Search Results (85)

Background/Objectives: Adverse pregnancy outcomes (APOs), which include hypertensive disorders of pregnancy (gestational hypertension, preeclampsia, and related disorders), gestational diabetes, preterm birth, fetal growth restriction, low birth weight, small-for-gestational-age newborn, placental abruption, and stillbirth, are health risks for pregnant women that can have fatal outcomes. This study’s aim is to investigate the usefulness of artificial intelligence (AI) in improving these outcomes and includes changes in the utilization of ultrasound, continuous monitoring, and an earlier prediction of complications, as well as being able to individualize processes and support clinical decision-making. This study evaluates the use of AI in improving at least one APO. Methods: PubMed, Web of Science, and Scopus databases were searched and limited to the English language, humans, and between 2020 and 2024. This scoping review included peer-reviewed articles across any study design. However, systematic reviews, meta-analyses, unpublished studies, and grey literature sources (e.g., reports and conference abstracts) were excluded. Studies were eligible for inclusion if they described the use of AI in improving APOs and the associated ethical issues. Results: Five studies met the inclusion criteria and were included in this scoping review. Although this review initially aimed to evaluate AI’s role across a wide range of APOs, including placental abruption and stillbirth, the five selected studies focused primarily on preterm birth, hypertensive disorders of pregnancy, and gestational diabetes. None of the included studies addressed placental abruption or stillbirth directly. The studies primarily utilized machine-learning models, including extreme gradient boosting (XGBoost) and random forest (RF), showing promising results in enhancing prenatal care and supporting clinical decision-making. Ethical considerations, including algorithmic bias, transparency, and the need for regulatory oversight, were highlighted as critical challenges. Conclusions: The application of these tools can improve prenatal care by predicting obstetric complications, but ethics and transparency are pivotal. Empathy and humanization in healthcare must remain fundamental, and flexible training mechanisms are needed to keep up with rapid innovation. AI offers an opportunity to support, not replace, the doctor–patient relationship and must be subject to strict legislation if it is to be used safely and fairly. Full article

Background: Thrombophilia is a prothrombotic disorder that can affect pregnancy outcomes, potentially leading to maternal complications, fetal growth restriction, and adverse perinatal events. However, the precise relationship between thrombophilia and these outcomes remains under investigation, and the impact of hematological, renal, hepatic, and coagulation alterations in thrombophilic pregnancies is not yet fully understood. This study aims to examine the maternal and neonatal consequences of thrombophilia by analyzing key laboratory parameters and perinatal outcomes in affected pregnancies. Methods: A retrospective observational study was conducted on 251 pregnant women, divided into thrombophilic (n = 226) and non-thrombophilic (n = 25) groups. Data on maternal demographics, laboratory parameters (hematological, metabolic, renal, hepatic, and coagulation markers), obstetric outcomes, and neonatal characteristics were extracted from medical records. Statistical analysis included t-tests, chi-square tests, and Pearson correlation analysis to assess the association between thrombophilia and clinical outcomes. Results: Thrombophilic pregnancies were associated with significantly lower fibrinogen levels (p = 0.036) and decreased INR (p = 0.006), suggesting a hypercoagulable state. Renal function was affected, as evidenced by elevated urea (p = 0.012) and creatinine (p = 0.009), indicating a predisposition to kidney dysfunction. Neonates from thrombophilic pregnancies exhibited slightly lower Apgar scores at 1 and 5 min, though the differences were not statistically significant (p = 0.101, p = 0.131). NICU admission rates were comparable between groups (p = 0.317), suggesting that thrombophilia may not be a major determinant of neonatal intensive care needs. However, gestational age and birth weight remained the strongest predictors of neonatal vitality (p < 0.001), while coagulation abnormalities and renal dysfunction correlated with poorer perinatal outcomes. Conclusions: Thrombophilia is associated with altered coagulation profiles, renal dysfunction, and potential risks for maternal complications. While neonatal outcomes were not significantly different, the observed trends suggest the need for enhanced monitoring in thrombophilic pregnancies. Early intervention, thromboprophylaxis, and individualized management strategies may improve maternal and neonatal prognosis. Further research is needed to refine preventive strategies and optimize therapeutic approaches in high-risk pregnancies. Full article

Depressive disorder during pregnancy is a common condition, affecting approximately 10–15% of pregnant women, and is associated with adverse pregnancy outcomes such as inadequate prenatal care, substance abuse, and fetal growth restriction. Beyond neurotransmitter disturbances, increasing evidence suggests that infectious agents may play a role in the pathophysiology of depression through immune system modulation. Toxoplasma gondii infection has been linked to various mental disorders in the general population, including depression and anxiety. This study aimed to investigate whether depressive disorder during pregnancy is associated with chronic T. gondii infection by analyzing cytokine levels involved in inflammatory response modulation. Serum levels of TNF, IFN-γ, TGF-β1, IL-6, IL-8, IL-10, and MIF were measured in 79 pregnant women (18–40 years old) during the third trimester of an uncomplicated pregnancy. Participants were divided into four groups: Group I—depressive disorder and T. gondii seropositive (n = 19); Group II—no depressive disorder and T. gondii seropositive (n = 20); Group III—depressive disorder and T. gondii seronegative (n = 20); and Group IV—no depressive disorder and T. gondii seronegative (n = 20). Depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS) during routine prenatal visits, and blood samples were collected during standard prenatal examinations. Significant differences in cytokine levels were observed among the study groups. Notably, the group with both depressive disorder and chronic T. gondii infection exhibited a distinct cytokine profile characterized by significantly elevated TNF, IL-6, and IL-10 levels and significantly reduced IL-8 and MIF levels compared to the other groups. These findings suggest that pregnant women with depressive disorder and chronic T. gondii infection exhibit an altered balance of pro- and anti-inflammatory cytokines. This is the first study to investigate the association between serum cytokine levels, depressive disorder, and chronic T. gondii infection in pregnant women. Further research is needed to evaluate the potential of these immunobiomarkers as diagnostic tools or for monitoring therapeutic and prognostic strategies in this context. Full article

This study evaluates the impact of PM2.5 exposure from wood combustion on reproductive health and fetal development using an experimental model in Sprague Dawley rats. The study was conducted in Temuco, Chile, where high levels of air pollution are primarily attributed to residential wood burning. A multigenerational exposure model was implemented using controlled exposure chambers with filtered (FA) and unfiltered (NFA) air. Second-generation (G2) female rats (n = 48) were exposed pregestationally (60 days) and gestationally (23 days) under four conditions: FA/FA, FA/NFA, NFA/FA, and NFA/NFA. PM2.5 concentration and composition were monitored using beta-ray attenuation and X-ray fluorescence spectrometry. Reproductive parameters, ovarian follicle counts, and hormonal levels were assessed via vaginal cytology, histological analysis, and chemiluminescence immunoassays. PM2.5 exposure disrupted estrous cyclicity (p = 0.0001), reduced antral and growing follicles (p = 0.0020; p = 0.0317), and increased post-implantation losses (p = 0.0149). Serum progesterone and estradiol levels were significantly altered (p < 0.05). Despite ovarian disruptions, fertility rates remained unchanged. These findings suggest that chronic exposure to wood smoke-derived PM2.5 adversely affects ovarian function and fetal growth without significantly impairing overall reproductive capacity. This study highlights the need for public health policies to mitigate wood smoke pollution. Full article

Maternal hormonal and metabolic disorders, such as diabetes and obesity, can adversely affect the intrauterine environment, resulting in suboptimal fetal growth and an elevated risk of cardiovascular and metabolic diseases in the later life of the offspring. In this review, we examine the long-term impact of elevated maternal androgen levels during pregnancy on offspring. Maternal hyperandrogenemia is linked to various neurodevelopmental disorders, including attention-deficit/hyperactivity disorder, autism spectrum disorder, and anxiety-like behaviors, mediated by alterations in key brain regions responsible for emotion and cognition. Furthermore, children born to mothers with hyperandrogenemia exhibit heightened risk of metabolic and cardiovascular dysfunctions, such as obesity, insulin resistance, and hypertension, which can manifest early in life. Prenatal exposure to androgens has also been linked to reduced birth weights and altered fetal growth, potentially due to impaired placental function. Additionally, maternal testosterone levels influence offspring sex ratios, often favoring male births, though exceptions occur in certain conditions, such as congenital adrenal hyperplasia. The findings of this review underscore the need for healthcare professionals to monitor maternal serum androgen profiles during pregnancy. Further research is needed to determine underlying mechanisms and potential interventions to mitigate these risks. Full article

The vector of modern obstetrics is aimed at finding ways to predict various placenta-associated complications, including those associated with neuronal dysfunction on in fetal growth restriction (FGR). The technology of fetal neuronal exosome (FNE) isolation from the maternal bloodstream opens up unique opportunities for detecting early signs of fetal brain damage. Using this method, FNEs were isolated from the blood of pregnant women with and without early-onset FGR, and the expression of a number of proteins in their composition was assessed (Western blotting). Significant changes in the level of proteins involved in neurogenesis (pro-BDNF (brain-derived neurotrophic factor), pro-NGF (nerve growth factor), TAG1/Contactin2) and presynaptic transmission (Synapsin 1, Synaptophysin) were revealed. The preliminary data on the expression of FNE proteins that perform post-translational modifications—sumoylation (SUMO 1, UBC9) and neddylation (NEDD8, UBC12)—were obtained. A relationship was established between altered protein expression and neonatal outcomes in newborns with growth restriction. Our study opens up new possibilities for non-invasive prenatal monitoring of fetal neurodevelopment disorders and possibilities of their correction in placenta-associated diseases. Full article

Preterm birth represents a nutritional emergency and a sudden dissociation of the maternal–placental–fetal unit that regulates metabolic and endocrine physiology. Growth demonstrates health and is a signal of physiological well-being. Growth is expensive for a critically ill infant and possible only after other homeostasis energy demands are met. Despite an expert-stated goal that preterm infants should grow at a similar rate to their gestational age-matched fetal counterparts, this is not the reality for many preterm infants. Other investigators have proposed new metrics for growth quality in the neonatal intensive care unit. This review discusses growth assessment and standards in very-low-birth-weight infants and attempts to address the knowledge gap of which growth metrics are the most important to monitor. Full article

Lymphangioleiomyomatosis (LAM) is a rare, progressive, and poor-prognosis systemic disorder that primarily affects women of reproductive age, with a higher prevalence among individuals of Caucasian origin. However, there are limited reliable data on the prevalence of LAM during pregnancy. The fulminant respiratory clinical presentation that often includes progressive dyspnea on exertion, cough, or hemoptysis, frequently complicated by pneumothorax, and the increased risk of spontaneous abortion due to increased estrogen and progesterone production during gestation, are arguments that most often make the diagnosed woman avoid pregnancy. Elevated levels of vascular endothelial growth factor D (VEGF-D), decline in respiratory function, and radiological findings are sufficient arguments in favor of the diagnosis in the pregnant woman. Sirolimus, an mTOR inhibitor, has demonstrated effectiveness in slowing the decline of lung function. Although sirolimus treatment is often recommended to be discontinued before conception due to the increased risk of fetal growth restriction, maintaining a dose level of <5 pcg/mL, with serum drug levels of 3–5 pcg/L, has been considered safe. Given the potential risks, individualized decisions about pregnancy are advised for patients with LAM. For those who choose to proceed, close monitoring by a multidisciplinary team is essential to manage complications effectively. Ongoing research aims to provide clearer guidance to optimize outcomes for both mother and child. Full article

Objectives: The aim of the present study was to examine the growth dynamics of the first sacral vertebra and its ossification center in the human fetus, based on their linear, planar, and volumetric parameters. Methods: The examinations were carried out on 54 human fetuses of both sexes (26 males and 28 females) aged 18–30 weeks of gestation, which had been preserved in 10% neutral formalin solution. Using CT, digital image analysis software, 3D reconstruction, and statistical methods, the size of the first sacral vertebra and its ossification center was evaluated. Results: The first sacral vertebra and its ossification center grew proportionately according to fetal weeks. Conclusions: The numerical data obtained from computed tomography and the growth patterns of the body of the first sacral vertebra and its ossification center may serve as age-specific normative intervals relevant for gynecologists, obstetricians, pediatricians, and radiologists during fetal ultrasound screening. Our findings on the growth of the body of the first sacral vertebra and its ossification center may be useful in daily clinical practice, particularly in ultrasonic monitoring of normal fetal growth and in screening for congenital defects and skeletal dysplasias. Full article

Background/Objectives: Gestational diabetes mellitus (GDM) presents significant risks for both maternal and neonatal health, affecting fetal growth and increasing the likelihood of future diabetes mellitus (DM) development in affected women. The dysregulation of metabolic biomarkers, including catestatin, has been implicated in GDM pathophysiology. However, the clinical significance of catestatin in GDM remains poorly understood, particularly in the context of different therapeutic approaches. Methods: This observational, prospective, and cross-sectional study was conducted to evaluate maternal serum catestatin levels in gestational diabetes mellitus (GDM) patients and healthy controls. Data were collected at a single time point during the second trimester of pregnancy (24 to 28 weeks). Participants were categorized based on their glucose tolerance and GDM management strategies (diet regulation or insulin therapy). Results: Receiver Operating Characteristic (ROC) analysis demonstrated the diagnostic significance of serum catestatin levels in GDM, suggesting a cut-off value of >9.61 ng/mL for discriminating between women with and without GDM. However, further research is needed to elucidate the mechanistic role of catestatin in GDM and its utility in guiding therapeutic interventions. Conclusions: Our study highlights the potential of catestatin as a biomarker for GDM risk stratification and monitoring, complementing existing diagnostic tools. Integrating metabolic biomarkers like catestatin into clinical management approaches may optimize maternal and neonatal health outcomes in GDM. However, the limitations of our study, including its cross-sectional design and sample size, underscore the need for future multicenter studies to validate our findings comprehensively. Full article

Twin pregnancies are at increased risk of morbidity and mortality compared to singletons. Among all twins, monochorionic pregnancies are at higher risk of specific and non-specific complications compared to dichorionic pregnancies. Therefore, it is of great importance to properly counsel future parents with monochorionic pregnancies regarding the risks of adverse outcomes and the modalities of monitoring and intervention of the potential complications. Conditions related to the monochorionicity include twin-to-twin transfusion syndrome (TTTS), twin reversed arterial perfusion sequence (TRAP), and twin anemia polycythemia syndrome (TAPS); other complications include selective fetal growth restriction (sFGR) and congenital anomalies. This review aims to summarize the information available in the current literature regarding the complications in monochorionic diamniotic twin pregnancies, including outcomes and guideline recommendations about the clinical surveillance, management, and timing of interventions of these conditions that should be included in counselling in routine clinical practice. Full article

Intrauterine growth restriction (IUGR), the failure of the fetus to achieve his/her growth potential, is a common and complex problem in pregnancy. Clinically, IUGR is usually monitored using Doppler ultrasound of the umbilical artery (UA). The Doppler waveform is generally divided into three typical patterns in IUGR development, from normal blood flow (Normal), to the loss of end diastolic blood flow (LDBF), and even to the reversal of end diastolic blood flow (RDBF). Unfortunately, Doppler ultrasound hardly provides complete UA hemodynamics in detail, while the present in silico computational fluid dynamics (CFD) can provide this with the necessary ultrasound information. In this paper, CFD is employed to simulate the periodic UA blood flow for three typical states of IUGR, which shows comprehensive information on blood flow velocity, pressure, and wall shear stress (WSS). A new finding is the “hysteresis effect” between the UA blood flow velocity and pressure drop in which the former always changes after the latter by 0.1–0.2 times a cardiac cycle due to the unsteady flow. The degree of hysteresis is a promising indicator characterizing the evolution of IUGR. CFD successfully shows the hemodynamic details in different development situations of IUGR, and undoubtedly, its results would also help clinicians to further understand the relationship between the UA blood flow status and fetal growth restriction. Full article

Pregnancy is a vulnerable period of time during which pregnant people are prone to infections like COVID-19, which can increase risks for both the mother and fetus. These infections may lead to complications such as preterm birth, developmental delays, and congenital abnormalities. While COVID-19 poses additional risks like placental dysfunction and neonatal infections, studies on long-term effects remain limited. Ongoing research and monitoring are essential to understand and mitigate potential cognitive and developmental challenges in children born to mothers infected with COVID-19. This review aims to guide clinicians in managing these risks throughout childhood. Maternal COVID-19 infection during pregnancy can have significant implications for fetal development, even if the newborn is not infected at birth. The release of inflammatory cytokines may cross the placental barrier, potentially disrupting fetal brain development and increasing the risk of long-term cognitive and behavioral issues, such as ADHD or autism. Placental dysfunction, caused by inflammation or thrombosis, can lead to intrauterine growth restriction (IUGR), preterm birth, or hypoxia, affecting both neurological and respiratory health in newborns. Furthermore, a compromised fetal immune system can increase susceptibility to autoimmune conditions and infections. The early diagnosis and management of infections during pregnancy are crucial in mitigating risks to both the mother and fetus. Swift intervention can prevent complications like preterm birth and long-term developmental challenges, ensuring better health outcomes for both the mother and child. Long-term monitoring of children born to mothers infected with COVID-19 is necessary to understand the full extent of the virus’s impact. This review evaluates the long-term systemic effects of maternal COVID-19 infection during pregnancy on fetuses, newborns, and children, focusing beyond vertical transmission. It highlights the broader impacts on fetal development, offering insights to help clinicians manage potential issues that may arise later in life. Full article

The umbilical cord, comprising three vital blood vessels, serves as the lifeline between mother and fetus. Prenatal care emphasizes detailed ultrasound examinations of the umbilical cord and postnatal inspections of the placenta and cord to preemptively address potential complications. Studies have consistently shown a significant link between a single umbilical artery and unfavorable perinatal consequences, such as mortality and congenital abnormalities. Conversely, the impact of additional vessels remains uncertain. This review is dedicated to enhancing our understanding and refining diagnostic and therapeutic approaches in prenatal healthcare. The objective is to identify knowledge gaps and propose evidence-based solutions to improve care for pregnant women and their unborn babies. The presence of a single umbilical artery in prenatal diagnosis may signify potential risks for fetal anomalies and adverse pregnancy outcomes such as hemodynamic instability, ischemia, and an increased likelihood of intrauterine growth restriction. Additionally, even the presence of supernumerary vessels may be associated with fetal malformations. Serial fetal evaluations are recommended for detecting anomalies and monitoring fetal growth throughout pregnancy. Despite the generally benign nature of isolated SUA and supernumerary vessels, close monitoring and comprehensive prenatal care are essential to ensuring optimal outcomes for both mother and baby. Full article

Poor placental development and placental defects can lead to adverse pregnancy outcomes such as pre-eclampsia, fetal growth restriction, and stillbirth. This study introduces two sensors, which use a near-infrared spectroscopy (NIRS) technique to measure placental oxygen saturation transabdominally. The first one, an NIRS sensor, is a wearable device consisting of multiple NIRS channels. The second one, a Multimodal sensor, which is an upgraded version of the NIRS sensor, is a wireless and wearable device, integrating a motion sensor and multiple NIRS channels. A pilot clinical study was conducted to assess the feasibility of the two sensors in measuring transabdominal placental oxygenation in 36 pregnant women (n = 12 for the NIRS sensor and n = 24 for the Multimodal sensor). Among these subjects, 4 participants had an uncomplicated pregnancy, and 32 patients had either maternal pre-existing conditions/complications, neonatal complications, and/or placental pathologic abnormalities. The study results indicate that the patients with maternal complicated conditions (69.5 ± 5.4%), placental pathologic abnormalities (69.4 ± 4.9%), and neonatal complications (68.0 ± 5.1%) had statistically significantly lower transabdominal placental oxygenation levels than those with an uncomplicated pregnancy (76.0 ± 4.4%) (F (3,104) = 6.6, p = 0.0004). Additionally, this study shows the capability of the Multimodal sensor in detecting the maternal heart rate and respiratory rate, fetal movements, and uterine contractions. These findings demonstrate the feasibility of the two sensors in the real-time continuous monitoring of transabdominal placental oxygenation to detect at-risk pregnancies and guide timely clinical interventions, thereby improving pregnancy outcomes. Full article