Search Results (1,988)

Background: A short cervix in the second trimester significantly increases preterm birth risk, yet no reliable first-trimester prediction method exists. Current guidelines lack consensus on which women should undergo transvaginal ultrasound (TVUS) screening for cost-effective prevention. Therefore, it is vital to establish a highly accurate and economical method for use in the early stages of pregnancy to predict short cervix in mid-pregnancy. Methods: A total of 1480 pregnant women with singleton pregnancies and at least one risk factor for spontaneous preterm birth (<37 weeks) were recruited from January 2020 to December 2020 at the Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine. Cervical length was assessed at 20–24 weeks of gestation, with a short cervix defined as <25 mm. Feature selection employed tree models, regularization, and recursive feature elimination (RFE). Seven machine learning models (logistic regression, linear discriminant analysis, k-nearest neighbors, support vector machine, decision tree, random forest, XGBoost) were trained to predict mid-trimester short cervix. The XGBoost model—an ensemble method leveraging sequential decision trees—was analyzed using Shapley Additive Explanation (SHAP) values to assess feature importance, revealing consistent associations between clinical predictors and outcomes that align with known clinical patterns. Results: Among 1480 participants, 376 (25.4%) developed mid-trimester short cervix. The XGBoost-based prediction model demonstrated high predictive performance in the training set (Recall = 0.838, F1 score = 0.848), test set (Recall = 0.850, F1 score = 0.910), and an independent dataset collected in January 2025 (Recall = 0.708, F1 score = 0.791), with SHAP analysis revealing pre-pregnancy BMI as the strongest predictor, followed by second-trimester pregnancy loss history, peripheral blood leukocyte count (WBC), and positive vaginal microbiological culture results (≥10⁵ CFU/mL, measured between 11⁺⁰ and 13⁺⁶ weeks). Conclusions: The XGBoost model accurately predicts mid-trimester short cervix using first-trimester clinical data, providing a 6-week window for targeted interventions before the 20–24-week gestational assessment. This early prediction could help guide timely preventive measures, potentially reducing the risk of spontaneous preterm birth (sPTB). Full article

Osteoporosis is a common disease characterized by a reduction in bone mineral density (BMD), leading to an increased risk of pathological fractures and even mortality. Although menopause is a major risk factor, osteoporosis can also occur in premenopausal women. The aim of this study was to identify genetic variants associated with the development of osteoporosis in Korean premenopausal women. Subjects were recruited from the Anseong and Ansan cohorts of the Korean Genome and Epidemiology Study (KoGES). Clinical and epidemiological characteristics were assessed, and participants were classified based on BMD values measured at the distal radius and mid-shaft tibia. Individuals with confounding risk factors such as low body weight, smoking, high alcohol consumption, steroid/hormone therapy, or relevant medical history were excluded. A total of 247 healthy controls and 57 osteoporosis patients were included. Genotyping was performed using the Illumina Infinium HumanExome BeadChip and the Affymetrix Axiom Exome Array. Data were analyzed using the SNP and Variation Suite and PLINK, with quality control thresholds set at MAF ≥ 0.05 and HWE p ≥ 0.01. Functional annotation and protein structure predictions were performed using PolyPhen-2, SIFT, and PROVEAN. Genome-wide association analyses identified 113 single-nucleotide polymorphisms (SNPs) in 69 genes significantly associated with osteoporosis (p < 0.05) in both platforms, with 18 SNPs showing high cross-platform consistency (p < 0.01). Several of these genes were implicated in bone metabolism (e.g., ESRRG, PECAM1, COL6A5), vitamin D metabolism (e.g., NADSYN1, EFTUD1), skeletal muscle function (e.g., PACSIN2, ESRRG), and reproductive processes (e.g., CPEB1, EFCAB6, ASXL3). Notably, the CPEB1 rs783540 SNP exhibited the strongest association (p < 0.001) in both analyses. Our findings suggest that genetic polymorphisms in pathways related to bone metabolism, vitamin D signaling, muscle–bone interaction, and reproductive hormone regulation may contribute to the development of osteoporosis in Korean premenopausal women. These results provide a genetic basis for early identification of at-risk individuals and warrant further functional studies to elucidate the underlying mechanisms. Full article

Background/Objectives: Gestational diabetes mellitus (GDM) is a state of hyperglycemia during pregnancy, increasing the risk of birth complications, and subsequent type 2 diabetes mellitus in the mother and offspring. Risk factors such as diet, obesity, and family history have demonstrated strong association with GDM, but no clear pathophysiology has been ascertained. Methods: An analysis was conducted on 38 women with and 296 without GDM, within a case/control study of pre-eclampsia. The genetic variants examined were selected from among a published polygenic risk score of 10 variants (PRS-10). Genetic models were evaluated for each variant by multivariate logistic regression methods adjusted for age, body mass index, and pre-eclampsia. Since the genotypes for three of the PRS-10 were not available, a risk score comprising the total risk alleles among seven of the variants (PRS-7) was evaluated among those with all genotypes available. Results: Multivariate logistic regression showed significant, independent, positive associations between body mass index (BMI) and age. The posited PRS-7 showed a trend (OR 1.56, 95% CI 0.92–2.56, p = 0.070), and sensitivity analysis comprising three variants (PRS-3) was significantly associated with GDM (OR 2.43, 95% CI 1.17–5.06, p = 0.017). In univariate analysis, rs1421085 was associated with GDM (OR 0.50, 95% CI 0.26–0.95, p = 0.034), but not after adjustment for covariates, and paradoxically not for the expected risk allele. None of the other six variants showed an individual association with GDM. The previously published meta-analysis of PRS-10 showed a degree of heterogeneity (p_Q= 0.03) among the three cohorts analyzed, suggesting that variant effects may differ according to the genetic background, which points to the importance of examining the generalizability of any posited polygenic risk scores. Conclusions: In conclusion, we provide additional support for and further refine the results of a previously published polygenic risk score for GDM in an ethically unrelated population. Full article

Background: Postpartum depression (PPD) is a major public health issue affecting maternal well-being and infant development. This systematic review and meta-analysis aimed to determine the prevalence and risk factors of PPD among Saudi women. Methods: A systematic search of PubMed, Web of Science, ProQuest, and EBSCOHost was conducted for studies published up to 31 March 2025. Statistical analysis was performed using R software (v4.4.2) with a random effects model. Study quality was assessed using the Joanna Briggs Institute (JBI) tool. Results: A total of 32 studies published between 2014 and 2024, including 10,975 women with a mean age of 30.38 ± 6.22 years, were analyzed. Prevalence of PPD varied based on the cutoff scores of the Edinburgh Postnatal Depression Scale (EPDS): 18% (95% CI: 10–27%) at EPDS ≥ 14, 30% (95% CI: 21–38%) at EPDS ≥ 13, 59% (95% CI: 33–85%) at EPDS ≥ 12, and 45% (95% CI: 28–62%) at EPDS ≥ 10. Across studies, 32 significant risk factors for PPD were identified. The most frequently reported included lack of social support, delivery method, young maternal age, and personal or family history of depression. In the meta-analysis, three factors showed statistically significant associations with postpartum depression: limited family support (p < 0.00001), poor spouse support (p < 0.00001), and unplanned pregnancy (p = 0.04). Conclusions: PPD is highly prevalent among Saudi women, with marked regional disparities. These findings highlight the need for tailored mental health strategies and region-specific interventions. Full article

Objective: To assess gestational diabetes mellitus (GDM) awareness among women in the Northern Borders Province of Saudi Arabia and identify factors associated with knowledge levels. Methods: A cross-sectional study was conducted among 461 women using a structured, validated online questionnaire assessing demographics, medical history, and knowledge of GDM’s effects on maternal and neonatal outcomes. Associations between demographic factors and GDM awareness were analyzed using chi-square tests. Results: Most participants (98.5%) were Saudi nationals, with a mean age of 34.5 ± 10.0 years; 82.6% had university-level education. Overall, 42.3% demonstrated fair awareness of GDM, 34.3% had good awareness, and 23.4% had poor awareness. Knowledge of GDM’s maternal complications varied: 70% recognized the risk of emergency cesarean section, but only 8.2% were aware of increased preeclampsia risk. For neonatal outcomes, 58.4% identified high birth weight as a risk, while only 31.9% recognized the risk of congenital anomalies. Higher awareness was significantly associated with education level (p = 0.02), pregnancy status (p = 0.001), trimester (p = 0.002), and family history of relevant conditions (p = 0.04). Conclusion: Although many women showed fair-to-good awareness of GDM, notable gaps remain, especially regarding specific complications. Targeted educational interventions, particularly for less-educated and non-pregnant women, are recommended to improve GDM awareness and pregnancy outcomes. Full article

Background and Objectives: Congenital abnormalities are a leading cause of neonatal morbidity and mortality and are frequently detectable through prenatal ultrasound. While widely implemented in high-income countries, such screening remains inconsistently applied in low- and middle-income regions. This study aimed to estimate the prevalence of congenital abnormalities identified via prenatal ultrasound in Lebanon and to explore associated maternal, obstetric, and psychosocial factors. Methods: A multicenter retrospective observational study, supplemented by follow-up interviews, was conducted in five Order of Malta medical centers. Pregnant women in their second trimester underwent an obstetric ultrasound, and data were collected through structured questionnaires and follow-up phone interviews. Variables included maternal demographics, obstetric history, anxiety levels (GAD-7 scores), and ultrasound findings. Results: A total of 426 pregnant women were enrolled (mean age: 28.8 ± 5.9 years). The overall prevalence of congenital abnormalities was 13.1%. Growth abnormalities were observed in 8.5% of fetuses and were significantly associated with obstetric complications and the presence of multiple abnormalities. Morphological malformations were found in 10.1% of cases and were more common among women of advanced maternal age, those with a history of anomalies, and those reporting elevated anxiety scores. Combined abnormalities, as well as growth and morphological malformations, were significantly associated with higher parity, prior anomalies, and current pregnancy complications. Conclusions: Prenatal ultrasound is essential for early detection of congenital abnormalities, facilitating timely intervention and improved neonatal outcomes. These findings emphasize the need to integrate systematic screening into prenatal care in Lebanon and for ongoing research to identify context-specific risk factors. Full article

Background and Clinical Significance: Many women use pessaries to manage their symptoms of pelvic organ prolapse. Hydroxyquinoline is the active ingredient in gels and ointments that are often used to lubricate a pessary prior to vaginal insertion and to provide antimicrobial effects while the pessary is in situ. Case Presentation: A 74-year-old woman with multiple medication allergies develops vulvovaginal erythema and pruritus after increasing vaginal Trimo-San application frequency for pessary care and maintenance. These symptoms are deemed to be consistent with an allergic reaction to hydroxyquinoline, the active ingredient in Trimo-San. Conclusions: This report highlights the importance of personalized treatment in pessary management. It also demonstrates how personalized medicine can optimize outcomes and improve treatment adherence among individuals with complex medical histories. Full article

This study investigates the impact of the COVID-19 pandemic on clinically diagnosed depression in South Korea, focusing on gender disparities and structural risk factors such as job loss and childcare burden. Although mental health inequalities have received growing attention during the pandemic, most existing research relies on self-reported survey data with inherent limitations. To address this gap, we utilized administrative health data from a 2% stratified random sample of the total population (N = 297,368) in the National Health Insurance Database, focusing on employed individuals without a prior history of depression. Multivariable Cox proportional hazard regression revealed that women had higher risks of depression than men, particularly among those in their 20s to 40s, those who experienced job loss, those who had children aged 7–9, and those who belonged to high-income groups. These findings suggest that the intersection of employment instability and caregiving responsibilities disproportionately affected women’s mental health during the pandemic. The results underscore the urgent need for gender-sensitive public health policies that expand childcare support, institutionalize flexible work arrangements such as telecommuting, and enhance access to targeted mental health services to reduce pandemic-induced gender disparities in mental health. Full article

Background: A high prevalence of vitamin D deficiency (VDD) during early pregnancy has been reported globally, along with a high risk of adverse pregnancy and birth outcomes. The present cut-off to diagnose VDD during pregnancy is <20 ng/mL of serum 25-hydroxyvitamin-D (25(OH)D) concentration, but there is a lack of consensus on this value. We evaluated this diagnostic cut-off specifically during early pregnancy among apparently healthy Indian women. Methods: Demographic details, obstetrics history, anthropometric measurements, and blood samples were collected from 395 apparently healthy pregnant Indian women at ≤14 weeks of gestation, after obtaining written informed consent. The inverse relationship between 25(OH)D and parathyroid hormone (PTH) concentrations was examined to define the breakpoint at which PTH was maximally suppressed using a segmented regression analysis. Covariate exposures associated with VDD were also examined. Results: The breakpoint at which a sharp increase in PTH was observed in response to decreasing 25(OH)D concentrations occurred at 15.76 ng/mL (95%CI: 12.3–19.2; p < 0.001). Using this diagnostic threshold, 66.1% of pregnant women were VDD compared to 82.0% when using the present cut-off. Statistically significant associations between VDD and parity (p = 0.011), season (winter: p = 0.001; post-monsoon: p < 0.001), anemia status (p = 0.044), and physical activity (p = 0.045) were also found. Conclusions: Our diagnostic cut-off for VDD, derived from PTH regulation in early pregnancy, is lower than the currently recommended threshold. Although assessing vitamin D status may be challenging due to the influence of modifiable and non-modifiable factors such as parity, anemia, season, and physical activity. These findings underscore the need to re-evaluate existing cut-offs through well-designed longitudinal studies to prove causality between this threshold and adverse pregnancy outcomes. Full article

Background: Pulmonary benign metastasizing leiomyoma (PBML) is a rare condition characterized by histologically benign smooth muscle tumors occurring at extrauterine sites, often in women with a history of uterine leiomyoma. While PBML generally exhibits indolent behavior, its pathogenesis, management, and malignant potential remain unclear. Methods: This study retrospectively analyzes the clinical characteristics, imaging features, diagnostic approaches, pathological findings, treatment strategies, and outcomes of seven patients with PBML treated at our institution between January 2016 and May 2025. Results: Seven patients were included, with a mean age at diagnosis of 48.9 ± 5.6 years. Two patients presented with respiratory symptoms. Imaging revealed multiple bilateral pulmonary nodules in four patients and solitary nodules in three. Six patients were diagnosed via video-assisted thoracoscopic surgery, and one through computed tomography-guided percutaneous biopsy. Immunohistochemistry revealed positivity for SMA and Desmin in all cases, ER in six, and PR in five, with the Ki-67 labeling index ≤3% in six patients. One patient had a coexisting in situ mucinous adenocarcinoma within the PBML lesion. All had a history of uterine leiomyoma. After diagnosis, one patient received hormonal therapy, and another underwent right adnexectomy. The remaining patients were managed with surveillance without additional treatment. During follow-up, one patient developed distant organ metastasis. Conclusions: PBML is a rare, typically indolent condition with potential for metastasis. Accurate diagnosis relies on imaging, histopathology, and immunohistochemistry. This study reports a unique case of PBML coexisting with intratumoral in situ mucinous adenocarcinoma, a previously unreported finding that may broaden the known histopathological spectrum. Full article

Soy has a long history of consumption in Asia and was traditionally prepared by rinsing, cooking, and simmering, methods which remove estrogenic isoflavones (Isofls). Population studies have indicated that soy and/or Isofls may be associated with a decreased risk of breast cancer (BC), while in vitro and experimental data indicate dose-related proliferative effects of Isofls on breast cells. This review attempts to decipher the role of soy and Isofls in the risk of BC in women, since previous studies have suggested a lack of association with BC. Several dozen population studies conducted in Asian and Western countries were analyzed, as were data collected during in vitro animal and clinical trials of relevant doses of soy and Isofls. Although soy intake has been estimated well in Asian countries and could be related to preventive effects on BC risk, this has not been the case in the West, where the consumption of hidden soy is often omitted. However, in both cultures, the Isofl intake is misestimated, and the groups are misclassified. Indeed, in Asia, the origin of soy foods, i.e., homemade or industrial, has never been reported, and in the West, the amount of Isofls consumed in hidden soy has not been determined. Moreover, in most cohort studies, only a few subjects were exposed to active doses of Isofls on breast cells. Similarly, clinical interventions showed estrogenic effects of Isofls at relevant doses. Finally, population studies have not shown any convincing link between soy or Isofl intake and BC risk, likely because they have opposite effects on this pathology. Thus, based on in vitro, experimental, and clinical data, a deleterious effect of Isofls cannot be excluded when active doses are ingested, even if the soy food matrix can be protective. Full article

This study aimed to analyze the perception of women who were victims of rape about the care provided at a teaching hospital located in the northeast of Brazil. A qualitative study was conducted with seven women. The interviews took place in a trustworthy and confidential environment in the presence of a psychologist. The data were analyzed through content analysis, evidencing the women’s perceptions. The sample was achieved by convenience sampling and was homogeneous, with a profile of women who were young, white/black, and single, with low education and a history of sexual violence. Positive views about the care provided at the hospital included its status as a reference center, motivating women to seek health services. The legitimization of women’s rights, effective care, and the possibility of having a legal abortion were also mentioned. The challenges reported included the need for a prepared health team and more humanized and multidisciplinary care. Women who had suffered rape sought medical assistance for support, guidance, and a humane approach to understanding their rights, often finding a compassionate response from the teaching hospital staff. Despite advances in care, challenges remain, such as perceived judgment regarding legal abortion, highlighting the need for policies that better meet the needs of victims. Full article

Background/Objectives: Preeclampsia (PE) is a major cause of maternal and perinatal morbidity and mortality, particularly in low- and middle-income countries. Early-onset PE (EOP) and late-onset PE (LOP) are distinct clinical entities with differing pathophysiological mechanisms and prognoses. However, few studies have explored differential risk factors for EOP and LOP in Latin American populations. This study aimed to identify and assess clinical risk factors for predicting EOP and LOP in a cohort of pregnant women from Bogotá, Colombia, using traditional statistics and machine learning (ML). Methods: A cross-sectional observational study was conducted on 190 pregnant women diagnosed with PE (EOP = 80, LOP = 110) at a tertiary hospital in Bogotá between 2017 and 2018. Risk factors and perinatal outcomes were collected via structured interviews and clinical records. Traditional statistical analyses were performed to compare the study groups and identify associations between risk factors and outcomes. Eleven ML techniques were used to train and externally validate predictive models for PE subtype and secondary outcomes, incorporating permutation-based feature importance to enhance interpretability. Results: EOP was significantly associated with higher maternal education and history of hypertension, while LOP was linked to a higher prevalence of allergic history. The best-performing ML model for predicting PE subtype was linear discriminant analysis (recall = 0.71), with top predictors including education level, family history of perinatal death, number of sexual partners, primipaternity, and family history of hypertension. Conclusions: EOP and LOP exhibit distinct clinical profiles in this cohort. The combination of traditional statistics with ML may improve early risk stratification and support context-specific prenatal care strategies in similar settings. Full article

Background/Objectives: Chronic kidney disease (CKD) and osteoporosis are critical public health concerns, particularly among older adults, due to their prevalence and associated complications. While CKD-related disruptions in bone mineral metabolism are believed to increase osteoporosis risk, this relationship remains unclear in diverse populations such as Korea. Methods: This longitudinal cohort study utilized data from the Korean National Health Insurance Service Health Screening Cohort (2002–2019), including 13,622 patients with newly diagnosed CKD and 54,488 matched controls. CKD was defined as having at least two outpatient or inpatient records with ICD-10 codes N18 or N19 and/or evidence of dialysis treatment claims, following a 1-year washout period to exclude prevalent cases. Individuals with a prior history of osteoporosis or incomplete baseline data were excluded. Propensity score overlap weighting was applied, and adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using Cox proportional hazards models, with subgroup analyses based on demographic and clinical factors. Results: CKD was not associated with an increased risk of osteoporosis. On the contrary, CKD patients exhibited an 18% lower risk of developing osteoporosis compared to controls (HR = 0.82, 95% CI: 0.77–0.87, p < 0.001). This inverse association was more pronounced among women, non-smokers, individuals with low alcohol consumption, and those with a higher comorbidity burden. Conclusions: These findings suggest that certain subgroups of CKD patients may have a reduced risk of osteoporosis, highlighting the importance of individualized risk assessment and tailored preventive strategies. Full article

The etiology of women with gestational diabetes mellitus (GDM) and a greater risk of developing type 2 diabetes (T2D) after delivery remains unknown. This study aimed to investigate the global gene expression in four postpartum women with previous GDM (pGDM), three with T2D, and three with a history of normoglycemic pregnancy (controls). Total RNA was extracted from whole blood between March and May 2020. Global mRNA expression was determined using an Affymetrix Human Gene 2.0 ST Array. The expression of the selected focused genes was validated by RT-PCR. The microarray revealed 140 transcripts (p < 0.05, fold change cut-off ≥ 2) in patients with pGDM compared to controls. We identified 583 gene-altered transcripts between patients with T2D and controls. Interestingly, 60 transcripts had genes shared by pGDM or T2D versus the controls. The selected upregulated genes involved in inflammatory response, glycosylation, and death-like domains, according to the functional network analysis of pGDM (TNFAIP6, PDK3) and T2D (MMP9 and CARD6), showed similar trends to those obtained via microarray. Thus, these differentially expressed genes and their corresponding network and pathway analyses in women with pGDM and T2D offer valuable insights into the possible biological mechanisms of the progression of GDM to T2D. Full article