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Life
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Clinical Management and Prevention of Adverse Pregnancy Outcomes
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Clinical Management and Prevention of Adverse Pregnancy Outcomes

A special issue of Life (ISSN 2075-1729). This special issue belongs to the section "Reproductive and Developmental Biology".

Deadline for manuscript submissions: 31 December 2025 | Viewed by 8315

Special Issue Editors

Dr. Zoltan Kozinszky

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Guest Editor
Capio Specialized Center for Gynecology, 171 45 Solna, Sweden
Interests: molecular, ultrasound and clinical characterization of pregnancy complications; placental histology
Special Issues, Collections and Topics in MDPI journals
Dr. Andrea Suranyi

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Guest Editor
Department of Obstetrics and Gynecology, University of Szeged, H-6725 Szeged, Hungary
Interests: perinatal ultrasound; serum markers for complications of pregnancy; histopathology of the placenta; neonatal pathological conditions
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The clinical characteristics of various pregnancy complications are pivotal to prevent maternal and neonatal morbidity and mortality. Molecular, sonographic and clinical screening are essential to optimize the management of complicated pregnancies. Pre-eclampsia and gestational diabetes are among the most common complications and are unique to humans. Chronic diseases also represent risk for fetoplacental development. Therapeutic strategies completed with novel screening methods help augment early screening during gestation. Significant advances can be provided in the prediction and prevention of preterm birth if multiple risk factors can be identified. Increasing evidence points to the substantial role of genetic, immunologic and other fetoplacental development-related factor levels in screening for pregnancy outcomes. Cytogenetic and molecular mapping are identified as a useful tool in almost every complication of pregnancies, and even in stillbirth. Gestational diseases (such as gestational diabetes mellitus or intrahepatic cholestasis) are a growing public health problem worldwide, and nutrigenetic and epigenetic characterization may decrease the short- and long-term complications for both mother and offspring. Pregnancy affected by any complication might have a transgenerational effect. Inventing additional screening specifics may help us to better understand the clinical course of pregnancies and chronic pathologies, and avoid adverse outcomes.

Dr. Zoltan Kozinszky
Dr. Andrea Suranyi
Guest Editors

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Keywords

  • pathologic pregnancies
  • ultrasound
  • clinical and molecular characteristics
  • fetal pathologies

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Published Papers (5 papers)

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Research

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12 pages, 1690 KiB  
Article
The Intensity of BCL2A1 Expression Increases According to the Stage Progression of Acute Histologic Chorioamnionitis in the Extra-Placental Membranes of Spontaneous Preterm Birth
by Chan-Wook Park, Eun-Mi Lee, Seung-Han Shin, Chul Lee and Jae-Kyung Won
Life 2024, 14(12), 1535; https://doi.org/10.3390/life14121535 - 22 Nov 2024
Viewed by 838
Abstract
Our prior findings showed that BCL2A1 in neutrophils is highly expressed in the extra-placental membranes (EPMs) of both the human spontaneous preterm-birth (PTB) (i.e., PTL or preterm PROM) and nonhuman-primate PTB model. However, no data exist on whether the intensity of BCL2A1 expression [...] Read more.
Our prior findings showed that BCL2A1 in neutrophils is highly expressed in the extra-placental membranes (EPMs) of both the human spontaneous preterm-birth (PTB) (i.e., PTL or preterm PROM) and nonhuman-primate PTB model. However, no data exist on whether the intensity of BCL2A1 expression quantitatively increases according to the stage progression of acute histologic chorioamnionitis (acute HCA) in EPM. The objective is to investigate whether the intensity of BCL2A1 expression quantitatively increases according to the stage progression of acute HCA in EPM among spontaneous PTB cases, as measured using QuPath. The study population included 121 singleton PTBs (gestational age [GA] at delivery < 34 weeks) due to either preterm labor or preterm PROM. With digital image analysis, we calculated the percentage of BCL2A1-positive cells in immunohistochemistry according to the stage progression of acute HCA in EPMs as the primary outcome and examined the relationship between the percentage of BCL2A1-positive cells and either the GA at delivery or the amniotic-fluid (AF) WBC count as the secondary outcome. The median percentage of BCL2A1-positive cells progressively increases with the stage progression of acute HCA in EPM (group-1 vs. group-2 vs. group-3 vs. group-4 vs. group-5; 7.62 vs. 5.15 vs. 43.57 vs. 71.07; γ = 0.552, p < 0.000001). The percentage of BCL2A1-positive cells in EPMs and the AFWBC count shows a positive correlation (γ = 0.492, p = 0.000385). Moreover, the percentage of BCL2A1-positive cells in EPMs continuously decreased with increasing GA at delivery (γ = −0.253, p = 0.005148). In conclusion, the intensity of BCL2A1 expression increases according to the stage progression of acute HCA in EPMs and the elevation of AFWBC among spontaneous PTB cases. This finding suggests BCL2A1 in EPMs may be a promising marker and target for acute HCA. Full article
(This article belongs to the Special Issue Clinical Management and Prevention of Adverse Pregnancy Outcomes)
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Review

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21 pages, 1489 KiB  
Review
The Hidden Impact of Gestational Diabetes: Unveiling Offspring Complications and Long-Term Effects
by Elsa Al Bekai, Carla El Beaini, Karim Kalout, Ouhaila Safieddine, Sandra Semaan, François Sahyoun, Hilda E. Ghadieh, Sami Azar, Amjad Kanaan and Frederic Harb
Life 2025, 15(3), 440; https://doi.org/10.3390/life15030440 - 11 Mar 2025
Viewed by 3170
Abstract
Background: Gestational diabetes mellitus (GDM), characterized by gestational hyperglycemia due to insufficient insulin response, poses significant risks to both maternal and offspring health. Fetal exposure to maternal hyperglycemia leads to short-term complications such as macrosomia and neonatal hypoglycemia and long-term risks including obesity, [...] Read more.
Background: Gestational diabetes mellitus (GDM), characterized by gestational hyperglycemia due to insufficient insulin response, poses significant risks to both maternal and offspring health. Fetal exposure to maternal hyperglycemia leads to short-term complications such as macrosomia and neonatal hypoglycemia and long-term risks including obesity, metabolic syndrome, cardiovascular dysfunction, and type 2 diabetes. The Developmental Origins of Health and Disease (DOHaD) theory explains how maternal hyperglycemia alters fetal programming, increasing susceptibility to metabolic disorders later in life. Objective: This review explores the intergenerational impact of GDM, linking maternal hyperglycemia to lifelong metabolic, cardiovascular, and neurodevelopmental risks via epigenetic and microbiome alterations. It integrates the most recent findings, contrasts diagnostic methods, and offers clinical strategies for early intervention and prevention. Methods: A comprehensive literature search was conducted in PubMed, Scopus, and ScienceDirect to identify relevant studies published between 1 January 2000 and 31 December 2024. The search included studies focusing on the metabolic and developmental consequences of GDM exposure in offspring, as well as potential mechanisms such as epigenetic alterations and gut microbiota dysbiosis. Studies examining preventive strategies and management approaches were also included. Key Findings: Maternal hyperglycemia leads to long-term metabolic changes in offspring, with epigenetic modifications and gut microbiota alterations playing key roles. GDM-exposed children face increased risks of obesity, glucose intolerance, and cardiovascular diseases. Early screening and monitoring are crucial for risk reduction. Practical Implications: Understanding the intergenerational effects of GDM has important clinical implications for prenatal and postnatal care. Early detection, lifestyle interventions, and targeted postnatal surveillance are essential for reducing long-term health risks in offspring. These findings emphasize the importance of comprehensive maternal healthcare strategies to improve long-term outcomes for both mothers and their children. Full article
(This article belongs to the Special Issue Clinical Management and Prevention of Adverse Pregnancy Outcomes)
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Other

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10 pages, 562 KiB  
Case Report
Laparoscopic Cholecystectomy Under Combined Spinal and Epidural Anesthesia in the First Trimester of Pregnancy—Case Report and Literature Review
by Gabriel-Petre Gorecki, Andrei Bodor, Zoltan-Janos Kövér, Maria-Mihaela Comănici, Romina-Marina Sima, Anca-Maria Panaitescu, Adrian-Vasile Comănici, Emilia Furdu-Lungut, Ancuta-Alina Constantin, Liana Pleș, Andrei Sebastian Diaconescu and Vasile Lungu
Life 2024, 14(11), 1492; https://doi.org/10.3390/life14111492 - 16 Nov 2024
Viewed by 1195
Abstract
Can combined spinal and epidural anesthesia be the gold standard for laparoscopic surgery for pregnant patients? This case report presents a first trimester pregnant patient who was admitted for obstructive jaundice syndrome (pain in the right hypochondrium, nausea, and vomiting). Initially, because of [...] Read more.
Can combined spinal and epidural anesthesia be the gold standard for laparoscopic surgery for pregnant patients? This case report presents a first trimester pregnant patient who was admitted for obstructive jaundice syndrome (pain in the right hypochondrium, nausea, and vomiting). Initially, because of the risk/benefit ratio of pregnancy, the treatment was medical and the patient was immediately discharged because her clinical condition improved, but she was rapidly readmitted to the surgery department because of worsening symptoms. Emergency surgical intervention (laparoscopic cholecystectomy) under combined spinal and epidural anesthesia (CSEA) was performed to reduce the patient’s risks. Since most analgesics are insufficiently studied in pregnancy, analgesia with ropivacaine 0.2% was used on the epidural catheter. No pathological changes were identified in the fetal Doppler ultrasound preoperatively and postoperatively. Similarly to other studies, our case highlights the necessity for cholecystectomy for acute cholecystitis even if the patient is in the first trimester of pregnancy. If the decision is delayed, the morbidity and mortality for mother and fetus become unjustified. The peculiarity of the present report is the type of anesthesia chosen. We consider that combined spinal and epidural anesthesia may become a possible gold standard suitable for laparoscopy in the first trimester of pregnancy. Full article
(This article belongs to the Special Issue Clinical Management and Prevention of Adverse Pregnancy Outcomes)
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11 pages, 8431 KiB  
Case Report
Ectopic Kidney, a Challenging First Trimester Diagnosis—Case Report and Literature Review
by Mircea-Octavian Poenaru, Fernanda-Ecaterina Augustin, Ionuț-Didel Vâlcea, Romina-Marina Sima, Mihaela Amza, Oana Denisa Bălălău and Liana Pleș
Life 2024, 14(11), 1466; https://doi.org/10.3390/life14111466 - 12 Nov 2024
Viewed by 1350
Abstract
(1) Background: Crossed fused renal ectopia is a rare migration and fusion renal anomaly, more frequently affecting males, with an incidence of between 1:2000 and 1:7500 observed at autopsy. (2) Case presentation: This paper presents the case of a 34-year-old woman, IIIG IIIP, [...] Read more.
(1) Background: Crossed fused renal ectopia is a rare migration and fusion renal anomaly, more frequently affecting males, with an incidence of between 1:2000 and 1:7500 observed at autopsy. (2) Case presentation: This paper presents the case of a 34-year-old woman, IIIG IIIP, who presented to our clinic for a first-trimester screening evaluation. The risk calculation was performed using the Fetal Medicine Foundation’s first-trimester screening software, version 2.8.1. The screening indicated a low risk for aneuploidies, but the ultrasound scan revealed an empty right renal fossa in the standard coronal section. A more detailed axial examination raised the suspicion of crossed fused renal ectopia. No other anomalies were detected. The morphological scans conducted in the second and third trimesters confirmed and upheld the diagnosis initially established in the first trimester. The fetus did not develop any potential antepartum complications. The patient gave birth via caesarean section at 36 weeks to a live female infant, weighing 3000 g, with an APGAR score of 9 at 1 min. Postnatally, the first trimester diagnosis of the renal malformation was confirmed. (3) Conclusions: Crossed fused renal ectopia, probably the rarest renal migration anomaly, can be diagnosed as early as the first trimester of pregnancy. Full article
(This article belongs to the Special Issue Clinical Management and Prevention of Adverse Pregnancy Outcomes)
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9 pages, 1730 KiB  
Case Report
Multidisciplinary Approach in the Diagnosis and Treatment of Twin Anemia Polycythemia Sequence in Monochorionic Twin Pregnancies: Case Report
by Marina Fortún Agud, María Marfil González, Susana Monis Rodríguez, Maria Suarez Arana, Marta Blasco Alonso, Jesus Jimenez Lopez and Isidoro Narbona Arias
Life 2024, 14(9), 1071; https://doi.org/10.3390/life14091071 - 27 Aug 2024
Viewed by 1117
Abstract
Twin anemia–polycythemia sequence (TAPS) in monochorionic twin pregnancies is a potentially serious complication caused by unidirectional vascular anastomoses in the placenta, resulting in one anemic donor twin and one polycythemic recipient twin. Diagnosis of this condition is achieved through Doppler ultrasound assessment of [...] Read more.
Twin anemia–polycythemia sequence (TAPS) in monochorionic twin pregnancies is a potentially serious complication caused by unidirectional vascular anastomoses in the placenta, resulting in one anemic donor twin and one polycythemic recipient twin. Diagnosis of this condition is achieved through Doppler ultrasound assessment of the difference between the MoM of the peak systolic velocity of the middle cerebral artery between the twins, establishing the diagnosis with a delta value >0.5 MoM. Management of this situation is individualized and may include intrauterine transfusions, intrauterine laser treatment, and expectant management through ultrasound monitoring of both fetuses to prevent complications. In severe cases, pregnancy termination may be necessary. It is essential that these pregnancies are managed by a multidisciplinary team of professionals, including obstetricians specialized in fetal medicine and neonatologists, to ensure the best possible outcome for both the mother and the fetuses. Early detection and treatment are crucial in the management of pregnancies complicated by twin anemia–polycythemia sequence. The main objective of this article is to conduct a review of the existing literature on the anemia–polycythemia sequence in monochorionic pregnancies, emphasizing the exceptional nature of the presented case due to its spontaneous occurrence, which has a very low prevalence compared to post-laser TAPS cases. It also discusses the different treatment options, highlighting the importance of expectant management and individualization in each case. Full article
(This article belongs to the Special Issue Clinical Management and Prevention of Adverse Pregnancy Outcomes)
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