American Journal of Obstetrics and Gynecology MFM

There is limited evidence regarding optimal gestational weight gain in women with twin pregnancies and gestational diabetes mellitus.This study aimed to examine the association between gestational weight gain and perinatal outcomes among women with gestational diabetes mellitus and twin pregnancies and to explore the gestational weight gain targets by prepregnancy body mass index category.A national population-based cohort study of twin pregnancies with gestational diabetes mellitus was conducted between 2014 and 2020. Women with gestational diabetes mellitus aged between 18 and 45 years with live-born twins without congenital malformations between 24 and 42 weeks of gestation were included in the analysis. Two approaches were used to determine the optimal gestational weight gain targets by body mass index category: an interquartile range method to calculate targets in low-risk gestational diabetes mellitus pregnancies and a logistic model method to identify the odds ratio targets at which a composite adverse outcome decreased.Of 29,308 women with gestational diabetes mellitus and twin pregnancies, 8239 (28.1%) were normal-weight, 7626 (26.0%) were overweight, and 13,443 (45.9%) were obese. The continuous standardized gestational weight gain by 36 weeks was associated with preterm birth <36 weeks, large-for-gestational-age infants, small-for-gestational-age infants, and gestational hypertensive disorders. The interquartile range targets were 13.6 to 20.9 kg, 10.9 to 20.4 kg, and 7.7 to 17.7 kg for normal-weight, overweight, and obese women, respectively. The odds ratio targets were 14.1 to 20.0 kg, 12.1 to 16.0 kg, and 6.1 to 12.0 kg for normal-weight, overweight, and obese women, respectively. Gestational weight gain outside these targets was associated with preterm birth <36 weeks, large-for-gestational-age and small-for-gestational-age infants, and gestational hypertensive disorders, and exhibited significant population attributable fractions for preterm birth <36 weeks, large-for-gestational-age infants, and gestational hypertensive disorders across body mass index categories.Compared with the Institute of Medicine guidelines, more stringent gestational weight gain targets would be beneficial for improved perinatal outcomes in women with gestational diabetes mellitus and twin pregnancies.

Dongxin Lin

Dazhi Fan

Pengsheng Li

Gengdong Chen

Zixing Zhou

Jiaming Rao

Shaoxin Ye

Lijuan Wang

Jinping Feng

Demei Lu

Caihong Luo

Zhengping Liu

American Journal of Obstetrics & Gynecology MFM

Optimal gestational weight gain in women with twin pregnancies and gestational diabetes mellitus: a population-based study in the United States

双胎妊娠合并妊娠期糖尿病妇女的最佳孕期体重增长：基于美国人群的研究

The mechanisms responsible for the onset and progression of labor remain uncertain. Myometrial contractile activity gradually increases until labor onset as a result of a number of intrinsic and hormonal changes, and this a believed to be the essential process responsible for labor. At the same time, the cervix slowly effaces and dilates throughout pregnancy, and these are the only physiologic parameters predictive labor onset. It is feasible that an interaction exists between increasing contractile activity and cervical softening that is responsible for labor onset and progression. The novel biomedical hypothesis presented here is that labor onset and progression rely on a positive feedback loop involving uterine contractility, myometrial shortening, and shortening-related myometrial prostaglandin F2α production, which occurs when contractile force exceeds the resistance to myometrial shortening. Immediately before labor onset and during early labor, first cervical effacement and then dilation allows the cervix to be pulled up over the presenting part, thus permitting myometrium to assume a decreasing percentage of uterine circumference, which enables myometrium to shorten with each uterine contraction. After complete dilation, further shortening is allowed by decreasing uterine volume resulting from fetal egress from the uterus and complete uterine emptying at delivery. Since contractile activity can shorten myometrium and shortening has been shown to increase myometrial prostaglandin F2α production, the ability of myometrial shortening to stimulate contractile activity results in a positive feedback loop that plays an important role in both labor onset and progression. Premature labor occurs whenever this positive feedback loop develops prior to term because of pathologically increased contractile activity or decreased resistance to shortening. Details of this hypothesis and the mechanisms that either resist or allow myometrial shortening are presented, followed by a review of the laboratory and clinical evidence that either supports or appears to contradict this hypothesis.

William W Hurd

Am J Obstet Gynecol MFM

Myometrial Shortening Stimulates Contractility: A Biomechanical Hypothesis for Labor Onset and Progression

子宫肌层缩短刺激收缩性：关于分娩启动和进展的生物力学假说

Sarah Boudova

Laurie Griffin

Carolina Martinez-King

John Soehl

Virginia Watkins

Tiffany Yang

Increasing dialogue surrounding controversies in antepartum management among trainees

关于产前管理争议的讨论在实习生中日益增多

Antonio F Saad

Eunice Yang

Andrew H Nguyen

Garima Sharma

Scott A Sullivan

George L Maxwell

Luis D Pacheco

George R Saade

A Practical Approach to Diagnosing and Managing Long QT Syndrome from Pregnancy through Postpartum.

从妊娠到产后诊断和管理长QT间期综合征的实用方法。

Dilapan-S is a cervical ripening agent approved by the FDA that has been found to be just as effective as other agents and can be utilized for outpatient ripening. No large-scale studies have been conducted to compare cesarean delivery rates between Dilapan-S and other ripening methods. Our objective was to combine these trials to compare cesarean delivery rates for Dilapan-S with other cervical ripening methods, overall and in sub-groups.

Claudia Pedroza

Rachana Gavara

Janesh Gupta

Ronald J Wapner

Dilapan-S versus Standard Methods for Cervical Ripening in Term Pregnancies: An Individual Patient Data Meta-Analysis

Dilapan-S与标准方法用于足月妊娠宫颈成熟度的比较：一项个体患者数据Meta分析

Postpartum hemorrhage (PPH) is a leading cause of maternal mortality worldwide, particularly in resource-limited settings. Enhancing maternal safety in relation to PPH requires optimizing care protocols, continuous monitoring, and timely interventions. However, integrating these methodologies into vaginal delivery practices remains underexplored.

Pei Zhang

Yifan Fan

Hui Song

Yan Lv

Hao Geng

Pingchuan Ma

Hongyan Cui

Yanju Jia

Xu Chen

Step forward: Implementation and evaluation of STEPS program to optimize postpartum hemorrhage management in vaginal deliveries

向前一步：实施和评估STEPS计划以优化阴道分娩后产后出血管理

Abbreviation	Am. J. Obstet. Gynecol. MFM.
Journal Impact	4.00
Quartiles(Global)	OBSTETRICS & GYNECOLOGY(Q1)

ISSN	2589-9333
h-index	33

Publication Information	Publisher: Elsevier Inc.，Publishing cycle: ，Journal Type: journal，Open Access Journals: No
Basic data	Year of publication: 2019，Proportion of original research papers: 80.71%，Self Citation Rate:5.30%， Gold OA Rate: 13.91%

American Journal of Obstetrics and Gynecology MFM

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Optimal gestational weight gain in women with twin pregnancies and gestational diabetes mellitus: a population-based study in the United States

Myometrial Shortening Stimulates Contractility: A Biomechanical Hypothesis for Labor Onset and Progression

Increasing dialogue surrounding controversies in antepartum management among trainees

A Practical Approach to Diagnosing and Managing Long QT Syndrome from Pregnancy through Postpartum.

Dilapan-S versus Standard Methods for Cervical Ripening in Term Pregnancies: An Individual Patient Data Meta-Analysis

Increasing dialogue surrounding controversies in antepartum management among trainees

Myometrial Shortening Stimulates Contractility: A Biomechanical Hypothesis for Labor Onset and Progression

A Practical Approach to Diagnosing and Managing Long QT Syndrome from Pregnancy through Postpartum.

Dilapan-S versus Standard Methods for Cervical Ripening in Term Pregnancies: An Individual Patient Data Meta-Analysis

Step forward: Implementation and evaluation of STEPS program to optimize postpartum hemorrhage management in vaginal deliveries