Search Results (1,126)

Modern genetic selection for high productivity has created a physiological conflict in ruminants, where the metabolic demands of lactation compete directly with the energy requirements of reproduction. This review provides a mechanistic synthesis of how key nutritional factors modulate the endocrine and cellular pathways governing reproductive success in cattle and sheep. Negative energy balance (NEB), characteristic of the early postpartum period, suppresses the hypothalamic–pituitary–gonadal (HPG) axis by impairing the pulsatile secretion of gonadotropin-releasing hormone (GnRH) and luteinizing hormone (LH), mediated through reduced kisspeptin signaling, growth hormone (GH) resistance, and decreased circulating insulin, insulin-like growth factor-1 (IGF-1), and leptin. At the macronutrient level, excess rumen-degradable protein elevates blood urea nitrogen and impairs the uterine environment, while omega-3 polyunsaturated fatty acids inhibit prostaglandin F2α synthesis to support corpus luteum maintenance. At the micronutrient level, selenium, copper, and zinc are essential antioxidant cofactors protecting gametes and embryos from oxidative stress, while vitamins A, D, and E regulate gene expression in reproductive tissues. Furthermore, maternal nutrition during critical gestational windows programs the reproductive capacity of offspring through epigenetic modifications, with profound implications for long-term herd fertility. Understanding these nutritional–reproductive interactions is crucial for developing precision feeding strategies that optimize herd fertility, improve animal welfare, and ensure the economic sustainability of livestock management. A thorough understanding of these nutritional–reproductive interactions is essential for developing precision feeding strategies that optimize fertility in high-producing ruminants. Full article

Background/Objectives: We aimed to evaluate the association between diabetes mellitus (DM) during pregnancy and retinopathy of prematurity (ROP) in preterm infants younger than 32 gestational weeks or infants with low birthweight (<1500 g). Methods: We conducted a retrospective nested case–control study of all premature infants who were born alive and survived the post-delivery hospitalization period in Soroka Medical Center, with either gestational age younger than 32 weeks or birthweight less than 1500 g, during the years 2013–2021. The infants were divided into two groups according to ROP status. Multivariable Generalized Estimating Equations (GEE) were used to analyze the association between ROP and DM, adjusting for potential confounders, including maternal age, diabetes type (GDM vs. pre-gestational DM), gestational age, birthweight (<1250 g), duration of oxygen supplementation, antenatal corticosteroid courses, and birth plurality. Results: During the study period, there were 881 pairs of women and newborns who met the inclusion criteria. The ROP group included 345 infants (39.1%). Twenty-two (6.4%) of the mothers in the ROP group were diagnosed with DM during pregnancy compared with 52 of 536 (9.7%) in the control group (p = 0.082). ROP was associated with oxygen treatment (OR 1.05; 95% CI, 1.03–1.08; p < 0.001), birthweight < 1250 g (OR 2.70; 95% CI, 1.93–3.78; p < 0.001) and advanced maternal age (OR 1.04; 95% CI, 1.01–1.06; p = 0.006). Prenatal steroid treatment was identified as a significant protective factor against ROP (OR 0.73; 95% CI, 0.60–0.89; p = 0.002). No statistically significant association was observed between maternal DM and ROP (OR 0.62; 95% CI 0.34–1.13; p = 0.12). These findings should be interpreted cautiously given the retrospective design and the limited availability of glycemic control data. Conclusions: Maternal diabetes mellitus was not significantly associated with the risk of ROP in this cohort. Full article

Objective: This study aimed to investigate the effect of hydroxychloroquine (HCQ) application during pregnancy on perinatal outcomes in cases of combined non-specific auto-antibodies. Methods: A retrospective cohort study was carried out. Cases of pregnancy combined with isolated auto-antibody positivity at Peking University Third Hospital from 2016 to 2020 were included. HCQ use during pregnancy was defined as the primary exposure. The impact of HCQ on perinatal outcomes was explored through univariate and multivariate analyses, and stratified analyses of its effects were conducted according to prophylactic anticoagulation use and medication duration. Results: A total of 338 cases were included, accounting for 39.62% (338/853) of pregnancies with autoimmune abnormalities during the same period. Univariate analysis of the overall population showed that HCQ use during pregnancy was associated with a significantly lower incidence of pre-eclampsia (9.13% vs. 25.53%), early-onset pre-eclampsia (1.37% vs. 10.08%), and small for gestational age (SGA) (12.07% vs. 22.88%). In the subgroup without anticoagulation, both multivariate and univariate analyses revealed that HCQ was associated with markedly lower rates of pre-eclampsia (0% vs. 36.67%, p = 0.004), early-onset pre-eclampsia (0% vs. 15.00%, p = 0.046), and SGA (0% vs. 28.33%, p = 0.006), and a significantly longer pregnancy gestational age with a higher birth weight. The timing of HCQ initiation showed no significant impact on adverse pregnancy outcomes. Conclusions: HCQ use during pregnancy is associated with favorable perinatal outcomes among women with isolated non-specific auto-antibody positivity, especially in those not receiving anticoagulation. Strengthened clinical evaluation and careful risk–benefit assessment are warranted to avoid unnecessary interventions. Full article

Background: Sleep disturbance and psychosocial stress are emerging contributors to hypertensive disorders of pregnancy. The present cohort was recruited during the COVID-19 period, a time marked by substantial changes in prenatal care delivery, social support, and daily routines, which may have influenced maternal sleep and stress burden. Objective: This study aimed to evaluate the independent and integrated associations between maternal sleep quality, psychological stress, and pregnancy outcomes in women at moderate to high risk for preeclampsia. Methods: In a single-center observational cohort of 170 pregnant women enrolled at 16 weeks’ gestation, sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Fitbit Sense 2™ wearable data, while stress was measured through the Perceived Stress Scale (PSS-10), Generalized Anxiety Disorder-7 (GAD-7), and morning salivary cortisol. Associations with preeclampsia, birth weight, gestational age, and NICU admission were analyzed using multivariate regression and receiver operating characteristic (ROC) models. The COVID-19 period was treated as the contextual background of recruitment rather than as a directly compared exposure. Results: Poorer subjective sleep quality (higher PSQI) correlated negatively with birth weight (r = −0.34, p = 0.008) and gestational age (r = −0.28, p = 0.04). Elevated morning cortisol was significantly associated with NICU admission (r = 0.28, p = 0.002). The combined sleep + stress model predicted birth weight (R² = 0.26, p = 0.003) and preeclampsia (pseudo R² = 0.15, p = 0.015) more accurately than individual domains, achieving an ROC-AUC of 0.86 (95% CI: 0.78–0.92). Conclusions: In high-risk pregnancies, integrated evaluation of sleep and stress parameters may improve the prediction of fetal growth impairment and preeclampsia beyond single-domain models. These findings support the incorporation of psychosocial and behavioral markers into antenatal risk stratification. Because no pre-pandemic or post-pandemic comparator group was included, the COVID-19 period should be interpreted as the contextual background of the study rather than as an independently tested exposure. Full article

Patterns of resource selection are driven by the decision-making processes of animals occurring at multiple scales from where to establish a home range (i.e., second order selection) to which resource patches to use within the home range (i.e., third order selection). Elk (Cervus canadensis) were reintroduced to southwestern Virginia, USA, from 2012 to 2014 following successful translocations onto reclaimed surface coal mines in the region. We sought to understand how elk have acclimated following their translocation using location data from GPS-collared adult female elk (n = 33) collected from 2019 to 2022 along with remotely sensed terrain and land cover data. We utilized continuous-time movement models paired with generalized linear mixed-effects modeling to describe seasonal resource selection at second and third orders. At both scales of selection and throughout the year, female elk selected reclaimed surface mines, conifer forests, ridgetops, and areas with lower terrain roughness, while avoiding mixed hardwood and oak (Quercus spp.) forests. Unmined open land was only selected at the third order during periods of forage scarcity (i.e., winter) and increased metabolic requirements (i.e., late gestation). Although surface coal mining leaves legacy environmental impacts on the landscape, management of these sites provides benefits to elk and maintains open habitat that is otherwise limited. Full article

Objective: Nutrition is a key determinant of women’s health across all life stages. Clinical practice remains heterogeneous because of lack of evidence and non-homogeneous guidelines. Despite growing research on micronutrient supplementation, skeptical opinions persist around universal versus individualized approaches, optimal dosages, and life-stage-specific recommendations. Material and methods: This is a modified Delphi process conducted under the supervision of the Italian Association of University Gynecologists and Obstetricians (AGUI). Thirteen Italian experts in gynecology and obstetrics completed two rounds of anonymous online surveys (September–November 2025). The questionnaire, developed through a scoping review, covered six domains: pre-/periconception, pregnancy, postpartum, routine supplementation in non-pregnant women, nutrition in gynecological conditions, and menopause. Consensus was defined as ≥75% agreement on a 10-point Likert scale. Quantitative data were summarized descriptively, and qualitative comments contextualized findings. Results: Experts strongly supported personalized nutritional strategies across all life stages. Consensus was reached on individualized micronutrient supplementation in the preconception period and on the prescription of active folates for women undergoing assisted reproduction. In pregnancy, agreement emerged for universal DHA supplementation (200–300 mg/day); however, universal vitamin D supplementation lacked consensus except in gestational diabetes. In the postpartum period, iron supplementation for non-breastfeeding women reached consensus, while micronutrient recommendations for breastfeeding women remained uncertain. Strong agreement supported personalized dietary approaches for PCOS, endometriosis, and gestational diabetes, including inositol use, while evidence for interventions in severe premenstrual syndrome remained insufficiently supported. In menopause, consensus was reached for macronutrient adjustments and universal calcium and vitamin D supplementation. Conclusions: This Delphi consensus highlights shared expert perspectives on nutritional care in women and identifies key evidence gaps, particularly regarding vitamin D in physiological pregnancy, postpartum micronutrient needs during breastfeeding, and nutritional strategies for premenstrual disorders. Unified life-course guidelines and future research on standardized nutritional assessments are necessary for nutritional approach management. Full article

Oxidative stress contributes to reproductive disorders, immune dysfunction, and reduced productivity in livestock during periods of high metabolic demand and environmental challenge. Selenium supports antioxidant defense systems because it is incorporated as selenocysteine into selenoproteins, including glutathione peroxidases and thioredoxin reductases that detoxify peroxides and sustain redox balance. The review summarizes selenium occurrence and chemical forms in feeds, as well as its absorption, transportation, and storage. The review also outlines the major features of selenoprotein biosynthesis and its prioritized allocation, with an emphasis on cattle, pigs, sheep, and goats. Evidence from multiple sources indicates that selenium status and supplementation interacts with antioxidant capacity, immune competence, thyroid hormone metabolism, reproductive performance, and the transfer of selenium to milk and offspring. In ruminants, rumen microbial transformations can reduce the bioavailability of inorganic selenium salts, and organic sources, such as selenium-enriched yeast, hydroxy-selenomethionine, and selenitetriglycerides, often increase blood and milk selenium more effectively. In pigs, organic selenium is commonly associated with enhanced antioxidant and immune indices in sows and piglets during late gestation, lactation, and weaning, whereas effects on growth performance are inconsistent. The review emphasizes the narrow margin between adequacy and excess and outlines practical considerations for supplementation and monitoring, alongside research needs for emerging selenium forms and functional biomarkers. Full article

Gestational Diabetes Mellitus (GDM) is the most common metabolic complication of pregnancy, affecting approximately 14% of pregnancies globally. Despite the frequent normalization of glycemic parameters immediately after delivery, GDM is an important precursor of subsequent chronic disease, increasing the risk of type 2 diabetes (T2DM). Current international guidelines suggest just a strictly observational approach during the immediate puerperium, recommending metabolic screening only between 6 and 12 weeks postpartum. This has contributed to the creation of a therapeutic “orphan window” where women receive no specific metabolic support, leaving their metabolic status unassessed and unmanaged. We postulate that the immediate postpartum period represents a critical window of “metabolic plasticity” where the abrupt cessation of placental hormones offers a unique opportunity to restore insulin sensitivity and promote “beta-cell rest” before the onset of irreversible dysfunction. Consequently, this narrative review and perspective examines the epidemiological urgency of the GDM-to-T2DM transition and provides a biological rationale for early pharmacological or nutraceutical intervention. Specifically, we discuss the limitations of metformin and present the hypothesis of myo-inositol combined with alpha-lactalbumin as a safe, lactation-compatible “bridging therapy” to preserve beta-cell function, improve compliance, and modify the natural history of diabetes in this high-risk population, highlighting that this theoretical proposal requires validation through future clinical trials. Full article

Objectives: Gestational diabetes is linked to increased inflammatory and metabolic stress during the neonatal period. Among the biomarkers elucidating the relationship between diabetes and inflammation, the interleukin-33 (IL-33)/ST2 signaling pathway is of particular interest. Research on the IL-33/sST2 axis in pregnancies complicated by diabetes indicates that these biomarkers are associated with maternal metabolic disorders and inflammation. Therefore, evaluating sST2 levels in infants of diabetic mothers is essential for identifying a biological marker of systemic inflammation resulting from intrauterine hyperglycemia and for clarifying the specific risks associated with this condition. The objective of this study was to examine sST2 levels in infants born to diabetic mothers and to assess their association with perinatal inflammation, metabolic stress, and clinical outcomes. Methods: This prospective observational study included term infants born at Pamukkale University Medical Faculty Hospital. The study group comprised term infants whose mothers had gestational diabetes, while the control group consisted of term infants born to healthy mothers without diabetes. sST2 levels were measured from serum samples obtained from cord blood at birth using the ELISA method. Factors influencing sST2 levels were analyzed using regression analyses. Results: sST2 levels were significantly higher in the diabetic group than in the control group (p < 0.001). The incidences of large for gestational age (LGA), small for gestational age (SGA), hypoglycemia, postnatal respiratory distress, and both the frequency and duration of neonatal intensive care unit admissions were also significantly elevated in the diabetic group. Multivariate analysis identified gestational diabetes as independent predictor. Conclusions: This study is among the first to demonstrate increased sST2 levels at birth in infants of diabetic mothers. The results indicate that intrauterine exposure to hyperglycemia due to gestational diabetes may be associated with heightened inflammation and metabolic stress in the neonatal period, and that sST2 may serve as a potential biomarker reflecting fetal exposure. Full article

Background: Gestational diabetes mellitus (GDM) affects many pregnancies worldwide and is associated with adverse maternal and fetal outcomes. Current screening at 24–28 weeks limits opportunities for early intervention. We evaluated whether machine learning (ML) models using first-trimester clinical and dietary data can predict GDM risk before the standard oral glucose tolerance test. Methods: We analyzed data from 797 pregnant women enrolled in the BORN2020 prospective cohort study (Thessaloniki, Greece). Ten ML algorithms were evaluated across five class-imbalance handling strategies using stratified 5-fold cross-validation, with final evaluation on an independent 20% held-out test set. Features included maternal demographics, obstetric history, lifestyle factors, and 22 dietary micronutrient intakes from the pre-pregnancy period assessed by Food Frequency Questionnaire. Results: The best-performing model (Logistic Regression without resampling) achieved an AUC-ROC of 0.664 (95% CI: 0.542–0.777), with sensitivity of 0.783 and NPV of 0.932 at the pre-specified threshold. The high NPV should be interpreted in the context of the low GDM prevalence (14.7%), as NPV is mathematically dependent on disease prevalence. A reduced nine-feature model using only routine clinical and demographic variables achieved a numerically higher AUC of 0.712 (95% CI: 0.589–0.825), with overlapping confidence intervals, indicating that detailed FFQ-derived micronutrient data did not improve prediction. Maternal age and pre-pregnancy BMI were the strongest individual predictors by SHAP analysis. No model reached the AUC >0.80 threshold for good discrimination. Substantial miscalibration was observed (slope: 0.56; intercept: −1.83), limiting use for absolute risk estimation. Conclusions: This exploratory study demonstrates that first-trimester ML models achieve modest discriminative ability for early GDM prediction, with routine clinical variables performing comparably to models incorporating detailed dietary assessment. These findings should be interpreted with caution, as no external validation cohort was available and the low events-per-variable ratio (~3.8) constrains the reliability of individual model estimates. Substantial miscalibration further limits use for absolute risk estimation. Accordingly, these models should be regarded as exploratory risk-ranking tools only and require external validation and recalibration before any clinical implementation. Full article

Background/Objectives: In Japan, hospital births predominate, with home births comprising only 0.1% of deliveries. This study assessed how documented practices for planned home births attended by independent midwives align with national guidelines and WHO intrapartum care recommendations, and assess maternal and neonatal differences before and after the COVID-19 pandemic. Methods: Records of 430 low-risk pregnant women who received continuous care at a private midwifery home over 25 years were reviewed. After excluding 8 maternal and 22 neonatal transfers, 400 records were analyzed. Descriptive statistics were compared with WHO recommendations and between the pre-pandemic (1999–2019) and post-pandemic (2020–2024) periods. Results: All women experienced spontaneous singleton cephalic labors with intermittent fetal heart rate auscultation. The mean gestational age was 277.3 days and the median labor duration was 303.5 min. Labor onset was spontaneous in 83.5% of cases. Nearly half of the women had no perineal lacerations. Postpartum blood loss ≥500 mL occurred in 14.1% of cases. Family presence was nearly universal. Neonates had a mean birth weight of 3129.0 g and high Apgar scores. Skin-to-skin contact occurred in 52.9%; exclusive breastfeeding reached 93.8% at 1 month. Post-pandemic births showed higher maternal age and higher neonatal birth weight, although these differences should be interpreted cautiously due to the small post-pandemic sample. Conclusions: Independent midwives provided evidence-based, physiologically oriented care, partially aligning with selected WHO intrapartum recommendations during planned home births. Midwife-led home births may support positive childbirth experiences and favorable maternal/neonatal outcomes for low-risk women. Post-pandemic shifts underscore the need for continued monitoring and flexible, community-based perinatal support, while recognizing the limitations of retrospective, single-site data. Full article

This article addresses physical activity during pregnancy and the postpartum period, a crucial public health concern. We examine the latest insights into physical activity during the perinatal phase, highlighting key findings on the attitudes, perceived barriers, and factors that influence participation. Engaging in moderate physical activity during this period is deemed safe and offers numerous benefits, such as lowered risks of gestational diabetes, preeclampsia, and excessive weight gain, alongside enhanced mental health and sleep quality. After childbirth, continued physical activity provides advantages such as weight management, reduced postpartum depression risk, improved sleep patterns, and a better overall quality of life. However, activity during these stages is often hindered by various barriers stemming from personal issues, societal influences, knowledge gaps, and environmental obstacles. Notably, these challenges tend to shift between pregnancy and postpartum; safety concerns are more prevalent during pregnancy, while issues like fatigue, lack of time, and childcare responsibilities become more significant after delivery. This article uses a socio-ecological framework to analyze these obstacles in depth, categorizing them into intrapersonal, interpersonal, environmental, organizational, and policy-based levels. Full article

Background and Objectives: Predictive performance of the modified myocardial performance index (Mod-MPI) for emergency cesarean delivery secondary to intrapartum fetal compromise (IFC) was examined in late-onset fetal growth restriction (FGR) or small-for-gestational-age (SGA) pregnancies. Materials and Methods: This prospective observational cohort comprised 120 singleton term pregnancies affected by late-onset FGR or SGA, classified in line with the Delphi consensus criteria, for whom a trial of vaginal delivery was planned. The primary endpoint was emergency cesarean delivery indicated by IFC, while the secondary endpoint was the development of composite adverse perinatal outcomes (CAPO). Measurements of Mod-MPI, the umbilical artery, the middle cerebral artery, and the cerebroplacental ratio (CPR) were performed within the final 72 h before delivery and were blinded to the clinicians managing the intrapartum period. Results: IFC constituted 28.3% (n = 34) of the study cohort. The IFC group exhibited significantly higher Mod-MPI values and lower CPR values (p < 0.001). In multivariable analysis, elevated Mod-MPI (≥0.61) and reduced CPR (<5th percentile) were identified as independent predictors of IFC. On receiver operating characteristic analysis, Mod-MPI demonstrated superior discriminative performance compared with CPR for predicting IFC (area under the curve [AUC]: 0.835 vs. 0.759). In contrast, CPR showed the highest diagnostic performance for predicting CAPO (AUC: 0.779). Conclusions: Mod-MPI reflects subclinical cardiac dysfunction in fetuses with late-onset FGR and SGA and represents a valuable parameter for predicting tolerance to acute intrapartum stress. Rather than routine implementation, it appears most appropriate as a complementary tool contributing to intrapartum risk assessment in selected high-risk cases. Full article

Background: some consensus guidelines include C-reactive protein (CRP) in the diagnostic workup of early-onset neonatal sepsis (EOS), but its routine use remains debated due to variable diagnostic performance. The experiences and data from individual centers can help clarify its clinical utility and inform local practice. Methods: Retrospective analysis at a level III center assessing the impact of discontinuing routine C-reactive protein (CRP) testing for suspected early-onset sepsis (EOS). Laboratory use, antibiotic therapy, and outcomes in neonates of all gestational ages were compared before (2021–2022) and after (2024–2025) the policy change. Results: A total of 638 neonates were included (period 1, n = 348; period 2, n = 290). CRP testing decreased markedly (218/348 in period 1 vs. 40/290 in period 2; p < 0.001), alongside a significant reduction in the number of complete blood counts performed (285/348 vs. 214/290; p = 0.02). Concurrently, both the proportion of short antibiotic courses (≤48 h) initiated within the first 3 days of life (98/181 vs. 88/133) and the median duration of antibiotic therapy (48.0 h vs. 40.0 h; p < 0.001) decreased without worsening outcomes. The duration of antibiotic therapy was even shorter in infants born before 34 weeks’ gestation (48.0 h vs. 37.5 h; p < 0.001). Conclusions: Restricting the use of CRP in the evaluation of EOS was associated with a reduction in unnecessary antibiotic exposure. This strategy may be considered a core component of neonatal antibiotic stewardship programs. Full article

This population-based study aimed to analyze the annual incidence and case fatality trends, and the clinical-epidemiological profile of gastroschisis in the state of Paraná, Brazil, between 2013 and 2024. Specifically, temporal trends in annual incidence and mortality rates related to gastroschisis were examined. Maternal, gestational, and neonatal characteristics were analyzed. Data from the Live Birth Information System and the Mortality Information System were analyzed using polynomial regression modeling. During the study period, 1,798,727 live births were recorded, including 491 cases of gastroschisis and 179 related deaths. The mean incidence was 2.73 per 10,000 live births. A significant 39.5% decrease over the study period was observed (p < 0.001). The case fatality rate was 36.5%. The mothers of children with gastroschisis were: young mothers (<25 years old; 77%), with low education (87.7%) and no partner (59.1%). High frequencies of cesarean deliveries (84.3%), prematurity (57.3%), low birth weight (63.7%), and low Apgar scores were also observed. The profiles of the mothers and children at birth were unfavorable when compared to the population of live births. Gastroschisis incidence in Paraná declined significantly from 2013 to 2024. While the annual incidence showed a decreasing trend, mortality fluctuated. The persistently high case fatality rate underscores the need for public policies focused on prenatal care and specialized neonatal management. Full article