Pregnancy (Hoboken, N.J.)最新文献

{"title":"Low-normal birthweight in the first pregnancy as a risk factor for small for gestational age in the second pregnancy: A matched case-control study.","authors":"Boujenah Jeremy, Beddock Richard, Patrick Rozenberg","doi":"10.1002/pmf2.70335","DOIUrl":"https://doi.org/10.1002/pmf2.70335","url":null,"abstract":"<p><strong>Background: </strong>Recurrent obstetric complications may stem from chronic placental dysfunction or maternal vulnerability, with potential worsening across successive pregnancies. Subtle intrauterine growth restriction in a first pregnancy, even within the appropriate-for-gestational-age (AGA) range, may signal underlying risk for subsequent adverse outcomes.</p><p><strong>Objectives: </strong>To determine whether low-normal birthweight in a first AGA pregnancy is associated with increased risk of small-for-gestational-age (SGA) birth in the second pregnancy among women with two consecutive term singleton births.</p><p><strong>Methods: </strong>We conducted a retrospective matched case-control study nested within a historical cohort of all births between 2014 and 2024. All cases (<i>n</i> = 125) that delivered a first AGA and a second SGA infant were included. Controls (<i>n</i> = 250) who delivered two consecutive AGA infants, matched 1:2 on infant sex and date of birth of the second child. Primary exposure was standardized birthweight <i>Z</i>-score of the first child, categorized as <-0.5 standard deviation (SD) or <-1 SD. Primary outcome was SGA birth (<10th percentile) in the second pregnancy. Logistic regression, adjusted for maternal age, prepregnancy weight, height, ethnicity, smoking, socioeconomic status, and time to conception, and generalized structural equation model (GSEM) accounted for within-woman correlation were performed.</p><p><strong>Results: </strong>Among 375 women analyzed, first-born infants of cases had lower mean birthweight than controls (3072 vs. 3375 g). Compared with reference birthweight (<i>Z</i>-score ≥-0.5 SD), first-born <i>Z</i>-score <-0.5 SD was associated with fivefold increased odds of subsequent SGA (adjusted odds ratio [aOR], 5.11; 95% confidence interval [CI], 2.51-10.41). Risk increased for <i>Z</i>-score <-1 SD (aOR, 8.52; 95% CI, 3.40-21.30), demonstrating dose-response (OR for trend 3.32; 95% CI, 2.16-5.10). GSEM confirmed findings (aOR, 5.46 and 8.00, respectively; <i>ρ</i> = 0.33). Quantitative bias analysis suggested that unmeasured confounding was unlikely to explain the observed associations.</p><p><strong>Conclusions: </strong>Low-normal birthweight in a first AGA pregnancy is associated with subsequent SGA in the subsequent pregnancy suggesting an undetected placental or maternal vulnerability.</p>","PeriodicalId":520540,"journal":{"name":"Pregnancy (Hoboken, N.J.)","volume":"2 4","pages":"e70335"},"PeriodicalIF":0.0,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13344237/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148765930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The risk of uterine rupture in trial of labor after cesarean in grand multiparous parturients.","authors":"Aviya Hetzroni, Elyasaf Bitton, Shulamit Hakuone, Yael Yekel, Ron Rosenberg, Hila Hochler","doi":"10.1002/pmf2.70322","DOIUrl":"https://doi.org/10.1002/pmf2.70322","url":null,"abstract":"<p><strong>Background: </strong>Previous cesarean delivery is the main risk factor for subsequent uterine rupture. This study aimed to determine whether grand multiparity (≥5th delivery) elevates the risk for uterine rupture in trial of labor after cesarean (TOLAC).</p><p><strong>Study design: </strong>Retrospective study including all TOLACs with vertex presentation, from 2013 to 2024 in a university-affiliated medical center. The study groups were as follows: (1) grand multiparous parturients (current delivery ≥5), (2) parturients at their third-fourth delivery, and (3) parturients at their second delivery. The primary outcome was uterine rupture rate. Secondary outcomes were obstetric and neonatal complications.</p><p><strong>Results: </strong>A total of 8410 TOLACs were recorded during the study period, including 2516 grand multiparous parturients, 2695 women at their third-fourth delivery, and 3199 parturients at their second delivery. Grand multiparous parturients were older (<i>p</i> < 0.001), had higher birthweights (<i>p</i> < 0.001), and had less preterm deliveries (<i>p</i> = 0.003). Induction and augmentation of labor were conducted in 15% and 17% of grand multiparous parturients, respectively, 11.7% and 15.2% in third-fourth deliveries, and 13.9% and 29% in second deliveries (<i>p</i> = 0.001). Incidence of uterine rupture was lowest among grand multiparous women (0.2% for grand multiparous, 0.6% for third-fourth delivery, and 0.9% for second delivery, <i>p</i> = 0.002). A multivariable model adjusted for maternal age, birthweight, induction, and augmentation revealed that grand multiparity was not associated with an increased risk of uterine rupture in TOLAC, compared to both second (adjusted odds ratio [aOR], 0.16; <i>p</i> < 0.01) and third-fourth deliveries (aOR, 0.27; <i>p</i> = 0.014). Re-analysis restricted to women with parity ≥6, compared to lower-parity women, yielded identical results.</p><p><strong>Conclusions: </strong>Grand multiparity does not appear to be associated with an increased risk of uterine rupture in TOLAC.</p>","PeriodicalId":520540,"journal":{"name":"Pregnancy (Hoboken, N.J.)","volume":"2 4","pages":"e70322"},"PeriodicalIF":0.0,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13344267/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148763448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe maternal morbidity according to sickle cell disease genotype.","authors":"Tetsuya Kawakita, Natsume Furukawa, Sora A Jones, Salimah Navaz Gangji","doi":"10.1002/pmf2.70338","DOIUrl":"https://doi.org/10.1002/pmf2.70338","url":null,"abstract":"<p><strong>Background: </strong>Sickle cell disease (SCD) is a genetic hemoglobinopathy that disproportionately affects individuals of African descent and is associated with elevated risks of maternal complications. However, the contribution of specific SCD genotypes to severe maternal morbidity (SMM) and postpartum readmission remains poorly characterized at the population level.</p><p><strong>Objective: </strong>We sought to examine the association between SCD genotypes-hemoglobin SS (HbSS) disease, hemoglobin SC (HbSC) disease, sickle thalassemia, and sickle cell trait-and SMM, hospital readmission, and related adverse maternal outcomes.</p><p><strong>Study design: </strong>This was a retrospective cohort study using the Nationwide Readmissions Database from 2016 through 2022, representing over 20 million weighted delivery hospitalizations. SCD genotypes were identified using International Classification of Diseases, Tenth Revision, Clinical Modification codes. The primary outcome was SMM (non-transfusion, no sickle crisis), identified using the Centers for Disease Control and Prevention algorithm, excluding transfusion and sickle cell crisis. Secondary outcomes included transfusion, hospital readmission within 42 days, and sickle cell crisis. Adjusted relative risks (aRRs) with 95% confidence intervals (CIs) were estimated using survey-weighted modified Poisson regression, adjusting for demographic, clinical, and hospital-level characteristics.</p><p><strong>Results: </strong>Among 20,928,182 delivery hospitalizations, 13,501 had HbSS disease, 1526 had HbSC disease, 2063 had sickle thalassemia, 149,219 had sickle cell trait, and 20,761,873 had no SCD or trait. Compared with individuals without SCD or trait, SMM risk was substantially elevated among those with HbSS disease (6.0%; aRR, 5.81; 95% CI, 5.25-6.43), HbSC disease (7.9%; aRR, 6.06; 95% CI, 4.66-7.87), sickle thalassemia (3.5%; aRR, 3.61; 95% CI, 2.57-5.06), and sickle cell trait (1.4%; aRR, 1.41, 95% CI, 1.32-1.50). A similar graded pattern was observed for hospital readmission and transfusion. When compared with HbSS disease directly, no statistically significant difference in SMM risk was detected for HbSC disease (aRR, 1.21; 95% CI, 0.92-1.59), whereas sickle thalassemia was associated with a lower risk (aRR, 0.63; 95% CI, 0.44-0.89).</p><p><strong>Conclusion: </strong>SCD is associated with markedly elevated risks of SMM, transfusion, and hospital readmission, with the magnitude varying by genotype. HbSS and HbSC disease confer markedly elevated risks, with no statistically significant difference detected between the two genotypes. Sickle thalassemia is associated with comparatively lower but still clinically significant risks. These findings underscore the need for genotype-informed, multidisciplinary peripartum management.</p>","PeriodicalId":520540,"journal":{"name":"Pregnancy (Hoboken, N.J.)","volume":"2 4","pages":"e70338"},"PeriodicalIF":0.0,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13344230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148764194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical predictors of postpartum vaginal and vulvar hematomas and the need for surgical treatment.","authors":"Itai Atar, Einat Tako, Daniel Gabbai, Itamar Gilboa, Yariv Yogev, Emmanuel Attali","doi":"10.1002/pmf2.70316","DOIUrl":"https://doi.org/10.1002/pmf2.70316","url":null,"abstract":"<p><strong>Objective: </strong>To identify risk factors for postpartum vaginal or vulvar hematoma and to determine clinical predictors of surgical intervention.</p><p><strong>Study design: </strong>A retrospective matched case-control study was conducted at a tertiary, university-affiliated center (2012-2024). Women diagnosed with vaginal or vulvar hematoma (cases) during the postpartum hospitalization were matched in a 1:3 ratio by maternal and gestational age to controls. Independent risk factors were identified using conditional logistic regression with a Cox regression model. A risk score was derived from the multivariable model, and ROC analysis was used to assess performance. A subgroup analysis evaluated predictors of surgery.</p><p><strong>Results: </strong>Among 147,045 deliveries, 57 women (0.04%) had postpartum hematoma; 170 matched controls were included. Mean diagnosis time was 1.0 ± 1.6 days post-partum. Hematoma was associated with vacuum-assisted delivery (21.1% vs. 4.7%, <i>p</i> < 0.001), episiotomy (24.6% vs. 2.4%, <i>p</i> < 0.001), second-degree laceration (38.6% vs. 15.3%, <i>p</i> < 0.001), nulliparity, and lower body mass index (BMI; <i>p</i> < 0.001). In multivariable analysis, episiotomy (odds ratio [OR] 35.9, 95% confidence interval [CI] 5.6-232.4), second-degree laceration (OR 10.3, 95% CI 3.2-32.9), and vacuum delivery (OR 5.0, 95% CI 1.0-24.5) independently increased risk, whereas higher BMI (OR 0.69/unit, 95% CI 0.55-0.85) and epidural analgesia (OR 0.33, 95% CI 0.12-0.93) were protective. The model's AUC was 0.83; a score ≥3 yielded 68% sensitivity and 79% specificity and a 97.8% negative predictive value, supporting its utility in ruling out hematoma and reducing surgical interventions. Among women with a hematoma, 26.3% required surgery. Mean time to surgery from diagnosis averaged 6.5 ± 3.8 h. Prolonged second stage (20% vs. 2.4%, <i>p</i> < 0.05) was significantly associated with surgery, with trends toward more vacuum deliveries, no epidural, and greater hemoglobin decline. Postpartum hemorrhage and blood transfusion rates did not differ between groups.</p><p><strong>Conclusion: </strong>Postpartum hematoma is rare but associated with vacuum delivery, episiotomy, second-degree laceration, and low BMI, while epidural analgesia is protective. Early recognition supports timely management.</p>","PeriodicalId":520540,"journal":{"name":"Pregnancy (Hoboken, N.J.)","volume":"2 4","pages":"e70316"},"PeriodicalIF":0.0,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13344242/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148763975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Selection of standards for estimated fetal weight percentiles.","authors":"C Andrew Combs, Olaide Ashimi Balogun, Sushma Amara, Zachary S Bowman, Peter A Combs","doi":"10.1002/pmf2.70337","DOIUrl":"https://doi.org/10.1002/pmf2.70337","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate which of 10 standards or references should be used for determination of percentiles of estimated fetal weight (EFW).</p><p><strong>Study design: </strong>Cross-sectional study using pooled data from four maternal-fetal medicine (MFM) practices. Inclusion criteria were as follows: ultrasound exam during 2022, singleton fetus, gestational age 24^0/7 to 39^6/7 weeks, biometry measured, and fetal cardiac activity present. EFW was calculated using the three-parameter formula of Hadlock et al. We evaluated five American birth weight (BW) references and five fetal weight (FW) standards. The fit of each reference or standard to our EFW distribution was assessed by seven criteria: mean <i>z</i>-score close to 0, standard deviation (SD) of <i>z</i> close to 1, Kolmogorov-Smirnov D-statistic close to 0, close to 10% of EFWs <10th percentile, close to 10% of EFWs > 90th percentile, and Youden J-statistics close to 1 at the 10th and 90th percentiles.</p><p><strong>Results: </strong>In 20,643 ultrasound exams, the formulas from the 1991 FW standard of Hadlock et al. had the best fit to our distribution of EFW (mean <i>z</i>-score 0.07, SD of <i>z</i> 1.04, D-statistic 0.036, J-statistics 0.946 and 0.972 at 10th and 90th percentile, respectively). All five EFW standards had better fit than any of the BW references, primarily because the range of normal of the BW references was much larger than the normal range of observed EFWs, resulting in underdiagnosis of abnormal EFW (both EFW <10th percentile and EFW >90th percentile). The range of normal from the Hadlock table was larger than that from the Hadlock formulas and the observed range, resulting in fewer diagnoses of abnormal EFW. In the subgroup of patients at low risk for small for gestational age or large for gestational age, the Hadlock formulas still had the best fit to our EFW distribution.</p><p><strong>Conclusions: </strong>Of the norms studied, the FW distribution from the Hadlock 1991 formulas had the best fit to our observed EFW distribution and are the most appropriate standard for determination of EFW percentiles in our US-based MFM practices. All the FW standards had better fit to our data than any of the BW references, so EFW percentiles should be based on FW standards, especially the Hadlock standard, not BW references.</p>","PeriodicalId":520540,"journal":{"name":"Pregnancy (Hoboken, N.J.)","volume":"2 4","pages":"e70337"},"PeriodicalIF":0.0,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13344239/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148766204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Indication for delivery and neonatal outcomes in prenatally diagnosed gastroschisis: A 20-year retrospective cohort study.","authors":"Nikan Zargarzadeh, Giulia Bonanni, Enaja Sambatur, Ehsan Rojhani, Eyal Krispin, Kjersti Aagaard, Alireza A Shamshirsaz","doi":"10.1002/pmf2.70333","DOIUrl":"https://doi.org/10.1002/pmf2.70333","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The optimal timing and indication for delivery in gastroschisis remain subjects of ongoing debate. This study evaluates clinical characteristics and postnatal outcomes associated with varying indications for delivery in this population.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This Institutional Review Board approved retrospective cohort study included all pregnancies with a prenatal ultrasound diagnosis of gastroschisis delivered between 34 0⁄7 and 38 6⁄7 weeks' gestation at a single tertiary care center from January 2000 through December 2023. This gestational age range represents a clinically relevant window encompassing late-preterm and early-term births, during which delivery timing is frequently influenced by physician decision-making rather than spontaneous labor. Pregnancies were categorized according to indication for delivery into three groups: (1) &lt;i&gt;medically indicated delivery&lt;/i&gt;, defined as delivery prompted by maternal, fetal, or placental conditions, including abnormal fetal surveillance findings (non-stress test or biophysical profile); (2) &lt;i&gt;spontaneous labor&lt;/i&gt;, defined as spontaneous onset of labor without preceding fetal surveillance abnormalities or ultrasound-based concerns; and (3) &lt;i&gt;fetal bowel concern&lt;/i&gt;, defined as delivery prompted by ultrasound findings suggestive of bowel compromise, including persistent bowel dilation, bowel wall thickening, or increased echogenicity. Neonatal outcomes assessed included age at abdominal wall closure, number of surgical interventions within the first month and first year of life, length of hospital stay, incidence of sepsis, age at initiation of enteral feeding, and rate of complex gastroschisis. Comparisons of outcomes across delivery indication groups were adjusted for gestational age at delivery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 83 infants met the inclusion criteria, including 22 delivered for fetal bowel concern, 36 for medically indicated delivery, and 25 following spontaneous labor. Age at abdominal wall closure occurred significantly earlier in the medically indicated delivery and spontaneous labor groups compared with the fetal bowel concern group after adjustment for gestational age at delivery (adjusted &lt;i&gt;p&lt;/i&gt; = 0.013 and &lt;i&gt;p&lt;/i&gt; = 0.025, respectively). There were no significant differences across delivery indication groups in the number of surgical interventions within the first month or first year of life, length of hospital stay, incidence of sepsis, age at initiation of enteral feeding, or rate of complex gastroschisis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Although bowel-related concerns frequently prompted delivery, this approach was not associated with improvements in key neonatal outcomes in this cohort. In contrast, infants delivered following spontaneous labor or medically indicated delivery demonstrated comparable, and in some cases more favorable, postnatal trajectories. These findings question the clinical utility of bowel-","PeriodicalId":520540,"journal":{"name":"Pregnancy (Hoboken, N.J.)","volume":"2 4","pages":"e70333"},"PeriodicalIF":0.0,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13344206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148764396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Co-occurring opioid and stimulant use disorder and the relationship to severe maternal morbidity.","authors":"Tucker E Doiron, Noor Al-Hammadi, Alexandra R Schroeder, Niraj R Chavan","doi":"10.1002/pmf2.70334","DOIUrl":"https://doi.org/10.1002/pmf2.70334","url":null,"abstract":"<p><strong>Introduction: </strong>To evaluate the impact of the use of opioids, stimulants, or both on the rates of various severe maternal morbidity (SMM) events during inpatient delivery-related hospitalizations among patients with substance use disorder (SUD).</p><p><strong>Methods: </strong>We performed a cross-sectional analysis of inpatient pregnancy hospitalizations from the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) from 2016 to 2022. Hospital and core files were linked and cross-referenced for demographic information. International classification of diseases (ICD) 10 codes were used to identify patients with SUD who had an SMM event during a delivery hospitalization. SMM was defined as a composite of individual maternal morbidity diagnoses, as characterized by the centers for disease control (CDC). Survey-weighted multivariable logistic regression models estimated the adjusted odds of SMM among delivery hospitalizations of patients with opioid use disorder (OUD), stimulant use disorder (StUD), or co-occurring OUD and StUD, using delivery hospitalizations of patients without any SUD as the reference group. Models adjusted for maternal age, race/ethnicity, primary insurance payer, household income quartile, hospital region, hospital location and teaching status, hospital bed size, cohort year, and Elixhauser comorbidity score. Prevalence of composite SMM and individual SMM events was compared across exposure groups using Rao-Scott chi-square tests.</p><p><strong>Results: </strong>Of the 4,804,219 delivery-related inpatient pregnancy hospitalizations over the study period, 45,671 admissions were identified as having SUD with either opioids (28,464), stimulants (13,920), or both (3287). There was an increasing trend of StUD from 2016 to 2021 (<i>p</i> < 0.0001). Overall rates of SMM between 2016 and 2022 were significantly higher among pregnancy hospitalizations for those with co-occurring SUD (adjusted odds ratio [aOR], 5.12; 95% confidence interval [CI], 4.48-5.84), followed by StUD (aOR, 3.84; 95% CI, 3.578-4.13) and OUD (aOR, 2.23; 95% CI, 2.09-2.38), compared with delivery hospitalizations of patients without any SUD. There were significant differences between the rates of individual SMM events between those with StUD, OUD, and those with co-occurring use disorder at all time points.</p><p><strong>Conclusion: </strong>Pregnant people with co-occurring OUD and StUD are at a significantly increased risk of SMM overall, as well as risk of certain individual SMM events as compared to those with OUD or StUD alone.</p>","PeriodicalId":520540,"journal":{"name":"Pregnancy (Hoboken, N.J.)","volume":"2 4","pages":"e70334"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13344222/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148766212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebral autoregulation in normal pregnancy, preeclampsia, and 1-year postpartum.","authors":"Niclas Carlberg, Katja Junus, Anna-Karin Wikström, Lina Bergman, Karusha Knipe, Catherine Cluver, Henrik Imberg, Ronney B Panerai, Teelkien van Veen","doi":"10.1002/pmf2.70324","DOIUrl":"https://doi.org/10.1002/pmf2.70324","url":null,"abstract":"<p><strong>Introduction: </strong>Cerebral complications of preeclampsia pose a significant threat to pregnant women worldwide. The underlying pathophysiology is unclear, but impaired cerebral autoregulation may contribute to adverse maternal outcomes. Long-term consequences of preeclampsia include cerebrovascular disease, and impairment of cerebral autoregulation could contribute to these outcomes. The aim of this study was to assess cerebral autoregulation in women with preeclampsia and normotensive pregnancies during pregnancy and 1-year postpartum to quantify impairment during disease and evaluate its persistence or recovery over time.</p><p><strong>Methods: </strong>This multicenter, prospective, observational cohort study included women from the UPMOST or GoPROVE studies. Women with preeclampsia were examined at diagnosis. Participants underwent transcranial Doppler examinations at inclusion and 1-year postpartum. Women were categorized as having normotensive pregnancies or preeclampsia with or without maternal complications. Cerebral autoregulation was assessed by the autoregulation index (ARI). Differences in mean ARI between and within groups were analyzed using regression models for repeated measures.</p><p><strong>Results: </strong>A total of 124 women were included in the analysis. During pregnancy, mean ARI was higher in normotensive pregnancies compared with preeclampsia (6.90 [SD, 0.77] vs. 6.12 [SD, 1.45]; mean difference 0.78 [95% CI, 0.37-1.19]), but no difference was observed 1-year postpartum (6.11 [SD, 1.14] vs. 6.15 [SD, 1.10]; mean difference -0.03 [95% CI, -0.47 to 0.54]). Mean ARI did not differ between preeclampsia with or without severe features, either during pregnancy (6.24 [SD, 1.49] vs. 5.98 [SD, 1.40]; mean difference 0.27 [95% CI, -0.43 to 0.96]), or 1-year postpartum (6.13 [SD, 1.23] vs. 6.18 [SD, 0.94]; mean difference -0.05 [95% CI, -0.64 to 0.54]).</p><p><strong>Conclusion: </strong>Preeclampsia impairs the autoregulatory advantage offered by pregnancy. This renders the maternal brain more vulnerable to neurovascular injury. This impairment appears to resolve by 1-year postpartum, suggesting that persistently depressed cerebral autoregulation is unlikely to account for long-term cerebrovascular consequences of preeclampsia.</p>","PeriodicalId":520540,"journal":{"name":"Pregnancy (Hoboken, N.J.)","volume":"2 4","pages":"e70324"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13344215/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Wearable-based phenotyping of activity patterns during pregnancy.","authors":"Oren Barak, Alexander D Bauer, Edi Vaisbuch, Samantha N Piekos, Yoel Sadovsky","doi":"10.1002/pmf2.70326","DOIUrl":"https://doi.org/10.1002/pmf2.70326","url":null,"abstract":"<p><strong>Objective: </strong>Wearable activity trackers provide scalable, objective measures of behavior, but their potential use for early detection of high-risk conditions during pregnancy remains to be evaluated.</p><p><strong>Study design: </strong>Using longitudinal Fitbit data from 336 participants in the Deep Phenotyping of Pregnancy Project (DP3), we evaluated both conventional and novel, pattern-level, digital biomarkers of activity in relation to common pregnancy complications, including hypertensive disorders of pregnancy (HDP), fetal growth restriction (FGR), and spontaneous preterm birth (sPTB).</p><p><strong>Results: </strong>Beyond average weekly step counts, we derived two novel metrics: cyclicality, reflecting the persistence of weekly rhythmic activity patterns, and time-to-drop, the gestational length interval until activity levels declined below group norms. While mean step counts did not differ among the groups, the groups of participants with complications were significantly less likely to exhibit cyclical activity patterns (87.2% vs. 77.6%, <i>p</i> < 0.05) and showed shorter time-to-drop compared to controls (34.3 vs. 28.4 weeks, <i>p</i> < 0.05). Neither sleep duration nor active minutes were associated with the outcomes.</p><p><strong>Conclusion: </strong>These findings suggest that pattern-based digital phenotypes, rather than aggregate step counts, capture activity deviations associated with adverse pregnancy outcomes. Our data support scalable, passive risk stratification and inform precision prenatal care.</p>","PeriodicalId":520540,"journal":{"name":"Pregnancy (Hoboken, N.J.)","volume":"2 4","pages":"e70326"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13344241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148765989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Society for Maternal-Fetal Medicine Statement: Acetaminophen use during pregnancy.","authors":"","doi":"10.1002/pmf2.70318","DOIUrl":"https://doi.org/10.1002/pmf2.70318","url":null,"abstract":"<p><p>Acetaminophen has long been considered safe to use during pregnancy. A growing body of cohort studies and meta-analyses has explored the potential association between prenatal acetaminophen use and neurodevelopmental outcomes in children. Although some studies report modestly increased risks of neurodevelopmental disorders in children exposed to acetaminophen prenatally, these findings must be interpreted with caution, given the inherent limitations of observational studies that may significantly affect the validity of the observed associations. While advanced statistical methods can help reduce bias, they cannot fully account for unmeasured or familial confounding. The Society for Maternal-Fetal Medicine continues to advise that acetaminophen is the recommended first-line medication for the treatment of pain and fever during pregnancy.</p>","PeriodicalId":520540,"journal":{"name":"Pregnancy (Hoboken, N.J.)","volume":"2 4","pages":"e70318"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13344438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}