American Journal Of Perinatology[JOURNAL]
Sun
200 papers
The Effect of Delivery Timing on Cesarean Delivery Rate in Pregnancies Complicated by Pregestational Diabetes and Large-for-Gestational-Age Neonate.
Ward H, Khanuja K, McLaren R … +2 more , Markovic ES, Al-Kouatly H
Am J Perinatol · 2026 Jun · PMID 42061311 · Publisher ↗
OBJECTIVE: The Big Baby Trial found that early induction in patients with suspected large-for-gestational-age (LGA) fetuses reduced shoulder dystocia and prelabor cesarean rates. However, it excluded patients with preges...
OBJECTIVE: The Big Baby Trial found that early induction in patients with suspected large-for-gestational-age (LGA) fetuses reduced shoulder dystocia and prelabor cesarean rates. However, it excluded patients with pregestational diabetes mellitus (PGDM), who are at increased risk of adverse outcomes. We sought to evaluate delivery outcomes by gestational week in patients with PGDM and LGA fetuses. STUDY DESIGN: This was a population-based cohort study of nulliparous, nonanomalous, singleton, live births complicated by PGDM and LGA between 36 and 41 weeks using the U.S. Natality Vital Statistics Database from 2015 to 2023. Births following a prior cesarean delivery were excluded. Planned delivery group included births at each completed week from 36 to 40 weeks that underwent labor induction or scheduled cesarean delivery, excluding spontaneous labor. Expectant management group included all births that delivered in subsequent weeks (e.g., planned birth 36-36 compared with all births ≥37 weeks). The primary outcome was cesarean delivery rate and the secondary outcome was a composite of adverse neonatal outcomes (5-min Apgar score < 7, assisted neonatal ventilation > 6 hours, neonatal seizures, 10-min Apgar score of 0, and neonatal death). Outcomes were compared between groups at each week using multivariable logistic regression. RESULTS: There were 9,805 births analyzed. Cesarean delivery rate ranged from 77 to 87%. After adjusting for baseline differences between groups, planned delivery at 39 weeks was associated with decreased odds of cesarean delivery than expectantly managed pregnancies. After 38 weeks, planned delivery and expectant management had similar odds of cesarean delivery and neonatal morbidity. CONCLUSION: In pregnancies complicated by PGDM and LGA, planned delivery after 39 weeks was associated with lower odds of cesarean delivery compared with expectant management. Planned delivery at 38 weeks had similar odds of cesarean delivery and neonatal morbidity. These data suggest that providers should be cautious expectantly managing these pregnancies past 38 weeks. KEY POINTS: · Pregnancies complicated by PGDM and LGA are associated with higher risk of cesarean delivery.. · Across all gestational ages, planned delivery group was more likely to deliver by cesarean delivery than those expectantly managed.. · Planned delivery after 39 weeks was associated with lower odds of cesarean delivery compared with expectant management.. · Planned delivery prior to 38 weeks (36-37 weeks) is associated with increased cesarean delivery rates and higher neonatal morbidity..
Factors Associated with Nonadherence to American College of Obstetricians and Gynecologists Guidelines for Labor Arrest Disorders.
Carbonell KV, Simpson L, Beermann S … +5 more , Paul R, Frolova A, Kelly JC, Raghuraman N, Goodman B
Am J Perinatol · 2026 May · PMID 42057402 · Publisher ↗
OBJECTIVE: The American College of Obstetricians and Gynecologists (ACOG)/Society for Maternal-Fetal Medicine Safe Prevention of Primary Cesarean Delivery guidelines provide minimum time criteria at which cesarean delive...
OBJECTIVE: The American College of Obstetricians and Gynecologists (ACOG)/Society for Maternal-Fetal Medicine Safe Prevention of Primary Cesarean Delivery guidelines provide minimum time criteria at which cesarean delivery (CD) should be performed for a labor arrest disorder. We evaluated factors associated with nonadherence to these guidelines. STUDY DESIGN: This is a retrospective case-control study of CDs with an indication of labor arrest disorders at a single center from June 2018 to September 2021. Charts were reviewed for adherence to minimum criteria for failed induction of labor (IOL), arrest of dilation, and arrest of descent. Cases and controls were patients who underwent CD prior to (i.e., nonadherent) or after (i.e., adherent) meeting minimum criteria, respectively. Maternal, fetal, and system-level factors were compared. RESULTS: Of 308 primary CDs with an indication of a labor arrest disorder, 54% met minimum ACOG criteria and 46% did not. Nonadherence was less likely for provider groups with 24-hour in-house coverage (adjusted odds ratio [aOR]: 0.39, 95% confidence interval [CI]: 0.19-0.76) and in the setting of maternal obesity (aOR: 0.49, 95% CI: 0.27-0.89). Nonadherence was more likely when Category II tracing was present (aOR: 1.89, 95% CI: 1.04-3.46). Nonadherence differed by type of labor arrest. Nonadherence was less likely in cases of failed IOL (aOR: 0.41, 95% CI: 0.25-0.66) and was more likely in cases of arrest of descent (aOR: 4.08, 95% CI: 2.35-7.07). CONCLUSION: Multiple factors influence adherence to the ACOG guidelines for labor arrest disorders. Addressing modifiable factors may improve adherence and decrease CD rates. KEY POINTS: · Nonadherence to the ACOG/Society for Maternal-Fetal Medicine guidelines was more common when labor was managed remotely.. · Nonadherence was more common in the presence of Category II fetal tracing.. · Nonadherence was more common in cases of arrest of descent.. · Nonadherence was less common in cases of failed induction of labor and maternal obesity.. · Addressing modifiable factors may improve adherence and decrease CD rates..
Maternal Age and Elective Inductions of Labor in Nulliparous Patients: A Multicenter Cohort Study.
Sarker M, Noonan G, Canfield D … +6 more , Poorman GW, Levy B, Edmundson P, Emeruwa U, Gyamfi-Bannerman C, Lamale-Smith L
Am J Perinatol · 2026 May · PMID 42049174 · Publisher ↗
OBJECTIVE: We aimed to investigate whether advanced maternal age is associated with cesarean delivery in nulliparous individuals undergoing elective induction of labor (eIOL). STUDY DESIGN: We queried a multicenter outpa...
OBJECTIVE: We aimed to investigate whether advanced maternal age is associated with cesarean delivery in nulliparous individuals undergoing elective induction of labor (eIOL). STUDY DESIGN: We queried a multicenter outpatient electronic medical record to perform a retrospective cohort study of nulliparous individuals undergoing eIOL between 39 and 40 weeks from January 2017 to June 2024. To investigate the relationship between age and eIOL, we created multiple study cohorts: (1) Age <35 years, (2) age 35-39 years, and (3) age ≥40 years. We excluded pregnancies complicated by multifetal gestation, oligohydramnios, hypertensive disorders, diabetes requiring treatment, autoimmune disorders, or fetal growth restriction. The primary outcome was the rate of cesarean delivery, and secondary outcomes included indication for cesarean delivery and adverse maternal and neonatal outcomes. RESULTS: Of the 84,156 eligible individuals, 932 met our inclusion criteria, with 728 (78.1%), 141 (15.1%), and 63 (6.8%) with age <35 years, 35-39 years, and ≥40 years, respectively. We found an increased incidence of cesarean delivery with increasing age (25.8% for age <35 years, 41.1% for age 35-39 years, and 55.6% for age ≥40 years, < 0.01). After adjusting for confounders including pre-pregnancy body mass index (BMI), diet-controlled gestational diabetes, and in vitro fertilization, and using age <35 years as the reference in a multivariable regression, this relationship remained consistent (age 35-39: adjusted odds ratio (OR) = 1.82 [95% confidence interval (CI): 1.14-2.91], and age ≥40: adjusted OR = 3.70 [95% CI: 1.90-7.22]). Aside from cesarean for arrest of dilation, there were no significant differences noted in the indications for cesarean delivery or other adverse outcomes. CONCLUSION: Our findings highlight an association between increasing maternal age and cesarean delivery among nulliparous individuals undergoing eIOL. Further studies should determine whether biologic or immunologic factors play a role or whether altered labor management may improve these outcomes. KEY POINTS: · Among patients undergoing eIOL, increased age is associated with cesarean delivery.. · After adjusting for confounders in multivariable regression, age remained associated with cesarean delivery.. · Future studies are needed to determine the etiology of increased cesarean delivery with maternal age..
Maternal Hyperglycemia and Adult Offspring Overweight and Obesity: Is Birthweight a Mediator?
McWhorter KL, Wells G, Bowers K … +8 more , Summer S, Dolan L, Catalano P, Szczesniak RD, Altaye M, Rosenn B, Khoury JC, Ehrlich S
Am J Perinatol · 2026 Jun · PMID 42049055 · Publisher ↗
OBJECTIVES: We and others have shown that maternal hyperglycemia during pregnancy in women with insulin-dependent diabetes mellitus (IDDM) influences fetal growth. Less is understood regarding how trimester-specific glyc...
OBJECTIVES: We and others have shown that maternal hyperglycemia during pregnancy in women with insulin-dependent diabetes mellitus (IDDM) influences fetal growth. Less is understood regarding how trimester-specific glycemic patterns, particularly glucose variability, shape offspring obesity risk across the life course and whether this is mediated by birthweight. Leveraging data from the Diabetes in Pregnancy Program Grant (PPG; 1978-1995) and the Transgenerational Effects on Adult Morbidity (TEAM Study; 2017-2023) cohort, we aimed to evaluate whether the association between maternal glycemic control and adult offspring obesity status was mediated in part through infant birthweight. STUDY DESIGN: Maternal glycohemoglobinA1 levels were collected monthly during pregnancy and harmonized across laboratories using standard deviation units (HbASD). Functional principal component analysis characterized patterns in blood glucose level and variability. TEAM Study participants, adult offspring of PPG women, completed in-person or online assessments (via Zoom) of body anthropometrics. Linear mixed-effects models and generalized estimating equations estimated associations between maternal glycemia and adult offspring outcomes. Classical mediation methods tested whether birthweight mediated observed relationships. RESULTS: Consistent with prior findings, third-trimester HbASD demonstrated the most consistent positive associations with adult offspring body mass index (BMI) outcomes, after adjustment for maternal BMI at last menstrual period, maternal education, gestational weight gain, and sex of offspring (for offspring weight only). There was no evidence that birthweight mediated the relationship between maternal glycemic patterns and adult offspring overweight and obesity; however, birthweight exhibited an independent direct effect on adult offspring BMI in fully adjusted models. CONCLUSION: Infant birthweight was not shown to be a mediator in the association of maternal gestational glycemic control and overweight/obesity in adult offspring of women with IDDM. Although birthweight does not appear to mediate these long-term associations, the findings underscore the importance of trimester-specific evaluation of blood glucose level and variability, motivating further investigation into transgenerational metabolic risk pathways. KEY POINTS: · It is unlikely that birthweight mediates the association between gestational blood glucose levels and offspring adult obesity.. · Higher birthweight is an important risk factor for overweight and obesity in the adult offspring.. · Early gestation hyperglycemia may program obesity in adult offspring of IDDM women..
Association of Left Ventricular Mass with Hospital Length of Stay and Glucose Infusion Needs in Infants of Diabetic Mothers.
Kannan A, Spray BJ, Theisen B … +4 more , Daily JA, Rumpel JA, Dajani N, Bolin EH
Am J Perinatol · 2026 Apr · PMID 42034050 · Publisher ↗
OBJECTIVE: We aimed to assess the relationship between postnatal left ventricular mass (LVM) z-score and clinical outcomes among infants of diabetic mothers (IDMs). STUDY DESIGN: We performed a retrospective cohort study...
OBJECTIVE: We aimed to assess the relationship between postnatal left ventricular mass (LVM) z-score and clinical outcomes among infants of diabetic mothers (IDMs). STUDY DESIGN: We performed a retrospective cohort study of infants born to mothers with pregestational diabetes mellitus. The primary predictor was postnatal LVM z-score; the primary outcome was hospital length of stay (LOS). A secondary outcome was maximum glucose infusion rate (GIR) during hospitalization. RESULTS: There were 112 infants who met the inclusion criteria (52% male). After multiple linear regression, there was a weak relationship between LVM z-score and LOS (R = 0.055; = 0.002); the relationship between LVM z-score and maximum GIR was somewhat stronger (R = 0.205, < 0.001). CONCLUSION: LVM measured by echocardiography during the first week of life is weakly but independently associated with total LOS and maximum GIR among infants born to mothers with pregestational diabetes mellitus. The impact of left ventricular hypertrophy in IDMs on clinical outcomes should be considered in clinical context. KEY POINTS: · Increased LVM is marginally associated with longer LOS in IDMs.. · Elevated LVM is linked to higher maximum GIR in IDMs.. · Higher LVM may reflect illness severity in IDMs..
Long-Term Effects of Maternal Glycemic Measures in Pregnancy and Offspring Adverse Glycemic Outcomes: Results from the TEAM Study.
Bowers K, Bhoopathy K, Szczesniak R … +10 more , Sawyer RP, Shah AS, Ehrlich S, Dolan LM, Summer S, Smith E, Altaye M, Ollberding NJ, Catalano P, Khoury JC
Am J Perinatol · 2026 Jun · PMID 42030981 · Publisher ↗
OBJECTIVE: In utero exposure to maternal prepregnancy diabetes is associated with an increased risk for abnormal glycemic outcomes in children, including impaired glucose tolerance, insulin resistance, and type 2 diabete...
OBJECTIVE: In utero exposure to maternal prepregnancy diabetes is associated with an increased risk for abnormal glycemic outcomes in children, including impaired glucose tolerance, insulin resistance, and type 2 diabetes. Our objective was to evaluate the timing of exposure to maternal dysglycemia and whether the effects persist into adulthood. STUDY DESIGN: The Transgenerational Effects on Adult Morbidity (TEAM) Study followed offspring of mothers with prepregnancy insulin-dependent diabetes mellitus (IDDM), who participated in a Program Project Grant (PPG) between 1978 and 1995. These women had a detailed characterization of glycemic measures across pregnancy and comprehensive obstetric and delivery data. Offspring participated in a complete clinical exam, which included an oral glucose tolerance test (OGTT). Multiple regression methods were used to identify associations between trimester-specific maternal hemoglobin A1 (HbA1) standard deviation (HbA1SD) and maternal glucose profiles with offspring glycemic outcomes, adjusting for covariates. RESULTS: Among 161 offspring up to 42 years of age (mean age, 32.3 years), first trimester HbASD was associated with increased offspring fasting plasma glucose and HbA1c ≥6.5% after adjusting for maternal age, family history of diabetes, presence of microvascular disease, and body mass index (BMI) at the last menstrual period. Both second- and third-trimester maternal HbA1SD were positively associated with offspring HbA1c and inversely associated with the acute insulin response to glucose (AIRg), defined as the rapid, first-phase release of insulin from pancreatic beta-cells within 10 minutes of the OGTT. CONCLUSION: Our findings add to the current literature showing that the association between trimester-specific gestational maternal glycemic status and offspring adverse glycemic outcome persists into adulthood in the offspring. KEY POINTS: · Exposure to maternal IDDM is associated with offspring glycemic outcomes.. · Maternal glycohemoglobin, particularly in the first trimester, is associated with HbA1c and fasting glucose.. · Mid-late pregnancy hyperglycemia was associated with reduced offspring acute insulin response..
Antenatal Corticosteroids in Preterm Pregnancies Complicated by Diabetes: A Review and Clinical Commentary.
Higgs A, Meeks K, Reece EA … +1 more , Seif KE
Am J Perinatol · 2026 Jun · PMID 42030980 · Publisher ↗
OBJECTIVE: This study aimed to review the biologic mechanisms, clinical evidence, and therapeutic considerations surrounding antenatal corticosteroid (ACS) use in preterm pregnancies complicated by gestational and preges...
OBJECTIVE: This study aimed to review the biologic mechanisms, clinical evidence, and therapeutic considerations surrounding antenatal corticosteroid (ACS) use in preterm pregnancies complicated by gestational and pregestational diabetes, with a particular focus on the late preterm period and associated neonatal outcomes. STUDY DESIGN: Narrative review of randomized trials, observational studies, and mechanistic investigations evaluating fetal lung development, ACS exposure, and neonatal respiratory outcomes in diabetic pregnancies. RESULTS: Diabetes disrupts fetal lung maturation through fetal hyperinsulinemia and delayed surfactant synthesis, resulting in increased neonatal respiratory morbidity extending into the late preterm period. While late preterm ACS reduce the need for neonatal respiratory support, including transient tachypnea of the newborn, in non-diabetic populations, pregestational diabetic pregnancies were excluded from pivotal trials. Emerging observational and randomized data suggest similar respiratory benefit in diabetic pregnancies, though accompanied by predictable metabolic effects, including maternal hyperglycemia, which are modifiable with anticipatory clinical management. CONCLUSION: Available biologic and clinical evidence supports consideration of late preterm ACS in pregnancies complicated by diabetes when delivery is anticipated within 7 days. With proactive metabolic management, respiratory benefits can be achieved while minimizing maternal and neonatal risks. KEY POINTS: · Diabetes delays fetal lung maturation.. · Late preterm respiratory risk remains high.. · Antenatal corticosteroids (ACS) may reduce respiratory morbidity.. · Metabolic effects are predictable and modifiable.. · Individualized care optimizes outcomes..
From Knowledge to Competency: Building a Stratified Training Model in Maternal-Fetal Medicine for Advanced Diabetes in Pregnancy Care.
Hariharan S, Gallo M, Roca AS … +2 more , Crimmins SD, Reece EA
Am J Perinatol · 2026 Jun · PMID 42030979 · Publisher ↗
OBJECTIVE: Diabetes mellitus (both preexisting and gestational) and obesity are rising globally and concomitantly, and this increase is adversely impacting pregnancies complicated by diabetes mellitus. There is a need to...
OBJECTIVE: Diabetes mellitus (both preexisting and gestational) and obesity are rising globally and concomitantly, and this increase is adversely impacting pregnancies complicated by diabetes mellitus. There is a need to develop a structured framework to guide clinical scholars through the evolving evidence-based research that informs modern care of diabetes in pregnancy. The objective of this study is to create and propose an evidence-based stratified training model in maternal-fetal medicine for advanced diabetes in pregnancy care. STUDY DESIGN: A review of fundamental research, including landmark trials, collaborative studies, and prospective studies, was conducted along with reference to consensus-based suggested practice guidelines. These were organized into four developmental stages designed to parallel other competency domain structures for clinical scholars. RESULTS: The resulting stratified training model provides a structured framework for competency development in diabetes care across the reproductive lifespan. Early stages of training focus on screening, diagnosis, diet and lifestyle counseling, and antenatal/intrapartum management. Intermediate stages focus on pharmacotherapy initiation, insulin management, continuous glucose monitoring, and recognition of acute complications. The latter stages expand to complex diabetes physiology, postpartum transition, long-term metabolic risk counseling, diabetic embryopathy, and emerging therapies. Across all stages, relevant literature is emphasized to contextualize modern practice and to introduce the scholarly underpinnings of current guidelines. CONCLUSION: This tiered stratified training model offers an evidence-informed framework for diabetes care in pregnancy and will enhance trainee confidence, clinical competence, and readiness to engage with research discoveries and developments that advance modern practice in diabetes care. KEY POINTS: · A stratified training model was created to improve diabetes in pregnancy management.. · Equips trainees in maternal-fetal medicine with progressive competency in diabetes in pregnancy care.. · From basics of management to emerging evidence..
Blood Product Use for Hemorrhage during Cesarean Delivery.
Pacheco LD, Weiner SJ, Saade GR … +16 more , Clifton RG, Parry S, Thorp JM, Longo M, Salazar A, Tita ATN, Gyamfi-Bannerman C, Chauhan SP, Metz TD, Rood K, Rouse DJ, Bailit JL, Grobman WA, Simhan HN, Macones GA, Eunice Kennedy Shriver National Institute of Child Health Human Development Maternal-Fetal Medicine Units (MFMU) Network
Am J Perinatol · 2026 May · PMID 42025207 · Publisher ↗
OBJECTIVE: Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality. Little is known about transfusion practices in patients requiring blood tansfusions following cesarean delivery. The obj...
OBJECTIVE: Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality. Little is known about transfusion practices in patients requiring blood tansfusions following cesarean delivery. The objective of this study is to describe the use of blood products, clotting factors, colloids, and antifibrinolytics in a contemporary cohort of patients with hemorrhage during cesarean and compare blood product use with a historic cohort of patients with a similar diagnosis. STUDY DESIGN: Secondary analysis of a multicenter trial of tranexamic acid versus placebo to prevent PPH during cesarean delivery. Patients with qualitative estimated intraoperative blood loss (EBL) of more than 1 L were included in this analysis. Variables analyzed included transfusion of blood products, ratio of transfused packed red blood cell (PRBC) to fresh frozen plasma (FFP) and platelets, and use of clotting factors, anti-fibrinolytics, and colloids. Transfusion strategies were also compared with a historic cohort from the APEX study. RESULTS: Of the 707 (7.7%) who had EBL of greater than 1 liter, packed red cells were transfused in 21.1%, FFP in 5.4%, platelets in 2.4%, and cryoprecipitate in 2.3%. Among patients who received both PRBC and FFP, three quarters had a PRBC:FFP ratio between 1:1 and 2:1. Patients receiving both PRBC and platelets had a 1:1 ratio or less in 76.5% of cases. Clotting factor concentrates were not used in any case. Albumin was administered in 10.2% of cases. When compared with the historic cohort with an EBL > 1 L during cesarean, no differences in the use of blood products was noted. CONCLUSION: 1 in 5 patients with intraoperative EBL > 1 L received PRBC transfusion. The use of other blood products was rare. There was no difference in transfusion strategies overtime when compared with a similar historic cohort. Obstetrical hemorrhage in patients undergoing cesarean delivery rarely involves intensive transfusion therapy. KEY POINTS: · A total of 21% of patients with hemorrhage during cesarean received packed red cells.. · Use of other blood products was rare.. · Pathological activation of the clotting cascade is unlikely.. · No difference in transfusion strategies was noted overtime..
Diagnostic and Clinical Outcomes of Sex Chromosome Abnormalities Detected on Noninvasive Prenatal Screening.
Ogamba-Alphonso I, Rozenblyum A, Dunn T … +3 more , Yang X, Cacace N, Suhag A
Am J Perinatol · 2026 Apr · PMID 42015930 · Publisher ↗
OBJECTIVE: Noninvasive prenatal screening (NIPS) screens for aneuploidy, but its positive predictive value for sex chromosome aneuploidies (SCA) is variable. NIPS reports include "atypical sex chromosome findings," which...
OBJECTIVE: Noninvasive prenatal screening (NIPS) screens for aneuploidy, but its positive predictive value for sex chromosome aneuploidies (SCA) is variable. NIPS reports include "atypical sex chromosome findings," which may indicate fetal/maternal SCAs or mosaicism, although sensitivity is unknown. Previous studies are limited by small cohorts and insufficient maternal testing and ultrasound data. This study evaluates confirmation rates and outcomes for screen-positive SCAs, including "atypical sex chromosome" on NIPS. STUDY DESIGN: This retrospective study included singleton pregnancies that underwent diagnostic testing for screen-positive SCAs or atypical sex chromosome findings on NIPS from 2019 to 2024. Data collected included demographics, ultrasound findings, cytogenetics, maternal karyotype, and perinatal outcomes. The primary outcome was diagnostic confirmation, defined as proportion of NIPS screen-positive SCA and "atypical sex chromosome" confirmed by diagnostic testing. Secondary outcomes included fetal/placental mosaicism, incidental genetic findings, and maternal genetic results. Chi-squared and Kruskal-Wallis tests were used for categorical and continuous variables, respectively. RESULTS: Of 510 patients who underwent diagnostic testing, 91 met inclusion criteria. Overall, 41.8% ( = 38) of NIPS-predicted SCAs were confirmed. Confirmation rates varied by SCA type: monosomy X (32.1%), XXY (80%), XYY (100%), XXX (66.7%), and atypical findings (26.2%) ( < 0.001). Mosaicism was present in 31.6% of confirmed cases. Incidental genetic findings, including fetal copy number variants, occurred in 11 cases. Maternal karyotype was normal in 100% of confirmed cases versus 54.2% of nonconfirmed ( = 0.033). Perinatal outcomes were generally favorable. CONCLUSION: Fewer than half of NIPS-predicted SCAs were confirmed, with low confirmation rates for monosomy X and atypical findings. Mosaicism accounted for nearly one-third of confirmed cases. False-positive results often included incidental fetal and maternal findings, which may contribute to high false-positive rates. These findings emphasize the need for comprehensive pretest counseling and standardized testing guidelines, given the risk of unexpected maternal SCAs and fetal copy number variants. KEY POINTS: · Less than half of NIPS-predicted SCAs were true-positive.. · Nearly one-third of confirmed SCAs involved mosaicism.. · Abnormal maternal karyotype may drive false-positive rates..
Diabetes in Pregnancy: Can Ultrasound Help?
Abramowicz JS
Am J Perinatol · 2026 Jun · PMID 42015922 · Publisher ↗
OBJECTIVE: Every year millions of fetuses are exposed to diabetes, in utero. Maternal diabetes may be associated with major fetal/neonatal complications, such as congenital anomalies, macrosomia (but also growth restrict...
OBJECTIVE: Every year millions of fetuses are exposed to diabetes, in utero. Maternal diabetes may be associated with major fetal/neonatal complications, such as congenital anomalies, macrosomia (but also growth restriction), shoulder dystocia, and stillbirth. Several of these complications are amenable to prenatal diagnosis. The objective of this article is to review prenatal ultrasound contribution to the diagnosis of these complications. STUDY DESIGN: Review of previously recently published literature (not a meta-analysis or a systematic review). RESULTS: The major imaging technology that can help in the management of the diabetic mother is ultrasound, specifically for anomalies, macrosomia, and growth restriction. The prediction of shoulder dystocia is much more challenging. CONCLUSION: Prenatal ultrasound remains the optimal technology to attempt and diagnose complications of diabetic pregnancies, such as fetal anomalies, macrosomia, and growth restriction. It is less optimal for shoulder dystocia and stillbirth. KEY POINTS: · Ultrasound can diagnose many fetal anomalies in mothers with diabetes.. · Fetal macrosomia is a common complication of diabetes in pregnancy.. · It is difficult to predict shoulder dystocia with clinical or imaging methods.. · Occasionally, maternal diabetes can result in fetal growth restriction..
Delayed versus Early Umbilical Cord Clamping in Preterm Multiple Gestation: A Randomized Controlled Trial.
Sharma U, Ananthan A, Balasubramanian H … +3 more , Raghavendra P, Vijayanathan M, Samant P
Am J Perinatol · 2026 Apr · PMID 42013866 · Publisher ↗
OBJECTIVE: The objective of this study is to evaluate the effects of delayed cord clamping (DCC) on hematocrit at 6 hours and 6 weeks of age, hospital stay, and other clinical outcomes at discharge. STUDY DESIGN: This ra...
OBJECTIVE: The objective of this study is to evaluate the effects of delayed cord clamping (DCC) on hematocrit at 6 hours and 6 weeks of age, hospital stay, and other clinical outcomes at discharge. STUDY DESIGN: This randomized controlled trial was conducted in a tertiary care center in Western India. Preterm multiple gestations were randomized to DCC at 60 seconds of birth or early cord clamping (ECC) within 30 seconds of birth. The primary outcome was hematocrit at 6 hours of age. RESULTS: A total of 76 mothers and 155 preterm infants of multiple gestation (73 twins and 3 triplets) were randomized. The mean hematocrit at 6 hours was significantly higher in the DCC group (61.9 ± 5.5 vs. 55.8 ± 5.3, = 155, < 0.001). Hematocrit at 6 weeks was also significantly higher in the DCC group (55.5 ± 3.8 vs. 49.6 ± 4.5, = 142, < 0.001). DCC adherence rate was 88% ( = 70) in the intervention group. Mortality was observed in six infants in the DCC group (7.5%) and eight infants (11%) in the ECC group. Infants in the DCC group had a higher peak bilirubin level, although not statistically significant (13.1 ± 2.3 vs. 11.1 ± 2.5 mg/dL, = 0.09) and significantly prolonged duration of phototherapy (93.6 ± 32.8 vs. 61.4 ± 38.6 hours, < 0.001). Other secondary outcomes were similar between the two groups. CONCLUSION: DCC was feasible in preterm multiple gestation and resulted in improved hematocrit at 6 hours and 6 weeks of life. There was a nonsignificant trend toward higher peak bilirubin levels in infants who received DCC. This trial is registered with the Clinical Trials Registry of India (identifier: CTRI/2023/10/058944). KEY POINTS: · DCC increased hematocrit at 6 hours and 6 weeks in preterm multiple gestation.. · DCC increased peak bilirubin levels and prolonged the duration of phototherapy.. · DCC is feasible in preterm multiple gestation..
Evaluating TikTok Content on Gestational Diabetes Screening: Accuracy and Impact.
Perone H, Langley M, Patek K … +1 more , Gonik B
Am J Perinatol · 2026 Jun · PMID 42013865 · Publisher ↗
OBJECTIVE: This study evaluates the accuracy and engagement with information on social media about the oral glucose challenge test, a screening tool for gestational diabetes. STUDY DESIGN: A cross-sectional study was con...
OBJECTIVE: This study evaluates the accuracy and engagement with information on social media about the oral glucose challenge test, a screening tool for gestational diabetes. STUDY DESIGN: A cross-sectional study was conducted on December 1, 2024, by first identifying posts in English on TikTok from February 1, 2020, to October 31, 2024, using keywords: glucola, glucose drink, and gestational diabetes screening. Metrics such as views, shares, likes, comments, and follower counts were obtained. Posts were analyzed to determine account type, theme, tone, and readability ease, and then scored using JAMA, DISCERN criteria, and a harm-benefit analysis. RESULTS: A total of 1,130 posts were identified, with 306 posts meeting inclusion criteria. Thematic analysis demonstrated that posts were for entertainment ( = 190) or educational ( = 116) purposes. Doctors contributed the most educational content (94.1%), while patients contributed content considered to be entertainment (67.6%, < 0.05). The majority of posts had a neutral or positive tone regarding testing (80.7%). More than half of negative and neutral posts were shared by patients, while doctors favored posting positive content (85.5%). Doctor-generated posts were of longer duration, had more difficult reading comprehension scores, and scored higher on JAMA and DISCERN criteria compared to other groups ( < 0.05). Inaccurate or partially accurate posts made up 42% of educational posts and were most frequently shared by non-medical personnel. Higher view count was found among beneficial posts compared to neutral or harmful posts with a median of 44,600 compared to 41,300 and 6,449 views, respectively ( < 0.05). CONCLUSION: TikTok represents a growing, open-access platform for medical and non-medical personnel to rapidly share health information such as screening guidelines for gestational diabetes. Without regulatory oversight and future promotion of accurate content, exposure to unregulated information may influence medical decision-making and pregnancy outcomes in the future. KEY POINTS: · TikTok posts discuss gestational diabetes screening.. · Patients share glucola-related content most frequently.. · Up to 42% of posts contain misleading information.. · Doctors share educational and more accurate information..
A Practical Approach to Insulin Pump, Continuous Glucose Monitoring, and Automated Insulin Delivery in the Management of Type 1 Diabetes in Pregnancy.
Wong M, Maayeh MG, Saade GR … +1 more , Saad A
Am J Perinatol · 2026 Jun · PMID 41991101 · Publisher ↗
OBJECTIVE: The objective of this study is to provide clinicians with practical, pregnancy-specific guidance for initiating and optimizing continuous subcutaneous insulin infusion (CSII), continuous glucose monitoring (CG...
OBJECTIVE: The objective of this study is to provide clinicians with practical, pregnancy-specific guidance for initiating and optimizing continuous subcutaneous insulin infusion (CSII), continuous glucose monitoring (CGM), and automated insulin delivery (AID) in pregnancies complicated by Type 1 diabetes (T1D). STUDY DESIGN: Narrative review of key trials and device labeling, paired with pragmatic algorithms for antepartum titration, intrapartum management, and postpartum dose reduction. RESULTS: CGM improves glycemic metrics and neonatal outcomes in T1D pregnancy. Continuation of CSII during labor is safe and achieves similar or improved glycemic control compared with intravenous insulin strategies. Hybrid closed-loop AID increases time in the pregnancy target range of 60 to 140 mg/dL and reduces time above range without increasing severe hypoglycemia. Because the majority of AID systems are used off-label in pregnancy, clinicians need explicit protocols for pump failure, ketone monitoring, steroid exposure, and prevention of euglycemic diabetic ketoacidosis. CONCLUSION: With frequent review and clear escalation pathways, diabetes technology can help achieve pregnancy glycemic targets across gestation, labor, and the early postpartum period. KEY POINTS: · Technology optimization: in order to adapt standard pump algorithms to strict pregnancy-specific glycemic targets, clinicians must employ "off-label" strategies, such as lowering active insulin time.. · Dynamic dosing: insulin requirements fluctuate significantly by gestational age, peaking at 1.0 µ/kg in late pregnancy before requiring an immediate 50% reduction postpartum to prevent severe hypoglycemia.. · Intrapartum safety: continuing insulin pump therapy during labor is safe and often results in improved glycemic control and patient satisfaction compared with switching to intravenous insulin..
Insights from U.S. Women on Navigating Dietary Recommendations for Gestational Diabetes Mellitus: A Qualitative Interview Study.
Palatnik A, Balza J, Akinola I … +3 more , Yee LM, Peterson Z, Flynn KE
Am J Perinatol · 2026 Jun · PMID 41985493 · Publisher ↗
OBJECTIVE: Gestational diabetes mellitus (GDM) affects nearly 10% of pregnancies in the United States, and dietary modification is the cornerstone of treatment. However, adherence to medical nutrition therapy (MNT) can b...
OBJECTIVE: Gestational diabetes mellitus (GDM) affects nearly 10% of pregnancies in the United States, and dietary modification is the cornerstone of treatment. However, adherence to medical nutrition therapy (MNT) can be challenging. This study aimed to explore the experiences of U.S. women diagnosed with GDM in adopting recommended nutrition therapy. STUDY DESIGN: We conducted in-depth, semistructured interviews with 20 women diagnosed with GDM to identify common challenges, strategies, and sources of support related to dietary management. Interviews were analyzed thematically. RESULTS: Key themes included the importance of family and social support, the role of structured daily routines, strategies for adapting carbohydrate intake without complete restriction, and the use of online communities as supplemental sources of support and information. CONCLUSION: Women with GDM employ multiple adaptive strategies to navigate dietary recommendations. These findings highlight opportunities to develop more person-centered, supportive approaches to nutrition therapy during pregnancy. KEY POINTS: · Dietary change is essential but challenging in GDM.. · Social support and structural support matter.. · Women supplement clinical guidance with online communities..
Association of Active Antenatal Management in the Periviable Period and Parental Morbidity in the United States.
Edel K, Bender W
Am J Perinatol · 2026 Apr · PMID 41980613 · Publisher ↗
OBJECTIVE: The objective of this study is to describe the incidence of parental morbidity with periviable delivery and its relationship to antenatal interventions, including antenatal corticosteroids, antibiotics, and ce...
OBJECTIVE: The objective of this study is to describe the incidence of parental morbidity with periviable delivery and its relationship to antenatal interventions, including antenatal corticosteroids, antibiotics, and cesarean delivery. STUDY DESIGN: This is a population-based case-control study of the National Center for Health Statistics database of periviable deliveries (20-25 weeks) from 2016 to 2021. Subjects were included if they delivered a nonanomalous live singleton gestation in a hospital. To minimize inaccurate dating, subjects were excluded for birthweight > 97% for gestational age. The composite morbidity outcome was defined as parental blood transfusion, intensive care unit (ICU) admission, or unplanned hysterectomy. We assessed this outcome's relationship to parental demographic and clinical characteristics, including the receipt of selected antenatal interventions, including antenatal corticosteroids, antibiotics, and cesarean delivery. Multivariable logistic regression was used to assess the relationship between antenatal intervention and parental morbidity. RESULTS: Of 45,339,472 births during the study period, 93,686 met the inclusion criteria for this study. A total of 2,726 (3.1%) parents experienced parental morbidity. The rate of perinatal morbidity increased over the study period. Black parents were less likely to experience morbidity compared to non-Black parents (2.7 vs. 3.4%, < 0.001). Parents who received antenatal steroids or antibiotics and those undergoing cesarean delivery had higher rates of morbidity compared to their counterparts who did not receive these interventions. CONCLUSION: Birthing parents who received steroids or antibiotics prior to periviable delivery and those undergoing cesarean delivery were more likely to experience parental morbidity of transfusion, hysterectomy, or ICU admission. The relationship of these interventions, intended to improve neonatal outcomes or prolong pregnancy, to parental morbidity should be incorporated into the nuanced counseling required for parents at risk of periviable deliveries. Additional research is warranted to understand the institutional, provider, and patient factors underlying these findings. CONCLUSION: KEY POINTS: . CONCLUSION: · Neonatal outcomes after periviable birth are linked to gestational age and receipt of antenatal interventions.. · Parents who received active antenatal interventions were more likely to experience parental morbidity.. · The potential for morbidity following antenatal intervention in the periviable period should be included in the nuanced counseling required in these cases..
Laterality Spectrum Disorders in the Prenatal Era: Outcomes Across the Severity Spectrum and Associations with Pregestational Diabetes.
Tanaka K, Seger L, Tieu K … +3 more , Witcher K, Turan O, Turan S
Am J Perinatol · 2026 Jun · PMID 41974186 · Publisher ↗
OBJECTIVE: This study aimed to describe severity-stratified early outcomes in pregnancies with prenatally suspected laterality spectrum disorders (LSD), defined as abnormalities of left-right body patterning affecting th...
OBJECTIVE: This study aimed to describe severity-stratified early outcomes in pregnancies with prenatally suspected laterality spectrum disorders (LSD), defined as abnormalities of left-right body patterning affecting thoracoabdominal situs and associated cardiovascular and visceral structures, and to explore phenotype patterns associated with pregestational diabetes mellitus (PDM). STUDY DESIGN: Retrospective cohort study of pregnancies evaluated at a tertiary fetal care and fetal cardiology referral center (2010-2026). LSD subtype was assigned using a prespecified operational framework. Cardiac severity was classified as major versus nonmajor congenital heart disease (CHD). Outcomes included termination, intrauterine fetal demise (IUFD), neonatal survival (≤28 days), infant survival (28 days-1 year), cardiac surgery, and gastrointestinal morbidity. RESULTS: Seventy-eight pregnancies were included; 16/78 (20.5%) had PDM. Major CHD was present in 49/78 (62.8%). Pregnancy outcomes included live birth in 62/78 (79.5%), IUFD in 5/78 (6.4%), and termination in 11/78 (14.1%); all terminations occurred among major CHD cases. Among live births, neonatal survival was 59/62 (95.2%), and infant survival among neonatal survivors was 46/53 (86.8%). In major CHD live births ( = 33), neonatal survival was 30/33 (90.9%) and infant survival among neonatal survivors with available follow-up was 20/27 (74.1%). Cardiac surgery occurred in 22/62 (35.5%) and was more common in major versus nonmajor CHD (63.6 vs. 3.4%). Intestinal malrotation occurred in 18/62 (29.0%). Abdominal situs inversus was more frequent in PDM pregnancies (37.5 vs. 8.1%). CONCLUSION: In LSD, major CHD drives pregnancy termination, surgical intervention, and early mortality concentrated during infancy. PDM was associated with a higher frequency of abdominal situs phenotypes, supporting deliberate postnatal gastrointestinal surveillance planning. KEY POINTS: · In LSD, infant outcomes vary with CHD severity.. · Major CHD drives termination/surgery.. · PDM occurs across the LSD spectrum..
Predictors of Maternal Morbidity among Individuals at Low Risk of Postpartum Hemorrhage.
Bart Y, Wiley RL, Mendez-Figueroa H … +3 more , Ghose I, Sibai BM, Chauhan SP
Am J Perinatol · 2026 Apr · PMID 41974185 · Publisher ↗
OBJECTIVE: This study aimed to identify predictors for maternal morbidity among individuals categorized as low-risk for postpartum hemorrhage (PPH) according to American College of Obstetrics and Gynecology (ACOG) Practi...
OBJECTIVE: This study aimed to identify predictors for maternal morbidity among individuals categorized as low-risk for postpartum hemorrhage (PPH) according to American College of Obstetrics and Gynecology (ACOG) Practice Bulletin (no.: 183). STUDY DESIGN: A retrospective cohort study of all singleton births between March 2020 and February 2022 at a Level IV maternity center. Individuals deemed at medium- or high-risk for PPH according to the ACOG risk stratification and those with missing data were excluded from the main analysis. Individuals with the composite maternal hemorrhagic outcome (CMHO) were compared with those without. Variables previously associated with maternal morbidity yet absent from the ACOG stratification were examined as potential predictors of the CMHO. Possible predictors were identified using a multivariable logistic regression and further assessed with a receiver operating characteristic curve (ROC). RESULTS: Out of 8,623 deliveries, 3,472 (40.3%) met the inclusion criteria. Among them, 175 (5.0%) had a CMHO. Individuals with the composite outcome were older, had a higher body mass index, and had higher rates of Hispanic race/ethnicity, diabetes, postterm pregnancy, scheduled cesarean delivery, and neonatal birth weight ≥ 4,000 g. The combination of ≥ 2 risk factors among low-risk patients, present in 16%, was associated with a similar CMHO rate compared with those at medium PPH risk by the ACOG criteria. The combined presence of ≥ 4 factors was associated with a CMHO rate of 36% and yielded a 10.47 positive likelihood ratio (95% confidence interval [CI]: 3.55-30.90). The area under the curve for the ROC curve of the final model was 0.63 (95% CI: 0.62-0.65). CONCLUSION: Among low-risk PPH patients, several risk factors with low predictive value flagged roughly one out of six with morbidity similar to medium risk. KEY POINTS: · Five percent of individuals categorized as low-risk for PPH have hemorrhagic morbidity.. · Several predictors of morbidity were identified.. · Low-risk patients with ≥ 2 predictors had similar morbidity to patients with a moderate PPH risk..
Characteristics and Outcomes Associated with the Attempt of External Cephalic Version in U.S. Birth Certificate Data.
Verster A, Patel E, Ramus R … +2 more , Robinson A, Springel E
Am J Perinatol · 2026 Apr · PMID 41962582 · Full text
OBJECTIVES: Malpresentation is the indication for approximately 17% of primary cesarean deliveries (CD). External cephalic version (ECV) is a safe and effective procedure to reduce CD. Our primary objective is to identif...
OBJECTIVES: Malpresentation is the indication for approximately 17% of primary cesarean deliveries (CD). External cephalic version (ECV) is a safe and effective procedure to reduce CD. Our primary objective is to identify associations between patient demographics and rate of ECV attempt. Secondary objectives include determining the rate of ECV attempt in the United States, and assessing neonatal and maternal outcomes associated with ECV attempt. STUDY DESIGN: Data were obtained from the National Center for Health Statistics birth certificate data from 2014 to 2021. We analyzed live, singleton, non-anomalous births at term (37-42 weeks). Observations lacking complete information on the mode of delivery, presentation at delivery, or whether an ECV was attempted were excluded. We reasoned that subjects who either had an ECV attempt or were non-cephalic at the time of delivery constituted an ECV-eligible cohort. The association between patient characteristics and ECV attempts was examined using logistic regression to obtain odds ratios and 95% confidence intervals. RESULTS: A total of 30,656,644 deliveries were recorded in the database from 2014 to 2021, and 925,082 subjects met inclusion criteria and were considered ECV-eligible. Only 7.9% of the ECV-eligible population had an ECV attempt. Non-Hispanic Black and Hispanic race/ethnicity, unmarried status, lack of a college degree, non-private insurance, delayed prenatal care, increased age, lower parity, one prior CD, and increased BMI were associated with decreased rates of ECV attempt. In regards to neonatal and maternal outcomes, differences were statistically significant but absolute differences were small. CONCLUSION: Our findings are limited by the quality of data collection, but strongly suggest that ECV is underutilized and not uniformly offered to patients. We identified patient characteristics including race and other demographics that were associated with decreased rates of ECV attempt, and found no clinically significant differences in neonatal or maternal outcomes with ECV attempt other than decreased CD rate. KEY POINTS: · External cephalic version (ECV) is underutilized.. · Disparities exist in receiving an ECV attempt.. · ECV is safe for neonates and pregnant people..
The Impact of Insurance Status and State-of-Residence on Abortion Decision-Making in Spina Bifida.
Liesman DR, Papastefan ST, Bian Y … +7 more , Ogu NQ, Singh M, Marriott WS, Ito JA, Fry JT, Shaaban AF, Premkumar A
Am J Perinatol · 2026 Apr · PMID 41962581 · Publisher ↗
OBJECTIVES: Insurance coverage for abortion varies by state, and fetal centers often care for patients traveling from out-of-state. How insurance status and state-of-residence impact pregnancy decision-making for spina b...
OBJECTIVES: Insurance coverage for abortion varies by state, and fetal centers often care for patients traveling from out-of-state. How insurance status and state-of-residence impact pregnancy decision-making for spina bifida remains unclear. We evaluated whether insurance payor and state-of-residence are associated with consideration and subsequent completion of abortion among patients with spina bifida. STUDY DESIGN: We conducted a retrospective study of singletons with spina bifida at a fetal center. Exposures were residence (in-state vs. out-of-state) and insurance (governmental vs. private). Because state laws influence abortion coverage, the exposure was modeled as an interaction term. Primary outcomes were abortion consideration and completion. Abortion consideration was determined by a nurse intake coordinator. Before presentation at our fetal center, patients were asked whether they were considering abortion. If they answered "yes" or "maybe," then the patient was classified as considering abortion. RESULTS: Among 149 patients (63.7% in-state; 72.5% private insurance), 127 had complete decision-making data, with 40.2% (51/127) considering abortion and 27.6% (35/127) completing abortion. Governmental insured patients were more likely to reside in-state than privately insured. Insurance had no association with abortion intent or completion. However, when the interaction term was introduced, in-state residents with private insurance had higher risk of abortion consideration (relative risk [RR] = 2.17, 95% confidence interval [CI]: 1.02-4.60) but not completion (RR = 1.94, 95% CI: 0.86-4.40) versus out-of-state private insurance patients. In a sub-analysis, abortion consideration and completion did not differ pre- vs. post-2019 Illinois Reproductive Health Act. CONCLUSION: Abortion consideration for spina bifida is associated with insurance status and state-of-residence. Fetal care centers that serve regions of the country should be aware of the sociopolitical and economic differences of their patient catchment. Further evaluation of state-specific restrictions on insurance coverage for abortion care may elucidate barriers to the spectrum of spina bifida management options. KEY POINTS: · Abortion consideration is associated with joint modeling of state-of-residence and insurance status.. · Insurance payor among those who considered and completed abortion was not altered by the Illinois Reproductive Health Act (RHA).. · Counseling for spina bifida should include considerations for insurance status and state-of-residence..
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe