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Introduction: The advanced maternal age (AMA) pregnancies escalate rapidly, which are frequently linked to higher risks of adverse outcomes. Advanced maternal age (AMA) placenta exhibited premature aging, presumably resulting in trophoblast dysfunction, inadequate placentation. However, the precise reasons and mechanisms of trophoblast aging in AMA placenta remain unclear, posing a significant limitation to provide effective guidance for prenatal healthcare in clinical settings. Notably, the organism shows heightened vulnerability to oxidative damage as it ages. YAP (Yes-associated protein) was reported to play a critical role in regulation of aging and resisting oxidative damage, yet these roles had not been elucidated in the placenta. Therefore, this study explored the relationship between trophoblast cell aging and oxidative injury and YAP in AMA pregnancy, which not only provided an insight into the mechanisms of trophoblast cell aging, but also provide valuable directions for healthcare during AMA pregnancy. Methods: In this study, human term placentas were collected from AMA and normal pregnancies for the analysis of aging, oxidative damage and YAP level. HTR8/SVneo cells were manipulated with (hydrogen peroxide) H2O2 to explore the effects of oxidative damage on trophoblast cell senescence and YAP levels. YAP expression in HTR8/SVneo cells was manipulated to investigate its role in trophoblastic senescence and oxidative damage. Results: Compared with the control group, the AMA placenta exhibits increased aging biomarkers, which is coupled with an elevation in oxidative damage within placental trophoblast cells and a notable decline in YAP levels. Cellular experiments demonstrated that oxidative damage from H2O2 triggered trophoblast cell senescence and resulted in a reduction of YAP levels. Furthermore, employing molecular modification to silence YAP expression in these cells led to an induction of aging. Conversely, overexpressing YAP ameliorated both trophoblast cell aging and the associated DNA oxidative damage that arised from H2O2. Conclusion: The decline of YAP in AMA pregnancy should be responsible for the increased oxidative injury and premature placenta aging, indicating that YAP plays a significant role in combating oxidative damage and delaying aging, thereby providing a new guidance for prenatal care in AMA pregnancies. Maintaining YAP levels or implementing anti-oxidative stress interventions could potentially mitigate the incidence of complications involved AMA pregnancy. [ABSTRACT FROM AUTHOR]

Objective: To explore the relationship between pregnancy complications and maternal near-miss (MNM). Methods: Data were obtained from the Maternal Near-Miss Surveillance System in Hunan Province, China, 2012–2022. The MNM ratio refers to the number of MNM per 1000 live births, and maternal mortality refers to the number of maternal deaths per 100,000 live births. Chi-square trend tests (χ2trend) were used to determine trends in proportions by year. Multivariate logistic regression analysis (method: Forward, Wald, α = 0.05) and adjusted odds ratios (aORs) were used to identify risk factors for MNM. Results: Our study included 780,359 women with 731,185 live births, a total of 2461 MNMs, and 52 maternal deaths were identified. The MNM ratio was 3.37‰ (95%CI: 3.23–3.50), and the maternal mortality was 7.11 per 100,000 live births (95%CI: 5.18–9.04). Coagulation/hematological dysfunction was the most common cause of MNM (75.66%). From 2012 to 2022, the proportion of coagulation/hematological dysfunction among MNM increased from 49.14% in 2012 to 86.39% in 2022, which was the only cause of MNM that showed an increased trend (χ2trend = 7.43, P = 0.01). Results of multivariate logistic regression analysis showed that 10 pregnancy complications were risk factors for MNM: hemorrhage disorder (aOR = 21.50, 95%CI: 19.64–23.54), infections (aOR = 1.91, 95%CI: 1.64–2.22), hypertension (aOR = 4.50, 95%CI: 4.08–4.98), heart disease (aOR = 14.96, 95%CI: 11.51–19.44), embolic disease (aOR = 171.70, 95%CI: 94.08-313.36), liver disease (aOR = 1.54, 95%CI: 1.25–1.90), anaemia (aOR = 4.72, 95%CI: 4.29–5.19), renal disease (aOR = 5.44, 95%CI: 4.00-7.40), pulmonary disease (aOR = 14.85, 95%CI: 8.33–26.50), and connective tissue disease (aOR = 5.15, 95%CI: 3.06–8.66). Conclusion: The MNM ratio was relatively low in Hunan Province. Several pregnancy complications increased the risk of MNM. It is helpful for clinical counseling and public health policies, which may contribute to preventing MNM. [ABSTRACT FROM AUTHOR]

Aim: In our study, the relationship between preterm birth and genitourinary system infections during pregnancy was investigated. Materials and Methods: Our study is retrospective. Patients who gave birth in our hospital between 2013 and 2023 were included in the study. Our study was carried out with 1005 patients, 504 cases, and 501 control groups. Births between 20 0/7 and 36 6/7 weeks of gestation were taken as preterm birth. Patients with singleton pregnancy were included in the study. SPSS (IBM SPSS for Windows, Ver.26) statistical package program was used for statistical analysis of our study. Results: A total of 1005 patients were included in the study. The mean age of the patients was 27.98±4.8. In our study, the rate of preterm birth in the control group was % 13. As a result of our study, the rate of preterm birth was found to be statistically significantly higher in the group diagnosed with infection during pregnancy compared to the control group (p=0.000). The risk of preterm birth was found to be 5.6 times higher in the group diagnosed with infection during pregnancy compared to the control group (Odds Ratio: 5.593). Conclusion: Having a genitourinary system infection during pregnancy leads to a significant increase in the risk of preterm birth. [ABSTRACT FROM AUTHOR]

Objectives: Antiphospholipid syndrome (APS) is an autoimmune disease driven by antiphospholipid antibodies (aPL). Currently, APS diagnosis requires a combination of clinical manifestations (thrombosis and/or obstetric morbidity) and the persistent presence of at least one criteria aPL: anti‐cardiolipin antibodies (aCL), anti‐β2‐glycoprotein I antibodies (aβ2GPI) or lupus anticoagulant (LA). Patients with suggestive obstetric symptoms but lacking criteria aPL face diagnostic challenges. Non‐criteria aPL screening may enhance discrimination. This study proposes a classification incorporating both criteria and non‐criteria antibodies to improve obstetric APS diagnosis. Methods: Blood samples from non‐pregnant women (n = 68) with a history of vascular, obstetric, or vascular and obstetric manifestations were analysed. Among them, 30 had previous diagnosis of APS. Healthy women with proven gestational success were included as controls (n = 16). Criteria and non‐criteria (anti‐phosphatidylglycerol, anti‐phosphatidylethanolamine, anti‐phosphatidylinositol, anti‐phosphatidylserine and anti‐phosphatidic acid) IgG aPL were evaluated by ELISA and coagulation tests. Based on the resulting aPL profile, patients were reclassified. Responsiveness to treatment was obtained from medical records. Results: Criteria aPL levels marginally differentiated women previously managed as obstetric APS from unexplained/other causes of obstetric morbidity. Including non‐criteria aPL improved separation. The proposed classification identified an obstetric APS group that exhibits non‐criteria aPL and aβ2GPI titres below the cut‐off but higher than healthy women (7.88 vs. 2.47 SGU, P = 0.006). Compared to cases of other causes of obstetric morbidity, these patients retrospectively responded better to aspirin and/or heparin treatment (71.43% vs. 11.11%, P = 0.035). Conclusions: Assessing non‐criteria antibodies may identify isolated obstetric APS cases benefiting from established therapies. [ABSTRACT FROM AUTHOR]

Background Pregnancy complications can impact the mother and child's health in the short and longterm resulting in an increased risk of chronic disease later in life. Telomere length is a biomarker of future cardiometabolic diseases and may offer a novel way of identifying offspring most at risk for future chronic diseases. Objective(s) To qualitatively explore General Practitioners' (GPs) perspectives on the feasibility and uptake for recommending a telomere screening test in children who were born after a pregnancy complication. Methods Twelve semi-structured interviews were conducted with GPs within metropolitan Adelaide, South Australia. Interviews were audio recorded, transcribed verbatim, and analysed for codes and themes. Results Two themes were generated: ethical considerations and practical considerations. Ethically, the GP participants discussed barriers including consenting on behalf of a child, parental guilt, and the impact of health insurance, whereas viewing it for health promotion was a facilitator. For practical considerations, barriers included the difficulty in identifying people eligible for screening, maintaining medical communication between service providers, and time and financial constraints, whereas linking screening for telomere length with existing screening would facilitate uptake. Conclusions GPs were generally supportive of potential telomere screening in infants, particularly via a saliva test that could be embedded in current antenatal care. However, several challenges, such as lack of knowledge, ethical considerations, and time and financial constraints, need to be overcome before such a test could be implemented into practice. [ABSTRACT FROM AUTHOR]

Introduction: Effect of physical activity in pregnancy on preeclampsia (PE) and angiogenic markers is not well understood. We studied the association of physical activity and PE in a case-control setting and assessed whether exercise in PE and non-PE women associate with maternal serum concentrations of soluble fms-like tyrosine kinase 1 (s-Flt-1), placental growth factor (PlGF) and soluble endoglin (sEng) and sFlt-1/PlGF ratio in the Finnish Genetics of Pre-eclampsia Consortium (FINNPEC) cohort. Materials and methods: Participants completed a questionnaire on their background information and serum samples were collected from a subset. Questionnaire data on physical activity were available from 708 PE women and 724 non-PE women. Both first trimester serum samples and questionnaire data on physical activity were available from 160 PE women and 160 non-PE women, and second/third trimester serum samples and questionnaire data on physical activity were available from 139 PE women and 47 non-PE women. The PE and non-PE women were divided into categories of physically active (exercise 2-3 times/week or more) and physically inactive (exercise less than 2-3 times/week). Results: A total of 43.4% of the PE women and 42.4% of the non-PE women were categorized as physically active. There were no differences in physical activity and exercise habits between the groups. The physically active women were more often nulliparous and non-smokers and had a lower body mass index. There were no differences in the concentrations of angiogenic markers (sFlt-1, PlGF and sEng and sFlt-1/PlGF ratio) between the groups who exercised more or less than 2-3 times/week. Conclusions: In the FINNPEC study cohort, there was no association between physical activity and PE and no associations of physical activity in pregnant women with and without PE with maternal serum concentrations of sFlt-1, PlGF and sEng and sFlt-1/PlGF ratio. [ABSTRACT FROM AUTHOR]

A growing body of research suggests a correlation between probiotic supplementation during pregnancy and the prevention and treatment of pregnancy complications. As modulators of gut microbiota, probiotics possess anti-inflammatory and immunomodulatory properties, potentially offering benefits in preventing pregnancy complications and improving clinical symptoms. This review aims to summarize the potential effects of probiotic supplementation during pregnancy on common pregnancy complications, including gestational diabetes mellitus, preeclampsia, intrahepatic cholestasis of pregnancy, premature birth and spontaneous abortion, due to the current limitations in clinical research on probiotics and the heterogeneity of existing findings. This review provides a reference for the clinical application of probiotic supplements in the prevention and treatment of pregnancy complications.

Background: Coronavirus disease (COVID-19) infection and the risk of abortion have become a major concern for pregnant women worldwide. Whereas research studies have not yet determined the exact risk of abortion due to COVID-19 infection, the virus could increase the risk of pregnancy complications through inflammatory cytokines and immune response. Objective: The study highlights prognostic markers for pregnancy complications during COVID-19 infections by testing interleukin-6 (IL-6), interleukin-18 (IL-18), tumor necrosis factors-α (TNF-α), and interferon-γ (INF-γ) in the serum of pregnant women with and without COVID-19. Materials and Methods: A case‐control study consists of 100 cases; included are 50 COVID-19 pregnant women matched with 50 non-COVID-19 pregnant women, with both groups free from any abortion risk factors. The study measured serum IL-6, IL-18, TNF-α and INF-γ tests to predict cases with severe infection and those at high risk for fetal loss. Results: The statistical analysis showed a significant relationship between elevated immunological markers levels and the severity of COVID-19 and pregnancy complication P value (0.001, 0.005, 0.001, and 0.001 for IL-6, IL-18, TNF-α, and INF-γ, respectively). Furthermore, the odd ratio explains that elevated immunological markers increased the risk of baby loss; through COVID-19 infection. In addition, receiver operating characteristic curve analysis verified these accuracies; the excellent test referred to IL-6, followed by IL-18 and INF-γ very good tests, then TNF-α as a medium test to predict the risk of pregnancy complication. Conclusion: These results concluded that monitoring these immunological markers’ levels could help predict COVID-19 infection in the severe stage and the risk of pregnancy complications in COVID-19-positive women.

HIGHLIGHTS • Underweight pregnant women, face an imbalance in energy and protein intake. • TAC, SOD, and IL6 with administration of DHA to pregnant women with chronic energy deficiency in the third trimester provide benefits. ABSTRACT Objective: Underweight pregnant women face oxidative stress and inflammation, increasing their risk of intrauterine growth restriction (IUGR) and preterm birth. This study investigates the effects of DHA supplementation on Total Antioxidant Capacity (TAC), Superoxide Dismutase (SOD), and Interleukin-6 (IL-6) in underweight pregnant women, along with the correlation between DHA and these markers. Materials and Methods: This experimental pre-test/post-test study focused on underweight pregnant women in the Made District, Surabaya, Indonesia. Eligible participants were in their second or third trimester, had a BMI below 18.5, and were taking DHA regularly. Exclusion criteria included early pregnancy (gestational age < 14 weeks), BMI above 18.5, irregular DHA intake, and withdrawal from the study. The study ran from July to December 2023, using non-probability sampling to select participants. Blood samples were collected before and after two months of DHA supplementation. Results: Following the intervention, TAC levels demonstrated a noteworthy increase (p < 0.05). SOD levels also exhibited a significant difference (p

Objective: To investigate the prevalence and longitudinal trend of severe maternal morbidity (SMM) at nationwide level in Taiwan. The associated maternal factors contributing to SMM were also analyzed. Materials and methods: A population-based secondary analysis using administrative datasets released by Ministry of Health and Welfare of Taiwan from 2011 to 2021 was carried out. SMM was defined from ICD-9 or10-CM diagnosis and procedure codes previously released by CDC. The existence of any SMM indicators identified by delivery and postpartum hospitalizations between≧20 weeks of gestational age and within 42 days after childbirth was retrieved for analysis. Kendall Tau-b correlation was applied for trend test. Logistic regression was used to investigate the associated maternal factors for SMM. All the data were analyzed using SAS statistical software version 9.4. Statistical significance was defined as P value

ABSTRACT Introduction Methods Result Conclusion The increase in fibrinogen levels is vital for the formation of a prothrombotic state during gestation to counter‐bleeding challenges at delivery. However, pregnancy complications characterized by systemic inflammatory response syndrome may consume fibrinogen, resulting in elevated D‐dimer levels.Our study is based on a total of 16 768 pregnant women who delivered between December 1, 2013, and December 1, 2018, to study fibrinogen and D‐dimer changes during gestation under normal and multiples of pathogenic states.Compared with nonpregnant women (3.04[3.02–3.08]), pregnant women depicted higher fibrinogen levels throughout gestation (p < 0.001). In the uncomplicated group, fibrinogen levels increased throughout the first (3.28[3.26–3.29]), second (4.04[4.01–4.07]), and third trimesters (4.40[4.38–4.41]) but dropped at delivery (4.30[4.28–4.31]), similar to the changing pattern of the pregnancy‐related complication group and pre‐existing disorder group. Women with pregnancy‐related complications showed significantly higher mean fibrinogen levels throughout gestation (p < 0.001), except for placental abruption, where, it decreased from the third trimester and was lower than that of uncomplicated pregnancies (3.89[3.60–4.17] vs. 4.40 [4.38–4.41], p = 0.001). Among uncomplicated pregnancies, D‐dimer grew rapidly throughout the first trimester (0.09[0.06–0.15]), second trimester (0.28[0.19–0.40]), third trimester (0.51[0.36–0.78]), and delivery (0.70[0.47–1.03]).Women with pregnancy‐related complications and pre‐existing disorders shared similar changing patterns; however, the D‐dimer of women with placenta accreta presented higher levels than those with uncomplicated pregnancies since the first trimester. We concluded that fibrinogen levels are expected to increase steadily, but in patients with placental abruption, fibrinogen levels dropped during the third trimester. D‐dimer levels typically rise consistently throughout pregnancy, yet in patients with placenta accreta, they show abnormal elevation since an early stage of pregnancy. [ABSTRACT FROM AUTHOR]

BACKGROUND Women with endometriosis may constitute a group at a particularly increased risk of pregnancy-related complications. Furthermore, women selected for assisted reproductive technology (ART) are exposed to additional endocrinological and embryological factors that have been associated with adverse pregnancy outcomes. OBJECTIVE AND RATIONALE This study aimed to investigate the independent effect of endometriosis, adenomyosis, and various ART-related factors on adverse maternal, placental, fetal, and neonatal outcomes. SEARCH METHODS Published randomized controlled trials, cohort studies, and case–control studies were considered eligible. PubMed, MEDLINE, ClinicalTrials.gov, Embase, and Scopus were systematically searched up to 1 March 2024. This systematic review and meta-analysis was performed in line with the PRISMA and the MOOSE reporting guidelines. To thoroughly investigate the association between endometriosis/adenomyosis and adverse pregnancy outcomes, sub-analyses were conducted, whenever possible, according to: the method of conception (i.e. ART and non-ART conception), the endometriosis stage/phenotype, the coexistence of endometriosis and adenomyosis, any pre-pregnancy surgical treatment of endometriosis, and the form of adenomyosis. The odds ratio (OR) with 95% CI was used as effect measure. The quality of evidence was assessed using the GRADE approach. OUTCOMES We showed a higher risk of placenta previa in women with endometriosis compared to controls (34 studies, OR 2.84; 95% CI: 2.47, 3.26; I 2 = 83%, moderate quality). The association was observed regardless of the method of conception and was particularly strong in the most severe forms of endometriosis (i.e. rASRM stage III–IV endometriosis and deep endometriosis (DE)) (OR 6.61; 95% CI: 2.08, 20.98; I 2 = 66% and OR 14.54; 95% CI: 3.67, 57.67; I 2 = 54%, respectively). We also showed an association, regardless of the method of conception, between endometriosis and: (i) preterm birth (PTB) (43 studies, OR 1.43; 95% CI: 1.32, 1.56; I 2 = 89%, low quality) and (ii) cesarean section (29 studies, OR 1.52; 95% CI: 1.41, 1.63; I 2 = 93%, low quality). The most severe forms of endometriosis were strongly associated with PTB. Two outcomes were associated with adenomyosis both in the main analysis and in the sub-analysis that included only ART pregnancies: (i) miscarriage (14 studies, OR 1.83; 95% CI: 1.53, 2.18; I 2 = 72%, low quality) and (ii) pre-eclampsia (7 studies, OR 1.70; 95% CI: 1.16, 2.48; I 2 = 77%, low quality). Regarding ART-related factors, the following associations were observed in the main analysis and confirmed in all sub-analyses conducted by pooling only risk estimates adjusted for covariates: (i) blastocyst stage embryo transfer (ET) and monozygotic twinning (28 studies, OR 2.05; 95% CI, 1.72, 2.45; I 2 = 72%, low quality), (ii) frozen embryo transfer (FET) and (reduced risk of) small for gestational age (21 studies, OR 0.59; 95% CI, 0.57, 0.61; P  < 0.00001; I 2 = 17%, very low quality) and (increased risk of) large for gestational age (16 studies, OR 1.70; 95% CI, 1.60, 1.80; P  < 0.00001; I 2 = 55%, very low quality), (iii) artificial cycle (AC)-FET and pre-eclampsia (12 studies, OR 2.14; 95% CI: 1.91–2.39; I 2 = 9%, low quality), PTB (21 studies, OR 1.24; 95% CI 1.15, 1.34; P  < 0.0001; I 2 = 50%, low quality), cesarean section (15 studies, OR 1.59; 95% CI 1.49, 1.70; P  < 0.00001; I 2 = 67%, very low quality) and post-partum hemorrhage (6 studies, OR 2.43; 95% CI 2.11, 2.81; P  < 0.00001; I 2 = 15%, very low quality). WIDER IMPLICATIONS Severe endometriosis (i.e. rASRM stage III–IV endometriosis, DE) constitutes a considerable risk factor for placenta previa and PTB. Herein, we recommend against superimposing on this condition other exposure factors that have a strong association with the same obstetric adverse outcome or with different outcomes which, if coexisting, could determine the onset of an ominous obstetric syndrome. Specifically, we strongly discourage the use of AC regimens for FET in ovulatory women with rASRM stage III–IV endometriosis or DE. We also recommend single ET at the blastocyst stage in this high-risk population. REGISTRATION NUMBER CRD42023401428. [ABSTRACT FROM AUTHOR]

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Objective: The aim of the present study is to discuss the clinical presentation, laboratory findings, and maternal and fetal outcomes of patients with acute fatty liver of pregnancy (AFLP) presenting to a tertiary care institution. Materials and Methods: All pregnant patients presenting to our institution with acute liver failure from January 2019 to December 2020 were evaluated for AFLP based on Swansea criteria. The demographic, clinical, and laboratory parameters of all patients, course of pregnancy, mode of delivery, and maternal and fetal outcomes of the pregnancy were evaluated for all patients. Results: Eight patients were identified to have AFLP during the study period. The mean age at presentation was 26 years, the mean gestational age at presentation was 33 weeks. Three patients were primigravida, two had twin pregnancies, and 40% of patients who delivered had a male fetus. All patients presented with vomiting and jaundice and the majority had abdominal pain. Leukocytosis was observed in 75%, thrombocytopenia in 37.5%, coagulopathy in 37.5%, renal failure in 50%, encephalopathy in 75%, and hypoglycemia in 100% of patients. Two patients had ultrasound findings suggestive of AFLP. Two patients had a cesarean section, three had vaginal deliveries, and three maternal deaths occurred with undelivered status. There were five maternal deaths, and out of the five delivered patients, there were two fetal deaths. Conclusion: Acute fatty liver of pregnancy is associated with high morbidity and mortality. Adverse maternal and fetal prognosis can be prevented by diagnosis early in the course of disease, prompt termination of pregnancy, and good supportive care. [ABSTRACT FROM AUTHOR]

PFAS (per- and polyfluoroalkyl substances) have been extensively used across numerous industries and consumer goods. Due to their high persistence and mobility, they are ubiquitous in the environment. Exposure to PFAS occurs in people via multiple pathways such as dermal contact, water supply, air inhalation, and dietary intake. Even if some PFAS are being phased out because of their persistent presence in the environment and harmful impacts on human health, mixes of replacement and legacy PFAS will continue to pollute the ecosystem. Numerous toxicological investigations have revealed harmful effects of PFAS exposure on female reproductive health, e.g., polycystic ovaries syndrome, premature ovarian failure, endometriosis, reproductive system tumors, pregnancy complications, and adverse pregnancy outcomes. Despite extensive epidemiological studies on the reproductive toxicity of PFAS, research findings remain inconsistent, and the underlying mechanisms are not well understood. In this review, we give an in-depth description of the sources and pathways of PFAS, and then review the reproductive toxicity of PFAS and its possible mechanisms. [ABSTRACT FROM AUTHOR]

Threatened miscarriage is a common complication of early pregnancy characterized by symptoms of vaginal bleeding with/without abdominal cramps/pain in the first trimester. Progestogens are often administered for the management of this condition. Presented herein is the protocol of an ongoing, multicentric clinical trial to investigate the efficacy and safety of micronized progesterone (natural progestogen) compared to dydrogesterone (synthetic isomer of progesterone). A total of 304 eligible pregnant women aged 20–39 years, diagnosed with threatened miscarriage, will be enrolled during 5–12 weeks of gestation and randomized equally to receive either oral dydrogesterone (40 mg stat, followed by 10 mg three times a day) or oral micronized progesterone (200 mg two times a day) up to one week after stoppage of bleeding or if bleeding does not stop, then treatment will be continued till a maximum of 14 weeks of gestation (unless miscarriage is confirmed earlier or the investigator decides to prolong treatment for better outcome or if bleeding relapses). Scheduled visits after enrollment will be conducted during 6–13, 8–14, 18–20 and 24–26 weeks of gestation, in addition to a visit at the end of treatment at 14 weeks and another after parturition. The primary endpoint of the study is the miscarriage rate before 20 weeks of gestation. Secondary endpoints include the ongoing pregnancy rate at 24 weeks, treatment-induced changes in serum levels of cytokines and time to symptom resolution. Apart from the incidence of treatment-emergent adverse events, safety endpoints include changes in complete blood count and the results of liver and kidney function tests from baseline to 14 and 24–26 weeks of gestation. Delivery outcomes are exploratory endpoints of the study.

IntroductionThe advanced maternal age (AMA) pregnancies escalate rapidly, which are frequently linked to higher risks of adverse outcomes. Advanced maternal age (AMA) placenta exhibited premature aging, presumably resulting in trophoblast dysfunction, inadequate placentation. However, the precise reasons and mechanisms of trophoblast aging in AMA placenta remain unclear, posing a significant limitation to provide effective guidance for prenatal healthcare in clinical settings. Notably, the organism shows heightened vulnerability to oxidative damage as it ages. YAP (Yes-associated protein) was reported to play a critical role in regulation of aging and resisting oxidative damage, yet these roles had not been elucidated in the placenta. Therefore, this study explored the relationship between trophoblast cell aging and oxidative injury and YAP in AMA pregnancy, which not only provided an insight into the mechanisms of trophoblast cell aging, but also provide valuable directions for healthcare during AMA pregnancy.MethodsIn this study, human term placentas were collected from AMA and normal pregnancies for the analysis of aging, oxidative damage and YAP level. HTR8/SVneo cells were manipulated with (hydrogen peroxide) H2O2 to explore the effects of oxidative damage on trophoblast cell senescence and YAP levels. YAP expression in HTR8/SVneo cells was manipulated to investigate its role in trophoblastic senescence and oxidative damage.ResultsCompared with the control group, the AMA placenta exhibits increased aging biomarkers, which is coupled with an elevation in oxidative damage within placental trophoblast cells and a notable decline in YAP levels. Cellular experiments demonstrated that oxidative damage from H2O2 triggered trophoblast cell senescence and resulted in a reduction of YAP levels. Furthermore, employing molecular modification to silence YAP expression in these cells led to an induction of aging. Conversely, overexpressing YAP ameliorated both trophoblast cell aging and the associated DNA oxidative damage that arised from H2O2.ConclusionThe decline of YAP in AMA pregnancy should be responsible for the increased oxidative injury and premature placenta aging, indicating that YAP plays a significant role in combating oxidative damage and delaying aging, thereby providing a new guidance for prenatal care in AMA pregnancies. Maintaining YAP levels or implementing anti-oxidative stress interventions could potentially mitigate the incidence of complications involved AMA pregnancy.

AbstractIntroduction Effect of physical activity in pregnancy on preeclampsia (PE) and angiogenic markers is not well understood. We studied the association of physical activity and PE in a case-control setting and assessed whether exercise in PE and non-PE women associate with maternal serum concentrations of soluble fms-like tyrosine kinase 1 (s-Flt-1), placental growth factor (PlGF) and soluble endoglin (sEng) and sFlt-1/PlGF ratio in the Finnish Genetics of Pre-eclampsia Consortium (FINNPEC) cohort.Materials and methods Participants completed a questionnaire on their background information and serum samples were collected from a subset. Questionnaire data on physical activity were available from 708 PE women and 724 non-PE women. Both first trimester serum samples and questionnaire data on physical activity were available from 160 PE women and 160 non-PE women, and second/third trimester serum samples and questionnaire data on physical activity were available from 139 PE women and 47 non-PE women. The PE and non-PE women were divided into categories of physically active (exercise 2 − 3 times/week or more) and physically inactive (exercise less than 2 − 3 times/week).Results A total of 43.4% of the PE women and 42.4% of the non-PE women were categorized as physically active. There were no differences in physical activity and exercise habits between the groups. The physically active women were more often nulliparous and non-smokers and had a lower body mass index. There were no differences in the concentrations of angiogenic markers (sFlt-1, PlGF and sEng and sFlt-1/PlGF ratio) between the groups who exercised more or less than 2 − 3 times/week.Conclusions In the FINNPEC study cohort, there was no association between physical activity and PE and no associations of physical activity in pregnant women with and without PE with maternal serum concentrations of sFlt-1, PlGF and sEng and sFlt-1/PlGF ratio.

Children born from pregnancy complications are at higher risk of chronic diseases in adulthood. Identifying which children born from a complicated pregnancy are likely to suffer from later chronic disease is important in order to intervene to prevent or delay the onset of disease. This study examined the associations between the major pregnancy complications (gestational diabetes, high blood pressure, small- and large for gestational age, and preterm birth) and child telomere length, a biomarker of chronic disease risk. This was a population-based longitudinal analysis using data from the Longitudinal Study of Australian Children. The primary outcome is telomere length, measured in 11–12-year-old children. Multivariable linear regression was used to estimate the association between pregnancy complications and child telomere length, adjusting for a range of a priori confounders. Data from 841 families were used. One in four pregnancies (27.1%) featured a pregnancy complication. In the adjusted analysis, there was no association between pregnancy complications and child telomere length (high blood pressure: mean difference (95% CI): 0.00 (−0.12, 0.12); gestational diabetes (0.05 (−0.10, 0.19)); small for gestational age (0.07 (−0.04, 0.19)); large for gestational age (−0.06 (−0.15, 0.03)); and preterm birth (−0.10 (−0.21, 0.01)). Our results do not support the notion that telomere length is shorter in children born to mothers after a pregnancy complication. Methodological considerations should be rigorous to improve the reproducibility of findings.

Background: Preeclampsia (PE) and eclampsia (E) are severe pregnancy complications with significant maternal and neonatal health impacts. This study explores the association of the rs5707 polymorphism in the renin-angiotensin system (RAS) with PE/E and related neonatal outcomes. Materials and Methods: We conducted a cross-sectional study involving 400 mother–newborn dyads at the "Pius Brinzeu" Emergency Clinical Hospital Timisoara. Participants were divided into a control group (254 normotensive women) and a PE/E group (146 women with PE/E). Genotyping for the rs5707 polymorphism was performed using real-time PCR, and statistical analyses assessed associations with maternal body mass index (BMI) and neonatal outcomes. Results: The AA genotype of rs5707 was significantly associated with a reduced risk of PE/E and more favorable neonatal outcomes, including higher Apgar scores, greater birth weights, and longer gestational ages. Conversely, the AC genotype correlated with increased maternal BMI and adverse neonatal outcomes. Odds ratios highlighted the protective effect of the AA genotype against PE/E and the increased risk associated with the AC genotype. Conclusions: This study revealed the critical role of the rs5707 polymorphism in PE/E development and neonatal health. Genetic screening for rs5707 could enhance early identification and personalized intervention strategies, improving outcomes for both mothers and neonates. Further research is needed to validate these findings across diverse populations and to uncover the underlying mechanisms. [ABSTRACT FROM AUTHOR]

Children born from pregnancy complications are at higher risk of chronic diseases in adulthood. Identifying which children born from a complicated pregnancy are likely to suffer from later chronic disease is important in order to intervene to prevent or delay the onset of disease. This study examined the associations between the major pregnancy complications (gestational diabetes, high blood pressure, small- and large for gestational age, and preterm birth) and child telomere length, a biomarker of chronic disease risk. This was a population-based longitudinal analysis using data from the Longitudinal Study of Australian Children. The primary outcome is telomere length, measured in 11–12-year-old children. Multivariable linear regression was used to estimate the association between pregnancy complications and child telomere length, adjusting for a range of a priori confounders. Data from 841 families were used. One in four pregnancies (27.1%) featured a pregnancy complication. In the adjusted analysis, there was no association between pregnancy complications and child telomere length (high blood pressure: mean difference (95% CI): 0.00 (−0.12, 0.12); gestational diabetes (0.05 (−0.10, 0.19)); small for gestational age (0.07 (−0.04, 0.19)); large for gestational age (−0.06 (−0.15, 0.03)); and preterm birth (−0.10 (−0.21, 0.01)). Our results do not support the notion that telomere length is shorter in children born to mothers after a pregnancy complication. Methodological considerations should be rigorous to improve the reproducibility of findings. [ABSTRACT FROM AUTHOR]

OBJECTIVES The study aimed to determine the maternal morbidities in patients with placenta previa in a tertiary care hospital. Moreover, patients’ risk factors and outcomes will also be accessed as secondary outcomes. METHODOLOGY This prospective cross-sectional study was undertaken at Ayub Teaching Hospital Abbottabad from January 2022 to July 2024. Any pregnant patients carrying the ultrasound diagnosis of placenta previa in an emergency or the ward were included in the study. A non-randomized convenience technique was applied for sample collection. Patients with other placental anomalies, such as placenta accreta, were excluded from the current study. The data was analyzed in SPSS version 21, and significance was kept below 0.005. RESULTS In the present study, 104 cases of placenta previa were recruited, among which 76(73%) patients fall in the age range between 24 and 34 years. The incidence of major placenta previa was observed in 76/104 cases. In 86% of cases, obstetric trauma was observed, and in 54 (52%) cases, purpureal sepsis was recorded. The purpureal sepsis was 10/36(28%) in patients with tamponade placement and 8/36(22%) in APH patients with a significance of 0.001. Presentation with antepartum hemorrhage was seen in 67% of cases (8/12) in the age group < 20 years. The maternal mortality was 2%. CONCLUSION The complication rate was relatively higher than reported in previous studies. The rate of morbidity can be minimized by following a multi-disciplinary approach. The cases should be managed in settings with ICU care and blood bank facilities.

Abstract Background Endometriosis is one of the most common and costly diseases among women. This study was carried out to investigate pregnancy outcomes in women with endometriosis because of the high prevalence of endometriosis in reproductive ages and its effect on pregnancy-related complications outcomes. Methods This was a cross-sectional study performed on 379 pregnant women with endometriosis who were referred to the endometriosis clinic of the Avicenna Infertility Treatment Center from 2014 to 2020. Maternal and neonatal outcomes were assessed for the endometriosis group and healthy mothers. The group with endometriosis was further divided into two groups: those who underwent surgery and those who either received medication alone or were left untreated before becoming pregnant. The analysis of the data was done using SPSS 18. Results The mean age of the patients was 33.65 ± 7.9 years. The frequency of endometriosis stage (P = 0.622) and surgery (P = 0.400) in different age groups were not statistically significant. The highest rates of RIF and infertility were in stages 3 (N = 46, 17.2%) (P = 0.067), and 4 (N = 129, 48.3%) (P = 0.073), respectively, but these differences were not statistically different, and the highest rate of pregnancy with ART/spontaneous pregnancy was observed in stage 4 without significant differences (P = 0.259). Besides, the frequency of clinical/ectopic pregnancy and cesarean section was not statistically different across stages (P > 0.05). There is no significant relationship between endometriosis surgery and infertility (P = 0.089) and RIF (P = 0.232). Most of the people who had endometriosis surgery with assisted reproductive methods got pregnant, and this relationship was statistically significant (P = 0.002) in which 77.1% (N = 138) of ART and 63% (N = 264) of spontaneous pregnancies were reported in patients with endometriosis surgery. The rate of live births (59.4%) was not statistically significant for different endometriosis stages (P = 0.638). There was no stillbirth or neonatal death in this study. All cases with preeclampsia (N = 5) were reported in stage 4. 66.7% (N = 8) of the preterm labor was in stage 4 and 33.3% (N = 4) was in stage 3 (P = 0.005). Antepartum bleeding, antepartum hospital admission, preterm labor, gestational diabetes, gestational hypertension, abortion, placental complications and NICU admission were higher in stage 4, but this difference had no statistical difference. Conclusion Endometriosis is significantly correlated with infertility. The highest rates of RIF and infertility are observed in stages 3 and 4 of endometriosis. The rate of pregnancy with ART/spontaneous pregnancy, preterm labor, preeclampsia and pregnancy-related complications is higher in stage 4. Most of the people who had endometriosis surgery with assisted reproductive methods got significantly pregnant. Clinical/ectopic pregnancy, cesarean sections, and live birth were not affected by the endometriosis stages.

Aim: To estimate the incidence of abruption in first births and recurrence in the subsequent birth in patients of a large US‐based integrated health care system. Methods: Retrospective population‐based cohort study of patients with first two consecutive singleton births using data from the Kaiser‐Permanente South California health care system who delivered over a period of 30 years (1991–2021), using longitudinally linked electronic health records. ICD‐9/ICD‐10 codes "641.20" and "O45.x" identified placental abruption. We calculated the incidence and rates of abruption in first and second pregnancies. We used logistic regression to estimate the adjusted odds ratios (aOR) for abruption in second pregnancies in patients with and without abruptions in their first pregnancies. Results: Of the 126 264 patients with first two consecutive singleton births over the period, 805 had abruptions in their first births, and 861 in their second births. Rates of abruption in first and second births were 0.63% and 0.68%, respectively. Twenty‐seven patients had abruptions in both first and second births. Rates of abruption in the second birth among individuals with and without previous placental abruption were 3.35% and 0.66%, respectively, giving an approximately five‐fold increased odds of abruption in a second pregnancy in individuals who had abruption in their first birth when compared with those who did not have placental abruption in their first birth (aOR: 4.95, 95% confidence interval: 3.35–7.31, p < 0.00001). Interpregnancy interval had no statistically significant association with recurrence. Conclusion: Abruption in a first birth is associated with an approximately five‐fold increased odds of abruption in a second birth. [ABSTRACT FROM AUTHOR]

Objective: Docosahexaenoic acid (DHA) is recommended routinely in pregnancy to promote fetal development. DHA has anti‐inflammatory activity, but its effects on the fetal heart and circulation are unknown. This study aimed to investigate whether maternal DHA supplementation in the third trimester affects maternal prostaglandin levels and fetal ductus arteriosus flow dynamics. Methods: This was a double‐blind randomized controlled trial with parallel groups conducted between 2018 and 2021. Pregnant women aged over 18 years with a normal fetus at 27–28 weeks' gestation showing no cardiac/extracardiac anomalies or ductal constriction were eligible for the trial. Women consuming substances with a known inhibitory effect on prostaglandin metabolism, such as non‐steroidal anti‐inflammatory drugs and polyphenol‐rich foods, were excluded. The intervention group received oral supplementation of omega‐3 with 450 mg/day of DHA for 8 weeks and the placebo group received capsules of soy lecithin for 8 weeks. Anthropometric measurements, assessment of polyphenol and omega‐3 consumption, fetal morphological ultrasound examination, fetal Doppler echocardiographic examination and blood sample collection were performed at the start of the study and the latter two were repeated at follow‐up. Prostaglandin E2 (PGE2) level and echocardiographic parameters were compared between the intervention and placebo groups and between baseline and follow‐up. Results: A total of 24 participants were included in each group. After 8 weeks, there were no significant differences between the intervention and placebo groups in maternal serum PGE2 level or Doppler echocardiographic parameters of ductal flow. No case of ductus arteriosus constriction was observed. The expected intragroup changes in cardiac morphology, as a result of advancing gestation, were present. Conclusions: Maternal DHA supplementation in the third trimester at a clinically recommended dose did not result in inhibition of PGE2 or constriction of the ductus arteriosus. These findings should be confirmed in postmarket surveillance studies with larger patient numbers in order to test the full safety profile of DHA and provide robust clinical reassurance. © 2024 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

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Preeclampsia (PE) is a severe pregnancy complication due to placental dysfunction. Thrombomodulin (TM), a glycoprotein expressed on the trophoblast cell membrane, plays an organ-protective role in the placenta by regulating coagulation and inflammation. TM-mediated regulation of High Mobility Group Box1(HMGB1) is an essential mechanism that contributes to placental homeostasis and prevents pregnancy complications in mice. Here, we aimed to clarify the role of placental TM and HMGB1 in the pathophysiology of human PE. In this study, maternal blood serum and placental tissue were obtained from 72 PE patients and 110 normal controls. Soluble TM(sTM) and HMGB1 levels in the maternal serum were assessed. The placental TM and HMGB1 expression levels were evaluated using immunohistochemistry and qPCR. Serum sTM and HMGB1 levels gradually increased with gestational age in normal pregnancies; however, both circulating sTM and HMGB1 levels were significantly higher in the PE group. Serum HMGB1/sTM ratio was elevated in PE patients compared to that in normal controls, which correlated positively with the clinical severity of PE. The immunohistochemistry analysis revealed the loss of TM and the increase in extranuclear HMGB1. TM mRNA expression was diminished in PE placentas, which negatively correlated with soluble fms-like tyrosine kinase-1 (sFlt-1) expression. The increase in circulating sTM and HMGB1 could be attributed to the enhanced placental TM shedding in PE patients. The molecular events mediated by the imbalance in the placental TM and HMGB1 levels could be an underlying feature of PE; maternal serum HMGB1/sTM ratio could reflect this status. • Preeclampsia (PE) is a severe and fatal pregnancy complication due to placental dysfunction. • We aimed to clarify the role of placental thrombomodulin (TM) and HMGB1 in the pathophysiology of human PE. • The imbalance of placental TM and HMGB1 expression is observed in PE patients. • Maternal serum HMGB1/sTM ratio reflects the severity of PE which could be a novel PE biomarker. • Altered release of placental TM and HMGB1 could be the unknown cause of PE. [ABSTRACT FROM AUTHOR]

Obesity is recognized by the World Health Organization (WHO) as a disease in its own right. Moreover, obesity is an increasingly concerning public health issue across the world and its prevalence is rising amongst women of reproductive age. The fertility of over-weight and obese women is reduced and they experience a higher rate of miscarriage. In pregnant women obesity not only increases the risk of antenatal complications, such as preeclampsia and gestational diabetes, but also fetal abnormalities, and consequently the overall feto-maternal mortality. Ultrasound is one of the most valuable methods to predict and evaluate pregnancy complications. However, in overweight and obese pregnant women, the ultrasound examination is met with several challenges, mainly due to an impaired acoustic window. Overall obesity in pregnancy poses special challenges and constraints to the antenatal care and increases the rate of pregnancy complications, as well as complications later in life for the mother and child. [ABSTRACT FROM AUTHOR]

Obstetrical hemorrhage is a relatively frequent obstetrical complication and a common cause of maternal morbidity and mortality worldwide. The majority of maternal deaths attributable to hemorrhage are preventable, thus, developing rapid and effective means of treating postpartum hemorrhage is of critical public health importance. Intrauterine devices are one option for managing refractory hemorrhage, with rapid expansion of available devices in recent years. Intrauterine packing was historically used for this purpose, with historical cohorts documenting high rates of success. Modern packing materials, including chitosan-covered gauze, have recently been explored with success rates comparable to uterine balloon tamponade in small trials. There are a variety of balloon tamponade devices, both commercial and improvised, available for use. Efficacy of 85.9% was cited in a recent meta-analysis in resolution of hemorrhage with the use of uterine balloon devices, with greatest success in the setting of atony. However, recent randomized trials have demonstrated potential harm associated with improvised balloon tamponade use In low resource settings and the World Health Organization recommends use be restricted to settings where monitoring is available and care escalation is possible. Recently, intrauterine vacuum devices have been introduced, which offer a new mechanism for achieving hemorrhage control by mechanically restoring uterine tone via vacuum suction. The Jada device, which is is FDA-cleared and commercially available in the US, found successful bleeding control in 94% of cases in an initial single-arm trial, with recent post marketing registry study described treatment success following hemorrhage in 95.8% of vaginal and 88.2% of cesarean births. Successful use of improvised vacuum devices has been described in several studies, including suction tube uterine tamponade via Levin tubing, and use of a modified Bakri balloon. Further research is needed with head-to-head comparisons of efficacy of devices and assessment of cost within the context of both device pricing and overall healthcare resource utilization. [ABSTRACT FROM AUTHOR]

Ectopic pregnancies within previous cesarean section scars are rare but potentially life-threatening complications. Diagnosis can be challenging, particularly in primary care settings, where the focus is often on routine primary care services. We present a case report of a patient who initially presented to a primary care clinic with non-specific symptoms of ectopic pregnancy and was referred to a tertiary center for incomplete miscarriage. It was found to be a viable ectopic pregnancy within a cesarean scar. This case highlights the importance of keeping an open mind in patients with a history of cesarean section and uterine manipulation procedures such as manually evacuating a retained placenta. It emphasizes prompt diagnosis and referral to a specialized healthcare facility. [ABSTRACT FROM AUTHOR]

PFAS (per- and polyfluoroalkyl substances) have been extensively used across numerous industries and consumer goods. Due to their high persistence and mobility, they are ubiquitous in the environment. Exposure to PFAS occurs in people via multiple pathways such as dermal contact, water supply, air inhalation, and dietary intake. Even if some PFAS are being phased out because of their persistent presence in the environment and harmful impacts on human health, mixes of replacement and legacy PFAS will continue to pollute the ecosystem. Numerous toxicological investigations have revealed harmful effects of PFAS exposure on female reproductive health, e.g., polycystic ovaries syndrome, premature ovarian failure, endometriosis, reproductive system tumors, pregnancy complications, and adverse pregnancy outcomes. Despite extensive epidemiological studies on the reproductive toxicity of PFAS, research findings remain inconsistent, and the underlying mechanisms are not well understood. In this review, we give an in-depth description of the sources and pathways of PFAS, and then review the reproductive toxicity of PFAS and its possible mechanisms.

Cardiovascular disease (CVD) is a leading cause of mortality and disease burden in women globally. A healthy diet is important for the prevention of CVD. Research has consistently favoured the Mediterranean diet as a cardio-protective diet. Several studies have evaluated associations between the Mediterranean diet and cardiovascular outcomes, including traditional risk factors like hypertension, type 2 diabetes mellitus, and obesity. In addition, consistent evidence suggests that the components of the Mediterranean diet have a synergistic effect on cardiovascular risk due to its anti-inflammatory profile and microbiome effects. While the benefits of the Mediterranean diet are well-established, health advice and dietary guidelines have been built on largely male-dominant studies. Few studies have investigated the beneficial associations of the Mediterranean diet in sex-specific populations, including those with non-traditional risk factors that are specific to women, for instance polycystic ovarian syndrome and high-risk pregnancies, or more prevalent in women, such as chronic inflammatory diseases. Therefore, this review aims to provide a comprehensive overview of the current evidence regarding the Mediterranean diet in women in relation to cardiovascular health outcomes. [ABSTRACT FROM AUTHOR]

Aim: To analyse key pregnancy and birth outcomes for First Nations women and children at a Western Sydney metropolitan tertiary referral centre. Methods: The birth and health‐determining characteristics of 470 First Nations infants born at Nepean Hospital in 2018 and their mothers were included in a retrospective audit and compared with a contemporaneous control group of 470 infants and their mothers. Results: Mothers of First Nations infants had significantly higher rates of socioeconomic disadvantage (P < 0.001), psychosocial vulnerability (P < 0.007), mental illness (P < 0.001), teenage pregnancy (P < 0.001), smoking (45.6% vs. 19.4%, P < 0.001) and drug and alcohol use than control mothers (P < 0.001, P < 0.048). First Nations peoples did not have increased rates of maternal morbidity, nor any difference in rates of Caesarean section, resuscitation at birth, NICU admission, preterm birth or low birth weight in multivariable analysis. However, multivariable analysis demonstrated significant associations between low birth weight and maternal smoking (P < 0.001), hypertension (P < 0.01) and drug use (P < 0.01). Conclusions: Despite challenges facing First Nations mothers and infants, our study found no significant difference in maternal morbidity nor adverse birth outcomes for First Nations infants. The study occurred in the context of culturally specific, First Nations‐led antenatal and infant services. Future studies should further investigate relationships between participation in these services and health outcomes. This could identify strengths and areas for improvement in current services, with the goal of further improving outcomes for First Nations peoples through targeted health services that address their psychosocial vulnerabilities and support women to make healthy choices during pregnancy. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has had a significant and enduring influence on global health, including maternal and fetal well-being. Evidence suggests that placental dysfunction is a potential consequence of SARS-CoV-2 infection during pregnancy, which may result in adverse outcomes such as preeclampsia and preterm birth. However, the molecular mechanisms underlying this association remain unclear, and it is uncertain whether a mature placenta can protect the fetus from SARS-CoV-2 infection. To address the above gap, we conducted a transcriptome-based study of the placenta in both maternal and fetal compartments. We collected placental samples from 16 women immediately after term delivery, seven of which had SARS-CoV-2 infection confirmed by PCR before parturition. Notably, we did not detect any viral load in either the maternal or fetal compartments of the placenta, regardless of symptomatic status. We separately extracted total RNA from placental tissues from maternal and fetal compartments, constructed cDNA libraries, and sequenced them to assess mRNA. Our analysis revealed 635 differentially expressed genes when a false discovery rate (FDR ≤ 0.05) was applied in the maternal placental tissue, with 518 upregulated and 117 downregulated genes in the SARS-CoV-2-positive women (n = 6) compared with the healthy SARS-CoV-2-negative women (n = 8). In contrast, the fetal compartment did not exhibit any significant changes in gene expression with SARS-CoV-2 infection. We observed a significant downregulation of nine genes belonging to the pregnancy-specific glycoprotein related to the immunoglobulin superfamily in the maternal compartment with active SARS-CoV-2 infection (fold change range from −13.70 to −5.28; FDR ≤ 0.01). Additionally, comparing symptomatic women with healthy women, we identified 1788 DEGs. Furthermore, a signaling pathway enrichment analysis revealed that pathways related to oxidative phosphorylation, insulin secretion, cortisol synthesis, estrogen signaling, oxytocin signaling, antigen processing, and presentation were altered significantly in symptomatic women. Overall, our study sheds light on the molecular mechanisms underlying the reported clinical risks of preeclampsia and preterm delivery in women with SARS-CoV-2 infection. Nonetheless, studies with larger sample sizes are warranted to further deepen our understanding of the molecular mechanisms of the placenta's anti-viral effects in maternal SARS-CoV-2 infection. [ABSTRACT FROM AUTHOR]

Background and objectives: Maternal obesity influences pregnancy course in several different manners, and imbalanced nutrition during pregnancy may lead to various adverse pregnancy outcomes. Additionally, nutritional status during pregnancy may have implications for the health of the offspring and may possibly influence early motor development in children. The aim of this study was to assess the impact of excessive gestational weight gain (EGWG) on pregnancy outcomes and infant's motor development within the first twelve months of life. Materials and methods: The study included 200 participants divided in two groups based on their gestational weight gain. Maternal, perinatal, and neonatal factors were analyzed, and early motor development was assessed using the Alberta infant motor scale (AIMS). Results: EGWG was significantly associated with: pre-pregnancy BMI (p < 0.001), family history for cardiovascular diseases (p = 0.013) and diabetes mellitus (p = 0.045), hypertensive disorder of pregnancy (p = 0.003), gestational diabetes mellitus (p < 0.001), gestational anemia (p = 0.001), vitamin D deficiency (p = 0.001), metformin use (p = 0.045), pre-labor premature rupture of membranes (p = 0.031), amniotic fluid index (p = 0.047), and APGAR score in the first five min of life (p = 0.007). Scored by AIMS, EGWG was significantly associated with parameters of early motor development at the age of three AIMS total (p < 0.001), six AIMS total (p < 0.001), nine AIMS total (p < 0.001), and twelve AIMS total (p < 0.001) months of infant's life. Conclusions: The link between EGWG and adverse neurodevelopmental outcomes in offspring is a complex and multifaceted issue. Our results imply significant alterations in early motor development in the group of infants born from mothers who gained weight excessively during pregnancy. Further studies are needed to unravel the intricacies of this relationship and inform strategies for preventive interventions and supportive care during pregnancy and infancy. [ABSTRACT FROM AUTHOR]

BACKGROUND The establishment of maternal–fetal crosstalk is vital to a successful pregnancy. Glycosylation is a post-translational modification in which glycans (monosaccharide chains) are attached to an organic molecule. Glycans are involved in many physiological and pathological processes. Human endometrial epithelium, endometrial gland secretions, decidual immune cells, and trophoblasts are highly enriched with glycoconjugates and glycan-binding molecules important for a healthy pregnancy. Aberrant glycosylation in the placenta and uterus has been linked to repeated implantation failure and various pregnancy complications, but there is no recent review summarizing the functional roles of glycosylation at the maternal–fetal interface and their associations with pathological processes. OBJECTIVE AND RATIONALE This review aims to summarize recent findings on glycosylation, glycosyltransferases, and glycan-binding receptors at the maternal–fetal interface, and their involvement in regulating the biology and pathological conditions associated with endometrial receptivity, placentation and maternal–fetal immunotolerance. Current knowledge limitations and future insights into the study of glycobiology in reproduction are discussed. SEARCH METHODS A comprehensive PubMed search was conducted using the following keywords: glycosylation, glycosyltransferases, glycan-binding proteins, endometrium, trophoblasts, maternal–fetal immunotolerance, siglec, selectin, galectin, repeated implantation failure, early pregnancy loss, recurrent pregnancy loss, preeclampsia, and fetal growth restriction. Relevant reports published between 1980 and 2023 and studies related to these reports were retrieved and reviewed. Only publications written in English were included. OUTCOMES The application of ultrasensitive mass spectrometry tools and lectin-based glycan profiling has enabled characterization of glycans present at the maternal–fetal interface and in maternal serum. The endometrial luminal epithelium is covered with highly glycosylated mucin that regulates blastocyst adhesion during implantation. In the placenta, fucose and sialic acid residues are abundantly presented on the villous membrane and are essential for proper placentation and establishment of maternal–fetal immunotolerance. Glycan-binding receptors, including selectins, sialic-acid-binding immunoglobulin-like lectins (siglecs) and galectins, also modulate implantation, trophoblast functions and maternal–fetal immunotolerance. Aberrant glycosylation is associated with repeated implantation failure, early pregnancy loss and various pregnancy complications. The current limitation in the field is that most glycobiological research relies on association studies, with few studies revealing the specific functions of glycans. Technological advancements in analytic, synthetic and functional glycobiology have laid the groundwork for further exploration of glycans in reproductive biology under both physiological and pathological conditions. WIDER IMPLICATIONS A deep understanding of the functions of glycan structures would provide insights into the molecular mechanisms underlying their involvement in the physiological and pathological regulation of early pregnancy. Glycans may also potentially serve as novel early predictive markers and therapeutic targets for repeated implantation failure, pregnancy loss, and other pregnancy complications. [ABSTRACT FROM AUTHOR]

Background: The Gambia has the 12th highest maternal mortality rate in the world, with 80% of deaths resulting from avoidable causes. Unawareness of pregnancy danger signs (DS) has been shown to be a barrier to seeking obstetric care, while app-based education intervention has shown promise. Objective: We aim to assess patient awareness of DS, identify barriers to awareness, and evaluate potential for implementing smartphone-based technologies for education. Methods: A cross-sectional semi-structured survey was administered to Gambian women (n = 100) across five hospitals/health centers. Data and informed consent were collected via an online survey portal. Analysis included bivariate analysis and descriptive statistics with p < 0.05 significance level. Recall of 0–2 DS per category was classified as "low" knowledge, 3–5 as "moderate" knowledge, and 6+ as "sufficient" knowledge. Cross-category recall was quantified for overall awareness level (0–6 = "low", 7–12 = "moderate", 13+ = "sufficient". N = 28 total DS). Findings: Although 75% of participants (n = 100) self-perceived "sufficient" knowledge of DS, the average recall was only two (SD = 2, n = 11) pregnancy DS, one labor and delivery DS (SD = 1, n = 8), and one postpartum DS (SD = 1, n = 9). Twenty-one women were unable to recall any danger signs. "Low" awareness was identified in 77% of women, while 23%, and 0% of women showed "moderate" and "sufficient" overall awareness, respectively. Education level was significantly correlated with overall danger sign recall (ρ(98) =.243, p =.015) and awareness level (ρ(98) =.265, p =.008). Monthly income was significantly correlated with awareness level (ρ(97) =.311, p =.002). Smartphone ownership was reported by 76% of women, and 97% expressed interest in using app-based video (94%) or provider (93%) teaching. Conclusions: Women had low knowledge of obstetric danger signs, and true awareness of danger signs was remarkably lower than self-perceived knowledge. However, patients exhibited proper healthcare-seeking behavior when danger signs arose. Findings suggest that video- or messaging-based education from local healthcare providers may be effective DS educational interventions. [ABSTRACT FROM AUTHOR]

Background: Women present to the emergency department (ED) with pregnancy complications including bleeding. They seek investigations, treatment and clear discharge and referral pathways. Aims: The aim was to identify trends, characteristics, ED care and discharge pathways for women who present to the ED with early pregnancy bleeding. Methods: Retrospective data (from 2011 to 2020) were extracted from a regional health district's databank. Data were processed, and deterministic linking was used to produce a final data set. Descriptive statistics were used to identify trends and characteristics. Linear and logistic regression models were used to identify factors that influence health service use, outcomes and discharge pathways. Results: Over the 10 years, there have been almost 15 000 presentations to the ED for early pregnancy bleeding, from approximately 10 000 women, 0.97% of all ED presentations. The frequency of presentations increased by 19.6% over the study period. The average age of women who presented to the ED was 29.1 years, which increased from 28.5 years (2011) to 29.3 (2020). The median length of stay was less than 4 h, and most women were treated and discharged from the ED. One‐third of presentations received neither ultrasound nor pathology, but health service costs increased by 330% from 2014 to 2020. Conclusions: Maternal age is increasing, as is the frequency of ED presentations for early pregnancy bleeding, and both factors increase demands on the ED. Findings from this study may inform strategies to improve current care models and improve quality and safety practices within the ED. [ABSTRACT FROM AUTHOR]

STUDY QUESTION Can we identify genetic variants associated with ectopic pregnancy by undertaking the first genome-wide association study (GWAS) leveraging two large-scale biobank initiatives? SUMMARY ANSWER We identified two novel genome-wide significant associations with ectopic pregnancy, highlighting MUC1 (mucin 1) as the most plausible affected gene. WHAT IS KNOWN ALREADY Ectopic pregnancy is an important cause of maternal morbidity and mortality worldwide. Despite being a common early pregnancy complication, the genetic predisposition to this condition remains understudied and no large scale genetic studies have been performed so far. STUDY DESIGN, SIZE, DURATION A GWAS meta-analysis including 7070 women with ectopic pregnancy and 248 810 controls from Estonian Biobank and the FinnGen study. PARTICIPANTS/MATERIALS, SETTING, METHODS We identified ectopic pregnancy cases from national registers by ICD (International Classification of Disease) codes (ICD-10 O00), and all remaining women were considered controls. We carried out standard GWAS meta-analysis and additionally annotated GWAS signals, analysed co-localization with quantitative trait loci, estimated genetic correlations and identified associated phenotypes to characterize the genetic signals, as well as to analyse the genetic and phenotypic relationships with the condition. MAIN RESULTS AND THE ROLE OF CHANCE We identified two genome-wide significant loci on chromosomes 1 (rs4971091, P  = 5.32 × 10−9) and 10 (rs11598956, P  = 2.41 × 10−8) potentially associated with ectopic pregnancy. Follow-up analyses propose MUC1 , which codes for an epithelial glycoprotein with an important role in barrier function, as the most likely candidate gene for the association on chromosome 1. We also characterize the phenotypic and genetic correlations with other phenotypes, identifying a genetic correlation with smoking and diseases of the (genito)urinary and gastrointestinal system, and phenotypic correlations with various reproductive health diagnoses, reflecting the previously known epidemiological associations. LARGE SCALE DATA The GWAS meta-analysis summary statistics are available from the GWAS Catalogue (GCST90272883). LIMITATIONS, REASONS FOR CAUTION The main limitation is that the findings are based on European-based ancestry populations, with limited data on other populations, and we only captured maternal genomes. Additionally, further larger meta-analysis or independent studies are needed to validate these findings. WIDER IMPLICATIONS OF THE FINDINGS This study encourages the use of large-scale genetic datasets to unravel genetic factors linked to ectopic pregnancy, which is difficult to study in experimental settings. Increased sample size might bring additional genetic factors associating with ectopic pregnancy and inform its heritability. Altogether, our results provide more insight into the biology of ectopic pregnancy and, accordingly, the biological processes governing embryo implantation. STUDY FUNDING/COMPETING INTEREST(S) N.P.G. was supported by MATER Marie Sklodowska-Curie which received funding from the European Union's Horizon 2020 research and innovation program under grant agreement No. 813707. This study was funded by European Union through the European Regional Development Fund Project No. 2014-2020.4.01.15-0012 GENTRANSMED. Computations were performed in the High-Performance Computing Center of University of Tartu. The authors declare no competing interests. [ABSTRACT FROM AUTHOR]

ObjectiveThe aim of this study is to evaluate the contribution of pre-pregnancy obesity and overweight to peripartum cardiomyopathy.Study designThis population-based study used linked birth record and maternal hospital discharge data from live births in California during 2007 to 2012 (n = 2,548,380). All women who had a diagnosis of peripartum cardiomyopathy during the childbirth hospitalization or who were diagnosed with peripartum cardiomyopathy during a postpartum hospital readmission within 5 months of birth were identified as cases. Pre-pregnancy body mass index (BMI, kg/m2) was classified as normal weight (18.5-24.9), overweight (25.0-29.9), obesity class 1 (30.0-34.9), obesity class 2 (35.0-39.9), and obesity class 3 (≥40). Because of small numbers, we excluded women with underweight BMI, and in some analyses, we combined obesity classes into one group. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) expressing associations between BMI and peripartum cardiomyopathy, adjusted for maternal age, race/ethnicity, education, health care payer, parity, plurality, and comorbidities.ResultsThe overall prevalence of peripartum cardiomyopathy during hospital admissions was 1.3 per 10,000 live births (n = 320). Unadjusted ORs were 1.32 (95% CI: 1.01-1.74) for women with overweight BMI and 2.03 (95% CI: 1.57-2.62) for women with obesity, compared with women with normal pre-pregnancy BMI. Adjusted ORs were 1.26 (95% CI: 0.95-1.66) for overweight women and 1.38 (95% CI: 1.04-1.84) for women with obesity. The ORs suggested a dose-response relationship with increasing levels of obesity, but the 95% CIs for the specific classes of obesity included 1.00.ConclusionPre-pregnancy obesity was associated with an increased risk of peripartum cardiomyopathy. These findings underscore the importance of BMI during pregnancy. There is a need to recognize the increased risk of peripartum cardiomyopathy in women with high BMI, especially in the late postpartum period.Key points· Pre-pregnancy obesity affects maternal health.. · Effects may extend to peripartum cardiomyopathy.. · The risk includes peripartum cardiomyopathy that emerges postpartum..

The term ‘chronic ectopic pregnancy’ refers to a type of tubal pregnancy in which a pelvic mass frequently develops as a result of repeated small ectopic ruptures or abortions, rather than a single episode of bleeding. Chronic ectopic pregnancy can often present with vague symptoms, making it susceptible to misdiagnosis and delaying treatment. In this case, a 27-year-old woman with para 2 and 2 live births presented with complaints of on-and-off abdominal pain in the right inguinal region for the past two months. During the clinical examination, a substantial, firm mass measuring 6×6 cm was palpated in the right adnexal region, not associated with any adnexal tenderness. Transabdominal sonography suggested an empty uterus with a solid cystic mass, round/ oval in shape, located in the right adnexal region measuring approximately 6.9×6.4 cm. The ultrasound findings in these patients can either show an amorphous, avascular mass or a highly vascular complex. The diagnosis can be mistaken for endometriosis, acute pelvic inflammatory illness, vascular tumours, pelvic abscess, or, in this instance, a cystadenoma. In most cases, radiologic findings are essential in the differential diagnosis, but it is mostly confirmed through surgery, as in this case. A laparotomy was performed, which revealed a chronic ectopic pregnancy, and a salpingo-oophrectomy was performed.

Background: The study aimed to know the adverse pregnancy outcome in patients with previous spontaneous abortions. Material and methods: The present prospective observational study was conducted on 80 patients of age between 18 to 40 years with a history of one or more spontaneous abortions irrespective of the period of gestation. A detailed history of each patient including details of the present pregnancy, previous pregnancy, and previous abortion was obtained. All the routine examination was done and patients were followed up till delivery and obstetrics outcomes were noted. Results: The majority of women were belonged to 21-30 years of age (82.6%).30% of subjects were from socioeconomic class IV followed by 27.5%, 18.8%, 12.5%, and 11.3% of patients belonged to socioeconomic class III, II, I, and V respectively. Moreover, 56.25% and 20% of women were gravida 3 and 2 respectively. The maximum number of study subjects (78.75%) had one previous abortion whereas 17.5% and 3.75% of women had two and three previous abortions respectively. In 77.6% of women, the type of delivery was LSCS followed by in 11.3% of patients it was FTVD. The most common intrapartum complication was foetal distress (17.5%) followed by intrapartum haemorrhage (5%), followed by prolonged labour (3.7%). In 75% of cases foetal outcomes were abnormal this including low birth weight, prematurity, meconium stained liquor, intrauterine growth restriction, intrauterine death, and tachypnoea. Previous spontaneous delivery was found to be significantly associated with type of delivery and foetal outcomes (P<0.05). Conclusion: Pregnancy with previous spontaneous abortion are associated with the adverse pregnancy and foetal outcomes. The maternal and foetal complications can be overcome by providing proper antennal care. [ABSTRACT FROM AUTHOR]