Search Results (468)

Background: Preterm birth, the leading cause of neonatal mortality, is associated with reduced nephron endowment and an increased risk of kidney disease in later life. In preterm infants, the interruption of nephrogenesis leads to a lower nephron number and structural abnormalities. Prenatal factors such as intrauterine growth restriction, and postnatal factors including nephrotoxic medications, patent ductus arteriosus, perinatal asphyxia, and infections contribute to this deficit. Ultrasound is a key tool for assessing renal volume at birth and can, when indexed to body weight, be used to estimate nephron endowment, which is known to vary widely among individuals. Methods: This study analyzed 52 preterm infants with birth weight < 1000 g, assessing combined renal volume (sum of right and left kidney volumes) indexed to body weight. Results: The mean combined kidney volume-to-body weight ratio was 12.12 (SD = 2.03). Values below the 10th percentile (9.46) or more than one standard deviation below the mean (10.11) may indicate nephron deficiency at birth. Conclusions: Standardized ultrasound-based parameters enable the early identification of neonates at risk for nephron deficit, supporting targeted preventive strategies. Long-term follow-up is essential to detect early renal functional impairment and reduce the risk of chronic kidney disease. Full article

Background/Objectives: Oocyte donation (OD) pregnancies involve complete maternal–fetal genetic disparity and are associated with increased placental dysfunction and adverse perinatal outcomes. However, a unified histopathological framework to characterize alloimmune-mediated placental injury in OD gestations is lacking. This study evaluates immune and vascular alterations in OD triplet placentas and proposes a structured scoring system, the Placental Allograft Rejection-like Score (PARS), to quantify immunovascular dysregulation. Methods: This retrospective study included all OD triplet pregnancies with placental examination performed during 24 years at a tertiary referral center. Maternal, obstetric, fetal, neonatal, and pathological variables were analyzed at the pregnancy level. Histological and immunohistochemical features previously shown to differ between OD and non-OD pregnancies were grouped into six domains: innate immunity, adaptive immunity, checkpoint regulation, vascular remodeling, complement activation, and trophoblastic behavior. Binary thresholds, immunoreactive scores or established morphological cut-offs, were applied to construct a 20-point score classified into three grades. Results: Forty-five OD triplet pregnancies were analyzed. Intra-pregnancy concordance for PARS components was high, with intraclass correlation coefficient ≥0.70 in 87.3% pregnancies. Increasing PARS grades demonstrated a clear clinical gradient. Grade 3 pregnancies had significantly lower birthweight, higher rates of prematurity (<34 weeks), and increased fetal growth restriction. Placental weight decreased progressively with higher PARS. Histologically, grade 3 placentas showed significantly increased accelerated villous maturation and intervillous fibrin deposition. Conclusions: PARS integrates immune and vascular placental lesions into a structured and reproducible framework that correlates with clinically relevant perinatal outcomes and may support future clinical risk stratification, although further validation in larger, multicenter prospective cohorts is required. Full article

Background/Objectives: Early postnatal nutrition is a modifiable determinant of brain maturation in preterm infants. Exclusive human milk-based diets (EHMD) are associated with improved neurodevelopmental outcomes. The objective of this exploratory ancillary analysis of the NEOVASC randomized controlled trial was to determine whether prolonging an exclusive human milk-based diet, specifically through continued human milk-based fortification until 36 weeks postmenstrual age, is associated with differences in early brain structure and functional motor development compared with earlier introduction of bovine milk-based fortifier or formula at 32 weeks postmenstrual age. Methods: This ancillary study of the NEOVASC trial included preterm infants (<32 gestational weeks and birthweight of 500–1250 g) randomized to either prolonged EHMD until 36 weeks PMA or a diet introducing bovine milk-based fortifier or formula from 32 weeks. Quantitative brain metrics, fractional anisotropy (FA), and apparent diffusion coefficient (ADC) were analyzed at 40 weeks PMA. Functional maturation was assessed repetitively using the General Movement Optimality Score (GMOS) (34, 36, and 40 weeks PMA) and Motor Optimality Score (52 weeks PMA). Results: Fifty-four infants were included. Groups did not differ in brain growth metrics. After adjustment for imbalances in clinical characteristics, no FA or ADC differences remained statistically significant. GMOS at 40 weeks PMA was higher in the intervention group, with no differences at other time points. Conclusions: In this exploratory ancillary analysis of the NEOVASC trial, prolonging an exclusive EHMD until 36 weeks postmenstrual age was not associated with consistent differences in early brain maturation or motor performance. Given the high overall exposure to human milk in both groups, subtle effects may have been attenuated. These findings require confirmation in larger, adequately powered studies with long-term follow-up. Full article

Background/Objectives: Appetite-regulating hormones are bioactive components of human milk. We tested the associations of leptin and adiponectin with infant growth and eating behaviors to age 6 months. Methods: In a cohort of 70 healthy, full-term infants and their mothers, human milk adiponectin and leptin were assayed at age 2 months (m). At infant ages 2, 4, and 6 m, infant anthropometry was obtained, mothers reported feeding frequency, duration, and breastfeeding intensity and completed the Baby Eating Behavior Questionnaire (Enjoyment of Food, Food Responsiveness, and General Appetite), and infant sucking vigor using an artificial nipple (burst duration and sucking frequency) was measured. Mothers reported demographics, gestational diabetes and pre-pregnancy body mass index (BMI), gestational age, and infant birthweight. Multivariate models evaluated predictors of leptin and adiponectin, and associations of leptin and adiponectin with infant growth and eating behaviors. Results: Human milk leptin was predicted by maternal BMI (β = 0.02) and breastfeeding intensity (β = −0.32). Regarding infant growth, infant weight-for-age and weight-for-length z-scores at 6 m were predicted by leptin (β = 0.91 and β = 1.22, respectively) and adiponectin (β = 0.01 and β = 0.01, respectively). Regarding infant eating behaviors, feeding duration at 2 m and feeding frequency at 4 m were predicted by adiponectin (β = 0.03 and β = −0.02, respectively). Conclusions: Human milk leptin and adiponectin may contribute to weight gain in early infancy, but the effect does not appear to be mediated substantially by infant eating behaviors. Further investigation into the metabolic programming of early infant weight gain is warranted. Full article

Background/Objectives: We aimed to evaluate the association between diabetes mellitus (DM) during pregnancy and retinopathy of prematurity (ROP) in preterm infants younger than 32 gestational weeks or infants with low birthweight (<1500 g). Methods: We conducted a retrospective nested case–control study of all premature infants who were born alive and survived the post-delivery hospitalization period in Soroka Medical Center, with either gestational age younger than 32 weeks or birthweight less than 1500 g, during the years 2013–2021. The infants were divided into two groups according to ROP status. Multivariable Generalized Estimating Equations (GEE) were used to analyze the association between ROP and DM, adjusting for potential confounders, including maternal age, diabetes type (GDM vs. pre-gestational DM), gestational age, birthweight (<1250 g), duration of oxygen supplementation, antenatal corticosteroid courses, and birth plurality. Results: During the study period, there were 881 pairs of women and newborns who met the inclusion criteria. The ROP group included 345 infants (39.1%). Twenty-two (6.4%) of the mothers in the ROP group were diagnosed with DM during pregnancy compared with 52 of 536 (9.7%) in the control group (p = 0.082). ROP was associated with oxygen treatment (OR 1.05; 95% CI, 1.03–1.08; p < 0.001), birthweight < 1250 g (OR 2.70; 95% CI, 1.93–3.78; p < 0.001) and advanced maternal age (OR 1.04; 95% CI, 1.01–1.06; p = 0.006). Prenatal steroid treatment was identified as a significant protective factor against ROP (OR 0.73; 95% CI, 0.60–0.89; p = 0.002). No statistically significant association was observed between maternal DM and ROP (OR 0.62; 95% CI 0.34–1.13; p = 0.12). These findings should be interpreted cautiously given the retrospective design and the limited availability of glycemic control data. Conclusions: Maternal diabetes mellitus was not significantly associated with the risk of ROP in this cohort. Full article

Background/Objectives: We aimed to determine risk factors and to design a clinically based predictive model for a failed vacuum assisted delivery (VAD). Methods: We conducted a retrospective cohort study in a single tertiary university-affiliated medical center between 2011 and 2023. The study population consisted of singleton pregnancies with a VAD trial. The study group comprised cases of a failed VAD, defined as the occurrence of any of the following: (1) more than two vacuum cup detachments; (2) extraction duration exceeding 20 min; or (3) abandonment of the vacuum attempt by the operating physician, with conversion to urgent cesarean delivery (CD). The control group comprised cases of successful VADs. Factors associated with failed VAD were examined by univariate and multivariate analyses. A prediction score was developed to predict failed VAD. A receiver-operating characteristic curve (ROC) was utilized for the model. Internal validation was performed by means of a 70/30 train–test split, with model performance evaluated on the validation set using ROC analysis. Results: A total of 131,019 women delivered in our center during the study period. VAD was attempted in 8885 (6.8%) cases, of which 172 (1.9%) failed trials that led to urgent CDs. Several risk factors for a failed VAD were identified, including induction of labor, fetal head station below +2 cm relative to the ischial spines, duration of the second stage of delivery >3.5 h, preeclampsia, birthweight >3750 g, and male gender. The prediction score demonstrated good discriminatory performance, with an AUC of 0.723 (95% CI 0.637–0.810). Internal validation using a 30% holdout cohort revealed that the model maintained good performance, with an AUC of 0.764 (95% CI 0.619–0.909; p < 0.001). Conclusions: Our model has the potential to assist obstetricians with VAD decision-making and parturient counseling, as well as identifying parturients at high risk for complicated deliveries. Full article

Background/Objectives: Preinduction of labor is commonly performed in women with unfavorable cervical conditions at term. Oral misoprostol is increasingly used due to its ease of administration and effectiveness; however, optimal dosing regimens remain under investigation. This study aimed to evaluate the safety and effectiveness of two oral misoprostol regimens (25 µg every 2 h versus 50 µg every 4 h) for preinduction of labor in term pregnancies. Methods: This single-center retrospective cohort study included 270 women with singleton term pregnancies who underwent oral misoprostol preinduction. Women received either 25 µg every 2 h (n = 60) or 50 µg every 4 h (n = 210) according to routine clinical protocols. Data were collected from electronic medical records and included demographic and obstetric characteristics, labor course, need for additional interventions (e.g., Foley catheter), and neonatal outcomes. The primary outcome was a composite maternal and neonatal safety endpoint. Secondary outcomes included mode of delivery, need for Foley catheter use, and time to delivery. Results: Both regimens were effective in facilitating labor progression. In crude analysis, the need for additional cervical ripening with a Foley catheter was higher in the 50 µg group compared with the 25 µg group (37.1% vs. 21.7%, p = 0.037); however, after stratification by prelabor rupture of membranes (PROM), this difference was no longer statistically significant (p = 0.39). Cesarean section rates did not differ significantly between groups (29.0% vs. 20.0%, p = 0.22). The time from the last misoprostol dose to delivery was shorter in the 50 µg group, but the difference was not statistically significant (p = 0.17). Neonatal outcomes, including birthweight, Apgar scores, and umbilical cord blood gas parameters, were comparable between groups. No severe maternal or neonatal adverse events were recorded. Conclusions: In this single-center retrospective cohort study, the 25 μg every 2 h and 50 μg every 4 h oral misoprostol regimens were associated with comparable obstetric and neonatal outcomes within the analyzed parameters. No significant differences in recorded maternal or neonatal safety outcomes were observed. Selection of the dosing regimen should take into account individual clinical factors, including parity, cervical status, and membrane status. Full article

Background: Adverse newborn outcomes in patients with severe maternal morbidity (SMM) are understudied, and this study examines their association with insurance type (Medicaid vs. commercial) in patients who experienced SMM. The aim of this study is to examine disparities in preterm birth, low birthweight, and neonatal intensive care (NICU) admission among Medicaid vs. commercially insured patients with severe maternal morbidity in Maryland. Methods: This cross-sectional study analyzed data from 588 SMM patients enrolled in Maryland’s Severe Maternal Morbidity (SMM) Surveillance Program (August 2020–December 2023). We utilized unadjusted and multivariable logistic regression models to evaluate the relationship between primary insurance type and the outcomes of interest: preterm birth (<37 weeks), low birthweight (<2500 g), and neonatal intensive care unit (NICU) admissions. Results: Of 588 patients with SMM, 45.1% had Medicaid. These patients were younger, more often non-Hispanic Black or Hispanic, had higher parity and comorbidity scores, and initiated prenatal care later compared with commercially insured patients. Medicaid patients had 2.2 to 2.6 times higher odds of adverse newborn outcomes after adjusting for other socio-demographic and medical factors. Patients’ comorbidities significantly increased the odds of adverse newborn outcomes, as did all other primary SMM causes other than obstetric hemorrhage. Conclusions: Adverse newborn outcomes were more prevalent among Medicaid than commercially insured patients who experienced SMM. Differences in maternal health status and primary SMM cause partly explain the observed differences in newborn outcomes. Our findings emphasize the need for comprehensive prenatal care and improved healthcare access for women with high-risk pregnancies. Full article

Background: The risk of morbidity and mortality increases in newborns requiring postpartum transport. Various scoring systems have been developed to determine mortality risk, such as the Transport Risk Index of Physiologic Stability (TRIPS) and Mortality Index for Neonatal Transportation (MINT) scores. This study aimed to evaluate the efficiency of MINT and TRIPS scores by comparing them with the Score for Neonatal Acute Physiology-Perinatal Extension (SNAPPE-II) scoring system in preterm and term infants transported within the first 24 h after birth. Methods: This retrospective study included neonates transported within the first 24 h of life to the NICU of Etlik Zübeyde Hanım Women’s Health Training and Research Hospital between 2016 and 2021, following ethics approval. Perinatal data, admission clinical and laboratory parameters, and TRIPS, MINT, and SNAPPE-II scores calculated within the were recorded. Mortality and short-term morbidities were analysed. Group comparisons were conducted using Mann–Whitney U and chi-square tests. Predictive performance and optimal cut-off values were determined by receiver operating characteristic curve analysis using the Youden index. p value <0.05 was considered significant. Results: A total of 137 newborns were included in the study. Seventy-two cases (52.6%) were preterm, and 65 cases (47.4%) were term newborns. The median gestational age and birthweight were 35.6 weeks and 2485 g, respectively. A total of 10 patients died. For mortality prediction, the areas under the curve for TRIPS, MINT, and SNAPPE-II were 0.919, 0.907, and 0.973, respectively (p < 0.001). The determined cut-off values for TRIPS, MINT, and SNAPPE-II were >19, >4, and >35, respectively. The TRIPS score showed the best accuracy for prediction of mortality in preterm infants. Conclusions: Our data show that MINT and TRIPS scores are efficient beyond SNAPPE-II. They demonstrated high diagnostic effectiveness in predicting mortality in preterm and term infants. The TRIPS score exhibits superior mortality prediction in preterm infants. Full article

Objectives: To develop and prospectively validate a predictive model to estimate the fetal postmortem interval (PMI) using three-dimensional postmortem ultrasound (3D PM-US) measurements of corneal and ocular volumes. Methods: Single-center study including fetuses ≥ 20 weeks’ gestation with known time of death after feticide. A retrospective training cohort (n = 63; November 2022–July 2023) and a prospective validation cohort (n = 28; February–August 2025) were used. Corneal and ocular volumes were measured using the VOCAL™ rotation multiplanar technique; the cornea-to-eyeball volume ratio was calculated for each case. Automated machine learning (AutoML) was used to develop and validate a gradient boosting machine (GBM) model. Model performance was evaluated using the root mean squared error (RMSE), mean absolute error (MAE), and coefficient of determination (R²). Results: Ninety-four fetuses were included; three were excluded (two for extreme death–US intervals of 165 and 166 h; one for open eyelids). Median gestational age was 29.3 weeks (IQR 27.2–32.9); median birthweight was 1325 g (IQR 980–1880). The cornea-to-eyeball volume ratio was an independent predictor of PMI (p < 0.001). The GBM model explained 91% of the variance in the training cohort (R² = 0.91, RMSE = 11.49 h, MAE = 8.45 h) and 75% in the validation cohort (R² = 0.75, RMSE = 18.32 h, MAE = 14.49 h), demonstrating strong predictive accuracy and minimal overfitting. Variable importance analysis confirmed the cornea-to-eyeball ratio as the most influential and biologically plausible predictor of PMI. A Shiny web application was developed to facilitate clinical implementation. Conclusions: 3D PM-US measurements of the fetal cornea and eyeball can reliably and quantitatively estimate the PMI with good predictive accuracy using a GBM model. Multicenter studies are required to further refine the model, enable external validation, and determine its clinical and forensic utility. Full article

Background and Objectives: To evaluate pregnancy outcomes and transthoracic echocardiographic (TTE) findings during the antenatal and postpartum periods in women with repaired Tetralogy of Fallot (ToF) who delivered at Çukurova University Faculty of Medicine, Balcalı Hospital, between 2011 and 2025 and to interpret these findings in the context of the 2025 European Society of Cardiology (ESC) recommendations. Materials and Methods: This single-center retrospective cohort study undertaken between 2011 and 2025 included 11 pregnant women with surgically repaired ToF. Maternal demographic characteristics, obstetric outcomes, mode of delivery, neonatal outcomes, and antenatal TTE parameters were recorded. Cardiac measurements obtained during pregnancy were compared with postpartum TTE findings performed 3–6 months after delivery to assess pregnancy-related cardiac adaptation and recovery. Results: A total of 11 pregnancies in women with repaired ToF were analyzed. Nine pregnancies resulted in live births, while one ended in missed abortion at 9 + 2 weeks and one in intrauterine fetal demise at 34 + 2 weeks. Among live births, the mean gestational age was 36 + 2 weeks and the mean birthweight was 2865 g, with a preterm delivery rate of 55.6%. Cesarean section was performed in 70% of cases, while 30% delivered vaginally. During pregnancy, the mean left ventricular ejection fraction was 62.6%, and residual tricuspid regurgitation was the most frequently observed echocardiographic finding. Postpartum TTE evaluations indicated that echocardiographic parameters were largely stable over the observation period, with no numerical change and no clear evidence of deterioration in ventricular function or progression of valvular regurgitation. Conclusions: Despite successful surgical repair, pregnancy may still pose potential risks for women with ToF, underscoring the importance of individualized, multidisciplinary management. In this cohort, pregnancy appeared to be generally well-tolerated when care was provided in accordance with contemporary ESC recommendations. The observation of preserved ejection fraction and overall stable right ventricular function in the early postpartum period suggests that favorable maternal cardiac adaptation may be achievable in carefully selected patients. Early postpartum echocardiographic assessment may be useful for identifying functional changes and informing structured long-term follow-up strategies. Full article

Background: ROP Check^® monitoring and documentation software from 28 American hospitals collected clinical data from 2010 to 2024 representing infants from a wide range of races and ethnicities. Methods: De-identified data compared gender to treatment status, race, birthweight (BW), gestational age (GA) and gestational age at first treatment. Results: From 7070 total patients, with 5060 having timely or early initial exams based on American Academy of Pediatrics (AAP) guidelines, 386 had treatment for ROP. Males constituted 54.3% of treated infants and 54.4% of all infants. There was no gender difference in gestational age or age at treatment, but males had greater birthweights (685 to 610 g). There were more females treated under 600 g. There were race-related birthweight differences in infants treated for ROP. Conclusion: There are more males screened and treated for ROP, but treatment rates are similar for both genders. Male preponderance reverses for infants with birthweight less than 600 g. Race has an influence on treated ROP. Full article

Background: Pregnant adolescents are at higher risk of adverse birth outcomes. Tailoring antenatal care (ANC) to adolescents’ unique needs may be a way to reduce adverse maternal and child outcomes within this population. This systematic review aimed to evaluate ANC services for pregnant adolescents and their impact on maternal and infant outcomes. Methods: Two reviewers independently searched five electronic databases (September 2024) to evaluate existing ANC services that are tailored to adolescents and the impact they have on maternal and infant outcomes. Studies were assessed for quality using the NICE quality appraisal tool and a narrative synthesis was carried out to present the findings. In addition, a survey was disseminated through the Global Adolescent Nutrition Network (GANN) to gain further insights into stakeholder views and experiences of tailored ANC for adolescents. Results: 11,236 articles were reviewed, with 14 studies included for analysis. Interventions as part of ANC for pregnant adolescents included micronutrient supplementation, supplementary feeding, community-based delivery, group-delivery, tailored nutrition education, and additional support and counselling. Outcomes such as birthweight, preterm birth, and gestational age were reported, with most studies (11/14) demonstrating positive effects. Of 103 survey responses, 100% agreed that ANC for pregnant adolescents need to be delivered in a youth-friendly manner, and 57% indicated that providing both youth-friendly delivery and additional support are crucial. Inclusive and supportive care, tailored educational support, tailored nutrition care, and mental health support were most commonly mentioned as key components for tailored ANC. Conclusions: The systematic review and survey data concur in identifying key elements of adolescent-tailored ANC. Some of these have already been shown to be effective; however, due to the high heterogeneity of the study designs, a stronger evidence-base is needed. Specific elements of future ANC packages for pregnant adolescents might include group ANC delivery, community-based services, increased confidentiality measures, mental health support and counselling, health education, and nutrition care tailored to adolescents’ physiological and emotional needs. Full article

Small for gestational age (SGA) is often used as a proxy for fetal growth restriction (FGR), yet not all FGR fetuses are born SGA. SGA individuals, particularly those with catch-up growth, have increased cardiometabolic risk. We therefore studied infants and children from pregnancies at increased FGR risk, irrespective of birthweight. Two cohorts enriched for suboptimal fetal growth were recruited: an infant cohort (N = 80) to examine relationships between fetal weight trajectory and postnatal growth and a cohort of children aged 3–7 years (N = 80), 31 of whom provided blood samples for transcriptome and metabolome analyses. In infants, fetal weight trajectory correlated negatively with BMI change from birth to three months (R = −0.40, p = 0.004) and six months (R = −0.38, p = 0.012), as well as with skinfold, abdominal and arm circumferences. In children, supervised transcriptome analysis highlighted a pathway including ARG1. Unsupervised analysis had previously identified two SBP-differentiated groups; novel findings include LATS1, implicated in SBP GWAS, as the most significant gene, and GHRL, suggesting appetite-regulation mechanisms underlie SBP differences. Ornithine, a differentially expressed metabolite between fetal and childhood weight trajectory quartiles, together with ARG1, suggested involvement of the arginine-nitric oxide pathway. Early life indicators of cardiometabolic risk have been elucidated, highlighting pathways to inform future prevention. Full article

Background: Gestational diabetes mellitus (GDM) complicates a significant number of pregnancies and is associated with both short- and long-term risks for the mother and child. Twin pregnancies are inherently high risk, and the coexistence of GDM may amplify these risks. While the effects of GDM in singleton pregnancies have been widely studied, data on its impact in twin gestations remain limited. The aim of this study was to determine differences regarding metabolic characteristics, treatment requirements, and maternal as well as fetal outcomes between twin and singleton pregnancies with GDM to contribute to improved perinatal care. Methods: This retrospective study included obstetric data from 73 twin pregnancies (146 neonates) and 1664 singleton pregnancies with a GDM diagnosis at a tertiary perinatal center in Berlin, Germany, between 2015 and 2022. Baseline characteristics and perinatal outcomes were assessed. Adjusted multiple linear and logistic regression analyses were used for group comparisons. Results: Women with GDM in twin and singleton pregnancies exhibited comparable glucose values in the 75 g oral glucose tolerance test (OGTT) (median fasting: 95 vs. 96 mg/dL; 1 h: 183 vs. 183 mg/dL; 2 h: 144 vs. 139 mg/dL). Despite this, insulin therapy was required significantly less often in twin (5.5%) compared to singleton pregnancies (22.3%) (OR = 0.86; 95% CI: 0.78–0.96). Among insulin-treated women, combined insulin therapy was most common in twins (75%), while singleton mothers most frequently received long-acting insulin alone (61.7%), followed by combined therapy (31.3%) and short-acting insulin alone (7%). Birthweight was significantly lower in twins (β = –0.83 kg; 95% CI: –0.98 to –0.69), and when evaluated using twin-based growth standards, twins were more likely to be classified as having intrauterine growth restriction (IUGR, <3rd percentile) (OR = 3.37; 95% CI: 0.96–9.11), being small for gestational age (SGA, <10th percentile) (OR = 2.50; 95% CI: 1.23–4.76), or having a birthweight below the 30th percentile (OR = 6.11; 95% CI: 3.49–11.12). No large-for-gestational-age (LGA, >90th percentile) neonates were observed in the twin group. Conclusions: GDM manifests differently in twin and singleton pregnancies. Despite similar OGTT values, twin mothers require insulin less frequently. Growth-related complications such as IUGR and SGA are significantly more frequent in twins, likely reflecting the physiological constraints of multiple gestations rather than GDM itself. Conversely, LGA is predominantly a concern in singleton pregnancies. These findings underscore the need for individualized diagnostic criteria and management strategies for GDM in twin pregnancies. Full article