American Journal of Obstetrics & Gynecology Mfm最新文献

{"title":"Novel machine learning applications in peripartum care: a scoping review","authors":"Shani Steinberg MD , Melissa Wong MD, MHDS , Eyal Zimlichman MD, MSc , Abraham Tsur MD, MBA","doi":"10.1016/j.ajogmf.2025.101612","DOIUrl":"10.1016/j.ajogmf.2025.101612","url":null,"abstract":"<div><h3>Objective</h3><div>Machine learning (ML), a subtype of artificial intelligence (AI), presents predictive modeling and dynamic diagnostic tools to facilitate early interventions and improve decision-making. Considering the global challenges of maternal, fetal, and neonatal morbidity and mortality, ML holds the potential to enable significant improvements in maternal and neonatal health outcomes. We aimed to conduct a comprehensive review of ML applications in peripartum care, summarizing the potential of these tools to enhance clinical decision-making and identifying emerging trends and research gaps.</div></div><div><h3>Data Sources</h3><div>We conducted a scoping review on MEDLINE, Cochrane Library, and EMBASE databases from inception to April 2024. We gathered additional relevant studies through snowball sampling. We meticulously screened titles and abstracts and chose full-text articles for further analysis.</div></div><div><h3>Study Eligibility Criteria</h3><div>We included primary research articles and abstracts focusing on pregnant individuals, employing ML methods for peripartum care.</div></div><div><h3>Study Appraisal and Synthesis Methods</h3><div>No formal quality assessment was performed. Data were extracted using a custom template to capture study characteristics and ML models. Findings were synthesized using summary tables and figures to highlight key trends and results.</div></div><div><h3>Results</h3><div>Among 406 studies, 78% were published within the last five years. Most studies originated from high-income or well-resourced countries, with 27% from North America (including 24% from the United States) and 34% from Asia, predominantly China (18%). Studies from low- and middle-income regions were notably scarce, reflecting significant regional disparities. Predictive modeling tasks were the most prevalent (59%), followed by classification tasks (29%). Supervised learning dominated (90%), with algorithms such as Support Vector Machines, Random Forests, and Logistic Regression most commonly used. Key topics included fetal distress and acidemia (32%), preterm birth (22%), mode of delivery (13%), and birth weight (13%). Notably, Explainable AI methods were utilized in only 19% of studies, and external validation was performed in just 5%. Despite these advancements, only 1% of models resulted in accessible clinical tools, and none were fully integrated into healthcare systems.</div></div><div><h3>Conclusions</h3><div>ML holds significant potential to enhance peripartum care by improving diagnostic accuracy and predictive capabilities. However, realizing this potential requires responsible AI practices, including robust validation with external datasets, prospective investigations across diverse populations, and the development of digital and data infrastructure for seamless integration into electronic health records. Additionally, transparent AI that provides insights into risk stratification logic is essential for clinician ","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 3","pages":"Article 101612"},"PeriodicalIF":3.8,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143042184","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":"Cochrane update: news and reviews from the Cochrane US network","authors":"Erin Plummer BS , Shayesteh Jahanfar PhD , Tiffany Duque MPH, RDN , Jeanne-Marie Guise MD, MPH, MBA , David M. Haas MD, MS","doi":"10.1016/j.ajogmf.2025.101611","DOIUrl":"10.1016/j.ajogmf.2025.101611","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 3","pages":"Article 101611"},"PeriodicalIF":3.8,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143042182","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":"Treatment for anxiety, depression, and stress in pregnant people experiencing antepartum hospitalization: a systematic review and meta-analysis","authors":"John R. Soehl MD ,&nbsp;Kathryn Anthony MD ,&nbsp;Adam K. Lewkowitz MD, MPHS ,&nbsp;Lauren Fletcher MLIS, MA ,&nbsp;L.G. Ward PhD ,&nbsp;Emily S. Miller MD, MPH","doi":"10.1016/j.ajogmf.2025.101613","DOIUrl":"10.1016/j.ajogmf.2025.101613","url":null,"abstract":"<div><h3>Objective</h3><div>To systematically evaluate inpatient interventions to reduce symptoms of anxiety, depression, or stress in pregnant individuals during antepartum hospitalization.</div></div><div><h3>Data Sources</h3><div>Searches were conducted in Ovid MEDLINE, Embase, CINAHL Plus, Cochrane CENTRAL, and PsycINFO from database inception through April 2023.</div></div><div><h3>Study eligibility criteria</h3><div>Randomized controlled trials and cohort studies were eligible for inclusion if an intervention was compared to treatment as usual (TAU) to reduce symptoms of anxiety, depression, or stress among pregnant individuals admitted to a hospital's antepartum unit.</div></div><div><h3>Study Appraisal and Synthesis Methods</h3><div>Two authors independently screened all abstracts for eligibility and reviewed all potentially eligible full-text articles for inclusion. The primary outcome was the score on the assessment for symptoms of anxiety, depression, or stress after the intervention. The Hedges method was used to detect standardized mean difference (SMD) in studies using different psychometric scales, and weighted mean differences (WMD) were used in studies using the same psychometric scales. Risk of bias was assessed using the Cochrane Handbook for Systematic Reviews of Interventions.</div></div><div><h3>Results</h3><div>Of 1185 articles originally identified, 19 full-text manuscripts were reviewed, and 3 studies (all randomized controlled studies)—corresponding to 226 patients randomized to an intervention and 263 patients randomized to TAU—were included. Compared to TAU, interventions significantly reduced mean scores on validated scales assessing symptoms of anxiety (SMD –0.65 [95% Confidence Interval (CI) –0.83, –0.46]), depression (WMD –0.52 [95% CI –0.76, –0.28]), and stress (WMD -0.57 [95% CI –0.82, –0.31]).</div></div><div><h3>Conclusion</h3><div>Though data are limited, interventions given to birthing people who experience antepartum hospitalization modestly—but significantly—reduce symptoms of anxiety, depression, and stress. These data highlight a need for further high-quality trials to support the mental health needs of this high-risk population.</div></div><div><h3>Funding</h3><div>This project was supported by the Department of Maternal Fetal Medicine at the Alpert School of Medicine of Brown University. AKL was supported by NICHD (K23HD103961). ESM was supported by NICHD (R01HD105499) and NINR (R01NR021126-01). LGW was supported by K23HD107296-01A1 and P20GM139767.</div></div><div><h3>Systematic Review Registration</h3><div>PROSPERO, CRD42023444189</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 3","pages":"Article 101613"},"PeriodicalIF":3.8,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143042202","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":"Effect of a perineal protection device in vacuum-assisted births: a prospective randomized controlled interventional trial","authors":"Knut Haadem MD, PhD","doi":"10.1016/j.ajogmf.2025.101615","DOIUrl":"10.1016/j.ajogmf.2025.101615","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 4","pages":"Article 101615"},"PeriodicalIF":3.8,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029918","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":"Author reply to the letter to the editor regarding “Effect of a perineal protection device in vacuum-assisted births - a prospective randomized controlled interventional trial”","authors":"Nina Kimmich MD","doi":"10.1016/j.ajogmf.2025.101616","DOIUrl":"10.1016/j.ajogmf.2025.101616","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 4","pages":"Article 101616"},"PeriodicalIF":3.8,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029980","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":"Paracetamol prior to catheter balloon insertion for labor induction—A randomized controlled trial","authors":"Maya Frank Wolf MD ,&nbsp;Inshirah Sgayer MD ,&nbsp;Raneen Abu Shqara MD ,&nbsp;Karina Naskovica MD ,&nbsp;Fatina Kassis MA ,&nbsp;Nataly Kushnir MA ,&nbsp;Miri Lavinsky MA ,&nbsp;Nasra Idilbi PhD ,&nbsp;Lior Lowenstein MD","doi":"10.1016/j.ajogmf.2025.101610","DOIUrl":"10.1016/j.ajogmf.2025.101610","url":null,"abstract":"<div><h3>Background</h3><div>Assessing maternal pain and satisfaction following administration of paracetamol vs. placebo prior to catheter balloon placement.</div></div><div><h3>Methods</h3><div>Primiparous women at term admitted for medically-indicated labor induction were randomized to receive intravenous paracetamol 1 gram in 100cc normal saline (N=71) or placebo of 100cc normal saline (N=70) prior to catheter balloon insertion. The women were blinded to the intervention allocation. Primary outcomes were visual analog scale (VAS) scores and maternal satisfaction, assessed via questionnaire.</div></div><div><h3>Results</h3><div>Pre-induction maternal pain did not differ between the paracetamol and placebo groups. Median VAS scores at 2, 30, and 60 minutes after catheter insertion were comparable between the groups: 6.46±2.77 vs. 6.66±2.78, <em>P=.</em>68; 5.53±3.20 vs. 5.93±3.01, <em>P=.</em>46; and 5.83±3.25 vs. 6.49±2.88, <em>P=.</em>26, respectively. For the paracetamol vs. placebo group, the mean sum of VAS scores was lower (4.39 vs. 5.37, <em>P=.</em>045) and the proportion with a mean VAS score &lt;5 was higher (65.2% vs. 44.1%, <em>P=.</em>016). This difference persisted in a multivariate logistic regression analysis adjusted for maternal age (OR=2.2, 95% CI 1.1–4.5, <em>P=.</em>036). After balloon insertion, relatively fewer women in the paracetamol vs. placebo group showed immobility (33.8% vs 50.0%, <em>P=.</em>037) and needed analgesics (31.3% vs. 66.1%, <em>P</em>&lt;.001). Maternal satisfaction score was similar between the groups (<em>P=.</em>877). Cervical ripening, duration from catheter insertion to delivery, and labor and neonatal outcomes did not differ significantly between the groups.</div></div><div><h3>Conclusions</h3><div>The administration of paracetamol compared with placebo prior to catheter balloon insertion was associated with lower VAS score and less analgesic use and maternal immobility.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 4","pages":"Article 101610"},"PeriodicalIF":3.8,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030001","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":"Cervical balloon catheter versus Dilapan-S for outpatient cervical ripening: A randomized controlled trial.","authors":"Rachel L Wood, Clarissa Bluemm, Sarah C Lassey, Sarah E Little","doi":"10.1016/j.ajogmf.2025.101608","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2025.101608","url":null,"abstract":"<p><strong>Background: </strong>As induction of labor increases in the United States, safe, effective outpatient cervical ripening has been explored as a method to decrease the inpatient time burden. The most effective method of outpatient mechanical cervical ripening remains unclear.</p><p><strong>Objective: </strong>To evaluate if Dilapan-S is non-inferior to cervical balloon for outpatient cervical ripening (CR) based on change in Bishop score.</p><p><strong>Study design: </strong>This was a single-blind, randomized controlled trial at a single tertiary hospital. Term patients, both nulliparous and multiparous, aged 18-50 with a singleton, cephalic fetus and no prior c-section who were scheduled for outpatient CR per pre-existing hospital policy were eligible. Participants were randomized to single balloon cervical ripening with a Cook catheter with 60mL in the intrauterine balloon or placement of 3 to 5 Dilapan-S hydroscopic dilators and were then discharged home. On return to the hospital, the CR agent was removed, a blinded cervical exam performed, and participants completed a satisfaction survey. Further induction proceeded per their obstetrical provider. The primary outcome was change in Bishop score. Secondary outcomes included patient satisfaction, mode of delivery, induction time, adverse maternal and neonatal outcomes and a cervical ripening failure composite (failure to place randomized cervical ripening agent, prelabor rupture of membranes prior to scheduled return to hospital, significant vaginal bleeding, or need for further cervical ripening after the initial agent is removed) .We had 80% power to show non-inferiority in change in Bishop score with a margin of 2 and standard deviation of 3.</p><p><strong>Results: </strong>From May 2022 to June 2023, 80 participants were randomized with no difference in baseline demographic data, starting dilation, or Bishop score. 70% of participants in each arm were nulliparous. There was no difference in change in Bishop score between Dilapan-S and cervical balloon (median change 3 (interquartile range (IQR) 2-5) vs 3 (IQR2-4.5) respectively, p=0.91). There was no difference in time to delivery, mode of delivery, or maternal or neonatal outcomes. Participants randomized to Dilapan-S were more satisfied with their experience (satisfaction scale 0-10, median 9 (IQR 8-10) vs 8 (IQR 5-9), p<0.01) and were less likely to experience cervical ripening failure (7(17.5%) vs 18(45%), p<0.01) compared to participants who were randomized to cervical balloon.</p><p><strong>Conclusions: </strong>Dilapan-S was non-inferior to cervical balloon catheter for outpatient cervical ripening based on change in Bishop score. Participants were more satisfied with Dilapan-S and less likely to experience cervical ripening failure compared to a cervical catheter with single balloon inflation.</p>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101608"},"PeriodicalIF":3.8,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013215","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":"Nitroglycerine for retained placenta: a meta-analysis of randomized controlled trials.","authors":"Alessandro Petrecca, Gabriele Saccone, Vincenzo Berghella","doi":"10.1016/j.ajogmf.2025.101605","DOIUrl":"https://doi.org/10.1016/j.ajogmf.2025.101605","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effect of nitroglycerine on placenta delivery after retained placenta DESIGN: Systematic review with meta-analysis DATA SOURCES: MEDLINE, PROSPERO, Scopus, ClinicalTrials.gov, EMBASE, Sciencedirect, the Cochrane Library, Scielo were searched from their inception until February 2024.</p><p><strong>Eligibility criteria for selecting studies: </strong>We included all randomized clinical trials comparing use of nitroglycerine (i.e. intervention group) with placebo or with no treatment (i.e. control group) given for retained placenta after vaginal delivery.</p><p><strong>Data synthesis: </strong>The primary outcome was rate of manual removal of the placenta. The summary measures were reported as relative risk (RR) or as mean difference (MD) with 95% of confidence interval (CI).</p><p><strong>Results: </strong>Five trials, including 1,362 pregnancies, were analyzed. The quality of the RCTs included was moderate. Pooled results showed that administration of nitroglycerine in women with retained placenta after vaginal delivery was associated with similar incidence of manual removal compared to control (87% vs 89%; RR 0.92, 95% CI 0.75 to 1.13). We also found similar mean postpartum blood loss, and no significant differences in the incidence of drop of hb > 15 or 30%, need for uterotonics.</p><p><strong>Conclusions: </strong>Use of nitroglycerine in women with retained placenta after vaginal delivery did not reduce the use of manual removal of the placenta.</p>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":" ","pages":"101605"},"PeriodicalIF":3.8,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013238","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":"Association between the dietary inflammatory index and adverse pregnancy outcomes","authors":"Ummayhany Bharmal MBBS ,&nbsp;Misa Hayasaka MD ,&nbsp;George Saade MD ,&nbsp;Tetsuya Kawakita MD, MS","doi":"10.1016/j.ajogmf.2025.101609","DOIUrl":"10.1016/j.ajogmf.2025.101609","url":null,"abstract":"<div><h3>Background</h3><div>Limited research exists on the association between preconception pro-inflammatory diets and adverse pregnancy outcomes, and this relationship remains poorly understood.</div></div><div><h3>Objective</h3><div>To investigate the association between preconception dietary inflammatory potential, as measured by the dietary inflammatory index (DII), and adverse pregnancy outcomes in nulliparous individuals.</div></div><div><h3>Methods</h3><div>This was a secondary analysis of the data from the Nulliparous Outcomes Study: Mothers-to-be (nuMoM2b). Preconception dietary habits, assessed via food frequency questionnaires, were used to calculate DII scores based on 29 pro- and anti-inflammatory food items. Participants were categorized into DII quartiles (Q1–Q4), with Q1 representing the most anti-inflammatory and Q4 the most pro-inflammatory diets. The primary outcome was a composite of adverse pregnancy outcomes, including preterm birth, hypertensive disorders of pregnancy (preeclampsia, gestational hypertension, or eclampsia), small for gestational age (&lt;5th percentile), and stillbirth. Secondary outcomes included the individual components of the primary outcome and gestational diabetes. Adjusted relative risks (aRR) and 95% confidence intervals (CIs) were calculated using modified Poisson regression, controlling for confounders.</div></div><div><h3>Results</h3><div>Among the 7994 participants included, 1829 (22.8%) experienced the primary outcome. Participants in Q4 had a significantly higher risk of the primary outcome compared to Q1 (25.9% vs 22.1%; aRR 1.15, 95% CI 1.03–1.28) and a notably increased risk of stillbirth (0.9% vs 0.3%; aRR 2.68, 95% CI 1.01–7.07). No significant associations were found for Q2 or Q3 compared to Q1 for the primary outcome (aRR 1.02, 95% CI 0.91–1.14; aRR 0.97, 95% CI 0.86–1.09, respectively). Other secondary outcomes were not statistically significant. Among individual food items, only folic acid was associated with a reduced risk of adverse pregnancy outcomes (aRR 0.97, 95% CI 0.94–0.99).</div></div><div><h3>Conclusion</h3><div>A pro-inflammatory preconception diet was associated with an increased risk of composite adverse pregnancy outcomes, particularly stillbirth, among nulliparous individuals. These findings underscore the potential role of dietary interventions during the preconception period to mitigate these risks.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 3","pages":"Article 101609"},"PeriodicalIF":3.8,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013207","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":"Systematic review of interventions in early pregnancy among pregnant individuals at risk for hyperglycemia","authors":"Larissa Calancie PhD ,&nbsp;Madelin O. Brown ,&nbsp;Wooyon A. Choi ,&nbsp;Jessica L. Caouette MS, RD ,&nbsp;James McCann MNSP ,&nbsp;Eunice Y. Nam ,&nbsp;Erika F. Werner MD, MS","doi":"10.1016/j.ajogmf.2025.101606","DOIUrl":"10.1016/j.ajogmf.2025.101606","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;The maternal metabolic environment in early pregnancy can influence fetal growth trajectories. Our objective was to identify interventions initiated in early pregnancy (&lt;20 weeks gestation) in pregnant individuals with risk factors for hyperglycemia and report their impact on primary (neonatal adiposity, small for gestational age, large for gestational age, macrosomia) and secondary outcomes (gestational weight gain, maternal hypertensive disorder, birth injury, NICU admission, preterm delivery, emergency cesarean section).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Data Sources&lt;/h3&gt;&lt;div&gt;We searched Cochrane Central database, Medline, Embase, CINAHL databases, and clinicaltrials.gov (September 2024) for clinical trials published between 2009 and 2024. Search terms included the key words “early OR during” OR “first trimester OR second trimester” AND “gestation OR pregnancy” OR “prenatal care” AND “insulin resistance” OR “metabolic health” OR “diabet*” OR “body composition” OR “obes*” OR “weight gain” OR “gestational diabetes” OR “hyperglycemia” OR “metabolic syndrome” AND “clinical trial.”&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study eligibility criteria&lt;/h3&gt;&lt;div&gt;Randomized controlled trials (RCTs) and other trials reporting interventions initiated before 20 weeks gestation in participants with singleton pregnancies at risk for hyperglycemia (overweight and/or obesity, history of type 2 diabetes, and/or history of GDM) that reported at least one primary outcome were included. Studies had to be conducted with humans in high income countries as defined by the World Bank, written in English.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study appraisal and synthesis methods&lt;/h3&gt;&lt;div&gt;We used the Downs and Black checklist to evaluate the methodological quality and risk. Data was extracted independently and any questions were resolved through group discussion. Interventions were categorized and synthesized by type.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;21,924 records were identified and 70 full-text articles met inclusion criteria. 65 articles were RCTs. Eight intervention categories were identified: diet only, physical activity or exercise only, diet and physical activity or exercise combined, lifestyle counseling, supplements, pharmaceuticals, early GDM screening, and mixed interventions. Only 12 studies reported statistically significant effects on primary neonatal outcomes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Interventions initiated in early pregnancy (&lt;20 weeks) among pregnant individuals at risk for hyperglycemia that include one or more of the following strategies can reduce risk of excess neonatal adiposity, macrosomia, large for gestational age and small for gestational age neonates: goal-setting and motivational strategies to improve diet and increase physical activity through individual and group sessions; lifestyle coaching that included behavioral techniques designed to empower participants by fostering autonomy in a supportive environment; structured group exercise cla","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 3","pages":"Article 101606"},"PeriodicalIF":3.8,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956176","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}