Maternal-fetal Medicine
RCT | Intrapartum azithromycin fails to reduce neonatal sepsis and death
14 Mar, 2023 | 14:00h | UTCSummary: This randomized controlled trial aimed to evaluate the effectiveness of administering azithromycin during labor to reduce neonatal sepsis and mortality. The randomized trial involved 11,983 birthing parents and their infants in West Africa.
The study found no significant difference in the incidence of neonatal sepsis or mortality between the azithromycin and placebo groups. On the other hand, the rate of non-invasive infections, including skin infections in newborns, and mastitis and puerperal fever in parents, was lower in the azithromycin group in the following four weeks.
The authors concluded that these results do not support the routine introduction of oral intrapartum azithromycin to reduce neonatal sepsis or mortality. However, it is important to notice that a recent large study published in the New England Journal of Medicine showed conflicting results.
Article: Effect of Intrapartum Azithromycin vs Placebo on Neonatal Sepsis and Death: A Randomized Clinical Trial – JAMA (link to abstract – $ for full-text)
Commentaries:
Azithromycin during labor doesn’t reduce sepsis, mortality in newborns – CIDRAP
Effect of antibiotics during pregnancy on neonatal sepsis and mortality – MedicalResearch.com
Related study with conflicting results: Azithromycin to Prevent Sepsis or Death in Women Planning a Vaginal Birth – New England Journal of Medicine (link to abstract – $ for full-text)
News Release: Single-dose antibiotic prevents maternal sepsis and death – NIH News
Commentaries:
In large study, a single antibiotic dose slashed rate of sepsis in childbirth – STAT
Dose of azithromycin found to cut risk of maternal death, sepsis in childbirth – CIDRAP
Commentary on Twitter
Study results do not support routine introduction of oral intrapartum azithromycin to reduce neonatal sepsis or mortality. https://t.co/yDpg1CCGa2 pic.twitter.com/5Oc4HqZ4sX
— JAMA (@JAMA_current) March 7, 2023
Review | Pathogenesis, epidemiology and control of Group A Streptococcus infection
14 Mar, 2023 | 13:38h | UTC
Commentary on Twitter
NEW??Pathogenesis, epidemiology and control of Group A Streptococcus infectionhttps://t.co/XFSKQrTe1P
Brouwer & co. summarize the epidemiological and clinical features of Group A Streptococcus infection, and the molecular mechanisms of GAS virulence and drug resistance. pic.twitter.com/qm23YgnKlg
— Nature Reviews Microbiology (@NatureRevMicro) March 10, 2023
RCT | Sulfadoxine-pyrimethamine vs. dihydroartemisinin-piperaquine for preventive treatment of malaria in pregnant women in Africa
13 Mar, 2023 | 14:43h | UTC
RCT | Vaginal cleansing before unscheduled cesarean delivery did not reduce postoperative infections
10 Mar, 2023 | 14:23h | UTCVaginal cleansing before unscheduled cesarean delivery to reduce infection: a randomized clinical trial – American Journal of Gynecology & Obstetrics (link to abstract – $ for full-text)
Related studies with conflicting results:
Vaginal Cleansing Before Cesarean Delivery: A Systematic Review and Meta-analysis – Obstetrics & Gynecology (link to abstract – $ for full-text)
Commentary on Twitter
Vaginal Cleansing Before Unscheduled Cesarean Delivery to Reduce Infection: A Randomized Clinical Trial https://t.co/QuNWfCxl3D @acog pic.twitter.com/sauvsRq5C1
— AJOG (@AJOG_thegray) November 30, 2022
Pregnancy complications linked to long-term mortality in a racially diverse cohort
10 Mar, 2023 | 14:01h | UTCPregnancy Complications and Long-Term Mortality in a Diverse Cohort – Circulation
Related:
Severity of obstructive coronary artery stenosis after pre-eclampsia – Heart
Consensus bundle on cardiac conditions in obstetric care
9 Mar, 2023 | 14:14h | UTC
RCT | Home telemonitoring vs. hospital care in complicated pregnancies in the Netherlands
9 Mar, 2023 | 13:58h | UTC
Commentary on Twitter
NEW Research investigating home #telemonitoring versus hospital care in complicated #pregnancy. Read it here: https://t.co/Cu5DvAgJ58@BekkerMN @hotelstudie @umcutrecht pic.twitter.com/wcTthWPaxK
— The Lancet Digital Health (@LancetDigitalH) February 23, 2023
Position Statement | Telemedicine in obstetrics — quality and safety considerations
8 Mar, 2023 | 14:23h | UTC
Commentary on Twitter
Society for Maternal-Fetal Medicine Special Statement: Telemedicine in obstetrics—quality and safety considerations https://t.co/15knjAg4tc @MySMFM @acog #telemedicine pic.twitter.com/jUL7inHuu4
— AJOG (@AJOG_thegray) March 7, 2023
Cohort Study | Early pregnancy exposure to NSAIDs is associated with slightly higher risks of neonatal and maternal adverse outcomes
7 Mar, 2023 | 12:56h | UTCSummary:
A nationwide cohort study in South Korea, including 1.8 million pregnancies, investigated the association between the use of nonsteroidal anti-inflammatory drugs (NSAIDs) during early pregnancy and neonatal and maternal adverse outcomes.
The study revealed that pregnant women exposed to NSAIDs during early pregnancy were at increased risk of oligohydramnios and had a slightly higher likelihood of having an infant with major congenital malformations and low birth weight. These risks remained elevated when comparing NSAIDs against acetaminophen or past users.
The study suggests that clinicians should weigh the need to prescribe NSAIDs in early pregnancy against the modest but possible risk of neonatal and maternal outcomes and consider prescribing nonselective NSAIDs for <10 days, with continued careful monitoring for any safety signals.
Severity and impact of accidental bowel leakage two decades after no, one, or two obstetrical sphincter injuries
3 Mar, 2023 | 13:56h | UTCSummary: This study investigated the long-term severity and subjective impact of anal incontinence among women who had experienced 1 or 2 consecutive obstetrical anal sphincter injuries compared with those without injuries. The study used prospectively registered data and a questionnaire to analyze outcomes, including the frequency of fecal and gas incontinence, the impact on daily life, and the effect on other pelvic floor disorders. The results showed that the severity and impact of anal incontinence doubled and quadrupled in women with 1 or 2 consecutive sphincter injuries, respectively, compared with those without injury. The second sphincter injury had an equally large additive effect compared to the first injury. However, the study found that 1 or 2 sphincter injuries did not affect other pelvic floor disorders or lower urinary tract symptoms compared to women without injury.
News Release: Decades-long suffering from obstetric injuries – University of Gothenburg
Maternal diabetes and overweight as risk factors for congenital heart defects in offspring – A nationwide register study from Finland
3 Mar, 2023 | 13:51h | UTCSummary: The study aimed to determine the association between maternal diabetes and overweight/obesity and the risk of congenital heart defects (CHDs) in offspring. The study analyzed data from all children born in Finland between 2006 and 2016 and their mothers. Maternal type 1 diabetes (T1DM) was found to be associated with a significantly increased risk for any CHD, with an odds ratio of 3.71, whereas maternal overweight and obesity were associated with only a slightly increased risk for complex defects and left ventricular outflow tract obstruction. Maternal diabetes was responsible for 3.0% of offspring’s CHD, while maternal overweight and obesity were responsible for 0.7%, indicating weaker associations between maternal overweight and obesity and CHD in the offspring than previously reported.
Commentary from the author on Twitter
Proudly presenting our preprint (thread):
Maternal diabetes and overweight as risk factors for congenital heart defects in offspring – A nationwide register study from Finland https://t.co/rFnlNYPrgn 1/7
— Emmi Helle (@EmmiHelle) February 27, 2023
M-A | Incidence, indications, risk factors, and outcomes of emergency peripartum hysterectomy worldwide
2 Mar, 2023 | 12:54h | UTC
Cohort Study | Association between marked fetal heart rate variability and neonatal acidosis
2 Mar, 2023 | 12:44h | UTCCommentary: Marked variability associated with twofold increased risk of neonatal acidosis: BJOG
WHO Report | A woman dies every two minutes due to pregnancy or childbirth
28 Feb, 2023 | 14:04h | UTCSummary: This new report by United Nations agencies shows that a woman dies every two minutes due to pregnancy or childbirth. The report covers maternal deaths from 2000 to 2020 and reveals that maternal deaths either increased or stagnated in nearly all regions of the world, with some regions experiencing major setbacks. The poorest parts of the world and countries affected by conflict continue to have the highest rates of maternal deaths. Severe bleeding, high blood pressure, pregnancy-related infections, complications from unsafe abortion, and underlying conditions aggravated by pregnancy are the leading causes of maternal deaths, which are largely preventable and treatable with access to high-quality healthcare. The COVID-19 pandemic may have further held back progress on maternal health. The report calls for urgent action to ensure every woman and girl has access to critical health services before, during, and after childbirth, so they can fully exercise their reproductive rights.
News Release: A woman dies every two minutes due to pregnancy or childbirth: UN agencies – World Health Organization
Commentaries:
Ambitious goal to slash maternal deaths in jeopardy – Nature
U.N.: Progress on reducing global maternal mortality has stalled since 2015 – STAT
Eight Hundred Women Die Every Day During Pregnancy or Childbirth – Health Policy Watch
M-A | Adverse perinatal outcomes associated with antiretroviral therapy in women living with HIV
27 Feb, 2023 | 12:48h | UTC
Review | Pre-eclampsia
27 Feb, 2023 | 12:47h | UTCPre-eclampsia – Nature Reviews Disease Primers (if the link is paywalled, try this one)
RCT | Aspirin discontinuation at 24 to 28 weeks’ gestation in pregnancies at high risk of preterm preeclampsia
24 Feb, 2023 | 13:56h | UTCArticle: Aspirin Discontinuation at 24 to 28 Weeks’ Gestation in Pregnancies at High Risk of Preterm Preeclampsia: A Randomized Clinical Trial – JAMA (free for a limited period)
Editorial: Biomarkers and the Risk of Preeclampsia – JAMA (free for a limited period)
Commentary on Twitter
Aspirin discontinuation at 24 to 28 weeks of gestation was noninferior to aspirin continuation for preventing preterm preeclampsia in pregnant individuals at high risk of preeclampsia and a normal sFlt-1:PlGF ratio. https://t.co/6yIBsfxwU5 pic.twitter.com/RGqQLvb20l
— JAMA (@JAMA_current) February 21, 2023
SR | Antenatal dietary supplementation with myo‐inositol for preventing gestational diabetes
24 Feb, 2023 | 13:45h | UTCSummary: The article discusses the effectiveness of myo-inositol, a naturally occurring sugar, as a dietary supplement for preventing gestational diabetes in pregnant women. The review included seven randomized controlled trials, with a total of 1319 women who were 10 to 24 weeks pregnant at the start of the studies. The results showed that myo-inositol may reduce the incidence of gestational diabetes, hypertensive disorders of pregnancy, and preterm birth, but there was limited data on other outcomes, such as perinatal mortality and serious infant morbidity. The certainty of the evidence was low to very low due to small sample sizes, inconsistency in doses and timing of administration, and lack of data from diverse populations. The authors suggest that further well-designed studies are needed to assess the effectiveness of myo-inositol in preventing gestational diabetes and improving other health outcomes for mothers and their babies.
Cohort Study | Association of large-for-gestational age birth and prediabetes/diabetes 10-14 years’ postpartum
24 Feb, 2023 | 13:43h | UTCSummary: Several studies show that women who develop diabetes during pregnancy are at increased risk of developing diabetes later in life. This study investigated whether giving birth to a larger-than-normal baby is associated with an increased risk of prediabetes or diabetes 10-14 years after pregnancy in individuals without gestational diabetes. The study used data from the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Follow-up Study, including pregnant individuals without gestational diabetes. After adjusting for various baseline maternal characteristics, the researchers found that individuals who gave birth to a large-for-gestational age (LGA) infant had a 21% higher risk of being diagnosed with prediabetes or diabetes 10-14 years after delivery compared to those who had an appropriate-for-gestational age (AGA) infant. The study concluded that having a previous LGA infant is a marker of increased risk of developing prediabetes or diabetes in individuals without gestational diabetes.
Abstract: Association of large-for-gestational age birth and prediabetes/diabetes 10-14 years’ postpartum in the HAPO follow-up study – American Journal of Obstetrics & Gynecology (link to abstract, presented at the Society for Maternal-Fetal Medicine’s annual meeting)
Commentaries:
Delivering a Plus-Sized Baby Could Be Sign of Diabetes Risk – HealthDay
Large for Gestational Age Births Could Increase Diabetes Risk in Women – HCP Live
M-A | Pregnancy outcomes in Takayasu arteritis patients
24 Feb, 2023 | 13:40h | UTCSummary: The systematic review and meta-analysis examined the data from 27 studies with 825 pregnancies and found that pregnant women with Takayasu arteritis (TA) are at higher risk for adverse pregnancy outcomes; 37% developed hypertension, 14% developed pre-eclampsia, and the occurrence of miscarriage was 16%. High disease activity during pregnancy, renal artery involvement, and history of hypertension were identified as risk factors, while maternal age or prolonged disease duration did not pose a risk. The most common treatments were corticosteroids, anti-hypertensive agents, low-dose aspirin, and azathioprine. The study was limited by the heterogeneity of the included studies and the lack of large-scale prospective case-control studies, indicating the need for further research.
ISUOG Practice Guidelines | Performance of 11–14-week ultrasound scan
23 Feb, 2023 | 13:35h | UTC
Cohort Study | Pre-pregnancy migraine linked to a higher risk of adverse pregnancy outcomes
23 Feb, 2023 | 13:31h | UTCSummary: This study investigated the relationship between migraine and adverse pregnancy outcomes. Researchers examined data from the Nurses’ Health Study II, which included 30,555 pregnancies from 19,694 women. Pre-pregnancy migraine was associated with a higher risk of preterm delivery, gestational hypertension, and preeclampsia. Migraine with aura was associated with a higher preeclampsia risk than migraine without aura. However, migraine was not associated with low birth weight or gestational diabetes mellitus. The study suggests that migraine history, and to a lesser extent, migraine phenotype, could be useful in identifying women at risk of pregnancy complications. Regular aspirin use prior to pregnancy was associated with a lower risk of preterm delivery for women with migraine, but randomized trials are needed to evaluate this hypothesis.
Article: Prepregnancy Migraine, Migraine Phenotype, and Risk of Adverse Pregnancy Outcomes – Neurology (link to abstract – $ for full-text)
News Release: Migraine associated with increased risk for pregnancy complications – Brigham and Women’s Hospital
Commentary: Prepregnancy Migraine Tied to Adverse Pregnancy Outcomes – HealthDay
AHA Scientific Statement | Anesthetic care of the pregnant patient with cardiovascular disease
20 Feb, 2023 | 12:29h | UTCSummary: The AHA emphasizes the need for specialized cardio-obstetric anesthesiology care for pregnant patients with cardiovascular disease, involving a multidisciplinary team of obstetricians, cardiologists, anesthesiologists, and other specialists as needed. The approach includes preoperative evaluation, intraoperative management, and postoperative care to maintain maternal hemodynamic stability, optimize oxygen delivery to the fetus, and avoid factors that exacerbate cardiovascular disease. Vaginal delivery with effective neuraxial analgesia is the preferred mode of delivery, with cesarean delivery used for obstetrical indications or high-risk patients. Specific recommendations are also provided for the management of patients with different types of cardiovascular disease, including congenital heart disease, valvular heart disease, pulmonary hypertension, and hypertrophic cardiomyopathy.
Top Things to Know: Statement on the anesthetic care of the pregnant patient with cardiovascular disease – American Heart Association
10-year follow-up on preterm prelabor rupture of membranes: induced labor vs. expectant management childhood outcomes
16 Feb, 2023 | 15:05h | UTCSummary: This study aimed to compare the long-term outcomes of children born after singleton pregnancies complicated by preterm prelabor rupture of membranes and managed by induction of labor vs. expectant management in RCTs undergone between 2007 and 2011. The study assessed the children’s cognition, motor function, and behavior as the primary outcomes. It found that expectant management did not improve long-term outcomes compared to induction of labor for children born after pregnancies with preterm prelabor (between 34 0/7 and 36 6/7 weeks of pregnancy) rupture of membranes. The confidence in the results of this follow-up study is diminished because only 35% of the children who participated in the original trials participated in the follow-up study.
*Note: This summary was created through the collaboration of a medical editor and ChatGPT.
AHA Statement | Optimizing prepregnancy cardiovascular health improves outcomes for pregnant women, offspring
15 Feb, 2023 | 16:14h | UTCSummary: This statement highlights the need to optimize cardiovascular health before pregnancy to reduce the risk for adverse pregnancy outcomes and cardiovascular disease in mothers and children. It emphasizes the role of clinicians in promoting early cardiovascular health, clinical trials to investigate interventions, and the use of a life course framework to monitor health. By targeting cardiovascular health before pregnancy, interventions can improve health outcomes across generations.*
News Release: Does risk for heart disease start before birth? – American Heart Association
*Note: This summary was created through the collaboration of a medical editor and ChatGPT.