American journal of perinatology最新文献

{"title":"Novel Placental Biomarker Shows Predictive Potential for Spontaneous Preterm Labor.","authors":"Bingbing Wang, Karl Seif, Jun Lei, Mary Mangione, Sifa Turan, E Albert Reece, Irina Burd, Peixin Yang","doi":"10.1055/a-2491-4391","DOIUrl":"10.1055/a-2491-4391","url":null,"abstract":"<p><strong>Objective: </strong> Human parturition involves many events among mother, fetus, and placenta, and the initiation of these events is the consequence of activation of a series of endocrine and immune responses. Multiple underlying pathways account for the cascade of events that culminate in spontaneous preterm labor. In this study, we aimed to characterize these signaling pathways of placental origin at molecular levels.</p><p><strong>Study design: </strong> We used single-cell RNA-sequencing (sc-RNA-seq) analysis to probe transcriptional heterogeneity in human placenta delivered at preterm or term and then used RNA in situ hybridization (RNA-ISH) assay on formalin-fixed paraffin-embedded (FFPE) placental tissues to validate these results.</p><p><strong>Results: </strong> By using sc-RNA-seq on villous cytotrophoblast (CTB) isolated from a preterm placenta, we found that signaling pathways implicated in the initiation of term or preterm labor including ferroptosis, kisspeptin (<i>KISS1</i>), and senescence were constitutively activated in distinct cellular clusters of these trophoblastic stem cells. RNA-ISH-based spatial gene expression profiling in FFPE tissues revealed that pregnancy-specific beta-1-glycoprotein 4 (PSG4), a potent molecular driver for cellular aging, was significantly increased in preterm placentas (<i>N</i> = 30) compared to their full-term counterparts (<i>N</i> = 9). Furthermore, <i>PSG4</i> mRNA signals were predominantly detected in the villous syncytiotrophoblast and the discontinuous monolayer of CTB as well as the intervillous space where maternal blood circulates.</p><p><strong>Conclusion: </strong> Our study provides strong support for <i>PSG4</i> overexpression serving as a biomarker for pregnant women at risk for preterm delivery, which can allow for the development of timely and clinical preventive strategies.</p><p><strong>Key points: </strong>· A sc-RNA-seq analysis on a preterm placenta identified multiple signaling pathways constitutively activated in distinct clusters of CTB.. · RNA-ISH assay uncovered that the mRNA levels of PSG4, a molecular driver for cellular senescence significantly increased in preterm placentas compared to the term counterparts.. · PSG4 mRNA signals were largely observed in the villous trophoblast as well as the intervillous space..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142754565","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":"Bedside Utilization of Intestinal Pathology in Preterm Infants with Surgical Necrotizing Enterocolitis.","authors":"Padma P Garg, Victoria G Weis, Jeffrey Shenberger, Jared A Weis, Anna McDonald, Parvesh M Garg","doi":"10.1055/a-2483-5736","DOIUrl":"10.1055/a-2483-5736","url":null,"abstract":"<p><p>Necrotizing enterocolitis (NEC) is one of the most common conditions requiring emergency surgery in the neonatal intensive care unit and is associated with multiorgan dysfunction, multiple systemic morbidities, and mortality. The resected bowel commonly shows evidence of coagulative necrosis, inflammation, interstitial hemorrhages, and reparative changes on the pathology examination. The severity of these pathological abnormalities may correlate with the disease's severity and pace of progression and may assist in the prediction of clinical outcomes. This review presents current evidence about the clinical utility of intestinal pathology in bedside decision-making, accurate diagnosing, prediction of outcomes, and the prognostication of preterm infants with surgical NEC. Developing refined and validated noninvasive methods to diagnose the extent of bowel injury and monitoring tissue repair throughout disease progression is paramount to mitigate the long-term morbidities in preterm infants with surgical NEC. Improved imaging methods such as targeted bowel ultrasound capable of assessing the inflammation and necrosis in real time will greatly advance care and provide focus for the temporal framework of surgical interventions. KEY POINTS: · The degree and severity of intestinal pathological changes are associated with different outcomes.. · Bedside utilization of the intestinal pathological changes may help improve outcomes.. · Targeted noninvasive methods to diagnose the extent of bowel injury in real time are greatly needed..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142715037","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. KEY POINTS: · 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":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Flat Oral Glucose Tolerance Test during Pregnancy and Risk for Type 2 Diabetes: A 5-Year Cohort Study.","authors":"Danit Tarashandegan, Amir Naeh, Mordechai Hallak, Yoel Toledano, Rinat Gabbay-Benziv, Esther Maor-Sagie","doi":"10.1055/a-2490-3183","DOIUrl":"10.1055/a-2490-3183","url":null,"abstract":"<p><strong>Objective: </strong> This study aimed to evaluate the risk of type 2 diabetes mellitus (T2DM) in women with flat response in the 100-g oral glucose tolerance test (OGTT) performed during pregnancy in a large cohort of women with up to 5 years of follow-up.</p><p><strong>Study design: </strong> A retrospective analysis of women with documented OGTT during pregnancy and T2DM data up to 5 years after pregnancy. Gestational diabetes mellitus (GDM) screening was done by a two-step strategy. Glucose levels during pregnancy were extracted from the computerized laboratory system of Meuhedet Health Maintenance Organization (HMO) and cross-tabulated with the Israeli National Diabetes Registry. Flat OGTT was defined as fasting glucose <95 mg/dl and three postprandial values lower than 100 mg/dl. The cohort was stratified by OGTT results to normal glucose values, flat OGTT, and GDM according to Carpenter and Coustan thresholds. Cumulative risk for T2DM was evaluated and compared between groups. Statistical analysis included univariate analysis followed by survival analysis.</p><p><strong>Results: </strong> A total of 14,122 parturients entered the analysis. Of them, 965 (6.8%) had flat OGTT, 11,427 (80.9%) had normal OGTT, and 1,730 (12.3%) had GDM. Women with flat OGTT were younger, had lower body mass index (BMI; kg/m²), and had lower rates of hypertension. Their glucose values throughout pregnancy were lower compared with the other groups (<i>p</i> < 0.001 for all). During the study period and following adjustment to maternal age, obesity, and hypertension, women with flat OGTT had a low incidence of T2DM, even when compared with women with normal OGTT (adjusted hazard ratio 0.212, 95% confidence interval 0.052-0.856).</p><p><strong>Conclusion: </strong> Parturients with flat OGTT during pregnancy are at a low risk of developing T2DM up to 5 years following pregnancy.</p><p><strong>Key points: </strong>· Women with flat OGTT are younger, with lower BMI and lower hypertension rates.. · During pregnancy, glucose levels were lower in flat OGTT women than in normal OGTT or GDM.. · Postpartum women with flat OGTT had lower risk of developing type 2 diabetes over 5 years..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142749750","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":"Derivation and Validation of Prediction of Preterm Preeclampsia Using Machine Learning Algorithms.","authors":"Tetsuya Kawakita, Juliana G Martins, Yara H Diab, Lea Nehme, George Saade","doi":"10.1055/a-2495-3600","DOIUrl":"10.1055/a-2495-3600","url":null,"abstract":"<p><strong>Objective: </strong> This study aimed to develop machine learning (ML) models for predicting preterm preeclampsia using the information available before 23 weeks gestation.</p><p><strong>Study design: </strong> This was a secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) cohort. We considered 131 features available before 23 weeks including maternal demographics, obstetrics and family history, social determinants of health, physical activity, nutrition, and early second-trimester ultrasound. Our primary outcome was preterm preeclampsia before 37 weeks. The dataset was randomly split into a training set (70%) and a validation set (30%). ML models using glmnet, multilayer perceptron, random forest, XGBoost (extreme gradient boosting), and LightGBM models were developed. Using the ML approach that achieved the best area under the curve (AUC), we developed the final model. Further feature selection was conducted from the top 25 important features based on SHapley Additive exPlanations (SHAP) values. The performance of the final model was assessed using the validation dataset.</p><p><strong>Results: </strong> Of 9,467 individuals, 219 (2.3%) had preterm preeclampsia. The AUC of the XGBoost model was the highest (AUC = 0.749 [95% confidence interval (95% CI), 0.736-0.762]) compared with other models. Therefore, XGBoost was used to develop models using fewer variables. The XGBoost model with the eight features (in order of importance: mean uterine artery pulsatility index in the early second trimester, chronic hypertension, pregestational diabetes, uterine artery notch, systolic and diastolic blood pressure in the first trimester, body mass index, and maternal age) was chosen as the final model as it had an AUC of 0.741 (95% CI, 0.730-0.752) which was not inferior to the original model (<i>p</i> = 0.58). The final model in the validation dataset had an AUC of 0.779 (95% CI, 0.722-0.831). An online application of the final model was developed ( https://kawakita.shinyapps.io/Preterm_preeclampsia/ ).</p><p><strong>Conclusion: </strong> ML algorithms using information available before 23 weeks can accurately predict preterm preeclampsia before 37 weeks.</p><p><strong>Key points: </strong>· Prediction models using uterine artery Doppler have not been adopted in the US.. · We developed a model using an ML algorithm.. · An online application of the final model was developed.. · ML algorithms using information available before 23 weeks can accurately predict preterm preeclampsia before 37 weeks..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779181","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 Social Determinants of Health on Follow-up for Neonates Requiring Neurocritical Care.","authors":"Isabella Eiler, Lakeisha Boyd, Melissa Klitzman, Bittu Majmudar-Sheth, Beatrice M Stefanescu","doi":"10.1055/a-2486-8994","DOIUrl":"10.1055/a-2486-8994","url":null,"abstract":"<p><strong>Objective: </strong> This study aimed exploration of associations of social determinants of health (SDH) with attrition rates of neurocritical care graduates at follow-up.</p><p><strong>Study design: </strong> An observational retrospective cohort study was conducted to evaluate the attrition rates of an infant's first appointment scheduled with the NeuroNICU follow-up clinic in correlation with SDH.</p><p><strong>Results: </strong> The \"No Show\" group was more likely to have unemployed (<i>p</i> = 0.014), black or multiracial mothers (<i>p</i> = 0.005), public insurance (<i>p</i> < 0.001), lower gestational age (<i>p</i> < 0.001), live further from the clinic (0.011), and a lower zip code-associated income (<i>p</i> = 0.008). After controlling for driving time, race, and education, infants who had private insurance were 2.268 times more likely to attend their follow-up visit when compared with infants who had public insurance (<i>p</i> = 0.014).</p><p><strong>Conclusion: </strong> A significant SDH-related difference existed among the \"Show\" and \"No Show\" groups. Identifying these factors during neonatal intensive care unit (NICU) admission can facilitate targeted support for families while inpatient and promote improved outpatient follow-up.</p><p><strong>Key points: </strong>· Follow-up for neonates requiring neurocritical care is strongly influenced by social determinants.. · Standardized SDH screening in NICUs, identifying high-risk infants for attrition, is used by few.. · Factors influencing disparities in the utilization of follow-up programs require further study.. · Equity-based attrition prevention interventions could improve outcomes and reduce costs..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142724777","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":"Innovations in Diabetes Management for Pregnant Women: Artificial Intelligence and the Internet of Medical Things.","authors":"Ellen M Murrin, Antonio F Saad, Scott Sullivan, Yuri Millo, Menachem Miodovnik","doi":"10.1055/a-2489-4462","DOIUrl":"10.1055/a-2489-4462","url":null,"abstract":"<p><p>Pregnancies impacted by diabetes face the compounded challenge of strict glycemic control with mounting insulin resistance as the pregnancy progresses. New technological advances, including artificial intelligence (AI) and the Internet of Medical Things (IoMT), are revolutionizing health care delivery by providing innovative solutions for diabetes care during pregnancy. Together, AI and the IoMT are a multibillion-dollar industry that integrates advanced medical devices and sensors into a connected network that enables continuous monitoring of glucose levels. AI-driven clinical decision support systems (CDSSs) can predict glucose trends and provide tailored evidence-based treatments with real-time adjustments as insulin resistance changes with placental growth. Additionally, mobile health (mHealth) applications facilitate patient education and self-management through real-time tracking of diet, physical activity, and glucose levels. Remote monitoring capabilities are particularly beneficial for pregnant persons with diabetes as they extend quality care to underserved populations and reduce the need for frequent in-person visits. This high-resolution monitoring allows physicians and patients access to an unprecedented wealth of data to make more informed decisions based on real-time data, reducing complications for both the mother and fetus. These technologies can potentially improve maternal and fetal outcomes by enabling timely, individualized interventions based on personalized health data. While AI and IoMT offer significant promise in enhancing diabetes care for improved maternal and fetal outcomes, their implementation must address challenges such as data security, cost-effectiveness, and preserving the essential patient-provider relationship. KEY POINTS: · The IoMT expands how patients interact with their health care.. · AI has widespread application in the care of pregnancies complicated by diabetes.. · A need for validation and black-box methodologies challenges the application of AI-based tools.. · As research in AI grows, considerations for data privacy and ethical dilemmas will be required..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142724778","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":"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. KEY POINTS: · 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":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Queen City Legacy: 45 Years of Research in Pregnant Women with Insulin-Dependent Diabetes Mellitus, The Diabetes in Pregnancy Program Project Grant.","authors":"Jane C Khoury, Menachem Miodovnik, Francis B Mimouni, Shelley Ehrlich, Rhonda Szcznesiak, Barak Rosenn","doi":"10.1055/a-2490-3118","DOIUrl":"https://doi.org/10.1055/a-2490-3118","url":null,"abstract":"<p><p>The Diabetes in Pregnancy Program Project Grant (PPG) was a 15-year program focused on enhancing the care for women with insulin-dependent diabetes mellitus (IDDM) during pregnancy and improving the well-being of their offspring. Launched in July 1978 at the University of Cincinnati, the PPG pursued a multifaceted research agenda encompassing basic science, animal and placental studies, and maternal and neonatal clinical trials to understand the physiological and pathophysiological aspects of IDDM during pregnancy. A total of 402 singleton pregnancies in 259 women with IDDM were enrolled prior to 10 weeks gestation over the 15-year period. Of the 402 pregnancies, there were 295 live births, 1 stillbirth, 4 neonatal deaths, and 15 infants were born with major congenital malformations. Central to the program's methodology was the management of diabetes during pregnancy, involving intensive insulin therapy and meticulous monitoring using the cutting-edge technology of the time to achieve glycemic control. The extensive research of the PPG yielded profound insights into the effects of maternal diabetes on embryonic and fetal development and neonatal health. Through animal studies, notably using pregnant sheep, the program clarified the mechanisms of fetal hypoxia and metabolic disorders. Clinical trials underscored the significance of early glycemic control in mitigating the risks of spontaneous abortions, congenital malformations, and neonatal complications. The program also examined the influence of pregnancy on the progression of microvascular diseases, the role of maternal weight and weight gain in pregnancy outcomes, and the distinctive growth patterns of fetuses in IDDM pregnancies. Furthermore, the PPG probed the incidence and underlying mechanisms of hypoglycemia during pregnancy and the heightened risk of obstetric complications in IDDM patients. Our findings established a foundation of knowledge to aid clinicians, researchers, and health care providers in best practices and ensure a lasting impact on the care of pregnant women with pregestational diabetes. KEY POINTS: · Prepregnancy management reduces maternal, fetal, and neonatal complications in IDDM.. · Strict glycemic control improves many pregnancy outcomes in IDDM.. · Fetal glycemic exposure may have lifelong effects..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885231","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":"Longer Interpregnancy Interval Is Associated with Gestational Diabetes Mellitus Recurrence.","authors":"Tzuria Peled, Daniella Federmesser, Eyal Mazaki, Hen Y Sela, Sorina Grisaru-Granovsky, Misgav Rottenstreich","doi":"10.1055/a-2480-5407","DOIUrl":"10.1055/a-2480-5407","url":null,"abstract":"<p><strong>Objective: </strong> This study aimed to evaluate the effect of interpregnancy interval (IPI) on the gestational diabetes mellitus (GDM) recurrence rate in the subsequent pregnancies following an initial pregnancy complicated by GDM.</p><p><strong>Study design: </strong> A multicenter, retrospective cohort study was conducted. The study included women diagnosed with GDM during their index pregnancy who subsequently delivered between 26 and 42 weeks of gestation from 2005 to 2021. The study population was categorized into eight groups according to their IPIs: up to 3, 3-5, 6-11, 12-17, 18-23, 24-35, 36-47, and over 48 months. We examined the recurrence rate of GDM in the different groups while comparing it to the 18-23-month group that was defined as the reference group. Statistical analyses included univariate analyses and multiple logistic regression.</p><p><strong>Results: </strong> Out of 3,532 women who were included in the study, 1,776 (50.3%) experienced GDM recurrence in subsequent pregnancy. The recurrence rate was 44.6% for women IPI <6 months, 42.6% for women IPI of 6-11 months, 48.0% for women IPI of 12-17 months, 49.7% for women IPI of 18-23 months, 58.0% for women IPI of 24-47 months, and 62.6% for women IPI above 48 months. Multivariable logistic regression revealed that IPIs of 24-47 months and over 48 months were significantly associated with higher recurrence rates as compared with the 18-23-month reference group (adjusted odds ratio [aOR], 95% confidence interval [CI]: 1.66 [1.04-2.64] and 3.15 [1.07-9.29], respectively). This analysis also revealed other independent risk factors for GDM recurrence, including medication-controlled GDM in the index pregnancy, obesity, maternal age, parity, and gravidity.</p><p><strong>Conclusion: </strong> Longer IPIs (over 24 months) are associated with an increased risk of GDM recurrence in subsequent pregnancies. These findings suggest that clinicians should consider IPI while managing postpartum care and planning future pregnancies for women with a history of GDM.</p><p><strong>Key points: </strong>· Longer IPIs (over 24 months) are associated with an increased risk of GDM recurrence.. · Clinicians should consider IPI while managing postpartum care for women with a history of GDM.. · GDM A1, obesity, maternal age, parity, and gravidity were found as risk factors for GDM recurrence..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142685973","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}