Search Results (3,640)

Background/Objectives: Most evidence on SARS-CoV-2 infection in pregnancy comes from hospitalised or symptomatic cohorts sampled early in the pandemic. We described maternal and neonatal outcomes in an unselected cohort of PCR-confirmed infections ending in live birth, identified characteristics associated with neonatal intensive care unit (NICU) admission and with prolonged maternal hospitalisation, and benchmarked event rates against national data. Methods: A retrospective cohort of all pregnant women with a positive nasopharyngeal SARS-CoV-2 RT-PCR result at a Turkish tertiary centre between March 2020 and May 2023. Of 151 women identified, 133 had retrievable records; eight pregnancies did not end in a live birth, leaving 125. Prespecified subgroups (NICU admission; maternal stay >3 days) were compared using Mann–Whitney U and χ²/Fisher exact tests, and cohort proportions with 2024 Turkish national rates by one-sample exact binomial tests. Results: The mean maternal age was 29.9 ± 5.5 years and gestational age at delivery was 38.0 ± 2.0 weeks; 19 women (15.2%) delivered preterm and 76 (60.8%) were diagnosed in the third trimester. Sixteen neonates (12.8%) required NICU care and two mothers (1.6%) intensive care; there were no maternal deaths or stillbirths. NICU admission was associated with preterm birth (56.2% vs. 9.2%, p < 0.001) and lower Apgar scores, and prolonged maternal stay with preterm birth, pregnancy-related comorbidity, and caesarean delivery (all p ≤ 0.001). Neither the trimester of infection nor vaccination status was associated with either outcome. Caesarean (64.0%) and preterm birth (15.2%) rates did not exceed national values (p = 0.58 and p = 0.42). Conclusions: Adverse outcomes clustered with preterm delivery and pre-existing pregnancy complications rather than with the timing of infection. Without a matched control group, and with power limited to large effects, these descriptive findings cannot exclude a clinically important effect of SARS-CoV-2. Full article

Background: Psoriasis is a chronic, immune-mediated inflammatory skin disorder that frequently exhibits spontaneous clinical remission during pregnancy. However, the underlying cell-type-specific transcriptomic alterations—particularly the involvement of dermal fibroblasts and hormone receptor signaling—remain poorly understood. Methods: We established an imiquimod (IMQ)-induced psoriasis-like dermatitis model in BALB/c mice comparing pregnant and non-pregnant cohorts. Multi-omics profiling combing bulk and single-cell RNA sequencing was integrated with computational intercellular communication and trajectory analysis. In vitro hormone-stimulation assays with ELISA quantification and in situ multiplex immunofluorescence were performed for experimental evaluation. Results: Compared with non-pregnant IMQ-treated mice, pregnant mice exhibited reduced psoriasis area and severity index scores and diminished epidermal thickening. Bulk RNA sequencing revealed downregulated Th1/Th17 inflammatory transcripts and upregulated hormone-associated genes (e.g., Pgr, Esr1, Ghr). Single-cell RNA sequencing identified 11 distinct cell types, with fibroblasts displaying distinct hormone receptor profiles and functional heterogeneity. Fibroblasts displayed transcripts encoding both anti-inflammatory factors (e.g., Tgfb2, Gas6, Grn) and pro-inflammatory factors (e.g., Fgf7, Mif). Keratinocytes exhibited an anti-inflammatory transcriptional phenotype with attenuated proliferation signatures. Monocytes/macrophages shifted toward M2-like transcriptional signatures and displayed computationally predicted communication with fibroblasts via candidate pathways including GRN and Gas6. Experimentally, primary mouse dermal fibroblasts stimulated with estradiol, progesterone, and growth hormone in vitro significantly increased secretion of PGRN. Gas6 secretion was significantly augmented by estradiol and growth hormone, whereas progesterone induced a modest elevation with borderline significance (p = 0.060). In contrast, TGF-β2 protein remained undetectable in culture supernatants. Furthermore, multiplex immunofluorescence demonstrated significantly increased expression of the Gas6 receptor MerTK on dermal macrophages in the IMQ + pregnancy group. Conclusions: Pregnancy-induced hormonal fluctuations may be associated with the amelioration of IMQ-induced psoriatic dermatitis, which correlates with a fibroblast-involved immunoregulatory network. These findings highlight the association of stromal-immune crosstalk in disease remission and suggest the GRN and Gas6 pathways as candidate pathways for future functional validation. Full article

Background: Toxoplasma gondii infection during pregnancy may lead to congenital toxoplasmosis and serious pregnancy complications. In Kenya, however, toxoplasmosis is not screened during routine antenatal care, and there is limited local data on maternal seroprevalence and associated risk factors. This study determined the seroprevalence of T. gondii infections. It examined its association with socio-demographic, obstetric characteristics, awareness levels, and exposure behaviours among pregnant women visiting the antenatal clinic at Pumwani Maternity Hospital in Nairobi, Kenya. Methods: A cross-sectional study was conducted among 298 pregnant women consecutively recruited at Pumwani Maternity Hospital in Nairobi County between July and October 2025. Data on socio-demographics, obstetric characteristics, knowledge, and exposure practices were collected using a structured questionnaire. Blood specimens were obtained from consenting prenatal patients, and anti-T. gondii IgG antibodies were detected by indirect enzyme-linked immunosorbent assay (ELISA). Associations between seropositivity and risk factors were assessed using univariable logistic regression, followed by two separate multivariable models. Variables with p < 0.25 were considered for multivariable analysis, followed by backward likelihood-ratio elimination. Model calibration was assessed using the Hosmer–Lemeshow test. Results: The overall seroprevalence of anti-T. gondii IgG was 24.5% (73 of 298). In the sociodemographic model, women who were self-employed (adjusted odds ratio [AOR] = 0.26, 95% CI: 0.13–0.53) and formally employed (AOR = 0.25, 95% CI: 0.11–0.59) had lower odds of seropositivity than unemployed women. Women aged 25–33 years had higher odds than those aged 18–24 years (AOR = 2.45, 95% CI: 1.06–5.62). Having two children was associated with lower odds than a first birth (AOR = 0.40, 95% CI: 0.18–0.90), while parity of four or more showed a borderline increase in odds (AOR = 3.11, 95% CI: 0.99–9.76). In the knowledge/exposure model, good awareness of population risk groups was linked to higher odds of seropositivity (AOR = 3.34, 95% CI: 1.21–9.24), but exposure-practice variables were not independently associated. Stratified analyses showed significant demographic differences in exposure practices, such as eating undercooked meat in the third trimester of pregnancy (p = 0.021) and unwashed vegetable consumption by pregnant women from Kamkunji Sub-County (p = 0.005). Parity of three increased infection risk (p = 0.007). Conclusions: About 25% of participants showed evidence of prior T. gondii exposure. Seropositivity correlated with specific sociodemographic and obstetric factors as well as awareness of groups at risk. These results endorse targeted antenatal education that emphasises practical food safety and environmental hygiene, aligned with a One Health approach. Further longitudinal and multicenter research, including IgM and IgG avidity testing, is needed to differentiate recent from past infections and to better understand risks associated with congenital toxoplasmosis. Full article

Fetal electroencephalogram (fEEG) recording could address the gap of functional fetal brain testing and enable direct assessment of fetal brain status during pregnancy and labor. However, the fetal EEG signal (~1 µV) is masked by roughly 80 dB (about 10,000×) of maternal ECG and other bioelectric interferences. This synthetic-data feasibility study presents whether the fetal EEG can be recovered from the maternal abdomen surface by using the following three sensing architectures on physiologically scaled synthetic data: single electrode, dual electrode, and a concentric 28-electrode array centered over the fetal head. We show that exploiting a known geometric attenuation steering vector with a minimum-variance distortionless-response (MVDR) beamformer raises recovery correlation from ~0 to ~0.28 and improves signal-to-noise ratio (SNR) by ~67 dB. A follow-up validation replaces the synthetic EEG generator with actual neonatal EEGs recorded from the scalp, obtained from OpenNeuro ds004577 and the Helsinki Zenodo corpus. Comparable recovery performance across both datasets confirms that the synthetic feasibility conclusion generalizes to real neonatal EEG composition and behavioral characteristics. The primary evaluation is based on waveform-level engineering metrics (correlation, SNR, and RMSE), while exploratory secondary analyses assess aEEG envelopes, band-power trends, and burst detection. These analyses are not intended as clinical validation. Independent per-electrode sensor noise remains the dominant residual limiter under the homogeneous geometric model. The reported r ≈ 0.28 should not be interpreted as expected in vivo performance at all gestational ages: an intact vernix layer can add approximately 35 dB of attenuation and makes the required noise floor substantially more stringent. This analysis adds a five-layer volume-conductor analysis, misalignment, depth and impedance-drift stress tests, recording-level statistics, comparisons with classical extraction families (PCA, ICA, adaptive cancelation, and multichannel Wiener filtering), an interference-alignment sensitivity analysis, and exploratory biomarker-level analyses, which together bound the idealizations of the forward model. Full article

Background/Objectives: Endometrial polyps (EPs) are common benign intrauterine lesions associated with abnormal uterine bleeding, infertility, recurrent implantation failure, and recurrent pregnancy loss. Although traditionally considered hormone-dependent lesions, increasing evidence suggests that chronic endometritis (CE) may contribute to their development and recurrence. This review summarizes current evidence regarding the relationship between CE and EPs, focusing on pathophysiological mechanisms, diagnostic approaches, and clinical implications. Methods: This narrative review was conducted according to the Scale for the Assessment of Narrative Review Articles (SANRA). A literature search was performed using PubMed/MEDLINE, Scopus, and Google Scholar to identify original studies, systematic reviews, meta-analyses, and consensus statements addressing CE, EPs, infertility, endometrial microbiota, and polyp recurrence. Results: Current evidence demonstrates a consistent association between CE and EPs, with approximately half of premenopausal women with EPs showing histological evidence of CE. Chronic inflammation may promote polyp formation through immune activation, inflammatory cytokine signaling, abnormal angiogenesis, extracellular matrix remodeling, dysregulated apoptosis, and alterations in the endometrial microbiome. CE has also been identified as an independent predictor of EP recurrence after hysteroscopic polypectomy and may impair endometrial receptivity. Histopathological examination with CD138 immunohistochemistry remains the diagnostic reference standard. Conclusions: Emerging evidence supports an inflammatory component in the pathogenesis of endometrial polyps and suggests that CE may represent a potentially modifiable risk factor for recurrence and reproductive failure. Incorporating assessment of CE into the evaluation of selected women with recurrent polyps or infertility may improve individualized management. However, prospective studies are needed before routine screening and treatment can be universally recommended. Full article

Background: Cell-free DNA non-invasive prenatal testing (NIPT) is recommended by the American College of Obstetricians and Gynecologists (ACOG) and the American College of Medical Genetics and Genomics (ACMG) for fetal aneuploidy screening in all pregnancies, yet most testing is performed by centralized reference laboratories. We evaluated whether a whole-genome sequencing (WGS) NIPT assay implemented in a high-complexity clinical laboratory can achieve a performance consistent with established reference laboratories. Methods: We retrospectively analyzed 11,235 evaluable clinical NIPT samples processed in a single Clinical Laboratory Improvement Amendments (CLIA)-certified, College of American Pathologists (CAP)-accredited laboratory using the Illumina VeriSeq NIPT Solution v2, which reports trisomy 21 (T21), trisomy 18 (T18), trisomy 13 (T13), and sex chromosome aneuploidies (SCA). Results were compared with the diagnostic and clinical follow-up; the performance was calculated overall and by maternal age with 95% confidence intervals (CIs). Results: Of 11,318 accessioned samples, 83 (0.73%) were not reportable and excluded. The sensitivity was 100% for all conditions (T21 95% CI 92.1–100%); per-condition specificity exceeded 99.9% (99.81% for any reported aneuploidy overall), with no false-negative results among cases with available follow-ups. Observed positive predictive values (PPVs) were 91.8% (T21), 85.7% (T18), 63.6% (T13), and 79.3% (SCA), consistent with published ranges for this routine, unselected screening population. Conclusions: A high-complexity clinical laboratory can deliver WGS-based NIPT at this level of performance, supporting broader, more timely access to guideline-recommended screening. NIPT remains a screening test, and high-risk results require diagnostic confirmation. Full article

Background: Recurrent implantation failure (RIF) remains one of the most challenging presentations in assisted reproductive technology and is characterized by failure to achieve clinical pregnancy despite the transfer of multiple good-quality embryos. Advances in embryo selection and preimplantation genetic testing have highlighted the contribution of endometrial factors to a substantial proportion of otherwise unexplained implantation failures. Methods: This narrative review summarizes current evidence regarding endometrial receptivity, the principal endometrial mechanisms implicated in RIF, contemporary diagnostic approaches, and available therapeutic strategies. Electronic literature searches were conducted using PubMed/MEDLINE, Scopus, ScienceDirect, and the Cochrane Library for publications available up to June 2026. Results: Anatomical, inflammatory, temporal, hormonal, immunological, and vascular endometrial causes of RIF can all be broadly categorized. Progesterone resistance, impaired decidualization, chronic endometritis, microbiome dysbiosis, displacement of the window of implantation, and immune dysregulation represent proposed mechanisms contributing to implantation failure in selected patients. Diagnostic evaluation is most effective when performed using a stepwise approach that prioritizes clinically actionable findings and avoids indiscriminate testing. Management primarily focuses on optimizing hormonal support, whereas immunomodulatory and antithrombotic therapies should be reserved for carefully selected patients. Emerging approaches, including granulocyte colony-stimulating factor, platelet-rich plasma, and microbiome-directed therapies, have shown promising preliminary results in selected patient populations; however, further validation is required. Conclusions: RIF is best regarded as a heterogeneous clinical outcome rather than a single disease entity, reflecting multiple disturbances in endometrial receptivity. Overall, current evidence supports a mechanism-informed approach that integrates targeted diagnostics with individualized, evidence-based therapeutic strategies. Full article

Interventional radiology (IR) has reshaped contemporary management strategies for selected gynecological and obstetric disorders by introducing minimally invasive, organ-sparing therapeutic alternatives to conventional surgical approaches. This review examines the current applications of IR in the treatment of symptomatic uterine fibroids, pelvic congestion syndrome, placenta accreta spectrum, cesarean scar pregnancy, and selected gynecological malignancies requiring palliative or preoperative embolization. In addition, selected vascular conditions in pregnancy, including visceral and cerebral aneurysms, are discussed due to their high-risk clinical profile and growing relevance for endovascular management. These entities were chosen because of their substantial clinical relevance, risk of severe complications, and the expanding body of evidence supporting endovascular management. Techniques such as uterine artery embolization and ovarian vein embolization are associated with high technical success and meaningful symptom reduction, while simultaneously decreasing hospitalization time, perioperative morbidity, and convalescence compared with traditional surgery. In complex obstetric scenarios—including placenta accreta spectrum and splenic artery aneurysm—prophylactic balloon occlusion and endovascular embolization may significantly limit life-threatening hemorrhage and improve maternal prognosis in appropriately selected patients when implemented within a multidisciplinary setting; for splenic artery aneurysm in particular, this evidence currently derives from case reports and small case series rather than comparative trials. Imaging modalities, including ultrasonography, computed tomography, magnetic resonance imaging, and angiography, are integral to diagnosis, patient qualification, procedural planning, and post-intervention monitoring. Although existing data generally confirm the safety and efficacy of interventional techniques, important limitations persist, including heterogeneous study populations, relatively small cohorts, and insufficient long-term reproductive follow-up. Greater standardization of clinical indications and procedural protocols, ongoing technological advancement, and well-designed multicenter trials are required to consolidate the evidence base. In gynecologic oncology, embolization techniques may provide effective hemorrhage control and facilitate surgical treatment in selected patients. In addition, uterine artery embolization has emerged as an important uterus-preserving adjunct in the management of cesarean scar pregnancy, although long-term reproductive (fertility) outcome data remain limited. IR is becoming an increasingly important component of modern gynecological care, supporting individualized, uterus-preserving, and less invasive therapeutic strategies; fertility preservation specifically is an important goal that, for several of the indications discussed, remains incompletely proven by long-term reproductive-outcome data. Full article

Background/Objectives: Sickle cell thalassemia (HbSβ-thal) and related sickle cell disease (SCD) genotypes are associated with substantial maternal, fetal, and neonatal morbidity during pregnancy. This systematic review aimed to summarize pregnancy outcomes and clinical management strategies in women with HbSβ-thal and related hemoglobinopathies, with an additional narrative comparison to sickle cell trait (SCT)—a distinct, heterozygous, and generally benign carrier state that is not a form of SCD. Methods: A systematic literature search was conducted in PubMed, MEDLINE, Web of Science, EMBASE, and Scopus for studies published between 2016 and 2026 using terms related to sickle cell anemia, sickle cell disease, sickle cell thalassemia, HbS/beta-thalassemia, sickle cell trait, pregnancy outcomes, maternal complications, neonatal outcomes, fetal outcomes, and clinical/obstetric management. Studies reporting maternal, fetal, or neonatal outcomes were included, while letters, commentaries, conference abstracts, and presentations were excluded. Study selection followed PRISMA principles. Risk of bias was assessed using appropriate tools according to study design, including the Newcastle–Ottawa Scale (NOS), AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews), SANRA (Scale for the Assessment of Narrative Review Articles), and CARE (CAse REport) guidelines. SCT terms were included in the same search strategy, so that SCT studies were retrieved and screened through the same PRISMA process and are reported as a prespecified comparator subgroup. Results: Fourteen studies met the inclusion criteria: ten reporting outcomes in HbSβ-thal and related SCD genotypes and four reporting outcomes in SCT. The most frequently reported maternal complications were severe anemia, vaso-occlusive crises (VOCs), preeclampsia, thromboembolic events, infections, acute chest syndrome, cesarean delivery, and postpartum complications, which led to a significant increase in hospitalization rates. Fetal and neonatal outcomes were also unfavorable, with increased rates of preterm birth, low birth weight, intrauterine growth restriction, placental insufficiency, and neonatal intensive care admission. Placental vascular malperfusion and low maternal hemoglobin were important mechanisms underlying fetal growth restriction. By contrast, the included SCT literature suggested outcomes generally closer to the general obstetric population, with a smaller number of specific associations (e.g., preeclampsia, intrauterine fetal death) reported inconsistently across studies. Conclusions: Pregnancies complicated by HbSβ-thal and related hemoglobinopathies remain high-risk and require early identification, preconception counseling, multidisciplinary care, close antenatal surveillance, individualized transfusion strategies, and postpartum thromboprophylaxis when indicated. Prospective genotype-specific studies, particularly isolating HbSβ-thal from broader SCD cohorts, are needed to optimize evidence-based management. Full article

Vanishing twin syndrome (VTS) denotes the spontaneous loss of one conceptus from an initially recognized multiple pregnancy, most often during the first trimester. Its clinical relevance has increased with in vitro fertilization and embryo transfer (IVF-ET), as multiple embryo transfer creates the substrate for dizygotic VTS, while blastocyst transfer may be followed by monozygotic splitting and serial early ultrasonography increases detection. However, the literature remains heterogeneous, with empty gestational sacs, losses after fetal cardiac activity, and later single fetal demise often grouped together despite different biological and prognostic implications. New evidence published in recent years on frozen embryo transfer outcomes, cell-free DNA screening, and early childhood development warrants an updated synthesis of vanishing twin syndrome to inform individualized risk assessment, counselling, and standardized research reporting. Overall, the surviving singleton appears to have a lower risk than an ongoing twin pregnancy but a higher risk than a primary singleton, particularly for preterm birth, low birthweight, and small-for-gestational-age birth, with risk increasing when loss occurs after fetal cardiac activity or later in gestation. Nevertheless, evidence is not unanimous, as several well-characterized cohorts and earlier meta-analyses reported no measurable perinatal disadvantage. Two reports from a single tertiary center, based on substantially overlapping recruitment periods, further suggest that VTS may be proportionally less frequent among established twin pregnancies after IVF/ICSI than after spontaneous conception, while IVF-associated VTS has been linked to placental abnormalities, diabetes, and fetal growth restriction; this observation requires independent confirmation. Contemporary frozen embryo transfer cohorts indicate that VTS remains relevant in modern practice, whereas limited long-term data have not demonstrated impaired early childhood growth or development. Management should document the initial number of gestational sacs, embryonic structures, cardiac activity, chorionicity, and timing of loss, while adapting aneuploidy screening to residual trophoblastic DNA and individualizing fetal-growth surveillance. Elective single-embryo transfer remains the most effective preventive strategy, although it cannot eliminate monozygotic twinning. Standardized definitions and long-term offspring follow-up are needed. Full article

Background: The Turkestan region is one of the regions with a high birth rate; therefore, analysis of the effectiveness of an early detection system for chromosomal abnormalities in this region is important for practical healthcare. Objective: To evaluate the diagnostic potential of first-trimester prenatal screening markers for identifying Down syndrome in the Turkestan region. Methods: A retrospective analytical study was conducted based on the analysis of medical records of pregnancies registered at perinatal centers in the Turkestan region between 2020 and 2025. The final analytical sample included 143 cases, comprising 71 pregnancies affected by Down syndrome and 72 randomly selected pregnancy cases included for comparative analysis. Maternal age, nuchal translucency (NT) thickness, pregnancy-associated plasma protein A (PAPP-A), free beta-human chorionic gonadotropin (free β-hCG), and fetal nasal bone hypoplasia/aplasia were assessed. Multivariable logistic regression and receiver operating characteristic (ROC) curve analysis were used. Results: In the multivariable analysis, maternal age (odds ratio [OR] = 1.16; p < 0.001) and NT (OR = 3.01; p = 0.001) showed statistically significant independent associations with Down syndrome. PAPP-A and free β-hCG did not demonstrate statistically significant independent associations in the multivariable model. The area under the ROC curve (AUC) was 0.855 for Model 1 and 0.903 for Model 2, which additionally included fetal nasal bone status. Conclusions: The exploratory models demonstrated good discriminatory performance within the present retrospective analytical sample. Maternal age and ultrasound markers showed the strongest associations with Down syndrome in the multivariable analysis. These models are not intended for direct clinical application at this stage and require external validation in independent and representative prenatal screening populations before their potential clinical utility can be assessed. Full article

Non-communicable diseases remain the dominant cause of adult morbidity and mortality, yet cardiometabolic, vascular and renal risk may originate before birth. This structured narrative review critically evaluates human evidence linking pregnancy-related exposures, placental pathophysiology and later offspring health within a maternal–placental–fetal–life-course framework. Evidence published from 2020 to 2026 was emphasised, while seminal earlier cohorts were retained when they provided uniquely long follow-up or direct placental measurements. The most consistent associations concern maternal obesity, gestational diabetes, excessive gestational weight gain and hypertensive disorders, which are linked with higher offspring blood pressure, greater adiposity and adverse glucose–insulin profiles. Human placental studies implicate vascular malperfusion, altered nutrient transport, inflammatory and oxidative signalling, endocrine function and epigenetic regulation. Few studies, however, have measured the prenatal exposure, a specific placental phenotype and a long-term offspring outcome within the same longitudinal design; most proposed placental pathways are supported by convergent evidence or biological plausibility rather than demonstrated mediation. Preterm birth and fetal growth restriction are clinically observable, etiologically heterogeneous sentinel phenotypes, not obligatory mediators. Placental and offspring epigenetic signatures, telomere biology and mitochondrial function represent distinct domains of biological embedding; their causal and prognostic significance remains uncertain. Longitudinal studies integrating maternal exposures, placental histopathology and molecular phenotypes, fetal organ development, childhood cardiometabolic trajectories and adult clinical outcomes are needed to determine whether, and under what circumstances, the placenta plays an intermediary role rather than merely serving as a marker of an adverse pregnancy environment. Full article

Background/Objectives: Schistosomiasis affects about 250 million people globally, including an estimated 40 million women of reproductive age and over 10 million pregnant women each year. Praziquantel is a key component of schistosomiasis control and is recommended by the World Health Organization (WHO) for use during pregnancy; nevertheless, its use is uneven due to ongoing safety concerns. Methods: This narrative review synthesizes evidence from randomized controlled trials (with the strongest evidence for the second and third trimesters), observational studies (including limited first-trimester exposures), pharmacokinetic analyses, case series, and WHO policy documents published between 1980 and March 2026. Results: Across all major Schistosoma species, praziquantel demonstrates high efficacy in pregnancy, with cure rates comparable to those in non-pregnant populations. No increased risk of miscarriage, stillbirth, congenital anomalies, preterm birth, or low birth weight has been observed in randomized controlled trials (RCTs) or cohort studies. Treatment of S. haematobium improves maternal anemia and may confer benefits on neonatal iron status and immune development; evidence gaps remain regarding first-trimester exposures and long-term offspring outcomes. Conclusions: Aligning national policies with WHO guidance and integrating praziquantel into antenatal care could substantially reduce maternal morbidity and improve neonatal health. Full article

Background/Objectives: Hypothyroidism may influence lactation physiology, but evidence regarding its association with mature human milk composition remains limited. This cross-sectional study evaluated macronutrient composition and apparent thyroid-stimulating hormone (TSH) concentration in 24 h composite mature milk samples from women with a documented history/diagnosis of treated or clinically managed hypothyroidism attending lactation counseling and human milk-bank consultation, compared with controls without known thyroid disorders. Methods: Sixty-six lactating women attending the Human Milk Bank in Toruń, Poland, were enrolled (31 with hypothyroidism, including six with Hashimoto’s disease; 35 controls). Thyroid characterization was based on diagnoses and laboratory results documented during routine preconception or early-pregnancy/perinatal care; the study did not include contemporaneous maternal serum TSH/FT4 testing at milk collection in either group. Composite 24 h milk samples were analyzed using the MIRIS Human Milk Analyzer for fat, crude protein, true protein, carbohydrates, total solids, and energy. Milk TSH was measured using a third-generation ELFA assay. Because this serum/plasma assay was not formally validated for the human milk matrix, values are reported as exploratory apparent milk TSH concentrations. Results: No statistically significant between-group differences were observed in macronutrient composition in the analyses performed. For example, the HG-CG mean difference for energy content was −3.47 kcal/100 mL (95% CI: −8.45 to 1.52; p = 0.169; q = 0.814), and all confidence intervals for milk-composition outcomes included zero. Median apparent milk TSH concentration was 0.0180 [IQR 0.0130–0.0208] µIU/mL in controls and 0.0155 [IQR 0.0093–0.0210] µIU/mL in the hypothyroidism group (Mann–Whitney U = 459.0, p = 0.286). Hyperlactation was frequent in this selected cohort and was more common in controls (27/35; 77.1%) than in the hypothyroidism group (16/31; 51.6%). Exploratory analyses of pre-pregnancy BMI and Hashimoto’s disease were limited by small subgroup sizes. Conclusions: In this small selected cohort, a documented diagnosis/history of treated or clinically managed hypothyroidism was not associated with statistically significant differences in mature milk macronutrient composition or apparent milk TSH concentration. These findings are exploratory and should not be interpreted as evidence of equivalence, confirmed euthyroidism at sampling, or exclusion of smaller effects. Full article

Background: Brief psychotherapies have been shown to improve clinical symptoms within a limited number of sessions without compromising treatment quality. Objectives: This study aims to test the effects of the experimental Behavioral Analysis Therapy of Feelings (BATF) in a randomized controlled trial design. Methods: This randomized, controlled, assessor-blinded clinical trial compares BATF with Brief Focal Psychotherapy in individuals presenting symptoms of anxiety and/or depression. Participants with substance use disorders, tobacco or alcohol use, pregnancy, or use of oral contraceptives will be excluded. Participants will be randomized in a 1:1 ratio with stratification by clinical condition. Outcomes will be assessed at baseline, Week 4, and Week 13 using the Hamilton Anxiety Rating Scale, the Montgomery–Åsberg Depression Rating Scale, the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, and the Pittsburgh Sleep Quality Index. In addition to clinical outcomes, exploratory salivary and blood biomarkers associated with stress, inflammation, and neurobiological function will be evaluated. The trial is registered in the Brazilian Clinical Trials Registry (RBR-10p45rdg) and has Universal Trial Number U1111-1313-4499. Conclusions: This protocol describes a randomized controlled trial comparing BATF with Brief Focal Psychotherapy. The study is designed to generate preliminary evidence on the effects of the intervention in anxiety and depressive symptoms. Full article