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Clinical Risks and Perinatal Outcomes in Pregnancy and Childbirth: 2nd Edition

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

Deadline for manuscript submissions: 25 July 2026 | Viewed by 25465

Special Issue Editors

Prof. Dr. Apostolos Mamopoulos

E-Mail Website
Guest Editor
Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
Interests: obstetrics; maternal medicine
Special Issues, Collections and Topics in MDPI journals
Dr. Ioannis Tsakiridis

E-Mail Website
Guest Editor
Third Department of Obstetrics and Gynecology, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Agiou Dimitriou, 54124 Thessaloniki, Greece
Interests: maternal and fetal medicine; high-risk pregnancies
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

It is our pleasure to invite you to contribute to the upcoming Special Issue of Journal of Clinical Medicine, entitled “Clinical Risks and Perinatal Outcomes in Pregnancy and Childbirth: 2nd Edition”. This new edition of course follows out fir we published 19 papers in the first edition. For more details, please visit: https://www.mdpi.com/journal/jcm/special_issues/F72RCZF0A6.

Pregnancy and childbirth are both situations that can bring about many changes. Pregnancy complications, including hypertensive disorders, gestational diabetes, fetal growth restriction (FGR), stillbirth and preterm delivery, are relatively common and may affect up to 25% of all pregnancies. These complications are in turn associated with both short- and long-term maternal and neonatal morbidity, including increased risk for neurodevelopmental and cardiovascular disease in the future. The goal of maternal–fetal medicine specialists is to the improve perinatal outcomes of high-risk pregnancies while also prolonging the gestational age at delivery and eliminating the risk of complications, although the implementation of new techniques or medications is often an obstacle to current research because of ethical issues. The goal of this Special Issue is to encourage the submission of papers on current advances in prenatal diagnosis, the screening, management, prediction and prevention of pregnancy complications and associated clinical risks, and perinatal outcomes in modern obstetrics.

Prof. Dr. Apostolos Mamopoulos
Dr. Ioannis Tsakiridis
Guest Editors

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

  • pregnancy complications
  • perinatal outcomes
  • childbirth
  • hypertension
  • diabetes
  • fetal growth restriction
  • stillbirth
  • preterm delivery

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Related Special Issue

Published Papers (6 papers)

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Research

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12 pages, 1380 KB  
Article
Longitudinal Influences on Maternal–Infant Bonding at 18 Months Postpartum: The Predictive Role of Perinatal and Postpartum Depression and Childbirth Trauma
by Maria Vega-Sanz, Ana Berastegui and Alvaro Sanchez-Lopez
J. Clin. Med. 2025, 14(10), 3424; https://doi.org/10.3390/jcm14103424 - 14 May 2025
Cited by 4 | Viewed by 4244
Abstract
Background: This study investigated the pathways through which various psychological problems occurring across the perinatal period influence mother–child bonding within the first 18 months postpartum, with a particular focus on the relationship between perinatal and postpartum depression and childbirth-related posttraumatic stress symptomatology. Methods: [...] Read more.
Background: This study investigated the pathways through which various psychological problems occurring across the perinatal period influence mother–child bonding within the first 18 months postpartum, with a particular focus on the relationship between perinatal and postpartum depression and childbirth-related posttraumatic stress symptomatology. Methods: A multi-stage longitudinal design included three assessment points: recruitment and initial assessment in the third trimester of pregnancy (T1), a second assessment at 8 months postpartum (T2), and a final assessment at 18 months postpartum (T3). A total of N = 51 mothers completed all three waves (total follow-up period per participant: approximately 21 months). Sociodemographic data were collected, and all assessments were completed online. Results: Our findings revealed significant indirect effects, linking higher levels of perinatal depressive symptoms in the third trimester with mother–child bonding difficulties at 18 months postpartum. This association was mediated by both greater childbirth-related posttraumatic stress symptoms and elevated postpartum depressive symptoms at 8 months. Conclusions: These preliminary results highlight how complex perinatal factors at different stages (i.e., during pregnancy and early postpartum) influence mother–child bonding at 18 months postpartum. Understanding these pathways is essential in order to inform targeted interventions and to promote optimal maternal mental health and bonding outcomes. Full article
(This article belongs to the Special Issue Clinical Risks and Perinatal Outcomes in Pregnancy and Childbirth: 2nd Edition)
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Review

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14 pages, 477 KB  
Review
The Rising Global Cesarean Section Rates and Their Impact on Maternal and Child Health: A Scoping Review
by Sofia Thomaidi, Antigoni Sarantaki, Maria Tzitiridou Chatzopoulou, Eirini Orovou, Vaidas Jotautis and Dimitrios Papoutsis
J. Clin. Med. 2025, 14(22), 8102; https://doi.org/10.3390/jcm14228102 - 15 Nov 2025
Cited by 5 | Viewed by 8236
Abstract
Background: A cesarean section (CS) is a method of childbirth involving a surgical cut made in the abdominal and uterine wall to deliver the infant. But while it saves the lives of women and infants, it has been implicated in several immediate [...] Read more.
Background: A cesarean section (CS) is a method of childbirth involving a surgical cut made in the abdominal and uterine wall to deliver the infant. But while it saves the lives of women and infants, it has been implicated in several immediate and long-term complications and adverse consequences as a result of its ineffective use. This study attempts to address the major public health issue of the inappropriate use of CS by exploring its impact on maternal, neonatal, and child health. More specifically, the study aims to investigate the immediate and long-term health impacts on the mother, including her physical and mental health, as well as the immediate and long-term psychosomatic consequences on the neonate’s, infant’s, and child’s health as a result of the inappropriate use of CS. Methods: A scoping review was conducted spanning from 2015 to 2025 according to the PRISMA criteria and checklist. Searches were performed in PubMed, Scopus, and Google Scholar. The inclusion criteria comprised original articles with clear exposure and outcome written in English, and studies that did not involve reviews of any kind or letters to the editors. Results: The review identified 42 relevant studies. The results showed several immediate and long-term complications of CS in mothers, neonates, infants, and children, while its ineffective use carries equally high risks, such as high levels of morbidity and mortality. Conclusions: This scoping review presents the problems that arise in the immediate and long-term health of mother and child from the improper use of cesarean section and underlines the need for immediate action and measures to be taken by health policy makers. Full article
(This article belongs to the Special Issue Clinical Risks and Perinatal Outcomes in Pregnancy and Childbirth: 2nd Edition)
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Other

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18 pages, 2733 KB  
Systematic Review
Maternal Smoking During Pregnancy and Risk of Autism Spectrum Disorder in Offspring: A Systematic Review and Meta-Analysis
by Afroditi Peltekidi, Vaidas Jotautis, Maria Tzitiridou-Chatzopoulou, Vasiliki E. Georgakopoulou, Aikaterini Sousamli, Athina Diamanti, Victoria Vivilaki, Eirini Orovou and Antigoni Sarantaki
J. Clin. Med. 2025, 14(23), 8584; https://doi.org/10.3390/jcm14238584 - 3 Dec 2025
Viewed by 2066
Abstract
Background/Objectives: Autism spectrum disorder (ASD) is a heterogeneous neurodevelopmental condition characterized by persistent social-communication deficits and repetitive behaviors. While genetic factors play a major role, prenatal environmental exposures may also contribute. Maternal smoking during pregnancy is a known risk factor for adverse [...] Read more.
Background/Objectives: Autism spectrum disorder (ASD) is a heterogeneous neurodevelopmental condition characterized by persistent social-communication deficits and repetitive behaviors. While genetic factors play a major role, prenatal environmental exposures may also contribute. Maternal smoking during pregnancy is a known risk factor for adverse perinatal outcomes, but its association with ASD remains unclear. Methods: We conducted a systematic review and meta-analysis following PRISMA 2020 guidelines. A comprehensive literature search was performed in PubMed, Embase, Web of Science, Scopus, PsycINFO, and Google Scholar up to September 2025. Eligible observational studies evaluated maternal active smoking during pregnancy and ASD diagnosis in offspring. Effect estimates were pooled using a random-effects model and expressed as relative risks (RR) with 95% confidence intervals (CI). Heterogeneity was quantified using I2, with subgroup and sensitivity analyses performed. Results: Twenty-one studies including several million mother–child pairs met the inclusion criteria. The pooled RR for ASD associated with maternal smoking was 1.01 (95% CI: 0.95–1.08), indicating no significant association. Subgroup and sensitivity analyses confirmed the robustness of the findings, with no evidence of publication bias. Conclusions: Maternal smoking during pregnancy does not appear to increase ASD risk in offspring. Nevertheless, smoking cessation remains critical due to established adverse fetal effects. Full article
(This article belongs to the Special Issue Clinical Risks and Perinatal Outcomes in Pregnancy and Childbirth: 2nd Edition)
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13 pages, 1291 KB  
Systematic Review
A Systematic Review and Meta-Analysis of Single-Dose GnRH Agonist on the Day of Frozen Embryo Transfer in Artificial Cycles: Preliminary Evidence from Randomized Trials
by Luz Franco Pire, Laura Morales López, María Hernández Hernández, Raquel Campos Romero, Ignacio Cristóbal García and Ignacio Cristóbal Quevedo
J. Clin. Med. 2025, 14(16), 5763; https://doi.org/10.3390/jcm14165763 - 14 Aug 2025
Cited by 1 | Viewed by 3001
Abstract
Background/Objectives: GnRH agonists may offer potential benefits when used for luteal phase support in assisted reproductive treatments. This systematic review and meta-analysis of randomized controlled trials evaluates the effect of a single-dose administration of gonadotropin-releasing hormone (GnRH) agonist on the day of [...] Read more.
Background/Objectives: GnRH agonists may offer potential benefits when used for luteal phase support in assisted reproductive treatments. This systematic review and meta-analysis of randomized controlled trials evaluates the effect of a single-dose administration of gonadotropin-releasing hormone (GnRH) agonist on the day of frozen-thawed embryo transfer (FET) in artificial cycles, in terms of reproductive outcomes. Methods: A comprehensive literature search was performed using the PubMed and Cochrane databases to identify relevant studies. The outcomes assessed were live birth rate, clinical pregnancy rate, positive pregnancy test, implantation rate, and miscarriage rate. Three randomized controlled trials were included in the analysis. Results: The clinical pregnancy rate (56.5% vs. 47.4%; OR 1.27; 95% CI: 1.01–1.60; p = 0.0426) and live birth rate (34.3% vs. 23.9%; OR 1.71; 95% CI: 1.00–2.91; p = 0.0483) were significantly higher in the treatment group compared to the control group. No statistically significant differences were observed between the groups in terms of positive pregnancy test, implantation rate, or miscarriage rate, although the analysis revealed a trend toward improved outcomes in the intervention group. Conclusions: In summary, although our meta-analysis indicates that a single dose of GnRH agonist in artificial FET cycles may be associated with improved clinical pregnancy and live birth rates, these findings are based on a limited number of available trials. Larger, well-designed randomized controlled trials are urgently needed before any changes to clinical recommendations can be justified. Full article
(This article belongs to the Special Issue Clinical Risks and Perinatal Outcomes in Pregnancy and Childbirth: 2nd Edition)
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33 pages, 17821 KB  
Systematic Review
Pregestational Diabetes Mellitus and Adverse Perinatal Outcomes: A Systematic Review and Meta-Analysis
by Dionysios Gazis, Antigoni Tranidou, Antonios Siargkas, Aikaterini Apostolopoulou, Georgia Koutsouki, Dimitrios G. Goulis, Christos Tsakalidis, Ioannis Tsakiridis and Themistoklis Dagklis
J. Clin. Med. 2025, 14(13), 4789; https://doi.org/10.3390/jcm14134789 - 7 Jul 2025
Cited by 5 | Viewed by 3639
Abstract
Background/Objectives: As the incidence of diabetes mellitus (DM) is increasing rapidly worldwide, it is anticipated that an increasing number of women will enter pregnancy with pregestational diabetes mellitus (PGDM) in the future. Compelling evidence suggests that hyperglycemia in pregnancy is related to multiple [...] Read more.
Background/Objectives: As the incidence of diabetes mellitus (DM) is increasing rapidly worldwide, it is anticipated that an increasing number of women will enter pregnancy with pregestational diabetes mellitus (PGDM) in the future. Compelling evidence suggests that hyperglycemia in pregnancy is related to multiple adverse perinatal outcomes. This systematic review and meta-analysis aims to assess and quantify the association of PGDM with a range of adverse perinatal outcomes, providing a comprehensive understanding of its impact on pregnancy. Methods: The data sources of this systematic review and meta-analysis were Medline/PubMed, Scopus and Cochrane Library (January 1999 to August 2023), complemented by hand-searching for additional references. Observational studies reporting perinatal outcomes of pregnancies with PGDM diagnosed before pregnancy versus control pregnancies were eligible for inclusion. A systematic review and meta-analysis were conducted as per the PRISMA guidelines. Pooled estimate odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to determine the risk of adverse pregnancy outcomes between PGDM and control pregnancies. Results: The systematic search of the literature yielded 81 observational studies meeting inclusion criteria and in total, 137,237,640 pregnancies were included in the analysis. A total of 19 adverse perinatal outcomes were assessed, revealing a significant association with PGDM. In pregnancies with PGDM there was an increased risk of adverse perinatal outcomes, including gestational hypertension (OR 3.16, 95% CI 2.65–3.77), preeclampsia (OR 4.46, 95% CI 3.94–5.05), preterm delivery (OR 3.46, 95% CI 3.06–3.91), cesarean delivery (OR 3.12, 95% CI 2.81–3.47), induction of labor (OR 2.92, 95% CI 2.35–3.63), macrosomia (OR 2.23, 95% CI 1.76–2.83), LGA neonates (OR 3.95, 95% CI 3.47–4.49), low 5-min Apgar score (OR 2.49, 95% CI 2.07–2.99), shoulder dystocia (OR 3.05, 95% CI 2.07–4.50), birth trauma (OR 1.40, 95% CI 1.22–1.62), polyhydramnios (OR 5.06, 95% CI 4.33–5.91), oligohydramnios (OR 1.61, 95% CI 1.19–2.17), neonatal hyperbilirubinemia (OR 3.45, 95% CI 2.51–4.74), neonatal hypoglycemia (OR 19.19, 95% CI 2.78–132.61), neonatal intensive care unit (NICU) admission (OR 4.54, 95% CI 3.87–5.34), congenital malformations (OR 2.44, 95% CI 1.96–3.04), stillbirth (OR 2.87, 95% CI 2.27–3.63) and perinatal mortality (OR 2.94, 95% CI 2.18–3.98). Subgroup analyses indicated a higher risk of neonatal hypoglycemia, stillbirth and perinatal mortality in T1DM pregnancies compared with T2DM pregnancies. Conclusions: This study provides a robust synthesis of evidence underlying the strong association between PGDM and several adverse perinatal outcomes. Early detection, optimal glycemic control during the periconceptional and pregnancy periods, and proper antenatal care are critical to mitigate these risks. Full article
(This article belongs to the Special Issue Clinical Risks and Perinatal Outcomes in Pregnancy and Childbirth: 2nd Edition)
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27 pages, 520 KB  
Systematic Review
The Role of Placental Mitochondrial Dysfunction in Adverse Perinatal Outcomes: A Systematic Review
by Charalampos Voros, Sofoklis Stavros, Ioakeim Sapantzoglou, Despoina Mavrogianni, Maria Anastasia Daskalaki, Marianna Theodora, Panagiotis Antsaklis, Peter Drakakis, Dimitrios Loutradis and Georgios Daskalakis
J. Clin. Med. 2025, 14(11), 3838; https://doi.org/10.3390/jcm14113838 - 29 May 2025
Cited by 13 | Viewed by 3401
Abstract
Background: Mitochondria are essential for placental function as they regulate energy metabolism, oxidative balance, and apoptotic signaling. Increasing evidence suggests that placental mitochondrial dysfunction may play a role in the development of many poor perinatal outcomes, including preeclampsia, intrauterine growth restriction (IUGR), premature [...] Read more.
Background: Mitochondria are essential for placental function as they regulate energy metabolism, oxidative balance, and apoptotic signaling. Increasing evidence suggests that placental mitochondrial dysfunction may play a role in the development of many poor perinatal outcomes, including preeclampsia, intrauterine growth restriction (IUGR), premature birth, and stillbirth. Nonetheless, no systematic review has thoroughly investigated this connection across human research. This study aims to consolidate evidence from human research concerning the link between placental mitochondrial dysfunction and negative birth outcomes. Methods: A systematic search of PubMed, Scopus, and Web of Science identified human research examining placental mitochondrial features (e.g., mtDNA copy number, ATP production, oxidative stress indicators) in connection with adverse pregnancy outcomes. Methodological variety resulted in narrative data extraction and synthesis. Results: Twenty-nine studies met the inclusion criteria. Mitochondrial dysfunction was consistently associated with PE, IUGR, FGR, and PTB. The most often observed outcomes included diminished mtDNA copy number, decreased ATP production, elevated reactive oxygen species (ROS), and disrupted mitochondrial dynamics, characterized by increased DRP1 and decreased MFN2. Early-onset preeclampsia and symmetric fetal growth restriction exhibited particularly severe mitochondrial abnormalities, indicating a primary placental origin of the condition. Conclusions: A significant factor contributing to adverse pregnancy outcomes is the dysfunction of placental mitochondria. The analogous molecular signatures across many disorders suggest promising avenues for developing targeted therapies aimed at improving maternal–fetal health and predictive biomarkers. Full article
(This article belongs to the Special Issue Clinical Risks and Perinatal Outcomes in Pregnancy and Childbirth: 2nd Edition)
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