Women, Volume 6, Issue 2 (June 2026) – 11 articles

The United States faces a worsening maternal mortality crisis that starkly contrasts with trends in other high-income nations. Maternal mortality rates (MMRs) have more than doubled over the past two decades, rising from 9.65 deaths per 100,000 live births in 1999–2002 to 23.6 in 2018–2021, with approximately 700 deaths annually. Black and American Indian/Alaska Native women experience maternal mortality rates two to three times higher than their White counterparts, reflecting persistent structural inequities rather than biological differences. This narrative review synthesizes current evidence on the underlying drivers of racial inequities in maternal mortality and evaluates evidence-based interventions and policy strategies to address these disparities. A comprehensive literature review between 2000 and 2025 was conducted using databases including PubMed, Scopus, Web of Science, and Google Scholar, focusing on studies examining clinical, social, and structural determinants of maternal health outcomes, as well as evidence-based interventions and maternal health policy. Targeted searches of policy reports and grey literature were also performed to identify relevant policy initiatives and system-level interventions. Key contributors to disparities include underlying health conditions, postpartum mental health inequities, provider shortages, and limited access to postpartum care, with pregnancy-associated breast cancer (PABC) representing a less common but clinically significant risk factor that warrants further investigation in the context of racial inequities. Structural racism and socioeconomic disparities further exacerbate inequities through differential access to care, treatment bias, and barriers to healthcare utilization. System-level challenges, including workforce shortages, maternity care deserts, and the absence of federally mandated paid maternity leave, disproportionately impact marginalized populations. Although policy initiatives such as Medicaid postpartum coverage extensions, the Maternal Health Momnibus Act, and Maternal Mortality Review Committees represent important progress, they remain insufficient without broader structural reform. Evidence-based interventions, including midwife- and doula-led care, community-based peer support, and culturally tailored mental health programs, demonstrate measurable improvements in maternal outcomes. Outcomes of this review highlight the need for a comprehensive, equity-centered approach to reducing maternal mortality disparities, emphasizing structural reform, expanded access to care, strengthened data systems, and community-driven solutions. Full article

Emerging evidence suggests that psychological trauma, chronic stress, and unresolved emotional conflict may influence cancer-related processes through neuroendocrine and immunological pathways. However, the clinical relevance of trauma-related psychological profiles in oncology remains insufficiently defined, particularly in women with breast and gynecological cancers. This exploratory observational study included 135 women with breast, cervical, ovarian, and endometrial cancers undergoing multimodal oncological treatment. Psychological assessments were performed using validated instruments, including the PTSD Checklist (PCL), Hamilton Anxiety and Depression Scales (HAM-A, HAM-D), the Adult Attachment Scale (AAS), and a Lazarus-based checklist of stressful life events to assess cumulative stress exposure. Descriptive and exploratory analyses were conducted to identify clinically relevant patterns. A high prevalence of anxiety, depressive symptoms, and trauma-related distress was observed. Insecure attachment patterns were frequent and associated with increased psychological burden. Many patients reported moderate-to-high cumulative stress exposure, suggesting broader vulnerability profiles characterized by emotional dysregulation. These findings support a biopsychosocial model in which trauma, attachment insecurity, and cumulative stress are associated with psychological vulnerability in oncology. Although causal relationships cannot be established, these factors may influence coping and adaptation to disease. Integrating trauma-informed psychological assessment into oncology care may enhance patient-centered management. Full article

Systemic inflammation plays a key role in the pathophysiology of pre-eclampsia (PE) and gestational diabetes mellitus (GDM). Recently, the Systemic Immune Inflammation (SII) and Systemic Inflammation Response Index (SIRI) indices have emerged as potential risk predictors, but current evidence shows mixed results. The aim of this meta-analysis was to assess the association between elevated SII/SIRI levels and the development of both complications. In accordance with the PRISMA guidelines, a search was conducted in PubMed, Scopus and Web of Science (up to February 2026). Observational studies linking the SII and SIRI indices to PE and GDM were included. Methodological quality (NHLBI tools) and evidence (GRADE) were assessed, and a random-effects meta-analysis was applied to synthesise the measures of association. Thirteen studies involving more than 150,000 pregnant women were included. The meta-analyses demonstrated that elevated levels of SII and SIRI are associated with an increased risk of GDM by 28% (OR = 1.28; 95% CI: 1.16–1.42) and 27% (OR = 1.27; 95% CI: 1.11–1.48) respectively, albeit with considerable heterogeneity. They also increase the risk of PE by 16% (OR = 1.16; 95% CI: 1.08–1.24) and 21% (OR = 1.21; 95% CI: 1.05–1.40), without significant heterogeneity. Although the quality of the studies was good, the strength of the evidence was low for GDM and very low for PE. Therefore, while these indices show potential as early biomarkers, these findings should be considered suggestive and require further validation and standardisation across diverse populations. Full article

Gender-based violence constitutes a major public health and social concern, with particularly complex implications in structurally vulnerable contexts such as rural settings. However, empirical evidence regarding the specific profile and risk perception of women experiencing gender-based violence in small municipalities remains limited. The aim of this study was to analyze the sociodemographic characteristics of women victims of gender-based violence residing in small rural municipalities and to examine their associations with mental health indicators and perceived risk of future violence. The sample comprised 30 women receiving support at a Specialized Care Centre for Victims of Gender-Based Violence (CAVI) serving three small municipalities in the Vega Media region (Region of Murcia, Spain). Standardized measures of depression, anxiety, and stress were administered, together with an assessment of perceived risk. The findings suggest a specific sociodemographic profile characterized by moderate levels of depression, anxiety, and stress symptoms and generally low perceived risk. Women without children reported higher levels of psychological distress and perceived risk than those with children, although these differences should be interpreted with caution given the sample size. Overall, these findings provide preliminary insights into the characteristics and risk perception of women experiencing gender-based violence in rural settings and highlight the need for context-sensitive prevention and intervention strategies. Full article

Motherhood is a profoundly transformative stage, associated with both emotional fulfillment and psychological and physical vulnerability. The aim of this study was to assess the perceptions, difficulties and resources needed by mothers in the experience of motherhood. We conducted an exploratory cross-sectional observational study, based on an online questionnaire administered to 172 mothers. We analyzed socio-demographic data, experiences related to pregnancy and childbirth, perceived level of support, emotional difficulties, and resources considered useful in the role of motherhood. Most participants were women aged 30 to 45, with university or postgraduate education, married and with one or more children. Although motherhood was predominantly described in positive terms such as “fulfillment”, “love” and “joy”, a significant percentage of mothers reported increased fatigue, lack of personal time and emotional difficulties. The resources considered essential for maternal balance were family support, personal time, emotional support and access to clear and empathetic medical information. In conclusion motherhood is perceived as a complex experience, in which fulfillment frequently coexists with emotional overload and vulnerability. This exploratory study highlights the complex emotional and psychosocial dimensions of motherhood among Romanian women. The findings suggest the need for accessible emotional and social support resources. A comprehensive approach addressing both emotional and practical needs may contribute to improved maternal well-being. Full article

The Latin American Development Group for Maturity (GDLAM) protocol has been widely used to assess functional autonomy (FA) in community-dwelling older adults. However, to date, no percentile-based rating scale has been established for older Chilean women living in the community. The aim was to create a percentile-based rating scale for the GDLAM protocol in community-dwelling older Chilean women. 347 older women volunteered for this study. The sample was divided into five groups by age ranges (G1: 60.0–64.9 years, G2: 65.0–69.9 years, G3: 70.0–74.9 years, G4: 75.0–79.9 years, and G5: ≥80.0 years). The research had an observational, cross-sectional design with a descriptive strategy. The GDLAM protocol included (a) Putting on and taking off a T-shirt (PTS), (b) Standing up from the sitting position (SSP), (c) Standing up from the prone position (SPP), (d) Walking 10 m (W10 m), and (e) Sit-ting and getting up from the chair and moving around the house (SCMA), all assessed in seconds (s), while the General Index of Autonomy (GI) was calculated in points (p). The percentile-based classification was developed with the following thresholds: percentile ≤ 0.15: “Very Good,” percentile 0.16–0.49: “Good,” percentile 0.50–084: “Regular,” and percentile ≥ 0.85: “Poor.” After creating the percentile-based ranking scale for the five age ranges, it was observed that the older the age, the lower the FA, as represented by the five tests and the GI. The percentile-based ranking scale presented in this research will enable us to accurately assess and interpret the FA of older and community-dwelling women in Chile. However, the study is limited to women and cannot be generalized to older adults in general. Full article

The protective effect of physical activity on breast cancer recurrence may be mediated changes in by sex hormone levels. In this study, we examined the association between habitual physical activity and estrogen and androgen plasma levels in postmenopausal women with localised breast cancer. We conducted a cross-sectional study among 47 postmenopausal women who were breast cancer survivors with estrogen receptor-positive tumours (enrolled at the Medical Oncology Department of University Hospital Dr. Peset, Valencia, Spain). Habitual physical activity was assessed using the International Physical Activity Questionnaire (IPAQ), and a weighted estimate of total physical activity per week (MET∙min∙wk⁻¹) was calculated. Total plasma levels of estrone, 17β-estradiol, progesterone, androstenedione, testosterone, and dehydroepiandrosterone-sulphate (DHEA-sulphate) were measured. Bivariate analyses by the Spearman correlation test were done between physical activity and each hormone concentration. Multivariate analyses (linear regression) using concentration of each hormone as the dependent variable and physical activity, age, marital status, BMI, Charlson Comorbidity Index, tumour stage, previous radiotherapy, or previous chemotherapy as predictor variables. Estrone concentration was positively and significantly correlated with BMI (ρ = 0.332, p = 0.022), but no other correlations were found between BMI and the other hormone concentrations, nor were concentrations of any hormone associated with age or Charlson Comorbidity Index (p > 0.05 in all cases). Physical activity was significantly and inversely correlated with estrone concentration (ρ = −0.308; p = 0.035). Linear regression analysis confirmed a statistically significant association between estrone concentration and BMI and physical activity, after adjusting for all potential confounders (for BMI: standardised β coefficient = 0.407; non-standardised β coefficient = 1.054; t = 2.898; p = 0.006; 95% CI for non-standardised beta: 0.318- to 1.790; for physical activity: standardised β coefficient = −0.300; non-standardised β coefficient = −0.005; t = −2.135; p = 0.039; 95% CI for non-standardised beta: −0.010- to 0.000). The relationship between estrone concentration and physical activity may be further explored as a biomarker for evaluating the protective effect of physical activity against breast cancer recurrence in women receiving anti-estrogen therapies. Full article

Gestational diabetes mellitus (GDM) is a prevalent metabolic disorder associated with adverse maternal and fetal outcomes. However, current diagnostic strategies have a limited capacity to identify women at risk early in pregnancy. In this longitudinal prospective pilot study, 200 pregnant Mexican women were recruited at 11–14 weeks and underwent follow-up throughout pregnancy. Of these, 34 women (19 with GDM and 15 with normal glucose tolerance [NGT]) completed follow-up and were included in the final analyses. Most withdrawals were due to logistical constraints, although the reduced final sample size should be considered when interpreting generalizability. Nine serum proteins (ADIPOQ, AFM, FABP4, IGFBP-5, PAPP-A, PAPP-A2, RBP4, RETN, SHBG) were measured simultaneously using an antibody array and subsequently validated by ELISA. FABP4 showed the greatest increase in the first trimester (4.9-fold, p = 0.0105) and the highest apparent discriminative performance (AUC = 0.91), which declined in the second and third trimesters. Exploratory, hypothesis-generating multivariable analyses suggested a stronger association when FABP4 was combined with gravidity and serum triglycerides (AUC up to 0.97). Overall, FABP4 emerged as a promising candidate biomarker for early GDM detection in Mexican women; however, these findings are preliminary and require validation in larger, independent cohorts to support early risk stratification. Full article

The purpose of this study was to examine relationships between infant feeding and parenting self-efficacy. Mothers (N = 121) receiving home visiting reported on PSE and infant feeding at two times (e.g., longitudinally). Mothers were exclusively formula feeding (46.7%), exclusively breastfeeding (19.8%) or combining breastfeeding and formula (33.1%). Infant feeding was regressed on parenting self-efficacy and relevant demographics using logistic regression. Mothers with higher parenting self-efficacy were more likely to be exclusively formula feeding or combination feeding at Time 1. Continued breastfeeding was not predicted by self-efficacy but rather by working status and earlier supplementation. Results suggest higher parenting self-efficacy associated with formula feeding suggests social reinforcement or feelings of success around the enactment of or choice in infant feeding method. Lower parenting self-efficacy associated with initial breastfeeding suggests unsuccessful enactment (i.e., breastfeeding challenges) or negative social reinforcement. More research is needed to understand infant feeding norms and practices in relationship to parenting self-efficacy to best promote breastfeeding intervention and support maternal mental health. Practitioners should work to extend exclusive breastfeeding through supportive positive reinforcement, while limiting formula supplementation. The importance of parental leave for longer breastfeeding duration should be considered when establishing leave policies. Full article

High-intensity interval training (HIIT) has emerged as a time-efficient exercise strategy with potential benefits for older adults. However, evidence regarding its effects on functional fitness, body composition, and quality of life in older women remains limited. This randomized controlled trial included community-dwelling older women allocated to a HIIT group or a control group. The intervention consisted of a 65-week HIIT program (3 sessions/week), while the control group maintained usual activities. Functional fitness was assessed using standardized field-based tests, body composition was evaluated by bioelectrical impedance analysis, and quality of life was measured using the WHOQOL-BREF questionnaire. Pre- and post-intervention assessments were performed under standardized conditions. Data were analyzed using mixed ANOVA models, with significance set at p < 0.05. Compared with the control group, the HIIT group significantly improved aerobic capacity (2MST: +25.4 vs. −19.6 repetitions; p < 0.001), lower-limb strength (30s CST: +4.8 vs. −2.6 repetitions; p < 0.001), and mobility (TUG: −0.3 vs. +0.4 s; p < 0.001). Body composition improved with reductions in body fat percentage (−1.8% vs. +1.9%; p < 0.001) and visceral fat index (−0.6 vs. +0.3; p < 0.001), alongside increased total body water (+2.3% vs. −1.8%; p < 0.001). Quality of life improved significantly in physical, psychological, and environmental domains (p < 0.001). HIIT was associated with improvements in functional fitness, body composition, and quality of life, with no major adverse events reported. These findings support the use of HIIT as a practical intervention to enhance health and functional independence in aging populations. Full article

Respiratory Syncytial Virus infection is a significant cause of morbidity and mortality in infants. Maternal vaccination with the bivalent vaccine Abrysvo^® in the third trimester (24–36 weeks) is an effective strategy to prevent severe respiratory illnesses in newborns. However, the introduction of this new technology faces structural obstacles that amplify inequalities. This rapid literature review sought to map and synthesize evidence on inequalities and inequities in adherence and accessibility to maternal vaccination among Black pregnant women. A rapid literature review was conducted using a mixed-methods approach (narrative synthesis and thematic analysis), following guidelines adapted from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Cochrane Handbook. The research question was structured using the acronym Population/Problem, Exposure, Comparison, and Outcome, focusing on Black pregnant women, maternal vaccination, comparison with other groups, and barriers/determinants. The search was conducted in databases such as PubMed (via Medical Literature Analysis and Retrieval System Online), Scopus and Literatura Latino-Americana e do Caribe em Ciências da Saúde, covering studies published between 2022 and 2025 that presented disaggregated analysis by race. The analysis and interpretation of the findings were guided by Critical Race Theory. The analysis of the twelve included studies (mainly from the United States, the United Kingdom, and Brazil) revealed systematic and robust disparities. Black pregnant women had lower vaccination coverage and were less likely to receive timely recommendations compared to White pregnant women. The barriers identified include: institutional distrust (resulting from structural racism), poor access to prenatal care, inadequate communication, and socioeconomic factors. Inequities are structural and multifactorial phenomena. To ensure that the benefits of the vaccine are distributed equitably, strategies such as anti-racist training for healthcare teams, active vaccination outreach, and continuous monitoring of data disaggregated by race are essential. Full article