Obstetrics and gynecology最新文献

{"title":"Fezolinetant and Elinzanetant Therapy for Menopausal Women Experiencing Vasomotor Symptoms: A Systematic Review and Meta-analysis.","authors":"Artur Menegaz de Almeida, Paloma Oliveira, Lucca Lopes, Marianna Leite, Victória Morbach, Francinny Alves Kelly, Ítalo Barros, Francisco Cezar Aquino de Moraes, Alexandra Prevedello","doi":"10.1097/AOG.0000000000005812","DOIUrl":"https://doi.org/10.1097/AOG.0000000000005812","url":null,"abstract":"<p><strong>Objective: </strong>To assess the efficacy and safety of fezolinetant and elinzanetant for vasomotor symptoms in menopausal women.</p><p><strong>Data sources: </strong>MEDLINE, EMBASE, and Cochrane databases were systematically searched until August 22, 2024. Because the Cochrane Library included all the identified randomized controlled trials (RCTs), it was unnecessary to search ClinicalTrials.gov. The following words made up the search strategy, which was applied to the three databases: fezolinetant, elinzanetant, vasomotor symptoms, and menopause.</p><p><strong>Methods of study selection: </strong>Only RCTs comparing fezolinetant and elinzanetant with placebo for vasomotor symptoms in menopausal women were included.</p><p><strong>Tabulation, integration, and results: </strong>We extracted the number of patients, mean age, body mass index (BMI), and number of patients who underwent oophorectomy. Data were examined with the Mantel-Haenszel method and 95% CIs. Heterogeneity was assessed with I2 statistics. R 4.3.2 was used for statistical analysis. Seven RCTs with 4,087 patients were included in the analysis. Fezolinetant and elinzanetant were associated with diminished vasomotor symptom frequency: fezolinetant 30 mg (mean difference 2.16, 95% CI, 1.54-2.79, I2=0%), fezolinetant 45 mg (mean difference 2.54, 95% CI, 1.86-3.21, I2=0%), and elinzanetant 120 mg (mean difference 2.99, 95% CI, 1.74-4.23, I2=0%). Both drugs also showed a decrease in vasomotor symptom severity: fezolinetant 30 mg (mean difference 0.20, 95% CI, 0.09-0.33, I2=0%), fezolinetant 45 mg (mean difference 0.24, 95% CI, 0.13-0.34, I2=0%), and elinzanetant 120 mg (mean difference 0.36, 95% CI, 0.26-0.46, I2=0%). Elinzanetant 120 mg showed a significant improvement in sleep quality (mean difference 4.65, 95% CI, 3.73-5.56, I2=0%). Elinzanetant 120 mg was associated with the occurrence of drug-related adverse events (11.70% vs 20.75%, risk ratio [RR] 0.57, 95% CI, 0.39-0.82, I2=19%) and headache (2.54% vs 8.0%, RR 0.32, 95% CI, 0.16-0.64, I2=0%).</p><p><strong>Conclusion: </strong>In this meta-analysis, consistent results suggest that fezolinetant and elinzanetant are associated with beneficial outcomes in menopausal women with vasomotor symptoms. Elinzanetant provided a larger effect size in vasomotor symptom frequency and severity reduction and greatly improved sleep quality compared with fezolinetant.</p><p><strong>Systematic review registration: </strong>PROSPERO, CRD42023469952.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142922412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a Practical Prediction Model for Adverse Neonatal Outcomes at the Start of the Second Stage of Labor.","authors":"Mark A Clapp, Siguo Li, Kaitlyn E James, Emily S Reiff, Sarah E Little, Thomas H McCoy, Roy H Perlis, Anjali J Kaimal","doi":"10.1097/AOG.0000000000005776","DOIUrl":"10.1097/AOG.0000000000005776","url":null,"abstract":"<p><strong>Objective: </strong>To develop a prediction model for adverse neonatal outcomes using electronic fetal monitoring (EFM) interpretation data and other relevant clinical information known at the start of the second stage of labor.</p><p><strong>Methods: </strong>This was a retrospective cohort study of individuals who labored and delivered at two academic medical centers between July 2016 and June 2020. Individuals were included if they had a singleton gestation at term (more than 37 weeks of gestation), a vertex-presenting, nonanomalous fetus, and planned vaginal delivery and reached the start of the second stage of labor. The primary outcome was a composite of severe adverse neonatal outcomes. We developed and compared three modeling approaches to predict the primary outcome using factors related to EFM data (as interpreted and entered in structured data fields in the electronic health record by the bedside nurse), maternal comorbidities, and labor characteristics: traditional logistic regression, LASSO (least absolute shrinkage and selection operator), and extreme gradient boosting. Model discrimination and calibration were compared. Predicted probabilities were stratified into risk groups to facilitate clinical interpretation, and positive predictive values for adverse neonatal outcomes were calculated for each.</p><p><strong>Results: </strong>A total of 22,454 patients were included: 14,820 in the training set and 7,634 in the test set. The composite adverse neonatal outcome occurred in 3.2% of deliveries. Of the three modeling methods compared, the logistic regression model had the highest discrimination (0.690, 95% CI, 0.656-0.724) and was well calibrated. When stratified into risk groups (no increased risk, higher risk, and highest risk), the rates of the composite adverse neonatal outcome were 2.6% (95% CI, 2.3-3.1%), 6.7% (95% CI, 4.6-9.6%), and 10.3% (95% CI, 7.6-13.8%), respectively. Factors with the strongest associations with the composite adverse neonatal outcome included the presence of meconium (adjusted odds ratio [aOR] 2.10, 95% CI, 1.68-2.62), fetal tachycardia within the 2 hours preceding the start of the second stage (aOR 1.94, 95% CI, 1.03-3.65), and number of prior deliveries (aOR 0.77, 95% CI, 0.60-0.99).</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"73-81"},"PeriodicalIF":5.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delivery-Related Maternal Morbidity and Mortality Among Patients With Cardiac Disease.","authors":"Isabella Toledo, Heather Czarny, Emily DeFranco, Carri Warshak, Robert Rossi","doi":"10.1097/AOG.0000000000005780","DOIUrl":"10.1097/AOG.0000000000005780","url":null,"abstract":"<p><strong>Objective: </strong>To assess the risk of severe maternal morbidity (SMM) and mortality among pregnant patients with cardiovascular disease (CVD).</p><p><strong>Methods: </strong>This was a retrospective cohort study of U.S. delivery hospitalizations from 2010 to 2020 using weighted population estimates from the National Inpatient Sample database. The primary objective was to evaluate the risk of SMM and maternal mortality among patients with CVD at delivery hospitalization. International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification codes were used to identify delivery hospitalizations, CVD, and SMM events. Multivariable logistic regression analyses were performed to compare SMM and mortality risk among patients with CVD and those without CVD. Given the substantial racial and ethnic disparities in SMM, mortality, and CVD burden, secondary objectives included evaluating SMM and mortality across racial and ethnic groups and assessing the population attributable fraction within each group. Lastly, subgroup analyses of SMM by underlying CVD diagnoses (eg, congenital heart disease, chronic heart failure) were performed. Variables used in the regression models included socioeconomic and demographic maternal characteristics, maternal comorbidities, and pregnancy-specific complications.</p><p><strong>Results: </strong>Among 38,374,326 individuals with delivery hospitalizations, 203,448 (0.5%) had CVD. Patients with CVD had an increased risk of SMM (11.6 vs 0.7%, adjusted odds ratio [aOR] 12.5, 95% CI, 12.0-13.1) and maternal death (538 vs 5 per 100,000 delivery hospitalizations, aOR 44.1, 95% CI, 35.4-55.0) compared with those without CVD. Patients with chronic heart failure had the highest SMM risk (aOR 354.4, 95% CI, 301.0-417.3) among CVD categories. Black patients with CVD had a higher risk of SMM (aOR 15.9, 95% CI, 14.7-17.1) than those without CVD with an adjusted population attributable fraction of 10.5% (95% CI, 10.0-11.0%).</p><p><strong>Conclusion: </strong>CVD in pregnancy is associated with increased risk of SMM and mortality, with the highest risk of SMM among patients with chronic heart failure. Although CVD affects less than 1% of the pregnant population, it contributes to nearly 1 in 10 SMM events in the United States.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"e1-e10"},"PeriodicalIF":5.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Full-Term Nulliparous Individuals Without a Medical Indication for Delivery: ACOG Clinical Practice Update.","authors":"","doi":"10.1097/AOG.0000000000005783","DOIUrl":"10.1097/AOG.0000000000005783","url":null,"abstract":"<p><p>This Clinical Practice Update integrates data from a large, randomized controlled trial (the ARRIVE trial [A Randomized Trial of Induction Versus Expectant Management]) and subsequent other related studies into existing American College of Obstetricians and Gynecologists' guidance regarding management of pregnant individuals at 39 0/7-41 6/7 weeks of gestation without a medical indication for delivery. This document updates Practice Bulletin No. 146, Management of Late-Term and Postterm Pregnancies (Obstet Gynecol 2014;124:390-396) and replaces the Clinical Guidance for Integration of the Findings of the ARRIVE Trial: Labor Versus Expectant Management in Low-Risk Nulliparous Women Practice Advisory, originally published in August 2018.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"e45-e50"},"PeriodicalIF":5.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in Short Interpregnancy Interval Births in the United States, 2016-2022.","authors":"Lindsay K Admon, Colleen MacCallum-Bridges, Jamie R Daw","doi":"10.1097/AOG.0000000000005784","DOIUrl":"10.1097/AOG.0000000000005784","url":null,"abstract":"<p><strong>Objective: </strong>To measure contemporary trends in the prevalence of short interpregnancy interval (IPI) births in the United States.</p><p><strong>Methods: </strong>We conducted a repeated cross-sectional analysis using 2016-2022 natality data from the National Vital Statistics System. We included all singleton live births to individuals with at least one prior live birth. We examined trends over time in short IPIs less than 18 months, as well as for specific durations within this time frame (less than 6 months, 6-11 months, and 12-17 months), using linear probability models that estimated changes in the prevalence of each IPI duration over time. We then estimated the prevalence of each short IPI duration by maternal race and ethnicity, socioeconomic characteristics (age, education, insurance payer at delivery), and geography (U.S. census region, state of residence).</p><p><strong>Results: </strong>The study sample included 14,770,411 singleton live births to individuals with at least one prior live birth in 2016-2022. Roughly a third (29.8%) of births had an overall IPI of less than 18 months (5.0% less than 6 months, 11.0% 6-11 months, and 13.8% 12-17 months). For IPIs less than 6 months, a slight statistical decline in prevalence was identified over the study period in unadjusted and adjusted models (adjusted annual percentage point change -0.02, 95% CI, -0.03 to -0.02). Slight statistical increases in the prevalence of IPIs of 6-11 and 12-17 months were identified in unadjusted models but were no longer significant and reversed direction in adjusted models, respectively. Long-standing inequities in the distribution of the shortest IPIs (less than 6 months) were stable compared with prior work across the indicators examined in this study.</p><p><strong>Conclusion: </strong>Overall, it appears the prevalence of short IPIs has remained stable between 2016 and 2022.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"82-90"},"PeriodicalIF":5.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11630652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age to Initiate Routine Breast Cancer Screening: ACOG Clinical Practice Update.","authors":"","doi":"10.1097/AOG.0000000000005757","DOIUrl":"10.1097/AOG.0000000000005757","url":null,"abstract":"<p><p>This Clinical Practice Update provides revised guidance on the age to start routine breast cancer screening with mammography. This document is a focused update of related content in Practice Bulletin No. 179 , Breast Cancer Risk Assessment and Screening in Average-Risk Women (Obstet Gynecol 2017;130:e1-16).</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"e40-e44"},"PeriodicalIF":5.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcutaneous Electric Nerve Stimulation for Analgesia During Outpatient Endometrial Biopsy: A Randomized Controlled Trial.","authors":"Jenny Wu, Stephanie Lim, Amelia Scott, Taylor Hayes, Shakthi Unnithan, Alaattin Erkanli, Laura J Havrilesky, Jonas J Swartz","doi":"10.1097/AOG.0000000000005727","DOIUrl":"10.1097/AOG.0000000000005727","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether transcutaneous electric nerve stimulation (TENS) decreases pain at the time of outpatient endometrial biopsy.</p><p><strong>Methods: </strong>We conducted a randomized, double-blind trial of active TENS compared with placebo TENS at the time of endometrial biopsy. The primary outcome was pain measured on a 0- to 100-mm visual analog scale immediately after biopsy, with secondary outcomes including satisfaction and tolerability of TENS and pain scores at other procedural time points. To detect a 15-mm reduction in pain with a 30-mm SD, 80.0% power, and a significance level of 0.05, 64 participants were required in each arm.</p><p><strong>Results: </strong>From December 2022 to December 2023, 135 participants were randomized with 67 in the placebo TENS arm and 68 in the active TENS arm. Baseline demographic and clinical characteristics were similar between groups. The median (interquartile range) pain score immediately after biopsy was 50 mm (20-80 mm) in the active TENS group and 60 mm (40-100 mm) in the placebo TENS group ( P =.039). Pain scores at other time intervals were not statistically significantly different. In a subset analysis, participants with higher-than-median baseline anxiety had postprocedural pain scores (interquartile range) of 50 mm (40-80 mm) in the active TENS group compared with 80 mm (50-100 mm) in the placebo TENS group. Overall satisfaction (interquartile range) with pain control (with 100 mm representing completely satisfied) was 87.5 mm (60-100 mm) for active TENS and 70 mm (41-100 mm) for placebo TENS; 85.3% of active TENS participants would use TENS in a future endometrial biopsy. Minimal side effects were associated with TENS, with one participant reporting itching at the pad sites.</p><p><strong>Conclusion: </strong>Despite a statistical difference in pain scores, a clinical difference was not seen between active and placebo TENS for pain during endometrial biopsy. Satisfaction was higher in the active TENS group, and there were overall minimal side effects associated with TENS.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov , NCT05472740.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"e14-e23"},"PeriodicalIF":5.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11637977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142687600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenging the American College of Obstetricians and Gynecologists' Clinical Practice Update on Screening for Pre-existing Diabetes and Early Gestational Diabetes.","authors":"Kent D Heyborne, Linda A Barbour","doi":"10.1097/AOG.0000000000005777","DOIUrl":"10.1097/AOG.0000000000005777","url":null,"abstract":"<p><p>A recent American College of Obstetricians and Gynecologists Clinical Practice Update continues to recommend targeted (as opposed to universal) screening for pregestational diabetes, no longer recommends screening for early gestational diabetes mellitus (GDM), and provides updated guidelines for immediate postpartum testing for diabetes in patients with GDM. Here, we present data that the targeted screening paradigm, which has repeatedly been shown to fail in practice because of its complexity, no longer makes sense in the context of the high and rising prevalence of diabetes and diabetic risk factors, and we argue that the time has come for universal early pregnancy screening for pregestational diabetes. Furthermore, the recommendation against early screening for GDM is based on 2021 U.S. Preventive Services Task Force guidance, which in turn is based almost entirely on a single underpowered study that excluded individuals at highest risk and does not account for more recent research showing benefits of early diagnosis and treatment. Universal early pregnancy screening for pregestational diabetes may also help to identify patients at risk who will benefit from early GDM diagnosis and treatment and may provide rationale for prioritizing postpartum diabetes testing.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"31-38"},"PeriodicalIF":5.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142558350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimization of Timing for Risk-Reducing Salpingectomy and Oophorectomy.","authors":"Kathryn P Pennington, Stephanie L Pugh, Warner Huh, Joan L Walker, Elizabeth Jewell, Laura J Havrilesky, Jeanne Carter, Carolyn Y Muller, Ronny Drapkin, Heather A Lankes, Tara Castellano, Abigail S Zamorano, Stephanie V Blank, Lisa A Kachnic","doi":"10.1097/AOG.0000000000005781","DOIUrl":"10.1097/AOG.0000000000005781","url":null,"abstract":"<p><strong>Clinical trial registration: </strong>ClinicalTrials.gov , NCT04251052.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":"21-30"},"PeriodicalIF":5.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11637911/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142605409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Novel Antiphospholipid Antibodies and Adverse Pregnancy Outcomes.","authors":"Kimberly A Moyle, D Ware Branch, Lisa K Peterson, Marta M Guerra, Amanda A Allshouse, Ashley E Benson, Jane E Salmon","doi":"10.1097/AOG.0000000000005729","DOIUrl":"10.1097/AOG.0000000000005729","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To investigate the value of anti-β2 glycoprotein-I domain 1 (aD1) and antiphosphatidylserine-prothrombin antibodies for predicting adverse pregnancy outcomes in an at-risk population and to describe the relationship among aD1, antiphosphatidylserine-prothrombin, lupus anticoagulant, and other antiphospholipid antibodies (aPL).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Data were obtained from a prospective cohort of pregnant patients with aPL, with systemic lupus erythematosus (SLE) (n=59) or without SLE (n=106), or SLE without aPL (n=100) (PROMISSE [Predictors of Pregnancy Outcome in Systemic Lupus Erythematosus and Antiphospholipid Syndrome] study; NCT00198068). Levels of aD1 and antiphosphatidylserine-prothrombin were quantified with the QUANTA Flash and QUANTA Lite systems, respectively, in sera collected at less than 18 weeks of gestation. Adverse pregnancy outcome was defined as delivery at before 34 weeks of gestation for preeclampsia or placental insufficiency or fetal death after 12 weeks of gestation. Receiver operating characteristic (ROC) analysis assessed the diagnostic properties of aD1 and antiphosphatidylserine-prothrombin for adverse pregnancy outcomes. Bivariate comparisons were made between each biomarker. Multivariable regression modeling of adverse pregnancy outcomes was performed, and backward selection determined variables for a final model for adverse pregnancy outcomes. Logistic regression of lupus anticoagulant quantified the association with aD1 and antiphosphatidylserine-prothrombin. The rate of adverse pregnancy outcomes was described by combined results of lupus anticoagulant, aD1, and antiphosphatidylserine-prothrombin immunoglobulin G (IgG).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 265 individuals, 45 (17.0%) experienced adverse pregnancy outcomes. Area under the curve from ROC analysis for aD1 was 0.734 (95% CI, 0.664-0.805), for antiphosphatidylserine-prothrombin IgG was 0.83 (95% CI, 0.751-0.899), and for antiphosphatidylserine-prothrombin immunoglobulin M (IgM) was 0.612 (95% CI, 0.520-0.703). Markers associated with adverse pregnancy outcomes were aD1 (P&lt;.001), anticardiolipin IgG (P&lt;.001), β2-glycoprotein I IgG (P=.003), antiphosphatidylserine-prothrombin IgG (P&lt;.001), antiphosphatidylserine-prothrombin IgM (P=.03), and lupus anticoagulant (P&lt;.001). Backward selection identified lupus anticoagulant, aD1, and antiphosphatidylserine-prothrombin IgG for final adverse pregnancy outcome modeling: lupus anticoagulant odds ratio (OR) 7.0 (95% CI, 3.4-14.4), aD1 OR 12.1 (95% CI, 3.64-40.2), and antiphosphatidylserine-prothrombin IgG OR 11.4 (95% CI, 5.2-25.2). Both aD1 and antiphosphatidylserine-prothrombin IgG remained significant when lupus anticoagulant was removed from the model. Both aD1 and antiphosphatidylserine-prothrombin IgG performed the best in ruling in adverse pregnancy outcomes. With a likelihood ratio less than 0.1, aD1 or antiphosphatidylserine-prothrombin IgG performed well for ruling ","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"145 1","pages":"55-64"},"PeriodicalIF":5.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11643356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}