Role of Second-Trimester Genetic Sonography After Down Syndrome Screening

To estimate the effectiveness of second-trimester genetic sonography in modifying Down syndrome screening test results

Maternal stress and neonatal anthropometry: the NICHD Fetal Growth Studies

BackgroundThe effect of maternal mood disorders on neonatal measurements is not well-defined. The Fetal Growth Studies-Singletons provide a unique opportunity to evaluate the relationship between perceived maternal stress and neonatal growth measurements.ObjectiveThe purpose of this study was to determine whether perceived maternal stress during pregnancy is associated with anthropometric measurements in the neonate.Study designThis analysis was based on a prospective, multicenter longitudinal study of fetal growth. Women 18-40 years old with a body mass index of 19.0-29.9 kg/m2 were screened at 8+0 to 13+6 weeks gestation for low-risk status associated with optimal fetal growth (eg, healthy, nonsmoking) and underwent serial sonographic examination at 6 study visits throughout gestation. At each study visit, women completed the Cohen's Perceived Stress Survey, which could have a score that ranges from 0-40. We used a latent class trajectory model to identify distinct groupings (ie, classes) of the Perceived Stress Survey trajectories over pregnancy. Trend analysis was used to determine whether neonatal measurements including birthweight, length, head circumference, and abdominal circumference differed by Perceived Stress Survey class and whether this relationship was modified by maternal race/ethnicity, after adjustment for gestational age at delivery, maternal height, age, and parity.ResultsOf the 2334 women enrolled in the study, 1948 women had complete neonatal anthropometry and were included in the analysis. Latent class analysis identified 3 Perceived Stress Survey trajectory classes, with mean Perceived Stress Survey scores of 2.82 (low), 7.95 (medium), and 14.80 (high). Neonatal anthropometric measures of birthweight, length, head circumference and abdominal circumference were similar (P=.78, =.10, =.18, and =.40 respectively), regardless of the participants' Perceived Stress Survey class. There was no effect modification by maternal race/ethnicity.ConclusionNeonatal measurements did not differ by levels of perceived stress among low-risk pregnant women

Dichorionic twin trajectories: the NICHD Fetal Growth Studies

BACKGROUND: Systematic evaluation and estimation of growth trajectories in twins require ultrasound measurements across gestation, performed in controlled clinical settings. Currently there are few such data for contemporary populations. There is also controversy about whether twin fetal growth should be evaluated using the same benchmarks as singleton growth. OBJECTIVES: Our objective was to empirically define the trajectory of fetal growth in dichorionic twins using longitudinal two-dimensional ultrasonography and to compare the fetal growth trajectories for dichorionic twins with those based on a growth standard developed by our group for singletons. STUDY DESIGN: A prospective cohort of 171 women with twin gestations was recruited from eight U.S. sites from 2012 to 2013. After an initial sonogram at 11w0d–13w6d where dichorionicity was confirmed, women were randomized to one of two serial ultrasonology schedules. Growth curves and percentiles were estimated using linear mixed models with cubic splines. Percentiles were compared statistically at each gestational week between the twins and 1,731 singletons, after adjustment for maternal age, race/ethnicity, height, weight, parity, employment, marital status, insurance, income, education and infant sex. Linear mixed models were used to test for overall differences between the twin and singleton trajectories using likelihood ratio tests of interaction terms between spline mean structure terms and twin-singleton indicator variables. Singleton standards were weighted to correspond to the distribution of maternal race in twins. For those ultrasound measurements where there were significant global tests for differences between twins and singletons, we tested for week-specific differences using Wald tests computed at each gestational age. In a separate analysis, we evaluated the degree of reclassification in small for gestational age, defined as below the 10(th) percentile that would be introduced if fetal growth estimation for twins was based upon an unweighted singleton standard. RESULTS: Women underwent a median of 5 ultrasounds. The 50(th) percentile abdominal circumference and estimated fetal weight trajectories of twin fetuses diverged significantly beginning at 32 weeks, while biparietal diameter in twins was smaller from 34 through 36 weeks. There were no differences in head circumference or femur length. The mean head circumference/abdominal circumference ratio was progressively larger for twins compared with singletons beginning at 33 weeks, indicating a comparatively asymmetric growth pattern. At 35 weeks, the average gestational age at delivery for twins, the estimated fetal weights for the 10(th), 50(th) and 90(th) percentiles were 1960, 2376, and 2879 g for dichorionic twins and 2180, 2567, and 3022 g for the singletons. At 32 weeks, the initial week when the mean estimated fetal weight for twins was smaller than that of singletons, 34% of twins would be classified as small for gestational age using a singleton, non-Hispanic white standard. By 35 weeks, 38% of twins would be classified as small for gestational age. CONCLUSIONS: The comparatively asymmetric growth pattern in twin gestations, initially evident at 32 weeks, is consistent with the concept that the intrauterine environment becomes constrained in its ability to sustain growth in twin fetuses. Near term, nearly 40% of twins would be classified as small for gestational age based on a singleton growth standard

Fetomaternal Hemorrhage following Placement of an Intrauterine Pressure Catheter: Report of a New Association

Fetomaternal hemorrhage (FMH) can be associated with significant perinatal mortality. Our review of the literature did not identify any cases of FMH following placement of an intrauterine pressure catheter (IUPC). In our case, an IUPC was inserted in a patient undergoing induction of labor at term. Fetal bradycardia ensued shortly after placement, warranting an emergent cesarean delivery. Severe neonatal anemia was identified, and evaluation of maternal blood was consistent with massive FMH. This is the first reported association between FMH and IUPC placement. If this relationship is validated in future reports, appropriate changes in clinical practice may be warranted

Trends and outcomes for deliveries with hypertensive disorders of pregnancy from 2000 to 2018: A repeated cross‐sectional study

ObjectiveTo analyse trends, risk factors, and outcomes related to hypertensive disorders of pregnancy (HDP).DesignRepeated cross-sectional.SettingUS delivery hospitalisations.PopulationDelivery hospitalisations in the 2000-2018 National Inpatient Sample.MethodsUS hospital delivery hospitalisations with HDP were analysed. Several trends were analysed: (i) the proportion of deliveries by year with HDP, (ii) the proportion of deliveries with HDP risk factors and (iii) adverse outcomes associated with HDP including maternal stroke, acute renal failure and acute liver injury. Risk ratios were determined using regression models with HDP as the exposure of interest.Main outcome measuresPrevalence of HDP, risk factors for HDP and associated adverse outcomes.ResultsOf 73.1 million delivery hospitalisations, 7.7% had an associated diagnosis of HDP. Over the study period, HDP doubled from 6.0% of deliveries in 2000 to 12.0% in 2018. The proportion of deliveries with risk factors for HDP increased from 9.6% in 2000 to 24.6% in 2018. In adjusted models, HDP were associated with increased stroke (aRR [adjusted risk ratio] 15.9, 95% CI 14.8-17.1), acute renal failure (aRR 13.8, 95% CI 13.5-14.2) and acute liver injury (aRR 1.2, 95% CI 1.2-1.3). Among deliveries with HDP, acute renal failure and acute liver injury increased; in comparison, stroke decreased.ConclusionHypertensive disorders of pregnancy increased in the setting of risk factors for HDP becoming more common, whereas stroke decreased.Tweetable abstractWhile hypertensive disorders of pregnancy increased from 2000 to 2018, stroke appears to be decreasing