Search Results (2,967)

Environmental stressors during the crucial period of fetal development can have a substantial impact on long-term health outcomes. A major concern is dietary exposure to endocrine-disrupting chemicals (EDCs), which can readily cross the placenta and disrupt fetal hormonal signaling and developmental programming. Examples of these chemicals include bisphenols, phthalates, pesticides, and persistent organic pollutants (POPs). Prenatal exposure to EDC has been associated with long-term effects in children, including immune disruption, metabolic dysregulation, impaired neurodevelopment, and reproductive alterations, as evidenced by human cohort studies and experimental models. Epigenetic reprogramming, direct interference with endocrine signaling, and oxidative stress (OS) are hypothesized pathways for these adverse consequences, which often combine to produce long-lasting physiological changes. This narrative review summarizes current research on maternal dietary exposure to EDCs during pregnancy, highlighting associations with adverse child health outcomes. It also discusses the growing evidence of transgenerational effects, the potential mechanisms linking prenatal exposure to long-term outcomes, and the importance of understanding the roles of timing, dosage, and chemical type. By highlighting the necessity of focused interventions to lower maternal EDC exposure and lessen threats to the health of offspring, the review concludes by discussing implications for future research, preventive measures, and public health policy. Full article

Background/objectives: Maternal adiposity is a known risk factor for adverse pregnancy outcomes, yet routine antenatal care primarily relies on body mass index (BMI), which has limitations. This study aimed to explore the acceptability of incorporating a broader range of adiposity measurements into early pregnancy antenatal care, assessing pregnant women’s perceptions to inform implementation strategies. Methods: A qualitative study using semi-structured interviews was conducted with 14 pregnant women purposively sampled to capture variation in BMI, age, and parity. Interviews occurred approximately 4–5 months post-measurement experience. The Theoretical Framework of Acceptability (TFA) guided thematic analysis of transcribed data, with independent coding to ensure rigour. Results: Participants generally viewed the current reliance on BMI as outdated and expressed neutral to positive attitudes toward the use of more detailed adiposity measurements. Most reported little emotional discomfort with the process. However, some reflected likelihood of more body self-consciousness had it been their first pregnancy. Time involved in measurements was not seen as burdensome, however waiting between procedures was a minor inconvenience. Self-assessing body shape was described as difficult. Women emphasised the importance of choice, autonomy, and informed consent, especially in relation to partner involvement, the gender of the anthropometrist, and the nature of the procedures. Clear, advance communication and supportive explanations during appointments were seen as essential to ensuring a positive experience. Conclusions: Expanding adiposity assessments in early pregnancy is acceptable to women if implemented ethically, prioritising consent, privacy, emotional safety, and effective communication. Integration into routine care requires staff training and pre-appointment guidance. Full article

Background: The definitions and approaches used to diagnose gestational diabetes (GD) are varied. The two-step approach recommended by the American College of Obstetricians and Gynecologists (ACOG) combines the sensitivity of a glucose challenge test (GCT) with the specificity of a 3-hour oral glucose tolerance test (OGTT). We investigated if minor modification of the two-step procedure can provide improved detection of GD by identifying a risk group of pregnant women with high risk of GD. Methods: We conducted a prospective cohort study of pregnant women enrolled early during pregnancy and followed till delivery. All participants underwent the ACOG-recommended two-step procedure for GD diagnosis. Based on GCT and OGTT results, the participants were divided into four risk groups (RGs): GCT-negative (RG0), GCT-positive but OGTT normal (RG1), single abnormal value on OGTT or raised HbA1c (RG2) and diagnosed GD (RG3). Baseline evaluation included dietary history (24 hour recall) and physical activity. A series of multivariable logistic regression analyses were conducted to estimate the odds of maternal and fetal outcomes. Results: A total of 1041 pregnant women were included in the study, of whom 16 (1.6%) were diagnosed as GD. Our two-step approach identified 48 (4.6%) women as GD, while RG2, RG1 and RG0 comprised 75 (7.2%), 218 (20.9%) and 700 (67.2%), respectively. Compared to RG0, RG2 showed a higher likelihood of antepartum complications [odds ratio and 95% confidence interval 2.38 (1.16–4.15)], any adverse outcome without [2.04 (1.17–3.55)] or with cesarean section [2.09 (1.21–3.61)] and primary cesarean section [1.68 (1.01–2.81)] after adjustment for potential confounders. RG2 was also significantly associated with pregnancy-induced hypertension, meconium-stained amniotic fluid and premature rupture of membranes. Conclusions: In the study participants, we identified a subgroup (RG2) at high risk of GD with perinatal outcomes showing profile consistent with that of GD. Full article

Background: Odontogenic abscesses may significantly affect maternal health during pregnancy. Aim: This study analyzes three cases of pregnant patients with odontogenic infections, comparing them to a control group of non-pregnant women, and reviews recent literature. Materials and Methods: Between January 2020 and April 2025, 3 pregnant and 70 non-pregnant women with odontogenic abscesses were treated. Clinical presentation, pathogens, therapy, and outcomes were compared. Results: Severe sequelae, such as rapid abscess spread and systemic inflammation, were more frequent in pregnant women, though not statistically significant (p = 0.068). Pregnant patients also tended toward prolonged intubation (p = 0.194) and targeted antibiotic use (p = 0.133). Antibiotic selection was based on gestational age, with beta-lactams preferred. Surgical interventions were more extensive, often involving multiple neck spaces. Hospitalization was longer (≥4 days in most cases) due to maternal–fetal monitoring. Conclusions: Odontogenic abscesses in pregnancy require individualized management and gestation-adjusted antibiotic therapy. Full article

Background and Clinical Significance: The occurrence of acute myeloid leukemia (AML) in pregnancy represents a diagnostic and management challenge in the attempt to balance and achieve both maternal and fetal wellbeing. Pregnancy-specific manifestations mimic the initial symptoms of leukemia and may lead to a delay in diagnosis, especially during the first trimester of pregnancy. Decision-making strategies involve the patient and couples counseling with a multidisciplinary team of hematologists, obstetricians, neonatologists and psychologists. Maternal outcome depends on the disease subtype, progression and response to medication. Fetal outcome depends on other potential pregnancy complications, possible teratogenicity, gestational age at delivery and sometimes iatrogenic prematurity. Case Presentation: We present the case of a 38-year-old multiparous patient with a late first trimester, with an AML diagnosis presenting with hyperemesis gravidarum-like symptoms. Genetic testing revealed the presence of an Fms-like tyrosine kinase 3-internal tandem duplication mutation (FLT3-ITD). Following that, a repeatedly refused termination of pregnancy and rapid disease progression with azacitidine therapy was initiated. Elective cesarean delivery was performed at 34 weeks of gestation due to progressive leukocytosis, which persisted postpartum, requiring the use of first-, second-, and eventually third-line chemotherapy. Fetal outcome was favorable at 3 months postpartum. Conclusions: Cases of AML in pregnancy require a tailored approach according to guidelines, but also patient/couple preferences, while the choice of chemotherapy is limited considering its potential teratogenic effects. This is a case with a misleading first presentation and a challenging therapeutic choice due to its genetic subtype and maternal treatment postponement. Full article

Caffeine is one of the most widely consumed psychoactive substances globally and is a common component of daily diets, particularly among women of reproductive age. Numerous in vitro and in vivo studies have indicated potential adverse effects of prenatal caffeine exposure, including disturbances in fetal growth, metabolic dysregulation, organ malformations, and neurodevelopmental alterations. These findings suggest that caffeine may influence multiple physiological pathways during gestation, including epigenetic modifications and metabolic programming. However, evidence from human studies remains heterogeneous and often inconclusive. Recent cohort studies and meta-analyses have reported that moderate maternal caffeine intake is not significantly associated with increased risks of gestational diabetes mellitus, gestational hypertension, or preeclampsia, although higher intake levels have been linked to anemia, preterm birth, and low birth weight in some populations. Furthermore, emerging data suggest potential associations between prenatal caffeine exposure and early neurodevelopmental outcomes, including behavioral changes, subtle structural brain differences, and alterations in offspring metabolic health and obesity risk. Despite these findings, the magnitude and clinical relevance of these effects remain uncertain, partly due to variability in caffeine sources, dosages, study designs, and reliance on self-reported intake. This review aims to synthesize current evidence on maternal caffeine consumption, its impact on pregnancy complications, fetal development, and long-term child health outcomes. By integrating experimental and clinical data, the study provides a comprehensive overview that may assist clinicians and healthcare professionals in counseling pregnant women regarding caffeine intake and potential risks. Full article

Background and Objectives: Iron deficiency anemia (IDA) is the most common cause of anemia in pregnant women and can adversely affect both maternal and fetal health. This study aimed to compare pregnancy outcomes between women with and without IDA in Northern Thailand, a region with a high prevalence of anemia. Methods: A retrospective cohort study was conducted on all singleton pregnancies attending antenatal care (ANC) and/or delivering at Maharaj Nakorn Chiang Mai Hospital between 2003 and 2024. The study group consisted of women diagnosed with IDA in the first half of pregnancy, while the control group comprised women with low-risk pregnancies during the same study period. Results: Of the 38,979 pregnancies, after applying exclusion criteria, 634 pregnancies (2.2%) with laboratory-confirmed IDA and 28,132 controls remained available for analysis. Women with IDA had significantly higher parity, lower socioeconomic status, and lower hemoglobin levels throughout pregnancy. Multivariate regression analysis revealed that IDA was significantly associated with increased risks of preterm birth (adjusted odds ratio; aOR 1.04; 95% CI: 1.01–1.07), fetal growth restriction (FGR) (aOR 1.02; 95% CI: 1.00–1.04), and low birth weight (aOR 1.05; 95% CI: 1.03–1.08). Conclusions: IDA, even with treatment, may still slightly increase the risk of adverse pregnancy outcomes, particularly preterm birth, fetal growth restriction, and low birth weight. The residual risk likely reflects incomplete correction of anemia. Optimizing management requires strict compliance, judicious use of parenteral iron, and attention to coexisting nutritional deficiencies, underscoring the need for closer monitoring and improved care strategies. Full article

Maternal overweight and obesity have reached global epidemic levels, altering metabolic adaptations during pregnancy and lactation. Beyond their well-known impact on gestational outcomes, elevated BMI profoundly influences the secretion of adipokines—hormones derived from adipose tissue that circulate in maternal blood and are secreted into breast milk—thereby directly linking maternal metabolism to offspring development. In this state-of-the-art narrative review, we synthesize current evidence on how maternal overweight and obesity shape concentrations of key adipokines (leptin, adiponectin, ghrelin, obestatin, and resistin) in serum, cord blood and breast milk. Excess maternal weight robustly increases leptin, while effects on adiponectin, ghrelin, obestatin, and resistin remain uncertain. To our knowledge, this is the first review to focus specifically on the impact of maternal overweight and obesity on adipokine alterations across both pregnancy and lactation. Future studies should apply standardized sampling and analytical protocols and use longitudinal designs including body composition assessments to clarify their role in maternal and child metabolic health. Full article

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: Immunisation remains one of the most effective and cost-efficient public health interventions for preventing infectious diseases in children. Despite global progress, Sub-Saharan Africa (SSA) continues to face challenges in achieving equitable immunisation coverage. Gender-related disparities, rooted in sociocultural and structural inequalities, significantly influence the prevalence of zero-dose and under-immunised children in the region. This review critically examines the gender-associated barriers to routine childhood immunisation in SSA to inform more inclusive and equitable health interventions. Methods: A critical literature review was conducted generally following some steps of the PRISMA-P and CRD guidelines. Using the Population–Concept–Context (PCC) framework, studies were selected that examined gender-related barriers to routine immunisation for children under five in Sub-Saharan Africa. Comprehensive searches were performed across PubMed, Google Scholar, and relevant organisational websites, targeting articles published between 2015 and 2025. A total of 3683 articles were retrieved, with 24 studies ultimately meeting the inclusion criteria. Thematic analysis was used to synthesise the findings. Results: Four major themes emerged: (1) women’s empowerment and autonomy, including limited decision-making power, financial control, and the impact of gender-based violence; (2) male involvement and prevailing gender norms, where patriarchal structures and low male engagement negatively influenced vaccine uptake; (3) socioeconomic and structural barriers, such as poverty, geographic inaccessibility, maternal workload, and service availability; and (4) education, awareness, and health system responsiveness. Conclusions: Gender dynamics have a significant impact on childhood immunisation outcomes in Sub-Saharan Africa. Future policies must integrate these insights to improve immunisation equity and reduce preventable child morbidity and mortality across the region. Full article

Background/Objectives: Human colostrum plays a crucial role in early microbial colonization, immune development, and gut health of newborns. Its microbiota is highly dynamic and influenced by numerous factors, yet the determinants remain poorly understood. This systematic review aims to investigate the composition of colostrum microbiota and the intrinsic and extrinsic factors that influence its diversity and abundance. Methods: PubMed and Scopus were systematically searched using a prespecified search phrase. Data on microbial composition, diversity, and influencing factors were extracted and analyzed. The systematic review is registered in PROSPERO (CRD42025644017). Results: A total of 44 eligible studies involving 1982 colostrum samples were identified. Colostrum microbiota consists predominantly of Firmicutes and Proteobacteria, with core genera including Staphylococcus, Streptococcus, Lactobacillus, and Bifidobacterium. Some studies reported higher diversity in colostrum compared to mature milk, while others noted elevated bacterial abundance in the former. Factors influencing colostrum microbiota include maternal BMI, delivery mode, gestational age, diet, gestational diabetes mellitus (GDM), maternal stress, maternal age, secretor status, perinatal antibiotic exposure, neonatal gender, geographic location, feeding type, milk collection method, and mastitis. Conclusions: Colostrum hosts a diverse and dynamic microbiota shaped by multiple maternal, neonatal, and environmental factors. Understanding these influences is crucial for optimizing infant health outcomes, emphasizing the need for further research on the functional roles of colostrum’s microbiota. Full article

Background/Objectives: Alcohol and smoking during pregnancy may be associated with several complications, but the underlying mechanism is still unclear. The aim of this study was to evaluate the role of oxidative stress induced by smoking and alcohol during pregnancy and their effects on fetal and neonatal outcomes. Material and methods: We considered pregnant women at term. Validated questionnaires were used to investigate smoking and alcohol habits. Ultrasound was performed to evaluate fetal weight, amniotic fluid index, and maternal-fetal Doppler velocimetry. At the time of delivery, we collected a tuft of maternal hair, maternal venous blood, and cord blood. In these samplings we determined in phase I nicotine, cotinine, and ethyl glucuronide on the maternal keratin matrix with the gas chromatography-mass spectrometry technique. In phase II, the Free Oxygen Radicals Test (FORT) and Free Oxygen Radical Defense (FORD) test were used to assess circulating reactive oxygen species (ROS). Results: 119 pregnant patients were enrolled (n = 62 for smoking and n = 57 for alcohol). Twenty-six patients (42%) out of 62 were active smokers. Three patients (5%) out of 57 were alcoholic consumers. Mean neonatal weight and mean placental weight were significantly lower for active smokers (p = 0.0001). The neonatal weight was in the 1st–2nd percentile for all alcohol abusers. Considering two subgroups (n = 10 non-smokers and n = 10 smokers) for ROS determination, a statistically significant higher oxidative stress in the blood of smoking patients was evidenced (p < 0.0001). In cord blood the differences were not statistically significant (p = 0.2216). Conclusions: Fetal growth restriction was present in the group of active smokers and in patients with alcohol abuse. Oxidative stress was higher in smoking patients than in non-smokers. However, in cord blood, FORT was negative in all cases, suggesting a protective mechanism in utero. Given the limited sample size, the results obtained are preliminary and require future studies. Full article

Objective: To evaluate the predictive value of umbilical artery half peak systolic velocity deceleration time (UA hPSV-DT) for composite adverse perinatal outcomes (CAPO) in pregnancies complicated by gestational diabetes mellitus (GDM). Methods: In this prospective observational study, 120 singleton pregnancies in the third trimester were enrolled: 30 insulin-regulated GDM (IRGDM), 30 diet-regulated GDM (DRGDM), and 60 healthy controls. UA hPSV-DT and standard Doppler indices were measured using a standardized protocol by a single perinatologist. An abnormal UA hPSV-DT was defined as <5th percentile for gestational age. Maternal metabolic parameters, fetal biometry, and neonatal outcomes were recorded. The primary outcome was CAPO, defined as the presence of one or more adverse perinatal events. Results: Median UA hPSV-DT values were significantly lower in IRGDM (171 ms) and DRGDM (184 ms) compared with controls (227 ms) (p = 0.006). Abnormal UA hPSV-DT occurred in 43.3% of GDM cases and was associated with higher estimated fetal weight and abdominal circumference percentiles, increased amniotic fluid, elevated OGTT values, higher HbA1c, and more frequent insulin therapy (p < 0.01 for all). In GDM pregnancies, CAPO occurred in 73.1% of the abnormal UA hPSV-DT group versus 11.8% of the normal group (p < 0.001). ROC analysis identified a cut-off of < 181 ms for predicting CAPO (AUC 0.741, 70.3% sensitivity, 66.7% specificity). Conclusions: UA hPSV-DT is a novel, reproducible Doppler parameter that independently predicts adverse perinatal outcomes in GDM pregnancies, even when conventional UA Doppler indices are normal. Incorporating UA hPSV-DT into routine surveillance may improve risk stratification and guide management to optimize perinatal outcomes. Full article

Breastfeeding is a complex biological system and a bidirectional physiological dialogue in which the infant may contribute to maternal breast health. This review synthesizes current evidence, clearly separating established findings from emerging hypotheses, to examine the possible infant-driven mechanisms that influence hormonal and immune homeostasis in the mammary gland. We evaluate how neonatal suckling coordinates interconnected hormonal reflexes and immune activity, and we explore the hypothesis that the retrograde flow of infant saliva to the breast tissue could activate maternal enzymatic defenses, particularly the xanthine oxidase and lactoperoxidase systems. We also consider the activation of antimicrobial peptides through direct contact at the nipple and areola, including cathelicidin and defensins, as well as the potential roles of fetal microchimerism and microbial transfer from the infant’s mouth in strengthening breast resilience. Although much of the evidence remains indirect and based on in vitro and animal models, the convergence of data supports a reformulated conceptual model that presents the infant as an active physiological partner rather than a passive recipient of milk. Recognizing this shift has important clinical implications for the prevention of inflammatory conditions such as mastitis, the improvement of breastfeeding support strategies, and the optimization of maternal and infant health outcomes. The review also identifies significant gaps in current knowledge and cautiously proposes hypotheses to explore these mechanisms. While preliminary, this framework offers an original perspective that may guide future research and open new paths in the study of human lactation biology. Full article

Background/Objectives: Gestational diabetes mellitus (GDM) is one of the most common metabolic complications of pregnancy and is linked to long-term metabolic and cardiovascular risks for both mother and child. Its pathophysiology includes increased generation of reactive oxygen species (ROS) and/or decreased antioxidant defenses; nonetheless, the redox dynamics between mother and fetus are still poorly understood. Our goal was to assess oxidative stress (via derivatives of reactive oxygen metabolites, d-ROMs) and antioxidant capacity (via biological antioxidant potential, BAP) in maternal, umbilical cord, and neonatal blood from women with GDM compared to normoglycemic controls, and to investigate potential associations with clinical and neonatal outcomes. Methods: In this single-center cross-sectional study, 56 women with GDM and 52 matched controls provided maternal venous, umbilical cord, and neonatal blood samples at delivery. Plasma d-ROMs and BAP were measured using colorimetric assays. Clinical and neonatal outcome data were collected. Results: Women with GDM had considerably higher maternal d-ROM levels compared to both the umbilical cord and neonatal compartments. BAP measurements revealed that maternal blood had the lowest antioxidant capacity, while cord and newborn samples had higher levels. GDM mothers had significantly greater maternal d-ROMs and lower BAP compared to controls (both p < 0.05). There were no differences in cord blood d-ROMs or BAP between the GDM and the control group. The maternal BAP/d-ROM ratio decreased significantly in the GDM group (p < 0.01), but the cord ratio remained constant. Notably, neither maternal nor neonatal redox indicators were related to perinatal outcomes, indicating a limited prognostic potential for unfavorable neonatal occurrences. Conclusions: GDM is associated with increased maternal oxidative stress and decreased antioxidant capacity, with no substantial changes in newborn redox status. Redox indicators did not predict perinatal issues across this group. These findings demonstrate the need for larger prospective research to determine whether early changes in redox balance can predict the development of GDM or unfavorable outcomes. Full article