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Journal of Women's HealthVol. 29, No. 4 CommentaryFree AccessSex and Gender Disparities in the COVID-19 PandemicJewel Gausman and Ana LangerJewel GausmanWomen & Health Initiative, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.Search for more papers by this author and Ana LangerAddress correspondence to: Ana Langer, MD, Women & Health Initiative, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 651 Huntington Avenue, FXB Building 6th Floor Office 643B, Boston, MA 02115 E-mail Address: [email protected]Women & Health Initiative, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.Search for more papers by this authorPublished Online:17 Apr 2020https://doi.org/10.1089/jwh.2020.8472AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookXLinked InRedditEmail In the case of the ongoing COVID-19 pandemic, sex-disaggregated data suggest that fewer women are dying from the disease than men.1 However, taking this observation at face value oversimplifies the biological, behavioral, and social and systemic factors that may cause differences to emerge with regard to how women and men experience both the disease and its consequences. As governments react with swift and severe measures in their ongoing fight to control the pandemic's spread, it is important to understand how these actions may disproportionately increase the risks for women both directly and indirectly with regard to sex and gender.Pregnant women are often among the most vulnerable groups during public health emergencies. In some cases, pregnant women face increased biological susceptibility to adverse health outcomes, as in the case of some respiratory infections. With other emergent coronaviruses, such as those responsible for severe acute respiratory syndrome (SARS) and middle east respiratory syndrome (MERS), pregnant women who became infected were found to be more likely than nonpregnant women to experience severe complications.2 It is still too early to tell whether this will be the case with COVID-19.In the ongoing pandemic, other factors may have a ripple effect that put women at increased risk even if the disease itself does not. As made clear during the 2014 Ebola outbreak, the consequences of large-scale infectious disease outbreaks on uninfected pregnant women can be dire. Routine prenatal care appointments, if not interrupted or discontinued, may put women at increased risk of exposure to the virus. Overwhelmed hospitals struggling to function with staff and supply shortages may not be able to provide the high quality of care that all pregnant women and their newborns deserve, let alone respond to emergency obstetric complications. Furthermore, there is also a risk that life-saving treatments or vaccines will be denied to pregnant women over concern for fetal safety or a lack of data.3,4The fear of infection, concern for the well-being of friends and loved ones, uncertainty, disruption, and social isolation that have become part and parcel of daily life for many around the world will undoubtedly have profound effects on mental health on the population at large, but being pregnant during a global pandemic is likely to be even more frightening for many women. Although containment strategies, such as those that require women to deliver without a companion present, including partners and doulas, that have already been put into place in some cities in the United States,5 or those that separate newborns from their mothers immediately after birth if the mother is infected with COVID-196 may be clinically important to reduce transmission, they may also have profound short- and long-term mental health implications for women. Among women who have young children, previous research in Ethiopia, India, and Vietnam found that women who experience family-related stressful life events, such as illness or death within the household and financial uncertainty, are more likely to experience episodes of severe mental distress.7 With the ongoing need to social distance, family and community networks may struggle and pregnant and postpartum women may feel even more vulnerable and isolated over a lack of social support.The adverse effects of the pandemic in relation to women's reproductive health are not limited to pregnancy or motherhood. As movement restrictions are put into place, supply chains are disrupted, and businesses are shuttered, some women may be at increased risk of unintended pregnancy should it become difficult to obtain their regular contraceptive method or emergency contraceptives, if needed. Furthermore, some states within the United States have begun to impose restrictions on certain medical procedures that they deem to be elective, including abortion, suggesting they must be delayed until after the pandemic is over.8 Spikes in domestic violence during times of crisis are another area of grave concern for women's health, and as governments continue to put into place more extreme measures to enforce social distancing, for some women, more time at home may mean more time spent with an abusive partner. Fewer social interactions may also mean less accountability for perpetrators and fewer opportunities for others to intervene.Gender-related factors may also increase the impact of the COVID-19 pandemic on women globally. Women constitute a disproportionately high percentage of caregivers in both the formal and informal sectors.9 A large proportion of frontline health care professionals (nurses, community health workers, health technicians, etc.) is women who face a higher risk of infection, morbidity, and death as a result of their profession.9 At the same time, women more frequently serve as the primary caregivers within a household, which may further increase their risk of exposure. In the United States, 65% of unpaid family caregivers are estimated to be women and 80% of them care for someone aged 50 years or older.10 Outside of their caregiving role, women are overrepresented in the informal employment sector. In low-and middle-income countries, two-thirds of women who work do so as part of the informal economy with limited access to health care for themselves and their families.9 Containment and mitigation policies that limit women's ability to perform their duties without offering effective alternatives, such as closing of daycare facilities for their children or not providing paid sick leave, may result in unnecessary exposure to disease and increased family vulnerability.It is urgent that we adopt a gender lens to study the pandemic and its effects, including the policies and actions that are put into place at the global, country, and local levels. This may be especially important in disadvantaged populations and resource-poor communities, where women are especially vulnerable. The public health community must ensure that existing health and social services meant to support women in the face of their unique needs do not disappear in lieu of the all-encompassing focus on stopping the pandemic. Furthermore, we argue that special attention needs to be paid to ensure that informal caregivers are supported, informed, and protected. To avoid making existing gender disparities larger as a result of the pandemic, a special body at the U.S. Centers of Disease Control and Prevention is urgently needed to track sex disaggregated data and analyze policies related to COVID-19 using a gender lens.Author Disclosure StatementNo competing financial interests exist.Funding InformationNo funding was received for this article.References1. Cai H. Sex difference and smoking predisposition in patients with COVID-19. Lancet Respir Med 2020;pii: S2213-2600(20)30117-X. Medline, Google Scholar2. Favre G, Pomar L, Musso D, Baud D. 2019-nCoV epidemic: What about pregnancies? Lancet 2020;395:e40. Crossref, Medline, Google Scholar3. Rasmussen SA, Smulian JC, Lednicky JA, Wen TS, Jamieson DJ. Coronavirus disease 2019 (COVID-19) and pregnancy: What obstetricians need to know. Am J Obstet Gynecol 2020;pii: S0002-9378(20)30197-6. Medline, Google Scholar4. Weigel G. Novel coronavirus "COVID-19": Special considerations for pregnant women. Available at: https://www.kff.org/womens-health-policy/issue-brief/novel-coronavirus-covid-19-special-considerations-for-pregnant-women/?utm_source=Global+Health+NOW+Main+List Accessed March 17, 2020. Google Scholar5. Caron C, Syckle KV. Laboring alone: Some hospitals bar partners because of virus fears. The New York Times. 2020. Google Scholar6. American College of Obstetricians and Gynecologists. Practice advisory: Novel coronavirus 2019 (COVID-19). Available at: https://www.acog.org/Clinical-Guidance-and-Publications/Practice-Advisories/Practice-Advisory-Novel-Coronavirus2019?IsMobileSet=false Accessed March 13, 2020. Google Scholar7. Gausman J, Austin SB, Subramanian S, Langer A. Adversity, social capital, and mental distress among mothers of small children: A cross-sectional study in three low and middle-income countries. PLoS One 2020;15:e0228435. Crossref, Medline, Google Scholar8. Tavernise S. Texas and Ohio include abortion as medical procedures that must be delayed. The New York Times. 2020. Google Scholar9. Langer A, Meleis A, Knaul FM, et al. Women and health: The key for sustainable development. Lancet 2015;386:1165–1210. Crossref, Medline, Google Scholar10. Feinberg L, Reinhard SC, Houser A, Choula R. Valuing the invaluable: 2011 update, the growing contributions and costs of family caregiving. Washington, DC: AARP Public Policy Institute, 2011:32. 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E. and April 2021 | Journal of Women's Health, Vol. 30, No. and of and in March 2021 | Medicine, Vol. No. impact of COVID-19 on the mental health of and Science & Medicine, Vol. of and with in April 2021 | Vol. 12, No. health and well-being of staff during the coronavirus disease 2019 4 and in an March 2021 | Journal of Vol. of Gender in the and of Coronavirus Disease 2019 An of Health and and March 2021 | Journal of Women's Health, Vol. 30, No. of the COVID-19 pandemic on and Vol. of COVID-19 and of and Public Health, Vol. No. cross-sectional study of the of and with perceptions of to March 2021 | Open, Vol. 11, No. research and social of health: at the of of impact on and of Clinical Medicine, Vol. 17, No. differences in responses to SARS-CoV-2 in patients with January 2021 | Reports, Vol. No. and to COVID-19 in and January 2021 | Policy and Practice, Vol. impact of COVID-19 among and of November | & Health, Vol. 26, No. in case and mortality of coronavirus disease 2019 (COVID-19) among states in the United November | of Medicine, Vol. No. and pandemic risk and fear among September 2021 | Health and Behavioral Medicine, Vol. No. June 2021 | Vol. No. of and with of Coronavirus Related September 2021 | Vol. a January 2021 | Cadernos de Saúde Vol. No. and Among Vol. of Psychological Distress and Factors among During the COVID-19 Pandemic at in March 2021 | Disease and Vol. and on During the COVID-19 Pandemic in of Social Media October 2021 | Journal of Medical Research, Vol. 23, No. and and attitudes, and practices toward COVID-19 among birth of and Health Vol. 10, No. the of in COVID-19 October | Health Vol. No. in the of COVID-19 and political Vol. services in times of in of quality care for pregnant women and their October | Health Care for Women Vol. No. social support in the face of the December | Journal of & Vol. 12, No. with fear and during the COVID-19 pandemic in October | and Health, Vol. 16, No. and of People from by December | Journal of in Health, and Education, Vol. 10, No. is in gender and age for COVID-19 A December | Journal of and Vol. No. of SARS-CoV-2 Among Nursing and in September | Journal of Medicine, Vol. No. role of in the severity of learned from Vol. on gender disparities in the impact of the U.S. COVID-19 Research, Vol. Gender Women's Health and October | Frontiers in Global Women's Health, Vol. and the risk to and women during Journal of Vol. No. With Disparities in COVID-19 Outcomes in an Health Care October | JAMA Network Open, Vol. No. in the time of in August | Vol. 17, No. de la en en por September | Vol. No. de la COVID-19 en la de September | Vol. No. Perspectives to Health Research and Prevention During the COVID-19 | and Health Vol. 24, No. and Disease Disparities in the United in Vol. No. for a to | Global Public Health, Vol. No. and of in September | Vol. 11, No. and What is the Vol. No. we in Covid-19 women and men Vol. in of COVID-19: Insights a Vol. No. will The need to for the research on and the role of and and Vol. Impact and Factors During the of the Coronavirus (COVID-19) Pandemic Among the Population in June | Frontiers in Psychology, Vol. and of and the in SARS-CoV-2 to the in May | International Journal of Sciences, Vol. No. Coronavirus Disease 2019 the of August | Vol. Gender of to in January | Vol. Social of Vol. of of and Digital Vol. this Gausman and Ana and Gender Disparities in the COVID-19 of Women's in April 17,

Breastfeeding MedicineVol. 15, No. 5 CorrespondenceFree AccessManaging COVID-19-Positive Maternal–Infant Dyads: An Italian ExperienceGuglielmo Salvatori, Domenico Umberto De Rose, Carlo Concato, Dario Alario, Nicole Olivini, Andrea Dotta, and Andrea CampanaGuglielmo SalvatoriNeonatal Intensive Care Unit and Human Milk Bank, Department of Neonatology, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy.Search for more papers by this author, Domenico Umberto De RoseAddress correspondence to: Domenico Umberto De Rose, MD, Neonatal Intensive Care Unit and Human Milk Bank, Department of Neonatology, IRCCS "Bambino Gesù" Children's Hospital, Piazza S. Onofrio 4, Rome 00165, Italy E-mail Address: [email protected]Neonatal Intensive Care Unit and Human Milk Bank, Department of Neonatology, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy.Search for more papers by this author, Carlo ConcatoVirology Unit, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy.Search for more papers by this author, Dario AlarioPediatrics Unit, "San Paolo" Hospital, Civitavecchia (Rome), Italy.Search for more papers by this author, Nicole OliviniDepartment of Pediatrics, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy.Search for more papers by this author, Andrea DottaNeonatal Intensive Care Unit and Human Milk Bank, Department of Neonatology, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy.Search for more papers by this author, and Andrea CampanaDepartment of Pediatrics, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy.Search for more papers by this authorPublished Online:8 May 2020https://doi.org/10.1089/bfm.2020.0095AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookXLinked InRedditEmail Dear Editor:We report our experience in Italy during COVID-19 viral outbreak. At time of writing, on April 13, 2020, the number of confirmed cases was 1,699,595 worldwide, with 106,138 deaths, resulting in a crude fatality rate of 6.2%.1Although children seem to have a milder disease than adults, newborns and infants could be more at risk than other pediatric categories; thus, they deserve special attention because of insidious and nonspecific symptoms.2Although there is currently no evidence showing a vertical transmission of SARS-CoV-2 infection in fetuses of women developing COVID-19 pneumonia in late pregnancy,3 a major concern involves the possible transmission of the infection to their fragile infants, in particular after delivery. The virus can be detected by real-time polymerase chain reaction (RT-PCR) in different biological fluids (bronchoalveolar-lavage fluid, sputum, saliva, nasopharyngeal swabs, and feces) but no positive breast milk samples have been found in different reported cohorts for a total number of 32 dyads.2Therefore, for COVID-19-positive new mothers, whenever possible, it is advisable to plan a joint management of the mother with her infant, to promote the beginning of breastfeeding, while assessing on a case-by-case basis if eventual drugs administered to infected mothers could be harmful to the infant. According to the indications of the Italian Society of Neonatology,4 if a mother previously identified as COVID-19 positive is asymptomatic or paucisymptomatic, rooming-in is a reasonable management and direct breastfeeding is prudent, ensuring strict measures of infection control (washing often mother's hands before touching the infant and wearing a face mask). In most cases, a hospital stay of ∼1 week is preferred.Herein we describe our experience in our children's hospital, which is a referral care center in Rome (Italy) for ill out born neonates, who are transferred from other institutions. We report the first two maternal–infant dyads presenting to our emergency department because of a positive nasopharyngeal swab for SARS-CoV-2 both in the mother and in the child; clinical characteristics are summarized in Table 1. They were probably infected by a third person at the same time. Neither the mothers nor the infants needed intensive care unit admission; therefore, newborns were prudently isolated from their paucisymptomatic mothers.Table 1. Clinical Features of Newborns with Postnatal Confirmed SARS-CoV-2 Infection and Their Mothers Mother 1/newborn 1Mother 2/newborn 2Maternal age, years3626Maternal symptomsAnosmia and dysgeusiaBack and thoracic painMaternal ICU admissionNoNoMaternal nasopharyngeal swabPositivePositivePositive breast milk samplesNoNoExclusive breast milkYesYesFeeding: breastfeeding or feeding bottleBreastfeedingBreastfeedingNeonatal nasopharyngeal swab on admissionPositivePositiveGestational age, weeks41 + 239Birth weight, g4,4403,120Neonatal genderMaleFemaleNeonatal age on admission, days1810Neonatal weight on admission, g5,2003,200Neonatal symptoms and complicationsNoCoughDiarrheaPoor feedingNeonatal body temperature on admission36°C36.7°CNeonatal SatO2 on admission99%100%Neonatal oxygen supportNoNoNeonatal ICU admissionNoNoNeonatal recoveryAsymptomatic patientNo more diarrhea and need of intravenous fluids on day 5ICU, intensive care unit.We analyzed expressed breast milk samples of both mothers, and SARS-CoV-2 was not detected by RT-PCR, as already described.2 Virus detection analysis after pasteurization was not performed because the virus was not found already in expressed milk.To the best of our knowledge, these are the first data on postnatal horizontal COVID-19 infection in newborns and breast milk analysis in Italy. We confirm that SARS-CoV-2 seems to spare breast milk and horizontal transmission from mother to neonate could occur through respiratory droplets rather than through milk. Therefore, when SARS-CoV-2 is identified both in the mother and in the child, there are no reason to stop breastfeeding and separate them. Whenever direct breastfeeding is not possible, the use of expressed mother's milk should be considered and promoted to take advantage of its unquestionable benefits.In conclusion, we agree that medical staff and nurses should not only focus on care of COVID-19 mothers and infants, but also protect, promote, and support breastfeeding. Breastfeeding creates a unique relationship between mother and child, thus reducing the length of hospital stay and the negative effects linked to quarantine and stress because of this pandemic viral outbreak.Authors' ContributionsAll authors participated in the conception and design of the study, acquisition and interpretation of data, and drafting the article. All authors read and approved the final version.Ethical StatementThe authors declare that they have followed the protocols of their work center on the publication of patients' data and Helsinki Declaration: no patient is recognizable with data appearing in this article. An informed consensus was obtained before enrolling patients, records were anonymized and deidentified before analysis, and all data were fully anonymized before any access by the authors.Disclosure StatementNo competing financial interests exist.Funding InformationNo funding was received for this article.References1. World Health Organization. WHO: Novel Coronavirus (COVID-19) Situation Reports. https://who.sprinklr.com/ (accessed on April 13, 2020). Google Scholar2. De Rose DU, Piersigilli F, Ronchetti MP, et al. Novel coronavirus disease (COVID-19) in newborns and infants: what we know so far. Ital J Pediatr 2020 (in press). Google Scholar3. Chen H, Guo J, Wang C, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet 2020;395:809–815. Crossref, Medline, Google Scholar4. Davanzo R, Moro G, Sandri F, et al. Breastfeeding and coronavirus disease-2019. Ad interim indications of the Italian Society of Neonatology endorsed by the Union of European Neonatal & Perinatal Societies. Matern Child Nutr 2020:e13010. 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We and others have shown that maternal hyperglycemia during pregnancy in women with insulin-dependent diabetes mellitus (IDDM) influences fetal growth. Less is understood regarding how trimester-specific glycemic patterns, particularly glucose variability, shape offspring obesity risk across the life course and whether this is mediated by birthweight. Leveraging data from the Diabetes in Pregnancy Program Grant (PPG; 1978-1995) and the Transgenerational Effects on Adult Morbidity (TEAM Study; 2017-2023) cohort, we aimed to evaluate whether the association between maternal glycemic control and adult offspring obesity status was mediated in part through infant birthweight. Maternal glycohemoglobinA1 levels were collected monthly during pregnancy and harmonized across laboratories using standard deviation units (HbA1SD). Functional principal component analysis characterized patterns in blood glucose level and variability. TEAM Study participants, adult offspring of PPG women, completed in-person or online assessments (via Zoom) of body anthropometrics. Linear mixed-effects models and generalized estimating equations estimated associations between maternal glycemia and adult offspring outcomes. Classical mediation methods tested whether birthweight mediated observed relationships. Consistent with prior findings, third-trimester HbA1SD demonstrated the most consistent positive associations with adult offspring body mass index (BMI) outcomes, after adjustment for maternal BMI at last menstrual period, maternal education, gestational weight gain, and sex of offspring (for offspring weight only). There was no evidence that birthweight mediated the relationship between maternal glycemic patterns and adult offspring overweight and obesity; however, birthweight exhibited an independent direct effect on adult offspring BMI in fully adjusted models. Infant birthweight was not shown to be a mediator in the association of maternal gestational glycemic control and overweight/obesity in adult offspring of women with IDDM. Although birthweight does not appear to mediate these long-term associations, the findings underscore the importance of trimester-specific evaluation of blood glucose level and variability, motivating further investigation into transgenerational metabolic risk pathways. · It is unlikely that birthweight mediates the association between gestational blood glucose levels and offspring adult obesity.. · Higher birthweight is an important risk factor for overweight and obesity in the adult offspring.. · Early gestation hyperglycemia may program obesity in adult offspring of IDDM women..

In utero exposure to maternal prepregnancy diabetes is associated with an increased risk for abnormal glycemic outcomes in children, including impaired glucose tolerance, insulin resistance, and type 2 diabetes. Our objective was to evaluate the timing of exposure to maternal dysglycemia and whether the effects persist into adulthood. The Transgenerational Effects on Adult Morbidity (TEAM) Study followed offspring of mothers with prepregnancy insulin-dependent diabetes mellitus (IDDM), who participated in a Program Project Grant (PPG) between 1978 and 1995. These women had a detailed characterization of glycemic measures across pregnancy and comprehensive obstetric and delivery data. Offspring participated in a complete clinical exam, which included an oral glucose tolerance test (OGTT). Multiple regression methods were used to identify associations between trimester-specific maternal hemoglobin A1 (HbA1) standard deviation (HbA1SD) and maternal glucose profiles with offspring glycemic outcomes, adjusting for covariates. Among 161 offspring up to 42 years of age (mean age, 32.3 years), first trimester HbA1SD was associated with increased offspring fasting plasma glucose and HbA1c ≥6.5% after adjusting for maternal age, family history of diabetes, presence of microvascular disease, and body mass index (BMI) at the last menstrual period. Both second- and third-trimester maternal HbA1SD were positively associated with offspring HbA1c and inversely associated with the acute insulin response to glucose (AIRg), defined as the rapid, first-phase release of insulin from pancreatic beta-cells within 10 minutes of the OGTT. Our findings add to the current literature showing that the association between trimester-specific gestational maternal glycemic status and offspring adverse glycemic outcome persists into adulthood in the offspring. · Exposure to maternal IDDM is associated with offspring glycemic outcomes.. · Maternal glycohemoglobin, particularly in the first trimester, is associated with HbA1c and fasting glucose.. · Mid-late pregnancy hyperglycemia was associated with reduced offspring acute insulin response..

Insurance coverage for abortion varies by state, and fetal centers often care for patients traveling from out-of-state. How insurance status and state-of-residence impact pregnancy decision-making for spina bifida remains unclear. We evaluated whether insurance payor and state-of-residence are associated with consideration and subsequent completion of abortion among patients with spina bifida. We conducted a retrospective study of singletons with spina bifida at a fetal center. Exposures were residence (in-state vs. out-of-state) and insurance (governmental vs. private). Because state laws influence abortion coverage, the exposure was modeled as an interaction term. Primary outcomes were abortion consideration and completion. Abortion consideration was determined by a nurse intake coordinator. Before presentation at our fetal center, patients were asked whether they were considering abortion. If they answered "yes" or "maybe," then the patient was classified as considering abortion. Among 149 patients (63.7% in-state; 72.5% private insurance), 127 had complete decision-making data, with 40.2% (51/127) considering abortion and 27.6% (35/127) completing abortion. Governmental insured patients were more likely to reside in-state than privately insured. Insurance had no association with abortion intent or completion. However, when the interaction term was introduced, in-state residents with private insurance had higher risk of abortion consideration (relative risk [RR] = 2.17, 95% confidence interval [CI]: 1.02-4.60) but not completion (RR = 1.94, 95% CI: 0.86-4.40) versus out-of-state private insurance patients. In a sub-analysis, abortion consideration and completion did not differ pre- vs. post-2019 Illinois Reproductive Health Act. Abortion consideration for spina bifida is associated with insurance status and state-of-residence. Fetal care centers that serve regions of the country should be aware of the sociopolitical and economic differences of their patient catchment. Further evaluation of state-specific restrictions on insurance coverage for abortion care may elucidate barriers to the spectrum of spina bifida management options. · Abortion consideration is associated with joint modeling of state-of-residence and insurance status.. · Insurance payor among those who considered and completed abortion was not altered by the Illinois Reproductive Health Act (RHA).. · Counseling for spina bifida should include considerations for insurance status and state-of-residence..

The objective of this study is to evaluate whether full quantitative blood loss (FBL), which incorporates the weight of blood soaked materials, improves the prediction of hemorrhage-related clinical decision-making compared with volumetric blood loss (VBL) using calibrated drapes alone.We performed a secondary analysis of an IRB-approved retrospective cohort including all deliveries over 2 years at a large, urban academic center. During the study period, a quantitative blood loss protocol was introduced without other changes to hemorrhage management. VBL consisted of calibrated drape measurement with visual estimation of laps and clots, while FBL additionally included weighing of soaked materials. The primary outcome was hemorrhage intervention, defined as transfusion, surgical management of atony, balloon tamponade, ICU admission, or hysterectomy. Predictive performance of VBL and FBL was compared using receiver operating characteristic curves and area under the curve (AUC). Secondary outcomes included uterotonic use, correlation with peripartum hemoglobin change, and a subgroup analysis of vaginal deliveries with blood loss of 500 to 1,000 mL.Among 8,359 deliveries, 1,524 (18.4%) had both VBL and FBL recorded, allowing direct comparison. Overall, hemorrhage intervention occurred in 5.4% of deliveries. There was no significant difference in predicting intervention in either the direct-comparison group or the full cohort. In the paired sample, VBL better predicted uterotonic use than FBL (AUC: 0.713 vs. 0.680, p&#xbc;0.02). FBL identified more deliveries as having abnormal blood loss and more cases meeting PPH criteria; however, this did not translate into higher intervention rates. Both methods correlated modestly with hemoglobin change, explaining <13% of variance, with no meaningful difference between approaches.When calibrated drapes are used, adding weighing of blood-soaked materials provides minimal additional clinical value in predicting hemorrhage interventions or physiologic impact. These findings support streamlined blood loss quantification strategies, particularly in low-resource settings where simplicity and efficiency are critical. &#xb7; Full quantification of blood loss increases rate of PPH classification without increase in severe morbidity.. &#xb7; The addition of weighing blood soaked materials does not better detect hemorrhage related morbidity.. &#xb7; Volumetric assessment of blood loss alone may be sufficient..

This study aimed to examine rates of fetal growth restriction (FGR) and small for gestational age (SGA) neonates before, during, and after the COVID-19 pandemic. We retrospectively evaluated patients with singleton deliveries &#x2265; 22 weeks of gestation in a single hospital system from March 2018 to December 2022. Patients were assigned to one of three COVID-19 epochs: acute-COVID-19, based on gestational age&#x2009;<&#x2009;20 weeks on February 3, 2020, and estimated due date before January 1, 2021; pre-COVID-19 and postacute-COVID-19 epochs consisted of patients with matched months 2 years before and after the acute-COVID-19 epoch. Outcomes were FGR and SGA; FGR was defined by International Classification of Diseases-10 codes, and SGA was defined by birthweight&#x2009;<&#x2009;10th percentile, using the Aris distribution for gestational age and neonatal sex. Patient attributes were compared across COVID-19 epochs, FGR, and SGA separately, using chi-square tests or ANOVA, as appropriate. Crude and adjusted logistic regression models were performed, including covariates associated with each dependent variable. A total of 9,692 patients were included; differences across COVID-19 epochs were observed for advanced maternal age, body mass index &#x2265; 30 at delivery, smoking, chronic hypertension, hypertensive disorders of pregnancy, number of prenatal care visits, and ultrasounds. Patients in the acute- and post-COVID-19 epochs had an increased odds of FGR (aOR: 1.76, 95% CI: 1.44-2.16 and aOR: 1.64, CI: 1.38-1.94, respectively) compared with the pre-COVID-19 epoch. Compared with the pre-COVID-19 epoch, patients in the acute-COVID-19 epoch had reduced odds of SGA (aOR: 0.80, 95% CI: 0.65-0.98). During the acute-COVID-19 epoch, FGR diagnosis increased compared with pre-COVID-19, while SGA at birth decreased. This highlights the limitation of prenatal ultrasound for precisely identifying fetuses at the highest risk of FGR, which may be due to confirmation bias or broad diagnostic criteria for FGR. &#xb7; We found no significant difference in the number of prenatal visits across COVID-19 epochs.. &#xb7; The rate of FGR increased during the acute-COVID-19 epoch, while the rate of SGA decreased.. &#xb7; Incongruence of FGR and SGA rates highlights the limitation of ultrasound to precisely identify at-risk fetuses..

Hemolytic disease of the fetus and newborn (HDFN) is a rare and serious immune-mediated condition that can result in poor fetal and neonatal outcomes. During pregnancy, monitoring with middle cerebral artery Doppler ultrasound and intrauterine transfusions (IUTs) are the current standard of care, although intravenous immunoglobulin (IVIg) has been adopted in some centers to attempt to delay the onset of fetal anemia. Significant gaps remain in understanding the safety and effectiveness of current HDFN management, both during pregnancy and in neonates and children. We present the design of the Global Prospective Hemolytic Disease of the Fetus and Newborn Registry (GERANIUM; ClinicalTrials.gov Identifier: NCT07194070), a study that will provide real-world, prospective, longitudinal data on management, clinical course, and outcomes of HDFN from the antenatal period up to 2 years after birth.GERANIUM is a prospective, observational study enrolling alloimmunized pregnant individuals (aged &#x2265;18 years) before 24 weeks of gestational age who are at high risk for HDFN based on previous obstetric history. This study will enroll approximately 175 participants across multiple global sites. Data collected during pregnancy include fetal loss, frequency and severity of HDFN, treatment patterns, as well as effectiveness and adverse outcomes of IUTs and other interventions. Following birth, infants will be followed for the first 2 years of life, with documentation of HDFN sequelae, including treatments, growth, and development. Impact on the parents and children will be assessed using validated participant- and observer-reported outcome measures.The GERANIUM registry will provide prospective, contemporaneous data on current management of HDFN and associated outcomes. &#xb7; HDFN can result in fetal loss or poor long-term outcomes.. &#xb7; IUT and IVIg can be associated with serious complications.. &#xb7; Impacts of HDFN on patients' quality of life are unclear.. &#xb7; GERANIUM will provide contemporaneous data on HDFN care.. &#xb7; Prospective data for mothers/infants will be collected..

This article is a plain language summary of publication (PLSP) of the following article: "Study Design of the Global Prospective Hemolytic Disease of the Fetus and Newborn Registry (GERANIUM)" by Tjoa et al published by the American Journal of Perinatology on March 20, 2026. This PLSP describes the design of the GERANIUM registry, which will collect data to help researchers understand how doctors manage hemolytic disease of the fetus and newborn (HDFN) in clinical settings. Researchers will also study outcomes related to the health and well-being of pregnant participants affected by HDFN, their children, and their families over time. This PLSP aims to help the general public, including those affected by HDFN, and health care professionals understand the design of the GERANIUM registry. &#xb7; Data reflecting today's clinical care of HDFN are lacking.. &#xb7; GERANIUM is a registry collecting real-world data on HDFN.. &#xb7; Design of the GERANIUM registry is described.. &#xb7; HDFN-related outcomes are collected during pregnancy.. &#xb7; Infant outcomes will be recorded up to 2 years after birth..

To establish the due date in a singleton gestation in the second trimester, U.S. societal guidelines recommend using a composite of the fetal biparietal diameter, head circumference, abdominal circumference, and femur length. In twin pregnancies, evidence supports using either the head circumference or composite biometry of the larger twin. Our objective was to compare the accuracy of these two approaches in determining the true gestational age of twin gestations. We conducted a retrospective cohort study of dichorionic, diamniotic gestations conceived with assisted reproductive technologies between 2006 and 2016, excluding fetuses with major anomalies that could impact accurate dating, pregnancies complicated by loss of one or both twins, or higher-order multiple gestations reduced to twins. The earliest second-trimester ultrasound study for each subject was reviewed and the gestational age was calculated using head circumference alone and composite biometry based on Hadlock's formulas. Paired sample statistics were used to calculate the mean difference in days from the observed versus true gestational age to assess the accuracy of each strategy and represented graphically using Bland-Altman plots. A total of 179 subjects with a second-trimester ultrasound were identified that met criteria over the 10-year period. Ultrasounds were performed at a mean gestational age of 19.9 days (range: 14.43-26.14). Use of head circumference alone resulted in a mean absolute difference of 3.11 days from the true gestational age (standard deviation [SD]: 4.51, standard error mean [SEM]: 0.34). Composite biometry resulted in a mean absolute difference of 1.74 days (SD: 3.60; SEM: 0.27). The difference of approximately 1 to 2 days was significant (p&#x2009;<&#x2009;0.001). In our twin population, the use of composite biometry of the larger twin more accurately approximates gestational age compared with head circumference alone, though the difference between the two approaches is modest. &#xb7; Head circumference or composite biometry is used to date twins.. &#xb7; In our study, composite biometry improved accuracy.. &#xb7; The difference between the two was modest (1-2 days)..

Pregnancy induces a hypercoagulable state, heightening the risk of thromboembolic events, particularly for women with prothrombotic tendencies or a history of thromboembolism. Although anticoagulant treatment may improve outcomes for women with a prior stroke and thrombophilic disorders, the risk of recurrent thromboembolic events during subsequent pregnancies remains unclear. This study aims to assess pregnancy outcomes and the risk of recurrence in women with a history of stroke.This retrospective study analyzed pregnancy outcomes of women with a history of cerebrovascular events who delivered at Sheba Medical Center between 2005 and 2023. Data included cerebrovascular events, pregnancy outcomes, and obstetric complications. Comprehensive thrombophilia screening was performed. Patients were treated with low-molecular-weight heparin (LMWH) or low-dose aspirin (LDA). A control group without cerebrovascular events matched for maternal age, delivery timing, and plurality was used for comparison.A total of 107 women were included, 49 pregnancies with a previous cerebrovascular thrombosis, and 58 with a previous transient cerebrovascular ischemic attack. About 50.4% of the study group women had prothrombotic conditions. Cesarean section rates were higher in the study group (44%) versus controls (14%, p&#x2009;<&#x2009;0.001). Preterm delivery rates were also higher (11 vs. 1.9%, p&#x2009;=&#x2009;0.0057). Other obstetric complications were similar. A subgroup analysis of women without thrombophilia still showed increased risks for cesarean section and preterm delivery. Two women experienced recurrent thromboembolic events during pregnancy, both without maternal thrombophilia.Higher cesarean and preterm delivery rates were observed, regardless of thrombophilia status. The recurrence rate of thromboembolic events was low (2.2%), highlighting that with appropriate prenatal care and tailored prophylactic treatment, women with a history of cerebrovascular events may achieve favorable pregnancy outcomes. &#xb7; This study analyzed pregnancy outcomes in women with a history of stroke.. &#xb7; Cesarean section rates were higher in the study group versus controls. Preterm delivery rates were also higher, while other obstetric complication rates were similar.. &#xb7; The recurrence rate of thromboembolic events was low.. &#xb7; With appropriate care, women after cerebrovascular events may achieve favorable outcomes..

Antepartum hospitalization during pregnancy can compromise patients' sense of control and are associated with higher rates of depression or anxiety. There are no validated scales that measure this sense of control in this hospitalized setting. The authors adapted the Labour Agentry Scale (LAS) to the antepartum inpatient setting by developing and preliminarily validating a novel Antepartum Agentry Scale (AAS).Fifty-nine candidate statements were derived from the LAS original source material. These statements were iteratively reviewed in three rounds using a content valuation index by Maternal Fetal Medicine providers, resulting in 25 statements that comprised the AAS. The AAS, Patient Health Questionnaire (PHQ-9), and General Anxiety Disorder (GAD-7) scale were administered to 50 individuals hospitalized for a complication during pregnancy. Factor analysis was performed to assess construct validity and evaluate whether the AAS measured a construct distinct from the PHQ-9 or GAD-7. The AAS scores were then classified as "Low," "Average," or "High" based on the mean score and standard deviation in the study population. Fisher's exact test was used to evaluate the relation between scores on the AAS and scores of 10 or higher on the PHQ-9 and GAD-7.The AAS had a Cronbach alpha of 0.902. Factor analysis demonstrated minimal overlap between the AAS and items on the PHQ-9 or GAD-7. There was a significant relationship between "Low," "Average," and "High" AAS scores and PHQ-9 scores of 10 or more (67 vs. 13 vs. 10%, p&#x2009;=&#x2009;0.003) and GAD-7 of 10 or more (67 vs. 19 vs. 0%, p&#x2009;=&#x2009;0.002).Those with higher agentry are less likely to concurrently report clinically significant symptoms of depression or anxiety. Initial results suggest strong internal consistency of the AAS, which may measure a construct distinct from measures of depression or anxiety. &#xb7; The LAS is a measure of perception of control during labor and delivery.. &#xb7; The AAS was adapted from the LAS focusing on antenatal hospitalization.. &#xb7; Higher scores on the AAS inversely correlated with symptoms of anxiety and depression.. &#xb7; The AAS has strong internal consistency with a Cronbach's alpha of 0.902.. &#xb7; The AAS appears to measure a construct distinct from the PHQ-9 or GAD-7..

The objective of this study is to describe the incidence of parental morbidity with periviable delivery and its relationship to antenatal interventions, including antenatal corticosteroids, antibiotics, and cesarean delivery. This is a population-based case-control study of the National Center for Health Statistics database of periviable deliveries (200/7-256/7 weeks) from 2016 to 2021. Subjects were included if they delivered a nonanomalous live singleton gestation in a hospital. To minimize inaccurate dating, subjects were excluded for birthweight&#x2009;>&#x2009;97% for gestational age. The composite morbidity outcome was defined as parental blood transfusion, intensive care unit (ICU) admission, or unplanned hysterectomy. We assessed this outcome's relationship to parental demographic and clinical characteristics, including the receipt of selected antenatal interventions, including antenatal corticosteroids, antibiotics, and cesarean delivery. Multivariable logistic regression was used to assess the relationship between antenatal intervention and parental morbidity. Of 45,339,472 births during the study period, 93,686 met the inclusion criteria for this study. A total of 2,726 (3.1%) parents experienced parental morbidity. The rate of perinatal morbidity increased over the study period. Black parents were less likely to experience morbidity compared to non-Black parents (2.7 vs. 3.4%, p&#x2009;<&#x2009;0.001). Parents who received antenatal steroids or antibiotics and those undergoing cesarean delivery had higher rates of morbidity compared to their counterparts who did not receive these interventions. Birthing parents who received steroids or antibiotics prior to periviable delivery and those undergoing cesarean delivery were more likely to experience parental morbidity of transfusion, hysterectomy, or ICU admission. The relationship of these interventions, intended to improve neonatal outcomes or prolong pregnancy, to parental morbidity should be incorporated into the nuanced counseling required for parents at risk of periviable deliveries. Additional research is warranted to understand the institutional, provider, and patient factors underlying these findings. KEY POINTS: &#x2003;. &#xb7; Neonatal outcomes after periviable birth are linked to gestational age and receipt of antenatal interventions.. &#xb7; Parents who received active antenatal interventions were more likely to experience parental morbidity.. &#xb7; The potential for morbidity following antenatal intervention in the periviable period should be included in the nuanced counseling required in these cases..

This study aimed to identify predictors for maternal morbidity among individuals categorized as low-risk for postpartum hemorrhage (PPH) according to American College of Obstetrics and Gynecology (ACOG) Practice Bulletin (no.: 183). A retrospective cohort study of all singleton births between March 2020 and February 2022 at a Level IV maternity center. Individuals deemed at medium- or high-risk for PPH according to the ACOG risk stratification and those with missing data were excluded from the main analysis. Individuals with the composite maternal hemorrhagic outcome (CMHO) were compared with those without. Variables previously associated with maternal morbidity yet absent from the ACOG stratification were examined as potential predictors of the CMHO. Possible predictors were identified using a multivariable logistic regression and further assessed with a receiver operating characteristic curve (ROC). Out of 8,623 deliveries, 3,472 (40.3%) met the inclusion criteria. Among them, 175 (5.0%) had a CMHO. Individuals with the composite outcome were older, had a higher body mass index, and had higher rates of Hispanic race/ethnicity, diabetes, postterm pregnancy, scheduled cesarean delivery, and neonatal birth weight &#x2265; 4,000&#x2009;g. The combination of &#x2265; 2 risk factors among low-risk patients, present in 16%, was associated with a similar CMHO rate compared with those at medium PPH risk by the ACOG criteria. The combined presence of &#x2265; 4 factors was associated with a CMHO rate of 36% and yielded a 10.47 positive likelihood ratio (95% confidence interval [CI]: 3.55-30.90). The area under the curve for the ROC curve of the final model was 0.63 (95% CI: 0.62-0.65). Among low-risk PPH patients, several risk factors with low predictive value flagged roughly one out of six with morbidity similar to medium risk. &#xb7; Five percent of individuals categorized as low-risk for PPH have hemorrhagic morbidity.. &#xb7; Several predictors of morbidity were identified.. &#xb7; Low-risk patients with &#x2265; 2 predictors had similar morbidity to patients with a moderate PPH risk..

OBJECTIVE: To investigate the impact of violence against mothers on mortality risks for their offspring before 5 years of age in Nicaragua. METHODS: From a demographic database covering a random sample of urban and rural households in Le n, Nicaragua, we identified all live births among women aged 15-49 years. Cases were defined as those who had died before the age of 5 years, between January 1993 and June 1996. For each case, two referents, matched for sex and age at death, were selected from the database. A total of 110 mothers of the cases and 203 mothers of the referents were interviewed using a standard questionnaire covering mothers' experience of physical and sexual violence. The data were analysed for the risk associated with maternal experience of violence of infant and under-5 mortality. FINDINGS: A total of 61% of mothers of cases had a lifetime experience of physical and/or sexual violence compared with 37% of mothers of referents, with a significant association being found between such experiences and mortality among their offspring. Other factors associated with higher infant and under-5 mortality were mother's education (no formal education), age (older), and parity (multiparity). CONCLUSIONS: The results suggest an association between physical and sexual violence against mothers, either before or during pregnancy, and an increased risk of under-5 mortality of their offspring. The type and severity of violence was probably more relevant to the risk than the timing, and violence may impact child health through maternal stress or care-giving behaviours rather than through direct trauma itself.

Noninvasive prenatal screening (NIPS) screens for aneuploidy, but its positive predictive value for sex chromosome aneuploidies (SCA) is variable. NIPS reports include "atypical sex chromosome findings," which may indicate fetal/maternal SCAs or mosaicism, although sensitivity is unknown. Previous studies are limited by small cohorts and insufficient maternal testing and ultrasound data. This study evaluates confirmation rates and outcomes for screen-positive SCAs, including "atypical sex chromosome" on NIPS. This retrospective study included singleton pregnancies that underwent diagnostic testing for screen-positive SCAs or atypical sex chromosome findings on NIPS from 2019 to 2024. Data collected included demographics, ultrasound findings, cytogenetics, maternal karyotype, and perinatal outcomes. The primary outcome was diagnostic confirmation, defined as proportion of NIPS screen-positive SCA and "atypical sex chromosome" confirmed by diagnostic testing. Secondary outcomes included fetal/placental mosaicism, incidental genetic findings, and maternal genetic results. Chi-squared and Kruskal-Wallis tests were used for categorical and continuous variables, respectively. Of 510 patients who underwent diagnostic testing, 91 met inclusion criteria. Overall, 41.8% (n&#x2009;=&#x2009;38) of NIPS-predicted SCAs were confirmed. Confirmation rates varied by SCA type: monosomy X (32.1%), XXY (80%), XYY (100%), XXX (66.7%), and atypical findings (26.2%) (p&#x2009;<&#x2009;0.001). Mosaicism was present in 31.6% of confirmed cases. Incidental genetic findings, including fetal copy number variants, occurred in 11 cases. Maternal karyotype was normal in 100% of confirmed cases versus 54.2% of nonconfirmed (p&#x2009;=&#x2009;0.033). Perinatal outcomes were generally favorable. Fewer than half of NIPS-predicted SCAs were confirmed, with low confirmation rates for monosomy X and atypical findings. Mosaicism accounted for nearly one-third of confirmed cases. False-positive results often included incidental fetal and maternal findings, which may contribute to high false-positive rates. These findings emphasize the need for comprehensive pretest counseling and standardized testing guidelines, given the risk of unexpected maternal SCAs and fetal copy number variants. &#xb7; Less than half of NIPS-predicted SCAs were true-positive.. &#xb7; Nearly one-third of confirmed SCAs involved mosaicism.. &#xb7; Abnormal maternal karyotype may drive false-positive rates..

Malpresentation is the indication for approximately 17% of primary cesarean deliveries (CD). External cephalic version (ECV) is a safe and effective procedure to reduce CD. Our primary objective is to identify associations between patient demographics and rate of ECV attempt. Secondary objectives include determining the rate of ECV attempt in the United States, and assessing neonatal and maternal outcomes associated with ECV attempt. Data were obtained from the National Center for Health Statistics birth certificate data from 2014 to 2021. We analyzed live, singleton, non-anomalous births at term (37-42 weeks). Observations lacking complete information on the mode of delivery, presentation at delivery, or whether an ECV was attempted were excluded. We reasoned that subjects who either had an ECV attempt or were non-cephalic at the time of delivery constituted an ECV-eligible cohort. The association between patient characteristics and ECV attempts was examined using logistic regression to obtain odds ratios and 95% confidence intervals. A total of 30,656,644 deliveries were recorded in the database from 2014 to 2021, and 925,082 subjects met inclusion criteria and were considered ECV-eligible. Only 7.9% of the ECV-eligible population had an ECV attempt. Non-Hispanic Black and Hispanic race/ethnicity, unmarried status, lack of a college degree, non-private insurance, delayed prenatal care, increased age, lower parity, one prior CD, and increased BMI were associated with decreased rates of ECV attempt. In regards to neonatal and maternal outcomes, differences were statistically significant but absolute differences were small. Our findings are limited by the quality of data collection, but strongly suggest that ECV is underutilized and not uniformly offered to patients. We identified patient characteristics including race and other demographics that were associated with decreased rates of ECV attempt, and found no clinically significant differences in neonatal or maternal outcomes with ECV attempt other than decreased CD rate. &#xb7; External cephalic version (ECV) is underutilized.. &#xb7; Disparities exist in receiving an ECV attempt.. &#xb7; ECV is safe for neonates and pregnant people..

Patients with hypertensive disorders of pregnancy (HDPs) are recommended to attend an early postpartum follow-up visit for blood pressure monitoring. Follow-up frequency for patients with HDPs can vary widely, with some patients requiring multiple office visits. We sought to determine factors associated with multiple postpartum blood pressure visits among patients with HDPs.We retrospectively identified patients with HDPs who delivered at our maternity center in 2019 and compared factors between patients who attended a single blood pressure follow-up appointment without requiring further clinical evaluation for hypertension and patients who required multiple postpartum clinical evaluations for persistent hypertension. Univariate logistic regression models were used to identify factors associated with increased odds of having multiple clinically indicated postpartum visits for blood pressure monitoring.We identified 328 patients with HDPs, of whom 260 (79.3%) attended an initial postpartum blood pressure follow-up appointment and were included in further analyses. Of the 260 patients, 70 (26.9%) had multiple blood pressure visits. Factors associated with multiple blood pressure visits included delivery between 34 and less than 37 weeks of gestation (odds ratio [OR], 3.62; 95% CI, 1.07-12.30), systolic blood pressure before discharge of 140&#x2009;mm Hg or higher (OR, 5.02; 95% CI, 2.57-9.82), and discharge with blood pressure medication (OR, 3.42; 95% CI, 1.82-6.41).Patients with HDPs who deliver preterm, have persistent hypertension before discharge, or are discharged with antihypertensive medication require continued close postpartum observation and continuity of care. &#xb7; Postpartum follow-up care for patients with HDPs should be tailored to the patient.. &#xb7; Preterm delivery, persistence of hypertensive blood pressure at discharge, and discharge with antihypertensive medication are associated with multiple postpartum ambulatory office visits.. &#xb7; High-risk patients should be diligently monitored with postpartum continuity of care..

Our study aims to explore the possible predictive role of Ultrasound Cardiac Output Monitoring (USCOM) parameters toward unfavorable maternal and neonatal complications during labor and delivery in a cohort of women followed by the high-risk pregnancy clinic of a tertiary Italian hospital.A prospective, monocentric descriptive study was run at the AOU Policlinico of Modena. USCOM was implemented in March 2022. Patients in charge of the high-risk pregnancy clinic who received USCOM hemodynamic monitoring during their whole pregnancy were included in the study, with the last examination performed around 37 weeks. By considering the characteristics of labor and delivery, they were divided into two groups (complicated delivery and uncomplicated delivery). Adverse maternal outcomes (AMOs) and adverse neonatal outcomes (ANOs) were prospectively collected from electronic records and analyzed using the R version 4.3.2 statistical software. Continuous variables were presented as means with standard deviations, and categorical variables as counts and percentages.While maternal and perinatal variables, including maternal age, parity, and anthropometric measures, were comparable between groups, significant differences emerged in the USCOM measurements. Cardiac output (CO) was significantly lower in the group with ANO compared with uneventful neonates (4.35&#x2009;&#xb1;&#x2009;1.42 L/min vs. 4.97&#x2009;&#xb1;&#x2009;1.44 L/min; adjusted odds ratio [aOR]&#x2009;=&#x2009;0.79; 95% CI: 0.49, 0.99, p&#x2009;=&#x2009;0.049). Additionally, peak velocity of ventricular ejection (VPK) was significantly reduced in neonates with ANO compared with neonates without adverse complications (0.92&#x2009;&#xb1;&#x2009;0.27 vs. 1.08&#x2009;&#xb1;&#x2009;0.42; aOR&#x2009;=&#x2009;0.08, 95% CI: 0.01-0.63, p&#x2009;=&#x2009;0.016). Finally, cardiac index was lower (2.26&#x2009;&#xb1;&#x2009;0.67 vs. 2.54&#x2009;&#xb1;&#x2009;0.74, aOR&#x2009;=&#x2009;0.49; 95% CI: 0.23-1.03, p&#x2009;=&#x2009;0.060) and systemic vascular resistance was higher (1,800.9&#x2009;&#xb1;&#x2009;546 vs. 1,638.2&#x2009;&#xb1;&#x2009;588.4, aOR&#x2009;=&#x2009;1.00; 95% CI: 1.00-1.00, p&#x2009;=&#x2009;0.245) in the ANO group comparing with those without ANO, although both results do not reach statistical significance.Our findings suggest that the implementation of USCOM in clinical practice may enhance the identification of women at increased risk for ANOs, particularly those presenting with low CO and reduced ventricular peak velocity (VPK) before labor. Further studies with larger sample sizes are needed to confirm and strengthen these observations. &#xb7; USCOM identifies women at increased risk for adverse neonatal outcomes.. &#xb7; USCOM improves the quality and safety of obstetric care.. &#xb7; USCOM is applicable across obstetric settings, including labor wards..