Miscarriage Research Articles

Perinatal mortality in women in minority ethnic groups in Ireland (2011-2021)

Abstract Women in minority ethnic groups (MEG) have been consistently overrepresented in the National Perinatal Epidemiology Centre (NPEC) Perinatal Mortality (PM) reports in Ireland (IE). International research, report similar findings. A secondary analysis of NPEC PM national clinical audit data (2011-21) examined factors associated with PM in women in MEG and differences between these and white women. Maternal sociodemographic and obstetric characteristics, maternal medical history, infant characteristics and PM outcomes of women in MEG were analysed and compared with women of white ethnicity with χ2 tests. There were 4314 PMs in IE from 2011-21; 2896 stillbirths (SB) and 1418 early neonatal deaths (ENND). Women in MEG who experienced PM were younger (p < 0.001) and 46% were employed (vs 75% of white women, p < 0.001). A greater proportion of women in MEG had previous pregnancies (77% vs 68%, p < 0.001), and more than twice as many had ≥3 previous completed pregnancies versus white women (26% vs. 12%, p < 0.001). Women in MEG also had more previous pregnancy medical issues (49% vs 38%, p = 0.001). Twice as many women in MEG had their first prenatal appointment after 20 weeks’ gestation or never received prenatal care (p < 0.001). Analysing by type of PM, statistically significant differences persisted for all these variables in both SB and ENND groups. Women in MEG experienced more placental conditions and obstetric factors as causes of PM, but fewer congenital anomalies compared to white women (p = 0.047). These differences only persisted in the SB group when data was analysed by type of PM. Factors highlighted in this study such as employment, parity, and prenatal care access may explain the over-representation of women in MEG in PM. These findings provide further knowledge useful to create targeted interventions (e.g. initiatives to improve maternal health literacy for women in MEG). Further studies are needed to promote change that would specifically address these systemic inequities. Key messages • Data shows systemic inequities that may contribute to the over-representation of women in minority ethic groups in perinatal mortalities. Clear and tangible changes are needed to address these issues. • Further research needs to clarify factors restricting access of women in minority ethic groups to prenatal care and promote interventions to ensure adequate prenatal care is available and accessible.

Very Early Pregnancy Loss: The Role of PM2.5 Exposure in IVF-ET Outcomes

Very Early Pregnancy Loss: The Role of PM_2.5 Exposure in IVF-ET Outcomes

Female Reproductive System and Thyroid Dysfunction: Findings from a 12-Year Follow-Up in the Tehran Thyroid Study.

Background: The impact of thyroid dysfunction (TD) on the female reproductive system has been extensively documented. While there is evidence suggesting that alteration in female reproductive status may affect thyroid function, conflicting results have prevented definitive conclusions. This study aimed to investigate the associations of parity, spontaneous abortion (mentioned as abortion throughout this study), and menopause status with the prevalence and incidence of TD. Methods: From the Tehran thyroid study population, 2711 participants were included in the cross-sectional analysis to explore associations between female reproductive status and TD. Overall, 2191 participants with euthyroid were included in the survival study and followed up in 3-year intervals. Multinomial logistic regression was adopted in cross-sectional analysis and multivariable Cox proportional hazard model was used to determine associations between the incidence of TD with parity, abortion, and menopause status, adjusting for age, smoking, body mass index, and thyroid peroxidase antibodies positivity. Results: At the baseline, multiple parities (≥4) were significantly associated with overt hypothyroidism (odds ratio [OR] = 1.12; confidence interval [CI] 1.0-1.26) and subclinical hyperthyroidism (OR = 1.11 [CI 1.03-1.21]). Furthermore, multiple abortions were associated with overt hyperthyroidism (OR = 2.09 [CI 1.02-4.26]). Over the course of the study, multiple parities were significantly associated with the incident subclinical and clinical hypothyroidism. Conversely, a history of abortion was associated with a reduced risk of incident overt hypothyroidism. We found no significant association between menopause status and the prevalence or incidence of either hypothyroidism or hyperthyroidism. Conclusions: Our results suggest that the female reproductive system may be associated with thyroid function. Parity and abortion are associated with the occurrence of TD. A deeper understanding of the underlying mechanisms of the cellular and molecular alterations in signaling cascades during pregnancy is necessary to fully elucidate these associations.

Workers’ experiences of pregnancy loss: qualitative insights from a mixed-methods study

Abstract Background Pregnancy loss affects approximately one in four pregnancies. The workplace is an important context to consider in pregnancy loss experiences as most women of reproductive age are in paid employment. Currently in the Republic of Ireland (ROI) there are no statutory leave entitlements if a pregnancy ends <24 weeks. Given the lack of research in this area internationally, we aimed to explore workplace experiences of early pregnancy loss. Methods In 2023, we conducted an online mixed-methods survey study (Mar-Apr), followed by qualitative interviews (Jun-Sept). People who experienced a pregnancy loss <24 weeks-whilst working and living in ROI in the preceding five years-were eligible to participate. The survey was distributed through professional/social networks and contained quantitative and qualitative questions-addressing pregnancy loss, experiences of workplace supports, and desired supports. Survey participants were asked to indicate their willingness to participate in a follow-up interview and were purposively sampled. The interview topic guide focused on specific aspects of workplace experiences which required further exploration following preliminary analysis of survey responses. Qualitative data were analysed in NVivo using reflexive thematic analysis. Results Most survey participants (N = 913) were female (74%), employed full-time (86%) and experienced a first-trimester miscarriage (75%). We conducted interviews with 13 people, across a range of demographics. Three initial themes were identified: (1) Personal experiences of pregnancy loss and dealing with emotional and physical impacts at work; (2) Challenges with the social side of pregnancy loss-disclosure and workplace interactions; (3) Workplace supports (4) Public policy and awareness. Conclusions Our analysis highlights the need for statutory leave, appropriate workplace policies and procedures, and education and training to better support workers who experience pregnancy loss. Key messages • There is a gap between workers’ needs and workplace supports regarding pregnancy loss <24 weeks gestation. Statutory leave, workplace policies and procedures, and education and training, are needed. • There is a need to discuss pregnancy loss in workplaces and society, to raise awareness and reduce the stigma/taboo on the topic. Recognition from Government is crucial to promote this.

The Significance of the Myocardial Performance Index and Fetal Doppler Abnormalities in Growth-Restricted Fetuses: A Systematic Review of the Literature

Introduction: This review aims to investigate the clinical implications of using the myocardial performance index (MPI), obtained through tissue Doppler imaging (TDI) and spectral Doppler, in assessing fetal cardiac function in growth-restricted fetuses. It explores the MPI’s potential in predicting adverse perinatal outcomes and its utility when combined with conventional pulsed-wave Doppler assessments for enhanced fetal well-being evaluations. Material and Methods: A systematic search of PubMed and Google Scholar databases spanning from 2004 to 2023 was conducted to identify pertinent articles on the MPI’s clinical application in managing growth-restricted fetuses. Inclusion criteria followed the Fetal Medicine Barcelona definition of fetal growth restriction (FGR) to mitigate study group heterogeneity. The research sources were PubMed and Google Scholar databases, and the review was conducted without any specific clinical or laboratory setting. Only articles meeting the inclusion criteria for FGR, as per the Fetal Medicine Barcelona definition, were considered. Six studies meeting these criteria were included in the review. The review analyzed the correlation between MPI values and conventional Doppler parameters, investigating the progression of myocardial function impairment and its association with the risk of fetal demise. The primary outcome measures included the relationship between MPI values, fetal well-being, and the potential for prenatal cardiac dysfunction in growth-restricted fetuses. Results: The findings indicate that as conventional Doppler parameters deteriorate, MPI values increase, suggesting progressive myocardial dysfunction. The MPI may cross the 95th percentile before abnormal flow in the ductus venosus and aortic isthmus, highlighting the potential for diastolic dysfunction preceding hypoxia in growth-restricted fetuses. Elevated MPI levels were observed in both growth-restricted and small-for-gestational-age (SGA) fetuses, indicating prenatal cardiac impairment. The strong association between an abnormal MPI and perinatal mortality has been shown for early FGR. Conclusions: MPI alterations appear to precede abnormal Doppler parameters in early- and late- onset FGR, potentially indicating diastolic dysfunction preceding hypoxia. Additionally, the MPI correlates with the risk of fetal demise. However, larger studies are needed to establish its sensitivity and specificity. Furthermore, the significance of prenatal cardiac impairment in some SGA fetuses raises questions about its potential impact on perinatal outcomes and cardiovascular programming.

Type, Complications and Treatment of Abortion in a Tertiary Hospital

Background: Abortion remains a critical public health issue, particularly in low-resource settings like Bangladesh, where access to safe abortion services is often restricted. This study aimed to analyze the types of abortions, treatment methods, and post-abortion complications in a tertiary hospital in Bangladesh. Methods: A cross-sectional study was conducted from January to December 2017, including 100 cases of abortion at a 250-bed district hospital in Joypurhat, Bangladesh. Data were collected from patient records, focusing on demographic characteristics, type and nature of abortion, treatment methods, and complications. Descriptive statistics were used for analysis. Results: The majority of patients (42%) were aged 26–30 years, and 58% were primigravida. Most abortions (75%) occurred before 13 weeks of gestation, with incomplete abortions accounting for 86% of cases. Spontaneous abortions constituted 86%, and D&C was the primary treatment method in 83% of cases. Post-abortion complications were infrequent, with incomplete D&C (8%), shock (6%), and septicemia (3%) being the most common. Conclusion: Incomplete abortions and spontaneous abortions are the most common types observed, with D&C being the predominant treatment method. Although complications were low, the findings underscore the need for better access to safe abortion methods, including medical abortion, and the reduction of unsafe practices through improved healthcare education and policy reform.

Safety concerns of paternal drug exposure on fertility, pregnancy and offspring: An analysis based on the FDA adverse event reporting system.

Growing evidence indicates that paternal condition significantly influences pregnancy outcomes and offspring health. However, assessing the safety of paternal drug exposure via randomized controlled trials poses ethical challenges, and relevant clinical studies consume a lot of resources to evaluate only a few drugs. Currently, safety data on paternal drug exposure are scarce. To investigate the impact of paternal drug exposure on fertility, pregnancy outcomes, and offspring health. Data from the FDA adverse event reporting system (FAERS) were analyzed (2010-2022). Disproportionality analyses were used to identify signals of each drug-adverse event pair associated with paternal drug exposure in a different hierarchical manner. Out of the 16,180,533 reports, 3210 were related to paternal exposure, encompassing 7808 concomitant adverse events. Drugs used to treat rheumatoid arthritis, cancer, and infections were primary sources of paternal exposure. Analysis identified 115 signals concerning reproductive health. Notably, the signals of diazepam-small for dates baby and finasteride-cryptorchidism were particularly significant (reporting odds ratio, ROR>800, N>10). Moreover, spontaneous abortion signals occur frequently in biologics for the treatment of immune inflammation; the use of immunosuppressive drugs was associated with the highest number of congenital anomalies, with the strongest signals for belatacept-skeletal dysplasia, and tacrolimus-talipes. Only mycophenolic acid, estrogen and imatinib have signals on male fertility. Anti-tumor agents had high numbers of each reproductive toxicity, with the highest values of trisomy 13 signals associated with etoposide and cisplatin. This is the first research to fully assess the safety of paternal exposure to the majority of medications in terms of reproduction. Clinical and scientific researchers should pay close attention to the list of risk medications included in this study, particularly the following association combinations: biologics used to treat inflammatory diseases-abortion, diazepam-small for date baby, finasteride-cryptorchidism, etoposide and cisplatin-13 trisomy.

Patient-reported pregnancy loss and maternal complications: Insights from the sickle cell disease implementation consortium.

Sickle cell disease (SCD) is associated with complications during pregnancy and can negatively influence maternal outcomes. Our study aimed to determine the prevalence and predictors of maternal morbidity among participants enrolled in an eight-site SCD Implementation Consortium (SCDIC) registry. We conducted a cross-sectional analysis of female registry participants, aged 15-45 years, with a confirmed diagnosis of SCD. Participants completed a survey of self-reported pregnancies and outcomes. Seven hundred and thirty-eight individuals had at least one pregnancy event, with 1076 live births. Twenty percent reported a pregnancy loss or fetal demise. Of the 1076 live births, 75% involved at least one complication. The most prevalent complications were pain crises (61.1%) and pregnancy requiring blood transfusion(s) (33.0%). Multiparous individuals with a prior occurrence of a complication in a previous pregnancy had higher odds of recurrence of the same complication in subsequent pregnancies (i.e., previous acute crisis was associated with subsequent acute pain events odds ratio [OR]: 3.13; 95% confidence interval [CI]: 2.06-4.76) and prior transfusion requiring another transfusion (OR: 3.22; 95% CI: 2.01-5.16). Individuals reported a high prevalence of pregnancy loss and maternal complications. Our findings underscore the importance of preconception counseling and early initiation of perinatal care in SCD.

Safety assessment of sapropterin dihydrochloride: real-world adverse event analysis based on the FDA adverse event reporting system (FAERS)

ObjectiveSapropterin dihydrochloride is the first drug for the therapy of phenylketonuria, which is a rare disease that occurs one of 10,000–15,000 newborns. As a result, detailed and comprehensive reports on the safety of sapropterin in large, real-world populations are required. The purpose of this study is to undertake a complete analysis of sapropterin’s adverse events (AEs) using the FDA Adverse Event Reporting System (FAERS) database.MethodsWe retrieved reports of adverse events with sapropterin as the principal suspect from FAERS between the first quarter of 2008 and the first quarter of 2024. The Reporting Odds Ratio (ROR), Proportional Reporting Ratio (PRR), and Bayesian Confidence Propagation Neural Network (BCPNN) were utilized to detect AE signals.ResultsThe study collected 4,953 suspected AE cases from the FAERS database, with sapropterin as the major suspect. A total of 130 positive signals were obtained utilizing the ROR, PRP, and BCPNN. The FAERS database revealed that common clinical AEs of sapropterin included vomiting, upper respiratory infection, rhinorrhea, and a reduction in amino acid concentrations. Furthermore, we detected probable unexpected adverse events (AEs) using disproportionality analysis, including gastroesophageal reflux disease, flatulence, influenza, ear infection, viral infection, pharyngitis streptococcal, spontaneous abortion, and nephrolithiasis.ConclusionBy analyzing huge amounts of real-world data from the FAERS database, we found potential novel AEs of sapropterin using disproportionate analysis. It is advantageous for healthcare professionals and pharmacists to focus on efficiently managing sapropterin’s high-risk adverse events, improving drug levels in clinical settings, and ensuring patient medication safety.

Outcomes for Female Physicians Compared With Nonphysicians After Assisted Reproductive Technology.

To evaluate outcomes of female physicians after assisted reproductive technology (ART). We conducted a retrospective cohort study using data from 248 physician patients and 3,470 nonphysician patients who underwent a total of 10,095 fresh or frozen ART cycles at a single academic center in an insurance-mandated state between January 2015 and March 2022. The primary outcome was live-birth rate. The secondary outcomes were implantation rate, early pregnancy loss rate, and time to pregnancy. Models were adjusted for confounders where appropriate. Both groups were similar in age (mean physician age 36.29 years; mean nonphysician age 35.96 years, P=.35). Physicians had lower body mass index (BMI) (mean physician BMI 23.51, mean nonphysician BMI 26.37, P<.01), and a higher proportion were diagnosed with unexplained infertility (physician 33.9%, nonphysician 25.9%, P<.01) and used preimplantation genetic testing for aneuploidy (physician 21.5%, nonphysician 12.7%). Physicians and nonphysicians had similar live-birth rates (physician 39.3%, nonphysician 38.2%; adjusted relative risk [aRR] 1.01 95% CI, 0.91-1.13), implantation rates (physician 34.7%, nonphysician 33.7%; relative risk 1.03 95% CI, 0.94-1.14), and early pregnancy loss rates (physician 21.9%, nonphysician 19.8%; aRR 1.18 95% CI, 0.99-1.41) per transfer. Physicians had a shorter time from initial ART cycle to pregnancy (physician 21.82 weeks, nonphysician 25.16 weeks; aRR 0.86, 95% CI, 0.83-0.89). There was no difference between female physicians and nonphysicians in assisted reproduction cycle outcomes. Physicians become pregnant slightly faster than nonphysicians.

Analysis of chromosome test results of 24,175 miscarried fetuses in Japan from 2000 to 2021.

Fetal chromosome abnormalities, the most common cause of spontaneous abortion, were investigated pre-1980s. In recent years, chromosome testing has been outsourced to testing companies in Japan, and there have been few epidemiological studies of chromosome testing of miscarried fetuses on a nationwide scale. We analyzed the chromosome test data of SRL, Inc., one of the largest clinical laboratories that has collected tissue specimens of products of conception derived from miscarried fetuses from hospitals throughout Japan from 2000. We collected and analyzed 24,175 cases, among which 8,726 (36.1%) were normal chromosomes, 1,298 (5.4%) were sex chromosome abnormalities, 9,735 (40.3%) were autosomal trisomies, 73 (0.3%) were autosomal monosomies, 840 (3.5%) were ploidy, 512 (2.1%) were chromosome structural abnormalities, and 2,991 (12.4%) were mosaics. The frequency of autosomal trisomy increased at the older maternal ages. By chromosome number, trisomies 22, 16, 21, and 15 were associated with advanced maternal age, but trisomies 13, 14, and 18 were not associated with advanced maternal age. The presence or absence of this maternal age effect was correlated with the chromosome segregation being due to maternal meiosis I or meiosis II. For the sex ratios of the fetuses, we focused on trisomies 22, 21, 18, 16, 15, 14, and 13, and found that only trisomy 16 was significantly more frequently seen in female fetuses. The findings of this study provide insights into the basic understanding of miscarriage and will be useful in counseling and medical education.

The effect of sequential embryo transfer on pregnancy outcomes in patients with recurrent implantation failure: a systematic review and meta-analysis of randomized controlled trials.

The aim of our study was to assess the impact of sequential embryo transfer on pregnancy outcomes among patients with recurrent implantation failure (RIF). We conducted a comprehensive search across various databases for eligible clinical trials from inception to January 2024. Randomized controlled trials (RCTs) were included if they compared sequential embryo transfer, comprising both cleavage-stage and blastocyst-stage embryos, with other transfer protocols in infertile women with repeated implantation failure. Meta-analysis was performed using Revman software. Our primary focus was on the ongoing pregnancy rate. Our secondary measures included rates of chemical pregnancies, clinical pregnancies, miscarriages, and multiple pregnancies. Seven RCTs, encompassing 909 patients, met the inclusion criteria. Sequential embryo transfer demonstrated a significant increase in the ongoing pregnancy rate compared to the control group (OR = 2.28, 95% CI [1.46, 3.56], p = 0.003). Moreover, the sequential embryo transfer group exhibited notable improvements in chemical and clinical pregnancy rates. There were no statistically significant differences between the groups regarding multiple pregnancy and miscarriage rates (p > 0.05). Sequential embryo transfer shows promise in enhancing pregnancy outcomes among RIF patients. However, additional trials are warranted to validate our findings.

Lupus activity and pregnancy outcomes in systemic lupus erythematosus patients undergoing assisted reproductive therapy: A systematic review and meta-analysis.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease primarily impacting women of childbearing age. While pregnancy and hormonal stress can trigger SLE flare-ups, the effects of assisted reproductive therapies (ARTs) on SLE patients are not well defined. We conducted a search of PubMed/Medline, Embase, and CENTRAL until March 20, 2024, to find observational studies assessing the prevalence of SLE flares and pregnancy outcomes following ARTs. Our analysis included random-effects meta-analysis and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach for evaluating evidence quality. Five studies involving 237 SLE women who underwent ARTs were eligible. The meta-analysis indicated a prevalence of SLE flares at 17% (95% CI: 10-25%) with moderate-quality evidence. The pooled prevalence of arthritis flares was 7% (95% CI: 0-25%) with low-quality evidence. Successful pregnancy rates were 58% (95% CI: 43-72%), and live birth rates were 96% (95% CI: 83-100%), both with low-quality evidence. Moderate-quality evidence showed pregnancy complications, including preterm premature rupture of membranes (PPROM) at 8% (95% CI: 3-16%), miscarriages at 2% (95% CI: 0-9%), intrauterine fetal demise (IUFD) at 4% (95% CI: 0-11%), and preeclampsia at 7% (95% CI: 1-17%). Low-quality evidence showed preterm labor at 10% (95% CI: 0-32%) and ovarian hyperstimulation syndrome (OHSS) at 2% (95% CI: 0-11%). SLE flares, as well as pregnancy complications such as IUFD, miscarriage, PPROM, and preeclampsia in ART recipients, are equivalent to those in spontaneous conception. This indicates that ART is relatively safe for SLE patients with meticulous pregnancy planning. Key Points •Systemic lupus erythematosus (SLE) is a chronic autoimmune disease primarily impacting women of childbearing age. • Pregnancy in women with SLE poses elevated maternal and fetal risks compared to healthy women. • SLE flares and pregnancy complications while receiving ART are equivalent to those in spontaneous conception and ART is relatively safe for SLE patients.

Uterine Rupture Due to Oxytocin Overdose Leading to Dystocia in a Labrador Bitch

A three-year-old Labrador bitch brought to the TVCC-FVAS-BHU-Mirzapur, with the history of whelped one dead puppy 12 hrs before further no progress of delivery. The bitch administered with a total dose of 30 IU of oxytocin intramuscularly but there was no progress. Abdominal palpation revealed presence of fetal like mass and per-vaginal examination revealed presence of fetal parts in the birth canal. The bitch was treated with oxytocin @ 0.2 IU/kg body weight slow IV with 25% dextrose 0.2ml/kg body weight slow IV, a dead male fetus was removed through mutational operation after 15 minutes, after that no puppies were palpable. Radiographic examination revealed presence of four fetuses in the abdominal cavity. It was then decided to go for cesarean section. The surgical operation was done as per the standard routine procedures. The bitch was treated with antibiotic and analgesic for 3 days. The bitch had uneventful recovery with proper postoperative care. In the present study we concluded that the dystocia was due to uterine rupture and this can be corrected through exploratory laparotomy.

Call attention to the comprehensive diagnosis and treatment strategies of infertility caused by chronic endometritis

Chronic endometritis (CE) is a persistent inflammation of the endometrium caused by microbial infection, which is characterized by the infiltration of plasma cells into the endometrial stromal area. CE emerges as a critical determinant in the etiology of female infertility and is closely associated with adverse pregnancy outcomes, such as recurrent spontaneous abortion and repeated implantation failure, imposing a heavy burden on patients and their families. However, current understanding of CE-induced infertility remains superficial, leading to delays and inconsistent approaches in the diagnosis and treatment of the condition. Emphasizing the diagnosis and treatment of CE can help improve women's reproductive health, alleviate the economic and psychological pressures of patients and their families, resolve family conflicts and promote family and social harmony. This article provides an in-depth analysis of the diagnostic criteria and current application status of CE, its impact on endometrial receptivity and fallopian tubal function, as well as its interplay with other gynecological disorders. In alignment with clinical practice, we propose suggestions including enhancing the understanding of CE, strengthening publicity and education, standardizing the diagnostic process for CE, exploring the molecular mechanisms of CE and optimizing treatment strategies, in order to improve the comprehensive diagnosis and treatment strategies of CE-induced infertility and make greater contributions to the reproductive health of women in China.

ITGA3 participates in the pathogenesis of recurrent spontaneous abortion by downregulating ULK1-mediated autophagy to inhibiting trophoblast function.

Recurrent spontaneous abortion (RSA) is a significant challenge encountered by couples of reproductive ages, with inadequate trophoblast invasion identified as a primary factor in RSA pathogenesis. However, the precise molecular mechanisms through which trophoblast cells dysfunction leads to RSA remain incompletely understood. Research has highlighted the critical role of integrins in embryo implantation and development. While integrin α-3 (ITGA3) is recognized for its promotion of invasion in cancer cells, its involvement in miscarriage remains poorly characterized. This investigation initially assessed ITGA3 expression in villous tissues obtained from RSA patients and induced abortion patients. The findings demonstrated a notable reduction in ITGA3 levels in the villous tissues of RSA patients compared control group. Subsequent in vitro analyses indicated that ITGA3 knockdown inhibited the migration, invasion, and proliferation of trophoblast cells. Through RNA sequencing and subsequent experimentation, it was revealed that ITGA3 regulated ULK1-mediated autophagy to influence trophoblast cells invasion, migration, and proliferation. Furthermore, utilizing a miscarriage animal model, the diminished expression of ITGA3 and ULK1 in the placentas of RSA mice was confirmed. In conclusion, the study findings suggest that the downregulation of ITGA3 suppresses ULK1 expression, consequently impeding autophagy to initiation and impeding trophoblast cells invasion and migration, thereby contributing to the pathological progression of RSA.

Identification of potential hub genes associated with recurrent miscarriage through combined transcriptomic and proteomic analysis

Recurrent miscarriage (RM) is currently difficult to prevent and treat due to a lack of comprehensive understanding of its molecular mechanisms. The aim of this study was to identify genes potentially involved in the pathogenesis of RM and to observe their expression in the decidual tissues of RM patients. A total of 1823 differentially expressed genes (DEGs) and 148 differentially expressed proteins (DEPs) in decidual tissues between RM and control groups were identified. Subsequently, DCN, DPT, LUM, MFAP4, and ISG15 were identified from the DEGs/DEPs as RM-related hub genes through systematic bioinformatics analysis. Bioinformatics analysis of the single-cell dataset GSE214607 revealed that the expression of these five hub genes in the decidual stromal cells of RM patients appeared to be upregulated, while the RT-qPCR assay showed that their decidual expression levels were significantly increased in RM patients. Uterine Isg15expression was significantly increased, whereas the uterine expression of Dcn, Dpt, Lum, and Mfap4 was decreased in LPS-induced early pregnancy loss mice. MiR-16-5p, -21-3p, -27a-3p, and -941 were identified as potentially involved in the regulation of these five hub genes, and their decidual expression levels were significantly decreased in RM patients. The abnormally increased ISG15 expression in the decidual tissues of RM patients and uterine tissues of LPS-induced mice was validated by WB analysis. ISG15 expression was significantly reduced during the in vitro decidualization of human endometrial stromal cells (hESCs). Collectively, DCN, DPT, LUM, MFAP4, and ISG15 were identified as RM-related hub genes, and their expression in the decidual tissues of RM patients was significantly increased. The decidualization of hESCs was accompanied by reduced ISG15 expression, suggesting that increased decidual ISG15 expression might lead to early pregnancy loss by disrupting the decidualization process.

Maternal, Fetal, and Labour Outcomes of Dupilumab Use for Atopic Dermatitis During Pregnancy: A Systematic Review.

Atopic dermatitis is a chronic complex inflammatory disease that significantly impacts maternal well-being and quality of life during pregnancy, warranting effective therapeutic interventions that prioritize maternal health and fetal safety. Dupilumab is approved for moderate-to-severe atopic dermatitis, but limited data exist regarding its safety during pregnancy. We conducted a systematic review to review and analyze maternal, fetal, and labour outcomes in patients receiving dupilumab for atopic dermatitis during pregnancy. Comprehensive searches were conducted using databases including OVID, Scopus, and Web of Science, covering studies published until May 2024. Our search yielded 285 studies, of which 13 met the eligibility criteria. These studies included 68 patients with 69 pregnancies, revealing 58 live births and 11 spontaneous abortions. Dupilumab therapy was administered continuously throughout pregnancy in 22.2% of cases, while 77.8% received intermittent treatment. Maternal atopic dermatitis outcomes showed significant improvement in disease severity. Most pregnancies (86.3%) progressed without complications. Labour-associated outcomes varied, with 82.4% of women undergoing vaginal deliveries. The majority of births occurred at full term (82.5%), with a mean gestational age of 38.4 weeks. Fetal outcomes demonstrated a normal birth weight in 92.3% of cases, with no reported congenital defects. Our review suggests that dupilumab use during pregnancy is associated with improvement of atopic dermatitis and low or minimal risk of major adverse outcomes in treated patients or their newborns. Prospective studies with long-term follow-up are warranted to confirm the safety of dupilumab in this population.

Association of different types of abortions with neonatal outcomes in subsequent pregnancy.

Abortion is an important issue that concerns all women. It holds great significance to investigate the correlation between various types of abortion histories and the neonatal outcomes of subsequent pregnancies. This retrospective cohort study included pregnant women who gave birth to singleton live-born in Shanghai First Maternity and Infant Hospital from 2016 to 2020 (n = 75 773). Women with a history of abortion, including spontaneous abortion (SAB) and induced abortion (IA), were included in the exposed group, and the remaining were included in the unexposed group. The main outcomes were birthweight and preterm birth in the subsequent pregnancy. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) for the association of maternal abortion history with birthweight and risk of preterm birth in subsequent pregnancy. Women who have experienced SAB history had an increased risk of delivering very low birth weight (VLBW) and preterm birth children, with (OR = 1.63, 95% CI = 1.15-2.32; OR = 1.38, 95% CI = 1.07-1.79). However, women with a history of IA were at greater risk of macrosomia (OR = 1.16; 95% CI = 1.06-1.27). We also observed that the likelihood of delivering a VLBW baby was heightened by the number of SAB occurrences (OR = 0.87, 95% CI = 0.54-1.38; OR = 1.84, 95% CI = 1.01-3.36, OR = 5.71, 95% CI = 3.21-10.15). Our study indicates that pregnant women with a history of SAB are at an increased risk of delivering VLBW infants and experiencing preterm labour. The risk is positively associated with the number of SABs. Conversely, women with a history of IA are more likely to deliver macrosomic infants.

Factors associated with modern contraceptive utilization among reproductive age women in Cambodia; evidenced by the recent Cambodia demographic and health survey

IntroductionCambodia is a low-income country with limited access to family planning (FP) in terms of modern contraceptive utilization. Despite several FP programs designed to make contraceptives accessible, adoption of contraceptives has been difficult in Cambodia, which has high rates of fertility and maternal mortality. This gap in essential care can put women and adolescent girls at greater risk of adverse outcomes such as stillbirth, spontaneous abortion, unwanted pregnancy, or even maternal death. One of the goals set by the government to decrease both maternal and child mortality and morbidity was increasing the modern contraceptives utilization. So, the main objective of this study was to evaluate spatial variations in modern contraceptives utilization and its contributing factors among women.MethodsData from the Cambodia 2021–22 Demographic and Health Survey datasets were used for secondary data analysis. A total of 19,496 women of reproductive age participated in the study. A spatial and multilevel mixed effects analysis was done on the factors affecting modern contraceptives utilization among Cambodian women. Finally, the percentage, odd ratio, together with their 95% confidence intervals and the results of the spatial analysis were provided.ResultThe prevalence of modern contraceptive use was 31.2% in Cambodia. Living in an urban area [AOR = 1.224; 95% CI = (1.126.1.330); P = 0.0001]; being married [AOR = 34.131; 95% CI= (12.673, 91.921); P = 0.0001]; and having a history of terminated pregnancy [AOR = 1.137; 95% CI= (1.055, 1.225); P = 0.0001] were found to be positively associated with modern contraceptive utilization. In contrast to this, being between the age range of 46–49 [AOR = 0.421; 95% CI = (0.364, 0.487); P = 0.0001]; being a female-headed household [AOR = 0.784; 95% CI = (0.723, 0.850); P = 0.0001]; and current breast feeding [AOR = 0.84; 95% CI = (0.75, 0.93); P = 0.010] were found to be negatively associated with modern contraceptive utilization. Additionally, the spatial analysis of modern contraceptive utilization showed that a higher proportion was utilized in the southern and southwest regions of Cambodia.ConclusionIn this study, living in urban area, being married and having history of terminated pregnancy were found positively associated with modern contraceptive utilization. In contrast to this, being old age, being female headed household and being currently breast-feeding women were found negatively associated with modern contraceptive utilization. In addition to this, there were geographic (spatial) variations in modern contraceptive utilization among Cambodian’s women across the country.