The association between parental SARS-CoV-2 infection in pregnancy and fetal growth restriction.

OBJECTIVES: Although the relationship between maternal viral infections and fetal growth restriction (FGR) is well established, the association between SARS-CoV-2 infection in pregnancy and FGR remains unclear. We investigated the association between SARS-CoV-2 infection in pregnancy and FGR at a single county hospital. METHODS: We performed a prospective cohort study with cohorts matched by gestational age and month of SARS-CoV-2 PCR testing between April 2020 and July 2022. Individuals were included if they had a SARS-CoV-2 PCR testing up to 32 weeks of gestation and had a third trimester ultrasound. Primary outcome was a diagnosis of FGR, while secondary outcomes were rates of preeclampsia, small for gestational age (SGA) and birthweight. Univariate analyses, chi-square test and logistic regression were used for analysis. RESULTS: Our cohorts constituted of 102 pregnant individuals with a positive SARS-CoV-2 PCR test result and 103 pregnant individuals with a negative SARS-CoV-2 PCR test result in pregnancy. FGR rates were 17.8 % and 19.42 % among positive and negative SARS-CoV-2 cohorts respectively. While a statistical difference in preeclampsia rates was noted (34.31 % vs. 21.36 %, p=0.038) between cohorts, odds of getting preeclampsia based on SARS-CoV-2 test result was not significant (aOR 1.01, CI=0.97-1.01, p=0.75). No statistical difference was noted in demographics, FGR and SGA rates, and birthweight. CONCLUSIONS: Our findings suggest no association between SARS-CoV-2 infection in pregnancy and FGR at a single institution. Our results validate emerging data that additional fetal growth ultrasonographic assessment is not indicated solely based on SARS-CoV-2 infection status.

Pregnancy outcomes associated with an abnormal 50-g glucose screen during pregnancy: a systematic review and Meta-analysis.

OBJECTIVE: To assess the association between an abnormal 1-h 50-g glucose challenge test (GCT) followed by a normal 3-h 100-g glucose tolerance test (GTT) on fetal macrosomia and other adverse outcomes. DATA SOURCES: MEDLINE, Cochrane, clinicaltrials.gov, and Google Scholar were searched from inception to March 2019. METHODS OF STUDY SELECTION: Any studies reporting adverse perinatal and/or maternal outcomes in women with an abnormal 50-g 1-h glucose challenge test (GCT) followed by a normal 3-h, 100-g glucose tolerance test (GTT) were included. Studies were critically appraised by three independent reviewers. Outcomes included fetal macrosomia, cesarean delivery, preeclampsia, birth weight, neonatal hypoglycemia, shoulder dystocia, NICU admission, respiratory morbidity, and low Apgar score. A random-effects model was employed to calculate pooled odds ratios (OR) for each outcome with their 95% confidence intervals (CI) and 95% predictive intervals (PI). TABULATION, INTEGRATION, AND RESULTS: We identified 30 studies comprising 18,067 patients with a normal 3-h GTT after an abnormal 1-h GCT (study group) and 117,091 patients with a normal 1-h, 50-g GCT (comparison group). Patients in the study group had an increased risk of macrosomia (OR 1.68, 95% CI 1.48-1.91, 27 studies, 132,027 patients), cesarean delivery (OR 1.39, 95% CI 1.30-1.48, 24 studies, 128,495 women), preeclampsia (OR 1.48, 95% CI 1.15-1.91, 17 studies, 110,930 patients), hypoglycemia (OR 1.43, CI 1.07-1.91) and shoulder dystocia (OR 1.52, 95% CI 1.09-2.12, 9 studies, 41,229 patients). Neonatal birth weight was significantly higher in the study group. The incidence of NICU admission, low Apgar score, and respiratory morbidity was similar in the two groups. Controlling for body mass index and 1-h glucose screen cut off did not alter these results. CONCLUSION: Even in the absence of gestational diabetes, patients who fail the GCT test are at mildly increased risk of maternal and neonatal morbidity including macrosomia, cesarean delivery, preeclampsia, and shoulder dystocia.

A Low 50-gram, 1-hour Glucose Challenge Test Value Predicts Neonatal Birth Weight Less than the 10th Percentile: A Systematic Review and Meta-Analysis.

OBJECTIVE: This study aimed to perform a systematic review with meta-analysis to investigate if women with a low 50-g, 1-hour glucose challenge test (GCT) value are at risk for having neonates with a birth weight less than the 10th percentile. STUDY DESIGN: A computerized literature search was conducted to identify studies that compared outcomes of pregnant women with a low GCT value versus women with a normal GCT value during routine screening for gestational diabetes. RESULTS: Sixteen cohort studies were included for analysis. Women with a low GCT value were noted to have a 43% increased odds of having neonates with birth weight less than the 10th percentile (odds ratio [OR]: 1.43; 95% confidence interval [CI]: 1.28-1.60) and 30% increased odds of having neonates with a birth weight less than 2,500 g (OR: 1.3; 95% CI: 1.0-1.7) when compared with women with a normal GCT value. The rates of preterm delivery, neonatal intensive care unit (NICU) admission, pregnancy-induced hypertension (PIH)/preeclampsia, respiratory distress, NICU, and Apgar scores less than 7 were similar in the two groups. CONCLUSION: A low GCT value defined as less than 90 mg/dL identifies pregnancies at elevated risk for having neonates with a birth weight less than the 10th percentile.

Povidone-iodine 1% is the most effective vaginal antiseptic for preventing post-cesarean endometritis: a systematic review and network meta-analysis.

BACKGROUND: Direct comparison metaanalyses have reported benefits with presurgical vaginal preparation before cesarean delivery for the reduction of endometritis. These reports did not perform a multitreatment comparison of the various antiseptic solutions assessed in previous studies. OBJECTIVE: The purpose of this study was to review the literature systematically and quantitate and summarize indirectly the comparative efficacy of antiseptic formulations and their concentrations that are used for the preparation of the vagina before cesarean delivery in the prevention of endometritis and other infectious complications. STUDY DESIGN: We used MEDLINE, EMBASE (from their inception to November 2018) and Cochrane databases, biographies, and conference proceedings. We used randomized clinical trials of patients who underwent surgical preparation of the vagina with antiseptic formulations before cesarean delivery with the aim of reducing the risk of infectious morbidity. Our systematic review was registered and followed the Preferred Reporting Items for Systematic Review and Meta-analysis Extension for network meta-analysis guidelines. Network meta-analysis was performed with computerized software and used user-written programs to assess consistency, inconsistency, ranking probabilities, and graphing results. Direct and indirect pairwise comparisons of the various formulations and their concentrations were performed with the use of multivariate random-effects models and metaregression. A frequentist inference method was employed for the fitted model to estimate the ranking probabilities. Subgroup analyses for patients in labor, not in labor, and with ruptured membranes were conducted. RESULTS: For the prevention of endometritis, we identified 23 studies that comprised 7097 women who were allocated to the following treatments: povidone-iodine (1%, 5%, 10%), chlorhexidine (0.2%, 0.4%), metronidazole gel, cetrimide, or normal saline solution/no treatment. Direct and indirect pairwise comparisons indicated that, when compared with saline solution or no treatment, all antiseptic formulations decreased rates of endometritis (5.2% vs 9.1%; odds ratio, 0.48; 95% confidence interval, 0.35-0.65; 22 studies/6994 women). Individually, povidone-iodine (odds ratio, 0.43; 95% confidence interval, 0.28-0.64; 16 studies/5968 women), cetrimide (odds ratio, 0.34; 95% confidence interval, 0.13-0.90; 1 study/200 women), and metronidazole (odds ratio, 0.38; 95% confidence interval, 0.16-0.90; 1 study/224 women) significantly reduced the risk of endometritis. Rankings of vaginal preparations indicated that povidone-iodine 1% had the highest probability (72.7%) of being the most effective treatment for the prevention of endometritis. For the secondary outcomes of postoperative wound infection and fever, a significant reduction was found only with povidone-iodine (odds ratio, 0.61; 95% confidence interval, 0.48-0.78; 16 studies/5968 women; and odds ratio, 0.58; 95% confidence interval, 0.40-0.83; 12 studies/4667 women). Subgroup analyses also found that povidone-iodine significantly reduced risk of endometritis for women in labor (odds ratio, 0.42; 95% confidence interval, 0.20-0.88; 5 studies/1211 women), with ruptured membranes(odds ratio, 0.21; 95% confidence interval, 0.10-0.44; 4 studies/476 women), and undergoing planned cesarean delivery (odds ratio, 0.39; 95% confidence interval, 0.27-0.57; 8 studies/1825 women). CONCLUSION: Among patients who underwent cesarean delivery, presurgical vaginal irrigation with povidone-iodine had the highest probability of reducing the risk of endometritis, postoperative wound infections, and fever.