Utforsk forskningen

Hypertensive disorders of pregnancy (HDP) encompass chronic hypertension, gestational hypertension, preeclampsia, and preeclampsia superimposed on chronic hypertension, affecting about 5% to 10% of pregnancies worldwide and remaining a major cause of maternal and perinatal morbidity and mortality. Their burden is increasing with rising obesity, advanced maternal age, evolving diagnostic criteria, and marked socioeconomic and racial-ethnic disparities. This review summarises current evidence on the epidemiology, pathophysiology, biomarkers, clinical management, and long-term outcomes of HDP, highlighting recent advances and unresolved questions. Mechanistically, HDP is characterised by systemic endothelial dysfunction and angiogenic imbalance, particularly involving soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF), and soluble endoglin (sEng), together with immune maladaptation, oxidative stress, and genetic and environmental contributors such as endocrine-disrupting chemicals (EDCs) and sleep-disordered breathing (SDB). The sFlt-1/PlGF ratio is among the most validated tools for short-term risk assessment in suspected preeclampsia, while retinal microvascular imaging may provide a non-invasive marker of systemic microvascular dysfunction. Clinically, trial evidence supports treating mild chronic hypertension to below 140/90 mmHg to reduce adverse outcomes without compromising foetal growth. Long-term maternal cardiovascular and metabolic risks vary according to HDP phenotype, severity, gestational age at onset, and associated preterm delivery or foetal growth restriction, whereas offspring neurodevelopmental associations are largely observational and may be influenced by prematurity and shared familial or socioeconomic factors. Experimental strategies supported primarily by preclinical or early translational evidence include PPARγ agonists, placenta-targeted nanomedicine, and transcutaneous auricular vagus nerve stimulation. Machine learning combined with longitudinal multi-omics data may support precision risk stratification and individualised management.

This study evaluated the predictive value of methylenetetrahydrofolate reductase (MTHFR) rs1801133 and vitamin D receptor (VDR) FokI rs2228570 polymorphisms combined with uterine artery pulsatility index (PI) for preeclampsia (PE), and explored mediating pathways underlying genetic risk. A two-phase prospective study was conducted. Phase I (n = 73) screened PE-related single nucleotide polymorphisms (SNPs) via targeted sequencing; Phase II (n = 195) validated the candidates and collected clinical and ultrasound metrics. Independent predictors were identified by multivariate logistic regression to build a nomogram, and the nomogram was evaluated by receiver operating characteristic (ROC) curve, calibration, and decision curve analyses. Mediation analysis was performed to quantify the contribution of serum biomarkers. The T allele of MTHFR rs1801133 showed a marginal association with PE risk under dominant model (OR = 1.82, 95% CI: 0.96-3.44, P = 0.067), while VDR rs2228570 was not significantly associated (OR = 1.74, 95% CI: 0.89-3.39, P = 0.104). Pre-pregnancy body mass index (BMI) ≥25 kg/m² (OR = 2.75, 95% CI: 1.45-5.21, P = 0.002) and elevated uterine artery PI (OR = 4.75, 95% CI: 1.38-16.41, P = 0.014) were independent risk factors. The nomogram achieved an area under the curve (AUC) of 0.711 (95% CI: 0.640-0.783), with sensitivity of 75.53% and specificity of 59.41%. Asymmetric dimethylarginine (ADMA) and 8-iso-PGF2α mediated 77.5% and 26.0% of the effect of MTHFR on PE risk, respectively. Pre-pregnancy BMI and uterine artery PI are independent predictors of PE. The integrated model offers moderate predictive value. ADMA-mediated endothelial dysfunction may be involved in MTHFR-related PE risk.

Arrhythmias during pregnancy are increasingly recognized due to increased age, risk factors, and the physiologic cardiovascular changes of pregnancy. Premature atrial contractions, premature ventricular contractions, supraventricular tachycardia, and sinus tachycardia, are benign and often resolve postpartum, with management centered on reassurance, lifestyle modification, and occasionally medication treatment. However, sustained arrhythmias including atrial fibrillation or atrial flutter require more comprehensive evaluation, rate or rhythm control, and potential anticoagulation. A structured approach emphasizing symptom assessment, electrocardiogram evaluation, and recognition of high-risk features helps clinicians distinguish benign rhythm disturbances from pathologic arrhythmias, enabling appropriate reassurance, management, and referral to cardiology/cardio-obstetrics teams when necessary.

Ion channels coordinate diverse physiological functions through tightly regulated fluxes of Ca 2+ , K + , Na + , Cl - , and H + across both plasma and intracellular membranes. In the reproductive system, ion channels have emerged as key regulators of processes essential for reproductive success. They control epithelial transport and ciliary activity in the oviduct, regulate uterine smooth muscle contractility and receptivity, and orchestrate sperm capacitation, hyperactivation, acrosome reaction, and fertilization. These functions require precise spatial and temporal integration of environmental cues, including bioactive lipids, pH, temperature, and mechanical forces encountered throughout the reproductive tract. Dysregulation of ion channel activity has been increasingly linked to infertility, pregnancy complications, and other reproductive disorders. Recent advances in live-cell imaging, superresolution microscopy, electrophysiology, and cryo-electron microscopy have transformed our understanding of ion channel architecture, regulation, and organization within specialized membrane microdomains in reproductive tissues. In this review, we highlight recent discoveries of ion channels and their regulatory mechanisms specifically in reproductive tissues, with a focus on emerging roles of potassium channel Kir7.1 in uterine physiology and calcium channel CatSper in sperm motility, and discuss emerging questions that will guide future research in reproductive ion channel biology.

To investigate an association of inter-arm blood pressure differences (IAD) and within-visit variability of blood pressure in early pregnancy with pre-eclampsia. Blood pressure information was available on 8117 participants from the prospective PREeclampsia Screening In DEnmark (PRESIDE) study. Three consecutive blood pressure (BP) measurements were taken on both arms simultaneously in participants attending the first-trimester ultrasound. Maternal characteristics, medical history, and pregnancy outcome were collected. Outcomes were pre-eclampsia overall, further stratified into preterm (delivery < 37 weeks of gestation) and term cases (delivery ≥ 37 weeks of gestation). Women developing pre-eclampsia had a higher diastolic IAD (2.67 mmHg vs 2.33 mmHg) and pulse pressure IAD (4.67 mmHg vs 4.33 mmHg OR 1.04 (95% CI: 1.01; 1.07)). Pulse pressure IAD was associated with pre-eclampsia (adjusted OR 1.04, 95% CI 1.01, 1.07) and term pre-eclampsia (OR 1.05, 95 % CI 1.02, 1.08), but not with preterm pre-eclampsia (OR 0.99, 95% CI 0.9, 1.06). There were no associations between systolic IAD, within-visit BP variability and pre-eclampsia. Diastolic IAD and pulse pressure IAD in early pregnancy were higher in women developing pre-eclampsia. No association was found between systolic IAD or within-visit BP variability and pre-eclampsia.

Preeclampsia is a pregnancy-specific hypertensive disorder characterized by new-onset hypertension after 20 weeks of gestation, accompanied by end-organ dysfunction with or without proteinuria. Affecting approximately 5-7% of pregnancies worldwide, it remains a leading cause of maternal and fetal morbidity and mortality. Despite decades of research, the underlying pathophysiology of preeclampsia remains incompletely understood. However, increasing evidence implicates placental mitochondrial oxidative stress in its pathogenesis. In this review, we summarize the current literature pertaining to ultrastructural evidence of mitochondrial damage, defects in oxidative phosphorylation and electron transport chain activity, and alterations in reactive oxygen species production, antioxidant defense, and mitochondrial biogenesis. Finally, we discuss translational considerations and highlight how therapeutic strategies targeted at restoring mitochondrial function may represent a promising approach for managing preeclampsia.

This article reports on the world's first live birth after ovarian tissue cryopreservation and transplantation (OTCT) in a patient with colon cancer. A 29-year-old unmarried nulliparous patient underwent ovarian tissue cryopreservation before chemotherapy. After chemotherapy-induced premature ovarian insufficiency, she received the first transplantation of six thawed ovarian cortex strips. Despite normal ovarian function being maintained for over 2 years, she requested and underwent a second transplantation with another six strips to maximize her chances of pregnancy. After the first transplantation, she resumed spontaneous menstruation with restored ovarian function, which was remained functional for 28 months until the second transplantation. Following the second transplantation, she conceived spontaneously without assisted reproductive technology two months after grafting. Routine prenatal examinations showed normal fetal development without abnormalities. She delivered a healthy baby girl weighing 2785 g with Apgar scores of 8/9 at 1 and 5 min. This case demonstrates the feasibility and safety of OTCT for fertility and ovarian function preservation in patients with colon cancer.

SARS-CoV-2 infection during pregnancy has been associated with higher rates of preeclampsia (PE). While placental abnormalities resembling PE have been reported in COVID-19 pregnancies, the molecular mechanisms underlying the association remain unclear. We conducted bulk RNA sequencing on placental tissues from four pregnancy groups: uneventful prepandemic (preCOVID-19), prepandemic PE (preCOVID-19 PE), COVID-19 without PE (COVID no PE), and COVID-19 complicated by PE or other hypertensive disorders (COVID PE). Differential expression was analyzed using Deseq2 likelihood ratio test (LRT), and gene set enrichment analysis identified dysregulated pathways. Clustering of LRT-significant differentially expressed genes (DEGs) identified a set of 16 genes (defined by the false discovery rate adjusted p -value < 0.05) across the four pregnancy groups, showing stepwise expression changes-lowest in preCOVID-19 uneventful, followed by those in COVID-19 without PE, then preCOVID-19 PE, and highest in COVID PE. This cluster included genes associated with placental dysfunction, such as LAMA5 and BTNL9 . While morphogenesis-related pathways were enriched across all pathological groups, immune activation pathways were predominantly enriched in COVID PE, moderately in preCOVID-19 PE, and absent in COVID no PE. Our findings identify a COVID-19-associated placental signature that mirrors PE features and shows a progressive expression pattern defining a continuum of placental stress, with maternal SARS-CoV-2 infection potentially exacerbating underlying dysfunction.

We assessed vaccine hesitancy toward two novel respiratory syncytial virus (RSV) immunization strategies, maternal vaccines and infant monoclonal antibodies (mAbs), among 4422 couples across eight Chinese provinces, via a multicenter cross-sectional survey with convenience sampling from medical institutions. Vaccine hesitancy was measured using the 5C scale (confidence, complacency, constraints, calculation, collective responsibility), with total scores (higher indicating lower hesitancy) as the primary outcome. Linear mixed-effects models analyzed sociodemographic and pregnancy-related factors. Women had marginally lower total 5C scores than partners for maternal vaccines (45.88 [SD 5.90] vs. 46.25 [5.74]; Cohen's d = -0.06, 95% CI: -0.09 to -0.03; p < .001), with no significant difference for mAbs. For both strategies, calculation scored highest in both sexes. Within-couple correlations across domains for the same strategy were low (r ranged from 0.31 to 0.48). In multivariable models, older age, rural residence and lower income were associated with greater hesitancy for both strategies (e.g. age: maternal vaccines, β = -0.09, 95% CI: -0.12 to -0.05; mAbs, β = -0.09, 95% CI: -0.12 to -0.06). Among women, third-trimester status and prior children were each independently associated with higher hesitancy. Prior influenza vaccination during pregnancy was associated with lower hesitancy toward maternal vaccines ( β = 0.73, 95% CI: 0.32 to 1.13) but not mAbs. Ultimately, Chinese expectant and new parents show a hesitancy profile toward RSV immunization strategies dominated by active information-seeking. Prenatal counseling and broader communication efforts should include both parents. Efforts should prioritize older, rural, and lower-income couples.

This study aimed to examine the associations between hypertensive disorders during pregnancy and intelligence quotient (IQ) in children at the ages of 8 and 16 years. Our study sample comprised participants in the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort, an ongoing population-based longitudinal birth cohort in Bristol, Avon, United Kingdom. Offspring IQ was assessed using a shortened version of the Wechsler Intelligence Scale for Children (WISC-III) at age 8 and the Wechsler Abbreviated Scale of Intelligence (WASI) at approximately age 16. This study included over 4900 and 3300 mother‒child pairs at ages 8 and 16, respectively. Binary and multinomial logistic regression models were used to estimate odds ratios and 95% confidence intervals for the associations. Hypertensive disorders of pregnancy were not associated with lower offspring IQ at ages 8 or 16. Although gestational hypertension, but not pre-eclampsia, was associated with higher odds of above-average IQ compared with average IQ at age 16 in the multinomial logistic regression model, this association was not observed at age 8 or replicated in the sensitivity analysis using age-specific IQ tertiles. We found no evidence that hypertensive disorders of pregnancy were associated with lower offspring IQ at ages 8 or 16. Further studies are warranted to confirm these findings.

The impact of chronic hypertension (CHTN) combined with left ventricular hypertrophy (LVH) on adverse maternal and fetal pregnancy outcomes remains unclear. This multicenter retrospective cohort study included pregnant women with CHTN from four tertiary hospitals in China. Baseline characteristics were compared using the Kruskal-Wallis and Chi-squared tests with Bonferroni correction. Logistic regression (LR) identified risk factors for adverse outcomes. Four machine learning (ML) algorithms were validated, nomograms were developed for model visualization, and SHapley Additive exPlanations (SHAP) determined variable importance. Among 500 women, 117 (23.4%) had normal geometry, 118 (23.6%) concentric remodeling, 88 (17.6%) eccentric hypertrophy, and 177 (35.4%) concentric hypertrophy. Adverse maternal and fetal outcomes occurred in 126 (25.2%) and 359 (71.8%) women, respectively. LVH was independently associated with adverse maternal outcomes (OR 2.16, 95% CI 1.13-4.13) and fetal outcomes (OR 2.42, 95% CI 1.31-4.45). Additional maternal predictors included NYHA class III-IV, pre-eclampsia, oligohydramnios, elevated alanine aminotransferase and lactate dehydrogenase, hypoalbuminemia, greater bleeding loss, and blood transfusion. Fetal predictors included increased posterior wall thickness, oligohydramnios, abnormal umbilical artery flow, elevated alanine aminotransferase and blood urea nitrogen, low total protein, and proteinuria. ML models showed AUCs of 0.70-0.87 for maternal and 0.80-0.88 for fetal outcomes; SHAP identified LVH as an important contributor in both models. Early-pregnancy LVH was associated with higher risks of adverse maternal and fetal outcomes in women with CHTN. These models may support individualized risk stratification but require prospective external validation before clinical implementation.

Early diagnosis of preeclampsia (PE) remains challenging. We previously linked the long non-coding (lnc) RNA MIR210HG to pathological placental development. Here, we investigated its differential expression, pathophysiological phenotypic specificity, and non-invasive diagnostic potential for PE in the peripheral blood and placental tissue. We enrolled 88 PE patients (case group) and 81 normal pregnant women (control group) from the Affiliated Hospital of Qingdao University during January 2020-December 2021. MIR210HG expression was detected via RT-PCR and western blotting, and was modulated using siRNA/overexpression plasmid transfection in human trophoblasts and vascular endothelial cells. MIR210HG expression was specifically upregulated in the peripheral blood of patients with early-onset PE, with superior diagnostic efficacy for the PE-fetal growth restriction subtype. Additionally, CDHR5 was upregulated in PE-associated placental tissues ( P = 0.004). Cellular assays confirmed that MIR210HG knockdown reduced CDHR5 expression in trophoblasts and endothelial cells (Bewo: P = 0.019; JEG3: P = 0.006), and CDHR5 knockdown also downregulated MIR210HG expression (Bewo: P = 0.023). Therefore, MIR210HG may contribute to placental pathological injury by regulating CDHR5, though the pathogenic mechanism remains unclear. In contrast to the invasive and lagging placental-derived lncRNA biomarkers reported in previous studies, peripheral blood MIR210HG allows for non-invasive monitoring during pregnancy, making it more clinically applicable for early screening and phenotypic stratification of PE.

Postpartum depression (PPD) is a common perinatal disorder that affects maternal and child health. Although vitamin D deficiency has been linked to depressive symptoms, the dose‑response relationship between perinatal serum 25(OH)D and PPD and predictive value remains unclear. To investigate the dose‑response relationship between perinatal 25(OH)D and PPD and evaluate its predictive value. A total of 326 perinatal women were enrolled, PPD was assessed within 6 weeks postpartum, and serum 25(OH)D was measured at 24-48 hours after delivery. Analyses included baseline characteristics, EPDS scores, risk factors, dose‑response, predictive performance, and interactions with supplementation. PPD incidence was 23.31%. The PPD group had lower 25(OH)D, negatively correlated with EPDS scores. Each 1 ng/mL increase in 25(OH)D reduced PPD risk by 25% (OR = 0.75, 95% CI: 0.68-0.82, P < 0.001). Primiparity and fair spousal relationship were risk factors; planned pregnancy, sunlight, and oral supplementation were protective. Positive interactions with sunlight and supplementation were observed, with linear dose‑response. The AUC was 0.822, with an optimal cutoff of 24.26 ng/mL (sensitivity 67.11%, specificity 85.20%). Perinatal 25(OH)D levels are linearly and negatively correlated with PPD risk and show good screening utility; exogenous supplementation appears to modify this protective effect.

Midwifery continuity models of care have been associated with positive health outcomes and positive childbirth experiences. Such models may be beneficial for women with fear of birth but remain uncommon in Sweden. To explore thoughts and perceptions of midwifery continuity of care among women with fear of birth and describe their experiences of fragmented maternity care. A qualitative research design in which semi-structured telephone interviews were conducted during pregnancy and postpartum with women scoring above 70 on the Fear of Birth Scale. Data was analyzed using reflexive thematic analysis. Two themes were identified: A desire for knowing and being known and Unheld in the hands of many . These illustrate women's desire to feel secure and their belief that a trusting relationship with a known midwife throughout pregnancy, childbirth and the postpartum period could reduce their fear. Fragmented standard care was perceived as stressful, and all women expressed interest in midwifery continuity of care. Women with fear of birth believed that relational continuity with a known midwife could foster trust, guidance and reduce fear. The fragmented standard care was perceived as uncertain, contributing to emotional distress. These findings highlight the need for personalized and relational midwifery care.

During the COVID-19 pandemic, pregnant women experienced increased psychological distress, while access to routine mental health care was often disrupted. Psychological interventions may provide an effective strategy to support maternal mental health under these circumstances. This systematic review aimed to provide an overview of psychological interventions for pregnant women during the COVID-19 pandemic and to evaluate their effectiveness in reducing distress and enhancing resilience. A systematic search of four databases was conducted up to 3 September 2025. Randomised and non-randomised studies evaluating psychological interventions during pregnancy were included. Sixteen studies met the inclusion criteria. Interventions included cognitive behavioural therapy, mindfulness-based interventions, psychoeducation, and other psychological approaches delivered through individual, group, digital, or hybrid formats. Most studies reported reductions in depression, anxiety, or stress, and some found improvements in resilience-related factors. However, the methodological quality was modest; with heterogeneous outcome measures and limited follow-up. Overall, psychological interventions adapted for digital or hybrid delivery show promise for improving maternal emotional well-being in times of crises. The findings suggest that accessible and scalable psychological interventions may support maternal mental health during crisis situations when routine care is disrupted. Future research should prioritize larger, methodologically rigorous trials with standardized outcomes, and longer follow-up periods.

Early gut microbiota development plays an important role in lifelong human health, and meconium offers a unique matrix to understand prenatal microbial exposures. This study from the LIMIT cohort aimed at investigating associations between maternal pre-pregnancy body mass index (pre-BMI) and gestational weight gain (GWG), as well as other maternal lifestyle and environmental factors, with the structure of meconium microbiota at delivery. Two hundred pregnant women were enrolled during the pre-hospital care before birth at Fondazione IRCCS Policlinico San Matteo (Pavia), according to the inclusion/exclusion criteria. Mothers were grouped based on their GWG gain category according to the IOM guidelines. 168 meconium samples were analyzed using a targeted long-reads sequence approach. Bacterial 16S rRNA (V1-V8) amplicons were sequenced using the Oxford Nanopore PromethION platform. Supervised analyses assessed associations between maternal variables and bacterial diversity, while an unsupervised learning approach based on the Partitioning Around Medoids (PAM) clustering algorithm was applied to identify specific microbial clusters unrelated to the cohort's metadata. No significant associations were observed between GWG, pre-BMI or other lifestyle factors and overall microbial diversity. Unsupervised learning revealed five distinct meconium microbial clusters, i.e. "microbiota-types", related to different taxonomic profiles, determined by the variations in specific bacterial species. No significant influence of the studied variables was observed on meconium microbiota. However, the meconium microbial communities appear to organize into enterotype-like structures, highlighting the need for longitudinal studies to identify key determinants of early colonization.

Maternal deterioration during pregnancy, childbirth, or the postpartum period can rapidly progress to severe maternal morbidity if early warning signs are not recognized and managed promptly. This study aimed to assess maternity nurses' knowledge and attitudes regarding maternal deterioration and to examine their association with nurses' preparedness to recognize and manage maternal deterioration in maternity units. A cross-sectional study was conducted among 360 nurses working in maternity units of tertiary hospitals. Data were collected using a structured questionnaire assessing demographic characteristics, knowledge related to maternal deterioration, professional attitudes toward obstetric emergency care, and preparedness for managing maternal deterioration. Descriptive statistics, correlation analysis, and multiple regression analysis were used to examine relationships between study variables. Data were collected over a six-month period from January to June 2026. The mean knowledge score was 3.45 ± 0.71, indicating a high level of knowledge among participants. The mean attitude score was 3.68 ± 0.64, reflecting generally positive attitudes toward managing maternal emergencies. Preparedness for managing maternal deterioration showed a mean score of 3.41 ± 0.59, indicating a moderate-to-high level of preparedness. Knowledge and attitudes were significantly correlated with preparedness ( p < 0.05). Multiple linear regression analysis demonstrated that nurses' knowledge and attitudes were significant independent factor associated with preparedness for managing maternal deterioration. Higher knowledge and more positive attitudes were associated with greater preparedness after controlling for the other variables included in the regression model. Nurses' knowledge and professional attitudes significantly influence preparedness to manage maternal deterioration in maternity units. Strengthening competency-based education, simulation-based obstetric emergency training, and implementation of maternal early warning systems may enhance maternity nurses' preparedness and contribute to improved maternal safety outcomes.

The Australian dietary guidelines for pregnancy advise on optimal maternal intake. However, previous literature demonstrates suboptimal adherence to guidelines, with no evidence of the experience of sourcing nor uptake of the dietary guidelines among pregnant women. We aimed to explore pregnant women's knowledge of nutrition information, including the current Australian dietary guidelines for pregnancy. Nineteen pergnant women were recruited using convenient sampling. Semi-structured interviews were analysed thematically, underpinned by the Capability, Opportunity, Motivation and Behaviour (COM-B) model and Theoretical Domains Framework. Three themes were identified. Women showed limited awareness and/or utilization of the dietary guidelines for pregnancy, partially due to the inconsistent opportunity to receive guidelines from maternity healthcare providers. When seeking advice independently, women's capability to acquire pregnancy-related food knowledge was primarily dedicated to food safety and to identifying reliable advice from other non-evidence-based information. Women's motivation to utilize the dietary guidelines for pregnancy is low, with the perception that the broad recommendations may not meet their diverse, individual nutritional needs. To optimize pregnancy nutritional intake, multi-disciplinary efforts should be made to increase the awareness of the dietary guidelines for pregnancy and to support the delivery and uptake of dietary advice among pregnant women.

This article rethinks teenage pregnancy in rural Zimbabwe through a decolonial Afro-feminist lens, foregrounding the lived narratives of 26 teenage mothers in Shamva. Rather than pathologising their experiences or framing early pregnancy as a failure of knowledge or morality, we conceptualise the notion of a reproductive pipeline-a system through which poverty, gendered power, inadequate healthcare, and emphasised femininity converge to constrain girls' reproductive autonomy. The analysis reveals how early pregnancy is produced through a reproductive pipeline where poverty, patriarchy, kinship expectations and clinic gatekeeping constrain girls' agency with reduced capacity to negotiate safe sex and better social, educational and health outcomes. Afro-feminist theory helps illuminate how girls exercise constrained agency within histories of colonial dispossession and contemporary moral economies that value sexual silence and respectability over autonomy and care. Girls' efforts to resist through withholding sex, seeking contraception, or rejecting unsafe abortions are often blocked by economic, relational and institutional obstacles. These findings call for interventions based on reproductive justice rooted in African epistemologies, structural analysis, and care ethics. African girls in rural Zimbabwe, we argue deserve the right to choose and to imagine futures beyond coerced maternity and structural abandonment.

This study aimed to examine the association between body roundness index (BRI) and female infertility. This cross-sectional study utilized data from the National Health and Nutrition Examination Survey from 2013 to 2020. BRI was calculated using standardized measurements of height and waist circumference. Multivariable logistic regression models assessed the relationship between BRI and infertility, adjusting for potential confounders. Subgroup analyses examined the stability of the relationship between BRI and infertility, and smooth-fitting curves were applied to explore the linear or non-linear relationship between them. Among the participants, 483 (13.43%) women were diagnosed with infertility. BRI was positively related to infertility (adjusted odds ratio [OR] 1.09; 95% confidence interval [CI] 1.05, 1.13). When categorized into tertiles, women in the highest BRI tertile had a 78% higher risk of infertility (OR 1.78; 95% CI 1.37, 2.32) compared with the lowest tertile. Subgroup analyses revealed potential interactions of age and pregnancy history regarding the association between BRI and infertility, showing an S-shaped relationship in women under 36 years and those without a pregnancy history. BRI is positively correlated with infertility in United States women. This finding suggests that BRI could serve as a valuable predictor in female infertility assessment.

Dysregulation of maternal adaptations to pregnancy due to high pre-pregnancy BMI (pBMI) is associated with worsened health outcomes for mothers and children. The role of the gut microbiome in these adaptations remains unclear. Stool samples were collected from pregnant participants ( n = 52) enrolled in the Be Healthy in Pregnancy study (NCT01689961) during first, second, and third trimesters, and 6-months postpartum, along with samples from their infants at 6 months of age. Following 16S rRNA gene sequencing, we implemented time-aligned LDA (TALDA) using a time-weighted sampling strategy with exponentially decaying weights to construct time-proximal cohorts, applied LDA to each cohort independently, and aligned resulting topics using the alto R package. Infant samples were analyzed using standard LDA. Seven distinct subcommunities were identified, one of which represented perineal contamination and was excluded from further analysis. Remaining subcommunities had distinct taxonomic definitions which remained stable throughout pregnancy (mean cross-cohort stability 0.899) while subcommunity proportions within individuals varied. Multiparous individuals showed greater shifts in subcommunity proportions during early pregnancy, while primiparous individuals displayed progressively increasing shifts with the largest changes during the transition from pregnancy to postpartum. High pBMI was associated with reduced microbiome remodelling, particularly among multiparous individuals. In exploratory analyses, maternal SCFA-producing subcommunity abundance at late pregnancy was positively associated with infant Bifidobacterium-dominated subcommunity proportions at 6 months, while pBMI > 25 was independently associated with lower infant Bifidobacterium. TALDA effectively distinguished between stable subcommunity definitions and dynamic subcommunity proportions, revealing that the microbiome maintains functional organization while subcommunity proportional contributions shift over the course of pregnancy and postpartum. These maternal dynamics may have intergenerational consequences through their influence on infant gut colonization. This work demonstrates that maternal factors modify microbiome trajectories and supports the existence of an ecological memory of pregnancy history within the maternal gut microbiome.

Maternal mental health during pregnancy may influence obstetric outcomes. This study examines associations between psychiatric vulnerability [PV]-defined as current or past psychiatric disorder-and mode of delivery and its indication. A retrospective cohort study was conducted in a large Dutch maternity hospital. Primiparous women aged ≥ 18 with singleton pregnancies were included between January 2015 and March 2020. In total, 705 women with and 837 women without PV were included. No differences in delivery method were found between these groups. However, women using psychotropic medication had significantly higher odds of undergoing an assisted vaginal delivery [AVD] than a spontaneous vaginal delivery [SVD] (aOR = 2.00). Indications related to maternal mental health for unplanned caesarean section [CS] were exclusively observed in the group with PV (3.4%). No differences were observed in obstetric or fetal indications. Although mode of delivery did not differ between women with and without PV, women using psychotropic medications had higher risks for undergoing an AVD than a SVD. Only in a small proportion of women with PV, maternal mental health constituted an indication for unplanned CS. Further research is warranted to better understand the intersection of PV and psychotropic medication on delivery method.

Preeclampsia is a serious pregnancy complication associated with substantial maternal and infant morbidity worldwide. The adverse outcomes related to preeclampsia increase healthcare costs, highlighting the importance of quantifying its economic burden to inform healthcare policy and resource allocation. This systematic review aimed to synthesize evidence on the economic burden of preeclampsia and identify key cost drivers. MEDLINE, PubMed, Web of Science, and the Cochrane Library were searched for English-language studies published between 2014 and 2024. Studies reporting healthcare resource utilization or costs associated with preeclampsia were included. The review followed PRISMA 2020 guidelines and was registered in PROSPERO (CRD42025650091). Of 3,107 records identified, 12 studies were included; most were conducted in high-income countries. All cost estimates were converted to 2024 US dollars for comparability. Direct medical costs ranged from US$109.84 to US$87,339.71, with a mean cost of US$33,585.48 per patient. National healthcare system costs were estimated at €6.5-€9.1 million in Ireland and US$2.18 billion in the United States. Preterm birth was identified as a major driver of economic burden, with earlier gestational age significantly increasing maternal and infant costs. Indirect costs and regional disparities remain underexplored, highlighting important gaps for future research.

Existing studies often examined single psychological states in isolation (depression, anxiety, stress) or used static assessments, limiting the understanding of dynamic trajectories and synergistic effects of co-occurring psychological states. The study was designed to tackle both major limitations. 609 pregnant women in their third trimester were enrolled. Maternal depression, anxiety, and perceived stress were repeatedly assessed at the third trimester and 1, 3, and 6 months postpartum using the Edinburgh Postnatal Depression Scale, Generalized Anxiety Disorder 7-item scale, and Perceived Stress Scale. Infant neurodevelopment was evaluated at the same postpartum timepoints using the Ages and Stages Questionnaire-Third Edition. Group-based multi-trajectory modeling (GBMTM) was used to identify joint developmental trajectories of three negative psychological states, and multilevel models assessed their association with neurodevelopmental outcomes. Growth mixture modeling was applied to identify independent trajectories for each psychological state. A total of 417 mother-infant dyads completed the longitudinal follow-up. The GBMTM identified three distinct trajectories: Stable Low Negative Psychological State Group (29.9%), Stable Moderate Negative Psychological State Group (55.2%), and Unstable High Negative Psychological State Group (14.8%). After adjusting for confounders, maternal negative psychological states were significantly correlated with poorer offspring neurodevelopment, including communication, gross motor, fine motor, problem solving, personal-social skills. Stratified analysis revealed sex-specific effects of negative psychological states. Maternal perinatal negative psychological states were significant risk factors for adverse early infant neurodevelopment. These findings highlight the importance of screening for and addressing co-occurring maternal negative psychological states during perinatal period.

Preterm infants are at increased risk of neurodevelopmental difficulties, and maternal depressive symptoms may further affect early developmental outcomes. However, their longitudinal relationship remains unclear. In this prospective longitudinal study, 286 mother-preterm infant dyads from a tertiary hospital in Wuhan, China, were followed after discharge. Maternal depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale at 2 weeks after discharge and at approximately 4-6 and 7-9 months postpartum. Infant neurodevelopment was assessed using the Ages and Stages Questionnaire, Third Edition, at 1, 3, 6, and 12 months corrected age. Cross-lagged panel modeling, group-based trajectory modeling, and logistic regression were performed. Maternal depressive symptoms declined over follow-up, with EPDS scores ≥10 decreasing from 41.96% to 31.81%. Infant developmental abnormalities decreased from 1 to 6 months corrected age and then increased slightly at 12 months. In the cross-lagged panel model, maternal depressive symptoms at the third assessment were associated with lower neurodevelopment scores at 12 months corrected age, whereas infant neurodevelopment at 3 months was associated with subsequent maternal depressive symptoms. Persistent maternal depressive symptoms were associated with a higher risk of overall developmental abnormality at 12 months corrected age (OR = 2.787, 95% CI 1.063-7.306), with stronger but exploratory associations observed in the gross motor, problem-solving, and personal-social domains. Persistent maternal depressive symptoms were associated with adverse 12-month developmental outcomes in preterm infants, highlighting the potential value of repeated maternal mental health assessment and early developmental support after preterm birth.

Postpartum depression has been known to emerge during the peripartum period or within the first 4-6 weeks of childbirth. However, its long-term progression and the underlying mechanisms of its different trajectories remain poorly understood. This longitudinal study examined the diagnostic stability and changes in 191 mothers who were non-depressed (ND), depressed, or had an adjustment disorder (AD). Fine-meshed repeated measures of depressive symptoms from childbirth through 12 months, along with assessments of mother-infant attachment and perceived stress, revealed distinct trajectories reflecting recovery, persistence, or new onset of depression. Approximately half of the postpartum depression (PPD) cases were found to recover, showing improvement within six months, with no recovery seen in the rest of the cases. Among the initially healthy participants, 4.7% developed major depressive disorder (MDD) within the first postpartum year, while 25.6% of those with early AD developed depression in the same period. Persistent PPD was found to be characterized by the strongest negative affective burden, low attachment, and an accumulation of characteristics including premenstrual syndrome (PMS), prior depression, childhood maltreatment, and low social support. In contrast, the recovering cases reported frequent baby blues and PMS, which can be understood as proxy indicators of a heightened hormonal sensitivity. These findings reveal that, rather than being a static condition confined to the early postpartum period, PPD is a heterogeneous and dynamic process. Close monitoring of new mothers in the first postpartum year combined with robust social support may help improve maternal and infant mental-health outcomes.

Psychological birth trauma (PBT) is associated with early breastfeeding difficulties, but pathways linking PBT to reduced breastfeeding self-efficacy (BSE) remain underexplored. To examine statistical associations among PBT, BSE, mother-infant bonding, and psychological resilience, evaluating bonding and resilience as parallel mediators. In this cross-sectional study, 528 postpartum women recruited from a tertiary maternity hospital completed validated scales assessing PBT, BSE, bonding, and resilience. Data were analyzed using bivariate correlations and PROCESS Macro. PBT was negatively correlated with BSE (r = -0.558), resilience (r = -0.559), and bonding (r = -0.459; all p < 0.001). Parallel mediation revealed significant indirect pathways via bonding (B = -0.070, 95% CI [-0.112, -0.026]) and resilience (B = -0.107, 95% CI [-0.166, -0.057]), with a total indirect effect of B = -0.177 (95% CI [-0.233, -0.121]). The direct association between PBT and BSE remained significant (B = -0.350, 95% CI [-0.435, -0.265]). PBT, dyadic bonding, and resilience demonstrate robust concurrent associations with initial maternal breastfeeding self-efficacy. While these cross-sectional findings delineate patterns of statistical covariance rather than temporal or causal pathways, they highlight the relevance of integrating relational and intrapersonal screening into early postpartum maternal care.

Pregnant and postpartum women living with HIV face several challenges to antiretroviral therapy adherence and retention in care. Our WiseMama trial in Uganda assessed the effectiveness of real-time wireless pill containers that delivered text message reminders when ART doses were missed and provided data-informed counselling for women with low levels of adherence. The trial found overall poor adherence and retention and no differences between intervention and control arms. To better understand these findings, we collected qualitative data at the conclusion of the trial. Twenty women participated in in-depth interviews, and 36 women participated in focus group discussions that explored the barriers and facilitators to ART adherence and retention in HIV care. Barriers included lack of disclosure to male partners and lack of autonomy and financial independence to afford transportation to the clinic, food to be able to take their medication, and effectively use the wireless pill container. The main facilitators included desire for a healthy baby, disclosure to male partners, supportive clinic staff, and use of the wireless pill container. While WiseMama focused on individual-level determinants of adherence and retention in care, it did not address the critical interpersonal and structural barriers faced by pregnant and postpartum women in Uganda.

Childbirth during the COVID-19 pandemic involved infection-control measures and changes in maternity care that may have increased psychological stress and affected early mother-infant bonding, particularly among women infected at delivery. This study aimed to compare postpartum depressive symptoms, anxiety levels, and mother-infant bonding among women with positive versus negative COVID-19 PCR test results at the time of delivery. The study included 107 postpartum women (53 COVID-19 positive, 54 COVID-19 negative). Participants completed a sociodemographic form, the Edinburgh Postnatal Depression Scale, the State-Trait Anxiety Inventory and the Postpartum Bonding Questionnaire within the first few days of postpartum hospitalization. COVID-19-positive women had significantly higher depressive symptoms, state anxiety, and bonding difficulty scores. In both groups, depressive and anxiety symptoms were positively correlated with bonding problems, with stronger associations in the positive group. In multivariate analyses, depressive symptoms and particularly state anxiety remained independently associated with bonding difficulties, whereas COVID-19 status was no longer significantly associated after adjustment for anxiety. This study emphasizes the importance of considering care practices that support both maternal mental health and healthy mother-infant bonding when planning maternity services during public health emergencies.