Utforsk forskningen

Successful weight management is important for menopausal women, given the high prevalence of overweight and obesity. This study evaluated the efficacy of a cognitive-behavioural e-Health group intervention for weight management in postmenopausal women with overweight or obesity. The intervention incorporates the Health Action Process Approach, Health Belief Model, Oxford Food and Activity Behaviours, and Behaviour Change Techniques. This randomised controlled trial involved 27 participants - 13 in the intervention group (IG), who received an 8-week intervention, and 14 in the control group (CG), who received an informative leaflet. Five longitudinal assessments were performed. All variables were measured using quantitative instruments, and Body Mass Index was calculated from self-reported weight and height. Latent growth models (LGM) were conducted according to the intention-to-treat principle. The LGM showed that some weight management strategies increase significantly over time in IG (energy compensation, regulation: rule setting) and regarding subjective well-being (positive affect and satisfaction with life). Additionally, the IG showed a decrease in emotional and uncontrolled eating, and an increase in self-esteem and health-related determinants. Long-term effects of this cognitive-behavioural intervention were found in some measures, while others only increased for a certain period. Increasing session frequency and incorporating monthly maintenance sessions are recommended to achieve more sustainable results over time.

A growing body of evidence implicates the menopausal transition as a neurobiological inflection point in women's brain aging and Alzheimer's disease (AD) vulnerability. Menopause is a midlife neuroendocrine transition characterized by a decline in sex steroid hormones and widespread systemic effects. The brain is not a passive recipient of ovarian hormones but an active endocrine-sensing organ. Menopause, however, does not act in isolation: the ovarian-brain axis is established embryonically, activated at puberty, remodeled during pregnancy and postpartum, and reconfigured during the menopausal transition, with implications for later-life brain aging. This review places menopause within a lifespan neuroendocrine framework, examining mechanisms by which the transition may influence the brain, including altered hormone signaling, bioenergetics, synaptic plasticity, neurovascular function, inflammation, and AD-related pathology. It then reviews evidence linking menopausal timing to neurobiological and AD vulnerability, discusses estrogen therapy, and considers menopause as a biologically plausible window for risk stratification and prevention.

To describe the perceived impact of menopause on quality of life, symptom prevalence, and treatment use among Spanish women, based on the findings of an online survey conducted among women residing in Spain, promoted by the HM Foundation Chair in Menopause. An anonymous open online survey was conducted between January and June 2024. A total of 3,825 women aged 40-65 years participated. Data were analyzed using descriptive statistics based on self-reported responses, 95% confidence intervals (Wilson method), and two-sided proportion tests against a 50% reference value. The mean age was 52.1±7.4 years, with an estimated BMI of 25.0kg/m 2 . Most participants were non-smokers (88.7%) and had an intact uterus (94.9%). The most frequent symptoms were sleep disturbances (84.1%), fatigue (80.5%), emotional changes (75.7%), cognitive difficulties (71.9%), and hot flashes (71.4%). A total of 79.8% reported a perceived negative impact on quality of life, and 70.1% reported moderate to severe productivity impairment. Only 12.0% were receiving menopausal hormone therapy (MHT), and 44.0% considered themselves well informed about menopause. The most commonly used medications were those for sleep or anxiety (21.6%) and cholesterol control (12.3%). Preventive screening rates were high (mammography 93.8%, Pap smear 91.2%). Despite the high prevalence of symptoms and good participation in preventive programs, the use of MHT remains low, while the uptake of specific non-hormonal therapeutic options, such as fezolinetant, remains limited. These findings highlight an information gap and underscore the relevance of sleep and emotional well-being to the perceived impact of menopause.

Midlife has been framed through biomedical deficit narratives that emphasize decline, alongside a competing healthy-aging narrative that casts decline as something to be managed through individual effort; yet emerging scholarship calls for more inclusive, embodied, and intersectional approaches that center women's lived experiences. This qualitative study challenges deficit-based narratives of midlife by exploring how women negotiate between these narratives as they navigate this transition. We interviewed 27 women aged 39-57 using semi-structured interviews. Thematic analysis revealed three central themes: (1) reimagining 'midlife' - revealing tensions between societal expectations and personal agency, (2) embodied experiences of aging -navigating bodily changes while confronting medical dismissal and gender bias, and (3) evolving relational roles across diverse family structures. Participants actively negotiated deficit and healthy-aging narratives, describing midlife not as inevitable decline but as a period of profound reflection and redefinition. Many contested the 'midlife' label itself, challenged ageist and sexist expectations, and reclaimed bodily autonomy despite healthcare systems that frequently dismissed their embodied knowledge. These findings demonstrate how midlife is shaped by intersecting systems of power-ageism, sexism, and medical authority-yet also reveal possibilities for resistance and renegotiation. This research offers a more specific account of how midlife women negotiate between deficit and healthy-aging narratives, while also navigating broader relational narratives of family, gender, and caregiving, contributing a starting point for the new narratives on aging women this literature has called for. Future research must prioritize intersectional approaches with racially, economically, and culturally diverse samples to fully capture the complexity of midlife transitions.

To examine the physical, emotional, and relational responses of expectant fathers and to elucidate how Couvade-related phenomena influence couple dynamics. This qualitative study was conducted between July 2025 and October 2025 with nine married couples ( n = 18). A total of 27 interviews were carried out, including 18 individual interviews and 9 joint couple interviews. Data were collected using a semi-structured interview guide developed by academic midwives, transcribed verbatim, and analyzed using Braun and Clarke's reflexive thematic analysis. Five main themes were identified: sharing of bodily reflections, emotional sensitivity and anxieties, questioning of masculinity norms, changes in relationship closeness and dynamics, and construction of fatherhood identity with supportive partnership. Findings revealed that Couvade syndrome extends beyond physiological symptoms, transforming men's emotional experiences, strengthening partner communication, and contributing significantly to the preparation for fatherhood. This study highlights that Couvade syndrome is not limited to physical manifestations but also represents a multidimensional process involving emotional sensitivity, relationship changes, questioning of masculinity norms, and construction of a fatherhood identity. Expectant fathers are not passive observers of pregnancy but active partners in this journey.

The effects of maternal antenatal depression (AND) across different stages of pregnancy on offspring neurodevelopment remain poorly understood, and the underlying microbiota-related mechanisms are largely unknown. In a multicenter prospective cohort of 2053 pregnant women, we found that elevated depressive symptoms at any trimester were significantly associated with delayed infant neurodevelopment. Using a nested case‒control design with 16S rRNA sequencing of 504 maternal fecal samples, we identified a consistent reduction of butyrate-producing bacteria and disruption of amino acid metabolism in women with AND symptoms - features that correlated with poorer infant cognitive outcomes. To establish causality, fecal microbiota transplantation (FMT) from women with AND symptoms was administered to germ-free dams, resulting in impaired intestinal barrier integrity, heightened neuroinflammatory signaling, and altered polyunsaturated fatty acid and amino acid metabolism in fetal brains at E18.5, leading to postnatal cognitive deficits in the offspring. Remarkably, maternal butyrate supplementation partially rescued these molecular and neurodevelopmental abnormalities. Together, these findings reveal a mechanistic link between maternal mood, gut microbial ecology, and fetal brain development, and identify the maternal gut microbiota and its metabolites as potential therapeutic targets to prevent the intergenerational effects of antenatal depression.

The gut microbiome undergoes significant alterations during pregnancy. Perturbations in these microbial communities are increasingly associated with a range of pregnancy complications, including miscarriage, gestational diabetes mellitus, preeclampsia, preterm birth, and fetal growth restriction, among others. This review synthesizes current evidence on the dynamic changes in the maternal gut microecosystem including bacterial, fungal, and viral communities throughout gestation and examines its relationships with various pregnancy complications. We also summarize the underlying mechanisms driving these interactions, focusing on metabolic regulations involving short-chain fatty acids, bile acids, indoles, sex hormones, intestinal barrier integrity, and the modulation of maternal immune responses essential for fetal tolerance. Additionally, we discuss the lasting impact of the maternal microbiome on offspring health via vertical transmission and developmental programming. This review provides a conceptual framework that integrates mechanistic insights with clinical findings, with the goal of informing future research and supporting the development of microbiome-based interventions to improve maternal and neonatal health outcomes.

The underlying mechanism of recurrent pregnancy loss (RPL) is still not fully understood. We aimed to identify the key genes involved in the process by which obesity influences RPL. RPL and obesity data were retrieved from the GEO database. The differentially expressed genes (DEGs) between disease and normal samples among RPL and obesity were selected. Through intersecting the above DEGs, important DEGs were obtained. GO and KEGG analyses were used to analyze the function of these important genes. Two algorithms (LASSO and SVM) and receiver operator characteristic (ROC) analysis were used to optimize the DEGs. Furthermore, the immune infiltration and single gene enrichment analysis were performed to explore the correlations between key biomarkers and immune cells. A total of 1857 RPL-related DEGs and 2880 obesity-related DEGs were selected, respectively. Through intersecting the above two parts of DEGs, 100 important genes were obtained, which were involved in immune response processes such as the EGFR tyrosine kinase inhibitor resistance JAK-STAT signaling pathway, and T cell receptor signaling pathway. Through LASSO, SVM, and ROC analyses, five down-regulated optimal genes in RPL were finally considered as biomarkers in obesity-related RPL: GIPR, KRTAP4-11, NFU1, OPN4, and PRMT7. The five biomarkers showed effective diagnostic ability in RPL, with AUC above 0.8. Furthermore, eosinophils, CD56 bright natural killer cells, and monocytes were significantly correlated with the five biomarkers. This study identified five effectively diagnostic genes and explored their correlations with immune cells, providing indications for the following development of diagnostic tools and potential mechanism exploration. Five genes are predicted to involve obesity-related RPL: GIPR, KRTAP4-11, NFU1, OPN4, and PRMT7.The diagnostic ability of the five key genes are effective, with AUC > 0.8.The five genes are down-regulated in RPL than in normal samples.The five genes are closely related to immune cell like Eosinophil, CD56 bright natural killer cell, and Monocyte.

Women with HIV represent an increasing proportion of people with HIV, yet their specific needs during childbirth remain insufficiently addressed. This study explored how the experiences of women with HIV who delivered in the early antiretroviral therapy (ART) era can inform current HIV care. Semi-structured interviews were conducted with 12 women with HIV who gave birth between 2000 and 2008 in an urban area of French-speaking Switzerland. Content analysis identified key themes in the women's narratives. Median age at interview was 51 years. Eight women delivered between 2001 and 2004, and four delivered between 2005 and 2008, on average, 9.2 years after HIV diagnosis. Three themes emerged: (1) HIV's impact on social interactions, including stigma and discussing HIV status with their child; (2) medical concerns, including the value of trust-based relationships with HIV physicians and (3) adjustment to life with a newborn. Women recalled difficulties in accepting imposed interventions-mandatory Caesarean section and avoidance of breastfeeding-perceiving these as depriving them of a 'full' motherhood experience. They also described the emotional burden ofwaiting for confirmation of their child's HIV-negative status. Societal attitudes were a major barrier to HIV-status sharing. Although current ART guidelines have evolved, women who delivered in the early ART era expressed long-lasting feelings of loss associated with past interventions. Their narratives highlight gaps between clinical progress and lived experience and underscore the need for holistic, long-term support for women with HIV and recognition that HIV can shape motherhood well beyond childbirth.

Advanced maternal age (AMA, ≥35 years), particularly prevalent in Japan, is associated with adverse perinatal outcomes, including hypertensive disorders of pregnancy (HDP), which vary in severity based on the timing of onset (early-onset and late-onset). This study aimed to investigate the association between maternal age and early-onset and late-onset HDP. A total of 80,872 pregnant women were included in this prospective birth cohort study. Associations between maternal age and early-onset, preterm late-onset, and term late-onset HDP were evaluated using a multinomial logistic regression model adjusted for potential confounding factors. Maternal age was categorized into five: <25, 25‒29.9, 30‒34.9, 35‒39.9, and ≥40 years, with the reference category set as 30‒34.9 years. Higher maternal age was significantly associated with increased odds of developing early-onset, preterm late-onset, and term late-onset HDP. The adjusted odds ratios (aORs) for early-onset HDP in women aged 35‒39.9 and ≥40 years were 2.724 (95% confidence interval [CI]: 2.095-3.542) and 3.493 (95% CI: 2.349-5.196), respectively. Regarding preterm late-onset HDP, the aORs were 1.346 (95% CI: 1.057-1.714) and 3.011 (95% CI: 2.171-4.176) for these age groups, respectively. Similarly, the aORs for term late-onset HDP were 1.417 (95% CI: 1.206-1.664) and 1.762 (95% CI: 1.341-2.316), respectively. Higher maternal age was associated with an increased HDP risk, irrespective of diagnosis timing. Associations between maternal age and early-onset and preterm late-onset HDP were stronger than that with t erm late-onset HDP.

This study evaluated the effectiveness of antiretroviral therapy (ART) and associated factors on viral suppression before, during, and after pregnancy (maternal timeline). We conducted a cohort study, retrospectively reviewing records of 1291 pregnant and breastfeeding women on ART. Descriptive statistics summarised the demographics and clinical characteristics. Chi-square, Fisher's exact, and generalised estimating equations were used to assess variations in viral suppression across the maternal timeline. ART regimens comprised 62.5% dolutegravir (DTG)-, 28.8% efavirenz (EFV)-, 4.5% nevirapine (NVP)-, and 4.2% protease inhibitor (PI)-based therapy. Viral suppression rates before, during, and after pregnancy were DTG- (95.0%, 94.6%, 95.7%), EFV- (94.9%, 94.2%, 93.6%), NVP- (93.1%, 94.7%, 93.5%), and PI-based (79.6%, 88.0%, 85.7%). ART regimens varied in effectiveness, with statistical significance observed before ( p < 0.001) and after ( p = 0.018), but not during pregnancy ( p = 0.678). PI-based regimens showed higher risk of non-suppression in the non-adjusted model (IRR = 3.20, 95% CI: 1.63-6.30, p = 0.001). In the adjusted model, poor adherence (aIRR = 7.80, 95% CI: 2.54-23.90, p < 0.001), fair adherence (aIRR = 5.03, 95% CI: 1.11-22.86, p = 0.036), second-line ART (aIRR = 3.14, 95% CI: 1.75-5.62, p < 0.001), and third-line ART (aIRR = 8.48, 95% CI: 1.82-39.43, p = 0.006) remained significant. ART effectiveness showed variation before and after, but not during pregnancy. EFV- and NVP-based regimens achieved suppression rates comparable to DTG across maternal timelines, with the exception of PI-based regimens. Adherence and ART drugs influence outcomes more than regimen choice alone, with good adherence essential for optimal maternal outcomes.

Rates of hypertensive disorders affecting pregnancy are increasing, and bipolar disorder is more common in pregnancy than previously thought. The authors investigated differences in the incidence of hypertensive disorders of pregnancy between those with and without bipolar disorder (BPD) and between those receiving and not receiving pharmacotherapy for BPD. Differences in the incidence of hypertensive disorders of pregnancy in those with BPD between those on prophylactic aspirin (ASA) and not, were also examined. EPIC COSMOS was used to examine records from 2019 to 2023. The authors found a meaningful difference in proportions between those with and without BPD when observing development of hypertensive disorders of pregnancy across years. Slightly increased odds of hypertensive disorders were found among those reporting BPD pharmacotherapy compared to those not. Slightly increased odds of hypertensive disorders occurred in those with BPD reporting ASA. The increased odds among those reporting BPD pharmacotherapy could be due to sequelae of disease, medication used, or comorbidities. These findings further corroborate prior evidence of the increasing prevalence of both maternal health complications and mental health disorders int eh United States.

This study investigates factors associated with long-term posttraumatic stress following later termination of pregnancy due to fetal anomaly. N = 159 women undergoing later termination of pregnancy were assessed at four time points: pre-termination (T0), at four months (T1, N = 115), one year (T2, N = 99), and four years post-termination (T3, N = 90). Participants answered a questionnaire containing questions about posttraumatic stress (IES), optimism (LOT-R), social support (F-SozU) and several sociodemographic as well as pregnancy related variables. To assess changes in posttraumatic stress over time and possible predictors, generalized estimating equations were calculated. Average posttraumatic stress declined significantly from T1 (52.3% above average) to T2 (20.0%) and T3 (17.8%). Optimism at T0 was a significant predictor for lower overall posttraumatic stress, avoidance and intrusion. Having previous children and higher gestational age were significant predictors for higher intrusion scores. Findings align with research indicating that most women recover from the initial distress, though some experience prolonged symptoms and should thus receive adequate psychological support. Lower optimism, having previous children and higher gestational age may be risk factors for higher posttraumatic stress levels. Further research should examine the sources of posttraumatic stress among people seeking abortion later in pregnancy due to fetal anomaly.

Germ-free (GF) animals, which are entirely devoid of all microorganisms, are one of the most powerful tools for studying the role of the microbiome in a phenotype, moving the microbiome field from association to causation. They allow the introduction of specific microbes or microbial communities to interrogate the causality of microbiomes in protecting against or contributing to a phenotype. Here, we report critical and underappreciated challenges in using GF models to investigate the intergenerational effects of maternal diet and microbiota on offspring health. Using 57 GF and littermate conventionalized GF dams, we observed unexpectedly high maternal (odds ratio 11.5, p < 0.0001) and offspring (odds ratio 4.12, p < 0.0001) mortality in GF animals. Remarkably, GF dams had an extremely low pregnancy and parturition ( p microbiome < 0.0001) and a high incidence of cecal torsion (18.2%) compared to the conventionalized group, underscoring the indispensable role of the maternal microbiome in reproductive success and early development. Notably, even conventionalized GF mothers on high-fiber diets exhibited poor fertility, suggesting that microbial colonization timing and maternal microbial capacity to metabolize fiber are crucial. These findings not only reveal significant limitations in GF breeding protocols but also indicate that the maternal microbiota might influence offspring health far earlier than previously recognized, with implications for the developmental origins of health and disease research.

Pregnancy is a time of rapid physical transformations. Medical and societal pressures regarding women's weight and body image throughout pregnancy may increase body dissatisfaction, which can negatively affect psychological health and health behaviors. Yet healthcare providers (HCPs) often feel uncomfortable addressing the topic. This study explored women's experiences of body changes during pregnancy, as well as the practices and challenges faced by midwives and dietitians in supporting them. A purposeful sample of 20 pregnant women (16-32 weeks of gestation) in Switzerland participated in face-to-face semi-structured interviews. In addition, four focus groups were conducted with six midwives and four dietitians. All narratives were transcribed verbatim and analyzed using thematic analysis. Three themes were identified in pregnant women's interviews: navigating body changes, managing the unmanageable, and experiencing lack of support around body image and weight gain. Women worried about weight gain, attempted to monitor their diet, and often felt unsupported by HCPs. Two themes were identified in HCP focus groups: reassuring and conveying information, and experiencing practical obstacles and societal challenges. HCPs acknowledged the sensitivity of the topic and described adopting a reassuring stance while conveying information and seeking ways to help women make peace with their bodies. Tailored support for body image during pregnancy is needed to promote maternal and fetal health. Midwives and dietitians are well placed to provide interdisciplinary consultations addressing gestational weight gain and body dissatisfaction. Training in positive body image could enhance their confidence in addressing these issues.

Reliable background estimates of adverse maternal and neonatal outcomes are needed to interpret safety signals as maternal vaccines are introduced but remain limited in many African settings. We established facility-based pregnancy registries in The Gambia to estimate site-specific background rates of selected adverse events of special interest (AESIs) relevant to maternal immunization safety monitoring. We conducted prospective observational surveillance from August 2022 to August 2024 at three high-volume antenatal care facilities in the Western Region of The Gambia. Pregnant women aged 18 years or older were enrolled during routine antenatal care and followed through delivery to the 4-6-week postnatal visit. Selected AESIs were ascertained irrespective of vaccination status and delivery location, using routinely available clinical records. Diagnostic certainty was assessed using Global Alignment of Immunization Safety Assessment in Pregnancy (GAIA) definitions. Outcome-specific rates were calculated with 95% confidence intervals (CIs). Among 5099 enrolled women, 419 (8%) discontinued participation or were lost to follow-up. We recorded 4680 deliveries resulting in 4775 infants, including 4671 live births and 104 stillbirths. Six maternal deaths were recorded, corresponding to a maternal mortality rate of 1.3 per 1000 births (95% CI: 0.5-2.7). Stillbirth and neonatal mortality rates were 21.8 (17.8-26.3) and 15.6 (12.3-19.6) per 1000 live births, respectively. There were 398 preterm births, 277 infants with low birth weight and two babies with major external structural congenital anomalies. Surveillance embedded in routine antenatal care generated site-specific background rates of selected adverse maternal and neonatal outcomes relevant to maternal immunization safety monitoring. Strengthening clinical documentation, diagnostic capacity, and vaccination history ascertainment could improve outcome classification and the utility of these platforms for future safety monitoring.

the ABO and Rhesus systems remain the most clinically significant blood group antigens on red blood cell membranes. Rhesus isoimmunization occurs when maternal Rh antibodies in a RhD-negative woman react with red blood cells of an RhD-positive fetus, leading to adverse fetal and neonatal outcomes. a cross-sectional review of 194 medical records of RhD-negative pregnant women managed at Kenyatta National Hospital (KNH) between 2013 and 2019 was conducted. Data on sociodemographic, obstetric, and clinical characteristics were extracted and analyzed using SPSS version 23. Multivariable logistic regression was performed to determine associations between Rh isoimmunization and adverse pregnancy outcomes. Adjusted odds ratios (aORs) with 95% confidence intervals were calculated, and p<0.05 was considered statistically significant. the mean age (SD) of participants was 30.1 years, and the mean gestational age at delivery was 38.9 weeks. Most participants were multigravida (69.1%) and married (91.2%). The prevalence of Rh isoimmunization was 4.1%. Isoimmunized women had significantly higher odds of miscarriage (aOR 5.64, 95% CI 1.48-21.53; p=0.01), hydrops fetalis (aOR 8.72, 95% CI 2.10-36.12; p<0.001), intrauterine foetal death (aOR 9.83, 95% CI 2.75-35.12; p<0.001), low birth weight <2500g (aOR 7.40, 95% CI 1.93-28.43; p=0.004), and poor APGAR score <7 at 5 minutes (aOR 10.26, 95% CI 2.98-35.32; p<0.001). Neonates of isoimmunized mothers were also more likely to require neonatal intensive care unit (NICU) admission (aOR 6.92, 95% CI 1.41-33.84; p=0.02). the prevalence of Rh isoimmunization among RhD-negative women at KNH was 4.1%. Isoimmunization was significantly associated with miscarriage, hydrops fetalis, IUFD, low birth weight, poor APGAR scores, and NICU admission. Strengthening routine anti-D prophylaxis and improving documentation of its administration after pregnancy loss or delivery are critical to reducing isoimmunization and related complications.

The pregnancy that occurred due to in vitro fertilization is characterized by higher risk of development of gestational diabetes mellitus. The purpose of the study was to investigate course and outcomes of pregnancy resulted from in vitro fertilization in women with gestational diabetes mellitus, depending on time of its manifestation. The analysis of course of pregnancy, childbirth and condition of newborns in 179 women with gestational diabetes mellitus under pregnancy resulted from in vitro fertilization was carried out. It is established that early manifestation of gestational diabetes mellitus is associated with older age of pregnant women, higher rate of birth of large fetus in anamnesis, higher body mass index, more frequent prescription of insulin therapy to treat gestational diabetes mellitus, higher rate of development of early threatened miscarriage, isthmic cervical insufficiency, anemia, chronic arterial hypertension, gestational arterial hypertension, moderate preeclampsia, severe preeclampsia, premature normally placed placenta detachment, fetal growth retardation, chronic intrauterine fetal hypoxia, diabetic fetopathy, prenatal rupture of amniotic fluid, premature birth, more frequent birth of large fetus, development of fetal renal pyelectasia. The female patients with late manifestation of gestational diabetes mellitus had higher level of fasting plasma glycemia, frequent development of placenta previa, polyhydramnios, pathological and insufficient gain of body mass during pregnancy, dis-coordination of labor and clinically narrow pelvis during labor, more frequent operative delivery and early delivery. The gestational diabetes mellitus, developed both in early and late periods, complicates the course and childbirth under pregnancy resulted from in vitro fertilization, adversely affects state of the newborn. The study in depth is needed to establish possible mechanisms of development of gestational diabetes mellitus in this cohort of women with implementation of screening examinations and determination of further tactics of management of pregnancy depending on time of its manifestation. Беременность, наступившая с помощью экстракорпорального оплодотворения, характеризуется более высоким риском развития гестационного сахарного диабета. Цель исследования — изучить течение и исходы беременности, наступившей в результате экстракорпорального оплодотворения, у женщин с гестационным сахарным диабетом в зависимости от срока его манифестации. Проведен анализ течения беременности, родов и состояния новорожденных 179 женщин с гестационным сахарным диабетом при беременности, наступившей в результате экстракорпорального оплодотворения. Установлено, что ранняя манифестация гестационного сахарного диабета связана с более старшим возрастом беременных женщин, большей частотой рождения крупного плода в анамнезе, большим индексом массы тела, более частым назначением инсулинотерапии для лечения гестационного сахарного диабета, большей частотой развития раннего угрожающего выкидыша, истмико-цервикальной недостаточности, анемии, хронической артериальной гипертензии, гестационной артериальной гипертензии, умеренной преэклампсии, тяжелой преэклампсии, преждевременной отслойки нормально расположенной плаценты, задержки роста плода, хронической внутриутробной гипоксии плода, диабетической фетопатии, дородового излития околоплодных вод, преждевременных родов, более частым рождением крупного плода, развитием пиелоэктазии почек плода. У пациенток с поздней манифестацией гестационного сахарного диабета определялся более высокий уровень гликемии плазмы натощак, частое развитие предлежания плаценты, многоводия, патологической и недостаточной прибавки массы тела за беременность, дискоординации родовой деятельности и клинически узкого таза в родах, более частое оперативное родоразрешение, ранний срок родоразрешения. Гестационный сахарный диабет, развившийся как в ранние, так и в поздние сроки, осложняет течение и роды при беременности, наступившей в результате экстракорпорального оплодотворения, неблагоприятно влияет на состояние новорожденного. Необходимо углубленное изучение возможных механизмов развития гестационного сахарного диабета в данной когорте женщин с внедрением скрининговых исследований и определением дальнейшей тактики ведения беременности в зависимости от срока его манифестации.

Spontaneous intracranial hypotension, typically resulting from spontaneous leakage of spinal cerebrospinal fluid (CSF), is an uncommon and underrecognized condition, particularly during pregnancy. Diagnosis can be challenging when cranial imaging is normal, and presentations in very early pregnancy are sparsely reported. This report describes the case of a 33-year-old woman (gravida 2, para 1) who presented at 4 weeks and 4 days of gestation following frozen embryo transfer with a severe orthostatic bi-occipital headache associated with nausea, vomiting and neck pain. There was no preceding trauma or recent spinal instrumentation. Magnetic resonance imaging (MRI) of the brain was unremarkable; however, whole-spine MRI revealed an extensive longitudinal CSF-signal collection extending from the cervical to the lumbar spine, compatible with spinal CSF leakage. Three epidural blood patches produced partial but progressive symptomatic improvement. Residual symptoms were managed conservatively with hydration, caffeine, analgesia, and relative activity restriction, with eventual complete clinical resolution. The remainder of the pregnancy progressed to term without recurrence, and the patient underwent a repeat cesarean delivery under general anesthesia in accordance with maternal preference. Spontaneous intracranial hypotension should be considered in pregnant patients presenting with new-onset orthostatic headache. Normal brain MRI does not exclude the diagnosis, and spinal MRI may demonstrate evidence of CSF leakage when clinical suspicion remains high. This case highlights that spontaneous spinal CSF leakage may present in very early pregnancy, following a medicated frozen embryo transfer, an infrequently reported clinical scenario. Management should be individualized and multidisciplinary, given the limited pregnancy-specific evidence and variable response to epidural blood patching.

Pregnancy increases the risk of venous thromboembolism, and pulmonary embolism (PE) remains a leading cause of maternal morbidity and mortality. Diagnosis is challenging due to symptom overlap with normal pregnancy, and management is complex in severe cases without hemodynamic instability. A 32-year-old woman at 32 weeks' gestation presented with dyspnea, chest pain, and hypoxemia. CT pulmonary angiography confirmed a saddle PE with right ventricular strain. Despite high oxygen requirements, she remained hemodynamically stable. She was managed in the intensive care unit with therapeutic anticoagulation and high-flow oxygen, while thrombolysis was deferred due to bleeding risk. Fetal monitoring showed intermittent nonreassuring findings likely related to maternal hypoxia. Following multidisciplinary discussion, conservative management was continued. The patient improved clinically, was discharged on low-molecular-weight heparin, and later delivered at 39 weeks with good maternal and neonatal outcomes.

COVID-19 poses significant risks to pregnant women, with pregnancy recognized as a risk factor for severe disease. This vulnerability may be exacerbated by iron deficiency anemia (IDA) due to impaired immune function, reduced oxygen transport, and altered coagulation and endothelial function. A retrospective cohort study of 271 unvaccinated, otherwise healthy women aged 18-38 with COVID-19 was conducted at Al-Shifa Hospital, Gaza (2021). Pregnant ( n = 97) and nonpregnant ( n = 174) groups were stratified by IDA, investigating the impact of pregnancy and IDA on the severity of COVID-19. Iron deficiency was determined by transferrin saturation levels <20% measured during acute infection, whereas ferritin levels were not available. Overall pregnancy was significantly associated with COVID-19 severity ( p < 0.001), with pregnant women having higher odds of critical illness (OR = 4.61, 95% CI 2.27-9.39, p < 0.001) and death (OR = 5.25, 95% CI 1.91-14.44, p = 0.001) compared with moderate illness. All deaths were due to acute respiratory distress syndrome; no venous thromboembolism cases occurred. IDA was associated with COVID-19 severity in both pregnant ( p = 0.015) and non-pregnant ( p = 0.002) women. In a multivariable model including pregnancy, IDA was associated with higher odds of severe (OR = 3.57, 95% CI 1.97-6.48, p < 0.001), critical (OR = 2.25, 95% CI 1.09-4.64, p = 0.029), and fatal illness (OR = 7.23, 95% CI 1.96-26.74, p = 0.003) compared with moderate illness. This study suggests that among young, otherwise healthy, unvaccinated women with COVID-19, pregnancy and IDA are associated with increased COVID-19 severity. However, interpretation requires caution considering the small number of events, particularly deaths, and the assessment of iron status during acute infection using transferrin saturation alone without ferritin measurements, which limits the ability to distinguish preexisting iron deficiency from inflammation-related changes in iron metabolism.

Cardiovascular health (CVH) often declines in midlife. Diet during pregnancy, a similarly sensitive period involving physiological changes, may influence long-term CVH, but few studies have examined this relationship. We examined the associations between diet during pregnancy and CVH in midlife. Participants are 776 women enroled in Project Viva during early pregnancy (1999-2002, mean 32.7 years). Participants completed food frequency questionnaires during the first and second trimesters, from which we calculated three diet scores (higher scores = better diet): Dietary Approaches to Stop Hypertension (DASH), Mediterranean Diet (MD) and Dietary Inflammatory Index (DII × -1). We averaged scores across trimesters and generated internal z-scores. At the midlife visit (2017-2021, mean 51.1 y), we assessed CVH using the American Heart Association's Life's Essential 8 (range 0-100; higher scores = better CVH), including behavioural (diet, physical activity, sleep, smoking) and biomedical (BMI, blood pressure, lipids, glucose) subscores. We assessed associations using linear regression adjusted for age, race and ethnicity, nativity, education, parity, marital status and income at enrolment. Most participants were non-Hispanic White (70%) and college graduates (76%). Mean midlife CVH score was 76.3 points. Higher (per 1-SD) DASH z-scores were associated with better overall (β 3.3; 95% CI 2.2-4.3), behavioural (3.5; 2.5-4.4) and biomedical (3.1; 1.5-4.7) CVH scores. Higher MD z-scores were associated with better overall CVH (2.4; 1.4-3.4), behavioural (2.6; 1.6-3.5) and biomedical (2.6; 1.0-4.2) scores. Higher DII (× -1) z-scores were associated with better overall CVH (2.6; 1.6-3.7), behavioural (2.7; 1.7-3.7) and biomedical (2.5; 0.9-4.1) scores. A better pregnancy diet was associated with higher CVH scores for diet, physical activity and BMI, and both DASH and DII with blood pressure. Women who consumed healthier diets during pregnancy had better CVH two decades later. Dietary assessment in pregnancy may identify women at risk for both short-term and long-term health problems.

This study investigates the relationships between maternal factors and gestational diabetes mellitus (GDM), as well as third‑trimester maternal lipids and adverse pregnancy outcomes among GDM patients. This study enrolled 3,973 pregnant women, divided into a control group ( n = 3166) and a GDM group ( n = 807). The GDM group was further divided into well-controlled ( n = 152) and poorly controlled subgroups ( n = 655). Univariate and multivariate logistic regression analyses were performed to evaluate factors associated with GDM risk. Baseline clinical/laboratory characteristics were compared across groups via parametric, nonparametric, and chi‑square tests to assess associations of third‑trimester maternal lipid levels with adverse pregnancy outcomes. Receiver operating characteristic analyses evaluated the predictive values of body mass index (BMI) and third‑trimester maternal lipid levels. Age (OR = 1.069, 95% CI:1.050-1.087, p < .001), overweight (OR = 1.678 95% CI:1.396-2.013, p < .001), and obesity (OR = 2.018, 95% CI:1.511-2.677, p < .001) are key risk factors for GDM. Significant differences existed in age ( p = .001), BMI ( p < .001), fasting blood glucose (FBG, p < .001) and 2-hour postprandial plasma glucose (2hPPG, p = .001) across subgroups, as well as triglycerides (TG, p < .001), high-density lipoprotein cholesterol (HDL-C, p = .001), and free fatty acids (FFAs, p < .001) among the three groups. Subgroup analysis by lipid levels showed TG predominantly affected delivery mode ( p = .031), neonatal birth weight ( p = .005), and quantitative blood loss (QBL, p = .019) in GDM, while HDL-C mainly influenced fetal growth curve ( p = .004) and neonatal birth weight ( p = .002). Subgroup analysis by triglyceride-glucose index (TyG index) revealed significant differences in glycemic control ( p = .002), delivery mode ( p = .002), neonatal weight ( p = .005), and QBL ( p = .005). The area under the curve of pre-pregnancy BMI for GDM complicated by hypertensive disorders of pregnancy was 0.738, third-trimester BMI 0.720, and 0.709 for macrosomia prediction in non-advanced-age women with GDM. Age, overweight, and obesity are independent risk factors for GDM. Among women with GDM, third-trimester lipid levels are associated with adverse pregnancy outcomes. Therefore, lipid levels should be considered in GDM clinical management, rather than focusing exclusively on glycemic control.

Venous thromboembolism (VTE) remains a leading cause of maternal morbidity and mortality. Pregnancy is a hypercoagulable state that increases VTE risk due to physiologic and anatomic changes of pregnancy. A clear understanding of risk assessment, diagnosis, and management of VTE in pregnancy is essential to optimize maternal outcomes. Diagnosis of VTE in pregnancy is often challenging, as symptoms may overlap with physiologic pregnancy-related changes. Accurate diagnosis requires high clinical suspicion and an understanding of various imaging modalities in pregnancy. Anticoagulation is the primary form of management of VTE in pregnancy and requires close care coordination and multidisciplinary management.

Tachycardia is a common physiologic finding in pregnancy due to increased blood volume and sympathetic activity, with heart rate typically rising by 15 to 20 bpm and peaking in the third trimester. However, persistent tachycardia may signal underlying pathology, including cardiac, endocrine, infectious, or hematologic conditions. A resting heart rate above 110 bpm should prompt further evaluation. Because cardiac disease remains a leading cause of maternal mortality, distinguishing benign physiologic changes from clinically significant conditions is critical. This article outlines a structured approach to evaluating pregnant patients with tachycardia, emphasizing early identification, risk stratification to optimize maternal and fetal outcomes.

Advanced abdominal pregnancy (AAP) is a rare and potentially life-threatening form of ectopic pregnancy. We report the case of a 33-year-old woman, G2P0010, who presented with progressive abdominal pain and distension found to be 30 weeks and 1 day of gestation by ultrasound biometry. Ultrasound demonstrated an abdominal pregnancy with fetal demise and MRI confirmed an extrauterine fetus within the peritoneal cavity, an empty uterus, and a placenta extending from the mid-abdomen into the pelvis with mass effect on the sigmoid colon, without definite bowel invasion. Surgical exploration confirmed the MRI findings; the placenta was adherent to the rectosigmoid colon and left ovary but was removed without bowel resection, with ovarian preservation. This case highlights the utility of MRI in confirming AAP, mapping placental implantation, and guiding preoperative surgical planning.

The association between semen parameters on the day of fertilization and preimplantation genetic testing for aneuploidy (PGT-A) outcomes in couples with idiopathic early recurrent pregnancy loss (RPL) remains uncertain. This retrospective cohort study included 998 couples with idiopathic early RPL who underwent their first next-generation sequencing-based PGT-A cycle between January 2017 and December 2022, yielding 4352 biopsied blastocysts. Semen volume, sperm concentration, and total motility were assessed on the day of intracytoplasmic sperm injection according to World Health Organization sixth-edition thresholds. Embryo-level associations were analyzed using generalized estimating equations, and clinical outcomes after single euploid frozen-thawed embryo transfer were evaluated using multivariable logistic regression. Lower sperm concentration (<16 × 10 6 /mL) was not significantly associated with embryo aneuploidy but was associated with increased odds of embryo mosaicism in the adjusted model (adjusted odds ratio [aOR] 1.437, 95% confidence interval [CI] 1.108-1.864; p = 0.006). This association remained significant in the multivariable model (OR 1.432, 95% CI 1.084-1.892; p = 0.012). Semen volume <1.4 mL and total motility <42% were not significantly associated with embryo aneuploidy or mosaicism. In analyses of reproductive outcomes after single euploid embryo transfer, semen volume, sperm concentration, and total motility were not significantly associated with live birth or total pregnancy loss. These findings suggest that reduced sperm concentration on the day of fertilization may be associated with embryo mosaicism in couples with idiopathic early RPL undergoing PGT-A, whereas conventional semen parameters do not appear to compromise live birth or pregnancy loss outcomes once a euploid embryo is transferred.