Search Results (6,900)

Syphilis, a curable sexually transmitted infection, has resurged globally, challenging public health systems in both high-income countries and low- and middle-income countries (LMICs). In nations like the United States, the United Kingdom, parts of Europe, Canada, and Japan, cases have surged due to declining condom use, digital platforms facilitating casual sex, and practices like chemsex and broader drug use for sex, with rising congenital syphilis rates. In LMICs, such as those in East Africa, South Asia, Latin America, and Southeast Asia, limited healthcare access, inadequate prenatal screening, and socioeconomic barriers drive persistent high prevalence, particularly among pregnant women and vulnerable populations. Despite contextual differences, shared drivers include stigma, health disparities, and outdated surveillance systems. This resurgence underscores the need for globally coordinated, equity-focused strategies, including universal syphilis testing, modernized surveillance, and context-specific sexual health education. Addressing structural and behavioral factors through collaborative international efforts is critical to reversing this trend and strengthening global STI control. Full article

Aims: Gestational diabetes mellitus (GDM) represents an increasing global challenge. Mediterranean diet interventions have proven benefits, but their implementation is limited by the absence of nutritionists in many public health systems. This study aimed to evaluate whether a video intervention guided by a nutritionist could increase compliance to Mediterranean diet and reduce the incidence of GDM and adverse maternal–neonatal outcomes. Methods: In this randomized controlled trial, 1750 consecutive pregnant women were allocated (1:1) to standard care (verbal, printed advice) or to a video designed by a nutritionist promoting a Mediterranean and physical activity. The primary outcome was the incidence of GDM; secondary outcomes included other pregnancy-related complications. Dietary adherence was assessed using the 14-item Mediterranean Diet Adherence Screener (MEDAS) score. Results: The experimental group increased their MEDAS score from baseline to GDM screening (mean difference (95% CI) 0.41 (0.23; 0.60); p < 0.001), mainly through greater extra virgin olive oil and nut intake and lower consumption of juices and confectionery. GDM incidence declined from 25.1% to 20.7% (p = 0.025), with significant reductions in gestational hypertension, episiotomy and neonatal intensive care unit admissions. Conclusions: Nutritionist-guided video intervention improves adherence to Mediterranean diet and reduces GDM incidence and adverse outcomes. This low-cost, scalable approach may help overcome structural limitations in public health systems. Full article

Background: A 33-year-old pregnant woman experienced ear trauma from contact with a fish while swimming. Afterwards, the woman presented with vertigo and hearing loss. Methods: Clinical examination showed a foreign body (FB) in the middle and inner ear, which was removed surgically under general anesthesia. Postoperative care included antibiotics; the FB was sent to the lab for analysis. Results: Although vertigo resolved after surgical intervention, the woman continued to experience hearing loss and finally experienced deafness. Patient had an unusual mechanism of inner ear trauma. The FB was identified as part of a fish and determined to originate from a fish species of the genus Hemiramphus which is listed as harmless to humans in FishBase. Conclusions: As severe penetration of an FB into the middle and inner ear can lead to serious complications, removal of an FB from the ear requires special competence and should therefore only be performed by specifically skilled professional staff. Full article

Preeclampsia is a multisystem disorder that develops during pregnancy and is associated with severe complications for both the pregnant woman and her infant. It remains a leading cause of maternal and perinatal mortality and morbidity. Although it affects only 2–8% of pregnancies, over 70,000 women and 500,000 children die from it each year. The exact etiology of preeclampsia is unclear; it is often referred to as a disease of theories and hypotheses. This paper reviews the most significant hypotheses and studies that aim to explain the etiology of preeclampsia. This may help identify new research paths and concepts that could bring us closer to understanding the exact etiology of preeclampsia. The complexity of pathogenetic relationships and mechanisms, heterogeneous clinical presentations, and the development of underlying changes early in pregnancy when patients are clinically asymptomatic and appear healthy are among the main reasons for difficulty identifying the exact causes of preeclampsia. Furthermore, preeclampsia is specific to human pregnancy; there is no ideal animal study model whose results could be fully extrapolated to humans. A more holistic approach that combines all the information, hypotheses, and pathogenetic relationships may offer hope for understanding why preeclampsia occurs and how to prevent and treat it effectively. A better understanding of the precise etiology of the condition holds promise for developing new options for the early diagnosis, effective prevention, and modern causal treatment of preeclampsia. This would reduce the risk of severe complications in affected patients and could have enormous implications for clinical practice. Full article

Background and Clinical Significance: Spontaneous intracranial hypotension (SIH) is a rare cause of headache characterised by cerebrospinal fluid (CSF) leakage, with an estimated incidence of 3.7 to 5 cases per 100,000 per year, peaking around the age of 40 years. Its diagnosis and management are particularly challenging in pregnancy due to overlapping symptoms and limited diagnostic options. Case Presentation: We report the case of a 42-year-old pregnant woman at 14 weeks of gestation presenting with a history of orthostatic headache and facial sinus tenderness, later diagnosed as spontaneous intracranial hypotension. Conclusions: Headache is a common clinical symptom that may be associated with a wide spectrum of underlying conditions, ranging from benign causes such as migraine or tension-type headache to potentially life-threatening pathologies, including subarachnoid haemorrhage. This case illustrates the diagnostic complexity of SIH in pregnancy and the importance of a multidisciplinary approach and vigilance for neurological symptoms during pregnancy. Full article

Small extracellular vesicles (small EVs) play pivotal roles in intercellular communication and pregnancy maintenance, but their clinical significance in preeclampsia (PE) remains unclear. We obtained plasma samples from non-pregnant women, healthy pregnant women, and patients with early-onset (EoPE) and late-onset PE (LoPE). Small EVs were isolated using ultracentrifugation and validated using transmission electron microscopy and nanoparticle tracking analysis; in addition, Western blotting was performed to identify suitable surface markers for plasma-derived small EVs. In our analysis, we consistently detected cluster of differentiation 9 (CD9), whereas classical markers such as cluster of differentiation 63 (CD63) and tumor susceptibility gene 101 (TSG101) were absent. In a prospective, nested case–control study, we analyzed first-trimester samples by using a CD9-based ELISA for small-EV quantification. The number of small EVs did not significantly differ between non-pregnant and healthy pregnant women regardless of the gestational age. However, EVs were significantly elevated in both EoPE (3.5-fold) and LoPE (1.5-fold) compared with matched controls. First-trimester EV levels did not show differences between women who later developed PE and normal controls. These findings indicate that CD9 is a promising marker for plasma-derived small EVs and that an elevated number of small EVs is associated with established PE but has limited predictive value in early pregnancy. Further studies are required to elucidate the cellular origin and clinical implications of small EVs in PE. Full article

Gestational Diabetes Mellitus (GDM) is a metabolic condition characterized by glucose intolerance, which manifests or is diagnosed for the first time during pregnancy. Hyperglycemia associated with GDM can induce a systemic and local inflammatory environment, directly affecting the maternal–fetal interface, particularly the placenta. The placenta, in turn, plays a central role in immune modulation and can alter cytokine and immune cell expression in response to metabolic stress. This study aimed to evaluate levels of inflammatory cytokines and the profiles of type 1 (M1) and type 2 (M2) macrophages in placentas from pregnant women with GDM. Forty placental samples were analyzed and divided into two groups: pregnant women with GDM (n = 20) and normoglycemic pregnant women (n = 20). The villous and extravillous portions were separated and analyzed for cytokine levels by flow cytometry and for macrophage immunophenotyping. The results showed a significant increase in IL-6, IL-8, IL-10, and IL-12P70 levels in the placentas of mothers with GDM, whereas IL-1β and TNF-α were reduced in the extravillous portion of this group. In addition, a higher percentage of CD14+ cells and M2 macrophages was observed, especially in the villous portion of the placentas of pregnant women with GDM. These findings suggest that gestational hyperglycemia modulates the placental immune response, altering cytokine levels and macrophage polarization patterns. GDM influences the placental immunological microenvironment, which can contribute to alterations in placental function and increased risks to fetal development. The data underscore the placenta’s role as an immunoregulatory organ and highlight the need for greater attention to inflammation associated with GDM in maternal and child health. Full article

Background: Thalassemia has been recognized as a critical public health issue in Bangladesh, especially among pregnant women, due to its hereditary nature and the lack of early screening infrastructure. Early identification of at-risk individuals is essential to prevent the transmission of this genetic disorder to future generations and to reduce the burden on an already strained healthcare system. Methods: In this study, an innovative framework for thalassemia risk assessment has been developed by integrating Multi-Criteria Decision-Making (MCDM) methods—specifically AHP-TOPSIS—with machine learning algorithms including Random Forest, XGBoost, and CatBoost. Explainable Artificial Intelligence (XAI) techniques such as SHAP and LIME have also been incorporated to improve model transparency and trustworthiness. Real-world clinical and demographic data, consisting of 16 features and 1200 samples, have been collected through a structured survey and processed using rigorous feature selection and ranking methods. Risk stratification has been performed to classify patients into high, medium, and low categories, enabling targeted intervention. Results: Among all models, the XGBoost classifier trained on AHP–TOPSIS–prioritized features achieved a consistent accuracy of 99.28% under stratified 20-fold cross-validation, demonstrating robust diagnostic classification performance. The model predominantly captures hematologic patterns characteristic of thalassemia manifestations, functioning as an assistive diagnostic framework rather than a causal risk predictor. The explainability of predictions, ensured through comprehensive visual and statistical analyses, further enhances the model’s clinical transparency and reliability. Conclusions: The proposed MCDM–machine learning framework demonstrates strong potential for improving thalassemia risk assessment, enabling early detection and informed decision-making in maternal healthcare. The proposed framework should be regarded as a preliminary proof-of-concept system that demonstrates the feasibility of integrating Multi-Criteria Decision-Making (AHP–TOPSIS) with advanced machine learning and explainable-AI techniques for thalassemia assessment. Although the model achieved strong diagnostic performance under nested cross-validation, additional external validation and inclusion of causal predictors are required before clinical deployment. Full article

Introduction: The demographic shift amongst pregnant women, including older age and increasing obesity, has resulted in an increased risk of cardiometabolic complications during pregnancy, particularly gestational diabetes. This paper presents physical activity and gestational diabetes data in a multi-ethnic urban Australian population. Methods and analysis: The PROMOTE cohort study is an ongoing prospective pregnancy cohort study recruiting pregnant participants < 16 weeks gestation at a large urban public teaching hospital with high social and cultural diversity in Sydney, Australia. Participants are surveyed about their physical activity levels, dietary quality, emotional wellbeing and socio-demographic status using validated tools. Participants are consented for use of routinely collected clinical and social data, including medical conditions, body mass index (BMI), blood pressure (BP) and glycaemia. Follow-up is from routinely collected data. Results: A total of 459 participants were recruited between February 2022 and February 2024. Physical activity levels at recruitment were sufficiently active, low active and inactive in 39%, 45% and 16% of participants. Participation in moderate or vigorous physical activity was reported in 19% and 16% of participants, respectively. Participation in vigorous physical activity occurred in 10% of those with GDM vs. 17% of those without GDM (p = 0.11). Participation in any moderate/vigorous physical activity was reported in 20% of those with GDM vs. 30% of those without GDM (p = 0.058). Compared to inactive behaviour, the unadjusted odds ratio of developing GDM amongst those participating in any moderate/vigorous physical activity was 0.58 (95% CI 0.33–0.97), p = 0.045. Participation in any moderate/vigorous physical activity showed an association with lower oral glucose tolerance test levels at 1 h (7.49 vs. 8.17 mmol/L, p = 0.002). Participation in any vigorous activity was associated with lower oral glucose tolerance test levels at 1 h (7.25 vs. 8.11, p = <0.001). Conclusions: Uptake of existing physical activity recommendations is low. Gestational diabetes risk showed a trend toward variation by intensity of physical activity, with a trend toward greater intensity being associated with a possible lower rate of gestational diabetes. Full article

Background: Non-invasive prenatal testing (NIPT) based on cell-free fetal DNA (cfDNA) in maternal blood has revolutionized prenatal screening for trisomies 21, 18, and 13. This approach, based on next-generation sequencing (NGS), usually allows the detection of other chromosomal abnormalities; however, their clinical value in routine practice requires further evidence. Objectives: This study aimed to assess the experience and clinical utility of genome-wide NIPT in pregnant women at intermediate risk in the autonomous communities of Aragón and Valencia, Spain. Methods: For this purpose, a retrospective cohort study was conducted between 2020 and 2024 across two public hospitals. Pregnant women at intermediate risk for trisomies 21, 18, or 13, were included, as well as those meeting specific clinical criteria. Participants were offered either basic or expanded NIPT, and positive results were confirmed by invasive prenatal testing or placental analysis. Results: Among 9,059 expanded NIPT tests, 132 (1.45%) indicated a high-risk result for less common chromosomal anomalies, comprising 60 rare autosomal aneuploidies (RAAs), 39 copy number variants (CNVs), 23 sex chromosome aneuploidies (SCAs), and 10 multiple abnormalities. The positive predictive value (PPV) was 5.5% for RAAs in the fetus, 12.8% for CNVs (31% for deletions), and 58% for SCAs. Conclusions: Several confirmed anomalies were clinically significant and would not have been detected through conventional screening. Opportunistic use of expanded NIPT enables the detection of additional clinically relevant abnormalities, potentially improving obstetric management without substantially increasing invasive testing. Full article

Alcohol (ethanol; EtOH) intake affects one in ten pregnancies in the United States and is a leading cause of developmental defects collectively known as fetal alcohol spectrum disorders (FASDs). Cerebral circulation is a critical target of prenatal ethanol exposure (PEE), yet the target(s) involved remain poorly understood. In adult cerebral circulation, mitochondrial function is essential in regulating smooth muscle contractility, suggesting mitochondria as a potential target of alcohol in the developing cerebral arteries. In this study, pregnant C57BL/6J mice were administered ethanol (3, 4.5, 6, or 7 g/kg) during either the second trimester equivalent of human pregnancy (gestational days 9–19), or the third trimester equivalent during postnatal days 1–10. Maternal and progeny blood ethanol concentrations, progeny brain weight, cerebral artery oxygen consumption, and corticosterone levels were measured. At lower ethanol concentrations (3 g and 4.5 g/kg), no significant alterations in fetal cerebral artery mitochondrial function were detected. In contrast, heavy maternal ethanol exposure (6 g/kg) significantly increased mitochondrial respiratory parameters in developing cerebral arteries during the third trimester equivalent of human pregnancy. Sex-specific dimorphism was also observed at this developmental stage. Corticosterone was not elevated in fetuses and pups. In summary, our findings demonstrate developmental stage- and sex-dependent vulnerabilities of cerebrovascular oxygen consumption to ethanol exposure. Full article

Background: The presence of ectopic endometrial glands within the uterine myometrium in patients with adenomyosis has been associated with adverse fertility outcomes. UP (Uterine Peristalsis), a movement of contractions at the junctional zone of the non-pregnant uterus, can be impacted by an altered architecture of uterine layers. Abnormal contractility patterns could impact both uterotubal sperm transport as well as embryo implantation. Because of this potential influence on clinical symptoms and reproduction in patients with adenomyosis, studies have been analyzing the feasibility of diagnostic techniques in assessing uterine peristalsis. Objective: This systematic review and meta-analysis aimed to detect an alteration in patterns of UP in patients with adenomyosis. Methods: A systematic literature search of Medline, Embase, Cochrane, CENTRAL databases and Google Scholar was conducted up to June 2025, including studies evaluating UP and adenomyosis. Clinical studies evaluating uterine contractility were included, excluding those potentially affected by therapeutic interventions. The meta-analysis pooled data from studies to compare uterine contractility direction between patients with adenomyosis and control groups. Results: In seven included studies (442 women), uterine contractility varied significantly in association with menstrual cycle phases and pathological conditions. The meta-analysis revealed two statistically significant findings: women with adenomyosis showed significantly reduced uterine contraction frequency (SMD −1.81, 95% CI: −3.04 to −0.58, p = 0.0039) and fewer antegrade contractions (OR 0.35, 95% CI: 0.13–0.96, p = 0.0423) compared to controls. Other contractility patterns showed non-significant trends with substantial heterogeneity. Conclusions: Our findings show a significant difference in uterine contraction patterns in patients with adenomyosis compared to controls, namely a decrease in frequency and an increased number of retrograde uterine contractions in the adenomyosis group. The remarkable heterogeneity of the results highlighted the need for larger study cohorts in the future, especially to address the main diagnostic possibilities and treatments in order to improve reproductive outcomes. Full article

Bovine respiratory disease is a significant health concern in dairy calves, impacting short-term growth and potentially long-term productivity. While previous studies have linked early-life lung consolidation, often subclinical and diagnosed by lung ultrasonography, to reduced preweaning average daily gain, its extended effects on production and reproductive parameters remain less studied, particularly in specific geographical contexts. This study presents a follow-up analysis on a cohort of dairy calves originally monitored weekly from birth to weaning for lung consolidation via TUS in an Iranian dairy herd. Two years post-weaning, comprehensive production and reproduction data were collected and analyzed for these same animals. Our objective was to investigate the long-term associations between early-life lung consolidation and subsequent outcomes, including mature equivalent milk yield, corrected milk yield, culling risk before and during lactation, age at first breeding, age at first calving, and reproduction parameters such as services per conception and conception rate (the percentage of cows or heifers that become pregnant after a single insemination or breeding attempt). Data analysis, employing descriptive statistics, survival analysis, and non-parametric tests, revealed that while early-life lung consolidation (defined by ≥1 cm or ≥3 cm depth, and number of episodes) did not show significant associations with culling probability or mature equivalent milk yield, interesting numerical trends were observed. The study highlights the complexities of establishing clear long-term links, suggesting that while subclinical BRD can have immediate growth impacts, its chronic effects on later production and reproduction may be subtle and require larger cohorts or more targeted analysis to achieve statistical significance. The findings reinforce the need for cautious interpretation of p-values in the context of multiple comparisons and underscore the challenges in quantifying long-term economic consequences of early-life respiratory health. Full article

Background: Proper nutrition supports maternal and fetal health. Gaps in nutritional knowledge (NK) and nutritional literacy (NL) can affect maternal and fetal health. NK refers to knowing facts and processes about nutrition, while NL is a broader component that includes competencies and skills needed to obtain, understand, and apply nutrition information to make dietary decisions. NL and NK limitations may contribute to adverse maternal and neonatal outcomes. This scoping review aims to understand the relationship between NK, NL, and pregnancy outcomes, offering insights into areas for future nutrition-based interventions. Methods: Seven databases were searched for studies assessing NK and NL among pregnant women. A total of 5080 articles were identified, with 4249 retained after removing duplicates. Following title and abstract screening, 18 articles underwent full-text review, and 11 met the inclusion criteria. Data were extracted, analyzed, and categorized into nine key themes. Results: All eleven studies employed survey-based methods; ten focused on NK and one on NL. Overall, NK was generally low. The evidence for an association between NK or NL and pregnancy outcomes was limited. Education, income, occupation, and family influence were identified as key factors influencing the NK and NL of pregnant women. Education and income levels were identified as having the most significant impact on NK overall. Only one study accessed the relationship between NK and adverse birth and neonatal outcomes, and this only included HDP and preterm labor. Also, only one out of the eleven studies was conducted in the US. Conclusions: In this review, we found that NK and NL among pregnant women was generally low, with limited evidence linking it to pregnancy outcomes; education and income emerged as the most influential factors of NK and NL. Future studies in high-income countries are recommended to assess the association between NL and adverse maternal outcomes, especially GDM. Full article

Parvovirus B19 (B19V) infection during pregnancy represents a significant clinical concern due to its potential impact on the fetus and pregnancy outcome. We analyzed temporal, spatial, and seasonal B19V seroepidemiology in childbearing-aged and pregnant women in Croatia over 10 years (2015–2024). A total of 976 women who underwent routine TORCH screening were included. The overall B19V IgG and IgM seroprevalence was 63.7 and 8.7%, respectively, with significant temporal differences (IgG 36.8–72.3%, IgM 1.3–18.4). Significant differences in the IgG seropositivity were observed among age groups, from 42.3% in the 16–20 group to 72.7% in the 36–40 group. Spatial analysis showed no significant differences in the IgG or IgM seroprevalence between regions (City of Zagreb/Northern Croatia, Pannonian and Adriatic Croatia) and settlements (urban, suburban/rural). Additionally, seropositivity did not differ significantly in relation to obstetric history. In a logistic regression model, age was a significant predictor for IgG seroprevalence, with each additional year of age associated with increased odds of IgG seropositivity. Year, region, and settlement type were not significant predictors, indicating no evidence of temporal trends, regional differences, or differences between urban and rural settings after adjusting for age. Year of sampling, age, and region were significant predictors for IgM positivity. Acute infections were most common from March to July (61.2%) and December (9.4%), with regional variations in seasonal prevalence patterns. Given that screening in pregnancy is not routinely recommended, the high susceptibility to B19V observed in Croatia supports targeted serologic testing in women with clinical symptoms, known exposure, or occupational risk. Full article