Explore the impact of abnormal coagulation test results on pregnancy complications and perinatal outcomes by establishing the trimester-specific reference intervals of singleton and twin pregnancies

Thromboelastography Maximum Amplitude Is a Valuable Biomarker for Early Atherosclerosis in Rheumatoid Arthritis Patients: A Single-Center Cross-Sectional Study

Hypercoagulability contributes to atherosclerosis (AS) progression in individuals suffering from rheumatoid arthritis (RA), and thromboelastography (TEG) is a valuable diagnostic tool. This hospital-based cross-sectional study assessed the clinical efficacy of TEG parameters in detecting hypercoagulability and subclinical AS by purposively sampling 372 RA patients and 105 healthy controls. TEG indices, conventional coagulation markers, and biochemical profiles were assessed. Multivariable logistic modeling and receiver operating characteristic (ROC) analyses were utilized to identify independent risk factors for early AS in patients with RA. Our results indicated that patients with RA experienced a hypercoagulable state in comparison to controls, which was particularly pronounced in RA patients with early AS compared to their non-AS counterparts. Logistic regression analysis revealed that the TEG maximum amplitude (MA) is an independent risk factor for early AS in patients with RA, with an odds ratio of 1.219 and a 95% confidence interval of 1.128-1.317. Additional independent risk factors identified are fibrinogen (FIB), low-density lipoprotein cholesterol (LDL-C), and the adjusted atherogenic index of plasma (aAIP). ROC analysis revealed that MA achieved an area under the curve (AUC) of 0.711 (sensitivity: 71.5%; specificity: 63.5%) for early AS diagnosis. Combining with FIB, LDL-C, and aAIP significantly enhanced diagnostic performance, with an AUC of 0.831 (sensitivity: 77.6%; specificity: 75.3%). These findings highlight MA as a valuable biomarker for early detection of AS in patients with RA. Furthermore, integrating MA with FIB, LDL-C, and aAIP improves diagnostic accuracy, supporting its clinical role in risk stratification and early intervention.

Differences in physiological indicators between twin and singleton pregnancy

OBJECTIVE

It has been widely reported that there are physiological differences between twin and singleton pregnancies, as evidenced by physiological indicators examined during prenatal period. However, not all physiological indicators have been evaluated. Physiological indicators of twin pregnancies still refer to the standards of single pregnancies and lack precise variation intervals. Therefore, our study compared and analyzed the differences in physiological indicators between twin and singleton pregnancies.

METHODS

Retrospective cohort data of deliveries at Peking University Third Hospital from January 1, 2012, to February 8, 2021, were utilized. Information of pregnant women, including maternal characteristics, 49 physiological indicators examined during four periods (postpartum, first, second, and third trimester), and pregnancy complications, was extracted from medical records. Mann-Whitney test and multiple linear regressions were conducted to evaluate the differences in physiological indicators between twin and singleton pregnancies and to demonstrate their variation trend throughout gestation.

RESULTS

A total of 40 746 cases were included (38 320 singleton pregnancy cases and 2426 twin pregnancy cases). In twin pregnancies, 16 indicators related to red blood cells, platelets, coagulation function, protein, creatinine, and blood lipids exhibited distinctions compared to singleton pregnancies throughout gestation. The results remained stable regardless of maternal complications.

CONCLUSION

Twin and singleton pregnancies are in distinct physiological conditions. It is of great necessity to establish specific reference intervals for twin pregnancies. Further study is needed to investigate the impact of physiological indicators on predicting adverse outcomes in twin pregnancies.

Clinical Features and Outcomes of Twin Pregnancies with Antiphospholipid Antibodies Positivity: A Retrospective Study

Objective

This study aimed to evaluate the impact of twin pregnancies with antiphospholipid antibody (aPL) positivity, a rare and complex clinical condition that remains a huge challenge for management.

Methods

This study enrolled twin-pregnant women at our hospital between January 2018 and August 2023. Women with and without aPL positivity were selected using propensity score matching (PSM). Clinical features and pregnancy outcomes were compared between the two groups in the PSM cohort. To analyze the effect of aPL positivity on pregnancy outcomes, multivariate logistic models were used to obtain adjusted odds ratios (aOR) with 95% confidence intervals (CI).

Results

Among the 773 women with twin pregnancies, aPL positivity was found in 26 women (3.36%). In the PSM cohort, there were 24 twin-pregnant women with positive aPL, and 48 women without aPL were selected as controls. Twin-pregnant women with aPL positivity had a higher proportion of abortion (8.33% vs 0, P = 0.043), preterm birth < 34 weeks (33.33% vs 8.33%, P = 0.007) and very low birthweight (<1500 g) (20.83% vs 4.17%, P = 0.016) than the control group. In addition, stillbirth of one fetus was observed in one twin-pregnant woman with positive aPL. Multivariate logistic regression analysis revealed that twin pregnancy with aPL positivity was associated with preterm birth < 34 weeks (aOR = 2.76, 95% CI: 0.83-4.70, P = 0.005), very low birthweight (<1500 g) (OR = 2.40, 95% CI: 0.18-4.67, P = 0.034) and small for gestational age (SGA) (aOR = 1.66, 95% CI: 0.22-3.10, P =0.024).

Conclusion

Twin pregnancies with aPL positivity were correlated with obstetric complications, including abortion, preterm birth < 34 weeks and very low birthweight (<1500 g). The detection of aPL may be of clinical significance for women with twin pregnancies and should be considered in future studies.

Trajectories tracking of maternal and neonatal health in eastern China from 2010 to 2021: A multicentre cross-sectional study

Background

China's fertility policy has dramatically changed in the past decade with the successive promulgation of the partial two-child policy, universal two-child policy and three-child policy. The trajectories of maternal and neonatal health accompanied the changes in fertility policy are unknown.

Methods

We obtained data of 280 203 deliveries with six common pregnancy complications and thirteen perinatal outcomes between 2010 and 2021 in eastern China. The average annual percent change (AAPC) was calculated to evaluated the temporal trajectories of obstetric characteristics and adverse outcomes during this period. Then, the autoregressive integrated moving average (ARIMA) models were constructed to project future trend of obstetric characteristics and outcomes until 2027.

Results

The proportion of advanced maternal age (AMA), assisted reproduction technology (ART) treatment, gestational diabetes mellitus (GDM), anaemia, thrombocytopenia, thyroid dysfunction, oligohydramnios, placental abruption, small for gestational age (SGA) infants, and congenital malformation significantly increased from 2010 to 2021. However, the placenta previa, large for gestational age (LGA) infants and stillbirth significantly decreased during the same period. The AMA and ART treatment were identified as independent risk factors for the uptrends of pregnancy complications and adverse perinatal outcomes. The overall caesarean section rate remained above 40%. Importantly, among multiparas, a previous caesarean section was found to be associated with a significantly reduced risk of hypertensive disorders of pregnancy (HDP), premature rupture of membranes (PROM), placenta previa, placental abruption, perinatal asphyxia, LGA infants, stillbirths, and preterm births. In addition, the ARIMA time series models predicted increasing trends in the ART treatment, GDM, anaemia, thrombocytopenia, postpartum haemorrhage, congenital malformation, and caesarean section until 2027. Conversely, a decreasing trend was predicted for HDP, PROM, and placental abruption premature, LGA infants, SGA infants, perinatal asphyxia, and stillbirth.

Conclusions

Maternal and neonatal adverse outcomes became more prevalent from 2010 to 2021 in China. Maternal age and ART treatment were independent risk factors for adverse obstetric outcomes. The findings offered comprehensive trajectories for monitoring pregnancy complications and perinatal outcomes in China, and provided robust intervention targets in obstetric safety. The development of early prediction models and the implementation of prevention efforts for adverse obstetric events are necessary to enhance obstetric safety.

Establishment of trimester-specific reference intervals of renal function tests and their predictive values in pregnant complications and perinatal outcomes: A population-based cohort study

Objectives

In this study, we aimed to establish the trimester-specific RIs of renal function tests (RFTs) in singleton pregnant women and investigate the associations between adverse perinatal outcomes and abnormal renal function laboratory results.

Methods

The results of RFTs and the associated medical records were retrieved from 16489 singleton pregnant women who underwent first- and third-trimester prenatal screening and gave a live birth at out institute between August 2018 and December 2019. The RFTs were performed on the automated immunochemistry platform ARCHITECT ci16200 (Abbott Laboratories Ltd, Abbott Park, Illinois, US) in the clinical laboratory of our institute. The nonparametric 2.5th-97.5th percentile intervals and the indirect Hoffmann methods were used to define the trimester-specific RIs. The associations between abnormal RFTs and adverse pregnancy outcomes was assessed statistically by logistic regression.

Results

There was no significant difference between the direct observational and the indirect Hoffmann methods in establishing RIs of RFTs. Compared with RFTs in the first trimester, the concentrations of serum BUN and Crea were slightly decreased (p < 0.001), and the serum UA and Cys C levels were significantly elevated in the third trimester (p < 0.001). In the logistic regression analysis, high concentrations of UA, Crea, and Cys C in late pregnancy were associated with an increased risk of postpartum hemorrhage. Meanwhile, early pregnancy UA was associated with a modestly increased risk of GDM, GH, and PE.

Conclusion

It is necessary to establish trimester-specific RIs for RFTs, in order to appropriately interpret laboratory results and to identify women with high risks of developing various adverse outcomes.