Objective:To investigate the characteristics of weight gain in the mid and late pregnancy of women with early pregnancy weight loss, and the relationship between weight gain and weight gain rate before the diagnosis of gestational diabetes mellitus (GDM) and GDM.Methods:A retrospective study was conducted on 2 614 singleton pregnant women who underwent prenatal care and delivered at Beijing Obstetrics and Gynecology Hospital, Capital Medical University, from January 2014 to December 2021, and whose weight decreased compared to pre-pregnancy weight by 16 weeks of gestation. The rate of weight gain in mid and late pregnancy, also weight gain and weight gain rate at each stage were analyzed. Multivariate logistic regression was used to analyze the impact of total weight gain and weight gain rate at each stage before the diagnosis of GDM on the risk of GDM.Results:The rates of weight gain in mid and late pregnancy for women with early pregnancy weight loss who were underweight, normal weight, overweight, and obese before pregnancy were (0.60±0.15), (0.59±0.18), (0.53±0.20), and (0.42±0.20) kg/week, respectively, all higher than the "Chinese Recommended Standards for Weight Gain During Pregnancy" [which are (0.37-0.56), (0.26-0.48), (0.22-0.37), and (0.15-0.30) kg/week, respectively]. The weight gain rates at each stage of mid and late pregnancy in women with early pregnancy weight loss showed a "bimodal" trend, with the first peak in weight gain rate occurring at 16-20 or 20-24 weeks of gestation [weight gain rates for underweight, normal weight, overweight, and obese women before pregnancy were 0.75 kg/week (0.44-1.00 kg/week), 0.74 kg/week (0.50-1.00 kg/week), 0.63 kg/week (0.39-0.86 kg/week), and 0.50 kg/week (0.25-0.74 kg/week), respectively] and the second peak occurring at 28-32 weeks [weight gain rates for underweight, normal weight, overweight, and obese women before pregnancy were 0.63 kg/week (0.50-1.00 kg/week), 0.63 kg/week (0.38- 0.88 kg/week), 0.60 kg/week (0.25-0.88 kg/week), and 0.50 kg/week (0.22-0.75 kg/week). As of 28 weeks and 36 weeks of gestation, 53.7% (1 404/2 614) and 77.4% (1 946/2 512) of pregnant women, respectively, reached the lower limit of the recommended weight gain for the corresponding gestational weeks. No association was found between insufficient weight gain ( aOR=0.828, 95% CI: 0.639-1.071, P=0.151) or excessive weight gain ( aOR=0.936, 95% CI: 0.598-1.465, P=0.773) before the diagnosis of GDM and the risk of GDM. However, obese women with a weight loss greater than 5% of their pre-pregnancy weight in early pregnancy and a rapid weight gain rate (> P 75) between 16-20 weeks of gestation had an increased risk of developing GDM ( aOR=32.870, 95% CI: 1.625-664.775, P=0.023). Conclusions:In clinical practice, dynamic monitoring of weight changes at various stages of pregnancy in women who lose weight in early pregnancy is recommended. Targeted weight management during mid-pregnancy for women who are obese before pregnancy and experience significant weight loss in early pregnancy may help prevent excessive gestational weight gain and decrease the risk of GDM.

This paper reported a case of fetal congenital chloride diarrhea (CCD) indicated by prenatal ultrasound and confirmed by whole-exome sequencing. At 26 weeks and two days of gestation, a routine prenatal ultrasound revealed fetal bowel dilation and numerous floating echogenic particles in the amniotic fluid, suggesting the possibility of CCD. Multiple follow-up ultrasounds in late pregnancy showed persistent bowel dilation, polyhydramnios with numerous floating echogenic particles, and fetal development larger than the gestational age. Whole-exome sequencing and Sanger validation revealed two compound heterozygous mutations in the fetal SLC26A3 gene: c.2006C>A (p.S669*) inherited from the mother and c.1355T>A (p.L452Q) inherited from the father, leading to a diagnosis of CCD. Postnatally, the infant exhibited persistent watery diarrhea. Based on prenatal ultrasound and diagnostic results, the infant was immediately given intravenous and oral electrolyte supplementation after birth, preventing severe electrolyte imbalance. As of June 2024, the infant was five months old, with follow-up showing good growth and development.

Objective:To investigate the ultrasound characteristics and outcomes of congenital hepatic hemangioma (CHH).Methods:A retrospective study was conducted on 14 cases of CHH diagnosed by prenatal ultrasound and postnatal mother-infant rooming-in ultrasound examination at Women and Children's Hospital Affiliated to Ningbo University from April 2021 to March 2024. Prenatal and postnatal ultrasound findings, clinical manifestations, treatments, and outcomes of these cases were analyzed.Results:Among the 14 cases, the male-to-female ratio was 1∶1; six cases were preterm infants, including two low birth weight infants. Ten cases were diagnosed by prenatal ultrasound, and four with no abnormality in the prenatal ultrasound findings were identified through postnatal abdominal ultrasound. Eleven cases had a single hepatic lesion, and three cases had multiple lesions. Ten cases had lesions in the right lobe of the liver, three had lesions in the left lobe, and one had both lobes involved. One case presented with a giant hepatic hemangioma. The echogenicity of hepatic hemangioma lesions varied, including hyperechoic, hypoechoic, and heterogeneous echopattern. Two cases were complicated by arteriovenous fistulas. All 14 cases underwent regular ultrasound examinations and were followed up to an average of (1.2±0.9) years old, ranging from 42 d after birth to 4 years old. Eight cases received medication, while six cases were treated conservatively. One case developed progressive severe pulmonary hypertension and heart failure after birth, which was unresponsive to medication. The patient received interventional embolization one month after birth and recovered well after the surgery. The latest follow-up ultrasound findings showed that the lesions in seven cases had completely disappeared, among which five cases were solitary lesions in the right lobe of the liver, mostly 10-20 mm in size, with the largest being 33 mm×24 mm, all of which were treated conservatively. One case of single lesion in the right lobe of the liver, measuring 37 mm × 28 mm, was treated with oral propranolol and the lesion disappeared after the age of one. One case had multiple lesions in the left and right lobes of the liver. After intervention, oral propranolol was continued, and the lesions disappeared at the age of 2. And the other seven cases were still under follow-up.Conclusions:Ultrasound has high accuracy and specificity for diagnosing CHH. Close postnatal follow-up and timely management result in good outcomes and prognosis.

Objective:To explore the prenatal ultrasound diagnostic features and prognosis of congenital megalourethra (CM).Methods:A retrospective analysis was conducted on the clinical data and prenatal ultrasound features of two fetuses with CM diagnosed and treated at the Affiliated Hospital of Jining Medical College from July to December 2023. Literature related to the prenatal diagnosis of fetal CM was searched using the Chinese keywords "megalourethra" and "congenital megalourethra" in CNKI, Wanfang, Yiigle, and VIP Chinese Journal Database; and the same keywords in English were used for the retrieval in PubMed, Embase, and Web of Science databases, with the search period from January 1, 1955, to December 31, 2023. Descriptive methods were used to analyze and summarize the prenatal ultrasound features, outcomes, and prognosis of all included cases.Results:(1) Cases from our hospital: Case 1, at 19 weeks of gestation, an ultrasound revealed the symptoms of penile urethral dilation and urinary tract obstruction, with the distal urethral opening visible. Case 2, at 17 weeks of gestation, an ultrasound showed the entire urethra of the fetus was dilated, particularly the penile urethra, with the urethral opening visible at the front end, and bilateral mild pyelectasis. Both cases were considered as fetal CM. The first case decided to terminate the pregnancy after examination at a higher-level hospital; the second case was re-examined two weeks later, showing linear separation of the penile urethra and significant relief in bilateral pyelectasis. Subsequent ultrasound examinations showed no significant changes, and a male infant was delivered by cesarean section at 37 weeks of gestation, with normal urination. (2) Literature review: A total of 54 fetal CM cases were retrieved, plus two cases from our hospital, making a total of 56 cases. Among the 56 cases, 49 cases (88%) were detected in the second trimester; penile urethral dilation was observed in all cases, with 54 cases (96%) being complicated by urinary system abnormalities, and 30 cases (54%) having other system abnormalities; 24 cases (43%) had oligohydramnios or no amniotic fluid. Eighteen cases (32%) resulted in the termination of pregnancy, one case (2%) involved intrauterine fetal death, and 37 cases (66%) resulted in live births, among which, six neonatal deaths occurred (all with oligohydramnios, three with renal dysplasia, two with increased renal parenchymal echogenicity, and one with impaired renal function). Among the 31 surviving cases, six experienced spontaneous resolution of fetal megalourethra in utero, with a favorable prognosis. Of the 20 cases with increased renal parenchymal echogenicity or renal dysplasia, nine (45%) resulted in termination of pregnancy, five (25%) in neonatal death, and among the six (30%) surviving infants, four underwent renal function tests, all showing renal impairment. Among the four cases detected in early pregnancy, two resulted in termination of pregnancy, one in neonatal death, and one infant developed end-stage renal disease.Conclusions:Fetal CM ultrasound images are characterized by dilatation of the penile urethra. Early detection, increased renal echogenicity or renal dysplasia, and oligohydramnios may be associated with adverse outcomes such as neonatal death or renal impairment.

The placenta is a temporary organ connecting the mother and fetus during embryonic development, facilitating fetal growth by transporting oxygen and nutrients and removing waste products. Placental dysfunction can lead to severe maternal and fetal complications, with potential long-term health consequences. Therefore, monitoring placental function is a critical aspect of prenatal care. Traditional clinical assessments rely on indirect methods, but functional quantitative magnetic resonance imaging (qMRI) offers a new approach. The use of qMRI enables direct evaluation of the oxygenation in the placenta and fetal organs, providing precise quantitative metrics. This technology holds promise for early detection and intervention before the onset of placental failure or fetal injury. This article reviews the latest advancements in MRI technology for evaluating placental and fetal multi-organ oxygenation.

Maternal vaccination against influenza (commonly known as the flu) and the novel coronavirus (widely referred to as COVID-19) represents an effective strategy for infection prevention during pregnancy. The administration of inactivated flu vaccine during pregnancy is safe, and available evidence does not show adverse effects on maternal or neonatal outcomes such as gestational diabetes, gestational hypertension, or neonatal low birth weight. Both inactivated flu vaccines and inactivated COVID-19 vaccines have demonstrated protective efficacy when administered during pregnancy. This article summarizes the latest evidence on flu and COVID-19 vaccination during pregnancy, providing a scientific foundation to support vaccination practice during pregnancy in China.

This paper reported a case of simultaneous twin pregnancy and successful delivery in each horn of uterus didelphys. The patient had a history of adverse pregnancies and was diagnosed with a uterus didelphys with double cervix through hysteroscopy, although the uterine cavity morphology was normal. This pregnancy was conceived naturally, with the last menstrual period on December 21, 2023. The patient underwent regular prenatal check-ups at Xi'an People's Hospital (Xi'an Fourth Hospital). Early pregnancy ultrasound confirmed simultaneous twin pregnancy in each horn of uterus didelphys. Multiple ultrasounds showed no fetal growth restriction or other abnormalities. At 37 weeks of gestation, the patient experienced chest tightness and shortness of breath due to polyhydramnios, and one fetus was in the cephalic position while the other was in the breech position, posing a high risk for vaginal delivery. Therefore, an elective cesarean section was performed at 37 weeks and one day of gestation, delivering a male infant weighing 3 260 g and a female infant weighing 2 400 g. The 1-,5-, and 10-minute Apgar scores were all 10 points, with favorable maternal and neonatal outcomes.

Objective:To explore the correlation between the elevation of glycated hemoglobin A1c (HbA1c) in the first trimester and its change from the first to the second trimester and adverse pregnancy outcomes.Methods:This was a bidirectional cohort study. Singleton pregnant women who delivered in the First Affiliated Hospital, Sun Yat-sen University from March 1, 2021, to July 31, 2024, and had HbA1c results in the first and second trimesters were included. Those with HbA1c<5.7% in the first trimester were described as group E1, and those with HbA1c between 5.7% and 6.4% were described as group E2. Those with HbA1c<5.2% in the second trimester were described as group S1, and those with HbA1c between 5.2% and 6.4% were described as group S2. Accordingly, the changing trend of HbA1c from the first to the second trimester was divided into group E1-S1, group E1-S2, group E2-S1, and group E2-S2. Clinical indicators such as gestational diabetes mellitus (GDM), preeclampsia, preterm birth, preterm premature rupture of membranes (PPROM), polyhydramnios, large for gestational age infants, small for gestational age infants, neonatal hypoglycemia, and neonatal transfer were collected. Comparisons between groups were performed using t-tests, analysis of variance, Mann-Whitney U tests, Kruskal-Wallis tests, Chi square tests, and Fisher's exact test. Multivariate logistic regression analysis was used to analyze the impact of HbA1c in the first trimester and the changing trend of HbA1c from the first to the second trimester on pregnancy outcomes. Results:During the study period, a total of 6 500 pregnant women were included for analysis, among which 209 (3.2%) had HbA1c between 5.7% and 6.4% in the first trimester. Taking those with HbA1c<5.7% as a reference, HbA1c between 5.7% and 6.4% in the first trimester was an independent risk factor for GDM, preterm birth, and PPROM [ OR (95% CI) were 3.304 (2.465-4.427), 1.545 (1.008-2.368), and 1.872 (1.042-3.361), respectively]. Taking group E1-S1 as a reference, HbA1c<5.7% in the first trimester and 5.2%-6.4% in the second trimester (group E1-S2) was an independent risk factor for GDM, preterm birth, PPROM, and neonatal hypoglycemia [ OR (95% CI) were 2.770 (2.370-3.237), 1.424 (1.132-1.791), 1.614 (1.179-2.211), and 2.047 (1.024-4.092), respectively]; HbA1c between 5.7% and 6.4% in the first trimester and<5.2% in the second trimester (group E2-S1) was an independent risk factor for PPROM [ OR (95% CI) was 3.408 (1.187-9.784)]; HbA1c between 5.7% and 6.4% in the first trimester and 5.2%-6.4% in the second trimester (group E2-S2) was an independent risk factor for GDM and preterm birth [ OR (95% CI) were 4.651 (3.282-6.592) and 1.724 (1.066-2.786), respectively]. Conclusions:HbA1c between 5.7% and 6.4% in the first trimester was significantly associated with an increased risk of GDM, preterm birth, and PPROM. For those with HbA1c between 5.7% and 6.4% in the first trimester, if the HbA1c level decreased in the second trimester, only the risk of PPROM increased significantly; conversely, if the HbA1c level continued to increase in the second trimester, the risks of GDM and preterm birth both increased significantly.

For women with type 1 diabetes mellitus (T1DM) reaching reproductive age, the disease course generally protracted, often accompanied by varying degrees of microvascular complications. Hence, the need for preconception planning and comprehensive screening and management of complications is urgent to avoid serious maternal and fetal complications. The recommended preconception glycated hemoglobin control target is currently set at<6.5%. In cases of unintended pregnancies where pre-existing microvascular complications are present, multidisciplinary standardized management during the pregnancy is essential. Although a multidisciplinary expert consensus on gestational management of T1DM has been published in China in 2020, several issues remain regarding the clinical management of T1DM in pregnancy across the nation. Strengthening nutritionally balanced management, actively and reasonably utilizing insulin therapy, and leveraging new technologies such as the internet plus artificial intelligence hold promise to achieve more optimal glucose control, reduce the incidence of maternal and fetal complications associated with T1DM, and ultimately achieve favorable outcomes for both mother and child.

American Aiabetes Association (ADA) updated the "Management of Diabetes in Pregnancy: Standards of Care in Diabetes-2025" based on the latest medical evidence. The main points of this updated guideline include the preconception counseling section, the continuous glucose monitoring part in the glycemic goals in pregnancy section, the nutritional counseling part and automated insulin delivery systems part in the management of diabetes in pregnancy section, and the use of lipid-lowering drugs medications and statins therapy part in the pregnancy and drug considerations section. This article provides a detailed introduction and interpretation of the updated guidelines, in order to provide a reference for clinical practice.