Adverse maternal and neonatal outcomes in women with preeclampsia in Iran

Background: Preeclampsia is relatively a common complication in pregnancy and is characterized by high blood pressure and protein in urine during pregnancy. Consistent with the adverse outcomes followed by preeclampsia, this study designed to investigate the how preeclampsia is associated with preterm, low birth weight (LBW), cesarean section, and weigh gain during pregnancy.

Methods: In this population-based cross-sectional study, 5166 deliveries from 103 hospitals in Tehran (Capital of Iran) were included in the analysis in 2015. The independent variable was preeclampsia during pregnancy and weight gain during pregnancy, preterm birth, cesarean section, and LBW were considered as interested outcomes. The data were analyzed by statistical Stata software (version 13, Stata Inc., College Station, TX).

Results: Adjusted results showed that the mean of weight gain in women with preeclampsia was significantly higher than women without preeclampsia (mean difference: 1.77?kg, 95%CI: 0.76–12.78, p?=?.001). The adjusted odds ratio for preterm birth, cesarean section, and LBW were 4.19 (95%CI: 2.71–6.48, p?=?.001), 1.92 (95%CI: 1.24–2.98, p?=?.003), and 1.19 (95%CI: 0.61–2.31, p?=?.599), respectively.

Conclusion: Weight gain in women with preeclampsia was higher than women without preeclampsia and also the odds of preterm birth, cesarean section and LBW in women with preeclampsia was higher than women without preeclampsia.     

Maternal asthma: pregnancy course and outcome

Objective: To evaluate the association between maternal asthma and perinatal outcome.

Study design: In this retrospective population-based cohort study, all pregnancies between 1991 and 2014 in a tertiary medical center, were included. Multiple pregnancies and congenital malformations were excluded. Pregnancy course and outcomes were compared between women with and without asthma, and multivariable generalized estimating equations were used to control for confounders.

Results: During the study period, 243,363 deliveries met the inclusion criteria, 1.35% of which (n?=?3283) occurred in women diagnosed with asthma. Multiple perinatal complications were found to be associated with maternal asthma, including hypertensive disorders, preterm delivery, and cesarean delivery. However, no significant differences between the groups were noted in neonatal outcomes, including perinatal mortality rates and low Apgar scores. In the regression model, maternal asthma was noted as an independent risk factor for preterm delivery, hypertensive disorders of pregnancy, and cesarean delivery (aOR?=?1.21, 95%CI 1.1–1.4, p?=?.007; aOR?=?1.35, 95%CI 1.2–1.6, p?p?Conclusions: Maternal asthma is associated with an increased risk for adverse pregnancy outcome. This association remains significant while controlling for variables considered to coexist with maternal asthma. Nevertheless, perinatal outcome is generally favorable.     

Pulmonary edema in preeclampsia: an Indonesian case–control study

Objective: To analyze risk factors, obstetric outcome and the need for mechanical ventilation in preeclampsia complicated by pulmonary edema.

Materials and methods: Case–control study using medical record on preeclampsia complicated by pulmonary edema patients in East Java tertiary referral hospital over 2?years. A simple scoring system was developed to predict the need for mechanical ventilation, using logistic regression.

Results: 1106 cases of preeclampsia were admitted, with 62 cases (5.6%) had pulmonary edema. Postpartum (p?p?=?.001) proportions were higher in the preeclampsia with pulmonary edema group. Of the 62 cases with pulmonary edema, 81% required intensive care admission and 60% needed mechanical ventilation support. Mechanical ventilation used was associated with eclampsia (p?=?.04), hypertensive crisis (p?=?.02), lower serum albumin (p?=?.05) and higher creatinine (p?=?.01). A simple scoring model developed could predict a 46%–99% probability of need for mechanical ventilation (AUC (ROC): 0.856, 95%CI 0.763–0.95).

Conclusions: Pulmonary edema is a common complication of preeclampsia in Indonesian referral hospitals. This severe complication increased maternal and perinatal morbidity and mortality. The developed scoring model in this study can be used as a triage tool to predict the probability of mechanical ventilation use due to this complication.     

The association between maternal race and adverse outcomes in twin pregnancies with similar healthcare access

Objective: To compare twin pregnancy outcomes between white and nonwhite women with similar access to health care.

Methods: Retrospective cohort study of all twin pregnancies delivered by a single maternal–fetal medicine practice from 2005–2016. All patients had private health insurance and equal access to physician care. Outcomes were compared between white and nonwhite women using logistic regression to adjust for differences at baseline.

Results: Of the 858 women included, 730 (85.1%) were white and 128 (14.9%) were nonwhite. Univariate analysis demonstrated that nonwhite women had higher rates of preterm birth <32 weeks (12.5 versus 6.7%, p?=?.022), cesarean delivery (78.1% versus 61.4% of all women, p?p?p?=?.029) and gestational diabetes (23.2% versus 7.3%, p?Conclusions: Nonwhite women with twin pregnancies have an increased risk of adverse outcomes that cannot be explained by access to care. Although improving access to care is an important goal for health care systems, our data suggest that this alone will not eliminate all disparities in health care outcomes between women of different races.     

Intrapartum fever and the risk for perinatal complications – the effect of fever duration and positive cultures

Objective: To estimate the association between intrapartum fever and adverse perinatal outcome.

Methods: A retrospective cohort study of women attempting vaginal delivery at term in a tertiary hospital (2012–2015). Perinatal outcome of deliveries complicated by intrapartum fever (≥38.0?°C) were compared to women with no intrapartum fever matched by parity and gestational age at delivery in a 1:2 ratio. Maternal outcome included cesarean section (CS), operative vaginal delivery (OVD), retained placenta or post-partum hemorrhage. Neonatal outcome included 5-minute Apgar score <7, umbilical artery pH <7.1, meconium aspiration syndrome, need for mechanical ventilation or hypoxic ischemic encephalopathy.

Results: Overall, 309 women had intrapartum fever and 618 served as controls. Women with intrapartum fever had higher rates of OVD (34.3 versus 19.6%, p?p?p?p?p?=?.01).

Conclusions: Intrapartum fever was associated with adverse perinatal complications. The duration of intrapartum fever, maternal bacteremia, and positive cultures further increase this risk.     

Vaginal delivery among women who underwent labor induction with vaginal dinoprostone (PGE2) insert: a retrospective study of 1656 women in China

Objective: This study aimed to qualify relevant factors for vaginal delivery among women who underwent labor induction with vaginal dinoprostone (PGE2) insert in a Chinese tertiary maternity hospital.

Material and methods: A retrospective study was conducted in Hubei Maternal and Child Health Hospital. A total of 1656 pregnancies that underwent labor induction with vaginal dinoprostone insert between January and August 2016 were finally included in this study. Data were analyzed using univariate and multivariable regression modeling.

Results: Of 1656 women with PGE2-induced labor at term, 396 (23.91%) gave birth by cesarean section, 1260 (76.09%) had a vaginal delivery among which 921 (55.61%) delivered vaginally within 24?h. Multivariable regression analysis showed that maternal age (p?p?p?=?.009, OR = 0.98, 95%CI 0.96–0.99), and birth weight (p?p?p?p?=?.004, OR = 0.96, 95%CI 0.94–0.99), and birth weight (p?Conclusions: Our findings suggested a vaginal delivery rate of 76.09% when dinoprostone vaginal insert was used for labor induction, which was markedly higher than the overall annual vaginal delivery rate of 65.1% in China during 2014. Maternal age, parity, baseline fetal heart rate, and birth weight were significant factors for vaginal delivery. This study enables us to better understand the efficiency of dinoprostone and the potential predictors of vaginal delivery in dinoprostone-induced labor, which may be helpful to guide the clinical use of dinoprostone and therefore provide better service clinically.     

Analysis of preventability of hypertensive disorder in pregnancy-related maternal death using the nationwide registration system of maternal deaths in Japan

Objective: Hypertensive disorder of pregnancy (HDP) is a major cause of maternal death. The goal of this study was to investigate factors associated with maternal death due to HDP.

Study design: HDP-related maternal deaths in Japan reported to the Committee of the Ministry of Health, Labor and Welfare from 2010 to 2015 were examined.

Results: Out of 47 cases of HDP, 30 were identified as the major cause of maternal death. The median maternal age was 34 years (range 24–45) and the mortality in women aged ≥40 years was seven times higher that than in women aged <34 years. The etiologies were intracerebral hemorrhage (n?=?22), subarachnoid hemorrhage (n?=?3), subcapsular hematoma of the liver (n?=?2), peripartum cardiomyopathy (n?=?2), and eclampsia (n?=?1), and 19 cases were deemed preventable. The most frequent antepartum problems were delays in hospitalization, maternal transfer, and termination of pregnancy. In four cases, diagnosis of HELLP syndrome was too late because laboratory data were not checked, despite the patient reporting epigastric pain or showing elevation of blood pressure (BP). Treatment for lowering of BP was improper in 2/3 intrapartum cases, even though BP was elevated during pregnancy (144 versus 188?mmHg, p?p?p?p?p?Conclusion: HDP accounts for 11% of maternal deaths in Japan. Mothers aged ≥40 years are most at risk for HDP-related maternal death. Major concerns for preventabilities were late hospitalization, maternal transportation, and termination of pregnancy for term or near-term HDP. Regular vital checks and prompt lowering of BP were lacked during labor in most cases. HELLP syndrome should be managed at a general hospital with sufficient medical resources.     

Maternal obesity is associated with chorioamnionitis and earlier indicated preterm delivery among expectantly managed women with preterm premature rupture of membranes

Objective: To determine the association between maternal obesity and delivery due to chorioamnionitis prior to labor onset, among expectantly managed women with preterm premature rupture of membranes (pPROM).

Methods: This was a secondary analysis of a multicenter randomized trial of magnesium sulfate versus placebo to prevent cerebral palsy or death among offspring of women with anticipated delivery at 24–31-week gestation. After univariable analysis, Cox proportional hazard evaluated the association between maternal obesity and chorioamnionitis, while Laplace regression investigated how obesity affects the gestational age at delivery of the first 20% of women developing the outcome of interest.

Results: A total of 164 of the 1942 women with pPROM developed chorioamnionitis prior to labor onset. Obese women had a 60% increased hazard of developing such complication (adjusted HR 1.6, 95%CI 1.1–2.1, p?=?.008), prompting delivery 1.5 weeks earlier, as the 20th survival percentile was 27.2-week gestation (95%CI 26–28.6) among obese as opposed to 28.8 weeks (95%CI 27.4–30.1) (p?=?.002) among nonobese women.

Conclusions: Maternal obesity is a risk factor for chorioamnionitis prior to labor onset. Future studies will determine if obesity is important enough to change the management of latency after pPROM according to maternal BMI.     

A first trimester prediction model for gestational diabetes utilizing aneuploidy and pre-eclampsia screening markers

Objective: We examined whether first trimester aneuploidy and pre-eclampsia screening markers predict gestational diabetes mellitus (GDM) in a large multi-ethnic cohort and the influence of local population characteristics on markers.

Methods: Clinical and first trimester markers (mean arterial pressure (MAP), uterine artery pulsatility index (UtA PI), pregnancy associated plasma protein A (PAPP-A), free-β human chorionic gonadotropin (free-hCGβ)) were measured in a case-control study of 980 women (248 with GDM, 732 controls) at 11 to 13?+?6 weeks’ gestation. Clinical parameters, MAP-, UtA PI-, PAPP-A-, and free-hCGβ-multiples-of-the-median (MoM) were compared between GDM and controls; stratified by ethnicity, parity, and GDM diagnosis?<24 versus?≥24 weeks’ gestation. GDM model screening performance was evaluated using AUROC.

Results: PAPP-A- and UtA PI-MoM were significantly lower in GDM versus controls (median ((IQR) PAPP-A-MoM 0.81 (0.58–1.20) versus 1.00 (0.70–1.46); UtA PI-MoM 1.01 (0.82–1.21) versus 1.05 (0.84–1.29); p?p?Conclusions: Addition of aneuploidy and pre-eclampsia markers is cost-effective and enhances early GDM detection, accurately identifying early GDM, a high-risk cohort requiring early detection, and intervention. Ethnicity and parity modified marker association with GDM, suggesting differences in pathophysiology and vascular risk.     

Maternal and neonatal outcomes associated with infertility

Objective: To investigate perinatal outcomes in a cohort of fertile and infertile nulliparous women.

Design: Retrospective cohort study.

Setting: Academic medical center.

Patients: All nulliparous women delivering singletons ≥24-week gestation at our center from 1 January 2012 to 31 December 2012 were included. Women were classified into two groups – fertile and infertile – based on a chart review at the time of delivery.

Outcome measure: Perinatal outcomes of interest included mode of delivery, gestational age at delivery, and birth weight.

Results: A total of 3293 mother/infant dyads fulfilled the inclusion criteria. Of these, 277 women (8.4%) were classified as infertile. Infertile women were significantly older than fertile women. In bivariate analyses, infertile women were more likely to undergo cesarean delivery (51.8 versus 36.1%, p?p?β coefficient ?0.42, 95%CI ?0.64, ?0.2). There was no difference in infant birth weight. Late preterm deliveries (34–36 completed gestational weeks) accounted for 8.3% of deliveries for infertile women compared to 4.3% for fertile women (p?=?.032).

Conclusions: We conclude that the increased risk of cesarean section associated with infertility is driven by maternal age. Late preterm infants represent a key cohort for further evaluation in the perinatal outcomes of infertile women.     

Fetal hydrops and the risk of severe preeclampsia

Objective: To assess the incidence and severity of preeclampsia in pregnancies complicated by fetal hydrops.

Methods: We performed a retrospective cohort study of singleton gestations from 2005 to 2008 in California. The primary predictor was fetal hydrops and the primary outcome was preeclampsia. Selected adverse maternal and neonatal events were assessed as secondary outcomes. Potential confounders examined included fetal anomalies, polyhydramnios, race/ethnicity, nulliparity, chronic hypertension, and gestational or pregestational diabetes mellitus.

Results: We identified 337 pregnancies complicated by fetal hydrops, 70.0% had a concomitant fetal anomaly and 39.8% had polyhydramnios. Compared to the general population, hydrops was associated with an increased risk for severe preeclampsia (5.26 versus 0.91%, p?p?=?.29). In multivariable analysis, fetal hydrops remained an independent risk factor for severe preeclampsia (as adjusted odds ratios (aOR) 3.13, 1.91–5.14). Hydrops was also associated with increased rates of eclampsia, acute renal failure, pulmonary edema, postpartum hemorrhage, blood transfusion, preterm birth, and neonatal death.

Conclusions: We find that fetal hydrops is an independent risk factor for severe preeclampsia. In light of serious concerns for maternal and neonatal health, heightened surveillance for signs and symptoms of severe preeclampsia is warranted in all pregnancies complicated by fetal hydrops.     

The impact of maternal epilepsy on perinatal outcome in singleton gestations

Objective: We sought to evaluate perinatal outcomes in women with epilepsy.

Methods: We performed a retrospective cohort study between 2007 and 2014, at a tertiary, university-affiliated medical center. All women with singleton gestation who delivered during the study period were included, except for pregnancies in which fetuses with chromosomal or structural anomalies were diagnosed. Perinatal outcome was compared between two groups: women diagnosed with epilepsy and women without epilepsy.

Results: Out of 62,102 deliveries during the study period, 61,455 met the inclusion criteria, of whom 206 (0.3%) had epilepsy. The only difference found in maternal demographics was higher rate of nulliparity in the epilepsy group (p?=?.02). As for maternal adverse outcome, higher rates of placental abruption and longer postpartum admission were found in women with epilepsy (p?=?.02 and p?p?p?=?.02), neonatal intensive care unit (NICU) admissions (OR 1.84, 95%CI 1.25–2.70, p?=?.002), seizures (OR 4.33, 95%CI 1.60–11.77, p?=?.004), transient tachypnea of the newborn (OR 2.47, 95%CI 1.005–6.05, p?=?.049) and respiratory distress syndrome (OR 7.16, 95%CI 2.47–20.76, p?Conclusions: Epilepsy in pregnant women is associated with adverse perinatal outcomes, including neonatal seizures, placental abruption and respiratory problems.     

The risk of preterm birth associated with a low cerebroplacental ratio

Objective: This paper investigated whether a cerebroplacental ratio (CPR)?Methods: This was a retrospective cohort study of 8977 women during 2014 and 2015 at a major tertiary referral hospital. Selection criteria included women who had a nonanomalous, singleton fetus and underwent an ultrasound scan between 23?+?0–36?+?6 weeks gestation.

Results: A low CPR increased the risk of preterm birth or birth within 2 weeks of the scan with the highest odds of birth within 2 weeks seen at 28-week gestation (odds ratio (OR) 3.78, 95%CI 1.63–8.77) – the mode of delivery was most likely emergency caesarean section for nonreassuring fetal status (aOR 2.11, 95%CI 1.69–2.64, p?p?Conclusions: A low CPR is associated with an increased risk of preterm birth and birth within 2 weeks but not spontaneous preterm birth.     

Outpatient versus inpatient management for superimposed preeclampsia without severe features: a retrospective,multicenter study

Purpose: To determine if women with preterm superimposed preeclampsia without severe features can be successfully and safely triaged to outpatient management.

Materials and methods: This was a multicenter, retrospective, cohort study of singleton pregnancies with superimposed preeclampsia without severe features diagnosed before 37?weeks managed outpatient versus inpatient at Thomas Jefferson University (Philadelphia, PA) and at University of Naples (Naples, Italy) from January 2008 to July 2015. The attending physician made the decision to manage outpatient or inpatient at his or her discretion. The primary outcome was composite maternal morbidity defined as development of at least one of the following: severe features, HELLP syndrome, placental abruption, eclampsia, postpartum hemorrhage, intensive care unit admission, or maternal death. Logistic regression, presented as adjusted odds ratio (aOR) with the 95% of confidence interval (CI) was performed.

Results: A total of 365 women with superimposed preeclampsia without severe features before 37?weeks were analyzed. 198 (54.2%) were managed outpatient, and 167 (45.8%) were managed inpatient. Women managed as outpatients had a similar rate of maternal morbidity compared to those managed as inpatients (36.4% versus 41.3%, aOR 0.82, 95%CI 0.55–1.17). Fetuses from women in the outpatient group had a significantly lower risk of small for gestational age (17.7% versus 29.3%; aOR 0.53, 95%CI 0.30–0.84), and lower risk of admission to neonatal intensive care unit (40.4% versus 47.9%; aOR 0.72, 95%CI 0.39–0.95) compared to women managed as inpatients.

Conclusions: Low risk women with superimposed preeclampsia without severe features can be triaged to outpatient management without increased maternal morbidity.     

Linear association between maternal age and need of medical interventions at delivery in primiparae: a cohort of 21,235 singleton births

Objectives: We sought to investigate the potential association between maternal age and the need for active obstetrical intervention intrapartum in primiparas.

Study design: Observational study over 14 years (2001–2014) of all consecutive primiparous singleton births having delivered at the Centre Hospitalier Universitaire Hospitalier Sud Reunion’s maternity (French overseas department, Indian Ocean).

Results: Of the 21,235 singleton primiparous births, there were three significant linear associations between maternal age from 12 years of age to 42?+?(all χ² for linear trend, p?2), “heavy babies” (>3.5?kg), and ethnicity. Using maternal age remained significantly an independent risk factor (p?p?Conclusions: Increasing maternal age has a linear association with vaginal deliveries without any medical intervention, rate of cesarean sections, and rate of operative vaginal procedures. These associations are independent of maternal BMI and maternal height. We currently do not have a specific explanation why younger women appear to be protected from requiring intrapartum obstetric intervention. Nevertheless, these strong facts deserve acknowledgement and further research.     

The association of first trimester uterine arteries Doppler velocimetry with different clinical phenotypes of hypertensive disorders of pregnancy: a longitudinal study

Introduction: Current classification of hypertensive disorders of pregnancy (HDP) is mostly based on temporal classification differentiating HDP according to early and late onset of the disease. However, epidemiological and clinical data suggest that there are two different clinical phenotypes of HDP that coexist at any gestational age: HDP associated to intrauterine growth restriction (HDP-IUGR) and HDP associated to appropriate for gestational age fetal growth (HDP-AGAf). The aim of the study was to evaluate the association of first trimester uterine arteries (UtA) by Doppler velocimetry, and maternal risk factors with HDP according to two different classifications: one based on gestational age at delivery (early- and late-HDP), and one based on longitudinal ultrasound evaluation of fetal growth (HDP-IUGR and HDP-AGAf), independently of the gestational age.

Methods: Maternal characteristics and mean pulsatility index (PI) of UtA were collected at 11–13 gestational weeks. A longitudinal ultrasound follow-up of fetal growth in each trimester and clinical outcome were obtained in 4290 singleton pregnancies.

Results: UtA-PI was significantly higher in women who developed HDP-IUGR (n?=?22) and the odds ratio (OR) to develop HDP-IUGR from 25 to 39 weeks was 8.6 (p?n?=?112) was significantly associated with a higher BMI, multiparity, and maternal age, but not with UtA-PI (OR 1.3; p?=?.2). In women with an abnormal UtA-PI, the odds of developing early (n?=?15) and late-HDP (n?=?119) were 3.0 (p?=?.03) and 1.7 (p?=?.002), respectively. The AUCs for HDP-IUGR and early-HDP were 0.84 and 0.71, respectively.

Discussion: UtA Doppler velocimetry in the first trimester was strongly associated with HDP-IUGR all along gestation, as a proxy of placental insufficiency, and showed no association with HDP-AGAf. Our findings suggest an efficacy of first trimester UtA Doppler velocimetry to identify HDP-IUGR independently of the gestational age, and a limited value for HDP not associated with intrauterine growth restriction (IUGR).     

Aspirin or heparin or both in the treatment of recurrent spontaneous abortion in women with antiphospholipid antibody syndrome: a meta-analysis of randomized controlled trials

Objective: This study was designed to evaluate the efficacy of aspirin or heparin or both in the treatment for recurrent spontaneous abortion (RSA) in women with antiphospholipid antibody syndrome (APS).

Methods: Systematic searches for randomized clinical trials (RCTs) evaluating on live birth and preterm delivery, preeclampsia, intrauterine growth restriction, gestational diabetes, bleeding of RSA with APS patients receiving aspirin, and heparin therapy were carried out, from PubMed, EMBASE, ScienceDirect, and CNKI. Related data were extracted from eligible studies and then subjected to Reviewer Manage 5.3 for analysis. Relative risk (RR) and its 95% confidence interval were calculated.

Results: Nineteen publications with randomized controlled trials were selected for this study, which included a total of 1251 pregnant patients with diagnosis of RSA with APS. With respect to live birth, it was remarkably improved in aspirin plus heparin or heparin alone group [RR?=1.23, 95% CI (1.12–1.36), p?p?=?.02]; aspirin alone group, however, there was no statistically significant difference compare to placebo [RR?=?0.97, 95% CI (0.80–1.16), p?=?.71]. Meanwhile, aspirin plus heparin therapy did not significantly reduce the risk of recurrent placenta-mediated pregnancy complications including preterm birth, intrauterine growth retardation (IUGR), gestational diabetes, and minor bleeding. A beneficial therapeutic effect of heparin alone therapy was found on preventing preterm birth and low-dose aspirin plus heparin therapy was significant reduce the risk of preeclampsia.

Conclusion: An improvement of pregnancy outcomes in women with RSA and APS can be achieved by treatment strategies combining low-dose aspirin plus heparin or heparin alone. Aspirin alone, by contrast, seemed inferior to other treatments in achieving more live birth.     

The profiles of soluble adhesion molecules in the “great obstetrical syndromes”*

Objective: The objective of this study was to determine the profiles of maternal plasma soluble adhesion molecules in patients with preeclampsia, small-for-gestational-age (SGA) fetuses, acute pyelonephritis, preterm labor with intact membranes (PTL), preterm prelabor rupture of the membranes (preterm PROM), and fetal death.

Materials and methods: A cross-sectional study was conducted to determine maternal plasma concentrations of sE-selectin, sL-selectin, and sP-selectin as well as sICAM-1, sVCAM-1, and sPECAM-1 in patients with (1) an uncomplicated pregnancy (control, n?=?100); (2) preeclampsia (n?=?94); (3) SGA fetuses (in women without preeclampsia/hypertension, n?=?45); (4) acute pyelonephritis (n?=?25); (5) PTL (n?=?53); (6) preterm PROM (n?=?24); and (7) fetal death (n?=?34). Concentrations of soluble adhesion molecules and inflammatory cytokines (tumor necrosis factor (TNF)-α and interleukin (IL)-8) were determined with sensitive and specific enzyme-linked immunoassays.

Results: In comparison to women with a normal pregnancy, (1) women with preeclampsia had higher median concentrations of sE-selectin, sP-selectin, and sVCAM-1, and a lower concentration of sL-selectin (all p values?p values?p values?p values?p values?p values p values?Conclusions: The results of this study show that endothelial cell activation/dysfunction reflected by the plasma concentration of sE-selectin is not specific to preeclampsia but is present in pregnancies complicated by SGA fetuses, acute pyelonephritis, and fetal death. Collectively, we report that each obstetrical syndrome appears to have a stereotypical profile of soluble adhesion molecules in the peripheral circulation.     

Impact of early supplementation with low-dose aspirin on functional first trimester parameters in low-risk pregnancies

Introduction: There is recent evidence that prophylaxis with 150?mg of aspirin given before 14–16 weeks significantly reduces preeclampsia rates and may improve pregnancy outcome. We conducted an observational study that investigates the effect of low-dose aspirin initiated early in pregnancy or in preconception on functional parameters assessed at 11–14 weeks.

Materials and methods: We have retrospectively selected 128 pregnant women that presented for the first trimester screening for aneuploidies between 11⁺⁰ and 13⁺⁶ weeks of gestation and received low-dose aspirin before 14 weeks. We excluded cases with an estimated high risk for early preeclampsia (cut-off?>?1:100). This group was matched to 1044 cases that did not receive aspirin in early pregnancy. We have selected for statistical analysis maternal parameters, ultrasound parameters (crown-rump length, nuchal translucency thickness, pulsatility index in uterine arteries – left, right, average and average uterine PI expressed in multiple of median (MoM)), first trimester maternal biochemical markers (free β hCG and PAPP-A expressed in MoM), and the calculated risk for early onset and late onset preeclampsia.

Results: The most common dosages of aspirin were 75?mg (77 cases) and 100?mg (32 cases). The most significant results are within the aspirin group. In the subgroup that received aspirin before 11 weeks (110 cases), irrespective of the dosage, the uterine blood flow is significantly improved (average uterine PI 1.7 compared with 2.22, p?p?>?.05, [(?0.65)???0.02] 95% CI). The estimated risk for both early and late onset preeclampsia in this group is reduced (1:2141 compared with 1:333 for early preeclampsia, p?p?Conclusion: Even though the results are not always statistically significant, they demonstrate that placentation parameters improve with higher doses of aspirin started before 11 weeks.     

What factors are related to recurrent preterm birth among underweight women?*

Objective: Our objective was to identify factors associated with recurrent preterm birth among underweight women.

Methods: Maternally linked hospital and birth certificate records of deliveries in California between 2007 and 2010 were used. Consecutive singleton pregnancies of women with underweight body mass index (BMI?<18.5?kg/m²) in the first pregnancy were analyzed. Pregnancies were categorized based on outcome of the first and second birth as: term-term; term-preterm; preterm-term and preterm-preterm.

Results: We analyzed 4971 women with underweight BMI in the first pregnancy. Of these, 670 had at least one preterm birth. Among these 670, 86 (21.8%) women experienced a recurrent preterm birth. Odds for first term – second preterm birth were decreased for increases in maternal age (aOR: 0.90, 95%CI: 0.95–0.99) whereas inter-pregnancy interval <6?months was related to both first term – second preterm birth (aOR:1.66, 95%CI: 1.21–2.28) and first preterm birth – second term birth (aOR: 1.43, 95%CI: 1.04–1.96). Factors associated with recurrent preterm birth were: negative or no change in pre-pregnancy weight between pregnancies (aOR: 1.67, 95%CI: 1.07–2.60), inter-pregnancy interval?<6?months (aOR: 2.14, 95%CI: 1.29–3.56), and maternal age in the first pregnancy (aOR: 0.93, 95%CI: 0.90–0.97).

Conclusions: Recurrent preterm birth among underweight women was associated with younger age, short inter-pregnancy interval, and negative or no weight change between pregnancies.