妊娠晚期生殖道感染与妊娠结局的相关性分析

目的探讨妊娠晚期几种常见的生殖道病原微生物感染与妊娠结局的相关性。方法选取2013年1月至2015年4月新疆医科大学第二附属医院收治的妊娠晚期生殖道病原微生物感染患者633例作为观察组,同时随机选取同期病原体检测阴性者413例作为对照组,比较两组不良妊娠结局的发生情况。结果经过临床实验室检查,观察组中病原微生物培养情况分布以支原体感染491例(46.94%)、假丝酵母菌感染195例(18.64%)两种较为多见,观察组中支原体感染者胎膜早破、产褥感染、新生儿感染(χ2=65.44,P0.05);衣原体感染者早产、产褥感染(χ2=72.87,P0.05);滴虫感染者胎膜早破、产褥感染(χ2=24.20,P0.05);假丝酵母菌感染者早产、胎膜早破、产褥感染、胎儿窘迫、新生儿感染率(χ2=71.76,P0.05)明显高于对照组,差异有统计学意义。剖宫产率及新生儿窒息率的比较差异无统计学意义(χ2=1.04,P0.05)。而多重与单一病原体感染比较,除早产外其余妊娠结局差异无统计学意义(χ2=73.08,P0.05)。结论妊娠晚期生殖道病原微生物感染,会增加不良妊娠结局的发生率,应引起围产妇及临床医师的重视,适时进行干预减少不良结局的发生。     

妊娠期生殖道支原体、衣原体感染与妊娠结局的关系分析

目的 探讨围产期孕妇支原体、衣原体感染与不良妊娠结局的相关性.方法 采用病例对照研究方法,比较分析95例孕期和88例正常产妇的不良妊娠结局.结果 UU、CT感染孕妇的不良妊娠结局发生率高于正常孕妇(P＜0.05).结论 加强产前保健,重视生殖道感染对于改善围产结局具有重要意义.     

高龄孕妇妊娠晚期心电图与妊娠结局的关系

目的：观察妊娠晚期孕妇的异常心电图变化和妊娠结局。方法：妊娠晚期孕妇按年龄分为35岁以上组和35岁以下组,行心电图检查,统计各型异常心电图发生率,记录妊娠、分娩结局及是否出生低体重儿。结果：妊娠晚期35岁以上组孕妇异常心电图发生率显著高于35岁以下组（P〈0．05）;其中,卵段改变、心律失常发生率前者显著高于后者（P〈0．05）;各型心律失常中,前者窦性心动过缓、室性早搏的发生率显著高于后者（P〈0．05）,而窦性心动过速的发生率明显低于后者（P〈0．05）。心电图异常者35岁以上组妊娠丢失率明显高于35岁以下心电图正常和异常组（P〈0．05）;35岁以上孕妇心电图异常组早产发生率高于心电图正常组（P〈0．05）;心电图异常35岁以上组新生儿低体重发生率显著高于心电图正常35岁以下组（P〈0．05）。结论：高龄孕妇妊娠晚期易发生心律失常、心肌缺血等异常心电图,异常心电图高龄孕妇易发生妊娠丢失、早产及分娩低体重婴儿。     

妊娠合并乙肝病毒感染患者血清DNMT1、TIM-3与HBV-DNA病毒载量和妊娠结局的关系分析

摘要 目的：探讨妊娠合并乙肝病毒（HBV）感染患者血清脱氧核糖核酸甲基转移酶1（DNMT1）、T细胞免疫球蛋白粘蛋白-3（TIM-3）与乙型肝炎病毒-脱氧核糖核酸（HBV-DNA）病毒载量和妊娠结局的关系。方法：选取2021年1月～2022年1月南京医科大学第一附属医院收治的186例妊娠合并HBV感染患者为HBV感染组,根据HBV-DNA病毒载量分为阳性组56例和阴性组130例,根据妊娠结局分为结局不良组和结局良好组,另选取同期于南京医科大学第一附属医院进行孕检的150名健康孕妇为对照组。采用酶联免疫吸附法检测血清DNMT1、TIM-3水平。比较HBV感染组与对照组、阳性组与阴性组血清DNMT1、TIM-3水平。采用单因素及多因素Logistic回归分析妊娠合并HBV感染患者妊娠结局不良的影响因素,受试者工作特征（ROC）曲线分析血清DNMT1、TIM-3水平对妊娠合并HBV感染患者妊娠结局不良的预测价值。结果：与对照组比较,HBV感染组血清DNMT1、TIM-3水平升高（P＜0.05）。与阴性组比较,阳性组血清DNMT1、TIM-3水平升高（P＜0.05）。186例妊娠合并HBV感染患者妊娠结局不良发生率为55.38%（103/186）。单因素分析显示,妊娠结局不良与HBV感染孕周、HBV-DNA病毒载量、谷草转氨酶（AST）、谷丙转氨酶（ALT）、DNMT1、TIM-3有关（P＜0.05）。多因素Logistic回归分析显示,HBV-DNA病毒载量阳性和DNMT1＞34.94 ng/mL、TIM-3＞18.96 pg/mL为妊娠合并HBV感染患者妊娠结局不良的独立危险因素（P＜0.05）。ROC曲线分析显示,血清DNMT1、TIM-3水平单独和联合检测预测妊娠合并HBV感染患者妊娠结局不良的曲线下面积分别为0.798、0.791、0.870。结论：妊娠合并HBV感染患者血清DNMT1、TIM-3水平升高与HBV-DNA病毒载量阳性和妊娠结局不良密切相关,血清DNMT1、TIM-3水平联合对妊娠合并HBV感染患者妊娠结局预测价值良好。     

围产期B族链球菌感染对妊娠结局的影响

目的:调查妊娠35~37周孕妇B族链球菌(GBS)带菌情况,探讨GBS感染与不良妊娠结局的关系。方法:收集妊娠35~37周孕妇265例,取阴道下段1/3分泌物和直肠分泌物,采用实时荧光定量PCR法进行GBS检测,观察其妊娠结局。结果:265例孕妇中GBS阳性者42例,阴性者223例,带菌率约为15.84%;GBS阳性孕妇的宫内感染、胎儿窘迫和新生儿肺炎发生率高于GBS阴性组(P0.05)。结论:围产期妇女GBS感染会导致宫内感染、胎儿窘迫及新生儿肺炎的发生率升高,对妊娠结局会产生不良影响。     

先兆流产孕妇宫颈分泌物的细菌菌种分布、耐药性及对妊娠结局的影响

目的探讨先兆流产孕妇宫颈分泌物的细菌菌种分布、耐药性及对妊娠结局的影响。方法对200例在我院就诊的先兆流产孕妇的宫颈分泌物培养细菌菌种分布及耐药性进行回顾性分析。根据检查结果分为检测出致病菌孕妇与未检测出致病菌孕妇,将检测出致病菌的孕妇归为观察组,未检测出致病菌的孕妇归为对照组,并追踪孕妇的妊娠结局,比较两组妊娠结局的差别。结果 200例先兆流产孕妇中,82例培养出致病菌共97株,感染率达41.00%(82/200),其中细菌52株、真菌45株;最常见的细菌为大肠埃希菌、金黄色葡萄球菌、阴沟肠杆菌、表皮葡萄球菌及屎肠球菌,最常见的真菌为白假丝酵母菌、光滑假丝酵母菌与克柔假丝酵母菌;细菌对万古霉素、阿米卡星与亚胺培南的耐药率较低,真菌对两性霉素B与5-氟胞嘧啶的耐药率较低;观察组不良妊娠结局发生率明显少于对照组(χ2=5.35,P0.05)。结论先兆流产孕妇宫颈分泌物致病菌感染率较高,感染的致病菌对多种常用抗生素耐药率较高,一旦感染会增加不良妊娠结局的发生率,因此应对先兆流产孕妇宫颈分泌物进行致病菌培养及耐药性分析,合理选择抗生素治疗。     

孕期膳食管理对孕妇体重及妊娠结局的影响

目的：研究孕期对孕妇进行孕期膳食管理对孕妇体重变化及妊娠结局的影响。方法：选择我院接受产前检查并分娩的女性共92例纳入研究并分为观察组和对照组,对照组接受常规产前检查健康宣教,观察组接受孕期膳食管理;比较两组孕妇孕期体重变化情况、自然分娩率、巨大儿发生比率、不良妊娠结局发生情况。结果：两组孕妇孕25±2周时体重变化无明显差异（P＞0.05）;孕33±2周及分娩前体重情况均低于对照组,差异显著（P＜0.05）;观察组孕妇自然分娩率明显高于对照组,巨大儿及不良妊娠结局发生情况显著低于对照组,以上差别有统计学意义（P＜0.05）。结论：孕期膳食管理应用于孕妇孕期体重管理,有助于改善孕期体重增长过快及巨大儿发生情况,降低临床不良妊娠结局,值得临床推广应用。     

HPV感染对患者阴道菌群及妊娠结局的影响

目的研究HPV感染对患者阴道菌群以及妊娠结局的影响。方法选择2017年9月至2018年9月在本院定期产检的孕妇,根据妊娠结局将孕妇分为正常妊娠组和不良妊娠组。收集两组患者一般资料及其阴道样本进行微生物检测及分析。结果不良妊娠组患者中HPV阳性患者比例明显高于正常妊娠组,正常妊娠组中HPV阴性和HPV阳性患者及不良妊娠组中HPV阴性患者阴道中乳杆菌(Lactobacillus)丰度最高,其次是加德纳菌(Gardnerella),普氏菌(Prevotella)和纤毛球菌(Sneathia)。不良妊娠组中HPV阳性患者阴道中乳杆菌(Lactobacillus)丰度最高,其次是加德纳菌(Gardnerella),芽孢杆菌(Bacillus),巨球菌(Megasphaera)和链球菌(Streptococcus)。不良妊娠组HPV阳性患者阴道中链球菌、巨球菌和芽孢杆菌丰度明显高于HPV阴性患者,乳杆菌和奇异菌(Atopobium)丰度明显低于HPV阴性患者。结论 HPV感染女性更易产生不良妊娠结局,其机制可能是HPV降低了阴道中乳杆菌丰度,增加阴道微生物群多样性和丰富度。     

早发型与晚发型重度子痫前期的临床表现及母婴结局的对比分析

目的：探讨早发型与晚发型重度子痫前期的不同临床表现及母婴结局,提高对重度予痫前期的临床认识。方法：回顾性分析重度子痫前期患者76例,按照不同的发病孕周,分为早发型（发病孕周〈32周）和晚发型（发病孕周1〉32周）,比较两组孕妇临床情况、孕妇的并发症及围产儿结局。结果：早发型孕妇与晚发型孕妇在上述方面比较,差异均具有统计学意义（P〈0．05）,早发型孕妇的各项临床表现显著差于晚发型孕妇。结论：对早发型重度子痫前期孕妇,更应加强临床各项监护措施,选择理想的终止妊娠的时机,同时加强预防措施,避免早发型重度子痫前期的发生。     

1200例孕中期产前筛查结果的回顾性分析

目的：评价孕妇血清标记物（甲胎蛋白AFP、β-绒毛膜促性腺激素β-hCG和雌三醇uE3）的孕中期三联筛查在临床中的应用价值。方法：采用酶联免疫吸附法（ELISA）对1200例孕中期（14～22周）孕妇进行血清标记物AFP、β-hCG和uE3的检测,结合孕龄、孕周、体重等因素,经专门的筛查分析软件,计算唐氏综合征,18三体及神经管缺陷（NTD）的风险率。如孕妇为高风险,则进行胎儿的超声检查和染色体核型分析的产前诊断。结果：在1200例孕妇中,筛查高风险的孕妇有73例,其中唐氏综合征,18三体,NTD高风险孕妇分别为65例,5例和3例,假阳性率为6.08%（73/1200）。其中59例接受了产前诊断,占高风险孕妇的80.8%（59/73）。共检出1例唐氏综合征儿和1例无脑儿,未发现18三体,检出率为100%（2/2）,未有漏诊的情况。妊娠不良结局在筛查高风险组和低风险组的比率分别为17.1%和1.32%,两组有显著性差异（P〈0.01）。结论：利用孕妇血清标记物（AFP、β-hCG和uE3）的孕中期无创伤性产前筛查,结合产前诊断,对减少出生缺陷儿的出生,具有重要意义,并且高风险的筛查结果对胎儿的预后有一定的提示作用。     

妊娠晚期阴道B族链球菌的感染对肠道菌群和妊娠结局的影响

目的探究妊娠晚期阴道B族链球菌(group B Streptococcus,GBS)的感染对肠道菌群和妊娠结局的影响。方法选取2018年3月至2019年11月大连市中心医院孕检并分娩的妊娠妇女744人为对象,调查并统计B族链球菌的感染率;筛选有和没有B族链球菌感染妊娠妇女各47人,调查不良妊娠结局的发生率;选取信息匹配的妊娠晚期阴道B族链球菌感染和未感染的妊娠妇女,采集粪便样本,提取菌群DNA,用16S rDNA方法分析菌群变化。结果744名妊娠妇女中B族链球菌检出49例,感染率为6.59%;B族链球菌感染组总的不良妊娠发生比例为76.6%,正常组发生比例为27.7%(χ^2=5.491,P<0.05)。B族链球菌感染组妊娠妇女胎膜早破(χ^2=16.177,P<0.01)、难产(χ^2=21.134,P<0.01)和羊水异常(χ^2=22.989,P<0.05)的发生率与未感染组比较显著增高。B族链球菌感染组妊娠妇女肠道菌群发生显著变化。结论妊娠晚期阴道B族链球菌的感染可能引起肠道菌群紊乱,增加不良妊娠结局。     

Cytomegalovirus Seroprevalence in Pregnant Women and Association with Adverse Pregnancy/Neonatal Outcomes in Jiangsu Province,China

Background

In this study, we aimed to determine the provincial population-based seroprevalence in pregnant women and to further explore the association of maternal CMV infection status and adverse pregnancy/neonatal/growth outcomes in Jiangsu, China.

Methods

In this case-control study, the sera from 527 pregnant women with adverse pregnancy/neonatal outcomes and 496 mothers of healthy infants in Jiangsu Province, collected at gestation age of 15–20 weeks, were tested for anti-CMV IgG, IgM and IgG avidity. Adverse pregnancy/neonatal outcomes were identified based on pregnancy/neonatal outcomes.

Results

The overall seroprevalence of anti-CMV IgG was 98.7%, with 99.4% and 98.0% in the case and control groups, respectively (P = 0.039). The prevalence of anti-CMV IgG+/IgM+, was higher in the case group than that in the control group (3.8% vs. 1.6%, P = 0.033). Anti-CMV IgG avidity assay showed that none in the control group were primarily infected, but five (0.9%) in the case group underwent primary infection (P = 0.084); all five infants of these women presented severe adverse neonatal/growth outcomes. Exact logistic regression analysis showed that anti-CMV IgG+/IgM+ was associated with adverse pregnancy/neonatal/growth outcomes (aOR = 2.44, 95% CI 1.01–6.48, P = 0.047). Maternal low education level and prior abnormal pregnancies also were risk factors for adverse pregnancy/neonatal outcomes.

Conclusions

In populations with very high prevalence of latent CMV infection, active maternal CMV infection during pregnancy might be a risk factor for adverse pregnancy/neonatal outcomes.     

The effect of age, acquired resistance, pregnancy and lactation on some reactions of cattle to infection with Ostertagia ostertagi

An experiment is described in which the effects of age, previous infection, pregnancy and lactation on some reactions of cattle to infection with Ostertagia ostertagi were studied. It was found that an acquired resistance to the establishment of worms developed more rapidly in 20-month-old heifers than in calves, that it was unaffected by pregnancy of the host but that it was largely lost by heifers in early lactation. The rate at which populations were turned over, i.e. the mean life-span of worms through the late 4th and 5th stages was unaffected by the factors studied. Although, in the conditions of the experiment, development of the worms was not arrested in susceptible calves, both age of the host and its previous experience of infection were significant causes of arrest, and in previously infected 20-month-old cattle 86% of the worms of a challenge infection were arrested. Pregnancy did not affect the proportion of worms that was arrested but in lactating heifers only marginally more worms were arrested than in calves. Worms that were not arrested grew more rapidly in calves and in lactating heifers than in empty heifers or those in mid-pregnancy.     

Prostaglandins in the human fetal circulation in mid-trimester and term pregnancy

Concentrations of prostaglandins in fetal and maternal plasma during mid-pregnancy and fetal plasma at term have been measured. Fetal levels at both gestations were higher than found in maternal blood. The stable chemical breakdown product of prostacyclin, 6-keto-prostaglandin F_1∝, was consistently considerably higher in the fetus during mid-pregnancy compared with at term. Prostaglandin F levels were also significantly higher in mid-pregnancy, though there was no difference in the concentrations of the major circulating prostaglandin F metabolite, PGFM. Concentrations of prostaglandin E were similar at the two stages of pregnancy. The physiological significance of these findings is discussed.     

Blood concentrations of gonadotrophins, prolactin and gonadal steroids in males and in non-pregnant and pregnant female African elephants (Loxodonta africana)

No seasonal variation in any of the hormones measured was apparent in males or females. Testosterone levels in males increased around puberty (10-11 years) and remained significantly higher in adult than prepubertal males. This was not accompanied by any significant change in levels of LH, FSH or prolactin. In non-pregnant females there was no apparent difference in levels of LH, FSH or prolactin with age. There was a significant increase in progesterone around puberty (12 years) but there was considerable overlap in values between prepubertal and adult females. During pregnancy, progesterone levels were significantly higher than in non-pregnant females with maximum levels occurring at mid-pregnancy (9-12 months). However, there was considerable overlap in values between non-pregnancy and pregnancy. Concentrations of LH and FSH decreased significantly during mid-pregnancy while prolactin levels increased dramatically during pregnancy; after 7 months of gestation until term levels were always at least 8 ng/ml greater than in any non-pregnant female. It is suggested that this consistent increase in plasma/serum levels of prolactin can be used to diagnose pregnancy in the elephant.     

Cutaneous and Mucosal Phaeohyphomycosis Caused by Exophiala spinifera in a Pregnant Patient: Case Report and Literature Review

We report a case of mucocutaneous phaeohyphomycosis caused by Exophiala spinifera. Crusty plaques and nodules were major clinical features. Histological examination revealed brown yeast-like cells and hyphae. Mycological and molecular data identified E. spinifera as etiologic agent. Oral itraconazole was effective, which was in accordance with the results of in vitro susceptibility testing. We speculated that her pregnancy may play a role of risk factor in the infection by E. spinifera.     

Toxoplasma gondii Infection Regulates the Balance of Activating and Inhibitory Receptors on Decidual Natural Killer Cells

Inhibitory receptors and activating receptor expressed on decidual natural killer (dNK) cells are generally believed to be important in abnormal pregnancy outcomes and induced adverse pregnancy. However, if Toxoplasma gondii (T. gondii) infection induced abnormal pregnancy was related to dNK cells changes is not clear. In this study, we used human dNK cells co-cultured with human extravillous cytotrophoblast (EVT) cells following YFP-Toxoplasma gondii (YFP-T. gondii) infection in vitro and established animal pregnant infection model. Levels of inhibitory receptors KIR2DL4 and ILT-2, their ligand HLA-G, and activating receptor NKG2D in human decidua, and NKG2A and its ligand Qa-1 and NKG2D in mice uterine were analyzed by real-time PCR and flow cytometry with levels of NKG2D significantly higher than those of KIR2DL4 and ILT-2 in vitro and in invo. The level of NKG2D was positively correlated with cytotoxic activity of dNK cells in vitro. Numbers of abnormal pregnancies were significantly greater in the infected group than in the control group. This result demonstrated that the increased NKG2D expression and imbalance between inhibitory receptors of dNK cells and HLA-G may contribute to abnormal pregnancy outcomes observed upon maternal infection with T. gondii.     

妊娠合并需氧菌性阴道炎的微生态特征和围产结局分析

目的探讨妊娠合并需氧菌性阴道炎(aerobic vaginitis,AV)的微生态特征和围产结局。方法选取AV孕妇120例为研究对象,并与同期正常孕妇100例作对照,取阴道分泌物行湿片、涂片染色、细菌培养及检测IL-6、IL-8,回顾性分析其病原菌菌群的分布,局部IL-6、IL-8水平及其对妊娠结局的影响。结果 120例妊娠合并AV主要致病菌是:大肠埃希菌45例(37.50%)、B族链球菌34例(28.33%)、粪肠球菌20例(16.67%)、金黄色葡萄球菌12例(10.00%),这四种细菌占致病菌总数的84.17%;与正常孕妇相比,AV组孕妇胎膜早破、产褥感染、新生儿感染发生率明显升高,分别是25.00%vs 11.00%(P0.01)、12.50%vs 4.00%(P0.05)、10.83%vs 3.00%(P0.05),差异有统计学意义;而两组孕妇绒毛膜炎和早产发生率分别为8.30%vs 3.00%(P0.05)、10.83%vs9.00%(P0.05),差异无统计学意义;AV孕妇阴道分泌物中IL-6、IL-8表达的水平均明显高于正常组[(17.64±4.53)ng/Lvs(13.54±4.39)ng/L,P0.001;(38.08±6.29)ng/L vs(27.34±5.10)ng/L,P0.001]。结论孕期AV由肠源性细菌引起,可导致不良的围产结局,需要及时处理。     

Maternal and Neonatal Outcomes among Pregnant Women with 2009 Pandemic Influenza A(H1N1) Illness in Florida, 2009-2010: A Population-Based Cohort Study

Introduction

Pregnant women have been identified as a high risk group for severe illness with 2009 pandemic influenza A(H1N1) virus infection (pH1N1). Obesity has also been identified as a risk factor for severe illness, though this has not been thoroughly assessed among pregnant women. The objectives of this study were to provide risk estimates for adverse maternal and neonatal outcomes associated with pH1N1 illness during pregnancy and to assess the role of obesity in these outcomes.

Methods

We established a retrospective population-based cohort of all live births occurring in Florida during the first 15 months of the pandemic. Illness with pH1N1 during pregnancy was ascertained through record linkage with the Florida state notifiable disease surveillance database. Data from the birth record, including pre-pregnancy body mass index, were analyzed to assess risk of adverse outcomes associated with pH1N1 illness.

Results

A total of 194 women were identified through surveillance with pH1N1 illness during pregnancy. Children born to women with pH1N1 illness during pregnancy were at increased risk for low birth weight [OR (95%CI): 1.78 (1.11-2.860)], premature birth [2.21 (1.47-3.330)], and infant death [4.46 (1.80-11.00)], after adjusting for other factors. Women with pH1N1 illness during pregnancy were at increased risk for severe outcomes including admission to an intensive care unit. Obesity was an observed risk factor, both for the more severe pH1N1 illness detected through surveillance, and for severe maternal outcomes.

Conclusions

Case-patients in this analysis likely represent the most severely ill subset of all women infected with pH1N1 during pregnancy, limiting the generalizability of these findings to more severely ill patients rather than influenza infection in general. Nevertheless, these results suggest that more severe pH1N1 illness during pregnancy is associated with adverse neonatal outcomes and that pregnant women should continue to be targeted for appropriate prophylaxis and early treatment.     

Early Gestational Weight Gain Rate and Adverse Pregnancy Outcomes in Korean Women

During pregnancy, many women gain excessive weight, which is related to adverse maternal and neonatal outcomes. In this study, we evaluated whether rate of gestational weight gain (RGWG) in early, mid, and late pregnancy is strongly associated with adverse pregnancy outcomes. A retrospective chart review of 2,789 pregnant Korean women was performed. Weights were recorded at the first clinic visit, during the screening test for fetal anomaly, and during the 50g oral glucose challenge test and delivery, to represent early, mid, and late pregnancy, respectively. A multivariate logistic regression analysis was performed to examine the relationship between RGWG and adverse pregnancy outcomes. At early pregnancy, the RGWG was significantly associated with high risk of developing gestational diabetes mellitus (GDM), pregnancy-induced hypertension (PIH), large for gestational age (LGA) infants, macrosomia, and primary cesarean section (P-CS). The RGWG of mid pregnancy was not significantly associated with any adverse pregnancy outcomes. The RGWG at late pregnancy was significantly associated with a lower risk of developing GDM, preterm birth and P-CS, but with a higher risk of developing LGA infants and macrosomia. When the subjects were divided into three groups (Underweight, Normal, and Obese), based on pre-pregnancy body mass index (BMI), the relationship between early RGWG and adverse pregnancy outcomes was significantly different across the three BMI groups. At early pregnancy, RGWG was not significantly associated to adverse pregnancy outcomes for subjects in the Underweight group. In the Normal group, however, early RGWG was significantly associated with GDM, PIH, LGA infants, macrosomia, P-CS, and small for gestational weight (SGA) infants, whereas early RGWG was significantly associated with only a high risk of PIH in the Obese group. The results of our study suggest that early RGWG is significantly associated with various adverse pregnancy outcomes and that proper preemptive management of early weight gain, particularly in pregnant women with a normal or obese pre-pregnancy BMI, is necessary to reduce the risk of developing adverse pregnancy outcomes.