Stillbirths in women with pre-gravid obesity

Abstract Objective To determine the association between pre-gravid obesity and stillbirth. Methods A retrospective study of a population-based dataset of births at ≥34 weeks’ gestation. We excluded fetal deaths due to lethal anomalies and intrapartum fetal deaths. We calculated the incidence of stillbirths, neonatal respiratory distress syndrome (RDS) and neonatal intensive care unit (NICU) admissions per ongoing pregnancies for each gestational week in the two body mass index (BMI) categories (≥30 vs.<30). Results Pre-pregnancy obesity (BMI≥30), pre-pregnancy diabetes, oligo- and polyhydramnios, being small for gestational age (SGA) and preeclampsia were significantly associated with stillbirth. However, the only pre-gravid factor that is amenable to intervention was obesity [adjusted odds ratio (OR) 2.0; 95% confidence interval (CI) 1.20, 3.3]. The rates of stillbirth seem to increase with gestational age in both BMI categories. RDS and NICU admission would be presented. Conclusion Birth near term might reduce stillbirths and decrease NICU admissions occurring in term and in post-term obese women. This presumable advantage might be offset by the potential risk of labor induction and cesarean section among obese women. Women of childbearing age with a BMI≥30 should be counseled about these risks of obesity during pregnancy and childbirth.

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Antenatal injection betamethasone- A fetal lung warrior

Indian Journal of Obstetrics and Gynecology Research ◽

10.18231/j.ijogr.2021.052 ◽

2021 ◽

Vol 8 (2) ◽

pp. 255-258

Author(s):

Manish R Pandya ◽

Kalpana Khandheriya ◽

Vinay Trivedi ◽

Khushbu Patel

Keyword(s):

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Gestational Age ◽

Neonatal Intensive Care ◽

Distress Syndrome ◽

Admission Rate ◽

Antenatal Corticosteroids ◽

Antenatal Steroids ◽

Term Delivery ◽

Nicu Admission

One of the most frequent causes of neonatal mortality or NICU admission of neonates especially in premature infants is Neonatal Respiratory Distress Syndrome (NRDS). Antenatal steroids are the most important and widely utilized interventions for improvement of neonatal outcomes like reducing incidence of respiratory distress syndrome (RDS), reducing neonatal NICU (neonatal intensive care unit) admission rates and also improve outcomes of pre-term infants. Antenatal steroids (ANS) like betamethasone 12 mg are given at 24 hourly IM at 28-34 weeks of gestation to mother. For administration of corticosteroids at less than 24 weeks of gestational age decision should be made at a senior level by taking all clinical aspects into consideration.To observe the effect of Betamethasone administration IM in pregnant women at risk of pre-term delivery and fetal outcomes in terms of development of Respiratory Distress Syndrome (RDS) and Neonatal Intensive Care Unit (NICU) admission rate by giving it between 28 to 34 weeks of gestation. Antenatal corticosteroids (betamethasone) play an important role for prevention of respiratory distress syndrome and reducing NICU admission rate of new borns and also reduce neonatal mortality and morbidity but benefits related to the time between administration of corticosteroid and delivery needed to be explored. Benefits of the injection betamethasone administration IM 12 mg between 24 hours and seven days on pre-term delivery has been established., This was prospective study conducted in private setup from November 2020 to March 2021 in Scientific Research Institute, Surendranagar, Gujarat, India. Study comprised of 100 women with single tone pregnancies (28 – 36 weeks gestational age) in age group of 19 – 33 years not in labour, but at risk for pre-term delivery based on fetal or maternal indications. These pregnant women were treated with two doses of 12 mg Betamethasone Intramuscularly apart of 24 hourly for maturation of fetal lungs. Antenatal corticosteroids like betamethasone have a significant benefit on neonatal outcome even if used after 34 weeks of pregnancy. This was given prophylactically to those who are known to have increased risk of pre-term labour. Antenatal steroid like betamethasone 12 mg IM is also of benefit to reduce neonatal respiratory distress syndrome (NRDS) and NICU admission rates by giving it at 28-34 weeks of gestational age.

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Incidence, Risk Factors, and Outcomes of Preterm and Early Term Births: A Population-Based Register Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18115865 ◽

2021 ◽

Vol 18 (11) ◽

pp. 5865

Author(s):

Salma Younes ◽

Muthanna Samara ◽

Rana Al-Jurf ◽

Gheyath Nasrallah ◽

Sawsan Al-Obaidly ◽

...

Keyword(s):

Risk Factors ◽

Hospital Mortality ◽

Gestational Age ◽

Neonatal Intensive Care ◽

Population Based ◽

Incidence Rates ◽

Large For Gestational Age ◽

Mortality And Morbidity ◽

Early Term ◽

Incidence Risk

Preterm birth (PTB) and early term birth (ETB) are associated with high risks of perinatal mortality and morbidity. While extreme to very PTBs have been extensively studied, studies on infants born at later stages of pregnancy, particularly late PTBs and ETBs, are lacking. In this study, we aimed to assess the incidence, risk factors, and feto-maternal outcomes of PTB and ETB births in Qatar. We examined 15,865 singleton live births using 12-month retrospective registry data from the PEARL-Peristat Study. PTB and ETB incidence rates were 8.8% and 33.7%, respectively. PTB and ETB in-hospital mortality rates were 16.9% and 0.2%, respectively. Advanced maternal age, pre-gestational diabetes mellitus (PGDM), assisted pregnancies, and preterm history independently predicted both PTB and ETB, whereas chromosomal and congenital abnormalities were found to be independent predictors of PTB but not ETB. All groups of PTB and ETB were significantly associated with low birth weight (LBW), large for gestational age (LGA) births, caesarean delivery, and neonatal intensive care unit (NICU)/or death of neonate in labor room (LR)/operation theatre (OT). On the other hand, all or some groups of PTB were significantly associated with small for gestational age (SGA) births, Apgar <7 at 1 and 5 minutes and in-hospital mortality. The findings of this study may serve as a basis for taking better clinical decisions with accurate assessment of risk factors, complications, and predictions of PTB and ETB.

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Antepartum hemorrhage and its fetomaternal outcome: a retrospective study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20204811 ◽

2020 ◽

Vol 9 (11) ◽

pp. 4562

Author(s):

Saloni K. Gandhi ◽

Ayushi P. Vamja ◽

Kishor P. Chauhan

Keyword(s):

Genital Tract ◽

Neonatal Intensive Care ◽

Distress Syndrome ◽

Placenta Previa ◽

Age Group ◽

Cesarean Sections ◽

Obstetrics And Gynaecology ◽

Still Births ◽

Abruptio Placenta ◽

Nicu Admission

Background: Antepartum hemorrhage (APH) is defined as any bleeding from or into the genital tract after the period of viability and before the delivery of the baby. Aim of the research was to study the fetomaternal outcome in patients with APH.Methods: The present study was a retrospective observational study undertaken in Obstetrics and Gynaecology department of Dhiraj General Hospital, during a period of 1.5 years from November 2018 to May 2020 in 84 cases of antepartum hemorrhage. Only patients with APH >28 weeks gestational age and willing to participate in study were included. Open STAT statistical software has been used to analyse the data in this study.Results: The incidence of antepartum hemorrhage was 2.86%. Maximum patients of APH lie between the age group of 26-34 years. In abruptio placenta (AP) 65% and in placenta previa (PP) 77.2% of the patients were multiparous. APH presents mostly between 34-36 weeks. Around 90% patients of APH required blood transfusion. APH overall shows increased rate of cesarean sections upto 62%. Around 9.5% patients went into shock, 4.7% had disseminated intravascular coagulation (DIC), 3.5% postpartum hemorrhage (PPH) and 8.3% had wound gap and peurperial pyrexia. 23.8% babies had asphyxia of which 60% were contributed to PP and 40% were in AP group. Respiratory distress syndrome was in 7.1% babies of which both groups equally contributed. Septicemia was seen in 13% and jaundice in 29.8%.Conclusions: Higher rates of neonatal intensive care unit (NICU) admission and stay were seen with these complications. This study showed 20.2% perinatal deaths as outcome of APH and 14.2% still births.

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Short Term Outcomes of Neonates Born after Prolonged Premature Rupture of Membranes < 34 Weeks Gestation

Research in Health Science ◽

10.22158/rhs.v4n2p83 ◽

2019 ◽

Vol 4 (2) ◽

pp. 83

Author(s):

Isam Bsisu ◽

Alaa Aldalaeen ◽

Rawan Elrajabi ◽

Ala AlZaatreh ◽

Rama Jadallah ◽

...

Keyword(s):

Birth Weight ◽

Gestational Age ◽

Neonatal Intensive Care ◽

Preterm Births ◽

University Hospital ◽

High Rate ◽

Premature Rupture Of Membranes ◽

Premature Rupture ◽

Gestational Week ◽

The Mean

Background: Preterm premature rupture of membranes (PPROM) is responsible for one?third of all preterm births worldwide. This aim of this study was to investigate the outcome of neonates born after prolonged PPROM with gestational age below 34 weeks. Materials and methods: This retrospective study included 65 patients who were born to mothers with Prolonged PPROM <34 weeks gestation between January 2011 and December 2015 and admitted to the neonatal intensive care unit (NICU) at Jordan University Hospital. Results: The mean gestational age of included patients was (31.9 ± 2.5 weeks), mean birth weight was (1840 ± 583 g) and 43 (66.2%) were males. The mortality rate in those infants was 12.3 %. Gestational age, birth weight, and Apgar score were significantly lower among mortality cases compared to surviving cases (P < 0.05). Conclusion: Prolonged PPROM before the 34th gestational week is associated with high rate of morbidity and mortality, for which early identification of risk factors for developing PPROM can help in reducing the risk for preterm labors and subsequent burden on healthcare system.

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Effect of methyldopa and labetolol on fetal outcomes in hypertensive disorders of pregnancy

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20175203 ◽

2017 ◽

Vol 6 (12) ◽

pp. 2832

Author(s):

Mary Rohini Pentareddy ◽

Shailendra D.

Keyword(s):

Gestational Age ◽

Small For Gestational Age ◽

Neonatal Intensive Care ◽

Distress Syndrome ◽

Medical Complication ◽

Effective Management ◽

Hypertensive Disorders ◽

Significant Difference ◽

Induced Hypertension ◽

Uterine Growth

Background: Hypertensive disorders represent the most common medical complication of pregnancy, with a reported incidence of 6-10% and accounts for 15% of maternal mortality. Effective management of pregnancy induced hypertension is vital to improve maternal and foetal outcomes. As data are scarce on comparison of labetolol and methyldopa this study was undertaken. The objectives of the study were to evaluate effect of both drugs on fetal outcomes.Methods: A comparative observational Study is designed. 30 patients who received Methyldopa and 30 patients who received Labetolol were included in the study. Methyldopa was started at a dose of 250-500mg thrice daily while Labetolol was started at a dose of 100-400mg twice daily. Patients were followed up during antenatal, intrapartum and postpartum period for perinatal outcomes.Results: Intra Uterine Growth Retarded (IUGR) babies were 10% in Methyldopa group and 6.66% in Labetolol group. 20% of new borns in Methyldopa group and 10% of new borns in Labetolol group got admitted in Neonatal Intensive Care Unit (NICU) because of distress. 13.3% of new borns in Methyldopa group are small for gestational age(SGA), whereas only 3.33% in Labetolol group are small for gestational age.Conclusions: Chances of development of IUGR, NICU admissions of neonates with respiratory distress syndrome and small for gestational age babies were more with methyldopa compared to Labetolol, but there was no statistically significant difference between two drugs.

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Birthweight by gestational age reference centile charts for Greek neonates

10.1101/2020.10.04.20204040 ◽

2020 ◽

Author(s):

A Tsagkari ◽

K Pateras ◽

D Ladopoulou ◽

E Kornarou ◽

N Vlachadis

Keyword(s):

Gestational Age ◽

Secondary Analysis ◽

Population Data ◽

Perinatal Period ◽

Population Based ◽

Accurate Identification ◽

Birth Registry ◽

Gestational Week ◽

Lms Method ◽

First Time

ABSTRACTObjectiveThe development of population based, sex-specific, birthweight for gestational age (GA) first-time reference centile charts for liveborn singletons in Greece.DesignSecondary analysis of national birth registry dataParticipantsData of birthweight by GA of all 633201 singleton live births in Greece between 2011 and 2017 were collected from the Hellenic Statistical Authority (ELSTAT).Main outcome measuresAfter excluding implausible birthweights, we estimated gender specific birthweight centiles for every gestational week from 22nd to 40th+ using the Lambda-Mu-Sigma (LMS) method via the GAMLSS package in R. Small (10th centile) and large-for GA (90th centile) cut-offs in certain gestational weeks were compared to previously published charts.ResultsMore than 90% of the 621043 neonates were born at term (>37 weeks of GA). The mean birthweight for boys and girls at 40+ weeks of GA were 3473 grams and 3327 grams respectively. Most neonates were born at 38 weeks of GA with a mean birth-weight of 3097 (97655 girls) and 3237 (104722 boys) grams. The proposed national centiles identified more or less deviant percentages of small and large for GA neonates in comparison to other (inter)national centiles.ConclusionsThe new centile charts provide important information on the contemporary distribution of birthweight for gestational age in Greece. They may assist physicians to classify high-risk neonates at birth based on national population data. Accurate identification of those in need of special care will help to prevent possible adverse sequelae in the perinatal period and beyond.

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Restoring Reproductive Function In Overweight And Obese Women Of Childbearing Age

The American Journal of Medical Sciences and Pharmaceutical Research ◽

10.37547/tajmspr/volume02issue08-11 ◽

2020 ◽

Vol 2 (08) ◽

pp. 77-81

Author(s):

Hamdamova M. T. ◽

Jurakulova Z. A

Keyword(s):

Negative Impact ◽

Reproductive Function ◽

Diet Therapy ◽

Overweight And Obesity ◽

Reproductive Age ◽

Obese Women ◽

Childbearing Age ◽

Women Of Reproductive Age ◽

Pregnancy And Childbirth ◽

Group 2

The prevalence of overweight and obesity among women in Uzbekistan is 31.7 %. There is an annual increase in people with obesity. The facts of the negative impact of fat mass on the hormonal system and, as a result, a decrease in fertility in women are not in doubt. The purpose of this study was to evaluate the results of Metformin use in overweight and obese women of reproductive age. The study included 45 women of reproductive age who could not reduce weight with diet therapy. All patients were divided into three groups: group 1-planning pregnancy (n = 15), group 2 – having abnormal weight gain after childbirth (n = 15), group 3 – having overweight and obesity not related to pregnancy and childbirth (n = 15). Weight loss while taking Metformin increases fertility and should be performed in obese women as pre-gravidar training.

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Neonatal complications in women with premature rupture of membranes (PROM) at term and near term and its correlation with time lapsed since PROM to delivery

Tropical Doctor ◽

10.1177/0049475519886447 ◽

2019 ◽

Vol 50 (1) ◽

pp. 8-11

Author(s):

Shruti Gupta ◽

Sunita Malik ◽

Shailesh Gupta

Keyword(s):

Latent Period ◽

Neonatal Mortality ◽

Neonatal Sepsis ◽

Neonatal Intensive Care ◽

Birth Asphyxia ◽

Premature Rupture Of Membranes ◽

Premature Rupture ◽

Neonatal Complications ◽

Near Term ◽

Nicu Admission

Premature rupture of membranes (PROM) is a common problem with controversies in its management. The aim of our study was to find out the prevalence of neonatal complications and their correlation with the latent period in babies born to mothers with PROM at 34–40 weeks of gestation. This prospective cohort study was performed on 200 pregnant women with PROM at or near term. After birth, neonates were screened for sepsis. Other outcome measures included birth asphyxia, stay in the Neonatal Intensive Care Unit (NICU) and neonatal mortality. These were correlated against time spent from PROM. Duration after which risk of neonatal sepsis increased immensely was calculated by ROC. The prevalence of specific neonatal complications was as follows: birth asphyxia (8%); neonatal sepsis (4%); NICU admission (26%); and neonatal mortality (2%). Complications increased with an increasing latent period. Beyond 37 h of latency, the rate of neonatal sepsis increases dramatically. In conclusion, pregnancies with PROM at and near term should not be managed expectantly. All neonates born after 37 h of latent PROM should be stringently evaluated for sepsis.

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FRI0306 WOMEN WITH AXIAL SPONDYLOARTHRITIS HAVE COMPARABLE RATES OF COMPLICATIONS IN PREGNANCY TO WOMEN IN THE GENERAL POPULATION BUT MORE CAESAREAN DELIVERIES: RESULTS FROM NATIONWIDE CLAIMS DATA

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.5241 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 743.2-743

Author(s):

I. Redeker ◽

A. Strangfeld ◽

U. Marschall ◽

A. Zink ◽

X. Baraliakos

Keyword(s):

Birth Weight ◽

Caesarean Section ◽

Gestational Age ◽

Small For Gestational Age ◽

Pregnancy Outcomes ◽

Axial Spondyloarthritis ◽

Population Based ◽

Research Support ◽

Increased Risk ◽

Gestational Week

Background:In contrast to other rheumatic inflammatory diseases, studies on pregnancy outcomes in axial spondyloarthritis (axSpA) are scarce, despite its onset in early adulthood affecting women in their reproductive years.Objectives:To investigate maternal and infant pregnancy outcomes among women with axSpA compared with population-based controls.Methods:Taking advantage of a large health insurance dataset, comprising the period 2006 – 2018, maternal and infant pregnancy outcomes and delivery outcomes of women with axSpA were assessed and compared with population-based controls (matched by maternal age and calendar year of birth). Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using generalised estimating equation analyses.Results:A total of 611 singleton births among 535 women with axSpA were included in the analysis. The mean age at delivery was 32.5 years. The pharmacological treatment within 12 months prior to and after conception is illustrated in the Figure. Infants of women with axSpA were only slightly more often preterm (5.2% vs 4.7%) and small-for-gestational-age (1.6% vs 1.1%) than infants of matched population-based controls, respectively. Caesarean section was performed in 36% of deliveries among women with axSpA compared with 29.5% in population-based controls, resulting in a significantly increased risk for receiving caesarean section (OR 1.35; 95% CI 1.06-1.73) (Table). The occurrence of pre-eclampsia, preterm birth, and small-for-gestational-age was moderately higher, but not significantly increased, among women with axSpA as compared to population-based controls.Conclusion:Women with axSpA had no significantly increased risks for adverse maternal or infant pregnancy outcomes compared to non-axSpA women. However, a significantly increased risk for receiving caesarean section and a tendency for a higher number of preterm deliveries and of small-for-gestational-age infants was observed in women with axSpA.Table.Prevalences and odds ratios with 95% confidence intervals for adverse pregnancy outcomesPregnancies in women with axSpAN=611Pregnancies in population-based controlsN=611Odds Ratio(95% CI)Preterm birth (< week 37)5.2% (32)4.7% (29)1.11 (0.66, 1.85)Gestational week 28-364.9% (30)4.7% (29)1.03 (0.61, 1.75)Gestational week <280.3% (2)0.2% (1)2.01 (0.18, 22.18)Small for gestational age1.6% (10)1.1% (7)1.43 (0.54, 3.79)Low birth weight (<2500 g)2.8% (17)2.6% (16)1.06 (0.53, 2.13)Exceptionally large baby(birth weight ≥4500 g)1.1% (7)0.2% (1)7.07 (0.87, 57.63)Pre-eclampsia7.5% (46)6.4% (39)1.21 (0.78, 1.90)Assisted vaginal delivery4.3% (26)3.1% (19)1.39 (0.76, 2.56)Caesarean section36.0% (220)29.5% (180)1.35 (1.06, 1.73)axSpA, axial Spondyloarthritis; CI, confidence interval.Acknowledgments:We would like to thank the BARMER Statutory Health Insurance for providing data for this study.Disclosure of Interests:Imke Redeker: None declared, Anja Strangfeld Speakers bureau: AbbVie, BMS, Pfizer, Roche, Sanofi-Aventis, Ursula Marschall: None declared, Angela Zink Speakers bureau: AbbVie, Amgen, BMS, Gilead, Hexal, Janssen, Lilly, MSD, Pfizer, Roche, Sanofi Aventis, UCB, Xenofon Baraliakos Grant/research support from: Grant/research support from: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Consultant of: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Speakers bureau: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen

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Morbidity Associated with Fetal Macrosomia among Women with Diabetes Mellitus

American Journal of Perinatology ◽

10.1055/s-0037-1608811 ◽

2017 ◽

Vol 35 (05) ◽

pp. 515-520 ◽

Cited By ~ 6

Author(s):

Amy O'Neil Dudley ◽

Hector Mendez-Figueroa ◽

Viviana Ellis ◽

Han-Yang Chen ◽

Suneet Chauhan ◽

...

Keyword(s):

Diabetes Mellitus ◽

Regression Models ◽

Neonatal Intensive Care ◽

Distress Syndrome ◽

Error Variance ◽

Outcome Data ◽

Adjusted Relative Risk ◽

Increased Risk ◽

Study Population ◽

Nicu Admission

Objective This article aims to compare the composite maternal and neonatal morbidities (CMM and CNM, respectively) between macrosomic (≥4,000 g) and nonmacrosomic (<4,000 g) newborns among women with diabetes mellitus (DM). Methods Maternal demographic and peripartum outcome data (N = 1,260) were collected from a retrospective cohort. CMM included chorioamnionitis/endometritis, wound infection, shoulder dystocia, eclampsia, pulmonary edema, admission for hypoglycemia, 3rd/4th degree perineal laceration, and death. CNM included 5-minute Appearance, Pulse, Grimace, Activity and Respiration (APGAR) score of <4, neonatal intensive care unit (NICU) admission, respiratory distress syndrome, mechanical ventilation, intraventricular hemorrhage grade III/IV, necrotizing enterocolitis stage II/III, hypoglycemia, hypocalcemia, bronchopulmonary dysplasia, sepsis, seizures, hyperbilirubinemia, and death. Multivariable Poisson regression models with robust error variance were used to calculate adjusted relative risk (aRR) and 95% confidence interval (CI). Results The study population consisted of 967 subjects, including 854 (88.3%) nonmacrosomic and 113 (11.7%) macrosomic infants. After adjustment, the risk of CMM was higher among macrosomic deliveries (aRR = 4.08, 95% CI = 2.45–6.80). The risk of CNM was also higher among macrosomic deliveries (aRR = 1.77, 95% CI = 1.39–2.24). Macrosomia was associated with an increased risk in NICU admission, hypoglycemia, and hyperbilirubinemia. Conclusion Among DM deliveries, macrosomia was associated with a fourfold higher risk of CMM and almost twofold higher risk of CNM.

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