Insulin Detemir Versus Glibenclamide in Gestational Diabetes Mellitus: A Retrospective Cohort Study.

BACKGROUND: Treatment of gestational diabetes mellitus (GDM) has been shown to improve both maternal and neonatal outcomes. For women with GDM who require glucose-lowering medication, insulin is regarded as the drug of choice by most medical societies. Oral therapy, with metformin or glibenclamide, is a reasonable alternative in certain medical circumstances. OBJECTIVES: To compare the efficacy and safety of insulin detemir (IDet) vs. glibenclamide for GDM when glycemic control cannot be achieved through lifestyle modification and diet. METHODS: We conducted a retrospective cohort analysis of 115 women with singleton pregnancy and GDM treated with IDet or glibenclamide. GDM was diagnosed via the two-step oral glucose tolerance test (OGTT) of 50 grams glucose, followed by 100 grams. Maternal characteristics and outcomes (preeclampsia and weight gain) and neonatal outcomes (birth weight and percentile, hypoglycemia, jaundice, and respiratory morbidity) were compared between groups. RESULTS: In total, 67 women received IDet and 48 glibenclamide. Maternal characteristics, weight gain, and the incidence of preeclampsia were similar in both groups. Neonatal outcomes were also similar. The proportion of large for gestational age (LGA) infants was 20.8% in the glibenclamide group compared to 14.9% in the IDet group (P = 0.04). CONCLUSIONS: In pregnant women with GDM, glucose control on IDet yielded comparable results as on glibenclamide, except for a significantly lower rate of LGA neonates.

The Impact of Total Deceleration Area and Fetal Growth on Neonatal Acidemia in Vacuum Extraction Deliveries.

We aimed to investigate the correlation between total deceleration area (TDA), neonatal birthweight and neonatal acidemia in vacuum extractions (VEs). This is a retrospective study in a tertiary hospital, including VE performed due to non-reassuring fetal heart rate (NRFHR). Electronic fetal monitoring during the 120 min preceding delivery was interpreted by two obstetricians who were blinded to neonatal outcomes. TDA was calculated as the sum of the area under the curve for each deceleration. Neonatal birthweights were classified as low (<2500 g), normal (2500-3999 g) or macrosomic (>4000 g). A total of 85 VEs were analyzed. Multivariable linear regression, adjusted for gestational age, nulliparity and diabetes mellitus, revealed a negative correlation between TDA in the 60 min preceding delivery and umbilical cord pH. For every 10 K increase in TDA, the cord pH decreased by 0.02 (p = 0.038; 95%CI, -0.05-0.00). The use of the Ventouse-Mityvac cup was associated with a 0.08 decrease in cord pH as compared to the Kiwi OmniCup (95%CI, -0.16-0.00; p = 0.049). Low birthweights, compared to normal birthweights, were not associated with a change in cord pH. To conclude, a significant correlation was found between TDA during the 60 min preceding delivery and cord pH in VE performed due to NRFHR.

Changes in maternal heart rate in delayed post-partum preeclampsia.

AIM: Delayed-onset postpartum preeclampsia (PET) is defined as a new diagnosis of preeclampsia presenting 48 h to 6 weeks postpartum. This disorder is infrequent and associated with a higher incidence of complications as compared to antepartum PET. There seems to be a need to further characterize this disorder. The aim of the study was to investigate the difference of maternal heart rate in women with delayed onset postpartum preeclampsia as compared to healthy controls. METHODS: The medical files of all women who were readmitted with delayed onset postpartum preeclampsia during 2014-2020 were reviewed. Data on maternal physiological characteristics were compared to healthy control group of women at the same post-partum day, with uncomplicated pregnancies. RESULTS: Included 45 women with the diagnosis of delayed onset of preeclampsia at 6.3 ± 2.86 post-partum day. As compared to controls (n = 49), women with delayed post-partum were older, 34.6 ± 5.4 vs. 32.3 ± 4.7 years, p = 0.003. There were no differences between groups regarding maternal gravidity, parity, BMI (kg/m2) or Hb level at delivery day. Women with delayed post-partum preeclampsia had lower mean pulse rate as compared to controls, 58 ± 15 bpm vs. 83 ± 11.6 bpm, respectively, P < 0.0001. Only 17% of the women in the delayed onset group had pulse rate above 70 bpm as compared to 83% in the control group. CONCLUSIONS: Maternal low heart rate in cases with delayed onset of post-partum preeclampsia is an important clinical characteristic that may reflect baroreceptors response to maternal hypertension.

The development of Hebrew zero and pronominal subject realization in the context of first and second person.

The study investigates the acquisition of Hebrew zero and pronominal subjects in the context of first and second person. We provide distributional evidence relative to verb tense, number, person, and conversational utterance type, in a peer-talk corpus (2;0-8;0 years). Findings show that acquisition starts early on, that verb inflectional morphology is crucial for the development of pronominal subjects, and that communicative contexts affect subject realization. Zero and pronominal subjects are not evenly distributed relative to the study variables, and cannot be treated as an alternation. A cluster analysis shows that each realization is linked to a distinguishable usage pattern, corresponding with particular discursive and communicative functions. These are defined as three Discourse Profile Constructions: (A) "calling for action" by 1st.Pl.Fut zero subjects (3;0 year olds); (B) "commenting on the interlocutor's actions" by 2nd.Sg.Past zero subjects (ages 4;0-6;0); and (C) "planning one's own actions" by 1st.Sg.Fut pronominal subjects (7;0-8;0 year olds).

Are There Similarities in Pregnancy Complications and Delivery Outcomes among Sisters?

This retrospective cohort study evaluated pregnancy outcomes and similarities between pairs of nulliparous sisters with a singleton fetus who delivered between 2013 and 2020. The "Sister-1 group" was defined as the sibling who delivered first, while the "Sister-2 group" included the siblings who gave birth after Sister-1. Obstetrical complications and delivery outcomes were compared. The relative risk for recurrence of a complication in Sister-2 was calculated. The study included 743 sister pairs. There were no between-group differences in maternal BMI, gestational age at delivery, gravidity, smoking, or epidural rates. The Sister-2 group was older than the Sister-1 group (26.4 ± 5 vs. 25.8 ± 4.7 years, respectively, p = 0.05). Higher birthweights and more large-for-gestational-age infants characterized the Sister-2 group compared with the Sister-1 group (3241 ± 485 g vs. 3148 ± 536 g, p < 0.001 and 7.7% vs. 4.8%, p = 0.025, respectively). There were no between-group differences in the rate of small-for-gestational-age, gestational diabetes, hypertensive disorders, pre-term births, vacuum extraction, or cesarean deliveries. Logistic regression analysis found that if Sister-1 underwent vacuum extraction, her sibling had an increased risk for vacuum delivery (adjusted RR 3.03, 95% CI 1.4−6.7; p = 0.003) compared with those whose sibling (Sister-1) did not. There was a three-fold risk of vacuum extraction delivery between sisters. This finding could be related to biological inheritance, environmental factors, and/or psychological issues that may affect similarities between siblings' delivery outcomes.

Physiological and psychological stress responses to labor and delivery during COVID-19 pandemic: a cohort study.

OBJECTIVE: To evaluate objective (saliva cortisol) and subjective (questionnaire) stress levels during the Coronavirus disease (COVID-19) pandemic compared to before the pandemic and their effects on obstetric and neonatal outcomes. METHODS: This cohort study included 36 women with low-risk, singleton, term deliveries at a tertiary academic center during the COVID-19 pandemic and 49 who delivered before. Physiological stress was evaluated with salivary cortisol measurements, and emotional stress with stress scale questionnaires (0-10) during active and full dilation stages of labor, and 2-min postpartum. Cord blood cortisol and pH were obtained. Delivery mode, complications, and neonatal outcomes were evaluated. RESULTS: Psychological stress was higher for the COVID-19 group compared to controls during full dilation (6.2 ± 3.4 vs. 4.2 ± 3, p = .009). The COVID-19 group had significantly lower cord cortisol levels (7.3 vs. 13.6 mcg/dl, p = .001). No differences were found regarding salivary cortisol level assessments at active, full dilation and 2-min post-delivery (p = .584, p = .254, p = .829, respectively). No differences were found regarding pH < 7.1 (p = .487), 1- and 5-min Apgar scores < 7 (p = .179) and neonatal weight (p = .958). CONCLUSIONS: Women who delivered during COVID-19 pandemic had higher stress levels at full dilation and lower cord cortisol levels, as may be expected after exposure to a chronic stressor.

Patterns of Adaptation in Child-Directed and Child Speech in the Emergence of Hebrew Verbs.

Children approach verb learning in ways that are specific to their native language, given the differential typological organization of verb morphology and lexical semantics. Parent-child interaction is the arena where children's socio-cognitive abilities enable them to track predictive relationships between tokens and extract linguistic generalizations from patterns and regularities in the ambient language. The current study examines how the system of Hebrew verbs develops as a network over time in early childhood, and the dynamic role of input-output adaptation in the network's increasing complexity. Focus is on the morphological components of Hebrew verbs in a dense corpus of two parent-child dyads in natural interaction between the ages 1;8-2;2. The 91-hour corpus contained 371,547 word tokens, 62,824 verb tokens, and 1,410 verb types (lemmas) in CDS and CS together. Network analysis was employed to explore the changing distributions and emergent systematicity of the relations between verb roots and verb patterns. Taking the Semitic root and pattern morphological constructs to represent linked nodes in a network, findings show that children's networks change with age in terms of node degree and node centrality, representing linkage level and construct importance respectively; and in terms of network density, as representing network growth potential. We put forward three main hypotheses followed by findings concerning (i) changes in verb usage through development, (ii) CS adaptation, and (iii) CDS adaptation: First, we show that children go through punctuated development, expressed by their using individual constructs for short periods of time, whereas parents' patterns of usage are more coherent. Second, regarding CS adaptation within a dynamic network system relative to time and CDS, we conclude that children are attuned to their immediate experience consisting of current CDS usage as well as previous usage in the immediate past. Finally, we show that parents (unintentionally) adapt to their children's language knowledge in three ways: First, by relating to their children's current usage. Second, by expanding on previous experience, building upon the usage their children have already been exposed to. And third, we show that when parents experience a limited network in the speech of their children, they provide them with more opportunities to expand their system in future interactions.

Intrahepatic cholestasis of pregnancy: machine-learning algorithm to predict elevated bile acid based on clinical and laboratory data.

PURPOSE: Applying machine-learning models to clinical and laboratory features of women with intrahepatic cholestasis of pregnancy (ICP) and creating algorithm to identify these patients without bile acid measurements. METHODS: This retrospective study included 336 pregnant women with a chief complaint of pruritis without rash during the second/third trimesters. Data extracted included: demographics, obstetric, clinical and laboratory features. The primary outcome was an elevated bile acid measurement ≥ 10 µmol/L, regardless of liver enzyme levels. We used different machine-learning models and statistical regression to predict elevated bile acid levels. RESULTS: Among 336 women who complained about pruritis, 167 had bile acids ≥ 10 µmol/L and 169 had normal levels. Women with elevated bile acids were older than those with normal levels (p = 0.001), higher parity (p = 0.001), and higher glutamic oxaloacetic transaminase ( GOT) (p = 0.001) and glutamic-pyruvic transaminase (GPT) levels (p = 0.001). Using machine-learning models, the XGB Classifier model was the most accurate (area under the curve (AUC), 0.9) followed by the K-neighbors model (AUC, 0.86); and then the Support Vector Classification (SVC) model (AUC, 0.82). The model with the lowest predicative ability was the logistic regression (AUC, 0.72). The maximum sensitivity of the XGB model was 86% and specificity 75%. The best predictive parameters of the XGB model were elevated GOT (Importance 0.17), elevated GPT (Importance 0.16), family history of bile disease (0.16) and previous pregnancy with ICP (0.13). CONCLUSION: Machine-learning models using clinical data may predict ICP more accurately than logistic regression does. Using detection algorithms derived from these techniques may improve identification of ICP, especially when bile acid testing is not available.

Morpho-Orthographic Complexity in Affix Spelling in Hebrew: A Novel Psycholinguistic Outlook Across the School Years.

The current study examined the factors underlying native Hebrew speakers' ability to learn homophonous affix spelling. It takes a novel view in investigating the effect of morpho-orthographic complexity of affix representation on the development of affix spelling across the school years. The role of five morpho-orthographic principles in homophonous affix letter spelling was studied: (i) morpho-orthographic transparency; (ii) affix letter prevalence; (iii) morpho-phonological competition; (iv) overtness of the phonological-orthographic link; and (v) phono-morpho-orthographic consistency. Taken together, these five principles of affix spelling constitute complexity metrics that pinpoint the loci of spelling challenge in homophonous Hebrew affixes. Study participants were 83 monolingual Hebrew-speaking students in four grade levels - 2nd, 4th, 7th, and 10th grades. The research instrument was a spelling task of 244 words containing affix letters in 57 morphological categories. The affixes appearing in the target words represented 56 different affix categories, covering all non-root morphological roles, both inflectional and derivational. While correct spelling increased across grade levels, a hierarchy emerged in interaction with grade level regarding these criteria: Younger spellers were mostly assisted by morpho-orthographic sites, morphological category frequency, and phonological transparency - while spelling in higher grade levels was more affected by morpho-orthographic prevalence. Thus, knowledge of how morphological roles are deployed in the orthography emerges as the most significant factor that affects learning to spell affix letters in Hebrew.

Input-output relations in Hebrew verb acquisition at the morpho-lexical interface.

This study examined early Hebrew verb acquisition, highlighting CDS-CS relations across inflectional and derivational verb learning. It was carried out on a corpus of longitudinal dense dyadic interactions of two Hebrew-speaking toddlers aged 1;8-2;2 and their parents. Findings revealed correlated patterns within and between CDS and CS corpora in terms of verbs, structural root categories, and their components (roots, binyan conjugations, and derivational verb families), and clear relations between lexical-derivational development and inflectional growth in input-output relations, measured by MSP. It also showed that both corpora had few, yet highly semantically coherent, derivational families. Lexical learning in Hebrew was shown to be morphologically oriented, with both inflectional and derivational learning supporting and being supported by the development of the verb lexicon. These findings support findings in the general literature regarding the close relationship between parental input and child speech, and the affinity between lexical and grammatical growth.

Can we predict the need for antihypertensive treatment during the early postpartum period for women with preeclampsia or gestational hypertension?

OBJECTIVES: To determine factors that predict the need for antihypertensive treatment during early postpartum period among women with preeclampsia or gestational hypertension. STUDY DESIGN: Retrospective cohort of 358 women. MAIN OUTCOME MEASURES: Demographic, clinical and laboratory data of 63 women diagnosed with preeclampsia or gestational hypertension during a singleton pregnancy and who needed antihypertensive agents during early postpartum period were compared to 295 who did not. RESULTS: No difference was found between groups regarding age, parity, body mass index, or weight gain (p = 0.95, 0.19, 0.56, and 0.078, respectively). Early onset preeclampsia or gestational hypertension was diagnosed among 28.6% of the women who subsequently needed antihypertensive treatment, as compared to 4.1% who did not (p < 0.001). Antepartum, mean maximum blood pressure in the treated vs. untreated group was 165/109 mmHg vs. 150/100 mmHg, respectively (p = 0.001). Groups did not differ regarding symptoms of preeclampsia (38.7% vs. 31.5%, p = 0.273) or laboratory abnormalities. The group that received antihypertensive treatment during early postpartum period, had more preterm deliveries (p < 0.001) and Cesarean deliveries (p < 0.001), and more received magnesium sulfate during labor (p < 0.001). During the early postpartum period, mean maximum blood pressure was higher among the treated group (167/106 vs. 143/92, p = 0.001), as were symptoms of preeclampsia (p = 0.001). The groups were similar regarding laboratory abnormalities that define preeclampsia. CONCLUSIONS: Early onset preeclampsia or gestational hypertension, severe antepartum hypertension, magnesium sulfate during labor, preterm, and Cesarean delivery might be good predictors of the need for antihypertensive treatment during early postpartum period.

Twin pregnancies and perinatal outcomes: a comparison between fresh and frozen embryo transfer: a two-centre study.

RESEARCH QUESTION: To assess the perinatal and obstetric outcomes of twin pregnancies resulting from IVF frozen embryo transfer (FET) in comparison with fresh embryo transfer. DESIGN: A retrospective cohort study of 773 twin pregnancies conceived via IVF treatment. Data were collected from the records of two outpatient fertility IVF clinics of cycles conducted between 2006 and 2016. RESULTS: A total of 773 pregnancies were evaluated: 614 (79.4%) following FET and 159 (20.6%) following fresh embryo transfer. The FET group had a significantly higher mean birthweight (P = 0.002), and lower rates of small for gestational age (P = 0.003), low (P = 0.003) and very low birthweight (P = 0.006) infants. Also, a significantly lower rate of spontaneous second trimester miscarriage compared with the fresh embryo transfer group was observed (P = 0.001). No significant difference was found between groups regarding gestational age at delivery, term birth (after 37 weeks of gestation), twin discordancy rate, fetal major malformation rate, and hospitalization duration. CONCLUSION: In twin pregnancies, FET might have better perinatal outcomes compared with fresh embryo transfer in regards to birthweight and spontaneous second trimester miscarriages. Further research is needed to evaluate these results.

Hebrew verbal passives in Later Language Development: the interface of register and verb morphology.

The current study examined the production of Hebrew verbal passives across adolescence as mediated by linguistic register and verb morphology. Participants aged eight to sixteen years and a group of adults were asked to change written active-voice sentences into corresponding passive-voice forms, divided by verb register (neutral and high), binyan pattern (Qal / Nif'al, Hif'il / Huf'al, and Pi'el / Pu'al), and verb tense (past and future tense). Results showed that Hebrew passive morphology is a very late acquisition, almost a decade later than in other languages, that passivizing neutral-register verbs was less challenging than high-register verbs, and that past tense verbs were easier to passivize than future tense verbs. An order of acquisition was determined among the three binyan pairs. The paper provides an account of these findings grounded in the event-telling role of Hebrew passives in discourse and the spurt of abstract, lexically specific vocabulary in Later Language Development.

Patients with high-risk pregnancies and complicated deliveries have an increased risk of maternal postpartum readmissions.

OBJECTIVE: Postpartum readmission after initial hospitalization for delivery can be diminished if better understood. The aim of this study was to determine the risk factors and indications for maternal re-hospitalization after delivery, in order to identify preventable factors. STUDY DESIGN: This was a case control study based on retrospective cohort of patients who delivered at our institution. The patients that were readmitted within 2 weeks of their delivery were included in the study group while the control group was conducted from patients who delivered at the same time but were not re-hospitalized and included twice the number of patients. Demographic characteristics as well as pregnancy, labour and postpartum courses were compared between the two groups. RESULTS: A total of 227 women were re-hospitalized within 14 days after initial discharge. The control group consisted of 450 women. The demographic characteristics were similar among the two groups, so were the rates of obesity, gestational weight gain and smoking. The major indication for readmission was postpartum infections, most of which were not related to immediate postpartum febrile morbidity. Emergency cesarean section was found to be an independent risk factor for readmission. CONCLUSIONS: The rate of patients with high-risk pregnancies and complicated deliveries is higher among postpartum maternal readmissions. These data might suggest more cautious postpartum care for those patients.

Morphological processing in Hebrew-speaking students with reading disabilities.

Marking number/gender agreement on Hebrew adjectives is a case in point: It is a challenging task requiring lexical and grammatical insight, a well-known source of processing errors in Hebrew usage. The current study examined impaired processing of noun and adjective inflection in adult speakers of Hebrew with dyslexia. Thirty normally reading university students, 30 university students with dyslexia, and 30 normally reading sixth-grade students were administered a production task on noun-adjective pluralization. Accuracy of noun form and adjective agreement were measured, as well as reaction time to producing the whole plural noun phrase. Of interest was the contrast between forms involving a stem change and forms taking a predictable (regular) versus idiosyncratic (irregular) suffix. The study found that individuals with dyslexia tended to be slower and less accurate overall, though the extent of this impairment was somewhat more pronounced for irregular forms and forms involving a stem change. Performance was also compared to younger controls (sixth graders) and indicated ways in which these deficits could versus could not be explained by their relative reading experience.

Phono-morpho-orthographic construal: the view from spelling.

A spelling model which has evolved in the parallel universe of spelling research resonates with Frost's reading model. Like reading, spelling cannot be based solely on phonology or orthography, but should accommodate all linguistic facets. The cognitive domain of spelling does not take place at the level of single grapheme or phoneme or syllable, but rather, at the lexical level.

Children's command of plural and possessive marking on Hebrew nouns: a comparison of obligatory versus optional inflections.

We compare learning of two inflection types - obligatory noun plurals and optional noun possessives. We tested 107 Hebrew-speaking children aged 6-7 on the same tasks at the beginning and end of first grade. Performance on both constructions improved during this short period, but plurals scored higher from the start, with improvement only in changing stems. The main remaining challenge in mastering noun plural marking in grade school is thus to learn the various types of stem changes. In contrast, possessives improved across the board in first grade, with higher success on non-changing stems and first person suffixes respectively. This intense gain in first grade occurs when children learn to read and write and turn to the written modality as their main source of linguistic input. The study thus testifies to the impact of the shift from spoken language to the 'language of literacy' on children's construal of Hebrew morphology.

Prosodic patterns in Hebrew child-directed speech.

The study examines prosodic characteristics of Hebrew speech directed to children between 0 ; 9-3 ; 0 years, based on longitudinal samples of 228,946 tokens (8,075 types). The distribution of prosodic patterns - the number of syllables and stress patterns - is analyzed across three lexical categories, distinguishing not only between open- and closed-class items, but also between these two categories and a third, innovative, class, referred to as between-class items. Results indicate that Hebrew CDS consists mainly of mono- and bisyllabic words, with differences between lexical categories; and that the most common stress pattern is word-final, with parallel distributions found for all categories. Additional analyses showed that verbs take word-final stress, but nouns are both trochaic and iambic. Finally, a developmental analysis indicates a significant increase in the number of iambic words in CDS. These findings have clear implications regarding the use of prosody for word segmentation and assignment of lexical class in infancy.