Background: Betamethasone (BMZ) is commonly administered to patients with fetal growth restriction (FGR) and abnormal umbilical artery Doppler (UAD) velocimetry due to the increased risk of preterm delivery; however, the clinical impact of UAD changes after BMZ exposure is unknown.Objective: To test the hypothesis that lack of UAD improvement after BMZ administration is associated with shorter latency and greater neonatal morbidity in patients with FGR.Study design: This was a retrospective cohort study of pregnancies complicated by FGR and abnormal UAD between 240 and 336 weeks gestation. Abnormal UAD included the following categories of increasing severity: elevated (pulsatility index >95%), absent end diastolic flow (EDF), or reversed EDF improvement was defined as any improvement in category of UAD within two weeks of BMZ. Sustained improvement was defined as improvement until the last ultrasound before delivery, whereas transient improvement was considered as unsustained. The primary outcome was latency, defined as interval from betamethasone administration to delivery. Secondary outcomes were gestational age at delivery, umbilical artery pH, and a composite of neonatal morbidity (intubation, necrotizing enterocolitis, ionotropic support, intraventricular hemorrhage, total parenteral nutrition, neonatal death). Outcomes were compared between (a) patients with and without UAD improvement and (b) patients with sustained and unsustained improvement, using univariable, multivariable and time-to-event analyses.Results: Of the 222 FGR pregnancies with abnormal UAD, 94 received BMZ and had follow-up ultrasounds. UAD improved in 48 (51.1%), with 27 (56.3%) having sustained improvement. Patients with hypertension and drug use were less likely to have UAD improvement. Patients without UAD improvement had shorter latency (21.5 days [interquartile range (IQR) 8,45] versus 35 [IQR 22,61], p = .02) and delivered at an earlier gestational age (34 weeks [IQR 31,36] versus 37 [IQR 33,37], p < .01) than those with improvement. There were no differences in umbilical artery pH between groups. Composite neonatal morbidity was higher in patients without UAD improvement, but this was not statistically significant after adjusting for confounders (aOR 2.0; 95% CI 0.08-5.1). There were no differences in outcomes between patients with sustained versus unsustained improvement.Conclusions: UAD improved in half of patients following BMZ. Lack of UAD improvement was associated with shorter latency and earlier gestational age at delivery, but no difference in composite neonatal morbidity. UAD response to BMZ may be useful to further risk stratify FGR pregnancies.
Objective The primary objective of this study was to evaluate coronavirus 2019 (COVID-19) pandemic–related changes in the antenatal utilization of high-risk obstetric services. Our secondary objective was to characterize change in stillbirth rate during the pandemic. Study Design This is a retrospective, observational study performed at a single, tertiary care center. Maternal-Fetal Medicine (MFM) visits, ultrasounds, and antenatal tests of fetal well-being during the pandemic epoch (2020), which spans the first 12 weeks of the year to include pandemic onset and implementation of mitigation efforts, were compared with the same epoch of the three preceding years visually and using general linear models to account for week and year effect. An analysis of stillbirth rate comparing the pandemic time period to prepandemic was also performed. Results While there were decreased MFM visits and antenatal tests of fetal well-being during the pandemic epoch compared with prepandemic epochs, only the decrease in MFM visits by year was statistically significant (p < 0.001). The stillbirth rate during the pandemic epoch was not significantly different when compared with the prepandemic period and accounting for both week (p = 0.286) and year (p = 0.643) effect. Conclusion The COVID-19 pandemic resulted in a significant decrease in MFM visits, whereas obstetric ultrasounds and antenatal tests of fetal well-being remained unchanged. While we observed no change in the stillbirth rate compared with the prepandemic epoch, our study design and sample size preclude us from making assumptions of association. Our findings may support future work investigating how changes in prenatal care for high-risk obstetric patients influence perinatal outcomes. Key Points
Evidence from studies of brain tumors, particularly adult gliomas, suggests that allergic conditions may protect against these tumors.It is widely recognized that individuals with the common genetic syndrome, Neurofibromatosis type 1 (NF1), are predisposed to developing pediatric brain tumors (PBTs), particularly optic gliomas; however, risk factors are not well defined.In this study, we sought to evaluate associations between allergic conditions and PBTs in NF1.NF1 subjects were ascertained from two data sources: (1) the NF1 Patient Registry Initiative (NPRI, n ¼ 1672) and (2) medical records (MRs) from a large medical center (n ¼ 629).Using logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (CIs), we determined associations between NPRI participant-or MR-reported PBTs and allergic condition diagnoses (allergies, asthma, and eczema).We observed significant positive associations between medication allergies and PBTs for both data sources, but not for other allergy types or eczema.Weak nonsignificant inverse associations between PBTs and asthma were observed (NPRI: OR ¼ 0.80, 95% CI 0.55-1.17;MR: OR ¼ 0.71, 95% CI 0.40-1.28),with a significant inverse association (OR ¼ 0.60; 95% CI 0.36-0.89)detected in an NPRI subgroup analysis that excluded PBT cases (and a matched non-case) whose asthma diagnosis was reported to occur after their PBT diagnosis.No significant associations were observed in similar analyses for eczema or allergies.In conclusion, our study supports a possible role for asthma in PBT risk in NF1.However, these results should be considered exploratory in light of limitations of both data sources with additional replication required to make firm conclusions.
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