Search Results (2,896)

Background: Missed miscarriage (MM) is a common first-trimester complication. Misoprostol alone achieves moderate success, while combination therapy with mifepristone improves outcomes in spontaneous pregnancies. Evidence in assisted reproductive technology (ART) pregnancies is scarce. We evaluated whether combined mifepristone–misoprostol improves outcomes in ART pregnancies compared with misoprostol alone and compared results with spontaneously conceived (SC) pregnancies. Methods: This retrospective matched cohort study was conducted at a single center (2017–2024). ART pregnancies were matched 1:2 with SC pregnancies by maternal age. Patients received misoprostol alone or 200 mg mifepristone followed 48 h later by misoprostol. The primary outcome was treatment success, defined as complete uterine evacuation without repeat misoprostol or surgery. Secondary outcomes included emergency visits, surgical procedures, and ART-related predictors. Subgroup analyses were performed by ART protocol. Results: Among 307 patients (94 ART, 213 SC), combined therapy yielded higher success than misoprostol alone in SC (84% vs. 71%, p = 0.023) and ART pregnancies (95% vs. 80%, p = 0.035). In hormonally supported frozen embryo transfer (HRT-FET) cycles, success was 100% with combined therapy versus 80% with misoprostol alone. Conclusions: Combined mifepristone–misoprostol is more effective than misoprostol alone, with particularly high success in HRT-FET cycles. Full article

Background: Breast cancer is the most frequently diagnosed cancer in women, and advances in genetic screening have led to a growing number of patients being identified as BRCA mutation carriers. For these women, the safety of pregnancy following cancer treatment remains insufficiently studied, and possible biological mechanisms—including defective DNA repair pathways and accelerated depletion of the ovarian reserve—may influence fertility potential and pregnancy outcomes. This exploratory research set out to examine whether BRCA status impacts reproductive outcomes in breast cancer survivors, while also considering underlying biological explanations for any observed differences. Methods: We performed a retrospective, single-institution cohort study involving young women with non-metastatic breast cancer who had undergone BRCA testing over a 17-year period. Clinical, oncologic, and reproductive data were collected and patients were followed longitudinally. Results: Of the 117 women who met eligibility criteria, 15 conceived at least once after cancer therapy; 11 carried no BRCA mutation, and 4 were BRCA-positive (2 with BRCA1 and 2 with BRCA2 variants). While the overall cohorts were broadly comparable, significant differences emerged in terms of tumor grade, hormone receptor status, HER2 expression, and treatment modalities. BRCA mutation status did not appear to influence reproductive outcomes, and all pregnancies in both groups progressed to full-term delivery without major obstetric complications or congenital anomalies. Conclusions: Within the limitations of a small, retrospective, single-center dataset without adjustment for confounding variables, these preliminary findings suggest that pregnancy after breast cancer may be safe for BRCA mutation carriers, with no apparent adverse effect on maternal prognosis or birth outcomes. Confirmation from larger, prospective, multicenter studies is essential to validate these results, clarify possible biological mechanisms, and inform evidence-based fertility counseling and survivorship planning for this patient population. Full article

Gestational diabetes mellitus (GDM) is one of the most common metabolic complications during pregnancy, affecting up to 14% of pregnancies globally. GDM is characterized by glucose intolerance that arises or is first identified during pregnancy and is linked to significant short- and long-term adverse outcomes for both mothers and their offspring. The pathophysiology of GDM involves more than maternal insulin resistance and β-cell dysfunction. It is influenced by complex interactions among placental hormones, adipokines, inflammatory mediators, and oxidative stress pathways. Additionally, placental-derived exosomes and metabolomic signatures have emerged as promising biomarkers for early prediction and monitoring of the disease. Despite advancements in clinical diagnosis and management, including lifestyle interventions and pharmacological treatments, current strategies are still inadequate to prevent complications for both mothers and newborns entirely. Recent molecular insights into GDM development have been explored, along with emerging biomarkers and potential therapies. This synthesis also considers prospects for precision medicine strategies that could significantly improve GDM management. The urgent need for improved prevention and treatment of GDM is evident. A deeper understanding of the molecular foundations of GDM is essential and urgent, as it may enhance clinical outcomes and provide opportunities for early prevention of intergenerational metabolic disease risk. Full article

Background: Concerns exist regarding the lowest effective dose of opioids in opioid-naïve pregnancies. This study aimed to compare the effectiveness of 25 µg vs. 50 µg fentanyl in relieving labor pain. Methods: In total, 122 term-singleton pregnant females, who planned vaginal delivery, were randomized to receive 25 µg or 50 µg intravenous fentanyl, followed by hourly doses—as needed—for labor pain relief. The primary outcome was the comparison of pain score reduction 30 min after treatment between these regimens. Secondary outcomes included maternal and neonatal safety, total fentanyl dose administered, maternal satisfaction with the fentanyl dosing regimen, and breastfeeding, which were analyzed using appropriate statistical tests. Results: Within-group analysis revealed significant pain score reduction 30 min after fentanyl injection: −1.57 (95% confidence interval, CI −2.1 to −1.1, p < 0.001) and −1.69 (95% CI −2.2 to −1.2, p < 0.001) for 25 µg and 50 µg fentanyl groups, respectively. No significant differences in the pain reduction were observed in between-group comparisons (0.3, 95% CI −0.6 to 1.2, p > 0.999), including secondary maternal and neonatal outcomes. Total fentanyl dose was significantly lower in the 25 µg group compared with the 50 µg group (32.8 ± 13.3 vs. 60.2 ± 22.1, p < 0.001). Conclusions: A 25 µg intravenous fentanyl dose can reduce VAS score, used for evaluating labor pain 30 min after treatment, and is comparable to a 50 µg intravenous fentanyl dose. Given the efficacy of the reduced dosage of fentanyl, this study suggests using 25 µg intravenous fentanyl as an alternative initial dosing for labor pain relief. Full article

Evaluating antenatal care quality involves understanding women’s experiences and their impact on pregnancy outcomes. This study examines how pregnant women in the Netherlands perceive the quality of antenatal care and which factors are related to these perceptions, with a focus on continuity of care. We conducted a cross-sectional study (2019–2020) among 1165 pregnant women (>32 weeks). Perceived quality of care was measured using the Pregnancy and Childbirth Questionnaire. Experienced continuity of care was measured using the Nijmegen Continuity Questionnaire. Regression analyses explored associated factors across both community and hospital care settings. Most women reported moderate-to-high levels of perceived quality. Personal continuity from community midwives, team continuity, and the presence of a coordinating care professional were associated with higher perceived quality. The use of a maternity care plan showed no association. Our findings suggest that involvement of a community midwife enhances perceived quality of antenatal care. Key contributing factors include continuity of care and experiencing a coordinating care professional. Full article

Background/Objectives: Infant feeding is critical for health and development, yet the influence of maternal psychosocial factors on its timing is not fully understood. While maternal adverse childhood experiences (ACEs) are known to affect perinatal outcomes, their impact on the specific timing of initiating formula and complementary foods remains under-investigated. We hypothesized that maternal ACEs are associated with delayed initiation of infant formula and complementary foods and that this association is mediated by postpartum depression (PPD). This study aimed to examine the link between maternal ACEs and delayed infant feeding, and to assess the mediating role of PPD using data from a large nationwide Japanese database. Methods: This cross-sectional study utilized data from the Japan COVID-19 and Society Internet Survey (JACSIS), conducted between July and August 2021. The analysis included 3446 postpartum mothers. Maternal ACEs were assessed using a 9-item questionnaire, and a cumulative score was categorized as high (≥4 ACEs) versus low (0–3 ACEs). The primary outcomes were infant feeding behavior including breastfeeding, formula feeding and complementary foods. We used logistic regression analysis with inverse probability of treatment weighting (IPTW) to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). A mediation analysis was conducted to evaluate the role of smoking, alcohol and PPD. Results: High ACE exposure (≥4) was present in 221 mothers (6.4%). A high maternal ACE score was significantly associated with delayed initiation of formula feeding (≥7 days) (Adjusted OR: 2.12, 95% CI: 1.12–4.01, p = 0.02) and late initiation of complementary foods (≥7 months) (Adjusted OR: 2.27, 95% CI: 1.38–5.01, p = 0.03); no significant associations were observed for ever/late/continued breastfeeding or ever/continued formula feeding. These associations attenuated to non-significance after adjusting for PPD. Conclusions: Maternal ACEs are associated with delayed initiation of complementary foods and formula, largely through PPD. Perinatal services should combine ACE/PPD screening with trauma-informed mental health and nutrition support to promote timely infant feeding. Full article

Background/Objectives: Our primary objective was to determine whether patients with a higher body mass index (BMI) who experienced postpartum hemorrhage (PPH) required ≥2 uterotonics more often than those with lower BMI. Methods: We conducted a retrospective cohort study that included all patients who experienced a PPH between 1 August 2020 and 31 July 2022. Extracted data included patient demographics, PPH risk factors, details regarding the labor course and hemorrhage management, and maternal and neonatal outcomes, such as mode of delivery, etiology of hemorrhage, need for nonpharmacological management, neonatal Apgar scores, requirement for phototherapy, neonatal intensive care unit (NICU) admission, and NICU length of stay. All variables were compared between four BMI classes: non-obese and classes I, II, and III obesity. Possible confounding factors were assessed with a logistic regression analysis. Results: Of the 6732 deliveries that occurred during the study period, a total of 891 (13.2%) patients had PPH. Differences were noted in the number of uterotonics used, although no direct correlation was found between increasing BMI class and the use of ≥2 uterotonics. Patients with higher BMIs were more likely to require cesarean delivery, have a classical hysterotomy incision, and have a hysterotomy extension, and were less likely to need a blood transfusion (p < 0.05 for all). There was no difference in the rate of uterine atony or other etiologies of hemorrhage, and no difference was observed in the non-pharmacologic management of hemorrhage between groups. Conclusions: In our study population, BMI alone does not appear to be directly associated with the use of ≥2 uterotonics. Full article

Placenta accreta spectrum (PAS) disorders remain a major cause of maternal morbidity and adverse perinatal outcomes due to abnormal placental adherence and invasion. Early and accurate prenatal diagnosis is essential to optimize surgical planning and reduce complications. Although ultrasound is well established as the cornerstone for PAS detection, the potential role of serial ultrasonography in refining risk assessment and predicting outcomes is increasingly being explored. Monitoring with serial ultrasonographic imaging may offer valuable insights into the progression of sonographic features, such as placental lacunae, myometrial thinning, placental bulge, and bladder wall disruption, which can predict surgical complexity and perinatal risk and influence decision-making and management. However, there is still limited evidence about the prognostic value of serial scans, and the variability in interpreting ultrasound markers continues, presenting challenges. While scoring systems incorporating ultrasound features show promise for risk stratification, further validation in larger studies is needed. Future research should focus on standardizing ultrasound protocols, validating predictive models, and exploring technological innovations, including artificial intelligence, to enhance diagnostic precision. Incorporating serial ultrasound assessments thoughtfully into clinical practice may improve individualized care and outcomes for women affected by PAS, but more studies are required. Full article

Objectives: This cross-sectional study assessed the nutritional knowledge of Saudi mothers and their children. Then, it examined the association between the nutritional knowledge of mothers and the nutritional knowledge and weight status of their schoolchildren in Makkah City, Saudi Arabia. Methods: The mothers’ nutritional knowledge was assessed using the validated Arabic version of the General Nutrition Knowledge Questionnaire (GNKQ). The children’s nutritional knowledge was assessed through an interviewer-administered questionnaire, and their weight status was determined based on their Body Mass Index (BMI) Z-score, which was calculated according to their anthropometric measurements. Results: One hundred children and sixty mothers were included in this study. Only 6.67% of the mothers had a high level of nutrition knowledge. A total of 54% of their children had low nutritional knowledge scores, and approximately 27% was classified as having excess weight. More than 40% of the children reported consuming fruits and vegetables 4–5 times/week, whereas 50% of the children consumed fast foods 1–3 times/week. Multiple linear regression analyses showed that higher nutritional knowledge scores among the children were significantly associated with higher mothers’ knowledge scores [(0.06 (95%CI: 0.0.03, 0.0.08)] and older age among these children [0.61 (95%CI: 0.44, 0.77)], as the older children had higher knowledge scores. The children’s nutritional knowledge, however, was not associated with the child’s sex, mothers’ age, or mothers’ education. The maternal knowledge scores were not associated with the child’s weight status. Conclusions: Given that the nutrition knowledge scores of Saudi mothers are significantly associated with those of their children, but not with their weight status, it can be concluded that nutrition knowledge alone may not be sufficient to address the overweight and obesity epidemic in Saudi Arabia. However, it remains a crucial component of multifaceted interventions that also enhance physical activity and promote behavior change to improve health outcomes and weight status in the Saudi population. Full article

Prenatal exposure to air pollution is a major public health concern due to its potential to impair fetal brain development. This study examined whether maternal inflammatory and oxidative stress biomarkers mediate the association between trimester-specific air pollutant exposure during pregnancy and infant neurodevelopment at one year. We analyzed 87 mother–infant pairs from the OBESO perinatal cohort in Mexico City. Trimester-specific exposure to CO, PM₁₀, PM_2.5, SO₂, and O₃ was estimated using residential geolocation. Biomarkers were measured in the first and third trimesters by protocol, and intra-pregnancy change was calculated as Δ(3T–1T) for cytokines (IL-1β, IL-6, TNFα) and oxidative stress markers (malondialdehyde (MDA), protein carbonyls (PC), and total antioxidant capacity (TAC). Infant neurodevelopment at 12 months was assessed using Bayley-III. Exploratory mediation analyses were conducted, adjusting for gestational age at birth, pre-eclampsia, gestational diabetes, fetal growth restriction, marital status, mode of delivery, and infant sex; bootstrapping was applied to obtain robust estimates. Third-trimester CO exposure was associated with poorer receptive language (coef = 0.754, p = 0.02). PM_2.5 exposure showed direct effects on expressive language in the first (coef = 0.01, p = 0.04) and third trimesters (coef = 0.007, p = 0.015) in models including IL-1β. Third-trimester O₃ and SO₂ exposures were linked to lower expressive scores in models including TNFα (coef = 0.007, p = 0.02), MDA (coef = 0.008, p = 0.04), and PC (coef = 0.007, 95% p = 0.04). Meanwhile PM₁₀ exposure was associated with socio-emotional outcomes in models with IL-6 and TAC (coef = 0.003, p = 0.04). These findings indicate that maternal inflammation and oxidative stress biomarkers did not mediate the associations between prenatal air pollution exposure and infant neurodevelopment, and this study cannot elucidate their specific biological role in neurodevelopment. Full article

Background/Objectives: Social Media Use has become an integral part of contemporary motherhood, with potential effects on maternal mental health and breastfeeding behaviors. This study aimed to examine the relationship between problematic social media use, anxiety levels, infant feeding attitudes, and feeding intentions among social media-native mothers. Methods: A mixed-methods design was used with 222 mothers. Quantitative data were collected using the Trait Anxiety Inventory (STAI-T), Social Media Disorders Scale (SMDS-9), Iowa Infant Feeding Attitude Scale (IOWA), and Newborn Feeding Intention Scale (IFI). Qualitative data were obtained through semi-structured interviews. Quantitative analyses explored associations between problematic social media use, anxiety, and feeding-related outcomes, while qualitative data were analyzed thematically. Results: SMDS-9 scores were generally low; only 2.7% of participants reported low feeding intention. No significant association was found between problematic social media use and breastfeeding intention or attitudes. Mothers with strong breastfeeding intentions demonstrated significantly more positive attitudes toward nursing than those with lower intentions. Higher problematic social media use was observed among high school graduates and those from high-income groups. Qualitative analysis identified two main themes of Negative Impacts and Positive Impacts, as well as five sub-themes of comparison and inadequacy, information overload, breastfeeding mistakes, anxiety, and social support. Conclusions: Problematic social media use did not directly affect breastfeeding intentions or attitudes; however, high school-educated and high-income mothers were more likely to report higher usage. Incorporating social media literacy into prenatal education and adapting tools for assessing postpartum anxiety to include indicators for problematic social media use, particularly for these at-risk groups, may support early detection, reduce stress, and promote positive breastfeeding practices. Full article

SARS-CoV-2 infection in pregnant women can lead to pregnancy-related complications. This work aims to study the spectrum of pathological changes in the placentas of SARS-CoV-2-infected pregnant women. The study involved 50 pregnant women with COVID-19 disease in the first (group I), second (group II), and third (group III) trimesters. Placental sections were examined by histopathology, electron microscopy, and immunohistochemistry to assess structural and molecular changes. The placentas of SARS-CoV-2-affected pregnant women exhibit nonspecific pathological changes, primarily associated with impaired blood circulation. The most frequent findings include thrombosis, chorangiosis, villous edema, and fibrinoid necrosis, all indicative of endothelial dysfunction. Increased expression of sclerostin and Annexin A2 was also detected in affected placentas. The main submicroscopic manifestations of placental insufficiency in COVID-19-affected women are dystrophic–destructive changes in the stroma of the villi, manifested by edema and fibrous processes, which cause significant disruption of the fetoplacental barrier. SARS-CoV-2 causes thrombotic and sclerotic changes, mainly in the maternal portion of the placenta. The manifestation of pathological changes in the placenta of COVID-19-affected women depends on the pregnancy period during which infection by SARS-CoV-2 has occurred. The established findings may provide insights into the connection between COVID-19 in pregnancy and antenatal and perinatal outcomes. Full article

Background/Objectives: The reciprocal relationship between Systemic Lupus Erythematosus (SLE) and pregnancy continues to elude the scientific community’s approaches for a clear understanding. Multiple studies have reached dissimilar results regarding the impact that SLE exerts on pregnancy, whilst the potential risks of lupus pregnancies continue to encumber women of childbearing age. Whether SLE predisposes to a complicated pregnancy and conversely whether pregnancy impacts the progression of the disease is aimed to be assessed by this systematic review. Methods: A thorough search of original research articles was conducted using online databases (PubMed, Google Scholar), initially identifying 877 potential studies. Results: Upon further assessment for relevance and eligibility, 65 articles were selected for detailed analysis. Conclusions: We concluded that, even though advanced approaches have optimized SLE prognosis and treatment, the complexity of the disease requires further extensive study in order to grasp the mechanism behind the susceptibility to adverse complications. SLE pregnancy cannot be considered without risk. Comprehensive, multidisciplinary, and continuous monitoring of the disease course prior to, during, and after pregnancy is necessary to ensure optimal recovery and minimal maternal and fetal complications. Tailored treatments and novel biomarkers would move us towards precise patient-centered care that addresses each patient’s unique disease profile and pregnancy needs, ultimately improving both maternal and fetal outcomes in women with systemic lupus erythematosus. Full article

Background/Objectives: Maternal depression, anxiety, perceived stress, and resilience are recognized determinants of perinatal health, yet routine psychological screening is still uncommon in Romanian obstetric practice. This study examined how these four psychological factors relate to preterm birth, gestational hypertension, intra-uterine growth restriction (IUGR), and low birth weight in primiparous women. Methods: In a cross-sectional study at a tertiary maternity center in Timișoara (February 2024–February 2025), 240 women at 20–28 weeks’ gestation completed the Edinburgh Postnatal Depression Scale (EPDS), Generalized Anxiety Disorder-7 (GAD-7), Perceived Stress Scale-10 (PSS-10), and Connor–Davidson Resilience Scale-25 (CD-RISC-25). Obstetric outcomes were abstracted from medical records. Pearson correlations described bivariate associations; multivariate logistic regression assessed independent effects after mutual adjustment. Results: Preterm birth occurred in 21% of pregnancies, gestational hypertension in 17%, IUGR in 15%, and low birth weight in 21%. Higher EPDS, GAD-7, and PSS-10 scores correlated positively with each complication (r = 0.19–0.36; p < 0.02), whereas CD-RISC-25 scores showed inverse correlations (r = −0.22 to −0.29; p ≤ 0.012). In the fully adjusted model, GAD-7 remained the only independent psychological predictor of the composite obstetric outcome (β = 0.047; 95% CI 0.010–0.083; p = 0.013). Perceived stress approached significance; depression and resilience were no longer significant after adjustment. Conclusions: Generalized anxiety was the most robust psychological determinant of adverse obstetric outcomes, with perceived stress, depression, and lower resilience showing contributory roles at the unadjusted level. Incorporating brief instruments such as the GAD-7, PSS-10, and CD-RISC-25 into routine prenatal care could facilitate early identification of at-risk pregnancies and inform targeted preventive interventions. Full article

Background: The potential impact of maternal SARS-CoV-2 infection during pregnancy on the neurodevelopment of offspring has raised considerable concern. Emerging studies have evaluated various developmental domains in exposed infants, yet findings remain inconsistent. Objective: To synthesize current evidence regarding neurodevelopmental outcomes in infants born to mothers with confirmed SARS-CoV-2 infection during pregnancy. Methods: We conducted a narrative review following PRISMA guidelines. A literature search was performed in PubMed, Cochrane, and ScienceDirect using keywords including “COVID-19”, “pregnancy”, “neurodevelopment”, and “SARS-CoV-2”. Nineteen studies were included. Data were extracted regarding study design, sample size, timing of exposure, age at assessment, developmental tools used, and key findings. Study quality was assessed using the Newcastle–Ottawa Scale. Results: Among 19 included studies, 12 reported at least some neurodevelopmental delays, particularly in motor and language domains. However, these delays were generally mild, domain-specific, and often not statistically significant. Seven studies, most of which were high-quality and low-risk, reported no significant differences between exposed and unexposed groups. Assessment tools and follow-up durations varied widely, limiting comparability. Conclusions: Current evidence does not support a consistent association between in utero SARS-CoV-2 exposure and an unfavorable neurodevelopmental outcome up to 24 months. However, heterogeneity in methods and short-term follow-up warrant further high-quality longitudinal research. Full article