Women with pre-existing diabetes remain at increased risks of adverse pregnancy complications. Optimising glycaemic control before and during pregnancy could reduce risk but data from Asian countries are limited. This study evaluates maternal glycaemia, management strategies and pregnancy outcomes in women with diabetes in a multiethnic cohort. We retrospectively studied pregnancies with pre-existing diabetes or prediabetes at a Singapore tertiary hospital from 01/01/2022 to 31/12/2024. Maternal data and pregnancy outcomes were analysed by diabetes subtype. Multivariate logistic regression identified factors linked to adverse outcomes, including fetal overgrowth (macrosomia and large-for-gestational-age [LGA]) using local birthweight standards. Of 289 pregnancies (75.8% Type 2 diabetes mellitus [T2DM], 19.0% prediabetes, 5.2% Type 1 diabetes mellitus [T1DM]), median maternal age was 33 years and pre-pregnancy body mass index (BMI) was 29.3 kg/m2. HbA1c improved from 7.0% to 6.1% across trimesters (p < 0.00). Macrosomia (≥ 4 kg) occurred in 4.2% of infants, while preterm birth was more frequent in T1DM (33.3%) than in T2DM (5.0%) or prediabetes (1.8%). Retinopathy screening was completed in 67.6% of patients and continuous glucose monitoring (CGM) or pump devices were not utilised. Using Singapore LGA reference, third trimester HbA1c < 6.5% was associated with lower odds of LGA. Multidisciplinary care enhanced glycaemic control and reduced macrosomia, but women with T1DM remain at increased risk of preterm delivery and neonatal morbidity. Enhanced preconception care, retinopathy screening and adoption of real-time CGM may improve outcomes in Asian women with pre-existing diabetes in pregnancy.

Low-frequency TMS ameliorates neonatal hypoxia-ischemia injury by normalizing glutamatergic transmission in penumbra.

Long-term region-specific mitochondrial respiration impairment after perinatal asphyxia is prevented by the NAD⁺ donor nicotinamide riboside: A real-time organotypic metabolic profiling approach.

Uterine incision-to-delivery interval and neonatal outcomes among nonurgent, term, cesarean deliveries.

Assessment of socioeconomic and demographic risk factors for low birth weight using model-agnostic explainable ensembles.

Background: Malaria in pregnancy remains a major public health problem in Nigeria, contributing significantly to maternal and neonatal morbidity and mortality. Despite the effectiveness of Intermittent Preventive Treatment in pregnancy with Sulfadoxine-Pyrimethamine (IPTp-SP), its uptake remains low due to weak antenatal care (ANC) systems and inadequate health education. Aim: This study aims to assess the effect of health system strengthening on IPTp-SP uptake in Osun State, Nigeria. Methods: A non-equivalent control-group quasi-experimental design was employed, with baseline and endline facility-based surveys conducted in three secondary health facilities across Osun State. The intervention was implemented at State Specialist Hospital, Asubiaro, while State Hospital Ede and State Hospital Ilesa served as control sites. A total of 250 pregnant women aged 18–49 years who had received at least one dose of IPTp-SP were recruited using systematic sampling. The intervention, conducted over eight weeks, included structured health education, provider training, improved data documentation using NHMIS registers, WhatsApp-based reminders, and logistical support for SP administration. Data were collected using interviewer-administered questionnaires via KoboCollect and analyzed using SPSS version 23. Descriptive and comparative analyses were performed, with statistical significance set at p &lt; 0.05. Results: At baseline, both groups showed poor knowledge of malaria and IPTp-SP. Following the intervention, the intervention group demonstrated a marked improvement in knowledge of malaria causation, risk during pregnancy, and IPTp-SP use, reaching 100% correct responses in key domains, while the control group showed minimal change. Conclusion: Health system strengthening through structured ANC education improves knowledge of malaria and IPTp-SP. Integrating such education into routine ANC is essential for improving IPTp-SP uptake and reducing malaria in pregnancy.

Prematurity remains a leading cause of neonatal mortality and morbidity; with neurodevelopmental disorders among its most significant complications. Erythropoiesis-stimulating agents (ESAs) have been explored for their neuroprotective potential. To evaluate whether early prophylactic administration of ESAs in preterm neonates ( < 37 weeks' gestation) improves neurodevelopmental outcomes up to 36 months of age. A systematic search of MEDLINE, Embase, Cochrane Library, and ICTRP identified 1142 studies, of which ten met the inclusion criteria. The meta-analysis included only randomized control trials (RCTs) reporting Bayley Scales of Infant Development scores or cerebral palsy diagnosis. Among the ten included studies (eight RCTs, two retrospective cohorts), comprising 2861 preterm infants, narrative synthesis was inconclusive. Meta-analysis showed reduced odds of adverse cognitive outcomes (OR: 0.55; 95% CI: 0.35-0.85), and cerebral palsy (OR: 0.66; 95% CI: 0.45-0.97) in ESA-treated group, with no evidence of publication bias. Sensitivity analyses indicated potential fragility of pooled estimates. Εarly ESAs administration may provide cognitive benefits. Standardized methodologies and longer-term studies are needed to confirm neurodevelopmental effects and clinical relevance.

In Mexico, the Guadalupe fur seal ( Arctocephalus townsendi , GFS) is listed as Risk of Extinction, with one breeding site on Guadalupe Island, and another potential colony proposed in the late 1990s on the San Benito Archipelago (SBA). Although there are some health and mortality studies regarding GFS on Guadalupe Island, the SBA colony remains understudied. This study aimed to characterize the causes of neonatal GFS morbidity and mortality, and to assess potential threats to species conservation associated with entanglement, alopecia syndrome, and marine pollution on the West Island of the SBA during the 2024 breeding season. Field data on total births and neonate mortalities were collected during the first 30 days of life. Entanglement and alopecia syndrome incidents were recorded and analyzed to determine age class and sex predilection using Bayesian analyses. Also, marine pollution was classified and quantified by environmental debris type. The neonatal mortality rate in GFS was 29.52%. Perinate deaths were considered natural and attributed to trauma (50%) and emaciation/infectious disease (50%). The prevalence of the alopecia syndrome in non-pup GFSs was high (21% to 26%) during the 2024 breeding season. Clinically, there were bilateral and asymmetrical presentations, with a higher probability of detection of this syndrome in yearlings and juveniles, particularly in males. Entanglements were related to marine debris (100%), affecting juvenile individuals (80%) and adults (20%). A field survey of the composition of marine debris along the SBA beaches revealed that 92% was plastic, predominantly bottles (65%) and fishing gear (16%). Local or regional sources appear to contribute to pollution in the SBA based on the composition of the debris and its proximity to human habitation. Mortality and alopecia rates in immature GFSs were much higher compared to Guadalupe Island, identifying potential challenges in health and survival during early development stages in the SBA. The establishment of the GFS population in the SBA spans almost three decades; however, key demographic factors remain undetermined. Continued efforts to characterize the factors limiting the transition of the SBA from a plausible mixed to a breeding colony are warranted.

Introduction- Early-onset neonatal sepsis (EONS) is a major cause of neonatal morbidity and mortality, particularly in developing countries. Its incidence remains high due to multiple maternal and neonatal risk factors. This study aims to determine the incidence and identify risk factors associated with EONS among neonates admitted to a tertiary care Neonatal intensive care unit (NICU). Material and Method- This prospective observational study was conducted over 6 months in a tertiary care NICU, including 270 neonates admitted within 72 hours. Clinical and laboratory evaluation identified EONS cases. Maternal and neonatal risk factors were recorded. Data were analyzed using appropriate statistical tests, and multivariate logistic regression identified independent predictors, with p&lt;0.05 considered significant. Result- Among 270 neonates, 54 (20%) developed EONS. Prematurity, low birth weight, PROM &gt;18 hours, and maternal fever were significant independent risk factors. Gram-negative organisms predominated, with 55.6% culture positivity. Most cases recovered (77.8%), while mortality was 11.1%. EONS was significantly associated with adverse perinatal factors and prolonged hospital stay. Conclusion- EONS showed a 20% incidence, with PROM, prematurity, low birth weight, and maternal fever as key risk factors. Gram-negative organisms predominated. Despite good recovery, mortality remained 11.1%, highlighting the need for early risk identification, improved intrapartum care, and strengthened neonatal infection control practices.

Blood group incompatibility, particularly ABO and Rhesus (Rh) systems, remains a major contributor to maternal and neonatal morbidity, especially in settings with limited access to preventive care. This study aimed to assess the knowledge, attitude, and practice of women of reproductive age regarding blood group and Rh factor, as well as awareness of associated risks and preventive measures such as anti-D prophylaxis. A descriptive cross-sectional study was conducted among 450 women aged 15–49 years attending primary health care centres in Basra city over a six-month period. Data were collected through structured face-to-face interviews using a pretested questionnaire covering sociodemographic characteristics and knowledge, attitude, and practice domains. The mean age of participants was 30.28 ± 7.84 years, with the majority being married housewives and having primary or intermediate education. Most women (85.1%) were aware of their blood group and Rh status, and 72.6% knew their husbands’ status; however, only 4.4% actively sought this information. Although 80.4% and 80.9% of participants recognized the risks of ABO incompatibility and Rh isoimmunisation respectively, accurate knowledge was limited, with only 8.4% demonstrating correct understanding of ABO-related risks. Awareness of anti-D was moderate (55.6%), but correct knowledge regarding its timing and indication was low, with only 6.1% identifying appropriate use. Family and relatives were the predominant sources of information. Significant associations were observed between knowledge and both age and marital status. In conclusion, despite relatively high awareness levels, substantial gaps exist in accurate knowledge and practical application, highlighting the need for targeted health education and improved counselling services.

Background: Short-term morbidities and mortality decreased significantly in the past decade at preterm born &lt; 25 weeks of gestation. Severe lifelong morbidities affect an important part of these patients. Objective: to investigate the in-hospital morbidity, mortality, and short-term complications of preterm neonates born ≤25 weeks of gestation. Methods: A prospective longitudinal cohort study was conducted in children born 2021–2024, ≤25 weeks of gestation, admitted to a 3rd-level unit, and care till discharge. Pregnancy complications’ effect on neonatal evolution was analyzed, six main in-hospital morbidities specific for preterm birth and other aggravating circumstances, with a possible effect on the evolution were analyzed, as follows: inflammatory syndrome, early pulmonary or digestive hemorrhages, and early inotropic support. The neurological development in the first year of life was analyzed through theparticipation of premature infants in the follow-up program after discharge. Results: Forty-nine premature infants were enrolled, with a mean gestational age of 24.37 ± 0.76 weeks and an average weight of 665 ± 143 g. Most newborns required intubation at birth (42/49), and 33/49 received 2-dose surfactant therapy postnatally. NEC was present in 26.5% of the group, being more common in patients with inflammatory syndrome—increase in procalcitonin (PCT), and those who received a higher number of blood transfusions. The BPD and ROP, as well as the severity of the latter, correlated with the oxygen requirement on the 28th day of life. BPD was more common in infants associated with PDA requiring combination treatment. ROP increased with the number of transfusions required by patients. At the follow-up at the first timepoint evaluation, were 51% of the study group, and 30.6% of them had normal neurological development. At 12 months of age, however, the neurological examination was normal in only three patients (23.08%) but only 36.5% of the study group attended the follow-up. Neurodevelopmental disorders were present in 10 of the patients, one with spastic diplegia. Conclusions: In the hospital, the morbidity and survival rate of the group was like other studies. The small number of follow-up participants does not allow the generalization of the data, but as far as neurological development is concerned, it is like that of other studies.

Group B Streptococcus (GBS) is a major cause of neonatal sepsis worldwide. Gastrointestinal colonization by GBS is an important risk factor for late-onset disease in newborns. Most studies of GBS pathogenesis rely on animal models with limited human relevance or use immortalized adult human cells that do not recapitulate the unique genetic and phenotypic features of the neonatal intestinal epithelium. Previous studies using tissue-derived human intestinal enteroids (HIEs) and induced pluripotent stem cell-derived human intestinal organoids (HIOs) to model host interactions with enteric pathogens have yielded valuable insights. Here, we describe the use of GBS-exposed HIEs and HIOs to study GBS interactions with the immature human intestinal epithelium. Using these models, we demonstrated that GBS induces changes in gene expression of both HIEs and HIOs that are distinct from what has been reported in immortalized adult cell lines. We observed GBS attachment to the apical surfaces of HIEs and HIOs and, in some cases, translocation across intestinal epithelial barriers. To examine the impact of GBS exposure on intestinal barrier function, we generated polarized HIE monolayers on Transwell plates. We observed GBS translocation across monolayers, accompanied by a trend in increased epithelial barrier permeability reflected by decreased transepithelial electrical resistance. These data demonstrate that both HIEs and HIOs are robust and useful models for studying the pathogenesis of late-onset GBS infection in the vulnerable newborn host. Importantly, they provide a much-needed platform to test novel preventative strategies.IMPORTANCEGroup B Streptococcus (GBS) is a major cause of infectious morbidity and mortality in neonates. Late-onset GBS disease, which develops after the first week of life, arises when GBS colonizes the neonatal gut and compromises intestinal barriers, resulting in systemic infection. Studies investigating the pathogenesis of late-onset GBS disease typically employ animal models or in vitro immortalized adult human intestinal cell lines, which can limit the applicability of findings to human neonates. In this study, we introduce the use of three-dimensional fetal tissue-derived human intestinal enteroids and induced pluripotent stem cell-derived human intestinal organoids to study GBS-host interactions within the gut. These novel models demonstrate improved ability to recapitulate the vulnerability of the immature human host and function as a platform to test novel interventional strategies to protect exposed newborns.

To examine the risks of maternal, neonatal and non-obstetrical medical complications in individuals with cerebral palsy (CP) compared to those without CP. Population-based cohort study. Ontario, Canada. Females aged 13-54 years with a livebirth or stillbirth, 2004-2023. Individuals with (N = 1400) and without CP (N = 2 276 561) were compared using modified Poisson regression, adjusted for socio-demographics, followed by clinical characteristics. Maternal (e.g., severe maternal morbidity or mortality), neonatal (e.g., severe neonatal morbidity or mortality) and non-obstetrical medical complications (e.g., seizure disorders) in the perinatal period. After adjusting for socio-demographics, individuals with CP had an elevated risk, compared to those without CP, of severe maternal morbidity or mortality (adjusted relative risk [aRR] 1.79, 95% confidence interval [CI] 1.36-2.34), caesarean section (1.38, 1.27-1.50) and maternal hospital readmission (1.86; 1.34-2.58). Their newborns were at elevated risk for preterm birth (1.67, 1.43-1.94), small for gestational age (1.34, 1.19-1.52), congenital anomalies (1.77, 1.40-2.24) and severe neonatal morbidity or mortality (1.48, 1.28-1.71). Individuals with CP were also at elevated risk of seizure disorders (13.06, 10.45-16.33) and urinary tract infections (1.50, 1.25-1.79) perinatally. aRRs were slightly attenuated, but remained statistically significant after further adjusting for clinical characteristics. Individuals with CP are at elevated risk of adverse pregnancy outcomes. Findings suggest the need for enhanced preconception counselling, perinatal monitoring and postpartum supports for individuals with CP, facilitated by multidisciplinary care teams.

Birthweight-for-gestational-age status was associated with distinct trajectories of early gut microbial maturation. SGA infants exhibited delayed microbial stabilization and fragmented interaction networks, whereas LGA infants demonstrated relatively early establishment of stable, Streptococcus-enriched communities. These growth-specific microbial patterns may reflect differences in early metabolic programming and highlight the potential importance of tailored microbiome-targeted strategies to optimize neonatal development. • Abnormal fetal growth is associated with increased neonatal morbidity and long-term metabolic risk. • Early-life gut microbiota play an important role in immune and metabolic development. • This longitudinal study demonstrates growth-specific trajectories of early gut microbial maturation among SGA, AGA, and LGA infants born at ≥35-week gestation. • SGA infants exhibit delayed microbial stabilization and fragmented microbial interaction networks, whereas LGA infants show relatively earlier establishment of stable microbial communities.

Preterm birth (PTB) is a principal contributor to neonatal morbidity, wherein inflammation and dysregulated cell death pathways are implicated as key drivers in its pathogenesis. However, the role of the RIPK1/RIPK3-MLKL signaling axis, a critical regulator of necroptosis and inflammatory responses, remains poorly characterized in the context of PTB. Here, we sought to elucidate the role of RIPK1-mediated activation of the RIPK3-MLKL pathway in placental inflammation and its involvement in PTB pathogenesis. In vitro experiments were conducted using TNF-α-stimulated HTR8/SVneo trophoblasts, while an LPS-induced murine model was employed to mimic inflammation-associated PTB. RIPK1 expression was modulated via shRNA-mediated knockdown or pharmacological inhibition with GSK2982772 and Nec-1. Molecular analyses included qPCR, Western blotting, ELISA, and the assessment of necroptosis via PI staining. We found that TNF-α and LPS significantly upregulated RIPK1 expression and activated the RIPK3-MLKL pathway in both the cellular and animal models. RIPK1 knockdown or pharmacological inhibition attenuated TNF-α-induced proinflammatory cytokine release (IL-1β, IL-6, TNF-α), uric acid accumulation, RIPK3-MLKL pathway activation, and necroptosis in trophoblasts at both 24 and 48 h. Notably, in vivo treatment with Nec-1 ameliorated LPS-induced placental damage. Collectively, our findings demonstrate that RIPK1 drives inflammation and necroptosis in PTB through RIPK3-MLKL activation, suggesting that targeting RIPK1 may represent a promising therapeutic strategy for inflammation-associated preterm labor.

Birth trauma remains a significant global health challenge and contributes substantially to neonatal morbidity and mortality. Although machine learning (ML) approaches have shown promise in predicting birth trauma, persistent limitations related to class imbalance, model interpretability, and incomplete characterization of risk hinder their clinical utility. This study aimed to develop and evaluate an ensemble ML framework capable of leveraging high-dimensional clinical data to capture both established and latent risk factors while maintaining transparency for clinical interpretation. We implemented a Super Learner ensemble integrating multiple base learners, class-balancing strategies, and SHAP-based explainability. On an independent test set, the ensemble correctly classified 102 true negatives and 12 true positives, with 25 false negatives and 2 false positives, yielding an overall accuracy of 80.9% (95% CI: 73.4%-87.0%). Model performance exceeded the no-information rate (p = 0.031) and demonstrated fair agreement beyond chance (Cohen's κ = 0.38). Diagnostic performance was characterized by high specificity (98.1%) and positive predictive value (85.7%), but limited sensitivity (32.4%), resulting in a balanced accuracy of 65.3%. These findings highlight the inherent trade-off between sensitivity and specificity in imbalanced neonatal datasets while underscoring the potential of ensemble ML methods to support early identification of neonates at elevated risk for birth trauma. Integrating robust data science methodologies with clinical domain expertise provides a pathway toward more accurate, interpretable, and actionable decision-support tools in neonatal care.

Maternal nutritional status during pregnancy plays a crucial role in fetal growth and is a key determinant of newborn birth weight. Inadequate maternal nutrition increases the risk of low birth weight (LBW), which is strongly associated with increased neonatal morbidity and mortality. This study aimed to examine the relationship between maternal nutritional status during pregnancy and newborn birth weight. A facility-based analytical study with a case–control design was conducted at a Community Health Center. A total of 36 mother–newborn pairs were recruited using a 1:1 case–control ratio. Maternal nutritional status was assessed using anthropometric indicators recorded during pregnancy, and newborn birth weight was measured within 1 hour of delivery. Data were analyzed using the chi-square test with α = 0.05. The analysis revealed a statistically significant association between maternal nutritional status and newborn birth weight (p = 0.003). Mothers with adequate nutritional status were more likely to deliver infants with normal birth weight than those with poor nutritional status. Conversely, low birth weight was more frequently observed among infants born to mothers with inadequate nutritional status during pregnancy. Maternal nutritional status during pregnancy is significantly associated with newborn birth weight in this primary health care setting. Strengthening early nutritional screening and interventions for pregnant women is essential to reduce the risk of low birth weight and improve neonatal health outcomes.

High-risk prenatal care is essential to reducing maternal and neonatal morbidity and mortality, especially when initiated early and provided continuously with quality standards. However, significant barriers still hinder access to specialized care. Structural obstacles include insufficient referral services, overloaded clinics, regulatory failures and fragmentation between primary and specialized care. Geographic and socioeconomic barriers, such as distance to specialized centers, transportation difficulties, travel costs, poverty and low educational levels, intensify inequalities. Psychosocial and cultural factors, including fear, anxiety, stigma and negative healthcare experiences, also compromise adherence. Late initiation of prenatal care increases adverse outcomes, reinforcing the need to strengthen public policies, expand service availability, integrate healthcare levels and improve professional training to ensure equitable and humanized care.

Perinatal asphyxia accounts for nearly one-quarter of neonatal complications worldwide, positioning as a primary driver of neonatal death and long-term health issues. For neonates identified with perinatal asphyxia, the probability of adverse outcomes fluctuates throughout their hospitalization, with distinct patient characteristics and medical variables impacting their recovery path differently at various points post-admission. Survival-based approaches that use duration of stay as the time scale are therefore essential for characterizing this time-varying risk in resourcelimited settings. A study was conducted on neonates admitted to the Neonatal Intensive Care Unit (NICU) and Special Newborn Care Units (SNCU) at Dr. Ram Manohar Institute of Medical Sciences (RMLIMS) in Lucknow, Uttar Pradesh, from January 1, 2024, to December 31, 2024, covering the period from admission to discharge. The event of interest was on perinatal asphyxia morbidity in neonates. Neonates who were discharged alive were treated as censored observations. We used semi-parametric Cox proportional hazards regression and parametric Weibull, Exponential, log-logistic, and Gompertz survival models to identify key predictors of perinatal asphyxia. Among these applied models, the Weibull proportional hazards model showed the best fit. The model's adequacy was confirmed with the Cox-Snell residual plot. Key significant predictors of perinatal asphyxia included the absence of cry at birth, a low five-minute APGAR score (Appearance, Pulse, Grimace, Activity, and Respiration), preterm gestational age, prolonged labor, fetal distress, and the need for resuscitation at birth. Weibull parametric survival models offer a solid framework for understanding time-dependent perinatal asphyxia risk in resource-limited NICU settings. The identified predictors define a clinically actionable risk profile spanning intrapartum events, neonatal condition at birth, and gestational maturity.

Maternal Attention Deficit Hyperactivity Disorder and Adverse Obstetrical and Perinatal Outcomes: A Population-based Cohort Study in Ontario, Canada.