Journal of Maternal-Fetal & Neonatal Medicine最新文献

Purpose: Current studies have indicated a potential association between inflammatory cytokines and Fetal Growth Restriction (FGR), but the causal relationship between specific inflammatory cytokines and FGR remains uncertain. In this study, we used Mendelian randomization (MR) to further investigate the causal link between 91 inflammatory cytokines and FGR.

Methods: We included data from a sample of 14,824 Europeans and FinnGen consortium fetal growth restriction data (4054 cases vs. 226,256 controls) encompassing 91 inflammatory cytokines. The primary analysis method used was inverse-variance weighted (IVW). Additionally, MR Egger, Weighted median, Simple mode, and Weighted mode were utilized as auxiliary analyses to reinforce the final results. Furthermore, sensitivity analysis was conducted to assess the robustness of the data.

Results: Our study revealed that C-C motif chemokine 4 (CCL4), C-X-C motif chemokine 1 (CXCL1), Fibroblast growth factor 19 (FGF-19), IL-10, IL-20, IL-24, and Monocyte chemoattractant protein-4 (CCL13) exhibited associations with FGR risk; however, due to horizontal pleiotropy concerns regarding CCL13 it was excluded from further investigation. Conversely, reverse MR results demonstrated no significant association between inflammatory factors and FGR.

Conclusion: This MR study provides evidence for an association between CCL4,CXCL1,FGF-19,IL-10, IL-20, IL-24, and FGR risk.More research is needed to evaluate the potential role of these cytokines in preventing and treating FGR.

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.

Background: Factor XII deficiency, a rare inherited coagulation disorder, typically presents with isolated prolonged activated partial thromboplastin tim without spontaneous bleeding. Paradoxically, it is associated with thrombotic events and adverse pregnancy outcomes. Evidence-based guidelines for managing FXII deficiency in pregnancy remain lacking.

Case presentation: A 27-year-old primigravida was incidentally diagnosed with severe FXII deficiency during routine prenatal screening. At 38⁺⁵weeks, she presented with vaginal spotting and spontaneous rupture of membranes. A multidisciplinary team planned a cesarean delivery under general anesthesia. Prophylactic fresh frozen plasma (FFP) 400 mL was administered preoperatively. Postoperative FFP (400 mL) was transfused. No bleeding & thrombotic complications occurred in the mother or neonate.

Systematic review: Analysis of 9 publications (19 pregnancies) revealed.

Conclusions: Successful perinatal outcomes hinge on multidisciplinary collaboration, dynamic risk stratification, and personalized bleeding-thrombosis balance. Prophylactic FFP with selective LMWH demonstrated safety in this case. Further studies are needed to optimize standardized pathways.

Objective: High-risk pregnancies are associated with increased risk of fetal and maternal morbidity and mortality. The non-stress test (NST) is the standard method for antenatal fetal monitoring, while the cerebroplacental ratio (CPR) has emerged as a noninvasive tool for predicting adverse perinatal outcomes. We aimed to evaluate the role of the CPR and NST in predicting adverse perinatal outcomes in high-risk pregnancies.

Methods: A prospective study was conducted with 672 high-risk pregnant women at Haiphong Hospital of Obstetrics and Gynecology in Vietnam from February 2024 to February 2025. All participants had a gestational age of 32 weeks or more. The CPR and an NST were performed on each woman. They were monitored until delivery to identify adverse perinatal outcomes, including cesarean section due to fetal distress, a 5-minute Apgar score below 7, admission to the neonatal intensive care unit, and perinatal death.

Results: There was a significant difference between CPR and NST between groups with adverse and normal perinatal outcomes (p < 0.05). After adjusting for confounding factors, significant associations were found between CPR and adverse perinatal outcomes in women with hypertensive disorders of pregnancy, fetal growth restriction, and hyperglycemia in pregnancy, with OR (95% CI) of 5.92 (1.38-25.45), 11.11 (1.61-76.76), and 6.66 (1.53-28.99), respectively. Similarly, NST results showed significant associations, with ORs (95% CI) of 13.56 (2.59-71.05), 15.44 (2.46-96.98), and 15.35 (3.01-78.33), respectively. While the sensitivity of CPR and NST in high-risk cases is low, their specificity exceeds 90%, and their overall accuracy exceeds 80%. The positive likelihood ratio (LR+) of the NST exceeds that of the CPR in predicting adverse perinatal outcomes across different high-risk groups. Notably, the LR+ for the combined CPR and NST in women with high-risk pregnancies, hypertensive disorders of pregnancy, fetal growth restriction, and hyperglycemia in pregnancy was 5.14, 16.2, 32.14, and 42.4, respectively.

Conclusion: In addition to NST, CPR is a valuable predictor of adverse perinatal outcomes in high-risk pregnancies. The NST shows greater predictive accuracy than the CPR when forecasting adverse perinatal outcomes across different high-risk groups. Combining these two indices provides a stronger prediction for adverse perinatal outcomes.

Objective: Parvovirus B19 infection during pregnancy can cause severe fetal anemia, hydrops fetalis, and fetal death. This study describes our experience managing ten cases of severe fetal anemia due to parvovirus B19 infection during the 2023-2024 national outbreak in Israel.

Methods: This single-center descriptive cohort study included ten singleton pregnancies with fetal anemia (MCA-PSV >1.5 MoM) requiring intrauterine transfusion. Parvovirus B19 infection was confirmed by maternal IgM serology and/or amniotic fluid PCR. For pregnancies <20 weeks of gestation, we implemented a modified intraperitoneal transfusion technique incorporating pre-transfusion ascites drainage. Intravascular transfusions were used for later gestations. Platelet transfusions were administered when thrombocytopenia was present. Serial fetal sonography and neuroimaging were performed throughout the follow-up period.

Results: Seventy percent of fetuses presented with anemia and hydrops before 20 weeks of gestation. The modified intraperitoneal transfusion technique doubled the mean transfused packed red blood cell volumes compared to the standard technique (40 mL vs. 20 mL; p = 0.009). We performed 15 intraperitoneal transfusions (mean 2.14 per fetus) and 11 intravascular transfusion procedures. One fetal death occurred following intraperitoneal transfusion. Complications included one iatrogenic abdominal wall defect post-intraperitoneal transfusion (successfully repaired postnatally) and one case of transient ascites with hemosiderin deposits (resolved after birth). Two fetuses required platelet transfusions. All surviving infants demonstrated normal neuroimaging. Mean gestational age at delivery was 37 weeks 5 days, with 88% delivered at term. One preterm delivery occurred at 27 weeks due to cervical shortening and contractions, resulting in neonatal complications of prematurity.

Conclusion: Intensive intrauterine intervention, including ascites drainage and repeated red blood cell and platelet transfusions, may improve fetal outcomes in severe parvovirus B19 anemia. The modified intraperitoneal transfusion technique with pre-transfusion ascites drainage enabled larger transfusion volumes. Early, aggressive intervention appears crucial for optimal outcomes in these challenging cases.