Changes in rate-pressure product associated with pregnancy.

BACKGROUND: In nonpregnant individuals, the rate-pressure product, the product of heart rate and systolic blood pressure, is used as a noninvasive surrogate of myocardial O2 consumption during cardiac stress testing. Pregnancy is considered a physiological cardiovascular stress test. Evidence describing the impact of pregnancy on myocardial O2 demand, as assessed by the rate-pressure product, is limited. OBJECTIVE: This study aimed to describe changes in the rate-pressure product for each pregnancy trimester, during labor and delivery, and the postpartum period among low-risk pregnancies. STUDY DESIGN: This was a retrospective cohort study that assessed uncomplicated pregnancies delivered vaginally at term. We collected rate-pressure product (heart rate × systolic blood pressure) values preconception, during pregnancy for each trimester (at ≤13 weeks + 6/7 days, at 14 weeks + 0/7 days through 27 weeks + 6/7 days, and at ≥28 weeks + 0/7 days), during the labor and delivery encounter (hospital admission until complete cervical dilation, complete cervical dilation until placental delivery, and after placental delivery until hospital discharge), and during the outpatient postpartum visit at 2 to 6 weeks after delivery. We calculated the percentage change at each time point from the preconception rate-pressure product (delta rate-pressure product). We used a mixed-linear model to analyze differences in the mean delta rate-pressure product over time and the influence of prepregnancy age, prepregnancy body mass index, and neuraxial anesthesia status during labor and delivery on these estimates. RESULTS: Our cohort comprised 316 patients. The mean rate-pressure product increased significantly from preconception starting at the third trimester of pregnancy and during labor and delivery (P≤.05). The mean delta rate-pressure product peaked at 12% and 38% in the third trimester and during labor and delivery, respectively. Prepregnancy body mass index was inversely correlated with the mean delta rate-pressure product changes (estimate, -0.308; 95% confidence interval, -0.536 to -0.80; P=.008). In contrast, neither the prepregnancy age, nor neuraxial anesthesia status during labor had a significant influence on this parameter. CONCLUSION: This study validates the transient but significant increase in the rate-pressure product, a clinical estimate of myocardial O2 demand, during uncomplicated pregnancies delivered vaginally at term. Pregnant individuals with lower prepregnancy body mass index experienced a sharper increase in this parameter. Patients who receive neuraxial anesthesia during labor and delivery experience similar changes in the rate-pressure product as those who did not.

[Association between maternal plasma one-carbon biomarkers during pregnancy and fetal growth in twin pregnancies].

Objective: To characterize the relationship between the levels of plasma methyl donor and related metabolites (including choline, betaine, methionine, dimethylglycine and homocysteine) and fetal growth in twin pregnancies. Methods: A hospital-based cohort study was used to collect clinical data of 92 pregnant women with twin pregnancies and their fetuses who were admitted to Peking University Third Hospital from March 2017 to January 2018. Fasting blood was collected from the pregnant women with twin pregnancies (median gestational age: 18.9 weeks). The levels of methyl donors and related metabolites in plasma were quantitatively analyzed by high-performance liquid chromatography combined with mass spectrometry. The generalized estimation equation was used to analyze the relationship between maternal plasma methyl donors and related metabolites levels and neonatal outcomes of twins, and the generalized additive mixed model was used to analyze the relationship between maternal plasma methyl donors and related metabolites levels and fetal growth ultrasound indicators. Results: (1) General clinical data: of the 92 women with twin pregnancies, 66 cases (72%) were dichorionic diamniotic (DCDA) twin pregnancies, and 26 cases (28%) were monochorionic diamniotic (MCDA) twin pregnancies. The comparison of the levels of five plasma methyl donors and related metabolites in twin pregnancies with different basic characteristics showed that the median levels of plasma choline and betaine in pregnant women ≥35 years old were higher than those in pregnant women <35 years old, and the differences were statistically significant (all P<0.05). (2) Correlation between plasma methyl donor and related metabolites levels and neonatal growth indicators: after adjusting for confounding factors, plasma homocysteine level in pregnant women with twins was significantly negatively correlated with neonatal birth weight (ß=-47.9, 95%CI:-94.3- -1.6; P=0.043). Elevated methionine level was significantly associated with decreased risks of small for gestational age infants (SGA; OR=0.5, 95%CI: 0.3-0.9; P=0.021) and low birth weight infants (OR=0.6, 95%CI: 0.4-0.9; P=0.020). Increased homocysteine level was associated with increased risks of SGA (OR=1.5, 95%CI: 1.0-2.2; P=0.029) and inconsistent growth in twin fetuses (OR=1.9, 95%CI: 1.0-3.7; P=0.049). (3) Correlation between the levels of plasma methyl donors and related metabolites and intrauterine growth indicators of twins pregnancies: for every 1 standard deviation increase in plasma choline level in pregnant women with twin pregnancies, fetal head circumference, abdominal circumference, femoral length and estimated fetal weight in the second trimester increased by 1.9 mm, 2.6 mm, 0.5 mm and 20.1 g, respectively, and biparietal diameter, abdominal circumference and estimated fetal weight increased by 0.7 mm, 3.0 mm and 38.4 g in the third trimester, respectively, and the differences were statistically significant (all P<0.05). (4) Relationship between plasma methyl donor and related metabolites levels in pregnant women with different chorionicity and neonatal birth weight and length: the negative correlation between plasma homocysteine level and neonatal birth weight was mainly found in DCDA twin pregnancy (ß=-65.9, 95%CI:-110.6- -21.1; P=0.004). The levels of choline, betaine and dimethylglycine in plasma of MCDA twin pregnancy were significantly correlated with the birth weight and length of newborns (all P<0.05). Conclusion: Homocysteine level is associated with low birth weight in twins, methionine is associated with decreased risk of SGA, and choline is associated with fetal growth in the second and third trimesters of pregnancy.

Cumulative effects of temperature on blood pressure during pregnancy: A cohort study of differing effects in three trimesters.

BACKGROUND: Little is known about the non-linear cumulative effects of temperature on blood pressure (BP) during pregnancy. We investigated the differing effects of daily ambient temperature on BP for up to 30 days in three trimesters. METHODS: The first, second, and third trimester analyses included 2547, 2299, and 2011 pregnant women, respectively, from a prospective cohort in Nanjing from January 2017 to January 2020. BP was measured at each follow-up visit. The individual daily temperature exposures were calculated for 30 days prior to the follow-up date. The Distributed Lag Non-linear Model was used to investigate the relationship between temperature and BP in each trimester. RESULTS: Temperatures under 15 °C elevate systolic, diastolic BP, and mean arterial pressure (SBP, DBP, and MAP) in the first trimester, while temperatures above 15 °C reduce SBP in the second and third trimesters. By using Distributed Lag Linear Models, we estimated that with a 1 °C decrease in daily temperature, the SBP and DBP increased by 0.32 (95 % CI: 0.12, 0.52) and 0.23 (95 % CI: 0.07, 0.39) mmHg, respectively, in the first trimester with a 20-day cumulative lag, while with a 1 °C increase in daily temperature, the SBP decreased by 0.23 (0.35, 0.10) mmHg in the third trimester with a 30-day cumulative lag. The significant effects of temperature mainly manifested between 2 and 4 weeks of exposure. CONCLUSIONS: Temperature has different effects on BP over three trimesters. Protective measures to reduce cold-related BP rise will help reduce the risk of hypertensive disorders of pregnancy.

Attention-guided deep learning for gestational age prediction using fetal brain MRI.

Magnetic resonance imaging offers unrivaled visualization of the fetal brain, forming the basis for establishing age-specific morphologic milestones. However, gauging age-appropriate neural development remains a difficult task due to the constantly changing appearance of the fetal brain, variable image quality, and frequent motion artifacts. Here we present an end-to-end, attention-guided deep learning model that predicts gestational age with R2 score of 0.945, mean absolute error of 6.7 days, and concordance correlation coefficient of 0.970. The convolutional neural network was trained on a heterogeneous dataset of 741 developmentally normal fetal brain images ranging from 19 to 39 weeks in gestational age. We also demonstrate model performance and generalizability using independent datasets from four academic institutions across the U.S. and Turkey with R2 scores of 0.81-0.90 after minimal fine-tuning. The proposed regression algorithm provides an automated machine-enabled tool with the potential to better characterize in utero neurodevelopment and guide real-time gestational age estimation after the first trimester.

Maternal non-steroidal anti-inflammatory drug exposure during pregnancy and risk of miscarriage: a systematic review and meta-analysis.

BACKGROUND: Numerous studies have suggested that non-steroidal anti-inflammatory drugs (NSAIDs) might be associated with increased risk of miscarriage. However, these results are conflicting and inconclusive. METHODS: We performed this systematic review and meta-analysis to assess the relationship between NSAIDs exposure and risk of miscarriage. A systematic literature search was conducted to identify relevant studies published from the time of database inception until June 2021. RESULTS: A total of ten studies involving 207,341 pregnant women were subjected to meta-analysis. There was no statistically significantly increased risk of miscarriage with the use of NSAIDs during pregnancy (OR = 1.37, 95% CI 0.99-1.88, p = 0.057). However, our findings showed that women exposed to NSAIDs around the time of conception were at increased risk of miscarriage (OR 2.32, 95% CI 1.16-4.66, p = 0.018). Furthermore, no significant association between NSAID use and miscarriage was evident during the first trimester of pregnancy (OR = 1, 95% CI = 0.83-1.2, p = 0.996), possibly attributable to the small sample size. CONCLUSION: Our findings indicate that NSAID exposure around the time of conception might be a risk factor for miscarriage. Further studies are needed to evaluate whether the risk varies by the type, dosage, or timing of NSAID exposure.

Determination of hand grip strength and its correlates during pregnancy: a cross-sectional study.

BACKGROUND: Pregnancy results in many changes, including reduced hand grip strength (HGS). However, good HGS is required for physical functions such as carrying and breastfeeding the baby after birth. The aim of this study was to determine the factors that may predict HGS during pregnancy. METHODS: The study was a cross-sectional study approved by the Research Ethics Committees of Kano State Ministry of Health and Aminu Kano Teaching Hospital in Kano, north-west, Nigeria. Pregnant women at the designated hospitals were included in the study if they had no serious comorbidities or any known neurological condition that affects the hands and the neck. Demographic characteristics and independent (predictor) variables (age, weight, height, BMI, maternity leave status, number of full-term deliveries, number of preterm deliveries, number of live births, number of abortuses, gravidity, trimester, systolic blood pressure, diastolic blood pressure, inter arm systolic BP difference [IASBP], inter arm diastolic BP difference [IADBP], and heart rate) of each of the participants were recorded by experienced therapists. The data were analysed using descriptive statistics, t-test, Pearson correlation coefficient and standard multiple regression. RESULT: One hundred and sixty-one pregnant women with mean age, 25.04 ± 4.83 years participated in the study. In the dominant hand, 120 participants (74.5%) had weak grip strength. In the non-dominant hand, 135 participants (83.9%) had weak grip strength. For the dominant hand, the total variance explained by the whole model was significant, 28.5%, F(11, 161) = 1.187, R2 = 0.081, p = 0.300 . In the final model, none of the variables significantly predicted HGS. However, systolic blood pressure contributed to the model more than any other variable (Beta = -0.155). For the non-dominant hand, the total variance explained by the whole model was not significant, 33.1%, F(11, 161) = 1.675, R2 = 0.111, p = 0.089 . In the final model, only systolic blood pressure (Beta = -0.254, p = 0.023) significantly predicted hand grip strength. CONCLUSION: Cardiovascular events or changes during pregnancy (such as change in systolic blood pressure) may be related to HGS in pregnant women. It is therefore, important for clinicians to pay attention to this, in planning rehabilitation strategies for pregnant women.

Prevalence of physical activity and associated factors among pregnant women: a cross-sectional population-based study in southern Brazil / Prevalência de atividade física e fatores associados entre gestantes: estudo transversal de base populacional no sul do Brasil

Abstract Objectives: to describe the prevalence of sufficient leisure-time physical activity (LPA) in the trimesters of pregnancy and to test its association with sociodemographic and contextual characteristics. Methods: cross-sectional study that in 2019 analyzed data from 3580 pregnant women residing in Santa Catarina, Brazil. LPA was categorized as "active" (150 minutes or more of LPA/week) and "inactive" (less than 150 minutes). Results: the prevalence for the recommended level of LPA was 15.3% (CI95%= 14.1-16.4) before pregnancy, gradually declining to 7.8% (CI95%= 7.3-8.7), 7.3% (CI95%= 6.58.2), and 5.8% (CI95%= 5.1-6.7) in the following trimesters of pregnancy. Higher level of education was associated with the four outcomes, increasing the chance of being active by 79% in the third trimester of pregnancy. In the second trimester, living in a neighborhood that stimulates physical activity increased the chance of being active by 39%. In the third trimester, having received guidance from a health professional was associated with an increase of 60% in the chance of practicing LPA. Conclusion: the prevalence of recommended LPA is low among pregnant women and living in a neighborhood favorable to outdoor practices, greater education level and receiving guidance from health professionals increased the chance of pregnant women to be active.

Resumo Objetivos: descrever a prevalência de atividade física no lazer (AFL) suficiente nos trimestres da gravidez e testar sua associação com características sociodemográficas e contextuais. Métodos: estudo transversal que analisou em 2019 dados de 3.580 gestantes residentes em Santa Catarina, Brasil. AFL foi categorizada como "ativa" (150 minutos ou mais de LPA / semana) e "inativa" (menos de 150 minutos por semana). Resultados: a prevalência para o nível recomendado de AFL foi de 15,3% (IC95%= 14,116,4) antes da gravidez, diminuindo gradualmente para 7,8% (IC95%= 7,3-8,7), 7,3% (IC95%= 6,5-8,2), e 5,8% (IC95%= 5,1-6,7) nos trimestres seguintes da gravidez. Maior escolaridade foi associada aos quatro desfechos, aumentando a chance de ser ativa em 79% no terceiro trimestre da gravidez. No segundo trimestre, morar em um bairro que estimula a atividade física aumentou em 39% a chance de ser ativa. Já no terceiro trimestre, ter recebido orientação de profissional de saúde esteve associado a um aumento de 60% na chance de praticar AFL. Conclusão: a prevalência de AFL recomendada é baixa entre gestantes e morar em bairro favorável a atividades ao ar livre, maior escolaridade e receber orientação de profissionais de saúde aumentam a chance de gestantes serem ativas.

Swedish intrauterine growth reference ranges for estimated fetal weight.

Fetal growth restriction is a strong risk factor for perinatal morbidity and mortality. Reliable standards are indispensable, both to assess fetal growth and to evaluate birthweight and early postnatal growth in infants born preterm. The aim of this study was to create updated Swedish reference ranges for estimated fetal weight (EFW) from gestational week 12-42. This prospective longitudinal multicentre study included 583 women without known conditions causing aberrant fetal growth. Each woman was assigned a randomly selected protocol of five ultrasound scans from gestational week 12 + 3 to 41 + 6. Hadlock's 3rd formula was used to estimate fetal weight. A two-level hierarchical regression model was employed to calculate the expected median and variance, expressed in standard deviations and percentiles, for EFW. EFW was higher for males than females. The reference ranges were compared with the presently used Swedish, and international reference ranges. Our reference ranges had higher EFW than the presently used Swedish reference ranges from gestational week 33, and higher median, 2.5th and 97.5th percentiles from gestational week 24 compared with INTERGROWTH-21st. The new reference ranges can be used both for assessment of intrauterine fetal weight and growth, and early postnatal growth in children born preterm.

Mid-trimester prediction of spontaneous preterm birth with automated cervical quantitative ultrasound texture analysis and cervical length: a prospective study.

The objective of this study was to evaluate a novel automated test based on ultrasound cervical texture analysis to predict spontaneous Preterm Birth (sPTB) alone and in combination with Cervical Length (CL). General population singleton pregnancies between 18 + 0 and 24 + 6 weeks' gestation were assessed prospectively at two centers. Cervical ultrasound images were evaluated and the occurrence of sPTB before weeks 37 + 0 and 34 + 0 were recorded. CL was measured on-site. The automated texture analysis test was applied offline to all images. Their performance to predict the occurrence of sPTB before 37 + 0 and 34 + 0 weeks was evaluated separately and in combination on 633 recruited patients. AUC for sPTB prediction before weeks 37 and 34 respectively were as follows: 55.5% and 65.3% for CL, 63.4% and 66.3% for texture analysis, 67.5% and 76.7% when combined. The new test improved detection rates of CL at similar low FPR. Combining the two increased detection rate compared to CL alone from 13.0 to 30.4% for sPTB < 37 and from 14.3 to 42.9% sPTB < 34. Texture analysis of cervical ultrasound improved sPTB detection rate compared to cervical length for similar FPR, and the two combined together increased significantly prediction performance. This results should be confirmed in larger cohorts.

The Association between Gestational Weight Gain in Each Trimester and Pregnancy Outcomes in Twin Pregnancies.

OBJECTIVE: Adequate maternal weight gain in twin pregnancies is associated with improved outcomes such as increased fetal growth and decreased incidence of preterm birth. However, it remains unclear when gestational weight gain has the greatest influence on pregnancy outcomes. Our objective was to identify at which time in a twin pregnancy does inadequate maternal weight gain have the greatest association with adverse pregnancy outcomes. STUDY DESIGN: This is a retrospective cohort study of women with twin pregnancies and normal prepregnancy body mass index (BMI, 18.5-24.9 kg/m2) who delivered at ≥24 weeks' gestation by a single maternal-fetal medicine practice between 2005 and 2017. Baseline characteristics and pregnancy outcomes were compared between women with and without adequate average gestational weight gain (weight gain per week based on the 2009 Institute of Medicine recommendations). This analysis was performed for weight gain over the entire pregnancy, as well as from 0 to 16, 16 to 24, and 24 weeks to delivery. Multivariable regression analysis was performed to control for potential confounding variables. RESULTS: A total of 609 women with twin pregnancies and normal prepregnancy BMI were included, of whom 386 (63.4%) had adequate average gestational weight gain over the entire pregnancy and 223 (36.6%) did not. Inadequate average gestational weight gain between 0 and 16 weeks' gestation was associated with a higher incidence of birthweight less than the 10th percentile for gestational age (adjusted odds ratio [aOR]: 1.67; 95% confidence interval [CI]: 1.11-2.51) and less than the 5th percentile for gestational age (aOR: 2.10; 95% CI: 1.29-3.40). Inadequate gestational weight gain between 16 and 24 weeks was associated with lower birthweight of the larger twin (ß: -0.09; p = 0.04). Inadequate weight gain from 24 weeks to delivery was associated with spontaneous preterm birth <37 weeks' gestation (aOR: 1.67; 95% CI: 1.13-2.47), <34 weeks' gestation (aOR: 4.32; 95% CI: 2.45-7.63), <32 weeks' gestation (aOR: 9.07; 95% CI: 3.66-22.48), and a lower incidence of preeclampsia (aOR: 0.31; 95% CI: 0.16-0.63). CONCLUSION: In twin pregnancies, gestational weight gain between 0 and 16 weeks as well as between 16 and 24 weeks is most associated with fetal growth, whereas gestational weight gain after 24 weeks is most associated with preterm birth. This may help elucidate the mechanism of action of the impact of gestational weight gain in twin pregnancies.

Physical activity before and during pregnancy: A cohort study.

OBJECTIVE: To estimate physical activity (PA) in healthy women before and during pregnancy and to evaluate the features associated with moderate PA (MPA). METHODS: A prospective cohort study was conducted on women selected 14 weeks of pregnancy during 2013-2015 in primary public health service centers in southern Spain. Type, duration, and frequency of PA (IPAQ questionnaire in first, second, and third trimesters [T1, T2, T3]) were measured. Variables associated with MPA were evaluated using multiple logistic regressions controlling for age, pre-pregnancy obesity, level of education, number of living children, pre-pregnancy PA, and adherence to Mediterranean diet (AMD). RESULTS: Out of 463 women, MPA was estimated in 64% pre-pregnancy, and 54%, 61%, and 59% in T1, T2, and T3, respectively. MPA was associated with greater AMD in T2 (adjusted odds ratio [aOR] 1.17, 95% confidence interval [CI] 1.04-1.33) and T3 (aOR 1.16, 95% CI 1.02-1.31), previous PA (aOR 13.5, 95% CI 8.12-22.5 in T1; aOR 2.61, 95% CI 1.72-3.96 in T2; aOR 2.59, 95% CI 1.65-4.05 in T3), and pre-pregnancy obesity (aOR 2.97, 95% CI 1.28-6.89 in T1; aOR 2.69, 95% CI 1.23-3.60 in T3). CONCLUSION: PA decreased at the beginning of pregnancy, but compliance remained over 50%. MPA was associated with diet, pre-pregnancy PA, and obesity.

HYPOXIA AND REPRODUCTIVE HEALTH: Oxygen and development of the human placenta.

Development of the human placenta takes place in contrasting oxygen concentrations at different stages of gestation, from ~20 mmHg during the first trimester rising to ~60 mmHg at the start of the second trimester before gradually declining to ~40 mmHg at term. In view of these changes, the early placenta has been described as 'hypoxic'. However, placental metabolism is heavily glycolytic, supported by the rich supply of glucose from the endometrial glands, and there is no evidence of energy compromise. On the contrary, the trophoblast is highly proliferative, with the physiological low-oxygen environment promoting maintenance of stemness in progenitor populations. These conditions favour the formation of the cytotrophoblastic shell that encapsulates the conceptus and interfaces with the endometrium. Extravillous trophoblast cells on the outer surface of the shell undergo an epithelial-mesenchymal transition and acquire invasive potential. Experimental evidence suggests that these changes may be mediated by the higher oxygen concentration present within the placental bed. Interpreting in vitro data is often difficult, however, due to the use of non-physiological oxygen concentrations and trophoblast-like cell lines or explant models. Trophoblast is more vulnerable to hyperoxia or fluctuating levels of oxygen than to hypoxia, and some degree of placental oxidative stress likely occurs in all pregnancies towards term. In complications of pregnancy, such as early-onset pre-eclampsia, malperfusion generates high levels of oxidative stress, causing release of factors that precipitate the maternal syndrome. Further experiments are required using genuine trophoblast progenitor cells and physiological concentrations to fully elucidate the pathways by which oxygen regulates placental development.

Changes in corneal biomechanics during pregnancy in Chinese healthy female.

PURPOSE: To evaluate the changes of corneal biomechanics and the intraocular pressure during pregnancy in a Chinese healthy female population. METHODS: A total of 222 unrelated Chinese females were recruited: 52 non-pregnant, 15 pregnant in the first trimester, 68 pregnant in the second trimester, and 87 pregnant in the third trimester. The intraocular pressure and corneal biomechanical parameters, including corneal-compensated intraocular pressure, Goldmann-correlated intraocular pressure, corneal hysteresis, and corneal resistance factor, were measured by an Ocular Response Analyzer G3. Central corneal thickness was measured by Lenstar (LS900). RESULTS: Corneal hysteresis and corneal resistance factor were significantly higher in pregnant women at the second and third trimesters. Corneal-compensated intraocular pressure was lower in women at the third trimester of pregnancy (p = 0.023), but the difference became insignificant after adjustment for corneal hysteresis. Central corneal thickness was marginally higher in pregnant women than non-pregnant women (p = 0.032). There was a negative correlation between corneal-compensated intraocular pressure and corneal hysteresis (r = -0.337, p < 0.001) and a positive correlation between central corneal thickness and corneal hysteresis (r = 0.711, p < 0.0001). After adjustment for corneal-compensated intraocular pressure, corneal hysteresis remained significantly higher in the second and third trimesters of pregnant women than non-pregnant women (p = 0.031, p = 0.005). CONCLUSION: This study revealed a significant increase in corneal hysteresis and corneal resistance factor in the second and third trimesters. The increase of corneal hysteresis was independent of corneal-compensated intraocular pressure, indicating pregnant females have unique characteristics in corneal-compensated intraocular pressure and corneal biomechanical properties that may be related to glaucoma and corneal ectatic diseases in pregnancy.

Maternal cardiac adaptation and fetal growth.

BACKGROUND: Pregnancies with small-for-gestational-age fetuses are at increased risk of adverse maternal-fetal outcomes. Previous studies examining the relationship between maternal hemodynamics and fetal growth were mainly focused on high-risk pregnancies and those with fetuses with extreme birthweights, such as less than the 3rd or 10th percentile and assumed a similar growth pattern in fetuses above the 10th percentile throughout gestation. OBJECTIVE: This study aimed to evaluate the trends in maternal cardiac function, fetal growth, and oxygenation with advancing gestational age in a routine obstetrical population and all ranges of birthweight percentiles. STUDY DESIGN: This was a prospective, longitudinal study assessing maternal cardiac output and peripheral vascular resistance by bioreactance at 11+0 to 13+6, 19+0 to 24+0, 30+0 to 34+0, and 35+0 to 37+0 weeks' gestation, sonographic estimated fetal weight in the last 3 visits and the ratio of the middle cerebral artery by umbilical artery pulsatility indices or cerebroplacental ratio in the last 2 visits. Women were divided into the following 5 groups according to birthweight percentile: group 1, <10th percentile (n=261); group 2, 10 to 19.9 percentile (n=180); group 3, 20 to 29.9 percentile (n=189); group 4, 30 to 69.9 percentile (n=651); and group 5, ≥70th percentile (n=508). The multilevel linear mixed-effects model was performed to compare the repeated measures of hemodynamic variables and z scores of the estimated fetal weight and cerebroplacental ratio. RESULTS: In visit 2, compared with visit 1, in all groups, cardiac output increased, and peripheral vascular resistance decreased. At visit 3, groups 1, 2, and 3, compared with 4 and 5, demonstrated an abrupt decrease in cardiac output and increase in peripheral vascular resistance. From visit 2, group 1 had a constant decline in estimated fetal weight, coinciding with the steepest decline in maternal cardiac output and rise in peripheral vascular resistance. In contrast, in groups 4 and 5, the estimated fetal weight had a stable or accelerative pattern, coinciding with the greatest increase in cardiac output and lowest peripheral vascular resistance. Groups 2 and 3 showed a stable growth pattern with intermediate cardiac output and peripheral vascular resistance. Increasing birthweight was associated with higher cerebroplacental ratio. Groups 3, 4, and 5 had stable cerebroplacental ratio across visits 3 and 4, whereas groups 1 and 2 demonstrated a significant decline (P<.001). CONCLUSION: In a general obstetrical population, maternal cardiac adaptation at 32 weeks' gestation parallels the pattern of fetal growth and oxygenation; babies with birthweight<20th percentile have progressive decline in fetal cerebroplacental ratio, decline in maternal cardiac output, and increase in peripheral vascular resistance.

Associations of Gestational Weight Gain Rate During Different Trimesters with Early-Childhood Body Mass Index and Risk of Obesity.

OBJECTIVE: This study aimed to estimate the associations of gestational weight gain rate (GWGR) during different trimesters with offspring growth and overweight/obesity risk. METHODS: The study included 4,807 mother-infant pairs enrolled in Wuhan, China. GWGR in each trimester was used as a continuous and a categorical variable to estimate the associations with offspring BMI z score (ZBMI) and overweight/obesity risk between 0 and 2 years. RESULTS: Greater GWGR (per 0.2 kg/wk) in the first, second, and third trimester was positively associated with offspring ZBMI across birth to 2 years old (ß 0.06 [95% CI: 0.04-0.09], ß 0.13 [95% CI: 0.09-0.16], and ß 0.04 [95% CI: 0.02-0.07], respectively). Excessive GWGR in the first trimester (≥ 0.30 kg/wk) was associated with an odds ratio (OR) of 1.58 (95% CI: 1.18-2.13) and 1.37 (95% CI: 1.11-1.71) for macrosomia and 2-year overweight/obesity, respectively. Excessive GWGR in the second trimester was associated with an OR of 2.09 (95% CI: 1.42-3.08), 1.21 (95% CI: 1.02-1.43), and 1.48 (95% CI: 1.15-1.90) for macrosomia, 1-year, and 2-year overweight/obesity, respectively. Excessive GWGR in the third trimester was associated with an OR of 1.91 (95% CI: 1.27-2.86) and 1.32 (95% CI: 1.02-1.72) for macrosomia and 2-year overweight/obesity, respectively. CONCLUSIONS: Excessive GWGR in each trimester was positively associated with offspring ZBMI and early-childhood overweight/obesity risk.

Revisión de la literatura: composición salival y su relación con caries dental en embarazadas / Review of the literature: salivary composition and its relationship with dental caries in pregnant women

La saliva es un fluido complejo muy importante en las funciones de la cavidad bucal. El embarazo es un estado normal en el que el embrión se forma y evoluciona durante nueve meses. En este proceso la mujer sufre una serie de cambios fisiológicos y psicológicos. Entre ellos, tiene modificaciones en la saliva y, por consiguiente, en el flujo, pH y concentración de proteínas salivales, que desempeñan un papel importante en la protección contra la infección en los seres humanos. Su nivel en la cavidad oral está sujeto a constantes fluctuaciones que dependen de numerosos factores. El embarazo genera adaptaciones en la fisiología femenina que pueden repercutir en la salud bucal de la gestante. Las afecciones bucales más frecuentes son la caries dental y la gingivitis. Si estas afecciones no son tratadas a tiempo, pueden repercutir en la salud del futuro bebé. Se realizó una revisión bibliográfica con el objetivo de conocer acerca de los componentes de la saliva y su relación con caries dental en las embarazadas, considerando los tres trimestres de gestación (AU)

Saliva is a complex fluid very important in the functions of the oral cavity. Pregnancy is a normal state in which the embryo forms and evolves for nine months. In this process, women undergo a series of physiological and psychological changes. Among them, it has modifications in saliva and, consequently, in the flow, pH and concentration of salivary proteins, which play an important role in protecting against infection in humans. Its level in the oral cavity is subject to constant fluctuations that depend on numerous factors. Pregnancy generates adaptations in female physiology that can affect the oral health of the pregnant woman. The most common oral conditions are dental caries and gingivitis. If these conditions are not treated in time, they can affect the health of the future baby. A bibliographic review was carried out with the objective of knowing about the components of saliva and its relationship with dental caries in pregnant women, considering the three trimesters of gestation (AU)

Frequency of Hyperemesis Gravidarum and associated risk factors among pregnant women.

OBJECTIVE: To determine the frequency of hyperemesis gravidarum (HG) and associated factors among pregnant women. METHODS: The hospital-based cross-sectional study was conducted from October 2016 to March 2017 at Lady Reading Hospital (LRH), Peshawar, District Headquarter Hospital (DHQ), Mardan, and District Headquarter Hospital, Nowshera, Khyber Pakhtunkhwa, Pakistan, and comprised data of 146 pregnant women with hyperemesis gravidarum. Data was compiled using pre-designed proforma. Frequency data of HG was also collected from the two hospitals of Peshawar and Mardan presenting in 2015 and 2016. Blood samples of all patients were analysed for serum electrolytes and complete blood count. Data was analyzed using Microsoft Excel 2010.. RESULTS: Mean frequency of HG in LRH Peshawar and DHQ Mardan during 2015 and 2016 was 14.5% and 8.34% respectively. Of the 146 women, 103(70.5%) belonged to Nowshera, 24(16.4%) to Peshawar and 19(13%) to Mardan. The overall mean age was 27±4.9 years, and maximum number of patients 67(45.89%) were aged 26-30 years. Major risk factor was urinary tract infection in Nowshera 30(29%) and Mardan 5(26.3%), while no major factor was identified in Peshawar. Patients in the first trimester were 59(57.28%) in Nowshera, 19(100%) in Mardan and 19(83.3%) in Peshawar, and primigravidas were 19(18.4%), 6(25%) and 8(42%) respectively. Overall, 119(81.5%) patients had no history of abortion. CONCLUSIONS: The prevalence of hyperemesis gravidarum was high in Nowshera, Mardan and Peshawar, predominantly during the first trimester of pregnancy.

The Relationship of Nutritional Energy and Macronutrient Intake with Pregnancy Outcomes in Czech Pregnant Women.

Maternal nutrition and metabolism play important roles for the well-being of both mother and fetus during pregnancy. This longitudinal study brings an original evaluation of the relationship between the nutritional energy and macronutrients intake (NEMI) and pregnancy outcomes and an assessment of the changes in such intake over the previous ten years. Sixty-five healthy Czech pregnant women were examined in three pregnancy periods (1st: 17th-27th; 2nd: 28th-35th; 3rd: 36th-38th gestational weeks). Results of 7-day dietary records were analyzed using NutriDan software. Energy intake decreased from 30.0 kcal/kg to 25.0 kcal/kg during pregnancy. The data also showed a decrease in macronutrients intake (p < 0.0001) with the advancing stage of pregnancy. Positive correlations were demonstrated between NEMI and birth weight (r = 0.410, p < 0.001). In the second pregnancy period, NEMI (excluding carbohydrates) positively associated with neonatal birth length (p < 0.01) and negatively with duration of birth (p < 0.05). An increased NEMI in the last period of pregnancy shortened the length of pregnancy.

DASH (Dietary Approaches to Stop Hypertension) dietary pattern and maternal blood pressure in pregnancy.

BACKGROUND: High blood pressure (BP) in pregnancy is associated with significant adverse outcomes. In nonpregnant populations, the DASH (Dietary Approaches to Stop Hypertension) diet is associated with reductions in blood pressure. The present study investigated the relationship between the DASH dietary pattern and maternal BP in pregnancy. METHODS: This is an observational study of 511 women who participated in the ROLO study (Randomized cOntrol trial of LOw glycaemic index diet for the prevention of recurrence of macrosomia), 2007-2011, Dublin, Ireland. Auscultatory blood pressure, systolic blood pressure (SBP) and diastolic blood pressure (DBP) measurements were taken. Mean arterial pressure (MAP) was calculated. Dietary intakes were recorded using 3-day food diaries in each trimester. DASH scoring criteria were used to score and rank participants from low to high intakes of foods recommended in the DASH diet. Statistical analysis using analysis of variance and multiple linear regression were used to determine the relationship between maternal BP and DASH scores. RESULTS: Dietary intake more closely resembling the DASH dietary recommendations throughout pregnancy was associated with a lower DBP (mmHg) in trimesters 1 [B: -0.70; 95% confidence interval (CI) = -1.21 to -0.18] and 3 (B: -0.68; 95% CI = -1.19 to -0.17), as well as lower MAP (mmHg) in trimesters 1 (B: -0.78; 95% CI = -1.33 to -0.25) and 3 (B: -0.54; 95% CI = -1.04 to -0.04), controlling for body mass index, age, education, energy intake and intervention grouping. CONCLUSIONS: The DASH dietary pattern was associated with lower maternal BP in pregnancy among healthy women without hypertensive disorders of pregnancy. Despite the observational nature of these findings, the results demonstrate the potential for healthcare professionals to intervene to promote cardiovascular health in pregnancy.

Associations between hydration state and pregnancy complications, maternal-infant outcomes: protocol of a prospective observational cohort study.

BACKGROUND: Water requirements increases with gestational age. Insufficient water intake causes dehydration, which may adversely affect maternal health and birth outcomes. However, few related studies have been conducted. The purposes are to assess the water intake and hydration state among pregnant women, and to investigate the associations with pregnancy complications and maternal and infant outcomes. METHODS: A prospective observational cohort study will be applied. A total of 380 pregnant women will be recruited from the First Affiliated Hospital of Hainan Medical University. Hydration biomarkers and health outcomes will be tested during 15~17 weeks' gestation, 20~22 weeks' gestation, 30~32 weeks' gestation, during childbirth and 42 days after childbirth. Daily fluid intake will be collected using a 24-h fluid intake record for 7 consecutive days. A semi-quantified food frequency method will be used to assess food intake and water intake from food. Anthropometric measurement will be taken following standardized processes. Intracellular fluid (ICF) and extracellular fluid (ECF) will be measured using a body composition analyzer. Morning fasting urine and blood osmolality will be tested by laboratory physicians using an osmotic pressure molar concentration meter. Pregnancy complications will be assessed and diagnosed throughout pregnancy and childbirth. Maternal-infant outcomes will be monitored using related indicators and technologies. In order to explore the internal mechanism and interactions from the perspective of endocrine, pregnancy related hormones (estradiol, prolactin, progesterone) and the hydration-related hormones (copeptin) will be tested during pregnancy. A mixed model of repeated measures ANOVA will be analyzed using SAS 9.2. RESULTS: The results may provide basic data on water intake among pregnant women. The association between hydration state and maternal-infant outcomes will also be explored. CONCLUSIONS: This preliminary exploratory study findings will fill the gaps in the research on water intake, hydration and maternal health, birth outcomes, provide scientific reference data for updating recommendation on water adequate intake among pregnant women, and provide suggestion for developing water intake interventions. TRIAL REGISTRATION: The protocol has been registered on the website of Chinese Clinical Trial Registry. The Identifier code is ChiCTR1800019284. The Registry date is 3 November, 2018. Registry name is "Study for the correlation between hydration state and pregnancy complications, maternal and infant outcomes during pregnancy".