Hypoglycaemia in screening oral glucose tolerance test in pregnancy with low birth weight fetus

Maternal hypoglycemia,a condition characterized by lower than normal blood glucose levels in pregnant women,has been increasingly associated with adverse pregnancy outcomes,including low birth weight(LBW)in neonates.LBW,defined as a birth weight of less than 2500 g,can result from various factors,including maternal nutrition,health status,and metabolic conditions like hypoglycemia.Maternal hypoglycemia may affect fetal growth by altering the supply of essential nutrients and oxygen to the fetus,leading to restricted fetal development and growth.This condition poses significant risks not only during pregnancy but also for the long-term health of the child,increasing the likelihood of developmental delays,health issues,and chronic conditions later in life.Research in this area has focused on understanding the mechanisms through which maternal hypoglycemia influences fetal development,with studies suggesting that alterations in placental blood flow and nutrient transport,as well as direct effects on fetal insulin levels and metabolism,may play a role.Given the potential impact of maternal hypoglycemia on neonatal health outcomes,early detection and management are crucial to minimize risks for LBW and its associated complications.Further investigations are needed to fully elucidate the complex interactions between maternal glucose levels and fetal growth,as well as to develop targeted interventions to support the health of both mother and child.Understanding these relationships is vital for improving prenatal care and outcomes for pregnancies complicated by hypoglycemia.

Intermittent Preventive Treatment in Pregnancy with Sulphadoxine-Pyrimethamine Does Not Have Effect on Maternal Hemoglobin at Delivery and Birth Weight in Kisangani, Democratic Republic of Congo

Background: The consequences of malaria during pregnancy are different regarding local conditions of malaria transmission. In stable malaria areas, the main complications are maternal anaemia and fetal growth restriction. This study aims to determine if pregnancy-associated malaria is associated with the risk of the above-mentioned complications and to determine if IPTp-sp reduces them in Kisangani. Methods: It is a cross-sectional analytical study conducted in parturients, in 6 medical facilities of Kisangani, from January 1st to September 30th, 2017. At delivery we measured their hemoglobin, we performed the thick blood smear of their peripheral blood and placental apposition;and we weighed their newborns at birth. Results: Risk of anaemia at delivery increased with malaria access during pregnancy (p = 0.0056;OR: 1.4221, 95% CI: 1.0851 - 1.8638) and peripheral parasitaemia at delivery (p = 0.0000;OR: 6.3855, 95% CI: 4.5552 - 8.9512). LBW increased with peripheral parasitaemia at delivery (p = 0.0000;OR: 3.5299, 95% CI: 2.4424 - 5.1015) and placental parasitaemia (p = 0.0000;OR: 18.3247, 95% CI: 12.5141 - 26.8332). IPTp-sp did not have effect on maternal hemoglobin at delivery (p = 0.1546;OR: 0.7553, IC à 95%: 0.4414 - 1.2923) and the birth weight (p = 0.1225;OR: 0.6638, IC à 95%: 0.3375 - 1.3056). Conclusion: In Kisangani, pregnancy-associated malaria is associated with maternal anaemia at delivery and LBW. IPTp-sp does not reduce the risk of these complications. Therefore, studies evaluating IPTp alternatives are required in malaria endemic areas.

Association of hypoglycaemia in screening oral glucose tolerance test in pregnancy with low birth weight fetus

BACKGROUND Gestational diabetes mellitus(GDM) is a common metabolic derangement in pregnant women. In the women identified to be at high risk of GDM, a 75 g oral glucose tolerance test(OGTT) at 24-28 wk gestation is the recommended screening test in the United Kingdom as per National Institute for Health and Care Excellence(NICE). Hypoglycaemia following the glucose load is often encountered and the implication of this finding for the pregnancy, fetus and clinical care is unclear.AIM To determine the prevalence of hypoglycaemia at any time during the screening OGTT and explore its association with birth weight.METHODS All deliveries between 2009 and 2013 at the local maternity unit of the University hospital were reviewed. Of the total number of 24,154 women without preexisting diabetes, those who had an OGTT for GDM screening based on NICE recommended risk stratification, who had a singleton delivery and had complete clinical and demographic data for analysis, were included for this study(n =3537). Blood samples for fasting plasma glucose(FPG), 2-hour plasma glucose(2-h PG) and HbA1 c had been obtained. Birth weight was categorised as low(≤ 2500 g), normal or Macrosomia(≥ 4500 g) and blood glucose ≤ 3.5 mmol/L was used to define hypoglycaemia. Binary logistic regression was used to determine the association of various independent factors with dichotomized variables; the differences between frequencies/proportions by χ~2 test and comparison between group means was by one-way ANOVA.RESULTS Amongst the study cohort(3537 deliveries), 96(2.7%) women had babies with LBW(< 2500 g). Women who delivered a LBW baby had significantly lower FPG(4.3 ± 0.6 mmol/L, P = 0.001). The proportion of women who had a 2-h PG ≤ 3.5 mmol/L in the LBW cohort was significantly higher compared to the cohorts with normal and macrosomic babies(8.3% vs 2.8% vs 4.2%; P = 0.007). The factors which predicted LBW were FPG, Asian ethnicity and 2-h PG ≤ 3.5 mmol/L,whereas maternal age, 2-h PG ≥ 7.8 mmol/L and HbA1c were not significant predictors.CONCLUSION A low FPG and 2-h PG ≤ 3.5 mmol/L on 75-gram OGTT are significantly associated with low birth weight in women identified as high risk for GDM.Women of ethnic backgrounds(Asians) appear to be more susceptible to this increased risk and may serve as a separate cohort in whom we should offer more intensive follow up and screening for complications. Cost implications and resources for follow up would need to be looked at in further detail to support these findings.

Heterotopic tubal pregnancy with live twin birth complicating ovulation induction assisted cycle

Heterotopic pregnancy is an uncommon clinical entity in Nigeria even though some of the risk factors are highly prevalent in the population. We report a case of heterotopic pregnancy following ovulation induction with clomiphene citrate. A favourable outcome resulting in live twin birth was recorded despite the presence of poor clinical features that affects pregnancy and foetal outcome.

Association between Pre-pregnancy Body Mass Index and Offspring Neuropsychological Development from 1 to 24 Months of Age: A Birth Cohort Study in China

Objective To explore the interactions between pre-pregnancy body mass index(BMI) and age on offspring neuropsychological development from 1 to 24 months in China.Methods In this birth cohort study, a total of 2,253 mother-child pairs were enrolled in Tianjin, China,between July 2015 and May 2018. The China Developmental Scale for Children was used to assess developmental quotient(DQ) of children aged from 1 to 24 months.Results Mixed-models analysis revealed significant age × pre-pregnancy BMI interactions for total DQ and five neurobehavioral domains(gross motor, fine motor, adaptive, language, and social;P < 0.001).Age × pre-pregnancy BMI ≥ 25 kg/m^2 was associated with a negative effect on total DQ and five neurobehavioral domains, as compared to pre-pregnancy BMI < 25 kg/m^2(P < 0.01). Multiple comparisons showed pre-pregnancy BMI ≥ 25 kg/m^2 of mothers had a positive effect on child total DQ at the age of 1 month but a negative effect at 24 months(P < 0.05).Conclusions This study supported the age × pre-pregnancy BMI interaction on offspring neuropsychological development. It also revealed a short-term positive impact of high pre-pregnancy BMI on neuropsychological development at 1 month of age, but a long-term negative effect(from 1 to24 months).

Birth outcomes and pregnancy complications of women with uterine leiomyoma—a population-based case-control study

Objective Uterine leiomyoma is not a rare pathological condition in pregnant women;thus the aim of the study was to evaluate the recent progress in the treatment of these pregnant women on the basis of the association of leiomyoma in pregnancy (LP) with pregnancy complications and birth outcomes including structural birth defects, i.e. congenital abnormalities (CA) in the offspring. Design Cases with CA and matched controls without CA in the population-based Hungarian Case-Control Surveillan- ce System of Congenital Abnormalities (HCC SCA) were evaluated. Only women with prospectively and medically recorded LP in prenatal maternity logbook and medically recorded birth outcomes (gestational age, birth weight, CA) were included to the study. Setting the HCCSCA, 1980-1996 contained 22,843 cases with CA and 38,151 matched controls without CA. Population Hungarian pregnant women and their informative offspring: live births, stillbirths and prenatally diagnosed malformed fetuses. Methods Comparison of birth outcomes of ca- ses with matched controls and pregnancy com- plications of pregnant women with or without LP. Main outcome measures Pregnancy complications, mean gestational age at delivery and birth weight, rate of preterm birth, low birthweight, CA. Results A total of 34 (0.15%) cases had mothers with LP compared to 71 (0.19%) controls. There was a higher incidence of threatened abortion, placental disorders, mainly abruption placentae and anaemia in mothers with LP. There was no significantly higher rate of preterm birth in the newborns of women with LP but their mean birth weight was higher and it associated with a higher rate of large birthweight newborns. A higher risk of total CA was not found in cases born to mothers with LP (adjusted OR with 95% CI = 0.7, 0.5-1.1), the spe- cified groups of CAs were also assessed versus controls, but a higher occurrence of women with LP was not revealed in any CA group. Con- clusions Women with LP have a higher risk of threatened abortion, placental disorders and anaemia, but a higher rate of adverse birth outcomes including CAs was not found in their offspring.

The Relationship between Drug－and Chemical－exposure and Birth Defects during Pregnancy

A case-control study was conducted in 36 hospitals of the urban and suburban areas of shanghai about the relationships between birth defects and drug use and chemical exposures during pregnancy in the period of july 1987-December 1990.The case group was composed if 1,609 subjects,and the control group 3,218 cases.On stall'stical analysl's,it was.found that a correlation ed'sted between birth defects and the intake Of APC and diazepam,and the exposure to pesticides,organic solvents.benzene,synthetic resin and physical.factors(noises)on foe part of foe mother.and the exposure to harmful chemicals and physical factors and the smoking of 20 or more cigarettes a day on the part Of the father.It is also found that foe familial heredilary history of the parents and multigravavidity,malnutrition,common colds,hepatitis and diarrhea during pregnancy may also be relaied to the birth defects.

Cervicovaginal Inflammatory Cytokines, Obesity and Inter-Pregnancy Interval Negatively Affect Pregnancy Duration in Pregnant Women at High-Risk for Recurrent Spontaneous Preterm Birth

Objectives: Evaluation of change of cervicovaginal fluid (CVF) cytokines’ levels during pregnancy and its relation to incidence of preterm birth (PTB). Patients & Methods: Pregnant women with history of PTB and cervical length α (TNF-α) and interleukins (IL)-6 and -10 levels. Study outcomes included differences in cytokines’ levels between samples and groups. Results: Sample-I cytokines’ levels were significantly higher in study than control women. Cytokines’ levels in Sample-II were significantly higher in control, while were significantly lower in study women compared to Sample-I. Sixteen study women had PTB and had significantly higher CVF levels of IL-10 and TNF-α estimated in both samples than women had no PTB. Pregnancy duration was negatively correlated with maternal body mass index (BMI) and cytokines’ levels, while was positively correlated with inter-pregnancy interval (IPI). Cytokines’ levels were positively correlated with BMI and negatively correlated with IPI. Short IPI and high TNF-α levels are negative predictors for pregnancy duration. Conclusion: High BMI, short IPI and high CVF inflammatory cytokines’ levels negatively affect pregnancy duration especially in women with history of recurrent PTB. Early prophylactic CC for women at high-risk of SPTB can modulate local immune disturbance, reduce incidence of SPTB and prolong pregnancy duration.

Efficacy of Danshen Injection Combined with Phosphocreatine Disodium in Treating Frequent Premature Contractions during Pregnancy and Its Effects on Maternal and Infant Outcomes

[Objectives]To explore the efficacy of Danshen Injection combined with phosphocreatine disodium in treating frequent premature contractions during pregnancy and its effect on maternal and infant outcomes.[Methods]A total of 200 pregnant women with normal pregnancy and frequent premature contractions who were treated in the outpatient department of internal medicine in Women and Children's Hospital of Hubei Province and Xinzhou District People's Hospital of Wuhan Central Hospital during September 2015 and October 2018 were selected and randomly divided into the control group and observation group,100 cases for each group.The observation group was treated with Danshen Injection combined with phosphocreatine disodium,and the control group was treated with phosphocreatine disodium alone.The course of treatment in both groups was one week.During the treatment,the changes of heart rate,heart rhythm,electrocardiogram and 24-h dynamic electrocardiogram(DCG)of both groups were observed.[Results]After treatment,the clinical efficacy of the observation group was better than that of the control group,and the difference was statistically significant(P<0.01).There were no adverse drug reactions in both groups.However,in the control group,non-sustained ventricular tachycardia(NSVT)was found in 24-h dynamic electrocardiogram(DCG)of 2 pregnant women with premature ventricular contraction.The pregnancy process was smooth,with full-term natural delivery and no fetal malformation.There was no significant difference in gestational age and neonatal weight between the two groups(P>0.05).However,there was a statistically significant difference in Apgar score between the two groups(P<0.05).During the 6-month postpartum follow-up,the mother and child were unharmed,and examination of repeated electrocardiograms showed that the conditions were normal.[Conclusions]Danshen Injection combined with phosphocreatine disodium has better efficacy in the treatment of frequent premature contractions during pregnancy and the maternal and infant outcomes than the treatment with phosphocreatine disodium alone,and it has good safety and can prevent premature contractions from progressing to tachyarrhythmias.

Birth experience of fathers in the setting of teenage pregnancy:Are they prepared?

AIM To explore the birth experiences of teenage fathers and determine the extent to which they are prepared for childbirth.METHODS A mixed methods observational study was undertaken comparing the birth experience of 50 fathers in the setting of teenage pregnancy(teenage) compared to a group of 50 older fathers. Fathers were recruited in the antenatal period and completed structured questionnaires following the birth of their child. Quantitative and qualitative analysis was undertaken.RESULTS Teenage fathers were younger, less educated and less likely to attend prenatal childbirth education classes(P < 0.0001). During birth, they were less prepared and consulted by attending staff(both P < 0.05). They reported limited roles in intrapartum decision-making(< 20%). In multivariate analysis being a father in the setting of teenage pregnancy remained significantly associated with feeling unprepared for birth. The major themes in qualitative analysis were feeling unprepared,shock, fear, a sense of detachment, happiness, pride, love of the baby and satisfaction with fertility.CONCLUSION Teenage fathers are less prepared for the birth of their child and this results in shock, fear and detachment that may impact on the early father-infant relationship.

Terminal Pregnancy Complicated by Measles and Premature Labor:a Case Report

Measles infection in pregnant women is a very dangerous clinical condition.Patients usually had complicated pneumonia,and virus could pass through the placenta to the fetus and lead to premature delivery,stillbirth,miscarriage and neonatal measles.In this report,one such case,which was diagnosed by clinical signs and symptoms,clinical and laboratory examination was described.After proper therapeutic treatment,the infection was well-controlled and a baby was born by nature labor.

Effect of curcumin on expressions of NF-κBp65,TNF-αand IL-8 in placental tissue of premature birth of infected mice

Objective:To observe the effect of curcumin on expressions of nuclear transcription factorkappa Bp65(NF-κBp65),TNF--α and IL-8 in placental tissue of premature birth of infected mice induced by lipopolysaccharide(LPS).Methods:A total of 60 C57BL/6 mice pregnant with 15 d were collected and randomly divided into control group,model group,treatment group and preventative group.LPS was repeatedly injected in abdominal cavity to construct infected premature birth model,while mice of control group were given with 100 mg/kg of vitamin C through abdominal cavity injection and mice of treatment group and preventative group were given curcumin of 100 mg/kg through abdominal cavity injection after modeling operation and before 1 d of modeling operation,respectively.A total of 5 mice of four groups respectively were executed by cervical dislocation after 6 h,12 h and 24 h after constructing model.Placental tissues were collected and the immunohistochemical mothod SABC of immunologic tissue was used to detect the expression of NF-d mice after 24 h was collected tκBp65,TNF-o detect the co-and IL-8 and peripheral blood of executencentrations of IL-8,malondialdehyde(MDA) and superoxide dismutase(SOD),meanwhile live birth rate of four groups was contrasted.Results:Staining intensity of NF-tissue of treatment group and preventative group was κBp65,TNF-significantly-αand IL-8 in placental higher than control group but lower than model group(P<0.05).Level of serum IL-8 and MDA of control group was significantly lower than the other three groups(P<0.05) and level of blood of SOD in model group was significantly lower than control group(P<0.05).Levels of serum IL-8 and MDA of treatment group and preventative group were significantly lower than model group(P<0.05) while level of SOD was significantly higher than model group(P<0.05).Live birth rate of treatment group and preventative group was significantly higher than model group(P<0.05).Conclusions:Curcumin can effectively prevent the active pathway of NF-t tissue of premature birth of infected mice,reduce the expression of TNF-κB in pregnanieve the damage of lipid peroxide of oxidative stress of LPS on mother-fetus-α and IL-8 and rel and further to achieve the objective of preventing and curing premature birth induced with infection.

Pregnancy Outcomes Following Transvaginal Cerclage for Cervical Insufficiency：Results From a Single-center Retrospective Study

To study maternal and perinatal outcomes after cervical cerclage in both singleton and twin pregnancies,we retrospectively reviewed women undergoing cervical cerclage for cervical insufficiency at Tongji Hospital,Wuhan,China from January 1,2010 to July 31,2015 to evaluate primary and secondary outcomes for subgroups with cervical length（CL） ≤15,〉15 to 〈25,and ≥25 mm.Of 166 patients who underwent cervical cerclage,after exclusion of patients with missed abortion and continuing pregnancy,141 patients（121 singleton and 20 twin pregnancies） were included in the analysis.Mean gestational age at birth was 34.22 and 28.27 weeks for singleton and twin pregnancies,respectively.There were 17（14.05%） and 13（33.33%） neonatal deaths in singleton and twin pregnancies,respectively.Mean age（31.60±4.62 vs.31.22±4.63 years,P=0.39） and gestational weeks at cerclage（18.50±4.62 vs.19.31±4.99,P=0.47） were similar for both groups.Mean gestational weeks at delivery（34.22±5.77 vs.28.27±6.17,P〈0.001） and the suture to delivery interval（15.72±7.15 vs.8.96±6.70,P〈0.001） were significantly longer in the singleton group.These variables indicate a linear negative correlation with the degree of CL shortening,with better outcomes in patients with CL ≥25 mm who underwent cerclage,both in singleton and twin pregnancies.No difference in mode of delivery existed between the singleton group and twin group.Our results indicate a high risk of preterm delivery in both groups,especially in the twin group.Patients with a history of preterm labor and CL 〉25 mm in the current pregnancy,possibly in a twin pregnancy,could benefit from elective cervical cerclage;however,cervical cerclage was inadvisable for twin pregnancies with a CL 〉15 and 〈25 mm.Our data emphasize the importance of re-evaluating the efficacy of cervical cerclage for twin pregnancies in well-designed clinical trials.

The Agreement Rate about Unintended Pregnancy and Its Relationship with Postpartum Depression in Parents of Preterm and Term Infants

Introduction: Postpartum depression (PPD) affects women’s health and self-confidence, and infant’s social, emotional, cognitive and even physical development. Studies show that parents of preterm infants frequently experience symptoms of depression and anxiety. Women with unintended pregnancy are subjected to more risk of depression than women with planned pregnancy. Unintended pregnancy may lead to increased maternal exposure to psychosocial stressors, reduced social support by the spouse, increased levels of depressive symptoms and decreased life satisfaction. Findings: No significant difference was observed between term and preterm infants’ mothers (p = 0.85) in terms of postpartum depression. However, two groups of fathers in terms of depression showed a significant difference (p = 0.045). McNemar’s test showed that parents of term infants (K = 0.322, p = 0.077), and parents of preterm infants (k = 0.17, p = 0.144) agreed with each other on unintended pregnancy. Conclusion: Fathers of preterm infants are at higher risk for mental disorders than fathers of term infants and they need more attention in future studies.

Pregnancy Outcomes for Day 5 Versus Day 6 Single Frozen-thawed Blastocyst Transfer with Different Qualities of Embryos: A Large Matched-cohort Study

Objective This study aimed to determine whether the day of blastocyst expansion affects pregnancy outcomes in frozen-thawed blastocyst transfer(FBT)cycles.Methods A retrospective match-cohort study was conducted.Patients who underwent blastocyst transfer in frozen-thawed cycles at day 5 or 6 were matched for potential confounding factors.A total of 2207 matched pairs of FBT cycles were included from January 2016 to December 2019 in our Reproductive Medicine Center.Results The clinical pregnancy rate(CPR)and live birth rate(LBR)were significantly increased in day 5 blastocyst transfers when compared to day 6 blastocyst transfers,in terms of the same embryo quality.For FBT cycles with good-quality embryo,the CPR at day 5 and 6 was 61.30%and 57.56%,respectively(P=0.045),and the LBR was 44.79%and 36.16%,respectively(P<0.001).For FBT cycles with poor-quality embryo,the CPR at day 5 and 6 was 48.61%and 40.89%,respectively(P=0.006),and the LBR was 31.71%and 25.74%,respectively(P=0.019).The CPR for FBT cycles with good-quality embryo was statistically higher at day 6 than that at day 5 with poor-quality embryo transferred(57.56%vs.48.61%,P=0.001).Maternal age,anti-Müllerian hormone(AMH),endometrial thickness,embryo quality,and the day of blastocyst expansion were independently correlated with the CPR and LBR.The FBT cycles at day 5 had significantly higher CPR(adjusted odds ratio[OR]=1.246,95%confidence intervals[CI]:1.097–1.415,P=0.001)and LBR(adjusted OR=1.435,95%CI:1.258–1.637,P<0.001)than those at day 6.Conclusion The embryo quality is the primary indicator for FBT cycles.Day 5 blastocysts should be preferred when the quality of embryo at day 5 is the same as that at day 6.

Improved Pregnancy Outcomes in a Prospective Study of Pregnant Women Enrolling in an Antenatal Clinic in Western Kenya

In areas of sub-Saharan Africa where malaria is endemic, pregnant women are at a greater risk of malaria than non-pregnant women leading to significant adverse consequences including anemia, intrauterine growth retardation, low birth weight (LBW), and pre-term delivery. The Kenya Ministry of Health adopted Intermittent Preventive Treatment (IPT) and use of insecticide-treated nets (ITN) as a National strategy for malaria prevention in pregnancy. In this report, we evaluated the prevalence of malaria, the anthropometric measures of birth outcomes and the reasons for loss to follow up among pregnant women participating in an ongoing cohort study in Western Kenya. A total of 175 HIV-negative pregnant women enrolled at antenatal clinic of Chulaimbo sub-District hospital were longitudinally evaluated in a monthly follow-up visits through antenatal visits (up to 4 per mother) and delivery. Thirty three percent and 15% of the pregnant women were malaria positive by real-time quantitative (Q)-PCR and microscopy respectively at enrolment, while 54% and 23% of the pregnant women had malaria by Q-PCR and microscopy respectively at any time during follow-up. Of the enrolled study participants, 65% delivered at Chulaimbo hospital. Overall, 39% (69) of the pregnant women were lost to follow-up. The major reasons for loss to follow up were relocation from the study area (26%) and delivery at alternative health facilities (25%). The mean birth weight of the newborn infants was 3202 g (range, 2000 g - 4000 g). Only 5.3% of the infants weighed less than 2500 g (low birth weight). The mean head circumference was 34 cm (range, 30 cm - 39 cm) with mean Apgar score (at 10 minutes) ± S.D. of 9.8 ± 0.97. In conclusion, we observed decreased adverse pregnancy outcomes among our study population. We recommend a larger study of all pregnant women attending the Chulaimbo hospital so as to assess whether effectiveness of malaria and anemia control programs lead to improved birth outcomes.

Clustering of Pregnancy Wastages among Young HIV-Positive Women in a High HIV Prevalence District in India

Context: This paper examined the clustering of pregnancy wastage among HIV-infected pregnant women, particularly focusing on the outcomes of abortions and stillbirths, from a large sample of HIV-positive women to bridge the existing information gap. Methods: Data from a cross-sectional survey conducted among currently married HIV positive women aged 15-29 years in Bagalkot district, Karnataka, India were used. Further to assess the clustering of pregnancy wastage, the binomial distribution was used. Results: The study shows that 2% of the women account for 32% of the total pregnancy wastages and 7% of all the interviewed HIV positive women account for 62% of the total pregnancy wastages. The study further shows that a higher percent observed (29.6%) than expected (15.5%) who had experienced 2 pregnancy wastages suggesting 14.1% more women experienced 2 pregnancy wastages than expected. Again, a positive deviant of 19.2 among women with at least 3 pregnancy wastage also suggests a higher observed than expected pregnancy wastages, and suggests clustering of pregnancy wastages among HIV-positive women. After adjusting for the socio-economic characteristics, the variance of the observed and expected has reduced only marginally. Conclusions: Clustering of pregnancy wastages among HIV positive women suggests for an increased attention on reproductive health of this marginalized group. The findings will be useful for the interventions working with WLHA in India, particularly the knowledge of clustering would help policy makers and program implementers to focus on high risk women who are likely to experience multiple pregnancy losses.

First Experience Using Brazilian Ingamed^&regCervical Pessary in Twin Pregnancy: A Case Series

Background: The rate of prematurity in twin pregnancies is higher than 50%. Due to its multifactorial nature, different strategies are necessary to reduce the incidence of premature birth or to increase the gestational age at birth of pregnancies at risk. In this context, cervical pessary may be indicated in twin pregnancies with short cervix. Methods: In this case series, we describe six twin pregnancies that were considered as high-risk for preterm labor due to short cervix (CL at second trimester and multiple risk factors for prematurity. Several strategies were associated for the goal of delaying gestational age at birth. The main strategies were: removal of labor activities, treatment of infections, vaginal micronized progesterone 400 mg/day and vaginal pessary insertion (Ingamed&reg?Brazil). Results: The gestational age of insertion of the pessary ranged from 16 to 24 weeks. The gestational age of birth ranged from 26 to 34 weeks. Three of the pregnancies were delivered due to spontaneous onset of labor, and three were delivered due to medical reasons. The mean length of pregnancy since pessary insertion to birth was 9 weeks (range 2 to 17 weeks). All infants without severe fetal malformation were discharged from the hospital without major sequelae. Conclusion: The use of cervical pessaries associated to micronized progesterone at a dose of 400 mg/day may be an option in the management of twins at risk for preterm birth. More controlled studies are needed to evaluate the simultaneous use of cervical pessary and progesterone on twin pregnancies.

Impact of Serum Progesterone Levels in GnRH Antagonist Assisted Reproduction Cycles on Pregnancy Outcomes: A Prospective Cohort Study

Background: With controlled ovarian hyperstimulation (COH) with gonadotrophin releasing hormone (GnRH) antagonists, sometimes it is associated with incomplete luteolysis leading to elevated serum progesterone in early follicular phase. Persistence of this elevation might reduce the chance for clinical pregnancy. Objective: To assess the effect of elevated early and late follicular progesterone (P) levels during gonadotrophins releasing hormone (GnRH) antagonist cycles on pregnancy outcome. Design: Prospective single center study. Setting: North-western Military hospital, Kingdom of Saudi Arabia. Patients: 302 in vitro fertilization/intra-cytoplasmic sperm injection (IVF-ICSI) patients. Intervention(s): Recombinant follicle stimulating hormone (r-FSH), (150 - 300 IU) started daily from cycle day 2;GnRH antagonist treatment started on day 6 of the cycle. The serum progesterone (P) measured twice on cycle day 2 and human chorionic gonadotrophin (hCG) day. Main Outcome Measures: Clinical pregnancy and live birth rates per started cycle. Results: The incidence of elevated serum P on day 2 was (5.3%) and on hCG day was (17.5%), statistically significant differences in clinical pregnancy rate (32.3% versus 13.0%) and in live birth rate (23.4% versus 11.1%) were present between the normal and high serum progesterone groups on hCG day, but these differences were not statistically significant in the groups of elevated basal progesterone. Conclusion: Follicular phase progesterone rise either on day 2 or the day of hCG trigger was associated with lower clinical pregnancy and live birth rates. This impact was more prominent with trigger day elevation.

Association of maternal hypertensive disorders in pregnancy with infant neurodevelopment

Inconsistent findings have been reported regarding the associations between hypertensive disorders in pregnancy (HDP) and infant neurodevelopment. Leveraging data from the Jiangsu Birth Cohort, in the present study, we re-visited such associations in one-year-old infants from 2 576 singleton pregnancies and 261 twin pregnancies. We first assessed infant neurodevelopment by the Bayley Scales of Infant and Toddler Development Screening Test (the Third Edition), and then estimated its association with maternal HDP using general linear regression models and Poisson regression models. In singleton pregnancies, compared with mothers unexposed to HDP, infants born to mothers with chronic hypertension exhibited a lower score (β, −0.67;95% confidence interval [CI], −1.19-−0.15) and a higher risk of "non-optimal" gross motor development (risk ratio [RR], 2.21;95% CI, 1.02-4.79);in twin pregnancies, infants born to mothers with HDP exhibited lower scores in cognition (β, −0.49;95% CI, −0.96-−0.01), receptive communication (β, −0.55;95% CI, −1.03-−0.06), and gross motor (β, −0.44;95% CI, −0.86-−0.03), and at a higher risk of "non-optimal" gross motor development (RR, 2.12;95% CI, 1.16-3.88). These findings indicate that infants born to mothers with HDP may have inferior neurodevelopment outcomes at the age of one year.