Journal of Maternal-Fetal & Neonatal Medicine最新文献

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.

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.

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).

Objective: To investigate fetal intrahepatic umbilical-portal-systemic venous shunts (IHUPSVS).

Methods: The study retrospectively analyzed cases of IHUPSVS at a single center from January 2015 to December 2024. Ultrasonographic features, IHUPSVS types, and postnatal outcomes were recorded and followed up.

Results: Overall, 30 IHUPSVS cases, including 22 Type I (17 Ia and five Ib), two Type II, three Type III, and three Type IV cases, were identified. As gestational age increased, compensatory dilation of the hepatic artery (HA), cardiomegaly, fetal growth restriction (FGR), and abnormal hemodynamics became more prevalent. Type I was mainly linked to FGR. Types II and III showed compensatory dilation of the HA and cardiomegaly. All types were associated with fetal structural malformations, with Type IV being the most prominent. Eleven pregnancies were terminated, and 19 live births occurred, with natural closure.

Conclusion: Prenatal ultrasound is useful for diagnosing IHUPSVS, monitoring fetal growth and hemodynamics, and predicting prognosis by IHUPSVS types.

Objective: To evaluate the effects of Early Essential Newborn Care (EENC) on neonatal hypoglycemia and breastfeeding in late preterm and term cesarean-born infants.

Methods: In this RCT, infants were randomly assigned to the EENC group (immediate skin-to-skin contact and early breastfeeding) or the control group (standard care). Blood glucose was measured at 1, 3, and 6 h post-birth. Breastfeeding outcomes included the onset of lactogenesis II and exclusive breastfeeding at discharge. Time to first breastfeeding was recorded solely as a process fidelity check to confirm intervention adherence. We used multiple imputation as the primary analysis for missing data and conducted pre-specified sensitivity analyses, including a complete-case analysis.

Results: Infants in the EENC group had significantly higher blood glucose levels at 1 h (aMD = 11.56 mg/dL [95%CI: 8.85, 14.27]), 3 h (aMD = 9.06 mg/dL [95%CI: 7.08, 11.04]), and 6 h (aMD = 6.83 mg/dL [95%CI: 5.31, 8.36]) post-birth, compared to the control group (all p < 0.001). The RR for hypoglycemia was significantly lower in the EENC group (RR = 0.88, [95%CI: 0.80, 0.96], p = 0.006). Additionally, mothers in the EENC group experienced earlier onset of lactogenesis II (aMD=-8.82 h [95%CI: -10.23, -7.41], p < 0.001), and had a higher rate of exclusive breastfeeding (RR = 1.31 [95% CI: 1.02, 1.26], p = 0.022). Sensitivity analyses yielded consistent directions for primary glycemic and breastfeeding outcomes.

Conclusion: The EENC improves neonatal glucose regulation and breastfeeding in cesarean-born late preterm and term infants, potentially enhancing neonatal health, maternal-infant bonding, and postpartum transition.

Objectives: To explore the genetic value and clinical management strategies for subsequent pregnancies in women with a history of adverse obstetric outcomes.

Methods: 204 pregnant women with a history of adverse obstetric outcomes, including spontaneous abortions and/or offspring with developmental anomalies, were retrospectively enrolled. The subjects were categorized into four groups based on the adverse characteristics of previous obstetric histories: inborn developmental anomalies group (IDAG, n = 53), genetic anomalies group (GAG, n = 35), composite group (CG, n = 52), and unknown etiology group (UEG, n = 64). In the subsequent pregnancy, the following strategies were conducted: ① All the fetuses underwent standardized ultrasound screening; ② Invasive fetal prenatal diagnosis were performed, including karyotyping (n = 204), copy number variation sequencing (CNV-seq, n = 161) and whole exome sequencing (WES, n = 11); ③ Dynamic ultrasound assessments and clinical follow-ups of pregnancy outcomes ranging from six months to six years were carried; ④ Fetal outcomes and maternal clinical characteristics among the different groups were further compared.

Results: ① Mean maternal age was not significant among four groups, however, the median gravidity and the median number of spontaneous abortion in UEG were the highest (p < 0.05). ② 8.33% (17/204) fetal genetic anomalies in subsequent pregnancy were found with abnormal chromosomes and 13.04% (21/161) anomalies were found by CNV-seq, among which 12 were investigated additionally. However, no significant difference was in the detection rate (DR) of karyotypes or CNVs among four groups. ③ 13 (6.37%, 13/204) fetuses presented abnormal ultrasonic manifestations accompanied with CNVs or pathogenic genes, and the DR of 9.38% (6/64) in abnormal manifestations of UEG was the highest. ④ 17 (8.33%, 17/204) chose termination and the survivors' growth and development were normal in the follow-ups from six months to six years.

Conclusion: Prenatal genetic diagnosis should be recommended for all subsequent pregnancies of families with adverse obstetric history. In addition, dynamic ultrasound and follow-up management are essential for clinicians to optimize neonatal outcomes.

Objective: To evaluate the contribution of the Causes of Death and Associated Condition (CODAC) classification system in reducing the proportion of nonspecific and unspecified causes of stillbirths compared to the ICD-10 system and to assess maternal and pregnancy-related factors associated with stillbirth in Brazil.

Methods: A retrospective cross-sectional study was conducted in ten tertiary obstetric care facilities in Brazil, including cases of stillbirths 2009 to 2018. Data were obtained from medical records, death certificates, and postmortem investigations. The CODAC system was applied to identify specific causes of death, and maternal and pregnancy characteristics were evaluated to find associations with stillbirth. Agreement between the two systems was assessed using the kappa coefficient, and McNemar's test was used to evaluate differences in the prevalence of unspecified causes.

Results: Of the 3390 initially assessed cases, 2545 were included in the final analysis. The CODAC system reduced the proportion of unspecified stillbirths from 40.79% (ICD-10) to 22.00%. Regional disparities were evident. Cases with unspecified causes (ICD-10 P20/P95) were more prevalent in the northeast (56.4%), whereas other specific ICD-10 causes were predominant in the southeast (47.9%). Maternal conditions such as preeclampsia (24.0% vs. 18.6%, p = 0.004) and placental abruption (20.6% vs. 10.0%, p < 0.001) were significantly associated with cases in which a specific cause of stillbirth was assigned. The agreement between the classification systems was low (kappa = 0.376), and McNemar's test showed a significant difference (p < 0.001).

Conclusion: The CODAC improves the understanding of causes of death over the ICD-10 classification system currently used in Brazil. The CODAC was able to decrease the proportion of unexplained cases, which could potentially contribute to better informing maternal and perinatal health policies.