Limited evidence exists on the association between maternal pregnancy complications and depressive and/or anxiety disorders in the longer term. We examined the association between pregnancy complications and later depressive and anxiety disorders. The study cohort consisted of mothers who participated in the UK Millennium Cohort Study. Pregnancy complications were self-reported at 9 months postpartum and categorised into 0, 1, 2, and 3 + complications. Follow-up surveys, including questions about clinically diagnosed depressive, and anxiety disorders were carried out at 3, 5,7,11, and 14 years postpartum. The primary outcome is the diagnosis of depressive and anxiety disorders, in the mother up to 14 years postpartum. We applied multivariable logistic regression models adjusting for several potential confounders. 10,510 mothers were included in the analyses, with n = 3935 (37

Prenatal stress is associated with deleterious neurodevelopmental consequences in affected offspring. Prenatal stress via exposure to high physiological levels of inflammation in utero may induce an inflammatory state in the fetal brain. However, inflammation is not only associated with disease-states but also can be seen in a healthy pregnancy. There is limited research examining the potential that exposure to biological mediators of stress may have on neurodevelopment. We aim to determine whether certain circulating biological markers in maternal serum influence neurite growth in partially differentiated SH-SY5Y cells as a potential mechanism impacting neurodevelopment. Blood was collected at 20-weeks' gestation as part of the SCOPE pregnancy cohort study. These factors, including pro-inflammatory cytokines, markers of tryptophan metabolism, and gut permeability that were previously analysed, were used to stratify women into low (n = 10) and high (n = 10) biological stress groups. Exposure to the serum categorised as 'high-stress' significantly reduced neurite length in comparison to serum categorised as 'low-stress', with tumour necrosis factor-α playing a substantial role in mediating this reduction. The 'high-stress' serum was subsequently found to increase the levels of phospho-Ser536-p65. Phosphorylation of p65 Ser536 has previously been shown to switch NF-κΒ from promoting neuronal growth, to inhibiting it. The reduction in neurite length seen following exposure to the 'high-stress' serum was prevented when NF-κΒ p65 was knocked down. The present study emphasises the potential negative impact that circulating factors may have on neuronal growth, and the mechanism behind it.

To develop and internally validate a model predicting neonatal mortality in infants with neonatal encephalopathy requiring therapeutic hypothermia (TH), using national data. Data from 385 infants treated with TH across 19 hospitals (2016–2021) were analysed. Multivariable logistic regression with backward stepwise selection was applied. Discrimination was assessed using the C-statistic, with internal validation by bootstrapping. The THERM (Therapeutic Hypothermia Early Risk Model for Mortality) tool was developed to calculate individualised mortality risk. Forty-six infants (11.9%) died within 28 days. Four predictors were retained: prelabour Caesarean section, adrenaline use, base excess ≤–22 mmol/L, and seizures during the first day of life. The model demonstrated excellent discrimination [optimism-adjusted C-statistic 0.885 (95% CI: 0.827–0.936)]. Four routinely collected variables predicted mortality in infants undergoing TH. The THERM tool provides a practical resource for clinicians, enabling personalised risk assessment and supporting parental counselling during the first day of life.

BACKGROUND:Adverse pregnancy outcomes are linked to increased risk of maternal cardiovascular disease. However, the association between preterm delivery (PTD) and long-term risk of stroke in the mother remains uncertain, particularly in the case of spontaneous PTD. METHODS:A systematic review and meta-analysis were performed to provide an up-to-date synthesis of the evidence on the association between PTD and long-term maternal stroke. PubMed, CINAHL, and Web of Science were searched for relevant articles published between January 1, 2000, and May 6, 2025. Eligible studies included cohort and case-control studies examining populations of parous women. Primary exposure was defined as any PTD; secondary exposures were spontaneous PTD and medically indicated PTD. The primary outcome was defined as any stroke; secondary outcomes were ischemic and hemorrhagic stroke. Two reviewers screened studies, extracted data, and performed quality assessments. Pooled unadjusted and adjusted effect estimates (as defined by the original study) were calculated separately using random effects inverse variance models. RESULTS:Eleven thousand twenty-five studies were screened for eligibility. Across 21 studies including a total of 8.7 million participants, PTD was consistently associated with increased stroke risk. The follow-up period ranged from 8 to 57 years. The primary meta-analysis demonstrated a positive association between any PTD and any stroke (adjusted risk ratio [aRR], 1.66 [95% CI, 1.34-2.05]). A high level of heterogeneity was observed (I2=97%, τ2=0.15), possibly due to variations in exposure definition, outcome ascertainment, and follow-up durations. Spontaneous PTD (aRR, 1.37 [95% CI, 1.15-1.64]) and medically indicated PTD (aRR, 2.08 [95% CI, 1.70-2.54]) were associated with any stroke. PTD was positively associated with ischemic (aRR, 1.59 [95% CI, 1.45-1.75]) and hemorrhagic stroke (aRR, 1.44 [95% CI, 1.06-1.94]). CONCLUSIONS:Women who have experienced a PTD, including spontaneous PTD, may be at increased risk of stroke in later life. These women may benefit from targeted cardio-metabolic preventive interventions postpartum to reduce their risk.

In this policy brief, we explain why pandemic preparedness must include significantly improving the availability of data on infection and vaccination in pregnant women in the Republic of Ireland (ROI). We base this on an in-depth analysis of data availability during the COVID-19 pandemic in ROI. These improvements include 1) the need to optimise research governance processes, 2) better linkage between different data sources, 3) improving documentation of data sources, 4) timely release of data, 5) prioritisation of pregnancy data collection, and 6) increased supports and funding.

Background Experiencing complications in pregnancy and birth is often associated with poor postpartum health outcomes and can have lasting consequences for women. Understanding women’s subjective experiences of pregnancy and/or birth complications and how they feel such experiences impact their current mental health is essential to better inform supports and resources. Aim To explore how women experience and describe their mental health following pregnancy and birth complications in Ireland. Methods We conducted semi-structured interviews with 21 women from February to May 2024. Participants were purposively sampled. Eligible women were ≥ 18 years of age and had been between 12 months and 5 years since experiencing a pregnancy and/or birth complication. Reflexive thematic analysis was used to develop themes and subthemes. Findings We developed four main themes: 1) ‘Expectations versus reality’ highlighted the disconnect between women’s hopes for pregnancy and birth, and the unexpected nature of their actual experiences. 2) ‘Unresolved consequences’ reflected women's ongoing psychological and mental health challenges, particularly regarding anxiety and concerns for future pregnancies. 3) ‘Perception of healthcare experiences’ highlighted the importance of effective communication with healthcare providers, 4) ‘Support and systems’ described interpersonal and structural supports, and networks important to women. Conclusion Women’s experiences of mental health following pregnancy and birth complications are impacted by multiple factors throughout their pregnancy and birth journey. To improve the mental health experiences of women who have pregnancy and/or birth complications, access to information, resources, and supports at interpersonal and structural levels is needed.

INTRODUCTION:Limited evidence exists on the association between mode of birth and long-term depression and/or severe anxiety in mothers. We aimed to examine the association between mode of birth and depression and/or severe anxiety by 14 years postpartum. METHODS:We used data from the Millennium Cohort Study. Data on mode of birth were collected when mothers were 9 months postpartum, and categorized as spontaneous vaginal birth (VB), assisted VB, induced VB, emergency cesarean section (CS), planned CS, and CS after induction. Depression/severe anxiety were collected as one variable and self reported by mothers at 9 months, 3, 5, 7, 11, and 14 years postpartum based on a doctor diagnosis. The primary outcome measure was a diagnosis of depression/severe anxiety up to 14 years postpartum. We used multivariable logistic regression models to estimate crude and adjusted odds ratios (OR) for the association between mode of birth and depression/severe anxiety by 14 years postpartum. RESULTS:There were 10,507 singleton mothers included in our analyses. Fully adjusted odds ratio (aOR)for the association between mode of birth and depression/severe anxiety by 14 years postpartum was induced VB, (aOR, 1.13 [95% CI], 1.01-2.28), assisted VB (aOR, 1.03 [95% CI], 0.89-1.19), Emergency CS, (aOR, 1.08 [95% CI], 0.92-1.27), planned CS (aOR, 1.09 [95% CI], 0.93-1.27), and CS after induction (aOR, 1.08 [95% CI], 0.91-1.28). Fully adjusted models did not report any significant association between mode of birth and depression/severe anxiety at other postpartum time points. CONCLUSIONS:The present findings provide support for association between induction of labor and the risk of long-term depression/severe anxiety by 14 years postpartum. The findings provide no evidence to support association between other modes of birth and maternal depression/anxiety.

BACKGROUND:Fetal pulse oximetry may improve intrapartum fetal evaluation by providing a non-invasive measurement of fetal oxygen saturation (FSpo2). OBJECTIVES:To assess the association between abnormal intrapartum FSpo2 and perinatal and long-term neurodevelopmental outcomes, and to evaluate if the addition of the measurement of FSpo2 to established forms of fetal monitoring, such as fetal heart rate monitoring, affects birth, perinatal, and long-term neurodevelopmental outcomes. SEARCH STRATEGY:We conducted a comprehensive search of PubMed, EMBASE, CINAHL, The Cochrane Library, Web of Science, ClinicalTrials.gov, and WHO ICTRP from database inception through February 2024, with no restrictions on date, geographic region, country income level, or language. SELECTION CRITERIA:Studies involving women in labor with a cephalic baby were included. Two interventions were reviewed: (1) low FSpo2 (<30%), and (2) the use of fetal pulse oximetry during labor. DATA COLLECTION AND ANALYSIS:Independent reviewers screened studies, extracted data, and assessed quality using the Risk of Bias tool and the Newcastle-Ottawa Scale. The approach evaluated evidence certainty. A random-effects meta-analysis followed PRISMA and MOOSE guidelines. MAIN RESULTS:Forty-seven studies with 13 071 mother-infant pairs were included. FSpo2 <30% was associated with umbilical artery pH <7.15 (odds ratio [OR] 7.86, 95% confidence interval [CI] 3.29-18.75, I2 = 71%, P < 0.001), 5-min Apgar score less than 7 (OR 16.63, 95% CI 5.64-49.01, I2 = 30%, P < 0.001) and NICU admission (OR 5.89, 95% CI 1.73-20.01, I2 = 0%, P < 0.005). FSpo2 monitoring combined with fetal heart rate monitoring was associated with lower odds of cesarean section for non-reassuring fetal status (OR 0.59, 95% CI 0.40-0.86, I2 = 71%, P = 0.006) without impacting 5-min Apgar scores <7 (OR 0.66, 95% CI 0.37-1.17, I2 = 0%, P = 0.160) or neonatal intensive care unit admissions (OR 0.98, 95% CI 0.82-1.18, I2 = 0%, P = 0.840). CONCLUSION:FSpo2 monitoring combined with fetal heart rate monitoring may reduce unnecessary cesarean sections for suspected fetal distress without affecting short-term neonatal outcomes. The association between FSpo2 <30% and adverse perinatal outcomes supports its potential as a valuable adjunct in intrapartum monitoring.

BACKGROUND:Iron deficiency during pregnancy has potentially serious health consequences for both the mother and her offspring. Few prospective studies have considered the impact of maternal nonanemic iron deficiency in early pregnancy on offspring health outcomes. OBJECTIVE:The objective of this study was to explore the impact of maternal iron deficiency in early pregnancy on neonatal iron status at birth and neurodevelopment at 2 y of age. METHODS:In a low-risk, primiparous nonanemic maternal-infant cohort, ferritin, soluble transferrin receptors, and inflammatory markers (C-reactive protein and α-glycoprotein) were measured at 15- and 20-weeks of gestation and in umbilical cord blood. Bayley Scales of Infant and Toddler Development (BSID-III) and the Child Behavior Checklist were assessed at 2 y. RESULTS:Participants with complete longitudinal data from 15 weeks of gestation to 2 y (n = 189) were Caucasian (96.8%), highly educated (78.8% university graduates), with singleton pregnancies. At 15-weeks of gestation, 3.2% had ferritin <15 μg/L and 18.5% had ferritin <30 μg/L, which increased to 8.5% and 42.3% <15 and <30 μg/L, respectively, at 20-weeks. Iron depletion (cord ferritin <76 μg/L) was observed in 7.4% of newborn infants. Cord ferritin concentrations were 42.3 μg/L lower in infants born to iron deficient mothers (using maternal ferritin <30 μg/L threshold) at 15-weeks, compared with those with iron sufficient mothers. Children born to mothers with ferritin <30 μg/L at 15- and 20-wk had lower BSID-III language [Estimated β (95% confidence interval), 15-wk: -7.3 (-14.0, -0.4), 20-wk: -6.3 (-11.0, -1.3)] and motor [15-wk: -5.8 (-11.0, -1.1), 20-wk: -4.0 (-7.8, -0.3)] composite scores at 2 y than those with iron sufficient mothers. CONCLUSIONS:Maternal nonanemic iron deficiency in early pregnancy was associated with low iron status at birth and worse language and motor outcomes at 2 y of age. This new evidence highlights the need to consider screening for iron deficiency early in pregnancy, even in well-resourced settings. This trial was registered at clinicaltrials.gov as NCT01891240.

BACKGROUND: Despite a focus on patient-reported outcome measures (PROM) in maternity care, a standardized tool is lacking. Current existing measures often focus on a single dimension of postpartum health. OBJECTIVE: This study evaluated the construct validity of using a suite of PROMs based on the top psychometrically validated tools available. They were combined to achieve coverage of all important aspects of postpartum well-being outlined by the International Consortium of Health Out comes (ICHOM) METHODS: Recruitment took place in a tertiary university maternity hospital between April 3rd 2023, and October 28th 2023, with final responses collected in January 2024. Postnatal women were recruited before hospital discharge and consented to completing the PROM tool which consisted of the additional questions on pelvic pain with sexual intercourse. The PROM was administered at T1=first week postpartum, T2=6 weeks and T3=12 weeks postpartum. We evaluated the construct validity of these tools through hypothesis testing, proposing that: (1) the instrument should differentiate between groups with and without morbidity, (2) the instrument should differentiate between groups based on delivery type, and (3) should detect change over the postpartum period. Statistical analyses, including chi-square tests, repeated measures ANOVA, and independent t-tests, were used for data analysis. RESULTS: 534 women were recruited, with an average age of 32 years (5.0), 90.6% (n=484) had term deliveries, 59% (n=316) were multiparous, 40% (n=216) had spontaneous vaginal deliveries (SVD), 12% (n=63) had operative vaginal deliveries and 47.7% (n= 255) had caesarean sections. Examining the tools' ability to detect changes based on morbidity found no significant differences in PQoL, ICIQ-UI SF or pelvic pain scores between groups with and without maternal morbidity. There were also no differences found in the scores of mothers who had babies admitted to the Neonatal Unit (NNU). Examining score differences based on delivery type, found no variations in total PQoL scores across all timepoints. There were no score differences at other time points in the ICIQ-UI SF or pelvic pain question scores. The PQoL, ICIQ-UI SF and the pelvic pain with sexual intercourse questions had statistically significant difference in their overall scores over the 3 timepoints of the study. The PQoL scores were T1: 128 [ 9.67], T2: 125 [ 8.47], and T3: 126 [ 8.51] P=.002. The ICIQ-UI SF had a median score and interquartile ranges of T1: 7.7 (IQR=6), T2: 9 (IQR=7), and T3: 9 (IQR=7), P=<.001. The pelvic pain with intercourse questions median score was T1: 6 (IQR=2), T2: 5.5 (IQR=2) and T3: 4 (IQR=2), P=.4957. CONCLUSION: While this suite of PROMs demonstrated sensitivity in detecting changes in postpartum well-being over time, it did not consistently discern differences based on morbidity (maternal or neonatal) or on delivery type. These findings suggest the need for a more clinically

OBJECTIVES:To investigate patients' perspectives on using the LEANBH app (home Blood Pressure BP monitoring system) and the Microlife Watch BP home monitor in a tertiary maternity hospital setting during the COVID-19 pandemic. STUDY DESIGN:134 Participants were asked to complete an anonymous usability questionnaire on their experience of LEANBH and the Microlife Watch. The questionnaire consisted of 5 background demographics, 9 items from the system usability scale (SUS), 14 items on the usability of the LEANBH app, and 6 on the acceptability of Microlife. RESULTS:The usability questionnaire for the LEANABH app suggested 69% (93) of respondents reported a very good initial impression of the app, while 29% agreed and 70% strongly agreed that it was easy to use. The Microlife Watch was tolerated very well with 42% agreeing and 56% strongly agree they would use it again. Only 8 (6%) reported it to be an inconvenience to take their own BP at home. Nearly all users (97%) agreed that the knowledge their BP was being monitored at home gave them a sense of safety. CONCLUSION:Patients' experience of the LEANBH app and Microlife Watch BP Home monitor were very reassuring and suggest it is an acceptable way of monitoring home BP in pregnant women who are at risk of rapid changes in health status. Women reported feeling a greater sense of health and safety with the use of this device. Further work remains to be done for the widespread validation and implementation of the LEANBH platform and application.

BACKGROUND:Preeclampsia is associated with increased long-term risks of cardiovascular disease, kidney disease, and stroke. International guidelines recommend structured follow-up care to prevent chronic disease, but limited research has explored women's knowledge of these risks, and their preferences regarding long-term follow-up care. This may impede how obstetric information is used for chronic disease prevention in practice. METHODS:This qualitative study used purposive and snowball sampling to recruit women in Ireland diagnosed with preeclampsia at least one year prior. Semi-structured interviews were conducted online, exploring awareness of chronic disease risks and provision of follow-up care. Thematic analysis was performed using an inductive approach. RESULTS:Twelve women aged 28-64 years were interviewed, at median six years since preeclampsia diagnosis. Participants' antenatal and postnatal care experiences varied widely, but most described follow-up care after preeclampsia as being inconsistent or absent. Three key themes were generated: (1) Preeclampsia in the 'rear-view mirror'-women often viewed preeclampsia as an acute, resolved event, and had limited awareness of any long-term risks. However, they regarded chronic disease risk information as valuable and empowering; (2) Changing priorities as 'life takes over'- women often prioritised other family members' health needs above their own, particularly in the newborn phase. They favoured delaying discussions about chronic disease risks, ideally to 6-12 months after pregnancy, preferably provided through primary care; (3) Desire for proactive, 'blameless' follow-up care-women favoured systematic, non-judgmental follow-up programmes underpinned by clear communication between obstetric and primary care services, continuity of healthcare providers, and free access. Some described residual anxiety relating to their preeclampsia experience, and emphasised the importance of sensitive, person-centred follow-up care. CONCLUSION:Women affected by preeclampsia in Ireland typically have limited awareness of its links with long-term chronic disease risks, and frequently experience a lack of structured follow-up care. They expressed strong support for receiving personalised information about opportunities for secondary prevention, and advocated for systematic, proactive follow-up. Participants emphasised that future models of care should be pragmatic, person-centred, and include default enrolment for all women.

In utero exposure to an increased level of maternal inflammation or a disrupted maternal gut microbiome during pregnancy have been linked to several neurodevelopmental disorders in the offspring. Despite the strong links between these two adverse events, few studies looked at the interaction between the maternal gut microbiome and maternal immune activation (MIA) on the neurodevelopmental outcomes in the offspring. Here, we aim to determine if maternal gut microbiome disruption exacerbated the impact of systemic inflammation on brain development, offspring behaviour, and long-term microbiome changes. A low dose of intraperitoneal lipopolysaccharide (LPS) was administered to pregnant Sprague Dawley rats from gestational day 12–18. Concurrently, an antibiotic cocktail (ampicillin, neomycin, vancomycin) was given in the drinking water to disturb the maternal microbiome. Embryos at gestational day 18 were found to have a reduced body size and weight, along with reduced placental weight following exposure to LPS, with some effects also seen with antibiotic exposure. Offspring exposed to LPS in utero were found to have increased anxiety-like behaviours and repetitive-behaviours. No behavioural changes were noted from antibiotic exposure. The expression of 5HT1a receptors in the prefrontal cortex was found to be reduced following LPS exposure. The offspring microbiome varied between the groups, with prenatal antibiotic exposure playing a role in reducing α-diversity and species richness in the periadolescent period. This study highlights the impact of prenatal exposures on different aspects of neurodevelopment. However, additional research is warranted to explore the role of the maternal immune system and microbiome on the offspring development, while also testing the potential therapeutic agents such as probiotics.

(Abstracted from Am J Obstet Gynecol 2024;231:196–210) Hypertensive disorders of pregnancy (HDPs), including chronic hypertension, gestational hypertension, preeclampsia (PE), eclampsia, and PE superimposed on chronic hypertension, affect 5%–15% of pregnancies and are associated with higher risks of cardiovascular disease, stroke, diabetes, and chronic kidney disease. Their potential impact on dementia, such as vascular dementia and Alzheimer disease, remains understudied.

Abstract Study question Investigate the safety of VMT and explore its effects on the vaginal microbiomes and local inflammation in healthy, asymptomatic volunteer women screened for vaginal dysbiosis Summary answer We demonstrate safety and engraftment of donor bacteria in 50% of recipients, and a distinct shift in local inflammatory markers following resolution of vaginal dysbiosis What is known already Dominance by a subset of vaginal Lactobacillus species is considered healthy. Dysbiosis characterized by high abundance of anaerobic species is observed in around one third of women, and affects fertility, pregnancy outcomes, risk of STIs and UTIs, and potentially cancer treatment. Current use of antibiotics is often insufficient with high recurrence rates and potentially antibiotic resistance. There is a clear need for alternatives and recently it was shown that VMT following antibiotic treatment resulted in long-lasting improvements in symptoms of bacterial vaginosis in four out of five patients, but RCTs without the use of antibiotics remain to be reported. Study design, size, duration We performed a randomized, placebo-controlled double-blinded trial in 34 recipients randomized in an active:placebo 3:1 ratio. Subjects in the active arm received VMTs from donor cervicovaginal secretions (CVS) while placebo participants received saline. All recipients were dosed on 3 consecutive days with active arm recipients receiving all 3 VMTs originating from the same donor. All recipients were followed for safety and efficacy assessments for 6 menstrual cycles after dosing. Participants/materials, setting, methods Donors: CVS was obtained from healthy subjects screened to be negative for a broad panel of infections and having lactobacilli-dominant vaginal microbiomes. RCT: Healthy, asymptomatic women aged 18 to 45 whose vaginal microbiome had combined lactobacilli relative abundance <10% and combined relative abundance of dysbiosis-associated bacteria >20% were included. VMTs were applied vaginally on three consecutive days. Follow-up visits were performed 1 week after the last VMT and then once every cycle for 6 cycles. Main results and the role of chance Here, we report the successful implementation of a donor program to obtain screened, frozen, and banked donor CVS to be used in the first VMT intervention RCT. In the ITT population, the primary efficacy analysis showed statistically significant increase from baseline in relative abundance of vaginal lactobacilli to follow-up timepoints 1 week and 3 cycles post intervention in the active arm, while no statistical significant change was observed in the placebo arm at any follow-up timepoint. Also, time-resolved metagenomic analysis showed that 50% of women treated with VMT displayed a shift of the vaginal microbiome toward the Lactobacillus-dominated donor CVS sample, confirmed with strain-level engraftment analysis. We observed no serious treatment-associated adverse events and the intervention was well tolerated. Further, the successful “twinning” of the recipient to match the donor microbiome post-VMT also led to a dramatic shift toward an anti-inflammatory environment based on transcriptomic analysis of CVS. Limitations, reasons for caution Recipients were asymptomatic and mainly Caucasian, which limits generalizability to other ethnicities and the symptomatic spectrum of vaginal dysbiosis. Due to COVID-19-related recruitment issues, the cohort size ended below the targeted number of n = 40. Future studies will aim to identify factors driving engraftment and its impact on clinical outcomes. Wider implications of the findings Vaginal microbial interventions including VMT have great potential as the first therapeutic intervention that provides effective and long-term vaginal microbiota restoration, positively impacting a wide variety of diseases and conditions affecting the female reproductive tract. Trial registration number NCT05114031

OBJECTIVE:To examine the association between threatened miscarriage, and neurodevelopmental disorders, including autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) in offspring by age 14 years. METHODS:We used data from the Millennium Cohort Study, a nationally representative longitudinal study of children born in the UK. Data on threatened miscarriage and potential confounders were maternal-reported and collected at 9 months postpartum. Data on ASD and ADHD were based on maternal-reported doctor diagnoses and collected when children were aged 5, 7, 11 and 14 years. A diagnosis of ASD or ADHD was assumed if parents reported ASD or ADHD at age 5, 7, 11 or 14 years. Crude and adjusted logistic regression examined threatened miscarriage and ASD and ADHD relationship, adjusting for several sociodemographic, maternal and lifestyle factors. RESULTS:A total of 18,294 singleton babies were included at baseline, and 1,104 (6.0%) women experienced a threatened miscarriage during their pregnancy. Adjusted results suggested an association between threatened miscarriage and ASD (OR: 1.55, 95% CI 1.15, 2.08), and ADHD (OR: 1.51, 95% CI 1.09, 2.10) by age 14 years. E-values for threatened miscarriage and ASD were 2.47, while the lower limits of the 95% CI were 1.57. E-values for threatened miscarriage and ADHD were 2.39, while the corresponding lower limits of the 95% CI were 1.40. CONCLUSION:Threatened miscarriage was associated with an increased likelihood of ASD and ADHD by the age of 14 years, however, residual confounding cannot be ruled out. Placental pathology may be a potential mechanism for the observed associations.

Fetal hypoxic brain injury is the deprivation of oxygen during labour and is associated with up to 60% mortality. The gold standard of fetal monitoring during labour, the cardio tocograph (CTG) and fetal blood sampling are poor at diagnosing hypoxia continuously and non-invasively. Our research is towards developing a non-invasive, continuous hypoxia assessment system using long wavelength near-infrared spectroscopy through a fiber optic based reflectance. Lactate is a key biomarker for hypoxia determination in babies during birth. For successful implementation of this probe, it is required that it detects lactate in maternal environment and in presence of other spectroscopic interferences. In this paper we look at lactate sensing through a liquid phantom containing spectrally interfering components alongside lactate like glucose, urea, triacetin and albumin. Through these experiments we determine the relevant wavelengths and their combination for effective lactate sensing.

BACKGROUND:Iron deficiency affects a large proportion of pregnant women worldwide, with potentially serious consequences for perinatal and infant outcomes, but well-powered, comprehensive analyses of longitudinal iron status during pregnancy are scarce. OBJECTIVES:This study aimed to evaluate the longitudinal changes in iron biomarkers across pregnancy and prevalence of iron deficiency in primiparous women in a high-resource setting and propose early pregnancy iron status cutoffs that predict iron deficiency in the third trimester. METHODS:In a prospective cohort of primiparous women with low-risk, singleton pregnancies in Ireland, iron [ferritin, soluble transferrin receptors (sTfR), total body iron (TBI)] and inflammatory markers (C-reactive protein, α-glycoprotein) were measured at 3 study visits: 15, 20, and 33 wk of gestation. Women with anemia (hemoglobin < 110g/L) at their first routine antenatal visit were excluded from this analysis. RESULTS:Participants (N = 629) were Caucasian (98.2%) and born in Ireland (80.6%). The prevalence of iron deficiency (ferritin < 15 μg/L) increased throughout pregnancy, at 4.5%, 13.7% and 51.2% at 15, 20, and 33 wk of gestation, respectively. Using a ferritin threshold of <30 μg/L, rates of deficiency were 20.7%, 43.7%, and 83.8% across these time points, respectively. Application of sTfR of >4.4 mg/L generated similar prevalence data as ferritin of <15 μg/L at 7.2%, 12.6%, and 60.9%, respectively. Using TBI of <0 mg/kg, deficiency rates were lower than using ferritin or sTfR (P < 0.001). Using a cutpoint analysis method (area under the curve = 0.750), ferritin of <60 μg/L emerged as the ferritin threshold at 15 wk that predicted the presence of iron deficiency (ferritin < 15 μg/L) at 33 wk. Iron-containing supplements (mainly multivitamins) taken prepreganancy/early pregnancy was associated with reduced risk of deficiency throughout pregnancy, including the third trimester (odds ratio: 0.57; 95% confidence interval: 0.39, 0.82; P = 0.002). CONCLUSIONS:Pregnancy places a remarkable strain on maternal iron status even in a high-resource, generally iron-supplemented population. Women should be screened early in pregnancy for iron status, with a suggested target ferritin concentration of >60 μg/L. This trial was registered at clinicaltrials.gov as NCT01891240 (IMPROvED Study; ==https://www. CLINICALTRIALS:gov/study/NCT01891240?cond=NCT01891240&rank=1).

Hypertensive disorders of pregnancy, including pre-eclampsia, are a leading cause of serious and debilitating complications that affect both the mother and the fetus. Despite the occurrence and the health implications of these disorders there is still relatively limited evidence on the molecular underpinnings of the pathophysiology. An area that has come to the fore with regard to its influence on health and disease is the microbiome. While there are several microbiome niches on and within the body, the distal end of the gut harbors the largest of these impacting on many different systems of the body including the central nervous system, the immune system, and the reproductive system. While the role of the microbiome in hypertensive disorders, including pre-eclampsia, has not been fully elucidated some studies have indicated that several of the symptoms of these disorders are linked to an altered gut microbiome. In this review, we examine both pre-eclampsia and microbiome literature to summarize the current knowledge on whether the microbiome drives the symptoms of pre-eclampsia or if the aberrant microbiome is a consequence of this condition. Despite the paucity of studies, obvious gut microbiome changes have been noted in women with pre-eclampsia and the individual symptoms associated with the condition. Yet further research is required to fully elucidate the role of the microbiome and the significance it plays in the development of the symptoms. Regardless of this, the literature highlights the potential for a microbiome targeted intervention such as dietary changes or prebiotic and probiotics to reduce the impact of some aspects of these disorders.

( Acta Obstet Gynecol Scand . 2023;102(11):1459–1468. doi: 10.1111/aogs.14659) Many studies have shown that socioeconomic factors have large impacts on many areas of life including education, unemployment, housing security, nutrition, and reduced access to health care. In addition, low-socioeconomic indicators have been linked to pregnancy complications for both mother and neonate and have persisted even in areas with universal health care systems. However, other studies have shown an absence of association with socioeconomic status for outcomes such as low birthweight and preterm birth. Previous literature has suggested that assessing individual-level socioeconomic factors and their association with pregnancy outcomes may provide better understanding than area-based analysis. This study was designed to evaluate associations of individual-level socioeconomic factors (education, employment, relationship status, and income) with adverse pregnancy and neonatal outcomes (gestational hypertension, preeclampsia, gestational diabetes, emergency cesarean delivery, preterm birth, post-term delivery, small for gestational age, and Apgar score).