American journal of perinatology最新文献

{"title":"Incidence of New, Nonphysiologic Maternal Findings on Fetal Magnetic Resonance Imaging.","authors":"Shirley J Shao, Andrew Grimes, Marley Rashad, Liina Poder, Dorothy Shum, Nasim C Sobhani","doi":"10.1055/a-2466-1319","DOIUrl":"10.1055/a-2466-1319","url":null,"abstract":"<p><p>Fetal magnetic resonance imaging (MRI) is increasingly used for evaluation of fetal anomalies, and rates of incidental maternal findings are not well characterized. Our objective was to evaluate the rate of incidental maternal findings at the time of antenatal MRI performed for fetal indications.This was a retrospective cohort study that included all fetal MRIs performed between 2018 and 2023 at a single tertiary care institution with a multidisciplinary fetal diagnosis and treatment center. The electronic medical record was reviewed to identify all documented maternal findings and any new, nonphysiologic maternal findings. The latter was defined as previously unknown abnormalities of maternal structures unrelated to normal physiology.Our study included 834 imaging events, performed at an average gestational age of 23 weeks. The most common indication for imaging was fetal anomaly (81.1%). The most common imaging type was fetal brain MRI (81.4%). Overall, 16.2% reported a maternal finding and 7% reported a new, nonphysiologic finding. The most common new, nonphysiologic findings were renal cysts (<i>n</i> = 11), liver cysts (<i>n</i> = 6), and gallstones or gallbladder sludge (<i>n</i> = 5). Compared with imaging events that included a fetal brain MRI, imaging events that included a fetal body MRI had a significantly higher rate of any maternal findings (53.0 vs. 10.4%, <i>p</i> < 0.001) and new, nonphysiologic maternal findings (26.9 vs. 3.7%, <i>p</i> < 0.001).Our results suggest that the risk of identifying new, nonphysiologic maternal findings on fetal MRI is low. The rate of any maternal and new, nonphysiologic maternal findings may differ by fetal MRI type due to differences in imaging depth and extent of radiology subspecialist review. These data should be incorporated into pretest counseling for patients planning to have fetal MRI. · The rate of incidental maternal findings on fetal MRI was 7%-lower than previously reported.. · Incidental maternal findings were more common on fetal body versus brain MRI.. · Maternal BMI did not impact incidence of new, nonphysiologic maternal findings.. · Our results could inform pretest counseling and consent discussions around fetal MRI..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1186-1191"},"PeriodicalIF":1.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612353","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":"Fetal Growth Restriction: A Pragmatic Approach.","authors":"Allan Nadel, Malavika Prabhu, Anjali Kaimal","doi":"10.1055/a-2483-5684","DOIUrl":"10.1055/a-2483-5684","url":null,"abstract":"<p><p>An accurate diagnosis of fetal growth restriction relies on a precise estimation of gestational age based on a carefully obtained history as well as early ultrasound, since a difference of just a few days can lead to a significant error. There is a continuum of risk for adverse outcome that depends on the certainty of dates and presence or absence of comorbidities, in addition to the estimated fetal weight percentile and the umbilical artery waveform. The results of several studies, most notably the TRUFFLE trial, demonstrate that optimal management of fetal growth restriction with an abnormal umbilical artery waveform requires daily electronic fetal heart rate monitoring, and this monitoring does not require computerized interpretation. The role of ductus venosus waveform, biophysical profile, and middle cerebral artery waveform is less clear, and the results of these three modalities should be interpreted with caution. · A correct diagnosis of fetal growth restriction requires a very precise estimate of gestational age.. · In the presence of abnormal umbilical artery Doppler, the cornerstone of surveillance is daily electronic fetal heart rate monitoring.. · Surveillance with biophysical profile, ductus venosus waveform, and middle cerebral artery waveform are less important than daily electronic fetal heart rate monitoring..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1223-1228"},"PeriodicalIF":1.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12136975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142715050","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":"Intrapartum Care for People with Diabetes-Working towards Evidence-Based Management.","authors":"Michal Fishel Bartal","doi":"10.1055/a-2405-1846","DOIUrl":"10.1055/a-2405-1846","url":null,"abstract":"<p><p>The consensus in the literature supports the need for careful monitoring and management of maternal blood glucose during labor to optimize neonatal outcomes. Guidelines generally recommend strict control of maternal blood glucose during labor, involving frequent checks, and the use of dextrose and insulin as needed. However, recent evidence has not consistently shown a strong association between strict control of blood glucose and a reduction in the rate of neonatal hypoglycemia. This raises questions about the extent to which intrapartum blood glucose control impacts neonatal hypoglycemia. This review aims to explore the literature on intrapartum maternal blood glucose management in individuals with pregestational or gestational diabetes, utilizing peer-reviewed journals and datasets, including PubMed, Google Scholar, and clinical guidelines. Observational studies, small sample sizes, variability in definitions of maternal hyperglycemia and neonatal hypoglycemia, and differences in measurement methods such as timing and thresholds for intervention limit the literature on this topic. Additionally, many studies may not fully account for confounding factors such as maternal body mass index, diet, and other comorbidities affecting blood glucose levels. These limitations underscore the need for a cautious interpretation of current findings and highlight the necessity for future research in this area. This review elaborates on the available data and summarizes evidence on managing labor in pregnancies complicated by diabetes. We also emphasize the need for further research to clarify the relationship between maternal blood glucose during labor and neonatal blood glucose. · The benefits of strict intrapartum blood glucose control are unclear.. · The optimal maternal blood glucose range to prevent neonatal hypoglycemia remains undefined.. · Additional research is necessary to understand the relationship between maternal and neonatal blood glucose..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1103-1108"},"PeriodicalIF":1.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142103504","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 Stakeholder Priorities for the Optimization of Care of the Preterm Infant in a Safety-Net NICU.","authors":"Elizabeth Sewell, Miguel Locsin, George Bugg, Kimarie Bugg, Kate McGinnis, Mary Jackson, Nathalie Maitre, Sierra Peagler, Dana Robinson, Andrea Serano, Jessica Roberts","doi":"10.1055/a-2463-4327","DOIUrl":"10.1055/a-2463-4327","url":null,"abstract":"<p><p>This study aimed to engage clinical and community stakeholders to create a prioritization matrix of interventions to reduce neonatal brain injury and improve neurodevelopmental outcomes.We collaborated with our community partner to establish a Lived Experience Advisory Group (LEAG). Faculty performed a literature review to identify neonatal neuroprotective interventions; additional priorities from the LEAG were also included. Project leaders scored and presented intervention bundles for impact. Stakeholder priorities for value/feasibility were obtained via questionnaire. Mean values were incorporated into a prioritization matrix.Themes from discussions with LEAG members included the role of the neonatal intensive care unit (NICU) parent, the experience of trauma, shared decision-making, communication and trust with the health care team, and bias in medical care. Five interventions were placed in the highest priority quadrant of the prioritization matrix: thermoregulation, maternal antepartum steroids, delayed cord clamping, optimized oxygen delivery, and optimized glucose regulation.It is feasible to incorporate community and parent values into clinically oriented neuroprotective intervention bundles for preterm infants. This clinical-community collaboration is vital to ensure that our project objectives meet the needs and priorities of the population it is intended to serve. · Including input from parent advisory groups supports interventions that meet the needs of families.. · Collaboration between clinical and community stakeholders can improve neuroprotective and neurodevelopmental strategies.. · Incorporation of clinical interventions into a prioritization matrix improves resource utilization.. · Five perinatal interventions were ranked highly for impact and feasibility in the prioritization matrix..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1152-1161"},"PeriodicalIF":1.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779215","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":"Fetal Heart Rate and Amniotic Fluid Volume Measurements with a Home Ultrasound Device.","authors":"Anat Pardo, Shir Nahum Fridland, Or Lee Rak, Emilie Klochendler Frishman, Hadar Zafrir Danieli, Anat Shmueli, Shiri Barbash-Hazan, Arnon Wiznitzer, Asnat Walfisch, Tomer Sela, Leor Wolff, Eran Hadar","doi":"10.1055/a-2469-0887","DOIUrl":"10.1055/a-2469-0887","url":null,"abstract":"<p><p>Pulsenmore ES is a self-scanning ultrasound (US) system for remote fetal assessment. It comprises a handheld transducer that serves as a smartphone cradle coupled with an application and clinician's web-viewer dashboard. Recently, a novel capability was added to the system allowing offline fetal heart rate (FHR) and maximal vertical pocket (MVP) measurements. The aim of this study was to evaluate these tools for usability and accuracy.A prospective, non-randomized, non-blinded clinical study design was used. Pulsenmore ES scans were obtained by non-professional laypersons in app-guided (AG) mode (user follows video tutorials in the application) or clinician-guided (CG) mode (user is guided by a health care professional in a real-time telemedicine visit). The scans were stored on a cloud for later interpretation by a health care professional. Each self-scan was immediately followed by a standard US scan performed by a clinician. The asynchronous FHR and MVP measurements made on the AG and CG scans through the designated dashboard were analyzed and compared with the real-time, in-clinic (INC) measurements.The cohort included 28 women. Rates of successful utilization of the Pulsenmore tool for measurement of FHR were 84.7 ± 11.24% of scans made in AG mode and 96.3 ± 6.35% of scans made in CG mode. Corresponding values for MVP were 91.7 ± 2.31% and 95.0 ± 1.73%. FHR accuracy (difference from INC values) was 10.8 ± 7.5 beats per minute (bpm; 7.2%) in AG mode and 5.8 ± 5.1 bpm (4%) in CG mode. MVP accuracy was 1.3 ± 1.4 cm (22%) and 0.9 ± 0.8 cm (14%), respectively. Sensitivity (87.5% and 100% in AG and CG modes, respectively) and specificity (95% and 95.5% in AG and CG modes, respectively) were established for MVP.FHR and MVP measurements obtained from scans captured by the self-operated Pulsenmore ES ultrasound platform are highly accurate and reliable for clinical use relative to standard INC measurements. · Pulsenmore ES is a self-scanning US system for remote fetal assessment.. · FHR and MVP can be accurately and remotely measured from home.. · Home US can play a critical role in remote antenatal surveillance..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1192-1199"},"PeriodicalIF":1.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12136976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142674822","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":"Simplifying Management of Cholestasis: A Proposal for a Classification System.","authors":"Minhazur Sarker, Gladys A Ramos, Lauren Ferrara, Cynthia Gyamfi-Bannerman","doi":"10.1055/a-2495-3553","DOIUrl":"10.1055/a-2495-3553","url":null,"abstract":"<p><p>Given the stillbirth risk associated with intrahepatic cholestasis of pregnancy, management to reduce this adverse outcome has primarily involved planned delivery as early as 36 weeks gestation. While earlier planned delivery has decreased the incidence of stillbirth in this population, recently, there have been multiple published retrospective studies to better correlate the association of adverse outcomes with cholestasis severity. Despite these new data, the uptake of individualized management for cholestasis has been varied from provider to provider. In this opinion, we briefly review the current literature and evidence regarding cholestasis and adverse outcomes and propose a cholestasis classification system with subsequent algorithms for management. · Recently, multiple studies have further characterized adverse outcomes with cholestasis.. · Incorporation of severity-associated management into clinical practice is variable.. · A cholestasis classification system will simplify and streamline management..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1229-1234"},"PeriodicalIF":1.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12137020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779248","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":"Retroverted Uterus in the First Trimester and Associated Pregnancy Outcomes.","authors":"Emily R Schneider, Agata Kantorowska, Joanna M Clough, Erin L Miller, Emmanuella Kobara, Jasmine Brite, Meredith L Akerman, Wendy L Kinzler, Anju Suhag, Martin R Chavez, Patricia Rekawek","doi":"10.1055/a-2466-1155","DOIUrl":"10.1055/a-2466-1155","url":null,"abstract":"<p><p>This study aimed to investigate if retroverted (RV) uterus noted on nuchal translucency (NT) ultrasound is associated with second-trimester pregnancy loss and other adverse pregnancy outcomes.This was a retrospective cohort study of patients with RV uterus documented on NT ultrasound at a single academic medical center from October 2019 to March 2023. Subjects were identified using a query for \"retroverted\" uterine position within an obstetric ultrasound imaging program. For each RV case, two anteverted (AV) subjects were selected for comparison. Patients with multiple gestation, Mullerian anomalies, or fetal aneuploidy were excluded. Maternal demographics, obstetric, and neonatal outcomes were obtained by chart review. Fisher's exact test and Mann-Whitney test were used for categorical and continuous variables, respectively, with <i>p</i>-value <0.05 denoting significance. Multivariable logistic regression was used to adjust for possible confounding variables.Analysis included 249 patients-83 RV and 166 AV. RV patients were more likely to identify as Caucasian (71.1 vs. 49.4%, <i>p</i> = 0.001), have private insurance (80.7 vs. 59.4%, <i>p</i> = 0.001), lower body mass index (25.4 ± 5.1 vs 29.1 ± 7.2, <i>p</i> < 0.001), and conceive by in vitro fertilization (IVF, 11 vs. 3%, <i>p</i> = 0.018). Most RV subjects (98%) had a resolution of retroversion by the second trimester. There was no difference in second-trimester pregnancy loss (0 vs. 1.2%, <i>p</i> = 0.55). After adjusting for race and IVF, RV subjects were four times more likely to have first-trimester vaginal bleeding (16.9 vs. 4.2%, odds ratio = 4.1, <i>p</i> = 0.0056). No other differences in adverse outcomes were observed.Persistent RV uterus in the first trimester is associated with increased risk of first-trimester vaginal bleeding. However, rates of pregnancy loss were similar between groups, providing valuable information for patient counseling. Significantly more RV subjects conceived by IVF, highlighting the need for further study in this population. · Pregnancy outcomes of patients with retroverted uterus have not been widely studied.. · Significantly more patients with a retroverted uterus conceived by in vitro fertilization.. · Patients with retroverted uterus were four times more likely to have first-trimester bleeding.. · Despite increased rates of vaginal bleeding, there was no increased rate of pregnancy loss..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"1179-1185"},"PeriodicalIF":1.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779242","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":"Placenta Accreta Spectrum Outcomes with a Multidisciplinary Team and Standardized Ultrasound Approach.","authors":"Elise A Rosenthal, Ashlyn K Lafferty, Jessica E Pruszynski, Naseem Uddin, Catherine Y Spong, Christina L Herrera","doi":"10.1055/a-2626-3120","DOIUrl":"https://doi.org/10.1055/a-2626-3120","url":null,"abstract":"<p><p>This study aimed to compare outcomes before and after starting a multidisciplinary PAS team with a standardized ultrasound approach.Retrospective cohort study of deliveries ≥ 24 weeks complicated by PAS from August 2009 to April 2022 at a large tertiary care hospital. The multidisciplinary team started in October 2020, and a standardized ultrasound approach was consistently practiced. We compared demographics and pregnancy characteristics before and after the formation of the PAS team. Statistical analysis included Fisher's exact test and <i>χ</i> ² for categorical variables student's <i>t</i>-test and Kruskal-Wallis test for continuous variables.Of 244 patients, 32 delivered with and 212 delivered before the PAS team. Median gestational age at delivery did not change (37 [36-38] vs. 37 [36-37] weeks before the team, <i>p</i> = 0.680). With the team, 31/32 cases of PAS were prenatally diagnosed (97%) compared with 177/212 (83%) before the team (<i>p</i> = 0.058). There were more cases of false positive prenatal suspicion present with the team (11% vs. 31%). Fewer hysterectomies occurred with the team at 21 (66%) versus 197 (93%) before the team, (<i>p</i> < 0.001). Pathologic severity in hysterectomy specimens significantly differed (<i>p</i> = 0.032), with 10 cases with negative pathology before and none with the team. Due to the lower rate of hysterectomy, the overall median EBL was lower with the team (<i>p</i> = 0.018), but other outcomes were similar. This difference in EBL did not persist when limiting to hysterectomy cases. Maternal LOS overall (6 [5-9] vs. 8 [5-15] days, <i>p</i> = 0.031) and within hysterectomies (6 [5-8] vs. 9 [6-16] days, <i>p</i> = 0.042) was significantly shorter with the team.A multidisciplinary PAS team with a standardized ultrasound approach decreased unnecessary hysterectomies and reduced the length of stay at a large tertiary hospital. A higher rate of false positive prenatal suspicion was observed. This finding supports a need for improved prenatal diagnosis to enable better preoperative risk stratification and planning. · A multidisciplinary PAS team with standardized ultrasound reduces unnecessary hysterectomy.. · Heightened assessment increased identification prenatally resulting in more false positive cases.. · Our findings highlight the need for improved preoperative risk stratification and planning..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511425","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":"Yoga in the NICU for Parents: A Pilot Study on Reducing Stress in the NICU.","authors":"Sara K Neches, Alanna Feltner, Mihai Puia-Dumitrescu, Krystle Perez, Leanne Matullo, Dennis E Mayock, Sandra E Juul","doi":"10.1055/a-2629-0956","DOIUrl":"10.1055/a-2629-0956","url":null,"abstract":"<p><p>Explore the effect of a 6-week online program of yogic breathing, meditation, and gentle postures for parents of infants hospitalized in the neonatal intensive care unit (NICU).From October 2021 to October 2023, we conducted a two-center pilot study of yoga for NICU parents. We assigned consented parents of NICU inpatients to receive yoga classes (YG) and/or usual care (UC) for parent support within 14 days of admission to the NICU. Self-directed yoga sessions were completed using an online platform. UC included parental support as practiced in each NICU and served as a control group. Primary outcomes were assessed at the study entrance, midpoint, and conclusion using the Parental Stressor Scale: Neonatal Intensive Care Unit (PSS: NICU) and the Postpartum Bonding Questionnaire (PBQ) in English and Spanish.A total of <i>n</i> = 51 parents (71%) mothers, were allocated using parallel assignment to UC (<i>n</i> = 28, 55%) or YG (<i>n</i> = 23, 45%). A total of <i>n</i> = 39 (76%) parents completed the classes to the midpoint of the study and <i>n</i> = 33 (65%) completed all 6 weeks of the study. There were no differences in baseline characteristics for parents or infants between groups. Average participation in the online yoga materials was 3 hours and 45 minutes per parent. A significant decrease in NICU-related parent stress emerged for all PSS: NICU subscales and total PSS: NICU scores for parents assigned to YG between enrollment and the midpoint of the study. Neither parents in UC nor YG approached thresholds indicating disorders of the parent-infant relationship as assessed by the PBQ.When initiated early, an online, asynchronous yoga intervention designed for parents may reduce NICU parent stress. · Yoga may reduce stress and enhance emotional health for parents of critically ill newborns.. · Virtual and self-directed mindfulness interventions for parents are feasible in the NICU environment.. · Sustaining parental wellness over an extended NICU hospitalization is challenging..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245780","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":"Late Preterm Antenatal Corticosteroids in Pregestational and Gestational Diabetic Pregnancies.","authors":"Lylach Haizler-Cohen, Maria C Alzamora, Nicole R Legro, Leila Eter, Tasha Freed, Suditi Rahematpura, Ayah Arafat, Victoria Greenberg, Sara N Iqbal","doi":"10.1055/a-2624-8405","DOIUrl":"10.1055/a-2624-8405","url":null,"abstract":"<p><p>This study aims to evaluate the association between late preterm antenatal corticosteroids (ACS) administration and the incidence of hypoglycemia and respiratory complications in neonates born to individuals with pregestational diabetes mellitus (PGDM) and gestational diabetes mellitus (GDM).Multi-center retrospective cohort study between 2016 and 2022. Pregnant people with PGDM or GDM who presented in the late preterm period with concern for preterm delivery were included. The indication for admission was classified as preterm labor, preterm prelabor rupture of membranes, poorly controlled diabetes, or other maternal/fetal indications. Exclusion criteria included multifetal gestations, fetal anomalies, stillbirths, prior course of ACS, or no anticipation for delivery in the next 7 days. The primary outcome was neonatal hypoglycemia. Secondary outcomes included composite respiratory morbidity, composite nonrespiratory morbidity, neonatal intensive care unit (NICU) admission, length of NICU stay, and neonatal death. Multivariable regression models were used to calculate the odds ratio and 95% confidence intervals for the outcomes after adjusting for an indication for admission, gestational age at delivery, and neonatal birth weight. Outcome data were then stratified by diabetes type (PGDM vs. GDM) and completion status of the ACS course (partial vs. complete). For PGDM pregnancies, outcome data were additionally stratified by glycemic control.In the study period, 453 patients (126 with PGDM and 327 with GDM) were included. Of those, 265 (58.5%) received ACS, and 188 (41.5%) did not. There were no significant differences in neonatal hypoglycemia and composite respiratory morbidity between the ACS and non-ACS groups, including in the subgroup analysis of PGDM and GDM pregnancies. However, late preterm ACS was associated with reductions in supplemental oxygen use, mechanical ventilation, and respiratory distress syndrome when a complete course of ACS was administered. In PGDM pregnancies, neonatal outcomes did not differ between the ACS and non-ACS groups, regardless of glycemic control.Late preterm ACS administration in diabetic pregnancies was not associated with increased neonatal hypoglycemia or improvements in composite respiratory morbidity. · Late preterm steroids in diabetic pregnancies are not associated with neonatal hypoglycemia.. · Composite respiratory morbidity is not improved in this setting.. · Glycemic control does not impact neonatal outcomes with late preterm steroid use..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207372","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}