Amir Naeh

This study aimed to evaluate the risk of type 2 diabetes mellitus (T2DM) in women with flat response in the 100-g oral glucose tolerance test (OGTT) performed during pregnancy in a large cohort of women with up to 5 years of follow-up.A retrospective analysis of women with documented OGTT during pregnancy and T2DM data up to 5 years after pregnancy. Gestational diabetes mellitus (GDM) screening was done by a two-step strategy. Glucose levels during pregnancy were extracted from the computerized laboratory system of Meuhedet Health Maintenance Organization (HMO) and cross-tabulated with the Israeli National Diabetes Registry. Flat OGTT was defined as fasting glucose <95 mg/dL and three postprandial values lower than 100 mg/dL. The cohort was stratified by OGTT results to normal glucose values, flat OGTT, and GDM according to Carpenter and Coustan thresholds. Cumulative risk for T2DM was evaluated and compared between groups. Statistical analysis included univariate analysis followed by survival analysis.A total of 14,122 parturients entered the analysis. Of them, 965 (6.8%) had flat OGTT, 11,427 (80.9%) had normal OGTT, and 1,730 (12.3%) had GDM. Women with flat OGTT were younger, had lower body mass index (BMI; kg/m2), and had lower rates of hypertension. Their glucose values throughout pregnancy were lower compared with the other groups (p < 0.001 for all). During the study period and following adjustment to maternal age, obesity, and hypertension, women with flat OGTT had a low incidence of T2DM, even when compared with women with normal OGTT (adjusted hazard ratio 0.212, 95% confidence interval 0.052–0.856).Parturients with flat OGTT during pregnancy are at a low risk of developing T2DM up to 5 years following pregnancy.

Background: The prevalence of pregestational diabetes mellitus (PGDM) in women of reproductive age has surged globally, contributing to increased rates of adverse pregnancy outcomes. Hemoglobin A1c (HbA1c) is a crucial marker for diagnosing and monitoring PGDM, with periconceptional levels influencing the risk of congenital anomalies and complications. Objectives: To evaluate the association between periconceptional HbA1c levels and perinatal complications in pregnant women with poorly controlled PGDM. Methods: We conducted a retrospective analysis of prospectively collected data of pregnancies between 2010 and 2019, HbAl c > 6% at 3 months prior to conception or during the first trimester. Outcomes of periconceptional HbA1c levels were compared. Results: The cohort included 89 women: 49 with HbA1c 6-8%, 29 with HbA1c 8-10%, and 11 with HbA1c > 10%. Higher HbA1c levels were more prevalent in type 1 diabetics and were associated with increased end-organ damage risk. Women with elevated HbAlc levels tended toward unbalanced glucose levels during pregnancy. The cohort exhibited high rates of preterm delivery, hypertensive disorders, cesarean delivery, and neonatal intensive care unit admission. Overall live birth rate was 83%. While a significant correlation was found between HbAlc levels and preterm delivery, no consistent association was observed with other adverse outcomes. Conclusions: Periconceptional glycemic control in PGDM pregnancies is important. Elevated HbA1c levels are associated with increased risks of adverse outcomes. Beyond a certain HbAlc level, risks of complications may not proportionally escalate.

In this retrospective cohort study, we aimed to investigate the variables associated with progression to preeclampsia with severe features in parturients already diagnosed with mild hypertensive disorders of pregnancy. The study was conducted in a single university-affiliated medical center between 2018 and 2020. All women admitted due to hypertensive disorders were included. Data collected was compared between parturients who progressed and did not progress to preeclampsia with severe features. Among 359 women presenting without severe features, 18 (5%) developed severe features, delivered smaller babies at lower gestational age, and with higher rates of cesarean delivery (p < 0.001 for all). Chronic hypertension, maternal diabetes, any previous gestational hypertensive disorder, gestational diabetes, number of hospitalizations, earlier gestational age at initial presentation, and superimposed preeclampsia as the preliminary diagnosis were all associated with preeclampsia progression to severe features. Previous delivery within 2–5 years was a protective variable from preeclampsia progression. Following regression analysis and adjustment to confounders, only gestational age at initial presentation and superimposed preeclampsia remained significant variables associated with progression to severe features (aOR 0.74 (0.55–0.96) and 34.44 (1.07–1111.85), aOR (95% CI), respectively, p < 0.05 for both) with combined ROC-AUC prediction performance of 0.89, 95% CI 0.83–0.95, p < 0.001. In conclusion, according to our study results, early gestational age at presentation and superimposed preeclampsia as the preliminary diagnosis are the only independent factors that are associated with progression to severe features in women already diagnosed with mild hypertensive disorders during pregnancy.

Objective: Evidence regarding the clinical significance of a single sporadic variable deceleration (SSD) in reactive non-stress test (NST) is scarce, and optimal management has yet to be established. We aim to evaluate whether SSD during a reactive NST at term is associated with a higher risk for fetal heart rate decelerations during labor and the need for intervention. Methods: This was a retrospective, case-control study of singleton term pregnancies at one university-affiliated medical center in 2018. The study group consisted of all pregnancies with an SSD in an otherwise reactive NST. For each case, two consecutive pregnancies without SSD were matched in a 1:2 ratio. The primary outcome was the rate of cesarean delivery (CD) due to non-reassuring fetal heart rate monitoring (NRFHRM). Results: 84 women with an SSD were compared to 168 controls. SSD during antenatal fetal surveillance did not increase the rate of CD overall or for NRFHRM (17.9% vs. 13.7% and 10.7% vs. 7.7%, respectively, p > 0.05). Rates of assisted deliveries and maternal and neonatal complications were similar between the groups. Conclusions: SSD during a reactive NST in term pregnancies is not associated with an increased risk for adverse perinatal outcomes. SSD should not necessarily require induction of labor, and expectant management is a reasonable alternative.

To identify risk factors, maternal and neonatal adverse outcomes related to unintended lower segment uterine extension during cesarean delivery (CD).A retrospective cohort analysis in a single, uni...

Purpose: The non-stress test (NST) is the most widely applied technique for antepartum fetal assessment with the goal to reduce stillbirth. The evidence regarding the clinical significance of a single sporadic variable deceleration (SSD) in reactive NST is scarce, and optimal management has yet been established. We aim to evaluate whether SSD during a reactive NST at term is associated with a higher risk for fetal heart rate decelerations during labor and the need for intervention. Methods: A retrospective, case-control study of singleton, term pregnancies at one university-affiliated medical center in 2018. Study group consisted of all pregnancies with an SSD in an otherwise reactive NST. For each case, two consecutive pregnancies without SSD were matched in a 1:2 ratio. The primary outcome was the rate of cesarean delivery (CD) due to non-reassuring fetal heart rate monitoring (NRFHRM). Results: 84 women with a diagnosis of SSD were compared to 168 controls. SSD during antenatal fetal surveillance was not associated with the presence of fetal heart rate decelerations during labor and did not increase the rate of CD overall or for NRFHRM (17.9% vs. 13.7% and 10.7% vs. 7.7%, study vs. control group, respectively, p>0.05). Likewise, rates of assisted deliveries, maternal outcomes, and neonatal complications were similar between the groups. Conclusions: SSD during a reactive NST in term pregnancies is not associated with an increased risk for adverse perinatal outcomes. Expectant management should be considered in pregnancies with SSD at term.

Gestational diabetes mellitus (GDM) complicates between 5 and 12% of pregnancies, with associated maternal, fetal, and neonatal complications. The ideal screening and diagnostic criteria to diagnose and treat GDM have not been established and, currently, diagnostic use with an oral glucose tolerance test occurs late in pregnancy and produces poor reproducibility. Therefore, in recent years, significant research has been undertaken to identify a first-trimester biomarker that can predict GDM later in pregnancy, enable early intervention, and reduce GDM-related adverse pregnancy outcomes. Possible biomarkers include glycemic markers (fasting glucose and hemoglobin A1c), adipocyte-derived markers (adiponectin and leptin), pregnancy-related markers (pregnancy-associated plasma protein-A and the placental growth factor), inflammatory markers (C-reactive protein and tumor necrosis factor-α), insulin resistance markers (sex hormone-binding globulin), and others. This review summarizes current data on first-trimester biomarkers, the advantages, and the limitations. Large multi-ethnic clinical trials and cost-effectiveness analyses are needed not only to build effective prediction models but also to validate their clinical use.