Aims We evaluated the clinical value of selected serum biomarkers BMP-4, BMP-2, GDF-15, MMP-9, and GP39 in pregnant women with obesity and the comorbidities diabetes mellitus (DM) and gestational hypertension (GHT). Methods This observational study had groups of controls, including healthy pregnant women; women with only obesity, including pregnant women with BMI≥30 kg/m²; women with gestational DM (GDM) with obesity, including pregnant women with GDM and obesity; women with pregestational DM (PGDM) with obesity, including pregnant women with PGDM and obesity; and women with GHT with obesity, including pregnant women with GHT and obesity. We measured serum levels of selected biomarkers by ELISA. ResultsObesity increased serum levels of all the biomarkers; GDM developed in obese women caused a more pronounced increase in the serum levels of BMP-4 and BMP-2, and GHT developed in obese women caused a more pronounced increase in the serum levels of GDF-15. In the women with GDM-, PGDM-, and GHT-complicated obesity, serum levels of MMP-9 and GP39 did not change meaningfully. Conclusions Obesity and its comorbidities DM and GHT lead to meaningful changes in the studied serum biomarkers. Since obesity has a causal effect on developing numerous conditions, reliable clinical biomarkers are needed to improve the early prediction and diagnosis of high-risk conditions during pregnancy. Received: 29 March 2022 Accepted after revision: 16 August 2022 Article published online: 28 September 2022 © 2022. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Coronavirus disease 2019 (COVID-19) may be asymptomatic or symptomatic in pregnant women. Compared to non-pregnant reproductive-aged women, symptomatic individuals appear to have a higher risk of acquiring severe illness sequelae. We assessed the clinical and laboratory characteristics and outcomes of pregnant COVID-19 patients unvaccinated for severe acute respiratory syndrome coronavirus 2 according to the trimester of pregnancy. This was a retrospective observational study conducted in a tertiary-level hospital in Turkey. This retrospective study reviewed the clinical and laboratory characteristics and outcomes of 445 pregnant COVID-19 patients hospitalized during the first, second, and third trimesters of pregnancy and 149 other pregnant women as controls in a tertiary center from April 2020 to December 2021. All participants were unvaccinated. Overall, the study groups were comparable in terms of baseline clinical pregnancy characteristics. There was no clear difference among the study participants with COVID-19 in the first, second, and third trimesters of pregnancy. However, a considerably high number of clinical and laboratory findings revealed differences that were consistent with the inflammatory nature of the disease. The study results reveal the importance of careful follow-up of hospitalized cases as a necessary step by means of regular clinical and laboratory examinations in pregnant COVID-19 patients. With further studies, after implementing vaccination programs for COVID-19 in pregnant women, these data may help determine the impact of vaccination on the outcomes of pregnant COVID-19 patients.

Background/Objectives: Preeclampsia can be divided into two groups (with and without severe features) based symptom severity. We aimed to distinguish these two entities with the aid of fibrinogen to albumin ratio (FAR), uric to acid albumin ratio (UAR) and LDH to albumin ratio (LAR). Methods: This retrospective study was conducted in Istanbul Basaksehir Cam and Sakura City Hospital between 2020 and 2023. Seventy-three patients with preeclampsia were included in this study which were categorized into two groups according to disease severity: 40 patients with preeclampsia without severe features and 33 patients with severe features. Additionally, 30 healthy pregnant women were included as a control group. Neutrophil–lymphocyte ratio (NLR), monocyte–lymphocyte ratio (MLR), platelet–lymphocyte ratio (PLR), mean platelet volume (MPV), red cell distribution width (RDW), mean platelet volume (MPV), Uric acid, LDH, AST, ALT, fibrinogen, albumin, FAR, UAR and LAR were compared among the groups. Results: FAR was significantly higher in preeclampsia patients with and without severe features compared to control group (Odds ratio 8.32 for ≥0.139 vs. <0.139, p < 0.001). There was no significant difference in FAR levels between preeclampsia patients according to disease severity. UAR and LAR were significantly different between preeclampsia patients with and without severe features and the control group (p < 0.001). Receiver operating characteristics (ROC) curves for UAR showed that a cut-off value of 1.727 had a sensitivity of 73% and a specificity of 68% in discriminating between preeclampsia with and without severe features (Odds ratio 5.53 for ≥1.727 vs. <1.727). ROC curves for LAR showed that a cut-off value of 79.09 had a sensitivity of 85% and a specificity of 73% in discriminating between preeclampsia with and without severe features (Odds ratio 14.76 for ≥79.09 vs. <79.09). Conclusions: UAR and LAR appear to be better markers than FAR for identifying preeclamptic patients who require delivery due to severe features. They are easily accessible and promising biomarkers, and to our knowledge, this is the first study to evaluate LAR in this context. Further studies are needed to validate their diagnostic accuracy and compare their performance with established biomarkers.

Background/Objectives: Complete blood count inflammatory indices are widely studied in obstetrics but rarely compared directly. We compared five first-trimester indices, the systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), pan-immune-inflammation value (PIV), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), for their associations with preterm birth, examined across its severity. Methods: In a retrospective single-centre cohort of 5003 singleton pregnancies with a first-trimester complete blood count, late (34–36 weeks) and early (<34 weeks) preterm births were analysed separately. The association of each index with preterm birth was assessed by logistic regression, per standard deviation, and by quartile, with adjustments made for maternal age, body mass index, parity, fetal sex, and gestational age at sampling; discrimination was compared using the DeLong test. The birthweight category, classified against the INTERGROWTH-21st standards, was a secondary outcome. Results: After adjustment, all indices except for the PLR were associated with preterm delivery, with similar effects per standard deviation. Among the five indices, the SIRI showed the most consistent association with the severity of preterm birth: its values rose at every step from term to late to early birth. It discriminated these births best (area under the curve 0.600, significantly greater than the SII), and its quartile gradient was steepest, with the odds more than doubling from the lowest to the highest quartile. All five remained weak discriminators, with every area under the curve being below 0.70, and none was associated with the birthweight category. Conclusions: These indices are not standalone predictive tests, but among them, the SIRI, which, unlike the SII, captures the monocyte count, was most closely associated with early, more severe preterm birth, consistent with the role of monocytes in the inflammation of labour.

Objectives: Non-visualization of the fetal gallbladder (NVFGB) is a rare prenatal ultrasound finding associated with a wide spectrum of outcomes, ranging from benign conditions to severe hepatobiliary and genetic disorders. This study evaluated the prenatal characteristics, prognostic significance of associated anomalies, and postnatal outcomes of fetuses diagnosed with NVFGB.Material and Methods: This retrospective cohort study included 25 pregnancies diagnosed with NVFGB between November 2020 and May 2025. Cases were categorized as isolated or non-isolated according to additional structural anomalies. Prenatal ultrasound findings, invasive prenatal testing and genetic analyses, and postnatal outcomes were retrospectively reviewed using descriptive statistical methods.Results: Isolated NVFGB was identified in 19 cases (76%), whereas six cases (24%) were non-isolated. Postnatal gallbladder visualization occurred in 12 (63%) of 19 isolated cases, and gallbladder agenesis was confirmed in seven (37%). One isolated case was associated with cystic fibrosis and another with a 22q11.2 microdeletion. In the non-isolated group, pregnancy termination was performed in two cases (33%), and postnatal gallbladder visualization occurred in two (33%). Two situs anomalies, one left atrial isomerism and one situs inversus totalis, were observed among fetuses with non–isolated NVFGB.Conclusions: Isolated NVFGB should prompt detailed ultrasound evaluation and consideration of genetic counseling, cystic fibrosis, and biliary atresia. Patients should be informed about likely postnatal outcomes, including postnatal gallbladder visualization or gallbladder agenesis. Non-visualization NVFGB is associated with poorer outcomes, underscoring the prognostic importance of associated anomalies for prenatal counseling and clinical decision-making.