Acta Obstetricia et Gynecologica Scandinavica最新文献

Introduction: It is well known that urinary tract infection (UTI) during pregnancy is associated with preterm birth, but information about the risk of preterm birth depending on gestational week of infection is sparingly described in the literature.

Material and methods: An observational study based on data from Swedish registers including women giving birth 2014-2020 (n = 684 595). Pregnant women with UTI diagnosis were identified by the ICD-10 codes (O230-O239, N300, N309, and N390) from the national patient registry. Hazard ratios (HR) for preterm birth after UTI diagnosis were calculated, considering the time elapsed after infection and interactions with gestational week at UTI diagnosis. Adjustments were made for maternal age, parity, previous caesarean section, body mass index, diabetes, and smoking.

Results: A diagnosis of UTI was detected in 2.8% of pregnant women. A significant association between UTI diagnosis and preterm birth was found. The aHR for preterm birth was most pronounced during the first week after a UTI diagnosis and was dependent on gestational week. The aHRs (with 95% CI) for preterm birth 0-6 days after UTI diagnosis were 18.5 (13.5-25.4), 13.5 (10.4-17.6), and 6.7 (5.6-8.0) for infections debuting week 22-27, 28-31, and 32-36, respectively. The corresponding aHRs for preterm birth 7-13 days after UTI diagnosis were 10.5 (7.2-15.2), 3.7 (2.4-5.7), and 2.9 (1.9-4.5). The increased risk for preterm birth was still significant 3 weeks or more after UTI diagnosis debuting at 22-27 weeks (aHR 2.5; 95% CI: 2.1-3.1) or at 28-31 weeks (aHR 3.2; 95% CI 2.0-4.6).

Conclusions: UTI diagnosis during pregnancy is an important risk factor for preterm birth. The magnitude of the increased risk is highest 0-6 days after diagnosis; thereafter, it declines but remains significant throughout pregnancy until 37 weeks. The increased risk is especially elevated (and especially concerning) if UTI diagnosis was confirmed before 28 weeks of gestation.

Introduction: Despite mounting evidence on Long COVID, data regarding its impact on women infected during pregnancy remains scarce. This study aimed to assess the development of Long COVID in women who had been infected with SARS-CoV-2 during pregnancy, focusing on possible risk factors and potential protective elements associated with its development.

Material and methods: We analyzed a cohort of 348 pregnant women with laboratory-confirmed SARS-CoV-2 infection admitted to ASST-Spedali Civili (Brescia, Italy) between March 2020 and May 2022. Data collection included demographics, comorbidities, COVID-19 severity markers, and vaccination status. To assess the possible association between the analyzed risk factors and Long Covid, beyond standard multivariable models, we employed inverse probability weighting techniques (IPTW) and calculated e-values to assess unmeasured confounding.

Results: Among study participants, 27.0% (94/348) developed Long COVID. Risk factors included preexisting respiratory comorbidities (adjusted OR = 3.171, 95% CI 0.99-10.1), pneumonia at admission (adjusted OR = 4.48, 95% CI 2.16-9.28), and earlier pregnancy stage at infection (adjusted OR = 0.96 per week, 95% CI 0.93-0.99). COVID-19 vaccination was associated with a significantly lower risk of Long COVID (15.5% in vaccinated vs. 31.8% in unvaccinated women; IPTW-adjusted OR = 0.38, 95% CI: 0.20-0.71, p-value: 0.003). The most common symptoms were fatigue (46.8%) and memory impairment (38.3%), with unvaccinated patients exhibiting a higher prevalence of neuropsychiatric symptoms.

Conclusions: Our data suggest that one in four pregnant women hospitalized with COVID-19 develop persistent symptoms. The most frequently affected women had preexisting respiratory disease, pneumonia at admission, and infection earlier in pregnancy. COVID-19 vaccination appears to reduce risk and alter symptom presentation. These findings underscore the importance of vaccination throughout pregnancy and highlight the need for targeted surveillance in high-risk subgroups.

Introduction: Over the past five decades, antenatal screening programs have evolved significantly, primarily through advancements in ultrasound technology and the shift from invasive to non-invasive prenatal testing methods. This study aimed to evaluate the impact of these developments in prenatal screening for Down syndrome (DS) on the prevalence of live and stillbirths, as well as terminations of pregnancy (TOP) with DS.

Material and methods: This population-based registry study included all pregnancies in Norway from 1967 to 2021, with data on TOPs available from 1999. Information on DS pregnancies was obtained from the Medical Birth Registry of Norway. Logistic regression models were applied to evaluate time trends and maternal characteristics associated with TOP.

Results: Among 3 231 159 pregnancies, 4764 (0.147%) were affected by DS. The prevalence of DS pregnancies increased from 0.165% in 1999 to 0.251% in 2021. During this period, the proportion of TOP rose from 20% to 55%, while prenatal detection rates improved from 18% to 70%. Despite increased detection, the proportion of TOP following prenatal diagnosis remained stable at approximately 80%. The prevalence of live births with DS remained stable at approximately 0.106%, while the prevalence of stillbirths was around 0.008%. Maternal age, parity, country of birth, and region of residence were associated with TOP decisions. Mean gestational age at termination decreased from 17.5 to 15.7 weeks.

Conclusions: Over recent decades, prenatal detection and termination of DS pregnancies have increased. However, the proportion of women continuing pregnancies after a prenatal diagnosis and the prevalence of live- and stillbirths with DS have remained stable.

Placenta accreta spectrum and uterine scar dehiscence in cases of low-lying or previa placentas have become an issue of intense debate among experts due to their common etiological origin. Some authors argue both conditions as a continuum while others maintain their distinct nature, while acknowledging both conditions could occur simultaneously. This ongoing debate has significant implications for diagnosis, patient counseling, and management. In this article, we present both sides of this debate, discuss diagnostic and management challenges, and call for standardization of terminology.

Introduction: Despite the growing use of pain management during delivery, evidence regarding the association between different modes of obstetric anesthesia and autism spectrum disorder in offspring is mixed.

Material and methods: We conducted a retrospective cohort study of 98 630 singleton live births at a single hospital (2011-2019), with follow-up through January 2023. Participants were grouped by delivery and anesthesia type: (1) vaginal delivery without analgesia, (2) vaginal delivery with epidural, (3) cesarean with neuraxial anesthesia, and (4) cesarean with general anesthesia. Autism spectrum disorder (ASD) diagnosis was the primary outcome. Kaplan-Meier plots and Cox regression were used to assess cumulative incidence and hazard ratios.

Results: Of the cohort (51.2% male, 62.0% Bedouin), 21.2% were born by vaginal delivery with epidural, 3.8% by cesarean with neuraxial anesthesia, and 11.4% by cesarean with general anesthesia. Cumulative ASD incidence was higher in all exposure groups (vaginal delivery with epidural: 1.25%, cesarean with neuraxial anesthesia: 1.56%, cesarean with general anesthesia: 1.50%) than in vaginal delivery without analgesia (0.55%). Nevertheless, after adjustment for covariates, only cesarean with general anesthesia was significantly associated with increased ASD risk (aHR = 1.571; 99% CI: 1.12-2.22).

Conclusions: These findings suggest that general anesthesia during cesarean delivery, but not neuraxial anesthesia or epidural use, might be associated with ASD risk. Further studies are needed to understand the underlying mechanisms.

Introduction: The potential effect of induced abortion and miscarriage on the risk of breast cancer has remained debated and has been a persistent source of misinformation. Many previous studies have been small and based on self-reported data. We assessed the associations of induced abortion and miscarriage with the risk of pre- and postmenopausal breast cancer using high-quality Finnish registry data.

Material and methods: This is a case-control study based on population-based registry data. It includes 31 687 women with breast cancer diagnosed between 1972 and 2021, and their 158 433 female population controls matched by birth year and parity. Data on induced abortions, miscarriages, deliveries, use of postmenopausal hormone therapy, socioeconomic status (SES), and occupation were collected from the Finnish national registries. Multivariate conditional logistic regression analysis was performed.

Results: The odds ratio (OR) of breast cancer among women with a history of induced abortion as compared with women with no history of induced abortion was 1.01 (95% confidence interval [CI] 0.92-1.10) in premenopausal (age <50 years) and 0.96 (95% CI 0.87-1.07) in postmenopausal (≥50 years) women. The corresponding ORs for miscarriage were 1.02 (95% CI 0.89-1.16) and 0.93 (95% CI 0.80-1.09). The OR did not vary significantly by the number of induced abortions or miscarriages, nor by the age at the time of first induced abortion or miscarriage.

Conclusion: A history of induced abortion and miscarriage, regardless of their number or age of the woman, is not associated with an increased risk of subsequent pre- or postmenopausal breast cancer.

Introduction: Screening for postnatal depression is widely acknowledged as an important public health initiative. The Whooley case-finding questions are well suited for screening purposes in primary health care settings, as the instrument is quick and easy to administer. However, the validity and diagnostic accuracy among postpartum women remain unclear. The purpose of the present study was to evaluate the validity and diagnostic accuracy of the Whooley questions compared to the Edinburgh postnatal depression scale (EPDS) in a community sample of postpartum women in Norway. The diagnostic accuracy of the Whooley questions was examined across different EPDS thresholds and compared to the measures of related constructs, including symptoms of childbirth-related post-traumatic stress disorder (PTSD) and anxiety.

Material and methods: Cross-sectional data were collected through an online questionnaire by postpartum women (0-52 weeks postpartum), recruited via social media, well-baby clinics, and other locations frequently visited by postpartum women. In total, 1154 women participated. The diagnostic accuracy of the Whooley questions was compared to three commonly used EPDS cutoffs (≥10, ≥12, and ≥13).

Results: The sensitivity of the Whooley questions relative to the EPDS was high and increased with higher thresholds for defining depression, correctly identifying 89% (EPDS ≥10), 96% (EPDS ≥12), and 97% (EPDS ≥13) of cases. Specificity was somewhat lower, at 0.82 (EPDS ≥10), 0.77 (EPDS ≥12), and 0.75 (EPDS ≥13). Positive predictive values were low, whereas negative predictive values were excellent, ranging from 0.97 (EPDS ≥10), through 0.99 (EPDS ≥12) to 1.00 (EPDS ≥13), increasing with higher thresholds. Convergent and divergent validity were supported by strong correlations with EPDS scores and moderate correlations with symptoms of childbirth-related PTSD and anxiety.

Conclusions: The Norwegian version of the Whooley questions demonstrates strong psychometric properties, supporting their usefulness as a case-finding tool for depression among postnatal women.

Introduction: The global cesarean section (CS) rate has increased to 21.1% between 1990 and 2018. In Singapore, the annual CS rate has increased by ~ 0.6%, reaching an overall rate of 37.4%. Almost one-third of all cesarean deliveries are performed for at least one previous CS. Women with two CSs are often denied a "trial of vaginal delivery" due to the increased risk of uterine scar rupture. This study aims to examine maternal and neonatal outcomes of women undergoing trials of labor following two CSs (TOLAC-2).

Material and methods: We conducted a retrospective observational study of women with singleton, term pregnancies in cephalic presentation who underwent TOLAC-2 at the National University Hospital, Singapore, between September 2013 and June 2022. Data were obtained through a detailed review of electronic medical records.

Results: Among 898 women with two previous CSs, 7.0% (63/898) attempted TOLAC-2, of whom 55.6% (35/63) achieved a successful vaginal birth (VBAC-2). Successful TOLAC-2 was associated with a significantly shorter duration of active labor (5.0 vs. 7.7 h, p = 0.013) and lower estimated blood loss (242mLs vs. 423mLs, p ≤ 0.001) compared with failed TOLAC-2. There were no perinatal complications of uterine rupture, APGAR <7 at 5 minutes, meconium aspiration syndrome or hypoxic-ischemic encephalopathy. We observed a trend toward successful VBAC-2 in women with a history of prior vaginal birth (74.6% vs. 48.9% p = 0.07).

Conclusions: In our cohort, more than half of the women attempting TOLAC-2 at term achieved a successful vaginal birth without serious perinatal or maternal complications. TOLAC-2 is a safe and reasonable option for appropriately selected women following adequate counseling, even in the absence of a prior vaginal delivery.

Introduction: Maternal outcomes of pregnancy with subclinical hypothyroidism continue to be active areas of research interest. The objective of this study was to compare severe maternal morbidity at delivery between pregnant patients with subclinical hypothyroidism and those with overt hypothyroidism.

Material and methods: This cross-sectional study queried the Healthcare Cost and Utilization Project's National Inpatient Sample. Study population included 11 620 hospital deliveries with a diagnosis code of subclinical hypothyroidism and 697 320 hospital deliveries with a diagnosis code of overt hypothyroidism. Main outcome was severe maternal morbidity per the Centers for Disease Control and Prevention definition (20 indicators), assessed with multivariable generalized linear model.

Results: Pregnancy with subclinical hypothyroidism was associated with a 54% higher rate of severe maternal morbidity at delivery compared with those with overt hypothyroidism (18.1 and 11.1 per 1000 deliveries, adjusted-incidence rate ratio [aIR] 1.54, 95% confidence interval [CI] 1.34-1.76). Among the individual severe maternal morbidity indicators, the incidence rate of eclampsia (2.2 versus 0.7 per 1000 deliveries, aIR 2.73, 95% CI: 1.83-4.09) was particularly higher among pregnancies with subclinical hypothyroidism compared with pregnancies with overt hypothyroidism. In an exploratory evaluation according to patient demographics, maternal age younger than 25 years (31.9 vs. 9.4 per 1000 deliveries, aIR 3.62, 95% CI: 2.62-5.01), Black individuals (55.2 vs. 24.7 per 1000 deliveries, aIR 2.21, 95% CI: 1.60-3.06), pregestational hypertension (70.2 vs. 27.2 per 1000 deliveries, aIR 2.20, 95% CI: 1.60-3.03), and obesity disorder (35.2 vs. 16.7 per 1000 deliveries, aIR 1.87, 95% CI: 1.48-2.35) were associated with higher rates of severe maternal morbidity for subclinical hypothyroidism compared with overt hypothyroidism. Severe maternal morbidity rates were more than twice as high for subclinical hypothyroidism compared with overt hypothyroidism among pregnant patients younger than 25 years with obesity disorder (79.4 vs. 10.1 per 1000 deliveries, aIR 7.89, 95% CI: 4.78-13.02), Black individuals with pregestational hypertension (157.9 vs. 40.2 per 1000 deliveries, aIR 3.15, 95% CI: 1.77-5.61), and Black individuals with obesity disorder (102.0 vs. 33.9 per 1000 deliveries, aIR 2.81, 95% CI: 1.83-4.32).

Conclusions: The results of this cross-sectional study suggest that subclinical hypothyroidism may be associated with higher rates of severe maternal morbidity at delivery compared with overt hypothyroidism.