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Search Results (470)

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Keywords = antenatal care

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8 pages, 275 KiB  
Article
Sex Differences in Wheezing During the First Three Years of Life After Delivery via Caesarean Section
by Evangelia Papathoma, Theodore Dassios, Maria Triga, Sotirios Fouzas and Gabriel Dimitriou
Children 2025, 12(8), 1071; https://doi.org/10.3390/children12081071 - 14 Aug 2025
Viewed by 240
Abstract
Background: Emerging evidence suggests that delivery by caesarean section predisposes to wheezing in early childhood, but the effect may differ between boys and girls. Such sex-specific differences remain insufficiently explored to date, particularly considering the wide range of perinatal and antenatal confounding factors. [...] Read more.
Background: Emerging evidence suggests that delivery by caesarean section predisposes to wheezing in early childhood, but the effect may differ between boys and girls. Such sex-specific differences remain insufficiently explored to date, particularly considering the wide range of perinatal and antenatal confounding factors. In this study, we aimed to investigate sex-specific differences in the association between delivery by caesarean section and preschool wheezing. Methods: This is a secondary analysis of a population of 470 children (53% boys), born and cared for between August 2009 and March 2011 at the maternity services of the University Hospital of Patras, Greece. Participants were followed up regularly until the age of 36 months. Wheezing was defined as at least one episode of doctor-diagnosed wheezing per year during the surveillance period of three years. Multivariable regression models were used to explore possible associations and adjust for confounders. Results: The rate of caesarean section was 51% (N = 240). Wheezing was reported in 144 (31%) of the children. Following delivery by caesarean section, 52 of 137 (38%) of the boys and 33 of 103 (32%) of the girls developed wheezing. In the whole cohort, development of wheezing was significantly associated with male sex [odds ratio: 1.83 (95% CI: 1.22–2.75), adjusted p = 0.004], but not with caesarean section or gestational age. In girls, the development of wheezing was significantly associated with caesarean section [odds ratio: 2.48 (95% CI: 1.28–4.83), adjusted p = 0.007]. In boys, the development of wheezing was not significantly associated with delivery by caesarean section. Conclusions: Girls born by caesarean section developed wheezing more frequently than their vaginally born counterparts during the first three years of life. Although male sex proved an overall predisposing factor to preschool wheezing, boys born by caesarean section were not diagnosed with wheezing more frequently than those delivered vaginally. Full article
(This article belongs to the Section Pediatric Neonatology)
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11 pages, 849 KiB  
Article
Prevalence of Preterm Birth in a Marginalized Roma Population—Quantitative Analysis in One of the Most Disadvantaged Regions of Hungary
by Kinga Pauwlik and Anita R. Fedor
Int. J. Environ. Res. Public Health 2025, 22(8), 1270; https://doi.org/10.3390/ijerph22081270 - 14 Aug 2025
Viewed by 344
Abstract
Preterm birth is a leading cause of perinatal morbidity and mortality and is particularly prevalent among socially disadvantaged female populations. This quantitative, cross-sectional study aimed to explore the prevalence of preterm birth in three segregated Roma communities in Hungary and to identify health [...] Read more.
Preterm birth is a leading cause of perinatal morbidity and mortality and is particularly prevalent among socially disadvantaged female populations. This quantitative, cross-sectional study aimed to explore the prevalence of preterm birth in three segregated Roma communities in Hungary and to identify health behavior and care factors associated with its occurrence. In our study, preterm birth was defined as delivery before 37 completed weeks of gestation (i.e., <259 days). Data were collected from 231 Roma women living in three municipalities of Szabolcs-Szatmár-Bereg County, one of Hungary’s most disadvantaged regions, using a structured interview questionnaire. The participants were women aged 18–65 years. Of these, 209 had been pregnant at least once in their lifetime. The questionnaire covered socio-demographic characteristics (age, level of education, employment status, housing conditions, marital status), health behaviors (smoking, alcohol consumption, drug use, vitamin supplementation, other substance use), antenatal care attendance, and birth outcomes (preterm birth, gestational age, low birth weight, newborn status). Statistical analyses included descriptive statistics, chi-square tests, and binary logistic regression with significance set at p < 0.05. Preterm birth was significantly more common among women who smoked, consumed alcohol or drugs during pregnancy, or had vaginal infections. Drug use showed the strongest association with a 22-fold increase in risk, followed by alcohol (nearly fivefold), smoking (over threefold), and infections (threefold). Although non-attendance at antenatal care was associated with increased risk, this relationship was not statistically significant. In the multivariate logistic regression model, alcohol consumption (OR = 1.744, p < 0.01), smoking (OR = 2.495, p < 0.01), drug use (OR = 25.500, p < 0.001), and vaginal infections (OR = 4.014, p < 0.01) during pregnancy were independently associated with an increased risk of preterm birth, whereas folic acid supplementation (OR = 0.448, p < 0.05) showed a significant protective effect. These findings highlight that preterm birth is intricately linked to socioeconomic disadvantage and adverse health behaviors. Culture-specific, community-based prevention strategies are essential to reduce perinatal risks in marginalized populations. Full article
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16 pages, 773 KiB  
Article
Barriers to Timely Referral of Children Born with Myelomeningocele in Zambia
by Rya Muller, Kabelele Sipalo, Caitlyn Beals, Angela Chazura, Stephanie Chola, Roxanna Garcia, Brooks Jackson, Joseph Feinglass, Kirill V. Nourski, Marie-Renee Mala Wa Mpoyi, Humphrey Kunda and Rebecca Reynolds
J. Clin. Med. 2025, 14(16), 5721; https://doi.org/10.3390/jcm14165721 - 13 Aug 2025
Viewed by 506
Abstract
Background: Congenital anomalies impact 52 million infants worldwide with an estimated 94% living in low- and middle-income countries (LMICs). Approximately 200,000 children are born with a neural tube defect (NTD) in LMICs annually. Zambia is an LMIC with a high burden of [...] Read more.
Background: Congenital anomalies impact 52 million infants worldwide with an estimated 94% living in low- and middle-income countries (LMICs). Approximately 200,000 children are born with a neural tube defect (NTD) in LMICs annually. Zambia is an LMIC with a high burden of myelomeningocele (MMC; a severe form of NTD). This study sought to characterize the barriers influencing access to healthcare for children born with MMC in Zambia. Methods: Two cross-sectional surveys were administered to healthcare providers at referring public health facilities and mothers of infants born with MMC undergoing surgical closure. The survey among mothers was nested in a longitudinal study evaluating surgical closure in Lusaka, Zambia from 28 May 2024 to 21 January 2025. Results: Sixty-nine mother–MMC baby dyads and 123 providers from 21 facilities were enrolled in the study. The median age at presentation for MMC was 7.5 (range 0–244) days old. Most patients were referred from rural district hospitals (51%; n = 35) and travelled greater than 250 km to access care (80%; n = 55). Seventy-seven percent (n = 53) of mothers reported receiving at least one antenatal ultrasound, with 62% (n = 43) undergoing an ultrasound after 20 weeks estimated gestational age. Of these, only 3% (n = 2) received an MMC diagnosis prior to delivery. Referring patients with MMC for further care greater than six hours after birth was reported by 59% providers (n = 73). Hospitals further away from the tertiary center were more likely to report late referrals (p < 0.001). Conclusions: There is a delay in the diagnosis and referral of infants with MMC to specialized care in Zambia, which may be attributed to inadequate in utero diagnosis capabilities and distance from the tertiary facility. Improving the accuracy of prenatal diagnosis and strengthening referral pathways to facilitate access to care among infants with MMC in Zambia are important for improving incidence and outcomes. Full article
(This article belongs to the Special Issue Neurosurgery: Current Challenges and New Perspectives)
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18 pages, 531 KiB  
Article
Exploring Empowerment in Group Antenatal Care: Insights from an Insider and Outsider Perspective
by Florence Talrich, Astrid Van Damme, Marlies Rijnders, Hilde Bastiaens and Katrien Beeckman
Healthcare 2025, 13(15), 1930; https://doi.org/10.3390/healthcare13151930 - 7 Aug 2025
Viewed by 274
Abstract
Background: Empowerment during pregnancy is linked to improved maternal and infant health outcomes and greater maternal well-being. Group Antenatal Care (GANC), a participant-centered model of care, promotes empowerment, active engagement, and the deconstruction of hierarchy between participants and care providers. It combines health [...] Read more.
Background: Empowerment during pregnancy is linked to improved maternal and infant health outcomes and greater maternal well-being. Group Antenatal Care (GANC), a participant-centered model of care, promotes empowerment, active engagement, and the deconstruction of hierarchy between participants and care providers. It combines health assessment, interactive learning, and community building. While empowerment is a core concept of GANC, the ways it manifests and the elements that facilitate it remain unclear. Method: We conducted a generic qualitative study across four organizations in Brussels, using multiple data collection methods. This included interviews with 13 participants and 21 observations of GANC sessions, combining both the insider and outsider perspective. An adapted version of the Pregnancy-Related Empowerment Scale (PRES) guided the interviews guide and thematic analysis. Results: We identified seven themes that capture how empowerment occurs in GANC: peer connectedness, provider connectedness, skillful decision-making, responsibility, sense of control, taking action, and gaining voice. Several aspects of GANC contribute to empowerment, particularly the role of facilitators. Conclusions: This study highlights how GANC enhances empowerment during pregnancy through interpersonal, internal, and external processes. Important components within GANC that support this process include the group-based format and the interactive nature of the discussions. The presence of skillful GANC facilitators is an essential prerequisite. In a diverse and often vulnerable context like Brussels, strengthening empowerment through GANC presents challenges but is especially crucial. Full article
(This article belongs to the Special Issue Midwifery-Led Care and Practice: Promoting Maternal and Child Health)
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5 pages, 144 KiB  
Case Report
Multidisciplinary Care Approach to Asymptomatic Brugada Syndrome in Pregnancy: A Case Report
by Isabella Marechal-Ross and Kathryn Austin
Reports 2025, 8(3), 138; https://doi.org/10.3390/reports8030138 - 5 Aug 2025
Viewed by 260
Abstract
Background and Clinical Significance: Brugada syndrome (BrS) is a rare inherited cardiac channelopathy, often associated with SCN5A loss-of-function mutations. Clinical presentations range from asymptomatic to malignant arrhythmias and sudden cardiac death. Physiological and pharmacological stressors affecting sodium channel function—such as pyrexia, certain medications, [...] Read more.
Background and Clinical Significance: Brugada syndrome (BrS) is a rare inherited cardiac channelopathy, often associated with SCN5A loss-of-function mutations. Clinical presentations range from asymptomatic to malignant arrhythmias and sudden cardiac death. Physiological and pharmacological stressors affecting sodium channel function—such as pyrexia, certain medications, and possibly pregnancy—may unmask or exacerbate arrhythmic risk. However, there is limited information regarding pregnancy and obstetric outcomes. Obstetric management remains largely informed by isolated case reports and small case series. A literature review was conducted using OVID Medline and Embase, identifying case reports, case series, and one retrospective cohort study reporting clinical presentation, obstetric management, and outcomes in maternal BrS. A case is presented detailing coordinated multidisciplinary input, antenatal surveillance, and intrapartum and postpartum care to contribute to the growing evidence base guiding obstetric care in this complex setting. Case Presentation: A 30-year-old G2P0 woman with asymptomatic BrS (SCN5A-positive) was referred at 31 + 5 weeks’ gestation for multidisciplinary antenatal care. Regular review and collaborative planning involving cardiology, anaesthetics, maternal–fetal medicine, and obstetrics guided a plan for vaginal delivery with continuous cardiac and fetal monitoring. At 38 + 0 weeks, the woman presented with spontaneous rupture of membranes and underwent induction of labour. A normal vaginal delivery was achieved without arrhythmic events. Epidural block with ropivacaine and local anaesthesia with lignocaine were well tolerated, and 24 h postpartum monitoring revealed no abnormalities. Conclusions: This case adds to the limited but growing literature suggesting that with individualised planning and multidisciplinary care, pregnancies in women with BrS can proceed safely and without complication. Ongoing case reporting is essential to inform future guidelines and optimise maternal and fetal outcomes. Full article
(This article belongs to the Section Obstetrics/Gynaecology)
24 pages, 6020 KiB  
Article
Seasonal Patterns of Preterm Birth During the COVID-19 Pandemic: A Retrospective Cohort Study in Romania
by Paula Trif, Cristian Sava, Diana Mudura, Boris W. Kramer, Radu Galiș, Maria Livia Ognean, Alin Iuhas and Claudia Maria Jurca
Medicina 2025, 61(8), 1398; https://doi.org/10.3390/medicina61081398 - 1 Aug 2025
Viewed by 339
Abstract
Background and Objectives: Preterm birth and stillbirth are primary adverse pregnancy outcomes. Research during the COVID-19 pandemic revealed reductions in preterm birth in some countries, while stillbirth rates increased or remained unchanged. These findings suggest the presence of preventable risk factors associated with [...] Read more.
Background and Objectives: Preterm birth and stillbirth are primary adverse pregnancy outcomes. Research during the COVID-19 pandemic revealed reductions in preterm birth in some countries, while stillbirth rates increased or remained unchanged. These findings suggest the presence of preventable risk factors associated with changes in physical activity and lower exposure to community-acquired infections due to lockdown measures, altered social interaction patterns or reduced access to antenatal care. Assessing seasonal variation may offer insights into whether lifestyle changes during the COVID-19 lockdown period influenced preterm birth rates. Materials and Methods: This retrospective cohort study used data from the electronic medical records of Bihor and Sibiu counties. Preterm deliveries (<37 weeks) and stillbirths during the COVID-19 pandemic (2020 and 2021) were compared with the corresponding pre-pandemic (2018 and 2019) and post-pandemic (2022 and 2023) period. Preterm birth rates during summer and winter in the pre-pandemic, pandemic, and post-pandemic years were analyzed. A comparison with rates during strict lockdown was made. Results: Out of 52,021 newborn infants, 4473 were born preterm. Preterm birth rates remained stable across all three periods (p = 0.13), and no significant seasonal pattern was identified (p = 0.65). In contrast, stillbirth rates increased notably during the strict lockdown period, with the median incidence almost doubling compared to other periods (0.87%, p = 0.05), while remaining unchanged during the rest of the pandemic (p = 0.52). Conclusions: Our study found that preterm birth rates remained unaffected by the pandemic and lockdown periods, while stillbirths increased significantly during the strict lockdown. These findings highlight the importance of maintaining access to timely antenatal care during public health emergencies to prevent adverse perinatal outcomes. Full article
(This article belongs to the Special Issue Advances in Obstetrics and Maternal-Fetal Medicine)
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15 pages, 1837 KiB  
Article
Cost-Effectiveness of Youth-Friendly Health Services in Health Post Settings in Jimma Zone, Ethiopia
by Geteneh Moges Assefa, Muluken Dessalegn Muluneh, Sintayehu Abebe, Genetu Addisu and Wendemagegn Yeshanehe
Int. J. Environ. Res. Public Health 2025, 22(8), 1179; https://doi.org/10.3390/ijerph22081179 - 25 Jul 2025
Viewed by 323
Abstract
Background: Adolescents in Ethiopia, particularly in rural areas, face significant barriers to accessing comprehensive sexual and reproductive health (SRH) services, resulting in poor health outcomes. The youth-friendly health services (YFHS) initiative addresses these challenges by training Health Extension Workers (HEWs) to deliver tailored, [...] Read more.
Background: Adolescents in Ethiopia, particularly in rural areas, face significant barriers to accessing comprehensive sexual and reproductive health (SRH) services, resulting in poor health outcomes. The youth-friendly health services (YFHS) initiative addresses these challenges by training Health Extension Workers (HEWs) to deliver tailored, age-appropriate care at the primary care level. This study evaluates the cost-effectiveness of YFHS implementation in rural health posts in the Jimma Zone, Ethiopia. Methods: Using an ingredient-based costing approach, costs were analyzed across six health posts, three implementing YFHS and three offering routine services. Health outcomes were modeled using disability-adjusted life years (DALYs) averted, and incremental cost-effectiveness ratios (ICERs) were calculated. Results: Results showed that YFHS reached 9854 adolescents annually at a cost of USD 29,680, compared to 2012.5 adolescents and USD 7519 in control sites. The study showed the ICER of USD 25.50 per DALY averted. The intervention improved health outcomes, including a 27% increase in antenatal care uptake, a 34% rise in contraceptive use, and a 0.065% reduction in abortion-related mortality, averting 52.11 DALYs versus 26.42 in controls. Conclusions: The ICER was USD 25.50 per DALY averted, well below Ethiopia’s GDP per capita, making it highly cost-effective by WHO standards. Scaling YFHS through HEWs offers a transformative, cost-effective strategy to advance adolescent SRH equity and achieve universal health coverage in Ethiopia. Full article
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13 pages, 2016 KiB  
Article
Pelvic Floor Adaptation to a Prenatal Exercise Program: Does It Affect Labor Outcomes or Levator Ani Muscle Injury? A Randomized Controlled Trial
by Aránzazu Martín-Arias, Irene Fernández-Buhigas, Daniel Martínez-Campo, Adriana Aquise Pino, Valeria Rolle, Miguel Sánchez-Polan, Cristina Silva-Jose, Maria M. Gil and Belén Santacruz
Diagnostics 2025, 15(15), 1853; https://doi.org/10.3390/diagnostics15151853 - 23 Jul 2025
Viewed by 639
Abstract
Background: Physical exercise during pregnancy is strongly recommended due to its well-established benefits for both mother and child. However, its impact on the pelvic floor remains insufficiently studied. This study aimed to evaluate pelvic floor adaptations to a structured prenatal exercise program using [...] Read more.
Background: Physical exercise during pregnancy is strongly recommended due to its well-established benefits for both mother and child. However, its impact on the pelvic floor remains insufficiently studied. This study aimed to evaluate pelvic floor adaptations to a structured prenatal exercise program using transperineal ultrasound, and to assess associations with the duration of the second stage of labor and mode of delivery. Methods: This is a planned secondary analysis of a randomized controlled clinical trial (RCT) (NCT04563065) including women with singleton pregnancies at 12–14 weeks of gestation. Participants were randomized to either an exercise group, which followed a supervised physical exercise program three times per week, or a control group, which received standard antenatal care. Transperineal ultrasound was used at the second trimester of pregnancy and six months postpartum to measure urogenital hiatus dimensions at rest, during maximal pelvic floor contraction, and during the Valsalva maneuver, to calculate hiatal contractility and distensibility and to evaluate levator ani muscle insertion. Regression analyses were performed to assess the relationship between urogenital hiatus measurements and both duration of the second stage of labor and mode of delivery. Results: A total of 78 participants were included in the final analysis: 41 in the control group and 37 in the exercise group. The anteroposterior diameter of the urogenital hiatus at rest was significantly smaller in the exercise group compared to controls (4.60 mm [SD 0.62] vs. 4.91 mm [SD 0.76]; p = 0.049). No other statistically significant differences were observed in static measurements. However, contractility was significantly reduced in the exercise group for both the latero-lateral diameter (8.54% vs. 4.04%; p = 0.012) and hiatus area (20.15% vs. 12.55%; p = 0.020). Distensibility was similar between groups. There were no significant differences in the duration of the second stage of labor or mode of delivery. Six months after delivery, there was an absolute risk reduction of 32.5% of levator ani muscle avulsion in the exercise group compared to the control group (53.3% and 20.8%, respectively; p = 0.009). Conclusions: A supervised exercise program during pregnancy appears to modify pelvic floor morphology and function, reducing the incidence of levator ani muscle avulsion without affecting the type or duration of delivery. These findings support the safety and potential protective role of prenatal exercise in maintaining pelvic floor integrity. Full article
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16 pages, 1162 KiB  
Review
Ultrasound for the Early Detection and Diagnosis of Necrotizing Enterocolitis: A Scoping Review of Emerging Evidence
by Indrani Bhattacharjee, Michael Todd Dolinger, Rachana Singh and Yogen Singh
Diagnostics 2025, 15(15), 1852; https://doi.org/10.3390/diagnostics15151852 - 23 Jul 2025
Viewed by 515
Abstract
Background: Necrotizing enterocolitis (NEC) is a severe gastrointestinal disease and a major cause of morbidity and mortality among preterm infants. Traditional diagnostic methods such as abdominal radiography have limited sensitivity in early disease stages, prompting interest in bowel ultrasound (BUS) as a complementary [...] Read more.
Background: Necrotizing enterocolitis (NEC) is a severe gastrointestinal disease and a major cause of morbidity and mortality among preterm infants. Traditional diagnostic methods such as abdominal radiography have limited sensitivity in early disease stages, prompting interest in bowel ultrasound (BUS) as a complementary imaging modality. Objective: This scoping review aims to synthesize existing literature on the role of ultra sound in the early detection, diagnosis, and management of NEC, with emphasis on its diagnostic performance, integration into clinical care, and technological innovations. Methods: Following PRISMA-ScR guidelines, a systematic search was conducted across PubMed, Embase, Cochrane Library, and Google Scholar for studies published between January 2000 and December 2025. Inclusion criteria encompassed original research, reviews, and clinical studies evaluating the use of bowel, intestinal, or Doppler ultrasound in neonates with suspected or confirmed NEC. Data were extracted, categorized by study design, population characteristics, ultrasound features, and diagnostic outcomes, and qualitatively synthesized. Results: A total of 101 studies were included. BUS demonstrated superior sensitivity over radiography in detecting early features of NEC, including bowel wall thickening, portal venous gas, and altered peristalsis. Doppler ultrasound, both antenatal and postnatal, was effective in identifying perfusion deficits predictive of NEC onset. Neonatologist-performed ultrasound (NEOBUS) showed high interobserver agreement when standardized protocols were used. Emerging tools such as ultra-high-frequency ultrasound (UHFUS) and artificial intelligence (AI)-enhanced analysis hold potential to improve diagnostic precision. Point-of-care ultrasound (POCUS) appears feasible in resource-limited settings, though implementation barriers remain. Conclusions: Bowel ultrasound is a valuable adjunct to conventional imaging in NEC diagnosis. Standardized protocols, validation of advanced technologies, and out come-based studies are essential to guide its broader clinical adoption. Full article
(This article belongs to the Special Issue Diagnosis and Management in Digestive Surgery: 2nd Edition)
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17 pages, 360 KiB  
Article
High Antenatal Psychosocial Risk Among Pregnant Women in Bulgaria: Evidence to Support Routine Mental-Health Screening
by Elitsa Gyokova, Eleonora Hristova-Atanasova and Georgi Iskrov
J. Clin. Med. 2025, 14(14), 5158; https://doi.org/10.3390/jcm14145158 - 21 Jul 2025
Viewed by 423
Abstract
Background: Antenatal depression and anxiety contribute significantly to maternal morbidity and adverse pregnancy outcomes. However, structured screening and targeted interventions are largely absent from standard prenatal care in many Eastern European countries, including Bulgaria. This study examines the prevalence and psychosocial predictors of [...] Read more.
Background: Antenatal depression and anxiety contribute significantly to maternal morbidity and adverse pregnancy outcomes. However, structured screening and targeted interventions are largely absent from standard prenatal care in many Eastern European countries, including Bulgaria. This study examines the prevalence and psychosocial predictors of antenatal psychosocial risk using the validated Antenatal Risk Questionnaire–Revised (ANRQ-R) in a nationally underrepresented population. Methods: A cross-sectional survey was conducted among 216 third-trimester pregnant women in Bulgaria. Data on sociodemographic characteristics, health behaviours, and reproductive history were collected. Multivariate logistic regression identified predictors of elevated psychosocial risk. Results: A total of 65.7% of participants met the criteria for elevated psychosocial risk. Significant risk factors included passive smoking exposure during pregnancy (OR = 5.03, p < 0.001), physical activity prior to pregnancy (OR = 1.81, p = 0.004), and a family history of hereditary disease (OR = 42.67, p < 0.001). Protective factors were better self-rated current health (OR = 0.37, p = 0.004), the presence of chronic illness (OR = 0.42, p = 0.049), previous childbirth experience (OR = 0.11, p = 0.032), and residence in Northwestern Bulgaria (OR = 0.31, p = 0.028). Despite the high prevalence of psychosocial vulnerability, only 9.5% of affected women sought professional help. Conclusions: While our findings point to important unmet needs in antenatal mental health, further research is required before national screening policies can be implemented. Pilot programs, cultural validation of tools, and system-level readiness assessments should precede broad adoption. Full article
(This article belongs to the Section Mental Health)
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22 pages, 2612 KiB  
Review
Pulmonary Hemorrhage in Premature Infants: Pathophysiology, Risk Factors and Clinical Management
by Sariya Sahussarungsi, Anie Lapointe, Andréanne Villeneuve, Audrey Hebert, Nina Nouraeyan, Satyan Lakshminrusimha, Yogen Singh, Christine Sabapathy, Tiscar Cavallé-Garrido, Guilherme Sant’Anna and Gabriel Altit
Biomedicines 2025, 13(7), 1744; https://doi.org/10.3390/biomedicines13071744 - 16 Jul 2025
Cited by 1 | Viewed by 2717
Abstract
Pulmonary hemorrhage (PH) is a life-threatening complication predominantly affecting preterm infants, particularly those with very low birth weight (VLBW) and fetal growth restriction (FGR). Typically occurring within the first 72 h of life, PH is characterized by acute respiratory deterioration and significant morbidity [...] Read more.
Pulmonary hemorrhage (PH) is a life-threatening complication predominantly affecting preterm infants, particularly those with very low birth weight (VLBW) and fetal growth restriction (FGR). Typically occurring within the first 72 h of life, PH is characterized by acute respiratory deterioration and significant morbidity and mortality. This review synthesizes current evidence on the multifactorial pathogenesis of PH, highlighting the roles of immature pulmonary vasculature, surfactant-induced hemodynamic shifts, and left ventricular diastolic dysfunction. Key risk factors include respiratory distress syndrome (RDS), hemodynamically significant patent ductus arteriosus (hsPDA), sepsis, coagulopathies, and genetic predispositions. Diagnostic approaches incorporate clinical signs, chest imaging, lung ultrasound, and echocardiography. Management strategies are multifaceted and include ventilatory support—particularly high-frequency oscillatory ventilation (HFOV)—surfactant re-administration, blood product transfusion, and targeted hemostatic agents. Emerging therapies such as recombinant activated factor VII and antifibrinolytics show promise but require further investigation. Preventive measures like antenatal corticosteroids and early indomethacin prophylaxis may reduce incidence, particularly in high-risk populations. Despite advancements in neonatal care, PH remains a major contributor to neonatal mortality and long-term neurodevelopmental impairment. Future research should focus on individualized risk stratification, early diagnostic tools, and optimized treatment protocols to improve outcomes. Multidisciplinary collaboration and innovation are essential to advancing care for this vulnerable population. Full article
(This article belongs to the Special Issue Progress in Neonatal Pulmonary Biology)
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12 pages, 356 KiB  
Review
Antenatal Corticosteroids in Early and Late Fetal Growth Restriction
by Valentina Tosto, Carolina Scala, Nicola Fratelli, Anna Fichera, Alessandra Familiari, Ambrogio Pietro Londero, Luca Antonio Ramenghi and Federico Prefumo
J. Clin. Med. 2025, 14(14), 4876; https://doi.org/10.3390/jcm14144876 - 9 Jul 2025
Viewed by 1141
Abstract
Antenatal corticosteroids are widely used to prevent newborn morbidity and mortality in special obstetric circumstances, especially in preterm birth, but there are ongoing concerns about possible neutral or even detrimental short- and long-term effects in pregnancies complicated by fetal growth restriction. Fetuses with [...] Read more.
Antenatal corticosteroids are widely used to prevent newborn morbidity and mortality in special obstetric circumstances, especially in preterm birth, but there are ongoing concerns about possible neutral or even detrimental short- and long-term effects in pregnancies complicated by fetal growth restriction. Fetuses with growth restriction may be a subset of preterm infants with a particular vulnerability to steroid exposure. The current scientific evidence on exogenous antenatal corticosteroid effects in this population is not conclusive. Gestational age (early versus late) is a critical issue to assess regarding their use as standard care in this special obstetric circumstance. Full article
(This article belongs to the Special Issue New Advances in Prenatal Diagnosis and Newborn Screening)
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33 pages, 17821 KiB  
Systematic Review
Pregestational Diabetes Mellitus and Adverse Perinatal Outcomes: A Systematic Review and Meta-Analysis
by Dionysios Gazis, Antigoni Tranidou, Antonios Siargkas, Aikaterini Apostolopoulou, Georgia Koutsouki, Dimitrios G. Goulis, Christos Tsakalidis, Ioannis Tsakiridis and Themistoklis Dagklis
J. Clin. Med. 2025, 14(13), 4789; https://doi.org/10.3390/jcm14134789 - 7 Jul 2025
Viewed by 621
Abstract
Background/Objectives: As the incidence of diabetes mellitus (DM) is increasing rapidly worldwide, it is anticipated that an increasing number of women will enter pregnancy with pregestational diabetes mellitus (PGDM) in the future. Compelling evidence suggests that hyperglycemia in pregnancy is related to multiple [...] Read more.
Background/Objectives: As the incidence of diabetes mellitus (DM) is increasing rapidly worldwide, it is anticipated that an increasing number of women will enter pregnancy with pregestational diabetes mellitus (PGDM) in the future. Compelling evidence suggests that hyperglycemia in pregnancy is related to multiple adverse perinatal outcomes. This systematic review and meta-analysis aims to assess and quantify the association of PGDM with a range of adverse perinatal outcomes, providing a comprehensive understanding of its impact on pregnancy. Methods: The data sources of this systematic review and meta-analysis were Medline/PubMed, Scopus and Cochrane Library (January 1999 to August 2023), complemented by hand-searching for additional references. Observational studies reporting perinatal outcomes of pregnancies with PGDM diagnosed before pregnancy versus control pregnancies were eligible for inclusion. A systematic review and meta-analysis were conducted as per the PRISMA guidelines. Pooled estimate odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to determine the risk of adverse pregnancy outcomes between PGDM and control pregnancies. Results: The systematic search of the literature yielded 81 observational studies meeting inclusion criteria and in total, 137,237,640 pregnancies were included in the analysis. A total of 19 adverse perinatal outcomes were assessed, revealing a significant association with PGDM. In pregnancies with PGDM there was an increased risk of adverse perinatal outcomes, including gestational hypertension (OR 3.16, 95% CI 2.65–3.77), preeclampsia (OR 4.46, 95% CI 3.94–5.05), preterm delivery (OR 3.46, 95% CI 3.06–3.91), cesarean delivery (OR 3.12, 95% CI 2.81–3.47), induction of labor (OR 2.92, 95% CI 2.35–3.63), macrosomia (OR 2.23, 95% CI 1.76–2.83), LGA neonates (OR 3.95, 95% CI 3.47–4.49), low 5-min Apgar score (OR 2.49, 95% CI 2.07–2.99), shoulder dystocia (OR 3.05, 95% CI 2.07–4.50), birth trauma (OR 1.40, 95% CI 1.22–1.62), polyhydramnios (OR 5.06, 95% CI 4.33–5.91), oligohydramnios (OR 1.61, 95% CI 1.19–2.17), neonatal hyperbilirubinemia (OR 3.45, 95% CI 2.51–4.74), neonatal hypoglycemia (OR 19.19, 95% CI 2.78–132.61), neonatal intensive care unit (NICU) admission (OR 4.54, 95% CI 3.87–5.34), congenital malformations (OR 2.44, 95% CI 1.96–3.04), stillbirth (OR 2.87, 95% CI 2.27–3.63) and perinatal mortality (OR 2.94, 95% CI 2.18–3.98). Subgroup analyses indicated a higher risk of neonatal hypoglycemia, stillbirth and perinatal mortality in T1DM pregnancies compared with T2DM pregnancies. Conclusions: This study provides a robust synthesis of evidence underlying the strong association between PGDM and several adverse perinatal outcomes. Early detection, optimal glycemic control during the periconceptional and pregnancy periods, and proper antenatal care are critical to mitigate these risks. Full article
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14 pages, 389 KiB  
Review
Relationship Between Vitamin D Deficiency and Postpartum Depression
by Ioanna Apostolidou, Marios Baloukas and Ioannis Tsamesidis
J. Pers. Med. 2025, 15(7), 290; https://doi.org/10.3390/jpm15070290 - 4 Jul 2025
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Abstract
Background/Objectives: Postpartum depression (PPD) affects approximately 10–20% of women during and after pregnancy, posing significant risks to maternal health, infant development, and family dynamics. Identifying modifiable risk factors is essential for prevention. Emerging evidence suggests that vitamin D, a neuroactive steroid hormone involved [...] Read more.
Background/Objectives: Postpartum depression (PPD) affects approximately 10–20% of women during and after pregnancy, posing significant risks to maternal health, infant development, and family dynamics. Identifying modifiable risk factors is essential for prevention. Emerging evidence suggests that vitamin D, a neuroactive steroid hormone involved in neurotransmitter synthesis, neuroinflammation regulation, and calcium homeostasis, may play a protective role against mood disorders, including PPD. Methods: The search was conducted through a comprehensive search of the PubMed, Scopus, and Web of Science databases using a combination of Medical Subject Headings (MeSH) and free-text terms including “vitamin D”, “25-hydroxyvitamin D”, “deficiency”, “pregnancy”, “postpartum”, “depression”, “antenatal depression”, “maternal mental health”, and “perinatal mood disorders”. Results: Numerous observational studies and systematic review reports around the world reinforce the potential global relevance of vitamin D insufficiency. This study advances personalized and precision medicine approaches by emphasizing the importance of individualized screening for vitamin D deficiency during pregnancy and postpartum, enabling tailored interventions that could mitigate the risk of postpartum depression. Conclusions: In conclusion, while a definitive causal relationship between vitamin D deficiency and perinatal depression remains unproven, screening for vitamin D levels during pregnancy could serve as a low-risk intervention to support maternal mental health. Future research should focus on well designed, large-scale randomized trials and standardization of diagnostic criteria to clarify vitamin D’s role in preventing perinatal depression. Recognizing vitamin D status as a modifiable biomarker allows for targeted nutritional and pharmacological strategies to optimize maternal mental health. Full article
(This article belongs to the Special Issue Hormone Therapies for Women)
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14 pages, 278 KiB  
Article
Predictors of Survival in Under-Five Children with Low Birth Weight: A Population-Based Study in Indonesia
by Eka Mishbahatul Marah Has, Ferry Efendi, Sylvia Dwi Wahyuni, Novianti Lailiah and Rio Arya Putra Mahendra
Nurs. Rep. 2025, 15(7), 238; https://doi.org/10.3390/nursrep15070238 - 29 Jun 2025
Viewed by 778
Abstract
Background/Objectives: The under-five mortality rate (U5MR) remains a serious health challenge in Indonesia, with low birth weight (LBW) being a key risk factor. This study aimed to identify predictors of survival among under-five children with LBW using data from the 2017 Indonesia Demographic [...] Read more.
Background/Objectives: The under-five mortality rate (U5MR) remains a serious health challenge in Indonesia, with low birth weight (LBW) being a key risk factor. This study aimed to identify predictors of survival among under-five children with LBW using data from the 2017 Indonesia Demographic and Health Survey (IDHS). Methods: This cross-sectional study included 625 children under five with LBW. The dependent variable was under-five mortality (children aged 0–59 months), while the independent variables include child (gender), maternal (age at delivery, education, empowerment, delivery complications, and breastfeeding history), health service (antenatal care-ANC and place of delivery), and household (wealth quintile and residence) factors. Data were obtained from the 2017 IDHS using household and women’s questionnaires and analyzed using univariate analysis, Kaplan–Meier estimation, and Cox regression. Results: 41 of 625 children born with LBW died before the age of five. The Kaplan–Meier estimation found that maternal (delivery complications and breastfeeding history), health service (ANC history and place of delivery), and household factors (residence) significantly influenced the survival of LBW children. The Cox regression results showed that LBW children who were breastfeed and whose mother had adequate antenatal care visits had a lower risk of under-five mortality. Surprisingly, children born in health facilities had a significantly higher risk of death compared to those born elsewhere. Conclusions: Exclusive breastfeeding, adequate antenatal care, and place of delivery are important determinants of survival among children born with LBW. This support targeted interventions to improve the survival chances of children born with LBW, particularly in their early years of life. Full article
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