American journal of perinatology最新文献

{"title":"Differences in Time of Birth between Spontaneous and Operative Vaginal Births.","authors":"Christopher X Hong, Mariana Masteling, Clarice G Zhou, Matthew K Janssen, Jourdan E Triebwasser","doi":"10.1055/a-2442-7396","DOIUrl":"10.1055/a-2442-7396","url":null,"abstract":"<p><strong>Objective: </strong> Previous studies have identified an association between obstetric interventions and the time of day in which they are performed; however, they do not account for granular variations in the temporality of delivery interventions, which is influenced by both health care providers and resource availability. We sought to assess differences in time of birth among spontaneous vaginal births (SVBs) versus operative (forceps- and vacuum-assisted) vaginal births (OVBs).</p><p><strong>Study design: </strong> This cross-sectional study used birth certificate data from the National Vital Statistics System from 2016 to 2021, which includes the time of birth and delivery method for recorded U.S. births. The number of SVBs and OVBs at each minute was normalized relative to the total births within each delivery group to facilitate balanced comparisons between groups. Logistic regression analysis assessed the odds of OVBs per time of day.</p><p><strong>Results: </strong> A total of 15,412,129 subjects who underwent vaginal birth were included in this analysis, 690,905 (4.5%) of whom underwent OVBs. Compared to births at other time intervals, those between 4:30 and 7:30 p.m. were more likely to be OVBs (odds ratio [OR] = 1.13, 95% confidence interval [CI]: 1.12-1.14). Conversely, births between 3:00 and 6:00 a.m. were less likely to be OVBs (OR = 0.87, 95% CI: 0.86-0.88). After adjusting for adjusting for maternal age, gestational age, and induction of labor, births between 4:30 and 7:30 p.m. remained more likely to be OVBs (adjusted odds ratio [aOR] = 1.09, 95% CI: 1.08-1.10) and births between 3:00 and 6:00 a.m. remained less likely to be OVBs (aOR = 0.91, 95% CI: 0.90-0.92).</p><p><strong>Conclusion: </strong> In this population-based study, we identified temporal differences between SVBs and OVBs with increased use of instrumentation during the late afternoon and reduced use in the early morning. These findings prompt further investigation into the indications for OVBs and root causes of these temporal variations, which are likely multifactorial and involve provider and resource availability.</p><p><strong>Key points: </strong>· This study identifies temporal differences between SVBs and OVBs.. · Compared to SVBs, operative births are more likely in the late afternoon.. · OVBs are also less likely in the early morning.. · These temporal trends suggest the influence of provider and resource availability..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142455954","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":"Incidence of new, non-physiologic maternal findings on fetal magnetic resonance imaging.","authors":"Shirley J Shao, Andrew Grimes, Marley Rashad, Liina Poder, Dorothy Shum, Nasim Camillia Sobhani","doi":"10.1055/a-2466-1319","DOIUrl":"https://doi.org/10.1055/a-2466-1319","url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Study design: </strong>This was a retrospective cohort study that included all fetal MRIs performed between 2018-2023 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, non-physiologic maternal findings. The latter was defined as previously unknown abnormalities of maternal structures unrelated to normal physiology.</p><p><strong>Results: </strong>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, non-physiologic finding. The most common new, non-physiologic findings were renal cysts (n=11), liver cysts (n=6), and gallstones or gallbladder sludge (n=5). Compared to 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%, p< 0.001) and new, non-physiologic maternal findings (26.9% vs 3.7%, p< 0.001).</p><p><strong>Conclusion: </strong>Our results suggest that the risk of identifying new, non-physiologic maternal findings on fetal MRI is low. The rate of any maternal and new, non-physiologic 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 pre-test counseling for patients planning to have fetal MRI.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-12","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":"Impact of Pharmacologic Patent Ductus Arteriosus Treatment on Acute Respiratory and Oxygenation Metrics in Very Low Birth Weight Infants.","authors":"Mara K Weigner, Sherry L Kausch, Karen D Fairchild, Brynne A Sullivan","doi":"10.1055/a-2441-6639","DOIUrl":"10.1055/a-2441-6639","url":null,"abstract":"<p><strong>Objective: </strong> Hypoxemia and respiratory compromise occur in very low birth weight (VLBW, <1,500 g) infants and may be associated with shunting across patent ductus arteriosus (PDA). The impact of pharmacologic PDA treatment on acute hypoxemia and respiratory metrics is unclear. This study aimed to determine whether pharmacologic PDA treatment is associated with acute improvement in hypoxemia and respiratory metrics in VLBW infants.</p><p><strong>Study design: </strong> At a single center (2012-2022), all VLBW infants with echocardiographic evidence of PDA and without exclusions were classified as having received or not received pharmacologic PDA treatment (PDA-T and PDA-NT). Mean daily fraction of inspired oxygen (FIO₂) and Respiratory Acuity Score (RAS, PMID 30374050) were compared at baseline (day 0) and 3 days after the start of treatment. For PDA-T infants with archived 0.5 Hz (every 2-second) oxygen saturation (SpO₂) data, mean daily SpO₂ and the percentage of time with severe hypoxemia (SpO₂ <80%) were compared before and after treatment. Severe hypoxemia was further analyzed after stratification by clinical variables (sex, medication, gestational age, and postnatal age).</p><p><strong>Results: </strong> We analyzed 125 VLBW infants with PDA, of whom 66 received pharmacologic PDA treatment. We analyzed a subgroup of 43 PDA-T infants with every 2-second SpO₂ data available. PDA-T infants had higher baseline FiO₂ and RAS and lower SpO₂ than PDA-NT infants (<i>p</i> < 0.05). Compared to baseline, RAS decreased from a median of 258 (interquartile range [IQR]: 171, 348) to 254 (IQR: 174, 419), 3 days after the start of treatment (<i>p</i> = 0.012), but median FiO₂ increased from 37% (IQR: 28, 46) to 40% (IQR: 29, 52; <i>p</i> = 0.008). SpO₂ and the percent time with severe hypoxemia were unchanged.</p><p><strong>Conclusion: </strong> In this 10-year, retrospective, single-center analysis, pharmacologic PDA treatment in VLBW infants was not associated with a major improvement in acute measures of oxygenation or level of respiratory support.</p><p><strong>Key points: </strong>· Infants with pharmacologically treated PDA had worse baseline respiratory and oxygenation metrics.. · RAS decreased but FiO2 increased 3 days after pharmacologic PDA treatment.. · Pharmacologic PDA treatment did not acutely improve SpO2 or severe hypoxemia..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142455955","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":"Exhaled Breath Volatile Organic Compounds in Pregnancy: A Pilot Study.","authors":"Mohsen A A Farghaly, Somaya Abuelazma, Farrell Ruth, Marwa Elgendy, David Grove, Jalal Abu-Shaweesh, Raed A Dweikc, Hany Aly","doi":"10.1055/a-2463-5352","DOIUrl":"https://doi.org/10.1055/a-2463-5352","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to assess the volatile organic compounds (VOC)s in breath samples collected non-invasively from pregnant women during pregnancy and postpartum and compare it to non-pregnant controls.</p><p><strong>Methods: </strong>This pilot study included 50 subjects: ten pregnant patients in their first trimester, ten in second trimester, ten in third trimester, ten in the first postpartum week, and ten non-pregnant subjects as a control. We collected exhaled breath from subjects who reported to be healthy and free of any respiratory symptoms. Clinical and demographic data were collected. The samples were analyzed for VOCs using a selected-ion flow-tube mass spectrometer (SIFT-MS).</p><p><strong>Results: </strong>The VOCs monitored were twenty-two compounds selected for their common presence in exhaled breath. During pregnancy and postpartum period, there were differences in five compounds mainly: 2-propanol, acrylonitrile, 1-nonene, 2-nonene, and hydrogen sulfide. Significant differences in VOCs were identified during each trimester compared to controls.</p><p><strong>Conclusions: </strong>Volatile organic compounds could be measured safely and noninvasively in pregnant women. VOCs differed significantly among non-pregnant, pregnant women and postpartum period. The utilization of this novel assay to identify fetal conditions or identifying women at risk premature delivery should be further investigated in future studies.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612349","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":"Congenital Colorectal Conditions: Caregiver Perspectives of Their Experience in the Neonatal Intensive Care Unit.","authors":"Vatche James Melkonian, Andrea Bischoff, Luis de la Torre, Jill Ketzer, Kristina Matkins, Laura Judd-Glossy","doi":"10.1055/a-2463-4207","DOIUrl":"https://doi.org/10.1055/a-2463-4207","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to examine the experiences of children with colorectal conditions who spent time in the Neonatal Intensive Care Unit (NICU) and their caregivers.</p><p><strong>Methods: </strong>In March 2024, a 36-question survey was sent to the Colorectal Support Network Facebook community, to gather information from caregivers of children who have a congenital colorectal diagnosis and spent time in the NICU.</p><p><strong>Results: </strong>Fifty-two families completed the survey. Most patients were diagnosed after birth (89.47%). Approximately half of respondents stayed in the NICU for one to two weeks (50.88%), lived less than 60 minutes away from the hospital (54.91%), and felt somewhat uncomfortable (28.07%) or very uncomfortable (21.05%) caring for their child's medical needs after discharge. Also 49.12% of caregivers were informed of their child's future bowel control prognosis. When asked for suggestions to improve care in the NICU, common themes included the importance of having colorectal congenital anomalies addressed by colorectal surgeons, and the need for families to be informed about support groups.</p><p><strong>Conclusions: </strong>Counseling families in the NICU with congenital colorectal conditions can be improved by providing additional information and support for families prior to discharge, informing them about their child's prognosis for bowel control, and connecting them with other families.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142602580","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":"AN ORGAN-SPECIFIC APPROACH TO THE MANAGEMENT OF GESTATIONAL HYPERTENSION - EVIDENCE VS. TRADITION.","authors":"Steven Clark, George Saade, Mary Tolcher, Michael Belfort, Dwight J Rouse, Robert M Silver, Avni Kapadia, Nathan Sundgren, Sai Saridey, Baha M Sibai","doi":"10.1055/a-2459-8748","DOIUrl":"https://doi.org/10.1055/a-2459-8748","url":null,"abstract":"<p><p>The management of hypertensive disease in pregnancy is currently guided by practice recommendations based largely on observational data from a half century ago and has changed only superficially since that time. These recommendations are both narrowly prescriptive (women without traditional features of severe disease should all be delivered at exactly 37 weeks and 0 days,) and at the same time frustratingly ambiguous (the presence of epigastric pain unresponsive to repeat analgesics precludes expectant management at any gestational age, regardless of laboratory studies.) Guidelines which ignore recent data from the obstetric, pediatric and internal medicine literature too often lead practitioners to be more aggressive than necessary in the delivery of very premature pregnancies, and, conversely, more complacent than patient safety would support in prolonging pregnancy with advanced fetal maturity. We present here an alternative, organ-specific based approach to the management of gestational hypertension which allows and encourages practitioners to formulate a management plan based on a thoughtful and, when possible, evidence- based synthesis of the continuous variables of blood pressure, degree of organ dysfunction and response to treatment, gestational age, and patient balancing of maternal and fetal/neonatal risks. Such clinical care is more complex and nuanced than simply basing life-altering critical management decisions, including timing of delivery, on whether the patient does, or does not have any one of the conditions described by box 4 of the current American College of Obstetricians and Gynecologists practice guidelines. Nonetheless, we believe this approach will not only improve care but will also open the door to useful investigations into prevention and management of the various entities traditionally considered as the same disease process.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142575088","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":"Unexpected findings of Duchenne muscular dystrophy in prenatal screening of chromosome abnormality based on cell-free fetal DNA.","authors":"Ganye Zhao, Lina Liu, Panlai Shi, Mingxin Gu, Shaozhe Yang, Xiangdong Kong","doi":"10.1055/a-2459-8924","DOIUrl":"https://doi.org/10.1055/a-2459-8924","url":null,"abstract":"<p><p>Objective：This study aims to assess the feasibility of detecting and diagnosing Duchenne muscular dystrophy (DMD) during prenatal screening for chromosome abnormalities using cell-free fetal DNA extracted from peripheral blood samples of pregnant women. Methods：Two pregnant women identified as high-risk through non-invasive prenatal testing (NIPT) underwent amniocentesis to obtain fetal cells. Subsequent fetal chromosomal karyotyping was conducted, and genomic DNA from fetal cells was extracted for Copy Number Variation Sequencing (CNV-Seq) analysis, complemented by Multiplex Ligation-dependent Probe Amplification (MLPA) to detect deletions or duplications within the DMD gene. Results：NIPT results for the two samples indicated potential abnormalities involving chromosomes 21 and 18. However, karyotype analysis of the fetuses revealed no abnormalities. CNV-Seq identified deletions of 0.28Mb and 0.18Mb within chromosome Xp21.1, encompassing the DMD gene, in each fetus. In family 1, MLPA results indicated a maternal heterozygous deletion spanning exons 12-41 in the DMD gene, while the fetus exhibited deletions in exons 12-41. In family 2, MLPA results confirmed normal DMD gene status in the pregnant woman's peripheral blood genomic DNA but revealed a fetal deletion spanning exons 48-52. Both fetuses were diagnosed with DMD and subsequently underwent termination. Conclusions：Abnormalities identified through NIPT necessitate further invasive prenatal diagnostic procedures. For cases involving chromosomal microdeletions or microduplications, a combination of karyotyping and CNV-Seq testing is essential for comprehensive diagnosis. NIPT followed by CNV-Seq may offer insights into large exon deletions within the DMD gene in specific instances.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142575127","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 ultrasound in obese patients for the detection of growth abnormalities.","authors":"Juliana Gevaerd Martins, Elizabeth Miller, Rebecca Horgan, Tetsuya Kawakita","doi":"10.1055/a-2460-5846","DOIUrl":"https://doi.org/10.1055/a-2460-5846","url":null,"abstract":"<p><strong>Objective: </strong>To examine the impact of maternal obesity on fetal growth abnormalities including fetal growth restriction (FGR) and large for gestational age (LGA) fetuses.</p><p><strong>Study design: </strong>Secondary analysis from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b). The study excluded individuals with pregestational or gestational diabetes, chronic hypertension, and other major maternal medical conditions. Ultrasound assessments were performed at 16 - 21 and 22 - 29 weeks of gestation. Our exposure was the presence of pre-pregnancy obesity. Our primary outcome was rates of fetal growth abnormalities identified by ultrasound, defined as FGR (estimated fetal weight [EFW] or abdominal circumference < 10th percentile) or LGA (EFW > 90 th percentile) among obese compared to non-obese women. A secondary analysis was performed after limiting ultrasound performed from 28-29 weeks. To estimate adjusted relative risks (aRR) with 95% confidence intervals (95%CIs), we used generalized linear models with Poisson distribution and log link using robust error variance, adjusting for the predefined covariates.</p><p><strong>Results: </strong>Of 7,354 participants, 1,443 (19.6%) had pre-pregnancy obesity while 5,911 (80.4%) did not. Pre-pregnancy obesity compared with normal weight was associated with an increased risk of fetal growth abnormalities both at 16-21 weeks (16.0% vs. 13.2%; aRR 1.23; 95%CI 1.06-1.42) and 22-29 weeks (16.0% vs. 12.1%; aRR 1.33; 95%CI 1.14-1.54). Furthermore, pre-pregnancy obesity compared with normal weight was associated with an increased risk of LGA both at 16-21 weeks (12.5% vs. 10.3%; aRR 1.24; 95%CI 1.05-1.47) and 22-29 weeks (10.6% vs. 6.9%; aRR 1.66; 95%CI 1.38-2.01). In a secondary analysis limited to the ultrasound 28-29 weeks, both fetal growth abnormalities and LGA were associated with the presence of obesity. In any of the analyses, pre-pregnancy obesity was not associated with FGR compared to normal weight.</p><p><strong>Conclusion: </strong>Maternal obesity is associated with an increased risk of fetal growth abnormalities and LGA fetuses.</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142575124","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":"Factors Associated with Maternal Morbidity among Black Women in the United States.","authors":"Catrine Ibrahim Sous, William Moravec, Emily DeFranco, Elizabeth A Kelly, Robert M Rossi","doi":"10.1055/a-2295-4058","DOIUrl":"10.1055/a-2295-4058","url":null,"abstract":"<p><strong>Objective: </strong> Non-Hispanic Black people (NHBP) have a three-fold higher rate of maternal mortality compared to other racial groups. Racial disparities in maternal morbidity are well-described; however, there are substantial differences in cultural, economic, and social determinants of health among racial groups. We thus sought to study the at-risk, non-Hispanic Black population as its own cohort to identify factors most associated with severe maternal morbidity (SMM).</p><p><strong>Study design: </strong> This is a population-based retrospective case-control study of all live births in the United States between 2017 and 2019 using birth records obtained from the National Center for Health Statistics. The primary outcome for this study was to determine demographic, social, medical, and obstetric factors associated with maternal morbidity among NHBP who did and did not experience an SMM event. Multivariable logistic regression was used to estimate the adjusted odds ratio between each individual factor and the outcome of SMM among NHBP.</p><p><strong>Results: </strong> Of the 1,624,744 NHBP who delivered between 2017 and 2019, 1.1% experienced an SMM event defined as a composite of blood product transfusion, eclamptic seizure, intensive care unit admission, unplanned hysterectomy, and uterine rupture. The rates of these individual SMM events per 10,000 deliveries were 50, 40, 20, 5, and 4 among NHBP, respectively. Among NHBP, factors associated in multivariable regression analysis with SMM in order of strength of association included cesarean delivery, earlier gestational age at delivery, preeclampsia, induction of labor, chronic hypertension, prior preterm birth, lower educational attainment, multifetal gestation, advanced maternal age, pregestational diabetes, and cigarette smoking. The population attributable fraction for cesarean delivery, preterm birth, and pregnancy-induced hypertensive disease for the outcome of SMM were 0.46, 0.23, and 0.07, respectively.</p><p><strong>Conclusion: </strong> The three factors most associated with SMM among NHBP are potentially avoidable or modifiable by aggressive screening, prevention, and treatment of preeclampsia and preterm birth as well as reducing cesarean rates in this population.</p><p><strong>Key points: </strong>· The rate of SMM in NHBP may be modifiable.. · NHBP have a three-fold higher rate of maternal mortality.. · Preeclampsia, preterm birth, and cesarean sections are most associated with maternal morbidity..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"2063-2071"},"PeriodicalIF":1.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140292394","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":"Prenatal Exposure to Acid Suppressor Medications and Development of Ductus Arteriosus in Term Newborns.","authors":"Ella Segal, Daniella Landau, Lior Hassan, Adir Israeli, Rafael Gorodischer","doi":"10.1055/a-2295-6339","DOIUrl":"10.1055/a-2295-6339","url":null,"abstract":"<p><strong>Objective: </strong> The ductus arteriosus normally closes after birth. Histamine 2 receptor antagonist (H₂RA) has been associated with patent ductus arteriosus (PDA). We aimed to study the characteristics of term infants with PDA and their possible association with prenatal exposure to antacids-proton pump inhibitors (PPIs) and H₂RA.</p><p><strong>Study design: </strong> This was a population-based matched case-control study of mothers registered at \"Clalit\" Health Maintenance Organization (HMO) and their infants born at \"Soroka\" University Medical Center (SUMC) between 2001 and 2018. Cases are defined as term infants born with PDA diagnosed by echocardiography and registered in the postdelivery discharge form. Each case was matched with four term newborns without PDA diagnosis. Exposure window was defined by the timing of first purchase of H₂RA or PPI during pregnancy and based on information from a computerized medication database (Clalit HMO, SUMC).</p><p><strong>Results: </strong> PDA was diagnosed in 1,884 term infants (4.9%). Characteristics included a significantly higher percentage of lack of prenatal care, cesarean section, in vitro fertilization, polyhydramnios, oligohydramnios, Apgar 1 minute <5, and prenatal exposure to H₂RA (odds ratio [OR] 4.18) and PPIs (OR 3.50; all <i>p</i> < 0.001). PDA association with exposure window was similar in each trimester (1.5-2%) for both H₂RA and PPI.</p><p><strong>Conclusion: </strong> PDA incidence in term infants in our population was greater than previously reported. PPI and H₂RA are both antiacids with different mechanisms of action. The similar OR for exposure to one as well as the other, and the lack of influence of the initial exposure period, are compatible with bias.</p><p><strong>Key points: </strong>· Term newborns with PDA have different characteristics than newborns without PDA.. · Prenatal exposure to PPIs or H2RA is associated with greater risk of PDA in term newborns.. · The possible effect mechanism of PPIs on the ductus is unclear and understudied..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"2091-2097"},"PeriodicalIF":1.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140304405","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}