American Journal Of Perinatology[JOURNAL]
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200 papers
Association between NT-proBNP and Persistent Postpartum Hypertension among Individuals with Hypertensive Disorders of Pregnancy.
Shay R, Bennett C, Smith C … +5 more , Catov J, Jeyabalan A, Gandley R, Countouris M, Hauspurg A
Am J Perinatol · 2026 Apr · PMID 41962554 · Publisher ↗
OBJECTIVE: This study aimed to evaluate the association of N-terminal pro B-type natriuretic peptide (NT-proBNP) concentration during the delivery hospitalization with persistence of postpartum hypertension and postpartu...
OBJECTIVE: This study aimed to evaluate the association of N-terminal pro B-type natriuretic peptide (NT-proBNP) concentration during the delivery hospitalization with persistence of postpartum hypertension and postpartum blood pressure (BP) trajectory among individuals with hypertensive disorders of pregnancy (HDP). STUDY DESIGN: This was a single-site cohort study including individuals with new-onset HDP who participated in a remote BP monitoring program and an obstetric biobank. Postpartum BP data were collected from the delivery hospitalization, remote monitoring program, and outpatient visits. Correlations between log(NT-proBNP) and BP values were assessed, and outcomes were compared between low-NT-proBNP (defined as less than 150 pg/mL based on previously published reference intervals in pregnancy) and high-NT-proBNP (greater than or equal to 150 pg/mL) groups. RESULTS: A total of 111 individuals were included, with 31 (27.9%) in the low-NT-proBNP group and 80 (72.1%) in the high-NT-proBNP group. Log(NT-proBNP) had a weakly positive correlation with maximum postpartum systolic (SBP) and diastolic BP (DBP) during the delivery hospitalization. Persistent postpartum hypertension, defined as antihypertensive medication or stage two hypertension at 6 weeks postpartum, occurred in 40.0% of the high-NT-proBNP group versus 19.4% of the low-NT-proBNP group ( = 0.04). The high-NT-proBNP group also had significantly different maximum postpartum DBP during the delivery hospitalization (101 vs. 94 mm Hg, = 0.01), maximum SBP during remote monitoring (145 vs. 139 mm Hg, = 0.049), and likelihood of being on antihypertensive medication at 6 weeks postpartum (31.3 vs. 12.9%, = 0.048) and at any time between delivery and 6 weeks postpartum (48.8 vs. 22.6%, = 0.01) compared with the low-NT-proBNP group. The high- versus low-NT-proBNP groups had significantly different SBP trajectories over the first 14 days postpartum, with the greatest difference noted in the first 3 to 4 days. CONCLUSION: NT-proBNP measurement among individuals with HDP at the time of delivery may be useful in assessing risk for persistent postpartum hypertension. KEY POINTS: · This study examined the association between NT-proBNP and postpartum blood pressure (BP) outcomes.. · High NT-proBNP was associated with persistent postpartum hypertension.. · Postpartum SBP trajectory differed between high- and low-NT-proBNP groups.. · NT-proBNP may be useful in assessing risk for persistent postpartum hypertension..
Gabapentin and Opioid Coexposure During Pregnancy and Adverse Perinatal Outcomes: A Population-Based Study, 2020-2024.
Umer A, Berry JH, Lilly C … +6 more , Davis N, Ganoe M, Lefeber C, Breyel J, John C, Najib U
Am J Perinatol · 2026 Apr · PMID 41950956 · Publisher ↗
OBJECTIVE: This study aimed to examine the association between prenatal gabapentin exposure, with and without opioid coexposure, and adverse perinatal outcomes. STUDY DESIGN: We conducted a retrospective, population-base...
OBJECTIVE: This study aimed to examine the association between prenatal gabapentin exposure, with and without opioid coexposure, and adverse perinatal outcomes. STUDY DESIGN: We conducted a retrospective, population-based cohort study of all live singleton births in West Virginia from January 2020 to July 2024 ( = 77,059). Exposure was categorized as no exposure to gabapentin or opioids, gabapentin alone, opioids alone, or both. Outcomes included birth weight, gestational age, 5-minute APGAR, low birth weight (LBW, <2,500 g), preterm birth, small for gestational age (SGA), neonatal abstinence syndrome (NAS), NICU admission, and congenital anomalies. Logistic and linear regression models were adjusted for maternal age, race, nicotine, and other substance use. RESULTS: Of 77,059 births, 177 infants (0.23%) were exposed to gabapentin and 2,868 (3.72%) to opioids. Notably, 105 gabapentin-exposed infants (59.3%) were also exposed to opioids. Compared with the group with no exposure to gabapentin or opioid, exposure to gabapentin alone was associated with lower mean birth weight (AMD = -372.6 g, 95% CI: -500.0, -245.2), lower gestational age (AMD = -0.67 weeks, 95% CI: -1.10, -0.23), and higher odds of LBW (AOR = 3.77, 95% CI: 2.23, 6.34), SGA (AOR = 2.93, 95% CI: 1.74, 4.94), and NICU admission (AOR = 5.59, 95% CI: 3.47, 9.01). Coexposure with opioids was associated with a higher risk of preterm birth (AOR = 3.97, 95% CI: 2.64, 5.97), lower 5-minute APGAR (AMD = -0.23, 95% CI: -0.38, -0.07), and higher NAS incidence (89 vs. 43% with gabapentin alone and 77% with opioids alone). Gabapentin use alone was not significantly associated with preterm birth, 5-minute APGAR scores, or congenital abnormalities. CONCLUSION: These findings highlight the pattern of gabapentin use during pregnancy, including frequent co-use with opioids. Due to data limitations, causal inferences cannot be drawn. Further research with detailed exposure information and maternal comorbidities is needed to clarify risks and inform clinical care and long-term outcomes. KEY POINTS: · Prenatal gabapentin exposure occurred in 2.3 per 1,000 live births (2020-2024).. · Two-thirds of the gabapentin-exposed infants were also exposed to opioids.. · Co-exposed infants had higher rates of adverse outcomes than those with single-substance exposure..
The Role of Birth Plan in Shaping Maternal and Neonatal Outcomes: A Systematic Review and Meta-analysis of Randomized Controlled Trials.
Martin GCC, Servidoni ACP, Machado GF … +6 more , Habiro Alves L, Armstrong BBS, Rodrigues CG, Lemos MJ, Lopes MD, Zugaib M
Am J Perinatol · 2026 Apr · PMID 41950955 · Publisher ↗
OBJECTIVE: This systematic review and meta-analysis discuss how birth plans impact maternal and infant outcomes. Our main objective is to analyze maternal fear of childbirth, labor phases duration, delivery method, neona...
OBJECTIVE: This systematic review and meta-analysis discuss how birth plans impact maternal and infant outcomes. Our main objective is to analyze maternal fear of childbirth, labor phases duration, delivery method, neonatal admission, and early breastfeeding initiation. STUDY DESIGN: We systematically searched PubMed, Embase, and Cochrane Central for studies published from inception until July 2025. Only randomized controlled trials involving pregnant individuals in labor that compared birth plan use (written or verbal) to standard care without a plan were included. A random-effects meta-analysis was conducted through RStudio version 4.4.1 to pool prevalences and rates. Heterogeneity and sensitivity analyses were performed with leave-one-out analysis. We used version 2 of the Cochrane Risk-of-Bias Tool for quality assessment. RESULTS: Birth plans were associated with a higher likelihood of normal vaginal delivery (risk ratio [RR]: 3.22; 95% confidence interval [CI]: 1.49-6.95; = 0.003) and increased odds of early breastfeeding (RR: 3.68; 95% CI: 1.48-9.15; = 0.005). No significant benefits were observed for episiotomy rates (RR: 0.47; 95% CI: 0.02-10.49; = 0.636) or labor augmentation (RR: 0.65; 95% CI: 0.30-1.41; = 0.274). Risk of bias was low across all studies. CONCLUSION: Birth plans may be associated with improved maternal outcomes, including increased rates of vaginal delivery, and early breastfeeding. The overall evidence suggests birth plans as a strategy to promote a more respectful childbirth. KEY POINTS: · Birth plans were associated with increased likelihood of vaginal delivery.. · Birth plan increased rates of early breastfeeding.. · The overall evidence suggests birth plans as a strategy to promote a more respectful childbirth..
Preserving Access to Evidence-Based Preventive Services in Pregnancy and Postpartum: The Impact of Kennedy v. Braidwood Supreme Court Decision.
Kumar NR, Fendrick AM, Zivin K … +1 more , Dalton VK
Am J Perinatol · 2026 Apr · PMID 41950954 · Publisher ↗
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Rates of Fetal Growth Restriction and Small for Gestational Age Neonates by COVID-19 Epochs: Did the Pandemic Affect Fetal Biometry Measurements?
Stortz S, Culhane J, Lundsberg L … +2 more , Partridge C, McAdow M
Am J Perinatol · 2026 Apr · PMID 41946476 · Publisher ↗
OBJECTIVE: This study aimed to examine rates of fetal growth restriction (FGR) and small for gestational age (SGA) neonates before, during, and after the COVID-19 pandemic. STUDY DESIGN: We retrospectively evaluated pati...
OBJECTIVE: This study aimed to examine rates of fetal growth restriction (FGR) and small for gestational age (SGA) neonates before, during, and after the COVID-19 pandemic. STUDY DESIGN: We retrospectively evaluated patients with singleton deliveries ≥ 22 weeks of gestation in a single hospital system from March 2018 to December 2022. Patients were assigned to one of three COVID-19 epochs: acute-COVID-19, based on gestational age < 20 weeks on February 3, 2020, and estimated due date before January 1, 2021; pre-COVID-19 and postacute-COVID-19 epochs consisted of patients with matched months 2 years before and after the acute-COVID-19 epoch. Outcomes were FGR and SGA; FGR was defined by International Classification of Diseases-10 codes, and SGA was defined by birthweight < 10th percentile, using the Aris distribution for gestational age and neonatal sex. Patient attributes were compared across COVID-19 epochs, FGR, and SGA separately, using chi-square tests or ANOVA, as appropriate. Crude and adjusted logistic regression models were performed, including covariates associated with each dependent variable. RESULTS: A total of 9,692 patients were included; differences across COVID-19 epochs were observed for advanced maternal age, body mass index ≥ 30 at delivery, smoking, chronic hypertension, hypertensive disorders of pregnancy, number of prenatal care visits, and ultrasounds. Patients in the acute- and post-COVID-19 epochs had an increased odds of FGR (aOR: 1.76, 95% CI: 1.44-2.16 and aOR: 1.64, CI: 1.38-1.94, respectively) compared with the pre-COVID-19 epoch. Compared with the pre-COVID-19 epoch, patients in the acute-COVID-19 epoch had reduced odds of SGA (aOR: 0.80, 95% CI: 0.65-0.98). CONCLUSION: During the acute-COVID-19 epoch, FGR diagnosis increased compared with pre-COVID-19, while SGA at birth decreased. This highlights the limitation of prenatal ultrasound for precisely identifying fetuses at the highest risk of FGR, which may be due to confirmation bias or broad diagnostic criteria for FGR. KEY POINTS: · We found no significant difference in the number of prenatal visits across COVID-19 epochs.. · The rate of FGR increased during the acute-COVID-19 epoch, while the rate of SGA decreased.. · Incongruence of FGR and SGA rates highlights the limitation of ultrasound to precisely identify at-risk fetuses..
Social Determinants of Health, Perceived Stress Scores, and Adverse Pregnancy Outcomes.
Saiki K, Lim E, Riel J … +6 more , Benny P, Gragas A, Stevenson M, Stevens J, Lee MJ, Yamasato K
Am J Perinatol · 2026 Apr · PMID 41946475 · Publisher ↗
OBJECTIVE: This study aimed to evaluate self-reported first-trimester perceived stress and social needs and their associations with subsequent pregnancy adverse outcomes in a cohort in Hawai'i. STUDY DESIGN: In this sing...
OBJECTIVE: This study aimed to evaluate self-reported first-trimester perceived stress and social needs and their associations with subsequent pregnancy adverse outcomes in a cohort in Hawai'i. STUDY DESIGN: In this single-center prospective cohort study, patients with singleton pregnancies were recruited from 2021 to 2022 at the time of routine first trimester genetic screening. Participants completed surveys assessing social needs and perceived stress. Pregnancy adverse outcomes, including preterm birth, hypertensive disease of pregnancy, small for gestational age, large for gestational age, and gestational diabetes, were obtained through chart review. Associations between reported social needs, perceived stress, and adverse outcomes were evaluated using multivariable logistic regressions, adjusting for demographic factors. RESULTS: Out of 351 participants, 141 (40.2%) experienced at least one adverse pregnancy outcome. For the composite adverse outcome, participants who reported food insecurity had lower odds of the composite outcome than those who did not (odds ratio = 0.47, 95% confidence interval = 0.23-0.92). No associations were observed between social needs and individual adverse outcomes. High perceived stress scores were also not associated with composite or individual adverse outcomes. CONCLUSION: In this socially and medically high-risk Pacific-Island cohort, self-reported first trimester social needs and perceived stress scores overall were not associated with subsequent adverse pregnancy outcomes, with the exception of decreased adverse outcomes in those reporting food insecurity. These findings add to the limited data on the complex interactions between social needs, psychological stress, and pregnancy outcomes, and suggest that alternative pathways for evaluation are needed. The manifestations of perceived stress in this culturally unique population appear to differ from other Western cohorts. KEY POINTS: · Food insecurity is associated with decreased adverse outcome.. · Perceived stress score is not associated with adverse outcomes.. · Interactions among social needs, stress, and outcomes are complex..
Renal Effects of Aminophylline in Cooled Neonates with Hypoxic-Ischemic Encephalopathy.
Baştuğ O, Canpolat A, Kafadar D … +2 more , Özdemir A, Baştuğ F
Am J Perinatol · 2026 Apr · PMID 41932345 · Publisher ↗
OBJECTIVE: This study aimed to evaluate the renal effects and safety of adjunct aminophylline therapy in neonates with hypoxic-ischemic encephalopathy (HIE) undergoing therapeutic hypothermia (TH). STUDY DESIGN: This ret...
OBJECTIVE: This study aimed to evaluate the renal effects and safety of adjunct aminophylline therapy in neonates with hypoxic-ischemic encephalopathy (HIE) undergoing therapeutic hypothermia (TH). STUDY DESIGN: This retrospective cohort study included neonates ≥36 weeks and >2,000 g diagnosed with HIE and treated with TH between May 2018 and January 2025. Infants were classified into two groups: those receiving TH alone (TH group) and those given a single intravenous 8 mg/kg dose of aminophylline at the initiation of cooling (TH + A group). Demographic, perinatal, and laboratory characteristics were collected, and serial serum creatinine (sCr) measurements at 24, 48, 72, and 96 hours were analyzed to compare renal and clinical outcomes. RESULTS: A total of 297 infants were included (TH: 210; TH + A: 87). Baseline demographic and clinical characteristics were similar between the groups. While sCr values at each fixed time point did not significantly differ, repeated-measures analysis demonstrated a significantly steeper decline in sCr over time in the TH + A group ( < 0.001). Convulsions were more frequent in the TH + A group (23.0 vs. 10.5%, = 0.005), whereas mortality and other major clinical outcomes were comparable. CONCLUSION: Aminophylline administration at the start of TH was associated with a steeper decline in serum creatinine, suggesting a potential renoprotective effect in neonates with HIE. However, the higher frequency of convulsions emphasizes the need for careful neurological monitoring. Further studies are needed to clarify optimal dosing and the balance between potential renal benefits and neurological risks. KEY POINTS: · Aminophylline did not change creatinine at fixed time points in cooled HIE.. · A steeper creatinine decline with aminophylline suggests a more favorable pattern of renal recovery.. · Convulsions were more frequent with aminophylline, requiring close monitoring..
Composite Biometry versus Head Circumference Alone in Second Trimester Dating of Twin Gestations: A Retrospective Cohort Study.
Chunn RA, Raiciulescu S, DeYoung TH … +3 more , Stortz SK, Lutgendorf MA, Thagard AS
Am J Perinatol · 2026 Apr · PMID 41916412 · Publisher ↗
OBJECTIVE: To establish the due date in a singleton gestation in the second trimester, U.S. societal guidelines recommend using a composite of the fetal biparietal diameter, head circumference, abdominal circumference, a...
OBJECTIVE: To establish the due date in a singleton gestation in the second trimester, U.S. societal guidelines recommend using a composite of the fetal biparietal diameter, head circumference, abdominal circumference, and femur length. In twin pregnancies, evidence supports using either the head circumference or composite biometry of the larger twin. Our objective was to compare the accuracy of these two approaches in determining the true gestational age of twin gestations. STUDY DESIGN: We conducted a retrospective cohort study of dichorionic, diamniotic gestations conceived with assisted reproductive technologies between 2006 and 2016, excluding fetuses with major anomalies that could impact accurate dating, pregnancies complicated by loss of one or both twins, or higher-order multiple gestations reduced to twins. The earliest second-trimester ultrasound study for each subject was reviewed and the gestational age was calculated using head circumference alone and composite biometry based on Hadlock's formulas. Paired sample statistics were used to calculate the mean difference in days from the observed versus true gestational age to assess the accuracy of each strategy and represented graphically using Bland-Altman plots. RESULTS: A total of 179 subjects with a second-trimester ultrasound were identified that met criteria over the 10-year period. Ultrasounds were performed at a mean gestational age of 19.9 days (range: 14.43-26.14). Use of head circumference alone resulted in a mean absolute difference of 3.11 days from the true gestational age (standard deviation [SD]: 4.51, standard error mean [SEM]: 0.34). Composite biometry resulted in a mean absolute difference of 1.74 days (SD: 3.60; SEM: 0.27). The difference of approximately 1 to 2 days was significant ( < 0.001). CONCLUSION: In our twin population, the use of composite biometry of the larger twin more accurately approximates gestational age compared with head circumference alone, though the difference between the two approaches is modest. KEY POINTS: · Head circumference or composite biometry is used to date twins.. · In our study, composite biometry improved accuracy.. · The difference between the two was modest (1-2 days)..
Transcranial Doppler Evaluation of Cerebral Hemodynamics in Term and Preterm Chinese Neonates Aged < 7 days: A Retrospective Cohort Study.
Shi S, Wen D, Zheng W … +1 more , Yang XF
Am J Perinatol · 2026 Apr · PMID 41895304 · Publisher ↗
The objective of this study is to establish normative transcranial Doppler (TCD)-derived cerebral blood flow values in term and preterm neonates and to assess differences between groups and their associations with gestat...
The objective of this study is to establish normative transcranial Doppler (TCD)-derived cerebral blood flow values in term and preterm neonates and to assess differences between groups and their associations with gestational age and anthropometric parameters.A retrospective cohort study was performed on 46 neurologically and hemodynamically stable neonates admitted to the Neonatal Ward of Zhongshan City People's Hospital between April and August 2025. TCD examinations of the anterior (ACA), middle (MCA), and posterior cerebral arteries (PCA) were completed within the first postnatal week in both term and preterm infants. Cerebral hemodynamic parameters-peak systolic velocity, end-diastolic velocity, mean velocity, pulsatility index, and resistance index-were compared between groups and correlated with gestational age, birth weight, and occipitofrontal head circumference.Hemodynamic findings showed that compared with term neonates, preterm neonates showed significantly lower blood flow velocities in the left MCA. In contrast, preterm infants exhibited significantly higher vascular resistance in multiple cerebral arteries, with the increase being more pronounced in the right hemisphere. Standardized linear regression analyses showed that gestational age and birth weight (BW) were positively associated with vascular velocity in both ACA and MCA. Models for left MCA flow velocities demonstrated moderate explanatory power ( values ranging from 0.25 to 0.34).Term and preterm neonates exhibited distinct hemodynamic profiles on TCD within the first 7 days of life. The most pronounced difference between the two groups was observed in the MCA. BW demonstrated the strongest association with these hemodynamic differences. · Normative TCD cerebral flow data established in Chinese neonates <7 days.. · Term neonates showed higher velocities and lower resistance than preterm.. · Birth weight showed the strongest association with MCA flow velocity..
The Clinical Benefit of Adding Weight of Blood-Soaked Materials to Quantification of Postpartum Blood Loss.
Wiley RL, Ghose I, Mendez-Figueroa H … +1 more , Chauhan SP
Am J Perinatol · 2026 Mar · PMID 41895300 · Publisher ↗
The objective of this study is to evaluate whether full quantitative blood loss (FBL), which incorporates the weight of blood soaked materials, improves the prediction of hemorrhage-related clinical decision-making compa...
The objective of this study is to evaluate whether full quantitative blood loss (FBL), which incorporates the weight of blood soaked materials, improves the prediction of hemorrhage-related clinical decision-making compared with volumetric blood loss (VBL) using calibrated drapes alone.We performed a secondary analysis of an IRB-approved retrospective cohort including all deliveries over 2 years at a large, urban academic center. During the study period, a quantitative blood loss protocol was introduced without other changes to hemorrhage management. VBL consisted of calibrated drape measurement with visual estimation of laps and clots, while FBL additionally included weighing of soaked materials. The primary outcome was hemorrhage intervention, defined as transfusion, surgical management of atony, balloon tamponade, ICU admission, or hysterectomy. Predictive performance of VBL and FBL was compared using receiver operating characteristic curves and area under the curve (AUC). Secondary outcomes included uterotonic use, correlation with peripartum hemoglobin change, and a subgroup analysis of vaginal deliveries with blood loss of 500 to 1,000 mL.Among 8,359 deliveries, 1,524 (18.4%) had both VBL and FBL recorded, allowing direct comparison. Overall, hemorrhage intervention occurred in 5.4% of deliveries. There was no significant difference in predicting intervention in either the direct-comparison group or the full cohort. In the paired sample, VBL better predicted uterotonic use than FBL (AUC: 0.713 vs. 0.680, p¼0.02). FBL identified more deliveries as having abnormal blood loss and more cases meeting PPH criteria; however, this did not translate into higher intervention rates. Both methods correlated modestly with hemoglobin change, explaining <13% of variance, with no meaningful difference between approaches.When calibrated drapes are used, adding weighing of blood-soaked materials provides minimal additional clinical value in predicting hemorrhage interventions or physiologic impact. These findings support streamlined blood loss quantification strategies, particularly in low-resource settings where simplicity and efficiency are critical. · Full quantification of blood loss increases rate of PPH classification without increase in severe morbidity.. · The addition of weighing blood soaked materials does not better detect hemorrhage related morbidity.. · Volumetric assessment of blood loss alone may be sufficient..
The Utility of Transcutaneous Bilirubin Measurement in Newborns with Hyperbilirubinemia: A Prospective, Observational Study during and after Phototherapy.
Besnili Acar D, Yilmaz Semerci S
Am J Perinatol · 2026 Apr · PMID 41887606 · Publisher ↗
OBJECTIVE: This study aimed to evaluate the accuracy of transcutaneous bilirubin (TcB) measurements during and after phototherapy (PT) in term and late-preterm infants. STUDY DESIGN: In this prospective, observational st...
OBJECTIVE: This study aimed to evaluate the accuracy of transcutaneous bilirubin (TcB) measurements during and after phototherapy (PT) in term and late-preterm infants. STUDY DESIGN: In this prospective, observational study, TcB levels were measured at both the glabela (covered skin) and the lower abdomen (covered by the diaper) during treatment, then 12 and 24 hours after discontinuing the PT. Total serum bilirubin (TSB) levels were simultaneously collected through a blood sample. The agreement between TcB and TSB levels during and after PT was evaluated using Bland-Altman plots. RESULTS: A total of 90 newborn infants and 540 paired bilirubin values were included in this study. The findings indicate that despite a moderate correlation with TSB levels, TcB measurements underestimate TSB levels. CONCLUSION: This study indicates a moderate correlation and agreement between TcB measurements and TSB levels in term and late-preterm infants undergoing PT, with a tendency to underestimate TSB values and considerable variability between the two methods. Hence, TcB measurements cannot be relied upon as a substitute for TSB measurements during and after PT. KEY POINTS: · TcB measurements show moderate correlation with TSB levels.. · Transcutaneous bilirubin measurements tend to underestimate total serum bilirubin levels, which may lead to potential undertreatment.. · Measurements from the lower abdomen are more practical for the evaluation of TcB.. · Transcutaneous bilirubin measurement is not a reliable substitute for total serum bilirubin levels in clinical settings during and after phototherapy.. · Further studies are needed to assess the accuracy of transcutaneous bilirubin measurements beyond 24 hours post-phototherapy..
Harnessing Large Language Models in Neonatal Intraventricular Hemorrhage: Exploring Retrieval Augmented Generation Methodology for Prognostic Variable Discovery.
Arora T, Beam K
Am J Perinatol · 2026 Mar · PMID 41871598 · Publisher ↗
The objective of this study is to evaluate whether large language models (LLMs) can autonomously synthesize existing literature and accurately extract prognostic variables for neonatal intraventricular hemorrhage (IVH) a...
The objective of this study is to evaluate whether large language models (LLMs) can autonomously synthesize existing literature and accurately extract prognostic variables for neonatal intraventricular hemorrhage (IVH) and its outcomes while assessing their capability for clinical feature ranking and risk stratification.This pilot study employed a systematic literature review combined with retrieval-augmented generation (RAG) methodology. GPT 4 (OpenAI) and Claude Sonnet (4.0, Anthropic) were prompted to identify peer-reviewed studies utilizing machine learning and deep learning to predict IVH outcomes in preterm neonates. Data extraction was prompted to follow TRIPOD artificial intelligence (AI) guidelines, capturing study design, population characteristics, predictor variables, and outcome measures. Semi-automated RAG extraction was performed with manual validation to mitigate hallucination risk.LLMs initially identified 39 studies, with 28 meeting some or all the validation criteria after excluding references that were hallucinated. From these, 14 distinct prognostic predictors were extracted across four outcome domains: mortality, progression, complications, and resolution. Universal high-impact predictors included gestational age (13 mentions; 41%), birth weight (8 mentions, 25%), and Apgar scores (11 mentions, 34%). Variables were categorized into three clinical tiers based on frequency, outcome breadth, and modifiability. A preliminary risk stratification model demonstrated high-risk neonates (<28 weeks, <1,000g, Apgar <3) with estimated progression risk >70%, and mortality >50%, while low-risk neonates (>32 weeks, >1,500 g, Apgar > 5) showed favorable trajectories.This study demonstrates that LLMs can synthesize medical literature and extract clinically relevant prognostic variables for neonatal IVH outcomes. However, LLM outputs were susceptible to hallucinations and incomplete data synthesis, underscoring the need for rigorous clinical oversight and human validation to ensure reliability. The identified universal predictors provide a foundation for developing AI-assisted clinical decision support tools. Notable research gaps include the complete absence of resolution prediction studies and limited investigation of complication predictors, highlighting opportunities for future investigation in precision neonatology. · LLMs can synthesize medical literature. · LLMs can assist in creating a prognostic ontology. · Human oversight is critical when using LLMs for healthcare.
Pancreas Size and Fat Content Increase during Pregnancy and Correlate with Glycemic Control.
Widen EM, Dube S, Harris I … +8 more , van Heukelum M, Do J, Dulaney A, Janumala I, Luci JJ, Harper LM, Cahill AG, Virostko J
Am J Perinatol · 2026 Mar · PMID 41871597 · Full text
The pancreas plays a critical role in adapting to the increased metabolic demands and insulin resistance of pregnancy. In rodents, beta cell proliferation during pregnancy induces pancreas growth, but whether similar cha...
The pancreas plays a critical role in adapting to the increased metabolic demands and insulin resistance of pregnancy. In rodents, beta cell proliferation during pregnancy induces pancreas growth, but whether similar changes occur in the human pancreas remains unknown. This study characterizes longitudinal changes in the size and composition of the pancreas during pregnancy and postpartum, and examines correlations with breastfeeding, adiposity, and metabolic assays.Sixty-one pregnant women were followed up to three visits during pregnancy (15, 25, and 35 weeks) and three postpartum (6 weeks, 6 months, and 12 months). MRI was conducted to assess pancreas, spleen, and kidney size as well as pancreas, liver, and whole-body adiposity. Glucose tolerance testing was performed at 24 to 28 weeks' gestation. In a subset of participants ( = 58), additional glucose assays were performed at 15 weeks' gestation. Pancreas size was normalized for concurrently measured body weight to calculate pancreas volume index (PVI).The size of the pancreas increased by approximately 20% from 15 to 35 weeks' gestation ( < 0.001) and declined postpartum. PVI was positively correlated with whole-body fat mass ( = 0.12) and fasting blood glucose ( = 0.18) at 15 weeks' gestation. Higher pancreas fat content at 15 weeks predicted impaired response to glucose challenge 10 weeks later ( = 0.33). PVI was low, and pancreatic fat was high at 15 weeks in two participants who were subsequently diagnosed with gestational diabetes mellitus. Any breastfeeding 1-year postpartum correlated with a smaller decline in PVI from 35 weeks' gestation to 1-year postpartum ( < 0.05).Pancreas size and fat content change dynamically during pregnancy and postpartum, and correlate with glucose levels, prenatal adiposity, and breastfeeding. · The pancreas adapts to the metabolic demands of pregnancy by increasing in size and shrinking postpartum.. · Small pancreas size and high pancreas fat content early in pregnancy may predict subsequent abnormal glucose tolerance.. · Breastfeeding 1-year postpartum was associated with a smaller decline in pancreas size compared to those who were not breastfeeding..
Post-Traumatic Stress Disorder, Anxiety, and Depression in Patients after Undergoing Cesarean Hysterectomy for Placenta Accreta Spectrum Disorder.
Oberlin A, Collado FK, Monk C … +8 more , D'Antonio K, Hesham H, Angley M, Overton E, Ilagan JG, Ring LE, Meritens AB, Mourad M
Am J Perinatol · 2026 Mar · PMID 41862222 · Publisher ↗
Medically complicated pregnancies and deliveries can lead to adverse mental health outcomes, including post-traumatic stress disorder (PTSD). However, few studies have examined mental health outcomes after surgery for pl...
Medically complicated pregnancies and deliveries can lead to adverse mental health outcomes, including post-traumatic stress disorder (PTSD). However, few studies have examined mental health outcomes after surgery for placenta accreta spectrum (PAS). Our aim was to identify prevalence of PTSD, anxiety, and depression in patients who underwent hysterectomy for PAS. We sought to understand whether more complex or emergent surgery was associated with a higher prevalence of PTSD and whether physical symptoms such as pelvic pain were correlated with patients' mental health outcomes.This was a cross-sectional study of patients who underwent a cesarean hysterectomy for PAS between January 2018 and August 2023 at a single urban hospital. Patients were recruited 6 months or more following surgery. The survey consisted of validated questionnaires (National Stressful Events Survey short scale for symptoms of PTSD, General Anxiety Disorder, and Patient Health Questionnaire) and clinical data were abstracted from the medical record.During the study period, 100 patients underwent a hysterectomy for PAS, of which 61 completed the survey. Patients most frequently screened positive for PTSD (/ = 13/61, 21.3%), followed by anxiety (/ = 10/61, 16.4%) and depression (/ = 8/61, 13.1%). The prevalence of anxiety and depression was similar to the patients' self-reported diagnosis prior to surgery. The prevalence of PTSD was not affected by severe maternal morbidity or urgency of the surgical case. However, pelvic floor symptoms, specifically urge incontinence, were associated with PTSD, anxiety, and depression.In patients who undergo cesarean hysterectomy for PAS, nearly a quarter may experience PTSD symptoms, higher than the general postpartum population. Given the high prevalence of symptoms and the lack of specific patient risk factors associated with PTSD, all patients with PAS should be offered mental health services before and after delivery. · Patients who undergo hysterectomy for PAS experience high prevalence of PTSD.. · Emergent surgery and severe morbidity are not associated with postpartum PTSD, anxiety, or depression.. · Adverse mental health outcomes are associated with pelvic floor symptoms, such as incontinence..
Plain Language Summary of Publication: Design of the Global Prospective Hemolytic Disease of the Fetus and Newborn Registry (GERANIUM).
Tjoa ML, Orillion A, Mankoski R … +6 more , Imran N, Mao C, Krumme A, Van Hoorde S, Linares-Rivas Rico B, Komatsu Y
Am J Perinatol · 2026 Mar · PMID 41862210 · Publisher ↗
This article is a plain language summary of publication (PLSP) of the following article: "Study Design of the Global Prospective Hemolytic Disease of the Fetus and Newborn Registry (GERANIUM)" by Tjoa et al published by...
This article is a plain language summary of publication (PLSP) of the following article: "Study Design of the Global Prospective Hemolytic Disease of the Fetus and Newborn Registry (GERANIUM)" by Tjoa et al published by the on March 20, 2026. This PLSP describes the design of the GERANIUM registry, which will collect data to help researchers understand how doctors manage hemolytic disease of the fetus and newborn (HDFN) in clinical settings. Researchers will also study outcomes related to the health and well-being of pregnant participants affected by HDFN, their children, and their families over time. This PLSP aims to help the general public, including those affected by HDFN, and health care professionals understand the design of the GERANIUM registry. · Data reflecting today's clinical care of HDFN are lacking.. · GERANIUM is a registry collecting real-world data on HDFN.. · Design of the GERANIUM registry is described.. · HDFN-related outcomes are collected during pregnancy.. · Infant outcomes will be recorded up to 2 years after birth..
Study Design of the Global Prospective Hemolytic Disease of the Fetus and Newborn Registry (GERANIUM).
Tjoa ML, Orillion A, Mankoski R … +6 more , Imran N, Mao C, Krumme A, Van Hoorde S, Linares-Rivas Rico B, Komatsu Y
Am J Perinatol · 2026 Mar · PMID 41862209 · Publisher ↗
Hemolytic disease of the fetus and newborn (HDFN) is a rare and serious immune-mediated condition that can result in poor fetal and neonatal outcomes. During pregnancy, monitoring with middle cerebral artery Doppler ultr...
Hemolytic disease of the fetus and newborn (HDFN) is a rare and serious immune-mediated condition that can result in poor fetal and neonatal outcomes. During pregnancy, monitoring with middle cerebral artery Doppler ultrasound and intrauterine transfusions (IUTs) are the current standard of care, although intravenous immunoglobulin (IVIg) has been adopted in some centers to attempt to delay the onset of fetal anemia. Significant gaps remain in understanding the safety and effectiveness of current HDFN management, both during pregnancy and in neonates and children. We present the design of the Global Prospective Hemolytic Disease of the Fetus and Newborn Registry (GERANIUM; ClinicalTrials.gov Identifier: NCT07194070), a study that will provide real-world, prospective, longitudinal data on management, clinical course, and outcomes of HDFN from the antenatal period up to 2 years after birth.GERANIUM is a prospective, observational study enrolling alloimmunized pregnant individuals (aged ≥18 years) before 24 weeks of gestational age who are at high risk for HDFN based on previous obstetric history. This study will enroll approximately 175 participants across multiple global sites. Data collected during pregnancy include fetal loss, frequency and severity of HDFN, treatment patterns, as well as effectiveness and adverse outcomes of IUTs and other interventions. Following birth, infants will be followed for the first 2 years of life, with documentation of HDFN sequelae, including treatments, growth, and development. Impact on the parents and children will be assessed using validated participant- and observer-reported outcome measures.The GERANIUM registry will provide prospective, contemporaneous data on current management of HDFN and associated outcomes. · HDFN can result in fetal loss or poor long-term outcomes.. · IUT and IVIg can be associated with serious complications.. · Impacts of HDFN on patients' quality of life are unclear.. · GERANIUM will provide contemporaneous data on HDFN care.. · Prospective data for mothers/infants will be collected..
When Pushing Is Not Enough: A Novel Description of Maternal Characteristics and Delivery Outcome.
Farago N, Bachar G, Amir A … +6 more , Siegler Y, Vitner D, Khatib N, Beloosesky R, Weiner Z, Zipori Y
Am J Perinatol · 2026 Mar · PMID 41856509 · Publisher ↗
Operative vacuum delivery (VD) is often used to expedite safe vaginal births for various reasons, including maternal exhaustion (MEX), which accounts for about 30% of cases. This study identifies risk factors associated...
Operative vacuum delivery (VD) is often used to expedite safe vaginal births for various reasons, including maternal exhaustion (MEX), which accounts for about 30% of cases. This study identifies risk factors associated with vacuum deliveries for MEX and evaluates maternal and neonatal outcomes compared to other indications.A retrospective cohort study analyzed singleton-term vacuum deliveries from 2011 to 2022 at a tertiary care center, categorizing patients into two groups: Those with MEX (group 1) and those without (group 2). Statistical analyses included chi-square tests, -tests, Mann-Whitney tests, and multivariable logistic regression.Out of 2,950 vacuum deliveries, 819 (27.8%) were indicated for exhaustion. Exhausted mothers were more likely to be nulliparous (75 vs. 71%, = 0.028), have gestational diabetes (7.7 vs. 5.4%, = 0.047), and use regional anesthesia (92.4 vs. 89.1%, = 0.006). They also experienced longer labor durations, with a second stage averaging 2.86 hours versus 2.54 hours in the non-exhausted group ( < 0.001). While postpartum hemorrhage and chorioamnionitis rates were higher in the exhaustion group, neonatal outcomes did not differ significantly. The duration of the second stage was found to increase the odds of MEX by 53% for each additional hour (OR = 1.53 [95% CI: 1.10-1.64]).Women in the exhaustion group had distinct characteristics linked to prolonged labor. Despite some complications, VD for MEX was safe for both mothers and neonates, suggesting a need for targeted interventions to mitigate exhaustion during labor. · Maternal exhaustion accounts for 30% of vacuum births.. · Higher maternal morbidity is observed in the exhaustion group.. · Neonatal outcomes are comparable between groups.. · Vacuum delivery for exhaustion remains a safe option.. · An intervention to reduce exhaustion is needed..
The Association of Maternal Body Fat Distribution with Cesarean Delivery, Spontaneous Labor, and Perinatal Morbidity in Women with Body Mass Index ≥ 40 kg/m2.
Subramaniam A, Owen J, Blanchard C … +4 more , Jauk V, Chandler-Laney P, Szychowski J, Tita A
Am J Perinatol · 2026 Mar · PMID 41856366 · Publisher ↗
The objective of this study is to evaluate the relationship between late and third-trimester ultrasonographic/anthropometric measures of central adiposity and cesarean delivery in patients with body mass index (BMI) ≥ 40...
The objective of this study is to evaluate the relationship between late and third-trimester ultrasonographic/anthropometric measures of central adiposity and cesarean delivery in patients with body mass index (BMI) ≥ 40 kg/m and compare their predictive value to BMI alone.Prospective observational cohort study of patients receiving prenatal care and delivering at a single center (2018-2021). Individuals with nonanomalous singleton pregnancies and either BMI ≥ 40 kg/m or normal BMI between 32 and 36 weeks were included. In both BMI groups, individuals with delivery < 36 weeks, prior cesarean, and contraindication to vaginal birth were excluded. Patients underwent a study visit > 36 weeks at which 19 central adiposity measures (ultrasonographic and anthropometric), fat distribution indices (e.g., abdominal fat index [aFI]) and BMI (predictive exposures) were obtained by trained research and ultrasound personnel. For our primary analysis (BMI ≥ 40 kg/m), the primary outcome was cesarean. Measurement exposures were evaluated at alpha = 0.05 using backward selection multivariable logistic regression to generate a parsimonious model. Receiver operator characteristic curves with area under the curve (AUC) assessed the model's predictive ability; AUCs for BMI and the parsimonious model were compared. A planned analysis included women with normal BMI.Of 611 individuals screened, 265 were eligible, 217 consented, and 201 met all study criteria and were analyzed: 149 with BMI ≥ 40 kg/m (mean BMI: 45.4 ± 5.2; cesarean rate: 21%). A model of maximum preperitoneal fat depth above the umbilicus, below umbilicus aFI, and subxiphoid aFI (all < 0.05) was significantly more predictive of cesarean (AUC: 0.76; 95% confidence interval [CI]: 0.67-0.86) than BMI alone (AUC: 0.60; 95% CI: 0.49-0.71; = 0.002). When analyzing the normal BMI group ( = 52), a six-measurement model had outstanding prediction (AUC: 0.97; 95% CI: 0.93-1.00)-exceeding BMI alone (AUC: 0.64; 95% CI: 0.49-0.78; < 0.001).Select maternal ultrasonographic fat depth measurements near delivery have significantly more predictive ability than BMI alone for cesarean delivery in patients with BMI ≥ 40 kg/m and should be further explored in those with normal BMI. · Select maternal ultrasound adiposity measurements were more predictive of cesarean than BMI in women with BMI ≥ 40 kg/m2.. · Select adiposity measurements may be more predictive of cesarean than BMI in women with normal BMI ≤ 25 kg/m2.. · There was outstanding prediction of cesarean using these measures in women with normal BMI.. · Select ultrasonographic fat depth measurements near delivery have more predictive ability for cesarean than BMI..
Where's the Cord Gas? Variation in Umbilical Cord Blood Gas Sampling in High-Risk Deliveries.
Eiler IT, Zhang J, Yan K … +4 more , Cabacungan E, Fitzgerald G, Polnaszek BE, Cohen SS
Am J Perinatol · 2026 Mar · PMID 41856365 · Publisher ↗
Umbilical cord blood gas (UCBG) sampling provides biochemical data to identify patients who may benefit from encephalopathy screening, but no standardized national guidelines are currently available. We aimed to determin...
Umbilical cord blood gas (UCBG) sampling provides biochemical data to identify patients who may benefit from encephalopathy screening, but no standardized national guidelines are currently available. We aimed to determine the prevalence of UCBG sampling in high-risk deliveries at a level IV perinatal center in the absence of standardized collection guidelines and to describe subsequent hospital courses among deliveries without UCBG sampling.This was a single-center retrospective cohort study of high-risk deliveries at ≥36 weeks gestation from 2019 to 2021. High-risk deliveries were defined by acute obstetric events, operative delivery, or 5-minute Apgar ≤ 5. UCBG sampling was classified as attempted, obtained (arterial pH documented), or not attempted. Maternal, intrapartum, and neonatal characteristics were compared between attempted and not-attempted groups, and subgroup analyses evaluated infants without UCBG sampling to identify patients who qualified for encephalopathy screening.The study cohort was comprised of 1,144 (11%) high-risk deliveries, of which 1,034 remained after exclusions. UCBG sampling was attempted in 655 (63%) deliveries, and arterial results were obtained in 541 (52%). Among 131 neonatal intensive care unit (NICU) admissions, 105 (80%) had UCBG sampling attempted, and 83 (63%) had arterial results available. Among 41 NICU admissions with respiratory diagnoses and available admission blood gases, 5 met biochemical criteria for encephalopathy screening, and only 1 had a documented comprehensive neurological examination.The lack of standardized guidelines leads to inconsistent UCBG sampling in high-risk deliveries, highlighting the need for standardized UCBG screening criteria and coordinated obstetric-neonatal workflows. · UCBG sampling is the first red flag for hypoxic-ischemic encephalopathy detection.. · Lack of UCBG guidelines leads to inconsistent sampling.. · Establishment of UCBG sampling guidelines can limit practice variation..
Evaluating Perceived Control in the Inpatient Antepartum Setting: Development and Validation of a Novel Antepartum Agentry Scale.
Soehl JR, Ayala NK, Griffin LB … +2 more , Miller ES, Clark MA
Am J Perinatol · 2026 Mar · PMID 41850327 · Publisher ↗
Antepartum hospitalization during pregnancy can compromise patients' sense of control and are associated with higher rates of depression or anxiety. There are no validated scales that measure this sense of control in thi...
Antepartum hospitalization during pregnancy can compromise patients' sense of control and are associated with higher rates of depression or anxiety. There are no validated scales that measure this sense of control in this hospitalized setting. The authors adapted the Labour Agentry Scale (LAS) to the antepartum inpatient setting by developing and preliminarily validating a novel Antepartum Agentry Scale (AAS).Fifty-nine candidate statements were derived from the LAS original source material. These statements were iteratively reviewed in three rounds using a content valuation index by Maternal Fetal Medicine providers, resulting in 25 statements that comprised the AAS. The AAS, Patient Health Questionnaire (PHQ-9), and General Anxiety Disorder (GAD-7) scale were administered to 50 individuals hospitalized for a complication during pregnancy. Factor analysis was performed to assess construct validity and evaluate whether the AAS measured a construct distinct from the PHQ-9 or GAD-7. The AAS scores were then classified as "Low," "Average," or "High" based on the mean score and standard deviation in the study population. Fisher's exact test was used to evaluate the relation between scores on the AAS and scores of 10 or higher on the PHQ-9 and GAD-7.The AAS had a Cronbach alpha of 0.902. Factor analysis demonstrated minimal overlap between the AAS and items on the PHQ-9 or GAD-7. There was a significant relationship between "Low," "Average," and "High" AAS scores and PHQ-9 scores of 10 or more (67 vs. 13 vs. 10%, = 0.003) and GAD-7 of 10 or more (67 vs. 19 vs. 0%, = 0.002).Those with higher agentry are less likely to concurrently report clinically significant symptoms of depression or anxiety. Initial results suggest strong internal consistency of the AAS, which may measure a construct distinct from measures of depression or anxiety. · The LAS is a measure of perception of control during labor and delivery.. · The AAS was adapted from the LAS focusing on antenatal hospitalization.. · Higher scores on the AAS inversely correlated with symptoms of anxiety and depression.. · The AAS has strong internal consistency with a Cronbach's alpha of 0.902.. · The AAS appears to measure a construct distinct from the PHQ-9 or GAD-7..
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