Birthweight in pregnant women with protein S deficiency treated with low-molecular-weight heparin: a retrospective cohort study

Objective: To determine the risk of small-for-gestational-age (SGA) and intrauterine growth retardation (IUGR) in pregnant women with protein S (PS) deficiency who received low-molecular-weight heparin (LMWH).

Methods: Retrospective cohort study of pregnant women seen from January 2002 to December 2011. The study cohort comprised a total of 328 patients with PS deficiency, who received prophylactic enoxaparin during pregnancy. The control cohort included 11 884 pregnant women without significant past medical history. The risk of SGA and IUGR was calculated as odds ratio. Multivariate regression analysis over the entire reference population was performed determining the risk of both SGA and IUGR by adjusting for maternal age, first delivery, maternal underweight status, pre-eclampsia, other treated thrombophilias or history of recurrent abortion.

Results: The SGA rates in the PS deficiency and control cohorts were 10.7% and 8.5%, respectively (p?>?0.05). There was no increased risk of SGA (unadjusted OR?=?1.28, 95% confidence interval [CI] 0.9–1.83; adjusted OR?=?1.35, 95% CI 0.91–2.01). The IUGR rate was 2.7% in pregnant women with PS deficiency versus 4.1% in the control group (p?>?0.05). Also, we did not find a significant risk of IUGR (OR?=?0.66; 95% CI 0.34–1.28; adjusted OR?=?0.843; 95% CI 0.42–1.70).

Conclusions: In women with PS deficiency treated with LMWH, the risk of SGA and IUGR is similar to the one found in healthy pregnant women.     

The association between birth weight at term and long-term endocrine morbidity of the offspring*

Objective: To investigate whether small-for-gestational-age (SGA) and large-for-gestational-age (LGA) birth weight at-term poses an increased risk for long-term pediatric endocrine morbidity.

Study design: A retrospective population-based cohort study compared the incidence of long-term pediatric hospitalizations due to endocrine morbidity of singleton children born SGA, appropriate-for-gestational-age (AGA), and LGA at-term. A multivariate generalized estimating equation (GEE) logistic regression model analysis was used to control for confounders.

Results: During the study period, 235,614 deliveries met the inclusion criteria; of which 4.7% were SGA (n?=?11,062), 91% were AGA (n?=?214,249), and 4.3% were LGA neonates (n?=?10,303). During the follow-up period, children born SGA or LGA at-term had a significantly higher rate of long-term endocrine morbidity. Using a multivariable GEE logistic regression model, controlling for confounders, being delivered SGA or LGA at-term was found to be an independent risk factor for long-term pediatric endocrine morbidity (Adjusted OR?=?1.4; 95%CI?=?1.1–1.8; p?=?.015 and aOR?=?1.4; 95%CI?=?1.1–1.8; p?=?.005, respectively). Specifically, LGA was found an independent risk factor for overweight and obesity (aOR?=?1.7; 95%CI?=?1.2–2.5; p?=?.001), while SGA was found an independent risk factor for childhood hypothyroidism (aOR?=?3.2; 95%CI?=?1.8–5.8; p?=?.001).

Conclusions: Birth weight either SGA or LGA at-term is an independent risk factor for long-term pediatric endocrine morbidity.     

Maternal anemia during pregnancy and small for gestational age: a systematic review and meta-analysis

Objective: Anemia is a major public health and nutritional problem in the world. Studies have reported the relationship between anemia during pregnancy and small for gestational age (SGA). Therefore, the present systematic review and meta-analysis was conducted to determine the relationship between maternal anemia during pregnancy and SGA.

Method: This meta-analysis was conducted without time limit until April 2017 based on the PRISMA protocol. Several international databases including Cochrane, Scopus, Web of Science (ISI), Pubmed, Embase, and Google Scholar search engine were searched independently by two researchers. The keywords include: anemia, pregnant women, gestational age, and pregnancy. The relative risk (RR) and 95% confidence interval were estimated regarding to the significance of the I² index based on the random effects model. Data were analyzed using Comprehensive Meta-Analysis Software version 2.

Results: Ten studies with a sample size including 620 080 pregnant women entered the meta-analysis process. The overall relationship between maternal anemia during pregnancy and SGA was not significant (RR?=?1.11 [95%CI: 0.99–1.24, p?=?.074]). The relationship between anemia during pregnancy and SGA based on pregnancy trimester showed that maternal anemia was significant in the first trimester, (RR?=?1.11 [95%CI: 1–1.22, p?=?.044]), but this relationship was not significant in the second trimester (RR?=?1.11 [95%CI: 0.85–1.18, p?=?.91]).

Conclusions: Maternal anemia in the first trimester of pregnancy can be considered as a risk factor for negative pregnancy outcomes (SGA).     

Cannabis Use in Pregnancy in British Columbia and Selected Birth Outcomes

ObjectiveThis study sought to determine the association between cannabis use in pregnancy and stillbirth, small for gestational age (SGA) (<10th percentile), and spontaneous preterm birth (<37 weeks).MethodsThe study used abstracted obstetrical and neonatal medical records for deliveries in British Columbia from April 1, 2008 to March 31, 2016 that were contained in the Perinatal Data Registry of Perinatal Services British Columbia. Chi-square tests were conducted to compare maternal sociodemographic characteristics by cannabis use. Logistic regression was conducted to determine the association between cannabis use and SGA and spontaneous preterm births. Cox proportional hazards regression modelling was used to identify the association between cannabis use and stillbirth. Secondary analyses were conducted to ascertain differences by timing of stillbirth (Canadian Task Force Classification II-2).ResultsMaternal cannabis use has increased in British Columbia over the past decade. Pregnant women who use cannabis are younger and more likely to use alcohol, tobacco, and illicit substances and to have a history of mental illness. Using cannabis in pregnancy was associated with a 47% increased risk of SGA (adjusted OR 1.47; 95% CI 1.33–1.61), a 27% increased risk of spontaneous preterm birth (adjusted OR 1.27; 95% CI 1.14–1.42), and a 184% increased risk of intrapartum stillbirth (adjusted HR [aHR] 2.84; 95% CI 1.18–6.82). The association between cannabis use in pregnancy and overall stillbirth and antepartum stillbirth did not reach statistical significance, but it had comparable point estimates to other outcomes (aHR 1.38; 95% CI 0.95–1.99 and aHR 1.34; 95% CI 0.88–2.06, respectively).ConclusionCannabis use in pregnancy is associated with SGA, spontaneous preterm birth, and intrapartum stillbirth.     

Pregnancy and perinatal outcomes of first-trimester crown−rump length discordant IVF dichorionic twin pregnancies – a retrospective cohort study

Research QuestionThis study aimed to evaluate the association between discordance in crown–rump length (CRL) and adverse pregnancy and perinatal outcomes in dichorionic twin pregnancies.DesignThis was a retrospective cohort study of dichorionic twin pregnancies after IVF that showed two live fetuses at the first ultrasound scan between 6 ⁺⁵ and 8 weeks gestational age from 1 January 2015 to 31 December 2016. Study groups were defined by the presence or absence of 20% or more discordance in CRL. The primary outcomes were early fetal loss of one or both fetuses before 12 weeks and birthweight discordance. Secondary outcomes included fetal anomalies, fetal loss between 12 and 28 weeks, stillbirth, small for gestational age (SGA) at birth, low birthweight (LBW), very low birthweight (VLBW), admission to the neonatal intensive care unit (NICU) and preterm delivery (PTD).ResultsCRL-discordant twin pregnancies were more likely to end in the loss of one fetus before 12 weeks’ gestation (odds ratio [OR] 15.877, 95% confidence interval [CI] 10.495–24.019). Discordant twin pregnancies with twin deliveries had a significantly higher risk of birthweight discordance (OR 1.943, 95% CI 1.032–3.989). There was no significant difference in perinatal outcomes including fetal anomalies, PTD, LBW, VLBW, SGA, neonatal death and admission to NICU between singleton or twin deliveries.ConclusionsDiscordant twin pregnancies were at increased risk of one fetal loss prior to 12 weeks’ gestation. Except for birthweight discordance, there was no significant difference between CRL discordance and other adverse perinatal outcomes.     

Chronic hypertension: effect of blood pressure control on pregnancy outcome

Objective: To examine whether in patients with CH and mild to moderate hypertension the level of control of blood pressure during pregnancy has a beneficial or adverse effect on the risk of PE or SGA.

Methods: We performed a systematic review and meta-analysis of randomized controlled trials of patients with mild to moderate CH in pregnancy that reported the impact of different levels of control of blood pressure on the risk of PE or SGA. We completed a literature search through PubMed, Embase, Cinahl, Web of science, Cochrane CENTRAL Library Relative risks with random effect were calculated with their 95% confidence intervals (95%CI).

Results: Six trials including 495 participants provided data on blood pressure (BP) after entry to the study. Four studies compared antihypertensive agents to no treatment and two studies compared antihypertensive agents to placebo. All trials were conducted between 1976 and 1990 and were considered to be at high risk of bias. There was high heterogeneity between studies for mean arterial pressure (MAP) after randomization (I²?=?87%) and SGA (I²?=?60%), but not for PE (I²?=?0%). There were large differences between studies in the inclusion criteria, antihypertensive regimens, targets of therapy, and gestational age range at entry to the trials. In women receiving antihypertensive therapy, compared to those receiving placebo or no treatment, the MAP after entry to the trial was significantly lower (mean difference ?4.2?mmHg, 95%CI ?6.6 to ?1.8; p?=?.006). However, there was no significant reduction in the risk of PE (relative risks (RR) 1.03, 95%CI 0.63–1.68; p?=?.90) or SGA (RR 1.01, 95%CI 0.35–2.93; p?=?.99).

Conclusions: The findings of the meta-analysis suggest that lowering the blood pressure by antihypertensive medication in women with mild to moderate hypertension in the context of CH has no significant effect on the risk of SGA or PE.     

Morbidity and mortality of very low birth weight multiples compared with singletons

Background: Previous studies comparing the neonatal outcome of very low birth weight (VLBW) multiples and singletons have suggested a worse outcome for multiples at gestational ages on the limits of viability.

Objectives: The objective of this study is to determine the neonatal mortality and morbidity of VLBW multiples compared to singletons.

Methods: This is a retrospective study including all infants registered in the Spanish network for infants under 1500?g (SEN1500), over a 12-year period (from 2002 to 2013). Mortality and major morbidities were compared between singletons and multiples.

Results: About 32,770 infants were included: 21,123 singletons (64.5%) and 11,647 multiples (35.5%), with a mean gestational age of 29.5 weeks (22–38), and mean birth weight of 1115?g (340–1500). When adjusted by other perinatal factors, multiple pregnancy has a significantly higher risk of mortality than singleton pregnancy (odds ratio (OR) 1.15; IC 95% 1.05–1.26, p?=?.002), but not a higher risk of major morbidity or composite adverse outcome. In the subgroup of infants born before 26 weeks, multiples showed a higher risk of mortality (63.9% versus 51%, OR 1.7; 95% CI 1.47–1.96) and a higher risk of composite adverse outcome (88.9% versus 81.5%, OR 1.82, 95% CI 1.28–2.24).

Conclusions: In preterm infants born with less than 1500?g, multiple pregnancy is a prognostic factor that can slightly increase mortality. Extremely preterm infants born before 26 weeks have a greater risk of mortality and major morbidity if they come from a multiple pregnancy.     

Pap Smear Knowledge Among Young Women Following the Introduction of the HPV Vaccine

Study ObjectiveInvestigate sexually active young women's knowledge of the term Pap smear since development of the HPV vaccine.DesignCross-sectional study conducted January–May 2007.SettingUniversity health services clinic at a university in southern United States.ParticipantsSexually active women, age 18–24, presenting for a Pap smear or STD testing (N = 145).Main Outcome MeasuresPap smear knowledge was assessed by participants' written definition of the term Pap smear and by multiple choice responses indicating Pap smear as a test for cervical cancer/ HPV and not a pelvic exam, STD test, or pregnancy test.Results9.7% provided accurate definitions; 12.4% checked appropriate Pap smear synonyms. 68.5% incorrectly responded that Pap smear was the same as “pelvic exam”; 42.5% indicated “STD test”; 11.7% indicated “pregnancy test.” Indicators of HPV risk (age of sexual debut, previous abnormal Pap smear, previous STD diagnosis) were not associated with knowledge. Never using condoms, increasing age, and lower depression scores predicted accurate Pap smear definition rating (R² = 0.08). Never using condoms, Caucasian race, and decreased lifetime number of sex partners predicted accurate identification of Pap smear synonyms (R² = 0.15).ResultsFew participants understood the meaning of the term Pap smear; there does not appear to be improvement in women's knowledge after development of the HPV vaccine. Poor Pap smear knowledge may affect young women's understanding of their overall sexual health.     

Obstetric risk factors for poor neonatal adaptation at birth

Purpose: To identify obstetric risk factors of delivering a neonate with poor neonatal adaptation at birth.

Material and methods: Nested case–control study. Poor neonatal adaptation was defined for presence of at least: umbilical cord artery pH <7.10, base deficit ≥12?mmol/L, Apgar score at 1′ ≤5. Controls were selected from the same population and matched with cases. The association between clinical parameters and poor neonatal adaptation was analyzed by logistic regression.

Results: One hundred and thirty three women (2.1% of all live births) with a neonate presenting a poor neonatal adaptation were matched with 133 subsequent controls. Significant contributions for the prediction of poor neonatal adaptation were provided by maternal age ≥35 years (p?≤?.001, odds ratio (OR) 3.9 [95%CI: 2.3–6.8]), nulliparity (p?≤?.001, OR 3.3 [95%CI: 1.8–6]), complications during pregnancy (p?=?.032, OR 2.2 [95%CI: 1.1–4.4]), gestational age at delivery <37 weeks (p?=?.008, OR 5.2 [95%CI: 1.5–17.8]) and cardiotocography category II or III (p?≤?.001, OR 36.3 [95%CI: 16.5–80.1]). The receiver operative characteristic curve was 0.91 [95%CI: 0.87–0.95], and detection rates 82.7% and 89.5% at 10% and 20% of false positive rates, respectively.

Conclusions: Several obstetric risk factors before and during labor can identify a subgroup of newborns at higher risk of a poor neonatal adaptation at birth.     

Effects of an extended free-of-fee strategy on the rate of cervical Papanicolaou smear screening in Israel

ObjectiveTo investigate the influence of an extended free-of-fee strategy on the rate of cervical Papanicolaou (Pap) smear screening in Israel.MethodsA retrospective analysis was conducted of data obtained from a computer-generated list of women aged 15–74 years who attended appointments with Clalit Health Services between January 1, 2008, and November 30, 2011, during which Pap smears were taken. The basic strategy allowed a no-fee Pap smear once every 3 years between the ages of 35 and 54 years; the extended strategy allowed a no-fee Pap smear once every 3 years between the ages of 25 and 54 years.ResultsIn all, 65 565 Pap smears were taken. The mean monthly study population was 161 438 women. The mean monthly Pap smear rate for the basic strategy was 0.64% ± 0.5% (95% confidence interval [CI], 0.59–0.68) versus 0.75% ± 0.6% (95% CI, 0.70–0.79) for the extended strategy (P = 0.004). Age group (P < 0.001), Pap smear strategy type (P < 0.001), and combined age group and strategy type (P = 0.028) each predicted the monthly rate of Pap smear screening in a univariate analysis.ConclusionImplementation of the extended free-of-fee strategy increased the rate of Pap smear screening among Israeli women.     

Perinatal outcome of pregnancies complicated with extreme birth weights at term

Objective: The objective of this study is to investigate whether an abnormal birthweight at term, either small for gestational age (SGA,??95th centile for gestational age), is a risk factor for perinatal complications as compared with birthweight appropriate for gestational age (AGA).

Methods: A population-based retrospective cohort analysis of all singleton pregnancies delivered between 1991 and 2014 at Soroka Medical Center. Congenital malformations and multiple pregnancies were excluded. A multivariable generalized estimating equation regression model was used to control for maternal clusters and other confounders.

Results: During the study period, 228,242 births met the inclusion criteria, of them 91% were AGA (n?=?207,652), 4.7% SGA, and 4.3% LGA. SGA significantly increased the risk for perinatal mortality (aOR 5.6, 95%CI 4.5–6.8) and low 5-min Apgar scores (aOR 2.2, 95%CI 2.0–2.4), while LGA did not. SGA and LGA were both significant risk factors for cesarean delivery. LGA was significantly associated with shoulder dystocia and post-partum hemorrhage (aOR =13.6, 95%CI 10.9–17.0, and aOR 1.7, 95%CI 1.2–2.6, respectively).

Conclusions: Extreme birthweights at term are significantly associated with adverse maternal and neonatal outcomes. As opposed to SGA, LGA is not independently associated with perinatal mortality.     

Comparison of the diagnostic value of the visual inspection with acetic acid (VIA) and Pap smear in cervical cancer screening

ObjectiveThis study aimed to compare the diagnostic value of VIA with Pap smear in screening for cervical cancer.Materials and methodsIn this cross-sectional study, 440 women who had eligibility criteria, in Kashan city were assessed. All women underwent Pap smear test and then a visual inspection with acetic acid and colposcopy-biopsy (Gold Standard). Then, the diagnostic value indices including the specificity, sensitivity, positive and negative predictive values for the results of VIA and Pap smear were analyzed by SPSS V16 software.ResultsFinding showed that 29.9% of women had abnormal Pap smear. The false positive rate of Pap smear was 40.2%, and its false negative rate was 37.4%. For VIA, the false positive and false negative rates were 21.2% and 4.6%. The sensitivity, specificity, NPV and PPV of Pap smear was 29.7%, 85.5%, 59.8%, 62.6%, and these values for VIA was 94.6%, 81.6%, 78.8%, 95.4% respectively. Combination of Pap smear and VIA showed the sensitivity of 97.3% and 100% in low grade and high grade cervical lesions.ConclusionVIA has a higher sensitivity than Pap smear in detection of low and high grade cervical lesions, however, its specificity is less than Pap smears. Therefore it is recommended to use of VIA along with Pap smear to reach a higher sensitivity.     

Effective reduction in inadequate Pap smears by using a saline-lubricated speculum and two glass slides

ObjectiveThe aim of the study was to propose a method using saline lubrication and two glass slides to reduce the proportion of inadequate Pap smears.Materials and methodsThis was a retrospective study of patients at a medical center in eastern Taiwan that performs 5000–6000 Pap smears annually. The extracted data only detailed the number and percentage of inadequate Pap smears. We applied two modifications to the conventional Pap smear technique. The first modification was lubricating the speculum with normal saline instead of jelly. The second modification was performing the smear on two glass slides instead of just one. We used the modified technique beginning in January 2017. Therefore, we collected data from 2016 (before the modified technique was employed) and 2018 (after the modified technique was employed). The categorical data are presented as numbers (percentages). The differences in the number and percentage of inadequate smears resulting from both techniques were assessed using the Chi-square test.ResultsDuring 2016 and 2018, 28 and 2 women received inadequate Pap smears among the total of 594 and 613 women who received Pap smears, respectively. The proportion of inadequate Pap smears was 4.71% and 0.33% in 2016 and 2018, respectively (P < 0.001).ConclusionsThe use of this modified technique effectively reduced the percentage of inadequate Pap smears.     

Clinical factors associated with pregnancy outcome in women with recurrent pregnancy loss

Abstract

The aim of this prospective cohort study was to evaluate clinical factors associated with pregnancy outcomes in women with recurrent pregnancy loss (RPL). Women with a history of two or more pregnancy losses underwent workups for clinical factors of RPL and their pregnancies were followed-up with informed consent. Two hundred eleven (81.5%) of 259 women with RPL became pregnant. The multivariable analyses demonstrated that age (p?<?.01, OR 0.9, 95%CI 0.97–0.83), uterine abnormality (p?<?.05, OR 0.3, 95%CI 0.11–0.8), and protein C (PC) deficiency (p?<?.01, OR 0.14, 95%CI 0.03–0.6) were independent factors for becoming pregnancy in women with RPL. The number of previous pregnancy loss (p?<?.01, OR 0.57, 95%CI 0.43–0.75) and natural killer (NK) cell activity ≥33% (p?<?.01, OR 0.31, 95%CI 0.13–0.73) were independent factors for live birth in the subsequent pregnancy. Advanced age, the presence of uterine abnormality, and PC deficiency were risk factors for reduced pregnancy rate in women with RPL. Increased number of previous pregnancy loss and high NK cell activity were risk factors for miscarriage in the subsequent pregnancy. These results involve important information and are helpful for clinical practitioners.     

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.     

The Impact of Isolated Maternal Hypothyroxinemia on Perinatal Morbidity

ObjectiveTo determine whether maternal hypothyroxinemia during early pregnancy is associated with adverse perinatal outcomes.MethodsSerum samples of a prospective cohort of 879 women collected at 15–16 weeks of pregnancy were analyzed for thyroid-stimulating hormone (TSH) and free thyroxine (T₄) concentrations. Women with TSH levels within the normal reference range (0.15–4.0 mU/L) and free T₄ levels below the 10th percentile of the sample (8.5 pmol/L) were classified as hypothyroxinemic and were compared with euthyroid women (who had normal TSH and free T₄ levels). Thyroid hormone measures were linked to pregnancy outcomes, including small for gestational age (SGA), standardized birth weight z-score, preterm delivery, and Apgar score used as a measure of early neonatal morbidity.ResultsAmong 89 hypothyroxinemic women, there was no evidence of an increased risk for fetal growth restriction, preterm birth, or low Apgar score. The relative risk of delivering an SGA infant was 0.38 (95% CI 0.11 to 1.33), the mean difference in birth weight z-score was 0.035 (95% CI −0.17 to 0.24), and the risk of preterm delivery was 0.79 (95% CI 0.38 to 1.67). None of the hypothyroxinemic women gave birth to an infant with a five-minute Apgar score < 7. When free T₄ levels were substituted for categories of thyroid hormone function, the pattern of results remained unaltered.ConclusionIsolated maternal hypothyroxinemia was not observed to have any adverse effect on fetal growth or pregnancy outcome. This study does not provide evidence to support treatment of this condition to prevent fetal growth restriction or neonatal morbidity.     

Maternal vitamin D status and adverse pregnancy outcomes: a systematic review and meta-analysis

Abstract

Objective: To estimate the associations between maternal vitamin D status and adverse pregnancy outcomes.

Study design: We searched electronic databases of the human literature in PubMed, EMBASE and the Cochrane Library up to October, 2012 using the following keywords: “vitamin D” and “status” or “deficiency” or “insufficiency” and “pregnancy”. A systematic review and meta-analysis were conducted on observational studies that reported the association between maternal blood vitamin D levels and adverse pregnancy outcomes including preeclampsia, gestational diabetes mellitus (GDM), preterm birth or small-for-gestational age (SGA).

Results: Twenty-four studies met the inclusion criteria. Women with circulating 25-hydroxyvitamin D [25(OH)D] level less than 50?nmol/l in pregnancy experienced an increased risk of preeclampsia [odds ratio (OR) 2.09 (95% confidence intervals 1.50–2.90)], GDM [OR 1.38 (1.12–1.70)], preterm birth [OR 1.58 (1.08–2.31)] and SGA [OR 1.52 (1.08–2.15)].

Conclusion: Low maternal vitamin D levels in pregnancy may be associated with an increased risk of preeclampsia, GDM, preterm birth and SGA.     

Body mass index at 11–13 weeks’ gestation and pregnancy complications in a Southern Chinese population: a retrospective cohort study

Objective: To assess the association between body mass index (BMI) and adverse pregnancy outcomes.

Materials and methods: A multicentre retrospective cohort study was conducted in three hospitals in Hong Kong including 67,248 women with singleton pregnancy at 11–13 weeks between 2010 and 2016. The relationship between maternal BMI and (1) miscarriage or stillbirth, (2) development of preeclampsia (PE), (3) gestational hypertension (GH), (4) development of gestational diabetes mellitus (GDM), (5) spontaneous preterm delivery (sPTD) <34 and <37 weeks, (6) delivery of a small for gestational age (SGA) or large for gestational age (LGA) neonate, (7) caesarean section (CS), and (8) postpartum haemorrhage (PPH) were examined after adjusting for confounding factors.

Results: The prevalence of maternal overweight (BMI 25–29.9?kg/m²) and obesity (BMI ≥30?kg/m²) were 13.2% and 2.9%, respectively. Women with a BMI ≥30?kg/m² were nine times more likely to develop GH (95%CI 7.3–11.7), five times more likely to develop PE (95%CI 4.3–6.8) and GDM (95%CI 5.0–6.5) and 1.5–2 times more likely to deliver SGA/LGA neonate. sPTD, required delivery by CS and developed PPH, than those with a BMI of 18.5–22.9?kg/m², and that maternal underweight (BMI <18.5?kg/m²) significantly reduced the risk of GDM, delivery by CS, and PPH. Increased risk of subsequent development of adverse outcomes was observed when BMI was ≥23.0?kg/m².

Conclusions: Maternal overweight and obesity are associated with an increased risk for subsequent development of various pregnancy complications. The need of increased awareness and health surveillance is essential when BMI ≥23?kg/m².     

Paternal involvement and support and risk of preterm birth: findings from the Boston birth cohort

Objective: To investigate to what extent paternal involvement and support during pregnancy were associated with preterm (PTB) and small-for-gestational age (SGA) births.

Methods: Using data from the Boston Birth Cohort (n?=?7047), multiple logistic regression models were performed to estimate the log odds of either PTB or SGA birth, with paternal involvement, paternal social support, and family and friend social support variables as the primary independent variables.

Results: About 10% of participating mothers reported their husbands not being involved or supportive during their pregnancies. Lack of paternal involvement was associated with 21% higher risk of PTB (OR?=?1.21, 95% CI: 1.01–1.45). Similarly, lack of paternal support was borderline associated with PTB (OR?=?1.13, 95% CI: 0.94–1.35). Also marginally significant, lack of paternal involvement (OR?=?1.18, 95% CI: 0.95–1.47) and father’s support (OR?=?1.19, 95% CI: 0.96–1.48) were associated with higher odds of SGA birth. No associations were found between familial and friend support during pregnancy and PTB or SGA.

Conclusions: Among predominantly low-income African Americans, lack of paternal involvement and lack of paternal support during pregnancy were associated with an increased risk of PTB, and suggestive of SGA birth. These findings, if confirmed in future research, underscore the important role a father can play in reducing PTB and/or SGA.     

Risk factors associated with altered fetal growth in patients with pregestational diabetes mellitus

Objective: To assess the risk factors for abnormal fetal growth in patients with pregestational diabetic mellitus (DM). Methods: A retrospective study was performed in 336 patients with pregestational DM. Small-for-gestational-age (SGA) and large-for-gestational-age (LGA) infants were defined as newborns with birth weights < 10th percentile and > 90th percentile, respectively. Logistic regression analysis was performed to identify risk factors for SGA and LGA. Results: Multivariate analysis of the patients with pregestational DM revealed a significant difference between patients who delivered SGA and appropriate-for-gestational-age (AGA) infants in terms of retinopathy (OR?=?5.73, 95%CI?=?1.39–23.59) and hemoglobin A1C (HbA1C) before delivery (OR?=?0.80, 95%CI?=?0.68 – 0.94, with a 0.1% increase in DCCT unit). Multivariate analysis revealed a significant difference between patients who delivered LGA and AGA infants in terms of primipara (OR?=?3.40, 95%CI?=?1.47–7.87) and HbA1C before delivery (OR?=?1.14, 95%CI?=?1.07–1.21, with a 0.1% increase in DCCT unit). Conclusions: HbA1C before delivery influenced both SGA and LGA infants in patients with pregestational DM. Tight glycemic control might be harmful to fetal growth in pregestational diabetic patients, especially when complicated with retinopathy.