Search Results (906)

Orthodontic treatment can be safely performed during pregnancy when tailored to the patient’s hormonal, physiological, psychological, and oral health changes. The study aims to establish a safe, trimester-specific orthodontic practical framework that minimizes maternal–foetal risks while ensuring effective treatment. A modular search on MEDLINE/PubMed (National Library of Medicine, Bethesda, MD, USA) was conducted using combined keywords and subtopic-specific queries to identify relevant literature on orthodontics during pregnancy. Most studies were literature reviews, followed by various observational, survey-based, clinical, and case report designs. Orthodontic care during pregnancy must be adapted to trimester-related risks, with minimal interventions in the first trimester, elective procedures in the second, comfort-focused management in the third, and treatment of complex care postpartum. This protocol requires individual adaptation, highlighting the need for personalized medicine and coordinated input from multiple specialists to address orthodontic, obstetric, and psychological factors during pregnancy. Full article

Background: Increased placental thickness has been associated with adverse perinatal outcomes and fetal functional and structural abnormalities. However, whether marked third-trimester placental thickening is associated with a distinct maternal clinical profile compared with pregnancies with normal placental thickness remains insufficiently characterized. This study aimed to compare maternal characteristics, comorbidities, medication exposure, infection history, and fetal findings between pregnancies with marked placental thickening, defined as placental thickness ≥70 mm, and gestational-age-matched control pregnancies with a placental thickness <70 mm and no documented maternal or fetal abnormalities. Methods: This retrospective matched case–control study included singleton pregnancies referred for fetal echocardiography to a tertiary referral center in Łódź, Poland, between 1 January 2022 and 14 March 2025. Placental thickness was measured sonographically in a perpendicular plane from the chorionic plate to the basal plate, excluding the umbilical cord insertion site. Only anterior and/or fundal placentas assessed at ≥28 weeks of gestation were included. Among pregnancies with recorded third-trimester placental thickness measurements, 99 cases with placental thickness ≥70 mm were identified as the thick-placenta group. A control group of 99 pregnancies with placental thickness <70 mm was selected and matched for gestational age. Control pregnancies had no documented maternal disease, no fetal structural or functional abnormalities, and no exposure to the medications analyzed in this study. Maternal demographic characteristics, body mass index, comorbidities, infection history, obstetric history, and medication use were compared between groups. Continuous variables were compared using Welch’s t-test and the Mann–Whitney U test, and categorical variables were compared using Fisher’s exact test. Results: The study included 99 pregnancies with marked placental thickening and 99 control pregnancies with normal placental thickness. Gestational age at examination was comparable between groups, with a mean of 35.5 weeks in controls and 35.0 weeks in the thick-placenta group (p = 0.662, Welch’s t-test). Median gestational age was also not significantly different between groups (35.4 vs. 36.43 weeks; p = 0.340, Mann–Whitney U test). Mean placental thickness was significantly greater in the thick-placenta group than in controls (81.4 mm vs. 46.9 mm; p < 0.0001). Maternal age and anthropometric characteristics were comparable between groups, whereas BMI > 25 kg/m² was more common in the thick-placenta group. In contrast to the clinically healthy control group, maternal infection was documented in 100.0% of thick-placenta cases, hormonal treatment in 97.0%, history of COVID-19 in 52.5%, hypothyroidism in 44.4%, prior miscarriage in 37.4%, aspirin or anticoagulant use in 32.3%, gestational diabetes mellitus in 25.3%, and pregnancy-induced hypertension in 7.1%. All evaluated maternal clinical factors were significantly more common in the thick-placenta group than in controls. Fetal cardiac or extracardiac dysfunction was present in 68.7% of thick-placenta pregnancies. Conclusions: In this gestational-age-matched case–control study, pregnancies with marked third-trimester placental thickening showed a distinct maternal profile compared with healthy controls with normal placental thickness. Despite comparable gestational age, maternal age, and maternal anthropometric characteristics, the thick-placenta group demonstrated a significantly higher infectious, hormonal, metabolic, and endocrine burden. These findings indicate that, in this selected tertiary referral cohort, placental thickness ≥70 mm was associated with a higher burden of maternal clinical abnormalities and fetal functional findings. Rather than representing an independent marker of placental maladaptation or maternal-fetal risk, marked placental thickening should be interpreted as a clinically relevant ultrasound finding that may prompt careful review of maternal history and targeted fetal assessment. Prospective studies are needed to determine which maternal factors are independently associated with placental thickening and to clarify their relationship with fetal function and perinatal outcomes. 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: Identifying pregnant women with heightened emotional vulnerability remains a challenge in antenatal care. A positive screening result is a comparatively infrequent event in clinical samples of moderate size, which complicates the statistical modelling of associated factors. This study aimed to characterise the psychosocial profile associated with a positive antenatal depression screen, integrating attachment style, perception of motherhood, previous emotional history and sleep problems. Methods: A total of 140 women in the third trimester of pregnancy were assessed cross-sectionally using the Edinburgh Postnatal Depression Scale (EPDS), with a threshold of 14 or above defining a positive screen; the Adult Attachment Scale; and single-item psychosocial indicators. Associations were examined using the chi-square test, the Fisher–Freeman–Halton exact test, and Firth penalized logistic regression, chosen to correct the separation arising from the small number of events. Results: The screen was positive in 15.0% of participants. Negative perception of motherhood, anxious–ambivalent attachment, previous emotional history and sleep disturbances were all significantly associated with depressive symptoms; in the multivariable model, only negative perception of motherhood remained independently associated with a positive screen. Conclusions: Structured psychosocial assessment may usefully complement standard EPDS screening in the early identification of antenatal emotional vulnerability. Full article

Alcohol exposure during pregnancy leads to fetal alcohol spectrum disorders (FASD), yet the mechanisms through which alcohol disrupts the developing cerebrovasculature remain poorly defined. Acetaldehyde, the first oxidative metabolite of alcohol, can alter vascular function, but whether developing cerebral arteries possess intrinsic capacity to generate acetaldehyde is unknown. Alcohol is primarily oxidized by alcohol dehydrogenase (ADH), cytochrome P450 2E1 (CYP2E1), and catalase (CAT), and their local metabolic activity may contribute to cerebrovascular vulnerability. In this study, cerebral arteries were isolated from postnatal day (PND) 10 C57BL/6J mouse offspring (third trimester-equivalent to human pregnancy), and incubated ex vivo with physiologically relevant alcohol concentrations (13 or 50 mM). Acetaldehyde generation, transcript expression, protein abundance, and catalase-dependent metabolism were evaluated. Alcohol exposure produced a concentration-dependent increase in acetaldehyde generation within developing cerebral arteries, with comparable responses between males and females. Transcript analysis revealed that Adh1, Cyp2e1, and Cat were expressed across developing tissues; however, Western blotting showed that catalase was the only alcohol-metabolizing enzyme detectable at the protein level within developing cerebral arteries. Accordingly, catalase inhibition by sodium azide altered acetaldehyde production, revealing a significant blocker–sex interaction at the higher inhibitor concentration (0.06 mM). In summary, our ex vivo findings demonstrate that developing cerebral arteries possess intrinsic metabolic capacity to oxidize alcohol to acetaldehyde and that catalase plays an essential role in supporting this process at this developmental stage. These results point to a previously unrecognized metabolic pathway within the developing cerebrovasculature that may potentially contribute to early-life vulnerability to alcohol exposure. Full article

Objective: To evaluate whether fetal intrahepatic umbilical–portal anastomosis type is associated with late-onset fetal growth restriction (FGR) and adverse neonatal outcomes. Methods: This prospective, single-center case–control study included 160 singleton pregnancies in the third trimester: 80 with late-onset FGR defined according to Delphi consensus criteria and 80 appropriate-for-gestational-age (AGA) controls. Umbilical–portal anastomosis was assessed by ultrasound and classified as T-shaped, X-shaped, or H-shaped. Maternal, sonographic, obstetric, and neonatal data were recorded. Multivariable logistic regression evaluated associations with FGR, and Firth’s penalized regression assessed composite adverse perinatal outcome (CAPO) within the FGR group. Results: X-shaped anastomosis predominated in FGR (55.0%; T-shaped, 26.3%; H-shaped, 18.8%), whereas T-shaped was most common in controls (61.3%; X-shaped, 23.8%; H-shaped, 15.0%). FGR cases showed higher umbilical artery pulsatility index, lower middle cerebral artery pulsatility index and cerebroplacental ratio, earlier delivery, lower birth weight, and higher rates of NICU (neonatal intensive care unit) admission, transient tachypnea of the newborn, and CAPO (35% vs. 15%). Both X-shaped and H-shaped types were independently associated with FGR, with a stronger effect for X-shaped (adjusted odds ratio [aOR], 5.27 vs. 2.85). Predicted probabilities increased stepwise from T-shaped to H-shaped to X-shaped (30.3%, 55.3%, and 69.6%). Within the FGR group, only X-shaped anastomosis was independently associated with CAPO, whereas Doppler indices were not discriminatory. Conclusions: X-shaped fetal intrahepatic umbilical–portal anastomosis was independently associated with both late-onset FGR and adverse neonatal outcome. Intrahepatic vascular configuration may provide additional value beyond conventional fetal biometry and arterial Doppler in risk stratification. Full article

Background and Objectives: Culture-based cervicovaginal assessment in late pregnancy may reveal bacterial and fungal findings beyond routine Group B Streptococcus (GBS) detection; however, third-trimester non-GBS findings remain insufficiently characterized. This study aimed to describe the distribution of culture-based cervicovaginal findings and to explore the associations between culture-confirmed Candida colonization and maternal, obstetric, and microscopic parameters. Materials and Methods: This prospective observational study included 300 third-trimester pregnant women at ≥28 gestational weeks who were receiving routine antenatal care at a tertiary center. Cervicovaginal samples were obtained using sterile swabs and analyzed with conventional culture-based methods. Findings were categorized according to the identified microorganisms, and GBS positivity was recorded. For Candida-focused analyses, only samples reported as fecal contamination were excluded; women with GBS-positive cervicovaginal cultures were retained in the evaluable cohort. Associations were evaluated using the Mann–Whitney U test and Fisher’s exact test. Results: The mean maternal age was 26.48 ± 5.67 years. Normal vaginal flora was observed in 252 women (84.0%). Candida colonization was the most frequent non-GBS finding, identified in 35 women (11.7%), whereas GBS was detected in seven women (2.3%). Other non-GBS bacterial isolates and fecal contamination were reported in four women (1.3%) and two samples (0.7%), respectively. Clue cells, direct microscopic yeast positivity, and Trichomonas vaginalis were identified in 20 women (6.7%), 12 women (4.0%), and 6 women (2.0%), respectively. After excluding samples reported as fecal contamination, 298 evaluable cervicovaginal cultures were included in the Candida-focused analysis. Direct microscopic yeast detection was more frequent among women with culture-confirmed Candida colonization than among those without colonization (14.3% vs. 2.3%, p = 0.005), whereas Candida colonization was not associated with maternal age, gravidity, parity, gestational age, clue cell positivity, Trichomonas vaginalis positivity, or GBS-positive cervicovaginal culture. Conclusions: In third-trimester pregnancy, culture-based cervicovaginal assessment showed that Candida colonization was the most prominent non-GBS finding. The higher detection rate of culture-confirmed Candida colonization compared with direct microscopic yeast positivity suggests that microscopy alone may underestimate fungal colonization. These findings suggest that reporting non-GBS culture-based cervicovaginal findings may provide additional descriptive microbiological information beyond routine GBS detection in late pregnancy; however, they should not be interpreted as evidence of clinical outcome associations. Full article

Background: Dyspnea is common in pregnancy and difficult to assess in the emergency department (ED), as it may reflect physiological adaptation or cardiopulmonary pathology. We evaluated whether novel BNP-derived uric acid composite indices aid the assessment of dyspnea in late pregnancy; to our knowledge, this is the first study of such indices in this setting. Methods: In this prospective observational study, third-trimester pregnant women (≥27 weeks) presenting to the ED with dyspnea were compared with age-matched asymptomatic pregnant controls. All underwent laboratory testing (including BNP, D-dimer, and uric acid) and standardised transthoracic echocardiography. Three composite indices were calculated (BNP/Albumin, BNP/Uric acid, and BNP × Uric acid), and diagnostic performance was assessed by receiver operating characteristic (ROC) analysis. Results: A total of 215 women were included (100 dyspnea, 115 controls). The dyspnea group had significantly higher D-dimer, BNP, uric acid, and all three composite indices (all p < 0.001), together with higher systolic pulmonary artery pressure (sPAP), right atrial and ventricular diameters, and lateral E/e′. Uric acid (AUC 0.998), the BNP × Uric acid product (AUC 0.846), and sPAP (AUC 0.836) showed the strongest discrimination; the BNP × Uric acid product outperformed BNP, D-dimer, and BNP/Albumin individually but did not surpass uric acid alone. Conclusions: Dyspneic third-trimester women show subtle but significant cardiopulmonary changes despite values that largely remain within normal ranges. These changes distinguished symptomatic from asymptomatic pregnancy but remained largely within normal ranges and do not by themselves identify acute cardiopulmonary disease; uric acid alone was the strongest discriminator, and the composite indices are proposed only as hypothesis-generating tools requiring external validation, ideally against dyspnoeic pregnant women with confirmed pathology. Full article

Background/Objectives: Pregnant women with obesity may experience a substantial burden of sleep disruption and obstetric risk, but prospective data integrating non-respiratory sleep symptoms, prescribed nutritional supplement exposure, and routinely collected hematological measures are limited. This single-center prospective pilot study aimed to describe longitudinal changes in anthropometry, non-respiratory sleep symptoms, prescribed nutritional supplement exposure, routine hematological and blood-count-derived inflammatory indices, and obstetric and neonatal outcomes, and to document study-accrual and data completeness metrics for a future controlled cohort. Methods: Seventeen adult women with singleton pregnancies and first-trimester body mass index (BMI) ≥ 30 kg/m² reached the sleep unit, and all consented to participate. Protocol-based assessments were performed in the first and third trimesters, whereas routine laboratory and treatment data were extracted from medical records. Nutritional exposure was defined solely by prescription status in routine records; doses, formulations, adherence, dietary intake, and serum micronutrient markers were unavailable. Analyses were endpoint-specific complete-case analyses. Results: Study accrual at the sleep unit occurred from 27 July 2023 to 14 March 2024 (17 participants over 7.6 months; approximately 2.2 participants/month). The number informed in Obstetrics and the number not reaching the sleep unit were not recorded. Paired anthropometry was available for 15/17 participants, paired Epworth and Insomnia Severity Index scores for 14/17, paired restless-legs scores for 13/17, and delivery outcomes for 16/17. Median paired changes were 6.0 kg (IQR 1.4–7.9) for weight and 2.3 kg/m² (IQR 0.5–3.1) for BMI. Hemoglobin decreased, and selected blood-count-derived indices varied across routine trimester measurements. Sleep scores showed no clear longitudinal change, although nocturnal awakenings and subclinical insomnia were frequent. Type III polygraphy was attempted in all 17 participants at T1 and was valid in 16; one participant declined a repeat study after a technically invalid recording. Polygraphy was valid in 15 participants at T3; a respiratory event index (REI) ≥5 events/h was observed in 6/16 (37.5%) and 8/15 (53.3%), respectively. Conclusions: This pilot provides feasibility, data completeness, and variability estimates for a larger controlled cohort. The small uncontrolled sample, non-standardized laboratory timing, treatment heterogeneity, and missing upstream referral logs prevent obesity-specific, mechanistic, or clinically actionable conclusions. Full article

Preeclampsia is a leading cause of maternal and perinatal morbidity and mortality worldwide. This significant burden necessitates effective early identification of pregnancies at high-risk for preeclampsia. Accurate prediction is essential in order to develop and optimize preventive strategies. The evolution of preeclampsia screening has progressed from a traditional checklist-based approach to individualized, multivariable models. The first-trimester triple test, which was developed by the Fetal Medicine Foundation (FMF), represents this advancement. It utilizes Bayes’ theorem to calculate patient-specific risks by integrating maternal factors, mean arterial pressure, uterine artery pulsatility index, and serum placental growth factor. This model, called “first trimester FMF triple test”, has undergone successful internal and external validation for the prediction of preterm preeclampsia. To ensure the reliability of biomarker measurements and achieve an optimal screening performance, it is essential to implement standardized measurement protocols and rigorous quality control processes in biomarker testing. The triple test could also be utilized in the 2nd and 3rd trimester, and the addition of biomarkers such as soluble fms-like tyrosine kinase-1 further improves risk stratification assessment and continued surveillance of high-risk pregnancies. Full article

This study proposes a multivariate analytical framework for transabdominally recorded intrauterine acoustic signals (TRIAS) and evaluates spectral changes across gestation. Using a digital stethoscope, 60 recordings were obtained from 44 pregnant women (≥14 weeks). Power spectral density (PSD) was calculated (30–2000 Hz) and analyzed using ordinary least squares (OLS) regression, principal component analysis (PCA), and partial least squares regression (PLSR). A consistent spectral peak was observed at 300–400 Hz. OLS revealed a significant decrease in PSD levels within 400–600 Hz (specifically 478.5 Hz and 521.5 Hz) during the second trimester (t ≈ −3.5), while changes were minimal in the third trimester. PCA identified maternal heart rate as the primary contributor to the first principal component, and PLSR showed that maternal cardiovascular dynamics and gestational progression were associated with distinct, largely independent components in the multivariate space. These results suggest that TRIAS may capture a composite maternal–fetal acoustic environment influenced by both maternal circulation and gestational uterine alterations. Specifically, the observed second-trimester spectral changes may reflect fluid dynamic or structural transitions—such as variations in amniotic fluid volume—and may serve as a baseline for future monitoring research. Full article

Background: Trisomy 21 (T21) is strongly associated with congenital heart disease, particularly atrioventricular septal defect (AVSD), ventricular septal defect (VSD), atrial septal defect (ASD) and selected conotruncal and arch anomalies. First- and second-trimester ultrasound, Doppler and fetal cardiac MRI enable increasingly early and detailed characterization of these lesions, while advances in molecular cardiogenesis have linked specific phenotypes to dosage-sensitive genes on chromosome 21. Methods: This narrative review synthesizes contemporary evidence on structural and functional cardiovascular anomalies in T21 fetuses in the first and second trimester, integrating fetal echocardiography, Doppler assessment and fetal cardiac MRI with embryologic and molecular insights, and summarizing trimester-specific detectability and pathophysiologic links to candidate genes in the Down syndrome-critical region. Approximately one quarter to one third of T21 fetuses have major congenital heart disease on high-quality prenatal echocardiography, with AVSD representing about half of all lesions and VSD, tetralogy of Fallot (TOF), arch anomalies, venous return abnormalities and functional markers (increased nuchal translucency, tricuspid regurgitation, ductus venosus abnormalities) comprising the remainder. Results: First-trimester detection relies on functional markers and early four-chamber and outflow-tract views, whereas second-trimester studies refine anatomic definition and hemodynamics, with MRI reserved for complex cases. Overexpression of genes such as DSCAM, COL6A1/COL6A2, DYRK1A and RCAN1 perturbs endocardial cushion, conotruncal and vascular development. Conclusions: Early, protocol-driven cardiac imaging in T21 supports timely diagnosis, risk stratification and multidisciplinary counselling, and links fetal imaging phenotypes with chromosome 21 gene dosage to advance personalized management and future genotype–phenotype research. Full article

Background: SARS-CoV-2 infection during pregnancy has been associated with adverse maternal and neonatal outcomes, particularly in severe disease. However, evidence stratified by disease severity from Southeastern Europe remains limited. The aim of this study was to compare obstetric and neonatal outcomes between mild and severe COVID-19 among pregnant women managed in tertiary maternity hospitals in Tirana, Albania. Methods: A retrospective multicenter observational study was conducted between January 2020 and December 2022 in the two main tertiary maternity hospitals in Tirana. Pregnant or postpartum women with RT-PCR-confirmed SARS-CoV-2 infection were included. COVID-19 cases were classified as mild or severe according to clinical presentation and oxygen saturation. Maternal, obstetric, and neonatal outcomes were analyzed and multivariable logistic regression was used to evaluate associations between disease severity and selected outcomes. Results: A total of 270 pregnant women were included, of whom 212 (78.5%) had mild COVID-19 and 58 (21.5%) severe disease. The mean maternal age was 29.4 years and most infections occurred during the third trimester (80.8%). Severe COVID-19 was associated with significantly higher odds of NICU admission (aOR 2.87, 95% CI 1.36–6.05), Apgar score < 7 at 5 min (aOR 8.39, 95% CI 1.49–47.35), low birth weight (aOR 2.53, 95% CI 1.06–6.03), and emergency cesarean section (aOR 8.10, 95% CI 2.64–24.86). Maternal age, obesity, parity, and comorbidities were not significantly associated with the examined outcomes. Conclusions: Severe COVID-19 during pregnancy was associated with poorer neonatal condition at birth and increased obstetric intervention, highlighting the importance of close monitoring and coordinated obstetric–neonatal management in pregnancies complicated by severe SARS-CoV-2 infection. Full article

Background/Objectives: Pregnancy is characterized by profound metabolic and physiological adaptations that influence systemic redox balance. Longitudinal data assessing trimester-specific changes in antioxidant status and oxidative stress markers remain limited. Methods: In this longitudinal study, plasma levels of non-enzymatic antioxidants (vitamins A, C, E, and carotenoids) and oxidative stress markers (malondialdehyde, conjugated dienes, protein carbonyls, and DNA strand breaks) were analyzed in 31 healthy non-smoking pregnant women during the first, second, and third trimester. Environmental tobacco smoke exposure was evaluated using urinary cotinine. Statistical analyses were performed using Friedman repeated-measures tests followed by Dunn’s post hoc comparisons with Benjamini–Hochberg false discovery rate correction. Results: Vitamin A was the only antioxidant that consistently decreased across all trimesters and represented the only antioxidant marker showing a consistent decline. In contrast, α-tocopherol, γ-tocopherol, xanthophylls, and lycopene increased significantly during gestation, whereas vitamin C remained relatively stable. Markers of oxidative damage, including malondialdehyde, conjugated dienes, protein carbonyls, and DNA strand breaks, showed significant trimester-dependent increases. Total antioxidant capacity (FRAP) remained unchanged throughout pregnancy. Conclusions: Physiological pregnancy is characterized by coordinated, marker-specific adaptations in systemic redox balance. Vitamin A was the only antioxidant showing a consistent decline across gestation, whereas several lipid-soluble antioxidants increased and total antioxidant capacity remained stable. These findings indicate that pregnancy is associated with increased oxidative activity accompanied by preservation of systemic antioxidant capacity rather than global antioxidant depletion. Full article

Background/Objectives: While satisfactory glycaemic control is possible with specialist care from a diabetologist and modern therapies, women with type 1 diabetes are still subject to poorer obstetric outcomes, even with optimal management. Methods: The analysis comprised a cohort of 55 pregnant patients with type 1 diabetes who attended the Diabetology Outpatient Clinic between 2018 and 2023; all were recruited no later than the first trimester. Qualified patients underwent medical interviews and physical examinations. Insulin pump, continuous glucose monitoring (CGM) system, and postpartum data were collected. Results: The median glycated haemoglobin (HbA1c) at the beginning of pregnancy was 6.1%, with means of 5.9% and 6.0% in the following trimesters. Only 1/3 of the women achieved the recommended HbA1c value throughout pregnancy. The average/median time in range (TIR) in each trimester was ≤70%. Among the women who achieved the recommended TIR target, the infants tended to have lower birth weights but a higher likelihood of jaundice. Almost half of the newborns were large for gestational age (LGA), and a third were macrosomic. The strongest predictor of LGA was a mean blood glucose level > 124 mg/dL in the third trimester, which increased the risk of LGA by almost 12 times. Conclusions: Good diabetes control does not prevent LGA/macrosomia. TIR appears to be a better predictor of obstetric complications, including LGA. A mean glucose level ≥ 124 mg/dL in the third trimester greatly increases the risk of LGA. Full article