Maternal-fetal medicine (Wolters Kluwer Health, Inc.)最新文献

Objective: To address the critical unmet need in managing unexplained recurrent pregnancy loss (URPL), where current empiric therapies exhibit limited efficacy, by leveraging patient-derived organoids (PDOs) for personalized therapeutic discovery. This single-case report serves as a proof-of-concept application of PDO-guided precision therapy in URPL.

Methods: A 29-year-old woman who experienced six consecutive pregnancy losses underwent endometrial PDO-based drug testing. Organoids and stromal cells were cultured from proliferative-phase endometrial biopsies, and growth responses were subsequently quantified using RNA-seq and functional assays.

Results: Histological examination of the endometrium revealed increased fibrosis alongside reduced stromal cell and CD3+ T-cell infiltration at the maternal-fetal interface. Initial observations of the PDOs indicated that epithelial growth was delayed. A synergistic triple-therapy regimen (aspirin + low-dose heparin + almuabumab) was identified as a candidate for restoring uterine homeostasis. Combination therapy achieved an ongoing pregnancy. Following conservative management of intrahepatic cholestasis and preeclampsia, a cesarean delivery was performed at 34⁺¹ weeks, resulting in the birth of a healthy neonate.

Conclusion: This study pioneered the use of PDOs as an innovative therapeutic model for URPL, targeting immune-thrombotic dysregulation and enabling precision therapy. These findings establish a precision medicine paradigm that integrates organoid pharmacology with dynamic pregnancy surveillance for refractory cases of URPL. However, these data are derived from a single patient and should thus be interpreted with caution, warranting confirmation in larger, prospective cohorts.

Objective: To evaluate perinatal outcomes in twin pregnancies, comparing different gestational diabetes mellitus (GDM) subgroups with pregnancies without GDM.

Methods: A retrospective cohort study of twin pregnancies was performed from January 2014 to December 2022. GDM was diagnosed based on the International Association of Diabetes and Pregnancy Study Groups criteria for the 2-h 75-g oral glucose tolerance test. Women with twin pregnancies were divided into four groups: healthy control, impaired fasting glucose (IFG), gestational impaired glucose tolerance (GIGT), and IFG + GIGT. Poisson regression models were performed to compare perinatal outcomes between these groups, including large for gestational age, small for gestational age, gestational hypertension, preeclampsia, hypertensive disorders of pregnancy, neonatal unit admission, neonatal jaundice, and neonatal respiratory distress syndrome. Generalized estimation equation models were utilized to address intertwin correlation.

Results: A total of 2162 women with twin pregnancies were eligible for analysis. IFG was associated with an increased risk of having large for gestational age infants (adjusted risk ratio (aRR): 2.62, 95% confidence interval (CI): 1.31-5.24 in the IFG; and aRR: 2.09, 95% CI: 1.19-3.66 in the IFG + GIGT group, respectively). An increased risk of preeclampsia (aRR: 1.78, 95% CI: 1.05-3.03) and hypertensive disorders of pregnancy (adjusted odds ratio: 1.85, 95% CI: 1.05-3.27) was observed in the IFG + GIGT group. Conversely, GIGT was not associated with any adverse perinatal outcomes.

Conclusion: The present findings revealed differences in perinatal outcomes between women with twin pregnancies with subgroups of GDM and without GDM. Classification of GDM by fasting glucose and post-load glucose may benefit risk stratification in the perinatal management of twin pregnancies.

Objective: To investigate gestational age-specific variations in cervical length (CL) and evaluate the predictive ability of CL for preterm delivery (PTD) across different trimesters.

Methods: This retrospective longitudinal study included a total of 8659 women who delivered singleton live births between June 1, 2022, and December 31, 2024, at Peking University First Hospital. Associations between CL measured at ≤ 19⁺⁶, 20-24⁺⁶, and 28-33⁺⁶ gestational weeks and PTD were evaluated using receiver operating characteristic curve analysis and log-rank tests.

Results: CL showed substantial variability across gestational ages, with pronounced shortening observed during 28-33⁺⁶ weeks. Significant differences in CL distribution between women with PTD and those with term delivery emerged as early as 20-24⁺⁶ weeks. The predictive value of CL for PTD increased with advancing gestational age. Optimal CL thresholds for predicting PTD ≤ 34⁺⁶ weeks were 28 mm, 15 mm, and 10 mm at ≤ 19⁺⁶, 20-24⁺⁶, and 28-33⁺⁶ weeks, respectively, while corresponding thresholds for PTD < 37 weeks were 28 mm, 26 mm, and 10 mm. Women with CL below these cut-offs had significantly lower probabilities of term delivery. The 26-mm threshold at mid-gestation (20-24⁺⁶ weeks) closely aligned with the conventional 25-mm definition of short cervix, supporting the validity of the minimum P approach. The consistent 10-mm threshold in late gestation suggests that lower diagnostic cut-offs after 28 weeks may be required to guide clinical management.

Conclusion: CL progressively decreases with increasing gestational age and has emerged as a more potent predictor of PTD after 20 weeks of gestation. A short cervix in late pregnancy may be more appropriately defined as < 10 mm at 28-33⁺⁶ gestational weeks.

Fetal premature atrial contractions (PACs) are the most common fetal arrhythmia, accounting for up to 90% of cases. Although predominantly benign and self-limiting, PACs carry a small but significant risk of adverse outcomes, including progression to supraventricular tachycardia (SVT), and heart failure. This review synthesizes current evidence on the epidemiology, etiology, and risk stratification of fetal PACs. We highlight the importance of M-mode and Doppler echocardiography in diagnosis and in distinguishing PACs from atrioventricular block (AVB). A risk-stratified management pathway is proposed: low-risk cases (isolated PACs, normal ventricular rate, no structural abnormalities) require weekly heart rate monitoring and routine obstetric care; high-risk cases-characterized by blocked PACs, bigeminy/trigeminy, frequent PACs, bursts of tachycardia, atrial septal aneurysm, heart failure, or associated congenital heart disease-warrant enhanced surveillance, multidisciplinary consultation, and consideration of antiarrhythmic therapy or timely delivery. Postnatal follow-up is essential to confirm resolution and manage late-onset SVT. Accurate diagnosis and risk-adapted intervention are critical to optimizing perinatal outcomes.

Objective: To identify, evaluate, and summarize evidence on the effects of prenatal exposure to organochlorine compounds (OCCs) and other pesticides on neonatal growth parameters.

Methods: Keywords were identified through systematic reviews and expert consultation, then finalized with an academic librarian. A comprehensive search was conducted in PubMed, Cochrane Library, MEDLINE (OVID), Scopus, Web of Science, and CINAHL from inception to February 26, 2024. Retrieved records were managed using EndNote 20. Two independent reviewers screened titles and abstracts based on predefined eligibility criteria. Full-text articles were further assessed for inclusion, with disagreements resolved by a third reviewer. A standardized process was followed during the full-text review. Studies were included if they involved pregnant women and their neonates, assessed prenatal exposure to OCCs, and reported at least one neonatal growth parameter. Data were extracted using Microsoft Excel^® and included study design, sample characteristics, exposure details (timing, route, and measurement), and neonatal growth outcomes. Methodological quality was assessed using the National Institutes of Health Quality Assessment Tool.

Results: This systematic review included 16 studies conducted between 1997 and 2023 across various countries, with the majority from the United States (n = 6). The studies employed diverse designs, including cohort, case-control, longitudinal cohort, and cross-sectional studies, to investigate the impact of prenatal pesticide exposure on neonatal health outcomes. Key neonatal growth parameters assessed were birth weight, length, head circumference, and gestational age. The quality of the included studies varied, with overall scores ranging between 64.28%-91.66%.

Conclusion: The findings demonstrate significant associations between prenatal exposure to OCCs and adverse neonatal growth outcomes. Frequently reported effects included reduced birth weight, smaller head circumference, shorter gestational age, and increased risk of growth restriction. These results underscore the importance of minimizing maternal exposure to persistent organic pollutants during pregnancy and highlight the need for targeted public health policies and preventive strategies.

Registration no: CRD42024621439.