Achieving Diagnostic Excellence in Prenatal Diagnosis Through Patient-Reported Measures Comment on "Achieving Diagnostic Excellence: Roadmaps to Develop and Use Patient-Reported Measures With an Equity Lens".

McDonald and colleagues' work "Achieving Diagnostic Excellence: Roadmaps to Develop and Use Patient-Reported Measures With an Equity Lens" emphasizes the critical role of patient-reported measures (PRMs) in achieving diagnostic excellence, with a focus on equity. PRMs capture patients' experiences, symptoms, and concerns throughout the diagnostic process, enhancing accuracy and addressing uncertainties. In contexts like maternity care, PRMs have been applied to reveal and reduce communication gaps and alleviate anxiety, offering crucial support for improving diagnostic experiences and outcomes.

Genetic association of preeclampsia to von Willebrand factor and its size-regulator ADAMTS13.

Preeclampsia is a common pregnancy-specific vascular disorder that develops during the second half of pregnancy. Preeclampsia shares features with thrombotic microangiopathies. Here we analyzed whether sequence variants in the coagulation system genes predispose to preeclampsia.

The association between exclusive breastfeeding and quality of care and maternal factors in a tertiary maternity hospital in Finland: A cross-sectional study.

Background: Mothers' perceptions of high-quality hospital care may improve breastfeeding outcomes, yet postnatal care in hospitals is often rated poorly by mothers, highlighting the need to focus on the quality and maternal perceptions of care, not just its provision. Fewer women exclusively breastfeed than intend to. The aim was to examine the association between exclusive breastfeeding, quality of care, and maternal factors based on maternal reports.

Cancer risk after preeclampsia: a cohort study in two Nordic populations.

Background: Limited evidence suggests that preeclampsia (PE) is associated with reduced cancer risk later in life. We aimed to investigate this using large registry-based cohorts. We hypothesised that enhanced immune activation in PE women, suggested by autoimmune-type reactivity, lowers their subsequent cancer risk.

Cardiometabolic health 8-12 years after pre-eclampsia: Role of obesity and gestational diabetes (FINNCARE study).

Objective: This study examined the long-term cardiometabolic health in subgroups of pre-eclampsia (PE) to identify individuals who would benefit from targeted cardiovascular screening. Design and main outcome: A cross-sectional cohort. We compared cardiometabolic profile (anthropometrics, body composition, blood biomarkers, and blood pressure) among normotensive control pregnancies (n = 92), de novo PE (n = 156), de novo PE with gestational diabetes mellitus (GDM) (PE + GDM, n = 16), and PE superimposed on chronic hypertension (n = 18).

The Effect of a Mobile App (eMOM) on Self-Discovery and Psychological Factors in Persons With Gestational Diabetes: Mixed Methods Study.

Background: Gestational diabetes is a type of diabetes that develops during pregnancy and increases the risk of developing type 2 diabetes later in life. The rising prevalence of gestational diabetes mellitus (GDM) highlights the need for more comprehensive treatment strategies, with a particular emphasis on supporting maternal self-management. We showed recently that a mobile app, eMOM, where glucose, nutrition, and physical activity are combined within a single app, significantly improves multiple clinical outcomes among persons with gestational diabetes.

Role of oxysterol 4β-hydroxycholesterol and liver X receptor alleles in pre-eclampsia.

Background: Liver X receptors (LXRs) are expressed in placenta and may be associated with pre-eclampsia (PE). Oxysterols act as agonists for LXRs. We recently proposed a new blood pressure-regulating circuit with oxysterol 4β-hydroxycholesterol (4βHC) acting as a hypotensive factor LXRs.

Effect of delivery hospital busyness on early mortality in small preterm infants: a Finnish population-based cohort study in 2006-2016.

Objectives: To evaluate the effect of delivery hospital busyness on the postnatal condition and the perinatal mortality among small preterm infants born at ≤32+0 gestational weeks.

Design: The daily delivery volume distribution is defined as lowest 10% ('quiet') and highest 10% ('busy') delivery-volume days, and days between (80%) as optimal delivery-volume days. We analysed differences in the incidence of selected adverse outcomes between quiet and busy days compared with optimal delivery-volume days by logistic regression followed by crude (ORs) and adjusted ORs (aORs) with 99% CIs.

Glycemic control in women with GDM: insights from a randomized controlled pilot trial on plant-based Nordic healthy diet versus moderately carbohydrate restricted diet.

Background: Gestational Diabetes Mellitus (GDM) prevalence is rising worldwide, but optimal dietary strategies remain unclear. The eMOM pilot RCT compared a plant-protein rich Healthy Nordic Diet (HND) and a moderately carbohydrate restricted diet (MCRD) and their potential effects on time in glucose target range (≤ 7.8 mmol/L, %TIR), and on newborn body composition.

Comparison of balloon catheter, oral misoprostol, or combination of both for cervical ripening in late-term and post-term nulliparous women: A Finnish randomized controlled multicenter pilot trial.

Introduction: Nulliparous women beyond term have high rates of induction failure. The aim of this study was to compare delivery outcomes for balloon catheter, misoprostol, and combination of both in nulliparous late- and post-term women with unfavorable cervices. We intended to explore whether the combination strategy has lower cesarean section rate and is as safe as either method alone.

Roles of different organizations in implementing patient-reported measures in routine maternity care in Finland.

Background: The integration of patient-centered care (PCC) and value-based healthcare (VBHC) principles, emphasizing personalized, responsive care and cost efficiency, is crucial in modern healthcare. Despite advocation from the International Consortium for Health Outcomes Measurement (ICHOM) for the global adoption of these principles through patient-reported measures (PRMs), their implementation, especially the pregnancy and childbirth (PCB) set, remains limited in maternity care. This study focuses on understanding the optimal organizational entity for integrating standard ICHOM-PCB-PRMs into routine maternity care in Finland.

Development and validation of prediction models for fetal growth restriction and birthweight: an individual participant data meta-analysis.

Background: Fetal growth restriction is associated with perinatal morbidity and mortality. Early identification of women having at-risk fetuses can reduce perinatal adverse outcomes.

Objectives: To assess the predictive performance of existing models predicting fetal growth restriction and birthweight, and if needed, to develop and validate new multivariable models using individual participant data.

Development and validation of a prognostic model to predict birth weight: individual participant data meta-analysis.

Objective: To predict birth weight at various potential gestational ages of delivery based on data routinely available at the first antenatal visit.

Design: Individual participant data meta-analysis.

Data Sources: Individual participant data of four cohorts (237 228 pregnancies) from the International Prediction of Pregnancy Complications (IPPIC) network dataset.

Optimizing postprandial glucose prediction through integration of diet and exercise: Leveraging transfer learning with imbalanced patient data.

Background: In recent years, numerous methods have been introduced to predict glucose levels using machine-learning techniques on patients' daily behavioral and continuous glucose data. Nevertheless, a definitive consensus remains elusive regarding modeling the combined effects of diet and exercise for optimal glucose prediction. A notable challenge is the propensity for observational patient datasets from uncontrolled environments to overfit due to skewed feature distributions of target behaviors; for instance, diabetic patients seldom engage in high-intensity exercise post-meal.

Infertility following trisomic pregnancies: A nationwide cohort study.

Objective: To study whether gynecologic or reproductive disorders show association with trisomic conceptions.

Methods: This nationwide cohort study utilized the Registry of Congenital Malformations to identify women who had a trisomic pregnancy (n = 5784), either with trisomy 13 (T13; n = 351), trisomy 18 (T18; n = 1065) or trisomy 21 (T21; n = 4369) from 1987 to 2018. We used the Finnish Maternity cohort to match the cases to population controls (n = 34 422) on the age, residence, and timing of pregnancy.

Cardiac Structure and Function in 8- to 12-Year-Old Children Following In-Utero Exposure to Preeclampsia (FINNCARE Study).

Background: We evaluated how elevated blood pressure in children exposed to preeclampsia (PE) impacted on their cardiac structure and function, as well as relations with maternal, gestational, and perinatal factors and child body size and composition.

Methods And Results: A total of 182 PE (46 early-onset preeclampsia) and 85 unexposed (non-PE) children were examined in the FINNCARE study 8 to 12 years after the index pregnancy with echocardiography; office, central, and 24-hour ambulatory blood pressures; and body anthropometrics and composition. PE children had lower right ventricular basal sphericity index (mean difference, -0.

Fetal cord plasma herpesviruses and preeclampsia: an observational cohort study.

A previous study suggested that fetal inheritance of chromosomally integrated human herpesvirus 6 (ici-HHV6) is associated with the hypertensive pregnancy disorder preeclampsia (PE). We aimed to study this question utilizing cord plasma samples (n = 1276) of the Finnish Genetics of Preeclampsia Consortium (FINNPEC) cohort: 539 from a pregnancy with PE and 737 without. We studied these samples and 30 placentas from PE pregnancies by a multiplex qPCR for the DNAs of all nine human herpesviruses.

Periodic mobile application (eMOM) with self-tracking of glucose and lifestyle improves treatment of diet-controlled gestational diabetes without human guidance: a randomized controlled trial.

Background: Digitalization with minimal human resources could support self-management among women with gestational diabetes and improve maternal and neonatal outcomes.

Objective: This study aimed to investigate if a periodic mobile application (eMOM) with wearable sensors improves maternal and neonatal outcomes among women with diet-controlled gestational diabetes without additional guidance from healthcare personnel.

Study Design: Women with gestational diabetes were randomly assigned in a 1:1 ratio at 24 to 28 weeks' gestation to the intervention or the control arm.

Labor induction at 41 gestational weeks or expectant management for the nulliparous woman: The Finnish randomized controlled multicenter trial.

Introduction: Neonatal and maternal risks increase in term pregnancy as gestational age advances and become increasingly evident post-term. Management practices of late- and post-term pregnancies vary, and the optimal time point for intervention by labor induction is yet to be determined.

Material And Methods: This randomized controlled trial of 381 nulliparous women with unripe cervices compared labor induction at 41 gestational weeks (early induction) with expectant management and labor induction at 41 to 42 gestational weeks (expectant management).

The impact of fear of childbirth on mode of delivery, postpartum mental health and breastfeeding: A prospective cohort study in Shanghai, China.

Background: The prevalence and impact of fear of childbirth (FOC) has not been sufficiently understood. We aimed to investigate the prevalence of FOC among Chinese population and its impact on mode of delivery, postpartum mental health and breastfeeding.

Methods: We conducted a prospective cohort study, wherein pregnant women in their third trimester who underwent antenatal assessments at Shanghai Changning Maternity and Infant Health Hospital between September 2020 and March 2021 were recruited.

Preeclampsia-exposed children's heart rate variability 8-12 yr after index pregnancy: FINNCARE study.

Preeclampsia is related with elevated systolic blood pressure (SBP) in children. We studied if preeclampsia-exposed (PE) children develop alterations in heart rate variability (HRV) and if this is reflected in their blood pressure (BP), as well as overall associations with body size and composition, gestational and perinatal factors. We examined 182 PE (46 early-onset PE) and 85 unexposed (non-PE) children 8-12 yr after preeclampsia exposure.

Supporting the Management of Gestational Diabetes Mellitus With Comprehensive Self-Tracking: Mixed Methods Study of Wearable Sensors.

Background: Gestational diabetes mellitus (GDM) is an increasing health risk for pregnant women as well as their children. Telehealth interventions targeted at the management of GDM have been shown to be effective, but they still require health care professionals for providing guidance and feedback. Feedback from wearable sensors has been suggested to support the self-management of GDM, but it is unknown how self-tracking should be designed in clinical care.

Determinants of vascular structure and function in at-risk children born to mothers managed for pre-eclampsia (FINNCARE study).

Background And Aim: Pre-eclampsia (PE) is related to elevated blood pressure (BP) in children. The study aims to investigate if elevated BP is reflected in child arterial health and how anthropometrics, body composition, and gestational and perinatal factors influenced this.

Methods: In this prospective cohort study, we assessed the arteries of 182 children exposed (46 had an early onset, with a diagnosis before 34 gestational weeks, and 136 had a late onset) and 85 children unexposed (non-PE) to PE at 8-12 years from delivery using ultra-high-frequency ultrasound in addition to ambulatory and central BPs, body composition and anthropometrics, and tonometry-derived pulse wave velocity (PWV).

Hypertensive pregnancy complications and maternal characteristics as predictors of cardiovascular health within ten years after delivery.

Objective: To identify the combination of maternal characteristics in women with hypertensive disorders of pregnancy (HDP) associated with hypertensive and other cardiovascular diseases (CVDs) within ten years following delivery. The aim is to understand who should receive the most intensive primary cardiovascular disease prevention.

Study Design: A prospective cohort study.

Socioeconomic status, maternal risk factors, and gestational diabetes mellitus across reproductive years: a Finnish register-based study.

Introduction: To evaluate the degree to which socioeconomic differences in gestational diabetes mellitus (GDM) are accounted for by differences in maternal risk factors, to assess whether age-related risks of GDM differ across socioeconomic groups, and to identify priority populations for future interventions.

Research Design And Methods: We performed a register-based study using data from the Finnish Medical Birth Register and Statistics Finland on the 474 166 women who gave birth in Finland from 2008 to 2015. We collected information on GDM based on the International Classification of Diseases 10th Revision codes O24.