Objective: This study aimed to examine the effect of incremental changes in body mass index (BMI, kg/m2) on the association with adverse pregnancy outcomes.
Study design: This was a retrospective cohort study of U.S. vital statistics Live Birth and Infant Death linked data from 2011 to 2020. We limited analyses to nulliparas with singleton pregnancies who delivered at 20 weeks or greater. Outcomes were compared according to the prepregnancy BMI category using 5 kg/m2 increments, with each of the other BMI categories sequentially as the referent. The composite neonatal outcome was defined as any neonatal death, neonatal intensive care unit (ICU), surfactant use, ventilation use, or seizure. Severe maternal morbidity was defined as any maternal ICU, transfusion, uterine rupture, and hysterectomy. Adjusted relative risks were calculated for each BMI category as a referent group, using modified Poisson regression and adjusting for confounders.
Results: A total of 11,174,890 nulliparous individuals were included. From 2011 to 2020, the proportions of individuals with BMI 40 or greater, BMI 50 or greater, and BMI 60 or greater increased significantly (from 3.1 to 4.9%, from 0.4 to 0.6%, from 0.03 to 0.06%, respectively; all trend p-values < 0.001). As BMI deviated from normal BMI, risks of neonatal and maternal adverse outcomes increased progressively. For example, as BMI deviated from normal BMI (18.5-24.9), the risk of composite neonatal outcome increased by 2% in individuals with BMI < 18.5 and up to 2.11-fold in individuals with BMI 65-69.9. When compared with BMI 40 to 44.9, BMI 35 to 39.9 was associated with an 8% decreased risk of composite neonatal outcome, whereas BMI 45 to 49.9 was associated with an 8% increased risk of composite neonatal outcome.
Conclusion: Incremental increases in prepregnancy BMI are linked to higher risks of adverse pregnancy outcomes, highlighting the need for effective weight management before conception.
{"title":"Neonatal and Maternal Outcomes in Nulliparous Individuals according to Prepregnancy Body Mass Index.","authors":"Tetsuya Kawakita, Rula Atwani, George Saade","doi":"10.1055/a-2388-6158","DOIUrl":"10.1055/a-2388-6158","url":null,"abstract":"<p><strong>Objective: </strong> This study aimed to examine the effect of incremental changes in body mass index (BMI, kg/m<sup>2</sup>) on the association with adverse pregnancy outcomes.</p><p><strong>Study design: </strong> This was a retrospective cohort study of U.S. vital statistics Live Birth and Infant Death linked data from 2011 to 2020. We limited analyses to nulliparas with singleton pregnancies who delivered at 20 weeks or greater. Outcomes were compared according to the prepregnancy BMI category using 5 kg/m<sup>2</sup> increments, with each of the other BMI categories sequentially as the referent. The composite neonatal outcome was defined as any neonatal death, neonatal intensive care unit (ICU), surfactant use, ventilation use, or seizure. Severe maternal morbidity was defined as any maternal ICU, transfusion, uterine rupture, and hysterectomy. Adjusted relative risks were calculated for each BMI category as a referent group, using modified Poisson regression and adjusting for confounders.</p><p><strong>Results: </strong> A total of 11,174,890 nulliparous individuals were included. From 2011 to 2020, the proportions of individuals with BMI 40 or greater, BMI 50 or greater, and BMI 60 or greater increased significantly (from 3.1 to 4.9%, from 0.4 to 0.6%, from 0.03 to 0.06%, respectively; all trend <i>p</i>-values < 0.001). As BMI deviated from normal BMI, risks of neonatal and maternal adverse outcomes increased progressively. For example, as BMI deviated from normal BMI (18.5-24.9), the risk of composite neonatal outcome increased by 2% in individuals with BMI < 18.5 and up to 2.11-fold in individuals with BMI 65-69.9. When compared with BMI 40 to 44.9, BMI 35 to 39.9 was associated with an 8% decreased risk of composite neonatal outcome, whereas BMI 45 to 49.9 was associated with an 8% increased risk of composite neonatal outcome.</p><p><strong>Conclusion: </strong> Incremental increases in prepregnancy BMI are linked to higher risks of adverse pregnancy outcomes, highlighting the need for effective weight management before conception.</p><p><strong>Key points: </strong>· Incremental BMI increases raise pregnancy risks.. · Higher BMI linked to adverse neonatal outcomes.. · Elevated BMI heightens severe maternal morbidity..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141981519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yosuke Komatsu, E J T Joanne Verweij, Eleonor Tiblad, Enrico Lopriore, Dick Oepkes, Prasheen Agarwal, Edwin Lam, Jocelyn H Leu, Leona E Ling, Robert M Nelson, Victor Olusajo, Shumyla Saeed-Khawaja, May Lee Tjoa, Jie Zhou, Umair Amin, Waheeda Sirah, Kenneth J Moise
Objective: Nipocalimab is a neonatal fragment crystallizable (Fc) receptor (FcRn)-blocking monoclonal antibody that inhibits placental immunoglobulin G (IgG) transfer and lowers circulating maternal IgG levels. In an open-label, single-arm, phase 2 study, nipocalimab demonstrated evidence of safety and efficacy that support further investigation in a pivotal phase 3 trial of recurrent hemolytic disease of the fetus and newborn (HDFN). The phase 3 AZALEA study aims to evaluate the efficacy and safety of nipocalimab in a larger population at risk for severe HDFN, defined as HDFN associated with poor fetal outcomes or neonatal death.
Study design: AZALEA is a multicenter, randomized, placebo-controlled, double-blind, phase 3 study enrolling alloimmunized pregnant individuals (N ≈ 120) at risk for severe HDFN based on obstetric history. Participants are randomized 2:1 to receive intravenous 45 mg/kg nipocalimab or placebo weekly from 13-16 to 35 weeks gestational age (GA). During the double-blind treatment period, participants receive standard-of-care weekly monitoring for fetal anemia until planned delivery at 37 to 38 weeks of GA. Postnatal follow-up periods are 24 weeks for maternal participants and 104 weeks for neonates/infants.
Results: The primary endpoint is the proportion of pregnancies that do not result in intrauterine transfusion (IUT), hydrops fetalis, or fetal loss/neonatal death from all causes. Key secondary endpoints include the severity of HDFN as measured by a composite HDFN severity index, the earliest time to occurrence of IUT or hydrops fetalis, the modified neonatal mortality and morbidity index in liveborn neonates, and the number of IUTs received. Other endpoints are safety, patient- and caregiver-reported outcomes, pharmacokinetics, pharmacodynamics (e.g., IgG, FcRn receptor occupancy), and immunogenicity of nipocalimab.
Conclusion: AZALEA, the first placebo-controlled, randomized, multicenter, prospective trial in severe HDFN, is designed to evaluate the safety and efficacy of nipocalimab, a potential preventive and noninvasive intervention, in at-risk HDFN pregnancies.
Key points: · Severe HDFN leads to poor fetal/neonatal outcomes.. · IUTs are associated with complications and fetal loss.. · Nipocalimab blocks IgG recycling and placental transfer.. · Nipocalimab reduces fetal anemia and IUTs in early-onset severe HDFN.. · The phase 3 AZALEA study evaluates nipocalimab in severe HDFN..
{"title":"Design of a Phase 3, Global, Multicenter, Randomized, Placebo-Controlled, Double-Blind Study of Nipocalimab in Pregnancies at Risk for Severe Hemolytic Disease of the Fetus and Newborn.","authors":"Yosuke Komatsu, E J T Joanne Verweij, Eleonor Tiblad, Enrico Lopriore, Dick Oepkes, Prasheen Agarwal, Edwin Lam, Jocelyn H Leu, Leona E Ling, Robert M Nelson, Victor Olusajo, Shumyla Saeed-Khawaja, May Lee Tjoa, Jie Zhou, Umair Amin, Waheeda Sirah, Kenneth J Moise","doi":"10.1055/a-2404-8089","DOIUrl":"10.1055/a-2404-8089","url":null,"abstract":"<p><strong>Objective: </strong> Nipocalimab is a neonatal fragment crystallizable (Fc) receptor (FcRn)-blocking monoclonal antibody that inhibits placental immunoglobulin G (IgG) transfer and lowers circulating maternal IgG levels. In an open-label, single-arm, phase 2 study, nipocalimab demonstrated evidence of safety and efficacy that support further investigation in a pivotal phase 3 trial of recurrent hemolytic disease of the fetus and newborn (HDFN). The phase 3 AZALEA study aims to evaluate the efficacy and safety of nipocalimab in a larger population at risk for severe HDFN, defined as HDFN associated with poor fetal outcomes or neonatal death.</p><p><strong>Study design: </strong> AZALEA is a multicenter, randomized, placebo-controlled, double-blind, phase 3 study enrolling alloimmunized pregnant individuals (<i>N</i> ≈ 120) at risk for severe HDFN based on obstetric history. Participants are randomized 2:1 to receive intravenous 45 mg/kg nipocalimab or placebo weekly from 13-16 to 35 weeks gestational age (GA). During the double-blind treatment period, participants receive standard-of-care weekly monitoring for fetal anemia until planned delivery at 37 to 38 weeks of GA. Postnatal follow-up periods are 24 weeks for maternal participants and 104 weeks for neonates/infants.</p><p><strong>Results: </strong> The primary endpoint is the proportion of pregnancies that do not result in intrauterine transfusion (IUT), hydrops fetalis, or fetal loss/neonatal death from all causes. Key secondary endpoints include the severity of HDFN as measured by a composite HDFN severity index, the earliest time to occurrence of IUT or hydrops fetalis, the modified neonatal mortality and morbidity index in liveborn neonates, and the number of IUTs received. Other endpoints are safety, patient- and caregiver-reported outcomes, pharmacokinetics, pharmacodynamics (e.g., IgG, FcRn receptor occupancy), and immunogenicity of nipocalimab.</p><p><strong>Conclusion: </strong> AZALEA, the first placebo-controlled, randomized, multicenter, prospective trial in severe HDFN, is designed to evaluate the safety and efficacy of nipocalimab, a potential preventive and noninvasive intervention, in at-risk HDFN pregnancies.</p><p><strong>Key points: </strong>· Severe HDFN leads to poor fetal/neonatal outcomes.. · IUTs are associated with complications and fetal loss.. · Nipocalimab blocks IgG recycling and placental transfer.. · Nipocalimab reduces fetal anemia and IUTs in early-onset severe HDFN.. · The phase 3 AZALEA study evaluates nipocalimab in severe HDFN..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142091393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sabrena Myers, Abigail Pyne, Alice Darling, Noor Al-Shibli, Jennifer J M Cate, Matthew R Grace, Sarahn Wheeler, Sarah K Dotters-Katz
Objective: This study aimed to assess the rates of vaginal delivery (VD) and the predictors of VD in a cohort of patients with early (<34 weeks) preeclampsia with severe features (Early Severe PreEClampsia [ESPEC]).
Study design: We conducted a retrospective cohort study of patients with ESPEC admitted to a single center from 2013 to 2019. Exclusion criteria included patients with contraindications to labor, multifetal gestation, or presenting in spontaneous labor. Patient characteristics were abstracted. The primary outcome was rate of VD. Secondary outcome was factors associated with VD. Secondary analysis performed including only primiparous patients. Bivariate statistics and logistic regression were used to analyze data.
Results: Of 229 patients with ESPEC, 184 (80%) were candidates for labor. Of those, 74 (40%) underwent prelabor cesarean delivery (CD). Among the 110 remaining patients who attempted VD, 47 (43%) were successful. No significant differences in characteristics between VD and CD patients were found on bivariate analysis. In regression models, BMI ≥ 40 was associated with increased odds of CD (adjusted odds ratio [aOR]: 2.83, 95% confidence interval [CI]: 1.01, 7.95), whereas private insurance was associated with reduced odds of CD (aOR: 0.37, 95% CI: 0.16, 0.86). In planned secondary analysis of primiparous patients, 101/123 (82%) were candidates for labor. Of those, 29 underwent prelabor CD. The VD rate among primiparous patients attempting labor was 40% (29/72). In this subgroup, private insurance was associated with VD (71 vs. 46%, p = 0.03). In regression models, only private insurance remained associated with CD (aOR: 0.30, 95% CI: 0.10, 0.92).
Conclusion: Patients with ESPEC who attempted VD were successful less than half of the time, with similar rates among the subset of primiparous patients. BMI ≥ 40 was associated with increased odds of CD, whereas private insurance was associated with reduced odds of CD. These data may aid providers in counseling patients with ESPEC on the likelihood of successful VD.
Key points: · Only 43% of ESPEC patients who attempted VD were successful.. · Subset of primiparous patients w/ESPEC had similar VD rate.. · BMI ≥40 kg/m2 in ESPEC patients was associated with increased odds of CD..
研究目的本研究旨在评估一组早期ESPEC患者的阴道分娩率和阴道分娩的预测因素：我们对 2013-2019 年间在一家中心住院的 ESPEC 患者进行了一项回顾性队列研究。排除标准包括有分娩禁忌症、多胎妊娠或自然分娩的患者。对患者特征进行了摘要分析。主要结果是VD发生率。次要结果是与顺产相关的因素。仅对初产妇进行二次分析。采用双变量统计和逻辑回归分析数据：在229名ESPEC患者中，184人（80%）适合分娩。其中，74 人（40%）进行了产前剖宫产（CD）。其余110名尝试顺产的患者中，47人（43%）顺产成功。经双变量分析，VD 和 CD 患者的特征无明显差异。在回归模型中，体重指数≥40 与 CD 的几率增加有关（aOR:2.83, 95%CI:1.01,7.95），而私人保险与 CD 的几率降低有关（aOR:0.37, 95%CI:0.16,0.86）。在计划对初产妇进行的二次分析中，101/123（82%）名初产妇符合分娩条件。其中 29 人接受了产前 CD。初产妇待产率为 40%（29/72）。在这个亚组中，私人保险与VD相关（71%vs46%,P=0.03）。在回归模型中，只有私人保险仍与CD相关（aOR:0.30, 95%CI:0.10,0.92）：结论：尝试阴道分娩的ESPEC患者只有不到一半的成功率，初产妇的成功率与之相似。体重指数≥40与阴道分娩几率增加有关，而私人保险与阴道分娩几率降低有关。这些数据可能有助于医疗服务提供者向ESPEC患者提供有关阴道分娩成功几率的咨询。
{"title":"Predictors of Vaginal Delivery among Patients Admitted with Severe Preeclampsia.","authors":"Sabrena Myers, Abigail Pyne, Alice Darling, Noor Al-Shibli, Jennifer J M Cate, Matthew R Grace, Sarahn Wheeler, Sarah K Dotters-Katz","doi":"10.1055/a-2405-1778","DOIUrl":"10.1055/a-2405-1778","url":null,"abstract":"<p><strong>Objective: </strong> This study aimed to assess the rates of vaginal delivery (VD) and the predictors of VD in a cohort of patients with early (<34 weeks) preeclampsia with severe features (Early Severe PreEClampsia [ESPEC]).</p><p><strong>Study design: </strong> We conducted a retrospective cohort study of patients with ESPEC admitted to a single center from 2013 to 2019. Exclusion criteria included patients with contraindications to labor, multifetal gestation, or presenting in spontaneous labor. Patient characteristics were abstracted. The primary outcome was rate of VD. Secondary outcome was factors associated with VD. Secondary analysis performed including only primiparous patients. Bivariate statistics and logistic regression were used to analyze data.</p><p><strong>Results: </strong> Of 229 patients with ESPEC, 184 (80%) were candidates for labor. Of those, 74 (40%) underwent prelabor cesarean delivery (CD). Among the 110 remaining patients who attempted VD, 47 (43%) were successful. No significant differences in characteristics between VD and CD patients were found on bivariate analysis. In regression models, BMI ≥ 40 was associated with increased odds of CD (adjusted odds ratio [aOR]: 2.83, 95% confidence interval [CI]: 1.01, 7.95), whereas private insurance was associated with reduced odds of CD (aOR: 0.37, 95% CI: 0.16, 0.86). In planned secondary analysis of primiparous patients, 101/123 (82%) were candidates for labor. Of those, 29 underwent prelabor CD. The VD rate among primiparous patients attempting labor was 40% (29/72). In this subgroup, private insurance was associated with VD (71 vs. 46%, <i>p</i> = 0.03). In regression models, only private insurance remained associated with CD (aOR: 0.30, 95% CI: 0.10, 0.92).</p><p><strong>Conclusion: </strong> Patients with ESPEC who attempted VD were successful less than half of the time, with similar rates among the subset of primiparous patients. BMI ≥ 40 was associated with increased odds of CD, whereas private insurance was associated with reduced odds of CD. These data may aid providers in counseling patients with ESPEC on the likelihood of successful VD.</p><p><strong>Key points: </strong>· Only 43% of ESPEC patients who attempted VD were successful.. · Subset of primiparous patients w/ESPEC had similar VD rate.. · BMI ≥40 kg/m2 in ESPEC patients was associated with increased odds of CD..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142103505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alissa Kathleen Prior,Cara Dolin,Whitney Renee Bender,Celeste Durnwald,Rebecca F Hamm
OBJECTIVEThe Endocrine Society recommends a postpartum fasting blood glucose (FBG) be performed for patients with gestational diabetes mellitus (GDM) prior to hospital discharge to screen for ongoing hyperglycemia. There is limited data, however, on whether a FBG can screen for glucose intolerance and if it correlates with the gold standard 4-to-12-week 2-hour oral glucose tolerance test (OGTT). Our objective was to evaluate if FBG correlates with the gold standard 2-hour OGTT.STUDY DESIGNThis retrospective cohort study of patients with GDM who delivered >20 weeks gestation at 2 urban centers from January 2017 to December 2020 included those who completed both a postpartum FBG prior to discharge and a 2-hour 75-gram OGTT within 1 year of delivery. Abnormal 2-hour OGTT was defined as fasting value ≥100mg/dL and/or 2-hour value ≥140mg/dL. We evaluated test characteristics (e.g. sensitivity, specificity) of postpartum FBG cutoffs at predicting an abnormal 2-hour OGTT result.RESULTS235 patients met inclusion criteria, of which 63% were diet-controlled and 37% required medical management. FBG ranged from 64-134mg/dL, with 6/235 (2.6%) with values ≥ 126mg/dL. 39/235 (16.6%) of patients had an abnormal 2-hour OGTT. Overall, AUC for FBG predicting abnormal 2-hour OGTT was 0.65. Traditionally considered high cutoffs (≥126mg/dL) for predicting persistent impaired glucose intolerance demonstrated poor PPV (< 20%). In contrast, low cutoffs demonstrated excellent NPV (>90%). A postpartum FBG of 88mg/dL was determined to be the optimal cutoff for FBG with NPV=92.4% (Youden index=0.34). In this dataset, if FBG ≥88mg/dL was used to determine if 2-hour OGTT was required, almost half of GDM patients could avoid further glucose tolerance testing.CONCLUSIONSWhile previously thought of as best utilized for its PPV, the FBG may be best used for its NPV. In our study, clinical application of a FBG <88mg/dL was highly correlative with a normal 2-hour OGTT.
{"title":"Utilization of a postpartum fasting blood glucose to predict impaired glucose tolerance in patients with gestational diabetes mellitus.","authors":"Alissa Kathleen Prior,Cara Dolin,Whitney Renee Bender,Celeste Durnwald,Rebecca F Hamm","doi":"10.1055/a-2416-5742","DOIUrl":"https://doi.org/10.1055/a-2416-5742","url":null,"abstract":"OBJECTIVEThe Endocrine Society recommends a postpartum fasting blood glucose (FBG) be performed for patients with gestational diabetes mellitus (GDM) prior to hospital discharge to screen for ongoing hyperglycemia. There is limited data, however, on whether a FBG can screen for glucose intolerance and if it correlates with the gold standard 4-to-12-week 2-hour oral glucose tolerance test (OGTT). Our objective was to evaluate if FBG correlates with the gold standard 2-hour OGTT.STUDY DESIGNThis retrospective cohort study of patients with GDM who delivered >20 weeks gestation at 2 urban centers from January 2017 to December 2020 included those who completed both a postpartum FBG prior to discharge and a 2-hour 75-gram OGTT within 1 year of delivery. Abnormal 2-hour OGTT was defined as fasting value ≥100mg/dL and/or 2-hour value ≥140mg/dL. We evaluated test characteristics (e.g. sensitivity, specificity) of postpartum FBG cutoffs at predicting an abnormal 2-hour OGTT result.RESULTS235 patients met inclusion criteria, of which 63% were diet-controlled and 37% required medical management. FBG ranged from 64-134mg/dL, with 6/235 (2.6%) with values ≥ 126mg/dL. 39/235 (16.6%) of patients had an abnormal 2-hour OGTT. Overall, AUC for FBG predicting abnormal 2-hour OGTT was 0.65. Traditionally considered high cutoffs (≥126mg/dL) for predicting persistent impaired glucose intolerance demonstrated poor PPV (< 20%). In contrast, low cutoffs demonstrated excellent NPV (>90%). A postpartum FBG of 88mg/dL was determined to be the optimal cutoff for FBG with NPV=92.4% (Youden index=0.34). In this dataset, if FBG ≥88mg/dL was used to determine if 2-hour OGTT was required, almost half of GDM patients could avoid further glucose tolerance testing.CONCLUSIONSWhile previously thought of as best utilized for its PPV, the FBG may be best used for its NPV. In our study, clinical application of a FBG <88mg/dL was highly correlative with a normal 2-hour OGTT.","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142268252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alexandria Kraus,Lauren Marie Kucirka,Julie Johnson,Albatoul AbouNouar,Sean V Connelly,Hannah L Thel,Heli S Kavi,Brazil M Bailey,Madelyn K Fox,Kimberly Malloy,Erin Huprich,Jamie L Conklin,Kim Boggess
OBJECTIVEWe aimed to summarize the available evidence examining the association between prenatal ultrasound findings and adverse fetal, obstetric, and neonatal outcomes in pregnancies complicated by type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) and to evaluate whether the predictive value of ultrasound findings for adverse outcomes varies between T1DM and T2DM pregnancies.DATA SOURCESWe conducted a systematic review of the existing literature through August 12, 2024.METHODS OF STUDY SELECTIONWe included articles in English that reported associations between ultrasound findings and fetal, obstetric, and neonatal outcomes in pregnant people with T1DM and T2DM. Two independent reviewers examined articles at the abstract level and, if eligible, at the full-text level; disagreements were adjudicated by a third reviewer.TABULATION, INTEGRATION, AND RESULTSOf the 2,088 unique citations reviewed, 12 studies met the inclusion criteria describing associations between ultrasound findings and fetal, obstetric, and neonatal outcomes among a total of 1,165 pregnant people with T1DM and 489 pregnant people with T2DM. Most studies (10/12) examined the association between ultrasound measures of growth, including estimated fetal weight (EFW) and its individual components, abdominal wall thickness, head circumference to abdominal circumference (HC/AC) ratio, and birthweight, large for gestational age (LGA) or small for gestational age (SGA). Studies did not examine stillbirth, neonatal demise, or maternal outcomes other than cesarean section.CONCLUSIONThis systematic review synthesizes the available literature on ultrasound risk markers of adverse fetal, obstetric, and neonatal outcomes separately in pregnant people with T1DM and T2DM. We identified very few studies that distinguished between pregnant people with T1DM and T2DM, and the majority focused on surrogate outcomes (e.g., LGA, SGA) of morbidity. Our findings highlight the need for further studies investigating these distinct diseases to provide evidence for antenatal management recommendations.
{"title":"Comparison of Ultrasound Findings Associated with Adverse Fetal, Obstetric, and Neonatal Outcomes in Pregestational Type 1 And Type 2 Diabetes: A Systematic Review.","authors":"Alexandria Kraus,Lauren Marie Kucirka,Julie Johnson,Albatoul AbouNouar,Sean V Connelly,Hannah L Thel,Heli S Kavi,Brazil M Bailey,Madelyn K Fox,Kimberly Malloy,Erin Huprich,Jamie L Conklin,Kim Boggess","doi":"10.1055/a-2414-0932","DOIUrl":"https://doi.org/10.1055/a-2414-0932","url":null,"abstract":"OBJECTIVEWe aimed to summarize the available evidence examining the association between prenatal ultrasound findings and adverse fetal, obstetric, and neonatal outcomes in pregnancies complicated by type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) and to evaluate whether the predictive value of ultrasound findings for adverse outcomes varies between T1DM and T2DM pregnancies.DATA SOURCESWe conducted a systematic review of the existing literature through August 12, 2024.METHODS OF STUDY SELECTIONWe included articles in English that reported associations between ultrasound findings and fetal, obstetric, and neonatal outcomes in pregnant people with T1DM and T2DM. Two independent reviewers examined articles at the abstract level and, if eligible, at the full-text level; disagreements were adjudicated by a third reviewer.TABULATION, INTEGRATION, AND RESULTSOf the 2,088 unique citations reviewed, 12 studies met the inclusion criteria describing associations between ultrasound findings and fetal, obstetric, and neonatal outcomes among a total of 1,165 pregnant people with T1DM and 489 pregnant people with T2DM. Most studies (10/12) examined the association between ultrasound measures of growth, including estimated fetal weight (EFW) and its individual components, abdominal wall thickness, head circumference to abdominal circumference (HC/AC) ratio, and birthweight, large for gestational age (LGA) or small for gestational age (SGA). Studies did not examine stillbirth, neonatal demise, or maternal outcomes other than cesarean section.CONCLUSIONThis systematic review synthesizes the available literature on ultrasound risk markers of adverse fetal, obstetric, and neonatal outcomes separately in pregnant people with T1DM and T2DM. We identified very few studies that distinguished between pregnant people with T1DM and T2DM, and the majority focused on surrogate outcomes (e.g., LGA, SGA) of morbidity. Our findings highlight the need for further studies investigating these distinct diseases to provide evidence for antenatal management recommendations.","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142247673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Helen Gomez Slagle,Richard J Caplan,Tetsuya Kawakita,Anthony Sciscione,Matthew Hoffman
OBJECTIVEChorioamnionitis is associated with neonatal morbidity and infection-related mortality, but our ability to predict intrapartum infection is limited. We sought to derive and validate a prediction model for chorioamnionitis among patients presenting to labor and delivery at term.STUDY DESIGNThis was a planned secondary analysis of a large cohort study from 2014 through 2018 at an academic tertiary care center. To derive a prediction model for chorioamnionitis, we limited our analysis to full-term (≥37 weeks) patients with a singleton gestation undergoing labor induction and presenting in labor. Both nulliparous and multiparous patients were included. Patients with a planned cesarean delivery, fever on admission, or missing data were excluded. The model was derived using multivariable logistic regression. Refinement of the prediction model with internal calibration was performed. External validation was performed utilizing a publicly available database (Consortium on Safe Labor) and applying the same inclusion and exclusion criteria. The discriminative power of each model was assessed using a bootstrap, bias-corrected area under the curve.RESULTSThe chorioamnionitis rates in the derivation and external validation groups were: 5% (1,005/19,966) and 5.8% (n = 3,005/52,171), respectively. In multivariable modeling, maternal age, nulliparity, gestational age, smoking status, group B streptococcus colonization, hours ruptured, number of cervical exams, length of labor, epidural use, internal monitoring, and meconium were significantly associated with infection. A calculator was created and externally validated with an area under the curve of 0.82 (95% confidence interval, 0.81-0.82). External validity was further confirmed with a calibration intercept of 0.81.CONCLUSIONThis is the first infection calculator created and validated for the prediction of developing chorioamnionitis in patients undergoing induction of labor at term. This calculator can be used to augment patient counseling and guide intrapartum infection surveillance in laboring patients.
{"title":"A Validated Calculator to Estimate Risk of Chorioamnionitis in Laboring and Induced Patients at Term.","authors":"Helen Gomez Slagle,Richard J Caplan,Tetsuya Kawakita,Anthony Sciscione,Matthew Hoffman","doi":"10.1055/a-2414-6959","DOIUrl":"https://doi.org/10.1055/a-2414-6959","url":null,"abstract":"OBJECTIVEChorioamnionitis is associated with neonatal morbidity and infection-related mortality, but our ability to predict intrapartum infection is limited. We sought to derive and validate a prediction model for chorioamnionitis among patients presenting to labor and delivery at term.STUDY DESIGNThis was a planned secondary analysis of a large cohort study from 2014 through 2018 at an academic tertiary care center. To derive a prediction model for chorioamnionitis, we limited our analysis to full-term (≥37 weeks) patients with a singleton gestation undergoing labor induction and presenting in labor. Both nulliparous and multiparous patients were included. Patients with a planned cesarean delivery, fever on admission, or missing data were excluded. The model was derived using multivariable logistic regression. Refinement of the prediction model with internal calibration was performed. External validation was performed utilizing a publicly available database (Consortium on Safe Labor) and applying the same inclusion and exclusion criteria. The discriminative power of each model was assessed using a bootstrap, bias-corrected area under the curve.RESULTSThe chorioamnionitis rates in the derivation and external validation groups were: 5% (1,005/19,966) and 5.8% (n = 3,005/52,171), respectively. In multivariable modeling, maternal age, nulliparity, gestational age, smoking status, group B streptococcus colonization, hours ruptured, number of cervical exams, length of labor, epidural use, internal monitoring, and meconium were significantly associated with infection. A calculator was created and externally validated with an area under the curve of 0.82 (95% confidence interval, 0.81-0.82). External validity was further confirmed with a calibration intercept of 0.81.CONCLUSIONThis is the first infection calculator created and validated for the prediction of developing chorioamnionitis in patients undergoing induction of labor at term. This calculator can be used to augment patient counseling and guide intrapartum infection surveillance in laboring patients.","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142247674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aneesha Cheedalla,Marissa Berry,Mahmoud Abdelwahab,Jamie Cowen,Alexandra Stiles,Isabelle Mason,Jonathan R Honegger,Kara Rood
OBJECTIVEBoth hepatitis C virus (HCV) and opioid use disorder (OUD) have been associated with higher rates of preterm birth (PTB). It is unknown whether the higher prevalence of HCV in individuals with OUD may contribute to this association. The objective of this study is to evaluate the association between HCV and PTB in pregnant individuals with OUD.STUDY DESIGNWe conducted a retrospective cohort of pregnant individuals with OUD who participated in >3 visits in a co-located multidisciplinary program. Inclusion criteria were a diagnosis of OUD, participation in treatment/prenatal care program, and laboratory evaluation of HCV status. The primary exposure was presence of HCV antibodies, and secondarily, a detectable viral load (viremia). The primary outcome was PTB, which was further classified as spontaneous or iatrogenic. Multivariable logistic regression was used to detect associations while adjusting for race, history of prior PTB, and tobacco use.RESULTSA total of 941 individuals were included in the study, 404 with HCV and 537 without. Rates of PTB did not differ between those with compared to those without HCV (20.3% vs 23.8%, aOR 0.75 [95% CI 0.53-1.07]). There were similar rates of spontaneous PTB (13.1% vs 16.2%, aOR 0.79 [95% CI 0.43-1.45]) and iatrogenic PTB (7.2% vs 7.6%, aOR 1.26 [95% CI 0.69-2.30]). Comparing those with viremia to those without, there were also similar rates of overall PTB (21.6 vs 17.9%, aOR 0.86 [95% CI 0.52-1.44]), spontaneous PTB (13.3% vs 12.9%, aOR 0.97 [95% CI 0.52-1.87]), and iatrogenic PTB (8.3 vs 5.0%, aOR 1.83 [95% CI 0.76-4.94]).CONCLUSIONHCV does not appear to be associated with spontaneous or iatrogenic PTB in pregnant persons with OUD who are engaged in treatment and prenatal care. The role of co-located multidisciplinary prenatal and addiction programs in the association between HCV and PTB warrants further investigation.
目的丙型肝炎病毒（HCV）和阿片类药物使用障碍（OUD）都与较高的早产率（PTB）有关。目前尚不清楚丙型肝炎病毒（HCV）在 OUD 患者中的流行率较高是否会导致这种关联。本研究的目的是评估患有 OUD 的孕妇中 HCV 与早产率之间的关系。研究设计我们对患有 OUD 的孕妇进行了回顾性队列研究，这些孕妇参加了在同一地点开展的多学科项目中的 3 次以上就诊。纳入标准为确诊为 OUD、参与治疗/产前护理计划以及 HCV 状态实验室评估。主要暴露指标是是否存在 HCV 抗体，其次是能否检测到病毒载量（病毒血症）。主要结果是PTB，进一步分为自发性和先天性。研究采用多变量逻辑回归法检测相关性，同时对种族、既往PTB病史和吸烟情况进行调整。与未感染 HCV 的患者相比，PTB 发生率没有差异（20.3% vs 23.8%，aOR 0.75 [95% CI 0.53-1.07]）。自发性 PTB（13.1% vs 16.2%，aOR 0.79 [95% CI 0.43-1.45]）和先天性 PTB（7.2% vs 7.6%，aOR 1.26 [95% CI 0.69-2.30]）的发生率相似。有病毒感染者与无病毒感染者相比，总体 PTB（21.6% vs 17.9%，aOR 0.86 [95% CI 0.52-1.44]）、自发性 PTB（13.3% vs 12.9%，aOR 0.97 [95% CI 0.52-1.87]）和先天性 PTB（8.3% vs 5.0%，aOR 1.26 [95% CI 0.69-2.30]）的发生率也相似。结论在接受治疗和产前护理的 OUD 孕妇中，HCV 似乎与自发性或先天性 PTB 无关。在HCV与PTB的关系中，多学科产前和戒毒计划的共同作用值得进一步研究。
{"title":"Hepatitis C virus infection in pregnant individuals with opioid use disorder and its association with preterm birth.","authors":"Aneesha Cheedalla,Marissa Berry,Mahmoud Abdelwahab,Jamie Cowen,Alexandra Stiles,Isabelle Mason,Jonathan R Honegger,Kara Rood","doi":"10.1055/a-2413-2306","DOIUrl":"https://doi.org/10.1055/a-2413-2306","url":null,"abstract":"OBJECTIVEBoth hepatitis C virus (HCV) and opioid use disorder (OUD) have been associated with higher rates of preterm birth (PTB). It is unknown whether the higher prevalence of HCV in individuals with OUD may contribute to this association. The objective of this study is to evaluate the association between HCV and PTB in pregnant individuals with OUD.STUDY DESIGNWe conducted a retrospective cohort of pregnant individuals with OUD who participated in >3 visits in a co-located multidisciplinary program. Inclusion criteria were a diagnosis of OUD, participation in treatment/prenatal care program, and laboratory evaluation of HCV status. The primary exposure was presence of HCV antibodies, and secondarily, a detectable viral load (viremia). The primary outcome was PTB, which was further classified as spontaneous or iatrogenic. Multivariable logistic regression was used to detect associations while adjusting for race, history of prior PTB, and tobacco use.RESULTSA total of 941 individuals were included in the study, 404 with HCV and 537 without. Rates of PTB did not differ between those with compared to those without HCV (20.3% vs 23.8%, aOR 0.75 [95% CI 0.53-1.07]). There were similar rates of spontaneous PTB (13.1% vs 16.2%, aOR 0.79 [95% CI 0.43-1.45]) and iatrogenic PTB (7.2% vs 7.6%, aOR 1.26 [95% CI 0.69-2.30]). Comparing those with viremia to those without, there were also similar rates of overall PTB (21.6 vs 17.9%, aOR 0.86 [95% CI 0.52-1.44]), spontaneous PTB (13.3% vs 12.9%, aOR 0.97 [95% CI 0.52-1.87]), and iatrogenic PTB (8.3 vs 5.0%, aOR 1.83 [95% CI 0.76-4.94]).CONCLUSIONHCV does not appear to be associated with spontaneous or iatrogenic PTB in pregnant persons with OUD who are engaged in treatment and prenatal care. The role of co-located multidisciplinary prenatal and addiction programs in the association between HCV and PTB warrants further investigation.","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142181944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Molly Siegel,Kaitlyn James,Bryann Bromley,Nathanael Koelper,Stephen T Chasen,Laurie B Griffin,Ashley S Roman,Meghana Limaye,Angela Clare Ranzini,Caitlin M Clifford,Joseph Biggio,Akila Subramaniam,Angela Rose Seasely,Jessica Page,Sara Nicholas,Jay Idler,Rashmi Rao,R Shree,Graham McLennan,Lorraine Dugoff
BACKGROUNDThe relationship between fetal fraction and birth weight in twin gestations is poorly understood.OBJECTIVETo investigate the relationship between first trimester cfDNA fetal fraction and birth weight < 10th percentile in twin gestations.STUDY DESIGNThis is a planned secondary analysis of the Twin cfDNA Study, a 17-center retrospective cohort of twin pregnancies screened for aneuploidy using cfDNA in the first trimester from 12/2011 - 2/2022, excluding those with positive screen results for chromosomal aneuploidy. CfDNA testing was performed by a single lab using massively parallel sequencing (MPSS). Baseline characteristics and birth weight of pregnancies with normal fetal fraction were compared to those with low (<5%) and high (>95%) fetal fraction using univariable analyses and multivariable regression.RESULTSA total of 1041 twin pregnancies were included. Chronic hypertension, elevated BMI, and self-identified Black race were associated with fetal fraction <5th percentile. There was no difference in median fetal fraction between those with birth weight <10th percentile in at least one twin (median [IQR] fetal fraction 12.2% [9.8, 14.8] versus those with normal birth weight (10th percentile) in both twins (median [IQR] fetal fraction 12.3% [9.7, 15.2] for normal birth weight, p = 0.49). There was no association between high or low fetal fraction and birth weight <10th percentile for one (p=0.45) or both (p=0.81) twins, and there was no association between high or low fetal fraction and birth weight <5th percentile for one (p=0.44) or both (p=0.74) twins. The results were unchanged after adjustment for potential confounders.CONCLUSIONIn this large cohort, there was no association between the extremes of cfDNA fetal fraction and birthweight < 10th percentile, suggesting that first trimester fetal fraction may not predict impaired fetal growth in twin gestations.
{"title":"First-Trimester Cell-Free DNA Fetal Fraction and Birth Weight in Twin Pregnancies.","authors":"Molly Siegel,Kaitlyn James,Bryann Bromley,Nathanael Koelper,Stephen T Chasen,Laurie B Griffin,Ashley S Roman,Meghana Limaye,Angela Clare Ranzini,Caitlin M Clifford,Joseph Biggio,Akila Subramaniam,Angela Rose Seasely,Jessica Page,Sara Nicholas,Jay Idler,Rashmi Rao,R Shree,Graham McLennan,Lorraine Dugoff","doi":"10.1055/a-2413-2353","DOIUrl":"https://doi.org/10.1055/a-2413-2353","url":null,"abstract":"BACKGROUNDThe relationship between fetal fraction and birth weight in twin gestations is poorly understood.OBJECTIVETo investigate the relationship between first trimester cfDNA fetal fraction and birth weight < 10th percentile in twin gestations.STUDY DESIGNThis is a planned secondary analysis of the Twin cfDNA Study, a 17-center retrospective cohort of twin pregnancies screened for aneuploidy using cfDNA in the first trimester from 12/2011 - 2/2022, excluding those with positive screen results for chromosomal aneuploidy. CfDNA testing was performed by a single lab using massively parallel sequencing (MPSS). Baseline characteristics and birth weight of pregnancies with normal fetal fraction were compared to those with low (<5%) and high (>95%) fetal fraction using univariable analyses and multivariable regression.RESULTSA total of 1041 twin pregnancies were included. Chronic hypertension, elevated BMI, and self-identified Black race were associated with fetal fraction <5th percentile. There was no difference in median fetal fraction between those with birth weight <10th percentile in at least one twin (median [IQR] fetal fraction 12.2% [9.8, 14.8] versus those with normal birth weight (10th percentile) in both twins (median [IQR] fetal fraction 12.3% [9.7, 15.2] for normal birth weight, p = 0.49). There was no association between high or low fetal fraction and birth weight <10th percentile for one (p=0.45) or both (p=0.81) twins, and there was no association between high or low fetal fraction and birth weight <5th percentile for one (p=0.44) or both (p=0.74) twins. The results were unchanged after adjustment for potential confounders.CONCLUSIONIn this large cohort, there was no association between the extremes of cfDNA fetal fraction and birthweight < 10th percentile, suggesting that first trimester fetal fraction may not predict impaired fetal growth in twin gestations.","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142223973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective Preterm infants often develop relative adrenal insufficiency (RAI) not only within the early neonatal period, but also beyond this period. RAI is commonly accompanied by hyponatremia, but the pathogenesis of hyponatremia with RAI has not been clarified. This study aimed to investigate the pathophysiology of hyponatremia in infants with RAI. Study design This is a single-centered retrospective cohort study. Preterm infants born at < 30 weeks of gestation or < 1000 g were enrolled. They were divided into the RAI group and the non-RAI group. The data of serum and urine examination, the amount of sodium intake, and fractional excretion of sodium were compared between the two groups. In the RAI group, data between before and after the administration of hydrocortisone were also compared. Results Sixteen infants in the RAI group and thirty-five infants in the non-RAI group were included in the analysis. In the RAI group, hyponatremia was common and preceded other clinical symptoms, such as oliguria and decreased blood pressure, therefore, hyponatremia with RAI was not likely to be caused by dilution due to oliguria. There was no difference in the fractional excretion of sodium between the two groups (adjusted for postconceptional age at examination), therefore, it is not likely that hyponatremia with RAI was mainly caused by excessive renal sodium loss. Since sodium intake was rather higher in the RAI group than in the non-RAI group, it is unlikely that insufficient sodium supplementation was the cause of RAI. Hyponatremia with RAI was considered to be likely caused by vascular hyperpermeability. Conclusion Hyponatremia is a common symptom among preterm infants with RAI and its pathogenesis can be vascular hyperpermeability.
目的 早产儿通常会出现相对肾上腺功能不全（RAI），不仅在新生儿早期，而且在新生儿期之后也会出现。RAI 通常伴有低钠血症，但 RAI 引起低钠血症的发病机制尚未明确。本研究旨在探讨 RAI 婴儿低钠血症的病理生理学。研究设计 这是一项单中心回顾性队列研究。研究对象为妊娠期小于 30 周或体重小于 1000 克的早产儿。他们被分为 RAI 组和非 RAI 组。比较了两组婴儿的血清和尿液检查数据、钠摄入量和钠的部分排泄量。RAI 组还比较了氢化可的松用药前后的数据。结果 RAI 组和非 RAI 组分别有 16 名和 35 名婴儿参与分析。在 RAI 组中，低钠血症很常见，而且发生在少尿、血压下降等其他临床症状之前，因此 RAI 引起的低钠血症不太可能是由于少尿导致的稀释引起的。两组间钠的分排泄量没有差异（根据受孕后的检查年龄进行调整），因此 RAI 引起的低钠血症不太可能主要由肾脏钠丢失过多引起。由于 RAI 组的钠摄入量高于非 RAI 组，因此钠补充不足不太可能是 RAI 的原因。RAI 引起的低钠血症被认为可能是由血管高渗透性引起的。结论 低钠血症是患有 RAI 的早产儿的常见症状，其发病机制可能是血管高渗透性。
{"title":"Pathophysiology of hyponatremia in preterm infants with relative adrenal insufficiency after the early neonatal period.","authors":"Mitsuyo Akita,Seiichi Tomotaki,Shintaro Hanaoka,Ryosuke Araki,Kouji Motokura,Yutaro Tomobe,Hiroko Tomotaki,Kougoro Iwanaga,Junko Takita,Masahiko Kawai","doi":"10.1055/a-2413-0844","DOIUrl":"https://doi.org/10.1055/a-2413-0844","url":null,"abstract":"Objective Preterm infants often develop relative adrenal insufficiency (RAI) not only within the early neonatal period, but also beyond this period. RAI is commonly accompanied by hyponatremia, but the pathogenesis of hyponatremia with RAI has not been clarified. This study aimed to investigate the pathophysiology of hyponatremia in infants with RAI. Study design This is a single-centered retrospective cohort study. Preterm infants born at < 30 weeks of gestation or < 1000 g were enrolled. They were divided into the RAI group and the non-RAI group. The data of serum and urine examination, the amount of sodium intake, and fractional excretion of sodium were compared between the two groups. In the RAI group, data between before and after the administration of hydrocortisone were also compared. Results Sixteen infants in the RAI group and thirty-five infants in the non-RAI group were included in the analysis. In the RAI group, hyponatremia was common and preceded other clinical symptoms, such as oliguria and decreased blood pressure, therefore, hyponatremia with RAI was not likely to be caused by dilution due to oliguria. There was no difference in the fractional excretion of sodium between the two groups (adjusted for postconceptional age at examination), therefore, it is not likely that hyponatremia with RAI was mainly caused by excessive renal sodium loss. Since sodium intake was rather higher in the RAI group than in the non-RAI group, it is unlikely that insufficient sodium supplementation was the cause of RAI. Hyponatremia with RAI was considered to be likely caused by vascular hyperpermeability. Conclusion Hyponatremia is a common symptom among preterm infants with RAI and its pathogenesis can be vascular hyperpermeability.","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142181945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sarah Crimmins,Scott Sullivan,Menachem Miodovnik,E Albert Reece,Kartik K Venkatesh
{"title":"Defining Research and Care in Diabetes in Pregnancy: Introduction to the Diabetes in Pregnancy Study Group of North America 25th Anniversary Biannual Meeting Special Edition.","authors":"Sarah Crimmins,Scott Sullivan,Menachem Miodovnik,E Albert Reece,Kartik K Venkatesh","doi":"10.1055/a-2401-5009","DOIUrl":"https://doi.org/10.1055/a-2401-5009","url":null,"abstract":"","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142181946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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