American journal of perinatology最新文献

{"title":"Maternal Prepregnancy Body Mass Index and Risk of Preterm Birth: The Role of Weight Gain during Pregnancy, Race, and Ethnicity.","authors":"Wendemi Sawadogo, Medhin Tsegaye, Andinet Gizaw, Hunter Newland, Tilahun Adera","doi":"10.1055/a-2494-2080","DOIUrl":"10.1055/a-2494-2080","url":null,"abstract":"<p><p>Preterm birth (PTB) is one of the leading causes of infant and neonatal mortality. Prepregnancy body mass index (BMI; kg/m²) has been linked to PTB but the evidence of this association by weight gain during pregnancy, race, and ethnicity is limited. This study aimed to assess the association between maternal prepregnancy BMI and PTB stratified by weight gain during pregnancy, race, and ethnicity.The U.S. natality data from 2017 to 2021 were used. In this analysis, we included mothers who had a live singleton birth and available data for prepregnancy BMI, gestational age at birth, weight gain during pregnancy, race, and ethnicity. Logistic regression models were used to assess the association between prepregnancy BMI categories and PTB stratified by weight gain during pregnancy, race, and ethnicity.A total of 17,311,509 singleton live births were included of which 1,393,889 (8.05 %) were PTBs. After adjusting for confounders, compared with normal prepregnancy BMI mothers (18.5-24.9), those with underweight BMI (<18.5) were at increased odds of PTB regardless of weight gain during pregnancy, race, and ethnicity. However, for mothers with a prepregnancy BMI above the normal weight (≥25), the association between prepregnancy BMI and PTB differs by weight gain during pregnancy, race, and ethnicity. Asian mothers with obesity II (35.0-39.9) had 93% (odds ratio [OR] = 1.93, 95% confidence interval [CI]: 1.62-2.30) increased odds of PTB for weight gain during pregnancy of 31 to 40 pounds. Their White, Hispanic, and Black counterparts experienced lower odds of PTB for similar weight gain during pregnancy (White: OR = 1.56, 95% CI: 1.51-1.60; Hispanic: OR = 1.48, 95% CI: 1.41, 1.54; and Black: OR = 1.22, 95% CI: 1.17-1.27).Mothers with underweight BMI were at increased risk of PTB regardless of weight gain during pregnancy, race, and ethnicity. However, the association between high prepregnancy BMI and PTB varied by weight gain during pregnancy, race, and ethnicity. · The association between prepregnancy BMI categories and PTB had a \"J\" shape, with lower odds in the normal weight group.. · Low prepregnancy BMI was associated with increased risk of PTB regardless of weight gain during pregnancy, race, and ethnicity.. · The association between high prepregnancy BMI and PTB varies by weight gain during pregnancy, race, and ethnicity..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1389-1399"},"PeriodicalIF":1.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Indomethacin and Cefazolin for Physical Exam-Indicated Cerclage to Improve Latency: A Protocol Validation Study.","authors":"Nicola R Young, Luke A Gatta, Sarahn M Wheeler, Jerome J Federspiel, Sarah K Dotters-Katz","doi":"10.1055/a-2502-7225","DOIUrl":"10.1055/a-2502-7225","url":null,"abstract":"<p><p>A single-center randomized trial showed improved latency with use of indomethacin and cefazolin (I/C) during and following exam-indicated cerclage (EIC). The same center recently published a pre/post comparison demonstrating similar results. This research aimed to validate the protocol in a different setting.Retrospective cohort study of singleton pregnancies undergoing EIC at a single center between 2013 and 2022. EIC was performed for painless cervical dilation between 16 and 23 weeks' gestation with dilation ≥1 cm. Exposure was defined as receipt of I/C during and following EIC. The primary outcome was latency ≥ 28 days after cerclage placement. Secondary outcomes included latency; gestational age at delivery; delivery ≤ 28 weeks; preterm premature rupture of membranes; intra-amniotic infection (IAI); and median birth weight. Bivariate statistics were used to analyze data; multivariable regression analyses were used to control for confounders (progesterone use, cervical dilation at time of cerclage placement, history of preterm birth, and prolapsing membranes).EIC was placed in 81 pregnancies and 48 (59%) received I/C. Baseline characteristics did not differ between groups, except that prolapsing membranes were significantly less likely in patients receiving I/C (6.2 vs. 21.2%; <i>p</i> = 0.04). Latency ≥ 28 days occurred in 90% of I/C recipients and 82% of the controls (<i>p</i> = 0.32); this difference remained nonsignificant after controlling for confounders (adjusted relative risk: 1.02 [95% confidence interval: 0.85, 1.21]). I/C recipients had lower rates of IAI (4.2 vs. 24.2%, <i>p</i> = 0.007), even after adjustment (adjusted relative risk: 0.18 [95% confidence interval: 0.04, 0.74]). Other secondary outcomes did not differ.Use of I/C at the time of EIC at this center was not associated with increased latency to delivery (albeit in a small cohort) but was associated with lower rates of intra-amniotic infection. Larger-scale validation studies would be helpful to confirm the value of this intervention. · Indomethacin/cefazolin (I/C) increased latency for exam-indicated cerclage in a trial.. · We performed an observational comparison to validate these findings.. · I/C use for exam-indicated cerclages was associated with decreased intra-amniotic infection.. · I/C was not associated with change in latency.. · Larger-scale validation studies needed to confirm the value of intervention..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1416-1420"},"PeriodicalIF":1.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12238287/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142833366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes in Neonates Receiving Therapeutic Hypothermia and Extracorporeal Membrane Oxygenation versus Extracorporeal Membrane Oxygenation Alone.","authors":"Erin Cicalese, Bryn H S Seltzer, Jason C Fisher, Sourabh Verma","doi":"10.1055/a-2499-4712","DOIUrl":"10.1055/a-2499-4712","url":null,"abstract":"<p><p>This study aimed to examine survival and outcomes in neonates who received therapeutic hypothermia (TH) for neonatal encephalopathy (NE) and extracorporeal membrane oxygenation (ECMO) versus ECMO alone.This is a retrospective review of Extracorporeal Life Support Organization (ELSO) Registry data from 2007 to 2017 for neonates undergoing ECMO and TH for NE (TH/ECMO) or ECMO alone. Primary outcomes were ECMO survival and survival to discharge. Secondary outcomes were complications while on ECMO. Statistical analysis was performed using Fisher's exact and Mann-Whitney U tests. Multivariate regression was performed to identify predictors of ECMO survival.Of 3,672 neonates, 215 (6%) received TH/ECMO, while 3,457 (94%) received ECMO alone. There was no significant difference in ECMO survival (92 vs. 92%, <i>p</i> = 0.70) or survival to discharge (87 vs. 85%, <i>p</i> = 0.43) between groups. TH/ECMO group had higher hemorrhagic (29 vs. 20%, <i>p</i> < 0.01), neurologic (24% vs. 12%, <i>p</i> < 0.01), and metabolic (28 vs. 15%, <i>p</i> < 0.01) complications. Multivariate regression identified higher gestational age, absence of inotropes during ECMO, and lack of neurologic, pulmonary, or hemorrhagic complications as independent predictors of ECMO survival.Neonates undergoing ECMO and TH for NE had survival rates comparable to those receiving ECMO alone. These findings suggest that ECMO can be considered for neonates with NE undergoing TH who meet the criteria for ECMO. · ECMO survival is comparable between neonates who underwent TH and ECMO versus ECMO alone.. · Neonates who underwent TH and ECMO had more hemorrhagic, neurologic, and metabolic complications.. · Offering ECMO to qualifying neonates also undergoing TH is reasonable..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1409-1415"},"PeriodicalIF":1.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142811926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Community Characteristics as Measured by Social Deprivation Index Score with Prenatal Care and Obstetrical Outcomes.","authors":"Alexa M Sassin, Natalie Osterlund, Haleh Sangi-Haghpeykar, Kjersti Aagaard","doi":"10.1055/a-2507-7371","DOIUrl":"10.1055/a-2507-7371","url":null,"abstract":"<p><p>We aimed to determine the relationships between socioeconomic disadvantage, as measured by the Social Deprivation Index (SDI), and prenatal care (PNC) utilization, obstetrical outcomes, and neonatal complications.All spontaneously conceived singleton deliveries of nulliparous gravida with residence zip code available (<i>n</i> = 4,786) were identified in a population-based database. Deliveries were assigned SDI scores based on preconception zip code. SDI scores (1-100) are a composite measure of seven community demographic characteristics of poverty, education, transportation, employment, and household composition. SDI scores were categorized into quartiles and grouped for analysis (Q1 [<i>n</i> = 1,342], Q2 + 3 [<i>n</i> = 1,752], and Q4 [<i>n</i> = 1,692]) with higher scores indicative of greater disadvantage. Statistical analysis was performed using a generalized linear mixed method.Among our cohort, gravida in the lowest (least-deprived) SDI quartile (Q1) were older, had lower prepregnancy body mass indices, and were more likely to receive PNC from a physician specializing in Obstetrics and Gynecology. Gravida residing in the highest (most-deprived) SDI quartile (Q4) attended fewer prenatal visits (mean [standard deviation] 11.17 [2.9]) than those living in Q1 (12.04 [2.3], <i>p</i> < 0.0001). Gravida in Q4 were less likely to receive sufficient PNC compared with those in Q1 (52 vs. 64.2%, <i>p</i> < 0.0001) and were more likely to fail to achieve appropriate gestational weight gain (GWG) (19.6 in Q4 vs. 15.9% in Q1, <i>p</i> < 0.01). No significant differences in composite maternal (CMM) or neonatal morbidity (CNM) were associated with SDI quartile.Outer quartile social deprivation was associated with higher proportions of primigravida not meeting recommendations for GWG and attending fewer prenatal visits, but it did not affect CMM or CNM. Improving care access and providing nutritional support to all gravida are likely important steps toward health equity. · Neighborhood social deprivation was not associated with composite maternal or neonatal morbidity.. · Community-level deprivation was associated with decreased PNC utilization.. · It is important to understand the underlying disparities that lend to suboptimal patterns of PNC.. · Doing so may inform programs that promote favorable birth outcomes in at-risk communities..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1452-1460"},"PeriodicalIF":1.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Coronavirus Disease-2019 on Influenza and Tdap Vaccination Rates in Pregnant Patients.","authors":"Ravyn Njagu, Katherine Freedy, Amanda Brucker, Kelvin Feng, Siera Lunn, Melissa Greene, Geeta K Swamy, Sarah Dotters-Katz","doi":"10.1055/a-2510-3783","DOIUrl":"10.1055/a-2510-3783","url":null,"abstract":"<p><p>Influenza and tetanus toxoid reduced diphtheria toxoid, and acellular pertussis (Tdap) are safe and effective vaccines that are recommended in pregnancy. Despite this, significant vaccine hesitancy exists in pregnancy. However, impact of the coronavirus disease 2019 (COVID-19) pandemic on vaccine hesitancy is not well understood. Thus, we sought to describe impact of the COVID-19 pandemic on influenza and Tdap vaccination rates in pregnant patients.Retrospective cohort study of patients delivering at single academic center from October 1, 2017 to August 31, 2021. Patients with missing vaccine data or delivering before 28 weeks (Tdap range) excluded. Patients delivering pre-COVID (October 1, 2017-August 31, 2019) compared with those delivering mid-COVID (October 1, 2020-August 31, 2021). Primary outcomes were vaccination rates for Tdap and influenza. Secondary outcome was rate of dual vaccination (receiving both) and variation by race/ethnicity. Chi-square tests and logistic regression were used to test for changes in vaccination rates.Of 8,650 unique patient pregnancies, 5,925(68.5%) occurred pre-COVID. Median patient age (30 years) and gestational age at delivery (39 weeks) not clinically different between groups. Patients in mid-COVID group had lower numbers of government-assisted insurance (47.3%) and higher non-Hispanic Black compared with pre-COVID (31.5%). The rate of influenza vaccination decreased 8.2 percentage points from pre-COVID to mid-COVID (69.9 vs. 61.7%, <i>p</i> < 0.001). Tdap vaccination rates also decreased, although less-so (88.5 vs. 85.1%, <i>p</i> < 0.001). The rate of patients receiving both vaccines during pregnancy decreased from 66.0 to 58.4% (<i>p</i> < 0.001). Significant decreases in influenza vaccination rates mid-COVID versus pre-COVID was seen in all race-ethnicity groups except non-Hispanic White patients. For Tdap vaccinations, the effect of COVID on the odds of receiving Tdap did not differ across race-ethnicity groups.Rates of influenza, Tdap, and dual vaccination in pregnancy dropped significantly during the COVID-19 pandemic. For influenza, these were most pronounced in all race-ethnicities included with exception of non-Hispanic White. These data emphasize the importance of continued counseling and education on vaccinations in pregnancy and raise important questions regarding vaccine access and patient hesitancy during pandemic-mediated prenatal care. · Influenza vaccination decreased with COVID-19.. · Tdap vaccination decreased with COVID-19.. · Decrease in flu vaccination in most race-ethnicity groups..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1485-1490"},"PeriodicalIF":1.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating Payor-Segregated Outpatient Obstetrics and Gynecology Care Models: The Patient Perspective.","authors":"Arina E Chesnokova, Annie Apple, Karampreet Kaur, Allison Schachter, Elizabeth A Clement, Marilyn M Schapira, Sarita Sonalkar, Florencia G Polite, Kavita Vinekar, Abike T James, Rebecca F Hamm","doi":"10.1055/a-2505-5508","DOIUrl":"10.1055/a-2505-5508","url":null,"abstract":"<p><p>Significant racial and ethnic disparities in maternal morbidity and mortality as well as gynecologic outcomes persist in the United States. The role of ambulatory care in obstetrics and gynecology (OBGYN), particularly in facilities that separate resident and attending care along payor (and de facto racial) lines, remains unclear. This study examines patient perspectives on payor-segregated health care delivery in an academic medical center (AMC) and opinions on possible integration.This is a qualitative study conducted at a single AMC with payor-segregated resident and attending outpatient sites. Interviews focused on patient perception of experience and value in outpatient OBGYN care, perspectives on the segregated care model, and attitudes about integration. Patients participated in a 30-minute semistructured interview with recruitment continuing until thematic saturation was reached (October 2022-August 2023). Interviews were coded using an integrated approach with grounded theory; 12% of transcripts were double-coded (<i>k</i> = 0.86).We interviewed 26 patients (16 from resident, 10 from attending site). Patients prioritized practical aspects such as clinic proximity and quality of clinician interaction. Most were unaware of the payor-segregated clinic system and disapproved upon learning about it. Opinions varied on topics of telehealth and continuity, indicating diverse patient needs. Notably, minoritized patients valued race and class concordance in clinical spaces. Patients generally supported care integration, conditional upon the preservation of aspects of care they valued.Successful OBGYN care integration requires meeting individual needs while ensuring diversity, safety, and community-oriented care, alongside access and convenience. Incorporating patient voices is crucial for aligning services with expectations and improving patient experiences. · Patients disapprove of payor-segregated care but prioritize practical aspects over care structure.. · Minoritized patients valued race/class concordance. Preferences varied on continuity, residents, and telehealth.. · Clear communication around prior payor segregation and motivations for integration will foster trust..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1425-1436"},"PeriodicalIF":1.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142862941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perinatal Mental Health Disorders and Resilience in Patients with Fetal Anomalies.","authors":"Sydney C Timmer-Murillo, Alyssa Mowrer, Maddie R Rundell, Kelly Jazinski-Chambers, Isela Piña, Terri A deRoon-Cassini, Amy J Wagner","doi":"10.1055/a-2508-2490","DOIUrl":"10.1055/a-2508-2490","url":null,"abstract":"<p><p>Pregnant women face heightened vulnerability to mental health disorders (MHDs). There remains a lack of data during the antenatal period, particularly for high-risk subpopulations such as those with fetal anomalies. Understanding the psychological impact of women receiving a fetal anomaly diagnosis is crucial, as it can lead to MHDs. Additionally, maternal stress due to such diagnoses can have adverse effects on short- and long-term health outcomes for both the mother and the child. This study aimed to address the gap in knowledge regarding prenatal MHDs in women with fetal anomalies by characterizing maternal peripartum psychological health and identifying factors related to MHDs.Women diagnosed with fetal anomalies (<i>N</i> = 110) were recruited from a tertiary fetal care center and completed surveys assessing resilience, anxiety, depression, and posttraumatic stress symptoms (PTSs). Demographic characteristics were also collected and analyzed. Multiple regression analyses were conducted to explore associations between demographic variables and mental health outcomes.Participants endorsed elevated depressive symptoms (45%), anxiety (43%), and PTSs (39%). Private insurance and relationship status were positively associated, and resilience was negatively associated, with depression and anxiety levels. Maternal perception of diagnostic severity correlated with increased depressive symptoms and PTSs, whereas physician ratings of diagnostic severity did not.The findings underscore the prevalence of MHD among pregnant women with fetal anomalies and emphasize the importance of assessing maternal perception of severity in predicting mental health outcomes. Identifying risk factors like insurance status and relationship status suggests avenues for targeted screening and intervention. Multidisciplinary collaboration is essential for implementing effective strategies to address peripartum psychopathology related to fetal anomalies and improve overall maternal and fetal health. · Pregnant women with fetal anomalies face poor mental health.. · Resilience is negatively related to poor mental health.. · Perception of severity impacts mental health symptoms..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1461-1468"},"PeriodicalIF":1.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143057781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of Hypovitaminosis D in Pregnancy and Potential Benefits of Oral Supplementation.","authors":"Gabriele Saccone, Giorgia Buonomo, Serena Guerra, Doriana Gentile, Attilio Di Spiezio Sardo","doi":"10.1055/a-2502-7295","DOIUrl":"10.1055/a-2502-7295","url":null,"abstract":"<p><p>This study aimed to evaluate prevalence of hypovitaminosis D in a cohort of Italian pregnant women, and to evaluate potential benefits of oral supplementationObservational cohort of women with singleton gestations who were referred to our institution for first trimester prenatal visit. Screening for hypovitaminosis D was performed at the time of first trimester routine scan between 11 and 13 weeks of gestations. Women were offered measurement of serum 25-hydroxyvitamin D (25[OH]D). Levels of 25(OH)D are interpreted as follows: 12 to <20 ng/mL: Vitamin D insufficiency; < 12 ng/mL: Vitamin D deficiency. Women with Vitamin D insufficiency or deficiency were offered daily oral supplementation at the dose of 2.000 UI, along with folic acid. The primary outcome was the prevalence of hypovitaminosis D in our cohort.During the study period, between January 2023 and January 2024, 250 pregnant women were included in the study and screened for 25(OH)D. More than half of the screened women had 25(OH)D < 20 ng/mL, with a prevalence of <12 ng/mL of 14%. Out of the 140 (140/250 = 56%) women with 25(OH)D < 20 ng/mL, 127/140 (90%) accepted supplementation with Vitamin D, whereas 13 refused the therapy for fear of teratogenic effects of the fetus. The overall rate of preterm delivery before 37 weeks was 8.4%, whereas the incidence of preeclampsia was 2.8%. Rate of preterm delivery was higher in women who did not received supplementation (9.5 vs. 30.8%), but the study was not powered for such comparison.Hypovitaminosis D has high prevalence in pregnant women. Universal screening in the first trimester with measurement of serum 25-hydroxyvitamin D (25[OH]D) can identify women at risk that may benefit of oral supplementation. · Hypovitaminosis D has high prevalence in pregnant women.. · Universal screening with measurement of serum 25(OH)D can identify women at risk.. · Oral supplementation can be recommended in women with vitamin D insufficiency..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1421-1424"},"PeriodicalIF":1.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142833374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intratracheal Administration of Budesonide with Surfactant for Prevention of Death or Bronchopulmonary Dysplasia in Extremely Low Birth Weight Infants: A before-after Study.","authors":"Anish Pillai, Nandkishor Kabra, Sharayu Kothavade, Anita Chevle, Sachin Sakharkar, Deepika Tiwari, Richa Choubey, Haribalakrishna Balasubramanian","doi":"10.1055/a-2506-2893","DOIUrl":"10.1055/a-2506-2893","url":null,"abstract":"<p><p>Previous studies have suggested a potential role for inhaled corticosteroids, such as budesonide, in reducing bronchopulmonary dysplasia (BPD) among preterm infants. The objective of our study was to investigate the effectiveness of intratracheal administration of corticosteroid with surfactant on the composite outcome of death or BPD at 36 weeks in extremely low birth weight (ELBW) infants.This before-after cohort study compared outcomes in ELBW infants with respiratory distress syndrome (RDS) who received intratracheal surfactant with budesonide to a historical cohort who received surfactant alone. Data were collected retrospectively for neonates in the surfactant group and prospectively for those receiving surfactant plus budesonide.A total of 385 ELBW infants were included. Death or BPD occurred in 123/203 (60.5%) in the surfactant with budesonide group versus 105/182 (57.6%) in the surfactant group; adjusted odds ratio 1.10 (95% CI: 0.69-1.75; <i>p</i> = 0.69). Statistical analysis revealed no significant difference in the incidence of the composite primary outcome (death or BPD at 36 weeks of postmenstrual gestational age), and its components, between the two study groups.In our study, coadministration of budesonide and surfactant was deemed safe and feasible among ELBW infants with RDS. However, we did not observe a significant reduction in the rates of composite or individual outcomes of death or BPD. Larger, randomized controlled trials are necessary to explore the potential advantages of this intervention. · Small clinical trials have shown promising benefits of intratracheal administration of budesonide with surfactant for improving respiratory outcomes in preterm infants.. · This before-after intervention study showed that intratracheal budesonide with surfactant was safe and feasible in ELBW infants.. · However, coadministration of budesonide and surfactant did not reduce the composite outcome of death or BPD in the study population..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1437-1444"},"PeriodicalIF":1.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142862942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Maternal Antioxidant Vitamin Supplementation on Maternal and Cord Blood Adiponectin Concentrations.","authors":"Jessica L Pippen, Paula McGee, James M Roberts, Leslie Myatt, Michael W Varner, Alan T N Tita, Ronald J Wapner, John M Thorp, Brian M Mercer, Beth A Plunkett, Sean C Blackwell, Anthony Sciscione, George R Saade","doi":"10.1055/a-2509-1828","DOIUrl":"10.1055/a-2509-1828","url":null,"abstract":"<p><p>Adiponectin is a hormone that modulates glucose regulation and fatty acid oxidation. Low adiponectin concentration has been associated with increased insulin resistance. Studies show a beneficial effect of vitamin E supplementation on insulin sensitivity. We aimed to investigate the association of prenatal antioxidant supplementation with increased adiponectin concentrations in pregnant participants and their newborn infants.Secondary analysis of a randomized control trial of prenatal vitamin C and E supplementation to prevent preeclampsia in low-risk nulliparous participants. Plasma of participants at time of randomization (9-16 weeks gestation) and delivery, and neonatal cord blood were analyzed by specific enzyme-linked immunosorbent assay for adiponectin concentration. Multivariable analysis was adjusted for confounders.A total of 198 (98 vitamin, 100 placebo) maternal-neonatal dyad samples were analyzed. Maternal and neonatal characteristics were similar between the vitamin and placebo groups, with the exception of race/ethnicity, with Whites more common in the placebo group (80 vs. 66.3%, <i>p</i> = 0.02). In bivariable analyses, adiponectin concentrations at delivery were higher in the vitamin group compared with the placebo group (29.4 vs. 27.5 µg/mL, <i>p</i> = 0.04), whereas cord blood adiponectin concentrations were similar (26.6 . vs. 27.4 µg/mL, <i>p</i> = 0.47) between the two groups. There was a significant interaction between treatment group and maternal baseline adiponectin level on the adiponectin concentrations at delivery (<i>p</i> = 0.04) and cord blood adiponectin (<i>p</i> < 0.05). For participants whose baseline adiponectin concentrations were in the highest tertile, vitamin supplementation was associated with higher adiponectin concentrations at delivery. However, for participants whose baseline adiponectin concentration were in the lowest tertile, vitamin supplementation was associated with lower cord blood adiponectin concentrations.For participants with high baseline adiponectin concentration, vitamin C and E supplementation is associated with higher adiponectin concentration at delivery. Conversely, vitamin supplementation is associated with lower cord adiponectin concentration among participants with low baseline adiponectin concentration. · Vitamin E is an antioxidant with metabolic properties.. · Adiponectin is a cytokine with metabolic properties.. · Vitamin E is associated with higher pregnancy adiponectin.. · Vitamin E is associated with lower neonatal adiponectin.. · Vitamin E correlated with positive pregnancy and neonatal adiponectin trends..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1469-1476"},"PeriodicalIF":1.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12286745/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143571850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}