Tamar Tzur

Can anemia in the first trimester predict obstetrical complications later in pregnancy

Objective: The present study examines whether there is an association between anemia during the first trimester and the risk to develop preterm delivery (PTD), intrauterine growth restriction, and other obstetrical complications. Methods: The study population included all registered births between 2000 and 2010. Anemia was defined as hemoglobin <10 g/dl. A comparison of obstetrical characteristics and perinatal outcomes was performed between women with and without anemia. Multiple logistic regression models were used to control for confounders. Results: The study population included 33,888 deliveries, of these 5.1% (1718) were with anemia during the first trimester. Women with anemia were significantly older, delivered earlier, and were more likely to be grand multiparous. There were significantly higher rates of PTD and low birth weight (LBW; <2500 g) among patients with anemia (12.3% vs. 9.3%; p < 0.001 and 11.7% vs. 9.0%; p < 0.001, respectively). On the contrary, no significant differences between the groups were noted regarding the rate of intrauterine growth restriction. Using a multivariable analysis, the significant association between anemia and PTD persisted (OR = 1.35; 95% CI 1.2–1.6, p < 0.01). Conclusions: Anemia during the first trimester is significantly and independently associated with an increased risk for subsequent PTD.

Timing of elective repeat caesarean section: maternal and neonatal morbidity and mortality

Timing of elective repeat caesarean section should take into account both fetal and maternal considerations. The percentage of caesarean deliveries has dramatically increased during the last decades. It undoubtedly leads to an increase in the number of women having multiple caesarean sections. While maternal morbidity increases with increased number of caesarean sections, when compared with their term counterparts, late pre-term infants face increased morbidity. Establishing the optimal time of delivery for both mother and child is a major challenge faced by clinicians. The aim of this review is to better understand neonatal and maternal morbidity and mortality that are associated with elective repeat caesarean section, and to provide an educated decision regarding the optimal timing for elective repeat caesarean section.

Is There an Association between Platelet Count during the First Trimester and Preeclampsia or Other Obstetric Complications Later in Pregnancy

Objective. To examine whether an association exists between platelet (PLT) count in the first trimester of pregnancy and the risk for hypertensive disorders or other obstetric complications. Methods. The study population included all registered births with available PLT count from the first trimester of pregnancy during 2000–2010. Thrombocytopenia was defined as PLT count below 100,000/μL. A comparison was performed between women with and without thrombocytopenia. Multiple logistic regression models were used to control for confounders. Results. The study population included 33,890 deliveries; of these, 119 (0.35%) were with thrombocytopenia. Women with thrombocytopenia had significantly higher rates of preterm delivery (16.0% vs. 9.4%; p = 0.015). There was no significant difference between the groups regarding hypertensive disorders. Conclusions. Hypertensive disorders cannot be predicted based on PLT count during the first trimester of pregnancy. Nevertheless, thrombocytopenia during the first trimester is a risk factor for preterm delivery.

Calcium level during the first trimester of pregnancy as a predictor of preeclampsia

Objective: To examine the association between calcium levels during the first trimester of pregnancy and preeclampsia. Methods: The study population included registered births (n = 5233) in a tertiary medical center between 2001 and 2011. A comparison was performed between women with and without hypocalcemia during the first trimester of pregnancy. A second analysis was performed after correcting calcium levels for albumin. Multiple logistic regression models were used to control for confounders. Receiver operating characteristic curve analysis graphs were used to describe the relationship between the true-positive rate (sensitivity) and the false-positive rate for different values of calcium during the first half of pregnancy in the prediction of preeclampsia. Results: Of 5233 deliveries, 841 (16%) had hypocalcemia and 4392 (84%) had a normal calcium level. No significant difference were found between the groups regarding mild preeclampsia [odds ratio (OR) = 1.216; 95% confidence interval (CI) 0.831–1.779; p = 0.312], severe preeclampsia (OR = 1.618; 95% CI 0.919–2.849; p = 0.092) and any hypertensive disorders (OR = 1.324; 95% CI 0.963–1.821; p = 0.083). Conclusions: Hypocalcemia during the first trimester of pregnancy is not a risk factor for preeclampsia.