Blood type and postpartum hemorrhage by mode of delivery: A retrospective cohort study

Effects of Selective Serotonin Reuptake Inhibitors and Ondansetron on Urinary Tract Infections in Pregnancy

Urinary tract infections (UTIs) are prevalent during pregnancy and pose risks of adverse outcomes. Recent research suggests that urethral serotonin signaling may protect against ascending uropathogens. With the common use of Selective Serotonin Reuptake Inhibitors (SSRIs) and ondansetron, a serotonin receptor antagonist, during pregnancy, it is essential to explore their interactions with serotonin mechanisms to improve maternal health care. This study examines the relationship between SSRIs and ondansetron use in pregnancy and the incidence of UTIs and other negative outcomes. A retrospective analysis of data from 7,023 pregnant women in the PeriBank database (IRB ID: 2023-0263), from February 2020 to April 2023, revealed that 1,019 received ondansetron and 316 were on SSRIs, including fluoxetine, sertraline, escitalopram, and citalopram. An experimental component involving pregnant mice treated with ondansetron or saline before E. coli infection further assessed UTI severity. Findings indicated that pregnant women using ondansetron had significantly increased odds of developing UTIs, while no significant association was noted for those on SSRIs. Additionally, pregnant mice administered ondansetron exhibited more severe bladder infections compared to those given saline. These results suggest SSRIs are not linked to an increased UTI risk or adverse outcomes, whereas ondansetron is associated with higher UTI risk and pre-term birth. Thus, careful use of ondansetron during pregnancy is recommended to avoid potential risks to maternal and fetal health.

Elevated Micro- and Nanoplastics Detected in Preterm Human Placentae

Recent analytical advancements have uncovered increasing micro- and nanoplastics (MNPs) in environmental, dietary, and biological domains, raising concerns about their health impacts. Preterm birth (PTB), a leading cause of maternal and neonatal morbidity and mortality, may be influenced by MNP exposure, yet this relationship remains unexplored. This study quantified 12 MNP polymers in placentae from term (n=87) and preterm (n=71) deliveries using pyrolysis-gas chromatography/mass spectrometry (Py-GC/MS). Cumulative MNP concentrations were 28% higher in PTB placentae (mean ±SD: 224.7 ± 180.7 μg/g vs. 175.5 ± 137.9 μg/g; p=0.038). Polyvinyl chloride (PVC), polyethylene terephthalate (PET), polyurethane (PU), and polycarbonate (PC) were significantly elevated in PTB, and PET, PU, and PC inversely correlated with gestational age and birth weight. Logistic regression identified PVC and PC as independent predictors of PTB. These findings suggest total and specific MNPs are associated with PTB, providing actionable insights and emphasizing the importance of minimizing exposure during pregnancy.

Blood Type and Outcomes in Pregnant Women with Placenta Previa

Background

Placenta previa increases the risks of obstetrical complications. Many studies have reported a link between various ABO blood types and pregnancy complications. This study is aimed at describing and comparing the characteristics and outcomes of women with placenta previa by ABO blood type.

Methods

Data for this study was obtained from a retrospective cohort study between January 1, 2014, and June 30, 2019, of all clinically confirmed placenta previa in a university-based tertiary medical center. Both types of A, B, O, AB, and combining O and non-O blood types were compared to the characteristics and outcomes.

Results

1678 participants with placenta previa were included in this study. The highest participants were blood type O with 666 (39.7%), followed by type A with 508 (30.3%) and type B with 395 (23.5%), and the lowest participants were AB with 109 (6.5%). Blood type AB had a higher incidence of antepartum hemorrhage (p = 0.017), predelivery anemia (p = 0.036), and preterm birth (p = 0.015) in placenta previa women. Meanwhile, the incidence of rhesus D positive (97.9% vs. 95.8%, p = 0.012) and twins (5.0% vs. 2.7%, p = 0.011) was higher in the non-O group, and the incidence of neonatal asphyxia (5.9% vs. 9.2%, p = 0.016) was lower in the non-O group.

Conclusion

Type AB blood may be a potential risk factor for women with placenta previa. This finding may help provide any obstetrician to predict the risk of complication for placenta previa women by the ABO blood types.

Examining prescribing practices with respect to oral iron supplementation for post-partum anemia: a retrospective review

PURPOSE

Treatment for post-partum anemia frequently entails oral iron supplementation, but questions remain regarding optimal dosing, frequency, and efficacy. The objective of this study was to describe oral iron prescribing practices in post-partum women delivered via Cesarean section, and identify factors associated with iron supplementation.

METHODS

A retrospective review of Cesarean section deliveries at a single tertiary center between May 2019 and April 2020 was undertaken. Patient demographics, hematological indices, indication for Cesarean section and discharge prescriptions were collected. Univariate and multivariable analyses were performed to identify factors associated with oral iron prescription at discharge.

RESULTS

During the study period, 1470 women were eligible for inclusion. The mean age at delivery was 34.4 ± 4.9 years and mean gestational age was 37.2 ± 3.6 weeks. Most pregnancies (92%) were singleton. Ninety-six total patients (6.5%) received intravenous iron post-partum. Fourteen percent of women (210/1470) received prescriptions for oral iron at discharge, most commonly ferrous fumarate (61.9%, 130/210). The most common dose provided was 300 mg (145/210). Ante-partum ferritin was available for most patients (64.3%, 945/1470), but only for 17 post-partum patients (1.2%). Factors significantly associated with oral iron prescription were earlier gestational age at birth (aOR 0.93, 95% CI 0.89-0.97), history of complications during pregnancy or labor (aOR 1.92, 95% CI 1.26-2.98), higher blood loss (aOR 2.66, 95% CI 1.36-5.44), post-partum anemia (aOR 6.28, 95%-CI 4.41-8.96), blood transfusion (aOR 5.43, 95%-CI 1.81-18.19) and antenatal iron supplementation (aOR 5.70, 95%-CI 4.02-8.17).

CONCLUSIONS

In summary, a relatively small proportion of women following Cesarean section were prescribed oral iron at discharge. We identified several factors associated with post-partum iron supplementation. This information will inform future prospective studies investigating the efficacy of iron supplementation in the treatment of post-partum anemia.