Search Results (1,982)

Background: We aimed to compare the perinatal outcomes of dichorionic/diamniotic twin (DC/DA) pregnancies resulting from in vitro fertilization (IVF) with those resulting from spontaneous DC/DA pregnancies. Methods: The study group included 99 women with DC/DA pregnancies resulting from IVF, and the control group included 92 women with spontaneous DC/DA pregnancies. Maternal demographic characteristics (age, parity, and gravidity), pre-existing conditions (chronic hypertension and pregestational diabetes mellitus), and obstetric history were recorded. Pregnancy outcomes included gestational age at delivery, number of fetuses, and mode of delivery. The antepartum complications that we evaluated include first- and second-trimester bleeding, placenta previa, preterm birth, fetal growth restriction (FGR), oligohydramnios, and tocolytic use. The obstetric complications that we assessed include prematurity, twin-to-twin transfusion syndrome (TTTS), and hydrops fetalis. Additionally, neonatal data such as 1st minute and 5th minute Apgar scores, birth weight, neonatal intensive care unit (NICU) admission, presence of congenital anomalies, and neonatal death were recorded, and comparisons were made between the groups. Results: Women in the IVF group were older (34.7 ± 6.9 vs. 32.3 ± 6.1 years, p = 0.03) and more frequently primiparous (73.7% vs. 37.0%, p < 0.001). The mean gestational age at delivery was slightly lower in the IVF group, though this was not statistically significant (34.3 ± 3.5 vs. 35.1 ± 2.5 weeks, p = 0.101). Cesarean delivery was common in both groups, with comparable overall rates (90.9% vs. 94.6%, p = 0.411), but emergency cesarean section occurred more frequently in IVF pregnancies (81.8% vs. 55.8%, p = 0.001). No significant differences were found regarding chronic hypertension or pregestational diabetes. However, several differences were demonstrated in terms of obstetric complications. For example, preterm births and fetal growth restriction (FGR) were significantly more frequent in IVF pregnancies (59.8% vs. 30.4%, p < 0.001), and tocolytic use was also more frequent (56.6% vs. 29.7%, p < 0.001). No significant differences were observed in terms of placenta previa, oligohydramnios, TTTS, hydrops fetalis, and neonatal outcomes. The logistic regression analysis revealed that IVF pregnancies were associated with an increased risk of preterm birth: OR 3.45, 95% CI 1.85–6.78 (p < 0.001); the risk of FGR was also higher in IVF pregnancies: OR 2.11, 95% CI 1.02–4.37 (p = 0.015). However, tocolytic use was not significantly associated with IVF: OR 1.49, 95% CI 0.50–4.44 (p = 0.471). Conclusions: Although DC/DA pregnancies conceived through IVF have a higher risk of preterm birth, fetal growth restriction, and greater use of tocolytic agents than spontaneous DC/DA pregnancies, their neonatal outcomes are similar. Full article

Background/Objectives: The optimal rate of enteral feeding advancement in preterm infants remains uncertain despite decades of clinical research. This uncertainty arises from concerns that rapid feeding progression may increase the risk of feeding intolerance and necrotizing enterocolitis (NEC), two major causes of morbidity and mortality in this population. The feeding rate may also influence intestinal oxygenation due to mesenteric hemodynamic changes during feeding. This study aimed to evaluate whether the rate of enteral feeding advancement (slow vs. rapid) affects intestinal oxygenation and its association with feeding intolerance (FI) or necrotizing enterocolitis in very low birth weight preterm infants. Methods: This prospective, randomized, two-center study included infants born at 28–32 weeks of gestation. Group 1 received slow advancement (20 mL/kg/day) and Group 2 rapid advancement (30 mL/kg/day) of enteral feeds. Splanchnic (srSO₂) and cerebral (crSO₂) oxygenation were monitored daily using the FDA-approved INVOS NIRS device during feeding periods (08:00–16:00). Monitoring was performed during minimal enteral nutrition (Phase 1), advancement phases (Phase 2), and for two days after achieving full enteral feeding (Phase 3). The splanchnic-to-cerebral oxygenation ratio (SCOR) was also calculated. Percentage changes in srSO₂ and SCOR during and after feeding were calculated from baseline (prefeeding) values and analyzed. Results: Sixty infants were enrolled. Mean gestational age and birth weight were 29.76 ± 1.33 weeks and 1375.05 ± 271.19 g, respectively. Group 2 achieved full enteral feeding significantly earlier (p = 0.001), with no other demographic differences between groups. No cases of NEC were observed. Feeding intolerance occurred in 14 infants (23.3%): 8 in Group 1 and 6 in Group 2 (p = 0.192). Both groups exhibited increased srSO₂ and SCOR during feeding; however, the between-group differences were not statistically significant (Phase 2 srSO₂ and SCOR: p = 0.07, 0.08; Phase 3 srSO₂ and SCOR: p = 0.069, 0.071). However, the percentage change from baseline in srSO₂ and SCOR during and after feeding was significantly greater in Group 2 during the advancement and full enteral feeding phases (Phase 2 srSO₂ and SCOR: p = 0.03, 0.022; Phase 3 srSO₂ and SCOR: p = 0.015, 0.048). Infants with feeding intolerance demonstrated significantly lower srSO₂ and SCOR values compared to tolerant infants, and this reduction persisted even after reaching full enteral feeding. ROC analysis suggested gestational age < 30 weeks, birth weight < 1180 g, srSO₂ < 52, and SCOR < 0.6 were associated with feeding intolerance. Conclusions: Intermittent bolus feeding increased intestinal oxygenation, with a more pronounced effect in the rapid advancement group. No difference in gastrointestinal adverse outcomes was observed between groups. Lower intestinal oxygenation was associated with feeding intolerance, and the suggested predictive criteria may help guide individualized feeding strategies. Full article

Background/Objectives: Prematurity is a significant global health concern, often associated with neurodevelopmental challenges. Solute Carrier Family 6 Member 4 (SLC6A4), the gene encoding the serotonin transporter, a key component in serotonin reuptake in the synaptic cleft, plays a key role in stress response and neurodevelopment. Epigenetic regulation of stress-related genes, such as SLC6A4, influences neonatal stress adaptation and developmental outcomes. This study aimed to quantify and compare DNA methylation levels at 13 CpG sites in the promoter region of the SLC6A4 gene between preterm and term neonates at three time points. Methods: A cohort of 46 preterm infants and a cohort of 49 full-term infants were analyzed. Blood samples collected at birth (D0), the fifth day (D5), and the thirtieth day (D30) were used to analyze DNA methylation, using bisulfite conversion and pyrosequencing. Results: Significant differences in SLC6A4 methylation were observed. At D0, CpGs 12 and 13 showed higher methylation in preterm infants. CpG 9 showed lower methylation in preterm infants at D5. Extremely preterm infants had the highest values of methylation at the three time points. Longitudinal mixed-effects analysis revealed distinct temporal patterns between groups. Total and site-specific methylation at CpGs 2, 8, and 9 increased over time in full-term infants, while methylation remained stable over time in very preterm and extremely preterm infants. Conclusions: This study reveals significant differences in SLC6A4 methylation between very preterm, extremely preterm, and full-term infants, highlighting the impact of prematurity and early-life stress on the epigenome. These findings contribute to improving our understanding of the epigenetic mechanisms shaping neurodevelopment and stress adaptation in neonates. Full article

Background and Objectives: Necrotizing enterocolitis (NEC) represents a severe gastrointestinal emergency in preterm infants. The aim of this study was to identify risk factors and predictive parameters for NEC requiring surgery and to evaluate associated short-term outcomes. Materials and Methods: We conducted a retrospective study in preterm neonates diagnosed with NEC admitted to a tertiary neonatal intensive care unit (NICU) between January 2015 and May 2025. Demographic data, perinatal events, risk factors, clinical signs, imaging findings, and outcomes were analyzed, with a particular focus on surgically managed cases. Descriptive and inferential statistical methods were applied. Results: Forty-four infants met the inclusion criterion. The mean gestational age (GA) was 29.34 ± 4.3 weeks, and the mean birth weight was 1100 ± 563 g. According to Bell’s severity index, 45.5% had Bell Stage I, 36.4% Stage II, and 18.2% Stage III. Eleven patients (25%) required surgery. All surgical patients had abdominal distension, and 63.6% had bilious gastric residue. Abdominal X-ray showed pneumoperitoneum in 72.7% and pneumatosis intestinalis in 27.3% of cases. Laboratory abnormalities, including thrombocytopenia, elevated C-reactive protein (CRP) and lactate dehydrogenase (LDH), and hyponatremia (45.5%; 133 ± 6.95 mmol/L), were frequently associated with surgical NEC. A lower GA and birth weight correlated with a higher Bell stage (p = 0.0085 and p = 0.0291). Overall mortality was 29.5% (13/44); surgical mortality was 9.1% (1/11). Conclusions: In this single-center lot, low gestational age and birth weight, abdominal distension with bilious residuals, systemic inflammation, and hyponatremia were frequent among infants who required surgery. Selected infants may benefit from early surgery even without perforation, but inferences are limited by this study’s sample size and retrospective design. Prospective multi-center studies are needed to validate predictors and refine surgical timing. Full article

(1) Background: Preterm infants are deprived of crucial growth and development that occurs during the last trimester of pregnancy. Optimal nutrition after birth, including sufficient intakes of protein and energy, have been emphasized to improve postnatal growth and development of preterm infants. This study investigated the impact of routine nutritional strategies as used in a Neonatal Intensive Care Unit in South Africa and in the Netherlands, respectively, on the preterm infant’s postnatal growth; (2) Methods: This retrospective observational study included 100 preterm infants from a South African cohort and 86 preterm infants from a Dutch cohort. Over the first four postnatal weeks, total intravenous (IV) fluid volume (i.e., IV. glucose and/or parenteral nutrition (PN) and enteral nutrition (EN) were recorded, and total energy and protein intakes were calculated. Anthropometric measurements were taken and expressed as Z-scores per week; (3) Results: At birth, the South African cohort had a higher gestational age compared to the Dutch cohort; however, weight, length and head circumference Z-scores were lower. During the first four postnatal weeks, the Dutch cohort had a significant higher total energy and protein intakes by the combination of PN and EN than the South African cohort, that mostly received EN only. In addition, the South African cohort showed a more pronounced decline in Z-scores compared to the Dutch cohort; (4) Discussion: Over the 4-week study period, the South African cohort showed more pronounced growth faltering compared to the Dutch cohort preceded by lower total energy and protein intakes; (5) Conclusions: The use of PN, while EN is incremented daily, should be considered in the South African cohort to diminish postnatal growth faltering in preterm infants. Full article

Background: Proper nutrition supports maternal and fetal health. Gaps in nutritional knowledge (NK) and nutritional literacy (NL) can affect maternal and fetal health. NK refers to knowing facts and processes about nutrition, while NL is a broader component that includes competencies and skills needed to obtain, understand, and apply nutrition information to make dietary decisions. NL and NK limitations may contribute to adverse maternal and neonatal outcomes. This scoping review aims to understand the relationship between NK, NL, and pregnancy outcomes, offering insights into areas for future nutrition-based interventions. Methods: Seven databases were searched for studies assessing NK and NL among pregnant women. A total of 5080 articles were identified, with 4249 retained after removing duplicates. Following title and abstract screening, 18 articles underwent full-text review, and 11 met the inclusion criteria. Data were extracted, analyzed, and categorized into nine key themes. Results: All eleven studies employed survey-based methods; ten focused on NK and one on NL. Overall, NK was generally low. The evidence for an association between NK or NL and pregnancy outcomes was limited. Education, income, occupation, and family influence were identified as key factors influencing the NK and NL of pregnant women. Education and income levels were identified as having the most significant impact on NK overall. Only one study accessed the relationship between NK and adverse birth and neonatal outcomes, and this only included HDP and preterm labor. Also, only one out of the eleven studies was conducted in the US. Conclusions: In this review, we found that NK and NL among pregnant women was generally low, with limited evidence linking it to pregnancy outcomes; education and income emerged as the most influential factors of NK and NL. Future studies in high-income countries are recommended to assess the association between NL and adverse maternal outcomes, especially GDM. Full article

Background/Objectives: Histological chorioamnionitis (HCAM) is a risk factor of chronic lung disease (CLD) in preterm neonates. Funisitis, an indicator of fetal inflammatory response, has been linked to adverse neonatal outcomes, but its impact on respiratory outcomes in extremely preterm neonates remains uncertain. In this study, we investigated whether HCAM with funisitis is associated with poorer respiratory outcomes when compared with HCAM alone in preterm (gestational age 22–36 weeks) neonates. Methods: This was a retrospective cohort study. We divided very low-birth weight (VLBW) preterm neonates with placenta histopathology examinations into three groups—normal, isolated HCAM, and HCAM with funisitis. Perinatal characteristics, radiographic findings, morbidities, and respiratory outcomes were compared. Results: Among 244 VLBW neonates, 25 (10.2%) had HCAM with funisitis, 88 (36.1%) had isolated HCAM, and the remaining 131 were in the normal group. Neonates with HCAM and funisitis had a significantly lower gestational age (26.44 ± 2.1 weeks) but a higher incidence of clinical chorioamnionitis (40.0%) than those with isolated HCAM (12.5%) or normal placentas (6.9%). Moreover, the incidence of cystic–interstitial lung changes before 2 weeks of postnatal age was higher in the HCAM with funisitis group (56.5%) than in the isolated HCAM group (25.0%), and the normal group (4.4%). CLD occurred in 66.7%, 37.7%, and 1.3% of these groups, respectively, and the need for home oxygen at follow-up was 26.1%, 13.7%, and 6.4%. Both isolated HCAM and HCAM with funisitis protected against severe respiratory distress syndrome. However, extremely preterm birth and funisitis had a more adverse impact on CLD development than HCAM alone (adjusted odds ratio 15.259 vs. 3.841). Conclusions: Funisitis independently predicts poor respiratory outcomes in extremely preterm infants. The long-term clinical impacts of funisitis in preterm infants should be further investigated. Full article

Background/Objectives: Prolonged hospitalization of clinically stable preterm infants may lead to nosocomial infections, interfere with breastfeeding, and hinder parent-infant bonding. We evaluated the impact of an early discharge program with hospital-at-home (HaH) on hospital stay and clinical outcomes among preterm infants. Methods: A retrospective case–control study was conducted in a tertiary neonatal unit (Spain). Fifty infants managed with HaH (2016–2020) were compared with ninety-six controls receiving conventional in-hospital care. Baseline characteristics, growth, and clinical events up to 12 months were collected. Analyses included bivariate comparisons and multiple linear regression for length of stay, adjusted for gestational age, birth weight, sex, and parental factors. Results: Baseline characteristics were comparable between groups. Discharge weight was lower in HaH infants (1865 vs. 2130 g; p < 0.001), but no differences were observed at 6 or 12 months. Length of stay was shorter in HaH infants (26.3 vs. 33.8 days; p = 0.081), and the multivariable model showed an independent 5.5-day reduction (β −5.53; 95% CI −10.96 to −0.11; p = 0.046). Exclusive breastfeeding was more frequent (74% vs. 59%; p = 0.08) and significantly longer in HaH infants (141.9 vs. 81.1 days; p = 0.024). No increases were found in complications at discharge, emergency visits (28% vs. 32%; p = 0.7), or readmissions (18% vs. 31%; p = 0.2). Conclusions: Among clinically stable preterm infants, early discharge with HaH was associated with a shorter hospital stay and longer exclusive breastfeeding duration, without evidence of increased morbidity or healthcare use; however, causal inference cannot be established due to the observational design. These findings support the implementation of nurse-led HaH programs as a safe, family-centered strategy for neonatal care. Full article

Background/Objectives: Melatonin, produced by the placenta and pineal gland, regulates circadian timing and has antioxidant and immunomodulatory actions. After birth, neonatal secretion is low and its circadian pattern matures over months; evidence in preterm neonates is mixed. We longitudinally monitored morning blood melatonin from birth to 38 weeks’ postmenstrual age (PMA) in breast milk-fed preterm neonates, assessing differences by time of birth (day vs. night), PMA, and weight-for-gestational-age (WfGA). Methods: A prospective NICU cohort, conducted within the ProMote study. In total, 132 preterm neonates were recruited from 112 mothers. For infants ≥33 weeks’ GA, three samples were obtained: umbilical cord (available in 94; otherwise at the first NICU admission), day of life (DOL) 4–7, and DOL 10–14; for infants <33 weeks’ GA, an additional sample at 35–36 weeks’ PMA. Melatonin was measured by ELISA. Primary analyses used raw melatonin concentrations in linear mixed-effects models; sensitivity analyses checked robustness. Results: A final sample comprised 122 neonates. Concentrations were low to modest with wide between-neonate variation and no monotonic change across PMA. Mixed models showed no consistent differences by time of birth and no stable WfGA effect; occasional PMA-specific contrasts did not recur at adjacent time points. Umbilical cord concentrations were low, and gestational age at birth did not materially influence levels at a given PMA. Sensitivity analyses led to the same inference. Conclusions: In breast milk-fed preterm neonates, morning serum melatonin from 26–38 weeks’ PMA shows substantial individual variability without consistent differences by time of birth, PMA, or WfGA. Full article

Preterm birth (PTB) is a leading cause of neonatal morbidity and mortality worldwide. This study investigated six single-nucleotide polymorphisms (SNPs) in the maternal and fetal progesterone receptor (PGR) gene and their association with spontaneous PTB, considering environmental and clinical risk factors. We conducted a case–control study including two groups of pregnant women (term and preterm, 292 in total) and two groups of newborns (term and preterm, 292 in total), and analyzed PGR variants (rs1042838, rs1042839, rs10895068, rs4574732, rs653752, and rs1942836) in relation to maternal age, fetal gender, and pregnancy complications such as vaginal bleeding. Results showed that PGR SNPs rs1942836 (OR 0.38, CI 95% 0.15–0.98, p = 0.03), rs4574732 (OR 2.4, CI 95% 1.01–5.57, p = 0.04), and rs653752 (OR 2.27, CI 95% 1.19–4.34, p = 0.02) were associated with PTB when considered in the context of clinical factors, highlighting gene–environment interactions. Our findings underscore the importance of integrating genetic and clinical information for a better understanding of PTB risk. Full article

Background: Central venous catheters are essential but associated with complications in premature infants. We compared the short-term outcomes of umbilical venous catheter (UVC) versus peripherally inserted central catheter (PICC) as the initial postnatal primary venous access in preterm infants. Methods: Preterm infants with a birth weight ≤ 1500 g within the first postnatal hours were included. Patients were randomly assigned to the UVC or PICC groups. Catheter insertion time, number of attempts, number of operators, duration of catheter use, reason for removal, and overall duration were recorded. Results: A total of 107 premature infants were included, with 63 receiving UVC and 44 receiving PICC. Nineteen infants who initially had UVC placement on day 1 required PICC placement on day 5. The number of attempts, number of operators, and insertion time were significantly higher in the PICC group compared with the UVC group (p < 0.001, p = 0.002, and p = 0.002, respectively). Catheter removal due to thrombosis or leakage occurred in 14.2% of UVC cases versus 40.1% of PICC cases (p = 0.002). Conclusion: UVC placement appears to be superior to PICC as the first venous access in preterm infants during the early postnatal period. PICC placement may be less advantageous in the first days of life due to a smaller catheter diameter, technical difficulty, and longer insertion time. Full article

Background/Objectives: Postnatal growth restriction and duration of hospital stay have been identified as risk factors for adverse neurodevelopment in preterm infants. Implementation of a family-centered care (FCC) program in our institution reduced length of stay in preterm infants. This study evaluates the effect of more early discharge on growth up to three months postmenstrual age (PMA). Methods: We conducted a prospective, single-center cohort study in a German level III neonatal unit (October 2020–November 2023) including six consecutive cohorts (n = 184) with progressive FCC implementation. This secondary analysis examined growth at discharge, term-equivalent age (TEA), and three months PMA. Results: PMA at discharge significantly decreased from the baseline to intervention cohort 5 (37.8 ± 2.1 vs. 35.7 ± 0.91 weeks PMA; p = 0.03). Compared to the baseline cohort, infants in intervention cohort 5 had significantly lower weight, length, and head circumference at discharge. However corresponding Z-Scores did not differ significantly between the cohorts. No significant differences in growth outcomes were observed at TEA or at three months PMA. Furthermore, there were no significant differences in the change in Z-Score for weight, length, and HC from birth to three months PMA. Conclusions: Early discharge under FCC did not impair growth to three months PMA, suggesting that early discharge is a safe practice with respect to growth outcomes in preterm infants. Further randomized multicenter studies are needed to confirm these results. Full article

Background/Objectives. Preterm birth (PTB), affecting approximately 11.1% of pregnancies globally, often results from inflammation at the maternal–fetal interface triggered by microbial or immune dysregulation. This study investigates the efficacy of cell-free supernatant derived from Bifidobacterium longum subsp. infantis CECT 7210 and Lacticaseibacillus paracasei CECT 30660 in mitigating inflammation-induced PTB in a murine model. Methods. Lipopolysaccharide (LPS) was administered to induce preterm labor and systemic inflammation, mimicking infection-related PTB. Results. The results demonstrated that combined administration of CECT 7210 and CECT 30660 cell-free supernatants reduced preterm deliveries from 85.6% to 42.8% in mice and significantly attenuated systemic and intrauterine proinflammatory cytokines, including TNF-α and IL-6, in maternal plasma and myometrial tissues. Importantly, this anti-inflammatory effect was independent of maternal progesterone or oxytocin levels, suggesting a direct modulation of immune responses in this animal model. The cell-free supernatant combination also inhibited the growth of pathogenic bacteria, including Streptococcus agalactiae, highlighting its antimicrobial potential. Conclusions. This study underscores the potential of CECT 7210 and CECT 30660 cell-free supernatants as a therapeutic strategy to reduce the risk of PTB by targeting inflammation pathways. The findings pave the way for further preclinical and clinical research to validate the efficacy of these cell-free supernatants in preventing PTB and associated complications, offering a promising alternative to traditional probiotic approaches. Full article

Background/Objectives: This study aims to investigate the development of oculomotor behavior in children born preterm using a DIVE device (Device for an Integral Visual Examination) equipped with eye-tracking technology. Visual and visuo-cognitive measures obtained through eye-tracking technology provide quantitative and sensitive indicators of early neural development, as visual function is one of the earliest cerebral processes to develop postnatally. Design: This is a cross-sectional study. Participants: The study included 428 children aged 0.5 to 14 years. Of these, 214 were born preterm (78 late preterm, born at 32–36 weeks’ gestation, and 136 early preterm, born at less than 32 weeks’ gestation) and 214 were full-term controls, matched by age and gender. Methods: All participants underwent a comprehensive ophthalmological assessment. Oculomotor behavior was analyzed using a DIVE device, focusing on fixation duration, saccadic performance and fixation stability. Fixation stability was quantified by the bivariate contour ellipse area for short tasks (BCEA), which measures (in deg²) the area of the ellipse enclosing a specified percentage of fixation positions—smaller BCEA values indicate greater fixation stability. We performed a cluster analysis on these oculomotor metrics to identify distinct oculomotor control patterns. Results: Preterm children exhibited significantly poorer fixation stability than controls (mean BCEA 0.21 vs. 0.09 logdeg², p = 0.004), alongside shorter fixation durations and longer saccadic reaction times. Early preterm children showed more unstable fixations compared to late-preterm and control groups (0.26 vs. 0.12 and 0.09 logdeg², respectively, p = 0.001). Cluster analysis revealed three distinct OMC (oculomotor control) patterns: “good,” “impulsive,” and “poor.” Children classified in the “good OMC” cluster demonstrated stable fixations and appropriate saccadic reaction times. In contrast, those in the “impulsive OMC” and “poor OMC” clusters exhibited more unstable fixations and abnormal saccadic times, with the “poor” cluster being significantly associated with extreme prematurity, lower birth weights, and a higher incidence of intraventricular hemorrhage (IVH). Conclusions: Preterm birth is associated with measurable oculomotor deficits, most pronounced in early preterm infants, affecting their fixation and saccadic abilities. The findings emphasize the need for targeted interventions to support the development of preterm children, particularly those with “poor” oculomotor control behavior. Full article

Objective: To determine whether a third-trimester drop in insulin requirements in pregnant people with pre-existing diabetes is associated with a subsequent occurrence of adverse pregnancy outcomes. Research Design and Methods: We conducted a retrospective cohort study of patients with type 1 and 2 diabetes who were followed at a tertiary referral center in Toronto, Canada. We collected data on insulin dosing in the third trimester (after 28 weeks of pregnancy) and compared outcomes in those with and without a third-trimester drop of 15% or more in their total insulin requirements. Our primary outcome was a composite of stillbirth, spontaneous preterm birth or preterm premature rupture of membranes, and iatrogenic preterm birth or cesarean birth for fetal wellbeing concerns, occurring following the drop in insulin requirements. We conducted regression analyses controlling for early pregnancy glycosylated hemoglobin, body mass index, and diabetes-related microvascular disease, and presented results as odds ratios (OR) with 95% confidence intervals (95%CI). Results: We included 350 pregnant people—146 with type 1 and 204 with type 2 diabetes. Of these, 54 (15.4%) had a third-trimester drop of 15% or more in their total insulin requirements. There was no difference in the primary outcome between groups (OR 0.97; 95% CI 0.41–2.10). Conclusions: Based on this single-center study, limited by sample size and analytic constraints, in people with pre-existing diabetes, a third-trimester drop of ≥15% in total insulin requirements was not associated with subsequent occurrence of adverse pregnancy outcomes. Larger prospective studies looking at associations between a drop in insulin requirements and subsequent occurrence of adverse pregnancy outcomes are necessary to inform meta-analyses and clinical decision making. Full article