Maternal advanced age, single parenthood, and ART increase the risk of child morbidity up to five years of age

Background Advanced maternal age, single status and use of assisted reproductive technology (ART) are increasing in mothers in high-income countries, and all are known risk factors for negative obstetric outcomes. Less is known about their long-term consequences for childhood morbidity. Thus, the aim of this study was to investigate morbidity up to five years of age, in the children of older, single, and/or ART-treated mothers. Methods A cross-sectional using Swedish registers was performed comprising 23 772 children. The prevalence of diagnosis and the number of hospital visits for specialist care, were compared and analyzed in relation to maternal age at childbirth, maternal civil status, and mode of conception. The odds ratio for specialized care within each ICD-chapter were estimated using single and multiple logistic regression. Results Children born to single mothers and children conceived using ART had significantly more outpatient visits for specialist care and significantly more diagnoses compared to children with married/cohabiting mothers, and spontaneously conceived children. Children born to mothers of advanced maternal age (≥40) had fewer in- and outpatient visits. However, they were significantly more often diagnosed within ICD-chapters XVI, XVII i.e., they experienced more morbidity in the neonatal period. Conclusion The results indicate that children born to single mothers and children of ART-treated mothers have a higher morbidity and consume more specialist care than children of married/cohabiting and spontaneously pregnant mothers. We conclude that the use of ART, maternal single status and advanced maternal age are risk factors of importance to consider in pediatric care and when counseling women who are considering ART treatment.

The expression of pregnancy-associated plasma protein-A (PAPP-A) in human blastocoel fluid–conditioned media: a proof of concept study

Purpose The aim of this study was to determine if pregnancy-associated plasma protein-A (PAPP-A), typically measured in maternal serum and a potential predictor of adverse maternal and fetal outcomes such as spontaneous miscarriage, pre-eclampsia, and stillbirth, is expressed in blastocoel fluid–conditioned media (BFCM) at the embryonic blastocyst stage. Design This is an in vitro study. Methods BFCM samples from trophectoderm-tested euploid blastocysts (n = 80) from in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) patients were analyzed for PAPP-A mRNA. BFCM was obtained from blastocyst stage embryos in 20 uL drops. Blastocysts underwent trophectoderm biopsy for preimplantation genetic testing for aneuploidy prior to blastocyst vitrification and BFCM collection for snap freezing. cfDNA was synthesized using BFCM collected from 80 individual euploid blastocysts. Next, real-time qPCR was performed to detect expression of PAPP-A with GAPDH for normalization of expression in each sample. Results PAPP-A mRNA was detected in 45 of 80 BFCM samples (56.3%), with varying levels of expression across samples. Conclusion Our study demonstrates the expression of PAPP-A in BFCM. To our knowledge, this is the first study to report detection of PAPP-A mRNA in BFCM. Further studies are required and underway to investigate a greater number of BFCM samples as well as the possible correlation of PAPP-A expression with pregnancy outcomes of transferred euploid blastocysts. If found to predict IVF and obstetric outcomes, PAPP-A may provide additional information along with embryonic euploidy for the selection of the optimal blastocyst for embryo transfer.

An Unusual Presentation of COVID-19 Associated Multisystem Inflammatory Syndrome in Adults (MIS-A) in a Pregnant Woman

Based on available literature, pregnant women are at an increased risk of severe illness from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, compared to nonpregnant women. Consequences of coronavirus disease 2019 (COVID-19) in pregnancy have many implications in women’s lives other than unfavorable obstetric outcomes. In addition to managing acute respiratory illness and symptoms, caregivers should be equipped to detect and manage the short-term, intermediate, and long-term consequences of SARS-CoV-2 infection as well. Many pregnant women can remain asymptomatic and continue their pregnancy without being diagnosed. Pregnancy outcomes and consequences of SARS-CoV-2 infected yet asymptomatic mothers have not been very well explained. Reports of a new multisystem inflammatory syndrome in children (MIS-C) and multisystem inflammatory syndrome in adults (MIS-A) following COVID-19 have been described. However, MIS-A in pregnancy is an extremely rare presentation that can cause a huge diagnostic dilemma to caregivers. We describe the successful management of a pregnant woman with MIS-A following SARS-CoV-2 infection.

Variation between Initial and Final Diagnosis as A Predictor of Adverse Obstetric Outcome among Post-Natal Women at Bungoma Hospitals, Kenya

Despite diagnosis being an important part of clinical or medical consultations, the diagnosis might fail leading to adverse effects. This is a global problem, where developed and developing countries go through. In sub-Saharan Africa, variations between initial diagnosis and final diagnosis lead to diagnostic errors with high maternal mortalities. In Kenya, a lot of measures have been put in place but still, variation in diagnosis appear to have become rampant. Bungoma county is one of the counties with a high mortality ratio, especially for pregnant women attributed to the variation between initial and final diagnosis. Therefore, it was crucial to investigate the variation between initial and final diagnosis in relation to obstetric outcomes at hospitals in Bungoma County. The cross-sectional research design was used (Bungoma and Webuye hospitals). Systematic sampling was used to obtain 384 respondents after proportionate allocation to each hospital, and purposive sampling to select 8 health care workers as key informants. Data was collected using a structured questionnaire and an interview guide. The pre-test was done with validity established through crosschecking and reliability calculated using the Cronbach method (0.89). Using a statistical package for social sciences version 25, descriptive and inferential statistics was run where chi-square and odds ratio was used to determine the influence between variables, significance and prediction. The study revealed a variation between initial diagnosis and the final diagnosis was 20.8% while diagnostic errors were significant predictors of obstetric outcomes among post-natal mothers at level five with a p-value of 0.045 at a significance of 5%(P=0.045). Demographic characteristics showed no relationship with obstetric outcomes (P=0.54>0.05). Matched diagnostic had no variations (N=327, M=1.00, SD=0.000); while unmatched diagnostic had variations (N=327, M=1.82, SD=.384). There was a relationship between diagnostic errors and obstetric outcome (ꭓ2 (1) = 251.86, p< .001). An association between diagnostic error with unsafe obstetric outcomes was significant at the odds ratio of 2.03(OR 2.03, 95% CI 1.31–2.16). The study demonstrates that a correct diagnosis is a viable strategy in preventing unsafe obstetric outcomes and by extension minimizing morbidity and mortality among pregnant women. The study concluded that there was a variation between initial diagnosis and final diagnosis which had an adverse obstetric outcome. it was recommended to build capacities for the health workers in order to address increased diagnostic errors.

Iodine supplementation: compliance and association with adverse obstetric and neonatal outcomes

Objectives Over 1.9 billion people worldwide are living in areas estimated to be iodine insufficient. Strategies for iodine supplementation include campaigns targeting vulnerable groups, such as women in pre-conception, pregnancy and lactation. Portuguese women of childbearing age and pregnant women were shown to be mildly-to-moderately iodine deficient. As a response, in 2013, the National Health Authority (NHA) issued a recommendation that all women considering pregnancy, pregnant or breastfeeding, take a daily supplement of 150–200 μg iodine. This study explored how the iodine supplementation recommendation has been fulfilled among pregnant and lactating women in Portugal, and whether the reported iodine supplements intake impacted on adverse obstetric and neonatal outcomes. Design and methods Observational retrospective study on pregnant women who delivered or had a fetal loss in the Braga Hospital and had their pregnancies followed in Family Health Units. Results The use of iodine supplements increased from 25% before the recommendation to 81% after the recommendation. This was mostly due to an increase in the use of supplements containing iodine only. Iodine supplementation was protective for the number of adverse obstetric outcomes (odds ratio (OR) = 0.791, P = 0.018) and for neonatal morbidities (OR = 0.528, P = 0.024) after controlling for relevant confounding variables. Conclusion The recommendation seems to have succeeded in implementing iodine supplementation during pregnancy. National prospective studies are now needed to evaluate the impact of iodine supplementation on maternal thyroid homeostasis and offspring psychomotor development and on whether the time of the beginning of iodine supplementation (how early during preconception or pregnancy) is relevant to consider.