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Objective To assess the relationship between the 5 min Apgar score and developmental vulnerability at 5 years of age. Design Population-based retrospective cohort study. Setting Manitoba, Canada. Participants All children born between 1999 and 2006 at term

BackgroundExposure to parental chronic illness is associated with several adverse developmental outcomes.ObjectivesWe examined the association between parental multiple sclerosis (MS) and childhood developmental outcomes.MethodsWe conducted a population-based retrospective cohort study in Manitoba, Canada, using linked databases. The outcome was childhood development at 5 years of age, expressed as vulnerability (absent vs. present) on the Early Development Instrument (EDI). Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI).ResultsChildren with an MS parent (n=153) were similar to children of unaffected parents (n=876) on all EDI domains. However, mental health morbidity was more common among MS parents compared with non-MS parents 49.5% vs. 35.3%. Among MS parents, mental health morbidity was associated with children's vulnerability on the social competence (OR, 5.73 [95% CI:1.11-29.58]) and emotional maturity (OR, 3.03 [95% CI:1.03-8.94]) domains. The duration of child's exposure to parental MS was associated with vulnerability on the physical health domain (OR, 1.49 [95%CI:1.03-2.15]).ConclusionParental MS was not associated with adverse early childhood developmental outcomes. However, children of parents with mental health morbidity, and those with longer duration of exposure to parental MS, were at higher risk for early childhood developmental vulnerability.

Objective: To evaluate whether there is a differential benefit of planned Cesarean delivery (CD) over planned vaginal delivery (VD) in women with a twin pregnancy and the first twin in cephalic presentation, depending on prespecified baseline maternal and pregnancy characteristics, and/or gestational age (GA) at delivery. Methods: This was a secondary analysis of the Twin Birth Study, which included 2804 women with a twin pregnancy and the first twin (Twin A) in cephalic presentation between 32 + 0 and 38 + 6 weeks' gestation at 106 centers in 25 countries. Women were assigned randomly to either planned CD or planned VD. The main outcome measure was composite adverse perinatal outcome, defined as the occurrence of perinatal mortality or serious neonatal morbidity in at least one twin. The baseline maternal and pregnancy characteristics (markers) considered were maternal age, parity, history of CD, use of antenatal corticosteroids, estimated fetal weight (EFW) of Twin A, EFW of Twin B, > 25% difference in EFW between the twins, presentation of Twin B, chorionicity on ultrasound, method of conception, complications of pregnancy, ruptured membranes at randomization and GA at randomization. Separate logistic regression models were developed for each marker in order to model composite adverse perinatal outcome as a function of the specific marker, planned delivery mode and the interaction between these two terms. In addition, multivariable logistic regression analysis with backward variable elimination was performed separately in each arm of the trial. The association between planned mode of delivery and composite adverse perinatal outcome, according to GA at delivery, was assessed using logistic regression analysis. Results: Of the 2804 women initially randomized, 1391 were included in each study arm. None of the studied baseline markers was associated with a differential benefit of planned CD over planned VD in the rate of composite adverse perinatal outcome. GA at delivery was associated differentially with composite adverse perinatal outcome in the treatment arms (P for interaction < 0.001). Among pregnancies delivered at 32 + 0 to 36 + 6 weeks, there was a trend towards a lower rate of composite adverse perinatal outcome in those in the planned‐VD group compared with those in planned‐CD group (29 (2.2%) vs 48 (3.6%) cases; odds ratio (OR) 0.62 (95% CI, 0.37–1.03)). In pregnancies delivered at or after 37 + 0 weeks, planned VD was associated with a significantly higher rate of composite adverse perinatal outcome, as compared with planned CD (23 (1.5%) vs 10 (0.7%) cases; OR, 2.25 (95% CI, 1.06–4.77)). Conclusion: The perinatal outcome of twin pregnancies with the first twin in cephalic presentation may differ depending on GA at delivery and planned mode of delivery. At 32–37 weeks, planned VD seems to be favorable, while, from around 37 weeks onwards, planned CD might be safer. The absolute risks of adverse perinatal outcomes at term are low and must be weighed against the increased maternal risks associated with planned CD. © 2019 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objective: Does planned caesarean compared with planned vaginal birth lower the risk of problematic urinary stress, faecal, or flatal incontinence?Design: Women between 320/7 and 386/7 weeks of gestation with a twin pregnancy were randomised to planned caesarean or planned vaginal birth.Setting: The trial took place at 106 centres in 25 countries.Population: A total of 2305 of the 2804 women enrolled in the study completed questionnaires at 2 years (82.2% follow-up): 1155 in the planned caesarean group and 1150 in the planned vaginal birth group.Methods: A structured self-administered questionnaire completed at 2 years postpartum.Main Outcome Measures: The primary maternal outcome of the Twin Birth Study was problematic urinary stress, or fecal, or flatal incontinence at 2 years RESULTS: Women in the planned caesarean group had lower problematic urinary stress incontinence rates compared with women in the planned vaginal birth group [93/1147 (8.11%) versus 140/1143 (12.25%); odds ratio, 0.63; 95% confidence interval, 0.47-0.83; P = 0.001]. Among those with problematic urinary stress incontinence, quality of life (measured using the Incontinence Impact Questionnaire, IIQ-7) was not different for planned caesarean versus planned vaginal birth groups [mean (SD): 18.4 (21.0) versus 19.1 (21.5); P = 0.82]. There were no differences in problematic faecal or flatal incontinence, or in other maternal outcomes.Conclusions: Among women with a twin pregnancy and no prior history of urinary stress incontinence, a management strategy of planned caesarean compared with planned vaginal birth reduces the risk of problematic urinary stress incontinence at 2 years postpartum. Our findings show that the prevalence but not the severity of urinary stress incontinence was associated with mode of birth.Funding: Canadian Institutes of Health Research (CIHR) (grant no. MCT-63164).Tweetable Abstract: For women with twins, planned caesarean compared with planned vaginal birth is associated with decreased prevalence but not severity of urinary stress incontinence at 2 years. [ABSTRACT FROM AUTHOR]

A review of the article ``Rationale and recommendations for improving definitions, registration requirements and procedures related to fetal death and stillbirth'' by S Alexander and J Zeitlin, which appeared in the periodical ``BJOG An International Journal of Obstetrics and Gynaecology'' on 2016, is presented

Objective: To compare outcomes at 3 months post partum for women randomised to give birth by planned caesarean section (CS) or by planned vaginal birth (VB) in the Twin Birth Study (TBS).Design: We invited women in the TBS to complete a 3-month follow-up questionnaire.Setting: Two thousand and eight hundred and four women from 25 countries.Population: Two thousand and five hundred and seventy women (92% response rate).Methods: Women randomised between 13 December 2003 and 4 April 2011 in the TBS completed a questionnaire and outcomes were compared using an intention-to-treat approach.Main Outcome and Measures: Breastfeeding, quality of life, depression, fatigue and urinary incontinence.Results: We found no clinically important differences between groups in any outcome. In the planned CS versus planned VB groups, breastfeeding at any time after birth was reported by 84.4% versus 86.4% (P = 0.13); the mean physical and mental Short Form (36) Health Survey (SF-36) quality of life scores were 51.8 versus 51.6 (P = 0.65) and 46.7 versus 46.0 (P = 0.09), respectively; the mean Multidimensional Assessment of Fatigue score was 20.3 versus 20.8 (P = 0.14); the frequency of probable depression on the Edinburgh Postnatal Depression Scale was 14.0% versus 14.8% (P = 0.57); the rate of problematic urinary incontinence was 5.5% versus 6.4% (P = 0.31); and the mean Incontinence Impact Questionnaire-7 score was 20.5 versus 20.4 (P = 0.99). Partner relationships, including painful intercourse, were similar between the groups.Conclusion: For women with twin pregnancies randomised to planned CS compared with planned VB, outcomes at 3 months post partum did not differ. The mode of birth was not associated with problematic urinary incontinence or urinary incontinence that affected the quality of life. Contrary to previous studies, breastfeeding at 3 months was not increased with planned VB.Tweetable Abstract: Planned mode of birth for twins doesn't affect maternal depression, wellbeing, incontinence or breastfeeding. [ABSTRACT FROM AUTHOR]

Linked article: This is a mini commentary on PWG Tennant et al., pp. 82–89 in this issue. To view this article visit https://doi.org/10.1111/1471-0528.16906 [ABSTRACT FROM AUTHOR]

Identification of women and fetuses at high risk for adverse perinatal outcomes is a central preoccupation in prenatal care. In recent years, the sonographically derived cerebroplacental ratio (CPR) has gained popularity for its potential ability to identify compromised fetuses among pregnancies with suspected growth restriction or placental disease. The recent, large IRIS study from the Netherlands (Henrichs et al. I BMJ i 2019;367:l5517) represents an example of isolated third-trimester biometry improving the identification of small-for-gestational-age fetuses among low-risk pregnancies but failing to lead to reductions in adverse perinatal outcomes. [Extracted from the article]

A letter to the editor is presented in response to the article "Maternal outcomes at 3 months after planned caesarean section versus planned vaginal birth for twin pregnancies in the Twin BirthStudy: a randomized controlled trial" in issue number 122.

Background: Although twin pregnancies are known to have higher rates of pre-eclampsia, the association between twin pregnancy and hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome has not been adequately studied. We assessed the association between twin pregnancy and HELLP syndrome, and also examined gestational age-specific rates of HELLP syndrome in twin and singleton pregnancies., Methods: We carried out a retrospective cohort study including women with singleton or twin live birth or stillbirth between 20 and 43 0 gestation in British Columbia, Canada, 2008/09-2019/20. Data on the demographic and clinical characteristics were obtained from the BC Perinatal Database Registry. Logistic regression was used to estimate adjusted odds ratios (AORs) and 95% confidence intervals (CI), adjusted for maternal age, body-mass-index, smoking and other potential confounders., Results: Among 524236 women (515953 singleton and 8283 twin pregnancies), there were 1510 women diagnosed with HELLP syndrome (2.9 per 1000 women). HELLP syndrome occurred in 181 twin pregnancies (21.9 per 1000 women), while 1329 cases occurred in singleton pregnancies (2.6 per 1000 women); rate ratio of 8.5 (95% CI 7.3-9.9). The aOR for HELLP syndrome was 7.1 (CI 6.0-8.5) comparing twin vs singleton pregnancies. In twin pregnancies, the incidence of HELLP syndrome increased markedly from 26 to 28 0 gestation until 37-39 weeks. In contrast, the incidence of HELLP syndrome increased more gradually from 23 to 40 0 gestation in singleton pregnancies., Conclusion: Twin pregnancy is strongly associated with HELLP syndrome. HELLP syndrome risk in twin pregnancies increases markedly from 26 0 gestation onwards., (Copyright © 2025. Published by Elsevier Inc.)

Objective: To estimate temporal changes in the prevalence of pre-existing chronic conditions among pregnant women in Sweden and evaluate the extent to which secular changes in maternal age, birth cohorts and obesity are associated with these trends., Design: Population-based cross-sectional study., Setting: Sweden, 2002-2019., Population: All women (aged 15-49 years) who delivered in Sweden (2002-2019)., Methods: An age-period-cohort analysis was used to evaluate the effects of age, calendar periods, and birth cohorts on the observed temporal trends., Main Outcome Measures: Pre-existing chronic conditions, including 17 disease categories of physical and psychiatric health conditions recorded within 5 years before childbirth, presented as prevalence rates and rate ratios (RRs) with 95% confidence intervals (CIs). Temporal trends were also adjusted for pre-pregnancy body mass index (BMI) and the mother's country of birth., Results: The overall prevalence of at least one pre-existing chronic condition was 8.7% (147 458 of 1 703 731 women). The rates of pre-existing chronic conditions in pregnancy increased threefold between 2002-2006 and 2016-2019 (RR 2.82, 95% CI 2.77-2.87). Rates of psychiatric (RR 3.80, 95% CI 3.71-3.89), circulatory/metabolic (RR 1.62, 95% CI 1.55-1.71), autoimmune/neurological (RR 1.69, 95% CI 1.61-1.78) and other (RR 2.10, 95% CI 1.99-2.22) conditions increased substantially from 2002-2006 to 2016-2019. However, these increasing rates were less pronounced between 2012-2015 and 2016-2019. No birth cohort effect was evident for any of the pre-existing chronic conditions. Adjusting for secular changes in obesity and the mother's country of birth did not affect these associations., Conclusions: The burden of pre-existing chronic conditions in pregnancy in Sweden increased from 2002 to 2019. This increase may be associated with the improved reporting of diagnoses and advancements in chronic condition treatment among women, potentially enhancing their fecundity., (© 2024 The Author(s). BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)

Background: Obesity is a risk factor for stillbirth and perinatal death and is often accompanied by chronic hypertension. However, there are few studies on the relationship between prepregnancy body mass index and gestational age-specific risks of stillbirth and perinatal death in women with chronic hypertension., Objective: This study aimed to examine the relationship between prepregnancy body mass index and gestational age-specific risks of stillbirth and perinatal death in the presence/absence of chronic hypertension., Study Design: This was a retrospective cohort study of all singleton births in the United States from 2016 to 2017. Data were obtained from the live birth and fetal death certificates available from the National Center for Health Statistics. Piecewise additive mixed models were used to assess the relationship between prepregnancy body mass index and gestational age-specific risks of stillbirth and perinatal death in women with and without chronic hypertension, adjusted for potential confounders. Results were expressed as gestational age-specific adjusted hazard ratios and 95% confidence intervals., Results: A total of 7,365,797 women were included in the study, of whom 255,464 (3.5%) were underweight; 3,233,710 (43.9%) had normal body mass index; 1,925,510 (26.1%) were overweight; and 1,065,958 (14.5%), 518,543 (7.0%), and 366,612 (5.0%) had obesity classes I, II, and III, respectively. Overall, stillbirth rates increased with increasing body mass index and were higher in women with chronic hypertension (14.2 per 1000 total births) than in those without chronic hypertension (4.7 per 1000 total births). The cumulative incidence of stillbirth increased at each gestational week, with the gradient increasing by body mass index category in women without chronic hypertension. However, this relationship was modified in women with chronic hypertension, for whom the increased risk of stillbirth by higher body mass index was reversed at 26 to 35 weeks of gestation. For example, at 31 weeks of gestation, the adjusted hazard ratio of women with a body mass index of 40 kg/m 2 vs those with a body mass index of 20 kg/m 2 and chronic hypertension was 0.78 (95% confidence interval, 0.65-0.93), whereas the adjusted hazard ratio of similar women without chronic hypertension was 1.39 (95% confidence interval, 1.30-1.48). The results were similar for perinatal death., Conclusion: The relationship between prepregnancy body mass index and stillbirth is modified in the presence of chronic hypertension at 26 to 35 weeks of gestation when elevated body mass index is associated with a lower or similar relative risk of stillbirth and perinatal death. Nevertheless, women with chronic hypertension and elevated body mass index have higher absolute risks of stillbirth and perinatal death at all gestations. Our results suggest that, in women with obesity, optimal timing of delivery may differ depending on the presence or absence of chronic hypertension., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Reports of high and rising maternal mortality ratios (MMR) in the United States have caused serious concern. We examined spatiotemporal patterns in cause-specific MMRs, in order to obtain insights into the cause for the increase., Methods: The study included all maternal deaths recorded by the Centers for Disease Control and Prevention from 1999 to 2021. Changes in overall and cause-specific MMRs were quantified nationally; in low-vs high-MMR states (i.e., MMRs <20 vs ≥26 per 100,000 live births in 2018-2021); and in California vs Texas (populous states with low vs high MMRs). Cause-specific MMRs included those due to unambiguous causes (e.g., selected obstetric causes such as pre-eclampsia/eclampsia) and less-specific/potentially incidental causes (e.g., "other specified pregnancy-related conditions", chronic hypertension, and malignant neoplasms)., Findings: MMRs increased from 9.60 (n = 1543) in 1999-2002 to 23.5 (n = 3478) per 100,000 live births in 2018-2021. The temporal increase in MMRs was smaller in low-MMR states (from 7.82 to 14.1 per 100,000 live births) compared with high-MMR states (from 11.1 to 31.4 per 100,000 live births). MMRs due to selected obstetric causes decreased to a similar extent in low-vs high-MMR states, whereas the increase in MMRs from less-specific/potentially incidental causes was smaller in low- vs high-MMR states (MMR ratio (RR) 5.57, 95% CI 4.28, 7.25 vs 7.07, 95% CI 5.91, 8.46), and in California vs Texas (RR 1.67, 95% CI 1.03, 2.69 vs 10.8, 95% CI 6.55, 17.7). The change in malignant neoplasm-associated MMRs was smaller in California vs Texas (RR 1.21, 95% CI 0.08, 19.3 vs 91.2, 95% CI 89.2, 94.8). MMRs from less-specific/potentially incidental causes increased in all race/ethnicity groups., Interpretation: Spatiotemporal patterns of cause-specific MMRs, including similar reductions in unambiguous obstetric causes of death and variable increases in less-specific/potentially incidental causes, suggest misclassified maternal deaths and overestimated maternal mortality in some US states., Funding: This work received no funding., Competing Interests: KSJ is supported by an Investigator award from the BC Children's Hospital Research Institute. AB is supported by a Junior 1 Research Scholar Award from the Fonds de recherche du Québec–Santé. SS and SJ are funded from a grant from the Canadian Institutes of Health Research. CVA is supported, in part, by the National Heart, Lung, and Blood Institute (R01-HL150065) and the National Institute of Environmental Health Sciences (R01-ES033190), National Institutes of Health., (© 2024 The Author(s).)

The biosynthesis of novel nanoparticles with varied morphologies, which has good implications for their biological capabilities, has attracted increasing attention in the field of nanotechnology. Bioactive compounds present in the extract of fungi, bacteria, plants and algae are responsible for nanoparticle synthesis. In comparison to other biological resources, brown seaweeds can also be useful to convert metal ions to metal nanoparticles because of the presence of richer bioactive chemicals. Carbohydrates, proteins, polysaccharides, vitamins, enzymes, pigments, and secondary metabolites in brown seaweeds act as natural reducing, capping, and stabilizing agents in the nanoparticle's synthesis. There are around 2000 species of seaweed that dominate marine resources, but only a few have been reported for nanoparticle synthesis. The presence of bioactive chemicals in the biosynthesized metal nanoparticles confers biological activity. The biosynthesized metal and non-metal nanoparticles from brown seaweeds possess different biological activities because of their different physiochemical properties. Compared with terrestrial resources, marine resources are not much explored for nanoparticle synthesis. To confirm their morphology, characterization methods are used, such as absorption spectrophotometer, X-ray diffraction, Fourier transforms infrared spectroscopy, scanning electron microscope, and transmission electron microscopy. This review attempts to include the vital role of brown seaweed in the synthesis of metal and non-metal nanoparticles, as well as the method of synthesis and biological applications such as anticancer, antibacterial, antioxidant, anti-diabetic, and other functions., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Ficus drupacea is a fruit-bearing tree that is distributed in Southeast Asia and Australia. The objective of this research was to ascertain the following with regard to ripened fruits: (i) their nutritional value, (ii) their mineral status, (iii) the fatty acid composition of fruit and seed oil, (iv) their phytochemical makeup, and (v) their antioxidant properties. The ripened fruits contained 3.21%, 3.25%, 0.92%, 1.47%, and 2.20% carbohydrate, protein, fat, ash, and fiber, respectively. Fruits had an energy content of 30.18 kcal/100 g. In terms of mineral content, the fruit was rich in potassium, magnesium, calcium, and nitrogen, with values of 21.03, 13.24, 11.07, and 4.13 mg/g DW. Iron, zinc, manganese, and boron had values of 686.67, 124.33, 114.40, and 35.78 µg/g DW, respectively. The contents of oxalate and phytate were 14.44 and 2.8 mg/g FW, respectively. The fruit and seed oil content were 0.67 and 8.07%, respectively, and the oil's physicochemical properties were comparable to those of fig fruit and seed oils. Omega-3 (α-linolenic acid), omega-6 (linoleic acid), and omega-9 (oleic acid) fatty acids were abundant in the oils. Fruit extracts in acetone, methanol, and water have greater concentrations of phenolics, flavonoids, and alkaloids. The 2,2-diphenyl-2-picrylhydrazyl, total antioxidant activity, and ferric reducing antioxidant power assays demonstrated increased antioxidant activities in close correlation with the higher concentrations of phenolics, flavonoids, and alkaloids. The results of this study demonstrate that the fruits of F. drupacea are a strong source of nutrients and phytochemicals, and they merit more investigation and thought for possible uses.

Importance: Maternal epilepsy is associated with adverse pregnancy and neonatal outcomes. A better understanding of this condition and the associated risk of mortality and morbidity at the time of delivery could help reduce adverse outcomes., Objective: To determine the risk of severe maternal and perinatal morbidity and mortality among women with epilepsy., Design, Setting, Participants: This prospective population-based register study in Denmark, Finland, Iceland, Norway, and Sweden took place between January 1, 1996, and December 31, 2017. Data analysis was performed from August 2022 to November 2023. Participants included all singleton births at 22 weeks' gestation or longer. Births with missing or invalid information on birth weight or gestational length were excluded. The study team identified 4 511 267 deliveries, of which 4 475 984 were to women without epilepsy and 35 283 to mothers with epilepsy., Exposure: Maternal epilepsy diagnosis recorded before childbirth. Prenatal exposure to antiseizure medication (ASM), defined as any maternal prescription fills from conception to childbirth, was also examined., Main Outcomes and Measures: Composite severe maternal morbidity and mortality occurring in pregnancy or within 42 days postpartum and composite severe neonatal morbidity (eg, neonatal convulsions) and perinatal mortality (ie, stillbirths and deaths) during the first 28 days of life. Multivariable generalized estimating equations with logit-link were used to obtain adjusted odds ratios (aORs) and 95% CIs., Results: The mean (SD) age at delivery for women in the epilepsy cohort was 29.9 (5.3) years. The rate of composite severe maternal morbidity and mortality was also higher in women with epilepsy compared with those without epilepsy (36.9 vs 25.4 per 1000 deliveries). Women with epilepsy also had a significantly higher risk of death (0.23 deaths per 1000 deliveries) compared with women without epilepsy (0.05 deaths per 1000 deliveries) with an aOR of 3.86 (95% CI, 1.48-8.10). In particular, maternal epilepsy was associated with increased odds of severe preeclampsia, embolism, disseminated intravascular coagulation or shock, cerebrovascular events, and severe mental health conditions. Fetuses and infants of women with epilepsy were at elevated odds of mortality (aOR, 1.20; 95% CI, 1.05-1.38) and severe neonatal morbidity (aOR, 1.48; 95% CI, 1.40-1.56). In analyses restricted to women with epilepsy, women exposed to ASM compared with those unexposed had higher odds of severe maternal morbidity (aOR ,1.24; 95% CI, 1.10-1.48) and their neonates had an increased odd of mortality and severe morbidity (aOR, 1.37; 95% CI, 1.23-1.52)., Conclusion and Relevance: This multinational study shows that women with epilepsy were at considerably higher risk of severe maternal and perinatal outcomes and increased risk of death during pregnancy and postpartum. Maternal epilepsy and maternal use of ASM were associated with increased maternal morbidity and perinatal mortality and morbidity.

In vitro plant cell and organ cultures are appealing alternatives to traditional methods of producing valuable specialized metabolites for use as: pharmaceuticals, food additives, cosmetics, perfumes, and agricultural chemicals. Cell cultures have been adopted for the production of specialized metabolites in certain plants. However, in certain other systems, adventitious roots are superior to cell suspension cultures as they are organized structures that accumulate high levels of specialized metabolites. The cultivation of adventitious roots has been investigated in various bioreactor systems, including: mechanically agitated, pneumatically agitated, and modified bioreactors. The main relevance and importance of this work are to develop a long-lasting industrial biotechnological technology as well as to improve the synthesis of these metabolites from the plant in vitro systems. These challenges are exacerbated by: the peculiarities of plant cell metabolism, the complexity of specialized metabolite pathways, the proper selection of bioreactor systems, and bioprocess optimization. This review's major objective is to analyze several bioreactor types for the development of adventitious roots, as well as the advantages and disadvantages of each type of bioreactor, and to describe the strategies used to increase the synthesis of specialized metabolites. This review also emphasizes current advancements in the field, and successful instances of scaled-up cultures and the generation of specialized metabolites for commercial purposes are also covered.