Explore the vast range of titles available.

Fetal growth is regulated by a complex interaction of maternal, placental, and fetal factors. The effects and outcomes that chemicals, widely distributed in the environment, may have on the health status of both the mother and the fetus are not yet well defined. Mainly mixtures of chemical substances are found in the mothers and placenta. Exposure to endocrine-disrupting chemicals (EDCs) can be associated with fetal growth retardation, thyroid dysfunction, and neurological disorders. EDCs mostly interfere with insulin, glucocorticoid, estrogenic, and thyroid pathways, with subsequent effects on normal endocrine and metabolic functions, which cause changes in the epigenome and state of inflammation with life-long effects and consequences. International scientific societies recommend the implementation of research and of all possible preventive measures. This review briefly summarizes all these aspects.

Background Advances in postnatal care for hemolytic disease of the fetus and newborn (HDFN) have occurred over the past decades, but little is known regarding the frequency of postnatal treatment and the clinical outcomes of affected neonates. Most studies reporting on HDFN originate from high-income countries or relatively large centers, but important differences between centers and countries may exist due to differences in prevalence and available treatment options. We therefore aimed to evaluate the postnatal treatment landscape and clinical outcomes in neonates with Rhesus factor D (Rh(D))- and/or K-mediated HDFN and to provide recommendations for future research. Methods We conducted a rapid literature review of case reports and series, observational retrospective and prospective cohort studies, and trials describing pregnancies or children affected by Rh(D)- or K-mediated HDFN published between 2005 and 2021. Information relevant to the treatment of HDFN and clinical outcomes was extracted. Medline, ClinicalTrials.gov and EMBASE were searched for relevant studies by two independent reviewers through title/abstract and full-text screening. Two independent reviewers extracted data and assessed methodological quality of included studies. Results Forty-three studies reporting postnatal data were included. The median frequency of exchange transfusions was 6.0% [interquartile range (IQR): 0.0–20.0] in K-mediated HDFN and 26.5% [IQR: 18.0–42.9] in Rh(D)-mediated HDFN. The median use of simple red blood cell transfusions in K-mediated HDFN was 50.0% [IQR: 25.0–56.0] and 60.0% [IQR: 20.0–72.0] in Rh(D)-mediated HDFN. Large differences in transfusion rates were found between centers. Neonatal mortality amongst cases treated with intrauterine transfusion(s) was 1.2% [IQR: 0–4.4]. Guidelines and thresholds for exchange transfusions and simple RBC transfusions were reported in 50% of studies. Conclusion Most included studies were from middle- to high-income countries. No studies with a higher level of evidence from centers in low-income countries were available. We noted a shortage and inconsistency in the reporting of relevant data and provide recommendations for future reports. Although large variations between studies was found and information was often missing, analysis showed that the postnatal burden of HDFN, including need for neonatal interventions, remains high. Systematic review registration PROSPERO 2021 CRD42021234940. Available from:  https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021234940 .

Male and female infants respond differentially to environmental stimuli, with different growth and neurodevelopmental trajectories. Male infants are more likely to be disadvantaged when subjected to adversity and show a higher risk of perinatal complications. However, the underlying causes of this sex-bias are not well defined and optimising the early life nutritional care may be necessary to minimise the “male disadvantage” that may be experienced early in life. Experimental models have demonstrated that animal milk composition differs according to offspring sex, suggesting that the tailoring of early life nutrition may be one mechanism to maximise health protection and development to infants of both sexes. However, evidence for a sex-specificity in human milk composition is limited and conflicting, with studies documenting higher milk energy content for either male or female infants. These data show sex differences, however, there has been limited compositional analysis of the current data nor strategies proposed for how sex-specific compositional differences in early life nutrition may be used to improve infant health. The present narrative review highlights that an improved understanding of sex-specific human milk composition is essential for promoting optimal infant growth and development.

Background: Hemolytic disease of the fetus and newborn (HDFN) can cause severe prenatal and postnatal outcomes. The main objective of this study is to characterize the clinical impact of HDFN on pregnant women and their newborns. Methods: A retrospective cohort study was performed on de-identified data extracted from Maccabi Healthcare Services (MHS), a large nationwide health organization. The cohort included women and newborns diagnosed with HDFN between January 1998 and December 2021. Cohort characteristics and outcomes are described. Results: Over the 24-year study period, the incidence rate of HDFN among pregnant women remained stable, while the incidence rate among newborns declined. Severe HDFN was diagnosed in 22 (30.1%) of 73 HDFN-affected pregnancies. Among 450 HDFN newborns, one-third were diagnosed with anemia or jaundice, and 5 cases of kernicterus were observed. Conclusions: Severe prenatal and postnatal outcomes were observed in cases of HDFN. Further studies are needed to evaluate treatment regimens and to assess the association between treatment management and both short- and long-term outcomes.

We analyzed and compared variations in the urinary metabolome, as well as postnatal clinical outcomes among preterm infants, based on the timing of antenatal corticosteroid (ACS) administration in response to preterm labor onset in their mothers. This was a prospective observational study held in the Neonatal Intensive Care Unit, Department of Woman’s and Child’s Health, Padova University Hospital (Italy). A urine sample was obtained from each patient within 24 h of birth; Mass Spectrometry-based untargeted metabolomics analysis was then conducted. We searched for any significant disparities in the metabolomic profile of preterm newborns subjected to antenatal corticosteroid (ACS) treatment at varying timings; their correlation with clinical outcomes were also evaluated. The group receiving ACS within the optimal time window (1–7 days before delivery) exhibited elevated levels of cysteine, N-acetylglutamine, propionyl carnitine and 5-hydroxyindolacetic acid, coupled with a decrease in pipecolic acid. Clinically, this group demonstrated a reduced need for invasive ventilation (p = 0.04). In conclusion, metabolomics analysis identified several metabolites that discriminated preterm infants whose mothers received ACS within the recommended time window. Elevated levels of cysteine and 5-Hydroxyindoleacetic acid, metabolites characterized by antioxidant and anti-inflammatory properties, were observed in these infants. This metabolic profile correlated with improved respiratory outcomes, as evidenced by a reduced necessity for invasive ventilation at birth.

Background: Pre-pregnancy overweight and obesity in reproductive-aged women becomes a growing tendency in middle- and high-income populations. This study aimed to evaluate whether maternal excess body mass index (BMI) before gestation is associated with children’s anthropometric characteristics, as well as perinatal and postnatal outcomes. Methods: This was a cross-sectional study performed on 5198 children aged 2–5 years old and their paired mothers, assigned from 9 different areas of Greece. Maternal and childhood anthropometric data, as well as perinatal and postnatal outcomes, were collected from medical history records or validated questionnaires. Results: Prevalences of 24.4% and 30.6% of overweight/obesity were recorded for the enrolled children and their mothers 2–5 years postpartum. Maternal pre-pregnancy overweight/obesity was more frequently observed in older mothers and female children, and was also associated with high childbirth weight, preterm birth, high newborn ponderal index, caesarean section delivery, diabetes type 1, and childhood overweight/obesity at pre-school age. In multivariate analysis, maternal pre-pregnancy overweight/obesity was independently associated with a higher risk of childhood overweight/obesity at pre-school age, as well as with a higher increased incidence of childbirth weight, caesarean section delivery, and diabetes type 1. Conclusions: Maternal overweight/obesity rates before gestation were related with increased childhood weight status at birth and 2–5 years postpartum, highlighting the necessity of encouraging healthy lifestyle promotion, including healthier nutritional habits, and focusing on obesity population policies and nutritional interventions among women of reproductive age.

Connective tissue diseases (CTDs) is a group of autoimmune diseases that damage multiple systems and can cause anxiety in pregnant women. The aim of this study was to identify risk factors of anxiety during third-trimester pregnancy among CTDs patients and to develop a predictive model to improve clinical outcomes. A total of 226 pregnant women with CTDs and 226 normal pregnant women were enrolled in this study during third-trimester pregnancy. This study analyzed risk factors for late pregnancy anxiety in pregnant women with CTDs using binary logistic regression. The probability of anxiety occurrence is predicted by nomogram and further validated by decision curve analysis (DCA), receiver operating characteristic curve (ROC), calibration curve. Anxiety levels were found to be significantly higher in pregnant women with CTDs compared to the control group (4.64±2.92 3.97±2.44, = 0.008). These results suggest that anxiety plays a critical role during the third trimester of pregnancy in this particular population. A total of 33 pregnant women with CTDs (14.6%) reported anxiety in third-trimester pregnancy. Risk factors associated with anxiety in third-trimester pregnancy include sleep disturbances (OR=4.226, 95CI% = 1.508-11.843), pregnancy stress (OR=1.121, 95CI% = 1.069-1.175) and family dysfunction (OR = 4.710, 95CI% =1.004-22.184). The nomogram has clinical utility and robustly predicts the associated anxiety model. During third-trimester pregnancy, sleep disturbances, pregnancy stress, and family dysfunction increase the risk of anxiety in pregnant women with CTDs, which can result in an increased likelihood of emergency cesarean sections and more postpartum blood loss at 2 hours.

Background Although Chiari type 1 malformation is common in the pediatric setting, no prenatal case has been reported. Objective To present a case of Chiari 1 malformation diagnosed prenatally based on both imaging and biological findings and describe the clinical and postnatal imaging follow-up. Case presentation. A 33-year-old woman was referred for a prenatal diagnosis of Chiari 2 malformation based on second trimester routine prenatal ultrasound. Neurosonogram depicted an abnormal posterior fossa including poor identification of the cerebellum borders with decrease of both infra- and supra-tentorial peri-cerebral spaces but without any evidence of spinal dysraphism. These features were consistent with normal alpha-fetoprotein and acetylcholinesterase levels. Fetal magnetic resonance imaging (MRI) at 24 gestational weeks confirmed sonographic data showing cerebellar tonsils ptosis below the foramen magnum associated with normal position of both fourth ventricle and vermis without any associated spinal anomalies. Postnatal MRI confirmed the prenatal diagnosis of Chiari type 1 malformation. Both clinical and imaging at 48-month follow-up demonstrated normal development without any clinical symptoms related to the Chiari type 1 malformation nor any other pathological features. Conclusion Although prenatal diagnosis of Chiari type 1 malformation has not yet been reported, this condition can be detected on both prenatal biological and imaging features. Postnatal natural evolution of this prenatal diagnosed condition can be benign when Chiari type 1 malformation is isolated, as suggested by our case.

Background and Objectives: In the last decades, simultaneously increasing trends have been recorded for both caesarean section delivery and childhood overweight/obesity around the world, which are considered serious public health concerns, negatively affecting child health. Aim: The present study aims to investigate whether caesarean section is associated with the increased rates of childhood overweight/obesity, low childbirth anthropometric indices and postnatal complications in pre-school age. Materials and Methods: This is a cross-sectional study in which 5215 pre-school children aged 2–5 years old were enrolled from nine different Greek regions after applying specific inclusion and exclusion criteria. Non-adjusted and adjusted statistical analysis was performed to assess the impact of caesarean section in comparison to vaginal delivery. Results: Children delivered by caesarean section were significantly more frequently overweight or obese at the age of 2–5 years, also presenting a higher prevalence of low birth weight, length and head circumference. Caesarean section was also associated with higher incidence of asthma and diabetes type I at the age of 2–5 years. In a multivariate analysis, caesarean section increased the risk of childhood overweight/obesity and low childbirth anthropometric indices even if adjusting for several childhood and maternal confounding factors. Conclusions: Increasing trends were recorded for both caesarean section delivery and childhood overweight/obesity, which are considered serious public health concerns. Caesarean section independently increased childhood overweight/obesity in pre-school age, highlighting the emergent need to promote health policies and strategies to inform future mothers about its short and long-term risks and that this mode of delivery should preferably be performed only when there are strong medical recommendations in emergency obstetric conditions.