Pregnancy Outcome

Objective: The elderly primigravid has inherent pregnancy risks which may have deleterious effects on both maternal and fetal outcomes. The purpose of this study is to review the obstetric and neonatal outcomes of singleton gestations among Filipino elderly primigravids who delivered in a tertiary government hospital from January 1, 2012 to December 31, 2016. Methods: This is a retrospective cohort study of including 80 primigravid women aged 35 years and older (study group) and 160 primigravid women aged 20 to 34 years old (control group). Data was collected through review of hospital records, and data processing and analysis were carried out using the software, Stata 13. Results: A total of 24,751 deliveries were attended to for the five-year period covered, giving the elderly primigravids a prevalence of 6.91%, with a mean age of 38 ± 2.63 years (range 35-43). Significantly, more women in the elderly group delivered at less than 36 weeks age of gestation, delivered abdominally, and had a history of infertility and important co-morbid conditions. No significant difference in the neonatal outcomes were noted between the two groups. Conclusion It can be suggested that there was no noted difference in terms of the maternal and neonatal outcomes between elderly primigravids than otherwise. Nevertheless, inherent differences between the study groups may be clinically important in customizing the management of these women.
Pregnancy Outcome

Background: For the past decade, advanced maternal age (AMA) became more common in developed and developing countries due to the postponement of pregnancy because of career goals, widespread use of family planning, and advances in assisted reproductive techniques. This increase bears an impact on maternal and perinatal outcomes. The link between AMA and adverse maternal, perinatal, and neonatal outcome showed contradicting results. This study was conducted to investigate the association between AMA and adverse outcomes among nulliparous, Filipino with singleton pregnancies who gave birth in a private tertiary hospital. Methodology: Medical records of patients admitted for delivery between January 2015 and December 2019 were reviewed retrospectively. The control (20–34 years), AMA 35–39 years, very AMA 40–44 years, and extremely advanced maternal age (EAMA) 45 years and above groups included 206, 111, 18, and 2, respectively. Results: Five-year total deliveries at a private tertiary hospital were 8495 with a prevalence of 38.9% (95% confidence interval CI: 33.6%–44.3%) for elderly Filipino primigravids. AMA is a risk factor for diabetes mellitus and small for gestational age newborn in all 3 advanced age groups. Pregnancy induced hypertension, having cesarean section, admission of newborn to neonatal intensive care unit, and administration of antibiotics were more common to AMA but same risk for EAMA. AMA predisposes to having oligohydramnios, placenta previa and preterm delivery but pregnancy at EAMA predisposes more complications in maternal and neonatal outcomes such as having polyhydramnios, abruptio placenta, postpartum hemorrhage, maternal and neonatal death, low Appearance Pulse Grimace Activity and Respiration score, and stillbirth. There is no noted association between AMA and large for gestational age newborn, having meconium staining and delivering by classical cesarean section. Conclusion AMA in Filipino gravida patients is markedly linked with adverse obstetrical, perinatal, and neonatal outcomes. This study confirms the current trend among women over 45 years that leads to more significant obstetric complications and neonatal morbidities.
Pregnancy Outcome

In adolescents, pregnancy and birth can cause not only severe outcomes but also the harassment for their families and the load for society. Due to insufficiency in nutrition for developing fetus and the body has not developed fully, the pregnant adolescents usually suffer from malnutrition and anemia and have more likely to be intervened during delivery, affect to health of mother and child. The lack of knowledge on childbirth and anxiety can lead to functional mental disorders. Adolescent pregnancy and birth also has severe impact on economic and social status. Some resolutions were proposed, including sexual education for adolescents; safe abortion; family-planing services must be available and easy to access. Information, education and counseling must be provided effectively both in family and school.
Pregnancy ; Adolescent ; Pregnancy Outcome

No abstract available.
Female ; Pregnancy ; Pregnancy Outcome* ; Pregnancy*

No abstract available.
Female ; Fertilization in Vitro* ; Pregnancy ; Pregnancy Outcome* ; Pregnancy*

No abstract available.
Antibodies, Anticardiolipin* ; Female ; Pregnancy ; Pregnancy Outcome* ; Pregnancy*

Introduction: In 2017, the American Thyroid Association (ATA) revised their guidelines that when trimester and assay specific TSH reference intervals is unavailable, a TSH cut-off of 4.0 mIU/L replacing the previously recommended 2.5-3.0 mIU/L may be used to define maternal hypothyroidism. It states that levothyroxine treatment is considered if anti-TPO levels are elevated and TSH is between 2.5 mIU/L and the trimester-specific upper limit. These recommendations are a major departure from our current practice because the local TSH trimester-specific reference interval is not applicable due to a different assay used and the anti-TPO result is not readily available. In this population-based study, we aimed to determine and compare the maternal and perinatal outcomes of pregnant women who are euthyroid (TSH 0.3-2.4 mIU/L) versus those with subclinical hypothyroidism at different TSH cut-off levels (TSH 2.5-4.0 mIU/L, TSH 4.0-10.0 mIU/L) treated with levothyroxine. Methods: This is a single-center, prospective cohort study conducted at Chong Hua Hospital, Cebu City from September 2017 to September 2018 where a total of 505 pregnant women qualified. The cohort was divided into three groups: the euthyroid group of 404 women with TSH 0.3-2.4 mIU/L as control subjects; 101 women with subclinical hypothyroidism treated with levothyroxine further subdivided into TSH level 2.5-4.0 mIU/L (81 women) and TSH level >4.0-10.0 mIU/L (20 women). These patients were followed through to delivery to document and compare the maternal and perinatal outcomes versus euthyroid patients. Results: There was no statistically significant difference among the group of patients with subclinical hypothyroidism treated with levothyroxine versus euthyroid patients in documented complications of pregnancy, such as GDM, gestational HPN, pre-eclampsia, PROM, low APGAR score and fetal distress. However, in patients with baseline TSH 2.5-4.0 mIU/L there was preterm delivery in six (7.41%) patients, post-term delivery in two (2.5%) patients, with seven (8.6%) small for gestational age (SGA) infants and two (2.5%) large for gestational age (LGA) infants. In patients with baseline TSH > 4.0-10.0 mIU/L, preterm delivery occurred in two (10%) patients. In secondary analysis adjusted for age and parity at enrolment, pregnant women treated with levothyroxine at baseline TSH 2.5-4.0 mIU/L and TSH > 4.0-10.0 mIU/L versus the untreated women with TSH < 2.5 mIU/L showed no difference in the maternal and perinatal outcomes of pregnancy measured. Conclusion This study has shown a 12.5% prevalence of subclinical hypothyroidism in our setting. There was no difference in the maternal and perinatal outcomes of pregnant patients who are euthyroid versus those with subclinical hypothyroidism treated with levothyroxine at a TSH threshold of 2.5-4.0 mIU/L and >4.0-10.0 mIU/L. These findings support the view that levothyroxine treatment in pregnant women with subclinical hypothyroidism at a TSH cut-off of 2.5 mIU/L shows no harmful effects.
Pregnancy ; Treatment Outcome

Introduction: Approximately 40% of women with gestational diabetes mellitus (GDM) will require insulin when diet failed to reduce glycemic levels. Insulin analogs have been noted to result in an improved glycemic control and an acceptable safety profile in diabetes mellitus. Our general objective was to evaluate the efficacy, safety, and pregnancy outcomes of insulin analog versus human insulin in women with GDM. Methods: Retrospective cohort analysis of women with singleton pregnancy and GDM from January 2013 to March 2016 at the University of Santo Tomas Hospital was performed. Women were grouped into Group A (diet-controlled), Group B (supplementary insulin analog), Group C (supplementary human insulin), and Group D (combination of supplementary insulin analog and human insulin). Maternal characteristics, glycemic data, and outcomes and neonatal outcomes were compared among the treatment groups. Parametric data were expressed as mean, standard deviation, frequency, and percentage. Chi-square and one-way analysis of variance were utilized to analyze data. Results: Of 144 women with GDM, 59 received insulin analog and 19 received human insulin. Good glycemic control and low rate of hypoglycemia in Group B were comparable to other groups. Maternal outcomes (hypertensive disorders of pregnancy and primary cesarean section) in Group B were not increased and similar to other groups. Neonatal outcomes (birth weight, large for gestational age, neonatal hypoglycemia, neonatal jaundice, and acute respiratory distress syndrome) in Group B were also not increased and comparable to other groups. Rates of prematurity were higher in Groups A and B. Conclusion Our study demonstrated that insulin analog was comparable to human insulin in terms of non-increased rates of adverse pregnancy outcomes with the exception of prematurity, and can be safely used as a viable treatment option without increased risk of hypoglycemia while achieving optimal glycemic control throughout pregnancy in Filipino women with GDM.
Diabetes, Gestational ; Pregnancy Outcome

Objectives: This study determined the prevalence, clinical characteristics and pregnancy outcomes of high-risk women diagnosed with gestational diabetes mellitus (GDM) before and after 24 weeks of gestation. Methodology: This retrospective study included all singleton deliveries with GDM at the Pasig City General Hospital from January 2018 to December 2019. Subjects were grouped into those who were diagnosed with GDM before 24 weeks of gestation (<24 weeks, n=61) and thereafter (≥24 weeks, n=219). Outcomes examined were preeclampsia, cesarean delivery, preterm birth, macrosomia, large-for-gestational age, small-for-gestational age, neonatal hypoglycemia, neonatal ICU admission, congenital malformations and perinatal mortality. Results: The group diagnosed with GDM before 24 weeks was significantly older (33.0 ± 5.7 years versus 29.4 ± 5.9 years, p<0.001), had higher 2-hour 75 g oral glucose tolerance test (OGTT) results (158.2 ± 20.0 mg/dL versus 150.0 ± 23.7 mg/dL, p=0.014), and had more pregnancies with preeclampsia (23.0% versus 9.6%, p=0.005). Conclusion High-risk women diagnosed with GDM before 24 weeks of gestation had a higher incidence of preeclampsia compared with high-risk women diagnosed with GDM after 24 weeks of gestation.
Prenatal Diagnosis ; Pregnancy Outcome