Introduction Rates of perinatal diabetes are increasing, most rapidly in rural communities. There is a gap in knowledge related to how birth location impacts parental and neonatal outcomes in pregnant individuals with diabetes. We assessed differences in clinical outcomes among individuals with perinatal diabetes in rural, suburban and urban settings within a large academic community health system.Methods This is a retrospective cohort study using an obstetric outcomes database including singleton, non-anomalous pregnancies with Type 1, Type 2 and Gestational Diabetes within a 11-birthing hospital system in 2023. Births were classified as rural, suburban or urban by delivery location. Baseline clinical characteristics and birth outcomes were collected. Our primary outcome was a composite of neonatal respiratory support and hypoglycemia.Results A total of 1220 births affected by perinatal diabetes were identified in rural (n = 139), suburban (n = 856), and urban (n = 225) hospitals. There were significant differences in types of diabetes and mode of birth between sites. There were significantly more White individuals in rural settings (p < 0.001). There was no significant difference in the composite outcome of neonatal respiratory support needs and hypoglycemia. However, the odds of neonatal hypoglycemia at suburban hospitals were lower (aOR 0.66 (0.45, 0.98), p = 0.037) than those for rural hospitals after adjustment for diabetes type. This did not lead to a difference in rates of interventions for hypoglycemia, with no significant difference in rate of D10 bolus or dextrose gel use within the first 48 h of life.Conclusions There was no difference in the primary composite outcome, but there was a small but statistically significant difference in rates of hypoglycemia at rural compared to suburban sites when adjusting for clinical differences between groups. This did not lead to an increase in need for interventions for hypoglycemia. Overall similar outcomes suggest a potential benefit to shared resources within the same hospital system for management of perinatal diabetes.
Objective To evaluate Doppler ultrasonography and placental shear wave elastography findings in pregnancies complicated by preeclampsia.Methods This prospective observational comparative study included 60 pregnant women, consisting of 30 patients with preeclampsia and 30 healthy controls. Bilateral uterine artery and umbilical artery Doppler ultrasonography was performed, and peak systolic velocity, pulsatility index, and resistance index values were recorded. Placental shear wave elastography was obtained from the right peripheral, central, and left peripheral placental regions on both fetal and maternal surfaces. Elastography measurements were expressed as stiffness values in kilopascals and velocity values in meters per second. Perinatal outcomes, including gestational age at birth, Apgar scores, and umbilical cord blood gas parameters, were recorded.Results Right uterine artery PI (1.19 ± 0.65 vs 0.74 ± 0.24, p = 0.003) and left uterine artery PI (1.35 ± 0.57 vs 0.84 ± 0.26, p < 0.001) were significantly higher in the preeclampsia group than in controls. All placental shear wave elastography parameters were significantly increased in the preeclampsia group, including right peripheral fetal placental stiffness (22.42 ± 11.36 vs 4.16 ± 1.45 kPa, p < 0.001) and central fetal placental stiffness (17.89 ± 6.60 vs 4.86 ± 2.73 kPa, p < 0.001). Gestational age at birth was lower in the preeclampsia group (35.0 ± 3.3 vs 37.2 ± 2.1 weeks, p = 0.002), with lower first- and fifth-minute Apgar scores and higher cord lactate levels. Right peripheral fetal placental shear wave velocity showed the highest apparent discriminatory performance in ROC analysis (AUC = 0.998).Conclusion Placental shear wave elastography may complement Doppler ultrasonography in assessing placental involvement in preeclampsia.
Objective To compare labor induction characteristics and delivery outcomes among individuals with body mass index < 40 versus ≥ 40 kg/m2 undergoing induction at termStudy Design This secondary analysis utilized data from the vaginal misoprostol arm of a cluster randomized controlled trial comparing vaginal to oral misoprostol for induction. Individuals at ≥ 37 weeks gestation with cervical dilation ≤ 2 cm undergoing induction using a standardized protocol were included. Vaginal misoprostol was given in 25 µg doses every three hours for up to five doses, followed by a standardized oxytocin protocol. We compared labor progression among individuals with BMI < 40 and ≥ 40 kg/m2 at delivery, including labor duration, misoprostol use, and obstetric and neonatal outcomes. Generalized estimating equations were used to account for clustering and comorbid conditions. Effect sizes were presented as odds ratios and adjusted mean differences with 95% confidence intervals.Results From May 2021 to September 2022, 1,322 patients received vaginal misoprostol for labor induction at term. Among these, 1,058 (80.0%) had a BMI < 40 kg/m2 and 264 (20.0%) had a BMI ≥ 40 kg/m2. Individuals with severe obesity were more likely to start induction with a closed cervix. After adjustment for clustering, initial cervical dilation, hypertension, and diabetes, inductions in the group with severe obesity had longer total durations (adjusted mean difference 3.5h, 95% CI 1.9–4.8), first stage of labor (adjusted mean difference 2.2h, 95% CI 0.6–3.8), and duration of oxytocin use (adjusted mean difference 2.5, 95% CI 1.1–3.8). Individuals with BMI ≥ 40 kg/m2 also had lower odds of vaginal delivery (aOR 0.6, 95% CI 0.4–0.8) and required more doses of misoprostol for induction.Conclusion Severe obesity, defined as BMI ≥ 40 kg/m2, is associated with longer time to delivery, increased misoprostol requirement, longer duration of oxytocin use, and lower odds of vaginal delivery compared to individuals with lower BMI. Consideration of alternative labor induction protocols must be balanced with increased comorbidities and overall obstetric morbidity in this group.
Objective Group B Streptococcus (GBS) contributes majorly to neonatal morbidity and mortality. Although antenatal culture screening and risk-based intrapartum antibiotic prophylaxis (IAP) reduce neonatal early-onset GBS (EOGBS) compared to no screening, limitations hinder further reduction of EOGBS incidence. Point-of-care polymerase chain reaction (PCR) tests can address these limitations and offer an alternative to detect intrapartum GBS colonization in near-patient settings. Despite European clinical consensus recommending PCR-based intrapartum screening, adoption remains limited, partly due to lack of health economic evidence. This systematic literature review (SLR) evaluated the clinical effectiveness and economic impact of GBS tests for intrapartum screening, and the health-related quality of life (HRQoL) associated with EOGBS.Methods Systematic searches were conducted on 19 March 2025 in Embase®, MEDLINE®, EBM Reviews, and EconLit® via OVID SP®, without geographic restriction. Eligible studies included pregnant women undergoing intrapartum GBS screening compared with intrapartum culture as the reference standard. Two reviewers independently screened studies using pre-defined eligibility criteria; a third resolved discrepancies. Study quality was appraised using Quality Assessment of Diagnostic Accuracy studies tool for clinical studies and Drummond and Jefferson checklist for economic studies. Sixty-six studies were included: 38 clinical, 17 economic, and 11 HRQoL/utility.Results Clinical evidence demonstrated that intrapartum PCR tests provide high diagnostic accuracy and operational reliability by delivering results in <60 min (significantly faster than antenatal cultures). Four assays (Xpert® GBS, Revogene® DBS GS, GenomEra®, and IDI-Strep B™) met the European clinical expert consensus criteria for reliable and effective intrapartum GBS screening (≥90% sensitivity and ≥95% specificity) in at least one study; only Xpert® GBS met these criteria in more than one study. Economic evidence indicated potential cost-neutrality or savings with intrapartum PCR, compared with antepartum culture. Higher PCR test costs were offset by cost-savings from reduced EOGBS cases and associated resource utilization (e.g. hospitalization/neonatal intensive care, treatment, long-term sequelae), in some studies resulting in dominant ICERs in cost-effectiveness analyses. HRQoL studies reported considerable risk of physical impairment due to long-term sequelae among neonates surviving EOGBS.Conclusion Point-of-care intrapartum PCR-based screening methods offer potential to improve prevention strategies for neonatal infection and reduce the clinical, economic, and HRQoL burden of GBS disease. Limited primary HRQoL evidence highlights the need for further research.
