Maternal ABO Phenotype as a Predictive Factor for Pregnancy Complications Related to Prematurity

Objective: The ABO blood types are associated with cancers, cardiovascular disease, and Type 2 diabetes in adult males and females. Associations of ABO blood type and adverse pregnancy outcomes have not been extensively studied. The purpose of this study was to investigate the relationship with ABO blood groups and risk of adverse pregnancy outcomes contributing to premature birth.Study design: Data on ABO phenotypes and pregnancy outcomes were collected from the medical records of 1,462 premature infants (22-34 weeks). Adverse pregnancy outcomes that were studied in relation to maternal blood type included gestational hypertension (GHTN), preeclampsia (PREE), chorioamnionitis (CA), preterm premature rupture of membranes (PPROM), and intrauterine growth restriction (IUGR)Results: 1,462 charts of mothers with premature infants (22-34 weeks) were studied measuring the relative risk by using standardized statistical software (SPSS).Our study group had 46 mothers with GHTN, 405 with PREE, 282 with CA, 504 with PPROM, and 94 with IUGR. A+ Caucasian mothers had a 28% increased risk of developing preeclampsia (RR= 1.28 (1.09-1.52); 95% CI= .003). B mothers are ata 46% decreased risk of developing chorioamnionitis versus all other blood groups (RR= 0.54, 95% CI= 0.36-0.81; P= .003). Conversely, O+ Caucasian mothers were 2.53 times more likely to develop chorioamnionitis compared to all other blood types (RR=2.53, 95% CI= 1.09-5.88; P= .031).Conclusions: Maternal ABO phenotype significantly influences the incidence of preeclampsia and chorioamnionitis. Pregnancy is a unique antigen-antibody phenomenon with the fetus serving as an antigen to the mother. We postulate that blood group antigen expression at the endothelial level may influence maternal disease states

Neonatal serial creatinine levels as an adjunct biomarker in timing of fetal neurologic injury

Objective: To investigate the rise and clearance of newborn creatinine in perinatal asphyxia as an adjunct biomarker to support or refute allegations of acute intrapartum asphyxia. Study design: In this retrospective chart review, newborns > 35 weeks gestational age were evaluated from closed medicolegal cases of confirmed perinatal asphyxia and reviewed for causation. Data collected included newborn demographic data, patterns of hypoxic ischemic encephalopathy, brain magnetic resonance imaging, Apgar scores, cord and initial newborn blood gases, and serial newborn creatinine levels during the first 96 h of life. Newborn serum creatinine values were collected at 0–12, 13–24, 25–48, and 49–96 h. Newborn brain magnetic resonance imaging was used to define 3 patterns of asphyxial injury: acute profound, partial prolonged, or Both. Results: Two hundred and eleven cases of neonatal encephalopathy from multiple institutions were reviewed from 1987 to 2019 with only 76 cases having serial creatinine values during the first 96 h of life. A total of 187 creatinine values were collected. Partial prolonged and Both had significantly greater degree of metabolic acidosis in the first newborn arterial blood gas in comparison to acute profound. Acute profound and Both had significantly lower 5- and 10- minute Apgar scores in comparison to partial prolonged. Newborn creatinine values were stratified by asphyxial injury. Acute profound injury showed minimally elevated creatinine trends with rapid normalization. Partial prolonged and Both demonstrated higher creatinine trends with delayed normalization. Mean creatinine values were significantly different between the three types of asphyxial injuries within 13–24 h of life at the time when creatinine values peaked (p = 0.01). Conclusion: Serial newborn serum creatinine levels taken within the first 96 h of life can provide objective data of timing and duration of perinatal asphyxia