Maternal-fetal medicine (Wolters Kluwer Health, Inc.)最新文献

Objective: To investigate whether coronavirus disease 2019 (COVID-19) infection increases the risk of gestational diabetes mellitus (GDM) in pregnant women and to assess whether this risk persists beyond the acute phase of infection.

Methods: A retrospective cohort study was conducted at Peking University First Hospital between January and February 2023, enrolling pregnant women who contracted COVID-19 between 16 and 32 weeks of gestation. The primary exposure was the time interval between the oral glucose tolerance test (OGTT) and the onset of COVID-19 infection. The primary outcome was the diagnosis of GDM based on OGTT results. A locally weighted scatterplot smoothing method was applied to visualize trends, and logistic regression was used to estimate odds ratios (ORs).

Results: The incidence of GDM increased from 23.1% (18/78) in women who underwent OGTT before COVID-19 infection to 36.6% (37/101) in those tested after infection (P = 0.051). All OGTT values were elevated post-infection, with postprandial glucose levels showing the most pronounced rise. As the time since infection increased, OGTT values gradually normalized. The elevated risk of GDM decreased over time: OR for 1-2 weeks post-infection was 3.58 (95% confidence interval: 1.27-10.23); 3-4 weeks: 2.47 (1.04-5.94); 5-6 weeks: 1.45 (0.44-4.41); and 7-8 weeks: 0.41 (0.08-1.55).

Conclusion: COVID-19 infection was associated with a transiently increased risk of GDM, particularly within the first month following symptom onset, suggesting that the infection may have a short-term impact on glucose metabolism during pregnancy.

Objective: To evaluate the efficacy and safety of internal iliac artery (IIA) ligation in the management of placenta accreta spectrum (PAS).

Methods: PubMed, Embase, Scopus, ScienceDirect, Cochrane Library, and Clinical Trials Registry were searched up to December 2024 for studies on IIA ligation in PAS. This PROSPERO-registered review followed PRISMA guidelines and included randomized controlled trials (RCTs) and non-RCTs comparing IIA ligation with no intervention, IIA balloon, uterine artery ligation, or temporary common iliac artery occlusion. Outcomes included intraoperative blood loss, transfusion needs, procedure duration, complications, intensive care unit admission, and hospital stay, with risk of bias assessed using Cochrane criteria and the Newcastle-Ottawa Scale, and evidence quality rated via GRADE. Effect estimates were reported as mean differences or odds ratios (95% confidence interval (CI)) using fixed- or random-effects models based on heterogeneity (I ²), with P < 0.05 considered significant.

Results: A total of 13 studies, including five RCTs and eight non-RCTs, involving 939 participants, met the inclusion criteria and were included in the study. Intraoperative blood loss was evaluated in 10 studies involving 631 participants (299 undergoing IIA ligation and 332 controls). The mean difference was -177.10 mL (95% CI: -701.46-347.27; P = 0.51; I ² = 95%). Postoperative hemoglobin reduction was analyzed in four studies with 233 participants (109 subjected to IIA ligation and 124 controls), yielding a mean difference of -0.17 g/dL (95% CI: -0.47-0.14, P = 0.29, I ² = 1%). Blood transfusion was assessed in five studies enrolling 248 participants (125 in the IIA ligation group and 123 controls). The mean difference was found to be -0.06 units (95% CI: -2.08-1.95, P = 0.95, I ² = 93%). The duration of the procedure was investigated in eight studies comprising 539 participants (271 undergoing IIA ligation and 268 controls). The mean difference was calculated as 12.85 minutes (95% CI: -7.2-32.9, P = 0.21, I ² = 87%).

Conclusion: Current evidence suggests that IIA ligation in PAS may not significantly reduce intraoperative blood loss, transfusion requirements, procedure duration, bladder injury, or hospital stay; however, the available studies are heterogeneous and of variable quality, and further high-quality research is needed to confirm these findings.

Registration: CRD42024626882, Date 13/12/2024.

Objective: To investigate whether a supervised exercise program during pregnancy induces modifications in the maternal lipid profile.

Methods: This unplanned secondary analysis of a multicenter randomized controlled trial (March 2021-June 2023) was conducted at Hospital Universitario de Torrejón, the only participating center with routine lipid profiling during all three trimesters and postpartum. Eligible women had a singleton pregnancy < 14⁺³ weeks without complications. Participants were randomized (1:1) to a supervised exercise program (three 55-60 min sessions/week, virtual or onsite) or control (usual activity). Exercise adherence was defined as ≥ 80% session attendance. Maternal characteristics, blood pressure, and weight were recorded at baseline and follow-up visits in the second and third trimesters and 6-12 months postpartum. Venous blood samples were collected for lipid profiling, including total cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C). Between-group differences were tested with Wilcoxon signed-rank tests, and repeated measures were analyzed with generalized estimating equations including gestational age, intervention group, delivery status, and obesity interaction. Both intention-to-treat and per-protocol analyses were performed. Statistical significance was considered at P < 0.05.

Results: A total of 202 pregnant women were enrolled, and 182 were included in the final analysis (90 in the control group and 92 in the intervention group). No significant between-group differences were observed in lipid profiles at the second trimester, third trimester, or postpartum. Longitudinal analysis showed higher HDL-C levels in the IG (+3.24 mg/dl; 95% confidence interval (CI): 0.13-6.35, P = 0.041), persisting postpartum, and a nonsignificant trend toward lower LDL-C (-6.02 mg/dl; 95% CI: -13.18 to 1.14, P = 0.099). These effects were not confirmed in the per-protocol analysis, and no interaction with obesity was observed.

Conclusion: A supervised exercise program throughout pregnancy may increase HDL-C levels and potentially reduce LDL-C, thereby improving the maternal lipid profile. Further studies are needed to confirm and expand upon these findings.

Registration: No. NCT04563065 (Randomized Controlled Clinical Trial).

Objective: To evaluate the safety and effectiveness of intermittent bolus administration of ephedrine, norepinephrine, and phenylephrine in the treatment of maternal hypotension during spinal anesthesia for cesarean sections in preeclamptic women.

Methods: This PRISMA-based systematic review included English random control trails (RCTs) of women with singleton preeclampsia (American College of Obstetricians and Gynecologists (ACOG) criteria) undergoing cesarean delivery with spinal anesthesia, excluding chronic hypertension or systemic disease. Interventions were intermittent bolus phenylephrine, norepinephrine, or ephedrine, with outcomes on maternal hemodynamics, neonatal status, and adverse events. Searches of PubMed, ScienceDirect, Google Scholar, and Cochrane (to December 2024) plus reference screening identified eligible studies. Two reviewers independently selected studies, extracted data, and assessed risk of bias (Cochrane RoB 2.0). Due to heterogeneity in vasopressor regimens and outcome measures, results were synthesized narratively.

Results: Of 2333 records screened, six RCTs (sample sizes 20-166) were included, all in preeclamptic women undergoing cesarean delivery. Overall risk of bias was low. Norepinephrine better preserved maternal hemodynamics than phenylephrine or ephedrine, with higher cardiac output (6.31 ± 1.08 vs. 5.45 ± 1.21 L/min; P = 0.009) and lower uteroplacental resistance (0.04 ± 0.02 vs. 0.06 ± 0.03; P = 0.002). Ephedrine caused higher heart rates (84.9 ± 7.1 vs. 76.6 ± 6.9 bpm; P < 0.05) and more nausea/vomiting. Neonatal umbilical artery pH was higher with norepinephrine or phenylephrine than ephedrine (7.32 ± 0.02 vs. 7.31 ± 0.03; P < 0.050), while Apgar scores did not differ. Adverse events favored norepinephrine, which reduced bradycardia versus phenylephrine (5.1% vs. 20.5%; relative risk (RR) = 0.25; P = 0.042) and tachycardia versus ephedrine (16.1% vs. 36.4%; RR = 0.54; P = 0.020).

Conclusion: Intermittent bolus administration of norepinephrine offers superior maternal cardiac output and neonatal safety, making it optimal for preeclamptic cesarean deliveries. Phenylephrine is effective for blood pressure control but may induce bradycardia, while the use of ephedrine is limited by its association with neonatal acidosis. Tailored vasopressor selection is thus essential for optimal outcomes.

Registration: PROSPERO; CRD42024565007.

Objective: To evaluate the early pregnancy loss (EPL) rates in women with and without low molecular weight heparin (LMWH) treatment during early pregnancy.

Methods: A retrospective, non-randomized study was conducted at Guangzhou Women and Children's Medical Center between June 2019 and March 2022, involving women diagnosed with polycystic ovary syndrome (PCOS). All participants conceived following standard preconception care and voluntarily chose either the control group or the LMWH intervention group during the first month of pregnancy. The intervention was administered throughout the entire first trimester. Early and final pregnancy outcomes were recorded, with a particular focus on EPL rates. In addition, venous blood samples and clinical data were collected to compare hormonal profiles, blood lipid levels, and anthropometric parameters between the two groups. Statistical analyses included the two-tailed unpaired Student's t-test, Mann-Whitney U test, Chi-square test, and Kaplan-Meier survival analysis. A value of P < 0.050 was considered statistically significant.

Results: Thirty-eight women in the LMWH group and 102 women in the control group were included. The EPL rates in the LMWH and control groups were 5.3% (2/38) and 26.5% (27/102), respectively (χ ² = 7.582, P = 0.006, odds ratio (OR) = 0.154, 95% confidence interval (CI): 0.035-0.685). The age (P = 0.005), PCOS subtype (P = 0.012), and levels of total cholesterol (P = 0.003), and high-density lipoprotein (P = 0.018) were significantly different between these two groups. Continued follow-up was performed to observe the long-time effects of LMWH treatment in early pregnancy. Seventy-three patients were successfully delivered, 23 patients in the LMWH group and 50 patients in the control group. There was no significant difference between the LMWH and control groups in gestation length, bleeding during delivery, birth weight, gender of the newborn, or mode of delivery. In addition, Kaplan-Meier curve analysis revealed that LMWH treatment may decrease the risk of EPL in PCOS patients in the first trimester (χ ² = 4.144, P = 0.040).

Conclusion: LMWH treatment during early pregnancy may reduce the EPL rate in women with PCOS.