American Journal Of Perinatology[JOURNAL]
Sun
200 papers
Regenerative Cell and Cell-Free Therapies for Necrotizing Enterocolitis: Progress Toward Clinical Translation.
Gunasekaran V, Woo S, Lodha A … +2 more , Malhotra A, Garg PM
Am J Perinatol · 2026 Jul · PMID 42385784 · Publisher ↗
OBJECTIVE: Necrotizing enterocolitis (NEC) remains one of the most devastating gastrointestinal diseases of prematurity, carrying high mortality and long-term morbidity with no targeted disease-modifying therapy currentl...
OBJECTIVE: Necrotizing enterocolitis (NEC) remains one of the most devastating gastrointestinal diseases of prematurity, carrying high mortality and long-term morbidity with no targeted disease-modifying therapy currently available. This review synthesizes preclinical and translational evidence for stem cell- and extracellular vesicle (EV)-based regenerative therapies in NEC and identifies the critical steps required for clinical translation. STUDY DESIGN: A narrative review of preclinical studies, systematic reviews, meta analyses, and early-phase clinical trial data evaluating stem cell-based and cell free EV therapies for NEC was performed. Evidence was organized across cell populations, mesenchymal stem cells (MSCs), amniotic fluid stem cells (AFSCs), placental-derived stem cells, and neural stem cells, and their derived EVs and considerations. regeneration, barrier exosomes, with synthesis of mechanistic, translational, safety, and ethical Results: Multiple stem cell types consistently reduce NEC incidence, severity, and mortality in experimental models. Protective effects are mediated through epithelial reinforcement, Wnt/β-catenin pathway activation, immunomodulation, and angiogenesis. Cell-free strategies using MSC- and AFSC derived EVs reproduce comparable benefits with a more favorable manufacturing and safety profile. Early-phase clinical trials of MSCs in other neonatal conditions confirm short-term tolerability, though no NEC-specific stem cell or EV trial has been completed. CONCLUSION: Regenerative cell and cell-free therapies represent a compelling disease-modifying strategy for NEC. Advancing this field requires standardized cell and EV characterization, optimized dosing and delivery protocols, large-animal model validation, and rigorously designed early-phase clinical trials with careful attention to safety, ethics, and regulatory frameworks.
WIC Participation and the Education-related Gap in Adverse Neonatal Outcomes: A Population-based Cohort Study.
Caron E, Balayla J
Am J Perinatol · 2026 Jul · PMID 42372785 · Publisher ↗
BACKGROUND: Lower maternal educational attainment is associated with adverse neonatal outcomes, including lower birthweight, low birthweight (<2500g), and neonatal intensive care unit (NICU) admission. The Special Supple...
BACKGROUND: Lower maternal educational attainment is associated with adverse neonatal outcomes, including lower birthweight, low birthweight (<2500g), and neonatal intensive care unit (NICU) admission. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is intended to improve nutritional and pregnancy outcomes among socioeconomically vulnerable mothers, but whether WIC participation attenuates education-related neonatal disparities remains uncertain. OBJECTIVE: To examine whether WIC participation is associated with narrowing of the neonatal outcome gap between mothers with lower and higher educational attainment. STUDY DESIGN: We conducted a population-based retrospective cohort study using the 2024 United States Natality Public Use File. The analysis was restricted to singleton live births with maternal education and WIC status. Lower education was defined as high school/GED or less, and higher education as bachelor's degree or higher. Outcomes were birthweight, low birthweight (<2,500 g), and NICU admission. Crude outcomes were compared across four education-WIC groups. Multivariable generalized linear models were adjusted for maternal age, race and Hispanic origin, marital status, prenatal care timing, prepregnancy body mass index, smoking, maternal medical risk factors, live-birth order, and infant sex. The primary parameter was the education-by-WIC interaction. RESULTS: The analytic cohort included 2,570,707 births. In crude analyses, the low-versus-high education gap in low birthweight was 3.56 percentage points among non-WIC births and 1.78 percentage points among WIC births; corresponding NICU admission gaps were 2.03 and 0.77 percentage points. In adjusted models, lower education was associated with lower birthweight and higher risks of low birthweight and NICU admission. WIC participation attenuated these disparities: the education-by-WIC interaction was +21.3 g for birthweight, -0.9 percentage points for low birthweight, and -0.7 percentage points for NICU admission (all < 0.001). CONCLUSION: WIC participation was associated with smaller education-related disparities in birthweight, low birthweight, and NICU admission. These findings suggest that WIC participation may be associated with partial attenuation of education-related neonatal outcome disparities and support further evaluation of WIC as part of broader perinatal equity strategies. KEY POINTS: · WIC was linked to smaller education gaps.. · Lower education predicted worse outcomes.. · WIC attenuated low-birthweight excess risk.. · WIC attenuated NICU-admission excess risk.. · Program engagement may support perinatal equity..
Low-Dose Aspirin Prophylaxis for Preeclampsia and the Risk of Postpartum Hypertensive Outcomes: A Propensity Score Analysis.
Mujic E, Ferguson S, Noel NL … +4 more , Mendez L, Abbott J, Yarrington CD, Parker SE
Am J Perinatol · 2026 Jun · PMID 42372759 · Publisher ↗
OBJECTIVE: The U.S. Preventive Services Task Force (USPSTF) recommends low-dose aspirin (LDA, 81 mg/day) after 12 weeks of pregnancy to reduce preeclampsia risk. While its effectiveness for prevention is well-established...
OBJECTIVE: The U.S. Preventive Services Task Force (USPSTF) recommends low-dose aspirin (LDA, 81 mg/day) after 12 weeks of pregnancy to reduce preeclampsia risk. While its effectiveness for prevention is well-established, less is known about the effects on postpartum hypertensive outcomes. This study aimed to examine whether LDA prescription in pregnancy (≤36 weeks' gestation) is associated with postpartum hypertensive outcomes through 6 weeks postpartum. STUDY DESIGN: This retrospective cohort study used electronic medical record data from deliveries (2018-2019) at New England's largest safety-net hospital. Among 1,773 patients meeting USPSTF criteria for LDA initiation, 523 were prescribed LDA. Patients were propensity score (PS)-matched 1:1 on risk factors and prenatal care site (primary matched cohort: = 784); a secondary PS-matched analysis was restricted to patients with one or more high-level risk factors (high-risk matched cohort: = 212). Primary outcomes included antihypertensive use during hospitalization, antihypertensive prescription at discharge, and severe-range postpartum hypertension. Risk ratios (RRs) were estimated using log-binomial regression. Joint effects of LDA and preeclampsia were assessed using LDA -/PreE- as reference. RESULTS: In the primary matched cohort, compared with LDA- patients, LDA+ patients had higher rates of antihypertensive use during hospitalization (RR: 1.54, 95% confidence interval [CI]: 1.12-2.12), discharge prescription (RR: 1.42, 95% CI: 0.95-2.12), and severe-range hypertension (RR: 1.48, 95% CI: 1.06-2.06). Associations did not persist in the high-risk matched cohort. In joint effects analyses, preeclampsia was associated with postpartum hypertensive outcomes regardless of LDA. Compared with LDA -/PreE - , the LDA +/PreE+ group had elevated risks; point estimates were highest among LDA -/PreE+ patients. CONCLUSION: Associations between LDA and postpartum hypertensive outcomes may vary by baseline risk. Among high-risk patients, LDA was not associated with increased postpartum risk and may attenuate severity for those developing preeclampsia. Further study is needed to clarify LDA's role in reducing postpartum cardiovascular risk. KEY POINTS: · LDA showed no overall reduction in postpartum hypertensive outcomes.. · In high-risk patients, LDA may lessen postpartum hypertensive complications.. · Among patients with preeclampsia, LDA use was linked to lower postpartum risks.. · Results highlight the need to study LDA in postpartum cardiovascular health..
Cystic Periventricular Leukomalacia in Preterm Infants: Clinical Risks, Heart Rate, and Oxygenation Patterns.
King M, Commeree A, Fairchild K … +1 more , Burnsed J
Am J Perinatol · 2026 Jul · PMID 42361835 · Publisher ↗
OBJECTIVE: Cystic periventricular leukomalacia (cPVL) is a major cause of neurodevelopmental impairment in preterm infants, yet associated clinical and physiologic variables remain incompletely defined. We sought to iden...
OBJECTIVE: Cystic periventricular leukomalacia (cPVL) is a major cause of neurodevelopmental impairment in preterm infants, yet associated clinical and physiologic variables remain incompletely defined. We sought to identify differences in maternal and infant clinical variables, including patterns of heart rate (HR) and oxygen saturation (SpO) in the first 6 weeks after birth, in infants with cPVL compared with matched controls. STUDY DESIGN: We conducted a single-center, retrospective study of infants admitted to a level IV neonatal intensive care unit (NICU) from 2012 to 2022. Infants with cPVL were matched 1:1 with controls by sex, gestational age, and birth year. Clinical variables were extracted from institutional databases. Hourly averages of HR and SpO mean, standard deviation, skewness, and kurtosis were calculated from 0.5 Hz data from standard NICU monitors from birth to day 42, and compared for infants with and without cPVL. Continuous variables were compared with -tests, categorical variables with χ tests, and time series HR and SpO metrics with -tests using Bonferroni correction for multiple comparisons. RESULTS: Nineteen infants with cPVL and 19 matched controls were identified. Maternal characteristics were similar between groups. A higher percentage of infants with cPVL received vasopressor support and were more likely to receive hydrocortisone therapy, while other morbidities and blood gas values were comparable between groups. In the cPVL group, General Movement Assessment was abnormal in all infants who had it performed, and cerebral palsy occurred more frequently. There were no consistent differences in HR metrics in the 42-day period. Infants with cPVL had consistently higher mean SpO but also more negative skewness (more desaturations) and higher kurtosis (more outlier values), implying more swings from low to high SpO. CONCLUSION: In this cohort, cPVL was associated with treatment for hypotension and sustained differences in SpO after birth, suggesting more oxidative stress. Further work is needed to determine how SpO dynamics reflect, predict, or perhaps contribute to cPVL. KEY POINTS: · cPVL was associated with treatment for hypotension with pressors or steroids.. · cPVL was associated with sustained differences in SpO2 after birth.. · There were no consistent differences in HR metrics between the cPVL and control cohorts..
International Consensus Curriculum and Competency Framework for Maternal Point-of-Care Ultrasound Training.
Spiel MH, Noor-Chelsea N, Lueck T … +2 more , Gupta M, Atkins KM
Am J Perinatol · 2026 Jul · PMID 42349512 · Publisher ↗
OBJECTIVE: Cardiopulmonary complications and hemorrhage remain the leading causes of maternal morbidity. Point-of-care ultrasound (POCUS) enables rapid bedside diagnostic assessment; however, there is a lack of standardi...
OBJECTIVE: Cardiopulmonary complications and hemorrhage remain the leading causes of maternal morbidity. Point-of-care ultrasound (POCUS) enables rapid bedside diagnostic assessment; however, there is a lack of standardized maternal-focused POCUS training in obstetrics. The aim of this study was to develop a consensus-based framework for a maternal POCUS curriculum. STUDY DESIGN: Using a modified Delphi process, international medical experts in POCUS participated in four iterative, anonymized survey rounds to achieve consensus (>70% agreement) on POCUS curriculum domains and topics. Participants rated topics as "essential for learners," "important but not essential," or "not important for learners." RESULTS: The study period was from November 2023 through October 2024 and included 8 categorized domains and more than 50 topics. Consensus was reached on 7 domains and 36 topics that were deemed "essential for learners" for a maternal POCUS curriculum. Consensus domains included basic equipment, image optimization, recognition of normal imaging, recognition of abnormal imaging, real-world cases, skill development through hands-on practice, and implementation. CONCLUSION: The resulting consensus-based domains and topics provide a framework for the development of a standardized maternal POCUS training curriculum for obstetric learners that is adaptable across diverse clinical settings. KEY POINTS: · Lack of standardized training remains a major barrier to integration of maternal POCUS into obstetric practice.. · Using a Delphi methodology, experts established consensus recommendations for curriculum content and implementation strategies.. · The framework emphasizes competency-based progression and deliberate practice.. · Consensus recommendations may facilitate scalable adoption across maternal care settings.. · Future work should evaluate educational outcomes and effects on clinical care..
From InSurE to MIST: A Quality Improvement Initiative in a Level IV NICU.
Ahn N, Yamada E, Barsotti K … +1 more , Hussain W
Am J Perinatol · 2026 Jun · PMID 42341819 · Publisher ↗
OBJECTIVE: Mechanical ventilation is a key modifiable risk factor for bronchopulmonary dysplasia (BPD) in preterm infants with respiratory distress syndrome (RDS). Minimally invasive surfactant therapy (MIST) enables sur...
OBJECTIVE: Mechanical ventilation is a key modifiable risk factor for bronchopulmonary dysplasia (BPD) in preterm infants with respiratory distress syndrome (RDS). Minimally invasive surfactant therapy (MIST) enables surfactant delivery to spontaneously breathing infants. MIST use has been associated with lower rates of adverse outcomes, including death and BPD; however, uptake in the U.S. neonatal intensive care units (NICUs) has been variable. At our level IV NICU, Intubate, Surfactant, Extubate (InSurE) was the standard method for surfactant delivery in infants on non-invasive respiratory support. We aimed to increase MIST utilization and evaluate its impact on respiratory care practices and clinical outcomes. STUDY DESIGN: A quality improvement (QI) initiative was launched with a specific, measurable, achievable, relevant, and time-bound (SMART) aim to increase MIST use from 3% to 80% within 1 year. Interventions included the development of standardized guidelines, creation of procedural kits, multidisciplinary education, and identification of clinical champions. Iterative Plan-Do-Study-Act (PDSA) cycles were supported by real-time audits and structured debriefings. Primary process measure was MIST utilization; secondary measures included procedural adherence, intubation within 7 days, and pharmacologic premedication use as a balancing measure. RESULTS: MIST use increased from 3% to 97% of eligible infants within 1 year, with special cause variation and sustained centerline shift on -chart analysis. Procedural adherence was high, with only minor single-step deviations on audit. The rate of intubation within 7 days of surfactant administration was unchanged pre- and post-MIST implementation (19% vs. 18%). Pharmacologic premedication use decreased significantly from 17% to 1% ( = 0.002). At the system level, the proportion of infants receiving surfactant via intubation decreased from 71% to 37%, reflecting a shift toward non-invasive respiratory management. CONCLUSION: A structured, multidisciplinary QI approach was associated with increased and sustained use of MIST and a shift toward noninvasive surfactant delivery. This initiative demonstrates the feasibility of implementing MIST in a high acuity level IV NICU. KEY POINTS: · Comparison of MIST versus InSurE.. · The effects of invasive ventilation.. · The use of sedation during MIST..
Adverse Perinatal Outcomes by Gestational Surrogacy Status among In Vitro Fertilization Pregnancies.
Xie F, Im TM, Park D … +3 more , Chiu VY, Fassett MJ, Getahun D
Am J Perinatol · 2026 Jun · PMID 42331008 · Publisher ↗
OBJECTIVE: This study aimed to examine adverse perinatal outcomes by gestational surrogacy status among in vitro fertilization (IVF) pregnancies. STUDY DESIGN: This was a retrospective cohort study of IVF pregnant women...
OBJECTIVE: This study aimed to examine adverse perinatal outcomes by gestational surrogacy status among in vitro fertilization (IVF) pregnancies. STUDY DESIGN: This was a retrospective cohort study of IVF pregnant women (2008-2023) who received obstetrical care at Kaiser Permanente Southern California, a large integrated health care system. Unstructured clinical notes abstracted from electronic health records were analyzed using natural language processing and chart reviews to identify IVF and surrogate pregnancy status. This study analyzed 997 (6.3%) surrogate pregnancies among 15,822 IVF pregnancies. Births at <20 weeks of gestation were excluded. Adjusted risk ratios (aRRs) derived from robust Poisson regression models were used to describe the magnitude of associations between surrogacy status and adverse perinatal outcomes among IVF pregnancies. RESULTS: Compared with non-surrogate pregnancies, women with gestational surrogacy were younger (<35 years, 46.7% vs. 66.6%), non-Hispanic White (29.8% vs. 39.8%), Hispanic (38.3% vs. 45.8%), privately insured (11.3% vs. 21.4%), and had multiple gestations (10.9% vs. 16.5%), respectively. They were less likely to smoke (0.8% vs. 0.4%) or drink alcohol (31.0% vs. 18.9%) during pregnancy. IVF gestational surrogacy was not associated with an increased risk of placenta previa (aRR: 1.20; 95% confidence interval [CI]: 0.98-1.47), placental abruption (aRR: 1.07; 95% CI: 0.63-1.81), or preterm birth (PTB; aRR: 1.03, 95% CI: 0.91-1.16) but was significantly associated with decreased risk of gestational diabetes (aRR: 0.82; 95% CI: 0.69-0.97), small for gestational age/intrauterine growth restriction (SGA/IUGR; aRR: 0.72; 95% CI: 0.61-0.84), preeclampsia/eclampsia (aRR: 0.70; 95% CI: 0.56-0.87), preterm premature rupture of membranes (PPROM; aRR: 0.56; 95% CI: 0.40-0.77), and chorioamnionitis (aRR: 0.42; 95% CI: 0.22-0.79). CONCLUSION: Gestational surrogacy had lower odds of selected adverse perinatal outcomes that were not previously reported. This information may be helpful to patients considering gestational surrogacy as a reproductive option. KEY POINTS: · Surrogate pregnancy was not associated with placental abruption, placenta previa, or PTB.. · Surrogate pregnancy was inversely linked to gestational diabetes mellitus, SGA, preeclampsia, PROM, and chorioamnionitis.. · Gestational surrogacy had lower odds of certain adverse perinatal outcomes not previously reported..
The Peezy Device Compared With Midstream Clean Catch in an Obstetric Population: A Randomized Controlled Trial.
Dhillon N, Kothawala A, Khemmani M … +5 more , Nwachokor J, Adams W, Wolfe AJ, Pham T, Lal AK
Am J Perinatol · 2026 Jun · PMID 42302826 · Publisher ↗
BACKGROUND: Screening for asymptomatic bacteriuria in pregnancy is part of routine prenatal care, as untreated bacteriuria can lead to acute pyelonephritis and adverse pregnancy outcomes. The standard clean catch midstre...
BACKGROUND: Screening for asymptomatic bacteriuria in pregnancy is part of routine prenatal care, as untreated bacteriuria can lead to acute pyelonephritis and adverse pregnancy outcomes. The standard clean catch midstream urine collection method can be difficult to obtain, and often results in contamination, particularly in patients with obesity. The Peezy urine collection device, designed to discard the initial voided urine, has shown promise in reducing contamination rates compared with the conventional clean catch method but has not been studied in the pregnant population. OBJECTIVE: This study aims to compare the rates of contamination in urine cultures collected before 20 weeks' gestation between the clean catch midstream urine sample and the Peezy urine sample. STUDY DESIGN: This randomized controlled trial at the Loyola University Medical Center enrolled adult English-speaking women presenting for prenatal care at an academic clinic from August 2022 to January 2024. Patients were excluded if they had urinary tract anomalies, ongoing antibiotic treatment, or recurrent urinary tract infections. Participants were randomized to either Peezy or clean catch urine collection methods. We compared the contamination rates of urine specimens collected using the Peezy collection device versus the standard midstream clean catch method in pregnant women using an intention-to-treat analysis. We also assessed whether the effect of the Peezy device on contamination rates varied by body mass index (BMI) status (nonobese vs. obese participants). RESULTS: Overall ( = 218), the contamination rate was 61.3% ( = 73/119) for control participants and 52.5% ( = 52/99) for Peezy participants (odds ratio = 0.7, 95% confidence interval: 0.4-1.2; = 0.19) and was not different between groups, even when stratified by BMI. CONCLUSION: This study did not show any reduction in contamination among participants using the Peezy. KEY POINTS: · This study is a randomized controlled trial between Peezy and standard clean catch.. · Ours is the first study of Peezy in a pregnant population.. · We found no difference in urine contamination rates..
Association between Gestational Weight Gain and Neonatal Hypoxic and Traumatic Events: Results from a Large Retrospective Cohort.
Chiossi G, Cuoghi Costantini R, Menichini D … +3 more , La Marca A, Facchinetti F, D'amico R
Am J Perinatol · 2026 Jun · PMID 42302825 · Publisher ↗
OBJECTIVE: Most of the published studies focus on the relationship between gestational weight gain (GWG) and maternal outcomes, and less so on the neonatal outcomes. Furthermore, optimal GWG ranges defined by the Institu...
OBJECTIVE: Most of the published studies focus on the relationship between gestational weight gain (GWG) and maternal outcomes, and less so on the neonatal outcomes. Furthermore, optimal GWG ranges defined by the Institute of Medicine were challenged by research showing the benefits of smaller GWG for overweight and obese mothers. Therefore, we intended to assess whether there is an association between GWG and hypoxic or traumatic events in the neonate, especially among overweight and obese mothers, as we sought the best methodological approach to study GWG. STUDY DESIGN: We used the Consortium on Safe Labor data, a retrospective cohort study collecting pregnancy data from 2002 to 2008 in 12 U.S. centers. The association between GWG and neonatal morbidity was estimated in singleton gestations ≥ 37 weeks' gestation using binomial logistic regression models. GWG was analyzed as a continuous linear, continuous quadratic, categorical, and binary variable. The Hosmer-Lemeshow test (HL) assessed calibration of the models, the Brier score evaluated calibration and the overall model performance, whereas the area under the receiver-operating characteristic curve (AUC) measured discrimination. RESULTS: Among 104,599 mothers 24,609 (23.5%) were overweight and 19,324 (18.5%) obese; 7,974 (7.6%) infants experienced hypoxic, whereas 2,031 (1.9%) developed traumatic morbidity. The risk of infant morbidity increased with GWG, with thresholds of 6 to 23 kg for ischemic events, and 4 to 21 kg for traumatic events ( < 0.05). Multivariable models showed adequate calibration for traumatic, and for hypoxic events, the latter only when GWG was analyzed as a quadratic or categorical variable (HL tests, > 0.01). In contrast, discrimination was poor for all models (AUCs ≤ 0.6), as their Brier score reached the cutoff value of 0.07 for ischemic and 0.02 for traumatic morbidity. CONCLUSION: In conclusion, while GWG was associated with neonatal morbidity, it was not predictive of neonatal ischemic or traumatic events. KEY POINTS: · As GWG increases, the risk of hypoxic and traumatic neonatal events rises significantly.. · The weight-gain above which adverse neonatal events increase depends on the way GWG was analyzed.. · There is no ideal methodological approach to study GWG and base recommendations on.. · Our multivariable models could not accurately predict infant morbidity based on GWG..
The Influence of Hindsight and Outcome Bias on Fetal Heart Rate Interpretation and Judgments of Obstetric Care Quality.
Blackwell SC, Chauhan SP, Grobman WA … +2 more , Gyamfi-Bannerman C, Saade GR
Am J Perinatol · 2026 Jun · PMID 42297030 · Publisher ↗
OBJECTIVE: To determine whether obstetricians evaluating management decisions for abnormal fetal heart rate (FHR) patterns are more likely to judge care as below the standard of care when informed of an adverse neonatal...
OBJECTIVE: To determine whether obstetricians evaluating management decisions for abnormal fetal heart rate (FHR) patterns are more likely to judge care as below the standard of care when informed of an adverse neonatal outcome rather than a healthy outcome. STUDY DESIGN: Obstetricians from four academic institutions participated in a study involving three clinical scenarios with abnormal intrapartum FHR tracings. Each case included clinical details, FHR tracing segments, and neonatal outcomes. Participants were asked to categorize the FHR tracing, assess the timing of cesarean delivery (CD), and evaluate the quality of care. All participants received identical information for the first two cases. For the third case, participants received identical intrapartum data and FHR tracings but were randomly assigned to one of two neonatal outcomes: healthy or adverse. RESULTS: A total of 128 obstetricians participated. Assessments for the first two cases did not differ between groups. For the third case, knowledge of an adverse neonatal outcome was associated with more severe categorization of the FHR tracing ( = 0.002), a greater likelihood of perceiving that CD was performed too late (79.3% vs. 48.6%; = 0.0001; RR, 1.6 [95% CI, 1.2-2.2]), and a higher likelihood of judging care as below the standard of care (72.4% vs. 37.1%; = 0.0001; RR, 2.0 [95% CI, 1.4-2.8]). CONCLUSION: Knowledge of an adverse neonatal outcome significantly altered interpretation of identical FHR tracings and doubled the likelihood that obstetrical care would be judged below the standard of care. These findings demonstrate the substantial influence of hindsight and outcome bias on retrospective clinical assessment ( = 253 words). CONCLUSION: Hindsight and outcome biases significantly influence FHR interpretation and retrospective assessments of obstetrical care quality. ( = 15 words). KEY POINTS: · Adverse outcomes altered FHR interpretation.. · Outcome knowledge doubled criticism of obstetrical care quality.. · Identical FHR tracings yielded different judgments.. · Bias increased Category III FHR classification..
Gestational Weight Gain and Perinatal Outcomes in Pregnancies with Prepregnancy BMI = 50 kg/m².
Aderibigbe OA, Gibson KS
Am J Perinatol · 2026 Jun · PMID 42297029 · Publisher ↗
OBJECTIVE: To compare perinatal outcomes in pregnancies with prepregnancy body mass index (BMI) ≥ 50 kg/m across prespecified gestational weight-gain categories, and to describe maternal characteristics more frequently o...
OBJECTIVE: To compare perinatal outcomes in pregnancies with prepregnancy body mass index (BMI) ≥ 50 kg/m across prespecified gestational weight-gain categories, and to describe maternal characteristics more frequently observed among individuals with preterm delivery. STUDY DESIGN: Retrospective cohort study of singleton pregnancies (June 2002-April 2020) at a tertiary academic institution comparing maternal and neonatal outcomes across four prespecified gestational weight-gain categories using unadjusted group-based analyses: weight loss/no gain, 0.45 to 4.5 kg (1-10 lb.), 5.0-9.1 kg (11-20 lb.), and >9.1 kg (>20 lb.). Statistical comparisons used Kruskal-Wallis H, Mann-Whitney U, Welch ANOVA, and chi-square tests ( = 0.05), with Holm's correction applied for multiple comparisons. RESULTS: Of 525 identified pregnancies, 483 met inclusion criteria. Groups 1 to 4 included 89, 113, 93, and 188 pregnancies, respectively. The cohort was predominantly parous (73.7%) and non-Hispanic Black (65.1%), with high rates of chronic hypertension (43.5%) and preexisting diabetes (10.1%). Preterm delivery occurred in 14.9% of individuals. Compared with term deliveries, those delivering preterm were older (30 years vs. 28 years; = 0.01), had higher prepregnancy BMI (55.4 vs. 54.1 kg/m; = 0.026), and were more likely to have chronic hypertension and preeclampsia (both < 0.01). Fetal growth restriction (FGR) was more frequent in the weight loss/no-gain group ( = 0.02), and infant birth weight increased linearly with greater gestational weight gain ( < 0.01). No consistent trend in perinatal complications was observed across weight-change categories. CONCLUSION: In pregnancies with BMI ≥ 50 kg/m, perinatal outcomes did not differ consistently across weight-gain categories. Birth weight increased linearly with greater weight gain, while FGR occurred more frequently with weight loss/no gain. Preterm birth was more frequent among older individuals with chronic hypertension, preeclampsia, and higher prepregnancy BMI; however, independent contributions remain undetermined from unadjusted comparisons. The relationship between gestational weight loss and FGR warrants prospective confirmation. KEY POINTS: · In pregnancies with BMI ≥ 50 kg/m2, outcomes did not differ consistently by weight gain categories.. · Birth weight increased linearly with greater weight gain.. · FGR occurred more frequently with weight loss/no gain.. · Prematurity was more frequent with older age, hypertension, preeclampsia and higher prepregnancy BMI..
Maternal Outcomes Associated with a Statewide Severe Hypertension Obstetric Quality Improvement Initiative.
Grayson H, Friedman AM, Simpson L … +4 more , Goffman D, D'Alton M, Andrikopoulou M, Wen T
Am J Perinatol · 2026 Jun · PMID 42269710 · Publisher ↗
OBJECTIVE: An obstetric severe hypertension bundle was implemented through a statewide quality improvement initiative in NY State. The objective of this study was to evaluate trends in adverse maternal outcomes associate...
OBJECTIVE: An obstetric severe hypertension bundle was implemented through a statewide quality improvement initiative in NY State. The objective of this study was to evaluate trends in adverse maternal outcomes associated with hypertensive disorders of pregnancy (HDP) during bundle implementation. STUDY DESIGN: Delivery hospitalizations in the 2007 to 2022 NY State Inpatient Database (SID) were analyzed for this repeated cross-sectional analysis. The NY SID includes all acute care inpatient discharge data for NY State. First, HDP diagnoses among all delivery hospitalizations were trended. Then, among deliveries with HDP, the following outcomes were trended: (1) transfusion, (2) nontransfusion severe maternal morbidity (SMM), (3) disseminated intravascular coagulation (DIC), and (4) stroke. Trend analyses were performed with joinpoint regression to determine the average annual percent change (AAPC) with the exception of stroke. Because of small numerators, stroke risk during two 8-year periods (2007-2014 and 2015-2022) was compared with the chi-square test. RESULTS: Among 3,579,336 delivery hospitalizations, HDP increased from 6.1% in 2007 to 15.6% in 2022. In joinpoint analysis, transfusion among deliveries with HDP increased from 2007 to 2012 but then decreased from 2012 to 2016 (AAPC: -4.9%, 95% confidence intervals [CI]: -10.9, -0.2) before increasing after 2016. SMM increased from 2007 to 2014 before decreasing from 2014 to 2017 (AAPC: -7.9%, 95% CI: -11.5, -1.4), before rising again from 2017 to 2022. DIC increased from 2007 to 2013, decreased from 2013 to 2017 (AAPC: -13.2%, 95% CI: -19.4, -7.9), and increased nonsignificantly from 2017 on. From 2007 to 2014, 44 cases of HDP-associated stroke occurred compared with 19 from 2015 to 2022 (3.5 vs. 1.0 per 10,000, < 0.01). CONCLUSION: The initiation of the hypertension bundle was associated with decreased risk for a range of adverse outcomes among deliveries with HDP, including stroke. Decreases in risk continued for approximately 3 to 4 years after initiation of the program. KEY POINTS: · HDP diagnoses increased substantially in New York between 2007 and 2022.. · Favorable outcome trend changes coincided with hypertension bundle rollout.. · HDP-associated stroke rates were lower after statewide implementation efforts..
Association between Maternal Pre-Pregnancy BMI and Early Motor Development in Chinese Infants: A Prospective Birth Cohort Study.
Fan Q, Li X, Liang J … +8 more , Yang X, Chen Z, Deng W, Zhu X, Jin M, Yang D, Huang Y, Du Q
Am J Perinatol · 2026 Jun · PMID 42269694 · Publisher ↗
OBJECTIVE: Maternal weight management during pregnancy is important for infant health, given the potential impact of overweight on offspring neurodevelopment. This study aimed to examine the association between maternal...
OBJECTIVE: Maternal weight management during pregnancy is important for infant health, given the potential impact of overweight on offspring neurodevelopment. This study aimed to examine the association between maternal pre-pregnancy body mass index (BMI) and infant motor development delay during the first year of life. STUDY DESIGN: This prospective cohort study included 227 mother-child pairs. Maternal pre-pregnancy BMI, calculated as weight (kg)/height (m), was analyzed as both a continuous and a categorical variable (underweight: <18.5 kg/m; normal: 18.5-23.9 kg/m; overweight/obese: ≥24 kg/m). Infant motor development was assessed using the Alberta Infant Motor Scale (AIMS) at 3, 6, 9, and 12 months of age. Group differences were tested with standard univariate methods. We used linear and non-linear regression models to explore potential associations between pre-pregnancy BMI and AIMS total scores. RESULTS: This study found that 26% of the mothers had pre-pregnancy overweight/obesity. Among the infants, 115 were boys, and 112 were girls, and the mean birth weight was 2.61 ± 0.50 kg. After full adjustment, higher pre-pregnancy BMI was inversely associated with 12-month AIMS total scores (β = - 0.37, 95% CI: -0.69 to -0.05). A significant J-shaped non-linear association was identified, with BMI ≥25 kg/m marking a threshold for elevated motor delay risk. For BMI ≥25 kg/m, each 1-kg/m increase corresponded to a 1.22-point reduction in AIMS total scores and a 96% higher odds of atypical motor development (OR = 1.96, 95% CI: 1.28-3.00). CONCLUSION: Elevated maternal pre-pregnancy BMI is associated with increasing motor delay during infancy, with a non-linear threshold near BMI ≥25 kg/m. Preconception weight management is vital for optimizing early neurodevelopment. KEY POINTS: · Maternal pre-pregnancy overweight/obesity may influence infant neurodevelopment.. · Elevated pre-pregnancy BMI (≥25 kg/m2) significantly increases the risk of atypical motor development.. · Preconception weight management may help optimize early motor development outcomes..
Serial versus Once-Only Cervical Length Screening in Twin Pregnancies.
Gulersen M, Jackson FI, Blitz MJ … +9 more , Kouba I, Rochelson B, Keyser S, Nicholas S, Nguyen M, Panchal A, Bodycot K, Berghella V, Roman A
Am J Perinatol · 2026 Jun · PMID 42263743 · Publisher ↗
OBJECTIVE: To assess the impact of serial versus once-only transvaginal ultrasound (TVU) cervical length (CL) screening in twin pregnancies. STUDY DESIGN: Multicenter retrospective cohort study including twin pregnancies...
OBJECTIVE: To assess the impact of serial versus once-only transvaginal ultrasound (TVU) cervical length (CL) screening in twin pregnancies. STUDY DESIGN: Multicenter retrospective cohort study including twin pregnancies who underwent TVU CL screening from 16 to 23 weeks of gestation between 2017 and 2022. Twin pregnancies resulting from multifetal pregnancy reduction after 14 weeks of gestation, monochorionic monoamniotic twins, and those undergoing a history-indicated cerclage were excluded. Cases were stratified into two groups based on number of TVU CL assessments: twins who had more than one CL assessment from 16 to 23 weeks' gestation (i.e., serial CL group) versus twins who had only one CL assessment at the time of their detailed fetal anatomy ultrasound from 18 to 21 weeks' gestation (i.e., once-only CL group). Sensitivity, specificity, positive predictive value, and negative predictive value of CL screening for predicting preterm birth (PTB) at various gestational age cutoffs (<34, <32, and <28 weeks of gestation) were calculated using thresholds of both ≤25 and ≤30 mm and compared between the two groups. Statistical significance was set at < 0.05. RESULTS: Of the 1,917 patients included, 962 (50.2%) were in the serial CL group and 955 (49.8%) were in the once-only CL group. The incidence of a short CL ≤ 25 mm was significantly higher in the serial CL group compared with the once-only CL group (12.6 vs. 0.9%, <0.001). The sensitivity of CL screening for predicting PTB, when using a threshold of ≤25 mm, was higher in the serial CL group compared with the once-only CL group for each PTB cut-off (<34 weeks: 27.9 vs. 4.2%; <32 weeks: 40.7 vs. 7.4%; <28 weeks: 47.2 vs. 11.8%, respectively). CONCLUSION: Serial TVU CL screening from 16 to 23 weeks of gestation should be considered in twin pregnancies. KEY POINTS: · Serial CL screening increased the detection of a short cervix compared with once-only screening.. · Serial CL screening improved sensitivity for predicting PTB compared with once-only screening.. · Serial transvaginal CL screening from 16 to 236/7 weeks should be considered in twin pregnancies..
Postpartum Pharmacologic Thromboprophylaxis Guideline Adherence and Post-Delivery Complications: A Single-Center, Retrospective Cohort Study.
Bruno AM, Allshouse AA, Warrick CM … +1 more , Metz TD
Am J Perinatol · 2026 Jun · PMID 42263742 · Publisher ↗
OBJECTIVE: Obstetric and anesthesia guidelines provide differing recommendations for the timing of initiation of postpartum pharmacologic thromboprophylaxis relative to delivery time, mode of delivery, and anesthesia typ...
OBJECTIVE: Obstetric and anesthesia guidelines provide differing recommendations for the timing of initiation of postpartum pharmacologic thromboprophylaxis relative to delivery time, mode of delivery, and anesthesia type and administration time. We aimed to (1) describe the rate of adherence to obstetric (OB) and anesthesia (ANE) guidelines for timing of postpartum pharmacologic thromboprophylaxis initiation, (2) assess trends in adherence over time, and (3) evaluate the association between guideline adherence and venous thromboembolism (VTE) and complications. STUDY DESIGN: Retrospective cohort of patients delivering at a single academic center from 2015 to 2023 receiving postpartum low-molecular-weight heparin (LMWH) prophylaxis. Those with an antepartum VTE or on therapeutic anticoagulation were excluded. The primary outcome was guideline adherence. OB guideline adherence was defined as LMWH initiation within 4 to 6 hours after vaginal, or 6 to 12 hours after cesarean, delivery. ANE guideline adherence was defined as LMWH initiation ≥12 hours post-neuraxial ANE placement and ≥4 hours post-neuraxial removal. Secondary outcomes included VTE, readmission, reoperation, and wound complications within 6 weeks postpartum. The rate of adherence to guidelines and trends in adherence were assessed. Multivariable models estimated the association between guideline adherence and secondary outcomes. RESULTS: Of the 5,959 included patients, 3,952 (66.3%) underwent cesarean delivery. Overall, 926 (15.5%) were OB guideline adherent, 4,800 (80.6%) ANE guideline adherent, and 488 (8.2%) both OB and ANE adherent. Guideline adherence increased over time ( < 0.001 for trend). OB guideline adherence was associated with decreased readmission among those undergoing cesarean delivery, but no difference in VTE, reoperation, or wound complications. ANE guideline or combined guideline adherence was not associated with any outcomes. CONCLUSION: Adherence to OB guidelines for timing of postpartum pharmacologic prophylaxis was low, while adherence to ANE guidelines was much higher. OB, ANE, or both guideline adherence was not associated with lower rates of VTE or complications. KEY POINTS: · Adherence to obstetric guidelines was low (16%).. · Adherence to anesthesia guidelines was high (81%).. · Frequency of VTE did not differ by guideline adherence..
Predictors of Completion of Postpartum Diabetes Screening among Patients with Gestational Diabetes.
Wetzler SR, Lee JH, Stoffels G … +3 more , Getrajdman C, Lambert C, DeBolt CA
Am J Perinatol · 2026 Jun · PMID 42250570 · Publisher ↗
OBJECTIVE: Despite the high lifetime risk of developing diabetes after gestational diabetes mellitus (GDM), postpartum completion of glucose tolerance testing (GTT) is disappointingly low, less than 50%. This study aimed...
OBJECTIVE: Despite the high lifetime risk of developing diabetes after gestational diabetes mellitus (GDM), postpartum completion of glucose tolerance testing (GTT) is disappointingly low, less than 50%. This study aimed to identify patient, obstetric, prenatal, and social factors associated with the likelihood of completing a postpartum GTT test. STUDY DESIGN: This retrospective study of 515 singleton pregnancies diagnosed with GDM used logistic regression to examine engagement in prenatal care, social determinants of health, and medical/obstetric factors impacting the completion of postpartum 2-hour GTT. RESULTS: About 46.3% of the cohort completed postpartum GTT. Each prenatal visit increased the odds of postpartum GTT by 7% (CI: 1.01,1.14). Black patients had 60% (CI: 0.23, 0.70) lower odds of postpartum GTT compared with White patients, and Hispanic patients had 53% (CI: 0.39, 0.72) lower odds compared with non-Hispanic patients. Patients with commercial insurance had 2.4 times (CI: 1.59, 3.72) the odds of postpartum testing compared with publicly insured patients. Those with chronic hypertension had 69% decreased odds compared with patients without (CI: 0.12, 0.85), and patients with preeclampsia had 52% lower odds compared with those without (CI: 0.25, 0.94). CONCLUSION: Our data demonstrate that less than 50% of our population completed postpartum GTT. The number of prenatal visits and a shorter interval between screening and diagnostic testing are key predictors of postpartum follow-up, and social determinants of health were significant risk factors for not following up. This study identified a broad spectrum of factors potentially associated with postpartum GTT completion, and its exploratory nature paves the way for further analyses that mitigate confounding and better elucidate the reasons for the gap in care. KEY POINTS: · Postpartum completion of GTT is disappointingly low.. · More prenatal visits increase the likelihood of postpartum diabetes screening.. · Social disparities exist regarding postpartum follow-up.. · Understanding this gap in care can inform interventions for postpartum pathways and follow-up..
Associations between Neonatal Auditory Brainstem Response and Long-Term Language Development in Preterm Children.
Takai A, Hasegawa T, Nakata M … +6 more , Kanaya A, Zuiki M, Tozawa T, Nakamura T, Teramukai S, Iehara T
Am J Perinatol · 2026 Jun · PMID 42248587 · Publisher ↗
OBJECTIVE: This study aimed to examine whether neonatal auditory brainstem conduction, as indexed by the interpeak latency between waves I and V (I-V IPL) on the auditory brainstem response (ABR), is associated with long...
OBJECTIVE: This study aimed to examine whether neonatal auditory brainstem conduction, as indexed by the interpeak latency between waves I and V (I-V IPL) on the auditory brainstem response (ABR), is associated with long-term language outcomes in preterm children. STUDY DESIGN: This retrospective cohort study included 45 preterm infants born at ≤33 weeks of gestation without hearing loss who underwent ABR testing at term-equivalent age. Demographic and clinical variables, ABR wave latencies and interpeak latencies, and language-social (L-: S) developmental quotients (DQs) at 3 and 5-6 years of age were collected. L-S DQs were assessed using the Kyoto Scale of Psychological Development 2001. RESULTS: Spearman's correlation analysis showed that longer I-V IPL at term-equivalent age was significantly correlated with lower L-S DQ scores at both 3 years of age ( = - 0.32, = 0.03) and 5-6 years of age ( = - 0.39, = 0.04). After adjustment for sex and age, a linear mixed-effects model showed that longer I-V IPL remained significantly associated with lower L-S DQ scores at 5-6 years ( = - 21.00, 95% CI: -40.6 to -1.40). CONCLUSION: The findings suggest that longer neonatal I-V IPL at term-equivalent age may be associated with poorer long-term language outcomes in preterm children. Neonatal measurement of I-V IPL may provide additional information for clinicians assessing the need for long-term follow-up of language development. KEY POINTS: · Neonatal ABR and later language were examined.. · Longer I-V IPL was linked to poorer language scores at 5 to 6 years.. · ABR may support long-term follow-up of preterm children..
Sonographic Findings Associated with Gestational Diabetes in Pregnancies Not Identified by Standard Screening.
DeAnnuntis T, Burgess A, Ehsanipoor RM
Am J Perinatol · 2026 Jun · PMID 42248586 · Publisher ↗
OBJECTIVE: This study aimed to assess the prevalence of gestational diabetes mellitus (GDM) in women without a prior GDM diagnosis who presented with third-trimester sonographic findings of estimated fetal weight (EFW) >...
OBJECTIVE: This study aimed to assess the prevalence of gestational diabetes mellitus (GDM) in women without a prior GDM diagnosis who presented with third-trimester sonographic findings of estimated fetal weight (EFW) >90%, abdominal circumference (AC) >95%, or polyhydramnios. STUDY DESIGN: Between 2018 and 2023, a perinatal diabetes registry tracked pregnant patients >28 weeks of gestation with sonographic findings of EFW >90%, AC >95%, or polyhydramnios (Amniotic Fluid Index [AFI] >25 cm), but no prior GDM diagnosis. These patients underwent a third-trimester 3-hour glucose tolerance test (GTT) or glucose panel. The primary outcome was a new diagnosis of GDM; secondary outcomes included delivery mode, live birth, shoulder dystocia, respiratory distress syndrome (RDS), preeclampsia, neonatal hypoglycemia, and neonatal intensive care unit (NICU) admission. RESULTS: Of 723 patients, 169 (23.4%) were newly diagnosed with GDM. Among those with specific sonographic findings, GDM was identified in 25.4% (EFW >90%), 24.4% (AC >95%), and 21.2% (polyhydramnios). GDM was diagnosed in 19.5% with one sonographic finding, 25.5% with two, and 26.9% with all three. New third-trimester GDM was significantly associated with increased neonatal hypoglycemia (30.4%; < 0.001), RDS (10.8%; = 0.037), and NICU admission (13.4%; = 0.036). CONCLUSION: Up to one in four women with third-trimester findings of EFW >90%, AC >95%, or polyhydramnios-despite a prior negative screen-were newly diagnosed with GDM. These cases were also linked to higher neonatal morbidity. Targeted third-trimester GDM screening in patients with these sonographic markers may help identify at-risk pregnancies and improve perinatal outcomes. KEY POINTS: · High rate of missed GDM: Nearly 25% with U.S. findings had late GDM diagnosis.. · Cumulative risk: GDM risk rises with more U.S. findings.. · Neonatal morbidity risk: Later diagnosis linked to higher neonatal risks.. · Clinical implications: Consider later GDM screen if U.S. markers are seen..
Patient Priorities and Experiences in the Management of Abnormal Postpartum Bleeding.
Berry M, Pandit R, Doan Mast DD … +2 more , Montaine O'Brien S, Rood KM
Am J Perinatol · 2026 Jun · PMID 42229439 · Publisher ↗
OBJECTIVE: The objective of this study is to assess patient experiences, priorities, and satisfaction with management of postpartum hemorrhage (PPH) requiring treatment beyond oxytocin. STUDY DESIGN: We conducted a cross...
OBJECTIVE: The objective of this study is to assess patient experiences, priorities, and satisfaction with management of postpartum hemorrhage (PPH) requiring treatment beyond oxytocin. STUDY DESIGN: We conducted a cross-sectional survey (January-April 2024) of postpartum individuals (≥37 weeks, aged 18-50) who experienced abnormal bleeding treated beyond first-line oxytocin at a tertiary academic center. Outcomes included patient priorities, treatment experiences, and satisfaction with decision-making. RESULTS: Of 428 screened patients, 142 met inclusion and 100 consented. Most received uterotonics (92%); 26% antifibrinolytics; 9% intrauterine vacuum device; 1% surgical intervention. Compared with uterotonics alone, device users had higher blood loss (1,755 vs. 516 mL, < 0.001), more transfusions (33.3 vs. 5.9%, = 0.01), and more surgical interventions (11.1 vs. 0%, < 0.01). Patient priorities (minimizing blood loss, avoiding transfusion, optimizing recovery) were consistent across groups. Dissatisfaction with treatment (5.4%) and clinician communication (15.1%) occurred only among those treated with uterotonics. CONCLUSION: Patients valued minimizing morbidity and optimizing recovery, with overall high satisfaction, but communication gaps remain. These findings highlight the need for patient-centered strategies in PPH care and future trials comparing pharmacological versus mechanical second-line options. KEY POINTS: · Patients value minimizing morbidity despite management approach.. · Patients value provider communication with complications.. · Assessing patient priorities guides patient-centered approaches..
The Dual Faces of Gestational Diabetes Mellitus: Maternal and Placental Origins.
Avagliano L, Parodi C, Ottanelli S … +3 more , Mecacci F, Massa V, Bulfamante G
Am J Perinatol · 2026 Jun · PMID 42229438 · Publisher ↗
Gestational diabetes mellitus (GDM) is a heterogeneous condition arising from the complex interplay between maternal metabolic characteristics and placental adaptations. Traditionally, GMD has been classified by the timi...
Gestational diabetes mellitus (GDM) is a heterogeneous condition arising from the complex interplay between maternal metabolic characteristics and placental adaptations. Traditionally, GMD has been classified by the timing of onset; however, this approach fails to capture the underlying pathophysiological diversity. Accordingly, increasing evidence suggests that hyperglycemia in pregnancy may arise either from preexisting maternal metabolic vulnerability-characterized by insulin resistance, obesity, and cardiometabolic risk factors-or from pregnancy-specific placental influences that alter maternal glucose homeostasis. We provide an overview of these two trajectories, which we term maternal-origin and placental-origin GDM, illustrating how these two distinct pathways converge to result in GDM, while exhibiting differences in underlying biology, etiological mechanisms, and potential clinical implications. Maternal-origin GDM is typically associated with more pronounced hyperglycemia, earlier detection, and a higher risk of chronic metabolic complications, underscoring the need for close monitoring and management both during and after pregnancy. In contrast, placental-origin GDM tends to manifest later in gestation, involves milder dysglycemia, and reflects both physiological and maladaptive endocrine activity of the placenta acting upon an otherwise metabolically healthy mother. The interaction between maternal and placental factors can generate a self-reinforcing cycle of inflammation, oxidative stress, and insulin resistance and may also underline mixed phenotypes. Recognizing distinct etiological origins of GDM not only provides a pathophysiological framework for interpreting the diverse clinical presentations but also can suggest tailored strategies for clinical approach. Shifting beyond a purely time-based classification emphasizes the importance of identifying the underlying drivers of dysglycemia, thereby enabling the potential for individualized care. · GDM arises from maternal metabolism and placental adaptations.. · Temporal classification fails to reflect pathophysiological diversity.. · Maternal-origin GDM is often linked to obesity, insulin resistance, and metabolic syndrome.. · Placental-driven GDM appears later with milder pregnancy-specific dysglycemia.. · Understanding GDM pathophysiology may enable future, more targeted clinical care..
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