Utilizing daily excessive concentration hours to estimate small for gestational age infants attributable to fine particulate matter in Wuhan, China.

Limited studies in China have explored the association between gravidae exposure to PM2.5 and small for gestational age infants (SGA), yielding inconsistent results. This study in Wuhan utilized daily excessive concentration hours (DECH) as a novel measure to assess PM2.5's impact on SGA. Data on air pollutants and pregnant women were collected from the Wuhan Municipal Ecology and Environmental Bureau and Wuhan Children's Hospital, respectively. Logistic regression models were employed to evaluate the contribution of PM2.5-DECH and PM2.5-mean to SGA. Significant correlations were observed between PM2.5-mean and SGA during the second trimester [OR = 1.23 (95% CI: 1.14-1.32)] and the entire pregnancy [OR = 1.15 (95% CI: 1.07-1.24)]. Similar correlations were found between PM2.5-DECH and SGA. These findings suggest that increased PM2.5 exposure is associated with a higher risk of SGA, and DECH may be used as a prospective substitute indicator for daily average concentration in similar studies.

Possible risks and benefits of adenomyomectomy on pregnancy outcomes: a retrospective analysis.

BACKGROUND: Adenomyosis is associated with unfavorable perinatal outcomes; however, the effect of an adenomyomectomy on pregnancy outcomes remains unclear. Pregnancy following an adenomyomectomy has been reported to be associated with a high risk for uterine rupture; however, the actual incidence remains unknown. OBJECTIVE: This study aimed to evaluate the effect of an adenomyomectomy on pregnancy outcomes by retrospectively comparing the pregnancy outcomes of women who underwent an adenomyomectomy with those of women with adenomyosis. STUDY DESIGN: This was a single-center retrospective study in which the pregnancy outcomes of women who underwent an adenomyomectomy and for whom complete resection of the affected tissue under laparotomy was achieved were compared with those of women with adenomyosis. The following pregnancy outcomes were examined: second-trimester miscarriage, preterm prelabor rupture of membranes, preterm delivery, spontaneous preterm delivery, preeclampsia, rate of cesarean delivery, blood loss during cesarean delivery, incidence of placenta accreta spectrum, neonatal body weight, and small for gestational age infants. RESULTS: A total of 18 pregnant women who underwent an adenomyomectomy and 105 pregnant women with adenomyosis were included in this study. All women who underwent an adenomyomectomy delivered via cesarean delivery, and among them, 1 had a uterine rupture at 30 weeks of gestation. Although there was no significant difference between pregnant women who underwent an adenomyomectomy and those with adenomyosis in the incidence of second-trimester miscarriage (0% [0/18] vs 7.6% [8/105], respectively; P=.22), preterm delivery (50% [9/18] vs 32% [34/105], respectively; P=.15), and spontaneous preterm delivery (6% [1/18] vs 15% [16/105], respectively; P=.26), a significant decrease in preterm prelabor rupture of membrane (0% [0/18] vs 12% [13/105], respectively; P<.05), preeclampsia (0% [0/18] vs 12% [13/105], respectively; P<.05), and small for gestational infants (0% [0/18] vs 15% [16/105], respectively; P<.05), as well as a significant increase in the incidence of placenta accreta spectrum (50% [9/18] vs 0% [0/105], respectively; P<.01) and blood loss during cesarean delivery (1748 mL vs 1330 mL, respectively; P<.05) were observed. CONCLUSION: Uterine rupture following an adenomyomectomy may occur because of the high incidence of placenta accreta spectrum. However, an adenomyomectomy may reduce adverse pregnancy outcomes associated with adenomyosis, such as preterm prelabor rupture of membranes, preeclampsia, and small for gestational age infants. An adenomyomectomy may be a viable option for women among whom the procedure is inevitable before conception.

Value of placental virtual magnetic resonance elastography and intravoxel incoherent motion-based diffusion and perfusion in predicting adverse outcomes of small-for-gestational-age infants.

OBJECTIVE: It is critical to early monitor and manage small-for-gestational age (SGA) infants with truly adverse outcomes not detected by conventional methods. We aimed to explore the value of diffusion-weighted imaging (DWI)-based virtual magnetic resonance elastography (vMRE) and intravoxel incoherent motion (IVIM)-based biexponential and stretched exponential parameters in predicting adverse outcomes of SGA infants. METHODS: Twenty SGA infants with adverse outcomes and forty without adverse outcomes were included in this prospective study. One DWI-based vMRE parameter [the stiffness value (µdiff)], five IVIM-based parameters [true diffusion coefficient (D), pseudo-diffusion coefficient (D*), perfusion fraction (f), diffusion distribution coefficient (DDC), and diffusion heterogeneity index (Alpha)] and apparent diffusion coefficient (ADC) were calculated and compared between groups. The predictive efficiency was compared by the logistic regression analysis and receiver operating characteristic curve analysis. The relationship between the µdiff value with gestational age was also evaluated. RESULTS: The placental µdiff value was remarkably higher, and the f, DDC, and ADC values were considerably lower in the SGA infants with adverse outcomes compared with those without adverse outcomes. The µdiff and f value were predictive risk factors for SGA infants with adverse outcomes. A combined predictive model (µdiff and f) improved the predictive efficacy. Moreover, there was no statistically significant correlation between the placental stiffness value and gestational age. CONCLUSIONS: Functional MRI parameters to quantify placenta elastography and microcirculation in SGA patients. This might be a useful tool to assess placental function and a vital non-invasive supplement for predicting adverse outcomes of SGA infants. CRITICAL RELEVANCE STATEMENT: This prospective study shows DWI-based virtual magnetic resonance elastography and intravoxel incoherent motion-based functional parameters to quantify placenta elastography and microcirculation in small-for-gestational-age patients, which could complement existing non-invasive methods for monitoring and predicting neonatal perinatal adverse outcome. KEY POINTS: • vMRE is an emerging non-invasive imaging technique for evaluating placenta stiffness. • SGA infants with adverse outcome have stiffer placental elasticity and lower microcirculation. • Risk factors combination displayed better efficacy in predicting adverse outcomes of SGA.

Fetal growth trajectories of small/large for gestational age infants in twin pregnancies.

BACKGROUND: Birthweight is the most common and accessible parameter in assessing neonatal perinatal outcomes and in evaluating the intrauterine environment globally. Infants born too large or too small not only may alter the maternal mode of delivery but also may face other long-term disorders, such as metabolic diseases and neurodevelopmental delay. Studies have revealed different growth profiles of large-for-gestational-age and small-for-gestational-age fetuses in singleton pregnancies. However, currently, no research is focused on the growth trajectories of these infants during twin pregnancies, even though they are at a much higher risk of being small for gestational age. OBJECTIVE: This study aimed to explore fetal growth trajectories of large-for-gestational-age and small-for-gestational-age infants in twin pregnancies to provide strategies for fetal growth management. STUDY DESIGN: This was a case-control study of all noncomplicated twin pregnancies delivered after 36 weeks of gestation at the Peking University First Hospital between 2012 and 2021. Ultrasound data were recorded every 2 to 4 weeks until delivery. All the infants were divided into large-for-gestational-age, small-for-gestational-age, and appropriate-for-gestational-age groups. Longitudinal fetal growth (estimated fetal weight, abdominal circumference, etc.) was compared among the 3 groups using a linear mixed model, and other maternal and neonatal perinatal outcomes were compared. Receiver operating characteristic curves were used to explore optimal biometric parameters and gestational weeks for predicting small-for-gestational-age infants. RESULTS: Here, 797 pregnant patients with 1494 infants were recruited, with 59 small-for-gestational-age infants, 1335 appropriate-for-gestational-age infants, and 200 large-for-gestational-age infants. The mean birthweights were 1985.34±28.34 g in small-for-gestational-age infants, 2662.08±6.60 g in appropriate-for-gestational-age infants, and 3231.24±11.04 g in large-for-gestational-age infants. The estimated fetal weight of the 3 groups differed from each other from week 26, with the small-for-gestational-age fetuses weighing 51.946 g less and the large-for-gestational-age fetuses weighing 35.233 g more than the appropriate-for-gestational-age fetuses. This difference increased with gestation; at 39 weeks, the small-for-gestational-age fetuses weighed 707.438 g less and the large-for-gestational-age fetuses weighed 614.182 g more than the appropriate-for-gestational-age fetuses (all P<.05). The small-for-gestational-age group had a significantly higher rate of hospitalization (89.9 %) and jaundice (40.7 %) than the appropriate-for-gestational-age group, whereas the hospitalization rate in the large-for-gestational-age group was significantly lower than the appropriate-for-gestational-age group (7.5% and 2.5%; all P<.05). The fetal weight of the small-for-gestational-age infants with adverse outcomes remained near the 10th percentile of the reference and fell below the 3rd percentile at 34 weeks of gestation. The estimated fetal weight after 30 weeks of gestation had a satisfactory diagnostic value in predicting small-for-gestational-age infants. At 30, 32, 34, and 36 weeks of gestation, the areas under the curve were 0.829, 0.840, 0.929, and 0.889 respectively. CONCLUSION: The growth patterns of small-for-gestational-age, appropriate-for-gestational-age, and large-for-gestational-age twin fetuses diverged from 26 weeks of gestation and continued to increase until delivery; therefore, closer monitoring is suggested from 26 weeks of gestation for those carrying small fetuses.

Placental perfusion using intravoxel incoherent motion MRI combined with Doppler findings in differentiating between very low birth weight infants and small for gestational age infants.

INTRODUCTION: Abnormalities in placental morphology and function can lead to small for gestational age infants (SGA) and very low birth weight infants (VLBWI). In this study, we explored the value of intravoxel incoherent motion (IVIM) histogram parameters, MRI morphological parameters, and Doppler findings of the placenta in differentiating between VLBWI and SGA. METHODS: Thirty-three pregnant women who were diagnosed with SGA and met the inclusion criteria were enrolled in this retrospective study and divided into two groups: 22 with non-VLBWI and 11 with VLBWI. The IVIM histogram parameters (perfusion fraction (f), true diffusion coefficient (D), and pseudo-diffusion coefficient (D*)), MRI morphological parameters, and Doppler findings were compared between groups. The diagnostic efficiency was compared by receiver operating characteristic (ROC) curve analysis. RESULTS: The Dmean, D90th, D*90th, fmax, and placental area of the VLBWI group were significantly lower than those of the non-VLBWI group (p < 0.05). The values of umbilical artery pulsatility index, resistance index (RI), and peak systolic velocity/end-diastolic velocity were significantly higher in the VLBWI group than in the non-VLBWI group (p < 0.05). D90th, placental area, and umbilical artery RI had the highest areas under the curve (AUCs) of the ROC curves, at 0.787, 0.785, and 0.762, respectively. A combined predictive model (D90th, placental area, and umbilical artery RI) improved the performance in differentiating between VLBWI and SGA compared with the single model (AUC = 0.942). DISCUSSION: IVIM histogram (D90th) and MRI morphological (placental area) parameters and a Doppler finding (umbilical artery RI) may be sensitive indicators for differentiating between VLBWI and SGA.

The perinatal outcomes by gestational weight gain range at 30 weeks of gestation among pre-pregnancy underweight women.

AIMS: To evaluate the perinatal outcomes by gestational weight gain (GWG) range at 30 weeks of gestation among underweight pregnant women (pre-pregnancy body mass index ≤ 18.5 kg/m2 ) in Japan. METHODS: This retrospective study was conducted at a hospital in Japan from 2003 to 2020. The underweight pregnant women (UPW; n = 3643) were divided into quartile groups based on the weight gain at 30 weeks of gestation: group Q1 ≤ 5.7 kg, 5.7 kg < Q2 ≤ 7.2 kg, 7.2 kg < Q3 ≤ 8.8 kg, and 8.8 kg < Q4. Clinical characteristics and outcomes were compared using the t-test, chi-square test, and multivariable logistic regression analysis. RESULTS: The cumulative incidences of preterm births were 7.5% (n = 70), 5.0% (n = 45), 5.4% (n = 50), and 4.9% (n = 44), and the birth rates of small for gestational age (SGA) infants were 15.7% (n = 147), 9.6% (n = 87), 6.9% (n = 64), and 5.9% (n = 53) in Q1, Q2, Q3, and Q4, respectively. Multivariable analysis revealed that Q1 was significantly associated with preterm births (adjusted odds ratio [aOR] = 1.6; 95% confidence interval [CI] = 1.0-2.3), and Q1 and Q2 were significantly associated with SGA (adj. OR = 3.0; 95% CI = 2.2-4.3; adj. OR = 1.7; 95% CI = 1.2-2.5, respectively). None of the quartile groups were significantly associated with the incidence of primary cesarean sections, gestational diabetes mellitus, and macrosomia. CONCLUSIONS: In UPW, GWG at 30 weeks of ≤5.7 kg and ≤7.2 kg are associated with preterm birth and SGA rates, respectively.

Risk factors of lower birth weight, small-for-gestational-age infants, and preterm birth in pregnancies following bariatric surgery: a scoping review.

PURPOSE: Bariatric surgery increases the risk of lower birth weight, small-for-gestational-age (SGA) infants, and preterm birth in a subsequent pregnancy. However, the factors that contribute to these adverse birth outcomes are unclear. This review aimed to collate available information about risk factors of lower birth weight, SGA, and preterm birth following bariatric surgery. METHODS: A literature search was conducted using five databases (PubMed, PsycINFO, EMBASE, Web of Science, and Cochrane Library) to obtain relevant studies. RESULTS: A total number of 85 studies were included. Studies generally excluded surgery-to-conception interval, pregnancy complications, cigarette use, and maternal age as influencing factors of birth weight, SGA, or preterm birth. In contrast, most studies found that malabsorptive procedures, lower gestational weight gain, lower glucose levels, abdominal pain, and insufficient prenatal care were associated with an elevated risk of adverse birth outcomes. Findings were mixed regarding the effects of surgery-to-conception weight loss, pre-pregnancy body mass index, micronutrient deficiency, and lipid levels on birth outcomes. The examination of maternal microbiome profiles, placental function, alcohol use, and exercise was limited to one study; therefore, no conclusions could be made. CONCLUSION: This review identified factors that appear to be associated (e.g., surgery type) or not associated (e.g., surgery-to-conception interval) with birth outcomes following bariatric surgery. The mixed findings and the limited number of studies on several variables (e.g., micronutrients, exercise) highlight the need for further investigation. Additionally, future studies may benefit from exploring interactions among risk factors and expanding to assess additional exposures such as maternal mental health.

Serum urea acid and urea nitrogen levels are risk factors for maternal and fetal outcomes of pregnancy: a retrospective cohort study.

BACKGROUND: In recent years, results on the association between serum uric acid (UA) and pregnancy outcomes have been inconsistent, and the association between urea nitrogen (UN) and adverse pregnancy outcomes in normal pregnant women has not been reported. Thus, we examined the association of UA and UN levels during gestation with the risk of adverse pregnancy outcomes in a relatively large population. METHODS: A total of 1602 singleton mothers from Union Shenzhen Hospital of Huazhong University of Science and Technology at January 2015 to December 2018 were included. Both UA and UN levels were collected and measured during the second (16-18th week) and third (28-30th week) trimesters of gestation respectively. Statistical analysis was performed using multivariate logistic regression. RESULTS: After adjustment, the highest quartile of UA in the third trimester increased the risk of premature rupture of membranes (PROM) and small for gestational age infants (SGA) by 48% (odds ratio [OR]: 1.48, 95% confidence interval [CI]: 1.04-2.10) and 99% (95% CI: 1.01-3.89) compared to those in the lowest quartile. The adjusted OR (95% CI) in the highest quartile of UN for the risk of SGA was 2.18 (95% CI: 1.16-4.13) and 2.29 (95% CI: 1.20-4.36) in the second and third trimester, respectively. In the second trimester, when UA and UN levels were both in the highest quartile, the adjusted OR (95% CI) for the risk of SGA was 2.51 (95% CI: 1.23-5.10). In the third trimester, when the group 1 (both indicators are in the first quartile) was compared, the adjusted ORs (95% CI) for the risk of SGA were 1.98 (95% CI: 1.22-3.23) and 2.31 (95% CI: 1.16-4.61) for group 2 (UA or UN is in the second or third quartile) and group 3 (both indicators are in the fourth quartile), respectively. CONCLUSIONS: Higher UA and UN levels increased the risk of maternal and fetal outcomes. The simultaneous elevation of UA and UN levels was a high-risk factors for the development of SGA, regardless of whether they were in the second or third trimester.

Adverse pregnancy outcomes are important public health problems in terms of high mortality and long-term health effects of maternal and newborn babies. This study assessed the association between serum urea acid and urea nitrogen levels during pregnancy and the risk of adverse pregnancy outcomes in Chinese women. The study was conducted between January 2015 and December 2018. Serum uric acid and urea nitrogen were measured at weeks 16­18 and 28­30, respectively. A total of 1602 singleton pregnant women participated in the study. We found that elevated levels of uric acid and urea nitrogen increased the risk of maternal and infant outcomes. In addition, we found for the first time that elevated uric acid and urea nitrogen concentrations were a risk factor for SGA, both in the second and third trimesters. Therefore, monitoring maternal uric acid and urea nitrogen biochemical parameters during pregnancy is necessary to optimize nursing and intervention. Furthermore, uric acid and urea nitrogen are simple, inexpensive, and readily available tests and should be evaluated additionally.

Hypertension and infant outcomes: North Carolina pregnancy risks assessment monitoring system data.

This study examined the risk factors that moderate the relationship between hypertension and infant outcomes or were independent risk factors in a large and diverse sample of pregnant women with and without hypertension before conception. The sample included 2,996 women, where 197 had hypertension. Black women comprised 35.5% of the hypertension group relative to 19.7% of non-hypertension. Women with hypertension were more likely to have more preterm births (17.7% vs. 7.4%; ARR = 1.91, p <.001) and have infants with low birth weights (16.8% vs. 6.7%; ARR = 2.26, p <.001), independent of other maternal risk factors in logistic modeling. Maternal Black race versus White also was independently associated with preterm birth (ARR = 1.42, p =.045) and low birth weight (ARR = 1.72, p <.001). Maternal age and race did not significantly moderate the effects of hypertension on infant outcomes, but both Black race and hypertension status were independently associated with adverse birth outcomes.

High hemoglobin level is a risk factor for maternal and fetal outcomes of pregnancy in Chinese women: A retrospective cohort study.

BACKGROUND: To examine the association of hemoglobin (Hb) levels during gestation with the risk of selected adverse pregnancy outcomes such as preterm birth (PTB), low-birth-weight infants (LBW) and small-for-gestational-age infants (SGA) in Chinese women. METHODS: This retrospective cohort study was conducted in the Department of Gynecology and Obstetrics at the Union Shenzhen Hospital of the Huazhong University of Science and Technology, using routinely collected maternity and hospital data on pregnancies (2015-2018). Hb levels were measured during the second (16-18th weeks) and third (28-30th weeks) trimesters of pregnancy, and pregnancy outcomes were recorded in the hospital information system. Hb levels were categorized into four groups as follows: < 110 g/L, 110-119 g/L, 120-130 g/L, and > 130 g/L. The second group (Hb 110-119 g/L) was defined as the reference group. Statistical analysis was performed using multivariate logistic regression. RESULTS: A total of 1911 singleton mothers were included. After multivariable adjustment, Hb levels > 130 g/L in the second trimester increased the risk of LBW (odds ratio [OR], 2.54; 95% confidence interval [CI], 1.12-5.76). In the third trimester of gestation, compared with women whose Hb levels between 110 and 119 g/L, women with Hb levels > 130 g/L had an increased risk of LBW (OR, 2.20; 95% CI, 1.07-4.51) and SGA (OR, 2.00; 95% CI, 1.05-3.80). When we compared the highest and lowest quartiles of changes in the Hb across the second and third trimesters, the adjusted ORs were 0.35 (95% CI: 0.18-0.68) for PTB and 0.47 (95% CI: 0.23-0.98) for LBW. CONCLUSION: Maternal Hb > 130 g/L was associated with increased risk of adverse pregnancy outcomes. Reduction of the risks of PTB and SGA were observed with the appropriate increase of Hb level during the third trimester.