Journal of Maternal-Fetal & Neonatal Medicine最新文献

Objective: To determine the predictive value of serum IGFBP-3 in combination with transvaginal ultrasonography cervical length in singleton pregnancies during the 18-23⁺⁶ weeks' gestational period for the prediction of preterm birth.

Methods: This prospective observational study included singleton pregnant women who received antenatal care at King Chulalongkorn Memorial Hospital at 18-23⁺⁶ weeks' gestation between December 2022 and April 2024. Cervical length was determined by transvaginal ultrasound and serum was collected to measure IGFBP-3 levels. Demographic data and pregnancy outcomes were recorded.

Results: A total of 176 pregnant women were analyzed. Twelve cases (6.8%) of preterm births were identified. Preterm birth prediction, when using serum IGFBP-3 values greater than 6.9 ng/ml, had a sensitivity of 75%, a specificity of 61.5%, a positive predictive value (PPV) of 12.3% and a negative predictive value (NPV) of 97.1%. When cervical length values less than 37 mm were used, the prediction had a sensitivity of 66.7%, a specificity of 44.6%, a PPV of 8%, and a NPV of 94.9%. When serum IGFBP-3 or cervical length was used to predict preterm birth, sensitivity, specificity, PPV and NPV were 83.3%, 27.1%, 7.6% and 95.7%, respectively.

Conclusions: The use of serum IGFBP-3 levels in combination with cervical length had a good sensitivity to predict preterm birth. While NPV is high, the low PPV limits its standalone use to predict preterm birth.

Purpose: The aim of this study was to compare the time to delivery between early (within 2 h) and late (after 2 h) amniotomy and oxytocin initiation in patients undergoing cervical ripening with a cervical ripening balloon (CRB).

Methods: Secondary analysis of data collected from a previous parallel randomized controlled trial comparing CRB removal after 6 versus 12 h. For our study, the full cohort from the original trial was divided into patients who had amniotomy and oxytocin infusion within 2 h of CRB removal (study group) and patients who hadamniotomy and oxytocin more than 2 h after CRB removal (control group). Inclusion criteria were age > 18 years, ≥ 37 gestational weeks, Bishop score < 5, singleton vertex presentation, intact membranes, and no contraindication for vaginal delivery. Primary outcome for the current study was the time from CRB removal to delivery. Secondary outcomes included the rate of cesarean delivery and adverse maternal and neonatal outcomes.

Results: A total of 197 patients were analyzed, 34 in the study group and 163 in the control group. The study and control groups did not differ in baseline characteristics but differences were observed in the treatment characteristics stemming from the division into the two groups for the analysis. Time from CRB removal to delivery was significantly shorter in the study group vs control (9 ± 6.7 vs.17 ± 11.9 h, p < 0.001) respectively. The rate of cesarean deliveries and other maternal and neonatal outcomes were similar in the two groups.

Conclusion: Our findings suggest that early amniotomy and oxytocin infusion combination in patients undergoing labor induction with a CRB is associated with a shorter duration of labor and similar cesarean deliveries rate. Latent confounding remains possible.

Background: Early-onset hypoglycemia is a frequent metabolic complication in preterm infants and may lead to adverse neurodevelopmental outcomes. Accurate risk prediction is essential for timely clinical intervention.

Methods: A retrospective study was conducted on 436 preterm infants admitted to a tertiary hospital in Guangzhou from January 2022 to November 2023. The dataset was randomly divided into a training set (n = 305) and a validation set (n = 131). Univariate analysis and LASSO logistic regression were used to screen predictive variables. A multivariate logistic regression model was developed and visualized as a nomogram. Internal validation was performed using calibration plots, ROC curves, and decision curve analysis (DCA).

Results: A retrospective cohort of 436 preterm infants was analyzed, among whom 124 cases (28.44%) experienced hypoglycemia within 48 h after birth. Multivariate logistic regression identified six independent risk factors: reduced gestational age, multiple births, cesarean delivery, maternal gestational diabetes, gestational hypertension, and abdominal distension observed on the second postnatal day. The predictive model exhibited solid discriminative power, with an AUC of 0.802 in the training group and 0.829 in the validation group. Model calibration was satisfactory across datasets. DCA further supported the model's clinical utility, indicating consistent net benefit over a wide spectrum of risk thresholds.

Conclusion: The model demonstrated promising predictive ability for early-onset hypoglycemia in preterm infants and could potentially serve as a preliminary tool to inform risk stratification strategies. However, its clinical translation requires confirmation through external validation in prospective, multicenter studies before any consideration of widespread implementation.

Objective: Listeria monocytogenes is a pathogenic Gram-positive bacterium that poses a serious threat to pregnant women and their fetuses. This case report aims to highlight the management and outcomes of such an infection in a pregnancy with multiple complications.

Methods: We describe the clinical management of a 33-year-old woman who conceived via in vitro fertilization (IVF) and presented in the third trimester with Listeria monocytogenes infection, complicated by complete placenta previa, a succenturiate placenta, and breech presentation.

Results: Despite prompt medical intervention, intrauterine fetal demise occurred. Following prophylactic uterine artery embolization (UAE), successful vaginal delivery was achieved. Three months postpartum, her menstrual cycle returned to normal. After monitoring her follicles during natural cycles, she successfully conceived again within one cycle, experienced a smooth pregnancy, and ultimately delivered a healthy baby boy at term.

Conclusions: This case underscores the importance of increased awareness regarding the risk of Listeria monocytogenes infection during pregnancy. It discusses the potential of applying next-generation sequencing (NGS) to amniotic fluid samples obtained via amniocentesis for early diagnosis and highlights that performing uterine artery embolization when necessary can help maximize the preservation of fertility.

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.