Objective: To evaluate the prediction performance of 1st trimester fasting plasma glucose (FPG) levels, as compared to gestational diabetes (GDM), for type 2 diabetes mellitus (T2DM), in a 5-year follow-up after pregnancy. Design: A retrospective analysis of prospectively collected data Setting: Mehuedet HMO, Israel Population or sample: 69,001 parturients with FPG levels measured at 1st-trimester and T2DM data up to 5 years after delivery. Methods: T2DM diagnosis was stratified by FPG levels divided into categories with 10 mg/dl increments. GDM was diagnosed using the two-step strategy. Prediction performance for T2DM was determined using ROC-AUC statistics with the utilization of the Youden index(YI) for the calculation of the best FPG cut-off for T2DM prediction. Survival analysis was applied to calculate hazard ratios(HRs) for T2DM prediction with further stratification to maternal obesity status. Main outcome measures: T2DM, as determined by the Israeli National Diabetes Registry.. Results: The determined FPG cut-off for predicting the risk of T2DM was 86.5mg/dl (sensitivity 53.3%, specificity 72.4%). This cutoff demonstrated superior predictive performance when compared to GDM diagnosis (0.615 vs. 0.586). Furthermore, all FPG level categories exceeding 80 mg/dL were associated with an increased risk of developing T2DM. FPG levels equal to or greater than 110 mg/dL exhibited even stronger predictive performance for T2DM compared to GDM diagnosis (HR 4.92 and 3.92, respectively). When stratified by maternal obesity, FPG levels displayed enhanced predictive capabilities for T2DM, particularly among women without obesity. Conclusions: 1st trimester FPG levels are associated with increased risk for T2DM, at least as GDM.

Objective: To evaluate the relations between Fear of COVID-19 and postpartum depression (PPD) symptoms. Design: A multicenter prospective observational study. Setting and Population: A cohort of women who delivered during COVID-19 pandemic between 03-05/2020. Methods: Participants were virtually approached after delivery and asked to complete an online questionnaire. Data was verified with each center’s perinatal database. The validated Fear of COVID-19 Scale was in use. PPD was evaluated using the EPDS questionnaire as a categorical (≥10) and as a continuous scale. Pre-existing maternal disability was defined as any prior physiological/psychological chronic health condition. Stress-contributing complications during pregnancy or at birth included pregnancy and labor related complications. Regression analysis and ROC statistics were utilized to evaluate associations and control for confounders. Main Outcome Measure: PPD symptoms. Results: Overall, 421 women completed the questionnaires. Of them, 99(23.5%) had a high EPDS score. Fear of COVID-19 was positively correlated with PPD symptoms (r=0.35,p=0.000),ROC-AUC 0.67, 95%CI 0.61-0.74. Following adjustment to confounders (maternal age, nulliparity, ethnicity, marital status, financial difficulties, maternal disability, accessibility to medical services, and stress-contributing complications during pregnancy (, the most important factor that correlated with depression was maternal disability (aOR3,95%CI 1.3-6.9) followed by Fear of COVID-19 (aOR1.1,95%CI 1.05-1.15). High accessibility to medical services (aOR0.59,95% CI 0.45-0.77) and stress-contributing complications during pregnancy (aOR0.2, 95% CI 0.11-0.82) were both protective for PPD symptoms. Conclusions: During the COVID-19 pandemic, maternal disability and Fear of COVID-19 are positively associated with a high EPDS score. High medical accessibility was found as a protective factor for PPD.

Objective: To evaluate the association between extremely elevated alkaline phosphatase (ALKP) levels (above 1000 U/L) and adverse perinatal outcome. Design: A retrospective case series Setting and popultion: All parturients with extremely elevated ALKP levels taken throughout pregnancy at a single university-affiliated medical center (2010-2018). Methods: Demographics and medical data were retrieved. Following literature review, previously reported similar cases were added to the cohort. We report perinatal outcome of our cohort as well as literature review. Results: During study period 11 parturients with high ALKP were identified. Ten more cases were retrieved from PubMed search. Overall, median ALKP levels were 1880 (range 1052-4488, U/L). Reasons for evaluation were mostly nonspecific symptoms (pruritus, headache, abdominal pain) or routine obstetrical evaluation. Twelve isoenzyme analysis were available - 10 of which were of placental fraction; median gestational age at delivery was 38 (35-41), four (19%) women delivered preterm, ; six patients (29%) had gestational diabetes mellitus and 6 (29%) had hypertensive disorder. Histopathology of the placenta was available in 8 cases: 3 normal histology (38%) and 5 with different non-specific pathologies. Conclusions: We report the largest case series of extremely elevated levels of ALKP in pregnancy thus far. Our data suggest association with adverse perinatal outcome.