J. Matern. Fetal. Neonatal. Med. [JOURNAL]
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200 papers
Comment on: "Role of the cerebroplacental ratio and non-stress test in predicting adverse perinatal outcomes in high-risk pregnancies".
Mughal SA, Un Nisa N, Sehar S
J Matern Fetal Neonatal Med · 2026 Dec · PMID 41819986 · Publisher ↗
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Placental weight may influence preeclampsia or eclampsia risk through modulating lipid metabolism: a mediation Mendelian randomization analysis.
Li Z, Chen L, Tang H … +6 more , He X, Yang J, Li W, Liu J, Han T, Li A
J Matern Fetal Neonatal Med · 2026 Dec · PMID 41819985 · Publisher ↗
INTRODUCTION: Preeclampsia/eclampsia (PE/E) is a leading cause of maternal and perinatal morbidity and mortality and is closely linked to placental dysfunction and maternal metabolic disturbance. Although abnormal lipid...
INTRODUCTION: Preeclampsia/eclampsia (PE/E) is a leading cause of maternal and perinatal morbidity and mortality and is closely linked to placental dysfunction and maternal metabolic disturbance. Although abnormal lipid profiles are consistently observed in PE/E, whether placental growth - proxied by placental weight (PW) - causally influences PE/E risk through lipid metabolism remains unclear. METHODS: We performed two-sample Mendelian randomization (MR) using summary statistics from a genome-wide association study (GWAS) of PW in term singleton pregnancies (19,861 child-mother-father trios), nuclear magnetic resonance (NMR)-based metabolic biomarkers in UK Biobank (∼120,000 participants of European ancestry), and PE/E GWAS data from FinnGen (9717 cases and 259,181 controls). We assessed (i) PW → PE/E, (ii) PW → 249 metabolic biomarkers, and (iii) biomarker → PE/E. Multiple testing across biomarkers was controlled using false discovery rate (FDR). Candidate mediators were taken forward to mediation analyses using two-step MR (product-of-coefficients) and multivariable MR (MVMR) as a sensitivity analysis to estimate direct effects. RESULTS: Genetically predicted higher PW (maternal genetic component) was associated with lower PE/E risk (inverse-variance weighted odds ratio (OR) per 1 SD increase in PW = 0.52, = 0.013). PW was associated with a subset of lipid-related biomarkers after FDR correction, predominantly very large high-density lipoprotein (HDL) lipid components. Mediation analyses were consistent with partial mediation very large HDL lipids, including total lipids (estimated mediated proportion ∼10.4%), cholesteryl esters (∼3.9%), and phospholipids (∼3.4%). CONCLUSION: These MR findings support a protective association of higher PW with PE/E risk and are consistent with a partial contribution of very large HDL lipid pathways. Given the assumptions of MR mediation and the possibility of overlapping metabolic pathways, these results should be interpreted as evidence consistent with mediation rather than definitive mechanistic proof.
The preventive effects of different interventions on gestational hypertension: incidence and network meta-analysis.
Wu Y, Guo K, Yang Y … +1 more , Yang K
J Matern Fetal Neonatal Med · 2026 Dec · PMID 41819984 · Publisher ↗
OBJECTIVE: A network meta-analysis based on randomized controlled trials was conducted to investigate the effects of different interventions in preventing gestational hypertension (GHT). METHODS: A comprehensive search o...
OBJECTIVE: A network meta-analysis based on randomized controlled trials was conducted to investigate the effects of different interventions in preventing gestational hypertension (GHT). METHODS: A comprehensive search of English databases was performed from database inception to March 1st, 2025 to identify randomized controlled trials (RCTs) evaluating different interventions for the prevention GHT. The methodological quality and risk of bias for the included trials were appraised according to the Cochrane Handbook tool. A network meta-analysis was conducted using Stata version 15.1 software, and pooled effect estimates were expressed as the odds ratio (OR) with 95% confidence interval (CI). RESULTS: A total of 50 randomized controlled trials involving 57,836 pregnant women were included in the network meta-analysis. For all included trials, 12 interventions were evaluated, resulting in 66 direct pairwise comparisons. The network meta-analysis demonstrated that compared with Placebo, Aspirin (OR = 0.68, 95% CI [0.48, 0.95]), Calcium (OR = 0.55, 95% CI [0.38, 0.80]), and the combination of Aspirin plus Calcium (OR = 0.12, 95% CI [0.03, 0.47]) were associated with a significantly reduced risk of gestational hypertension. Moreover, exercise (OR = 0.39, 95% CI [0.19, 0.82]) and aspirin plus calcium (OR = 0.12, 95% CI [0.03, 0.42]) were superior to usual-care in the prevention of GHT. Exercise includes yoga and walking. Ranking analysis based on the surface under the cumulative ranking curve (SUCRA) indicated that aspirin plus calcium had the highest probability of becoming the most effective intervention. CONCLUSIONS: Maternal exercise (such as yoga and walking) or combined aspirin plus calcium supplementation might be promising interventions for the prevention of GHT. However, due to the limited number of available trials and the presence of potential heterogeneity, further large-scale, high-quality randomized controlled trials are warranted to validate these findings.
Evaluation of ventricular dyssynchrony in fetuses of diabetic mothers measured by the tissue Doppler indices: a case-control study.
Hematian MN, Rahmanian M, Kalaee Moghadam M … +6 more , Hessami K, Saleh M, Torabi S, Aghajanian S, Shirdel Abdolmaleki A, Saleh M
J Matern Fetal Neonatal Med · 2026 Dec · PMID 41819847 · Publisher ↗
OBJECTIVE: Maternal diabetes is the most common causes of hypertrophic cardiomyopathy, which significantly increases the risk of fetal heart dysfunction. In this study, we sought to evaluate the effect of overt maternal...
OBJECTIVE: Maternal diabetes is the most common causes of hypertrophic cardiomyopathy, which significantly increases the risk of fetal heart dysfunction. In this study, we sought to evaluate the effect of overt maternal diabetes on fetal cardiac function. METHODS: This is a single-center and case-control study consisting of 26 pregnant women with overt diabetes (case group) and 26 women with uncomplicated pregnancies (control group). Cardiac function was assessed twice in the fetal period (18-22 weeks and 28 weeks of gestation) and once in the neonatal period (one week of postnatal). Fetal cardiac function was assessed using early-diastolic maximum velocity index (Em) of mitral valve, end-diastolic maximum velocity index (Am) of mitral valve, Em/Am ratio, left ventricular myocardial performance index (LVMPI) and inter-ventricular mechanical delay index (IVMDI). RESULTS: The case and control groups were not significantly different in terms of maternal age and gestational age at the time of fetal Doppler evaluation. Em ( = 0.007), Am ( < 0.001), LVMPI ( = 0.003), and IVMDI ( = 0.026) were significantly higher in fetuses of diabetic mothers, while there was no significant difference in Em/Am ratio ( = 0.264). Eight fetuses (30.8%) of diabetic mothers had dyssynchrony, while no cases of dyssynchrony were seen in fetuses of non-diabetic mothers ( = 0.004). Infants of diabetic mothers were 8.8 times more likely to develop adverse neonatal outcomes than infants of healthy mothers (RR = 8.8, 95% CI: 1.71-45.31, = 0.009). Regarding the predictive value of cardiac indices for adverse neonatal outcome, IVMDI had the area under curve of 0.887 ( = 0.001) and LVMPI had area under the curve of 0.762 ( = 0.024). CONCLUSION: The findings of the current study revealed significant cardiac dysfunction and dyssynchrony in fetuses of diabetic pregnant women. We also found that the IVMDI, which indicates the extent of inter-ventricular dyssynchrony, and the LVMPI index, which indicates the global dysfunction of the heart, can be used to predict adverse neonatal outcomes in pregnancies complicated with overt diabetes.
Characteristics of white matter microstructure development and blood perfusion in the second and third trimesters of normal fetuses: application of intravoxel incoherent motion diffusion-weighted imaging.
Lin XM, Yuan X, Yu M … +4 more , An P, Qu XY, Yue C, Wang W
J Matern Fetal Neonatal Med · 2026 Dec · PMID 41812674 · Publisher ↗
OBJECTIVE: To characterize alterations in white matter and blood perfusion in normal fetuses using quantitative parameters derived from intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI). METHODS: A total...
OBJECTIVE: To characterize alterations in white matter and blood perfusion in normal fetuses using quantitative parameters derived from intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI). METHODS: A total of 138 fetuses underwent IVIM-MRI. Subjects were categorized into two groups: second trimester (24-28 weeks; = 41) and third trimester (29-40 weeks; = 97). A single voxel block was utilized as an ROI to acquire paired pure diffusion coefficient (D), pseudodiffusion coefficient (D*), and perfusion fraction (f) in specific brain regions. RESULTS: 1) D values decreased significantly with advancing gestational age in all brain regions except the bilateral frontal lobes. 2) D values were significantly lower in the third trimester compared to the second trimester in all regions except the bilateral frontal lobes. 3) Cerebral blood perfusion (f value) exhibited laterality in specific regions: The f value of the left thalamus was consistently higher than the right across all fetuses. This thalamic laterality was significant in the third trimester. Additionally, the left parietal lobe displayed a lower f value relative to the right during the second trimester. CONCLUSION: The IVIM-derived D value provides a quantitative biomarker for assessing white matter maturational processes in the mid-to-late fetal stage of normal fetuses, offering potential clinical utility for early detection of delayed myelination. The f value metric revealed lateralized cerebral blood perfusion during normal fetal development, with laterality patterns evolving with gestational age.
Statement of Retraction: Levonorgestrel emergency contraceptive pills use during breastfeeding; effect on infants' health and development.
J Matern Fetal Neonatal Med · 2026 Dec · PMID 41807054 · Publisher ↗
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Effects of prior cesarean delivery on subsequent pregnancy outcomes using assisted reproductive technology: a narrative review.
Quaas AM, Castillo Farfán JC, Trolice MP … +2 more , Mackay G, Kol S
J Matern Fetal Neonatal Med · 2026 Dec · PMID 41802929 · Publisher ↗
BACKGROUND: Patients commonly struggle with secondary infertility following a prior cesarean section due to factors related to the delivery. Distortions in the pelvic anatomy may complicate subsequent treatment attempts...
BACKGROUND: Patients commonly struggle with secondary infertility following a prior cesarean section due to factors related to the delivery. Distortions in the pelvic anatomy may complicate subsequent treatment attempts using assisted reproductive technology (ART) on different levels, including the myometrium, endometrium, and cervix, as well as intraperitoneal structures. METHODS: In this narrative review, major databases were searched to examine the effect of a prior cesarean delivery (CD) on pregnancy outcomes from subsequent ART treatments. FINDINGS: Some mechanisms for the detrimental effect of CD on subsequent ART success, such as the development of a cesarean scar defect (CSD), are well-supported by existing evidence. Other putative mechanisms, namely an increase in difficulty of subsequent embryo transfers, are more speculative at this time. CONCLUSION/FUTURE DIRECTIONS: Rigorous standardization of CD technique as well as transparent meticulous reporting may mitigate the detrimental effect of prior CD on subsequent ART success.
Exploring the use of intrapartum ultrasound by Italian midwives: training, knowledge, practice, and perceived barriers: a cross-sectional study.
Selmin A, Cosmi E, Veneri A … +5 more , Zorzato P, Mappa I, Derme M, Youssef AMAKA, Visentin S
J Matern Fetal Neonatal Med · 2026 Dec · PMID 41802921 · Publisher ↗
PURPOSE: To explore the integration of Intrapartum Ultrasound (IUS) into midwifery practice across different regions of Italy, with particular focus on midwives' training, knowledge, clinical use, and perceived barriers...
PURPOSE: To explore the integration of Intrapartum Ultrasound (IUS) into midwifery practice across different regions of Italy, with particular focus on midwives' training, knowledge, clinical use, and perceived barriers to implementation. MATERIALS AND METHODS: A cross-sectional survey was conducted among 104 midwives working in various Italian regions. The questionnaire assessed participants' formal education and training in IUS, level of knowledge, extent of clinical application, and perceived obstacles to its broader adoption in clinical practice. Descriptive analyses were performed to evaluate regional differences and identify gaps in education and implementation. RESULTS: Although IUS appears to be widely utilized in clinical settings, a substantial proportion of midwives reported insufficient formal training. Significant barriers to broader implementation included cultural resistance within maternity care settings, limited access to structured educational programs, and regional disparities in clinical practice. Many respondents highlighted the need for improved competencies, particularly in the management of dystocic labor. CONCLUSIONS: This survey highlights the urgent need for standardized and comprehensive training programs to strengthen midwives' competencies in intrapartum ultrasound. Addressing educational gaps, reducing regional inequalities, and promoting cultural change within maternity care environments are essential steps to support the effective and consistent integration of IUS into midwifery practice.
Premature foramen ovale restriction/closure in pregnancy: echocardiographic features and overlap with aortic coarctation.
Ieno L, Altavilla F, Scimone IM … +1 more , Gulino FA
J Matern Fetal Neonatal Med · 2026 Dec · PMID 41802915 · Publisher ↗
OBJECTIVES: Evaluation of the foramen ovale (FO) is essential for understanding right heart predominance in the fetal circulation during the third trimester. Rather than considering the FO as a simple orifice, it should...
OBJECTIVES: Evaluation of the foramen ovale (FO) is essential for understanding right heart predominance in the fetal circulation during the third trimester. Rather than considering the FO as a simple orifice, it should be assessed as a complex anatomical and functional system. Premature FO restriction or closure represents a clinically relevant but diagnostically challenging condition in fetal echocardiography. METHODS: We conducted a monocentric retrospective study including 600 uncomplicated pregnancies between 22 and 38 weeks of gestation that underwent fetal echocardiography at the Cardiology Service of ASP Reggio Calabria between January and December 2023. The FO was assessed by evaluating septum primum morphology and mobility, ostium secundum configuration, and interatrial shunt direction and magnitude on color Doppler, together with indirect hemodynamic markers. All examinations were conducted by a single operator. All pregnancies resulted in term deliveries with normal neonatal outcomes, and postnatal follow-up lasted 6-9 months. RESULTS: Restrictive or premature closure of the FO was identified in 9 fetuses (incidence 1:66 pregnancies), with FO restrictiveness observed in seven cases and premature closure in two cases. Reduced interatrial shunting was defined as a limited or absent right-to-left flow across the FO on color Doppler, associated with impaired septum primum mobility and/or altered FO geometry. The most consistent indirect echocardiographic sign was right atrial dilation (100% of cases), followed by right ventricular and pulmonary artery predominance with a widely patent ductus arteriosus. In some fetuses, the FO appeared morphologically wide but functionally restrictive. All cases showed favorable early postnatal outcomes. CONCLUSION: This study evaluates the incidence of FO restriction or premature closure in physiologically normal pregnancies during the third trimester and reviews echocardiographic features useful for its identification.
Maternity in a foreign land: a protocol for identifying and addressing barriers to care for pregnant immigrants in the UK healthcare system.
Abdalla M
J Matern Fetal Neonatal Med · 2026 Dec · PMID 41802913 · Publisher ↗
INTRODUCTION: Pregnant immigrant women and birthing people face unique challenges in accessing and navigating healthcare systems in their host countries. In the United Kingdom, these barriers can lead to delayed care, mi...
INTRODUCTION: Pregnant immigrant women and birthing people face unique challenges in accessing and navigating healthcare systems in their host countries. In the United Kingdom, these barriers can lead to delayed care, missed appointments, and poorer maternal and neonatal outcomes. This protocol outlines a comprehensive methodology for investigating these barriers and developing solution-focused approaches to address them. METHODS: This cross-sectional, mixed-methods study will recruit 100-150 pregnant immigrant women from antenatal clinics, postnatal wards, and community settings associated with the Princess Royal University Hospital and other King's College Hospital NHS Foundation Trust facilities. Study Registration: King's College audit committee (Registration number #625, date 03 June 2025). Data will be collected using a structured questionnaire covering demographics, language and communication barriers, healthcare access and experiences, and satisfaction with services. Quantitative data will be analyzed using descriptive statistics, chi-square tests, and logistic regression, while qualitative responses will undergo thematic analysis. ANALYSIS: This study aims to identify the prevalence and nature of barriers to maternity care among immigrant women, examine associations between demographic factors and specific barriers, and develop practical recommendations for healthcare providers and policymakers. The findings will inform targeted interventions to enhance accessibility, cultural sensitivity, and overall quality of maternity services for this vulnerable population. By adopting a solution-focused approach, this study will move beyond problem identification to actionable recommendations, contributing to the development of more inclusive and responsive maternity services for immigrant women in the UK and potentially other countries with similar healthcare systems.
Efficacy and safety assessment of pliant forceps in assisted vaginal delivery.
Lin S, Liu S, Huang X … +5 more , Deng S, Wang M, Wang Z, Chen A, Liu B
J Matern Fetal Neonatal Med · 2026 Dec · PMID 41786457 · Publisher ↗
BACKGROUND: Forceps delivery often leads to increased maternal and neonatal complications, primarily attributed to the rigidity of traditional steel forceps, a major contributor to birth injury. AIMS: This study aims to...
BACKGROUND: Forceps delivery often leads to increased maternal and neonatal complications, primarily attributed to the rigidity of traditional steel forceps, a major contributor to birth injury. AIMS: This study aims to develop obstetric forceps with reduced rigidity and assess the safety and effectiveness of the newly designed pliant forceps. METHODS: Pliant forceps with varying materials and shapes were produced by three-dimensional printing, and a pilot simulation determined the optimal design. Three fetal mannequins were developed to measure force changes exerted on the fetal head. Simulated births with several resistance intensities, were conducted to compare the real-time force between pliant forceps and Simpson forceps. Perineal distension was assessed by recording maximum perineal distention during a simulated forceps delivery using pliant forceps and Simpson forceps. FINDINGS: The pliant forceps, constructed from polylactic acid with solid blades and angled shanks, featured foam tape on the fetal sides. In simulation studies on term fetal head model, pliant forceps achieved successful assisted vaginal delivery across all resistance levels. Compared to Simpson forceps, pliant forceps consistently exerted lower force on the fetal head during assisted vaginal delivery. The maximum force applied by pliant forceps occurred at RA1 site on fetal head (67.11 ± 4.35 N, Simpson forceps: 99.12 ± 10.53 N, < 0.001), and Simpson forceps reached its peak at RP2 site (177.37 ± 19.28 N, pliant forceps: 12.87 ± 5.11 N, < 0.001). Similar results were obtained in simulation experiments on large and small fetal head models. Perineal distension was determined to be smaller in births with pliant forceps compared with that in births with Simpson forceps (lateral perineal distension: 76.6 mm vs. 92.6 mm, < 0.001). CONCLUSIONS: The three-dimensional-printed pliant forceps demonstrated reduced force on the fetal head and less perineal distension compared to Simpson forceps in simulated births, which holds potential for decreasing birth injuries and maternal birth canal injuries during forceps delivery. Further research is required to ensure the safety and efficacy of pliant forceps before clinical application.
Intra-operative fetal monitoring during non-obstetric surgery for complications after bariatric surgery: a standard operating procedure.
Habraken V, van der Woude DAA, Houthoff-Khemlani K … +3 more , Leclercq WKG, Niemarkt HJ, van Laar JOEH
J Matern Fetal Neonatal Med · 2026 Dec · PMID 41786456 · Publisher ↗
INTRODUCTION: Pregnancy after bariatric surgery is a high-risk pregnancy. Post-bariatric complications may require emergency surgical intervention. During laparoscopic surgery, anesthetic drugs and formation of pneumoper...
INTRODUCTION: Pregnancy after bariatric surgery is a high-risk pregnancy. Post-bariatric complications may require emergency surgical intervention. During laparoscopic surgery, anesthetic drugs and formation of pneumoperitoneum influence maternal hemodynamics and may impair the perfusion of the utero-placental unit. Subsequent changes of the fetal heart rate (FHR) might be recognized with intra-operative fetal monitoring and guide maternal positioning and hemodynamic management to maintain fetal wellbeing. However, current fetal monitoring guidelines do not include FHR interpretation during general anesthesia. Furthermore, FHR registration using conventional cardiotocogram (CTG) may be technically difficult due to surgically induced pneumoperitoneum. We developed a multidisciplinary local standard operating procedure based on current literature and guidelines. Intra-operative fetal monitoring using conventional CTG was implemented during laparoscopic surgery for suspected complication after bariatric surgery. We aim to establish whether FHR monitoring during laparoscopy is technically feasible. Secondary, we aim to establish a guideline for interpretation of intra-operative FHR during surgery. METHODS AND ANALYSIS: Prospective, observational, feasibility study in a tertiary care hospital with a national referral function for post-bariatric complications in pregnancy. We will collect data from pregnant women with a gestational age of ≥ 24 weeks with a suspicion of a complication after bariatric surgery requiring surgical exploration. Non-Dutch speaking women and women with multiple gestation will be excluded. Data will be collected in Research Manager and analyzed using IBM SPSS Statistics for Windows, version 22. DISCUSSION: The available literature on intra-operative fetal monitoring is scarce. However, despite ambiguity in current international guidelines FHR monitoring is performed in various clinics. To avoid unnecessary caesareans during surgery it is important that FHR monitoring is of sufficient registration quality and that there are guidelines for interpretation of CTG during general anesthesia. However, the technique of intra-operative CTG has not been validated and hence the relevance of our standard operating procedure on intra-operative fetal monitoring during surgery for complications after bariatric surgery.
Statement of retraction: maternal serum inhibin-A for predicting preeclampsia.
J Matern Fetal Neonatal Med · 2026 Dec · PMID 41780510 · Publisher ↗
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Early postpartum severe maternal morbidity among mothers of very low and low birthweight infants: a population-based retrospective cohort study in Georgia, USA, 2016-2020.
Dunlop AL, Coloske MJ, Stanhope KK … +3 more , Kramer MR, Joski PJ, Adams EK
J Matern Fetal Neonatal Med · 2026 Dec · PMID 41775499 · Publisher ↗
BACKGROUND: The early postpartum period (first 42 days after delivery) is a high-risk window for severe maternal morbidity (SMM), yet clinical predictors are not well characterized. We examined rates and clinical factors...
BACKGROUND: The early postpartum period (first 42 days after delivery) is a high-risk window for severe maternal morbidity (SMM), yet clinical predictors are not well characterized. We examined rates and clinical factors that associate with early postpartum SMM by infant birthweight category to inform future intervention strategies. METHODS: We constructed a retrospective, population-based cohort of 542,702 live births in Georgia (2016-2020) using linked birth certificate and hospital discharge records. Infant birthweight was categorized as normal or above (NBW+, ≥2500 g), moderately low (LBW, 1500-2499 g), or very low (VLBW, <1500 g). We estimated early postpartum SMM rates, adjusted risk ratios (RRs), and population attributable risk percentages (PARs) for medical, obstetric, and delivery-related factors using multivariable modeling. RESULTS: Among 542,702 livebirths (492,190 NBW+; 41,337 LBW; 9,172 VLBW), early postpartum SMM rates were highest among VLBW (153 per 10,000) compared with LBW (76 per 10,000) and NBW+ (41 per 10,000) deliveries. Cesarean delivery was associated with the largest observed PAR for all birthweight categories (VLBW: 56.8%; LBW: 25.6%; NBW+: 26.8%) followed by SMM at delivery (VLBW: 15.0%; LBW: 11.4%; 4.2% for NBW+). Chronic and perinatal health conditions each accounted for ≤6% PAR. CONCLUSIONS: Women delivering VLBW and LBW infants experienced nearly four-fold and two-fold higher risks of early postpartum SMM, respectively, compared with NBW+ births. Delivery events, particularly cesarean and SMM at delivery, were associated with the greatest PAR of early postpartum SMM. Findings underscore the need for postpartum monitoring protocols, especially after complicated deliveries, and integrated models of maternal-infant care.
Statement of Retraction: Counseling and in-advance provision of levonorgestrel emergency contraceptive pills decrease the rate of unplanned pregnancy during breastfeeding: a randomized controlled trial.
J Matern Fetal Neonatal Med · 2026 Dec · PMID 41773518 · Publisher ↗
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Statement of Retraction: Nuchal cord: impact of umbilical artery Doppler indices on intrapartum and neonatal outcomes: a prospective cohort study.
J Matern Fetal Neonatal Med · 2026 Dec · PMID 41773513 · Publisher ↗
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The high-risk minority: undetected preterm SGA disproportionately contributes to adverse outcomes in a Chinese cohort.
Liu Q, Li Z, You H … +3 more , Zhang F, Zeng L, Wang Y
J Matern Fetal Neonatal Med · 2026 Dec · PMID 41771684 · Publisher ↗
INTRODUCTION: Small for gestational age (SGA) infants face higher risk of adverse outcomes compared to appropriate for gestational age (AGA) infants. Whether undetected SGA leads to worse clinical outcomes than detected...
INTRODUCTION: Small for gestational age (SGA) infants face higher risk of adverse outcomes compared to appropriate for gestational age (AGA) infants. Whether undetected SGA leads to worse clinical outcomes than detected SGA remains debated. This study compared perinatal outcomes between undetected and detected SGA in preterm and term pregnancies, and identified risk factors for missed diagnoses. MATERIAL AND METHODS: Singleton deliveries > 24 weeks at Peking University Third Hospital (January 2018-June 2023) were included. In this single-center retrospective study, participants were stratified into three groups: detected SGA, undetected SGA and AGA (matched by gestational age and delivery date with undetected SGA). Analysis was conducted in preterm and term deliveries respectively. Multivariate logistic regression models were conducted to compared neonatal outcomes between detected SGA and undetected SGA. Furthermore, differences in maternal demographic and clinical characteristics between AGA and undetected SGA were analyzed. RESULTS: Among 32158 deliveries, 1509 SGA infants were identified, including 679 detected prenatally and 830 undetected. Adverse outcomes occurred in 112 and 60 cases in these groups, respectively. Notably, preterm undetected SGA, representing only 6.7% (56/830) of undetected cases, accounted for 65% (39/60) of all adverse outcomes in that group. Compared to detected SGA, undetected SGA had significantly higher rates of composite adverse outcomes in both preterm (aOR 3.869, 95% CI: 1.919-7.801) and term deliveries (aOR 3.308, 95% CI: 1.236-8.855). In preterm infants, undetected SGA specifically increased risks of neonatal cerebral damage, neonatal respiratory distress syndrome, and necrotizing enterocolitis. Analysis of risk factors for undetected SGA (vs. AGA = 830) revealed that among preterm deliveries, higher maternal BMI (aOR 1.135, 95% CI: 1.016-1.267), hypertensive disorders (aOR 4.473, 95% CI: 1.872-10.688), and gestational diabetes mellitus (GDM) (aOR 8.371, 95% CI: 1.544-45.397) were associated with increased risk. Among term deliveries, hypertensive disorders, GDM, amniotic fluid index < 8 cm, uterine abnormality, nuchal cord, and placenta previa/accrete were significant risk factors. CONCLUSION: Undetected SGA was associated with adverse neonatal outcomes. Preterm undetected SGA carried a disproportionately high morbidity burden compared to term undetected SGA. Prenatal factors, including maternal complications, umbilical cord and placental abnormalities, played a crucial role in identifying SGA.
"Does severity of isolated oligohydramnios at term matter?".
Ganem N, Hinow S, Khamisy-Farah R … +4 more , Gzayev Z, Odeh M, Lowenstein L, Sgayer I
J Matern Fetal Neonatal Med · 2026 Dec · PMID 41765752 · Publisher ↗
OBJECTIVE: To examine the correlation between the severity of isolated oligohydramnios at term and adverse perinatal outcomes, aiming to inform clinical management strategies. STUDY DESIGN: This retrospective cohort stud...
OBJECTIVE: To examine the correlation between the severity of isolated oligohydramnios at term and adverse perinatal outcomes, aiming to inform clinical management strategies. STUDY DESIGN: This retrospective cohort study conducted at a tertiary university-affiliated hospital from 2028 to 2024 included women at 37-42 weeks of gestation diagnosed with isolated oligohydramnios, defined as an amniotic fluid index (AFI) ≤ 5 cm. Exclusion criteria included maternal comorbidities, fetal anomalies, abnormal Doppler studies, multifetal pregnancies, and fetuses with growth restriction or small for gestational age. Participants were categorized into severe (AFI ≤ 2 cm) and mild (AFI 2.1-5.0 cm) oligohydramnios groups. The primary outcome was a composite measure of adverse perinatal outcomes, including cesarean or vacuum delivery for fetal distress, 5-min Apgar score < 7, umbilical artery pH < 7.1, meconium-stained amniotic fluid, neonatal intensive care unit admission, or birth asphyxia. RESULTS: Among 29,759 deliveries during the study period, 432 (1.5%) involved isolated oligohydramnios, of which 66 (15%) had severe and 366 (85%) had mild oligohydramnios. The incidence of adverse perinatal outcomes was significantly higher in the severe group compared to the mild group (22.7% vs. 12.8%; = .039). Severe oligohydramnios remained an independent predictor of adverse outcomes after adjusting for confounders, with an adjusted odds ratio of 1.96 (95% CI:1.09-3.779, = .044). CONCLUSIONS: Severe isolated oligohydramnios at term is associated with nearly double the risk of adverse perinatal outcomes compared to mild cases. These findings underscore the importance of close monitoring and timely delivery planning in severe cases of isolated oligohydramnios at term.
The influence of miR-1246 on the clinical outcomes of neonatal respiratory distress syndrome.
Zou S, Wang P, Duan L … +3 more , Zhang C, Chen Y, Li G
J Matern Fetal Neonatal Med · 2026 Dec · PMID 41765751 · Publisher ↗
OBJECTIVE: Neonatal respiratory distress syndrome (NRDS) represents a serious threat to the life and health of newborns. This study aims to investigate the impact of miR-1246 on clinical outcomes in NRDS children and to...
OBJECTIVE: Neonatal respiratory distress syndrome (NRDS) represents a serious threat to the life and health of newborns. This study aims to investigate the impact of miR-1246 on clinical outcomes in NRDS children and to evaluate its prognosis role. METHODS: The study enrolled 98 NRDS children and 76 healthy newborns. Serum miR-1246 expression was quantified using quantitative real-time polymerase chain reaction. The prognostic impact of miR-1246 expression was evaluated using Kaplan-Meier curves and Cox regression analysis. The correlations between miR-1246 levels and the partial pressure of arterial oxygen/fraction of inspired oxygen (PaO/FiO, P/F), lung ultrasound score (LUS), and the Score for Neonatal Acute Physiology-Perinatal Extension (SNAPPE-II) was examined using Pearson correlation analysis. The prognostic value of miR-1246 combined with P/F, LUS, and SNAPPE-II in predicting the prognosis of NRDS children was evaluated using the receiver operating characteristic curve. RESULTS: Serum miR-1246 was upregulated in NRDS children. NRDS children who overexpressed miR-1246 had a poorer prognosis. miR-1246, P/F, LUS, and SNAPPE-II were closely associated with poor outcomes in NRDS children. In the poor prognosis group, miR-1246, LUS, and SNAPPE-II were elevated, while P/F was reduced. miR-1246 was negatively correlated with P/F and positively correlated with LUS and SNAPPE-II. The combined application of miR-1246, P/F, LUS, and SNAPPE-II could enhance the accuracy of prognostic prediction for NRDS children. CONCLUSION: miR-1246 is overexpressed in NRDS children and is associated with disease onset and clinical outcomes. miR-1246 may be a potential biomarker for assessing the prognosis of NRDS children.
Comparison of two strategies to prevent preterm birth in twins complicated by cervical insufficiency: a retrospective cohort study.
Liu Y, Meng L, Ni X … +8 more , Ru P, Xu W, Gu Z, Shi J, Wang L, Su X, Liu M, Duan T
J Matern Fetal Neonatal Med · 2026 Dec · PMID 41765749 · Publisher ↗
OBJECTIVE: The strategies of preventing preterm birth in twin pregnancies complicated by cervical insufficiency is controversial. We compared the efficacy of fetal reduction combined with prophylactic cervical cerclage a...
OBJECTIVE: The strategies of preventing preterm birth in twin pregnancies complicated by cervical insufficiency is controversial. We compared the efficacy of fetal reduction combined with prophylactic cervical cerclage and prophylactic cervical cerclage alone in preventing preterm birth in this population. METHODS: A retrospective cohort study was conducted in two tertiary hospitals in China. A total of 82 twins complicated by cervical insufficiency who received either fetal reduction combined with cervical cerclage treatment (reduction group, = 40) or only prophylactic cervical cerclage (ongoing group, = 42) were included in this study. The primary outcome is gestational age at delivery. The secondary outcomes included series of maternal and neonatal outcomes. RESULTS: Compared with the ongoing group, twins in the reduction group had a higher median gestational age (38.1 vs. 35.0 weeks, < 0.001) and lower rates of preterm birth of <24 weeks (0% vs. 14.3%, = 0.03), <28 weeks (2.5% vs. 19.0%, = 0.03), <34 weeks (15.0% vs. 38.1%, = 0.02), and <37 weeks of gestation (27.5% vs. 73.8%, < 0.001). Regarding the neonatal outcomes, pregnancies in the reduction group had a greater median birth weight (3110.0 vs.2282.5 g, < 0.001), lower rates of birth weight <2500 g (25.0% vs. 64.3%, < 0.001), birth weight <1500 g (2.5% vs. 23.8%, = 0.002), neonatal intensive care unit admission (15.0% vs. 41.7%, = 0.005), and respiratory distress syndrome (7.5% vs. 25.0%, = 0.02), compared with the ongoing group. Neonatal survival rate in the reduction group had an insignificant higher trend than that in the ongoing group (97.5% vs. 85.7%, = 0.059). Multivariate regression analysis showed that fetal reduction combined with cervical cerclage treatment was associated with a lower risk of preterm birth <34 weeks (aOR 0.25, 95% CI 0.08-0.83, = 0.02) and <37 weeks (aOR 0.13, 95% CI (0.05-0.37), < 0.001) of gestation. CONCLUSIONS: Fetal reduction combined with cervical cerclage strategy was associated with optimized gestational age at delivery and neonatal birth weight in twin pregnancies complicated by cervical insufficiency, representing a relatively safe strategy to prevent preterm birth in this population.
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