Collin-Bund V, Pierrat M, Zilliox M
… +7 more, Minella C, Begusic N, Montoya Y, Mersch V, Sananès N, Arnalsteen C, Weingertner AS
J Matern Fetal Neonatal Med
· 2026 Dec · PMID 42402436
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INTRODUCTION: Congenital cytomegalovirus (CMV) infection remains the most common congenital infection worldwide. The implementation of systematic first-trimester CMV screening during pregnancy has been widely debated. In...INTRODUCTION: Congenital cytomegalovirus (CMV) infection remains the most common congenital infection worldwide. The implementation of systematic first-trimester CMV screening during pregnancy has been widely debated. In June 2025, the French National Authority for Health recommended nationwide screening in pregnant women. This study aimed to describe maternal-fetal transmission, neonatal infection, and pregnancy outcomes following the implementation of early CMV screening within a regional perinatal network prior to national adoption. MATERIALS AND METHODS: We conducted a retrospective multicenter observational study in three maternity units in Alsace between April 2021 and November 2023. Eligible patients had a primary CMV infection diagnosed periconceptionally or during the first trimester, based on serological screening performed up to 14 weeks of gestation. The primary objective of this study was to describe maternal-fetal transmission rates and neonatal outcomes following first-trimester CMV screening within a regional perinatal network. Secondary objectives included describing antenatal management strategies, including valaciclovir use, and pregnancy outcomes. RESULTS: Thirty-eight patients with primary CMV infection were identified among 29,657 deliveries during the study period. Valaciclovir was administered in 47% of cases. Amniocentesis was performed in 68% of patients, with three positive results. Neonatal CMV testing was available in 80% of live births. Three newborns tested positive for CMV at birth, and one pregnancy was medically terminated due to confirmed CMV infection. The overall rate of congenital CMV infection among infected mothers was 10.5%. CONCLUSION: Early CMV screening enabled identification and management of primary maternal infection in routine practice. However, the descriptive design and limited sample size preclude conclusions regarding clinical effectiveness or impact on vertical transmission.
J Matern Fetal Neonatal Med
· 2026 Dec · PMID 42392869
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BACKGROUND: Intrahepatic cholestasis of pregnancy (ICP) is linked with adverse perinatal outcomes; however, its impact in twin pregnancies remains unclear. This systematic review and meta-analysis aimed to evaluate mater...BACKGROUND: Intrahepatic cholestasis of pregnancy (ICP) is linked with adverse perinatal outcomes; however, its impact in twin pregnancies remains unclear. This systematic review and meta-analysis aimed to evaluate maternal and neonatal outcomes in twin pregnancies complicated by ICP. METHODS: A comprehensive search of PubMed, Embase, Web of Science, and Scopus was conducted from inception to 14 February 2026. Cohort studies comparing twin pregnancies with and without ICP were included. Random-effects meta-analyses were performed to assess maternal and neonatal outcomes reported by at least three studies. RESULTS: Seven retrospective cohort studies were included. ICP in twin pregnancies was associated with increased risk of cesarean delivery, preeclampsia, and gestational diabetes mellitus. Preterm birth (PTB) <37 weeks was significantly increased with ICP in both crude and adjusted analysis. Mean gestational age was significantly reduced, and birthweight was lower in ICP. ICP was strongly associated with meconium-stained amniotic fluid and increased neonatal intensive care unit (NICU) admission. However, no significant association was noted between ICP and stillbirth, small-for-gestational age and postpartum hemorrhage. CONCLUSIONS: ICP in twin pregnancies is associated with PTB and increased maternal and neonatal morbidity. Current evidence is derived mostly from crude data and from a limited number of studies with high inter-study heterogeneity.
Osmundo GS, Ruocco RMSA, Peres SV
… +1 more, Francisco RPV
J Matern Fetal Neonatal Med
· 2026 Dec · PMID 42392867
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OBJECTIVES: To evaluate clinical and immunological characteristics associated with adverse perinatal outcomes among pregnant people living with HIV (PPLH). METHODS: This retrospective cohort study included singleton preg...OBJECTIVES: To evaluate clinical and immunological characteristics associated with adverse perinatal outcomes among pregnant people living with HIV (PPLH). METHODS: This retrospective cohort study included singleton pregnancies of PPLH followed between 2006 and 2019 at a Brazilian tertiary referral center for high-risk pregnancies. Clinical and HIV-related data, including viral load (VL), CD4+ cell count, lymphopenia, and opportunistic infections (OI), were obtained from medical records. The primary endpoint was a composite adverse perinatal outcome defined as preterm birth (PTB) and/or low birth weight (LBW). Multivariable logistic regression was performed to identify factors independently associated with adverse outcomes. RESULTS: A total of 167 pregnancies were analyzed. The prevalence of the composite adverse perinatal outcome was 28.1%. Adverse outcomes were associated with previous opportunistic infection ( = 0.049), gestational opportunistic infection ( = 0.019), higher baseline viral load ( = 0.049), baseline lymphopenia ( = 0.002), lower body mass index ( = 0.044), lower CD4 cell count at 34 weeks ( = 0.014), and lack of viral suppression at 34 weeks ( = 0.008). In multivariable analysis, baseline VL (adjusted OR = 1.73, 95% CI = 1.10-2.99) and baseline lymphopenia (adjusted OR = 7.67, 95% CI = 1.37-42.8) remained independently associated with adverse perinatal outcomes. CONCLUSIONS: Adverse perinatal outcomes remain frequent among PPLH. Baseline viral load and lymphopenia were independently associated with PTB and/or LBW, highlighting the importance of early viral suppression and immune stabilization during pregnancy.
Conley PM, Newman RA, Esakoff T
… +1 more, Bello NA
J Matern Fetal Neonatal Med
· 2026 Dec · PMID 42379844
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OBJECTIVES: Extremes of maternal age are associated with an increased risk of adverse pregnancy outcomes (APOs). Less is known about the independent effects of extremes of paternal age on reproductive risk. METHODS: We c...OBJECTIVES: Extremes of maternal age are associated with an increased risk of adverse pregnancy outcomes (APOs). Less is known about the independent effects of extremes of paternal age on reproductive risk. METHODS: We conducted a secondary analysis using data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) using restricted cubic spline logistic regression to examine the non-linear association between paternal age and APOs and adverse fetal/neonatal outcomes. RESULTS: After adjusting for maternal health and sociodemographic and paternal sociodemographic confounders, we found no evidence of overall association (χ = 3.88, = 0.143) or non-linearity (χ = 1.72, = 0.189) between paternal age and composite APOs and adverse fetal/neonatal outcomes (Table 1). Additionally, after adjustment we did not find any statistical significance when examining separate composite APO outcomes (overall: χ = 3.02, = 0.221; non-linearity: χ = 2.68, = 0.101) or composite adverse fetal/neonatal outcomes (overall: χ = 1.73, = 0.421; non-linearity: χ = 0.14, = 0.706). Among adjusted individual outcomes, only gestational hypertension showed statistical significance for both overall association (χ = 6.72, = 0.035) and evidence of non-linearity (χ = 4.12, = 0.042). CONCLUSIONS: While our findings do not support a strong independent association between paternal age and composite APOs and adverse fetal/neonatal outcomes, the non-linear association with gestational hypertension may warrant further study with sufficient paternal age representation and paternal health factors.
Li Y, Wu F, Yang M
… +4 more, Feng X, Li L, Peng Y, Xie H
J Matern Fetal Neonatal Med
· 2026 Dec · PMID 42379842
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INTRODUCTION: Cesarean delivery during the second stage of labor is increasing, while the use of forceps is declining. Evidence on forceps in trial of labor after cesarean (TOLAC) is limited. We compared maternal and neo...INTRODUCTION: Cesarean delivery during the second stage of labor is increasing, while the use of forceps is declining. Evidence on forceps in trial of labor after cesarean (TOLAC) is limited. We compared maternal and neonatal outcomes between attempted forceps delivery and second-stage repeat cesarean (ssRCD) among TOLAC women, and compared forceps outcomes between TOLAC women and those with no prior cesarean (NPC). METHODS: This retrospective cohort study (2015-2022) included singleton, term, vertex pregnancies requiring immediate second-stage delivery due to fetal distress, prolonged second stage, or maternal compromise. Three groups were defined: fd-TOLAC (forceps delivery in TOLAC), ssRCD (second-stage repeat cesarean without attempted forceps), and fd-NPC (forceps delivery in women with NPC). Outcomes were compared between fd-TOLAC and ssRCD, and between fd-TOLAC and fd-NPC. RESULTS: A total of 176, 30, and 769 women were included in the fd-TOLAC, ssRCD, and fd-NPC groups, respectively. Compared to ssRCD, fd-TOLAC had lower postpartum hemorrhage (1.1% vs 20.0%; aOR 0.05, 95% CI 0.01-0.33), blood transfusion (4.0% vs 23.3%; aOR 0.15, 95% CI 0.04-0.57), and postpartum infection (1.7% vs 10.0%; aOR 0.06, 95% CI 0.01-0.58). One hysterectomy occurred in ssRCD (3.3%), compared with none in fd-TOLAC ( = 0.234). No significant differences were observed in neonatal outcomes between the groups. Maternal and neonatal outcomes did not differ between fd-TOLAC and fd-NPC ( > 0.05). CONCLUSION: In TOLAC women requiring second-stage delivery, clinically feasible low forceps was associated with lower maternal morbidity than ssRCD without increased neonatal risk. Forceps outcomes in TOLAC were comparable to NPC. Findings suggest the safety of attempted forceps in selected TOLAC patients.
J Matern Fetal Neonatal Med
· 2026 Dec · PMID 42379841
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PURPOSE: This study aims to evaluate and compare the effectiveness of the Binocular Indirect Ophthalmoscope (BIO) and the Wide-Field Fundus Imaging System (RetCam) in the diagnosis of Retinopathy of Prematurity (ROP). ME...PURPOSE: This study aims to evaluate and compare the effectiveness of the Binocular Indirect Ophthalmoscope (BIO) and the Wide-Field Fundus Imaging System (RetCam) in the diagnosis of Retinopathy of Prematurity (ROP). METHODS: We retrospectively reviewed routinely collected records from a standardized paired-screening workflow for preterm infants examined for ROP in outpatient and inpatient settings during 2020-2021. BIO was performed first by a senior pediatric ophthalmologist, followed within 10 min by RetCam3 imaging by another ophthalmologist. The paired BIO sketches and RetCam images were reviewed by three experienced ophthalmologists, and disagreements were resolved by consensus to establish an adjudicated reference standard for this study. The primary outcome was diagnostic accuracy for ROP zone, stage, plus/pre-plus disease, and lesion extent. RESULTS: A total of 796 eyes from 398 preterm infants (birth weight 1323.8 +/- 456.2 g; gestational age 29.8 +/- 2.9 weeks) were examined using both BIO and RetCam. Compared with the adjudicated reference standard, BIO and RetCam achieved AUCs of 0.997 and 0.995 for detecting any ROP, 0.983 and 0.982 for zone classification, and 0.999 and 0.959 for stage classification, respectively. RetCam misdiagnoses were most common in zone III and stage 1 disease. BIO showed lower agreement than RetCam for lesion extent ( < 0.001). CONCLUSION: BIO and RetCam showed complementary strengths in ROP screening. BIO provided clearer peripheral three-dimensional assessment of subtle stage and plus/pre-plus findings, whereas RetCam provided objective wide-field documentation of lesion distribution. A combined strategy may improve diagnostic confidence and clinical management for ROP.
Judge-Golden C, Kuehn S, Ellestad S
… +2 more, Dotters-Katz S, Craig AM
J Matern Fetal Neonatal Med
· 2026 Dec · PMID 42379839
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OBJECTIVE: As neonatal resuscitation is offered at increasing extremes of prematurity, ultrasound-derived estimated fetal weight (EFW) is a crucial data point in patient counseling. We aimed to evaluate the accuracy of E...OBJECTIVE: As neonatal resuscitation is offered at increasing extremes of prematurity, ultrasound-derived estimated fetal weight (EFW) is a crucial data point in patient counseling. We aimed to evaluate the accuracy of EFW compared to birthweight (BW) among periviable neonates, and identify factors associated with accuracy. METHODS: Medical records were abstracted for all neonates born between 22 weeks 0/7 days and 24 weeks 6/7 days at a single tertiary center between January 2013 and May 2024. Liveborn, non-anomalous neonates with an ultrasound-derived EFW within 7 days of delivery were included. The primary outcome was absolute percent difference between Hadlock 3 EFW and BW ("accuracy"), with BW as the primary predictor. Multivariable linear mixed effects regression was performed including maternal BMI and variables associated with accuracy in univariate analyses at < 0.1. RESULTS: 141 neonates from 129 pregnancies were included. Median gestational age at delivery was 23 4/7 weeks, median BW was 560 g [IQR 480, 640], and median time from EFW to delivery was 2 days [IQR 1-3 days]. Over half (55%) of pregnant individuals had BMI >30. Median accuracy was 7.1% [IQR 2.9%, 12.2%]. EFW was within 10%, 15% and 20% of BW in 65.3%, 82.3% and 92.2% of cases, respectively. In univariate analyses, decreasing BW was associated with reduced accuracy ( = -0.012 [-0.02, -0.0002], = 0.04), and multiple gestations were associated with increased accuracy (median accuracy 3.1% among fetuses with a twin versus 7.9% among singletons; = 0.002). Maternal BMI was not associated with accuracy ( = 0.08). In multivariable analyses accounting for multiple gestations, BW remained inversely associated with accuracy ( = -0.014 [-0.027, -0.001], = 0.03). Oligohydramnios was also associated with reduced accuracy ( = 3.47 [1.03, 5.91], = 0.005). CONCLUSIONS: Hadlock ultrasound-derived EFW is an overall reasonable predictor of BW among periviable deliveries, but demonstrated reduced accuracy among extremely low birthweight neonates and in the setting of oligohydramnios.
Guo Y, Zhang Z, Zhang Y
… +4 more, Cong J, Li L, Yi W, Chang M
J Matern Fetal Neonatal Med
· 2026 Dec · PMID 42373140
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OBJECTIVE: To evaluate the association between integrated midwife-led continuous labor support with postpartum care and maternal and neonatal outcomes, psychological resilience, and labor pain in primiparous women. METHO...OBJECTIVE: To evaluate the association between integrated midwife-led continuous labor support with postpartum care and maternal and neonatal outcomes, psychological resilience, and labor pain in primiparous women. METHODS: Medical records of 150 nulliparous women who delivered at Beijing Ditan Hospital between October 2023 and July 2025 were retrospectively reviewed. The observation group received continuous midwife-led support during labor with extended postpartum care, while the control group received standard obstetric care. Outcomes were assessed using the Labor and Delivery Efficiency and Quality Index (LBDI), Connor-Davidson Resilience Scale (CD-RISC), Delivery Pain Assessment System (DPAS), and Pain Tolerance-Recovery Response Index (PTRR). Relevant clinical data were analyzed to explore associated factors. Data were analyzed using SPSS 26.0 and AMOS 24.0. RESULTS: Compared with the control group, the observation group showed higher composite LBDI scores (8.43 ± 0.57 vs. 7.77 ± 0.65, < 0.001, Cohen's = 1.09), higher spontaneous vaginal delivery rates (95% vs. 76%, < 0.001), and higher 5-minute Apgar scores (9.4 ± 0.4 vs. 8.8 ± 0.6, < 0.001), along with reduced postpartum hemorrhage and lower incidence of fetal distress (all < 0.05). Psychological resilience and labor pain responses were better in the observation group ( < 0.05). CONCLUSION: Integrated midwife-led labor support with postpartum continuity of care was associated with better delivery outcomes and higher psychological resilience scores in primiparous women. Prospective studies are needed to confirm causality.
Ulfsdottir H, Åberg K, Jonsson M
… +1 more, Ekéus C
J Matern Fetal Neonatal Med
· 2026 Dec · PMID 42366156
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INTRODUCTION: Congenital uterine anomalies (UA) result in an increased risk for infertility and miscarriage but there are few population-based studies investigating the prevalence and associations between UA and pregnanc...INTRODUCTION: Congenital uterine anomalies (UA) result in an increased risk for infertility and miscarriage but there are few population-based studies investigating the prevalence and associations between UA and pregnancy and perinatal outcomes. MATERIAL AND METHODS: This nationwide cohort study includes 599 840 singleton births of primiparas from ≥22 gestational weeks in Sweden between 2010-2022. The risk for adverse pregnancy and perinatal outcomes was compared between women diagnosed with/or treated for UA and those without diagnoses for UA. Logistic regression was used to calculate adjusted odds ratios (aOR) with 95% confidence intervals (CI). RESULTS: There were 1101 (0.2%) women diagnosed with UA. Compared with no UA, UA were associated with an increased risk of preterm birth <34 weeks (aOR 9.10 CI [7.64-10.83]), breech presentation (aOR; 25.46 95% CI [22.59-28.70]), placental abruption (aOR; 5.09 95% CI [3.23-8.03]), emergency caesarean section (aOR: 2.96 [(2.60-3.3]), manual removal of placenta, (aOR:1.73 [1.29-2.33]) and infant small for gestational age (aOR; 2.60 95% CI [(2.11-3.21)]) but not with oligohydramnios, uterine rupture or chorioamnionitis. CONCLUSION: UA was associated with an increased risk of adverse perinatal and intrapartum outcomes, including, preterm birth, infant being small for gestational age, emergency caesarean section and maternal complications including bleeding and manual removal of the placenta. These findings highlight the importance of awareness of these pregnancies in clinical practice to support appropriate monitoring during pregnancy and intrapartum management. KEY MESSAGE: Women with congenital uterine anomalies face substantially higher risks of adverse pregnancy and birth outcomes in a nationwide Swedish cohort of primiparas. These findings add crucial knowledge to guide tailored antenatal and intrapartum care for women with known uterine anomalies.
J Matern Fetal Neonatal Med
· 2026 Dec · PMID 42366154
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BACKGROUND: Viral hepatitis during pregnancy represents a heterogeneous group of infections with distinct virological, immunological, and clinical characteristics, resulting in variable maternal and fetal outcomes. Hepat...BACKGROUND: Viral hepatitis during pregnancy represents a heterogeneous group of infections with distinct virological, immunological, and clinical characteristics, resulting in variable maternal and fetal outcomes. Hepatotropic viruses and non-hepatotropic agents may affect the liver during pregnancy, with clinical presentations ranging from asymptomatic conditions to severe complications such as acute liver failure. METHODS: This manuscript was conducted as a narrative review aimed at providing a comprehensive and clinically oriented overview of viral hepatitis during pregnancy, including epidemiology, virology, immunology, maternal and fetal outcomes, vertical transmission, screening strategies, prevention, and clinical management. A literature search was performed using the PubMed/MEDLINE, Scopus, Embase, and Google Scholar databases focusing primarily on articles published between January 2000 and June 2026. RESULTS: While hepatitis A generally follows a self-limited course, hepatitis B and C are frequently associated with chronic infection and risk of vertical transmission, and hepatitis E is notably linked to increased maternal morbidity and mortality, particularly in the third trimester. Vertical transmission is a central concern, especially for hepatitis B and C, being strongly influenced by maternal viral load, serological status, and obstetric factors. In hepatitis B, perinatal transmission remains a major route of infection, with high rates of chronicity in neonates. In hepatitis C, transmission rates are lower but clinically relevant, particularly in the presence of sexually transmitted coinfections. In contrast, hepatitis E is associated with severe maternal disease and adverse perinatal outcomes, including fetal death and prematurity. CONCLUSION: Diagnosis relies on clinical suspicion, laboratory evaluation, and specific serological and molecular tests, while screening strategies during prenatal care play a crucial role in early identification and risk stratification. Preventive measures, including vaccination, antiviral therapy, and neonatal immunoprophylaxis, are essential to reduce vertical transmission and improve outcomes. Despite advances, important gaps remain in understanding pathophysiology, optimizing treatment during pregnancy, and ensuring equitable access to care. A comprehensive approach is fundamental to reducing the burden of viral hepatitis in maternal and neonatal health.
Gojnić M, Dugalić S, Jovanović L
… +4 more, Ivanović K, Milinčić M, Lazarević A, Pavlović D
J Matern Fetal Neonatal Med
· 2026 Dec · PMID 42342558
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BACKGROUND: Placental morphometry reflects intrauterine conditions and may serve as an early marker of chronic uteroplacental insufficiency and adverse perinatal outcomes. Although antenatal ultrasound can provide indire...BACKGROUND: Placental morphometry reflects intrauterine conditions and may serve as an early marker of chronic uteroplacental insufficiency and adverse perinatal outcomes. Although antenatal ultrasound can provide indirect information on placental size and morphology, the present study was based on postnatal morphometric and histopathological placental assessment. OBJECTIVE: To evaluate the association between postnatal placental morphometric and histopathological features and perinatal outcomes. MATERIALS AND METHODS: Retrospective observational study of placentas from 443 singleton pregnancies was analyzed. Placentas were classified as appropriate for gestational age (AGA-P) or small for gestational age (SGA-P) according to placental weight percentiles. Morphometric parameters and histopathological lesions were compared with gestational age at delivery, birth weight, Apgar scores, and adverse perinatal outcomes. RESULTS: SGA-P placentas were associated with significantly earlier delivery, lower neonatal birth weight and lower 5-minute Apgar scores compared with AGA-P placentas ( < 0.05). Placental weight, disk weight, and surface area were markedly reduced in the SGA-P group across both comorbid and healthy pregnancies. Histopathological examination demonstrated a higher prevalence of basal plate inflammation, fibrinoid deposition, impaired basal plate perfusion, and vascular lesions in SGA-P placentas. Adverse outcomes were more frequent in SGA-P placentas, and placental surface area independently predicted adverse outcome among women with comorbidities. CONCLUSIONS: Combined postnatal morphometric and histopathological assessment of the placenta may provide valuable prognostic information and facilitate recognition of placental phenotypes associated with adverse perinatal outcomes. Reduced placental weight and surface area identify a distinct placental phenotype associated with chronic uteroplacental insufficiency and unfavorable neonatal outcomes. Future prospective studies should evaluate whether antenatal ultrasound markers of placental size and morphology correlate with postnatal placental findings and improve prenatal risk stratification.
Zhang Y, Peng K, Wang L
… +5 more, Jiang Y, He N, Zou J, Zhang L, Zhou L
J Matern Fetal Neonatal Med
· 2026 Dec · PMID 42342556
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OBJECTIVE: We evaluated the association between gestational weight gain (GWG) and preeclampsia (PE) in twin pregnancies and explored potential non-linear patterns in continuous GWG. METHODS: In this retrospective cohort...OBJECTIVE: We evaluated the association between gestational weight gain (GWG) and preeclampsia (PE) in twin pregnancies and explored potential non-linear patterns in continuous GWG. METHODS: In this retrospective cohort study, 331 women with twin pregnancies who delivered at a tertiary-level maternal hospital in Beijing, China, between January 2021 and December 2024 were included. Total GWG was calculated as the difference between weight at delivery admission and pre-pregnancy weight, and categorized according to the 2009 Institute of Medicine (IOM) recommendations. GWG was also analyzed as a continuous variable. The primary outcome was PE; secondary outcomes were gestational diabetes mellitus (GDM), postpartum hemorrhage (PPH), and premature rupture of membranes (PROM). Multivariable logistic regression models were used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Non-linear associations between continuous GWG and PE were assessed using restricted cubic splines. Multicollinearity among covariates was assessed before model fitting, and no evidence of substantial collinearity was identified. RESULTS: PE occurred in 10.6% of women. Compared with excessive GWG, both inadequate (aOR 0.22, 95% CI 0.07-0.66; = 0.007) and adequate GWG (aOR 0.39, 95% CI 0.16-0.98; = 0.04) were associated with lower risks of PE. Spline analyses indicated a non-linear relationship between continuous GWG and PE risk, with the lowest risk observed at moderate GWG levels. GWG categories were not significantly associated with GDM, PPH, or PROM. CONCLUSIONS: Moderate GWG was associated with the lowest risk of PE in twin pregnancies, whereas excessive GWG increased risk. These findings suggest that moderate GWG may be associated with a lower risk of PE in twin pregnancies. Further prospective studies are needed to clarify temporality and optimal GWG ranges in twin gestations.