Journal of Maternal-Fetal & Neonatal Medicine最新文献

Objective: This study aimed to assess the relationship between increased body mass index (BMI) with severe maternal morbidity (SMM).

Study design: We obtained data for a retrospective cohort of singleton live births using an electronic birth certificate database from 2010 to 2022 in Central New York. Institutional review board exemption was obtained. Pre-pregnancy BMI was assessed as a continuous variable and a categorical variable with groups of BMI <18.5 kg/m², 30-39.9 kg/m², 40-49.9 kg/m², and ≥50 kg/m² compared to patients with BMI 18.5-29.9 kg/m². Primary outcomes were maternal intensive care unit (ICU) admission and composite SMM defined as ICU admission, unplanned hysterectomy, reoperation, eclampsia, and blood transfusion. Secondary outcomes were the individual SMM components, 5-minute APGAR score <7, and neonatal intensive care unit (NICU) admission. ANOVA and χ² were used to compare continuous and categorical variables respectively, and logistic regression was used to obtain adjusted odds ratios for primary and secondary outcomes.

Results: There were 223,837 patients with singleton live births with mean BMI 27.86 kg/m². 54,385 (24.3%) had BMI 30-39.9 kg/m², 13,299 (5.9%) had BMI 40-49.9 kg/m², and 1,958 (0.87%) had BMI ≥50 kg/m². 3,203 (1.4%) patients experienced SMM, and 423 (0.2%) patients were admitted to ICU. For each 1-point increase in BMI the adjusted odds ratio (aOR) of SMM increased by 0.8% (aOR 1.008, 95% CI 1.002-1.013) and ICU admission increased by 2.0% (aOR 1.02, 95% CI 1.005-1.034). Odds of ICU admission for those with BMI 40-49.9 kg/m² increased by 69% (aOR 1.69, 95% CI 1.16-2.47); BMI ≥50 kg/m² increased by 300% (aOR 3.01, 95% CI 1.53-5.91), but those with BMI 30-39.9 kg/m² did not have significantly higher odds of ICU admission (aOR 1.09, 95% CI 0.84-1.42).

Conclusion: Increasing BMI was significantly associated with increased SMM and maternal ICU admission.

Background: Pregnancy gingivitis is a common oral health issue that affects both maternal and fetal health. This study aims to evaluate the effectiveness of periodontal treatment in preventing pregnancy gingivitis, preterm birth, and low birth weight through a systematic review and meta-analysis of randomized controlled trials (RCTs).

Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. A comprehensive literature search was performed across CINAHL, Scopus, Cochrane, and PubMed/Medline databases from 2000 to the present. Study selection and data extraction were independently carried out by two reviewers. Statistical analyses, including heterogeneity tests, sensitivity analysis, and publication bias assessment, were conducted using RevMan 5.4 and R software.

Results: A total of 13 studies were included. The meta-analysis indicated that periodontal treatment might have a potential effect on preventing pregnancy gingivitis, but this was not statistically significant (OR = 0.85, 95% CI [0.68, 1.06], I² = 51%). Subgroup analysis revealed that periodontal treatment significantly reduced the rates of preterm birth and low birth weight in lower-quality studies, but no significant effects were observed in higher-quality studies. Sensitivity analysis and publication bias tests confirmed the stability and reliability of the results.

Conclusion: While lower-quality studies suggest that periodontal treatment may positively impact pregnancy gingivitis, preterm birth, and low birth weight, these effects were not supported by higher-quality evidence. Further well-designed RCTs are needed to confirm these findings and ensure their reliability. Periodontal treatment could potentially be considered as part of prenatal care to improve maternal oral health and pregnancy outcomes.

Background: Bronchopulmonary dysplasia (BPD) is the most common chronic respiratory disease in extremely premature infants. This study aims to identify gene expression dysregulation and explore various molecular pathways implicated in BPD.

Methods: This study integrated BPD genome-wide association study (GWAS), single-cell transcriptomics (scRNA-seq), and Mendelian randomization (MR) analysis to investigate the causal relationship between gene expression and BPD.

Results: Cell annotation and ligand-receptor analysis highlighted myofibroblasts as the most interactive cell type. Key genes, including CDH4, ENC1, and PAM, were identified as protective factors against BPD, while GRB10 was associated with increased disease risk. Immune metabolism-related pathways showed elevated activity of PAM, GRB10, and ENC1 in epithelial-mesenchymal transition. The Drug-Gene Interaction Database (DGIdb) predicted three drugs-LM10, navoximod, and ziprasidone-that potentially interact with these key genes.

Conclusion: This integrative genome-wide analysis provides valuable insights into the genetic mechanisms underlying BPD. The findings facilitate the identification of novel therapeutic targets and pave the way for personalized treatment strategies for affected neonates.

Background: Preterm birth, a significant global health concern, has been associated with alterations in the gut microbiota. However, the causal nature of this relationship remains uncertain due to the limitations inherent in observational studies.

Purpose: To investigate the potential causal relationship between gut microbiota imbalances and preterm birth.

Methods: We conducted a two-sample Mendelian randomization (MR) study using genome-wide association study (GWAS) data from the MiBioGen consortium focusing on microbiota and preterm birth. Single nucleotide polymorphisms (SNPs) associated with the microbiota were selected as instrumental variables. The inverse variance weighting (IVW) method was used to estimate causality. We confirmed pleiotropy and identified and excluded outlier SNPs using MR-PRESSO and MR-Egger regression. Cochran's Q test was applied to assess heterogeneity among SNPs, and a leave-one-out analysis was performed to evaluate the influence of individual SNPs on overall estimates.

Results: Our findings provide evidence for a causal link between specific components of the gut microbiota and preterm birth, with the identification of relevant metabolites.

Conclusion: This study highlights the causal role of gut microbiota imbalances in preterm birth, offering novel insights into the development of preterm birth and potential targets for prevention strategies.

Objectives: Intrahepatic cholestasis of pregnancy (ICP), a condition exclusive to pregnancy, necessitates prompt identification and intervention to improve the perinatal outcomes. This study aims to develop suitable machine-learning models for predicting ICP based on clinical and laboratory indicators.

Methods: This study retrospectively analyzed data from 1092 pregnant women, with 537 diagnosed with ICP and 555 healthy cases as a control. Two study schemes were devised. For scheme 1, 62 indicators from the first period of gestation were utilized to establish predictive models. For scheme 2, 62 indicators from at least two periods of gestation were utilized to establish predictive models. Under each scheme, three different machine-learning models were developed based on the Arya Privacy Computing Platform, encompassing Support Vector Machine (SVM), Deep Neural Network (DNN), and Xgboost for Scheme 1, and Recurrent Neural Network (RNN), Long Short-Term Memory Network (LSTM), and Gated Recurrent Unit (GRU) for Scheme 2. The predictive efficacy of each model on ICP was evaluated and compared.

Results: Under Scheme 1, the cohort comprised 1092 pregnant women (537 with ICP, 555 healthy). The SVM model exhibited a sensitivity, specificity, and accuracy of 85.5%, 47.50%, and 67.90%, respectively, while DNN showed 65.70%, 92.70%, and 79.40%, respectively, and Xgboost achieved 65.60%, 81.90%, and 73.40%, respectively. In Scheme 2, 899 pregnant women were analyzed (466 with ICP, 433 healthy). RNN demonstrated a sensitivity, specificity, and accuracy of 97.60%, 82.10%, and 90.50%, respectively; LSTM presented 90.70%, 81.70%, and 86.60%, respectively; and GRU achieved 89.90%, 83.80%, and 89.40%, respectively.

Conclusion: DNN and RNN are the two most suitable models to predict ICP in a convenient and available way. It provides flexible choice for medical staff and helps them optimize the therapeutic strategies to meet different clinical setting and improve the clinical prognosis of ICP.

Objective: To assess the neonatal survival rates, maternal complications, neonatal complications, and factors associated with survival rates following periviable premature rupture of membranes (PROM) between 15 and 23⁺⁶ weeks of gestation.

Materials and methods: The retrospective study included patients with periviable PROM between 15 and 23⁺⁶ weeks of gestation from January 1, 2008, to December 31, 2022. Multivariate regression analysis was performed to identify factors influencing neonatal survival.

Results: A total of 71 cases of periviable PROM between 15 and 23⁺⁶ weeks of gestation were included in the study, and the neonatal survival rate was found to be 26.8%. Maternal complications occurred in 59.2% of cases. Of the 19 surviving newborns, 89.5% experienced neonatal complications. Univariate analysis showed that gestational age at delivery, duration of latency and antenatal steroid administration were the factors significantly associated with increased survival rates after periviable PROM before 24 weeks of gestation.

Conclusion: The survival rate of periviable PROM between 15 and 23⁺⁶ weeks of gestation was 26.8% with neonatal complications of 89.5%. This information may be useful for counseling pregnant women experiencing periviable PROM.

Objective: To determine the obstetric and neonatal outcomes of pregnant women with extreme obesity at birth after late preterm gestation.

Methods: This was a retrospective study on extremely obese pregnant women with body mass index (BMI) ≥ 40.0 kg/m² (obesity stage III according to the BMI classification of the World Health Organization) who had delivered at Seoul National University Bundang Hospital between September 2003 and February 2023. Fetal death in utero and preterm births before 34 weeks of gestation were excluded. Obstetric and neonatal outcomes were reviewed.

Results: A total of 94 extremely obese pregnant women were included and the median value of BMI at delivery was 42.4 kg/m². When analyzed according to the obesity II category of pre-pregnancy BMI, the rate of chronic hypertension was higher in the alleged extreme obese women than those with lower pre-pregnancy BMI (34% vs. 10%, p = 0.012). However, preterm labor with tocolytics was higher in the group with lower BMI than 35.0 kg/m² (26% vs. 5%, p = 0.007). The proportion of adverse neonatal outcomes such as neonatal intensive care unit admission, the use of respiratory support (including positive pressure ventilation, continuous positive airway pressure, and mechanical ventilator), and jaundice were higher in the group with pre-pregnancy BMI < 35.0 kg/m² than that with BMI ≥ 35.0 kg/m² group (all p-value < 0.05). The use of neonatal respiratory support increased as the category of pre-pregnancy BMI was lower and as the degree of weight gain during pregnancy was higher.

Conclusions: In extremely obese women (stage III) at delivery in late preterm gestation, the obstetric outcomes such as use of tocolytics for preterm labor and adverse neonatal respiratory outcomes seemed to be higher for the women who were not that much obese before pregnancy than those who were already extremely obese. Therefore, weight gain during pregnancy needs to be closely monitored for pregnant women especially when obese.

Objective: This study aims to assess the predictive value of the stress hyperglycemia ratio (SHR) for left ventricular (LV) systolic dysfunction in patients with peripartum cardiomyopathy (PPCM).

Methods: We conducted a retrospective analysis of 78 consecutive PPCM patients from January 2007 to March 2023. Their clinical, laboratory, and auxiliary examination data were collected. The estimated average glucose (eAG) was calculated using the formula: eAG = [1.59 × hemoglobin A1c (%) -%2.59]. The SHR was determined by the formula: SHR = (blood glucose at admission)/eAG. The primary outcome measured was the recovery of LV systolic function. A receiver operating characteristic (ROC) curve was used to evaluate the SHR. Logistic regression analysis was performed to identify risk factors for LV systolic dysfunction in PPCM patients.

Results: The mean random blood glucose level in the PPCM patients was 6.38 mmol/L, with an SHR of 1.16. Among these patients, 37 (47.4%) exhibited persistent LV systolic dysfunction during follow-up. The SHR was significantly higher in the non-recovery group than in the recovery group (1.45 vs. 0.91, p < .001). An SHR cutoff of 1.079 predicted persistent LV systolic dysfunction with a sensitivity of 81.1% and a specificity of 90.2%, yielding a Youden index of 0.713. Logistic regression identified an SHR ≥ 1.079, a left ventricular end-diastolic diameter (LVEDD) > 55 mm, and digoxin usage as risk factors for LV systolic dysfunction.

Conclusions: PPCM patients with an SHR of 1.079 or higher should receive increased scrutiny for persistent LV systolic dysfunction.

Background: Adrenomedullin (AM) is a potent angiogenic, antioxidant and anti-inflammatory peptide protecting the developing lung from injury due to bronchopulmonary dysplasia (BPD) of the preterm infant. At this stage, no data on the potential effects of chorioamnionitis (CA) occurrence and glucocorticoids (GC) administration on AM in developing lungs are still lacking.

Objective: to investigate, in a sheep-based model, the positive/side-effects of combined exposure to CA and GC on AM concentrations measured in bronchoalveolar lavage fluid (BALF).

Methods: Time-mated ewes were randomly admitted to one of six treatment groups receiving injection: saline (controls); lipopolysaccharide (L) in intra-amniotic fluid treated alone at 7 or 14 d before delivery or associated with betamethasone (B) intramuscularly; B treated alone (7d) or associated with L (14d). Lambs were surgically delivered at 120 days gestation and euthanized. BALF was used for AM measurement in the studied groups.

Results: AM BALF levels significantly (p < 0.05, for all) changed both to B and L exposure in a time-dependent manner. The latter was characterized by AM levels at short term superimposable to controls, whilst significantly (p > 0.05) decreased at long-term. The former showed increased AM at short and decreased at long-term (p < 0.05, for all), respectively.

Conclusions: the present results showing AM BALF changes in a sheep-based model support the AM role in the hemodynamic patterns due to CA and BPD occurrence and open the way to further studies investigating the role of vasoactive agents as trustable markers of lung development/damage.