BACKGROUND: Prehypertension during pregnancy is currently not considered as a high-risk pregnancy state in existing guidelines despite recent research correlating it with higher rates of morbidity and mortality in both the mother and the fetus. Studies on prehypertension have not been conducted in Africa despite high rates of poor neonatal outcomes.
OBJECTIVE: The study aimed to determine the association between late pregnancy prehypertension and adverse outcomes in newborns of women with late pregnancy prehypertension at Jinja Regional Referral Hospital.
METHODS: Between September 2022 and January 2023, a hospital-based prospective cohort study including 300 pregnant women was conducted. Participants were divided according to third-trimester blood pressure, as determined by the JNC-8 criteria. Following hospital admission for labor and delivery, 150 normotensive women and 150 prehypertensive women were identified and followed until delivery, and their neonates were followed until death or hospital discharge. A p value of ≤ 0.05 was the threshold for statistical significance when comparing the groups using the relative risk, X2, and Mantel-Haenszel adjustment.
RESULTS: Composite adverse neonatal outcomes were more common in prehypertensive women compared to normotensive women (48.67% versus 32.67%), particularly Small-for-Gestation Age (SGA), stillbirth, and composite adverse neonatal outcomes had significantly higher likelihood, with aRRs of 1.63 (95% CI 1.10-2.42, p = 0.037), 9.0 (95% CI 1.15-70.16, p = 0.010), and 1.55 (95% CI 1.16-2.08, p < 0.001), respectively. By a linear model, birthweight decreased by 45.1 g for every 10 mmHg rise in systolic blood pressure (p = 0.041, Pearson correlation of -0.118).
CONCLUSIONS: Prehypertension in late pregnancy increased risks for adverse neonatal outcomes, thus a need to potentially lower pregnancy hypertension cut-off levels possibly through adopting the ACC/AHA blood pressure definitions for pregnant women.

This study was conducted to determine the predictive effect of insomnia on quality of life in last trimester pregnant women. This study is a cross-sectional study. The sample of the study consisted of 309 women who were pregnant in the last trimester and were followed up in the university hospital. The data was collected using Women\'s Health Initiative Insomnia Rating Scale(WHIIRS), World Health Organization Quality of Life Scale Short Form(WHOQOL-BREF). The Kolmogorov-Smirnov test was used to evaluate compliance with the normal distribution. Pearson correlation test used to examine the relationships between life quality subscales, discomforts during pregnancy, chronic disease, psychiatric disease, working status and insomnia. Hierarchical multiple linear regression analysis was used to determine the predictive factors of quality of life. There was a negative relationship between having problems in pregnancy and the physical domain and the psychological domain of quality of life. When working status and discomforts during pregnancy were controlled, it was determined that insomnia was an important predictor of physical, psychological, social relations and environmental areas of quality of life (respectively 21%, 6%, 5%, 4%,). As a result, it can be said that insomnia is one of the important areas that should be intervened to improve the quality of life in pregnant women.
Cette étude a été menée pour déterminer l\'effet prédictif de l\'insomnie sur la qualité de vie des femmes enceintes au dernier trimestre. Il s\'agit d\'une étude transversale. L\'échantillon de l\'étude était composé de 309 femmes enceintes au dernier trimestre et suivies à l\'hôpital universitaire. Les données ont été recueillies à l\'aide de l\'échelle d\'évaluation de l\'insomnie de la Women\'s Health Initiative (WHIIRS), de l\'échelle abrégée de la qualité de vie de l\'Organisation mondiale de la santé (WHOQOL-BREF). Le test de Kolmogorov-Smirnov a été utilisé pour évaluer la conformité à la distribution normale. Le test de corrélation de Pearson a été utilisé pour examiner les relations entre les sous-échelles de qualité de vie, les désagréments pendant la grossesse, les maladies chroniques, les maladies psychiatriques, le statut professionnel et l\'insomnie. Une analyse de régression linéaire multiple hiérarchique a été utilisée pour déterminer les facteurs prédictifs de la qualité de vie. Il y avait une relation négative entre le fait d\'avoir des problèmes pendant la grossesse et le domaine physique et le domaine psychologique de la qualité de vie. En prenant en compte le statut professionnel et les désagréments pendant la grossesse, il a été déterminé que l\'insomnie était un prédicteur important de la qualité de vie physique, psychologique, sociale et environnementale (respectivement 21 %, 6 %, 5 %, 4 %). Par conséquent, on peut dire que l\'insomnie est l\'un des domaines importants sur lesquels il faut intervenir pour améliorer la qualité de vie des femmes enceintes.

BACKGROUND: Short cervical length in the mid-trimester is a powerful predictor of preterm birth. However, clinical significance of cervical length in the third trimester for predicting preterm birth has not been established yet.
OBJECTIVE: To examine the predictive role of a shortened cervix in the third trimester for preterm birth in women who had a normal cervical length in the second trimester STUDY DESIGN: : This retrospective cohort study included women who underwent cervical length measured at least once in both the second trimester (16+0 weeks to 27+6weeks) and the early third trimester (28+0 weeks to 33+6weeks). Women with short cervical length in the second trimester, those with multiple pregnancies, those who underwent cerclage operation, and those who had iatrogenic preterm birth were excluded. The study population were divided into two groups based on cervical length in the third trimester: a short cervix (≤ 25 mm) group and a control group (> 25 mm). Rates of preterm birth (< 37 weeks) were compared between two groups. Predictive performances of cervical length in the third trimester for preterm birth were assessed.
RESULTS: Women with a short cervical length at 28+0 to 33+6 weeks accounted for 12.6% (n = 717) of the total study population (n = 5,682). Preterm birth rate was 9.5% in the short cervix group, which was significantly higher than that (3.2%) in the control group (p < 0.001). The adjusted odds ratio for short cervical length on preterm birth was 2.73 (95% CI: 1.96-3.79). A short cervix in the third trimester had a sensitivity of 30.1%, a specificity of 88.1%, a positive predictive value of 9.5%, and a negative predictive value of 96.8% in predicting preterm birth. The addition of third-trimester cervical length to the predictive model significantly increased the area under the curve from 0.64 (95% CI: 0.60-0.68) to 0.67 (95% CI: 0.63-0.71) (p = 0.002), demonstrating improved predictive performance.
CONCLUSIONS: Approximately 13% of women with normal cervical length in the mid-trimester had a short cervical length after 28 weeks, which increased the risk of preterm birth. The high specificity and negative predictive value of third-trimester cervical length measurements underscore their critical utility in identifying women at low risk for preterm delivery.

BACKGROUND: Sleep Disorder Breathing (SDB) in pregnant patients ranges from 3 to 27% and varies depending on gestational age and method used to diagnose. SDB increases the risk of advanced pregnancy complications such as gestational diabetes mellitus, pregnancy-induced hypertension, and preeclampsia. Screening and diagnosis of SDB during pregnancy remains a challenge, with existing screening tools underperforming during pregnancy. This study aimed to validate a previously developed model for predicting SDB during late pregnancy and compare the predictive value of bedpartner responses.
METHODS: Ninety-six women in the third trimester of pregnancy underwent polysomnography and completed the Berlin Questionnaire (BQ), with 81 bedpartners completing the BQ about their pregnant partner. A subset of BQ items (snoring volume and tiredness upon awakening) along with BMI > 32 kg/m2 was utilised to calculate the Wilson Optimized Model (WOM), which demonstrated strong predictive properties in development.
RESULTS: SDB (RDI/hr ≥ 5) was detected in 43.8% of women. BQ identified 72% of pregnant mothers as high risk for SDB (Sensitivity = 83%, Specificity = 37%), compared to 29% of mothers identified by the WOM (Sensitivity = 45%, Specificity = 83%). At RDI of ≥ 15, the WOM correctly classified more women according to SDB risk than the BQ (76.0% vs. 41.7% cases correct, X2(1) = 23.42, p < .001), with no difference at RDI ≥ 5. Bedpartners were more likely to report high risk for SDB on the WOM than pregnant women themselves (38.3% vs. 28.4%), however predictive ability was not improved by bedpartner input (RDI ≥ 5 bedpartner AUC = 0.69 v mother AUC = 0.73).
CONCLUSIONS: BQ largely overestimates the prevalence of SDB in pregnancy compared to the WOM which underestimates. Utilising bedpartner responses didn\'t improve screening for SDB in late pregnancy. More work is needed to develop a pregnancy-specific tool for quick and accurate screening for SDB.

Branch retinal artery occlusion is a rare cause of sudden vision loss. New-onset visual disturbances are considered a severe feature of preeclampsia and an indication for delivery regardless of gestational age. This report describes the management of a primigravida at 31 weeks of gestation, with multiple comorbidities, who presented with preeclampsia and a new dark spot in her vision. After extensive workup, her branch retinal artery occlusion was not attributable to her preexisting comorbidities nor an undiagnosed thrombophilia. Multidisciplinary collaboration and close observation enabled delay of delivery until 34 weeks of gestation without detriment and substantially mitigated the risks of preterm birth. Her visual defect was stable and permanent. This seems to be the first case in the literature to describe branch retinal artery occlusion diagnosed simultaneously with preeclampsia in the third trimester. Branch retinal artery occlusion may not be a severe feature of preeclampsia requiring delivery.

暂无摘要。

OBJECTIVE: To examine the association between elevated blood pressure (BP) in the early third trimester and cardiometabolic health 10-14 years after delivery.
METHODS: This is a secondary analysis from the prospective HAPO FUS (Hyperglycemia and Adverse Pregnancy Outcome Follow-Up Study). Blood pressure in the early third trimester was categorized per American College of Cardiology/American Heart Association thresholds for: normal BP below 120/80 mm Hg (reference), elevated BP 120-129/below 80 mm Hg, stage 1 hypertension 130-139/80-89 mm Hg, and stage 2 hypertension 140/90 mm Hg or higher. Cardiometabolic outcomes assessed 10-14 years after the index pregnancy were type 2 diabetes mellitus and measures of dyslipidemia, including low-density lipoprotein (LDL) cholesterol 130 mg/dL or higher, total cholesterol 200 mg/dL or higher, high-density lipoprotein (HDL) cholesterol 40 mg/dL or lower, and triglycerides 200 mg/dL or higher. Adjusted analysis was performed with the following covariates: study field center, follow-up duration, age, body mass index (BMI), height, family history of hypertension and diabetes, smoking and alcohol use, parity, and oral glucose tolerance test glucose z score.
RESULTS: Among 4,692 pregnant individuals at a median gestational age of 27.9 weeks (interquartile range 26.6-28.9 weeks), 8.5% (n=399) had elevated BP, 14.9% (n=701) had stage 1 hypertension, and 6.4% (n=302) had stage 2 hypertension. At a median follow-up of 11.6 years, among individuals with elevated BP, there was a higher frequency of diabetes (elevated BP: adjusted relative risk [aRR] 1.88, 95% CI, 1.06-3.35; stage 1 hypertension: aRR 2.58, 95% CI, 1.62-4.10; stage 2 hypertension: aRR 2.83, 95% CI, 1.65-4.95) compared with those with normal BP. Among individuals with elevated BP, there was a higher frequency of elevated LDL cholesterol (elevated BP: aRR 1.27, 95% CI, 1.03-1.57; stage 1 hypertension: aRR 1.22, 95% CI, 1.02-1.45, and stage 2 hypertension: aRR 1.38, 95% CI, 1.10-1.74), elevated total cholesterol (elevated BP: aRR 1.27, 95% CI, 1.07-1.52; stage 1 hypertension: aRR 1.16, 95% CI, 1.00-1.35; stage 2 hypertension: aRR 1.41 95% CI, 1.16-1.71), and elevated triglycerides (elevated BP: aRR 2.24, 95% CI, 1.42-3.53; stage 1 hypertension: aRR 2.15, 95% CI, 1.46-3.17; stage 2 hypertension: aRR 3.24, 95% CI, 2.05-5.11) but not of low HDL cholesterol.
CONCLUSIONS: The frequency of adverse cardiometabolic outcomes at 10-14 years after delivery was progressively higher among pregnant individuals with BP greater than 120/80 in the early third trimester.

OBJECTIVE: Depressive symptoms during the perinatal period have broad and enduring health implications for birthing parents and their offspring. Rising prevalence rates of perinatal depression highlight the need for research examining factors influencing depressive symptoms during pregnancy, and trajectories during the early postnatal period. Grounded in bioecological systems theory, this longitudinal multimethod study examined whether prenatal bioecological factors predict depressive symptoms from pregnancy to 36 months postpartum.
METHODS: Participants were 162 pregnant individuals, oversampled for high emotion dysregulation, who completed a life stress interview and physiological assessment during the 3rd trimester and a self-report measure of depression at five time-points (3rd trimester, within 48 h of birth, 7, 18, and 36 months postpartum). Multilevel models were used to test study aims.
RESULTS: Participants exhibited the highest levels of depressive symptoms at 3rd trimester, and substantial variability in depressive symptom trajectories over time. Lower resting respiratory sinus arrhythmia (RSA), an index of parasympathetic nervous system functioning, in the 3rd trimester was associated with higher concurrent depressive symptoms. Higher levels of stress related to partner relationships, finances, and health were concurrently associated with more depressive symptoms during pregnancy and decreases in depressive symptoms over time. Specifically, depressive symptoms decreased only for individuals who reported high levels of stress during pregnancy.
CONCLUSIONS: Although grounded in bioecological systems theory, this study did not assess the macrosystem.
CONCLUSIONS: Results of this study underscore the importance of multilevel predictors of perinatal health and highlights potential targets for preventing depression and promoting well-being during the perinatal transition.

BACKGROUND: A paucity of data exists to inform the use of interleukin (IL)-6 receptor antibodies (anti-IL-6) in pregnancy, particularly in the third trimester. This study aimed to describe outcomes of pregnant women and their neonates exposed to these medications given after the first trimester to treat COVID-19.
METHODS: In this retrospective cohort study, we included all women with COVID-19 who were treated with an anti-IL-6 during pregnancy at two tertiary hospitals in London, UK-Guy\'s and St Thomas\' NHS Foundation Trust and Imperial College Healthcare NHS Trust-between March 1, 2020, and Sept 30, 2022. Maternal demographics, clinical data, administered medications, and maternal and neonatal outcomes were assessed for all included women via a review of medical records and through maternal medicine networks.
RESULTS: 25 women received an anti-IL-6 for COVID-19 in pregnancy during the study period and were followed up for 12 months. The group described were a population at high risk, with 24 requiring level two or three critical care. 24 women received tocilizumab and one received sarilumab. All women were prescribed at least three concomitant medications. 16 received the anti-IL-6 in the third trimester of pregnancy and nine during the seocnd trimester. There were no women with maternal neutropenia or pancytopenia; increases in liver enzymes in 16 of 20 women with available alanine aminotransferase data were in keeping with the severity of COVID-19 reported and all three women who developed a secondary bacterial infection mounted a C-reactive protein response. There was one maternal death due to COVID-19. All pregnancies resulted in livebirths and there was one twin pregnancy. 16 of 26 babies were born preterm. One baby died at age 6 months due to complications of extreme prematurity. A transient neonatal cytopenia was described in six of 19 babies in whom a full blood count was performed. Although these findings are likely to be in keeping with prematurity alone, we cannot exclude the possibility that transplacental transfer of anti-IL-6 was contributory.
CONCLUSIONS: We report further data on the use of anti-IL-6 in the second and third trimesters of pregnancy for the management of COVID-19. When extrapolated, our data can inform shared decision making for individuals who would benefit from the use of anti-IL-6 into the third trimester of pregnancy for management of rheumatological disease.
BACKGROUND: None.

Evidence suggests that maternal metabolome may be associated with child health outcomes. We analyzed the association between the maternal metabolome between 28-35 gestational weeks and child growth and development during the first year. A prospective cohort of 98 mother-child dyads was followed at birth, 1, 6, and 12 months. Maternal serum samples were collected for targeted LC-MS/MS analysis, which measured 132 metabolites. The child\'s growth and development were assessed at each time-point. Z-scores were calculated based on WHO growth standards, and the domains of development were assessed using the Ages and Stages Questionnaires (ASQ-3). Multiple linear mixed-effects models were performed and confounders were identified using a Diagram Acyclic Graph. The Benjamini-Hochberg correction was used for multiple comparison adjustments. We found a positive association between lysophosphatidylcholines (14:0; 16:0; 16:1; 17:0; 18:0; 18:1; 18:2; 20:4) with the z-score of weight-for-age, and lysophosphatidylcholines (14:0; 16:0; 16:1; 18:0) and taurine with the z-score of weight-for-length, and lysophosphatidylcholines (14:0; 16:0; 16:1; 17:0; 18:0; 18:1; 18:2; 20:4) and glycine with the z-score of BMI-for-age. The leucine, methionine, tryptophan, and valine were negatively associated with the fine motor skills domain. We observed an association between maternal metabolome and the growth and child\'s development throughout the first year.