Maternal Preconception Body Mass Index Overtakes Age as a Risk Factor for Gestational Diabetes Mellitus.

Introduction-The purpose of this study was to determine the relative impact of modifiable and non-modifiable risk factors in the development of gestational diabetes mellitus (GDM), with a particular focus on maternal preconception body mass index (BMI) and age, two important determinants of insulin resistance. Understanding the factors that contribute most to the current escalation of GDM rates in pregnant women could help to inform prevention and intervention strategies, particularly in areas where this female endocrine disorder has an elevated prevalence. Methods-A retrospective, contemporary, large population of singleton pregnant women from southern Italy who underwent 75 g OGTT for GDM screening was enrolled at the Endocrinology Unit, "Pugliese Ciaccio" Hospital, Catanzaro. Relevant clinical data were collected, and the characteristics of women diagnosed with GDM or with normal glucose tolerance were compared. The effect estimates of maternal preconception BMI and age as risk factors for GDM development were calculated through correlation and logistic regression analysis by adjusting for potential confounders. Results-Out of the 3856 women enrolled, 885 (23.0%) were diagnosed with GDM as per IADPSG criteria. Advanced maternal age (≥35 years), gravidity, reproductive history of spontaneous abortion(s), previous GDM, and thyroid and thrombophilic diseases, all emerged as non-modifiable risk factors of GDM, whereas preconception overweight or obesity was the sole potentially modifiable risk factor among those investigated. Maternal preconception BMI, but not age, had a moderate positive association with fasting glucose levels at the time of 75 g OGTT (Pearson coefficient: 0.245, p < 0.001). Abnormalities in fasting glucose drove the majority (60%) of the GDM diagnoses in this study. Maternal preconception obesity almost tripled the risk of developing GDM, but even being overweight resulted in a more pronounced increased risk of developing GDM than advanced maternal age (adjusted OR for preconception overweight: 1.63, 95% CI 1.320-2.019; adjusted OR for advanced maternal age: 1.45, 95% CI 1.184-1.776). Conclusions-Excess body weight prior to conception leads to more detrimental metabolic effects than advanced maternal age in pregnant women with GDM. Thus, in areas in which GDM is particularly common, such as southern Italy, measures aiming to counteracting maternal preconception overweight and obesity may be efficient in reducing GDM prevalence.

Successful Pregnancy in a Woman of Advanced Maternal Age at Sixteen Months Post-Roux-en-Y Gastric Bypass Revision.

Obesity, defined as body mass index (BMI) > 30 kg/m2, complicates maternal and neonatal outcomes. Bariatric surgery (BS) is an option for weight reduction in several populations, including reproductive-aged women. However, there is a lack of consensus regarding the ideal time interval between BS and pregnancy. We report the case of a 43-year-old Hispanic female who underwent an initial Roux-en-Y gastric bypass (RYGB) in 2011, followed by a revision eight years later in 2019. The revision entailed the reduction of the gastric pouch size and the excision of the remnant stomach. It occurred sixteen months before the conception of her second pregnancy. Despite advanced maternal age and nutritional challenges following BS, this patient delivered a healthy male neonate and maintained a net weight loss compared to her preoperative weight. Factors leading to this positive outcome included the patient's adherence to dietary recommendations following the procedure and using weight loss adjuncts (phentermine and topiramate) to promote post-procedure weight loss. Sixteen months between RYGB revision and conception can lead to positive pregnancy outcomes, even in women of advanced maternal age and multiple prior BS. Further studies are required to understand better the optimal interval to reduce maternal and neonatal complications following RYGB specifically and the use of medications as weight loss adjuncts.

COVID-19 vaccinations in pregnancy: Save mother and baby from COVID-19 pandemic.

OBJECTIVE: The current study investigated the immune response of maternal coronavirus disease 2019 (COVID-19) vaccination and vertical transmission of anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike (S) and nucleocapsid (N) proteins. STUDY DESIGN: This retrospective study included pregnant women in Bahrain Defense Force Hospital from March 2021 to September 2021 who were vaccinated with Sinopharm or Pfizer/BioNTech. Testing of anti-N and -S levels from paired samples of maternal and umbilical cord blood was performed at the time of delivery. The immune response to vaccination, association with maternal and fetal factors, and vertical transmission of antibodies were studied. RESULTS: The current study included 79 pregnant women. The median gestational age for those vaccinated with Sinopharm was 28 weeks and those vaccinated with Pfizer was 31 weeks, with 100% of the vaccinated population generating antibodies and showing vertical transmission. The anti-N and -S titers and interval frequencies varied in both vaccinations. The anti-N and -S and transfer ratio statistically correlated with maternal age, gestational age at delivery, latency period, and birth weight of the neonates differently in both vaccines. In addition, the peak level of antibodies and transfer ratios varied. CONCLUSION: Although variations are exhibited in both types of vaccination, the vaccinated pregnant population generated a significant level of anti-N and -S and showed vertical transmission.

Maternal COVID-19 infection and subacute placental histopathology

Background: The emergence of coronavirus disease 19 (COVID-19) as a novel zoonotic disease has been of international concern, with recent studies highlighting the potential association of COVID-19 with placental vascular dysfunction.1,2 Because the increased incidence of histopathological lesions could imply an aetiologic relationship with SARS-CoV-2 infection, this study aims to audit the spectrum of subacute placental disease occurring in COVID-19 positive mothers. Method(s): Histopathological reports were obtained from Liverpool Hospital from 18 March 2020 to 18 March 2022 and subjected to retrospective histopathological report audit. Three hundred and five placentas from mothers with history of COVID-19 infection during pregnancy were compared with 305 randomly selected controls with no reported COVID-19 infection. Information obtained included maternal age, fetal gestation at delivery, macroscopic measurements and 12 histopathological variables. Missing data was imputed using a random forest algorithm, with downstream multivariate statistical analysis. Validation of findings was performed via non-linear principal component analysis (NLPCA). Result(s): A significant increase in mean placental weight was observed in mothers with a history of COVID-19 (COVID-19 cohort 480g, control cohort 423g, p < 0.0001). Median gestation was significantly increased within the COVID-19 cohort at 38.2 weeks compared to 36.5 weeks in controls (p <0.0001). Surprisingly, there was no increase in histopathological lesions within the COVID-19 cohort. Similar findings were confirmed with NLPCA. These findings highlight the possible resistance of the placental disc to COVID-19 infection and the utility of utilising imputation and NLPCA in the study of potential new pathological entities. References 1. Wong YP, Khong TY, Tan GC. The Effects of COVID-19 on placenta and pregnancy: what do we know so far? Diagnostics 2021;11: 94. 2. Boyraz B, James K, Hornick J, et al. Placental pathology from COVID-19 recovered (nonacute) patients. Human Pathology 2022;125: 18-22.

Insights into Prevention of Health Complications in Small for Gestational Age (SGA) Births in Relation to Maternal Characteristics: A Narrative Review.

Small for gestational age (SGA) births are a significant clinical and public health issue. The objective of this review was to summarize maternal biological and socio-demographic factors and preventive strategies used to reduce the risk of SGA births. A literature search encompassing data from the last 15 years was conducted using electronic databases MEDLINE/PubMed, Google Scholar and Scopus to review risk factors and preventive strategies for SGA. Current evidence shows that primiparity, previous stillbirths, maternal age ≤24 and ≥35 years, single motherhood, low socio-economic status, smoking and cannabis use during pregnancy confer a significant risk of SGA births. Studies on alcohol consumption during pregnancy and SGA birth weight are inconclusive. Beneficial and preventive factors include the "Mediterranean diet" and dietary intake of vegetables. Periconceptional folic acid supplementation, maternal 25-hydroxyvitamin D, zinc and iron levels are partly associated with birth weight. No significant associations between COVID-19 vaccinations and birthweight are reported. A midwifery-led model based on early and extensive prenatal care reduces the risk of SGA births in women with low socio-economic status. Major preventive measures relate to the awareness of modifiable and non-modifiable risk factors of SGA, leading to changes in parents' lifestyles. These data support that education, monitoring during pregnancy, and implementing preventive strategies are as important as biological determinants in risk reduction of SGA births.

Reproduction in a changing world.

Although the global population continues to increase, the total fertility rate in many high-income countries (HICs) is below replacement, a trend apparent over several decades. The timing and pace of this change will shape the age distribution in these countries, leading to an increasing proportion of older people. The well-established links of the "demographic transition" between improving female education and improved access to contraception continue to drive down the fertility rates in low-/middle-income countries. However, changes in the age distribution will not be as marked as in HICs in the coming decades. These relationships may now be changing in some HICs with greater prosperity at both the personal (in some sectors of society) and national levels, linked to an increase in the total fertility rates despite continuing trends toward older age at first birth. Key drivers in these countries include improved provision of free/low-cost childcare, paid parental leave, and higher paternal contributions to childcare. However, there is also an increase in the number of women who do not have children or who may be unable to complete their family plans. Coronavirus disease 2019 and environmental factors, including the increasing prevalence of obesity, add to pressures on the fertility rates. Variable knowledge of the realities of female reproductive aging, particularly by men, is also a contributing factor, and this complex mix has fueled the increase in the number of elective egg freezing.

Maternal risk factors of COVID-19-affected pregnancies: A comparative analysis of symptomatic and asymptomatic COVID-19 from the Q-PRECIOUS registry.

BACKGROUND: The novel coronavirus disease 2019 (COVID-19) pandemic has had consequences on the pregnant population, as disease severity is associated with the quality of maternal health and pregnancy complications, increasing maternal and neonatal morbidity. Worldwide descriptive data help describe risk factors that could predict symptomatic and severe COVID-19 in pregnancy. OBJECTIVES: To describe demographic features and risk factors of pregnant women with COVID-19 in Qatar and compare symptomatic versus asymptomatic disease. STUDY DESIGN AND METHODOLOGY: Clinical characteristics and risk factors of pregnant women with COVID-19 in Qatar from March 2020 to March 2021 was retrospectively reviewed, comparing the cohort with the general pregnant population. Crude and adjusted odds ratios (aORs) were computed, comparing symptomatic versus asymptomatic infection. RESULTS: Of the 500 women, 347 reported at least one symptom at diagnosis (347/500; 69.4%). The majority fell in the 30-39 years age group (241/500; 48%), with more than half in the obese body mass index (BMI) category. The cohort was 66% (332/500) Qatari women, compared with the 26% expected in the population (26.4% vs 66.4% p < 0.001). Compared with the 2019 national statistics, the number of women was higher in the >40 years age group (5% vs 7.6%, p = 0.027) and grand multiparous group (5.4% vs 13.6%, p < 0.001). The symptom most commonly reported by the symptomatic group was cough (276/500; 55%), followed by fever, fatigue, and myalgia. In the adjusted analysis, the symptomatic group had 2.7 times higher odds of being asthmatic (OR = 2.67, 95% CI 1.1-6.7, p = 0.037). Women aged >40 years had 6.6 times higher odds of symptomatic disease (aOR = 6.6, 95% CI 1.08-39.73, p = 0.041). A history of contact with a patient with symptomatic COVID and earlier gestational age at diagnosis increased the odds (aOR = 2.06, 95% CI 1.2-3.54, p = 0.009; aOR = 0.73 95% CI 0.57-0.96; p = 0.017). CONCLUSIONS: This study cohort included significantly more Qatari women, older women, grand multiparous women, a higher proportion with pre-existing and gestational diabetes, and higher BMI than national data. In addition, contact to a patient with symptomatic disease, history of asthma, older age, and earlier gestational age at diagnosis were significantly associated with symptomatic disease.