Pub Date : 2022-05-31DOI: 10.1080/14767058.2022.2081499
Timothy N. Dunn, D. Becker, J. Szychowski, J. Owen
Abstract Objectives To identify if there is an increased risk for spontaneous preterm birth (sPTB) across the continuum of measured, normal cervical lengths (CL) in low-risk women. Methods Retrospective cohort study of women with singleton pregnancies and no history of prior sPTB. Women were included if they underwent mid-trimester transvaginal CL measurement between February 2016 and August 2018 and had a measured, normal CL ≥25mm. Women were excluded for progesterone exposure, fetal anomalies, or an unmeasurable CL due to a poorly developed lower uterine segment. The primary study outcome was sPTB <37 weeks. Secondary outcomes included: sPTB <35 weeks, birth gestational age (GA), and the number of hospital evaluations for suspected preterm labor (PTL). Cervical length was considered in interval groups 25–29mm, 30–34mm, 35–39mm, 40–44mm, and ≥45mm. Outcomes were analyzed with χ2 test of trend and as a continuum (linear models, logistic regression and ROC curve), where appropriate. Results 985 women were included. The incidence of sPTB <37 weeks was 3.7%, with a mean birth GA of 38.7 ± 2.4 weeks. The odds of sPTB <37 weeks decreased with increasing cervical length, considered in 5 mm intervals (odds ratio = 0.67; 95% confidence interval 0.49–0.90) and an increasing birth GA of 1 additional day for each CL increase of 3mm (p = .0002). Conversely, sPTB <35 weeks (p = .49) and mean hospital evaluations for PTL (p = .26) were similar across groups. The ROC curve area-under-the-curve for sPTB <37 weeks of 0.64 showed poor predictive value. Conclusions Among women without a history of sPTB, there was an association of decreased risk of sPTB <37 weeks and advanced delivery GA with increasing, but normal-range CL measurements. However, the association was poor and was not associated with spontaneous preterm birth <35 weeks, or the number of hospital evaluations for PTL.
{"title":"Spontaneous preterm birth as a function of normal cervical length in low-risk women","authors":"Timothy N. Dunn, D. Becker, J. Szychowski, J. Owen","doi":"10.1080/14767058.2022.2081499","DOIUrl":"https://doi.org/10.1080/14767058.2022.2081499","url":null,"abstract":"Abstract Objectives To identify if there is an increased risk for spontaneous preterm birth (sPTB) across the continuum of measured, normal cervical lengths (CL) in low-risk women. Methods Retrospective cohort study of women with singleton pregnancies and no history of prior sPTB. Women were included if they underwent mid-trimester transvaginal CL measurement between February 2016 and August 2018 and had a measured, normal CL ≥25mm. Women were excluded for progesterone exposure, fetal anomalies, or an unmeasurable CL due to a poorly developed lower uterine segment. The primary study outcome was sPTB <37 weeks. Secondary outcomes included: sPTB <35 weeks, birth gestational age (GA), and the number of hospital evaluations for suspected preterm labor (PTL). Cervical length was considered in interval groups 25–29mm, 30–34mm, 35–39mm, 40–44mm, and ≥45mm. Outcomes were analyzed with χ2 test of trend and as a continuum (linear models, logistic regression and ROC curve), where appropriate. Results 985 women were included. The incidence of sPTB <37 weeks was 3.7%, with a mean birth GA of 38.7 ± 2.4 weeks. The odds of sPTB <37 weeks decreased with increasing cervical length, considered in 5 mm intervals (odds ratio = 0.67; 95% confidence interval 0.49–0.90) and an increasing birth GA of 1 additional day for each CL increase of 3mm (p = .0002). Conversely, sPTB <35 weeks (p = .49) and mean hospital evaluations for PTL (p = .26) were similar across groups. The ROC curve area-under-the-curve for sPTB <37 weeks of 0.64 showed poor predictive value. Conclusions Among women without a history of sPTB, there was an association of decreased risk of sPTB <37 weeks and advanced delivery GA with increasing, but normal-range CL measurements. However, the association was poor and was not associated with spontaneous preterm birth <35 weeks, or the number of hospital evaluations for PTL.","PeriodicalId":22921,"journal":{"name":"The Journal of Maternal-Fetal & Neonatal Medicine","volume":"67 1","pages":"9978 - 9982"},"PeriodicalIF":0.0,"publicationDate":"2022-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90368736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-30DOI: 10.1080/14767058.2022.2076590
F. Rivera, John Vincent Magalong, O. Tantengco, G. F. Mangubat, Mary Grace Villafuerte, A. Volgman
Abstract Purpose Several studies link maternal cardiovascular disease (CVD) to maternal and fetal morbidity and mortality. This study describes the profile of maternal, obstetric, and neonatal outcomes among pregnant women with CVD in a tertiary hospital in the Philippines. It identifies the clinical and sociodemographic variables associated with these outcomes. Materials and Methods A single-center, retrospective analysis of pregnant women admitted for delivery at the Philippine General Hospital from 2015 to 2019 was performed. Of these patients, pregnant women with CVD were identified as the cohort for this study. Data on clinical and sociodemographic factors, maternal major adverse cardiovascular events, neonatal adverse clinical events, and obstetric complications were collected. Logistic regression analysis was performed to determine the odds ratio for the risk factors for small-for-gestational-age (SGA) babies and preterm birth. Results Among 30,053 delivery admissions in the Philippine General Hospital from 2015 to 2019, 293 (0.98%) pregnant women had CVD. Of the CVDs present in this cohort, congenital heart diseases (n = 119, 40.6%) were the most common, followed by rheumatic heart disease (n = 109, 37.2%). Maternal adverse events were rarely observed. Four women experienced symptomatic arrhythmias, two presented with worsening heart failure, three experienced thromboembolic events, and one had cerebrovascular infarction. There was no reported maternal death, cardiac arrest, shock, or acute renal failure. The majority (69.3%) of the women included in the study were delivered by spontaneous vaginal delivery and assisted vaginal delivery by vacuum or forceps; however, a significant portion of these women had undergone cesarean section. Almost all the study cohort delivered live births, with most neonates being delivered at 37–38 weeks gestational age (83.6%) and only 16.0% born preterm. However, a significant portion, a third of the neonates, were classified as having low birth weight. Around 17.4% of neonates born from gravidocardiac mothers were admitted neonatal intensive care unit. Conditions associated with preterm birth were low educational attainment, previous history of early neonatal death, maternal low ejection fraction, and abnormal maternal left ventricular geometry. The conditions associated with SGA babies were high gravidity and parity, a history of abortion/stillbirth, a history of previous cesarean section delivery, low ejection fraction, a history of multiple gestations, and higher BMI. Conclusion In this cohort study, adverse maternal outcomes were rarely observed. CVD in pregnancy is associated with an increased risk of preterm birth and SGA babies. We identified certain maternal conditions and sociodemographic factors associated with these outcomes. Despite having CVD, our study cohort had no mortality from the pregnancy.
{"title":"Maternal and neonatal outcomes among pregnant women with cardiovascular disease in the Philippines: a retrospective cross-sectional study from 2015–2019","authors":"F. Rivera, John Vincent Magalong, O. Tantengco, G. F. Mangubat, Mary Grace Villafuerte, A. Volgman","doi":"10.1080/14767058.2022.2076590","DOIUrl":"https://doi.org/10.1080/14767058.2022.2076590","url":null,"abstract":"Abstract Purpose Several studies link maternal cardiovascular disease (CVD) to maternal and fetal morbidity and mortality. This study describes the profile of maternal, obstetric, and neonatal outcomes among pregnant women with CVD in a tertiary hospital in the Philippines. It identifies the clinical and sociodemographic variables associated with these outcomes. Materials and Methods A single-center, retrospective analysis of pregnant women admitted for delivery at the Philippine General Hospital from 2015 to 2019 was performed. Of these patients, pregnant women with CVD were identified as the cohort for this study. Data on clinical and sociodemographic factors, maternal major adverse cardiovascular events, neonatal adverse clinical events, and obstetric complications were collected. Logistic regression analysis was performed to determine the odds ratio for the risk factors for small-for-gestational-age (SGA) babies and preterm birth. Results Among 30,053 delivery admissions in the Philippine General Hospital from 2015 to 2019, 293 (0.98%) pregnant women had CVD. Of the CVDs present in this cohort, congenital heart diseases (n = 119, 40.6%) were the most common, followed by rheumatic heart disease (n = 109, 37.2%). Maternal adverse events were rarely observed. Four women experienced symptomatic arrhythmias, two presented with worsening heart failure, three experienced thromboembolic events, and one had cerebrovascular infarction. There was no reported maternal death, cardiac arrest, shock, or acute renal failure. The majority (69.3%) of the women included in the study were delivered by spontaneous vaginal delivery and assisted vaginal delivery by vacuum or forceps; however, a significant portion of these women had undergone cesarean section. Almost all the study cohort delivered live births, with most neonates being delivered at 37–38 weeks gestational age (83.6%) and only 16.0% born preterm. However, a significant portion, a third of the neonates, were classified as having low birth weight. Around 17.4% of neonates born from gravidocardiac mothers were admitted neonatal intensive care unit. Conditions associated with preterm birth were low educational attainment, previous history of early neonatal death, maternal low ejection fraction, and abnormal maternal left ventricular geometry. The conditions associated with SGA babies were high gravidity and parity, a history of abortion/stillbirth, a history of previous cesarean section delivery, low ejection fraction, a history of multiple gestations, and higher BMI. Conclusion In this cohort study, adverse maternal outcomes were rarely observed. CVD in pregnancy is associated with an increased risk of preterm birth and SGA babies. We identified certain maternal conditions and sociodemographic factors associated with these outcomes. Despite having CVD, our study cohort had no mortality from the pregnancy.","PeriodicalId":22921,"journal":{"name":"The Journal of Maternal-Fetal & Neonatal Medicine","volume":"128 1","pages":"9922 - 9933"},"PeriodicalIF":0.0,"publicationDate":"2022-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87633413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-22DOI: 10.1080/14767058.2022.2075695
T. Strauss, A. Dutton, Christina Cary, Emily Boniferro, G. Stoffels, K. Feldman, F. Hussain, G. Ashmead, Zainab Al-ibraheemi, L. Brustman
Abstract Objective There is no consensus for the method of aneuploidy screening in pregnancy. Cell free DNA (cfDNA) is the most sensitive screen for trisomies 21, 13, and 18, however the first trimester screen (FTS) is a marker for other adverse outcomes, such as structural anomalies, growth restriction, and preeclampsia. In 2019, we offered FTS (nuchal translucency (NT) and analytes) with or without cfDNA. The purpose of this study was to assess clinical relevance of abnormal FTS in women with normal cfDNA. Methods We retrospectively reviewed women undergoing screening in our Fetal Evaluation Unit in 2019. Women included had normal cfDNA and abnormal FTS; consisting of NT >95%, PAPP-A < 0.4 MoM, beta-HCG >2.5 MoM, or overall increased risk of trisomies. Results 195 patients had abnormal FTS and normal cfDNA. 41 (21%) had adverse maternal outcomes including hypertension, abnormal placentation, and placental abruption. 34 (17%) had adverse fetal outcomes including growth restriction, structural anomalies, fetal demise, polyhydramnios, previable PPROM, necrotizing enterocolitis after a preterm birth, and a balanced translocation. Conclusion Abnormal FTS predicts adverse outcomes in 33% of women with normal cfDNA. Our data suggests that offering universal FTS with cfDNA may have clinical benefit.
{"title":"The role of the first trimester screen in the face of normal cell free DNA","authors":"T. Strauss, A. Dutton, Christina Cary, Emily Boniferro, G. Stoffels, K. Feldman, F. Hussain, G. Ashmead, Zainab Al-ibraheemi, L. Brustman","doi":"10.1080/14767058.2022.2075695","DOIUrl":"https://doi.org/10.1080/14767058.2022.2075695","url":null,"abstract":"Abstract Objective There is no consensus for the method of aneuploidy screening in pregnancy. Cell free DNA (cfDNA) is the most sensitive screen for trisomies 21, 13, and 18, however the first trimester screen (FTS) is a marker for other adverse outcomes, such as structural anomalies, growth restriction, and preeclampsia. In 2019, we offered FTS (nuchal translucency (NT) and analytes) with or without cfDNA. The purpose of this study was to assess clinical relevance of abnormal FTS in women with normal cfDNA. Methods We retrospectively reviewed women undergoing screening in our Fetal Evaluation Unit in 2019. Women included had normal cfDNA and abnormal FTS; consisting of NT >95%, PAPP-A < 0.4 MoM, beta-HCG >2.5 MoM, or overall increased risk of trisomies. Results 195 patients had abnormal FTS and normal cfDNA. 41 (21%) had adverse maternal outcomes including hypertension, abnormal placentation, and placental abruption. 34 (17%) had adverse fetal outcomes including growth restriction, structural anomalies, fetal demise, polyhydramnios, previable PPROM, necrotizing enterocolitis after a preterm birth, and a balanced translocation. Conclusion Abnormal FTS predicts adverse outcomes in 33% of women with normal cfDNA. Our data suggests that offering universal FTS with cfDNA may have clinical benefit.","PeriodicalId":22921,"journal":{"name":"The Journal of Maternal-Fetal & Neonatal Medicine","volume":"1 1","pages":"9907 - 9912"},"PeriodicalIF":0.0,"publicationDate":"2022-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75575482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-22DOI: 10.1080/14767058.2022.2077098
T.B. Gowtham, S. Venkatesh, S. Palanisamy, S. Rathod
Abstract Objective Vitamin D deficiency in pregnant women is of special concern as mother is the only source of vitamin D for the developing fetus, and maternal hypovitaminosis D has been implicated in a number of maternal and neonatal adverse outcomes. The objective of this study was to assess the association of maternal circulating 25-hydroxy vitamin D3 [25(OH)D] concentration with cord blood 25(OH)D and adverse birth and neonatal outcomes. Methods This prospective cohort study was conducted in Mahatma Gandhi Medical College and Research Institute (MGMCRI) from January 2020 to December 2020. 121 babies born to mothers with singleton pregnancy tested for serum 25(OH)D level on admission for safe confinement were included in the study and cord blood of the babies were sampled for 25(OH)D. Based on the maternal 25(OH)D level, babies were categorized as those born to mothers with sufficient vitamin D level and those born to mothers with hypovitaminosis D (deficient/insufficient) and primary and secondary outcome was compared between two groups. Results Maternal and cord blood hypovitaminosis D was observed in 65% of mothers and 68.6% of babies, respectively. Maternal vitamin D level was the single most significant predictor of cord blood vitamin D level with five-fold increased risk of cord blood hypovitaminosis D in babies born to mothers with hypovitaminosis D. Birthweight (t = −2.219, p = .028) and preterm birth (aOR = 4.417, 95% CI: 1.03–18.9) was significantly associated with maternal hypovitaminosis D and a trend toward increased risk of LBW (aOR − 2.1, 95%CI: 0.6–7.3), SGA babies (aOR − 1.5, 95% CI: 0.5–4.7), perinatal depression (aOR − 1.5, 95% CI: 0.4–5.8) and neonatal hyperbilirubinemia (aOR = 2.68, 95%CI: 0.942–7.6) was observed. Conclusions Hypovitaminosis D in pregnant women is a significant health issue affecting both the mother and her baby. Safest dose for supplementation during pregnancy to prevent adverse perinatal outcome needs to be evaluated.
{"title":"Impact of maternal hypovitaminosis D on birth and neonatal outcome – a prospective cohort study","authors":"T.B. Gowtham, S. Venkatesh, S. Palanisamy, S. Rathod","doi":"10.1080/14767058.2022.2077098","DOIUrl":"https://doi.org/10.1080/14767058.2022.2077098","url":null,"abstract":"Abstract Objective Vitamin D deficiency in pregnant women is of special concern as mother is the only source of vitamin D for the developing fetus, and maternal hypovitaminosis D has been implicated in a number of maternal and neonatal adverse outcomes. The objective of this study was to assess the association of maternal circulating 25-hydroxy vitamin D3 [25(OH)D] concentration with cord blood 25(OH)D and adverse birth and neonatal outcomes. Methods This prospective cohort study was conducted in Mahatma Gandhi Medical College and Research Institute (MGMCRI) from January 2020 to December 2020. 121 babies born to mothers with singleton pregnancy tested for serum 25(OH)D level on admission for safe confinement were included in the study and cord blood of the babies were sampled for 25(OH)D. Based on the maternal 25(OH)D level, babies were categorized as those born to mothers with sufficient vitamin D level and those born to mothers with hypovitaminosis D (deficient/insufficient) and primary and secondary outcome was compared between two groups. Results Maternal and cord blood hypovitaminosis D was observed in 65% of mothers and 68.6% of babies, respectively. Maternal vitamin D level was the single most significant predictor of cord blood vitamin D level with five-fold increased risk of cord blood hypovitaminosis D in babies born to mothers with hypovitaminosis D. Birthweight (t = −2.219, p = .028) and preterm birth (aOR = 4.417, 95% CI: 1.03–18.9) was significantly associated with maternal hypovitaminosis D and a trend toward increased risk of LBW (aOR − 2.1, 95%CI: 0.6–7.3), SGA babies (aOR − 1.5, 95% CI: 0.5–4.7), perinatal depression (aOR − 1.5, 95% CI: 0.4–5.8) and neonatal hyperbilirubinemia (aOR = 2.68, 95%CI: 0.942–7.6) was observed. Conclusions Hypovitaminosis D in pregnant women is a significant health issue affecting both the mother and her baby. Safest dose for supplementation during pregnancy to prevent adverse perinatal outcome needs to be evaluated.","PeriodicalId":22921,"journal":{"name":"The Journal of Maternal-Fetal & Neonatal Medicine","volume":"101 1","pages":"9940 - 9947"},"PeriodicalIF":0.0,"publicationDate":"2022-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76207266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-05DOI: 10.1080/14767058.2022.2072723
V. Ferianec, M. Križko, M. Gábor, P. Papcun, Martin Alföldi, Michaela Feriancová
Abstract Objective To assess the use of amniopatch – intraamniotic application of maternal platelets and cryoprecipitate, in patients after spontaneous previable rupture of membranes (sPPPROM) in terms of its effect on the course and outcome of pregnancy in the largest cohort so far. Since the amniopatch is currently used only to treat patients with iatrogenic preterm rupture of membranes, aim of this study was to find out, if amniopatch could be also used in case of sPPPROM as a safe alternative to currently used expectant management and to compare the results with published data on expectant management. Methods The study included 53 patients with single-fetal pregnancy after sPPPROM who underwent amniopatch as an experimental method in the years 2008–2019. Authors evaluated individual characteristics for the whole group as well as a subgroup of live-born neonates who survived to discharge and abortions/live-born infants who did not survive to discharge. Results The mean time of sPPPROM was 19 + 3 gestational week (gw) and of amniopatch performance 22 + 0 gw. Across the group, the miscarriage rate was 33.96%, survival rate 66.03%, mortality rate after delivery 8.57%, survival rate to discharge 60.37%. The mean time of latency period was 5 + 3 gw in the total group, 7 + 1 gw in the group of live births who survived to discharge. We did not find any maternal/fetal complications related directly to amniopatch procedure. Conclusion Amniopatch is a safe treatment alternative in patients with sPPPROM who require an active approach. It is associated with high percentage of a success rate in terms of duration of pregnancy and neonatal survival. In order to elucidate the possible mechanism of amniopatch effect in sPPPROM despite failure of complete sealing of membrane defect, authors give novel hypothesis of antimicrobial effect of amniopatch based on literature data.
{"title":"Amniopatch as an active treatment of spontaneous previable rupture of membranes","authors":"V. Ferianec, M. Križko, M. Gábor, P. Papcun, Martin Alföldi, Michaela Feriancová","doi":"10.1080/14767058.2022.2072723","DOIUrl":"https://doi.org/10.1080/14767058.2022.2072723","url":null,"abstract":"Abstract Objective To assess the use of amniopatch – intraamniotic application of maternal platelets and cryoprecipitate, in patients after spontaneous previable rupture of membranes (sPPPROM) in terms of its effect on the course and outcome of pregnancy in the largest cohort so far. Since the amniopatch is currently used only to treat patients with iatrogenic preterm rupture of membranes, aim of this study was to find out, if amniopatch could be also used in case of sPPPROM as a safe alternative to currently used expectant management and to compare the results with published data on expectant management. Methods The study included 53 patients with single-fetal pregnancy after sPPPROM who underwent amniopatch as an experimental method in the years 2008–2019. Authors evaluated individual characteristics for the whole group as well as a subgroup of live-born neonates who survived to discharge and abortions/live-born infants who did not survive to discharge. Results The mean time of sPPPROM was 19 + 3 gestational week (gw) and of amniopatch performance 22 + 0 gw. Across the group, the miscarriage rate was 33.96%, survival rate 66.03%, mortality rate after delivery 8.57%, survival rate to discharge 60.37%. The mean time of latency period was 5 + 3 gw in the total group, 7 + 1 gw in the group of live births who survived to discharge. We did not find any maternal/fetal complications related directly to amniopatch procedure. Conclusion Amniopatch is a safe treatment alternative in patients with sPPPROM who require an active approach. It is associated with high percentage of a success rate in terms of duration of pregnancy and neonatal survival. In order to elucidate the possible mechanism of amniopatch effect in sPPPROM despite failure of complete sealing of membrane defect, authors give novel hypothesis of antimicrobial effect of amniopatch based on literature data.","PeriodicalId":22921,"journal":{"name":"The Journal of Maternal-Fetal & Neonatal Medicine","volume":"20 1","pages":"9900 - 9906"},"PeriodicalIF":0.0,"publicationDate":"2022-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90667782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-27DOI: 10.1080/14767058.2022.2049748
Morgen S Doty, Han-Yang Chen, Rebecca Grace, Sunbola S Ashimi, S. Chauhan
Abstract Objective To compare stress, anxiety and depression levels among 3 groups of pregnant women: 1) low-risk outpatient (LRO), 2) high-risk outpatient (HRO), and 3) inpatient (IP). Methods This was a cross-sectional study using validated instruments. Inclusion criteria were pregnancies 23–37 weeks and maternal age > 18 years. The primary outcome was mean/median scores of Perceived Stress Scale (PSS), State Trait Anxiety Inventory (STAI), and Edinburgh Depression Scale (EDS). Secondary outcome was rate of abnormal scores. Results Among 190 women approached, 180 (95%) participated, with 60 (33%) in each group. Mean PSS scores (range 0–40) significantly increased from LRO (12.0, standard deviation [SD] 7.8) to HRO (14.7, SD 7.9) to IP (15.6, SD 8.2); p = .04. Mean STAI scores (range 20–80) also significantly increased from LRO (32.0, SD 11.1) to HRO (35.8, SD 11.9) to IP (40.9, SD 13.1); p < .01. Abnormal anxiety (STAI ≥ 40) was present in 40% of women and significantly higher among IP compared to LRO (56% vs 25%; RR 2.24, 95% CI 1.36–3.67; aRR 2.24, 95% CI 1.34–3.74). Conclusion Stress and anxiety scores significantly differ in LRO, HRO, and IP women. While depression screening is common postpartum, screening for stress, anxiety and depression prenatally may be beneficial.
{"title":"Stress, anxiety and depression levels in pregnancy: outpatient versus inpatient","authors":"Morgen S Doty, Han-Yang Chen, Rebecca Grace, Sunbola S Ashimi, S. Chauhan","doi":"10.1080/14767058.2022.2049748","DOIUrl":"https://doi.org/10.1080/14767058.2022.2049748","url":null,"abstract":"Abstract Objective To compare stress, anxiety and depression levels among 3 groups of pregnant women: 1) low-risk outpatient (LRO), 2) high-risk outpatient (HRO), and 3) inpatient (IP). Methods This was a cross-sectional study using validated instruments. Inclusion criteria were pregnancies 23–37 weeks and maternal age > 18 years. The primary outcome was mean/median scores of Perceived Stress Scale (PSS), State Trait Anxiety Inventory (STAI), and Edinburgh Depression Scale (EDS). Secondary outcome was rate of abnormal scores. Results Among 190 women approached, 180 (95%) participated, with 60 (33%) in each group. Mean PSS scores (range 0–40) significantly increased from LRO (12.0, standard deviation [SD] 7.8) to HRO (14.7, SD 7.9) to IP (15.6, SD 8.2); p = .04. Mean STAI scores (range 20–80) also significantly increased from LRO (32.0, SD 11.1) to HRO (35.8, SD 11.9) to IP (40.9, SD 13.1); p < .01. Abnormal anxiety (STAI ≥ 40) was present in 40% of women and significantly higher among IP compared to LRO (56% vs 25%; RR 2.24, 95% CI 1.36–3.67; aRR 2.24, 95% CI 1.34–3.74). Conclusion Stress and anxiety scores significantly differ in LRO, HRO, and IP women. While depression screening is common postpartum, screening for stress, anxiety and depression prenatally may be beneficial.","PeriodicalId":22921,"journal":{"name":"The Journal of Maternal-Fetal & Neonatal Medicine","volume":"99 1","pages":"9608 - 9613"},"PeriodicalIF":0.0,"publicationDate":"2022-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84009448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-21DOI: 10.1080/14767058.2022.2066992
Vania Aldrete-Cortez, M. Rendón-Macías, H. Azcorra, Octavio Salvador-Ginez
Abstract Background Fetal growth restriction (FGR) may be related to ethnicity. Additionally, ethnic groups experience adverse socioeconomic circumstances that increase FGR risk. However, the dearth of evidence of the interaction between socioeconomic factors and FGR highlights the need for additional research. Objective To analyze the association between socioeconomic factors and FGR in Maya and non-Maya populations in Yucatan, Mexico. Methods A total of 21,320 singleton births in 2017 in Yucatan were analyzed. The student’s t-test and the chi-square test were used to compare the means and proportions of maternal and perinatal variables between the FGR group and the birthweight appropriate for gestational age (AGA) group. Path analysis was performed to identify the direct and indirect effects of socioeconomic factors on FGR and mediators between predictors and FGR. Results The prevalence of FGR at birth was 9.06%; this rate was higher in the Maya population (12.4, 95% CI 11.3–13.5), without differences between socioeconomic levels. Path analysis revealed sociostructural variables (ethnicity and poverty) are reliable predictors of FGR at birth mediated by maternal education (β = −.152, p < .001) and teenage pregnancy (β = .065, p = .037). The proposal path model had a good fit index CFI = .968, TLI = .920, RMSEA = .046. Conclusion The prevalence of FGR was higher among Maya women than non-Maya women The socioeconomic conditions associated with FGR at birth were ethnicity, poverty, maternal education, and teenage pregnancy. Maternal education and teenage pregnancy act as mediators between sociostructural variables and FGR at birth.
胎儿生长受限(FGR)可能与种族有关。此外，少数民族经历不利的社会经济环境，增加了FGR风险。然而，缺乏社会经济因素与FGR之间相互作用的证据，这凸显了进一步研究的必要性。目的分析墨西哥尤卡坦地区玛雅人和非玛雅人FGR与社会经济因素的关系。方法对2017年尤卡坦地区21320例单胎分娩进行分析。采用学生t检验和卡方检验比较FGR组和适宜孕龄出生体重(AGA)组的产妇和围产期变量的均值和比例。通过通径分析确定社会经济因素对FGR的直接和间接影响，以及预测因子与FGR之间的中介效应。结果新生儿FGR患病率为9.06%;这一比率在玛雅人群中更高(12.4,95% CI 11.3-13.5)，在社会经济水平之间没有差异。通径分析显示，社会结构变量(种族和贫困)是由母亲教育介导的出生时FGR的可靠预测因子(β =−)。152, p < .001)和青少年怀孕(β = .065, p = .037)。建议路径模型的拟合指数CFI = 0.968, TLI = 0.920, RMSEA = 0.046。结论玛雅女性的FGR患病率高于非玛雅女性，与FGR相关的社会经济条件是种族、贫困、母亲教育和少女怀孕。母亲教育和少女怀孕在社会结构变量和出生时FGR之间起中介作用。
{"title":"Differential fetal growth rates mediated by sociodemographic factors in Yucatan, Mexico: an epidemiological study","authors":"Vania Aldrete-Cortez, M. Rendón-Macías, H. Azcorra, Octavio Salvador-Ginez","doi":"10.1080/14767058.2022.2066992","DOIUrl":"https://doi.org/10.1080/14767058.2022.2066992","url":null,"abstract":"Abstract Background Fetal growth restriction (FGR) may be related to ethnicity. Additionally, ethnic groups experience adverse socioeconomic circumstances that increase FGR risk. However, the dearth of evidence of the interaction between socioeconomic factors and FGR highlights the need for additional research. Objective To analyze the association between socioeconomic factors and FGR in Maya and non-Maya populations in Yucatan, Mexico. Methods A total of 21,320 singleton births in 2017 in Yucatan were analyzed. The student’s t-test and the chi-square test were used to compare the means and proportions of maternal and perinatal variables between the FGR group and the birthweight appropriate for gestational age (AGA) group. Path analysis was performed to identify the direct and indirect effects of socioeconomic factors on FGR and mediators between predictors and FGR. Results The prevalence of FGR at birth was 9.06%; this rate was higher in the Maya population (12.4, 95% CI 11.3–13.5), without differences between socioeconomic levels. Path analysis revealed sociostructural variables (ethnicity and poverty) are reliable predictors of FGR at birth mediated by maternal education (β = −.152, p < .001) and teenage pregnancy (β = .065, p = .037). The proposal path model had a good fit index CFI = .968, TLI = .920, RMSEA = .046. Conclusion The prevalence of FGR was higher among Maya women than non-Maya women The socioeconomic conditions associated with FGR at birth were ethnicity, poverty, maternal education, and teenage pregnancy. Maternal education and teenage pregnancy act as mediators between sociostructural variables and FGR at birth.","PeriodicalId":22921,"journal":{"name":"The Journal of Maternal-Fetal & Neonatal Medicine","volume":"23 1","pages":"9884 - 9892"},"PeriodicalIF":0.0,"publicationDate":"2022-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82511582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-19DOI: 10.1080/14767058.2022.2066993
Elijah H. Bolin, B. Spray, P. Mourani, Craig Porter, R. Collins
Abstract Objective To assess the association between hypertrophic cardiomyopathy (HCM) and mortality among infants of diabetic mothers (IDMs). Methods We performed a retrospective cohort study of hospitalized IDMs admitted at ≤14-days-old in the Pediatric Health Information System (years 2004 − 2019). Multivariable logistic regression was used to evaluate the association between HCM and mortality; covariates in the model were prematurity, sex, and congenital malformations of the cardiovascular, nervous, urinary and musculoskeletal systems. Results Among 32,993 IDMs, there were 203 (0.6%) with HCM. Black and Hispanic children were disproportionately represented among children with HCM compared to those without HCM (23.2 vs. 14.9%, p = .001 for Black, and 30.0 vs. 22.1%, p = .007 for Hispanic). IDMs with HCM were also larger at birth (median birth weight 4120 g [interquartile range 3600-4703] vs. 3270 g [interquartile range 2535–3910]; p < .001). In-hospital mortality in patients with HCM was greater than in those without HCM (4.9 vs. 1.3%, p < 0.001), and odds of mortality were greater among those with HCM (adjusted odds ratio 2.10, 95% confidence interval: 1.04−4.25; p = .038). Conclusion We identify HCM as a contributor to in-hospital mortality. These data reinforce the need for more specific diagnostic criteria, better prevention of maternal diabetes, and effective therapies for HCM in IDMs.
摘要目的探讨糖尿病母亲(IDMs)婴儿肥厚性心肌病(HCM)与死亡率的关系。方法:我们对2004 - 2019年儿科健康信息系统(child Health Information System)中出生≤14天的住院idm进行回顾性队列研究。采用多变量logistic回归评估HCM与死亡率的相关性;模型中的协变量为早产儿、性别以及心血管、神经、泌尿和肌肉骨骼系统的先天性畸形。结果32993例idm中，HCM 203例(0.6%);黑人和西班牙裔儿童在HCM儿童中的比例高于非HCM儿童(23.2% vs. 14.9%， p =。黑人为0.001,30.0比22.1%，p =。007(西班牙语)。患有HCM的idm在出生时也较大(出生体重中位数为4120 g[四分位数范围3600-4703]vs. 3270 g[四分位数范围2535-3910];p < 0.001)。HCM患者的住院死亡率高于非HCM患者(4.9 vs. 1.3%， p < 0.001)， HCM患者的死亡率更高(校正优势比2.10,95%可信区间:1.04−4.25;p = .038)。结论:HCM是院内死亡率的一个因素。这些数据强调需要更具体的诊断标准，更好地预防孕产妇糖尿病，以及对idm HCM的有效治疗。
{"title":"Mortality among infants of diabetic mothers with hypertrophic cardiomyopathy","authors":"Elijah H. Bolin, B. Spray, P. Mourani, Craig Porter, R. Collins","doi":"10.1080/14767058.2022.2066993","DOIUrl":"https://doi.org/10.1080/14767058.2022.2066993","url":null,"abstract":"Abstract Objective To assess the association between hypertrophic cardiomyopathy (HCM) and mortality among infants of diabetic mothers (IDMs). Methods We performed a retrospective cohort study of hospitalized IDMs admitted at ≤14-days-old in the Pediatric Health Information System (years 2004 − 2019). Multivariable logistic regression was used to evaluate the association between HCM and mortality; covariates in the model were prematurity, sex, and congenital malformations of the cardiovascular, nervous, urinary and musculoskeletal systems. Results Among 32,993 IDMs, there were 203 (0.6%) with HCM. Black and Hispanic children were disproportionately represented among children with HCM compared to those without HCM (23.2 vs. 14.9%, p = .001 for Black, and 30.0 vs. 22.1%, p = .007 for Hispanic). IDMs with HCM were also larger at birth (median birth weight 4120 g [interquartile range 3600-4703] vs. 3270 g [interquartile range 2535–3910]; p < .001). In-hospital mortality in patients with HCM was greater than in those without HCM (4.9 vs. 1.3%, p < 0.001), and odds of mortality were greater among those with HCM (adjusted odds ratio 2.10, 95% confidence interval: 1.04−4.25; p = .038). Conclusion We identify HCM as a contributor to in-hospital mortality. These data reinforce the need for more specific diagnostic criteria, better prevention of maternal diabetes, and effective therapies for HCM in IDMs.","PeriodicalId":22921,"journal":{"name":"The Journal of Maternal-Fetal & Neonatal Medicine","volume":"47 1","pages":"9893 - 9899"},"PeriodicalIF":0.0,"publicationDate":"2022-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75357698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-19DOI: 10.1080/14767058.2022.2065193
Olivet Martinez, H. Moran, S. Wolff, Charles P. Gibbs, Gene T. Lee, K. Gorman, Angela S. Martin
Abstract Objective To compare vaginal progesterone to cerclage in preventing preterm birth and adverse perinatal outcomes in women with a singleton gestation, incidentally found sonographic cervical length of <15 mm, and no history of preterm birth. Study design A retrospective cohort study was conducted on 68 women who delivered at the University of Kansas Health System with a singleton gestation found to have a cervical length <15 mm on transvaginal ultrasound and no history of preterm birth. Women treated with vaginal progesterone (n = 29) were compared to women who underwent cerclage placement (n = 39). The primary outcome was preterm birth at <34 weeks of gestation. Secondary outcomes include preterm birth at <37 and <28 weeks of gestation and neonatal morbidities. Results Of the 268 patients who had a cervical length of <15 mm on transvaginal ultrasound, 68 participants met inclusion criteria and were included in the final analysis. Twenty-nine participants received vaginal progesterone and 39 participants received cervical cerclage. The average cervical length at initiation of therapy was greater in the progesterone cohort versus cerclage cohort, respectively (10.5 vs. 8.0 mm, p < .01). All other baseline characteristics were similar between groups, including no difference in average gestational age at initiation of therapy (21.6 vs. 21.5 weeks, p = .87). Average latency after therapy did not differ between groups (100 vs. 92.7 days p = .43). The incidence of preterm birth at <37 weeks (OR = 1.49, 95% CI = 0.57–3.93), <34 weeks (OR = 1.47, 95% CI = 0.52–4.18), and <28 weeks (OR = 1.90, 95% CI = 0.45–8.07), did not differ significantly between groups. Additionally, no difference in neonatal morbidity was detected. Conclusion At our institution, we found no difference between vaginal progesterone and cerclage in the average latency period or risk of preterm birth among women with an incidental short cervix of <15 mm and no history of preterm birth, despite the significantly shorter initial cervical length in the cerclage group. These findings suggest either vaginal progesterone or cerclage could be used to reduce the risk of preterm birth among this high-risk population.
摘要目的比较阴道孕酮与阴道环扎术对单胎妊娠、宫颈超声长度<15 mm、无早产史的孕妇预防早产及围产期不良结局的效果。研究设计一项回顾性队列研究对68名在堪萨斯大学卫生系统分娩的单胎妊娠妇女进行了研究，经阴道超声检查发现宫颈长度< 15mm，无早产史。接受阴道孕酮治疗的女性(n = 29)与接受环扎术的女性(n = 39)进行比较。主要结局是妊娠<34周的早产。次要结局包括妊娠<37周和<28周的早产和新生儿发病率。结果经阴道超声检查宫颈长度< 15mm的268例患者中，有68例符合纳入标准，纳入最终分析。29名参与者接受阴道黄体酮治疗，39名参与者接受宫颈环切术。治疗开始时，孕酮组的平均宫颈长度大于环扎组(10.5 mm vs 8.0 mm, p < 0.01)。所有其他基线特征在两组之间相似，包括治疗开始时的平均胎龄无差异(21.6周对21.5周，p = 0.87)。治疗后平均潜伏期在两组间无差异(100天vs. 92.7天p = 0.43)。<37周(OR = 1.49, 95% CI = 0.57-3.93)、<34周(OR = 1.47, 95% CI = 0.52-4.18)和<28周(OR = 1.90, 95% CI = 0.45-8.07)的早产发生率组间无显著差异。此外，没有发现新生儿发病率的差异。结论:在我们的机构，我们发现阴道孕酮和环扎术在意外短宫颈< 15mm且无早产史的妇女中，平均潜伏期和早产风险没有差异，尽管环扎术组的初始宫颈长度明显较短。这些发现表明，阴道黄体酮或环扎术都可以用于降低高危人群的早产风险。
{"title":"Cerclage versus vaginal progesterone in low-risk pregnant women with a short cervix","authors":"Olivet Martinez, H. Moran, S. Wolff, Charles P. Gibbs, Gene T. Lee, K. Gorman, Angela S. Martin","doi":"10.1080/14767058.2022.2065193","DOIUrl":"https://doi.org/10.1080/14767058.2022.2065193","url":null,"abstract":"Abstract Objective To compare vaginal progesterone to cerclage in preventing preterm birth and adverse perinatal outcomes in women with a singleton gestation, incidentally found sonographic cervical length of <15 mm, and no history of preterm birth. Study design A retrospective cohort study was conducted on 68 women who delivered at the University of Kansas Health System with a singleton gestation found to have a cervical length <15 mm on transvaginal ultrasound and no history of preterm birth. Women treated with vaginal progesterone (n = 29) were compared to women who underwent cerclage placement (n = 39). The primary outcome was preterm birth at <34 weeks of gestation. Secondary outcomes include preterm birth at <37 and <28 weeks of gestation and neonatal morbidities. Results Of the 268 patients who had a cervical length of <15 mm on transvaginal ultrasound, 68 participants met inclusion criteria and were included in the final analysis. Twenty-nine participants received vaginal progesterone and 39 participants received cervical cerclage. The average cervical length at initiation of therapy was greater in the progesterone cohort versus cerclage cohort, respectively (10.5 vs. 8.0 mm, p < .01). All other baseline characteristics were similar between groups, including no difference in average gestational age at initiation of therapy (21.6 vs. 21.5 weeks, p = .87). Average latency after therapy did not differ between groups (100 vs. 92.7 days p = .43). The incidence of preterm birth at <37 weeks (OR = 1.49, 95% CI = 0.57–3.93), <34 weeks (OR = 1.47, 95% CI = 0.52–4.18), and <28 weeks (OR = 1.90, 95% CI = 0.45–8.07), did not differ significantly between groups. Additionally, no difference in neonatal morbidity was detected. Conclusion At our institution, we found no difference between vaginal progesterone and cerclage in the average latency period or risk of preterm birth among women with an incidental short cervix of <15 mm and no history of preterm birth, despite the significantly shorter initial cervical length in the cerclage group. These findings suggest either vaginal progesterone or cerclage could be used to reduce the risk of preterm birth among this high-risk population.","PeriodicalId":22921,"journal":{"name":"The Journal of Maternal-Fetal & Neonatal Medicine","volume":"7 1","pages":"9878 - 9883"},"PeriodicalIF":0.0,"publicationDate":"2022-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75528584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-18DOI: 10.1080/14767058.2022.2065192
H. Kim, Min Soo Kim, Y. Seo, S. Yum
Abstract Objective To evaluate whether advanced maternal age (35–39 years, AMA)/very advanced maternal age (≥40 years, VAMA) impacts neonatal outcomes of very-low-birth-weight (VLBW) infants. Methods Data of VLBW infants admitted to our unit were reviewed. Demographic findings and neonatal outcomes were compared among maternal age [(<35 years, not advanced maternal age, n = 329), AMA (n = 209), and VAMA (n = 43)] groups. Univariate and multivariate analyses were performed to identify the associated risk factors for neonatal outcomes. Result Mortality and overall morbidities showed no significant intergroup differences, except for massive pulmonary hemorrhage (MPH). Multivariate analysis revealed that AMA/VAMA was not significantly associated with MPH development, while ≥ two doses of surfactant administration was. Higher gestational age and antenatal corticosteroid administration were protective. Conclusion AMA/VAMA is not associated with neonatal mortality and morbidities. Since the proportion of AMA/VAMA mothers is expected to increase, perinatal medicine practitioners should focus on approaches before and immediately after birth of such infants.
{"title":"Short-term outcomes of very-low-birth-weight infants born to mothers of advanced and very advanced maternal age","authors":"H. Kim, Min Soo Kim, Y. Seo, S. Yum","doi":"10.1080/14767058.2022.2065192","DOIUrl":"https://doi.org/10.1080/14767058.2022.2065192","url":null,"abstract":"Abstract Objective To evaluate whether advanced maternal age (35–39 years, AMA)/very advanced maternal age (≥40 years, VAMA) impacts neonatal outcomes of very-low-birth-weight (VLBW) infants. Methods Data of VLBW infants admitted to our unit were reviewed. Demographic findings and neonatal outcomes were compared among maternal age [(<35 years, not advanced maternal age, n = 329), AMA (n = 209), and VAMA (n = 43)] groups. Univariate and multivariate analyses were performed to identify the associated risk factors for neonatal outcomes. Result Mortality and overall morbidities showed no significant intergroup differences, except for massive pulmonary hemorrhage (MPH). Multivariate analysis revealed that AMA/VAMA was not significantly associated with MPH development, while ≥ two doses of surfactant administration was. Higher gestational age and antenatal corticosteroid administration were protective. Conclusion AMA/VAMA is not associated with neonatal mortality and morbidities. Since the proportion of AMA/VAMA mothers is expected to increase, perinatal medicine practitioners should focus on approaches before and immediately after birth of such infants.","PeriodicalId":22921,"journal":{"name":"The Journal of Maternal-Fetal & Neonatal Medicine","volume":"68 1","pages":"9870 - 9877"},"PeriodicalIF":0.0,"publicationDate":"2022-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83594814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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