Asia Pacific journal of clinical nutritionXiaohan Guo, Xiaomin Wang, Xiaofeng Weng, Yuanqing Fu, Jun Tang, Wensheng Hu
BACKGROUND AND OBJECTIVES: The gestational weight gain (GWG) range during mid-to-late pregnancy associated with the lowest combined risk of adverse birth outcomes in women with gestational diabetes mellitus (GDM) remains unclear. This study aims to examine the associations between GWG and adverse birth out-comes among women with GDM. METHODS AND STUDY DESIGN: This study included a cohort of 1,673 pregnant women with GDM. GWG was defined as weight gain from pre-pregnancy to a measurement between 24 and 32 gestational weeks, residualized for gestational age and standardized as z-scores. Multivariable logistic regression models were used to assess associations between GWG z-scores (per 1-SD increase and categories: <-1, -1 to 1 [reference], and ≥1) and small for gestational age (SGA), large for gestational age (LGA), and preterm birth. Restricted cubic splines were fitted to explore nonlinear associations. RESULTS: Each 1-SD higher in GWG z-score was associated with lower odds of SGA (odds ratio [OR], 0.55; 95% confidence interval [CI], 0.43-0.71) and higher odds of LGA (1.48; 1.29-1.70). Compared with the reference group, women with GWG z-scores <-1 had higher odds of SGA and lower odds of LGA, whereas those with z-scores ≥1 showed the opposite pattern. No significant association was observed with preterm birth. Spline analyses indicated that a GWG z-score of approximately -0.07 (equal to 8.2 kg at 28 weeks) was associated with the lowest combined odds of SGA and LGA. CONCLUSIONS: Among women with GDM, both insufficient and excessive mid-to-late pregnancy GWG were associated with adverse size-for-gestational-age outcomes.
Reviews of physiology, biochemistry and pharmacologyUndurti N Das
AA is a crucial fatty acid in pregnancy, especially for the growth and development of the fetus and its central nervous system (CNS). As already discussed in the previous chapters, AA regulates inflammation, immune response, and cell signaling. AA has a modulatory action on gene expression, serves as a mechanotransducer, and regulates cell membrane fluidity. By regulating cell membrane fluidity, AA modulates the expression and binding of several receptors located on the cell membrane. Eicosanoids derived from AA have both beneficial and harmful effects on pregnancy. For instance, (i) AA metabolites such as 14,15-EET and 15-HETE are associated with gestational hypertension and preeclampsia, (ii) AA in association with DHA is crucial for the fetal nervous system and neurocognitive development of the newborn, and (iii) for the growth and development of the fetus, especially during the third trimester. LA and AA are involved in human fertility and in the pathobiology of gestational diabetes.
Reviews of physiology, biochemistry and pharmacologyUndurti N Das
Human essential hypertension is driven by a network of interacting nutritional, metabolic, inflammatory, and endothelial mechanisms in which AA and other PUFAs play a critical role. Beyond excess sodium intake, population data supports the role of inadequate calcium, potassium, and magnesium intake and low antioxidant vitamin status in shaping blood pressure regulation. These nutrients influence vascular smooth muscle tone and act as cofactors that support Δ6 and Δ5 desaturase activities, thereby governing tissue availability of AA, EPA, and DHA and downstream formation of vasodilator and antiplatelet mediators (e.g., PGE1, prostacyclin), as well as inflammation-resolving lipid mediators (lipoxins, resolvins, protectins, maresins, and nitrolipids).Endothelial dysfunction characterized by reduced endothelial nitric oxide (eNO) bioavailability and increased oxidative stress seems to play an important role in the pathobiology of HTN. High salt intake, asymmetric dimethylarginine (ADMA), and activation of NAD(P)H oxidase and angiotensin II signaling promote superoxide generation that quenches NO and shifts the vascular balance toward vasoconstriction. Clinical and experimental observations indicate that antihypertensive therapies can partly restore NO and antioxidant defenses, while dietary patterns rich in n-3 fatty acids (particularly DHA) and balanced n-6/n-3 intake may lower blood pressure by suppressing thromboxane formation and enhancing vasoprotective, pro-resolving pathways.Preeclampsia can be considered as a model of reversible hypertension linked to oxidative stress and angiogenic imbalance (sFlt1, soluble endoglin), highlighting mechanistic overlap with essential hypertension. Hypertension is a low-grade systemic inflammatory condition whose origins may be present in the perinatal period through long-term programming of PUFA metabolism and endothelial function.
Problemy sotsial'noi gigieny, zdravookhraneniia i istorii meditsinyS M Gadzhieva
The global transformations in health care system, directed from reactive medicine to proactive and preventive model bring to the forefront issues of protection of female health. The health of woman is not only fundamental basis, but also key factor of social economic well-being of society, demographic stability and health of future generations. The traditional fragmented model of provision of obstetric gynecological care, focused mainly on treatment of already occurred pathologies and pregnancy management, demonstrates its inefficiency in the context of modern challenges: increase of chronic noncommunicable diseases, psycho-emotional loads and need of integration of reproductive health into general context of well-being of woman at all stages of her life. In the Russian Federation, the problem of modernization of obstetric gynecological service and, in particular, women consultations, is especially acute. Historically, The historically established system is often criticized for bureaucratization, insufficient focus on prevention and disparity between various levels of medical care. In this regard, emergence and implementation of new regional standards, in particular, metropolitan standard of obstetric gynecological care and Centers of Female Health is unique case requiring detailed scientific analysis and comparison with international advanced experience. The actuality of the study is conditioned by increasing need in developing new paradigm of medical care support of women, built on principles of complexity, continuity, personalization and orientation on prevention. The Centers of Female Health, integrating large spectrum of services, from screenings and diagnostics to psychological support and training programs, are considered by world community as gold standard of organization of such care.
Problemy sotsial'noi gigieny, zdravookhraneniia i istorii meditsinyN V Batrak, I V Ivanova
The pregnancy that occurred due to in vitro fertilization is characterized by higher risk of development of gestational diabetes mellitus. The purpose of the study was to investigate course and outcomes of pregnancy resulted from in vitro fertilization in women with gestational diabetes mellitus, depending on time of its manifestation. The analysis of course of pregnancy, childbirth and condition of newborns in 179 women with gestational diabetes mellitus under pregnancy resulted from in vitro fertilization was carried out. It is established that early manifestation of gestational diabetes mellitus is associated with older age of pregnant women, higher rate of birth of large fetus in anamnesis, higher body mass index, more frequent prescription of insulin therapy to treat gestational diabetes mellitus, higher rate of development of early threatened miscarriage, isthmic cervical insufficiency, anemia, chronic arterial hypertension, gestational arterial hypertension, moderate preeclampsia, severe preeclampsia, premature normally placed placenta detachment, fetal growth retardation, chronic intrauterine fetal hypoxia, diabetic fetopathy, prenatal rupture of amniotic fluid, premature birth, more frequent birth of large fetus, development of fetal renal pyelectasia. The female patients with late manifestation of gestational diabetes mellitus had higher level of fasting plasma glycemia, frequent development of placenta previa, polyhydramnios, pathological and insufficient gain of body mass during pregnancy, dis-coordination of labor and clinically narrow pelvis during labor, more frequent operative delivery and early delivery. The gestational diabetes mellitus, developed both in early and late periods, complicates the course and childbirth under pregnancy resulted from in vitro fertilization, adversely affects state of the newborn. The study in depth is needed to establish possible mechanisms of development of gestational diabetes mellitus in this cohort of women with implementation of screening examinations and determination of further tactics of management of pregnancy depending on time of its manifestation.
Problemy sotsial'noi gigieny, zdravookhraneniia i istorii meditsinyO N Bobrovskaya, A D Skvortsova
The problem of availability of abortion services for women in countries of world community is not only not losing its importance, but is undergoing new stage of actualization, since it has no clear understanding and is often raised in the context of solving demographic problems of aging society. At the same time, analysis reveals vulnerability of position of those using religious context in womans self-determination regarding disposal of her own body and right to refuse compulsion to terminate her pregnancy by physiological childbirth without her psychological, social and economic readiness and public support. Referring to various testimonies and sources, we appeal to necessity of working out common criteria to ensure womens access to medical care related to procedure of abortion in order to reduce mortality from diseases associated with self-abortions menacing live and health of women. The issues considered in the study may affect various spheres of social, medical and legal field and have wide area of practical implementation. The purpose of the study is to identify causes and to establish consequences of womens limited access to abortion services, as well as legal and ethical aspects of overcoming these restrictions.
Pakistan journal of pharmaceutical sciencesWeimin Kong, Yiting Yang, Xinru Guan, Yanting He, Caixia Yan, Tao Ma
BACKGROUND: Drug metabolism may be influenced by pregnancy. Use of acetaminophen (APAP) is prevalent among pregnant women, necessitating the development of effective methods for predicting its in-vivo disposition. OBJECTIVES: A whole physiologically based pharmacokinetic model was developed to predict the pharmacokinetic behavior of APAP following oral or intravenous administration in both healthy subjects and pregnant women across different trimesters (first, second, and third trimesters). METHODS: Phoenix WinNonlin 8.4 was used to establish the model, which was verified by literature data and the fold error method. Sensitivity analysis was used to identify the factors most sensitive to the model results. RESULTS: The model was established successfully. The clearance rate and half-life of intravenous APAP increased during pregnancy and the changes were more obvious with the increase of pregnancy trimesters. Theoretically, adjusting the oral and intravenous doses for pregnant women in the third trimester to 1.23 and 1.16 times those administered to healthy individuals may yield a comparable area under the curve in healthy subjects. According to the sensitivity analysis results, the influencing factors were ranked from largest to smallest as follows: activity of sulfatase > activity of glucuronidase > the constant of the gastrointestinal transport rate > activity of CYP450. CONCLUSION: Pregnancy affects the metabolism of APAP and more attention should be paid to pregnant women in clinical medication.
Journal of child and adolescent psychiatric nursing : official publication of the Association of Child and Adolescent Psychiatric Nurses, IncMeserret Aslan, Fadime Bayri Bingol, Aleyna Ozan, Ayşegül Alim Karamustafa, Ayşenur Hinisli
BACKGROUND: Adverse childhood experiences (ACEs) may have long-term effects on women's reproductive and psychological health, including premenstrual symptoms and fear of childbirth. PURPOSE: This study aimed to examine the relationships between ACEs, premenstrual syndrome (PMS), and fear of childbirth (FoC) among young women. METHODOLOGY: This cross-sectional and correlational study was conducted with 399 female university students in Türkiye between March and April 2022. Data were collected using the Adverse Childhood Experiences-Turkish Form (ACE-TF), Premenstrual Syndrome Scale (PMSS), and Women's Fear of Childbirth-Prior to Pregnancy Scale (WCF-PPS). Pearson correlation and linear regression analyses were performed. RESULTS: Of the participants, 58.6% reported at least one ACE and 71.7% had PMS symptoms. ACE scores were positively correlated with PMS (r = 0.476, p < 0.01) and FoC (r = 0.169, p < 0.01). PMS was also positively correlated with FoC (r = 0.455, p < 0.01). ACEs explained 22.5% of the variance in PMS scores (R2 = 0.225) and 2.6% of the variance in FoC scores (R2 = 0.026). CONCLUSIONS: Adverse childhood experiences were associated with greater premenstrual symptoms and fear of childbirth among young women. Incorporating trauma-informed assessment and individualized psychosocial support into reproductive health care may facilitate early identification of women at increased risk for reproductive and emotional distress.
Basic & clinical pharmacology & toxicologyMette Østergaard Thunbo, Line Kolding, Samuel Azuz, Terese Matthesen Kamronn, Lene Høimark, Lars Henning Pedersen
Cystitis is common during pregnancy and requires effective antibiotic treatment to prevent complications. Gastric bypass surgery alters gastrointestinal anatomy and may impair oral drug absorption, raising concerns about antibiotic effectiveness. We therefore aimed to examine antibiotic use for cystitis and the risk of treatment failure in pregnant women with prior gastric bypass. In this nationwide Danish register-based study, we compared 1985 pregnancies among women with prior gastric bypass with 1 400 174 pregnancies among women without bariatric surgery. We assessed redeemed prescriptions for cystitis-related antibiotics and potential treatment failure defined as repeated antibiotic prescriptions within 14 days, hospital-recorded cystitis or severe urinary tract complications (pyelonephritis or urosepsis). Pregnant women with prior gastric bypass more frequently redeemed cystitis-related antibiotics than those without bariatric surgery (22.6% vs. 12.7%). Among antibiotic-exposed pregnancies, prior gastric bypass was associated with an increased risk of potential treatment failure, including repeated antibiotic prescriptions (adjusted odds ratio [aOR] 1.69, 95% confidence interval [CI] 1.22-2.30) and hospital-recorded cystitis (aOR 2.22, 95% CI 1.24-3.67), while severe complications were rare. These findings suggest that antibiotic treatment may be less effective or that the clinical course is more complicated in this group, highlighting a need for closer monitoring and tailored treatment strategies.
Acta anaesthesiologica ScandinavicaJohan C Lund, Frederik T Kongensgaard, Anne C Brøchner, Helene K Nedergaard
BACKGROUND: Neuraxial anesthesia is the preferred anesthetic technique for cesarean delivery, yet a systematic review found that 14% of blocks for elective cesarean delivery were inadequate. This scoping review aimed to explore patients' and anesthesiologists' experiences of inadequate neuraxial anesthesia during emergency cesarean delivery. Secondary objectives were to examine its definitions, management strategies, and reported prevalence. METHODS: A systematic literature search was conducted based on predefined inclusion criteria according to the PCC framework (Population, Concept, Context). Studies published since 1995 that reported clinical data were eligible. Three authors independently screened titles, abstracts, and full texts. Study quality was assessed using the Mixed Methods Appraisal Tool. RESULTS: The literature search yielded 6375 titles, of which 63 were included in the review. Data on patients' and anesthesiologists' experiences with inadequate neuraxial anesthesia during emergency cesarean delivery is very limited. Clinicians may experience difficulties identifying patients experiencing intraoperative pain. No common definition of "inadequate neuraxial block" was found. Intravenous opioids followed by S-Ketamine were the most common pharmacological strategies used for supplementation. Due to the varying definition of "inadequate block" no incidence could be calculated. CONCLUSION: Data on both patients' and anesthesiologists' experiences with inadequate neuraxial anesthesia during emergency cesarean delivery are sparse. Inadequate neuraxial anesthesia is inconsistently assessed, and with no consensus on its definition or management. A wide range of pharmacological strategies is used to avoid conversion to general anesthesia, but their effectiveness remains unclear. The reported incidence of inadequate neuraxial block ranges from 0% to 27%. EDITORIAL COMMENT: This scoping review presents an updated systematic review on how to better understand this kind of event, so that it could be better studied.
Infant mental health journalRaphaëlle Giac, Sophie Chaput-Langlois, Linda Booij, Katherine Séguin, Angélique Brun, Natalie Castellanos-Ryan, Cathy Vaillancourt, Sarah Lippé, Catherine M H…
The perinatal period is marked by heightened vulnerability to maternal depression and anxiety symptoms, which have been associated with early child socio-emotional development, including difficult temperament. This longitudinal study investigated whether prenatal maternal depression and anxiety symptoms predicted infant difficult temperament at 12 months through parallel mediation by postnatal maternal symptoms and perceived partner support. Given emerging evidence on sex differences in the associations between prenatal maternal distress and early socio-emotional development, exploratory multi-group analyses by child sex were also conducted. Pregnant individuals were recruited (October 2020-September 2022) for the Resilience and Perinatal Stress during the Pandemic (RESPPA) study in Quebec, Canada. Measures included the EPDS, GAD-7, ICQ, and perceived partner support assessed via self-reported online questionnaires. Path analyses (N = 1422) were conducted using data from the third pregnancy trimester (T1), three months postpartum (T2), and 12 months postpartum (T3). Separate models were estimated for depression and anxiety symptoms. Greater prenatal depression symptoms predicted higher infant difficult temperament scores, with postnatal depression symptoms and perceived partner support fully mediating this association. Similar findings emerged for anxiety. No significant sex differences were observed. Findings highlight postnatal maternal depression and anxiety symptoms and perceived partner support as potential screening and intervention targets to promote infant development.
Developmental psychobiologyAndrew Justin Taylor, Robinson Carrasco-Gutiérrez, Arabia Olea-Araya, Pablo R Moya, Alexies Dagnino-Subiabre
Stressing rodent dams during lactation can impair offspring neurodevelopment, altering behavioral and physiological outcomes. Witnessed social defeat stress (WSDS) is a paradigm in which a juvenile or adult rodent observes aggressive encounters, affecting stress physiology and behavior. We developed a novel early-life stress model by exposing lactating rat dams to WSDS and assessed its impact on juvenile social behavior and stress-related physiology. At postnatal day 24, same-sex, age-matched pairs of offspring were tested for social play by scoring pouncing (play initiation), pinning, chasing, and evading. Locomotor activity was assessed in the open field on the same day. After behavioral testing, adrenal cortex weight was measured as an indirect marker of stress-related physiology. Maternal WSDS exposure was associated with a significant sex × WSDS interaction in pouncing behavior, with reduced pouncing in juvenile males, whereas no comparable effect was observed in females. WSDS exposure also increased adrenal cortex weight overall, although the sex × WSDS interaction for this measure was not significant. The reduction in pouncing was characterized by substantial within-group variability, and randomization-based sensitivity analysis indicated that the statistical significance of the sex × WSDS interaction was sensitive to focal-animal assignment. These findings suggest that maternal WSDS exposure may produce a specific and variable alteration in social play initiation, together with changes in stress-related physiology, during early juvenile development. This model may provide a useful framework for investigating how maternal psychosocial stress influences offspring behavioral and physiological development.
BACKGROUND: Unplanned births outside hospitals involve higher risks of complications for mothers and newborns and require special obstetric or pediatric skills. However, ambulance calls for childbirth are rare, making it difficult for ambulance staff to maintain their skills. In Europe, unplanned out-of-hospital deliveries constitute 0.10% to 0.61% of all births. The exact number of prehospital births in the Region of Southern Denmark remains unknown. The study aimed to determine the extent of unplanned prehospital births attended by the ambulance service outside hospitals in the Region of Southern Denmark from January 2016 through June 2024. We further aimed to identify where the unplanned pre-hospital births took place and to report any birth-related complications in the mothers or newborns encountered by ambulance staff. METHODS: The study was a cross-sectional study utilizing the pre-hospital electronic Patient Medical Record system over 8 years in a mixed urban-rural area with a population of 1.2 million people. All prehospital medical records for ambulance missions dispatched for childbirths were manually examined. The study period spanned from January 2016 through June 2024. RESULTS: Out of 1,137,222 ambulance dispatches, 3543 cases (0.31%) involved a dispatch code related to childbirth. Many labor incidents were considered uneventful by the prehospital personnel. Of all ambulance runs related to childbirth, we identified 310 births in the Region of Southern Denmark in which ambulance staff assisted with complicated out-of-hospital deliveries. An additional 10 labor cases were regarded as sufficiently complex that obstetric manoeuvres aimed at delaying the delivery of the baby were performed prehospitally, while the mother was rushed to hospital for delivery. CONCLUSION: Births outside the hospital while the mother is in the care of the EMS were rare, occurring in 0.03% of all ambulance missions. Most of the births took place without complications for both mother and neonate. In four cases, however, the neonate was in cardiac arrest and required resuscitation. Given the limited exposure to prehospital births, we suggest incorporating training in handling these rare events into routine training for prehospital caregivers. EDITORIAL COMMENT: This cohort study presents obstetrical cases that have been managed first in the prehospital setting by ambulance personnel. Obstetrical outcomes related to this are presented, and there are considerations for what can be desirable as preparation and competencies for ambulance responses for these types of cases.
Acta anaesthesiologica ScandinavicaChristina Draegert, Pernille Pape, Heidi Kruse, Helene K Nedergaard, Anne J Wikkelsø
BACKGROUND: Intrathecal morphine is widely used for postoperative analgesia following cesarean delivery. However, intrathecal morphine's potential association with hypothermia remains uncertain, although hypothermia may adversely affect maternal recovery and comfort. This scoping review aims to map the available evidence regarding temperature dysregulation associated with intrathecal morphine in patients undergoing cesarean delivery. METHODS: We conducted a scoping review according to the PRISMA-ScR guideline. A systematic literature search was performed in Medline, Embase, The Cochrane Library, and Cinahl. Studies reporting temperature outcomes in patients receiving intrathecal morphine during cesarean delivery were eligible. The primary outcome was the incidence of hypothermia or hyperthermia. Secondary outcomes included changes in core temperature, dose-response relation, duration, severity of temperature dysregulation, and impact on recovery. RESULTS: A total of 35 studies published between 1991 and 2025 were included. Four studies evaluated intrathecal morphine as intervention, whereas it was administered as standard care provided for all trial patients in the remaining studies. A total of 20 studies reported the incidence of hypothermia, corresponding to a pooled incidence of 21% among 773 patients. No studies reported an increase in temperature. A total of 12 case reports described severe hypothermia attributed to intrathecal morphine. However, our explorative analysis did not show an association between intrathecal morphine and hypothermia, and no dose response was identified. Clinical outcomes were infrequently reported, though several hypothermic patients were described as asymptomatic, suggesting that hypothermia may be clinically under-recognized. CONCLUSION: Current evidence does not demonstrate a consistent association between intrathecal morphine and hypothermia following cesarean delivery. However, interpretation is limited by substantial heterogeneity across studies. This scoping review highlights an important evidence gap in the literature and supports the need for well-designed studies to clarify whether intrathecal morphine contributes to clinically relevant hypothermia. EDITORIAL COMMENT: This review presents an overview of the evidence concerning intrathecal morphine treatment and post-caesarean temperature dysregulation. The evidence is incomplete, and this scoping review highlights areas where higher quality evidence is needed.
Sociology of health & illnessLeah Gilman, Alexus Davis
Informal donor conception (IDC) has an ambiguous status under UK law. Whilst not illegal, it is discouraged by regulators and only partially recognised in attributions of legal parenthood. In this paper, we analyse IDC as a lens to explore the politics of reproductive signification. We use this term to refer to the power dynamics at play in deciding the meaning of reproductive processes in people's everyday lives. Drawing on interviews with 19 donors and 30 (intended) parents via IDC, we explore how they manage the relational significance of conception, gestation and care in the context of a legal regime which is often at odds with their intentions. Building on theories of legal consciousness and stratified reproduction, we demonstrate how the politics of reproductive signification encompass not only cis/heteronormative legislation but also the ways in which inequalities, relating to economic resources, racialised and classed parenting ideals and relationship status, shape possibilities to work with the law and resist its relational authority via practices of de-animation or embrace legal ambiguity. Our analysis has implications for understanding how people negotiate the meaning of reproduction, particularly in the context of legal marginalisation.
Sexual healthManoji Gunathilake, Jerry L J Chen, Alice Ishwar, Puja Thapa, Roxana Sherry, Natasha Tatipata, Vicki Krause
BACKGROUND: This retrospective study describes the clinical outcomes and management of people diagnosed with syphilis during pregnancy and their newborns at risk of congenital syphilis in the Northern Territory (NT), Australia between 2013 and 2023. METHODS: Demographic, clinical, and contact tracing information on all pregnancies with syphilis diagnosed prior to or during pregnancy, and clinical information of neonates, were sourced from spreadsheets and the NT Syphilis Register Information System. RESULTS: A total of 380 pregnancies were monitored, of which 186 pregnancies were identified as at risk of mother-to-child transmission of syphilis. Reinfection accounted for 13.8% of the 181 new syphilis infections. Of the 188 neonates, there were 11 cases of congenital syphilis, including 1 case of stillbirth. All congenital syphilis cases occurred when maternal syphilis was diagnosed in the third trimester or at the time of childbirth. While maternal treatment was completed in all pregnancies, 22 (11.8%) received treatment less than 30 days prior to childbirth or were untreated at the time of childbirth. Initial treatment was inadequate in 10 pregnancies (5.4%). A lack of four-fold reduction in rapid plasma reagin (RPR) titres by the time of childbirth due to delayed diagnosis and treatment was significantly associated with neonatal congenital syphilis (P < 0.001), with a median RPR of 1:8. Among identified contact/s, 54 (43.2%) tested positive for syphilis. CONCLUSION: Early detection, treatment, and follow-up of maternal syphilis before and during pregnancy are key measures to prevent congenital syphilis. Universal syphilis screening with repeat testing should be incorporated into antenatal care to minimise stigma.
Sexual healthHengyue Zhang, Vivienne Y K Tao, Yujia Lei, Chun Feng, Anise M S Wu
BACKGROUND: Measures of fertility preference or intention, particularly those focused on fertility prevention, are increasingly needed in reproductive health, especially in countries such as China, which face challenges, such as declining fertility rates, an aging population and unintended pregnancies among young adults. This was the first study to take initial steps in addressing these issues by translating, validating and examining the latent structure of the unidimensional Desire to Avoid Pregnancy (DAP) scale, which has been shown to predict contraceptive use and pregnancy. METHODS: We conducted an online survey among emerging adults in China using convenience sampling. A total of 893 participants completed the survey. Psychometric properties were examined by assessing internal consistency, structural validity (via exploratory factor analysis and confirmatory factor analysis) and convergent validity. RESULTS: A three-factor structure of the 13-item Chinese version of the DAP scale was identified (AIC = 12,569.76), outperforming the one-factor model (AIC = 13824.834), with satisfactory reliability (AVE: F1 = 0.74, F2 = 0.74, F3 = 0.72; ρc: F1 = 0.90, F2 = 0.86, F3 = 0.76), accounting for 72.77% of the total observed variance. Convergent validity was supported by the expected positive correlations of the DAP scale scores with general anxiety and childbearing-specific worries, and a negative correlation with attitudes toward the importance of fertility for the future. CONCLUSION: The three-factor DAP scale was shown to be a valid, reliable tool for researching reproductive health literacy and fertility intention among Chinese emerging adults. Its three subscale scores and patterns can capture ambivalent desire, facilitating more precise screening and assessment in reproductive health contexts.
Sexual healthAmirpasha Rafizadeh, Damindu Kariyawasan Jalaththanthree, Stephanie Bond, Ei T Aung, Phyu Mon Latt, Christopher K Fairely, Marcus Y Chen, Jason J Ong, Nyi Nyi …
BACKGROUND: Sexually transmitted infections in pregnancy threaten both mother and baby, so early detection matters. This study aimed to describe the epidemiology and temporal trends of sexually transmitted infections (STIs) among pregnant women attending a large public sexual health clinic in Melbourne, Australia, from 2012 to 2025. METHODS: We retrospectively analysed electronic medical records from the Melbourne Sexual Health Centre, a large public sexual health service. Demographic, clinical, and laboratory data were extracted for pregnant women who attended in 2012-2025, including those referred by primary care providers. STI positivity were calculated with 95% confidence intervals (CI), and temporal trends were assessed using trend tests. RESULTS: Of 659 pregnant women, 111 (16.8%, 95% CI: 14.2-19.9%) had one or more STIs. Positivity was 12.2% (46/377) for syphilis, 10.9% (57/523) for chlamydia, 2.1% (9/385) for gonorrhoea, 0.6% (2/335) for HIV, and 2.3% (5/218) for trichomoniasis. Of syphilis cases, 73.9% were diagnosed in the first trimester. Syphilis positivity increased over the study period (Ptrend = 0.022), peaking in 2022-2023 (35.0%, 7/20), while other STIs remained stable. CONCLUSIONS: STIs were frequently detected among pregnant clinic attendees, with syphilis and chlamydia the most prevalent. The rising burden of syphilis highlights the need for strengthened antenatal testing and timely public health responses.
Reproduction, fertility, and developmentMuhammet Mükerrem Kaya, Hasan Ali Çay, Ramazan Arslan, Leyla Elif Özgü Ayözger, Sibel Kaymak, Nilüfer Vural, Hidayet Tutun, Ayhan Ata
CONTEXT: Naringenin is a citrus-derived flavanone with documented antioxidant, anti-inflammatory, and steroidogenic modulatory properties; yet, its effects under gonadotropin-stimulated superovulation have not been investigated. AIMS: This study evaluated the impact of naringenin co-administration during a pregnant mare serum gonadotropin (PMSG)/human chorionic gonadotropin (hCG) superovulation protocol on zygote yield, preimplantation embryo development, and ovarian and endometrial morphology in CD-1 mice. METHODS: Twenty-four females (8-10 weeks) received PMSG with either naringenin (20 mg/kg intraperitoneally; n = 12) or dimethyl sulfoxide vehicle (n = 12), followed by hCG 48 h later and mating with fertile males. Pronuclear-stage embryos were collected from oviducts 14-16 h post-mating and cultured in vitro for 96 h; cleavage and blastocyst formation were assessed at 24 h and 96 h respectively. Ovarian and uterine tissues were evaluated histopathologically. KEY RESULTS: Naringenin treatment significantly increased total zygote yield. Although cleavage rate was lower in the naringenin group (45% vs 53%), blastocyst formation among cleaved embryos was markedly higher (47% vs 25%). Treated animals exhibited significantly greater corpora lutea count, corpora lutea:cell ratio, ovarian diameter, and endometrial thickness. In silico molecular docking predicted favourable binding affinities of naringenin towards the progesterone receptor and follicle-stimulating hormone receptor, generating a computational hypothesis consistent with these in vivo findings. CONCLUSIONS: Naringenin enhances blastocyst developmental competence and post-ovulatory ovarian parameters under superovulation conditions. IMPLICATIONS: These findings support the potential of naringenin as an adjunct to gonadotropin-based reproductive biotechnology protocols.
FASEB journal : official publication of the Federation of American Societies for Experimental BiologyYong Xia, Junguo Zhao, Bo Gao
Preeclampsia (PE) affects 3%-5% of pregnancies worldwide and is a leading cause of maternal/perinatal mortality, yet its etiology remains unknown. We established a PE rat model using L-NAME to investigate postpartum cognitive dysfunction and its mechanisms, evaluated brain microstructural changes with MRI, explored correlations between MRI parameters and cognitive impairment, and assessed pravastatin's therapeutic effects. Sixty-three pregnant rats were divided into normal pregnant (NP), PE, and pravastatin-treated (PRA) groups, with three postpartum subgroups (10 days, 1 month, 3 months; n = 7 each). Morris water maze, HE/Nissl staining, transmission electron microscopy, and multimodal MRI (DTI, IVIM, DCE-MRI) were performed. ROIs included anterior/posterior cortex and hippocampus. Pearson correlation was used to relate MRI parameters to escape latency. (1) L-NAME induced a PE-like phenotype, alleviated by pravastatin. (2) Cognitive impairment appeared at 10 days postpartum and worsened over time. (3) FA, D, and f values decreased while Ktrans increased in the PE group (p < 0.05), changes that progressed over time and were abrogated by pravastatin. (4) FA and D were negatively correlated with escape latency, whereas Ktrans showed a positive correlation. (5) Neuronal degeneration, astrocyte activation, and BBB disruption in the PE group were ameliorated by pravastatin. PE model rats developed progressive postpartum cognitive dysfunction, likely due to neuronal degeneration, glial activation, and increased BBB permeability. Pravastatin partially alleviated these pathological and cognitive changes. Multimodal MRI effectively detected alterations in brain microstructure, microvascular perfusion, and BBB, consistent with histopathological findings.
FASEB journal : official publication of the Federation of American Societies for Experimental BiologyWenxin Jiang, Yike Yang, Xiao Yuan, Wei Deng, Mark D Kilby, Philip N Baker, Chao Tong, Yi Yang
Well-regulated trophoblast proliferation, migration, invasion, and cell turnover are essential for normal placental development in humans and rodents. Given the established role of oxidative stress in placentation and the redox activity of iron, we investigated whether ferroptosis-associated redox signaling contributes to trophoblast function and placental development. Placental iron profiling revealed significantly elevated total and ferrous iron levels in first-trimester human villi compared with term placentas, accompanied by the transcript levels of several iron uptake- and reduction-related genes, including TFRC, DMT1, ZIP8, STEAP3, and STEAP4, which were elevated in first-trimester villi. Murine placentas also exhibited gestational changes in iron abundance and iron-homeostasis-related gene expression. HO-1 protein abundance was highest during early gestation and declined thereafter, suggesting a potential association between heme degradation and gestational iron homeostasis. In contrast, placental labile iron pool (LIP) levels showed only modest, statistically nonsignificant changes across gestation, suggesting a relatively stable redox-active iron pool. Immunofluorescence analyses demonstrated spatially distinct expression of ferroptosis-associated regulators, with ACSL4 enriched in invasive trophoblast populations and GPX4 predominantly localized in surrounding decidual tissues, suggesting regional heterogeneity in ferroptosis-associated molecular features during placentation. Functional studies in HTR-8/SVneo trophoblast cells further demonstrated that mild ferroptosis-associated redox perturbation induced by low-dose erastin or ferrous iron enhanced trophoblast migration and invasion without overt cytotoxicity. These effects were attenuated by ferrostatin-1, deferoxamine mesylate (DFOM), or the mitochondria-targeted antioxidant MitoQ and were blunted following FTH1 and TFRC knockdown, indicating that trophoblast responsiveness depends on iron availability and ferroptosis-associated redox signaling. Importantly, these pro-invasive effects were preserved under physiologically relevant hypoxic conditions. Together, our findings support a model in which gestational changes in placental iron homeostasis are associated with ferroptosis-related molecular features, while experimentally induced iron-dependent redox signaling modulates trophoblast behavior. Rather than inducing overt ferroptotic cell death, sublethal iron-dependent redox perturbation may act as a signaling mechanism influencing trophoblast function during placental development.
Embryo implantation is a critical and complex process that requires coordination between the embryo and the receptive endometrium for its success. However, a multitude of factors have the potential to contribute to implantation failure. Among these factors, bacterial infections in the uterine environment are of particular concern and are increasingly being considered as a contributing factor to implantation failure. The presence of pathogenic bacteria has been demonstrated to stimulate inflammatory responses, alter the endometrial microbiome, interfere with critical signaling pathways, and finally change the uterus microenvironments that are required for implantation. We aimed to review bacterial infection as an important potential etiology of chronic endometritis pathophysiology and its correlation with implantation failure.
Global health actionAbdikerim Mohamed Moumin, Abdalle Ali Yusuf, Abdirizak Mohamed Moumin, Khadar Mowlid Abdi, Bishar Elmi Yey, Hibak Ahmed Nuh, Abdifatah Ahmed Osman
BACKGROUND: Postpartum depression (PPD) and fragmented maternal care are critical public health challenges in sub-Saharan Africa. OBJECTIVE: To examine the associations of psychosocial, structural, clinical, and health-system factors with self-reported postpartum depressive symptoms and maternal continuum-of-care (CoC) completion in Borama, Somaliland. METHODS: A community-based cross-sectional study analyzed 442 postnatal women. Postpartum depressive symptoms were assessed via binary self-report, and CoC was summarized using a 0-3 index (ANC4+, facility delivery, and postnatal care). Multivariable logistic regression estimated adjusted odds ratios (aORs) for depressive symptoms; robust multiple linear regression estimated adjusted CoC-score differences (N=442). RESULTS: Depressive symptoms were reported by 109/442 women (24.7%), and 152/442 (34.4%) completed all three CoC components. Higher adjusted odds of symptoms were observed among single mothers (aOR = 2.27, 95% CI 1.11-4.65), women with labor complications (aOR = 2.06, 95% CI 1.10-3.87), university/technical education (aOR = 2.49, 95% CI 1.16-5.33), and fair/poor self-rated health (aOR = 6.66, 95% CI 2.62-16.90). Among symptom-positive women, 37.6% spoke to no one about their distress. Adjusted symptom probabilities declined across increasing spousal-support categories, but the overall association was not statistically significant (p=.430). Early ANC initiation (B=0.345, 95% CI 0.205-0.486) and university/technical education (B=0.382, 95% CI 0.182-0.582) were positively associated with the CoC score. CONCLUSIONS: Postpartum depressive symptoms and incomplete continuity of care were prevalent in this sample. Maternal-health planning should consider integrating routine emotional symptom enquiry with strategies that strengthen early ANC engagement and postnatal follow-up.
Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and GynaecologyKübra Kurt Bilirer, Hale Özer Çaltek, Barış Boza, Selvi Aydın Şenel, Hamdullah Pekkolay, Mehmet Gümüştaş
BACKGROUND: Foetal situs abnormalities, including situs inversus totalis (SIT), right atrial isomerism (RAI) and left atrial isomerism (LAI), are associated with substantial variation in cardiac anatomy and postnatal outcomes. This study aimed to compare prenatal characteristics, associated abnormalities, perinatal outcomes, postnatal management and survival among foetuses with SIT, RAI and LAI. METHODS: This retrospective cohort study included 73 foetuses prenatally diagnosed with SIT (n = 12), RAI (n = 24) or LAI (n = 37) at a tertiary foetal cardiology and perinatology centre between 2021 and 2025. Prenatal cardiac and extracardiac findings, pregnancy and neonatal outcomes, postnatal surgical management pathways, and survival were evaluated. Survival was assessed using Kaplan-Meier's analysis, and factors associated with 1-year mortality were examined using Cox proportional hazards regression. RESULTS: Cardiac phenotypes differed significantly among groups. Interrupted inferior vena cava (IVC) occurred predominantly in LAI, whereas aortic-IVC juxtaposition, double-outlet right ventricle, anomalous pulmonary venous return and unbalanced atrioventricular septal defect were more frequent in RAI. Arrhythmias occurred exclusively in LAI. Postnatal surgical management pathways differed significantly among groups (p = 0.001), with univentricular pathway most frequent in RAI. Survival distributions did not differ significantly among SIT, RAI and LAI (log-rank p = 0.193). Exploratory multivariable analysis showed an association between right ventricular outflow tract obstruction (RVOTO) and increased 1-year mortality (HR 4.79, 95% CI 1.51-15.10; p = 0.008). CONCLUSIONS: Prenatally diagnosed SIT, RAI and LAI demonstrate distinct cardiac phenotypes and postnatal management requirements. Prognosis appears to depend not only on the laterality phenotype but also on specific cardiac morphology, with RVOTO emerging as an important prognostic marker. Detailed segmental foetal echocardiography may improve prenatal risk stratification, counselling and postnatal management planning.
Global health actionFelix Ikenna Onunkwor, Rose Aguolu
BACKGROUND: Quality assessment in family planning (FP) and post-abortion care (PAC) programmes is shaped by workforce capability, programme context, and assessment modality. Longitudinal evaluations may misattribute quality-score differences if repeated measurements and temporal patterning are ignored. OBJECTIVE: To examine associations of workforce characteristics, calendar period, service-delivery channel, and assessment modality with Quality Technical Assessment (QTA) performance in Sierra Leone, 2019-2022. METHODS: We analysed 108 QTA records from 23 service delivery points using Gaussian generalised estimating equations with facility-level clustering and robust standard errors. Models included year, modality, channel, active staff count, and core-service competency coverage; full-time staffing and assessor identity were examined in sensitivity analyses. In 2021, all facilities received planned in-person and then remote assessments in a fixed programme-wide sequence. RESULTS: Mean QTA scores increased descriptively from 89.8% (SD 7.4) in 2019 to 94.2% (SD 4.7) in 2022. In the primary model, 2020 scores were lower than 2019 (B = -5.15; 95% CI -9.99 to -0.32). Active staff count was inversely associated with QTA scores (B = -2.86; 95% CI -4.47 to -1.26). Remote assessment was associated with higher adjusted scores, but this cannot be interpreted causally because modality was confounded with year and assessment order. CONCLUSIONS: QTA performance varied across calendar periods and workforce structure. Longitudinal evaluations should account for within-facility correlation and modality timing before attributing quality differences to the workforce or assessment approach.
Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and GynaecologyXufeng Gong, Qian Zhu, Linlin Wang
BACKGROUND: Gestational diabetes mellitus (GDM) is a common pregnancy complication. Although lipid parameters, the triglyceride-glucose (TyG) index, and TyG-body mass index (TyG-BMI) have been associated with GDM, their relative value within an integrated lipid-glycaemic prediction framework remains unclear. This study developed and internally validated an interpretable model for GDM risk estimation. METHODS: This single-centre retrospective study included 287 pregnant women who underwent 75 g oral glucose tolerance testing and fasting lipid assessment at 24-28 gestational weeks, including 72 with GDM and 215 without GDM. Candidate predictors comprised maternal characteristics, fasting plasma glucose (FPG), routine lipid fractions, apolipoproteins, the TyG index, and TyG-BMI. Forward stepwise likelihood-ratio logistic regression was used to develop the original combined model. A structured alternative model replaced pre-pregnancy BMI, FPG, and triglycerides with TyG-BMI. Model performance was evaluated using receiver operating characteristic analysis, calibration measures, threshold-dependent diagnostic metrics, 1,000-resample bootstrap internal validation, paired DeLong testing, a nomogram, and decision curve analysis. RESULTS: Eight variables were retained in the original combined model: maternal age, pre-pregnancy BMI, FPG, total cholesterol, triglycerides, non-high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B. Its apparent and optimism-corrected AUCs were 0.848 (95% CI: 0.786-0.909) and 0.830, respectively; the bootstrap-corrected calibration intercept was -0.03, calibration slope was 0.86, and Brier score was 0.147. The TyG-BMI alternative model had apparent and optimism-corrected AUCs of 0.831 (95% CI: 0.765-0.897) and 0.817. The AUC difference was 0.017 (95% CI: -0.011 to 0.045; P = 0.235). Decision curve analysis indicated potential net benefit for both models across clinically relevant thresholds. CONCLUSION: Both models showed good internally validated discrimination and acceptable calibration for GDM risk estimation at routine screening. The original model had a numerically higher AUC, but discrimination did not differ significantly between models. External validation is required before clinical implementation.
Human fertility (Cambridge, England)Raashi Shah, Jennifer Barcroft, Hannan Al-Lamee, Erna Bayar, Rana Al-Odetalah, Marius Zaharia, Kinjal Shah, Anamika Sakhuja, Danai Balfoussia, Emil Barsoum, Ra…
Ovarian hyperstimulation syndrome (OHSS) is a serious complication of assisted reproductive technology (ART). Risk factors for OHSS include female age, polycystic ovarian morphology and high ovarian reserve. The use of a gonadotrophin-releasing hormone (GnRH) agonist trigger in a freeze-all cycle is an effective strategy for reducing the risk of OHSS in suspected high responders. Various GnRH agonist trigger preparations exist but their use is subject to manufacturer availability. The national shortage of Buserelin necessitated a switch to alternative GnRH agonist trigger preparations such as Modified-Release (MR) Triptorelin resulting in a spike in OHSS cases, prompting an urgent review of our local treatment protocols and an immediate switch to Nafarelin (nasal preparation). We performed a retrospective study of freeze-all GnRH antagonist treatment cycles treated with a GnRH agonist (Triptorelin-MR, Nafarelin, and Buserelin) trigger at a London fertility clinic. The high-risk cohort consisted of patients with ≥18 follicles >12mm on ultrasonography. The diagnosis of OHSS was based on the criteria outlined by the Royal College of Obstetricians and Gynaecologists (RCOG). Relevant clinical data were extracted from medical records including female age, antral follicle count (AFC), anti-Mullerian hormone (AMH), ovarian stimulation dose (international units; IU), trigger preparation, oestradiol level on trigger day (pmol/l), oocyte yield, and the diagnosis and management of OHSS. A total of 333 patients underwent a freeze-all GnRH antagonist cycle between January 2023 and September 2024, 224 due to a high-risk of OHSS (≥18 follicles >12mm). The GnRH agonist preparations used included: Triptorelin-MR only (0.75 mg subcutaneous injection, SC; n = 69), Triptorelin-MR (0.375 mg SC) plus Menopur (150 IU SC; n = 49), Buserelin (2 mg SC; n = 69), and Nafarelin (1.6 mg nasal spray; n = 37). Forty-three patients met the RCOG diagnostic criteria for OHSS (mild n = 5, moderate n = 25 and severe n = 13). Six patients required inpatient OHSS management; none required intensive care or a chest/abdominal drain. Of those that developed severe OHSS, 92.3% (n = 12/13) had received Triptorelin-MR only or in combination with Menopur. Based on this cohort, Triptorelin-MR containing triggers are associated with a 12-fold increased risk of severe OHSS compared with other preparations and should not be used as a GnRH agonist trigger in patients at high risk of OHSS.
Gynecological endocrinology : the official journal of the International Society of Gynecological EndocrinologyXiangyan Ruan, Juan Du, Muqing Gu, Fengyu Jin, Jing Jin, Yanglu Li, Jiaojiao Cheng, Yanqiu Li, Weimin Kong, Qi Zhang, Zecheng Wang, Mingzhen Zhang, Anming Liu,…
OBJECTIVE: This article reports on the world's first live birth after ovarian tissue cryopreservation and transplantation (OTCT) in a patient with colon cancer. METHODS: A 29-year-old unmarried nulliparous patient underwent ovarian tissue cryopreservation before chemotherapy. After chemotherapy-induced premature ovarian insufficiency, she received the first transplantation of six thawed ovarian cortex strips. Despite normal ovarian function being maintained for over 2 years, she requested and underwent a second transplantation with another six strips to maximize her chances of pregnancy. RESULTS: After the first transplantation, she resumed spontaneous menstruation with restored ovarian function, which was remained functional for 28 months until the second transplantation. Following the second transplantation, she conceived spontaneously without assisted reproductive technology two months after grafting. Routine prenatal examinations showed normal fetal development without abnormalities. She delivered a healthy baby girl weighing 2785 g with Apgar scores of 8/9 at 1 and 5 min. CONCLUSIONS: This case demonstrates the feasibility and safety of OTCT for fertility and ovarian function preservation in patients with colon cancer.
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal ObstetriciansMeng Hou, Weihong Wang, Meili Pei, Lu Zeng, Fanfan Gao
OBJECTIVE: Fetal foramen ovale restriction (FO-R) is an abnormal intracardiac flow disorder that may affect fetal cardiac hemodynamics and perinatal management. This retrospective cohort study aimed to characterize the echocardiographic features, associated abnormalities, and perinatal outcomes of pregnancies complicated by fetal FO-R, providing clinical evidence for obstetric decision-making. METHODS: A total of 283 fetuses diagnosed with FO-R by fetal echocardiography were enrolled. The diagnostic criteria were defined as a foramen ovale (FO) diameter <3 mm and a Doppler flow velocity >40 cm/s. Maternal clinical data, fetal echocardiographic findings, delivery details, and neonatal follow-up outcomes were collected and analyzed systematically. RESULTS: The incidence of FO-R was 1.88% among all fetal echocardiographic examinations. The median gestational age at diagnosis was 35 + 4 weeks, with 11.7% of cases diagnosed before 32 weeks of gestation. Coexisting pregnancy complications or fetal abnormalities were observed in 51.6% of cases, while 41.2% presented with isolated FO-R. Right heart enlargement was the most common associated cardiac finding (74.6%). The cesarean delivery rate was 64.7%, with fetal distress as the leading indication (24.0%). Multivariate analysis showed that FO diameter, timing of diagnosis, and presence of right heart enlargement did not significantly influence the delivery mode (all p > 0.05). Among 240 neonates with complete follow-up data, 27.1% had postnatal cardiac abnormalities, 93.8% of which resolved spontaneously within one year. Only 1.7% of neonates had persistent congenital heart defects. CONCLUSION: Fetal FO-R is mostly diagnosed in the third trimester and is frequently associated with right heart enlargement. Importantly, FO-R does not independently require cesarean delivery or preterm birth. Neonatal outcomes of fetuses with FO-R are generally favorable, with a high rate of spontaneous resolution of postnatal cardiac findings, which supports conservative obstetric management for most cases.
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal ObstetriciansMuyi Yang, Jiahui Qi, Lei Lei, Shuli Zhao
OBJECTIVE: Group B Streptococcus (GBS) colonization during pregnancy is associated with adverse outcomes. The associations between GBS colonization status and clinical parameters measured at different antenatal time points, and whether these differ by maternal age, remain unclear. This study aimed to explore age-stratified associations between GBS colonization and clinical parameters. METHODS: A retrospective case-control study was conducted at a single center. Cases were GBS-positive women (n = 110), and controls were GBS-negative women (n = 155) selected from the same cohort and matched on key characteristics. Participants were stratified by maternal age (<35 [GBS-positive: n = 90; GBS-negative: n = 96] vs. ≥35 years [GBS-positive: n = 20; GBS-negative: n = 59]). GBS colonization was determined by standard culture of vaginal and perianal swabs at 35-37 weeks. Oral glucose tolerance test (OGTT) was performed at 24-28 weeks. Hemoglobin (Hb) levels and other biomarkers were compared between cases and controls within each age group. RESULTS: Among women aged < 35 years, GBS colonization was not associated with second-trimester OGTT results but was associated with lower third-trimester hemoglobin levels (116.98 ± 9.89 g/L vs. 120.49 ± 10.19 g/L in controls, p < 0.05) and a statistically significant but clinically negligible earlier gestational age at delivery (39.11 ± 1.05 vs. 39.41 ± 0.98 weeks, p = 0.04). In women aged ≥ 35 years, GBS colonization was associated with significantly higher fasting and 2-hour OGTT glucose levels (p < 0.05) and a higher second-trimester neutrophil percentage (76.27% ± 5.43% vs. 73.90% ± 4.08%, p = 0.04) compared to controls. The 1-hour OGTT value showed a non-significant trend (p = 0.06). No significant differences were observed in birth weight, infant sex, or mode of delivery. CONCLUSIONS: This exploratory study suggests that maternal age may modify the associations between late-pregnancy GBS colonization status and clinical parameters measured earlier in gestation. The observed patterns highlight the potential importance of considering maternal age when evaluating prenatal laboratory findings in GBS-colonized women and generate hypotheses for future research. However, given the study's retrospective design and the small sample size in subgroups, these findings should be interpreted with caution as hypothesis-generating rather than as evidence to guide clinical practice.
Emergency medicine practiceXin Qi, Annie Leamon, Christopher Baugh
The expanding use of antiplatelet agents, anticoagulants, and fibrinolytics has made bleeding emergencies more frequent and more complex. A structured, evidence-based approach enables emergency clinicians to identify life-threatening and critical-site bleeding, initiate resuscitation, establish which antithrombotic agent the patient received and when, and weigh the benefit of restoring hemostasis against the risk for thrombosis. This review synthesizes current guidelines and evidence on the evaluation and management of bleeding in patients receiving antithrombotic therapy, identifying areas of consensus and ongoing uncertainty. Coagulation assays, agent-specific reversal and hemostatic strategies, periprocedural management, and bleeding in pregnancy are addressed.
Health expectations : an international journal of public participation in health care and health policyAlison Kay, Anne Goriely, Alexa Gummow, Lisa Hinton, Arti Patel, Marysia Price-Nowak, Shwetha Ramachandrappa, Jonathon Wells, Francesca Wicks, Minna Jeffery
INTRODUCTION: When a couple has a child with a genetic condition, it raises questions when considering future pregnancies. It has typically been considered an easier genetic test result to receive when the condition is de novo (new) in origin, because neither parent is understood to have passed on the genetic change, except in rare cases. However, new scientific research indicates de novo changes are more likely to originate from a single sperm-a risk that increases as fathers age. Research on a personalised recurrence risk assessment strategy is underway (the Impact of PREGCARE study-'iPREGCARE'). Couples may find this new information on de novo risks from fathers challenging without wider public awareness. This is a reflective case study of using co-produced theatre to address this need. METHODS: A range of participants (healthcare practitioners, those with relevant lived experience and the public) were creatively connected through scriptwriting to democratise knowledge production and research communication. Public and Patient Inclusion and Engagement (PPIE) participants were then asked to watch a staged reading of the playscript, to write letters to the characters, and to participate in a post-performance workshop. RESULTS: The staged reading and workshop were attended by 21 people; and over 336 people have viewed the publicly available recording to date. Qualitative analysis of the letters and workshop transcript indicate a major theme of informational discomfort. Two further themes, time pressures and support, focus on what the participants thought was needed but is often compromised or lacking. CONCLUSION: This approach created an opportunity to experiment with the benefits of theatre as a means to share the complicated dilemma couples may face due to new genomic information. Theatre, combined with the opportunity for the audience to write letters to the couple, provided an interactive means of communicating novel research on new reproductive genetic risk information to the public in a tangible and relatable form. PATIENT OR PUBLIC CONTRIBUTION: Six co-production panel members, two additional public contributors and two actors worked with the researchers to develop and deliver the project. A series of meetings and an online collaboration space were used to refine the key messages, approve the script and consider evaluation. The co-production panel reviewed and suggested edits to the draft journal manuscript.
Congenital arboviruses represent a significant public health concern because of their ability to cross the placental barrier and adversely affect fetal development. In this review, we delineate the epidemiology, pathogenesis, clinical manifestations, and diagnostic challenges associated with key congenital arboviral infections, including Zika, dengue, chikungunya, yellow fever, Oropouche, and West Nile virus. While vertical transmission mechanisms vary among arboviruses, inflammation, placental disruption, and viral replication within fetal tissues are common pathological features. Early diagnosis is complicated by overlapping clinical symptoms, limited laboratory capacity in endemic areas, and cross-reactivity in serological tests for flaviviruses. In this review, we highlight the need for improved surveillance, targeted diagnostics, and preventive strategies, including vector control and maternal vaccination, to reduce the burden of congenital arboviral diseases. Understanding the maternal-fetal dynamics of arboviral infections is essential for developing effective public health interventions and mitigating long-term outcomes in affected populations.
Japan journal of nursing science : JJNSKayo Ueda, Yukiko Honda, Yuko Masuzawa, Mai Takeshita, Rie Toyomoto, Kumiko Adachi, Hiromi Eto, Yuriko Usui, Rieko Fukuzawa, Tomoko Nishino
AIM: To evaluate the benefits and harms of bathing during the first stage of labor among healthy women with uncomplicated singleton cephalic pregnancies at ≥ 36 weeks' gestation. METHODS: Randomized controlled trials comparing warm-water bathing during the first stage of labor with no bathing were included. MEDLINE (PubMed), Cochrane Database of Systematic Reviews, CENTRAL, and Ichu-shi Web (updated to December 2024) were searched for English- and Japanese-language studies. Two reviewers independently assessed risk of bias using the Cochrane Risk of Bias 1.0 tool, and evidence certainty was appraised with GRADE. Random-effects meta-analyses reported risk ratios (RRs) or mean differences with 95% prediction intervals (PIs), and I2 statistics. RESULTS: Nine studies from eight countries (1994-2018; n = 1823) met inclusion criteria. Bathing did not significantly affect regional analgesia use (RR 0.91, 95% PI 0.82-1.01; I2 = 0%), perineal trauma, spontaneous vaginal birth, intact perineum, caesarean section, abnormal fetal heart rate patterns, neonatal infection, or episiotomy. Instrumental vaginal birth was reduced (RR 0.78, 95% PI 0.61-0.98; I2 = 0%). Satisfaction tended to be higher in the bathing group, though evidence was limited to two small heterogeneous trials. CONCLUSIONS: Evidence certainty was low to very low because of risk of bias, imprecision, lack of blinding, and limited woman-reported outcomes. Bathing appears safe for mothers and infants and may reduce instrumental delivery, but a clear analgesic-sparing effect was not shown. Implementation should ensure tub hygiene, water temperature regulation, and regular maternal and fetal monitoring. TRIAL REGISTRATION: Register name: Effect of Bathing for Pain Relief During the First Stage of Labor: A protocol for a systematic review and meta-analysis. Registration DOI: https://doi.org/10.17605/OSF.IO/J9GTS.
Frontiers of health services managementWendy Clarke Wilcox
New York City's (NYC) maternal health crisis drew close attention in the late 2010s, driven by alarming data: Approximately 30 women died annually during childbirth in NYC, Black non-Hispanic women were 12 times more likely to die than white women, and more than 3,000 women experienced life-threatening birth complications each year. In response, NYC committed $12.8 million in July 2018 to reduce maternal mortality and eliminate racial disparities.NYC Health + Hospitals (H+H)-the nation's largest public health system, serving 1.1 million patients annually with roughly 15,000 births per year-became the primary vehicle for this initiative. With 80 percent of the system's deliveries covered by Medicaid and a patient population that is 51.2 percent Hispanic and 27.1 percent Black, H+H is uniquely positioned to lead the fight against maternal health inequity.Three flagship programs anchor H+H's response to the city's maternal mortality rate. The OB Simulation Program, launched in 2012 and expanded in 2018, was the first in the nation to use mannequins of color to train thousands of providers in obstetric emergencies. The Maternal Home Program, piloted at H+H's Kings County Hospital in 2019 and scaled system-wide by 2021, has served more than 10,341 patients, generating more than 33,000 referrals for social, behavioral health, and community resources. The Cardio-Obstetrics Program located at Kings County Hospital targets cardiovascular disease-the leading cause of maternal death among Black women-through screening, education, and community outreach. These programs are a health equity imperative, made more urgent by impending federal Medicaid cuts resulting from the H.R.1 One Big Beautiful Bill Act (passed on July 4, 2025).
Applied psychology. Health and well-beingTharunnia M S Ganesan, Zuhrah Beevi, Alan J Gow, Guek Nee Ke
Positive psychology interventions (PPI) have been applied and demonstrated evidence in various population groups. The present systematic review focused on the types and influence of PPI on the physical and psychological health of pregnant women. Studies that matched the selection criteria were identified on EBSCOhost, PsychINFO, Web of Science, PubMed, Scopus and four positive psychology journals. From the 2528 records identified, finally eight studies were included in the review. PPI in this review were delivered utilising various positive psychology components such as hope, gratitude and optimism based on existing theories, for example, the strengths theory, broaden-and-build theory, and hope theory. Most interventions were conducted from 14 gestational weeks onwards and were delivered via virtual platforms or mobile applications. As a result of this systematic review, it was identified that PPIs for maternal well-being were aimed at improving (1) physical health, including labour pain, nausea and vomiting; (2) psychological health, including stress, emotions, anxiety and depression; and (3) subjective health, including life satisfaction, perceived social support and quality of life. Most of the selected studies provided significant evidence towards improvement of well-being outcomes from administering PPI. For future studies, in-depth PPI integrated coping and support approaches should be further evidenced among diverse pregnant populations.
To assess the variability in the population attributable fraction (PAF) of GDM to overweight/obesity and the relationship of BMI and GDM across three diagnostic criteria: IADPSG, NICE and Diabetes in Pregnancy Study Group India (DIPSI). The PAF of GDM to overweight/obesity and the relationship of GDM and BMI were estimated using Poisson regression models in a retrospective cohort of 4317 women who underwent GDM screening during the 2013-2017 period. Multiple linear regression models were applied to associate BMI with fasting, 1-h and 2-h plasma glucose values. The PAF of GDM to overweight/obesity for IADPSG, NICE and DIPSI criteria was 34.84%, 28.17% and 18.44%, respectively. There was a quadratic relationship between BMI and GDM for all criteria, and the peak BMI values for IADPSG, NICE and DIPSI criteria were 34.26, 33.28 and 32.01 kg/m2, respectively. The relationship between BMI and PG values was also quadratic, with peaks in FPG, 1-h and 2-h PG at BMI values of 40.91, 35.50 and 33.04 kg/m2, respectively. PAF of GDM to overweight/obesity among South Asian women varies by the GDM diagnostic criteria. The quadratic relationship between BMI and GDM probability and between BMI and plasma glucose values is a novel observation.
The Australian & New Zealand journal of obstetrics & gynaecologyGeorgia S Clarke, Kai Liu, Eskedar Getie Mekonnen, Jessica A Grieger
BACKGROUND: Adequate nutrition during pregnancy is well established; however, how pregnancy affects energy metabolism, particularly the relationship between energy intake, expenditure and maternal mass, remains poorly understood. Current dietary recommendations advise increasing energy intake across pregnancy, but these are based on theoretical estimates rather than contemporary empirical data. AIM: To describe changes in energy intake, total daily energy expenditure (TDEE) and body composition across pregnancy in a pilot study of pregnant people living in Australia and to assess the associations with maternal fat mass. MATERIALS AND METHODS: Pregnant people aged ≥ 18 years with singleton pregnancies were included. Assessments were conducted in each trimester (first: 8-13 weeks'; second: 23-25 weeks'; third: 34-37 weeks'). Dietary intake was measured using a 3-day weighed food diary. Total and active energy expenditure was assessed by a thigh-worn accelerometer and resting metabolic rate assessed using indirect calorimetry. RESULTS: Twenty-seven people were included. The mean (SD) total daily energy intake (8895 (2279) kJ to 8973 (1745) kJ), TDEE (10343 (2056) kJ to 11307 (1922) kJ) and active energy expenditure (3212 (1225) kJ to 3161 (1199) kJ) remained consistent over pregnancy (all p > 0.05), whereas resting metabolic rate increased (6081 (972) kJ to 7041 (1052) kJ, p = 0.002). Higher TDEE and active energy expenditure were positively associated with fat mass. CONCLUSION: Total energy intake, TDEE and activity-related energy expenditure was stable during pregnancy while resting metabolic rate increased. Larger, adequately powered studies are needed to better characterise energy balance in pregnancy and its clinical implications.
OBJECTIVE: To quantify persistence and transition dynamics of county obstetric service absence and assess whether birth volume and physician supply add predictive information beyond prior-year status. STUDY SETTING AND DESIGN: National longitudinal county-year panel study (2015-2023). Obstetric service absence was defined using a 2-year confirmation rule, with contemporaneous status used for the 2015 baseline year to reduce misclassification. We estimated annual conditional transition probabilities (entry and exit) and modeled current-year absence as a function of prior-year absence and year fixed effects, with and without contemporaneous birth volume and physician supply. DATA SOURCES AND ANALYTIC SAMPLE: All US counties (N = 3144) observed annually. Obstetric service availability was identified from Centers for Medicare & Medicaid Services Provider of Services files. Residence-based births, physician supply, and bed capacity were obtained from the Area Health Resources Files. Population denominators for women aged 15-44 were drawn from the American Community Survey. PRINCIPAL FINDINGS: Obstetric service absence was highly persistent. County prevalence was stable (34.2% in 2015 and 34.2% in 2023). Population exposure declined: the share of women aged 15-44 residing in counties without services decreased from 6.5% to 5.3%, and the share of births to residents of such counties decreased from 6.6% to 5.7%. Annual transitions were rare (entry ≤ 0.4%; exit ≤ 0.9%), and conditional stay probabilities were ≥ 0.991 for both presence and absence. In lagged-status models, prior-year absence strongly predicted current absence (0.994); adding birth volume and physician supply did not materially change the estimate (0.993). CONCLUSIONS: On policy-relevant timescales, obstetric service absence behaves as a high-inertia system state. Rare transitions and dominance of prior status suggest slow adjustment, with implications for closure prevention and targeting support near volume and workforce feasibility thresholds.
Pharmacoepidemiology and drug safetyLine Krag Ingholt, Chunsen Wu, Margit Bistrup Fisher, Casper P Hagen, Peter Damm, Christina Prinds, Lina Steinrud Mørch, Hanne Kristine Hegaard, Ane Lilleøre R…
PURPOSE: While having a chronic medical disease (CMD) increases use of analgesics and anti-inflammatory drugs, sufficient knowledge regarding patterns of use during pregnancy is lacking. We aimed to describe ibuprofen use before and in early pregnancy among women with and without CMD, and to assess the associations between CMD and ibuprofen use before and in early pregnancy. METHODS: We used self-reported data from 24 018 pregnancies from the Copenhagen Pregnancy Cohort (2013-2019) to compare ibuprofen use between women with and without CMD. Descriptive statistics and multivariable logistic regression models were applied. RESULTS: Women with CMD reported higher ibuprofen use before and in early pregnancy. However, use was markedly reduced from before to early pregnancy in both groups: from 19.8% to 0.61% among women with CMD (p < 0.001), and from 16.9% to 0.27% among women without. Before pregnancy, women with CMD more often reported frequent (daily or 1-2 times per week) ibuprofen use compared with women without (aOR 2.40, 95% CI 1.96-2.94), and in early pregnancy more often any use (aOR 2.08, 95% CI 1.31-3.32). Especially endometrioses, rheumatological, and neurological diseases were associated with frequent use before pregnancy (aOR 4.85, 95% CI 2.14-10.99; aOR 4.57, 95% CI 2.92-7.16; and aOR 3.55, 95% CI 2.09-6.04, respectively). Similar analyses of specific diseases in early pregnancy were precluded due to low numbers. CONCLUSIONS: Use of ibuprofen was markedly reduced in early pregnancy, among both women with and without CMD. Having CMD was associated with increased ibuprofen use before and in early pregnancy.