Differing risk factors for new onset and recurrent gestational diabetes mellitus in multipara women: a cohort study

Objectives To assess whether recurrent gestational diabetes mellitus (GDM) and newly diagnosed GDM share similar risk factors. Methods The study recruited a cohort of 10,151 multipara women with singleton pregnancy who delivered between 2016 and 2019 in Beijing, China. The prevalence of recurrent GDM and associated risk factors were analyzed between women with and without prior GDM history. Results Eight hundred and seventy-five (8.6%) multipara women had a diagnosis of GDM during previous pregnancies. The prevalence of GDM and pre-gestational diabetes mellitus were 48.34% (423/875) and 7.89% (69/875) if the women were diagnosed with GDM during previous pregnancies, as compared to 16.00% (1484/9276) and 0.50% (46/9276) if the women were never diagnosed with GDM before. In women without a history of GDM, a variety of factors including older maternal age, higher pre-pregnancy body mass index (PPBMI), prolonged interval between the two pregnancies, higher early pregnancy weight gain, family history of type 2 diabetes mellitus (T2DM), maternal low birth weight, and higher early pregnancy glycemic and lipid indexes were generally associated with an increased risk of GDM at subsequent pregnancy. In women with a history of GDM, higher PPBMI, higher fasting glucose level and maternal birthweight ≥4000 g were independent risk factors for recurrent GDM. Conclusions GDM reoccurred in nearly half of women with a history of GDM. Risk factors for recurrent GDM and newly diagnosed GDM were different. Identifying additional factors for GDM recurrence can help guide clinical management for future pregnancies to prevent GDM recurrence.

Stillbirth and neonatal mortality in a subsequent pregnancy following stillbirth: a population-based cohort study

Background A history of stillbirth is a risk factor for recurrent fetal death in a subsequent pregnancy. Reported risks of recurrent fetal death are often not stratified by gestational age. In subsequent pregnancies increased rates of medical interventions are reported without evidence of perinatal benefit. The aim of this study was to estimate gestational-age specific risks of recurrent stillbirth and to evaluate the effect of obstetrical management on perinatal outcome after previous stillbirth. Methods A retrospective cohort study in the Netherlands was designed that included 252.827 women with two consecutive singleton pregnancies (1st and 2nd delivery) between 1999 and 2007. Data was obtained from the national Perinatal Registry and analyzed for pregnancy outcomes. Fetal deaths associated with a congenital anomaly were excluded. The primary outcome was the occurrence of stillbirth in the second pregnancy stratified by gestational age. Secondary outcome was the influence of obstetrical management on perinatal outcome in a subsequent pregnancy. Results Of 252.827 first pregnancies, 2.058 pregnancies ended in a stillbirth (8.1 per 1000). After adjusting for confounding factors, women with a prior stillbirth have a two-fold higher risk of recurrence (aOR 1.96, 95% CI 1.07–3.60) compared to women with a live birth in their first pregnancy. The highest risk of recurrence occurred in the group of women with a stillbirth in early gestation between 22 and 28 weeks of gestation (a OR 2.25, 95% CI 0.62–8.15), while after 32 weeks the risk decreased. The risk of neonatal death after 34 weeks of gestation is higher in women with a history of stillbirth (aOR 6.48, 95% CI 2.61–16.1) and the risk of neonatal death increases with expectant obstetric management (aOR 10.0, 95% CI 2.43–41.1). Conclusions A history of stillbirth remains an important risk for recurrent stillbirth especially in early gestation (22–28 weeks). Women with a previous stillbirth should be counselled for elective induction in the subsequent pregnancy at 37–38 weeks of gestation to decrease the risk of perinatal death.

Pregnancy-related claustrophobia

A 35-year-old primigravida presented with significant anxiety symptoms at 26 weeks’ gestation. Symptoms were preceded by a nightmare about her upcoming labour. She developed repetitive intrusive thoughts of being trapped emotionally and physically in her pregnancy. Her symptoms were suggestive of new-onset claustrophobia associated with pregnancy, which has not been previously reported on. Her symptoms ameliorated with a combination of cognitive–behavioural therapy and pharmacotherapy (sertraline and low dose quetiapine). The later stages of pregnancy were associated with minimal symptoms and the resolution of her subjective ‘entrapment’. A subsequent pregnancy resulted in similar although less severe symptomatology. No postpartum anxiety symptoms were demonstrated on both occasions. Anxiety symptoms can adversely impact both the mother and fetus, and thus correct identification and management of pregnancy-related claustrophobia improved symptomatology and functioning and allowed for earlier detection and reduced symptomatology in a subsequent pregnancy.

Disease-severity in subsequent pregnancies with RhD immunization: a nationwide cohort

OBJECTIVE(S): to evaluate the severity of HDFN in subsequent pregnancies with RhD immunization and to identify predictive factors for severe disease. DESIGN: prospective cohort. SETTING: the Netherlands. POPULATION: nationwide selection of all pregnant women with RhD antibodies. METHODS: women with two subsequent RhD immunized pregnancies with RhD-positive children after antibodies were detected were included. MAIN OUTCOME MEASURE: the severity of HDFN in the first and subsequent pregnancy at risk. RESULTS: 62 RhD immunized women with a total of 150 RhD-positive children were included. The severity of HDFN increased significantly in the subsequent pregnancy (P<.001), although it remained equal or even decreased in 44% of women. When antibodies were already detected at first trimester screening in the first immunized pregnancy, severe HDFN in the next pregnancy was uncommon (22%), especially when no therapy or only non-intensive phototherapy was indicated during the first pregnancy (6%), or if the ADCC result remained <10%. Contrarily, women with antibodies detected during the first pregnancy of a RhD positive child (>= 27th week), most often before they had ever received RhIg prophylaxis, were most prone for severe disease in a subsequent pregnancy (48%). CONCLUSION(S): RhD-mediated HDFN in a subsequent pregnancy is generally more severe than in the first pregnancy at risk and can be estimated using moment of antibody detection and severity in the first immunized pregnancy. Women developing antibodies in their first pregnancy of a RhD-positive child are at highest risk of severe disease in the next pregnancy.

Postpartum Weight Change in Relation to Pre-Pregnancy Weight and Gestational Weight Gain in Women in Low-Income Setting: Data from the KITE Cohort in the Northern Part of Ethiopia

(1) Background: Postpartum weight may increase compared to pre-pregnancy due to weight retention or decrease due to weight loss. Both changes could pose deleterious effects on maternal health and subsequent pregnancy outcomes. Therefore, this study aimed to assess postpartum weight change and its associated factors. (2) Methods: A total of 585 women from the KIlte-Awlaelo Tigray Ethiopia (KITE) cohort were included in the analysis. (3) Results: The mean pre-pregnancy body mass index and weight gain during pregnancy were 19.7 kg/m2 and 10.8 kg, respectively. At 18 to 24 months postpartum, the weight change ranged from −3.2 to 5.5 kg (mean = 0.42 kg [SD = 1.5]). In addition, 17.8% of women shifted to normal weight and 5.1% to underweight compared to the pre-pregnancy period. A unit increase in weight during pregnancy was associated with higher weight change (β = 0.56 kg, 95% CI [0.52, 0.60]) and increased probability to achieve normal weight (AOR = 1.65, 95% CI [1.37, 2.00]). Food insecurity (AOR = 5.26, 95% CI [1.68, 16.50]), however, was associated with a shift to underweight postpartum. Interestingly, high symptoms of distress (AOR = 0.13, 95% CI [0.03, 0.48]) also negatively impacted a change in weight category. (4) Conclusions: In low-income settings such as northern Ethiopia, higher weight gain and better mental health during pregnancy may help women achieve a better nutritional status after pregnancy and before a possible subsequent pregnancy.

Survival of Women Previously Diagnosed of Melanoma with Subsequent Pregnancy: A Systematic Review and Meta-Analysis and a Single-Center Experience

Melanoma incidence has increased over the last few decades. How the prognosis of a previously diagnosed melanoma may be affected by a woman’s subsequent pregnancy has been debated in the literature since the 1950s, and the outcomes are essential to women who are melanoma survivors in their childbearing years. The main objective of this systematic review is to improve the understanding of whether the course of melanoma in a woman may be altered by a subsequent pregnancy and to help clinicians’ diagnosis. Eligible studies for the systematic review were clinical trials, observational cohort studies and case-control studies that compared prognosis outcomes for non-pregnant patients with melanoma, or pregnant before melanoma diagnosis, versus pregnant patients after a diagnosis of melanoma. The search strategy yielded 1101 articles, of which 4 met the inclusion criteria for the systematic review. All the studies were retrospective non-randomised cohorts with patients with melanomas diagnosed before pregnancy. According to our findings, a subsequent pregnancy was not a significant influence on the outcome of a previous melanoma. However, given the small number of identified studies and the heterogeneous data included, it is recommended to approach these patients with caution, and counselling should be given by known prognostic factors. We also reviewed the medical records of 84 patients of childbearing age (35.8 ± 6.3 years, range 21–45 years) who were diagnosed with cutaneous invasive melanoma in our hospital between 2008 and 2018 (N = 724). Of these, 11 (13.1%) had a pregnancy after melanoma diagnosis (age at pregnancy: 35.6 ± 6.3 years). No statistical differences in outcome were detected.

Clinical characteristics, predictors and pregnancy outcomes in Indian women with peripartum cardiomyopathy

Background Predictors, pregnancy and subsequent pregnancy outcomes in women with peripartum cardiomyopathy (PPCM) are poorly understood in our geographical region. Methods We retrospectively analysed 58 women with PPCM diagnosed using criteria by the European Society of Cardiology during 2015 to 2019. The main outcome measures were predictors of left ventricular (LV) recovery. LV recovery was defined as return of LV ejection fraction to over 50%. Results Nearly 80% of women had LV recovery during 6 months follow up. Univariate logistic regression revealed LV end diastolic diameter (adjusted odds ratio (OR); 0.87; 95% CI, 0.78–0.98; p = 0.02), LV end systolic diameter (OR; 0.89; 95% CI, 0.8–0.98; p = 0.02) and inotrope use (OR; 0.2, 95% CI, 0.05–0.7; p = 0.01) as predictors of LV recovery. Relapse was not seen in any of the nine women who had a subsequent pregnancy. Conclusion LV recovery was higher than those reported in contemporary PPCM cohorts from other parts of the world.

The effects of precisely meeting estimated daily energy and lysine requirements for gestating sows over three consecutive pregnancies on sow reproductive and lactation performance

The objective of the current study was to determine effects of precisely meeting estimated daily energy and Lys requirements for gestating sows over three consecutive pregnancies on sow reproductive and lactation performance. A total of 105 sows (initial reproductive cycle 1.4±0.5) were randomly assigned to a precision (PF; n=50) or control (CON; n=55) feeding program between d 2 and 9 of gestation and housed in group-pens equipped with electronic sow feeders capable of blending two diets. The PF sows received unique daily blends of two isocaloric diets [2518 kcal/kg NE; 0.80 and 0.20% standardized ileal digestible (SID) Lys, respectively] while CON sows received a static blend throughout gestation to achieve 0.56% SID Lys. After weaning, sows were re-bred and entered the same feeding program as in the previous pregnancy for two subsequent pregnancy cycles (PF: n=36; CON: n=37; average reproductive cycle: 2.4±0.5; PF: n=25; CON: n=24; average reproductive cycle: 3.5±0.5). Sows on the PF program received 97, 105, and 118 % (average over three pregnancy cycles) of dietary energy and 67, 79, and 106 % of SID Lys intakes compared to CON between d 5 and 37, 38 and 72, and 73 and 108 of gestation, respectively. Estimated N (26.1 %) retention did not differ between gestation feeding programs in any pregnancy, but excess N excretion was less (1617 vs. 1750 ± 54 g/sow; P &lt; 0.01) for PF versus CON sows. Regardless of pregnancy cycle, sows that received the PF program had greater ADG between d 38 and 72 (614 vs. 518 ± 63 g/d; P &lt; 0.05) and between d 73 and 108 (719 vs. 618 ± 94 g/d; P = 0.063) of gestation, and greater loin depth gain between d 63 and 110 of gestation (0.7 vs. -1.1 ± 1.6 mm; P &lt; 0.05), but BW (235.1 kg) and backfat (17.8 mm) and loin (70.5 mm) depths on d 110 of gestation did not differ. The number of piglets born alive, stillborn, and mummified, and litter birth weight (16.5 kg) did not differ in any pregnancy cycle, nor did piglet ADG during lactation (250 g/d) and piglet BW (6.7 kg) at weaning. Sows that received the PF program during gestation had lower ADFI during lactation (5.7 vs. 6.2 ± 0.2 kg; P &lt; 0.01). Therefore, using feeding programs that precisely match estimated daily energy and Lys requirements for gestating sows provides the opportunity to reduce N losses to the environment and reduce lactation feed usage, without negatively affecting sow reproductive and lactation performance.