Search Results (271)

Background/Objectives: Obesity and excessive gestational weight gain (EGWG) are known risk factors for adverse outcomes in pregnancy, but the comparative risk is less well defined and increasingly relevant in an era of increasing use of weight loss medications. We aimed to determine whether EGWG was associated with adverse maternal and neonatal outcomes, compared with prepregnancy obesity. Methods: Multicenter retrospective cohort study of pregnant patients who delivered a singleton within a single university health system from 2019–2024. Patients with missing prepregnancy body mass index (BMI) data, BMI < 18.5 kg/m², or pregestational diabetes were excluded. Logistic regression with propensity score weights and g-computation were used to evaluate if the incidence of several adverse maternal and neonatal outcomes were impacted by prepregnancy obesity and gestational weight gain (GWG). p values were adjusted for multiple comparisons. Results: Among the 129,615 pregnancies included, 28,516 (22.0%) had prepregnancy obesity, 36,943 (28.5%) were overweight prior to pregnancy, and 64,156 (49.5%) had a normal BMI prior to pregnancy. When compared to patients with obesity, patients with normal prepregnancy BMI and EGWG had a lower risk of adverse maternal and neonatal outcomes, including gestational diabetes, gestational hypertension, preeclampsia, eclampsia, cesarean delivery, and postpartum hemorrhage, as well as large and small for gestational age birthweight, stillbirth, neonatal intensive care unit admission, neonatal mechanical ventilation, respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, and sepsis. Beneficial effects were attenuated for patients with overweight prepregnancy BMI or for larger EGWG. Conclusions: Lower prepregnancy BMI, even with the potential unintended consequence of EGWG, may be more favorable than untreated prepregnancy obesity with regard to perinatal outcomes. Full article

Background: Maternal nutritional status before pregnancy may influence offspring long-term health; however, the association between pre-pregnancy dietary patterns and body composition in preschool children remains unclear. Methods: This study used data from the Taicang and Wuqiang Mother–Child Cohort Study (TAWS), comprising 582 mother–child pairs. Dietary intake during the month before pregnancy was assessed using a food frequency questionnaire. Dietary patterns were derived via principal component analysis. Standardized pattern scores (mean = 0, SD = 1) were analyzed as continuous variables (per 1-SD increase) and categorized into quartiles (Q1–Q4, with Q1 as reference). Body composition indicators (percent body fat [PBF], fat mass index [FMI], fat-free mass index [FFMI], and skeletal muscle index [SMI]) were measured by bioelectrical impedance analysis in children aged 3–6 years. Multiple linear regression was used to examine associations under two models: an unadjusted model and a multivariable model adjusted for child characteristics, maternal sociodemographic and gestational factors, family factors, feeding mode, and other dietary patterns. Interaction terms were introduced to test for potential effect modification by child sex and maternal pre-pregnancy BMI. Results: Results showed that five maternal pre-pregnancy dietary patterns were extracted: animal-based food, grain-vegetable-fruit, processed meat-dairy, vegetable-legume, and cured vegetable. In multivariable-adjusted models, the processed meat-dairy pattern was positively associated with FMI (Q4 vs. Q1: β = 0.262, 95% CI: 0.036 to 0.488). The grain-vegetable-fruit pattern was inversely associated with FFMI (Q4: β = −0.265, 95% CI: −0.510 to −0.020) and SMI (Q4: β = −0.256, 95% CI: −0.564 to −0.113). The vegetable-legume pattern was associated with higher PBF (Q3: β = 0.234, 95% CI: 0.007 to 0.461) and lower SMI (Q4: β = −0.338, 95% CI: −0.564 to −0.113). No significant associations were observed for the animal-based food or cured vegetable pattern after adjustment. Sex-stratified analyses showed that the animal-based food pattern was associated with FFMI and SMI in opposite directions between boys and girls (p for interaction = 0.048 and 0.013, respectively). Maternal pre-pregnancy BMI significantly modified only the association between the processed meat–dairy pattern and SMI (p for interaction = 0.032). Conclusions: Maternal pre-pregnancy dietary patterns were selectively associated with body composition in preschool children: the processed meat–dairy pattern was associated with higher fat mass, while the grain-vegetable-fruit and vegetable-legume patterns were associated with lower muscle indices. These associations are observational in nature and do not imply causality. In particular, the associations of plant-based dietary patterns with muscle indices should be interpreted with caution and should not be regarded as negative effects of plant-based diets. Full article

The aim of this study was to examine the modifying effect of body mass index (BMI) on the association of genome-wide association studies (GWAS)-significant for the level of sex hormones polymorphic loci with pre-eclampsia (PE). The work carried out genotyping of specially selected (according to data from previously conducted GWAS) 18 single nucleotide polymorphisms (SNP)that determine the content of various sex hormones in the organism. The sample of 891 pregnant women included two subgroups (they were formed based on the BMI values of women before pregnancy (pre-pregnancy BMI [preBMI]): preBMI < 25 (n = 592; 279 with PE/313 without PE) and preBMI ≥ 25 (n = 299; 152 with PE/147 without PE). The Firth’s penalized regression was used for the search of associations between SNPs and PE. As a whole, in the investigated cohort of women (PE [n = 431]/control group [n = 460], n = 891), an association of interactions of rs117585797 anoctamin-2 × preBMI with PE was found: OR_A = 0.86, 95%CI_A = 0.76–0.96, p_permt = 0.020. The results of our associative analysis in the two cohorts under consideration indicated the presence of a significant association only among women with preBMI < 25: SNP rs117585797 anoctamin-2 (C > A) was linked with PE risk (OR_A = 2.69, 95%CI_A = 1.26–5.72, p_permt = 0.011, power = 91.77%). In the women group with preBMI ≥ 25, we did not identify significant associations. The PE-associated locus rs117585797 of the anoctamin-2 gene and 14 of its LD variants were functionally significant for 57 proteins involved in PE-significant biological pathways such as regulation of gene expression, hormone- and estrogen-dependent processes, embryonic development, and adipogenesis. In conclusion, this study is the first to demonstrate a BMI—specific correlation between GWAS-significant for estradiol levels polymorphism rs117585797 anoctamin-2 (C > A) and PE: this SNP was PE-associated in preBMI < 25 pregnant women and not linked with PE risk in preBMI ≥ 25 pregnant women. Full article

Background: Erythrocyte fatty acid (FA) and oxidative stress levels are influenced by a range of factors. The aim of this study was to evaluate erythrocyte FA profiles and oxidative stress markers and their relationships with each other, nutrition, lifestyle, gestational age, and pregnancy outcomes in pregnant Latvian women. Methods: A total of 74 pregnant and postpartum women were cross-sectionally examined. Dietary intake was assessed using a validated food frequency questionnaire; erythrocyte FA composition was analyzed using gas chromatography with a flame ionization detector; and oxidative status was assessed based on Ferric Reducing Antioxidant Power (FRAP) assays, glutathione peroxidase (GPx) activity, and selenoprotein P (SEPP1) and malondialdehyde (MDA) levels. Results: Dietary fats constituted 42.0% of the total caloric intake. Saturated fatty acids (SFAs) predominated in erythrocytes (55.7%), with the highest concentration observed for 16:0. Although multiple significant correlations between dietary factors and laboratory parameters were identified, none remained significant after correction for multiple comparisons. Erythrocyte 18:3, n-3 was significantly associated with FRAP (p < 0.05). Gestational complications and age did not affect biochemical parameters (p > 0.05), though gestational age correlated with MDA (r = 0.377, p < 0.05) and pre-pregnancy body mass index (BMI) with MUFAs (r = 0.373, p < 0.01). The FA composition differed depending on smoking status and alcohol consumption. Conclusions: Given the exploratory nature of this study, findings should be interpreted with appropriate caution. Several associations retained statistical significance following correction for multiple comparisons, namely between erythrocyte 18:3, n-3 and FRAP, alcohol consumption and smoking with erythrocyte fatty acid profiles, maternal age and plasma MDA concentrations, and pre-gestational BMI and MUFA levels. The remaining associations did not withstand correction and should therefore be regarded as hypothesis-generating, warranting confirmation in larger, adequately powered, confirmatory studies. Full article

Background/Objectives: Maternal obesity is associated with an increased risk of adverse maternal and neonatal outcomes. This study evaluated whether participation in a multidisciplinary antenatal care pathway improved pregnancy outcomes compared with routine clinical practice in women with pre-pregnancy obesity. Methods: 711 women of reproductive age with preconception body mass index (BMI) ≥ 30 kg/m² were identified from medical records collected between 2010 and 2023: 233 women were managed according to the multidisciplinary clinical pathway (pathway group), and 478 served as historical controls, followed at the same unit before pathway implementation. Age, BMI, gestational diabetes frequency, weight gain during pregnancy, gestational hypertension, preeclampsia/eclampsia, time and mode of delivery, birthweight, macrosomia, large for gestational age, neonatal hypoglycemia, hyperbilirubinemia, respiratory distress, fetal morbidity, and congenital anomalies were collected. Fasting plasma glucose, glycated hemoglobin, plasma glucose values under oral glucose tolerance test, plasma cholesterol and triglyceride levels were also evaluated. Results: The first evaluation occurred significantly earlier in the pathway group than in controls. Only about half of the women in the pathway group developed gestational diabetes mellitus (GDM) during pregnancy compared with 84% of controls (47% vs. 84%, p < 0.001), a difference partly explained by a referral bias in the control group, where women were referred after GDM screening rather than on the basis of obesity alone. As for maternal complications, the frequency of hypertension, eclampsia, and preeclampsia was similar in the two groups. As for fetal outcomes, pathway group women with respect to control showed a significantly lower frequency of preterm birth (5% vs. 11%, p = 0.0275), fetal morbidity (2% vs. 6%, p = 0.0377) and a tendency to lower frequency of macrosomia (7% vs. 12%, p = 0.0677), large for gestational age (19% vs. 26%, p = 0.116) and small for gestational age babies (5% vs. 7%, p = 0.50). Conclusions: This study shows that a multidisciplinary antenatal clinical approach was associated with a reduction in some adverse maternal–fetal outcomes related to pregnancy complicated by obesity, despite a less favorable baseline risk profile in the pathway group. Preconception counseling starting before pregnancy may represent an even more effective strategy, and efforts must be made in this direction. Full article

Background/Objectives: Maternal overweight and obesity are increasing in Libya, yet multicity evidence among pregnant women remains limited, particularly regarding central adiposity and associations with socioeconomic characteristics, unhealthy eating behaviours (UEBs), physical inactivity, and sedentary behaviour. This study estimated the prevalence of women meeting standard WHO BMI cut-offs for overweight/obesity at antenatal assessment and examined associated socioeconomic, dietary, and lifestyle characteristics among women attending participating public antenatal clinics in six Eastern Libyan cities. Methods: This cross-sectional study included 3000 pregnant women attending participating public antenatal clinics in six Eastern Libyan cities. A multistage, city-stratified sampling strategy was used. Participants completed a structured Arabic questionnaire assessing socioeconomic characteristics, dietary intake, physical inactivity, and sedentary behaviour. Trained female nurses obtained standardised anthropometric measurements during antenatal assessment using the TANITA RD-545HR Smart Segmental Body Composition Analyser. Body mass index (BMI) was evaluated as an indicator of general pregnancy-period adiposity, while WC and BIA-derived visceral fat rating (VFR) were treated as complementary epidemiological indicators rather than precise or diagnostic measures of visceral adiposity. For each participant, BMI, WC, and VFR were obtained during the same antenatal assessment; however, participants were recruited across different gestational stages. Multivariable linear regression examined associations between the specified exposures and continuous adiposity measures, while modified Poisson regression with robust variance estimated adjusted prevalence ratios (aPRs) for overweight/obesity after adjustment for age, parity, gestational stage, and relevant covariates. Results: Among the recruited antenatal clinic sample, 60.6% had BMI-defined overweight/obesity (95% CI: 58.9–62.3); using prespecified descriptive thresholds, 58.9% had WC ≥ 88 cm (95% CI: 57.1–60.7) and 52.1% had BIA-derived VFR ≥ 10 (95% CI: 50.3–53.9). Lower educational attainment (aPR = 1.24, 95% CI: 1.15–1.35, p < 0.001) and lower household income (aPR = 1.18, 95% CI: 1.09–1.27, p = 0.004) were independently associated with a higher prevalence of overweight/obesity. In the primary scale-level analyses, higher physical inactivity sedentary lifestyle scores (aPR = 1.04, 95% CI: 1.03–1.05, p < 0.001) and higher UEBs scores (aPR = 1.07, 95% CI: 1.05–1.09, p < 0.001) were associated with a higher prevalence of BMI-defined overweight/obesity. In secondary exploratory item-level analyses, prolonged mobile phone use showed the strongest lifestyle association (aPR = 1.30, 95% CI: 1.20–1.41, p < 0.001), while consuming fewer than five daily portions of fruit and vegetables demonstrated the strongest dietary association (aPR = 1.36, 95% CI: 1.24–1.49, p = 0.003). The full adjusted models accounted for 6.4–17.6% of variance in the continuous adiposity measures, indicating limited-to-modest explanatory power. Conclusions: BMI-defined weight status and elevated pregnancy-period adiposity indicators were common among women attending participating public antenatal services across six Eastern Libyan cities and were associated with socioeconomic disadvantage, sedentary behaviour, and poorer diet quality. The BMI-based classification reflects weight status at antenatal assessment and should not be interpreted as pre-pregnancy overweight/obesity prevalence. Full article

Background/Objective: Maternal obesity is an established risk factor for adverse obstetric outcomes. However, its association with oligohydramnios remains unclear and has been examined using body mass index (BMI) alone. We assessed pre-pregnancy general and abdominal obesity in relation to oligohydramnios. Methods: We analyzed 762,104 women who delivered between 2010 and 2018 and had undergone a national health examination within two years before conception. Women were classified into four phenotypes by BMI (general obesity: ≥25 kg/m²) and waist circumference (abdominal obesity: ≥85 cm). Odds ratios were estimated by logistic regression adjusted for pre-pregnancy characteristics, and interaction was tested on the additive and multiplicative scales. Results: Oligohydramnios occurred in 13,860 women (1.82%). Relative to women with neither phenotype, adjusted odds were increased for abdominal obesity alone (1.163; 95% CI 1.013–1.336), general obesity alone (1.125; 95% CI 1.051–1.204), and both (1.336; 95% CI 1.241–1.438). Absolute risk was 2.19% among women with both phenotypes and 1.79% among those with neither, with no interaction on either scale (p = 0.811). Conclusions: General and abdominal obesity were each associated with oligohydramnios. Because nearly one in four women with abdominal obesity had a BMI below the obesity threshold, assessment by BMI alone leaves part of this risk unrecognized. Full article

Background/Objectives: Gestational diabetes mellitus (GDM) is one of the most common metabolic disorders during pregnancy and is associated with adverse maternal and neonatal outcomes. Xenopsin-Related Peptide-1 (XRP-1) has recently emerged as a potential regulator of glucose metabolism and insulin homeostasis. This study evaluated serum XRP-1 levels and assessed their diagnostic performance in women with GDM. Methods: In this prospective observational study, 120 pregnant women between 24 and 28 weeks of gestation were enrolled, including 60 women with GDM and 60 healthy controls. Serum XRP-1 concentrations were measured using an enzyme-linked immunosorbent assay (ELISA). Clinical, biochemical, and obstetric characteristics were compared between groups. Receiver operating characteristic (ROC) curve analysis and multivariable logistic regression were performed to evaluate the diagnostic performance and independent association of XRP-1 with GDM. Results: Serum XRP-1 levels were significantly higher in women with GDM than in healthy controls (3.45 ± 0.47 vs. 2.87 ± 0.46 ng/mL, p = 0.003). ROC analysis demonstrated moderate discriminatory performance for XRP-1 in identifying GDM (AUC = 0.658, 95% CI: 0.560–0.750), with an optimal cut-off value of 3.12 ng/mL, corresponding to 63.3% sensitivity and 61.7% specificity. Multivariable logistic regression demonstrated that serum XRP-1 remained independently associated with GDM after adjustment for maternal age, pre-pregnancy body mass index, gestational weight gain, and parity (adjusted OR 2.74, 95% CI 1.31–5.73; p = 0.007). HbA1c and C-reactive protein levels were also significantly higher in the GDM group. Conclusions: Serum XRP-1 concentrations were independently associated with GDM and demonstrated moderate diagnostic accuracy. Although XRP-1 cannot replace established diagnostic methods, it may represent a complementary biomarker for identifying gestational dysglycemia. Larger multicenter studies are required to validate its clinical utility. Full article

Objectives: This study aimed to describe the incidence and clinical spectrum of external cephalic versión (ECV)-related complications, to evaluate pre-procedural predictors of their occurrence, and to develop and internally validate a prediction model for ECV-related complications. Methods: This single-center cohort study included ECV procedures performed in singleton pregnancies with non-cephalic presentation at term between January 2014 and December 2025. All procedures followed a standardized protocol, including tocolysis and either deep sedation or spinal anesthesia. ECV-related complications were defined as maternal or fetal adverse events occurring during the procedure or within 24 h after ECV. A prespecified multivariable logistic regression model was developed using clinically relevant pre-procedural variables. Model discrimination was assessed using the area under the receiver operating characteristic curve (AUC), and internal validation was performed by bootstrap resampling. Results: A total of 1050 ECV procedures were included, of which 733 (69.7%) were successful. Complication status was available for 1050 procedures, among which 113 ECV-related complications were recorded (10.8%). Complications were more frequent after failed than successful ECV (17.6% vs. 7.8%). The most frequent events were non-reassuring fetal heart rate patterns, major vaginal bleeding, spotting, and uterine contractions. Emergent cesarean delivery within 24 h occurred in 72 complication cases (63.7%). No neonatal deaths occurred among cases with ECV-related complications. In the final multivariable model, lower maternal body mass index (adjusted OR 0.92 per kg/m²), lower deepest vertical pocket (adjusted OR 0.69 per 10 mm), and breech rather than transverse lie (adjusted OR 0.24) were independently associated with ECV-related complications. Adding deepest vertical pocket significantly improved model discrimination from an AUC of 0.645 to 0.714. Bootstrap internal validation demonstrated limited optimism, with an optimism-corrected AUC of 0.699. Conclusions: ECV performed under a standardized protocol achieved a high success rate with an acceptable safety profile, although approximately one in ten procedures was associated with an ECV-related complication when broadly defined. Lower maternal BMI, reduced amniotic fluid volume, and breech presentation were the main pre-procedural predictors of complications. These findings may facilitate individualized counselling and procedural planning, although external validation is required before clinical implementation. Full article

Background/Objectives: Maternal and neonatal intensive care unit (ICU) admissions are markers of severe perinatal morbidity, yet their co-occurrence within the same birth remains poorly characterized at the population level. The objective of this study was to examine temporal trends, distribution, and maternal risk factors associated with concurrent maternal and neonatal ICU admission among singleton births in the United States. Methods: This population-based, serial cross-sectional study used the US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (WONDER) database from 2016 to 2024. Singleton live births were included and classified into four mutually exclusive ICU phenotypes: maternal ICU admission only, neonatal ICU admission only, concurrent maternal–neonatal ICU admission, and neither. Annual rates per 1000 births were calculated, and temporal trends were assessed using joinpoint regression. Maternal characteristics associated with concurrent ICU admission were evaluated using descriptive analyses and crude relative risks. Results: The analytic cohort included 32,341,764 singleton births. Between 2016 and 2024, rates of neonatal ICU admission increased from 76.35 to 88.46 per 1000 births (average annual percent change [AAPC], 1.65%; 95% CI, 1.35–1.92%) and maternal ICU admission from 1.49 to 1.82 per 1000 births (AAPC, 2.48%; 95% CI, 1.73–3.14%). Concurrent maternal–neonatal ICU admission remained uncommon but increased from 0.70 to 0.92 per 1000 births (AAPC, 3.32%; 95% CI, 1.67–4.88%). Across gestational age, neonatal ICU admission without maternal ICU admission was the dominant phenotype, particularly at earlier gestational ages. Concurrent ICU admission showed a similar but attenuated pattern, whereas maternal ICU admission without neonatal ICU admission remained uncommon, with relatively higher rates at the earliest gestational ages. Concurrent ICU admission was associated with markers of maternal and pregnancy risk. The highest risks were observed among pregnancies complicated by eclampsia, pre-pregnancy diabetes, and pre-pregnancy hypertension, as well as among women with no prenatal care. Risk increased with advancing maternal age and higher body mass index, and disparities were observed across racial groups. Conclusions: Concurrent maternal and neonatal ICU admission is a rare but increasing outcome concentrated among high-risk pregnancies. These findings highlight the need for integrated maternal–neonatal risk assessment and continued surveillance of severe perinatal outcomes. Full article

Pregnancy is associated with physiological adaptations in calcium metabolism and skeletal homeostasis that may result in temporary reductions in bone mineral density (BMD). However, routine skeletal assessment during pregnancy remains limited because dual-energy X-ray absorptiometry (DXA) involves ionizing radiation. This study aimed to compare bilateral femoral neck BMD and Z-scores in pregnant and non-pregnant women using Radiofrequency Echographic Multi-Spectrometry (REMS), a radiation-free ultrasound-based technology, and to assess correlation between bilateral measurements. In this cross-sectional study, 100 women were enrolled, including 40 pregnant women and 60 non-pregnant women with comparable age and body mass index (BMI). Bilateral femoral neck BMD and age-adjusted Z-scores were evaluated using REMS. Pregnant women had a mean age of 33 ± 5 years, pre-pregnancy BMI of 25.8 ± 6.5 kg/m², and gestational age of 21 ± 5 weeks, with no significant differences in age or pre-pregnancy BMI compared with controls. Pregnant women demonstrated significantly lower left femoral neck BMD than controls (0.805 vs. 0.862 g/cm²; p = 0.0018) and lower left femoral neck Z-scores (−0.08 vs. 1.18 SD; p = 0.003). A strong positive correlation between left and right femoral neck BMD was observed (R = 0.78). Similarly, right femoral neck BMD was significantly lower in pregnant women compared with controls (0.835 g/cm² vs. 0.892 g/cm²; p = 0.0026). The right femoral neck Z-score was 0.15 ± 1.15 SD in pregnant women and 1.45 ± 1.10 SD in controls (p = 0.002). REMS demonstrated the ability to detect differences in femoral neck bone parameters between pregnant and non-pregnant women while providing bilateral measurement consistency. These findings support the feasibility of REMS as a safe, radiation-free approach for assessing maternal skeletal status during pregnancy. However, the cross-sectional design and lack of longitudinal follow-up limit conclusions regarding the progression and reversibility of pregnancy-associated bone changes. Future prospective studies with larger cohorts and postpartum monitoring are needed to further define the clinical role of REMS in maternal bone health assessment. Full article

Maternal anemia during pregnancy may adversely affect fetal growth, including neonatal head circumference (HC). This retrospective cohort study aimed to identify predictors of small HC among infants born to women with third-trimester anemia. Secondary data were obtained from the HosXP electronic medical database and delivery records of pregnant women who delivered between October 2020 and September 2023. A total of 934 women met the eligibility criteria and were included in the analysis. Maternal characteristics were summarized using descriptive statistics. Associations between maternal factors and neonatal HC were examined using the Chi-square test, Fisher’s exact test or Mann–Whitney U test, and independent predictors were identified using binary logistic regression analysis. The mean neonatal HC was 32.76 ± 1.50 cm, and 43.90% of infants were classified as having a small HC. Gravidity, pre-pregnancy body mass index (BMI), and gestational weight gain (GWG) were significantly associated with neonatal HC. Multivariable analysis revealed that women with two pregnancies (aOR = 0.51, 95% CI: 0.352–0.734) and those with three or more pregnancies (aOR = 0.54, 95% CI: 0.373–0.773) had lower odds of delivering infants with small HC than primigravida women. Pre-pregnancy overweight or obesity was associated with lower odds of small HC (aOR = 0.59, 95% CI: 0.426–0.805), whereas inadequate GWG increased the likelihood of this outcome (aOR = 1.38, 95% CI: 1.010–1.894). Maternal gravidity, pre-pregnancy BMI, and GWG may influence neonatal HC. These findings may support nurses in identifying women at risk, monitoring GWG, and providing targeted nutritional counseling during antenatal care. Full article

Background/Objectives: Gestational diabetes mellitus (GDM) is a common metabolic complication of pregnancy associated with adverse maternal and neonatal outcomes. Data on GDM in Central Asian populations remain limited. This study aimed to identify factors associated with GDM and evaluate selected obstetric outcomes among pregnant women in Kazakhstan. Methods: A retrospective case–control study based on medical record data was conducted among 256 pregnant women, including 106 women with GDM and 150 women with normal glucose tolerance. GDM was diagnosed using a 75 g oral glucose tolerance test according to the International Association of Diabetes and Pregnancy Study Groups criteria. Demographic, clinical, anthropometric, laboratory, and obstetric data were obtained from medical records. Multivariable logistic regression was used to identify factors statistically associated with GDM. Obstetric outcomes were compared using unadjusted analyses. Results: Women with GDM were older than controls (31.6 ± 5.8 vs. 28.6 ± 5.3 years, p < 0.001) and had a higher pre-pregnancy body mass index (BMI) (29 [25–33] vs. 26 [23–29] kg/m², p < 0.001). Thyroid-stimulating hormone levels were also higher in the GDM group (p = 0.026). In multivariable analysis, pre-pregnancy obesity (adjusted OR 4.54, 95% CI 2.08–9.91; p < 0.001) and educational level (overall p = 0.001) remained associated with GDM, whereas maternal age was not independently associated after adjustment. Hypertension (24.5% vs. 2.0%; p < 0.001), eclampsia (3.8% vs. 0%; p = 0.028), cesarean delivery (52.8% vs. 28.0%; p < 0.001), and fetal macrosomia (21.7% vs. 12.0%; p = 0.037) were more frequent among women with GDM. No significant difference was observed in neonatal birth weight. Conclusions: Pre-pregnancy obesity and educational level were independently associated with GDM. Women with GDM more frequently experienced hypertensive complications, cesarean delivery, and fetal macrosomia; however, these findings were based on unadjusted analyses and should be interpreted cautiously. Further multicenter prospective studies are needed to confirm these findings in Central Asian populations. Full article

This retrospective study examined the associations between pre-pregnancy body mass index (BMI), gestational weight gain (GWG), and perinatal outcomes among women with singleton pregnancies delivering at a general hospital in Nakhon Si Thammarat Province, Thailand. Secondary data were retrieved from the HosXP electronic medical database and delivery records. Of 4659 eligible delivery records, 4051 women met the study criteria and were included in the analysis. Multivariable binary logistic regression models were used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). The incidences of preterm birth, small-for-gestational-age (SGA) infants, and below-optimal head circumference (HC) were 6.99%, 18.22%, and 42.85%, respectively. Maternal underweight before pregnancy was significantly associated with increased odds of preterm birth (aOR = 1.60, 95% CI: 1.21–2.12), SGA (aOR = 1.79, 95% CI: 1.44–2.24), and below-optimal HC (aOR = 1.44, 95% CI: 1.18–1.76). Inadequate GWG was also associated with higher odds of SGA (aOR = 1.66, 95% CI: 1.38–2.00) and below-optimal HC (aOR = 1.29, 95% CI: 1.11–1.49). Conversely, maternal overweight/obesity and excessive GWG were associated with lower odds of SGA and below-optimal HC. These findings indicate that pre-pregnancy BMI and GWG were independently associated with adverse perinatal outcomes among Thai women with singleton pregnancies and may provide context-specific evidence to support maternal nutritional assessment and gestational weight monitoring during antenatal care. Full article

Cardiac tamponade in pregnancy is an exceptional maternal–fetal emergency in which physiological tachycardia, hypervolaemia and dependent oedema mask the classical signs of tamponade. Corynebacterium amycolatum is a non-diphtherial, Gram-positive coryneform commensal of human skin and mucosa that is increasingly recognised as a true invasive pathogen, although pericardial infection has rarely, if ever, been reported. We aimed to describe the diagnostic and decompression strategy in such a case. We report a 29-year-old woman at 30 + 4 weeks of gestation with class III obesity (pre-pregnancy body mass index 36 kg/m²), pregnancy-induced hypertension and diet-controlled type 2 diabetes referred after a routine echocardiogram suggested tamponade despite preserved haemodynamic compensation. Transthoracic echocardiography demonstrated a large circumferential pericardial effusion with diastolic right-atrial and right-ventricular collapse, a plethoric inferior vena cava and respiratory mitral-inflow variation. Severe maternal obesity superimposed on advanced gestation degraded the acoustic windows, elevated the diaphragm, displaced the heart anteriorly and brought the gravid uterus into the subxiphoid corridor, rendering percutaneous pericardiocentesis prohibitively hazardous. After multidisciplinary heart-team review, a left anterior mini-thoracotomy with pleuro-pericardial window evacuated approximately 1000 mL of fluid. Aerobic culture yielded C. amycolatum (MALDI-TOF), with histological pericarditis and a consistent antibiogram; autoimmune, viral and neoplastic causes were excluded, although blood cultures and extended viral testing were not performed. Targeted intravenous cefazolin was given, and the patient delivered a healthy term neonate at 39 weeks, with a normal 7-month echocardiogram. To the best of our knowledge, this is among the first reported cases of C. amycolatum pericardial tamponade in pregnancy. Because blood cultures and molecular confirmation of pericardial involvement were not obtained, a contaminant or incidental role for the organism cannot be entirely excluded, and the causal attribution should be regarded as probable rather than definitive. The case highlights heart-team-based individualised decompression and the cautious microbiological interpretation of organisms traditionally regarded as commensals. Full article