Search Results (8,080)

Background: Patients described as high-need, high-cost (HNHC) represent a subset of individuals with complex multimorbidity whose healthcare trajectories are characterised by recurrent instability and intensive use of acute care services. Concepts such as trajectory disruption, resilience, and complex adaptive behaviour are widely discussed in health systems research, yet linking these ideas to longitudinal patient care remains limited. The PaJR (Patient Journey Record) relational system was designed using principles from complex adaptive systems theory, enabling longitudinal observation of patient trajectories in real-world care. Objective: This study develops a middle-range theory grounded in longitudinal relational monitoring data. Methods: Two datasets (MonashWatch and Irish cohorts) provide empirical grounding through descriptive analysis of signal clustering, distribution, and multi-domain patterns. Monitoring calls capture structured patient-reported signals across multiple domains, including illness, medication, healthcare utilisation, social support, environmental factors, and self-care. Results: Results demonstrate long-tail signal distributions, temporal clustering, and multi-domain instability preceding admission. Alerts frequently occurred in clusters across consecutive monitoring calls 88% of alert calls were part of a consecutive alert sequence, with approximately 64% of alert calls occurring immediately after a previous alert. Alerts were also commonly multi-domain, with approximately 64% involving disturbances across more than one domain simultaneously.Conclusions: Longitudinal relational monitoring reveals instability patterns in patient journeys that are not visible in episodic health-system data. Recognising these instability phases may enable earlier, more adaptive responses for patients with complex healthcare needs and provides empirical grounding for emerging theories of healthcare trajectories within complex adaptive systems. Although grounded in relational monitoring data, the instability–plasticity framework may extend to inform interpretation across physiological and connected health monitoring systems. Full article

Aim: We aimed to provide a structured ex vivo protocol for cardiopulmonary micro-CT that combines gelatin–barium sulfate (gelatin–BaSO₄) contrast medium with agar embedding in neonatal canine cardiopulmonary specimens. Materials and Methods: Heart–lung specimens from 23 puppies that died shortly after birth were collected, stored at −20 °C, and then slowly thawed prior to imaging. Before perfusion, body mass and heart–lung complex mass were recorded. Body mass ranged from 140 to 951 g, and heart–lung complex mass ranged from 1.2 to 51.2 g. The cranial and caudal venae cavae, the brachiocephalic trunk, and the left subclavian artery were ligated. A catheter was introduced into the thoracic aorta. Contrast was prepared by dissolving porcine gelatin in hot water and mixing with a commercial BaSO₄ suspension. The mixture was maintained at a warm temperature to remain free-flowing and was delivered at low pressure until uniform opacification of the coronary and pulmonary arteries was observed. After in situ gelation, the organs were embedded in warm agar and sealed to limit motion and dehydration. Scans were performed on a benchtop system (120 kV, ~83 µA, ~1200 projections, ~2 s exposures; voxel ~40 µm). Reconstruction was performed in XMReconstructor, with post-processing in Falcon and RadiAnt. The reconstructed micro-CT datasets were reviewed anatomically by a medical cardiologist and a veterinary cardiologist, whereas vascular filling was evaluated semi-quantitatively by three observers with expertise in veterinary anatomy and cardiology. Results: In all specimens examined, the main coronary artery course was assessable. Conclusions: The gelatin–BaSO₄ contrast medium combined with agar immobilization provides a simple, lead-free, and affordable approach for structured cardiopulmonary micro-CT in very small post-mortem specimens. In the examined specimens, the workflow provided visually consistent low-pressure vascular opacification without gross evidence of vessel rupture or motion-related acquisition failure under the conditions of this study. Practical mitigations included temperature/viscosity control, avoidance of phosphate buffers, container sealing, and minimization of particle aggregation, bubbles, and dehydration. The protocol may complement conventional autopsy in very small post-mortem specimens in similar ex vivo research settings. Full article

Objective: To evaluate adverse effects associated with biologic therapy (Etanercept, Adalimumab, and Secukinumab) in patients with psoriasis, psoriatic arthritis, and hidradenitis suppurativa. Methods: This retrospective observational study included 58 patients receiving biologic therapy: 40 with generalized plaque psoriasis, 13 with psoriatic arthritis, and 3 with hidradenitis suppurativa. Eligibility was based on national treatment protocols (Psoriasis Area and Severity Index [PASI] > 10; Hurley stage II–III). Demographic data, treatment duration, therapy modifications, discontinuations, and adverse events were collected from medical records. Patients were monitored for both efficacy and safety outcomes. Results: Treatment discontinuation due to severe hepatotoxicity occurred in four patients (three receiving Etanercept and one Adalimumab), corresponding to 6.9% of the cohort. Adalimumab was discontinued in one patient due to cutaneous leishmaniasis after 24 months and in another due to pregnancy after 26 months. Upper limb edema was observed following a switch from Adalimumab to Secukinumab. One patient discontinued Etanercept due to lack of efficacy and subsequently died from a fatal methotrexate overdose. Treatment switches included Etanercept to Adalimumab for granulomatous uveitis (one case) and Adalimumab to Etanercept due to generalized urticaria (two cases). Conclusion: Adverse events were relatively infrequent, with an overall incidence below 10% (6.9% for the most common event and <2% for other events). Most adverse events were mild and reversible following dose adjustment or temporary discontinuation. No unexpected or fatal adverse events were directly attributable to biologic therapy. Full article

Background: Body contouring surgery is a critical aspect of reconstructive and esthetic care, addressing both functional and psychosocial needs. As the global prevalence of obesity and related metabolic disorders is constantly on the rise, it is inevitable that patients presenting for body contouring procedures would display comorbid cardiometabolic conditions that can negatively impact surgical outcomes. Clustered cardiometabolic abnormalities have been linked to increased rates of surgical complications, medical adverse events, prolonged hospitalization, and need for revision procedures. However, its impact on body contouring surgery outcomes remains insufficiently characterized. Materials and Methods: TriNetX Global Collaborative Network, comprising deidentified electronic medical records from over 170 healthcare organizations was utilized for this study. Adults undergoing body contouring surgery were stratified by the presence of a composite cardiometabolic burden, defined as the combination of obesity, diabetes mellitus and hypertension, in the year preceding surgery. Cohorts were matched 1:1 using propensity score matching based on baseline demographics, comorbidities, and substance use. Risk ratios with 95% confidence intervals were calculated, with statistical significance set at p < 0.05. Outcomes were assessed at 30, 60, and 90 days postoperatively. Results: Among 188,164 body contouring patients, 6892 with composite cardiometabolic burden were propensity score–matched to controls. The study group was associated with significantly higher wound complications, surgical site infections, antibiotic use, and emergency department visits at 30, 60, and 90 days postoperatively, with no difference in hypertrophic scarring. Conclusions: Composite cardiometabolic burden, as defined in the study, demonstrated a significantly increased risk of adverse events following body contouring surgery, including wound-related morbidity, surgical site infection and increased healthcare utilization. These risks are evident from the early postoperative period and persist through at least the first 90 days after the procedure. Full article

Background/Objectives: Clinical phenotyping from narrative electronic health records (EHRs) often relies on multi-stage pipelines involving span-level extraction, ontology mapping, and aggregation. Large language models (LLMs) may enable direct document-level abstraction of clinically meaningful phenotype features from complete notes. We evaluated whether GPT-5.2 could approximate human annotation for note-level multiple sclerosis (MS) phenotyping and compared its performance with human annotators, a locally run open-source LLM, HPO-based extraction tools, and a supervised clinical transformer encoder. Methods: We analyzed 100 de-identified MS neurology progress notes from a single academic medical center. Each note was annotated for the presence or absence of 17 predefined neurological phenotype categories. Two human annotators independently labeled all notes using a multi-label note-level framework in Prodigy, and disagreements were adjudicated to create a reference annotation set. GPT-5.2 was evaluated in a zero-shot setting using structured JSON output. Comparator methods included Llama-3.1 8B, Doc2Hpo, ClinPhen, PhenoSnap, and BioClinical ModernBERT. Performance was assessed using agreement, precision, recall, F1, Matthews correlation coefficient, and false-positive and false-negative assignments per note. Results: Human–human agreement was generally high, although lower for rare or ambiguously documented features. GPT-5.2 achieved the strongest automated performance, with macro-precision 0.734, macro-recall 0.921, macro-F1 0.801, and macro-averaged MCC 0.777, approaching human annotator performance. GPT-5.2 showed the lowest false-negative count per note but more false-positive assignments than either human annotator, reflecting a sensitive but more inclusive annotation profile. Llama-3.1 8B performed competitively among automated methods, whereas HPO-based extraction tools and BioClinical ModernBERT showed lower performance on this low-resource note-level task. Secondary review of GPT-5.2 discordant assignments found no clear hallucinations and suggested that some apparent false positives reflected phenotype evidence missed in the human-derived reference set. Conclusions: GPT-5.2 achieved near-human performance for document-level recognition of MS phenotype categories from narrative neurology notes. Direct note-level abstraction may provide a scalable approach for research and population-health phenotyping of large EHR note corpora. Full article

Background: Primary healthcare systems continue to face patient safety challenges, particularly misdiagnosis and medication errors, which contribute to preventable harm and reduced quality of care. Electronic Medical Records (EMRs) have the potential to improve clinical documentation, support decision-making, and reduce risks; however, these benefits depend on effective utilization in routine clinical practice. This study examined factors influencing EMR utilization in primary healthcare settings. Methods: A sequential explanatory mixed-methods design was conducted across 42 community health centers in one Indonesian city. Quantitative data from general practitioners were analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM) to examine the relationships among clinical workflow fit, digital health competency, governance, system capabilities, interprofessional collaboration, perceived patient engagement, and EMR utilization. Qualitative interviews were subsequently conducted to provide a contextual explanation of the quantitative findings. Results: Clinical workflow fit and digital health competency emerged as the strongest factors associated with EMR utilization. Their effects operated through interprofessional collaboration and perceived patient engagement, indicating the importance of integrating EMRs into everyday clinical workflows. Governance structures and system capabilities primarily functioned as enabling conditions rather than direct determinants of utilization. Qualitative findings further highlighted the importance of practical workflow integration, communication processes, and user competency in supporting meaningful system use. Conclusions: EMR utilization may contribute to improved care coordination, patient engagement, and service efficiency in primary healthcare settings. Strengthening workflow alignment and digital competency may help support safer and more reliable care delivery, particularly in resource-constrained environments where risks of misdiagnosis and medication errors remain significant. Full article

Background and Objectives: The systemic inflammatory response is important in cancer prognosis and progression. The inflammatory burden index (IBI) provides information about both inflammation and the immune response. Urothelial carcinomas are immunogenic; therefore, it has been suggested that inflammatory indices may predict disease prognosis. The aim of this study was to investigate the effects of systemic inflammatory indices, particularly the inflammatory burden index, on disease progression and overall survival in patients with metastatic urothelial cancer (affecting the bladder and upper urinary system) before first-line treatment and to demonstrate their prognostic importance. Materials and Methods: Within the scope of the study, the medical records of 130 patients who received systemic treatment for metastatic urothelial carcinoma at the medical oncology clinic were retrospectively reviewed. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal threshold values for IBI. Survival rates were calculated using the Kaplan–Meier method, and survival differences between groups were compared with the log-rank test. Univariate and multivariate analyses were performed using the Cox proportional hazards regression model to evaluate prognostic factors. Results: A total of 130 patients were included in the study. The median age was 64.9 years (IQR: 57.2–70.5). The primary tumor location was the bladder in 84.6% of patients, while the remaining 15.4% originated from the ureter and renal pelvis. In first-line systemic treatment, patients received a median of 4 cycles (IQR: 3–6). The median number of total treatment lines administered for metastatic disease was 1 (IQR: 1–2). In progression-free survival (PFS) analyses, the median PFS was 9.20 (95% CI 6.55–11.85) months in the IBI-low group (n = 47) and 5.82 (95% CI 4.56–7.07) months in the IBI-high group (n = 83) (p < 0.001). The median OS was calculated to be 18.96 (95% CI 16.61–21.30) months in the IBI-low group (n = 47), while it was found to be 9.50 (95% CI 7.70–11.29) months in the IBI-high group (n = 83) (p < 0.001). In multivariate analysis, high IBI and the presence of brain metastasis were found to be associated with the risk of progression. In terms of overall survival, the presence of brain metastasis, the presence of visceral metastasis, ECOG PS status, receipt of maintenance therapy, LMR, and the IBI score showed statistically significant prognostic effects. Conclusions: In metastatic urothelial carcinoma, the IBI was identified as an independent prognostic factor associated with progression-free and overall survival. These findings suggest that the IBI may have potential utility as a prognostic biomarker; however, larger, multicenter, and prospective studies are required to further validate its clinical applicability. Full article

Objective: To develop and evaluate an edge-hosted Large Language Model (LLM)-assisted system for automated Neonatal Intensive Care Unit (NICU) discharge summary generation using an evidence-grounded, field-level evaluation framework. Methods: This implementation and evaluation study was conducted in a Level III NICU in India. Longitudinal patient records were constructed from integrated bedside physiologic data (ARCHITECT) and a structured electronic medical record (EMR) platform Although an embedded audio–video module was present, it was not used in this study. Automated discharge summaries were generated by MORPHEUS, an edge-hosted orchestration pipeline running on NVIDIA Jetson AGX Orin hardware with JetPack 6.2. Local orchestration, preprocessing, and workflow execution were performed on the edge device, while language generation inference was performed using the OpenAI gpt-4o-mini API. Documentation quality was assessed with an LLM-based evaluator guided by a clinician-defined rubric comprising 72 fields organized across 14 section contexts and scored on five dimensions: clinical accuracy, completeness, actionability, coherence, and non-hallucination. Paired, field-level comparisons were performed against clinician-authored summaries. Of 549 NICU admissions screened between 1 October 2024 and 3 November 2025, 401 met the inclusion criteria for evaluation. Prompt refinement was performed iteratively using omission-derived feedback without model weight updates. Results: Across 401 evaluated admissions, MORPHEUS-generated summaries demonstrated higher rubric-based scores and lower omission burden than clinician-authored summaries within the structured evaluation framework used in this study, with mean scores of 0.93 versus 0.75 for accuracy, 0.91 versus 0.67 for completeness, 0.93 versus 0.72 for actionability, 0.94 versus 0.74 for coherence, and 0.95 versus 0.78 for non-hallucination, with the largest absolute advantage observed for completeness. Error taxonomy analysis demonstrated fewer omissions, unsupported assertions, and contradictions in AI-generated summaries than in clinician-authored summaries. Iterative prompt refinement was associated with directional improvement across quality dimensions and reduced omission burden, with omission rate per patient decreasing from 2.484 to 1.807 in the later iteration. Conclusions: An edge-hosted LLM-assisted pipeline can generate NICU discharge summaries that meet or exceed clinician-authored documentation quality under a reproducible, clinician-grounded evaluation framework. These findings support the feasibility of deploying edge-orchestrated generative AI systems for high-stakes neonatal clinical documentation using a clinician-grounded field-level evaluation framework. Full article

Objectives: We aimed to describe the healthcare utilization and economic burden of lower respiratory tract infections (LRTIs) among children aged 1–24 months across five tertiary hospitals in Saudi Arabia. Methods: This multicenter retrospective cohort study included 14,320 children diagnosed with LRTIs between August 2021 and July 2025. Data were extracted from the electronic medical records of the Ministry of National Guard Health Affairs. Demographics were analyzed using a patient-level dataset, whereas healthcare utilization and costs were evaluated at the episode level. Data were analyzed using descriptive and inferential statistics and multivariable logistic regression. Results: A total of 14,320 children contributed 22,895 LRTI-related episodes during the study period. Nearly half of the cohort (49.4%) were aged 1–6 months, and bronchiolitis was the predominant diagnosis (84.6%), followed by pneumonia (15.1%). Overall, 34.4% of patients required hospitalization, while 7.1% required ICU admission. LRTIs accounted for 21.0% of all pediatric ward admissions across participating hospitals. Total direct healthcare costs reached USD 23.0 million. Although ICU admissions represented only 7.1% of episodes, they accounted for 45.1% of total healthcare expenditures. In multivariable analysis, pneumonia was independently associated with higher odds of ICU admission compared with bronchiolitis (aOR 2.91, 95% CI 2.43–3.48; p < 0.001). Significant seasonal variation in LRTI episodes was observed, with higher episode volumes during winter months (p = 0.004). Conclusions: Pediatric LRTIs impose substantial clinical and financial burdens, particularly among younger infants, marked by disproportionate ICU-related costs. Full article

Background/Objectives: Allergen immunotherapy (AIT) is the only disease-modifying treatment for grass pollen allergy. However, the proportion of patients interested in AIT who meet guideline-defined eligibility criteria remains unclear. This study aimed to characterise symptom burden, medication use, and AIT eligibility in adult patients with grass pollen allergy during the peak pollen season. Methods: In this multicentre, prospective, non-interventional epidemiological study, 479 adults with confirmed grass pollen allergy recorded daily nasal, ocular, and systemic symptoms, as well as anti-allergic medication use, via a validated electronic diary (CCC STUDY Diary) over a 30-day period in June/July 2025. A combined symptom–medication score (CSMS) was calculated daily, with a predefined threshold of ≥1.5 indicating clinically relevant symptom severity and potential eligibility for AIT. Both additive and weighted calculation approaches for the CSMS and the daily medication score (dMS) were evaluated to assess methodological robustness and reproducibility. Results: The mean additive CSMS was 2.14, indicating moderate symptom burden. Overall, 63.3% of participants exceeded the CSMS threshold of 1.5 and were considered eligible for AIT. Sensitivity analyses demonstrated excellent concordance between additive and weighted CSMS/dMS calculations (Spearman’s ρ >0.98; p < 0.001), and Bland–Altman analysis confirmed minimal bias (0.157) and narrow limits of agreement. Asthma was reported as a comorbidity in 36% of patients, generally associated with mild to moderate daily respiratory symptoms. Limitations included the self-reported nature of the data and a slightly reduced sample size; however, the results are representative of adult patients seeking care in specialised allergy centres in Germany. Conclusions: The CSMS also in its additive and therefore modernised form is a reliable, reproducible, and clinically meaningful tool for quantifying symptom severity and identifying patients suitable for AIT. Approximately two-thirds of adults interested in grass pollen AIT exhibited moderate to severe symptoms and were eligible for treatment according to current guideline recommendations. Full article

Background/Objectives: Patients in long-term care hospitals (LTCHs) are at increased risk of harboring antimicrobial-resistant organisms due to frequent healthcare exposure and multiple comorbidities. This retrospective observational study aimed to compare the antimicrobial susceptibility of bacterial isolates from LTCH-onset infections (LTCHIs) with those from community-acquired infections (CAIs) in elderly patients. Methods: This study was conducted at a 700-bed urban tertiary university hospital and included patients aged ≥65 years with positive cultures for bacteremia, lower respiratory tract infections (LRTIs), or urinary tract infections (UTIs) within 48 h of admission. Medical records, including antimicrobial susceptibility test results, were reviewed for a total of 1780 patients and their isolates. Antimicrobial susceptibility patterns were compared between LTCHI and CAI patients. Results: Patients with LTCHI exhibited significantly higher antimicrobial non-susceptibility than those with CAIs across multiple pathogens and antimicrobial classes (p < 0.05). In bacteremia, Staphylococcus aureus, Escherichia coli, and Klebsiella pneumoniae from LTCHI cases showed increased non-susceptibility to β-lactams and fluoroquinolones. In LRTIs, Pseudomonas aeruginosa and Acinetobacter baumannii demonstrated high non-susceptibility to carbapenems (52.9% and 90%, respectively) and aminoglycosides. In UTIs, LTCHI isolates exhibited broader resistance among Enterobacterales and P. aeruginosa. Notably, the proportion of multidrug-resistant organisms, including carbapenem-resistant Enterobacterales (15.4–50.0%) and carbapenem-resistant Acinetobacter baumannii (90.5%), was substantially higher in the LTCHI group across all infection sites. Conclusions: Elderly patients with LTCHI are more likely to harbor antimicrobial-resistant pathogens than those with CAIs. Careful consideration of LTCHI origin is therefore essential for empirical antibiotic selection and for strategies aimed at limiting further resistance. Full article

Background/Objectives: Iron deficiency early in life can impair infant growth and cognitive development. Here, we follow infants’ plasma ferritin levels—an indicator of iron stores—over the first year of life and relate these to birth characteristics, maternal characteristics, and infant feeding. Methods: Children and their mothers enrolled in the Swedish birth cohort NICE (ClinicalTrials.gov identifier: NCT05809479) were followed from pregnancy to twelve months postpartum. Plasma ferritin was quantified in umbilical cord blood at birth (n = 345), in venous plasma at four months after birth (mother–infant dyads, n = 133), and at twelve months of age (n = 158), using sandwich ELISA. Perinatal and postnatal growth, together with infant and maternal characteristics, were extracted from medical birth records. Breastfeeding and formula feeding were assessed using repeated monthly questionnaires during the first year. Longitudinal changes were analyzed using linear mixed-effects models, and factors associated with ferritin concentrations were examined using Spearman correlations, linear regression models, and segmented generalized additive models. Results: The ferritin concentration declined over time (birth: 267 ng/mL; four months: 146 ng/mL; twelve months: 30 ng/mL). Boys had lower ferritin levels than girls at all timepoints. Ferritin status at four and twelve months was positively associated with ferritin concentrations in cord blood and with gestational age. Breastfeeding and formula feeding were not associated with ferritin concentrations. Conclusions: Infant sex, cord ferritin concentrations, and maternal ferritin concentrations were independently associated with infant ferritin concentrations across the first year of life, whereas neither breastfeeding nor formula feeding was associated with ferritin concentrations in the present analyses. Infant sex, cord ferritin, and maternal ferritin measured four months postpartum may help identify children at risk of low iron stores, with maternal ferritin potentially offering a less intrusive alternative to repeated infant sampling. However, the clinical relevance and potential use of maternal ferritin as a proxy for infant ferritin concentrations require further investigation. Full article

Objectives: This study aimed to estimate the prevalence of Post-COVID-19 Syndrome among older adults in Indonesia, using time-based definitions of symptoms persisting beyond >4 weeks, >8 weeks, and >12 weeks. Methods: A retrospective cohort study was conducted among 329 older patients (≥60 years) hospitalized with COVID-19 in two tertiary hospitals in Jakarta from January to December 2021. Data on risk factors and persistent symptoms were collected from medical records and interviews. Results: The prevalence of Post-COVID-19 Syndrome was 31% (>4 weeks), 18.24% (>8 weeks), and 10.64% (>12 weeks). Significant predictors included frailty (OR 2.814), immobility during hospitalization (OR up to 4.767), higher number of initial symptoms (OR 2.043), constipation, instability, and sensory impairment during follow-up. Conclusions: Frailty, symptom burden, and geriatric syndromes, particularly immobility are strongly associated with Post-COVID-19 Syndrome in older adults. Clinical Implications: Early identification of frailty, geriatric syndromes (especially immobility), and high initial symptom burden is essential for risk stratification, targeted monitoring, and implementation of preventive and rehabilitative interventions to reduce long-term post-COVID-19 complications in older populations. Full article

Background/Objectives: Survival rates after pediatric liver transplantation have improved substantially over recent decades, yet the psychiatric consequences for recipients remain a concern that warrants closer attention. We sought to map the psychiatric symptom burden across multiple domains in this population and to determine which symptom clusters carry the greatest impact on health-related quality of life (HRQOL). Materials and Methods: Fifty liver transplant recipients between the ages of 8 and 18 were enrolled at a single center. Children and their parents completed four psychiatric measures—the CBCL, CDI, SCARED, and CRIES-13—alongside the parent-proxy PedsQL to capture HRQOL across physical, emotional, social, and school functioning domains. Correlations between instruments were calculated, and linear regression was used to determine which psychiatric variables independently predicted PedsQL Total scores. Results: Across all psychiatric measures, higher symptom scores were associated with lower HRQOL, with school functioning recording the lowest absolute PedsQL domain score, while emotional functioning demonstrated the strongest and most consistent inverse correlations with all psychiatric symptom measures across instruments. CBCL Total (r = −0.607), SCARED Total (r = −0.557), and CRIES-13 Total (r = −0.548) scores all correlated meaningfully with overall HRQOL. When entered into multivariable analysis, anxiety symptoms measured by the SCARED (β = −0.295, p = 0.032) and post-traumatic stress symptoms measured by the CRIES-13 (β = −0.400, p = 0.004) stood out as the two independent predictors of worse PedsQL Total scores. Conclusions: Even in medically stable recipients, anxiety and post-traumatic stress symptoms were independently associated with lower daily functioning scores and overall quality of life. These findings suggest that routine psychosocial screening and trauma-informed approaches may warrant integration into post-transplant care protocols, and that prospective, adequately powered studies are needed to confirm and extend these associations. Full article

Background: Antenatal depression has been associated with systemic inflammation, autonomic imbalance, and vascular dysfunction, yet its relationship with clinically relevant cardiovascular complications during pregnancy remains insufficiently defined. Objective: To evaluate whether antenatal depression diagnosed before cardiologic assessment is associated with gestational hypertension, preeclampsia, and clinically significant Holter-confirmed arrhythmias in a tertiary-care population of pregnant women referred for cardiology assessment. Methods: We conducted a retrospective secondary matched cohort analysis nested within a prospectively approved doctoral research protocol (approval no. 76/02.10.2023; approved study interval: 2 October 2023–10 February 2025), including deliveries from October 2023 to February 2025. During this 16-month interval, 12,436 deliveries were recorded. The index point was the first cardiology specialist evaluation performed between 22 + 0 and 36 + 6 weeks’ gestation. Pregnancies with a depressive disorder diagnosed by structured psychiatric interview (SCID-5) before cardiology evaluation were classified as exposed. Depression severity was categorized as mild (n = 44), moderate (n = 62), or severe (n = 24), and psychotropic medication class at index was recorded. Each depressed case was matched 1:3 with non-depressed controls by gestational age at index, calendar year, maternal age, BMI category, smoking status, and parity; adjusted models included BMI and psychotropic medication class. Results: The final referral-enriched cohort included 130 depressed pregnancies and 390 matched controls (n = 520), all of whom underwent cardiology evaluation. Between 22 + 0 and 36 + 6 weeks’ gestation, gestational hypertension occurred in 18.5% vs. 10.0% (p = 0.010), preeclampsia in 8.5% vs. 4.9% (p = 0.12), and clinically significant Holter-confirmed arrhythmias in 15.4% vs. 6.9% (p = 0.003) in depressed versus control groups, respectively. After adjustment, depression remained independently associated with gestational hypertension (aOR 1.85, 95% CI 1.12–3.05; p = 0.016) and arrhythmia (aOR 2.05, 95% CI 1.18–3.57; p = 0.011). A numerical, exploratory severity-response gradient was observed across mild, moderate, and severe depression strata, most clearly for Holter-confirmed arrhythmias; however, the severe-depression stratum was small (n = 24). Conclusions: Antenatal depression was associated with a modest but significant increase in gestational hypertension and clinically significant Holter-confirmed arrhythmias during late pregnancy among women referred for cardiology assessment. The higher preeclampsia rate in depressed pregnancies was not statistically significant. These findings support antenatal depression as a cardiovascular risk marker in gestation rather than proof of causality. Full article