Objectives

Male sex is an independent risk factor for unfavorable outcomes of pregnancy and delivery.

Active induction of labor in term low risk gestations with isolated oligohydramnios translated into higher labor induction, operative vaginal delivery and cesarean section rates. This led to increased maternal risk and an increase in costs with no differences in neonatal outcome.

COVID-19 has reached pandemic proportions worldwide, with considerable consequences for both health and the economy. In pregnant women, COVID-19 can alter the metabolic environment, iron metabolism, and oxygen supply of trophoblastic cells, and therefore have a negative influence on essential mechanisms of fetal development. The purpose of this study was to investigate, for the first time, the effects of COVID-19 infection during pregnancy with regard to the oxidative/antioxidant status in mothers’ serum and placenta, together with placental iron metabolism. Results showed no differences in superoxide dismutase activity and placental antioxidant capacity. However, antioxidant capacity decreased in the serum of infected mothers. Catalase activity decreased in the COVID-19 group, while an increase in 8-hydroxy-2’-deoxyguanosine, hydroperoxides, 15-FT-isoprostanes, and carbonyl groups were recorded in this group. Placental vitamin D, E, and Coenzyme-Q10 also showed to be increased in the COVID-19 group. As for iron-related proteins, an up-regulation of placental DMT1, ferroportin-1, and ferritin expression was recorded in infected women. Due to the potential role of iron metabolism and oxidative stress in placental function and complications, further research is needed to explain the pathogenic mechanism of COVID-19 that may affect pregnancy, so as to assess the short-term and long-term outcomes in mothers’ and infants’ health.

ObjectiveTo evaluate the diagnostic accuracy of the Fetal Medicine Foundation (FMF) competing risk model (the triple test) for the prediction of preterm pre‐eclampsia (PE) in a Spanish population.MethodsThis was a prospective cohort study performed in eight fetal‐medicine units in five different regions of Spain between September 2017 and December 2019. All pregnant women with singleton pregnancies and non‐malformed live fetuses attending their routine ultrasound examination at 11+0‐13+6 weeks' gestation were invited to participate in the study. We recorded maternal demographic characteristics and medical history and measured MAP, UtA‐PI, and serum PlGF and PAPP‐A following standardized protocols. We also recorded whether the women were treated with aspirin during pregnancy. The raw values of the biomarkers were converted into multiples of the median (MoM), and audits were periodically performed for the operators and laboratories to receive continuous feedback. Risks for term and preterm PE were calculated according to the FMF competing risks model blinded to outcome. The performance of screening for PE, taking account of aspirin, was assessed by calculating the areas under the receiver‐operating‐characteristics curve (AUROC) and detection rates (DRs) with 95% confidence intervals (CI) at different fixed screen‐positive rates (SPRs). Risk calibration was also assessed.ResultsThe study population comprised 10,110 singleton pregnancies, including 72 (0.7%) that developed preterm PE. Compared to those without PE, the median MAP and UtA‐PI were significantly higher in the preterm PE group, and the median serum PlGF and pregnancy‐associated plasma protein A (PAPP‐A) were significantly lower. In the PE group, the deviation in biomarkers from normal was inversely related to the gestational age at delivery. In screening by a combination of maternal characteristics and medical history with MAP, UtA‐PI, and PlGF, at an SPR of 10%, the DR of preterm PE was 72.7 (95% CI, 62.9–82.6). An alternative strategy of replacing PlGF with PAPP‐A in the triple test was associated with poorer screening performance; the DR was 66.5% (95% CI, 55.8–77.2). Calibration plots showed good agreement between predicted and observed cases of preterm PE, with a slope of 0.983 (0.846–1.120) and an intercept of 0.154 (‐0.091 to 0.397). Our DR of preterm PE at 10% SPR by the triple test was lower than that reported by the FMF (72.7% vs. 74.8%).ConclusionsThe FMF model is effective in predicting preterm PE in the Spanish population. This method of screening is feasible and easy to implement in routine clinical practice, but it must be accompanied by a good audit and monitoring system, which helps ensure the quality of the screening.This article is protected by copyright. All rights reserved.