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Adverse Pregnancy Outcomes: Current Status, Challenges and Future Directions
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Adverse Pregnancy Outcomes: Current Status, Challenges and Future Directions

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Obstetrics & Gynecology".

Deadline for manuscript submissions: 10 March 2025 | Viewed by 5629

Special Issue Editors

Dr. Demetra Socolov

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Guest Editor
Department of Obstetrics and Gynecology, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
Interests: maternal–fetal medicine; in utero fetal surgery; prenatal diagnosis; artificial intelligence
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Iuliana Ceausu

E-Mail Website
Guest Editor
Department of Obstetrics and Gynaecology, “Carol Davila” University of Medicine and Pharmacy, "Dr I. Cantacuzno" Hospital, 020021 Bucharest, Romania
Interests: Biomarkers in obstetrics and gynaecology; gestational diabetes; maternal obesity; autoimmune diseases and pregnancy; preeclampsia; fetal medicine
Dr. Elena Bernad

E-Mail Website
Guest Editor
Department of Obstetrics and Gynecology, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
Interests: gynecology; obstetrics; gynecological oncology; endocrinology and reproductive medicine; ethics; medical education; research design; epidemiology and statistics; computer applications
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Adverse pregnancy outcomes pose a substantial challenge for obstetricians, with long-term consequences on maternal and neonatal health, including neurological injuries as well as cardiovascular and metabolic disorders. Current screening strategies and prophylactic measures have substantially influenced the incidence of these adverse outcomes. However, recent advancements in detection rates of obstetrical disorders using various biochemical, sonographic, genomic, and proteomic markers, as well as advanced screening algorithms powered by artificial intelligence, need to be highlighted.

This Special Issue, entitled “Adverse Pregnancy Outcomes: Current Status, Challenges, and Future Directions,” will focus on recent advancements in the screening, prediction, and diagnosis of maternal and neonatal outcomes in the context of preeclampsia, intrauterine growth restriction, preterm birth, gestational diabetes, and intraamniotic infections. Additionally, it will support the peer review of manuscripts that describe the prenatal and intrapartum management of high-risk pregnancies and their outcomes.

We welcome high-quality and informative original studies (clinical and experimental), meta-analyses, reviews, clinical cases, and expert opinions. We look forward to receiving your contributions!

Dr. Demetra Socolov
Prof. Dr. Iuliana Ceausu
Dr. Elena Bernad
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • great obstetrical syndromes
  • adverse pregnancy outcomes
  • screening
  • prediction
  • prophylaxis
  • diagnosis
  • long-term follow-up
  • perinatal management
  • intrapartum management

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Published Papers (6 papers)

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Research

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17 pages, 776 KiB  
Article
Awareness and Knowledge About Preconception Healthcare: A Cross-Sectional Study of Early Years UAE Medical Students
by Sara Maki, Shamsa Al Awar, Sara Alhosani, Latifa Alshamsi, Shamma Alzaabi, Mohammad Ali Alsaadi, Mahra Alhammadi, Hamad Alhosani, Gehan Sayed Salam, Stanisław Wójtowicz and Kornelia Zaręba
J. Clin. Med. 2025, 14(1), 181; https://doi.org/10.3390/jcm14010181 - 31 Dec 2024
Viewed by 512
Abstract
Background: Preconception health is critical for improving maternal and child health. The main objective of the study was to explore medical students’ health habits, quality of life, and knowledge of preconception healthcare. Methods: We conducted a cross-sectional study between 15 March 2023 and [...] Read more.
Background: Preconception health is critical for improving maternal and child health. The main objective of the study was to explore medical students’ health habits, quality of life, and knowledge of preconception healthcare. Methods: We conducted a cross-sectional study between 15 March 2023 and 31 May 2024 among medical students at United Arab Emirates University. To determine awareness and knowledge of preconception health, we administered a survey consisting of an author’s questionnaire with 35 questions covering sociodemographic characteristics and general knowledge of preconception health, as well as the WHO Quality of Life Scale-BREF (WHOQOL-BREF). Results: The participants were predominantly under 25 years old (98.5%), Emirati (91.1%), single (92.6%), and female (95.8%); only 3.4% had been pregnant before. Regarding health awareness and behaviors, a significant number of females (58.0%) had never visited a gynecologist. The majority of students (72.4%) participated in sports activities. The overall level of knowledge was low, with a mean level of 7.5 (SD = 6.36) out of 24. The Internet (webpages, blogs, webinars) (64.5%) was the major source of knowledge regarding healthcare information, followed by social media platforms (Twitter, Facebook, TikTok, Instagram) and mobile applications (57.5%), books (48.6%), and family members (57.0%). There was a statistically significant correlation between knowledge levels and the Internet (p < 0.004) or family (p < 0.001) as a source of knowledge. Additionally, there was a statistically significant positive correlation between knowledge and quality of life across all four WHOQOL domains. Conclusions: Medical knowledge might positively affect general well-being. Fostering stronger social networks and support systems could benefit preconceptional awareness and knowledge. Full article
(This article belongs to the Special Issue Adverse Pregnancy Outcomes: Current Status, Challenges and Future Directions)
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9 pages, 794 KiB  
Article
Risk Assessment for Preeclampsia in the Preconception Period Based on Maternal Clinical History via Machine Learning Methods
by Yeliz Kaya, Zafer Bütün, Özer Çelik, Ece Akça Salik and Tuğba Tahta
J. Clin. Med. 2025, 14(1), 155; https://doi.org/10.3390/jcm14010155 - 30 Dec 2024
Viewed by 485
Abstract
Objective: This study was aimed to identify the most effective machine learning (ML) algorithm for predicting preeclampsia based on sociodemographic and obstetric factors during the preconception period. Methods: Data from pregnant women admitted to the obstetric clinic during their first trimester [...] Read more.
Objective: This study was aimed to identify the most effective machine learning (ML) algorithm for predicting preeclampsia based on sociodemographic and obstetric factors during the preconception period. Methods: Data from pregnant women admitted to the obstetric clinic during their first trimester were analyzed, focusing on maternal age, body mass index (BMI), smoking status, history of diabetes mellitus, gestational diabetes mellitus, and mean arterial pressure. The women were grouped by whether they had a preeclampsia diagnosis and by whether they had one or two live births. Predictive models were then developed using five commonly applied ML algorithms. Results: The study included 100 mothers divided into four groups: 22 nulliparous mothers with preeclampsia, 25 nulliparous mothers without preeclampsia, 28 parous mothers with preeclampsia, and 25 parous mothers without preeclampsia. Analysis showed that maternal BMI and family history of diabetes mellitus were the most significant predictive variables. Among the predictive models, the extreme gradient boosting (XGB) classifier demonstrated the highest accuracy, achieving 70% and 72.7% in the respective groups. Conclusions: A predictive model utilizing an ML algorithm based on maternal sociodemographic data and obstetric history could serve as an early detection tool for preeclampsia. Full article
(This article belongs to the Special Issue Adverse Pregnancy Outcomes: Current Status, Challenges and Future Directions)
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11 pages, 252 KiB  
Article
Multidrug-Resistant Urinary Tract Infections in Pregnant Patients and Their Association with Adverse Pregnancy Outcomes—A Retrospective Study
by Gabriel-Ioan Anton, Liliana Gheorghe, Viorel-Dragos Radu, Ioana-Sadiye Scripcariu, Ingrid-Andrada Vasilache, Alexandru Carauleanu, Iustina-Solomon Condriuc, Razvan Socolov, Pavel Onofrei, Andreea-Ioana Pruteanu, Ramona-Gabriela Ursu, Tudor Gisca and Demetra Socolov
J. Clin. Med. 2024, 13(22), 6664; https://doi.org/10.3390/jcm13226664 - 6 Nov 2024
Cited by 1 | Viewed by 951
Abstract
Background/Objectives: Multidrug-resistant urinary tract infections (MDR UTIs) constitute an important public health problem, especially in pregnant patients. The aim of this retrospective study was to characterize the bacterial spectrum and the profile of microbial resistance in cases of UTIs occurring in pregnant [...] Read more.
Background/Objectives: Multidrug-resistant urinary tract infections (MDR UTIs) constitute an important public health problem, especially in pregnant patients. The aim of this retrospective study was to characterize the bacterial spectrum and the profile of microbial resistance in cases of UTIs occurring in pregnant women, as well as their impact on obstetrical and neonatal outcomes. Methods: A total of 371 pregnant patients with UTIs were included in the analysis and were segregated into the following groups based on the type of bacterial resistance to antibiotics: MDR UTIs (70 patients, group 1), UTIs resistant to one class of antibiotics (108 patients, group 2), UTIs resistant to two classes of antibiotics (102 patients, group 3), and sensitive UTIs (91 patients, group 4). We used descriptive statistics for characterizing and comparing the microbial spectrum and the clinical characteristics of the patients. A multinomial logistic regression model for evaluating the relationship between the type of urinary tract infection and adverse obstetric or neonatal outcomes was employed. Results: In the case of MDR UTIs, the bacterial spectrum mainly included Escherichia coli, Enterococcus faecalis, and Klebsiella species. We found almost universal resistance to ampicillin. Our data confirmed an increased risk of preterm birth, premature rupture of membranes, neonatal respiratory distress syndrome, and neonatal intensive care unit admission for patients with MDR infections. Conclusions: The increased incidence of pathogens resistant to commonly used antibiotic classes in pregnancy suggests the need for the development of local and national protocols that adapt therapeutic and prophylactic regimens to clinical realities. Full article
(This article belongs to the Special Issue Adverse Pregnancy Outcomes: Current Status, Challenges and Future Directions)
12 pages, 423 KiB  
Article
Maternal and Perinatal Outcomes in Pregnant Women with Heart Disease: A Case—Control Study
by Irene Aracil Moreno, Raquel Prieto-Arévalo, Virginia Ortega-Abad, Virginia Martín-Manzano, Laura Pérez-Burrel, Andrea Fraile-López, Carolina Devesa-Cordero, Fátima Yllana-Pérez, Miguel A. Ortega and Juan A. De León-Luis
J. Clin. Med. 2024, 13(17), 5084; https://doi.org/10.3390/jcm13175084 - 27 Aug 2024
Viewed by 1584
Abstract
Objective: We analyzed the obstetric and cardiac characteristics and results of pregnant women with heart disease (HD) and compared their results with those of healthy controls. Methods: In this retrospective single-center case–control study, women with HD attended between 2010 and 2018 [...] Read more.
Objective: We analyzed the obstetric and cardiac characteristics and results of pregnant women with heart disease (HD) and compared their results with those of healthy controls. Methods: In this retrospective single-center case–control study, women with HD attended between 2010 and 2018 were matched at a 1:2 ratio (according to date of delivery, parity, and singleton or twin pregnancy) with controls without heart disease treated in the same referral center. Results: We identified 141 pregnant women with HD, of whom 132 reached 22 weeks of gestation and were paired with 264 healthy controls, for a total of 396 participants and 408 newborns. Most common HDs were congenital HD (53 women), arrhythmia (46), valvular HD (35), and cardiomyopathy (16), having women with more than one coexisting HD. During pregnancy or the puerperium, 19.9% of mothers experienced a major adverse cardiac event (MACE), with 5% requiring intensive care unit (ICU) admission. The rates of cesarean section were 37.1% in the case group and 18.2% in the control group, with an odds ratio (OR) of 2.66 (95% CI = 1.66–4.26, p < 0.001). We also found a higher use of general anesthesia, with an OR of 10.73 (95% CI = 2.32–49.75, p = 0.002); more prolonged hospitalizations, with an OR of 2.91 (95% CI 1.02–8.35, p = 0.023); and a higher incidence of low neonatal weight, with an OR of 1.96 (95% CI 1.09–3.52, p = 0.012). There were no differences between groups in terms of gestational age at delivery; however, we observed greater prematurity in women with HD, without reaching statistical significance. The rate of congenital heart disease among the newborns of mothers with HD was 13.2%. Conclusions: HD increases maternal morbidity during pregnancy and it is associated with higher rates of cesarean section and low birth weight. Full article
(This article belongs to the Special Issue Adverse Pregnancy Outcomes: Current Status, Challenges and Future Directions)
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Review

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13 pages, 726 KiB  
Review
Maternal and Fetal Complications in Pregnant Women with Neurofibromatosis Type 1: Literature Review and Two Case Reports
by Ancuta Nastac, Anca Maria Panaitescu, Iulia Huluță, Nicolae Gică, Gabriel-Petre Gorecki, Radu Botezatu, Cristina Violeta Tutunaru, Vlad Mihai Voiculescu and Florina Mihaela Nedelea
J. Clin. Med. 2025, 14(2), 451; https://doi.org/10.3390/jcm14020451 - 12 Jan 2025
Viewed by 833
Abstract
Neurofibromatosis is a genetic disorder arising de novo or with an autosomal dominant transmission that typically presents either at birth or in early childhood, manifesting through distinctive clinical features such as multiple café-au-lait spots, benign tumors in the skin, bone enlargement, and deformities. [...] Read more.
Neurofibromatosis is a genetic disorder arising de novo or with an autosomal dominant transmission that typically presents either at birth or in early childhood, manifesting through distinctive clinical features such as multiple café-au-lait spots, benign tumors in the skin, bone enlargement, and deformities. This literature review aims to resume the spectrum of maternal and fetal complications encountered in pregnant women with neurofibromatosis type 1 (NF1). Thorough research was conducted on databases such as Web of Science, PubMed, Science Direct, Google Scholar, and Wiley Online Library. This review includes 48 case reports, original studies, and reviews on NF1 in pregnancy. The research on the interlink between NF1 and fertility and its influence on human-assisted reproduction techniques is limited. Preimplantation testing (by in vitro fertilization) and prenatal diagnosis (by chorionic villus sampling or amniocentesis) are available to detect affected fetuses. However, genotype–phenotype correlation is difficult to predict. Preconceptional planning and targeted investigations are crucial in understanding the extent of maternal disease. Although in some cases lesions can evolve rapidly during pregnancy, most pregnancies and births in NF1 go well with careful planning. There is a higher incidence of pheochromocytomas and pre-eclampsia, vascular rupture, and cardio-respiratory issues. Anesthesia at birth is a challenge in most cases, and before offering spinal anesthesia, imaging tests should be performed to characterize spinal lesions. General anesthesia may also be challenging when the disease affects the face, neck, upper spine, or airways. Birth-related difficulties may arise because of large neurofibromas located at the level of skin incision or birth canal; uterine atony may be expected if there are uterine lesions. Some complications can develop in postpartum, and affected women should be carefully followed even after pregnancy. Fetal risks include preterm birth (spontaneous or iatrogenic), growth restriction and developmental issues, birth complications, cardiovascular risk, and fetal/neonatal demise. Pregnancies in women with NF1 should be regarded as high-risk and followed in a multidisciplinary fashion. Careful assessment of lesions is of utmost importance before and during pregnancy for anticipating potential maternal risks and before birth to plan anesthesia and delivery. Full article
(This article belongs to the Special Issue Adverse Pregnancy Outcomes: Current Status, Challenges and Future Directions)
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14 pages, 764 KiB  
Review
Pre-Pregnancy Counselling for Women with Rheumatoid Arthritis: A Guide on Risks, Evaluations, and Multidisciplinary Approaches
by Ioana Cristina Saulescu, Anca Maria Panaitescu, Nicolae Gică, Elena Grădinaru and Daniela Opris-Belinski
J. Clin. Med. 2025, 14(1), 114; https://doi.org/10.3390/jcm14010114 - 28 Dec 2024
Viewed by 735
Abstract
This paper explores the essential role of pre-pregnancy counselling for women with rheumatoid arthritis (RA), focusing on minimising risks and optimising pregnancy outcomes. RA, a prevalent inflammatory arthritis with onset during childbearing years, necessitates targeted preconception counselling to manage disease activity and comorbidities [...] Read more.
This paper explores the essential role of pre-pregnancy counselling for women with rheumatoid arthritis (RA), focusing on minimising risks and optimising pregnancy outcomes. RA, a prevalent inflammatory arthritis with onset during childbearing years, necessitates targeted preconception counselling to manage disease activity and comorbidities effectively. The counselling ensures medication compatibility and planning around disease flares, and it involves a multidisciplinary team comprising rheumatologists, obstetricians, and other specialists to develop individualised care plans. This literature review highlights the challenges women with RA face, including prolonged time to pregnancy, increased risks during pregnancy, such as hypertension and preeclampsia, and potential fertility issues related to medication and disease activity. Emphasis is placed on the importance of assessing autoantibody presence and managing specific joint involvements that may affect anaesthetic procedures during pregnancy. This paper underscores the importance of timing conception during periods of low disease activity and adopting a “Treat-to-Target” approach using acceptable medications to maintain disease remission. This study calls for routine family planning discussions and preconception evaluations to address reproductive health and treatment plans, thereby supporting women with RA in achieving favourable pregnancy outcomes comparable to the general population. The multidisciplinary approach and regular counselling are critical to navigating the complexities of RA and pregnancy successfully. Full article
(This article belongs to the Special Issue Adverse Pregnancy Outcomes: Current Status, Challenges and Future Directions)
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