Journal of Maternal-Fetal & Neonatal Medicine最新文献

Objective: To characterize alterations in white matter and blood perfusion in normal fetuses using quantitative parameters derived from intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI).

Methods: A total of 138 fetuses underwent IVIM-MRI. Subjects were categorized into two groups: second trimester (24-28 weeks; n = 41) and third trimester (29-40 weeks; n = 97). A single voxel block was utilized as an ROI to acquire paired pure diffusion coefficient (D), pseudodiffusion coefficient (D*), and perfusion fraction (f) in specific brain regions.

Results: 1) D values decreased significantly with advancing gestational age in all brain regions except the bilateral frontal lobes. 2) D values were significantly lower in the third trimester compared to the second trimester in all regions except the bilateral frontal lobes. 3) Cerebral blood perfusion (f value) exhibited laterality in specific regions: The f value of the left thalamus was consistently higher than the right across all fetuses. This thalamic laterality was significant in the third trimester. Additionally, the left parietal lobe displayed a lower f value relative to the right during the second trimester.

Conclusion: The IVIM-derived D value provides a quantitative biomarker for assessing white matter maturational processes in the mid-to-late fetal stage of normal fetuses, offering potential clinical utility for early detection of delayed myelination. The f value metric revealed lateralized cerebral blood perfusion during normal fetal development, with laterality patterns evolving with gestational age.

Objective: Preterm prelabor rupture of membranes (PPROMs) is associated with high rates of neonatal mortality and morbidity. We aimed to review evidence on the risk of recurrent PPROM and preterm birth (PTB) in women with a history of PPROM in prior pregnancy.

Methods: PubMed, Embase, Scopus, and Web of Science databases were searched up to 26 August 2025, for studies reporting the recurrent risk of PPROM and/or PTB in the subsequent pregnancy. Pooled estimates with 95% confidence intervals (CIs) were calculated in the DerSimonian-Laird random-effects meta-analysis model.

Results: Nine studies were included. Pooled analysis showed that the overall risk of recurrent PPROM in women was 18% (95% CI: 12-25%). Inter-study heterogeneity was high (I² = 93%). On leave-one-out meta-analysis, the recurrence rate varied from 16% (95% CI: 11-22%) to 20% (95% CI: 14-27%). The risk of PTB when defined as <37 weeks was 34% (95% CI: 22-59%), while the risk was 23% (95% CI: 12-39%) and 20% (95% CI: 9-38%) when PTB was defined as <34 and <28 weeks, respectively. Subgroup analysis based on the definition of PPROM and location resulted in varied estimates.

Conclusions: Women with PPROM in the prior pregnancy have a high risk of recurrence of PPROM as well as PTB.

Introduction: Oxidative stress is a key component of maternal-fetal physiology and varies with the mode of delivery. Labor induces hypoxia-reoxygenation cycles that elevate reactive oxygen species, whereas elective cesarean section (CS) occurs in a controlled metabolic environment. Emergency CS combines labor-related hypoxia with acute surgical stress. Comprehensive comparisons of maternal and cord oxidative profiles across all delivery modes remain limited.

Methods: This prospective observational study included 126 term singleton pregnancies categorized as elective CS (n = 46), emergency CS (n = 39), or vaginal delivery (n = 41). Maternal blood was collected immediately before delivery and cord blood after birth. Total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI), and paraoxonase-1 (PON-1) activity were measured using automated RelAssay methods; OSI was calculated as (TOS/TAS)×100. Neonatal outcomes included Apgar scores and NICU admission. Group comparisons used ANOVA, Kruskal-Wallis, and chi-square tests, with ANCOVA adjusting for gestational age, maternal weight, diabetes, hypothyroidism, preeclampsia, and ASA use.

Results: Baseline characteristics were comparable. Emergency CS had lower Apgar-1 scores and higher NICU admission. Maternal OSI (p = 0.002) and PON-1 (p = 0.004) differed significantly, with elective CS showing the most favorable profile. Cord TOS (p < 0.001), OSI (p < 0.001), and PON-1 (p = 0.001) were also highest in emergency CS. Delivery mode independently predicted maternal OSI and PON-1, and cord TOS, OSI, and PON-1 (all p < 0.01).

Discussion: The pronounced oxidative shifts observed in emergency CS likely reflect the cumulative impact of prolonged labor, fetal distress, and abrupt surgical intervention. Elective CS, by avoiding labor-induced hypoxia and metabolic exhaustion, preserves a more balanced maternal-fetal redox environment. The parallel maternal and cord responses underscore the sensitivity of the fetoplacental unit to intrapartum oxidative changes. These findings clarify mechanistic differences between delivery modes and highlight redox status as a potential peripartum biomarker.

Conclusion: Elective CS preserves maternal-fetal redox homeostasis, whereas emergency CS results in significant oxidative disruption and poorer neonatal adaptation. These findings support the potential use of oxidative stress markers as adjunct indicators of acute intrapartum stress when interpreted alongside established clinical parameters.

Background: Fetal lung maturity (FLM) is closely associated with neonatal mortality, morbidity, and respiratory diseases such as neonatal respiratory distress syndrome (NRDS). At present, the assessment of FLM largely relies on invasive procedures, while the establishment of a noninvasive ultrasound-based method has important clinical significance.

Objective: To construct and validate a predictive model of FLM based on ultrasound parameters in late pregnancy, exploring a noninvasive approach for risk assessment in fetal lung development.

Methods: A total of 195 pregnant women (gestational age ≥34 weeks) who underwent ultrasound examinations at the Department of Ultrasound, The Fourth Hospital of Shijiazhuang, China, from January to December 2023 were enrolled. Maternal baseline information, ultrasound parameters, and neonatal outcomes were collected. Fetal lung maturity was assessed based on the occurrence of neonatal respiratory distress syndrome (NRDS), diagnosed using standard clinical criteria including symptoms, blood gas analysis, and chest X-ray findings. Propensity score matching (PSM) was performed with gestational age and corticosteroid use as matching conditions. Least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression were used to identify key predictors of FLM, and a nomogram prediction model was constructed. The model's discrimination and clinical utility were evaluated using 1,000 bootstrap resamples and 10-fold cross-validation.

Results: Among the 195 participants, the incidence of NRDS was 23.07%. Placental maturity, fetal breathing movement scores, and biparietal diameter were significantly higher in the lung-mature group compared with the NRDS group, while the proportion of gestational diabetes mellitus (GDM) was significantly higher in the NRDS group (all p < 0.005). Multivariate logistic regression after LASSO selection showed that GDM, placental maturity (p < 0.05), and biparietal diameter (OR = 0.027, 95% CI: 0.006-0.101, p < 0.001) were independent predictors of FLM. A nomogram incorporating these three predictors achieved an AUC of 0.871, and both bootstrap validation and 10-fold cross-validation showed promising discriminative ability in this sample; however, this performance is preliminary and requires validation in independent cohorts.

Conclusion: The nomogram developed in this study represents a preliminary model for evaluating fetal lung maturity using ultrasound measurements. However, these findings are from a small, single-center, cross-sectional study and require external validation in larger, diverse populations. BPD, gestational diabetes, and placental maturity play critical roles in FLM and warrant enhanced monitoring and management in clinical practice.

Aim: The association between maternal age and low birth weight (LBW) or small for gestational age (SGA) has been variably reported in previous epidemiological studies. In gestational diabetes mellitus (GDM), evidence on this issue remains limited and mixed. To date, no study has investigated these associations in Japanese women with GDM. The aim of this study was to address this gap by examining the association between maternal age and LBW/SGA in Japanese women with GDM.

Materials and methods: We enrolled 641 women with GDM in this study. Following exclusion of 94 cases with incomplete data, the final analytic sample comprised 547 women. Logistic regression analysis was performed to calculate crude odds ratios (ORs) and 95% confidence intervals (CIs) for the association between maternal age and LBW and SGA. Maternal age was categorized into tertiles (younger: <32 years, middle-aged: 32-35 years, and older: ≥36 years), and further evaluated in 5-year intervals (<30 years, 30-34 years, 35-39 years, and ≥40 years) for a more detailed analysis.

Results: The mean maternal age was 33.3 years. The prevalence of LBW and SGA was 12.8% and 9.0%, respectively. The younger group was independently and positively associated with LBW (adjusted OR, 2.43 [95% CI, 1.08-5.68]) and SGA (adjusted OR, 2.30 [95% CI, 1.19-4.65]). Compared with women aged 30-34 years old, those under 30 years old had significantly higher risks of both LBW (adjusted OR 3.63 [95% CI, 1.49-9.07], p for trend = 0.001) and SGA (adjusted OR 3.15 [95% CI, 1.50-6.77], p for trend = 0.001).

Conclusions: In Japanese patients with GDM, younger maternal age was independently associated with LBW and SGA.

Objective: Maternal diabetes is the most common causes of hypertrophic cardiomyopathy, which significantly increases the risk of fetal heart dysfunction. In this study, we sought to evaluate the effect of overt maternal diabetes on fetal cardiac function.

Methods: This is a single-center and case-control study consisting of 26 pregnant women with overt diabetes (case group) and 26 women with uncomplicated pregnancies (control group). Cardiac function was assessed twice in the fetal period (18-22 weeks and 28 weeks of gestation) and once in the neonatal period (one week of postnatal). Fetal cardiac function was assessed using early-diastolic maximum velocity index (Em) of mitral valve, end-diastolic maximum velocity index (Am) of mitral valve, Em/Am ratio, left ventricular myocardial performance index (LVMPI) and inter-ventricular mechanical delay index (IVMDI).

Results: The case and control groups were not significantly different in terms of maternal age and gestational age at the time of fetal Doppler evaluation. Em (p = 0.007), Am (p < 0.001), LVMPI (p = 0.003), and IVMDI (p = 0.026) were significantly higher in fetuses of diabetic mothers, while there was no significant difference in Em/Am ratio (p = 0.264). Eight fetuses (30.8%) of diabetic mothers had dyssynchrony, while no cases of dyssynchrony were seen in fetuses of non-diabetic mothers (p = 0.004). Infants of diabetic mothers were 8.8 times more likely to develop adverse neonatal outcomes than infants of healthy mothers (RR = 8.8, 95% CI: 1.71-45.31, p = 0.009). Regarding the predictive value of cardiac indices for adverse neonatal outcome, IVMDI had the area under curve of 0.887 (p = 0.001) and LVMPI had area under the curve of 0.762 (p = 0.024).

Conclusion: The findings of the current study revealed significant cardiac dysfunction and dyssynchrony in fetuses of diabetic pregnant women. We also found that the IVMDI, which indicates the extent of inter-ventricular dyssynchrony, and the LVMPI index, which indicates the global dysfunction of the heart, can be used to predict adverse neonatal outcomes in pregnancies complicated with overt diabetes.

Background: To further assess the relationship between obesity and infertility, we employed a novel anthropometric index, specifically designed to assess the relationship between a body shape index (ABSI) and infertility in women of childbearing age. Furthermore, we examined the correlation between ABSI and visceral obesity index (VAI) in relation to infertility.

Methods: A total of 1989 female participants of childbearing age were included, based on National Health and Nutrition Examination Survey (NHANES) data from 2013 to 2016. The ABSI is calculated by dividing waist circumference by body mass index (BMI) ^2/3* height^1/2. VAI was calculated using the following formula: waist circumference/(36.58 + (1.89*BMI)) x (triglycerides/0.81) × (1.52/HDL cholesterol). Infertility or fertility status was defined by interviewing female participants of childbearing age through a reproductive health questionnaire. Weighted multifactorial logistic regression analysis was used to explore the independent relationship between ABSI and infertility. Smoothed curve fitting, subgroup analyses and interaction tests were also performed.

Results: Among the 1989 participants, 183 (9.2%) women were categorized as infertile. Logistic regression modeling showed that ABSI was positively associated with infertility and remained significant even after adjusting for all confounders(OR = 1.31, 95% CI: 1.07-1.60, p = 0.0098). This association was consistent across all subgroups (age, race, smoking, alcohol consumption, hypertension, diabetes mellitus, and the regularity of menstruation over the previous 12 months), (p > 0.05 for all interactions). The results of the smooth curve fitting demonstrated a linear, positive association between ABSI and infertility.

Conclusion: There is a statistically significant positive correlation between body mass index and infertility. As a body shape index rises, women of childbearing age are at greater risk of infertility.

Objective: Women with Marfan-related disorders face an elevated risk of aortic dissection during pregnancy and the postpartum period. This study aimed to investigate the incidence of aortic dissection during the perinatal period in women with Marfan-related disorders.

Methods: This retrospective cohort study analyzed data extracted from the Japanese Diagnosis Procedure Combination, a nationwide administrative claims database. We included women diagnosed with Marfan-related disorders (Marfan syndrome, Loeys-Dietz syndrome, or Ehlers-Danlos syndrome) who delivered between 2010 and 2023. We assessed the incidence of aortic dissection during pregnancy or postpartum hospitalization, and the incidence of re-hospitalization for aortic dissection. Moreover, we described the use of cabergoline and the incidence of aortic dissection.

Results: During the study period, we identified a total of 226 deliveries by 175 women with Marfan-related disorders. Cesarean section accounted for 69.0% of deliveries. During pregnancy, 1.8% of cases (4/226) experienced aortic dissection and required aortic surgery. In the postpartum period, 2.7% of cases (6/226) experienced aortic dissection during postpartum hospitalization. Within 1 year after delivery, 2.7% of cases (6/226) underwent re-hospitalization for aortic dissection. Cabergoline was administered for elective avoidance of breastfeeding within 2 days postpartum in 15 (6.6%) cases. The incidence of postpartum aortic dissection did not differ significantly between cabergoline users and non-users.

Conclusions: Women with Marfan-related disorders may remain at risk of developing aortic dissection for up to 1 year postpartum.

Introduction: The prevalence of breech presentation ranges from 6.9% to 10.0% between weeks 32 and 36 of gestation, gradually declining to 3.0-5.0% by the time an external cephalic version (ECV) can be offered. The primary objective of our study was to identify the factors favoring a spontaneous version between the routine third-trimester ultrasound and the proposal of external cephalic version. We also compared the maternal and neonatal outcomes at delivery between fetuses who spontaneously turned to the cephalic presentation and those who were in the cephalic presentation after external cephalic version.

Method: This retrospective observational study included pregnant women with a breech fetus at their third trimester ultrasound scan (around 32 WG), who were under the care of a tertiary hospital between 2003 and 2022.

Results: A total of 2,439 women were included in the study. The rate of spontaneous version between 32 and 36-37 weeks was 65%. The favoring factors, after adjustment, were multiparity, maternal age under 25 years, polyhydramnios. No difference was found in the incidence of cesarean section (12.6% vs. 13.2% p = 0.32) or assisted vaginal delivery (12.1% vs. 13.0% p = 0.72) for fetuses lying in the cephalic presentation after external cephalic version, compared to those with spontaneous version into the cephalic presentation after third trimester scan.

Conclusion: The risk factors for a fetus remaining in the breech presentation after 32 weeks of gestation were similar to those associated with breech presentation in general. There was no difference in maternal or fetal outcomes between fetuses that were spontaneously or non-spontaneously versed fetuses (after external cephalic version).