Correlation between serum uric acid levels before delivery and adverse pregnancy outcomes.

Mechanisms of reproductive toxicity and endocrine disruption of bisphenols and per- and polyfluoroalkyl substances (PFAS): Implications for women's reproductive health.

O-GlcNAc modification orchestrates HUWE1-mediated ubiquitination of TfR1 to regulate ferroptosis and trophoblast syncytialization in preeclampsia.

Reducing worry and enhancing knowledge in relation to pregnancy and childbirth complications: Impact of an online antenatal education session.

Imbalances in the vaginal flora during pregnancy elevate risks for adverse outcomes. While nifuratel targets pathogens, probiotics restore acidity, and robust cohort evidence supporting their combined safety and efficacy in restoring the microbiome remains limited. This retrospective cohort study assessed nifuratel-nystatin therapy plus Lactobacillus probiotics for restoring vaginal flora in pregnancy. Employing a retrospective cohort design, this study enrolled pregnant women diagnosed with vaginal microecological abnormalities between March 2023 and 2024. Participants were allocated via 1:1 propensity score matching (PSM) into two groups (n=58 each): a combination group receiving nifuratel-nystatin therapy combined with vaginal Lactobacillus probiotics and a monotherapy group receiving nifuratel-nystatin alone. All received a 7-day treatment. The primary endpoint was clinical effectiveness assessed one week post-treatment. Secondary outcomes included vaginal pH, Lactobacillus and bacterial diversity normalization rates, recurrence, adverse pregnancy outcomes and drug-related adverse events, monitored until delivery. Multivariate logistic regression identified independent predictors of treatment efficacy. After PSM, baseline characteristics were balanced (P>0.05). The comparative analysis indicated a superior overall efficacy for the combination therapy (93.1%) over monotherapy (77.6%), with statistical significance (P<0.01) Both groups exhibited reduced vaginal pH and increased rates of normalized Lactobacillus and bacterial diversity, with greater improvements observed in the combination group (P<0.01). The recurrence rate was significantly lower in the combination group (8.6% vs. 22.4%; P<0.05), as was the total incidence of adverse pregnancy outcomes (6.9% vs. 20.7%; P<0.01). No significant difference in adverse drug reactions was found. Multivariate analysis identified combination therapy as an independent protective factor for clinical efficacy (aOR=4.25, 95% CI: 1.42-12.71, P<0.05). In pregnant women with vaginal dysbiosis, combining nifuratel-nystatin with Lactobacillus probiotics safely enhances clinical efficacy, normalizes pH and flora and reduces adverse pregnancy outcomes.

Background: Hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), and preterm delivery are associated with higher long-term cardiovascular, metabolic, and kidney disease risk. Their implications for living kidney donation remain uncertain. Methods: We conducted a retrospective cohort study of 498 female living kidney donors (2000–2017) from the Mayo Clinic Living Donor Program with documented pregnancy histories, pre-donation CT angiography, implantation kidney biopsy, and measured GFR. Donors with prior HDP (n=45), GDM (n=18), or preterm delivery (n=65) were compared with donors without adverse pregnancy outcomes (APO; n=385). Kidney morphometry, histology, and function were analyzed with adjustment for age at donation and first pregnancy, parity, and hypertension. Post-donation kidney outcomes were assessed using surveys and medical record review. Results: Donors with prior HDP and GDM had higher BMI at donation (+7.9% and +8.9%; p=0.006 and 0.04), whereas donors with preterm delivery had lower BMI (−4.8%; p=0.03) compared with donors with no APO. After adjustment, donors with HDP showed no differences in kidney volumes, biopsy features, or kidney function at donation or during follow-up. Donors with GDM had larger total and cortical kidney volumes (9.5–10%), less arterial luminal stenosis, and higher 5-year post-donation eGFR (+15%; p=0.03). Donors with preterm delivery had a lower risk of eGFR &lt;45 mL/min/1.73 m 2 (HR 0.28; p=0.03). Conclusions: Prior adverse pregnancy outcomes were not associated with adverse kidney structure at donation or accelerated kidney function decline post-donation. These findings support that APO history alone should not preclude living kidney donation when other eligibility criteria are met.

Background: Human cytomegalovirus (CMV), a ubiquitous beta-herpesvirus, induces significant oxidative stress leading to DNA damage, with 8-hydroxy-2'-deoxyguanosine (8-OHdG) serving as a key biomarker. Objectives: This case-control study aimed to evaluate the association between maternal anti-cardiolipin antibodies (aCL), 8-OHdG, and adverse pregnancy outcomes in CMV-infected women. Methodology: Peripheral blood was collected at 10–13 gestational weeks from (90) singleton pregnancies (70) CMV-positive patients and 20 matched controls). Serum levels of IgG and IgM aCL were quantified via ELISA, while total antioxidant capacity (TAC) and 8-OHdG were measured calorimetrically. Result: The Significant intergroup differences were observed in serum 8-hydroxy-2'-deoxyguanosine (8-OHdG) levels (P < 0.0001). Similarly, anticardiolipin antibody titers, also showed a highly significant difference (P = 0.0009). In contrast, no statistically significant variations were found in body mass index (BMI) (P = 0.416). Furthermore, the age distribution was comparable across all groups, showing no significant disparity. Conclusion, from the current study, that the values of 8-OHdG and aCL are strongly associated with CMV infection and adverse outcomes, while BMI and age group remain unaffected. These findings support routine screening for aCL and 8-OHdG in infected women, particularly those with recurrent pregnancy loss, to enable timely intervention and improve pregnancy outcomes.

We sought to examine the association between maternal-fetal medicine (MFM) physician density and adverse pregnancy outcomes at the state level. This was a cross-sectional analysis of publicly available, state-level data from 2018 to 2021, including Natality, Multiple Cause-of-Death, and Fetal Death databases. The number of active MFM physicians per year was obtained for each state from the American Medical Association Masterfile. The primary exposure was the density of MFM per state, categorized into three groups: (1) low density (<30 MFM physicians per 100,000 live births), (2) moderate density (30-59 MFM physicians per 100,000 live births), and (3) high density (≥60 MFM physicians per 100,000 live births). Our primary outcome was maternal mortality during pregnancy and up to 42 days postdelivery. Our secondary outcomes were pregnancy-related mortality up to 365 days postdelivery and stillbirth. We calculated adjusted incident rate ratios (aIRR) and average marginal effect (AME) with 95% confidence intervals (95% CI) using multivariable negative binomial mixed effects regression models. Overall, there were 14,792,743 live births, 3,440 maternal mortalities, 4,980 pregnancy-related mortalities, and 90,848 stillbirths included. The median MFM density across states was 31.6 per 100,000 live births (interquartile range: 21.9-42.5). States with high MFM density had a reduced risk of maternal mortality (aIRR: 0.70; 95% CI: 0.58-0.85) and pregnancy-related mortality (aIRR: 0.83; 95% CI: 0.71-0.98) compared with states with low MFM density, corresponding to 7.29 (AME: 95% CI: 3.58-11.00) and 5.57 (AME: 95% CI: 0.74-10.40) less mortality per 100,000 live births, respectively. States with moderate MFM density had a similar risk of maternal mortality compared with low MFM density states (aIRR: 1.02; 95% CI: 0.87-1.20). High MFM-density states have a decreased risk of maternal mortality compared with low MFM-density states, suggesting a critical role of MFM in reducing maternal mortality. · An association between MFM physician density and maternal mortality is unclear.. · States with higher MFM density had a lower risk of maternal mortality than those with fewer.. · This study highlights the importance of increasing MFM access in underserved areas to potentially reduce maternal mortality..

Previous studies have suggested that human papillomavirus (HPV) and HPV-related disease may be associated with increased risk of adverse pregnancy outcomes, e.g., hypertensive disorders of pregnancy, small for gestational age (SGA), and gestational diabetes mellitus (GDM). As active surveillance for cervical intraepithelial neoplasia grade 2 (CIN2) leaves the lesion and underlying infection untreated, we aimed to investigate whether the risk of adverse pregnancy outcomes differs between women who undergo active surveillance for CIN2 compared to women having an immediate large loop excision of the transformation zone (LLETZ). We conducted a nationwide register-based cohort study in Denmark. Individual-level data was collected from Danish healthcare registers. We included women aged 18-40 with a first-time diagnosis of CIN2 between January 1, 1998, and December 31, 2018, and a subsequent singleton birth. We estimated the risk of hypertensive disorder of pregnancy, SGA, and/or GDM in a subsequent pregnancy. We calculated crude and adjusted relative risks (aRR) adjusting for potential confounders using modified Poisson regression. We included 10 537 women with CIN2 and a subsequent singleton birth; 4430 women (42%) underwent active surveillance, and 6107 women (58%) had a LLETZ. We identified 548 (5.2%) cases of hypertensive disorders of pregnancy, 379 cases of SGA (3.6%), and 315 cases of GDM (3.0%). For all three outcomes, the adjusted relative risk was comparable between active surveillance and immediate LLETZ (aRR 1.08 (95% CI 0.91-1.29), aRR 0.94 (95% CI 0.74-1.19), aRR 0.92 (95% CI 0.73-1.16), respectively). Stratified analyses revealed insignificant differences in the risk of hypertensive disorders of pregnancy, SGA, and GDM. No association was found between CIN2 management and risks of hypertensive disorders, SGA, or GDM in later pregnancy. These findings suggest that untreated HPV-related lesions do not increase adverse pregnancy risks and may help reassure women during clinical counseling about future pregnancies after CIN2 treatment.

Sickle Cell Disease: Can genetic variability influence pregnancy outcomes?

The impact of endometriosis on long-term neurologic morbidity of the offspring: a population-based analysis.

Objective: To explore the predictive value of early-and mid-trimester glycolipid metabolic indicators for adverse pregnancy outcomes in pregnant women with normal glucose levels. Methods: A total of 12 457 pregnant women admitted to Yantai Yantaishan Hospital from January 2020 to December 2024 were retrospectively included. According to the occurrence of adverse pregnancy outcomes, they were divided into an adverse pregnancy outcome group (n=852) and a normal pregnancy outcome group (n=11 605). General data, pregnancy-related information, lipid profile, and fasting plasma glucose (FPG) in early pregnancy (gestational age≤14 weeks; T1), and oral glucose tolerance test (OGTT) results in the second trimester (24-28 weeks; T2) were compared between the two groups. The participants were randomly assigned to a training set (n=8 712) and a validation set (n=3 745) in a 7∶3 ratio. Multivariable logistic regression was applied in the training set to identify independent risk factors for adverse pregnancy outcomes, and a nomogram prediction model was constructed. The area under the receiver operating characteristic curve (AUC), calibration curve, and decision curve were used to evaluate the discrimination, calibration, and clinical applicability of the model, respectively. Results: The overall age was (30.9±3.8) years, BMI was (22.77±2.12) kg/m², T1 FPG was (4.43±0.29) mmol/L, T2 FPG was (4.51±0.27) mmol/L, the second-trimester 1 h glucose was (8.54±0.43) mmol/L, and the second-trimester 2 h glucose was (7.10±0.54) mmol/L. Multivariable logistic regression analysis showed that age (OR=1.126, 95%CI: 1.080-1.175), history of adverse pregnancy outcomes (OR=2.080, 95%CI 1.023-4.232), ΔMAP (the change in mean arterial pressure from the first to the second trimester) (OR=1.162, 95%CI 1.124-1.202), the TG/HDL-C ratio (OR=18.849, 95%CI: 11.512-30.862), T1 FPG (OR=3.191, 95%CI 2.120-4.803), ΔFPG (T2 FPG-T1 FPG) (OR=1.154, 95%CI: 1.036-1.285), ΔT2(1 h-FPG) (T2 1 h glucose-FPG) (OR=3.427, 95%CI: 2.674-4.391), and ΔT2(2 h-FPG) (T2 2 h glucose-FPG) (OR=4.155, 95%CI: 3.306-5.221) were risk factors for adverse pregnancy outcomes (all P<0.05). The AUC of the nomogram was 0.902 (95%CI: 0.884-0.919) in the training set and 0.895 (95%CI: 0.877-0.913) in the validation set. The calibration curve showed good agreement between predicted and observed probabilities (Hosmer-Lemeshow test: training set, P=0.708; validation set, P=0.102), and decision curve analysis indicated a net clinical benefit over a threshold probability range of 0.05 to 0.95. Conclusions: Age, history of adverse pregnancy outcomes, ΔMAP, the TG/HDL-C ratio, and dglycemic dynamic indicators during early and mid-trimester are independent predictors of adverse pregnancy outcomes in pregnant women with normal perinatal glucose levels. The nomogram constructed based on these factors demonstrates good discrimination, calibration, and clinical utility, and can serve as a quantitative tool for early risk identification in this population.

Independent and combined effects of first-trimester elevated fasting blood glucose and high-normal blood pressure on pregnancy outcomes.

Gestational diabetes mellitus (GDM) is one of the most frequent pregnancy complications. Investigating clinical risk factors for adverse pregnancy outcomes in women with GDM would help predict and prevent neonatal complications. We developed a machine learning model to discover risk factors for adverse pregnancy outcomes. Women with GDM from tertiary hospitals in Korea were included (n = 305, discovery cohort; n = 911, validation cohort). Supervised machine learning classification models, including ExtraTree, RandomForest, GradientBoosting, AdaBoost, Bagging, XGBoost, and Light Gradient Boosting Machine (LGBM), were developed to predict adverse pregnancy outcomes. Outcomes included large for gestational age (LGA), small for gestational age (SGA), low Apgar score, and preterm delivery. The top-ranked risk factors identified through feature importance were further validated using binary logistic regression analysis. In predicting LGA, the RandomForest model achieved the highest AUROC of 0.726 on the validation cohort. For SGA, the RandomForest model achieved the highest AUROC of 0.628. For low Apgar score and preterm delivery, the ExtraTree model showed the best performance with AUROCs of 0.689 and 0.616, respectively. This study presents machine learning models as a foundational tool for identifying factors associated with adverse pregnancy outcomes in women with GDM. These models may serve as a foundation for future development of clinical decision support tools.

Sexually transmitted infections (STIs) remain a major public health challenge, particularly in low- and middle-income countries where surveillance and routine screening are limited. In Central Africa, data on Chlamydia trachomatis, Mycoplasma genitalium, Ureaplasma urealyticum, Mycoplasma hominis, and Neisseria gonorrhoeae remain scarce, despite their role in infertility, adverse pregnancy outcomes, and potential contribution to antimicrobial resistance. This study aims to determine the prevalence of these bacteria and identify risk factors among women in the West Region of Cameroon and neighboring city of N'Djamena in Chad. A total of 1246 participants were enrolled. Endocervical swabs were analyzed by multiplex qPCR to detect the five pathogens. Sociodemographic, sexual behavioral, and clinical characteristics were collected and assessed to identify risk factors for infection. The prevalence of C. trachomatis, M. genitalium, U. urealyticum, M. hominis and N. gonorrhoeae was 2.96%, 15.40%, 24.87%, 9.55% and 20.14% respectively. Living apart (OR = 5.02) and polygamy (OR = 2.13) were significantly associated with M. genitalium infection. N. gonorrhoeae was associated with Semi-Bantu ethnicity, lower education level, alcohol consumption, vaginal bleeding, occasional condom use, and dyspareunia. It was also observed among women reporting anal sex (21.81%), substance use before sex (33.33%), and sex work (26.35%). The high prevalence of STIs in Cameroon and Chad highlights the urgent need to strengthen surveillance, implement systematic screening, and expand access to effective treatment. Our results showed the necessity of integrating STI prevention into reproductive health services and promoting cross-border collaboration to mitigate the spread of infections and antimicrobial resistance.

Sex-Specific Cellular and Molecular Mechanisms of PFAS-Induced Reproductive Toxicity.

We compare adverse pregnancy outcomes after the Solomon technique versus selective laser surgery for twin-twin transfusion syndrome (TTTS). Retrospective cohort study of monochorionic diamniotic (MCDA) twin pregnancies that underwent laser surgery for TTTS at two centers between 2006-2023. Pregnancy outcomes were compared between patients treated with the Solomon versus the selective laser technique. The primary outcomes were delivery <4 weeks after surgery and delivery <28 weeks. Secondary outcomes included placental abruption, and recurrent TTTS or twin anemia polycythemia sequence requiring additional surgery. Multivariable robust Poisson regression models were used to estimate relative risks (RR) for outcomes adjusted for TTTS stage, selective fetal growth restriction, and cervical length, among other covariables. Solomonization' s effect on surgery-to-delivery interval was evaluated via Cox regression. P<0.05 was used. Of 1,680 TTTS cases, 80 were excluded due to dual fetal death (n=47) or missing laser technique or delivery data (n=33). In the remaining 1,600 cases, 44.9% (n=719) underwent the Solomon technique. Multivariable robust Poisson regression showed that Solomonization was independently associated with delivery <4 weeks after surgery (RR: 2.46 95% CI: 1.31-4.60; p=0.005), delivery <28 weeks (RR: 1.67 95% CI: 1.15-2.51; p=0.008), and placental abruption (RR: 1.74; 95% CI: 1.02-2.97; p=0.04). Cox regression demonstrated a shorter surgery-to-delivery interval with the Solomon technique (hazard ratio: 1.66; 95% CI: 1.49-1.84; p<0.001). The Solomon group had higher laser time, energy consumption, and PPROM rates, earlier gestational age at delivery, and lower 30-day survival rate of at least one twin. Recurrent TTTS or post-laser TAPS requiring additional surgery were similar between groups. The Solomon technique is associated with increased risks, including extreme preterm delivery, shorter surgery-to-delivery interval, and placental abruption.

Preeclampsia, fetal growth restriction (FGR), and preterm birth remain major contributors to maternal and perinatal morbidity and mortality worldwide. Although these conditions are traditionally approached as distinct clinical entities, they frequently coexist and share overlapping risk factors, suggesting a common underlying pathophysiology. Increasing evidence indicates that placental dysfunction represents a central biological substrate linking these adverse pregnancy outcomes. Impaired placentation, inadequate spiral artery remodeling, and resultant uteroplacental hypoperfusion initiate a cascade of oxidative stress, angiogenic imbalance, immune dysregulation, and altered placental transport function. These placental disturbances precede clinical disease and shape both maternal and fetal manifestations across gestation. This narrative review synthesizes contemporary evidence supporting placental dysfunction as the shared mechanistic pathway underlying preeclampsia, FGR, and a substantial proportion of preterm births. Key histopathological, molecular, and imaging findings are reviewed, with particular emphasis on angiogenic signaling, Doppler velocimetry, and emerging biomarker-based approaches that reflect placental health. Differences between early- and late-onset disease phenotypes are discussed, highlighting how the timing and severity of placental insult influence clinical presentation and outcomes. The review also examines the implications of a placenta-centered framework for screening, surveillance, and timing of delivery. Recognition of these obstetric complications as manifestations of a common placental disease spectrum has important clinical implications. Integrating placenta-focused biomarkers and imaging into routine care offers an opportunity to improve risk stratification, personalize surveillance, and move toward earlier, prevention-oriented management. Future advances will depend on refining placenta-based phenotyping and translating mechanistic insights into equitable and clinically actionable strategies across diverse healthcare settings.

Prenatal education programs are a key component of maternal and newborn health promotion. Although the use of digital platforms for prenatal education increased during the COVID-19 pandemic, evidence for their effectiveness remains limited. In addition, conventional programs often omit content addressing adverse pregnancy outcomes due to concerns about increasing maternal anxiety or worry. This quasi-experimental study aimed to (1) evaluate participants' satisfaction and perceived acquisition of knowledge and health habits following a novel online prenatal education program delivered via Facebook, and (2) assess the impact of a novel session on managing complications during pregnancy and childbirth-preterm birth, newborn adaptation difficulties, and stillbirth-on participants' levels of pregnancy-related anxiety and worry. Participants completed the State Anxiety Inventory and Cambridge Worry Scale (CWS) before and after the session on complications (N = 162), and the modified EDUMA2 questionnaire at the program's conclusion (N = 93). High satisfaction (mean 9.01/10), improved self-rated knowledge and health habits, and high rates of recommendation were found. Post intervention, statistically significant reductions were observed in worry scores (CWS), particularly regarding fetal health, childbirth, and miscarriage, with no significant increase in anxiety levels (State-Trait Anxiety Inventory [STAI-S]). The online modality did not fully meet the social interaction needs of pregnant women and appeared to limit the participation of women's partners and migrant women. Online prenatal education can effectively promote maternal health literacy and may effectively address sensitive topics such as pregnancy and childbirth complications. Future programs should integrate hybrid formats and strategies to reduce digital access barriers, especially among vulnerable populations.

Polycystic ovary syndrome (PCOS) has been associated with adverse pregnancy outcomes, although reported risks vary across studies. Metabolic heterogeneity within PCOS may contribute to this variability. Dysglycemia during pregnancy may identify a subgroup at increased obstetric risk. The study aims to evaluate whether dysglycemia is associated with preeclampsia and other adverse pregnancy outcomes among individuals with PCOS. We performed a secondary analysis of the prospective Fatty Liver in Pregnancy (FLIP) cohort (n = 1,321). PCOS was defined by chart review of the electronic health record. Dysglycemia was defined as current or prior gestational diabetes, abnormal glucose tolerance testing, hemoglobin A1c > 5.7% during pregnancy, or pregestational diabetes. Participants were categorized as PCOS with dysglycemia (n = 36), PCOS without dysglycemia (n = 44), or non-PCOS controls (n = 1,238). The primary outcome was preeclampsia. Secondary outcomes included gestational hypertension, preterm birth, abnormal neonatal weight, and neonatal hypoglycemia. Multivariable logistic regression adjusted for maternal age and body mass index. Among 80 individuals with PCOS, 45% had evidence of dysglycemia. Preeclampsia occurred in 33% of those with PCOS and dysglycemia, 7% of those with PCOS without dysglycemia, and 12% of controls (p = 0.005 for PCOS with dysglycemia versus controls). In adjusted analyses, PCOS with dysglycemia was associated with preeclampsia (odds ratio [OR] 2.9; 95% confidence interval [CI]: 1.4-6.1), whereas PCOS without dysglycemia was not (adjusted odds ratio [aOR] 0.53; 95% CI: 0.16-1.73). PCOS with dysglycemia was also associated with increased preterm birth (OR: 2.3; 95% CI: 1.04-5.14), abnormal neonatal weight (OR: 2.87; 95% CI: 1.36-6.10), neonatal hypoglycemia (OR: 2.8; 95% CI: 1.38-5.77), and any adverse pregnancy outcome (aOR: 4.49; 95% CI: 1.94-10.40). In this prospective cohort, dysglycemia was associated with higher rates of hypertensive and metabolic pregnancy complications among individuals with PCOS. These findings suggest that coexisting dysglycemia may contribute to heterogeneity in obstetric risk among individuals with PCOS and warrant confirmation in larger studies.