Original research publications

Supporting maternal mental health is a priority in circumpolar settings, where seasonality and constrained service availability can limit psychosocial support. This qualitative study explored pregnant women's and healthcare providers' experiences of a postpartum depression prevention programme and perspectives on integrating it into routine antenatal care in Arkhangelsk, Northwest Russia. Four focus group discussions with pregnant women ( n = 17) and individual interviews with four healthcare providers were analysed using reflexive thematic analysis. Participants described the programme as providing trusting spaces for sharing, expert-led preparation for childbirth and the postpartum period, and brief individual follow-up after birth. Women reported greater confidence in identifying signs of vulnerability, articulating needs, and accessing support. Providers highlighted that these benefits depended on feasible scheduling, group formats, reusable materials, and coordinated delivery across professionals to avoid fragmentation. System-level factors (reach, retention, and cross-provider coordination) were seen as central for sustained uptake and routine integration. The findings suggest that the programme's contribution lies in the interaction between participant experiences of support and the organisational conditions needeed to sustain them in routine antenatal care. Preventive perinatal mental health programmes in circumpolar contexts can strengthen preparedness and help-seeking when designed for relational participation and supported by coordinated service structures.

Maternal intrapartum antibiotic prophylaxis (IAP) and postpartum maternal antibiotic usage are increasingly common and have been linked to altered growth and immune development in offspring. However, the mechanisms underlying these effects, particularly those arising from indirect early-life exposure to antibiotics, remain poorly understood. Here, using a preclinical murine model, we examined the impact of in vivo antepartum and postpartum maternal ampicillin administration on the maternal fecal microbiome and metabolome. Ampicillin treatment resulted in a significant depletion of bacterial species belonging to the Muribaculaceae family, including Muribaculum intestinale and Duncaniella dubosii , accompanied by a cohort-dependent enrichment of Enterococcus and Prevotella species. These microbial shifts coincided with substantial and reproducible metabolic remodeling, including elevated fecal acylcarnitines and altered bile acid profiles. Notably, we identified two previously uncharacterized trihydroxylated bile acids conjugated to a hexose moiety, which we annotated as cholic acid-galactose and taurocholic acid-galactose and synthesized. These metabolites were consistently associated with antibiotic exposure across public metabolomics data repositories. Finally, alterations in the maternal fecal microbiome and metabolome were associated with increased weight gain in offspring, suggesting potential pathways by which maternal antibiotic exposure may influence early developmental outcomes. These findings highlight microbial and metabolic signatures linked to perinatal antibiotic use and underscore the need to balance infection control with long-term infant health considerations.

Hypertensive disorders of pregnancy (HDP) are a major cause of illness and death and it can be prevented. We analysed Global Burden of Disease (GBD) 2023 estimates for maternal hypertensive disorders (ICD-10 O10-O16) in six locations (China, Japan, Democratic People's Republic of Korea [DPRK], Republic of Korea, Mongolia, and Taiwan [Province of China]) from 1990-2023 among women aged 20-54 years, reporting counts and age-standardised rates (per 100 000 population) for incidence, deaths and disability-adjusted life years (DALYs), and the maternal mortality ratio (MMR; per 100 000 live births), with 95% uncertainty intervals (UIs). In 2023, incident HDP cases were highest in China (654 396; 95% UI 446 312-949 988), while the age-standardised incidence rate peaked in Mongolia (419.03; 388.67-450.37). Mortality and disability burden were greatest in DPRK (age-standardised death rate 0.393; 0.184-0.749; DALY rate 25.73; 12.92-48.12; MMR 31.61; 13.23-60.86), followed by Mongolia, and lowest in Japan and the Republic of Korea. Across 1990-2023, rates declined markedly in all locations; for example, China's age-standardised death rate fell from 1.15 (0.82-1.57) to 0.03 (0.02-0.05) and its DALY rate from 80.08 (58.66-106.68) to 4.73 (3.04-6.87). With the increasing proportion of advanced maternal age, we must optimize antenatal risk stratification, adopt context-appropriate prevention and treatment, strengthen emergency obstetric care, and establish systematic postpartum cardiovascular follow-up to reduce HDP incidence.

Hypertensive disorders of pregnancy (HDP) are common and clinically consequential, affecting ~5%-10% of pregnancies and contributing substantially to maternal and perinatal morbidity and mortality. This review summarizes key concepts that inform bedside decision-making, including contemporary classification, major pathophysiologic pathways (placental dysfunction, endothelial injury, and systemic inflammation), and diagnostic criteria to support timely recognition and risk stratification. Clinically, early identification of preeclampsia and prompt management of severe hypertension and acute complications are central to reducing preventable harm. We highlight evidence-based treatment strategies, focusing on blood pressure control, monitoring for maternal-fetal deterioration, and coordinated multidisciplinary care. Beyond pregnancy, women with prior HDP face elevated long-term cardiovascular risk; therefore, structured postpartum follow-up, cardiovascular risk assessment, and preventive interventions are essential. By integrating current guidelines with recent evidence, this article provides practical recommendations to improve short-term maternal-fetal outcomes and long-term cardiovascular health.

To evaluate and compare the effects of continuous analgesia versus standard pain management on pain intensity, psychological status (anxiety and depression), and maternal-infant outcomes in pregnant women with hypertensive disorders. This retrospective cohort study analyzed 124 pregnant women with hypertensive disorders admitted between December 2021 and December 2023. Participants were categorized into two groups based on the labor analgesia received: a non-continuous analgesia group ( n = 51) and a continuous analgesia group ( n = 73). Outcome measures included pain scores at different stages of dilation (4 cm and 8 cm) and anxiety/depression levels assessed pre-delivery, post-delivery, and 24 hours postpartum. The continuous analgesia group demonstrated significantly lower pain scores at both 4 cm dilation (t = 8.888, P < 0.001) and 8 cm dilation (t = 9.604, P < 0.001) compared to the non-continuous group. Regarding psychological outcomes, the continuous analgesia group showed significantly lower anxiety levels pre-delivery (t = 2.606, P = 0.011), post-delivery (t = 2.343, P = 0.022), and 24 hours postpartum (t = 5.084, P < 0.001). Similarly, depression scores were significantly lower in the continuous analgesia group at all three time points: pre-delivery (t = 2.019, P = 0.046), post-delivery (t = 2.66, P = 0.009), and 24 hours postpartum (t = 4.103, P < 0.001). Correlation analysis revealed significant negative associations between continuous analgesia and maternal pain, anxiety, and depression ( P < 0.05). Continuous analgesia during labor is associated with superior pain relief and a significant reduction in anxiety and depression levels for pregnant women with hypertensive disorders compared to standard pain management. These findings suggest that continuous analgesia may be a beneficial intervention for improving the maternal psychological experience in this high-risk population.

Postpartum depression (PPD) disrupts early mother-infant synchrony, a key determinant of healthy socio-emotional development. The relational impact of prior early pregnancy loss (EPL) remains largely underexplored. This exploratory cross-sectional study examined the independent and combined effects of PPD severity and prior EPL on mother-infant synchrony. Ninety-six mother-infant dyads, recruited from a population vulnerable to depressive symptoms, were assigned to a control group or to one of three PPD severity groups (mild, moderate, severe). Dyadic synchrony was assessed using the CARE-Index, and EPL history was recorded. Chi-square tests and binary logistic regressions evaluated the effects of PPD severity and EPL on low synchrony. EPL significantly predicted low synchrony (OR = 7.50, 95% CI [1.16-48.36], p = 0.034), independently of PPD severity. Although depressive symptoms showed no overall significant effect (p = 0.123), a severity-response trend emerged: mild (OR = 3.06, p = 0.09), moderate (OR = 3.57, p = 0.06), severe (OR = 7.50, p = 0.01). No interaction between EPL and PPD was found. Prior EPL appears to have lasting effects on mother-infant synchrony, independent of current depressive severity. Larger studies are needed to confirm these findings.

Metabolic and immune development in neonates are shaped by the succession of the gut microbiome. Maternal obesity can perturb this process by altering interactions of human milk bioactive elements, including oligosaccharides (HMOs), microbial populations, and metabolites. We conducted a longitudinal study of Mexican mother-infant dyads to examine maternal BMI-associated variations in HMOs and infant fecal microbiota. Breastmilk samples from 97 mothers were collected at 48 h, one month, and three months postpartum. We used targeted and untargeted metabolomics to profile breastmilk samples, while shotgun metagenomics was used to analyze infant fecal microbiome composition in a subset of samples. Mothers with obesity showed decreased concentration of key HMOs shortly after birth, correlating with an altered succession of their infant's gut microbiota. This included reduced early colonizers (Enterobacteriaceae) and increased abundance of intermediate and late colonizers ( Bifidobacterium and members of the Lachnospiraceae family), over subsequent months. These taxa negatively correlated with HMOs such as 6'SL, LNnT, and LNT. Additionally, functional profiling revealed alterations in metabolic pathways related to polyamine biosynthesis, suggesting changes in microbial metabolism linked to maternal BMI. Despite the cohort's size, our study offers unique insights into the relationship between maternal obesity, HMO composition, and early infant microbial colonization in Latin-American mothers. This exploratory research serves as proof of concept, underscoring the need for larger-scale studies to validate these findings and better understand their implications for infant health. More importantly, our results highlight the interplay between maternal BMI and human milk bioactives, underscoring the importance of correlating microbial succession with maternal metabolic health to better understand early immune development in neonates.

Early life gut microbiota function as biological sensors for maternal prenatal exposure and play a crucial role in infant neurodevelopment. During pregnancy, air pollution and psychological distress are regarded as general and specific external exposures, respectively; however, the joint influence of these two domains on shaping early life gut microbiota remains unexplored. In this study, 309 mother-infant pairs were recruited from the obstetrics departments of two tertiary hospitals. We collected data on maternal prenatal air pollution exposure and psychological distress, obtained meconium samples within 48 h after birth, and assessed infant neurodevelopmental outcomes using the Ages and Stages Questionnaire-3 at 1, 3, and 6 months postpartum. Maternal prenatal air pollution-psychological distress exposure patterns were identified using a self-organizing map (SOM). The differential features of the meconium microbiota in relation to co-exposure patterns were assessed using multivariate association of linear models. Finally, the mediating role of the meconium microbiota in co-exposure patterns and infant neurodevelopment was analyzed using mediation analysis. We observed that the meconium microbiota at both the phylum and genus levels differed among the three patterns. Ruminococcus mediated the relationship between co-exposure patterns and infant neurodevelopment at 3 months of age (IE = 0.181-0.261, p FDR < 0.001). These findings support the inclusion of infant gut microbiota within frameworks assessing the risks of maternal prenatal co-exposure to environmental pollution and psychological distress, providing a scientific basis for policymakers to identify intervention targets for high-risk populations.

Rising global temperatures and heatwaves pose major health risks, particularly for pregnant women, infants and other vulnerable groups. Using Photovoice, we aimed to foreground how pregnant and postpartum women in an urban township in Tshwane, South Africa, experience and cope with heat stress. Fourteen women participated in two structured workshops held during the hot season (December 2023-January 2024). The first included reflective discussions on coping with heat and basic photography training. Over two weeks, participants captured over 300 images using disposable cameras or mobile phones. Selected images were reviewed and discussed in the second workshop. Thematic analysis of photographs and workshop transcripts identified three key themes: health impacts, coping strategies and structural challenges. Women preferred staying home on very hot days, where they had greater control over their environment. However, they struggled to soothe overheated infants, which they found distressing. They used simple cooling methods such as bathing or wet cloths but faced constraints including heat-trapping housing materials, inadequate ventilation, and limited access to water and electricity. These challenges led to a state of " un-coping" -where adaptation efforts are insufficient or counterproductive. Viewed through the women's "lens", these findings highlight the need for targeted adaptation strategies to improve climate resilience.

Transient osteoporosis of the hip is a rare condition characterized by temporary bone loss in the femoral head, leading to severe hip pain and walking difficulties. This report presents the case of a 39-year-old pregnant woman (gravida 4, para 0) who developed right hip pain and claudication at 33 weeks of gestation. Magnetic resonance imaging revealed right-sided transient osteoporosis. To mitigate the risk of femoral fracture during vaginal delivery, a scheduled cesarean section was performed at 38 weeks. Immediately postpartum, the patient experienced left leg pain, and a subsequent scan confirmed a new onset of transient osteoporosis in the left femoral head, establishing a diagnosis of asynchronous bilateral disease. Given the persistent decrease in bone mineral density and vitamin D deficiency, early weaning and rehabilitation were initiated. The patient's symptoms and bone density gradually improved over three months. This case underscores the importance of evaluating atypical hip pain in pregnancy and highlights the necessity of cautious postpartum follow-up, including nutritional support and early weaning to prevent fractures.

Depressive symptoms and attitudes toward seeking professional psychological help are both critical determinants of mental health outcomes during pregnancy and early postpartum. However, their longitudinal and reciprocal associations remain poorly understood. This multicenter prospective cohort study enrolled 1250 women during mid-pregnancy (T1) and followed them through late pregnancy (T2), 1 month postpartum (T3), and 3 months postpartum (T4). Depressive symptoms were measured using the Edinburgh Postnatal Depression Scale, and help-seeking attitudes were assessed with the Attitudes Toward Seeking Professional Psychological Help Scale-Short Form. Random-intercept cross-lagged panel model was applied to disentangle stable between-person differences from within-person temporal dynamics. At the between-person level, depressive symptoms were negatively correlated with help-seeking attitudes (β = -0.371, 95% CI [-0.444, -0.298]). At the within-person level, bidirectional associations emerged in a stage-specific manner. More favorable help-seeking attitudes were associated with lower subsequent depressive symptoms from T2 to T3 (β = -0.105, 95% CI [-0.190, -0.020]) and from T3 to T4 (β = -0.125, 95% CI [-0.202, -0.048]). Conversely, increases in depressive symptoms were associated with less favorable help-seeking attitudes from T3 to T4 (β = -0.126, 95% CI [-0.205, -0.047]). Depressive symptoms and help-seeking attitudes are dynamically and bidirectionally linked across pregnancy and early postpartum. These findings suggest that help-seeking attitudes may represent one potentially modifiable psychological factor relevant to perinatal mental health. However, given the modest effect sizes and the absence of direct measures of actual help-seeking behaviors, future intervention studies are needed to establish their clinical significance.

To identify latent classes of socio-contextual vulnerability among postpartum women and to examine whether these classes differed in postpartum depressive symptomatology and self-reported postpartum depression diagnosis. A total of 1308 women residing in Spain who had given birth within the previous 24 months participated in this cross-sectional online study. Latent class analysis (LCA) was conducted based on socio-demographic, caregiving, contextual, obstetric, and prior clinical-history indicators, including employment status, educational attainment, caregiving support, area of residence, age, partnership status, primiparity, postpartum time, and previous depression history. Differences between classes in EPDS screening positivity and self-reported postpartum depression diagnosis were subsequently explored. A 2-class model with better fit, parsimony, and interpretability was selected. The identified classes were characterized as Class 1: Higher socio-contextual vulnerability (27.5%) and Class 2: Lower socio-contextual vulnerability (72.5%). Relative to Class 2, Class 1 showed lower probabilities of employment (0.443 vs. 0.926) and higher education (0.482 vs. 0.833), together with higher probabilities of low caregiving support (0.392 vs. 0.132), unemployment (0.271 vs. 0.029), caregiving or home duties (0.248 vs. 0.038), younger age (0.666 vs. 0.443), and rural residence (0.288 vs. 0.122). Women in the higher socio-contextual vulnerability class showed a higher probability of EPDS screening positivity (0.632 vs. 0.551; OR = 1.401, 95% CI [1.163, 1.672]) and a somewhat higher probability of self-reported postpartum depression diagnosis (0.143 vs. 0.116). The findings suggest that postpartum depressive symptomatology is embedded within broader socio-contextual conditions and support the importance of incorporating socio-contextual indicators into postpartum mental health screening and prevention strategies.

Janus kinase inhibitors (JAKi) are increasingly used to treat systemic autoimmune rheumatic diseases in patients of reproductive age, but pregnancy safety data remain limited. Current guidelines recommend discontinuation before conception and avoidance during pregnancy; however, inadvertent early exposures occur and create counselling uncertainty. We identified 3 pregnancies with confirmed postconception JAKi exposure among 111 patients followed in a specialised pregnancy and rheumatic diseases clinic between July 2021 and September 2024. Two patients with psoriatic or seronegative inflammatory arthritis were exposed to upadacitinib 15 mg daily for 16 and 13 days after conception, respectively. One patient with rheumatoid arthritis was exposed to tofacitinib 5 mg twice daily for 30 days after conception. All JAKi were discontinued when pregnancy was recognised. One patient remained off immunosuppression until postpartum flare. One required prednisone and transitioned to certolizumab for a second-trimester inflammatory arthritis flare. One transitioned to hydroxychloroquine with stable disease. All pregnancies resulted in live births at 37 + 6 to 39 weeks. No congenital anomalies were identified. One infant, delivered by emergency caesarean section complicated by difficult fetal extraction, developed respiratory distress at birth and was admitted to the neonatal intensive care unit for 3 days for monitoring. The available documentation did not identify suspected or confirmed infection. These 3 cases add to limited real-world evidence regarding inadvertent first-trimester JAKi exposure in rheumatic disease. The findings are reassuring but cannot establish safety, and prospective data with longer infant follow-up remain needed.

This study aimed to evaluate the prevalence of antipsychotic prescriptions before, during, and after pregnancy in Japan, with a focus on new prescriptions and continuation after pregnancy confirmation. We conducted a claims-based analysis using a Japanese claims database (analytic period: 2010-2022). Antipsychotic prescription prevalence and new prescriptions were assessed from 180 days before pregnancy through 180 days postpartum. To assess continuation after pregnancy confirmation, prescription status was evaluated across gestational weeks 0-4, 5-13, and from 14 weeks to delivery. Among 120 735 women, 1698 (140.6/10 000 deliveries) received at least one antipsychotic prescription, including 809 (67.0/10 000 deliveries) during pregnancy. Prescription prevalence decreased during the first and second trimesters but increased postpartum. New prescriptions were less frequent during pregnancy but increased after delivery. Among 611 women prescribed antipsychotics during 0-4 weeks' gestation, 482 (78.9%) continued and 129 (21.1%) discontinued prescription during weeks 5-13; of those who continued prescription during 5-13 weeks, 334 (54.7%) continued until delivery. Evaluation of major indications showed that continuation until delivery was highest in those with schizophrenia (63.6%), followed by bipolar disorder (51.0%). This study provides the first comprehensive description of perinatal antipsychotic prescription trends in Japan. Substantial prescription discontinuation occurred after pregnancy confirmation. Increases in postpartum prescriptions might reflect new prescriptions or resumption among women who had discontinued treatment during pregnancy. These findings offer foundational epidemiological insights into real-world perinatal antipsychotic use.

Pregnancy and the postpartum period are times of significant hemodynamic change and can cause new cardiac disease, highlight previously unknown cardiovascular disease (CVD) or exacerbate known underlying CVD. While cardiovascular events frequently occur during pregnancy, half of maternal deaths occur in the postpartum period. Postpartum monitoring needs to be individualized based on the underlying disease process and must include inpatient and outpatient management plans. Care by a multidisciplinary team, including a mindful transition from obstetrics (OB) to primary care and/or cardiology, is necessary to optimize future pregnancy and long-term health.

The immediate postpartum period is marked by intense physiological and socio-emotional changes, requiring comprehensive and humanized care. In this context, nursing theories provide the necessary foundation to enhance the quality of care during this period. To identify in the scientific literature how theoretical frameworks are used in nursing care during the immediate postpartum period. An integrative review was conducted between September and November 2025. The literature search was performed in the CAPES Journal Portal, Medical Literature Analysis and Retrieval System Online, Web of Science, Scopus, Scientific Electronic Library Online, CINAHL, and the Nursing Database, using the descriptors "immediate postpartum period," "nursing theory," and "nursing care" and their synonyms, combined with the Boolean operators and OR. Original open-access articles that addressed the research question were included. Duplicate studies, reviews, and other types of grey literature were excluded. Categorical analysis and simple descriptive statistics were performed. Nine articles met the eligibility criteria. Five central themes emerged regarding the use of nursing theories in the immediate postpartum period: guiding the Nursing Care Systematization process; measuring and evaluating care and the nurse-postpartum woman relationship; guiding care in home and clinical settings; and understanding postpartum women's perceptions of the care environment. The application of theoretical frameworks in the immediate postpartum period reinforces person-centered care, values the therapeutic relationship, and promotes a holistic understanding of postpartum women's needs, strengthening their incorporation into practice, education, and the expansion of research on maternal outcomes. not registered.

Birth-related psychological trauma refers to mental health disorders resulting from negative experiences during labor and delivery, and it can negatively affect the mother's mental health, family relationships, and even child development. This study assessed the psychometric properties of the Birth Trauma Scale among Iranian women. This study involved 311 women, 4 to 8 weeks postpartum, selected through cluster random sampling from August 2024 to December 2025. The validity of the Birth Trauma Scale was assessed in five stages: content validity and face validity (both quantitatively and qualitatively), structural validity using exploratory factor analysis and confirmatory factor analysis, and reliability determined through internal consistency and test-retest reliability. In this study, the Content Validity Index and Content Validity Ratio of the Birth Trauma Scale were 0.98 and 0.97, respectively. The tool's four-factor structure in the exploratory factor analysis explained 59% of the variance. The model's fit indices in the confirmatory factor analysis supported its validity (Root Mean Square Error of Approximation = 0.078, Tucker-Lewis Index = 0.98, Comparative Fit Index = 0.98, normed chi-square= 3.9). Furthermore, Cronbach's alpha was 0.91, and the intra-class correlation coefficient with a 95% confidence interval was 0.88 (0.75 to 0.95). The Persian version of the Birth Trauma Scale is a valid and reliable instrument for evaluating psychological birth trauma in the Iranian population. IR.TBZMED.REC.1402.945.

Postpartum depression (PPD) significantly impacts the well-being of mothers and their families, with migrant and refugee women being particularly vulnerable due to unique stressors and limited access to care. Hence, this scoping review examines the specific barriers refugee and migrant women experiencing PPD face in accessing mental healthcare, as well as the diverse informal support strategies they rely on. This scoping review was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. A comprehensive literature search was performed across multiple databases, including Scopus, Web of Science, PubMed, Ovid, Cochrane Library, Google Scholar, and ScienceDirect, to identify relevant studies published from database inception to October 30, 2025. A total of 18 studies (out of 5453 references extracted from bibliographic databases) were included in this scoping review. Common barriers to help-seeking included stigma, lack of culturally sensitive care, language difficulties, and family-related barriers. The elements for seeking help were spiritual practices, support from family, friends, and peers, and community resources. This review highlights the need for culturally sensitive approaches to addressing PPD among migrant and refugee women. Understanding the barriers and informal support types they already use can inform the development of supportive policies and culturally appropriate mental health services to improve access to care and postpartum well-being.

Sustaining exclusive breastfeeding remains challenging, and integrated antenatal education targeting knowledge, attitudes, and practical skills may improve outcomes. This is a single-centre retrospective study. Women receiving conventional education (January-August 2024) were compared with women receiving a multicomponent knowledge, attitudes, and practices (KAP)-based breastfeeding education programme after its formal implementation (September 2024-June 2025). After 1:1 matching by maternal age, parity, and gestational age at enrolment, 640 women were included. Primary outcomes were KAP total score at 37-39 weeks of gestation and exclusive breastfeeding status at six months postpartum based on a structured 24-hour dietary recall; secondary outcomes included Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) score, early initiation, interim breastfeeding status, and lactation complications. The matched cohort included 320 women per group. The multicomponent KAP-based programme group showed higher KAP scores (80.8 ± 5.6 vs 63.4 ± 6.9; p < .001), BSES-SF scores (58.2 ± 4.8 vs 48.6 ± 5.4; p < .001), and a higher prevalence of exclusive breastfeeding at six months based on 24-hour recall (55.9% vs 31.6%; p < .001). Early initiation was increased, while nipple pain, engorgement, and mastitis were reduced (all p < .01). Exposure to the multicomponent KAP-based programme was independently associated with exclusive breastfeeding status at six months based on 24-hour recall (aOR 2.84, 95% CI 1.98-4.07; p < .001). Participation in a multicomponent KAP-based breastfeeding education programme was associated with better breastfeeding outcomes and fewer lactation complications. Multicentre studies are needed to confirm these findings. Breastfeeding provides important health benefits for both mothers and babies, but many women stop exclusive breastfeeding earlier than recommended. We evaluated a breastfeeding education programme based on knowledge, attitudes, and practical skills delivered during routine prenatal clinic visits. Women who received the programme had better understanding of breastfeeding, greater confidence in feeding their babies, and higher rates of exclusive breastfeeding six months after birth. They also experienced fewer common breastfeeding problems, such as nipple pain, breast swelling, and breast infection. These findings suggest that structured breastfeeding education may help mothers breastfeed successfully for longer.

Vaginal microecology is normally in a dynamic balance. Vaginal delivery can disrupt this equilibrium, yet limited studies have investigated the correlation between the occurrence of subinvolution of uterus and alterations in the vaginal microbiota. Vaginal secretions were collected 42 days postpartum from 30 patients with subinvolution of uterus (Group A) and 30 normal puerperae (Group B). Differences in the microbial composition between the two groups were evaluated via 16S rRNA gene sequencing. Intergroup taxonomic profiles and diversity variations were rigorously assessed. The alpha diversity revealed no significant differences between the two groups based on Chao1 and Observed Species indices, but showed significant differences in the Shannon and Simpson indices. The beta diversity analysis suggested significant compositional differences between the two groups. Group A exhibited a marked reduction in the relative abundance of Lactobacillus spp. Conversely, conditionally pathogenic bacteria, including Porphyromonas spp., were significantly enriched in Group A. Functional pathway prediction demonstrated a significant enrichment of bacterial toxin synthesis and lysine biosynthesis pathways in Group A. Furthermore, phenotypic analysis revealed significantly elevated proportions of Gram-negative and facultative anaerobes in the subinvolution group. Subinvolution of uterus is closely associated with vaginal microecological imbalance, which may be related to the weakening of mucosal barrier function due to the reduction of Lactobacillus spp. , chronic inflammation caused by the enrichment of conditionally pathogenic bacteria, and impaired uterine repair mediated by the disturbance of metabolic pathways. This finding is expected to provide new ideas for the prevention and treatment of subinvolution of uterus.

This case report describes a monocular woman with presumed Herpesviridae-associated acute retinal necrosis (ARN), including an atypical presumed postpartum reactivation and implications for long-term management. A 26-year-old woman with a history of presumed bilateral childhood-onset Herpesviridae-associated ARN, status post right-eye enucleation, arrived at initial presentation with acute vision changes in her remaining functional eye. Examination revealed anterior chamber cells, elevated intraocular pressure, and peripheral retinal whitening concerning for ARN reactivation. She was treated aggressively with intravitreal antivirals, high-dose systemic antivirals, and corticosteroids, with return of vision to 20/20. Eleven days postpartum two years later, she presented with visual symptoms, but imaging demonstrated persistence of retinal whitening with inferior extension. Increase of systemic antivirals dosing led to clinical improvement, suggesting possible atypical viral reactivation. Nearly three years later, she developed reduced vision, vitreous inflammation, and an intraocular pressure spike, requiring repeat intravitreal therapy and transition to high-dose antivirals. This report potentially illustrates the unpredictable course of suspected ARN, highlighting the need for aggressive empiric therapy and careful long-term surveillance. It emphasizes knowledge gaps regarding postpartum immune triggers, management strategies, and transition of pediatric ARN to adult retinal care.

National estimates in Somaliland report a modern contraceptive prevalence rate (mCPR) of 1%-3%, yet localized urban data are scarce. This study assessed mCPR, unmet need for family planning (FP), and sociodemographic determinants among mothers in Borama, Somaliland. A community-based cross-sectional study was conducted among 426 mothers with children under five using multistage cluster sampling (October-November 2025). Data were collected via structured interviews. Multivariate logistic regression with robust standard errors was performed to identify factors associated with contraceptive use, reported as adjusted odds ratios (AORs) with 95% confidence intervals (CIs). The mCPR was 18.5%, and unmet need was 17.4%, resulting in a total demand of 35.9%. Injectables (42%) and oral pills (30%) were the most common methods. The strongest predictor of use was postpartum counseling by health workers (AOR = 18.62, p < 0.001) and family members (AOR = 6.30, p < 0.001). University education (AOR = 2.80, p = 0.034) and business ownership (AOR = 2.68, p = 0.005) also independently predicted use. Model diagnostics, including Hosmer-Lemeshow and variance inflation factor (VIF), confirmed appropriate fit and absence of significant multicollinearity. Contraceptive use in Borama exceeds national estimates but remains low by regional standards. Postpartum counseling serves as a critical gateway to uptake. Policy considerations may include strengthening immediate postpartum counseling and community-based FP advocacy targeting husbands and mothers-in-law to address sociocultural barriers.

Triple-negative breast cancer (TNBC) is characterized by severely immunosuppressive tumor microenvironment (TME), which leads to tumor ferroptosis resistance and dominant protumor M2 macrophages, restraining innate-to-adaptive antitumor immune cascade. Herein, an endoplasmic reticulum (ER)-enriched pH/redox-sensitive SPIONS@P-CpG-DOX nanogel was constructed to realize dual ER-targeted manipulation on TNBC cells and tumor-associated macrophages (TAMs) to elicit an ER-centered innate-to-adaptive immune amplification axis. In TNBC cells, nanogel-induced ER stress inhibits the GSH-GPX4 axis and accelerates lipid peroxidation, triggering ER-originated ferroptosis and immunogenic cell death (ICD) to release antigens and damage-associated molecular patterns (DAMPs) for immune priming. In macrophages, nanogel activates ER-dependent STING/NF-κB pathways without ferroptosis, facilitating M2-to-M1 polarization and inflammatory TME remodeling. The dual ER-initiated pathways synergistically facilitate dendritic cell (DC) maturation, enhance intratumoral CD4 + and CD8 + T-cell infiltration and build long-term systemic immune memory. In 4T1 TNBC models, the nanogel efficiently inhibits primary tumor growth, postoperative recurrence, distant rechallenge and lung metastasis with favorable biosafety. This work validates ER as a core regulatory hub linking tumor ferroptosis and macrophage reprogramming, providing an organelle-targeted strategy for durable TNBC immunotherapy.

Although steroid metabolism in the maternal-placental-fetal unit is indispensable for pregnancy, the metabolic processes of each steroid are poorly understood. In the present study, we analyzed androgen profiles in 16 healthy full-term maternal-placental-fetal units. Classical and 11-oxygenated androgens in postnatal maternal blood, placental tissue, and cord blood were quantified using liquid chromatography-tandem mass spectrometry. We examined the effects of fetal sex and advanced maternal age (≥ 35 years) on steroid levels and analyzed correlations among steroid levels in paired samples. The results showed variation in steroid levels among samples. The placenta was enriched with 11-ketoandrostenedione (11KA4) and estradiol (E2). Maternal and cord blood samples contained large amounts of 11β-hydroxyandrostenedione (11OHA4). Steroid levels were comparable between male and female fetuses, except for high T levels in male cord blood samples, and between groups with and without advanced maternal age. 11OHA4 levels in maternal blood were correlated with 11KA4 levels in placental and cord blood samples. Classical androgen levels in the maternal blood were linked to E2 levels in the placenta. This study highlights inter-individual variations in steroid levels in healthy full-term maternal-placental-fetal units, which cannot be attributed to fetal sex or advanced maternal age. The placenta appears to be a unique steroidogenic organ characterized by high E2 and 11KA4 levels and low 11OHA4 levels. This study provides indirect evidence of close interaction across the maternal-placental-fetal unit for androgen metabolism. Given the small sample size and several methodological limitations, our results await further validation.

Menopause is accompanied by accelerated losses in muscle mass and strength and declining bone density. Whether creatine monohydrate benefits postmenopausal women are uncertain. We systematically reviewed randomized, placebo-controlled trials examining creatine supplementation, with or without resistance training (RT), in postmenopausal women. MEDLINE, Embase, Scopus, Web of Science, SPORTDiscus, and Cochrane CENTRAL were searched from 2000 to August 2025, supplemented by trial registries and reference-list screening. Eligible studies included postmenopausal women aged ≥40-45 years, intervention durations ≥6 weeks for primary analyses, and outcomes including DXA-derived lean mass, one-repetition maximum (1RM) strength, bone mineral density, physical function, and safety. Dual screening, duplicate extraction, and Cochrane RoB 2 assessment were performed. Random-effects meta-analysis used the Paule-Mandel estimator for τ² with Hartung-Knapp-Sidik-Jonkman adjustment. Heterogeneity (τ², I²), 95% prediction intervals, subgroup analyses by RT status, exploratory dose/duration meta-regression, small-study effects, and GRADE certainty were assessed. Seven RCTs ( n = 608 randomized; duration 12-104 weeks, median 38 weeks) enrolled postmenopausal women (mean age ≈ 62 y). Lean mass (k = 5; n = 338) favored creatine: mean difference (MD) + 0.37 kg (95% CI + 0.05 to + 0.69; I² = 25%; τ² = 0.01; 95% PI -0.10 to + 0.84). Leg-press 1RM (k = 3; n = 111) improved with creatine: MD + 7.5 kg (95% CI + 2.2 to + 12.8; I² = 0%). Benefits were evident when creatine ≥ 5 g·day⁻¹ was combined with RT; trials using ≤ 3 g·day⁻¹ without RT showed no measurable effect. Bone density was unchanged overall. Adverse events were mild and similar to placebo; renal indices were unchanged. Risk of bias was mostly "some concerns;" one large, preregistered, double-blind RCT was at low risk. In postmenopausal women, creatine, particularly ≥ 5 g·day⁻¹ with RT, yields small but meaningful gains in lean mass and strength without evidence of harm. Effects on bone density remain unclear.Registration: This review was not prospectively registered. De-identified data and supplementary materials were deposited on OSF after completion of the analysis (DOI: 10.17605/OSF.IO/BVTRZ).

Menopause is a neurobiological transition with important implications for neurologic care. This review summarizes the physiology and hormonal changes of spontaneous menopause and its treatment as applied to cognition, epilepsy, migraine, multiple sclerosis (MS), and stroke. It aims to serve as a resource for neurologists when managing patients in this transitional life stage. Hormonal shifts associated with menopause, particularly declining estrogen and fluctuating estrogen-to-progesterone ratios, influence symptoms, disease expression, and treatment across multiple neurologic conditions. Perimenopause is often associated with subjective cognitive complaints, in part attributed to hypoestrogenism, along with secondary effects from sleep disturbance, vasomotor symptoms, and mood changes. Cognitive symptoms are often transient and rarely with objective neuropsychological deficits or progression. In epilepsy, menopause-related endogenous and exogenous hormones may influence seizure susceptibility and alter antiseizure medication metabolism. Migraine may worsen during perimenopause, especially in estrogen-sensitive phenotypes, with postmenopause stabilization once hormones plateau. In MS, perimenopause and postmenopause contribute to overlapping age-related and MS-related symptoms and is a period of high clinical need with potential acceleration in disability progression despite reduced relapse rate. Ischemic stroke risk rises sharply in postmenopausal women driven by advancing age, accumulation of cardiometabolic risk, and loss of estrogen's protective effects. Oral estrogen-containing systemic menopause hormone therapy (MHT) is associated with increased thromboembolic events (including stroke), whereas transdermal regimens seem safer and are preferred at low or standard doses (≤50 mcg estradiol patch or ≤1.5 mg [or 2 pumps] per day of 0.06% estradiol gel). Timing of initiation also modulates this risk and plays a critical role with a favorable risk:benefit window when initiated in women younger than 60 years or within 10 years of menopause onset. Neurologists should routinely consider reproductive history, menopausal stage, symptom burden, and disease risk factors when evaluating midlife and older female patients. When appropriately selected, MHT can be safely used in many neurologic populations, with nonoral routes for estrogen and nonhormonal options generally preferred. Incorporating menopausal considerations into neurologic practice offers an important opportunity to optimize care and advance precision medicine.

Vaginal atrophy (VA), a common condition associated with oestrogen deficiency, significantly impacts women's quality of life. Src homology 2 domain-containing transforming protein 1 (SHC1) is implicated in various hormone-dependent processes. This project aims to investigate whether oestrogen promotes the proliferation, migration and differentiation of vaginal epithelial cells by regulating SHC1, and delineates the underlying mechanism. An ovariectomised (OVX) mouse model of VA was established and treated with 17β-estradiol (E2). Human vaginal epithelial VK2/E6E7 cells were stimulated with E2 (dose-dependent), transfected with SHC1 overexpression (OE-SHC1), SHC1 knockdown (sh-SHC1) or epidermal growth factor receptor (EGFR) overexpression (OE-EGFR) plasmids. Histological and immunohistochemical analyses were performed on vaginal tissues. Cellular proliferation and migration were assessed via CCK-8 and wound healing assays, respectively. Western blot analysed cellular/tissue proteins (differentiation/barrier markers, Ras/ERK pathway components). E2 upregulated SHC1 expression both in atrophic vaginal tissue and in VK2/E6E7 cells in a dose-dependent manner. SHC1 overexpression enhanced, while its knockdown attenuated, E2-induced cell proliferation, migration, and the expression of differentiation (Keratin 6a (krt6a), Keratin 13 (krt13)) and barrier (E-cadherin, occludin) markers. Mechanistically, SHC1 mediated the effects of E2 by acting as an adaptor of EGFR and subsequent activation of the downstream Ras/ERK pathway. EGFR overexpression rescued SHC1 deficiency phenotypes in E2-treated VK2/E6E7 cells. In OVX mice, SHC1 knockdown reversed E2-mediated restoration of vaginal epithelial architecture, proliferation (Ki67) and Ras/ERK signalling. SHC1 is a critical mediator of E2-induced vaginal epithelial homeostasis through the EGFR/Ras/ERK axis, representing a potential downstream therapeutic target for intervention in VA, particularly via localised delivery strategies. After menopause, the body produces much less oestrogen. This drop in oestrogen can cause the vaginal lining to become thin, dry and easily irritated – a condition called vaginal atrophy (VA). In this study, we looked closely at how oestrogen repairs the vaginal lining. Using mice and human cells in the lab, we found that oestrogen works like a key turning on a series of switches inside vaginal cells. One of these switches is a protein (SHC1) that we studied in detail. When this protein is active, it sends signals that tell vaginal cells to multiply, move and form a strong protective layer. When we blocked this protein, oestrogen could no longer repair the vaginal lining. Our findings suggest that future treatments for VA might be able to target this protein.