Acta Obstetricia et Gynecologica Scandinavica最新文献

{"title":"Antihypertensive therapy for pregnancy hypertension and implications for fetal and neonatal heart rate monitoring: A systematic review of randomized trials and observational studies","authors":"Akalya Ganeshamoorthy, Omiete Fubara Duke, Hiten D. Mistry, Jeffrey N. Bone, Marianne Vidler, Edgardo Abalos, Katie Badawy, Asma Khalil, Peter von Dadelszen, Laura A. Magee","doi":"10.1111/aogs.70019","DOIUrl":"10.1111/aogs.70019","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Our objective was to evaluate whether antihypertensives affect fetal (FHR) or neonatal (neoHR) heart rate.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and methods</h3>\u0000 \u0000 <p>Electronic databases and clinical trial registers were searched to August 31, 2024. Eligibility included randomized (RCTs) or observational studies evaluating antihypertensives for pregnancy hypertension. Two reviewers independently assessed studies for inclusion and extracted data. Random effects meta-analysis was used to determine risk ratios (RRs) and 95% confidence intervals (CIs). Network meta-analysis was undertaken in a sensitivity analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty-four RCTs (<i>n</i> = 5736 pregnancies) and 28 observational studies (<i>n</i> = 2 283 855) reported FHR (usually visually-interpreted) or neoHR (usually clinically-assessed).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> FHR: Non-Severe Hypertension</h3>\u0000 \u0000 <p>Antihypertensives did not increase adverse FHR effects in RCTs of antihypertensives versus placebo/no therapy (RR = 1.08, 95% CI [0.62–1.89]; <i>I</i><sup>2</sup> = 43%; <i>N</i> = 10, <i>n</i> = 1567 pregnancies), antihypertensives versus methyldopa (RR = 1.40 [0.97–2.04]; <i>I</i><sup>2</sup> = 0%; <i>N</i> = 6, <i>n</i> = 515), or labetalol or pure beta-blockers versus other antihypertensives (RR = 1.70 [0.96–2.99]; <i>I</i><sup>2</sup> = 30%; <i>N</i> = 5, <i>n</i> = 501). In observational studies, adverse FHR effects were more common with: labetalol versus methyldopa, nifedipine or Chinese herbal medication (RR = 2.17 [1.15–4.08]; <i>I</i><sup>2</sup> = 47%; <i>N</i> = 4, <i>n</i> = 664), and bendroflumethiazide versus metoprolol (but not hydralazine), but 95% CIs were wide.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> FHR: Severe Hypertension</h3>\u0000 \u0000 <p>Antihypertensives had no FHR effects in RCTs of antihypertensives versus either: placebo/no therapy (RR = 0.43 [0.16–1.20]; <i>I</i><sup>2</sup> = 0%; <i>N</i> = 3, <i>n</i> = 242), hydralazine (RR = 0.71 [0.29–1.72]; <i>I</i><sup>2</sup> = 13%; <i>N</i> = 11, <i>n</i> = 727), or CCBs (RR = 0.52 [0.12–2.16]; <i>I</i><sup>2</sup> = 0%, <i>N</i> = 9, <i>n</i> = 1675). In observational studies, there was no difference for labetalol versus other antihypertensives (RR = 0.34 [0.10–1.14], <i>I</i><sup>2</sup> = 87%; <i>N</i> = 4, <i>n</i> = 590), with heterogeneity due to a lower-quality labetalol versus hydralazine study. There were fewer adverse FHR effects for nifedipine versu","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 10","pages":"1822-1837"},"PeriodicalIF":3.1,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70019","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938077","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":"Improving prediction of fetal/neonatal intracranial hemorrhage in HPA-1a alloimmunized pregnancies to guide antenatal management: An observational cohort study","authors":"Siw Leiknes Ernstsen,&nbsp;Maria Therese Ahlen,&nbsp;Eirin Listau Bertelsen,&nbsp;Jens Kjeldsen-Kragh,&nbsp;Anne Husebekk,&nbsp;Heidi Tiller","doi":"10.1111/aogs.70031","DOIUrl":"10.1111/aogs.70031","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Maternal alloimmunization against human platelet antigen-1a (HPA-1a) may lead to severe intracranial hemorrhage (ICH) in the fetus or newborn as a life-threatening complication of fetal neonatal alloimmune thrombocytopenia (FNAIT). Most women who are HPA-1a-alloimmunized do not have a fetus/neonate with ICH. In the absence of predictive tools to identify pregnancies with high risk of ICH outcome, most countries offer weekly antenatal IVIg to all recognized HPA-1a-alloimmunized pregnancies. Norwegian FNAIT guidelines are restrictive regarding antenatal IVIg administration and have a long-standing tradition of longitudinal anti-HPA-1a antibody measurements when at-risk pregnancies are identified, facilitating exploration of the natural history of alloimmunized pregnancies. We aimed to explore associations between maternal anti-HPA-1a antibody levels and risk of fetal/neonatal ICH in non-IVIg treated HPA-1a alloimmunized pregnancies and assess if an antibody level threshold can be useful for identifying pregnancies with increased ICH risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>We compared anti-HPA-1a levels both from clinically referred and prospectively identified, non-IVIg treated, HPA-1a-immunized pregnancies stratified by previous neonatal FNAIT outcome (ICH or FNAIT without ICH) in Norway 1997–2023.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Anti-HPA-1a levels in pregnancies with ICH outcome were higher (median 29.6 IU/mL, range 0.1–222.1, <i>n</i> = 15) compared to no ICH FNAIT pregnancies (median 10.4 IU/mL, range 0.0–83.1, <i>n</i> = 55; <i>p</i> = 0.046, Mann–Whitney <i>U</i> test). A suggestive anti-HPA-1a threshold of 70 IU/mL was chosen based on receiver operating characteristic (ROC) analysis, with high specificity values (96.4%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Antenatal anti-HPA-1a levels may be useful when assessing the risk of ICH outcome and may enable a more targeted antenatal IVIg treatment both in a nonscreening and screening situation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 10","pages":"1859-1868"},"PeriodicalIF":3.1,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70031","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938294","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":"Endometriosis and chronic pelvic pain management: Between a rock (denial) and a hard place (overdiagnosis).","authors":"Paolo Vercellini, Noemi Salmeri, Veronica Bandini, Paola Viganò, Edgardo Somigliana","doi":"10.1111/aogs.70043","DOIUrl":"https://doi.org/10.1111/aogs.70043","url":null,"abstract":"","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854205","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":"Perinatal outcomes and maternal health before and after single motherhood through assisted conception: A multiregistry study in Sweden.","authors":"Evangelia Elenis, Cecilia Mitt Holm, Ove Axelsson, Agneta Skoog Svanberg, Claudia Lampic, Gunilla Sydsjö","doi":"10.1111/aogs.70037","DOIUrl":"https://doi.org/10.1111/aogs.70037","url":null,"abstract":"<p><strong>Introduction: </strong>Single motherhood by choice has been associated with increased perinatal risks and poorer psychological well-being for the families. However, limited evidence exists regarding the health status of these women before, during, and after pregnancy.</p><p><strong>Material and methods: </strong>This prospective multiregistry study was conducted in Sweden and included unpartnered women conceiving with the help of assisted conception (n = 296) and all partnered women conceiving through IVF with the couple's own gametes (n = 7294), giving birth during 2007-2014. The primary outcomes assessed maternal somatic and mental health diagnoses 3 years before and after pregnancy, while secondary outcomes examined obstetric and neonatal complications. Data were retrieved from Swedish population-based registers, capturing ICD-10 diagnoses, filled prescriptions of psychiatric medications, and manually recorded perinatal data. Crude and adjusted logistic regression analyses were performed.</p><p><strong>Results: </strong>Single mothers through assisted conception were older and had significantly higher rates of smoking and obesity compared to partnered women. They also had a higher prevalence of psychiatric diagnoses, including anxiety and depression, both before (14.2% vs. 4.3%, p < 0.001) and after childbirth (29.1 vs. 12.1%, p < 0.001). Psychiatric medication use was significantly higher among single mothers both before (34.1% vs. 13.8%, p < 0.001) and after pregnancy (34.5% vs. 15.0%, p < 0.001). Obstetric and neonatal outcomes, including preterm birth and low birth weight, showed no significant differences between the groups, except for a higher incidence of multiple births among single mothers. The index population had a twofold increased risk of psychiatric conditions or medications, despite adjustment, in the period immediately before [aOR 2.51 (1.92-3.27)] or after childbirth [aOR 2.00 (1.51-2.66)].</p><p><strong>Conclusions: </strong>The study reveals that single mothers through assisted conception face increased psychiatric risks before and after childbirth compared to partnered women undergoing autologous IVF. The findings highlight the need for careful eligibility assessment by healthcare professionals and underscore the importance of ensuring a robust support system to help these mothers manage the challenges of solo parenthood.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854206","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":"Acupuncture for induction of labor in uncomplicated term pregnancies and the role of the acupoint selection: A systematic review and meta-analysis.","authors":"An Chen, Jiawen Zhang, Du Gao, Ying Xu, Shijia Jin, Tianyi Zhou, Fan Qu, Ganesh Acharya","doi":"10.1111/aogs.70036","DOIUrl":"https://doi.org/10.1111/aogs.70036","url":null,"abstract":"<p><strong>Introduction: </strong>Acupuncture is increasingly used for inducing labor; however, its effects on labor progression and birth outcomes remain inconclusive, and differences in acupuncture techniques are not fully considered by previous reviews. This study aims to evaluate the effects of acupuncture for induction of labor (AC-IOL) after 37 weeks of gestation on labor progression and birth outcomes, with a particular focus on comparing the combined stimulation of local and distant (L-D) acupoints with the selective use of either local or distant acupoints.</p><p><strong>Material and methods: </strong>Following PRISMA 2020 guidelines, we searched PubMed, Embase, Web of Science, and three Chinese databases for randomized controlled trials (RCTs) evaluating AC-IOL in uncomplicated pregnancies. Outcomes included onset of spontaneous labor, labor duration, use of epidural analgesia, mode of delivery, and Apgar score at 5 min. Meta-analyses were performed for each outcome, with subgroup analyses based on acupoint selection strategies. Quality assessment for the included studies was conducted using the Cochrane RoB 2 tool, and certainty of evidence using GRADEpro GDT. The protocol was registered in PROSPERO (CRD42024497859).</p><p><strong>Results: </strong>Ten studies including 1,432 participants were included. Five studies used combined L-D acupoint stimulation, and five used distant acupoints only; none used local acupoints alone. No significant differences were found between the acupuncture and control groups (sham acupuncture or usual care) in the onset of spontaneous labor, use of epidural analgesia, mode of delivery, or neonatal Apgar score ≤7 at 5 min. No significant differences in these outcomes were found in comparisons between the acupuncture group using a combination of L-D acupoints and the control group, nor between the acupuncture group using distant-only acupoints and the control group.</p><p><strong>Conclusions: </strong>Moderate to very low-quality evidence suggests that AC-IOL was not associated with labor progression or birth outcomes in uncomplicated full-term pregnancies.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144833694","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":"Umbilical cord serum insulin-like growth factor-1 is associated with growth of fetal fractional limb volume: A prospective study.","authors":"Satoru Ikenoue, Junko Tamai, Keisuke Akita, Toshimitsu Otani, Marie Fukutake, Yoshifumi Kasuga, Mamoru Tanaka","doi":"10.1111/aogs.70042","DOIUrl":"https://doi.org/10.1111/aogs.70042","url":null,"abstract":"<p><strong>Introduction: </strong>Insulin-like growth factor-1 (IGF-1) promotes protein and carbohydrate metabolism, which consequently affects birth weight. Fetal fractional limb volume has been proposed as a useful parameter for predicting birth weight and quantifying fetal soft tissue development. However, the relationship between umbilical cord serum IGF-1 levels and fetal fractional limb volume remains unclear. Herein, we aimed to investigate the association of cord serum IGF-1 levels with longitudinal changes in fetal fractional limb volume in uncomplicated pregnancies.</p><p><strong>Material and methods: </strong>In this prospective study, 96 singleton pregnancies were followed. Fetal 3D ultrasonography was performed longitudinally at 24, 30, and 36 weeks of gestation to assess fractional arm volume and thigh volumes as cylindrical limb volumes, derived from 50% of the fetal total diaphysis length. Cord serum IGF-1 levels were measured using an electrochemiluminescence immunoassay. The relationship between cord blood IGF-1 levels and fetal fractional limb volume was analyzed using multiple linear regression; adjusted for potential confounding factors including maternal age, parity, pre-pregnancy body mass index, gestational weight gain, fetal sex, and gestational age at assessments.</p><p><strong>Results: </strong>Mean cord serum IGF-1 was 52.8 ± 18.4 ng/mL (mean ± SD). IGF-1 levels were not associated with fetal fractional limb volumes at 24 weeks and 30 weeks but were significantly correlated with fractional arm volume (r = 0.290, p = 0.006) and fractional thigh volume (r = 0.289, p = 0.006) at 36 weeks. After adjusting for covariates, cord serum IGF-1 explained 7.0% and 10.6% of the variation in fractional arm and thigh volumes at 36 weeks, respectively. Although IGF-1 was significantly correlated with the birth weight percentile, it did not correlate with the estimated fetal weight at 36 weeks.</p><p><strong>Conclusions: </strong>Cord serum IGF-1 levels significantly correlated with fetal fractional limb volumes in late gestation. Fractional limb volume may be an earlier and more sensitive ultrasound parameter affected by serum IGF-1 level than estimated fetal weight.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144833697","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 prenatal exposure to Crohn's disease and offspring psychiatric regulatory disturbances","authors":"Samson Nivins,&nbsp;Elin Skott,&nbsp;MaiBritt Giacobini,&nbsp;Daniel Lindqvist,&nbsp;Mika Gissler,&nbsp;Klas Sjöberg,&nbsp;Catharina Lavebratt","doi":"10.1111/aogs.70038","DOIUrl":"10.1111/aogs.70038","url":null,"abstract":"&lt;p&gt;Sir,&lt;/p&gt;&lt;p&gt;We thank Khawar et al. for their Letter “Reconsidering the association between maternal Crohn's disease and offspring psychiatric outcomes” published in &lt;i&gt;Acta Obstetricia et Gynecologica Scandinavica&lt;/i&gt;,&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; raising concerns regarding our study “Offspring exposure to Crohn's disease during pregnancy and association with psychiatric regulatory disturbances in childhood.”&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Khawar et al. propose that corticosteroid exposure may explain the associations we detected between Crohn's disease (CD) and offspring sleeping disorder, incontinence, and feeding disorders. Corticosteroids, commonly prescribed during CD flares, cross the placenta and have been associated with adverse neurodevelopmental risks. Although our original models adjusted for grouped anti-inflammatory-medication use in maternal CD (ATC codes A07E (intestinal anti-inflammatory agents), H02A (corticosteroids for systemic use), L04A (immunosuppressants) [yes/no]) dispensed either within (i) 3 months before pregnancy (B3)/trimester one (T1) or (ii) T2–T3, we acknowledge that corticosteroids might constitute distinct pharmacological exposures. To address this, we conducted post-hoc sensitivity analyses adjusting for corticosteroid medication (H02A) during these periods. Corticosteroids were dispensed to 11.7% of mothers with CD and were associated with mildly increased risks of sleeping disorders (HR&lt;sub&gt;B3–T1&lt;/sub&gt; = 1.67 (1.30–2.15), HR&lt;sub&gt;T2–T3&lt;/sub&gt; = 2.02 (1.55–2.63)), incontinence (HR&lt;sub&gt;B3–T1&lt;/sub&gt; = 1.20 (1.00–1.44), HR&lt;sub&gt;T2–T3&lt;/sub&gt; = 1.29 (1.05–1.59)), and other feeding disorders (HR&lt;sub&gt;B3–T1&lt;/sub&gt; = 1.46 (1.12–1.90), HR&lt;sub&gt;T2–T3&lt;/sub&gt; = 1.68 (1.23–2.29)). However, the adjustment for corticosteroid medication did not attenuate the effect sizes of the reported associations&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; between maternal CD and offspring sleeping disorders, incontinence, or other feeding disorders. We refer to Gastroenterology Rep review,&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; supporting continued use of most IBD therapies during pregnancy, citing low-risk profile for fetal neurodevelopment and emphasizing the importance of maternal disease control.&lt;/p&gt;&lt;p&gt;Khawar et al. suggest that the associations we observed between CD exposure and childhood sleeping, incontinence, and feeding disorders may reflect genetic predisposition. They cite GWAS findings,&lt;span&gt;&lt;sup&gt;4, 5&lt;/sup&gt;&lt;/span&gt; indicating that polygenic-risk scores for CD are associated with neurobiological pathways regulating sleep, appetite, and hypothalamic signaling. We agree that shared genetic mechanisms warrant further investigation. However, our population-based epidemiological study was without access to genetic data and was designed to explore associations between maternal CD and specific, often understudied, childhood psychiatric outcomes. We clearly stated that the study did not allow causal claims. We also adjusted for maternal psychiatric diagnoses before delivery, whic","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 10","pages":"2017-2018"},"PeriodicalIF":3.1,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70038","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144833695","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":"Impact of maternal body mass index above 30 kg/m² on adverse pregnancy outcomes in women with and without gestational diabetes mellitus in southeastern Sweden.","authors":"Anna Stogianni, Annika Jönsson, Malin Penna, Lena Lendahls, Michael Alvarsson, Mona Landin-Olsson, Pär Wanby, Maria Thunander","doi":"10.1111/aogs.70040","DOIUrl":"https://doi.org/10.1111/aogs.70040","url":null,"abstract":"<p><strong>Introduction: </strong>Our objective was to evaluate the association of early-pregnancy body mass index (BMI) in women with gestational diabetes mellitus (GDM) with maternal, delivery, and child outcomes, and compare with pregnancies without diabetes in southeastern Sweden, including after a surge of non-European immigration.</p><p><strong>Material and methods: </strong>A retrospective population-based observational study of all 401 singleton pregnancies with GDM in the Kronoberg and southern Kalmar regions, 2013-2018, and 377 pregnancies without diabetes, matched by date of delivery. Data were collected by chart review. Women with early-pregnancy BMI <30 kg/m²/≥30 kg/m² were compared. Main outcomes were gestational weight gain (GWG), continuous and dichotomized <8 kg/≥8 kg, preeclampsia, cesarean section (CS), and large-for-gestational-age (LGA). Maternal age, ethnicity, parity, smoking, physical activity, delivery type and week, birthweight, and the APGAR_5min score were also registered.</p><p><strong>Results: </strong>Obese women with GDM had lower mean GWG (9.2 ± 6.8 vs. 11.7 ± 6.1 kg); fewer reached ≥8 kg (54% vs. 75%), more had preeclampsia (13% vs. 2.6%), and infants weighed 200 g less than those of nonobese women with GDM all p < 0.001 and those of obese women without GDM (11.2 ± 5.8 kg, p < 0.001; 68%, p = 0.05, 3.1%, p = 0.03). APGAR_5min scores were high in all groups, 9.4-9.8. All women with GDM had a higher prevalence of LGA infants than controls without diabetes; obese 24% versus 12% (p = 0.03) and nonobese 11% versus 6% (p = 0.05). Obese women with GDM delivered more LGA infants than nonobese women with GDM, p = 0.001. The combination of GDM and obesity increased risk of LGA, OR 5.3 (2.76-10.1); preeclampsia OR 4.3 (1.83-10.23); and CS OR 1.9 (1.26-2.97) and decreased odds of GWG ≥8 kg, OR 0.25 (0.16-0.38), compared to the reference group of nonobese women without GDM. All results remained unchanged in a sensitivity analysis using the BMI obesity limit ≥27.5 kg/m² for Asians, who were overrepresented in the group of women with GDM.</p><p><strong>Conclusions: </strong>Women with GDM and obesity, especially in combination, had a greater risk for preeclampsia, CS, and delivering LGA infants; their lower GWG and high APGAR_5min scores in all groups, compared to earlier studies, suggested successful care interventions. Efforts to lower the levels of early-pregnancy obesity and strict glucose control in women with GDM are recommended to reduce adverse outcomes.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144833696","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":"Perinatal impacts of fetal growth velocity on small-for-gestational-age fetuses: A retrospective cohort study in a tertiary center.","authors":"Charlotte Prats, Marion Chesnais, Claire Thuillier, Anne-Sophie Boucherie, Juliette Francois, Paul Berveiller, Thibaud Quibel","doi":"10.1111/aogs.70035","DOIUrl":"https://doi.org/10.1111/aogs.70035","url":null,"abstract":"<p><strong>Introduction: </strong>The perinatal risk of reduced growth velocity among small for gestational age (SGA) has been poorly studied. Therefore, we assessed the impact of abdominal fetal growth velocity on perinatal morbidity and mortality among SGA fetuses with positive umbilical artery end-diastolic flow.</p><p><strong>Material and methods: </strong>This retrospective, single-center cohort study was conducted between January 1, 2018, and May 31, 2022, at a tertiary center. We included women with a singleton pregnancy, at least two ultrasounds with an estimated fetal weight in the <10th percentile at least 2 weeks apart between gestational weeks 24 and 36, and a positive umbilical artery end-diastolic flow. Abdominal circumference growth velocity (ACGV) was calculated. For each ACGV, a z-score was calculated using INTERGROWTH-21 standards. Reduced growth velocity (ACGV z score < -2) and normal (ACGV z score ≥ -2) groups were compared based on a composite perinatal criterion defined as one of the following: stillbirth, 5-min Apgar score <7, arterial pH at birth <7.10, neonatal intensive care unit admission, or infant death before discharge.</p><p><strong>Results: </strong>Among the 216 women included, 14.4% (31/216) had a fetus with reduced abdominal circumference growth velocity group and 85.6% (185/216) had a fetus with normal ACGV. Adverse neonatal outcomes occurred significantly more often in the reduced growth velocity group (58% in the reduced ACGV group vs 33% in the normal ACGV; p = 0.007). Nulliparous women, hypertensive disorders, and cerebroplacental redistribution at baseline and final Doppler examinations were significantly more frequent in the reduced ACGV group. After adjustment for confounding factors, ACGV z score < -2 was not significantly associated with an increased risk of perinatal adverse outcome (adjusted odds ratio [ORa] = 1.99), (95% confidence interval [CI]: [0.8-4.91]). However, hypertensive disorders (ORa = 4.48, 95% CI: [2-10.02]), cerebroplacental redistribution on the final Doppler examination (ORa = 3.12, 95% CI: [1.07-9.05]), and gestational diabetes (ORa = 3.72, 95% CI: [1.62-8.54]) remained statistically associated with increased perinatal morbidity risk.</p><p><strong>Conclusions: </strong>Among SGA fetuses, reduced abdominal circumference growth velocity was not associated with an increased adverse perinatal outcome risk. Further studies are needed to determine the impact of growth velocity on the issues of SGA fetuses.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783200","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":"Lifestyle-based and psychological interventions during pregnancy and risk of obesity and obesity-associated metabolic complications in the offspring: A scoping review","authors":"Tiina Pajuvirta,&nbsp;Linnea Aitokari,&nbsp;Anna Eurén,&nbsp;Sauli Palmu,&nbsp;Salla Kuusela,&nbsp;Hannele Laivuori,&nbsp;Kaija Nissinen,&nbsp;Kaija Puura,&nbsp;Kalle Kurppa","doi":"10.1111/aogs.70034","DOIUrl":"10.1111/aogs.70034","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Obesity is a major global health challenge. Maternal health issues may increase the risk for obesity and associated conditions in the offspring, emphasizing the importance of successful interventions during pregnancy. However, systematic data are lacking.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Material and Methods</h3>\u0000 \u0000 <p>A systematic literature review of the effectiveness of maternal interventions in preventing childhood obesity and associated metabolic comorbidities was conducted. The search was conducted by two independent reviewers using PubMed, Scopus, ScienceDirect, and reference screening for relevant studies published between 1990 and 2023. Interventions were included that were lifestyle-based, but those with psychological components were also eligible for inclusion. Only studies with data on offspring anthropometrics and/or metabolic comorbidities after age ≥2 years were included.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Altogether 22 studies met the inclusion criteria, 14 with physical activity and dietary components, six with one or the other of these, and two with other interventions. Of the studies combining diet and physical activity, eight reported reductions in gestational weight gain and two less gestational diabetes. One study reported lower offspring body mass index in compliant participants and another lower resting pulse rate. Of the studies with only a dietary or physical activity component or other interventions, four reported lower gestational weight gain. One of these reported lower weight and skinfold thickness in the offspring and another lower fasting glucose.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A limited number of studies have evaluated offspring outcomes beyond the neonatal period. Lifestyle-based interventions including psychological components are particularly scarce. The research conducted demonstrated only a minor impact on childhood anthropometric and metabolic outcomes; however, the interpretation of these findings is hampered by a considerable risk of bias, largely due to missing offspring data.</p>\u0000 </section>\u0000 </div>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 10","pages":"1808-1821"},"PeriodicalIF":3.1,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70034","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783199","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}