J. Matern. Fetal. Neonatal. Med. [JOURNAL]
Sun
200 papers
Chromosomal abnormalities and pregnancy outcomes in 350 pregnancies with prenatally diagnosed aberrant right subclavian artery: a phenotype-based retrospective cohort study.
Misirlioglu R, Bilginer C, Caliskan M … +4 more , Karaduman FS, Selcuk CGO, Guleroglu FY, Cetin A
J Matern Fetal Neonatal Med · 2026 Dec · PMID 42219360 · Publisher ↗
BACKGROUND: Aberrant right subclavian artery (ARSA) is the most frequent aortic-arch branching variant on prenatal sonography, and its clinical relevance is governed by the phenotypic context in which it is detected. Gen...
BACKGROUND: Aberrant right subclavian artery (ARSA) is the most frequent aortic-arch branching variant on prenatal sonography, and its clinical relevance is governed by the phenotypic context in which it is detected. Genotype-phenotype interpretation remains complicated by uneven genetic testing uptake and the additional anomaly burden carried in non-isolated cases. METHODS: This retrospective single-center cohort comprised 350 singleton pregnancies in which ARSA was diagnosed prenatally at a tertiary perinatology center between January 2020 and April 2025. Cases were classified as isolated ARSA ( = 200), ARSA with soft markers ( = 80), or non-isolated ARSA ( = 70). The primary outcome was chromosomal abnormalities, reported with explicit denominator separation: whole-cohort prevalence and diagnostic yield among invasively tested fetuses. The 22q11.2 deletion case definition required dual confirmation by FISH and chromosomal microarray analysis (CMA). Marker- and anomaly-specific yields were examined to identify findings most strongly linked to chromosomal and adverse pregnancy outcomes. RESULTS: Genetic evaluation acceptance varied by phenotype (75.0% isolated, 92.5% soft markers, 92.9% non-isolated; < 0.001). Whole-cohort chromosomal-abnormality prevalence was 4.5%, 17.5%, and 32.9%; diagnostic yield among invasively tested fetuses was 6.0%, 18.9%, and 35.4%. Trisomy 21 was the most frequent abnormality across phenotypes. Five 22q11.2 deletions (1/1/3 across phenotypes) fulfilled the dual-confirmation criteria; all three non-isolated 22q11.2 cases harbored a conotruncal cardiac anomaly. Marker co-occurrence (≥2 markers, 43.8% of soft-markers) and concurrent major anomalies (≥2, 44.3% of non-isolated) drove yield. Live-birth rates were 97.5%, 87.5%, and 71.4% ( < 0.001). On multivariable logistic regression, ARSA with soft markers (adjusted OR 4.52; 95% CI 1.86-10.96) and non-isolated ARSA (adjusted OR 10.51; 95% CI 4.52-24.44) remained independent predictors of chromosomal abnormality (optimism-corrected AUC 0.708). A compound phenotype (major anomaly + ≥2 soft markers) was present in 25.7% of non-isolated fetuses. CONCLUSIONS: Phenotype-based classification of prenatal ARSA reveals a significant risk gradient for chromosomal abnormality and adverse pregnancy outcome, with co-occurring markers and conotruncal anomalies emerging as the strongest individual signals. The findings support risk-concordant counseling: conservative invasive testing in confirmed isolated ARSA, intensified evaluation when soft markers co-occur, and a compound-phenotype-aware, anatomy-directed approach, including CMA and 22q11.2-targeted testing for conotruncal lesions, in the non-isolated subgroup.
The association between endometrial thickness and ectopic pregnancy among women who underwent in vitro fertilization, systematic review and meta-analysis.
Haddadi M, Jafarabady K, Rashidian P … +4 more , Ahmadi S, Safari R, Bakhtiyari M, Hantoushzadeh S
J Matern Fetal Neonatal Med · 2026 Dec · PMID 42219343 · Publisher ↗
BACKGROUND: Many women are turning to fertilization to address infertility. Experts are striving to reduce complications such as ectopic pregnancy and improve the chances of successful pregnancy. Endometrial thickness i...
BACKGROUND: Many women are turning to fertilization to address infertility. Experts are striving to reduce complications such as ectopic pregnancy and improve the chances of successful pregnancy. Endometrial thickness is used as a factor to predict complications. We aim to systematically review articles to investigate the association between endometrial thickness and ectopic pregnancy in women undergoing fertilization. METHODS: Studies evaluating the relationship between endometrial thickness and ectopic pregnancy rates in individuals after fertilization were found on PubMed, Embase, Scopus, and Web of Science. Pooled odds ratios with 95% confidence intervals were utilized. RESULTS: Out of 605 articles, 20 were included in the systematic review, and seven met the criteria for the meta-analysis. The combined analysis revealed a statistically significant correlation between endometrial thickness and the likelihood of ectopic pregnancy (combined odds ratio: 0.81, 95% CI: 0.78-0.85; I=0.01%; < 0.001). CONCLUSION: Thinner endometrial thickness is associated with an increased risk of ectopic pregnancy in IVF; however, this finding should be interpreted cautiously due to the observational design, potential confounding, and publication bias. Clinically, this may aid in risk stratification but should not be used alone, and further prospective studies are needed to confirm its independent predictive value.
Post-discharge healthcare resource utilization and surfactant administration in moderate to late preterm infants with respiratory distress syndrome.
Sun X, Mowla S, Simpson AN … +7 more , Lahiri A, Edelman D, Liu-Yi S, Corman S, Fuentes D, Dukhovny D, Kuzniewicz MW
J Matern Fetal Neonatal Med · 2026 Dec · PMID 42219337 · Publisher ↗
OBJECTIVES: Respiratory distress syndrome (RDS) is common in preterm infants, accounting for significant healthcare resource utilization (HCRU). To address knowledge gaps in mature preterm infants, this study evaluated o...
OBJECTIVES: Respiratory distress syndrome (RDS) is common in preterm infants, accounting for significant healthcare resource utilization (HCRU). To address knowledge gaps in mature preterm infants, this study evaluated one-year post-discharge HCRU by surfactant administration. METHODS: This study included moderate (32 0/7-33 6/7 weeks) and late preterm infants (34 0/7-36 6/7 weeks) with RDS (ICD-10-CM P22.0) requiring >12 h of respiratory support during birth hospitalization at a Kaiser Permanente Hospital in Northern California (2019-2023). Nested logistic regression estimated adjusted odds ratios (aORs) for associations between surfactant receipt and one-year outcomes [any/respiratory emergency department (ED) visits and hospitalizations] across four sequential models: unadjusted; +birth/demographic factors; +clinical severity; +social factors. RESULTS: Among 1,674 infants, 316 (18.9%) received surfactant and had greater in-hospital severity (moderate-to-severe RDS 23.1% vs. 2.3%; invasive ventilation 25.6% vs. 1.3%; respiratory support ≥94 h 54.2% vs 26.1%; < 0.001). After discharge, surfactant treated infants were more likely to have any ED visits and hospitalizations compared to non-treated infants. However, associations were attenuated and no longer significant after adjustment for birth/demographics, clinical severity and social factors for any ED visits (aOR:1.28 [0.93, 1.76]) and hospitalizations (aOR:1.33 [0.74, 2.40]). Respiratory ED visits remained elevated after adjustment while estimates for respiratory hospitalizations were imprecise. CONCLUSION: Among moderate and late preterm infants with RDS, surfactant receipt was associated with greater in-hospital severity. However, adjusting for severity when estimating odds of post-discharge outcomes resulted in small, inconsistent differences. Future studies should consider more precise measures of RDS severity and the impact of post-discharge factors on HCRU.
Integrated cell-free DNA and omics genetic scores for early detection of gestational diabetes: evidence from a nationwide multicenter study.
Dao VN, Tran NT, Vo TS … +43 more , Le HT, Thi Nguyen TH, Nguyen QV, Thi Ha MT, Le TM, Hoang DT, Nguyen Huynh KT, Nguyen NV, Nguyen CC, Bui TC, Nguyen XT, Le SV, Tran VD, Nguyen MB, Nguyen TV, Nguyen TT, Hoang BP, Nguyen TV, Nguyen TT, Nguyen TT, Duong TD, Pham CH, Luong KT, Dao CN, Hoang KV, Huynh TT, Nguyen KM, Tran ST, Tran HT, Nguyen SC, Tran TD, Nguyen PTL, Pham TV, Pham KC, Thai MD, Truong MT, Pham HH, Do TT, Tang SH, Nguyen HN, Phan MD, Dao HT, Giang H
J Matern Fetal Neonatal Med · 2026 Dec · PMID 42186414 · Publisher ↗
BACKGROUND: Gestational diabetes mellitus (GDM) affects 15.6% of pregnancies globally, with Vietnam exhibiting one of the highest prevalences at 21%. Current diagnostic approaches at 24-28 weeks limit early intervention...
BACKGROUND: Gestational diabetes mellitus (GDM) affects 15.6% of pregnancies globally, with Vietnam exhibiting one of the highest prevalences at 21%. Current diagnostic approaches at 24-28 weeks limit early intervention opportunities. We developed a multi-modal machine learning framework integrating cell-free DNA (cfDNA) structural features and genetic information for early GDM prediction at 10-12 weeks of gestation in Vietnamese women. METHODS: We analyzed blood samples from 1,086 pregnant women (435 GDM cases, 651 controls) collected at 9-12 weeks. Two parallel analytical pathways were employed: cfDNA profiling extracting cfDNA-specific features (fragment length, end motifs, GC content, nucleosome patterns), and whole-genome imputation generating predictions for ∼19,000 omics traits. Component scores were developed using TabPFN classifier and integrated logistic regression into a unified master score. RESULTS: Genome-wide analysis identified five omics traits with significant GDM associations: , , , , and . Component score optimization revealed distinct patterns-cfDNA scores peaked at 200 features (AUC = 71.53), while genetics-based scores improved with up to 2,000 omics traits (AUC = 77.21). The final master score, integrating three components (gbSC, gbSC, cfSC200), achieved AUCs of 86.82-87.19 across validation cohorts with 70% sensitivity and 89% specificity. Addition-deletion analysis confirmed that both cfDNA and genetic components provided essential, non-redundant contributions. CONCLUSIONS: This multi-modal framework demonstrates superior performance compared to single-biomarker approaches, enabling risk stratification from very low (4% GDM prevalence) to very high risk (90% prevalence). At the cutoff 0.4, the model identifies 78% of future GDM cases at 10-12 weeks while maintaining an 18% false-positive rate, potentially enabling early interventions to prevent GDM development and associated complications.
Inconsistent use of outdated terminology in a recent review on cervical cerclage failure.
Park YJ, Park MI
J Matern Fetal Neonatal Med · 2026 Dec · PMID 42186395 · Publisher ↗
Abstract loading — click title to view on PubMed.
Serum HMGB1 and sCD14 levels in neonates with jaundice: associations with disease severity and phototherapy efficacy.
He Y, Wei D
J Matern Fetal Neonatal Med · 2026 Dec · PMID 42186388 · Publisher ↗
OBJECTIVE: To investigate the associations of serum high-mobility group box-1 (HMGB1) and soluble cluster of differentiation antigen-14 (sCD14) with disease severity in neonatal jaundice, and to explore their relationshi...
OBJECTIVE: To investigate the associations of serum high-mobility group box-1 (HMGB1) and soluble cluster of differentiation antigen-14 (sCD14) with disease severity in neonatal jaundice, and to explore their relationship with phototherapy response. METHODS: A total of 345 neonates with hyperbilirubinemia (February 2023-May 2025) and 100 healthy controls were prospectively enrolled. Patients were stratified into mild ( = 273) and severe ( = 72) groups based on total serum bilirubin (TSB). Serum HMGB1 and sCD14 levels were measured by enzyme-linked immunosorbent assay (ELISA) according to the manufacturers' instructions with strict quality control. After intermittent phototherapy, response was classified as effective ( = 294) or ineffective ( = 51). Correlations were assessed by Spearman's rank test. Multivariable logistic regression and receiver operating characteristic (ROC) curve analyses were performed. RESULTS: Serum HMGB1 and sCD14 levels were elevated in jaundice patients versus controls, with further increases in severe versus mild hyperbilirubinemia (all < 0.05). TSB, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) showed similar patterns. HMGB1 and sCD14 positively correlated with TSB, AST, and ALT (all < 0.05). AST, ALT, HMGB1, and sCD14 differed significantly between the effective and ineffective phototherapy groups (all < 0.05). Multivariable logistic regression identified AST, ALT, HMGB1, and sCD14 as independent predictors of treatment failure (all < 0.05). ROC analysis revealed AUCs of 0.75 for HMGB1 alone and 0.75 for sCD14 alone, with their combination yielding a significantly higher AUC of 0.83. CONCLUSIONS: In term neonates with non-hemolytic jaundice without severe comorbidities, serum HMGB1 and sCD14 levels are closely associated with disease severity and correlate with the efficacy of phototherapy. Their combined assessment may provide valuable reference indices for predicting phototherapy outcomes.
Assessment of the relationship between maternal cardiometabolic health and fetal growth in pregnant women living with HIV on antiretroviral therapy in Mthatha, South Africa.
Matjuda EN, Nkeh-Chungag BN, Engwa GA … +4 more , Sewani-Rusike CR, Gubu-Ntaba NC, Businge CB, Goswami N
J Matern Fetal Neonatal Med · 2026 Dec · PMID 42184167 · Publisher ↗
BACKGROUND: The use of antiretroviral therapy (ART) during pregnancy among women living with human immunodeficiency virus (HIV) may adversely affect their cardiometabolic health, but its influence on fetal growth remains...
BACKGROUND: The use of antiretroviral therapy (ART) during pregnancy among women living with human immunodeficiency virus (HIV) may adversely affect their cardiometabolic health, but its influence on fetal growth remains underexplored. This study aimed to investigate the relationship between maternal cardiometabolic health and fetal growth in pregnant women living with HIV receiving ART in Mthatha, South Africa. METHODS: A pilot study included 21 HIV-positive and 53 HIV-negative pregnant women, measuring anthropometric parameters and blood pressure. Cardiometabolic risk factors were assessed, including dyslipidemia, glycemia, oxidative stress, endothelial function, and inflammatory markers. Noninvasive vascular function indicators, including uterine artery pulsatile index (UtA PI), flow-mediated slowing (FMS), carotid-femoral pulse wave velocity (cfPWV), and ankle-brachial index (ABI) were evaluated. Fetal growth parameters, including femur length (FL), biparietal diameter, head circumference (HC), abdominal circumference (AC), and estimated fetal weight, were recorded. Relationships between maternal health and fetal growth were analyzed with a significance threshold of ≤ 0.05. RESULTS: Prehypertension was more common among pregnant women living with HIV (14.29% vs. 1.89%). Additionally, higher cfPWV, UtA, and LDL-C levels were noted in the HIV-positive group ( ≤ 0.05). A negative correlation ( ≤ 0.05) was found between maternal UtA PI and fetal growth parameters such as AC, FL and HC. CONCLUSION: Vascular dysfunction was observed in pregnant women living with HIV on ART coupled with an inverse association between maternal vascular function and fetal growth suggesting that impaired maternal vascular function may limit placental blood flow and potentially affect fetal growth.
Terminology in cervical cerclage.
Wu Y, Huang J, Pei C
J Matern Fetal Neonatal Med · 2026 Dec · PMID 42179296 · Publisher ↗
Abstract loading — click title to view on PubMed.
Development of a nomogram model for individualized prediction of fetal growth restriction in pregnant women with iron deficiency anemia.
Yang X, Jiang F, Deng Q … +4 more , Wang X, Chen X, Shi H, Li Y
J Matern Fetal Neonatal Med · 2026 Dec · PMID 42178208 · Publisher ↗
PURPOSE: To develop a nomogram model for individualized prediction of fetal growth restriction (FGR) among pregnant women with iron deficiency anemia (IDA) and to evaluate its predictive performance and clinical utility....
PURPOSE: To develop a nomogram model for individualized prediction of fetal growth restriction (FGR) among pregnant women with iron deficiency anemia (IDA) and to evaluate its predictive performance and clinical utility. METHODS: A retrospective study was conducted on 351 pregnant women diagnosed with IDA between December 2017 and October 2024. After excluding 95 participants based on predefined criteria, 256 women were included and divided into a training cohort ( = 179) and an internal test cohort ( = 77) at a ratio of 7:3 for model construction and internal validation, respectively. Least absolute shrinkage and selection operator (LASSO) regression was used to identify independent risk factors and construct the nomogram. The model's performance was evaluated based on discrimination (ROC curve and AUC), calibration (calibration curves), and clinical utility (Decision Curve Analysis). RESULTS: Six independent predictors for FGR were identified: red blood cell count (RBC), hemoglobin (Hb), serum ferritin (SF), folic acid supplementation, gestational diabetes mellitus (GDM), and hypertensive disorders of pregnancy (HDP). The nomogram demonstrated excellent discriminative ability, with an AUC of 0.972 (95% CI: 0.946-0.998) in the training cohort and 0.950 (95% CI: 0.892-1.000) in the internal test cohort. Calibration curves showed high consistency between predicted and observed outcomes, and DCA confirmed the model's substantial net clinical benefit. CONCLUSION: The individualized nomogram model based on clinical and hematological parameters provides an accurate and practical tool for predicting FGR in women with gestational anemia due to IDA, offering substantial potential for clinical risk stratification and early intervention.
Peripartum dynamics of ischemia and heart failure biomarkers: the impact of delivery mode.
Abou Tabikh I, Mawas N, Kappelmeyer M … +3 more , Wagner S, Maier LS, Köninger A
J Matern Fetal Neonatal Med · 2026 Dec · PMID 42178205 · Publisher ↗
BACKGROUND: The uterus and its myometrium undergo several changes during delivery. In labor, the myometrium performs contractions to expel the newborn. In a cesarean section, however, the myometrium is incised. Little is...
BACKGROUND: The uterus and its myometrium undergo several changes during delivery. In labor, the myometrium performs contractions to expel the newborn. In a cesarean section, however, the myometrium is incised. Little is known about labor-induced changes in biomarkers that are known to rise during injuries and exhaustion of another muscle, the heart. These markers can also be produced by the myometrium, especially damaged myometrium. Since labor is known to cause slight myocardial challenge, physiological changes in cardiac biomarkers in the context of labor versus after an incision of the uterus are of new interest. Here, we question whether cardiac biomarkers could also be produced by the uterus. If this were the case, the interpretation of the myocardial ischemic marker peripartum needed a revision. This study investigated whether cardiac biomarkers might be influenced by uterine activity or injuries from cesarean sections. METHODS: We conducted a prospective study on the peripartum trajectories of creatine kinase (CK, cardiac isoenzyme CK-MB), high-sensitivity cardiac troponin-T (hs-cTnt), and N-terminal pro-B-type natriuretic peptide (NT-Pro-BNP) in 44 cardiologically healthy pregnant women. The participants were stratified by delivery mode: cesarean section (CS, = 24) versus vaginal delivery (VD, = 20). RESULTS: Our findings indicate that ischemia biomarkers (hs-cTnT, CK and CK-MB) increase more during the postpartum period than they do after a cesarean section, whereas NT-Pro-BNP levels increase after cesarean section. These elevations remained within normal ranges and were not associated with clinical symptoms. CONCLUSION: Biomarker levels differ based on delivery mode, indicating that mode of birth influences biomarker fluctuations postpartum within a physiological range. The incision of the uterus does not reveal higher marker levels than contractions do; therefore, this kind of myometrial damage is not associated with an increase in ischemic biomarkers. The observed elevations are linked to slight myocardial damage in the peripartum phase after labor, comparable to exercise. The myometrium does not appear to provide evidence for a clinically meaningful contribution based on peripheral measurements of highly sensitive troponin, CK and CKMB.
Cerebroplacental-uterine ratio combined with ultrasound parameters for predicting perinatal outcomes in late-onset FGR.
Chen C, Yan F, Li X … +3 more , Hou Q, Wei Y, Dong X
J Matern Fetal Neonatal Med · 2026 Dec · PMID 42168080 · Publisher ↗
OBJECTIVE: To investigate the predictive value of the cerebroplacental-uterine ratio (CPUR) combined with multiple ultrasound parameters for adverse perinatal outcomes (APOs) in late-onset fetal growth restriction (FGR)....
OBJECTIVE: To investigate the predictive value of the cerebroplacental-uterine ratio (CPUR) combined with multiple ultrasound parameters for adverse perinatal outcomes (APOs) in late-onset fetal growth restriction (FGR). METHODS: This retrospective study included 149 singleton pregnant women diagnosed with suspected late-onset FGR at our hospital from August 2023 to January 2025. Based on perinatal outcomes, they were divided into a non-adverse outcome group (105 cases) and an adverse outcome group (44 cases). Ultrasound parameters including umbilical artery pulsatility index (UA-PI), middle cerebral artery pulsatility index (MCA-PI), uterine artery pulsatility index (UtA-PI), cerebroplacental ratio (CPR), CPUR, aortic isthmus pulsatility index (AoI-PI), and estimated fetal weight (EFW) percentile were measured and compared between the two groups. Univariate analysis was used to screen significant variables, followed by binary logistic regression analysis to identify independent predictors. Receiver operating characteristic (ROC) curves were plotted to evaluate the predictive performance of individual indicators and combined models. RESULTS: The adverse outcome group had significantly higher levels of UA-PI, UtA-PI, AoI-PI, and a higher proportion of EFW <5th percentile compared to the non-adverse outcome group, while MCA-PI, CPR, and CPUR levels were significantly lower (all < 0.001). Multivariate regression analysis showed that CPUR (OR = 0.061, 95% CI: 0.021-0.172), AoI-PI (OR = 14.003, 95% CI: 3.928-49.925), and EFW <5th percentile (OR = 3.386, 95% CI: 1.124-10.193) were independent predictors of APOs in late-onset FGR. ROC curve analysis revealed that the combined prediction model incorporating CPUR, AoI-PI, and EFW (<5th) had the best predictive performance, with an AUC of 0.932 (95% CI: 0.890-0.974), sensitivity of 84.1%, and specificity of 86.7%, outperforming any single indicator. CONCLUSION: CPUR, AoI-PI, and EFW (<5th) are independent predictors of APOs in late-onset FGR. The combined prediction model constructed from these three parameters demonstrates high predictive value and may provide a reference for early identification of high-risk fetuses and optimization of perinatal management.
Spinal analgesia and labor outcomes in low-risk parturients: a single-center retrospective cohort study.
Maruyama S, Fujii T, Saito H … +2 more , Sato Y, Hashii K
J Matern Fetal Neonatal Med · 2026 Dec · PMID 42161864 · Publisher ↗
OBJECTIVE: To assess the association of a spinal analgesia (SA)-based intrapartum management strategy ("SA framework") with labor progression and selected maternal and neonatal outcomes in low-risk parturients. METHODS:...
OBJECTIVE: To assess the association of a spinal analgesia (SA)-based intrapartum management strategy ("SA framework") with labor progression and selected maternal and neonatal outcomes in low-risk parturients. METHODS: This single-center retrospective cohort study included low-risk parturients between June 2024 and February 2026. The primary outcome was prolonged second-stage labor defined using established clinical thresholds. Secondary outcomes were emergency cesarean delivery (ECD) and umbilical arterial pH ≤ 7.10. Associations were estimated using multivariable regression, with a sensitivity analysis adjusting for labor augmentation. RESULTS: Among 800 parturients, 610 (mean age: 31.83) and 190 (mean age: 32.21) were categorized into the non-SA and SA groups, respectively. The median second-stage labor was significantly longer in the SA group ( < 0.001); however, the SA framework was associated with a reduced risk (aOR 0.314, 95% CI 0.127-0.663) and an absolute risk reduction of 8.6% (95% CI 2.4-14.7%), corresponding to a number needed to treat of approximately 12, with consistent results in sensitivity analyses. More than 90% of parturients in the SA group delivered before reaching threshold durations. Vacuum-assisted delivery was more frequent in the SA group ( < 0.001). The incidences of ECD (1.0%) and low umbilical arterial pH (1.6%) were low. No clear safety signal was identified, although the study was underpowered for rare neonatal outcomes. CONCLUSION: The SA framework was associated with lower observed frequency of exceeding predefined thresholds. This apparent paradox may reflect earlier or more frequent obstetric interventions, suggesting a shift in the distribution of labor duration. These findings likely represent a bundled management strategy rather than a direct physiological effect of SA. Further prospective studies are needed to confirm these findings and clarify causal relationships.
Integrated metabolic and inflammatory biomarkers for early association and prediction of adverse pregnancy outcomes: a multicenter validation study.
Wu X, Wang B, Li W … +4 more , Gan B, He L, Weng Z, Wu J
J Matern Fetal Neonatal Med · 2026 Dec · PMID 42161861 · Publisher ↗
BACKGROUND: Adverse pregnancy outcomes (APOs) affect long-term maternal and offspring health. Conventional metabolic markers, including the triglyceride-glucose (TyG) index, inadequately capture pregnancy-related immuno-...
BACKGROUND: Adverse pregnancy outcomes (APOs) affect long-term maternal and offspring health. Conventional metabolic markers, including the triglyceride-glucose (TyG) index, inadequately capture pregnancy-related immuno-inflammatory dysregulation. We propose a composite index, TyNIR, integrating metabolic and inflammatory parameters, and assess its associations with APOs and predictive performance using machine learning. METHODS: Data were collected from two tertiary centers in Fujian, China (2023-2025), including 1,741 pregnancies and an external validation cohort of 300. Early-pregnancy parameters were used to derive TyNIR. Primary outcomes were gestational diabetes mellitus (GDM), gestational hypertension (GH), preterm birth (PB), low birth weight (LBW), and premature rupture of membranes (PROM). Multivariable regression, subgroup, and interaction analyses assessed associations between TyNIR and APOs. A feature selection approach developed the PREMIER model, which was compared with TyG and other models and externally validated. RESULTS: TyNIR was positively associated with GDM, GH, and PB. After adjustment, the highest quartile showed increased risks, with odds ratios (ORs) of 3.86 (95% CI 2.33-6.39) for GDM, 3.05 (1.74-5.36) for GH, and 3.45 (1.24-9.66) for PB. No associations were observed for LBW or PROM. The PREMIER model achieved area under the curve (AUC) values of 0.710 ± 0.031, 0.736 ± 0.040, and 0.742 ± 0.073, outperforming TyG and other models. External validation confirmed consistent associations and superior predictive performance. CONCLUSIONS: TyNIR consistently predicts risks of GDM, GH, and PB. The TyNIR-based PREMIER model shows robust predictive performance with external validation. These findings support early identification of high-risk pregnancies and may guide personalized management of APOs.
Innovative nomogram integrating bile acid metabolomics for early diagnosis of intrahepatic cholestasis of pregnancy.
Han S, Miao S, Yang L
J Matern Fetal Neonatal Med · 2026 Dec · PMID 42161851 · Publisher ↗
BACKGROUND: Intrahepatic cholestasis of pregnancy (ICP) is a severe pregnancy-specific liver disorder that increases the risk of adverse perinatal outcomes, including preterm birth and stillbirth. Early diagnosis of mild...
BACKGROUND: Intrahepatic cholestasis of pregnancy (ICP) is a severe pregnancy-specific liver disorder that increases the risk of adverse perinatal outcomes, including preterm birth and stillbirth. Early diagnosis of mild ICP remains challenging, as traditional biomarkers such as total bile acids (TBA) offer limited sensitivity and specificity during the early disease phase. Integrating metabolomic bile acid profiling with clinical indicators may enhance early diagnostic accuracy. OBJECTIVE: To develop and validate an innovative nomogram-based predictive model that integrates bile acid metabolomics and clinical indicators for early diagnosis of mild ICP. METHODS: This prospective cohort study included 128 pregnant individuals diagnosed with ICP and matched healthy controls recruited at Zhejiang Provincial People's Hospital (January 2019-June 2024). Bile acid profiles were quantified using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Clinical and biochemical variables were collected. Least Absolute Shrinkage and Selection Operator (LASSO) regression was used to select candidate variables, followed by multivariate logistic regression to construct a predictive model. A nomogram was generated. Model performance was assessed using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) with an internal training/validation cohort split (85:15). RESULTS: Ten independent predictors were identified and incorporated into the nomogram, including TBA subtypes and liver function markers. The model demonstrated excellent discrimination, with an AUC of 0.920 (95% CI: 0.873-0.959) in the training cohort and 0.940 (95% CI: 0.847-1.000) in the validation cohort, outperforming TBA alone (AUC = 0.832). Calibration curves confirmed strong agreement between predicted and observed outcomes. DCA indicated superior clinical utility at low-to-moderate risk thresholds (0.0-0.8). The model enables individualized risk-prediction and supports early clinical intervention for mild ICP. CONCLUSIONS: This novel nomogram-based model integrating bile acid metabolomics and clinical indicators significantly improves the early diagnostic accuracy of mild ICP over conventional methods. The approach offers high translational potential for clinical decision-making and maternal-fetal risk management. Future multicenter validation is warranted to confirm generalizability and clinical applicability.
Placental pathology in pregnancies complicated by hypertensive disorders of pregnancy and small for gestational age neonates: prevalence and severity of maternal vascular malperfusion in a prospectively collected cohort.
Schreiber-Gonzalez S, Freedman A, Miller G … +5 more , Keenan Devlin L, Borders A, Ernst LM, Crockett A, Suresh S
J Matern Fetal Neonatal Med · 2026 Dec · PMID 42156001 · Publisher ↗
OBJECTIVE: We evaluate how the presence and severity of placental pathology correlates with adverse pregnancy outcomes including hypertensive disorders of pregnancy (HDP) and small for gestational age (SGA) neonates. STU...
OBJECTIVE: We evaluate how the presence and severity of placental pathology correlates with adverse pregnancy outcomes including hypertensive disorders of pregnancy (HDP) and small for gestational age (SGA) neonates. STUDY DESIGN: This is a secondary, descriptive analysis of the prospectively collected Stress, Pregnancy, and Health study. We compared placentas from patients with neither HDP nor SGA neonate, HDP alone, SGA neonate alone, and both HDP+SGA neonate by four categories of placental pathology: acute inflammation (AI), chronic inflammation (CI), maternal vascular malperfusion (MVM), and fetal vascular malperfusion (FVM) as well as the number of MVM-related lesions. Univariable analysis was performed using chi-square tests, ANOVA, and Kruskal-Wallis as appropriate. Multivariable analysis with logistic regression adjusted for BMI, mode of conception, diabetes, and socioeconomic status. Sensitivity analysis excluding chronic hypertension in HDP diagnosis also performed. RESULTS: Of 571 participants included, 421 (74%) had neither HDP nor a SGA neonate, 121 (21%) had HDP alone, 17 (3%) had SGA neonate alone, and 12 (2%) had both HDP+SGA neonate. Prevalence of MVM was higher with increasing burden of HDP and/or SGA neonate (22.1% control, 45.5% HDP, 47.1% SGA neonate, 75% HDP+SGA neonate, <.001). After controlling for confounders, the odds of MVM was highest in the HDP+SGA group (aOR 11.3 [95% CI 2.9, 44.6]) when compared to the control group. This finding persisted when excluding chronic hypertension from HDP diagnosis (aOR 15.5 [95% CI 2.92, 82.2]). There was no significant difference in prevalence of AI ( = 0.13), FVM ( = 0.08), and CI ( = 0.55) between the four groups. In examining placental disease severity, increasing MVM score was seen with increasing burden of clinical disease (median [IQR] MVM score 0[0,1] for control, 1[0,3] for HDP alone, 1[0,4] for SGA neonate alone, 3.5[1.5,5] for HDP+SGA, =.0001). CONCLUSION: A combination of both HDP and SGA neonates, compared to either condition alone, is associated with greater prevalence of placental MVM lesions as well as higher MVM score. Future research should focus on further understanding the physiology of this relationship and identifying potential opportunities for intervention for patients with HDP and suspected SGA.
Predicting spontaneous preterm birth using machine learning algorithms.
Ma X, Li N, Zhang Y … +5 more , Qin F, Li M, Gao Y, Hu W, Chen Y
J Matern Fetal Neonatal Med · 2026 Dec · PMID 42151036 · Publisher ↗
STUDY DESIGN: This prospective cohort study included pregnant women from a tertiary hospital in Kunming between 2022 and 2023. Demographic characteristics, clinical history, and cervical elastography parameters were anal...
STUDY DESIGN: This prospective cohort study included pregnant women from a tertiary hospital in Kunming between 2022 and 2023. Demographic characteristics, clinical history, and cervical elastography parameters were analyzed. Four machine learning (ML) algorithms-Boruta, Lasso regression, Sliding Window Sequential Forward Selection (SWSFS), and XGBoost-were applied to screen predictors and construct logistic regression models. RESULTS: The incidence of sPTB was 9.06%. Cervical length (AUC = 0.784, cutoff ≤3.015 cm), anterior cervical angle (AUC = 0.731, cutoff >101.85°), posterior cervical angle (AUC = 0.623, cutoff >123.91°), and combined anterior + posterior cervical angles (AUC = 0.674, cutoff >204.49°) were significantly associated with sPTB. Consistently identified predictors across all algorithms included cervical length, strain rate, combined cervical angles, and history of sPTB. Among the models, the Boruta-based logistic regression achieved the best performance (AUC = 0.953). CONCLUSION: Cervical length ≤3.015 cm, combined cervical angles >204.49°, prior sPTB, and abnormal strain rate were critical predictors of sPTB. ML-based models demonstrated high predictive accuracy and hold promise for early clinical risk stratification in this ethnic minority population.
Voluntary childlessness in high-income countries: the impact of lifestyle and self-fulfillment choices.
Malamitsi-Puchner A, Briana DD, Di Renzo GC
J Matern Fetal Neonatal Med · 2026 Dec · PMID 42144380 · Publisher ↗
Abstract loading — click title to view on PubMed.
Investigating racial differences in the receipt of antenatal interventions prior to periviable delivery.
Monteserin N, Bender W
J Matern Fetal Neonatal Med · 2026 Dec · PMID 42144379 · Publisher ↗
BACKGROUND: The Society for Maternal Fetal Medicine (SMFM) provides guidance on the use of antenatal corticosteroids, antibiotics, and cesarean delivery in the periviable period. Although racial differences exist in post...
BACKGROUND: The Society for Maternal Fetal Medicine (SMFM) provides guidance on the use of antenatal corticosteroids, antibiotics, and cesarean delivery in the periviable period. Although racial differences exist in postnatal active management of periviable neonates have been described, less is known about racial differences in antenatal interventions preceding delivery. OBJECTIVE: To evaluate differences in the receipt of antenatal interventions before periviable delivery by birthing parent race. METHODS: We conducted a population-based cohort study using the National Center for Health Statistics database including periviable deliveries (20w0d-25w6d) from 2016-2021. Individuals delivering a non-anomalous live singleton gestation in a hospital were included. Births with birthweight >97 percentile for gestational age were excluded to minimize dating errors. The exposure was self-reported race with non-Hispanic White as the reference group. Outcomes included antenatal corticosteroid administration, antibiotic administration, and cesarean delivery. Multivariable logistic regression adjusted for maternal age, body mass index, insurance status, marital status, nulliparity, prior preterm birth, diabetes, hypertensive disorders of pregnancy, chronic hypertension, gestational age, and year of delivery. RESULTS: Among 55,306 periviable births, 31.2% occurred in non-Hispanic White parents, 35.1% Black, 23.9% Hispanic, 4.5% Asian. Antenatal corticosteroids were administered to 36.7% of non-Hispanic white parents compared with 32.9% of Black, 31.8% of Hispanic, and 30.5% of Asian parents. After adjustment, Black, Hispanic, and Asian parents had lower odds of receiving corticosteroids (aOR 0.84, 0.86, 0.74, respectively; all < 0.001). Black parents were also less likely to receive antibiotics (aOR 0.94, < 0.005). Cesarean delivery occurred less frequently in Asian parents (aOR 0.76, < 0.001). CONCLUSION(S): Differences in the receipt of antenatal interventions were observed across racial groups in the periviable period. Further research is needed to better understand the factors contributing to these differences and to support equitable, patient-centered care.
Factors associated with partial direct breastfeeding at discharge of preterm infants in the Neonatal Intensive Care Unit: a cohort study.
Xing L, Yan F, Zhang Y … +3 more , Xu L, Zhao H, Jiang T
J Matern Fetal Neonatal Med · 2026 Dec · PMID 42144377 · Publisher ↗
OBJECTIVE: To investigate the associations between clinical practices for facilitating breastfeeding and partial direct breastfeeding (defined as at least three direct breastfeeds) at discharge in preterm infants in Hohh...
OBJECTIVE: To investigate the associations between clinical practices for facilitating breastfeeding and partial direct breastfeeding (defined as at least three direct breastfeeds) at discharge in preterm infants in Hohhot, China. METHODS: A prospective cohort study was conducted involving 373 preterm infants admitted to the NICU in Hohhot from June 2023 to December 2024. Univariate and multivariate logistic regression analyses were used to assess the factors associated with partial direct breastfeeding at discharge. RESULTS: The overall prevalence of partial direct breastfeeding at discharge among preterm infants was 56.8% (212/373). Multivariate analysis indicated that lower birth weight (OR = 3.12, 95% CI: 1.55-6.28) and lower maternal breastfeeding confidence (OR = 5.36, 95% CI: 2.39-12.05) were significantly associated with failure of partial direct breastfeeding at discharge. In contrast, normal breast development (OR = 0.19, 95% CI: 0.08-0.45) and a shorter time to achieve full oral feeding (OR = 0.86, 95% CI: 0.80-0.94) were identified as protective factors for partial direct breastfeeding at discharge (all < 0.001). Sufficient milk volume at discharge (OR = 1.68, 95% CI: 0.79-3.57; = 0.180) and time to achieve full enteral nutrition (OR = 1.03, 95% CI: 0.99-1.06; = 0.095) were not significantly associated with the outcome in the final model. CONCLUSION: Preterm infants with lower birth weight and mothers with lower breastfeeding confidence may require additional clinical support. Normal breast development and earlier achievement of full oral feeding were associated with higher rates of partial direct breastfeeding at discharge.
Predictive value of transvaginal ultrasound cervical length combined with cervical index dynamic monitoring for preterm birth risk in nulliparous women: a retrospective cohort study.
Song WJ, Wei W, Li F … +4 more , An R, Tang L, Chen L, Chen L
J Matern Fetal Neonatal Med · 2026 Dec · PMID 42136256 · Publisher ↗
BACKGROUND: Preterm birth remains a leading cause of neonatal morbidity and mortality worldwide. Cervical length (CL) measured by transvaginal ultrasound is an established predictor, but single-timepoint measurements hav...
BACKGROUND: Preterm birth remains a leading cause of neonatal morbidity and mortality worldwide. Cervical length (CL) measured by transvaginal ultrasound is an established predictor, but single-timepoint measurements have limited accuracy, particularly in nulliparous women without prior obstetric history. This study evaluated whether dynamic monitoring of CL combined with cervical index (CI) improves preterm birth prediction in nulliparous women. METHODS: This retrospective cohort study included 644 nulliparous women with singleton pregnancies who underwent serial transvaginal ultrasound cervical assessments at three timepoints: T1 (16-20 weeks), T2 (20-24 weeks), and T3 (24-28 weeks). CL, CI (calculated as [funnel length + 1]/CL), and rate of cervical change (ΔCL rate) were measured. Multivariable logistic regression identified independent predictors. Prediction models were compared using area under the receiver operating characteristic curve (AUC), and a nomogram was developed for clinical application. RESULTS: Of 644 participants, 64 (9.9%) delivered preterm. Women who delivered preterm had significantly shorter CL at all timepoints (T2: 28.4 ± 7.2 vs. 36.6 ± 4.3 mm, < 0.001) and faster cervical shortening rates (-1.12 ± 0.58 vs. -0.55 ± 0.28 mm/week, < 0.001). The combined dynamic model incorporating CL, CI, and rate of change achieved superior predictive performance (AUC = 0.892, 95% CI: 0.849-0.935) compared to single CL measurement at T2 (AUC = 0.762, 95% CI: 0.698-0.826; < 0.001). Independent predictors included CL at T2 (OR 1.86 per 5 mm decrease), ΔCL rate (OR 2.34 per 0.5 mm/week increase), maximum CI (OR 1.42), cervical funneling (OR 2.89), and premature rupture of membranes (OR 4.28). The nomogram demonstrated good calibration (Hosmer-Lemeshow χ = 8.42, = 0.394) and clinical utility on decision curve analysis. CONCLUSIONS: Dynamic monitoring of cervical parameters significantly enhances preterm birth prediction in nulliparous women compared to single-timepoint assessment. The combined model incorporating CL, CI, and rate of change provides excellent discrimination and may facilitate targeted preventive interventions. External validation in multicenter cohorts is warranted.
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