Search Results (117)

Background/Objectives: Gestational weight gain (GWG) is a crucial factor influencing mother and fetal health, as high GWG is associated with adverse pregnancy outcomes and an increased long-term risk of obesity and metabolic issues in the children. In addition to controlling weight, maternal physical activity (PA) during pregnancy may influence fetal development through potential epigenetic mechanisms, including histone modifications, DNA methylation, and the production of non-coding RNA. Methods: This narrative review synthesizes evidence from randomized controlled trials (RCTs; n = 11, 3654 participants) investigating the impact of aerobic PA on GWG, while also highlighting emerging, primarily indirect findings on maternal–fetal epigenetic programming. Results: The majority of RCTs found that supervised PA interventions, especially when paired with nutritional counseling, decreased both the incidence of excessive GWG and total GWG. Enhancements in lipid metabolism, adipokine profiles, and maternal insulin sensitivity point to likely biochemical mechanisms that connect PA to epigenetic modification of fetal metabolic genes (e.g., IGF2, PGC-1α, LEP). Animal and observational studies suggest that maternal activity may influence offspring epigenetic pathways related to obesity and cardiometabolic conditions, although direct human evidence is limited. Conclusions: In addition to potentially changing gene–environment interactions throughout generations, prenatal PA is a low-cost, safe method of improving maternal and newborn health. Future RCTs ought to incorporate molecular endpoints to elucidate the epigenetic processes by which maternal exercise may provide long-term health benefits. Full article

Background/Objectives: Gestational diabetes mellitus (GDM) and maternal obesity are major global health gestation-related conditions associated with several adverse maternal and neonatal outcomes. GDM is a common gestational metabolic disorder, presented usually during the second or third trimester of pregnancy with maternal hyperglycemia due to insulin intolerance. Maternal obesity, defined as a BMI of a woman during gestation ≥ 30 kg/m², has been associated with maternal complications such as GDM, fetal macrosomia and others. Methods: The presented article is a narrative review. The aim of this study was to review scientific evidence and conduct a comprehensive analysis of GDM and maternal obesity (“diabesity”) and its immediate and late complications for both maternal and fetal/offspring wellbeing. Results: This review highlighted that gestational hyperglycemia results in oxidative and nitrogen stress development and that maternal obesity may have an impact similar to maternal diabetes, as it may cause fetal macrosomia and cardiometabolic complications later in life. Conclusions: Optimal diabetic control is responsible for the prevention of oxidative stress in diabetic pregnancies. Similarly, pregnant women should exercise regularly, receive folic acid supplementation and avoid excess weight gain during pregnancy. Breastfeeding during the first months of life has a positive impact on weight monitoring in infants born to mothers with diabesity and may be crucial in the prevention of obesity and metabolic syndrome later in life. Full article

During pregnancy, physiological adaptations occur in the respiratory and cardiovascular systems to support the increased metabolic needs of both mother and fetus. Key respiratory changes include mechanical adjustments of the chest wall and diaphragm to accommodate the growing uterus; decreases in functional residual capacity and its components—expiratory reserve volume and residual volume—with minimal or no change in total lung capacity; and an increase in minute ventilation. Major cardiovascular adaptations involve elevated cardiac output, stroke volume and heart rate, and decreased mean arterial pressure and systemic vascular resistance. During exercise in pregnancy, there is an increase in ventilation, alveolar diffusion, elevated oxygen consumption, greater carbon dioxide production and changes in respiratory volumes and capacities, as well as increases in cardiac output, stroke volume and heart rate. Understanding these normal physiological changes during pregnancy and exercise in pregnancy is essential for healthcare providers to develop and adapt exercise programs according to the gestational age and physical fitness level of the pregnant woman. Full article

Endocrine dysfunctions refer to alterations in hormone production, release, or regulation that can significantly impact health. In pregnant women or those planning pregnancy, these conditions may manifest as disorders such as polycystic ovary syndrome, hypothyroidism, endometriosis, gestational diabetes mellitus, and other metabolic issues, which could potentially cause infertility or pregnancy complications. Research and clinical experience indicate that hormones play a crucial role in basic physiology and are essential for overall health and well-being. At the same time, lifestyle—defined as daily habits related to nutrition, exercise, sleep, stress management, and other factors—directly influences microbial composition and hormonal regulation. The human microbiome, a diverse community of microorganisms residing within the human body, plays essential roles in supporting overall health. The increasing prevalence of hormonal disorders, especially in urban populations, has heightened interest in how modern lifestyles—characterised by sedentary habits, chronic stress, imbalanced diets, and inadequate sleep—may contribute to the development or aggravation of these conditions, leading to higher infertility rates or pregnancy complications if untreated. This review investigates the interaction between hormonal dysfunction, the human microbiome, and lifestyle factors, with a focus on their effects on pregnant women and those seeking to conceive. Its purpose is to provide a comprehensive overview of the underlying pathophysiological mechanisms and to examine preventative and therapeutic approaches that could alter these patterns. Full article

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

Background: Severe neonatal Ebstein’s anomaly (EA) is associated with a high risk of mortality. A new therapeutic approach aims to combine the advantages of Starnes’ procedure in stabilizing critically ill neonates with the long-term superiority of biventricular physiology after cone reconstruction. Case report: The echocardiography of a male preterm (36 weeks’ gestation; birth weight 2400 g) demonstrated EA Carpentier type C, membranous pulmonary atresia, and hypoplastic pulmonary arteries (PAs). After undergoing the Starnes procedure postnatally, multiple dilatations of the AP shunt and the Starnes fenestration followed. Cone reconstruction was performed at 15 months of age. Surgical revision addressed tricuspid and pulmonary valve insufficiency and PA bifurcation stenosis. Subsequently, PA branch stenosis with severe impairment of right ventricular function and dilatation required stent implantation. At the last follow-up, at 3 years of age, the patient was asymptomatic with sufficient exercise tolerance. Discussion: The American Association for Thoracic Surgery recently recommended evaluating all Starnes patients for potential conversion to cone. Consequently, the Starnes procedure should be modified to facilitate subsequent biventricular correction. Both the optimal timing of conversion and the appropriate assessment to reliably evaluate feasibility and the prospects for success require further investigation. Conclusions: Conversion from Starnes to cone is technically feasible, even in cases of severe EA, prematurity, low birth weight, and additional cardiac comorbidities, and provides promising initial results. Further research is needed to define candidacy and the optimal timing of conversion, and to assess long-term outcomes. The high therapeutic effort and complexity make this treatment approach suitable only for quaternary centers. Full article

With the increasing prevalence of diabetes and its growing impact on maternal and fetal health, management during pregnancy has become critical. This review describes the pathophysiology of insulin resistance during pregnancy, adverse outcomes correlated with diabetic pregnancies, and current management strategies. We investigate two leading approaches to managing pregnant patients with diabetes—lifestyle intervention and drug treatment. Lifestyle intervention, including dietary counseling, exercise regimens, patient education, and self-administered blood glucose monitoring, has demonstrated promising results in the management and prevention of gestational diabetes mellitus (GDM). Early intervention and treatment of at-risk patients have been critical for positive outcomes. Drug treatment, focusing on the utilization of insulin, insulin analogs, and antihyperglycemic agents has shown efficacy in achieving glycemic control and improving maternal and neonatal outcomes. These findings indicate that a combination of early lifestyle intervention and targeted drug treatment yields the most benefit in managing diabetes in pregnancy. To augment treatment, continuous glucose monitoring and telemedicine have become valuable tools in managing diabetes during pregnancy. Future research should aim to develop more effective antihyperglycemic agents, improve telehealth accessibility, and enhance preconception care for women at risk of developing GDM. By addressing these areas, we can significantly reduce the adverse outcomes associated with diabetes in pregnancy and improve overall maternal and fetal health. Full article

Gestational diabetes mellitus (GDM) is characterized by an inadequate pancreatic β-cell response to pregnancy-induced insulin resistance, resulting in hyperglycemia. The pathophysiology involves reduced incretin hormone secretion and signaling, specifically decreased glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), impairing insulinotropic effects. Pro-inflammatory cytokines, including tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6), impair insulin receptor substrate-1 (IRS-1) phosphorylation, disrupting insulin-mediated glucose uptake. β-cell dysfunction in GDM is associated with decreased pancreatic duodenal homeobox 1 (PDX1) expression, increased endoplasmic reticulum stress markers (CHOP, GRP78), and mitochondrial dysfunction leading to impaired ATP production and reduced glucose-stimulated insulin secretion. Excessive gestational weight gain exacerbates insulin resistance through hyperleptinemia, which downregulates insulin receptor expression via JAK/STAT signaling. Additionally, hypoadiponectinemia decreases AMP-activated protein kinase (AMPK) activation in skeletal muscle, impairing GLUT4 translocation. Placental hormones such as human placental lactogen (hPL) induce lipolysis, increasing circulating free fatty acids which activate protein kinase C, inhibiting insulin signaling. Placental 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) overactivity elevates cortisol levels, which activate glucocorticoid receptors to further reduce insulin sensitivity. GDM diagnostic thresholds (≥92 mg/dL fasting, ≥153 mg/dL post-load) are lower than type 2 diabetes to prevent fetal hyperinsulinemia and macrosomia. Management strategies focus on lifestyle modifications, including dietary carbohydrate restriction and exercise. Pharmacological interventions, such as insulin or metformin, aim to restore AMPK signaling and reduce hepatic glucose output. Emerging therapies, such as glucagon-like peptide-1 receptor (GLP-1R) agonists, show potential in improving glycemic control and reducing inflammation. A mechanistic understanding of GDM pathophysiology is essential for developing targeted therapeutic strategies to prevent both adverse pregnancy outcomes and the progression to overt diabetes in affected women. Full article

Gestational diabetes mellitus (GDM) is a prevalent condition impacting approximately 14% of pregnancies globally, posing significant health risks to mother and child. This review explores the role of diet, physical activity (PA), and sedentary behavior (SB) in preventing and managing GDM. Consumption of fish, fruits, vegetables, and legumes, and adherence to healthy dietary patterns, like the Mediterranean diet, are linked to lower GDM risk. Higher levels of PA and structured exercise consistently show protective effects against GDM, enhancing glucose metabolism and insulin sensitivity. Conversely, SB is a risk factor for GDM; prolonged sedentary periods detrimentally affect glucose regulation. The review emphasizes the need for a combined approach integrating healthy dietary habits, regular PA, and reduced SB to mitigate GDM risk effectively. Future research should prioritize standardized assessment methods and personalized lifestyle interventions to optimize GDM prevention strategies, ultimately informing public health guidelines and clinical recommendations for healthier pregnancies and better long-term outcomes. Full article

There has been accumulating evidence over the past two decades that metformin can be an effective treatment for gestational diabetes mellitus (GDM) in women whose diet and exercise fail to attain optimal glycemic control. The objective of this review was to comprehensively analyze all studies investigating the effectiveness of metformin compared to insulin and other drugs utilized for the treatment of GDM. After a comprehensive literature review based on PRISMA 2020, 35 studies were included after a selection process utilizing predetermined inclusion and exclusion criteria. A variety of short-term maternal and neonatal outcomes were assessed. Metformin is a highly efficient medication for attaining optimal control of blood sugar levels in women with GDM, resulting in a significant reduction in the amount of weight gained during pregnancy. Regarding additional maternal outcomes, such as pregnancy-induced hypertension and cesarean deliveries, some studies demonstrate a link between metformin and a reduced occurrence of both conditions. In contrast, others do not find an association. Regarding short-term neonatal outcomes, metformin does not exhibit any changes in gestational age at delivery. In contrast, metformin demonstrated substantial decreases in the likelihood of greater gestational birth weight and neonatal hospitalization when compared to other drugs. When compared primarily to insulin, metformin decreases the probability of several short-term outcomes related to pregnancy and newborns. Additional data are necessary for extended follow-up studies, including patients with GDM treated with metformin. Full article

Currently, there are no validated guidelines or recommendations for how to interpret cardiac biomarkers in the pediatric population. The most commonly used cardiac biomarkers are cardiac troponins and natriuretic peptides, but the clinical value of common cardiac biomarkers in pediatric laboratory medicine is restricted due to age- and sex-specific interpretations, and there are no standardized cut-off values. The results from the studies on reference values, as well as results from clinical studies, are difficult to compare with identical studies due to the heterogeneity of subject characteristics (gestational and chronological age, sex, pubertal status, menstrual cycle, exercise), assay characteristics (type of assay, generation of assay, analytical platform used), and experimental protocol characteristics (prospective or retrospective studies, reference population selection, patient population selection, inclusion and exclusion criteria, number of subjects). Future studies need to establish evidence-based cut-offs for specific indications to optimize utilization and standardize the interpretation of common cardiac biomarkers in neonates, children, and adolescents. The aim of this article was to summarize the current analytical and clinical limitations of cardiac troponins and natriuretic peptides in the pediatric population, as informed by the existing published literature. Full article

Objective: To assess the birth weight of newborns whose mothers gave birth during the COVID-19 pandemic. Methods: A cross-sectional study based on data collected from medical records and through postnatal interviews to assess maternal and neonatal health outcomes (n = 470) during the pandemic. All participants were assisted in three Brazilian public hospitals in 2020. Multinomial logistic regression was performed to assess factors associated with birth weight. Results: Low and insufficient birth weight reached 9.8% and 25.7% prevalence, respectively. COVID-19 symptoms were reported by 8% of participants. Low birth weight was more often observed in premature children (OR: 70.9; 95% CI: 16.4–305.8) delivered by cesarean sections (OR: 7.70; 95% CI: 2.33–25.4). Insufficient weight was more frequent in premature children (OR: 5.59; 95% CI: 1.53–20.4) and children whose mothers did not exercise during pregnancy (OR: 2.85; 95% CI: 1.38–5.89). Women presenting higher gestational weight gain had a lower chance of delivering babies with insufficient weight (OR: 0.94; 95% CI: 0.90–0.99). Conclusions: Inadequate birth weight was associated with prematurity, delivery type, lower gestational weight gain, and maternal physical inactivity during the pandemic. According to the results, it is necessary to have adequate prenatal care and promote a healthy lifestyle during pregnancy. Full article

Background: Lumbopelvic pain (LBP) is a prevalent condition during pregnancy, affecting a significant proportion of pregnant women. It arises from hormonal, biomechanical, and postural changes, often exacerbating discomfort and impairing quality of life. This study aimed to evaluate the effects of targeted motor control interventions focusing on sternal alignment on spinal alignment, pain, and muscle activity in pregnant women at risk of preterm birth. Methods: This pre–post quasi-experimental study included 32 pregnant women at 28–32 weeks of gestation, who were hospitalized due to the risk of preterm birth. Inclusion criteria required participants to have LBP lasting at least two weeks and the ability to walk and stand for 40 min. The intervention involved targeted motor control exercises designed to optimize sternal and sacral alignment. Spinal alignment, pain intensity, and muscle activity were measured pre- and post-intervention using the DIERS formetric system, numerical rating scale (NRS), and electromyography (EMG), respectively. Data were analyzed using Wilcoxon signed-rank tests. Results: Significant improvements were observed in spinal alignment parameters, including reductions in the sternal angle, sacral angle, cervical and lumbar lordosis depths, thoracic kyphosis angle, and pelvic tilt (p < 0.05). Pain intensity decreased significantly from a mean NRS score of 5.77 ± 1.42 in the relaxed posture to 2.54 ± 0.71 in the corrected posture (p < 0.05). Muscle activity of the rhomboid muscles increased in the corrected posture, correlating with improved thoracic kyphosis, while activity of the serratus anterior muscle showed reductions (p < 0.05). Conclusions: Targeted motor control focusing on sternal alignment effectively improved spinal alignment and reduced pain in pregnant women at risk of preterm birth with LBP. The intervention offers a safe, non-invasive, and practical approach to managing pregnancy-related musculoskeletal challenges. Future research should validate these findings in diverse populations and explore long-term effects and broader clinical applications. Full article

Our hypothesis is that myoinositol and metformin in pregnant women with high-risk factors for glucose intolerance would reduce insulin resistance and consequently lower the incidence of gestational diabetes mellitus (GDM), a metabolic disorder of pregnancy characterized by maternal hyperglycemia due to deficient response to physiological insulin resistance, which may have a negative impact on perinatal outcome and long-term sequelae. In recent years, this pathology has become increasingly important given the global obesity epidemic and the delay in becoming pregnant, especially in industrialized countries. For this reason, the attempt to prevent, rather than cure, gestational diabetes is particularly important. In addition to lifestyle changes (especially diet and doing more exercise), myoinositol and metformin are the most promising factors at the moment, although not all RCTs published so far agree on their real effectiveness. A review of the articles published so far allows us to assume, albeit with some distinctions, that they can play a positive role. Full article

The placenta is crucial to fetal development and performs vital functions such as nutrient exchange, waste removal and hormone regulation. Abnormal placental development can lead to conditions such as fetal growth restriction, pre-eclampsia and stillbirth, affecting both immediate and long-term fetal health. Placental development is a highly complex process involving interactions between maternal and fetal components, imprinted genes, signaling pathways, mitochondria, fetal sexomes and environmental factors such as diet, supplementation and exercise. Probiotics have been shown to make a significant contribution to prenatal health, placental health and fetal development, with associations with reduced risk of preterm birth and pre-eclampsia, as well as improvements in maternal health through effects on gut microbiota, lipid metabolism, vaginal infections, gestational diabetes, allergic diseases and inflammation. This review summarizes key studies on the influence of dietary supplementation on placental development, with a focus on the role of probiotics in prenatal health and fetal development. Full article