Childbearing Age Research Articles

Iron Deficiency Anemia: Etiology, Pathophysiology, Diagnosis, and Treatment Approaches

Iron deficiency anemia (IDA) is a common health problem that affects about 1.24 billion people around the world, mostly children and women of childbearing age. IDA happens when the body doesn't get enough iron, loses too much iron, or can't absorb it properly. This makes erythropoiesis, cellular metabolism, and immune function worse. The World Health Organization says that 40% of women who are pregnant and 32.5% of women who are not pregnant have anemia. People with IDA often feel tired, weak, pale, and have trouble thinking clearly. Lab tests, such as hemoglobin, blood ferritin, and transferrin saturation, are used to make the diagnosis. You can treat the condition in two ways: by taking iron supplements by mouth, such as ferrous sulfate, ferrous gluconate, and ferrous fumarate; or, for serious cases, by giving iron through an IV. Strategies for prevention depend on increasing the amount of iron you get from food, making it more bioavailable, and keeping infections under control. Food addition and fortification programs have been shown to help lower the number of people with IDA. However, problems still exist, especially in areas with poor economies. Recent advance in acknowledging how iron is used and controlled has implications for creating targeted therapeutic approaches. A key regulator of iron balance, hepcidin, is a key player in the pathophysiology of IDA. This review shows how complicated IDA is and how important it is to have treatment plans that consider underlying causes, dietary factors, and socioeconomic factors. Keywords: Iron Deficiency Anemia (IDA), Erythropoiesis, Hemoglobin, Nutritional Deficiencies, Neurological Disorders, Iron Supplements.

Racial and Ethnic Disparities in Epidural Blood Patch Utilization Among Obstetric Patients in the United States: A Nationwide Analysis, 2016–2020

BACKGROUND: Racial and ethnic disparities in health care delivery can lead to inadequate peripartum pain management and associated adverse maternal outcomes. An epidural blood patch (EBP) is the definitive treatment for moderate to severe postdural puncture headache (PDPH), a potentially debilitating neuraxial anesthesia complication associated with significant maternal morbidity if undertreated. In this nationwide study, we examine the racial and ethnic disparities in the inpatient utilization of EBP after obstetric PDPH in the United States. METHODS: In this retrospective observational study, we used the National Inpatient Sample, a nationally representative database of discharge records for inpatient admissions in the United States, from 2016 to 2020. We analyzed delivery hospitalizations of women of childbearing age (15–49 years) diagnosed with PDPH. Adjusting for maternal and hospitalization characteristics as confounders, we used a multilevel mixed-effects logistic regression model to compare the rates of EBP utilization by race and ethnicity. Secondarily, among hospitalizations with an EBP, we examined the association between race and ethnicity and the timing of the EBP procedure. RESULTS: We analyzed 49,300 delivery hospitalizations with a diagnosis of PDPH. An EBP was performed in 24,075 (48.8%; 95% confidence interval [CI], 47.8%–49.9%) of these hospitalizations. EBP was performed in 52.7% (95% CI, 51.3%–54.1%) of White non-Hispanic patients with PDPH. Compared to White non-Hispanic patients, Black non-Hispanic (adjusted odds ratio [aOR] = 0.69; 99% CI, 0.56–0.84), Hispanic (aOR = 0.80, 99% CI, 0.68–0.95), and Asian or Pacific Islander patients (aOR = 0.74, 99% CI, 0.58–0.96) were less likely to receive an EBP. The median (interquartile range [IQR]) time to perform an EBP was 2 (1–3) days after admission, with 90% of EBP procedures completed within 4 days of admission. There was no significant association between race and ethnicity and the timing of EBP placement. CONCLUSIONS: In this nationwide analysis of delivery hospitalizations from 2016 to 2020 in the United States with a diagnosis of PDPH, we identified racial and ethnic disparities in the utilization of EBP. Minoritized patients identified as Black non-Hispanic, Hispanic, or Asian or Pacific Islander were less likely to receive an EBP for the treatment of PDPH compared to White non-Hispanic patients. Suboptimal treatment of PDPH may be associated with adverse long-term outcomes such as postpartum depression, posttraumatic stress disorder, and chronic headaches. Racial and ethnic disparities in EBP utilization should be further investigated to ensure equitable health care delivery.

Global vaccination against hepatitis E virus: position paper from the ESGVH-ESCMID.

Hepatitis E Virus (HEV) is a significant global health issue, impacting both low- and middle-income countries (LMICs) and industrialized nations. HEV genotypes 1 and 2, primarily transmitted through contaminated water, are endemic in LMICs, while genotypes 3 and 4 are zoonotically transmitted in industrialized regions. Acute HEV infection poses severe risks, particularly to pregnant women and immunocompromised individuals, while chronic HEV infection leads to serious complications in those with pre-existing liver disease and transplant recipients. The development of an HEV vaccine offers new prevention opportunities, though its availability and integration into global immunization programs remain limited. This position paper was developed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Viral Hepatitis Study Group (ESGVH) through an extensive review of clinical data, safety profiles, efficacy, and immunogenicity of HEV vaccines. The study group focused particularly on high-risk and special populations, synthesizing global health insights and incorporating recommendations from the Strategic Advisory Group of Experts (SAGE) to formulate strategies for wider HEV vaccination use. The position paper evaluates the efficacy and safety of HEV vaccines in both general and special populations. It identifies key barriers to the integration of HEV vaccines into routine immunization programs, including infrastructure limitations, costs, and vaccine accessibility. The paper also proposes strategies to overcome these challenges and improve vaccine distribution. Furthermore, it addresses ways to enhance public awareness and international cooperation to promote HEV vaccination efforts globally. ESGVH-ESCMID recommends HEV vaccination for high-risk groups, including women of childbearing age, patients with chronic liver diseases, and immunosuppressed individuals. Prioritizing investments in vaccine logistics, integrating diagnostics, and educational outreach can enhance uptake.

Ethical considerations for non-procreative uterus transplantation.

The growing demand for uterus transplantation (UTx) invites continued philosophical evaluation of the function of UTx (and what constitutes its 'success'), as well as the recipient eligibility for UTx. Currently, UTx caters to partnered, cisgender women of childbearing age looking to get pregnant and give birth to a biogenetically related child. The medical justification for this-the treatment of uterine infertility-explains the primacy of this practice. However, this dominant conceptualization of UTx does not necessarily capture the diverse needs for which both cis- and transgender women might take interest in UTx that are not strictly procreative, such as bodily integrity and gender identity reasons. In this paper, I argue that non-procreative motivations for uterus acquisition ought to be taken seriously as a matter of non-discrimination and consistency.

The Correlation between Occupation and Birth Interval in Primary Postpartum Hemorrhage

ntroduction: Postpartum hemorrhage stands as one of the major contributors to maternal mortality globally. Postpartum hemorrhage is a rapid heavy vaginal bleeding that can cause signs and symptoms of hypovolemic shock. Many factors cause postpartum hemorrhage classified into indirect causes, namely type of delivery, age, parity, birth spacing, family income, education, and occupation. Objective: This study aims to determine the correlation between occupation and birth spacing with primary postpartum hemorrhage. Method: This study uses a case-control approach with a purposive sampling technique. The sample for this study included multigravida mothers and mothers diagnosed with primary postpartum hemorrhage at Ananda Maternity and Child Hospital, Makassar, in 2021. The total sample was 174 consisting of 84 cases and 84 control samples. The research instrument data is in the form of secondary data, namely medical records. Data analysis employed the chi-square test for bivariate analysis and multiple logistic regression for multivariate analysis, with a significance level of 0.05 Result: The results of the bivariate analysis showed a relationship between occupation (p-value: 0.000) and delivery distance (p-value: 0.000). Working mothers are 6 times at risk for experiencing primary postpartum hemorrhage (OR= 5.833) while mothers whose delivery interval is < 2 years or > 5 years have 4 times the risk (OR= 3.719). The results of the multivariate analysis show that the work and pregnancy distance is significantly related to the risk of postpartum hemorrhage (value P: 0,000) where the odds ratio for work (OR = 6,178) is higher than the distance of pregnancy (OR = 4.008). Conclusion: Occupational factors and birth spacing are significantly associated with primary postpartum hemorrhage, working mothers have a higher risk of experiencing primary postpartum hemorrhage. Pregnant women and women of childbearing age should receive more education about postpartum hemorrhage and its influencing factors to help prevent and identify it early.

Assisted reproductive technology, pregnancy and recurrent disease in melanoma patients: a 30-year single institution experience.

Objectives The aim of this study is to assess differences in melanoma recurrence between patients conceiving spontaneously versus those undergoing assisted reproductive technology (ART), to determine use of ART in post-melanoma patients and to examine the impact of counseling of this specific patient group. Design This study is a 30-year analysis including data from a single center questionnaire and a retrospective cohort study. Participants/Materials Women of childbearing age with a history of melanoma were requested to participate in our study. We selected patients who underwent either primary melanoma treatment or treatment of local / distant recurrence at our institute between 1994 and 2021. Each participant received a questionnaire and informed consent form. The questions concerned general health, primary tumor characteristics, utilization of ART, subsequent pregnancies and development of recurrent melanoma. Additional information was collected from the medical files. Setting The research was conducted in a dedicated oncology center and tertiary referral center for melanoma in The Netherlands. Methods Participants received the questionnaires by mail. Six weeks later a reminder was sent to non-responders. Analysis was performed using descriptive statistics. For comparisons between groups Chi-square tests were used. P-value was considered significant when below 0.05. A clinically relevant difference in recurrence rate was defined as a 10% difference. Results A total of 498 questionnaires were available for analyses, 449 from living patients and 49 from relatives of diseased patients. One hundred and seventy-nine patients (36%) with a history of melanoma became pregnant following their diagnosis. In this group, 28 patients (16%) attempted to conceive using ART, and eight of them experienced disease recurrence. There was no difference in the recurrence rate between patients who became pregnant after the diagnosis of melanoma and those who never subsequently conceived (37% vs 35%, p=0.609). Limitations The main limitations of the study are its size, observational design and questionnaire methodology. Conclusions Pregnancy did not increase the risk of recurrent melanoma. The group of patients conceiving after ART was small and therefore it is difficult to confidently conclude that the recurrence risk is comparable to the other groups. Prospective international registration of these patients, their oncologic follow-up and possible use of assisted reproduction, will provide valuable information to determine any potential association between ART and risk of recurrent melanoma. This would enable health professionals to develop surveillance strategies and pre-conception counselling of patients wishing to conceive.

Functional and imaging outcomes of the Fontan circulation following pregnancy.

The Fontan circulation palliates single-ventricle congenital heart disease by separating the systemic and pulmonary circulations. An increasing number of women with a Fontan circulation are wishing to become pregnant, however the ability to increase cardiac output during pregnancy is limited in many due to the chronic low output state. We describe pregnancy outcomes in these women at a large tertiary centre, including functional and imaging outcomes. We retrospectively investigated women with a Fontan circulation giving birth after 24 weeks' gestation between 1995 and 2023. Data collected included obstetric and neonatal complications, changes in cardiac volumes and ejection fraction (EF), and functional outcomes including change in NYHA class and exercise capacity pre- and post-pregnancy, compared to matched male controls. Twenty-six pregnancies occurred among 23 women. Almost half experienced obstetric complications, primarily bleeding, which was the commonest indication for emergency C-section. Worsening cardiac symptoms complicated 50 % of pregnancies, with 4 requiring hospital admission for decompensation. Arrhythmias were not uncommon. Mean VO2max declined post-pregnancy (p = 0.03), though not significantly compared to controls. Worsening of NYHA class was uncommon (15.4 %), suggesting that cardiovascular complications during pregnancy do not correlate with longer-term functional limitation. EF worsened post-pregnancy, declining significantly more so than in matched controls (p = 0.03), however there were no changes in cardiac volumes. Pregnancy in women with a Fontan circulation is associated with high rates of obstetric complications and worsening cardiac symptoms. However, successful pregnancies are possible, with little evidence of medium-term functional impairment. This data informs pre-pregnancy counselling of Fontan women of child-bearing age.

The role of mir-214-5p and mir-548-5p expressions in endometriosis.

Endometriosis is a benign gynecological disease that affects about 1% of all women and up to 15% of women of childbearing age. To date, none of the proposed theories exhaustively explain the pathophysiology of the disease or the associated clinical manifestations. As part of efforts to introduce new methods for the early and non-invasive diagnosis of endometriosis, this project investigated changes in the expression of miR-214-5p and miR-548-5p in ectopic and eutopic tissue compared to normal endometrial tissue. Forty-five samples (15 eutopic, 15 ectopic and 15 healthy controls) from women referred to Shahid Sadoughi Hospital (Yazd, Iran). RNA extraction was performed using an RNA extraction kit, and cDNA was synthesized. Two-step qRT-PCR was performed according to the manufacturer's instructions. GraphPad Prism 8 software and Two-Way ANOVA test were used to compare fold-change expression. The results indicate a significant down-regulation of miR-214-5p expression levels (P-value < 0.05) and an increase in miR-548-5p expression levels (P-value < 0.05) in endometriosis samples compared to those in control tissues. miR-214-5p and miR-548-5p may regulate the pathogenesis of endometriosis. The down-regulation of miR-214-5p in people with endometriosis compared to healthy individuals may indicate its suppressive role. The upregulation of miR-548-5p could confirm the oncogenic role of this microRNA in endometriosis. The development of new therapeutic strategies targeting these miRNAs could be promising in the treatment of this disease.

Prevalence and Antibiotic Resistance of Streptococcus agalactiae in Women of Childbearing Age Presenting Urinary Tract Infections from Western Romania

Urinary tract infections (UTIs) are a common bacterial infection in women of childbearing age. Streptococcus agalactiae (Group B Streptococcus—GBS), a rare causative pathogen of UTIs in this population, is particularly important due to the potential risk during pregnancy, when it can lead to life-threatening neonatal infections. The current study analyzed 17,273 urine samples collected from consecutive women aged 18–45 years from Arad County, Western Romania. A total of 2772 samples tested positive for UTIs. In 130 cases, GBS was identified as the causative agent. Univariate logistic regression analysis revealed that women aged 25–34 years were more likely to test positive for GBS than those aged 18–24 years (cOR = 1.91, 95% CI: 1.07–3.43, p = 0.03). Antibiotic sensitivity testing revealed that all GBS strains were fully sensitive to penicillin, ampicillin, and vancomycin. High resistance was observed for clindamycin (77.34%) and tetracycline (88.46%). While GBS was found to be a rare pathogen in UTIs, our results underscore the importance of monitoring GBS in women of childbearing age, especially due to its risks during pregnancy, and emphasize the need for appropriate antibiotic management.

Anesthetic Management of Cesarean Delivery for a Parturient With Dextro-Transposition of the Great Arteries Post-Senning Procedure: A Case Report

The Senning procedure is a palliation technique for addressing dextro-transposition of the great arteries; deoxygenated blood is redirected to the left ventricle, making the right ventricle the systemic ventricle. The physiologic increase in cardiac output during pregnancy may place additional stress on the right ventricle and given the existence of atrial scar tissue, trigger arrythmias. Because the technique was gradually abandoned starting in the 1970s, few remaining patients of child-bearing age remain. We emphasize here the importance of interdisciplinary team planning for delivery. Preparation for possible arrhythmia and potential decompensation in right ventricular function are essential.

Rubella antibody levels in the healthy Chinese population: a meta-analysis

ObjectivesTo gain a comprehensive understanding of rubella seroprevalence in the healthy population in China and to offer data-driven support for the goal of rubella elimination.MethodsCNKI, Wanfang database, VIP database, CBM, PubMed, web of Science, and Embase databases were searched to collect studies reporting the positive rate of rubella antibody among the Chinese healthy populations between 2001 and 2022. We conducted a meta-analysis using R language, and data were combined using random effects model.ResultsA total of 97 studies were included, encompassing a sample size of 103,018. Meta-analysis showed that the overall prevalence of rubella antibody positivity in the Chinese healthy population was 77.29% (95% CI: 75.26-79.33). The prevalence of rubella antibody varied significantly based on age and vaccination status. Among the age groups studied, the &amp;lt;1-year-old group exhibited the lowest positivity rate for rubella antibody at 47.87% (95% CI: 41.53-54.21),while the ≥50 years old group showed the highest positivity rate at 85.43% (95% CI: 81.01-89.85); individuals with a history of vaccination demonstrated a higher antibody positivity rate compared to those without vaccination history.ConclusionsThe prevalence of rubella antibody in healthy Chinese population is relatively low. In order to establish a solid immunity threshold levels, it requires conducting timely immunization programs on key groups such as middle school students and the women of childbearing age on the basis of ensuring a high level of rubella-containing-vaccines (RCV) coverage, so as to achieve the goal of eliminating rubella.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024607949.

Unintended consequences of maternity leave entitlements on female labor market outcomes in China

This study provides the first empirical evidence of the impact of maternity leave entitlements on labor market outcomes for women of childbearing age in urban China. We exploit a reform during which approximately two-thirds of the provinces in China extended their leave entitlements from 2014 to 2016 and employ a triple-difference strategy to deal with the identification. The results suggest unintended effects, as leave entitlement extensions led to a reduction in the likelihood of working, formal employment, and wage for women of childbearing age relative to their counterparts. We further establish that greater reliance on employer liability may be the main mechanism behind the unintended effects, highlighting the importance of payment schemes. This study provides novel evidence and mechanisms for the labor market effect of maternity leave in women of childbearing age and provides new insights for maternity leave related policy designs.

Prevalence and factors associated with undernutrition among 15-49-year-old women in Sierra Leone: A secondary data analysis of Sierra Leone Demographic Health Survey of 2019.

Undernutrition of women of childbearing age is pertinent for maternal and offspring health. This study aimed to determine the prevalence and factors associated with undernutrition (underweight and stunting) among women of reproductive age (15-49 years) in Sierra Leone using a secondary data analysis of the 2019 Demographic Health Survey. Anthropometric measurements and maternal characteristics were obtained from the Sierra Leone Demographic Health Survey (SLDHS) of 2019. The heights and weights of women were measured, and BMI in kg/m2 was calculated. Based on the World Health Organization's recommendations, stunting was defined as heights <145cm and being underweight as BMI <18.5kg/m2. Multivariate logistic regression analyses were conducted to identify factors associated with undernutrition, with a significant level set at p<0.05. A total of 7,514 women of reproductive age, 15-49 years were analyzed in this study. The prevalence of stunting and underweight were 1.5% (113/7514) and 6.7%(502/7,514), respectively. Women with primary education had a 47% lower likelihood of being stunted (adjusted Odds Ratio [aOR] = 0.53, 95% Confidence Interval [CI]:0.30-0.94;p = 0.029) than secondary education. Women in the poorest wealth index had a 51% lower likelihood of being stunted (aOR = 0.49,95%CI:0.27-0.88;p = 0.017) than the middle wealth index. Underweight was 1.48 times more likely among women with a parity of one-to-four (aOR = 1.48,95% CI:1.08-2.03;p = 0.015) than women who never gave birth. Also, underweight was 1.41 times more likely among women who listened to radios (aOR = 1.41,95% CI:1.14-1.74;p = 0.002) than those who did not. Age groups of 15-19 years and 40-49 years had a 54% (aOR = 0.46,95%CI:0.34-0.62;p<0.001) and 34% (aOR = 0.66,95%CI:0.45-0.97;p = 0.035) lower likelihood of being underweight than 20-29-year age group, respectively. Women with primary education had a 26% lower likelihood of being underweight (aOR = 0.74,95%CI:0.56-0.99;p = 0.042) than those with secondary education. However, none of the wealth indices was significantly associated with being underweight. The prevalence of underweight and stunting among women of reproductive age (15-49 years) in Sierra Leone was lower than regional and world data. This study highlights similarities and differences in this population's prevalence and factors associated with undernutrition. Underweight and stunting were less likely in women with primary education, while parity of one to four and listening to radios were significantly associated with being underweight. Further trend studies using DHS data from 2010, 2014, and 2019 are warranted to understand the dynamics of undernutrition among women (15-49 years) in Sierra Leone.

Determinants of Childbearing Age Couples Perform Early Detection of Cervical Cancer Through IVA Method (Visual Inspection of Acetic Acid) in Sigi Regency

Introduction: Cervical cancer is a malignant disease that is quite often heard among the public. Cervical cancer or commonly referred to as cervical cancer often occurs in women. Cervical cancer can occur due to a poor lifestyle and environment, such as having free sex, changing partners and a lack of personal hygiene. Objective: This study aims to determine the determinants of early detection of cervical cancer in couples of childbearing age (PUS) in Sigi Regency. Method: This study used a cross sectional research design. Result: There was a significant relationship between knowledge, attitude and behavior of early detection of cervical cancer in Sigi Regency. There was no significant relationship between education, employment and support of health workers and early detection behavior of cervical cancer in Sigi Regency. Conclusion: This study concluded that there is a significant relationship between knowledge, attitudes and behaviors for early detection of cervical cancer in Sigi Regency. And there was no significant relationship between education, employment and support of health workers and early detection behavior of cervical cancer in Sigi Regency.

QLTI-22. TEMOZOLOMIDE CHEMOTHERAPY EFFECTS ON GLIOMA PATIENT FERTILITY AND THEIR OFFSPRING: A RETROSPECTIVE REVIEW

Abstract Gliomas represent ~30% of primary brain tumors. Temozolomide (TMZ) chemotherapy with concurrent radiation or following radiation is the main course of treatment. Avoidance of pregnancy in female patients and partner of male patients is strongly encouraged due to unknown teratogenic and long-term effects to the health and development of fetus. Patients of childbearing age must wrestle with receiving TMZ treatment, potentially impacting fertility, and the desire for biological children in the future. Gamete preservation prior to TMZ induction is the current solution, which is often financially prohibitive, leaving patients to consider natural conception after completion of TMZ. We intend to identify potential difficulties in conception, pregnancy complications, birth abnormalities, and childhood developmental deficiencies that may be correlated to TMZ exposure prior to conception. Included patients conceived and delivered one or two children after completing treatment with TMZ. All patients received antiepileptic drugs (range = 1-4) which have variable known teratogenic effects during pregnancy. We identified 13 patients (7 male, 6 female; median age of 29) with diagnoses of astrocytoma (n=5), oligodendroglioma (n=5), oligoastrocytoma (n=2; diagnosed prior to 2021 WHO classification), and glioblastoma (n=1). Two reported issues with conceiving (1 male and 1 female) and 17 children were born. One child had developmental abnormalities (6%), and all other 16 children were healthy per parental assessment. Complete results of pregnancy complication and childhood development data will be updated at the meeting. Information on teratogenic and developmental effects of TMZ in humans is largely unknown. Animal studies have shown an increase in fetal malformations when exposed to TMZ during pregnancy. Despite the limitations of a retrospective study, our findings suggest that natural conception after the conclusion of TMZ treatment may be safer than suspected. Given the limited sample size, future comprehensive studies are warranted to corroborate these observations.

Lymphangioleiomyomatosis: A Review.

Lymphangioleiomyomatosis is a rare multisystem disorder belonging to the family of neoplasms exhibiting perivascular epithelioid differentiation. It primarily affects women of childbearing age. The disease is characterized by a proliferation of smooth muscle-like cells (lymphangioleiomyomatosis cells) within all lung compartments, leading to cystic parenchymal destruction and, in some cases, respiratory failure. These cells carry mutations in one or both tuberous sclerosis (TSC) genes and coexpress smooth muscle and melanocytic markers. Female hormones, particularly estrogens, influence the course of the disease. Symptoms of lymphangioleiomyomatosis vary significantly among patients, ranging from exertional dyspnea and coughing to chest pain and recurrent pneumothorax. To present the latest advancements in the understanding of disease pathogenesis and diagnosis, illustrate the pathologic and radiologic findings, provide a reference for pathologists and other health care professionals, briefly discuss recent evidence-based therapeutic approaches, and emphasize the importance of adopting a multidisciplinary approach to diagnosis and optimization of patient care. A comprehensive review of pertinent medical literature published in the last 30 years, focusing on publications written in the English language, was performed. Despite the recent significant advancements in the understanding and management of lymphangioleiomyomatosis, there are still significant gaps in our knowledge of its pathophysiology and the role of the immune system in the genesis and progression of the disease. The current changes in diagnostic algorithms favor the adoption of minimally invasive procedures as the standard of care. As a result, the clinical laboratory will play a larger role in the diagnosis of lymphangioleiomyomatosis, and surgical pathologists will likely be less involved in the diagnosis of pulmonary lymphangioleiomyomatosis than they currently are.

Time trends in maternal hypertensive disorder incidence in Brazil, Russian Federation, India, China, and South Africa (BRICS): an age-period-cohort analysis for the GBD 2021

ObjectivesMaternal hypertensive disorder (MHD) is a leading cause of significant maternal and fetal mortality and morbidity. The BRICS nations are crucial in the global MHD landscape, given their large populations and varied healthcare infrastructures. This investigation evaluates the incidence trends of MHD in BRICS countries from 1992 to 2021.Study design and methodsData on the number, all-age rate, age-standardized rate (ASR), and the relative change of MHD incidence from this study were sourced from the Global Burden of Disease (GBD) 2021 public dataset to investigate temporal trends in MHD incidence over three decades globally and in BRICS countries. The age-period-cohort (APC) model was used to estimate net drift, local drift, age-specific curves, and period (cohort) relative risks.ResultsA 15.87% increase in global MHD cases, alongside a 13.40% decrease in age-standardized incidence rates from 1992 to 2021. MHD incidence rates are declining across various BRICS age groups, except in China and Russian Federation, where most groups exhibit increasing trends. Annual net drift in MHD incidence ranges from − 4.25% in India to 2.38% in China. A shift in the age distribution of MHD cases from younger to older within the childbearing age range is observed in all BRICS nations. Countries exhibit similar age-effect patterns, with decreasing risk with increasing age, and varying period and cohort effects, indicative of differential control measures and temporal incidence trends.ConclusionsGlobal and BRICS-specific reductions in MHD incidence vary in magnitude. Customized preventive strategies, leveraging existing resources, are advisable for BRICS nations to address pregnancy complications. Enhancing primary healthcare and maternal care quality, particularly for older mothers, is imperative.

A pooled analysis of the efficacy of sertraline in women, with a focus on those of childbearing age

IntroductionGender- and age-specific research on medications is essential for personalizing treatment plans, optimizing dosing, minimizing adverse effects and improving outcomes. Women are twice as likely to be diagnosed with major depressive disorder (MDD), and it is commonly reported during their reproductive years. This post-hoc pooled analysis evaluated the efficacy of sertraline (one of the most studied medications in women) in women of reproductive age (18–44 years).MethodsData was pooled from nine clinical trials of sertraline that included 1832 subjects with MDD. The analysis set included 1097 women, 651 of those were of reproductive age. Sertraline was compared with placebo for changes in total HAM-D17 and CGI scores measured over time through MMRM analysis. The change from baseline to the end of study (-week 8) was assessed using ANCOVA.ResultsThe changes from baseline in total HAM-D17 and CGI scores were significantly higher for sertraline than for placebo at the end of 8 weeks for all women (LS Mean difference, 95% CI: -1.81(-3.01,-0.62), P = 0.0029; -0.38(-0.55,-0.20), P < 0.0001, respectively). For women of reproductive age these changes (LS Mean difference, 95% CI: -2.08(-3.52,-0.64), P = 0.0047; -0.44(-0.66,-0.22), P < 0.0001, respectively), were significant from week 2 (HAM-D17) and week 1 (CGI) till the end of study.LimitationsOnly sertraline and placebo arms were included in the analysis. The dosing varied between studies, and the effect of dose was not addressed.ConclusionsSertraline is an effective option for treatment of MDD in women, including those in the childbearing age.

Blood Loss in Women of Childbearing Potential Taking Oral Anticoagulants for Venous Thromboembolism (The BLEED Study).

Oral anticoagulants (OAC) may exacerbate menstrual bleeding in women of childbearing age; however, the existing literature on this issue has several limitations. This study investigates abnormal uterine bleeding (AUB) in women of childbearing age taking oral anticoagulants-Vitamin K antagonists (VKA) or Direct Oral Anticoagulants (DOAC)-for venous thromboembolism through a retrospective analysis of prospectively collected data. Uterine bleeding was assessed using the Pictorial Blood Assessment Chart (PBAC) and hemoglobin (Hb) values during anticoagulation compared to prior therapy. The number of unplanned medical visits for bleeding complications was also calculated. From June 2014 to November 2023, 110 women were recruited (median age, 36 years). PBAC scores correlated with Hb values at baseline and during therapy (ANOVA, p<0.01), with a significant difference in Hb values before and during anticoagulant therapy (Δ Hb) among groups (ANOVA, p=0.034). Seventeen women (15.4%) reported fibroids, experiencing a greater reduction in Hb values during anticoagulant administration than women without fibroids (Δ 0.3, IQR -0.8, 2.9 vs -0.5, IQR -1.2, 0.3; p=0.012). Women with fibroids required more frequent unplanned medical consultations for bleeding (mean visits 5 vs 4 respectively; Poisson regression, p<0.05). Among women with fibroids, those taking apixaban showed smaller Hb changes than those on other oral anticoagulants (ANOVA, p=0.047). This difference persisted even after adjusting for potential confounders (MANOVA, p=0.004). Women of childbearing potential taking OAC frequently experience changes in Hb values and PBAC scores during treatment, with fibroids playing a significant role.

Impact of symptomatic multiple sclerosis therapy on pregnancy outcome.

Information on symptomatic therapy (ST) use in women of childbearing age with multiple sclerosis is sparse, and data on the impact of ST pregnancy exposure on pregnancy outcome are lacking. To investigate (1) ST use patterns pre-conception, during pregnancy and postpartum and (2) pregnancy outcomes. Pregnancy data from the German Multiple Sclerosis and Pregnancy Registry were analyzed for the ST use from pre-conception to postpartum. Pregnancy outcomes were compared between ST-exposed (n = 282) and matched (disease modifying therapy and age) ST-naive (n = 536) pregnancies. Of 2,449 pregnancies, 1,053 (43.0%) received ST anytime between pre-conception and postpartum, 282 (11.5%) at pre-conception and during pregnancy. The most commonly used drug classes were antidepressants (24.8%), analgetics (31.0%), and anticonvulsives (8.7%). Exposure to ST during pregnancy did not result in an increased incidence of adverse pregnancy outcomes, major congenital abnormalities, or pregnancy complications. Nearly 50% of women used ST between pre-conception and postpartum, but only 12% pre-conception and during pregnancy. ST use during pregnancy did not adversely affect pregnancy outcomes in our cohort. More data are needed to analyze the effect of ST on pregnancy and fetal outcomes stratified by drug to improve recommendations for ST use in family planning.