American Journal of Obstetrics & Gynecology Mfm最新文献

{"title":"Group B Streptococcus colonization and risk of chorioamnionitis among nulliparous individuals","authors":"Marissa Berry MD, William A. Grobman MD, Jiqiang Wu MSc, Becky McNeil PhD, Lynn M. Yee MD, David M. Haas MD, Jessica L. Pippen MD, Hyagriv N. Simhan MD, Uma M. Reddy MD, Robert M. Silver MD, George R. Saade MD, Judith Chung MD, Lisa Levine MD, Kartik K. Venkatesh MD, PhD","doi":"10.1016/j.ajogmf.2025.101632","DOIUrl":"10.1016/j.ajogmf.2025.101632","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 4","pages":"Article 101632"},"PeriodicalIF":3.8,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374893","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":"The interplay between birth weight and intraventricular hemorrhage in very preterm neonates—a retrospective cohort study","authors":"Beth R. Piscopo BSc (Hons) , Atul Malhotra PhD , Rod W. Hunt PhD , Miranda L. Davies-Tuck PhD , Kirsten R. Palmer PhD , Amy E. Sutherland PhD , Graeme R. Polglase PhD , Beth J. Allison PhD , Suzanne L. Miller PhD","doi":"10.1016/j.ajogmf.2025.101628","DOIUrl":"10.1016/j.ajogmf.2025.101628","url":null,"abstract":"<div><h3>Background</h3><div>Intraventricular hemorrhage (IVH) most commonly occurs in infants born very preterm (<32 weeks’ gestation). There are mixed findings on whether infants small for gestational age (SGA) or with suspected fetal growth restriction (FGR) are at higher risk for IVH. Understanding the relationship between SGA or FGR and IVH is critical to inform clinical care.</div></div><div><h3>Objective</h3><div>The primary aim was to determine the rates of IVH in very preterm newborns, with SGA or suspected FGR, and to stratify for severity of both FGR and IVH. The secondary aim was to identify risk factors for IVH in a large contemporary cohort.</div></div><div><h3>Study Design</h3><div>A population-based retrospective cohort study using data from the Australian and New Zealand Neonatal Network. Participants were babies born before 32 weeks’ gestation (22–31 weeks + 6 days gestation) between 2014 and 2019 inclusive. The primary outcomes were IVH and severity of IVH. Small babies were classified as being SGA (SGA; birth weight <10th percentile), suspected FGR (birth weight <10th and ≥3rd birth weight percentile <em>and</em> abnormal antenatal ultrasound), or severe FGR (birth weight <3rd percentile). Multivariate regression was then performed, adjusting for potential maternal and fetal confounders to determine the association between FGR and IVH.</div></div><div><h3>Results</h3><div>20,551 very preterm newborns were included in the study with a median gestational age (25th, 75th) of 29 (27, 30) weeks gestation and birth weight of 1201 (383.9) grams. The incidence of any IVH was 20.02% (<em>n</em>=4115) and increased with decreasing gestation at birth (10% of infants born at 31 weeks had IVH compared with 70% of infants born at 22 weeks). The rate of severe IVH (Grade 3 or 4) was 3.23%. In this cohort, 7.7% were SGA (<em>n</em>=1583) and 6.23% (<em>n</em>=1281) of babies had suspected early-onset FGR. The incidence of SGA was reduced in babies with IVH (6.0% vs 8.1%, respectively, aOR, 0.82; 95% CI 0.68–0.97). Similarly, suspected FGR was significantly lower in infants with IVH (any grade) compared to those without (2.5% vs 4.6%, respectively, adjusted odds ratio (aOR), 0.69; 95% CI 0.54–0.89). Further, there was a negative association between SGA (aOR, 0.80; 95% CI 0.67–0.95) and FGR (aOR 0.69; 95% CI 0.54–0.88) and the severity of IVH. Severe FGR (<3rd birth weight percentile) was not associated with either the presence (1.9% with IVH, vs 2.1% without IVH, aOR, 0.86; 95% CI 0.64–1.16) or severity of IVH (aOR, 0.85; 95% CI 0.63–1.14).</div></div><div><h3>Conclusion</h3><div>This large retrospective cohort study identified that in very preterm infants born with a median gestational age at birth of 29 weeks and who survive to the neonatal unit, the presence of SGA or suspected FGR is associated with a reduced rate of IVH, compared to infants without SGA/FGR. Future studies should directly assess whether placental insufficien","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 4","pages":"Article 101628"},"PeriodicalIF":3.8,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366180","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 distance traveled and abortion consideration and completion among people with fetal myelomeningocele","authors":"Steven T. Papastefan MD , Daniel R. Liesman MD , Yuqi Bian BA , Nkechinyelum Q. Ogu MD , Manmeet Singh MS , William S. Marriott MS , Joyceline A. Ito RN , Jessica T. Fry MD , Aimen F. Shaaban MD , Ashish Premkumar MD, PhD","doi":"10.1016/j.ajogmf.2025.101631","DOIUrl":"10.1016/j.ajogmf.2025.101631","url":null,"abstract":"<div><h3>Background</h3><div>Due to the small number of centers performing maternal-fetal surgery for fetal myelomeningocele, many people are required to travel significant distances for perioperative counseling at an experienced center. As part of the decision-making process for the management of myelomeningocele, some pregnant individuals are interested in, and may ultimately proceed with, termination of pregnancy. Additional travel for abortion care may compound psychological and financial burdens for pregnant individuals, given the existing barriers to accessing abortion care across the United States.</div></div><div><h3>Objective</h3><div>The objective of this study was to evaluate the association between the distance traveled to a fetal care center and the consideration and completion of abortion among patients with fetal myelomeningocele.</div></div><div><h3>Study design</h3><div>We performed a retrospective cohort analysis of all singleton myelomeningocele consultations at a single fetal care center in Illinois from 2018 to 2024. The exposure was the distance traveled to the fetal care center defined as miles from the patient's zip code of residence to the fetal care center. Distance was analyzed in two ways: categorically (dichotomized based on median value) and continuously. The primary outcomes were abortion consideration, ascertained by a nurse during fetal care center intake, and abortion completion. Bivariate and multivariate log-binomial regression analyses were performed. A subgroup analysis was performed by participant state of residence. Statistical significance was considered <em>P</em><.05.</div></div><div><h3>Results</h3><div>There were 133 participants available for the abortion consideration analysis and 157 participants for the abortion completion analysis. Median distance traveled was 39 miles (IQR 15-116 miles). People traveling below the median distance were more likely to identify as Latinx, reside within Illinois, and present at an earlier gestational age when compared with those traveling above the median distance. Distance traveled was independently associated with abortion consideration, after controlling for gestational age at the time of presentation to the fetal care center (aRR 0.44, 95% CI 0.27–0.72). When treating the distance traveled as a continuous outcome, for every mile traveled the risk of considering abortion decreased by 1% (aRR 0.99, 95% CI 0.98–0.99). On subgroup analysis, this finding was persistent only among individuals living in Illinois. There was no significant relationship between the distance traveled to the fetal care center and abortion completion.</div></div><div><h3>Conclusions</h3><div>Increased distance traveled is associated with a lower risk of abortion consideration among individuals presenting to a fetal care center for fetal myelomeningocele consultation. These data emphasize the nuanced relationship between fetal diagnosis and abortion and the importance of providing comprehen","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 4","pages":"Article 101631"},"PeriodicalIF":3.8,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366177","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":"Proximate cord insertion in monochorionic twins with selective fetal growth restriction","authors":"Jip A. Spekman BSc ,&nbsp;Eva Ros BSc ,&nbsp;Liesbeth Lewi MD, PhD ,&nbsp;Femke Slaghekke MD, PhD ,&nbsp;E.J.T. Joanne Verweij MD, PhD ,&nbsp;Anne T.R. Noll MD ,&nbsp;Jeanine M.M. van Klink PhD ,&nbsp;Monique C. Haak MD, PhD ,&nbsp;Lotte E. van der Meeren MD, PhD ,&nbsp;Sophie G. Groene PhD ,&nbsp;Enrico Lopriore MD, PhD","doi":"10.1016/j.ajogmf.2024.101598","DOIUrl":"10.1016/j.ajogmf.2024.101598","url":null,"abstract":"<div><h3>Background</h3><div>Monochorionic (MC) twins share a single placenta which can be unequally shared, leading to selective fetal growth restriction (sFGR). Limited data is available on the prevalence and clinical consequences of proximate cord insertion (PCI) in sFGR pregnancies.</div></div><div><h3>Objective</h3><div>We aimed to investigate the prevalence of PCI in MC placentas with and without sFGR and per type of sFGR, and study the placental characteristics and perinatal outcome of PCI in sFGR pregnancies.</div></div><div><h3>Study design</h3><div>In this multicenter retrospective cohort study, we included all consecutive placentas of MC twin pregnancies with and without sFGR evaluated between 2002-2023. We excluded MC twins with twin-twin transfusion syndrome, twin anemia polycythemia sequence and monoamnionicity. Our primary outcome included the prevalence of PCI (distance between cord insertions ≤4 cm) and type of cord insertions categorized as concordant, intermediate or discordant. Secondary outcomes consisted of type and size of placental vascular anastomoses and short-term clinical outcomes including fetal demise and birth weight discordance (BWD).</div></div><div><h3>Results</h3><div>Of 813 MC placentas, 468 were from uncomplicated twins and 345 from sFGR twins (187 type I, 41 type II and 117 type III sFGR). The prevalence of PCI in uncomplicated versus sFGR placentas was 3.8% (18/468) and 4.6% (16/345), respectively (<em>p</em>=0.58). PCI in sFGR type I, II and III was detected in 0.5% (1/187), 0% (0/41) and 12.8% (15/117), respectively (<em>p</em>&lt;0.0001). The prevalence of discordant cord insertions (velamentous-paracentral) in uncomplicated twin placentas and sFGR placentas was 19.9% (93/468) and 45.5% (157/345), respectively (<em>p</em>&lt;0.0001). Diameter of arterio-arterial (AA) anastomoses in sFGR placentas with and without PCI was 3.0 mm (IQR 2.7-5.0) versus 2.2 mm (IQR 1.4-3.1; <em>p</em>&lt;0.0061). BWD in sFGR twins with PCI was 18.5% (IQR 16.4-21.0) and without PCI was 28.0% (IQR 21.8-35.9; <em>p</em>&lt;0.0001). Fetal demise occurred in 12.5% (2/16) of pregnancies with PCI and 6.1% (20/329) of sFGR pregnancies without PCI (<em>p</em>=0.27).</div></div><div><h3>Conclusion</h3><div>sFGR type III placentas exhibit a high prevalence of PCI, requiring increased awareness due to the presence of larger AA anastomoses and a potentially higher risk of fetal demise.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 2","pages":"Article 101598"},"PeriodicalIF":3.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024920","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":"Direct estimation of fetal biometry measurements from ultrasound video scans through deep learning","authors":"Szymon Płotka PhD,&nbsp;Karol Pustelnik Msc,&nbsp;Paula Szenejko MD,&nbsp;Kinga Żebrowska MD,&nbsp;Iga Rzucidło-Szymańska MD,&nbsp;Natalia Szymecka-Samaha MD, PhD,&nbsp;Tomasz Łęgowik MD,&nbsp;Katarzyna Kosińska-Kaczyńska MD, PhD,&nbsp;Przemysław Korzeniowski PhD,&nbsp;Piotr Biliński PhD,&nbsp;Asma Khalil MD, PhD,&nbsp;Robert Brawura-Biskupski-Samaha MD, PhD,&nbsp;Ivana Išgum PhD,&nbsp;Clara. I. Sánchez PhD,&nbsp;Arkadiusz Sitek PhD","doi":"10.1016/j.ajogmf.2025.101623","DOIUrl":"10.1016/j.ajogmf.2025.101623","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 4","pages":"Article 101623"},"PeriodicalIF":3.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123804","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":"Cardiac and obstetric outcomes among congenital heart disease patients with repeat pregnancies","authors":"John R. Rees MD,&nbsp;Lisa D. Levine MD, MSCE,&nbsp;Yuli Y. Kim MD,&nbsp;Jennifer A. McCoy MD, MSCE","doi":"10.1016/j.ajogmf.2024.101597","DOIUrl":"10.1016/j.ajogmf.2024.101597","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 2","pages":"Article 101597"},"PeriodicalIF":3.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928362","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 phenylephrine infusion on postpartum blood loss after cesarean delivery: a placebo-controlled, randomized clinical trial","authors":"Sanjeeth Raguramane MBBS ,&nbsp;Sandeep Kumar Mishra MBBS, MD ,&nbsp;Nivedita Jha MBBS, MS ,&nbsp;Satyen Parida MBBS, MD ,&nbsp;Ajay Kumar Jha MD, DM","doi":"10.1016/j.ajogmf.2024.101593","DOIUrl":"10.1016/j.ajogmf.2024.101593","url":null,"abstract":"<div><h3>Background</h3><div>Preclinical studies have documented the role of alpha-adrenergic agonists in myometrial contraction. Phenylephrine is frequently used to prevent and treat post-spinal hypotension during cesarean delivery. We hypothesized phenylephrine would reduce postpartum blood loss due to alpha-1 receptor-mediated uterine and vascular smooth muscle contraction.</div></div><div><h3>Objectives</h3><div>This translational study aimed to evaluate the role of phenylephrine in reducing postpartum blood loss due to alpha-1 receptor mediated uterine and vascular smooth muscle contraction.</div></div><div><h3>Methods</h3><div>This was a prospective, randomized, placebo-controlled, blinded, pilot, clinical trial<strong>.</strong> Low-risk parturients undergoing cesarean delivery under spinal anesthesia were recruited in this study. The women were randomized to receive phenylephrine or placebo (normal saline) infusion. Each mL of phenylephrine contained 60 micrograms. The study drug began simultaneously with the start of spinal anesthesia, and was stopped at the end of surgery. The infusion rate was started at 50 mcg/min and was titrated to maintain the systolic blood pressure between 80% and 120 % of baseline. The primary outcome measure was postpartum blood loss till 24 hours postpartum, and it was assessed using a surgical swab weighing technique added to suction canister blood contents. The secondary outcomes were incidence of hypertension, hypotension, Apgar score, cord blood gas analysis and neonatal intensive care unit admission (NICU) admission.</div></div><div><h3>Results</h3><div>One hundred six women received study drugs and were eligible for final analysis. The demographic data, obstetric profiles, and medications were comparable. In the phenylephrine group, the mean postpartum blood loss (median [interquartile range]) was significantly lower ([420 {349–502} vs 494 {397–600} mL; <em>p=.009</em>]). Additionally, a significantly lower number of women had &gt;500 mL of blood loss in the phenylephrine group (26.4% vs 47.1%; <em>p=.02</em>). Furthermore, more women in the control arm needed blood transfusion (37.7% vs 16.9%; <em>p=.01</em>). Six women each had bradycardia and hypertension in the phenylephrine group. NICU admission, Apgar score, and umbilical artery PH were comparable.</div></div><div><h3>Conclusion</h3><div>Continuous phenylephrine infusion led to a statistically significant but clinically inconsequential reduction in postpartum blood loss in low-risk parturients undergoing cesarean delivery under spinal anesthesia.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 2","pages":"Article 101593"},"PeriodicalIF":3.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142955920","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":"Factors associated with reported low-dose aspirin use and its association with adverse outcomes: a secondary analysis of the Medical Optimization of Management of Overt Type 2 Diabetes in Pregnancy study","authors":"Maura Jones Pullins MD,&nbsp;Kim A. Boggess MD,&nbsp;Ashley N. Battarbee MD, MSCR","doi":"10.1016/j.ajogmf.2025.101622","DOIUrl":"10.1016/j.ajogmf.2025.101622","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 4","pages":"Article 101622"},"PeriodicalIF":3.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123805","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":"Attention-deficit hyperactivity disorder medication discontinuation during pregnancy and resumption postpartum","authors":"Kevin Y. Xu MD, MPH,&nbsp;Lisa M. Pappas MS,&nbsp;Tashalee R. Brown MD, PhD,&nbsp;Madeline O. Jansen MD, MPH,&nbsp;Vitor S. Tardelli MD, MS, PhD,&nbsp;Thiago M. Fidalgo MD, PhD,&nbsp;Frances R. Levin MD,&nbsp;Richard A. Grucza PhD,&nbsp;Elizabeth A. Suarez PhD,&nbsp;Marcela C. Smid MD, MS,&nbsp;Joshua John Horns PhD ,&nbsp;Ann M. Bruno MD, MS","doi":"10.1016/j.ajogmf.2025.101625","DOIUrl":"10.1016/j.ajogmf.2025.101625","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 4","pages":"Article 101625"},"PeriodicalIF":3.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123802","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":"Risk of severe maternal morbidity and mortality among pregnant patients with chronic kidney disease","authors":"Joyce H. Xu BA,&nbsp;Heather N. Czarny MD,&nbsp;Isabella Toledo MD,&nbsp;Carri R. Warshak MD,&nbsp;Emily A. DeFranco DO, MS,&nbsp;Robert M. Rossi MD","doi":"10.1016/j.ajogmf.2024.101594","DOIUrl":"10.1016/j.ajogmf.2024.101594","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Chronic kidney disease is a significant cause of adverse obstetric outcomes. However, there are few studies assessing the risk of severe maternal morbidity and mortality among patients with chronic kidney disease and no studies assessing the association between individual indicators of severe maternal morbidity and chronic kidney disease.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;To evaluate the risk of severe maternal morbidity and mortality among pregnant patients with chronic kidney disease.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;div&gt;This was a population-based, retrospective cohort study including U.S. delivery hospitalizations from 2010−2020 utilizing the Healthcare Cost &amp; Utilization Project National Inpatient Sample database. Patients were identified as having a delivery hospitalization, chronic kidney disease, and severe maternal morbidity using International Classification Diagnoses codes (9&lt;sup&gt;th&lt;/sup&gt; and 10&lt;sup&gt;th&lt;/sup&gt; edition). The primary outcomes were severe maternal morbidity and mortality, as defined according to the Centers for Disease Control and Prevention criteria. Multivariate logistic regression analyses were performed to estimate adjusted relative risk and 95% confidence intervals of severe maternal morbidity and mortality among patients with chronic kidney disease. Subgroup analyses were performed by chronic kidney disease etiology, stage, race and ethnicity, and individual indicators of severe maternal morbidity.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Among the 38,374,326 parturients in this study, 95,272 (0.2%) had chronic kidney disease. The risk of severe maternal morbidity was higher for those with chronic kidney disease (12.2% vs 0.7%, aRR 6.4, 95% CI 6.0−6.8) compared to those without. Among severe maternal morbidity indicators, those with chronic kidney disease were at highest risk for acute renal failure (aRR 21.7, 95% CI 19.8−23.7) and sepsis (aRR 9.0, 95% CI 7.6−10.5). Chronic kidney disease was also associated with an increased risk of maternal death (aRR 4.1, 95% CI 2.9−5.8). Black individuals had higher adjusted population attributable fraction (aPAF) between severe maternal morbidity and chronic kidney disease (aPAF 4.0%, 95% CI 3.6−4.3). Increased risk of severe maternal morbidity was associated with all chronic kidney disease subtypes, stages, and a history of renal transplant. Maternal death was significantly associated with diabetic nephropathy, renovascular, and obstructive or unspecified renal disease (aRR 7.3−14.1), as well as stages 3−5 of chronic kidney disease and a history of renal transplant (aRR 15.5−32.6). Risk of severe maternal morbidity and mortality were similar in those with a history of renal transplant and those with stage 1 chronic kidney disease. The number needed to treat with renal transplant to prevent 1 severe maternal morbidity event or maternal death in those with stages 3−5 chronic kidney disease was 2.6 (95% CI 2.4−2.9) and 45.0 (95% CI 31.0−82.0),","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"7 2","pages":"Article 101594"},"PeriodicalIF":3.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928375","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}