BMC Pregnancy and Childbirth最新文献

Background: Pregnancy loss significantly affects physical and mental health. A nomogram for predicting spontaneous abortion risk was developed to improve pregnancy outcomes.

Methods: A total of 1346 pregnant women were enrolled from The Third Affiliated Hospital of Wenzhou Medical University (May 2020 - May 2022). The training set included 941 participants, and the validation set had 405. Feature selection was optimized using a random forest model, and a predictive model was constructed via multivariable logistic regression. The nomogram's performance was assessed with receiver operator characteristic (ROC), Hosmer-Lemeshow test, calibration curve, and clinical impact curve (CIC). Discrimination and clinical utility were compared between the nomogram and its individual variables.

Results: Antithrombin III (AT-III), homocysteine (Hcy), complement component 3 (C3), protein C (PC), and anti-β2 glycoprotein I antibody (anti-β2GP1) were identified as risk factors. The nomogram demonstrated satisfactory discrimination (Training AUC: 0.813, 95% CI: 0.790-0.842; Validation AUC: 0.792, 95% CI: 0.741-0.838). The Hosmer-Lemeshow test (P = 0.331) indicated a good fit, and the CIC showed clinical net benefit. The nomogram outperformed individual variables in discrimination (AUC: 0.804, 95% CI: 0.779-0.829).

Conclusion: The developed nomogram, incorporating AT-III, Hcy, C3, PC, and anti-β2GP1, aids clinicians in identifying pregnant women at high risk for spontaneous abortion.

Objective: To explore the patterns and influencing factors of blood pressure changes in pregnant women at different stages of pregnancy.

Method: A retrospective analysis of 445 pregnant women who underwent prenatal examination and delivered at the First Hospital of Hebei Medical University between December 2016 and November 2017. A questionnaire survey was conducted on pre-pregnancy information, and data was collected from pre-pregnancy blood routines, blood lipids, cortisol levels, and other biochemical indicators, as well as blood pressure measurements taken before pregnancy, in early pregnancy, mid-pregnancy, and late pregnancy. High-normal blood pressure (HNBP) during pregnancy and abnormal blood pressure variability (ABPV) were examined. Logistic regression and chi-square tests were used to identify risk factors and analyze the impact of ABPV on delivery outcomes.

Results: Blood pressure was significantly higher before pregnancy, decreased after conception, and gradually increased during mid- and late pregnancy (P < 0.001). Logistic regression identified pre-pregnancy systolic blood pressure (SBP), body mass index (BMI), and cortisol levels as high-risk factors for high systolic blood pressure during pregnancy (P < 0.05). Pre-pregnancy diastolic blood pressure (DBP) and occupation type were high-risk factors for high diastolic blood pressure (P < 0.05). SBP before pregnancy, family annual income, and total cholesterol levels were associated with abnormal blood pressure variability (ABPV) during pregnancy (P < 0.01). However, neither HNBP nor ABPV had a significant impact on gestational age, delivery method, delivery complications, or neonatal outcomes (all P > 0.05).

Conclusion: Blood pressure in pregnant women typically decreases in early pregnancy, then gradually rises during mid- and late pregnancy. The duration of HNBP is generally short, with most cases resolving on their own. Pre-pregnancy hypertension, BMI, cortisol levels, and occupational type are risk factors for gestational hypertension. However, normal blood pressure variability during pregnancy has little effect on maternal and neonatal outcomes.

Background: The risk of preterm birth (PTB) is associated with maternal hyperglycemia but differs by combinations of abnormal oral glucose tolerance test (OGTT) values. However, the potential pathway by which maternal hyperglycemia affects PTB is unclear. This study aimed to investigate the association between OGTT-related measures and PTB and evaluate the mediation effect of gestational weight gain (GWG) on the association between maternal hyperglycemia and the risk of PTB in women with gestational diabetes mellitus (GDM).

Methods: This retrospective cohort study included women with GDM from a women's and children's hospital in Chengdu, China, from December 2021 to December 2023. The associations between OGTT-related measures, GWG, and PTB were evaluated by logistic regression analyses. Two-step clustering was used to classify participants by area under the curve (AUC) of the OGTT. SPSS Process Macro was utilized to explore the mediation effect of GWG on the relationship between AUC and PTB.

Results: This study included 1860 women with GDM, of whom 694 (37.3%) women had higher AUC (≥ 17 mmol/L·h), 935 (50.3%) women had insufficient GWG, and 132 (7.1%) women had PTB. Multivariable logistic regression analyses showed that only higher AUC was associated with increased odds of PTB (OR:1.47, 95% CI:1.03 to 2.10; P = 0.036), and no significant associations between other OGTT-related measures and PTB were observed. Besides, GDM women with higher AUC had a higher risk of insufficient GWG (OR:1.23, 95% CI:1.02 to 1.49; P = 0.033), which was associated with increased odds of PTB (OR:2.15, 95% CI:1.47 to 3.14; P < 0.001). Mediation analyses revealed that the effect of AUC on PTB was mainly mediated through GWG (indirect effect: 0.15, bootstrapped 95% CI: 0.08 to 0.24).

Conclusions: This study found that AUC of the OGTT was positively associated with the occurrence of PTB, and GWG mainly mediated this positive association. Effective intervention strategies for GDM should pay close attention to avoiding insufficient GWG when managing their blood glucose, especially for those with higher AUC levels, to reduce the impact of maternal hyperglycemia on the risk of PTB.

Background: The age at first delivery is rising leading to an increasing proportion of women with advanced maternal age (AMA) which is defined as greater than or equal to 35 years at time of delivery. Previous studies have associated AMA with adverse maternal and neonatal outcomes leading to an arbitrary increased rate of cesarean sections amongst AMA women without clear medical indications.

Objective: To determine the associations between AMA and adverse maternal and neonatal outcomes in nulliparous women in a large cohort.

Methods: Our retrospective cohort study looked at 44,295 nulliparous women (39,496 < 35years and 4,799 ≥ 35years) with term singleton gestation who delivered in the obstetrical units of Hadassah Medical Organization in Jerusalem, Israel, between 2003 and 2017. Data on maternal characteristics and outcomes, and neonatal outcomes were extracted from the electronic database. Outcomes were compared between women with AMA and women < 35 using Chi square, Fisher exact and t-tests. Multivariable logistic regressions estimated odds ratios (OR) for outcomes, controlling for confounders. We reported two-sided p-values, adjusted odds ratio (aOR), and 95% confidence intervals (CI).

Results: Women with AMA were more likely to have c-sections compared to women < 35 years in the whole study population (aOR:2.29, 95% CI: 2.13-2.47, p < 0.0001) including women having inductions (aOR:1.38, 95% CI:1.25-1.53, p < 0.0001). Self-requested c-sections were significantly higher among women with AMA (16.8% vs. 2.8%, OR:6.9, 95% CI:5.5-8.8). AMA did not increase the risk of postpartum hemorrhage (aOR: 0.82, 95% CI: 0.72-0.94) and decreased likelihood of instrumental delivery (aOR:0.81, 95% CI: 0.73-0.89, p < 0.0001). Fewer women with AMA had 3rd- and 4th-degree tears (0.35% for ≥ 35years vs. 0.71% for < 35 years, RR:0.50, 95% CI:0.29-0.87, p = 0.012). Women with AMA were more than three times likely to have an intrauterine fetal demise (RR:3.53, 95% CI:2.54-4.90, p < 0.0001), but were not more likely to have low neonatal 5-minute APGAR scores (RR:0.79, 95% CI: 0.43-1.46, p value:0.44) or NICU admissions (RR:0.84, 95% CI: 0.61-1.17, p = 0.30).

Conclusions: Management of nulliparous AMA patients should be based on obstetric considerations and not solely on AMA status. Shared decision making is preferred to reduce the risks associated with AMA.

Puerperal sepsis is accountable for maternal death worldwide. The health promotion behaviour of postpartum mothers may contribute to preventing puerperal sepsis, which would promote maternal health. The study aims to identify the factors influencing health promotion behaviour on puerperal sepsis among postnatal mothers. A descriptive correlational study design was conducted among 112 postpartum women conveniently selected from Dhaka Medical College Hospital. The measures were personal characteristics questionnaire, perceived benefits questionnaire, perceived barrier, postpartum social support and puerperal sepsis preventive behaviour questionnaire. Data were collected and analyzed by the researcher using descriptive and inferential statistics. Descriptive statistics describe descriptive variables, such as mean, SD, frequency, and percentage. The inferential statistics Pearson's correlation, t-test, and ANOVA were used to describe the relationship among study variables. The mean age of participants was 25.4(SD = 5.14) years old. The socio-demographic characteristics of income (r = 0.24, p = 0.01)., residence (t= -2.12, p = 0.001) and ANC (t= -3.28; p = 0.001) visits were associated with puerperal sepsis preventive behaviour. In addition, the perceived benefit was positively associated (r = 0.62; p = 0.001) with puerperal sepsis preventive behaviour and the perceived barrier was found to be negatively correlated (r=-0.55, p = 0.001). The study findings help increase postpartum mothers' awareness about the benefits of puerperal sepsis preventive behaviour. Findings may be recommended for further experimental study to develop and assess the effect of health promotion guidelines on puerperal sepsis.

Background: Uterine rupture is rare and life-threatening for both mothers and newborns. This study aimed to explore the clinical manifestation, site of rupture, obstetric risk factors, maternal and neonatal complications, and birth outcomes with mid-trimester and late-pregnancy uterine rupture.

Methods: Data from patients with uterine rupture occurring at Hunan Maternal and Child Health Hospital between January 2013 and December 2022 were reviewed retrospectively.

Results: 153,722 deliveries occurred during the 10 years of the study period. A total number of 129 uterine ruptures were identified: 12 ruptures occurred in the second trimester and 117 cases of uterine rupture diagnosed at or after 28 weeks gestation. The total incidence was 8.4/10,000. Most of the patients had a history of cesarean section (73.6%). 59.7% cases had a history of dilation and curettage. The rupture was more likely to occur on the lower uterine segment (86.82%). Seventy-one patients (55%) presented with abdominal pain or vaginal bleeding. Twenty-seven (20.9%) cases underwent a labor trial. There were 17 perinatal deaths associated with uterine rupture and neonatal asphyxia was observed in five infants. There was one maternal death. Postpartum hemorrhage occurred in 25 cases. Five patients underwent hysterectomy. Patients with uterine rupture during mid-trimester were more likely to receive a blood transfusion and exhibited higher rates of bladder injury.

Conclusion: Uterine rupture especially mid-gestational uterine rupture is rare and remains a diagnostic challenge. Remarkably worse maternal outcomes were seen in patients with second-trimester rupture when compared with patients who experienced late-pregnancy rupture. Pregnant women with a history of uterine surgery, even at an early gestational age, should be closely monitored by obstetricians for the risk of uterine rupture if they experience persistent abdominal pain. Early recognition and prompt intervention are key to improve maternal and child outcomes.

Background: Gestational hypertension (GH) is linked to an increased risk of cardiometabolic diseases for both mother and child, but we lack reliable biomarkers to identify high-risk women early in pregnancy. MicroRNAs (miRNAs) are small non-coding RNA that have emerged as promising biomarkers for pregnancy complications. We thus aimed to identify first trimester circulating miRNAs associated with GH and to build a miRNA-based algorithm to predict GH incidence.

Methods: We quantified miRNAs using next-generation sequencing in plasma samples collected at first trimester of pregnancy in Gen3G (N = 413, including 28 GH cases) and 3D (N = 281, including 21 GH cases) prospective birth cohorts. MiRNAs associated with GH in Gen3G (identified using DESeq2, p-value < 0.05) and replicated in 3D were included in a stepwise logistic regression model to estimate the probability of developing GH based on the miRNAs (normalized z-score counts) and maternal characteristics that contribute most to the model.

Results: We identified 28 miRNAs associated with the onset of GH later in pregnancy (p < 0.05) in the Gen3G cohort. Among these, three were replicated in the 3D cohort (similar fold change and p < 0.1) and were included in stepwise logistic regression models with GH-related risk factors. When combined with first trimester mean arterial pressure (MAP), miR-208b-3p and miR-26a-1-3p achieve an AUC of 0.803 (95%CI: 0.512-0.895) in Gen3G and 0.709 (95%CI: 0.588-0.829) in 3D. The addition of miR-208b-3p, and miR-26a-1-3p to the model significantly improves the prediction performance over that of MAP alone (p = 0.03). We then proposed low and high-risk thresholds, which could help identify women at very low risk of GH and those who could benefit from prevention monitoring throughout their pregnancy.

Conclusion: The combination of circulating miR-208b-3p and miR-26a-1-3p with first trimester MAP offers good performance as early predictors of GH. Interestingly, these miRNAs target pathways related to the cardiovascular system and could thus be relevant to the pathophysiology of GH. These miRNAs thus provide a novel avenue to identify women at risk and could lead to even more adequate obstetrical care to reduce the risk of complications associated with GH.

Background: Pregnancy may result in gestational diabetes mellitus (GDM), discomfort, pregnancy-related musculoskeletal pain, sleep disturbances, and decreased quality of life in pregnant women. Physical activity during pregnancy can lower the odds ratio of developing GDM and offer numerous health benefits for mothers and infants. However, the prevalence of physical inactivity among pregnant women worldwide is high. The Behavior Change Wheel (BCW) can be used to develop interventions to enhance physical activity. However, no research has been conducted to evaluate the effectiveness of physical activity interventions among Chinese pregnant women using the BCW framework.

Methods/design: We will conduct a single-center, parallel, randomized controlled trial at a maternal-child health care center. A total of 244 pregnant women at high risk for GDM will be randomly allocated to either a study group receiving a physical activity counseling intervention or a control group receiving standard care. The intervention will comprise one face-to-face individual counseling session combined with three weekly online group counseling sessions based on Motivational Interviewing, supplemented by four biweekly counseling before 24 gestation weeks, and WeChat group support (Tencent, Shenzhen, China). Educational materials will also be available on the WeChat Official Account. The program will begin before 12⁺⁶ gestational weeks, the counseling sessions will end before 24 gestation weeks and WeChat group support will end before delivery. The primary outcomes will include physical activity, the incidence of GDM and glucose level. The secondary outcomes will include gestational weight gain, sleep quality, quality of life, low back pain, pelvic girdle pain, physical activity-related variables, and maternal and newborns health outcomes.

Discussion: This research will contribute to understanding the effects of a physical activity counseling intervention, including physical activity, incidence of GDM, glucose levels, gestational weight gain, sleep quality, quality of life, low back and pelvic girdle pain, and maternal and newborn health outcomes.

Trial registration: Chinese Clinical Trial Registry (CHiCTR) ChiCTR2400081364, on February 29, 2024.

Background: Infertility treatments are continually evolving, with vaginal probiotic supplementation before embryo transfer (ET) being explored as a potential method to improve clinical outcomes. So, this systematic review evaluated the effect of vaginal probiotics on pregnancy rates following ET.

Methods: Studies were identified through PubMed, Scopus, Web of Science, Cochrane, and clinical trial registries up to October 17, 2024. We included prospective interventional studies (RCTs or quasi-experimental) focusing on pregnancy outcomes post-ET. We excluded non-prospective studies, non-vaginal routes of probiotic administration, and studies with insufficient methodological or statistical details. The data was extracted from each qualifying study by two reviewers and recorded using an electronic form. Results were synthesized using a random-effects model, with Mantel-Haenszel (MH) risk ratio (RR) and 95% confidence intervals (CI) calculated for ET outcomes. Also, subgroup analyses were done to explore the history of recurrent implantation failure (RIF) as a probable source of heterogeneity.

Results: We included six studies with 850 participants (419 in intervention and 431 in control groups). Vaginal probiotics showed a non-significant increase in clinical pregnancy rates compared to the control group (157 per 419 [37.47%] versus 136 per 431 [31.55%], respectively; RR: 1.19; P = 0.07), with similar findings in women with and without a history of RIF. No significant differences were found in biochemical pregnancy (RR: 1.04; P = 0.74) or ongoing pregnancy rates (RR: 1.09; P = 0.53). A non-significant reduction in miscarriage risk was observed (RR: 0.67; P = 0.12).

Conclusions: Vaginal probiotics may offer a non-significant increase in clinical pregnancy rates and a slight non-significant reduction in miscarriage risk. However, considering the potential limitations of the included studies, findings should be interpreted with caution. Further research is needed to explore the potential of personalized probiotic therapy.

Prospero registration code: CRD42024550798.

Background: Early life microbial colonization of the neonatal gastrointestinal tract is crucial for imprinting of the immune system. Vertical transmission of maternal microbes is considered the key source of initial neonatal microbial colonization. We aimed to evaluate the role of the maternal vaginal and rectal microbiota in early neonatal gastrointestinal colonization in vaginally- and caesarean section-born neonates.

Methods: Maternal vaginal and rectal swabs were collected shortly before delivery. Neonatal fecal samples were collected at day 0, 7 and 28 postnatally in both vaginally-born (n = 23) and caesarean-section born (n = 40) neonates (total n = 63). All samples were analyzed by 16 S rRNA sequencing. The relative abundances of amplicon sequence variants (ASVs) shared between maternal swabs and fecal neonatal samples were compared in vaginally-versus caesarean section-born neonates.

Results: The median relative abundance of ASVs shared in the maternal rectal and vaginal swabs with all neonatal samples was low (below 10% for rectal or vaginal swabs with any of the three time-points). When focusing on vaginally- versus caesarean section-born neonates, there were no differences in the relative abundance of shared ASVs with the maternal vaginal swabs, and only on day 7 in the rectal swabs (p = 0.002). However, in both delivery routes, the relative abundance of ASV shared with the maternal rectal swab was higher (median 19% in vaginally-born neonates and 2% in caesarean section-born neonates) compared to the relative abundance of the ASVs shared with the maternal vaginal swab (0% for both vaginally- and caesarean section-born neonates) on day 28.

Conclusions: We observed that only a limited amount of ASVs were transferred from maternal rectal and vaginal compartments to the neonatal gastrointestinal tract. ASVs from the maternal gastrointestinal tract contributed to neonatal gut colonization to a greater extent than ASVs from the maternal genital tract at one month of age. Our findings contribute to an increased understanding of factors influencing neonatal gastrointestinal colonization in both caesarean section and vaginal birth, of importance as characteristics of early colonization have been associated with health outcomes later in life.

Trial registration: The original trial is registered with the Dutch Clinical Trial Registry (Trial registration number: NTR6000, https://www.trialregisternl/trial/5845 ) and the study protocol was published online.