First trimester vaginal bleeding and adverse pregnancy outcomes among Chinese women: from a large cohort study in China

Objectives: To examine the effect of first trimester vaginal bleeding on adverse pregnancy outcomes including preterm delivery, low birth weight and small for gestational age. Methods: This is a prospective population-based cohort study. A questionnaire survey was conducted on 4342 singleton pregnancies by trained doctors. Binary logistic regression was used to estimate risk ratios (RRs) and 95% con?dence intervals (95% CI). Results: Vaginal bleeding occurred among 1050 pregnant women, the incidence of vaginal bleeding was 24.2%, 37.4% of whom didn’t see a doctor, 62.6% of whom saw a doctor for vaginal bleeding. Binary logistic regression demonstrated that bleeding with seeing a doctor was significantly associated with preterm birth (RR 1.84, 95% CI 1.25–2.69) and bleeding without seeing a doctor was related to increased of low birth weight (RR 2.52, 95% CI 1.34–4.75) and was 1.97-fold increased of small for gestational age (RR 1.97, 95% CI 1.19–3.25). Conclusions: These results suggest that first trimester vaginal bleeding is an increased risk of low birth weight, preterm delivery and small for gestational age. Find ways to reduce the risk of vaginal bleeding and lower vaginal bleeding rate may be helpful to reduce the incidence of preterm birth, low birth weight and small for gestational age.     

Ongoing pregnancies in patients with unexplained recurrent pregnancy loss: adverse obstetric outcomes

To investigate the incidence of adverse pregnancy outcomes in couples with an unexplained Recurrent Pregnancy Loss (RPL) history, a retrospective cohort study was conducted between 2014 and 2015. The study group (A) included couples with an unexplained RPL, and the control group (B) was composed of couples who attended the Low-Risk Antenatal Unit during the same period. On the other hand, 53 couples were included in the study group (A) and on the other hand, 65 in the control group (B). Women with previous unexplained recurrent pregnancies loss had a significantly increased risk of gestational diabetes with 12 cases (22.6%) in the study group and 3 cases (4.6%) in the control (OR: 6.048; 95% CI: 1.607–22.762; p?=?0.007). A slight increase in the risk of preterm delivery and hepatic cholestasis was observed in the study group (6 cases, 11.3%, in study group and 1 case, 1.5% in the controls (OR: 8.170; 95% CI: 0.951–70.158; p?=?0.0555). Women with a history of RPL delivered more frequently by caesarean section (OR: 3.252; 95% CI: 1.460–7.241; p?=?0.0039). Women with a history of RPL were at an increased risk for adverse pregnancy outcomes, mainly gestational diabetes. Therefore, a closer surveillance during the antenatal period is recommended in this group of patients.     

Obstetric and perinatal outcome in women with twin pregnancy and gestational diabetes

Objective: The aim of this study was to evaluate pregnancy complications and obstetric and perinatal outcomes in women with twin pregnancy and GDM. Study Design: An observational multicentre retrospective study was performed and 534 pregnant woman and 1068 twins infants allocated into two groups, 257 with GDM and 277 controls, were studied. Main Outcome Measures: Pregnant women characteristics, hypertensive complications, preterm delivery rate, mode of delivery and birthweight were analysed. Results: Pregnant women with GDM were older (p?<?0.001) and had higher body mass index (p?<?0.001) than controls. GDM was associated with higher risk of prematurity in twin pregnancy (odds ratio 1.64, 95% confidence interval [1.14–2.32], p?=?0.005). This association was based on the association with other pregnancy complications. Birthweight Z-scores were significantly higher in the GDM group (p?=?0.02). The rate of macrosomia was higher in the GDM group (p?=?0.002) and small for gestational age (SGA) babies were significantly less frequent (p?=?0.03). GDM was an independent predictor of macrosomia (p?=?0.006). Conclusion: The presence of GDM in twin pregnancy was associated with a higher risk of hypertensive complications, prematurity and macrosomia, but significantly reduces the risk of SGA infants. Prematurity was related to the presence of other associated pregnancy complications.     

Adverse perinatal outcome and maternal risk factors in population versus customized defined SGA babies

Objective.?The purpose of this study was to compare population and customized-based birth weight centiles in their association with perinatal outcome and maternal risk factors, in nulliparous Caucasian women in a socio-economic disadvantaged region.

Methods.?We analyzed perinatal outcomes in births of 302 Caucasian women of which 155 were small for gestational age (SGA) and 147 were appropriate for gestational age (AGA). Out of the overall study group, two cohort studies were designed. One was classified by population centiles as either SGA (n= 133) or AGA (n?= 169) and the other was classified by customized centiles as either SGA (n?= 131) or AGA (n?= 172). Maternal risk factors and operative delivery rates for fetal distress, Apgar scores, need for resuscitation and neonatal nursery care given, were determined for both customized and population-based SGA babies.

Results.?The customized SGA only group showed more mental health problems and special nursery in comparison with the AGA group. The population SGA only group had more smoking and mental health problems than the AGA group, but no differences on neonatal outcome measures.

Conclusion.?Use of customized centiles does identify an additional group neonates with a significantly higher need for special nursery admission in a homogeneous ethnic Caucasian group.     

Pregnancy risk in female kidney and liver recipients: a retrospective comparative study

Objective: To determine and compare maternal, neonatal and graft outcomes in pregnant women after kidney or liver transplantation, who had delivered from 1 January 2005 to 1 February 2010. Methods: A retrospective, single-center study provided in Warsaw, Poland. Results: Complete data were collected in 38 deliveries in 37 women. Preexisting hypertension was present in 15 of 19 (79%) pregnant kidney recipients and in 2 of 19 (10.5%) women after liver transplantation (p?<?0.000). The incidence of preeclampsia was also more often in pregnant kidney recipients (p?=?0.04). Mean gestational age at labor was lower in the kidney group (34.9?±?3.56 vs. 37.5?±?1.62, p?=?0.000). A similar relation was observed in the frequency of preterm deliveries before 37 weeks of gestation (42% vs. 11%, respectively, p?=?0.02) and neonates small for gestational age (47% vs. 11%, respectively, p?=?0.008). Cesarean sections were performed in approximately 79% (15/19) and 95% (18/19) liver and kidney posttransplant pregnancies, respectively. Four of 38 infants presented structural malformations. Conclusions: Pregnancies after kidney transplantation are complicated with a higher prevalence of prematurity and worse neonatal prognosis, which depends mainly on the underlying condition.     

Amphetamine abuse in pregnancy: the impact on obstetric outcome

Objective To determine whether pregnant women with amphetamine abuse developed more obstetric complications than non-drug abuser pregnant women. Materials and methods A retrospective case control study was undertaken. Pregnant women with amphetamine abuse who delivered between January 2002 and December 2003 were compared to control pregnant women. Results Pregnant women who abused amphetamine were more likely to develop anemia, preterm delivery, thick meconium stained amniotic fluid, and delivered small for gestational age neonates. However, cephalopelvic disproportion was less frequently found in the amphetamine abuse group. Conclusion Pregnant women who abuse amphetamine experience more obstetric complications than the non-drug abuser. This information may be useful to medical personnel who are caregivers of these pregnant women to provide adequate perinatal care.     

Health,Physical Growth,and Neurodevelopmental Outcomes in Preterm Infants of Women With Hypertensive Disorders of Pregnancy

Objective

To compare the health, physical growth, and developmental outcomes in preterm infants of women with and without hypertensive disorders of pregnancy (HDP).

Effect of nonsurgical periodontal therapy during gestation period on adverse pregnancy outcome: a systematic review

Abstract

Objective: To confirm effectiveness of nonsurgical periodontal treatment during pregnancy on pregnancy outcome in terms of preterm birth and low birth weight (LBW).

Method: We searched for Randomized controlled trials in MEDLINE, CINAHL and EMBASE. from January 2000 to October 2012. References of included studies were hand searched. Studies which measured incidence of either preterm labor (PTL), LBW or both were included. Information on study design, population, risk of bias, periodontal parameters, time and type of periodontal treatment given and pregnancy outcome were abstracted independently by three reviewers.

Results: Total thirteen studies were included. Five studies had low risk of bias. Conclusive results could not be obtained for incidence of PTL or LBW because of heterogeneity in results due to various reasons, but all studies which assessed PTL and LBW combined showed significant difference in incidence of same in group which received non surgical periodontal treatment.

Conclusion: Our study suggests that treatment of periodontitis during gestation improves pregnancy outcome in terms of PTLBW, a fact which may be used for health and economical benefits but better RCTs with adequate sample size are required for conclusive evidence.     

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.     

Effects of zinc supplementation during pregnancy on pregnancy outcome in women with history of preterm delivery: A double-blind randomized,placebo-controlled trial

Objectives.?The aim of this study was to assess the effect of high dose zinc (Zn) supplement during pregnancy in pregnancy outcome in healthy pregnant women with a previous preterm delivery in Isfahan, Iran.

Methods.?A double-blind placebo-controlled randomized clinical trial was conducted between January 2007 and June 2008. Eighty-four pregnant women with a previous preterm delivery age 19 to 35 years were randomly allocated to receive either 50?mg/day Zn as Zn sulfate or placebo from 12 to 16 weeks of gestation till delivery. Pregnancy outcome was assessed in term of incidence of intrauterine growth retardation (IUGR), birth weight, crown-heel length, head circumference, Apgar score, and gestational age at delivery.

Results.?The mean birth head circumference was higher in Zn supplemented group than in the placebo group (35.0?cm vs. 33.7?cm, P?<?0.05). Although gestational age at delivery (37.1 week vs. 36.7 week) and birth weight (2960.6?g vs. 2819.0?g) of babies born in Zn supplemented group was slightly higher than placebo group, it was not statistically significant. No significant differences were seen for infant length, Apgar score, and IUGR.

Conclusions.?Adding Zn supplementation during pregnancy to routine care of women with a previous preterm delivery had no significant effect on the gestational age at delivery and birth weight but increased the birth head circumference.     

Patients with stages III and IV endometriosis have a poorer outcome of in vitro fertilization-embryo transfer than patients with tubal infertility

Objective: To evaluate the outcome of IVF in patients with stages III and IV endometriosis.

Design: Retrospective study.

Setting: The Sara Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Israel.

Patient(s): Fifty-eight patients with stages III and IV endometriosis and 60 patients with tubal infertility.

Intervention(s): IVF-ET for all couples.

Main Outcome Measure(s): Fertilization, pregnancy, and birth rates.

Result(s): The comparison between patients with endometriosis and those with tubal infertility indicated that the former had a poor IVF outcome in terms of reduced fertilization rate (40% vs. 70%), reduced pregnancy rate per cycle (10.6% vs. 22.4%), and reduced birth rate per cycle (6.7% vs. 16.6%). The differences were statistically significant.

Conclusion(s): The results show an unfavorable outcome of IVF-ET in patients with endometriosis when compared with those who have tubal infertility.     

The utility of an obesity-specific small for gestational age standard for pregnancies complicated by maternal obesity*

Introduction: An obesity-specific standard for small for gestational age (SGA) pregnancies may help identify additional at risk pregnancies.

Methods: This was a retrospective cohort study of all non-anomalous singleton neonates born in Texas from 2006–2011. Analysis was limited to births between 34 and 42?weeks gestation. Two SGA birth weight standards (birth weight ≤10th centile) were generated, one using the entire population (SGA_pop) and another using obese pregnancies (SGA_cust). The outcomes of interest included: risks of stillbirth, neonatal death, 5-minute Apgar score below 7, NICU admission, and assisted ventilation?>6?h.

Results: Using the population standard, the prevalence of SGA complicated by obesity was 8.1%, compared with 10.3% using the obesity-specific standard. 10,457 additional pregnancies were identified as SGA. Compared to obese AGA pregnancies, the aHR for stillbirth was 5.45 [4.28, 6.94] for SGA_pop, and 1.21 [0.54, 2.74] for SGA_cust-pop. The risks for the following neonatal complications were slightly higher for SGA_cust-pop group compared to AGA group: neonatal death aOR 1.40 [1.05, 1.87], low 5-minute Apgar 1.31 [1.09, 1.57], and NICU admission 1.13 [1.03, 1.25]. These risks were lower than SGA_pop.

Conclusions: Using an obesity-specific SGA standard, a subgroup of pregnancies with marginally increased risk for neonatal complications was identified.     

A 12-year cohort study on adverse pregnancy outcomes in Eastern Townships of Canada: impact of endometriosis

The aim of this study was to provide a temporal-spatial reference of adverse pregnancy outcomes (APO) and examine whether endometriosis promotes APO in the same population. Among the 31?068 women who had a pregnancy between 1997 and 2008 in Eastern Townships of Canada, 6749 (21.7%) had APO. These APO increased significantly with maternal age and over time (r^2?=?0.522, p?=?0.008); and were dominated by preterm birth (9.3%), pregnancy-induced hypertension (8.3%) including gestational hypertension (6.5%), low birth weight (6.3%), gestational diabetes (3.4%), pregnancy loss (2.2%) including spontaneous abortion (1.5%) and stillbirth (0.6%), intrauterine growth restriction (2.1%) and preeclampsia (1.8%). Among the 31?068 pregnancies, 784 (2.5%) had endometriosis and 183 (23.3%) had both endometriosis and APO. Endometriosis has been shown to increase the incidence of fetal loss (OR?=?2.03; 95% CI?=?1.42–2.90, p?p?=?0.005) and stillbirth (OR?=?2.29; 95% CI?=?1.24–5.22, p?=?0.012). This study provides a temporal-spatial reference on APO, which is a valuable tool for monitoring, comparing and correcting. It is also the first study to highlight an impact of endometriosis on the incidence of spontaneous abortion and stillbirth.     

Ethnicity and birth outcome: New Zealand trends 1980-2001: Part 2. Pregnancy outcomes for Maori women

BACKGROUND: While traditionally Maori perinatal mortality has been similar to that of other ethnic groups, rates of preterm birth, small for gestational age (SGA) and teenage pregnancy have remained high. AIMS: To review current trends in preterm birth, SGA and teenage pregnancy for Maori during 1980-2001 and to highlight the major factors that have influenced Maori reproductive outcomes during this period. METHODS: De-identified birth registration data from 1 189 120 singleton live births and 5775 stillbirths were analysed for 1980-2001. Outcomes of interest included preterm birth, SGA and late fetal death while explanatory variables included maternal ethnicity, age and NZ Deprivation Index decile. Trend analysis was undertaken for 1980-1994 and multivariate logistic regression was used to explore risk factors for 1996-2001. RESULTS: During 1980-1994, Maori women had the highest preterm birth rates of any ethnic group in New Zealand, but in relative terms, inequalities declined as a consequence of a non-significant 7% fall in rates being offset by a statistically significant 30% increase for the European/other ethnic group. Rates of SGA were also higher amongst Maori women but declined by 25% during the 1980-1994 period. In addition, Maori women experienced significant socioeconomic gradients in SGA, with risk for Maori women in the most deprived NZDep areas being double that of Maori living affluent areas. Paradoxically, while Maori women had high rates of teenage pregnancy, this did not confer additional risk for preterm birth or SGA during the 1996-2001 period. CONCLUSIONS: While high rates of teenage pregnancy amongst Maori women appear not to confer additional risk for preterm birth or SGA, the social consequences of early childbearing may well be significant. The persistence of elevated rates of preterm birth and large socioeconomic gradients in SGA amongst Maori suggest that broader social and policy interventions are necessary if Maori are to achieve optimal birth outcomes in the coming decades.