- Maternal risk factors in severe newborn asphyxia
Maternal risk factors in severe newborn asphyxia
Ukrainian Journal of Perinatology and Pediatrics. 2025.4(104): 10-16. doi: 10.15574/PP.2025.4(104).1016
Golyanovskyi V. O.1, Zokhnyuk N. M.1, Matata M. V.1, Govsieiev D. O.1,2
1Kyiv Perinatal Center, Ukraine
2Bogomolets National Medical University, Kyiv, Ukraine
For citation: Golyanovskyi VO, Zokhnyuk NM, Matata MV, Govsieiev DO. (2025). Maternal risk factors in severe newborn asphyxia. Ukrainian Journal of Perinatology and Pediatrics. 4(104): 10-16. doi: 10.15574/PP.2025.4(104).1016.
Article received: Jun 15, 2025. Accepted for publication: Nov 27, 2025.
Fetal distress during labor is one of the most serious obstetric complications, potentially leading to significant consequences for neonatal health, including hypoxic-ischemic encephalopathy, cerebral palsy, and, in severe cases, perinatal mortality.
Aim – to identify the primary maternal risk factors for severe neonatal asphyxia and to develop a predictive model for the prevention of fetal distress.
Materials and methods. The study included 213 patients. The study group consisted of 98 women whose newborns were diagnosed with severe asphyxia (Apgar score ≤ 3 at the first minute). The control group consisted of 115 patients without a diagnosis of fetal distress. Univariate and multivariate logistic regression models were used to identify the most significant factors.
Results. Univariate analysis revealed an increased risk of fetal distress in the presence of obesity, uterine leiomyoma, preeclampsia, and acute respiratory viral infection (ARVI), while a decreased risk was associated with pre-induction using prostaglandin E2. Multivariate analysis identified preeclampsia, anemia, ARVI during pregnancy, and labor dystocia as significant risk factors.
Conclusions. The resulting multivariate model demonstrates high predictive power, enabling the development of individualized recommendations for fetal distress prevention. Specifically, preeclampsia, obesity, and acute viral infection are critical factors — in this sample, all cases involving these conditions led to fetal distress. Other factors significantly alter the probability of distress: anemia and labor dystocia significantly increase the risk, while multiparity and thyroid pathology were found to have a protective effect.
The study was conducted according to the principles of the Declaration of Helsinki. The protocol was approved by the Local Ethics Committee of the Kyiv Perinatal Center. Informed consent was obtained from all participants.
The authors declare no conflict of interest.
Keywords: fetal distress, preeclampsia, obesity, labor induction, multivariate analysis.
REFERENCES
1. Burton G, Redman C. (2015). The pathophysiology of preeclampsia: New insights and implications for clinical practice. BMJ. 350: h1815. doi:10.1136/bmj.h1815.
2. Castelijn B, Hollander K, Hensbergen J, IJzerman RG, Valkenburg-van den Berg AW, Twisk J et al. (2018). Peripartum fetal distress in diabetic women: a retrospective case-cohort study. BMC Pregnancy Childbirth. 18(1): 228. https://doi.org/10.1186/s12884-018-1880-4; PMid:29898693 PMCid:PMC6001127
3. Catalano P, Shankar K. (2017). Obesity and pregnancy: mechanisms of short term and long term adverse consequences for mother and child. BMJ. 356: J1. https://doi.org/10.1136/bmj.j1; PMid:28179267 PMCid:PMC6888512
4. Cohen WR, Friedman EA. (2020). Guidelines for labor assessment: Failure to progress? American Journal of Obstetrics & Gynecology. 222(4): 342.e1-342.e4. https://doi.org/10.1016/j.ajog.2020.01.013; PMid:31954702
5. Dunn L, Flenady V, Kumar S. (2016, Jan 14). Reducing the risk of fetal distress with sildenafil study (RIDSTRESS): a double-blind randomised control trial. J Transl Med. 14: 15. https://doi.org/10.1186/s12967-016-0769-0; PMid:26767411 PMCid:PMC4712615
6. Friedman E, Cohen W. (2023, May). Dysfunctional labor and delivery: adverse effects on offspring. Am J Obstet Gynecol. 228(5S): S1104-S1109. https://doi.org/10.1016/j.ajog.2022.10.011; PMid:36997398
7. Hill MG, Reed KL, Brown RN. (2021, Jun). Perinatal asphyxia from the obstetric standpoint. Seminars in Fetal and Neonatal Medicine. 26(4): 101259. https://doi.org/10.1016/j.siny.2021.101259; PMid:34175240
8. Khan M. (1992). Intellectual and developmental assessment of cerebral palsy cases in Libyan city. Indian J Medical Sciences. 46(8): 235-238.
9. Lee S, Cabral H, Aschengrau A, Pearce E. (2020, May 1). Associations Between Maternal Thyroid Function in Pregnancy and Obstetric and Perinatal Outcomes. J Clin Endocrinol Metab. 105(5): e2015-2023. https://doi.org/10.1210/clinem/dgz275; PMid:31838502 PMCid:PMC7089848
10. McKnight J, Satterfield M, Li X, Gao H, Wang J et al. (2011, Jan 1). Obesity in pregnancy: problems and potential solutions. Front Biosci (Elite Ed). 3(2): 442-52. https://doi.org/10.2741/e259; PMid:21196324
11. Paradkar M, Mejia I, Abraheem R, Marroquín León E, Firdous A, Barroso M et al. (2024, Aug 16). Assessing the Impact of Hematological Changes in Pregnancy on Maternal and Fetal Death: A Narrative Review. Cureus. 16(8): e66982. https://doi.org/10.7759/cureus.66982; PMid:39280542 PMCid:PMC11402273
12. Parer J, Livingston E. (1990). What is fetal distress? American Journal of Obstetrics and Gynecology. 162(6): 1421-1427. https://doi.org/10.1016/0002-9378(90)90901-I; PMid:2193513
13. Penn A, Wintermark P, Chalak L, Armstrong J, Redline R et al. (2021). Placental contribution to neonatal encephalopathy. Seminars in Fetal and Neonatal Medicine. 26(4): 101276. https://doi.org/10.1016/j.siny.2021.101276; PMid:34420894 PMCid:PMC11912380
14. Prechtl H, Einspieler C. (1998). Earli prediction of later neurological deficits. Longitudinal studies in children at-risk. Satellite Meeting of the 8th International Neuroiogy Congress in Ljubljana: 5-6.
15. Russ J, Simmons R, Glass H. (2021, Mar). Neonatal Encephalopathy: Beyond Hypoxic-Ischemic Encephalopathy. Neoreviews. 22(3): e148-e162. https://doi.org/10.1542/neo.22-3-e148; PMid:33649088
16. Safarzadeh S, Banihashemi F, Montazeri F, Roozbeh N, Darsareh F. (2023, Dec 30). Maternal and Neonatal Outcomes of Iron Deficiency Anemia: A Retrospective Cohort Study. Cureus. 15(12): e51365. https://doi.org/10.7759/cureus.51365; PMid:38292987 PMCid:PMC10825386
17. Schoenmakers S, Snijder P, Verdijk R, Kuiken T, Kamphuis S, Koopman L et al. (2021, May 28). Severe Acute Respiratory Syndrome Coronavirus 2 Placental Infection and Inflammation Leading to Fetal Distress and Neonatal Multi-Organ Failure in an Asymptomatic Woman. J Pediatric Infect Dis Soc. b10(5): 556-561. https://doi.org/10.1093/jpids/piaa153; PMid:33367801 PMCid:PMC7798999
18. Sharami S, Milani F, Kabodmehri R, Naghdipour M, Mahmoudi Isaabadi A, Haghparast Ghadim-Limudahi Z. (2024, Jan-Mar). Dose Sildenafil Citrate Reduce the Incidence of Emergency Cesarean Section and Fetal Distress During Labor? A Randomized Double-Blinded Clinical Trial. J Reprod Infertil. 25(1): 46-55. https://doi.org/10.18502/jri.v25i1.15198; PMid:39157279 PMCid:PMC11330200
19. Shook L, Brigida S, Regan J, Flynn J, Mohammadi A, Etemad B et al. (2022, Mar). SARS-CoV-2 Placentitis Associated With B.1.617.2 (Delta) Variant and Fetal Distress or Demise. J Infect Dis. 225(5): 754-758. https://doi.org/10.1093/infdis/jiac008; PMid:35024844 PMCid:PMC8807229
20. Xiao H, Yao C, Qi Z, Liu J, Liu X, Zhou Y et al. (2023, Feb 20). Association between maternal short-term exposure to ambient air pollution and the risk of fetal distress: A matched case-control study. Sci Total Environ. 860: 160438. https://doi.org/10.1016/j.scitotenv.2022.160438; PMid:36435241
