{"title":"Neutrophil-To-Lymphocyte Ratio in Preterm Premature Rupture of Membranes.","authors":"Xiaoe Jiang,Yuelan Liu,Jingrui Huang","doi":"10.1111/1471-0528.70035","DOIUrl":"https://doi.org/10.1111/1471-0528.70035","url":null,"abstract":"","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"156 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145127295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Paolo Vercellini,Veronica Bandini,Noemi Salmeri,Paola Viganò,Edgardo Somigliana
{"title":"Optimising Hormonal Therapy Before Declaring Failure in Endometriosis-Associated Pain.","authors":"Paolo Vercellini,Veronica Bandini,Noemi Salmeri,Paola Viganò,Edgardo Somigliana","doi":"10.1111/1471-0528.70020","DOIUrl":"https://doi.org/10.1111/1471-0528.70020","url":null,"abstract":"","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145127294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
María Loreto Hernández-Martínez,Alonso Molina-Rodríguez,Marta Maes-Carballo,Aurora Bueno-Cavanillas,Naomi Cano-Ibáñez,Carmen Amezcua-Prieto
BACKGROUNDClinical Practice Guidelines (CPGs) are essential for promoting evidence-based maternal and neonatal care, but inconsistencies in recommendations can be confusing.OBJECTIVESTo analyse the quality and reporting of international CPGs for normal birth and summarise the recommendations.SEARCH STRATEGYRegistered on PROSPERO (CRD42021269488), the study identified CPGs on normal birth through systematic searches in databases like MEDLINE, Cochrane, Scopus and WOS, along with direct outreach to international organisations.SELECTION CRITERIACPGs published from 2010 to December 2024 were included, with no language restrictions.DATA COLLECTION AND ANALYSISThe quality and reporting of CPGs were evaluated using the AGREE II and RIGHT tools, and recommendations were summarised.MAIN RESULTSOf the 25 CPGs analysed, the median AGREE II quality score was 54%, and the median RIGHT reporting score was 50%. The highest scores were from WHO (2018), CINETS (2013) and the Spanish normal childbirth CPG (2010). Notably, 56% of CPGs had poor reporting, while only 8% were adequately informed. Common recommendations included the presence of support persons, avoiding routine interventions (e.g., enemas, shaving), encouraging fluid intake, allowing movement during labour and promoting skin-to-skin contact.CONCLUSIONSMost CPGs on normal childbirth are outdated and exhibit poor quality and reporting. There is a pressing need for improvements to ensure valid, consistent and updated recommendations that enhance maternal and neonatal health.
{"title":"Clinical Practice Guidelines on Normal Labour and Childbirth: A Systematic Review.","authors":"María Loreto Hernández-Martínez,Alonso Molina-Rodríguez,Marta Maes-Carballo,Aurora Bueno-Cavanillas,Naomi Cano-Ibáñez,Carmen Amezcua-Prieto","doi":"10.1111/1471-0528.70001","DOIUrl":"https://doi.org/10.1111/1471-0528.70001","url":null,"abstract":"BACKGROUNDClinical Practice Guidelines (CPGs) are essential for promoting evidence-based maternal and neonatal care, but inconsistencies in recommendations can be confusing.OBJECTIVESTo analyse the quality and reporting of international CPGs for normal birth and summarise the recommendations.SEARCH STRATEGYRegistered on PROSPERO (CRD42021269488), the study identified CPGs on normal birth through systematic searches in databases like MEDLINE, Cochrane, Scopus and WOS, along with direct outreach to international organisations.SELECTION CRITERIACPGs published from 2010 to December 2024 were included, with no language restrictions.DATA COLLECTION AND ANALYSISThe quality and reporting of CPGs were evaluated using the AGREE II and RIGHT tools, and recommendations were summarised.MAIN RESULTSOf the 25 CPGs analysed, the median AGREE II quality score was 54%, and the median RIGHT reporting score was 50%. The highest scores were from WHO (2018), CINETS (2013) and the Spanish normal childbirth CPG (2010). Notably, 56% of CPGs had poor reporting, while only 8% were adequately informed. Common recommendations included the presence of support persons, avoiding routine interventions (e.g., enemas, shaving), encouraging fluid intake, allowing movement during labour and promoting skin-to-skin contact.CONCLUSIONSMost CPGs on normal childbirth are outdated and exhibit poor quality and reporting. There is a pressing need for improvements to ensure valid, consistent and updated recommendations that enhance maternal and neonatal health.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"59 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145127005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Evidence Based Maternity Care Using Routinely Collected Data-We Need to Think Differently.","authors":"Per Kempe,Michael Robson","doi":"10.1111/1471-0528.70000","DOIUrl":"https://doi.org/10.1111/1471-0528.70000","url":null,"abstract":"","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145077855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
OBJECTIVETo estimate the effect on healthcare resource use after introducing the World Health Organization diagnostic criteria (WHO-2013) for gestational diabetes mellitus (GDM) compared to former criteria in Sweden (SWE-GDM).DESIGNA cost-analysis alongside the Changing Diagnostic Criteria for Gestational Diabetes (CDC4G) randomised controlled trial.SETTINGSweden, with risk-factor based screening for GDM.POPULATION47 080 pregnant women and their infants.METHODSA register-based cost-analysis from a healthcare perspective alongside a stepped-wedge cluster RCT of switching from SWE-GDM to WHO-2013 criteria in 2018. Analyses were made on the population level and repeated in the subgroup affected by the intervention, that is, those with plasma glucose values between SWE-GDM and WHO-2013 criteria. Sensitivity analysis by bootstrapping was performed.MAIN OUTCOME MEASURESEstimated costs for obstetric surveillance (including GDM-management), delivery and neonatal healthcare until 28 days postpartum.RESULTSOn a population level, the WHO-2013 criteria were associated with increased costs of obstetric surveillance (adjusted mean [bootstrap confidence interval]) €94.0 [24.5-169.1], delivery care €20.4 [-33.5 to 75.4] and neonatal care €331.0 [75.1-589.0] per pregnancy, and in the affected subgroup €606.9 [377.7-872.4], €348.5 [126.0-542.0] and €129.3 [-559.0 to 980.9] respectively.CONCLUSIONSImplementation of the WHO-2013 criteria in Sweden was associated with increased costs for obstetric surveillance and delivery on a population level, driven by the affected subgroup. The increased costs for neonatal care were associated with large uncertainty. A detailed understanding of the changes in resource use can guide decisions to mitigate cost increases.
{"title":"Implications of Changing the Diagnostic Criteria for Gestational Diabetes Mellitus (CDC4G): A Healthcare Cost Analysis Alongside a Stepped Wedge Cluster Randomised Trial.","authors":"Maryam de Brun,Naimi Johansson,David Simmons,Scott Montgomery,Kerstin Berntorp,Stefan Jansson,Ulla-Britt Wennerholm,Anna-Karin Wikström,Helena Strevens,Fredrik Ahlsson,Verena Sengpiel,Elisabeth Storck-Lindholm,Martina Persson,Kerstin Petersson,Carina Ursing,Linda Ryen,Helena Backman","doi":"10.1111/1471-0528.18364","DOIUrl":"https://doi.org/10.1111/1471-0528.18364","url":null,"abstract":"OBJECTIVETo estimate the effect on healthcare resource use after introducing the World Health Organization diagnostic criteria (WHO-2013) for gestational diabetes mellitus (GDM) compared to former criteria in Sweden (SWE-GDM).DESIGNA cost-analysis alongside the Changing Diagnostic Criteria for Gestational Diabetes (CDC4G) randomised controlled trial.SETTINGSweden, with risk-factor based screening for GDM.POPULATION47 080 pregnant women and their infants.METHODSA register-based cost-analysis from a healthcare perspective alongside a stepped-wedge cluster RCT of switching from SWE-GDM to WHO-2013 criteria in 2018. Analyses were made on the population level and repeated in the subgroup affected by the intervention, that is, those with plasma glucose values between SWE-GDM and WHO-2013 criteria. Sensitivity analysis by bootstrapping was performed.MAIN OUTCOME MEASURESEstimated costs for obstetric surveillance (including GDM-management), delivery and neonatal healthcare until 28 days postpartum.RESULTSOn a population level, the WHO-2013 criteria were associated with increased costs of obstetric surveillance (adjusted mean [bootstrap confidence interval]) €94.0 [24.5-169.1], delivery care €20.4 [-33.5 to 75.4] and neonatal care €331.0 [75.1-589.0] per pregnancy, and in the affected subgroup €606.9 [377.7-872.4], €348.5 [126.0-542.0] and €129.3 [-559.0 to 980.9] respectively.CONCLUSIONSImplementation of the WHO-2013 criteria in Sweden was associated with increased costs for obstetric surveillance and delivery on a population level, driven by the affected subgroup. The increased costs for neonatal care were associated with large uncertainty. A detailed understanding of the changes in resource use can guide decisions to mitigate cost increases.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145032130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Natasha Hirschhorn-Edwards,Hannah Dahlen,Sue Kildea,Sally K Tracy
{"title":"Are Private Obstetric Services Safer and More Cost Effective Than Midwife-Led Care in Australia?","authors":"Natasha Hirschhorn-Edwards,Hannah Dahlen,Sue Kildea,Sally K Tracy","doi":"10.1111/1471-0528.18365","DOIUrl":"https://doi.org/10.1111/1471-0528.18365","url":null,"abstract":"","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Refining Growth Dynamics and Clinical Translation of Machine Learning-Based Prediction of Adverse Perinatal Outcomes.","authors":"Ronghuang Li,Yuehua Yan,Qianyu Chen","doi":"10.1111/1471-0528.18369","DOIUrl":"https://doi.org/10.1111/1471-0528.18369","url":null,"abstract":"","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Josca M Schoonejans,Hanns-Ulrich Marschall,M Martineau,David McCance,Catherine Williamson
{"title":"Serum Bile Acid Composition in Women With Gestational Diabetes and Fasting Hyperglycaemia (HAPO): A Cohort Study.","authors":"Josca M Schoonejans,Hanns-Ulrich Marschall,M Martineau,David McCance,Catherine Williamson","doi":"10.1111/1471-0528.18363","DOIUrl":"https://doi.org/10.1111/1471-0528.18363","url":null,"abstract":"","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144960274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rhianna Davies, Ashwin Goyal, Zachary Nash, Sarah Hillman, Melanie Davies, Nick Panay, Jane Daniels, Tim Hillard, Bonnie Grant, Paula Briggs, Lynne Robinson, Haitham Hamoda, Channa N. Jayasena
ObjectiveTo investigate the factors associated with non‐vasomotor menopause symptoms among women in the UK, focusing on the perceived importance of specific symptoms and their association with demographic and treatment‐related factors.DesignA cross‐sectional online survey.SettingUK‐wide national survey conducted from February to March 2023.Population or SampleA total of 7285 women completed the survey.MethodsParticipants provided anonymised demographic data and rated the importance of five menopause symptoms (‘low mood’, ‘brain fog’, ‘aches and pains’, ‘feeling tired’, and ‘weight gain’) using a 10‐point Likert scale. The full questionnaire is provided in . Univariable and multivariable linear regression analyses were performed to assess the association between symptom importance scores and specific characteristics, including age, HRT and non‐HRT treatment, ethnicity, and geographical location.Main Outcome MeasuresImportance scores of menopause symptoms stratified by demographic and treatment factors.ResultsSignificant differences were identified in perceived symptom importance across age groups, geographic locations, ethnic backgrounds, and treatment status. Brain fog was the most frequently prioritised symptom overall. Several moderate‐strength associations were observed: for example, HRT use was associated with higher importance ratings for brain fog, tiredness, low mood, and aches and pains. Ethnic minority women (Asian and Black) also gave higher importance ratings to brain fog.ConclusionsThe findings highlight the prominence of cognitive and psychological symptoms during menopause and the influence of demographic and treatment variables on symptom prioritisation. These results support the need for personalised and inclusive menopause care that addresses a wider range of symptom concerns beyond vasomotor issues. These findings have implications for public health policy and financial investment.
{"title":"Factors Associated With Non‐Vasomotor Menopause Symptoms Experienced by 7285 Women: A UK‐Wide National Survey","authors":"Rhianna Davies, Ashwin Goyal, Zachary Nash, Sarah Hillman, Melanie Davies, Nick Panay, Jane Daniels, Tim Hillard, Bonnie Grant, Paula Briggs, Lynne Robinson, Haitham Hamoda, Channa N. Jayasena","doi":"10.1111/1471-0528.18353","DOIUrl":"https://doi.org/10.1111/1471-0528.18353","url":null,"abstract":"ObjectiveTo investigate the factors associated with non‐vasomotor menopause symptoms among women in the UK, focusing on the perceived importance of specific symptoms and their association with demographic and treatment‐related factors.DesignA cross‐sectional online survey.SettingUK‐wide national survey conducted from February to March 2023.Population or SampleA total of 7285 women completed the survey.MethodsParticipants provided anonymised demographic data and rated the importance of five menopause symptoms (‘low mood’, ‘brain fog’, ‘aches and pains’, ‘feeling tired’, and ‘weight gain’) using a 10‐point Likert scale. The full questionnaire is provided in . Univariable and multivariable linear regression analyses were performed to assess the association between symptom importance scores and specific characteristics, including age, HRT and non‐HRT treatment, ethnicity, and geographical location.Main Outcome MeasuresImportance scores of menopause symptoms stratified by demographic and treatment factors.ResultsSignificant differences were identified in perceived symptom importance across age groups, geographic locations, ethnic backgrounds, and treatment status. Brain fog was the most frequently prioritised symptom overall. Several moderate‐strength associations were observed: for example, HRT use was associated with higher importance ratings for brain fog, tiredness, low mood, and aches and pains. Ethnic minority women (Asian and Black) also gave higher importance ratings to brain fog.ConclusionsThe findings highlight the prominence of cognitive and psychological symptoms during menopause and the influence of demographic and treatment variables on symptom prioritisation. These results support the need for personalised and inclusive menopause care that addresses a wider range of symptom concerns beyond vasomotor issues. These findings have implications for public health policy and financial investment.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"74 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144928096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mackenzie Campbell,Johanna Koegl,Jeffrey N Bone,Sofia Nicolls,Janet Lyons,Chantal Mayer,Kenneth I Lim,Julie Van Schalkwyk,K S Joseph,Sarka Lisonkova,
OBJECTIVETo examine whether the associations between pre-pregnancy risk factors and severe preeclampsia/eclampsia (SPE) and/or HELLP syndrome differ between singleton and twin pregnancies.DESIGNA population-based retrospective cohort study.SETTINGBritish Columbia (BC), Canada.POPULATIONAll pregnancies with singletons or twins that resulted in a stillbirth or live birth at ≥ 20 weeks' gestation from 2008/09 to 2020/21.METHODSData were obtained from the BC Perinatal Database Registry. Logistic regression was used to estimate the association between each risk factor for SPE/HELLP (e.g., body-mass-index (BMI), in vitro-fertilisation (IVF), chronic hypertension, and diabetes) and the modifying effect of plurality by including interaction terms between these risk factors and plurality in the model.MAIN OUTCOME MEASURESSevere preeclampsia, eclampsia, and/or HELLP syndrome.RESULTSAmong 563 252 pregnancies (8841 twin, 554 411 singleton), the rate of SPE/HELLP was 4.7 per 1000 singleton pregnancies and 31.1 per 1000 twin pregnancies (relative risk 6.61; 95% confidence interval (CI) 5.84-7.49). Older maternal age (≥ 35 years), nulliparity, pre-pregnancy and gestational diabetes, chronic hypertension, prior mental health problems, substance use during pregnancy, and prior stillbirth increased the odds, while smoking decreased the odds of SPE/HELLP among both singleton and twin pregnancies. However, the adjusted associations between BMI, IVF, prior abortions, and SPE/HELLP differed by plurality (interaction p-values 0.002, < 0.0001, and 0.04, respectively). IVF was associated with increased odds of SPE/HELLP in singleton pregnancies (adjusted odds ratio (aOR) 1.93; 95% CI 1.64-2.27) but not in twins (aOR 0.85; CI 0.65-1.11). Similarly, overweight BMI was associated with elevated odds in singleton pregnancies (aOR 1.47; CI 1.32-1.64) but not in twins (aOR 0.86; CI 0.59-1.25), as was obese BMI (singleton aOR 1.88; CI 1.67-2.12; twin aOR 0.80; CI 0.51-1.24). Conversely, a history of prior abortions was associated with decreased odds in twin pregnancies (aOR 0.70; CI 0.54-0.92) but not singleton pregnancies (aOR 0.95; CI 0.88-1.04).CONCLUSIONSHigh BMI and IVF are associated with elevated risk of SPE/HELLP syndrome in singleton pregnancies, but not in twin pregnancies. This study provides insights regarding SPE/HELLP syndrome among singleton and twin pregnancies, and useful information for pre-pregnancy counselling.
目的探讨妊娠前危险因素与严重子痫前期/子痫（SPE）和/或HELLP综合征的相关性在单胎和双胎妊娠中是否存在差异。设计：基于人群的回顾性队列研究。背景：加拿大不列颠哥伦比亚省。所有在2008/09至2020/21年度妊娠≥20周导致死产或活产的单胎或双胞胎妊娠。方法数据来自BC省围产期数据库登记处。通过在模型中包括这些危险因素和多元性之间的相互作用项，使用Logistic回归来估计SPE/ help的每个危险因素（例如，身体质量指数（BMI）、体外受精（IVF）、慢性高血压和糖尿病）与多元性的修正效应之间的关联。主要结局指标：重度子痫前期、子痫和/或HELLP综合征。结果563 252例妊娠（双胎8841例，单胎55411例）中，SPE/HELLP发生率为每1000例单胎4.7例，每1000例双胎31.1例（相对危险度6.61,95%可信区间（CI） 5.84 ~ 7.49）。高龄产妇（≥35岁）、无产、孕前和妊娠期糖尿病、慢性高血压、既往精神健康问题、妊娠期间药物使用和既往死产增加了SPE/ help的几率，而吸烟降低了单胎和双胎妊娠发生SPE/ help的几率。然而，BMI、IVF、既往流产和SPE/ help之间调整后的相关性存在较大差异（相互作用p值分别为0.002、< 0.0001和0.04）。IVF与单胎妊娠发生SPE/ help的几率增加相关(校正优势比（aOR） 1.93；95% CI 1.64-2.27)，但在双胞胎中没有（aOR 0.85; CI 0.65-1.11）。同样，超重BMI与单胎妊娠的几率升高相关（aOR 1.47; CI 1.32-1.64），但与双胞胎无关（aOR 0.86; CI 0.59-1.25），肥胖BMI与之相关（单胎aOR 1.88; CI 1.67-2.12；双胞胎aOR 0.80; CI 0.51-1.24）。相反，既往流产史与双胎妊娠的风险降低相关（aOR 0.70; CI 0.54-0.92），但与单胎妊娠无关（aOR 0.95; CI 0.88-1.04）。结论高BMI和体外受精与单胎妊娠发生SPE/ help综合征的风险升高相关，但与双胎妊娠无关。本研究提供了关于单胎和双胎妊娠SPE/ help综合征的见解，并为孕前咨询提供了有用的信息。
{"title":"Differences in Risk Factors for Severe Preeclampsia and HELLP Syndrome in Singleton Versus Twin Pregnancies: A Population-Based Cohort Study.","authors":"Mackenzie Campbell,Johanna Koegl,Jeffrey N Bone,Sofia Nicolls,Janet Lyons,Chantal Mayer,Kenneth I Lim,Julie Van Schalkwyk,K S Joseph,Sarka Lisonkova, ","doi":"10.1111/1471-0528.18351","DOIUrl":"https://doi.org/10.1111/1471-0528.18351","url":null,"abstract":"OBJECTIVETo examine whether the associations between pre-pregnancy risk factors and severe preeclampsia/eclampsia (SPE) and/or HELLP syndrome differ between singleton and twin pregnancies.DESIGNA population-based retrospective cohort study.SETTINGBritish Columbia (BC), Canada.POPULATIONAll pregnancies with singletons or twins that resulted in a stillbirth or live birth at ≥ 20 weeks' gestation from 2008/09 to 2020/21.METHODSData were obtained from the BC Perinatal Database Registry. Logistic regression was used to estimate the association between each risk factor for SPE/HELLP (e.g., body-mass-index (BMI), in vitro-fertilisation (IVF), chronic hypertension, and diabetes) and the modifying effect of plurality by including interaction terms between these risk factors and plurality in the model.MAIN OUTCOME MEASURESSevere preeclampsia, eclampsia, and/or HELLP syndrome.RESULTSAmong 563 252 pregnancies (8841 twin, 554 411 singleton), the rate of SPE/HELLP was 4.7 per 1000 singleton pregnancies and 31.1 per 1000 twin pregnancies (relative risk 6.61; 95% confidence interval (CI) 5.84-7.49). Older maternal age (≥ 35 years), nulliparity, pre-pregnancy and gestational diabetes, chronic hypertension, prior mental health problems, substance use during pregnancy, and prior stillbirth increased the odds, while smoking decreased the odds of SPE/HELLP among both singleton and twin pregnancies. However, the adjusted associations between BMI, IVF, prior abortions, and SPE/HELLP differed by plurality (interaction p-values 0.002, < 0.0001, and 0.04, respectively). IVF was associated with increased odds of SPE/HELLP in singleton pregnancies (adjusted odds ratio (aOR) 1.93; 95% CI 1.64-2.27) but not in twins (aOR 0.85; CI 0.65-1.11). Similarly, overweight BMI was associated with elevated odds in singleton pregnancies (aOR 1.47; CI 1.32-1.64) but not in twins (aOR 0.86; CI 0.59-1.25), as was obese BMI (singleton aOR 1.88; CI 1.67-2.12; twin aOR 0.80; CI 0.51-1.24). Conversely, a history of prior abortions was associated with decreased odds in twin pregnancies (aOR 0.70; CI 0.54-0.92) but not singleton pregnancies (aOR 0.95; CI 0.88-1.04).CONCLUSIONSHigh BMI and IVF are associated with elevated risk of SPE/HELLP syndrome in singleton pregnancies, but not in twin pregnancies. This study provides insights regarding SPE/HELLP syndrome among singleton and twin pregnancies, and useful information for pre-pregnancy counselling.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"104 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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