Journal of Maternal-Fetal & Neonatal Medicine最新文献

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: 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.

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).

Background: Fetal hemoglobin (HbF) plays a critical role in the progressive adaptation to the postnatal oxygen-rich environment in preterm infants due to its peculiar properties and its postnatal decrease has been associated to the combined adverse effects of increasing tissue hyperoxia and decreasing antioxidant defenses in preterm infants.

Purpose: We aimed to assess the association between HbF fractions and the risk of bronchopulmonary dysplasia (BPD) intraventricular hemorrhage (IVH), and retinopathy of prematurity (ROP).

Methods: We studied 166 preterm infants with a gestational age of 27.1 ± 1.6 weeks. One hundred and twenty-six infants (74%) had no or mild BPD, and 40 (24%) moderate to severe BPD. One hundred and forty-three infants (86%) had no or grade 1 IVH, and 23 (14%) grade 2-4 IVH. One hundred and thirty (80%) had no ROP, and 32 (20%) had any grade ROP. HbF fractions were recorded during the first seven days of life, at 14, 21, and 28 days of life, and 31, 34, and 36 weeks of postmenstrual age. Mean values during the first week of life (HbF_{1st week}) and at 31, 34, and 36 weeks (HbF_{31-36 weeks}) were calculated.

Results: Logistic regression analysis showed that: HbF_{31-36 weeks} decreased the risk of moderate to severe BPD (OR 0.944, 95% CI 0.911-0.977; p = 0.001); female sex (OR 0.278, 95% CI 0.093-0.832; p = 0.022) and HbF_{1st week} (OR 0.949, 95% CI 0.901-0.999; p = 0.048) decreased the risk of grade 2-4 IVH; and HbF_{1st week} (OR 0.958, 95% Cl 0.919-0.998; p = 0.042) and HbF_{31-36 weeks} (OR 0.956, 95% CI 0.927-0.986; p = 0.004) decreased the risk of any grade ROP.

Conclusion: Low HbF fractions were associated with increased risk of moderate-to severe BPD, grade 2-4 IVH, and any grade ROP. These results confirm previous findings and support the importance of minimizing blood sampling from these fragile patients.

Objective: Limited data informing evidence-based regimens for antibiotic use in neonates undergoing fetal myelomeningocele (fMMC) repair have been published to date, and no standard of care has been established across centers. The goal of this study was to describe current neonatal antibiotic use practices following fMMC repair within the Children's Hospitals Neonatal Consortium (CHNC), a collaborative network of North American institutions with Level IV neonatal intensive care units.

Methods: We conducted a cross-sectional survey of site sponsors at all 48 CHNC centers from April 2024 to January 2025, and invited CHNC Fetal Therapy Focus Group members in May 2024, with one response requested per center.

Results: A neonatologist at 34 centers (center response rate = 71%) completed the survey, of which 30 (88%) reported performing fMMC repair surgery (15/34, 44%) or delivering/receiving fMMC neonates (15/34, 44%) at their center. One-quarter of responding centers (7/30, 23%) reported having an existing clinical protocol for antibiotic management for fMMC neonates after birth. Notably, there was heterogeneity across existing protocols with respect to criteria for antibiotic use, the specific antibiotics used, and the duration of use. Responding centers reported administering antibiotics with guidance from infectious disease, neurosurgery, and fetal specialists. Two responding centers (6%) reported performing beta-2 transferrin testing on dehisced wounds when there is a suspected cerebrospinal fluid (CSF) leak, while the majority did not do so (20/30, 67%), and the remainder did not know their institutional practice (7/30, 23%).

Conclusions: Current antibiotic use in fMMC neonates after birth varies widely between centers in North America, highlighting the need for evidence-based data to inform the development of best practice guidelines.

Background: The growing prevalence of gestational diabetes mellitus (GDM) presents a significant clinical concern. In parallel, obesity has escalated to epidemic levels, and the mental health-GDM connection has been increasingly documented. Against this backdrop, the present study primarily investigates the independent and joint contributions of relative fat mass (RFM) and depression to GDM risk.

Methods: Data were collected from the National Health and Nutrition Examination Survey (NHANES) covering the years 2007-2020. The separate associations of RFM and depression with GDM history were analyzed using a weighted logistic regression model, while interaction analysis was conducted to explore their combined effect. Subgroup analyses were conducted for further validation.

Results: Among 8622 eligible participants, 775 (9.00%) had a history of GDM. The median age at first live birth was 22.00 years (19.00, 26.00). After adjusting for confounding variables, both increased RFM (OR = 1.07; 95% CI: 1.05-1.09) and depression scores (OR = 1.04; 95% CI: 1.02-1.06) were linked to an elevated risk of GDM. The coexistence of obesity (RFM ≥ 40%) and depression yielded a synergistic effect greater than their individual impacts (RERI = 0.87; ROR = 1.33). These findings were consistent across subgroup and sensitivity analyses.

Conclusions: Concurrent elevation in RFM and depressive symptoms significantly heightens the likelihood of GDM history. These results support the integration of metabolic and psychological factors into preventive frameworks targeting GDM history.