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Recent Advances in Adverse Pregnancy and Neonatal Outcomes

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Dr. Sae-kyung Choi

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Department of Obstetrics and Gynecology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 21431, Republic of Korea
Interests: pregnancy; preterm; placenta; fetal growth

Special Issue Information

Dear Colleagues,

Adverse pregnancy and neonatal outcomes remain significant challenges in obstetric and neonatal care, with profound implications for maternal and neonatal health. Recent advances in research, diagnostics, and interventions have contributed to mitigating risks and improving outcomes for both mothers and infants. Conditions such as preterm birth, low birth weight (LBW), and fetal distress remain significant concerns, though improvements in maternal-fetal medicine have reduced their prevalence in some populations. Cesarean sections (CS), while life-saving, are associated with increased risks of uterine rupture, abnormal placentation, and neonatal complications like asthma and altered gut microbiome diversity. Multiple CS procedures further elevate risks of uterine dehiscence and surgical complications.

Innovations in fetal medicine, such as intrauterine surgeries for congenital conditions like spina bifida, have improved neonatal survival rates. Robotic-assisted surgeries and AI-based diagnostics are enhancing precision and early detection of complications like gestational diabetes. Despite these advancements, challenges persist in low-resource settings where maternal mortality from obstructed labor and hemorrhage remains high.

Efforts to optimize CS use and strengthen antenatal care are crucial for mitigating adverse outcomes. The integration of advanced technologies into maternal-fetal medicine offers promising pathways to improve health outcomes for mothers and newborns globally.

Dr. Sae-kyung Choi
Guest Editor

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Research

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8 pages, 232 KB

Open AccessArticle

Inflamed Pathways to Motherhood: Evaluating Obstetric and Neonatal Outcomes in Rheumatic Pregnancies

by Batuhan Turgay, Uğurcan Zorlu, Bulut Varlı, Gülşah Aynaoğlu Yıldız, Şahin Kaan Baydemir, Cem Somer Atabekoğlu and Tahsin Murat Turgay

J. Clin. Med. 2025, 14(16), 5692; https://doi.org/10.3390/jcm14165692 - 12 Aug 2025

Cited by 1 | Viewed by 1216

Abstract

Objective: This study aims to evaluate obstetric and neonatal outcomes in pregnancies complicated by RDs and to identify hemogram-derived biomarkers associated with adverse perinatal events. Methods: This retrospective cohort study analyzed 360 pregnancies in individuals diagnosed with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), systemic sclerosis (SSc), ankylosing spondylitis (AS), Sjögren’s disease, sarcoidosis, undifferentiated connective tissue disease (UCTD), and other autoimmune conditions, followed up at the Department of Obstetrics and Gynecology, Ankara University Faculty of Medicine, between 2013 and 2018. Data on disease activity, maternal complications, neonatal outcomes, and inflammatory markers were extracted from electronic medical records. Results: Patients with SSc had the highest rates of preterm birth (57.1%) and fetal growth restriction (FGR) (42.9%), whereas those with SLE (50%) and AS (25%) exhibited the highest disease flare rates. Neonates born to mothers with SSc, SLE, and Sjögren’s disease had significantly lower Apgar scores, suggesting increased neonatal distress. NICU admission was associated with elevated neutrophil-to-lymphocyte ratio (NLR) and eosinophil-to-lymphocyte ratio (ELR), with higher NLR and ELR also predicting spontaneous abortion. Monocyte-to-lymphocyte ratio (MLR) and ELR demonstrated the highest predictive value for composite adverse perinatal outcomes. Additionally, RA patients experiencing disease flares had an 87.5% cesarean section (CS) rate, significantly exceeding the general population rate. Conclusions: This study underscores the increased risk of preterm birth, FGR, and neonatal complications in RD pregnancies, particularly in SSc and SLE patients. The findings suggest that early risk assessment using hemogram-based inflammatory markers may improve perinatal management and patient stratification. Full article

(This article belongs to the Special Issue Recent Advances in Adverse Pregnancy and Neonatal Outcomes)

Review

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25 pages, 1326 KB

Open AccessReview

Systemic Immune-Inflammation Index as a Predictive Biomarker for Pre-Eclampsia

by Dimitris Baroutis, Eleni Katsianou, Aikaterini-Gavriela Giannakaki, Nikolaos Sindos, Ioannis Fragiskos, Konstantinos Koukoumpanis, Vasilios Lygizos, Marianna Theodora, Vasilios Pergialiotis, Michael Sindos and George Daskalakis

J. Clin. Med. 2026, 15(10), 3619; https://doi.org/10.3390/jcm15103619 - 8 May 2026

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Abstract

Pre-eclampsia, a major obstetric syndrome with an estimated global incidence of 2–8% of all pregnancies, ranks among the foremost causes of adverse maternal and perinatal outcomes worldwide. The Systemic Immune-Inflammation Index (SII)—derived as the product of platelet and neutrophil counts divided by the lymphocyte count—is a composite hematological parameter first established in oncological research that simultaneously captures neutrophil activation, lymphocyte dysfunction, and platelet alterations—three immunohematological disturbances implicated in pre-eclampsia pathophysiology. This narrative review synthesizes the current evidence regarding SII in pre-eclampsia, examining the biological rationale, clinical study findings, comparative performance against established inflammatory biomarkers, practical advantages, and limitations. A comprehensive literature search encompassing PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar was conducted, covering all available records up to January 2026. The available data reveal substantial heterogeneity in both the direction of association (elevated versus paradoxically decreased SII in pre-eclampsia) and diagnostic performance across populations. While some studies report significantly elevated first-trimester SII values in women who subsequently develop pre-eclampsia, others demonstrate lower values or no significant predictive capacity. The only available meta-analysis reported non-significant pooled results for the pre-eclampsia-specific subgroup. Although SII’s derivation from routine complete blood count testing presents the advantages of cost-effectiveness and universal accessibility, methodological limitations—including retrospective study designs, the absence of standardized thresholds, the inconsistent discriminatory performance, and the conflicting directionality of association—preclude clinical implementation at present. Integration within multiparametric prediction models may optimize SII’s clinical utility. Future research should prioritize prospective validation studies across diverse populations, mechanistic investigations, and randomized controlled trials to establish evidence-based clinical translation. Full article

(This article belongs to the Special Issue Recent Advances in Adverse Pregnancy and Neonatal Outcomes)

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