Search Results (488)

Metabolic dysfunction-associated steatotic liver disease (MASLD) encompasses a spectrum from simple steatosis to steatohepatitis (MASH), including liver fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). The 2023 EASL–EASD–EASO guidelines provide updated definitions and emphasize personalized management, yet do not explicitly address sex- and gender-related differences. This review highlights the impact of biological sex and gender on MASLD epidemiology, pathogenesis, clinical presentation, and therapeutic response. Men show earlier peak prevalence, greater visceral obesity, higher insulin resistance, and increased risk of fibrosis, HCC, and cardiovascular mortality. Women of childbearing age benefit from estrogen-mediated protection, which diminishes after menopause, leading to disease risk similar to men. Genetic variants (PNPLA3, TM6SF2), hormonal factors, platelet parameters, liver biomarkers, and environmental exposures contribute to sex-specific susceptibility and disease progression. Lifestyle interventions and pharmacological therapies exhibit differential efficacy across sexes, influenced by hormonal status. Integrating biological sex, gender identity, and sociocultural factors into diagnostic and therapeutic strategies is essential to optimize MASLD management and reduce its global burden. Full article

Background: The prevalence of being overweight and of obesity among women of childbearing age is constantly increasing. Objectives: To analyze the critical periods and goals of women’s weight management from early pregnancy to 3 years postpartum. Methods: Women’s weight was tracked from the first trimester of pregnancy to 3 years postpartum. We calculated their gestational weight gain (GWG) and postpartum weight retention (PPWR), and used linear mixed models and logistic models to estimate weight change velocities and risk factors associated with overweight/obesity at 1–3 years postpartum. Results: The medians of pre-pregnancy BMI (pre-BMI) and GWG among the 641 participants were 20.1 kg/m² and 15.0 kg. Among women with pre-BMI < 24 kg/m², those with excessive GWG remained at higher weights within 1.5 years postpartum than those with appropriate GWG (p < 0.05). Women’s weight decreased from 42 days to 1 year postpartum (β = −0.31 for low pre-BMI, β = −0.24 for normal pre-BMI, both p < 0.05), and remained unchanged from 1 to 3 years (p > 0.05). The rate of being overweight/obese at one year postpartum was mainly associated with pre-pregnancy weight (as a continuous variable, aOR = 1.58, 95%CI: 1.44–1.74) and 1-year PPWR (aOR = 1.78, 95%CI: 1.48–2.15). Compared with women who maintained normal BMI, those who shifted to being overweight/obese had higher pre-BMI and 1-year PPWR (22.6 kg/m² vs. 20.3 kg/m², 7.0 kg vs. 1.0 kg, p < 0.01). Conclusions: Normal and relatively low pre-BMI (18.5–22.0 kg/m²) and less than 2.0 kg of 1-year PPWR are goals of women’s weight management. Full article

Background: Some patients suffer from persistent symptoms following a COVID-19 infection, referred to as long COVID. The aims of the study were to estimate the prevalence of long COVID and study its determinants in Tunisia. Methods: We conducted a nationwide cross-sectional study among a representative sample of COVID-19 survivors residing in Tunisia between June and August 2022. We selected a random sample, stratified by age and region, among residents registered in the national surveillance database with a SARS-CoV-2 positive test taken from September 2020 to September 2021 (n = 479,743). The expected sample size was 384. We defined a patient with long COVID as having at least one self-reported symptom persisting for more than four weeks after the first confirmation of SARS-CoV-2 infection (RT-PCR or Ag-RDT) and not explained by an alternative diagnosis. Trained healthcare workers interviewed consenting respondents by phone using a structured questionnaire. We described continuous variables using median and interquartile range (IQR). We measured the prevalence of long COVID and its 95% confidence interval (95% CI). We estimated the association between explanatory variables (socio-demographic, lifestyle and comorbidities, SARS-CoV-2 history infection, COVID-19 vaccination status) and long COVID using a log-binomial model, reporting adjusted prevalence ratios (a-PR) and its 95% CI. Results: Of 1094 persons contacted, 416 were enrolled (response rate: 38%). Long-COVID prevalence was 64% (267/416); 95% CI [59–69%]. The sex ratio (M:F) was 0.72. Age ranged from 1 to 101 years, with a median of 41 years (IQR:31–55 years). The most common symptoms were fatigue (63%), myalgia/arthralgia (33%), and cognitive symptoms (52%). Median duration of long-COVID symptoms was 11 months (IQR: 3–14 months). In multivariate analysis, experiencing acute COVID-19 (a-PR = 1.5; 95% CI [1.0–2.1]), being a woman of childbearing age (a-PR = 1.2; 95% CI [1.0–1.4]) and residing in the central region (a-PR = 1.5; 95% CI [1.1–2.0]) were significantly associated with a higher prevalence of long COVID. Conclusions: Long COVID is prevalent in Tunisia affecting patients with multiple symptoms initially, those residing in the central region and young women. We recommend to enhance healthcare access and medical follow-up both during and after the infection, focusing on identified risk groups. We also recommend to conduct further research to optimize management of long-COVID patients. Full article

Background: Preservation of tooth structure is a key principle in pediatric dentistry, where restorative materials must balance mechanical strength with the preservation of pulp vitality and minimally invasive techniques. The aim of this in vitro study, as it relates to pediatric dentistry, was to investigate the flexural strength of common composite resins, glass ionomer cements, and resin-modified glass ionomer cement within standardized and homogeneous laboratory conditions. Methods: This study evaluated the flexural strength of seven restorative materials: four composites (Filtek™ Z250, Filtek™ Supreme XT, Gradia, Premise), two GICs (Ketac™ Molar Easymix, GC Fuji IX GP), and one RMGIC (Vitremer). Standardized specimens were prepared and tested using a three-point bending protocol with a universal testing machine (Zwick-Roell Z005). A total of 49 specimens were fabricated and analyzed. Statistical analysis was performed with a one-way ANOVA followed by Tukey’s post hoc test. Results: The flexural strength value of composite resins was significantly greater than that of the glass ionomer and resin-modified glass ionomer cements (p < 0.001). Filtek™ Z250 had the highest flexural strength, and Vitremer, a resin-modified glass ionomer cement, exhibited intermediate performance. Ketac™ Molar Easymix had the lowest values among conventional glass ionomer cements, whilst the flexural strength values obtained for GC Fuji IX GP were similar to some composite materials but with higher variability. Conclusions: Composite resins remain the most durable option for pediatric restorations in stress-bearing areas, whereas RMGICs provide a compromise between mechanical performance and biological advantages such as fluoride release and biocompatibility. Conventional GICs, despite their lower flexural strength, retain clinical relevance in low-load sites and for patients at a high risk of caries. Material selection in pediatric dentistry should therefore be tailored to the child’s age, tooth location, and functional demands to ensure long-lasting, minimally invasive restorations. This study involved only mechanical properties alone, and biological aspects, such as fluoride release and biocompatibility, were not considered. Material selection in pediatric dentistry should therefore take into account mechanical requirements, restorative location, and clinical environment. Full article

Iron deficiency anemia remains a major public health concern in Brazil, particularly among children, pregnant women, and women of childbearing age. This scoping review aimed to map the trend line of public policies on iron supplementation and food fortification implemented between 1977 and 2025. The review followed PRISMA-ScR guidelines and the Joanna Briggs Institute methodology, and included searches in PubMed/MEDLINE, Scopus, Web of Science, Embase, Google Scholar, and official government documents. Three main strategies were identified: iron supplementation, mandatory food fortification, and nutrition education. Key milestones included the National Iron Supplementation Program, the 2002 ANVISA Resolution (RDC No. 344/2002) mandating wheat and corn flour fortification, and the launch of the NutriSUS program in 2014. Despite important normative and programmatic advances, persistent critical issues remain, including low adherence, inadequate monitoring, data discontinuity, and bureaucratic barriers. Strengthening intergovernmental coordination, improving information systems, and adopting more bioavailable iron compounds are essential to increase the effectiveness of public policies aimed at preventing and controlling iron deficiency anemia in Brazil. Full article

Background: Dysregulation of the hypothalamic–pituitary–adrenal axis is implicated in both gestational diabetes mellitus (GDM) and mood disorders, suggesting a shared pathophysiology. However, the impact of GDM on maternal depressive symptoms, particularly among women with “low and late” fertility, remains poorly characterized. Methods: We compared the risk of postpartum depressive symptoms, assessed on the second postpartum day using the Edinburgh Postnatal Depression Scale (EPDS), with a cut-off score ≥ 12, and the Anhedonia, Anxiety, and Depression subscales, between Northeast Italian women with GDM and control participants with normal oral glucose tolerance tests (OGTT), classified as having “low and late fertility”. Results: Among the 2560 women included in the analysis, 231 (9.02%) had GDM. Compared with controls with normal OGTT, women with GDM were older (36.0 vs. 33.0 years, p < 0.001) and had higher pre-pregnancy BMI (23.4 vs. 21.6 kg/m², p < 0.001), but lower gestational weight gain (GWG) (11.0 vs. 13.0 kg, p < 0.001), with no difference in parity [2.00 vs. 1.00, p = 0.5. In addition, GDM was not associated with increased postpartum depressive symptoms (15% EPDS scores ≥12 in both groups, p > 0.9) or with Anhedonia, Anxiety, or Depression subscale scores (p = 0.7). Conclusions: Advanced maternal age and reduced parity, hallmarks of women postponing childbearing, do not appear to confer an increased risk of early postpartum mood comorbidities in the context of GDM. Promoting healthy physical and mental well-being among women in this demographic category requires integrated strategies encompassing nutrition, healthcare, and education. Full article

Background/Objectives: Risk minimization measures, including a pregnancy prevention program (PPP), have been established by the European Medicine Agency to strengthen the restrictions on valproate (VPA) use in pregnant women/women with childbearing potential. We aimed to assess pharmacists’ awareness of the new measures and behavior in terms of compliance to PPP recommendations. Methods: We performed a cross-sectional, national, non-interventional survey among pharmacists between December 2024 and February 2025. No sample size calculations were performed. Inclusion criteria were pharmacists active in community pharmacies in Romania. Results: In total, 267 pharmacists were included, balanced in terms of age groups, with a slight predominance for 31–40 year olds (33.7%) and mostly female (93.3%). More than half (60.7%) did not recall receiving any type of PPP information (direct healthcare professional communication [DHPC] or educational materials [EMs]). Participants generally read the DHPC, fully (64.1%) or partially (21.4%); all reportedly read the EMs, generally fully (73.0%). Half (145, 54.2%) dispensed VPA at least once during the last 12 months. Among this subgroup, 15.2% used the EMs, 38.6% counseled the patient regarding the VPA teratogenic risk, and 32.4% counseled on the importance of effective contraceptive measures at every VPA dispensing. Neither awareness nor behavior met the pre-established success criteria; therefore, the overall PPP compliance was not demonstrated. Conclusions: Despite notable proportions of pharmacists offering counseling when dispensing, overall PPP compliance and EM use could be enhanced. More research is needed to identify why some measures are not properly adhered to, in order to increase the overall risk mitigation efficacy. Full article

Objective: To synthesize the multifactorial determinants of fertility distress among reproductive-aged women with gynecological cancers, elucidating complex interactions among biological, psychological, and sociocultural dimensions. Methods: Comprehensive literature searches were performed in PubMed, Embase, and PsycINFO to identify relevant studies on factors influencing fertility distress in gynecologic cancer patients. Results: Gynecological cancers pose significant threats to women’s health, particularly in terms of fertility protection, which is a key priority for patients of childbearing age. Individuals diagnosed with these malignancies frequently experience fertility-related distress stemming from physiological alterations and exacerbated by psychological factors. Moreover, sociocultural support systems, familial expectations, and cultural norms significantly influence reproductive decision-making and psychological adjustment in this population. Fertility distress is determined by complex interactions among these dimensions. Conclusions: By integrating biological, psychological, and sociocultural perspectives, we provide clinical guidance for developing targeted interventions that address patients’ comprehensive needs, ultimately advancing patient-centered oncological care. Full article

Background: Polycystic ovary syndrome (PCOS) commonly causes fertility difficulties and is associated with substantial psychological distress, particularly in collectivist societies where motherhood is central to female identity and social status. This cross-sectional study examined the association between specific cultural perceptions of fertility difficulties and emotional well-being among married women with PCOS in rural Southern Punjab, Pakistan. Methodology: From July to September 2025, we recruited 583 married women aged 18–48 years with confirmed PCOS using systematic random sampling from the Gynecology Outpatient Department of DHQ Hospital Muzaffargarh. Data were collected using a structured questionnaire comprising validated scales for cultural perceptions of fertility difficulties (10 items, Cronbach’s α = 0.87) and emotional well-being (Urdu DASS-21 Depression and Anxiety subscales plus selected Fertility Problem Inventory items, Cronbach’s α = 0.84–0.91). Multiple linear regression models with robust standard errors were used in this study. Results: A higher perceived cultural importance of childbearing (β = 0.39, 95% CI 0.30–0.48, p < 0.001) and societal pressure to conceive soon after marriage (β = 0.36, 95% CI 0.27–0.45, p < 0.001) were significantly associated with increased depression and anxiety. Perceived stigma showed an unexpected negative association with depression (β = −0.15, 95% CI −0.24 to −0.06, p = 0.001), possibly reflecting resilience or the mobilization of social support. Conclusions: Cultural perceptions of fertility difficulties are strongly associated with emotional distress in rural populations. Therefore, culturally sensitive psychological screening and support integrated into reproductive health services are recommended. Full article

The prevalence of maternal obesity is rapidly increasing, which represents a major public health concern worldwide. Currently more than 50% of all adult women are overweight or obese, and this trend is reflected in women of child-bearing age. Maternal obesity is characterized by metabolic dysfunction and chronic inflammation, and is associated with health problems in both the mother and the offspring. Intrauterine programming occurs during embryonic and fetal development, a critical period not only for the formation of tissues and organs but also for the etiology of diseases later in life. The principal mechanisms underlying fetal programming in the offspring of obese mothers appear to involve DNA methylation and chromatin remodeling within progenitor cells. Aberrant DNA methylation patterns have been identified in genes involved in insulin signaling, lipid metabolism, and appetite regulation in the placenta and fetal tissues. Histone modifications, such as acetylation and methylation of histone tails, may also play a crucial role in modulating chromatin structure and accessibility of transcriptional machinery to DNA. The persistence of such modifications throughout life, and potentially across generations, can lead to permanent alterations in gene expression, thereby contributing to the intergenerational transmission of metabolic disorders. The aim of this paper is to present an overview of the current knowledge regarding the effects of maternal obesity on fetal development and the occurrence of fetal complications, as well as long-term complications observed in adulthood related to intrauterine exposure to maternal obesity, including hypertension and cardiovascular diseases, impaired insulin secretion and resistance, diabetes mellitus, and metabolic syndrome. The mechanisms underlying fetal programming are also discussed. Full article

Food insecurity (FI) is a major public health problem that disproportionately affects women, especially if they are migrants. In Chile, there is limited data on how gender and migration status intersect to explain vulnerability to FI. A cross-sectional analytical study was conducted among 2124 women of childbearing age (1062 Chilean and 1062 immigrants) residing in south-central Chile. Biosociodemographic variables were collected through a structured questionnaire, and FI was assessed using the Household Food Insecurity Access Scale (HFIAS). Multivariate logistic regression models were applied to estimate risk factors using odds ratios (OR). Overall, 39.2% of women experienced some degree of FI, with prevalence significantly higher among immigrants (49%) compared to Chileans (29%). Severe FI was twice as frequent in immigrant women (18.1% vs. 9.2%). The risk factor of FI in the total sample included immigrant status (OR = 2.61; 95% CI: 2.15–3.17), low socioeconomic status (OR = 2.25; 1.77–2.87), having children (OR = 1.82; 1.49–2.23), being head of household (OR = 1.53; 1.25–1.87), not having a job (OR = 1.27; 1.02–1.58), and suffering from depression (OR = 2.11; 1.66–2.67). Subgroup analyses confirmed similar determinants in both groups, with not having a job being relevant mainly for immigrants and age acting as a protective factor among Chileans. FI is highly prevalent among women in south-central Chile, particularly among immigrants. Structural determinants such as socioeconomic status, having children, being the head of the household, and depression increase vulnerability. Policies must integrate gender and migration perspectives, promoting access to adequate food, employment, childcare, and mental health support. Full article

Background/Objectives: Nutrition during the reproductive years shapes women’s immediate health, fertility, pregnancy outcomes, and long-term offspring well-being. This position paper narratively synthesizes and critically appraises evidence on how dietary patterns, macro-/micronutrients, and supplementation influence women’s health, female fertility, and reproductive outcomes, to inform practical recommendations. Methods: We narratively reviewed recent reviews, cohort studies, clinical trials, and public-health guidance on macronutrients, key micronutrients, dietary patterns (with emphasis on the Mediterranean diet), ultra-processed food (UPF) intake, and targeted supplementation relevant to menstrual, metabolic, cardiovascular, skeletal, and reproductive outcomes. Results: Balanced, diverse diets rich in whole and minimally processed foods support hormonal regulation, ovulatory function, healthy gestation, and chronic-disease risk reduction. Priority nutrients include iron, folate, calcium, vitamin D, zinc, vitamin B12, and long-chain omega-3s (DHA), with supplementation considered when dietary intake or bioavailability is inadequate. Evidence consistently links Mediterranean-style eating to improved metabolic health, insulin sensitivity, IVF success, lower gestational diabetes risk, and favorable neonatal outcomes. High UPF consumption is associated with poorer diet quality, inflammation, adverse pregnancy outcomes, and potential reproductive impairment, warranting a reduction in favor of nutrient-dense foods. Diet also influences cardiovascular and bone health through effects on lipids, glycemia, blood pressure, and mineral/vitamin status, with fiber-rich carbohydrates, unsaturated fats (notably olive oil), and adequate calcium–vitamin D emerging as central levers. Conclusions: For women of childbearing age, a Mediterranean-aligned, minimally processed dietary pattern—tailored to individual needs and complemented by prudent use of folate, iron, vitamin D, calcium, B12, and DHA when indicated—offers robust benefits across reproductive, metabolic, cardiovascular, and skeletal domains. Public-health actions should improve access to healthy foods, curb UPF marketing, and embed personalized nutrition counseling in routine care; further longitudinal research from preconception through postpartum is needed. Full article

Parvovirus B19 (B19V) infection during pregnancy represents a significant clinical concern due to its potential impact on the fetus and pregnancy outcome. We analyzed temporal, spatial, and seasonal B19V seroepidemiology in childbearing-aged and pregnant women in Croatia over 10 years (2015–2024). A total of 976 women who underwent routine TORCH screening were included. The overall B19V IgG and IgM seroprevalence was 63.7 and 8.7%, respectively, with significant temporal differences (IgG 36.8–72.3%, IgM 1.3–18.4). Significant differences in the IgG seropositivity were observed among age groups, from 42.3% in the 16–20 group to 72.7% in the 36–40 group. Spatial analysis showed no significant differences in the IgG or IgM seroprevalence between regions (City of Zagreb/Northern Croatia, Pannonian and Adriatic Croatia) and settlements (urban, suburban/rural). Additionally, seropositivity did not differ significantly in relation to obstetric history. In a logistic regression model, age was a significant predictor for IgG seroprevalence, with each additional year of age associated with increased odds of IgG seropositivity. Year, region, and settlement type were not significant predictors, indicating no evidence of temporal trends, regional differences, or differences between urban and rural settings after adjusting for age. Year of sampling, age, and region were significant predictors for IgM positivity. Acute infections were most common from March to July (61.2%) and December (9.4%), with regional variations in seasonal prevalence patterns. Given that screening in pregnancy is not routinely recommended, the high susceptibility to B19V observed in Croatia supports targeted serologic testing in women with clinical symptoms, known exposure, or occupational risk. Full article

Objectives: Endometrial carcinoma is the most common gynaecological cancer in developed countries, with both incidence and mortality rates continuing to rise globally. For women of reproductive age diagnosed with early-stage disease or endometrial intraepithelial neoplasia, fertility-preserving treatment should be considered to maintain the possibility of future childbearing. Effective fertility-sparing management requires a multidisciplinary approach that includes patient education, reduction in risk factors, accurate molecular and histological classification to guide targeted therapies, assisted reproductive technologies to improve early conception rates, and attention to the psycho-sexual well-being of patients to support treatment adherence. Methods: This retrospective cohort study analysed the clinicopathological features and treatment outcomes of thirteen patients who received fertility-preserving therapy between 2018 and 2023. Results: The mean age of the patients (n = 13) was 34.4 years, with a range of 20 to 41 years. The overall treatment response rate was 76.9%, including 69.2% complete and 7.7% partial responses. Stable disease was observed in 15.4% of cases, while progression occurred in 7.7%. Among those who achieved complete remission, in vitro fertilisation (IVF) was initiated in four cases, with two ongoing as of the time of data analysis. In one of the cases, after two unsuccessful assisted reproductive attempts, spontaneous conception occurred, resulting in the birth of a child. Conclusions: Our findings support the feasibility and success of fertility-preserving treatment in carefully selected patients, allowing the preservation of reproductive potential alongside oncological care. Full article

Background: The decline in fertility rates is a growing concern globally, impacting family dynamics and the economy. This study assesses women’s attitudes toward fertility and childbearing in Saudi Arabia and explored their associations with sociodemographic, medical, and psychological factors. Methods: This one-year cross-sectional study involved 2172 Arabic-speaking women aged 18–50 years in Saudi Arabia, with the data collected between December 2022 and January 2023. The online survey, distributed through posts on social media apps as WhatsApp, Twitter, Telegram, Snapchat, and Facebook, measured sociodemographic characteristics, medical and psychiatric history, childbearing preference, and the Arabic version of the Attitudes toward Fertility and Childbearing Scale (AFCS). Results: Item–total correlations ranged from r = 0.124 to higher, all significant at p < 0.01, supporting the scale’s validity. Exploratory Factor Analysis (EFA) identified four emerging factors (eigenvalues > 1), and Bartlett’s test confirmed sample suitability (p < 0.001; Kaiser–Meyer–Olkin = 0.898). Cronbach’s alpha coefficient was 0.898. Participants who were young (71.5%), unmarried (72%), and had psychiatric disorders (16.5%) were more likely to perceive childbearing as less important for their future. Nevertheless, these same groups, along with students (61%), frequently regarded childbearing as a present hindrance that necessitates preparation. Furthermore, participants who were undecided about having children (22.5%) exhibited lower scores in the female identity domain. Conclusions: The Arabic version of the Attitudes toward Fertility and Childbearing Scale appears to be psychometrically sound, encompassing four factors: importance for the future, hindrance at present, childbearing preparation, and female identity. This study found that younger women and those with psychiatric disorders showed lower scores regarding the importance of future childbearing, while college students exhibited more concerns about hindrance and preparation. Full article