Yu Xiong

Objective: To investigate whether noninvasive prenatal screening (NIPS) failure in a general‐risk population is associated with an increased likelihood of cytogenetic abnormalities. Methods: This was a retrospective observational cohort study at a tertiary center, based on a general‐risk population. Singleton pregnancies that underwent NIPS between May 12, 2017, and July 30, 2021, at the Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China, were included. The outcomes were the incidence of common autosomal aneuploidies (trisomy 21, 18, or 13), sex chromosome aneuploidies (SCAs), and copy number variations (CNVs) on the first attempt. From the reports of NIPS, the pregnancies with a failure were compared with those with a success. Propensity score overlap weighting was applied to adjust for maternal age, paternal age, parity, body mass index, method of conception and gestational age at the first blood collection. Results: Of the 42 121 pregnancies included, 41 776 (99.18%) received reports and 345 (0.82%) did not on the first attempt at NIPS. Pregnancies with NIPS failure showed no significantly statistical difference in the risk for trisomy 21, 18, or 13 (0.29% vs. 0.23%; overlap weighting risk ratio [OW RR] 1.17; 95% CI 0.16–8.46), SCAs (4.08% vs. 7.89%; OW RR 0.53; 95% CI, 0.13–2.26) and CNVs (6.12% vs. 8.13%; OW RR 0.76; 95% CI, 0.23–2.53), compared with those with successful NIPS. These findings remained consistent in the sensitivity analyses. Conclusions: The evidence was insufficient that NIPS failure after first‐trimester ultrasound screening could be associated with an increased risk of common autosomal aneuploidies, SCAs, and CNVs. Our findings suggest that in a general‐risk population those who experience NIPS failure need to be managed on the basis of their basic risk.

Administering antenatal corticosteroids (ACS) to those at risk for early-preterm delivery has been widely recommended, yet the evidence regarding twin pregnancies remains insufficient and controversial. This 8-year retrospective cohort study analyzed twin pregnancies at risk for early preterm birth (24 + 0 to 33 + 6 weeks of gestation) in a university-affiliated hospital in China from 2013 to 2020. Propensity score overlap weighting was used to analyze the association between ACS administration and the risk of neonatal outcomes. The primary outcome was the composite neonatal respiratory morbidity, defined as at least one of the following: postnatal occurrences respiratory distress syndrome, mechanical ventilation, surfactant administration, transferred with respiratory complications, or neonatal death. The study population consisted of 277 individuals with twin pregnancies, including 221 (79.8%) who received corticosteroids during 24 + 0 to 33 + 6 weeks of gestation as ACS group, and 56 (20.2%) who did not as no-ACS group. The propensity score overlap weighting showed no significant differences in the risk of neonatal primary outcome (161 [72.9%] vs. 40 [71.4%], weighted OR, 1.07[95% CI, 0.40–2.91]) between the two groups. None of the subgroup interaction tests were significant for the neonatal primary outcome in terms of year of delivery, advanced maternal age, parity, assisted reproductive technology, gestational diabetes mellitus, hypertensive disorders in pregnancy, gestational age at delivery, mode of delivery, chorionicity, intertwin growth discordance and infant sex, and neither was the sensitive analysis of using propensity score matching, different administration-to-birth interval, and treating twin infants as individuals. In this retrospective cohort study, no significant association was observed between ACS administration during the early-preterm period in twin pregnancies and a decreased risk of newborn morbidity. Further research is necessary to determine whether the same ACS regimen for twin pregnancies should be recommended in the real world as it is for singletons.

Fetal lingual lesion is a rare category of embryological anomalies, characterized by distinctive anatomical positioning, which may precipitate mechanical airway obstruction to unfavorable perinatal outcomes. There is a lack of comprehensive prenatal diagnostic strategies and effective treatments. This review has conducted a systematic literature overview of the clinical classification of fetal lingual anomalies, prenatal diagnosis, and perinatal treatment, including prenatal ultrasonography and magnetic resonance imaging, for optimizing perinatal care and obtaining an improved pregnancy outcome. Utilizing a multidisciplinary team framework, individualized peripartum management strategies are developed, contingent upon the presence or absence of airway compromise, with selective application of the ex-utero intrapartum treatment procedure as clinically warranted. By refining diagnostic accuracy and advancing therapeutic protocols, this review aims to elevate clinical management standards for congenital lingual lesions, thereby enhancing both short-term perinatal outcomes and long-term developmental prognoses.

It is well acknowledged that metabolic disorder binds closely with preeclampsia, though some of the causal relationships are still ambiguous. This review systematically summarizes the metabolic characteristics of carbohydrates, lipids, amino acids, and glycans in preeclampsia, highlighting their roles in oxidative stress, trophoblast autophagy, inflammatory response, and vascular tone regulation. Key findings include upregulated glycolysis and impaired mitochondrial function contributing to ATP deficiency, dysregulated lipid metabolism exacerbating oxidative stress and vascular dysfunction, and amino acid imbalances disrupting immune responses and redox homeostasis. Emerging therapies, such as metformin and pravastatin, demonstrate potential in targeting these pathways for prevention and treatment. Here, we reviewed thoroughly the related literature with a view to delineating the potential association of nutrient metabolism with preeclampsia, so that we could explore a promising therapeutic approach.

Fetal growth restriction (FGR) is a major determinant of perinatal morbidity and mortality. Our study aimed to develop a prediction model for the risk of FGR developing adverse perinatal outcome (APO) and evaluate its performance. This was a prospective observational cohort study of consecutive singleton gestations meeting the ACOG-endorsed criteria for FGR from January 2022 to June 2023 at Obstetrics and Gynecology Hospital of Fudan University. Clinical information, ultrasound indicators and serum biomarkers were collected. The primary composite APO comprised one or more of: perinatal death, intrauterine demise, intraventricular hemorrhage, periventricular leukomalacia, seizures, necrotizing enterocolitis, neonatal respiratory distress syndrome, sepsis and the length of stay in the neonatal intensive care unit > 7 days. Least absolute shrinkage and selection operator regression was used to screen variables for nomogram model construction. The discrimination, calibration and clinical effectiveness of the nomogram were evaluated using receiver operating characteristic curve, calibration plots and decision curve analysis in training and validation cohorts. A total of 122 pregnancies were enrolled in the final statistical analysis. Five variables were identified to establish a nomogram, including gestational weeks at diagnosis, abnormal umbilical artery Doppler, abnormal uterine artery Doppler, and multiples of the median values of placental growth factor and soluble fms-like tyrosine kinase-1. The area under the receiver-operating-characteristics curve of 0.87 (95% CI, 0.75–0.99) and 0.86 (95% CI, 0.74–0.98) in the training and validation cohort respectively, indicated satisfactory discriminative ability of the nomogram. The calibration plots showed favorable consistency between the nomogram’s predictions and actual observations. Decision curve analysis supported its practical value in a clinical setting. A nomogram was developed and validated to possess the promising capacity of predicting APO in FGR-afflicted neonates, and may prove useful in counseling and management of pregnancies complicated by FGR.

Over the past 4 decades, the prevalence of twin pregnancies has increased substantially and globally.^1,2 Meanwhile, the incidence of preterm births for twin pregnancies has remained notably high.^3,4 Among twins, those born in the late-preterm period (34 weeks and 0 days to 36 weeks and 6 days of gestation) comprise approximately 70% of twin pregnancies and experience a significantly higher rate of respiratory complications than do full-term infants.^5-7

Background: Preeclampsia is a common pregnancy complication characterized by high blood pressure and damage to organs. Abnormal placenta and vascular function can lead to preeclampsia. Accumulating evidence has suggested a potential link between circular RNAs (circRNAs) and preeclampsia. As a placenta and endothelial-expressed circRNA, hsa_circ_0002348, may be promising to be the novel molecular target for preeclampsia. However, the function and mechanism of hsa_circ_0002348 in preeclampsia has not been elucidated. Materials and methods: An overlap analysis of two circRNA profiles from placenta and endothelial cells was used to identify a functionally unknown circRNA, hsa_circ_0002348. Quantitative real-time PCR (qRT-PCR) and in situ hybridization (ISH) were used to detect its expression in the trophoblast cells and placental tissues. The mouse model of lipopolysaccharide (LPS)-induced preeclampsia was established to determine the in vivo role of hsa_circ_0002348. RNA immunoprecipitation (RIP), Luciferase reporter assay, qRT-PCR, western blot, gain- and loss-of-function and rescue experiments were conducted to uncover the role of hsa_circ_0002348 and its interaction with miR-126-3p and BAK1 in regulating trophoblast proliferation and apoptosis. Fluorescence in situ hybridization (FISH) and Immunohistochemistry (IHC) were performed to examine the expression of miR-126-3p and BAK1 in mice and human placentas, respectively. Results: Hsa_circ_0002348 was significantly increased in the preeclampsia placentas, and positively correlated with the severity of preeclampsia patients’ clinical manifestations. Its overexpression exacerbated preeclampsia-like features in the mouse model of LPS-induced preeclampsia. Functionally, hsa_circ_0002348 was found to inhibit trophoblast proliferation and promote trophoblast apoptosis. Mechanistically, hsa_circ_0002348, as an endogenous miR-126-3p sponge, upregulated the expression of BAK1. Additionally, both hsa_circ_0002348 knockdown and miR-126-3p overexpression enhanced the mammalian target of rapamycin (mTOR) and ERK1/2 signaling pathway. Conclusions: Hsa_circ_0002348 might be a novel regulator of trophoblast proliferation and apoptosis through miR-126-3p/BAK1 axis in preeclampsia, which may serve as a potential target for detecting and treating preeclampsia.

Twin pregnancy was associated with significantly higher rates of adverse neonatal and perinatal outcomes. One of the underlying causes is that twins are prone to preterm birth. Antenatal corticosteroids are widely used for reducing the incidence of neonatal respiratory distress syndrome initially and other neonatal mortality and morbidities subsequently. As it is widely used as a prophylactic treatment for potential premature births, there remain controversies of issues relating to twin gestations, including window for opportunity, timing of use, repeat course, optimal administration-to-delivery intervals, dosage, and type of corticosteroid. Thus, we present a thorough review of antenatal corticosteroids usage in twin gestation, emphasizing the aforementioned issues and attempting to offer direction for future investigation and clinical practice.

Objective: To explore the optimal cutoffs of growth discordance for the risk of preeclampsia in twin pregnancies.Methods: A retrospective cohort study in a university hospital which included twins delivered from February 2013 to September 2020. Restrictive cubic spline (RCS) model was applied to the trend of intertwin birthweight difference (BWD) with the risk of preeclampsia. Logistic regression and subgroup analysis were performed to find the cut-off with statistical significance and clinical meaningfulness.Results: A total of 2,631 women pregnant with twins were enrolled. RCS showed a nonlinear upward trend of preeclampsia with BWD, and the BWD of 15% was the initial rising point. With the confounders adjusted, only the group with BWD ≥ 25% was found to be significantly associated with an increased risk of preeclampsia (adjusted odds ratio [aOR], 2.44; 95% confidence interval [CI]: 1.74–3.42). Additionally, subgroup analysis showed that both monochorionic (MC) and small for gestational age (SGA) twins were more likely to complicate with preeclampsia.Conclusion: The growth discordance of 15% during pregnancy may be the preventive point of preeclampsia, and 25% may be the interventional point.