Search Results (328)

Background: Evidence regarding long-term outcomes among offspring following maternal or paternal exposure to BCR::ABL1 tyrosine kinase inhibitors (TKIs) is limited. We described pregnancy outcomes and offspring health through adolescence and early adulthood in a single-centre cohort of patients with chronic myeloid leukemia (CML). Methods: This retrospective, descriptive cohort study included patients with chronic-phase CML who experienced a pregnancy, or whose partner experienced a pregnancy, in association with TKI exposure and for whom longitudinal offspring follow-up was available. Long-term offspring outcomes were ascertained from detailed obstetric and pediatric medical records supplemented by parental reports. Fourteen patients (nine women and five men) contributed 21 pregnancy events and 23 live-born offspring, including two twin pregnancies in the paternal-exposure group. Results: In the maternal-exposure group, median gestational age at delivery was 38.0 weeks (range, 35–40), and four of 15 deliveries were preterm. In the paternal-exposure group, median gestational age was 39.0 weeks (range, 38–41), with no preterm deliveries. Median offspring follow-up was 252 months (range, 212–295), extending through adolescence and into early adulthood. One offspring had a primum atrial septal defect that was surgically corrected. No additional clinically documented major abnormalities in growth or developmental progress were identified during available follow-up. Given the small cohort, these observations were interpreted descriptively and were not considered evidence of equivalence with population-level rates. Conclusions: This small retrospective cohort provides unusually long observational follow-up of offspring after selected maternal or paternal TKI exposures. The findings are clinically informative but cannot establish reproductive safety or exclude rare adverse outcomes. Larger multicentre registries using standardized long-term developmental, neurocognitive, and endocrine assessments are needed. Full article

Background/Objectives: Adolescent pregnancy is associated with an increased risk of adverse perinatal outcomes; however, its hematological characteristics remain incompletely understood. The aim of this study was to compare antepartum and postpartum complete blood count (CBC) parameters together with hemogram-derived inflammatory indices in adolescent and adult pregnancies and to investigate their associations with maternal and neonatal outcomes. Methods: This retrospective comparative cohort study included 428 singleton pregnancies comprising 205 adolescent (14–17 years) and 223 adults (18–42 years). Antepartum blood samples were obtained at admission for delivery, whereas postpartum samples were collected approximately six hours after delivery according to the institutional practice. CBC parameters (including neutrophil, lymphocyte, monocyte, and platelet counts) were recorded, and hemogram-derived inflammatory indices, including neutrophil-to-lymphocyte ratio (NLR), Platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), aggregate index of systemic inflammation (AISI), and systemic inflammation-monocyte index (SIMI), were subsequently calculated. Comparisons were adjusted for gestational age at sampling and parity using a prespecified non-redundant marker set, and multiple testing was controlled using the Benjamini-Hochberg false discovery rate procedure. Multivariable logistic regression and machine-learning analyses were performed to evaluate associations with adverse maternal and neonatal outcomes. Results: Adolescent pregnancies demonstrated significantly higher antepartum neutrophil and monocyte counts than adult pregnancies (q < 0.05), and these differences remained significant after adjustment for gestational age at sampling and parity (both q < 0.01), whereas differences in hemoglobin and platelet counts were no longer significant (both q = 0.138). Low birth weight (10.2% vs. 4.5%), neonatal intensive care unit admission (15.1% vs. 8.5%), composite adverse outcome (22.9% vs. 15.2%), and birth weight below the 10th percentile (14.7% vs. 8.0%) were numerically more frequent among adolescents but were not statistically significant after false discovery rate correction (all q > 0.05). Across 30 prespecified marker–outcome associations, none remained significant after false discovery rate correction. Antepartum neutrophil count was not independently associated with low birth weight after multivariable adjustment (OR 1.233, 95% CI 0.858–1.737; p = 0.248, q = 0.413). Exploratory machine-learning models demonstrated only modest discrimination, with the highest cross-validated AUC of approximately 0.60, and did not outperform conventional regression models. Conclusions: Adolescent pregnancy was associated with higher neutrophil and monocyte counts during both the antepartum and postpartum periods, reflecting modest differences in hematological profile rather than an independently predictive inflammatory profile. These hematological differences were not independently associated with adverse maternal or neonatal outcomes after adjustment for confounding factors and correction for multiple testing. Hemogram-derived inflammatory indices should therefore be interpreted as mathematical transformations of routine CBC parameters rather than biologically independent biomarkers. Because blood samples were obtained at admission for delivery, these findings characterize the peripartum inflammatory profile and should not be interpreted as evidence of early pregnancy risk prediction. Full article

Background and Objectives: Adolescent pregnancy is associated with biological, behavioral, and healthcare-related vulnerabilities that are incompletely captured by structured datasets. This study aimed to characterize selected maternal vulnerability indicators derived from narrative clinical documentation and to examine their exploratory associations with documented prenatal care deficiency and neonatal outcomes. Materials and Methods: We conducted a retrospective cohort study including 759 singleton adolescent pregnancies managed at a Romanian secondary obstetric center between 2020 and 2024. Narrative clinical observations were reviewed to extract maternal vulnerability indicators, including smoking, anemia, infection, hypertensive disorders, obesity, Rh incompatibility, and documented prenatal care deficiency. Associations between extracted variables, documented prenatal care deficiency, and neonatal outcomes were evaluated using contingency analyses, Kendall’s tau-b correlations, and multivariable logistic regression models. Results: Among pregnancies with available narrative observations, documented prenatal care deficiency was identified in 612/692 (88.4%), maternal anemia in 207/692 (29.9%), and smoking during pregnancy in 186/692 (26.9%). Validation performance differed across categories, with a sensitivity of 57.1% (95% CI 18.4–90.1%) for hypertensive disorders and wide confidence intervals for rare categories. Correlations between extracted variables were weak, indicating limited clustering of maternal risk factors. Hypertensive disorders (aOR 0.31, 95% CI 0.10–0.95, p = 0.038) and maternal obesity (aOR 0.39, 95% CI 0.16–0.98, p = 0.044) were associated with lower odds of documented prenatal care deficiency. Significant neonatal associations were observed primarily for low birth weight. Hypertensive disorders were independently associated with increased odds of low birth weight (aOR 3.56, 95% CI 1.33–9.54, p = 0.011), whereas documented maternal anemia was associated with lower observed odds of LBW (aOR 0.45, 95% CI 0.24–0.82, p = 0.009). No significant associations were identified for preterm birth or Apgar score < 7 at 5 min. Conclusions: Narrative clinical documentation allowed the identification of heterogeneous maternal vulnerability indicators that showed weak interrelationships and selective associations with prenatal surveillance patterns and low birth weight. These exploratory findings should be interpreted in the context of healthcare engagement and documentation practices. Full article

Background: Adolescent pregnancy is a public health problem in Latin America, with a higher prevalence in rural areas. This population faces barriers to accessing education and healthcare services, increasing the risk of maternal and neonatal complications. Methods: This study employed a cross-sectional analytical design and included 72 adolescents aged 12 to 17 years in Lonya Grande. The associations between structural and intermediate social determinants of health and the prevalence of adolescent pregnancy were assessed. Results: Among the structural determinants, extreme poverty (PR: 2.48; 95% CI: 1.23–5.03; p = 0.004), type of public health insurance (PR: 3.05; 95% CI: 1.21–7.72; p = 0.005), and parental educational level were associated with a higher prevalence of adolescent pregnancy. After adjustment, having public health insurance (aPR: 0.49; 95% CI: 0.36–0.66; p < 0.001) and having parents who had completed primary school (aPR: 1.67; 95% CI: 1.15–2.42; p = 0.01) were associated with a higher prevalence of adolescent pregnancy. Among the intermediate determinants, alcohol consumption (PR: 2.77; 95% CI: 1.85–4.16; p < 0.001), knowledge about contraceptives (PR: 0.21; 95% CI: 0.03–0.85; p = 0.04), and being 17 years old (PR: 4.44; 95% CI: 1.48–13.39; p = 0.01) were associated with adolescent pregnancy. In the adjusted model, adolescents aged 15 years (aPR: 3.15; 95% CI: 1.04–9.52; p = 0.04) maintained a higher prevalence compared with those aged 14 years. Conclusions: An association was found between structural and intermediate social determinants of health and adolescent pregnancy in rural settings. These findings suggest the need for additional studies to better understand interventions targeting these associated factors. Full article

Social media influences community social issues in varied ways, yet their effects on teenage pregnancy remain uncertain. The purpose of this study is to explore how social media and human experiences are entangled in shaping teenage pregnancy in the Capricorn district of South Africa. Bandura’s social learning theory was used to determine the interplay between observation, imitation, social media modelling, peers, and society’ influences on teenage pregnancy. This study used a qualitative approach, engaging 34 Non-Governmental Organisations through purposive and convenience sampling and small focus groups to achieve saturation, examining how digital technologies and human experiences influence teenage pregnancy in Africa. Data analysis followed the Naeem, Ozuem, Howell, and Ranfagni thematic analysis six-step process. Two themes emerged: pervasive influences and positive influences of social media. Five sub-themes emerged supporting the pervasive and positive influences, that is, normalisation of risky sexual behaviours and experimentation; peer pressure influences and cyberbullying; promotion of gender-based violence and vulnerability; provision of adequate sexual education; and the consequences and promotion of supporting networks. Social media both supports and harms adolescents, influencing teenage pregnancy through its educational value and risky behavioural modelling. Positive role models can reduce vulnerability, while insights from this study guide policymakers, communities, and researchers in addressing social media’s complex effects on teenage pregnancy. Full article

Background: Effective HIV prevention in South Africa requires implementing pre-exposure prophylaxis (PrEP) service delivery options responsive to adolescents and young people (AYP) with diverse characteristics and needs. We aimed to identify characteristics associated with AYP’s choice of PrEP initiation setting. Methods: Fast-PrEP is an ongoing phase 4 HIV prevention programme in Cape Town, South Africa. Oral PrEP (TDF/FTC) is offered to AYP (15–29 years) within sexual and reproductive health services from four community-based mobile clinics and 12 public primary healthcare facilities. Descriptive statistics and logistic regression models evaluated sociodemographic, behavioural, and clinical factors associated with PrEP initiation from mobile clinics and public health facilities in 13,807 AYP between Aug’22 and Dec’24. Results: Most AYP (70.7%; n = 9760) initiated PrEP from mobile clinics. AYP with more complex healthcare needs, such as pregnancy, parenthood, known sero-different relationships, or currently having STI symptoms, were significantly more likely to use the public health facilities. Both male and female AYP initiating PrEP at mobile clinics had four times the odds of moderate-to-severe depression. Previous PrEP experience was not associated with the choice of PrEP service delivery platform. Conclusions: Our results indicate that offering community-based PrEP alongside public sector facilities increases the reach of a diverse group of AYP who may benefit from PrEP. Full article

Background: Adolescents in low- and middle-income countries (LMICs) continue to face substantial challenges related to sexual and reproductive health (SRH), including high rates of unintended pregnancy, sexually transmitted infections (STIs), and limited access to accurate reproductive health information and services. Rural provinces of South Africa, such as Limpopo, are no exception, with notably higher pregnancy rates. Aim: This study aimed to explore adolescent girls’ perceptions and experiences associated with school-based comprehensive sexuality education (CSE) programs and their perceived role in pregnancy prevention in Bolobedu, Limpopo province, South Africa. Methods: A qualitative, descriptive, and contextual design was employed. Data were collected through individual interviews and field notes from adolescent girls aged 14–19 years who were accessing contraceptives or had given birth. Content analysis was conducted using Tesch’s method. Findings: Results suggest that the quality and contents of CSE programs varied widely, leading to CSE intervention programs not being successfully implemented, leading to poor uptake and no behavior change. Implications: While research on CES programs shows that the CSE programming varies and can be vital to reducing adolescent pregnancy, its success depends on the quality of the implementation, which leads to behavior change. The research finds that the adoption of Comprehensive Sexual Education in schools and communities is vital to tackling the high incidence of adolescent pregnancy. However, its success depends on the quality of implementation, facilitator training, and resource availability. Full article

Background/Objectives: Adolescent pregnancy is associated with an increased risk of adverse neonatal outcomes, including low birth weight, preterm birth, and impaired neonatal adaptation. While maternal age is a well-established determinant, the independent role of parity in this population remains uncertain. This study aimed to assess the association between parity and neonatal outcomes in adolescent mothers. Methods: We conducted a retrospective cohort study including 751 singleton live-birth deliveries to adolescent mothers aged <18 years at a Romanian secondary-care hospital. The unit of analysis was the delivery episode recorded in the institutional birth registry. Mothers were classified according to parity at the time of the index delivery as primiparous or multiparous. Neonatal outcomes included low birth weight (<2500 g), preterm birth (<37 weeks), Apgar score < 7 at 5 min, and a composite adverse neonatal outcome. Multivariable logistic regression models were used to evaluate the association between parity and neonatal outcomes, adjusting for maternal age (<15 vs. ≥15 years), gestational age, and mode of delivery, as appropriate. Results: A total of 751 singleton live-birth delivery episodes were included; 609 (81.1%) occurred in primiparous adolescents and 142 (18.9%) in multiparous adolescents. Parity was not significantly associated with preterm birth (aOR 0.86, 95% CI 0.48–1.56, p = 0.622), Apgar score < 7 at 5 min, or the composite adverse neonatal outcome. Maternal age < 15 years and gestational age were independently associated with Apgar score < 7 at 5 min. Multiparity was associated with lower odds of low birth weight (aOR 0.40, 95% CI 0.17–0.92, p = 0.031). Conclusions: Parity was not independently associated with most neonatal outcomes in adolescent pregnancies. Multiparity was associated with lower odds of low birth weight, but this finding should be interpreted cautiously because residual confounding cannot be excluded. Full article

Adolescents with intellectual disabilities are often excluded from mainstream sexual reproductive health education and services. This exclusion is due to stigma and systemic barriers further increasing their vulnerability to exploitation, unintended pregnancies, and limited contraceptive access. Additionally, adolescent childbearing has been linked to an increased risk of long-term health and functional limitations. This study explored contraceptive awareness and decision-making among caregivers of adolescent learners with intellectual disabilities in selected Special Care Centres in Tshwane District Gauteng province. This exploratory, descriptive qualitative research utilised a purposive sampling method to select caregivers from five Special Care Centres to participate in focus group discussions. The sample size was 29 participants. Interviews were audio recorded and transcribed verbatim. Data were analysed using inductive thematic analysis on NVivo15 software and halted after reaching saturation. Intercoder reliability was achieved with consensus agreement among researchers. Three overarching themes, supported by two sub-themes emerged: (1) Caregivers’ understanding of contraception: (1.1) Perceived benefits and disadvantages of contraception; (1.2) Early exposure to contraceptive information. (2) Socio-economic influences on contraceptive decision-making: (2.1) Financial burden; (2.2) Preference for permanent contraceptive method. (3) Negotiating cultural expectations and practical caregiving realities: (3.1) Community acceptance of contraceptive use; (3.2) Willingness to forgo biological grandchildren. Caregivers’ awareness and decisions about contraception reflect not only their health knowledge but also the socio-economic pressures they face and the practical realities that shape choices within their communities. This study recommends disability-inclusive sexual reproductive health education that provides contextually relevant insights for strengthening community-based interventions among adolescents with intellectual disability. Full article

Youth in northern Ghana experience high rates of unintended pregnancy due to limited access to and use of sexual and reproductive healthcare (SRH) services. Peer-led interventions are effective in increasing the youth uptake of SRH services, but limited peer-led interventions have been developed for Ghana. This study explores youth (ages 15–24 years) and clinical provider perspectives on youth SRH to inform the co-design of a peer-led SRH counseling program in northern Ghana. We conducted a qualitative study using semi-structured interviews with 22 SRH providers and 27 youth. We then conducted an inductive thematic analysis and mapped themes onto the COM-B (Capability-Opportunity-Motivation-Behavior) model. Results revealed that youth capability to make informed and confident SRH decisions is constrained by a fragmented information environment. Although access to SRH services is increasing in the region, logistical and privacy barriers limit adolescents’ opportunities to engage in care. Religious and cultural norms stigmatize youth SRH care, though support for contraceptive use is growing among more educated sectors. Youth motivation to use SRH services is driven by a desire for autonomy but undermined by concerns about contraceptive side effects and anticipated stigma. This study supports the co-development of a contextually grounded peer counseling SRH intervention in northern Ghana. Full article

Overweight in childhood, adolescence and adulthood is now a world-wide epidemic. A variety of preventive and therapeutic measures are being developed with partial success. Since the pioneering studies of D.J. Barker linking maternal famine in pregnancy to long—term undesirable effects on the offspring—the “metabolic syndrome” that stems from long-lasting epigenetic changes, it became evident that there are many undesirable events which affect in-utero fetal growth and development. They often persist postnatally, through childhood and adulthood. The purpose of this review is to discuss the prenatal factors that may have long term effects on postnatal weight gain and obesity that are important contributors to the “obesity” epidemic. These prenatal undesired factors are pregestational and gestational diabetes, pre-pregnancy maternal obesity, excessive weight gain in pregnancy, placental dysfunction and maternal hormonal imbalances. They may affect fetal growth, generally causing excessive growth (macrosomia) and sometimes diminished growth (small for gestational age). These prenatal conditions are associated with epigenetic changes that may contribute to insulin resistance and subsequent metabolic alterations leading to increased food intake, overweight, and obesity. Studies also demonstrate that increased exposure in pregnancy to teratogens, like endocrine disruptors and cigarette smoking, may also affect prenatal and postnatal growth and adiposity. However, many the studies demonstrating the role of these factors are often weakened, as they mainly demonstrate associations and do not sufficiently consider possible confounding factors such as postnatal age, nutrition and lifestyle. Better understanding of these prenatal factors may support more effective prevention and management strategies for childhood overweight and obesity. Full article

Background/Objectives: Adolescent pregnancy remains a global public health challenge associated with adverse outcomes for both mothers and newborns. This study aimed to use two instruments and several multivariate techniques to identify a minimal set of variables that reproduces the instrument-based classification of adolescent pregnancy risk, while remaining parsimonious with the original instruments. Methods: A cross-sectional, quantitative methodological study was conducted among Colombian schoolgirls, comprising 160 adolescents in the face-validity phase and 319 in the risk-estimation and modeling phase. The IRENE and REND instruments, originally developed to assess the risk of adolescent pregnancy, underwent cultural adaptation, face validity and content validity. Subsequently, the instruments were administered to estimate the risk. Finally, Factor Analysis and Categorical Principal Component Analysis were applied as exploratory dimensionality reduction techniques to identify the most relevant variables for retention, thereby preserving the parsimony of the original versions. Results: Overall, 80.3% of participants were classified as not at risk, while the remainder were classified as at risk by one or both instruments. The results suggest that variables such as who the adolescent lives with, the age at which the adolescent had their first complete sexual intercourse, and how the adolescent would respond to an unplanned pregnancy are factors associated with the instrument-based risk classification. Subsequently, dimensionality reduction and logistic regression analyses identified a small subset of variables that can be used to reproduce the instrument-based classification of adolescent pregnancy risk. Conclusions: The reduced set of variables reproduced the instrument-based risk classification with high internal accuracy. Because the predictors and the outcome derive from the same instruments, these findings reflect internal reproduction of the instrument classification rather than prediction of an observed pregnancy, and they require external validation. Overall, the reduced and optimized set of variables from the IRENE and REND instruments offers a parsimonious approach that reproduces the instrument-based risk classification and that may support rapid screening once validated in independent adolescent samples. The main limitations are the use of a single institution, the non-probabilistic convenience sample, and the absence of an observed pregnancy outcome. Full article

Background: Maternal nutrition during pregnancy is increasingly recognized as an important determinant of offspring neurodevelopment. The Mediterranean diet has been associated with favorable cognitive and behavioral outcomes in children; however, evidence regarding autism-related traits remains limited, particularly during late childhood and adolescence. Objective: To investigate the association between maternal adherence to the Mediterranean diet during pregnancy and autism-related traits in preadolescent offspring in the KLOTHO birth cohort. Methods: This exploratory analysis included 96 adolescents (49 boys and 47 girls) from the KLOTHO birth cohort. Maternal adherence to the Mediterranean diet during pregnancy was assessed using a Mediterranean Diet Score derived from a food frequency questionnaire administered during gestation. Autism-related traits were evaluated during preadolescence using a parent-completed questionnaire that assessed social and emotional abilities, communication skills, cognitive characteristics, special interests, and motor skills. Associations were examined using Spearman’s correlation analyses and sex-stratified linear regression models adjusted for offspring body mass index, sleep duration, and physical activity, all assessed during the preadolescent follow-up examination. Results: Boys exhibited higher communication (3.92 ± 3.90 vs. 1.70 ± 2.89, p = 0.026), cognitive (5.76 ± 3.80 vs. 3.33 ± 2.99, p = 0.014), special-interest (2.64 ± 3.29 vs. 1.04 ± 2.16, p = 0.046), and overall autism-related trait scores (19.08 ± 13.92 vs. 10.15 ± 8.57, p = 0.009) compared with girls. In the overall cohort, maternal Mediterranean Diet Score was not associated with autism-related traits. Among boys, higher maternal Mediterranean Diet Scores were associated with lower communication-related trait scores (ρ = −0.442, p = 0.027). In multivariable analyses, the inverse association remained consistent in direction but did not retain statistical significance after adjustment for body mass index, sleep duration, and physical activity. Sensitivity analyses incorporating offspring KIDMED scores yielded similar findings. Conclusions: Higher maternal adherence to the Mediterranean diet during pregnancy was associated with lower communication-related trait scores in male offspring. These findings should be considered exploratory and require confirmation in larger prospective cohorts. Full article

Agricultural commodity markets remain central to household survival across many developing economies, yet their volatility is rarely framed as an adolescent sexual and reproductive health problem. This mini review uses a structured narrative approach anchored in a screened evidence map of 1065 records, from which 50 papers were retained and 16 studies were prioritized for full synthesis. We define adolescent reproductive health holistically, including sexual agency, contraceptive information and use, pregnancy intention, antenatal and obstetric care, protection from coercion, and maternal and neonatal outcomes. The review provides a concrete answer to the primary question: agricultural commodity price volatility is a distal, context-conditioned determinant of adolescent reproductive health, not a uniform direct cause. Its effects operate mainly through food security, household income, labor allocation, school continuity, gendered bargaining power, and service access. Negative shocks more consistently erode nutrition, schooling, transport to care, and access to adolescent-friendly services, especially among rural girls in households with weak shock buffers. Positive shocks may increase births or union formation when income effects dominate, but they may also harm health when higher labor demand raises the opportunity cost of caregiving and service use. Direct adolescent-specific causal evidence remains limited; therefore, adjacent evidence on fertility, child health, schooling, and maternal or neonatal outcomes is interpreted through an explicit evidence hierarchy rather than treated as equivalent to direct adolescent evidence. Policy priorities include shock-responsive social protection, school retention, contraceptive supply continuity, adolescent-friendly care, and early warning systems that trigger health and education responses during commodity instability. Full article

Background/Objectives: Automated insulin delivery (AID) systems have improved the management of type 1 diabetes (T1D), but exercise and nutrition remain challenging because they rapidly alter glucose flux, substrate oxidation, hepatic glucose output, insulin requirements, and fuel availability. This narrative review aimed to synthesize current evidence on the interaction between AID systems, physical activity, and nutritional strategies from a metabolism-oriented perspective. Methods: A narrative bibliographic approach was used to integrate evidence from clinical trials, observational studies, technical studies, consensus statements, and reviews involving people with T1D across different life stages, including pediatric, adolescent, adult, and pregnancy-related contexts, when available. The review focused on AID systems, exercise physiology, nutritional strategies, meal announcement, bolus adjustment, dual-hormone systems, metabolic biomarkers, and emerging metabolomic approaches. Results: AID systems generally improve time in range and reduce hypoglycemia across several user groups, although most exercise- and nutrition-specific evidence comes from adult and pediatric/adolescent cohorts rather than pregnancy-specific exercise studies. Exercise-related glucose responses remain highly dependent on user input, exercise modality, insulin on board, meal timing, and metabolic state. Planned exercise announcement, prandial bolus reduction before postprandial activity, and individualized carbohydrate intake remain key strategies. Biomarkers such as lactate, ketone bodies, non-esterified fatty acids, and counter-regulatory hormones may help explain interindividual variability and support future personalization. Conclusions: Nutrition and exercise management in AID users should be interpreted as a dynamic metabolic interface among exogenous insulin, endogenous counter-regulation, substrate availability, and algorithmic control. Emerging approaches, including activity sensors, adaptive algorithms, dual-hormone systems, digital twins, and metabolomics-informed personalization, may improve safety and reduce user burden, but several remain exploratory and require further validation in diverse free-living conditions. Full article