Gestational arginine vasopressin (AVP) disorder is classified into 3 categories: AVP deficiency (AVP-D), AVP resistance, and excess vasopressinase-induced AVP disorder. This is the first case report of gestational AVP disorder linked with magnesium sulfate administration. A 27-year-old woman pregnant with twins was admitted to our hospital with threatened preterm labor (TPL). The day after continuous intravenous magnesium sulfate administration for TPL was initiated, the patient suddenly developed thirst, polydipsia, and polyuria. Because the plasma AVP level was extremely low and the urine was hypotonic, AVP-D was initially suspected. Her symptoms were effectively controlled using desmopressin. However, its administration became unnecessary the day after delivery, inconsistent with the typical clinical course of AVP-D. The removed placenta was nearly twice as heavy as that in typical singleton cases, and serum vasopressinase levels immediately before delivery were markedly elevated. The results of the hypertonic saline infusion test performed soon after delivery suggested an underestimation of plasma AVP levels due to AVP degradation by excess vasopressinase. We have encountered 8 similar cases since 2021, suggesting that coexisting subclinical excess vasopressinase-induced AVP disorder may contribute to the development of magnesium sulfate-associated gestational AVP disorder. The inhibition of AVP secretion from the posterior pituitary gland by markedly increasing circulating magnesium ions may be associated with the manifestation of subclinical excess vasopressinase-induced AVP disorder. We encountered 9 cases of previously unreported magnesium sulfate-associated gestational AVP disorder in the past 4 years alone, suggesting that many similar cases may be overlooked in clinical practice.

Abstract Introduction: Aspirin or acetylsalicylic acid (ASA) is classified as a nonsteroidal anti-inflammatory drug, and it is commonly used to reduce fever, alleviate pain, and has anti-inflammatory properties. Pregnant women often use aspirin, especially in the first trimester of pregnancy, as it is easily available over-the-counter. It is prescribed for long-term use during pregnancy in certain chronic conditions and to manage obstetrical complications like preterm labor and polyhydramnios. As there is limited literature about the teratogenic effects of aspirin, the present study has been undertaken. Methods: Pregnant Swiss albino mice were separated into two groups, comprising 88 mice each: a control and a treated. The treated group was administered aspirin at a dose of 100 mg/kg body weight via the oral route from the 3 rd to the 5 th day of gestation, while the control group received an equivalent volume of tap water orally. On the 19 th day of gestation, the mice from each group were sacrificed. The collected fetuses were carefully examined and photographed to document any visible abnormalities. After being fixed in a 10% neutral formalin solution, the brain of the fetuses were extracted, photographed, and then further processed for histological examination. Results: Gross examination reveals no malformations in control group fetuses, while 40.3% of treated group fetuses show hemorrhagic spots, 20.7% have forelimb deformities, and other defects are noted, including reduced crown-rump length and venous congestion. Microscopic examination of the cerebral cortex in treated fetuses shows significant neurotoxic changes, including edema, cell degeneration, and prominent cellular debris. Conclusions: While aspirin is commonly utilized, it poses potential risks of toxicity and teratogenic effects. Therefore, clinicians should thoroughly justify its use in women during the early stages of pregnancy.

Cervical Stiffness Index as predictor of preterm birth in women with threatened preterm labor.

Prevalence, risk factors, diagnosis and outcomes of Toxoplasma gondii infection in pregnancy: A review.

Preterm labour induction: modalities, implications and outcomes.

Antenatal corticosteroid treatment (ACS), administered intramuscularly to pregnant women, is recommended as standard care when birth before 34 weeks of gestational age is anticipated. ACS is widely recognized for its ability to reduce neonatal mortality and morbidity, but it may affect maternal mental health due to its neuropsychiatric side effects and its timing during a period of heightened psychological vulnerability. Despite this, the potential association between ACS and maternal postpartum psychiatric disorders remains understudied. This study aimed to examine the possible associations between ACS and maternal postpartum depression and other postpartum psychiatric disorders. This register-based cohort study included 165,936 births by 130,235 unique women at seven Danish hospitals between 2003 and 2018. Data on ACS administration, pregnancies, births, postpartum psychiatric disorders, and potential confounders were retrieved from Danish registers. The women were followed 1 year after giving birth for incident psychiatric disorders, and associations with ACS were explored in Cox proportional hazards regression models. The models were clustered by maternal ID and adjusted for sociodemographic, obstetric, and psychiatric covariates to estimate hazard ratios (HRs) with corresponding 95% confidence intervals (CIs). An interaction between gestational age and ACS exposure was included in all models. Women who had been exposed to ACS but gave birth at term or post-term had significantly higher hazards of postpartum depression, other postpartum psychiatric disorders, and the combined outcome compared with non-exposed women giving birth at similar gestational ages, with HRs: 1.66 (1.18-2.33), 1.50 (1.03-2.19), and 1.64 (1.24-2.18), respectively. In contrast, associations among women who gave birth preterm were not statistically significant. ACS exposure was associated with increased risks of maternal postpartum psychiatric disorders among women who gave birth term or post-term, but not among those who gave birth preterm. The increased risks in the term/post-term group are likely attributable to unmeasured confounding. These findings provide reassurance that ACS is unlikely to substantially increase the risk of postpartum psychiatric disorders among women delivering preterm, but they also highlight the need for attentive follow-up of women with threatened preterm labor who ultimately give birth at term. Our results also call for improved registration of ACS administration to strengthen future surveillance and drug safety.

Background:Type 1 diabetes mellitus is associated with adverse maternal and neonatal outcomes. We aimed to evaluate the impact of CGM use on glycemic control and neonatal and maternal outcomes.Methods:This was a single-center study with prospective longitudinal data collection of pregnant women with T1DM allocated to 1 of 2 monitoring methods: Capillary blood monitoring and interstitial fluid glucose monitoring.Results:A total of 30 patients were enrolled. The average age was 31.26 ± 3.39 years, with an average gestational age of 9.4 ± 3.63 weeks at the first consultation. The average diabetes duration was 15.6 ± 7.36 years, with a mean preconception HbA1c of 8.67 ± 0.95%. The average BMI was 25 ± 2.88 kg/m2, and the average weight gain throughout pregnancy was 8.26 ± 5.84 kg. There was a substantial decrease in TBR compared to the control group. The control group had a slightly greater rate of pregnancy-induced hypertension, toxemia, eclampsia, and premature labor (33%, 13%, 7%, and 40%, respectively) than the CGM group (26%, 7%, 0%, and 26%). The differences were not statistically significant. Furthermore, the control group had a greater rate of preterm birth, neonatal hypoglycemia, NICU admission, and congenital abnormalities (27%, 40%, 46%, and 6.7%, respectively) than the CGM group (20%, 33%, 33%, and 0%, respectively), with no significant differences. The rates of macrosomia (20%), LGA (13%), neonatal respiratory distress (33%), and stillbirth (7%) were comparable between the groups. However, hydramnios occurred slightly more frequently in the CGM group (46% vs 40% in the control group).Conclusion:Early implementation and sustained use of CGM in pregnant women with T1DM may optimize glucose control and mitigate maternal-fetal risks.

Due to limitations in observational studies, the link between COVID-19 and adverse pregnancy outcomes (APOs) remains inconclusive. This study uses two-sample Mendelian randomization (MR) analyses to assess COVID-19's causal effects on APO traits. We applied inverse variance weighting (IVW), MR-Egger, weighted median, weighted mode, and simple mode to thoroughly evaluate the effects of COVID-19 infection, hospitalization, and critical status on eight APO traits. Our findings indicate that COVID-19 infection is associated with a decreased risk of eclampsia (OR: 0.35, 95%CI [0.13, 0.94]; p = 0.033) and the number of spontaneous miscarriages (OR: 0.95, 95%CI [0.91, 0.99]; p = 0.014), and an increased risk of preterm labor and delivery (OR: 1.30, 95%CI [1.04, 1.63]; p = 0.019). Hospitalized COVID-19 is associated with pre-eclampsia (OR: 1.13, 95%CI [1.00, 1.28]; p = 0.040), pre-eclampsia or eclampsia (OR: 1.14, 95%CI [1.01, 1.28]; p = 0.029), pregnancy hypertension (OR: 1.09, 95%CI [1.01, 1.18]; p = 0.021), hypertension complicating pregnancy, childbirth, and the puerperium (OR: 1.09, 95%CI [1.01, 1.18]; p = 0.021), and oedema, proteinuria, and hypertensive disorders in pregnancy, childbirth, and the puerperium (OR: 1.10, 95%CI [1.03, 1.19]; p = 0.005). Critical COVID-19 is a risk factor for pre-eclampsia or eclampsia (OR: 1.08, 95%CI [1.00, 1.17]; p = 0.044) and oedema, proteinuria, and hypertensive disorders in pregnancy, childbirth, and the puerperium (OR:1.05, 95%CI [1.00, 1.11]; p = 0.031). Our study uncovered genetic evidence supporting COVID-19 as a causal risk factor for APOs, suggesting the importance of prioritizing therapeutic interventions for pregnant women infected with COVID-19 within society.

ABSTRACTPurposeTo compare total testosterone (TT) measured by liquid chromatograph‐tandem mass spectrometry (LC–MS/MS) with electro‐chemiluminescent immunoassay (ECLIA) in the diagnosis and management of infertile women with polycystic ovary syndrome (PCOS).MethodsBaseline TT was measured by LC–MS/MS and ECLIA in 906 infertile women with PCOS. The associations of TT from both methods with clinical phenotypes and fertility outcomes were estimated; relative risk (RR) and 95% confidence intervals (CIs) were computed. Subgroup analysis was conducted according to the TT levels.ResultsThe average TT levels measured by ECLIA were higher than those measured by LC–MS/MS (mean percentage difference 23.8%, 95% limits of agreement −44.2% to 91.9%). When biochemical hyperandrogenism (HA) defined as TT ≥ 1.7 nmol/L by LC–MS/MS method, a higher proportion of patients were identified having biochemical HA using ECLIA (44.0% vs. 24.0%, p < 0.001) than LC–MS/MS. Only those with TT levels ≥ 1.7 nmol/L measured by LC–MS/MS had an increased risk of adverse fertility outcomes compared to patients with normal TT levels, including ovulation, preterm labor, and neonatal intensive care unit.ConclusionOur findings indicated that LC–MS/MS refined the diagnosis of biochemical hyperandrogenism and better identified the subgroup at genuine risk of adverse fertility outcomes in infertile women with PCOS.Trial RegistrationThe NIH Clinical Trial Registry number: NCT01573858 and Chinese Clinical Trial. Registry number: ChiCTR‐TRC‐12002081

A Comparative Study of Cervical Cerclage and Vaginal Progesterone in the Prevention of Preterm Labour

The aim of this research was to evaluate the diagnostic efficacy of integrating cervical length (CL), interleukin-6 (IL-6), placental alpha microglobulin-1 (PAMG-1), and fetal fibronectin (fFN) in predicting preterm birth among pregnant women with threatened preterm labor (TPL). This study retrospectively analyzed clinical data from 150 pregnant women admitted for TPL between January 2021 and December 2024. Participants were divided into two groups based on pregnancy outcome: full-term delivery (n=85) and preterm birth (n=65). Additionally, 100 healthy pregnant women with no history of adverse pregnancy outcomes who underwent routine prenatal examinations during the same period were selected as the healthy control group. All participants underwent transvaginal ultrasound to measure CL, and venous blood samples were collected to assess serum IL-6 levels. PAMG-1 and fFN levels were measured in vaginal secretions. There were no significant differences in baseline characteristics among the three groups. However, significant differences in CL, serum IL-6 levels, and positive rates of PAMG-1 and fFN were detected. Pearson correlation analysis showed significant associations between CL, IL-6, PAMG-1, fFN, and preterm birth. ROC curve analysis indicated that the AUC values for CL, IL-6, PAMG-1, and fFN alone were 0.798, 0.803, 0.753, and 0.754, respectively. The combined application of these markers yielded an AUC of 0.920, significantly higher than any single marker. The combined use of CL, IL-6, PAMG-1, and fFN significantly enhances the diagnostic accuracy of preterm birth in patients with TPL.

Women threatening premature delivery receive synthetic glucocorticoids (sGC) to reduce offspring neonatal respiratory distress. Evidence linking prenatal sGC exposures to adverse cardiovascular outcomes is accumulating. We studied adult baboons, which had been exposed in utero to sGC equivalent to a human therapeutic dose, and compared to age-matched saline-exposed controls (CTR). Magnetic resonance imaging was performed in middle-aged male offspring (~10.5 y.) and in both sexes at old age (~16.5 y.) to assess heart structure, function, and paracardial adipose thickness (PAT). Postmortem left ventricular (LV) tissues were analyzed for mitochondrial electron transport chain complex activities and protein expression. In sGC vs CTR males, LV end-systolic (ESSI) and end-diastolic (EDSI) sphericity indexes increased with age (ESSI: p=0.0001, EDSI: p=0.002) being greater in elderly sGC group (ESSI: p=0.03, EDSI: p=0.0001 two-way ANOVA). In sGC-exposed males, global longitudinal strain (GLS) decreased with age versus CTR (p=0.03) and PAT was greater (p=0.03) than CTR males. In elderly sGC-exposed baboons, ejection fraction (p=0.04), ESSI (p=0.002), and PAT (p=0.002) were greater in males than females, while global radial strain (p=0.032) and GLS (p=0.014) were lower. EDSI was higher in both male and female sGC than in CTR (M: p=0.014, F: p=0.009). Mitochondrial analyses revealed reduced Complex I-linked respirations (p<0.05) with a negative correlation between PAT and MTCO1 mitochondrial protein in males (p=0.02), but not females. These results indicate that fetal sGC exposure impairs heart function and metabolism. Enhanced lifelong monitoring could improve understanding of the sex-specific mechanisms impacted by antenatal sGC.

Challenges of pregnancy in pancreas-kidney transplant recipients: Experience from our center.

Abstract Background Peripartum cardiomyopathy (PPCM) is a rare but life-threatening form of heart failure that typically occurs in late pregnancy or early postpartum. Management of PPCM may be challenging due to hypotension and the unfavorable effect of medication on fetus. Case summary A 26-year-old woman with a twin pregnancy was referred at 10 weeks of gestation for evaluation of premature ventricular contractions. Echocardiography revealed left ventricular ejection fraction (LVEF) of 70%, and NT-proBNP level was 75 pg/mL on blood testing. She was hospitalized at 30 weeks of gestation for threatened preterm labor and diagnosed as pre-eclampsia. At that time, LVEF decreased to 40%, and NT-proBNP level increased to 4359 pg/mL, prompting an urgent cesarean section. After delivery, heart failure therapy with carvedilol, spironolactone and furosemide was initiated, but carvedilol was discontinued due to hypotension. On postpartum day 39, she was readmitted with worsening dyspnea. Breastfeeding was ceased. Although bisoprolol and empagliflozin were initiated, LVEF further dropped to 27%. She was discharged with NYHA functional class III. Because LVEF remained impaired despite ongoing heart failure therapy, sacubitril/valsartan was initiated on postpartum day 122. Subsequently, LVEF improved to 60%, and NT-pro BNP decreased to 569 pg/ml. The patient became asymptomatic and tolerated therapy well. Discussion This case highlights the complexity of PPCM management. Sacubitril/valsartan may serve as an effective therapeutic option for PPCM patients who are intolerant intolerant to conventional therapy.

BackgroundVaginal cervical cerclage and progesterone are established treatments for prevention of pregnancy loss and prematurity. There is limited data to assess the effect of these treatments in combination. The objective of this study was to investigate the association between progesterone and no progesterone treatment on pregnancy outcomes in women at high risk of preterm birth who had received a vaginal cervical cerclage.Methods and findingsThis is a secondary post-hoc analysis of women recruited to the C-STICH randomised controlled trial, which recruited in 75 obstetric units in the UK between 2015 and 2021. In the C-STICH trial, women with a singleton pregnancy, receiving a vaginal cervical cerclage due to a history of pregnancy loss or premature birth, or if indicated by ultrasound, were randomised to cerclage with braided or monofilament suture, with a primary outcome of pregnancy loss, defined as miscarriage, stillbirth, or neonatal death in the first week of life. In this secondary analysis, the primary outcome was pregnancy loss, defined as miscarriage and perinatal mortality, including any stillbirth or neonatal death in the first week of life. Secondary maternal outcomes included miscarriage and previable neonatal death; stillbirth; gestational age at delivery; preterm pre labour rupture of membranes, and sepsis. Secondary neonatal outcomes included early/late neonatal death and sepsis. For each outcome, regression models were fitted adjusting for prespecified prognostic variables.From the 2,048 women recruited to C-STICH, 1943 (95%) women had a vaginal cerclage placed and available progesterone data. Of these, 834 (43%) women received progesterone and 1,109 (57%) did not receive progesterone. In women with primary outcome data available, in our predefined analysis pregnancy loss occurred in 49 (5.9%) of 832 women who received progesterone and 91 (8.3%) of 1,103 women who did not receive progesterone (adjusted* risk ratio 0.70 (95% confidence interval (CI) [0.50, 0.99]); adjusted risk difference −0.02 (95% CI [−0.04, −0.001], *adjusted for indication, obstetric history, surgical technique, and maternal age). Further exploratory analysis excluding women who had termination of pregnancy for foetal anomaly demonstrated a nonsignificant reduction in the risk of pregnancy loss. Key limitations of this study include a nonrandomised trial design and unknown confounding relating to variation in progesterone use.ConclusionIn women with a vaginal cervical cerclage and concomitant progesterone there appears to be an association with a reduced risk of pregnancy loss. This combination therapy may be an important opportunity to further reduce the risk of pregnancy loss in this high-risk cohort.

Preterm infants are commonly treated with antibiotics on admission to the neonatal unit as part of routine care. We aimed to identify infants <32 weeks' gestation at low risk of early onset sepsis (EOS) in whom antibiotics could be safely withheld. This retrospective cohort study included infants <32 weeks' gestation admitted between January 2012 and June 2022. Data were extracted from electronic databases. Low risk for EOS (LR) was defined as caesarean section delivery, rupture of membranes <1 hour prior to birth, no preterm labour and no features of maternal chorioamnionitis. Maternal and neonatal characteristics and neonatal outcomes were compared between LR and not low risk (NLR) infants. IBM SPSS Statistics (Version 29) was used for data analysis. There were 3285 infants included in the analysis of which 1035 (31.5%) were LR and 2250 (68.5%) NLR. No LR infants had culture-confirmed EOS compared with 35 (1.6%) NLR infants. Antibiotics were commenced in the first 48 hours of life in 794 (76.7%) LR and 2159 (96.0%) NLR infants (p <0.001) and continued for ≥5 days in 226/782 (28.8%) LR and 603/2107 (28.6%) NLR infants, despite negative blood cultures. There was no difference in mortality or late-onset sepsis between LR and NLR infants. Simple clinical parameters available at birth can be used to identify very preterm infants at lower risk of EOS in whom withholding empiric antibiotics could be considered.

Maternal seroma has been noted following open maternal fetal surgery (OMFS) for fetal neural tube defect (fNTD) closure but the risk factors, timing of diagnosis, natural course and clinical significance have not been reported. Retrospective review of 340 patients who underwent OMFS for fNTD. Postoperative ultrasound images were reviewed and seroma details were recorded. Perioperative characteristics and delivery outcomes were then compared in patients that did or did not develop a seroma after OMFS. Multivariable logistic regression was performed to identify risk factors for seroma. Of 330 patients with ongoing pregnancies at least 10 days after OMFS,122 patients (37%) had sonographic evidence of seroma on postoperative imaging. Median postoperative day at diagnosis was 11 with median time to resolution of 21 days. Median longest diameter at diagnosis was 5.23 cm with an initial volume of 9.66 mL. Seromas minimally increased in size prior to resolution. Multivariable logistic regression identified increasing maternal age and BMI as significant risk factors for seroma (OR 1.08 and 1.17). There was no difference in the incidence of post-OMFS complications in those who did and did not develop seroma, including no difference in the rate of membrane separation, oligohydramnios, preterm premature rupture of membranes, placental abruption, preterm labor, gestational age at delivery, fetal demise, or hysterotomy dehiscence. Following cesarean delivery, there was no difference in wound infection, but there was a higher incidence of wound separation in the group that had a seroma (7.4% vs 1.9%, p=0.019). In this cohort, one-third of patients undergoing OMFS developed seroma with no associated change in wound healing or prenatal course. Risk factors included older maternal age and increased BMI. Most were small and resolved, without intervention, prior to delivery. Following cesarean, there was an increased rate of wound separation in patients who previously developed seroma.

Term full dilatation cesarean delivery (FDCD) is associated with an increased risk of subsequent spontaneous preterm birth (sPTB). The impact of preterm FDCD on recurrent sPTB is unknown. We investigated the relationship between recurrent sPTB and the mode of prior sPTB. This is a retrospective cohort study of singleton pregnant women attending two high-risk preterm birth surveillance clinics (University College London Hospital and St Thomas' Hospital London, UK), with one previous sPTB (24-36 + 6 weeks). Women were categorized according to their mode of birth in the index sPTB pregnancy: (1) preterm FDCD, (2) preterm vaginal birth and (3) preterm cesarean delivery at <10 cm cervical dilatation (CD < 10 cm). The primary outcome was recurrent sPTB <37 weeks of gestation. Secondary outcomes included sPTB <34 weeks, <28 weeks, spontaneous late miscarriage and short cervical length (≤25 mm). In a subgroup of women with preterm FDCD, CD scar characteristics were assessed during the second trimester of pregnancy using transvaginal ultrasound. Median gestation of prior sPTB was similar across all groups (32 weeks; p = 0.454). Recurrent sPTB <37 weeks was significantly more common in women with previous preterm FDCD, 38.1% (8/21) compared to vaginal birth, 15.1% (16/106) or CD < 10 cm, 13.8% (15/109); aOR 4.4 (95% CI 1.3-14.9; p = 0.023) and 5.1 (95% CI 1.6-16.5; p = 0.022), respectively. Recurrent sPTB <34 weeks was even higher in the previous preterm FDCD group, 23.8% (5/21) compared to vaginal birth 4.7% (5/106) or CD < 10 cm 8.3% (9/109); aOR 16.6 (95% CI 2.8-97.2; p = 0.016) and 5.7 (95% CI 1.4-23.1; p = 0.022), respectively. CD scar location was assessed in 15 women with preterm FDCD in one centre. Scar visualization was 87%, with 77% (10/13) of scars being located within the cervix or <5 mm above the internal cervical os. Women undergoing FDCD following preterm labor have a significantly higher risk of recurrent sPTB at <37 and <34 weeks of gestation compared to women with previous preterm vaginal birth or CD prior to the second stage of labor. These findings suggest that preterm FDCD may further compromise cervical function. It is important that clinicians are aware of this increased risk of recurrent sPTB to guide patient counseling and management accordingly.

Preterm birth occurs in approximately 10% of all pregnancies, and is not only the leading cause of neonatal mortality but also a major contributor to short- and long-term morbidities due to immaturity. Preterm birth has also been linked to an increased risk of maternal cardiovascular and cerebrovascular diseases, making it a critical concern in both perinatal medicine and women's lifelong health. Effective treatment requires interventions during threatened preterm labor, and several tocolytic agents have been developed and used in clinical practice. However, no pharmacological agent has been shown to prolong gestation and improve neonatal outcomes. Nifedipine, a calcium channel blocker, is widely used as a first-line tocolytic agent because of its oral administration route and relatively favorable safety profile compared with other drugs. Evidence from randomized controlled trials, meta-analyses, and Cochrane reviews suggests that nifedipine can delay delivery for a short period; however, robust evidence demonstrating sustained prolongation of pregnancy or improved neonatal survival is still lacking. Moreover, data on maternal hemodynamic changes and fetal effects are limited, highlighting the need for optimal dosing strategies and monitoring protocols. In this study, we discuss the clinical significance and limitations of nifedipine in the management of threatened preterm labor and outlined future directions. Future studies should involve large and homogeneous populations, continuous assessment of maternal hemodynamics, and application of novel biomarkers to support individualized therapy. Accumulation of such evidence is expected to optimize the management of threatened preterm labor and ultimately improve outcomes for mothers and infants.

Iron deficiency anemia (IDA) remains the most common hematologic disorder during pregnancy and one of the leading causes of maternal and perinatal complications worldwide. The increased iron demand associated with fetal growth, placental development, and maternal blood volume expansion often exceeds dietary intake, leading to progressive depletion of iron stores and the development of anemia. Severe IDA is associated with significant risks, including maternal fatigue, cardiovascular strain, infection, preterm labor, low birth weight, and impaired neonatal neurodevelopment. This review summarizes current international evidence from 2015 to 2025 on the clinical course, diagnosis, outcomes, and management of severe iron deficiency anemia in pregnant women, emphasizing WHO, ACOG, and FIGO guidelines. Analysis of recent studies indicates that timely screening, measurement of hemoglobin and ferritin levels, and individualized iron supplementation—preferably oral for mild to moderate cases and intravenous for severe anemia—are essential for improving maternal and fetal outcomes. Despite progress in prevention and treatment strategies, severe IDA continues to represent a significant challenge in obstetric practice, highlighting the need for stronger implementation of standardized screening protocols and broader access to evidence-based care.