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Background/Objectives: Sleep breathing disorders (SBDs) comprise a range of conditions characterized by abnormal respiratory patterns during sleep, with obstructive sleep apnea (OSA) being the most common. During pregnancy, SBDs are of clinical relevance, as they are associated with increased maternal and neonatal morbidity. Methods: A structured literature search was conducted to identify relevant studies addressing sleep breathing disordered in pregnancy, including longitudinal, observational, case-control, and cross-sectional studies, as well as other reviews and meta-analyses. Results: Adequate sleep during pregnancy is essential for maternal health and fetal development. OSA in pregnant women is strongly associated with hypertensive disorders of pregnancy (HDPs), potentially contributing to increased long-term cardiovascular risk. In addition to hypertensive complications, OSA has been linked to gestational diabetes and postpartum depression. Untreated SBDs may also have consequences beyond pregnancy, adversely affecting fetal and neonatal outcomes. Pathophysiological mechanisms related to maternal SBDs can result in fetal growth restriction, impaired neurocognitive development, and an increased risk of preterm birth. Conclusions: Current evidence indicates that OSA during pregnancy is associated with elevated short- and long-term risks for both mothers and offspring. Future research should prioritize large prospective studies with standardized diagnostic criteria and outcomes, as well as pragmatic trials to assess the implementation of SBD screening in prenatal care, particularly among high-risk populations such as obese women.

Objectives: Excessive fetal growth is the most common fetal complication associated with gestational diabetes (GDM), resulting in adverse short- and long-term outcomes. Our main objective was to evaluate the influence of excessive fetal growth on Doppler ultrasonographic measurements of the Umbilical Artery (UA) among women with GDM during the third trimester of pregnancy. Methods: A retrospective study among 472 women with GDM was conducted. UA-PI was measured by Doppler ultrasonography three different times during the third trimester of pregnancy at 28, 32, and 36 weeks. Pregnancies were grouped according to the fetal weight centile or birthweight in two groups: large for gestational age (LGA) group (>90th percentile or ≥4000 g at birth) and adequate for gestational age (AGA) group (p = 0.0001) and fasting blood glucose than the AGA group (97.08 ± 40.69 vs. 86.29 ± 39.58 mg/dL; p = 0.0550). They required insulin therapy more frequently to achieve glycemic control (63.2% vs. 34%, p = 0.0001). In LGA, UA-PI decreased progressively from 28 to 36 weeks (p = 0.0048). The most pronounced reduction occurred at 32 weeks (p = 0.0076). Conclusions: All fetuses from mothers with GDM had a significant and progressive decline in UA-PI during the third trimester of pregnancy. LGA fetuses showed lower UA-PI values compared with AGA fetuses. Since maternal hyperglycemia increases the risk of fetal overweight and GDM may represent a fetal vascular disorder, it therefore seems possible that in LGA fetuses, maternal hyperglycemia could influence the fetal vasculature.

Background/Objectives: Perimenopause, impacting 80–90% of women, encompasses a range of vasomotor, urogenital, cognitive, and psychiatric symptoms associated with the fluctuation and gradual reduction of gonadal hormones. Moreover, the onset or worsening of sleep disturbances is prevalent during the menopausal transition. This narrative review seeks to elucidate the pathogenetic processes behind sleep disturbances during perimenopause and the main therapeutic options. Methods: The electronic databases PubMed, Scopus, Google Scholar, Web of Science, and Embase were queried for publications up to May 2024. Longitudinal, observational, case–control, and cross-sectional studies, as well as reviews and meta-analyses, were included in the review in order to explore the prevalence of sleep disorders during perimenopause, the pathogenetic mechanisms underlying the association between menopausal transition and sleep disorders, and the available non-pharmacological and pharmacological treatment options. Results: Sleep disturbances are common among perimenopausal women and include insomnia, sleep-related breathing disorders, and movement disorders. Fluctuations in estrogen and progesterone affect sleep quality, while vasomotor symptoms can disrupt sleep. Circadian changes, decreased melatonin production, and physiological changes associated with aging and mood disorders further exacerbate sleep disturbances. Conclusions: Managing sleep disorders in perimenopause requires an individualized approach, considering the multifactorial nature of these disturbances and providing background knowledge about the relationship between reproductive hormonal changes and sleep. Non-pharmacological treatments should be considered the first-line therapy; hormone therapy or non-hormonal pharmacological treatments can be considered according to the patients’ specific needs and risk factors. However, there is still a lack of standards on the appropriate management and treatment of sleep disorders in perimenopause.

Background and Objectives: Conscientious objection to voluntary abortion remains a hot debate topic. This could affect the accessibility to pregnancy termination. Our aim is to evaluate the possible aspects related to an operators’ choice about objection for voluntary abortion, such as the following: the abolition of the time limit, the instruction of a multi-collegiate commission, the introduction of pharmacological rather than surgical procedures, the fetal/maternal illness and the case of sexual violence. Materials and Methods: This is an observational, descriptive study that involves a cohort of Italian healthcare workers who answered a web-survey. Results: Of the total 352 respondents, only 20.8% affirmed to be objectors versus 79.2% of non-objectors. For the objectors, 72.2% declared that they would not change status in case of pharmacological abortion; 79.7% would not suspend their choice for interruption in the second trimester; 63.3% would suspend the objection with a multi-collegiate commission, and 69.0% would discontinue their objection in the case of sexual violence. 72.0% of the total participants declared that the abolition of the time limit could have a resecuring impact on women’s choice. Conclusions: Most operators declared that the abolition of the time limit could have beneficial effects. Among the objectors, the status would change especially with the introduction of a multi-collegiate commission, and in case of serious maternal/fetal illness and/or sexual violence.

Introduction and Hypothesis Obstetric anal sphincter injuries (OASIs), third- and fourth-degree lacerations, represent a severe obstetric complication. Previous studies reported a higher incidence of OASIs in Asian women in non-Asian countries. This study was aimed at establishing a different OASIs prevalence among the racial/ethnic groups in Southern European centers. Methods A multicenter retrospective study that included pregnant women who had vaginal singleton delivery between January 2019 and September 2022 in two Italian University hospitals, Naples and Novara, was conducted. We excluded cesarean sections, nonvertex presentation, preterm delivery, multiple pregnancies, congenital malformations, or stillbirths. Statistical analysis with an independent association of ethnicity to the risk of OASIs using clinical characteristics-adjusted multivariate logistic regression was performed. Results A total of 3,049 pregnant women were included. 2.33% (71 patients) had an OASI. The median age was 31 years (IQR 7.00) and median gestational age was 39 weeks (IQR 1.40). Mean birth weight was 3,300 g (IQR 580.00). 1' and 5' Apgar scores were 9 and 9. The univariate logistic regression was not statistically significant. Multivariate logistic regression model adjusted for baseline clinical characteristics showed an OR 2.540 (p value 0.01) for OASIs in Asian women. Primiparous and secondiparous were protective factors for OASIs with OR 0.224 (p value < 0.001) and OR 0.209 (p value 0.01). Conclusions Our results confirm racial/ethnic disparities regarding OASIs, with an elevated risk for Asian women in Southern Europe. Prevention strategies and obstetric care in developed countries should be modulated to offset the risk of OASIs in this population. Additional research is needed to explain the specific mechanisms of these disparities.

The umbilical cord, comprising three vital blood vessels, serves as the lifeline between mother and fetus. Prenatal care emphasizes detailed ultrasound examinations of the umbilical cord and postnatal inspections of the placenta and cord to preemptively address potential complications. Studies have consistently shown a significant link between a single umbilical artery and unfavorable perinatal consequences, such as mortality and congenital abnormalities. Conversely, the impact of additional vessels remains uncertain. This review is dedicated to enhancing our understanding and refining diagnostic and therapeutic approaches in prenatal healthcare. The objective is to identify knowledge gaps and propose evidence-based solutions to improve care for pregnant women and their unborn babies. The presence of a single umbilical artery in prenatal diagnosis may signify potential risks for fetal anomalies and adverse pregnancy outcomes such as hemodynamic instability, ischemia, and an increased likelihood of intrauterine growth restriction. Additionally, even the presence of supernumerary vessels may be associated with fetal malformations. Serial fetal evaluations are recommended for detecting anomalies and monitoring fetal growth throughout pregnancy. Despite the generally benign nature of isolated SUA and supernumerary vessels, close monitoring and comprehensive prenatal care are essential to ensuring optimal outcomes for both mother and baby.

Birth weight, which exhibits variability across different populations, is influenced by a mix of genetic, environmental, and dietary factors originating from both the mother and father. Maternal characteristics, including age, socioeconomic status, prior pregnancies, weight, height, and weight increase throughout pregnancy, have a substantial influence on fetal growth and the health of the infant. On the other hand, the influence of paternal characteristics on the weight of newborns is still not fully comprehended in a consistent manner. Birth weight is an important factor that can help predict various maternal complications, such as the probability of having a C-section, experiencing postpartum hemorrhage or infections. It can also indicate future health challenges like asthma, cognitive impairment, and chronic diseases such as hypertension and diabetes. Nineteen publications were found through a thorough search of the Medline, PubMed, and Scopus databases, which provide insights into how paternal variables contribute to variations in birth weight. Significantly, the age of the father was found to be associated with higher chances of preterm birth and having a smaller size for gestational age in premature infants, while full-term children were more likely to have a larger size for gestational age. In addition, there is a constant correlation between the height of the father and the birth weight of the child. Taller dads are more likely to have babies with a higher birth weight and a lower likelihood of being small for gestational age (SGA). Although there were some discrepancies in the data about the weight and BMI of fathers, it was found that the height of fathers played a significant role in determining the size of the fetus and the weight of the newborn. While there may be differences in the conducted studies, these findings provide valuable insights into the complex connection between parental characteristics and fetal development. This data can be utilized to enhance clinical treatment strategies and enhance our comprehension of outcomes for neonates. Further homogeneous investigations are required to conclusively validate and build upon these findings.

Background/Objectives: Gestational diabetes mellitus (GDM) is one of the most common morbidities of pregnancy. The impact of increased maternal blood glucose on fetoplacental hemodynamics is not fully elucidated, especially in patients with uncontrolled GDM necessitating insulin therapy. The objective of this study was to assess the impact of insulin therapy on the umbilical artery dopplers in GDM pregnancies adequate for gestational-age fetuses. Methods: Retrospective observational study among 447 GDM pregnant women, divided according to their treatment (nutritional therapy (NT), long acting (LA) insulin, combined insulin) and 100 healthy controls with the same gestational age. The umbilical artery pulsatility index (UA-PI) was recorded at 28, 32 and 36 weeks. Results: UA-PI values declined in both GDM and healthy controls at all three time intervals. The combined insulin group showed reduced UA-PI values in comparison to the LA insulin group, but the difference never reached statistical significance. The combined insulin group exhibited significantly reduced UA-PI values at 32- and 36-weeks’ gestation compared to the NT groups. Conclusions: A decreased impedance to blood flow in the umbilical artery of diabetic mothers on insulin therapy was observed. This was more pronounced during the last trimester. The extent to which umbilical artery PI can predict unfavorable outcomes has yet to be determined. Further additional studies are necessary to confirm the precise impact of glucose levels and medical interventions on the circulation of both the fetus and the mother.

Purpose Gestational diabetes mellitus (GDM) is one of the most common morbidities of pregnancy. The impact of increased maternal blood glucose on fetoplacental hemodynamics is not fully elucidated, especially in patients with uncontrolled GDM necessitating insulin therapy. The objective of this study was to assess the impact of insulin therapy on the umbilical artery dopplers in GDM pregnancies with adequate for gestational age fetuses. Methods Retrospective observational study among 447 GDM pregnant women, divided according to their treatment: nutritiona therapy (NT), long acting (LA) insulin and combined insulin. The umbilical artery pulsatility index (UA-PI) was recorded at 28, 32 and 36 weeks. Results UA-PI values declined in both GDM and healthy controls at all 3 time interval. The combined insulin group showed always a reduced UA-PI values in comparison to LA insulin group but the difference never reached statistical significance. The combined insulin group exhibited significant reduced UA-PI values at 32 and 36-weeks’ gestation compared to the NT groups. Conclusion A decreased impedence to blood flow in the umbilical artery of diabetic mothers on insulin therapy was observed, more pronounced during the final stage of pregnancy. Maternal hyperglycemia could have a worsening effect on fetal vasculature. Nevertheless, the extent to which umbilical artery PI can predict unfavorable outcomes associated with maternal hyperglycemia has yet to be determined. Further additional prospective studies are necessary to confirm the precise impact of glucose levels and medical interventions on the circulation of both the fetus and the mother.