Submit to Special Issue Submit Abstract to Special Issue Review for JCM Propose a Special Issue

Journal Menu

Journal Browser

Maternal–Fetal Medicine: Current Status, Challenges, and Future Directions

Print Special Issue Flyer
Special Issue Editors
Special Issue Information
Keywords
Benefits of Publishing in a Special Issue
Published Papers

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Obstetrics & Gynecology".

Deadline for manuscript submissions: 20 June 2026 | Viewed by 7210

Share This Special Issue

Special Issue Editor

Dr. Jessian Munoz

E-Mail Website
Guest Editor

Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Division of Fetal Intervention, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX 77030, USA
Interests: maternal–fetal medicine; pregnancy; newborn; obstetrics; high-risk pregnancy; mother-to-child infection; spontaneous abortion; recurrent spontaneous abortion
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

It is well known that despite the huge advances in genomics, immunology, ultrasonography, pharmacology, and other fields—they all serve complex pregnancies—the incidence of pathology and the patient care outcomes have continued to be suboptimal. For example, preterm birth is an ongoing challenge for both obstetricians and neonatologists due to limitations in predicting such births. This requires the establishment of a personalized strategy and a clear direction of treatment that takes into account the underlying mechanisms of the condition. Additional complexities include understanding that preterm births can be caused by preterm labor, preterm pre-labor rupture of membranes (PPROM), cervical insufficiency, and iatrogenic preterm delivery due to pregnancy or maternal complications.

As cesarean delivery rates continue to increase worldwide, the morbidity associated with repeat hysterotomies has become a global problem. The placenta accreta spectrum, uterine dehiscence, cesarean scar ectopic pregnancies, and peripartum hysterectomies have also increased in incidence, each with their own morbidity and mortality risks.

As part of the maternal–fetal dyad, infants are also significantly impacted by the intricacies of perinatology. The morbidity and mortality of premature newborns are higher than those of full-term infants.Analysis of this issue has highlighted the importance of the projection of fetal development in utero, continuing with the neonatal period, childhood, and even adulthood. In addition, the advancements in fetal surgery (in utero) interventions have allowed for the earlier treatment of complex fetal conditions.

Future research in the field of maternal–fetal medicine has many complexities to address surrounding the various aspects of care for both the mother and child.

Dr. Jessian Munoz
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

maternal–fetal medicine
preterm delivery
preterm birth management
newborn
obstetrics
high-risk pregnancy
perinatal outcome
placenta accreta, fetal surgery

Benefits of Publishing in a Special Issue

Ease of navigation: Grouping papers by topic helps scholars navigate broad scope journals more efficiently.
Greater discoverability: Special Issues support the reach and impact of scientific research. Articles in Special Issues are more discoverable and cited more frequently.
Expansion of research network: Special Issues facilitate connections among authors, fostering scientific collaborations.
External promotion: Articles in Special Issues are often promoted through the journal's social media, increasing their visibility.
Reprint: MDPI Books provides the opportunity to republish successful Special Issues in book format, both online and in print.

Further information on MDPI's Special Issue policies can be found here.

Published Papers (6 papers)

Download All Papers

Order results

Result details

Show export options Show export options

Select all

Export citation of selected articles as:

Research

Jump to: Other

13 pages, 651 KB

Open AccessArticle

Adverse Pregnancy Outcomes with Co-Occurring Opioid and Stimulant Use Disorders

by Alexandra R. Schroeder, Noor Al-Hammadi, Tucker Doiron and Niraj R. Chavan

J. Clin. Med. 2026, 15(8), 2811; https://doi.org/10.3390/jcm15082811 - 8 Apr 2026

Viewed by 226

Abstract

Background/Objectives: Substance use disorder (SUD) in pregnancy is an increasingly complex public health challenge that is known to worsen maternal and neonatal outcomes. Rates of polysubstance use are steadily rising. The objective of this study was to assess the impact of co-occurring opioid and stimulant use disorder on adverse pregnancy outcomes (APOs) among inpatient pregnancy hospitalizations. Methods: We conducted a cross-sectional analysis of inpatient pregnancy hospitalizations for delivery admissions from the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) from 2016 to 2020. ICD-10 codes were used to identify patients with opioid and stimulant use disorder and with APOs. APO was defined as a composite to include hypertensive disorders of pregnancy, antepartum hemorrhage, postpartum hemorrhage, preterm birth, and fetal growth restriction. Multivariable logistic regression analyses were undertaken to predict the likelihood of APOs among pregnancy hospitalizations with opioid use, stimulant use, or co-occurring (opioid and stimulant) use disorders. Sociodemographic covariates, including age, race and/or ethnicity, insurance payor type, and income level, were accounted for. Results: From 2016 to 2020, 32,602 delivery hospitalizations complicated by stimulant or opioid use disorder were identified. Of these admissions, 21,049 (64.6%) had opioid use disorder, 9472 (29.1%) had stimulant use disorder, and 2081 (6.4%) had co-occurring opioid and stimulant use disorder. In the entire cohort, the prevalence of APOs was significantly highest among pregnancy delivery hospitalizations with co-occurring opioid use and stimulant use disorder (1136/2081—54.6%, p < 0.001), as compared with opioid use disorder (8923/21,049—42.4%) or stimulant use disorder alone (4654/9472—49.1%). Rates of APOs increased in subsequent years for all cohort groups. Adjusting for relevant sociodemographic covariates, co-occurring opioid and stimulant use disorder was an independent predictor of APO (aOR 3.65; CI 95%, 3.34–3.99). In comparison, opioid use disorder and stimulant use disorder were independent predictors of APOs with a less strong correlation, aOR 2.22 (CI 95%, 2.16–2.29) and aOR 2.89 (CI 95%, 2.77–3.02), respectively. Conclusions: Patients with co-occurring opioid and stimulant use disorder have the highest exposure risk for APOs, acting as an independent predictor for APOs when adjusting for sociodemographic covariates. Full article

(This article belongs to the Special Issue Maternal–Fetal Medicine: Current Status, Challenges, and Future Directions)

► Show Figures

Figure 1

16 pages, 3344 KB

Open AccessArticle

From Diagnosis to Decision—Fetal Limb Abnormalities

by Andreea Florentina Stancioi-Cismaru, Razvan Grigoras Capitanescu, Mihaela-Simona Naidin, Cristian Constantin, Marina Dinu, Florin Burada, Oana Sorina Tica, Mihaela Gheonea, Bianca Catalina Andreiana, Razvan Cosmin Pana and Stefania Tudorache

J. Clin. Med. 2026, 15(2), 486; https://doi.org/10.3390/jcm15020486 - 8 Jan 2026

Viewed by 700

Abstract

Background/Objectives: Our aim was to investigate the diagnostic accuracy of prenatal ultrasound (US) in fetal limb abnormalities. As a secondary target, we wanted to correlate various predictors for the diagnosis accuracy. Methods: We prospectively enrolled cases with routine prenatal US performed in five participating centers. Subsequently, we selected and processed all cases with limb abnormalities: suspected, diagnosed, and missed on the prenatal diagnosis scans. We collected data on the type of anomaly, the US equipment and probes used, the operator’s expertise, the gestational age at the diagnosis, the length of the examination, and the use of US reporting form. SPSS 22.0 software was applied to perform the analyses using non-parametric statistical methods. Associations between categorical variables were evaluated using Fisher’s exact test and Chi-square tests. For correlations between the gestational age and the anomaly severity, we used Spearman’s rank-order correlation. Predictive performance of operator- and scan-related variables for diagnostic accuracy was assessed using receiver operating characteristic (ROC) curve analysis, with area under the curve (AUC) estimates, standard errors (SE), confidence intervals (95% CI), and p-values reported. Results: Our data showed that most US examinations were performed as part of routine screening (79.7%), and the most frequent anomaly diagnosed was clubfoot. Operators’ expertise demonstrated the highest predictive performance, while technical parameters—scan duration (AUC = 0.20, p = 0.1188) and US equipment (AUC = 0.30, p = 0.3478)—did not significantly predict diagnostic accuracy. Conclusions: The overall diagnostic accuracy of prenatal US was 85.5%. Our findings indicate that diagnostic performance is driven primarily by operator expertise and training, rather than by gestational age at scan and technical parameters. Full article

(This article belongs to the Special Issue Maternal–Fetal Medicine: Current Status, Challenges, and Future Directions)

► Show Figures

Figure 1

19 pages, 1188 KB

Open AccessArticle

The Prognostic Significance of Proteinuria Severity in Pregnancy: A Retrospective Cohort Study of Maternal and Neonatal Outcomes

by Barış Boza, Fırat Ersan, Verda Alpay and Hakan Erenel

J. Clin. Med. 2026, 15(1), 345; https://doi.org/10.3390/jcm15010345 - 2 Jan 2026

Viewed by 770

Abstract

Objective: To investigate the impact of proteinuria severity on obstetric and neonatal outcomes and to assess the predictive value of 24 h urinary protein excretion, both alone and within a multivariable model, for adverse pregnancy outcomes. Methods: This retrospective cohort study included 203 pregnant women with proteinuria who were classified into mild (≥0.3 g/day and <3.0 g/day, n = 50), severe (≥3.0 g/day and <5.0 g/day, n = 67), and massive (≥5.0 g/day; n = 86) groups based on 24 h urine protein levels. Maternal and neonatal outcomes were compared between these groups. Correlation analysis, receiver operating characteristic (ROC) curve analysis, and multivariable logistic regression were used to evaluate the predictive value of proteinuria for obstetric complications and identification of increased risk of early delivery. The AUC values of the proteinuria-only model and the multivariable model were compared using the DeLong test, as both models were derived from the same dataset and therefore represented correlated ROC curves. Results: The incidence of obstetric complications was significantly higher in the severe (68.7%) and massive (81.4%) proteinuria groups compared with the mild group (32.0%; p < 0.001). Increasing proteinuria severity was associated with earlier gestational age at delivery, lower birth weight, and higher rates of fetal growth restriction (all p < 0.001). The 24 h proteinuria level demonstrated moderate predictive ability for obstetric complications (AUC 0.73; 95% CI 0.66–0.80). A multivariable model including nephrotic-range proteinuria (≥3 g/day) and gestational age at diagnosis showed improved discriminatory performance compared with proteinuria alone (AUC 0.81; 95% CI 0.75–0.88). The model based on continuous 24 h proteinuria yielded an AUC of 0.73 (95% CI, 0.66–0.80) for identifying pregnancies at increased risk of obstetric complications. The multivariable model showed a numerically higher AUC of 0.81 (95% CI, 0.73–0.86); however, the difference between the two AUCs was not statistically significant according to the DeLong test (z = 0.82, p = 0.41). Conclusions: The severity of maternal proteinuria is associated with a higher likelihood of adverse maternal and neonatal outcomes, and higher proteinuria levels appear to show a graded association with increasing risk. A multivariable model integrating proteinuria with key clinical parameters demonstrated moderate discriminatory ability for obstetric complications, may support a more holistic approach to risk stratification in clinical practice. Full article

(This article belongs to the Special Issue Maternal–Fetal Medicine: Current Status, Challenges, and Future Directions)

► Show Figures

Figure 1

9 pages, 367 KB

Open AccessArticle

Risk Factors and Clinical Significance of Urologic Injury in Cesarean Hysterectomy for Placenta Accreta Spectrum

by J. Connor Mulhall, Kayla E. Ireland, John J. Byrne, Patrick S. Ramsey, Georgia A. McCann and Jessian L. Munoz

J. Clin. Med. 2025, 14(20), 7199; https://doi.org/10.3390/jcm14207199 - 13 Oct 2025

Viewed by 1203

Abstract

Background/Objectives: Placenta accreta spectrum (PAS) is an obstetric condition with placental adherence to the underling myometrium characterized by significant surgical morbidity at time of delivery. PAS delivery is most commonly performed by cesarean hysterectomy. The most common morbidities associated with PAS cesarean hysterectomy are blood transfusion, intensive care unit admission and urinary tract injuries. This requires interdisciplinary team management including obstetricians and urologists. Our objective was to identify pre- and intra-operative risk factors for urologic injury in this high-risk condition. Methods: A retrospective cohort study was performed at a single tertiary center with the Center for the Management of Placenta Accreta Spectrum disorders from 2012 to 2022. Urologic injuries were considered as injury to either the bladder or ureters. Furthermore, bladder injuries were subdivided into those inherent to the procedure (intentional cystotomy) and those considered unplanned complications (incidental cystotomy). Inclusion criteria required complete antenatal documentation for assessment, and these were accessed by electronic medical records. Multivariate analysis was performed for significant variables on univariate analysis. Results: During the 11-year study period, 146 cases of PAS were managed by our team. Of these, 39 (26.7%) were complicated by urologic injury. Intentional cystotomies were performed in 28.2% (11/39) of cases. There were 28 (28/39, 71.8%) incidental cystotomies and 5 (5/39, 12.8%) ureteral injuries were encountered. Of note, all 5 patients with ureteral injuries also had cystotomies. Upon univariate analysis, anterior placentation (OR 2.96 [1.94, 4.67], p = 0.04), percreta by antenatal ultrasound (OR 2.59 [1.13, 5.9], p = 0.02) and >2 pre-delivery vaginal bleeding episodes (OR 4.27 [1.54, 12.16], p = 0.005) were associated with urologic injury. Multivariate analysis revealed the independent significance of these variables. Of note, the presence of zero, one, two, and all three risk factors were associated with urologic injury rates of 11.1%, 22.5%, 41.9%, and 71.4%, respectively. Conclusions: Urologic injury during cesarean hysterectomy occurs in almost one-third of cases. Pre-operative risk factors may be used to identify those at greater risk for this surgical complication. Determining patient risk allows for the use of resources such as formal urology consultation, surgical planning, and intraoperative assistance, as well as detailed patient counseling. Full article

(This article belongs to the Special Issue Maternal–Fetal Medicine: Current Status, Challenges, and Future Directions)

► Show Figures

Figure 1

10 pages, 478 KB

Open AccessArticle

Association Between Body Mass Index and Uterotonic Use in Postpartum Hemorrhage: A Retrospective Cohort Study

by CeCe Cheng, Bryce T. Munter, Michaela Y. Lee, Claire D. Sundjaja, Natasha D. Paul, Margaret M. Klausmeyer, Nastassia A. Yammine, Patrick S. Ramsey and John J. Byrne

J. Clin. Med. 2025, 14(17), 6283; https://doi.org/10.3390/jcm14176283 - 5 Sep 2025

Viewed by 1312

Abstract

Background/Objectives: Our primary objective was to determine whether patients with a higher body mass index (BMI) who experienced postpartum hemorrhage (PPH) required ≥2 uterotonics more often than those with lower BMI. Methods: We conducted a retrospective cohort study that included all patients who experienced a PPH between 1 August 2020 and 31 July 2022. Extracted data included patient demographics, PPH risk factors, details regarding the labor course and hemorrhage management, and maternal and neonatal outcomes, such as mode of delivery, etiology of hemorrhage, need for nonpharmacological management, neonatal Apgar scores, requirement for phototherapy, neonatal intensive care unit (NICU) admission, and NICU length of stay. All variables were compared between four BMI classes: non-obese and classes I, II, and III obesity. Possible confounding factors were assessed with a logistic regression analysis. Results: Of the 6732 deliveries that occurred during the study period, a total of 891 (13.2%) patients had PPH. Differences were noted in the number of uterotonics used, although no direct correlation was found between increasing BMI class and the use of ≥2 uterotonics. Patients with higher BMIs were more likely to require cesarean delivery, have a classical hysterotomy incision, and have a hysterotomy extension, and were less likely to need a blood transfusion (p < 0.05 for all). There was no difference in the rate of uterine atony or other etiologies of hemorrhage, and no difference was observed in the non-pharmacologic management of hemorrhage between groups. Conclusions: In our study population, BMI alone does not appear to be directly associated with the use of ≥2 uterotonics. Full article

(This article belongs to the Special Issue Maternal–Fetal Medicine: Current Status, Challenges, and Future Directions)

► Show Figures

Graphical abstract

Other

Jump to: Research

13 pages, 725 KB

Open AccessSystematic Review

Impact of Perioperative Antibiotic Prophylaxis in Caesarean Section on the Maternal Gut Microbiome: A Systematic Review

by Elisabeth AL Feles, Claudio Neidhöfer, Christina Wessels, Rosalie Gruber and Frauke Mattner

J. Clin. Med. 2025, 14(14), 5104; https://doi.org/10.3390/jcm14145104 - 18 Jul 2025

Cited by 4 | Viewed by 2003

Abstract

Background/Objectives: Caesarean section (CS) accounts for over 20% of global births and routinely involves perioperative antibiotic prophylaxis (PAP) to reduce surgical site infections. While the impact of such prophylaxis on neonatal microbiome development is well described, effects on the maternal gut microbiome remain underexplored. This systematic review synthesizes current evidence on how antibiotic prophylaxis during CS affects maternal gut microbiome composition and diversity—an underrepresented, but clinically relevant aspect of maternal–fetal medicine. Methods: A systematic literature search was conducted in Medline (PubMed), the Cochrane Library, and the WHO International Clinical Trials Registry Platform (ICTRP) through November 2024. Inclusion criteria were defined according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies used molecular techniques to report maternal gut microbiome outcomes (alpha- and beta-diversity). The search concentrated on beta-lactam antibiotics. Reference lists were screened, but no additional grey literature was searched. Synthesis followed the Synthesis Without meta-analysis (SWiM) approach. No review protocol was registered. The review received no external funding. Results: Out of 1011 records, three studies (total 286 mothers) met the inclusion criteria. All reported maternal microbiome outcomes secondarily to infant-focused research. Only one study provided pre- and post-birth stool samples. Applied antibiotic regimens, sequencing methods, and reported microbiome metrics for alpha- and beta-diversity varied considerably, thus limiting comparability of results. Due to high heterogeneity, no formal risk of bias was assessed. While taxonomic diversity changes were inconsistent, significant shifts in functional diversity metrics were observed postpartum. Conclusions: Evidence on maternal microbiome disruption following perioperative antibiotic prophylaxis in CS is methodologically fragmented and limited by small sample sizes and inconsistent antibiotic protocols. Nonetheless, functional diversity appears sensitive to antibiotic exposure. To improve clinical understanding and safety, maternal-focused studies using standardized protocols are urgently needed. The maternal microbiome may play a key role in both recovery and shaping the newborn’s early microbial environment. Full article

(This article belongs to the Special Issue Maternal–Fetal Medicine: Current Status, Challenges, and Future Directions)

► Show Figures

Journal Menu

Journal Browser

Maternal–Fetal Medicine: Current Status, Challenges, and Future Directions

Share This Special Issue

Special Issue Editor

Special Issue Information

Keywords

Benefits of Publishing in a Special Issue

Published Papers (6 papers)

Research

Other

Further Information

Guidelines

MDPI Initiatives

Follow MDPI