Journal of Maternal-Fetal & Neonatal Medicine最新文献

Background: Gestational diabetes mellitus (GDM) affects approximately one in six pregnant women worldwide, imposing a significant health and economic burden. The uric acid to high-density lipoprotein cholesterol ratio (UHR), as a biomarker reflecting metabolic dysfunction, may be utilized to assess the prevalence of developing GDM.

Methods: We calculated the UHR index using data from pregnant women who participated in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2020. Subsequently, we conducted in-depth validation through analytical methods including multivariate logistic regression, smooth curve fitting, and subgroup analysis.

Results: The logistic regression model demonstrated a positive correlation between the UHR index and GDM, which remained significant even after adjusting for all confounding variables (Odds Ratio [OR] = 1.16, 95% Confidence Interval [CI]: 1.07-1.26, p < 0.001). A linear dose-response relationship was observed in the restricted cubic spline (RCS) regression (p for overall < 0.001, p for nonlinear = 0.293). This association remained consistent in sensitivity analyses and subgroup analyses. The diagnostic utility of the UHR index for GDM was limited (Area Under the Curve [AUC] = 0.611, 95% CI: 0.554-0.667).

Conclusions: Although UHR demonstrated limited independent diagnostic accuracy (AUC = 0.611), its dual role in correlating inflammation and lipid metabolism may confer complementary value within multiparametric models, a hypothesis that warrants future research validation.

Children in the first months of life are at highest risk for Respiratory Syncytial Virus (RSV) bronchiolitis. Maternal specific anti-RSV IgG antibodies play a key role in preventing infection in early life. The COVID-19 pandemic changed the seasonality of RSV epidemics. We hypothesized that COVID-19 restrictions, affecting RSV circulation, altered RSV-specific immunity of pregnant women and their newborns. We compared anti-RSV IgM and IgG levels in maternal and cord blood (CB) samples collected from mother-newborn dyads at Policlinico Umberto I Hospital, Rome, Italy, across three consecutive RSV seasons: Group 1 (Nov 2020-Mar 2021; N: 24 dyads), Group 2 (Nov 2021-Mar 2022; N: 38 dyads), and Group 3 (Sep 2022-Mar 2023; N: 31 dyads). Median maternal anti-RSV IgM values were significantly higher in Group 3 (p = 0.001) and in Group 2 (p = 0.004) compared to Group 1. Anti-RSV IgG median values were significantly lower in Group 2 both in maternal (p = 0.039) and CB (p = 0.05) and in Group 3 in CB (p = 0.029) compared to Group 1. These findings suggest that the COVID-19 pandemic caused an RSV-specific immunological debit in pregnant women and their infants, potentially explaining the altered RSV seasonality and increased bronchiolitis hospitalizations during 2021-2022.

Objective: Magnesium sulfate is administered intrapartum for seizure prophylaxis in patients with preeclampsia with severe features. We aimed to quantify the effect of magnesium sulfate on duration of labor induction in nulliparous patients undergoing induction of labor for hypertensive disorders of pregnancy at term gestation.

Methods: This retrospective cohort study was a secondary analysis from the Consortium on Safe Labor, a multicenter cohort study of 228,438 deliveries in 19 U.S. hospitals. The analysis included nulliparous patients ≥ 18 years old with singleton gestation undergoing induction of labor for hypertensive disorders of pregnancy with delivery at ≥37 weeks gestation. Primary outcome was duration of labor induction, defined as time in hours (h) from initiation of induction to delivery, between patients who received magnesium sulfate and those who did not. Secondary outcomes were rate of cesarean delivery and perinatal outcomes.

Results: Total 5,886 patients met inclusion criteria, of whom 2102 (35.7%) received magnesium sulfate intrapartum. Median duration of labor induction was significantly longer in the magnesium cohort (16.8h, IQR 10.3h-25.3h vs 15.0h, IQR 9.0h-22,9h; p < 0.001). Multivariate logistic regression controlling for baseline characteristics different between groups found that magnesium use was significantly associated with labor length over 12 h (adjusted odds ratio [aOR] 1.36; 95% confidence interval [CI] 1.21-1.54; p < 0.001) as well as over 24 h (aOR, 1.44; 95% CI, 1.26-1.64; p < 0.001). The overall rate of CD was 39.2% in the cohort. Magnesium use was not associated with higher rate of CD (p = 0.58) but was associated with longer maternal length of stay (p < 0.001) and higher rate of endometritis (p < 0.001). Magnesium use was associated with higher rates of neonatal intensive care unit admission (p < 0.001), 5-minute APGAR ≤ 7 (p < 0.001), respiratory distress syndrome (p < 0.001), and composite neonatal morbidity (p < 0.001).

Conclusion: Magnesium sulfate administration is significantly associated with longer induction of labor length amongst patients undergoing induction for hypertension, though it did not impact mode of delivery. Appropriate care should be taken in expeditiously managing labor for this high-risk patient cohort.

Objective: To compare maternal and neonatal outcomes of singleton and twin gestations complicated by hypertensive disorders of pregnancy (HDP).

Methods: PubMed, Cochrane Library, Scopus, Web of Science, Embase, and Google Scholar were searched for comparative studies till 15th May 2025.

Results: Thirteen studies were included. The analysis of crude data found a significantly elevated risk of preterm birth and cesarean section with twins compared to singleton gestations complicated by HDP. A significantly higher risk of small-for-gestational-age (SGA) was noted in twin pregnancies, but the effect was lost on subgroup analysis for preeclampsia. The analysis did not show any differences in 5-min Apgar score <7, respiratory distress, or neonatal intensive care unit (NICU) admission. Twin pregnancies were linked with significantly greater risk of neonatal death.

Conclusion: Twin pregnancies with HDP may be associated with significantly higher risk of preterm birth, cesarean section, SGA, and neonatal death, but without any difference in 5-min Apgar score <7, respiratory distress, and NICU admission as compared to singleton pregnancies complicated by HDP. Limited research indicates that twin pregnancies with preeclampsia may confer protection against SGA, but the findings should be interpreted with caution. Lack of adjustment of confounders is a major limitation of present evidence.

Background: The period of life after childbirth represents a particularly demanding phase in a woman's life and may significantly compromise both mental and physical health. Adhering to the World Health Organization's (WHO) recommendation of 150 min of physical activity per week, in addition to maintaining adequate sleep quality, may pose considerable challenges during this time.

Method: Prospective cross-sectional study including women between three months and two years after childbirth. Physical activity was self-reported and measured by the International Physical Activity Questionnaire (IPAQ, Version 6, long form); quality of life was assessed by the World Health Organization Quality of Life questionnaire (WHOQOL-BREF); and sleep quality was evaluated through the Pittsburgh Sleep Quality Index (PSQI-BR). Sociodemographic data were collected using a personal characterization questionnaire.

Results: 187 women were included. Of the total sample, 86.1% reported engaging in physical activity prior to pregnancy, 71.1% during pregnancy, and 43.3% in the postpartum period. The majority was primiparous (62.6%), white (73.8%), in a stable relationship (95.2%), engaged in paid employment (82.4%), and had completed high school education (96.3%). According to IPAQ classification, 42.2% of participants exhibited a moderate level of physical activity. Based on PSQI, 59.9% of the women presented with poor sleep quality. The most physically active women during pregnancy were those over 30 years of age, primiparous, and with a well-established support network. Those with lower activity levels also reported worse sleep and lacked support. Women who engaged in physical activity during pregnancy were approximated seven times more likely to maintain physical activity in the postpartum period (OR 7.25 95% CI 2.85-18.45).

Conclusion: A reduction in physical activity levels was observed after childbirth. The most active women were primiparous, over 30 years of age, and had a structured support network. Engaging in physical activity during pregnancy was associated with a greater likelihood of maintaining such a habit after childbirth.

Objective: To identify maternal risk factors for gestational diabetes mellitus (GDM) and to evaluate its perinatal implications in dichorionic (DC) twin pregnancies, a population in which metabolic demands and placental physiology differ substantially from singleton gestations.

Methods: A retrospective cohort study was conducted among 378 women with confirmed DC twin pregnancies, including 122 women with GDM and 256 without GDM, delivered at a tertiary maternal-fetal medicine center between 2018 and 2023. GDM was diagnosed using IADPSG criteria following a 75-g oral glucose tolerance test. Maternal demographic factors, conception mode, early ultrasound parameters, obstetric outcomes, and neonatal outcomes were compared between women with and without GDM using univariate analyses and multivariate logistic regression.

Results: Pre-pregnancy BMI ≥25 kg/m² (adjusted OR 1.857, 95% CI 1.050-3.284) and conception via assisted reproductive technology (adjusted OR 1.608, 95% CI 1.029-2.514) independently increased the likelihood of developing GDM. Most maternal and neonatal outcomes-including preterm birth, birth weight patterns, neonatal hypoglycemia, and NICU admission-did not differ significantly between the two groups. However, GDM was associated with a higher incidence of single intrauterine fetal demise (7.4% vs. 2.7%, p = 0.036).

Conclusion: In DC twin pregnancies, maternal overweight and ART conception constitute significant risk factors for GDM. While many perinatal outcomes appear unaffected, the elevated risk of single fetal demise underscores the need for intensified fetal surveillance and individualized management in this high-risk population.

Objective: To evaluate the association between third-trimester placental vascularization measured by microvascular flow (MV-Flow) imaging and the risk of small-for-gestational-age (SGA) neonates.

Methods: In this prospective cohort study, women with singleton pregnancies at 30-32 weeks' gestation underwent MV-Flow ultrasound for quantification of placental vascular indices (VI). Maternal characteristics, fetoplacental Doppler parameters, and MV-Flow-derived VI were analyzed, and pregnancy outcomes were recorded.

Results: Of 207 pregnancies, 20 (9.7%) resulted in SGA neonates and 187 in appropriate-for-gestational-age (AGA) neonates. Compared with the AGA pregnancies, placental VI in the SGA group were significantly lower across the upper, middle, and lower regions of the placenta (upper: 32.0 ± 13.4 vs 43.1 ± 13.8, middle: 36.0 ± 15.3 vs 49.6 ± 15.0, lower: 30.3 ± 10.0 vs 42.5 ± 13.5; all p < 0.001). The SGA group also exhibited higher uterine artery pulsatility index (UtA-PI) and lower middle cerebral artery PI (MCA-PI) and cerebroplacental ratio (CPR) (all p < 0.05). In multivariable logistic regression, UtA-PI, CPR, and mid-placental VI were independently associated with SGA. The middle placental VI demonstrated moderate discriminative for SGA (AUC 0.756) compared with UtA-PI (AUC 0.626) and CPR (AUC 0.695). A combined model incorporating UtA-PI, CPR, and placental VI achieved an AUC of 0.866 with 55% sensitivity and a 10% false-positive rate.

Conclusions: Reduced placental vascularization index measured by MV-Flow ultrasonography is significantly associated with SGA. Integration of MV-Flow-derived VI with conventional Doppler parameters may improve risk stratification for SGA and provides supportive evidence for the potential clinical value of MV-Flow in assessing placental microcirculation and fetal growth.

Objective: Preeclampsia complicates 3-8% of pregnancies worldwide, an obstetric condition contributed to the short- and long-term morbidity and mortality of mothers and newborns. For its treatment and prevention, it is essential to comprehend the risk factors. This study aimed to investigate the potential causal influence of basal metabolic rate (BMR) on preeclampsia risk.

Methods: We utilized data from publicly available genome-wide association studies (GWAS) of European populations, focusing on BMR and preeclampsia. We selected single-nucleotide polymorphisms (SNPs) as instrumental variables for basal metabolic rate (BMR). Causal estimates were derived using multiple Mendelian Randomization (MR) methods: inverse-variance weighted (IVW), MR-Egger, weighted median, simple mode, and weighted mode. To ensure result robustness, we conducted comprehensive sensitivity analyses assessing potential pleiotropy and heterogeneity.

Results: We found evidence of a causal relationship between specific BMR indicators (ebi-a-GCST90029025, ukb-a-268, and ukb-a-16446) and preeclampsia risk. The IVW model indicated that genetically predicted higher BMR was associated with increased odds of preeclampsia. Cochran's Q test and I² statistics indicated no significant heterogeneity between ukb-a-16446 and preeclampsia, however, slight heterogeneity was observed for the other indicators. According to the MR-Egger regression, our findings were barely impacted by horizontal pleiotropy.

Conclusion: This MR study supports a causal role of BMR in preeclampsia risk. This highlights the potential of targeting metabolic pathways in preeclampsia prevention. Future research should be performed to explore the underlying mechanisms and evaluate the potential interventions modulating BMR to reduce preeclampsia incidence.

Objective: To investigate the effects of Shengxuening (SXN) tablets on gestational anemia and iron metabolism, focusing on efficacy differences among pregnant women with the thalassemia trait and those stratified by baseline serum ferritin (SF) levels.

Methods: A retrospective single-center cohort (2016-2022) reviewed prenatal records of 843 pregnant women. Participants were allocated to either an SXN prophylaxis group (n = 620) or a non-prophylaxis group (n = 223) based on whether hemoglobin (Hb) was ≥110 g/L when iron supplementation was initiated. Within the SXN group, women were further stratified by baseline SF levels (<30, 30-70, 71-100, and >100 µg/L) to evaluate efficacy across SF subgroups. Primary endpoints were the incidence of gestational anemia and iron deficiency (ID). Secondary outcomes included changes in Hb, red blood cell (RBC) count, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), and SF.

Results: Among the 843 pregnant women, the incidence of ID ranged from 59.52% to 73.58% in the second and third trimesters, while iron deficiency anemia (IDA) was observed in 22.51% to 32.84% of cases. Comparative analysis within the SXN prophylaxis group, stratified by baseline SF levels, revealed that participants with SF ≥ 30 μg/L had significantly higher rates of adequate Hb levels before delivery (p = 0.003) and higher mean SF concentrations at 30-34 weeks of gestation (p = 0.025) compared to those with SF < 30 μg/L. Among 57 pregnant women with the thalassemia trait, the SXN prophylaxis group demonstrated significantly better Hb adequacy rates across gestational weeks and superior iron-related parameters compared to the non-prophylaxis group (p < 0.05).

Conclusion: SXN tablets effectively ameliorate ID and anemia in both the general obstetric population and pregnant women with the thalassemia trait. The greatest benefit occurs when prophylaxis is initiated at baseline SF ≥30 μg/L. Baseline SF levels positively correlate with therapeutic response, indicating that adequate iron reserves enhance treatment efficacy. Routine, guideline-based iron supplementation should remain a cornerstone of antenatal care; however, individualized regimens tailored to initial iron status warrant further investigation.