Search Results (1,024)

Preeclampsia (PE) is a severe pregnancy-specific hypertensive disorder characterized by immune microenvironment dysregulation at the maternal–fetal interface, with decidual macrophage phenotypic imbalance being a key pathological feature. The Ghrelin/growth hormone secretagogue receptor-1a (GHSR-1a) axis exerts immunomodulatory and anti-inflammatory effects, but its role in regulating decidual macrophage infiltration and phenotypic marker expression in PE remains unclear. In this study, we first detected the expression of the Ghrelin/GHSR-1a axis in decidual tissues from 10 healthy pregnant women and 12 PE patients via immunohistochemistry (IHC). We then established a lipopolysaccharide (LPS)-induced PE-like rat model to investigate the axis’s functional role and underlying mechanisms. Intriguingly, clinical analysis revealed a severity-dependent compensatory escalation of the Ghrelin/GHSR-1a axis in PE decidual tissues, potentially representing an endogenous antagonistic response to pregnancy-associated pathological stress. In the animal model, exogenous Ghrelin supplementation reversed LPS-induced PE-like phenotypes, including hypertension, proteinuria, fetal growth restriction (FGR), and placental dysfunction, and alleviated pathological damage to the maternal liver, kidney, and placenta. Mechanistically, Ghrelin modulated decidual macrophage phenotypic marker expression by downregulating the M1 marker CD86 and upregulating the M2 marker CD163 and promoted trophoblast invasion and spiral artery remodeling by restoring laminin, α-cytokeratin 7 (α-CK7), and α-smooth muscle actin (α-SMA) expression in placental tissue. All protective effects of Ghrelin were abrogated by co-administration of D-lys-3-GHRP-6, a specific GHSR-1a antagonist, confirming the dependence on the Ghrelin/GHSR-1a axis. Collectively, our findings suggest that the Ghrelin/GHSR-1a axis is compensatorily upregulated in PE and may exert a protective role by regulating decidual macrophage phenotypic marker expression and improving placental function, providing preliminary evidence that this axis merits further investigation as a potential research target for PE. Full article

Background/Objectives: Adolescent pregnancy, defined as pregnancy occurring between ages 10 and 19, remains a pressing global health concern with significant disparities in prevalence and outcomes across countries. Early and systematic diagnostic screening may allow timely risk stratification and adequate management. Methods: We conducted this retrospective cohort study at a tertiary referral center from January 2015 through December 2024, including all women who delivered live fetuses at our facility, analyzing adolescent pregnancy outcomes in our region and comparing them with adult pregnancy outcomes. Results: Younger adolescents have higher rates of vaginal infections (45.3% vs. 38.1%), chorioamnionitis, urinary tract infections (6% vs. 4.9%), preterm birth, higher cesarean section rates, SGA and FGR fetuses, with more frequent NICU admissions than older adolescents. Adolescent pregnancies more often resulted in vaginal births compared to adult pregnancies but also showed higher rates of operative vaginal delivery, episiotomy, perineal tears, vaginal tears, and cervical lacerations. Gestational diabetes and excessive gestational weight gain were overall less common in adolescents, but pre-pregnancy maternal obesity was significantly more prevalent in the older adolescent group than in the younger ones. Gestational hypertension was about twice as frequent in adult pregnancies, while HELLP syndrome was approximately six times more common in adults than in adolescents. Conclusions: In summary, adolescent pregnancy presents both potential biological advantages and notable disadvantages, with outcomes resulting from the complex interplay of biological immaturity and socioeconomic factors. These results highlight the critical importance of implementing comprehensive early diagnostic screening protocols and structured antenatal care to facilitate earlier identification and mitigation of modifiable risk factors to improve both maternal and fetal outcomes. Full article

Background/Objectives: Sleep breathing disorders (SBDs) comprise a range of conditions characterized by abnormal respiratory patterns during sleep, with obstructive sleep apnea (OSA) being the most common. During pregnancy, SBDs are of clinical relevance, as they are associated with increased maternal and neonatal morbidity. Methods: A structured literature search was conducted to identify relevant studies addressing sleep breathing disordered in pregnancy, including longitudinal, observational, case-control, and cross-sectional studies, as well as other reviews and meta-analyses. Results: Adequate sleep during pregnancy is essential for maternal health and fetal development. OSA in pregnant women is strongly associated with hypertensive disorders of pregnancy (HDPs), potentially contributing to increased long-term cardiovascular risk. In addition to hypertensive complications, OSA has been linked to gestational diabetes and postpartum depression. Untreated SBDs may also have consequences beyond pregnancy, adversely affecting fetal and neonatal outcomes. Pathophysiological mechanisms related to maternal SBDs can result in fetal growth restriction, impaired neurocognitive development, and an increased risk of preterm birth. Conclusions: Current evidence indicates that OSA during pregnancy is associated with elevated short- and long-term risks for both mothers and offspring. Future research should prioritize large prospective studies with standardized diagnostic criteria and outcomes, as well as pragmatic trials to assess the implementation of SBD screening in prenatal care, particularly among high-risk populations such as obese women. Full article

Background/Objectives: The aim of this study was to evaluate the association between hypertensive disorders of pregnancy and the frequency of urinary incontinence and lower urinary tract symptoms and to assess the impact of these symptoms on quality of life in pregnant women. Methods: This observational comparative study was conducted between March 2024 and September 2025 and included 182 pregnant women between 24 and 40 weeks of gestation. The study group consisted of 91 pregnant women diagnosed with hypertensive disorders of pregnancy, while 91 normotensive pregnant women served as controls. Demographic and obstetric characteristics were recorded. Urinary incontinence and selected lower urinary tract symptoms, as well as the impact of urinary symptoms on quality of life, were assessed using the International Consultation on Incontinence Questionnaire–Short Form, Urinary Distress Inventory-6, and Incontinence Impact Questionnaire-7. Logistic regression analyses were performed to identify independent factors associated with the presence of urinary incontinence. Results: Urinary incontinence was significantly more frequent in the hypertensive group compared with controls (65.9% vs. 20.9%, p < 0.001). Lower urinary tract symptoms were also more prevalent among hypertensive pregnant women (71.5% vs. 53.8%, p = 0.011). UDI-6, ICIQ-SF, and total IIQ-7 scores were significantly higher in the hypertensive group, indicating greater symptom severity and worse quality of life (all p < 0.001). In multivariable logistic regression analysis including the entire study population, hypertensive pregnancy was independently associated with urinary incontinence (OR: 8.33, 95% CI: 4.00–16.67, p < 0.001), whereas age, body mass index, smoking status, and gravida were not independently associated with UI. Conclusions: Hypertensive disorders of pregnancy are strongly and independently associated with an increased frequency of urinary incontinence and lower urinary tract symptoms, as well as a significant deterioration in quality of life. These findings highlight the importance of routine evaluation of urinary symptoms in hypertensive pregnancies and support a multidisciplinary approach to their management. Full article

Catestatin is a chromogranin A–derived peptide involved in sympathetic, cardiovascular, inflammatory, and metabolic regulation, but its longitudinal profile during pregnancy remains insufficiently defined. This prospective cohort study aimed to evaluate changes in serum catestatin concentrations from the first to the third trimester and to explore their associations with blood pressure and metabolic parameters in initially low-risk singleton pregnancies. Fifty pregnant women were followed longitudinally from 11–13 + 6/7 to 30–41 + 5/7weeks of gestation. Clinical and biochemical parameters were assessed at both visits, and serum catestatin concentrations were measured using a commercial enzyme immunoassay. Serum catestatin concentrations were significantly lower in the third trimester than in the first trimester (median [IQR]: 9.4 [4.9–15.5] vs. 13.4 [9.9–24.6] ng/mL; p < 0.001). Longitudinal changes in catestatin were positively associated with third-trimester insulin concentrations after adjustment for selected covariates. Third-trimester catestatin concentrations were positively correlated with systolic blood pressure (r = 0.356, p = 0.011) and remained associated with systolic blood pressure in a limited multivariable model. These findings suggest that catestatin concentrations decline from early to late pregnancy and may reflect selected metabolic and hemodynamic changes. Larger longitudinal studies including pathological pregnancy cohorts are needed to clarify its clinical relevance. Full article

Background/Objectives: Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used for postpartum pain management. However, previous studies have indicated that NSAIDs may increase systolic blood pressure, particularly in patients receiving antihypertensive therapy. The aim of the present study was to assess whether postpartum ibuprofen administration is associated with a higher risk of severe postpartum hypertension and increased mean arterial pressure (MAP) compared with acetaminophen. Methods: A systematic literature search was conducted in PubMed, Scopus, and Web of Science to identify relevant studies. Only randomized controlled trials were considered eligible for inclusion. For dichotomous outcomes, effect sizes were expressed as risk ratios (RRs) with corresponding 95% confidence intervals (CIs). For continuous outcomes, mean differences (MDs) with 95% CIs were calculated. Statistical heterogeneity among studies was assessed using the I² statistic. A fixed-effects model was applied in cases of low heterogeneity (I² < 20%). Results: No significant difference was observed in the prevalence of severe postpartum hypertension between the ibuprofen and acetaminophen groups (RR 1.07, 95% CI 0.84 to 1.35; p = 0.59; I² = 0%). Similarly, MAP did not differ significantly between groups (MD −0.05 mmHg, 95% CI −1.53 to 1.42; p = 0.94; I² = 0%). Conclusions: No increased risk of postpartum hypertension or difference in mean arterial pressure was observed between the ibuprofen and acetaminophen groups, supporting the safety of ibuprofen for postpartum analgesia in women with hypertensive disorders of pregnancy. Full article

Background: Entrustable Professional Activities (EPAs) that transform competencies into distinct, assessable clinical tasks have not yet been developed for US nephrology fellowships. We created and achieved consensus on a set of nephrology-specific EPAs and aligned them with Accreditation Council for Graduate Medical Education (ACGME) competency standards. Methods: This study was conducted within the University of New Mexico nephrology fellowship program. An initial EPA list was generated by the study team using program objectives, a literature review, and clinician insight. Study participants included eight faculty nephrologists and one nephrology fellow, who completed an online-based three-round modified Delphi consensus-building processes. Each EPA was rated on a five-point Likert scale with consensus requiring strict criteria. Finalized EPAs were independently mapped to ACGME nephrology program requirements. Results: Nine study participants (100% response rate) completed all survey rounds. Through iterative consensus, utilizing strict criteria, a final list of 22 distinct EPAs was created, covering 10 core domains of practice including dialysis management, acute kidney injury, chronic kidney disease, electrolyte abnormalities, hypertension, kidney stones, glomerular disease, pregnancy, transplant care, and education. Finalized EPAs were mapped to 38 different ACGME-required sub-competencies, showcasing diversity and applicability to national expectations. Conclusions: We developed the first consensus-based set of EPAs geared for US nephrology fellowship programs, providing a foundation for standardized assessment and curriculum development that could be implemented across nephrology fellowship programs nationally. 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

Introduction: Hypertensive disorders in pregnancy (HDP) and gestational diabetes mellitus (GDM) represent two significant maternal cardiometabolic disorders closely related to each other. This study aims to identify predictive risk factors for gestational hypertension in patients with GDM within our population. Methods: This cohort study was conducted at the Department of Obstetrics and Gynecology, Policlinico “G. Martino” of Messina from January 2012 to December 2019. It included 684 pregnant women diagnosed with GDM by Oral Glucose Tolerance Test (OGTT) according to Italian guidelines. A detailed medical history was taken for each patient to identify potential predictive risk factors for HDP. Patients with pre-existing hypertension or diabetes were excluded. Results: Among 684 women with GDM, 69 (10.1%) developed hypertensive disorders of pregnancy (HDP). Women with HDP had a significantly higher pregestational BMI (30.1 ± 7.7 vs. 26.5 ± 5.6 kg/m², p = 0.001) and a higher prevalence of obesity (51% vs. 34%, p = 0.0001). Post-load glucose at 60 min was higher in the HDP group (178 ± 34 vs. 164 ± 32 mg/dL, p = 0.0001), with more women exceeding the diagnostic threshold (>180 mg/dL: 56% vs. 35%, p = 0.001). Multivariate analysis confirmed that pregestational obesity and higher 60-min glucose levels during OGTT were the strongest independent predictors of HDP. Conclusions: Obesity and glycemia above the cut-off after 1 h during OGTT are predictive risk factors for hypertensive disorders in patients with GDM. Full article

Preeclampsia (PE) is a multifactorial hypertensive disorder of pregnancy that significantly increases both short- and long-term cardiovascular risk for affected women. PE and cardiovascular disease (CVD) share common risk factors, including endothelial dysfunction, obesity, insulin resistance, and dyslipidemia. Women with a history of PE face a markedly elevated risk of chronic hypertension, heart failure, and adverse cardiac remodeling, with evidence suggestive of persistent vascular and myocardial changes after pregnancy. The complex pathophysiology of PE is multifactorial and is thought to involve a combination of abnormal placentation, immune dysregulation, and anti-angiogenic factors, which may induce permanent cardiovascular alterations. Genetic predispositions may further link PE with cardiomyopathies and peripartum cardiomyopathy. However, despite these well-established risks, standardized long-term surveillance and management strategies for women with prior PE remain lacking. Early identification and targeted intervention in women with a history of PE represent critical opportunities to mitigate future cardiovascular morbidity and mortality. This review highlights the urgent need for comprehensive, evidence-based strategies that incorporate personalized follow-up and risk stratification to improve cardiovascular outcomes in this high-risk population. Full article

Preeclampsia is a pregnancy-specific multisystem disorder and a major cause of maternal and perinatal morbidity and mortality worldwide. This narrative review summarizes current evidence on the principal risk factors and pathophysiological mechanisms involved in its development. The disease is best explained by the two-stage model: in stage 1, inadequate trophoblast invasion and incomplete spiral artery remodeling lead to placental hypoperfusion, hypoxia, and oxidative stress; in stage 2, the hypoxic placenta releases anti-angiogenic and pro-inflammatory factors, including soluble fms-like tyrosine kinase-1 (sFlt-1) and soluble endoglin (sEng), which trigger systemic endothelial dysfunction and the maternal clinical syndrome. The review highlights the central role of angiogenic imbalance, immune dysregulation, and chronic inflammation in disease progression. Particular emphasis is placed on maternal risk factors such as primiparity, advanced maternal age, obesity, diabetes mellitus, chronic hypertension, multiple pregnancy, prior preeclampsia, genetic susceptibility, and epigenetic regulation. We also emphasize the contribution of microRNAs in relation to placental hypoxia, trophoblast invasion, angiogenesis, endothelial injury and microchimerism to the development of preeclampsia. The review also examines the role of T helper 1 (Th1)/Th2/Th17/regulatory T cells (Treg) imbalance and uterine natural killer cell dysfunction at the maternal–fetal interface. Improved understanding of these interconnected mechanisms may support earlier diagnosis, better risk stratification, and the development of targeted preventive and therapeutic strategies. Full article

Background/Objectives: Placental abruption remains one of the leading causes of maternal morbidity, and the development of disseminated intravascular coagulation (DIC) significantly worsens outcomes. We sought to develop and internally validate a prediction model—the Placental Abruption DIC (PAD) Score—using parameters routinely collected at presentation. Methods: We conducted a retrospective cohort study at a tertiary referral center in Istanbul, Turkey (January 2019–December 2024). Women with singleton pregnancies ≥22 weeks diagnosed with placental abruption were eligible. The primary outcome was overt disseminated intravascular coagulation (DIC) within 24 h of admission, adjudicated using the original International Society on Thrombosis and Haemostasis (ISTH) overt DIC scoring algorithm; a total score of ≥5 was considered compatible with overt DIC. We built a multivariable logistic regression model with bootstrap internal validation (1000 resamples). Robustness was evaluated through prespecified sensitivity analyses including complete-case analysis, single imputation, Firth-penalized logistic regression, exclusion of patients transferred from external facilities, a four-variable model excluding preeclampsia, and alternative score threshold grouping. Comparative discrimination against the admission ISTH overt DIC score, the Erez pregnancy-modified DIC score, and the Kobayashi obstetrical DIC score were evaluated using the area under the receiver operating characteristic curve and DeLong testing. Results: Of 237 women, 54 (22.8%) developed DIC. The final model retained five predictors: fibrinogen concentration, shock index, platelet count, placental separation percentage, and chronic hypertension/preeclampsia. The optimism-corrected area under the receiver operating characteristic curve (AUC) was 0.916, with calibration slope 0.96 and Brier score 0.12. DIC incidence was 2.9% in low-risk (0–4 points), 7.6% in moderate-risk (5–8 points), and 86.0% in high-risk (≥9 points) patients. Discrimination remained stable across complete-case (AUC 0.909), single-imputation (0.913), Firth-penalized (0.914), transfer-excluded (0.902), four-variable (0.892), reduced three-predictor (0.842, excluding fibrinogen and platelet count), pathology-confirmed subgroups (0.887) and composite clinical outcome (0.801) analyses, and exceeded that of the ISTH (0.812), Erez (0.848) and Kobayashi (0.793) comparator scores. Conclusions: The PAD Score offers a straightforward method for stratifying DIC risk in placental abruption. External validation in independent cohorts is needed before clinical implementation. Full article

Pregnancy involves major cardiovascular adaptations, yet its long-term impact on maternal brain health remains poorly understood. The American Heart Association’s Life’s Simple 7 (LS7) and Life’s Essential 8 (LE8) are validated tools to assess cardiovascular and brain health, but their use in obstetric populations is limited. Following PRISMA-ScR guidelines, we searched three databases (2010–2024) for studies assessing ≥ 1 LS7/LE8 component during pregnancy with mid- or later-life cognitive or dementia outcomes; narrative synthesis and meta-analyses were conducted where feasible. Of 3940 screened abstracts, 30 studies met the inclusion criteria. Most examined hypertensive disorders of pregnancy (HDP), few assessed diabetes independently, and none evaluated the full LS7/LE8 construct. Meta-analyses showed that HDP was associated with increased risk of all-cause dementia (HR 1.34; 95% CI 1.11–1.62) and vascular dementia (HR 1.76; 95% CI 1.03–3.00; n = 3 studies), but not Alzheimer’s disease (HR 1.22; 95% CI 0.96–1.56). Although LS7/LE8 are established frameworks for cardiovascular and brain health, their application during pregnancy remains limited. Integrating LE8 into obstetric care may enable earlier identification of individuals at risk for later-life cognitive decline and inform strategies to promote maternal brain health across the lifespan. Full article

Background/Objectives: Preterm birth (PTB) is a major public health concern worldwide, which may lead to detrimental maternal and neonatal outcomes. Maternal nutritional status, gestational weight gain (GWG), and lifestyle factors are potentially modifiable determinants of adverse pregnancy outcomes. This study examined the association between PTB and maternal GWG and assessed whether maternal dietary habits and lifestyle factors were related to GWG in women delivering preterm versus at term. Methods: A retrospective case–control study was conducted at a tertiary center in Hungary (MANOR Study, 2019). The case group included n = 100 women with PTB, while n = 200 matched term deliveries served as controls (1:2 ratio). Data were collected using a self-administered questionnaire and medical records. Pre-pregnancy body mass index (BMI) was categorized using standard definitions, while GWG was classified as inadequate, recommended, or excessive according to the US 2009 Institute of Medicine guidelines. A 7-item dietary index score was calculated based on gestational dietary habits. Results: Pre-pregnancy BMI distribution did not considerably differ between groups (p > 0.05); over one-third of women in both groups were overweight or had obesity (38.7% vs. 36.7%). Previous PTB (p < 0.001) and gestational hypertension (GHT) (p = 0.003) were more common among current PTB cases, while smoking, alcohol consumption, and gestational diabetes mellitus (GDM) showed negligible differences (p > 0.05)—28.0% of cases, and 34.5% of controls were classified as having healthy dietary habits, based on the dietary index score calculated. Inadequate GWG was more prevalent among PTB cases (49.0% vs. 26.8%), whereas excessive GWG was less frequent among cases (21.9% vs. 38.4%). Being within the recommended GWG range and the manifestation of gestational hypertension were associated with lower (aOR: 0.39; 95% CI: 0.18–0.87; p = 0.020) and higher (aOR: 3.43; 95% CI: 1.44–8.19; p = 0.005) odds of PTB, respectively. Conclusions: Inadequate GWG was more common in PTB, while excessive GWG was more frequent in term pregnancies. Fast-food consumption was associated with excessive GWG among term births. Optimizing GWG and improving maternal diet quality should be included as key, cross-cutting interventions targeting the improvement of antenatal care. Full article

Background: Bushfire smoke exposure (BFSE) is associated with adverse pregnancy and neonatal outcomes; however, the specific impact of BFSE on pregnancies complicated by asthma is not well characterised. Methods: A retrospective cohort study analysed data from 22,166 pregnant women who gave birth in the Illawarra Shoalhaven region between January 2017 and December 2022. Women with asthma were identified by the ICD-10-AM code for asthma during hospital admission for birth. Exposure was defined using a fixed time-window assumption. Women were considered exposed to bushfire smoke if they experienced at least 4 weeks of their pregnancy between 25 October 2019 and 4 February 2020. Results: Prevalence of asthma in the total population was 8.31%. In the control cohort, outcomes for pregnant women with asthma were poorer than those without. Pregnant women with BFSE had increased odds of postpartum haemorrhage (OR 1.603; 95% CI 1.42–1.81), and decreased odds of gestational hypertension (OR 0.615; 95% CI 0.49–0.77), gestational diabetes mellitus (OR 0.703; 95% CI 0.63–0.79) and preterm birth (OR 0.813; 95% CI 0.67–0.98). Maternal asthma did not confound the relationship between BFSE and any of the primary study outcomes. Conclusions: This study emphasises the independent effects of asthma on pregnancy outcomes. The impact of BFSE on pregnant women with asthma remains unclear. Further research is needed to characterise the true effect of BFSE on pregnancies, uncomplicated and complicated by asthma. Full article