Predicting Perinatal Outcomes With an Obstructive Sleep Apnea Screening Tool [13N

Prediction by maternal risk factors of neonatal intensive care admissions: Evaluation of >59,000 women in national managed care programs

ObjectiveActive inflammatory bowel disease (IBD) during pregnancy may require the use of corticosteroids. The aim of this study was to investigate the impact of in utero corticosteroid exposure on adverse...

This study aimed to evaluate the preterm birth and additional perinatal outcomes between spontaneous and in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) dichorionic-diamnionic (DCDA) twin pregnancies. This retrospective cohort study was conducted in a tertiary university-affiliated medical center. All women with DCDA twin pregnancies were considered for inclusion. The primary outcome of interest was preterm birth <37weeks of gestation and secondary outcomes included spontaneous preterm birth, iatrogenic (induced) preterm birth, gestational diabetes mellitus, pregnancy-induced hypertensive disorder, preeclampsia, preterm premature rupture of membranes (PPROM), intrahepatic cholestasis of pregnancy, placenta previa, neonatal intensive care unit (NICU) admission, birthweight discordance, small for gestational age, neonatal respiratory distress syndrome, ventilator support, and perinatal death and/or severe morbidity. These outcomes were compared between IVF/ICSI and spontaneous twin pregnancies. Multivariable logistic regressions were used to adjust for confounders. General estimated equation models were used to address intertwin correlation. A total of 1297 twin pregnancies, including 213 spontaneous and 1084 IVF/ICSI DCDA pregnancies, met the inclusion criteria. Women with IVF/ICSI pregnancies were older and had higher body mass index, adherence with prenatal care and proportion of nulliparity. After adjustment for confounders, IVF/ICSI pregnancies were associated with a slight increase in preterm birth <37weeks of gestation (adjusted odds ratio [aOR] 1.72; 95% CI 1.24-2.39), iatrogenic preterm birth <37weeks of gestation (aOR 1.41; 95% CI 1.00-1.97) as well as NICU admission (aOR 1.34; 95% CI 1.00-1.80). IVF/ICSI pregnancies were associated with a decrease in PPROM (aOR 0.64; 95% CI 0.42-0.99). There were no differences between IVF/ICSI and spontaneous DCDA pregnancies in terms of spontaneous preterm birth, gestational diabetes mellitus, pregnancy-induced hypertensive disorder, preeclampsia, intrahepatic cholestasis of pregnancy, placenta previa, birthweight discordance, small for gestational age, neonatal respiratory distress syndrome, ventilator support, and perinatal death and/or severe morbidity. IVF/ICSI DCDA twin pregnancies were associated with a slight increase in preterm birth <37weeks of gestation, iatrogenic preterm birth <37weeks of gestation, and NICU admission but with a decrease in PPROM. Other outcomes were comparable between IVF/ICSI and spontaneous DCDA twin pregnancies. Multicenter studies with adequate power remain warranted.

Objective The objectives of this study were to identify maternal psychological responses to infants’ neonatal intensive care unit (NICU) admission, understand the relationship between psychological symptoms and maternal-infant attachment, and evaluate change in psychological symptoms over time. Background Accumulating evidence suggests that infants’ admission to a NICU may adversely impact maternal psychiatric functioning. NICU mothers typically experience high levels of depressive, anxiety, and stress symptoms. Methods Mothers (N = 127) recruited from their infants’ NICU bedside at three hospitals in the Philadelphia area completed self-report measures of depression, anxiety, stress, and maternal-infant attachment during the NICU admission and then 2–4 months later. A series of bivariate correlations, paired samples t-tests, and linear regression analyses were used to evaluate the primary study aims. Results NICU mothers reported elevated rates of depressive, anxiety, and stress symptoms. Maternal-infant attachment was negatively associated with anxiety and stress symptoms. Both depressive and anxiety symptoms were higher during NICU admission compared to 2–4 months later, and depressive symptoms during NICU admission predicted depressive symptoms 2–4 months later. Conclusions This study demonstrates that NICU admission may heighten maternal risk for psychiatric symptoms, and maternal-infant attachment in the NICU may be an important correlate of maternal anxiety and stress symptoms.

Unexpected term NICU admissions: a marker of obstetrical care quality?

Induction-to-delivery time interval under general anesthesia and neonatal intensive care unit admissions: a single-center retrospective cross-sectional study in planned cesarean deliveries (2014-2024).

To investigate whether obstetric complications prior to systemic sclerosis (SSc) diagnosis are more common in SSc patients compared to the general obstetric population. A case-control study was performed at Kaiser Permanente Northern California to compare prior obstetric complications in adult women who later developed SSc (cases) with women from the general obstetric population who did not develop SSc (controls; matched 10:1 by age and year of delivery) from 2007 to 2016. Exposures included past hypertensive disorders of pregnancy (preeclampsia, eclampsia, gestational hypertension), premature rupture of membranes (PROM), intrauterine growth restriction (IUGR), maternal infections, neonatal intensive care unit (NICU) admission, and preterm birth. Fischer's exact tests were used to compare categorical variables. Conditional logistic regression models estimated the odds ratio (OR), and corresponding 95% confidence intervals (95% CIs) for the outcome SSc. Seventeen SSc cases and 170 non-SSc controls were identified, with median maternal age at delivery 34 years (range 23-46 years) and median time from delivery to SSc diagnosis 2 years (range 0.2-7.3 years). Women with SSc were more likely to be Hispanic and Black. Prior obstetric complications appeared higher in women with an eventual SSc diagnosis compared to controls (70.6% versus 50%), including hypertensive disorders (17.7% versus 9.4%), PROM (11.8% versus 4.1%), IUGR (5.9% versus 1.8%), maternal infection (29.4% versus 14.1%), NICU admissions (23.5% versus 7.7%), and preterm delivery (29.4% versus 21.8%). Women with SSc had a higher odds of delivering infants requiring NICU admission (OR 4.7 [95% CI 1.2-18.8]). Women who eventually develop SSc had trends toward more complicated pregnancy histories before overt diagnosis.

Background Placenta previa is a potentially dangerous condition that can affect pregnant women, leading to significant maternal morbidity and adverse perinatal outcomes. Aim of the Work Evaluation of placenta previa management, study of maternal and perinatal outcomes in cases of placenta previa, and study of risk factors for placenta previa. Patients and Methods The study included 80 women with placenta previa who were diagnosed and managed at El-Demerdash Maternity Hospital. Results The sociodemographic characteristics of the included patients showed a preponderance of the ages above 30 years, multiparity, history of previous cesarean section, and history of uterine scarring. Maternal outcomes showed a reasonable decrease in the hemoglobin level postoperatively compared with preoperatively. However, there was a high incidence of blood transfusion. There was an overabundance of general anesthesia performance during surgical intervention. The majority of the placenta previa patients had cesarean delivery; however, there was a low incidence of maternal surgical injuries and mortality. Regarding neonatal outcomes, most of the neonates belonged to the preterm group. The neonatal intensive care unit (NICU) admission was reported in nearly half of the included patients, attributed to preterm, respiratory distress (RD), and intrauterine growth restriction (IUGR). There was a low incidence of perinatal mortality. Conclusion In El-Demerdash Maternity Hospital, risk factors for placenta previa were age above 30 years, multiparity, history of previous cesarean section, and history of uterine scarring. Most placenta previa patients received conservative surgical management rather than cesarean hysterectomy. Despite the higher rate of conservative surgical management compared to cesarean hysterectomy, maternal surgical morbidity and mortality were low. However, there was a higher frequency of blood transfusion to manage postpartum hemorrhage. Most of the neonates were preterm, and neonatal intensive care unit admission was reported in nearly half of the included patients. There was a low incidence of perinatal mortality.

Polyhydramnios is usually diagnosed with an amniotic fluid index (AFI) ≥ 24.0 cm or a maximum vertical pocket (MVP) ≥ 8.0 cm [1]. However, which methodology—AFI versus MVP—has a stronger association with adverse perinatal outcomes is uncertain. Our aim was to undertake a systematic review of the literature of studies comparing AFI, MVP or AFI&MVP for polyhydramnios related to adverse perinatal outcomes. We conducted a systematic review of the literature. Medline, Cochrane Library, EMBASE, Pubmed Central, Scopus and ClinicalTrial.gov were electronically searched from their inception to April 2025. Multiple combinations of (MeSH) terms and word variants (‘amniotic fluid index’, ‘AFI’, ‘deepest vertical pocket’, ‘DVP’, ‘maximum vertical pocket’, ‘MVP’, ‘polyhydramnios’, ‘hydramnios’) were used. No restrictions for geographic location or temporal limit were applied. Evaluation of each included study followed the Newcastle Ottawa Scale for cohort studies [2]. Disagreements were resolved by discussion until a consensus was reached. As we originally planned to do a systematic review and meta-analysis, the review was registered with the PROSPERO International Prospective Register of Systematic Reviews (registration No. CRD420251040958). Studies were included if they evaluated adverse perinatal outcomes by either AFI, MVP or AFI and MVP for the diagnosis of polyhydramnios. Electronic search, inclusion criteria and risk of bias assessment were independently assessed by two reviewers (AP and VB). Data from each eligible study were extracted without modification of original data onto custom-made data collection forms. The primary outcome was perinatal mortality, as defined by the included studies [3] (sum of stillbirths and neonatal deaths). Secondary outcomes were large for gestational age (LGA) or macrosomia (estimate of fetal weight ≥ 90th percentile or absolute weight ≥ 4000 g, respectively), fetal growth restriction (FGR, estimate of fetal weight < 10th percentile or as defined by included studies), IUFD, neonatal intensive care unit (NICU) admission and neonatal death. Out of 133 studies screened, there were no RCTs comparing the outcomes using MVP, AFI or both. Five non-RCT studies were assessed for eligibility for a total of 5319 patients [3-7] (Figure 1). However, only one retrospective study reported neonatal outcomes [7] (Table 1) and could be included in the analysis, and it was judged as low quality. In this study, polyhydramnios was identified by an AFI ≥ 24 cm or an MVP ≥ 8 cm on at least one ultrasound ≥ 20 weeks [7]. Those diagnosed with polyhydramnios by both methods had an increased risk of perinatal mortality (aRR = 5.94, 95% CI 3.07–11.50), including IUFD (aRR = 5.58, 95% CI 2.81–11.09) and neonatal death (aRR = 13.07, 95% CI 1.72–99.60), compared to those with normal amniotic fluid (Table 1). Only MVP and AFI were associated with increased risks of FGR, IUFD, NICU admission, neonatal and perinatal death (Table 1). Although polyhydramnios is frequently found in clinical practice, there is limited prospective, high-quality data concerning the best ultrasonographic methodology associated with adverse perinatal outcomes. Only Kraus et al. [7] compare AFI, MVP or both in terms of adverse perinatal outcomes, finding that polyhydramnios diagnosed by both methods is associated with an increased risk of perinatal mortality (Table 1). This is interestingly in contrast with the literature regarding oligohydramnios. A recent meta-analysis included 6 RCTs for a total of 4278 patients in the setting of oligohydramnios [4] showed that the use of MVP was associated with significantly lower rates of non-reassuring fetal heart tracing, Caesarean Delivery for non-reassuring fetal heart testing, and induction of labour, but without any worsening of adverse pregnancy outcomes [4]. To our knowledge, there are no ongoing RCTs on polyhydramnios diagnosis in terms of adverse perinatal outcomes. There is an urgent need for RCTs comparing different ultrasonographic methodologies for the diagnosis of polyhydramnios in terms of adverse perinatal outcomes, leading to an evidence-based management of polyhydramnios in everyday clinical practice. All authors fulfil the criteria of authorship. The authors have nothing to report. Transparency: The lead author (the manuscript's guarantor) affirms that the manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted and that any discrepancies from the study as planned have been explained. The authors have nothing to report. The authors have nothing to report. The authors declare no conflicts of interest. The data that support the findings of this study are available from the corresponding author upon reasonable request.

ObjectiveTo compare maternal and infant outcomes with different antihypertensive medications in pregnancy.DesignRetrospective cohort study.SettingKaiser Permanente, a large healthcare system in the United States.PopulationWomen aged 15–49 years with a singleton birth from 2005–2014 treated for hypertension.MethodsWe identified medication exposure from automated pharmacy data based on the earliest dispensing after the first prenatal visit. Using logistic regression, we calculated weighted outcome prevalences, adjusted odds ratios (aORs) and 95% confidence intervals, with inverse probability of treatment weighting to address confounding.Main outcome measuresSmall for gestational age, preterm delivery, neonatal and maternal intensive care unit (ICU) admission, preeclampsia, and stillbirth or termination at > 20 weeks.ResultsAmong 6346 deliveries, 87% with chronic hypertension, the risk of the infant being small for gestational age (birthweight < 10th percentile) was lower with methyldopa than labetalol (prevalence 13.6% vs. 16.6%; aOR 0.77, 95% CI 0.63 to 0.92). For birthweight < 3rd percentile the aOR was 0.57 (0.39 to 0.80). Compared with labetalol (26.0%), risk of preterm delivery was similar for methyldopa (26.5%; aOR 1.10 [0.95 to 1.27]) and slightly higher for nifedipine (28.5%; aOR 1.25 [1.06 to 1.46]) and other β-blockers (31.2%; aOR 1.58 [1.07 to 2.23]). Neonatal ICU admission was more common with nifedipine than labetalol (25.9% vs. 23.3%, aOR 1.21 [1.02 to 1.43]) but not elevated with methyldopa. Risks of other outcomes did not differ by medication.ConclusionsRisk of most outcomes was similar comparing labetalol, methyldopa and nifedipine. Risk of the infant being small for gestational age was substantially lower for methyldopa, suggesting this medication may warrant further consideration.

Objective Evaluate the association between current recommendations for active labor duration in nulliparous women undergoing labor induction and adverse perinatal outcomes. Study design Retrospective cohort study from 2012 to 2015. Subjects were nulliparous, 18–44 years, cephalic, singleton ≥37 weeks undergoing labor induction who reached active labor. We created three subgroups, defined by active labor duration from 6 to 10cm as < the median, median-95th percentile, and >95th percentile based on contemporary labor curves. We evaluated the association between subgroups and cesarean delivery, chorioamnionitis, blood loss (EBL), 5-minute Apgar score < 7, and neonatal intensive care unit (NICU) admission using logistic regression. Results Among 356 women, 34.8% had an active labor duration < median, 43.3% were between the median-95th percentile, and 21.9% were >95th percentile. The risk of cesarean delivery increased with longer active labor duration; 1.8-fold (95%CI = 1.1–3.1) and 4.0-fold (95%CI = 2.5–6.5) for women whose active labors were between the median-95th percentile and >95th percentile, respectively. Chorioamnionitis increased by 3.9-fold (95%CI = 1.2–13.2) in the >95th percentile subgroup. Active labor length was not associated with EBL, Apgar scores, or NICU admission. Conclusions Cesarean delivery and chorioamnionitis increased significantly as induced active labor duration exceeded the median. This study provides a better understanding regarding the risks of longer active labor as defined by contemporary labor curves.

To evaluate trends in neonatal intensive care unit (NICU) admissions, illness acuity, and hospitalization costs among U.S. children's hospitals from 2017 to 2022. This retrospective cohort study used data from the Pediatric Health Information System (PHIS) and included all NICU admissions. We examined trends in patient characteristics (e.g., gestational age, complex chronic conditions), illness severity scores, and standardized hospital costs. Interrupted time series analyses assessed changes in NICU costs over time. There were 234,571 infants admitted to NICUs in US children's hospitals between 2017 and 2022. NICU admissions shifted significantly by gestational age with admissions increasing by 10-18% among extremely, very, and late preterm infants. Term infants remained the largest admission group, averaging 45% annually (p < 0.001). Infants with ≥1 complex chronic condition increased from 46.6% in 2017 to 50.9% in 2022 (p < 0.001). NICU-specific illness severity increased modestly over time (1.14-1.24, p < 0.001). Median standardized NICU hospital costs rose by approximately 20% over the study period, with notable inflections in early 2020 and 2021. Among US children's hospitals in the PHIS database, NICU admissions were increasingly complex and costly. These findings highlight the importance of ongoing monitoring of resource use and patient mix in specialized NICU settings.

Aim: This study was to evaluate the applicability of Doppler velocimetry to determine its correlation with fetal outcome in dichorionic twin pregnancies. Material and methods: Doppler examination of the umbilical artery (UA) and middle cerebral artery (MCA) was performed in 57 twin pairs. Abnormal values of the umbilical artery pulsatility index (PI), umbilical artery Resistive index (RI) were above the 95th percentile and below 5th percentile for the Middle cerebral artery pulsatility index (MCA PI) and Middle cerebral artery resistivity index (MCA RI) for gestational week. The difference of UA PI ≥0.5 in twin pairs was considered abnormal. Results: 33 subjects had a fetal discordance of greater than 15%. Birth weight was found to be significantly lower in subjects with Umbilical artery PI greater than 95th percentile for gestational age (p=0.014). Abnormal MCA RI (P=0.018) and Umbilical artery RI values above 95th percentile was significantly associated with increased risk of IUGR (intra uterine growth restriction) (P=0.036) and NICU (Neonatal intensive care unit) admission (P=0.005). Increased Umbilical artery PI values above 95th percentile was significantly associated with IUGR (P=0.003). Increased Umbilical Artery systolic/diastolic ratio above 95th percentile was significantly associated with IUGR (P=0.002), NICU admission (P=0.026) and still birth (P=0.026). Abnormal cerebra-umbilical ratio ( 0.5) was significantly correlated with increased degree of birth weight discordance of the twins, IUGR (P=0.001) and still birth (P=0.001). Conclusion: Abnormal Doppler values in discordant twin fetus are more likely to be associated with abnormal fetal outcome.

Evidence is inconsistent regarding grand multiparity and its association with adverse obstetric outcomes. Few large American cohorts of grand multiparas have been studied. We assessed if increasing parity among grand multiparas is associated with increased odds of adverse perinatal outcomes. Multicenter retrospective cohort of patients with parity ≥ 5 who delivered a singleton gestation in New York City from 2011 to 2019. Outcomes included postpartum hemorrhage, preterm delivery, hypertensive disorders of pregnancy, shoulder dystocia, birth weight > 4,000 and <2,500 g, and neonatal intensive care unit (NICU) admission. Parity was analyzed continuously, and multivariate analysis determined if increasing parity and other obstetric variables were associated with each adverse outcome. There were 2,496 patients who met inclusion criteria. Increasing parity among grand multiparas was not associated with any of the prespecified adverse outcomes. Odds of postpartum hemorrhage increased with history (adjusted odds ratio [aOR]: 2.65, 95% confidence interval [1.83, 3.84]) and current cesarean delivery (aOR: 4.59 [3.40, 6.18]). Preterm delivery was associated with history (aOR: 12.36 [8.70-17.58]) and non-White race (aOR: 1.90 [1.27, 2.84]). Odds of shoulder dystocia increased with history (aOR: 5.89 [3.22, 10.79]) and birth weight > 4,000 g (aOR: 9.94 [6.32, 15.65]). Birth weight > 4,000 g was associated with maternal obesity (aOR: 2.92 [2.22, 3.84]). Birth weight < 2,500 g was associated with advanced maternal age (aOR: 1.69 [1.15, 2.48]), chronic hypertension (aOR: 2.45 [1.32, 4.53]), and non-White race (aOR: 2.47 [1.66, 3.68]). Odds of hypertensive disorders of pregnancy increased with advanced maternal age (aOR: 1.79 [1.25, 2.56]), history (aOR: 10.09 [6.77-15.04]), and non-White race (aOR: 2.79 [1.95, 4.00]). NICU admission was associated with advanced maternal age (aOR: 1.47 [1.06, 2.02]) and non-White race (aOR: 2.57 [1.84, 3.58]). Among grand multiparous patients, the risk factor for adverse maternal, obstetric, and neonatal outcomes appears to be occurrence of those adverse events in a prior pregnancy and not increasing parity itself. · Increasing parity is not associated with adverse obstetric outcomes among grand multiparas.. · Prior adverse pregnancy outcome is a risk factor for the outcome among grand multiparas.. · Advanced maternal age is associated with adverse obstetric outcomes among grand multiparas..

Assisted Reproductive Technology (ART) has made great strides in the past forty-years, but no medical treatment comes without side effects. Despite several studies reporting high incidences of perinatal complications, the association is inconclusive. Also, the effect of racially and ethnically distinguished Asian population undergoing ART on perinatal outcomes is not well studied. Therefore, this study attempts to compare various perinatal outcome parameters in ART, and spontaneously conceived singleton pregnancies from a single high-volume tertiary care center. This is a retrospective cohort study from a single tertiary infertility center, carried out from January 2011 to September 2020. The study included 1,125 IVF conceived babies (AB group) and 7,193 spontaneous conceived babies (SB group). The groups were compared using the Pearson Chi-square test and adjusted odds ratio, calculated using the multivariate analysis. Most of the perinatal complications, such as preterm birth (PTB), early preterm birth, low birth weight (LBW), extremely low birth weight, small for gestational age, large for gestational age babies, neonatal intensive care unit (NICU) admission, need for surfactant, meconium aspiration syndrome, neonatal seizures, intraventricular hemorrhage, hypoxic-ischemic encephalopathy, and patent ductus arteriosus was significantly increased in the AB group when compared to the SB group (p<0.05). In-vitro fertilization (IVF) independently increases the risk of LBW (aOR 2.530; 95% CI 2.194-2.917), PTB (aOR 4.004; 95% CI 3.496-4.587), NICU admission (aOR 2.003; 95% CI 1.610-2.492) and neonatal seizures (aOR 9.805; 95% CI 5.755-16.706).Conclusions: All ART-conceived pregnant patients should receive antenatal counselling regarding perinatal complications and should deliver at a tertiary care center with appropriate NICU support.