemingly huge placenta: A rare case of confined placental mosaicism and literature review.

PubMed

Kawasaki, Kaoru; Kondoh, Eiji; Minamiguchi, Sachiko; Matsuda, Fumihiko; Higasa, Koichiro; Fujita, Kohei; Mogami, Haruta; Chigusa, Yoshitsugu; Konishi, Ikuo

2016-08-01

A partial molar pregnancy almost always ends in miscarriage due to a triploid fetus. We describe a rare case of a singleton, partial molar pregnancy with a seemingly huge placenta, which continued to delivery of a live-born diploid baby. A 27-year-old primigravida suffered from severe pre-eclampsia and progressive anemia. The uterus was enormously enlarged for the gestational age. A cesarean section was performed because of deterioration of maternal status at 25 weeks' gestation, when more than 3000 mL blood spouted concurrently with the delivery of the placenta. The histological examination showed congestion in the decidua, which indicated disturbance of maternal venous return from the intervillous space. The chromosome complement of the placenta and the neonate were 69,XXX and 46,XX, respectively. We also reviewed all published cases of a singleton, partial molar pregnancy. A literature search yielded 18 cases of a singleton, diploid fetus with partial molar pregnancy. The mean gestational age at delivery was 24.5 ± 6.2 weeks, and fetuses survived outside the uterus in only four cases (22.2%). Intriguingly, previous reports numbered 10 cases with diploid placenta as well as five cases with no karyotyping of the placenta, indicating that they may have included a complete mole in a twin pregnancy or placental mesenchymal dysplasia. In conclusion, this was the first case of placentomegaly that presented manifestations of excessive abdominal distension and maternal severe anemia, and the second case of a singleton, partial molar pregnancy confirmed by chromosome analysis resulting in a diploid living baby. © 2016 Japan Society of Obstetrics and Gynecology.

Long-term follow-up after cervical cancer treatment and subsequent successful surrogate pregnancy.

PubMed

Agorastos, T; Zafrakas, M; Mastrominas, M

2009-08-01

Preservation of fertility is a major concern for premenopausal women after diagnosis of cervical cancer. Successful surrogate pregnancy after treatment for cervical cancer has very rarely been reported. In the present report, a case of successful surrogate pregnancy after radical hysterectomy, lymphadenectomy and ovarian transposition for cervical cancer, followed by radiation therapy, is presented. After stimulation of the transposed ovaries using the short gonadotrophin-releasing hormone (GnRH) analogue protocol, four oocytes were retrieved transabdominally from the genetic mother. IVF followed and two embryos were transferred to the surrogate mother, leading to an uneventful singleton pregnancy, and ultimately normal vaginal delivery of a healthy female infant at term. The unique aspect in this case is the long-lasting favourable outcome for both genetic mother and child, observed during 8.5 years of follow-up, the longest follow-up period reported to date in such cases.

[Effect of hyperandrogenism on obstetric complications of singleton pregnancy from in vitro fertilization in women with polycystic ovary syndrome].

PubMed

Wei, D M; Zhang, Z Z; Wang, Z; Li, P; Wang, J F; Liu, Y J; Zhang, J T; Shi, Y H

2018-01-25

Objective: To compare the difference in risks of obstetric complications of singleton pregnancy between women with hyperandrogenic polycystic ovary syndrome (PCOS) and women with normoandrogenic PCOS. Methods: Prospective cohort study. This study was a secondary analysis of data collected during a multicenter randomized controlled clinical trial. Women who got clinical singleton pregnancy were grouped according to whether they were diagnosed with hyperandrogenism at baseline. There were 118 women with hyperandrogenism and 366 women without hyperandrogenism. The incidences of obstetric complications and birth weight were compared between the two groups. Results: Women with hyperandrogenic PCOS had a significantly higher risk of preterm delivery than women with normoandrogenic PCOS [12.7% (15/118) versus 3.6% (13/366); OR= 3.94, 95% CI: 1.82-8.56]. After adjustment of age, duration of infertility, body mass index, and fresh or frozen embryo transfer group, hyperandrogenism was still associated with an increased risk of preterm delivery ( OR= 3.67, 95% CI: 1.67-8.07). Compared with women with normoandrogenic PCOS, women with hyperandrogenic PCOS had similar risks of pregnancy loss, gestational diabetes mellitus, pre-eclampsia, placenta previa, and postpartum hemorrhage (all P> 0.05). Birth weight as well as the risks of being small for gestational age and large for gestational age were also comparable between the two groups (all P> 0.05). Conclusion: In women with PCOS and singleton pregnancy, those with preconceptional hyperandrogenism have a higher risk of preterm delivery than those without hyperandrogenism.

[Pregnancy and delivery with transfer of vitrified blastocysts following trophectoderm biopsy].

PubMed

Mátyás, Szabolcs; Varga, Tünde; Kovács, Péter; Kónya, Márton; Rajczy, Klára; Babenko, Éva; Szabó, Barbara; Kaali, G Steven; Szentirmay, Zoltán

2015-11-01

Application of preimplantation genetic diagnosis makes it possible to transfer only embryos unaffected by a certain genetic disorder. The authors have applied the combination of trophectoderm biopsy and vitrification in order to detect a monogenic disorder. Previously diagnosed type 1 neurofibromatosis of the woman was the indication for genetic examination. In vitro fertilisation and embryo culture was performed using sequential culture mediums. Seven blastocysts could be sampled on the fifth day and were vitrified subsequently. Two blastocysts turned out to be genetically normal based on the result of genetic examination using polimerase chain reaction. A healthy boy was delivered following the transfer of warmed blastocysts and an uneventful singleton pregnancy.

Twin pregnancy among women with pregestational type 1 or type 2 diabetes mellitus.

PubMed

González González, Nieves L; González Dávila, Enrique; Goya, Maria; Vega, Begoña; Hernández Suarez, Mercedes; Bartha, Jose L

2014-07-01

To assess the impact of twin versus singleton pregnancy on obstetric and perinatal outcomes among women with pregestational diabetes mellitus (DM). Multicenter retrospective cohort study of women with pregestational DM and twin or singleton pregnancy, conducted in Spain during 2005-2010. Each group included 63 women (type 1 DM, n=39; type 2 DM, n=24). Of 269 565 deliveries, 68 (0.025%) were twins of mothers with pregestational DM, with 28/63 (44.4%) conceptions achieved with assisted reproduction technology. Among women with type 1 DM, hypertensive complications were more common among those with twins than among controls (13% versus 3%, P=0.02); the rate of preterm birth was higher (69% versus 15%, P<0.001); and the rate of admission to the neonatal intensive care unit was higher (51% versus 21%, P=0.005). Twin pregnancy was an independent risk factor for adverse perinatal outcomes regardless of the type of diabetes. Twin pregnancy in women with either type of DM dramatically increased the risk of perinatal morbidity. In mothers with type 1 DM, twin pregnancy was more often associated with hypertensive complications than singleton pregnancy. Transfer of more than one embryo should be avoided if ART is needed in a woman with DM. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Smoking during pregnancy was up to 70% more common in the most deprived municipalities - a multilevel analysis of all singleton births during 2005-2010 in Finland.

PubMed

Räisänen, Sari; Kramer, Michael R; Gissler, Mika; Saari, Juho; Hakulinen-Viitanen, Tuovi; Heinonen, Seppo

2014-10-01

We investigated whether there was an association between maternal smoking habits during pregnancy and municipality level deprivation defined based on education, income and unemployment after adjustment for individual level covariates, including socioeconomic status (SES), in Finland, a Nordic welfare state. Data were gathered from the Medical Birth Register and comprised all singleton births (n=337,876) during 2005-2010. To account for any correlation of women clustered within a municipality, we fitted generalized estimating equation (GEE) models. In total, 15.3% of the women with singleton pregnancies smoked during pregnancy. After adjustment for individual level confounders, smoking during pregnancy was 5.4-fold higher among women with the lowest as compared with highest individual SES. Controlling for individual SES, age and year of birth, women living in municipalities defined as intermediately and highly deprived based on education were 53.7% (adjusted odds ratio [aOR] 1.537, 95% confidence interval [CI] 1.493-1.583) and 71.5% (aOR 1.715, 95% CI 1.647-1.785), respectively, more likely to smoke during pregnancy than women in the least deprived municipalities. Individual SES is the strongest correlate of smoking during pregnancy but conditional on individual variables; lower municipality aggregate education is associated with up to 70% higher smoking prevalence. Copyright © 2014 Elsevier Inc. All rights reserved.

Outcome of singleton preterm small for gestational age infants born to mothers with pregnancy-induced hypertension. A population-based study.

PubMed

Regev, Rivka H; Arnon, Shmuel; Litmanovitz, Ita; Bauer-Rusek, Sofia; Boyko, Valentina; Lerner-Geva, Liat; Reichman, Brian

2015-04-01

Pregnancy-induced hypertension (PIH) has been associated with a decreased risk of infant mortality in small for gestational age (SGA) preterm infants. To evaluate the influence of PIH on mortality and major neonatal morbidities in singleton preterm SGA infants, in the presence and absence of acute pregnancy complications. Population-based observational study of singleton SGA infants, born at 24 to 32 weeks gestation in the period 1995-2010 (n = 2139). Multivariable logistic regression analyses were used to assess the independent effect of PIH on mortality and neonatal morbidities. Acute pregnancy complications comprised premature labor, premature rupture of membranes >6 h, antepartum hemorrhage and clinical chorioamnionitis. In the absence of pregnancy complications, the odds ratio (95% confidence interval) for mortality (0.77; 0.50-1.16), survival without severe neurological morbidity (1.14; 0.79-1.65) and survival without bronchopulmonary dysplasia (BPD) (0.85; 0.59-1.21) were similar in the PIH versus no-PIH groups. In the presence of pregnancy complications, mortality (0.76; 0.40-1.44), survival without severe neurological morbidity (1.16; 0.64-2.12) and survival without BPD (1.04; 0.58-1.86) were also similar in the PIH versus no-PIH groups. PIH was not associated with improved outcome in preterm SGA infants, both in the presence and absence of acute pregnancy complications.

Maternal serum pregnancy-associated plasma protein A and fetal nuchal translucency thickness for the prediction of fetal trisomies in early pregnancy.

PubMed

Brizot, M L; Snijders, R J; Bersinger, N A; Kuhn, P; Nicolaides, K H

1994-12-01

To determine if the risk for fetal trisomies during the first trimester of pregnancy can be derived by combining data from maternal serum pregnancy-associated plasma protein A (PAPP-A) and fetal nuchal translucency thickness. Pregnancy-associated plasma protein A was measured in samples from 87 singleton pregnancies with fetal chromosomal abnormalities (45 trisomy 21, 19 trisomy 18, eight trisomy 13, 11 sex chromosome aneuploidies, four triploidies) and 348 chromosomally normal controls at 10-13 weeks' gestation. Likelihood ratios for trisomies 21, 18, and 13 in relation to PAPP-A, in multiples of the normal median (MoM) for crown-rump length, were derived from the overlapping gaussian frequency distribution curves for normal and abnormal pregnancies. In the chromosomally normal group, maternal serum PAPP-A correlated significantly with fetal crown-rump length (r = 0.421, P < .0001). In the chromosomally abnormal group, the median PAPP-A was significantly lower than in the normal controls. The respective median values expressed in MoM for trisomies 21, 18, and 13 and other aneuploidies were 0.5 MoM (90% confidence interval [CI] 0.09-1.67, z = 6.0, P < .001), 0.17 MoM (90% CI 0.06-1.45, z = 6.6, P < .001), 0.25 MoM (90% CI 0.10-0.62, z = 4.5, P < .001), and 0.72 MoM (90% CI 0.09-2.48, z = 2.2, P < .05), respectively. There was no significant linear association between PAPP-A and fetal nuchal translucency thickness in either the chromosomally normal (r = -0.01, P = .89) or abnormal groups (r = -0.19, P = .08). The risks for fetal trisomies at 10-13 weeks' gestation can be derived by combining data on maternal age, maternal serum PAPP-A, and fetal nuchal translucency thickness.

Perinatal Outcomes Associated With Isolated Velamentous Cord Insertion in Singleton and Twin Pregnancies.

PubMed

Sinkin, Joshua A; Craig, Wendy Y; Jones, Michael; Pinette, Michael G; Wax, Joseph R

2018-02-01

To evaluate perinatal outcomes in singleton and twin pregnancies with pathologically confirmed velamentous cord insertion without vasa previa. This retrospective case-control study included all nonanomalous singleton and twin pregnancies with pathologically confirmed velamentous cord insertion delivered in a single institution between January 1, 2005, and July 1, 2015, and having an ultrasound examination by maternal-fetal medicine. For each case, the next 2 consecutive deliveries matched for gestational age at delivery ± 1 week and, in twins, amnionicity and chorionicity served as controls. Primary outcomes included surgical delivery for a nonreassuring intrapartum fetal heart rate tracing, umbilical arterial cord pH of less than 7.2, 5-minute Apgar score of less than 7, birth weight below the 10th percentile, neonatal intensive care unit admission, fetal or neonatal death, and cord avulsion necessitating manual placental extraction. Outcomes were available for 53 singletons with 103 matched controls and 33 twin pregnancies with 65 matched controls. In singletons, velamentous cord insertion was associated with cord pH of less than 7.2 (odds ratio [OR] 3.5; 95% confidence interval [CI], 1.1-11.2; P = .039), 5-minute Apgar score of less than 7 (OR, 5.3; 95% CI, 0.99-28.1; P = .045), and cord avulsion requiring manual placental extraction (7.5% versus 0%; P = .012). Associations were suggested with increased surgical delivery for a nonreassuring intrapartum fetal heart rate tracing (OR, 2.4; 95% CI, 0.9-6.9; P = .14), birth weight below the 10th percentile (OR, 2.1; 95% CI, 0.8-5.9; P = .21), and fetal or neonatal death (3.8% versus 0%; P = .11). Velamentous cord insertions were also associated with placental abruption in singletons (7.5% versus 0%; P = .013). Among twins, velamentous cord insertion was associated with fetal or neonatal death (9.1% versus 0%; P = .036). Isolated confirmed velamentous cord insertion is associated with adverse perinatal outcomes in singleton and twin gestations. © 2017 by the American Institute of Ultrasound in Medicine.

Effects of Prepregnancy Body Mass Index and Gestational Weight Gain on Pregnancy Outcomes.

PubMed

Zhang, Cui Hong; Liu, Xiang Yu; Zhan, Yi Wei; Zhang, Long; Huang, Yan Jie; Zhou, Hong

2015-09-01

To investigate the single and joint effects of prepregnancy body mass index (BMI) and gestational weight gain (GWG) on pregnancy outcomes, electronic medical records of 14,196 women who delivered singleton live infant at a maternal and child health hospital in Beijing, China, in 2012 were reviewed. Logistic regression was used to assess the associations, adjusting for maternal age, height, education, parity, and offspring sex. Women of high prepregnancy BMI or excessive GWG had higher risks of gestational diabetes mellitus, hypertensive disorders in pregnancy, postpartum hemorrhage, caesarean delivery, macrosomia, and large for gestational age infant, while women of inadequate GWG had higher risks of preterm delivery, low birth weight, and small for gestational age infant. Findings suggest that antenatal care providers should help pregnant women control their GWG to normal. © 2015 APJPH.

Extremities of body mass index and their association with pregnancy outcomes in women undergoing in vitro fertilization in the United States.

PubMed

Kawwass, Jennifer F; Kulkarni, Aniket D; Hipp, Heather S; Crawford, Sara; Kissin, Dmitry M; Jamieson, Denise J

2016-12-01

To investigate the associations among underweight body mass index (BMI), pregnancy, and obstetric outcomes among women using assisted reproductive technology (ART). Retrospective cohort study using national data and log binomial regression. Not applicable. Women undergoing IVF in the United States from 2008 to 2013. None. Pregnancy outcomes (intrauterine pregnancy, live birth rates) per transfer, miscarriage rate per pregnancy, and low birth weight and preterm delivery rates among singleton and twin pregnancies. For all fresh autologous in vitro fertilization (IVF) cycles in the United States from 2008 to 2013 (n = 494,097 cycles, n = 402,742 transfers, n = 180,855 pregnancies) reported to the national ART Surveillance System, compared with normal weight women, underweight women had a statistically significant decreased chance of intrauterine pregnancy (adjusted risk ratio [aRR] 0.97; 95% confidence interval [CI], 0.96-0.99) and live birth (aRR 0.95; 95% CI, 0.93-0.98) per transfer. Obese women also had a statistically decreased likelihood of both (aRR 0.94; 95% CI, 0.94-0.95; aRR 0.87; 95% CI, 0.86-0.88, respectively). Among cycles resulting in singleton pregnancy, both underweight and obese statuses were associated with increased risk of low birth weight (aRR 1.39; 95% CI, 1.25-1.54, aRR 1.26; 95% CI, 1.20-1.33, respectively) and preterm delivery (aRR 1.12; 95% CI, 1.01-1.23, aRR 1.42; 95% CI, 1.36-1.48, respectively). The association between underweight status and miscarriage was not statistically significant (aRR 1.04; 95% CI, 0.98-1.11). In contrast, obesity was associated with a statistically significantly increased miscarriage risk (aRR 1.23; 95% CI, 1.20-1.26). Among women undergoing IVF, prepregnancy BMI affects pregnancy and obstetric outcomes. Underweight status may have a limited impact on pregnancy and live-birth rates, but it is associated with increased preterm and low-birth-weight delivery risk. Obesity negatively impacts all ART and obstetric outcomes investigated. Copyright © 2016 American Society for Reproductive Medicine. All rights reserved.

Risk of poor neonatal outcome at term after medically assisted reproduction: a propensity score-matched study.

PubMed

Ensing, Sabine; Abu-Hanna, Ameen; Roseboom, Tessa J; Repping, Sjoerd; van der Veen, Fulco; Mol, Ben Willem J; Ravelli, Anita C J

2015-08-01

To study risk of birth asphyxia and related morbidity among term singletons born after medically assisted reproduction (MAR). Population cohort study. Not applicable. A total of 1,953,932 term singleton pregnancies selected from a national registry for 1999-2011. None. Primary outcome Apgar score <4; secondary outcomes Apgar score <7, intrauterine fetal death, perinatal mortality, congenital anomalies, small for gestational age, asphyxia related morbidity, and cesarean delivery. The risks of birth asphyxia and related morbidity were calculated in women who conceived either through MAR or spontaneously (SC), with a subgroup analysis for in vitro fertilization (IVF). An additional propensity score matching analysis was performed with matching on multiple maternal baseline covariates (maternal age, ethnicity, socioeconomic status, parity, year of birth, and preexistent diseases). Each MAR pregnancy was matched to three SC controls. Relative to SC, the MAR singletons had an increased risk of adverse neonatal outcomes including Apgar score <4 (adjusted odds ratio [OR] 1.29; 95% CI, 1.14-1.46) and intrauterine fetal death (adjusted OR 1.61; 95% CI, 1.35-1.91). After propensity score matching, the risk of an Apgar score <4 was comparable between MAR and SC singletons (OR 0.99; 95% CI, 0.87-1.14). Cesarean delivery for both fetal distress and nonprogressive labor occurred more among MAR pregnancies compared with SC pregnancies. Term singletons conceived after MAR have an increased risk of morbidity related to birth asphyxia. Because this is mainly due to maternal characteristics, obstetric caregivers should be aware that the increased rates of cesareans reflect the behavior of women and physicians rather than increased perinatal complications. Copyright © 2015 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Association between vaginal birth after cesarean delivery and primary cesarean delivery rates.

PubMed

Rosenstein, Melissa G; Kuppermann, Miriam; Gregorich, Steven E; Cottrell, Erika K; Caughey, Aaron B; Cheng, Yvonne W

2013-11-01

To estimate the association between vaginal birth after cesarean delivery (VBAC) rates and primary cesarean delivery rates in California hospitals. Hospital VBAC rates were calculated using birth certificate and discharge data from 2009, and hospitals were categorized by quartile of VBAC rate. Multivariable logistic regression analysis was performed to estimate the odds of cesarean delivery among low-risk nulliparous women with singleton pregnancies at term in vertex presentation (nulliparous term singleton vertex) by hospital VBAC quartile while controlling for many patient-level and hospital-level confounders. There were 468,789 term singleton births in California in 2009 at 255 hospitals, 125,471 of which were low-risk nulliparous term singleton vertex. Vaginal birth after cesarean delivery rates varied between hospitals, with a range of 0-44.6%. Rates of cesarean delivery among low-risk nulliparous term singleton vertex women declined significantly with increasing VBAC rate. When adjusted for maternal and hospital characteristics, low-risk nulliparous term singleton vertex women who gave birth in hospitals in the highest VBAC quartile had an odds ratio of 0.55 (95% confidence interval 0.46-0.66) of cesarean delivery compared with women at hospitals with the lowest VBAC rates. Each percentage point increase in a hospital's VBAC rate was associated with a 0.65% decrease in the low-risk nulliparous term singleton vertex cesarean delivery rate. Hospitals with higher rates of VBAC have lower rates of primary cesarean delivery among low-risk nulliparous women with singleton pregnancies at term in vertex presentation. II.

The effect of fetal sex on customized fetal growth charts.

PubMed

Rizzo, Giuseppe; Prefumo, Federico; Ferrazzi, Enrico; Zanardini, Cristina; Di Martino, Daniela; Boito, Simona; Aiello, Elisa; Ghi, Tullio

2016-12-01

To evaluate the effect of fetal sex on singleton pregnancy growth charts customized for parental characteristics, race, and parity Methods: In a multicentric cross-sectional study, 8070 ultrasonographic examinations from low-risk singleton pregnancies between 16 and 40 weeks of gestation were considered. The fetal measurements obtained were biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL). Quantile regression was used to examine the impact of fetal sex across the biometric percentiles of the fetal measurements considered together with parents' height, weight, parity, and race. Fetal gender resulted to be a significant covariate for BDP, HC, and AC with higher values for male fetuses (p ≤ 0.0009). Minimal differences were found among sexes for FL. Parity, maternal race, paternal height and maternal height, and weight resulted significantly related to the fetal biometric parameters considered independently from fetal gender. In this study, we constructed customized biometric growth charts for fetal sex, parental, and obstetrical characteristics using quantile regression. The use of gender-specific charts offers the advantage to define individualized normal ranges of fetal biometric parameters at each specific centile. This approach may improve the antenatal identification of abnormal fetal growth.

Perinatal Advantages and Disadvantages of Being Underweight before Pregnancy: A Population-Based Study.

PubMed

Trojner Bregar, Andreja; Blickstein, Isaac; Bržan Šimenc, Gabrijela; Janša, Vid; Verdenik, Ivan; Lučovnik, Miha; Tul, Nataša

2017-01-01

To evaluate the advantages and disadvantages of being underweight before pregnancy. Cohort study of a large population-based dataset of singleton births was used to compare maternal and neonatal outcomes of pre-gravid underweight body mass index (BMI <18.5 kg/m2) women with pre-gravid normal weight controls (BMI 18.5-24.9 kg/m2). A total of 10,995 pre-gravid underweight and 146,155 pre-gravid normal weight mothers were compared. The mean maternal age and gestational age were not different but lean mothers were significantly and more frequently primiparous, had a higher incidence of births at <36 and <32 weeks' gestation, and had a significantly higher incidence of low and very low birth weight infants. Lean mothers had a significantly lower incidence of birth weights >4,000 g, less cesarean births and a lower incidence of gestational diabetes and hypertensive disorders. A tradeoff exists between the advantages of being lean before pregnancy in terms of less maternal morbidity in return for gaining a more advanced gestational age and higher birth weight. © 2016 S. Karger AG, Basel.

Two consecutive twin and a singleton pregnancy in a patient with chronic myeloid leukemia.

PubMed

Halim, T A; Nabeel, N

2014-01-01

Consecutive multiple pregnancies with Chronic myeloid leukemia is a rare event and little is known about its prevalence and management with or without chemotherapy. We present a case of three consecutive pregnancies in a woman with CML, two of which were multiple pregnancies.

Mitral balloon valvuloplasty during pregnancy:The long term up to 17 years obstetric outcome and childhood development

PubMed Central

A, Gulraze; W, Kurdi; FA, Niaz; ME, Fawzy

2014-01-01

Background & Objectives : We report 17 years outcome of subsequent pregnancies of women with severe Mitral Stenosis (MS) who underwent Mitral Balloon Valvuloplasty (MBV) during pregnancy and the follow up of the children born of such pregnancies. Methods: Twenty three pregnant patients suffering from severe MS (NYHA-New York Heart Association class III/IV) who underwent MBV by Inoue balloon catheter technique during second trimester were enrolled. The study was performed between January 1992 and December 2008 at King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia, during which time, details about the obstetric outcome and childhood development were recorded. Mean follow up period was 10± 5.5 years (range 1-17 years). Results: MBV was successful in all patients with improvement in their NYHA class to I/II. All patients were followed until term and had uneventful course after MBV. Twenty two (95.6%) patients delivered 23 babies including a twin birth. These children exhibited normal growth and development according to their age. Nineteen patients had further pregnancies and gave birth to 38 live & healthy babies with one still birth and no unfavorable maternal outcome. Of these, 97.4% were singleton pregnancies while 2.6% were twin pregnancies. Spontaneous abortions were recorded in 21.5% and there was one still birth (2.5%) and one ectopic pregnancy (2.5%). Conclusion : Mitral Balloon Valvuloplasty is a safe and useful procedure during pregnancy, with no short or long term adverse affects on the mothers and their obstetric future. The children born of subsequent pregnancies exhibited normal physical and mental development. PMID:24639837

The placental factor in spontaneous preterm birth in twin vs. singleton pregnancies.

PubMed

Weiner, Eran; Dekalo, Ann; Feldstein, Ohad; Barber, Elad; Schreiber, Letizia; Bar, Jacob; Kovo, Michal

2017-07-01

The association between infection and inflammatory response in singleton preterm birth (PTB) is well established, yet, less is known about PTB in twins. We aimed to compare the placental component and pregnancy outcome in pregnancies complicated with PTB of singletons vs. twin deliveries. We hypothesized that due to different underlying mechanisms, placental inflammatory lesions will be more prevalent in placentas derived from singleton pregnancies than twins. Labor characteristics, neonatal outcome and placental histopathology reports of spontaneous PTB at 24-33 6 / 7 weeks, from 1/2008-12/2015, were reviewed. were compared between dichorionic-diamniotic twin deliveries (twins group) and singleton deliveries (singleton group) matched for gestational age. Excluded from the study medically indicated deliveries, due to preeclampsia or fetal growth restriction, and monochorionic twins. Placental lesions were classified to maternal vascular supply lesions, fetal vascular supply lesions, and maternal (MIR) and fetal (FIR) inflammatory responses. Composite neonatal outcome was defined as one or more of early complications: respiratory distress, necrotizing enterocolitis, sepsis, blood transfusion, ventilation, seizures, intra-ventricular hemorrhage, hypoglycemia, phototherapy, or death. The twins group (n=72) was characterized by higher maternal BMI (p=0.009), and higher rates of assisted reproductive techniques (56.2% vs. 17.8%, p<0.001) and cesarean deliveries (75.3% vs. 32.8%, p<0.001) as compared to the singleton group (n=72). Placentas from the singleton group were characterized by higher rate of MIR, 58.9% vs. 19.2%, (p<0.001), FIR, 31.5% vs. 3.4%, (p<0.001), retro-placental hemorrhage, 26% vs. 8.9% (p<0.001), and vascular lesions related to maternal malperfusion, 28.8% vs. 9.6%, (p<0.001), as compared to placentas from the twins group. Higher rate of neonatal sepsis was observed in the singleton group as compared to the twins group, 24.7% vs. 4.1%, p<0.001, respectively. By logistic regression analyses retro-placental hemorrhage, placental maternal vascular malperfusion lesions, MIR, FIR and neonatal sepsis were found to be independently associated with singleton PTB: aOR 3.4, 95% CI 2.1-6.9, p<0.001, aOR=3.1, 95% CI 1.8-7.2, p<0.001, aOR=2.9, 95% CI 1.4-7.8, p<0.001, aOR=4.9, 95% CI 2.3-6.9, p<0.001, and aOR=4.8, 95% CI 2.3-6.7, p<0.001 respectively. Placentas from singleton PTBs are characterized by higher rate of inflammatory and malperfusion lesions. The lack of these findings in twins PTBs suggests different factors that participate in the development of preterm birth in twins, such as over-distension of the uterus and up regulation of oxytocin receptors. Copyright © 2017 Elsevier B.V. All rights reserved.

Effect of individualised dietary education at medical check-ups on maternal and fetal outcomes in pregnant Japanese women.

PubMed

Tajirika-Shirai, Reiko; Takimoto, Hidemi; Yokoyama, Tetsuji; Kaneko, Hitoshi; Kubota, Toshiro; Miyasaka, Naoyuki

2018-01-01

An increased prevalence of low maternal weight and insufficient pregnancy weight gain may be responsible for an increase in low birthweight infants in Japan. We aimed to examine the effects of individualised dietary education at medical check-ups on maternal/fetal outcomes in Japanese women. Four hundred and six underweight and normal weight singleton pregnant women, who attended check-ups at an obstetric facility until ≥30 weeks gestation and delivered at 36-41 weeks gestation, were selected for analyses. Weight gain was assessed at each check-up based on the official "Dietary Guidelines for Pregnant and Lactating Women". Individual dietary advice was provided by dieticians to those with insufficient or excess weight gain status around 28 weeks gestation. The medical records from uncomplicated singleton deliveries (36-41 weeks gestation) at the same facility from 2008-2010 were used (n=792) to examine the effect of dietary education on maternal/fetal outcomes. Pre-pregnancy underweight was present in >24% of women in both the intervention and non-intervention groups. Adequate weight gain occurred more frequently in the intervention group (p<0.01). There were no significant differences in mean birthweight or the proportion of low birthweight infants. However, the proportion of extremely small for gestational age infants (birthweight <3rd percentile) was lower in the intervention group (p=0.011). There were no differences in the frequency of caesarean delivery, pregnancy induced hypertension, or infant Apgar scores <7. Dietary education during pregnancy check-ups promotes adequate maternal weight gain and helps prevent extreme fetal growth restraint.

[Reference ranges of gestational weight gain in Chinese population on the incidence of macrosomia: a multi-center cross-sectional survey].

PubMed

Liang, H; Zhang, W Y; Li, X T

2017-03-25

Objective: To investigate the influence of gestational weight gain (GWG) on the incidence of macrosomia, and to establish the reference ranges of GWG based on the incidence of macrosomia. Methods: A multicenter, cross-sectional study was conducted. Totally, 112 485 women were recruited from 39 hospitals in 14 provinces in China. Totally, 61 149 cases were eligible with singleton pregnancies and non-premature deliveries. The associations of pre-pregnancy body mass index (BMI), GWG, newborn gender and gestational diabetes with macrosomia were analyzed with logistic regression. The normal GWG ranges were calculated in all maternal BMI subgroups, based on the normal incidence of macrosomia was set as the range of 5.0% to 10.0%. Results: In this study, the incidence of macrosomia was 7.46% (4 563/611 149). The macrosociam was positive related with maternal height, delivery week, pre-pregnancy BMI, GWG, gestational diabetes, primipara, and male babies significantly ( P< 0.05), based on unadjusted and adjusted logestic regression. The normal range of GWG 20.0-25.0, 10.0-20.0, 0-10.0 and 0-5.0 kg in subgroups of underweight (pre-pregnancy BMI<18.5 kg/m(2)), normal (18.5-24.9 kg/m(2)), overweight (25.0-29.9 kg/m(2)) and obese (≥30.0 kg/m(2)), respectively. Conclusion: The reference range of GWG in China based on the incidence of macrosomia is established.

Nutritional status and dietary intake among pregnant women in relation to pre-pregnancy body mass index in Japan.

PubMed

Uno, Kaoru; Takemi, Yukari; Hayashi, Fumi; Hosokawa, Momo

2016-01-01

Objective The present study examined nutritional status and dietary intake of pregnant women in Japan in relation to pre-pregnancy body mass index (BMI).Methods Participants included 141 Japanese women with singleton pregnancies, from the outpatient department of the S hospital, Gunma prefecture, Japan. Two-day food records, dietary assessment questionnaires, and clinical records were obtained at 20 weeks gestation. Nine patients were excluded from the study due to morning sickness. The remaining 132 participants were divided into 3 groups according to pre-pregnancy BMI: underweight, normal weight, and overweight. Nutritional status and dietary intake were analyzed in relation to BMI using the chi-square test, Fisher's exact test, Kruskal-Wallis test, one-way analysis of variance, and analysis of covariance with adjustment for age, employment status, and total energy intake.Results Women who were underweight before pregnancy were more frequently working full-time than normal weight and overweight women. Underweight women were also more frequently anemic (P=0.038, underweight 39.3%, normal weight 24.7%, overweight 0%) and had lower mean hemoglobin (Hb) (P=0.021, underweight 11.3 g/dL, normal weight 11.6 g/dL, overweight 12.1 g/dL) and hematocrit (Hct) levels (P=0.025, underweight 33.7%, normal weight 34.3%, overweight 36.0%). Their dietary intake of protein, iron, magnesium, and folic acid was lower than that of normal weight and overweight women. Their meals tended to include fewer meat, fish, egg, and soybean dishes (underweight, mean of 4.7 servings per day; normal weight, 6.1 servings; overweight, 6.1 servings).Conclusion Pregnant women who were underweight before pregnancy had increased risk of anemia as well as reduced Hb and Hct levels. They had lower dietary intake of protein, iron and folic acid compared to women in the other BMI categories. Anemia and these nutrient deficiencies are known risk factors for low birth weight. Our findings suggest the importance of providing underweight pregnant women with support to improve dietary intake during their pregnancy, especially to increase intake of protein and iron through consumption of fish and meat dishes.

Linear and nonlinear features of fetal heart rate on the assessment of fetal development in the course of pregnancy and the impact of fetal gender.

PubMed

Spyridou, K; Chouvarda, I; Hadjileontiadis, L; Maglaveras, N

2018-01-30

This work aims to investigate the impact of gestational age and fetal gender on fetal heart rate (FHR) tracings. Different linear and nonlinear parameters indicating correlation or complexity were used to study the influence of fetal age and gender on FHR tracings. The signals were recorded from 99 normal pregnant women in a singleton pregnancy at gestational ages from 28 to 40 weeks, before the onset of labor. There were 56 female fetuses and 43 male. Analysis of FHR shows that the means as well as measures of irregularity of FHR, such as approximate entropy and algorithmic complexity, decrease as gestation progresses. There were also indications that mutual information and multiscale entropy were lower in male fetuses in early pregnancy. Fetal age and gender seem to influence FHR tracings. Taking this into consideration would improve the interpretation of FHR monitoring.

Observed Rate of Down Syndrome in Twin Pregnancies.

PubMed

Sparks, Teresa N; Norton, Mary E; Flessel, Monica; Goldman, Sara; Currier, Robert J

2016-11-01

To evaluate the observed incidence of Down syndrome in twins compared with that expected based on maternal age-matched singletons, which is the current clinical approach. This was a retrospective review of California Prenatal Screening Program participants with expected delivery dates between July 1995 and December 2012. Cases confirmed prenatally or postnatally with a genetic imbalance leading to phenotypic Down syndrome (trisomy 21, mosaic trisomy 21, or translocations) were included. Pregnancies conceived with ovum donation and women older than 45 years were excluded. We compared the observed Down syndrome incidence per pregnancy for twins with expected incidence by extrapolating from singleton data and expected zygosity as is the current clinical approach. This extrapolation assumes that monozygotic pregnancies have equivalent Down syndrome risk per pregnancy relative to maternal age-matched singletons and dizygotic pregnancies have twice the risk of at least one affected fetus. Zygosity for affected cases was presumed to be monozygotic with Down syndrome concordance and dizygotic with Down syndrome discordance. Counts were compared using cumulative Poisson distributions. Of 77,279 twin pregnancies, 182 (0.2%) had at least one fetus with Down syndrome confirmed by karyotype. The ratio of observed-to-expected Down syndrome incidence per pregnancy was 33.6%, 75.2%, and 70.0% for monozygotic, dizygotic, and all twins, respectively (P<.001 for all comparisons). Considering maternal age subgroups and twin zygosity, a significantly lower-than-expected Down syndrome incidence was seen for women aged 25 to 45 years with monozygotic pregnancies and overall for women aged 25 to 45 years with dizygotic pregnancies. The observed incidence of Down syndrome in twin pregnancies is lower than expected, most notably for monozygotic pregnancies and with increasing maternal age. Risk-based counseling can strongly affect women's choices regarding testing and management during pregnancy, so an understanding of the true Down syndrome risk in twin gestations is crucial.

Risk of Intrapartum Cervical Lacerations in Vaginal Singleton Deliveries in Women With Cerclage

PubMed Central

Suzuki, Shunji

2015-01-01

Background We examined the obstetric outcomes of singleton vaginal deliveries in women with cerclage at our institute to confirm the risk of intrapartum cervical lacerations in vaginal deliveries of women with cerclage. Methods Data on all Japanese singleton vaginal deliveries at ≥ 34 weeks’ gestation managed at the Japanese Red Cross Katsushika Maternity Hospital between 2008 and 2014 were collected. Results During the study period, cervical cerclage was performed in 95 of 9,490 (1.0%) women with singleton pregnancy at 12 - 22 weeks of singleton pregnancy who delivered at ≥ 34 weeks’ gestation. The incidence of intrapartum cervical lacerations and postpartum hemorrhage ≥ 1,000 mL in the women with cerclage were higher significantly than that in the women without cerclage (cervical lacerations: crude odds ratio (OR): 26.9, 95% confidence interval (CI): 14 - 51, P < 0.01; postpartum hemorrhage: crude OR: 2.86, 95% CI: 1.6 - 4.9, P < 0.01). Using a multivariate analysis, cerclage was independently associated with the increased incidence of intrapartum cervical lacerations (P < 0.01). Conclusions Cervical cerclage is an independent risk factor of intrapartum cervical lacerations in vaginal deliveries. PMID:26251687

Higher Prevalence of Left-Handedness in Twins? Not After Controlling Birth Time Confounders.

PubMed

Heikkilä, Kauko; Vuoksimaa, Eero; Saari-Kemppainen, Aulikki; Kaprio, Jaakko; Rose, Richard J; Haukka, Jari; Pitkäniemi, Janne; Iivanainen, Matti

2015-10-01

Pregnancy- and birth-related factors may have an effect on handedness. Compared with singletons, twins have a lower birth weight, shorter gestational age, and are at higher risk for birth complications. We tested whether the prevalence of left-handedness is higher among twins than singletons, and if so, whether that difference is fully explained by pregnancy and birth-related differences between twins and singletons. We analyzed Finnish population-based datasets; included were 8,786 twins and 5,892 singletons with information on birth weight (n = 12,381), Apgar scores (n = 11,129), and gestational age (n = 11,811). Two twin cohorts were involved: FinnTwin12 included twins born during 1983-1987, and FinnTwin16 included twins born during 1974-1979. We had two comparison groups of singletons: 4,101 individuals born during 1986-1988 and enrolled in the Helsinki Ultrasound Trial, and 1,791 individuals who were partners of FinnTwin16 twins. We used logistic regression models with writing hand as the outcome for comparison and evaluating effects of covariates. Left-handedness was more common in twins (9.67%) than in singletons (8.27%; p = .004). However, Apgar scores were associated with handedness, and after controlling for covariates, we found no difference in the prevalence of left-handedness between twins and singletons. Increased left-handedness among twins, often reported by others, was evident in our data, but only among our older twin cohorts, and that association disappeared after removing effects of perinatal covariates.

Reference range of fetal transverse cerebellar diameter between 18 and 24 weeks of pregnancy in a Brazilian population.

PubMed

Araujo Júnior, Edward; Martins, Wellington P; Nardozza, Luciano Marcondes Machado; Pires, Claudio Rodrigues; Filho, Sebastião Marques Zanforlin

2015-02-01

To determine a reference range of fetal transverse cerebellar diameter in Brazilian population. This was a retrospective cross-sectional study with 3772 normal singleton pregnancies between 18 and 24 weeks of pregnancy. The transverse cerebellar diameter was measured on the axial plane of the fetal head at the level of the lateral ventricles, including the thalamus, cavum septum pellucidum, and third ventricle. To assess the correlation between transverse cerebellar diameter and gestational age, polynomial equations were calculated, with adjustments by the determination coefficient (R2). The mean of fetal transverse cerebellar diameter ranged from 18.49 ± 1.24 mm at 18 weeks to 25.86 ± 1.66 mm at 24 weeks of pregnancy. We observed a good correlation between transverse cerebellar diameter and gestational age, which was best represented by a linear equation: transverse cerebellar diameter: -6.21 + 1.307*gestational age (R2 = 0.707). We determined a reference range of fetal transverse cerebellar diameter for the second trimester of pregnancy in Brazilian population. © The Author(s) 2014.

Polycystic ovary disease and the risk of pregnancy-induced hypertension.

PubMed

Kashyap, S; Claman, P

2000-12-01

To compare the incidence of pregnancy-induced hypertension in patients with and without polycystic ovary disease (PCOD). We conducted a retrospective, case-control analysis of patients who achieved singleton pregnancies with human menopausal gonadotropin (hMG) therapy. Twenty-two PCOD patients were compared to 27 infertility patients without PCOD who were pregnant after hMG therapy. Non-PCOD patients received hMG for superovulation as part of superovulation/intrauterine insemination or in vitro fertilization/embryo transfer. PCOD patients were receiving hMG for simple ovulation induction. Pregnancy-induced hypertension was defined as late pregnancy blood pressure > 140/90 mm Hg on two readings six hours apart and return to normal blood pressure by four to six weeks postpartum. There were no differences between PCOD and non-PCOD patients with reference to age, body mass index, parity or other pregnancy-induced hypertension risk factors (i.e., chronic hypertension, diabetes or chronic renal disease). Pregnant PCOD patients had a much higher incidence of pregnancy-induced hypertension, 31.8% (7/22), versus non-PCOD patients, who only had a pregnancy-induced hypertension incidence of 3.7% (1/27) (P = .016, OR = 12.1, 95% CI = 1.3-566.8). PCOD patients are at very high risk of pregnancy-induced hypertension when pregnant after ovulation induction.

Lying Down after Premature Rupture of the Membranes in Term Singleton Pregnancies: An Evidence-Based Recommendation?

PubMed

Portz, S; Schmidt, M; Weitz, M

2016-10-01

Objectives: In many countries pregnant women in term singleton pregnancies are advised by obstetricians and midwives to lie down immediately after rupture of membranes until engagement of the foetal head is confirmed. The horizontal positioning aims to prevent the prolapse of the umbilical cord. The objective of this systematic review is to assess the effects of the maternal lying down measure in term singleton pregnancies. Search methods: We searched the databases of MEDLINE/PubMed, EMBASE/Ovid and CENTRAL (Issue 10, 2015) from their inception until September 30 th , 2015. Additionally, we searched selected trial registers, the reference lists of potentially relevant studies and national and international obstetrical clinical guidelines. All types of studies without language restriction were selected. Main results: One retrospective study was found. Only one woman with a term singleton pregnancy had the event of an umbilical cord prolapse following premature rupture of membranes (0.008%). The study did not report on the presence of an engaged foetal head in this woman. Conclusions and implications: Recommendations cannot be made in favour or against the lying down positioning based solely on the single identified study. For that reason, the widespread recommendation given by obstetricians and midwives should be critically reassessed. Also, induction of maternal anxiety and increased costs to the healthcare system following transportation to the delivery unit have to be considered in the light of the given minimal risk of umbilical cord prolapse in conjuncture with lacking evidence for the utility of the common recommendation. © Georg Thieme Verlag KG Stuttgart · New York.

Mineral Metabolism in Singleton and Twin-pregnant Dairy Goats

PubMed Central

Härter, C. J.; Castagnino, D. S.; Rivera, A. R.; Lima, L. D.; Silva, H. G. O.; Mendonça, A. N.; Bonfim, G. F.; Liesegang, A.; St-Pierre, N.; Teixeira, I. A. M. A.

2015-01-01

During pregnancy, the maternal body undergoes significant physiological changes. The present study assessed the changes on calcium (Ca), phosphorus (P), magnesium (Mg), sodium (Na) and potassium (K) metabolism in singleton and twin-pregnant dairy goats. The 42 goats used (49.5 kg±7.6 body weight [BW]) were assigned at random to treatments that were factorially arranged to account for 2 breeds (Oberhasli and Saanen), 2 pregnancy types (singleton and twin) and 3 gestation periods (80, 110, and 140 days). Digestibility trials were performed at 80, 110, and 140 days of gestation. Mineral retention during pregnancy was determined in the maternal body, femur, uterus, mammary gland, fetus and fetal fluid. Blood samples were taken during pregnancy before and after a meal, and Ca, P, Mg, Na, K ions and alkaline phosphatase activity determined in serum. Bone mineral density was determined in the right femur. Statistical analyses were performed using the SAS MIXED procedure. Dry matter intake decreased linearly up to 140 days of gestation. Maternal BW gain, and Ca, P, and Mg retention (g/kg) decreased linearly with the advance of gestation days. Macromineral retention in maternal body (g/kg) was greater in Oberhasli than Saanen goats, and their fetuses had higher Ca, P, and Mg deposition (mg/g). Mineral retention (mg/g) increased in fetuses according to pregnancy development, with no differences between singleton and twin pregnancy. In the mammary gland, the retention of all minerals (g) increased with the days of pregnancy. In conclusion, related to Ca, P, and Mg metabolism can be divided into two stages. Up to 80 days of gestation, was characterized by the preparation of the maternal body reserves for future mineral demands. From 80 days of gestation onward, was characterized by the transfer of maternal body reserves for fetal development and colostrum production. Na and K supply was provided by adjustments in endogenous excretion and an increase in intestinal absorption. Finally, mineral metabolism was specific to each genotype and, except for Na, was not affected by the number of fetuses. PMID:25557674

Assessment of foetal wellbeing in pregnant women subjected to pelvic floor muscle training: a controlled randomised study.

PubMed

Okido, Marcos Massaru; Valeri, Fabiana Lellis; Martins, Wellington Paula; Ferreira, Cristine Homsi Jorge; Duarte, Geraldo; Cavalli, Ricardo Carvalho

2015-10-01

The objective was to assess foetal wellbeing in pregnant women subjected to pelvic floor muscle training (PFMT) by evaluating the acute and chronic effects of the procedure using the Doppler method. Ninety-six primigravidae with singleton pregnancies and at a low risk of pregnancy complications were randomised to either intervention with PFMT or no intervention. The final analysis included 26 women in the intervention group and 33 in the control group. Women from the intervention group were subjected to a daily PFMT program. Evidence of possible foetal risk was assessed by Doppler and the control group received standard care. The protocol was conducted from 20 to 36 weeks' gestation. The pulsatility indices (PI) of the uterine, umbilical and middle cerebral arteries were determined at 28, 32 and 36 weeks' gestation. The acute effects were determined by comparing the values obtained before and after exercise in the group subjected to PFMT and the chronic effects were determined by comparing the resting values of the trained group with those of the control group. The results obtained showed normal values for the three gestational ages in both groups, with no difference between groups. Comparison before and after exercise showed a significant decline in the PI of uterine artery at 36 weeks without changes in the flow of umbilical and middle cerebral arteries. Pelvic floor muscle training in low-risk primigravidae with singleton pregnancies was associated with a significant decline in PI of the uterine artery after exercise, while no significant changes in the flow of the middle cerebral and umbilical arteries were found. The PFMT may be recommended to women as a first-line measure to prevent of urinary incontinence during pregnancy.

Polyhydramnios or Excessive Fetal Growth Are Markers for Abnormal Perinatal Outcome in Euglycemic Pregnancies.

PubMed

Crimmins, Sarah; Mo, Cecilia; Nassar, Yomna; Kopelman, Jerome N; Turan, Ozhan M

2018-01-01

 This study aims to investigate the perinatal outcome of fetuses with polyhydramnios and/or accelerated growth among women with a normal oral glucose challenge test (oGCT).  Singleton, nonanomalous pregnancies with an oGCT(< 130 mg/dL) at 24 to 28 weeks, who subsequently demonstrate polyhydramnios (amniotic fluid index > 24 cm or maximum vertical pocket > 8 cm) and/or accelerated growth (abdominal circumference > 95th percentile) on two-third trimester examinations were studied. Maternal demographics, delivery, and neonatal information were recorded. Cases were compared with a reference group (normal oGCT with neither abnormal third-trimester growth nor polyhydramnios).  A total of 282 pregnancies were in the study group, and 663 were in the reference group. Deliveries in the study group were at a higher risk for birth weight (BW)% > 90%, standard deviation, and postpartum hemorrhage when compared with the reference group (adjusted odds ratio: 2.3-5.6). Pregnancies complicated by both polyhydramnios and accelerated fetal growth were significantly more likely to result in a BW% > 90% (odds ratio [OR]: 18.5; 95% confidence interval [CI]: 8.9-38.6) and PPH (OR: 4.2; 95% CI: 2.4-7.6).  Pregnancies with normal oGCT that develop polyhydramnios and accelerated growth are at higher risk for maternal and neonatal complications. Isolated polyhydramnios without accelerated growth increases the risk for delivery complications but not neonatal morbidity. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Circulating Angiogenic Factors and the Risk of Preeclampsia in Systemic Lupus Erythematosus Pregnancies.

PubMed

Leaños-Miranda, Alfredo; Campos-Galicia, Inova; Berumen-Lechuga, María Guadalupe; Molina-Pérez, Carlos José; García-Paleta, Yolanda; Isordia-Salas, Irma; Ramírez-Valenzuela, Karla Leticia

2015-07-01

To investigate whether angiogenic factors are associated with risk of developing preeclampsia in pregnant women with systemic lupus erythematosus (SLE). We performed a nested case-control study within a cohort of SLE women with singleton pregnancies. The study included 42 patients with SLE who eventually developed preeclampsia and 75 normal SLE pregnancies. Serum samples were collected at 4-week intervals (from weeks 12 to 36). Serum samples were analyzed for soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF), and soluble endoglin (sEng). Women destined to develop preeclampsia had lower PlGF levels and higher sFlt-1 and sEng levels, and a higher sFlt-1/PlGF ratio than normal pregnancies. These changes became significant at 12 weeks in patients destined to develop either early onset (< 34 weeks, p ≤ 0.003) or late-onset preeclampsia (≥ 34 weeks, p ≤ 0.02). The risk to develop preeclampsia was higher among patients with PlGF concentration values in the lowest quartile or with sFlt-1 and sEng levels, and sFlt-1/PlGF ratio, in the highest quartile of the normal SLE pregnancies distribution. The OR were higher and appeared earlier in patients destined to develop early onset preeclampsia (OR ≥ 16.2, from Week 12 onward) than in patients who presented preeclampsia later (OR ≥ 8.9, from Week 24 onward). Changes in circulating concentrations of sFlt-1, PlGF, sEng, and the sFlt-1/PlGF ratio precede the onset of preeclampsia in SLE pregnancies. The risk profile of circulating angiogenic factors for developing preeclampsia distinctly evolves depending on whether this condition is manifested earlier or later.

A clinical opinion on how to manage the risk of preterm birth in twins based on literature review.

PubMed

Collins, Anna; Shennan, Andrew

2016-01-01

Twin pregnancies are prone to preterm birth and consequent morbidity. There is an increasing evidence base concerning the prediction and prevention of preterm birth in singletons, including the reduction of morbidity with therapies such as magnesium sulphate and antenatal corticosteroids. However, the research in twins is less clear, partly due to fewer numbers being investigated, but also evidence is largely based on twins without a previous history. Prophylactic interventions such as cerclage, progesterone and vaginal pessaries are increasingly showing benefit in singleton pregnancies with a prior history and when the cervix is short. Cerclage in twins has not been adequately researched in women with previous preterm birth, and as with singletons should not be used on the basis of a short cervix alone. Vaginal progesterone does not work in twins, but its value in high-risk twins, with a prior history and short cervix is uncertain. The vaginal pessary may be valuable in the twin with a short cervix. Currently, it is reasonable to extrapolate some of the evidence from singletons to twins, e.g. with antenatal corticosteroids and magnesium sulphate. Cerclage, vaginal pessaries and progesterone should not be routinely used in twin pregnancies without an additional high-risk factor such as prior history of preterm birth or short cervix, until further evidence is obtained.

Pregnancy outcomes among women with beta-thalassemia trait.

PubMed

Charoenboon, Chitrakan; Jatavan, Phudit; Traisrisilp, Kuntharee; Tongsong, Theera

2016-04-01

To compare the obstetric outcomes between pregnant women affected by beta-thalassemia trait and normal controls. A retrospective cohort study was conducted on singleton pregnant women complicated by beta-thalassemia trait and normal controls, randomly selected with the controls-to-case ratio of 2:1. All were low-risk pregnancies without underlying medical diseases and fetal anomalies. The pregnancies undergoing invasive prenatal diagnosis were excluded. A total of 597 pregnant women with beta-thalassemia trait and 1194 controls were recruited. Baseline characteristics and maternal outcomes in the two groups were similar, except that hemoglobin levels were slightly lower in the study group. The prevalence of small for gestational age and preterm birth tended to be higher in the study group but not reached the significant levels but the rate of low birth weight was significantly higher in the study group (relative risk 1.25; 95 % CI 1.00-1.57). Additionally, abortion rate was also significantly higher in the study group (relative risk 3.25; 95 % CI 1.35-7.80). Beta-thalassemia trait could minimally, but significantly, increase risk of low birth weight but did not increase rates of maternal adverse outcomes.

Perinatal outcomes in uncomplicated late preterm pregnancies with borderline oligohydramnios.

PubMed

Sahin, Erdem; Madendag, Yusuf; Tayyar, Ahter Tanay; Sahin, Mefkure Eraslan; Col Madendag, Ilknur; Acmaz, Gokhan; Unsal, Deniz; Senol, Vesile

2017-08-16

The purpose of this study is to determine the adverse perinatal outcomes in uncomplicated late preterm pregnancies with borderline oligohydramnios. A total of 430 pregnant women with an uncomplicated singleton pregnancy at a gestational age of 34 + 0-36 + 6 weeks were included. Borderline oligohydramnios was defined as an amniotic fluid index (AFI) of 5.1-8 cm, which was measured using the four-quadrant technique. Adverse perinatal outcomes were compared between the borderline and normal AFI groups. Approximately 107 of the 430 pregnant women were borderline AFI, and 323 were normal AFI. The demographic and obstetric characteristics were similar in both groups. Delivery <37 weeks, cesarean delivery for non-reassuring fetal heart-rate testing, meconium-stained amniotic fluid, Apgar 5 min <7, transient tachypnea of the newborn, respiratory distress syndrome, neonatal intensive care unit, and hyperbilirubinemia were not statistically different between the groups (p = .054, p = .134, p = .749, p = 0.858, p = .703, p = .320, p = .185, and p = .996, respectively). Although gestational age was full-term, induction of labor rates were significantly higher in the borderline AFI group (p = .040). In addition, fetal renal artery pulsatility index pulsatility index (PI) was significantly lower in the borderline AFI group than in the normal AFI group (p = .014). Our results indicated that borderline AFI was not a risk for adverse perinatal outcomes in uncomplicated, late preterm pregnancies.

Obstetric consequences of subfertility: a retrospective cohort study.

PubMed

DoPierala, A L; Bhatta, S; Raja, E A; Bhattacharya, S; Bhattacharya, S

2016-07-01

To compare the risk of adverse pregnancy outcomes in women with and without subfertility and to investigate whether fertility treatment contributes to the adverse outcomes. Register-based retrospective cohort study. Aberdeen, Scotland The exposed group included women with subfertility attending Aberdeen Fertility Clinic between 1989 and 2008 and delivering a singleton (n = 3188) or twin (n = 350) at Aberdeen Maternity Hospital between 1992 and 2009. The unexposed cohort included the remainder of women (singleton n = 52443, twin n = 1125) delivering at Aberdeen Maternity Hospital between 1992 and 2009. The Aberdeen Fertility Centre database and Aberdeen Maternity and Neonatal Databank were linked using Community Health Index numbers. Regression models were used to calculate risk ratios and 95% confidence intervals adjusting for potential confounders. Maternal outcomes including pre-eclampsia, antepartum haemorrhage, preterm birth, induction of labour; delivery outcomes including operative vaginal delivery, caesarean section; and offspring outcomes including low birthweight, stillbirth and neonatal death. Women with a history of subfertility who delivered a singleton were at a higher risk of pre-eclampsia [adjusted risk ratios (aRR) 1.18, 95% confidence intervals (CI) 1.02-1.37], antepartum haemorrhage (aRR 1.32, 95% CI 1.18-1.47), induction of labour (aRR 1.21, 95% CI 1.11-1.31) and very preterm delivery (<32 weeks) (aRR 1.96, 95% CI 1.53-2.49). Subfertile women delivering twins were at a higher risk of being delivered by emergency caesarean section (aRR 2.14, 95% CI 1.26-3.66). There were no significant differences in adverse outcomes for singleton pregnancies between the treated and untreated subfertile couples. Subfertility per se, rather than fertility treatment, was associated with increased risk of adverse outcomes in singleton pregnancies. Large cohort study found higher incidence of adverse outcome in subfertile women having singletons or twins. © 2015 Royal College of Obstetricians and Gynaecologists.

[Characteristics of pregnancy and delivery of fetuses affected by either central nervous system malformations or chromosomal abnormalities].

PubMed

Friedler, Jordana Mashiach; Mazor, Moshe; Shoham-Vardi, Ilana; Bashiri, Asher

2011-11-01

To determine whether fetuses affected by either chromosomal abnormalities or central nervous system (CNS) malformations are prone to complications during pregnancy and delivery. In this study, 320 singleton pregnancies with CNS malformations and 133 singleton pregnancies with chromosomal abnormaLities were compared with 149,112 singleton births without any known congenital anomalies. Exclusion criteria were: births with other congenital anomalies or malformations, pregnancies Lacking prenatal care and multiple pregnancies. Data was obtained using the computerized birth discharge records. The statistical analysis was performed with the SPSS package. There were no statistically significant differences in maternal age, ethnicity, uterine anomalies or parity. The ratio of general anesthesia was almost double in the study groups compared to the control group: 25% in the CNS malformation group (RR 2.617, CI 2.031-3.372) and 25.6% in the chromosomal abnormality group (RR 2.696, CI 1.825-3.982) and 11.3% in the control group (p < 0.001). There were nearly double cesarean sections (CS) rates in both study groups: 21.5% in the CNS malformation group, 20.3% in the chromosomal abnormaLity group and 12% in the control group. A logistic regression model that included previous CS, maLpresentation, non-reassuring fetal heart monitor (NRFHR) and presence of a malformation, concluded that the presence of a malformation was not an independent risk factor for CS. However, indirect causes, such as malpresentation (4.34 OR), were independently associated with the malformations. Fetuses affected by either CNS malformations or chromosomal abnormalities have a higher rate of pregnancy and delivery complications, including those which increase the risk of maternal morbidity and mortality.

Perinatal outcomes after natural conception versus in vitro fertilization (IVF) in gestational surrogates: a model to evaluate IVF treatment versus maternal effects.

PubMed

Woo, Irene; Hindoyan, Rita; Landay, Melanie; Ho, Jacqueline; Ingles, Sue Ann; McGinnis, Lynda K; Paulson, Richard J; Chung, Karine

2017-12-01

To study the perinatal outcomes between singleton live births achieved with the use of commissioned versus spontaneously conceived embryos carried by the same gestational surrogate. Retrospective cohort study. Academic in vitro fertilization center. Gestational surrogate. None. Pregnancy outcome, gestational age at birth, birth weight, perinatal complications. We identified 124 gestational surrogates who achieved a total of 494 pregnancies. Pregnancy outcomes for surrogate and spontaneous pregnancies were significantly different (P<.001), with surrogate pregnancies more likely to result in twin pregnancies: 33% vs. 1%. Miscarriage and ectopic rates were similar. Of these pregnancies, there were 352 singleton live births: 103 achieved from commissioned embryos and 249 conceived spontaneously. Surrogate births had lower mean gestational age at delivery (38.8 ± 2.1 vs. 39.7 ± 1.4), higher rates of preterm birth (10.7% vs. 3.1%), and higher rates of low birth weight (7.8% vs. 2.4%). Neonates from surrogacy had birth weights that were, on average, 105 g lower. Surrogate births had significantly higher obstetrical complications, including gestational diabetes, hypertension, use of amniocentesis, placenta previa, antibiotic requirement during labor, and cesarean section. Neonates born from commissioned embryos and carried by gestational surrogates have increased adverse perinatal outcomes, including preterm birth, low birth weight, hypertension, maternal gestational diabetes, and placenta previa, compared with singletons conceived spontaneously and carried by the same woman. Our data suggest that assisted reproductive procedures may potentially affect embryo quality and that its negative impact can not be overcome even with a proven healthy uterine environment. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Human Uterine Wall Tension Trajectories and the Onset of Parturition

PubMed Central

Sokolowski, Peter; Saison, Francis; Giles, Warwick; McGrath, Shaun; Smith, David; Smith, Julia; Smith, Roger

2010-01-01

Uterine wall tension is thought to be an important determinant of the onset of labor in pregnant women. We characterize human uterine wall tension using ultrasound from the second trimester of pregnancy until parturition and compare preterm, term and twin pregnancies. A total of 320 pregnant women were followed from first antenatal visit to delivery during the period 2000–2004 at the John Hunter Hospital, NSW, Australia. The uterine wall thickness, length, anterior-posterior diameter and transverse diameter were determined by serial ultrasounds. Subjects were divided into three groups: women with singleton pregnancies and spontaneous labor onset, either preterm or term and women with twin pregnancies. Intrauterine pressure results from the literature were combined with our data to form trajectories for uterine wall thickness, volume and tension for each woman using the prolate ellipsoid method and the groups were compared at 20, 25 and 30 weeks gestation. Uterine wall tension followed an exponential curve, with results increasing throughout pregnancy with the site of maximum tension on the anterior wall. For those delivering preterm, uterine wall thickness was increased compared with term. For twin pregnancies intrauterine volume was increased compared to singletons (), but wall thickness was not. There was no evidence for increased tension in those delivering preterm or those with twin gestations. These data are not consistent with a role for high uterine wall tension as a causal factor in preterm spontaneous labor in singleton or twin gestations. It seems likely that hormonal differences in multiple gestations are responsible for increased rates of preterm birth in this group rather than increased tension. PMID:20585649

Early Malnutrition and Child Neurobehavioral Development: Insights from the Study of Children of Diabetic Mothers.

ERIC Educational Resources Information Center

Rizzo, Thomas A.; And Others

1997-01-01

Studied whether disturbances in mothers' metabolism (N=139) during pregnancy may exert long-range effects on neurobehavioral development of singleton progeny. Examined detailed pregnancy and perinatal records of mothers who experienced diabetes in pregnancy and intelligence tests of their offspring, administered at ages 7 to 11 years. All…

Maternal age and preterm births in singleton and twin pregnancies conceived by in vitro fertilisation in the United States.

PubMed

Xiong, Xu; Dickey, Richard P; Pridjian, Gabriella; Buekens, Pierre

2015-01-01

Among natural conceptions, advanced maternal age (≥ 35 years) is associated with an increased risk of preterm birth. However, few studies have specifically examined this association in births resulting from in vitro fertilisation (IVF). A retrospective cohort study was conducted in 97288 singleton and 40961 twin pregnancies resulting from fresh non-donor IVF cycles using 2006-10 data from the Society for Assisted Reproductive Technology Clinic Online Reporting System. Rates of very early preterm (<28), early preterm (<32), and preterm birth (<37 completed weeks) decreased with increasing maternal age in both singleton and twin births (PTrend <0.01). With women aged 30-34 years as the reference, those aged <30 years were at an increased risk of all types of preterm births. The adjusted odd ratio (95% confidence interval [CI]) for very early preterm birth, early preterm birth, and preterm birth in women aged 25-29 years were 1.3 [95% CI 1.1, 1.5], 1.2 [95% CI 1.1, 1.4], and 1.1 [95% CI 1.02, 1.2] in singletons. This increased risk of preterm births among younger women was even more significant in twin births. However, women aged ≥ 35 years were not at an increased risk of any type of preterm births in both singleton and twin births. In contrast to natural conception, advanced maternal age is not associated with an increased risk of preterm births in pregnancies conceived by IVF. Women who seek IVF treatments before 30 years old are at higher risk of all stages of preterm births. © 2014 John Wiley & Sons Ltd.

Embryo cryopreservation and preeclampsia risk.

PubMed

Sites, Cynthia K; Wilson, Donna; Barsky, Maya; Bernson, Dana; Bernstein, Ira M; Boulet, Sheree; Zhang, Yujia

2017-11-01

To determine whether assisted reproductive technology (ART) cycles involving cryopreserved-warmed embryos are associated with the development of preeclampsia. Retrospective cohort study. IVF clinics and hospitals. A total of 15,937 births from ART: 9,417 singleton and 6,520 twin. We used linked ART surveillance, birth certificate, and maternal hospitalization discharge data, considering resident singleton and twin births from autologous or donor eggs from 2005-2010. We compared the frequency of preeclampsia diagnosis for cryopreserved-warmed versus fresh ET and used multivariable logistic regression to adjust for confounders. Among pregnancies conceived with autologous eggs resulting in singletons, preeclampsia was greater after cryopreserved-warmed versus fresh ET (7.51% vs. 4.29%, adjusted odds ratio = 2.17 [95% CI 1.67-2.82]). Preeclampsia without and with severe features, preeclampsia with preterm delivery, and chronic hypertension with superimposed preeclampsia were more frequent after cryopreserved-warmed versus fresh ET (3.99% vs. 2.55%; 2.95% vs. 1.41%; 2.76 vs. 1.48%; and 0.95% vs. 0.43%, respectively). Among pregnancies from autologous eggs resulting in twins, the frequency of preeclampsia with severe features (9.26% vs. 5.70%) and preeclampsia with preterm delivery (14.81% vs. 11.74%) was higher after cryopreserved versus fresh transfers. Among donor egg pregnancies, rates of preeclampsia did not differ significantly between cryopreserved-warmed and fresh ET (10.78% vs. 12.13% for singletons and 28.0% vs. 25.15% for twins). Among ART pregnancies conceived using autologous eggs resulting in live births, those involving transfer of cryopreserved-warmed embryos, as compared with fresh ETs, had increased risk for preeclampsia with severe features and preeclampsia with preterm delivery. Copyright © 2017 American Society for Reproductive Medicine. All rights reserved.

Excessive urinary tract dilatation and proteinuria in pregnancy: a common and overlooked association?

PubMed

Piccoli, Giorgina B; Attini, Rossella; Parisi, Silvia; Vigotti, Federica N; Daidola, Germana; Deagostini, Maria Chiara; Ferraresi, Martina; De Pascale, Agostino; Porpiglia, Francesco; Veltri, Andrea; Todros, Tullia

2013-02-27

Proteinuria and dilatation of the urinary tract are both relatively common in pregnancy, the latter with a spectrum of symptoms, from none to severe pain and infection. Proteinuria is a rare occurrence in acute obstructive nephropathy; it has been reported in pregnancy, where it may pose a challenging differential diagnosis with pre-eclampsia.The aim of the present study is to report on the incidence of proteinuria (≥ 0.3; ≥ 0.5 g/day) in association with symptomatic-severe urinary tract dilatation in pregnancy. Case series. Nephrological-Obstetric Unit dedicated to pregnancy and kidney diseases (January 2000-April 2011). database prospectively updated since the start of the Unit. Retrospective review of clinical charts identified as relevant on the database, by a nephrologist and an obstetrician. From January 2000 to April 2011, 262 pregnancies were referred. Urinary tract dilatation with or without infection was the main cause of referral in 26 cases (predominantly monolateral in 19 cases): 23 singletons, 1 lost to follow-up, 1 twin and 1 triplet. Patients were referred for urinary tract infection (15 cases) and/or renal pain (10 cases); 6 patients were treated by urologic interventions ("JJ" stenting). Among them, 11 singletons and 1 triple pregnancy developed proteinuria ≥ 0.3 g/day (46.1%). Proteinuria was ≥ 0.5 g/day in 6 singletons (23.1%). Proteinuria resolved after delivery in all cases. No patient developed hypertension; in none was an alternative cause of proteinuria evident. No significant demographic difference was observed in patients with renal dilatation who developed proteinuria versus those who did not. An association with the presence of "JJ" stenting was present (5/6 cases with proteinuria ≥ 0.5 g/day), which may reflect both severer obstruction and a role for vescico-ureteral reflux, induced by the stent. Symptomatic urinary tract dilatation may be associated with proteinuria in pregnancy. This association should be kept in mind in the differential diagnosis with other causes of proteinuria in pregnancy, including pre-eclampsia.

A weight-gain-for-gestational-age z score chart for the assessment of maternal weight gain in pregnancy.

PubMed

Hutcheon, Jennifer A; Platt, Robert W; Abrams, Barbara; Himes, Katherine P; Simhan, Hyagriv N; Bodnar, Lisa M

2013-05-01

To establish the unbiased relation between maternal weight gain in pregnancy and perinatal health, a classification for maternal weight gain is needed that is uncorrelated with gestational age. The goal of this study was to create a weight-gain-for-gestational-age percentile and z score chart to describe the mean, SD, and selected percentiles of maternal weight gain throughout pregnancy in a contemporary cohort of US women. The study population was drawn from normal-weight women with uncomplicated, singleton pregnancies who delivered at the Magee-Womens Hospital in Pittsburgh, PA, 1998-2008. Analyses were based on a randomly selected subset of 648 women for whom serial prenatal weight measurements were available through medical chart record abstraction (6727 weight measurements). The pattern of maternal weight gain throughout gestation was estimated by using a random-effects regression model. The estimates were used to create a chart with the smoothed means, percentiles, and SDs of gestational weight gain for each week of pregnancy. This chart allows researchers to express total weight gain as an age-standardized z score, which can be used in epidemiologic analyses to study the association between pregnancy weight gain and adverse or physiologic pregnancy outcomes independent of gestational age.

Distribution and predictors of exercise habits among pregnant women in the Danish National Birth Cohort.

PubMed

Juhl, M; Madsen, M; Andersen, A-M N; Andersen, P K; Olsen, J

2012-02-01

Physical activity is recommended during pregnancy, although strong evidence on reproductive health is lacking. We present exercise habits and predictors of exercise during pregnancy. From the Danish National Birth Cohort (1996-2002), 88,200 singleton pregnancies were analyzed in logistic regression. About one-third of the women exercised in early/mid pregnancy and slightly less in late pregnancy. Bicycling, swimming, and low-impact activities were most common. Exercising more than three times per week was strongly correlated with older age, being a student or out of work, eating disorders, moderate alcohol consumption, and a healthy diet. Multiparity, a normal or less good self-rated health, smoking, and a less health conscious diet were the strongest predictors of not doing exercise. Women of 25 years or older, with metabolic or psychiatric disorders, or who had received subfecundity treatment were more likely to increase their activity level substantially from early to late pregnancy than comparison groups. In conclusion, exercising during pregnancy correlated with a number of maternal characteristics. The findings may be used to identify pregnant women not likely to exercise, to target activities that may fit their needs, and, for research purposes, to identify adjustment variables or guide sensitivity analyses when data on confounders are lacking. © 2010 John Wiley & Sons A/S.

Dichorionic triamniotic triplet pregnancy complicated by twin anemia polycythemia sequence: the place of fetal therapy.

PubMed

Griersmith, Thérèse H; Fung, Alison M; Walker, Susan P

2014-12-01

Monochorionic twins as part of a high order multiple pregnancy can be an unintended consequence of the increasingly common practice of blastocyst transfer for couples requiring in vitro fertilisation (IVF) for infertility. Dichorionic triamniotic (DCTA) triplets is the most common presentation, and these pregnancies are particularly high risk because of the additional risks associated with monochorionicity. Surveillance for twin-to-twin transfusion syndrome, including twin anemia polycythemia sequence, may be more difficult, and any intervention to treat the monochorionic pair needs to balance the proposed benefits against the risks posed to the unaffected singleton. Counseling of families with DCTA triplets is therefore complex. Here, we report a case of DCTA triplets, where the pregnancy was complicated by threatened preterm labour, and twin anemia polycythemia sequence (TAPS) was later diagnosed at 28 weeks. The TAPS was managed with a single intraperitoneal transfusion, enabling safe prolongation of the pregnancy for over 2 weeks until recurrence of TAPS and preterm labour supervened. Postnatal TAPS was confirmed, and all three infants were later discharged home at term corrected age, and were normal at follow-up. This case highlights that in utero therapy has an important role in multiple pregnancies of mixed chorionicity, and can achieve safe prolongation of pregnancy at critical gestations.

Recall of Prenatal Counselling Among Obese and Overweight Women from a Canadian Population: A Population Based Study.

PubMed

Vinturache, Angela E; Winn, Anika; Tough, Suzanne C

2017-11-01

Objective The objective of this study was to evaluate the recall of prenatal counselling received among overweight and obese women in primary care settings. Methods A sample of 1996 women with singleton, term deliveries and pre-pregnancy BMI >18.5 kg/m 2 were identified from the All Our Babies pregnancy cohort. Information on socio-demographic characteristics and women's experiences with prenatal counselling on nutrition, vitamin and mineral supplements, exercise, weight gain, employment, alcohol and drug use, and smoking during pregnancy were collected through questionnaires administered at <25 weeks and 34-36 weeks gestation. Multivariable logistic regression analyses explored the associations between pre-pregnancy BMI and the domains of prenatal counselling, controlling for confounders. Results Women reported high levels of comfort asking questions and satisfaction with their health care provider. Women reported getting information about nutrition (69.3%), weight gain (67.8%), exercise (64.4%), vitamins and minerals supplementation (86.1%). Obese women (211, 10.6%) were more likely than normal weight women (1313, 65.8%) to be Caucasian (p = 0.004), less educated (p = 0.001), and to have been born or lived in Canada for at least 5 years (p = 0.01). There was no difference in the prenatal advice received on nutrition, weight gain and exercise in pregnancy between obese, overweight, and normal weight women. Conclusions for Practice Pre-pregnancy BMI did not appear to influence the recall of prenatal counselling women receive in community health care centers. Given the importance of nutrition and weight gain during pregnancy, and guidelines for weight gain based on pre-pregnancy BMI, there are missed opportunities in knowledge exchange between women and providers in the prenatal period.

Concurrent levels of maternal salivary cortisol are unrelated to self-reported psychological measures in low-risk pregnant women

PubMed Central

VOEGTLINE, Kristin M.; COSTIGAN, Kathleen A.; KIVLIGHAN, Katie T.; LAUDENSLAGER, Mark L.; HENDERSON, Janice L.; DIPIETRO, Janet A.

2013-01-01

Associations between salivary cortisol and maternal psychological distress and well-being were examined prospectively on 112 women with normally progressing, singleton pregnancies between 24 and 38 weeks gestation. At each of 5 visits, conducted in 3-week intervals, women provided a saliva sample and completed questionnaires measuring trait anxiety, depressive symptoms, pregnancy-specific hassles and uplifts, and psychological well-being. Maternal salivary cortisol was unrelated to psychological measures with the exception of minor associations detected with measures of anxiety and depressive symptoms between 30 and 32 weeks only. Findings indicate that self-reported maternal psychological distress and well-being are not associated with significant variation in maternal salivary cortisol levels during the second half of gestation. This suggests that studies that measure psychological factors in pregnancy but do not measure maternal cortisol should exercise caution in assuming activation of the maternal hypothalamic-pituitary-adrenal (HPA) axis is the mechanism through which maternal psychological factors are transduced to the fetus. PMID:23269500

Placental disease and abnormal umbilical artery Doppler waveforms in trisomy 21 pregnancy: A case-control study.

PubMed

Corry, Edward; Mone, Fionnuala; Segurado, Ricardo; Downey, Paul; McParland, Peter; McAuliffe, Fionnuala M; Mooney, Eoghan E

2016-11-01

The objectives of this study were firstly to determine the proportion of placental pathology in fetuses affected by trisomy 21 (T21) using current pathological descriptive terminology and secondly to examine if a correlation existed between the finding of an abnormal umbilical artery Doppler (UAD) waveform, the presence of T21 and defined placental pathological categories. This case-control study assessed singleton fetuses with karyotypically confirmed trisomy 21 where placental histopathology had been conducted from 2003 to 2015 inclusive, within a university tertiary obstetric centre. This was compared with unselected normal singleton control pregnancies matched within a week of gestation at delivery. Data included birthweight centiles and placental histopathology. Comparisons of Doppler findings across placental pathological categories were performed using statistical analysis. 104 cases were analysed; 52 cases of trisomy 21 and 52 controls. Fetal vascular malperfusion (48.1% vs. 5.8%, p = 0.001) and maturation defects (39.2% vs. 15.7%, p = 0.023) were more common in trisomy 21 placentas. Compared with controls, trisomy 21 fetuses were more likely to have shorter umbilical cords (p = 0.001) and had more UAD abnormalities. Amongst T21 pregnancies, umbilical artery Doppler abnormalities are associated with the presence of maternal vascular malperfusion. Fetal vascular malperfusion and maturation defects are more common in trisomy 21 placentas. Abnormal umbilical artery Doppler waveforms are more common in T21 and are associated with maternal vascular malperfusion. Placental disease may explain the increased rate of intrauterine death in T21. Copyright © 2016 Elsevier Ltd. All rights reserved.

Reference range of fetal nasal bone length between 18 and 24 weeks of pregnancy in an unselected Brazilian population: experience from a single service.

PubMed

Araujo Júnior, Edward; Martins, Wellington P; Pires, Claudio Rodrigues; Moron, Antonio Fernandes; Zanforlin Filho, Sebastião Marques

2014-08-01

To determine reference range of fetal nasal bone length (NBL) during the second trimester of pregnancy in a Brazilian population. This was a retrospective cross-sectional study with 2681 normal singleton pregnancies between 18 and 24 weeks of gestation. The NBL was obtained in the mid-sagittal plane of the fetal face profile using the following landmarks: nasal bone, overlying skin and the tip of the nose. The NBL was measured by placing the calipers in the out-to-out position. To assess the correlation between NBL and gestational age (GA), polynomial equations were calculated, with adjustments by coefficient of determination (R(2)). The mean of NBL ranged from 5.72 ± 0.87 mm at 18-18 + 6 weeks to 7.45 ± 1.23 mm at 24-24+6 weeks of pregnancy. We observed a good correlation between NBL and GA, best represented by a linear equation: NBL = 0.080+0.276*GA (R(2 )= 0.16). We established a reference range of fetal NBL in the second trimester of pregnancy in a Brazilian population.

Vegan-vegetarian low-protein supplemented diets in pregnant CKD patients: fifteen years of experience.

PubMed

Attini, Rossella; Leone, Filomena; Parisi, Silvia; Fassio, Federica; Capizzi, Irene; Loi, Valentina; Colla, Loredana; Rossetti, Maura; Gerbino, Martina; Maxia, Stefania; Alemanno, Maria Grazia; Minelli, Fosca; Piccoli, Ettore; Versino, Elisabetta; Biolcati, Marilisa; Avagnina, Paolo; Pani, Antonello; Cabiddu, Gianfranca; Todros, Tullia; Piccoli, Giorgina B

2016-09-20

Pregnancy in women with advanced CKD becoming increasingly common. However, experience with low-protein diets in CKD patients in pregnancy is still limited. Aim of this study is to review the results obtained over the last 15 years with moderately restricted low-protein diets in pregnant CKD women (combining: CKD stages 3-5, proteinuria: nephrotic at any time, or > =1 g/24 at start or referral; nephrotic in previous pregnancy). CKD patients on unrestricted diets were employed for comparison. January, 2000 to September, 2015: 36 on-diet pregnancies (31 singleton deliveries, 3 twin deliveries, 1 pregnancy termination, 1 miscarriage); 47 controls (42 singleton deliveries, 5 miscarriages). The diet is basically vegan; since occasional milk and yoghurt are allowed, we defined it vegan-vegetarian; protein intake (0.6-0.8 g/Kg/day), keto-acid supplementation, protein-unrestricted meals (1-3/week) are prescribed according to CKD stage and nutritional status. Statistical analysis was performed as implemented on SPSS. Patients and controls were similar (p: ns) at baseline with regard to age (33 vs 33.5), referral week (7 vs 9), kidney function (CKD 3-5: 48.4 % vs 64.3 %); prevalence of hypertension (51.6 % vs 40.5 %) and proteinuria >3 g/24 h (16.1 % vs 12.2 %). There were more diabetic nephropathies in on-diet patients (on diet: 31.0 % vs controls 5.3 %; p 0.007 (Fisher)) while lupus nephropathies were non-significantly higher in controls (on diet: 10.3 % vs controls 23.7 %; p 0.28 (Fisher)). The incidence of preterm delivery was similar (<37 weeks: on-diet singletons 77.4 %; controls: 71.4 %). The incidence of other adverse pregnancy related outcomes was non-significantly lower in on-diet patients (early preterm delivery: on diet: 32.3 % vs controls 35.7 %; birth-weight = <1.500 g: on diet: 9.7 % vs controls 23.8 %). None of the singletons in the on-diet series died, while two perinatal deaths occurred among the controls (p = 0.505). The incidence of small for gestational age (SGA <10th centile) and/or extremely preterm babies (<28th week) was significantly lower in singletons from on-diet mothers than in controls (on diet: 12.9 % vs controls: 33.3 %; p: 0.04 (Fisher)). Moderate protein restriction in the context of a vegan-vegetarian supplemented diet is confirmed as a safe option in the management of pregnant CKD patients.

Early neonatal mortality in twin pregnancy: Findings from 60 low- and middle-income countries.

PubMed

Bellizzi, Saverio; Sobel, Howard; Betran, Ana Pilar; Temmerman, Marleen

2018-06-01

Around the world, the incidence of multiple pregnancies reaches its peak in the Central African countries and often represents an increased risk of death for women and children because of higher rates of obstetrical complications and poor management skills in those countries. We sought to assess the association between twins and early neonatal mortality compared with singleton pregnancies. We also assessed the role of skilled birth attendant and mode of delivery on early neonatal mortality in twin pregnancies. We conducted a secondary analysis of individual level data from 60 nationally-representative Demographic and Health Surveys including 521 867 singleton and 14 312 twin births. We investigated the occurrence of deaths within the first week of life in twins compared to singletons and the effect of place and attendance at birth; also, the role of caesarean sections against vaginal births was examined, globally and after countries stratification per caesarean sections rates. A multi-level logistic regression was used accounting for homogeneity within country, and homogeneity within twin pairs. Early neonatal mortality among twins was significantly higher when compared to singleton neonates (adjusted odds ratio (aOR) 7.6; 95% confidence interval (CI) = 7.0-8.3) in these 60 countries. Early neonatal mortality was also higher among twins than singletons when adjusting for birth weight in a subgroup analysis of those countries with data on birth weight (n = 20; less than 20% of missing values) (aOR = 2.8; 95% CI = 2.2-3.5). For countries with high rates (>15%) of caesarean sections (CS), twins delivered vaginally in health facility had a statistically significant (aOR = 4.8; 95% CI = 2.4-9.4) increased risk of early neonatal mortality compared to twins delivered through caesarean sections. Home twin births without SBA was associated with increased mortality compared with delivering at home with SBA (aOR = 1.3; 95% CI = 1.0-1.8) and with vaginal birth in health facility (aOR = 1.7; 95% CI = 1.4-2.0). Institutional deliveries and increased access of caesarian sections may be considered for twin pregnancies in low- and middle- income countries to decrease early adverse neonatal outcomes.

Early neonatal mortality in twin pregnancy: Findings from 60 low- and middle-income countries

PubMed Central

Bellizzi, Saverio; Sobel, Howard; Betran, Ana Pilar; Temmerman, Marleen

2018-01-01

Background Around the world, the incidence of multiple pregnancies reaches its peak in the Central African countries and often represents an increased risk of death for women and children because of higher rates of obstetrical complications and poor management skills in those countries. We sought to assess the association between twins and early neonatal mortality compared with singleton pregnancies. We also assessed the role of skilled birth attendant and mode of delivery on early neonatal mortality in twin pregnancies. Methods We conducted a secondary analysis of individual level data from 60 nationally-representative Demographic and Health Surveys including 521 867 singleton and 14 312 twin births. We investigated the occurrence of deaths within the first week of life in twins compared to singletons and the effect of place and attendance at birth; also, the role of caesarean sections against vaginal births was examined, globally and after countries stratification per caesarean sections rates. A multi-level logistic regression was used accounting for homogeneity within country, and homogeneity within twin pairs. Results Early neonatal mortality among twins was significantly higher when compared to singleton neonates (adjusted odds ratio (aOR) 7.6; 95% confidence interval (CI) = 7.0-8.3) in these 60 countries. Early neonatal mortality was also higher among twins than singletons when adjusting for birth weight in a subgroup analysis of those countries with data on birth weight (n = 20; less than 20% of missing values) (aOR = 2.8; 95% CI = 2.2-3.5). For countries with high rates (>15%) of caesarean sections (CS), twins delivered vaginally in health facility had a statistically significant (aOR = 4.8; 95% CI = 2.4-9.4) increased risk of early neonatal mortality compared to twins delivered through caesarean sections. Home twin births without SBA was associated with increased mortality compared with delivering at home with SBA (aOR = 1.3; 95% CI = 1.0-1.8) and with vaginal birth in health facility (aOR = 1.7; 95% CI = 1.4-2.0). Conclusions Institutional deliveries and increased access of caesarian sections may be considered for twin pregnancies in low- and middle- income countries to decrease early adverse neonatal outcomes. PMID:29423189

Reference Curve for the Mean Uterine Artery Pulsatility Index in Singleton Pregnancies.

PubMed

Weichert, Alexander; Hagen, Andreas; Tchirikov, Michael; Fuchs, Ilka B; Henrich, Wolfgang; Entezami, Michael

2017-05-01

Doppler sonography of the uterine artery (UA) is done to monitor pregnancies, because the detected flow patterns are useful to draw inferences about possible disorders of trophoblast invasion. Increased resistance in the UA is associated with an increased risk of preeclampsia and/or intrauterine growth restriction (IUGR) and perinatal mortality. In the absence of standardized figures, the normal ranges of the various available reference curves sometimes differ quite substantially from one another. The causes for this are differences in the flow patterns of the UA depending on the position of the pulsed Doppler gates as well as branching of the UA. Because of the discrepancies between the different reference curves and the practical problems this poses for guideline recommendations, we thought it would be useful to create our own reference curves for Doppler measurements of the UA obtained from a singleton cohort under standardized conditions. This retrospective cohort study was carried out in the Department of Obstetrics of the Charité - Universitätsmedizin Berlin, the Department for Obstetrics and Prenatal Medicine of the University Hospital Halle (Saale) and the Center for Prenatal Diagnostics and Human Genetics Kurfürstendamm 199. Available datasets from the three study locations were identified and reference curves were generated using the LMS method. Measured values were correlated with age of gestation, and a cubic model and Box-Cox power transformation (L), the median (M) and the coefficient of variation (S) were used to smooth the curves. 103 720 Doppler examinations of the UA carried out in singleton pregnancies from the 11th week of gestation (10 + 1 GW) were analyzed. The mean pulsatility index (Mean PI) showed a continuous decline over the course of pregnancy, dropping to a plateau of around 0.84 between the 23rd and 27th GW, after which it decreased again. Age of gestation, placental position, position of pulsed Doppler gates and branching of the UA can all change the flow pattern. The mean pulsatility index (Mean PI) showed a continuous decrease over time. There were significant differences between our data and alternative reference curves. A system of classifying Doppler studies and a reference curve adapted to the current technology are urgently required to differentiate better between physiological and pathological findings.

Is it appropriate for Korean women to adopt the 2009 Institute of Medicine recommendations for gestational weight gain?

PubMed

Wie, Jeong Ha; Park, In Yang; Namkung, Jeong; Seo, Hae Won; Jeong, Min Jin; Kwon, Ji Young

2017-01-01

The 2009 Institute of Medicine (IOM) guidelines for gestational weight gain (GWG) are intended for use among women in the United States. Little data are available on whether the 2009 IOM recommendations can be applied to Asian women. This study aimed to evaluate whether the recommendations are related to adverse pregnancy outcomes in Korean pregnant women. A retrospective cohort study was conducted for all singleton-pregnant women at a university hospital in Korea. After classifying the enrolled women into four Korean pre-pregnancy body mass index (BMI) categories, the risk of adverse pregnancy outcomes were analyzed for women who gained inadequate or excessive GWG based on 2009 IOM recommendations. Of 7,843 pregnancies, 64.0% of women had normal pre-pregnancy BMI and 42.7% achieved optimal GWG. Across all BMI categories, adverse pregnancies outcomes such as small for gestational age (SGA), large for gestational age (LGA), preterm birth, preeclampsia, and cesarean due to dystocia were significantly associated with GWG (all P ≤ 0.001).Women with normal BMI who gained inadequate weight were more likely to develop SGA and preterm birth and less likely to develop LGA (adjusted odds ratio (aOR) 2.21, 1.33, and 0.54, respectively). Whereas, women with normal BMI who gained excessive weight were more likely to develop LGA, preterm birth, preeclampsia, and cesarean section due to dystocia (aOR 2.10, 1.33, 1.37, and 1.37, respectively) and less likely to develop SGA (aOR 0.60). It is tolerable for Korean women to follow recommended GWG from the 2009 IOM guidelines to decrease adverse pregnancy outcomes. This will be helpful for antenatal care on GWG not only for Korean pregnant women, but also other Asian women who have lower BMI criteria than Caucasian women.

Is it appropriate for Korean women to adopt the 2009 Institute of Medicine recommendations for gestational weight gain?

PubMed Central

Namkung, Jeong; Seo, Hae Won; Jeong, Min Jin

2017-01-01

Background The 2009 Institute of Medicine (IOM) guidelines for gestational weight gain (GWG) are intended for use among women in the United States. Little data are available on whether the 2009 IOM recommendations can be applied to Asian women. This study aimed to evaluate whether the recommendations are related to adverse pregnancy outcomes in Korean pregnant women. Methods and findings A retrospective cohort study was conducted for all singleton-pregnant women at a university hospital in Korea. After classifying the enrolled women into four Korean pre-pregnancy body mass index (BMI) categories, the risk of adverse pregnancy outcomes were analyzed for women who gained inadequate or excessive GWG based on 2009 IOM recommendations. Of 7,843 pregnancies, 64.0% of women had normal pre-pregnancy BMI and 42.7% achieved optimal GWG. Across all BMI categories, adverse pregnancies outcomes such as small for gestational age (SGA), large for gestational age (LGA), preterm birth, preeclampsia, and cesarean due to dystocia were significantly associated with GWG (all P ≤ 0.001).Women with normal BMI who gained inadequate weight were more likely to develop SGA and preterm birth and less likely to develop LGA (adjusted odds ratio (aOR) 2.21, 1.33, and 0.54, respectively). Whereas, women with normal BMI who gained excessive weight were more likely to develop LGA, preterm birth, preeclampsia, and cesarean section due to dystocia (aOR 2.10, 1.33, 1.37, and 1.37, respectively) and less likely to develop SGA (aOR 0.60). Conclusions It is tolerable for Korean women to follow recommended GWG from the 2009 IOM guidelines to decrease adverse pregnancy outcomes. This will be helpful for antenatal care on GWG not only for Korean pregnant women, but also other Asian women who have lower BMI criteria than Caucasian women. PMID:28704550

Does assisted reproduction technology, per se, increase the risk of preterm birth?

PubMed

Blickstein, I

2006-12-01

There is little doubt that all methods of assisted reproduction increase the likelihood of multiple pregnancy and, as a result, increase the likelihood of preterm birth. Data from the East Flanders Prospective Twin Study clearly show that the proportion of spontaneous to iatrogenic twins has changed from 25:1 to 1:1 over the past two decades. Data from the very low birthweight (VLBW) Infant Database of the Israel Neonatal Network showed that 10% of VLBW singletons were a result of assisted reproduction compared with 60% of the VLBW twins and 90% of the VLBW triplets. Irrespective of plurality, an association between preterm birth and assisted reproduction has long been suspected and was related to causes such as iatrogenic preterm birth (in the so-called 'premium' pregnancies), fertility history, past obstetric performance and to underlying medical conditions of the female partner. With more data available, a clearer picture is defined. Two different, recent meta-analyses showed that singleton pregnancies resulting from in vitro fertilisation (IVF) have increased rates of preterm birth at <33 weeks of gestation (OR 2.99; 95% CI 1.54-5.80), at <37 weeks of gestation (OR 1.93; 95% CI 1.36-2.74) and a relative risk of 1.98 (95% CI 1.77-2.22) for preterm birth in singleton pregnancies resulting from in vitro fertilisation embryo transfer/gamete intra fallopian transfer (IVF-ET/GIFT) compared with naturally conceived pregnancies. Since there is no way to predict which pregnant woman is at increased risk of preterm birth, it may be advisable to consider all pregnancies after assisted reproduction as being at risk. In any case, the most appropriate endpoint after assisted reproduction should also include preterm or term birth as measure of success.

McDonald versus Shirodkar cervical cerclage for the prevention of preterm birth: impact of body mass index.

PubMed

Figueroa, Reinaldo; Crowell, Rebecca; Martinez, Alvin; Morgan, Marielle; Wakefield, Dorothy

2018-04-30

To compare obstetrical outcomes on women undergoing a McDonald or Shirodkar cerclage and to estimate the impact of maternal body mass index (BMI) on these outcomes. We conducted a retrospective review of the medical records of all women with singleton pregnancies who underwent placement of a McDonald or Shirodkar cerclage at St. Francis Hospital from January 2008 to October 2013. The subjects were categorized based on BMI groups (normal: less than 25 kg/m 2 , overweight: 25-29 kg/m 2 , obese: 30 kg/m 2 or more). The primary outcome was gestational age at delivery. Statistical analyses included chi-square, Student's t-test, and multivariable regression analysis. Of 95 women, 47 (49.5%) received a Shirodkar, and 48 (50.5%) a McDonald cerclage. 16 women (16.8%) were categorized as normal weight, 35 (36.8%) as overweight, and 44 (46.3%) as obese. Gestational age at delivery differed significantly by group, decreasing with each categorical increase in BMI (normal: 39.0 ± 0.3 weeks; overweight: 36.6 ± 0.7 weeks; obese: 33.0 ± 1.1 weeks; p < .01). Overall, women receiving a Shirodkar cerclage had significantly longer pregnancies than women with a McDonald cerclage (36.7 ± 0.6 weeks versus 33.9 ± 1.0 weeks; p = .02). However, analysis showed a significant interaction between weight status and gestational age at delivery. Obese women had significantly longer pregnancies when they received a Shirodkar cerclage versus a McDonald cerclage (32.6 ± 1.0 weeks versus 28.8 ± 0.9 weeks; p < .01). However, there was no significant difference in gestational age at delivery between women categorized as normal/overweight (Shirodkar: 33.5 ± 0.9 weeks; McDonald: 32.9 ± 0.9 weeks; p = .63). Compared to obese women receiving a McDonald cerclage, obese women receiving a Shirodkar cerclage had significantly longer pregnancies. No significant differences in pregnancy duration were found in normal/overweight women regardless of cerclage technique. Pregnancy duration in obese women receiving a Shirodkar cerclage was similar to the pregnancy duration of normal/overweight women.

Is twin pregnancy a risk factor for devolopmental dysplasia of the hip - retrospective analysis using ultrasonography.

PubMed

Czubak, Jarosław; Mazela, Jan L; Majda, Waldemar; Woźniak, Waldemar

2003-12-30

Background. Disorders in development of the hip in the uterus are caused mainly by mechanical factors. Their influence has been established on the basis of the results of examinations of newborns from singleton pregancies. Malposition of the fetus and the lack of space in the uterus are present in higher frequency in twin pregnancies. Thus, it is probable, that twin pregnacy may be a risk factor in developmental dysplasia of the hip.
Material and methods. We examined clinically and ultrasonographically 308 hip joints of 154 newborn twins and compare the values of the alpha related to different position in uterus, birthweight, gender, length of gestation and mode of delivery. The only pathological position of the fetus in the uterus is the tranverse one.
Results and Conclusions. The results of ultrasound examinations reveal that in the cramped space inside the uterus in twin pregnancies hip joints develop in different conditions than in singleton pregnancies and the twin pregnancy cannot be regarded as a risk factor which may cause developmental dysplasia of the hip.

Long term costs and effects of reducing the number of twin pregnancies in IVF by single embryo transfer: the TwinSing study

PubMed Central

2010-01-01

Background Pregnancies induced by in vitro fertilisation (IVF) often result in twin gestations, which are associated with both maternal and perinatal complications. An effective way to reduce the number of IVF twin pregnancies is to decrease the number of embryos transferred from two to one. The interpretation of current studies is limited because they used live birth as outcome measure and because they applied limited time horizons. So far, research on long-term outcomes of IVF twins and singletons is scarce and inconclusive. The objective of this study is to investigate the short (1-year) and long-term (5 and 18-year) costs and health outcomes of IVF singleton and twin children and to consider these in estimating the cost-effectiveness of single embryo transfer compared with double embryo transfer, from a societal and a healthcare perspective. Methods/Design A multi-centre cohort study will be performed, in which IVF singletons and IVF twin children born between 2003 and 2005 of whom parents received IVF treatment in one of the five participating Dutch IVF centres, will be compared. Data collection will focus on children at risk of health problems and children in whom health problems actually occurred. First year of life data will be collected in approximately 1,278 children (619 singletons and 659 twin children). Data up to the fifth year of life will be collected in approximately 488 children (200 singletons and 288 twin children). Outcome measures are health status, health-related quality of life and costs. Data will be obtained from hospital information systems, a parent questionnaire and existing registries. Furthermore, a prognostic model will be developed that reflects the short and long-term costs and health outcomes of IVF singleton and twin children. This model will be linked to a Markov model of the short-term cost-effectiveness of single embryo transfer strategies versus double embryo transfer strategies to enable the calculation of the long-term cost-effectiveness. Discussion This is, to our knowledge, the first study that investigates the long-term costs and health outcomes of IVF singleton and twin children and the long-term cost-effectiveness of single embryo transfer strategies versus double embryo transfer strategies. PMID:20961411

Long term costs and effects of reducing the number of twin pregnancies in IVF by single embryo transfer: the TwinSing study.

PubMed

van Heesch, Mirjam M J; Bonsel, Gouke J; Dumoulin, John C M; Evers, Johannes L H; van der Hoeven, Mark Ahbm; Severens, Johan L; Dykgraaf, Ramon H M; van der Veen, Fulco; Tonch, Nino; Nelen, Willianne L D M; van Zonneveld, Piet; van Goudoever, Johannes B; Tamminga, Pieter; Steiner, Katerina; Koopman-Esseboom, Corine; van Beijsterveldt, Catharina E M; Boomsma, Dorret I; Snellen, Diana; Dirksen, Carmen D

2010-10-20

Pregnancies induced by in vitro fertilisation (IVF) often result in twin gestations, which are associated with both maternal and perinatal complications. An effective way to reduce the number of IVF twin pregnancies is to decrease the number of embryos transferred from two to one. The interpretation of current studies is limited because they used live birth as outcome measure and because they applied limited time horizons. So far, research on long-term outcomes of IVF twins and singletons is scarce and inconclusive. The objective of this study is to investigate the short (1-year) and long-term (5 and 18-year) costs and health outcomes of IVF singleton and twin children and to consider these in estimating the cost-effectiveness of single embryo transfer compared with double embryo transfer, from a societal and a healthcare perspective. A multi-centre cohort study will be performed, in which IVF singletons and IVF twin children born between 2003 and 2005 of whom parents received IVF treatment in one of the five participating Dutch IVF centres, will be compared. Data collection will focus on children at risk of health problems and children in whom health problems actually occurred. First year of life data will be collected in approximately 1,278 children (619 singletons and 659 twin children). Data up to the fifth year of life will be collected in approximately 488 children (200 singletons and 288 twin children). Outcome measures are health status, health-related quality of life and costs. Data will be obtained from hospital information systems, a parent questionnaire and existing registries. Furthermore, a prognostic model will be developed that reflects the short and long-term costs and health outcomes of IVF singleton and twin children. This model will be linked to a Markov model of the short-term cost-effectiveness of single embryo transfer strategies versus double embryo transfer strategies to enable the calculation of the long-term cost-effectiveness. This is, to our knowledge, the first study that investigates the long-term costs and health outcomes of IVF singleton and twin children and the long-term cost-effectiveness of single embryo transfer strategies versus double embryo transfer strategies.

Gestational Weight Gain: Association with Adverse Pregnancy Outcomes.

PubMed

Hannaford, Karen E; Tuuli, Methodius G; Odibo, Linda; Macones, George A; Odibo, Anthony O

2017-01-01

Background  It is unclear how adherence to the Institute of Medicine's (IOM) guidelines for weight gain affects pregnancy outcomes. Objective  We investigated how weight gain outside the IOM's recommendations affects the risks of adverse pregnancy outcomes. Study Design  We performed a secondary analysis of a prospective cohort study including singleton, nonanomalous fetuses. The risks of small for gestational age (SGA), macrosomia, preeclampsia, cesarean delivery, gestational diabetes, or preterm birth were calculated for patients who gained weight below or above the IOM's recommendations based on body mass index category. A time-to-event analysis was performed to account for gestational age at delivery. A Cox proportional model was fit to estimate hazard ratios accounting for possible confounders. Results  Women who gained weight below recommendations were 2.5 times more likely to deliver SGA and twice as likely to deliver preterm. Normal-weight patients who gained below recommendations were 2.5 times more likely to deliver SGA and twice as likely to deliver preterm. Obese patients who gained inadequate weight were 2.5 times more likely to deliver SGA. Conclusion  Among normal-weight patients, adhering to IOM recommendations may prevent growth abnormalities and preterm delivery. Among obese patients, a minimum weight gain requirement may prevent SGA infants. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Effect of a prenatal lifestyle intervention on physical activity level in late pregnancy and the first year postpartum

PubMed Central

Sagedal, Linda Reme; Haakstad, Lene Annette Hagen; Lohne-Seiler, Hilde

2017-01-01

Background Despite documented health benefits for mother and baby, physical activity (PA)-level tends to decline in pregnancy. Overweight/obese and physically inactive women are two selected groups at increased risk of pregnancy complications. Thus, efficient strategies to maintain or increase PA-level in pregnancy and the postpartum period, especially among these women, are warranted. This secondary analysis examined the effect of a prenatal lifestyle-intervention on PA-level in late pregnancy and the first year postpartum, with subanalysis on initially physically active versus inactive and normal-weight versus overweight/obese women. Method The Norwegian Fit for Delivery (NFFD) randomized controlled trial included healthy primiparous women with singleton pregnancies and body mass index (BMI) ≥19 kg/m2 assigned to an intervention group, n = 303 (twice weekly group-exercises and dietary counseling) or a control group, n = 303 (standard prenatal care). The International Physical Activity Questionnaire short-form was used to assess PA-levels at inclusion (mean gestational week (GW) 16), GW 36, and six and 12 months postpartum. Results At GW 36, a positive intervention-effect with a significant between-group difference in total PA-level compared to time of inclusion was found for the total group (530 MET-min/week, p = 0.001) and the subgroups of normal-weight (533 MET-min/week, p = 0.003) and initially active women (717 MET-min/week, p<0.001). Intervention-effect was dependent on exercise-adherence among overweight/obese and inactive women. Compared to time of inclusion, the intervention groups maintained total PA-level at GW 36, while total PA-level decreased in the control groups. The PA-levels increased postpartum, but with no significant differences between the randomization groups. Conclusion The NFFD prenatal combined lifestyle intervention had a significant effect on TPA-level in late pregnancy among women entering pregnancy normal-weight or physically active, thereby preventing the downward trend typically seen during pregnancy. Intervention-effect among overweight/obese and physically inactive women was, however, dependent on exercise-adherence. Long-term intervention-effect was not observed in the postpartum period. PMID:29176762

Effect of a prenatal lifestyle intervention on physical activity level in late pregnancy and the first year postpartum.

PubMed

Sanda, Birgitte; Vistad, Ingvild; Sagedal, Linda Reme; Haakstad, Lene Annette Hagen; Lohne-Seiler, Hilde; Torstveit, Monica Klungland

2017-01-01

Despite documented health benefits for mother and baby, physical activity (PA)-level tends to decline in pregnancy. Overweight/obese and physically inactive women are two selected groups at increased risk of pregnancy complications. Thus, efficient strategies to maintain or increase PA-level in pregnancy and the postpartum period, especially among these women, are warranted. This secondary analysis examined the effect of a prenatal lifestyle-intervention on PA-level in late pregnancy and the first year postpartum, with subanalysis on initially physically active versus inactive and normal-weight versus overweight/obese women. The Norwegian Fit for Delivery (NFFD) randomized controlled trial included healthy primiparous women with singleton pregnancies and body mass index (BMI) ≥19 kg/m2 assigned to an intervention group, n = 303 (twice weekly group-exercises and dietary counseling) or a control group, n = 303 (standard prenatal care). The International Physical Activity Questionnaire short-form was used to assess PA-levels at inclusion (mean gestational week (GW) 16), GW 36, and six and 12 months postpartum. At GW 36, a positive intervention-effect with a significant between-group difference in total PA-level compared to time of inclusion was found for the total group (530 MET-min/week, p = 0.001) and the subgroups of normal-weight (533 MET-min/week, p = 0.003) and initially active women (717 MET-min/week, p<0.001). Intervention-effect was dependent on exercise-adherence among overweight/obese and inactive women. Compared to time of inclusion, the intervention groups maintained total PA-level at GW 36, while total PA-level decreased in the control groups. The PA-levels increased postpartum, but with no significant differences between the randomization groups. The NFFD prenatal combined lifestyle intervention had a significant effect on TPA-level in late pregnancy among women entering pregnancy normal-weight or physically active, thereby preventing the downward trend typically seen during pregnancy. Intervention-effect among overweight/obese and physically inactive women was, however, dependent on exercise-adherence. Long-term intervention-effect was not observed in the postpartum period.

Multivariate analysis identifies the estradiol level at ovulation triggering as an independent predictor of the first trimester pregnancy-associated plasma protein-A level in IVF/ICSI pregnancies.

PubMed

Giorgetti, C; Vanden Meerschaut, F; De Roo, C; Saunier, O; Quarello, E; Hairion, D; Penaranda, G; Chabert-Orsini, V; De Sutter, P

2013-10-01

Can independent predictors of pregnancy-associated plasma protein-A (PAPP-A) levels be identified in a group of women who conceived following IVF/ICSI? The significantly decreased PAPP-A level in IVF and ICSI pregnancies compared with non-IVF/ICSI pregnancies was correlated strongly with the serum estradiol (E2) level at ovulation triggering. The first trimester prenatal combined screening test for fetal aneuploidies in pregnancies conceived following assisted reproduction techniques (ART) is complicated by an alteration of the maternal biomarkers free β-hCG and PAPP-A, causing a higher false-positive rate compared with pregnancies which are conceived naturally. The use of controlled ovarian stimulation prior to IVF/ICSI is suggested to be the principle reason for these alterations of biomarkers in ART pregnancies. Between January 2010 and December 2011, 1474 women who conceived naturally and 374 women who conceived following IVF (n = 89), ICSI (n = 204) or intrauterine insemination (IUI, n = 81) were included in this retrospective study. Only singleton pregnancies were eligible for this study. For all women, serum analysis was performed in the same clinical laboratory. Measurement of nuchal translucency (NT) thickness was performed by four physicians belonging to the same infertility centre. First-trimester combined screening test of aneuploidy parameters (maternal age, PAPP-A and free β-hCG, NT thickness) were compared between non-ART and ART (IVF, ICSI and IUI) singleton pregnancies. Next, a minimal threshold E2 level at ovulation triggering was suggested for IVF/ICSI pregnancies above which the PAPP-A levels were significantly decreased compared with non-ART pregnancies. Finally, a multivariate analysis was performed to reveal independent predictors of PAPP-A level in IVF/ICSI pregnancies. We showed a decrease of the multiple of the median (MoM) PAPP-A level in IVF and ICSI singleton pregnancies compared with non-ART singleton pregnancies (P < 0.001), with MoM values of 0.74 (0.16-3.16) and 0.81 (0.12-4.61) versus 0.98 (0.14-5.76), respectively. Analysis of variance of the overall model was highly significant (Fisher test 3.76, P = 0.01), indicating that the model explains a significant portion of the variation in the data. No difference in PAPP-A level was found between non-ART and IUI pregnancies. The free β-hCG level and NT thickness did not differ between ART and non-ART pregnancies. PAPP-A levels in IVF and ICSI pregnancies were strongly correlated with the E2 level at ovulation triggering. We showed by multivariate analysis that an E2 cut-off level of 1300 pg/ml at the time of ovulation could predict a significantly lower PAPP-A level at first trimester combined screening (β -0.239 ± 0.088, P < 0.005). The measures of biochemical markers can differ between laboratories and with the used equipment; therefore, extrapolation of the E2 cut-off level to other infertility centres should be undertaken with caution. One should be careful when using correction factors for ART patients undergoing the first trimester combined screening test. The proposed E2 cut-off level may help to identify a subgroup of women within the population of ART patients for whom use of a correction factor is justified. None.

Association of Pre-pregnancy BMI and Postpartum Weight Retention Before Second Pregnancy, Washington State, 2003-2013.

PubMed

Ketterl, Tyler G; Dundas, Nicolas J; Roncaioli, Steven A; Littman, Alyson J; Phipps, Amanda I

2018-03-06

Background Maternal overweight and obesity is one of the most common high-risk obstetric conditions associated with adverse birth outcomes. Smaller studies have suggested that pre-pregnancy body mass index (BMI) is associated with postpartum weight retention. Objective The primary objective of this study was to examine the association between pre-pregnancy BMI status and maternal weight retention. Study design We conducted a population-based retrospective cohort study using Washington State birth certificate data from 2003-2013. We included women who had two sequential births during this time period, with the second birth occurring within 18-36 months of the first singleton delivery date. BMI before a women's first pregnancy ("pre-pregnancy BMI") was categorized as normal (18.5-24.9 kg/m 2 ) and overweight/obese (25-40 kg/m 2 ). Women were classified as having returned to first pre-pregnancy BMI if their BMI before their second pregnancy was no more than 1 kg/m 2 more compared to their BMI before their first pregnancy. Analyses were stratified by gestational weight gain during the first pregnancy (below, met, exceeded recommended gestational weight gain). Results A total of 49,132 mothers were included in the study. Among women who met their recommended gestational weight gain, compared to mothers with a normal BMI, obese/overweight mothers were less likely to return to their pre-pregnancy BMI (76.5 vs 72.3%; RR Obese/Overweight  = 0.88; 95% CI: 0.85-0.92). A similar pattern was observed among women who exceeded their recommended gestational weight gain (62.6 vs 53.2%; RR Obese/Overweight  = 0.79, 95% CI: 0.78-0.80). Conclusion Pre-pregnancy BMI in the overweight/obese range is associated with a decreased likelihood of returning to pre-pregnancy BMI. Further research to support women during and after their pregnancy to promote behavior changes that prevent excessive weight gain during pregnancy and weight retention after birth is needed.

Development of customized fetal growth charts in twins.

PubMed

Ghi, Tullio; Prefumo, Federico; Fichera, Anna; Lanna, Mariano; Periti, Enrico; Persico, Nicola; Viora, Elsa; Rizzo, Giuseppe

2017-05-01

Twin gestations are at significantly higher risk of fetal growth restriction in comparison with singletons. Using fetal biometric charts customized for obstetrical and parental characteristics may facilitate an accurate assessment of fetal growth. The objective of the study was to construct reference charts for the gestation of fetal biometric parameters stratified by chorionicity and customized for obstetrical and parental characteristics. Fetal biometric measurements obtained from serial ultrasound examinations in uncomplicated twin pregnancies delivering after 36 weeks of gestation were collected by 19 Italian fetal medicine units under the auspices of the Società Italiana di Ecografia Ostetrica e Ginecologica. The measurements acquired in each fetus at each examination included biparietal diameter, head circumference, abdominal circumference, and femur length. Multilevel linear regression models were used to adjust for the serial ultrasonographic measurements obtained and the clustering of each fetus in twin pregnancy. The impact of maternal and paternal characteristics (height, weight, ethnicity), parity, fetal sex, and mode of conception was also considered. Models for each parameter were stratified by fetal chorionicity and compared with our previously constructed growth curves for singletons. The data set included 1781 twin pregnancies (dichorionic, n = 1289; monochorionic diamniotic, n = 492) with 8923 ultrasonographic examinations with a median of 5 (range, 2-8) observations per pregnancy in dichorionic and 6 in (range, 2-11) monochorionic pregnancies. Growth curves of twin pregnancies differed from those of singletons, and differences were more marked in monochorionic twins and during the third trimester. A significant influence of parental characteristics was found. Curves of fetal biometric measurements in twins are influenced by parental characteristics. There is a reduction in the growth rate during the third trimester. The reference limits for gestation constructed in this study may provide a useful tool for a more accurate assessment of fetal growth in twin pregnancies. Copyright © 2017 Elsevier Inc. All rights reserved.

Successful application of preimplantation genetic diagnosis for Leigh syndrome.

PubMed

Unsal, Evrim; Aktaş, Yasemin; Uner, Ozge; BaltacI, Aysun; Ozcan, Sarp; Turhan, Feriba; Baltaci, Volkan

2008-11-01

To perform preimplantation genetic diagnosis (PGD) for a SURF1 gene mutation of the Leigh syndrome to transfer unaffected or carrier embryo/embryos. Case report. Clinical IVF laboratory. A couple carrying an nt769 G/A mutation that is associated with Leigh syndrome. Oocytes were fertilized by means of intracytoplasmic sperm injection. The resulting embryos were biopsied 3 days after fertilization. One blastomere was taken and whole-genome amplification was performed. Amplification of the mutation site was achieved by polymerase chain reaction (PCR) and restriction digestion was completed. Gel Imager was used to measure the digests of normal and mutant load. Embryo testing by means of PGD-PCR and pregnancy. Successful preimplantation genetic diagnosis for a SURF1 gene mutation and transfer of healthy or carrier embryos. Successful singleton pregnancy resulting in the delivery of healthy baby girl. We report the first case of successful PGD for Leigh syndrome resulting in delivery of a healthy newborn.

Comparison of the clinical outcomes between fresh blastocyst and vitrified-thawed blastocyst transfer.

PubMed

Ku, Pei-Yun; Lee, Robert Kuo-Kuang; Lin, Shyr-Yeu; Lin, Ming-Huei; Hwu, Yuh-Ming

2012-12-01

To compare the clinical outcomes between fresh and vitrified-thawed day 5 blastocyst transfers. Retrospective case control study. Tertiary referral center. Patients 38 years of age or less who underwent IVF/ICSI cycles with fresh or frozen-thawed blastocysts transferred from June 1, 2009 to November 30, 2011 Vitrification and thawing of day 5 blastocysts using the Cryotop method. (Kitazato BioPharma Co., Ltd., Fuji city, Shizuoka, Japan) Clinical pregnancy rate, implantation rate, ongoing pregnancy rate, and multiple pregnancy rates. Of the 118 cycles in the fresh transfer group, 234 blastocysts were transferred. The clinical pregnancy rate was 66.1 % and implantation rate was 50.9 %. The ongoing pregnancy rate was 56.8 % and the rates for singleton and twin pregnancies were 53.7 % and 44.8 %. Of the 59 cycles in the vitrified-thawed group, 111 blastocysts were transferred. The clinical pregnancy rate was 59.3 % and implantation rate was 43.2 %. The ongoing pregnancy rate was 47.5 % and the rates for singleton and twin pregnancies were 60.7 % and 39.3 %. The clinical pregnancy rate, implantation rate and ongoing pregnancy rate did not differ significantly between the two groups. The implantation rates were not significantly different between the fresh and the vitrified-thawed groups. Thus, single embryo transfer may be considered in fresh cycles to decrease multiple pregnancy rates. The surplus embryos should be vitrified for the frozen embryo transfer to improve the cumulative pregnancy rate.

Excessive urinary tract dilatation and proteinuria in pregnancy: a common and overlooked association?

PubMed Central

2013-01-01

Background Proteinuria and dilatation of the urinary tract are both relatively common in pregnancy, the latter with a spectrum of symptoms, from none to severe pain and infection. Proteinuria is a rare occurrence in acute obstructive nephropathy; it has been reported in pregnancy, where it may pose a challenging differential diagnosis with pre-eclampsia. The aim of the present study is to report on the incidence of proteinuria (≥0.3; ≥0.5 g/day) in association with symptomatic-severe urinary tract dilatation in pregnancy. Methods Case series. Setting: Nephrological-Obstetric Unit dedicated to pregnancy and kidney diseases (January 2000-April 2011). Source: database prospectively updated since the start of the Unit. Retrospective review of clinical charts identified as relevant on the database, by a nephrologist and an obstetrician. Results From January 2000 to April 2011, 262 pregnancies were referred. Urinary tract dilatation with or without infection was the main cause of referral in 26 cases (predominantly monolateral in 19 cases): 23 singletons, 1 lost to follow-up, 1 twin and 1 triplet. Patients were referred for urinary tract infection (15 cases) and/or renal pain (10 cases); 6 patients were treated by urologic interventions (“JJ” stenting). Among them, 11 singletons and 1 triple pregnancy developed proteinuria ≥0.3 g/day (46.1%). Proteinuria was ≥0.5 g/day in 6 singletons (23.1%). Proteinuria resolved after delivery in all cases. No patient developed hypertension; in none was an alternative cause of proteinuria evident. No significant demographic difference was observed in patients with renal dilatation who developed proteinuria versus those who did not. An association with the presence of “JJ” stenting was present (5/6 cases with proteinuria ≥0.5 g/day), which may reflect both severer obstruction and a role for vescico-ureteral reflux, induced by the stent. Conclusions Symptomatic urinary tract dilatation may be associated with proteinuria in pregnancy. This association should be kept in mind in the differential diagnosis with other causes of proteinuria in pregnancy, including pre-eclampsia. PMID:23446427

Inadequate gestational weight gain and adverse pregnancy outcomes among normal weight women in China

PubMed Central

Wen, Tingyuan; Lv, Yanwei

2015-01-01

Objective: The objective of the paper is to find the association between inadequate gestational weight gain and pregnancy outcomes in normal weight women in China. Method: A retrospective study was conducted among 13,776 normal weight pregnant women who received antenatal care and delivered singleton infants at the participating hospital during August, 2009 to July, 2013. Adverse pregnancy outcomes like low birth weight (LBW), preterm birth, birth asphyxia, neonatal intensive care unit (NICU) admission and length of hospital stay were compared and analyzed between two groups with inadequate and adequate gestational weight gain. Results: According to the IOM recommendations, inadequate gestational weight gain was found to be 14.7% in this study. Women with inadequate gestational weight gain (GWG) were found to be at a higher risk for LBW (aOR = 2.13, 95% CI: 1.75, 2.86) and preterm birth (aOR = 1.44, 95% CI: 1.21, 1.67) than those in the adequate gestational weight gain group, after adjusting for monthly family income, maternal education, occupation, and whether they received any advice regarding benefits of gestational weight gain and residential area. However, inadequate GWG was not associated with longer hospital stay (aOR = 1.13, 95% CI: 0.91-1.43) in adjusted model. In addition, the rate of birth asphyxia and NICU admission were similar in both groups (P > 0.05). Conclusions: Normal weight pregnant women with GWG below the recommended AIOM 2009 guidelines were found to be at an increased risk of low birth weight and preterm birth. PMID:25932249

Inadequate gestational weight gain and adverse pregnancy outcomes among normal weight women in China.

PubMed

Wen, Tingyuan; Lv, Yanwei

2015-01-01

The objective of the paper is to find the association between inadequate gestational weight gain and pregnancy outcomes in normal weight women in China. A retrospective study was conducted among 13,776 normal weight pregnant women who received antenatal care and delivered singleton infants at the participating hospital during August, 2009 to July, 2013. Adverse pregnancy outcomes like low birth weight (LBW), preterm birth, birth asphyxia, neonatal intensive care unit (NICU) admission and length of hospital stay were compared and analyzed between two groups with inadequate and adequate gestational weight gain. According to the IOM recommendations, inadequate gestational weight gain was found to be 14.7% in this study. Women with inadequate gestational weight gain (GWG) were found to be at a higher risk for LBW (aOR = 2.13, 95% CI: 1.75, 2.86) and preterm birth (aOR = 1.44, 95% CI: 1.21, 1.67) than those in the adequate gestational weight gain group, after adjusting for monthly family income, maternal education, occupation, and whether they received any advice regarding benefits of gestational weight gain and residential area. However, inadequate GWG was not associated with longer hospital stay (aOR = 1.13, 95% CI: 0.91-1.43) in adjusted model. In addition, the rate of birth asphyxia and NICU admission were similar in both groups (P > 0.05). Normal weight pregnant women with GWG below the recommended AIOM 2009 guidelines were found to be at an increased risk of low birth weight and preterm birth.

Risk of major congenital malformations in relation to maternal overweight and obesity severity: cohort study of 1.2 million singletons

PubMed Central

Cnattingius, Sven; Villamor, Eduardo; Söderling, Jonas; Pasternak, Björn; Stephansson, Olof; Neovius, Martin

2017-01-01

Objective To estimate the risks of major congenital malformations in the offspring of mothers who are underweight (body mass index (BMI) <18.5), overweight (BMI 25 to <30), or in obesity classes I (BMI 30 to <35), II (35 to <40), or III (≥40) compared with offspring of normal weight mothers (BMI 18.5 to <25) in early pregnancy. Design Population based cohort study. Setting Nationwide Swedish registries. Participants 1 243 957 liveborn singleton infants from 2001 to 2014 in Sweden. Data on maternal and pregnancy characteristics were obtained by individual record linkages. Exposure Maternal BMI at the first prenatal visit. Main outcome measures Offspring with any major congenital malformation, and subgroups of organ specific malformations diagnosed during the first year of life. Risk ratios were estimated using generalised linear models adjusted for maternal factors, sex of offspring, and birth year. Results A total of 43 550 (3.5%) offspring had any major congenital malformation, and the most common subgroup was for congenital heart defects (n=20 074; 1.6%). Compared with offspring of normal weight mothers (risk of malformations 3.4%), the proportions and adjusted risk ratios of any major congenital malformation among the offspring of mothers with higher BMI were: overweight, 3.5% and 1.05 (95% confidence interval 1.02 to 1.07); obesity class I, 3.8% and 1.12 (1.08 to 1.15), obesity class II, 4.2% and 1.23 (1.17 to 1.30), and obesity class III, 4.7% and 1.37 (1.26 to 1.49). The risks of congenital heart defects, malformations of the nervous system, and limb defects also progressively increased with BMI from overweight to obesity class III. The largest organ specific relative risks related to maternal overweight and increasing obesity were observed for malformations of the nervous system. Malformations of the genital and digestive systems were also increased in offspring of obese mothers. Conclusions Risks of any major congenital malformation and several subgroups of organ specific malformations progressively increased with maternal overweight and increasing severity of obesity. For women who are planning pregnancy, efforts should be encouraged to reduce adiposity in those with a BMI above the normal range. PMID:28615173

Borderline amniotic fluid index and perinatal outcomes in the uncomplicated term pregnancy.

PubMed

Choi, Soo Ran

2016-01-01

To determine perinatal outcomes in uncomplicated term pregnancies with a borderline amniotic fluid index (AFI). A retrospective review was conducted of uncomplicated singleton pregnancies at term (>37 weeks). Borderline and normal AFI were defined as 5.1 ≤ AFI ≤ 8.0 cm and 8.1 ≤ AFI ≤ 24 cm, respectively. Adverse perinatal outcomes, cesarean delivery for non-reassuring fetal heart rate testing, meconium-stained amniotic fluid, a 5-min Apgar score of <7, admission to the neonatal intensive care unit (NICU), and whether the neonate was small for gestational age were compared between the borderline and normal AFI groups. Borderline AFI was not significantly associated with cesarean delivery for non-reassuring fetal heart rate testing (p = 0.513), meconium-stained amniotic fluid (p = 0.641), admission to the NICU (p = 0.368), or a 5-min Apgar score of <7 (p = 1.00). However, the number of neonates who were small for gestational age (p = 0.021) and rates of induction of labor (p < 0.001) were significantly higher in the borderline group. Multiple logistic regression analysis showed that borderline AFI was not associated with cesarean delivery for non-reassuring fetal heart rate testing (odds ratio [OR] = 0.72, 95% confidence interval [CI] 0.27-1.91, p = 0.52). In uncomplicated term pregnancies, a borderline AFI does not increase the risk of adverse perinatal outcomes.

Community and federal collaboration to assess pregnancy outcomes in Alaska Native women, 1997-2005.

PubMed

Kim, Shin Y; England, Lucinda J; Shapiro-Mendoza, Carrie K; Wilson, Hoyt G; Klejka, Joseph; Tucker, Myra; Lewis, Claire; Kendrick, Juliette S

2014-04-01

The objectives are to report the estimated prevalence of pregnancy complications and adverse pregnancy outcomes in a defined population of Alaska Native women and also examine factors contributing to an intensive and successful collaboration between a tribal health center and the Centers for Disease Control and Prevention. Investigators abstracted medical record data from a random sample of singleton deliveries to residents of the study region occurring between 1997 and 2005. We used descriptive statistics to estimate the prevalence and 95% confidence intervals of selected pregnancy complications and adverse pregnancy outcomes. Records were examined for 505 pregnancies ending in a singleton delivery to 469 women. Pregnancy complication rates were 5.9% (95% CI 4.0, 8.4) for gestational diabetes mellitus, 6.1% (95% CI 4.2, 8.6%) for maternal chronic hypertension and 11.5% (95% CI 8.8, 14.6) for pregnancy associated hypertension, and 22.9% (95% CI 19.2-26.5 %) for anemia. The cesarean section rate was 5.5% (95% CI 3.5, 7.5) and 3.8% (95% CI 2.3, 5.8) of newborns weighed >4,500 g. Few previous studies reported pregnancy outcomes among Alaska Native women in a specific geographic region of Alaska and regarding the health needs in this population. We highlight components of our collaboration that contributed to the success of the study. Studies focusing on special populations such as Alaska Native women are feasible and can provide important information on health indicators at the local level.

Pregnancy after hydrosalpinx treatment with Essure

PubMed Central

Inocêncio, Gonçalo; Coutinho, Lúcia; Maciel, Raquel; Barreiro, Márcia

2013-01-01

We present a case of a 29-year-old woman, with a history of ectopic pregnancy, which required left salpingectomy, and with a tortuous and impermeable right fallopian tube, compatible with hydrosalpinx. As hydrosalpinx itself can compromise a future pregnancy, treatment with Essure was proposed before passing to medically assisted procreation techniques. Five months after placement of Essure in the right fallopian tube, an in vitro fertilisation cycle was successfully completed and the woman had a singleton pregnancy and vaginal delivery without intercurrences. PMID:23536627

Following the 2009 American Institute of Medicine recommendations for normal body mass index and overweight women led to an increased risk of fetal macrosomia among Taiwanese women.

PubMed

Tsai, Yieh-Loong; Chong, Kian-Mei; Seow, Kok-Min

2013-09-01

This study aimed to investigate the risk of birth weights over 4000 g (macrosomia) in association with following the 2009 American Institute of Medicine (AIOM) recommendations. Seventy-six nondiabetic women who delivered a singleton, term macrosomic fetus and 82 women who delivered a singleton, term fetus weighing <4000 g were analyzed retrospectively. The relationship between the risk of macrosomia and gestational weight gain in different periods of pregnancy was investigated using logistic regression. The incidence of macrosomia from January 2008 to December 2009 was 1.8% among the Taiwanese women. The incidences of cesarean delivery (54.5% vs. 18.2%, p < 0.001) and blood loss >1000 mL at delivery (35.5% vs. 6.1%, p < 0.0001) were associated with macrosomia. The risk of macrosomia among normal weight women with gestational weight gain greater than 13 kg increased four-fold [odds ratio (OR) = 4.88; 95% confidence interval (CI) 1.84-12.90]. For overweight women with total gestational weight gain >11.5 kg, the risk of macrosomia increased nine-fold (OR = 9.63; 95% CI 1.76-52.74). Macrosomia resulted in more cesarean deliveries and greater maternal blood loss at birth. In Taiwan, to prevent macrosomia, we suggest that the total gestational weight gain should be <11.5 kg among normal weight women and within 10 kg for overweight women. Copyright © 2013. Published by Elsevier B.V.

Lifestyle and Pregnancy Loss in a Contemporary Cohort of Women Recruited Prior to Conception, LIFE Study

PubMed Central

Buck Louis, Germaine M.; Sapra, Katherine J.; Schisterman, Enrique F.; Lynch, Courtney D.; Maisog, José M.; Grantz, Katherine L.; Sundaram, Rajeshwari

2016-01-01

Objective To estimate pregnancy loss incidence in a contemporary cohort of couples whose lifestyles were measured during sensitive windows of reproduction to identify factors associated with pregnancy loss for the continual refinement of preconception guidance. Design Prospective cohort with preconception enrollment. Setting 16 counties in Michigan and Texas. Patients 344 couples with a singleton pregnancy followed daily through 7 post-conception weeks of gestation. Interventions None. Daily, couples recorded use of cigarettes, caffeinated and alcoholic beverages, and multivitamins. Women used fertility “monitors” for ovulation detection and digital pregnancy tests. Pregnancy loss was denoted by conversion to a negative pregnancy test, onset of menses or clinical confirmation depending upon gestation. Using proportional hazards regression and accounting for right censoring, we estimated adjusted hazard ratios and 95% confidence intervals (aHR; 95% CI) for couples’ lifestyles (cigarette smoking, alcoholic and caffeinated drinks, multivitamins) during three sensitive windows: preconception, early pregnancy and periconception. Main outcomes measured Incidence and risk factors for pregnancy loss. Results 98/344 (28%) women with a singleton pregnancy experienced an observed pregnancy loss. In the preconception window, loss was associated with female age ≥35 years (1.96; 1.13-3.38) accounting for couples’ ages, female and male consumption >2 daily caffeinated beverages (1.74; 1.07-2.81 and 1.73; 1.10-2.72, respectively), and females’ vitamin adherence (0.45; 0.25-0.80). The findings were similar for lifestyle during the early pregnancy and periconception windows. Conclusions Couples’ preconception lifestyle factors were associated with pregnancy loss, though women’s multivitamin adherence dramatically reduced risk. The findings support continual refinement and implementation of preconception guidance. PMID:27016456

Lifestyle and pregnancy loss in a contemporary cohort of women recruited before conception: The LIFE Study.

PubMed

Buck Louis, Germaine M; Sapra, Katherine J; Schisterman, Enrique F; Lynch, Courtney D; Maisog, José M; Grantz, Katherine L; Sundaram, Rajeshwari

2016-07-01

To estimate pregnancy loss incidence in a contemporary cohort of couples whose lifestyles were measured during sensitive windows of reproduction to identify factors associated with pregnancy loss for the continual refinement of preconception guidance. Prospective cohort with preconception enrollment. Sixteen counties in Michigan and Texas. Three hundred forty-four couples with a singleton pregnancy followed daily through 7 postconception weeks of gestation. None. Couples daily recorded use of cigarettes, caffeinated and alcoholic beverages, and multivitamins. Women used fertility monitors for ovulation detection and digital pregnancy tests. Pregnancy loss was denoted by conversion to a negative pregnancy test, onset of menses, or clinical confirmation depending upon gestation. Using proportional hazards regression and accounting for right censoring, we estimated adjusted hazard ratios and 95% confidence intervals (aHR, 95% CI) for couples' lifestyles (cigarette smoking, alcoholic and caffeinated drinks, multivitamins) during three sensitive windows: preconception, early pregnancy, and periconception. Incidence and risk factors for pregnancy loss. Ninety-eight of 344 (28%) women with a singleton pregnancy experienced an observed pregnancy loss. In the preconception window, loss was associated with female age ≥35 years (1.96, 1.13-3.38) accounting for couples' ages, women's and men's consumption of >2 daily caffeinated beverages (1.74, 1.07-2.81; and 1.73, 1.10-2.72, respectively), and women's vitamin adherence (0.45, 0.25-0.80). The findings were similar for lifestyle during the early pregnancy and periconception windows. Couples' preconception lifestyle factors were associated with pregnancy loss, although women's multivitamin adherence dramatically reduced risk. The findings support continual refinement and implementation of preconception guidance. Published by Elsevier Inc.

Risk of stillbirth and infant deaths after assisted reproductive technology: a Nordic study from the CoNARTaS group.

PubMed

Henningsen, A A; Wennerholm, U B; Gissler, M; Romundstad, L B; Nygren, K G; Tiitinen, A; Skjaerven, R; Nyboe Andersen, A; Lidegaard, Ø; Forman, J L; Pinborg, A

2014-05-01

Is the risk of stillbirth and perinatal deaths increased after assisted reproductive technology (ART) compared with pregnancies established by spontaneous conception (SC)? A significantly increased risk of stillbirth in ART singletons was only observed before 28 + 0 gestational weeks. The current literature indicates that children born after ART have an increased risk of perinatal death. The knowledge on stillbirth in ART pregnancies is limited. A population based case-control study. A total of 62 485 singletons and 29 793 twins born after ART in Denmark, Finland, Norway and Sweden, from 1982 to 2007, were compared with 362 798 spontaneously conceived (SC) singletons and 132 181 twins. The adjusted rate ratio for stillbirth at gestational weeks 22 + 0 to 27 + 6 was 2.08 [95% confidence interval (CI) 1.55-2.78] for ART versus SC singletons. After 28 + 0 gestational weeks there was no significant difference in the risk of stillbirth between ART and SC singletons. ART twins had a lower risk of stillbirth compared with SC twins, but when restricting the analysis to opposite-sex twins and excluding all monozygotic twins, there was no significant difference between the groups. Singletons conceived by ART had an overall increased risk of early neonatal death (adjusted odds ratio 1.54, 95% CI 1.28-1.85) and death within the first year after birth (1.45, 1.26-1.68). No difference regarding these two parameters was found when further adjusting for the gestational age [(0.97, 0.80-1.18) and (0.99, 0.85-1.16), respectively]. ART twins had a lower risk of early neonatal and infant deaths than SC twins, but no difference was found when restricting the analyses to opposite-sex twins. We were not able to adjust for potential confounders, such as a prior history of stillbirth, induction of labour, body mass index or smoking. The risk of stillbirth in ART versus SC singletons was only increased for very early gestational ages (before 28 weeks). This might indicate that the current clinical management of ART pregnancies is sufficient regarding prevention of stillbirth during the third trimester. No conflict of interest was reported. The European Society for Human Reproduction and Embryology (ESHRE), the University of Copenhagen, Denmark, the Danish Agency for Science, Technology and Innovation and Sahlgrenska University Hospital, Gothenburg, Sweden supported the project. The CoNARTaS group has received travel and meeting funding from the Nordic Society of Obstetrics and Gynecology (NFOG).

Singleton birth at term: an old alarm or a new debate?

PubMed

Hughes, Edward G

2015-10-01

In 2004, Human Reproduction published a debate series focusing on the rising tide of multiple pregnancy associated with IVF. The premise of the primary report in that debate was that by considering IVF outcomes differently-by focusing on healthy singleton birth at term rather than clinical pregnancy, the standard currency at that time-the necessary shift toward reduced numbers of embryos transferred might be accelerated. The choice of end-point in that debate-Birth Emphasizing a Successful Singleton at Term (BESST)-was not an effort to 'dumb down' the complex equation linking risks and benefits. That balance is a dynamic and various mix of issues that clinicians discuss with patients on a daily basis. And BESST was certainly not proposed as a new primary outcome for application to other treatment modalities in reproductive medicine, such as ovulation induction. It was simply a responsible and brave call for change in the accelerating and competitive world of IVF. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Twins: prevalence, problems, and preterm births.

PubMed

Chauhan, Suneet P; Scardo, James A; Hayes, Edward; Abuhamad, Alfred Z; Berghella, Vincenzo

2010-10-01

The rate of twin pregnancies in the United States has stabilized at 32 per 1000 births in 2006. Aside from determining chorionicity, first-trimester screening and second-trimester ultrasound scanning should ascertain whether there are structural or chromosomal abnormalities. Compared with singleton births, genetic amniocentesis-related loss at <24 weeks of gestation for twin births is higher (0.9% vs 2.9%, respectively). Selective termination for an anomalous fetus is an option, although the pregnancy loss rate is 7% at experienced centers. For singleton and twin births for African American and white women, approximately 50% of preterm births are indicated; approximately one-third of these births are spontaneous, and 10% of the births occur after preterm premature rupture of membranes. From 1989-2000, the rate of preterm twin births increased, for African American and white women alike, although the perinatal mortality rate has actually decreased. As with singleton births, tocolytics should be used judiciously and only for a limited time (<48 hours) in twin births. Administration of antenatal corticosteroids is an evidence-based recommendation. Copyright © 2010 Mosby, Inc. All rights reserved.

[Obstetric prognostic factors of newborn infants with very low birth weight (< or = 1,500 gram) with reference to survival rate and early childhood development].

PubMed

Hamm, W; Göhring, U J; Günther, M; Kribs, A; Neuhaus, W; Roth, B; Bolte, A

1995-03-01

Prognostic factors influencing survival in 235 very low birthweight prematures (< or = 1500 g) born between 1986 and 15.11. 1993 at the Department of Obstetrics and Gynaecology, University Hospital of Cologne, were retrospectively evaluated. Chromosomal anomalies and severe congenital malformations were excluded. Of 180 singletons 84 were classified as appropriate-for-gestational-age (AGA) and 96 as small-for-gestational-age (SGA). By interrogating the attending paediatricians data regarding the early development of 62/65 surviving singletons born between 1986 to 1990 were recorded (follow-up rate 95%). Survival was significantly correlated to singleton pregnancy (p < 0.05), female sex (p = 0.001) and in the AGA-prematures to prenatal corticoid prophylaxis. With similar mean birthweight SGA-singletons showed a three weeks higher mean gestational age; the mortality showed an inverse correlation to birthweight and gestational age being 11% higher in the AGA-group compared with the SGA-group (32% versus 21%). At the age of between 11 months and 6 years severe handicaps and developmental retardations were found more often in previous AGA-prematures (6/26) than in previous SGA-prematures (4/36); type and degree of later handicap were not correlated to birthweight. According to our results survival rates of very low birthweight prematures are strongly influenced by singleton pregnancy, by fetal sex, by gestational age and in the AGA-group by prenatal corticoid prophylaxis; mortality shows an inverted correlation to birthweight and gestational age, whereas the later prognosis of survivors does not seem to be influenced by birthweight or gestational age.

A retrospective comparison of pregnancy outcomes between women with alpha-thalassaemia 1 trait and normal controls.

PubMed

Traisrisilp, Kuntharee; Jatavan, Phudit; Tongsong, Theera

2017-11-01

The objective of this retrospective cohort study was to compare pregnancy outcomes between low-risk pregnant women with alpha-thalassaemia-1 trait and normal controls. The database of the Maternal-Foetal Medicine unit was used to identify low-risk singleton pregnant women complicated by alpha-thalassaemia-1 trait who gave birth between January 2002 and October 2014. The low-risk pregnancies with non-carrier status for thalassaemia were assigned into the control group, with a control-to-case ratio of 10:1. During the study period, 595 women with alpha-thalassaemia-1 trait and 5950 normal controls were identified. There was no significant difference in the incidence of preterm birth and most obstetric outcomes between the two groups. However, a statistically significant difference was detected between them in terms of gestational age at delivery, 37.76 ± 2.81 vs. 38.11 ± 2.50 weeks (p = .001), birth weight, 2876 ± 581 vs. 2948 ± 527 g (p = .002) as well as the rate of low-birth weight, 17.1 vs. 12.8% (p = .002). In conclusion, this study provides new insights that alpha-thalassaemia-1 trait has minimal effect on gestational age at delivery and low-birth weight whereas other common adverse pregnancy outcomes are not increased. Impact statement What is already known on this subject: Thalassaemia trait is associated with some degree of anaemia. What the results of this study add: The prevalence of common adverse outcomes such as preterm birth, stillbirth, low Apgar scores and pregnancy-induced hypertension were not significantly different between both the groups, possibly caused by too small sample size to gain enough power. However, the rate of low-birth weight was significantly increased among pregnancy with alpha-thalassaemia-1 trait. What the implications are of these findings for clinical practice and/or further research: The information may be provided for alpha thalassaemia-1 trait mothers and their families. Physicians should guard against the occurrence of adverse pregnancy in these mothers. Prospective control study should be conducted to overcome the limitation of retrospective nature.

Associations of the pre-pregnancy body mass index and gestational weight gain with pregnancy outcomes in Taiwanese women.

PubMed

Tsai, I-Hsien; Chen, Chih-Ping; Sun, Fang-Ju; Wu, Chia-Hsun; Yeh, Sung-Ling

2012-01-01

Pre-pregnancy weight and gestational weight gain (GWG) are important factors in both maternal and infant outcomes. Little information is available in relation to different levels of pre-pregnancy body mass index (BMI) and body weight gain on obstetric outcomes in Taiwan. This study investigated the associations between pregnancy complications with pre-pregnant BMI and GWG, in Taiwanese women. Data were extracted from a delivery room information bank on all women delivering singleton babies in a medical center. Eight hundred and sixty pregnant women were included. The collected variables included basic information, GWG, and pregnancy and neonatal outcomes. Pregnant women were categorized according to their pre-pregnant BMI and GWG to evaluate the impacts of pre-pregnant BMI and maternal weight gain on the risk of pregnancy complications. Univariate and multivariable logistic regression analyses were performed, and odds ratios were calculated. Pre-pregnancy BMI>=24 kg/m2 increased the risks of gestational diabetes mellitus, preeclampsia, and preterm labor. Preeclampsia and Cesarean delivery were positively associated with high weight gains (>18 kg), whereas a low birth weight and preterm labor were strongly associated with low weight gains (<10 kg). A higher birth weight was found with a GWG of >14 kg in women who were underweight and normal weight before pregnancy. An appropriate maternal BMI (18.5-24 kg/m2) at conception followed by a suitable gestational weight gain (10-14 kg) has substantial impact on the overall health of pregnant women and would lead to better obstetric management for Taiwanese women.

Second trimester fetal nasal bone length in a low-risk Turkish population.

PubMed

Yanik, Filiz Fatma; Eroglu, Derya; Baser, Eralp; Dursun, Polat; Karakaya, Burcu Kisa

2011-10-01

To define normal values of second trimester fetal nasal bone length (NBL) in a low-risk Turkish population. Prenatal records of singleton fetuses who underwent second trimester ultrasonographic examination in the 16 to 23 weeks of pregnancy were retrospectively analyzed for NBL and biometric measurements (BPD, FL and HL). The relationship among NBL and gestational age (GA), biparietal diameter (BPD), femur length (FL) and humerus length (HL) was determined. Additionally, percentile values of NBL for each gestational week were provided. A total of 1467 fetuses were included in this study. There was a significant linear association among NBL and GA (R(2) = 0.709), BPD (R(2) = 0.752), FL (R(2) = 0.742) and HL (R(2) = 0.747). Fifth percentile values of fetal NBL were 3.11 mm for 16th, 3.50 mm for 17th, 3.70 mm for 18th, 4.10 mm for 19th, 4.50 mm for 20th, 4.62 mm for 21st, 5.24 mm for 22nd and 5.37 mm for 23rd gestational weeks. The study provides normal ranges of NBL between 16 and 23 weeks of pregnancy in a low-risk Turkish population. Future studies with larger sample sizes including pregnancies carrying high risk for aneuploidy are needed to define cut-off values for NBL. Copyright © 2011 John Wiley & Sons, Ltd.

Neonatal hypoglycemia in term, nondiabetic pregnancies.

PubMed

DePuy, Amy M; Coassolo, Kara M; Som, Dara A; Smulian, John C

2009-05-01

To define the incidence of hypoglycemia and identify risk factors in neonates from term, singleton, nondiabetic pregnancies. We conducted a matched case-control study of term, singleton infants weighing more than 2500 g in nondiabetic pregnancies. Cases with hypoglycemia (glucose < 50 mg/dL) were identified by International Classification of Diseases, ninth revision, codes. Two controls per case were matched on race, maternal age, and birthweight. Conditional logistic regression analyses were performed. There were 116 cases and 232 controls studied. The incidence density of neonatal hypoglycemia was 24.7 per 1000 infant-days at risk. Hypoglycemia was less commonly associated with later gestational age (odds ratio [OR], 0.66; 95% confidence interval [CI], 0.53-0.85 per week of gestation). Maternal fever during labor was more common with hypoglycemia (OR, 4.08; 95% CI, 1.39-11.79). Public insurance was more than twice as common with hypoglycemia compared with those privately insured (OR, 2.31; 95% CI, 1.17-4.58). Neonatal hypoglycemia was associated with earlier gestational age, intrapartum fever, and public insurance.

Maternal hyperuricemia in normotensive singleton pregnancy, a prenatal finding with continuous perinatal and postnatal effects, a prospective cohort study

PubMed Central

2014-01-01

Background To assess the association of maternal hyperuricemia with adverse pregnancy outcome and neonatal metabolic, neurologic and respiratory disturbances in normotensive singleton pregnant women. Method This prospective multicentric cohort study was conducted on 404 normotensive singleton pregnant women who were admitted for delivery in Vali-Asr and Akbar-Abadi teaching hospitals of Tehran University of Medical Sciences, Tehran, Iran. Upon enrollment maternal and umbilical sera were obtained for determining uric acid levels. 1 and 5 minutes Apgar scores, the need for neonatal resuscitation and neonatal intensive care unit (NICU) admission were recorded. In case of NICU admission a neonatal blood sample was drawn for determining uric acid, blood sugar and bilirubin levels. An intracranial ultrasound imaging was also carried out for the admittd neonates for detecting intraventricular hemorrhage. Results Maternal hyperuricemia (uric acid one standard deviation greater than the appropriate gestational age) was independently associated with preterm birth (odds ratio (OR), 3.17; 95% confidence interval (CI), 2.1 – 4.79), small for gestational age delivery (OR, 1.28; 95% CI, 1.04 – 2.57), NICU admission (OR, 1.65; 95% CI, 1.12 – 2.94) and neonatal IVH (OR, 8.14; 95% CI, 1.11 – 87.1). Conclusions Maternal hyperuricemia in normotensive singleton pregnant women is significantly associated with preterm and SGA delivery and the development of neonatal IVH. PMID:24636149

A Systematic Review on Normative Values of Trimester-specific Thyroid Function Tests in Indian Women.

PubMed

Kannan, Subramanian; Mahadevan, Shriraam; Sigamani, Alben

2018-01-01

Small cross-sectional studies are published on the trimester-specific normal ranges of thyrotropin and thyroxine levels in Indian women from various parts of the country. We sought to review the published literature on thyroid function tests in normal pregnant Indian women to see if the pooled data from various studies can define normative data and hypothyroidism in pregnancy. We retrieved 56 studies from online databases with detailed search using multiple search terms. Unanimously eight studies were finalized. Data of 2703 pregnant women (age 16-45 years; 966 were in the first trimester, 1072 in their second trimester, and 1037 women in their third trimester) were analyzed. All eight studies included singleton pregnancies from the northern and eastern part of India with seven studies being cross-sectional in nature. The exclusion criteria in all studies included those with historical/clinical evidence of thyroid dysfunction, those with family history of thyroid dysfunction, infertility and those with history of recurrent miscarriages (usually >3). Ultrasound evidence of thyroid disease, urinary iodine assessment, and thyroid antibodies were included as additional exclusion criteria in two, three, and four studies, respectively. None of the studies included the outcome of pregnancy as part of follow-up. As part of the pooled data analysis, the 5 th -95 th centile values of normal TSH extended from 0.09 to 6.65 IU/mL in the first trimester, 0.39-6.61 IU/mL in the second trimester, and 0.70-5.18 IU/mL in the third trimester. The FT4 levels (5 th -95 th centile values) extended from 8.24 to 25.74 pmol/L in the first trimester, 6.82-26.0 pmol/L, and 5.18-25.61 pmol/L in the third trimester. With due limitations imposed by the quality of the available studies, the current review suggests that upper normal limit of TSH values can extend up to 5-6 IU/mL in pregnancy.

The type of culture medium and the duration of in vitro culture do not influence birthweight of ART singletons.

PubMed

De Vos, A; Janssens, R; Van de Velde, H; Haentjens, P; Bonduelle, M; Tournaye, H; Verheyen, G

2015-01-01

Does the type of in vitro culture medium or the duration of in vitro culture influence singleton birthweight after IVF/ICSI treatment? In a comparison of two culture media, neither the medium nor the duration of culture (Day 3 versus Day 5 blastocyst transfer) had any effect on mean singleton birthweight. Previous studies indicated that in vitro culture of human embryos may affect birthweight of live born singletons. Both the type of culture medium and the duration of culture may be implicated. However, these studies are small and report conflicting results. A large retrospective analysis was performed including all singleton live births after transferring fresh Day 3 or Day 5 embryos. IVF and ICSI cycles performed between April 2004 and December 2009 at a tertiary care centre were included for analysis. A total of 2098 singleton live births resulting from singleton pregnancies were included for analysis. Two different sequential embryo culture media were concurrently used in an alternating way: Medicult (n = 1388) and Vitrolife (n = 710). Maternal age, maternal and paternal BMI, maternal parity, maternal smoking, main cause of infertility, cycle rank, stimulation protocol, method of fertilization (IVF or ICSI), time in culture and number of embryos transferred were taken into account. Embryo transfers were performed either on Day 3 (n = 1234) or on Day 5 (n = 864). Singleton birthweight was the primary outcome parameter. Gestational age and gender of the newborn were accounted for in the multiple regression analysis. No significant differences in mean singleton birthweight were observed between the two culture media: Medicult 3222 g (±15 SE) and Vitrolife 3251 g (±21 SE) (P = 0.264). The mean singleton birthweight was not different between Day 3 embryo transfers (3219 ± 16 g) and Day 5 blastocyst transfers (3250 ± 19 g; P = 0.209). Multiple regression analysis controlling for potential maternal, paternal, treatment and newborn confounders confirmed the non-significant differences in mean singleton birthweight between the two culture media. Likewise, the adjusted mean singleton birthweight was not different according to the duration of in vitro culture (P = 0.521). The conclusions are limited by its retrospective design; however, the two different sequential culture systems were used in an alternating way during the same time period. Pregnancy-associated factors possibly influencing birthweight (such as diabetes, hypertension, pre-eclampsia) were not included in the analysis. This large retrospective study does not support earlier concerns that both the type of culture medium and the duration of embryo culture influence singleton birthweight. However, a continuous surveillance of human embryo culture procedures (medium type, culture duration and other culture conditions) should remain a priority within assisted reproduction technology. None. © The Author 2014. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Accelerated fetal growth in early pregnancy and risk of severe large-for-gestational-age and macrosomic infant: a cohort study in a low-risk population.

PubMed

Simic, Marija; Wikström, Anna-Karin; Stephansson, Olof

2017-10-01

Our objective was to examine the association between fetal growth in early pregnancy and risk of severe large-for-gestational-age (LGA) and macrosomia at birth in a low-risk population. Cohort study that included 68 771 women with non-anomalous singleton pregnancies, without history of diabetes or hypertension, based on an electronic database on pregnancies and deliveries in Stockholm-Gotland Region, Sweden, 2008-2014. We performed multivariable logistic regression to estimate the association between accelerated fetal growth occurring in the first through early second trimester as measured by ultrasound and LGA and macrosomia at birth. Restricted analyses were performed in the groups without gestational diabetes and with normal body mass index (18.5-24.9 kg/m 2 ). When adjusting for confounders, the odds of having a severely LGA or macrosomic infant were elevated in mothers with fetuses that were at least 7 days larger than expected as compared with mothers without age discrepancy at the second-trimester scan (adjusted odds ratio 1.80; 95% CI 1.23-2.64 and adjusted odds ratio 2.15; 95% CI 1.55-2.98, respectively). Additionally, mothers without gestational diabetes and mothers with normal weight had an elevated risk of having a severely LGA or macrosomic infant when the age discrepancy by second-trimester ultrasound was at least 7 days. In a low-risk population, ultrasound-estimated accelerated fetal growth in early pregnancy was associated with an increased risk of having a severely LGA or macrosomic infant. © 2017 Nordic Federation of Societies of Obstetrics and Gynecology.

Assisted reproduction and risk of preterm birth in singletons by infertility diagnoses and treatment modalities: a population-based study.

PubMed

Dunietz, Galit Levi; Holzman, Claudia; Zhang, Yujia; Li, Chenxi; Todem, David; Boulet, Sheree L; McKane, Patricia; Kissin, Dmitry M; Copeland, Glenn; Bernson, Dana; Diamond, Michael P

2017-11-01

The purpose of this study is to examine the spectrum of infertility diagnoses and assisted reproductive technology (ART) treatments in relation to risk of preterm birth (PTB) in singletons. Population-based assisted reproductive technology surveillance data for 2000-2010 were linked with birth certificates from three states: Florida, Massachusetts, and Michigan, resulting in a sample of 4,370,361 non-ART and 28,430 ART-related singletons. Logistic regression models with robust variance estimators were used to compare PTB risk among singletons conceived with and without ART, the former grouped by parental infertility diagnoses and treatment modalities. Demographic and pregnancy factors were included in adjusted analyses. ART was associated with increased PTB risk across all infertility diagnosis groups and treatment types: for conventional ART, adjusted relative risks ranged from 1.4 (95% CI 1.0, 1.9) for male infertility to 2.4 (95% CI 1.8, 3.3) for tubal ligation. Adding intra-cytoplasmic sperm injection and/or assisted hatching to conventional ART treatment did not alter associated PTB risks. Singletons conceived by mothers without infertility diagnosis and with donor semen had an increased PTB risk relative to non-ART singletons. PTB risk among ART singletons is increased within each treatment type and all underlying infertility diagnosis, including male infertility. Preterm birth in ART singletons may be attributed to parental infertility, ART treatments, or their combination.

Determinants of Maternal Sex Steroids During the First Half of Pregnancy

PubMed Central

Toriola, Adetunji T; Vääräsmäki, Marja; Lehtinen, Matti; Zeleniuch-Jacquotte, Anne; Lundin, Eva; Rodgers, Kenneth-Gary; Lakso, Hans-Ake; Chen, Tianhui; Schock, Helena; Hallmans, Goran; Pukkala, Eero; Toniolo, Paolo; Grankvist, Kjell; Surcel, Helja-Marja; Lukanova, Annekatrin

2011-01-01

Objective To examine the associations of maternal and child characteristics with early pregnancy maternal concentrations of testosterone, androstenedione, progesterone, 17-hydroxyprogesterone and estradiol. Methods We analyzed these hormones among 1,343 women with singleton pregnancies who donated serum samples to the Finnish Maternity Cohort from 1986 to 2006 during the first half of pregnancy (median, 11 weeks). The associations of maternal and child characteristics with hormone concentrations were investigated by correlation and multivariable regression. Results Women above age 30 had lower androgen and estradiol but higher progesterone concentrations than women below that age. Multiparous women had 14% lower testosterone, 11% lower androstenedione and 17-hydroxyprogesterone, 9% lower progesterone, and 16% lower estradiol concentrations compared to nulliparous women (all P<.05). Smoking mothers had 11%, 18%, and 8% higher testosterone, androstenedione, and 17-hydroxyprogesterone levels, respectively, but 10% lower progesterone compared to non-smoking women (all P<.05). Estradiol concentrations were 9% higher (P<0.05) among women with a female fetus compared to those with a male fetus. Conclusions Parity, smoking, and to a lesser extent maternal age and child gender are associated with sex steroid levels during the first half of a singleton pregnancy. The effects of smoking on the maternal hormonal environment and the possible long-term deleterious consequences on the fetus deserve further evaluation. PMID:22015870

The biologic error in gestational length related to the use of the first day of last menstrual period as a proxy for the start of pregnancy.

PubMed

Nakling, Jakob; Buhaug, Harald; Backe, Bjorn

2005-10-01

In a large unselected population of normal spontaneous pregnancies, to estimate the biologic variation of the interval from the first day of the last menstrual period to start of pregnancy, and the biologic variation of gestational length to delivery; and to estimate the random error of routine ultrasound assessment of gestational age in mid-second trimester. Cohort study of 11,238 singleton pregnancies, with spontaneous onset of labour and reliable last menstrual period. The day of delivery was predicted with two independent methods: According to the rule of Nägele and based on ultrasound examination in gestational weeks 17-19. For both methods, the mean difference between observed and predicted day of delivery was calculated. The variances of the differences were combined to estimate the variances of the two partitions of pregnancy. The biologic variation of the time from last menstrual period to pregnancy start was estimated to 7.0 days (standard deviation), and the standard deviation of the time to spontaneous delivery was estimated to 12.4 days. The estimate of the standard deviation of the random error of ultrasound assessed foetal age was 5.2 days. Even when the last menstrual period is reliable, the biologic variation of the time from last menstrual period to the real start of pregnancy is substantial, and must be taken into account. Reliable information about the first day of the last menstrual period is not equivalent with reliable information about the start of pregnancy.

Variations from morning to afternoon of middle cerebral and umbilical artery blood flow, and fetal heart rate variability, and fetal characteristics in the normally developing fetus.

PubMed

Avitan, Tehila; Sanders, Ari; Brain, Ursula; Rurak, Dan; Oberlander, Tim F; Lim, Ken

2018-05-01

To determine if there are changes in maternal uterine blood flow, fetal brain blood flow, fetal heart rate variability, and umbilical blood flow between morning (AM) and afternoon (PM) in healthy, uncomplicated pregnancies. In this prospective study, 68 uncomplicated singleton pregnancies (mean 35 + 0.7 weeks gestation) underwent a standard observational protocol at both 08:00 (AM) and 13:30 (PM) of the same day. This protocol included Doppler measurements of uterine, umbilical, and fetal middle cerebral artery (MCA) volume flow parameters (flow, HR, peak systolic velocity [PSV], PI, and RI) followed by computerized cardiotocography. Standard descriptive statistics, χ 2 and t tests were used where appropriate. P < .05 was considered significant. A significant increase in MCA flow and MCA PSV was observed in the PM compared to the AM. This was accompanied by a fall in MCA resistance. Higher umbilical artery resistance indices were also observed in the PM compared to AM. In contrast, fetal heart rate characteristics, maternal uterine artery Doppler flow and resistance indices did not vary significantly between the AM and PM. In normal pregnancies, variations in fetal cerebral and umbilical blood flow parameters were observed between AM and PM independent of other fetal movements or baseline fetal heart rate. In contrast, uterine flow parameters remained stable across the day. These findings may have implications for the use of serial Doppler parameters used to guide clinical management in high-risk pregnancies. © 2017 Wiley Periodicals, Inc.

The relationship of initial embryo crown--rump length to pregnancy outcome and abortus karyotype based on new growth curves for the 2-31 mm embryo.

PubMed

Dickey, R P; Gasser, R F; Olar, T T; Curole, D N; Taylor, S N; Matulich, E M; West, J D; Tsien, F

1994-02-01

The objective of this study was to determine if measurement of initial crown--rump length (CRL) is helpful in predicting low birth weight, newborn length, spontaneous abortions, or abortus karyotype. We measured CRL prospectively in 837 consecutive singleton pregnancies at the time a heart rate was first detectable with transvaginal ultrasonography and compared these measurements to normal values for the 10th through 90th centiles determined from 227 transvaginal ultrasound measurements in in-vitro fertilization and gamete intra-Fallopian transfer pregnancies with known ovulation dates. The relationship of initial CRL to birth weight and length and to abortion and abortus karyotype was analysed after all pregnancies had delivered. Initial CRL measured after the 28th post-ovulation day was predictive of subsequent abortion, but not of low birth weight or length. The abortion rate was 3.3% [95% confidence interval (CI) 1.5%, 5.1%] when initial CRL > or = 50th centile, compared to 19.4% (95% CI 15.4%, 23.4%) when < 50th centile. Initial CRL was < 50th centile in 13 out of 14 trisomic and in eight out of 10 other karyotypically abnormal aborti. These results indicate that initial CRL measured after the 28th post-ovulation day may help to identify pregnancies at increased risk of abortion due to abnormal karyotypes.

Should multifetal pregnancy reduction be used for prevention of preterm deliveries in triplet or higher order multiple pregnancies?

PubMed

Papiernik, E; Grangé, G; Zeitlin, J

1998-01-01

This article reviews the arguments for the use of multifetal pregnancy reduction (MFPR) for the prevention of preterm deliveries in triplet and higher order multiple pregnancies and evaluates its effectiveness based on data from published studies. The arguments in favour of pregnancy reduction are based on the substantial mortality and morbidity associated with these pregnancies. Triplets and higher order multiples have increased rates of preterm delivery and intrauterine growth retardation, both of which are independent risk factors for death and handicap. Even controlling for gestational age, rates of mortality and handicap are higher for multiples than for singletons. Moreover, the family's risk of losing a child or having a handicapped child is greater because there are more infants at risk. MFPR effectively lowers these risk by reducing the frequency of preterm delivery. However, its effectiveness may be limited. In some studies, the proportion of preterm deliveries in reduced pregnancies remains above levels found in spontaneous twin or singleton pregnancies and MFPR does not appear to reduce the prevalence of low birth weight. Furthermore, the procedure itself has unwanted side effects: it increases the risk of miscarriage, premature rupture of the membranes and causes adverse psychological effects such as grief or depression for many patients. The authors note that a majority of the higher order multiple pregnancies result from a medical intervention in the first place, either through IVF techniques or the use of ovulation stimulation drugs. Although MFPR is an effective measure for reducing the substantial morbidity and mortality associated with higher order multiple pregnancies, preventive methods, such as limiting to 2 the number of embryos transferred for IVF and better control of the use of ovulation induction drugs, remain more effective and less intrusive.

Between pregnancy biological variability of first trimester markers of Down syndrome and the implications for screening in subsequent pregnancies: an issue revisited.

PubMed

Spencer, Kevin

2002-10-01

To assess the level of correlation of first trimester biochemical and biophysical markers of Down syndrome between different pregnancies in the same individual. To assess the impact that between pregnancy biological variability has on the likelihood that women who are at increased risk in a first pregnancy being also at increased risk in a subsequent pregnancy. During a three period women attending the OSCAR clinic at Harold Wood Hospital have had the opportunity to have first trimester screening for Down syndrome and other aneuploidies using the maternal serum biochemical markers free beta-human chorionic gonadotrophin (hCG) and pregnancy associated plasma protein-A (PAPP-A) in conjunction with fetal nuchal translucency (NT) thickness and maternal age. Of the 111,105 women undergoing such screening, the computer records were examined for women who had more than one pregnancy. The results from 1002 women with two normal singleton pregnancies were available for analysis. Marker correlations (as MoM) were established between the pregnancies and the proportion of women likely to be at increased risk in each pregnancy estimated, as was the likelihood of women being at increased risk in both pregnancies. For fetal NT there was no correlation between NT MoM in the first and second pregnancy (r = 0.0959, p > 0.10). For maternal serum free beta-hCG MoM a significant correlation was found (r = 0.3976, p < 0.001), as was also found for PAPP-A MoM (r = 0.4371, p < 0.001). The implication for such between pregnancy marker association is that women who have an increased risk of Down syndrome in one pregnancy are two or three times more likely to repeat this event in their next pregnancy. This information may be useful in counselling women when undergoing first trimester screening in a subsequent pregnancy. Copyright 2002 John Wiley & Sons, Ltd.

Childhood and adult cancer in twins: evidence from the Utah genealogy.

PubMed

Neale, Rachel E; Mineau, Geraldine; Whiteman, David C; Brownbill, Pat A; Murphy, Michael F G

2005-05-01

Evidence suggests that the in utero environment may contribute to subsequent development of cancers in childhood and adulthood. Raised levels of estrogen during pregnancy may be the primary in utero etiologic factor. Mothers of twins have higher estrogen levels during pregnancy than mothers of singletons, therefore, assessment of cancer risk in twins may be informative. We conducted a retrospective cohort study of cancer among twin and singleton newborns selected from the Utah Population Database, matched on birth year and sex. Cancer diagnoses were determined by linkage with the Utah state cancer register. Relative rates of all cancers in childhood and in adulthood in twins compared with singletons, and for specific cancers including testicular, breast and melanoma, were calculated using Poisson regression. Twin (35,271) and singleton (74,199) births were identified, among whom there were 336 and 691 cancer diagnoses, respectively. The relative risk (RR) of childhood cancer in twins compared with singletons was 0.82 [95% confidence interval (CI) 0.55-1.24] and of adult cancer was 1.06 (0.92-1.22). We found nonsignificant increases in risk among adult twins for cancers of the breast, prostate, testis, lymphatic system, thyroid, and large bowel. The largest departures from unity were for testicular cancer (RR 1.47; 95% CI, 0.73-2.95) and melanoma (RR 0.67; 95% CI, 0.42-1.06). These results are consistent with the body of evidence suggesting that twins have a reduced risk of cancer in childhood. Although there is no overall differential in adult cancer risk, these data support the hypothesis that the in utero environment may play an important role in specific cancers.

Poorer detection rates of severe fetal growth restriction in women of likely refugee background: A case for re-focusing pregnancy care.

PubMed

Biro, Mary Anne; East, Christine

2017-04-01

Severe fetal growth restriction (FGR) (< third centile) in a singleton pregnancy undelivered by 40 weeks is one of a number of Victorian Perinatal Services Performance Indicators, which aim to provide a measure of the quality and safety of maternity care. Women of refugee background have been found to have poorer perinatal outcomes compared to others and these outcomes can in part be explained by previous history. However, less access to and engagement with pregnancy care may also be contributing factors. This study examined the impact of likely refugee background on severe FGR in a singleton pregnancy undelivered by 40 weeks. A retrospective study was undertaken utilising data on women who gave birth to a severely growth-restricted infant at Monash Health during January 2013-July 2015. Unadjusted and adjusted analyses were undertaken to examine the association between the mother being of likely refugee background and severe FGR in singletons delivered after 40 weeks. There was an association between the mother being of likely refugee background and giving birth to a severely growth-restricted baby after 40 weeks with these mothers at two and half times the odds compared to mothers of non-refugee background (adjusted odds ratio 2.52; 95% confidence interval: 1.44-4.42). While detecting FGR is clinically challenging, our findings suggest that maternity services need to be supported to offer care tailored to the specific needs of vulnerable and disadvantaged populations. Providing quality, culturally responsive and accessible care is fundamental to addressing refugee maternal and perinatal health inequalities. © 2017 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Effect of pre-pregnancy body mass index on adverse pregnancy outcome in north of China.

PubMed

Liu, Xuemin; Du, Juan; Wang, Guixi; Chen, Zhenyu; Wang, Wei; Xi, Qi

2011-01-01

To investigate the effect of pre-pregnancy BMI on adverse maternal and neonatal outcomes in pregnancy women of northern China. We conducted a retrospective population-based cohort study of 5,047 singleton nulliparous pregnancies. The subjects were categorized into four groups by BMI-underweight (BMI < 18.5 kg/m(2)), normal (BMI 18.5-24 kg/m(2)), overweight (BMI 24-28 kg/m(2)) and obese (BMI ≥ 28 kg/m(2)). Logistic regression was used to adjust the potential confounder. Maternal and neonatal outcomes were evaluated with relative risks and 95% confidence intervals. 11.5, 63.4, 18.3, and 6.8% of the subjects were underweight, normal BMI, overweight and obese, respectively. Compared with women of normal BMI, the risk of the following outcomes was significantly increased in overweight and obese women and expressed as [adjusted RR (95% confidence interval)] respectively: pre-eclampsia [2.99 (2.21-4.06), 5.68 (3.97-8.11)]; gestational diabetes [2.49 (1.82-3.39), 4.35 (3.00-6.31)]; premature rupture of the membranes [1.64 (1.20-2.23), 1.73 (1.11-2.72)]; abruption placentae [1.84 (1.19-2.87), 2.79 (1.60-4.83)]; cesarian section [1.47 (1.27-1.70), 2.51 (1.97-3.20)]; postpartum hemorrhage [2.31 (1.51-3.54), 3.73 (2.37-5.04)]; perineal rupture [2.89 (1.44-5.81), 3.36 (1.55-7.30)]; large-for-gestational age [1.46 (1.02-2.08), 1.91 (1.17-3.10)]. However, anemia (2.54, 1.15-5.63), small-for-gestational age (1.67, 1.07-2.61) were significantly more common in the underweight group. The prevalence of overweight and obesity in women of northern China is much lower than in the Caucasian population or Chinese in Hong Kong. The increased maternal BMI is associated with many adverse pregnancy outcomes and its risk increases with the degree of obesity. Maternal underweight has a protective effect although increases the risk of having small-for-gestational age baby and anemia.

The Independent Importance of Pre-pregnancy Weight and Gestational Weight Gain for the Prevention of Large-for Gestational Age Brazilian Newborns.

PubMed

Mastroeni, Marco F; Czarnobay, Sandra A; Kroll, Caroline; Figueirêdo, Katherinne B W; Mastroeni, Silmara S B S; Silva, Jean C; Khan, Mohammad K A; Loehr, Sarah; Veugelers, Paul J

2017-04-01

Objectives To study the independent effect of pre-pregnancy weight, gestational weight gain (GWG), and other important risk factors on newborn birth weight. Methods Baseline data of 435 adult women and their singletons born between January and February 2012 at a public hospital in Brazil were used. Logistic regression was applied to determine the independent importance of pre-pregnancy weight and GWG for large for gestational age (LGA) newborns. Results Among all mothers, 37.9 % were overweight and obese before pregnancy and 45.3 % experienced excessive GWG. Among the newborns, 24.4 % were classified as LGA. Univariate analysis showed an association of family income, GWG, pre-pregnancy BMI and excessive GWG with LGA newborns. Smoking before and during pregnancy was associated with a decreased likelihood of giving birth to an LGA newborn compared to mothers who did not smoke. After adjustment for confounding variables, age at birth of first child, GWG, HbA1c and pre-pregnancy weight-GWG were significant and independent determinants of giving birth to an LGA newborn. Mothers with pre-pregnancy overweight and excessive GWG were more likely to deliver an LGA newborn (OR 2.54, P < 0.05) compared to mothers who were normal weight and experienced adequate GWG. Conclusions for Practice Age at first birth of child, GWG, HbA1c and pre-pregnancy overweight combined with excessive GWG are independent determinants of LGA newborns. The results of this study suggest that both primary prevention of overweight in women of childbearing age and management of GWG may be important strategies to reduce the number of LGA newborns and, consequently, the long-term public health burden of obesity.

Maternal hepatitis B infection and gestational diabetes mellitus.

PubMed

Lao, Terence T; Chan, Ben C P; Leung, Wing-Cheong; Ho, Lai-Fong; Tse, Ka-Yu

2007-07-01

This retrospective cohort study was performed to examine the relationship between maternal hepatitis B virus infection, as indicated by the surface antigen status, with the development of gestational diabetes mellitus in a normal-risk Chinese obstetric population. Maternal demographics, risk factors, and pregnancy outcome of 13,683 singleton pregnancies delivering in 1998-2001 were analysed according to maternal hepatitis B surface antigen status, which was routinely screened. Multiple logistic regression analysis was performed to examine the role of hepatitis B infection in the development of gestational diabetes mellitus. The 1138 women (8.3%) with hepatitis B infection had lower mean weight and body mass index, similar prevalence of chronic medical diseases and smokers, but increased prevalence of gestational diabetes mellitus, which remained significant (odds ratio 1.24, 95% confidence interval 1.01-1.51) after adjustment for confounding variables. However, there was no difference in pregnancy outcome. Our results confirmed the independent association between hepatitis B infection with gestational diabetes mellitus. The magnitude of chronic hepatitis B infection in the developing world and certain ethnic groups could have contributed to the high prevalence of gestational and possibly type 2 diabetes in these populations. Further studies on the long-term implications of our finding are warranted.

The protein source in embryo culture media influences birthweight: a comparative study between G1 v5 and G1-PLUS v5.

PubMed

Zhu, Jinliang; Li, Ming; Chen, Lixue; Liu, Ping; Qiao, Jie

2014-07-01

Does protein source or human serum albumin (HSA) in embryo culture media influence the subsequent birthweight? A significant difference was observed in gestational age- and gender-adjusted birthweight (Z scores) and the proportion of large-for-gestational age (LGA) babies between embryos cultured in G1 v5 and those cultured in G1-PLUS v5 media. It has been reported that the birthweights of singletons born from embryos cultured in Vitrolife are significantly higher than those cultured in the Cook group of media, and that G1-PLUS (Vitrolife, Gothenburg, Sweden) is associated with increased birth and placenta weights compared with Medicult ISMI. This study was a retrospective analysis of neonatal birthweights, and included 1097 singletons born from fresh embryo transfer cycles at the Center for Reproductive Medicine of Peking University Third Hospital between January 2011 and August 2012. The number of singletons born from G1 v5 culture media was 489, and the number of singletons born from G1-PLUS v5 media was 608. Patients <40 years of age with a BMI <30 kg/m² were analysed. Only data from newborns from singleton pregnancies and born alive after the 28th week of gestation were included. Patients with a vanishing twin or with pregnancy-related complications, such as diabetes and hypertension, were excluded, as were patients who received preimplantation genetic diagnosis or used donor oocytes. Multiple linear regression analysis was performed to determine the influence of individual factors on birthweights of singleton newborns. The birthweights and Z scores of singletons and LGA babies were compared between the G1 v5 and G1-PLUS v5 media groups. The absolute birthweights for singletons resulting from G1-PLUS v5 were not different from singletons resulting from G1 v5 (3375.9 ± 479.6 g versus 3333.2 ± 491.6 g, respectively; P = 0.14). However the Z scores for singletons from embryos cultured in G1-PLUS v5 were significantly higher than for singletons cultured in G1 v5 (0.28 ± 1.12 versus 0.09 ± 1.15, respectively; P = 0.04), and more LGA babies were born from G1-PLUS v5 culture compared with G1 v5 (16.8 versus 12.1%, respectively; P = 0.03) culture. Finally, multiple linear regression analysis suggested that female weight (P = 0.00), male height (P = 0.04), gestational age at birth (P = 0.00), infant gender (P = 0.00) and culture media (P = 0.04) all had significant effects on the birthweights of singleton newborns. This study was limited by its retrospective design. Our study suggests that protein source/HSA has a significant effect on birthweights of singleton newborns. This study was funded by the National Natural Science Foundation of China for Young Scholars (81300483). The authors have no conflicts of interest to declare. Not applicable.

Risk of major congenital malformations in relation to maternal overweight and obesity severity: cohort study of 1.2 million singletons.

PubMed

Persson, Martina; Cnattingius, Sven; Villamor, Eduardo; Söderling, Jonas; Pasternak, Björn; Stephansson, Olof; Neovius, Martin

2017-06-14

Objective  To estimate the risks of major congenital malformations in the offspring of mothers who are underweight (body mass index (BMI) <18.5), overweight (BMI 25 to <30), or in obesity classes I (BMI 30 to <35), II (35 to <40), or III (≥40) compared with offspring of normal weight mothers (BMI 18.5 to <25) in early pregnancy. Design  Population based cohort study. Setting  Nationwide Swedish registries. Participants  1 243 957 liveborn singleton infants from 2001 to 2014 in Sweden. Data on maternal and pregnancy characteristics were obtained by individual record linkages. Exposure  Maternal BMI at the first prenatal visit. Main outcome measures  Offspring with any major congenital malformation, and subgroups of organ specific malformations diagnosed during the first year of life. Risk ratios were estimated using generalised linear models adjusted for maternal factors, sex of offspring, and birth year. Results  A total of 43 550 (3.5%) offspring had any major congenital malformation, and the most common subgroup was for congenital heart defects (n=20 074; 1.6%). Compared with offspring of normal weight mothers (risk of malformations 3.4%), the proportions and adjusted risk ratios of any major congenital malformation among the offspring of mothers with higher BMI were: overweight, 3.5% and 1.05 (95% confidence interval 1.02 to 1.07); obesity class I, 3.8% and 1.12 (1.08 to 1.15), obesity class II, 4.2% and 1.23 (1.17 to 1.30), and obesity class III, 4.7% and 1.37 (1.26 to 1.49). The risks of congenital heart defects, malformations of the nervous system, and limb defects also progressively increased with BMI from overweight to obesity class III. The largest organ specific relative risks related to maternal overweight and increasing obesity were observed for malformations of the nervous system. Malformations of the genital and digestive systems were also increased in offspring of obese mothers. Conclusions  Risks of any major congenital malformation and several subgroups of organ specific malformations progressively increased with maternal overweight and increasing severity of obesity. For women who are planning pregnancy, efforts should be encouraged to reduce adiposity in those with a BMI above the normal range. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Maternal care and birth outcomes among ethnic minority women in Finland

PubMed Central

Malin, Maili; Gissler, Mika

2009-01-01

Background Care during pregnancy and labour is of great importance in every culture. Studies show that people of migrant origin have barriers to obtaining accessible and good quality care compared to people in the host society. The aim of this study is to compare the access to and use of maternity services, and their outcomes among ethnic minority women having a singleton birth in Finland. Methods The study is based on data from the Finnish Medical Birth Register in 1999–2001 linked with the information of Statistics Finland on woman's country of birth, citizenship and mother tongue. Our study data included 6,532 women of foreign origin (3.9% of all singletons) giving singleton birth in Finland during 1999–2001 (compared to 158,469 Finnish origin singletons). Results Most women have migrated during the last fifteen years, mainly from Russia, Baltic countries, Somalia and East Europe. Migrant origin women participated substantially in prenatal care. Interventions performed or needed during pregnancy and childbirth varied between ethnic groups. Women of African and Somali origin had most health problems resulted in the highest perinatal mortality rates. Women from East Europe, the Middle East, North Africa and Somalia had a significant risk of low birth weight and small for gestational age newborns. Most premature newborns were found among women from the Middle East, North Africa and South Asia. Primiparous women from Africa, Somalia and Latin America and Caribbean had most caesarean sections while newborns of Latin American origin had more interventions after birth. Conclusion Despite good general coverage of maternal care among migrant origin women, there were clear variations in the type of treatment given to them or needed by them. African origin women had the most health problems during pregnancy and childbirth and the worst perinatal outcomes indicating the urgent need of targeted preventive and special care. These study results do not confirm either healthy migrant effect or epidemiological paradox according to which migrant origin women have considerable good birth outcomes. PMID:19298682

Signs of fetal brain sparing are not related to umbilical cord blood gases at birth.

PubMed

Cheema, Riffat; Dubiel, Mariusz; Gudmundsson, Saemundur

2009-07-01

Fetal chronic hypoxia leads to centralization of circulation in order to spare the vital organs brain, adrenals and the heart. This can be documented by Doppler ultrasound. Increased blood velocity in the fetal middle cerebral artery (MCA) is an acknowledged sign of centralization of circulation in chronic hypoxia, and is called brain sparing. Our aim was to assess the relationship between signs of brain sparing in the MCA and umbilical cord blood gases at birth. A prospective study. Singleton 57 high-risk pregnancies (outcome was compared with 21 normal pregnancies). MCA Doppler was performed within 24 h of elective caesarean section in high-risk pregnancies. Umbilical cord blood gases were analysed at birth. Cord blood gases were related to signs of centralization of fetal circulation in the MCA. No correlation between signs of brain sparing in the MCA and cord blood gases. Apgar score at 5'<7 was seen in three newborns, but only one of these had antenatal signs of brain sparing. Newborns with antenatal brain sparing were admitted more often (p<0.04) and had a longer duration of stay in NICU (p<0.03) compared to newborns without brain sparing. Decreased pulsatility index in MCA is an acknowledged sign of fetal centralization of circulation during chronic hypoxia. However, signs of brain sparing are not related to cord blood gases at birth, which might suggest that redistribution of fetal circulation can maintain normal blood gases for a long time during chronic hypoxia.

A prospective evaluation of whole-exome sequencing as a first-tier molecular test in infants with suspected monogenic disorders.

PubMed

Stark, Zornitza; Tan, Tiong Y; Chong, Belinda; Brett, Gemma R; Yap, Patrick; Walsh, Maie; Yeung, Alison; Peters, Heidi; Mordaunt, Dylan; Cowie, Shannon; Amor, David J; Savarirayan, Ravi; McGillivray, George; Downie, Lilian; Ekert, Paul G; Theda, Christiane; James, Paul A; Yaplito-Lee, Joy; Ryan, Monique M; Leventer, Richard J; Creed, Emma; Macciocca, Ivan; Bell, Katrina M; Oshlack, Alicia; Sadedin, Simon; Georgeson, Peter; Anderson, Charlotte; Thorne, Natalie; Melbourne Genomics Health Alliance; Gaff, Clara; White, Susan M

2016-11-01

To prospectively evaluate the diagnostic and clinical utility of singleton whole-exome sequencing (WES) as a first-tier test in infants with suspected monogenic disease. Singleton WES was performed as a first-tier sequencing test in infants recruited from a single pediatric tertiary center. This occurred in parallel with standard investigations, including single- or multigene panel sequencing when clinically indicated. The diagnosis rate, clinical utility, and impact on management of singleton WES were evaluated. Of 80 enrolled infants, 46 received a molecular genetic diagnosis through singleton WES (57.5%) compared with 11 (13.75%) who underwent standard investigations in the same patient group. Clinical management changed following exome diagnosis in 15 of 46 diagnosed participants (32.6%). Twelve relatives received a genetic diagnosis following cascade testing, and 28 couples were identified as being at high risk of recurrence in future pregnancies. This prospective study provides strong evidence for increased diagnostic and clinical utility of singleton WES as a first-tier sequencing test for infants with a suspected monogenic disorder. Singleton WES outperformed standard care in terms of diagnosis rate and the benefits of a diagnosis, namely, impact on management of the child and clarification of reproductive risks for the extended family in a timely manner.Genet Med 18 11, 1090-1096.

[A dose-response analysis on the association of gestational weight gain rate and the normal term neonate birth weight].

PubMed

Mao, Yuanyuan; Hu, Wenbin; Liu, Qin; Liu, Li; Li, Yuanming; Shen, Yueping

2015-08-01

To examine the dose-response relationship between gestational weight gain rate and the neonate birth weight. A total of 18 868 women with singleton gestations who delivered between January 2006 and December 2013 were included in this study. Maternal and neonate details of these women were drawn from the Perinatal Monitoring System database. Gestational weight gain rate was defined as the total weight gain during the last and first prenatal care visits divided by the interval weeks. Both Multiple logistic regression analysis and restricted cubic spline methods were performed. Confounding factors included maternal age, education, pre-pregnancy body mass index (BMI), state of residence, parity, gestational weeks of prenatal care entry, and sex of the neonate. The adjusted odds ratio for macrosomia was associated with gestational weight gain rate in lower pre-pregnancy BMI (OR = 3.15, 95% CI: 1.40-7.07), normal (OR = 3.64, 95% CI: 2.84-4.66) or overweight (OR = 2.37, 95% CI: 1.71-3.27). The odds ratios of low birth weight appeared a decrease in those women with lower pre-pregnancy BMI (OR = 0.28, 95% CI: 0.13-0.61) while the normal weight (OR = 0.37, 95% CI: 0.22-0.64) group with gestational weight gain, the rate showed an increase. Association of gestational weight gain rate for macrosomia was found a S-curve in those term delivery women (non-linearity test P < 0.000 1). However, L-curve was observed for low birth weight and gestational weight gain rate in term births (non-linearity test P < 0.000 1). A S-curve was seen between gestational weight gain rate and term delivered macrosomia while L-curve was observed among term delivered low birth weight neonates.

Congenital abnormalities in newborns of consanguineous and nonconsanguineous parents.

PubMed

Naderi, S

1979-02-01

The aim of this study was to determine the types, patterns, and frequencies of congenital anomalies among newborns of both consanguineous and nonconsanguineous parents in southern Iran. From 9526 consecutive pregnancies observed, 9623 newborns resulted (9431 singleton and 95 sets of multiple gestation). There were 7261 newborns from nonconsanguineous parents and 2362 (24.5%) babies from consanguineous marriages. Of the total pregnancies, 1.54% resulted in malformed children (1.53% of singleton and 2.1% of multiple gestations). The incidence of congenital abnormalities in newborns of nonconsanguineous parents was 1.66% as compared to 4.02% for newborns of the consanguineous group. Major and multiple malformations were found to be slightly more common in the consanguinous group. Prematurity, prenatal mortality rate, and congenital abnormalities were more common in the consanguineous group. Probably the closer the familial relationship of the parents, the greater the chances of congenital abnormalities.

Perinatal outcomes following labor induction with dinoprostone in pregnancies with borderline amniotic fluid index at term: A clinical observation study.

PubMed

Yin, Heng; Zhao, Lei; Lin, Ying; Wang, Ying; Hu, Yaping; Sun, Guoqiang; Xiao, Mei

2018-06-22

To compare perinatal outcomes of dinoprostone for induced labor in pregnancies with a borderline versus normal amniotic fluid index (AFI) at term, and to investigate the related factors affecting outcomes of cesarean section. The retrospective study was carried out in Hubei Maternal and Child Health Hospital with singleton pregnancies of 37-42 weeks' gestation from January to August 2016. A total of 992 subjects were divided into two groups: borderline AFI group (n =125) with 5 < AFI ≤ 8 and normal AFI group (n = 867) with 8 < AFI ≤ 24. Time to delivery (P =0.004) and use of oxytocin augmentation (P = 0.011) were significantly lower in pregnancies with borderline AFI. There were no significant differences between the two groups in terms of delivery mode, time to onset of labor, fetal distress, Apgar scores, meconium-stained amniotic fluid, birth weight, or incidences of admission to neonatal intensive care unit (NICU). Gestational hypertension and birth weight were the major factors affecting outcomes of cesarean section in the borderline group (odds ratio [OR] = 13.61, 95% confidence interval [CI] 1.96-94.49, P =0.008 and OR = 1.003, 95% CI 1.001-1.005, P =0.001, respectively). Maternal age (OR = 1.12, 95% CI 1.06-1.19, P < 0.001), parity (OR = 7.57, 95% CI 3.05-18.76, P < 0.001), biparietal diameter (OR = 0.55, 95% CI 0.33-0.91, P = 0.021), and meconium-stained amniotic fluid (OR = 1.56, 95% CI 1.12-2.17, P = 0.009) were related factors in the normal group. The perinatal outcomes of dinoprostone for induced labor are comparable between the two groups. Gestational hypertension and birth weight are factors related to outcomes of cesarean section in the borderline group. © 2018 Japan Society of Obstetrics and Gynecology.

The impact of fetal gender on first trimester nuchal translucency and maternal serum free beta-hCG and PAPP-A MoM in normal and trisomy 21 pregnancies.

PubMed

Cowans, Nicholas J; Stamatopoulou, Anastasia; Maiz, Nerea; Spencer, Kevin; Nicolaides, Kypros H

2009-06-01

To investigate if fetal sex has an impact on 1st trimester combined screening for aenuploidy. We studied the first trimester PAPP-A, free beta-human chorionic gonadatropin (beta-hCG) and nuchal translucency levels in 56,024 normal, singleton pregnancies with known fetal sex at birth. We also examined the distributions in 722 pregnancies with trisomy 21 of known fetal sex. We have found a 14.74% increase in first trimester maternal serum (MS) median free beta-hCG MoM, 6.25% increase of PAPP-A and a 9.41% decrease in delta NT, when the fetus was female. Analysis of data has shown that women carrying a female fetus were 1.084 times more likely to be in the 'at risk' group than those carrying a male fetus. In examining data from 722 pregnancies in which the fetus was affected by trisomy 21, we observed a similar 20.8% increase in free beta-hCG MoM, 5.7% increase in PAPP-A and a 12% decrease in delta NT when the fetus was female. Amongst the trisomy 21 cases, 88.8% of male trisomy 21 cases were detected compared with 91.2% in female cases, this difference was not statistically significant. Correcting for fetal sex redressed the balance in screen-positive rate between the sexes and had a minimal impact on detection rate. Correcting for fetal sex may be a worthwhile consideration. A cost-benefit analysis would be required to determine if it is feasible to introduce fetal gender assignment into the routine first trimester scan for the purpose of marker correction and whether this would have any significant impact. (c) 2009 John Wiley & Sons, Ltd.

Successful ovulation induction, conception, and normal delivery after chronic therapy with etanercept: a recombinant fusion anti-cytokine treatment for rheumatoid arthritis.

PubMed

Sills, E S; Perloe, M; Tucker, M J; Kaplan, C R; Palermo, G D

2001-11-01

Etanercept (Enbrel; Wyeth-Ayerst/Immunex Inc, Seattle, WA, USA) is a subcutaneously administered novel fusion protein consisting of the extracellular ligand-binding domain of the 75 kD receptor for tumor necrosis factor-alpha (anti-TNFalpha) and the Fc portion of human IgG1. The agent is synthesized by plasmid transfection of a Chinese hamster ovary cell line, utilizing recombinant DNA technology. Etanercept was approved by the US FDA for treatment of multi-drug resistant rheumatoid arthritis in 1998, but no human data exist regarding the impact of anti-TNFalpha therapy on human reproductive function or its use before ovulation induction. As TNFalpha potentiates collagenolysis via matrix metalloproteinase gene expression (thereby facilitating ovulation), there exists a theoretical risk that TNFalpha-inhibition could exert an undesirable effect on ovulation and pregnancy. In this report, we describe the first case of ovulation induction, intrauterine insemination, normal pregnancy and singleton delivery of a healthy infant following chronic ( > 1 year) pre-ovulatory TNFalpha-inhibitor therapy for rheumatoid arthritis. Reproductive endocrinologists and obstetrician-gynecologists should be familiar with etanercept therapy in the context of severe rheumatic disease, and offer appropriate reassurance regarding its safe use for infertility patients planning ovulation induction.

Pre-Pregnancy BMI, Gestational Weight Gain, and the Risk of Hypertensive Disorders of Pregnancy: A Cohort Study in Wuhan, China

PubMed Central

Hu, Ronghua; Zhang, Yiming; Bassig, Bryan A.; Triche, Elizabeth; Yang, Shaoping; Qiu, Lin; Zhang, Yaqi; Yao, Cong; Xu, Shunqing; Wang, Youjie; Xia, Wei; Qian, Zhengmin; Zheng, Tongzhang; Zhang, Bin

2015-01-01

Background Hypertensive disorders of pregnancy (HDP) are major causes of maternal death worldwide and the risk factors are not fully understood. Few studies have investigated the risk factors for HDP among Chinese women. A cohort study involving 84,656 women was conducted to investigate pre-pregnancy BMI, total gestational weight gain (GWG), and GWG during early pregnancy as risk factors for HDP among Chinese women. Methods The study was conducted between 2011–2013 in Wuhan, China, utilizing data from the Maternal and Children Healthcare Information Tracking System of Wuhan. A total of 84,656 women with a live singleton pregnancy were included. Multiple unconditional logistic regression was conducted to evaluate associations between putative risk factors and HDP. Results Women who were overweight or obese before pregnancy had an elevated risk of developing HDP (overweight: OR = 2.66, 95% CI = 2.32–3.05; obese: OR = 5.53, 95% CI = 4.28–7.13) compared to their normal weight counterparts. Women with total GWG above the Institute of Medicine (IOM) recommendation had an adjusted OR of 1.72 (95% CI = 1.54–1.93) for HDP compared to women who had GWG within the IOM recommendation. Women with gestational BMI gain >10 kg/m2 during pregnancy had an adjusted OR of 3.35 (95% CI = 2.89–3.89) for HDP, compared to women with a gestational BMI gain <5 kg/m2. The increased risk of HDP was also observed among women with higher early pregnancy (up to 18 weeks of pregnancy) GWG (>600g/wk: adjusted OR = 1.48, 95% CI = 1.19–1.84). Conclusion The results from this study show that maternal pre-pregnancy BMI, early GWG, and total GWG are positively associated with the risk of HDP. Weight control efforts before and during pregnancy may help to reduce the risk of HDP. PMID:26305565

Pre-Pregnancy BMI, Gestational Weight Gain, and the Risk of Hypertensive Disorders of Pregnancy: A Cohort Study in Wuhan, China.

PubMed

Zhou, Aifen; Xiong, Chao; Hu, Ronghua; Zhang, Yiming; Bassig, Bryan A; Triche, Elizabeth; Yang, Shaoping; Qiu, Lin; Zhang, Yaqi; Yao, Cong; Xu, Shunqing; Wang, Youjie; Xia, Wei; Qian, Zhengmin; Zheng, Tongzhang; Zhang, Bin

2015-01-01

Hypertensive disorders of pregnancy (HDP) are major causes of maternal death worldwide and the risk factors are not fully understood. Few studies have investigated the risk factors for HDP among Chinese women. A cohort study involving 84,656 women was conducted to investigate pre-pregnancy BMI, total gestational weight gain (GWG), and GWG during early pregnancy as risk factors for HDP among Chinese women. The study was conducted between 2011-2013 in Wuhan, China, utilizing data from the Maternal and Children Healthcare Information Tracking System of Wuhan. A total of 84,656 women with a live singleton pregnancy were included. Multiple unconditional logistic regression was conducted to evaluate associations between putative risk factors and HDP. Women who were overweight or obese before pregnancy had an elevated risk of developing HDP (overweight: OR = 2.66, 95% CI = 2.32-3.05; obese: OR = 5.53, 95% CI = 4.28-7.13) compared to their normal weight counterparts. Women with total GWG above the Institute of Medicine (IOM) recommendation had an adjusted OR of 1.72 (95% CI = 1.54-1.93) for HDP compared to women who had GWG within the IOM recommendation. Women with gestational BMI gain >10 kg/m2 during pregnancy had an adjusted OR of 3.35 (95% CI = 2.89-3.89) for HDP, compared to women with a gestational BMI gain <5 kg/m2. The increased risk of HDP was also observed among women with higher early pregnancy (up to 18 weeks of pregnancy) GWG (>600g/wk: adjusted OR = 1.48, 95% CI = 1.19-1.84). The results from this study show that maternal pre-pregnancy BMI, early GWG, and total GWG are positively associated with the risk of HDP. Weight control efforts before and during pregnancy may help to reduce the risk of HDP.

[Gestational weight gain and optimal ranges in Chinese mothers giving singleton and full-term births in 2013].

PubMed

Wang, J; Duan, Y F; Pang, X H; Jiang, S; Yin, S A; Yang, Z Y; Lai, J Q

2018-01-06

Objective: To analyze the status of gestational weight gain (GWG) among Chinese mothers who gave singleton and full-term births, and to look at optimal GWG ranges. Methods: In 2013, using the multi-stage stratified and population proportional cluster sampling method, we investigated 8 323 mother-child pairs at their 0-24 months postpartum from 55 counties (cities/districts) of 30 provinces (except Tibet) in mainland China. Questionnaire was used to collect data on body weight before pregnancy and delivery, diseases during gestation, hemorrhage or not at postpartum, child birth weight and length, and other information about pregnant outcomes. We measured mother's body weight and height, and child's body weight and length. Based on 'Chinese Adult Body Weight Standard', we divided mothers into four groups according to their body weight before pregnancy: low weight (BMI<18.5 kg/m(2)), normal weight (BMI 18.5-23.9 kg/m(2)), overweight (BMI 24.0-27.9 kg/m(2)) and obesity (BMI≥28.0 kg/m(2)). The status of GWG was assessed by IOM optimal GWG guidelines. Chinese optimal GWG ranges were calculated according to the association of GWG with pregnant outcomes and anthropometry of mothers and children, and according to P25-P75 of GWG among mothers who had good pregnant outcomes and good anthropometry, and whose children had good anthropometry. The status of GWG was assessed by the new optimal ranges. Results: P50 (P25-P75) of GWG among the 8 323 mothers was 15.0 (10.0-19.0) kg. According to the proposed optimal GWG ranges of IOM, the proportions of inadequate, optimal and excessive GWG accounted for 27.2% (2 263 mothers), 36.2% (3 016 mothers) and 36.6% (3 044 mothers). The optimal GWG ranges for low weight, normal weight, overweight and obesity were 11.5-18.0, 10.0-15.0, 8.0-14.0 and 5.0-11.5 kg. Based on these optimal GWG ranges established in this study, the rates of inadequate, optimal and excessive GWG were 15.7% (1 303 mothers), 45.0% (3 744 mothers) and 39.3% (3 276 mothers), and these rates were significantly different from that defined by the IOM standards (χ2=345.36, P<0.001). Conclusion: The median of GWG among Chinese mothers is 15.0 kg, which is at a relatively higher level. This study suggests the optimal GWG ranges for Chinese women who give singleton and full-term babies, which appears lower than IOM's.

Association of early maternal hypertriglyceridemia with pregnancy-induced hypertension.

PubMed

Chandi, Anadeep; Sirohiwal, Daya; Malik, Roopa

2015-11-01

Hypertensive diseases are directly responsible for 24 % of maternal deaths in India. A screening method is yet to be discovered to reduce the morbidity and mortality related to it. Serum triglyceride (TG) levels are reported to increase in hypertensive pregnant women. To predict pregnancy-induced hypertension (PIH) by serum triglyceride values. This study is a prospective cohort study that was conducted over three hundred normotensive, primigravida women with singleton pregnancy at 14-20 weeks of gestation. These were divided into two groups on the basis of their TG concentration estimated at 14-20 weeks of gestation. The pregnancy was then followed till delivery and, signs and symptoms of PIH were noted in both the groups. Out of 300 women, 210 women completed the study. Fifty-nine women developed PIH and 151 women remained normotensive. Among 59 women, 45 women had raised TG values i.e., ≥160 mg/dL and 14 women were with normal TG levels i.e., <160 mg/dL. A significant positive correlation was found between serum TG concentration and systolic and diastolic blood pressure. It was observed that a cutoff of 162.50 mg/dL for TG could reliably predict PIH with sensitivity of 76 % and specificity of 85 %. Also, the mothers with hypertriglyceridemia were found to be at higher risk of developing early-onset PIH. Our study supports the evidence that early pregnancy hypertriglyceridemia is associated with an increased risk of PIH.

Fetal tissue Doppler imaging in pregnancies complicated with preeclampsia with or without intrauterine growth restriction.

PubMed

Zhou, Qiongjie; Ren, Yunyun; Yan, Yingliu; Chu, Chen; Gui, Yonghao; Li, Xiaotian

2012-11-01

This study's aim was to evaluate the effect of preeclampsia and intrauterine growth restriction (IUGR) on fetal cardiac function, and the relationship of the latter with adverse pregnancy outcomes. We did a cross-sectional study of 132 women with uncomplicated singleton pregnancies, 34 with preeclampsia without IUGR, and 12 with preeclampsia and IUGR. Fetal cardiac structure and function were evaluated using fetal two-dimension ultrasound, pulsed wave Doppler and tissue Doppler imaging (TDI). Data were analyzed by t-tests, ANOVA, Chi-square tests, or Wilcoxon rank-sum test. Compared with the normal pregnancy group, mitral/tricuspid early systolic peak velocity of annulus/late diastolic peak velocity of annulus (Sa) and left ventricular (LV)/right ventricular (RV) early diastolic peak velocity at the annulus (Ea) in TDI decreased in preeclampsia with or without IUGR (P < 0.05). LV/RV Ea underwent a gestational decrease in preeclampsia with or without IUGR (P < 0.05). The changes in mitral/tricuspid Sa and LV Sa associated with preeclampsia were even more pronounced with preterm delivery at less than 34 gestational weeks and stillbirth (P < 0.05). Intrauterine growth restriction influences fetal cardiac function in the presence of preeclampsia, and TDI may be a sensitive and preferable method to detect such changes. Fetal LV/RV Ea is a potential marker for early fetal cardiac diastolic impairment, and mitral/tricuspid Sa and LV Sa may be predictors for adverse pregnancy outcomes. © 2012 John Wiley & Sons, Ltd.

Participant Characteristics in the Kumamoto University Regional Center of Japan Environment and Children's Study (JECS): Association of Pregnancy Outcomes with Pregestational Maternal Body Mass Index and Maternal Weight Gain during Pregnancy.

PubMed

Kaimura, Michiko; Oda, Masako; Mitsubuchi, Hiroshi; Ohba, Takashi; Katoh, Takahiko

2017-01-01

The purpose of this study was to identify participant characteristics in the Kumamoto University Regional Center of the Japan Environment and Children's Study (K-JECS) and to investigate the association of pregnancy outcomes with pregestational maternal body mass index (BMI) and maternal weight gain during pregnancy (MWG). The subjects were women with singleton birth, who had been recruited by the K-JECS, and were registered in the data systems for the first and second questionnaires and transcripts of medical records. The subjects were categorized by BMI with further classification by MWG. The chi-squared test and one-way analysis of variance were performed to determine the correlations of BMI and MWG with perinatal outcomes. Logistic regression analysis was performed to examine perinatal outcome risks. The subject characteristics were similar to the trends observed in the Japanese general population. The odds ratio for natural delivery was low in the overweight groups (OW) and normal weight groups (NW) with excessive weight gain. On the other hand, the risk of cesarean section was high in the OW, and risk of induced or accelerated delivery was high in the NW with excessive weight gain. The risks of preterm birth and LBW were high in the insufficient weight gain groups regardless of BMI. The risks of pregnancy-induced hypertension and gestational diabetes were high in the OW.

Home cervical ripening with dinoprostone gel in nulliparous women with singleton pregnancies.

PubMed

Stock, Sarah J; Taylor, Rebecca; Mairs, Rebecca; Azaghdani, Abdulhamid; Hor, Kahyee; Smith, Imogen; Dundas, Kirsty; Kissack, Chris; Norman, Jane E; Denison, Fiona

2014-08-01

To evaluate whether home cervical ripening is safe and results in shorter hospital stay. This was a retrospective cohort study of women with singleton pregnancies having induction of labor for postmaturity at a single center between January 2007 and June 2010. Women were offered home cervical ripening with 1 mg dinoprostone gel if they were nulliparous, had uncomplicated singleton pregnancies, and the indication for induction was postmaturity. Nine hundred seven of 1,536 (59.1%) nulliparous women having induction of labor for postmaturity were eligible for home cervical ripening. The median number of hours at home was 11.76 hours (range 0-24.82 hours). There were no cases of birth outside of the hospital, uterine rupture, or significant neonatal morbidity or neonatal death related to home cervical ripening. Eighty-five (5.5%) women who underwent hospital cervical ripening because of maternal preference or social issues formed a hospital cervical ripening comparison group. There was no significant difference in the total number of hours before delivery spent in the hospital between the two groups (26.25; 95% confidence interval [CI] 25.27-27.23 in home cervical ripening group compared with 24.28; 95% CI 22.5-26.0 in the hospital group; P=.26). Clinical outcomes are comparable in nulliparous women who receive a single dose of dinoprostone gel for home cervical ripening compared with those who undergo hospital cervical ripening. However, preadmission home cervical ripening with 1 mg dinoprostone does not decrease the number of hours women spend in the hospital. II.

Maternal smokeless tobacco use in Alaska Native women and singleton infant birth size.

PubMed

England, Lucinda J; Kim, Shin Y; Shapiro-Mendoza, Carrie K; Wilson, Hoyt G; Kendrick, Juliette S; Satten, Glen A; Lewis, Claire A; Whittern, Persenia; Tucker, Myra J; Callaghan, William M

2012-01-01

To examine the effects of maternal prenatal smokeless tobacco use on infant birth size. A retrospective medical record review of 502 randomly selected deliveries. Singleton deliveries to Alaska Native women residing in a defined geographical region in western Alaska, 1997-2005. A regional medical center's electronic records were used to identify singleton deliveries. Data on maternal tobacco exposure and pregnancy outcomes were abstracted from medical records. Logistic models were used to estimate adjusted mean birthweight, length and head circumference for deliveries to women who used no tobacco (n=121), used smokeless tobacco (n=237) or smoked cigarettes (n=59). Differences in mean birthweight, length and head circumference, 95% confidence intervals and p-values were calculated using non-users as the reference group. Infant birthweight, crown-heel length and head circumference. After adjustment for gestational age and other potential confounders, the mean birthweight of infants of smokeless tobacco users was reduced by 78 g compared with that of infants of non-users (p=0.18) and by 331 g in infants of smokers (p<0.01). No association was found between maternal smokeless tobacco use and infant length or infant head circumference. We found a modest but non-significant reduction in the birthweight of infants of smokeless tobacco users compared with infants of tobacco non-users. Because smokeless tobacco contains many toxic compounds that could affect other pregnancy outcomes, results of this study should not be construed to mean that smokeless tobacco use is safe during pregnancy. © 2011 Nordic Federation of Societies of Obstetrics and Gynecology No claim to original US government works.

Contribution of changing risk factors to the trend in breech presentation at term.

PubMed

Bin, Yu Sun; Roberts, Christine L; Nicholl, Michael C; Nassar, Natasha; Ford, Jane B

2016-12-01

Recent population-wide changes in perinatal risk factors may affect rates of breech presentation at birth, and have implications for the provision of breech services and training in breech management. To investigate whether changes in maternal and pregnancy characteristics explain the observed trend in breech presentation at term. All singleton term (≥37 week) births in New South Wales during 2002-2012 were identified through birth and associated hospital records. Annual rates of breech presentation were determined. Logistic regression modelling was used to predict expected rates of breech presentation and these were compared with observed rates over time. A priori predictors included maternal age, country of birth, parity, smoking during pregnancy, diabetes, pregnancy hypertension, placenta praevia, previous singleton term breech, previous caesarean section, infant sex, gestational age, birthweight and congenital anomalies. Hospital and Medicare data were used to assess concomitant trends in external cephalic version. Among 914 147 singleton term births, 3.1% were breech at delivery. Rates of breech presentation declined from 3.6% in 2002 to 2.7% in 2012 (test for trend P < 0.001), but was predicted to increase from 3.6% in 2002 to 4.3% in 2012 because of increased maternal age, nulliparity, maternal diabetes, history of breech presentation and previous caesarean section. However, use of external cephalic version appears to have increased over time. Breech presentation at delivery has decreased in New South Wales. Increased use of external cephalic version likely accounts for this decline, as changes in risk factors do not. © 2016 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Is there a difference in cognitive development between preschool singletons and twins born after intracytoplasmic sperm injection or in vitro fertilization?*

PubMed Central

Xing, Lan-feng; Qian, Yu-li; Chen, Lu-ting; Zhang, Fan-hong; Xu, Xin-fen; Qu, Fan; Zhu, Yi-min

2014-01-01

Objective: To explore whether there exist differences in cognitive development between singletons and twins born after in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). Methods: A total of 566 children were recruited for the study, including 388 children (singletons, n=175; twins, n=213) born after IVF and 178 children (singletons, n=87; twins, n=91) born after ICSI. The cognitive development was assessed using the Chinese-Wechsler Intelligence Scale for Children (C-WISC). Results: For all pre-term offspring, all the intelligence quotient (IQ) items between singletons and twins showed no significant differences no matter if they were born after IVF or ICSI. There was a significant difference in the cognitive development of IVF-conceived full-term singletons and twins. The twins born after IVF obtained significantly lower scores than the singletons in verbal IQ (containing information, picture & vocabulary, arithmetic, picture completion, comprehension, and language), performance IQ (containing maze, visual analysis, object assembly, and performance), and full scale IQ (P<0.05). The cognitive development of full-term singletons and twins born after ICSI did not show any significant differences. There was no significant difference between the parents of the singletons and twins in their characteristics where data were collected, including the age of the mothers, the current employment status, the educational backgrounds, and areas of residence. There were also no consistent differences in the duration of pregnancy, sex composition of the children, age, and height between singletons and twins at the time of our study although there existed significant differences between the two groups in the sex composition of the full-term children born after ICSI (P<0.05). Conclusions: Compared to the full-term singletons born after IVF, the full-term twins have lower cognitive development. The cognitive development of full-term singletons and twins born after ICSI did not show any significant differences. For all pre-term offspring, singletons and twins born after IVF or ICSI, the results of the cognitive development showed no significant differences. PMID:24390744

Is there a difference in cognitive development between preschool singletons and twins born after intracytoplasmic sperm injection or in vitro fertilization?

PubMed

Xing, Lan-feng; Qian, Yu-li; Chen, Lu-ting; Zhang, Fan-hong; Xu, Xin-fen; Qu, Fan; Zhu, Yi-min

2014-01-01

To explore whether there exist differences in cognitive development between singletons and twins born after in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). A total of 566 children were recruited for the study, including 388 children (singletons, n=175; twins, n=213) born after IVF and 178 children (singletons, n=87; twins, n=91) born after ICSI. The cognitive development was assessed using the Chinese-Wechsler Intelligence Scale for Children (C-WISC). For all pre-term offspring, all the intelligence quotient (IQ) items between singletons and twins showed no significant differences no matter if they were born after IVF or ICSI. There was a significant difference in the cognitive development of IVF-conceived full-term singletons and twins. The twins born after IVF obtained significantly lower scores than the singletons in verbal IQ (containing information, picture & vocabulary, arithmetic, picture completion, comprehension, and language), performance IQ (containing maze, visual analysis, object assembly, and performance), and full scale IQ (P<0.05). The cognitive development of full-term singletons and twins born after ICSI did not show any significant differences. There was no significant difference between the parents of the singletons and twins in their characteristics where data were collected, including the age of the mothers, the current employment status, the educational backgrounds, and areas of residence. There were also no consistent differences in the duration of pregnancy, sex composition of the children, age, and height between singletons and twins at the time of our study although there existed significant differences between the two groups in the sex composition of the full-term children born after ICSI (P<0.05). Compared to the full-term singletons born after IVF, the full-term twins have lower cognitive development. The cognitive development of full-term singletons and twins born after ICSI did not show any significant differences. For all pre-term offspring, singletons and twins born after IVF or ICSI, the results of the cognitive development showed no significant differences.

The association between maternal hydronephrosis and acute flank pain during pregnancy: a prospective pilot-study.

PubMed

Farr, Alex; Ott, Johannes; Kueronya, Verena; Margreiter, Markus; Javadli, Elchin; Einig, Sabrina; Husslein, Peter W; Bancher-Todesca, Dagmar

2017-10-01

Maternal hydronephrosis may cause flank pain during pregnancy. We aimed to investigate the association between maternal hydronephrosis and flank pain intensity. From 2014 to 2015, all consecutive women with singleton pregnancies, who presented at our tertiary center due to acute flank pain, were prospectively evaluated by renal ultrasonography and pain questionnaires. A visual analogue scale was used to assess pain intensity. The study had 90% power to detect a significant correlation between hydronephrosis and flank pain (Spearman's test). A total of 51 consecutive women with left-sided (13.7%), right-sided (64.7%) or bilateral (21.6%) pain were enrolled. The mean gestational age of these women, who presented due to their pain, was 27.5 ± 6.8 weeks at the time of consultation. The mean VAS score was 7.6 ± 2.2. In 43/51 (84.3%) women, hydronephrosis was found on renal sonograms. No correlation was found between the grade of hydronephrosis and pain intensity (p = 0.466; r= -0.28). Women delivered at a mean gestational age of 38.1 ± 2.4 weeks and their infants had a mean birthweight of 3138 ± 677 g. Hydronephrosis is a common finding among pregnant women with acute flank pain. The grade of hydronephrosis does not affect pain intensity. This study suggests normal pregnancy outcomes in these women.

Evaluation of the use of umbilical artery Doppler flow studies and outcome of pregnancies at a secondary hospital.

PubMed

Hugo, Elizabeth J C; Odendaal, Hein J; Grove, Debbie

2007-03-01

To investigate the use of a personal computer (PC)-based, continuous-wave Doppler machine by a trained midwife at a secondary hospital to assess umbilical artery flow velocity waveforms (FVW) in referred women. Pregnant women referred for suspected poor fetal growth were evaluated from June 2002 through December 2004. The Umbiflow apparatus, consisting of a Pentium 3 PC with an ultrasound transducer plugged into the USB port and software, was used to analyze the FVW of the umbilical artery. Pregnancies in which the resistance index (RI) was <75(th) percentile (P75) were not further evaluated for fetal well-being unless the clinical condition of the mother changed. Pregnancies with an RI >or=P75 were followed up according to a specific protocol. Primary end points were intrauterine death and intrauterine growth restriction. A total of 572 singleton pregnancies were followed up. Significantly more infants were small-for-gestational-age when the RI was >P95 (55.6%) than those between P75 and P95 (41.2%) or P95, respectively. A normal Doppler FVW of the umbilical artery is less likely to be followed by perinatal death.

Clinical Validation of Non-Invasive Cardiac Output Monitoring in Healthy Pregnant Women.

PubMed

McLaughlin, Kelsey; Wright, Stephen P; Kingdom, John C P; Parker, John D

2017-11-01

Non-invasive hemodynamic monitoring has the potential to be a valuable clinical tool for the screening and management of hypertensive disorders of pregnancy. The objective of this study was to validate the clinical utility of the non-invasive cardiac output monitoring (NICOM) system in pregnant women. Twenty healthy pregnant women with a singleton pregnancy at 22 to 26 weeks' gestation were enrolled in this study. Measures of heart rate, stroke volume, and cardiac output were obtained through NICOM and compared with Doppler echocardiography. NICOM significantly overestimated measures of both stroke volume and cardiac output compared with Doppler echocardiography (95 ± 4 vs. 73 ± 4 mL, P < 0.0001; and 7.4 ± 0.2 vs. 5.6 ± 0.2 L/min, P < 0.0001; respectively). There is no gold standard for the measurement of cardiac output in the setting of pregnancy. However, once normal values have been established, NICOM has the potential to be a useful clinical tool for monitoring maternal hemodynamics in pregnant women. Further investigation regarding the validity of NICOM is required in larger populations of healthy and hypertensive pregnant women to determine whether this device is appropriate for maternal hemodynamic assessment during pregnancy. Copyright © 2017 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.

Trimester of maternal gestational weight gain and offspring body weight at birth and age five.

PubMed

Margerison-Zilko, Claire E; Shrimali, Bina P; Eskenazi, Brenda; Lahiff, Maureen; Lindquist, Allison R; Abrams, Barbara F

2012-08-01

To investigate associations of trimester-specific GWG with fetal birth size and BMI at age 5 years. We examined 3,015 singleton births to women without pregnancy complications from the Child Health and Development Studies prospective cohort with measured weights during pregnancy. We used multivariable regression to examine the associations between total and trimester gestational weight gain (GWG) and birth weight for gestational age and child BMI outcomes, adjusting for maternal age, race/ethnicity, education, marital status, parity, pre-pregnancy body mass index (BMI), and smoking; paternal overweight, gestational age, and infant sex. We explored differences in associations by maternal BMI and infant sex. GWG in all trimesters was significantly and independently associated with birth weight with associations stronger, though not significantly, in the second trimester. First trimester GWG was associated with child BMI outcomes (OR for child overweight = 1.05; 95% CI = 1.02, 1.09). Each kg of first trimester GWG was significantly associated with increased child BMI z-score in women of low (β = 0.099; 95% CI = 0.034, 0.163) and normal (β = 0.028; 95% CI = 0.012, 0.044), but not high pre-pregnancy BMI. GWG in all trimesters was associated with birth weight; only first trimester GWG was associated with child BMI. If replicated, this information could help specify recommendations for maternal GWG and elucidate mechanisms connecting GWG to child BMI.

Muscle free amino acid profiles are related to differences in skeletal muscle growth between single and twin ovine fetuses near term.

PubMed

Sales, Francisco; Pacheco, David; Blair, Hugh; Kenyon, Paul; McCoard, Sue

2013-01-01

Twin sheep fetuses have reduced skeletal muscle weight near birth relative to singles as a result of restricted muscle hypertrophy. Intracellular free amino acids (FAA) are reported to regulate metabolic pathways which control muscle protein accretion, whereby reduced intracellular content of specific FAA may reduce their activation and therefore, muscle hypertrophy. The aim of this study was to determine whether differences in muscle weight between singleton and twin fetuses, under different maternal conditions is associated with reduced concentration of specific FAA. The FAA content in the semitendinosus muscle (ST) in singleton and twin fetuses (rank) at 140 days of gestation from heavy (H) or light (L) ewes fed ad libitum (A) or maintenance (M) level of nutrition was measured. Muscle weight was reduced in twin fetuses compared to singletons in all groups. Reduced concentrations of leucine, threonine and valine, but higher concentrations of methionine, ornithine, lysine and serine were found in twin fetuses compared to singletons. Maternal size and nutrition interaction with rank resulted in reduced glutamine in twins from HM-ewes (H-ewes under M nutrition) compared to their singleton counterparts. Maternal weight interaction with pregnancy rank reduced the concentration of arginine in twins, with a larger effect on H-ewes compared with L-ewes. Maternal size interaction with pregnancy rank resulted in twins from M-ewes to have lower alanine, while twins from A-ewes had lower aspartic acid concentration compared to singletons. The ST muscle weight was positively correlated only with arginine concentration after taking into account rank, size and nutrition. The present results indicate that reduced concentrations of specific intracellular FAA, such as arginine, leucine, valine, glutamine, which are known to play a role in muscle growth, could be acting as limiting factors for muscle hypertrophy in twin fetuses during late gestation. Ewe size and nutrition can influence the concentration of specific FAA in muscle and should be considered in any intervention plan to improve twin fetal muscle growth.

Increased risk of preterm birth in singleton pregnancies after blastocyst versus Day 3 embryo transfer: Canadian ART Register (CARTR) analysis.

PubMed

Dar, S; Librach, C L; Gunby, J; Bissonnette, F; Cowan, L

2013-04-01

Are the fetal outcomes of singleton pregnancies that result from cleavage stage embryo transfer (ET) different from the outcomes from Day 5/6 blastocyst stage ET? There was a significantly higher risk of preterm birth (<37 weeks) in singletons after extended embryo culture (Day 5/6) compared with cleavage stage (Day 3) transfer. Two recent studies, from Sweden and the USA, reported an increased risk of preterm birth in singleton pregnancies after Day 5/6 ET compared with Day 3 ET. The US study also showed increased early preterm births and the Swedish study showed increased fetal malformations in this group. A retrospective cohort study was performed. Data were collected from the Canadian ART Register database for all singleton births after fresh IVF/ICSI ET cycles (2001-2009). A total of 12 712 singleton births were included. Of these, 9506 resulted from a Day 3 ET and 3206 resulted from a blastocyst (Day 5/6) ET. Preterm birth rate <37 weeks (unadjusted by potential confounding factors) was higher with Day 5/6 versus Day 3 transfers (17.2 versus 14.1%, P < 0.001). Using logistic regression analysis to adjust for confounding factors, preterm birth rate <37 weeks was the only outcome significantly increased after Day 5/6 compared with Day 3 transfer (odds ratio 1.32, 95% confidence interval 1.17-1.49). The following confounding factors were adjusted for: year of treatment (2001-2009), maternal age (continuous), parity (0 versus ≥1 birth), diagnosis category, number of oocytes retrieved [≤20 versus >20 (high responder group)], insemination method (IVF versus ICSI), number of embryos transferred (1, 2 or ≥3) and the presence of a vanishing twin (≥1 fetal heart on the initial ultrasonographic examination). Post-natal follow-up studies will be required to determine if this difference we observed translates into adverse long-term effects on these offspring. The rate of early preterm births (<32 weeks) was higher in Day 5/6 versus Day 3, but the low number of cases in this category did not have the power to show a difference (3.0 versus 2.7%, P = 0.34). We found a significantly higher risk of preterm birth (<37 weeks) in singletons after extended embryo culture (Day 5/6) compared with cleavage stage (Day 3) transfer, even when adjusting for confounding factors. Our findings are in agreement with the previous two studies; however, we did not show a difference in the very preterm deliveries (unlike the US study) or in fetal malformations (as in the Swedish study). We hypothesize that there may be a deleterious effect of prolonged in vitro embryo culture on subsequent placentation. Longer term follow-up studies will be required to determine if prolonged in vitro culture to the blastocyst stage has an adverse effect on the long-term health of offspring when compared with shorter cleavage stage culture. None.

Impact of police-reported intimate partner violence during pregnancy on birth outcomes.

PubMed

Lipsky, Sherry; Holt, Victoria L; Easterling, Thomas R; Critchlow, Cathy W

2003-09-01

To examine the relationship of police-reported intimate partner violence during pregnancy and adverse birth outcomes. We conducted a population-based, retrospective, cohort study in Seattle, Washington, using Seattle police data and Washington State birth certificate files from January 1995 through September 1999. Exposed subjects were women with an intimate partner violence incident reported to police during pregnancy and who subsequently had a singleton live birth or fetal death registered in the state of Washington. Unexposed subjects were randomly selected Seattle residents with a singleton live birth or fetal death in the same time period and who did not report an incident. The main outcome measures were low birth weight (LBW less than 2500 g), very LBW (VLBW less than 1500 g), preterm birth (20-36 weeks' gestation), very preterm birth (20-31 weeks), and neonatal death (before discharge). Women reporting any partner violence during pregnancy were significantly more likely to have a LBW infant (adjusted odds ratio [aOR] 1.70; 95% confidence interval [CI] 1.20, 2.40), a VLBW infant (aOR 2.54; 95% CI 1.32, 4.91), a preterm birth (aOR 1.61; 95% CI 1.14, 2.28), a very preterm birth (aOR 3.71; 95% CI 1.80, 7.63), and a neonatal death (aOR 3.49; 95% CI 1.43, 8.50). Police-reported partner violence during pregnancy is significantly associated with an increased risk of adverse birth outcomes. There is a critical need to identify pregnancy among women with reported incidents and to provide women health and social service information and referrals, particularly referrals to high-risk pregnancy programs.

Micronutrients and macronutrients and parameters of antioxidative ability in saliva of women: inhabitants of Krakow (Poland) in the course of uncomplicated singleton pregnancy.

PubMed

Kolarzyk, Emilia; Pietrzycka, Agata; Stepniewski, Marek; Łyszczarz, Justyna; Mendyk, Aleksander; Ostachowska-Gasior, Agnieszka

2006-01-01

There were two aims of the present study: (1) to evaluate changes of superoxide dismutase (SOD) activity and total antioxidative status measured as the ferric reducing ability of plasma (FRAP) concentration in saliva of pregnant women during the first, second, and third trimesters of singleton uncomplicated pregnancy and (2) to assess possible relations among SOD, FRAP, and intake of macronutrients and micronutrients in daily nutritional rations (DNRs) during pregnancy. Forty pregnant women aged 27.1+/-5.4 yr (examined group) and 40 healthy women (the control group) were recruited for this study. The relationship between FRAP and SOD in saliva and the intake of macronutrients (proteins, carbohydrates, total fat, saturated fatty acid, monounsaturated fatty acids, polyunsaturated fatty acids), minerals (Na, K, Ca, P, Mg, Fe, Zn, Cu, Mn), and vitamins (A, C, E, B1, B2, B6, PP) in DNR was evaluated by clustering analysis with Ward's grouping method. During pregnancy, FRAP and SOD values were lower than in the controls, but only for FRAP were the differences statistically significant (p < 0.001). For the whole pregnancy period, cluster analysis identified two major clusters for which the differentiating variables were SOD and retinoids intake, but different patterns for each trimester of pregnancy were revealed. The following were concluded: (1) FRAP values were the lowest in the second trimester. It suggests that in this trimester of uncomplicated pregnancy, women might be not fully adapted to increased demands for antioxidative mechanisms. (2) Cluster analysis showed that there were no statistical relationships between the intake of micronutrients and macronutrients in DNRs and the SOD or FRAP level in the saliva of pregnant women.

Gestational age, gender and parity specific centile charts for placental weight for singleton deliveries in Aberdeen, UK.

PubMed

Wallace, J M; Bhattacharya, S; Horgan, G W

2013-03-01

The weight of the placenta is a crude but useful proxy for its function in vivo. Accordingly extremes of placental weight are associated with adverse pregnancy outcomes while even normal variations in placental size may impact lifelong health. Centile charts of placental weight for gestational age and gender are used to identify placental weight extremes but none report the effect of parity. Thus the objective was to produce gender and gestational age specific centile charts for placental weight in nulliparous and multiparous women. Data was extracted from the Aberdeen Maternity and Neonatal Databank for all women delivering singleton babies in Aberdeen city and district after 24 weeks gestation. Gestational age specific centile charts for placental weight by gender and parity grouping (n = 88,649 deliveries over a 30 year period) were constructed using the LMS method after exclusion of outliers (0.63% of deliveries meeting study inclusion criteria). Tables and figures are presented for placental weight centiles according to gestational age, gender and parity grouping. Tables are additionally presented for the birth weight to placental weight ratio by gender. Placental weight and the fetal:placental weight ratio were higher in male versus female deliveries. Placental weight was greater in multiparous compared with nulliparous women. We present strong evidence that both gender and parity grouping influence placental weight centiles. The differences at any given gestational age are small and the effects of parity are greater overall than those of gender. In contrast the birth weight to placental weight ratio differs by gender only. These UK population specific centile charts may be useful in studies investigating the role of the placenta in mediating pregnancy outcome and lifelong health. Copyright © 2012 Elsevier Ltd. All rights reserved.

The effect of fertility treatment on adverse perinatal outcomes in women aged at least 40 years.

PubMed

Harlev, Avi; Walfisch, Asnat; Oran, Eynan; Har-Vardi, Iris; Friger, Michael; Lunenfeld, Eitan; Levitas, Eliahu

2018-01-01

To compare perinatal outcomes between spontaneous conception and assisted reproductive technologies (ART) among patients of advanced maternal age. The present retrospective study included data from singleton pregnancies of women aged at least 40 years who delivered between January 1, 1991, and December 31, 2013, at Soroka University Medical Center, Beer Sheva, Israel. Demographic, obstetric, and perinatal data were compared between pregnancies conceived with ART (in vitro fertilization [IVF] or ovulation induction) and those conceived spontaneously. Multiple regression models were used to define independent predictors of adverse outcomes. A total of 8244 singleton pregnancies were included; 229 (2.8%) following IVF, 86 (1.0%) following ovulation induction, and 7929 (96.2%) were spontaneous. Preterm delivery (P<0.001), fetal growth restriction (FGR) (P<0.001), and cesarean delivery (P<0.001) demonstrated linear associations with the conception mode; the highest rates for each were observed for IVF, with decreased rates for ovulation induction and spontaneous conception. The incidence of gestational diabetes and hypertensive disorders were highest among pregnancies following ART. No association was observed between conception mode and perinatal mortality. Multivariate logistic regression demonstrated that IVF was independently associated with increased odds of preterm delivery (P<0.001) and FGR (P=0.027) compared with spontaneous conception. Among patients of advanced maternal age, ART were independently associated with increased FGR and preterm delivery rates compared with spontaneous pregnancies; perinatal mortality was comparable. © 2017 International Federation of Gynecology and Obstetrics.

The risk of adverse pregnancy outcomes in women who are overweight or obese

PubMed Central

2010-01-01

Background The prevalence of obesity amongst women bearing children in Australia is rising and has important implications for obstetric care. The aim of this study was to assess the prevalence and impact of mothers being overweight and obese in early to mid-pregnancy on maternal, peripartum and neonatal outcomes. Methods A secondary analysis was performed on data collected from nulliparous women with a singleton pregnancy enrolled in the Australian Collaborative Trial of Supplements with antioxidants Vitamin C and Vitamin E to pregnant women for the prevention of pre-eclampsia (ACTS). Women were categorized into three groups according to their body mass index (BMI): normal (BMI 18.5-24.9 kg/m2); overweight (BMI 25-29.9 kg/m2) and; obese (BMI 30-34.9 kg/m2). Obstetric and perinatal outcomes were compared by univariate and multivariate analyses. Results Of the 1661 women included, 43% were overweight or obese. Obese women were at increased risk of pre-eclampsia (relative risk (RR) 2.99 [95% confidence intervals (CI) 1.88, 4.73], p < 0.0001) and gestational diabetes (RR 2.10 [95%CI 1.17, 3.79], p = 0.01) compared with women with a normal BMI. Obese and overweight women were more likely to be induced and require a caesarean section compared with women of normal BMI (induction - RR 1.33 [95%CI 1.13, 1.57], p = 0.001 and 1.78 [95%CI 1.51, 2.09], p < 0.0001, caesarean section - RR 1.42 [95%CI 1.18, 1.70], p = 0.0002 and 1.63 [95%CI 1.34, 1.99], p < 0.0001). Babies of women who were obese were more likely to be large for gestational age (LFGA) (RR 2.08 [95%CI 1.47, 2.93], p < 0.0001) and macrosomic (RR 4.54 [95%CI 2.01, 10.24], p = 0.0003) compared with those of women with a normal BMI. Conclusion The rate of overweight and obesity is increasing amongst the Australian obstetric population. Women who are overweight and obese have an increased risk of adverse pregnancy outcomes. In particular, obese women are at increased risk of gestational diabetes, pregnancy induced hypertension and pre-eclampsia. Effective preventative strategies are urgently needed. Trial Registration Current Controlled Trials ISRCTN00416244 PMID:20849609

Associations of pre-pregnancy body mass index and gestational weight gain with pregnancy outcome and postpartum weight retention: a prospective observational cohort study

PubMed Central

2014-01-01

Background Excessive gestational weight gain (GWG) is associated with pregnancy complications, and Norwegian Health Authorities have adopted the GWG recommendations of the US Institute of Medicine and National Research Council (IOM). The aim of this study was to evaluate if a GWG outside the IOM recommendation in a Norwegian population is associated with increased risk of pregnancy complications like hypertension, low and high birth weight, preeclampsia, emergency caesarean delivery, and maternal post-partum weight retention (PPWR) at 6 and 18 months. Methods This study was performed in 56 101 pregnant women included in the prospective national Norwegian Mother and Child Cohort Study (MoBa) in the years 1999 to 2008. Women who delivered a singleton live born child during gestational week 37 to 42 were included. Maternal prepregnant and postpartum weight was collected from questionnaires at 17th week of gestation and 6 and 18 months postpartum. Results A weight gain less than the IOM recommendations (GWG < IOM rec.) increased the risk for giving birth to a low weight baby among normal weight nulliparous women. A weight gain higher than the IOM recommendations (GWG > IOM rec.) significantly increased the risk of pregnancy hypertension, a high birth weight baby, preeclampsia and emergency cesarean delivery in both nulliparous and parous normal weight women. Similar results were found for overweight women except for no increased risk for gestational hypertension in parous women with GWG > IOM rec. Seventy-four percent of the overweight nulliparous women and 66% of the obese women had a GWG > IOM rec. A GWG > IOM rec. resulted in increased risk of PPWR > 2 kg in all weight classes, but most women attained their prepregnant weight class by 18 months post-partum. Conclusions For prepregnant normal weight and overweight women a GWG > IOM rec. increased the risk for unfavorable birth outcomes in both nulliparous and parous women. A GWG > IOM rec. increased the risk of a PPWR > 2 kg at 18 months in all weight classes. This large study supports the Norwegian Health authorities’ recommendations for normal weight and overweight women to comply with the IOM rec. PMID:24917037

Associations of pre-pregnancy body mass index and gestational weight gain with pregnancy outcome and postpartum weight retention: a prospective observational cohort study.

PubMed

Haugen, Margaretha; Brantsæter, Anne Lise; Winkvist, Anna; Lissner, Lauren; Alexander, Jan; Oftedal, Bente; Magnus, Per; Meltzer, Helle Margrete

2014-06-11

Excessive gestational weight gain (GWG) is associated with pregnancy complications, and Norwegian Health Authorities have adopted the GWG recommendations of the US Institute of Medicine and National Research Council (IOM). The aim of this study was to evaluate if a GWG outside the IOM recommendation in a Norwegian population is associated with increased risk of pregnancy complications like hypertension, low and high birth weight, preeclampsia, emergency caesarean delivery, and maternal post-partum weight retention (PPWR) at 6 and 18 months. This study was performed in 56 101 pregnant women included in the prospective national Norwegian Mother and Child Cohort Study (MoBa) in the years 1999 to 2008. Women who delivered a singleton live born child during gestational week 37 to 42 were included. Maternal prepregnant and postpartum weight was collected from questionnaires at 17th week of gestation and 6 and 18 months postpartum. A weight gain less than the IOM recommendations (GWG < IOM rec.) increased the risk for giving birth to a low weight baby among normal weight nulliparous women. A weight gain higher than the IOM recommendations (GWG > IOM rec.) significantly increased the risk of pregnancy hypertension, a high birth weight baby, preeclampsia and emergency cesarean delivery in both nulliparous and parous normal weight women. Similar results were found for overweight women except for no increased risk for gestational hypertension in parous women with GWG > IOM rec. Seventy-four percent of the overweight nulliparous women and 66% of the obese women had a GWG > IOM rec. A GWG > IOM rec. resulted in increased risk of PPWR > 2 kg in all weight classes, but most women attained their prepregnant weight class by 18 months post-partum. For prepregnant normal weight and overweight women a GWG > IOM rec. increased the risk for unfavorable birth outcomes in both nulliparous and parous women. A GWG > IOM rec. increased the risk of a PPWR > 2 kg at 18 months in all weight classes. This large study supports the Norwegian Health authorities' recommendations for normal weight and overweight women to comply with the IOM rec.

Periconceptional undernutrition and being a twin each alter kidney development in the sheep fetus during early gestation.

PubMed

MacLaughlin, Severence M; Walker, Simon K; Kleemann, David O; Tosh, Darran N; McMillen, I Caroline

2010-03-01

Adaptive growth responses of the embryo and fetus to nutritional restraint are important in ensuring early survival, but they are implicated in the programming of hypertension. It has been demonstrated that kidney growth and nephrogenesis are each regulated by intrarenal factors, including the insulin-like growth factors, glucocorticoids, and the renin-angiotensin system. Therefore, we have investigated the impact of periconceptional undernutrition (PCUN; from approximately 6 wk before to 7 days after conception) in singleton (control, n = 18; PCUN, n = 16) and twin pregnancies (control, n = 6; PCUN, n = 5) on the renal mRNA expression of 11beta- hydroxysteroid dehydrogensase type 1 and type 2 (11beta-HSD-1 and -2), the glucocorticoid (GR), and mineralocorticoid receptors, angiotensinogen, angiotensin receptor type 1 (AT1R) and 2 (AT2R), IGF-1 and IGF-2, and IGF1R and IGF2R at approximately 55 days gestation. There was no effect of PCUN or fetal number on fetal weight on relative kidney weight at approximately day 55 of gestation. There was an inverse relationship between the relative weight of the fetal kidney at approximately day 55 and maternal weight loss during the periconceptional period in fetuses exposed to PCUN. Exposure to PCUN resulted in a higher expression of IGF1 in the fetal kidney in singleton and twin pregnancies. Being a twin resulted in higher intrarenal expression of IGF-1 and IGF-2, GR, angiotensinogen, AT1R, and AT2R mRNA at 55 days gestation. Renal 11beta-HSD-2 mRNA expression was higher in PCUN singletons, but not PCUN twins, compared with controls. Thus, there may be an adaptive response in the kidney to the early environment of a twin pregnancy, which precedes the fetal growth restriction that occurs later in pregnancy. The kidney of the twin fetus exposed to periconceptional undernutrition may also be less protected from the consequences of glucocorticoid exposure.

Maternal and neonatal outcomes of vaginal breech delivery for singleton term pregnancies in a carefully selected Cameroonian population: a cohort study

PubMed Central

Dohbit, Julius Sama; Foumane, Pascal; Mamoudou, Fadimatou; Temgoua, Mazou N; Tankeu, Ronni; Aletum, Veronica; Mboudou, Emile

2017-01-01

Background and objectives Vaginal breech delivery (VBD) is known to be associated with more perinatal and maternal complications. Very few studies on the subject have been carried out in poor-resource settings. The aim of this study was to determine maternal and neonatal outcomes in carefully selected cases of VBD for singleton term pregnancies in a tertiary centre in Cameroon. Design A retrospective cohort study. Setting A tertiary hospital in Yaounde, Cameroon. Participants Cases of VBD of newborns weighing 2500–3500 g were matched in a ratio of 1:4 to consecutive vaginal cephalic deliveries (VCDs) of newborns weighing 2500–3500 g over a 5-year period. Both groups were matched for maternal age and parity. We excluded cases of multiple gestations, footling breech, clinically inadequate maternal pelvis, preterm delivery, post-term pregnancies, fetal demise prior to the onset of labour, placenta praevia and fetal anomaly incompatible with vaginal delivery. Outcome measures Neonatal and maternal adverse outcomes of VBD observed till 6 weeks after delivery analysed using Bonferroni correction. Results Fifty-three (53) VBDs were matched against 212 VCD. Unlike women who had VCD, those who underwent VBD were more likely to have prolonged labour (OR 8.05; 95% CI 3.00 to 11.47; P<0.001), and their newborns were more likely to suffer from birth asphyxia (OR 10.24; 95% CI 4.92 to 21.31; P<0.001). Conclusion The study infers a strong association between VBD of singleton term pregnancies and maternofetal morbidity when specific protocols are applied. This, however, failed to translate into higher differences in perinatal mortality. This finding does not discount the role of VBD in low-income countries, but we emphasise the need for specific precautions like close monitoring of labour and adequate anticipation for neonatal resuscitation in order to reduce these complications. PMID:29170287

Trial protocol OPPTIMUM– Does progesterone prophylaxis for the prevention of preterm labour improve outcome?

PubMed Central

2012-01-01

Background Preterm birth is a global problem, with a prevalence of 8 to 12% depending on location. Several large trials and systematic reviews have shown progestogens to be effective in preventing or delaying preterm birth in selected high risk women with a singleton pregnancy (including those with a short cervix or previous preterm birth). Although an improvement in short term neonatal outcomes has been shown in some trials these have not consistently been confirmed in meta-analyses. Additionally data on longer term outcomes is limited to a single trial where no difference in outcomes was demonstrated at four years of age of the child, despite those in the “progesterone” group having a lower incidence of preterm birth. Methods/Design The OPPTIMUM study is a double blind randomized placebo controlled trial to determine whether progesterone prophylaxis to prevent preterm birth has long term neonatal or infant benefit. Specifically it will study whether, in women with singleton pregnancy and at high risk of preterm labour, prophylactic vaginal natural progesterone, 200 mg daily from 22 – 34 weeks gestation, compared to placebo, improves obstetric outcome by lengthening pregnancy thus reducing the incidence of preterm delivery (before 34 weeks), improves neonatal outcome by reducing a composite of death and major morbidity, and leads to improved childhood cognitive and neurosensory outcomes at two years of age. Recruitment began in 2009 and is scheduled to close in Spring 2013. As of May 2012, over 800 women had been randomized in 60 sites. Discussion OPPTIMUM will provide further evidence on the effectiveness of vaginal progesterone for prevention of preterm birth and improvement of neonatal outcomes in selected groups of women with singleton pregnancy at high risk of preterm birth. Additionally it will determine whether any reduction in the incidence of preterm birth is accompanied by improved childhood outcome. Trial registration ISRCTN14568373 PMID:22866909

Maternal and neonatal outcomes of antenatal anemia in a Scottish population: a retrospective cohort study.

PubMed

Rukuni, Ruramayi; Bhattacharya, Sohinee; Murphy, Michael F; Roberts, David; Stanworth, Simon J; Knight, Marian

2016-05-01

Antenatal anemia is a major public health problem in the UK, yet there is limited high quality evidence for associated poor clinical outcomes. The objectives of this study were to estimate the incidence and clinical outcomes of antenatal anemia in a Scottish population. A retrospective cohort study of 80 422 singleton pregnancies was conducted using data from the Aberdeen Maternal and Neonatal Databank between 1995 and 2012. Antenatal anemia was defined as haemoglobin ≤ 10 g/dl during pregnancy. Incidence was calculated with 95% confidence intervals and compared over time using a chi-squared test for trend. Multivariable logistic regression was used to adjust for confounding variables. Results are presented as adjusted odds ratios with 95% confidence interval. The overall incidence of antenatal anemia was 9.3 cases/100 singleton pregnancies (95% confidence interval 9.1-9.5), decreasing from 16.9/100 to 4.1/100 singleton pregnancies between 1995 and 2012 (p < 0.001). Maternal anemia was associated with antepartum hemorrhage (adjusted odds ratio 1.26, 95% confidence interval 1.17-1.36), postpartum infection (adjusted odds ratio 1.89, 95% confidence interval 1.39-2.57), transfusion (adjusted odds ratio 1.87, 95% confidence interval 1.65-2.13) and stillbirth (adjusted odds ratio 1.42, 95% confidence interval 1.04-1.94), reduced odds of postpartum hemorrhage (adjusted odds ratio 0.92, 95% confidence interval 0.86-0.98) and low birthweight (adjusted odds ratio 0.77, 95% confidence interval 0.69-0.86). No other outcomes were statistically significant. This study shows the incidence of antenatal anemia is decreasing steadily within this Scottish population. However, given that anemia is a readily correctable risk factor for major causes of morbidity and mortality in the UK, further work is required to investigate appropriate preventive measures. © 2016 Nordic Federation of Societies of Obstetrics and Gynecology.

Association of third-trimester abdominal circumference with provider-initiated preterm delivery

PubMed Central

Hawkins, Leah K.; Schnettler, William T.; Modest, Anna M.; Hacker, Michele R.; Rodriguez, Diana

2016-01-01

Objective Evaluate the association of a small third-trimester abdominal circumference (AC < 10th percentile) in the setting of a normal estimated fetal weight (EFW ≥ 10th percentile) with gestational age at delivery, indication for delivery and neonatal outcomes. Methods Retrospective cohort study at an academic hospital of women with singleton pregnancy seen for ultrasound from 28+0-33+6 weeks of gestation during 2009-2011. Outcomes were compared between two groups: normal AC (AC and EFW ≥ 10th percentile) and small AC (AC < 10th percentile and EFW ≥ 10th percentile). Results Among 592 pregnancies, fetuses in the small AC group (n = 55) experienced a higher incidence of overall preterm delivery (RR: 2.2, 95% Cl: 1.3–3.7) and provider-initiated preterm delivery (RR: 3.7, Cl: 1.8–7.5) compared to those in the normal AC group (n = 537). Neonates in the small AC group had a lower median birth weight whether delivered at term (p < 0.001) or preterm (p = 0.04), but were not more likely to experience intensive care unit admission or respiratory distress syndrome (all p ≥ 0.35). Conclusions Small AC, even in the setting of an EFW ≥ 10th percentile, was associated with a higher incidence of overall and provider-initiated preterm delivery despite similar neonatal outcomes. Further investigation is warranted to determine whether these preterm deliveries could be prevented. PMID:24102316

Perinatal outcome in singleton pregnancies complicated with preeclampsia and eclampsia in Ecuador.

PubMed

Phoa, K Y N; Chedraui, P; Pérez-López, F R; Wendte, J F; Ghiabi, S; Vrijkotte, T; Pinto, P

2016-07-01

Preeclampsia in Ecuador is an understudied subject since available epidemiological data are scarce. The aim of this study was to describe perinatal outcomes among singleton pregnancies complicated with preeclampsia and eclampsia in a sample of low-income Ecuadorian women. Pregnant women complicated with preeclampsia (mild and severe) and eclampsia (defined according to criteria of the ACOG) delivering at the Enrique C. Sotomayor Obstetrics and Gynecology Hospital, Guayaquil, Ecuador were surveyed with a structured questionnaire containing maternal (socio-demographic) and neonatal data. Perinatal outcomes were compared according to severity of clinical presentation. A total of 163 women with preeclampsia [mild (23.9%), severe (68.7%) and eclampsia (7.4%)] were surveyed. Perinatal mortality and stillbirth rate was similar among studied groups (mild vs. severe preeclampsia/eclampsia cases). However, severe cases displayed higher rates of adverse perinatal outcomes: lower birth Apgar scores, more preterm births, and more low birth weight and small for gestational age infants. Caesarean-section rate and the number of admissions to intensive or intermediate neonatal care were higher in severe cases. A similar trend was found when analysis excluded preterm gestations. In conclusion, in this specific low-income Ecuadorian population perinatal outcome was adverse in pregnancies complicated with severe preeclampsia/eclampsia.

Prophylactic cefazolin in amnioinfusions administered for meconium-stained amniotic fluid.

PubMed Central

Edwards, R K; Duff, P

1999-01-01

OBJECTIVE: To determine if amnioinfusion with an antibiotic solution decreased the rate of clinical chorioamnionitis and puerperal endometritis in patients with meconium-stained amniotic fluid. METHODS: Patients in labor at 36 weeks of gestation or greater with singleton pregnancies and meconium-stained amniotic fluid were randomized to receive either cefazolin, 1 g/1,000 mL, of normal saline (n = 90) or normal saline (n = 93) amnioinfusion. Rates of clinically diagnosed chorioamnionitis and endometritis and of suspected and culture-proven neonatal infection were determined. RESULTS: Between the study and control groups, the incidences of clinical chorioamnionitis (7.8% vs. 8.6%), endometritis (2.4% vs. 3.5%), aggregate intrauterine infection (10.0% vs. 11.8%), suspected neonatal infection (17.8% vs. 21.5%), and proven neonatal infection (0.0% vs. 2.2%) were not significantly different. CONCLUSIONS: Prophylactic use of cefazolin in amnioinfusions did not significantly reduce rates of maternal or neonatal infection in patients with meconium-stained amniotic fluid. PMID:10371474

A prospective randomized trial comparing Foley catheter, oxytocin, and combination Foley catheter-oxytocin for labour induction with unfavourable cervix.

PubMed

El Khouly, Nabih I

2017-04-01

The purpose of this study was to evaluate the effectiveness and safety of transcervical Foley catheter with and without oxytocin versus oxytocin alone for labour induction with unfavourable cervix. This trial enrolled 108 women with singleton pregnancies presented for labour induction with unfavourable cervix. Patients were randomly assigned to receive Foley catheter alone (I), Foley catheter plus oxytocin (II) or oxytocin alone (III). Outcomes were analysed in terms of success of induction, induction delivery interval, route of delivery, dose and duration of oxytocin, and complications. Successful normal vaginal delivery was more common in group I (p = .02) compared to group III. Induction delivery time was statistically shorter in group II and group III (p < .001). Patients in group I required significantly less oxytocin dose and duration (p < .001). This led to our conclusion that induction of labour with Foley catheter without oxytocin increases success rate of normal vaginal delivery; however, it has a longer induction delivery interval with similar complications.

Neonatal Outcomes of Low-Risk, Late-Preterm Twins Compared With Late-Preterm Singletons.

PubMed

Salem, Shimrit Yaniv; Kibel, Mia; Asztalos, Elizabeth; Zaltz, Arthur; Barrett, Jon; Melamed, Nir

2017-09-01

To test the hypothesis that the risk of neonatal morbidity among late-preterm twins is similar to that of late-preterm singletons. We conducted a retrospective cohort study of all women with twin or singleton pregnancy who gave birth during the late-preterm period in a single tertiary center between 2008 and 2015. Neonatal outcomes of low-risk, late-preterm twins were compared with those of low-risk, late-preterm singletons. The primary outcome was the same primary composite respiratory morbidity variable that was used in the randomized controlled trial of Gyamfi-Bannerman et al on the administration of antenatal corticosteroids during the late-preterm period. A total of 922 singleton and 721 twin late-preterm neonates met the inclusion criteria. The rates of composite respiratory morbidity and severe composite respiratory morbidity were similar for twins and singletons (8.3% compared with 7.4%, P=.5 and 6.8% compared with 6.0%, P=.5, respectively), but were lower than the rates of the same composite respiratory morbidity variable in the randomized controlled study described previously. The odds for respiratory morbidity were similar for twins and singletons for both composite respiratory morbidity (adjusted odds ratio [OR] 0.73, 95% CI 0.48-1.12) and severe composite respiratory morbidity (adjusted OR 0.79, 95% CI 0.50-1.24). The risk of respiratory morbidity among late-preterm twins is similar to that of late-preterm singletons. Still, the low absolute rates of the composite respiratory morbidity in our population suggest that administration of antenatal corticosteroids may be mostly justified among neonates born closer to 34 weeks of gestation.

Acute Air Pollution Exposure and Blood Pressure at Delivery Among Women With and Without Hypertension

PubMed Central

Männistö, Tuija; Liu, Danping; Leishear, Kira; Sherman, Seth; Laughon, S. Katherine

2015-01-01

BACKGROUND Chronic air pollution exposure increases risk for hypertensive disorders of pregnancy, but the effect of acute air pollution exposure on blood pressure during pregnancy is less well known. METHODS We studied 151,276 singleton term deliveries from the Consortium on Safe Labor (2002–2008) with clinical blood pressure measured at admission to labor/delivery and diagnoses of hypertensive disorders collected from electronic medical records and hospital discharge summaries. Air pollution exposures were estimated for the admission hour and the 4 hours preceding admission using a modified version of the Community Multiscale Air Quality models and observed air monitoring data. Blood pressure was categorized as normal; high normal; and mild, moderate, or severe hypertension based on pregnancy cut points. Adjusted ordinal logistic regression estimated the odds of women having a higher admission blood pressure category as a function of air pollutant, hypertensive disorders, and their interaction effect. RESULTS Odds of high blood pressure at admission to labor/delivery were increased in normotensive women after exposure to nitrogen oxides (by 0.2%/5 units), sulfur dioxide (by 0.3%/1 unit), carbon monoxide and several air toxics (by 3%–4%/high exposure). The effects were often similar or stronger among women with gestational hypertension and preeclampsia. Exposure to particulate matter <10 μm increased odds of high blood pressure in women with preeclampsia by 3%/5 units. CONCLUSIONS Air pollution can influence admission blood pressure in term deliveries and may increase likelihood of preeclampsia screening at delivery admission. PMID:24795401

Basal-bolus insulin therapy reduces maternal triglycerides in gestational diabetes without modifying cholesteryl ester transfer protein activity.

PubMed

Olmos, Pablo R; Borzone, Gisella R

2017-09-01

Macrosomia in the offspring of overweight/obese mothers with glucose-controlled gestational diabetes mellitus (GDM) is due to excessive rise of maternal triglycerides (TG). We aimed to ascertain whether basal-bolus insulin therapy (BBIT), or other components of the treatment, could reduce TG in GDM. We studied the records of 131 singleton pregnancies with GDM, using stepwise multiple linear regression, Mann-Whitney, χ 2 , and Jonckheere-Terpstra tests. As maternal TG increased steadily during normal pregnancy, these were transformed as z-scores. The atherogenic index of plasma (AIP) was calculated as a measure of cholesteryl ester transfer protein activity. Multiple regression showed that only BBIT (but neither limitation of weight gain nor metformin) reduced maternal TG z-scores (P = 0.011). When the 131 pregnancies were split into two groups - without BBIT (n = 58; HbA1c = 5.3 ± 0.3%) and with BBIT (n = 73; HbA1c = 5.4 ± 0.6; P = 0.2005) - we observed that BBIT (n = 73) reduced maternal TG z-scores in a dose-related fashion (Jonckheere-Terpstra P = 0.03817). The atherogenic index of plasma remained within normal range in both groups. BBIT (but not weight gain control nor metformin) reduced maternal TG in mothers with glucose-controlled GDM. This beneficial effect of BBIT was not related to changes in the cholesteryl ester transfer protein activity. © 2017 Japan Society of Obstetrics and Gynecology.

Long-term pediatric skin eruption-related hospitalizations in offspring conceived via fertility treatment.

PubMed

Krieger, Yuval; Wainstock, Tamar; Sheiner, Eyal; Harlev, Avi; Landau, Daniella; Horev, Amir; Bogdanov-Berezovsky, Alexander; Walfisch, Asnat

2018-03-01

Although concerns have been raised regarding the long-term health risks of offspring conceived following fertility treatments, limited information is available regarding their health status beyond the neonatal period. We aimed to evaluate the risk of long-term eruptive dermatological morbidity among children born following fertility treatments as compared to those conceived spontaneously. A population-based cohort study was conducted, including all singleton deliveries occurring between the years 1991 and 2014 at a single tertiary medical center. Fetuses with congenital malformations and multiple gestations were excluded. Children delivered following fertility treatment pregnancies and spontaneous pregnancies were compared. Hospitalizations of the offspring up to the age of 18 years involving cutaneous eruptions were evaluated. A Kaplan-Meier survival curve was used to compare cumulative morbidity incidence and a Cox regression model to control for confounders. During the study period, 242,187 singleton deliveries met the inclusion criteria, 1.8% of which were following fertility treatments (n = 4324). Eruptive dermatological morbidity of the offspring up to the age of 18 years was significantly more common in the fertility treatment group (1.5%) as compared to spontaneous pregnancies (1.1%; P = 0.023). The Kaplan-Meier survival curve demonstrated a significantly higher cumulative incidence of eruptive dermatological morbidity following fertility treatments (log-rank P = 0.007). Using the Cox regression model, while controlling for multiple confounders, fertility treatment was noted as an independent risk factor for long-term pediatric eruptive dermatological morbidity (adjusted HR = 1.43, CI 1.12-1.83, P = 0.004). Singletons conceived via fertility treatments appear to be at an increased risk for long-term eruptive dermatological morbidity. © 2018 The International Society of Dermatology.

Effectiveness of progesterone, cerclage and pessary for preventing preterm birth in singleton pregnancies: a systematic review and network meta-analysis.

PubMed

Jarde, A; Lutsiv, O; Park, C K; Beyene, J; Dodd, J M; Barrett, J; Shah, P S; Cook, J L; Saito, S; Biringer, A B; Sabatino, L; Giglia, L; Han, Z; Staub, K; Mundle, W; Chamberlain, J; McDonald, S D

2017-07-01

Preterm birth (PTB) is the leading cause of infant death, but it is unclear which intervention is best to prevent it. To compare progesterone, cerclage and pessary, determine their relative effects and rank them. We searched Medline, EMBASE, CINAHL, Cochrane CENTRAL and Web of Science (to April 2016), without restrictions, and screened references of previous reviews. We included randomised trials of progesterone, cerclage or pessary for preventing PTB in women with singleton pregnancies at risk as defined by each study. We extracted data by duplicate using a piloted form and performed Bayesian random-effects network meta-analyses and pairwise meta-analyses. We rated evidence quality using GRADE, ranked interventions using SUCRA and calculated numbers needed to treat (NNT). We included 36 trials (9425 women; 25 low risk of bias trials). Progesterone ranked first or second for most outcomes, reducing PTB < 34 weeks [odds ratio (OR) 0.44; 95% credible interval (CrI) 0.22-0.79; NNT 9; low quality], <37 weeks (OR 0.58; 95% CrI 0.41-0.79; NNT 9; moderate quality), and neonatal death (OR 0.50; 95% CrI 0.28-0.85; NNT 35; high quality), compared with control, in women overall at risk. We found similar results in the subgroup with previous PTB, but only a reduction of PTB < 34 weeks in women with a short cervix. Pessary showed inconsistent benefit and cerclage did not reduce PTB < 37 or <34 weeks. Progesterone was the best intervention for preventing PTB in singleton pregnancies at risk, reducing PTB < 34 weeks, <37 weeks, neonatal demise and other sequelae. Progesterone was better than cerclage and pessary to prevent preterm birth, neonatal death and more in network meta-analysis. © 2017 Royal College of Obstetricians and Gynaecologists.

Perinatal mortality in twin pregnancy: an analysis of birth weight-specific mortality rates and adjusted mortality rates for birth weight distributions.

PubMed

Fabre, E; González de Agüero, R; de Agustin, J L; Pérez-Hiraldo, M P; Bescos, J L

1988-01-01

The objective of this study is to compare the fetal mortality rate (FMR), early neonatal mortality rate (ENMR) and perinatal mortality rate (PMR) of twin and single births. It is based on a survey which was carried out in 22 Hospital Centers in Spain in 1980, and covered 1,956 twins born and 110,734 singletons born. The FMR in twins was 36.3/1000 and 8.8/1000 for singletons. The ENMR in twins was 36.1/1000 and 5.7/1000 for singletons. The PMR in twins was 71.1/1000 and 14.4/1000 for singletons. When birthweight-specific PMR in twin and singletons births are compared, there were no differences between the rates for groups 500-999 g and 1000-1499 g. For birthweight groups of 1500-1999 g (124.4 vs 283.8/1000) and 2000-2999 g (29.6 vs 73.2/1000) the rates for twins were about twice lower than those for single births. The PMR for 2500 g and over birthweight was about twice higher in twins than in singletons (12.5 vs 5.5/1000). After we adjusted for birthweight there was a difference in the FMR (12.6 vs 9.8/1000) and the PMR (19.1 vs 16.0/1000, and no difference in the ENMR between twins and singletons (5.9 vs 6.4/1000), indicating that most of the differences among crude rates are due to differences in distribution of birthweight.

Variation in hospital rates of induction of labour: a population-based record linkage study.

PubMed

Nippita, Tanya A; Trevena, Judy A; Patterson, Jillian A; Ford, Jane B; Morris, Jonathan M; Roberts, Christine L

2015-09-02

To examine interhospital variation in rates of induction of labour (IOL) to identify potential targets to reduce high rates of practice variation. Population-based record linkage cohort study. New South Wales, Australia, 2010-2011. All women with live births of ≥24 weeks gestation in 72 hospitals. Variation in hospital IOL rates adjusted for differences in case-mix, according to 10 mutually exclusive groups derived from the Robson caesarean section classification; groups were categorised by parity, plurality, fetal presentation, prior caesarean section and gestational age. The overall IOL rate was 26.7% (46,922 of 175,444 maternities were induced), ranging from 9.7% to 41.2% (IQR 21.8-29.8%) between hospitals. Nulliparous and multiparous women at 39-40 weeks gestation with a singleton cephalic birth were the greatest contributors to the overall IOL rate (23.5% and 20.2% of all IOL respectively), and had persisting high unexplained variation after adjustment for case-mix (adjusted hospital IOL rates ranging from 11.8% to 44.9% and 7.1% to 40.5%, respectively). In contrast, there was little variation in interhospital IOL rates among multiparous women with a singleton cephalic birth at ≥41 weeks gestation, women with singleton non-cephalic pregnancies and women with multifetal pregnancies. 7 of the 10 groups showed high or moderate unexplained variation in interhospital IOL rates, most pronounced for women at 39-40 weeks gestation with a singleton cephalic birth. Outcomes associated with divergent practice require determination, which may guide strategies to reduce practice variation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Decreased serum vitamin D levels in early spontaneous pregnancy loss.

PubMed

Hou, W; Yan, X-T; Bai, C-M; Zhang, X-W; Hui, L-Y; Yu, X-W

2016-09-01

Effects of vitamin D deficiency in pregnancy have been associated with some adverse pregnancy outcomes. The objective of this study was to analyze the relationship between vitamin D deficiency in childbearing aged women and pregnancy loss (PL) in the first trimester. This is a cross-sectional study. Plasma was collected from 60 nulliparous women with singleton at 7-9 weeks of gestation (30 with viable gestation and 30 with PL) and 60 non-gravid childbearing aged women (30 with a successful pregnancy history, and 30 with one or more spontaneous first-trimester PL history). Quantitation of serum 25-hydroxyvitamin D (25(OH)D) and 25-hydroxyvitamin D-1 alpha hydroxylase (CYP27B1) was assayed. By pregnancy/non-gravid, normal pregnant women had higher 25(OH)D (49.32 μg/l) and CYP27B1 (82.00 pg/ml) than PL women (34.49 μg/l and 37.87 pg/ml, both P<0.01); the non-gravid women with a successful pregnancy history also had higher 25(OH)D (39.56 μg/l) and CYP27B1 (39.04 pg/ml) than women with PL history (12.30 μg/l and 12.35 pg/ml, both P<0.01). The 96.7% of non-gravid women with PL history and 43.3% of PL women had serum 25(OH)D concentrations below 30 μg/l. There was a strong association between low vitamin D levels and PL (odds ratio 1.71; 95% confidence interval: 1.2-2.4, P<0.001). The regression analyses showed that PL was significantly inversely correlated with 25(OH)D (P<0.01) and CYP27B1 levels (P<0.01). Vitamin D deficiency associated with PL in the first trimester of pregnancy. Decreased serum vitamin D levels among childbearing aged women with the failed clinical pregnancies history may predispose to increased risk for PL.

Investigation on the suitability of the International Association of Diabetes and Pregnancy Study Group diagnostic criteria for gestational diabetes mellitus in China.

PubMed

Shang, M; Lin, L; Ma, L; Yin, L

2014-02-01

The aim of this study was to compare pregnancy outcomes of Chinese women diagnosed with gestational hyperglycaemia by the well-established American Diabetes Association (ADA) criteria, with those women meeting the newer criteria established by International Association of Diabetes and Pregnancy Study Groups (IADPSG). The study subjects consisted of 6,201 pregnant Chinese women with a singleton pregnancy who had received prenatal care and delivered between December 2008 and December 2011. Women who were screened positive with 1 h glucose load of ≥ 7.8 mmol/l underwent a diagnostic 3 h oral glucose tolerance test. Gestational hyperglycaemia was diagnosed using the ADA criteria and re-diagnosed according to the IADPSG criteria. The correlation between the incidences of adverse pregnant outcomes with gestational hyperglycaemia was analysed. In total, 570 patients (9.19% of 6,201) met the ADA criteria and 676 (10.90% of 6,201) met the IADPSG criteria. The 518 patients who met both standards showed a reduced caesarean section rate, as compared with 158 patients who only met the IADPSG standard and received no intervention (71.2% vs 79.7%, p < 0.05). The IADPSG-only group also had a higher rate of macrosomia and pre-eclampsia than the control group. The IADPSG criteria identified a group of women previously classified as normal according to the ADA criteria, but revealing poor pregnancy outcomes and requiring management. Therefore, we conclude that the IADPSG criteria are more suitable for the diagnosis of gestational hyperglycaemia in China.

Anxiety during pregnancy and autonomic nervous system activity: A longitudinal observational and cross-sectional study.

PubMed

Mizuno, Taeko; Tamakoshi, Koji; Tanabe, Keiko

2017-08-01

To assess the longitudinal change in autonomic nervous system (ANS) activity during pregnancy and the association between anxiety during pregnancy and ANS activity. Pregnant Japanese women with a singleton fetus and normal pregnancy were recruited (n=65). ANS activity and anxiety were measured using a self-rating questionnaire at approximately 20, 30, and 36weeks of gestation. Very low (VLF) and high (HF) frequency bands of heart rate variability spectrums were used. Anxiety was assessed using the Japanese version of the State-Trait Anxiety Inventory. A score of 45 or more on trait-anxiety and the other represent the trait-anxiety group and the non- trait-anxiety group, respectively. The state-anxiety group and the non-state-anxiety group were defined in the same manner. Longitudinal observation of individual pregnant women indicated the significant increasing trend (p=0.002) of VLF power and the significant decreasing trend (p<0.001) of HF power during 20 to 36 gestation weeks. Compared with the non-trait-anxiety group, the trait-anxiety group had significantly lower VLF values at 20 gestational weeks (p=0.033) and had significantly lower HF values at 30 and 36 gestational weeks (p=0.015 and p=0.044, respectively). The increasing rate of VLF from 20 to 36 gestational weeks was higher among the trait-anxiety group. The same associations were observed between the state-anxiety and non-state-anxiety groups at 20 gestational weeks. Anxiety during pregnancy decreased heart rate variability. Anxiety in second trimester pregnancy promoted a subsequent increase in sympathetic activity. Copyright © 2017 Elsevier Inc. All rights reserved.

Severe Diabetic Nephropathy in Type 1 Diabetes and Pregnancy - A Case Series

PubMed Central

Piccoli, Giorgina B.; Tavassoli, Elisabetta; Melluzza, Carmela; Grassi, Giorgio; Monzeglio, Clara; Donvito, Valentina; Leone, Filomena; Attini, Rossella; Ghiotto, Sara; Clari, Roberta; Moro, Irene; Fassio, Federica; Parisi, Silvia; Pilloni, Eleonora; Vigotti, Federica N.; Giuffrida, Domenica; Rolfo, Alessandro; Todros, Tullia

2013-01-01

BACKGROUND: Diabetes and nephropathy are important challenges during pregnancy, increasingly encountered because of the advances in maternal-fetal care. AIM: To evaluate the maternal and fetal outcomes recorded in "severe" diabetic nephropathy in type 1 diabetic patients referred to nephrological healtcare. METHODS: The study was performed in an outpatient unit dedicated to kidney diseases in pregnancy (with joint nephrological and obstetric follow-up and strict cooperation with the diabetes unit). 383 pregnancies were referred to the outpatient unit in 2000-2012, 14 of which were complicated by type 1 diabetes. The report includes 12 deliveries, including 2 pregnancies in 1 patient; one twin pregnancy; 2 spontaneous abortions were not included. All cases had long-standing type 1 diabetes (median of 21 (15-31) years), relatively high median age (35 (29-40) years) and end-organ damage (all patients presented laser-treated retinopathy and half of them clinical neuropathy). Median glomerular filtration rate (GFR) at referral was 67 ml/min (48-122.6), proteinuria was 1.6 g/day (0.1-6.3 g/day). RESULTS: Proteinuria steeply increased in 11/12 patients, reaching the nephrotic range in nine (6 above 5 g/day). One patient increased by 2 chronic kidney disease (CKD) stages. Support therapy included blood pressure and diabetes control, bed rest, and moderate protein restriction. All children were preterm (7 early preterm); early spontaneous labor occurred in 4/12 patients. All singletons were appropriate for gestational age and developed normally after birth. The male twin child died 6 days after birth (after surgery for great vessel transposition). CONCLUSIONS: Diabetic patients with severe diabetic nephropathy are still present a considerable challenge. Therefore, further investigations are required, particularly on proteinuria management and the occurrence of spontaneous labor. PMID:24172700

The relationship between maternal serum iron and zinc levels and their nutritional intakes in early pregnancy with gestational diabetes.

PubMed

Behboudi-Gandevani, Samira; Safary, Kolsum; Moghaddam-Banaem, Lida; Lamyian, Minoor; Goshtasebi, Azita; Goshtasbi, Azita; Alian-Moghaddam, Narges

2013-07-01

The aim of this study was to investigate the association between maternal iron/zinc serum levels and their nutritional intake in early pregnancy with gestational diabetes. The maternal serum zinc/iron levels were measured in 1,033 healthy singleton pregnant women aged 20-35 between 14 and 20 weeks of gestation, within two groups: namely, normal and gestational diabetes, and participants were followed up to 24-28 weeks of gestation. Food frequency questionnaire was used to assess nutritional intakes of iron/zinc. The main outcome was gestational diabetes screened with the 50-g glucose challenge test and diagnosed with oral glucose tolerance test at 24-28 weeks of gestation. Gestational diabetes occurred in 72 (6.96 %) of 1,033 women in study. There was a statistical relationship between early pregnancy maternal serum iron and gestational diabetes, mean (SD), 143.8 (48.7) vs. 112.5 (83.5) μg/dl, P value of <0.0001. There was no statistical significant difference in zinc levels and iron/zinc nutritional intake between groups. The results remained unchanged after using regression model for adjustment of potential risk factors with an adjusted OR of 1.006 (95 % CI 1.002 to 1.009; P = 0.001) for early pregnancy maternal serum iron to cause gestational diabetes. The receiver-operator characteristic curve identified that a maternal serum iron above 100 μg/dl in early pregnancy is the optimum cutoff value for predicting gestational diabetes, which showed a sensitivity and specificity of 80.6 and 50.7 %, respectively. In conclusion, high maternal serum iron in early pregnancy could increase the risk of gestational diabetes. Also, it could be used as a sensitive and specific predictor for gestational diabetes.

Obstetric outcomes after fresh versus frozen-thawed embryo transfers: A systematic review and meta-analysis.

PubMed

Roque, Matheus; Valle, Marcello; Sampaio, Marcos; Geber, Selmo

2018-05-21

To evaluate if there are differences in the risks of obstetric outcomes in IVF/ICSI singleton pregnancies when compared fresh to frozen-thawed embryo transfers (FET). This was a systematic review and meta-analysis evaluating the obstetric outcomes in singleton pregnancies after FET and fresh embryo transfer. The outcomes included in this study were pregnancy-induced hypertension (PIH), pre-eclampsia, placenta previa, and placenta accreta. The search yielded 654 papers, 6 of which met the inclusion criteria and reported on obstetric outcomes. When comparing pregnancies that arose from FET or fresh embryo transfer, there was an increase in the risk of obstetric complications in pregnancies resulting from FET when compared to those emerging from fresh embryo transfers in PIH (aOR 1.82; 95% CI 1.24-2.68), pre-eclampsia (aOR 1.32, 95% CI 1.07, 1.63), and placenta accreta (aOR 3.51, 95% CI 2.04-6.05). There were no significant differences in the risk between the FET and fresh embryo transfer groups when evaluating placenta previa (aOR 0.70; 95% CI 0.46-1.08). The obstetric outcomes observed in pregnancies arising from ART may differ among fresh and FET cycles. Thus, when evaluating to perform a fresh embryo transfer or a freeze-all cycle, these differences found in obstetric outcomes between fresh and FET should be taken into account. The adverse obstetric outcomes after FET found in this study emphasize that the freeze-all policy should not be offered to all the patients, but should be offered to those with a clear indication of the benefit of this strategy.

Perinatal outcomes among singletons after assisted reproductive technology with single-embryo or double-embryo transfer versus no assisted reproductive technology.

PubMed

Martin, Angela S; Chang, Jeani; Zhang, Yujia; Kawwass, Jennifer F; Boulet, Sheree L; McKane, Patricia; Bernson, Dana; Kissin, Dmitry M; Jamieson, Denise J

2017-04-01

To examine outcomes of singleton pregnancies conceived without assisted reproductive technology (non-ART) compared with singletons conceived with ART by elective single-embryo transfer (eSET), nonelective single-embryo transfer (non-eSET), and double-embryo transfer with the establishment of 1 (DET -1) or ≥2 (DET ≥2) early fetal heartbeats. Retrospective cohort using linked ART surveillance data and vital records from Florida, Massachusetts, Michigan, and Connecticut. Not applicable. Singleton live-born infants. None. Preterm birth (PTB <37 weeks), very preterm birth (VPTB <32 weeks), small for gestational age birth weight (<10th percentile), low birth weight (LBW <2,500 g), very low birth weight (VLBW <1,500 g), 5-minute Apgar score <7, and neonatal intensive care unit (NICU) admission. After controlling for maternal characteristics and employing a weighted propensity score approach, we found that singletons conceived after eSET were less likely to have a 5-minute Apgar <7 (adjusted odds ratio [aOR] 0.33; 95% CI, 0.15-0.69) compared with non-ART singletons. There were no differences among outcomes between non-ART and non-eSET infants. We found that PTB, VPTB, LBW, and VLBW were more likely among DET -1 and DET ≥2 compared with non-ART infants, with the odds being higher for DET ≥2 (PTB aOR 1.58; 95% CI, 1.09-2.29; VPTB aOR 2.46; 95% CI, 1.20-5.04; LBW aOR 2.17; 95% CI, 1.24-3.79; VLBW aOR 3.67; 95% CI, 1.38-9.77). Compared with non-ART singletons, singletons born after eSET and non-eSET did not have increased risks whereas DET -1 and DET ≥2 singletons were more likely to have adverse perinatal outcomes. Copyright © 2017 American Society for Reproductive Medicine. All rights reserved.

Maternal serum free-beta-chorionic gonadotrophin, pregnancy-associated plasma protein-A and fetal nuchal translucency thickness at 10-13(+6) weeks in relation to co-variables in pregnant Saudi women.

PubMed

Ardawi, Mohammed-Salleh M; Nasrat, Hasan A; Rouzi, Abdulrahim A; Qari, Mohammed H; Al-Qahtani, Mohammed H; Abuzenadah, Adel M

2007-04-01

To establish normative values and distribution parameters of first-trimester screening markers, namely, fetal nuchal translucency (NT), maternal serum free beta-human chorionic gonadotrophin (beta-hCG) and pregnancy-associated plasma protein-A (PAPP-A), at 10 to 13(+6) weeks of gestation in Saudi women and to evaluate the effect of co-variables including maternal body weight, gravidity, parity, fetal gender, twin pregnancy, smoking and ethnicity on these markers. A cohort of Saudi women (first cohort n = 1616) with singleton pregnancies prospectively participated in the present study, and fetal NT together with maternal serum free beta-hCG and PAPP-A were determined at 10 to 13(+6) weeks of gestation. The distribution of gestational age-independent multiples of the median (MoM) of the parameters was defined and normative values were established, and correction for maternal body weight was made accordingly. The influence of various co-variables was examined using the data collected from the first and the second (n = 1849) cohorts of women and 62 twin pregnancies, and compared with other studies. All markers exhibited log-normally distributed MoMs. Gestational age-independent normative values were established. Maternal body weight was corrected, particularly for maternal free beta-hCG and PAPP-A using standard methods. Fetal NT showed a negative relationship with increasing gravidity (r = -0.296) or parity (r = -0.311), whereas both free beta-hCG and PAPP-A exhibited a significant positive relationship. There was a significant increase in the MoM of free beta-hCG in female fetuses. Smoking decreased MoM values of free beta-hCG (by 14.6%; P < 0.01) and PAPP-A (by 18.8%; P < 0.001). Twin pregnancy showed significant increases in MoM values of free beta-hCG (by 1.87-fold) and PAPP-A (by 2.24-fold), with no significant changes in fetal NT MoM values. Fetal NT MoM values were lower in Africans and Asians but higher in Orientals, as compared to Saudi women (P < 0.05; in each case). MoM values (body weight-corrected) of free beta-hCG were 25.2% higher in Africans and 19.4% higher in Orientals but 6.8% lower in other Arabian and Asian (by 5.8%) women as compared to Saudi women (P < 0.05; in each case). The normative values and distribution parameters for fetal NT, maternal serum free beta-hCG and PAPP-A were established in Saudi singleton pregnancies, the maternal body weight together with smoking, twin pregnancy and ethnicity being important first-trimester screening co-variables. Gravidity, parity and fetal gender are also considered to influence one or more of the first-trimester markers examined. Copyright (c) 2007 John Wiley & Sons, Ltd.

Purse-string suture technique to enable laparoscopic management of the interstitial gestation of a heterotopic pregnancy.

PubMed

Aust, Thomas; O'Neill, Aoife; Cario, Gregory

2011-01-01

To describe the laparoscopic management of an interstitial gestation of a heterotopic pregnancy. Case report and technique description. Tertiary-level private practice. Woman with a 6-week gestation spontaneous heterotopic twin pregnancy: one twin intrauterine, one interstitial. A purse-string suture was applied to the proximal portion of the interstitial heterotopic pregnancy. To enable a cornual resection to be performed with minimal bleeding and without recourse to laparotomy. At 8 weeks gestation an ultrasound scan confirmed a viable singleton intrauterine pregnancy, but a scan at 12 weeks showed a missed miscarriage. The embedding of the suture into the uterine serosa prevents slipping of the ligature that could occur with a pretied loop. Copyright © 2011 American Society for Reproductive Medicine. All rights reserved.

Adverse pregnancy outcomes in women with nausea and vomiting of pregnancy.

PubMed

Temming, Lorene; Franco, Albert; Istwan, Niki; Rhea, Debbie; Desch, Cheryl; Stanziano, Gary; Joy, Saju

2014-01-01

To examine the influence of nausea and vomiting of pregnancy (NVP) on pregnancy outcomes. Outcomes were compared for primigravidas with a current singleton gestation enrolled at <20 weeks' gestation in a maternity risk screening and education program (n = 81 486). Patient-reported maternal characteristics and pregnancy outcomes were compared for women with and without NVP and within the NVP group for those with and without poor weight gain. 6.4% of women reported NVP as a pregnancy complication. Women reporting NVP were more likely to be younger, obese, single and smoke. They had higher rates of preterm delivery, pregnancy-induced hypertension and low birth weight <2500 g. Almost one-quarter of women with NVP had lower than recommended weight gain. Poor weight gain was associated with a higher incidence of adverse outcomes. Obesity, tobacco use and poor pregnancy weight gain independently increased the odds of an adverse outcome. NVP and subsequent poor weight gain may be associated with adverse pregnancy outcomes.

Progestogens in singleton gestations with preterm prelabor rupture of membranes: a systematic review and metaanalysis of randomized controlled trials.

PubMed

Quist-Nelson, Johanna; Parker, Pamela; Mokhtari, Neggin; Di Sarno, Rossana; Saccone, Gabriele; Berghella, Vincenzo

2018-03-31

Preterm prelabor rupture of membranes occurs in 3% of all pregnancies. Neonatal benefit is seen in uninfected women who do not deliver immediately after preterm prelabor rupture of membranes. The purpose of this study was to evaluate whether the administration of progestogens in singleton pregnancies prolongs pregnancy after preterm prelabor rupture of membranes. Searches were performed in MEDLINE, OVID, Scopus, EMBASE, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials with the use of a combination of keywords and text words related to "progesterone," "progestogen," "prematurity," and "preterm premature rupture of membranes" from the inception of the databases until January 2018. We included all randomized controlled trials of singleton gestations after preterm prelabor rupture of membranes that were randomized to either progestogens or control (either placebo or no treatment). Exclusion criteria were trials that included women who had contraindications to expectant management after preterm prelabor rupture of membranes (ie, chorioamnionitis, severe preeclampsia, and nonreassuring fetal status) and trials on multiple gestations. We planned to include all progestogens, including but not limited to 17-α hydroxyprogesterone caproate, and natural progesterone. The primary outcome was latency from randomization to delivery. Metaanalysis was performed with the use of the random effects model of DerSimonian and Laird to produce relative risk with 95% confidence interval. Analysis was performed for each mode of progestogen administration separately. Six randomized controlled trials (n=545 participants) were included. Four of the included trials assessed the efficacy of 17-α hydroxyprogesterone caproate; 1 trial assessed rectal progestogen, and 1 trial had 3 arms that compared 17-α hydroxyprogesterone caproate, rectal progestogen, and placebo. The mean gestational age at time randomization was 26.9 weeks in the 17-α hydroxyprogesterone caproate group and 27.3 weeks in the control group. 17-α Hydroxyprogesterone caproate administration was not found to prolong the latency period between randomization and delivery (mean difference, 0.11 days; 95% confidence interval, -3.30 to 3.53). There were no differences in mean gestational age at delivery, mode of delivery, or maternal or neonatal outcomes between the 2 groups. Similarly, there was no difference in latency for those women who received rectal progesterone (mean difference, 4.00 days; 95% confidence interval, -0.72 to 8.72). Progestogen administration does not prolong pregnancy in singleton gestations with preterm prelabor rupture of membranes. Copyright © 2018 Elsevier Inc. All rights reserved.

[The effect of pre-pregnancy weight and the increase of gestational weight on fetal growth restriction: a cohort study].

PubMed

Shi, M Y; Wang, Y F; Huang, K; Yan, S Q; Ge, X; Chen, M L; Hao, J H; Tong, S L; Tao, F B

2017-12-06

Objective: To investigate the effect of pre-pregnancy weight and the increase of gestational weight on fetal growth restriction. Methods: From May 2013 to September 2014, a total of 3 474 pregnant women who took their first antenatal care and willing to undergo their prenatal care and delivery in Ma 'anshan Maternity and Child Care Centers were recruited in the cohort study. Excluding subjects without weight data before delivery ( n= 54), pregnancy termination ( n= 162), twins live births ( n= 39), without fetal birth weight data ( n= 7), 3 212 maternal-singleton pairs were enrolled for the final data analysis. Demographic information of pregnant woman, pregnancy history, disease history, height and weight were collected. In the 24(th)-28(th), 32(nd)-36(th) gestational week and childbirth, three follow-up visits were undertaken to collect data of pregnancy weight, pregnancy vomiting, gestational hypertension, gestational diabetes mellitus, newborn gender and birth weight. χ(2) test was used to compare the detection rate of fetal growth restriction in different groups. Multivariate unconditional logistic regression model and spreadsheet were used to analyze the independent and interaction effect of pre-pregnancy weight and the increase of gestational weight on fetal growth restriction. Results: The incidence of fetal growth restriction was 9.7%(311/3 212). The incidence of fetal growth restriction in pre-pregnancy underweight group was 14.9% (90/603), higher than that in normal pre-pregnancy weight group (8.7% (194/2 226)) (χ(2)=24.37, P< 0.001). The incidence of fetal growth restriction in inadequate increase of gestational weight group was 17.9% (50/279), higher than the appropriate increase of weight group (11.8% (110/932)) (χ(2)=36.89, P< 0.001). Multivariate unconditional logistic regression analysis showed that compared with normal pre-pregnancy weight group, pre-pregnancy underweightwas a risk factor for fetal growth restriction, with RR (95 %CI ) at 1.76 (1.34-2.32); Compared with the appropriate increase of gestational weight group, inadequate weight increase during pregnancy was a risk factor for fetal growth restriction, with the RR (95 %CI ) at 1.70 (1.17-2.48). No additive model interaction [relative excess risk of interaction, attributable proportions of interaction, the synergy index and their 95 %CI were 0.75 (-2.14-3.63), 0.21 (-0.43-0.86) and 1.43 (0.45-4.53), respectively] or multiplication model interaction ( RR (95 %CI ): 1.00 (0.44-2.29)) existed between pre-pregnancy underweight and inadequate increase of gestational weight on fetal growth restriction. Conclusion: Pre-pregnancy underweight and inadequate increase of gestational weight would increase the risk of fetal growth restriction without interaction.

Medicolegal issues in multiple pregnancy.

PubMed

Gersell, Deborah J

2007-02-01

Any discussion of multiple pregnancy figures prominently in the consideration of the medicolegal aspects of placental pathology. Multiple gestations are common and becoming more so with assisted reproductive techniques, and multiples are associated with a disproportionate share of complications that may result in disputes over quality of care. Higher rates of intrauterine growth retardation, prematurity, stillbirth, morbidity, mortality, cerebral palsy, anomalous development, and malformation as compared with singletons are well documented in multiple pregnancy and should be anticipated. Monochorionic placentation and complications of vascular anastomosis are important factors contributing to poor outcome. Other factors, although occurring in all gestations, are relevant because they are more common in multiple gestations.

Serum alpha-fetoprotein in the three trimesters of pregnancy: effects of maternal characteristics and medical history.

PubMed

Bredaki, F E; Sciorio, C; Wright, A; Wright, D; Nicolaides, K H

2015-07-01

To define the contribution of maternal variables which influence the measured level of maternal serum alpha-fetoprotein (AFP) in screening for pregnancy complications. Maternal characteristics and medical history were recorded and serum AFP was measured in women with a singleton pregnancy attending for three routine hospital visits at 11 + 0 to 13 + 6, 19 + 0 to 24 + 6 and 30 + 0 to 34 + 6 weeks' gestation. For pregnancies delivering phenotypically normal live births or stillbirths ≥ 24 weeks' gestation, variables from maternal demographic characteristics and medical history that are important in the prediction of AFP were determined from a linear mixed-effects multiple regression. Serum AFP was measured in 17 071 cases in the first trimester, 8583 in the second trimester and 8607 in the third trimester. Significant independent contributions to serum AFP were provided by gestational age, maternal weight, racial origin, gestational age at delivery and birth-weight Z-score of the neonate of the previous pregnancy and interpregnancy interval. Cigarette smoking was found to significantly affect serum AFP in the first trimester only. The machine used to measure serum AFP was also found to have a significant effect. Random-effects multiple regression analysis was used to define the contribution of maternal variables that influence the measured level of serum AFP and express the values as multiples of the median (MoMs). The model was shown to provide an adequate fit of MoM values for all covariates, both in pregnancies that developed pre-eclampsia and in those without this pregnancy complication. A model was fitted to express measured serum AFP across the three trimesters of pregnancy as MoMs, after adjusting for variables from maternal characteristics and medical history that affect this measurement. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

OXTR and ZEB1 expression before and after progesterone dosing in pregnant women with threatened premature labor.

PubMed

Xu, Y-J; Ren, L-D; Zhai, S-S; Ran, L-M; Hu, L-L; Luo, X-H; Hong, T; Liu, R; Yu, Y-R; Ban, Y-J

2017-07-01

To investigate changes in the peripheral blood mRNA levels of oxytocin receptor (OXTR) and Zinc finger E-box-binding homeobox 1 (ZEB1) before and after progesterone dosing in pregnant women with threatened premature labor. Blood samples were collected from 30 healthy pregnant women with 28- to 33+6-week gestational age and singleton pregnancy (group A) and from 30 pregnant women with singleton pregnancy and threatened premature labor before and 48 hours after progesterone dosing (groups B and C, respectively) for quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR) assay to assess the OXTR and ZEB1 mRNA levels. The OXTR mRNA level was higher in the group B than in the groups A and C, and the ZEB1 mRNA level was lower in the group B than in the groups A and C. Notably, no significant difference was found in the mRNA level of OXTR or ZEB1 between group A and group C. The peripheral blood mRNA level of OXTR was increased, and that of ZEB1 was decreased in pregnant women with threatened premature labor. Progesterone helped to maintain pregnancy by readjusting the mRNA levels of OXTR and ZEB1.

The association of placenta previa and assisted reproductive techniques: a meta-analysis.

PubMed

Karami, Manoochehr; Jenabi, Ensiyeh; Fereidooni, Bita

2018-07-01

Several epidemiological studies have determined that assisted reproductive techniques (ART) can increase the risk of placenta previa. To date, only a meta-analysis has been performed for assessing the relationship between placenta previa and ART. This meta-analysis was conducted to estimate the association between placenta previa and ART in singleton and twin pregnancies. A literature search was performed in major databases PubMed, Web of Science, and Scopus from the earliest possible year to April 2017. The heterogeneity across studies was explored by Q-test and I 2 statistic. The publication bias was assessed using Begg's and Egger's tests. The results were reported using odds ratio (OR) and relative risk (RR) estimates with its 95% confidence intervals (CI) using a random-effects model. The literature search yielded 1529 publications until September 2016 with 1,388,592 participants. The overall estimate of OR was 2.67 (95%CI: 2.01, 3.34) and RR was 3.62 (95%CI: 0.21, 7.03) based on singleton pregnancies. The overall estimate of OR was 1.50 (95%CI: 1.26, 1.74) based on twin pregnancies. We showed based on odds ratio reports in observational studies that ART procedures are a risk factor for placenta previa.

Maternal early pregnancy body mass index and risk of preterm birth.

PubMed

Wang, Ting; Zhang, Jun; Lu, Xinrong; Xi, Wei; Li, Zhu

2011-10-01

To determine the association between maternal body mass index (BMI) in early pregnancy and the risk of preterm birth (PTB) in Chinese women. Data were obtained from a population-based perinatal care program in China during 1993-2005. Women whose height and weight information was recorded at the first prenatal visit in the first trimester of pregnancy and delivered a singleton live infant were selected. Women with multiple gestations, stillbirths, delivery before 28 weeks or after 44 weeks of gestation, and infants affected by major external birth defects were excluded. BMI was categorized as underweight (less than 18.5 kg/m(2)), normal weight (18.5-23.9 kg/m(2)), overweight (24-27.9 kg/m(2)), and obese (≥28 kg/m(2)) based on BMI classification criteria for Chinese. Logistic regression analysis was conducted to adjust for potential confounders, such as maternal age, education, occupation, city or county, gender of infant, and year of delivery. A total of 353,477 women were selected. The incidence of preterm birth in women who were underweight, normal weight, overweight, obese was 3.69% (3.61-3.76%), 3.59% (3.55-3.62%), 3.83% (3.71-3.96%), 4.90% (4.37-5.43%), respectively. The incidence of elective preterm birth, overweight, and obesity increased remarkably during 2000-2005 compared with that during 1993-1996. After having adjusted for potential confounders including maternal age, maternal occupation, education, city or county, gender of the infant and year of birth, the risk of PTB increased significantly with BMI (P < 0.05). Among nulliparae, the risk of elective preterm birth increased with increasing BMI. Nulliparae who were underweight were less likely to deliver elective preterm births (OR = 0.89, 95% CI 0.80-0.98). Nulliparae who were overweight and obese in early pregnancy were at a greater risk of elective PTB than normal weight nulliparae (for the overweight OR = 1.36, 95% CI 1.18-1.56, for the obese OR = 2.94, 95% CI 2.04-4.25). In this study, indigenous Chinese cohort women who are overweight, obese, and nulliparous are at an increased risk of elective preterm birth.

Pregnancy in infertile PCOD patients. Complications and outcome.

PubMed

Urman, B; Sarac, E; Dogan, L; Gurgan, T

1997-08-01

To evaluate the complications and outcome of pregnancy in women with polycystic ovary disease (PCOD). The course and outcome of 47 singleton pregnancies in women with well-documented PCOD were compared with those in 100 healthy controls. Women with PCOD had a significantly higher body mass index as compared to the control group (P < .05); however, the proportion of lean versus obese subjects in the two groups was similar. The incidence of an abnormal glucose challenge test, gestational diabetes mellitus and pregnancy-induced hypertension was significantly increased in pregnant women with PCOD (P < .05). When lean PCOD subjects were compared with lean control subjects, the difference in the incidence of the above complications was still significant (P < .05). The incidence of pregnancy complications was similar when obese PCOD subjects were compared with obese controls. Women with PCOD were at increased risk of gestational diabetes and pregnancy-induced hypertension, and this risk appeared to be independent of body mass index.

High-risk of preterm birth and low birth weight after oocyte donation IVF: analysis of 133,785 live births.

PubMed

Kamath, Mohan Shashikant; Antonisamy, Belavendra; Mascarenhas, Mariano; Sunkara, Sesh Kamal

2017-09-01

A higher risk of pregnancy complications occurs after assisted reproductive techniques compared with spontaneously conceived pregnancies. This is attributed to the underlying infertility and assisted reproduction technique procedures involved during treatment. It is a matter of interest whether use of donor oocytes affects perinatal outcomes compared with pregnancies after autologous IVF. Anonymized data were obtained from the Human Fertilization and Embryology Authority. The analysis included 5929 oocyte donation and 127,856 autologous IVF live births. Data from all women who underwent donor oocyte recipient or autologous IVF cycles, both followed with fresh embryo transfer, were analysed to compare perinatal outcomes of preterm birth (PTB) and low birthweight (LBW) after singleton and multiple live births. The risk of adverse perinatal outcomes after oocyte donation was increased: adjusted OR (aOR) 1.56, 99.5% CI 1.34 to 1.80 for PTB and aOR 1.43, 99.5% CI 1.24 to 1.66 for LBW were significantly higher after oocyte donation compared with autologous IVF singletons. The adjusted odds PTB (aOR 1.21, 99.5% CI 1.02 to 1.43) was significantly higher after oocyte donation compared with autologous IVF multiple births. Analysis of this large dataset suggests significantly higher risk of PTB and LBW after ooctye donation compared with autologous IVF pregnancies. Copyright © 2017 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

Costs and effects of screening and treating low risk women with a singleton pregnancy for asymptomatic bacteriuria, the ASB study.

PubMed

Kazemier, Brenda M; Schneeberger, Caroline; De Miranda, Esteriek; Van Wassenaer, Aleid; Bossuyt, Patrick M; Vogelvang, Tatjana E; Reijnders, Frans J L; Delemarre, Friso M C; Verhoeven, Corine J M; Oudijk, Martijn A; Van Der Ven, Jeanine A; Kuiper, Petra N; Feiertag, Nicolette; Ott, Alewijn; De Groot, Christianne J M; Mol, Ben Willem J; Geerlings, Suzanne E

2012-06-21

The prevalence of asymptomatic bacteriuria (ASB) in pregnancy is 2-10% and is associated with both maternal and neonatal adverse outcomes as pyelonephritis and preterm delivery. Antibiotic treatment is reported to decrease these adverse outcomes although the existing evidence is of poor quality. We plan a combined screen and treat study in women with a singleton pregnancy. We will screen women between 16 and 22 weeks of gestation for ASB using the urine dipslide technique. The dipslide is considered positive when colony concentration ≥105 colony forming units (CFU)/mL of a single microorganism or two different colonies but one ≥105 CFU/mL is found, or when Group B Streptococcus bacteriuria is found in any colony concentration. Women with a positive dipslide will be randomly allocated to receive nitrofurantoin or placebo 100 mg twice a day for 5 consecutive days (double blind). Primary outcomes of this trial are maternal pyelonephritis and/or preterm delivery before 34 weeks. Secondary outcomes are neonatal and maternal morbidity, neonatal weight, time to delivery, preterm delivery rate before 32 and 37 weeks, days of admission in neonatal intensive care unit, maternal admission days and costs. This trial will provide evidence for the benefit and cost-effectiveness of dipslide screening for ASB among low risk women at 16-22 weeks of pregnancy and subsequent nitrofurantoin treatment. Dutch trial registry: NTR-3068.

Costs and effects of screening and treating low risk women with a singleton pregnancy for asymptomatic bacteriuria, the ASB study

PubMed Central

2012-01-01

Background The prevalence of asymptomatic bacteriuria (ASB) in pregnancy is 2-10% and is associated with both maternal and neonatal adverse outcomes as pyelonephritis and preterm delivery. Antibiotic treatment is reported to decrease these adverse outcomes although the existing evidence is of poor quality. Methods/Design We plan a combined screen and treat study in women with a singleton pregnancy. We will screen women between 16 and 22 weeks of gestation for ASB using the urine dipslide technique. The dipslide is considered positive when colony concentration ≥105 colony forming units (CFU)/mL of a single microorganism or two different colonies but one ≥105 CFU/mL is found, or when Group B Streptococcus bacteriuria is found in any colony concentration. Women with a positive dipslide will be randomly allocated to receive nitrofurantoin or placebo 100 mg twice a day for 5 consecutive days (double blind). Primary outcomes of this trial are maternal pyelonephritis and/or preterm delivery before 34 weeks. Secondary outcomes are neonatal and maternal morbidity, neonatal weight, time to delivery, preterm delivery rate before 32 and 37 weeks, days of admission in neonatal intensive care unit, maternal admission days and costs. Discussion This trial will provide evidence for the benefit and cost-effectiveness of dipslide screening for ASB among low risk women at 16–22 weeks of pregnancy and subsequent nitrofurantoin treatment. Trial registration Dutch trial registry: NTR-3068 PMID:22892110

Maternal height and length of gestation: does this impact on preterm labour in Asian women?

PubMed

Chan, Ben Chong-Pun; Lao, Terence Tzu-Hsi

2009-08-01

Both maternal height and ethnicity may influence the gestation length, but their independent effect is unclear. This study was performed to examine the relationship between maternal height and gestational length in women with singleton pregnancies in a Chinese and southeast Asian population. A retrospective cohort study was performed on women carrying singleton pregnancies with spontaneous labour in a 48-month period managed under our department to determine the relationship between maternal height, expressed in quartiles, with the mean gestational age and incidence of preterm labour. Of the 16 384 women who delivered within this period, the 25th, 50th and 75th percentile values of maternal height were 153 cm, 156 cm and 160 cm respectively. Excluded from analysis were 6597 women because of multifetal pregnancy, teenage pregnancy (maternal age < or = 19 years old), induction of labour or elective caesarean section, or incomplete data due to no antenatal booking in our hospital. Significant differences were found in the maternal weight and body mass index, incidences of multiparity and smokers, gestational age and birthweight among the four quartiles. There was significantly increased incidence of preterm birth between 32 and 37 weeks gestation in women with shorter stature. In our population, maternal height has an influence on gestational length, and the lower three quartiles was associated with increased odds of labour at > 32 to < 37 weeks. This effect should be taken into consideration in the adoption of international recommendations in obstetric management and intervention.

A systematic review and meta-analysis of velamentous cord insertion among singleton pregnancies and the risk of preterm delivery.

PubMed

de Los Reyes, Samantha; Henderson, Janice; Eke, Ahizechukwu C

2018-03-23

Observational studies have reported varying results about the association of velamentous cord insertion (VCI) with adverse pregnancy outcomes. To evaluate the risk of preterm delivery among singleton pregnancies complicated by VCI. Various databases were searched for English-language articles published up to February, 28, 2017, using keywords including VCI; abnormal placentation; abnormal cord insertions; adverse perinatal outcomes; and preterm birth. Outcome measures included preterm delivery; pre-eclampsia; cesarean delivery; fetal demise in utero (FDIU); and small for gestational age (SGA). Only studies involving VCI were included in the meta-analysis. Analyses were performed using RevMan version 5.3.5 (The Nordic Cochrane Centre, Copenhagen, Denmark). There were six studies included in the analysis. The VCI and control groups comprised 16 295 and 1 366 485 women, respectively. An increased incidence of preterm delivery was found for the VCI group compared with the control group (11.8% vs 7.0%; adjusted odds ratio [aOR] 1.95, 95% confidence interval [CI] 1.85-2.04). A diagnosis of VCI was also associated with cesarean delivery (aOR 1.17, 95% CI 1.12-1.23), SGA (aOR 1.93, 95% CI 1.83-2.04), and FDIU (aOR 3.96, 95% CI 3.21-4.89). The presence of VCI was associated with adverse pregnancy outcomes. © 2018 International Federation of Gynecology and Obstetrics.

Screening for Depressive and Anxiety Symptoms During Pregnancy and Postpartum at a Japanese Perinatal Center

PubMed Central

Suzuki, Shunji; Eto, Masako

2017-01-01

Background We examined the current status of depressive and anxiety symptoms in Japanese women during pregnancy and postpartum. Methods We asked 220 Japanese women who gave birth to singleton babies at term to answer the two self-administered questionnaires (Whooley’s two questions and two-item generalized anxiety disorder scale) at first, second and third trimester of pregnancy and 1 month after delivery. Results The rates of women with depressive symptoms were common during the first trimester of pregnancy (25%) and the postpartum (17%), while the women with anxiety symptoms were common during the first trimester of pregnancy (36%). Eight percent women had histories of mental disorders, and 95% of them showed depressive and/or anxiety symptoms somewhere during pregnancy. Of the women who had depressive symptoms during postpartum, 86% showed depressive and/or anxiety symptoms somewhere during pregnancy. Conclusion Screening for depressive and anxiety symptoms during pregnancy was suggested to be useful to detect high risk women of postpartum depression. PMID:28496552

Advanced abdominal pregnancy: an increasingly challenging clinical concern for obstetricians

PubMed Central

Huang, Ke; Song, Lei; Wang, Longxia; Gao, Zhiying; Meng, Yuanguang; Lu, Yanping

2014-01-01

Advanced abdominal pregnancy is rare. The low incidence, high misdiagnosis rate, and lack of specific clinical signs and symptoms explain the fact that there are no standard diagnostic and treatment options available for advanced abdominal pregnancy. We managed a case of abdominal pregnancy in a woman who was pregnant for the first time. This case was further complicated by a concurrent singleton intrauterine pregnancy; the twin pregnancy was not detected until 20 weeks of pregnancy. The case was confirmed at 26 weeks gestational age using MRI to be an abdominal combined with intrauterine pregnancy. The pregnancy was terminated by cesarean section at 33 + 5 weeks gestation. We collected the relevant data of the case while reviewing the advanced abdominal pregnancy-related English literature in the Pubmed, Proquest, and OVID databases. We compared and analyzed the pregnancy history, gestational age when the diagnosis was confirmed, the placental colonization position, the course of treatment and surgical processes, related concurrency rate, post-operative drug treatment programs, and follow-up results with the expectation to provide guidance for other physicians who might encounter similar cases. PMID:25337188

Acute air pollution exposure and blood pressure at delivery among women with and without hypertension.

PubMed

Männistö, Tuija; Mendola, Pauline; Liu, Danping; Leishear, Kira; Sherman, Seth; Laughon, S Katherine

2015-01-01

Chronic air pollution exposure increases risk for hypertensive disorders of pregnancy, but the effect of acute air pollution exposure on blood pressure during pregnancy is less well known. We studied 151,276 singleton term deliveries from the Consortium on Safe Labor (2002-2008) with clinical blood pressure measured at admission to labor/delivery and diagnoses of hypertensive disorders collected from electronic medical records and hospital discharge summaries. Air pollution exposures were estimated for the admission hour and the 4 hours preceding admission using a modified version of the Community Multiscale Air Quality models and observed air monitoring data. Blood pressure was categorized as normal; high normal; and mild, moderate, or severe hypertension based on pregnancy cut points. Adjusted ordinal logistic regression estimated the odds of women having a higher admission blood pressure category as a function of air pollutant, hypertensive disorders, and their interaction effect. Odds of high blood pressure at admission to labor/delivery were increased in normotensive women after exposure to nitrogen oxides (by 0.2%/5 units), sulfur dioxide (by 0.3%/1 unit), carbon monoxide and several air toxics (by 3%-4%/high exposure). The effects were often similar or stronger among women with gestational hypertension and preeclampsia. Exposure to particulate matter <10 μm increased odds of high blood pressure in women with preeclampsia by 3%/5 units. Air pollution can influence admission blood pressure in term deliveries and may increase likelihood of preeclampsia screening at delivery admission. © Published by Oxford University Press on behalf of American Journal of Hypertension Ltd 2014. This work is written by (a) US Government employees(s) and is in the public domain in the US.

Postnatal Anthropometric and Body Composition Profiles in Infants with Intrauterine Growth Restriction Identified by Prenatal Doppler

PubMed Central

Mazarico, E.; Martinez-Cumplido, R.; Díaz, M.; Sebastiani, G.; Ibáñez, L.; Gómez-Roig, M. D.

2016-01-01

Introduction Infant anthropometry and body composition have been previously assessed to gauge the impact of intrauterine growth restriction (IUGR) at birth, but the interplay between prenatal Doppler measurements and postnatal development has not been studied in this setting. The present investigation was performed to assess the significance of prenatal Doppler findings relative to postnatal anthropometrics and body composition in IUGR newborns over the first 12 months of life. Patients and Methods Consecutive cases of singleton pregnancies with suspected IUGR were prospectively enrolled over 12 months. Fetal biometry and prenatal Doppler ultrasound examinations were performed. Body composition was assessed by absorptiometry at ages 10 days, and at 4 and12 months. Results A total of 48 pregnancies qualifying as IUGR were studied. Doppler parameters were normal in 26 pregnancies. The remaining 22 deviated from normal, marked by an Umbilical Artery Pulsatility Index (UA-PI) >95th centil or Cerebro-placental ratio (CPR) <5th centile. No significant differences emerged when comparing anthropometry and body composition at each time point, in relation to Doppler findings. Specifically, those IUGR newborns with and without abnormal Doppler findings had similar weight, length, body mass index, lean and fat mass, and bone mineral content throughout the first 12 months of life. In a separate analysis, when comparing IUGR newborns by Doppler (abnormal UA-PI vs. abnormal CPR), anthropometry and body composition did not differ significantly. Conclusions Infants with IUGR maintain a pattern of body composition during the first year of life that is independent of prenatal Doppler findings. Future studies with larger sample sizes and correlating with hormonal status are warranted to further extend the phenotypic characterization of the various conditions now classified under the common label of IUGR. PMID:26938993

Fetal nasal bone length and Down syndrome during the second trimester in a Chinese population.

PubMed

Hung, Jeng-Hsiu; Fu, Chong Yau; Chen, Chih-Yao; Chao, Kuan-Chong; Hung, Jamie

2008-08-01

The purpose of the present study was to build a database of reference ranges of fetal nasal bone length (NBL) in a Chinese population. The accuracy rate of detecting Down syndrome was also analyzed using fetal NBL as a marker. The control group of fetuses included 342 normal singleton pregnancies with no chromosomal or congenital anomalies. The present study was a cross-section study and the control group was used to construct percentile values of NBL from 13 to 29 gestational weeks of age. Two-dimensional ultrasonography was used for the nasal bone studies. Measurements of NBL were collected and each fetus contributed a single value to the reference sample. During the study period, 14 fetuses with Down syndrome were examined. Measurement of fetal NBL was made during amniocentesis, with gestational age ranging from 13 to 19 weeks. From 342 normal fetuses with gestational age ranging from 13 to 29 weeks, reference ranges of NBL were constructed. The reference ranges were constructed from the 100(1 - p)% reference range: Y +/- Zp x square root sigma 2, where Y = 25 - exp(3.58 - 0.044 x t + 0.0006 x t2), with Y being the fitted mean of regression model and t being gestational age (weeks). Using fetal NBL, the regression model was Pr(Down syndrome) = exp(W)/ [1 + exp(W)], where W = 0.62-4.80 x NBL (multiples of the median) in predicting Down syndrome. Fetal NBL was found to have a sensitivity and specificity of 0.78 and 0.78, respectively, in predicting Down syndrome in the second trimester of pregnancy. Fetal NBL measurement can provide a simple and useful algorithm to predict Down syndrome during the second trimester of pregnancy.

Perinatal outcomes among young Indigenous Australian mothers: A cross-sectional study and comparison with adult Indigenous mothers.

PubMed

Steenkamp, Malinda; Boyle, Jacqueline; Kildea, Sue; Moore, Vivienne; Davies, Michael; Rumbold, Alice

2017-09-01

The teenage pregnancy rate is high among Indigenous Australian women, yet little is known about their pregnancy outcomes. Moreover, against a background of extreme social disadvantage, the relative importance of age as a risk factor for adverse outcomes among Indigenous pregnancies is unclear. We compared perinatal outcomes for Indigenous teenagers (<20 years) with adult Indigenous women (20-34 years), and described outcomes in subgroups of teenagers. Data were analyzed for 2421 singleton births to Indigenous women aged <35 years in Australia's Northern Territory from 2003 to 2005. Regression was used to assess the effect of young maternal age on normal birth, healthy baby, preterm birth, low birthweight, special care admission, and mean birthweight, adjusting for covariates. Three-quarters of teenagers and 62% of adult mothers lived in remote areas. Smoking rates were around 50% in both groups. Teenagers were more likely to have a normal birth than adults (adjusted odds ratio 1.78 [95% CI 1.35-2.34]). The groups did not differ for healthy baby, preterm birth, or low birthweight. Babies of teenagers weighed 135 g less than those of adults; however, adjustment for covariates eliminated this difference. Examination of teenage subgroups (≤16 years and 17-19 years) revealed risk behaviors being higher for 17-19 years olds than for the younger group, and more prevalent among urban-based mothers. Young maternal age is not a risk factor for adverse perinatal outcomes among Indigenous women. Rather, they are having babies in disadvantaged circumstances within a system challenged to support them socially and clinically. © 2017 Wiley Periodicals, Inc.

Impact of infertility characteristics and treatment modalities on singleton pregnancies after assisted reproduction.

PubMed

Poikkeus, P; Unkila-Kallio, L; Vilska, S; Repokari, L; Punamäki, R-L; Aitokallio-Tallberg, A; Sinkkonen, J; Almqvist, F; Tulppala, M; Tiitinen, A

2006-07-01

Obstetric and neonatal outcomes of assisted reproduction and control singletons were evaluated after taking into account treatment characteristics and infertility background. The elective single embryo transfer (eSET) group (n = 45) was compared with the compulsory single embryo transfer (cSET; n = 52), double embryo transfer (DET; n = 227) and control (n = 304) groups. Infertility-related prognostic factors for neonatal outcomes were also analysed. Data were collected with structured questionnaires at gestational week 20 and 8 weeks after delivery. Spontaneous onset of delivery was more typical of the eSET group than of cSET and DET groups (68.9 versus 52.0%, P = 0.02). Mean (+/-SD) gestation at birth (39.3 +/- 1.6 weeks) and mean birth weight (3,470 +/- 505 g) of eSET singletons were comparable with other assisted reproduction groups, but gestational duration was lower than in the eSET group than in the control group (39.9 +/- 1.4; P < 0.05). However, numbers of preterm births and low birth weight infants were similar between groups. History of induced abortion increased risk of preterm birth (OR 4.5 and 95% CI 1.2-17.1) in assisted reproduction singletons. A small though clinically unimportant difference in gestational age at birth and birth weight between assisted reproduction and control singletons was found regardless of the number of embryos transferred.

Placental size and the prediction of severe early-onset intrauterine growth restriction in women with low pregnancy-associated plasma protein-A.

PubMed

Proctor, L K; Toal, M; Keating, S; Chitayat, D; Okun, N; Windrim, R C; Smith, G C S; Kingdom, J C P

2009-09-01

Screening studies for trisomy 21 demonstrate that low maternal serum pregnancy-associated plasma protein-A (PAPP-A) at 11-13 weeks' gestation is associated with stillbirth, intrauterine growth restriction (IUGR) and pre-eclampsia in chromosomally normal fetuses. However, the strength of these associations is too weak to justify screening for these placental insufficiency syndromes. Our objective was to evaluate placental size and uterine artery (UtA) Doppler imaging as second-stage screening tests for women with low PAPP-A. We prospectively studied 90 normal singleton pregnancies with first-trimester PAPP-A

Dose-adjusted plasma concentrations of sublingual buprenorphine are lower during than after pregnancy.

PubMed

Bastian, Jaime R; Chen, Huijun; Zhang, Hongfei; Rothenberger, Scott; Tarter, Ralph; English, Dennis; Venkataramanan, Raman; Caritis, Steve N

2017-01-01

Buprenorphine is a Food and Drug Administration-approved maintenance therapy for opioid use disorders and is increasingly being used in pregnant women with opioid use disorders as an alternative to methadone. Dosing of buprenorphine in pregnant women is based on the regimen recommended for nonpregnant females and males. Limited data are available defining the pharmacokinetic properties of sublingual buprenorphine administered during pregnancy. This study evaluated the impact of physiological changes associated with pregnancy on the pharmacokinetics of sublingual buprenorphine during and after pregnancy. Pregnant women (n = 13), between 18 0/7 and 37 6/7 weeks' singleton gestation, receiving sublingual buprenorphine twice daily for opioid use disorders were studied. Pharmacokinetic-2 studies were performed between 18 and 25 weeks (n = 7), pharmacokinetic-3 studies were performed between 31 and 37 weeks (n = 11), and pharmacokinetic-P was performed 4-18 weeks postpartum (n = 10). On the day of the study, blood was withdrawn prior to the daily morning dose of buprenorphine and at 0.25, 0.5, 0.75, 1, 1.5, 2, 4, 8, and 12 hours after the dose. Buprenorphine plasma concentrations were analyzed by liquid chromatography tandem mass spectrometric detection. All pharmacokinetic parameters were observed or estimated using Microsoft Excel. Statistical analyses were performed to identify significant changes in study participants' buprenorphine pharmacokinetic parameter estimates over the duration of the study. Univariate linear and generalized linear mixed models were used to investigate changes in these measures over time, some of which were log transformed for normality. Dose-normalized (plasma concentration per dose) buprenorphine plasma concentrations were significantly lower during pregnancy (pharmacokinetic-2 plus pharmacokinetic-3) than during the postpartum period (pharmacokinetic-P). Specific pharmacokinetic parameters (and level of significance) were as follows: the area under the buprenorphine plasma concentration-time curves (P < .003), maximum buprenorphine concentrations (P < .018), buprenorphine concentrations at 0 hour (P < .002), and buprenorphine concentrations at 12 hours (P < .001). None of these parameters differed significantly during pregnancy (ie, pharmacokinetic-2 vs pharmacokinetic-3). The time to maximum buprenorphine concentrations did not differ significantly between groups. The dose-normalized plasma concentrations during a dosing interval and the overall exposure of buprenorphine (area under the buprenorphine plasma concentration-time curves) are lower throughout pregnancy compared with the postpartum period. This indicates an increase in apparent clearance of buprenorphine during pregnancy. These data suggest that pregnant women may need a higher dose of sublingual buprenorphine compared with postpartum individuals. The dose of buprenorphine should be assessed after delivery to maintain similar buprenorphine exposure during the postpartum period. Copyright © 2016 Elsevier Inc. All rights reserved.

Prenatal Brain MR Imaging: Reference Linear Biometric Centiles between 20 and 24 Gestational Weeks.

PubMed

Conte, G; Milani, S; Palumbo, G; Talenti, G; Boito, S; Rustico, M; Triulzi, F; Righini, A; Izzo, G; Doneda, C; Zolin, A; Parazzini, C

2018-05-01

Evaluation of biometry is a fundamental step in prenatal brain MR imaging. While different studies have reported reference centiles for MR imaging biometric data of fetuses in the late second and third trimesters of gestation, no one has reported them in fetuses in the early second trimester. We report centiles of normal MR imaging linear biometric data of a large cohort of fetal brains within 24 weeks of gestation. From the data bases of 2 referral centers of fetal medicine, accounting for 3850 examinations, we retrospectively collected 169 prenatal brain MR imaging examinations of singleton pregnancies, between 20 and 24 weeks of gestational age, with normal brain anatomy at MR imaging and normal postnatal neurologic development. To trace the reference centiles, we used the CG-LMS method. Reference biometric centiles for the developing structures of the cerebrum, cerebellum, brain stem, and theca were obtained. The overall interassessor agreement was adequate for all measurements. Reference biometric centiles of the brain structures in fetuses between 20 and 24 weeks of gestational age may be a reliable tool in assessing fetal brain development. © 2018 by American Journal of Neuroradiology.

Impact of ART on pregnancies in California: an analysis of maternity outcomes and insights into the added burden of neonatal intensive care.

PubMed

Merritt, T A; Goldstein, M; Philips, R; Peverini, R; Iwakoshi, J; Rodriguez, A; Oshiro, B

2014-05-01

We reviewed the occurrence of prematurity, low birth weight, multiple gestations, frequency of stillbirths and maternity care-associated variables including hospital stay and hospital charges of women conceiving using assisted reproductive technology (ART) or artificial insemination (AI) compared with women with a history of infertility who conceived naturally, and all other naturally conceived pregnancies in California at non-federal hospitals between 2009 and 2011. At a single center, infants born after ART/AI were compared with infants provided care in the normal nursery. Publically available inpatient data sets from the California Office of Statewide Health Planning and Development for years 2009-2011 using data from all California non-federal hospitals were used to determine the impact of ART on a variety of pregnancy-related outcomes and infant characteristics. Infant data from a single center was used to determine hospital charges for infants delivered over an 18-month period to compare the hospital and physician charges indexed to similar charges for infants admitted to the 'normal' newborn nursery. Among ART/AI pregnancies, there was a 4-5-fold increase in stillbirths, compared with a 2-3-fold increase among women with infertility compared with other naturally conceiving women. ART/AI pregnancies underwent more cesarean sections (fourfold), and a near fourfold increase in the rate of preterm deliveries. Multiple gestations were increased 24-27-fold compared with naturally conceived pregnancies. Maternal hospital stay and hospital charges were increased among those undergoing ART/AI. Infant charges were increased multi-fold for singletons, twins and triplets delivered after ART/AI compared with naturally conceived infants. Multiple births, preterm births and a higher overall rate of fetal anomalies were found in California after ART/AI for 2009-2011. Cesarean section rates, longer length of maternal stay and hospital charges among women receiving ART/AI could be lowered if emphasis on elective single embryo transfers was a higher priority among providers. Charges for the care of infants delivered after ART/AI are substantially higher than among naturally conceived infants born late preterm or at term. Families seeking ART/AI need to be informed of the impact of these adverse pregnancy outcomes, including neonatal outcomes and charges for medical care for their infant(s), when considering ART/AI.

Treatment of Subclinical Hypothyroidism or Hypothyroxinemia in Pregnancy.

PubMed

Casey, Brian M; Thom, Elizabeth A; Peaceman, Alan M; Varner, Michael W; Sorokin, Yoram; Hirtz, Deborah G; Reddy, Uma M; Wapner, Ronald J; Thorp, John M; Saade, George; Tita, Alan T N; Rouse, Dwight J; Sibai, Baha; Iams, Jay D; Mercer, Brian M; Tolosa, Jorge; Caritis, Steve N; VanDorsten, J Peter

2017-03-02

Subclinical thyroid disease during pregnancy may be associated with adverse outcomes, including a lower-than-normal IQ in offspring. It is unknown whether levothyroxine treatment of women who are identified as having subclinical hypothyroidism or hypothyroxinemia during pregnancy improves cognitive function in their children. We screened women with a singleton pregnancy before 20 weeks of gestation for subclinical hypothyroidism, defined as a thyrotropin level of 4.00 mU or more per liter and a normal free thyroxine (T 4 ) level (0.86 to 1.90 ng per deciliter [11 to 24 pmol per liter]), and for hypothyroxinemia, defined as a normal thyrotropin level (0.08 to 3.99 mU per liter) and a low free T 4 level (<0.86 ng per deciliter). In separate trials for the two conditions, women were randomly assigned to receive levothyroxine or placebo. Thyroid function was assessed monthly, and the levothyroxine dose was adjusted to attain a normal thyrotropin or free T 4 level (depending on the trial), with sham adjustments for placebo. Children underwent annual developmental and behavioral testing for 5 years. The primary outcome was the IQ score at 5 years of age (or at 3 years of age if the 5-year examination was missing) or death at an age of less than 3 years. A total of 677 women with subclinical hypothyroidism underwent randomization at a mean of 16.7 weeks of gestation, and 526 with hypothyroxinemia at a mean of 17.8 weeks of gestation. In the subclinical hypothyroidism trial, the median IQ score of the children was 97 (95% confidence interval [CI], 94 to 99) in the levothyroxine group and 94 (95% CI, 92 to 96) in the placebo group (P=0.71). In the hypothyroxinemia trial, the median IQ score was 94 (95% CI, 91 to 95) in the levothyroxine group and 91 (95% CI, 89 to 93) in the placebo group (P=0.30). In each trial, IQ scores were missing for 4% of the children. There were no significant between-group differences in either trial in any other neurocognitive or pregnancy outcomes or in the incidence of adverse events, which was low in both groups. Treatment for subclinical hypothyroidism or hypothyroxinemia beginning between 8 and 20 weeks of gestation did not result in significantly better cognitive outcomes in children through 5 years of age than no treatment for those conditions. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Institute of Neurological Disorders and Stroke; ClinicalTrials.gov number, NCT00388297 .).

Treatment of Subclinical Hypothyroidism or Hypothyroxinemia in Pregnancy

PubMed Central

Casey, B.M.; Thom, E.A.; Peaceman, A.M.; Varner, M.W.; Sorokin, Y.; Hirtz, D.G.; Reddy, U.M.; Wapner, R.J.; Thorp, J.M.; Saade, G.; Tita, A.T.N.; Rouse, D.J.; Sibai, B.; Iams, J.D.; Mercer, B.M.; Tolosa, J.; Caritis, S.N.; VanDorsten, J.P.

2017-01-01

BACKGROUND Subclinical thyroid disease during pregnancy may be associated with adverse outcomes, including a lower-than-normal IQ in offspring. It is unknown whether levothyroxine treatment of women who are identified as having subclinical hypothyroidism or hypothyroxinemia during pregnancy improves cognitive function in their children. METHODS We screened women with a singleton pregnancy before 20 weeks of gestation for subclinical hypothyroidism, defined as a thyrotropin level of 4.00 mU or more per liter and a normal free thyroxine (T4) level (0.86 to 1.90 ng per deciliter [11 to 24 pmol per liter]), and for hypothyroxinemia, defined as a normal thyrotropin level (0.08 to 3.99 mU per liter) and a low free T4 level (<0.86 ng per deciliter). In separate trials for the two conditions, women were randomly assigned to receive levothyroxine or placebo. Thyroid function was assessed monthly, and the levothyroxine dose was adjusted to attain a normal thyrotropin or free T4 level (depending on the trial), with sham adjustments for placebo. Children underwent annual developmental and behavioral testing for 5 years. The primary outcome was the IQ score at 5 years of age (or at 3 years of age if the 5-year examination was missing) or death at an age of less than 3 years. RESULTS A total of 677 women with subclinical hypothyroidism underwent randomization at a mean of 16.7 weeks of gestation, and 526 with hypothyroxinemia at a mean of 17.8 weeks of gestation. In the subclinical hypothyroidism trial, the median IQ score of the children was 97 (95% confidence interval [CI], 94 to 99) in the levothyroxine group and 94 (95% CI, 92 to 96) in the placebo group (P = 0.71). In the hypothyroxinemia trial, the median IQ score was 94 (95% CI, 91 to 95) in the levothyroxine group and 91 (95% CI, 89 to 93) in the placebo group (P = 0.30). In each trial, IQ scores were missing for 4% of the children. There were no significant between-group differences in either trial in any other neurocognitive or pregnancy outcomes or in the incidence of adverse events, which was low in both groups. CONCLUSIONS Treatment for subclinical hypothyroidism or hypothyroxinemia beginning between 8 and 20 weeks of gestation did not result in significantly better cognitive outcomes in children through 5 years of age than no treatment for those conditions. PMID:28249134

Factors associated with pregnancy-associated glycoprotein (PAG) levels in plasma and milk of Holstein cows during early pregnancy and their effect on the accuracy of pregnancy diagnosis.

PubMed

Ricci, A; Carvalho, P D; Amundson, M C; Fourdraine, R H; Vincenti, L; Fricke, P M

2015-04-01

Lactating Holstein cows (n = 141) were synchronized to receive their first timed artificial insemination (TAI). Blood and milk samples were collected 25 and 32 d after TAI, and pregnancy status was determined 32 d after TAI using transrectal ultrasonography. Cows diagnosed pregnant with singletons (n = 48) continued the experiment in which blood and milk samples were collected and pregnancy status was assessed weekly using transrectal ultrasonography from 39 to 102 d after TAI. Plasma and milk samples were assayed for pregnancy-associated glycoprotein (PAG) levels using commercial ELISA kits. Compared to ultrasonography, accuracy was 92% for the plasma PAG ELISA test and 89% for the milk PAG ELISA test 32 d after TAI. Plasma and milk PAG levels for pregnant cows increased from 25 d to an early peak 32 d after TAI. Plasma and milk PAG levels then decreased from 32 d after TAI to a nadir from 53 to 60 d after TAI for the plasma PAG assay and from 46 to 67 d after TAI for the milk PAG assay followed by an increase from 74 to 102 d after TAI. Overall, plasma PAG levels were approximately 2-fold greater compared with milk PAG levels, and primiparous cows had greater PAG levels in plasma and milk compared with multiparous cows. The incidence of pregnancy loss from 32 to 102 d after TAI based on ultrasonography was 13% for cows diagnosed with singleton pregnancies, and plasma and milk PAG levels decreased to nonpregnant levels within 7 to 14 d after pregnancy loss. Both plasma and milk PAG levels were negatively correlated with milk production for both primiparous and multiparous cows. We conclude that stage of gestation, parity, pregnancy loss, and milk production were associated with plasma and milk PAG levels after TAI similarly. Based on plasma and milk PAG profiles, the optimal time to conduct a first pregnancy diagnosis is around 32 d after AI, coinciding with an early peak in PAG levels. Because of the occurrence of pregnancy loss, all pregnant cows should be retested 74 d after AI or later when plasma and milk PAG levels in pregnant cows have rebounded from their nadir. Copyright © 2015 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Current overview of pregnancy complications and live-birth outcome of assisted reproductive technology in mainland China.

PubMed

Yang, Xiaokui; Li, Ying; Li, Changdong; Zhang, Weiyuan

2014-02-01

To survey the proportion of births born after assisted reproductive technology (ART) and compare the obstetric and prenatal complications between ART and spontaneous pregnancy in women in mainland China. Retrospective analysis. Thirty-nine hospitals. A total of 112,403 deliveries from 14 provinces and 39 different hospitals composed our retrospective study. A multiprovince, hospital-based survey was performed. The prevalence of obstetric complications, mode of delivery, and prenatal outcomes were compared between ART and spontaneous pregnancy. For each group, data included singleton and twin deliveries. The proportion of infants born as a result of ART in mainland China was about 1.013% in 2011. The incidence of hypertensive disorder in pregnancy (11.0%, odds ratio [OR], 1.27, 95% confidence interval [CI] 1.04-1.60), premature delivery (27.0%, OR, 4.53, 95% CI 3.91-5.25), gestational diabetes mellitus (15.1%, OR 3.05, 95% CI 2.57-3.60), and placenta previa (4.5%, OR 2.18, 95% CI 1.62-2.94) were markedly increased in women who conceived using ART. The cesarean section rate in the ART pregnancy group was 85.3%, which is significantly higher than spontaneous pregnancies (54.0%). Compared with spontaneous pregnancy, ART pregnancy had a significantly increased incidence of low birth weight babies (29.7%) and birth gestational age of less than 37 weeks (30.0%). Infants conceived by ART have increased low 5-minute Apgar and mortality. This population-based survey demonstrates that the proportion of births from ART in mainland China was about 1.013% in 2011. Multiple gestation is significantly increased in ART pregnancies, relative to spontaneous pregnancies. The increasing incidence and risk of maternal complications in ART pregnancies (e.g., premature delivery, placenta previa, gestational diabetes mellitus) are found in singleton and twin gestations in ART. A higher cesarean section rate, low birth weight infants, and higher infant mortality rate were also observed in ART pregnancies. Our survey provides a comprehensive overview of the prevalence of ART and ART-associated complications in mainland China, and provides insight into attitudes toward ART among the mainland Chinese population. Copyright © 2014 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Noninvasive Prenatal Diagnosis of Hypohidrotic Ectodermal Dysplasia by Tooth Germ Sonography.

PubMed

Wünsche, S; Jüngert, J; Faschingbauer, F; Mommsen, H; Goecke, T; Schwanitz, K; Stepan, H; Schneider, H

2015-08-01

Hypohidrotic ectodermal dysplasia, a potentially life-threatening heritable disorder, may be recognized already in utero by characteristic features such as oligodontia and mandibular hypoplasia. As therapeutic options and prognosis depend on the time point of diagnosis, early recognition was attempted during routine prenatal ultrasound examinations. Fetuses of nine pregnant women (one triplet and eight singleton pregnancies) with family histories of hypohidrotic ectodermal dysplasia were investigated by sonography between the 20th and 24th week of gestation. In 4 male and 2 female fetuses reduced amounts of tooth germs were detected, whereas 5 fetal subjects showed the normal amount. Three-dimensional ultrasound evaluation revealed mandibular hypoplasia in 5 of the 6 fetuses with oligodontia. Molecular genetic analysis and/or clinical findings after birth confirmed the prenatal sonographic diagnosis in each subject. In subjects with a family history of hypohidrotic ectodermal dysplasia, the diagnosis of this rare condition can be established noninvasively by sonography in the second trimester of pregnancy. Early recognition of the disorder may help to prevent dangerous hyperthermic episodes in infancy and may allow timely therapeutic interventions. © Georg Thieme Verlag KG Stuttgart · New York.

Male fetuses are associated with increased risk for cesarean delivery in Malaysian nulliparae.

PubMed

Viegas, Osborn A C; Lee, Pei Sue; Lim, Keng Joo; Ravichandran, Jeganathan

2008-01-01

The association between fetal sex and outcome of pregnancy and labor has been well documented in western populations. However, no studies in Malaysia or other developing countries have examined the effect of fetal sex on such outcomes.The main objective of this study was to determine the influence of fetal sex on the outcome of labor at term in a cohort of Malaysian nulliparae.A retrospective observational study was designed using data from 4644 Malaysian nulliparae who gave birth consecutively to singleton male babies at Hospital Sultanah Aminah, Johor Bahru, after normal full-term pregnancies.The results of this study indicate that mothers giving birth to male infants have a greater risk of requiring cesarean delivery because male babies are heavier and have statistically significantly greater head circumference (P < .001). These findings concur with those obtained in western populations and suggest that the differences in outcome observed are biological, not dictated by race, ethnicity, or environmental conditions. Such information could help in the antenatal assessment of Malaysian patients and stimulate more comprehensive studies of the mechanisms involved in this sex-based difference in outcomes. Reasons for such differences are proposed.

The cervical mucus plug inhibits, but does not block, the passage of ascending bacteria from the vagina during pregnancy.

PubMed

Hansen, Lea K; Becher, Naja; Bastholm, Sara; Glavind, Julie; Ramsing, Mette; Kim, Chong J; Romero, Roberto; Jensen, Jørgen S; Uldbjerg, Niels

2014-01-01

To evaluate the microbial load and the inflammatory response in the distal and proximal parts of the cervical mucus plug. Experimental research. Twenty women with a normal, singleton pregnancy. Vaginal swabs and specimens from the distal and proximal parts of the cervical mucus plug. Immunohistochemistry, enzyme-linked immunosorbent assay, quantitative polymerase chain reaction and histology. The total bacterial load (16S rDNA) was significantly lower in the cervical mucus plug compared with the vagina (p = 0.001). Among women harboring Ureaplasma parvum, the median genome equivalents/g were 1574 (interquartile range 2526) in the proximal part, 657 (interquartile range 1620) in the distal part and 60,240 (interquartile range 96,386) in the vagina. Histological examinations and quantitative polymerase chain reaction revealed considerable amounts of lactobacilli and inflammatory cells in both parts of the cervical mucus plug. The matrix metalloproteinase-8 concentration was decreased in the proximal part of the plug compared with the distal part (p = 0.08). The cervical mucus plug inhibits, but does not block, the passage of Ureaplasma parvum during its ascending route from the vagina through the cervical canal. © 2013 Nordic Federation of Societies of Obstetrics and Gynecology.

Role of fetal sex in amniotic fluid alphafetoprotein screening.

PubMed

Knippel, Alexander Johannes

2002-10-01

Previous studies have shown that fetal gender has influence on various pregnancy complications and prenatal diagnostic biochemical markers. We have evaluated, whether elevation of amniotic fluid alphafetoprotein (AF AFP) is associated with fetal sex and whether a sex-related difference can help to identify pregnancies with AFP-associated malformations or fetal loss. From our database we obtained 6461 singleton gestations with AF AFP measurements for the period April 1997-March 1999. Patients with AF AFP >1.9 MoM were identified, details of pregnancy outcome were obtained and compared to matched-pair controls having AF AFP <2 MoM. In 232 of 262 patients having AF AFP levels >1.9 MoM outcome information was available. Of these fetuses, significantly more had male gender (147 male fetuses versus 85 female). Having a screen-positive result the risk of AFP-associated malformations was significantly higher for female fetuses (25 female fetuses (29.4%) versus 22 male fetuses (15%) with AFP-associated malformations). Adjusting the cut-off MoM to 2.5 for male and to 2.0 for female fetuses halves the false positive rate from 3.4 to 1.7% without affecting the detection rate of 95%. Pregnancies with false positive AF AFP had a significantly higher risk for fetal loss compared with pregnancies having normal AF AFP (ten fetal losses from 185 versus two fetal losses from 232), but fetal gender had no significant influence. Adjusting AF AFP MoM cut-offs for fetal gender could increase performance of AF-AFP screening. Larger studies are required to determine suitable sex-adjusted cut-off levels. Copyright 2002 John Wiley & Sons, Ltd.

Consequences of prenatal geophagy for maternal prenatal health, risk of childhood geophagy and child psychomotor development.

PubMed

Mireku, Michael O; Davidson, Leslie L; Zoumenou, Romeo; Massougbodji, Achille; Cot, Michel; Bodeau-Livinec, Florence

2018-06-07

To investigate the relationship between prenatal geophagy, maternal prenatal haematological indices, malaria, helminth infections and cognitive and motor development among offspring. At least a year after delivery, 552 of 863 HIV-negative mothers with singleton births who completed a clinical trial comparing the efficacy of sulfadoxine-pyrimethamine and mefloquine during pregnancy in Allada, Benin, responded to a nutrition questionnaire including their geophageous habits during pregnancy. During the clinical trial, helminth infection, malaria, haemoglobin and ferritin concentrations were assessed at 1st and 2nd antenatal care visits (ANV) and at delivery. After the first ANV, women were administered daily iron and folic acid supplements until three what? post-delivery. Singleton children were assessed for cognitive function at age 1 year using the Mullen Scales of Early Learning. The prevalence of geophagy during pregnancy was 31.9%. Pregnant women reporting geophagy were more likely to be anaemic (AOR= 1.9, 95% CI [1.1, 3.4]) at their first ANV if they reported geophagy at the first trimester. Overall, prenatal geophagy was not associated with maternal haematological indices, malaria or helminth infections, but geophagy during the third trimester and throughout pregnancy was associated with poor motor function (AOR= -3.8, 95% CI [-6.9, -0.6]) and increased odds of geophageous behaviour in early childhood, respectively. Prenatal geophagy is not associated with haematological indices in the presence of micronutrient supplementation. However, it may be associated with poor child motor function and infant geophagy. Geophagy should be screened early in pregnancy. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Immortal time bias in observational studies of drug effects in pregnancy.

PubMed

Matok, Ilan; Azoulay, Laurent; Yin, Hui; Suissa, Samy

2014-09-01

The use of decongestants during the second or third trimesters of pregnancy has been associated with a decreased risk of preterm delivery in two observational studies. This effect may have been subject to immortal time bias, a bias arising from the improper classification of exposure during follow-up. We illustrate this bias by repeating the studies using a different data source. The United Kingdom Hospital Episodes Statistics and the Clinical Practice Research Datalink databases were linked to identify all live singleton pregnancies among women aged 15 to 45 years between 1997 and 2012. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals of preterm delivery (before 37 weeks of gestation) by considering the use of decongestants during the third trimester as a time-fixed (biased analysis which misclassifies unexposed person-time as exposed person-time) and time-varying exposure (unbiased analysis with proper classification of unexposed person-time). All models were adjusted for maternal age, smoking status, maternal diabetes, maternal hypertension, preeclampsia, and parity. Of the 195,582 singleton deliveries, 10,248 (5.2%) were born preterm. In the time-fixed analysis, the HR of preterm delivery for the use of decongestants was below the null and suggestive of a 46% decreased risk (adjusted HR = 0.54; 95% confidence interval, 0.24-1.20). In contrast, the HR was closer to null (adjusted HR = 0.93 95% confidence interval, 0.42-2.06) when the use of decongestants was treated as a time-varying variable. Studies of drug safety in pregnancy should use the appropriate statistical techniques to avoid immortal time bias, particularly when the exposure occurs at later stages of pregnancy. © 2014 Wiley Periodicals, Inc.

Quantifying Low Birth Weight, Preterm Birth and Small-for-Gestational-Age Effects of Malaria in Pregnancy: A Population Cohort Study

PubMed Central

Rijken, Marcus J.; De Livera, Alysha M.; Lee, Sue J.; Boel, Machteld E.; Rungwilailaekhiri, Suthatsana; Wiladphaingern, Jacher; Paw, Moo Kho; Pimanpanarak, Mupawjay; Pukrittayakamee, Sasithon; Simpson, Julie A.; Nosten, François; McGready, Rose

2014-01-01

Background The association between malaria during pregnancy and low birth weight (LBW) is well described. This manuscript aims to quantify the relative contribution of malaria to small-for-gestational-age (SGA) infants and preterm birth (PTB) in pregnancies accurately dated by ultrasound on the Thai-Myanmar border at the Shoklo Malaria Research Unit. Methods and Findings From 2001 to 2010 in a population cohort of prospectively followed pregnancies, we analyzed all singleton newborns who were live born, normal, weighed in the first hour of life and with a gestational age (GA) between 28+0 and 41+6 weeks. Fractional polynomial regression was used to determine the mean birthweight and standard deviation as functions of GA. Risk differences and factors of LBW and SGA were studied across the range of GA for malaria and non-malaria pregnancies. From 10,264 newborns records, population centiles were created. Women were screened for malaria by microscopy a median of 22 [range 1–38] times and it was detected and treated in 12.6% (1,292) of pregnancies. Malaria was associated with LBW, PTB, and SGA compared to those without malaria. Nearly two-thirds of PTB were classified as LBW (68% (539/789)), most of which 83% (447/539) were not SGA. After GA 39 weeks, 5% (298/5,966) of non-LBW births were identified as SGA. Low body mass index, primigravida, hypertension, smoking and female sex of the newborn were also significantly and independently associated with LBW and SGA consistent with previous publications. Conclusions Treated malaria in pregnancy was associated with an increased risk for LBW, PTB, and SGA, of which the latter are most important for infant survival. Using LBW as an endpoint without adjusting for GA incorrectly estimated the effects of malaria in pregnancy. Ultrasound should be used for dating pregnancies and birth weights should be expressed as a function (or adjusted for GA) of GA in future malaria in pregnancy studies. PMID:24983755

Pessary or Progesterone to Prevent Preterm delivery in women with short cervical length: the Quadruple P randomised controlled trial.

PubMed

van Zijl, Maud D; Koullali, Bouchra; Naaktgeboren, Christiana A; Schuit, Ewoud; Bekedam, Dick J; Moll, Etelka; Oudijk, Martijn A; van Baal, Wilhelmina M; de Boer, Marjon A; Visser, Henricus; van Drongelen, Joris; van de Made, Flip W; Vollebregt, Karlijn C; Muller, Moira A; Bekker, Mireille N; Brons, Jozien T J; Sueters, Marieke; Langenveld, Josje; Franssen, Maureen T; Schuitemaker, Nico W; van Beek, Erik; Scheepers, Hubertina C J; de Boer, Karin; Tepe, Eveline M; Huisjes, Anjoke J M; Hooker, Angelo B; Verheijen, Evelyn C J; Papatsonis, Dimitri N; Mol, Ben Willem J; Kazemier, Brenda M; Pajkrt, Eva

2017-09-04

Preterm birth is in quantity and in severity the most important topic in obstetric care in the developed world. Progestogens and cervical pessaries have been studied as potential preventive treatments with conflicting results. So far, no study has compared both treatments. The Quadruple P study aims to compare the efficacy of vaginal progesterone and cervical pessary in the prevention of adverse perinatal outcome associated with preterm birth in asymptomatic women with a short cervix, in singleton and multiple pregnancies separately. It is a nationwide open-label multicentre randomized clinical trial (RCT) with a superiority design and will be accompanied by an economic analysis. Pregnant women undergoing the routine anomaly scan will be offered cervical length measurement between 18 and 22 weeks in a singleton and at 16-22 weeks in a multiple pregnancy. Women with a short cervix, defined as less than, or equal to 35 mm in a singleton and less than 38 mm in a multiple pregnancy, will be invited to participate in the study. Eligible women will be randomly allocated to receive either progesterone or a cervical pessary. Following randomization, the silicone cervical pessary will be placed during vaginal examination or 200 mg progesterone capsules will be daily self-administered vaginally. Both interventions will be continued until 36 weeks gestation or until delivery, whichever comes first. Primary outcome will be composite adverse perinatal outcome of perinatal mortality and perinatal morbidity including bronchopulmonary dysplasia, intraventricular haemorrhage grade III and IV, periventricular leukomalacia higher than grade I, necrotizing enterocolitis higher than stage I, Retinopathy of prematurity (ROP) or culture proven sepsis. These outcomes will be measured up until 10 weeks after the expected due date. Secondary outcomes will be, among others, time to delivery, preterm birth rate before 28, 32, 34 and 37 weeks, admission to neonatal intensive care unit, maternal morbidity, maternal admission days for threatened preterm labour and costs. This trial will provide evidence on whether vaginal progesterone or a cervical pessary is more effective in decreasing adverse perinatal outcome in both singletons and multiples. Trial registration number: NTR 4414 . Date of registration January 29th 2014.

Maternal hemodynamics, fetal biometry and Dopplers in pregnancies followed up for suspected fetal growth restriction.

PubMed

Roberts, Llinos A; Ling, Hua Zen; Poon, Liona; Nicolaides, Kypros H; Kametas, Nikos A

2018-04-01

To assess whether in a cohort of patients with small for gestational age (SGA) foetuses with estimated fetal weight ≤10 th percentile, maternal hemodynamics, fetal biometry and Dopplers at presentation, can predict the subsequent development of abnormal fetal Dopplers or delivery with birthweight <3 rd percentile. The study population comprised of 86 singleton pregnancies with SGA fetuses presenting at a median gestational age of 32 (range 26-35) weeks. We measured maternal cardiac function with a non-invasive transthoracic bioreactance monitor (NICOM, Cheetah), mean arterial pressure, fetal biometry, umbilical artery (UA), middle cerebral artery (MCA) and uterine artery (UT) pulsatility index (PI) and the deepest vertical pool (DVP) of amniotic fluid. Z-scores of these variables were calculated based on reported reference ranges and the values were compared between those with evidence of abnormal fetal Dopplers at presentation (group 1), those that developed abnormal Dopplers in subsequent visits (group 2) and those who did not develop abnormal Dopplers throughout pregnancy (group 3). Abnormal fetal Dopplers were defined as UAPI >95 th percentile, or MCA PI <5 th percentile. Differences in measured variables at presentation were also compared between pregnancies delivering a baby with birthweight <3 rd and ≥3 rd percentile. Multivariate logistic regression analysis was used to determine significant predictors of birthweight <3 rd percentile and evolution from normal fetal Dopplers to abnormal fetal Dopplers in groups 2 and 3. In the study population 14 (16%) cases were in group 1, 19 (22%) in group 2 and 53 (62%) in group 3. The birthweight was <3 rd percentile in 39 (45%) cases and ≥3 rd percentile in 47 (55%). In the study groups, compared to normal populations, there was decreased cardiac output and stroke volume and increased peripheral vascular resistance and mean arterial pressure (MAP) and the deviations from normal were most marked in group 1. Pregnancies with a birthweight <3 rd , compared to those ≥3 rd percentile, had higher deviations from normal in fetal biometry, maternal cardiac output, stroke volume, heart rate and peripheral vascular resistance and UT-PI. Multivariate logistic regression analysis demonstrated that in the prediction of birth weight ≤3 rd percentile, maternal hemodynamics provided significant improvement to the prediction provided by maternal demographics, fetal biometry and UT-PI, UA-PI and MCA-PI (difference between AUCs 0.18, 95% CI 0.06-0.29, p=0.002). In contrast, there was no significant independent contribution from maternal hemodynamics in the prediction of subsequent abnormal fetal Dopplers. In pregnancies with SGA fetuses there is decreased maternal cardiac output and stroke volume and increased peripheral vascular resistance and MAP and the deviations from normal are most marked in cases of redistribution in the fetal circulation and reduced amniotic fluid volume. This article is protected by copyright. All rights reserved.

Screening of gestational diabetes mellitus in early pregnancy by oral glucose tolerance test and glycosylated fibronectin: study protocol for an international, prospective, multicentre cohort trial.

PubMed

Huhn, E A; Fischer, T; Göbl, C S; Todesco Bernasconi, M; Kreft, M; Kunze, M; Schoetzau, A; Dölzlmüller, E; Eppel, W; Husslein, P; Ochsenbein-Koelble, N; Zimmermann, R; Bäz, E; Prömpeler, H; Bruder, E; Hahn, S; Hoesli, I

2016-10-12

As the accurate diagnosis and treatment of gestational diabetes mellitus (GDM) is of increasing importance; new diagnostic approaches for the assessment of GDM in early pregnancy were recently suggested. We evaluate the diagnostic power of an 'early' oral glucose tolerance test (OGTT) 75 g and glycosylated fibronectin (glyFn) for GDM screening in a normal cohort. In a prospective cohort study, 748 singleton pregnancies are recruited in 6 centres in Switzerland, Austria and Germany. Women are screened for pre-existing diabetes mellitus and GDM by an 'early' OGTT 75 g and/or the new biomarker, glyFn, at 12-15 weeks of gestation. Different screening strategies are compared to evaluate the impact on detection of GDM by an OGTT 75 g at 24-28 weeks of gestation as recommended by the International Association of Diabetes and Pregnancy Study Groups (IADPSG). A new screening algorithm is created by using multivariable risk estimation based on 'early' OGTT 75 g and/or glyFn results, incorporating maternal risk factors. Recruitment began in May 2014. This study received ethical approval from the ethics committees in Basel, Zurich, Vienna, Salzburg and Freiburg. It was registered under http://www.ClinicalTrials.gov (NCT02035059) on 12 January 2014. Data will be presented at international conferences and published in peer-reviewed journals. NCT02035059. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Pre-implantation genetic screening using fluorescence in situ hybridization in couples of Indian ethnicity: Is there a scope?

PubMed Central

Saxena, Shailaja Gada; Desai, Kundanbala; Shewale, Lata; Ranjan, Prabhat

2014-01-01

CONTEXT: There is a high incidence of numerical chromosomal aberration in couples with repeated in vitro fertilization (IVF) failure, advanced maternal age, repeated unexplained abortions, severe male factor infertility and unexplained infertility. Pre-implantation genetic screening (PGS), a variant of pre-implantation genetic diagnosis, screens numerical chromosomal aberrations in couples with normal karyotype, experiencing poor reproductive outcome. The present study includes the results of the initial pilot study on 9 couples who underwent 10 PGS cycles. AIM: The aim of the present study was to evaluate the beneficial effects of PGS in couples with poor reproductive outcome. SETTINGS AND DESIGN: Data of initial 9 couples who underwent 10 PGS for various indications was evaluated. SUBJECTS AND METHODS: Blastomere biopsy was performed on cleavage stage embryos and subjected to two round fluorescence in situ hybridization (FISH) testing for chromosomes 13, 18, 21, X and Y as a two-step procedure. RESULTS: Six of the 9 couples (10 PGS cycles) conceived, including a twin pregnancy in a couple with male factor infertility, singleton pregnancies in a couple with secondary infertility, in three couples with adverse obstetric outcome in earlier pregnancies and in one couple with repeated IVF failure. CONCLUSION: In the absence of availability of array-comparative genomic hybridization in diagnostic clinical scenario for PGS and promising results with FISH based PGS as evident from the current pilot study, it is imperative to offer the best available services in the present scenario for better pregnancy outcome for patients. PMID:24829527

Fetal size in mid- and late pregnancy is related to infant alertness: the generation R study.

PubMed

Henrichs, Jens; Schenk, Jacqueline J; Schmidt, Henk G; Arends, Lidia R; Steegers, Eric A P; Hofman, Albert; Jaddoe, Vincent W V; Verhulst, Frank C; Tiemeier, Henning

2009-03-01

The vulnerability for behavioral problems is partly shaped in fetal life. Numerous studies have related indicators of intrauterine growth, for example, birth weight and body size, to behavioral development. We investigated whether fetal size in mid- and late pregnancy is related to infant irritability and alertness. In a population-based birth cohort of 4,255 singleton full-term infants ultrasound measurements of fetal head and abdominal circumference in mid- and late pregnancy were performed. Infant irritability and alertness scores were obtained by the Mother and Baby Scales at 3 months and z-standardized. Multiple linear regression analyses revealed curvilinear associations (inverted J-shape) of measures of fetal size in both mid- and late pregnancy with infant alertness. Fetal size characteristics were not associated with infant irritability. These results suggest that alterations of intrauterine growth affecting infant alertness are already detectable from mid-pregnancy onwards.

The Effects of Meperidine Analgesia during Labor on Fetal Heart Rate

PubMed Central

Sekhavat, Leila; Behdad, Shecoofah

2009-01-01

To estimate the effects of intramuscular meperidine analgesia on fetal heart rate (FHR) patterns compared with placebo. In a prospective randomized study, 150 healthy women with singleton term pregnancy requesting analgesia during active labor were planned to receive either intramuscular meperidin 50 mg (meperidin group) or normal saline (control group) when they requested analgesia. Fetal heart rate patterns occurring within 40 minutes of initiation of labor analgesia were retrospectively read by maternal fetal medicine specialist who was blind to type of labor analgesia. Meperidine, compared with placebo, was associated with statistically significantly less beat to beat variability (absent or less than 5 beats per minute) (28% versus 5% of fetuses, P<0.05), lower proportion of accelerations (37.3% versus 17.3% P<0.05) and of the FHR. Also FHR deceleration was significantly more than control group (25.5% versus 4%, P<0.05). Meperidine has deleterious effects on FHR. PMID:23675116

Amnioinfusion in preterm PROM: effects on amnion and cord histology.

PubMed

Locatelli, A; Andreani, M; Ghidini, A; Verderio, M; Pizzardi, A; Vergani, P; Salafia, C M

2008-02-01

To investigate the effects of transabdominal amnioinfusion (TA) on the histology of amnion (A) and umbilical cord (UC). From a cohort of 56 singleton pregnancies with premature rupture of membranes (PROM) at

Second- to third-trimester longitudinal growth assessment for prediction of small-for-gestational age and late fetal growth restriction.

PubMed

Caradeux, J; Eixarch, E; Mazarico, E; Basuki, T R; Gratacós, E; Figueras, F

2018-02-01

Detection of fetal growth restriction (FGR) remains poor and most screening strategies rely on cross-sectional evaluation of fetal size during the third trimester. A longitudinal and individualized approach has been proposed as an alternative method of evaluation. The aim of this study was to compare second- to third-trimester longitudinal growth assessment to cross-sectional evaluation in the third trimester for the prediction of small-for-gestational age (SGA) and late FGR in low-risk singleton pregnancy. This was a prospective cohort study of 2696 unselected consecutive low-risk singleton pregnancies scanned at 21 ± 2 and 32 ± 2 weeks. For cross-sectional growth assessment, abdominal circumference (AC) measurements were transformed to z-values according the 21st-INTERGROWTH standards. Longitudinal growth assessment was performed by calculating the AC z-velocity and the second- to third-trimester AC conditional growth centile. Longitudinal assessment was compared with cross-sectional assessment at 32 weeks. Association of cross-sectional and longitudinal evaluations with SGA and late FGR was assessed by logistic regression analysis. Predictive performance was determined by receiver-operating characteristics curve analysis. In total, 210 (7.8%) newborns were classified as SGA and 103 (3.8%) as late FGR. Neither longitudinal measurement improved the association with SGA or late FGR provided by cross-sectional evaluation of AC z-score at 32 weeks. Areas under the curves of AC z-velocity and conditional AC growth were significantly smaller than those of cross-sectional AC z-scores (P < 0.001), although AC z-velocity performed significantly better than did conditional AC growth (P < 0.001). Longitudinal assessment of fetal growth from the second to third trimester has a low predictive capacity for SGA and late FGR in low-risk singleton pregnancy compared with cross-sectional growth evaluation. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Implementation of maternal blood cell-free DNA testing in early screening for aneuploidies.

PubMed

Gil, M M; Quezada, M S; Bregant, B; Ferraro, M; Nicolaides, K H

2013-07-01

To explore the feasibility of routine maternal blood cell-free (cf) DNA testing in screening for trisomies 21, 18 and 13 at 10 weeks' gestation. In this prospective study, women attending The Fetal Medicine Centre in London, UK, between October 2012 and April 2013, with singleton pregnancy and live fetus with CRL 32-45 mm, were screened for trisomies 21, 18 and 13 by cfDNA testing at 10 weeks and the combined test at 12 weeks. cfDNA testing was performed in 1005 singleton pregnancies with a median maternal age of 37 (range, 20-49) years. Risks for trisomies were provided for 957 (95.2%) cases and in 98.0% these were available within 14 days from sampling. In 48 (4.8%) cases no result was provided due to problems with delivery to the laboratory, low fetal fraction or assay failure. Repeat sampling was performed in 40 cases and a result obtained in 27 (67.5%) of these. In 11 cases the risk score for trisomy 21 and in five cases that for trisomy 18 was > 99%, in one the risk for trisomy 13 was 34% and in 968 the risk for each of the three trisomies was < 0.01%. The suspected trisomies were confirmed by karyotyping after chorionic villus sampling (CVS), except in one case of trisomy 18 in which the karyotype was normal. On the basis of the maternal age distribution of the study population, the expected and observed numbers for each of the three trisomies were similar. Both cfDNA and combined testing detected all trisomies, but the estimated false-positive rates (FPR) were 0.1% and 3.4%, respectively. Routine screening for trisomies 21, 18 and 13 by cfDNA testing at 10 weeks is feasible and has a lower FPR than does combined testing, but abnormal results require confirmation by CVS. Copyright © 2013 ISUOG. Published by John Wiley & Sons, Ltd.

Prediction of uncomplicated pregnancies in obese women: a prospective multicentre study.

PubMed

Vieira, Matias C; White, Sara L; Patel, Nashita; Seed, Paul T; Briley, Annette L; Sandall, Jane; Welsh, Paul; Sattar, Naveed; Nelson, Scott M; Lawlor, Debbie A; Poston, Lucilla; Pasupathy, Dharmintra

2017-11-03

All obese pregnant women are considered at equal high risk with respect to complications in pregnancy and birth, and are commonly managed through resource-intensive care pathways. However, the identification of maternal characteristics associated with normal pregnancy outcomes could assist in the management of these pregnancies. The present study aims to identify the factors associated with uncomplicated pregnancy and birth in obese women, and to assess their predictive performance. Data form obese women (BMI ≥ 30 kg/m 2 ) with singleton pregnancies included in the UPBEAT trial were used in this analysis. Multivariable logistic regression was used to identify sociodemographic, clinical and biochemical factors at 15 +0 to 18 +6 weeks' gestation associated with uncomplicated pregnancy and birth, defined as delivery of a term live-born infant without antenatal or labour complications. Predictive performance was assessed using area under the receiver operating characteristic curve (AUROC). Internal validation and calibration were also performed. Women were divided into fifths of risk and pregnancy outcomes were compared between groups. Sensitivity, specificity, and positive and negative predictive values were calculated using the upper fifth as the positive screening group. Amongst 1409 participants (BMI 36.4, SD 4.8 kg/m 2 ), the prevalence of uncomplicated pregnancy and birth was 36% (505/1409). Multiparity and increased plasma adiponectin, maternal age, systolic blood pressure and HbA1c were independently associated with uncomplicated pregnancy and birth. These factors achieved an AUROC of 0.72 (0.68-0.76) and the model was well calibrated. Prevalence of gestational diabetes, preeclampsia and other hypertensive disorders, preterm birth, and postpartum haemorrhage decreased whereas spontaneous vaginal delivery increased across the fifths of increasing predicted risk of uncomplicated pregnancy and birth. Sensitivity, specificity, and positive and negative predictive values were 38%, 89%, 63% and 74%, respectively. A simpler model including clinical factors only (no biomarkers) achieved an AUROC of 0.68 (0.65-0.71), with sensitivity, specificity, and positive and negative predictive values of 31%, 86%, 56% and 69%, respectively. Clinical factors and biomarkers can be used to help stratify pregnancy and delivery risk amongst obese pregnant women. Further studies are needed to explore alternative pathways of care for obese women demonstrating different risk profiles for uncomplicated pregnancy and birth.

Gender- and parity-specific reference charts for fetal size in low risk singleton pregnancies at the onset of the third trimester.

PubMed

De Reu, Paul; Smits, Luc J; Oosterbaan, Herman P; Snijders, Rosalinde J; De Reu-Cuppens, Marga J; Nijhuis, Jan G

2007-01-01

To determine fetal growth in low risk pregnancies at the beginning of the third trimester and to assess the relative importance of fetal gender and maternal parity. Dutch primary care midwifery practice. Retrospective cohort study on 3641 singleton pregnancies seen at a primary care midwifery center in the Netherlands. Parameters used for analysis were fetal abdominal circumference (AC), fetal head circumference (HC), gestational age, fetal gender and maternal parity. Regression analysis was applied to describe variation in AC and HC with gestational age. Means and standard deviations in the present population were compared with commonly used reference charts. Multiple regression analysis was applied to examine whether gender and parity should be taken into account. The fetal AC and HC increased significantly between the 27th and the 33rd week of pregnancy (AC r2=0.3652, P<0.0001; HC r2=0.3301, P<0.0001). Compared to some curves, our means and standard deviations were significantly smaller (at 30+0 weeks AC mean=258+/-13 mm; HC mean=281+/-14 mm), but corresponded well with other curves. Fetal gender was a significant determinant for both AC (P<0.0001) and HC (P<0.0001). Parity contributed significantly to AC only but the difference was small (beta=0.00464). At the beginning of the third trimester, fetal size is associated with fetal gender and, to a lesser extent, with parity. Some fetal growth charts (e.g., Chitty et al.) are more suitable for the low-risk population in the Netherlands than others.

Effect of maternal age on maternal and neonatal outcomes after assisted reproductive technology.

PubMed

Wennberg, Anna Lena; Opdahl, Signe; Bergh, Christina; Aaris Henningsen, Anna-Karina; Gissler, Mika; Romundstad, Liv Bente; Pinborg, Anja; Tiitinen, Aila; Skjærven, Rolv; Wennerholm, Ulla-Britt

2016-10-01

To compare the effect of maternal age on assisted reproductive technology (ART) and spontaneous conception (SC) pregnancies regarding maternal and neonatal complications. Nordic retrospective population-based cohort study. Data from national ART registries were cross-linked with national medical birth registries. Not applicable. A total of 300,085 singleton deliveries: 39,919 after ART and 260,166 after SC. None. Hypertensive disorders in pregnancy (HDP), placenta previa, cesarean delivery, preterm birth (PTB; <37 weeks), low birth weight (LBW; <2,500 g), small for gestational age (SGA), and perinatal mortality (≥28 weeks). Adjusted odds ratios (AORs) were calculated. Associations between maternal age and outcomes were analyzed. The risk of placenta previa (AOR 4.11-6.05), cesarean delivery (AOR 1.18-1.50), PTB (AOR 1.23-2.19), and LBW (AOR 1.44-2.35) was significantly higher in ART than in SC pregnancies for most maternal ages. In both ART and SC pregnancies, the risk of HDP, placenta previa, cesarean delivery, PTB, LBW, and SGA changed significantly with age. The AORs for adverse neonatal outcomes at advanced maternal age (>35 years) showed a greater increase in SC than in ART. The change in risk with age did not differ between ART and SC for maternal outcomes at advanced maternal age. Having singleton conceptions after ART results in higher maternal and neonatal outcome risks overall, but the impact of age seems to be more pronounced in couples conceiving spontaneously. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

[Impact of autosomal dominant polycystic kidney disease on the outcomes of intracytoplasmic sperm injection in infertile males].

PubMed

Su, Huang; Liu, Bian-jiang; Yang, Xiao-yu; Song, Ning-hong; Yin, Chang-jun; Zhang, Wei; Liu, Jia-yin

2015-01-01

To summarize the features and treatment of male infertility induced by autosomal dominant polycystic kidney disease (ADPKD), and compare the outcomes of intracytoplasmic sperm injection (ICSI) for infertile men with ADPKD and those with congenital bilateral absence of vas deferens (CBAVD). We retrospectively analyzed 21 cases of ADPKD-induced infertility, 15 treated by ICSI (group A), and another 164 cases of strictly matched CBAVD-induced infertility (group B). We compared the two groups in the couples' age, the number of ICSI oocytes, and the rates of fertilization, transferrable embryos, good embryos, embryos implanted, clinical pregnancy, biochemical pregnancy, early abortion, singleton and twins in the first cycle. After 28 cycles of ICSI, 10 of the 15 ADPKD-induced infertility patients achieved clinical pregnancy, including 7 cases of live birth, 1 case of spontaneous abortion, and 2 cases of pregnancy maintenance. No significant differences were observed between groups A and B in the couples' age, the wives' BMI, or the numbers of ICSI oocytes and embryos transplanted (P >0.05), nor in the rates of ICSI fertilization (72.64% vs 76.17%), transferrable embryos (51.28% vs 63.24%), quality embryos (38.46% vs 49.83%), embryo implantation (17.64% vs 38.50%), abortion (0 vs 9.23%), singleton (50% vs 81.54%) and twins (50% vs 18.46%). However, the rates of clinical pregnancy (13.33% vs 42.68%, P = 0.023 <0.05) and biochemical pregnancy (13.33% vs 39.63%, P = 0.032 <0.05) were significantly lower in group A than in B. ICSI is effective in the treatment of male infertility induced by either ADPKD or CBAVD, but the ADPKD cases have a lower success rate than the CBAVD cases in an individual cycle. The affected couples should be informed of the necessity of prenatal genetic diagnosis before embryo implantation and the inevitable vertical transmission of genetic problems to the offspring.

Endometriosis increases the risk of obstetrical and neonatal complications.

PubMed

Berlac, Janne Foss; Hartwell, Dorthe; Skovlund, Charlotte Wessel; Langhoff-Roos, Jens; Lidegaard, Øjvind

2017-06-01

The objective of this study was to assess obstetrical complications and neonatal outcomes in women with endometriosis as compared with women without endometriosis. National cohort including all delivering women and their newborns in Denmark 1997-2014. Data were extracted from the Danish Health Register and the Medical Birth Register. Logistic regression analysis provided odds ratios (OR) with 95% confidence intervals (CI). Sub-analyses were made for primiparous women with a singleton pregnancy and for women with endometriosis who underwent gynecological surgery before pregnancy. In 19 331 deliveries, women with endometriosis had a higher risk of severe preeclampsia (OR 1.7, 95% CI 1.5-2.0), hemorrhage in pregnancy (OR 2.3, 95% CI 2.0-2.5), placental abruption (OR 2.0, 95% CI 1.7-2.3), placenta previa (OR 3.9, 95% CI 3.5-4.3), premature rupture of membranes (OR 1.7, 95% CI 1.5-1.8), and retained placenta (OR 3.1, 95% CI 1.4-6.6). The neonates had increased risks of preterm birth before 28 weeks (OR 3.1, 95% CI 2.7-3.6), being small for gestational age (OR 1.5, 95% CI 1.4-1.6), being diagnosed with congenital malformations (OR 1.3, 95% CI 1.3-1.4), and neonatal death (OR 1.8, 95% CI 1.4-2.1). Results were similar in primiparous women with a singleton pregnancy. Gynecological surgery for endometriosis before pregnancy carried a further increased risk. Women with endometriosis had a significantly higher risk of several complications, such as preeclampsia and placental complications in pregnancy and at delivery. The newborns had increased risk of being delivered preterm, having congenital malformations, and having a higher neonatal death rate. Pregnant women with endometriosis require increased antenatal surveillance. © 2017 Nordic Federation of Societies of Obstetrics and Gynecology.

The changing association between prenatal participation in WIC and birth outcomes in New York City.

PubMed

Joyce, Ted; Gibson, Diane; Colman, Silvie

2005-01-01

We analyze the relationship between prenatal WIC participation and birth outcomes in New York City from 1988-2001. The analysis is unique for several reasons. First, we have over 800,000 births to women on Medicaid, the largest sample ever used to analyze prenatal participation in WIC. Second, we focus on measures of fetal growth distinct from preterm birth, since there is little clinical support for a link between nutritional supplementation and premature delivery. Third, we restrict the primary analysis to women on Medicaid who have no previous live births and who initiate prenatal care within the first four months of pregnancy. Our goal is to lessen heterogeneity between WIC and non-WIC participants by limiting the sample to highly motivated women who have no experience with WIC from a previous pregnancy. Fourth, we analyze a large sub-sample of twin deliveries. Multifetal pregnancies increase the risk of anemia and fetal growth retardation and thus may benefit more than singletons from nutritional supplementation. We find no relationship between prenatal WIC participation and measures of fetal growth among singletons. We find a modest pattern of association between WIC and fetal growth among U.S.-born Black twins. Our findings suggest that prenatal participation in WIC has had a minimal effect on adverse birth outcomes in New York City.

Meta-analysis of randomized controlled trials comparing 17α-hydroxyprogesterone caproate and vaginal progesterone for the prevention of recurrent spontaneous preterm delivery.

PubMed

Oler, Elizabeth; Eke, Ahizechukwu C; Hesson, Ashley

2017-07-01

Vaginal progesterone and 17α-hydroxyprogesterone (17α-OHP) are both used to prevent preterm delivery in women who have experienced spontaneous preterm delivery (SPTD) previously. Randomized trial data of the comparative effectiveness of these interventions have been mixed. To compare the efficacy of intramuscular 17α-OHP and vaginal progesterone in the prevention of recurrent SPTD. Cochrane Central Register of Controlled Trials, African Journals Online, Embase, Google Scholar, ISI Web of Science, LILACS, CINAHL, PubMed, and registers of ongoing trials were searched using keywords related to 17α-OHP, vaginal progesterone, and preterm delivery. Randomized controlled trials published between January 1, 1966, and November 30, 2016, comparing 17α-OHP and vaginal progesterone for the prevention of recurrent SPTD during singleton pregnancies were included. Study data were extracted and meta-analyses were performed when outcomes were comparable. The meta-analyses included data from three randomized trials. Lower rates of SPTD before 34 weeks (relative risk 0.71, 95% confidence interval 0.53-0.95) and before 32 weeks (relative risk 0.62, 95% confidence interval 0.40-0.94) of pregnancy were observed among patients treated with vaginal progesterone. Vaginal progesterone and 17α-OHP were comparable for the prevention of recurrent SPTD in singleton pregnancies; vaginal progesterone could be superior. © 2017 International Federation of Gynecology and Obstetrics.

Spontaneous abortion in multiple pregnancy: focus on fetal pathology.

PubMed

Joó, József Gábor; Csaba, Ákos; Szigeti, Zsanett; Rigó, János

2012-08-15

Multiple pregnancy with its wide array of medical consequences poses an important condition during pregnancy. We performed perinatal autopsy in 49 cases of spontaneous abortion resulting from multiple pregnancies during the study period. Twenty-seven of the 44 twin pregnancies ending in miscarriage were conceived naturally, whereas 17 were conceived through assisted reproductive techniques. Each of the 5 triplet pregnancies ending in miscarriage was conceived through assisted reproductive techniques. There was a positive history of miscarriage in 22.4% of the cases. Monochorial placentation occurred more commonly in multiple pregnancies terminating with miscarriage than in multiple pregnancies without miscarriage. A fetal congenital malformation was found in 8 cases. Three of these cases were conceived through assisted reproductive techniques, and 5 were conceived naturally. Miscarriage was due to intrauterine infection in 36% of the cases. Our study confirms that spontaneous abortion is more common in multiple than in singleton pregnancies. Monochorial placentation predicted a higher fetal morbidity and mortality. In pregnancies where all fetuses were of male gender, miscarriage was more common than in pregnancies where all fetuses were female. Assisted reproductive techniques do not predispose to the development of fetal malformations. Copyright © 2012 Elsevier GmbH. All rights reserved.

The effect of maternal obesity on pregnancy outcomes of women with gestational diabetes controlled with diet only, glyburide, or insulin.

PubMed

Joy, Saju; Roman, Ashley; Istwan, Niki; Rhea, Debbie; Desch, Cheryl; Stanziano, Gary; Saltzman, Daniel

2012-09-01

To examine the effect of obesity on maternal and neonatal outcomes in women diagnosed with gestational diabetes mellitus (GDM) and managed with diet only, glyburide, or insulin. Women with singleton gestations enrolled for outpatient services diagnosed with GDM and without history of pregnancy-related hypertension at enrollment or in a prior pregnancy were identified in a database. Women with GDM controlled by diet only (n = 3918), glyburide (n = 873), or insulin without prior exposure to oral hypoglycemic agents (n = 2229) were included. Pregnancy outcomes were compared for obese versus nonobese women within each treatment group and also compared across treatment groups within the obese and nonobese populations. Within each treatment group, obesity was associated with higher rates of cesarean delivery, pregnancy-related hypertension, macrosomia, and hyperbilirubinemia (all p < 0.05). Higher rates of pregnancy-related hypertension and hyperbilirubinemia were observed in women receiving glyburide. Obesity adversely affects pregnancy outcome in women with GDM. Higher rates of pregnancy-related hypertension and hyperbilirubinemia were observed in pregnant women receiving glyburide. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Placenta previa and risk of major congenital malformations among singleton births in Finland.

PubMed

Kancherla, Vijaya; Räisänen, Sari; Gissler, Mika; Kramer, Michael R; Heinonen, Seppo

2015-06-01

Placenta previa has been associated with adverse birth outcomes, but its association with congenital malformations is inconclusive. We examined the association between placenta previa and major congenital malformations among singleton births in Finland. We performed a retrospective population register-based study on all singletons born at or after 22+0 weeks of gestation in Finland during 2000 to 2010. We linked three national health registers: the Finnish Medical Birth Register, the Hospital Discharge Register, and the Register of Congenital Malformations, and examined several demographic and clinical characteristics among women with and without placenta previa, in association with major congenital malformations. We estimated adjusted odds ratios and 95% confidence intervals using multivariable logistic regression models. The prevalence of placenta previa was estimated as 2.65 per 1000 singleton births in Finland (95% confidence interval, 2.53-2.79). Overall, 6.2% of women with placenta previa delivered a singleton infant with a major congenital malformation, compared with 3.8% of unaffected women (p ≤ 0.001). Placenta previa was positively associated with almost 1.6-fold increased risk of major congenital malformations in the offspring, after controlling for maternal age, parity, fetal sex, smoking, socio-economic status, chorionic villus biopsy, In vitro fertilization, pre-existing diabetes, depression, preeclampsia, and prior caesarean section (adjusted odds ratio = 1.55; 95% confidence interval, 1.27-1.90). Using a large population-based study, we found that placenta previa was weakly, but significantly associated with an increased risk of major congenital malformations in singleton births. Future studies should examine the association between placenta previa and individual types of congenital malformations, specifically in high-risk pregnancies. © 2015 Wiley Periodicals, Inc.

Obesity or Underweight-What is Worse in Pregnancy?

PubMed

Agrawal, Sumi; Singh, Abha

2016-12-01

This study was conducted to compare underweight and obese women and their weight gain during pregnancy on fetomaternal outcome. This is a prospective, non-interventional, observational study on 1000 women (BMI between 20 and 30 were excluded). Women attending ANC OPD with singleton pregnancy at or before 16 weeks were included and BMI calculated in early pregnancy. Their weight gain during pregnancy was noted. Any complications in the mother or perinate were noted. Incidence of obesity in our institute was 17 % and that of underweight was 18 %. Pre-eclampsia, gestational hypertensions, gestational DM, antepartum hemorrhage, all were more common among obese women, while anemia was more common in the underweight. Post-dated pregnancy, induction of labor, cesarean delivery, and postpartum complications were more common in obese women. Fetal complications were also higher in obese patients. Lower as well as higher prepregnancy BMI is an independent risk factor that is associated with increased morbidity and mortality in both the mother and the fetus.

Ovarian hyperstimulation syndrome in a spontaneous singleton pregnancy.

PubMed

Cabar, Fábio Roberto

2016-05-24

The ovarian hyperstimulation syndrome is the combination of increased ovarian volume, due to the presence of multiple cysts and vascular hyperpermeability, with subsequent hypovolemia and hemoconcentration. We report a case of spontaneous syndrome in a singleton pregnancy. This was a spontaneous pregnancy with 12 weeks of gestational age. The pregnancy was uneventful until 11 weeks of gestational age. After that, the pregnant woman complained of progressive abdominal distention associated with abdominal discomfort. She did not report other symptoms. In the first trimester, a routine ultrasonography showed enlarged ovaries, multiples cysts and ascites. Upon admission, the patient was hemodynamically stable, her serum β-hCG was 24,487mIU/mL, thyroid-stimulating hormone was 2.2µUI/mL and free T4 was 1.8ng/dL. All results were within normal parameters. However, levels of estradiol were high (10,562pg/mL). During hospitalization, she received albumin, furosemide and prophylactic dose of enoxaparin. The patient was discharged on the sixth hospital day. RESUMO A síndrome de hiperestimulação ovariana é a combinação do aumento dos ovários, devido à presença de múltiplos cistos e de hiperpermeabilidade vascular, com subsequente hipovolemia e hemoconcentração. Relata-se um caso de síndrome espontânea em uma gestação única. Trata-se de gravidez espontânea com 12 semanas de idade gestacional. A gravidez ocorreu sem intercorrências até 11 semanas de idade gestacional. Após, a gestante passou a se queixar de distensão abdominal progressiva, associada com desconforto abdominal. A paciente não relatava outros sintomas. A ultrassonografia de rotina no primeiro trimestre mostrou ovários aumentados com múltiplos cistos e ascite. No momento da internação, a paciente apresentava-se hemodinamicamente estável, com β-hCG sérico de 24.487mUI/mL, hormônio estimulante da tireoide de 2,2µUI/m e T4 livre de 1,8ng/dL, ou seja, valores dentro dos parâmetros normais. Porém, os níveis de estradiol estavam elevados (10.562pg/mL). Durante a internação, a paciente recebeu albumina, furosemida e enoxaparina profilática. A alta hospitalar ocorreu no sexto dia de internação.

Normal ranges for fetal electrocardiogram values for the healthy fetus of 18-24 weeks of gestation: a prospective cohort study.

PubMed

Verdurmen, Kim M J; Lempersz, Carlijn; Vullings, Rik; Schroer, Christian; Delhaas, Tammo; van Laar, Judith O E H; Oei, S Guid

2016-08-17

The fetal anomaly ultrasound only detects 65 to 81 % of the patients with congenital heart disease, making it the most common structural fetal anomaly of which a significant part is missed during prenatal life. Therefore, we need a reliable non-invasive diagnostic method which improves the predictive value for congenital heart diseases early in pregnancy. Fetal electrocardiography could be this desired diagnostic method. There are multiple technical challenges to overcome in the conduction of the fetal electrocardiogram. In addition, interpretation is difficult due to the organisation of the fetal circulation in utero. We want to establish the normal ranges and values of the fetal electrocardiogram parameters in healthy fetuses of 18 to 24 weeks of gestation. Women with an uneventful singleton pregnancy between 18 and 24 weeks of gestation are asked to participate in this prospective cohort study. A certified and experienced sonographist performs the fetal anomaly scan. Subsequently, a fetal electrocardiogram recording is performed using dedicated signal processing methods. Measurements are performed at two institutes. We will include 300 participants to determine the normal values and 95 % confidence intervals of the fetal electrocardiogram parameters in a healthy fetus. We will evaluate the fetal heart rate, segment intervals, normalised amplitude and the fetal heart axis. Three months postpartum, we will evaluate if a newborn is healthy through a questionnaire. Fetal electrocardiography could be a promising tool in the screening program for congenital heart diseases. The electrocardiogram is a depiction of the intimate relationship between the cardiac nerve conduction pathways and the structural morphology of the fetal heart, and therefore particularly suitable for the detection of secondary effects due to a congenital heart disease (hypotrophy, hypertrophy and conduction interruption).

Clinical outcomes following cryopreservation of blastocysts by vitrification or slow freezing: a population-based cohort study.

PubMed

Li, Z; Wang, Y A; Ledger, W; Edgar, D H; Sullivan, E A

2014-12-01

What are the clinical efficacy and perinatal outcomes following transfer of vitrified blastocysts compared with transfer of fresh or of slow frozen blastocysts? Compared with slow frozen blastocysts, vitrified blastocysts resulted in significantly higher clinical pregnancy and live delivery rates with similar perinatal outcomes at population level. Although vitrification has been reported to be associated with significantly increased post-thaw survival rates compared with slow freezing, there has been a lack of general consensus over which method of cryopreservation (vitrification versus slow freezing) is most appropriate for blastocysts. A population-based cohort of autologous fresh and initiated thaw cycles (a cycle where embryos were thawed with intention to transfer) performed between January 2009 and December 2011 in Australia and New Zealand was evaluated retrospectively. A total of 46 890 fresh blastocyst transfer cycles, 12 852 initiated slow frozen blastocyst thaw cycles and 20 887 initiated vitrified blastocyst warming cycles were included in the data analysis. Pairwise comparisons were made between the vitrified blastocyst group and slow frozen or fresh blastocyst group. A Chi-square test was used for categorical variables and t-test was used for continuous variables. Cox regression was used to examine the pregnancy outcomes (clinical pregnancy rate, miscarriage rate and live delivery rate) and perinatal outcomes (preterm delivery, low birthweight births, small for gestational age (SGA) births, large for gestational age (LGA) births and perinatal mortality) following transfer of fresh, slow frozen and vitrified blastocysts. The 46 890 fresh blastocyst transfers, 11 644 slow frozen blastocyst transfers and 19 978 vitrified blastocyst transfers resulted in 16 845, 2766 and 6537 clinical pregnancies, which led to 13 049, 2065 and 4955 live deliveries, respectively. Compared with slow frozen blastocyst transfer cycles, vitrified blastocyst transfer cycles resulted in a significantly higher clinical pregnancy rate (adjusted relative risk (ARR): 1.47, 95% confidence intervals (CI): 1.39-1.55) and live delivery rate (ARR: 1.41, 95% CI: 1.34-1.49). Compared with singletons born after transfer of fresh blastocysts, singletons born after transfer of vitrified blastocysts were at 14% less risk of being born preterm (ARR: 0.86, 95% CI: 0.77-0.96), 33% less risk of being low birthweight (ARR: 0.67, 95% CI: 0.58-0.78) and 40% less risk of being SGA (ARR: 0.60, 95% CI: 0.53-0.68). A limitation of this population-based study is the lack of information available on clinic-specific cryopreservation protocols and processes for slow freezing-thaw and vitrification-warm of blastocysts and the potential impact on outcomes. This study presents population-based evidence on clinical efficacy and perinatal outcomes associated with transfer of fresh, slow frozen and vitrified blastocysts. Vitrified blastocyst transfer resulted in significantly higher clinical pregnancy and live delivery rates with similar perinatal outcomes compared with slow frozen blastocyst transfer. Comparably better perinatal outcomes were reported for singletons born after transfer of vitrified blastocysts than singletons born after transfer of fresh blastocysts. Elective vitrification could be considered as an alternative embryo transfer strategy to achieve better perinatal outcomes following Assisted Reproduction Technology (ART) treatment. No specific funding was obtained. The authors have no conflicts of interest to declare. © The Author 2014. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Exercise during pregnancy in normal-weight women and risk of preterm birth: a systematic review and meta-analysis of randomized controlled trials.

PubMed

Di Mascio, Daniele; Magro-Malosso, Elena Rita; Saccone, Gabriele; Marhefka, Gregary D; Berghella, Vincenzo

2016-11-01

Preterm birth is the major cause of perinatal mortality in the United States. In the past, pregnant women have been recommended to not exercise because of presumed risks of preterm birth. Physical activity has been theoretically related to preterm birth because it increases the release of catecholamines, especially norepinephrine, which might stimulate myometrial activity. Conversely, exercise may reduce the risk of preterm birth by other mechanisms such as decreased oxidative stress or improved placenta vascularization. Therefore, the safety of exercise regarding preterm birth and its effects on gestational age at delivery remain controversial. The objective of the study was to evaluate the effects of exercise during pregnancy on the risk of preterm birth. MEDLINE, EMBASE, Web of Sciences, Scopus, ClinicalTrial.gov, OVID, and Cochrane Library were searched from the inception of each database to April 2016. Selection criteria included only randomized clinical trials of pregnant women randomized before 23 weeks to an aerobic exercise regimen or not. Types of participants included women of normal weight with uncomplicated, singleton pregnancies without any obstetric contraindication to physical activity. The summary measures were reported as relative risk or as mean difference with 95% confidence intervals. The primary outcome was the incidence of preterm birth <37 weeks. Of the 2059 women included in the meta-analysis, 1022 (49.6%) were randomized to the exercise group and 1037 (50.4%) to the control group. Aerobic exercise lasted about 35-90 minutes 3-4 times per week. Women who were randomized to aerobic exercise had a similar incidence of preterm birth of <37 weeks (4.5% vs 4.4%; relative risk, 1.01, 95% confidence interval, 0.68-1.50) and a similar mean gestational age at delivery (mean difference, 0.05 week, 95% confidence interval, -0.07 to 0.17) compared with controls. Women in the exercise group had a significantly higher incidence of vaginal delivery (73.6% vs 67.5%; relative risk, 1.09, 95% confidence interval, 1.04-1.15) and a significantly lower incidence of cesarean delivery (17.9% vs 22%; relative risk, 0.82, 95% confidence interval, 0.69-0.97) compared with controls. The incidence of operative vaginal delivery (12.9% vs 16.5%; relative risk, 0.78, 95% confidence interval, 0.61-1.01) was similar in both groups. Women in the exercise group had a significantly lower incidence of gestational diabetes mellitus (2.9% vs 5.6%; relative risk, 0.51, 95% confidence interval, 0.31-0.82) and a significantly lower incidence of hypertensive disorders (1.0% vs 5.6%; relative risk, 0.21, 95% confidence interval, 0.09-0.45) compared with controls. No differences in low birthweight (5.2% vs 4.7%; relative risk, 1.11, 95% confidence interval, 0.72-1.73) and mean birthweight (mean difference, -10.46 g, 95% confidence interval, -47.10 to 26.21) between the exercise group and controls were found. Aerobic exercise for 35-90 minutes 3-4 times per week during pregnancy can be safely performed by normal-weight women with singleton, uncomplicated gestations because this is not associated with an increased risk of preterm birth or with a reduction in mean gestational age at delivery. Exercise was associated with a significantly higher incidence of vaginal delivery and a significantly lower incidence of cesarean delivery, with a significantly lower incidence of gestational diabetes mellitus and hypertensive disorders and therefore should be encouraged. Copyright © 2016. Published by Elsevier Inc.

Improving Women’s Preconceptional Health: Long-Term Effects of the Strong Healthy Women Behavior Change Intervention in the Central Pennsylvania Women’s Health Study

PubMed Central

Weisman, Carol S.; Hillemeier, Marianne M.; Downs, Danielle Symons; Feinberg, Mark E.; Chuang, Cynthia H.; Botti, John J.; Dyer, Anne-Marie

2013-01-01

Purpose To investigate the long-term (6- and 12-month) effects of the Strong Healthy Women intervention on health-related behaviors, weight and body mass index (BMI), and weight gain during pregnancy. Strong Healthy Women is a small-group behavioral intervention for pre- and interconceptional women designed to modify key risk factors for adverse pregnancy outcomes; pretest–posttest findings from a randomized, controlled trial have been previously reported. The following questions are addressed: 1) were significant pretest–posttest changes in health-related behaviors (previously reported) maintained over the 12-month follow-up period; 2) did the intervention impact weight and BMI over the 12-month follow-up period; and 3) did the intervention impact pregnancy weight gain for those who gave birth during the follow-up period? Methods Data are from 6- and 12-month follow-up telephone interviews of women in the original trial of the Strong Healthy Women intervention (n = 362) and from birth records for singleton births (n = 45) during the 12-month follow-up period. Repeated measures regression was used to evaluate intervention effects. Main Findings At the 12-month follow-up, participants in the Strong Healthy Women intervention were significantly more likely than controls to use a daily multivitamin with folic acid and to have lower weight and BMI. The intervention’s effect on reading food labels for nutritional values dropped off between the 6- and 12-month follow-up. Among those who gave birth to singletons during the follow-up period, women who participated in the intervention had lower average pregnancy weight gain compared with controls. Although the intervention effect was no longer significant when controlling for pre-pregnancy obesity, the adjusted means show a trend toward lower weight gain in the intervention group. Conclusion These findings provide important evidence that the Strong Healthy Women behavior change intervention is effective in modifying important risk factors for adverse pregnancy outcomes and may improve an important pregnancy outcome, weight gain during pregnancy. Because the intervention seems to help women manage their weight in the months after the intervention and during pregnancy, it may be an effective obesity prevention strategy for women before, during, and after the transition to motherhood. PMID:21536455

PubMed Central

Weichert, Alexander; Hagen, Andreas; Tchirikov, Michael; Fuchs, Ilka B.; Henrich, Wolfgang; Entezami, Michael

2017-01-01

Introduction Doppler sonography of the uterine artery (UA) is done to monitor pregnancies, because the detected flow patterns are useful to draw inferences about possible disorders of trophoblast invasion. Increased resistance in the UA is associated with an increased risk of preeclampsia and/or intrauterine growth restriction (IUGR) and perinatal mortality. In the absence of standardized figures, the normal ranges of the various available reference curves sometimes differ quite substantially from one another. The causes for this are differences in the flow patterns of the UA depending on the position of the pulsed Doppler gates as well as branching of the UA. Because of the discrepancies between the different reference curves and the practical problems this poses for guideline recommendations, we thought it would be useful to create our own reference curves for Doppler measurements of the UA obtained from a singleton cohort under standardized conditions. Material and Methods This retrospective cohort study was carried out in the Department of Obstetrics of the Charité – Universitätsmedizin Berlin, the Department for Obstetrics and Prenatal Medicine of the University Hospital Halle (Saale) and the Center for Prenatal Diagnostics and Human Genetics Kurfürstendamm 199. Available datasets from the three study locations were identified and reference curves were generated using the LMS method. Measured values were correlated with age of gestation, and a cubic model and Box-Cox power transformation (L), the median (M) and the coefficient of variation (S) were used to smooth the curves. Results 103 720 Doppler examinations of the UA carried out in singleton pregnancies from the 11th week of gestation (10 + 1 GW) were analyzed. The mean pulsatility index (Mean PI) showed a continuous decline over the course of pregnancy, dropping to a plateau of around 0.84 between the 23rd and 27th GW, after which it decreased again. Conclusion Age of gestation, placental position, position of pulsed Doppler gates and branching of the UA can all change the flow pattern. The mean pulsatility index (Mean PI) showed a continuous decrease over time. There were significant differences between our data and alternative reference curves. A system of classifying Doppler studies and a reference curve adapted to the current technology are urgently required to differentiate better between physiological and pathological findings. PMID:28579623

Academic achievement of twins and singletons in early adulthood: Taiwanese cohort study.

PubMed

Tsou, Meng-Ting; Tsou, Meng-Wen; Wu, Ming-Ping; Liu, Jin-Tan

2008-07-21

To examine the long term effects of low birth weight on academic achievements in twins and singletons and to determine whether the academic achievement of twins in early adulthood is inferior to that of singletons. Cohort study. Taiwanese nationwide register of academic outcome. A cohort of 218 972 singletons and 1687 twins born in Taiwan, 1983-5. College attendance and test scores in the college joint entrance examinations. After adjustment for birth weight, gestational age, birth order, and sex and the sociodemographic characteristics of the parents, twins were found to have significantly lower mean test scores than singletons in Chinese, mathematics, and natural science, as well as a 2.2% lower probability of attending college. Low birthweight twins had an 8.5% lower probability of college attendance than normal weight twins, while low birthweight singletons had only a 3.2% lower probability. The negative effects of low birth weight on the test scores in English and mathematics were substantially greater for twins than for singletons. The twin pair analysis showed that the association between birth weight and academic achievement scores, which existed for opposite sex twin pairs, was not discernible for same sex twin pairs, indicating that birth weight might partly reflect other underlying genetic variations. These data support the proposition that twins perform less well academically than singletons. Low birth weight has a negative association with subsequent academic achievement in early adulthood, with the effect being stronger for twins than for singletons. The association between birth weight and academic performance might be partly attributable to genetic factors.

Cesarean Section Rate in Singleton Primiparae and Related Factors in Beijing, China.

PubMed

Song, Geng; Wei, Yu-Mei; Zhu, Wei-Wei; Yang, Hui-Xia

2017-10-20

The cesarean section rate (CSR) has been a main concern worldwide. The present study aimed to investigate the CSR in Beijing, China, and to analyze the related factors of CS delivery. An observational study was conducted in 15 medical centers in Beijing using a systemic cluster sampling method. In total, 15,194 pregnancies were enrolled in the study between June 20, 2013 and November 30, 2013. Independent t-tests and Pearson's Chi-square test were used to examine differences between two groups, and related factors of the CSR were examined by multivariable logistic regression. The CSR was 41.9% (4471/10,671) in singleton primiparae. Women who were more than 35 years old had a 7.4-fold increased risk of CS delivery compared with women <25 years old (odd ratio [OR] = 7.388, 95% confidence interval [CI] = 5.561-9.816, P < 0.001). Prepregnancy obese women had a 2-fold increased risk of CS delivery compared with prepregnancy normal weight women (OR = 2.058, 95% CI = 1.640-2.584, P < 0.001). The excessive weight gain group had a 1.4-fold increased risk of CS delivery compared with the adequate weight gain group (OR = 1.422, 95% CI = 1.289-1.568, P < 0.001). Gestational diabetes mellitus (GDM) women and DM women had an increased risk of CS delivery (1.2- and 1.7-fold, respectively) compared with normal blood glucose women. Women who were born in rural areas had a lower risk of CS delivery than did those who were born in urban areas (OR = 0.696, 95% CI = 0.625-0.775, P < 0.001). The risk of CS delivery gradually increased with a decreasing education level. Neonates weighing 3000-3499 g had the lowest CSR (36.2%). Neonates weighing <2500 g had a 2-fold increased risk of CS delivery compared with neonates weighing 3000-3499 g (OR = 2.020, 95% CI = 1.537-2.656, P < 0.001). Neonates weighing ≥4500 g had an 8.3-fold increased risk of CS delivery compared with neonates weighing 3000-3499 g (OR = 8.313, 95% CI = 4.436-15.579, P < 0.001). Maternal age, prepregnancy body mass index, gestational weight gain, blood glucose levels, residence, education level, and singleton fetal birth weight are all factors that might significantly affect the CSR.

Autism Spectrum Disorder Risk in Relation to Maternal Mid-Pregnancy Serum Hormone and Protein Markers from Prenatal Screening in California

ERIC Educational Resources Information Center

Windham, Gayle C.; Lyall, Kristen; Anderson, Meredith; Kharrazi, Martin

2016-01-01

We examined prenatal screening markers and offspring autism spectrum disorder (ASD) using California statewide data on singleton births in 1996 and 2002. Second trimester levels of unconjugated estriol (uE3), human chorionic gonadotropin (hCG), and maternal serum alpha-fetoprotein (MSAFP) were compared between mothers of children with ASD…

Anemia--prevalence and risk factors in pregnancy.

PubMed

Bencaiova, Gabriela; Burkhardt, Tilo; Breymann, Christian

2012-09-01

To assess the prevalence of decreased iron stores and anemia in pregnant women. To determine whether the risk factors: socio-demographic background, age, BMI, and parity are associated with abnormal hemoglobin concentrations and/or abnormal iron status. A longitudinal study was carried out at the Department of Obstetrics, University Hospital of Zurich to establish the risk factors and prevalence of the decreased iron stores and anemia in early pregnancy. In order to determine the hematological parameters and ferritin levels, venous blood samples of 470 singleton pregnancies between 16 and 20 pregnancy weeks were collected. According to hemoglobin and iron status, the patients were divided into four groups: patients with iron deficiency anemia, patients with decreased iron stores, patients with anemia for other reasons and normal patients. The determinants socio-demographic background, age, BMI and parity were explored using multiple logistic regression analysis. The prevalence of decreased iron stores (ferritin<20 μg/l) was observed in 31.8% of subjects (149/470) and anemia (Hb<110 g/l) in 18.5% (87/470). The prevalence of iron deficiency anemia was higher among women coming from former Yugoslavia and developing countries (p=0.004 and p=0.012). In patients coming from developing countries, a significant increase of anemia for other reasons was observed (p=0.027) and in patients older than 30 years, a significant increase of decreased iron stores (p=0.018). In our study population with low parity, the prevalence of abnormal hemoglobin and abnormal iron status was 50.2% (236/470), and socio-demographic background was the most important risk factor of anemia. Copyright © 2012 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

Sildenafil Citrate Therapy for Oligohydramnios: A Randomized Controlled Trial.

PubMed

Maher, Mohammad Ahmed; Sayyed, Tarek Mohammad; Elkhouly, Nabih

2017-04-01

To compare sildenafil plus hydration with hydration alone in improving the amniotic fluid index and neonatal outcomes in pregnancies complicated by idiopathic oligohydramnios ( amniotic fluid index less than 5 cm without underlying maternal or fetal causes and with normal fetal growth). This was an open-label randomized trial for women carrying singleton pregnancies at 30 weeks of gestation or more with idiopathic oligohydramnios detected during routine ultrasonogram. Women received either oral sildenafil citrate (25 mg every 8 hours) plus intravenous infusion of 2 L isotonic solution or fluids only until delivery. The primary study outcome was the amniotic fluid volume at 6 weeks of follow-up or the final volume before delivery, whichever occurred first. Secondary outcomes were duration of pregnancy prolongation, mode of delivery, and select neonatal outcomes. The study was powered to detect a 45% difference between groups, so, at an α level of 0.05 and 80% power, a sample size of 167 women was required. From February 24, 2015, through April 2016, 196 women were screened and 184 were randomized. Follow-up was completed in 166 (90%): 82 in the sildenafil group and 84 in the hydration group. Baseline characteristics were similar between groups. The amniotic fluid volume was higher in the sildenafil group at the final assessment (11.5 compared with 5.4 cm, P=.02). The sildenafil group delivered later (38.3 compared with 36.0 weeks of gestation, P=.001), had a lower rate of cesarean delivery (28% compared with 73%), and their neonates were less likely to be admitted to the neonatal intensive care unit (11% compared with 41%, P=.001). Sildenafil citrate increases amniotic fluid volume in pregnancies complicated by oligohydramnios. ClinicalTrials.gov, www.clinicaltrials.gov, NCT02372487.

Fetal gender effects on induction of labor in postdate pregnancies.

PubMed

Torricelli, Michela; Voltolini, Chiara; Vellucci, Francesca L; Conti, Nathalie; Bocchi, Caterina; Severi, Filiberto M; Challis, John R; Smith, Roger; Petraglia, Felice

2013-06-01

To determine delivery outcome in women undergoing induction of labor for postdate pregnancy in relation to fetal gender. A total of 365 nulliparous and 127 multiparous women carrying singleton postdate pregnancies with unfavorable cervix were enrolled. Clinical characteristics and delivery outcome were analyzed in relation to fetal gender. Women carrying male fetuses showed higher rate of caesarean section than those carrying females, in both nulliparous and multiparous women. Moreover, women carrying male fetuses presented more frequently with (i) interval between induction of labor and delivery >24 hours (P < .0002); (ii) augmentation of labor after cervical ripening (P < .0391); (iii) meconium-stained liquor (P< .0126); and (iv) higher neonatal weight (P < .0011) than those carrying females. Male fetuses are more likely to be associated with higher rates of cesarean section. In maternal fetal medicine, gender differences may add prognostic information on the delivery outcome in women induced for postdate pregnancy.

Impact of the 2008 Beijing Olympics on the Risk of Pregnancy Complications

PubMed Central

Assibey-Mensah, Vanessa; Liu, Kaibo; Thurston, Sally W.; Stevens, Timothy P.; Zhang, Junfeng; Zhang, Jinliang; Kane, Cathleen; Pan, Ying; Weinberger, Barry; Ohman-Strickland, Pamela; Woodruff, Tracey; Rich, David Q.

2015-01-01

Taking advantage of the natural experiment of the 2008 Beijing Olympics (8/8 to 9/24), when air pollution levels decreased by 13%–60%, we assessed whether having ≥1 pregnancy month during the Olympics was associated with decreased risks of hypertensive disorders (HD) and/or fetal-placental conditions (FPC). We included singleton births to mothers with ≥1 pregnancy month in 2008 or 2009 (n=56,155). Using generalized additive models, we estimated the risk of HD and FPC associated with 1) the 2008 Olympics compared with the same dates in 2009, and 2) increased mean ambient PM10, NO2 and SO2 concentrations during each trimester. However, we found no association between HD or FPC and having any trimester during the 2008 Olympic period. This may, in part, be due to a small number of pregnancy complications in this population. PMID:26066998

Perforated peptic ulcer (PPU) in pregnancy during Ramadan fasting.

PubMed

Gali, B M; Ibrahim, A G; Chama, C M; Mshelia, H B; Abubakar, A; Takai, I U; Takie, U; Bwala, S

2011-01-01

Perforated Peptic Ulcer (PPU) is extremely rare in pregnancy. We report a case of perforated peptic ulcer in pregnancy during Ramadan fasting. The patient is a 16 years old primigravida who presented with features of peritonitis at 28weeks of gestation while fasting during Ramadan. Ultrasound scan reported a singleton live fetus at 28 weeks gestation. At laparotomy via upper midline incision; a 1 cm roundish perforation located on the duodenum anteriorly was found with about a litre of gastric juice mixed with blood and food particles in the peritoneal cavity. The perforation was close transversely with omental patch (Modified Graham's patch) and peritoneal lavage done with warm saline. She had a preterm delivery of a 1 kg baby 3 days post-operatively by a spontaneous vaginal delivery, but the baby died 3 days later. Perforated Peptic Ulcer(PPU) though rare in pregnancy can occur and fasting can be a risk factor.

Development of a prognostic model for predicting spontaneous singleton preterm birth.

PubMed

Schaaf, Jelle M; Ravelli, Anita C J; Mol, Ben Willem J; Abu-Hanna, Ameen

2012-10-01

To develop and validate a prognostic model for prediction of spontaneous preterm birth. Prospective cohort study using data of the nationwide perinatal registry in The Netherlands. We studied 1,524,058 singleton pregnancies between 1999 and 2007. We developed a multiple logistic regression model to estimate the risk of spontaneous preterm birth based on maternal and pregnancy characteristics. We used bootstrapping techniques to internally validate our model. Discrimination (AUC), accuracy (Brier score) and calibration (calibration graphs and Hosmer-Lemeshow C-statistic) were used to assess the model's predictive performance. Our primary outcome measure was spontaneous preterm birth at <37 completed weeks. Spontaneous preterm birth occurred in 57,796 (3.8%) pregnancies. The final model included 13 variables for predicting preterm birth. The predicted probabilities ranged from 0.01 to 0.71 (IQR 0.02-0.04). The model had an area under the receiver operator characteristic curve (AUC) of 0.63 (95% CI 0.63-0.63), the Brier score was 0.04 (95% CI 0.04-0.04) and the Hosmer Lemeshow C-statistic was significant (p<0.0001). The calibration graph showed overprediction at higher values of predicted probability. The positive predictive value was 26% (95% CI 20-33%) for the 0.4 probability cut-off point. The model's discrimination was fair and it had modest calibration. Previous preterm birth, drug abuse and vaginal bleeding in the first half of pregnancy were the most important predictors for spontaneous preterm birth. Although not applicable in clinical practice yet, this model is a next step towards early prediction of spontaneous preterm birth that enables caregivers to start preventive therapy in women at higher risk. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Predictive factors of gestational diabetes in pregnancies following assisted reproductive technology: a nested case-control study.

PubMed

Kouhkan, Azam; Khamseh, Mohammad E; Moini, Ashraf; Pirjani, Reihaneh; Valojerdi, Ameneh Ebrahim; Arabipoor, Arezoo; Hosseini, Roya; Baradaran, Hamid Reza

2018-05-05

To evaluate predictive factors for gestational diabetes mellitus (GDM) in singleton pregnancy following assisted reproductive technology (ART). This nested case-control study was performed during October 2016-June 2017. Pregnant women who conceived following ART procedures referred to infertility clinic were selected and categorized into GDM and non-GDM based on ADA/IAPDSG criteria. The study variables including age, educational status, first-degree family history of chronic diseases, systolic and diastolic blood pressure, previous obstetric and perinatal outcomes, infertility history, and ART cycle characteristics were collected from medical records. Prediction model to develop GDM was employed by binary logistic regression analysis after adjustment for age and body mass index, family history of diabetes, and gravidity. In total, 270 women with singleton pregnancies (consisted of 135 GDM and 135 non-GDM women) conceived were studied. According to the final model, significant predictors of GDM were history of polycystic ovarian syndrome (PCOS), previous ovarian hyper-stimulation syndrome (OHSS) risk and progesterone injections. Administration of injectable progesterone during the first 10-12 weeks of pregnancy was associated with an approximately twofold increased risk of developing GDM [odds ratio (OR) 2.28, 95% confidence interval (CI) 1.27-4.09)] compared to vaginal progesterone. In addition, the regression analysis revealed that previous OHSS risk (OR 2.40, 95% CI 1.34-4.31) and history of PCOS (OR 2.76, 95% CI 1.26-6.06) were other most important predictors of GDM. The route of progesterone administration, previous OHSS risk and history of PCOS seem to be putative risk factors for GDM in women conceived by ART.

Divergent biparietal diameter growth rates in twin pregnancies.

PubMed

Houlton, M C

1977-05-01

Twenty-eight twin pregnancies were monitored by serial ultrasonic cephalometry from 30 or 31 weeks' gestation. The rates of growth of the individual twins as determined by biparietal diameters were similar in 11 cases (39%) and divergent in 17 (61%). When the rates of growth were divergent, the lesser rate was always below the mean for singleton pregnancies, and the incidence of small-for-gestational-age babies was 18 of 34 (53%). It was apparent that the greater the difference in biparietal diameters within the 2 weeks preceding delivery, the higher the risk of a small-for-gestation-age baby being delivered. No comment could be made on the growth rate prior to 28 weeks except that at diagnosis there was little or no difference in biparietal diameters.

Association of pre-pregnancy body mass index, gestational weight gain with cesarean section in term deliveries of China

PubMed Central

Xiong, Chao; Zhou, Aifen; Cao, Zhongqiang; Zhang, Yaqi; Qiu, Lin; Yao, Cong; Wang, Youjie; Zhang, Bin

2016-01-01

China has one of the highest rates of cesarean sections in the world. However, limited epidemiological studies have evaluated the risk factors for cesarean section among Chinese women. Thus, the aim of this cohort study was to investigate the associations between pre-pregnancy BMI, gestational weight gain (GWG) and the risk of cesarean section in China. A total of 57,891 women with singleton, live-born, term pregnancies were included in this analysis. We found that women who were overweight or obese before pregnancy had an elevated risk of cesarean section. Women with a total GWG above the Institute of Medicine (IOM) recommendations had an adjusted OR for cesarean section of 1.45 (95% CI, 1.40–1.51) compared with women who had GWG within the IOM recommendations. Women with excessive BMI gain during pregnancy also had an increased risk of cesarean section. When stratified by maternal pre-pregnancy BMI, there was a significant association between excessive GWG and increased odds of cesarean section across all pre-pregnancy BMI categories. These results suggest that weight control efforts before and during pregnancy may help to reduce the rate of cesarean sections. PMID:27872480

Association of pre-pregnancy body mass index, gestational weight gain with cesarean section in term deliveries of China.

PubMed

Xiong, Chao; Zhou, Aifen; Cao, Zhongqiang; Zhang, Yaqi; Qiu, Lin; Yao, Cong; Wang, Youjie; Zhang, Bin

2016-11-22

China has one of the highest rates of cesarean sections in the world. However, limited epidemiological studies have evaluated the risk factors for cesarean section among Chinese women. Thus, the aim of this cohort study was to investigate the associations between pre-pregnancy BMI, gestational weight gain (GWG) and the risk of cesarean section in China. A total of 57,891 women with singleton, live-born, term pregnancies were included in this analysis. We found that women who were overweight or obese before pregnancy had an elevated risk of cesarean section. Women with a total GWG above the Institute of Medicine (IOM) recommendations had an adjusted OR for cesarean section of 1.45 (95% CI, 1.40-1.51) compared with women who had GWG within the IOM recommendations. Women with excessive BMI gain during pregnancy also had an increased risk of cesarean section. When stratified by maternal pre-pregnancy BMI, there was a significant association between excessive GWG and increased odds of cesarean section across all pre-pregnancy BMI categories. These results suggest that weight control efforts before and during pregnancy may help to reduce the rate of cesarean sections.

Stable fetal hemodynamics measured by Doppler flow after initiation of anti-hypertensive treatment with methyldopa in pregnant women with diabetes.

PubMed

Pedersen, Berit Woetmann; Ringholm, Lene; Damm, Peter; Tabor, Ann; Søgaard, Kirsten; Hellmuth, Ellinor; Mathiesen, Elisabeth R

2016-01-01

To evaluate whether initiation of anti-hypertensive treatment with methyldopa affects fetal hemodynamics in women with pregestational diabetes. Prospective study of unselected singleton pregnant women with diabetes (seven type 1 and two type 2 diabetes), normal blood pressure and kidney function at pregnancy booking. Methyldopa treatment was initiated at blood pressure >135/85 mmHg and/or urinary albumin excretion (UAE) >300 mg/g creatinine. Pulsatility indices (PI) of the uterine, umbilical, middle cerebral arteries before and 1 week after initiation of methyldopa treatment (250 mg three times daily) was performed and the cerebro-placental ratio (CPR) was calculated. Methyldopa treatment was initiated at median 249 (range 192-260) gestational days, mainly due to gestational hypertension (n = 7). Blood pressure declined from 142 (112-156)/92 (76-103) mmHg before to 129 (108-144)/82 (75-90) mmHg after initiation of methyldopa treatment (p = 0.11 and 0.04 for systolic and diastolic blood pressure, respectively). There were no significant changes in the umbilical artery PI (0.82 (0.72-1.40) versus 0.87 (0.64-0.95), p = 0.62) or CPR (1.94 (0.96-2.33) versus 1.78 (1.44-2.76), (p = 0.73). Gestational age was 265 (240-270) d. Apgar scores were normal. Stable Doppler flow velocity waveforms were documented after initiation of methyldopa treatment for pregnancy-induced hypertensive disorders in this cohort of pregnant women with pregestational diabetes.

First trimester examination of fetal nasal bone in the Turkish population.

PubMed

Ozer, Alev; Ozaksit, Gulnur; Kanat-Pektas, Mine; Ozer, Serdar

2010-08-01

The present study aims to assign the reference values for nasal bone length (NBL) screened at 11-14 weeks of pregnancy in the Turkish population, determining whether the NBLs specified for Caucasians can be validated for Turkish people. The values of NBL were investigated in a total of 415 singleton fetuses that had Turkish parents and normal neonatal outcome. Sonographic measurements of NBL were done on a transabdominal midsagittal plane at 11-14 weeks' gestation. Regression analysis was used to assess the relationship between NBL and crown-rump length (CRL). Reference values, including the 5(th), 50(th) and 95(th)percentiles, were calculated for each gestational age. The mean NBL was estimated to be 2.5 mm for 11-11 + 6/7 weeks, 2.9 mm for 12-12 + 6/7 and 3.4 mm for 13-13 + 6/7 weeks' gestation. The measurements of NBL showed a significant increase with CRL so that a linear and direct correlation was found between NBL and CRL (NBL = 0.267 + 0.043 x CRL, P < 0.001). Moreover, a significant and linear relationship was detected between NBL and gestational age (NBL = -3.858 + 0.537 x gestational age, P < 0.001). The measurement of NBL is found to be achievable in the majority of first trimester pregnancies. The reference range of NBL in normal Turkish fetuses is established so that basic data can be recorded for further studies related to NBL measurements in screening for various chromosomal abnormalities including Down syndrome within Turkish population.

Influence of gravidity and foetal gender on the value of screening variables in the first trimester of pregnancy.

PubMed

Illescas, Tamara; Fernández, Cristina; Ortega, Dolores; de la Puente, Miriam; Coronado, Pluvio; Montalvo, Joaquín

2013-03-01

Combined screening for chromosome abnormalities in the first trimester of pregnancy is based on maternal age, nuchal translucency (NT) and biochemical markers (PAPP-A and free β-hCG). We sought to assess the value of the variables used in the combined screening strategy taking into account maternal gravidity and foetal gender. Between July 1999 and December 2009, a total of 21,193 singleton pregnancies were screened for aneuploidy in the first trimester, in the Hospital Clínico San Carlos (Madrid, Spain). In the original database foetal gender data were available in 4370 euploid cases, and there were 2343 women with at least two consecutive pregnancies. We conducted a retrospective assessment of ultrasound and biochemical markers taking into account foetal gender and maternal gravidity, and evaluated the effect on the performance of screening, in terms of detection rates and false positive rates. Information on pregnancy outcome was obtained from the hospital's intranet medical records or by contacting the patient by telephone postpartum. Karyotype was ascertained by amniocentesis or chorionic villus sampling, and euploid status was assumed in newborns with normal phenotype. Student's t-tests (paired or unpaired as appropriate) were applied to the data, and the Bland-Altmann method was applied in evaluating individual differences in markers between successive gestations. PAPP-A decreased significantly between the first and the second pregnancy (p<0.01). PAPP-A and free β-hCG values were significantly higher (p=0.04 and p<0.01 respectively) and NT was lower (p=0.02) in pregnancies with a female foetus. Correlations between the biochemical variables in relation to gravidity and foetal gender can introduce a bias in the calculated risk of chromosome abnormalities. Differences in NT measurements with respect to foetal gender do not seem to be of clinical importance. NT is independent of gravidity so routine use of NT compensates for the influence of these maternal-foetal variables on the values of biochemical parameters. Hence, the bias in overall combined screening is small. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

The influence of parity and gravidity on first trimester markers of chromosomal abnormality.

PubMed

Spencer, K; Ong, C Y; Liao, A W; Nicolaides, K H

2000-10-01

We have studied changes in first trimester fetal nuchal translucency (NT) and maternal serum free beta-hCG and PAPP-A with gravidity and parity in 3252 singleton pregnancies unaffected by chromosomal abnormality or major pregnancy complications. We have shown that gravidity and parity is associated with a small but progressive decrease in fetal NT and a small but progressive increase in free beta-hCG and PAPP-A. None of these small changes with increasing gravidity or parity are statistically significant and hence correction for these variables is not necessary when considering first trimester screening for chromosomal abnormalities. Copyright 2000 John Wiley & Sons, Ltd.

Obstetric and Anesthetic Approaches to External Cephalic Version.

PubMed

Lim, Stephanie; Lucero, Jennifer

2017-03-01

Breech presentation is the most common abnormal fetal presentation and complicates approximately 3% to 4% of all pregnancies. External cephalic version (ECV) should be recommended to women with a breech singleton pregnancy, if there is no maternal or fetal contraindication. ECV increases the chance of cephalic presentation at the onset of labor and decreases the rate of cesarean delivery by almost 40%. The success rate of ECV is approximately 60%. Review of the risks and benefits for performing an ECV and for both the timing of ECV and the number of attempts should be should be discussed with the patient. Copyright © 2016 Elsevier Inc. All rights reserved.

Association of low-protein supplemented diets with fetal growth in pregnant women with CKD.

PubMed

Piccoli, Giorgina B; Leone, Filomena; Attini, Rossella; Parisi, Silvia; Fassio, Federica; Deagostini, Maria Chiara; Ferraresi, Martina; Clari, Roberta; Ghiotto, Sara; Biolcati, Marilisa; Giuffrida, Domenica; Rolfo, Alessandro; Todros, Tullia

2014-05-01

Women affected by CKD increasingly choose to get pregnant. Experience with low-protein diets is limited. The aim of this study was to review results obtained from pregnant women with CKD on supplemented vegan-vegetarian low-protein diets. This was a single-arm, open intervention study between 2000-2012 of a low-protein diet in pregnant patients with stages 3-5 CKD or severe proteinuria (>1 g/d in the first trimester or nephrotic at any time). Stages 3-5 CKD patients who were not on low-protein diets for clinical, psychologic, or logistic reasons served as controls. The setting was the Obstetrics-Nephrology Unit dedicated to kidney diseases in pregnancy. The treated group included 24 pregnancies--21 singleton deliveries, 1 twin pregnancy, 1 abortion, and 1 miscarriage. Additionally, there were 21 controls (16 singleton deliveries, 5 miscarriages). The diet was a vegan-vegetarian low-protein diet (0.6-0.8 g/kg per day) with keto-acid supplementation and 1-3 protein-unrestricted meals allowed per week. Treated patients and controls were comparable at baseline for median age (35 versus 34 years), referral week (7 versus 8), eGFR (59 versus 54 ml/min), and hypertension (43.5% versus 33.3%); median proteinuria was higher in patients on the low-protein diet (1.96 [0.1-6.3] versus 0.3 [0.1-2.0] g/d; P<0.001). No significant differences were observed in singletons with regard to gestational week (34 versus 36) or Caesarean sections (76.2% versus 50%). Kidney function at delivery was not different, but proteinuria was higher in the diet group. Incidence of small for gestational age babies was significantly lower in the diet group (3/21) versus controls (7/16; chi-squared test; P=0.05). Throughout follow-up (6 months to 10 years), hospitalization rates and prevalence of children below the third percentile were similar in both groups. Vegan-vegetarian supplemented low-protein diets in pregnant women with stages 3-5 CKD may reduce the likelihood of small for gestational age babies without detrimental effects on kidney function or proteinuria in the mother.

Endoglin in pregnancy complicated by fetal intrauterine growth restriction in normotensive and preeclamptic pregnant women: a comparison between preeclamptic patients with appropriate-for-gestational-age weight infants and healthy pregnant women.

PubMed

Laskowska, Marzena; Laskowska, Katarzyna; Oleszczuk, Jan

2012-06-01

The aim of this study was to determine the maternal serum endoglin concentration in pregnancies with intrauterine growth restriction (IUGR) in the presence or absence of preeclampsia and to compare the results with preeclamptic pregnant women with appropriate-for-gestational-age weight infants and with healthy pregnant controls. The study was performed on 52 normotensive pregnant patients with pregnancy complicated by isolated IUGR, 33 patients with preeclampsia complicated by IUGR and 33 preeclamptic patients with appropriate-for-gestational-age weight infants. The control group consisted of 54 healthy normotensive pregnant patients with singleton uncomplicated pregnancies. The maternal serum endoglin concentrations were determined using a sandwich enzyme-linked immunosorbent assay assay. Our study revealed increased levels of endoglin in the serum of women with normotensive pregnancy complicated by isolated IUGR, and in both groups of preeclamptic patients with and without IUGR. The levels of endoglin were the highest in pregnancy complicated by fetal intrauterine growth restriction (IUGR) in the course of preeclampsia. The mean values were 12.2 ± 4.3 ng/ml in the IUGR group, 14.1 ± 3.6 ng/ml in preeclamptic patients with normal intrauterine fetal growth, 15.1 ± 3.2 ng/ml in preeclamptic pregnant women with IUGR and 10.6 ± 3.7 ng/ml in the healthy controls. We also found positive correlations between serum endoglin levels and systolic and diastolic blood pressure and inverse correlations between maternal endoglin and infant birth weight. Our results suggest that increased endoglin concentration may be at least responsible for the pathogenesis of preeclampsia and/or intrauterine fetal growth restriction. It seems that the pathomechanism underlying the development of preeclampsia and isolated IUGR is similar, but that their beginning or intensity may be different in these two pregnancy complications. The positive correlation between endoglin and blood pressure and inverse correlation between endoglin and infant birth weight and additionally higher levels of ENG in patients with pregnancy complicated by HELLP syndrome (hemolysis, increased liver enzymes, low platelet count) or eclampsia suggest that endoglin may be a marker of severity of these pregnancy disorders.

The Effects of Fetal Gender on Serum Human Chorionic Gonadotropin and Testosterone in Normotensive and Preeclamptic Pregnancies

PubMed Central

Lorzadeh, Nahid; Kazemirad, Sirous

2012-01-01

Introduction. The aim of the present study was to evaluate the effects of fetal sex on serum human chorionic gonadotropin (hCG) and testosterone in normotensive and preeclamptic pregnancies. Materials and Methods. This is a cross-sectional study and 139 women with singleton pregnancies in the third trimester were studied. Seventy-one pregnancies were uncomplicated; among those were 35 male and 36 female fetuses. Sixty-eight pregnancies were complicated by preeclampsia; among those were 35 male and 33 female fetuses. Human chorionic gonadotropin and total testosterone were measured in maternal peripheral blood. Data analyzed by SPSS software. Results. In male-bearing pregnancies, maternal hCG and testosterone serum levels were significantly higher in preeclamptic than normotensive mothers (P < 0.001 and P < 0.001, resp.) in female-bearing pregnancies testosterone levels were significantly higher in preeclamptic than normotensive mothers (P < 0.001). Total testosterone levels were significantly higher in pregnancies with either gender and significantly higher in mlae-bearing than in female-bearing pregnancies. Conclusion. According to our results, there is a correlation between maternal serum hCG and testosterone levels and preeclampsia. Therefore these tests can be used as routine during 30–38 weeks of gestation. High maternal serum concentrations of these markers can predict preeclampsia. PMID:22518314

The influence of IVF/ICSI treatment on human embryonic growth trajectories.

PubMed

Eindhoven, S C; van Uitert, E M; Laven, J S E; Willemsen, S P; Koning, A H J; Eilers, P H C; Exalto, N; Steegers, E A P; Steegers-Theunissen, R P M

2014-12-01

Is in vitro fertilization treatment with or without intracytoplasmatic sperm injection (IVF/ICSI) associated with changes in first and second trimester embryonic and fetal growth trajectories and birthweight in singleton pregnancies? Embryonic and fetal growth trajectories and birthweight are not significantly different between pregnancies conceived with IVF/ICSI treatment and spontaneously conceived pregnancies with reliable pregnancy dating. IVF/ICSI treatment has been associated with increased risks of preterm birth, fetal growth restriction and low birthweight. Decreased first-trimester crown-rump length (CRL) in the general population has been inversely associated with the same adverse pregnancy outcomes. In a prospective periconception birth cohort study conducted in a tertiary centre, 146 singleton pregnancies with reliable pregnancy dating and nonmalformed live borns were investigated, comprised of 88 spontaneous and 58 IVF/ICSI pregnancies. Serial 3D ultrasound scans were performed from 6 to 12 weeks of gestation. As estimates of embryonic growth, CRL and embryonic volume (EV) were measured using the I-Space virtual reality system. General characteristics were obtained from self-administered questionnaires at enrolment. Fetal growth parameters at 20 weeks and birthweight were obtained from medical records. To assess associations between IVF/ICSI and embryonic growth trajectories, estimated fetal weight and birthweight, stepwise linear mixed model analyses and linear regression analyses were performed using square root transformed CRL and fourth root transformed EV. In 146 pregnancies, 934 ultrasound scans were performed of which 849 (90.9%) CRLs and 549 (58.8%) EVs could be measured. Embryonic growth trajectories were comparable between IVF/ICSI pregnancies and spontaneously conceived pregnancies (CRL: βIVF/ICSI = 0.10√mm; P = 0.10; EV: βIVF/ICSI = 0.03(4)√cm³; P = 0.13). Estimated fetal weight and birthweight were also comparable between both groups (βIVF/ICSI = 6 g; P = 0.36 and βIVF/ICSI = 80 g; P = 0.24, respectively). Variations in embryonic growth trajectories of spontaneously conceived pregnancies with reliable pregnancy dating may partially be a result of less precise pregnancy dating and differences in endometrium receptivity compared with IVF/ICSI pregnancies. The absence of a significant difference in embryonic and fetal growth trajectories suggests safety of IVF/ICSI treatment with regard to early embryonic growth. However, further research is warranted to ascertain the influence of IVF/ICSI treatments in a larger study population, and to estimate the impact of the underlying causes of the subfertility and other periconceptional exposures on human embryonic and fetal growth trajectories. This study was supported by the Department of Obstetrics and Gynaecology of the Erasmus MC, University Medical Centre. No competing interests are declared. © The Author 2014. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Analysis of hospital cost outcome of DHA-rich fish-oil supplementation in pregnancy: Evidence from a randomized controlled trial.

PubMed

Ahmed, Sharmina; Makrides, Maria; Sim, Nicholas; McPhee, Andy; Quinlivan, Julie; Gibson, Robert; Umberger, Wendy

2015-12-01

Recent research emphasized the nutritional benefits of omega-3 long chain polyunsaturated fatty acids (LCPUFAs) during pregnancy. Based on a double-blind randomised controlled trial named "DHA to Optimize Mother and Infant Outcome" (DOMInO), we examined how omega 3 DHA supplementation during pregnancy may affect pregnancy related in-patient hospital costs. We conducted an econometric analysis based on ordinary least square and quantile regressions with bootstrapped standard errors. Using these approaches, we also examined whether smoking, drinking, maternal age and BMI could influence the effect of DHA supplementation during pregnancy on hospital costs. Our regressions showed that in-patient hospital costs could decrease by AUD92 (P<0.05) on average per singleton pregnancy when DHA supplements were consumed during pregnancy. Our regression results also showed that the cost savings to the Australian public hospital system could be between AUD15 - AUD51 million / year. Given that a simple intervention like DHA-rich fish-oil supplementation could generate savings to the public, it may be worthwhile from a policy perspective to encourage DHA supplementation among pregnant women. Copyright © 2015 Elsevier Ltd. All rights reserved.

Gestational age estimates from singleton births conceived using assisted reproductive technology.

PubMed

Callaghan, William M; Schieve, Laura A; Dietz, Patricia M

2007-09-01

Information on gestational age for public health research and surveillance in the US is usually obtained from vital records and is primarily based on the first day of the woman's last menstrual period (LMP). However, using LMP as a marker of conception is subject to a variety of errors and results in misclassification of gestational age. Pregnancies conceived through assisted reproductive technology (ART) are unique in that the estimates of gestational age are not based on the LMP, but on the date when fertilisation actually occurred, and thus most gestational age errors are likely to be due to errors introduced in recording and data entry. The purpose of this paper was to examine the birthweight distribution by gestational age for ART singleton livebirths reported to a national ART surveillance system. Gestational age was categorised as 20-27, 28-31, 32-36 and 37-44 weeks; birthweight distributions were plotted for each category. The distributions of very-low-birthweight (VLBW; <1500 g), moderately low-birthweight (1500-2499 g) and normal-birthweight infants for each gestational week were examined. At both 20-27 and 28-31 weeks, there was an extended right tail to the distribution and a small second mode. At 32-36 weeks, there were long tails in either direction and at 37-44 weeks, an extended tail to the left. There was a high proportion of VLBW infants at low gestational ages and a decreasing proportion of VLBW infants with increasing gestational age. However, there was also a fairly constant proportion of normal-birthweight infants at every gestational age below 34 weeks, which suggested misclassification of gestational age. Approximately 12% of ART births classified as 28-31 weeks' gestation had a birthweight in the second mode of the birthweight distribution compared with approximately 29% in national vital statistics data. Even when the birthweight and dates of conception and birth are known, questions remain regarding the residual amount of misclassification and the true nature of the birthweight distributions.

Adequacy of Prenatal Care and Gestational Weight Gain

PubMed Central

Crandell, Jamie L.; Jones-Vessey, Kathleen

2016-01-01

Abstract Background: The goal of prenatal care is to maximize health outcomes for a woman and her fetus. We examined how prenatal care is associated with meeting the 2009 Institute of Medicine (IOM) guidelines for gestational weight gain. Sample: The study used deidentified birth certificate data supplied by the North Carolina State Center for Health Statistics. The sample included 197,354 women (≥18 years) who delivered singleton full-term infants in 2011 and 2012. Methods: A generalized multinomial model was used to identify how adequate prenatal care was associated with the odds of gaining excessive or insufficient weight during pregnancy according to the 2009 IOM guidelines. The model adjusted for prepregnancy body size, sociodemographic factors, and birth weight. Results: A total of 197,354 women (≥18 years) delivered singleton full-term infants. The odds ratio (OR) for excessive weight gain was 2.44 (95% CI 2.37–2.50) in overweight and 2.33 (95% CI 2.27–2.40) in obese women compared with normal weight women. The OR for insufficient weight gain was 1.15 (95% CI 1.09–1.22) for underweight and 1.34 (95% CI 1.30–1.39) for obese women compared with normal weight women. Prenatal care at the inadequate or intermediate levels was associated with insufficient weight gain (OR: 1.32, 95% CI 1.27–1.38; OR: 1.15, 95% CI 1.09–1.21, respectively) compared with adequate prenatal care. Women with inadequate care were less likely to gain excessive weight (OR: 0.88, 95% CI 0.86–0.91). Conclusions: Whereas prenatal care was effective for preventing insufficient weight gain regardless of prepregnancy body size, educational background, and racial/ethnic group, there were no indications that adequate prenatal care was associated with reduced risk for excessive gestational weight gain. Further research is needed to improve prenatal care programs for preventing excess weight gain. PMID:26741198

Birthweight distribution in ART singletons resulting from embryo culture in two different culture media compared with the national population.

PubMed

Lemmen, J G; Pinborg, A; Rasmussen, S; Ziebe, S

2014-10-10

Is there a difference in birthweight distribution in ART singletons born after IVF culture in two different culture media? There is no effect of culture media on both crude and adjusted birthweight distributions in ART singletons from nulliparous mothers. Studies on human ART singletons have reported a difference in birthweight in singletons following IVF culture in different culture media. However, other studies comparing different culture media have not shown any significant differences in birthweight. This study was a retrospective comparison of birthweights in IVF/ICSI singletons conceived after fresh embryo transfer following embryo culture in Cook or Medicult medium and in a national cohort of naturally conceived singletons in nulliparous women. The study compares four independent groups consisting of singletons in nulliparous women from Cook-d2: 2-day culture in Cook medium at Rigshospitalet (n = 974), Medicult-d2: 2-day culture in Medicult EmbryoAssist medium at Rigshospitalet (n = 147), Medicult-d3: 3-day culture in Medicult EmbryoAssist medium with and without added GM-CSF (n = 204), and DK: pregnancies from the Danish birth registry (n = 106842). The study compares the birthweights of singletons from nulliparous women in the four independent groups mentioned above; Cook-d2: Medicult-d2: Medicult-d3: and DK. In addition, distributions of large and small for gestational age infants were compared between the groups and a multiple linear regression analysis was used to determine which factors determined birthweight. We found no significant difference in the crude birthweight distributions between singletons born after culture in Cook-d2 or Medicult-groups. Singleton girls from the Cook-d2 group weighed 3302 ± 28 g, versus 3252 ± 76 in the Medicult-d2 group (difference 50 g; P = 0.547). Singleton boys from the Cook-d2 group weighed 3430 ± 27 g, versus 3354 ± 56 in the Medicult-d2 group (difference 76 g; P = 0.279). In the background population, mean birthweights for singleton girls and boys were 3383 ± 2.4 g and 3494 ± 2.5 g, respectively. The mean birthweights of girls, 3315 ± 61 g, and boys, 3383 ± 64 g, in the Medicult-d3 group were not significantly different from that in the Medicult-d2 group. When pooling data from all culture media groups, we found the same slightly lower mean birthweight in IVF/ICSI singletons when compared with the national birth cohort as has been previously reported (Cook-d2 + Medicult-d2 + d3 versus birth cohort; girls: P < 0.001, boys: P < 0.001). We also pooled data on boys and girls and calculated the mean birthweight for the Cook-d2, Medicult-d2 and Medicult-d3 groups and found no significant differences. The retrospective design and the inherent risk of confounding factors is a limitation. Selection bias cannot be excluded as the embryos cultured in Cook-d2 and Medicult-d2 were from single centre studies while data in Medicult-D3 group were derived from a multicentre study. This large cohort of singletons born after IVF/ICSI shows no difference in crude mean birthweight after culture in two different culture media, indicating that if such a difference exists, this must be specific for certain culture media. As expected we found a slightly lower mean birthweight in ART compared with naturally conceived singletons. This suggests that parental characteristics or IVF technique related factors other than type of culture medium may influence the birthweight in ART singletons. No external funding was used for this study. No conflicts of interest are declared. © The Author 2014. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Birth weight by gestational age in twin pregnancies: analysis of 661 pairs.

PubMed

Hsieh, T T; Chen, C J; Hsu, J J

1992-02-01

The mortality of twin infants is four to five times higher than that of singletons, and one-half to two-thirds of all twins weigh < 2,500 g at birth. The appropriate interpretation of fetal growth throughout pregnancy is dependent upon the availability of adequate standards. We reviewed 661 pairs of live twin infants born at Chang Gung Memorial Hospital from 1979 to 1990. The frequency of twin births was 1.17% (1:86), and the ratio of males to females was 1.03. The frequency of preterm births (< 37 weeks) was 36.9%, the frequency of low birth weight (< 2,500 g) was 47.9% and very low birth weight (< 1,500 g) was 6.7%. A fetus grows most rapidly from the 32nd to the 35th week of gestation (200 g per week). The growth was 145 g per week from the 28th to the 32nd week and from the 35th to the 38th week of gestation. After the 38th week, the mean birth weight increased by only 35 g per week. Compared with a singleton birth, the mean birth weight of twins was about 100 g lighter during the 28th to the 32nd week, then the difference increased gradually to about 500 g at term.

Bone mineral density changes during pregnancy in actively exercising women as measured by quantitative ultrasound.

PubMed

To, William W K; Wong, Margaret W N

2012-08-01

To evaluate whether bone mineral density (BMD) changes in women engaged in active exercises during pregnancy would be different from non-exercising women. Consecutive patients with singleton pregnancies who were engaged in active exercise training during pregnancy were prospectively recruited over a period of 6 months. Quantitative USG measurements of the os calcis BMD were performed at 14-20 weeks and at 36-38 weeks. These patients were compared to a control cohort of non-exercising low-risk women. A total of 24 physically active women undergoing active physical training of over 10 h per week at 20 weeks gestation and beyond (mean 13.1 h, SD 3.3) were compared to 94 non-exercising low-risk women. A marginal fall in BMD of 0.015 g/cm(2) (SD 0.034) was demonstrable from early to late gestation in the exercising women, which was significantly lower than that of non-exercising women (0.041 g/cm(2); SD 0.042; p = 0.005). Logistic regression models confirmed that active exercises in pregnancy were significantly associated with the absence of or less BMD loss in pregnancy. In women actively engaged in physical training during pregnancy, the physiological fall in BMD during pregnancy was apparently less compared to those who did not regularly exercise.

[Uterine subrogation: medical and legal aspects of the first legally supported case in Argentina].

PubMed

Urquiza, M Fernanda; Carretero, Inés; Quaini, Fabiana Marcela; Inciarte, Florencia; Pasqualini, R Agustín; Pasqualini, R Sergio

2014-01-01

A woman aged 38 was referred to this center for surrogacy treatment, after subtotal ablation of her uterus due to a severe postpartum hemorrhage. Her hormonal profiles and ovarian structure were normal. The husband proved fertile and semen analysis was normal. The carrier, a woman 39 years old, fertile with two children of her own, and a long bonding friendship with the patient. After hormonal stimulation with gonadotropins and GnRH antagonist, six mature oocytes were obtained. These originated four embryos after in vitro fertilization, three of which were transferred to the carrier, achieving a singleton pregnancy which led to the birth of a normal child, now more than a year old. A lawsuit was filed after birth requesting the baby be registered with the biological parents name. The judge granted the request based on evidence and testimonies provided, international jurisprudence history and specification in Article 19 of the Argentine Constitution: "No inhabitant of the Nation shall be obliged to do what the law does not demand .nor be deprived of what it does not prohibit". This is an almost ideal example of the proceedings in a case of subrogation. However, we must always bear in mind the fact that in our country there is as yet no regulatory framework for these treatments, therefore there is a high probability of conflict.

Lower dietary vitamin E intake during the second trimester is associated with insulin resistance and hyperglycemia later in pregnancy.

PubMed

Ley, S H; Hanley, A J; Sermer, M; Zinman, B; O'Connor, D L

2013-11-01

Beneficial effects of vitamin E on insulin sensitivity have been reported in observational and short-term intervention studies in non-pregnant populations. We aimed to investigate whether dietary vitamin E intake during the second trimester would be associated with glucose metabolism later in pregnancy and whether this association would be influenced by an insulin-sensitizing hormone adiponectin. Women with singleton pregnancies (n=205) underwent a 3-h oral glucose tolerance test at 30 weeks gestation and were asked to recall second trimester dietary intake. Higher dietary vitamin E intake was associated with lower fasting glucose, lower HOMA insulin resistance, and higher Matsuda insulin sensitivity index after covariate adjustment including serum adiponectin among women consuming daily multivitamin supplements (all P≤0.03). Lower dietary vitamin E intake during the second trimester is associated with hyperglycemia and insulin resistance later in pregnancy among women consuming daily multivitamin supplementations. Further, these associations are not influenced by adiponectin.

Impact of the 2008 Beijing Olympics on the risk of pregnancy complications.

PubMed

Assibey-Mensah, Vanessa; Liu, Kaibo; Thurston, Sally W; Stevens, Timothy P; Zhang, Junfeng; Zhang, Jinliang; Kane, Cathleen; Pan, Ying; Weinberger, Barry; Ohman-Strickland, Pamela; Woodruff, Tracey; Rich, David Q

2016-07-03

Taking advantage of the natural experiment of the 2008 Beijing Olympics (August 8 to September 24), when air pollution levels decreased by 13% to 60%, the authors assessed whether having ≥1 pregnancy month during the Olympics was associated with decreased risks of hypertensive disorders (HDs) and/or fetal-placental conditions (FPCs). Singleton births to mothers with ≥1 pregnancy month in 2008 or 2009 (N = 56,155) were included. Using generalized additive models, the authors estimated the risk of HDs and FPCs associated with (1) the 2008 Olympics compared with the same dates in 2009, and (2) increased mean ambient PM10 (particulate matter with an aerodynamic diameter <10 μm), NO2 (nitrogen dioxide), and SO2 (sulfur dioxide) concentrations during each trimester. However, no association between HDs or FPCs and having any trimester during the 2008 Olympic period was found. This may, in part, be due to a small number of pregnancy complications in this population.

Sports and leisure time physical activity during pregnancy in nulliparous women.

PubMed

Hegaard, Hanne Kristine; Damm, Peter; Hedegaard, Morten; Henriksen, Tine Brink; Ottesen, Bent; Dykes, Anna-Karin; Kjaergaard, Hanne

2011-08-01

To describe patterns of leisure time physical activity during pregnancy in relation to pre-pregnancy leisure time physical activity, socio-demographic characteristics, fertility history, and lifestyle factors. 4,718 nulliparous with singleton pregnancy and intended spontaneous vaginal delivery were included in the study at gestational week 33 from May 2004 to July 2005. Information was provided by self-administered questionnaires. Leisure time physical activity was categorised into four categories: competitive sport, moderate-to-heavy, light or sedentary. In this population of nulliparous women, 4% participated in competitive sport, 25% in moderate-to-heavy activities, 66% in light activities, and 5% in sedentary activities in the year prior to pregnancy. Physical activity before pregnancy was statistically significantly associated with age, pre-pregnancy BMI, chronic diseases, number of years at school, and smoking habits. The proportion of women who took part in competitive sports, and moderate-to-heavy activities decreased over the three trimesters of pregnancy. The proportion of women with light physical activity was stable during pregnancy while the proportion of women with sedentary activity increased from 6% to 29%. During the third trimester women performing competitive sports or moderate-to-heavy activities before pregnancy continued to have a higher level of physical activity than women with light activities or sedentary activities before pregnancy. In general the intensity and time spent on exercise decreased during pregnancy. Women with the highest level of exercise prior to pregnancy continued to be the most active during pregnancy. Among women with sedentary activities before pregnancy one-fourth changed to light activity during pregnancy.

Maternal Uncontrolled Anxiety Disorders Are Associated With the Increased Risk of Hypertensive Disorders in Japanese Pregnant Women

PubMed Central

Suzuki, Shunji; Shinmura, Hiroki; Kato, Masahiko

2015-01-01

Background We examined the risk of hypertensive disorders in relation to maternal depressive and anxiety disorders which were diagnosed before or during early pregnancy in Japanese women. Methods We reviewed the obstetric records of all Japanese singleton deliveries at ≥ 22 weeks’ gestation managed at the Japanese Red Cross Katsushika Maternity Hospital between 2009 and 2014. Potential risk factors for hypertensive disorders with maternal depressive and anxiety disorders were selected as follows: maternal age, parity, medications, self-interruption of medications and economic problems. Results The incidence of hypertensive disorders did not increase in the pregnant women with depressive disorders compared with that in the normal control pregnant women (P = 0.96). However, the incidence of hypertensive disorders in the women with anxiety disorders was higher than that in the control women (odds ratio (OR): 2.61, 95% confidence interval (CI): 1.4 - 5.0, P < 0.01). In the women with anxiety disorders, 19% performed self-interruption of medications during pregnancy, and it was associated with the increased risk of hypertensive disorders (vs. no medication group, OR: 7.50, 95% CI: 1.5 - 38, P = 0.03; vs. medication group, OR: 16.0, 95% CI: 2.4 - 110, P < 0.01). Conclusions Maternal uncontrolled anxiety disorders due to self-interruption of medications seemed to be associated with the increased risk of hypertensive disorders in Japanese pregnant women. PMID:26346308

Early Dexamethasone Treatment Induces Placental Apoptosis in Sheep

PubMed Central

Meng, Wenbin; Shang, Hongkai; Li, Shaofu; Sloboda, Deborah M.; Ehrlich, Loreen; Lange, Karolin; Xu, Huaisheng; Henrich, Wolfgang; Dudenhausen, Joachim W.; Plagemann, Andreas; Newnham, John P.; Challis, John R. G.

2015-01-01

Glucocorticoid treatment given in late pregnancy in sheep resulted in altered placental development and function. An imbalance of placental survival and apoptotic factors resulting in an increased rate of apoptosis may be involved. We have now investigated the effects of dexamethasone (DEX) in early pregnancy on binucleate cells (BNCs), placental apoptosis, and fetal sex as a determinant of these responses. Pregnant ewes carrying singleton fetuses (n = 105) were randomized to control (n = 56, 2 mL saline/ewe) or DEX treatment (n = 49, intramuscular injections of 0.14 mg/kg ewe weight per 12 hours over 48 hours) at 40 to 41 days of gestation (dG). Placentomes were collected at 50, 100, 125, and 140 dG. At 100 dG, DEX in females reduced BNC numbers, placental antiapoptotic (proliferating cell nuclear antigen), and increased proapoptotic factors (Bax, p53), associated with a temporarily decrease in fetal growth. At 125 dG, BNC numbers and apoptotic markers were restored to normal. In males, ovine placental lactogen-protein levels after DEX were increased at 50 dG, but at 100 and 140 dG significantly decreased compared to controls. In contrast to females, these changes were independent of altered BNC numbers or apoptotic markers. Early DEX was associated with sex-specific, transient alterations in BNC numbers, which may contribute to changes in placental and fetal development. Furthermore, in females, altered placental apoptosis markers may be involved. PMID:25063551

Efficacy of first-trimester ultrasound parameters for prediction of early spontaneous abortion.

PubMed

Datta, Mamta Rath; Raut, Ankush

2017-09-01

To assess first-trimester ultrasound measurements for the prediction of early spontaneous abortion. In a prospective observational study in Jamshedpur, India, women with singleton pregnancies of 42-76 days were enrolled between November 2014 and April 2016. Inclusion criteria were spontaneous conception, embryonic cardiac activity, and regular menstrual cycle. Fetal crown-to-rump length (CRL), gestational sac diameter (GSD), yolk sac diameter (YSD), and fetal heart rate (FHR) were measured by transvaginal ultrasonography. Ultrasonography was repeated at 12 weeks and beyond to determine pregnancy continuation. Among 800 women, 140 (17.5%) experienced early spontaneous abortion. CRL, GSD, and FHR values below the 5th percentile (odds ratio [OR] 26.48, 26.94, and 100.63, respectively), and YSD above the 95th percentile (OR 1.04) were predictors of early abortion. Normal YSD did not reduce the risk of abortion if the other three parameters were below the 5th percentile (OR 34.27). For every 10-bpm decrease in FHR below 130, there was 26.7% increased risk of abortion. GSD-CRL difference of less than 5 mm was associated with a higher likelihood of abortion (OR 4.88). First-trimester ultrasound measurements are predictors of early abortion. Risk assessment tables based on combinations of abnormal measures might improve prediction rates. © 2017 International Federation of Gynecology and Obstetrics.

Determining optimal gestational weight gain in a multiethnic Asian population.

PubMed

Ee, Tat Xin; Allen, John Carson; Malhotra, Rahul; Koh, Huishan; Østbye, Truls; Tan, Thiam Chye

2014-04-01

To define the optimal gestational weight gain (GWG) for the multiethnic Singaporean population. Data from 1529 live singleton deliveries was analyzed. A multinomial logistic regression analysis, with GWG as the predictor, was conducted to determine the lowest aggregated risk of a composite perinatal outcome, stratified by Asia-specific body mass index (BMI) categories. The composite perinatal outcome, based on a combination of delivery type (cesarean section [CS], vaginal delivery [VD]) and size for gestational age (small [SGA], appropriate [AGA], large [LGA]), had six categories: (i) VD with LGA; (ii) VD with SGA; (iii) CS with AGA; (iv) CS with SGA; (v) CS with LGA; (vi) and VD with AGA. The last was considered as the 'normal' reference category. In each BMI category, the GWG value corresponding to the lowest aggregated risk was defined as the optimal GWG, and the GWG values at which the aggregated risk did not exceed a 5% increase from the lowest aggregated risk were defined as the margins of the optimal GWG range. The optimal GWG by pre-pregnancy BMI category, was 19.5 kg (range, 12.9 to 23.9) for underweight, 13.7 kg (7.7 to 18.8) for normal weight, 7.9 kg (2.6 to 14.0) for overweight and 1.8 kg (-5.0 to 7.0) for obese. The results of this study, the first to determine optimal GWG in the multiethnic Singaporean population, concur with the Institute of Medicine (IOM) guidelines in that GWG among Asian women who are heavier prior to pregnancy, especially those who are obese, should be lower. However, the optimal GWG for underweight and obese women was outside the IOM recommended range. © 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.

Meconium indicators of maternal alcohol abuse during pregnancy and association with patient characteristics.

PubMed

Goecke, Tamme W; Burger, Pascal; Fasching, Peter A; Bakdash, Abdulsallam; Engel, Anne; Häberle, Lothar; Voigt, Franziska; Faschingbauer, Florian; Raabe, Eva; Maass, Nicolai; Rothe, Michael; Beckmann, Matthias W; Pragst, Fritz; Kornhuber, Johannes

2014-01-01

Identification of women with moderate alcohol abuse during pregnancy is difficult. We correlated self-reported alcohol consumption during pregnancy and patient characteristics with objective alcohol indicators measured in fetal meconium. A total of 557 women singleton births and available psychological tests, obstetric data and meconium samples were included in statistical analysis. Alcohol metabolites (fatty acid ethyl esters (FAEEs) and ethyl glucuronide (EtG)), were determined from meconium and correlated with patient characteristics. We found that 21.2% of the 557 participants admitted low-to-moderate alcohol consumption during pregnancy. Of the parameters analyzed from meconium, only EtG showed an association with alcohol history (P < 0.01). This association was inverse in cases with EtG value above 120 ng/g. These values indicate women with most severe alcohol consumption, who obviously denied having consumed alcohol during pregnancy. No other associations between socioeconomic or psychological characteristics and the drinking status (via meconium alcohol metabolites) could be found. Women who drink higher doses of ethanol during pregnancy, according to metabolite measures in meconium, might be less likely to admit alcohol consumption. No profile of socioeconomic or psychological characteristics of those women positively tested via meconium could be established.

Perinatal outcomes in pregnancy with asthma.

PubMed

Syed, Rashid Zaheer; Zubairi, Ali Bin Sarwar; Zafar, Muhammad Ahsan; Qureshi, Rahat

2008-09-01

To examine the relationship between asthmatic pregnancies and selected maternal and neonatal outcomes in a representative cohort. A retrospective cohort study was conducted at the Aga Khan University Hospital during the year 2004. A random selection was made of 65 asthmatic and 63 non-asthmatic singleton births. The neonatal outcomes studied were birth weight, premature birth and Apgar scores at 1 and 5 minutes. The maternal outcomes studied were number of hospital admissions, and number of documented UTI during the studied pregnancy and past history of abortions and stillbirths. The mean age of asthmatics and nonasthmatics were 28.0 +/- 4.9 years and 27.7 +/- 3.6 years respectively. The average parity among asthmatic women was 2.97 while that in controls was 2.57 (p < 0.137). Neonates born to asthmatic mothers had shorter mean gestational age with increased risk of premature birth and lower Apgar scores. Asthmatic mothers had a greater risk of abortions and low birth weight babies. They also had higher rates of UTIs and hospital admissions. Asthmatic pregnancies are more likely to result in abortion, premature delivery and low birth weight babies. The asthmatic pregnancies were also linked with higher rates of maternal UTI. Thcrefore a more vigilant monitoring is required in asthmatic pregnancies.

Detection of a de novo Y278C mutation in FGFR3 in a pregnancy with severe fetal hypochondroplasia: prenatal diagnosis and literature review.

PubMed

Chen, Chih-Ping; Su, Yi-Ning; Lin, Tzu-Hung; Chang, Tung-Yao; Su, Jun-Wei; Wang, Wayseen

2013-12-01

We describe a prenatal molecular diagnosis of hypochondroplasia (HCH) in a pregnancy not at risk of HCH and review the literature on prenatal diagnosis of HCH. A 28-year-old primigravid woman was referred for genetic counseling at 30 weeks of gestation because of short-limbed dwarfism in the fetus. The woman had a body height of 152 cm. Her husband had a body height of 180 cm. Level II ultrasound showed a normal amount of amniotic fluid and a singleton fetus with fetal biometry equivalent to 30 weeks except for short limbs. Fetal biometry measurements were as follows: biparietal diameter = 7.38 cm (30 weeks); head circumference = 28.14 cm (30 weeks); abdominal circumference (AC) = 24.64 cm (30 weeks); femur length (FL) = 3.97 cm (<5th centile); FL/AC ratio = 0.161 (normal > 0.18); humerus = 3.64 cm (<5th centile); radius = 3.49 cm (30 weeks); ulna = 3.76 cm (<5(th) centile); tibia = 3.67 cm (<5th centile); and fibula = 3.72 cm (<5th centile). The digits and craniofacial appearance were normal. A tentative diagnosis of achondroplasia (ACH) was made. DNA testing for the FGFR3 gene and whole-genome array comparative genomic hybridization (aCGH) analysis were performed using cord blood DNA obtained by cordocentesis. FGFR3 mutation analysis revealed a de novo heterozygous c.833A > G, TAC > TGC transversion in exon 7 leading to a p.Tyr278Cys (Y278C) mutation in the FGFR3 protein. aCGH analysis revealed no genomic imbalance in cord blood. After delivery, the fetus had short limbs, a narrow thorax, brachydactyly, and relative macrocephaly. Cytogenetic analysis of cultured placental cells revealed a karyotype of 46,XX. Prenatal diagnosis of abnormal ultrasound findings suspicious of ACH should include a differential diagnosis of HCH by molecular analysis of FGFR3. Copyright © 2013. Published by Elsevier B.V.

Difference in birth weight of consecutive sibling singletons is not found in oocyte donation when comparing fresh versus frozen embryo replacements.

PubMed

Galliano, Daniela; Garrido, Nicolás; Serra-Serra, Vicente; Pellicer, Antonio

2015-12-01

First, to assess if there are any differences in birth weight or gestational length in newborns from egg-donation pregnancies delivering singletons, originating from either fresh or frozen-thawed embryos when they were developed and delivered within the same mothers. Second, to determine if there are any clinical, phenotypic, or laboratory factors influencing this relationship, including the origin of the oocyte (same or different donor), the order of the children (first fresh or first frozen-thawed embryo transfer), the embryo freezing technique (vitrification or slow freezing), the in vitro embryo culture length, and the duration that embryos remained frozen. Retrospective cohorts study. University-affiliated infertility centers. A total of 360 women undergoing oocyte donation (OD), delivering (>28 weeks) at least two babies, each one from a single pregnancy, originating from at least one fresh and one frozen-thawed embryo transfer, controlling maternal and laboratory characteristics, to test the effect of embryo freezing on children size (n = 731). None. Birth weight, gestational age, weight percentile, being large for gestational age (LGA), small for gestational age (SGA), size out of normal range (ONR = LGA + SGA), and macrosomy. From fresh versus thawed embryos, respectively, mean birth weight of children was 3,183.7 g versus 3,226.4 g, gestational age was 272.1 days versus 268.8 days, and mean weight percentiles were 47.6 versus 50.1. The proportions and corresponding odds ratios (ORs) from fresh versus thawed embryos, respectively, were for LGA 13.6% versus 11.3% (OR 0.81), for SGA 9.4% versus 12.5% (OR 1.37), for ONR 23.1% versus 23.8% (OR 1.04), and for macrosomy 0.3% versus 0.8% (OR 3.1). After adjusting for clinically relevant variables, the ORs were for LGA 0.96, for SGA 1.40, for ONR 1.20, and for macrosomy not computable. None of the stated measures were significantly different. Also, independent analyses run on the origin of the oocytes, cryopreservation technique, cleavage stage of the embryos, and time that embryos remained frozen did not reveal any significant trends. This study comparing siblings from OD cycles, and eliminating the independent variables that affect early events in pregnancy, revealed no difference in duration of gestation and live birth weights between fetuses obtained after the replacement of fresh or frozen embryos. Moreover, no clinical, phenotypic, or laboratory factors appeared to be relevant, once statistically controlled. Copyright © 2015 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Advanced maternal age and risk perception: A qualitative study

PubMed Central

2012-01-01

Background Advanced maternal age (AMA) is associated with several adverse pregnancy outcomes, hence these pregnancies are considered to be “high risk.” A review of the empirical literature suggests that it is not clear how women of AMA evaluate their pregnancy risk. This study aimed to address this gap by exploring the risk perception of pregnant women of AMA. Methods A qualitative descriptive study was undertaken to obtain a rich and detailed source of explanatory data regarding perceived pregnancy risk of 15 women of AMA. The sample was recruited from a variety of settings in Winnipeg, Canada. In-depth interviews were conducted with nulliparous women aged 35 years or older, in their third trimester, and with singleton pregnancies. Interviews were recorded and transcribed verbatim, and content analysis was used to identify themes and categories. Results Four main themes emerged: definition of pregnancy risk, factors influencing risk perception, risk alleviation strategies, and risk communication with health professionals. Conclusions Several factors may influence women's perception of pregnancy risk including medical risk, psychological elements, characteristics of the risk, stage of pregnancy, and health care provider’s opinion. Understanding these influential factors may help health professionals who care for pregnant women of AMA to gain insight into their perspectives on pregnancy risk and improve the effectiveness of risk communication strategies with this group. PMID:22988825

Pregnancy Intention and Post-partum Depressive Affect in Louisiana Pregnancy Risk Assessment Monitoring System.

PubMed

Suh, Elizabeth Y; Ma, Ping; Dunaway, Lauren Futrell; Theall, Katherine P

2016-05-01

Postpartum depression is associated with negative physical and mental health outcomes for both the mother and infant. This study examines the relationship between a mother and/or her partner's pregnancy intentions and reported post-partum depressive symptoms (PPDs). Using Louisiana pregnancy risk assessment monitoring system, 2000-2003, a secondary cross-sectional analysis was conducted on 5549 mothers, stratified by race, who delivered a singleton, live birth and whose infant was still alive at the time of the survey. Bivariate and multivariable logistic regressions were conducted, taking into account the complex survey design. In multivariable models, unwanted pregnancies were associated with severe PPDs (aOR 1.76, 95 % CI 1.23-2.53). Furthermore, the association between husbands/partners' who did not want or care about the pregnancy and mild PPDs remained for White women (aOR 1.32, 95 % CI 1.02-1.69); while among Black women, neither parent's pregnancy intention were associated with mild or severe PPDs. This study supports existing research demonstrating the association between pregnancy intention and PPDs. This study contributes to the limited information on the role that partner pregnancy intention plays on maternal mental health outcomes, however further discussion is needed on the impact of this role across races. Findings can be used in programs aiming to reduce adverse mental health outcomes among high-risk mothers.

Cesarean Section Rate in Singleton Primiparae and Related Factors in Beijing, China

PubMed Central

Song, Geng; Wei, Yu-Mei; Zhu, Wei-Wei; Yang, Hui-Xia

2017-01-01

Background: The cesarean section rate (CSR) has been a main concern worldwide. The present study aimed to investigate the CSR in Beijing, China, and to analyze the related factors of CS delivery. Methods: An observational study was conducted in 15 medical centers in Beijing using a systemic cluster sampling method. In total, 15,194 pregnancies were enrolled in the study between June 20, 2013 and November 30, 2013. Independent t-tests and Pearson's Chi-square test were used to examine differences between two groups, and related factors of the CSR were examined by multivariable logistic regression. Results: The CSR was 41.9% (4471/10,671) in singleton primiparae. Women who were more than 35 years old had a 7.4-fold increased risk of CS delivery compared with women <25 years old (odd ratio [OR] = 7.388, 95% confidence interval [CI] = 5.561–9.816, P < 0.001). Prepregnancy obese women had a 2-fold increased risk of CS delivery compared with prepregnancy normal weight women (OR = 2.058, 95% CI = 1.640–2.584, P < 0.001). The excessive weight gain group had a 1.4-fold increased risk of CS delivery compared with the adequate weight gain group (OR = 1.422, 95% CI = 1.289–1.568, P < 0.001). Gestational diabetes mellitus (GDM) women and DM women had an increased risk of CS delivery (1.2- and 1.7-fold, respectively) compared with normal blood glucose women. Women who were born in rural areas had a lower risk of CS delivery than did those who were born in urban areas (OR = 0.696, 95% CI = 0.625–0.775, P < 0.001). The risk of CS delivery gradually increased with a decreasing education level. Neonates weighing 3000–3499 g had the lowest CSR (36.2%). Neonates weighing <2500 g had a 2-fold increased risk of CS delivery compared with neonates weighing 3000–3499 g (OR = 2.020, 95% CI = 1.537–2.656, P < 0.001). Neonates weighing ≥4500 g had an 8.3-fold increased risk of CS delivery compared with neonates weighing 3000–3499 g (OR = 8.313, 95% CI = 4.436–15.579, P < 0.001). Conclusions: Maternal age, prepregnancy body mass index, gestational weight gain, blood glucose levels, residence, education level, and singleton fetal birth weight are all factors that might significantly affect the CSR. PMID:29052558

Delivery of a very low birth weight infant and increased maternal risk of cancer and death: a population study with 16 years of follow-up.

PubMed

Grisaru-Granovsky, Sorina; Gordon, Ethel Sherry; Haklai, Ziona; Schimmel, Michael S; Drukker, Lior; Samueloff, Arnon; Keinan-Boker, Lital

2015-11-01

Pregnancy complications represent sentinel events for women's future health. We investigated whether delivery of a very low birth weight (VLBW) infant is associated with increased maternal risk for future incidence of maternal cancer and death. This is a population-based cohort study of linked Israeli Ministry of Health datasets between 1995 and 2011. Women delivering a live singleton <1,500 g infant (VLBW group) were compared with women delivering a live singleton, 3,000-3,500 g (control). The first pregnancy eligible for entry into the study, the "index pregnancy," reflected exposure status for each participant. Primary outcomes were maternal cancer and death. Cancer diagnoses were further classified by primary site. Cox regression models adjusted for follow-up period and maternal characteristics at index pregnancy: Age at delivery, ethnicity, years of education, marital status, and previous cancer afforded calculation of hazard ratios (HR) and 95% confidence intervals (CI). During the study period, 982,091 mothers with 2,243,736 live births were identified; of these, 13,773 births were VLBW eligible for inclusion in the study and 448,743 births were controls. Groups differed significantly by average follow-up and all maternal characteristics evaluated. Overall rate of cancers and death was significantly increased for VLBW women compared to controls: 18.4 versus 15.7% and 7.3 versus 3.2%, both p < 0.0001. The Cox model adjusted for maternal characteristics showed significantly increased risk of cancer (all sites) in the VLBW women: HR 1.18 (95% CI 1.02-1.37) and for death: HR 2.13 (95% CI 1.68-2.71), and an increased combined risk of both outcomes: HR 1.4 (95% CI 1.23-1.59). The delivery of a VLBW newborn is an independent lifetime risk factor for subsequent maternal cancers and death. These women may benefit from targeted cancer screening and counseling.

Acute antepartum pyelonephritis in pregnancy: a critical analysis of risk factors and outcomes.

PubMed

Farkash, Evelina; Weintraub, Adi Y; Sergienko, Ruslan; Wiznitzer, Arnon; Zlotnik, Alex; Sheiner, Eyal

2012-05-01

To test the incidence and sonographic parameters of pyelonephritis during pregnancy, and to examine risk factors and pregnancy outcomes of women with acute antepartum pyelonephritis. A retrospective population-based study comparing all singleton pregnancies of patients with and without acute antepartum pyelonephritis was performed. Patients lacking prenatal care as well as multiple gestations were excluded from the study. Multiple logistic regression models were used to control for confounders. Out of 219,612 singleton deliveries in 1988-2010, 165 women (0.07%) suffered from acute antepartum pyelonephritis. Abnormal sonographic findings were found in 85.7% of the patients with pyelonephritis. Pyelonephritis was significantly associated with nulliparity (46.1% vs. 24.4%, p<0.001), younger maternal age (26.3 ± 6.0 vs. 28.6 ± 5.8 years, p<0.001), intrauterine growth restriction (IUGR) (6.7% vs. 2.1%, p<0.001), placental abruption (3.6% vs. 0.7%, p<0.001), low 1 min Apgar scores (10.3% vs. 6.0%, p<0.05), urinary tract infection (UTI) (4.2% vs. 0.4%, p<0.001) and preterm delivery (less than 37 weeks gestation; 20.0% vs. 7.8%; p<0.001). Using a multivariable analysis, independent risk factors for acute antepartum pyelonephritis were nulliparity (OR 2.0; 95% C.I 1.4-2.9; p<0.001), UTI (OR 10.3; 95% C.I 4.8-22.1; p<0.001) and younger maternal age (OR 0.96; 95% C.I 0.93-0.99; p=0.009). Using another multivariable analysis, with preterm delivery as the outcome variable, acute antepartum pyelonephritis was found as an independent risk factor for preterm delivery (OR 2.6; 95% C.I 1.7-3.9; p<0.001). Acute antepartum pyelonephritis is associated with adverse perinatal outcomes and specifically is an independent risk factor for preterm delivery. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Biopsychosocial determinants of pregnancy length and fetal growth.

PubMed

St-Laurent, Jennifer; De Wals, Philippe; Moutquin, Jean-Marie; Niyonsenga, Theophile; Noiseux, Manon; Czernis, Loretta

2008-05-01

The causes and mechanisms related to preterm delivery and intrauterine growth restriction are poorly understood. Our objective was to assess the direct and indirect effects of psychosocial and biomedical factors on the duration of pregnancy and fetal growth. A self-administered questionnaire was distributed to pregnant women attending prenatal ultrasound clinics in nine hospitals in the Montérégie region in the province of Quebec, Canada, from November 1997 to May 1998. Prenatal questionnaires were linked with birth certificates. Theoretical models explaining pregnancy length and fetal growth were developed and tested, using path analysis. In order to reduce the number of variables from the questionnaire, a principal component analysis was performed, and the three most important new dimensions were retained as explanatory variables in the final models. Data were available for 1602 singleton pregnancies. The biophysical score, covering both maternal age and the pre-pregnancy body mass index, was the only variable statistically associated with pregnancy length. Smoking, obstetric history, maternal health and biophysical indices were direct predictors of fetal growth. Perceived stress, social support and self-esteem were not directly related to pregnancy outcomes, but were determinants of smoking and the above-mentioned biomedical variables. More studies are needed to identify the mechanisms by which adverse psychosocial factors are translated into adverse biological effects.

Obesity and the association with maternal mental health symptoms.

PubMed

Ruhstaller, Kelly E; Elovitz, Michal A; Stringer, Marilyn; Epperson, C Neill; Durnwald, Celeste P

2017-08-01

To evaluate the association between maternal obesity and mood disorders including depression, anxiety, stress, and pregnancy-specific stress during pregnancy. This was a planned secondary analysis of a prospective cohort study investigating factors associated with preterm delivery. The cohort included women who initiated prenatal care before 20 weeks with a singleton pregnancy. Maternal mental health was assessed using four standard psychosocial behavioral measures to screen for depression, pregnancy-specific stress, anxiety, and stress. Screen positive scores for each tool were established based on previously published "high" scores. Of the 1010 women included in the cohort, 355 (35.1%) were obese. There was no significant difference in the number of obese women with stress (64.2% versus 68.4%, p = 0.18), pregnancy-specific stress (26.2% versus 22.1%, p = 0.15), or anxiety (38.6% versus 41.2%, p = 0.42); however, a greater number of obese women did report symptoms consistent with major depression when compared to women with BMIs <30 (30.4% versus 21.2%, p < 0.01). Obese women had higher rates of depression in early pregnancy compared to nonobese women. As many of the health behavior interventions for obese women during pregnancy have proven ineffective, incorporating depression screening and treatment into prenatal care may improve perinatal outcomes.

Further evidence that culture media affect perinatal outcome: findings after transfer of fresh and cryopreserved embryos.

PubMed

Nelissen, Ewka C; Van Montfoort, Aafke P; Coonen, Edith; Derhaag, Josien G; Geraedts, Joep P; Smits, Luc J; Land, Jolande A; Evers, Johannes L; Dumoulin, John C

2012-07-01

We have previously shown that the medium used for culturing IVF embryos affects the birthweight of the resulting newborns. This observation with potentially far-reaching clinical consequences during later life, was made in singletons conceived during the first IVF treatment cycle after the transfer of fresh embryos. In the present study, we hypothesize that in vitro culture of embryos during the first few days of preimplantation development affects perinatal outcome, not only in singletons conceived in all rank order cycles but also in twins and in children born after transfer of frozen embryos. Furthermore, we investigated the effect of culture medium on gestational age (GA) at birth. Oocytes and embryos from consecutive treatment cycles were alternately assigned to culture in either medium from Vitrolife or from Cook. Data on a cohort of 294 live born singletons conceived after fresh transfer during any of a patient's IVF treatment cycles, as well as data of 67 singletons conceived after frozen embryo transfer (FET) and of 88 children of 44 twin pregnancies after fresh transfer were analysed by means of multiple linear regression. In vitro culture in medium from Cook resulted in singletons after fresh transfer with a lower mean birthweight (adjusted mean difference, 112 g, P= 0.03), and in more singletons with low birthweight (LBW) <2500 g (P= 0.006) and LBW for GA ≥ 37 weeks (P= 0.015), when compared with singletons born after culture in medium from Vitrolife AB. GA at birth was not related to the medium used (adjusted difference, 0.05 weeks, P = 0.83). Among twins in the Cook group, higher inter-twin mean birthweight disparity and birthweight discordance were found. Z-scores after FET were -0.04 (± 0.14) in the Cook group compared with 0.18 (± 0.21) in the Vitrolife group (P> 0.05). Our findings support our hypothesis that culture medium influences perinatal outcome of IVF singletons and twins. A similar trend is seen in case of singletons born after FET. GA was not affected by culture medium. These results indicate that in vitro culture might be an important factor explaining the poorer perinatal outcome after assisted reproduction technology (ART). Further research is needed to confirm this culture medium-induced effect in humans and to provide more insight into whether it is caused by epigenetic disturbance of imprinted genes in fetal or placental tissues. Moreover, embryo culture media and their effects need to be investigated thoroughly to select the best embryo culture medium in order to minimize or prevent short-term risks and maybe even long-term disease susceptibility.

Does meperidine analgesia affect the incidence of obstetric lacerations at vaginal delivery?

PubMed

Mizrachi, Yossi; Leytes, Sophia; Levy, Michal; Ginath, Shimon; Bar, Jacob; Ezri, Tiberiu; Kovo, Michal

2018-03-01

To study whether meperidine analgesia affects the incidence of obstetric lacerations at normal vaginal deliveries. A retrospective cohort study of all women with term vertex singleton pregnancies, who underwent normal vaginal deliveries, in a single tertiary hospital, between 2011 and 2015, was performed. The incidence of various obstetric lacerations was compared between deliveries with meperidine analgesia and deliveries with no analgesia. Deliveries with epidural analgesia and instrumental deliveries were excluded. An intravenous infusion of 75 mg of meperidine was administered together with 25 mg of promethazine. A multivariate logistic regression analysis was performed to assess the association between meperidine analgesia and obstetric lacerations, after controlling for confounders. Overall, 5227 (91.8%) deliveries with no analgesia and 466 (8.1%) deliveries with meperidine analgesia were included. Meperidine analgesia was associated with a decreased risk of first- and second-degree perineal lacerations (adjusted OR = 0.63, 95% CI = 0.49-0.81), and a decreased risk of any suturing (adjusted OR = 0.73, 95% CI = 0.59-0.91), after controlling for confounders. Meperidine analgesia did not affect the risk of severe perineal lacerations or episiotomies. Meperidine analgesia may have a protective effect against first- and second-degree perineal lacerations.

Iodine Status during Pregnancy in a Region of Mild-to-Moderate Iodine Deficiency is not Associated with Adverse Obstetric Outcomes; Results from the Avon Longitudinal Study of Parents and Children (ALSPAC).

PubMed

Torlinska, Barbara; Bath, Sarah C; Janjua, Aisha; Boelaert, Kristien; Chan, Shiao-Yng

2018-03-01

Severe iodine deficiency during pregnancy has been associated with pregnancy/neonatal loss, and adverse pregnancy outcomes; however, the impact of mild-to-moderate iodine insufficiency, though prevalent in pregnancy, is not well-documented. We assessed whether mild iodine deficiency during pregnancy was associated with pregnancy/infant loss, or with other adverse pregnancy outcomes. We used samples and data from the Avon Longitudinal Study of Parents and Children (ALSPAC), from 3140 singleton pregnancies and from a further 42 women with pregnancy/infant loss. The group was classified as mildly-to-moderately iodine deficient with a median urinary iodine concentration of 95.3 µg/L (IQR 57.0-153.0; median urinary iodine-to-creatinine ratio (UI/Creat) 124 µg/g, IQR 82-198). The likelihood of pregnancy/infant loss was not different across four UI/Creat groups (<50, 50-149, 150-250, >250 µg/g). The incidence of pre-eclampsia, non-proteinuric gestational hypertension, gestational diabetes, glycosuria, anaemia, post-partum haemorrhage, preterm delivery, mode of delivery, being small for gestational age, and large for gestational age did not differ significantly among UI/Creat groups, nor were there any significant differences in the median UI/Creat. We conclude that maternal iodine status was not associated with adverse pregnancy outcomes in a mildly-to-moderately iodine-deficient pregnant population. However, in view of the low number of women with pregnancy/infant loss in our study, further research is required.

External cephalic version for breech presentation at term.

PubMed

Rauf, Bushra; Nisa, Mehrun-; Hassan, Lubna

2007-09-01

To assess the success rate of External Cephalic Version (ECV) at term and its effects on measures of pregnancy outcome. A quasi-experimental study. The study was conducted at Hayatabad Medical Complex, Peshawar, from December 2003 to January 2005. A total of 40 patients were offered ECV over a period of fourteen months. All singleton breech presentations with an otherwise normal antenatal course between 36-41 weeks of gestation were included in the study. Exclusion criteria included contraindications to ECV i.e. multiple pregnancy, oligohydramnios, growth retardation, antepartum hemorrhage, rupture of membranes toxemias of pregnancy, non-reassuring fetal monitoring pattern, previous uterine scar, bad obstetric history, any contraindication to vaginal delivery, labour and patient wishes after thorough counseling. Overall success rate of the procedure and its effect on maternal and fetal outcome was determined. Significance of results was determined using Chi-square test. A total of 40 patients were recruited for the trial. Overall success rate was 67.5% with only 30% being primi-gravida (p < 0.05). Multi-gravida showed higher success rate of 80%. Following successful ECV, spontaneous vaginal delivery was attained in 77.7% (n=21), while caesarean section was performed due to various indications in about 6 cases (p < 0.05). Following failed version, 61.5% (n=8) had elective C/S and only 5 delivered vaginally. Route of delivery did not affect the perinatal outcome except for congenital abnormalities. Following successful ECV, there was only one stillbirth. Overall live births associated with successful version was 96.2% (p < 0.05), while in failed version, there were no fetal deaths. ECV at term appears to be a useful procedure to reduce the number and associated complications of term breech presentation. It is safe for the mother and the fetus and helps to avoid a significant number of caesarean sections.

MATERNAL HEIGHT AND PRE-PREGNANCY WEIGHT STATUS ARE ASSOCIATED WITH FETAL GROWTH PATTERNS AND NEWBORN SIZE.

PubMed

Pölzlberger, Eva; Hartmann, Beda; Hafner, Erich; Stümpflein, Ingrid; Kirchengast, Sylvia

2017-05-01

The impact of maternal height, pre-pregnancy weight status and gestational weight gain on fetal growth patterns and newborn size was analysed using a dataset of 4261 singleton term births taking place at the Viennese Danube Hospital between 2005 and 2013. Fetal growth patterns were reconstructed from three ultrasound examinations carried out at the 11th/12th, 20th/21th and 32th/33th weeks of gestation. Crown-rump length, biparietal diameter, fronto-occipital diameter, head circumference, abdominal transverse diameter, abdominal anterior-posterior diameter, abdominal circumference and femur length were determined. Birth weight, birth length and head circumference were measured immediately after birth. The vast majority of newborns were of normal weight, i.e. between 2500 and 4000 g. Maternal height showed a just-significant but weak positive association (r=0.03: p=0.039) with crown-rump length at the first trimester and with the majority of fetal parameters at the second trimester (r>0.06; p0.09; p0.08; p0.17; p0.13; p0.13; p<0.001), were significantly positively associated with newborn size. Some of these associations were quite weak and the statistical significance was mainly due to the large sample size. The association patterns between maternal height and pre-pregnancy weight status with fetal growth patterns (p<0.001), as well as newborn size (p<0.001), were independent of maternal age, nicotine consumption and fetal sex. In general, taller and heavier women gave birth to larger infants. This association between maternal size and fetal growth patterns was detectable from the first trimester onwards.

Is consumption of sugar‐sweetened soft drinks during pregnancy associated with birth weight?

PubMed Central

Grundt, Jacob H.; Eide, Geir Egil; Brantsæter, Anne‐Lise; Haugen, Margaretha

2016-01-01

Abstract In Norway, there were parallel increases and subsequent decreases in birth weight (BW) and consumption of sugar‐sweetened carbonated soft drinks (SSC) during the period 1990–2010, and by an ecological approach, we have suggested that the relationship was causal. The objective of this study was to examine if such a relationship was present in a prospectively followed cohort of pregnant women. The study population included 62,494 term singleton mother–infant dyads in the Norwegian Mother and Child Cohort Study (MoBa), a national prospective cohort study in Norway from 1999 to 2008. The association between SSC consumption and BW was assessed using multiple regression analyses with adjustment for potential confounders. Each 100 ml intake of SSC was associated with a 7.8 g (95% confidence interval [CI]: −10.3 to −5.3) decrease in BW, a decreased risk of BW > 4,500 g (odds ratio [OR]: 0.94, 95% CI: 0.90 to 0.97) and a near significantly increased risk of BW < 2,500 g (OR: 1.05, 95% CI: 0.99 to 1.10). The negative association with SSC consumption was aggravated by smoking, lack of exercise, and obesity. For mothers with gestational diabetes mellitus, we observed an increased risk of BW > 4,500 g (OR: 1.18, 95% CI: 1.00 to 1.39) and a trend towards significant increase in mean BW (25.1 g, 95% CI: −2.0 to 52.2) per 100 ml SSC. Our findings suggest that increasing consumption of rapidly absorbed sugar from SSC had opposite associations with BW in normal pregnancies and pregnancies complicated by gestational diabetes mellitus. PMID:27928892

Is consumption of sugar-sweetened soft drinks during pregnancy associated with birth weight?

PubMed

Grundt, Jacob H; Eide, Geir Egil; Brantsaeter, Anne-Lise; Haugen, Margaretha; Markestad, Trond

2017-10-01

In Norway, there were parallel increases and subsequent decreases in birth weight (BW) and consumption of sugar-sweetened carbonated soft drinks (SSC) during the period 1990-2010, and by an ecological approach, we have suggested that the relationship was causal. The objective of this study was to examine if such a relationship was present in a prospectively followed cohort of pregnant women. The study population included 62,494 term singleton mother-infant dyads in the Norwegian Mother and Child Cohort Study (MoBa), a national prospective cohort study in Norway from 1999 to 2008. The association between SSC consumption and BW was assessed using multiple regression analyses with adjustment for potential confounders. Each 100 ml intake of SSC was associated with a 7.8 g (95% confidence interval [CI]: -10.3 to -5.3) decrease in BW, a decreased risk of BW > 4,500 g (odds ratio [OR]: 0.94, 95% CI: 0.90 to 0.97) and a near significantly increased risk of BW < 2,500 g (OR: 1.05, 95% CI: 0.99 to 1.10). The negative association with SSC consumption was aggravated by smoking, lack of exercise, and obesity. For mothers with gestational diabetes mellitus, we observed an increased risk of BW > 4,500 g (OR: 1.18, 95% CI: 1.00 to 1.39) and a trend towards significant increase in mean BW (25.1 g, 95% CI: -2.0 to 52.2) per 100 ml SSC. Our findings suggest that increasing consumption of rapidly absorbed sugar from SSC had opposite associations with BW in normal pregnancies and pregnancies complicated by gestational diabetes mellitus. © 2016 The Authors Maternal & Child Nutrition Published by John Wiley & Sons Ltd.

Predictors of successful outcomes after external cephalic version in singleton term breech pregnancies: a nine-year historical cohort study.

PubMed

Cho, L Y; Lau, W L; Lo, T K; Tang, Helen H T; Leung, W C

2012-02-01

To study the success rate, predictors for success, and pregnancy outcomes after external cephalic version. Historical cohort study. Regional hospital, Hong Kong. All women who had singleton term breech pregnancies at term and opted for external cephalic version during 2001 and 2009. Their demographic data, clinical and ultrasound findings, procedure details, complications, and delivery outcomes were analysed. Predictive factors for successful external cephalic version. A total of 209 external cephalic versions were performed during the 9-year period. The success rate was 63% (75% for multiparous and 53% for nulliparous women). There was no significant complication. On univariate analysis, predictors of successful external cephalic version were: multiparity, unengaged presenting part, higher amniotic fluid index (≥ 10 cm), thin abdominal wall, low uterine tone, and easily palpable fetal head (subjective assessment by practitioners before external cephalic version). On multivariate analysis, only multiparity, non-engagement of the fetal buttock and thin maternal abdomen were associated with successful external cephalic version. In all, 69% of those who had successful external cephalic version succeeded in the first roll (P<0.001), and 82% of the women with successful external cephalic versions had vaginal deliveries (93% in multiparous and 69% in nulliparous women). Uptake rate of external cephalic version was studied in the latter part of the study period (2006-2009). Whilst 735 women were eligible for external cephalic version, 131 women chose to have the procedure resulting in an uptake rate of 18%. External cephalic version was effective in reducing breech presentations at term and corresponding caesarean section rates, but the uptake rate was low. Further work should address the barriers to the low acceptance of external cephalic version. The results of this study could encourage women to opt for external cephalic version.

Childhood Health and Educational Outcomes Associated With Maternal Sleep Apnea: A Population Record-Linkage Study.

PubMed

Bin, Yu Sun; Cistulli, Peter A; Roberts, Christine L; Ford, Jane B

2017-11-01

Sleep apnea in pregnancy is known to adversely affect birth outcomes. Whether in utero exposure to maternal sleep apnea is associated with long-term childhood consequences is unclear. Population-based longitudinal study of singleton infants born during 2002-2012 was conducted using linked birth, hospital, death, developmental, and educational records from New South Wales, Australia. Maternal sleep apnea during pregnancy was identified from hospital records. Outcomes were mortality and hospitalizations up to age 6, developmental vulnerability in the first year of school (aged 5-6 years), and performance on standardized tests in the third year of school (aged 7-9 years). Cox proportional hazards and modified Poisson regression models were used to calculate hazard and risk ratios for outcomes in children exposed to maternal apnea compared with those not exposed. Two hundred nine of 626188 singleton infants were exposed to maternal sleep apnea. Maternal apnea was not significantly associated with mortality (Fisher's exact p = .48), developmental vulnerability (adjusted RR 1.29; 95% CI 0.75-2.21), special needs status (1.58; 0.61-4.07), or low numeracy test scores (1.03; 0.63-1.67) but was associated with low reading test scores (1.55; 1.08-2.23). Maternal apnea significantly increased hospitalizations in the first year of life (adjusted HR 1.81; 95% CI 1.40-2.34) and between the first and sixth birthdays (1.41; 1.14-1.75). This is partly due to admissions for suspected pediatric sleep apnea. Maternal sleep apnea during pregnancy is associated with poorer childhood health. Its impact on developmental and cognitive outcomes warrants further investigation. © Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.

Predicting gestational diabetes mellitus during the first trimester using anthropometric measurements and HOMA-IR.

PubMed

Alptekin, Hüsnü; Çizmecioğlu, Ahmet; Işık, Hatice; Cengiz, Türkan; Yildiz, Murat; Iyisoy, Mehmet Sinan

2016-05-01

To determine the predictability of gestational diabetes mellitus (GDM) during the first trimester using the degree of insulin resistance and anthropometric measurements and to assign the risk of developing GDM by weight gained during pregnancy (WGDP). A total of 250 singleton pregnancies at 7-12 gestational weeks were studied. Body mass index (BMI), waist/hip ratio (WHR), quantitative insulin sensitivity check index (QUICKI), homeostasis model assessment-insulin resistance (HOMA-IR) scores and WGDP were determined. The backward stepwise method was applied to estimate possible associations with GDM. Cutoff points were estimated using receiver operating characteristic curve analysis. GDM was found in 20 of 227 singleton pregnancies (8.8 %). The calculated HOMA-IR, QUICKI, BMI, WHR, WGDP, and parity were significantly associated with GDM. Logistic regression analyses showed that three covariates (HOMA-IR, BMI, WGDP) remained independently associated with GDM. It was calculated as OR 1.254 (95 % CI 1.006-1.563), AUC 0.809, sensitivity 90 %, specificity 61 % with cutoff = 2.08 for HOMA-IR; OR 1.157 (CI 1.045-1.281), AUC 0.723, sensitivity 80 %, specificity 58 % with cutoff = 25.95 for BMI; OR 1.221, (CI 1.085-1.374), AUC 0.654, sensitivity 80 %, specificity 46 % with cutoff = 4.7 for WGDP. Despite a HOMA-IR score of >3.1 in pregnant women, GDM was detected in only three of 29 patients (10.3 %) if WGDP was <4.7 kg at weeks 24-28. First trimester screening for GDM can be achieved based on maternal anthropometric measurements and HOMA-IR. In particular, if BMI is >25.95 kg/m(2) and the HOMA-IR score >2.08, controlling weight gain may protect against GDM.

Pregnancy complications in women with inherited thrombophilia.

PubMed

Weintraub, Adi Y; Sheiner, Eyal; Levy, Amalia; Yerushalmi, Ronit; Mazor, Moshe

2006-06-01

The purpose of this study was to examine whether women with inherited thrombophilia have an increased risk of developing pregnancy complications. All singleton pregnancies with known inherited thrombophilia were compared to those without inherited thrombophilia for deliveries during the years 2000-2002 in a tertiary medical center. Data regarding inherited thrombophilia (International Classification of Disease 9th revision, Clinical Modification code 286.3) were available from the perinatal database in our center. Women lacking prenatal care were excluded from the analysis. Stratified analysis, using a multiple logistic regression model, was performed to control for confounders. Out of 32,763 singleton deliveries that occurred during the study period, 0.2% (n=57) of the women were diagnosed with inherited thrombophilia. Using a multivariate analysis, with backward elimination, the following conditions were significantly associated with inherited thrombophilia: previous fetal losses [odds ratio (OR)=5.5; 95% confidence interval (CI) 2.9-10.3; P<0.001], recurrent abortions (OR=9.5; 95% CI 5.5-16.3; P<0.001), fertility treatments (OR=3.7; 95% CI 1.3-10.6; P=0.014), and intrauterine growth restriction (OR=7.2; 95% CI 3.4-15; P<0.001). Perinatal mortality was significantly higher in women with inherited thrombophilia than in those without known thrombophilia 5.3% (3/57) versus 0.6% (477/32,763) P=0.017. However, inherited thrombophilia was not found to be an independent risk factor for perinatal mortality (OR=3.05; 95% CI 0.90-10.3; P<0.073) in a multivariate analysis with perinatal mortality as the outcome variable, controlling for recurrent abortions, IUGR, and gestational age. Inherited thrombophilia, associated with previous fetal losses, recurrent abortions, fertility treatments, and intrauterine growth restriction, was not an independent risk factor for perinatal mortality.

Placental NFE2L2 is discordantly activated in monochorionic twins with selective intrauterine growth restriction and possibly regulated by hypoxia.

PubMed

Wu, Jing; He, Zhiming; Gao, Yu; Zhang, Guanglan; Huang, Xuan; Fang, Qun

2017-04-01

Nuclear factor, erythroid 2 like 2 (NFE2L2) is an important transcription factor that protects cells from oxidative stress (OS). NFE2L2 deficiency in placentas is associated with pregnancy complications. We have demonstrated that elevated OS existed in placental shares of the smaller fetus in selective intrauterine growth restriction (sIUGR); however, the role of NFE2L2 in the development of sIUGR remains unknown. In this study, we examined the levels of NFE2L2 and heme oxygenase 1 (HMOX1), a major antioxidant regulated by NFE2L2, in sIUGR placentas. We also investigated the relationship between hypoxia and NFE2L2 activation, which may be involved in the pathogenesis of sIUGR. Real-time PCR, Western blot, and immunohistochemistry were used to detect the levels of NFE2L2 and HMOX1 in placentas from 30 monochorionic diamniotic (MCDA) twin pregnancies. The trophoblast cell line HTR-8/SVneo was cultured under severe (3%) or mild (10%) hypoxia. NFE2L2 and HMOX1 were both up-regulated in placental shares of the smaller fetus in the sIUGR group. No significant inter-twin differences in NFE2L2 and HMOX1 were detected in the normal group. In vitro, NFE2L2 was suppressed under severe hypoxia (3% O 2 ) but was clearly up-regulated under mild hypoxia (10% O 2 ). Compared with the suppression of NFE2L2 in placentas of fetal growth restriction (FGR) in singleton pregnancies, NFE2L2 was up-regulated in placental shares of the smaller fetus in sIUGR pregnancies. The asymmetrical activation of NFE2L2 in placental shares of sIUGR twins may be a compensation for hypoxia that protects the smaller fetus from OS damage.

Rate of gestational weight gain, pre-pregnancy body mass index and preterm birth subtypes: a retrospective cohort study from Peru

PubMed Central

Carnero, AM; Mejía, CR; García, PJ

2014-01-01

Objective To examine the shape (functional form) of the association between the rate of gestational weight gain, pre-pregnancy body mass index (BMI), and preterm birth and its subtypes. Design Retrospective cohort study. Setting National reference obstetric centre in Lima, Peru. Population Pregnant women who delivered singleton babies during the period 2006–2009, resident in Lima, and beginning prenatal care at ≤12 weeks of gestation (n = 8964). Methods Data were collected from the centre database. The main analyses consisted of logistic regression with fractional polynomial modelling. Main outcome measures Preterm birth and its subtypes. Results Preterm birth occurred in 12.2% of women, being mostly idiopathic (85.7%). The rate of gestational weight gain was independently associated with preterm birth, and the shape of this association varied by pre-pregnancy BMI. In women who were underweight, the association was linear (per 0.1 kg/week increase) and protective (OR 0.88; 95% CI 0.82–1.00). In women of normal weight or who were overweight, the association was U-shaped: the odds of delivering preterm increased exponentially with rates <0.10 or >0.66 kg/week, and <0.04 or >0.50 kg/week, respectively. In women who were obese, the association was linear, but nonsignificant (OR 1.01; 95% CI 0.95–1.06). The association described for preterm birth closely resembled that of idiopathic preterm birth, although the latter was stronger. The rate of gestational weight gain was not associated with indicated preterm birth or preterm prelabour rupture of membranes. Conclusions In Peruvian pregnant women starting prenatal care at ≤12 weeks of gestation, the rate of gestational weight gain is independently associated with preterm birth, mainly because of its association with idiopathic preterm birth, and the shape of both associations varies by pre-pregnancy BMI. PMID:22607522

Rate of gestational weight gain, pre-pregnancy body mass index and preterm birth subtypes: a retrospective cohort study from Peru.

PubMed

Carnero, A M; Mejía, C R; García, P J

2012-07-01

To examine the shape (functional form) of the association between the rate of gestational weight gain, pre-pregnancy body mass index (BMI), and preterm birth and its subtypes.   Retrospective cohort study.   National reference obstetric centre in Lima, Peru.   Pregnant women who delivered singleton babies during the period 2006-2009, resident in Lima, and beginning prenatal care at ≤ 12 weeks of gestation (n=8964).   Data were collected from the centre database. The main analyses consisted of logistic regression with fractional polynomial modelling.   Preterm birth and its subtypes.   Preterm birth occurred in 12.2% of women, being mostly idiopathic (85.7%). The rate of gestational weight gain was independently associated with preterm birth, and the shape of this association varied by pre-pregnancy BMI. In women who were underweight, the association was linear (per 0.1 kg/week increase) and protective (OR 0.88; 95% CI 0.82-1.00). In women of normal weight or who were overweight, the association was U-shaped: the odds of delivering preterm increased exponentially with rates <0.10 or >0.66 kg/week, and <0.04 or >0.50 kg/week, respectively. In women who were obese, the association was linear, but non-significant (OR 1.01; 95% CI 0.95-1.06). The association described for preterm birth closely resembled that of idiopathic preterm birth, although the latter was stronger. The rate of gestational weight gain was not associated with indicated preterm birth or preterm prelabour rupture of membranes.   In Peruvian pregnant women starting prenatal care at ≤ 12 weeks of gestation, the rate of gestational weight gain is independently associated with preterm birth, mainly because of its association with idiopathic preterm birth, and the shape of both associations varies by pre-pregnancy BMI. © 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG.

Co-morbidity of cervical incompetence with polycystic ovarian syndrome (PCOS) negatively impacts prognosis: A retrospective analysis of 178 patients.

PubMed

Wang, Yongqing; Gu, Xunke; Tao, Liyuan; Zhao, Yangyu

2016-10-12

Cervical incompetence is an important cause of miscarriage and premature birth and polycystic ovary syndrome is a heterogeneous endocrine disorder that is the most common cause of anovulatory infertility and eugonadotrophic hypogonadism. By now, it is still debated whether women with PCOS have an increased risk of miscarriage and there have been no studies about the pregnancy outcomes of cervical incompetence patients with PCOS. The following clinical data of cervical incompetence patients with/without PCOS who were treated between September 2006 and September 2013 were retrospectively analysed: onset gestational age, termination gestational age, pregnancy outcome, co-morbid insulin resistance (IR) in PCOS patients, the influence of IR, co-morbid hyperandrogenism (HA) in PCOS patients, and the influence of HA. The independent samples t-test and chi-square trend test were used to analyse the data. A total of 178 singleton pregnancy cases with cervical incompetence were identified. The average onset gestational age was 23.9 ± 4.3 weeks, and the average termination gestational age was 32.5 ± 5.5 weeks. Of these 178 singleton pregnancy cases, 40 (22.5 %) ended in miscarriage, 82 (46.1 %) ended in preterm birth, and 56 (31.5 %) ended in term birth. Eighty cases (44.9 %) exhibited PCOS co-morbidity, and those cases had an average onset gestational age of 22.3 ± 3.8 weeks and an average termination gestational age of 31.2 ± 5.7 weeks, which were both significantly different from those of the non-PCOS group (both P < 0.001). Compared with the non-PCOS group (15.3 % miscarriage, 48.0 % preterm birth, and 36.7 % term birth), the PCOS group exhibited worse pregnancy outcomes (31.3 % miscarriage, 43.8 % preterm birth, and 25 % term birth) (P = 0.01). Among the 80 PCOS patients, 45 (56.3 %) exhibited co-morbid IR, and the IR group exhibited significantly worse pregnancy outcomes than the non-IR group (P = 0.03). Among the 80 PCOS patients, 54 cases (67.5 %) exhibited co-morbid HA, and there was no statistical difference on the pregnancy outcomes between the two groups. The multivariate logistic regression model revealed that PCOS was significantly correlated with miscarriage (OR: 3.72, 95 % CI: 1.37-10.13). The cervical incompetence patients with co-morbid PCOS exhibited earlier onset gestational ages, earlier termination gestational ages and worse pregnancy outcomes. For patients with co-morbid insulin resistance, the pregnancy outcomes were worse than expected.

Transient postpartum diabetes insipidus associated with HELLP syndrome.

PubMed

Ellidokuz, Ender; Uslan, Ihsan; Demir, Serap; Cevrioglu, Serhan; Tufan, Gulnihal

2006-12-01

Diabetes insipidus in pregnancy has different causes. The association of diabetes insipidus with disturbances of liver function has been reported, however, diabetes insipidus has rarely been reported in HELLP syndrome. We present a 23-year-old primigravida with a singleton gestation complicated by HELLP syndrome who developed postpartum diabetes insipidus. Labor was induced promptly to terminate pregnancy because of intrauterine fetal death and liver dysfunction. 1-deamino-8-D-arginine-vasopressin was administered. Diabetes insipidus and liver dysfunction resolved within 2 weeks. Development of diabetes insipidus may result from increased vasopressinase activity mainly caused by deterioration of liver functions caused by HELLP syndrome. In pregnant women with liver disease as a result of any cause, the development of diabetes insipidus should be assessed with particular attention.

Reproductive Outcomes Among Male and Female Workers at an Aluminum Smelter

PubMed Central

Sakr, Carine J.; Taiwo, Oyebode A.; Galusha, Deron H.; Slade, Martin D.; Fiellin, Martha G.; Bayer, Felicia; Savitz, David A.; Cullen, Mark R.

2010-01-01

Objectives Several adverse pregnancy outcomes were reported among female laboratory workers in a North American aluminum smelter. To determine whether these outcomes were associated with any occupational exposure at the plant, a cross sectional survey was undertaken. Methods Rates of miscarriage, premature singleton birth, and major congenital anomaly occurring during employment were compared to a reference group comprised of all pregnancies that occurred prior to employment. Results Among female workers, the excess of congenital anomalies among female laboratory workers that defined the initial cluster was observed, but no specific pattern was found. Conclusions Based on these analyses, the increase in congenital anomalies could not be attributed to occupational exposures at the smelter, nor could potential exposure likely explain the diverse anomalies described. PMID:20134342

Anovulation and ovulation induction

PubMed Central

Katsikis, I; Kita, M; Karkanaki, A; Prapas, N; Panidis, D

2006-01-01

Conventional treatment of normogonadotropic anovulatory infertility is ovulation induction using the antiestrogen clomiphene citrate, followed by follicle-stimulating hormone. Multiple follicle development, associated with ovarian hyperstimulation, and multiple pregnancy remain the major complications. Cumulative singleton and multiple pregnancy rate data after different induction treatments are needed. Newer ovulation induction interventions, such as insulin-sensitizing drugs, aromatase inhibitors and laparoscopic ovarian electrocoagulation, should be compared with conventional treatments. Ovulation induction efficiency might improve if patient subgroups with altered chances for success or complications with new or conventional techniques could be identified, using multivariate prediction models based on initial screening characteristics. This would make ovulation induction more cost-effective, safe and convenient, enabling doctors to advise patients on the most effective and patient-tailored treatment strategy. PMID:20351807

Hospital costs during the first 5 years of life for multiples compared with singletons born after IVF or ICSI.

PubMed

van Heesch, M M J; Evers, J L H; van der Hoeven, M A H B M; Dumoulin, J C M; van Beijsterveldt, C E M; Bonsel, G J; Dykgraaf, R H M; van Goudoever, J B; Koopman-Esseboom, C; Nelen, W L D M; Steiner, K; Tamminga, P; Tonch, N; Torrance, H L; Dirksen, C D

2015-06-01

Do in vitro fertilization (IVF) multiples generate higher hospital costs than IVF singletons, from birth up to age 5? Hospital costs from birth up to age 5 were significantly higher among IVF/ICSI multiple children compared with IVF/ICSI singletons; however, when excluding the costs incurred during the birth admission period, hospital costs of multiples and singletons were comparable. Concern has risen over the long-term outcome of children born after IVF. The increased incidence of multiple births in IVF as a result of double-embryo transfer predisposes children to a poorer neonatal outcome such as preterm birth and low birthweight. As a consequence, IVF multiples require more medical care. Costs and consequences of poorer neonatal outcomes in multiples may also exist later in life. All 5497 children born from IVF in 2003-2005, whose parents received IVF or ICSI treatment in one of five participating Dutch IVF centers, served as a basis for a retrospective cohort study. Based on gestational age, birthweight, Apgar and congenital malformation, children were assigned to one of three risk strata (low-, moderate- or high-risk). To enhance the efficiency of the data collection, 816 multiples and 584 singletons were selected for 5-year follow-up based on stratified (risk) sampling. Parental informed consent was received of 322 multiples and 293 singletons. Individual-level hospital resource use data (hospitalization, outpatient visits and medical procedures) were retrieved from hospital information systems and patient charts for 302 multiples and 278 singletons. The risk of hospitalization (OR 4.9, 95% CI 3.3-7.0), outpatient visits (OR 2.6, 95% CI 1.8-3.6) and medical procedures (OR 1.7, 95% CI 1.2-2.2) was higher for multiples compared with singletons. The average hospital costs amounted to €10 018 and €2093 during the birth admission period (P < 0.001), €1131 and €696 after the birth admission period to the first birthday (not significant (n.s.)) and €1084 and €938 from the second to the fifth life year (n.s.) for multiples and singletons, respectively. Hospital costs from birth up to age 5 were 3.3-fold higher for multiples compared with singletons (P < 0.001). Among multiples and singletons, respectively, 90.8 and 76.2% of the total hospital costs were caused by hospital admission days and 8.9 and 25.2% of the total hospital costs during the first 5 years of life occurred after the first year of life. Resource use and costs outside the hospital were not included in the analysis. This study confirms the increased use of healthcare resources by IVF/ICSI multiples compared with IVF/ICSI singletons. Single-embryo transfer may result in substantial savings, particularly in the birth admission period. These savings need to be compared with the extra costs of additional embryo transfers needed to achieve a successful pregnancy. Besides costs, health outcomes of children born after single-embryo transfer should be compared with those born after double-embryo transfer. This study was supported by a research grant (grant number 80-82310-98-09094) from the Netherlands Organization for Health Research and Development (ZonMw). There are no conflicts of interest in connection with this article. Not applicable. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Long-term Recall of Pregnancy-related Events.

PubMed

Chin, Helen B; Baird, Donna D; McConnaughey, D Robert; Weinberg, Clarice R; Wilcox, Allen J; Jukic, Anne Marie

2017-07-01

Early-life factors can be associated with future health outcomes and are often measured by maternal recall. We used data from the North Carolina Early Pregnancy Study and Follow-up to characterize long-term maternal recall. We used data from the Early Pregnancy Study as the gold standard to evaluate the accuracy of prepregnancy weight, early pregnancy behaviors, symptoms and duration of pregnancy, and child's birthweight reported at follow-up, for 109 women whose study pregnancies had resulted in a live birth. Most (81%) participants reported a prepregnancy weight at follow-up that correctly classified them by BMI category. Women reported experiencing pregnancy symptoms later at follow-up than what they reported in the Early Pregnancy Study. Accuracy of reporting of early pregnancy behaviors varied based on exposure. Overall, women who had abstained from a behavior were more likely to be classified correctly. Sensitivity of reporting was 0.14 for antibiotics, 0.30 for wine, 0.71 for brewed coffee, and 0.82 for vitamins. Most misclassification at follow-up was due to false-negative reporting. Among women who gave birth to singletons, 94% could report their child's correct birthweight within ½ pound and 86% could report duration of pregnancy within 7 days at follow-up. Self-report of prepregnancy weight, duration of pregnancy, and child's birthweight after almost 30 years was good, whereas self-reported pregnancy-related exposures resulted in higher levels of reporting error. Social desirability appeared to influence women's report of their behaviors at follow-up. Self-reported assessment of confidence in the recalled information was unrelated to accuracy.

Fetal sex-specific differences in gestational age at delivery in pre-eclampsia: a meta-analysis

PubMed Central

Schalekamp-Timmermans, Sarah; Arends, Lidia R; Alsaker, Elin; Chappell, Lucy; Hansson, Stefan; Harsem, Nina K; Jälmby, Maya; Jeyabalan, Arundhathi; Laivuori, Hannele; Lawlor, Debbie A; Macdonald-Wallis, Corrie; Magnus, Per; Myers, Jenny; Olsen, Jørn; Poston, Lucilla; Redman, Christopher W; Staff, Anne C; Villa, Pia; Roberts, James M; Steegers, Eric A

2017-01-01

Abstract Background: Pre-eclampsia (PE) is a major pregnancy disorder complicating up to 8% of pregnancies. Increasing evidence indicates a sex-specific interplay between the mother, placenta and fetus. This may lead to different adaptive mechanisms during pregnancy. Methods: We performed an individual participant data meta-analysis to determine associations of fetal sex and PE, with specific focus on gestational age at delivery in PE. This was done on 219 575 independent live-born singleton pregnancies, with a gestational age at birth between 22.0 and 43.0 weeks of gestation, from 11 studies participating in a worldwide consortium of international research groups focusing on pregnancy. Results: Of the women, 9033 (4.1%) experienced PE in their pregnancy and 48.8% of the fetuses were female versus 51.2% male. No differences in the female/male distribution were observed with respect to term PE (delivered ≥ 37 weeks). Preterm PE (delivered < 37 weeks) was slightly more prevalent among pregnancies with a female fetus than in pregnancies with a male fetus [odds ratio (OR) 1.11, 95% confidence interval (CI) 1.02–1.21]. Very preterm PE (delivered < 34 weeks) was even more prevalent among pregnancies with a female fetus as compared with pregnancies with a male fetus (OR 1.36, 95% CI 1.17–1.59). Conclusions: Sexual dimorphic differences in the occurrence of PE exist, with preterm PE being more prevalent among pregnancies with a female fetus as compared with pregnancies with a male fetus and with no differences with respect to term PE. PMID:27605586

Less-Restrictive Food Intake During Labor in Low-Risk Singleton Pregnancies: A Systematic Review and Meta-analysis.

PubMed

Ciardulli, Andrea; Saccone, Gabriele; Anastasio, Hannah; Berghella, Vincenzo

2017-03-01

To evaluate benefits and harms of food intake during labor. Electronic databases such as MEDLINE and ClinicalTrials.gov were searched from their inception until October 2016. We included randomized trials comparing a policy of less-restrictive food intake with a policy of more restrictive food intake during labor. The primary outcome was the mean duration of labor. Meta-analysis was performed using the random-effects model of DerSimonian and Laird to produce summary treatment effects in terms of either a relative risk or a mean difference with 95% confidence interval (CI). Ten trials, including 3,982 laboring women, were included. All the studies involved laboring singletons considered at low risk because they had no obstetric or medical complications that would increase the likelihood of cesarean delivery. In three studies, women were allowed to select from a low-residue diet throughout the course of labor. One study had honey date syrup as the allowed food intake. Five studies had carbohydrate drinks as food intake in labor. The last one was the only trial that allowed unrestrictive food intake. In the included studies, all women in the intervention group were allowed the assigned food intake until delivery, whereas women in a control group were allowed only ice chips, water, or sips of water until delivery. A policy of less-restrictive food intake was associated with a significantly shorter duration of labor (mean difference -16 minutes, 95% CI -25 to -7). No other benefits or harms in obstetric or neonatal outcome were noticed. Regurgitation during general anesthesia and Mendelson syndrome did not occur in either group. Women with low-risk singleton pregnancies who were allowed to eat more freely during labor had a shorter duration of labor. A policy of less-restrictive food intake during labor did not influence other obstetric or neonatal outcomes nor did it increase the incidence of vomiting. Operative delivery rates were similar.

Epigenetic changes in fetal hypothalamic energy regulating pathways are associated with maternal undernutrition and twinning.

PubMed

Begum, Ghazala; Stevens, Adam; Smith, Emma Bolton; Connor, Kristin; Challis, John R G; Bloomfield, Frank; White, Anne

2012-04-01

Undernutrition during pregnancy is implicated in the programming of offspring for the development of obesity and diabetes. We hypothesized that maternal programming causes epigenetic changes in fetal hypothalamic pathways regulating metabolism. This study used sheep to examine the effect of moderate maternal undernutrition (60 d before to 30 d after mating) and twinning to investigate changes in the key metabolic regulators proopiomelanocortin (POMC) and the glucocorticoid receptor (GR) in fetal hypothalami. Methylation of the fetal hypothalamic POMC promoter was reduced in underfed singleton, fed twin, and underfed twin groups (60, 73, and 63% decrease, respectively). This was associated with reduced DNA methyltransferase activity and altered histone methylation and acetylation. Methylation of the hypothalamic GR promoter was decreased in both twin groups and in maternally underfed singleton fetuses (52, 65, and 55% decrease, respectively). This correlated with changes in histone methylation and acetylation and increased GR mRNA expression in the maternally underfed singleton group. Alterations in GR were hypothalamic specific, with no changes in hippocampi. Unaltered levels of OCT4 promoter methylation indicated gene-specific effects. In conclusion, twinning and periconceptional undernutrition are associated with epigenetic changes in fetal hypothalamic POMC and GR genes, potentially resulting in altered energy balance regulation in the offspring.

Subfertility factors rather than assisted conception factors affect cognitive and behavioural development of 4-year-old singletons.

PubMed

Schendelaar, Pamela; La Bastide-Van Gemert, Sacha; Heineman, Maas Jan; Middelburg, Karin J; Seggers, Jorien; Van den Heuvel, Edwin R; Hadders-Algra, Mijna

2016-12-01

Research on cognitive and behavioural development of children born after assisted conception is inconsistent. This prospective study aimed to explore underlying causal relationships between ovarian stimulation, in-vitro procedures, subfertility components and child cognition and behaviour. Participants were singletons born to subfertile couples after ovarian stimulation IVF (n = 63), modified natural cycle IVF (n = 53), natural conception (n = 79) and singletons born to fertile couples (reference group) (n = 98). At 4 years, cognition (Kaufmann-ABC-II; total IQ) and behaviour (Child Behavior Checklist; total problem T-score) were assessed. Causal inference search algorithms and structural equation modelling was applied to unravel causal mechanisms. Most children had typical cognitive and behavioural scores. No underlying causal effect was found between ovarian stimulation and the in-vitro procedure and outcome. Direct negative causal effects were found between severity of subfertility (time to pregnancy) and cognition and presence of subfertility and behaviour. Maternal age and maternal education acted as confounders. The study concludes that no causal effects were found between ovarian stimulation or in-vitro procedures and cognition and behaviour in childrenaged 4 years born to subfertile couples. Subfertility, especially severe subfertility, however, was associated with worse cognition and behaviour. Copyright © 2016 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

Employment, working conditions, and preterm birth: results from the Europop case-control survey.

PubMed

Saurel-Cubizolles, M J; Zeitlin, J; Lelong, N; Papiernik, E; Di Renzo, G C; Bréart, G

2004-05-01

To analyse the relation between preterm birth and working conditions in Europe using common measures of exposure and to test whether employment related risks varied by country of residence. A case-control study in which cases included all consecutive singleton preterm births and controls included one of every ten singleton term births in each participating maternity unit. Data about working conditions were obtained by interview from women after delivery. Sixteen European countries. The analysis included 5145 preterm and 7911 term births of which 2369 preterm and 4098 term births were to women employed during pregnancy. Analyses of working conditions were carried out for women working through at least the third month of pregnancy. Employed women did not have an excess risk of preterm birth. Among working women, a moderate excess risk was observed for women working more than 42 hours a week (OR = 1.33, CI = 1.1 to 1.6), standing more than six hours a day (OR = 1.26, CI = 1.1 to 1.5), and for women with low job satisfaction (OR = 1.27, CI = 1.1 to 1.5). There were stronger links in countries with a lower overall level of perinatal health and a common practice of long prenatal leaves. These findings show that specific working conditions affect the risk of preterm birth. They also suggest employment related risks could be mediated by the social and legislative context.

Comparison of Fetomaternal Outcome between 47 Deliveries Following Successful External Cephalic Version for Breech Presentation and 7456 Deliveries Following Spontaneous Cephalic Presentation.

PubMed

de Gregorio, Nikolaus; Friedl, Thomas; Schramm, Amelie; Reister, Frank; Janni, Wolfgang; Ebner, Florian

2017-08-25

Achieving a cephalic position after a successful external cephalic version (ECV) is desired to result in delivery and fetal outcomes that are similar to those of deliveries following spontaneous cephalic presentation. We performed a retrospective cohort study including patients with successful ECV following fetal breech position (ECV cohort, n = 47) or with a singleton spontaneous cephalic pregnancy at ≥37 weeks of gestational age (control group, n = 7,456) attempting a vaginal delivery between 2010 and 2013 at the University Hospital Ulm. The mode of delivery and fetal outcome parameters were compared between these 2 groups using nonparametric statistics. ECV cohort and control group did not differ with respect to maternal age, parity, gestational age at birth, and fetal gender. There were no significant differences between the 2 groups with regard to all parameters indicating fetal outcome. However, the rate of cesarean sections was higher after successful ECV compared to spontaneous cephalic presentation (27.7 vs. 12.8%, OR 2.615). While vaginal delivery is less likely to happen after a successful ECV compared to spontaneous cephalic singleton pregnancies, fetal outcome parameters showed no difference between the 2 groups. Physicians should be counseling and encouraging women to attempt ECV, as it is a safe and effective procedure. © 2017 S. Karger AG, Basel.

Gender mix in twins and fetal growth, length of gestation and adult cancer risk.

PubMed

Luke, Barbara; Hediger, Mary; Min, Sung-Joon; Brown, Morton B; Misiunas, Ruta B; Gonzalez-Quintero, Victor Hugo; Nugent, Clark; Witter, Frank R; Newman, Roger B; Hankins, Gary D V; Grainger, David A; Macones, George A

2005-01-01

This study evaluated the effect of gender mix (the gender combinations of twin pairs) on fetal growth and length of gestation, and reviewed the literature on the long-term effects of this altered fetal milieu on cancer risk. In singletons, it is well established that females weigh less than males at all gestations, averaging 125-135 g less at full term. This gender difference is generally believed to be the result of the effect of androgens on fetal growth. The gender difference in fetal growth is greater before the third trimester and less towards term, with males growing not only more, but also earlier than females. Plurality is a known risk factor for reduced fetal growth and birthweight. Compared with singletons, the mean birthweight percentiles of twins fall substantially (by 10% or more) below the singleton 10th percentile by 28 weeks, below the singleton 50th percentile by 30 weeks, and below the singleton 90th percentile by 34 weeks. In unlike-gender twin pairs, it has been reported that the female prolongs gestation for her brother, resulting in a higher birthweight for the male twin than that of like-gender male twins. Other researchers have demonstrated that females in unlike-gender pairs had higher birthweights than females in like-gender pairs. Analyses from our consortium on 2491 twin pregnancies with known chorionicity showed longer gestations and faster rates of fetal growth in both males and females in unlike-gender pairs compared with like-gender male or female pairs, although these differences were not statistically significant. The post-natal effects for females growing in an androgenic-anabolic environment include increased sensation-seeking behaviour and aggression, lowered visual acuity, more masculine attitudes and masculinising effects of the auditory system and craniofacial growth. In contrast, there is no evidence to suggest that there might be a similar feminising effect on males from unlike-gender pairs. This hormonal exposure in utero may influence adult body size and susceptability to breast cancer.

Prevalences and pregnancy outcome of vanishing twin pregnancies achieved by in vitro fertilization versus natural conception.

PubMed

Márton, Virág; Zádori, János; Kozinszky, Zoltan; Keresztúri, Attila

2016-11-01

To evaluate whether vanishing twin (VT) pregnancies achieved by in vitro fertilization and intracytoplasmic sperm injection (IVF-ICSI) had a more adverse perinatal outcome than those after natural conception. Longitudinal, retrospective cohort study. Tertiary university hospital. Three hundred and six (78 after IVF-ICSI and 228 after natural conception) VT pregnancies over a 22-year period, with VT cases matched to primarily singleton controls. None. Obstetric and neonatal outcome data. The incidence of VT was statistically significantly higher after natural conception (18.2% of twins) than after IVF-ICSI (12.6% of twins). The odds of VT in pregnancies complicated with pregestational or gestational diabetes were disproportionally higher in IVF-ICSI cases than in spontaneously conceived VT pregnancies (adjusted odds ratio [AOR]: 0.80 vs. 3.10 and 1.00 vs. 1.07, respectively). Previous induced abortion (AOR 1.34) or second-trimester fetal loss (AOR 3.3) increased the risk of VT pregnancies after spontaneous conception. Gestational diabetes mellitus in both the previous (AOR 5.41) and the present (AOR 2.3) pregnancy as well as chronic maternal diseases (AOR 3.5) and placentation anomalies all represented independent risk factors for VT after IVF-ICSI. Vanishing twin pregnancies had a lower prevalence and a worse perinatal outcome after IVF-ICSI as compared with those of their spontaneously conceived counterparts. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Maternal micronutrient consumption periconceptionally and during pregnancy: a prospective cohort study.

PubMed

Livock, Michelle; Anderson, Peter J; Lewis, Sharon; Bowden, Stephen; Muggli, Evelyne; Halliday, Jane

2017-02-01

To examine overall micronutrient intake periconceptionally and throughout pregnancy in a population-based cohort of Australian women. In a prospective cohort study, micronutrient dosages were extracted from self-reported maternal supplement use, recorded pre-conception, and for each trimester of pregnancy. A food frequency scale (DQESv2) captured usual maternal diet for gestational weeks 14-26. The influence of sociodemographic and lifestyle factors associated with supplement use was examined using logistic regression, and changes in micronutrient intakes prior to and throughout pregnancy were assessed using repeated-measures ANOVA analyses. Metropolitan hospital sites in Melbourne, Australia. Women with a viable singleton pregnancy were recruited at less than 19 weeks' gestation (n 2146). Compared with non-users, women using supplements during pregnancy were more likely to have planned their pregnancy, be >25 years old, primiparous, Caucasian, non-smokers, have a tertiary education and be consuming a folate-rich diet. Intakes of folate, Fe and Zn were significantly lower in the periconceptional period, compared with other periods (P<0·001). Intakes below Recommended Daily Intake levels were common both periconceptionally and throughout pregnancy, with 19-46 % of women not meeting the Recommended Daily Intake for folate, 68-82 % for Fe and 17-36 % for Zn. Conversely, 15-19 % of women consumed beyond the recommended Upper Limit for folate and 11-24 % for Fe. The study highlights the need for improved public health education on nutritional needs during pregnancy, especially among women with lower educational achievements and income.

Intrapartum Cervical Laceration and Subsequent Pregnancy Outcomes

PubMed Central

Wong, Luchin F.; Wilkes, Jacob; Korgenski, Kent; Varner, Michael W.; Manuck, Tracy A.

2016-01-01

Objective The objective of this study was to describe pregnancy outcomes, including cervical insufficiency and preterm birth, in the subsequent pregnancy following an intrapartum cervical laceration. Study Design Retrospective cohort of women with their first two consecutive singleton pregnancies carried to ≥ 200/7 weeks' gestation within a tertiary health care system from 2002 to 2012. Cervical laceration cases were identified by ICD9 codes and included if suture repair was required. Results In this study, 55 women were confirmed to have a cervical laceration in the first delivery; 43 lacerations after vaginal delivery (VD) and 12 after cesarean delivery (CD). The median gestational age of the first delivery was 400/7 weeks and the median birth weight 3,545 g; these did not differ between VD and CD. In the second pregnancy, 2 of 55 women (4.6%) had a prophylactic cerclage placed; 1 carried to term and the other delivered at 356/7 weeks. In total, four women (9.3%) delivered the second pregnancy < 37 weeks: three had a prior term VD and one had a prior 34 weeks VD. There was only one case of recurrent cervical laceration, occurring in the setting of vaginal deliveries. Conclusion Obstetric cervical lacerations are uncommon. Complications in the following pregnancy were low, despite lack of additional prophylactic cerclage use. PMID:27621953

Intrapartum Cervical Laceration and Subsequent Pregnancy Outcomes.

PubMed

Wong, Luchin F; Wilkes, Jacob; Korgenski, Kent; Varner, Michael W; Manuck, Tracy A

2016-07-01

The objective of this study was to describe pregnancy outcomes, including cervical insufficiency and preterm birth, in the subsequent pregnancy following an intrapartum cervical laceration. Retrospective cohort of women with their first two consecutive singleton pregnancies carried to ≥ 20(0/7) weeks' gestation within a tertiary health care system from 2002 to 2012. Cervical laceration cases were identified by ICD9 codes and included if suture repair was required. In this study, 55 women were confirmed to have a cervical laceration in the first delivery; 43 lacerations after vaginal delivery (VD) and 12 after cesarean delivery (CD). The median gestational age of the first delivery was 40(0/7) weeks and the median birth weight 3,545 g; these did not differ between VD and CD. In the second pregnancy, 2 of 55 women (4.6%) had a prophylactic cerclage placed; 1 carried to term and the other delivered at 35(6/7) weeks. In total, four women (9.3%) delivered the second pregnancy < 37 weeks: three had a prior term VD and one had a prior 34 weeks VD. There was only one case of recurrent cervical laceration, occurring in the setting of vaginal deliveries. Obstetric cervical lacerations are uncommon. Complications in the following pregnancy were low, despite lack of additional prophylactic cerclage use.

Pregnancy outcome after induction of labor in women with previous cesarean section.

PubMed

Ashwal, Eran; Hiersch, Liran; Melamed, Nir; Ben-Zion, Maya; Brezovsky, Alex; Wiznitzer, Arnon; Yogev, Yariv

2015-03-01

As conflicting data exist concerning the safety of induction of labor (IoL) in women with previous single lower segment cesarean section (CS), we aimed to assess pregnancy outcome following IoL in such patient population. All singleton pregnancies with previous single CS which underwent IoL during 2008-2012 were included (study group). Their pregnancy outcome was compared to those pregnancies with previous single CS that admitted with spontaneous onset of labor (control group). Overall, 1898 pregnancies were eligible, of them, 259 underwent IoL, and 1639 were admitted with spontaneous onset of labor. Parity, gestational age at delivery and birthweight were similar. Women in the study group were more likely to undergo CS mainly due to labor dystocia (8.1 versus 3.7%, p < 0.01). The rate of CS due to non-reassuring fetal heart rate was similar. No difference was found in the rate of uterine rupture/dehiscence. Short-term neonatal outcome was similar between the groups. On multivariable logistic regression analysis, IoL was not independently associated with uterine rupture (OR 1.33, 95% C.I 0.46-3.84, p = 0.59). Our data suggest that IoL in women with one previous low segment CS neither increases the risk of uterine rupture nor adversely affects immediate neonatal outcome.

Fetal cell-free DNA fraction in maternal plasma for the prediction of hypertensive disorders of pregnancy.

PubMed

Suzumori, Nobuhiro; Sekizawa, Akihiko; Ebara, Takeshi; Samura, Osamu; Sasaki, Aiko; Akaishi, Rina; Wada, Seiji; Hamanoue, Haruka; Hirahara, Fumiki; Izumi, Haruna; Sawai, Hideaki; Nakamura, Hiroaki; Yamada, Takahiro; Miura, Kiyonori; Masuzaki, Hideaki; Yamashita, Takahiro; Okai, Takashi; Kamei, Yoshimasa; Namba, Akira; Murotsuki, Jun; Tanemoto, Tomohiro; Fukushima, Akimune; Haino, Kazufumi; Tairaku, Shinya; Matsubara, Keiichi; Maeda, Kazutoshi; Kaji, Takashi; Ogawa, Masanobu; Osada, Hisao; Nishizawa, Haruki; Okamoto, Yoko; Kanagawa, Takeshi; Kakigano, Aiko; Kitagawa, Michihiro; Ogawa, Masaki; Izumi, Shunichiro; Katagiri, Yukiko; Takeshita, Naoki; Kasai, Yasuyo; Naruse, Katsuhiko; Neki, Reiko; Masuyama, Hisashi; Hyodo, Maki; Kawano, Yukie; Ohba, Takashi; Ichizuka, Kiyotake; Nagamatsu, Takeshi; Watanabe, Atsushi; Shirato, Nahoko; Yotsumoto, Junko; Nishiyama, Miyuki; Hirose, Tatsuko; Sago, Haruhiko

2018-05-01

The purpose of this study is to compare the fetal fractions during non-invasive prenatal testing (NIPT) in singleton pregnancies according to gestational age and maternal characteristics to evaluate the utility of this parameter for the prediction of pregnancy complications including gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP). This study was a multicenter prospective cohort study. The present data were collected from women whose NIPT results were negative. The relationships between the fetal fractions and the gestational age, maternal weight and height, and incidences of miscarriage, preterm delivery, and pregnancy complications including GDM, HDP and placental abruption were assessed. A total of 5582 pregnant women with verified NIPT negative results were registered in the study. The demographic characteristics of the study populations were statistically analyzed, and the women with HDP tended to have a low fetal fraction in samples taken during early gestation. The area under the curve (AUC) in a receiver operating characteristic curve (ROC) analysis was 0.608 for women with HDP. A low fetal fraction on NIPT might be correlated with future HDP. However, predicting HDP during early pregnancy in women with a low fetal fraction might be difficult. Copyright © 2018 Elsevier B.V. All rights reserved.

Risk assessment and management to prevent preterm birth.

PubMed

Koullali, B; Oudijk, M A; Nijman, T A J; Mol, B W J; Pajkrt, E

2016-04-01

Preterm birth is the most important cause of neonatal mortality and morbidity worldwide. In this review, we review potential risk factors associated with preterm birth and the subsequent management to prevent preterm birth in low and high risk women with a singleton or multiple pregnancy. A history of preterm birth is considered the most important risk factor for preterm birth in subsequent pregnancy. General risk factors with a much lower impact include ethnicity, low socio-economic status, maternal weight, smoking, and periodontal status. Pregnancy-related characteristics, including bacterial vaginosis and asymptomatic bacteriuria, appear to be of limited value in the prediction of preterm birth. By contrast, a mid-pregnancy cervical length measurement is independently associated with preterm birth and could be used to identify women at risk of a premature delivery. A fetal fibronectin test may be of additional value in the prediction of preterm birth. The most effective methods to prevent preterm birth depend on the obstetric history, which makes the identification of women at risk of preterm birth an important task for clinical care providers. Copyright © 2016 Elsevier Ltd. All rights reserved.

Investigation of Metronidazole Use during Pregnancy and Adverse Birth Outcomes

PubMed Central

Koss, Catherine A.; Baras, Dana C.; Lane, Sandra D.; Aubry, Richard; Marcus, Michele; Markowitz, Lauri E.

2012-01-01

To assess whether treatment with metronidazole during pregnancy is associated with preterm birth, low birth weight, or major congenital anomalies, we conducted chart reviews and an analysis of electronic data from a cohort of women delivering at an urban New York State hospital. Of 2,829 singleton/mother pairs, 922 (32.6%) mothers were treated with metronidazole for clinical indications, 348 (12.3%) during the first trimester of pregnancy and 553 (19.5%) in the second or third trimester. There were 333 (11.8%) preterm births, 262 (9.3%) infants of low birth weight, and 52 infants (1.8%) with congenital anomalies. In multivariable analysis, no association was found between metronidazole treatment and preterm birth (odds ratio [OR], 1.02 [95% confidence interval [CI], 0.80 to 1.32]), low birth weight (OR, 1.05 [95% CI, 0.77 to 1.43]), or treatment in the first trimester and congenital anomalies (OR, 0.86 [0.30 to 2.45]). We found no association between metronidazole treatment during the first or later trimesters of pregnancy and preterm birth, low birth weight, or congenital anomalies. PMID:22751543

Associations of dietary intake and plasma concentrations of eicosapentaenoic and docosahexaenoic acid with prenatal depressive symptoms in Japan.

PubMed

Shiraishi, Mie; Matsuzaki, Masayo; Yatsuki, Yuko; Murayama, Ryoko; Severinsson, Elisabeth; Haruna, Megumi

2015-06-01

The association between depression and omega-3 polyunsaturated fatty acids, including eicosapentaenoic and docosahexaenoic acid, continues to gain focus. In this study, we examined whether dietary intakes and plasma concentrations of eicosapentaenoic and docosahexaenoic acid were associated with depressive symptoms during pregnancy. Healthy Japanese women with singleton pregnancies were recruited at a university hospital in Tokyo between 2010 and 2012. The depressive-symptom group included participants with Edinburgh Postnatal Depression Scale scores greater than eight. Of the 329 participants, 19 (5.8%) had depressive symptoms. Lower plasma docosahexaenoic acid concentration was significantly associated with prenatal depressive symptoms. Women with depressive symptoms had a higher rate of pregnancy-associated nausea than those with non-depressive symptoms (52.6% vs 28.7%, respectively). Although we adjusted for the presence of pregnancy-associated nausea, dietary fatty acid intake was not associated with depressive symptoms in the multiple logistic regression analyses. Further large studies would be required to examine any preventive effect of dietary fatty acid intake on depressive symptoms among pregnant women. © 2014 Wiley Publishing Asia Pty Ltd.

Amniotic fluid cortisol and alpha-fetoprotein in normal and aneuploid pregnancies.

PubMed

Drugan, A; Subramanian, M G; Johnson, M P; Evans, M I

1988-01-01

Cortisol and alpha-fetoprotein (AFP) levels were measured in amniotic fluid (AF) samples at 15-20 weeks of gestation from 125 normal pregnancies and 29 pregnancies affected by aneuploidy. The normal pregnancy group was further subdivided into 'low' AF-AFP (less than 0.6 MOM, n = 60) and 'normal' AF-AFP (0.6 less than AFP less than 1.4 MOM, n = 65). A significant, inverse, linear correlation was found between cortisol and AF-AFP for both normal AFP and low AFP groups (r = -0.26, and r = -0.4, respectively, p less than 0.05). Gestational age was significantly correlated with both cortisol and AFP levels in the normal pregnancy groups. No difference was found when cortisol levels were compared between the low and normal AFP groups. The correlation between cortisol and AFP in aneuploid pregnancies was not significant (p = 0.37). The strong association between cortisol or AFP and gestational age in normal pregnancy (p less than 0.00001) was lost in trisomic gestation. We conclude that higher cortisol levels do not seem to be the cause of low AFP in normal or aneuploid pregnancies.

Fetal eyeball volume: relationship to gestational age and biparietal diameter.

PubMed

Odeh, Marwan; Feldman, Yulia; Degani, Shimon; Grinin, Vitali; Ophir, Ella; Bornstein, Jacob

2009-08-01

To measure and determine normal values of the fetal eyeball volume between 14 and 40 weeks of gestation. The volume of the fetal eyeball was measured with three-dimensional ultrasound between 14 and 40 weeks of gestation using the VOCAL software.Only singleton pregnancies without fetal growth restriction, diabetes mellitus, hypertension or major fetal malformation were included. Over all, 203 women were studied. In 125 both eyeballs were measured while in 78 only one eyeball was measured. The volume of the eyeball correlated strongly with gestational age (right: R = 0.946, P < 0.001, n = 171. left: R = 0.945, P < 0.001, n = 156), and with the biparietal diameter (BPD) (right: R = 0.949, P < 0.001, n = 171. left: R = 0.953, P < 0.001, n = 156). Using regression analysis the best correlation between eyeball volume and the BPD were: square of right eyeball = -0.180 + 0.187 BPD, square of left eyeball = -0.182 + 0.187 BPD. The volume of the eyeball has strong positive correlations with gestational age and BPD. Our data may be helpful in fetuses suspected of having eye anomalies.

Ovine prenatal growth restriction impacts glucose metabolism and body composition throughout life in both sexes.

PubMed

Wallace, Jacqueline M; Milne, John S; Aitken, Raymond P; Horgan, Graham W; Adam, Clare L

2018-05-22

Low birthweight is a risk factor for later adverse health. Here the impact of placentally-mediated prenatal growth-restriction followed by postnatal nutrient abundance on growth, glucose metabolism and body composition was assessed in both sexes at key stages from birth to mid-adult life. Singleton-bearing adolescent dams were fed control or high nutrient intakes to induce normal or growth-restricted pregnancies, respectively. Restricted lambs had ~40% reduced birthweight. Fractional growth rates were higher in restricted lambs of both sexes predominantly during suckling/juvenile phases. Thereafter, rates and patterns of growth differed by sex. Absolute catch-up was not achieved and restricted offspring had modestly reduced weight and stature at mid-adulthood necropsy (~109 weeks). Dual-energy X-ray absorptiometry revealed lower bone mineral density in restricted versus normal lambs at 11, 41, 64 and 107 weeks, with males>females from 41 weeks onwards. Body fat percentage was higher in females versus males throughout, in restricted versus normal lambs at weaning (both sexes), and in restricted versus normal females at mid-adulthood. Insulin secretion after glucose-challenge was greater in restricted versus normal of both sexes at 7 weeks, and in restricted-males at 32 weeks. In both sexes fasting glucose concentrations were greater in restricted offspring across the life-course, while glucose area-under-the-curve after challenge was higher in restricted offspring at 32, 60, 85 and 106 weeks, indicative of persistent glucose intolerance. Therefore prenatal growth-restriction has negative consequences for body composition and metabolism throughout the life-course with the effects modulated by sex differences in postnatal growth rates, fat deposition and bone mass accrual.

Human chorionic gonadotropin, fetal sex and risk of hypertensive disorders of pregnancy: A nested case-control study.

PubMed

Zheng, Qizhen; Deng, Yuqing; Zhong, Shilin; Shi, Yu

2016-01-01

To assess whether human chorionic gonadotropin (HCG) and fetal sex are two independent risk factors for hypertensive pregnancy in the early second-trimester of pregnancy. This was a retrospective nested case-control study based on a cohort of 2521 singleton pregnancies, among whom we recruited 98 hypertensive pregnancies (subdivided into severe preeclampsia, n=34; mild preeclampsia, n=29 and gestational hypertension, n=35) and 196 normotensive pregnancies. Maternal serum HCG levels were measured at 15-20 weeks of gestation and fetal sex was determined from the neonatal record. Mann-Whitney U and chi-square tests were performed to assess differences of HCG levels and fetal sex between groups. Logistic regressions were performed to evaluate the effect of HCG and fetal sex on hypertensive pregnancy. There were 35 male and 63 female fetuses in the hypertensive group, and 102 male and 94 female fetuses in the normotensive group (p=0.008). HCG (MoM) levels were significantly higher in only severe preeclamptic pregnancies (n=34) (p=0.013). There were no significant differences of the HCG (MoM) levels between male and female fetuses in each sub-group. aOR for increased maternal HCG levels and female fetus were 2.4 (95% CI: 1.434-3.954) and 2.9 (95% CI: 1.227-6.661) respectively in severe preeclamptic pregnancies compared with normotensive pregnancies. There is a female preponderance in hypertensive pregnancies. Increased HCG levels and female fetus are two independent risk factors for severe preeclampsia in the early second-trimester of pregnancy. Copyright © 2016 International Society for the Study of Hypertension in Pregnancy. Published by Elsevier B.V. All rights reserved.

Social inequality in pre-pregnancy BMI and gestational weight gain in the first and second pregnancy among women in Sweden.

PubMed

Holowko, Natalie; Chaparro, M Pia; Nilsson, Karina; Ivarsson, Anneli; Mishra, Gita; Koupil, Ilona; Goodman, Anna

2015-12-01

High pre-pregnancy body mass index (BMI) and inappropriate gestational weight gain (GWG) are associated with adverse short and long-term maternal and neonatal outcomes and may act as modifiable risk factors on the path to overweight/obesity, but their social patterning is not well established. This study investigates the association of education with BMI and GWG across two consecutive pregnancies. The study includes 163,352 Swedish women, having their first and second singleton birth in 1982-2010. In both pregnancies, we investigated the association of women's education with (1) pre-pregnancy weight status and (2) adequacy of GWG. We used multinomial logistic regression, adjusting for child's birth year, mother's age and smoking status. Overall, the odds of starting either pregnancy at an unhealthy BMI were higher among women with a low education compared to more highly-educated women. Lower education also predicted a greater increase in BMI between pregnancies, with this effect greatest among women with excessive GWG in the first pregnancy (p<0.0001 for interaction). Education was also inversely associated with odds of excessive GWG in both pregnancies among healthy weight status women, but this association was absent or even weakly reversed among overweight and obese women. Lower educated women had the largest BMI increase between pregnancies, and these inequalities were greatest among women with excessive GWG in the first pregnancy. The importance of a healthy pre-pregnancy BMI, appropriate GWG and a healthy postpartum weight should be communicated to all women, which may assist in reducing existing social inequalities in body weight. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Placenta previa and immediate outcome of the term offspring.

PubMed

Walfisch, Asnat; Sheiner, Eyal

2016-10-01

Immediate neonatal outcome in pregnancies complicated by placenta previa is largely dependent on gestational age. We aimed to investigate whether placenta previa increases the risk for perinatal mortality and immediate morbidity of the offspring born at term. A population-based cohort study included all singleton pregnancies, with and without placenta previa, delivered at term. Maternal and pregnancy characteristics as well as immediate neonatal morbidity and mortality were compared. Deliveries occurred between the years 1991-2013 in a tertiary medical center. Multiple pregnancies, and fetal congenital malformations were excluded. During the study period 233,123 consecutive term deliveries met the inclusion criteria; 0.2 % of the babies were born to mothers diagnosed with placenta previa. Women with placenta previa were significantly older and more likely to have had a previous cesarean section. Pregnancies were more likely to be complicated with pathological presentations and cesarean hysterectomies. Babies born at term following pregnancies with placenta previa were more likely to weigh less than 2500 g (OR 2.78 CI 1.9-3.9, p < 0.001). However, 5 min Apgar score and perinatal mortality rates were comparable between the groups. Neonatal outcomes remained comparable between the groups in a sub-analysis of cesarean deliveries only. Although placenta previa pregnancies involve higher maternal morbidity rates, term offsprings are not at an increased risk for immediate adverse outcome.

The perception of primiparous mothers of comfortable resources in labor pain (a qualitative study).

PubMed

Boryri, Tahereh; Noori, Noor Mohammad; Teimouri, Alireza; Yaghobinia, Fariba

2016-01-01

Natural delivery is the most painful event that women experience in their lifetime. That is why labor pain relief has long been as one of the most important issues in the field of midwifery. Thus, the present study aims to explore the perception of primiparous mothers on comfortable resources for labor pain. In the present study, qualitative content analysis technique was used. The participants had singleton pregnancy with normal vaginal delivery. These women referred to the Imam Javad Health Center within 3-5 days after delivery for screening thyroid of their babies. During the content analysis process, five themes emerged that indicated the nature and dimensions of the primiparous mothers' perception of comfortable resources. These themes were: "religious and spiritual beliefs," "use of analgesic methods" (medicinal and non-medicinal), "support and the continuous attendance of midwife and delivery room personnel," "family's and husband's support during pregnancy and in vaginal delivery encouragement," and finally "lack of familiarity with the delivery room and lack of awareness about structured delivery process." The results showed that mothers received more comfort from human resources than from the environment and modern equipment. Despite the need for specialized midwife with modern technical facilities, this issue shows the importance of highlighting the role of midwife and humanistic midwife care. Therefore, considering midwives and the standardization of human resources in health centers are more important than physical standardization. This will result in midwife interventions being performed with real understanding of the patients' needs.

Steroid concentrations in antepartum and postpartum saliva: normative values in women and correlations with serum

PubMed Central

2013-01-01

Background Saliva has been advocated as an alternative to serum or plasma for steroid monitoring. Little normative information is available concerning expected concentrations of the major reproductive steroids in saliva during pregnancy and the extended postpartum. Methods Matched serum and saliva specimens controlled for time of day and collected less than 30 minutes apart were obtained in 28 women with normal singleton pregnancies between 32 and 38 weeks of gestation and in 43 women during the first six months postpartum. Concentrations of six steroids (estriol, estradiol, progesterone, testosterone, cortisol, dehydroepiandrosterone) were quantified in saliva by enzyme immunoassay. Results For most of the steroids examined, concentrations in antepartum saliva showed linear increases near end of gestation, suggesting an increase in the bioavailable hormone component. Observed concentrations were in agreement with the limited data available from previous reports. Modal concentrations of the ovarian steroids were undetectable in postpartum saliva and, when detectable in individual women, approximated early follicular phase values. Only low to moderate correlations between the serum and salivary concentrations were found, suggesting that during the peripartum period saliva provides information that is not redundant to serum. Conclusions Low correlations in the late antepartum may be due to differential rates of change in the total and bioavailable fractions of the circulating steroid in the final weeks of the third trimester as a consequence of dynamic changes in carrier proteins such as corticosteroid binding globulin. PMID:23575245

Academic performance in adolescents born after ART-a nationwide registry-based cohort study.

PubMed

Spangmose, A L; Malchau, S S; Schmidt, L; Vassard, D; Rasmussen, S; Loft, A; Forman, J; Pinborg, A

2017-02-01

Is academic performance in adolescents aged 15-16 years and conceived after ART, measured as test scores in ninth grade, comparable to that for spontaneously conceived (SC) adolescents? ART singletons had a significantly lower mean test score in the adjusted analysis when compared with SC singletons, yet the differences were small and probably not of clinical relevance. Previous studies have shown similar intelligence quotient (IQ) levels in ART and SC children, but only a few have been on adolescents. Academic performance measured with standardized national tests has not previously been explored in a complete national cohort of adolescents conceived after ART. A Danish national registry-based cohort including all 4766 ART adolescents (n = 2836 singletons and n = 1930 twins) born in 1995-1998 were compared with two SC control cohorts: a randomly selected singleton population (n = 5660) and all twins (n = 7064) born from 1995 to 1998 in Denmark. Nine children who died during the follow-up period were excluded from the study. Mean test scores on a 7-point-marking scale from -3 to 12 were compared, and adjustments were made for relevant reproductive and socio-demographic covariates including occupational and educational level of the parents. The crude mean test score was higher in both ART singletons and ART twins compared with SC adolescents. The crude mean differences were +0.41 (95% CI 0.30-0.53) and +0.45 (95% CI 0.28-0.62) between ART and SC singletons and between ART and SC twins, respectively. However, the adjusted mean overall test score was significantly lower for ART singletons compared with SC singletons (adjusted mean difference -0.15 (95% CI -0.29-(-0.02))). For comparison, the adjusted mean difference was +2.05 (95% CI 1.82-2.28) between the highest and the lowest parental educational level, suggesting that the effect of ART is weak compared with the conventional predictors. The adjusted analyses showed significantly lower mean test scores in mathematics and physics/chemistry for ART singletons compared with SC singletons. Comparing ART twins with SC twins yielded no difference in academic performance in the adjusted analyses. Similar crude and adjusted overall mean test scores were found when comparing ART singletons and ART twins. Missing data on educational test scores occurred in 6.6% of adolescents aged 15-16 years for the birth cohorts 1995-1997, where all of the children according to their age should have passed the ninth grade exam at the time of data retrieval. As sensitivity analyses yielded no significant difference in the adjusted risk of having missing test scores between any of the groups, it is unlikely that this should bias our results. Adjustment for body mass index and smoking during pregnancy was not possible. As our results are based on national data, our findings can be applied to other populations. The findings of this paper suggest that a possible small negative effect of parental subfertility or ART treatment is counterbalanced by the higher educational level in the ART parents. The Danish Medical Association in Copenhagen (KMS) funded this study with a scholarship grant. None of the authors had any competing interests. 704676. © The Author 2017. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Competing risks model in screening for preeclampsia by maternal factors and biomarkers at 11-13 weeks gestation.

PubMed

O'Gorman, Neil; Wright, David; Syngelaki, Argyro; Akolekar, Ranjit; Wright, Alan; Poon, Leona C; Nicolaides, Kypros H

2016-01-01

Preeclampsia affects approximately 3% of all pregnancies and is a major cause of maternal and perinatal morbidity and death. In the last decade, extensive research has been devoted to early screening for preeclampsia with the aim of reducing the prevalence of the disease through pharmacologic intervention in the high-risk group starting from the first trimester of pregnancy. The purpose of this study was to develop a model for preeclampsia based on maternal demographic characteristics and medical history (maternal factors) and biomarkers. The data for this study were derived from prospective screening for adverse obstetric outcomes in women who attended for their routine first hospital visit at 11-13 weeks gestation in 2 maternity hospitals in England. We screened 35,948 singleton pregnancies that included 1058 pregnancies (2.9%) that experienced preeclampsia. Bayes theorem was used to combine the a priori risk from maternal factors with various combinations of uterine artery pulsatility index, mean arterial pressure, serum pregnancy-associated plasma protein-A, and placental growth factor multiple of the median values. Five-fold cross validation was used to assess the performance of screening for preeclampsia that delivered at <37 weeks gestation (preterm-preeclampsia) and ≥37 weeks gestation (term-preeclampsia) by models that combined maternal factors with individual biomarkers and their combination with screening by maternal factors alone. In pregnancies that experienced preeclampsia, the values of uterine artery pulsatility index and mean arterial pressure were increased, and the values of serum pregnancy-associated plasma protein-A and placental growth factor were decreased. For all biomarkers, the deviation from normal was greater for early than late preeclampsia; therefore, the performance of screening was related inversely to the gestational age at which delivery became necessary for maternal and/or fetal indications. Combined screening by maternal factors, uterine artery pulsatility index, mean arterial pressure, and placental growth factor predicted 75% (95% confidence interval, 70-80%) of preterm-preeclampsia and 47% (95% confidence interval, 44-51%) of term-preeclampsia, at a false-positive rate of 10%; inclusion of pregnancy-associated plasma protein-A did not improve the performance of screening. Such detection rates are superior to the respective values of 49% (95% confidence interval, 43-55%) and 38% (34-41%) that were achieved by screening with maternal factors alone. Combination of maternal factors and biomarkers provides effective first-trimester screening for preterm-preeclampsia. Copyright © 2016. Published by Elsevier Inc.

Mortality among twins and singletons in sub-Saharan Africa between 1995 and 2014: a pooled analysis of data from 90 Demographic and Health Surveys in 30 countries.

PubMed

Monden, Christiaan W S; Smits, Jeroen

2017-07-01

Sub-Saharan Africa has the world's highest under-5 and neonatal mortality rates as well as the highest naturally occurring twin rates. Twin pregnancies carry high risk for children and mothers. Under-5 mortality has declined in sub-Saharan Africa over the last decades. It is unknown whether twins have shared in this reduction. We pooled data from 90 Demographic and Health Surveys for 30 sub-Saharan Africa countries on births reported between 1995 and 2014. We used information on 1 685 110 singleton and 56 597 twin livebirths to compute trends in mortality rates for singletons and twins. We examined whether the twin-singleton rate ratio can be attributed to biological, socioeconomic, care-related factors, or birth size, and estimated the mortality burden among sub-Saharan African twins. Under-5 mortality among twins has declined from 327·7 (95% CI 312·0-343·5) per 1000 livebirths in 1995-2001 to 213·0 (196·7-229·2) in 2009-14. This decline of 35·0% was much less steep than the 50·6% reduction among singletons (from 128·6 [95% CI 126·4-130·8] per 1000 livebirths in 1995-2001 to 63·5 [61·6-65·3] in 2009-14). Twins account for an increasing share of under-5 deaths in sub-Saharan Africa: currently 10·7% of under-5 mortality and 15·1% of neonatal mortality. We estimated that about 315 000 twins (uncertainty interval 289 000-343 000) die in sub-Saharan African each year. Excess twin mortality cannot be explained by common risk factors for under-5 mortality, including birthweight. The difference with singletons was especially stark for neonatal mortality (rate ratio 5·0, 95% CI 4·5-5·6). 51·7% of women pregnant with twins reported receiving medical assistance at birth. The fate of twins in sub-Saharan Africa is lagging behind that of singletons. An alarming one-fifth of twins in the region dies before age 5 years, three times the mortality rate among singletons. Twins account for a substantial and growing share of under-5 and neonatal mortality, but they are largely neglected in the literature. Coordinated action is required to improve the situation of this extremely vulnerable group. None. Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Transvaginal ultrasonographic measurement of cervical length in asymptomatic high-risk women with a short cervical length in the previous pregnancy.

PubMed

Crane, J M G; Hutchens, D

2011-07-01

To determine if asymptomatic women at high risk of preterm delivery who had a short cervical length in their previous pregnancy and delivered at term are at increased risk of having a short cervical length in their next pregnancy, and whether they are at increased risk of preterm birth. This retrospective cohort study included high-risk (those with a history of spontaneous preterm birth, uterine anomaly or excisional treatment for cervical dysplasia) asymptomatic women who were pregnant with a singleton gestation delivering between April 2003 and March 2010, who had had a previous pregnancy and who had transvaginal ultrasonographic cervical length measurement performed at 16-30 weeks' gestation in both pregnancies. Comparison was among women who had a short cervical length (< 3.0 cm) in their previous pregnancy but delivered at term in that pregnancy (Short Term Group), women with a history of a normal cervical length (≥ 3.0 cm) in their previous pregnancy delivering at term (Long Term Group), and women who had a short cervical length (< 3.0 cm) in their previous pregnancy delivering preterm (Short Preterm Group). Primary outcomes were spontaneous preterm birth at < 37 weeks' gestation and cervical length. Secondary outcomes were spontaneous preterm birth at < 35 weeks and < 32 weeks, low birth weight, maternal outcomes and neonatal morbidity. A total of 62 women were included. Women in the Short Term Group were more likely to have a short cervical length in their next pregnancy compared with those in the Long Term Group (10/23 (43.5%) vs. 4/26 (15.4%), respectively) but not as likely as women in the Short Preterm Group (9/13 (69.2%); P=0.003). Women in the Short Term Group were not at an increased risk of spontaneous preterm birth at < 37 weeks in the next pregnancy compared with women in the Long Term Group (2/23 (8.7%) vs. 2/26 (7.7%), respectively), but women in the Short Preterm Group were at an increased risk (6/13 (46.2%); P<0.0001). Compared with women in the Short Term and Long Term groups, women in the Short Preterm Group were also at an increased risk of threatened preterm labor (6/23 (26.1%) and 4/26 (15.4%) vs. 9/13 (69.2%), respectively; P=0.002) and of receiving corticosteroids for fetal lung maturation (6/23 (26.1%) and 4/26 (15.4%) vs. 11/13 (84.6%), respectively; P<0.0001). Although high-risk asymptomatic women with a short cervical length in their previous pregnancy who delivered at term are at increased risk of having a short cervix in their next pregnancy, they are not at increased risk of preterm birth. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.

Birthweight and placental weight; do changes in culture media used for IVF matter? Comparisons with spontaneous pregnancies in the corresponding time periods.

PubMed

Eskild, Anne; Monkerud, Lars; Tanbo, Tom

2013-12-01

Have changes in culture media used for IVF resulted in changes in offspring birthweight or placental weight that differed from the trends in offspring from spontaneous conceptions during the corresponding time periods? Changes in culture media used for IVF were associated with significant differences in offspring birthweight and in placental weight to birthweight ratio when compared with the trend in offspring from spontaneous conceptions during the time periods. The effect of culture media used for IVF on offspring birthweight has varied between studies. There is a large variation in birthweight between newborns, and birthweight may vary across populations and over time. Such variations may therefore have influenced previous results. We included all singleton births from IVF at one treatment center in Norway during the years 1999-2011(n = 2435) and all singleton births from spontaneous conceptions in Norway during the same years (n = 698 359). Three different media were used for embryo culture; Medicult Universal IVF (1999 through 2007, n = 1584), Medicult ISM1 (2008 until 20 September 2009, n = 402) and Vitrolife G-1 PLUS (21 September 2009 through 2011, n = 449). We estimated mean birthweight and placental weight in IVF pregnancies by culture media. We also estimated mean weights in IVF and in spontaneous pregnancies by year of birth. Thereafter, we studied whether the changes in mean weights in IVF pregnancies differed from the changes in weight in spontaneous pregnancies in the periods corresponding to culture media changes by applying a grouped difference-in-difference analysis. Adjustments were made for parity, maternal age and gestational age at birth. In singleton offspring from IVF the mean birthweight was 3447.6 g with Medicult Universal, 3351.7 g with Medicult ISM1 and 3441.4 g with Vitrolife G-1 PLUS (P < 0.05). The corresponding mean placental weights were 684.1, 693.4 and 704.3 g (P < 0.05). In offspring from spontaneous conceptions the mean birthweight decreased (56.9 g) and the placental weight increased (9.3 g) during the study period. The adjusted difference in birthweight in offspring from IVF decreased with 35.0 g by the change from Medicult Universal to Medicult ISM1 (P = 0.16) and increased with 79.9 g by the change from Medicult ISM1 to Vitrolife G-1 PLUS (P = 0.01) when compared with changes in offspring after spontaneous conceptions, We also found a significant increase in placental weight in relation to birthweight by the change from Medicult ISM1 to Vitrolife G-1 PLUS (P = 0.02). There may be underlying factors that have influenced both birthweight and the use of culture media in IVF pregnancies. Lack of adjustment for such possible factors may have biased our results. We found a significant effect of culture media used for IVF on birthweight and on placental weight in relation to birthweight. Also the population changes over time should encourage identification of factors in very early embryonic life that may influence birthweight and placental weight. We received funding from the South-Eastern Regional Health Authority in Norway for this study (2011136-2012). None of the authors has any conflicts of interest to declare.

Early prediction of hypertension during pregnancy in a low-resource setting.

PubMed

Kumar, Manisha; Gupta, Usha; Bhattacharjee, Jayashree; Singh, Ritu; Singh, Shalini; Goel, Manish; Sharma, Karuna; Rehman, Mujeeb U

2016-02-01

To evaluate the role of maternal factors, biomarkers, and uterine-artery Doppler in the prediction of hypertension during pregnancy. A prospective cohort study was performed between December 2012 and November 2014. All singleton pregnancies between 11 weeks and 13 weeks, 6 days of pregnancy were included. Patients had their body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters), mean arterial pressure, uterine-artery Doppler pulsatility index, and pregnancy-associated plasma protein A (PAPP-A) and free β-human chorionic gonadotropin levels recorded. Any patients diagnosed with hypertension during follow-up were assigned to the case cohort; all other patients were assigned to the control group. Hypertension during pregnancy was observed in 198 (9.7%) of 2042 patients that attended follow-up. The mean BMI, mean arterial pressure, uterine-artery Doppler pulsatility index, and the PAPP-A level at study enrollment were all significantly correlated with the later development of hypertension (P<0.001 for all variables). The combined sensitivity, specificity, positive predictive value, and negative predictive value of using the investigated parameters to predict hypertension was 76%, 80%, 31%, and 93%, respectively. Patient BMI, mean arterial pressure, PAPP-A, and pulsatility index were found to be effective predictors of hypertension during pregnancy. Combining these predictors may be beneficial in selecting individuals for close monitoring and early intervention during pregnancy. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Trisomy 13 and the risk of gestational hypertensive disorders: a population-based study.

PubMed

Dotters-Katz, Sarah K; Humphrey, Whitney M; Senz, Kayli L; Lee, Vanessa R; Shaffer, Brian L; Kuller, Jeffrey A; Caughey, Aaron B

2018-08-01

To describe the rate and severity of gestational hypertensive disorders (GHDs) in pregnancies complicated by trisomy 13 (T13). Retrospective cohort study of singleton deliveries in California from 2005 to 2008 using vital statistics and ICD-9 data. We were interested in gestational hypertension (gHTN), preeclampsia with and without severe features (sPREX and PREX), and gestational age at delivery. Pregnancies and maternal complications affected by prenatally diagnosed T13 were compared to unaffected pregnancies. Regression models were used to compute adjusted odds ratios for pregnancy outcomes by T13 status. Of the 2,029,004 deliveries, 142 women had prenatally diagnosed T13. A diagnosis of GHD occurred in 26.8% of the T13 pregnancies versus 6% of the non-T13 pregnancies (p < .001). This remained true for gHTN (9.2% versus 3.2%, p=.001), PREX (12% versus 2.2%, p < .001), and sPREX (8.5% versus 0.9%, p < .001). After adjusting for confounders, T13 pregnancies were 6.3-times more likely to be affected by GHD, and 12.5-times more likely to have sPREX. Delivery <37 and <32 weeks in the setting of GHD was 14.1-times and 11.2-times likely among women with T13. Women with T13 pregnancies were significantly more likely to have gHTN, preeclampsia, sPREX, and to deliver <32 weeks.

Placental weight in the first pregnancy and risk for preeclampsia in the second pregnancy: A population-based study of 186 859 women.

PubMed

Dypvik, Johanne; Larsen, Sandra; Haavaldsen, Camilla; Jukic, Anne M; Vatten, Lars J; Eskild, Anne

2017-07-01

To study whether placental weight in the first pregnancy is associated with preeclampsia in the second pregnancy. In this population-based study, we included all women with two consecutive singleton pregnancies reported to the Medical Birth Registry of Norway during 1999-2012 (n=186 859). Placental weight in the first pregnancy was calculated as z-scores, and the distribution was divided into five groups of equal size (quintiles). We estimated crude and adjusted odds ratios with 95% confidence intervals for preeclampsia in the second pregnancy according to quintiles of placental weight z-scores in the first pregnancy. The 3rd quintile was used as the reference group. Among women without preeclampsia in the first pregnancy, 1.4% (2507/177 149) developed preeclampsia in the second pregnancy. In these women, the risk for preeclampsia in the second pregnancy was associated with placental weight in the first pregnancy in both lowest (crude odds ratio (cOR) 1.30, 95% confidence interval (CI); 1.14-1.47) and highest quintile (cOR 1.20, 95% CI; 1.06-1.36). The risk associated with the highest quintile of placental weight was confined to term preeclampsia. Among women with preeclampsia in the first pregnancy, 15.7% (1522/9710) developed recurrent preeclampsia, and the risk for recurrent preeclampsia was associated with placental weight in lowest quintile in the first pregnancy (cOR 1.30, 95% CI; 1.10-1.55). Adjustment for interval between pregnancies, maternal diabetes, age, and smoking in the first pregnancy did not alter these estimates notably. Placental weight in the first pregnancy might help to identify women who could be at risk for developing preeclampsia in a second pregnancy. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Assessing long-run economic benefits attributed to an IVF-conceived singleton based on projected lifetime net tax contributions in the UK.

PubMed

Connolly, M; Gallo, F; Hoorens, S; Ledger, W

2009-03-01

Over the past decade, demand for fertility treatments has increased as a result of delaying time to first pregnancy and growing awareness and acceptance of available treatment options. Despite increasing demand, health authorities often view infertility as a low health priority and consequently limit access to treatments by rationing and limiting funds. To assess the long-term economic benefits attributed to in vitro fertilization (IVF)-conceived children, we developed a health investment model to evaluate whether state-funded IVF programmes in the UK represent sound fiscal policies. Based on the average investment cost to conceive an IVF singleton, we describe the present value of net taxes derived from gross taxes paid minus direct government transfers received (e.g. education, health, pension) over the lifetime of the child. To establish the present value of investing in IVF, we have discounted all costs from benefits (i.e. lifetime taxes paid) using UK Treasury department rates based on a singleton delivery with similar characteristics for education, earnings, health and life expectancy to a naturally conceived child. The lifetime discounted value of net taxes from an IVF-conceived child with mother aged 35 is pound 109,939 compared with pound 122,127 for a naturally conceived child. The lifetime undiscounted net tax contribution for the IVF-conceived child and naturally conceived child are pound 603,000 and pound 616,000, respectively. An investment of pound 12,931 to achieve an IVF singleton is actually worth 8.5-times this amount to the UK Treasury in discounted future tax revenue. The analysis underscores that costs to the health sector are actually investments when a broader government perspective is considered over a longer period of time.

Embryo number and periconceptional undernutrition in the sheep have differential effects on adrenal epigenotype, growth, and development

PubMed Central

Williams-Wyss, Olivia; Zhang, Song; MacLaughlin, Severence M.; Kleemann, David; Walker, Simon K.; Suter, Catherine M.; Cropley, Jennifer E.; Morrison, Janna L.; Roberts, Claire T.

2014-01-01

Exposure to poor maternal nutrition around the time of conception results in an early prepartum activation of the fetal pituitary-adrenal axis and in increased adrenal growth and stress response after birth associated with epigenetic changes in a differentially methylated region (DMR) of adrenal IGF2/H19. We have determined the effects of maternal undernutrition during the periconceptional period (PCUN: 70% of control intake from 60 days before until 6 days after conception) and early preimplantation period (PIUN: 70% of control intake for 6 days after conception) on fetal plasma ACTH and cortisol concentrations and fetal adrenal ACTHR, StAR, 3βHSD, CYP11B, CYP17, TGFβ1, IGF1, IGF1R, IGF2, and IGF2R mRNA expression and the methylation level of sites within the DMRs of IGF2/H19 and IGF2R in the adrenal of twin and singleton fetuses at 136–138 days gestation. Being a twin resulted in a delayed prepartum increase in fetal ACTH and in a lower cortisol response to CRH in the control but not PCUN and PIUN groups. PCUN, but not PIUN, resulted in an increase in adrenal weight and CYP17 expression in singletons, a decrease in adrenal IGF2 expression in singletons, and an increase in adrenal IGF2R expression in both twins and singletons. IGF2/H19 and IGF2R DMR methylation levels and ACTHR expression were lower in the twin adrenal. Thus, exposure of the oocyte and embryo to maternal undernutrition or to the environment of a twin pregnancy have differential effects on epigenetic and other factors that regulate fetal adrenal growth and IGF2 and IGF2R expression. PMID:24844259

Gestational Weight Gain and Post-Partum Weight Loss Among Young, Low-Income, Ethnic Minority Women

PubMed Central

ROTHBERG, Bonnie E. Gould; MAGRIPLES, Urania; KERSHAW, Trace S.; RISING, Sharon Schindler; ICKOVICS, Jeannette R.

2010-01-01

Objective Document weight change trajectories that lead to gestational weight gain or postpartum weight loss outside clinical recommendations established by Institute of Medicine (IOM). Methods Women aged 14-25 receiving prenatal care and delivering singleton infants at term (N=427). Medical record review and four structured interviews conducted: second and third trimester, 6- and 12-months postpartum. Longitudinal mixed modeling to evaluate weight change trajectories. Results Only 22% of participants gained gestational weight within IOM guidelines. 62% exceeded maximum recommendations -- more common among those overweight/obese (BMI≥25.0; p<0.0001). 52% retained ≥10 pounds one-year postpartum. Increased weight gain and retention documented among smokers and women with pregnancy-induced hypertension; breastfeeding promoted postpartum weight loss (all p<.02). BMI by race interaction suggested healthier outcomes for Latinas (p=0.02). Conclusion Excessive pregnancy weight gain and inadequate postpartum weight loss are highly prevalent among young low-income ethnic minority women. Pregnancy and postpartum are critical junctures for weight management interventions. PMID:20974459

Prevalence and predictors of unintended pregnancy among women: an analysis of the Canadian Maternity Experiences Survey.

PubMed

Oulman, Elizaveta; Kim, Theresa H M; Yunis, Khalid; Tamim, Hala

2015-10-13

Unintended pregnancies (mistimed or unwanted during the time of conception) can result in adverse outcomes both to the mother and to her newborn. Further research on identifying the characteristics of unintended pregnant women who are at risk is warranted. The present study aims to examine the prevalence and predictors of unintended pregnancy among Canadian women. The analysis was based on the 2006 Maternity Experiences Survey targeting women who were at least 15 years of age and who had a singleton live birth, between February 15, 2006 to May 15, 2006 in the Canadian provinces and November 1, 2005 to February 1, 2006 for women in the Canadian territories. The primary outcome was the mother's pregnancy intention, where unintended pregnancy was defined as women who wanted to become pregnant later or not at all. Sociodemographic, maternal and pregnancy related variables were considered for a multivariable logistic regression. Adjusted Odds Ratios (OR) and 95% Confidence Intervals (95% CI) were reported. Overall, the prevalence of unintended pregnancy among Canadian women was 27%. The odds of experiencing an unintended pregnancy were statistically significantly increased if the mother was: under 20 years of age, immigrated to Canada, had an equivalent of a high school education or less, no partner, experienced violence or abuse and had 1 or more previous pregnancies. Additionally, mothers who reported smoking, drinking alcohol and using drugs prior to becoming pregnant, were all associated with an increased likelihood of experiencing an unintended pregnancy. The study findings constitute the basis for future research into these associations to aid in developing effective policy changes and interventions to minimize the odds of experiencing an unintended pregnancy and its associated consequences.

Predicting preeclampsia from a history of preterm birth.

PubMed

Rasmussen, Svein; Ebbing, Cathrine; Irgens, Lorentz M

2017-01-01

To assess whether women with a history of preterm birth, independent on the presence of prelabour rupture of the membranes (PROM) and growth deviation of the newborn, are more likely to develop preeclampsia with preterm or preterm birth in a subsequent pregnancy. We conducted a population-based cohort study, based on Medical Birth Registry of Norway between 1967 and 2012, including 742,980 women with singleton pregnancies who were followed up from their 1st to 2nd pregnancy. In the analyses we included 712,511 women after excluding 30,469 women with preeclampsia in the first pregnancy. After preterm birth without preeclampsia in the first pregnancy, the risk of preterm preeclampsia in the second pregnancy was 4-7 fold higher than after term birth (odds ratios 3.5; 95% confidence interval (CI) 3.0-4.0 to 6.5; 95% CI 5.1-8.2). The risk of term preeclampsia in the pregnancy following a preterm birth was 2-3 times higher than after term birth (odds ratios 1.6; 95% CI 1.5-1.8 to 2.6; 95% CI 2.0-3.4). After spontaneous non-PROM preterm birth and preterm PROM, the risk of preterm preeclampsia was 3.3-3.6 fold higher than after spontaneous term birth. Corresponding risks of term preeclampsia was 1.6-1.8 fold higher. No significant time trends were found in the effect of spontaneous preterm birth in the first pregnancy on preterm or term preeclampsia in the second pregnancy. The results suggest that preterm birth, regardless of the presence of PROM, and preeclampsia share pathophysiologic mechanisms. These mechanisms may cause preterm birth in one pregnancy and preeclampsia in a subsequent pregnancy in the same woman. The association was particularly evident with preterm preeclampsia.

Discriminant analysis forecasting model of first trimester pregnancy outcomes developed by following 9,963 infertile patients after in vitro fertilization.

PubMed

Yi, Yan; Li, Xihong; Ouyang, Yan; Lin, Ge; Lu, Guangxiu; Gong, Fei

2016-05-01

To investigate a forecasting method developed to predict first trimester pregnancy outcomes using the first routine ultrasound scan for early pregnancy on days 27-29 after ET and to determine whether to perform a repeated scan several days later based on this forecasting method. Prospective analysis. Infertile patients at an assisted reproductive technology center. A total of 9,963 patients with an early singleton pregnancy after in vitro fertilization (IVF)-ET. None. Ongoing pregnancy >12 weeks of gestation. The classification score of ongoing pregnancy was equal to (1.57 × Maternal age) + (1.01 × Mean sac diameter) + (-0.19 × Crown-rump length) + 25.15 (if cardiac activity is present) + 1.30 (if intrauterine hematomas are present) - 47.35. The classification score of early pregnancy loss was equal to (1.66 × Maternal age) + (0.84 × Mean sac diameter) + (-0.38 × Crown-rump length) + 8.69 (if cardiac activity is present) + 1.60 (if intrauterine hematomas are present) - 34.77. In verification samples, 94.44% of cases were correctly classified using these forecasting models. The discriminant forecasting models are accurate in predicting first trimester pregnancy outcomes based on the first scan for early pregnancy after ET. When the predictive result is ongoing pregnancy, a second scan can be postponed until 11-14 weeks if no symptoms of abdominal pain or vaginal bleeding are present. When the predictive results suggest early pregnancy loss, repeated scans are imperative to avoid a misdiagnosis before evacuating the uterus. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Prevalence, antenatal management and perinatal outcomes of monochorionic monoamniotic twin pregnancies: a collaborative multicentre study in England, 2000-2013.

PubMed

Glinianaia, Svetlana V; Rankin, Judith; Khalil, Asma; Binder, Julia; Waring, Gareth; Sturgiss, Stephen N; Thilaganathan, Basky; Hannon, Therese

2018-06-13

To determine the prevalence of monochorionic monoamniotic (MCMA) twin pregnancies and to describe perinatal outcomes and clinical management of these pregnancies. This multicentre cohort study used population-based data on MCMA twin pregnancies from 11 Northern Survey of Twin and Multiple Pregnancy (NorSTAMP) maternity units for the prevalence estimation of MCMA twinning. Pregnancy outcomes at <24 weeks' gestation, antenatal parameters and perinatal outcomes (from ≥24 weeks to the first 28 days of life) were analysed using combined data on pregnancies with confirmed MCMA chorionicity from the NorSTAMP and the Southwest Thames Region of London Obstetric Research Collaborative (STORK) multiple pregnancy cohort for 2000-2013. The estimated total prevalence of MCMA twin pregnancies in the North of England was 8.2 per 1000 total twin pregnancies (59/7170), the birth prevalence was 0.08 per 1000 all (singleton and multiple) pregnancies. The rate of a spontaneous or iatrogenic fetal death at <24 weeks' gestation was 31.8% (54/170); the overall perinatal mortality was 14.7% (17/116), ranging from 69.2% at <30 weeks to 4.5% at ≥33 weeks' gestation. MCMA twins who survived in utero beyond 24 weeks were delivered, usually by caesarean section, at a median of 33 weeks of gestation (interquartile range=32-34). In MCMA twins surviving beyond 24 weeks of gestation, there was a higher survival rate compared to previous decades presumably due to early diagnosis, close surveillance and elective birth around 32-34 weeks of gestation. High perinatal mortality at early gestations was mainly attributed to extreme prematurity due to preterm spontaneous labour. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Obstetric and perinatal outcomes of singletons after single blastocyst transfer: is there any difference according to blastocyst morphology?

PubMed

Bouillon, Céline; Celton, Noémie; Kassem, Sandra; Frapsauce, Cynthia; Guérif, Fabrice

2017-08-01

A strong correlation between blastocyst morphology and implantation has been shown by many studies. The consequences and effects of assisted reproductive techniques on children's short and long-term health have always been a source of discussion. The obstetric and perinatal outcome of singletons according to blastocyst morphology has rarely been evaluated. The aim of this observational study is to determine whether a relationship exists between blastocyst morphology and obstetric and perinatal outcomes. A total of 799 singleton clinical pregnancies were analysed after transfer of a single fresh blastocyst on day 5 between 2006 and 2013. Blastocysts were divided into four groups based on their morphology on day 5: group 1 = good morphology blastocysts; group 2 = fair morphology blastocysts; group 3 = poor morphology blastocysts and group 4 = early (B1/B2) blastocysts. Obstetric and perinatal outcomes were compared between the four groups. After adjustment for some confounding variables, main obstetric and perinatal outcomes after transfer of blastocysts with poor morphological characteristics were not associated with increased adverse obstetric and perinatal events. Sex ratio was significantly higher in group 1 compared with groups 2, 3 and 4, and in Group 2 compared with Group 3 (P < 0.001) even after adjustment (P < 0.05). Copyright © 2017 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

The Ontario Birth Study: A prospective pregnancy cohort study integrating perinatal research into clinical care.

PubMed

Anderson, Laura N; Knight, Julia A; Hung, Rayjean J; Hewko, Sheryl L; Seeto, Ryan A; Martin, Mary-Jean; Fleming, Alison; Maguire, Jonathon L; Matthews, Stephen G; Murphy, Kellie E; Okun, Nan; Jenkins, Jennifer M; Lye, Stephen J; Bocking, Alan

2018-05-01

Pregnancy and early childhood represent critical periods that impact health throughout the life-course. The Ontario Birth Study (OBS) is a pregnancy cohort study designed as a platform for research on pregnancy complications, maternal and infant health, and the developmental origins of health and disease. Pregnant women <17 weeks gestational age were recruited between 2013 and 2015 from antenatal clinics at Mount Sinai Hospital, Toronto, Canada. Life style and diet questionnaires, biospecimens, and clinical data were collected throughout the pregnancy and postpartum period at the time of clinical care. The OBS was integrated into clinical care to reduce participant burden, improve efficiency, and increase research potential. There were 3181 eligible women approached for recruitment and 1374 (43%) participated in the study. Among the 1374 participants, 1272 (93%) delivered a liveborn infant and were followed to 6-10 weeks postpartum. Of the 1272 women who completed the study, 98% had at least one pregnancy blood sample collected, 97% had vaginal swabs collected, 90% completed the prenatal life style questionnaires, and 78% completed the Diet History Questionnaire. Most women (88%) were ≥30 years of age, 55% had no previous children, 24% were overweight or obese pre-pregnancy and 78% of parents had postsecondary education. Most pregnancies were singleton (3% twins), 34% delivered by caesarean section, and 6% preterm (<37 weeks gestation). The OBS is a contemporary cohort with detailed data including banked biospecimens for studies of pregnancy health and the gene-environment interactions that establish developmental trajectories to health, learning, and social functioning. © 2018 John Wiley & Sons Ltd.

Experience of in vitro fertilization surrogacy in Finland.

PubMed

Söderström-Anttila, Viveca; Blomqvist, Tom; Foudila, Tuija; Hippeläinen, Maritta; Kurunmäki, Henri; Siegberg, Rita; Tulppala, Maija; Tuomi-Nikula, Merja; Vilska, Sirpa; Hovatta, Outi

2002-08-01

In vitro fertilization (IVF) surrogacy makes it possible for women who do not have a functional uterus to have their own genetic offspring. We describe here our experience of IVF surrogacy in Finland over a 10-year period. This retrospective study included 17 women who underwent ovarian stimulation in connection with surrogacy in 1991-2001 at four clinics. The surrogate mothers were unpaid volunteers: six sisters, three mothers, one husband's sister, one cousin, four friends and three other volunteers. Thorough counseling was given to the commissioning couples and to the surrogate mothers and their partners. The commissioning couples were prepared to adopt their biological children. Twenty-eight surrogate IVF cycles were started in 17 women. One couple received donated oocytes. Trans-vaginal oocyte retrieval was feasible in every case, including those five women with congenital absence of the vagina and uterus. An average of 1.8 embryos was transferred at a time, and 11 pregnancies were achieved [50% per fresh embryo transfer (ET) and 16% per frozen-thawed ET]. Nine healthy singletons and one set of twins were born. One pregnancy ended in miscarriage. The mean birth weight of singleton infants was 3498 g (2270-4650 g). The birth weights of the twins were 2900 and 2400 g. In all cases the genetic parents took care of the infant immediately after birth. Two surrogate mothers had postpartum depression. Altruistic IVF surrogacy works well, but careful counseling of all parties involved is essential.

Economic Conditions During Pregnancy and Adverse Birth Outcomes Among Singleton Live Births in the United States, 1990-2013.

PubMed

Margerison-Zilko, Claire E; Li, Yu; Luo, Zhehui

2017-11-15

We know little about the relationship between the macroeconomy and birth outcomes, in part due to the methodological challenge of distinguishing effects of economic conditions on fetal health from effects of economic conditions on selection into live birth. We examined associations between state-level unemployment rates in the first 2 trimesters of pregnancy and adverse birth outcomes, using natality data on singleton live births in the United States during 1990-2013. We used fixed-effect logistic regression models and accounted for selection by adjusting for state-level unemployment before conception and maternal characteristics associated with both selection and birth outcomes. We also tested whether associations between macroeconomic conditions and birth outcomes differed during and after (compared with before) the Great Recession (2007-2009). Each 1-percentage-point increase in the first-trimester unemployment rate was associated with a 5% increase in odds of preterm birth, while second-trimester unemployment was associated with a 3% decrease in preterm birth odds. During the Great Recession, however, first-trimester unemployment was associated with a 16% increase in odds of preterm birth. These findings increase our understanding of the effects of the Great Recession on health and add to growing literature suggesting that macro-level social and economic factors contribute to perinatal health. © The Author(s) 2017. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Fertility treatment and childhood type 1 diabetes mellitus: a nationwide cohort study of 565,116 live births.

PubMed

Kettner, Laura Ozer; Matthiesen, Niels Bjerregaard; Ramlau-Hansen, Cecilia Høst; Kesmodel, Ulrik Schiøler; Bay, Bjørn; Henriksen, Tine Brink

2016-12-01

To investigate the association between specific types of fertility treatment and childhood type 1 diabetes mellitus. Nationwide birth cohort study. Not applicable. All pregnancies resulting in a live-born singleton child in Denmark from 1995 to 2003. Not applicable. Childhood type 1 diabetes mellitus identified from redeemed prescriptions for insulin until 2013. The study included 565,116 singleton pregnancies. A total of 14,985 children were conceived by ovulation induction or intrauterine insemination, and 8,490 children were conceived by in vitro fertilization or intracytoplasmic sperm injection. During the follow-up period, 2,011 (0.4%) children developed type 1 diabetes mellitus. The primary analyses showed no association between fertility treatment and childhood type 1 diabetes mellitus. In secondary analyses, ovulation induction or intrauterine insemination with follicle-stimulating hormone was associated with an increased risk of type 1 diabetes mellitus (hazard ratio 3.22; 95% confidence interval 1.20 to 8.64). No clear associations were seen with other types of fertility treatment or with specific treatment indications. No association between fertility treatment and childhood type 1 diabetes mellitus was found. Ovulation induction or intrauterine insemination with follicle-stimulating hormone may be associated with an increased risk of childhood type 1 diabetes mellitus. However, this finding may be due to chance or to confounding by indication and thus requires further investigation. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Are congenital malformations more frequent in fetuses with intrahepatic persistent right umbilical vein? A comparative study.

PubMed

Adiego-Calvo, Ignacio; Saviron-Cornudella, Ricardo; Martinez-Payo, Cristina; Rubio-Aranda, Encarna; Sancho-Sauco, Javier; Cisneros-Gimeno, Ana Isabel; Perez-Perez, Pilar; Lerma-Puertas, Diego; Whyte-Orozco, Jaime

2016-12-01

Persistent right umbilical vein (PRUV) is a vascular anomaly where the right umbilical vein remains as the only conduit that returns oxygenated blood to the fetus. It has classically been described as associated with numerous defects. We distinguish the intrahepatic variant (better prognosis) and the extrahepatic variant (associated with worse prognosis). The objective of this study was to compare rates of congenital malformations in fetuses with intrahepatic PRUV (I-PRUV) versus singleton pregnancies without risk factors. A multicenter, crossover design, comparative study was performed between 2003 and 2013 on fetuses diagnosed with I-PRUV (n=56), and singleton pregnancies without congenital malformation risk factors (n=4050). Fifty-six cases of I-PRUV were diagnosed (incidence 1:770). A statistically significant association between I-PRUV and the presence of congenital malformations (odds ratio 4.321; 95% confidence interval 2.15-8.69) was found. This positive association was only observed with genitourinary malformations (odds ratio 3.038; 95% confidence interval 1.08-8.56). Our rate of malformations associated with I-PRUV (17.9%) is similar to previously published rates. I-PRUV has shown a significant increase in the rate of associated malformations, although this association has only been found to be statistically significant in the genitourinary system. Noteworthy is the fact that this comparative study has not pointed to a significant increase in the congenital heart malformation rate. Diagnosis of isolated I-PRUV does not carry a worse prognosis. Copyright © 2016. Published by Elsevier B.V.

Association between oocyte number retrieved with live birth rate and birth weight: an analysis of 231,815 cycles of in vitro fertilization

PubMed Central

Baker, Valerie L.; Brown, Morton B.; Luke, Barbara; Conrad, Kirk P.

2015-01-01

Objective To determine if number of oocytes correlates with live birth rate and incidence of low birthweight (LBW). Design Retrospective cohort. Setting N/A. Patients Women undergoing fresh embryo transfer utilizing either autologous (n=194,627) or donor (n=37,188) oocytes whose cycles were reported to the Society for Assisted Reproductive Technology 2004–2010. Main outcome measures Live birth rate, birthweight, birth weight z-score, LBW. Interventions None. Results For both autologous and donor oocyte cycles, increasing number of oocytes retrieved paralleled live birth rate and embryos available for cryopreservation in most analyses performed with all models adjusted for age and prior births. For cycles achieving singleton pregnancy using autologous oocytes via transfer of 2 embryos, a higher number of oocytes retrieved was associated with lower mean birth weight, lower birthweight z-score, and greater incidence of LBW. In contrast, for cycles using donor oocytes, there was no association of oocyte number retrieved with measures of birthweight. Conclusions A higher number of oocytes retrieved was associated with an increased incidence of LBW in autologous singleton pregnancies resulting from transfer of 2 embryos but not in donor oocyte cycles. Although the effect of high oocyte number on the incidence of LBW in autologous cycles was of modest magnitude, further study is warranted to determine if a subgroup of women may be particularly vulnerable. PMID:25638421

[Estimation of the atrioventricular time interval by pulse Doppler in the normal fetal heart].

PubMed

Hamela-Olkowska, Anita; Dangel, Joanna

2009-08-01

To assess normative values of the fetal atrioventricular (AV) time interval by pulse-wave Doppler methods on 5-chamber view. Fetal echocardiography exams were performed using Acuson Sequoia 512 in 140 singleton fetuses at 18 to 40 weeks of gestation with sinus rhythm and normal cardiac and extracardiac anatomy. Pulsed Doppler derived AV intervals were measured from left ventricular inflow/outflow view using transabdominal convex 3.5-6 MHz probe. The values of AV time interval ranged from 100 to 150 ms (mean 123 +/- 11.2). The AV interval was negatively correlated with the heart rhythm (p<0.001). Fetal heart rate decreased as gestation progressed (p<0.001). Thus, the AV intervals increased with the age of gestation (p=0.007). However, in the same subgroup of the fetal heart rate there was no relation between AV intervals and gestational age. Therefore, the AV intervals showed only the heart rate dependence. The 95th percentiles of AV intervals according to FHR ranged from 135 to 148 ms. 1. The AV interval duration was negatively correlated with the heart rhythm. 2. Measurement of AV time interval is easy to perform and has a good reproducibility. It may be used for the fetal heart block screening in anti-Ro and anti-La positive pregnancies. 3. Normative values established in the study may help obstetricians in assessing fetal abnormalities of the AV conduction.

Pregnancy outcome in joint hypermobility syndrome and Ehlers-Danlos syndrome.

PubMed

Sundelin, Heléne E K; Stephansson, Olof; Johansson, Kari; Ludvigsson, Jonas F

2017-01-01

An increased risk of preterm birth in women with joint hypermobility syndrome or Ehlers-Danlos syndrome is suspected. In this nationwide cohort study from 1997 through 2011, women with either joint hypermobility syndrome or Ehlers-Danlos syndrome or both disorders were identified through the Swedish Patient Register, and linked to the Medical Birth Register. Thereby, 314 singleton births to women with joint hypermobility syndrome/Ehlers-Danlos syndrome before delivery were identified. These births were compared with 1 247 864 singleton births to women without a diagnosis of joint hypermobility syndrome/Ehlers-Danlos syndrome. We used logistic regression, adjusted for maternal age, smoking, parity, and year of birth, to calculate adjusted odds ratios for adverse pregnancy outcomes. Maternal joint hypermobility syndrome/Ehlers-Danlos syndrome was not associated with any of our outcomes: preterm birth (adjusted odds ratio = 0.6, 95% confidence interval 0.3-1.2), preterm premature rupture of membranes (adjusted odds ratio = 0.8; 95% confidence interval 0.3-2.2), cesarean section (adjusted odds ratio = 0.9, 95% confidence interval 0.7-1.2), stillbirth (adjusted odds ratio = 1.1, 95% confidence interval 0.2-7.9), low Apgar score (adjusted odds ratio = 1.6, 95% confidence interval 0.7-3.6), small for gestational age (adjusted odds ratio = 0.9, 95% confidence interval 0.4-1.8) or large for gestational age (adjusted odds ratio = 1.2, 95% confidence interval 0.6-2.1). Examining only women with Ehlers-Danlos syndrome (n = 62), we found a higher risk of induction of labor (adjusted odds ratio = 2.6; 95% confidence interval 1.4-4.6) and amniotomy (adjusted odds ratio = 3.8; 95% confidence interval 2.0-7.1). No excess risks for adverse pregnancy outcome were seen in joint hypermobility syndrome. Women with joint hypermobility syndrome/Ehlers-Danlos syndrome do not seem to be at increased risk of adverse pregnancy outcome. © 2016 Nordic Federation of Societies of Obstetrics and Gynecology.

Low dose aspirin in the prevention of recurrent spontaneous preterm labour - the APRIL study: a multicenter randomized placebo controlled trial.

PubMed

Visser, Laura; de Boer, Marjon A; de Groot, Christianne J M; Nijman, Tobias A J; Hemels, Marieke A C; Bloemenkamp, Kitty W M; Bosmans, Judith E; Kok, Marjolein; van Laar, Judith O; Sueters, Marieke; Scheepers, Hubertina; van Drongelen, Joris; Franssen, Maureen T M; Sikkema, J Marko; Duvekot, Hans J J; Bekker, Mireille N; van der Post, Joris A M; Naaktgeboren, Christiana; Mol, Ben W J; Oudijk, Martijn A

2017-07-14

Preterm birth (birth before 37 weeks of gestation) is a major problem in obstetrics and affects an estimated 15 million pregnancies worldwide annually. A history of previous preterm birth is the strongest risk factor for preterm birth, and recurrent spontaneous preterm birth affects more than 2.5 million pregnancies each year. A recent meta-analysis showed possible benefits of the use of low dose aspirin in the prevention of recurrent spontaneous preterm birth. We will assess the (cost-)effectiveness of low dose aspirin in comparison with placebo in the prevention of recurrent spontaneous preterm birth in a randomized clinical trial. Women with a singleton pregnancy and a history of spontaneous preterm birth in a singleton pregnancy (22-37 weeks of gestation) will be asked to participate in a multicenter, randomized, double blinded, placebo controlled trial. Women will be randomized to low dose aspirin (80 mg once daily) or placebo, initiated from 8 to 16 weeks up to maximal 36 weeks of gestation. The primary outcome measure will be preterm birth, defined as birth at a gestational age (GA) < 37 weeks. Secondary outcomes will be a composite of adverse neonatal outcome and maternal outcomes, including subgroups of prematurity, as well as intrauterine growth restriction (IUGR) and costs from a healthcare perspective. Preterm birth will be analyzed as a group, as well as separately for spontaneous or indicated onset. Analysis will be performed by intention to treat. In total, 406 pregnant women have to be randomized to show a reduction of 35% in preterm birth from 36 to 23%. If aspirin is effective in preventing preterm birth, we expect that there will be cost savings, because of the low costs of aspirin. To evaluate this, a cost-effectiveness analysis will be performed comparing preventive treatment with aspirin with placebo. This trial will provide evidence as to whether or not low dose aspirin is (cost-) effective in reducing recurrence of spontaneous preterm birth. Clinical trial registration number of the Dutch Trial Register: NTR 5675 . EudraCT-registration number: 2015-003220-31.

Prevalence of helminth infestation during pregnancy and its association with maternal anemia and low birth weight.

PubMed

Aderoba, Adeniyi K; Iribhogbe, Oseihie I; Olagbuji, Biodun N; Olokor, Oghenefegor E; Ojide, Chiedozie K; Ande, Adedapo B

2015-06-01

To determine the prevalence of helminth infestation during pregnancy and the associated risks of adverse maternal and infant outcomes. A cross-sectional study of women with a singleton pregnancy of at least 34 weeks was conducted at a teaching hospital in Benin City, Nigeria, between April 1 and September 30, 2010. Socioeconomic and clinical data were obtained. Stool samples were used to determine helminth infection. Birth weight was recorded at delivery. Multivariable analysis was used to assess the link between helminth infestation and maternal and perinatal outcomes. Among 178 women, 31 (17.4%) had a helminth infestation (15 [8.4%] had ascariasis, 8 [4.5%] trichuriasis, and 25 [14.0%] hookworm infestation). Multivariate analysis found that helminth infestations was associated with maternal anemia (adjusted odds ratio 12.4; 95% confidence interval 4.2-36.3) and low birth weight (adjusted odds ratio 6.8; 95% confidence interval 2.1-21.9). Approximately one in five women had a helminth infestation in the third trimester of pregnancy. Maternal helminth infestation significantly increased the risks of maternal anemia and low birth weight, indicating that routine administration of anthelminthic drugs during early pregnancy might improve perinatal outcomes. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Return to military weight standards after pregnancy in active duty working women: comparison of marine corps vs. navy.

PubMed

Greer, Joy A; Zelig, Craig M; Choi, Kenny K; Rankins, Nicole Calloway; Chauhan, Suneet P; Magann, Everett F

2012-08-01

To compare the likelihood of being within weight standards before and after pregnancy between United States Marine Corps (USMC) and Navy (USN) active duty women (ADW). ADW with singleton gestations who delivered at a USMC base were followed for 6 months to determine likelihood of returning to military weight standards. Odds ratio (OR), adjusted odds ratio (AOR) and 95% confidence intervals were calculated; p < 0.05 was considered significant. Similar proportions of USN and USMC ADW were within body weight standards one year prior to pregnancy (79%, 97%) and at first prenatal visit (69%, 96%), respectively. However, USMC ADW were significantly more likely to be within body weight standards at 3 months (AOR 4.30,1.28-14.43) and 6 months after delivery (AOR 9.94, 1.53-64.52) than USN ADW. Weight gained during pregnancy did not differ significantly for the two groups (40.4 lbs vs 44.2 lbs, p = 0.163). The likelihood of spontaneous vaginal delivery was significantly higher (OR 2.52, 1.20-5.27) and the mean birth weight was significantly lower (p = 0.0036) among USMC ADW as compared to USN ADW. Being within weight standards differs significantly for USMC and USN ADW after pregnancy.

Pathology of twin placentas with special attention to monochorionic twin placentas.

PubMed

Nikkels, P G J; Hack, K E A; van Gemert, M J C

2008-12-01

The risk of perinatal morbidity and mortality in twins is 3-7 times higher than in singletons. In comparison to dichorionic twins, monochorionic twins are at increased risk for perinatal mortality and serious morbidity. In both type of twins growth discordance can occur. Discordant growth of dichorionic twins could be due to differences in placental mass or differences in placental parenchymal lesions, whereas birth weight discordancy in monochorionic twins is caused by placental vascular anastomoses. In this review the different types of complications (acardiac twins, acute and chronic twin-twin transfusion syndrome) due to different combinations of vascular anastomoses are discussed in relation to a computer model developed to gain more insight into the development of the twin-twin transfusion syndrome. The angioarchitecture of 395 monochorionic twin placentas was studied. Mortality was highest in the absence of an arterio-arterial anastomosis (42%) and lowest in the presence of an arterio-arterial anastomosis (15%). If mortality occurred, pregnancies with double mortality usually had an arterio-arterial anastomosis. If pregnancies were complicated by one death, a veno-venous anastomosis is more likely to be present. In conclusion, monochorionic twin pregnancies are a high risk pregnancy with a high chance of both mortality and morbidity; placental characteristics are a major contributor to adverse outcome in these pregnancies.

Increased incidence of preeclampsia in mothers of advanced age conceiving by oocyte donation.

PubMed

Dior, Uri P; Laufer, Neri; Chill, Henry H; Granovsky-Grisaru, Sorina; Yagel, Simcha; Yaffe, Haim; Gielchinsky, Yuval

2018-05-01

The aim of this study was to evaluate the risk of preeclampsia in women of advanced age who conceived through donated oocytes as compared with natural conceptions. A historical prospective study of singleton live births of parturients ≥ 45 years of age at four university hospitals was conducted. For the purpose of the study, the population was divided by the mode of conception into two groups: oocyte donation and natural conception. The main outcome variable in this study was preeclampsia. Secondary outcomes included pregnancy-induced hypertension and Small for Gestational Age. Two hundred and seventy pregnancies were achieved naturally and 135 women conceived by oocyte donation. Mean age at delivery for the natural conception and oocyte donation groups was 45.7 and 47.8, respectively. Preeclampsia complicated 3 out of 270 (1.1%) natural conception pregnancies and 17 out of 135 (12.6%) oocyte donation conceptions. After adjusting for confounders, oocyte donation pregnancies were found to be associated with a 12-fold increased risk for preeclampsia (P = 0.001). Among oocyte donation pregnancies, the risk of preeclampsia was not affected by parity or age. A substantially increased risk for preeclampsia was found in oocyte donation pregnancies, suggesting that the foreign oocyte may play a specific biologic role in the development of preeclampsia after the age of 45.

Successful Pregnancies After Adequate Hormonal Replacement in Patients With Combined Pituitary Hormone Deficiencies.

PubMed

Correa, Fernanda A; Bianchi, Paulo H M; Franca, Marcela M; Otto, Aline P; Rodrigues, Rodrigo J M; Ejzenberg, Dani; Serafini, Paulo C; Baracat, Edmundo Chada; Francisco, Rossana P V; Brito, Vinicius N; Arnhold, Ivo J P; Mendonca, Berenice B; Carvalho, Luciani R

2017-10-01

Women with hypopituitarism have lower pregnancy rates after ovulation induction. Associated pituitary hormone deficiencies might play a role in this poorer outcome. We evaluated fertility treatment and pregnancy outcomes in five women with childhood-onset combined pituitary hormone deficiencies (CPHD). Five women with CPHD were referred for fertility treatment after adequacy of hormone replacement was determined. Patients were subjected to controlled ovarian stimulation (COS) for timed intercourse, intrauterine insemination, or in vitro fertilization, according to the presence or absence of other infertility factors (male or tubal). All women became pregnant. The number of COS attempts until pregnancy was achieved varied between 1 and 5. The duration of COS resulting in at least one dominant follicle varied between 9 and 28 days, and total gonadotropin consumed varied between 1200 and 3450 IU. Two patients with severely suppressed basal gonadotropin levels since an early age had a cancelled COS cycle. All pregnancies were singleton except one (monochorionic twin gestation). The gestational ages at birth ranged from 35 weeks to 39 weeks and 4 days; three patients underwent cesarean section, and two had vaginal deliveries. Only one newborn was small for gestational age (delivered at 35 weeks). Adequate hormonal replacement prior to ovarian stimulation resulted in successful pregnancies in patients with childhood-onset CPHD, indicating that hormone replacement, including growth hormone, is an important step prior to fertility treatments in these patients.

A single-center retrospective study of pregnancy outcomes after emergency cerclage for cervical insufficiency.

PubMed

Wang, Sheng; Feng, Ling

2017-10-01

To compare maternal and perinatal outcomes after emergency cerclage with those after elective cerclage. In a retrospective review, data were assessed from women with a viable singleton pregnancy who underwent elective or emergency cerclage for cervical insufficiency at the Tongji Hospital, Wuhan, China, between January 2010 and July 2015. Subgroup analyses based on cervical length (CL; ≤15, 15-25, and 25-30 mm) were also conducted among women undergoing emergency cerclage. In total, 68 women underwent elective cerclage and 53 underwent emergency cerclage. The suture-to-delivery interval was significantly longer in the elective group (19.17 ± 5.86 weeks) than in the emergency group (11.29 ± 7.27 weeks; P<0.001). There was no difference between the elective and emergency groups in mean pregnancy length at delivery, frequency of Apgar score below 7 at 5 minutes (live births only), or birth weight (live births only). An inverse trend in the degree of CL shortening with pregnancy outcomes was observed; women with a CL of 25-30 mm had the best outcomes. Pregnancy outcomes were similar after emergency and elective cerclage. There was an inverse trend in the degree of CL shortening with pregnancy outcomes in the emergency cerclage group, with better outcomes observed for women with longer CL. © 2017 International Federation of Gynecology and Obstetrics.

Blunted neuroactive steroid and HPA axis responses to stress are associated with reduced sleep quality and negative affect in pregnancy: a pilot study.

PubMed

Crowley, Shannon K; O'Buckley, Todd K; Schiller, Crystal E; Stuebe, Alison; Morrow, A Leslie; Girdler, Susan S

2016-04-01

Anxiety during pregnancy has been linked to adverse maternal health outcomes, including postpartum depression (PPD). However, there has been limited study of biological mechanisms underlying behavioral predictors of PPD during pregnancy. Considering the shared etiology of chronic stress amongst antenatal behavioral predictors, the primary goal of this pilot study was to examine associations among stress-related physiological factors (including GABA-ergic neurosteroids) and stress-related behavioral indices of anxiety during pregnancy. Fourteen nulliparous women in their second trimester of a singleton pregnancy underwent speech and mental arithmetic stress, following a 2-week subjective and objective recording of sleep-wake behavior. Lower cortisol, progesterone, and a combined measure of ALLO + pregnanolone throughout the entire stressor protocol (area under the curve, AUC) were associated with greater negative emotional responses to stress, and lower cortisol AUC was associated with worse sleep quality. Lower adrenocorticotropic hormone was associated with greater anxious and depressive symptoms. Stress produced paradoxical reductions in cortisol, progesterone, and a combined measure of allopregnanolone + pregnanolone, while tetrahydrodeoxycorticosterone levels were elevated. These data suggest that cortisol, progesterone, and ALLO + pregnanolone levels in the second trimester of pregnancy are inversely related to negative emotional symptoms, and the negative impact of acute stress challenge appears to exert its effects by reducing these steroids to further promote negative emotional responses.

Fever in pregnancy and offspring head circumference.

PubMed

Dreier, Julie Werenberg; Strandberg-Larsen, Katrine; Uldall, Peter Vilhelm; Nybo Andersen, Anne-Marie

2018-02-01

To examine whether maternal fever during pregnancy is associated with reduced head circumference and risk of microcephaly at birth. A prospective study of 86,980 live-born singletons within the Danish National Birth Cohort was carried out. Self-reported maternal fever exposure was ascertained in two interviews during pregnancy and information on head circumference at birth was extracted from the Danish Medical Birth Registry. Fever in pregnancy was reported by 27% of the mothers, and we identified 3370 cases of microcephaly (head circumference less than or equal to third percentile for sex and gestational age) and 1140 cases of severe microcephaly (head circumference less than or equal to first percentile for sex and gestational age). In this study, maternal fever exposure was not associated with reduced head circumference (adjusted β = 0.03, 95% confidence intervals [CI]: 0.01-0.05), increased risk of microcephaly (odds ratio: 0.95, 95% CI: 0.88-1.03) nor severe microcephaly (odds ratio: 1.01, 95% CI: 0.88-1.15) in the offspring. These findings were consistent for increasing numbers of fever episodes, for increasing fever severity, and for exposure in both early pregnancy and midpregnancy. In this most comprehensive study to date, we found no indication that maternal fever in pregnancy is associated with small head size in the offspring. Copyright © 2017 Elsevier Inc. All rights reserved.

Ethnicity and the risk of late-pregnancy stillbirth.

PubMed

Drysdale, Henry; Ranasinha, Sanjeeva; Kendall, Amanda; Knight, Michelle; Wallace, Euan M

2012-09-03

To determine if maternal country of birth is associated with the risk of antepartum stillbirth in late pregnancy. Retrospective cross-sectional study of all singleton births at 37-42 weeks' gestation, excluding those with congenital abnormalities and intrapartum stillbirths, between 1 June 2001 and 31 May 2011 at Southern Health, a large metropolitan maternity service in Melbourne, Australia. Rate of late-pregnancy antepartum stillbirth, analysed by maternal country of birth. Among 44 326 births, there was a significant difference in the stillbirth rate by maternal country of birth (P < 0.001). The rate of stillbirth per 1000 births was 1.48 among Australian-born women, 3.55 among South Asian-born women and 1.06 among South-East-East Asian-born women. Women born in South Asia were 2.4 (95% CI, 1.4-4.0) times more likely to have a late-pregnancy stillbirth than women born in Australia (P < 0.001). There was no significant difference between women born in Australia and women born in South-East-East Asia (P = 0.34). Adjusting for potential confounding factors, South Asian maternal birth remained an independent risk factor for stillbirth (adjusted odds ratio, 2.5; 95% CI, 1.3-5.1; P = 0.009). Women born in South Asia have an increased risk of antepartum stillbirth in late pregnancy, compared with other women. This observation may have implications for the delivery of pregnancy care in Australia.

A Ten-Year Review of Antenatal Complications and Pregnancy Outcomes Among HIV-Positive Pregnant Women.

PubMed

Yudin, Mark H; Caprara, Daniela; MacGillivray, S Jay; Urquia, Marcelo; Shah, Rajiv R

2016-01-01

To review the incidence of antenatal complications among a cohort of HIV-positive pregnant women over a 10-year period. A retrospective review was performed of all HIV-positive pregnant women receiving multidisciplinary prenatal care at an urban tertiary care centre from March 2000 to March 2010. Collected data included the presence of additional infectious or medical conditions, genetic screening information, and the presence or absence of antenatal complications. One hundred and forty-two singleton pregnancies during the study period were identified. Almost 95% of women were taking combination antiretroviral therapy during pregnancy, and greater than 90% had viral loads less than 1000 copies/ml at delivery. The presence of co-infections was low. Forty-one women (29%) had other medical comorbidities. Genetic screening occurred in 104 pregnancies (73%); 4% were abnormal screens. Rates of any hypertension, gestational diabetes, and fetal growth restriction were all low. Thirty-two percent of women were colonized with group B streptococcus. This study adds strength to the argument that good outcomes can be achieved for HIV-positive pregnant women with good access to both prenatal and HIV care, and appropriate management. Women with HIV should be optimally cared for in advance of and during pregnancy in order to maximize the likelihood of good pregnancy outcomes. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

Infertility treatment and children's longitudinal growth between birth and 3 years of age

PubMed Central

Yeung, E.H.; Sundaram, R.; Bell, E.M.; Druschel, C.; Kus, C.; Xie, Y.; Buck Louis, G.M.

2016-01-01

STUDY QUESTION Does early childhood growth from birth through to 3 years of age differ by mode of conception? SUMMARY ANSWER Findings suggest early childhood growth was comparable for children irrespective of infertility treatment, but twins conceived with ovulation induction with or without intrauterine insemination (OI/IUI) were slightly smaller than twins conceived without treatment. WHAT IS KNOWN ALREADY Although studies have found that babies conceived with infertility treatment are born lighter and earlier than infants conceived without treatment, little research especially for non-assisted reproductive technology (ART) treatments has focused on their continued growth during early childhood. STUDY DESIGN, SIZE, DURATION Upstate KIDS recruited infants born (2008–2010) to resident upstate New York mothers. Infants were sampled based on birth certificate indication of infertility treatment; specifically, for every singleton conceived by infertility treatment, three singletons without infertility treatment were recruited and matched on region of birth. All multiple births irrespective of treatment were also recruited. Children were prospectively followed, returning questionnaires every 4–6 months until 3 years of age. In total, 3905 singletons, 1129 sets of multiples (96% of whom were twins) enrolled into the study. Analyses included 3440 (88%) singletons (969 conceived with treatment; specifically, 433 with ART and 535 with OI/IUI) and 991 (88%) sets of multiples (439 conceived with treatment; specifically 233 with ART and 206 with OI/IUI) with growth data available. PARTICIPANTS/MATERIALS, SETTING, METHODS Mothers reported infertility treatment use at baseline and children's height and weight from pediatric visits. Self-reported use of ART was previously verified by linkage with the US Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) database. Mixed linear models with cubic splines accounting for age and age–gender interactions were used to estimate mean differences in growth from birth to 3 years by infertility treatment status and adjusting for maternal age, race, education, private insurance, smoking status during pregnancy, maternal pre-pregnancy and paternal body mass indices (BMI). MAIN RESULTS AND THE ROLE OF CHANCE Compared with singletons conceived without treatment (n = 2471), singletons conceived by infertility treatment (433 by assisted reproductive technologies (ART), 535 by OI/IUI and 1 unknown specific type) did not differ in growth. Compared with twins not conceived with treatment (n = 1076), twins conceived with OI/IUI (n = 368) weighed slightly less over follow-up (122 g). They were also proportionally smaller for their length (−0.17 weight-for-length z-score units). No differences in mean size over the 3 years were observed for twins conceived by ART, though some evidence of rapid weight gain from birth to 4 months (adjusted OR 1.08; 95% CI: 1.00–1.16) suggestive of catch up growth was observed. LIMITATIONS, REASONS FOR CAUTION Participants from upstate New York may not be representative of US infants. Although accounted for in statistical analysis, attrition during follow-up may have limited power to detect small differences. WIDER IMPLICATIONS OF THE FINDINGS This study is the first to prospectively track the growth of children conceived with and without infertility treatment in the USA, including a substantial number of twins. Our findings are similar to what was previously observed in the ART literature outside of the states. STUDY FUNDING/COMPETING INTEREST(S) Supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD; contracts #HHSN275201200005C, #HHSN267200700019C). Authors have no competing interests to declare. TRIAL REGISTRATION NUMBER Not applicable. PMID:27165624

Response to fifty grams oral glucose challenge test and pattern of preceding fasting plasma glucose in normal pregnant Nigerians.

PubMed

Adegbola, Omololu; Ajayi, Godwin Olufemi

2014-03-01

Diabetes mellitus in pregnancy has profound implications for the baby and mother and thus active screening for this is desirable. Fifty grams oral glucose challenge test was administered after obtaining consent to 222 women in good health with singleton pregnancies without diabetes mellitus at 24 to 28 weeks gestation after an overnight fast. Venous blood sample was obtained before and 1 hour after the glucose load. A diagnostic 3-hour 100 g oral glucose tolerance test was subsequently performed in all. Two hundred and ten women had a normal response to oral glucose tolerance test i.e. venous plasma glucose below these cut-off levels: fasting 95 mg/dl (5.3 mmol/l), 1 hour 180 mg/dl (10.0 mmol/l), 2 hours 155 mg/dl (8.6 mmol/l) and 3 hours 140 mg/dl (7.8 mmol/l), while 12 were found to have gestational diabetes mellitus and were subsequently excluded from the study. They were appropriately managed. The mean maternal age was 30.9 ± 4.1 years (range 19 to 45 years) and the mean parity was 1.2 ± 1.1 (range 0 to 5). The mean fasting plasma glucose was 74.5 ± 11.5 mg/dl (range 42 to 117 mg/dl), while the mean plasma glucose 1 hour after 50 g glucose challenge test was 115.3 ± 19.1 mg/dl (range 56 to 180 mg/dl). The mean fasting plasma glucose in normal pregnant Nigerians was 74.5 ± 11.5 mg/dl (range 42 to 117 mg/dl). There is a need to re-appraise and possibly review downwards the World Health Organization fasting plasma glucose diagnostic criteria in pregnant Nigerians for better detection of gestational diabetes mellitus. Pregnant women with venous plasma glucose greater than 153.5 mg/dl (8.5 mmol/l) 1 hour after 50 g glucose challenge test are strongly recommended for diagnostic test of gestational diabetes mellitus.

Prescriptions for category D and X drugs during pregnancy in Taiwan: a population-based study.

PubMed

Kao, Li-Ting; Chen, Yi-Hua; Lin, Herng-Ching; Chung, Shiu-Dong

2014-10-01

This study aimed to investigate the most prescribed medications and principle diagnoses for category D and X drugs during pregnancy using a population-based dataset in Taiwan. The data for the present study were sourced from the Taiwan Longitudinal Health Insurance Database 2000. We selected 14 125 women who had live singleton births between 1 January 2009 and 31 December 2011. In total, 217 226 prescriptions prescribed to these pregnant women were identified. Of the total 217 226 prescriptions, 1.1% were category D or X drugs; in the first, second, and third trimesters of pregnancy, 1.8%, 0.7%, and 0.5% of prescriptions were category D or X drugs, respectively. Progestins (15.3%) and propylthiouracil (10.7%) were the two most frequently prescribed category D or X drugs during pregnancy. In particular, progestins (20.4%) and estrogens (15.6%) were the most frequently prescribed category D or X drug in the first trimester of pregnancy. Propylthiouracil was the most prescribed category D or X drug in the second (20.3%) and third trimesters (23.1%) of pregnancy, respectively. The most common principal diagnosis during pregnancy was "disorders of menstruation and other abnormal bleeding from the female genital tract" (22% of all principal diagnoses for prescribing category D and X drugs). Our study found that the physicians obviously reduced the use of category D and X drugs for women after becoming aware that they were pregnant. Copyright © 2014 John Wiley & Sons, Ltd.

Fine particulate matter and risk of preterm birth in Connecticut in 2000-2006: a longitudinal study.

PubMed

Pereira, Gavin; Belanger, Kathleen; Ebisu, Keita; Bell, Michelle L

2014-01-01

Several studies have examined associations between particulate matter with aerodynamic diameter of 2.5 µm or less (PM2.5) and preterm birth, but it is uncertain whether results were affected by individual predispositions (e.g., genetic factors, social conditions) that might vary considerably between women. We tested the hypothesis that a woman is at greater risk of preterm delivery when she has had elevated exposure to ambient PM2.5 during a pregnancy than when she has not by comparing pregnancies in the same woman. From 271,204 births, we selected 29,175 women who had vaginal singleton livebirths at least twice in Connecticut in 2000-2006 (n = 61,688 births). Analyses matched pregnancies to the same woman. Adjusted odds ratios per interquartile range (2.33-µg/m(3)) increase in PM2.5 in the first trimester, second trimester, third trimester, and whole pregnancy were 1.07 (95% confidence interval (CI): 1.00, 1.15), 0.96 (95% CI: 0.90, 1.03), 1.03 (95% CI: 0.97, 1.08), and 1.13 (95% CI: 1.01, 1.28), respectively. Among Hispanic women, the odds ratio per interquartile range increase in whole-pregnancy exposure was 1.31 (95% CI: 1.00, 1.73). Pregnancies with elevated PM2.5 exposure were more likely to result in preterm birth than were other pregnancies to the same woman at lower exposure. Associations were most pronounced in the first trimester and among Hispanic women.

Fetal body weight and the development of the control of the cardiovascular system in fetal sheep.

PubMed

Frasch, M G; Müller, T; Wicher, C; Weiss, C; Löhle, M; Schwab, K; Schubert, H; Nathanielsz, P W; Witte, O W; Schwab, M

2007-03-15

Reduced birth weight predisposes to cardiovascular diseases in later life. We examined in fetal sheep at 0.76 (n = 18) and 0.87 (n = 17) gestation whether spontaneously occurring variations in fetal weight affect maturation of autonomic control of cardiovascular function. Fetal weights at both gestational ages were grouped statistically in low (LW) and normal weights (NW) (P < 0.01). LW fetuses were within the normal weight span showing minor growth dysproportionality at 0.76 gestation favouring heart and brain, with a primary growth of carcass between 0.76 and 0.87 gestation (P < 0.05). While twins largely contributed to LW fetuses, weight differences between singletons and twins were absent at 0.76 and modest at 0.87 gestation, underscoring the fact that twins belong to normality in fetal sheep not constituting a major malnutritive condition. Mean fetal blood pressure (FBP) of all fetuses was negatively correlated to fetal weight at 0.76 but not 0.87 gestation (P < 0.05). At this age, FBP and baroreceptor reflex sensitivity were increased in LW fetuses (P < 0.05), suggesting increased sympathetic activity and immaturity of circulatory control. Development of vagal modulation of fetal heart rate depended on fetal weight (P < 0.01). These functional associations were largely independent of twin pregnancies. We conclude, low fetal weight within the normal weight span is accompanied by a different trajectory of development of sympathetic blood pressure and vagal heart rate control. This may contribute to the development of elevated blood pressure in later life. Examination of the underlying mechanisms and consequences may contribute to the understanding of programming of cardiovascular diseases.

Gestational Weight Gain Trend and Population Attributable Risks of Adverse Fetal Growth Outcomes in Ohio.

PubMed

Chen, Aimin; Xu, Fan; Xie, Changchun; Wu, Tianying; Vuong, Ann M; Miao, Maohua; Yuan, Wei; DeFranco, Emily A

2015-07-01

The trend of gestational weight gain (GWG) in relation to the Institute of Medicine (IOM) guidelines and the population attributable risks (PARs) of GWG on fetal growth outcomes remain unclear. We analysed Ohio birth certificates from 2006 to 2012 to examine GWG trend by prepregnancy body mass index, to calculate the risk of small- and large-for-gestational age (SGA and LGA), and macrosomia (birthweight >4000 g or >4500 g) infants, and to estimate the PARs of GWG below or above the guidelines. Of 869,531 women who delivered singleton live births at 22-44 weeks of gestation, 4.5% were underweight, 48.9% were normal weight, 23.9% were overweight, and 22.7% were obese before pregnancy. About 36.5% of underweight, 52.6% of normal weight, 72.5% of overweight, and 62.4% of obese women gained weight above the guidelines, with only slight changes from 2006 to 2012. Also, 34.9% of underweight, 20.1% of normal weight, 16.3% of overweight, and 27.0% of obese women gained weight below the guidelines. The PAR of GWG below or above the guidelines was -13% for SGA, 32.6% for LGA, 28.1% for macrosomia >4000 g, and 48.3% for macrosomia >4500 g, mostly driven by currently GWG above the guidelines in normal weight, overweight, and obese women. A high percentage of pregnant women gained weight outside of the current IOM GWG guidelines; however, changes from 2006 to 2012 were small. GWG above the IOM guidelines significantly contributed to a large proportion of LGA and macrosomic infants in the general population. © 2015 John Wiley & Sons Ltd.

Variants close to NTRK2 gene are associated with birth weight in female twins.

PubMed

Metrustry, Sarah J; Edwards, Mark H; Medland, Sarah E; Holloway, John W; Montgomery, Grant W; Martin, Nicholas G; Spector, Tim D; Cooper, Cyrus; Valdes, Ana M

2014-08-01

Low weight at birth has previously been shown to be associated with a number of adult diseases such as type 2 diabetes, cardiovascular disease, high blood pressure, and obesity later in life. Genome-wide association studies (GWAS) have been published for singleton-born individuals, but the role of genetic variation in birth weight (BW) in twins has not yet been fully investigated. A GWAS was performed in 4,593 female study participants with BW data available from the TwinsUK cohort. A genome-wide significant signal was found in chromosome 9, close to the NTRK2 gene (OMIM: 600456). QIMR, an Australian twin cohort (n = 3,003), and UK-based singleton-birth individuals from the Hertfordshire cohort (n = 2,997) were used as replication for the top two single nucleotide polymorphism (SNPs) underpinning this signal, rs12340987 and rs7849941. The top SNP, rs12340987, was found to be in the same direction in the Australian twins and in the singleton-born females (fixed effects meta-analysis beta = -0.13, SE = 0.02, and p = 1.48 × 10-8) but not in the singleton-born males tested. These findings provide an important insight into the genetic component of BW in twins who are normally excluded due to their lower BW when compared with singleton births, as well as the difference in BW between twins. The NTRK2 gene identified in this study has previously been associated with obesity.

Pregnancy before recurrent pregnancy loss more often complicated by post-term birth and perinatal death.

PubMed

Wagner, Marise M; Visser, Jantien; Verburg, Harjo; Hukkelhoven, Chantal W P M; Van Lith, Jan M M; Bloemenkamp, Kitty W M

2018-01-01

The cause of recurrent pregnancy loss often remains unknown. Possibly, pathophysiological pathways are shared with other pregnancy complications. All women with secondary recurrent pregnancy loss (SRPL) visiting Leiden University Medical Center (January 2000-2015) were included in this retrospective cohort to assess whether women with SRPL have a more complicated first pregnancy compared with control women. SRPL was defined as three or more consecutive pregnancy losses before 22 weeks of gestation, with a previous birth. The control group consisted of all Dutch nullipara delivering a singleton (January 2000-2015). Information was obtained from the Dutch Perinatal Registry. Outcomes were preeclampsia, preterm birth, post-term birth, intrauterine growth restriction, breach position, induction of labor, cesarean section, congenital abnormalities, perinatal death and severe hemorrhage in the first ongoing pregnancy. Subgroup analyses were performed for women with idiopathic SRPL and for women ≤35 years. In all, 172 women with SRPL and 1 196 178 control women were included. Women with SRPL were older and had a higher body mass index; 29.7 years vs. 28.8 years and 25.1 kg/m 2 vs. 24.1 kg/m 2 , respectively. Women with SRPL more often had a post-term birth (OR 1.86, 95% CI 1.10-3.17) and more perinatal deaths occurred in women with SRPL compared with the control group (OR 5.03, 95% CI 2.48-10.2). Similar results were found in both subgroup analyses. The first ongoing pregnancy of women with (idiopathic) SRPL is more often complicated by post-term birth and perinatal death. Revealing possible links between SRPL and these pregnancy complications might lead to a better understanding of underlying pathophysiology. © 2017 Nordic Federation of Societies of Obstetrics and Gynecology.

Intrauterine fetal death and risk of shoulder dystocia at delivery.

PubMed

Larsen, Sandra; Dobbin, Joanna; McCallion, Oliver; Eskild, Anne

2016-12-01

Vaginal delivery is recommended after intrauterine fetal death. However, little is known about the risk of shoulder dystocia in these deliveries. We studied whether intrauterine fetal death increases the risk of shoulder dystocia at delivery. In this population-based register study using the Medical Birth Registry of Norway, we included all singleton pregnancies with vaginal delivery of offspring in cephalic presentation in Norway during the period 1967-2012 (n = 2 266 118). Risk of shoulder dystocia was estimated as absolute risk (%) and odds ratio with 95% confidence interval. Adjustment was made for offspring birthweight (in grams). We performed sub-analyses within categories of birthweight (<4000 and ≥4000 g) and in pregnancies with maternal diabetes. Shoulder dystocia occurred in 1.1% of pregnancies with intrauterine fetal death and in 0.8% of pregnancies without intrauterine fetal death (p < 0.0001) (crude odds ratio 1.5, 95% confidence interval 1.2-4.9). After adjustment for birthweight, the odds ratio was 5.9 (95% confidence interval 4.7-7.4). In pregnancies with birthweight ≥4000 g, shoulder dystocia occurred in 14.6% of pregnancies with intrauterine fetal death and in 2.8% of pregnancies without intrauterine fetal death (p < 0.001) (crude odds ratio 5.9, 95% confidence interval 4.5-7.9). In pregnancies with birthweight ≥4000 g and concurrent maternal diabetes, shoulder dystocia occurred in 57.1% of pregnancies with intrauterine fetal death and 9.6% of pregnancies without intrauterine fetal death (p < 0.001) (crude odds ratio 12.6, 95% confidence interval 5.9-26.9). Intrauterine fetal death increased the risk of shoulder dystocia at delivery, and the absolute risk of shoulder dystocia was particularly high if offspring birthweight was high and the mother had diabetes. © 2016 Nordic Federation of Societies of Obstetrics and Gynecology.

Risk of Vaginal Infections at Early Gestation in Patients with Diabetic Conditions during Pregnancy: A Retrospective Cohort Study.

PubMed

Marschalek, Julian; Farr, Alex; Kiss, Herbert; Hagmann, Michael; Göbl, Christian S; Trofaier, Marie-Louise; Kueronya, Verena; Petricevic, Ljubomir

2016-01-01

Pregnant women with gestational diabetes mellitus (GDM) are reported to be at increased risk for infections of the genital tract. This study aimed to compare the prevalence of asymptomatic bacterial vaginosis (BV) and Candida colonization at early gestation between pregnant women with and without diabetic conditions during pregnancy. We included data from 8, 486 singleton pregnancies that underwent an antenatal infection screen-and-treat programme at our department. All women with GDM or pre-existing diabetes were retrospectively assigned to the diabetic group (DIAB), whereas non-diabetic women served as controls (CON). Prevalence for BV and Candida colonization was 9% and 14% in the DIAB group, and 9% and 13% in the CON group, respectively (n.s.). No significant difference regarding stillbirth and preterm delivery (PTD), defined as a delivery earlier than 37 + 0 (37 weeks plus 0 days) weeks of gestation was found. We could not find an increased risk of colonization with vaginal pathogens at early gestation in pregnant women with diabetes, compared to non-diabetic women. Large prospective studies are needed to evaluate the long-term risk of colonization with vaginal pathogens during the course of pregnancy in these women.

Risk of intrapartum cervical lacerations in women with cerclage.

PubMed

Seravalli, Viola; Potti, Sushma; Berghella, Vincenzo

2013-02-01

The aim of our study was to estimate whether the placement of cerclage in pregnancy to prevent preterm birth (PTB) is associated with higher incidence of intrapartum cervical lacerations. A retrospective cohort study was conducted on singleton pregnancies with risk factors for PTB. The study group consisted of women with either a history- or ultrasound-indicated cerclage placed between 12 and 24 weeks of gestation, while the control group consisted of women with similar risk factors for PTB but who did not receive a cerclage. Primary outcome was the incidence of intrapartum cervical lacerations. A sample size calculation was performed on the basis of the results of previous studies on cervical lacerations. We identified 134 women who had a cerclage placed in pregnancy. They were compared with 236 controls with no cerclage. Cases and controls had similar risk factors for cervical lacerations. Cervical lacerations occurred with similar frequencies in the cerclage and no-cerclage group (2.2 vs 1.3%, p = 0.78). There was no significant difference between the two groups for the risk of cervical lacerations (RR 1.76, 95% CI: 0.36-8.60). Cerclage placement during pregnancy is not associated with an increased risk of intrapartum cervical lacerations.

The Predictive Effects of Early Pregnancy Lipid Profiles and Fasting Glucose on the Risk of Gestational Diabetes Mellitus Stratified by Body Mass Index.

PubMed

Wang, Chen; Zhu, Weiwei; Wei, Yumei; Su, Rina; Feng, Hui; Lin, Li; Yang, Huixia

2016-01-01

This study aimed at evaluating the predictive effects of early pregnancy lipid profiles and fasting glucose on the risk of gestational diabetes mellitus (GDM) in patients stratified by prepregnancy body mass index (p-BMI) and to determine the optimal cut-off values of each indicator for different p-BMI ranges. A retrospective system cluster sampling survey was conducted in Beijing during 2013 and a total of 5,265 singleton pregnancies without prepregnancy diabetes were included. The information for each participant was collected individually using questionnaires and medical records. Logistic regression analysis and receiver operator characteristics analysis were used in the analysis. Outcomes showed that potential markers for the prediction of GDM include early pregnancy lipid profiles (cholesterol, triacylglycerols, low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratios [LDL-C/HDL-C], and triglyceride to high-density lipoprotein cholesterol ratios [TG/HDL-C]) and fasting glucose, of which fasting glucose level was the most accurate indicator. Furthermore, the predictive effects and cut-off values for these factors varied according to p-BMI. Thus, p-BMI should be a consideration for the risk assessment of pregnant patients for GDM development.

Maternal urinary tract infection: is it independently associated with adverse pregnancy outcome?

PubMed

Mazor-Dray, Efrat; Levy, Amalia; Schlaeffer, Francisc; Sheiner, Eyal

2009-02-01

This population-based study was aimed to determine whether there is an association between urinary tract infections (UTI) during pregnancy, among patients in whom antibiotic treatment was recommended, and maternal and perinatal outcome. A retrospective population-based study comparing all singleton pregnancies of patients with and without UTI was performed. Multiple logistic regression models were performed to control for confounders. Out of 199,093 deliveries, 2.3% (n = 4742) had UTI during pregnancy and delivery. Patients with UTI had significantly higher rates of intra-uterine growth restriction (IUGR), pre-eclampsia, caesarean deliveries (CD) and pre-term deliveries (either before 34 weeks or 37 weeks of gestation). Although controlling for possible confounders such as maternal age and parity, using multivariable analyses, the significant association between UTI and IUGR, pre-eclampsia, CD and preterm deliveries persisted. In contrast, no significant differences in 5-min Apgar scores less than 7 or perinatal mortality were noted between the groups (0.6% vs. 0.6%; p = 0.782, and 1.5% vs. 1.4%; p = 0.704, respectively). Maternal UTI is independently associated with pre-term delivery, pre-eclampsia, IUGR and CD. Nevertheless, it is not associated with increased rates of perinatal mortality compared with women without UTI.

Environmental risk factors and perinatal outcomes in preterm newborns, according to family recurrence of prematurity

PubMed Central

Krupitzki, Hugo B.; Gadow, Enrique C.; Gili, Juan A.; Comas, Belén; Cosentino, Viviana R.; Saleme, César; Murray, Jeffrey C.; Lopez Camelo, Jorge S.

2014-01-01

Objetive We analyzed the role of environmental risk factors, socio-demographic characteristics, clinical characteristics, and reproductive history in preterm births and their associated perinatal outcomes in families classified according to their histories of preterm recurrence among siblings. Study Design A retrospective study was conducted at “Nuestra Señora de la Merced” Maternity Hospital in the city of Tucumán, Argentina. A total of 348 preterm, non-malformed, singleton children born to multipara women were reviewed. The family history score described by Khoury was applied, and families were classified as having no, medium or high genetic aggregation. Results Families with no familial aggregation showed a higher rate of short length of cohabitation, maternal urinary tract infections during the current pregnancy and maternal history of miscarriage during the previous pregnancy. Families with a high level of aggregation had a significantly higher incidence of pregnancy complications, such as diabetes, hypertension and immunological disorders. Conclusion Reproductive histories clearly differed between the groups, suggesting both a different response to environmental challenges based on genetic susceptibility, and the activation of different pathophysiological pathways to determine the duration of pregnancy in each woman. PMID:23132119

Preliminary evaluation of foetal liver volume by three-dimensional ultrasound in women with gestational diabetes mellitus.

PubMed

İlhan, Gülşah; Gültekin, Hüseyin; Kubat, Ayça; Gokmen Karasu, Ayse Filiz; Güngör, Emre Sinan; Zebitay, Galip Ali; Verit Atmaca, Fatma Ferda

2018-03-19

The aim of the study was to assess the standard foetal biometric measurements and foetal liver volume (FLV) in pregnancies complicated by gestational diabetes mellitus (GDM) at the time of GDM screening and to compare the results with foetuses in normal pregnancies. Ninety-seven pregnant women with normal singleton uncomplicated pregnancies between 24 and 28 weeks of gestation were allocated into GDM (+) (n: 33) and GDM (-) (n: 64) groups based on their 75 g oral glucose tolerance test results. Foetal biometric measurements and FLV measurements of the groups were compared. Although there were no significant differences in the standard biometric measurements between the two groups, FLV was significantly higher in the women with GDM (p < .01). The ROC analysis implied that with a cut-off value of FLV of 32.72 cm 3 for GDM prediction, the sensitivity was 78.8% and specificity was 56.3%. We suggest that FLV measurements during the second-trimester ultrasound scanning may be a tool for the prediction of GDM in the obstetric population. Impact statement What is already known on this subject? GDM is an important pregnancy disease, because of its possible foetal and maternal complications. Besides the standard biometric measurements, some other foetal body dimensions such as the anterior abdominal wall thickness, skinfold thickness, adipose tissue thickness, Wharton's jelly thickness, foetal liver length and foetal liver volume (FLV) have been evaluated as ultrasound parameters of glycaemic control. While the evaluation of foetal liver dimensions has a role in identifying foetal growth acceleration, previous studies addressed patients with insulin-dependent diabetes mellitus rather than gestational diabetes mellitus, utilised two-dimensional ultrasound and did not argue the diagnostic value of these findings. What do the results of this study add? In our study, besides the standard biometric measurements, the FLV measurements were evaluated by a three-dimensional ultrasound. Although there were no significant differences in the standard biometric measurements between the GDM (+) and GDM (-) groups, the FLV was significantly higher in women with GDM. The FLV was found to be a potential predictive factor for GDM. The ROC analysis implied that as a cut-off value of FLV of 32.72 cm 3 for GDM prediction, the sensitivity was 78.8% and the specificity was 56.3%. What are the implications of these findings for clinical practise and/or further research? Screening for GDM with oral glucose tolerance test within the limited weeks of gestation may not always be feasible. On the other hand, the mid-trimester ultrasound scanning is done almost in all pregnancies. Accordingly, FLV measurement might be an alternative method for the GDM diagnosis.

Stolen twin: fascination and curiosity/twin research reports: evolution of sleep length; dental treatment of craniopagus twins; cryopreserved double embryo transfer; gender options in multiple pregnancy/current events: appendectomy in one twin; autistic twin marathon runners; 3D facial recognition; twin biathletes.

PubMed

Segal, Nancy L

2014-02-01

The story of her allegedly stolen twin brother in Armenia is recounted by a 'singleton twin' living in the United States. The behavioral consequences and societal implications of this loss are considered. This case is followed by twin research reports on the evolution of sleep length, dental treatment of craniopagus conjoined twins, cryopreserved double embryo transfer (DET), and gender options in multiple pregnancy. Current events include the diagnosis of appendectomy in one identical twin, the accomplishments of autistic twin marathon runners, the power of three-dimensional (3D) facial recognition, and the goals of twin biathletes heading to the 2014 Sochi Olympics in Russia.

Maternal dietary intake and pregnancy outcome.

PubMed

Ferland, Suzanne; O'Brien, Huguette Turgeon

2003-02-01

To study the relationship between maternal diet and infant anthropometric measurements in 56 women, aged 28 +/- 5.1 years, with singleton pregnancies. The overall quality of the diet (three 24-hour recalls), including supplementation, was evaluated at 34 +/- 1.3 weeks using a total mean adequacy ratio (TMAR) of 12 nutrients. Specific interviewing techniques were used to minimize social desirability bias. Anthropometric measurements of both parents and maternal lifestyle practices were also obtained. Infant weight, crown-heel length and head circumference were measured 14.6 +/- 4.4 days after birth. Stepwise multiple regression analysis revealed that maternal diet quality (TMAR) was significantly related to infant weight (r = .039, P = .036) and crown-heel length (r = .071, P = .007). Other significant predictors included gestational age, maternal height, sex, smoking and physical activity. Maternal diet was positively associated with infant weight and crown-heel length.

Comparison of Fetal and Neonatal Growth Curves in Detecting Growth Restriction

PubMed Central

Marconi, Anna Maria; Ronzoni, Stefania; Bozzetti, Patrizia; Vailati, Simona; Morabito, Alberto; Battaglia, Frederick C

2009-01-01

Objective To evaluate the outcome of intrauterine growth restriction (IUGR) infants with abnormal pulsatility index of the umbilical artery according to the neonatal birth weight/gestational age standards and the intrauterine growth charts. Methods We analyzed 53 pregnancies with severe IUGR classified as Group 2 (22 IUGR: abnormal pulsatility index and normal fetal heart rate) and Group 3 (31 IUGR: abnormal pulsatility index and fetal heart rate). Neonatal birth weight/gestational age distribution, body size measurements, maternal characteristics and obstetric outcome, and neonatal major and minor morbidity and mortality were compared with those obtained in 79 singleton pregnancies with normal fetal growth and pulsatility index, matched for gestational age [appropriate for gestational age (AGA) group]. Differences were analyzed with the χ2 test and the Student’s t test. Differences between means corrected for gestational age in the different groups were assessed by analysis of covariance test. A P value <0.05 was considered significant. Results At delivery, utilizing the neonatal standards, 25/53 (47%) IUGR showed a birthweight above the 10th percentile (IUGRAGA) whereas in 28, birthweight was below the 10th percentile (IUGRSGA). All body size measurements were significantly higher in AGA than in IUGRAGA and IUGRSGA. Forty-nine out of 79 (62%) AGA and 49/53 (92%) IUGR were admitted in the neonatal intensive care unit (p<0.001). One out of 79 (1%) AGA and 6/53 (11%) IUGR newborns died within 28 days (p<0.02). Major and minor morbidity was not different. Conclusion This study shows that neonatal outcome is similar in IUGR of the same clinical severity, whether or not they could be defined AGA or SGA according to the neonatal standards. Neonatal curves are misleading in detecting low birthweight infants and should be utilized only when obstetrical data are unavailable. PMID:19037030

Pre-term birth and low birth weight following preimplantation genetic diagnosis: analysis of 88 010 singleton live births following PGD and IVF cycles.

PubMed

Sunkara, Sesh Kamal; Antonisamy, Belavendra; Selliah, Hepsy Y; Kamath, Mohan S

2017-02-01

Is PGD associated with the risk of adverse perinatal outcomes such as pre-term birth (PTB) and low birth weight (LBW)? There was no increase in the risk of adverse perinatal outcomes of PTB, and LBW following PGD compared with autologous IVF. Pregnancies resulting from ART are associated with a higher risk of pregnancy complications compared with spontaneously conceived pregnancies. The possible reason of adverse obstetric outcomes following ART has been attributed to the underlying infertility itself and embryo specific epigenetic modifications due to the IVF techniques. It is of interest whether interventions such as embryo biopsy as performed in PGD affect perinatal outcomes. Anonymous data were obtained from the Human Fertilization and Embryology Authority (HFEA), the statutory regulator of ART in the UK. The HFEA has collected data prospectively on all ART performed in the UK since 1991. Data from 1996 to 2011 involving a total of 88 010 singleton live births were analysed including 87 571 following autologous stimulated IVF ± ICSI and 439 following PGD cycles. Data on all women undergoing either a stimulated fresh IVF ± ICSI treatment cycle or a PGD cycle during the period from 1996 to 2011 were analysed to compare perinatal outcomes of PTB and LBW among singleton live births. Logistic regression analysis was performed adjusting for female age category, year of treatment, previous IVF cycles, infertility diagnosis, number of oocytes retrieved, whether IVF or ICSI was used and day of embryo transfer. There was no increase in the risk of PTB and LBW following PGD versus autologous stimulated IVF ± ICSI treatment, unadjusted odds of PTB (odds ratio (OR) 0.68, 95% CI: 0.46-0.99) and LBW (OR 0.56, 95% CI: 0.37-0.85). After adjusting for the potential confounders, there was again no increase in the risk of the adverse perinatal outcomes following PGD: PTB (adjusted odds ratio (aOR) 0.66, 95% CI: 0.45-0.98) and LBW (aOR 0.58, 95% CI: 0.38-0.88). Although the analysis was adjusted for a number of important confounders, the data set had no information on confounders such as smoking, body mass index and the medical history of women during pregnancy to allow adjustment. There was no information on the stage of embryo at biopsy, whether blastomere or trophectoderm biopsy. The demonstration that PGD is not associated with higher risk of PTB and LBW provides reassurance towards its current expanding application. No funding was obtained. There are no competing interests to declare. © The Author 2016. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Maternal use of cannabis and pregnancy outcome.

PubMed

Fergusson, David M; Horwood, L John; Northstone, Kate

2002-01-01

To document the prevalence of cannabis use in a large sample of British women studied during pregnancy, to determine the association between cannabis use and social and lifestyle factors and assess any independent effects on pregnancy outcome. Self-completed questionnaire on use of cannabis before and during pregnancy. Over 12,000 women expecting singletons at 18 to 20 weeks of gestation who were enrolled in the Avon Longitudinal Study of Pregnancy and Childhood. Any association with the use of cannabis before and during pregnancy with pregnancy outcome was examined, taking into account potentially confounding factors including maternal social background and other substance use during pregnancy. Late fetal and perinatal death, special care admission of the newborn infant, birthweight, birth length and head circumference. Five percent of mothers reported smoking cannabis before and/or during pregnancy; they were younger, of lower parity, better educated and more likely to use alcohol, cigarettes, coffee, tea and hard drugs. Cannabis use during pregnancy was unrelated to risk of perinatal death or need for special care, but, the babies of women who used cannabis at least once per week before and throughout pregnancy were 216 g lighter than those of non-users, had significantly shorter birth lengths and smaller head circumferences. After adjustment for confounding factors, the association between cannabis use and birthweight failed to be statistically significant (P = 0.056) and was clearly non-linear: the adjusted mean birthweights for babies of women using cannabis at least once per week before and throughout pregnancy were 90 g lighter than the offspring of other women. No significant adjusted effects were seen for birth length and head circumference. The results of this study suggest that the use of cannabis during pregnancy was not associated with increased risk of perinatal mortality or morbidity in this sample. However, frequent and regular use of cannabis throughout pregnancy may be associated with small but statistically detectable decrements in birthweight.

Increased time to pregnancy is associated with less optimal neurological condition in 4-year-old singletons, in vitro fertilization itself is not.

PubMed

Schendelaar, P; Van den Heuvel, E R; Heineman, M J; La Bastide-Van Gemert, S; Middelburg, K J; Seggers, J; Hadders-Algra, M

2014-12-01

Does ovarian hyperstimulation, the in vitro procedures required for in vitro fertilization (IVF)/ intracytoplasmic sperm injection or the combination of both, affect the neurological outcome of 4-year-old singletons? Ovarian hyperstimulation, the in vitro procedure and the combination of both, were not associated with the worse neurological outcome in 4-year-old singletons. Assisted reproduction techniques (ARTs) are not associated with neurological dysfunction during the first post-natal years; however, effects on the long-term neurological outcome are still inconclusive. An increased time to pregnancy (TTP, a proxy for the severity of subfertility) has been associated with a less optimal neurological condition at age 2. The present study focuses on the neurodevelopmental outcome of 4-year-old ART-offspring. Longitudinal, prospective follow-up study. Four-year-old singletons born to subfertile parents (subfertile group, n = 195), including singletons born after controlled ovarian hyperstimulation IVF (COH-IVF, n = 63), modified natural cycle IVF (MNC-IVF, n = 53) and natural conception (Sub-NC, n = 79). Data on underlying cause of subfertility and TTP were present. In addition, we assessed newly recruited 4-year-old singletons born to fertile parents after natural conception (reference group, n = 98). Neurological development was evaluated with the neurological examination according to Hempel, resulting in a neurological optimality score (NOS), a fluency score and the occurrence of the clinically relevant form of minor neurological dysfunction (complex MND). The primary outcome was the fluency score, as fluency of movements is easily reduced by subtle brain dysfunction. Data were analysed with univariable and multivariable regression analyses, in which special attention was paid to sex differences in the neurological outcome. The fluency score, NOS and the prevalence of complex MND were similar in COH-IVF, MNC-IVF and Sub-NC children. The neurological condition of children born to subfertile parents was similar to that of children of fertile parents and was independent of the underlying cause of subfertility. No statistically significant associations were found between TTP and the fluency score and NOS. However, a positive correlation was found between TTP and the prevalence of complex MND (TTP in years, adjusted odds ratio [OR] [95% confidence interval, CI]: 1.207 [1.038 to 1.404], P = 0.014); a correlation which could be attributed to girls, in whom an evident positive correlation was present (adjusted OR [95% CI]: 1.542 [1.161 to 2.047], P = 0.003). A similar association was absent in boys. The prospective design of our study and small post-natal attrition rate (9.3%) reduced potential selection bias based on the child's development or health. The assessors were blind to the mode of conception, except for the group of children born to fertile parents, which was newly recruited. The study lacks sufficient power to conclude firmly that increased TTP is associated with a higher prevalence of complex MND. Our study suggests that the severity of subfertility, rather than its simple presence or components of IVF treatment, affects the neurological outcome. Moreover, girls may be neurologically more vulnerable for the effect of severity of subfertility. The finding that the severity of subfertility may be the decisive factor rather than the presence of a history of subfertility per se corroborates previous reports. Our results cannot be generalized to multiples, as we studied singletons only. The study was financially supported by the University Medical Center Groningen, grant number: 754510, the Junior Scientific Masterclass, the Postgraduate School Behavioural and Cognitive Neurosciences and the Cornelia Foundation, Groningen, The Netherlands. The authors have no conflicts of interest to declare. © The Author 2014. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Prevalence and characteristics of intended adolescent pregnancy: an analysis of the Canadian maternity experiences survey.

PubMed

Sekharan, Vineeth S; Kim, Theresa H M; Oulman, Elizaveta; Tamim, Hala

2015-11-05

There is limited research focusing on adolescent women who intended to become pregnant, as majority of research examines unintended adolescent pregnancies. The objective was to examine the prevalence and characteristics of Canadian adolescent women who intended to become pregnant. The analysis was based on the national 2006 Maternity Experiences Survey consisting of women who had a singleton live birth. The sample was restricted to adolescent women between 15 to 19 years of age. The main outcome of this study was the adolescent woman's pregnancy intention. A variety of sociodemographic, maternal, and pregnancy related factors were examined using a multivariable logistic regression. Adjusted odds ratios (OR) and 95 % confidence intervals (CI) were reported for all variables. The sample size was 290, weighted to represent 2224 adolescent women. Based on the adjusted model, the odds of experiencing an intended pregnancy were increased if the adolescent woman was between 18-19 years old (OR 2.62, 95 % CI 1.05, 6.57), had a partner (OR 2.37, 95 % CI 1.12, 4.99), experienced no violence/abuse (OR 3.08, 95 % CI 1.38, 6.86), and consumed no alcohol before pregnancy (OR 3.17, 95 % CI 1.56, 6.45). Additionally, adolescent women who reported drug use prior to pregnancy were more likely to have an intended pregnancy (OR 0.39, 95 % CI 0.16, 0.95). The findings from this study can be used as the basis for future research to investigate the characteristics and needs represented by this group of adolescents and to aid in the development of effective policies and programs.

Is maternal smoking during pregnancy associated with bipolar disorder in offspring?

PubMed

Chudal, Roshan; Brown, Alan S; Gissler, Mika; Suominen, Auli; Sourander, Andre

2015-01-15

Prenatal smoking exposure affects fetal growth and development and is associated with increased risk of various neurodevelopmental disorders. Only one previous study has examined the association between maternal smoking during pregnancy and the risk of bipolar disorder (BPD). In this nested case control study derived from all singleton live births in Finland between January 1st 1987 and December 31st 1998, we identified 724 children diagnosed and/or treated with BPD until 2008 and 1419 matched controls from four nationwide registers. Conditional logistic regression was used to examine the association between maternal smoking during pregnancy and BPD adjusting for potential confounding due to parental psychiatric history, maternal age and education level. 18.5% of offspring were exposed to maternal smoking during pregnancy. In the unadjusted analysis, smoking during pregnancy was associated with a 1.41-fold (95% CI 1.12-1.79, P=0.004) increased risk of BPD. In the final model adjusting for potential covariates, the risk was 1.14-fold (95% CI 0.88-1.49, P=0.323). The limitations of this study include: hospital based clinical diagnosis for case ascertainment, inclusion of early onset BPD cases, and lack of information on alcohol or other substance abuse during pregnancy. This study demonstrated that, in this sample, an increased risk of BPD among offspring of mothers who smoked during pregnancy is most likely due to confounding by familial background factors. Future studies including information on serological measures of smoking exposure in pregnancy e.g. cotinine are warranted to further clarify this association. Copyright © 2014 Elsevier B.V. All rights reserved.

Unemployment at municipality level is associated with an increased risk of small for gestational age births--a multilevel analysis of all singleton births during 2005-2010 in Finland.

PubMed

Räisänen, Sari; Kramer, Michael R; Gissler, Mika; Saari, Juho; Heinonen, Seppo

2014-10-18

Neighbourhood level deprivation has been shown to influence adverse perinatal outcomes independent of individual level socioeconomic status (SES) in countries with high income inequality, such as the United States. The present study evaluates whether municipality level deprivation defined based on education (proportion of inhabitants with university level education), income (mean income per capita) and unemployment were associated with the prevalence of preterm birth (<37 weeks) and small for gestational age (SGA, birth weight <2 standard deviations) after adjustment for individual level socio-demographics (age, parity, prior preterm births, smoking during pregnancy and SES defined based on maternal occupation at birth) in Finland. The study design was cross-sectional. The data gathered from the Medical Birth Register included all singleton births (n = 345,952) in 2005-2010. We fitted Generalized Estimating Equations (GEE) models to account for correlation of preterm birth and SGA clustering within municipality. Of all the women with singleton pregnancies, 4.5% (n = 15,615) gave birth preterm and 3.8% (n = 13,111) of their newborns were classified as SGA. Individual level SES and smoking were important risk factors for each outcome in adjusted models. Controlling for individual level factors, women living in intermediate and high unemployment class municipalities were 6.0% (adjusted odds ratio (aOR) = 1.06; 95% confidence interval (CI) 1.01-1.12) and 13.0% (aOR = 1.13; 95% CI 1.06-1.20), respectively, more likely to give birth to an SGA newborn than women living in low unemployment class municipalities. After adjustment for individual level socio-demographics, the prevalence of SGA was around 6-13% higher in municipalities with an intermediate or high unemployment rate than municipalities with the lowest unemployment rate. The results suggested that the unemployment rate has an important public health effect with clinical implications since SGA is associated with a higher risk of adverse long-term health outcomes.

Postnatal depression, eating, exercise, and vomiting before and during pregnancy.

PubMed

Abraham, S; Taylor, A; Conti, J

2001-05-01

To examine the postnatal distress and the eating, exercise, and weight losing behavior of women before and during pregnancy. The subjects were healthy women who had given birth to a singleton healthy baby in the week before the study. They were drawn from two consecutive series of mothers of babies whose birth weights were either < or =2,500 g or >2,500 g. A total of 181 women were interviewed using a standardized interview modified for pregnancy and related behaviors. They also completed the Edinburgh Postnatal Distress Questionnaire. Regression analysis produced a final model containing variables that made a unique contribution to predicting the level of distress of women in the week following childbirth. The model accounted for 25% of the variance and included four variables that were associated with greater distress: fear of weight gain before and during pregnancy, being distracted by thoughts of food during pregnancy, being afraid of gaining more weight than the pregnancy would explain, and vomiting more frequently during the first 3-4 months of pregnancy. A fifth variable accounted for less distress, that is, participating in low-intensity exercise for reasons of shape and weight during months 3-4 of pregnancy. Other variables associated with distress only in the preliminary analysis were maternal age, binge eating, and vomiting before pregnancy. The most distressed mothers were suffering from an eating disorder at the time of pregnancy. The binge and/or purge type of eating disorder was associated with more distress than a food restriction type. Postnatal distress is associated with body weight and shape concerns, with disordered eating before and during pregnancy, and with vomiting during pregnancy. The protective role of low-intensity exercise during early pregnancy needs to be explored. Women with eating disorders should be considered at risk for postnatal problems. Copyright 2001 by John Wiley & Sons, Inc.

Recurrence of breech presentation in consecutive pregnancies

PubMed Central

Ford, JB; Roberts, CL; Nassar, N; Giles, W; Morris, JM

2010-01-01

Objective To investigate the recurrence risk of breech presentation at term, and to assess the risk factors that contribute to its recurrence. Design Cohort study. Setting New South Wales, Australia. Population Women with their first two (n = 113 854) and first three (n = 21 690) consecutive singleton term pregnancies, in the period 1994–2002. Methods Descriptive statistics including rates, relative risks and adjusted relative risks, as determined from logistic regression and Poisson analyses. Main outcome measures Rates and risks of occurrence and recurrence of breech presentation at birth in each pregnancy, and maternal and infant risk factors associated with breech recurrence. Results First-time breech presentation at term occurred in 4.2% of first pregnancy deliveries, 2.2% of second pregnancies and 1.9% of third pregnancies. The rate of breech recurrence in a second consecutive pregnancy was 9.9%, and in a third consecutive pregnancy (after two prior breech deliveries) was 27.5%. The relative risk of breech recurrence in a second pregnancy was 3.2 (95% CI 2.8–3.6), and in a third consecutive breech pregnancy was 13.9 (95% CI 8.8–22.1). First pregnancy factors associated with recurrence included placenta praevia [adjusted relative risk (aRR) 2.2; 95% CI 1.3–3.7], maternal diabetes (aRR 1.4; 95% CI 1.0–2.1) and a maternal age of ≥35 years (aRR 1.2; 95% CI 0.9–1.6). Second pregnancy factors included birth defects (aRR 2.5; 95% CI 1.4–4.2), placenta praevia (aRR 2.5; 95% CI 1.5–4.1) and a female infant (aRR 1.2; 95% CI 1.0–1.5). Conclusions The increased recurrence risk of breech presentations suggests that women with a history of breech delivery should be closely monitored in the latter stages of pregnancy. PMID:20482538

Who are the Women Who Work in Their Last Month of Pregnancy? Social and Occupational Characteristics and Birth Outcomes of Women Working Until the Last Month of Pregnancy in France.

PubMed

Vigoureux, Solène; Blondel, Béatrice; Ringa, Virginie; Saurel-Cubizolles, Marie-Josèphe

2016-09-01

Introduction The prenatal leave law in France protects women during pregnancy and their employment. We aimed to estimate the proportion of women who worked late in their pregnancy, to analyze the occupational, social and medical factors associated with late prenatal leave and to compare the pregnancy outcome of these women and those who left earlier in the pregnancy. Methods The sample was extracted from the 2010 French National Perinatal Survey. All women who delivered within a 1-week period were interviewed before discharge from the maternity unit. Women with a singleton live birth at or after 37 weeks' gestation and who were working during pregnancy (n = 8463) were included. Data were collected on employment, date of leave, and sociodemographic and medical characteristics. Results Overall, 328 women (3.9 %) took a late prenatal leave (at or after 37 weeks' gestation). Women who left late were older than 30 years old, with a high educational level and were living in an urban area. Being self-employed and having a managerial or upper-intellectual occupation was highly associated with late leave, before and after controlling for relevant variables. Perinatal and delivery outcomes were similar for women who took a late leave and those who left before 37 weeks' gestation. Discussion Occupational characteristics are the main determinants of late prenatal leave. Women working in the last month of pregnancy had a favorable social and occupational situation and did not did not experience an adverse pregnancy or birth outcome. Other studies are needed to understand the reasons for late leave and evaluate the post-partum fatigue and health of these women.

Renal and obstetric outcomes in pregnancy after kidney transplantation: Twelve-year experience in a Singapore transplant center.

PubMed

Kwek, Jia Liang; Tey, Vanessa; Yang, Liying; Kanagalingam, Devendra; Kee, Terence

2015-09-01

Renal and obstetric outcomes in pregnancy after kidney transplantation in Singapore were last studied in 2002. A review of these outcomes in Singapore is now timely following advances in transplant and obstetric medicine. The aim was to evaluate the renal and obstetric outcomes in pregnancy after kidney transplantation in a Singapore tertiary center. Kidney transplant recipients who underwent pregnancy after transplantation at Singapore General Hospital between January 2001 and December 2012 were identified. Data on demographics, comorbidities and clinical outcomes were collected. There were 10 pregnancies identified in nine recipients. The median age of recipient at childbearing was 34.6 years (IQR, 32.8-36.8) and the median interval from transplantation to conception was 69 months (IQR, 38-97). There was no difference between the median pre-pregnancy estimated glomerular filtration rate (eGFR) (47.9 mL/min/1.73 m(2); IQR, 38.4-56.8) and median eGFR at time of last post-partum follow up (43.9 mL/min/1.73 m(2); IQR, 34.5-48.7, P = 0.549). Borderline allograft rejection occurred in one recipient (10.0%) 36 days after birth due to non-adherence to immunosuppressive medication, with subsequent allograft loss 37 months after birth. No mortalities were recorded during the study period. All the 10 pregnancies (100%) ended in singleton live births. Pre-eclampsia occurred in five pregnancies (50.0%), and there were seven (70.0%) preterm deliveries. The median gestational age was 35.4 weeks (IQR, 32.6-38.2) and the median birthweight was 2353 g (IQR, 1811-2648). Post-transplantation pregnancies ended successfully with no significant worsening of allograft function, but they were associated with risks to both recipients and newborns. © 2015 Japan Society of Obstetrics and Gynecology.

Population based study of rates of multiple pregnancies in Denmark, 1980-94.

PubMed Central

Westergaard, T.; Wohlfahrt, J.; Aaby, P.; Melbye, M.

1997-01-01

OBJECTIVE: To study trends in multiple pregnancies not explained by changes in maternal age and parity patterns. DESIGN: Trends in population based figures for multiple pregnancies in Denmark studied from complete national records on parity history and vital status. POPULATION: 497,979 Danish women and 803,019 pregnancies, 1980-94. MAIN OUTCOME MEASURES: National rates of multiple pregnancies, infant mortality, and stillbirths controlled for maternal age and parity. Special emphasis on primiparous women > or = 30 years of age, who are most likely to undergo fertility treatment. RESULTS: The national incidence of multiple pregnancies increased 1.7-fold during 1980-94, the increase primarily in 1989-94 and almost exclusively in primiparous women aged > or = 30 years, for whom the adjusted population based twinning rate increased 2.7-fold and the triplet rate 9.1-fold. During 1989-94, the adjusted yearly increase in multiple pregnancies for these women was 19% (95% confidence interval 16% to 21%) and in dizygotic twin pregnancies 25% (21% to 28%). The proportion of multiple births among infant deaths in primiparous women > or = 30 years increased from 11.5% to 26.9% during the study period. The total infant mortality, however, did not increase for these women because of a simultaneous significant decrease in infant mortality among singletons. CONCLUSIONS: A relatively small group of women has drastically changed the overall national rates of multiple pregnancies. The introduction of new treatments to enhance fertility has probably caused these changes and has also affected the otherwise decreasing trend in infant mortality. Consequently, the resources, both economical and otherwise, associated with these treatments go well beyond those invested in specific fertility enhancing treatments. PMID:9080993

Prospective longitudinal study of the pregnancy DNA methylome: the US Pregnancy, Race, Environment, Genes (PREG) study

PubMed Central

Moyer, Sara; Olivares, Emily; Amstadter, Ananda B; Kinser, Patricia A; Latendresse, Shawn J; Jackson-Cook, Colleen; Roberson-Nay, Roxann; Strauss, Jerome F; York, Timothy P

2018-01-01

Purpose The goal of the Pregnancy, Race, Environment, Genes study was to understand how social and environmental determinants of health (SEDH), pregnancy-specific environments (PSE) and biological processes influence the timing of birth and account for the racial disparity in preterm birth. The study followed a racially diverse longitudinal cohort throughout pregnancy and included repeated measures of PSE and DNA methylation (DNAm) over the course of gestation and up to 1 year into the postpartum period. Participants All women were between 18 and 40 years of age with singleton pregnancies and no diagnosis of diabetes or indication of assisted reproductive technology. Both mother and father had to self-identify as either African-American (AA) or European-American (EA). Maternal peripheral blood samples along with self-report questionnaires measuring SEDH and PSE factors were collected at four pregnancy visits, and umbilical cord blood was obtained at birth. A subset of participants returned for two additional postpartum visits, during which additional questionnaires and maternal blood samples were collected. The pregnancy and postpartum extension included n=240 (AA=126; EA=114) and n=104 (AA=50; EA=54), respectively. Findings to date One hundred seventy-seven women (AA=89, EA=88) met full inclusion criteria out of a total of 240 who were initially enrolled. Of the 63 participants who met exclusion criteria after enrolment, 44 (69.8%) were associated with a medical reason. Mean gestational age at birth was significantly shorter for the AA participants by 5.1 days (M=272.5 (SD=10.5) days vs M=277.6 (SD=8.3)). Future plans Future studies will focus on identifying key environmental factors that influence DNAm change across pregnancy and account for racial differences in preterm birth. PMID:29743320

Does the thyroid-stimulating hormone measured concurrently with first trimester biochemical screening tests predict adverse pregnancy outcomes occurring after 20 weeks gestation?

PubMed

Ong, Gregory S Y; Hadlow, Narelle C; Brown, Suzanne J; Lim, Ee Mun; Walsh, John P

2014-12-01

Maternal hypothyroidism in early pregnancy is associated with adverse outcomes, but not consistently across studies. First trimester screening for chromosomal anomalies is routine in many centers and provides an opportunity to test thyroid function. To determine if thyroid function tests performed with first trimester screening predicts adverse pregnancy outcomes. A cohort study of 2411 women in Western Australia with singleton pregnancies attending first trimester screening between 9 and 14 weeks gestation. We evaluated the association between TSH, free T4, free T3, thyroid antibodies, free beta human chorionic gonadotrophin (β-hCG) and pregnancy associated plasma protein A (PAPP-A) with a composite of adverse pregnancy events as the primary outcome. Secondary outcomes included placenta previa, placental abruption, pre-eclampsia, pregnancy loss after 20 weeks gestation, threatened preterm labor, preterm birth, small size for gestational age, neonatal death, and birth defects. TSH exceeded the 97.5th percentile for the first trimester (2.15 mU/L) in 133 (5.5%) women, including 22 (1%) with TSH above the nonpregnant reference range (4 mU/L) and 5 (0.2%) above 10 mU/L. Adverse outcomes occurred in 327 women (15%). TSH and free T4 did not differ significantly between women with or without adverse pregnancy events. On the multivariate analysis, neither maternal TSH >2.15 mU/L nor TSH as a continuous variable predicted primary or secondary outcomes. Testing maternal TSH as part of first trimester screening does not predict adverse pregnancy outcomes. This may be because in the community setting, mainly mild abnormalities in thyroid function are detected.

Rate of Second and Third Trimester Weight Gain and Preterm Delivery Among Underweight and Normal Weight Women.

PubMed

Sharma, Andrea J; Vesco, Kimberly K; Bulkley, Joanna; Callaghan, William M; Bruce, F Carol; Staab, Jenny; Hornbrook, Mark C; Berg, Cynthia J

2016-10-01

Objectives Low gestational weight gain (GWG) in the second and third trimesters has been associated with increased risk of preterm delivery (PTD) among women with a body mass index (BMI) < 25 mg/m(2). However, few studies have examined whether this association differs by the assumptions made for first trimester gain or by the reason for PTD. Methods We examined singleton pregnancies during 2000-2008 among women with a BMI < 25 kg/m(2) who delivered a live-birth ≥28 weeks gestation (n = 12,526). Women received care within one integrated health care delivery system and began prenatal care ≤13 weeks. Using antenatal weights measured during clinic visits, we interpolated GWG at 13 weeks gestation then estimated rate of GWG (GWGrate) during the second and third trimesters of pregnancy. We also estimated GWGrate using the common assumption of a 2-kg gain for all women by 13 weeks. We examined the covariate-adjusted association between quartiles of GWGrate and PTD (28-36 weeks gestation) using logistic regression. We also examined associations by reason for PTD [premature rupture of membranes (PROM), spontaneous labor, or medically indicated]. Results Mean GWGrate did not differ among term and preterm pregnancies regardless of interpolated or assumed GWG at 13 weeks. However, only with GWGrate estimated from interpolated GWG at 13 weeks, we observed a U-shaped relationship where odds of PTD increased with GWGrate in the lowest (OR 1.36, 95 % CI 1.10, 1.69) or highest quartile (OR 1.49, 95 % CI 1.20, 1.85) compared to GWGrate within the second quartile. Further stratifying by reason, GWGrate in the lowest quartile was positively associated with spontaneous PTD while GWGrate in the highest quartile was positively associated with PROM and medically indicated PTD. Conclusions Accurate estimates of first trimester GWG are needed. Common assumptions applied to all pregnancies may obscure the association between GWGrate and PTD. Further research is needed to fully understand whether these associations are causal or related to common antecedents.

The perception of primiparous mothers of comfortable resources in labor pain (a qualitative study)

PubMed Central

Boryri, Tahereh; Noori, Noor Mohammad; Teimouri, Alireza; Yaghobinia, Fariba

2016-01-01

Background: Natural delivery is the most painful event that women experience in their lifetime. That is why labor pain relief has long been as one of the most important issues in the field of midwifery. Thus, the present study aims to explore the perception of primiparous mothers on comfortable resources for labor pain. Materials and Methods: In the present study, qualitative content analysis technique was used. The participants had singleton pregnancy with normal vaginal delivery. These women referred to the Imam Javad Health Center within 3–5 days after delivery for screening thyroid of their babies. Results: During the content analysis process, five themes emerged that indicated the nature and dimensions of the primiparous mothers' perception of comfortable resources. These themes were: “religious and spiritual beliefs,” “use of analgesic methods” (medicinal and non-medicinal), “support and the continuous attendance of midwife and delivery room personnel,” “family's and husband's support during pregnancy and in vaginal delivery encouragement,” and finally “lack of familiarity with the delivery room and lack of awareness about structured delivery process.” Conclusions: The results showed that mothers received more comfort from human resources than from the environment and modern equipment. Despite the need for specialized midwife with modern technical facilities, this issue shows the importance of highlighting the role of midwife and humanistic midwife care. Therefore, considering midwives and the standardization of human resources in health centers are more important than physical standardization. This will result in midwife interventions being performed with real understanding of the patients' needs. PMID:27186200

Determinants and outcome of fetal macrosomia in a Nigerian tertiary hospital.

PubMed

Olokor, Oghenefegor Edwin; Onakewhor, Joseph Ubini; Aderoba, Adeniyi Kolade

2015-01-01

To determine the incidence and risk factors of fetal macrosomia and maternal and perinatal outcome. This was a 1-year prospective case-control study of singleton pregnancies in a Nigerian tertiary hospital. Only women who gave consent were recruited for the study. The maternal and perinatal outcomes in women who delivered macrosomic infants (birth weight ≥ 4000 g) were compared with the next consecutive delivery of normal birth weight (2500-3999 g) infants. The total deliveries for the study period were 2437, of which 135 were macrosomic babies. The incidence of fetal macrosomia was 5.5%. The mean birth weights of macrosomic and nonmacrosomic babies were 4.26 ± 0.29 kg and 3.20 ± 0.38 kg, respectively, P = 0.000. Mothers with macrosomic babies were more likely to be older (P = 0.047), of higher parity (0.001), taller (P = 0.007), and weighed more at delivery (P = 0.000). Previous history of fetal macrosomia (P = 0.000) and maternal diabetes (P = 0.007) were factors strongly associated with the delivery of macrosomic infants. Pregnancies associated with fetal macrosomia had increased duration of labor (P = 0.007), interventional deliveries (P = 0.000), shoulder dystocia, and genital laceration (P = 0.000). There was no significant difference in the incidence of primary postpartum hemorrhage (P = 0.790), birth asphyxia, and perinatal mortality (P = 0.197). Fetal macrosomia is associated with maternal and fetal morbidities. The presence of the observed risk factors should elicit the suspicion of a macrosomic fetus and the need for appropriate management to reduce maternal and fetal morbidities.

Metabolomic profiling in the prediction of gestational diabetes mellitus

PubMed Central

Huynh, Jennifer; Xiong, Grace; Lee, Hang; Wenger, Julia; Clish, Clary; Nathan, David; Thadhani, Ravi; Gerszten, Robert

2015-01-01

Aims/hypothesis Metabolomic profiling in populations with impaired glucose tolerance has revealed that branched chain and aromatic amino acids (BCAAs) are predictive of type 2 diabetes. Because gestational diabetes mellitus (GDM) shares pathophysiological similarities with type 2 diabetes, the metabolite profile predictive of type 2 diabetes could potentially identify women who will develop GDM. Methods We conducted a nested case–control study of 18- to 40-year-old women who participated in the Massachusetts General Hospital Obstetrical Maternal Study between 1998 and 2007. Participants were enrolled during their first trimester of a singleton pregnancy and fasting serum samples were collected. The women were followed throughout pregnancy and identified as having GDM or normal glucose tolerance (NGT) in the third trimester. Women with GDM (n=96) were matched to women with NGT (n=96) by age, BMI, gravidity and parity. Liquid chromatography–mass spectrometry was used to measure the levels of 91 metabolites. Results Data analyses revealed the following characteristics (mean±SD): age 32.8±4.4 years, BMI 28.3±5.6 kg/m2, gravidity 2±1 and parity 1±1. Six metabolites (anthranilic acid, alanine, glutamate, creatinine, allantoin and serine) were identified as having significantly different levels between the two groups in conditional logistic regression analyses (p<0.05). The levels of the BCAAs did not differ significantly between GDM and NGT. Conclusions/interpretation Metabolic markers identified as being predictive of type 2 diabetes may not have the same predictive power for GDM. However, further study in a racially/ethnically diverse population-based cohort is necessary. PMID:25748329

The associations between depressive and anxiety symptoms, body image, and weight in the first year postpartum: a rapid systematic review.

PubMed

Hartley, Eliza; Hill, Briony; McPhie, Skye; Skouteris, Helen

2018-02-01

The aim of this study was to conduct a rapid systematic review of the evidence of associations between postpartum depressive symptoms, anxiety symptoms, body image and weight status in the first 12 months post birth. The postpartum period places the mother and infant at risk of a number of negative health outcomes. Mental health conditions such as depression and anxiety are common in the postpartum, as are poor body image and excessive weight retention as women adjust to their post pregnancy body. However, the associations between body image, weight status and psychological distress are not currently well understood.   Articles in English, published between 2006 and 2017, involving singleton pregnancies of normally developing infants and maternal depression or anxiety were eligible for this systematic review.  From the total of 1805 articles located, 12 were identified as relevant and were subsequently reviewed in full. In the nine studies of depressive symptoms, body image or weight status, four found a significant relationship. Significant associations were not found in the three studies investigating postpartum anxiety symptoms, body image or weight. Body dissatisfaction was associated significantly with poorer postpartum weight status in all nine studies. Further research is needed to determine the nature of the relationships between body image, weight status and depressive and anxiety symptoms across the first year after birth. This information will assist health professionals to promote healthy lifestyle behaviours in the postpartum, as well as inform clinical interventions that target behaviour change to prevent the worsening of these issues and related negative outcomes.

The periconception maternal cardiovascular risk profile influences human embryonic growth trajectories in IVF/ICSI pregnancies.

PubMed

Wijnands, K P J; van Uitert, E M; Roeters van Lennep, J E; Koning, A H J; Mulders, A G M G J; Laven, J S E; Steegers, E A P; Steegers-Theunissen, R P M

2016-06-01

Is the maternal cardiovascular (CV) risk profile associated with human embryonic growth trajectories and does the mode of conception affect this association? This small study suggests that the maternal CV risk profile is inversely associated with first trimester embryonic growth trajectories in in vitro fertilization (IVF)/intra-cytoplasmic sperm injection (ICSI) pregnancies, but not in spontaneously conceived pregnancies. Maternal high-blood pressure and smoking affect placental function, accompanied by increased risk of fetal growth restriction and low-birthweight. Mothers who experience pregnancies complicated by fetal growth restriction are at increased risk of CV disease in later life. In a prospective periconception birth cohort conducted in a tertiary hospital, 111 singleton ongoing pregnancies with reliable pregnancy dating, no pre-existing maternal disease and no malformed live borns were investigated. Spontaneously conceived pregnancies with a reliable first day of the last menstrual period and a regular menstrual cycle of 25-31 days only (n = 66) and IVF/ICSI pregnancies (n = 45) were included. Women underwent weekly three-dimensional ultrasound scans (3D US) from 6- to 13-week gestational age. To estimate embryonic growth, serial crown-rump length (CRL) measurements were performed using the V-Scope software in a BARCO I-Space. Maternal characteristics and CV risk factors were collected by self-administered questionnaires. The CV risk profile was created based on a score of risk factors, including maternal age, body-mass index, CV disease in the family, diet and smoking. Quartiles of the CV risk score were calculated. Associations between the CV risk score and embryonic growth were assessed using square root transformed CRL in multivariable linear mixed model analyses. From the 111 included pregnancies, 696 3D US data sets were obtained of which 637 (91.5%) CRLs could be measured. In the total group, The CV risk score was inversely, but not significantly associated with embryonic growth (-0.03√mm; P = 0.291). Stratified by mode of conception, the CV risk score was inversely and significantly associated with embryonic growth (β = -0.04√mm; P = 0.025, adjusted for possible confounders) in the IVF/ICSI group. Compared with the first quartile, embryos in the upper quartile were 10.4% smaller at 6(+0) weeks (4.4 versus 4.9 mm) and 3.1% smaller at 12(+0) weeks (56.5 versus 58.4 mm) of gestation. Although the CV risk score was slightly, but significantly, higher in women conceiving spontaneously compared with those undergoing IVF/ICSI treatment [CV risk score = 2.06 (SD: 1.23) and 1.60 (SD: 1.15), respectively], no association was established with embryonic growth in that particular group. Participants included in the present cohort are women with a singleton ongoing pregnancy without any pre-existing disease and selected from a tertiary hospital. Hence, they represent a selected group of women. Larger and population-based periconception birth cohort studies are recommended to demonstrate external validity. Differences in embryonic growth between pregnancies conceived spontaneously and after IVF/ICSI treatment in relation with CV risk factors substantiate the importance of more investigation into differences in sensitivity of endometrial, endothelial, placental and embryonic tissues. Funded by the Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands. The authors declare no conflict of interest. © The Author 2016. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Mechanism and preclinical prevention of increased breast cancer risk caused by pregnancy.

PubMed

Haricharan, Svasti; Dong, Jie; Hein, Sarah; Reddy, Jay P; Du, Zhijun; Toneff, Michael; Holloway, Kimberly; Hilsenbeck, Susan G; Huang, Shixia; Atkinson, Rachel; Woodward, Wendy; Jindal, Sonali; Borges, Virginia F; Gutierrez, Carolina; Zhang, Hong; Schedin, Pepper J; Osborne, C Kent; Tweardy, David J; Li, Yi

2013-12-31

While a first pregnancy before age 22 lowers breast cancer risk, a pregnancy after age 35 significantly increases life-long breast cancer risk. Pregnancy causes several changes to the normal breast that raise barriers to transformation, but how pregnancy can also increase cancer risk remains unclear. We show in mice that pregnancy has different effects on the few early lesions that have already developed in the otherwise normal breast-it causes apoptosis evasion and accelerated progression to cancer. The apoptosis evasion is due to the normally tightly controlled STAT5 signaling going astray-these precancerous cells activate STAT5 in response to pregnancy/lactation hormones and maintain STAT5 activation even during involution, thus preventing the apoptosis normally initiated by oncoprotein and involution. Short-term anti-STAT5 treatment of lactation-completed mice bearing early lesions eliminates the increased risk after a pregnancy. This chemoprevention strategy has important implications for preventing increased human breast cancer risk caused by pregnancy. DOI: http://dx.doi.org/10.7554/eLife.00996.001.

IL-10 and pregnancy complications.

PubMed

Azizieh, F Y; Raghupathy, R

2017-01-01

Successful pregnancy depends on the ability of the mother's immune system to undergo a process of immunoregulation in order to tolerate the fetus, and also to create and sustain a nurturing environment during all the stages of pregnancy. Several reports point to interleukin 10 (IL-10) as being vital for normal pregnancy, and low IL-10 levels as being associated with preg- nancy complications. This study aimed to compare IL-10 levels in normal and complicated pregnancy conditions. The authors compared levels of IL-10 produced upon stimulation of maternal peripheral blood mononuclear cells (PBMC) from women at different stages of normal gestation with those produced by women with pregnancy complications, such as recurrent spontaneous miscarriage (RSM), preterm delivery (PTD), premature rupture of fetal membranes (PROM), pre-eclampsia, and intrauterine fetal growth retardation (IUGR). Median levels of IL-10 are statistically significantly lower in pathological conditions as com- pared to matching gestational ages of normal pregnancy. Healthy pregnancy is associated with higher levels of IL-10, while pathologic pregnancies are associated with lower levels of IL-10.

Assessment of the concordance among 2-tier, 3-tier, and 5-tier fetal heart rate classification systems.

PubMed

Gyamfi Bannerman, Cynthia; Grobman, William A; Antoniewicz, Leah; Hutchinson, Maria; Blackwell, Sean

2011-09-01

In 2008, a National Institute of Child Health and Human Development/Society for Maternal-Fetal Medicine-sponsored workshop on electronic fetal monitoring recommended a new fetal heart tracing interpretation system. Comparison of this 3-tier system with other systems is lacking. Our purpose was to determine the relationships between fetal heart rate categories for the 3 existing systems. Three Maternal-Fetal Medicine specialists reviewed 120 fetal heart rates. All tracings were from term, singleton pregnancies with known umbilical artery pH. The fetal heart rates were classified by a 2-tier, 3-tier, and 5-tier system. Each Maternal-Fetal Medicine examiner reviewed 120 fetal heart rate segments. When compared with the 2-tier system, 0%, 54%, and 100% tracings in categories 1, 2, and 3 were "nonreassuring." There was strong concordance between category 1 and "green" as well as category 3 and "red" tracings. The 3-tier and 5-tier systems were similar in fetal heart rate interpretations for tracings that were either very normal or very abnormal. Whether one system is superior to the others in predicting fetal acidemia remains unknown. Copyright © 2011 Mosby, Inc. All rights reserved.

Maternal serum placental growth factor at 12, 22, 32 and 36 weeks' gestation in screening for pre-eclampsia.

PubMed

Tsiakkas, A; Cazacu, R; Wright, A; Wright, D; Nicolaides, K H

2016-04-01

To examine the distribution of maternal serum placental growth factor (PlGF) at 12, 22, 32 and 36 weeks' gestation in singleton pregnancies which develop pre-eclampsia (PE) and examine the performance of this biomarker in screening for PE. Serum PlGF was measured in 40 212 cases at 11-13 weeks, in 10 282 cases at 19-24 weeks, in 10 400 at 30-34 weeks and 4043 at 35-37 weeks. Bayes' theorem was used to combine the a-priori risk from maternal characteristics and medical history with serum PlGF. The performance of screening for PE requiring delivery < 32, at 32 + 0 to 36 + 6 and ≥ 37 weeks' gestation was estimated. In pregnancies that developed PE, serum PlGF was decreased and the separation in multiples of the median (MoM) values from normal was greater with earlier, compared to later, gestational age at which delivery for PE became necessary. Additionally, the slope of the regression lines of PlGF MoM with gestational age at delivery in pregnancies that developed PE increased with advancing gestational age at screening. The detection rates (DRs), at a false-positive rate (FPR) of 10%, for PE delivering < 32 weeks were 79% and 97% with screening at 12 and 22 weeks, respectively. The DRs for PE delivering at 32 + 0 to 36 + 6 weeks were 57%, 65% and 90% with screening at 12, 22 and 32 weeks. The DRs for PE delivering ≥ 37 weeks were 40%, 37%, 54% and 64% with screening at 12, 22, 32 and 36 weeks, respectively. The performance of combined screening with maternal factors, medical history and PlGF is superior in screening for early, compared to late, PE and improves with advancing gestational age at screening. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

Cost Implications for Subsequent Perinatal Outcomes After IVF Stratified by Number of Embryos Transferred: A Five Year Analysis of Vermont Data.

PubMed

Carpinello, Olivia J; Casson, Peter R; Kuo, Chia-Ling; Raj, Renju S; Sills, E Scott; Jones, Christopher A

2016-06-01

In states in the USA without in vitro fertilzation coverage (IVF) insurance coverage, more embryos are transferred per cycle leading to higher risks of multi-fetal pregnancies and adverse pregnancy outcomes. To determine frequency and cost of selected adverse perinatal complications based on number of embryos transferred during IVF, and calculate incremental cost per IVF live birth. Medical records of patients who conceived with IVF (n = 116) and delivered at >20 weeks gestational age between 2007 and 2011 were evaluated. Gestational age at delivery, low birth weight (LBW) term births, and delivery mode were tabulated. Healthcare costs per cohort, extrapolated costs assuming 100 patients per cohort, and incremental costs per infant delivered were calculated. The highest prematurity and cesarean section rates were recorded after double embryo transfers (DET), while the lowest rates were found in single embryo transfers (SET). Premature singleton deliveries increased directly with number of transferred embryos [6.3 % (SET), 9.1 % (DET) and 10.0 % for ≥3 embryos transferred]. This trend was also noted for rate of cesarean delivery [26.7 % (SET), 36.6 % (DET), and 47.1 % for ≥3 embryos transferred]. The proportion of LBW infants among deliveries after DET and for ≥3 embryos transferred was 3.9 and 9.1 %, respectively. Extrapolated costs per cohort were US$718,616, US$1,713,470 and US$1,227,396 for SET, DET, and ≥3 embryos transferred, respectively. Attempting to improve IVF pregnancy rates by permitting multiple embryo transfers results in sharply increased rates of multiple gestation and preterm delivery. This practice yields a greater frequency of adverse perinatal outcomes and substantially increased healthcare spending. Better efforts to encourage SET are necessary to normalize healthcare expenditures considering the frequency of very high cost sequela associated with IVF where multiple embryo transfers occur.

First and second trimester maternal serum inhibin A levels in twins with pre-eclampsia.

PubMed

Svirsky, Ran; Maymon, Ron; Melcer, Yaakov; Klog, Esther; Cuckle, Howard

2016-11-01

To investigate maternal serum inhibin as a marker of pre-eclampsia (PE) in twins. One hundred forty-three twins and 109 unaffected singleton pregnancies were recruited in the first trimester from the same institution. Blood samples were stored at recruitment and in the second trimester, retrospectively tested for inhibin and values expressed in multiples of the gestation-specific median (MoMs) in singletons, adjusted for maternal weight, as appropriate. The median inhibin level in unaffected twins was 2.04 MoM compared with 1.00 MoM in singletons (P < 0.0001, Wilcoxon Rank Sum Test, one-tailed). Excluding early fetal losses the median in 22 samples from 12 twins with PE was 2.65 MoM compared with 1.99 MoM in 201 samples from 120 unaffected twins (P < 0.02, Wilcoxon Rank Sum Test). This effect was restricted to second trimester samples with medians in cases and controls of 2.86 and 1.91 MoM respectively. Logistic regression of inhibin A together with established PE marker placental growth factor and placental associated plasma protein showed that in the second trimester, it improved screening performance although not reaching statistical significance (P = 0.08). Inhibin A is a potential second trimester marker of PE in twins. It may improve on existing twin screening protocols but more data are required. © 2016 John Wiley & Sons, Ltd. © 2016 John Wiley & Sons, Ltd.

Epigenetic changes in fetal hypothalamic energy regulating pathways are associated with maternal undernutrition and twinning

PubMed Central

Begum, Ghazala; Stevens, Adam; Smith, Emma Bolton; Connor, Kristin; Challis, John R. G.; Bloomfield, Frank; White, Anne

2012-01-01

Undernutrition during pregnancy is implicated in the programming of offspring for the development of obesity and diabetes. We hypothesized that maternal programming causes epigenetic changes in fetal hypothalamic pathways regulating metabolism. This study used sheep to examine the effect of moderate maternal undernutrition (60 d before to 30 d after mating) and twinning to investigate changes in the key metabolic regulators proopiomelanocortin (POMC) and the glucocorticoid receptor (GR) in fetal hypothalami. Methylation of the fetal hypothalamic POMC promoter was reduced in underfed singleton, fed twin, and underfed twin groups (60, 73, and 63% decrease, respectively). This was associated with reduced DNA methyltransferase activity and altered histone methylation and acetylation. Methylation of the hypothalamic GR promoter was decreased in both twin groups and in maternally underfed singleton fetuses (52, 65, and 55% decrease, respectively). This correlated with changes in histone methylation and acetylation and increased GR mRNA expression in the maternally underfed singleton group. Alterations in GR were hypothalamic specific, with no changes in hippocampi. Unaltered levels of OCT4 promoter methylation indicated gene-specific effects. In conclusion, twinning and periconceptional undernutrition are associated with epigenetic changes in fetal hypothalamic POMC and GR genes, potentially resulting in altered energy balance regulation in the offspring.—Begum, G., Stevens, A., Smith, E. B., Connor, K., Challis, J. R. G., Bloomfield, F., White, A. Epigenetic changes in fetal hypothalamic energy regulating pathways are associated with maternal undernutrition and twinning. PMID:22223754

Pregnancy and Labor Complications in Female Survivors of Childhood Cancer: The British Childhood Cancer Survivor Study

PubMed Central

Bright, Chloe J.; Winter, David L.; Fidler, Miranda M.; Wong, Kwok; Guha, Joyeeta; Kelly, Julie S.; Frobisher, Clare; Edgar, Angela B.; Skinner, Roderick; Wallace, W. Hamish B.; Hawkins, Mike M.

2017-01-01

Abstract Background: Female survivors of childhood cancer treated with abdominal radiotherapy who manage to conceive are at risk of delivering premature and low-birthweight offspring, but little is known about whether abdominal radiotherapy may also be associated with additional complications during pregnancy and labor. We investigated the risk of developing pregnancy and labor complications among female survivors of childhood cancer in the British Childhood Cancer Survivor Study (BCCSS). Methods: Pregnancy and labor complications were identified by linking the BCCSS cohort (n = 17 980) to the Hospital Episode Statistics (HES) for England. Relative risks (RRs) of pregnancy and labor complications were calculated by site of radiotherapy treatment (none/abdominal/cranial/other) and other cancer-related factors using log-binomial regression. All statistical tests were two-sided. Results: A total of 2783 singleton pregnancies among 1712 female survivors of childhood cancer were identified in HES. Wilms tumor survivors treated with abdominal radiotherapy were at threefold risk of hypertension complicating pregnancy (relative risk = 3.29, 95% confidence interval [CI] = 2.29 to 4.71), while all survivors treated with abdominal radiotherapy were at risk of gestational diabetes mellitus (RR = 3.35, 95% CI = 1.41 to 7.93) and anemia complicating pregnancy (RR = 2.10, 95% CI = 1.27 to 3.46) compared with survivors treated without radiotherapy. Survivors treated without radiotherapy had similar risks of pregnancy and labor complications as the general population, except survivors were more likely to opt for an elective cesarean section (RR = 1.39, 95% CI = 1.16 to 1.70). Conclusions: Treatment with abdominal radiotherapy increases the risk of developing hypertension complicating pregnancy in Wilms tumor survivors, and diabetes mellitus and anemia complicating pregnancy in all survivors. These patients may require extra vigilance during pregnancy. PMID:28419299

Adherence to the Caffeine Intake Guideline during Pregnancy and Birth Outcomes: A Prospective Cohort Study.

PubMed

Peacock, Amy; Hutchinson, Delyse; Wilson, Judy; McCormack, Clare; Bruno, Raimondo; Olsson, Craig A; Allsop, Steve; Elliott, Elizabeth; Burns, Lucinda; Mattick, Richard P

2018-03-07

The aims of this study were to identify: (i) the proportion of women exceeding the caffeine intake guideline (>200 mg/day) during each trimester, accounting for point of pregnancy awareness; (ii) guideline adherence trajectories across pregnancy; (iii) maternal characteristics associated with trajectories; and (iv) association between adherence and growth restriction birth outcomes. Typical and maximal intake per consumption day for the first trimester (T1; pre- and post-pregnancy awareness), second (T2), and third trimester (T3) were recorded for a prospective cohort of pregnant Australian women with singleton births ( n = 1232). Birth outcomes were birth weight, small for gestational age, and head circumference. For each period, participants were classified as abstinent, within (≤200 mg), or in excess (>200 mg). Latent class growth analyses identified guideline adherence trajectories; regression analyses identified associations between adherence in each trimester and birth outcomes. The percentage of participants who reported caffeine use declined between T1 pre- and post-pregnancy awareness (89% to 68%), and increased in T2 and T3 (79% and 80%). Trajectories were: ' low consumption ' (22%): low probability of any use; ' within-guideline ' (70%): high probability of guideline adherence; and ' decreasing heavy use ' (8%): decreasing probability of excess use. The latter two groups were more likely to report alcohol and tobacco use, and less likely to report planning pregnancy and fertility problems. Exceeding the guideline T1 pre-pregnancy awareness was associated with lower birth weight after covariate control (b = -143.16, p = 0.011). Overall, high caffeine intake pre-pregnancy awareness occurs amongst a significant minority of women, and continued excess use post-pregnancy awareness is more common where pregnancy is unplanned. Excess caffeine consumption pre-pregnancy awareness may increase the risk for lower birth weight. Increasing awareness of the guideline in pregnancy and preconception health care may be warranted.

Adherence to the Caffeine Intake Guideline during Pregnancy and Birth Outcomes: A Prospective Cohort Study

PubMed Central

Peacock, Amy; Hutchinson, Delyse; Wilson, Judy; McCormack, Clare; Bruno, Raimondo; Olsson, Craig A.; Allsop, Steve; Elliott, Elizabeth; Burns, Lucinda; Mattick, Richard P.

2018-01-01

The aims of this study were to identify: (i) the proportion of women exceeding the caffeine intake guideline (>200 mg/day) during each trimester, accounting for point of pregnancy awareness; (ii) guideline adherence trajectories across pregnancy; (iii) maternal characteristics associated with trajectories; and (iv) association between adherence and growth restriction birth outcomes. Typical and maximal intake per consumption day for the first trimester (T1; pre- and post-pregnancy awareness), second (T2), and third trimester (T3) were recorded for a prospective cohort of pregnant Australian women with singleton births (n = 1232). Birth outcomes were birth weight, small for gestational age, and head circumference. For each period, participants were classified as abstinent, within (≤200 mg), or in excess (>200 mg). Latent class growth analyses identified guideline adherence trajectories; regression analyses identified associations between adherence in each trimester and birth outcomes. The percentage of participants who reported caffeine use declined between T1 pre- and post-pregnancy awareness (89% to 68%), and increased in T2 and T3 (79% and 80%). Trajectories were: ‘low consumption’ (22%): low probability of any use; ‘within-guideline’ (70%): high probability of guideline adherence; and ‘decreasing heavy use’ (8%): decreasing probability of excess use. The latter two groups were more likely to report alcohol and tobacco use, and less likely to report planning pregnancy and fertility problems. Exceeding the guideline T1 pre-pregnancy awareness was associated with lower birth weight after covariate control (b = −143.16, p = 0.011). Overall, high caffeine intake pre-pregnancy awareness occurs amongst a significant minority of women, and continued excess use post-pregnancy awareness is more common where pregnancy is unplanned. Excess caffeine consumption pre-pregnancy awareness may increase the risk for lower birth weight. Increasing awareness of the guideline in pregnancy and preconception health care may be warranted. PMID:29518946

Maternal lipid profile during early pregnancy and pregnancy complications and outcomes: the ABCD study.

PubMed

Vrijkotte, Tanja G M; Krukziener, Náthalie; Hutten, Barbara A; Vollebregt, Karlijn C; van Eijsden, Manon; Twickler, Marcel B

2012-11-01

Elevated lipid levels during late pregnancy are associated with complications and adverse outcome for both mother and newborn. However, it is inconclusive whether a disturbed lipid profile during early pregnancy has similar negative associations. Our objective was to investigate whether nonfasting maternal total cholesterol and triglyceride levels during early pregnancy are associated with six major adverse pregnancy outcomes. Data were derived from the Amsterdam Born Children and Their Development (ABCD) cohort study. Random blood samples of nonfasting total cholesterol and triglyceride levels were determined during early gestation (median = 13, interquartile range = 12-14 wk). Outcome measures were pregnancy-induced hypertension (PIH), preeclampsia, preterm birth, small/large for gestational age (SGA/LGA), and child loss. Only nondiabetic women with singleton deliveries were included; the baseline sample consisted of 4008 women. Analysis for PIH and preeclampsia were performed in nulliparous women only (n = 2037). Mean (sd) triglyceride and total cholesterol levels were 1.33 (0.55) and 4.98 (0.87) mmol/liter, respectively. The incidence of pregnancy complications and perinatal outcomes were as follows: PIH, 4.9%; preeclampsia, 3.7%; preterm birth, 5.3%; SGA, 9.3%; LGA, 9.3%; and child loss, 1.4%. After adjustments, every unit increase in triglycerides was linearly associated with an increased risk of PIH [odds ratio (OR) = 1.60, P = 0.021], preeclampsia (OR = 1.69, P = 0.018), LGA (OR = 1.48, P < 0.001), and induced preterm delivery (OR = 1.69, P = 0.006). No associations were found for SGA or child loss. Total cholesterol was not associated with any of the outcome measures. Elevated maternal triglyceride levels measured during early pregnancy are associated with pregnancy complications and adverse pregnancy outcomes. These results suggest that future lifestyle programs in women of reproductive age with a focus on lowering triglyceride levels (i.e. diet, weight reduction, and physical activity) may help to prevent hypertensive complications during pregnancy and adverse birth outcomes.

Effects of maternal serum 25-hydroxyvitamin D concentrations in the first trimester on subsequent pregnancy outcomes in an Australian population.

PubMed

Schneuer, Francisco J; Roberts, Christine L; Guilbert, Cyrille; Simpson, Judy M; Algert, Charles S; Khambalia, Amina Z; Tasevski, Vitomir; Ashton, Anthony W; Morris, Jonathan M; Nassar, Natasha

2014-02-01

Low serum 25-hydroxyvitamin D [25(OH)D] concentrations during pregnancy have been associated with adverse pregnancy outcomes in a few studies but not in other studies. We assessed the serum 25(OH)D concentration at 10-14 wk of pregnancy and its association with adverse pregnancy outcomes and examined the predictive accuracy. In this nested case-control study, we measured serum 25(OH)D in 5109 women with singleton pregnancies who were attending first-trimester screening in New South Wales, Australia. Multivariate logistic regression was conducted to examine the association between low 25(OH)D concentrations and adverse pregnancy outcomes (small for gestational age, preterm birth, preeclampsia, gestational diabetes, miscarriage, and stillbirth). The predictive accuracy of models was assessed. The median (IQR) 25(OH)D concentration for the total population was 56.4 nmol/L (43.3-69.8 nmol/L). Serum 25(OH)D concentrations showed significant variation by parity, smoking, weight, season of sampling, country of birth, and socioeconomic status. After adjustment for maternal and clinical risk factors, low 25(OH)D concentrations were not associated with most adverse pregnancy outcomes. The area under the receiver operating characteristic curve (AUC) and likelihood ratio for a composite of severe adverse pregnancy outcomes of 25(OH)D concentrations <25 nmol/L were 0.51 and 1.44, respectively, and, for risk factors alone, were 0.64 and 2.87, respectively. The addition of 25(OH)D information to maternal and clinical risk factors did not improve the ability to predict severe adverse pregnancy outcomes (AUC: 0.64; likelihood ratio: 2.32; P = 0.39). Low 25(OH)D serum concentrations in the first trimester of pregnancy are not associated with adverse pregnancy outcomes and do not predict complications any better than routinely assessed clinical and maternal risk-factor information.

Timing of probiotic milk consumption during pregnancy and effects on the incidence of preeclampsia and preterm delivery: a prospective observational cohort study in Norway

PubMed Central

Nordqvist, Mahsa; Jacobsson, Bo; Brantsæter, Anne-Lise; Myhre, Ronny; Nilsson, Staffan; Sengpiel, Verena

2018-01-01

Objectives To investigate whether the timing of probiotic milk intake before, during early or late pregnancy influences associations with preeclampsia and preterm delivery. Design Population based prospective cohort study. Setting Norway, between 1999 and 2008. Participants 70 149 singleton pregnancies resulting in live-born babies from the Norwegian Mother and Child Cohort Study (no chronic disease, answered questionnaires, no placenta previa/cerclage/serious malformation of fetus, first enrolment pregnancy). Only nulliparous women (n=37 050) were included in the preeclampsia analysis. Both iatrogenic and spontaneous preterm delivery (between gestational weeks 22+0 and 36+6) with spontaneous term controls (between gestational weeks 39+0 and 40+6) were included in the preterm delivery analysis resulting in 34 458 cases. Main outcome measures Adjusted OR for preeclampsia and preterm delivery according to consumption of probiotic milk at three different time periods (before pregnancy, during early and late pregnancy). Results Probiotic milk intake in late pregnancy (but not before or in early pregnancy) was significantly associated with lower preeclampsia risk (adjusted OR: 0.80 (95% CI 0.68 to 0.94) p-value: 0.007). Probiotic intake during early (but not before or during late pregnancy) was significantly associated with lower risk of preterm delivery (adjusted OR: 0.79 (0.64 to 0.97) p-value: 0.03). Conclusions In this observational study, we found an association between timing of probiotic milk consumption during pregnancy and the incidence of the adverse pregnancy outcomes preeclampsia and preterm delivery. If future randomised controlled trials could establish a causal association between probiotics consumption and reduced risk of preeclampsia and preterm delivery, recommending probiotics would be a promising public health measure to reduce these adverse pregnancy outcomes. PMID:29362253

Gestational weight gain and subsequent postpartum weight loss among young, low-income, ethnic minority women.

PubMed

Gould Rothberg, Bonnie E; Magriples, Urania; Kershaw, Trace S; Rising, Sharon Schindler; Ickovics, Jeannette R

2011-01-01

Document weight change trajectories that lead to gestational weight gain or postpartum weight loss outside clinical recommendations established by the Institute of Medicine. Women aged 14-25 receiving prenatal care and delivering singleton infants at term (n = 427). Medical record review and 4 structured interviews conducted: second and third trimester, 6- and 12-months postpartum. Longitudinal mixed modeling to evaluate weight change trajectories. Only 22% of participants gained gestational weight within Institute of Medicine guidelines. There were 62% that exceeded maximum recommendations-more common among those overweight/obese (body mass index ≥25.0; P < .0001). 52% retained ≥10 lb 1-year postpartum. Increased weight gain and retention documented among smokers and women with pregnancy-induced hypertension; breastfeeding promoted postpartum weight loss (all P < .02). Body mass index by race interaction suggested healthier outcomes for Latinas (P = .02). Excessive pregnancy weight gain and inadequate postpartum weight loss are highly prevalent among young low-income ethnic minority women. Pregnancy and postpartum are critical junctures for weight management interventions. Copyright © 2011 Mosby, Inc. All rights reserved.

An examination of periodontal treatment, dental care, and pregnancy outcomes in an insured population in the United States.

PubMed

Albert, David A; Begg, Melissa D; Andrews, Howard F; Williams, Sharifa Z; Ward, Angela; Conicella, Mary Lee; Rauh, Virginia; Thomson, Janet L; Papapanou, Panos N

2011-01-01

We examined whether periodontal treatment or other dental care is associated with adverse birth outcomes within a medical and dental insurance database. In a retrospective cohort study, we examined the records of 23,441 women enrolled in a national insurance plan who delivered live births from singleton pregnancies in the United States between January 1, 2003, and September 30, 2006, for adverse birth outcomes on the basis of dental treatment received. We compared rates of low birthweight and preterm birth among 5 groups, specifying the relative timing and type of dental treatment received. We used logistic regression analysis to compare outcome rates across treatment groups while adjusting for duration of continuous dental coverage, maternal age, pregnancy complications, neighborhood-level income, and race/ethnicity. Analyses showed that women who received preventive dental care had better birth outcomes than did those who received no treatment (P < .001). We observed no evidence of increased odds of adverse birth outcomes from dental or periodontal treatment. For women with medical and dental insurance, preventive care is associated with a lower incidence of adverse birth outcomes.

Sonographical predictive markers of failure of induction of labour in term pregnancy.

PubMed

Brik, Maia; Mateos, Silvia; Fernandez-Buhigas, Irene; Garbayo, Paloma; Costa, Gloria; Santacruz, Belen

2017-02-01

Predictive markers of failure of induction of labour in term pregnancy were evaluated. A prospective study including 245 women attending induction of labour was performed. The inclusion criteria were singleton pregnancies, gestational age 37-42 weeks and the main outcomes were failure of induction, induction to delivery interval and mode of delivery. Women with a longer cervical length prior to induction (CLpi) had a higher rate of failure of induction (30.9 ± 6.8 vs. 23.9 ± 9.3, p < .001). BMI was higher and maternal height was lower in the group of caesarean section compared to vaginal delivery (33.1 ± 8 vs. 29.3 ± 4.6, 160 ± 5 vs. 164 ± 5, p < .001, respectively). A shorter CLpi correlated with a shorter induction to delivery interval (R Pearson .237, p < .001). In the regression analysis, for failure of induction the only independent predictor was the CL prior to induction. Therefore, the CLpi is an independent factor for prediction of failure of induction of labour.

Influence of storage time on vitrified human cleavage-stage embryos froze in open system.

PubMed

Li, Wei; Zhao, Wanqiu; Xue, Xia; Zhang, Silin; Zhang, Xin; Shi, Juanzi

2017-02-01

During in vitro fertilization, rapid growth of vitrification and liquid nitrogen storage of embryos have been well characterized. However, the effect of storage time on vitrified cleavage-stage embryos in an open system is poorly understood. To investigate the influence of storage time on the survival and pregnancy outcomes of vitrified human cleavage-stage embryos froze and stored in an open system. A retrospective study of 786 vitrified-warmed cycles of 735 patients was performed from January 2013 to October 2013. The cycles were divided into five groups according to storage time: 1-3 months, 4-6 months, 7-12 months, 13-24 and 25-60 months. The clinical outcomes of cycles with different storage time were analyzed. There were no significant differences of the survival rate, clinical pregnancy outcomes, birth rate, gestational weeks and singleton birthweights at various storage times. For vitrified embryos froze and stored in an open system, the storage time would not influence the survival rate and pregnancy outcomes by storage time up to 5 years.

Electronic fetal heart rate monitoring and its relationship to neonatal and infant mortality in the United States.

PubMed

Chen, Han-Yang; Chauhan, Suneet P; Ananth, Cande V; Vintzileos, Anthony M; Abuhamad, Alfred Z

2011-06-01

To examine the association between electronic fetal heart rate monitoring and neonatal and infant mortality, as well as neonatal morbidity. We used the United States 2004 linked birth and infant death data. Multivariable log-binomial regression models were fitted to estimate risk ratio for association between electronic fetal heart rate monitoring and mortality, while adjusting for potential confounders. In 2004, 89% of singleton pregnancies had electronic fetal heart rate monitoring. Electronic fetal heart rate monitoring was associated with significantly lower infant mortality (adjusted relative risk, 0.75); this was mainly driven by the lower risk of early neonatal mortality (adjusted relative risk, 0.50). In low-risk pregnancies, electronic fetal heart rate monitoring was associated with decreased risk for Apgar scores <4 at 5 minutes (relative risk, 0.54); in high-risk pregnancies, with decreased risk of neonatal seizures (relative risk, 0.65). In the United States, the use of electronic fetal heart rate monitoring was associated with a substantial decrease in early neonatal mortality and morbidity that lowered infant mortality. Copyright © 2011 Mosby, Inc. All rights reserved.

Is frozen embryo transfer better for mothers and babies? Can cumulative meta-analysis provide a definitive answer?

PubMed

Maheshwari, Abha; Pandey, Shilpi; Amalraj Raja, Edwin; Shetty, Ashalatha; Hamilton, Mark; Bhattacharya, Siladitya

2018-01-01

Initial observational studies and a systematic review published 5 years ago have suggested that obstetric and perinatal outcomes are better in offspring conceived following frozen rather than fresh embryo transfers, with reduced risks of preterm birth, small for gestational age, low birth weight and pre-eclampsia. More recent primary studies are beginning to challenge some of these findings. We therefore conducted an updated systematic review and cumulative meta-analysis to examine if these results have remained consistent over time. The aim of this study was to perform a systematic review and cumulative meta-analysis (trend with time) of obstetric and perinatal complications in singleton pregnancies following the transfer of frozen thawed and fresh embryos generated through in-vitro fertilisation. Data Sources from Medline, EMBASE, Cochrane Central Register of Clinical Trials DARE and CINAHL (1984-2016) were searched using appropriate key words. Observational and randomised studies comparing obstetric and perinatal outcomes in singleton pregnancies conceived through IVF using either fresh or frozen thawed embryos. Two independent reviewers extracted data in 2 × 2 tables and assessed the methodological quality of the relevant studies using CASP scoring. Both aggregated as well as cumulative meta-analysis was done using STATA. Twenty-six studies met the inclusion criteria. Singleton babies conceived from frozen thawed embryos were at lower relative risk (RR) of preterm delivery (0.90; 95% CI 0.84-0.97) low birth weight (0.72; 95% CI 0.67-0.77) and small for gestational age (0.61; 95% CI 0.56-0.67) compared to those conceived from fresh embryo transfers, but faced an increased risk (RR) of hypertensive disorders of pregnancy (1.29; 95% CI 1.07-1.56) large for gestational age (1.54; 95% CI 1.48-1.61) and high birth weight (1.85; 95% CI 1.46-2.33). There was no difference in the risk of congenital anomalies and perinatal mortality between the two groups. The direction and magnitude of effect for these outcomes have remained virtually unchanged over time while the degree of precision has improved with the addition of data from newer studies. The results of this cumulative meta-analysis confirm that the decreased risks of small for gestational age, low birth weight and preterm delivery and increased risks of large for gestational age and high birth weight associated with pregnancies conceived from frozen embryos have been consistent in terms of direction and magnitude of effect over several years, with increasing precision around the point estimates. Replication in a number of different populations has provided external validity for the results, for outcomes of birth weight and preterm delivery. Meanwhile, caution should be exercised about embarking on a policy of electively freezing all embryos in IVF as there are increased risks for large for gestational age babies and hypertensive disorders of pregnancy. Therefore, elective freezing should ideally be undertaken in specific cases such as ovarian hyperstimulation syndrome, fertility preservation or in the context of randomised trials. © The Author 2017. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Cost-effectiveness analysis of different types of labor for singleton pregnancy: real life data.

PubMed

Lakić, Dragana; Petrović, Branko; Petrova, Guenka

2014-01-01

Views on the conduct of labor have changed over time, and a significant difference exists in relation to obstetric centers. To assess cost, clinical outcomes and cost-effectiveness of different types of labor in singleton pregnancies. A decision model was used to compare vaginal labor, induced labor and planned cesarean section. All data were taken from the Book of Labor from the University Hospital for Gynecology and Obstetrics "Narodni Front", Belgrade, Serbia for labors conducted during one month period in 2011. Successful delivery (i.e. labor that began up to 42 gestation weeks, without maternal mortality and the newborn Apgar scores greater than or equal to seven in the fifth minute of life) was considered as the outcome of the cost effectiveness-analysis. To test the robustness of this definition probabilistic sensitivity analysis was performed. From a total of 667 births, vaginal labor was conducted in 98 cases, induced vaginal in 442, while planned cesarean section was performed 127 times. Emergency cesarean section as a complication was much higher in the vaginal labor cohort compared to the induced vaginal cohort (OR=17.374; 95% CI: 8.522 to 35.418; p<0.001). The least costly type of labor was induced vaginal labor: average cost 461 euro, with an effectiveness of 98.17%. Both, vaginal and planned cesarean labor were dominated by the induced labor. The results were robust. Elective induction of labor was associated with the lowest cost compared to other types of labor, with favorable maternal and neonatal outcomes.

Raising multiples: mental health of mothers and fathers in early parenthood

PubMed Central

Battle, Cynthia L.; Tezanos, Katherine M.

2015-01-01

The rate of twin and higher-order gestation births has risen dramatically in recent decades in the United States as well as other Western countries. Although the obstetrical and neonatal risks of multiple gestation pregnancies are well-documented, much less is known regarding the mental health impact on parents of multiples during the perinatal and early parenthood period. Given that parents of multiples face greater functional demands, as well as other pressures (financial, medical) this population may be at risk for heightened distress. We conducted a systematic review of quantitative, English language studies that assessed mental health outcomes of parents of multiples during pregnancy, in the first postpartum year, and in the period of early parenthood, including depression, anxiety, stress, and related constructs. Twenty-seven articles published between 1989 and 2014 met selection criteria and were included in the review. Studies utilized a wide range of methods and outcome constructs, often making comparisons difficult. Although some studies found no differences, most investigations that compared mental health outcomes in parents of multiples versus parents of singletons found that parents of multiples experience heightened symptoms of depression, anxiety, and parenting stress. We discuss gaps in the existing body of literature on parental mental health related to multiple gestation birth and conclude by discussing the need for novel intervention strategies to meet the needs of this growing population. Parents of multiples may experience worse mental health outcomes than parents of singletons. More research is needed, and future work should explore potential treatment and support options. PMID:25515039

Developmental programming, adiposity, and reproduction in ruminants.

PubMed

Symonds, M E; Dellschaft, N; Pope, M; Birtwistle, M; Alagal, R; Keisler, D; Budge, H

2016-07-01

Although sheep have been widely adopted as an animal model for examining the timing of nutritional interventions through pregnancy on the short- and long-term outcomes, only modest programming effects have been seen. This is due in part to the mismatch in numbers of twins and singletons between study groups as well as unequal numbers of males and females. Placental growth differs between singleton and twin pregnancies which can result in different body composition in the offspring. One tissue that is especially affected is adipose tissue which in the sheep fetus is primarily located around the kidneys and heart plus the sternal/neck region. Its main role is the rapid generation of heat due to activation of the brown adipose tissue-specific uncoupling protein 1 at birth. The fetal adipose tissue response to suboptimal maternal food intake at defined stages of development differs between the perirenal abdominal and pericardial depots, with the latter being more sensitive. Fetal adipose tissue growth may be mediated in part by changes in leptin status of the mother which are paralleled in the fetus. Then, over the first month of life plasma leptin is higher in females than males despite similar adiposity, when fat is the fastest growing tissue with the sternal/neck depot retaining uncoupling protein 1, whereas other depots do not. Future studies should take into account the respective effects of fetal number and sex to provide more detailed insights into the mechanisms by which adipose and related tissues can be programmed in utero. Copyright © 2016 Elsevier Inc. All rights reserved.

Reference charts of fetal biometric parameters in 31,476 Brazilian singleton pregnancies.

PubMed

Araujo Júnior, Edward; Martins Santana, Eduardo Félix; Martins, Wellington P; Júnior, Julio Elito; Ruano, Rodrigo; Pires, Claudio Rodrigues; Filho, Sebastião Marques Zanforlin

2014-07-01

The purpose of this study was to establish reference charts of fetal biometric parameters measured by 2-dimensional sonography in a large Brazilian population. A cross-sectional retrospective study was conducted including 31,476 low-risk singleton pregnancies between 18 and 38 weeks' gestation. The following fetal parameters were measured: biparietal diameter, head circumference, abdominal circumference, femur length, and estimated fetal weight. To assess the correlation between the fetal biometric parameters and gestational age, polynomial regression models were created, with adjustments made by the determination coefficient (R(2)). The means ± SDs of the biparietal diameter, head circumference, abdominal circumference, femur length, and estimated fetal weight measurements at 18 and 38 weeks were 4.2 ± 2.34 and 9.1 ± 4.0 cm, 15.3 ± 7.56 and 32.3 ± 11.75 cm, 13.3 ± 10.42 and 33.4 ± 20.06 cm, 2.8 ± 2.17 and 7.2 ± 3.58 cm, and 256.34 ± 34.03 and 3169.55 ± 416.93 g, respectively. Strong correlations were observed between all fetal biometric parameters and gestational age, best represented by second-degree equations, with R(2) values of 0.95, 0.96, 0.95, 0.95, and 0.95 for biparietal diameter, head circumference, abdominal circumference, femur length, and estimated fetal weight. Fetal biometric parameters were determined for a large Brazilian population, and they may serve as reference values in cases with a high risk of intrauterine growth disorders. © 2014 by the American Institute of Ultrasound in Medicine.

Exercise level before pregnancy and engaging in high-impact sports reduce the risk of pelvic girdle pain: a population-based cohort study of 39 184 women.

PubMed

Owe, Katrine Mari; Bjelland, Elisabeth K; Stuge, Britt; Orsini, Nicola; Eberhard-Gran, Malin; Vangen, Siri

2016-07-01

To examine whether an association exists between exercise levels pre-pregnancy and pelvic girdle pain in pregnancy. Pelvic girdle pain in pregnancy has been associated with physical inactivity, a risk factor for adverse pregnancy outcomes. We used data from a population-based cohort study including 39 184 nulliparous women with a singleton pregnancy enrolled in the Norwegian Mother and Child Cohort study. Pre-pregnancy exercise frequency and types were assessed by questionnaire in pregnancy week 17. Pelvic girdle pain, defined as combined pain in the anterior pelvis and in the posterior pelvis bilaterally, was self-reported in pregnancy week 30. Multivariable Poisson regression estimated risks of pelvic girdle pain associated with pre-pregnancy exercise. We examined a dose-response association of prepregnancy exercise frequency using restricted cubic splines. A test for non-linearity was also conducted. Final models were adjusted for pre-pregnancy BMI, age, education, history of low back pain and history of depression. 4069 women (10.4%) reported pelvic girdle pain in pregnancy and the prevalence among women who were non-exercisers prepregnancy was 12.5%. There was a non-linear association for pre-pregnancy exercise and risk of pelvic girdle pain (test for non-linearity, p=0.003). Compared to non-exercisers, women exercising 3-5 times weekly pre-pregnancy had a 14% lower risk of developing pelvic girdle pain in pregnancy (aRR 0.86, 95% CI 0.77 to 0.96). Taking part in high-impact exercises such as running, jogging, orienteering, ballgames, netball games and high-impact aerobics were associated with less risk of pelvic girdle pain. Women who exercise regularly and engage in high-impact exercises before the first pregnancy may have a reduced risk of pelvic girdle pain in pregnancy. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Successful Pregnancies After Adequate Hormonal Replacement in Patients With Combined Pituitary Hormone Deficiencies

PubMed Central

Bianchi, Paulo H. M.; Franca, Marcela M.; Otto, Aline P.; Rodrigues, Rodrigo J. M.; Ejzenberg, Dani; Serafini, Paulo C.; Baracat, Edmundo Chada; Francisco, Rossana P. V.; Brito, Vinicius N.; Arnhold, Ivo J. P.; Mendonca, Berenice B.

2017-01-01

Context: Women with hypopituitarism have lower pregnancy rates after ovulation induction. Associated pituitary hormone deficiencies might play a role in this poorer outcome. Objective: We evaluated fertility treatment and pregnancy outcomes in five women with childhood-onset combined pituitary hormone deficiencies (CPHD). Patients and Methods: Five women with CPHD were referred for fertility treatment after adequacy of hormone replacement was determined. Patients were subjected to controlled ovarian stimulation (COS) for timed intercourse, intrauterine insemination, or in vitro fertilization, according to the presence or absence of other infertility factors (male or tubal). Results: All women became pregnant. The number of COS attempts until pregnancy was achieved varied between 1 and 5. The duration of COS resulting in at least one dominant follicle varied between 9 and 28 days, and total gonadotropin consumed varied between 1200 and 3450 IU. Two patients with severely suppressed basal gonadotropin levels since an early age had a cancelled COS cycle. All pregnancies were singleton except one (monochorionic twin gestation). The gestational ages at birth ranged from 35 weeks to 39 weeks and 4 days; three patients underwent cesarean section, and two had vaginal deliveries. Only one newborn was small for gestational age (delivered at 35 weeks). Conclusion: Adequate hormonal replacement prior to ovarian stimulation resulted in successful pregnancies in patients with childhood-onset CPHD, indicating that hormone replacement, including growth hormone, is an important step prior to fertility treatments in these patients. PMID:29264457

Double versus single cervical cerclage for patients with recurrent pregnancy loss: a randomized clinical trial.

PubMed

Zolghadri, Jaleh; Younesi, Masoumeh; Asadi, Nasrin; Khosravi, Dezire; Behdin, Shabnam; Tavana, Zohre; Ghaffarpasand, Fariborz

2014-02-01

To compare the effectiveness of the double cervical cerclage method versus the single method in women with recurrent second-trimester delivery. In this randomized clinical trial, we included 33 singleton pregnancies suffering from recurrent second-trimester pregnancy loss (≥2 consecutive fetal loss during second-trimester or with a history of unsuccessful procedures utilizing the McDonald method), due to cervical incompetence. Patients were randomly assigned to undergo either the classic McDonald method (n = 14) or the double cerclage method (n = 19). The successful pregnancy rate and gestational age at delivery was also compared between the two groups. The two study groups were comparable regarding their baseline characteristics. The successful pregnancy rate did not differ significantly between those who underwent the double cerclage method or the classic McDonald cerclage method (100% vs 85.7%; P = 0.172). In the same way, the preterm delivery rate (<34 weeks of gestation) was comparable between the two study groups (10.5% vs 35.7%; P = 0.106). Those undergoing the double cerclage method had longer gestational duration (37.2 ± 2.6 vs 34.3 ± 3.8 weeks; P = 0.016). The double cervical cerclage method seems to provide better cervical support, as compared with the classic McDonald cerclage method, in those suffering from recurrent pregnancy loss, due to cervical incompetence. © 2013 The Authors. Journal of Obstetrics and Gynaecology Research © 2013 Japan Society of Obstetrics and Gynecology.

Effect of weight and adiposity at conception and wide variations in gestational dietary intake on pregnancy outcome and early postnatal performance in young adolescent sheep.

PubMed

Wallace, Jacqueline M; Milne, John S; Aitken, Raymond P

2010-02-01

Nutritional backgrounds prior to pregnancy may interact with subsequent gestational intake to influence pregnancy outcome, particularly in young, growing adolescents. To investigate this interaction, singleton pregnancies were established in two groups of adolescent sheep of identical age but different initial weight and adiposity score, classified as good (G) and poor (P) body mass index (BMI). Thereafter, ewes were offered either an optimal control (C) intake to maintain adiposity throughout pregnancy, undernourished (UN) to maintain weight at conception but deplete maternal body reserves, or overnourished (ON) to promote rapid maternal growth and adiposity, resulting in a 2 x 3 factorial design. Gestation length was independent of BMI and reduced in ON dams. Average placental and lamb birth weights were influenced by initial BMI (G > P) and gestational intake (C > UN > ON), with the highest incidence of growth restriction in ON groups. Metabolic challenges at two thirds of gestation revealed enhanced insulin insensitivity in ON dams (higher glucose postinsulin challenge and higher insulin postglucose challenge), but nevertheless fetal growth was constrained. Initial colostrum yield, total IgG, and nutrient supply were reduced in ON groups, but these low-birth-weight lambs exhibited rapid catch-up growth to weaning. Thus, both maternal BMI at conception and gestational intake have a profound influence on pregnancy outcome in young, putatively growing adolescent sheep and may have implications for the nutritional management of pregnant adolescent humans.

Thyroperoxidase and thyroglobulin antibodies in early pregnancy and placental abruption.

PubMed

Haddow, James E; McClain, Monica R; Palomaki, Glenn E; Neveux, Louis M; Lambert-Messerlian, Geralyn; Canick, Jacob A; Malone, Fergal D; Porter, T Flint; Nyberg, David A; Bernstein, Peter S; D'Alton, Mary E

2011-02-01

To estimate the relationship between thyroid antibodies and placental abruption. This cohort study assesses thyroperoxidase and thyroglobulin antibodies in relation to placental abruption among 10,062 women with singleton viable pregnancies (from the First and Second Trimester Risk of Aneuploidy [FaSTER] trial). A thyroperoxidase antibody cutoff of 50 international units/mL is used for comparison with published data from another cohort. Women with elevated thyroperoxidase antibody levels in the first and second trimesters have a higher rate of placental abruption than antibody-negative women. This relationship is less strong in the first trimester (1.51% compared with 0.83%; odds ratio [OR], 1.83; 95% confidence interval [CI], 0.99-3.37) than in the second trimester (1.78% compared with 0.82%; OR, 2.20; 95% CI, 1.21-3.99). A similar, but weaker, relationship is present for thyroglobulin antibodies. Sixty-four of 782 thyroperoxidase antibody-positive pregnancies without abruption become negative by the second trimester; one pregnancy with abruption becomes antibody-positive. Odds ratios for pregnancies with both thyroperoxidase and thyroglobulin antibody elevations are also higher (first trimester: OR, 2.10; 95% CI, 0.91-4.86; second trimester: OR, 2.73; 95% CI, 1.17-6.33). The present data confirm an association between thyroid antibody elevations and placental abruption described in a recent report. These findings, however, do not provide support for recommending routine testing for thyroid antibodies during pregnancy. II.

Assessment of maternal serum sialic acid levels in preterm versus term labor: a prospective-controlled clinical study.

PubMed

Ugur, Mete Gurol; Kurtul, Naciye; Balat, Ozcan; Ekici, Melek; Kul, Seval

2012-11-01

To compare total serum sialic acid (SA) levels between singleton pregnant women diagnosed with preterm labor between 24th and 36th weeks of pregnancy, singleton pregnant women at term, and their gestational age-matched controls. Thirty pregnants diagnosed with preterm labor (group I), 30 gestational age-matched control pregnants (group II), 30 pregnants with labor at term (group III), and 30 gestational age-matched control pregnants (group IV) were enrolled. Detailed history, demographic data (age, gravidity, parity, abortion), ultrasound parameters, cervical dilatation and effacement, fetal tococardiography, routine laboratory tests, and total SA levels were assessed. There was no statistically significant difference between the parameters other than SA. SA levels of the preterm labor group (group I) were significantly higher than the other three groups. We may suggest that pathways including SA or molecules containing SA in subclinical infection without the clinical manifestations of apparent infection may be involved in the pathogenesis of preterm birth. Future longitudinal studies are needed to investigate prediction performance and to better understand the role of SA in molecular mechanisms leading to preterm labor.

Percutaneous vesicoamniotic shunting versus conservative management for fetal lower urinary tract obstruction (PLUTO): a randomised trial.

PubMed

Morris, Rachel K; Malin, Gemma L; Quinlan-Jones, Elisabeth; Middleton, Lee J; Hemming, Karla; Burke, Danielle; Daniels, Jane P; Khan, Khalid S; Deeks, Jon; Kilby, Mark D

2013-11-02

Fetal lower urinary tract obstruction (LUTO) is associated with high perinatal and long-term childhood mortality and morbidity. We aimed to assess the effectiveness of vesicoamniotic shunting for treatment of LUTO. In a randomised trial in the UK, Ireland, and the Netherlands, women whose pregnancies with a male fetus were complicated by isolated LUTO were randomly assigned by a central telephone and web-based randomisation service to receive either the intervention (placement of vesicoamniotic shunt) or conservative management. Allocation could not be masked from clinicians or participants because of the invasive nature of the intervention. Diagnosis was by prenatal ultrasound. The primary outcome was survival of the baby to 28 days postnatally. All primary analyses were done on an intention-to-treat basis, but these results were compared with those of an as-treated analysis to investigate the effect of a fairly large proportion of crossovers. We used Bayesian methods to estimate the posterior probability distribution of the effectiveness of vesicoamniotic shunting at 28 days. The study is registered with the ISRCTN Register, number ISRCTN53328556. 31 women with singleton pregnancies complicated by LUTO were included in the trial and main analysis, with 16 allocated to the vesicoamniotic shunt group and 15 to the conservative management group. The study closed early because of poor recruitment. There were 12 livebirths in each group. In the vesicoamniotic shunt group one intrauterine death occurred and three pregnancies were terminated. In the conservative management group one intrauterine death occurred and two pregnancies were terminated. Of the 16 pregnancies randomly assigned to vesicoamniotic shunting, eight neonates survived to 28 days, compared with four from the 15 pregnancies assigned to conservative management (intention-to-treat relative risk [RR] 1·88, 95% CI 0·71-4·96; p=0·27). Analysis based on treatment received showed a larger effect (3·20, 1·06-9·62; p=0·03). All 12 deaths were caused by pulmonary hypoplasia in the early neonatal period. Sensitivity analysis in which non-treatment-related terminations of pregnancy were excluded made some slight changes to point estimates only. Bayesian analysis in which the trial data were combined with elicited priors from experts suggested an 86% probability that vesicoamniotic shunting increased survival at 28 days and a 25% probability that it had a large, clinically important effect (defined as a relative increase of 55% or more in the proportion of neonates who survived). There was substantial short-term and long-term morbidity in both groups, including poor renal function-only two babies (both in the shunt group) survived to 2 years with normal renal function. Seven complications occurred in six fetuses from the shunt group, including spontaneous ruptured membranes, shunt blockage, and dislodgement. These complications resulted in four pregnancy losses. Survival seemed to be higher in the fetuses receiving vesicoamniotic shunting, but the size and direction of the effect remained uncertain, such that benefit could not be conclusively proven. Our results suggest that the chance of newborn babies surviving with normal renal function is very low irrespective of whether or not vesicoamniotic shunting is done. UK National Institute of Health Research, Wellbeing of Women, Hannah Eliza Guy Charity (Birmingham Children's Hospital Charity). Copyright © 2013 Elsevier Ltd. All rights reserved.

Percutaneous vesicoamniotic shunting versus conservative management for fetal lower urinary tract obstruction (PLUTO): a randomised trial

PubMed Central

Morris, Rachel K; Malin, Gemma L; Quinlan-Jones, Elisabeth; Middleton, Lee J; Hemming, Karla; Burke, Danielle; Daniels, Jane P; Khan, Khalid S; Deeks, Jon; Kilby, Mark D

2013-01-01

Summary Background Fetal lower urinary tract obstruction (LUTO) is associated with high perinatal and long-term childhood mortality and morbidity. We aimed to assess the effectiveness of vesicoamniotic shunting for treatment of LUTO. Methods In a randomised trial in the UK, Ireland, and the Netherlands, women whose pregnancies with a male fetus were complicated by isolated LUTO were randomly assigned by a central telephone and web-based randomisation service to receive either the intervention (placement of vesicoamniotic shunt) or conservative management. Allocation could not be masked from clinicians or participants because of the invasive nature of the intervention. Diagnosis was by prenatal ultrasound. The primary outcome was survival of the baby to 28 days postnatally. All primary analyses were done on an intention-to-treat basis, but these results were compared with those of an as-treated analysis to investigate the effect of a fairly large proportion of crossovers. We used Bayesian methods to estimate the posterior probability distribution of the effectiveness of vesicoamniotic shunting at 28 days. The study is registered with the ISRCTN Register, number ISRCTN53328556. Findings 31 women with singleton pregnancies complicated by LUTO were included in the trial and main analysis, with 16 allocated to the vesicoamniotic shunt group and 15 to the conservative management group. The study closed early because of poor recruitment. There were 12 livebirths in each group. In the vesicoamniotic shunt group one intrauterine death occurred and three pregnancies were terminated. In the conservative management group one intrauterine death occurred and two pregnancies were terminated. Of the 16 pregnancies randomly assigned to vesicoamniotic shunting, eight neonates survived to 28 days, compared with four from the 15 pregnancies assigned to conservative management (intention-to-treat relative risk [RR] 1·88, 95% CI 0·71–4·96; p=0·27). Analysis based on treatment received showed a larger effect (3·20, 1·06–9·62; p=0·03). All 12 deaths were caused by pulmonary hypoplasia in the early neonatal period. Sensitivity analysis in which non-treatment-related terminations of pregnancy were excluded made some slight changes to point estimates only. Bayesian analysis in which the trial data were combined with elicited priors from experts suggested an 86% probability that vesicoamniotic shunting increased survival at 28 days and a 25% probability that it had a large, clinically important effect (defined as a relative increase of 55% or more in the proportion of neonates who survived). There was substantial short-term and long-term morbidity in both groups, including poor renal function—only two babies (both in the shunt group) survived to 2 years with normal renal function. Seven complications occurred in six fetuses from the shunt group, including spontaneous ruptured membranes, shunt blockage, and dislodgement. These complications resulted in four pregnancy losses. Interpretation Survival seemed to be higher in the fetuses receiving vesicoamniotic shunting, but the size and direction of the effect remained uncertain, such that benefit could not be conclusively proven. Our results suggest that the chance of newborn babies surviving with normal renal function is very low irrespective of whether or not vesicoamniotic shunting is done. Funding UK National Institute of Health Research, Wellbeing of Women, Hannah Eliza Guy Charity (Birmingham Children's Hospital Charity). PMID:23953766

Date fruit consumption at term: Effect on length of gestation, labour and delivery.

PubMed

Razali, Nuguelis; Mohd Nahwari, Siti Hayati; Sulaiman, Sofiah; Hassan, Jamiyah

2017-07-01

Labour induction and augmentation with Prostaglandin and Oxytocin are well established as standard practice worldwide. They are safe when used judiciously, but may be associated with maternal and neonatal morbidities. Other safer alternatives have been studied including dates consumption during late pregnancy with various outcomes. The aim of this randomised controlled trial was to investigate the effect of date fruit consumption during late pregnancy on the onset of labour and need for induction or augmentation of labour. A total of 154 nulliparous women with an uncomplicated singleton pregnancy were randomly allocated to either dates-consumer (77) or control group (77). The women in the dates-consumer group had significantly less need for augmentation of labour and longer intervention to delivery interval. There was no significant difference in the onset of spontaneous labour. Dates consumption reduces the need for labour augmentation but does not expedite the onset of labour. Impact statement • Dates fruit consumption during late pregnancy has been shown to positively affect the outcome of labour and delivery. In this study, date consumption reduced the need for labour augmentation with oxytocin but did not expedite the onset of labour. Therefore, dates consumption in late pregnancy is a safe supplement to be considered as it reduced the need for labour intervention without any adverse effect on the mother and child. This further supports the finding of earlier studies.

Chronic hypertension and the risk for adverse pregnancy outcome after superimposed pre-eclampsia.

PubMed

Vanek, M; Sheiner, E; Levy, A; Mazor, M

2004-07-01

To determine the risk factors and pregnancy outcome of patients with chronic hypertension during pregnancy after controlling for superimposed preeclampsia. A comparison of all singleton term (>36 weeks) deliveries occurring between 1988 and 1999, with and without chronic hypertension, was performed. Stratified analyses, using the Mantel-Haenszel technique, and a multiple logistic regression model were performed to control for confounders. Chronic hypertension complicated 1.6% (n=1807) of all deliveries included in the study (n=113156). Using a multivariable analysis, the following factors were found to be independently associated with chronic hypertension: maternal age >40 years (OR=3.1; 95% CI 2.7-3.6), diabetes mellitus (OR=3.6; 95% CI 3.3-4.1), recurrent abortions (OR=1.5; 95% CI 1.3-1.8), infertility treatment (OR=2.9; 95% CI 2.3-3.7), and previous cesarean delivery (CD; OR=1.8 CI 1.6-2.0). After adjustment for superimposed preeclampsia, using the Mantel-Haenszel technique, pregnancies complicated with chronic hypertension had higher rates of CD (OR=2.7; 95% CI 2.4-3.0), intra uterine growth restriction (OR=1.7; 95% CI 1.3-2.2), perinatal mortality (OR=1.6; 95% CI 1.01-2.6) and post-partum hemorrhage (OR=2.2; 95% CI 1.4-3.7). Chronic hypertension is associated with adverse pregnancy outcome, regardless of superimposed preeclampsia.

Changes in first trimester screening test parameters in pregnancies complicated by placenta previa and association with hyperemesis gravidarum

PubMed Central

Tülek, Fırat; Kahraman, Alper; Taşkın, Salih; Özkavukçu, Esra; Söylemez, Feride

2014-01-01

Objective To assess the possible changes in first trimester screening test parameters in pregnancies complicated with placenta previa and to determine whether there is an association between hyperemesis gravidarum and placenta previa. Material and Methods A total of 131 singleton spontaneously conceived pregnancies that were complicated by placenta previa and delivered between May 2006 and May 2013 were evaluated from birth charts. Ninety patients without placenta previa were selected amongst patients who delivered within the same period of time as the control group. Cases of low lying placenta (n=52) within the study group were assessed as a separate group. The rest of the cases was considered to be in a different group. Results Beta human chorionic gonadotropin (BhCG) multiples of medians (MoMs) and nuchal translucency (NT) MoMs were significantly higher in the placenta previa group in comparison with the low lying placenta and control groups. Apgar scores at both the 1st and 5th minutes were significantly lower in the placenta previa group. Hyperemesis gravidarum was found to be significantly more frequent in the placenta previa group. Conclusion The prevalence of hyperemesis gravidarum in the first trimester is higher in pregnancies complicated by placenta previa. Paying more attention to the development of placenta previa in the routine pregnancy follow-up of patients with hyperemesis gravidarum could be considered. PMID:25584028

Changes in first trimester screening test parameters in pregnancies complicated by placenta previa and association with hyperemesis gravidarum.

PubMed

Tülek, Fırat; Kahraman, Alper; Taşkın, Salih; Özkavukçu, Esra; Söylemez, Feride

2014-01-01

To assess the possible changes in first trimester screening test parameters in pregnancies complicated with placenta previa and to determine whether there is an association between hyperemesis gravidarum and placenta previa. A total of 131 singleton spontaneously conceived pregnancies that were complicated by placenta previa and delivered between May 2006 and May 2013 were evaluated from birth charts. Ninety patients without placenta previa were selected amongst patients who delivered within the same period of time as the control group. Cases of low lying placenta (n=52) within the study group were assessed as a separate group. The rest of the cases was considered to be in a different group. Beta human chorionic gonadotropin (BhCG) multiples of medians (MoMs) and nuchal translucency (NT) MoMs were significantly higher in the placenta previa group in comparison with the low lying placenta and control groups. Apgar scores at both the 1st and 5th minutes were significantly lower in the placenta previa group. Hyperemesis gravidarum was found to be significantly more frequent in the placenta previa group. The prevalence of hyperemesis gravidarum in the first trimester is higher in pregnancies complicated by placenta previa. Paying more attention to the development of placenta previa in the routine pregnancy follow-up of patients with hyperemesis gravidarum could be considered.

Iranian pregnant teenage women tell the story of "fast development": A phenomenological study.

PubMed

Mohammadi, Nooredin; Montazeri, Simin; Alaghband Rad, Javad; Ardabili, Hassan Eftekhar; Gharacheh, Maryam

2016-08-01

Teenage pregnancy is a major health problem significantly associated with negative impacts on the health of both teenage mothers and their newborn. However, little is known about teenage pregnancy from teenager's perspective, particularly in developing countries including Iran. This study aimed to explore the experience of pregnancy in Iranian teenage women. An interpretive phenomenological study was used as a suitable research design to conduct this research. Data were collected through individual, semi structured and in-depth interview with 11 married teenage women aged between 15 and 19 years old, primigravida with singleton pregnancy. Data were analysed through thematic analysis approach. "Fast development" was the main theme that emerged from the participants' experiences. It refers to the unexpected development process that occurs simultaneously with other important development events. Fast development consists of three themes, 'unexpected development', 'development within development', and 'struggle with development'. Teenage pregnant women simultaneously encounter multiple developmental challenges related to adolescence period, marriage, pregnancy, and mothering responsibilities. According to the results, fast development concept should be considered by healthcare providers in order to offer comprehensive and age-appropriate health services to pregnant teenage women for successful transition from the multiple developmental stages. Moreover, this concept will help health care providers, especially midwives, to understand how to deal with pregnant teenagers. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

[Which invasive diagnostic procedure should we use for twin pregnancies: chorionic villous sampling or amniocentesis?].

PubMed

Gallot, D; Vélémir, L; Delabaere, A; Accoceberry, M; Niro, J; Vendittelli, F; Laurichesse-Delmas, H; Jacquetin, B; Lémery, D

2009-12-01

To describe invasive diagnostic procedures (amniocentesis/choriocentesis) and subsequent risks in twin pregnancies. PubMed and Cochrane database investigations were conducted using following key words: twin gestation, amniocentesis, chorionic villous sampling, karyotype. Guidelines for twin management edicted by different societies were reviewed. Risk of pregnancy loss after invasive diagnostic procedure in twin pregnancies seems to be slightly higher to singletons, i.e about 1.5-2% after mid-trimester amniocentesis and about 2% after first trimester choriocentesis. Dual sampling is not always mandatory but can be performed on parent's request. Specific risks are associated with twins: redundant sampling, permutation or misidentification of affected twin in case of discordant status. Procedures should be performed by highly-skilled operators under permanent ultrasound-guidance. A scheme describing placental locations and funicular insertions appears to be useful for correct identification. If foeticide can be anticipated, diagnostic procedure and foeticide should be performed by the same operators. For amniocentesis, one or two needles can be used except for cases with infectious disease (two needles and two separate insertions required). For choriocentesis, sampling should be performed close to funicular insertions. First-trimester choriocentesis makes earlier diagnosis and earlier foeticide possible compared with mid-trimester amniocentesis. Both techniques require highly-skilled operators to reduce subsequent risks in the context of twin pregnancies. Copyright © 2009 Elsevier Masson SAS. All rights reserved.

Cell-free DNA testing in the maternal blood in high-risk pregnancies after first-trimester combined screening.

PubMed

Persico, Nicola; Boito, Simona; Ischia, Benedetta; Cordisco, Adalgisa; De Robertis, Valentina; Fabietti, Isabella; Periti, Enrico; Volpe, Paolo; Fedele, Luigi; Rembouskos, Georgios

2016-03-01

The objective of this study was to investigate a strategy for clinical implementation of cell-free DNA (cfDNA) testing in high-risk pregnancies after first-trimester combined screening. In 259 singleton pregnancies undergoing invasive testing after first-trimester combined screening, a maternal blood sample was sent to the laboratory Natera for cfDNA testing using a single-nucleotide polymorphism-based methodology. The cfDNA test provided a result in 249 (96.1%) pregnancies and, among these, identified as being at high risk 35 of 36 cases of trisomy 21, 13 of 13 with trisomy 18, five of five with trisomy 13 and three of four with sex chromosome aneuploidies. A policy of performing an invasive test in women with a combined risk of ≥1 in 10 or NT ≥4 mm and offering cfDNA testing to the remaining cases would detect all cases of trisomy 21, 18 or 13, 80% of sex aneuploidies and 62.5% of other defects and would avoid an invasive procedure in 82.4% of euploid fetuses. In high-risk pregnancies after combined screening, a policy of selecting a subgroup for invasive testing and another for cfDNA testing would substantially reduce the number of invasive procedures and retain the ability to diagnose most of the observed aneuploidies. © 2016 John Wiley & Sons, Ltd.

Physiological adaptation of maternal plasma volume during pregnancy: a systematic review and meta-analysis.

PubMed

de Haas, S; Ghossein-Doha, C; van Kuijk, S M J; van Drongelen, J; Spaanderman, M E A

2017-02-01

To describe the physiological pattern of gestational plasma volume adjustments in normal singleton pregnancy and compare this with the pattern in pregnancies complicated by pregnancy-induced hypertension, pre-eclampsia or fetal growth restriction. We performed a meta-analysis of the current literature on plasma volume adjustments during physiological and complicated pregnancies. Literature was retrieved from PubMed (NCBI) and EMBASE (Ovid) databases. Included studies reported both reference plasma volume measurements (non-pregnant, prepregnancy or postpartum) and measurements obtained during predetermined gestational ages. Mean differences bet ween the reference and pregnancy plasma volume measurements were calculated for predefined intervals of gestational age using a random-effects model described by DerSimonian and Laird. Thirty studies were included in the meta-analysis with publication dates ranging from 1934 to 2007. Plasma volume increased in the first weeks of pregnancy, with the steepest increase occurring during the second trimester. Plasma volume continued to increase in the third trimester with a pooled maximum increase of 1.13 L (95% CI, 1.07-1.19 L), an increase of 45.6% (95% CI, 43.0-48.1%) in physiological pregnancies compared with the reference value. The plasma volume expansion in gestational hypertensive and growth-restricted pregnancies was 0.80 L (95% CI, 0.59-1.02 L), an increase of 32.3% (95% CI, 23.6-41.1%) in the third trimester, a smaller increase than in physiological pregnancies (P < 0.0001). During physiological pregnancy, plasma volume increases by, on average, more than 1 L as compared with non-pregnant conditions. In pregnancies complicated by pregnancy-induced hypertension, pre-eclampsia or fetal growth restriction, plasma volume increase in the third trimester is 13.3% lower than in normal pregnancy. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. Adaptación fisiológica del volumen del plasma materno durante el embarazo: una revisi\\xF3n sistemática y metaanálisis RESUMEN OBJETIVO: Describir el patrón fisiológico de los cambios en el volumen del plasma gestacional en embarazos normales con feto único y compararlo con el patrón en los embarazos complicados por hipertensión gestacional, preeclampsia o restricción del crecimiento fetal. MÉTODOS: Se realizó un metaanálisis de la literatura actual sobre los cambios en el volumen de plasma durante embarazos complicados y fisiológicos. La literatura se obtuvo de las bases de datos PubMed (NCBI) y EMBASE (Ovid). Los estudios incluidos mencionaban tanto mediciones de referencia del volumen plasmático (no embarazada, antes del embarazo o después del parto) como mediciones tomadas a edades gestacionales predeterminadas. Se calcularon las medias de las diferencias entre las mediciones de referencia y las del embarazo para el volumen plasmático a intervalos predefinidos de la edad gestacional, utilizando un modelo de efectos aleatorios descrito por DerSimonian y Laird. En el metaanálisis se incluyeron treinta estudios con fechas de publicación entre 1934 y 2007. El volumen plasmático aumentó en las primeras semanas de embarazo y el mayor incremento se produjo durante el segundo trimestre. El volumen de plasma continuó aumentando en el tercer trimestre con un aumento combinado máximo de 1,13L (IC 95%, 1,7-1,19 L), lo que supone un aumento del 45,6% (IC 95%, 43,0-48,1%) en embarazos fisiológicas en comparación con el valor de referencia. El aumento del volumen plasmático en los embarazos con hipertensión y con crecimiento intrauterino restringido fue de 0,80L (IC 95%, 0,59-1,02 L), lo que supone un aumento del 32,3% (IC 95%, 23,6-41,1%) en el tercer trimestre, y un incremento menor que en los embarazos fisiológicos (P <0,0001). Durante el embarazo fisiológico el volumen de plasma aumenta, en promedio, más de 1L, en comparación con el de las no embarazadas. En los embarazos complicados por hipertensión gestacional, preeclampsia o restricción del crecimiento fetal, el aumento del volumen plasmático en el tercer trimestre es un 13,3% menor que en el embarazo normal. :meta : ,、。 : meta。PubMed(NCBI)EMBASE(Ovid)。(、)。DerSimonianLaird,。 : Meta30,19342007。,。,1.13 L(95% CI,1.07~1.19 L),,45.6%(95% CI,43.0%~48.1%)。0.80 L(95%CI,0.59~1.02 L),32.3%(95% CI,23.6%~41.1%),(P<0.0001)。 : ,,1 L。、,13.3%。. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Use of prescribed opioid analgesics and co-medication with benzodiazepines in women before, during, and after pregnancy: a population-based cohort study.

PubMed

Handal, Marte; Engeland, Anders; Rønning, Marit; Skurtveit, Svetlana; Furu, Kari

2011-09-01

The aim of the study was to describe the use of prescribed opioid analgesics for noncancer pain and the degree of possible concurrent co-medication with benzodiazepines to women in Norway before, during, and after pregnancy. This was a population-based cohort study based on linkage of two nationwide registries: the Medical Birth Registry of Norway, and the Norwegian Prescription Database. Prescribed opioid analgesics and benzodiazepines issued to women 3 months prior to, during, and 3 months after pregnancies were identified. The study population consisted of 194,937 singleton pregnancies beginning in March 2004 or later and ending before January 2009. About 6% of the women were dispensed opioid analgesics before, during, or after pregnancy. Almost all these women received weak opioids (99%) with short-acting codeine in combination with paracetamol (acetaminophen) as the most frequently dispensed drug. The dispensing of codeine was reduced from 24/1,000 women before pregnancy to 10/1,000 in the last trimester, increasing to 17/1,000 during the breastfeeding period. Most women were dispensed codeine once, and treatment was of short duration (about 1 week). A small group of women (n = 271) were dispensed opioids in all trimesters. Increasing benzodiazepine use was observed as the number of opioid prescriptions increased. The use of opioid analgesics in pregnant women in Norway was dominated by treatment of short duration of the weak opioid codeine. As pregnancy proceeded, opioid use was reduced. However, the increase in opioid use during the nursing period has the potential for serious adverse effects.

Timing of pregnancy after gastric bypass-a national register-based cohort study.

PubMed

Kjær, Mette Mandrup; Nilas, Lisbeth

2013-08-01

Current recommendations suggest postponing pregnancy by at least 1 year after gastric bypass. During the first postoperative year, women are in a catabolic phase with a rapid weight loss which may increase the risk of adverse pregnancy and neonatal outcomes. This study tested the hypothesis that the risk of adverse pregnancy and neonatal outcomes is increased in women who conceive during the first year after gastric bypass surgery. This is a national register-based cohort study covering all Danish deliveries during 2004-2010 in women with prior Roux-en-Y gastric bypass surgery. Only the first postoperative birth was included. The risk of adverse pregnancy and neonatal outcomes was compared between women who conceived within the first postoperative year and women who conceived later. Data were extracted from the Danish National Patient Registry and The Danish Medical Birth Register. Of 286 women who had a singleton delivery after Roux-en-Y gastric bypass surgery, 158 women conceived within the first year and 128 later. There was no statistically significant difference (p > 0.05) between the two groups regarding neonatal birth weight, gestational age, risk of preeclampsia, gestational diabetes mellitus, labor induction, cesarean section, postpartum hemorrhage (>500 ml), preterm birth (before 37 weeks), small for gestational age, large for gestational age, or Apgar score (5 min ) below 7, or in the need of neonatal intensive care. This study showed no evidence to support a recommendation to delay pregnancy until after the first postoperative year. At present, the optimal time for pregnancy after gastric bypass is unknown.

Human trophoblast cell during first trimester after IVF-ET differs from natural conceived pregnancy in development and function.

PubMed

Yang, Rui; Liu, Ying-Ying; Zhao, Liang; Wang, Ying; Li, Rong; Liu, Ping; Ma, Cai-Hong; Chen, Xin-Na; Qiao, Jie

2017-03-01

To explore the differences of the trophoblast cell function in first trimester between natural pregnancy and pregnancy after IVF-ET therapy. 102 cases with twin to singleton fetal reduction after IVF-ET treatment from July 2010 to August 2013 in Peking University Third Hospital were involved in analysis, and eight specimens were obtained from this group. 10 natural-pregnancy cases undergoing artificial abortion with unwanted pregnancy were recruited as control. Semi-quantitative immunohistochemical method was used to detect the expression of EGFR, Bcl-2, tubulin-α, metallothionein and AFP in villi in both groups. Of the 102 cases, 14 cases (13.73%) were aborted. Preterm birth occurred in seven cases (7.86%). Low birth weight occurred in three patients (3.37%), and extremely low birth weight occurred in four cases (4.49%). The expression of EGFR, tubulin-α, Bcl-2, and metallothionein in the IVF-ET group was significantly lower than that in the control group (P<0.05). However, AFP expression was significantly higher in IVF-ET group than in control group (P<0.05). In IVF-ET group, the miscarriage case had weaker EGFR, tubulin-α, and metallothionein expression than full-term pregnancy; the early preterm labor case had weaker Bcl-2, tubulin-α, and metallothionein expression; and velamentous cord insertion case had weaker tubulin-α expression. The trophoblast cell function of IVF-ET group in first trimester is different from control group in proliferation, invasion, apoptosis and vascular development, and optimal pregnancy outcome depends on the self-healing balance of trophoblast cells.

Does the extended parallel process model fear appeal theory explain fears and barriers to prenatal physical activity?

PubMed

Redmond, Michelle L; Dong, Fanglong; Frazier, Linda M

2015-01-01

Few studies have looked at the impact of fear on exercise behavior during pregnancy using a fear appeal theory. It is beneficial to understand how women receive the message of safe exercise during pregnancy and whether established guidelines have any influence on their decision to exercise. Using the extended parallel process model (EPPM), we explored women's fears about prenatal physical activity. We conducted a prospective, cross-sectional study on the fears and barriers to prenatal exercise among a racially/ethnically diverse population of pregnant women. Participants were recruited from local prenatal clinics. Ninety females with a singleton pregnancy between 16 and 30 weeks gestation were enrolled in the study. The primary outcome measure was classification of risk behavior based on the EPPM theory. Women who scored high on self-efficacy for exercising safely were more likely to exercise during pregnancy (adjusted odds ratio, 5.95; 95% CI, 1.39-25.39; P=.016) for at least 90 minutes per week. Participants who exercised at least 90 minutes per week during pregnancy scored higher on their perceived ability to control danger to the baby, as well as less susceptibility of harm and threat to baby of moderate exercise from prenatal exercise. More education and counseling on specific guidelines for safely exercising during pregnancy are needed. The EPPM framework has the potential to help improve health communications about exercise safety and guidelines between patients and health care professionals during pregnancy. Copyright © 2015 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Maternal Smoking Among Women With and Without Use of Assisted Reproductive Technologies

PubMed Central

Tong, Van T.; Kissin, Dmitry M.; Bernson, Dana; Copeland, Glenn; Boulet, Sheree L.; Zhang, Yujia; Jamieson, Denise J.; England, Lucinda J.

2016-01-01

Objective To estimate smoking prevalence during the year before pregnancy and during pregnancy and adverse outcomes among women who delivered infants with and without assisted reproductive technology (ART) using linked birth certificates (BC) and National ART Surveillance System (NASS) data. Methods Data were analyzed for 384,390 women and 392,248 infants born in Massachusetts and Michigan during 2008–2009. Maternal smoking prevalence was estimated using smoking indicated from BC by ART status. For ART users, to evaluate underreporting, prepregnancy smoking was estimated from BC, NASS, or both sources. Effect of prenatal smoking on preterm and mean birthweight (term only) for singleton infants were examined by ART status. Results Maternal smoking prevalence estimates were significantly lower for ART users than nonusers (pre-pregnancy = 3.2% vs. 16.7%; prenatal = 1.0% vs. 11.1%, p < 0.05). When combining smoking information from BC and NASS, prepregnancy smoking prevalence estimates for ART users could be as high as 4.4% to 6.1%. Adverse effects of smoking on infant outcomes in ART pregnancies were consistent with the effects seen in non-ART pregnancies, specifically decline in infant birthweight and increase in preterm delivery, although association between smoking and preterm was not significant. Conclusion A low, but substantial proportion of ART users smoked before and during pregnancy. As ART users are highly motivated to get pregnant, it should be clearly communicated that smoking can decrease fertility and adversely affect pregnancy outcomes. Continued efforts are needed to encourage smoking cessation and maintain tobacco abstinence among all women of reproductive age. PMID:27243366

Pregnancy Outcomes and Insulin Requirements in Women with Type 1 Diabetes Treated with Continuous Subcutaneous Insulin Infusion and Multiple Daily Injections: Cohort Study.

PubMed

Abell, Sally K; Suen, Matthew; Pease, Anthony; Boyle, Jacqueline A; Soldatos, Georgia; Regan, John; Wallace, Euan M; Teede, Helena J

2017-05-01

We aimed to compare glycemic control, insulin requirements, and outcomes in women with type 1 diabetes in pregnancy treated with continuous subcutaneous insulin infusion (CSII) and multiple daily injections (MDI). A retrospective cohort study was conducted of singleton pregnancies (>20 weeks gestation) in women with type 1 diabetes (2010-2015) at a specialist multidisciplinary maternity network in Australia. Antenatal characteristics, diabetes history and treatment details, and maternal and neonatal outcomes were compared for women with type 1 diabetes using CSII and MDI. Bolus calculator settings were reviewed for CSII. Data were obtained from individual medical records, linkage to pathology, and the Birthing Outcomes System database. There were no differences in maternal characteristics or diabetes history between women managed with CSII (n = 40) and MDI (n = 127). Women treated with CSII required less insulin and less increase in total daily insulin dose/kg than MDI (40% vs. 52%). Both groups achieved similar glycemic control and no differences in pregnancy outcome. In the CSII group, carbohydrate:insulin ratios were intensified across gestation (30% breakfast, 27% lunch, 22% dinner), and insulin sensitivity factors (ISFs) changed little (7% breakfast, 0% lunch, -10% dinner). There was no difference in glycemic control or pregnancy outcomes in women using CSII or MDI managed in a multidisciplinary setting. Greater adjustments are needed to ISFs with CSII therapy. Overall, these data do not support recommending CSII in pregnancy with potentially higher patient and staff demands and costs and lack of improvement in HbA1c and pregnancy outcomes.

Fine Particulate Matter and Risk of Preterm Birth in Connecticut in 2000–2006: A Longitudinal Study

PubMed Central

Pereira, Gavin; Belanger, Kathleen; Ebisu, Keita; Bell, Michelle L.

2014-01-01

Several studies have examined associations between particulate matter with aerodynamic diameter of 2.5 µm or less (PM2.5) and preterm birth, but it is uncertain whether results were affected by individual predispositions (e.g., genetic factors, social conditions) that might vary considerably between women. We tested the hypothesis that a woman is at greater risk of preterm delivery when she has had elevated exposure to ambient PM2.5 during a pregnancy than when she has not by comparing pregnancies in the same woman. From 271,204 births, we selected 29,175 women who had vaginal singleton livebirths at least twice in Connecticut in 2000–2006 (n = 61,688 births). Analyses matched pregnancies to the same woman. Adjusted odds ratios per interquartile range (2.33-µg/m3) increase in PM2.5 in the first trimester, second trimester, third trimester, and whole pregnancy were 1.07 (95% confidence interval (CI): 1.00, 1.15), 0.96 (95% CI: 0.90, 1.03), 1.03 (95% CI: 0.97, 1.08), and 1.13 (95% CI: 1.01, 1.28), respectively. Among Hispanic women, the odds ratio per interquartile range increase in whole-pregnancy exposure was 1.31 (95% CI: 1.00, 1.73). Pregnancies with elevated PM2.5 exposure were more likely to result in preterm birth than were other pregnancies to the same woman at lower exposure. Associations were most pronounced in the first trimester and among Hispanic women. PMID:24068199

Maternal pre-pregnancy obesity and gestational weight gain influence neonatal neurobehaviour.

PubMed

Aubuchon-Endsley, Nicki; Morales, Monique; Giudice, Christina; Bublitz, Margaret H; Lester, Barry M; Salisbury, Amy L; Stroud, Laura R

2017-04-01

Maternal weight before and during pregnancy is associated with offspring neurobehaviour in childhood. We investigated maternal weight prior to and during pregnancy in relation to neonatal neurobehaviour. We hypothesized that maternal obesity and excessive gestational weight gain would be associated with poor neonatal attention and affective functioning. Participants (n = 261) were recruited, weighed and interviewed during their third trimester of pregnancy. Pre-pregnancy weight was self-reported and validated for 210 participants, with robust agreement with medical chart review (r = 0.99). Neurobehaviour was measured with the NICU Network Neurobehavioural Scale (NNNS) administered on Days 2 and 32 postpartum. Maternal exclusion criteria included severe or persistent physical or mental health conditions (e.g. chronic disease or diagnoses of Bipolar Disorder or Psychotic Spectrum Disorders), excessive substance use, and social service/foster care involvement or difficulty understanding English. Infants were from singleton, full-term (37-42 weeks gestation) births with no major medical concerns. Outcome variables were summary scores on the NNNS (n = 75-86). For women obese prior to pregnancy, those gaining in excess of Institute of Medicine guidelines had infants with poorer regulation, lower arousal and higher lethargy. There were no main effects of maternal pre-pregnancy body mass index on neurobehaviour. Women gaining above Institute of Medicine recommendations had neonates with better quality of movement. Additional studies to replicate and extend results past the neonatal period are needed. Results could support underlying mechanisms explaining associations between maternal perinatal weight and offspring outcomes. These mechanisms may inform future prevention/intervention strategies. © 2016 Blackwell Publishing Ltd. © 2016 Blackwell Publishing Ltd.

Low-level exposure to air pollution and risk of adverse birth outcomes in Hillsborough County, Florida.

PubMed

Mainolfi, Maria B; Salihu, Hamisu M; Wilson, Roneé E; Mbah, Alfred K

2013-05-01

In this retrospective cohort (1998 to 2007), 145,445 singleton live births in Hillsborough, Florida, were analyzed to elucidate the relationship between fetal morbidity and prenatal exposure to six criteria air pollutants. This study was based on three linked databases: Florida Hospital Discharge, vital statistics records, and air pollution meteorological data from the Environmental Protection Agency. The primary outcomes of interest were low birth weight, preterm births, and small for gestational age. This study used structural equation modeling and trimester groupings to evaluate the relationship between air pollution and birth outcomes of pregnant residents. The latent variables of structural equation modeling yielded a significant B value of 0.35, indicating that exposure to the criteria pollutants in pregnancy may have a significant relationship to fetal morbidity. Exposure to criteria air pollutants in pregnancy is associated with fetal morbidity outcomes.

First-trimester serum folate levels and subsequent risk of abortion and preterm birth among Japanese women with singleton pregnancies.

PubMed

Yamada, Takashi; Morikawa, Mamoru; Yamada, Takahiro; Kishi, Reiko; Sengoku, Kazuo; Endo, Toshiaki; Saito, Tsuyoshi; Cho, Kazutoshi; Minakami, Hisanori

2013-01-01

To determine whether a low serum folate level during the first trimester predicts subsequent late abortion, preterm birth, or fetal growth restriction (FGR). A prospective cohort study involving 5,075 women whose serum folate levels were measured during the first trimester. The participants were informed of their serum folate levels. The pregnancy duration, birthweight, rate of late abortion/preterm birth, and the rate of FGR did not differ significantly among the four groups classified according to folate status. The mean serum folate levels did not differ among quartiles classified according to the gestational week at the time of delivery. Nineteen of the 20 women with folate deficiency gave birth at term to infants with a birthweight of 3.132 ± 321 g; only one infant had FGR. Low serum folate levels during the first trimester were not associated with the risk of late abortion, preterm birth, or FGR.

Effects of lifestyle intervention on dietary intake, physical activity level, and gestational weight gain in pregnant women with different pre-pregnancy Body Mass Index in a randomized control trial.

PubMed

Hui, Amy Leung; Back, Lisa; Ludwig, Sora; Gardiner, Phillip; Sevenhuysen, Gustaaf; Dean, Heather J; Sellers, Elisabeth; McGavock, Jonathan; Morris, Margaret; Jiang, Depeng; Shen, Garry X

2014-09-24

The objectives of this study were to assess the efficacy of lifestyle intervention on gestational weight gain in pregnant women with normal and above normal body mass index (BMI) in a randomized controlled trial. A total of 116 pregnant women (<20 weeks of pregnancy) without diabetes were enrolled and 113 pregnant women completed the program. Participants were randomized into intervention and control groups. Women in the intervention group received weekly trainer-led group exercise sessions, instructed home exercise for 3-5-times/week during 20-36 weeks of gestation, and dietary counseling twice during pregnancy. Participants in the control group did not receive the intervention. All participants completed a physical activity questionnaire and a 3-day food record at enrolment and 2 months after enrolment. The participants in the intervention group with normal pre-pregnancy BMI (≤24.9 kg/M2, n = 30) had lower gestational weight gain (GWG), offspring birth weight and excessive gestational weight gain (EGWG) on pregnancy weight gain compared to the control group (n = 27, p < 0.05). Those weight related-changes were not detected between the intervention (n = 27) and control group (n = 29) in the above normal pre-pregnancy BMI participants. Intervention reduced total calorie, total fat, saturated fat and cholesterol intake were detected in women with normal or above normal pre-pregnancy BMI compared to the control group (p < 0.05 or 0.01). Increased physical activity and reduced carbohydrate intake were detected in women with normal (p < 0.05), but not above normal, pre-pregnancy BMI at 2 months after the onset of the intervention compared to the control group. The results of the present study demonstrated that the lifestyle intervention program decreased EGWG, GWG, offspring birth weight in pregnant women with normal, but not above normal, pre-pregnancy BMI, which was associated with increased physical activity and decreased carbohydrate intake. NCT00486629.

IVF culture medium affects human intrauterine growth as early as the second trimester of pregnancy.

PubMed

Nelissen, Ewka C M; Van Montfoort, Aafke P A; Smits, Luc J M; Menheere, Paul P C A; Evers, Johannes L H; Coonen, Edith; Derhaag, Josien G; Peeters, Louis L; Coumans, Audrey B; Dumoulin, John C M

2013-08-01

When does a difference in human intrauterine growth of singletons conceived after IVF and embryo culture in two different culture media appear? Differences in fetal development after culture of embryos in one of two IVF media were apparent as early as the second trimester of pregnancy. Abnormal fetal growth patterns are a major risk factor for the development of chronic diseases in adult life. Previously, we have shown that the medium used for culturing embryos during the first few days after fertilization significantly affects the birthweight of the resulting human singletons. The exact onset of this growth difference was unknown. In this retrospective cohort study, all 294 singleton live births after fresh embryo transfer in the period July 2003 to December 2006 were included. These embryos originated from IVF treatments that were part of a previously described clinical trial. Embryos were allocated to culture in either Vitrolife or Cook commercially available sequential culture media. We analysed ultrasound examinations at 8 (n = 290), 12 (n = 83) and 20 weeks' (n = 206) gestation and used first-trimester serum markers [pregnancy-associated plasma protein-A (PAPP-A) and free β-hCG]. Differences between study groups were tested by the Student's t-test, χ(2) test or Fisher's exact test, and linear multivariable regression analysis to adjust for possible confounders (for example, parity, gestational age at the time of ultrasound and fetal gender). A total of 294 singleton pregnancies (Vitrolife group nVL = 168, Cook group: nC = 126) from 294 couples were included. At 8 weeks' gestation, there was no difference between crown-rump length-based and ovum retrieval-based gestational age (ΔGA) (nVL = 163, nC = 122, adjusted mean difference, -0.04 days, P = 0.84). A total of 83 women underwent first-trimester screening at 12 weeks' gestation (nVL = 45, nC = 38). ΔGA, nuchal translucency (multiples of median, MoM) and PAPP-A (MoM) did not differ between the study groups. Free β-hCG (MoM) ± SEM differed significantly (1.55 ± 0.19 in Vitrolife versus 1.06 ± 0.10 in Cook; P = 0.031, Student's t-test). At 20 weeks' gestation, a more advanced GA, reflecting an increased fetal growth, was seen at ultrasound examination in the Vitrolife group (n = 115) when compared with the Cook group (n = 91). After adjustment for confounding factors, both the difference between GA based on three biparietal diameter dating formulas minus the actual (ovum retrieval based) GA (adjusted mean difference + 1.14 days (P = 0.04), +1.14 days (P = 0.04) and +1.36 days (P = 0.048)), as well as head circumference (HC) and trans-cerebellar diameter (TCD) were significantly higher in the Vitrolife group (HCvl 177.3 mm, HCc 175.9 mm, adjusted mean difference 1.8, P = 0.03; TCDvl 20.5 mm, TCDc 20.2 mm, adjusted mean difference 0.4, P = 0.008). A first trimester (12 weeks) fetal screening was not yet offered routinely during the study period, therefore only 28% of women in our study participated in this elective screening programme. Although all sonographers were experienced and specially trained to perform these ultrasound examinations and were unaware of the randomization procedure, we cannot totally rule out possible intra- and inter-observer variability. Despite being indispensable in daily practice, sonographic weight formulas have a limited accuracy. According to the fetal origins hypothesis, many adult diseases originate in utero owing to adaptations made by the fetus to the environment it encounters. This study indicates that the embryonic environment is already important for fetal development. Therefore, our study emphasizes the need to investigate fetal growth patterns after assisted reproduction technologies and long-term health outcomes of IVF children, especially in relation to the culture medium used during the first few days of preimplantation development. Not applicable.

Risk factor profile and pregnancy outcome in women with type 1 and type 2 diabetes mellitus.

PubMed

Handisurya, Ammon; Bancher-Todesca, Dagmar; Schober, Edith; Klein, Katharina; Tobler, Karin; Schneider, Barbara; Pollak, Arnold; Husslein, Peter; Luger, Anton; Kautzky-Willer, Alexandra

2011-02-01

To assess differences in congenital anomalies, infant mortality, and obstetrical complications as well as risk factors associated with an adverse pregnancy outcome in women with type 1 (T1DM) and type 2 diabetes mellitus (T2DM). This observational study was performed at a university clinic and included a total of 200 singleton pregnancies between January 1995 and December 2006. Outcome measures comprise the prevalence of major congenital malformations, fetal losses, stillbirths, and neonatal deaths as well as the combined end point, adverse pregnancy outcome, and obstetrical complications. Despite changes in prevailing risk factors, the rate of congenital anomalies and embryonic as well as perinatal death was comparable in type 1 diabetic women over time as well as between women with T1DM and T2DM. Outcome measures and risk factor profile were similar in women with preconception and newly diagnosed T2DM. Glycemic control and increased body mass index (BMI) during the first trimester were the strongest predictors of an adverse pregnancy outcome. Hemoglobin A1c (HbA1c) was higher in T1DM than in T2DM but similar in women with T1DM over time. BMI was highest in women with T2DM, followed by T1DM women of the most recent time period. In addition to HbA1c, other risk factors, especially high BMI, strongly influence pregnancy outcome. The higher prevalence of these risk factors in T2DM might compensate for the better glycemic control, resulting in a pregnancy outcome comparable to that of T1DM. Pregnancy outcome in T1DM remained unchanged over time, possibly because of the missing amelioration of HbA1c levels and the increasing BMI.

Decreased first trimester PAPP-A is a predictor of adverse pregnancy outcome.

PubMed

Yaron, Yuval; Heifetz, Sigal; Ochshorn, Yifat; Lehavi, Ofer; Orr-Urtreger, Avi

2002-09-01

Low levels of maternal serum pregnancy associated plasma protein-A (PAPP-A) have been linked to chromosome anomalies such as trisomy 21, 13 and 18, triploidy and sex chromosome aneuploidy. Low levels of PAPP-A have also been implicated in spontaneous miscarriage. The purpose of this study was to evaluate whether low levels of first trimester PAPP-A are predictive of other adverse pregnancy outcomes. The study included patients with singleton pregnancies who underwent combined first trimester screening using nuchal translucency (NT) and maternal serum free beta-human chorionic gonadotrophin (free beta-hCG) and PAPP-A at 10-13 weeks' gestation. Patients with chromosome aberrations or fetal anomalies were excluded. Serum marker levels were expressed as gestational age-specific multiples of the median (MoMs). The incidences of various adverse pregnancy outcomes (spontaneous preterm labor, fetal growth restriction (FGR), proteinuric and non-proteinuric pregnancy induced hypertension (PIH), intrauterine fetal demise, oligohydramnios, spontaneous miscarriage and placental abruption) were evaluated, according to maternal PAPP-A MoM levels. Of the 1622 patients in the study, pregnancy complications were observed in 184 (11.3%). Patients with PAPP-A < or =0.25 MoM had significantly higher rates of FGR (RR = 3.12), proteinuric PIH (RR = 6.09), spontaneous miscarriage (RR = 8.76). No statistically significant differences were noted for other adverse outcomes evaluated Women with PAPP-A < or =0.50 MoM also had significantly higher rates of FGR (RR = 3.30) and spontaneous miscarriage (RR = 3.78). We conclude that decreased levels of first trimester maternal serum PAPP-A are predictive not only of chromosome anomalies but also of adverse pregnancy outcome. Copyright 2002 John Wiley & Sons, Ltd.

Maternal depression, pregnancy intention, and return to paid work after childbirth.

PubMed

Dagher, Rada K; Hofferth, Sandra L; Lee, Yoonjoo

2014-01-01

Maternal depression is an important public health issue for women, their families, and their employers. Previous studies have examined the impact of leave duration on maternal depression, but none have studied the association between maternal depression and the pace of return to paid work. We examine herein the relationship between maternal depression and return to work, and the moderating effects of pregnancy intention. We utilized data from the Listening to Mothers II Survey collected from January 20 through February 21, 2006. The woman had to be 18 to 45 years old, speak English, and have given birth in 2005 to a live singleton baby in a U.S. hospital. Our analyses were limited to women who worked for an employer during pregnancy (n = 882). The primary outcome was return to paid work at the time of the interview and the analyses utilized Cox proportional hazard models. In combination, intending the baby and being depressed suppressed return to paid work. Nondepressed mothers with unintended pregnancies returned to work the soonest. Compared with mothers who were not depressed and with unintended pregnancy, the risk ratio of returning to paid work (0.70) was significantly lower for mothers who were depressed and had an intended pregnancy. Mothers who were not depressed and with intended pregnancy also had a significantly lower risk ratio (0.60) of returning to paid work than those who were not depressed and with unintended pregnancy. Primary care providers and policy makers can use these findings to support employed women in their childbearing years. Copyright © 2014 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Hypothyroidism incidence in and around pregnancy: a Danish nationwide study.

PubMed

Andersen, S L; Carlé, A; Olsen, J; Laurberg, P

2016-11-01

Immunological changes in and after a pregnancy may influence the onset of autoimmune diseases. An increased incidence of hyperthyroidism has been observed both in early pregnancy and postpartum, but it remains to be studied if the incidence of hypothyroidism varies in a similar way. Population-based cohort study using Danish nationwide registers. All women who gave birth to a singleton live-born child in Denmark from 1999 to 2008 (n = 403 958) were identified, and data on hospital diagnosis of hypothyroidism and redeemed prescriptions of thyroid hormone were extracted. The overall incidence rate (IR) of hypothyroidism during 1997-2010 and the IR in three-month intervals before, during and after the woman's first pregnancy in the study period were calculated and compared with the IR of hyperthyroidism. Altogether 5220 women were identified with onset of hypothyroidism from 1997 to 2010 (overall IR 92.3/100 000/year) and 1572 women developed hypothyroidism in the period from 2 years before to 2 years after birth of the first child in the study period. The incidence of hypothyroidism decreased during the pregnancy (incidence rate ratio (IRR) vs overall IR in the rest of the study period: first trimester: 0.89 (95% CI: 0.66-1.19), second trimester: 0.71 (0.52-0.97), third trimester: 0.29 (0.19-0.45)) and increased after birth with the highest level at 4-6 months postpartum (IRR 3.62 (2.85-4.60)). These are the first population-based data on the incidence of hypothyroidism in and around pregnancy. The incidence declined during pregnancy followed by a sharp increase postpartum. Notably, hypothyroidism as opposed to hyperthyroidism showed no early pregnancy increase. © 2016 European Society of Endocrinology.

Prevalence of female sexual dysfunction during pregnancy among Egyptian women.

PubMed

Ahmed, Magdy R; Madny, Elham H; Sayed Ahmed, Waleed A

2014-04-01

The aim of this study was to assess the prevalence of female sexual dysfunction (FSD) during pregnancy in a sample of women from Egypt. This prospective cohort study was conducted among pregnant women who presented to the Obstetrics Outpatient Clinic - Suez Canal University Hospital for routine antenatal care between February 2012 and February 2013. The 451 women who completed the study attended during their first trimester with a singleton pregnancy and were in a stable relationship with their partners for the last 6 months. Sexual function was assessed using the Female Sexual Function Index (FSFI) questionnaire during the 4 weeks preceding pregnancy and then in each trimester during the antenatal visits. Prevalence of FSD during pregnancy was estimated to be 68.8%. According to the FSFI, scores of all domains and total score were significantly reduced during the whole period of pregnancy (average 22.5 ± 3.7) compared to the pre-conception period (30.5 ± 5.6). However, there was significant increase of all domains and total score during the second trimester (26.6 ± 3.9) in comparison to the first and third trimesters (22.4 ± 4.1 and 18.6 ± 3.8, respectively). Total FSFI score was found to be positively correlated to pre-conception total FSFI score. However, age, parity and duration of marriage were negatively correlated. FSD is a prevalent problem during pregnancy among Egyptian women. The magnitude of the problem is highest during the third trimester while the second trimester represents the peak of sexual function during pregnancy. © 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.

Parental smoking during pregnancy and the risk of gestational diabetes in the daughter

PubMed Central

Bao, Wei; Michels, Karin B; Tobias, Deirdre K; Li, Shanshan; Chavarro, Jorge E; Gaskins, Audrey J; Vaag, Allan A; Hu, Frank B; Zhang, Cuilin

2016-01-01

Abstract Background: Fetal exposure to parental smoking may have long-term impact on the development of disease in adulthood. We examined the association of parental smoking during pregnancy with risk of gestational diabetes mellitus (GDM) in the daughter. Methods: We included 15 665 singleton pregnancies from 10 152 women in the Nurses' Health Study II cohort whose mothers participated in the Nurses’ Mothers’ Cohort Study. Data on maternal and paternal smoking during pregnancy and associated covariates were recalled by the mothers. GDM diagnosis was self-reported by the daughters and was validated by medical record review in a previous study. We used log-binomial models with generalized estimating equations to estimate relative risks (RRs) and 95% confidence intervals (CIs). Results: We observed a positive association between maternal heavy smoking during pregnancy and risk of GDM in the daughter. The multivariable-adjusted RRs (95% CIs) of GDM among women whose mothers did not smoke during pregnancy, continued smoking 1–14, 15–24, and ≥25 cigarettes/day were 1.00 (reference), 1.05 (0.81–1.35), 1.27 (0.95–1.70) and 1.98 (1.18–3.30), respectively ( P for trend = 0.01). Further adjustment for the women’s perinatal variables, adult-life characteristics and body mass index during various periods of life modestly attenuated the association. No association was observed between paternal smoking during the pregnancy period and risk of GDM in the daughter. Conclusions: Maternal heavy smoking (≥25 cigarettes/day) during pregnancy was associated with higher risk of gestational diabetes in the daughter. Further studies are warranted to confirm our findings and to elucidate the underlying mechanisms. PMID:26748845

Exercise in pregnancy: an association with placental weight?

PubMed

Hilde, Gunvor; Eskild, Anne; Owe, Katrine Mari; Bø, Kari; Bjelland, Elisabeth K

2017-02-01

Women with high levels of physical exercise have an increased demand for oxygen and nutrients. Thus, in pregnancies of women with high levels of exercise, it is conceivable that the supply of oxygen and nutrients to the placenta is suboptimal, and growth could be impaired. The objective was to study the association of frequency of exercise during pregnancy with placental weight and placental to birthweight ratio. This was a prospective study of 80,515 singleton pregnancies in the Norwegian Mother and Child Cohort Study. Frequency of exercise was self-reported by a questionnaire at pregnancy weeks 17 and 30. Information on placental weight and birthweight was obtained by linkage to the Medical Birth Registry of Norway. Placental weight decreased with increasing frequency of exercise (tests for trend, P < .001). For nonexercisers in pregnancy week 17, the crude mean placental weight was 686.1 g compared with 667.3 g in women exercising ≥6 times weekly (difference, 18.8 g; 95% confidence interval, 12.0-25.5). Likewise, in nonexercisers in pregnancy week 30, crude mean placental weight was 684.9 g compared with 661.6 g in women exercising ≥6 times weekly (difference, 23.3 g; 95% confidence interval, 14.9-31.6). The largest difference in crude mean placental weight was seen between nonexercisers at both time points and women exercising ≥6 times weekly at both time points (difference, 31.7 g; 95% confidence interval, 19.2-44.2). Frequency of exercise was not associated with placental to birthweight ratio. We found decreasing placental weight with increasing frequency of exercise in pregnancy. The difference in placental weight between nonexercisers and women with exercising ≥6 times weekly was small and may have no clinical implications. Copyright © 2016 Elsevier Inc. All rights reserved.

The role of maternal anorexia nervosa and bulimia nervosa before and during pregnancy in early childhood wheezing: Findings from the NINFEA birth cohort study.

PubMed

Popovic, Maja; Pizzi, Costanza; Rusconi, Franca; Gagliardi, Luigi; Galassi, Claudia; Trevisan, Morena; Merletti, Franco; Richiardi, Lorenzo

2018-05-02

This study evaluates associations of maternal eating disorders (bulimia nervosa, anorexia nervosa, and purging behaviors) with infant wheezing and examines the effects of eating disorders on several wheezing determinants. We studied 5,150 singletons from the NINFEA birth cohort. Maternal bulimia nervosa and anorexia nervosa diagnoses were ascertained from the questionnaires completed in pregnancy and 6 months after delivery, and were analyzed as: ever diagnosis, only before pregnancy, and during pregnancy. Purging behaviors were assessed for 12 months before or during pregnancy. The associations with wheezing between 6 and 18 months of age were assessed in models adjusted for a priori selected confounders. Children born to mothers with lifetime eating disorders were at an increased risk of developing wheezing (adjusted OR 1.68; [95% CI: 1.08, 2.60]), and this risk further increased when the disorders were active during pregnancy (2.52 [1.23, 5.19]). Increased risk of offspring wheezing was observed also for purging behaviors without history of eating disorder diagnosis (1.50 [1.10, 2.04]). The observed associations were not explained by comorbid depression and/or anxiety. Bulimia nervosa and/or anorexia nervosa during pregnancy were also associated with several risk factors for wheezing, including maternal smoking, adverse pregnancy outcomes, shorter breastfeeding duration, and day-care attendance. The associations of maternal eating disorders with offspring wheezing suggest long-term adverse respiratory outcomes in children of mothers with eating disorders. A better understanding of mechanisms implicated is necessary to help reduce the respiratory disease burden in these children. © 2018 Wiley Periodicals, Inc.

Antidepressant use during pregnancy and childhood cancer in the offspring.

PubMed

Momen, Natalie C; Munk-Olsen, Trine; Li, Jiong; Ingstrup, Katja G; Olsen, Jørn; Bergink, Veerle; Liu, Xiaoqin

2018-01-01

Antidepressant use during pregnancy has been increasing in recent years. We evaluated whether in utero exposure to antidepressants increased the risk of childhood cancer. This population-based cohort study using national registers in Denmark comprised 915 128 liveborn singletons during 1998-2012. We categorised children into three mutually exclusive exposure groups according to maternal redemption of an antidepressant prescription from 2 years before pregnancy until delivery of the index child: Unexposed (N = 863 033), prior user (use before but not during pregnancy) (N = 30 607), and use during pregnancy (N = 21 488). The children were followed from birth until first diagnosis of cancer, death, emigration, or December 31, 2012, whichever came first. The children were followed maximum 14.9 years and contributed to 6.9 × 10 6 person-years at risk. We estimated hazard ratios (HRs) of cancer using Cox regression with 95% confidence intervals (CIs). In total, 1298 (0.1%) children were diagnosed with cancer. Antidepressant use during pregnancy was not associated with a significantly increased risk of childhood cancer in general; the HR was 1.03 (95% CI, 0.63-1.68), compared to children born by mothers who discontinued antidepressant use prior to pregnancy. The association between in utero exposure to antidepressants and childhood cancer did not depend on type or duration of antidepressant use. There was no strong evidence indicating a higher risk of leukaemia or nervous system tumours among children exposed to antidepressants in utero. Antidepressant use during pregnancy was not significantly associated with childhood cancer in general nor with leukaemia or nervous system tumours in specific. Copyright © 2017 John Wiley & Sons, Ltd.

Parental smoking during pregnancy and the risk of gestational diabetes in the daughter.

PubMed

Bao, Wei; Michels, Karin B; Tobias, Deirdre K; Li, Shanshan; Chavarro, Jorge E; Gaskins, Audrey J; Vaag, Allan A; Hu, Frank B; Zhang, Cuilin

2016-02-01

Fetal exposure to parental smoking may have long-term impact on the development of disease in adulthood. We examined the association of parental smoking during pregnancy with risk of gestational diabetes mellitus (GDM) in the daughter. We included 15,665 singleton pregnancies from 10,152 women in the Nurses' Health Study II cohort whose mothers participated in the Nurses' Mothers' Cohort Study. Data on maternal and paternal smoking during pregnancy and associated covariates were recalled by the mothers. GDM diagnosis was self-reported by the daughters and was validated by medical record review in a previous study. We used log-binomial models with generalized estimating equations to estimate relative risks (RRs) and 95% confidence intervals (CIs). We observed a positive association between maternal heavy smoking during pregnancy and risk of GDM in the daughter. The multivariable-adjusted RRs (95% CIs) of GDM among women whose mothers did not smoke during pregnancy, continued smoking 1-14, 15-24, and ≥ 25 cigarettes/day were 1.00 (reference), 1.05 (0.81-1.35), 1.27 (0.95-1.70) and 1.98 (1.18-3.30), respectively (P for trend = 0.01). Further adjustment for the women's perinatal variables, adult-life characteristics and body mass index during various periods of life modestly attenuated the association. No association was observed between paternal smoking during the pregnancy period and risk of GDM in the daughter. Maternal heavy smoking (≥ 25 cigarettes/day) during pregnancy was associated with higher risk of gestational diabetes in the daughter. Further studies are warranted to confirm our findings and to elucidate the underlying mechanisms. Published by Oxford University Press on behalf of International Epidemiological Association 2016. This work is written by US Government employees and is in the public domain in the US.

Mechanism and preclinical prevention of increased breast cancer risk caused by pregnancy

PubMed Central

Haricharan, Svasti; Dong, Jie; Hein, Sarah; Reddy, Jay P; Du, Zhijun; Toneff, Michael; Holloway, Kimberly; Hilsenbeck, Susan G; Huang, Shixia; Atkinson, Rachel; Woodward, Wendy; Jindal, Sonali; Borges, Virginia F; Gutierrez, Carolina; Zhang, Hong; Schedin, Pepper J; Osborne, C Kent; Tweardy, David J; Li, Yi

2013-01-01

While a first pregnancy before age 22 lowers breast cancer risk, a pregnancy after age 35 significantly increases life-long breast cancer risk. Pregnancy causes several changes to the normal breast that raise barriers to transformation, but how pregnancy can also increase cancer risk remains unclear. We show in mice that pregnancy has different effects on the few early lesions that have already developed in the otherwise normal breast—it causes apoptosis evasion and accelerated progression to cancer. The apoptosis evasion is due to the normally tightly controlled STAT5 signaling going astray—these precancerous cells activate STAT5 in response to pregnancy/lactation hormones and maintain STAT5 activation even during involution, thus preventing the apoptosis normally initiated by oncoprotein and involution. Short-term anti-STAT5 treatment of lactation-completed mice bearing early lesions eliminates the increased risk after a pregnancy. This chemoprevention strategy has important implications for preventing increased human breast cancer risk caused by pregnancy. DOI: http://dx.doi.org/10.7554/eLife.00996.001 PMID:24381245

Predicting preeclampsia from a history of preterm birth

PubMed Central

Ebbing, Cathrine; Irgens, Lorentz M.

2017-01-01

Objective To assess whether women with a history of preterm birth, independent on the presence of prelabour rupture of the membranes (PROM) and growth deviation of the newborn, are more likely to develop preeclampsia with preterm or preterm birth in a subsequent pregnancy. Methods We conducted a population-based cohort study, based on Medical Birth Registry of Norway between 1967 and 2012, including 742,980 women with singleton pregnancies who were followed up from their 1st to 2nd pregnancy. In the analyses we included 712,511 women after excluding 30,469 women with preeclampsia in the first pregnancy. Results After preterm birth without preeclampsia in the first pregnancy, the risk of preterm preeclampsia in the second pregnancy was 4–7 fold higher than after term birth (odds ratios 3.5; 95% confidence interval (CI) 3.0–4.0 to 6.5; 95% CI 5.1–8.2). The risk of term preeclampsia in the pregnancy following a preterm birth was 2–3 times higher than after term birth (odds ratios 1.6; 95% CI 1.5–1.8 to 2.6; 95% CI 2.0–3.4). After spontaneous non-PROM preterm birth and preterm PROM, the risk of preterm preeclampsia was 3.3–3.6 fold higher than after spontaneous term birth. Corresponding risks of term preeclampsia was 1.6–1.8 fold higher. No significant time trends were found in the effect of spontaneous preterm birth in the first pregnancy on preterm or term preeclampsia in the second pregnancy. Conclusions The results suggest that preterm birth, regardless of the presence of PROM, and preeclampsia share pathophysiologic mechanisms. These mechanisms may cause preterm birth in one pregnancy and preeclampsia in a subsequent pregnancy in the same woman. The association was particularly evident with preterm preeclampsia. PMID:28738075

Why non-invasive maternal hemodynamics assessment is clinically relevant in early pregnancy: a literature review.

PubMed

Vonck, Sharona; Staelens, Anneleen Simone; Bollen, Ine; Broekx, Lien; Gyselaers, Wilfried

2016-10-12

The maternal cardiovascular system adapts quickly when embryo implantation is recognized by the body. Those adaptations play an important role, as a normal cardiovascular adaptation is a requirement for a normal course of pregnancy. Disturbed adaptations predispose to potential hypertensive disorders further in pregnancy [1-3]. This report aims to briefly inform the obstetricians, general practitioners and midwives, who are the key players in detecting and treating hypertensive disorders during pregnancy. The PubMed database was used as main tool to find studies involving clearly defined first trimester hemodynamic changes in normal pregnancies and hypertensive pregnancies. In addition, the bibliographies of these studies were investigated for further relevant literature. A comprehensive overview is given concerning the normal adaptations in the cardiovascular tree in a first trimester pregnancy. Additionally, signs of abnormal cardiovascular changes observed in first trimester are described together with the normal reference range for each non-invasive, easily applicable technique for maternal hemodynamics assessment. With a combination of techniques, it is possible to integrate and evaluate the maternal heart, veins and arteries at 12 weeks of pregnancy. Applying those techniques into the daily clinic opens perspectives to prevention and prophylactic treatment, aiming for a reduction of the risk for hypertension during pregnancy.