Andreja Trojner Bregar

Impact of pre-gravid body mass index and body mass index change on preeclampsia and gestational diabetes in singleton and twin pregnancies

Abstract Objective: To examine pre-gravid body mass index (BMI) and gestational BMI change impact on preeclampsia and gestational diabetes mellitus (GDM). Methods: Retrospective population-based cohort study. Data from Slovenian National Perinatal Information System were analyzed for the period 2002–2011. Three singleton controls were matched by parity and maternal age to each twin pregnancy delivered at >36 weeks. Student’s t test was used to compare pre-gravid BMI and gestational BMI change in different groups (p < 0.05 significant). Results: 2046 twin and 6138 singleton pregnancies were included. Twin and singleton patients with preeclampsia or GDM had higher pre-gravid BMI (p < 0.001). Gestational BMI change was smaller in twins with GDM (p < 0.001), and not associated with preeclampsia (p = 0.07). Smaller gestational BMI change in singleton pregnancies was associated with GDM (p < 0.001), and greater BMI change with preeclampsia (p = 0.004). Conclusions: Pre-gravid BMI is more strongly associated with preeclampsia and GDM in twin and singleton pregnancies than gestational BMI change. Smaller gestational BMI change in GDM pregnancies reflect the importance of dietary counseling.

Changes in incidence of iatrogenic and spontaneous preterm births over time: a population-based study

Abstract Objective: To examine the proportion of iatrogenic births among all preterm births over a 26-year period. Patients and methods: A registry-based survey of preterm deliveries between 1987 and 2012 analyzed by the onset of labor: spontaneous with intact membranes, preterm premature rupture of membranes (PPROM) or iatrogenic. Stratification into categories by gestation (22 weeks to 27 weeks and 6 days, 28 weeks to 31 weeks and 6 days, 32 weeks to 33 weeks and 6 days, 34 weeks to 36 weeks and 6 days) was performed. Preterm birth rates were analyzed using the Mantel-Haenszel linear-by-linear association χ2-test (P<0.05 significant). Logistic regression was used to account for potential confounders. Results: Overall preterm birth rate was 5.9% (31328 deliveries) including 2358 (0.4%) before 28 completed weeks, 3388 (0.6%) between 28 weeks and 31 weeks 6 days, 3970 (0.8%) between 32 weeks and 33 weeks and 6 days, and 21611 (4.1%) between 34 weeks and 36 weeks and 6 days There was an increase in overall preterm birth rate (P<0.001). The rate of iatrogenic preterm births and PPROM increased over time (P<0.001 and P<0.014, respectively). Rates of spontaneous preterm birth decreased (P<0.001). After accounting for potential confounders, year of birth remained an independent risk factor for iatrogenic preterm delivery in all four gestational age categories (P<0.001). Conclusion: The incidence of iatrogenic preterm birth is increasing with a concomitant decrease in the incidence of spontaneous preterm birth. Attempts to analyze, interpret and decrease preterm birth rates should consider spontaneous and iatrogenic preterm births separately.

A dose?response relation exists between different classes of pre-gravid obesity and selected perinatal outcomes

ObjectiveTo examine if a “dose–response” relation exists between different classes of pre-gravid obesity and selected perinatal outcomes.MethodsWe evaluated 16,566 obese mothers, including 12,064 (72.8%), 3410 (20.6%), and 1092 (6.6%) with obesity class I, II, and III, respectively. We compared maternal age, primiparity, gestational age at birth, birth weight, GDM, hypertensive disorders, and the incidence of cesarean sections.ResultsThere was a significantly increased incidence (from class I to class III) for GDM (8.5–14.4%), chronic hypertension (2.8–9.0%), gestational hypertension (6.7–14.2%), and for preeclampsia (5.3–9.3%). No such relationship existed for birth weight and gestational duration.ConclusionClasses of obesity during pregnancy exhibit a “dose–response” relationship with maternal morbidity, but no such relationship was found with pregnancy duration and birth weight.

Respiratory morbidity in twins by birth order, gestational age and mode of delivery.

Abstract Objective: To evaluate the relationship between respiratory morbidity in twins by gestational age, birth order and mode of delivery. Methods: All twin deliveries at <37 weeks, registered in a national database, in the period 2003–2012 were classified into four gestational age groups: 33–36, 30–32, 28–29, and <28 weeks. Outcome variables included transient tachypnea of the newborn (TTN), respiratory distress syndrome (RDS) and need for assisted ventilation. Results: A total of 1836 twins were born vaginally, and 2142 twins were born by cesarean delivery, for a grand total of 3978 twins. TTN did not appear to be related to birth order and to the mode of delivery. In contrast, RDS was more frequent among the second born twins in the vaginal birth groups born at 30–36 weeks [odds ratio (OR) 2.5, 95% confidence interval (CI) 1.2–5.1 and OR 2.0, 95% CI 1.2–3.5 for 33–36 weeks and 30–32 weeks, respectively], whereas this trend was seen in the cesarean birth groups born earlier (OR 3.8, 95% CI 1.1–13.0 for 28–29 weeks). Cesarean delivery significantly increased the frequency of RDS in twin A as well as in twin B compared with vaginal birth, but only at gestational ages <30 weeks. Conclusion: Mode of delivery and birth order have a gestational age dependent effect on the incidence of RDS.

Uterine electromyography during active phase compared with latent phase of labor at term

In a prospective study in a tertiary university hospital we wanted to determine whether uterine electromyography (EMG) can differentiate between the active and latent phase of labor.

The effect of gestational diabetes, pre-gravid maternal obesity, and their combination (‘diabesity’) on outcomes of singleton gestations

Abstract Objective: To assess the effect of the combination of gestational diabetes mellitus (GDM) and pre-gravid obesity (‘diabesity’) in singleton gestations. Methods: We compared perinatal outcomes of singleton gestations in mothers with GDM and pre-gravid obesity, with GDM but with normal pre-gravid BMI, and obese mothers without GDM. Results: We compared diabesity mothers (n = 1525, 24.4% of mothers with GDM, 9.9% of all obese women) to mothers with GDM but with normal BMI (n = 4704, 75.6% of mothers with GDM) and to obese mothers without GDM (n = 13,937, 90.1% of all obese mothers). Obesity, with and without GDM, increased the odds of having chronic hypertension whereas preeclampsia appears to be influenced by obesity only, as were the risk of births at <33 weeks’ gestation, of birth weight >4000 g, low 5-min Apgar scores and NICU admissions. Conclusion: Obesity (without diabetes) is more frequently associated with adverse perinatal outcomes than diabesity or GDM in non-obese mothers. A campaign to decrease pre-gravid obesity should have at least the same priority as any campaign to control GDM.

A population-based comparison between actual maternal weight gain and the Institute of Medicine weight gain recommendations in singleton pregnancies.

Abstract Objective: To compare the actual maternal weight gain to that recommended by the Institute of Medicine (IOM) in term singleton gestations. Methods: We used data from the Slovenian National Perinatal Information System to select singleton pregnancies born at ≥38 weeks during the period from 2003 to 2012. We calculated the frequencies of mothers who gained less than, more than, and as recommended by the IOM according to their pregravid body mass index (BMI). We also compared the fetal size parameters in under- and over-gainer to those who gained weight as recommended by the IOM. Results: We selected 173,715 patients who delivered at ≥38 weeks. Of these patients, the recommended weight gain was achieved by 56,868 (32.7%, 95% CI 32.5, 32.9) only, 82,617 (47.6%, 95% CI 47.3, 47.8) were over-gainers, and 34,230 (19.7%, 95% CI 19.5, 19.8) gained less than recommended. Neither undergaining nor overgaining were always synonymous with adverse fetal outcomes. Conclusions: Roughly two-thirds of singleton mothers did not gain weight during pregnancy according to the IOM recommendations. Inappropriate maternal weight gain, however, was not always associated with adverse fetal outcomes and this implies that a tailored approach rather than strict adherence to the IOM recommendations may be more practical.

Outcome of monochorionic-biamniotic twins conceived by assisted reproduction: a population-based study.

Abstract Objecive: To evaluate the perinatal outcome of monochorionic-diamniotic twins conceived by assisted reproduction technology (ART). Methods: We compared data from a national population-based perinatal registry on perinatal outcomes of monochorionic-diamniotic twins conceived by ART with their dichorionic counterparts and with spontaneous monochorionic-diamniotic twins. We compared maternal characteristics, pregnancy complications and perinatal outcomes. Results: Monochorionic-diamniotic twin pregnancies (n=45) comprised 5.5% of all ART twins, and 9.3% of all monochorionic twins in this dataset. ART does not appear to increase the already high risk of monochorionicity compared to spontaneous conception, with the latter having an increased incidence for birth weight <1500 g [odds ratio (OD) 2.6, 95% confidence interval (CI) 1.2–5.4]. Conclusion: Our results disagree with hospital-based data and suggest that monochorionic-diamniotic twins following ART are not at increased risk of adverse perinatal outcomes compared to spontaneous monochorionic-diamniotic twins as well as to dichorionc twins conceived by ART.

Outcome of small for gestational age preterm singletons: a population-based cohort study.

Abstract Objective: To examine the outcomes of births among small and appropriate for gestational age (SGA and AGA) infants by gestational age and maternal characteristics. Materials and methods: We used a national perinatal registry to compare the selected maternal and neonatal outcomes between AGA and SGA neonates born at gestational age groups 33–36, 30–32, 28–29, and <28 weeks. We evaluated maternal body mass index (BMI), pre-gestational/gestational diabetes, hypertensive disorders, and cesarean births as well as frequencies of 5-min Apgar score <7, intraventricular hemorrhage (IVH), respiratory distress syndrome (RDS), the need for assisted ventilation, and early neonatal deaths. Results: We evaluated 159,774 AGA (8871 preterm) and 13,735 SGA (1147 preterm) infants and found a gradual decrease in the incidence of SGA infants with increasing gestational age. Diabetes was unrelated to having an SGA or AGA infant among preterm births, but the odds ratio (OR) for preeclampsia among preterm-SGA pregnancies was up to 6.9 (95% CI 3.8, 12.5) at <28 weeks. SGA infants fare worse compared to AGA neonates in every parameter tested but only in preterm births >30 weeks. Conclusions: Being SGA further complicates preterm births after 30 weeks of gestation but not earlier. This might suggest that an extended period in the hostile intrauterine environment, or that being born at <30 weeks, is bad enough and is not further aggravated by being SGA.

Do tall women beget larger babies

Abstract Objective: To evaluate the possible relationship between maternal height and fetal size. Patients and methods: We used a population-based cohort of apparently healthy mothers of singletons to evaluate quartiles of the maternal height distribution for parity, being overweight or obese, and for gestational age and birth weight parameters. We also generated birth weight by gestational age curves for each quartile. Results: We analyzed data of 198 745 mothers. Mother from the four quartiles had similar parity, pre-gravid BMI, and gestational age at birth. Short mothers had a significantly higher rate of VLBW and LBW and 2501–4000 g infants, for an OR = 1.38 (95% CI: 1.17–1.62), OR = 2.2 (95% CI: 2.05–2.37) and OR = 1.82 (95% CI: 1.73–1.87) between the shortest and tallest mothers, respectively. By contrast, the opposite trend was noticed for birth weights >4000 g, for an OR = 2.77 (95% CI: 2.65–2.89) between the tallest and shortest mothers. A very similar “growth curve” was apparent until 33 weeks, when a slower growth velocity was observed for shorter compared with taller women. Conclusions: Maternal stature does not appear to be associated with gestational age but significantly influences birth weight. Height-related differences between mothers appears to begin after 33 weeks’ gestation.