Pregnancy adverse outcomes related to pregravid body mass index and gestational weight gain, according to the presence or not of gestational diabetes mellitus: A retrospective observational study

International audienceAim. - This study retrospectively evaluated the complications associated with prepregnancy overweight (OW) or obesity (OB) and gestational weight gain (GWG) in women with or without universally screened and treated gestational diabetes mellitus (GDM). Methods. - A total of 15,551 non-Asian women without pregravid diabetes or hypertension who delivered singleton babies (2002-2010) were classified according to GDM (13.5%), pregestational body mass index (BMI; normal range: 18.5-24.9 kg/m(2)), OW (26.2%), OB (13.9%; BMI >= 30 kg/m(2)) and GWG ( 16 kg: 8%). Main outcome measures were large/small for gestational age (LGA/SGA), caesarean section, preeclampsia, preterm delivery and shoulder dystocia. Results. - GDM was associated with more LGA babies [Odds Ratio (OR): 2.12, 95% confidence interval (CI): 1.85-2.43], caesarean section (OR: 1.49, 95% CI: 1.34-1.65) and preeclampsia (OR: 1.59, 95% CI: 1.21-2.09). OW/OB and GWG were associated with LGA infants whatever the GDM status, and with SGA babies only in women without GDM. LGA status was independently associated with GWG in women with GDM (11.6-16 kg: OR: 1.74, 95% CI: 1.49-2.03 and > 16 kg OR: 3.42, 95% CI: 2.83-4.13 vs 7-11.5 kg) and in women without GDM (OR: 2.14, 95% CI: 1.54-2.97 or OR: 2.65, 95% CI: 1.68-4.17, respectively), and with BMI only in women without GDM (OR: 1.12, 95% CI: 1.00-1.24, per 10 kg/m2). SGA status was independently associated with OW (OR: 0.86, 95% CI: 0.77-0.98), OB (OR: 0.84, 95% CI: 0.72-0.98) and GWG <7 kg (1.14, 95% CI: 1.01-1.29) only in women without GDM. Conclusion. - In our European cohort and considering the triumvirate of GDM, BMI and GWG, GDM was the main contributor to caesarean section and preeclampsia. OW/OB and GWG contributed to LGA and SGA infants mainly in women without GDM

The efficacy of hydroxychloroquine for obstetrical outcome in anti-phospholipid syndrome: Data from a European multicenter retrospective study

In European multicenter study, we aimed to describe the real-life hydroxychloroquine use in APS patients during pregnancy and determine its benefit in refractory obstetrical APS. We analyzed the outcome of pregnancies treated by hydroxychloroquine in patients with APS or asymptomatic antiphospholipid (aPL) antibodies carriers. Thirty patients with APS with 35 pregnancies treated by hydroxychloroquine were analyzed. Comparing the outcome of pregnancies treated by the addition of hydroxychloroquine to previous pregnancies under the conventional treatment, pregnancy losses decreased from 81% to 19% (p<0.05), without differences in the associated treatments. The univariate analysis showed that the previous intrauterine deaths and higher hydroxychloroquine amount (400mg per day) were the factors associated with pregnancy outcome. Considering 14 patients with previous refractory obstetrical APS (n=5 with obstetrical and thrombotic primary APS and n=9 with purely obstetrical APS), all with previous pregnancy losses under treatment (aspirin with LMWH in 11 cases and LMWH in 3 cases), the addition of hydroxychloroquine resulted in live born babies in 11/14 (78%) cases (p<0.05). Our study shows the benefit of hydroxychloroquine addition in patients with refractory obstetrical APS and raises the need of prospective studies to confirm our preliminary study

European registry of babies born to mothers with antiphospholipid syndrome.

OBJECTIVE:This study aimed to describe the long-term outcome and immunological status of children born to mothers with antiphospholipid syndrome, to determine the factors responsible for childhood abnormalities, and to correlate the child's immunological profile with their mothers. METHODS: A prospective follow-up of a European multicentre cohort was conducted. The follow-up consisted of clinical examination, growth data, neurodevelopmental milestones and antiphospholipid antibodies (APL) screening. Children were examined at 3, 9, 24 months and 5 years. RESULTS: 134 children were analysed (female sex in 65 cases, birth weight 3000\ub1500 g, height 48\ub13 cm). Sixteen per cent had a preterm birth (&lt;37 weeks; n=22), and 14% weighted less than 2500 g at birth (n=19). Neonatal complications were noted in 18 cases (13%), with five infections (4%). During the 5-year follow-up, no thrombosis or systemic lupus erythematosus (SLE) was noted. Four children displayed behavioural abnormalities, which consisted of autism, hyperactive behaviour, feeding disorder with language delay and axial hypotony with psychomotor delay. At birth lupus anticoagulant was present in four (4%), anticardiolipin antibodies (ACL) IgG in 18 (16%), anti-\u3b2(2) glycoprotein-I (anti-\u3b22GPI) IgG/M in 16 (15%) and three (3%), respectively. ACL IgG and anti-\u3b22GPI disappeared at 6 months in nine (17%) and nine (18%), whereas APL persisted in 10% of children. ACL and anti-\u3b22GPI IgG were correlated with the same mother's antibodies before 6 months of age (p&lt;0.05). CONCLUSION: Despite the presence of APL in children, thrombosis or SLE were not observed. The presence of neurodevelopmental abnormalities seems to be more important in these children, and could justify long-term follow-up