Perinatal outcome in large-for-gestational-age infants. Is it influenced by gestational impaired glucose tolerance?

OBJECTIVE: To examine the relationship between the World Health Organization category of impaired glucose tolerance (IGT) (two-hour value of the 75-g oral glucose tolerance test at 8-10.9 mmol/L) and outcome in large-for-gestational age (LGA) infants to determine whether IGT affects perinatal morbidity in addition to affecting infant size. STUDY DESIGN: A retrospective study was performed on 461 LGA newborns (birth weight > 90th percentile) from singleton pregnancies delivering after 36 completed weeks in a 12-month period to determine the difference in perinatal outcome between nondiabetic pregnancies (n = 382) and pregnancies with diet-treated IGT (n = 79). RESULTS: The IGT group had significantly higher mean maternal age, prepregnancy weight and body mass index (BMI) but lower absolute and percent gestational weight gain and no difference in infant gestational age, birth weight, BMI, incidence of macrosomia (birth weight > or = 4,000 g) or obstetric complications. However, the IGT group had an increased incidence of Erb's palsy (OR 7.81, 95% CI 1.76-34.62), meconium aspiration syndrome (OR 5.29, 95% CI 1.27-22.02), phototherapy (OR 2.10, 95% CI 1.03-5.69), sepsis (OR 2.90, 95% CI 1.25-6.74) and shoulder dystocia (OR 5.64, 95% CI 1.06-29.89) after adjusting for confounding factors (maternal age and BMI, postdate pregnancy, mode of delivery and infant sex). CONCLUSION: Despite dietary treatment, maternal IGT is associated with increased perinatal morbidity independent of its effect on fetal size.     

Implications of a high placental ratio in pregnancies with appropriate-for-gestational age neonates

OBJECTIVE: To determine the relationship between the placental weight to birth weight ratio (placental ratio) with maternal pre-pregnancy weight, gestational weight gain, and neonatal outcome in non-diabetic pregnancies resulting in appropriate-for-gestational age (AGA) infants. METHODS: A retrospective study was performed on 593 patients with singleton pregnancies, normal results in the 75-gram oral glucose tolerance test and who delivered AGA newborns within a 1-year period. The patients were categorized into high placental ratio (> mean +1 SD based on previous data, n = 113 or 19.1%) and normal ratio groups for the comparison of maternal and neonatal anthropometric parameters. RESULTS: The high placental ratio group had a higher pre-pregnancy weight, body mass index, placental weight, and incidence of low Apgar score, but decreased absolute and percentage gestational weight gain, gestational age, and birth weight. After controlling for pre-pregnancy weight and gestational age, only the correlation between placental weight and percent weight gain remained significant. CONCLUSION: Our finding suggests that a high placental ratio can identify AGA newborns who are disproportionately small relative to maternal size, and may reflect some form of fetal growth impairment.     

Neonatal outcomes with placenta previa

OBJECTIVE: To identify neonatal complications associated with placenta previa. METHODS: This was a population-based, retrospective cohort study involving all singleton deliveries in Nova Scotia from 1988 to 1995. The study group consisted of all completed singleton pregnancies complicated by placenta previa; all other singleton pregnancies were considered controls. Patient information was collected from the Nova Scotia Atlee perinatal database. Neonatal complications were evaluated while controlling for potential confounders. The data were analyzed using chi2, Fisher exact test, and multiple logistic regression. RESULTS: Among 92,983 pregnancies delivered during the study period, 305 cases of placenta previa were identified (0.33%). After controlling for potential confounders, neonatal complications significantly associated with placenta previa included major congenital anomalies (odds ratio [OR] 2.48), respiratory distress syndrome (OR 4.94), and anemia (OR 2.65). The perinatal mortality rate associated with placenta previa was 2.30% (compared with 0.78% in controls) and was explained by gestational age at delivery, occurrence of congenital anomalies, and maternal age. Although there was a higher rate of preterm births in the placenta previa group (46.56% versus 7.27%), there was no difference in birth weights between groups after controlling for gestational age at delivery. CONCLUSION: Neonatal complications of placenta previa included preterm birth, congenital anomalies, respiratory distress syndrome, and anemia. There was no increased occurrence of fetal growth restriction.     

Assessment of glucose tolerance and pregnancy outcome of polycystic ovary patients.

OBJECTIVES: To determine the impact of polycystic ovary syndrome (PCOS) on glucose tolerance during pregnancy and perinatal outcome. METHODS: Pregnancy records of 38 PCOS patients were compared retrospectively with 136 non-PCOS patients randomly. Patients with glucose challenge tests values of >130 mg/dl were referred for the 3-h, 100-g oral glucose tolerance test (OGTT). RESULTS: A family history of diabetes mellitus, pre-pregnancy body mass index (BMI), gestational weight gain was significantly higher in PCOS patients than controls. The prevalence of gestational diabetes mellitus (GDM) was similar in both groups. Impaired glucose tolerance (IGT) was observed in 18.4% of PCOS patients vs. 5.1% of controls. The main predictor of GDM was found pre-pregnancy BMI >25 while main predictor of IGT was found as PCOS. Mean gestational age at delivery, prevalence of preterm labor, modes of delivery, mean birthweight, mean Apgar score at 5 min, proportion of babies admitted to the neonatal intensive care unit (NICU) were similar in both groups. CONCLUSIONS: Higher IGT prevalence in PCOS patients might be related to maternal obesity and excess gestational weight gain and does not affect perinatal outcome.     

The effect of third-trimester glycemic control on maternal and perinatal morbidities in pregestational diabetes mellitus.

From May 1974 to March 1989, 48 cases of pregestational diabetes mellitus treated during the third trimester of pregnancy at the Obstetric Clinic of the National Taiwan University Hospital had complete maternal-fetal chart, and were enrolled into this retrospective review. Of these cases, 28 were class B, 13 were class C and seven were class D-R. The maternal complications and perinatal morbidities of each class were reviewed. The mean fasting, postprandial plasma glucose concentrations and the mean excursion of plasma glucose levels were calculated for statistical analysis. Among the maternal complications, urinary tract infections and preterm labor were significantly associated with mean fasting plasma glucose concentrations. Among perinatal morbidities, neonatal respiratory distress and metabolic problems (including neonatal hyperbilirubinemia, symptomatic hypoglycemia, hypocalcemia and polycythemia) were significantly associated with mean plasma fasting glucose concentrations, and perinatal asphyxia was associated with a mean excursion of plasma glucose levels. In view of the paucity of knowledge about the etiology of complications in diabetic pregnancies, it is necessary to conduct a prospective multi-center study with well-characterized morbidities to search for the role of glycemic control in obstetric and perinatal complications.     

Impaired Glucose Tolerance in Pregnancy - Is It of Consequence?

Summary: This study was done to determine if impaired glucose tolerance in pregnancy was associated with increased maternal and neonatal morbidity and if so, whether the increased morbidity was due to the confounding factors of increased maternal age and maternal obesity. It was a retrospective analysis to compare 944 women with impaired glucose tolerance (IGT) in pregnancy with 10,065 women without abnormal glucose tolerance. The incidence of impaired glucose tolerance in pregnancy was 8.6% in this study. Even when maternal age and obesity were excluded, the IGT group had significantly higher risks of labour induction (relative risk, RR, 1.15); Caesarean section (RR: overall 1.43, elective 1.72, emergency 1.31); Caesarean section for dystocia/no progress (RR 1.60); macrosomia (RR 1.69,1.76,1.61 for birth-weight =97th, 95th, 90th percentiles respectively) and shoulder dystocia (RR 2.84) when compared to the nondiabetics (NDM). The risks of hypertensive disease (RR 1.22) and Caesarean section for fetal distress/thick meconium-stained liquor (RR 1.53) were also higher in the IGT group but these increases were not statistically significant when maternal age and obesity were excluded. There was no significant difference in the rates of low Apgar scores at 1 and 5 minutes between the 2 groups.     

Intrauterine growth restriction and pregnancy outcome

AIM: This prospective study was performed to evaluate perinatal outcome and maternal risk factors in pregnancies complicated by fetal intrauterine growth restriction (IUGR). METHODS: A total of 3 537 women pregnant with a singleton gestation were enrolled in the study: 219 of these pregnancies were complicated by fetal growth restriction (6.2%). Statistical analysis was performed using Wilcoxon test, Kruskall-Wallis test, c2 analysis of variance and ANOVA test. Statistical significance was set at P-value <0.05. Correlations were calculated by Spearman's coefficient. RESULTS: Ethnic group, physical demanding work, maternal smoking, alcohol abuse do not seem to be associated with lower birth weight and worse Apgar score. Sonographic assessment of fetal weight obtained by Hadlock's formula underestimate real newborn's weight. The difference between estimate weight and real weight is statistically significant. Women with intrauterine growth restriction underwent caesarean sections more often than women with appropriate fetal growth selected as controls (P<0.05). CONCLUSION: In conclusion, the obstetrician must recognize and accurately diagnose inadequate fetal growth and attempt to determine its cause (especially placental factors) in order to reduce fetal and maternal risks and establish the appropriate clinical management, timing and mode of delivery. If the growth-restricted fetus is identified and appropriate management instituted, perinatal mortality can be reduced.     

The effects of adjuvant insulin therapy among pregnant women with IGT who failed to achieve the desired glycemia levels by diet and moderate physical activity

Objective: Evaluation of adjuvant insulin therapy effects on glycemic control, perinatal outcome and postpuerperal glucose tolerance in impaired glucose tolerance (IGT) pregnant women who failed to achieve desired glycemic control by dietary regime. Methods: A total of 280 participants were classified in two groups: Group A patients continued with dietary regime and Group B patients were treated with adjuvant insulin therapy. Glycemic control was assessed by laboratory and ultrasonograph means. Pregnancy outcomes were evaluated by prevalence of pregnancy induced hypertension (PIH), high birth weight, neonatal hypoglycemia and caesarean section rates. Postpuerperal glucose tolerance was assessed by oral glucose tolerance test (oGTT). Results: All laboratory and ultrasound indicators of glycemic control had significantly lower values in Group B. Group A women were more likely to develop the EPH (Edema, Proteinuria, Hypertension) syndrome, 20% versus 7.86% (p?=?0.003). High birth weight occurred more frequently in Group A, but the difference was not significant (p?=?0.197). Higher rate of caesarean delivery was in Group A than in Group B, 16.43% versus 26.43% (p?=?0.041). The difference in neonatal hypoglycemia was not significant (p?=?0.478). Pathological oGTT results were observed in 73 Group A patients and in 15 Group B patients. Conclusion: Lower caesarean section rates and the EPH syndrome incidence are the benefits of adjuvant insulin therapy in IGT patients.     

Preterm Prelabour Rupture of Membranes With Cervical Cerclage: A Review of Perinatal Outcomes With Cerclage Retention

Cervical cerclage may be indicated in specific clinical situations in an attempt to reduce the risk of preterm delivery. Preterm prelabour rupture of membranes (PPROM) occurs sometimes in the presence of a cerclage, and these pregnancies are at substantial risk of adverse maternal, fetal, and neonatal outcomes that may be attributed to complications associated with infectious morbidity and preterm birth. The benefits of retaining a cerclage in situ with ruptured membranes are unclear. This systematic review identified studies estimating maternal and perinatal morbidity and mortality associated with pregnancies with cerclage complicated by PPROM, in order to clarify the consequences of cerclage retention.     

The outcome of triplet versus twin pregnancies

OBJECTIVE: The purpose of this study was to examine and to determine whether triplet pregnancies are associated with a significantly greater risk of adverse outcome than are twin pregnancies. METHODS: Maternal and perinatal outcomes were evaluated retrospectively in 41 sets of triplets and twin pregnancies that were matched for maternal age, parity, mode of delivery, preterm delivery, mode of conception, and antepartum complications. MAIN OUTCOME MEASURES: Perinatal outcome in triplet versus twin gestation. RESULTS: Triplets had a significantly lower mean average birth weight than in twin gestation (1,596 vs. 2,317 g, p<0.018) and gestational age at delivery (32.9 vs. 35.9 weeks; p< 0.03). Preterm labour occurred significantly more often in triplet than in twin gestation (80.5 vs. 41.5%) as did preterm delivery (87.8 vs. 46.2%). Triplets required a longer hospital stay than did twins (25 vs. 9 days; p<0.04). There were no significant differences between the groups in number of administrations to the Special Care Baby Unit (32.5 vs. 30.5%). Apgar score <7 at 5 min was significantly more in triplet as compared with twin gestation (17 vs. 6%; p<0.0015). Neonatal deaths occurred significantly more in triplets than in twins (26 vs. 8.5%; p< 0.0001). There were no significant differences between the groups in maternal antepartum or neonatal complications such as anaemia, pregnancy-induced hypertension, placental abruption, respiratory distress syndrome or intraventricular haemorrhage. Preterm labour was the only complication that occurred significantly more often in the triplet than in the twin gestation. CONCLUSIONS: We concluded that this information could be useful in counseling patients with respect to the anticipated perinatal outcome of triplet pregnancies.     

Perinatal outcome in 41 sets of triplets

OBJECTIVE: To determine the perinatal outcome associated with triplet pregnancies and to compare abdominal delivery with vaginal delivery. METHODS: Retrospective analysis of maternal and neonatal medical records of 41 triplets. 21 were delivered vaginally and 20 were delivered by cesarean section. MAIN OUTCOME: To measure perinatal mortality and early neonatal complications. RESULTS: Between January 1, 1994, and June 30, 1999, there were 41 triplets delivered at our institution. Of these 21 triplets were delivered vaginally and 20 triplets were delivered abdominally. The perinatal mortality rate was 32/123 (26.0%), primarily due to the respiratory distress syndrome. The perinatal deaths are mainly at a birth weight of 500-1,500 g (29/32; 90.6%). Breech presentation was associated with a significantly higher perinatal mortality rate than vertex presentation (62.5 vs. 37.5%). Cesarean delivery was associated with a higher perinatal mortality rate than vaginal delivery (30.0 vs. 22. 2%). CONCLUSIONS: Abdominal delivery in triplets is not superior to vaginal delivery in terms of fetal and early neonatal outcome. The perinatal deaths are increased with low birth weight (500-1,500 g) and with breech presentation. The main cause of neonatal mortality is the respiratory distress syndrome.     

Evaluation of the neonatal status from pregnancies complicated by PROM or oligohydramnios in smoking women

OBJECTIVES: The aim of the study was analysis of neonatal status from pregnancies complicated oligohydramnios and from pregnancies complicated premature rupture of the membranes (PROM). MATERIALS AND METHODS: Authors analyzed 15 newborns from pregnancies with oligohydramnios diagnosed and 15- from pregnancies complicated PROM. Mothers of these newborns smoked cigarettes or were exposed to tobacco smoke. The features taken into consideration was prematurity, hypotrophy, malformations, birth weight, Apgar scale gained by newborns in first minutes after delivery. RESULTS AND CONCLUSIONS: The higher perinatal mortality, more frequent occurrence of hypotrophy and malformations were shown in newborns from pregnancies complicated oligohydramnios. The most frequent developmental anomaly was defect of nervosal system. Status of newborns from PROM pregnancies was getting better in according to lengthening duration of gestation. It wasn't stated in case of pregnancies with oligohydramnios complications.     

Perinatal outcome in triplet versus twin gestations

The present study was conducted to determine whether triplet pregnancies are associated with a significantly worse perinatal outcome than twin pregnancies. Maternal and neonatal outcome was evaluated in 15 triplet and twin pregnancies that were matched for maternal age, race, type of medical insurance, delivery mode, parity, and history of previous preterm delivery. Preterm labor occurred significantly more often in triplet than in twin gestations (80 versus 40%), as did preterm delivery (87 versus 26.7%). Triplets had a significantly lower mean birth weight (1720 versus 2475 g) and gestational age at delivery (33 versus 36.6 weeks). In addition, 53.3% of triplet pregnancies but only 6.7% of twin pregnancies had one or more neonates with intrauterine growth retardation. Discordancy also occurred more frequently in triplets than in twins (66.7 versus 13.3%). The mean averaged neonatal hospital stay was significantly higher in triplets (29 versus 8.5 days), and triplets had a fivefold increased risk of requiring neonatal intensive care as compared with twins. However, there were no significant differences between the groups in maternal morbidity or major neonatal complications such as respiratory distress syndrome or intraventricular hemorrhage. We believe that these data will be useful in counseling patients with respect to the anticipated perinatal outcome of triplet pregnancies.     

Maternal and neonatal outcomes after attempted suicide

OBJECTIVE: The purpose of this study was to describe identifiers and estimate maternal and neonatal outcomes in women who attempt suicide during pregnancy. METHODS: A linked Vital Statistics-Patient Discharge database of the State of California was used to identify cases of intentional injury during pregnancy. A retrospective analysis of maternal and neonatal outcomes in pregnant women who were admitted for attempted suicide is presented. RESULTS: There were 4,833,286 deliveries in California from 1991 to 1999. Of those deliveries, 2,132 were complicated by attempted suicide during pregnancy (0.4 per 1,000 pregnancies). The control population was composed of patients who did not attempt suicide. The group of women that attempted suicide during pregnancy had increases in premature labor, cesarean delivery, and need for blood transfusion. Analysis of neonatal outcomes revealed increases in respiratory distress syndrome and low birth weight infants. A subanalysis, including women who delivered at the hospitalization for attempted suicide, demonstrated increased premature delivery, respiratory distress syndrome, and neonatal and infant death. CONCLUSION: Attempted suicide is associated with significantly higher rates of maternal and perinatal morbidity, and in some cases, perinatal mortality. The best identifier for women at risk for attempting suicide is substance abuse. Care provider identification and prevention are of key importance in preventing these outcomes.     

Cesarean delivery for twins: a systematic review and meta-analysis

OBJECTIVE: We undertook a systematic review and meta-analysis to determine whether a policy of planned cesarean section or vaginal delivery is better for twins. STUDY DESIGN: We searched MEDLINE and EMBASE from 1980 through May 2001 using combinations of the following terms: twin, delivery, cesarean section, vaginal birth, birth weight, and gestational age. Studies that compared planned cesarean section to planned vaginal birth for babies weighing at least 1500 g or reaching at least 32 weeks' gestation were included. We computed pooled odds ratios for perinatal or neonatal mortality, low 5-minute Apgar score, neonatal morbidity, and maternal morbidity. The infant was the unit of statistical analysis. Results were considered statistically significant if the 95% CI did not encompass 1.0. RESULTS: We retrieved 67 articles, 63 of which were excluded. Four studies with a total of 1932 infants were included in the analysis. A low 5-minute Apgar score occurred less frequently in twins delivered by planned cesarean section (odds ratio, 0.47; 95% CI, 0.26-0.88) principally because of a reduction among twins if twin A was in breech position (odds ratio, 0.33; 95% CI, 0.17-0.65). Twins delivered by planned cesarean section spent significantly longer in the hospital (mean difference, 4.01 days; 95% CI, 0.73-7.28 days). There were no significant differences in perinatal or neonatal mortality, neonatal morbidity, or maternal morbidity. CONCLUSION: Planned cesarean section may decrease the risk of a low 5-minute Apgar score, particularly if twin A is breech. Otherwise, there is no evidence to support planned cesarean section for twins.     

Insulin glargine versus neutral protamine Hagedorn insulin for treatment of diabetes in pregnancy

We compared maternal and neonatal outcomes in diabetic pregnancies treated with either insulin glargine or neutral protamine Hagedorn (NPH) insulin. We performed a retrospective chart review of diabetic pregnant patients using the Diabetes Care Center of Wake Forest University during the years 2000 to 2005. Outcomes of interest included maternal hemoglobin A1C, average fasting and 2-hour postprandial blood sugars, mode of delivery, birth weight, 5-minute Apgar score < 7, umbilical artery pH < 7.20, incidence of neonatal hypoglycemia, and pregnancy complications. A total of 52 diabetic pregnant patients were included in this study. Twenty-seven women used insulin glargine. A total of 13 women used insulin glargine during the first trimester. Glycemic control was similar in women who used NPH insulin and insulin glargine, as determined by hemoglobin A1C levels and mean blood sugar values. There were no differences in mode of delivery, average birth weight, or neonatal outcomes. Maternal and fetal/neonatal outcomes appear similar in pregnant diabetic women who use either NPH insulin or insulin glargine in combination with a short-acting insulin analogue to achieve adequate glycemic control during pregnancy. Insulin glargine appears to be an effective insulin analogue for use in women whose pregnancies are complicated by diabetes.     

Perinatal outcome in growth retarded pregnancies dated by ultrasound

To analyse the incidence of fetal growth retardation and its impact on perinatal mortality and neonatal morbidity, pregnancies complicated by intra-uterine growth retardation (IUGR) were compared with matched non-IUGR pregnancies. The IUGR group included all infants born in the city of Malm? during the study period and having a birthweight of 2 standard deviations or more below the mean birthweight for gestational age. The gestational age of all pregnancies was assessed with ultrasound in the first half of pregnancy. The IUGR fetuses were more vulnerable during delivery, and emergency cesarean section due to imminent fetal asphyxia was performed more frequently, but Apgar scores were similar in both groups. The frequency of respiratory disorders was lower in the IUGR group than in the non-IUGR group when corticosteroid-treated pregnancies were excluded. The IUGR group required slightly longer care on the neonatal ward than the non-IUGR group, but not more intervention. The IUGR group as a whole had an unexpectedly low neonatal complication rate, such complications as did occur being related to preterm birth rather than to growth retardation.     

Incidence,obstetric risk factors and pregnancy outcome of preterm placental abruption: a retrospective analysis

Objective: To determine obstetric risk factors for the occurrence of preterm placental abruption and to investigate its subsequent perinatal outcome. Study design: A retrospective comparison of all singleton preterm deliveries complicated with placental abruption, between the years 1990-1998, to all singleton preterm deliveries without placental abruption, in the Soroka University Medical Center. Results: Placental abruption complicated 300 (5.1%) of all preterm deliveries (n = 5934). A back-step multivariable analysis found the following factors to be independently correlated with the occurrence of preterm placental abruption: grandmultiparity (more than five deliveries), early gestational age, severe pregnancy-induced hypertension, previous second-trimester bleeding and non-vertex presentation. These pregnancies had a significantly lower rate of preterm premature rupture of membranes than preterm pregnancies without placental abruption. Pregnancies complicated with preterm placental abruption had significantly higher rates of cord prolapse, non-reassuring fetal heart rate patterns, congenital malformations, Cesarean deliveries, perinatal mortality, Apgar scores lower than 7 at 5 min, postpartum anemia and delayed discharge from the hospital than did preterm deliveries without placental abruption. In order to assess whether the increased risk for perinatal mortality was due to the placental abruption, or due to its significant association with other risk factors, a multivariable analysis was constructed with perinatal mortality as the outcome variable. Placental abruption (OR 3.0, 95% CI 2.1-4.1) as well as cord prolapse, previous perinatal death, low birth weight and congenital malformations were found to be independent risk factors for perinatal mortality. Conclusion: Preterm placental abruption is an unpredictable severe complication associated with significant perinatal morbidity and mortality. Factors found to be independently associated with placental abruption were grandmultiparity, severe pregnancy-induced hypertension, malpresentation, earlier gestational age and a history of second-trimester vaginal bleeding.     

The Neonatal Implications of a High Placental Ratio in Small-for-Gestational Age Infants

An increased placental ratio has been associated with small-for-gestational age (SGA) infants. A retrospective study on 252 singleton SGA infants without major anomalies born within a 1-year period was performed to determine the relationship between placental ratio and maternal/infant characteristics, and perinatal complications. The cases were categorized into three groups according to the placental ratio (<1 sd below the mean, within 1 sd of the mean, >1 sd above the mean) based on our previous data. There were more infants with a high ratio (32.9 per cent) than with a low ratio (15.5 per cent). While there was no difference in the maternal characteristics or antenatal complications, there was a significant trend in decreasing birthweight and an increasing placental weight in relation to an increasing placental ratio. The infants with a high ratio had increased incidence of meconium stained liquor, hypocalcaemia, hypomagnesaemia and phototherapy, a trend that was consistent even after exclusion of the preterm infants. Our data indicated that a high placental ratio in SGA infants was due to both increased placental size and decreased birthweight, and this was associated with increased neonatal morbidity.     

Does marriage between first cousins have any predictive value for maternal and perinatal outcomes in pre-eclampsia?

AIM: To assess the consequences of consanguineous unions between first cousins on the severity of pre-eclampsia and associated perinatal morbidity. METHODS: Six hundred and eighty-six women admitted with a diagnosis of pre-eclampsia were included. The study group consisted of 62 preeclamptic women with a union between first cousins. The remaining patients admitted throughout the same period (n = 624) served as controls. The groups were compared regarding the presence of severe pre-eclampsia, hemolysis elevated liver enzymes low platelets (HELLP) syndrome, eclampsia, placental abruption, hematological complications, renal failure, requirement for antihypertensive or magnesium sulfate treatments, cesarean section for acute fetal distress, birthweight, Apgar scores, perinatal mortality and neonatal morbidity including admission to the neonatal intensive care unit, respiratory distress syndrome, sepsis, convulsions, intracranial hemorrhage, hypoglycemia, hypocalcemia, and jaundice. Student's t-test, chi(2)-test and logistic regression analysis were used for statistical evaluation. RESULTS: Univariate analysis yielded significant differences in parity (P = 0.034), maternal platelet counts (P = 0.02), and maternal serum potassium levels (P = 0.016) among the groups. Respiratory distress syndrome was more frequent (P = 0.043) in infants of unrelated couples. Multivariate analysis, controlling for the confounding factors, revealed that marriages between first cousins had no effect on any of our outcome variables including neonatal respiratory distress syndrome. CONCLUSIONS: Third-degree consanguinity in terms of a union between first cousins seems to have no effect on the development of maternal and perinatal complications in established pre-eclampsia.