Adherence to alternate Healthy Eating Index (AHEI), alternate Mediterranean diet (AMED), and Dietary Approaches to Stop Hypertension (DASH) has been linked to lower risks of chronic diseases. ...However, their associations with common pregnancy complications are unclear.
This study investigates the associations of AHEI, AMED, and DASH during periconception and pregnancy with common pregnancy complication risks.
The study included 1887 pregnant women from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Fetal Growth Studies–Singletons. Women responded to an FFQ at 8–13 gestational weeks, and they performed a 24-h dietary recall at 16–22 and 24–29 wk. Gestational diabetes (GDM), gestational hypertension, preeclampsia, and preterm delivery were ascertained using medical records.
Healthier diet indicated by higher AHEI, AMED, and DASH scores was generally related to lower risks of pregnancy complications. Significant inverse associations were observed between AHEI score reported at 16–22 wk and GDM risk adjusted RR (95% CI), highest (Q4) vs. lowest quartile (Q1): 0.32 (0.16, 0.66), P-trend = 0.002; DASH score reported at both 8–13 adjusted RR (95% CI), Q4 vs. Q1: 0.45 (0.17, 1.17), P-trend = 0.04 and 16–22 wk adjusted RR (95% CI), Q4 vs. Q1: 0.19 (0.05, 0.65), P-trend = 0.01 and gestational hypertension risk; AHEI score reported at 24–29 wk and preeclampsia risk adjusted RR (95% CI), Q4 vs. Q1: 0.31 (0.11, 0.87), P-trend = 0.03; AMED score reported at 8–13 wk adjusted RR (95% CI), Q4 vs. Q1: 0.50 (0.25, 1.01), P-trend = 0.03 and DASH score reported at 24–29 wk adjusted RR (95% CI), Q4 vs. Q1: 0.50, (0.26, 0.96), P-trend = 0.03 and preterm delivery risk.
Adherence to AHEI, AMED, or DASH during periconception and pregnancy was related to lower risks of GDM, gestational hypertension, preeclampsia, and preterm delivery.
This study was registered at ClinicalTrials.gov as NCT00912132.
Background Placental abruption traditionally is defined as the premature separation of the implanted placenta before the delivery of the fetus. The existing clinical criteria of severity rely ...exclusively on fetal (fetal distress or fetal death) and maternal complications without consideration of neonatal or preterm delivery-related complications. However, two-thirds of abruption cases are accompanied by fetal or neonatal complications, including preterm delivery. A clinically meaningful classification for abruption therefore should include not only maternal complications but also adverse fetal and neonatal outcomes that include intrauterine growth restriction and preterm delivery. Objectives The purpose of this study was to define severe placental abruption and to compare serious maternal morbidity profiles of such cases with all other cases of abruption (ie, mild abruption) and nonabruption cases. Study Design We performed a retrospective cohort analysis using the Premier database of hospitalizations that resulted in singleton births in the United States between 2006 and 2012 (n = 27,796,465). Severe abruption was defined as abruption accompanied by at least 1 of the following events: maternal (disseminated intravascular coagulation, hypovolemic shock, blood transfusion, hysterectomy, renal failure, or in-hospital death), fetal (nonreassuring fetal status, intrauterine growth restriction, or fetal death), or neonatal (neonatal death, preterm delivery or small for gestational age) complications. Abruption cases that did not qualify as being severe were classified as mild abruption cases. The morbidity profile included amniotic fluid embolism, pulmonary edema, acute respiratory or heart failure, acute myocardial infarction, cardiomyopathy, puerperal cerebrovascular disorders, or coma. Associations were expressed as rate ratios with 95% confidence intervals that were derived from fitting log-linear Poisson regression models. Results The overall prevalence rate of abruption was 9.6 per 1000, of which two-thirds of cases were classified as being severe (6.5 per 1000). Serious maternal complications occurred in 15.4, 33.3, and 141.7 per 10,000 among nonabruption cases and mild and severe abruption cases, respectively. In comparison with no abruption, the rate ratio for serious maternal complications were 1.52 (95% confidence interval, 1.35–1.72) and 4.29 (95% confidence interval, 4.11–4.47) in women with mild and severe placental abruption, respectively. Rate ratios for the individual complications were 2- to 7-fold higher among severe abruption cases. Furthermore, the rate ratios for serious maternal complications among severe abruption cases compared with mild abruption cases was 3.47 (95% confidence interval, 3.05–3.95). This association was considerably stronger for virtually all maternal complications among cases with severe abruption compared with mild abruption. Annual rates of mild and severe abruption were fairly constant during the study period. Although the maternal complication rate among non-abruption births was stable from 2006-2012, the rate of complications among mild abruption cases dropped from 2006-2008 and then leveled off thereafter. In contrast, the rate of serious complications among severe abruption cases remained fairly stable from 2006-2010 and increased sharply thereafter. Conclusions Severe abruption was associated with a distinctively higher morbidity risk profile compared with the other 2 groups. The clinical characteristics and morbidity profile of mild abruption were more similar to those of women without an abruption. These findings suggest that the definition of severe placental abruption based on the proposed specific criteria is clinically relevant and may facilitate epidemiologic and genetic research.
To apply scientometric methodology to characterize influential articles in the
(JPM).
We performed a cross-sectional study of all JPM articles indexed in Clarivate Web of Science (WOS), NIH Open ...Citation Collection, and Altmetric Explorer databases (1973-2022). We identified articles cited ≥100 times in WOS and articles with highest Relative Citation Ratios (RCR, a metric of influence based on citations) and highest Altmetric Attention Scores (AAS, a metric of engagement with social media and public platforms). We performed descriptive analysis to characterize influential articles based on citation rates vs. highest AAS, and quantile regression with bootstrapping to estimate the median differences (95% confidence intervals).
We identified 4095 JPM articles that were indexed in the WOS, of which 3,959 (96.7%) had RCRs and 939 (22.9%) had AASs. The study cohort included 34 articles cited ≥100 times and the 34 top-RCR and 34 top-AAS articles, representing 83 unique articles. These influential articles had median 67 citations (IQR 17-114), median RCR 3.4 (IQR 1.7-5.0), and median AAS 14 (IQR 3-28). The majority were observational studies and reviews. Compared to top-AAS articles, top-cited articles had higher median citations (117 IQR 111-147 vs. 13 IQR 5-62; median difference 104.0, 95% CI 86.6-121.4) and citations per year (7.3 IQR 4.9-10.6 vs. 2.3 0.7-4.6; median difference 5.5 95% CI 3.1-7.9). Results were similar for top-RCR vs. top-AAS articles.
We identified influential articles during 50 years of JPM, providing insight into the impact of the journal and providing a template for future studies of academic journals.
To compare the accuracy of a new formula with one developed in 1984 (and still in common use) and to develop and compare racial and ethnic-specific and racial and ethnic-neutral formulas.
The Eunice ...Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Fetal Growth Studies-Singletons was a prospective cohort study that recruited women in four self-reported racial-ethnic groups-non-Hispanic black, Hispanic, non-Hispanic white, and Asian-with singleton gestations from 12 U.S. centers (2009-2013). Women with a certain last menstrual period confirmed by first-trimester ultrasonogram had longitudinal fetal measurements by credentialed study ultrasonographers blinded to the gestational age at their five follow-up visits. Regression analyses were performed with linear mixed models to develop gestational age estimating formulas. Repeated cross-validation was used for validation. The estimation error was defined as the mean squared difference between the estimated and observed gestational age and was used to compare the formulas' accuracy.
The new formula estimated the gestational age (±2 SD) within ±7 days from 14 to 20 weeks of gestation, ±10 days from 21 to 27 weeks of gestation, and ±17 days from 28 to 40 weeks of gestation. The new formula performed significantly better than a formula developed in 1984 with an estimation error of 10.4 compared with 11.2 days from 21 to 27 weeks of gestation and 17.0 compared with 19.8 days at 28-40 weeks of gestation, respectively. Racial and ethnic-specific formulas did not outperform the racial and ethnic-neutral formula.
The NICHD gestational age estimation formula is associated with smaller errors than a well-established historical formula. Racial and ethnic-specific formulas are not superior to a racial-ethnic-neutral one.
Placental chorioangioma is the most common benign non-trophoblastic tumor of the placenta. It is derived from primitive chorionic mesenchyme and is typically vascular. Placenta chorioangiomas occur ...in approximately 1% of pregnancies. Most placental chorioangiomas are small and are not clinically important. However, those measuring more than 4-5 cm in diameter may be associated with maternal and fetal complications. Early diagnosis, close prenatal surveillance and appropriate intervention may prevent severe complications and perinatal mortality caused by chorioangioma. Here we review the incidence, prenatal diagnosis, complications, the pathophysiological mechanisms of maternal and fetal complications, and the therapeutic possibilities in pregnancies complicated by placental chorioangiomas.
Objective
To describe differences in outcomes between pregnant women with and without coronavirus dsease 2019 (COVID‐19).
Design
Prospective cohort study of pregnant women consecutively admitted for ...delivery, and universally tested via nasopharyngeal (NP) swab for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) using reverse transcription–polymerase chain reaction. All infants of mothers with COVID‐19 underwent SARS‐CoV‐2 testing.
Setting
Three New York City hospitals.
Population
Pregnant women >20 weeks of gestation admitted for delivery.
Methods
Data were stratified by SARS‐CoV‐2 result and symptomatic status, and were summarised using parametric and nonparametric tests.
Main outcome measures
Prevalence and outcomes of maternal COVID‐19, obstetric outcomes, neonatal SARS‐CoV‐2, placental pathology.
Results
Of 675 women admitted for delivery, 10.4% were positive for SARS‐CoV‐2, of whom 78.6% were asymptomatic. We observed differences in sociodemographics and comorbidities among women with symptomatic COVID‐10 versus asymptomatic COVID‐19 versus no COVID‐19. Caesarean delivery rates were 46.7% in symptomatic COVID‐19, 45.5% in asymptomatic COVID‐19 and 30.9% in women without COVID‐19 (P = 0.044). Postpartum complications (fever, hypoxia, readmission) occurred in 12.9% of women with COVID‐19 versus 4.5% of women without COVID‐19 (P < 0.001). No woman required mechanical ventilation, and no maternal deaths occurred. Among 71 infants tested, none were positive for SARS‐CoV‐2. Placental pathology demonstrated increased frequency of fetal vascular malperfusion, indicative of thrombi in fetal vessels, in women with COVID‐19 versus women without COVID‐19 (48.3% versus 11.3%, P < 0.001).
Conclusion
Among pregnant women with COVID‐19 at delivery, we observed increased caesarean delivery rates and increased frequency of maternal complications in the postpartum period. Additionally, intraplacental thrombi may have maternal and fetal implications for COVID‐19 remote from delivery.
Tweetable
COVID‐19 at delivery: more caesarean deliveries, postpartum complications and intraplacental thrombi.
Tweetable
COVID‐19 at delivery: more caesarean deliveries, postpartum complications and intraplacental thrombi.
This article includes Author Insights, a video available at https://vimeo.com/rcog/authorinsights16403
By combining the disciplines of laser physics, ultrasound imaging, and fetoscopic in-utero surgery, we have progressed from a rate of fetal and neonatal death before 1990 of 80% or more to a survival ...rate of about 80%.6 The disease is more complex, gaining knowledge about the disease is more difficult, and access to the fetus or fetuses is more problematic than with isoimmunisation. Most important was the systematic study of twin-to-twin transfusion syndrome and development of fetoscopic in-utero laser ablation of vascular connections between twins, which began in the 1980s.7,8 A landmark study9 was concluded and published in 2004 and showed the superiority of laser ablation over amnioreduction, and efforts to perfect this treatment have continued and have been expanded since.6 The most important issues with Slaghekke and colleagues' study1 are those of boundaries.
Open maternal-fetal surgery for fetal myelomeningocele results in reduction in neonatal morbidity related to spina bifida but may be associated with fetal, neonatal, and maternal complications in ...subsequent pregnancies.
The objective of this study was to ascertain obstetric risk in subsequent pregnancies after open maternal-fetal surgery for fetal myelomeningocele closure.
An international multicenter prospective observational registry created to track and report maternal, obstetric, fetal/neonatal, and subsequent pregnancy outcomes following open maternal-fetal surgery for fetal myelomeningocele was evaluated for subsequent pregnancy outcome variables. Institutional Review Board approval was obtained for the registry.
From 693 cases of open maternal-fetal surgery for fetal myelomeningocele closure entered into the registry, 77 subsequent pregnancies in 60 women were identified. The overall live birth rate was 96.2%, with 52 pregnancies delivering beyond 20 weeks gestational age and median gestational age at delivery of 37 (36.3–37.1) weeks. The uterine rupture rate was 9.6% (n = 5), resulting in 2 fetal deaths. Maternal transfusion was required in 4 patients (7.7%).
The risk of uterine rupture or dehiscence in subsequent pregnancies with associated fetal morbidity after open maternal-fetal surgery is significant, but is similar to that reported for subsequent pregnancies after classical cesarean deliveries. Future pregnancy considerations should be included in initial counseling for women contemplating open maternal-fetal surgery.
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