scholarly journals The Association between Glucose Levels and Adverse Pregnancy Outcomes in Nondiabetic Twin Pregnancies

2020 ◽  
Vol 10 (03) ◽  
pp. e217-e223
Author(s):  
Kevin Cheung ◽  
Nathan S. Fox
Keyword(s):  
Cesarean Delivery ◽  
Pregnancy Outcomes ◽  
Adverse Pregnancy Outcomes ◽  
Adverse Outcomes ◽  
Neonatal Hypoglycemia ◽  
Glucose Levels ◽  
Increased Risk ◽  
Adverse Pregnancy ◽  
Maternal Glucose Levels ◽  
Twin Pregnancies

Abstract Objective The aim of this study is to determine if hyperglycemia in twin pregnancies without gestational diabetes mellitus (GDM) is associated with an increased risk of adverse pregnancy outcomes. Study Design Retrospective cohort study of twin pregnancies in a single Maternal–Fetal Medicine practice between 2005 and 2019 who underwent two-step GDM screening at 24 to 28 weeks. We excluded women with pregestational or gestational diabetes. We examined the association between maternal glycemia and adverse pregnancy outcomes. Glycemia was defined as the 1-hour GCT in all women, and each of the four values of the 3-hour OGTT in women who failed the GCT (≥130 mg/dL). Primary outcomes were preeclampsia, cesarean delivery, and neonatal hypoglycemia in either twin. Statistical tests used included Pearson's correlation, Student's t-test, Mann–Whitney U test, Chi-square test for trend, and logistic regression. Results A total of 847 women underwent a GCT and 246 women underwent an OGTT. Increasing maternal glucose levels had no positive association with adverse outcomes. Women with preeclampsia, cesarean delivery, and neonatal hypoglycemia did not have higher mean GCT or OGTT values than women without these outcomes. There was no increased risk of adverse outcomes with increasing quartiles of the GCT or OGTT values. Conclusion In women with twin pregnancies without GDM, elevated maternal glucose levels are not associated with preeclampsia, cesarean delivery, or neonatal hypoglycemia. The altered physiology of twin gestations may modify the effect of maternal hyperglycemia on perinatal outcomes as compared with singleton pregnancies. Current approaches to screening for and treating GDM during pregnancy might not adequately account for these unique considerations among twins.

The Effect of Treated Overt Hypothyroidism on Outcomes in Twin Pregnancies

2017 ◽  
Vol 34 (14) ◽  
pp. 1447-1450
Author(s):  
Nathan Fox ◽  
Daniel Saltzman ◽  
Andrei Rebarber ◽  
Simi Gupta ◽  
Jonathan Rosner
Keyword(s):  
Pregnancy Outcomes ◽  
Adverse Pregnancy Outcomes ◽  
Adverse Outcomes ◽  
Overt Hypothyroidism ◽  
Thyroid Function Tests ◽  
Spontaneous Preterm Birth ◽  
Increased Risk ◽  
Adverse Pregnancy ◽  
Twin Pregnancies

Objective The objective of this study was to determine if treatment of overt hypothyroidism in twin pregnancies reduces adverse outcomes associated with overt hypothyroidism in pregnancy. Methods This is a retrospective cohort study of all patients who were presented with twin gestations between 2005 and 2013 to a single obstetrical practice. Patients who were diagnosed with overt hypothyroidism were identified. Patients were followed up with serial thyroid function tests and treated appropriately. Rates of adverse pregnancy outcomes were compared between patients with and without hypothyroidism with p < 0.05 used for significance. Results In this study, 612 twin pregnancies were included; 85 patients were diagnosed with overt hypothyroidism. Patients with overt hypothyroidism were more likely to have had in vitro fertilization (78 vs. 62%; p < 0.01). After adjusting for confounding variables, patients with overt hypothyroidism had no increased risk of spontaneous preterm birth < 37 weeks' gestation (adjusted odds ratio [aOR]: 0.833; 95% confidence interval [CI]: 0.498–1.393), intrauterine growth restriction (aOR: 0.720; 95% CI: 0.446–1.163), gestational diabetes (aOR: 0.812; 95% CI: 0.353–1.871), or composite adverse outcomes (aOR: 0.659; 95% CI 0.391–1.111) compared with patients who did not have overt hypothyroidism. There was a trend toward decreased hypertensive disorders of pregnancy (aOR: 0.470; 95% CI: 0.234–0.944). Conclusion Our study shows that in twin gestations, there is no increased risk of adverse pregnancy outcomes between patients with treated overt hypothyroidism and those without overt hypothyroidism.

scholarly journals Low-dose aspirin for primary prevention of adverse pregnancy outcomes in twin pregnancies: an observational cohort study based on propensity score matching

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ying Ye ◽  
Li Wen ◽  
Xiyao Liu ◽  
Lan Wang ◽  
Yamin Liu ◽  
...  
Keyword(s):  
Pregnancy Outcomes ◽  
Postpartum Hemorrhage ◽  
Low Dose ◽  
Adverse Pregnancy Outcomes ◽  
Clinical Trial Registry ◽  
Dose Aspirin ◽  
Increased Risk ◽  
Low Dose Aspirin ◽  
Adverse Pregnancy ◽  
Twin Pregnancies

Abstract Background Since the effectiveness of low-dose aspirin (LDA) in twin pregnancies is uncertain, we aimed to preliminarily assess whether LDA is beneficial in preventing preeclampsia in twin pregnancies. Methods This study is an observational study in two hospitals in China. Among 932 women, 277 in the First Affiliated Hospital of Chongqing Medical University were routinely treated with aspirin (100 mg daily) from 12 to 16 weeks to 35 weeks of gestational age, while 655 in Chongqing Health Center for Women and Children were not taking aspirin during pregnancy. We followed each subject and the individual details were recorded. Results LDA significantly reduced the risk of preeclampsia (RR 0.48; 95% CI 0.24–0.95) and preterm birth 34 weeks (RR 0.50; 95% CI 0.29–0.86) and showed possible benefits to lower the rate of SGA babies (RR 0.74; 95% CI 0.55–1.00). Moreover, the risk of postpartum hemorrhage was not increased by LDA (RR 0.89; 95% CI 0.35–2.26). Conclusions Treatment with low-dose aspirin in twin pregnancies could offer some protection against adverse pregnancy outcomes in the absence of significantly increased risk of postpartum hemorrhage. Trial registration Chinese Clinical Trial Registry (ChiCTR); ChiCTR-OOC-16008203, Retrospectively registered date: April 1st, 2016;

scholarly journals Prediction of adverse pregnancy outcomes by extreme values of first trimester screening markers

2017 ◽  
Vol 10 (3) ◽  
pp. 132-137 ◽  
Author(s):  
Marina S Gomes ◽  
Mariana Carlos-Alves ◽  
Vera Trocado ◽  
Diana Arteiro ◽  
Paula Pinheiro
Keyword(s):  
Pregnancy Outcomes ◽  
Extreme Values ◽  
Protein A ◽  
First Trimester ◽  
Adverse Pregnancy Outcomes ◽  
Adverse Outcomes ◽  
Increased Risk ◽  
Trimester Screening ◽  
Adverse Pregnancy ◽  
Β Hcg

Background To determine the association between extreme values of first trimester markers and adverse pregnancy outcomes. Methods A retrospective cohort study of 916 women who underwent first-trimester combined screening during 2015 was performed. Extreme values of NT, pregnancy-associated plasma protein-A (PAPP-A) and free β-hCG, and their association with adverse pregnancy outcomes were analyzed. Results Low PAPP-A (<10th percentile) was associated with an increased risk for preeclampsia (adjusted odds ratio (AOR) 4.13), fetal growth restriction (AOR 3.94) and abruptio placentae (AOR 52.63). Abnormally low or high free β-hCG, high PAPP-A or increased NT was not associated with an increased risk for adverse outcomes. Discussion PAPP-A <10th percentile could be associated with an increased risk for adverse outcomes. However, the majority of patients with these events do not have abnormal PAPP-A and few patients with PAPP-A <10th percentile will have an adverse outcome.

The Need for Personalized Risk-Stratified Approaches to Treatment for Gestational Diabetes: A Narrative Review

2021 ◽  
Author(s):  
Shamil D. Cooray ◽  
Jacqueline A. Boyle ◽  
Georgia Soldatos ◽  
Shakila Thangaratinam ◽  
Helena J. Teede
Keyword(s):  
Gestational Diabetes ◽  
Pregnancy Outcomes ◽  
Population Based ◽  
Adverse Pregnancy Outcomes ◽  
Therapeutic Interventions ◽  
Clinical Prediction Model ◽  
Increased Risk ◽  
Adverse Pregnancy ◽  
The Individual ◽  
Personalized Risk

AbstractGestational diabetes mellitus (GDM) is common and is associated with an increased risk of adverse pregnancy outcomes. However, the prevailing one-size-fits-all approach that treats all women with GDM as having equivalent risk needs revision, given the clinical heterogeneity of GDM, the limitations of a population-based approach to risk, and the need to move beyond a glucocentric focus to address other intersecting risk factors. To address these challenges, we propose using a clinical prediction model for adverse pregnancy outcomes to guide risk-stratified approaches to treatment tailored to the individual needs of women with GDM. This will allow preventative and therapeutic interventions to be delivered to those who will maximally benefit, sparing expense, and harm for those at a lower risk.

scholarly journals Assessing the relationship between pregravid body mass index and risk of adverse maternal pregnancy and neonatal outcomes: prospective data in Southwest China

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yue Chen ◽  
Ke Wan ◽  
Yunhui Gong ◽  
Xiao Zhang ◽  
Yi Liang ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Cesarean Delivery ◽  
Body Mass ◽  
Gestational Age ◽  
Pregnancy Outcomes ◽  
Maternal Age ◽  
Southwest China ◽  
Adverse Pregnancy Outcomes ◽  
Relative Importance ◽  
Adverse Pregnancy

AbstractThe relevance of pregestational body mass index (BMI) on adverse pregnancy outcomes remained unclear in Southwest China. This study aimed to investigate the overall and age-category specific association between pre-gestational BMI and gestational diabetes mellitus (GDM), preeclampsia, cesarean delivery, preterm delivery, stillbirth, macrosomia, and small-for-gestational age (SGA) or large-for-gestational age (LGA) neonates in Southwest China. Furthermore, it explores the relative importance of influence of pregravid BMI and maternal age on pregnancy outcomes. 51,125 Chinese singleton pregnant women were recruited as study subjects. Multiple logistic regression models were used to examine the influence of pre-pregnancy BMI on adverse pregnancy outcomes. Gradient boosting machine was used to evaluate the relative importance of influence of pregravid BMI and maternal age on pregnancy outcomes. It is found that women who were overweight or obese before pregnancy are at higher risk of adverse pregnancy outcomes except for SGA neonates, while pre-pregnancy underweight is a protective factor for GDM, preeclampsia, cesarean delivery, macrosomia and LGA, but not SGA. Younger mothers are more susceptible to GDM and macrosomia neonates, while older mothers are more prone to preeclampsia. Pre-pregnancy BMI has more influence on various pregnancy outcomes than maternal age. To improve pregnancy outcomes, normal BMI weight as well as relatively young maternal ages are recommended for women in child-bearing age.

Maternal educational inequalities about adverse pregnancy outcomes observed in a rural area of a province of China during a time period (2010–2018)

2022 ◽  
pp. jech-2021-217754
Author(s):  
Lixin Li ◽  
Yanpeng Wu ◽  
Yao Yang ◽  
Ying Wu ◽  
Yan Zhuang ◽  
...  
Keyword(s):  
Pregnancy Outcomes ◽  
Maternal Education ◽  
Rural China ◽  
Education Level ◽  
Adverse Pregnancy Outcomes ◽  
Secondary Outcome ◽  
Health Examination ◽  
Educational Inequalities ◽  
Increased Risk ◽  
Adverse Pregnancy

BackgroundThe relationship between maternal education and adverse pregnancy outcomes is well documented. However, limited research has investigated maternal educational disparities in adverse pregnancy outcomes in China. This study examined maternal educational inequalities associated with adverse pregnancy outcomes in rural China.MethodsWe conducted a population-based cohort study using participants enrolled in the National Free Preconception Health Examination Project in Yunnan province from 2010 to 2018. The primary outcome was stillbirth, and the secondary outcome was adverse pregnancy outcomes, defined as a composite event of stillbirth, preterm birth or low birth weight. The study was restricted to singleton births at 20–42 weeks’ gestation. Univariate and multivariate log-binomial regression models were performed to estimate crude risk ratios (RRs) and confounding-adjusted RRs (ARRs) for stillbirth and adverse pregnancy outcomes according to maternal education level.ResultsA total of 197 722 singleton births were included in the study. Compared with mid-educated women, low-educated women were at a significantly increased risk of stillbirth (ARR, 1.20; 95% CI, 1.05 to 1.38) and adverse pregnancy outcomes (ARR, 1.11; 95% CI, 1.07 to 1.16). However, the risk of stillbirth (ARR, 1.16; 95% CI, 1.01 to 1.35) was significantly higher for high-educated women compared with mid-educated women.ConclusionCompared with women with medium education level, women with lower education level were more likely to experience adverse pregnancy outcomes, including stillbirth, and women with higher education level were more likely to experience stillbirth.

scholarly journals Interpregnancy Body Mass Index Changes: Distribution and Impact on Adverse Pregnancy Outcomes in the Subsequent Pregnancy

2018 ◽  
Vol 36 (05) ◽  
pp. 517-521 ◽  
Author(s):  
Whitney Bender ◽  
Adi Hirshberg ◽  
Lisa Levine
Keyword(s):  
Body Mass Index ◽  
Preterm Birth ◽  
Body Mass ◽  
Pregnancy Outcomes ◽  
Subsequent Pregnancy ◽  
Adverse Pregnancy Outcomes ◽  
Increased Risk ◽  
History Of ◽  
Index Changes ◽  
Adverse Pregnancy

Objective To examine the change in body mass index (BMI) categories between pregnancies and its effect on adverse pregnancy outcomes. Study Design We performed a retrospective cohort study of women with two consecutive deliveries from 2005 to 2010. Analysis was limited to women with BMI recorded at <24 weeks for both pregnancies. Standard BMI categories were used. Adverse pregnancy outcomes included preterm birth at <37 weeks, intrauterine growth restriction (IUGR), pregnancy-related hypertension, and gestational diabetes mellitus (GDM). Women with increased BMI category between pregnancies were compared with those who remained in the same BMI category. Results In total, 537 women were included, of whom 125 (23%) increased BMI category. There was no association between increase in BMI category and risk of preterm birth, IUGR, or pregnancy-related hypertension. Women who increased BMI category had an increased odds of GDM compared with women who remained in the same BMI category (6.4 vs. 2.2%; p = 0.018). The increased risk remained after controlling for age, history of GDM, and starting BMI (adjusted odds ratio: 8.2; 95% confidence interval: 2.1–32.7; p = 0.003). Conclusion Almost one-quarter of women increased BMI categories between pregnancies. This modifiable risk factor has a significant impact on the risk of GDM.

scholarly journals Impact of Wildfire Smoke on Adverse Pregnancy Outcomes in Colorado, 2007–2015

2019 ◽  
Vol 16 (19) ◽  
pp. 3720 ◽  
Author(s):  
Mona Abdo ◽  
Isabella Ward ◽  
Katelyn O’Dell ◽  
Bonne Ford ◽  
Jeffrey Pierce ◽  
...  
Keyword(s):  
Birth Weight ◽  
Pregnancy Outcomes ◽  
Gestational Hypertension ◽  
Adverse Pregnancy Outcomes ◽  
Adverse Outcomes ◽  
Wildfire Smoke ◽  
Secondary Outcomes ◽  
Adverse Pregnancy ◽  
The Impact ◽  
Zip Code

Colorado is regularly impacted by long-range transport of wildfire smoke from upwind regions. This smoke is a major source of ambient PM2.5. Maternal exposure to total PM2.5 during pregnancy has been linked to decreased birth weight and other adverse outcomes, although the impact of wildfire smoke contribution has only recently been investigated. The objective of this study was to estimate associations between adverse pregnancy outcomes and ambient wildfire smoke PM2.5. Wildfire smoke PM2.5 exposures were estimated using a previously published method incorporating ground-based monitors and remote sensing data. Logistic regression models stratified by ZIP code and mixed models with random intercept by ZIP code were used to test for associations. The primary outcomes of interest were preterm birth and birth weight. Secondary outcomes included gestational hypertension, gestational diabetes, neonatal intensive care unit admission, assisted ventilation, small for gestational age, and low birth weight. Exposure to wildfire smoke PM2.5 over the full gestation and during the second trimester were positively associated with pre-term birth (OR = 1.076 (μg/m3)−1 [95% CI = 1.016, 1.139; p = 0.013] and 1.132 (μg/m3)−1 [95% CI = 1.088, 1.178]; p < 0.0001, respectively), while exposure during the first trimester was associated with decreased birth weight (−5.7 g/(μg/m3) [95% CI: −11.1, −0.4; p = 0.036]). Secondary outcomes were mixed.

scholarly journals Predicting pregnancy outcomes from homocysteine level: an evidence from a North Indian study

2020 ◽  
Vol 9 (4) ◽  
pp. 1487
Author(s):  
Shaina Chamotra ◽  
Kushla Pathania ◽  
S. K. Verma ◽  
Ankit Chaudhary
Keyword(s):  
Pregnancy Outcomes ◽  
Homocysteine Level ◽  
Perinatal Outcomes ◽  
Normal Subjects ◽  
Adverse Pregnancy Outcomes ◽  
Intrauterine Death ◽  
Increased Risk ◽  
Causal Pathway ◽  
Mother And Child ◽  
Adverse Pregnancy

Background: Hypertensive disorders of pregnancy are a major cause of adverse pregnancy outcomes. Though the etiology of spectrum of vascular disorders of pregnancy is still not understood completely, yet abnormally elevated homocysteine level has been implicated in the causal pathway and pathogenesis. Hyperhomocysteinemia has been significantly associated with increased risk of poor maternal and foetal outcomes in terms of PIH, abruption, IUGR, recurrent pregnancy loss, intrauterine death and prematurity.Methods: The present prospective study was conducted among 180 pregnant women (57 exposed and 123 non exposed) in Kamla Nehru State Hospital for Mother and Child, IGMC Shimla, Himachal Pradesh with an objective of determining association of abnormally elevated homocysteine level in pregnancy and adverse pregnancy outcomes. Socio-demographic, clinical, biochemical including homocysteine level, laboratory, ultrasonographic parameters and foeto-maternal outcomes of pregnancy of all the participants were documented.Results: The mean homocysteine level of exposed group (23.26±10.77 µmol/L) was significantly higher than the unexposed group (8.99±2.47 µmol/L). Among hyperhomocysteinemic subjects, 10.5% had abruption, 15.8% had PRES and 8.7% PPH which was significantly higher than normal subjects. Similarly, patients with homocysteinemia had significantly higher proportion (21.3%) of poor Apgar score, more (41.9%) NICU admissions and higher frequency (4.7%) of meconium aspiration syndrome.Conclusions: The present study generates necessary evidence for associating abnormally elevated homocysteine levels with pregnancy related hypertensive ailments and adverse pregnancy outcomes. It further demands the need of robustly designed studies and trials to further explore the phenomenon. Moreover, it emphasizes on a simple and timely intervention like estimating the much-neglected homocysteine levels during pregnancy which can definitely contribute in predicting and preventing adverse perinatal outcomes.

scholarly journals Semiconductor Work and Adverse Pregnancy Outcomes Associated with Male Workers: A Retrospective Cohort Study

2019 ◽  
Vol 63 (8) ◽  
pp. 870-880
Author(s):  
Kyung-Hwa Choi ◽  
Hyunjoo Kim ◽  
Myoung-Hee Kim ◽  
Ho-Jang Kwon
Keyword(s):  
Pregnancy Outcomes ◽  
Semiconductor Manufacturing ◽  
Retrospective Cohort ◽  
Reproductive Toxicity ◽  
Adverse Pregnancy Outcomes ◽  
Adverse Outcomes ◽  
Office Workers ◽  
Adverse Pregnancy ◽  
Male Workers ◽  
Semiconductor Production

Abstract Objectives A hazardous work environment in semiconductor factories is a threat to the workers’ health. Semiconductor manufacturing characteristically requires young workers, and reproductive toxicity is an important issue. Studies investigating reproductive toxicity among individuals working in the semiconductor manufacturing industry have primarily focused on outcomes in women. Information on the reproductive health of male semiconductor factory workers is limited. This study aimed to evaluate the association between workplace exposures among male workers in a Korean semiconductor company and adverse pregnancy outcomes. Methods Based on the data from the 2015 Semiconductor Health Survey (SHS), which evaluated the workplace exposures, pregnancy outcomes, and general health of 21 969 employees of the semiconductor industry in South Korea, we included 3868 male workers with 7504 pregnancy outcomes identified by self-reports for this retrospective cohort study. Data regarding the pregnancy outcomes, order of pregnancy, and the years of the outcomes were collected via the SHS questionnaire. Adverse pregnancy outcomes were defined as preterm labor, spontaneous abortion, and stillbirth. Workplace exposures were classified as fabrication, assembly, others, lab, and office work (reference group). A generalized estimating equations model including repeated events of individuals and producing relative risk (RR) and 95% confidence interval (CI) was used to estimate the association between workplace exposure and adverse pregnancy outcomes. Analyses were adjusted for work location, spouse’s employment in semiconductor production work, educational level, marital status, risky alcohol drinking, smoking status, body mass index, order of pregnancy, and age and year of pregnancy outcome, which were based on a priori decisions. Results The adjusted risk for adverse outcomes was higher [RR (95% CI): 1.47 (1.04, 2.07)] among assembly process workers compared with the office workers. Adjusted risks for adverse outcomes among workers in assembly and fabrication, whose spouses also worked in semiconductor production, were 1.60 (95% CI: 1.04, 2.46) and 1.74 (95% CI: 1.18, 2.57) times higher, respectively, compared with the office workers with spouses not working in semiconductor production. Conclusions Based on these findings, semiconductor work might be considered a risk factor for reproductive toxicity among male workers, especially for those whose spouses have the same job.

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