Prompt diagnosis and treatment with contemporary antimicrobial therapy and intensive care unit management of respiratory compromise has reduced the maternal morbidity and mortality due to pneumonia in pregnancy. Prevention with vaccination in at-risk populations may reduce the prevalence and severity of pneumonia in pregnant women.

What's already known about this topic? Noninvasive prenatal testing for detection of trisomies 21, 18, and 13 is clinically available and is reported to have a false positive rate of 1% or less This technology utilizes massively parallel shotgun sequencing of cell‐free DNA, of maternal and placental origin, present in maternal plasma What does this study add? Unexplained abnormal noninvasive prenatal testing results should prompt consideration of a maternal source of the abnormal cell‐free DNA, such as malignancy

OBJECTIVE To determine the effect of maternal super-obesity (BMI ≥50 kg/m2) compared to morbid obesity (BMI 40–49.9 kg/m2) or obesity (BMI 30–39.9 kg/m2) on perinatal outcomes. STUDY DESIGN Retrospective cohort study of birth records linked to hospital discharge data for all live born singleton term infants born to obese Missouri residents from 2000–2006. We excluded major congenital anomalies and women with diabetes or chronic hypertension. RESULTS There were 64,272 births meeting study criteria, including 1,185 (1.8%) super-obese mothers. Super-obese women were significantly more likely than obese women to have preeclampsia (aRR 1.7, 95% CI 1.4, 2.1), macrosomia (aRR 1.8, 95% CI 1.3, 2.5), and cesarean delivery (aRR 1.8, 95% CI 1.5, 2.1). Almost half (49.1%) of all super-obese women delivered via cesarean, and 33.8% of super-obese nulliparous women underwent scheduled primary cesarean. CONCLUSION Women with a BMI ≥50 kg/m2 are at significantly increased risk for perinatal complications compared to obese women of lower BMI.

Twin pregnancies contribute a disproportionate degree to perinatal morbidity, partly because of increased risks of low birth weight and prematurity. Although the cause of the morbidity is multifactorial, attention to twin-specific maternal nutrition may be beneficial in achieving optimal fetal growth and birth weight. Achievement of body mass index (BMI)-specific weight gain goals, micronutrient and macronutrient supplementation specific to the physiology of twin gestations, and carbohydrate-controlled diets are recommended for optimal twin growth and pregnancy outcomes. The daily recommended caloric intake for normal-BMI women with twins is 40-45 kcal/kg each day, and iron, folate, calcium, magnesium, and zinc supplementation is recommended beyond a usual prenatal vitamin. Daily supplementation of docosahexaenoic acid and vitamin D should also be considered. Multiple gestation-specific prenatal care settings with a focus on nutritional interventions improve birth weight and length of gestation and should be considered for the care of women carrying multiples. Antepartum lactation consultation can also improve the rate of postpartum breastfeeding in twin pregnancies. Twin gestation-specific nutritional interventions seem effective in improving the outcome of these pregnancies and should be emphasized in the antepartum care of multiple gestations. This review examines the available evidence and offers recommendations for twin pregnancy-specific nutritional interventions.

Background: Open maternal-fetal surgery (OMFS) for fetal myelomeningocele (fMMC) results in reduction in neonatal morbidity related to spina bifida but may be associated with fetal, neonatal, and maternal complications in subsequent pregnancies. Objective:The objective of this study was to ascertain obstetric risk in subsequent pregnancies after OMFS for fMMC closure.Study Design: An international multicenter prospective observational registry created to track and report maternal, obstetric, fetal/neonatal and subsequent pregnancy outcomes following OMFS for fMMC, was evaluated for subsequent pregnancy outcome variables. Institutional Review Board approval was obtained for the registry.Results: From 693 cases of OMFS for fMMC closure entered into the registry, 77 subsequent pregnancies in 60 women were identified. The overall live birth rate was 96.2% with 52

Congenital cytomegalovirus (CMV) infections are associated with stillbirth, neonatal death, deafness, and cognitive and motor delay. Small observational studies have evaluated CMV hyperimmune globulin to prevent congenital infection in women with primary CMV infection during pregnancy; however, the results were either inconsistent or inconclusive. The goal of this study was to determine if CMV hyperimmune globulin can prevent congenital CMV in affected women early in pregnancy.This was a multicenter, double-blind trial conducted at 16 centers in the Maternal-Fetal Medicine Units Network of the Eunice Kennedy Shriver National Institute of Child Health and Human Development and at 1 military medical center. Oral or written informed consent was obtained before enrolling in the study. Pregnant women with primary CMV infection diagnosed before 24 weeks' gestation were eligible for participation. Primary CMV infection was defined as either the presence of CMV IgM antibody of at least 1.00 index, IgG antibody of at least 6.0 AU per milliliter, and IgG avidity less than 50%; or a positive CMV IgG screening result after an initial negative screen earlier in pregnancy. Enrolled patients were randomly assigned to either receive a monthly infusion of CMV hyperimmune globulin or placebo until delivery. Each infusion was administered at a rate of 0.3 mL/kg per hour. If no adverse reactions were noted, the dose was increased in increments.The primary outcome for this study was a composite of confirmed fetal infection or congenital infection diagnosed by 3 weeks of age or fetal or neonatal death (including pregnancy termination) if CMV testing was not performed in the fetus or neonate. Secondary outcomes were hypertensive disorders of pregnancy, placental abruption, and adverse events. In all, 206,082 pregnant women were screened and 399 underwent randomization. Of the 399 enrolled patients, 206 were assigned to receive hyperimmune globulin and 193 were assigned to receive placebo. A total of 5 patients were lost to follow-up, so 203 were included in the final hyperimmune globulin group and 191 were included in the final placebo group.A primary outcome event occurred in 46 fetuses or neonates (22.7%) in the group that received hyperimmune globulin and in 37 fetuses or neonates in the placebo group (19.4%; relative risk, 1.17; 95% confidence interval [CI], 0.80-1.72; P = 0.42). Death occurred in 4.9% of fetuses or neonates in the hyperimmune globulin group and in 2.6% in the placebo group (relative risk, 1.88; 95% CI, 0.66-5.41). Preterm birth occurred in 12.2% of the hyperimmune globulin group and 8.3% in the placebo group (relative risk, 1.47; 95% CI, 0.81-2.67). Birth weight was below the fifth percentile in 10.3% of the hyperimmune globulin group and 5.4% of the placebo group (relative risk, 1.92; 95% CI, 0.92-3.99). Participants who received hyperimmune

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Variation in practice patterns for offering and performing maternal-fetal surgery for myelomeningocele repair exists among centers. Ongoing evaluation of inclusion and exclusion criteria as well as operative techniques is warranted to ensure continued safety, effectiveness, and beneficence.