American journal of obstetrics and gynecology最新文献

{"title":"Spontaneous vaginal deliveries with delayed pushing (Letter-to-the-Editor).","authors":"Ryan Findlay","doi":"10.1016/j.ajog.2026.04.042","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.04.042","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.4,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147855445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mycoplasma genitalium Infection and Adverse Perinatal Outcomes.","authors":"Irene A Stafford, Erik Munson, Sahana Kodali, Mason Collie, Han-Yang Chen, Damon Getman, Sean C Blackwell","doi":"10.1016/j.ajog.2026.04.041","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.04.041","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.4,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maternal cytomegalovirus infection in the first trimester of pregnancy: timing, fetal brain injury, and long-term neurodevelopmental outcomes including autism spectrum disorder.","authors":"Marianne Leruez-Ville, David Grevent, Nicolas Bourgon, Christos Chatzakis, Marine Parodi, Jacques Fourgeaud, Nicolas Veyrenche, Nadia Bahi-Buisson, Christine Pichon, Jean-Francois Magny, Nathalie Boddaert, Yves Ville","doi":"10.1016/j.ajog.2026.04.040","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.04.040","url":null,"abstract":"<p><strong>Background: </strong>Congenital cytomegalovirus (CMV) infection is the leading non-genetic cause of sensorineural hearing loss and is associated with a broad spectrum of neurodevelopmental outcomes. A possible association between congenital CMV and autism spectrum disorder has been hypothesised for several decades, based on case reports and small retrospective studies.</p><p><strong>Objective: </strong>The objective was to estimate the strength of the association between congenital CMV and neurodevelopmental abnormalities including autism spectrum disorder, their dependence on the timing of maternal infection, and their potential neuroanatomical correlates.</p><p><strong>Study design: </strong>We conducted a prospective observational cohort study including children with confirmed congenital CMV infection followed at a single tertiary referral centre in France between 2001 and 2024. Maternal CMV infections were classified and dated using centralized serological assessment. Children underwent standardized longitudinal follow-up, including audiological, neurological, behavioural, and neuroimaging evaluations, up to 48 months of age. Fetal brain MRI was available for cases diagnosed antenatally. Outcomes of interest included hearing loss, neurodevelopmental impairment, and autism spectrum disorder.</p><p><strong>Results: </strong>Among 642 children with confirmed congenital CMV infection, 504 (78.5%) were exposed to a maternal primary infection with known timing. Of these, 288 (57.1%) followed first-trimester infection, 144 (28.6%) second-trimester infection, and 72 (14.3%) third-trimester infection. Long-term congenital CMV-related sequelae, including hearing loss and neurodevelopmental impairment, were observed exclusively in children exposed to first-trimester maternal primary infection. Autism spectrum disorder was diagnosed in 11 children (1.7%), all of whom were symptomatic at birth; all cases following maternal primary infection occurred after first-trimester exposure. Compared with estimates from the general French population, prevalence in children with congenital CMV was 4-fold higher (odds ratio 4.25, 95% CI 1.63-21.33). In all children diagnosed with autism spectrum disorder, temporal lobe white matter abnormalities, especially in the temporal poles, were identified on postnatal MRI and were present on antenatal imaging in fetuses who underwent prenatal MRI. The review of all fetal MRIs from the prenatally diagnosed subgroup, temporal lobe white matter abnormalities were present in a minority of cases and no child without temporal lobe abnormality developed autism spectrum disorder.</p><p><strong>Conclusions: </strong>In this large prospective cohort, adverse long-term outcomes following maternal primary infection were observed only after first trimester exposure. Autism spectrum disorder occurred exclusively in this group and was consistently associated with temporal lobe white matter abnormalities. These findings support a ti","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.4,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sonographic diagnosis of umbilical cord presentation in preterm prelabor rupture of membranes.","authors":"Ivana Musilova, Bo Jacobsson, Helena Hornychova, Marian Kacerovsky","doi":"10.1016/j.ajog.2026.04.039","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.04.039","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.4,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147809567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between hematologic response to iron therapy and risk of stillbirth in pregnant singletons with moderate iron deficiency anemia.","authors":"Rc Boelig, Mk Georgieff, S Thind, Mb Bellad, Ms Somannavar, S Bhandari, S Mehta, S Mehta, Dk Sharma, S Yogeshkumar, U Charantimath, Ap Patil, Aa Mallapur, U Ramadurg, R Sangavi, P Patil, S Roy, P Vastrad, Be Leiby, R Hartman, Zh Aghai, Rj Derman","doi":"10.1016/j.ajog.2026.04.038","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.04.038","url":null,"abstract":"<p><strong>Background: </strong>Maternal iron deficiency anemia (iron deficiency anemia) is a persistent global health challenge with increased risk of adverse perinatal outcomes. A recent multicenter clinical trial found reduced rates of low birthweight infants in mothers treated initially (early second trimester) with IV ferric carboxymaltose compared to oral iron. Secondary findings included improved hematologic indices 4 weeks post-treatment, as well as reduced rate of stillbirth with single dose IV iron infusion.</p><p><strong>Objective: </strong>We aimed to determine if the initial response to iron therapy was associated with risk of stillbirth and other adverse perinatal outcomes in pregnant singletons with moderate iron deficiency anemia STUDY DESIGN: This is a secondary analysis of a multi-center randomized controlled trial in India that compared single dose intravenous iron to oral iron for the initial management of moderate iron deficiency anemia (Hb 7.0-9.9g/dL) at 14-17 weeks gestation. The primary outcome for this secondary analysis is stillbirth. Secondary outcomes were early preterm birth <34 weeks, small for gestational age infants (<10%ile). The predictors of interest were maternal hemoglobin, ferritin, and transferrin saturation (TSAT), measured at 20-24 weeks gestation. Longitudinal hematologic and iron indices through pregnancy and association with outcomes were also assessed. Relative risk of each outcome based on post-treatment hemoglobin, ferritin, and TSAT was assessed with Poisson regression, adjusting for maternal age, BMI, parity, treatment modality, baseline Hb, and study site. Two-sided alpha=0.05 used for all analyses. Given that most nutrients exhibit U-shaped or threshold risk curves, we also fit models allowing for a quadratic function for the relationship between hematologic parameters at all times and risk of each event RESULTS: 4252 participants were included in this analysis, 1421, 1424, 1407 received intravenous ferric derisolmaltose, ferric carboxymaltose, and oral iron respectively. In evaluating the linear relationship, each unit of increasing Hb response at 20-24 weeks was significantly associated with reduced risk of stillbirth (RR 0.74 (0.56, 0.98). In evaluating the quadratic relationship, we found that there was a significantly progressively increased risk of stillbirth (p<0.0001) and early preterm birth< 34 weeks (p=0.01). Although there was a significant quadratic relationship identified with small for gestational age infant and Hb (p=0.008), the relative risk of SGA and lower Hb was not statistically significant.</p><p><strong>Conclusion: </strong>Inadequate improvement in hemoglobin at 20-24 weeks following iron therapy in pregnancies complicated by moderate iron deficiency anemia is associated with increased risk of stillbirth and early preterm birth. Our findings highlight the potential importance of early screening and treatment of maternal anemia,. Given the association between persistent ane","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.4,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147809559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to 'Society for Maternal-Fetal Medicine Consult Series #69: Hepatitis B in Pregnancy: Updated Guidelines' [American Journal of Obstetrics and Gynecology 230/4 (2024) B2-B11].","authors":"Martina L Badell, Malavika Prabhu, Jodie Dionne, Alan T N Tita, Neil S Silverman","doi":"10.1016/j.ajog.2026.04.007","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.04.007","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.4,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147809569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of misclassification in progression of CIN2 during active surveillance: results from a historical cohort.","authors":"Marie Brønd, Therese Christensen, Tina Hovgaard Randrup, Cecilie L G Tarpø, Christina Sand, Mark Stoler, David Jenkins, Sara Bønløkke, Anne Hammer","doi":"10.1016/j.ajog.2026.04.035","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.04.035","url":null,"abstract":"<p><strong>Background: </strong>Many countries have recently implemented active surveillance for cervical intraepithelial neoplasia grade 2 (CIN2) as an option in younger women due to high regression rates and because excisional treatment is associated with increased risk of preterm birth. However, the known low reproducibility of the CIN2 diagnosis poses a major challenge for active surveillance, suggesting that the observed risk of progression in prior studies may be due to initial misclassification of the CIN2 diagnosis.</p><p><strong>Objective: </strong>This study aimed to assess the association between expert-verified histological diagnoses of cervical biopsies in women undergoing active surveillance for CIN2 and the subsequent risk of cervical intraepithelial grade 3 or worse (CIN3+).</p><p><strong>Study design: </strong>We conducted a historical cohort study on women undergoing active surveillance for CIN2, diagnosed at Aarhus University Hospital from 2000-2010. Women were identified through the Danish Pathology Data Bank and were eligible for inclusion if they were 23-40 years old at the time of CIN2 diagnosis. Women with a prior history of CIN2 or worse (CIN2+), loop electrosurgical excision procedure (LEEP), or hysterectomy were excluded. Three expert pathologists independently graded cervical lesions by reviewing hematoxylin and eosin (H&E) and p16 stained tissue slides from the time of CIN2 diagnosis. Women were followed for 28 months, from the date of the CIN2 diagnosis until a record of progression, LEEP, hysterectomy, or end of follow-up, whichever occurred first. Using modified Poisson regression analysis, we estimated the crude and adjusted relative risks of CIN3+, including corresponding 95% confidence intervals (CI). We adjusted for age, index cytology, and HPV genotype as potential confounders.</p><p><strong>Results: </strong>A total of 437 women were included with a median age of 27 years. Upon expert review, 56 (12.8%) were upgraded to CIN3, 261 (59.7%) had CIN2 confirmed, and 120 (27.5%) were downgraded to CIN1/normal. Overall, 173 (39.6%) women had a subsequent record of CIN3+, ranging from 22.5% in women with expert CIN1/normal, to 42.2% in women with expert CIN2, and 64.3% in women with expert CIN3. Thus, women with an expert-verified CIN3 diagnosis were more likely to have a subsequent record of CIN3+ during follow-up (adjusted relative risk, aRR 1.37 (1.07; 1.75)) compared to those who had expert CIN2. This association remained significant in stratified analyses for women aged 31-40 years (aRR 1.85 (1.25; 2.76)), in women with high-grade index cytology (aRR 1.43 (1.04; 1.97)), and women with a non-HPV16 lesion (aRR 1.66 (1.09; 2.52)). The risk of CIN3+ remained high for women presenting with a high-grade cytology or HPV16 positivity at baseline, irrespective of expert diagnosis.</p><p><strong>Conclusion: </strong>Our findings demonstrate substantial interobserver variability in the diagnosis of community-detected CIN2,","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.4,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147809639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neonatal and Obstetric Outcomes Following Periconceptional Exposure to Glucagon-Like Peptide-1 Receptor Agonists: A Systematic Review and Meta-analysis.","authors":"Jolie Hakim, Diya Rajesh, Javier A Tello","doi":"10.1016/j.ajog.2026.04.037","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.04.037","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the association between periconceptional exposure to glucagon-like peptide-1 receptor agonists and fetal, pregnancy-related, obstetric, and delivery outcomes.</p><p><strong>Data sources: </strong>PubMed, Embase, and Web of Science were searched from database inception through November 2025 to identify relevant studies.</p><p><strong>Study eligibility criteria: </strong>Cohort and observational studies comparing human pregnancies with periconceptional glucagon-like peptide-1 receptor agonist exposure to unexposed comparator groups were included. Case reports and case series were also included for narrative synthesis. Studies involving non-human animals were excluded from the primary meta-analysis but referenced in the background synthesis.</p><p><strong>Study appraisal and synthesis methods: </strong>This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Random-effects meta-analyses were performed using odds ratios or mean differences with ninety-five percent confidence intervals. Heterogeneity was assessed using the I-squared statistic. Sensitivity analyses were conducted using comparator-specific control groups to account for maternal disease.</p><p><strong>Results: </strong>Twenty-two studies, comprising 49,395 human pregnancies with periconceptional glucagon-like peptide-1 receptor agonist exposure, were included. Meta-analysis of ten cohort and observational studies showed no statistically significant association between exposure and major congenital malformations, cardiac malformations, gestational age and weight, preterm delivery, live birth, spontaneous pregnancy loss, hypertensive disorders or pregnancy, or cesarean delivery. A small but statistically significant association with renal malformations was detected (OR 1.23, 95% CI 1.09-1.39), however, this was largely driven by a single large cohort with substantial baseline imbalances. Heterogeneity was moderate to high for several outcomes. Narrative synthesis of case reports and series identified no consistent pattern of adverse outcomes.</p><p><strong>Conclusions: </strong>Current human evidence does not demonstrate a consistent association between periconceptional glucagon-like peptide-1 receptor agonist exposure and major adverse fetal, pregnancy, obstetric, or labor outcomes. The observed risk for renal malformations should be interpreted with caution as it likely reflects residual confounding by maternal disease severity. These findings provide cautious reassurance following inadvertent exposure but do not support routine use during pregnancy, highlighting the need for robust studies with long-term follow-up.</p>","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.4,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147809593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"LNG-IUS versus hysteroscopic niche resection: addressing concerns on study design and interpretation (Reply to Letter-to-the-Editor).","authors":"Jian Zhang, Qian Zhu, Lirong Yan","doi":"10.1016/j.ajog.2026.04.034","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.04.034","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.4,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Late-Onset Diagnosis of Gestational Diabetes After Normal Mid-Pregnancy Screening in Women with Large for Gestational Age or Polyhydramnios: A Systematic Review and Meta-Analysis.","authors":"Omri Dominsky, Roza Berkovitz-Shperling, Michal Rosenberg-Fridman, Daniel Gabbai, Shai Ram, Yariv Yogev","doi":"10.1016/j.ajog.2026.04.036","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.04.036","url":null,"abstract":"<p><strong>Objective: </strong>To determine the detection rate of late-onset gestational diabetes mellitus (GDM) and associated perinatal outcomes in women with normal mid-pregnancy glucose screening who undergo repeat oral glucose tolerance testing (OGTT) due to suspected large-for-gestational-age (LGA) fetuses or polyhydramnios.</p><p><strong>Data sources: </strong>We systematically searched PubMed/MEDLINE, Embase, Web of Science, and the Cochrane Library for studies published from January 2010 to November 2024.</p><p><strong>Study eligibility criteria: </strong>We included cohort studies reporting late GDM detection rates in women with documented normal mid-pregnancy glucose testing (negative glucose challenge test or normal 75g OGTT at 24-28 weeks) who underwent repeat OGTT after 28 weeks due to sonographic findings of suspected LGA or polyhydramnios. We excluded studies of women with pre-existing diabetes, those lacking documented normal mid-pregnancy screening, and those examining routine late testing without specific clinical indication.</p><p><strong>Study appraisal and synthesis methods: </strong>Study quality was assessed using the Newcastle-Ottawa Scale. Pooled detection rates with 95% confidence intervals were calculated using random-effects meta-analysis. Subgroup analyses were performed by clinical indication, timing of testing, initial screening method (two-step vs one-step), and maternal BMI. Perinatal outcomes were compared using pooled odds ratios calculated with the Mantel-Haenszel method.</p><p><strong>Results: </strong>Six cohort studies including 2,166 women met inclusion criteria. The pooled detection rate was 15.0% (95% CI: 9.9-21.0%; I²=91%). Detection rates varied significantly by indication: suspected LGA 20.8% (95% CI: 17.4-24.6%) vs. isolated polyhydramnios 4.8% (95% CI: 2.0-10.8%). Women with late-onset GDM had significantly higher rates of neonatal hypoglycemia (OR 1.82; 95% CI: 1.18-2.81), overall cesarean delivery (OR 2.00; 95% CI: 1.47-2.72), elective cesarean for LGA/macrosomia (OR 3.37; 95% CI: 2.01-5.64), emergent cesarean (OR 1.64; 95% CI: 1.05-2.57), and induction of labor (OR 2.27; 95% CI: 1.32-3.89). Macrosomia by birth weight and LGA at delivery were not significantly elevated.</p><p><strong>Conclusions: </strong>Late OGTT detects GDM in approximately one in six women with normal mid-pregnancy screening who develop LGA or polyhydramnios. Late-onset GDM is associated with significantly increased neonatal hypoglycemia and cesarean delivery, with the largest effect for elective cesarean for suspected LGA/macrosomia. These findings may inform clinical decision-making regarding repeat glucose testing in the third trimester.</p>","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.4,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}