Significance and Outcomes of Fetal Growth Restriction Below the 5th Percentile Compared to the 5th to 10th Percentiles on Midgestation Growth Ultrasonography

OBJECTIVE

To determine whether there are differences in neonatal and pregnancy outcomes in pregnancies complicated by severe fetal growth restriction, defined as estimated fetal weight below the 5th percentile, compared with estimated fetal weight in the 5th to 10th percentiles at midgestation.

METHODS

We conducted a retrospective review of singleton nonanomalous gestations with estimated fetal weight at or below the 10th percentile (Hadlock et al. Radiology 1991; 181:129-133) at 18 to 24 weeks' gestation. The cohort was divided into fetuses with estimated fetal weight below the 5th percentile and estimated fetal weight in the 5th to 10th percentiles. Antenatal and neonatal outcomes were compared across the groups.

RESULTS

Of the 254 growth-restricted fetuses, 91 had estimated fetal weight below the 5th percentile, and 163 were in the 5th to 10th percentiles. Fetuses below the 5th percentile were 2.82 times more likely to be born small for gestational age compared to fetuses at the 5th to 10th percentiles (P = .001). Fetuses with estimated fetal weight below the 5th percentile had higher rates of hypertensive disorders of pregnancy (relative risk [RR], 1.79; P = .04), abnormal umbilical artery Doppler waveforms (RR, 6.27; P = .01), labor induction (RR, 1.45; P = .002), neonatal intensive care unit admission (RR, 1.73; P = .02), and Apgar scores of less than 7 at 1 minute (RR, 2.05; P = .04).

CONCLUSIONS

Severely growth-restricted fetuses with an estimated fetal weight below the 5th percentile at 18 to 24 weeks are born smaller and have worse antepartum and neonatal outcomes than those with an estimated fetal weight in the 5th to 10th percentiles. These findings suggest that severely growth-restricted fetuses at midgestation should be treated and counseled differently than those in the 5th to 10th percentiles.

Incidence of kidney stones in pregnancy and associations with adverse obstetrical outcomes: a systematic review and meta-analysis of 4.7 million pregnancies

BACKGROUND

Renal stones are a common cause of non-obstetrical abdominal pain in pregnant women. Though the management of renal stones in pregnancy is challenging, it remains unclear how the incidence of kidney stones may affect the course of pregnancy and delivery.

OBJECTIVE

To determine the incidence of renal stones in pregnancy and its impact on adverse obstetrical outcomes.

DATA SOURCES

We conducted a systematic literature search of three databases: Ovid MEDLINE, Ovid EMBASE, and EBSCO CINAHL Plus. After the selection of articles, an additional hand-search of their citations was completed to maximize sensitivity. Databases were examined from the last four decades (19 March 1970) up to the search date (19 March 2020).

STUDY ELIGIBILITY CRITERIA

Articles were excluded if they were not relevant to kidney stones or did not report outcomes related to pregnancy. Case reports, animal studies, and cadaveric studies were excluded. Conference abstracts, gray literature, and unpublished data were not eligible.

STUDY APPRAISAL AND SYNTHESIS METHODS

All screening, extraction, and synthesis were completed in duplicate with two independent reviewers. All outcomes reported in the included studies were systematically evaluated to determine suitability for meta-analysis. Random-effects models and sensitivity analyses were used to account for interstudy variation. Renal stone incidence rates were pooled to generate summary proportions. Risk of bias assessment was completed using the Risk of Bias Assessment tool for Non-randomized Studies.

RESULTS

Twenty-one studies were included through systematic review and approximately 4.7 million pregnancies across nine studies were included for meta-analysis. There are three major findings of this review regarding renal stone incidence in pregnancy and maternal, child, and birth-related outcomes associated with renal stones. First, we found pooled incidence of renal stones was 0.49%, or one case for every 204 pregnancies. Second, renal stones during pregnancy were significantly associated with the development of preeclampsia and urinary tract infection, as well as increased likelihood of low birth weight, preterm labor, and C-section deliveries. However, renal stones were not significantly associated with premature rupture of membranes or infant mortality. Third, there were limited obstetrical complications reported with either medical or surgical therapies although comparative outcomes were not provided in the majority of studies, precluding formal meta-analysis.

CONCLUSIONS

Although renal stones in pregnancy are relatively rare, there may be an associated risk of serious adverse obstetrical outcomes. However, further research is required to understand whether these obstetrical outcomes are causal or due to other confounders. Interdisciplinary care and pregnancy-specific counseling should be advised for pregnant women with kidney stones.

Antenatal and perinatal outcomes of refugees in high income countries

OBJECTIVES

The World Health Organisation (WHO) has highlighted a marked trend for worse pregnancy-related indicators in migrants, such as maternal and neonatal morbidity and mortality, poor mental health and suboptimal care. The aim of this study was to determine whether such adverse outcomes occurred in refugees who moved to high income countries by comparing their antenatal and perinatal outcomes to those of non-immigrant women.

METHODS

A literature search was undertaken. Embase and Medline databases were searched using Ovid. Search terms included "refugee", "pregnan*" or "neonat*", and "outcome".

RESULTS

The search yielded 194 papers, 23 were included in the final analysis. All the papers included were either retrospective cohort or cross-sectional studies. The refugees studied originated from a wide variety of source countries, including Eritrea, Somalia, Afghanistan, Iraq, and Syria. Refugee women were more likely to be socially disadvantaged, but less likely to smoke or take illegal drugs during pregnancy. Refugee women were more likely to have poor, late, or no attendance at antenatal care. Miscarriages and stillbirth were more common amongst refugee women than non-refugees. Perinatal mortality was higher among refugees.

CONCLUSIONS

Despite better health care services in high income countries, refugee mothers still had worse outcomes. This may be explained by their late or lack of attendance to antenatal care.

Outcomes of antenatal depression in women and the new-born: a retrospective cohort study

OBJECTIVE

To determine what effect maternal antenatal depression has on pregnancy and infant outcomes in the Lleida health region.

METHODS

Retrospective observational cohort study in pregnant women between 2012 and 2018 in the Lleida health region. Variables included age, body mass index, caesarean section, pre-eclampsia, birth weight, and Apgar score. We performed multivariate analysis, with linear regression coefficients and 95% confidence interval (CI).

RESULTS

Antenatal depression was diagnosed in 2.54% pregnant women from a total sample of 17 177. Depression is significantly associated with a higher risk pregnancy and low birth weight. Pre-eclampsia, 1-minute Apgar score, and caesarean section were not significantly associated with depression.

CONCLUSIONS

Antenatal depression increases the risk of pregnancy complications. In addition, depression in the mother increases the probability of low birth weight.