Search Results (527)

Fetal growth restriction (FGR) is a major contributor to perinatal morbidity and mortality, most commonly arising from placental dysfunction, with increasing evidence implicating aberrant DNA methylation in its pathogenesis. To identify robust epigenetic alterations associated with FGR, we analyzed placental chorionic villi from an in-house early-onset FGR cohort and compared them with a publicly available dataset (GSE100197). DNA methylation profiling was performed using Illumina EPIC (in-house) and 450K (public) arrays, processed with identical normalization and quality-control pipelines, including adjustment for gestational age and estimation of placental cell-type composition. Differentially methylated positions (DMPs) were identified using linear regression models, revealing 10,427 DMPs in the in-house cohort and 7467 in the public dataset, with 108 shared DMPs showing consistent direction of change across both cohorts. Promoter-associated DMPs were mapped to genes involved in angiogenesis, morphogenesis, immune regulation, and transcriptional control, including EPHA1, ANGPTL6, ITGAX, BCL11B, and CYP19A1, while additional novel candidates such as SLC39A12, YEATS4, and MIR515 family members were also identified. Functional annotation suggests that these methylation changes may influence pathways essential for placental vascular development and structural organization. Overall, this cross-cohort comparison highlights reproducible epigenetic signatures of FGR and underscores the need for standardized approaches to clarify the molecular mechanisms underlying placental insufficiency. Full article

Introduction: Gestational diabetes (GD) screening remains limited in many low- and middle-income countries (LMICs) due to resource constraints, limited training, and low community awareness. Although community-centered approaches may improve access to screening in rural and Indigenous settings, the implementation processes through which such approaches are designed and operationalized are rarely documented. Methods: This study presents a community-based implementation process report describing the development, adaptation, and early implementation of a GD screening program in rural Guatemala, guided by the Exploration, Preparation, Implementation, and Sustainment (EPIS) implementation science framework. Using a participatory approach, international screening guidelines were systematically adapted to the local context through iterative protocol refinement, structured stakeholder engagement, and ongoing feedback from community health educators and partner institutions. Aggregate program data were used descriptively to characterize early screening uptake and feasibility. Results: Key implementation challenges included patient no-shows, community skepticism, and difficulties among health educators in interpreting screening procedures. Iterative adaptations were introduced to simplify protocols, reduce loss to follow-up, and strengthen community engagement. Over time, the program expanded from point-of-care screening to more comprehensive prenatal services and increased collaboration with the Ministry of Health and local community outlets. A total of 103 Indigenous Mayan Tz’utujil women were screened (mean age: 26.9 years; range: 15–46), of whom, 12 were diagnosed with GD. Conclusions: This implementation process report demonstrates the scientific value of systematically documenting real-world adaptation, feasibility, and stakeholder engagement when introducing GD screening in rural Indigenous LMIC settings. The implementation lessons described may inform similar maternal health initiatives in comparable contexts. Full article

Daoist female alchemy (nüdan 女丹) texts articulate a bodily paradigm in which humans and nature mutually enfold one another, and in which yin and yang interact in harmonious complementarity. Through an analysis of three key dimensions, the yin-yang cosmology embedded in these texts, the ways menstruation, desire, and the female breasts are reconceived in the course of cultivation, and the ideal of gestating an a priori (xiantian 先天) embryo, this article argues that nüdan writings present a gender-symmetrical, pre-sexual symbolic culture. This culture both acknowledges gender difference and ultimately transcends it, seeking a return to the undifferentiated, yin-yang combined condition of primordial Dao. These texts reveal that women and men possess complementary yin and yang attributes that must be reintegrated in order to return to the a priori state and attain infinite vitality. They likewise suggest that both women and men harbor active, originary desire, and that only through equivalent processes of bodily transformation, reverting the sexualized, adult bodies into the unsexualized bodies of the girl and boy, can practitioners acquire the power to gestate the inner elixir, symbolizing inexhaustible vitality. In this sense, nüdan writings develop a pre-sexual narrative centered on vitality, offering a resonant response to concerns within postmodern feminism regarding how to dismantle centralized, phallogocentric narratives while enriching non-gender-centralized symbolic cultures. They thus provide a special path to reconsider gender not by advancing forward, but by stepping back into a more primordial, integrated ideal. Full article

The integration of artificial intelligence (AI) with ultrasonic biosensing presents a transformative opportunity for enhancing diagnostic accuracy in agricultural and biomedical applications. This study develops a data-driven deep learning model to address the challenge of acoustic artifacts in B-mode ultrasound imaging, specifically for sow pregnancy diagnosis. We designed a biosensing system centered on a mechanical sector-scanning ultrasound probe (5.0 MHz) as the core biosensor for data acquisition. To overcome the limitations of traditional filtering methods, we introduced a lightweight Deep Neural Network (DNN) based on the YOLOv8 architecture, which was data-driven and trained on a purpose-built dataset of sow pregnancy ultrasound images featuring typical artifacts like reverberation and acoustic shadowing. The AI model functions as an intelligent detection layer that identifies and masks artifact regions while simultaneously detecting and annotating key anatomical features. This combined detection–masking approach enables artifact-aware visualization enhancement, where artifact regions are suppressed and diagnostic structures are highlighted for improved clinical interpretation. Experimental results demonstrate the superiority of our AI-enhanced approach, achieving a mean Intersection over Union (IOU) of 0.89, a Peak Signal-to-Noise Ratio (PSNR) of 34.2 dB, a Structural Similarity Index (SSIM) of 0.92, and clinically tested early gestation accuracy of 98.1%, significantly outperforming traditional methods (IoU: 0.65, PSNR: 28.5 dB, SSIM: 0.72, accuracy: 76.4). Crucially, the system maintains a single-image processing time of 22 ms, fulfilling the requirement for real-time clinical diagnosis. This research not only validates a robust AI-powered ultrasonic biosensing system for improving reproductive management in livestock but also establishes a reproducible, scalable framework for intelligent signal enhancement in broader biosensor applications. Full article

Background: Postnatal growth failure in very preterm infants remains a major concern in neonatal care and clinical management is complicated by the lack of a standardized definition. This study aims to identify risk factors for growth faltering (GF) and undernutrition (UN) at hospital discharge, defined according to the latest consensus definitions established by the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). Methods: We conducted a retrospective observational study of 416 preterm infants (gestational age < 32 weeks and/or birth weight < 1500 g). Growth was monitored using the Intergrowth 21st standards. In line with ESPGHAN criteria, GF was defined longitudinally as a weight for age (WFA) z-score decline ≥ 1 SD from birth, while UN was defined cross-sectionally as a WFA or length for age z-score < −2 SD at discharge. Logistic regression models were used to determine independent predictors for both growth phenotypes. Results: At discharge, the prevalence of GF and UN was 45.3% and 33.1%, respectively. In infants born without growth restriction (GR), UN was almost entirely driven by GF (89.7%). In contrast, 85.5% of infants born with GR remained undernourished at discharge. Multivariate analysis identified bronchopulmonary dysplasia and higher maximal postnatal weight loss as major independent risk factors for GF, while female sex and human milk feeding at discharge were associated with a lower risk of GF. For infants born with adequate weight, maternal hypertension, extremely low birth weight, and the co-occurrence of GF were the strongest predictors of UN. Conclusions: Nearly half of very preterm infants experience significant growth impairment before discharge. By assessing the dynamic process of GF and the static endpoint of UN, we identified distinct clinical trajectories. Standardized ESPGHAN criteria allow for the identification of high-risk “phenotypes”—particularly those with GR at birth or severe neonatal morbidity—enabling more targeted and intensive nutritional management during the critical developmental window. Full article

Background/Objectives: Greater than 50% of surviving very preterm infants are affected by postnatal growth failure and are at high risk of associated development of bronchopulmonary dysplasia (BPD). Given the influence of enteral feeding on growth failure, we aimed to determine the impact of type, volume, and time of introduction of enteral feeds on mitigating the risk of postnatal growth failure and BPD risk. Methods: This was a retrospective chart review of mothers’ own milk (MOM), pooled pasteurized donor human milk (PDHM) feeding, postnatal growth, and BPD severity in preterm infants <33 weeks of gestation admitted to the Children’s Hospital of Richmond at VCU neonatal intensive care unit between 2021 and 2024. Statistical analysis included linear regression with moderation analysis using the Hayes Process model, chi-square tests, linear and multinomial logistic regression, with p-value < 0.05 considered significant. Results: After controlling for the percentage of MOM received at 34 weeks corrected gestational age (cGA), greater severity of BPD was associated with lower infant weight and growth failure, p < 0.001. Early introduction of MOM (3 days of life) and greater volume of MOM showed better linear growth and decreased risk of severe BPD, respectively (p < 0.001). Conclusions: Provision of MOM to preterm infants within 3 days of life was associated with a moderation of the relationship between gestational age and growth velocity, with improved growth velocity trajectory. Preterm infants who received a greater volume of MOM through 34 weeks cGA experienced less severe BPD compared to those fed higher volumes of PDHM. As the incidence of growth failure paralleled the incidence of BPD severity, identification of key MOM components becomes important to address and augment the value of PDHM in the management of preterm infants. Full article

Background/Objectives: Children born small for gestational age (SGA) are at increased risk for impaired growth, metabolic disturbances, and neurodevelopmental difficulties. Although previous research has examined cognitive and behavioral outcomes in this population, findings remain inconsistent. Moreover, limited evidence is available regarding the potential effects of recombinant human growth hormone (rhGH) therapy on cognitive development. We aimed to assess cognitive performance, emotional–behavioral functioning, and neonatal predictors of neurocognitive outcomes in term SGA children compared with age- and sex-matched peers born appropriate for gestational age (AGA). We also explored potential differences in cognitive outcomes between rhGH-treated and untreated SGA children. Methods: A total of 18 term SGA children and 23 AGA controls underwent anthropometric measurements, biochemical evaluation, cognitive testing using the Wechsler Intelligence Scale for Children—Fourth Edition (WISC-IV), and behavioral assessment through the Child Behavior Checklist (CBCL). Birth weight, length, and head circumference were analyzed as potential predictors of cognitive performance. Results: SGA children demonstrated significantly lower Intelligence Quotient (IQ) scores than AGA peers, with marked weaknesses in Perceptual Reasoning index (PRI) and Processing Speed index (PSI), while Verbal Comprehension and Working Memory were preserved. They also exhibited higher internalizing behavioral symptoms, whereas externalizing behaviors did not differ between groups. Birth head circumference emerged as a strong predictor of PRI and a modest predictor of PSI. No associations were found between rhGH treatment parameters and cognitive outcomes. Larger longitudinal studies are needed to clarify how early growth restriction affects brain development and cognition and whether GH therapy influences these processes. Full article

Background/Objectives: Our aim was to investigate the diagnostic accuracy of prenatal ultrasound (US) in fetal limb abnormalities. As a secondary target, we wanted to correlate various predictors for the diagnosis accuracy. Methods: We prospectively enrolled cases with routine prenatal US performed in five participating centers. Subsequently, we selected and processed all cases with limb abnormalities: suspected, diagnosed, and missed on the prenatal diagnosis scans. We collected data on the type of anomaly, the US equipment and probes used, the operator’s expertise, the gestational age at the diagnosis, the length of the examination, and the use of US reporting form. SPSS 22.0 software was applied to perform the analyses using non-parametric statistical methods. Associations between categorical variables were evaluated using Fisher’s exact test and Chi-square tests. For correlations between the gestational age and the anomaly severity, we used Spearman’s rank-order correlation. Predictive performance of operator- and scan-related variables for diagnostic accuracy was assessed using receiver operating characteristic (ROC) curve analysis, with area under the curve (AUC) estimates, standard errors (SE), confidence intervals (95% CI), and p-values reported. Results: Our data showed that most US examinations were performed as part of routine screening (79.7%), and the most frequent anomaly diagnosed was clubfoot. Operators’ expertise demonstrated the highest predictive performance, while technical parameters—scan duration (AUC = 0.20, p = 0.1188) and US equipment (AUC = 0.30, p = 0.3478)—did not significantly predict diagnostic accuracy. Conclusions: The overall diagnostic accuracy of prenatal US was 85.5%. Our findings indicate that diagnostic performance is driven primarily by operator expertise and training, rather than by gestational age at scan and technical parameters. Full article

For decades, cervical insufficiency (CI) has been framed predominantly as a mechanical failure of the cervix resulting in painless mid-trimester dilatation. This disease-centered paradigm, reinforced by clinical teaching and administrative coding, does not fully capture the dynamic and biologically integrated nature of cervical remodeling. Accumulating evidence suggests that cervical change is governed by coordinated mechanical, inflammatory, and immunologic interactions rather than by a purely anatomic defect. To outline a process-oriented conceptual framework that situates CI within the broader preterm-birth continuum, this perspective aims to integrate biomechanical, inflammatory, and immunologic dimensions of cervical remodeling and to emphasize that infection- and inflammation-related changes represent dynamic, potentially modifiable elements that may inform more individualized, biology-guided clinical decision-making. This Perspective traces the evolution from a traditional “disease entity” interpretation of CI toward a more integrated view of cervical remodeling as a dynamic, biology-responsive process. Emerging data suggest that when intra-amniotic infection or inflammation is appropriately managed, cervical competence may be partially restored, and mechanical support can be applied more safely in selected patients. Clinical observations indicate that infection-controlled cerclage is associated with meaningful prolongation of gestation. Earlier reports describing double-level mechanical reinforcement techniques conceptually align with contemporary interpretations of infection-controlled emergent cerclage by linking surgical timing with the underlying biology of cervical change. Rather than proposing a prescriptive management pathway, this framework highlights how mechanical, inflammatory, and immunologic factors may interact across heterogeneous CI etiologies and how individualized intervention may be guided by biologic context. Understanding CI as a dynamic rather than a fixed condition provides a framework that integrates its mechanical, inflammatory, and immunologic dimensions within the preterm birth continuum. Such a perspective encourages individualized, biology-informed interpretation of cervical change and supports more context-specific use of established interventions such as cerclage. By emphasizing developmental processes rather than a static defect, this approach seeks to bridge classical clinical practice with contemporary insights into cervical remodeling. Full article

Background/Objectives: Respiratory syncytial virus (RSV) is the most common cause of lower respiratory tract infection in young children, especially during infancy, resulting in substantial morbidity and mortality. Methods: Acknowledging the real-world evidence on RSV immunization, the College of Pediatrics, Academy of Medicine of Malaysia, has appointed an expert panel to develop a position paper on recommendations for infant and/or maternal vaccination against childhood RSV, specifically in the Malaysian context with year-round RSV activity. Results: Recognizing the potential constraints and limitations in the implementation process, the expert panel recommends targeted immunization with long-acting RSV monoclonal antibody (mAb) for high-risk infants as a pragmatic first step, with subsequent scale-up to universal immunization of infants when resources permit. Conclusions: Immunization is the most effective strategy to prevent RSV-related lower respiratory tract infection in childhood. Year-round maternal vaccination between 28 and 36 weeks’ gestation, combined with immunization at six months for all infants, may potentially circumvent the unclear seasonality. Full article

Maternal nutrition during gestation profoundly influences fetal growth, organogenesis, and long-term offspring performance through developmental programming. Among the molecular mechanisms responsive to maternal nutrient availability, one-carbon metabolism plays a central role by integrating folate, methionine, choline, and vitamin B₁₂ pathways that regulate methylation, nucleotide synthesis, and antioxidant defense. These processes link maternal nutritional status to epigenetic remodeling, cellular proliferation, and redox balance during fetal development. Mitochondria act as nutrient sensors that translate maternal metabolic cues into bioenergetic and oxidative signals, shaping tissue differentiation and metabolic flexibility. Variations in maternal diet have been associated with shifts in fetal amino acid, lipid, and energy metabolism, suggesting adaptive responses to constrained intrauterine environments. This review focuses on the molecular interplay between one-carbon metabolism, mitochondrial function, and metabolomic adaptation in developmental programming of ruminant livestock. Understanding these mechanisms offers opportunities to design precision nutritional strategies that enhance fetal growth, offspring productivity, and long-term resilience in livestock production systems. Full article

Background/Objectives: In low-resource settings, diagnostic delays and limited specialist access worsen health inequalities, making hypertensive disorders of pregnancy (HDPs) defined by new-onset blood pressure ≥ 140/90 mmHg after 20 weeks of gestation, with or without proteinuria, a major cause of maternal morbidity and mortality. This study evaluated the diagnostic effectiveness of a rural-applicable clinical model for detecting HDPs in a real-world population from Hospital General San Felipe (Tegucigalpa, Honduras). Methods: A cross-sectional diagnostic accuracy study was conducted on 147 consecutive pregnant women in February 2025. Clinical documentation from the initial appointment defined HDP. We modeled HDP risk using penalized logistic regression and common factors such maternal age, gestational age, blood pressure, BMI, primary symptoms, semi-quantitative proteinuria, and medical history. Median imputation was utilized for missing numbers and stratified five-fold cross-validation assessed performance. We assessed AUROC, AUPRC, Brier score, calibration, and operational utility at a data-driven threshold. Results: Of patients, 27.9% (41/147) had HDP. The model had an AUROC of 0.614, AUPRC of 0.461 (cross-validation averages), and Brier score of 0.253. The threshold with the highest F1-score (0.474) had a sensitivity of 0.561, specificity of 0.679, positive predictive value of 0.404, and negative predictive value of 0.800. HDP had higher meaning systolic/diastolic/mean arterial pressure (130.7/82.9/98.9 vs. 120.5/76.1/90.9 mmHg) and ordinal proteinuria (0.59 vs. 0.36 units). Conclusions: The model had moderate but clinically meaningful discriminative performance using low-cost, commonly obtained variables, excellent calibration, and a good negative predictive value for first exclusion. These findings suggest modification of predictors, a larger sample size, and clinical usefulness assessment using decision curves and process outcomes, including quick referral and prophylaxis. This approach aligns with contemporary developments in the 2023–2025 European Society of Cardiology (ESC) and 2024 American Heart Association (AHA) guidelines, which emphasize earlier identification and risk-stratified management of hypertensive disorders during pregnancy as a cornerstone of women’s cardiovascular health. Full article

Background/Objectives: Gestational exposure to a high-fat diet (HFD) reprograms hypothalamic orexigenic circuits prenatally. However, whether astrocytes, critical modulators of this system, are also imprinted by HFD in the fetal brain remains unknown. We investigated the impact of HFD on the prenatal neuroglial architecture of the lateral hypothalamic area (LHA). Methods: Female Wistar rats were fed a control or a 60% fat diet for 12 weeks. Upon reaching obesity (Lee index ≥ 310), dams were mated. Fetuses were harvested via cesarean section at term, and their brains were processed for immunohistochemistry and morphometry to assess cell proliferation, orexin neuron density, and astrocytic reactivity in the LHA. Results: HFD significantly increased cell proliferation and orexinergic neuron density, and induced early signs of astrocyte reactivity in the fetal LHA. These findings reveal that both neuronal and glial components of the LHA orexigenic axis are structurally reprogrammed before birth. Conclusions: This study provides the first evidence that HFD simultaneously alters neuronal and glial developmental trajectories in the fetal hypothalamus. The concurrent programming of astrocytes and orexigenic neurons suggests a prenatal origin for neuroinflammatory susceptibility, reframing obesity as a neurodevelopmental disorder shaped by early life nutritional environments. Full article

In viviparous teleosts, the lack of oviducts defines intraovarian gestation, with the ovary being the site for oogenesis but also the site for insemination, fertilization, and gestation. Consequently, intraovarian gestation is a complex and exceptional type of reproduction among vertebrates. The analysis of the morphological and physiological components of intraovarian gestation documents the evolutionary process of nutrition in viviparous species. Two types of embryonic nutrition may occur during gestation: (a) lecithotrophy, when most nutrients for the embryo come from the abundant yolk stored during oogenesis, and (b) matrotrophy, when nutrients for the embryo with scarce yolk must be obtained during gestation by additional maternal provisioning, developing a placenta. Then, investment of maternal nutrients for the embryo is greater during oogenesis in lecithotrophic species, and investment of maternal resources for the nutrition of the embryo is greater during gestation in matrotrophic species. Microscopic techniques allow for proper observation of maternal and embryonic structures involved in both types of nutrition during the development of embryos. Specifically, we focused on the morphology of placental structures associated with embryonic nutrition at different stages of development, which are the yolk sac and the pericardial sac. The oocytes of Poecilia latipinna contain a large amount of yolk (an average oocyte diameter of 1.9 mm); in contrast, the oocytes of Heterandria formosa contain extremely reduced amounts of yolk (an average oocyte diameter of 0.4 mm). Therefore, these species represent appropriate models for studying the strategy of two different types of embryonic nutrition, lecithotrophy and matrotrophy, in viviparous teleosts. Full article

Background/Objectives: Pregnancy represents a unique physiological state marked by extensive metabolic adaptations, particularly in lipid pathways essential for maternal adjustments, fetal development, and postpartum recovery. This study aimed to explore these changes through untargeted lipidomic profiling. Methods: This observational, comparative, non-interventional clinical study included 107 women, of which 65 were in the third trimester of pregnancy (mean age 27.9 ± 5 years) and 42 were in the early postpartum period (≤7 days, mean age 28.9 ± 5.9 years). Inclusion criteria were singleton, term pregnancies (37–41 weeks) with neonates weighing > 2500 g and no associated pregnancy-related pathologies; exclusion criteria included multiple gestation, use of lipid-altering medications, maternal age > 40 years, or diagnosed pregnancy complications. Plasma samples were analyzed using High-Performance Liquid Chromatography–Quadrupole Time-Of-Flight–Electrospray Ionization (positive mode)–Mass Spectrometry, data were processed with MetaboAnalyst 6.0 using multivariate and univariate analyses (Partial Least Squares–Discriminant Analysis, Volcano Plot, Random Forest, Receiver Operating Characteristic analysis), with statistical significance set at p < 0.05. Results: Multivariate analysis demonstrated a clear separation between groups with high predictive accuracy as reflected by strong classification metrics (Accuracy = 0.90, R² = 0.75, Q² = 0.68). Several discriminative lipids were consistently identified across statistical models, including 2-Methoxyestrone (AUC = 0.861), Eicosanedioic acid (AUC = 0.854), and Pregnenolone sulfate (AUC = 0.843). These biomarkers were further categorized into five major lipid classes: steroid hormones, long-chain fatty acids, lysophospholipids, ceramides/sphingolipids, and glycerolipids. Conclusions: Untargeted lipidomic profiling revealed distinct metabolic signatures that differentiate late pregnancy from early post-partum states. The identification of robust lipid biomarkers with high discriminative performance highlights their potential utility in maternal health monitoring, obstetric risk assessment, and postpartum recovery surveillance. Full article