Problemy sotsial'noi gigieny, zdravookhraneniia i istorii meditsinyN V Batrak, I V Ivanova
The pregnancy that occurred due to in vitro fertilization is characterized by higher risk of development of gestational diabetes mellitus. The purpose of the study was to investigate course and outcomes of pregnancy resulted from in vitro fertilization in women with gestational diabetes mellitus, depending on time of its manifestation. The analysis of course of pregnancy, childbirth and condition of newborns in 179 women with gestational diabetes mellitus under pregnancy resulted from in vitro fertilization was carried out. It is established that early manifestation of gestational diabetes mellitus is associated with older age of pregnant women, higher rate of birth of large fetus in anamnesis, higher body mass index, more frequent prescription of insulin therapy to treat gestational diabetes mellitus, higher rate of development of early threatened miscarriage, isthmic cervical insufficiency, anemia, chronic arterial hypertension, gestational arterial hypertension, moderate preeclampsia, severe preeclampsia, premature normally placed placenta detachment, fetal growth retardation, chronic intrauterine fetal hypoxia, diabetic fetopathy, prenatal rupture of amniotic fluid, premature birth, more frequent birth of large fetus, development of fetal renal pyelectasia. The female patients with late manifestation of gestational diabetes mellitus had higher level of fasting plasma glycemia, frequent development of placenta previa, polyhydramnios, pathological and insufficient gain of body mass during pregnancy, dis-coordination of labor and clinically narrow pelvis during labor, more frequent operative delivery and early delivery. The gestational diabetes mellitus, developed both in early and late periods, complicates the course and childbirth under pregnancy resulted from in vitro fertilization, adversely affects state of the newborn. The study in depth is needed to establish possible mechanisms of development of gestational diabetes mellitus in this cohort of women with implementation of screening examinations and determination of further tactics of management of pregnancy depending on time of its manifestation.
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal ObstetriciansDilly O C Anumba, Cath M Harrison, Gian Carlo Di Renzo
AIM: Preterm birth, defined as delivery at gestational age less than 37 weeks, is a major contributor to neonatal morbidity, placing a significant burden on healthcare resources. This analysis explores the prevalence and patterns of critical care admissions among preterm neonates in England. METHODS: Hospital-level data were obtained from the Hospital Episode Statistics Data-NHS England 2022-2023 database. Data were analyzed for newborns in England for April 2022-March 2023, focusing on gestational age categories and the care level of facilities managing these infants. RESULTS: Among all 541,765 singleton births in England during the examined interval, 7.0% (37,815) were preterm. Of these preterm infants, 71.3% (26,965) had a recorded gestational age. Of those with recorded gestational ages, 0.6% (149) were born <28 weeks (extremely preterm), 10.5% (2,844) at 28-32 weeks (very preterm), and 88.9% (23,972) at 33-37 weeks (moderate and late preterm). While 58.4% (87) of extremely preterm neonates were delivered in a hospital with appropriate facilities, 32.2% (48) of extremely preterm neonates, and 4.3% (121) of very preterm neonates were born in hospitals without neonatal intensive care facilities. CONCLUSION: Persistent gaps in triage for women at risk of preterm birth highlights the need for improved early risk recognition and in utero referral systems to ensure appropriate delivery in recommended critical care facilities and to reduce postnatal transfers for babies.
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal ObstetriciansVennila Ponnusamy, Nicky Holland, Jasmine Myhill, Lucy Pocock, Paul Clarke
BACKGROUND: Wireless monitoring technologies may offer practical advantages over conventional monitoring approaches in neonatal care. We aimed to evaluate the feasibility and acceptability of a wireless heart rate monitoring device in preterm infants across different neonatal clinical settings. METHODS: Between January 2022 and August 2023, we prospectively evaluated the SurePulse VS wireless heart rate monitoring device (SurePulse Medical Ltd, Nottingham, UK) in 62 preterm infants at birth and during postnatal care in two UK tertiary neonatal intensive care units. Staff completed structured questionnaires assessing the device feasibility and acceptability in this preterm population. Downloaded device data were analyzed as exploratory operational metrics and compared with contemporaneously collected staff assessments of signal availability and heart rate acquisition time. RESULTS: Staff reported device cap fitting as "Easy" or "Very Easy" in 88% (45/51) of deployments. Heart rate visibility was reported as available for "All" or "Most" of the monitoring period in 82% (42/51) of cases, and heart rate acquisition within 60 s was reported in 69% (35/51) of cases. Downloaded data were available for 51 infants and provided exploratory operational measures of signal availability and acquisition time that broadly aligned with staff-reported assessments. CONCLUSIONS: The SurePulse VS device demonstrated a high level of feasibility and acceptability among clinical staff across a range of neonatal care settings. These findings support the feasibility of wireless heart rate monitoring in preterm infants and provide insight into practical considerations and challenges for implementation in routine clinical care.
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal ObstetriciansYuhong Jia, Jing Xie, Xiangrong Zuo, Xiuxian Wang, Ruihong Ma
BACKGROUND: To investigate the independent and combined associations of tear-fluid and serum chitinase-3-like protein 1 (CHI3L1) and pentraxin-3 (PTX3) with retinopathy of prematurity (ROP) severity and long-term neurovascular outcomes, and to evaluate their incremental predictive value beyond conventional risk factors. METHODS: This prospective cohort study enrolled 235 premature infants with ROP (diagnosed January 2024-May 2025) and 110 gestational-age-matched controls. ROP infants were stratified into poor-outcome (n = 34) and favorable-outcome (n = 201) subgroups based on treatment response and longitudinal neurovascular findings. Poor outcome was defined as posterior pole retinal fold involving the macula, retinal detachment, or posterior pole obscuration by fibrous tissue or a "white mass" at ≥6 months after intravitreal anti-VEGF therapy. Tear fluid and venous blood were collected within 24 h of the first ROP diagnosis; CHI3L1 and PTX3 were measured by enzyme-linked immunosorbent assay. Spearman correlation, multivariable logistic regression, and receiver operating characteristic (ROC) curves were employed to examine the associations. RESULTS: Tear and serum CHI3L1 and PTX3 concentrations increased stepwise across control, mild-ROP, and severe-ROP groups (all p < 0.05), correlating positively with fundus stage (Spearman r = 0.610-0.779). Infants with unfavorable neurovascular outcomes had higher baseline levels than those with favorable outcomes (p < 0.05). Multivariable analysis identified gestational age, birth weight, severe ROP, bronchopulmonary dysplasia, tear CHI3L1, tear PTX3, serum CHI3L1, and serum PTX3 as independent predictors of poor outcome (p < 0.05). The four-biomarker panel predicted progression with an area under the curve of 0.847 (95% CI 0.775-0.919), outperforming individual markers (p < 0.05). CONCLUSION: Tear and serum CHI3L1 and PTX3 are associated with ROP severity and may serve as a noninvasive early biomarker panel for risk assessment.
Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and GynaecologyYing Hu, Shuqi Zhu, Jia Liu, Die Hong, Hong Wen, Lu Chen, Xixi Chen, Yuqing Zou, Jingjing Liu, Danqing Chen, Lu Qi, Zhaoxia Liang
BACKGROUND: To evaluate the association between the weight-gain-for-gestational-age z-score and preterm birth (PTB) in a large Chinese twin pregnancy cohort. METHODS: A hospital-based retrospective study included 2832 twin pregnancies between January 1, 2015, and December 31, 2019. The primary composite outcome was defined as PTB. The total gestational weight gain was converted into z-score, and logistic regression models were used to examine the associations between z-scores and PTB. RESULTS: We developed a weight-gain-for-gestational-age z-score to determine the gestational weight gain during twin pregnancies in Chinese women. Low (<P25) and high (≥P75) z-scores were associated with a higher risk for spontaneous PTB (SPTB) than scores between the 25th and 75th percentiles (adjusted odds ratio [OR]: 1.35, 95% confidence interval [CI]: 1.05-1.74; 1.28, 0.99-1.66; respectively). Similarly, low z-scores (1.40, 1.12-1.76) and high z-scores (1.97, 1.57-2.47) were also associated with an increased risk for iatrogenic PTB (IPTB). Normal weight subgroups exhibited comparable outcomes. In addition, z-scores between the 25th and 75th percentiles indicated an equivalent total gestational weight gain at 37 weeks of 15.8-20.9 kg for underweight, 14.6-20.3 kg for normal weight, and 11.8-18.6 kg for overweight or obese women, which are narrower than the 2009 IOM recommendation. CONCLUSIONS: Our findings indicate that inadequate gestational weight gain, as evaluated by the z-score, is associated with a significantly increased risk for SPTB, whereas inadequate and excessive gestational weight gain are associated with a significantly increased risk for IPTB, in a large Chinese twin pregnancy cohort.
Global public healthSphindile Mapumulo, Mary Kinney, Lyn Haskins, Silondile Luthuli, Vaughn M John, Loveday Penn-Kekana, Veronique Filippi, Christiane Horwood, Tanya Doherty
Neonatal care increasingly emphasizes improving the experience of care by engaging mothers as active partners alongside health workers providing clinical care for newborns. Guided by the World Health Organization's Standards for improving the quality of care for small and sick newborns, this study focuses on Standard 4, which promotes care that is respectful, responsive, and supportive of families' needs and preferences. We conducted a concurrent triangulation mixed-methods study among health workers and mothers of small and sick newborns admitted to neonatal units in two rural districts of KwaZulu-Natal, South Africa. Effective communication emerged as a foundational factor shaping mothers' experiences of care. Many mothers reported frustration due to inadequate, unfriendly communication and exclusion from clinical decision-making, resulting in limited collaboration and lack of informed consent. Health workers, in turn, described barriers to providing respectful, family-centred care, citing overcrowding, staff shortages, fatigue, and lack of space for mothers to participate. Findings reveal persistent gaps in the implementation of Standard 4 within rural neonatal units. Strengthening communication and integrating family-centered newborn care in rural settings requires investment in health workers' communication training, facility infrastructure that enables maternal presence, and policy adaptations that promote shared caregiving and decision-making.
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal ObstetriciansMerve Genco, Harika Göçer, Emrah Göçer, Mehmet Çopuroğlu, Cemal Ünlü, Mehmet Genco
OBJECTIVE: To evaluate the association between Edinburgh Postnatal Depression Scale (EPDS) scores on postpartum day 7 and maternal demographic, sociodemographic, obstetric, complication-related, and neonatal factors. METHODS: This retrospective cohort study included 1,032 women who delivered at a tertiary referral hospital in 2025. Patients were stratified into low-risk (EPDS <13, n = 893) and high-risk (EPDS ≥13, n = 139) groups. Demographic, sociodemographic, obstetric, neonatal, and laboratory variables were compared, and independent predictors of high-risk status were identified by multivariable logistic regression. RESULTS: Of 1,032 patients, 13.5% (n = 139) screened high-risk. On univariable analysis, any prior abortion was significantly less frequent in the high-risk than in the low-risk group (5.0% vs 11.5%, p = 0.020).Higher education (university 30.2% vs 21.6%, p = 0.041) and employment (41.7% vs 26.9%, p < 0.001) were more frequent in the high-risk group. On multivariable analysis, prior abortion count was the only independent inverse predictor (aOR = 0.536, 95% CI 0.299-0.959, p = 0.036); gestational diabetes did not reach significance (aOR = 0.311, p = 0.053). Sociodemographic variables were analyzed univariately and were not entered into the multivariable model. No other variables differed significantly. CONCLUSIONS: In this Turkish obstetric population, a higher prior abortion count was independently associated with a lower likelihood of high EPDS risk on postpartum day 7. This unexpected inverse association is hypothesis-generating and should be interpreted with caution, given the small number of events, the inability to distinguish loss subtypes, and the multiple comparisons performed. Univariate associations of higher education and employment with EPDS risk diverge from Western literature and warrant prospective multicenter confirmation.
Meningococcal infections remain a significant cause of morbidity and mortality in childhood. In Türkiye, meningococcal vaccines are not included in the national immunization program and are mainly administered through optional, self-funded services. This study aimed to examine temporal trends in meningococcal vaccination counts and to assess their association with public attention. This retrospective time-series study included children who received meningococcal vaccination at a tertiary hospital in Istanbul, Türkiye, between January 2024 and June 2025. Demographic and vaccination data were obtained from hospital records. Public attention was assessed using Google Trends data for meningococcal-related search terms. In addition, official public health announcements, professional society statements, and well-child clinic visits were considered as contextual factors. A total of 182 children were vaccinated, with a marked increase observed in 2025. Infants aged 0-24 months accounted for the majority of vaccinations. MenB was administered more frequently than MenACWY, and concomitant administration was common. Increased vaccination activity temporally coincided with peaks in Google Trends search interest, particularly for the term "meningitis," along with concurrent public health announcements. Meningococcal vaccination counts increased during periods of heightened public attention. In settings where vaccines are optional, vaccination demand may be influenced not only by epidemiological factors but also by media visibility, public awareness, and healthcare professionals' recommendations.
Annals of medicineJialin Mu, Meng Sun, Yulin Li, Panpan Li, Hui Zou
Objective: To evaluate real-world implementation of newborn genetic screening (NBGS) in terms of positivity rate, carrier frequency, and diagnostic accuracy for inherited metabolic disorders (IMDs), and to explore feasibility and challenges in regional clinical application.Methods: This study enrolled 1590 newborns (August 2023-November 2024) whose parents opted for NBGS. A targeted sequencing panel covering 465 genes for 596 diseases alongside traditional biochemical screening for 46 disorders were performed. Variants were classified per ACMG guidelines. Positive cases were recalled for confirmatory Sanger sequencing and auxiliary biochemical tests. We calculated uptake, carrier frequency, identified hotspot variants, and compared allele frequencies with gnomAD_EAS. Diagnostic performance was compared with biochemical screening.Results: Uptake was 10.41% (1590/15,272). Overall positivity was 7.74% (123/1590). Among these, 10 were positive for IMDs‑related genes, with 8 confirmed, giving a positive predictive value (PPV) of 80.00% for IMDs - significantly higher than biochemical screening's 5.71%. We detected 2,354 variants, with carrier frequency 70.94%. Hotspot IMDs variants included MMACHC c.609G>A, c.658_660del, and MUT c.1286A>G, whose minor allele frequencies differed from gnomAD, indicating regional specificity. High carrier rates were also seen for lysosomal storage genes (GALC c.1901T>C, 53.57%; c.2041G>A, 32.14%).Conclusion: NBGS offers high PPV and specificity, reducing false positives and providing early molecular evidence for IMDs. Regional hotspot and MAF differences underscore the need for a local genetic database. Although the acceptance of NBGS is increasing, factors such as cost and varying levels of awareness among healthcare providers remain barriers to its broader implementation. This study provides preliminary data supporting the implementation of regional newborn genetic screening programs and informs secondary and tertiary prevention strategies.
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal ObstetriciansAnthony C Sciscione, Cynthia Gyamfi-Bannerman, Michael Walker, Babak Shahbaba, Jannik Godt, Brian K Iriye
OBJECTIVES: The PRIME randomized trial demonstrated improved neonatal outcomes using biomarker-guided risk stratification to target interventions to pregnancies at higher risk of preterm birth (PTB). This subgroup analysis evaluated its effectiveness in nulliparous pregnancies, a population with higher baseline risk and limited obstetric history to inform risk assessment. METHODS: PRIME (NCT04301518) was a 19‑center randomized controlled trial evaluating a screen‑guided care strategy using the IGFBP4/SHBG biomarker ratio versus routine care in otherwise low‑risk singleton pregnancies. Those who were randomized to the screen-guided care arm and screened as higher risk for PTB were offered vaginal progesterone, low‑dose aspirin, and weekly telephonic nursing support. All other participants received routine care. This secondary analysis of nulliparous pregnancies of PRIME reports composite neonatal morbidity and neonatal intensive care unit (NICU) admissions. Models were adjusted for pre‑enrollment aspirin use and COVID‑19 status. RESULTS: Of 5018 PRIME participants, 1783 were nulliparous (G1P0). Significant reductions in composite neonatal morbidity scores were identified for neonates in the screen-guided care arm versus routine care. The NICU admission rate was 12.8% in the screen-guided care arm, compared to 16.4% of neonates in the routine care arm (p = .039), which equates to a number needed to screen of 28 nulliparous pregnancies to prevent one NICU admission. When adjusted for pre-enrollment aspirin use and COVID-19 status, the screen-guided care arm had significantly fewer NICU admissions (OR 0.75; 95% CI, 0.57-0.98; p = .036). NICU admission reductions were concentrated in spontaneous PTBs of nulliparous pregnancies. The interventions were well-tolerated, and there were no serious adverse events among the nulliparous subgroup of PRIME participants in the screen-guided care arm. CONCLUSIONS: In nulliparous PRIME trial participants, IGFBP4/SHBG screen-guided care reduced composite neonatal morbidity and NICU admissions compared to routine care. These findings support the clinical utility of biomarker-guided preventive strategies in first-time pregnancies lacking prior obstetric history.
BACKGROUND: Globally, more than 230 million girls and women have undergone female genital mutilation/cutting (FGM/C). It is estimated that about one-fourth of them reside in East Africa. Studies highlight educational attainment as one of the major factors contributing to the practice. OBJECTIVE: This study aimed to assess maternal education-related inequality in FGM/C among daughters aged 0-14 years by using Demographic and Health Survey (DHS) data (2016-2022) from three East African countries. METHODS: Stata version 17 was used for the data analysis. We analyzed pooled, nationally representative DHS data (2016-2022) from three East African countries (Ethiopia, Kenya, and Tanzania), involving a weighted sample of 23,596 daughters. Maternal education-related inequality was measured using the Erreygers Normalized Concentration Index. A decomposition analysis was conducted to determine the percentage contribution of maternal and household-level factors to the observed inequality. RESULTS: The findings revealed a pro-low-education distribution of the practice, with an Erreygers index of -0.126 (p < 0.001), indicating that FGM/C is significantly concentrated among daughters of less educated mothers. Decomposition analysis showed that maternal education accounted for the largest share of the observed inequality (42.51%), followed by maternal FGM/C status (23.79%), non-exposure to media (22.58%), rural residence (13.86%), and maternal age < 18 years at first cohabitation (8.7%), whereas the wealth index narrowed the inequality by 23.44%. CONCLUSIONS: FGM/C is disproportionately concentrated among daughters of less educated mothers. The observed inequality was largely shaped by maternal factors, indicating that limited educational attainment and intergenerational transmission play a substantial role in sustaining FGM/C among daughters.
Human vaccines & immunotherapeuticsYu Song, Jingjing Sun, Yu Ling, Sixiang Liu, Zhen Xu, Min Ma, Ou Zhang, Xueyan Zhao
Children with special health care needs (CSHCN) are at increased risk of vaccine-preventable diseases, yet concerns about safety often lead to delayed or incomplete immunization. We conducted a retrospective analysis of 1278 CSHCN attending the Special Vaccination Consultation Clinic of Kunming Children's Hospital in Yunnan Province, China, between January 2023 to December 2024. We examined their disease spectrum, vaccination recommendations, and incidence of adverse events following immunization (AEFI). The cohort had a male-to-female ratio of 1.3:1, with infants aged 0-1 y constituting the majority (56.4%). Neurological (38.3%), neonatal (33.6%), and cardiovascular diseases (21.4%) predominated the consultation spectrum, with a marked age-dependent shift from neonatal conditions in early infancy to neurological disorders thereafter. Following specialist evaluation, 92.5% of children received vaccination advice: 76.7% were recommended for standard or single-dose sequential vaccination, and 15.8% for inactivated vaccines only; only 2.7% were advised to defer all vaccinations. Among 1182 children who were subsequently vaccinated, 174 reported AEFI, yielding an incidence of 14.7%. Fever was the predominant manifestation (70.7% of AEFI), and the vast majority (99.4%) of events occurred in children under 4 y of age. This study demonstrates that under the guidance of a specialized vaccination clinic, over 90% of CSHCN can be safely vaccinated. Individualized assessment based on age and disease characteristics is pivotal to ensuring immunization in this vulnerable population, thereby safeguarding their right to protection against vaccine-preventable diseases.
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal ObstetriciansVirginie Collin-Bund, Mathilde Pierrat, Marie Zilliox, Chris Minella, Nathan Begusic, Yohny Montoya, Véronique Mersch, Nicolas Sananès, Charlotte Arnalsteen, A…
INTRODUCTION: Congenital cytomegalovirus (CMV) infection remains the most common congenital infection worldwide. The implementation of systematic first-trimester CMV screening during pregnancy has been widely debated. In June 2025, the French National Authority for Health recommended nationwide screening in pregnant women. This study aimed to describe maternal-fetal transmission, neonatal infection, and pregnancy outcomes following the implementation of early CMV screening within a regional perinatal network prior to national adoption. MATERIALS AND METHODS: We conducted a retrospective multicenter observational study in three maternity units in Alsace between April 2021 and November 2023. Eligible patients had a primary CMV infection diagnosed periconceptionally or during the first trimester, based on serological screening performed up to 14 weeks of gestation. The primary objective of this study was to describe maternal-fetal transmission rates and neonatal outcomes following first-trimester CMV screening within a regional perinatal network. Secondary objectives included describing antenatal management strategies, including valaciclovir use, and pregnancy outcomes. RESULTS: Thirty-eight patients with primary CMV infection were identified among 29,657 deliveries during the study period. Valaciclovir was administered in 47% of cases. Amniocentesis was performed in 68% of patients, with three positive results. Neonatal CMV testing was available in 80% of live births. Three newborns tested positive for CMV at birth, and one pregnancy was medically terminated due to confirmed CMV infection. The overall rate of congenital CMV infection among infected mothers was 10.5%. CONCLUSION: Early CMV screening enabled identification and management of primary maternal infection in routine practice. However, the descriptive design and limited sample size preclude conclusions regarding clinical effectiveness or impact on vertical transmission.
AIMS: In December 2025, the Advisory Committee on Immunization Practices recommended individual-based decision-making-termed shared clinical decision-making (SCDM) on CDC schedules-for hepatitis B (HepB) birth-dose vaccination in infants of mothers documented as HBsAg-negative at delivery. We evaluated projected economic, health, and distributional consequences for the 2026 US birth cohort. MATERIALS AND METHODS: A hybrid decision tree-Markov cohort model took the societal perspective over a lifetime horizon for 3.6 million 2026 US births, under three coverage-decline scenarios (10-, 20-, and 30-percentage-point). Costs (2026 US dollars) and outcomes were discounted 3% annually. Outcomes included costs, infections, deaths, quality-adjusted life years (QALYs), and equity impacts by insurance, race/ethnicity, hospital type, and geography. Probabilistic sensitivity analysis used 10,000 iterations; reporting followed CHEERS 2022. RESULTS: Under the base-case 20-percentage-point decline, SCDM was projected to produce approximately 44 additional acute infections, 8 additional chronic HBV cases, 2 additional HBV-related deaths (incomplete-linkage scenario), and 56 discounted QALYs lost per cohort. Assuming incremental counseling time for all policy-sensitive births, SCDM generated approximately $301 million in net societal cost-driven principally by provider counseling opportunity cost, not disease treatment-and was dominated by universal vaccination. With counseling time assigned zero cost, SCDM remained less effective but less costly, implying approximately $0.7 million per QALY to retain universal vaccination. Modeled burdens concentrated among Medicaid/CHIP and safety-net populations. LIMITATIONS: This early assessment used scenario-based coverage-decline, counseling-time, mortality, and completion assumptions as post-policy data were unavailable; results are projections, not observations. CONCLUSIONS: Moving from universal birth-dose vaccination to SCDM was projected to reduce timely vaccination and increase preventable infections across all scenarios. The societal-cost conclusion hinged on whether SCDM imposed counseling-time burden at scale, whereas the unfavorable health-effect direction was robust. Postimplementation evidence on coverage, counseling, completion, and linkage to care is needed before treating SCDM as low-cost or low-risk.
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal ObstetriciansGilmar de Souza Osmundo, Rosa Maria de Souza Aveiro Ruocco, Stela Verzinhasse Peres, Rossana Pulcineli Vieira Francisco
OBJECTIVES: To evaluate clinical and immunological characteristics associated with adverse perinatal outcomes among pregnant people living with HIV (PPLH). METHODS: This retrospective cohort study included singleton pregnancies of PPLH followed between 2006 and 2019 at a Brazilian tertiary referral center for high-risk pregnancies. Clinical and HIV-related data, including viral load (VL), CD4+ cell count, lymphopenia, and opportunistic infections (OI), were obtained from medical records. The primary endpoint was a composite adverse perinatal outcome defined as preterm birth (PTB) and/or low birth weight (LBW). Multivariable logistic regression was performed to identify factors independently associated with adverse outcomes. RESULTS: A total of 167 pregnancies were analyzed. The prevalence of the composite adverse perinatal outcome was 28.1%. Adverse outcomes were associated with previous opportunistic infection (p = 0.049), gestational opportunistic infection (p = 0.019), higher baseline viral load (p = 0.049), baseline lymphopenia (p = 0.002), lower body mass index (p = 0.044), lower CD4 cell count at 34 weeks (p = 0.014), and lack of viral suppression at 34 weeks (p = 0.008). In multivariable analysis, baseline VL (adjusted OR = 1.73, 95% CI = 1.10-2.99) and baseline lymphopenia (adjusted OR = 7.67, 95% CI = 1.37-42.8) remained independently associated with adverse perinatal outcomes. CONCLUSIONS: Adverse perinatal outcomes remain frequent among PPLH. Baseline viral load and lymphopenia were independently associated with PTB and/or LBW, highlighting the importance of early viral suppression and immune stabilization during pregnancy.
Gut microbesNina M Frerichs, Rimke R de Kroon, Yannick van Schajik, Sofia El Manouni El Hassani, Aranka J van Wesemael, Willem P de Boode, Veerle Cossey, Christian V Hulze…
Intestinal bacterial translocation to the bloodstream is a route of infection for late-onset sepsis (LOS) in preterm infants, highlighting the potential of fecal microbiota profiling for early risk stratification. We aimed to identify and validate LOS-specific gut microbiota signatures. Fifty-eight preterm infants (gestational age < 30 weeks) with blood culture-proven LOS (excluding coagulase-negative staphylococci) were matched to controls (1:1) across three cohorts (Discovery (DC) n = 18; Validation 1 and 2; VC1 n = 12, VC2 n = 28). Fecal samples collected up to 10 days before LOS onset underwent 16S rRNA gene sequencing. Microbial composition, diversity, and discriminatory taxa were compared across LOS subgroups. Random Forest (RF) models were trained in DC and validated in VC1/VC2. Microbiota variation was largely explained by LOS pathogen (R2 = 17%, P < 0.001). Infants with non-staphylococcal and E. coli-LOS showed a temporal increase in relative abundance of Escherichia/Shigella. The RF model distinguishing E. coli-LOS from controls displayed the highest discriminatory performance (AUC = 0.99/0.78/0.61 for DC/VC1/VC2) compared to non-staphylococcal LOS (AUC = 0.96/0.46/0.41). Our findings demonstrate profound microbiota shifts preceding E. coli-LOS, with higher discriminatory ability compared to non-staphylococcal-LOS. While pathogen-specific microbiota-based risk stratification may offer added clinical value, reduced validation performance highlights the limited generalizability and underscores the need for future research before clinical translation.
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal ObstetriciansLvping Gu, Jie Shen
BACKGROUND: Intrahepatic cholestasis of pregnancy (ICP) is linked with adverse perinatal outcomes; however, its impact in twin pregnancies remains unclear. This systematic review and meta-analysis aimed to evaluate maternal and neonatal outcomes in twin pregnancies complicated by ICP. METHODS: A comprehensive search of PubMed, Embase, Web of Science, and Scopus was conducted from inception to 14 February 2026. Cohort studies comparing twin pregnancies with and without ICP were included. Random-effects meta-analyses were performed to assess maternal and neonatal outcomes reported by at least three studies. RESULTS: Seven retrospective cohort studies were included. ICP in twin pregnancies was associated with increased risk of cesarean delivery, preeclampsia, and gestational diabetes mellitus. Preterm birth (PTB) <37 weeks was significantly increased with ICP in both crude and adjusted analysis. Mean gestational age was significantly reduced, and birthweight was lower in ICP. ICP was strongly associated with meconium-stained amniotic fluid and increased neonatal intensive care unit (NICU) admission. However, no significant association was noted between ICP and stillbirth, small-for-gestational age and postpartum hemorrhage. CONCLUSIONS: ICP in twin pregnancies is associated with PTB and increased maternal and neonatal morbidity. Current evidence is derived mostly from crude data and from a limited number of studies with high inter-study heterogeneity.
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal ObstetriciansYunxiu Li, Fei Wu, Ming Yang, Xiaoling Feng, Liangliang Li, Yan Peng, Hongfa Xie
INTRODUCTION: Cesarean delivery during the second stage of labor is increasing, while the use of forceps is declining. Evidence on forceps in trial of labor after cesarean (TOLAC) is limited. We compared maternal and neonatal outcomes between attempted forceps delivery and second-stage repeat cesarean (ssRCD) among TOLAC women, and compared forceps outcomes between TOLAC women and those with no prior cesarean (NPC). METHODS: This retrospective cohort study (2015-2022) included singleton, term, vertex pregnancies requiring immediate second-stage delivery due to fetal distress, prolonged second stage, or maternal compromise. Three groups were defined: fd-TOLAC (forceps delivery in TOLAC), ssRCD (second-stage repeat cesarean without attempted forceps), and fd-NPC (forceps delivery in women with NPC). Outcomes were compared between fd-TOLAC and ssRCD, and between fd-TOLAC and fd-NPC. RESULTS: A total of 176, 30, and 769 women were included in the fd-TOLAC, ssRCD, and fd-NPC groups, respectively. Compared to ssRCD, fd-TOLAC had lower postpartum hemorrhage (1.1% vs 20.0%; aOR 0.05, 95% CI 0.01-0.33), blood transfusion (4.0% vs 23.3%; aOR 0.15, 95% CI 0.04-0.57), and postpartum infection (1.7% vs 10.0%; aOR 0.06, 95% CI 0.01-0.58). One hysterectomy occurred in ssRCD (3.3%), compared with none in fd-TOLAC (p = 0.234). No significant differences were observed in neonatal outcomes between the groups. Maternal and neonatal outcomes did not differ between fd-TOLAC and fd-NPC (p > 0.05). CONCLUSION: In TOLAC women requiring second-stage delivery, clinically feasible low forceps was associated with lower maternal morbidity than ssRCD without increased neonatal risk. Forceps outcomes in TOLAC were comparable to NPC. Findings suggest the safety of attempted forceps in selected TOLAC patients.
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal ObstetriciansPatrick M Conley, Rachel A Newman, Tania Esakoff, Natalie A Bello
OBJECTIVES: Extremes of maternal age are associated with an increased risk of adverse pregnancy outcomes (APOs). Less is known about the independent effects of extremes of paternal age on reproductive risk. METHODS: We conducted a secondary analysis using data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) using restricted cubic spline logistic regression to examine the non-linear association between paternal age and APOs and adverse fetal/neonatal outcomes. RESULTS: After adjusting for maternal health and sociodemographic and paternal sociodemographic confounders, we found no evidence of overall association (χ2 = 3.88, p = 0.143) or non-linearity (χ2 = 1.72, p = 0.189) between paternal age and composite APOs and adverse fetal/neonatal outcomes (Table 1). Additionally, after adjustment we did not find any statistical significance when examining separate composite APO outcomes (overall: χ2 = 3.02, p = 0.221; non-linearity: χ2 = 2.68, p = 0.101) or composite adverse fetal/neonatal outcomes (overall: χ2 = 1.73, p = 0.421; non-linearity: χ2 = 0.14, p = 0.706). Among adjusted individual outcomes, only gestational hypertension showed statistical significance for both overall association (χ2 = 6.72, p = 0.035) and evidence of non-linearity (χ2 = 4.12, p = 0.042). CONCLUSIONS: While our findings do not support a strong independent association between paternal age and composite APOs and adverse fetal/neonatal outcomes, the non-linear association with gestational hypertension may warrant further study with sufficient paternal age representation and paternal health factors.
Gut microbesLaura Haag, Stefanie Dietz-Ziegler, Julian Schwarz, Gabriele Kaiser, Jessica Rühle, Janine Hebel, Till Lesk, Trim Lajqi, Jennifer Müller, Ulrich Schoppmeier, R…
Neonatal sepsis represents a major risk in preterm infant care, resulting in widespread early-life antibiotic exposure. While the latter has been linked to immune maturation in term-born neonates, its impact on preterm immune development remains unclear. The aim of this prospective observational study was to investigate the effect of early antibiotic exposure on vaccine titers at a corrected age of four months. To achieve this, blood and stool samples were analyzed from 69 preterm infants (<32 weeks gestational age; 35 with 34 without antibiotic exposure during the first postnatal week) at postnatal day 14 and again at four months corrected age. We assessed vaccine-induced antibody titers against Bordetella pertussis and Haemophilus influenzae, immune cell profiles (flow cytometry), gut microbiome composition (16S rRNA sequencing), and plasma amino acid and acylcarnitine levels (tandem mass spectrometry). Preterm infants exposed to early antibiotics showed reduced antibody titers following vaccination, with differences appearing more pronounced in girls. Antibiotic-exposed girls displayed increased monocytes and myeloid-derived suppressor cells (MDSCs), both of which inversely correlated with antibody titers. Early antibiotic exposure was associated with differences in microbial community types at postnatal day 14, with Klebsiella-dominated and Bifidobacteria-lacking communities occurring more frequently in antibiotic-exposed infants. Antibiotic-exposed girls exhibited distinct metabolomic alterations, including elevated levels of two unsaturated fatty acids that negatively correlated with monocyte and MDSC abundance. Our findings suggest that early antibiotic exposure impairs vaccine responses in preterm infants and indicates a potentially sex-specific susceptibility. Antibiotic-driven changes in the microbiome and metabolome may sustain suppressive innate immune cell populations, which may in turn weaken adaptive responses to vaccination.