Original research publications

Hypertensive disorders of pregnancy (HDP) increase the risk of chronic hypertension (HTN) and cardiovascular (CV) disease later in life. It is unknown how strict blood pressure (BP) monitoring postpartum (PP) may affect rates of HTN at 6 weeks PP. We evaluate the effect of a PP HTN standardized clinical assessment and management plan (SCAMP) on HTN at 6 weeks PP. This is a secondary analysis of a prospective cohort study of patients with PP HTN at a quaternary care center for 6 months after enacting an institution-wide SCAMP. The prospective group was compared with historical controls who delivered prior to initiation of the SCAMP. The SCAMP included (1) initiation or uptitration of medication for any BP ≥150/100 or any 2 BPs ≥140/90 within a 24-h period with a goal of BP <140/90 12 h prior to discharge and (2) enrollment in a remote BP monitoring system upon discharge. Inclusion criteria were an existing diagnosis of chronic HTN or HDP and a documented BP at a 6-week PP visit. The primary outcome was HTN, defined as systolic BP (SBP) ≥140 or diastolic BP (DBP) ≥90, at 6 weeks PP. Secondary outcomes included mean BP values as measured in the outpatient setting at 6 weeks PP and use of anti-HTNs at the time of the 6-week PP visit. For all analyses, p values were two-way, and the level of statistical significance was set at p < 0.05. Of 780 PP HTN patients in the prospective cohort study, 627 (80.4%) met inclusion criteria for the secondary analysis, 305 in the SCAMP cohort and 322 historical controls. The SCAMP cohort had lower rates of chronic HTN, more patients on anti-HTNs, and higher rate of nifedipine use. The primary outcome of HTN at 6 weeks PP was significantly lower in the SCAMP group (10.5% vs. 18.3%, p = 0.005). After adjusting for confounding variables, multivariable logistic regression showed that the SCAMP group had 38% reduced odds of HTN at 6 weeks PP compared to controls (adjusted odds ratio [aOR], 0.62; 95% confidence interval [CI], 0.38-0.996; p = 0.048). Mean SBP at 6 weeks PP was significantly lower in the SCAMP group (120 ± 12 vs. 124 ± 14 mmHg, p < 0.001), as was mean DBP (76 ± 8 vs. 81 ± 8 mmHg, p < 0.001). A subanalysis only including patients with diagnosed HDP and excluding those with only chronic HTN demonstrated similar findings. Implementation of a SCAMP was associated with reduced rates of HTN at 6 weeks PP, with lower mean SBP and DBP. More data are needed to evaluate how these findings mitigate long-term HTN risk.

Preliminary data suggest sustained disease control with ocrelizumab (OCR) or rituximab (RTX) in women with multiple sclerosis (MS) after pregnancy suspension; however, the influence of washout duration and cumulative dosing remains unknown. This study investigates disease activity during and after pregnancy in women with relapsing-remitting MS treated with OCR/RTX before pregnancy. In this cohort study, pregnancies of women treated with OCR/RTX documented in the German MS and Pregnancy Registry were stratified by timing of last infusion (≥ or <4 months to last menstrual period [LMP]) and number of cycles (≥ or <2 cycles). Relapses treated with high-dose glucocorticosteroids were analyzed, as was persistent disability (following a relapse) at 1-year postpartum, defined as a ≥2.0-point increase in Expanded Disability Status Scale (EDSS) or new/worsening ambulatory impairment (Severe Relapse Disability Composite Score [SRDCS]). Of 294 pregnancies among 275 women, only 28.6% (n = 84) suspended OCR/RTX ≥4 months before LMP and most (79.3% [n = 233]) received ≥2 cycles. Relapses during pregnancy (2.0%) and within 12 months postpartum (8.5%) were rare. Four women (1.6%) reached the SRDCS postpartum. Neither the time of last infusion nor the number of cycles was associated with a higher relapse risk during pregnancy (time between OCR/RTX and LMP: <4 months adjusted OR: 0.60, CI: 0.09-5.02, p value: 0.60; number of cycles: <2 cycles adjusted OR: 2.23, CI: 0.34-15.5, p value: 0.39) or postpartum (time between OCR/RTX and LMP: <4 months adjusted OR: 0.62, CI: 0.23-1.77, p value: 0.36; number of cycles: <2 cycles adjusted OR: 0.64, CI: 0.16-2.03, p value: 0.48, time of anti-CD20 antibody restart postpartum: >6 weeks adjusted OR: 1.15, CI: 0.37-4.11, p value: 0.82) or with reaching the SRDCS or EDSS worsening postpartum. In women receiving ≥2 cycles and interrupting treatment <4 months before LMP, numerically fewer relapses during pregnancy could be observed (1/163: 0.6% vs 5/131: 3.8%, p value: 0.09). Relapses and disability during and after pregnancy after OCR/RTX interruption are rare and independent of timing and number of cycles. However, potential differences may not be detectable due to the low number of events and should be evaluated in larger studies. In addition, the applicability to ofatumumab, given its different dosing interval, remains unclear.

Maternal representations of the child begin forming during pregnancy and evolve through interactions with the baby. Research suggests that prenatal representations may have a more stable impact on parenting than postnatal representations, but their long-term impact remains unclear. This study examines (1) how prenatal and 1-year postnatal representations are associated with parenting when child is age 4 and (2) whether prenatal representations have a more enduring influence on later caregiving than postnatal representations by exploring how stability or shifts in representations across time shape parenting. One hundred fifty-five US mothers, oversampled for intimate partner violence and low income, participated in this longitudinal study. Prenatal balanced representations were significantly associated with more sensitive and less unresponsive parenting, whereas disengaged representations were linked to lower sensitivity and greater unresponsiveness. Postnatal representations predicted sensitive parenting but were not significantly associated with intrusive or unresponsive behaviors. Examination of changes in prenatal to postnatal representations revealed that mothers who shifted from balanced (prenatal) to non-balanced (postnatal) representations displayed higher sensitivity than those who remained non-balanced. Results highlight the consistent impact of prenatal representations on parenting, emphasizing the need for timely interventions during pregnancy and the early postpartum period to promote positive parenting.

To examine whether there is variation in postpartum hemorrhage (PPH) management and whether differences are associated with patient-level factors and delivery hospital. This is a retrospective cohort study of patients delivered at ≥20 weeks of gestation at any of four hospitals within one Connecticut healthcare system, with evidence of PPH, and receipt of intervention from 2012 to 2023. Patients with placenta accreta spectrum disorders, obstetric anal sphincter injuries, or stillbirth were excluded. The primary dependent variable was type of PPH treatment administered and structured as a four-level categorical variable: (1) usual care treatment including synthetic oxytocin infusion and uterine massage; (2) receipt of less aggressive medication treatment with uterotonics only; (3) receipt of more aggressive medication treatment with uterotonics only; and (4) any procedure with or without medication use. Although hysterectomy is considered a later-stage procedure in the setting of PPH, patients undergoing hysterectomy were included in the procedure group because insufficient cases of hysterectomy did not allow separate grouping. Maternal sociodemographic, clinical and pregnancy factors, and delivery hospital site were compared across the four-level PPH treatment categories. Bivariate analyses and crude and adjusted multinomial logistic regression analyses were performed. Of 110,690 delivery encounters, 10,829 (9.8%) had documented evidence of study-defined PPH. Of these deliveries, 10,075 (93.0%) met eligibility criteria and were included in the analysis: 4941 (49.0%) received usual care treatment, 2982 (29.6%) received less aggressive medication use only, 1308 (13.0%) received more aggressive medication use only, and 844 (8.4%) underwent procedure(s) with or without medication use. There was a wide range in the number of medication types and doses received, as well as a wide spectrum of the number and types of procedures employed. Adjusted multinomial logistic regression analyses showed significant differences in patient-level factors (e.g., maternal age, race and ethnicity, gestational age, placenta previa, hypertensive disorders, and in vitro fertilization [IVF]) and delivery hospital among different types of PPH management. There is significant variation in the management of PPH, and differences are associated with patient-level factors and delivery hospital type and region, which may be a proxy for clinical management and available resources.

Postpartum remote blood pressure monitoring (RBPM) programs have emerged as an important adjunct to the management of hypertensive disorders of pregnancy (HDP). These programs have demonstrated robust patient participation and satisfaction with reduced readmissions and severe maternal morbidity. Despite this, data describing blood pressure (BP) trends throughout program participation and across different antihypertensive regimens remain limited. We sought to evaluate BP trends and time in target range (TTR) during our 6-week RBPM program. This is a retrospective cohort study of postpartum individuals participating in an RBPM program from November 2023 through December 2024. This program utilizes a standardized nurse (RN)-driven protocol for antihypertensive medication initiation and titration to achieve a goal BP of <140/90 mmHg. Target range was defined as SBP (systolic BP) 100-139 mmHg and DBP (diastolic BP) 60-89 mmHg. The primary outcomes were BP trend and TTR throughout program participation stratified by antihypertensive medication at discharge. The cohort included 465 individuals. Mean BPs were <140/90 mmHg for all groups for each program week. Most participants were within the target range throughout with TTR between 80.3% and 90.4%. Of participants, 175 (81.4%) were prescribed nifedipine monotherapy and 40 (18.6%) labetalol monotherapy. Mean BP trends were within goal for both groups; however, those discharged with nifedipine spent more TTR (nifedipine 87.5% vs. labetalol 80.3%, p = 0.03). There were no significant differences in rates of severe hypertension or hypotension; however, those on nifedipine experienced fewer elevated BPs and fewer patients who were discharged on nifedipine required antihypertensives at 6 weeks postpartum (nifedipine 35.7% vs. labetalol 73.5%, p < 0.001; adjusted odds ratio [OR], 0.27; 95% confidence interval [CI], 0.11-0.61). Postpartum RBPM is an important tool for postpartum care. Utilization of a standardized RN-driven protocol for antihypertensive medication initiation and titration can result in optimal BP management irrespective of medication regimen at discharge. These data suggest that nifedipine may be associated with more rapid and sustained achievement of target BPs throughout 6 weeks postpartum compared to labetalol.

This study aimed to examine associations of gestational weight gain (GWG) and postpartum weight retention (PPWR) with women's mid-life cardiovascular health. We studied 838 Project Viva participants enrolled 1999-2002 (mean age: 32.6 years). We categorized GWG as inadequate, adequate, or excessive using 2009 Institute of Medicine guidelines and calculated PPWR at 6 months, 1 year, and 2 years. At the Mid-Life Visit (2017-2021; mean age: 51.0 years), we derived Life's Essential 8 (LE8) scores (0-100; higher = better). We used linear regression models adjusted for pre-pregnancy BMI, age at enrollment, pregnancy smoking status, household income, and educational attainment. Excessive versus adequate GWG was associated with worse weight status (β = -8.99, 95% CI: -12.81, -5.18) but not with the overall LE8 score (β = -1.93, 95% CI: -3.92, 0.07) or the biomedical domain score (β = -2.31, 95% CI: -5.66, 1.05). Each 1-kg higher 1-year PPWR was associated with worse biomedical domain (β = -0.49, 95% CI: -0.84, -0.14), weight status (β = -1.54, 95% CI: -1.90, -1.17), and blood pressure scores (β = -0.62, 95% CI: -1.15, -0.10). PPWR at 6 months and 2 years was also associated with worse glycemic traits scores. Excessive GWG was associated primarily with worse mid-life weight status, whereas higher PPWR was associated with worse mid-life cardiovascular health.

Oxytocin is often used in the second stage of labor and despite studies demonstrating dose-dependent oxytocin receptor desensitization, the relationship between second stage exposure and postpartum hemorrhage (PPH) risk is not well established. We sought to evaluate the relationship between second-stage oxytocin exposure and postpartum bleeding outcomes. Secondary analysis of a multicenter randomized controlled trial of term singleton nulliparous patients with neuraxial analgesia comparing immediate versus delayed pushing in the second stage. Estimated cumulative second-stage oxytocin exposure was calculated as the product of oxytocin dose at complete dilation and second-stage duration and was modeled continuously per 100-milliunit (mU) increase. The primary outcome was a maternal composite consisting of PPH, blood transfusion, or additional uterotonic administration. Modified Poisson regression with robust variance estimation was used to estimate risk ratios (RRs) and adjusted risk ratios (aRRs), controlling for randomized pushing assignment, admission diagnosis, and prolonged second-stage duration. Exploratory analyses evaluated estimated blood loss (EBL) as a continuous outcome; sensitivity analyses examined categorical exposure groups using median cumulative dose defined as no exposure (0 mU), low exposure (<816 mU), and high exposure (≥816 mU). A total of 2302 participants were included from the parent trial. Each 100-mU increase in estimated second-stage oxytocin exposure was associated with a 2.5% higher risk of the primary maternal composite outcome (aRR, 1.025, 95% confidence interval [CI], 1.014-1.036; p < 0.001) and a 2.7% higher risk of PPH (aRR, 1.027, 95% CI, 1.015-1.038; p < 0.001). In exploratory analyses, increasing exposure was associated with greater EBL (aRR, 1.008, 95% CI, 1.006-1.010; p < 0.001). Categorical sensitivity analyses demonstrated similar findings, with high exposure associated with a 60% higher risk of the primary maternal composite outcome and a 63% higher risk of PPH compared with no exposure. Greater cumulative second-stage oxytocin exposure was associated with increased maternal morbidity, particularly postpartum hemorrhage, with findings supporting a dose-response relationship.

The postpartum period remains a vulnerable phase for maintaining virologic suppression among women with HIV (WWH); however, evidence on postpartum virologic failure (VF) among women virologically suppressed at delivery is limited. We analyzed data from the CoRIS cohort including WWH aged 18-50 years who had a live birth while receiving antiretroviral therapy (ART) and were virologically suppressed at delivery between 2004 and 2024. The primary outcome was time to VF within 12 months postpartum, defined as two consecutive HIV RNA measurements >50 copies/mL or a single measurement >1000 copies/mL. Secondary outcomes included virologic non-suppression (VnS) and CD4 + cell count changes at 12 months postpartum. Kaplan-Meier and Cox models were used to assess time to VF and generalized estimating equations (logistic and linear model) to evaluate VnS and CD4 + changes, accounting for repeated deliveries. The analysis included 422 deliveries among 337 women. The cumulative incidence of VF was 15.7% (95% CI: 12.1-19.1) at 12 months postpartum. VF risk was lower in more recent calendar periods. At 12 months postpartum, 18.0% of deliveries showed VnS. Earlier calendar periods, younger maternal age, and protease inhibitor-based ART regimens were associated with higher odds of non-suppression. Mean CD4 + cell counts increased by 88.5 cells/µL overall, with greater improvements in more recent years. Postpartum ART discontinuation decreased markedly over time, alongside increasing treatment stability. Maintaining virologic suppression postpartum remains challenging despite advances in ART. Targeted postpartum strategies are needed to ensure durable virologic control.

Coxiella burnetii is endemic in Great Britain dairy herds but detailed investigations of C. burnetii epidemiology and impacts on livestock production in this region are scarce. The objectives of this cross-sectional study were to first determine the within-herd prevalence of C. burnetii on a commercial Scottish dairy farm with prior detection of C. burnetii and second assess the relationship between pathogen load and individual health and performance traits. Vaginal swabs were collected from cows up to seven days postpartum. DNA extracts were tested for C. burnetii by IS1111 qPCR assay. Generalized linear models were used to estimate the relationships between bacterial load and health and performance traits. A total of 313 swabs were collected between 15 December 2022 and 06 July 2023, of which 301 (96.1%) had detectable C. burnetii DNA with Ct ≤ 40. The Ct values observed (12.9-38.7) corresponded to estimated genome equivalents per reaction of < 1 to ∼2.5 million genomes. Higher bacterial loads were seen in primiparous compared to multiparous cows. Higher bacterial loads were also more likely in cows that had experienced one or more negative reproductive outcomes, including abortion, premature delivery, prolonged gestation, stillbirth and dystocia. The direction of causation underlying the observed associations and representativeness of findings from this single herd require further investigation. This study provides insights into the within-herd dynamics of C. burnetii and evidence generated through sampling and diagnostic testing approaches that can inform future work to characterize the epidemiology and impacts of this infection in Great Britain dairy cattle and globally.

Nasal breathing is an underrecognized and poorly understood component of maternal physiology. Pregnancy remodels nearly every physiologic system, yet whether breathing occurs through the nose or mouth is often overlooked. The nose undergoes hormonally driven adaptations beginning early in gestation. Rising estrogen and progesterone engorge the nasal turbinates, increase mucosal edema, and progressively raise nasal airflow resistance. These changes are frequently dismissed as benign; however, they may carry consequences that extend beyond congestion. This narrative review examines the physiologic functions of the nose in pregnancy, the consequences of impaired nasal airflow, and breathing-based, mechanical, and behavioral strategies intended to preserve nasal function and support maternal health. Nasal breathing conditions inspired air, delivers sinus-derived nitric oxide that supports pulmonary vasodilation and host defense, and participates in the carbon dioxide homeostasis that sustains the maternal-fetal diffusion gradient. Progressive nasal obstruction may contribute to mouth breathing, snoring, sleep fragmentation, and sleep-disordered breathing, conditions associated with hypertensive disorders of pregnancy, gestational diabetes, and other adverse maternal and perinatal outcomes. Nasal breathing practices (pranayama) have been shown to provide therapeutic benefit in the non-pregnant population. Slow nasal breathing, including alternate nostril breathing, has shown favorable effects on respiratory rate, blood pressure, autonomic regulation, sleep, and perceived well-being in preliminary pregnancy studies. Humming-based breathing practices increase nasal nitric oxide and produce acute cardiovascular responses during practice that differ from post-intervention or longer-term effects. Cooling breathing techniques also influence hemodynamic function, whereas energizing practices and breath retention remain insufficiently studied in pregnancy. Mechanical and behavioral approaches, including external nasal dilators, saline irrigation, humidification, and positional strategies, improve nasal patency and symptoms but have not been shown to prevent or treat pregnancy-related sleep-disordered breathing. Mouth taping remains investigational because pregnancy-specific safety and efficacy data are absent. Future studies should objectively characterize nasal function, distinguish among specific breathing techniques, and evaluate maternal symptoms, sleep, autonomic and blood pressure trajectories, fetal growth, and perinatal outcomes. Recognizing the route and pattern of breathing as potentially modifiable dimensions of maternal respiratory physiology may provide new insight into pathways contributing to pregnancy complications and identify opportunities for nonpharmacologic intervention.

The objective was to determine whether combining equine chorionic gonadotropin (eCG) and 48-h temporary calf removal (CR) at the end of an estradiol and progesterone (P4)-based estrous synchronization protocol for fixed-time AI (TAI) improves pregnancy per AI (P/AI) in suckled multiparous and primiparous Nellore cows. Suckled cows (n = 2643) with adequate body condition score (>95% with BCS ≥ 2.5 on a 5-point scale) were assigned to receive CR, 300 IU of eCG, or eCG + CR on day -2 (D-2) followed by measurement of follicular diameter and estrus expression by TAI (D0), serum P4 concentrations on D7, pregnancy per AI (P/AI) on D30, and calf weaning weights. At TAI, eCG-treated cows had larger follicle diameter (13.5 mm) than CR-treated cows (13.2 mm vs. eCG + CR: 13.1 mm, SEM: 0.2), P < 0.05. Estrus expression was greater in CR and eCG + CR treated cows than in eCG-treated cows (eCG: 59.5 b % vs. CR: 77.8 a % vs. eCG + CR: 75.0 a %). Among primiparous cows, eCG-based treatment (eCG and eCG + CR) resulted in greater serum P4 concentrations on D7 than CR alone. Despite these physiological differences, P/AI was similar among treatments (eCG: 49.8% vs. CR: 53.6% vs. eCG + CR: 49.4%). Calves from cows treated with CR and eCG + CR were lighter (unadjusted weaning weights: 184.1 and 186.2 kg, respectively) than calves from eCG-treated cows (189.2 kg). In conclusion, combining eCG and CR did not improve P/AI compared with either treatment alone. Temporary 48-h calf removal increased estrus expression but did not improve fertility and reduced calf weaning weight. In contrast, eCG alone resulted in heavier calves at weaning, supporting its use over temporary 48-h calf removal in estrous synchronization programs when calf weaning weight is also considered.

Background: Adverse childhood experiences (ACEs) disproportionately affect women and significantly increase the risk of postpartum post-traumatic stress disorder (PTSD). However, the psychological mechanisms underlying this relationship remain inadequately investigated. Aim: To develop a constructivist grounded theory explaining how ACEs influence the development of postpartum PTSD. Methods: Employing a constructivist grounded theory approach, this qualitative study was conducted at a tertiary hospital in South China between November 2023 and October 2024. Data were collected through in-depth interviews conducted with 10 women who experienced ACEs and subsequently developed postpartum PTSD. Early maladaptive schemas (EMS) were identified as the central construct in the resulting theory. Results: The developed theory contains five components: (1) the origin of EMS; (2) the formation of EMS; (3) the trigger of EMS; (4) the operation of EMS; and (5) the outcome of EMS. Findings suggest that ACEs were perceived as providing the foundation for EMS, which gradually solidified during an individual's developmental trajectory to become an ingrained subconscious framework for responding to external stressors. During the stress-inducing event of childbirth, EMS appeared to be activated, influencing cognitive appraisals of the stressor, coping strategies, and perceived social support, ultimately contributing to the experience of postpartum PTSD symptoms. Conclusion: This study advances a constructivist grounded theory that elucidates how ACEs relate to the development of postpartum PTSD within the context of the formation, activation, and operationalisation of EMS. Given the modifiable nature of EMS, these findings highlight the potential of targeted interventions like schema therapy and trauma-informed care. Effective maternal support should address both the immediate stress of childbirth and the persisting influence of ACEs. This inaugural qualitative study, employing a constructivist grounded theory methodology, outlines the theoretical pathway linking adverse childhood experiences to postpartum post-traumatic stress disorder.Early maladaptive schemas emerged as a core construct in participants’ accounts of the relationship between adverse childhood experiences and postpartum post-traumatic stress disorder. These schemas appear to distort appraisals, may foster maladaptive coping, and can impair social support utilisation when activated by childbirth.The findings highlight the critical need for trauma-informed perinatal care and schema-focused interventions to mitigate the long-term impact of adverse childhood experiences on maternal mental health. Antecedentes: Las experiencias adversas en la infancia (ACEs en sus siglas en inglés) afectan de manera desproporcionada a las mujeres y aumentan significativamente el riesgo de trastorno por estrés postraumático (TEPT) posparto. Sin embargo, los mecanismos psicológicos que subyacen a esta relación aún no se han investigado lo suficiente. Objetivo: Desarrollar una teoría fundamentada constructivista que explique cómo las experiencias adversas en la infancia (ACEs) influyen en el desarrollo del trastorno de estrés postraumático posparto. Métodos: Este estudio cualitativo que emplea una teoría fundamentada constructivista, se llevó a cabo en un hospital terciario del sur de China entre noviembre de 2023 y octubre de 2024. Los datos se recopilaron a través de entrevistas en profundidad realizadas a 10 mujeres que habían sufrido experiencias adversas en la infancia (ACEs) y que posteriormente desarrollaron un trastorno de estrés postraumático posparto. Los esquemas desadaptativos tempranos (EMS, en sus siglas en inglés) se identificaron como el constructo central de la teoría resultante. Resultados: La teoría desarrollada consta de cinco componentes: (1) el origen del EMS; (2) la formación de los EMS; (3) el desencadenante de los EMS; (4) el funcionamiento de los EMS; y (5) el resultado de los EMS. Los hallazgos sugieren que las ACEs se percibían como la base de los EMS, que se fue consolidando gradualmente a lo largo de la trayectoria de desarrollo del individuo hasta convertirse en un marco subconsciente arraigado para responder a los factores estresantes externos. Durante el evento estresante del parto, los EMS parecieron activarse, influyendo en las evaluaciones cognitivas del factor estresante, las estrategias de afrontamiento y el apoyo social percibido, lo que en última instancia contribuyó a la experiencia de síntomas de TEPT posparto. Conclusión: Este estudio propone una teoría fundamentada constructivista que aclara cómo las ACEs se relacionan con el desarrollo del TEPT posparto en el contexto de la formación, la activación y la operacionalización de los EMS. Dada la naturaleza modificable de los EMS, estos hallazgos resaltan el potencial de intervenciones específicas como la terapia de esquemas y la atención informada sobre el trauma. Un apoyo materno eficaz debe abordar tanto el estrés inmediato del parto como la influencia persistente de las ACEs.

Postpartum falls threaten maternal and infant safety, yet evidence on postpartum women's fall-prevention knowledge, attitude, and behaviour (KAB) and their sociodemographic correlates remains limited. This study examined postpartum fall-prevention KAB and associations among KAB dimensions and in-hospital fall occurrence. In this cross-sectional study, 1,220 postpartum women from a tertiary hospital in Chengdu, China, completed a general questionnaire and a self-developed Postpartum Fall Prevention KAB Scale (Cronbach's α = 0.926). Multivariable linear regression examined associations of maternal education, companion education, and residence with KAB scores. Structural equation modelling examined associations among knowledge, attitude, behaviour, and in-hospital fall occurrence. Higher maternal education was associated with higher knowledge (B = 0.22, 95% CI 0.06 to 0.38; p = 0.009), attitude (B = 0.23, 95% CI 0.02 to 0.43; p = 0.030), and behaviour scores (B = 0.57, 95% CI 0.02 to 1.11; p = 0.044). Residence was associated with attitude score (B = 0.77, 95% CI 0.13 to 1.41; p = 0.020), but not with knowledge or behaviour. Companion education was associated with behaviour score (B = -0.67, 95% CI -1.15 to -0.20; p = 0.005), but not with knowledge or attitude. In the structural model, knowledge was associated with attitude (estimate = 0.289, 95% CI 0.206 to 0.379; p < 0.001) and behaviour (estimate = 0.663, 95% CI 0.455 to 0.908; p < 0.001), and attitude was associated with behaviour (estimate = 0.471, 95% CI 0.304 to 0.634; p < 0.001). behaviour was not associated with in-hospital fall occurrence (estimate = 0.001, 95% CI -0.001 to 0.002; p = 0.506). Maternal education, residence, and companion education were associated with postpartum fall-prevention KAB scores. The findings support associations broadly consistent with the KAB framework, but causality cannot be inferred. Tailored fall-prevention education should be evaluated in longitudinal, multi-centre studies. After giving birth, some women may be more likely to fall in hospital because of tiredness, weakness, dizziness, pain, or the effects of medication. We wanted to understand what postpartum women know about fall prevention, how they feel about it, and what safety behaviours they report during their hospital stay.We surveyed 1,220 postpartum women in a hospital in Chengdu, China. We found that women with higher education tended to have higher scores for fall-prevention knowledge, attitude, and behaviour. Women from different residential backgrounds showed differences mainly in attitude scores. Companion education was associated with behaviour scores, but not with all aspects of knowledge or attitude.We also found that women with higher knowledge scores tended to report more positive attitudes, and both knowledge and attitude were associated with safer reported behaviours. However, reported behaviour was not significantly associated with actual in-hospital fall occurrence in this study.These findings suggest that postpartum fall-prevention education may need to be adapted for women from different sociodemographic backgrounds. Because this was a cross-sectional study conducted in one hospital, the results show associations rather than cause-and-effect relationships.

The early postpartum period (first 42 days after delivery) is a high-risk window for severe maternal morbidity (SMM), yet clinical predictors are not well characterized. We examined rates and clinical factors that associate with early postpartum SMM by infant birthweight category to inform future intervention strategies. We constructed a retrospective, population-based cohort of 542,702 live births in Georgia (2016-2020) using linked birth certificate and hospital discharge records. Infant birthweight was categorized as normal or above (NBW+, ≥2500 g), moderately low (LBW, 1500-2499 g), or very low (VLBW, <1500 g). We estimated early postpartum SMM rates, adjusted risk ratios (RRs), and population attributable risk percentages (PARs) for medical, obstetric, and delivery-related factors using multivariable modeling. Among 542,702 livebirths (492,190 NBW+; 41,337 LBW; 9,172 VLBW), early postpartum SMM rates were highest among VLBW (153 per 10,000) compared with LBW (76 per 10,000) and NBW+ (41 per 10,000) deliveries. Cesarean delivery was associated with the largest observed PAR for all birthweight categories (VLBW: 56.8%; LBW: 25.6%; NBW+: 26.8%) followed by SMM at delivery (VLBW: 15.0%; LBW: 11.4%; 4.2% for NBW+). Chronic and perinatal health conditions each accounted for ≤6% PAR. Women delivering VLBW and LBW infants experienced nearly four-fold and two-fold higher risks of early postpartum SMM, respectively, compared with NBW+ births. Delivery events, particularly cesarean and SMM at delivery, were associated with the greatest PAR of early postpartum SMM. Findings underscore the need for postpartum monitoring protocols, especially after complicated deliveries, and integrated models of maternal-infant care. Study question Do mothers of very low birthweight (VLBW) and low birthweight (LBW) infants face higher risk of severe maternal morbidity (SMM) in the first six weeks after delivery, and what factors associate with elevated risk for early postpartum SMM?What’s already known The early postpartum period is a high-risk window for maternal complications. Risk factors are not well described, and less is known about outcomes for mothers of infants with very low or low birthweight.What this study adds In Georgia, mothers of VLBW and LBW infants had four-fold and two-fold higher risks of early postpartum SMM compared with mothers with higher birthweight infants. Cesarean delivery and complications at delivery explained most of the excess risk, highlighting the need for integrated maternal–infant care models for closer postpartum maternal monitoring.

This article embarks on a journey through recent advances in postpartum depression (PPD), specifically focusing on rapid-acting neuroactive steroids, the first medications approved specifically for PPD.

Postpartum hypertension is a common complication following hypertensive disorders of pregnancy and is associated with increased short- and long-term cardiovascular risk. Evidence guiding optimal oral antihypertensive therapy in the postpartum period remains limited. To compare the efficacy and safety of oral nifedipine vs a combination of enalapril-hydrochlorothiazide in the management of postpartum hypertension. This open-label, randomized controlled trial was conducted at a tertiary care institute between February 2024 and February 2025. Women with systolic blood pressure (SBP) >140 mmHg and/or diastolic blood pressure (DBP) >90 mmHg occurring from delivery up to 6 weeks postpartum were enrolled. Participants were randomized to receive either oral nifedipine (Group A, n=80) or oral enalapril-hydrochlorothiazide (Group B, n=83). The primary outcome of the study was the sustained blood pressure control defined as absence of episodes of severe blood pressure defined as SBP>160 mmHg and DBP>110 mmHg for minimum of 48 hours. Secondary outcomes included time required to achieve target blood pressure (defined as SBP<140 mmHg and DBP<90 mmHg), mean change in SBP and DBP, number of doses required to achieve target BP, requirement of additional antihypertensive drugs, total duration of drug requirement, maternal complications due to raised BP, any side effects associated with drug intake and mean BP at 1-week and 6-week follow-up. Intention-to-treat analysis was performed. Sustained BP control for 48 hours did not differ significantly (63.75% vs 72.2%; P=.242) among the groups. However, post-treatment mean SBP was significantly lower in the enalapril-hydrochlorothiazide group (SBP: 138.3±11.69 vs 133.0±11.31 mmHg, mean difference, -5.3 mmHg; P=.003). Similarly, mean DBP was significantly lower in Group B than in Group A (84.8±9.14 vs 88.0±7.66 mmHg; mean difference, -3.2 mmHg; P=.02). The percentage reduction in SBP and DBP was also greater with combination therapy. Both groups achieved BP control within a comparable time frame (3.65±1.77 vs 3.76±1.6 hours; P=.101). Additionally, the need for additional antihypertensive medication was significantly higher in the nifedipine group (28.7% vs 14.4%; P=.02). Adverse effects were mild and comparable between groups, with no maternal complications observed. Enalapril-hydrochlorothiazide provided greater blood pressure reduction and reduced the need for additional antihypertensive therapy compared with nifedipine in the management of postpartum hypertension.

Infertility and its treatment impose significant psychosocial burdens that impair quality of life (QoL). Its impact on pregnancy outcomes after embryo transfer (ET) in assisted reproduction technologies (ART) remains underexplored. This study prospectively examined the association between QoL-measured by the FertiQoL instrument-and cumulative live birth rates (CLBRs) in women undergoing ART. In this prospective cohort study, 1,233 women initiating IVF/ICSI completed the FertiQoL questionnaire pretreatment. Latent profile analysis (LPA) identified distinct QoL subgroups based on domain scores. Multivariable regression models, adjusted for confounders, assessed associations between QoL profiles/scores and pregnancy outcomes, with CLBRs as the primary endpoint. Smoothed curve fitting and threshold analyses explored nonlinear relationships. LPA delineated three FertiQoL subgroups: Low ( n = 278), Medium ( n = 676), and High ( n = 279). Multivariate regression revealed that, relative to the Low-QoL group, the Medium-QoL group had significantly higher CLBRs (adjusted odds ratio [OR]: 1.704; 95% CI: 1.217-2.380) and reduced miscarriage risk (adjusted OR: 0.513; 95% CI: 0.304-0.875). Smoothed curve fitting indicated a nonlinear association between total FertiQoL score and CLBRs. Threshold analysis identified a cutoff of 74.306 (log-likelihood ratio test p = 0.054); below this value, each one-unit increase in score corresponded to a 2.1% higher CLBR (adjusted OR: 1.021; 95% CI: 1.006-1.036). Bootstrap internal validation confirmed the stability of this cutoff. QoL was significantly associated with CLBRs following ET. A threshold effect was evident: improvements in QoL below a score of 74.306 were associated with higher live birth rates. These findings underscore the importance of integrating QoL assessment and intervention into infertility care.

The problem of availability of abortion services for women in countries of world community is not only not losing its importance, but is undergoing new stage of actualization, since it has no clear understanding and is often raised in the context of solving demographic problems of aging society. At the same time, analysis reveals vulnerability of position of those using religious context in womans self-determination regarding disposal of her own body and right to refuse compulsion to terminate her pregnancy by physiological childbirth without her psychological, social and economic readiness and public support. Referring to various testimonies and sources, we appeal to necessity of working out common criteria to ensure womens access to medical care related to procedure of abortion in order to reduce mortality from diseases associated with self-abortions menacing live and health of women. The issues considered in the study may affect various spheres of social, medical and legal field and have wide area of practical implementation. The purpose of the study is to identify causes and to establish consequences of womens limited access to abortion services, as well as legal and ethical aspects of overcoming these restrictions. Проблема доступности услуги прерывания беременности для женщин в странах мирового сообщества не только не утрачивает своего значения, а проходит новый этап актуализации, поскольку не имеет однозначного понимания и нередко поднимается в контексте решения демографических проблем стареющего общества. Вместе с тем в результате анализа выявляется уязвимость позиции тех, кто использует религиозный контекст в самоопределении женщины по поводу распоряжения собственным телом и права на отказ от понуждения к разрешению ее беременности физиологическими родами без ее психологической, социальной и экономической готовности и общественной поддержки. Обращаясь к различным свидетельствам и источникам, мы апеллируем к необходимости выработки единых критериев для обеспечения доступа женщин к медицинской помощи, связанной с проведением прерывания беременности, в целях снижения смертности от заболеваний, связанных с проведением самоабортов, угрожающих жизни и здоровью женщин. Поднятые в исследовании проблемы могут затрагивать различные сферы социального, медицинского и правового поля и иметь широкую область применения на практике.

Non-criteria antiphospholipid antibodies (NC-aPLs) may supplement criteria antiphospholipid antibody testing in women with pregnancy loss, but their prevalence, laboratory-associated variability, and susceptibility to pregnancy status remain incompletely characterized. This cross-sectional study included 1897 women with a history of pregnancy loss who underwent testing for 10 NC-aPLs at three independent commercial laboratories. Positivity was defined using laboratory-specific manufacturer reference ranges. We compared positivity across laboratories and by criteria aPL status, pregnancy status at testing, and number of previous losses. Multivariable logistic regression evaluated associations between pregnancy status and individual NC-aPL positivity. Overall, 55.5% of women had at least one positive NC-aPL; 54.6% of those negative for criteria aPLs remained positive for at least one NC-aPL. Positivity differed across laboratories for 8 of 10 markers, with marked variation for aAnxA5-IgG (8.6%-29.8%) and aPE-IgG (4.8%-24.3%). After adjustment, pregnancy at testing was associated with higher odds of aAnxA5-IgG positivity, whereas no significant associations were observed for the other nine markers. NC-aPL positivity showed no significant trend with the number of previous pregnancy losses. NC-aPLs were common in women with pregnancy loss, including those negative for criteria aPLs. Substantial laboratory-associated variability highlights a barrier to clinical interpretation and the need for assay standardization. The association between pregnancy status and aAnxA5-IgG positivity warrants longitudinal evaluation.

Climate change is worsening air pollution and increasing global temperatures, which is adversely affecting human health in many ways. Pregnant people appear to be at greater risk for complications related to exposure to excess heat and air pollution due to normal physiologic adaptations that occur in pregnancy. Social and structural determinants of health contribute to disproportionate exposure to environmental hazards among some populations which worsens existing inequities in perinatal outcomes. Nurses are uniquely positioned to educate patients about environmental health risks, promote adaptation strategies to reduce adverse outcomes, and lead advocacy efforts aimed at climate mitigation.

Meningiomas, the most common primary central nervous system (CNS) tumors, are typically benign and hormonally responsive. They have a higher incidence in women, particularly during the reproductive years. Pregnancy may trigger rapid tumor progression and symptom onset due to elevated hormone levels. Although rare in pregnancy, meningiomas may adversely affect maternal and fetal outcomes, increasing the risk of complications such as preterm labor and gestational hypertension. Management strategies range from conservative monitoring to surgical intervention depending on gestational age, tumor size, severity of symptoms, and maternal-fetal stability. This report describes the case of a 34-year-old woman (para 1 + 2, gravida 4), with a history of type 1 diabetes mellitus, who presented to an obstetric emergency unit at 32 weeks of gestation. She had a one-day history of projectile vomiting (three episodes), severe global headache, right-sided hemiparesis, speech difficulty, and reduced fetal movement. She also had pre-existing anemia and a Glasgow Coma Scale (GCS) score of 14/15 on admission. Brain MRI revealed a left medial sphenoid meningioma with midline shift and hydrocephalus. On day 2, she underwent emergency caesarean section due to fetal tachycardia and distress. She was later admitted to intensive care after her GCS score dropped to 10/15 and she developed feeding difficulties. 2D echocardiography revealed a left ventricular ejection fraction of 38%. An emergency craniotomy was performed on day 4, and the tumor adherent to the middle cerebral artery was excised. She was discharged after 14 days with marked improvement. Six months post-discharge, she had made a full clinical recovery. Meningiomas in pregnancy pose diagnostic and therapeutic challenges. Management must be tailored to individual patient needs. A multidisciplinary team approach is essential to optimize both maternal and fetal outcomes.

Fetal foramen ovale restriction (FO-R) is an abnormal intracardiac flow disorder that may affect fetal cardiac hemodynamics and perinatal management. This retrospective cohort study aimed to characterize the echocardiographic features, associated abnormalities, and perinatal outcomes of pregnancies complicated by fetal FO-R, providing clinical evidence for obstetric decision-making. A total of 283 fetuses diagnosed with FO-R by fetal echocardiography were enrolled. The diagnostic criteria were defined as a foramen ovale (FO) diameter <3 mm and a Doppler flow velocity >40 cm/s. Maternal clinical data, fetal echocardiographic findings, delivery details, and neonatal follow-up outcomes were collected and analyzed systematically. The incidence of FO-R was 1.88% among all fetal echocardiographic examinations. The median gestational age at diagnosis was 35 + 4 weeks, with 11.7% of cases diagnosed before 32 weeks of gestation. Coexisting pregnancy complications or fetal abnormalities were observed in 51.6% of cases, while 41.2% presented with isolated FO-R. Right heart enlargement was the most common associated cardiac finding (74.6%). The cesarean delivery rate was 64.7%, with fetal distress as the leading indication (24.0%). Multivariate analysis showed that FO diameter, timing of diagnosis, and presence of right heart enlargement did not significantly influence the delivery mode (all p > 0.05). Among 240 neonates with complete follow-up data, 27.1% had postnatal cardiac abnormalities, 93.8% of which resolved spontaneously within one year. Only 1.7% of neonates had persistent congenital heart defects. Fetal FO-R is mostly diagnosed in the third trimester and is frequently associated with right heart enlargement. Importantly, FO-R does not independently require cesarean delivery or preterm birth. Neonatal outcomes of fetuses with FO-R are generally favorable, with a high rate of spontaneous resolution of postnatal cardiac findings, which supports conservative obstetric management for most cases. What’s already known about this topic?Prenatally diagnosed FO-R has been reported as a possible predictor of longer postnatal hospitalization, but the severity, outcome and the influences on newborn of FO-R are still unclear.What does this study add?This large cohort confirms FO-R typically presents in the late third trimester with right heart enlargement. Importantly, FO-R severity, early diagnosis, or associated cardiac findings did not independently drive cesarean or preterm delivery decisions. Neonatal outcomes were excellent, with over 93% of postnatal defects resolving spontaneously within one year and no surgical interventions required.

Pregnancy is a vulnerable window for environmental pollutant exposure, yet the contribution of metals and metalloids (metal(loid)s) to gestational diabetes mellitus (GDM) remains insufficiently characterized. This prospective cohort study evaluated whether early-pregnancy urinary metal(loid)s were associated with subsequent GDM and explored their predictive and mechanistic value. Among 1201 pregnant women included in Guilin, China, nine urinary metal(loid)s were measured by inductively coupled plasma mass spectrometry. GDM was diagnosed by a 75-g oral glucose tolerance test at 24-28 gestational weeks. Restricted cubic spline and weighted quantile sum regression assessed dose-response and mixture effects. Machine learning models evaluated early prediction, and network toxicology explored molecular pathways. GDM occurred in 312 participants. Cadmium, arsenic, manganese, thallium, and lead showed nonlinear associations with GDM risk. Cadmium and arsenic dominated the overall mixture effect. Adding urinary metal(loid)s to conventional biochemical indicators modestly improved discrimination, with the XGBoost performing best. Network toxicology identified shared cadmium/arsenic targets enriched in oxidative stress, inflammation, apoptosis, endothelial dysfunction, and insulin-resistance pathways, including AGE-RAGE, HIF-1, TNF, and IL-17 signaling. These findings suggest that early-pregnancy metal(loid)s mixture exposure, particularly cadmium and arsenic, is associated with GDM risk, with arsenic the most consistent contributor across mixture methods and non-linear signals for lead and manganese warranting further investigation. Urinary metal(loid)s may serve as complementary biomarkers for early GDM risk stratification.

•Pregnancy can cause rapid growth in the size of a pituitary microadenoma.•The size of a pituitary microadenoma can regress after delivery.•The prolactinoma responsive to cabergoline may show treatment resistance during pregnancy.•Tumor apoplexy may happen in the case of rapid tumor growth.

Pharmacists have the potential to take on a leading role in menopause service provision, but this calls for a well-educated workforce. To support this ambition, high-quality undergraduate teaching is paramount so qualified pharmacists are prepared to take on these roles. This study aims find out current confidence and knowledge of pharmacy students on menopause and hormone replacement therapy. Pharmacy students at eight universities in the United Kingdom were invited by email to complete an online survey on menopause and hormone replacement therapy. Students were asked to self-report their confidence on each topic (0 = not confident at all, 10 = very confident), answer subject-specific questions and specify their preferred teaching methods. Data were analysed using descriptive statistics and a thematic approach where appropriate. In total 178 students (158 [88.8%] aged 18-24 years, 147 [82.6%] female) in years 1 (59, 33.1%), 2 (35, 19.7%), 3 (28, 15.7%) and 4 (56, 31.5%) completed the survey. Median [interquartile range] self-reported confidence in knowledge on menopause and hormone replacement therapy was 5.0 [4-6] and 4.0 [2-5], respectively. Students had basic knowledge of what menopause is, how long it lasts and common symptoms, but were uncertain about the risks and benefits of hormone replacement therapy. Students most commonly chose lectures (133/176, 75.6%) as their preferred teaching method. Pharmacy students lack confidence in their own knowledge of menopause and hormone replacement therapy. Pharmacy schools must evaluate their current curricula and consider how these topics are taught, specifically the associated risks with hormone replacement therapy.

To evaluate the efficacy and safety of low-dose paroxetine (20 mg/day) compared with placebo for managing vasomotor symptoms (VMS) in women with surgical menopause. This was a pilot randomized, double-blind, placebo-controlled trial conducted at the Instituto Hondureño de Seguridad Social (IHSS), Tegucigalpa, Honduras, from January 30 to July 31, 2025. Women aged <48 years, within 6 months of total hysterectomy with bilateral salpingo-oophorectomy, and experiencing moderate-to-severe VMS (≥ 7 episodes/week) were eligible. Participants were randomized 1:1 to receive paroxetine 20 mg/day or matching placebo (folic acid 5 mg) for 12 weeks. The primary outcome was change in total Menopause Rating Scale (MRS) score. Secondary outcomes included quality of life (SF-36) and adverse events. Analysis followed the per-protocol approach, with intention-to-treat sensitivity analysis. Of 150 women assessed, 90 were randomized. A total of 47 women in the paroxetine group and 43 in the placebo group completed follow-up and were analyzed. At 12 weeks, the paroxetine group showed greater reduction in total MRS score compared with placebo (mean 16.9 ± 7.7 vs. 22.6 ± 6.1; mean difference -5.7, 95% CI -8.6 to -2.8; P < 0.001). SF-36 scores also improved more with paroxetine (91.0 ± 6.4 vs. 86.9 ± 4.8; mean difference 4.1, 95% CI 1.7 to 6.5; P = 0.001). Adverse events (headache, fatigue, drowsiness) were more frequent with paroxetine but mild and transient; no serious events occurred. The dropout rate was 14.4% (13/90), and intention-to-treat analysis showed consistent findings with slightly attenuated effect sizes. In this pilot study, paroxetine 20 mg/day showed promise in reducing VMS and improving quality of life in Honduran women with surgical menopause, with acceptable tolerability. The high attrition rate underscores the need for larger trials to confirm these findings.