Search Results (2,284)

Background and Objectives: Pre-eclampsia (PE) is an obstetric complication defined by placental insufficiency, including intrauterine growth restriction and placental abruption. Timely and accurate detection and treatment of pre-eclampsia are difficult because its diagnostic criteria are still based on nonspecific signs and symptoms and because the association between common severity criteria, and unfavorable outcomes for mother and fetus remain unclear. Therefore, the aim of this study was to evaluate the potential use of blood and urine PE risk markers—soluble Fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF), sFlt-1/PlGF ratio, and albumin/creatin ratio—in predicting and managing PE in groups at risk for preterm and term PE (gestational weeks 24–37) and to correlate the levels of blood and urine PE markers with pregnancy outcome indicators. Materials and Methods: This study was conducted at the Department of Obstetrics and Gynecology and at the Center of Laboratory Diagnostics and Nuclear Medicine, University Clinical Center of Vojvodina. This study included 166 pregnant women (GW 24–37) divided into two groups: study group P (n = 52), consisting of pregnant women who were identified as a high-risk group for PE according to clinical signs and medical history and who subsequently developed PE; control group C (n = 114), consisting of pregnant women who had risk factors in their medical history but did not eventually develop PE symptoms. The evaluated parameters included two groups: blood and urine PE risk indicators—biochemical markers such as PlGF, sFlt-1, and sFlt-1/PlGF ratio; urine risk indicators such as albumin/creatine ratio; and pregnancy outcome indicators—gestational age of delivery (GW) and neonatal birth weight (NW). Results: The results of the analysis support that the PE risk biochemical indicators (PlGF, sFlt-1, sFlt-1/PlGF ratio, and albumin/creatine ratio) show statistically significant differences between the analyzed groups, that they correlate with PE occurrence, and that they have good predictive value. As expected, sFlt-1/PlGF ratio and albumin/creatine ratio, as the most valuable PE risk indicators, show good predictive value. However, our results also demonstrate that pro- and antiangiogenic indicators alone, especially sFlt-1 (high values), may play roles in risk evaluation and prediction of preterm and term PE (GW 24–37). Conclusions: In our study, all evaluated blood and urine indicators (PlGF, sFlt-1, sFlt-1/PlGF ratio, and albumin/creatine ratio) show high predictive value for PE in a PE risk group of pregnancies between GW 24 and 37. The results suggest that sFlt-1 alone has equal predictive value to sFlt-1/PlGF ratio and outperformed PlGF in predicting PE onset. The combined use of pro- and antiangiogenic biochemical markers, indices, and urine markers in blood, together with patient history and clinical parameters, shows potential as a more effective means of predicting PE than a single biochemical parameter such as sFlt-1/PlGF ratio. Full article

Background: Survival after early breast cancer has improved to the point where reproductive health is no longer a peripheral concern in young survivors but a routine one. This review synthesizes current evidence on oncologic safety, obstetric and neonatal outcomes, fertility preservation, breastfeeding, and psychosocial survivorship to develop a counseling framework that clinicians can apply in practice. Methods: This narrative review was informed by a structured literature search of PubMed/MEDLINE, Embase, and the Cochrane Library covering studies published from January 2000 to July 2026, with greater analytic weight given to studies published from 2010 onward to ensure the synthesis reflects contemporary treatment standards. Relevant evidence was identified and narratively synthesized according to the clinical and reproductive aspects of pregnancy after breast cancer. No formal risk-of-bias assessment or quantitative synthesis was undertaken. Results: On the currently available evidence, pregnancy after breast cancer is not associated with an increased risk of recurrence. This holds in hormone receptor-positive disease and in BRCA1/2 carriers, and it is supported prospectively by the POSITIVE trial, whose preplanned update at a median follow-up of 71 months found a five-year incidence of breast cancer-free interval events of 12.3% against 13.2% in matched external controls. Obstetric and neonatal risks are higher than in the general obstetric population, although the pooled effect sizes are small to moderate: odds ratios are approximately 1.14 for cesarean delivery, 1.45 for preterm birth, 1.50 for low birth weight, and 1.16 for small-for-gestational-age birth. The excess concentrates in pregnancies conceived within the first one to two years after diagnosis and attenuates thereafter. Fertility preservation techniques appear both effective and oncologically safe. Fertility-related distress, by contrast, is common and does not reliably resolve once treatment ends. Conclusions: Oncologic risk alone is not a reason to advise against pregnancy after breast cancer. Early oncofertility referral, multidisciplinary planning, and risk-adapted obstetric surveillance remain the priorities. Because the evidence base is predominantly observational, these conclusions describe what the current data show rather than establishing safety definitively. Full article

Bronchopulmonary dysplasia (BPD) remains the most common chronic respiratory complication of extremely preterm infants despite major advances in neonatal intensive care. Although contemporary therapies have improved survival by reducing secondary lung injury, they have had limited impact on the disrupted lung development that characterizes modern BPD. This has renewed interest in developmental therapeutics that seek to restore physiologic signaling pathways interrupted by premature birth rather than treat established disease. Among the developmental pathways disrupted by premature birth, observational studies consistently demonstrate that low postnatal IGF-1 concentrations in extremely preterm infants are associated with an increased risk of BPD and other complications of prematurity. Although these associations do not establish causality, they provide a biologically plausible basis for investigating physiologic IGF-1 replacement. This review summarizes the developmental biology of the IGF axis and the translational pathway supporting the clinical development of OHB-607, a recombinant human IGF-1/IGF-binding protein-3 complex intended to restore physiologic IGF-1 concentrations in extremely preterm infants at high risk for BPD. The program provides one example of how developmental biology, translational animal models, developmental pharmacology, and clinical implementation can be integrated into a framework for advancing mechanism-based therapies aimed at preserving normal lung development after extremely premature birth. Whether this approach improves clinically meaningful outcomes remains to be determined in adequately powered randomized clinical trials. Full article

Background/Objectives: Preterm birth remains the leading cause of neonatal morbidity and mortality, with cervical insufficiency being a major risk factor. Quantitative fetal fibronectin (qfFN) and the QUiPP App version 2.0 are established tools for preterm birth prediction; however, the value of repeated assessments remains unclear. This study aimed to evaluate the prognostic accuracy of longitudinal qfFN measurements and QUiPP risk assessment in women with progressive cervical insufficiency and to evaluate the prognostic performance of repeated assessments. Methods: In this retrospective cohort study, 88 women with progressive cervical insufficiency who underwent repeated qfFN measurements were included. Cervical length, qfFN, and QUiPP risk were assessed at diagnosis and at subsequent time points. Prognostic performance for delivery within one week and before 34 and 37 gestational weeks was evaluated. Results: The prognostic performance represented by the area under the curve increased from 0.71 to 0.75 for qfFN and from 0.74 to 0.82 for QUiPP from the first to the final assessment, although neither difference reached statistical significance (qfFN p = 0.522; QUiPP risk p = 0.135). For imminent preterm birth, qfFN demonstrated excellent rule-out performance, with a negative predictive value of 100% at <10 ng/mL. QUiPP risk provided superior risk stratification and achieved excellent prognostic accuracy for delivery before 34 weeks at the final assessment (area under the curve = 0.82). Receiver operating characteristic analysis identified optimal cutoffs of approximately 40 ng/mL for qfFN and 23% for QUiPP risk in predicting delivery before 34 weeks. Conclusions: Repeated qfFN assessment combined with QUiPP risk estimation was associated with numerically higher discriminatory performance at the final assessment. While the identified optimal cutoff values need to be validated in prospective trials, they might have the potential to safely reduce unnecessary interventions in the future. qfFN functioned as an effective rule-out test, whereas QUiPP enhanced risk stratification, supporting their combined repeated use to guide clinical management before 34 + 0 weeks of gestation. Full article

Background: Early discharge with home nasogastric (NGT) feeding has been associated with favorable infant outcomes and high parental satisfaction. However, its impact on parental mental health has been insufficiently studied. We aimed to evaluate symptoms of anxiety and depression in mothers and fathers of very preterm infants discharged with or without NGT feeding. Methods: This prospective cohort study was conducted at a German tertiary perinatal center between October 2020 and May 2024. A total of 238 preterm infants with a birth weight ≤ 1500 g and/or a postmenstrual age (PMA) ≤ 32 weeks were included; 131 were discharged with full oral feeding and 107 with NGT feeding. Symptoms of anxiety and depression were assessed in mothers and fathers using the Hospital Anxiety and Depression Scale (HADS-D) at discharge and at three months corrected age (CA). A total of 201 parent–infant dyads were included. HADS-D assessments were completed by 155 mothers and 135 fathers at discharge and by 121 mothers and 119 fathers at three months CA. Results: At discharge, depression and anxiety scores did not differ between parents of infants discharged with and without NGT feeding. At three months CA, mothers of infants discharged on full oral feeding had higher depression and anxiety scores than mothers of infants discharged with NGT feeding (4.95 ± 3.62 vs. 3.18 ± 2.89; p ≤ 0.01 and 6.42 ± 3.85 vs. 4.79 ± 3.72; p = 0.04), and clinically significant depression scores (≥8) were more frequent (23.53% vs. 10.45%; p = 0.04). Similarly, fathers in the non-tube-feeding group had higher depression scores at 3 months CA (4.78 ± 3.74 vs. 3.48 ± 2.72; p = 0.04), with a trend towards a greater proportion showing clinically significant depression scores (24.14% vs. 13.11%; p = 0.12. Conclusions: Early discharge of very preterm infants with home NGT feeding was not associated with increased parental psychological distress at discharge and at 3 months CA. Across the outcomes, parental distress tended to be lower at 3 months CA with NGT feeding at discharge. However, as no NGT × time interaction was statistically significant after correction for multiple testing, these group differences should be interpreted as exploratory in nature. Full article

Background/Objectives: Fentanyl is widely used in ventilated preterm neonates, but respiratory safety evidence is limited. We assessed the association between fentanyl exposure during mechanical ventilation and respiratory outcomes in preterm neonates <34 weeks and explored a candidate exposure-duration threshold, defined as the duration of continuous fentanyl infusion beyond which the risk of adverse respiratory outcomes rises sharply. Methods: Single-centre retrospective cohort study at Policlinico Umberto I, Sapienza University, Rome (2015–2022). Fentanyl-exposed neonates were 1:2 matched to unexposed neonates on gestational age and birth-weight z-score. Primary outcome: bronchopulmonary dysplasia at 36 weeks postmenstrual age (multivariable logistic regression); secondary outcome: duration of invasive ventilation. A composite outcome (bronchopulmonary dysplasia or invasive ventilation ≥ 7 days) was used for threshold analysis with restricted cubic splines, maximally selected Wald χ², and segmented logistic regression. Results: Of 315 eligible neonates, 50 fentanyl-exposed neonates were matched with 92 unexposed neonates (n = 142). Fentanyl exposure was associated, after adjustment for gestational age and fetal distress, with bronchopulmonary dysplasia (adjusted odds ratio 5.49, 95% CI 1.72–17.54) and longer invasive ventilation (adjusted exp(β) 2.25, 95% CI 1.54–3.29). Three complementary threshold methods were consistent with an exploratory signal around 3 days of continuous infusion, beyond which composite-outcome odds rose, although the breakpoint estimate was imprecise. Conclusions: Fentanyl exposure during mechanical ventilation was associated, after adjustment for gestational age and fetal distress, with bronchopulmonary dysplasia and longer invasive ventilation in preterm neonates <34 weeks. A possible signal around 3 days of continuous infusion is proposed as a hypothesis-generating stewardship prompt, not as a decision rule. Full article

Objectives: An association between erythropoietin (Epo) administration and infantile hemangiomas (IH) in preterm infants was previously described; however, scarce data exists on a newer drug, darbepoetin (Darbe) and IH. We aimed to determine whether Darbe treatment was associated with IH in our preterm population. Methods: Retrospective observational cohort study including a consecutive sample of premature babies born < 32 weeks at a single tertiary center between the years 2012–2023. We compared the rate of IH with Epo exposure, Darbe exposure and no exposure. Results: The cohort comprised 390 infants: 262 infants with no exposure, 36 infants with Epo exposure, and 92 infants with Darbe exposure. Exposed infants had significantly lower birth weight and gestational age compared to non-exposed infants. No differences were found in gestational age or birth weight between the two drug exposure groups. The rate of IH was 6.8%, 8.3% and 18.4% in the no exposure, Epo exposure and Darbe exposure groups, respectively. The rate of IH in the Darbe group was significantly higher compared to the non-exposed group (p = 0.003), and Darbe exposure was found to be significantly correlated with IH in a multiple logistic regression model (OR 3.07, 95% CI 1.5–6.2; p = 0.002). However, after adjusting for gestational age or birth weight, this correlation was no longer significant. Conclusions: Darbe exposure was associated with a higher rate of IH than no exposure in this cohort, but the association did not persist after adjustment for maturity, and the design does not allow us to distinguish the effect of Darbe from the effect of prematurity itself. Further prospective studies are needed to ascertain these findings. Full article

Background and Objectives: Adolescent pregnancy is associated with biological, behavioral, and healthcare-related vulnerabilities that are incompletely captured by structured datasets. This study aimed to characterize selected maternal vulnerability indicators derived from narrative clinical documentation and to examine their exploratory associations with documented prenatal care deficiency and neonatal outcomes. Materials and Methods: We conducted a retrospective cohort study including 759 singleton adolescent pregnancies managed at a Romanian secondary obstetric center between 2020 and 2024. Narrative clinical observations were reviewed to extract maternal vulnerability indicators, including smoking, anemia, infection, hypertensive disorders, obesity, Rh incompatibility, and documented prenatal care deficiency. Associations between extracted variables, documented prenatal care deficiency, and neonatal outcomes were evaluated using contingency analyses, Kendall’s tau-b correlations, and multivariable logistic regression models. Results: Among pregnancies with available narrative observations, documented prenatal care deficiency was identified in 612/692 (88.4%), maternal anemia in 207/692 (29.9%), and smoking during pregnancy in 186/692 (26.9%). Validation performance differed across categories, with a sensitivity of 57.1% (95% CI 18.4–90.1%) for hypertensive disorders and wide confidence intervals for rare categories. Correlations between extracted variables were weak, indicating limited clustering of maternal risk factors. Hypertensive disorders (aOR 0.31, 95% CI 0.10–0.95, p = 0.038) and maternal obesity (aOR 0.39, 95% CI 0.16–0.98, p = 0.044) were associated with lower odds of documented prenatal care deficiency. Significant neonatal associations were observed primarily for low birth weight. Hypertensive disorders were independently associated with increased odds of low birth weight (aOR 3.56, 95% CI 1.33–9.54, p = 0.011), whereas documented maternal anemia was associated with lower observed odds of LBW (aOR 0.45, 95% CI 0.24–0.82, p = 0.009). No significant associations were identified for preterm birth or Apgar score < 7 at 5 min. Conclusions: Narrative clinical documentation allowed the identification of heterogeneous maternal vulnerability indicators that showed weak interrelationships and selective associations with prenatal surveillance patterns and low birth weight. These exploratory findings should be interpreted in the context of healthcare engagement and documentation practices. Full article

Background/Objectives: Artificial intelligence may improve obstetric risk stratification by identifying clinically meaningful patterns that are not captured by single-outcome prediction models. This study evaluated whether unsupervised machine learning applied to first-trimester maternal, biophysical, and biochemical data could identify phenotypes associated with adverse obstetric outcomes. Methods: We analyzed 1583 first-trimester records that were ambispectively collected including maternal characteristics, obstetric history, mean arterial pressure, uterine artery pulsatility index, nuchal translucency, and PAPP-A. Principal component analysis followed by k-means clustering was used to derive AI phenotypes. Associations were tested for hypertensive, metabolic, delivery, neonatal, and actionable obstetric outcomes. Robustness of the clustering solution and phenotype–outcome associations was assessed using inverse probability weighting, false discovery rate correction, adverse-event burden scoring, cross-algorithm agreement analyses, and multiple sensitivity analyses. Results: Four clinically interpretable phenotypes were identified. Phenotype 4 represented a cardiometabolic–vascular subgroup that showed the greatest enrichment for adverse obstetric outcomes. It had higher rates of maternal metabolic or hypertensive complications (52.4%; RR 4.31) and clinically actionable adverse pregnancy outcomes (57.1%; RR 2.31). These associations remained significant after false discovery rate correction and were consistent in inverse probability weighting analyses. Phenotype 4 also had the highest cumulative adverse-event burden score (1.29 versus 0.35–0.47). Exploratory analyses demonstrated high specificity (97.2%) but limited sensitivity for clinically actionable adverse pregnancy outcomes. Incremental discrimination over conventional predictors was observed only for selected secondary outcomes, including early preterm birth and low Apgar score. Conclusions: Unsupervised AI phenotyping identified a cardiometabolic–vascular pregnancy subgroup associated with increased obstetric morbidity. Full article

Prenatal alcohol exposure (PAE) leads to fetal alcohol spectrum disorder (FASD), the most common preventable cause of neurodevelopmental impairment. The classical narrative attributes the clinical picture of FASD exclusively to direct ethanol-induced brain injury. In the present review, we argue that this perspective is incomplete and leads to diagnostic errors, most often to the misdiagnosis of ADHD in children who in fact have FASD. We propose that, alongside the direct neurotoxicity of ethanol, an important and clinically under-recognized complementary mechanism is gut–brain axis dysfunction: alcohol damages the enteric nervous system and enteric glial cells, induces dysbiosis with deep deficits of butyrate and other short-chain fatty acids (SCFAs), damages the enterochromaffin cells responsible for 90% of peripheral serotonin production, and—through translocation of lipopolysaccharide (LPS) and activation of the Toll-like receptor 4 (TLR4)—sustains a neuroinflammatory brain signature. This cascade—superimposed on direct ethanol neurotoxicity—may account for the high rates of depression, anxiety, self-injurious behavior, and suicide attempts observed in individuals with FASD and for the limited efficacy of traditional interventions focused solely on the central nervous system. The 2024 Polish Institute of Mother and Child (Okulicz-Kozaryn et al.) study showed that 50.3% of pregnant women consumed alcohol, and 11% did so regularly, against only 7% who admitted so in questionnaires. The real clinical picture of children with FASD is further complicated by three factors to which we devote separate sections in this paper: prenatal co-exposure to nicotine, cannabinoids, and opioids; the loss of vertical microbiota transmission and breastfeeding in children transferred to foster care (where the prevalence of FASD is 18.8% and in children’s homes in some regions reaches up to 80%); and the substantial over-representation of preterm and small-for-gestational-age (SGA) infants (in the Hasken et al. cohort, 18.4% of children with FASD were born preterm and 51.4% were born SGA). In the final section, we present a structured, staged protocol for nutritional and microbiological intervention grounded in a hierarchy of evidence: from interventions supported by randomized controlled trials (RCT-level; choline) through interventions supported by strong mechanistic rationale and RCTs in related populations (sodium butyrate, Lactobacillus rhamnosus GG, GOS/FOS prebiotics—galacto-oligosaccharides and fructo-oligosaccharides, and omega-3 fatty acids) to experimental interventions. The protocol also covers the window before 2 years of age: we argue that, given the over-representation of preterm and SGA infants among children with FASD, the analogy to preterm infants on parenteral nutrition and to post-institutional infants applies in substantial part to the same patients, which justifies extending the indications for choline and other nutritional interventions. The paper includes a compact table of dosing proposals for each age window (from pregnancy to school-age child) and provides clinicians with concrete answers: where to start, what to avoid, and what to monitor, with explicit signposting of regulatory limitations for individual substances in Poland and the European Union. Full article

Background and objectives: Children born prematurely are more likely to have altered sensory profiles, which can affect family and school functioning. This scoping review aimed to analyze the relationship between prematurity and the development of atypical sensory profiles. Methods: A scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), including studies evaluating children aged 1 to 12 years who were born at a gestational age of ≤32 weeks. The data sources were PubMed, Scopus, and Web of Science. The search was limited to English-language studies published in the previous 10 years. The keywords “Sensory Processing”, “Child Development”, “Perception”, “Sensory Profile”, “Sensory Integration”, “Preterm”, “Infant Premature”, “Infant Extremely Low Birth Weight”, and “Infant Low Birth Weight” were used to search the databases. Articles with outcomes related to cerebral palsy, blindness, low vision, hearing impairment, behavioral disorders, and autism were excluded. After article selection, the atypical sensory profiles identified were organized into thematic categories and evaluated according to frequency of occurrence. Results: Seven articles were included and showed frequent atypical sensory profiles in very preterm children, especially in sensory processing, particularly hyporesponsiveness, and visual perception. Conclusions: These findings indicate altered sensory performance among very preterm children, which may negatively affect motor, cognitive, and behavioral development. Early sensory screening may improve detection and guide interventions to minimize adverse developmental outcomes. Full article

Background: Pregnancy after solid organ transplantation carries increased maternal and fetal risks, compounded by the teratogenicity, nephrotoxicity, and metabolic effects of available immunosuppressive agents. Belatacept, a calcineurin inhibitor-sparing T-cell costimulation blocker with favorable renal and metabolic profiles, has emerged as an alternative; however, evidence regarding its safety during pregnancy remains scarce. Methods: A scoping review was conducted per PRISMA-ScR recommendations. PubMed, Google Scholar, Web of Science, Scopus, and the Cochrane Library were searched (January 2015–March 2025), supplemented by citation searching, for studies reporting pregnancy outcomes in solid organ transplant recipients receiving belatacept. Methodological quality was assessed using Joanna Briggs Institute critical appraisal tools. Results: Three studies (one case series and two case reports) encompassing 21 pregnancies among 15 recipients were included, predominantly in kidney transplant recipients; several recipients contributed more than one pregnancy, so pregnancy-level outcomes are not statistically independent. Sixteen pregnancies resulted in live birth and five ended in miscarriage, at least four of which occurred in pregnancies with periconception mycophenolate exposure. No congenital malformations were reported among live-born infants, although the number of exposures is far too small to characterize teratogenic risk. Stable allograft function was reported in 14 of 19 pregnancies with available follow-up, with no rejection episodes during belatacept exposure. Maternal complications included preeclampsia (8 of 16 in the case series), gestational diabetes, cytomegalovirus reactivation, and acute kidney injury. Low birth weight (<2500 g) was reported in all live births, predominantly in the context of preterm delivery. Conclusions: The published cases have not identified congenital malformations to date, but the number of documented exposures is far too small to characterize teratogenic risk, and the overall certainty of evidence is very low. Because no comparative studies were available, maternal and neonatal outcomes cannot be assumed equivalent to those of conventional immunosuppression. Belatacept cannot be recommended for routine use during pregnancy; clinical decisions must remain individualized, and preconception counseling and prospective multicenter registries are urgently needed. Full article

Perinatal mental health remains a critical global challenge, with maternal mortality, preterm birth, and persistent disparities in care contributing to adverse outcomes for mothers. In addition, mental health difficulties in the perinatal period are associated with poorer developmental outcomes for young children and impose an economic burden on societies. Addressing these issues requires innovative approaches that can complement traditional clinical practices. Artificial intelligence (AI) has emerged as a powerful tool with the potential to transform perinatal care by enabling early risk prediction, personalised interventions, and scalable support systems. However, there are no existing reviews on use of AI across different stages of perinatal mental health. We conclude with a call to action for clinicians, researchers, policymakers, and technology developers to collaborate on a consensus framework that ensures ethical, safe, and equitable integration of AI into perinatal care. Full article

Background/Objectives: Hypertensive disorders of pregnancy (HDPs) such as preeclampsia are associated with adverse maternal and perinatal outcomes and related to high soluble fms-like tyrosine kinase-1 (sFlt-1) levels and low placental growth factor (PlGF) levels. While these biomarkers are used for predicting and diagnosing preeclampsia, their impact on postnatal neonatal nutritional management, growth, and body composition is not well-established. Therefore, we aimed to evaluate the association between maternal angiogenic markers, neonatal growth, and body composition. Methods: This study represents a secondary analysis of a prospective cohort study conducted at the Medical University of Vienna. Women with HDP were included in the analysis, and infants were stratified by gestational age at birth into preterm (<37 weeks of gestation) and term (≥37 weeks of gestation) groups. Maternal angiogenic markers were routinely measured at the time when HDP was first suspected, and neonatal body composition was assessed at term-equivalent age. Results: A total of 335 infants were screened, 94 of which (preterm: n = 72; term: n = 22) were included. Higher sFlt-1/PlGF ratios were significantly correlated with lower fat-free mass (FFM) z-scores (rs = −0.408; p = 0.004), but not with fat mass (FM) z-scores (p = 0.21), weight (p = 0.19), length (p = 0.31), or head circumference z-scores (p = 0.32) in preterm infants. In a linear regression model adjusted for potential neonatal confounders, higher sFlt-1/PlGF ratios were independently and significantly associated with lower FFM in preterm infants (median: −0.10, 95% CI: −0.2, 0.00; p = 0.036). In term infants, sFlt-1/PLGF ratios were not significantly correlated with FFM (p = 0.86), FM z-scores (p = 0.41), weight (p = 0.10), length (p = 0.12), or head circumference z-scores (p = 0.2). Conclusions: These findings suggest that the sFlt-1/PLGF ratio is not only a well-established marker of HDP severity during pregnancy but may also be associated with adverse effects on body composition in preterm infants, particularly in fat-free mass (FFM). Full article

Background/Objectives: Complete blood count inflammatory indices are widely studied in obstetrics but rarely compared directly. We compared five first-trimester indices, the systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), pan-immune-inflammation value (PIV), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), for their associations with preterm birth, examined across its severity. Methods: In a retrospective single-centre cohort of 5003 singleton pregnancies with a first-trimester complete blood count, late (34–36 weeks) and early (<34 weeks) preterm births were analysed separately. The association of each index with preterm birth was assessed by logistic regression, per standard deviation, and by quartile, with adjustments made for maternal age, body mass index, parity, fetal sex, and gestational age at sampling; discrimination was compared using the DeLong test. The birthweight category, classified against the INTERGROWTH-21st standards, was a secondary outcome. Results: After adjustment, all indices except for the PLR were associated with preterm delivery, with similar effects per standard deviation. Among the five indices, the SIRI showed the most consistent association with the severity of preterm birth: its values rose at every step from term to late to early birth. It discriminated these births best (area under the curve 0.600, significantly greater than the SII), and its quartile gradient was steepest, with the odds more than doubling from the lowest to the highest quartile. All five remained weak discriminators, with every area under the curve being below 0.70, and none was associated with the birthweight category. Conclusions: These indices are not standalone predictive tests, but among them, the SIRI, which, unlike the SII, captures the monocyte count, was most closely associated with early, more severe preterm birth, consistent with the role of monocytes in the inflammation of labour. Full article