J. Matern. Fetal. Neonatal. Med. [JOURNAL]
Sun
200 papers
Perinatal outcomes among pregnant women with cardiac disease at tertiary care hospital, Riyadh, Saudi Arabia.
Althobaiti R, Babic I, Ali S … +4 more , Bedaiwi W, Alshareef B, Alaqeeli A, Saleh A
J Matern Fetal Neonatal Med · 2026 Dec · PMID 42336660 · Publisher ↗
BACKGROUND: Cardiac disease in pregnancy is associated with increased maternal and fetal morbidity and mortality. Functional status, particularly as assessed by the New York Heart Association (NYHA) classification, plays...
BACKGROUND: Cardiac disease in pregnancy is associated with increased maternal and fetal morbidity and mortality. Functional status, particularly as assessed by the New York Heart Association (NYHA) classification, plays a critical role in predicting outcomes. OBJECTIVE: To evaluate maternal, fetal, and neonatal outcomes among pregnant women with cardiac disease managed at a tertiary care center and to assess the impact of functional cardiac status on outcomes. METHODS: This retrospective descriptive study included pregnant women with diagnosed cardiac disease who were managed at tertiary care hospital, over a six-year period. Descriptive statistics were used to summarize baseline characteristics and outcomes by using SPSS version 20. Comparison between NYHA Class I-II and III-IV groups were assessed using odds ratios (OR) with 95% confident intervals (CI). A p-value <0.05 was considered statistically significant. RESULTS: A total of 181 pregnancies complicated by maternal cardiac disease were included. Rheumatic heart disease was the most common acquired condition. Preterm birth occurred in 18.0% of NYHA I-II women compared to 55.6% in NYHA III-IV. ICU admission rates were 8.1% vs 44.4%, and cesarean delivery rates were 47.1% vs 77.8%, respectively. NICU admission was required for 23.8% of neonates, and congenital heart disease was identified in 25.2%. CONCLUSION: Functional cardiac status is significantly associated with adverse outcomes. Multidisciplinary, risk-stratified care is essential to optimize outcomes.
Correction.
J Matern Fetal Neonatal Med · 2026 Dec · PMID 42331743 · Publisher ↗
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Antimicrobial resistance patterns and polymicrobial co-detection characteristics of vaginal Group B Streptococcus in pregnant women: a retrospective study.
Zhang M, Ma Z, Cao Y
J Matern Fetal Neonatal Med · 2026 Dec · PMID 42331738 · Publisher ↗
OBJECTIVE: This study aimed to describe antimicrobial resistance profiles, temporally proximate polymicrobial co-detection patterns, and clinical characteristics of Group B Streptococcus (GBS) in pregnant women, and to e...
OBJECTIVE: This study aimed to describe antimicrobial resistance profiles, temporally proximate polymicrobial co-detection patterns, and clinical characteristics of Group B Streptococcus (GBS) in pregnant women, and to explore potential factors related to multidrug resistance (MDR) and pregnancy outcomes. METHODS: A retrospective analysis was conducted on 508 pregnant women (gestational age ≥28 weeks) who underwent vaginal culture and antimicrobial susceptibility testing between January 2020 and December 2023 at a tertiary hospital in southern China. Pathogens were identified using the VITEK 2 system, and susceptibility testing was interpreted per CLSI 2023 criteria. Polymicrobial co-detection was operationally defined as the detection of ≥2 pathogens from the same anatomical site in the same specimen, on the same day, or within a predefined ±7-day interval. Clinical data and pregnancy outcomes were extracted from medical records. RESULTS: GBS was detected in 23.6% (120/508) of participants. Based on the operational definition, 75.8% of GBS-positive women had temporally proximate detection of at least one additional pathogen, most commonly , , and . GBS isolates showed high susceptibility to penicillin (≥95%), whereas resistance to erythromycin (35.0%) and clindamycin (33.0%) was observed. Among isolates with complete susceptibility data, 9.0% (6/67) met the MDR definition. In exploratory analyses, gestational diabetes mellitus showed an elevated but imprecise association with MDR, while no robust evidence of association was observed for polymicrobial co-detection. Unadjusted comparisons indicated higher rates of cesarean delivery and premature rupture of membranes in GBS-positive women. CONCLUSION: GBS colonization in pregnancy is frequently accompanied by temporally proximate detection of additional vaginal pathogens and macrolide/lincosamide resistance. MDR-related findings and clinical associations should be interpreted as exploratory and hypothesis-generating, and require confirmation in larger prospective studies.
Association between maternal cardiovascular health assessed by modified Life's Essential 8 and risks of adverse pregnancy outcomes.
Gao S, Su S, Zhang E … +8 more , Zhang Y, Liu J, Xie S, Cui Y, Li S, Yue W, Liu R, Yin C
J Matern Fetal Neonatal Med · 2026 Dec · PMID 42324210 · Publisher ↗
BACKGROUND: The American Heart Association (AHA) has updated the definition of cardiovascular health (CVH) from "Life's Simple 7" (LS7) to "Life's Essential 8" (LE8). The association between gestational LE8 CVH status an...
BACKGROUND: The American Heart Association (AHA) has updated the definition of cardiovascular health (CVH) from "Life's Simple 7" (LS7) to "Life's Essential 8" (LE8). The association between gestational LE8 CVH status and adverse pregnancy outcomes is unclear. METHODS: We recruited pregnant women from the China birth cohort study during 6-13 gestation weeks and followed them up until delivery to identify pregnancy outcomes. According to the modified AHA definitions, baseline gestational modified LE8 (mLE8) and LS7 CVH scores were calculated based on body mass index, nicotine exposure, physical activity, diet, blood pressure, blood glucose, and lipid levels. Multivariable adjusted logistic regression and receiver operating characteristic (ROC) curves were used to investigate the association between gestational CVH and adverse pregnancy outcomes. RESULTS: Among the 5168 pregnant women finally included, the overall gestational mLE8 CVH score was 81.4 ± 9.6 points. After multivariate adjustment, each 10-points increase in the total overall gestational mLE8 CVH score was significantly associated with a decreased risk of pregnancy loss [odds ratio (OR) = 0.85, 95% CI: 0.76-0.95), hypertensive disorders of pregnancy (OR = 0.50, 95% CI: 0.44-0.58), gestational diabetes mellitus (GDM) (OR = 0.62, 95% CI: 0.57-0.67), preterm birth (OR = 0.76, 95% CI: 0.67-0.86), large-for-gestational age (LGA) (OR = 0.81, 95% CI: 0.73-0.90), and cesarean delivery (OR = 0.77, 95% CI: 0.72-0.82)]. The areas under the ROC curves (AUC) of mLE8 were higher than those of LS7 for pregnancy loss (0.553 vs. 0.537, = 0.031), GDM (0.626 vs. 0.615, = 0.023), LGA (0.575 vs. 0.557, = 0.016), and cesarean delivery (0.574 vs. 0.564, = 0.005). CONCLUSIONS: Higher gestational mLE8 CVH scores in the first trimester are significantly associated with a lower risk of adverse pregnancy outcomes. Although the capacity to predict adverse pregnancy outcomes was modest, mLE8 slightly outperformed LS7 in predicting PE, GDM, LGA, and cesarean delivery.
Maternal age at delivery and intrapartum cesarean delivery risk in a large contemporary term birth cohort.
Kroll H, Martinez E, Lin JC
J Matern Fetal Neonatal Med · 2026 Dec · PMID 42315323 · Publisher ↗
BACKGROUND: Cesarean delivery rates and maternal age at delivery have both increased in the United States. Although maternal age has been associated with cesarean delivery, the extent to which this association persists a...
BACKGROUND: Cesarean delivery rates and maternal age at delivery have both increased in the United States. Although maternal age has been associated with cesarean delivery, the extent to which this association persists after adjustment for measured confounders remains clinically relevant, particularly at very advanced maternal ages. OBJECTIVE: To evaluate the association between maternal age at delivery and risk of intrapartum cesarean delivery. STUDY DESIGN: Multicenter retrospective cohort study of live births in a large integrated healthcare system (2012-2022). We excluded preterm deliveries (<37 weeks gestation), multifetal gestations, scheduled cesarean deliveries, patients with inadequate prenatal care (<4 prenatal visits), and those not between the ages of 18-60. Logistic regression was used to adjust for race and ethnicity, parity, body mass index (BMI), hypertension, pre-eclampsia, gestational diabetes, pre-gestational diabetes, fetal distress, fetal growth restriction, large for gestational age fetuses, macrosomia, chorioamnionitis, meconium staining, and pregnancies resulting from assisted reproductive technology. Cesarean delivery risk was compared across 5-year age intervals using ages 25-34 as the reference group. RESULTS: Among 328,145 participants, cesarean delivery rates increased progressively with advancing age. The cesarean delivery rate in the reference group was 16.1%. Compared with the reference group ages 25-34, ages 18-24 had lower odds of cesarean delivery (13.0%; aOR 0.70, 95% CI 0.68-0.72), while odds were higher among ages 35-39 (20.7%; aOR 1.44, 95% CI 1.40-1.47), 40-44 (25.7%; aOR 1.89, 95% CI 1.81-1.97), 45-49 (33.5%; aOR 2.60, 95% CI 2.23-3.04), and 50-60 (50.0%; aOR 4.56, 95% CI 2.57-8.09). CONCLUSION: Maternal age is associated with intrapartum cesarean delivery risk after adjustment for measured confounders. The association was progressive across age strata. These findings may inform counseling and delivery planning and underscore the need for future work addressing cesarean indications and additional obstetric confounders.
Fetomaternal hemorrhage: a case highlighting the significance of multifaceted prenatal detection and timely intervention.
Gao Y, Duan G, Ma Q … +1 more , Lu Y
J Matern Fetal Neonatal Med · 2026 Dec · PMID 42313483 · Publisher ↗
INTRODUCTION: Fetomaternal hemorrhage (FMH), a life-threatening obstetric complication with high concealment and poor prognosis, is mostly postnatally diagnosed. CASE REPORT: This case reports the 30 years old primigravi...
INTRODUCTION: Fetomaternal hemorrhage (FMH), a life-threatening obstetric complication with high concealment and poor prognosis, is mostly postnatally diagnosed. CASE REPORT: This case reports the 30 years old primigravida at 32 + 1 weeks, preoperatively identified with FMH combined indicators: markedly elevated maternal serum alpha-fetoprotein (AFP) (16698.2 μg/L post-dilution), decreased fetal movement, two non-reassuring fetal heart rate tracings, and polyhydramnios. Emergency cesarean section was done. The neonate had severe anemia (Hb 5.9 g/dL) and metabolic acidosis, with Hb rising to 137 g/dL after 26 mL packed red blood cell transfusion. Maternal K-B test confirmed 1.1% fetal Hb (116 mL blood loss). The neonate was discharged at 40 + 2 weeks corrected gestational age. CONCLUSION: This case emphasizes that the integration of multiple prenatal clinical and laboratory cues facilitates early detection of FMH, thereby contributing to improved perinatal prognosis.
Longitudinal first-trimester reference charts for crown to rump length and related fetal structures in a Population-based setting.
de Groot JM, Gonçalves R, Schipper MC … +7 more , Boxem AJ, Sol C, van Brienen CP, Mulders AGMGJ, Gaillard R, Steegers EAP, Jaddoe VWV
J Matern Fetal Neonatal Med · 2026 Dec · PMID 42309804 · Publisher ↗
BACKGROUND: Early fetal growth is a critical period for human development and of great importance for later life health. Detailed knowledge on normal and abnormal development of first trimester fetal and related structur...
BACKGROUND: Early fetal growth is a critical period for human development and of great importance for later life health. Detailed knowledge on normal and abnormal development of first trimester fetal and related structures is limited. This study aimed to construct first-trimester population distribution centiles for weeks of gestation and reference centiles for fetal crown to rump length, and yolk, gestational and amniotic sac between 6 and 13 weeks of gestation. METHODS: We used data from 3464 ultrasounds in 1609 pregnant women with information on first day of last menstrual period (LMP) and regular menstrual cycles participating in a population-based cohort study from preconception onwards. Ultrasound assessments were performed in a dedicated research center around 7, 9 and 11 weeks of gestation and included measurements of the crown to rump length, and diameters and volumes of the yolk, amniotic and gestational sac. Using Generalized Additive Modeling for Location, Size and Shape (GAMLSS), distribution and reference centiles were estimated for gestational age, crown to rump length, yolk sac, gestational sac and amniotic sac for the first trimester. RESULTS: We constructed distribution centiles for pregnancy dating based on first-trimester crown to rump length from 10 to 70 mm. Next, we generated gestational-age-based 5th, 10th, 25th, 50th, 75th, 90th, and 95th reference centiles for crown to rump length, and yolk, gestational and amniotic sac diameter and volume from 6 + 0 to 12 + 6 weeks of gestation. Length and diameter outcomes appeared to follow a nearly linear growth trajectory during this period of gestation. Confidence intervals showed that the centiles were most reliable between 6 + 0 and 12 + 6 weeks gestation. CONCLUSIONS: Using an urban population-based cohort in a high-income, Western country, we calculated descriptive population distribution centiles for LMP-based weeks of gestation, as well as reference charts for crown to rump length, yolk sac, gestational sac and amniotic sac for LMP-based gestational age. The latter are intended for use in clinical and population-based settings. Interpretation of these charts should proceed with the source population and potential bias in mind.
Methodological considerations in Mendelian randomization mediation analysis of sleep apnea syndrome, body mass index, and postpartum depression.
Swaika S, Dhyani A, Kumar R … +1 more , Arora H
J Matern Fetal Neonatal Med · 2026 Dec · PMID 42297638 · Publisher ↗
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Risk factors for recurrent abortion after induced abortion in Chinese women: a prospective study.
Zhu J, Shen C, Chen J … +7 more , Fan C, Zhai X, Song J, Jiang H, Pan X, Fan C, Wu J
J Matern Fetal Neonatal Med · 2026 Dec · PMID 42297631 · Publisher ↗
BACKGROUND: The increasing risk of complications after repeat induced abortions seriously threatens women's reproductive health and lives. This study aimed to identify risk factors for repeat abortion through time-strati...
BACKGROUND: The increasing risk of complications after repeat induced abortions seriously threatens women's reproductive health and lives. This study aimed to identify risk factors for repeat abortion through time-stratified analysis to improve post-abortion care (PAC). METHODS: A prospective cohort study was conducted on patients undergoing abortion at Fengcheng Hospital, Fengxian District, Shanghai, between September 2022 and December 2024 ( = 557). Data were collected using structured questionnaires and hospital records. Participants were categorized into two groups based on the number of existing children: ≤1 birth ( = 133) and ≥2 births ( = 424). Univariate analyses were employed to identify variables with < 0.05 for inclusion in multifactorial logistic regression models. Three time-stratified models (1-3, 4-6, and 7-12 months) were established to analyze the temporal characteristics of repeat abortion. RESULTS: Multiple regression analyses revealed significant associations between repeat abortion outcomes and several independent variables at different time intervals. Within 12 months, ethnic minorities exhibited 21.86-fold higher adjusted odds of repeat abortion compared to Han Chinese ethnicity (adjusted odds ratio (aOR) = 21.86, 95% CI: 4.92-97.17). Preoperative self-rating anxiety scale (SAS) scores ≥50 exhibited 83% risk reduction compared to SAS scores <50 (aOR = 0.17, 95% CI: 0.03-0.91). Preoperative self-rating depression scale (SDS) scores ≥53 revealed a 74% lower risk of repeat abortion compared to SDS scores <53 (aOR = 0.26, 95% CI: 0.07-0.94). Time-stratified analysis showed that the risk of repeat abortion was significantly higher among ethnic minorities from January to March (aOR = 35.56, 95% CI: 5.95-212.68). Furthermore, the risk was significantly higher among ethnic minorities from April to June (aOR = 32.73, 95% CI: 7.80-137.29). From July to December, ethnic minorities (aOR = 36.19, 95% CI: 9.69-135.18), a preoperative SAS score ≥50 (aOR = 0.15, 95% CI: 0.03-0.78), and a postoperative C-CSE score ≥30 (aOR = 0.21, 95% CI: 0.08-0.54) were significantly associated with repeat abortion. There were no significant differences in the incidence of repeat abortion across different time intervals. CONCLUSION: Ethnic minorities served as an independent risk factor for repeat abortion among Chinese women. However, due to the small sample size, our findings regarding the role of ethnic minorities should be interpreted cautiously. Additionally, psychological factors were identified as significant factors. In particular, preoperative anxiety (SAS ≥50) was associated with reduced odds of repeat abortion. This suggests that moderate anxiety may improve contraceptive adherence and lower the risk of repeat abortion. Postoperative contraceptive self-efficacy (C-CSE ≥30) protects against repeat abortion in the long term; therefore, enhancing contraceptive confidence is crucial for preventing repeat abortion.
Association between congenital uterine anomalies and placenta accreta spectrum: an exploratory retrospective observational study.
Hayashi K, Kawamura H, Kato M … +3 more , Tsuyoshi H, Yoshida Y, Orisaka M
J Matern Fetal Neonatal Med · 2026 Dec · PMID 42289895 · Publisher ↗
OBJECTIVE: To investigate the association between congenital uterine anomalies (CUAs) and placenta accreta spectrum (PAS), and to explore obstetric outcomes following hysteroscopic septal resection. METHODS: This retrosp...
OBJECTIVE: To investigate the association between congenital uterine anomalies (CUAs) and placenta accreta spectrum (PAS), and to explore obstetric outcomes following hysteroscopic septal resection. METHODS: This retrospective cohort study included singleton pregnancies delivered at ≥22 weeks of gestation at a tertiary referral center between 2013 and 2024. PAS was diagnosed based on the 2019 International Federation of Gynecology and Obstetrics (FIGO) clinical or pathological criteria. The association between CUAs and PAS was evaluated using Firth's penalized logistic regression analysis. Sensitivity analyses were additionally performed using conventional logistic regression models. Obstetric outcomes following hysteroscopic septal resection were descriptively analyzed. RESULTS: Among 2,891 pregnancies, 31 (1.1%) involved CUAs, including 11 pregnancies following hysteroscopic septal resection. PAS occurred more frequently in the CUA group than in the non-CUA group (9.7% vs. 1.3%, < 0.01). Firth's penalized logistic regression showed that CUAs were significantly associated with PAS (crude odds ratio [OR], 9.25; 95% confidence interval [CI], 2.42-26.1; < 0.01). After adjustment for placenta previa or low-lying placenta, the association became stronger (adjusted OR, 21.8; 95% CI, 5.47-67.0; < 0.001). Sensitivity analyses adjusting for advanced maternal age, assisted reproductive technology, and previous cesarean delivery showed consistent results. Cesarean delivery was significantly more common in pregnancies complicated by CUAs. In an exploratory descriptive analysis, no PAS cases were observed among following septal resection. CONCLUSION: CUAs may be a potential risk factor for PAS. In contrast, our exploratory analysis did not identify PAS cases following hysteroscopic septal resection. Large-scale multicenter studies using PAS defined according to the diagnostic criteria proposed by FIGO are essential to validate these findings and clarify the underlying mechanisms.
Evaluation of the Z-score accuracy of noninvasive prenatal testing for trisomies 21, 18 and 13: a cohort study based on cell-free fetal DNA and maternal age.
Zhai X, Chen J, Xiong Y … +6 more , Zhang J, Shi M, Zhou Y, Wang C, Zeng J, Lai C
J Matern Fetal Neonatal Med · 2026 Dec · PMID 42289888 · Publisher ↗
OBJECTIVE: This study aimed to evaluate the relationship between the Z-score of positive noninvasive prenatal testing (NIPT) results and the positive predictive value (PPV), as well as the correlation between Z-score and...
OBJECTIVE: This study aimed to evaluate the relationship between the Z-score of positive noninvasive prenatal testing (NIPT) results and the positive predictive value (PPV), as well as the correlation between Z-score and cell-free fetal DNA (cff-DNA) concentration, and the association between PPV and maternal age. METHODS: A total of 278 singleton pregnant women with high-risk NIPT results were included. Fetal karyotyping or copy number variation sequencing (CNV-Seq) was performed to confirm the presence of chromosomal abnormalities. The study evaluated the correlation between Z-scores of true positive NIPT results and the concentration of cff-DNA. Additionally, the study analyzed the association between NIPT Z-score and PPV, as well as the relationship between PPV and maternal age. Logistic regression analysis was used to assess the correlation between Z-scores and PPV. The diagnostic performance of Z-scores in detecting chromosomal aneuploidy was evaluated using receiver operating characteristic (ROC) curve analysis. RESULTS: Of the 242 pregnant women who opted for prenatal diagnosis through invasive amniocentesis, 184 cases were diagnosed as true positives. The total PPVs of NIPT screening for trisomy 21 (T21), trisomy 18 (T18), and trisomy 13 (T13) were 89.82%, 67.65%, and 26.83%, respectively. The Z-scores of T18 and T21 are positively correlated with the concentration of cff-DNA. The PPVs of T18 and T21 increase with rising Z-score. When 5 < ≤ 20, the PPV of T21 is the highest, while that for T13 is the lowest under the same Z-score. Furthermore, the PPV was found to be higher among pregnant women aged ≥35 years compared to those younger than 35 years. The ROC curve analysis showed that the optimal cutoff value of Z-scores for T21, T18, and T13 was 9.189, 14.08, and 13.72. The logistic regression analysis revealed that Z-scores of NIPT-positive results were significantly associated with the PPV at T21 (<0.001), T18 (=0.008), and T13 (=0.034). CONCLUSION: Z-score showed a positive correlation with cff-DNA concentration and PPV for T21 and T18. Based on these findings and current knowledge, we suggest that, a multi-parameter model (including Z-score, maternal age, cff-DNA%, and ultrasound markers) be evaluated in future studies to potentially improve NIPT accuracy and reduce false positives. This suggestion is speculative and requires prospective validation.
Distinct causal associations of mitochondrial function-related proteins with eclampsia versus pre-eclampsia: a two-sample Mendelian randomization analysis.
Wang Z, Ma M, Gu J … +3 more , Lu W, Deng T, Shi L
J Matern Fetal Neonatal Med · 2026 Dec · PMID 42289879 · Publisher ↗
OBJECTIVE: Eclampsia (E) and pre-eclampsia (PE) exhibit significant pathophysiological differences, yet the mitochondrial mechanisms underlying these differences are unclear. Our study conducted the first Mendelian rando...
OBJECTIVE: Eclampsia (E) and pre-eclampsia (PE) exhibit significant pathophysiological differences, yet the mitochondrial mechanisms underlying these differences are unclear. Our study conducted the first Mendelian randomization (MR) analysis to explore the specific causal effects of mitochondrial function-related proteins on E and PE, identifying actionable targets for precise prevention. METHODS: This two-sample Mendelian randomization study utilized three European-ancestry cohorts from FinnGen R12 (E/PE, E, and PE). Causal effects of mitochondrial proteins were estimated the inverse variance weighted (IVW) method, with robustness confirmed through sensitivity analyses and MR-PRESSO for outlier removal. For mitochondrial genes identified through correction methods, we further conducted transcriptomic validation using independent GEO datasets to identify disease-causing genes associated with E/PE. RESULTS: The IVW results revealed distinct causal associations for E and PE. Specifically, 2,4-dienoyl-CoA reductase (DECR1) was associated with an increased risk of E (OR = 1.8788, 95% CI 1.0446-3.3791, = 0.0352), while Serine-tRNA ligase (SerRS) showed a protective association with E (OR = 0.3090, 95% CI 0.1346-0.7097, = 0.0056). For pre-eclampsia, Persulfide dioxygenase ETHE1 was associated with decreased risk (OR = 0.9341, 95% CI 0.8762-0.9958, = 0.0367), while Transmembrane protein 70 (TMEM70) was associated with increased risk (OR = 1.0937, 95% CI 1.0023-1.1935, = 0.0442). External validation using GEO datasets showed differential expression patterns of these genes in PE placental tissues. CONCLUSION: This MR study suggests distinct mitochondrial pathways for E and PE, with DECR1 and SerRS associated with E, and ETHE1 and TMEM70 with PE. These preliminary findings suggest non-overlapping genetic underpinnings and highlight the proteins as potential biomarkers for further investigation.
Comment on "baseline serum AMH‑to‑FSH ratio, menstrual pattern, and risk of intra‑uterine adhesion recurrence: a prospective multi‑state Markov model study".
Mughal SA, Zaidi SAN, Un Nisa N … +1 more , Mughal F
J Matern Fetal Neonatal Med · 2026 Dec · PMID 42252259 · Publisher ↗
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IGFBP-1 combined with CHRDL1 in mid-pregnancy serum for predicting fetal growth restriction in late pregnancy among women with gestational hypertension: a prospective nested case-control study.
Diao H, Chen W, Zhang W
J Matern Fetal Neonatal Med · 2026 Dec · PMID 42252258 · Publisher ↗
OBJECTIVE: To investigate the association between mid-pregnancy serum levels of insulin-like growth factor binding protein-1 (IGFBP-1) and chordin-like 1 (CHRDL1) and the occurrence of fetal growth restriction (FGR) in l...
OBJECTIVE: To investigate the association between mid-pregnancy serum levels of insulin-like growth factor binding protein-1 (IGFBP-1) and chordin-like 1 (CHRDL1) and the occurrence of fetal growth restriction (FGR) in late pregnancy among women with gestational hypertension (GH). METHODS: This prospective nested case-control study was conducted within an established cohort of pregnant women with GH from January 2021 to January 2025. A total of 731 singleton pregnant women with GH at 20-24 gestational weeks were enrolled and followed up by dedicated nurses (those lost to follow-up were contacted at least three times) until late pregnancy (≥28 weeks), with 711 completing the entire follow-up. Based on prenatal ultrasound diagnosis, 106 cases of FGR were identified. These cases were individually matched in a 1:2 ratio (matching factors: maternal age, pre-pregnancy body mass index (BMI), and parity) with 212 controls selected from women without FGR, resulting in a final nested case-control sample of 318 participants. Fasting serum samples were collected at 20-24 weeks of gestation, and IGFBP-1 and CHRDL1 levels were measured by enzyme-linked immunosorbent assay (ELISA). FGR occurrence was assessed based on estimated fetal weight (EFW) monitored by B-ultrasound. Spearman's correlation analysis evaluated associations between mid-pregnancy serum concentrations of IGFBP-1 and CHRDL1 with EFW. Conditional logistic regression identified determinants of FGR development in late pregnancy within the GH cohort. The discriminative performance of mid-pregnancy serum IGFBP-1 and CHRDL1 for late-pregnancy FGR prediction was assessed using receiver operating characteristic (ROC) curve analysis. RESULTS: Among 731 pregnant women with GH, 20 (2.74%) were lost to follow-up, and 711 completed the entire follow-up; of these, 106 (14.91%) developed FGR. Following 1:2 matching with 212 controls, 318 participants were included in the nested analysis. Serum levels of IGFBP-1 and CHRDL1 were significantly higher in the FGR group compared with the control group (both < 0.001). The two biomarkers were positively correlated with each other ( = 0.455, < 0.05) and negatively correlated with EFW ( = -0.335, -0.304, both < 0.05). Conditional logistic regression analysis revealed that elevated systolic blood pressure (SBP), diastolic blood pressure (DBP), IGFBP-1, and CHRDL1 were independent risk factors for FGR, while elevated triglycerides (TG) were protective factors. ROC curve analysis demonstrated that the area under the curve (AUC) for IGFBP-1 and CHRDL1 alone in predicting FGR was 0.734 (95%CI: 0.677-0.791) and 0.704 (95%CI: 0.645-0.762), respectively; the combined AUC was 0.801 (95%CI: 0.750-0.852). CONCLUSIONS: Elevated serum IGFBP-1 and CHRDL1 levels in mid-pregnancy are independent risk factors for FGR in late pregnancy among women with GH. The combination of these two biomarkers demonstrates favorable predictive value, providing an actionable biomarker panel for early identification of high-risk populations in clinical practice, enabling intensified monitoring and intervention initiation at 20-24 weeks of gestation, and ultimately improving perinatal outcomes.
Cervical length and fetal fibronectin for the identification of true spontaneous onset of labor.
Warintaksa P, Youkhong C, Trikasemmart M … +3 more , Thongchai R, Hadradchai S, Chaemsaithong P
J Matern Fetal Neonatal Med · 2026 Dec · PMID 42235958 · Publisher ↗
INTRODUCTION: True labor is characterized by regular uterine contractions and cervical changes. However, the precise diagnosis of the "onset" of true labor is challenging, as the examination of cervical changes requires...
INTRODUCTION: True labor is characterized by regular uterine contractions and cervical changes. However, the precise diagnosis of the "onset" of true labor is challenging, as the examination of cervical changes requires multiple timepoints, and it is a retrospective diagnosis. The objectives of this study are to determine the predictive performance of 1) cervical length, 2) cervicovaginal fluid fetal fibronectin, and 3) maternal angiogenic factors concentration [placental growth (PlGF), soluble fms-like tyrosine kinase-1 (sFlt-1), or its ratio (sFlt-1/PlGF)] for the identification of spontaneous true onset of labor at term within 24 h of the assessment in singleton pregnant women presenting with labor symptoms (i.e. differentiating true and false labor). MATERIAL AND METHODS: Design: A prospective observational cohort studySetting: Labor and Delivery unit, Bangkok, ThailandMethods: 146 singleton pregnancies with symptoms of labor were enrolled. A total of 132 patients underwent transvaginal measurements of cervical length and angiogenic factors, with cervicovaginal fluid fetal fibronectin available in 90 cases.Main Outcome Measures: The primary outcome was the spontaneous onset of true labor at term, defined as regular uterine contractions occurring at a frequency of at least 4 in 20 min with either cervical dilatation ≥4 cm or effacement of ≥ 80% or cervical changes or spontaneous rupture of membranes, followed by delivery within 24 h of the onset of true labor in women at ≥37 weeks of gestation. Predictive performance of individual biomarkers and the combined model was calculated to identify the spontaneous onset of true labor at term. RESULTS: The combination of cervical length and fetal fibronectin yielded significantly better predictive performance than the individual markers, with a sensitivity of 62.1%, a specificity of 90.6%, a positive predictive value of 92.3%, a negative predictive value of 56.9%, as well as a positive and a negative likelihood ratio of 6.62 and 0.42, respectively, for the identification of spontaneous true onset labor at term with delivery within 24 h of the assessment. CONCLUSION: Cervical length measurement with fetal fibronectin had a high specificity, positive predictive value, and positive likelihood ratio, but low negative predictive value and moderate negative likelihood ratio for identifying the spontaneous true onset of labor at term. This test may be used as a bedside test to rule in the diagnosis of true labor. However, its moderate sensitivity and negative likelihood ratio, along with a low negative predictive value, indicate that a negative result cannot safely discharge patients and may limit its use as a standalone triage test, warranting the search for other biomarkers.
Reference values for fetal heart rate monitoring in a large tertiary hospital population: a retrospective study.
Eenkhoorn C, Goos TG, Franx A … +3 more , Dankelman J, Willemsen SP, Eggink AJ
J Matern Fetal Neonatal Med · 2026 Dec · PMID 42235956 · Publisher ↗
OBJECTIVE: To establish reference values for fetal heart rate (FHR) indices across time, frequency and nonlinear domains throughout pregnancy in a tertiary hospital population, considering sex. The influence of the numbe...
OBJECTIVE: To establish reference values for fetal heart rate (FHR) indices across time, frequency and nonlinear domains throughout pregnancy in a tertiary hospital population, considering sex. The influence of the number of fetuses, birth weight ,and time to delivery on FHR was evaluated. METHODS: This retrospective cohort study analyzed the initial FHR tracing upon hospital admission between 24° and 41° weeks of gestation, excluding cases in labor, with medication use, or a confirmed medical indication. Reference values were established using the Generalized Additive Models for Location Scale and Shape framework. Likelihood ratio test assessed whether including clinical variables significantly improved model fit. RESULTS: The cohort included 3219 fetuses, of which 48% were female and 91% singleton pregnancies. Median gestational age was 32. Birth weight was below p10 in 22% and above p90 in 9%. Median tracing duration was 42.5 min and median signal loss was 1.95%. Most indices were significantly associated with gestational age and several showed significant sex differences. Model fit significantly improved for multiple indices when including number of fetuses, birth weight, or time to delivery. CONCLUSIONS: This article presents gestational age- and sex-specific reference values for FHR in a large tertiary hospital population. The influence of gestational age was reaffirmed and significant differences related to sex, number of fetuses, birth weight, and time to delivery were identified. This enhances understanding of fetal autonomic regulation and supports a more individualized approach to predictive fetal monitoring. Further research is needed to determine the clinical utility of these reference values in practical monitoring and risk assessment.
Comparison of three Doppler ratio indices for predicting adverse perinatal outcomes in late-onset fetal growth restriction.
Wang SJ, Wang B, Qiu QQ … +3 more , Gong L, Xu Q, Wu F
J Matern Fetal Neonatal Med · 2026 Dec · PMID 42235951 · Publisher ↗
OBJECTIVE: To compare the predictive performance of three Doppler ratio indices-cerebroplacental ratio (CPR), cerebral-placental-uterine ratio (CPUR), and uteroplacental-cerebral ratio (UCPR)-for adverse perinatal outcom...
OBJECTIVE: To compare the predictive performance of three Doppler ratio indices-cerebroplacental ratio (CPR), cerebral-placental-uterine ratio (CPUR), and uteroplacental-cerebral ratio (UCPR)-for adverse perinatal outcomes in late-onset fetal growth restriction (FGR). METHODS: This retrospective cohort study analyzed singleton pregnancies diagnosed with late-onset FGR (≥32 weeks) between October 2024 and January 2026. Doppler parameters-umbilical artery pulsatility index (UA-PI), middle cerebral artery pulsatility index (MCA-PI), and mean uterine artery pulsatility index (mean UtA-PI)-were retrieved at diagnosis. Three indices were calculated: CPR (MCA-PI/UA-PI), CPUR (CPR/mean UtA-PI), and UCPR ((UA-PI + mean UtA-PI)/MCA-PI). Univariable and multivariable logistic regression models (adjusting for estimated fetal weight percentile and gestational age) were constructed. Internal validation used bootstrap resampling ( = 1000). AUC pairwise comparisons employed the DeLong test, and decision curve analysis (DCA) evaluated clinical utility. RESULTS: Of 155 pregnancies, adverse perinatal outcomes occurred in 48 (31.0%). Affected pregnancies had earlier delivery (35.88 ± 1.17 vs. 37.74 ± 1.20 weeks, < 0.001) and lower birth weight (1948.04 ± 213.15 vs. 2336.05 ± 306.45 g, < 0.001). All indices differed significantly between groups ( < 0.05). In univariable analysis, CPUR achieved the highest AUC of 0.781 (95% CI: 0.698-0.856), followed by UCPR (0.777, 95% CI: 0.698-0.851) and CPR (0.740, 95% CI: 0.652-0.820). Optimal cutoffs were CPR ≤ 1.44, CPUR ≤ 1.38, and UCPR > 1.32. Pairwise comparisons revealed no statistically significant differences (all > 0.05). In multivariable analysis, all ratios remained independently associated with adverse outcomes (CPR: aOR 0.37; CPUR: aOR 0.29; UCPR: aOR 2.71; all < 0.001), with improved discrimination (AUC: 0.793-0.816). DCA demonstrated clinical benefit across threshold probabilities of 15-50%. CONCLUSIONS: In late-onset FGR, CPR, CPUR, and UCPR showed comparable predictive accuracy for adverse perinatal outcomes, each maintaining independent predictive value after adjustment for disease severity and gestational age. Statistically non-significant pairwise differences should not be interpreted as clinical equivalence; multicenter prospective studies are warranted. These indices may assist clinical decision-making in late-onset FGR management.
Development and internal validation of a preprocedural prediction model for failed umbilical venous catheterization in neonates.
Ye Z, Li Z, Ding W
J Matern Fetal Neonatal Med · 2026 Dec · PMID 42230281 · Publisher ↗
OBJECTIVE: Umbilical venous catheterization (UVC) may fail because of resistance during catheter advancement, malposition, impaired catheter function, or procedure termination. Preprocedural predictors of failed UVC rema...
OBJECTIVE: Umbilical venous catheterization (UVC) may fail because of resistance during catheter advancement, malposition, impaired catheter function, or procedure termination. Preprocedural predictors of failed UVC remain poorly defined. This study developed and internally validated a preprocedural model for failed UVC in neonates. METHODS: This single-center retrospective cohort study included 123 neonates who underwent UVC between April 2023 and May 2025. Candidate predictors were restricted to variables available before or at catheterization, including perinatal characteristics, Apgar scores, blood gas parameters, respiratory support, congenital anomalies, inflammatory markers, and coagulation indices. Failed UVC was defined as technical failure, positional failure, functional failure, or clinical termination. An Elastic Net penalized logistic regression model was developed and internally validated using 100 repetitions of stratified 10-fold cross-validation. RESULTS: UVC failure occurred in 40 of 123 neonates (32.5%). Failed UVC was associated with lower birth weight, more severe acidosis, impaired gas exchange, and coagulation abnormalities. During internal validation, the model showed high discrimination in this single-center cohort, with a mean AUC of 0.9999 (2.5th-97.5th percentile: 0.9997-1.0000) and a mean Brier score of 0.0062 (0.0038-0.0081). Base excess, PaCO, birth weight, prothrombin time, activated partial thromboplastin time, and fibrinogen were consistently retained during repeated cross-validation. CONCLUSIONS: A preprocedural model based on routinely available clinical and laboratory indicators showed high internal performance for estimating failed UVC risk in this cohort. The retained predictors mainly reflected preprocedural illness severity. Observed UVC failure may also involve procedural context and local workflow. The model should be regarded as exploratory pending multicenter prospective external validation.
Delivery-room escalation, risk factors, and early neonatal outcomes among term infants with a low 5-minute Apgar score in a regional Australian hospital: a case-control study.
Pathak S, Thomas R, Dhakal P … +2 more , Han-Menz C, Kozgar SAM
J Matern Fetal Neonatal Med · 2026 Dec · PMID 42226581 · Publisher ↗
BACKGROUND: Low 5-minute Apgar scores are widely used as indicators of neonatal compromise and in perinatal performance assessments, but interpretation varies by case mix and local escalation and transfer protocols, espe...
BACKGROUND: Low 5-minute Apgar scores are widely used as indicators of neonatal compromise and in perinatal performance assessments, but interpretation varies by case mix and local escalation and transfer protocols, especially in regional (non-tertiary) hospitals. This study examines delivery-room escalation, early neonatal care, and maternal and intrapartum risk factors associated with Apgar scores below 7. METHODS: The study used an unmatched case-control design of term infants (≥37 weeks' gestation) born at a regional Australian health service from 2018 to 2022. Cases were liveborn infants with a 5-minute Apgar score <7; controls had a score ≥7. Delivery-room escalation events, early postnatal disposition, and tertiary transfer were compared between groups. Multivariable logistic regression identified maternal and intrapartum factors associated with low Apgar scores, with significance at < 0.05. RESULTS: Among 3,919 term births, the incidence of a 5-minute Apgar score below 7 was 2.32%, higher than the national average (1.4%). Cases had higher odds of requiring active resuscitation, delivery room escalation, and higher-acuity postnatal care. Resuscitation was performed in 100% of cases versus 41.8% of controls; code blue activation occurred in 40.7% of cases and 2.2% of controls. Special Care Nursery admission was in 81.3% of cases; 6.6% required tertiary transfer, whereas controls were more often managed on the postnatal ward (50.5%). Multivariable analysis identified cesarean delivery (aOR 2.60, 95% CI 1.21-5.58), prolonged rupture of membranes (aOR 2.91, 95% CI 1.06-7.95), and shoulder dystocia (aOR 9.38, 95% CI 1.07-82.54) as associated with Apgar <7. Intrapartum morphine use (aOR 0.13, 95% CI 0.05-0.38) and previous cesarean (aOR 0.31, 95% CI 0.11-0.87) were inversely associated and potentially protective. CONCLUSION: In this regional, non-tertiary setting, a low 5-minute Apgar score, reported more frequently, identifies a clinically meaningful "at-risk transition" phenotype associated with a substantial, quantifiable escalation burden. Rather than being interpreted as an isolated quality figure, it may also inform more nuanced local audits, benchmarking, and service planning.
Associations of BMI and OGTT glucose measures with pregnancy outcomes in risk-based screening for GDM.
van Hoorn EGM, Prins JR, Koning SH … +6 more , Erwich JJHM, Lutgers HL, Kooy A, Wolffenbuttel BHR, van Dijk PR, Hoogenberg K
J Matern Fetal Neonatal Med · 2026 Dec · PMID 42219375 · Publisher ↗
BACKGROUND: Gestational diabetes mellitus (GDM) arises from increasing insulin resistance during pregnancy combined with inadequate pancreatic β-cell adaptation and is associated with adverse pregnancy outcomes. Obesity...
BACKGROUND: Gestational diabetes mellitus (GDM) arises from increasing insulin resistance during pregnancy combined with inadequate pancreatic β-cell adaptation and is associated with adverse pregnancy outcomes. Obesity and maternal hyperglycemia contribute to these risks, yet GDM is increasingly recognized as a heterogeneous condition. We evaluated whether pre-pregnancy BMI and oral glucose tolerance tests (OGTT)-derived fasting (FPG) and 2-hour glucose values show distinct associations with adverse pregnancy outcomes in a risk-based screened cohort. MATERIAL AND METHODS: We performed a post-hoc analysis of 4,431 OGTTs (2011-2016) from a Dutch risk-based screening cohort. Outcomes were described across predefined BMI and glucose categories, followed by multivariable logistic regression with BMI, FPG measured at the time of OGTT, and 2-hour glucose entered simultaneously and additionally adjusted for treatment status. Eight clinical subgroups combining BMI with fasting and 2-hour glucose thresholds were also explored. RESULTS: Higher BMI was mainly associated with hypertensive disorders of pregnancy and cesarean delivery. Higher FPG levels showed the broadest associations, including adverse maternal, delivery and neonatal outcomes. Higher 2-hour post-load glucose levels were primarily associated with fetal growth-related outcomes and neonatal hypoglycemia. Adjustment for treatment attenuated some 2-hour glucose-related associations but did not materially affect BMI- or FPG-related risks. CONCLUSIONS: In women undergoing OGTT because of risk factors or clinical suspicion of GDM, pre-pregnancy BMI, fasting glucose measured at the time of OGTT, and 2-hour post-load glucose demonstrate distinct patterns of association with adverse pregnancy outcomes. These findings suggest heterogeneous patterns of dysglycemia-related risk, alongside the independent contribution of BMI, in a risk-based screening population.
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