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Pregnancy Complications and Maternal-Perinatal Outcomes

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Dear Colleagues,

Pregnancy is a dynamic and complex physiological process that can be affected by a wide range of maternal and fetal complications. Conditions such as gestational diabetes mellitus (GDM), preeclampsia, fetal growth restriction (FGR), and other high-risk pregnancy factors continue to represent major causes of maternal and perinatal morbidity and mortality worldwide. The aim of this Special Issue is to gather high-quality original research articles, systematic reviews, and clinical studies focusing on the clinical pathophysiology, diagnosis, prevention, and management of pregnancy-related complications. Particular attention will be given to studies exploring the role of the placenta, maternal metabolic status, and the use of ultrasound and other diagnostic tools in monitoring maternal and fetal health. We welcome submissions that enhance the understanding of mechanisms underlying high-risk pregnancies and that propose innovative strategies to improve outcomes for both mothers and newborns.

Dr. Angelo Sirico
Guest Editor

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14 pages, 398 KB

Open AccessArticle

Fetuin-A Concentration in the Perinatal Period and Maternal BMI Dynamics During Pregnancy, Labor, and Early Postpartum: Is ΔBMI a Parameter Worth Considering?

by Aleksandra Obuchowska-Standyło, Żaneta Kimber-Trojnar, Monika Czuba, Katarzyna Trojnar and Bożena Leszczyńska-Gorzelak

J. Clin. Med. 2025, 14(19), 6782; https://doi.org/10.3390/jcm14196782 - 25 Sep 2025

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Background/Objectives: Fetuin-A is a multifunctional glycoprotein involved in metabolic and inflammatory regulation. Although its role in insulin resistance, type 2 diabetes, and cardiovascular disease is well recognized, its relationship with pregnancy-related body mass changes remains unclear. This study aimed to explore associations between maternal BMI dynamics during and shortly after pregnancy and serum fetuin-A concentrations. Methods: Fifty-five healthy Caucasian women with term singleton pregnancies were enrolled. BMI was recorded at three time points: pre-pregnancy, before delivery, and 48 h postpartum. Based on ΔBMI (postpartum minus pre-pregnancy BMI), participants were divided into two groups: ΔBMI ≤ 1 kg/m² (n = 32) and ΔBMI > 1 kg/m² (n = 23). Serum fetuin-A levels were measured before delivery and postpartum using ELISA. Additional laboratory parameters and body composition were assessed postpartum via standard tests and bioelectrical impedance analysis (BIA). Results: No significant differences were found between groups in BMI at any single time point or in laboratory or BIA-derived parameters. However, all three BMI change indices (ΔBMI_gestational, ΔBMI_puerperal, and ΔBMI) differed significantly between groups. Fetuin-A concentrations did not differ significantly between groups. Importantly, fetuin-A levels decreased significantly after delivery in both groups, suggesting a potential role of the placenta in its regulation. A significant correlation was observed between pre-delivery fetuin-A and postpartum uric acid in Group ΔBMI > 1 kg/m² (p = 0.016), indicating a possible link in women with greater gestational weight gain. Conclusions: While fetuin-A was not directly associated with BMI changes, its peripartum dynamics and correlation with uric acid may reflect underlying metabolic-inflammation pathways. ΔBMI indices may offer a more individualized measure of weight dynamics in pregnancy research. Full article

(This article belongs to the Special Issue Pregnancy Complications and Maternal-Perinatal Outcomes)

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18 pages, 2151 KB

Open AccessSystematic Review

Clinical Scores of Peripartum Patients Admitted to Maternity Wards Compared to the ICU: A Systematic Review and Meta-Analysis

by Jennifer A. Walker, Natalie Jackson, Sudha Ramakrishnan, Claire Perry, Anandita Gaur, Anna Shaw, Saad Pirzada and Quincy K. Tran

J. Clin. Med. 2025, 14(14), 5113; https://doi.org/10.3390/jcm14145113 - 18 Jul 2025

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Background/Objectives: Hospitalized peripartum patients who later decompensate and require an upgrade to the intensive care unit (ICU) may have an increased risk for poor outcomes. Most of the literature regarding the need for ICU involves Modified Early Warning Scores in already hospitalized patients or the evaluation of specific comorbid conditions or diagnoses. This systematic review and meta-analysis aimed to assess the differences in clinical scores at admission among adult peripartum patients to identify the later need for ICU. Methods: We systematically searched Ovid-Medline, PubMed, EMBASE, Web of Science and Google Scholar for randomized and observational studies of adult patients ≥18 years of age who were ≥20 weeks pregnant or up to 40 days post-partum, were admitted to the wards from the emergency department and later required critical care services. The primary outcome was the Sequential Organ Failure Assessment (SOFA) score. Secondary outcomes included other clinical scores, the hospital length of stay (HLOS) and mortality. The Newcastle–Ottawa Scale was utilized to grade quality. Descriptive analyses were performed to report demographic data, with means (±standard deviation [SD]) for continuous data and percentages for categorical data. Random-effects meta-analyses were performed for all outcomes when at least two studies reported a common outcome. Results: Seven studies met the criteria, with a total of 1813 peripartum patients. The mean age was 27.2 (±2.36). Patients with ICU upgrades were associated with larger differences in mean SOFA scores. The pooled difference in means was 2.76 (95% CI 1.07–4.46, p < 0.001). There were statistically significant increases in Sepsis in Obstetrics Scores, APACHE II scores, and HLOS in ICU upgrade patients. There was a non-significantly increased risk of mortality in ICU upgrade patients. There was high overall heterogeneity between patient characteristics and management in our included studies. Conclusions: This systematic review and meta-analysis demonstrated higher SOFA or other physiologic scores in ICU upgrade patients compared to those who remained on the wards. ICU upgrade patients were also associated with a longer HLOS and higher mortality compared with control patients. Full article

(This article belongs to the Special Issue Pregnancy Complications and Maternal-Perinatal Outcomes)

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