Search Results (2,090)

Background: Type 2 inflammatory diseases are among the most common chronic inflammatory conditions in childhood and represent a growing global health burden. Increasing evidence suggests that early-life nutritional exposures may influence immune programming and allergic disease development. This Position Paper aims to summarize the current evidence regarding the immunomodulatory role of polyunsaturated fatty acids (PUFAs), particularly omega-3 long-chain fatty acids, in the prevention of allergic diseases during early life. Methods: A scoping literature review and consensus process were conducted to map biological mechanisms and clinical evidence linking omega-3 PUFAs with allergic disease prevention. This document analyzed experimental, observational, and randomized controlled studies evaluating maternal prenatal/lactational omega-3 exposure. The clinical evidence was qualitatively appraised using study-design-specific Joanna Briggs Institute (JBI) Critical Appraisal Tools. Particular attention was given to immune modulation, inflammatory pathways, epithelial barrier function, gut microbiota interactions, and the ferroptosis–immune–metabolic axis. Results: Omega-3 PUFAs, including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), exert immunomodulatory and anti-inflammatory effects through multiple mechanisms, including specialized pro-resolving mediator production, regulation of T-helper cell responses, cytokine modulation, maintenance of epithelial barrier integrity, and microbiota interaction. Emerging evidence also supports their involvement in oxidative stress and ferroptosis regulation. Current clinical evidence, particularly from higher-quality prenatal randomized trials and evidence syntheses, suggests that adequate maternal omega-3 intake during pregnancy and lactation may reduce the risk of respiratory allergic outcomes, especially wheezing and asthma, in selected offspring. Conclusions: Adequate omega-3 PUFA intake, such as 2 g/die, during critical windows of immune maturation may represent a valuable strategy for the primary prevention of allergic diseases. Current evidence most strongly supports supplementation during pregnancy and lactation, particularly in populations with low dietary omega-3 intake or increased allergic risk. Omega-3 supplementation should be considered within a broader multifactorial preventive approach aimed at promoting immune tolerance and reducing the future burden of allergic diseases. Full article

Oocyte formation occurs successfully within a meticulously controlled follicular environment characterized by well-documented endocrine, metabolic, and paracrine signals. Yet, the immunological landscape of the follicle and its role in influencing oocyte competency has received less attention in research. Growing research indicates that the ovarian follicle functions as an immunological-active niche necessitating a precise equilibrium between controlled inflammation and targeted immune tolerance. The programmed cell death-1 (PD-1) receptor and its ligand PD-L1 constitute a crucial immune checkpoint pathway, essential for sustaining peripheral immunological tolerance and averting excessive immune activation. Despite their comprehensive research in cancer biology and maternal–fetal interactions, their possible function in the follicular microenvironment remains mostly unexamined. We propose that PD-1/PD-L1 signaling may facilitate the formation of a localized immune-tolerant milieu inside the follicle to safeguard the developing oocyte from inflammatory injury and immune-mediated stress. The disturbance of this suggested equilibrium may lead to a pro-inflammatory follicular environment, compromised granulosa cell function, and modified oocyte maturation, hence affecting fertilization and embryonic developmental potential. In clinical contexts with immunological dysregulation, such as endometriosis, polycystic ovarian syndrome, and unexplained IVF failure, such processes may be especially significant. The purpose of this narrative review is to assimilate the current comprehension of immune regulation in the follicle with the established biology of PD-1/PD-L1 and to investigate a potential correlation between immune checkpoint signaling, oocyte competence, and assisted reproductive outcomes. Considering the follicle as an immune-regulated microenvironment offers a new paradigm for comprehending infertility and identifying novel indicators or therapeutic targets. Full article

Background: Measles remains a significant public health challenge in Ethiopia, and the country has not achieved measles elimination despite the commitments outlined in the Immunization Agenda 2030. This study assessed inequalities in MCV2 vaccination among children aged 24–35 months in Ethiopia. Methods: This study used nationally representative data from the 2022/23 National Health Equity Survey, which employed a two-stage stratified cluster sampling design across all regions and city administrations. A total of 1987 mothers/caregivers of eligible children were interviewed. Descriptive statistics, bivariable analyses, and multivariable logistic regression were conducted using Stata 17 software, and determinants of MCV2 uptake were identified. Wealth-related inequality was assessed using concentration index analysis. Statistical significance was set at p < 0.05. Results: Overall MCV2 coverage was 60.4%. The multivariable analysis identified a significant inequality in second-dose measles vaccination (MCV2) in Ethiopia. Children born in health facilities had higher odds of vaccination (AOR = 1.88; 95% CI: 1.49–2.38), and maternal age of 25–34 years was associated with increased uptake compared to younger mothers (AOR = 2.03; 95% CI: 1.18–3.48). Postnatal care utilization and vitamin A supplementation strongly improved vaccination coverage, with children receiving vitamin A showing markedly higher odds of MCV2 uptake (AOR = 16.74; 95% CI: 9.61–29.14). Female children were more likely to be vaccinated than males (AOR = 1.50; 95% CI: 1.01–2.24), and higher maternal education (college or above) significantly increased uptake (AOR = 2.78; 95% CI: 1.02–7.73). Wealth status also influenced coverage. Conclusion: Improving MCV2 coverage in Ethiopia requires strengthening of maternal and child health services and promotion of integrated care, including PNC, vitamin A supplementation, and routine immunization. Early and consistent contact with the health system, along with addressing gaps in health education and supporting younger mothers, is essential. Persistent inequalities by place of birth, household wealth, and region highlight the need for targeted interventions. Strengthening equitable immunization services remains critical to achieving national and global measles elimination goals. Full article

Background/Objectives: Given the growing need for prenatal care, Nordic Walking (NW) is a promising intervention for maintaining maternal physical activity and quality of life (QoL). We aimed to investigate the influence of NW on gait kinematics, pelvic girdle pain, low back pain (LBP), and QoL during pregnancy. Methods: This is a single-blind randomized controlled trial. A total of 44 pregnant women aged 20 to 40 years with 13–28 weeks of gestation and mild to moderate musculoskeletal pain were included. Participants were randomly assigned to either the study (NW) group or the control group. The study group received the NW program for 12 weeks, three sessions per week, each lasting 45 min. The control group received standard prenatal care plus 30 min of moderate walking three days a week. The GAITRite system was used to measure gait kinematics, and the Visual Analog Scale (VAS) for pain and the SF-36 for QoL were administered at baseline, the fourth week, and the twelfth week. Results: NW significantly improved gait kinematics and reduced musculoskeletal pain (p < 0.001) with improvements in pain and gait speed exceeding the previous reported MCID thresholds. QoL improved across all SF-36 domains in the NW group (p < 0.001) compared with the control group, with large effect sizes observed for the primary outcomes. Conversely, the control group experienced declines in several QoL domains, including energy/fatigue and emotional well-being, despite moderate walking exercise and standard prenatal care over 12 weeks. Conclusions: NW may represent an effective prenatal exercise regimen associated with improved gait, reduced pain, and better overall QoL compared with moderate exercise, consistent with standard prenatal care. Full article

During pregnancy, hormonal, metabolic, and immunological changes influence the composition and function of maternal microbial communities. Increasing evidence suggests that the maternal microbiota—particularly in the vaginal, gut, and oral environments—plays a significant role in maintaining pregnancy homeostasis and supporting fetal development. In healthy pregnancies, the vaginal microbiota is typically dominated by Lactobacillus species, which help maintain a low vaginal pH and protect against ascending infections. However, disruption of this balance (vaginal dysbiosis) has been associated with obstetrical complications such as intrauterine infection and preterm birth. Similarly, the maternal gut microbiota undergoes trimester-specific changes that contribute to metabolic adaptations required for fetal growth, while alterations in microbial composition have been linked to metabolic disorders including gestational diabetes mellitus and preeclampsia. Changes in oral microbiota and periodontal disease have also been associated with adverse pregnancy outcomes through systemic inflammatory pathways and potential microbial translocation to the placenta. Recent advances in sequencing technologies have improved the understanding of host–microbiome interactions in pregnancy, although the existence of a placental microbiome remains controversial. Overall, maternal microbiota plays an important role in pregnancy physiology, and its dysregulation may contribute to obstetrical complications. Understanding these mechanisms may facilitate the development of microbiome-based diagnostic and therapeutic strategies in maternal–fetal medicine. Full article

The global obesity epidemic is expanding at an alarming rate, posing significant health risks for women of reproductive age due to immediate pregnancy complications and adverse long-term effects on offspring. Consequently, several non-pharmacological strategies have been proposed to mitigate these impacts. Therefore, we hypothesized that the combined application of the probiotic Lacticaseibacillus rhamnosus GG (LGG) and enriched environment (EE) will result in improved metabolic and histopathologic findings within a model of maternal obesity, surpassing the efficacy of individual therapeutic strategies. Using nulliparous Wistar rats, LGG was administered before, during, and after gestation, while EE was implemented during pregnancy and lactation. LGG supplementation and an enriched environment separately improved blood triacylglycerols. The enriched environment was more effective in reducing the effects of maternal obesity, even lessening liver damage observed in obese subjects in the form of vacuolar infiltrates. The results obtained suggest a potential functional interaction in this combined model, and the findings indicate that LGG may have influenced the modulation of enriched environment effects on metabolic parameters. Diet, probiotic supplementation, and environmental setting during the perinatal period have specific effects on biochemical and tissular parameters, establishing their descriptive role as non-pharmacological intervention strategies and underscoring the need for mechanistic studies to elucidate the biological pathways underlying these effects. Full article

Background: Pregnancy is a vital period during which maternal nutrition profoundly influences both maternal health and fetal development. Carotenoids, predominantly found in fruits and vegetables, are bioactive compounds that enhance antioxidant defenses and facilitate vitamin A metabolism throughout pregnancy. However, assessing carotenoids intake presents challenges due to the lack of dietary assessment tools capable of quantifying individual carotenoids, coupled with limited data from populations in Eastern Europe. Methods: A cross-sectional study involving 621 pregnant women in Romania was conducted to estimate dietary carotenoids intake and investigate associations with dietary patterns and overall diet quality. Dietary data were obtained using the EPIC Food Frequency Questionnaire (EPIC-FFQ), adapted for Romanian populations. A dedicated carotenoid estimation model was developed utilizing the USDA Carotenoid Database. Principal component analysis (PCA) was employed to identify dietary patterns, and diet quality was evaluated using the Diet Quality Index during Pregnancy (DQI-P). Results: The findings revealed significant individual variability. The median intake was highest for β-carotene (2464 μg), and lycopene (1664 μg), followed by lutein and zeaxanthin (908 μg), α-carotene (615 μg), and β-cryptoxanthin (121 μg). The Vegetable-meal pattern exhibited the strongest positive correlation with carotenoids intake, whereas the Energy-dense pattern was primarily associated with vitamin E and tocopherols/tocotrienols, and the Mixed pattern with vitamins A and D. Higher DQI-P scores were consistently correlated with increased carotenoids consumption. Conclusions: Overall, maternal carotenoids intake during pregnancy was frequently insufficient and showed considerable variation among women. A diet rich in vegetables and higher overall diet quality were associated with elevated carotenoids intake levels. These findings enhance the understanding of dietary carotenoids intake among pregnant women in Eastern Europe. Full article

Background: Despite being considered a country with a larger health workforce in Africa, the South African health workforce continues to experience shortages and a maldistribution of health workers across regions and sectors. Current projections suggest that the workforce is expected to decline further, especially among doctors, nurses and midwives, in large part, due to attrition—which could compromise the delivery of primary health and maternity services. These health workforce shortages and uneven distribution threaten the sustainability and effectiveness of health services in South Africa and drives the need to investigate the factors that may be influencing career choice and change decisions among health professionals in South Africa. Methods: A qualitative exploratory study, making use of purposive sampling and semi-structured interviews, was conducted to investigate the factors influencing career choice and change decisions among health professionals in South Africa. The participants were qualified health professionals in the fields of medicine, nutrition, pharmacy, nursing, and psychology working in the private, public, and academic sectors. Data was collected until saturation was achieved and then thematically analyzed using MAXQDA 24. Results: A total of 10 participants made up of three males and seven females were interviewed. These participants worked in different employment sectors with some having dual roles in private practice, public sector, and academia. The analysis revealed three major themes that capture the nature of and factors influencing career choice and career changes occurring in South Africa. The first theme related to factors influencing career choice (including altruism, family influence, personal experiences, financial/job security, academic achievement, career guidance, and opportunity for change). The second theme focused on career change dynamics (nature of career changes and career transitions occurring in the form of specialization, switching health professions, exiting health professions, adding non-health interests, and shifting focus areas). The third theme revealed factors influencing career change. These were categorized into personal and individual factors, workplace or job-specific factors, and administrative factors. This study has contributed to understanding the career choices and career changes taking place within the health professions in South Africa. It has also revealed a need for reforms in policy and practice for the current health professionals who have no intention of changing their careers while highlighting implications for future training of health professionals. Also, addressing the challenges of poor working conditions, lack of support, unemployment and placement delays, and other administrative barriers will help mitigate some of the issues leading to health workforce shortages and inequities in the South African context. Conclusions: The strongest motivator for choosing a career in health professions is the desire to care for others, while retention of the health workforce is challenged by personal, workplace, and administrative factors. Enhancing workplace conditions and support systems, implementing policy reforms, and minimizing administrative barriers is essential for achieving universal health coverage and sustaining a resilient health workforce in South Africa. Full article

This study evaluated the effects of maternal overfeeding during mid-to-late gestation on maternal productivity, metabolic status, reproductive recovery, and calf performance in Hanwoo cattle using conventional statistics and machine learning (ML) approaches. A total of 243 pregnant cows were assigned to either a control group or an overfeeding group from gestation day 90 to parturition. The overfeeding treatment increased nutrient supply to approximately 140–145% of the control level. Maternal body weight (BW), body condition score (BCS), serum metabolites, and reproductive traits were evaluated throughout gestation and postpartum, while calf growth, morphometrics, and metabolic traits were assessed at birth and weaning. Calves were further classified into growth- or meat-quality-oriented genotypes using SNP-based profiling. Overfeeding increased maternal BW gain and BCS during gestation and reduced circulating non-esterified fatty acid concentrations, indicating improved maternal energy status. However, overfed cows showed a longer interval to postpartum estrus return. Calf birth weight was not significantly affected by maternal overfeeding, whereas calf growth and morphometric traits at weaning were more strongly influenced by parity, sex, and genotype. Machine learning models identified gestational BW, metabolic indicators, calf feed intake, and genotype as major predictors of maternal and calf outcomes, with random forest and XGBoost showing superior predictive performance compared with linear models. These findings suggest that parity- and genotype-informed nutritional management combined with ML-based prediction may support precision feeding strategies in beef cattle production systems. Full article

Background: Assisted reproductive technology (ART) is increasingly utilized worldwide, and approximately 30% of ART pregnancies result in twin gestations. Chorionicity strongly influences perinatal risk, yet its specific impact on ART-conceived twins has not been systematically clarified. Objective: To compare obstetrical and neonatal outcomes in assisted ART-conceived monochorionic (MC) versus dichorionic (DC) twin pregnancies and evaluate the impact of chorionicity on maternal and perinatal outcomes. Methods: This systematic review was conducted according to PRISMA guidelines and registered in PROSPERO (CRD42024600292). PubMed, Scopus, and Web of Science were searched through October 2024 for studies comparing obstetrical and neonatal outcomes in ART-conceived monochorionic and dichorionic twin pregnancies. Eligible studies were qualitatively synthesized. Results: Thirty-five studies comprising 15,648 ART-conceived twin pregnancies were included, including 371 monochorionic and 15,277 dichorionic pregnancies. MC pregnancies consistently demonstrated less favorable perinatal outcomes compared with DC pregnancies, including an earlier gestational age at delivery, increased prematurity, lower birth weight, and higher rates of perinatal mortality. By contrast, maternal complications, such as hypertensive disorders, gestational diabetes mellitus, PROM, and cesarean delivery, varied considerably across the studies without a consistent association with chorionicity. The baseline maternal characteristics were generally comparable between the groups. Conclusions: Monochorionicity in ART-conceived twin pregnancies is associated with increased adverse neonatal and perinatal outcomes, particularly prematurity and perinatal mortality, while maternal outcomes appear less clearly influenced by chorionicity. Standardized prospective studies are needed to further clarify the chorionicity-specific risks in ART twin pregnancies. Full article

Background/Objectives: Embryo implantation is a highly regulated, multistep process requiring precise synchronization between a developmentally competent blastocyst and a receptive endometrium. Despite advances in reproductive medicine, implantation failure remains a major limiting factor in assisted reproductive technology (ART), particularly in cases of recurrent implantation failure (RIF). This review aims to summarize current knowledge on the molecular, cellular, and immunological mechanisms governing embryo–endometrial interaction and to evaluate contemporary strategies for optimizing implantation outcomes. Methods: This narrative review synthesizes the current literature on embryo implantation, including studies addressing uterine receptivity, etiological factors contributing to implantation failure, and emerging diagnostic and therapeutic approaches. The review integrates findings from molecular biology, clinical ART practices, and bioengineering-based models. Key areas include transcriptomic tools such as endometrial receptivity analysis, time-lapse imaging, artificial-intelligence-based embryo selection, and advanced in vitro models (e.g., microfluidic “womb-on-a-chip” systems and three-dimensional embryo–endometrial platforms). The literature was identified through major biomedical databases, following a structured but non-systematic approach. Results: Implantation success is dependent on a complex interplay of hormonal regulation, gene expression, immune modulation, and embryo quality. Disruption of uterine receptivity during the window of implantation is a critical contributor to infertility and RIF. Multiple factors—including genetic abnormalities, maternal age, lifestyle influences, immunological imbalance, uterine pathology, and chronic endometrial conditions—are implicated in implantation failure. Emerging technologies, such as AI-assisted embryo selection, transcriptomic profiling, and advanced in vitro implantation models, provide enhanced insight into implantation dynamics and offer potential for improved clinical outcomes. Conclusions: Advances in understanding embryo implantation and the development of innovative diagnostic and therapeutic technologies hold significant promise for improving reproductive success. However, further research, validation, and standardization are required before these approaches can be fully integrated into routine clinical practice. A more personalized and mechanism-based approach to implantation may ultimately enhance ART outcomes and reduce the burden of infertility. Full article

Background: Frozen embryo transfer (FET) use in assisted reproductive technology (ART) has increased globally, with multiple reviews linking FET—particularly medicated cycles—to higher risks of obstetric complications including hypertensive disorders of pregnancy (HDP). Given that HDP is a sex-specific risk factor for future cardiovascular disease (CVD), this study aimed to assess acute cardiovascular changes in medicated versus natural modified FET cycles. Methods: This was a prospective observational cohort study at a fertility centre in London. Patients were recruited from May 2021 to March 2022. Maternal demographics including age, body mass index, smoking status, ethnicity and parity were recorded. Cardiovascular parameters including blood pressure along with measures of left ventricular systolic and diastolic function, assessed by transthoracic echo, were analysed at baseline in the luteal phase of the preceding cycle and on the day of embryo transfer, in medicated and natural modified FET cycles. Repeat measures analysis of the cardiac variables for the two time points, comparing the two protocols after controlling for maternal demographics, was performed by linear mixed models. Results: Seventy-two healthy patients were included in the analysis; of those, 59 (82%) underwent the medicated protocol. For both protocols, after controlling for maternal demographic characteristics, the left atrial area significantly increased (p = 0.004) from baseline to embryo transfer with a mean difference of 0.98 (95% CI [0.33, 1.63]). When comparing the interaction between the protocols between the two time points, whilst no effect could be seen on haemodynamic variables or left ventricular diastolic/systolic function, medicated FET cycles were associated with a statistically significant improvement in mean average global longitudinal strain (GLS) (p = 0.024) with a mean difference of −2.24 (95% CI [−4.17, −0.31]), whereas natural modified cycles demonstrated a slight shift toward more positive strain values. Conclusions: In this cohort of healthy patients undergoing FET, both protocols were associated with a significant increase in left atrial area from baseline to embryo transfer possibly resulting from an increased preload due to progesterone administration. The improvement in left ventricular average GLS seen in medicated FET cycles may reflect protocol-related physiological effects, potentially mediated by sustained exogenous oestrogen exposure and its influence on vascular loading conditions and myocardial relaxation. Full article

Objectives: This study aims to assess the acceptance of vaccinations among pregnant women, particularly against influenza, pertussis, COVID-19, and RSV, and to identify factors influencing their willingness to get vaccinated. It also seeks to evaluate the impact of the COVID-19 pandemic on maternal attitudes and behaviors regarding vaccination. Methods: The analysis involved a review of existing literature and studies to evaluate the level of vaccine acceptance among pregnant women before and after the COVID-19 pandemic. Factors contributing to vaccine hesitancy, including misinformation, lack of knowledge, and the influence of healthcare professionals, were examined. Results: The findings indicated that, despite scientific evidence supporting the safety and efficacy of vaccines during pregnancy, public concerns remain about their impact on the developing fetus. The outbreak of the COVID-19 pandemic has increased awareness of the risk of infectious diseases, but at the same time, its impact on vaccination rates among pregnant women is ambiguous and geographically diverse. Misinformation and decreased access to healthcare during the pandemic negatively affected vaccine uptake. Trustworthy information provided by healthcare professionals emerged as a key factor in promoting vaccine acceptance. Conclusions: To improve vaccination rates among pregnant women, it is essential to provide clear, evidence-based information through healthcare professionals, particularly those directly caring for pregnant women. Educational campaigns should address concerns calmly and without judgment, emphasizing the safety and benefits of vaccinations. Enhanced access to healthcare and vaccinations, along with strategic information dissemination, can significantly improve vaccine acceptance during pregnancy. Lessons learned from past pandemics should be incorporated into the development of healthcare strategies aimed at implementing recommended vaccinations for pregnant women in the future. Full article

Background/Objectives: Maternal mortality remains disproportionately high in low- and middle-income countries, where ineffective referral systems and a lack of infrastructure contribute to delays in emergency obstetric care. In sub-Saharan Africa, referrals are largely conducted via paper, often resulting in lost documents and limited follow-up. Mobile health (mHealth) offers a promising solution by enabling real-time, bidirectional communication. This study aimed to examine how the Mobile Obstetric Referral Emergency System (MORES), a WhatsApp-based referral platform piloted in 20 rural health facilities and two district hospitals in Bong County, Libera, influences healthcare providers’ communication, collaboration, and relationships. Methods: A mixed-methods design was used. Ninety one (N = 91) providers completed demographic and Trust and Teamwork surveys. Of the 91 providers, 35 providers from rural health facilities and 56 providers from district hospitals participated in a 10-question survey and individual interviews. Results: Survey results indicated high levels of mutual respect, confidence, and teamwork perceived by both the rural health facility and district hospital providers. Qualitative data further expanded on the quantitative results showing the MORES intervention enhanced the timeliness and accuracy of referrals, supported problem-solving between facilities, and fostered shared goals, mutual respect, and knowledge exchange. Conclusions: Providers perceived the MORES to be associated with increased collaboration and continuity of care, as well as a feasible, low-cost, and sustainable intervention to improve obstetric referral systems in low-resource settings. Full article