Search Results (667)

Obesity in women of reproductive age is a major issue. It is associated with reduced fertility and an increased risk of obstetric and perinatal complications. Bariatric surgery is the most effective treatment for severe obesity, leading to substantial weight reduction, improvement of metabolic disorders, and enhanced fertility. Consequently, an increasing number of women are becoming pregnant after undergoing bariatric surgery. The aim of this paper is to review current recommendations and research data regarding the care of women after bariatric surgery in the periconceptional and perinatal periods, as well as throughout pregnancy, delivery, and the postpartum period. Research suggests that pregnancy after bariatric surgery is associated with a lower risk of gestational diabetes, hypertension, preeclampsia, and fetal macrosomia compared with pregnancies in women with similar baseline BMI (body mass index) who have not undergone surgical treatment. At the same time, an increased risk is observed for low birth weight, maternal micro- and macronutrient deficiencies, and complications characteristic of bariatric procedures, such as dumping syndrome or intra-abdominal hernias. Most scientific societies recommend postponing pregnancy planning for 12–18 months after surgery and using effective contraception, preferably methods that do not require gastrointestinal absorption. Regular monitoring of laboratory parameters, individually tailored supplementation, and interdisciplinary care are essential for the safe management of pregnancy after bariatric surgery. In particular, care should include achieving a stable body weight before conception, monitoring of nutritional status, verifying proper weight gain during pregnancy, and considering alternative methods for gestational diabetes screening (e.g., glycaemic monitoring instead of oral glucose tolerance testing) due to the risk of dumping syndrome. Appropriate preparation for pregnancy and proper management throughout its course allow for reducing the risk of perinatal complications. Bariatric surgery itself is not a contraindication to vaginal delivery. Full article

Background/Objectives: Inguinal hernia and hydrocele are common pediatric surgical conditions resulting from failed obliteration of the processus vaginalis during fetal development. Although prenatal exposure to fine particulate matter (PM2.5) has been linked to adverse perinatal outcomes and congenital anomalies, its role in structurally defined pediatric surgical diseases remains unclear. We examined the association between maternal PM2.5 exposure during pregnancy and the risk of inguinal hernia or hydrocele in offspring. Methods: We performed a retrospective cohort study of 1093 mother–offspring pairs delivering at a tertiary referral center (July 2016–June 2019). Monthly residential PM2.5 levels were estimated at geocoded maternal addresses using kriging interpolation from fixed-site monitoring stations. Offspring diagnosed with inguinal hernia or hydrocele through March 2024 were identified using ICD-10 codes. Perinatal characteristics were compared using t-tests and chi-square tests, and multivariable logistic regression assessed trimester-specific PM2.5 exposure and risk. Results: During follow-up, 53 offspring (4.85%) developed inguinal hernia or hydrocele. Male sex (odds ratio [OR], 24.71; 95% CI, 5.95–102.54; p < 0.001) and second-trimester PM2.5 exposure (OR, 1.07 per µg/m³; 95% CI, 1.01–1.14; p = 0.028) were independent risk factors. A dose–response pattern was observed across quartiles of second-trimester exposure; an interquartile range increase was associated with a 64% higher risk (OR, 1.64). The model showed good discrimination (AUC, 0.804). Conclusions: Elevated maternal PM2.5 exposure during the second trimester was independently associated with increased risk of inguinal hernia or hydrocele in offspring. Prenatal air pollution may contribute to persistence of the processus vaginalis and represents a potentially modifiable environmental risk factor. Full article

Reliable, explainable prediction of the maternal mortality ratio (MMR) is challenging in global health because country-level indicators are heterogeneous and missingness is often informative rather than random. This study aims to develop and validate a missingness-aware TabNet (MA-TabNet), an attention-based framework that treats absence patterns as learnable signals while maintaining a stable feature space for country-level MMR forecasting and interpretation. We build a country–year panel from a publicly available global nutrition and health dataset and predict MMR using socioeconomic and health indicators to test whether missingness patterns add predictive signal beyond observed covariates. The model applies a distribution-aware selective masking strategy, adding missingness indicators only for variables with high missing rates; remaining gaps are handled by median imputation, with indicators retained to explicitly encode reporting uncertainty. Country codes and regional groupings are encoded as learnable embeddings, and entmax-based sequential attention is used to improve feature selection via sparse, competition-style masks under correlated determinants. Hyperparameters are tuned using Bayesian optimization, and evaluation follows a temporally realistic protocol (train on earlier years; test on a future held-out year). MA-TabNet achieves a mean absolute error (MAE) of 21.05, root mean squared error (RMSE) of 36.24, and R² of 0.9739, outperforming strong tree-based baselines and improving on the original TabNet while avoiding the training instability observed in some transformer-style tabular models. For transparency, we report attention-derived global and local importance, compare original versus missing-mask features in model importances, and complement these with permutation-based Shapley additive explanation summaries, permutation importance (MAE drop), partial dependence plots for top drivers, and continent-stratified residual analyses to clarify how structural reporting gaps shape predictions and to support trustworthy maternal health monitoring. Overall, these findings suggest that modeling missingness as a measurable reporting signal can yield accurate, auditable forecasts that are better aligned with temporally realistic SDG 3.1 monitoring than “fill-and-forget” preprocessing. Full article

Background: Maternal vitamin D deficiency (VDD) compromises fetal skeletal development. The impact of postnatal vitamin D supplementation on osteocalcin (OC) carboxylation, converting undercarboxylated (ucOC) to carboxylated osteocalcin (cOC), in offspring remains unclear, given conflicting reports on the correlation between serum 25-hydroxyvitamin D (25(OH)D) and specific OC forms. This study investigated OC profile recovery in a mouse model of maternal VDD. Methods: Female C57BL/6J mice were fed a VDD diet from four weeks pre-conception through lactation. Weaned offspring were maintained on the VDD diet and randomized to three groups: control (saline), standard-dose (1500 IU/kg), or high-dose (4500 IU/kg) vitamin D supplementation. Serum 25(OH)D, cOC, and ucOC were quantified via ELISA at 1, 2, and 4 weeks post-intervention. Results: Controls remained vitamin D-deficient (<13 ng/mL). Supplementation dose-dependently increased serum 25(OH)D (p < 0.05). Crucially, while absolute ucOC levels remained stable across all groups, supplementation significantly upregulated cOC and total osteocalcin at all time points (p < 0.05). Consequently, the ucOC/cOC ratio significantly decreased in supplemented groups. Partial correlation analysis revealed a strong positive correlation between 25(OH)D and cOC (r_partial = 0.718) and a negative correlation with the ucOC/cOC ratio (r_partial = −0.433), but no correlation with ucOC (r_partial = −0.102). Conclusions: In offspring affected by maternal VDD, vitamin D supplementation improves the osteocalcin carboxylation profile primarily by driving carboxylated osteocalcin synthesis rather than reducing the undercarboxylated pool. Serum cOC and the ucOC/cOC ratio serve as superior functional biomarkers to ucOC for monitoring therapeutic efficacy in this early-life developmental model. Full article

Background: Pregnancy in women with liver cirrhosis is considered a rare clinical condition due to the decreased fertility commonly associated with chronic liver disease. Hormonal disturbances, anovulation and impaired hepatic function contribute to the lower conception rates observed in this population. However, when pregnancy occurs, it is associated with a significantly increased risk of maternal and fetal complications. Maternal risks include hepatic decompensation, variceal bleeding, ascites, coagulopathy and a higher rate of hypertensive disorders during pregnancy and related complications. Fetal complications involve prematurity, intrauterine growth restriction, and increased perinatal mortality. Methods: We present the clinical case of a woman with idiopathic liver cirrhosis who experienced four consecutive pregnancies with different clinical courses and outcomes. Results: The case highlights the complexity of managing pregnancy in patients with chronic liver disease and underscores the importance of individualized clinical assessment and multidisciplinary management. This report also reviews current management strategies and discusses key considerations for optimizing care in pregnant women with liver cirrhosis. Conclusions: Advances in multidisciplinary care and improved management strategies have contributed to better pregnancy outcomes in recent years. Careful monitoring during pregnancy, appropriate management of portal hypertension, and coordinated care between obstetricians, hepatologists, and neonatologists are essential to minimizing potential complications, ensuring favorable maternal and fetal outcomes. Full article

Background/Objectives: Bordetella bronchiseptica is a Gram-negative bacterium that, either acting alone or in concert with other bacterial or viral pathogens, is a major cause of the canine infectious respiratory disease (CIRD) complex in dogs. Most currently available vaccines are given intranasally or orally and, whilst providing satisfactory reduction in disease severity, can be difficult to use especially in aggressive or anxious dogs. Whilst a small number of injectable B. bronchiseptica vaccines have been developed, little is known about their characteristics with regard to the age at first vaccination, the onset of immunity, duration of immunity, induction of antibody responses, concurrent use with the core vaccines used in most dogs, efficacy in the face of maternally derived antibodies (MDAs) or existing immunity and safety in pregnant animals. Here we describe the development of a safe and efficacious injectable B. bronchiseptica vaccine that utilises a novel process to purify fimbriae. Methods: The fimbrial antigen was formulated with a vitamin E-based oil-in-water adjuvant known to be safe in dogs (Nobivac^® Respira Bb). To evaluate dose response, thirty-nine naïve 5–6-week-old Beagle puppies were allocated to four groups and vaccinated subcutaneously with Nobivac^® Respira Bb at 69 U, 25 U, and 7 U (with a booster at two weeks). All groups were challenged with B. bronchiseptica two weeks after the booster. To evaluate the onset of immunity at 5–6 weeks of age, twenty-one naïve Beagle dogs were split into two groups: group 1 received Nobivac Respira Bb (88 U/dose) plus Nobivac DHPPi and Nobivac L4; group 2 received DHPPi and L4 only. Both groups were challenged with B. bronchiseptica two weeks after the second vaccination. Safety in pregnancy was evaluated by vaccinating pregnant dams and monitoring whelping outcomes and puppy health. Protection in puppies with maternally derived antibodies (MDAs) was studied in 28 pups (11 MDA-negative and 17 MDA-positive from vaccinated and unvaccinated dams). Pups were vaccinated at 5–6 weeks; one group remained unvaccinated to monitor MDA kinetics. All puppies were challenged with B. bronchiseptica at 19 weeks, after MDAs became undetectable. Serology was monitored throughout; daily clinical observations and nasal swabs post-challenge assessed protection and bacterial shedding. Results: Nobivac Respira Bb (MSD Animal Health), was safe for use in 5–6-week-old puppies alongside other Nobivac core canine vaccines without vaccine interference. The vaccine has an onset of immunity of two weeks and significantly reduces both the clinical signs of B. bronchiseptica-induced disease and bacterial excretion into the environment. Furthermore, the vaccine is equally efficacious in puppies with maternally derived antibodies derived from vaccinated dams and can be used safely in pregnant bitches. Conclusions: This vaccine represents a convenient, safe and efficacious alternative to vaccines delivered via the oral or intranasal routes and is a positive addition to the range of vaccines targeted at reducing disease induced by B. bronchiseptica. Full article

Background/Objectives: Wolfram syndrome type 1 (WS1) is a rare, progressive, multisystem neurodegenerative disorder characterized by diabetes mellitus, optic atrophy, diabetes insipidus, and sensorineural hearing loss. As survival has improved, an increasing number of affected women are reaching reproductive age. However, evidence on pregnancy and peripartum management in WS1 remains scarce, and practical guidance is limited. This case report describes the multidisciplinary management of pregnancy and delivery in a woman with genetically confirmed WS1 and highlights key considerations for peripartum care. Case Presentation: A woman with genetically confirmed WS1 and long-standing multisystem involvement, including diabetes mellitus, diabetes insipidus, neurogenic bladder requiring frequent self-catheterization, progressive neurologic manifestations, and severe sensory impairment, achieved pregnancy through assisted reproduction with oocyte donation and was closely monitored by a multidisciplinary team. Due to persistent breech presentation, a planned external cephalic version was performed at 37 + 5 weeks’ gestation with immediate availability for cesarean delivery. After unsuccessful attempts, cesarean delivery was performed under combined spinal–epidural anesthesia. Peripartum management focused on strict glycemic control, careful monitoring of fluid balance and urine output, neuraxial anesthesia with proactive hemodynamic management, precautions related to the cochlear implant, and tailored communication strategies. Postpartum recovery was favorable, although anemia on postoperative day 1 required transfusion of one unit of packed red blood cells and intravenous iron therapy. Discussion and Conclusions: Pregnancy in WS1 represents a high-risk clinical scenario because of the coexistence of endocrine, urologic, and neurologic comorbidities, while published evidence on peripartum management remains limited. This case supports an individualized, multidisciplinary approach to obstetric and anesthetic planning and the use of a practical framework to optimize peripartum management and enhance maternal–fetal safety in this rare condition. Full article

Background: Non-invasive intrauterine resuscitation measures, such as maternal repositioning and intravenous fluid therapy, are used in the presence of suspicious or pathological cardiotocographic (CTG) patterns during labor. However, evidence regarding their link with CTG abnormalities, amniotic fluid color, and immediate neonatal outcomes is limited. Objectives: To analyze the link between maternal repositioning and intravenous fluid therapy and the occurrence of suspicious or pathological intrapartum CTG patterns, as well as their relationship with amniotic fluid color and immediate neonatal effects. Methods: An analytical, observational, prospective study was conducted in women in labor with continuous monitoring. Changes in maternal position, administration of intravenous fluid therapy, CTG patterns, amniotic fluid color, and immediate neonatal outcomes were analyzed. Links were evaluated using appropriate statistical tests, considering maternal positions in isolation and in combination. Results: Maternal repositioning, both alone and in combination, was associated with the presence of suspicious or pathological CTG and with statistically significant differences in the 5 min Apgar score when analyzed as a continuous variable. No significant association was observed between intravenous fluid therapy and CTG patterns or neonatal outcomes. The presence of meconium-stained amniotic fluid was associated with a higher frequency of suspicious or pathological CTG. Conclusions: Maternal repositioning was most frequently applied as a clinical response to a suspicious CTG. Intravenous fluid therapy showed no link with CTG abnormalities or adverse neonatal outcomes. These findings reinforce the need to interpret intrapartum CTG in an integrated manner with the overall clinical context and support the use of maternal repositioning as a non-invasive measure in intrapartum management. Full article

Accurate assessment of hypoxia-related fetal risk during labour is essential for improving perinatal outcomes while avoiding unnecessary operative interventions. Although deep learning has shown promise for automated fetal risk assessment, most existing approaches rely on cardiotocography (CTG) alone; CTG interpretation is known to suffer from a high false-positive rate and may not fully reflect fetal status without complementary clinical context. To address this limitation, we propose MIRF-Net, a multimodal intrapartum fetal risk assessment framework that jointly models (i) CTG time-series signals, (ii) Gramian Angular Difference Field (GADF) images that encode global correlation structure of fetal heart rate, and (iii) structured maternal metadata. MIRF-Net combines a PatchTST encoder for CTG, a pretrained ResNet101 for GADF images, and an autoencoder for maternal metadata and then performs cross-modal interaction learning with a fusion Transformer for final risk prediction. Using 552 eligible CTG recordings from the public CTU-UHB intrapartum database, which were split into training, validation, and test sets at a ratio of 6:2:2, MIRF-Net outperforms representative baselines on the test set, achieving a quality index (QI) of 74.76%, AUC of 0.7413, and Brier score of 0.2537, indicating improved discrimination and better-calibrated risk probabilities. Ablation studies further confirm the complementary contributions of each modality and show that Transformer-based fusion yields the most consistent overall gains. These results suggest that MIRF-Net provides reliable decision support for intelligent intrapartum monitoring. Full article

The fetal electrocardiogram (FECG) is critical for assessing fetal cardiac electrophysiology and detecting fetal distress and arrhythmias. Single-channel abdominal electrocardiogram (AECG) enables home-based monitoring but faces challenges posed by weak fetal signals, maternal interference, and the lack of spatial information. Ensemble Empirical Mode Decomposition (EEMD) is suitable for nonstationary AECG signals but relies on accurate selection of intrinsic mode functions (IMFs). In this study, a deep learning-guided method was proposed: a one-dimensional convolutional neural network (1D CNN) scored and selected EEMD-derived IMFs, followed by maternal QRS template subtraction and secondary EEMD purification to achieve automatic FECG extraction. Leave-one-subject-out (LOSO) cross-validation was performed on 15 simulated cases and 5 ADFECGDB records, yielding a mean AUC of 0.9282 ± 0.0189 for the IMF classifier. On the independent DaISy and NIFEA arrhythmia datasets, the proposed CNN-2×EEMD method achieved correlation coefficients of 0.94–0.96, F1-scores of 0.8372–0.9565 for fetal R-peak detection, and SNR improvements of 13.39–15.88 dB. This method outperformed conventional automatic selection methods and matched the performance of manual selection. Ablation studies validated the optimal network design and IMF selection strategy, while complexity analysis (0.08 GFLOPs, 2.24 ms latency) confirmed its suitability for real-time wearable deployment. Full article

Total body water (TBW) undergoes substantial physiological expansion during pregnancy, reflecting coordinated cardiovascular, renal, and endocrine adaptations required to support maternal metabolism, uteroplacental perfusion, and fetal growth. These changes involve not only an overall increase in body water but also shifts in the distribution of extracellular water (ECW) and intracellular water (ICW), which influence maternal body composition, the interpretation of biochemical biomarkers affected by hemodilution, and pregnancy-related clinical outcomes. Despite its physiological and clinical relevance, the regulation and assessment of body-water compartments during pregnancy remain insufficiently integrated within nutritional and clinical research. This narrative review synthesizes current knowledge on the physiological regulation of TBW and its compartments across gestation and provides a critical analysis of the methodological approaches used to assess body-water distribution in pregnant populations. We review the mechanisms underlying plasma volume expansion, interstitial fluid accumulation, and tissue hydration, and discuss their implications for fetal growth, hypertensive disorders of pregnancy, and gestational diabetes mellitus. We also examine the principles, strengths, and limitations of the main techniques used to assess TBW and body-water compartments during pregnancy. Isotope dilution using stable isotopes (²H₂O and H₂¹⁸O) remains the reference method for TBW assessment, whereas bioelectrical impedance-based approaches, including bioelectrical impedance analysis (BIA), bioelectrical impedance spectroscopy (BIS), and bioelectrical impedance vector analysis (BIVA), offer practical alternatives for longitudinal monitoring of fluid redistribution during gestation. By integrating physiological and methodological perspectives, this review provides a framework for understanding body-water dynamics during pregnancy and for selecting appropriate approaches to assess maternal body composition and hydration. Full article

Respiratory Syncytial Virus infection is a significant cause of morbidity and mortality in infants. Maternal vaccination with the bivalent vaccine Abrysvo^® in the third trimester (24–36 weeks) is an effective strategy to prevent severe respiratory illnesses in newborns. However, the introduction of this new technology faces structural obstacles that amplify inequalities. This rapid literature review sought to map and synthesize evidence on inequalities and inequities in adherence and accessibility to maternal vaccination among Black pregnant women. A rapid literature review was conducted using a mixed-methods approach (narrative synthesis and thematic analysis), following guidelines adapted from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Cochrane Handbook. The research question was structured using the acronym Population/Problem, Exposure, Comparison, and Outcome, focusing on Black pregnant women, maternal vaccination, comparison with other groups, and barriers/determinants. The search was conducted in databases such as PubMed (via Medical Literature Analysis and Retrieval System Online), Scopus and Literatura Latino-Americana e do Caribe em Ciências da Saúde, covering studies published between 2022 and 2025 that presented disaggregated analysis by race. The analysis and interpretation of the findings were guided by Critical Race Theory. The analysis of the twelve included studies (mainly from the United States, the United Kingdom, and Brazil) revealed systematic and robust disparities. Black pregnant women had lower vaccination coverage and were less likely to receive timely recommendations compared to White pregnant women. The barriers identified include: institutional distrust (resulting from structural racism), poor access to prenatal care, inadequate communication, and socioeconomic factors. Inequities are structural and multifactorial phenomena. To ensure that the benefits of the vaccine are distributed equitably, strategies such as anti-racist training for healthcare teams, active vaccination outreach, and continuous monitoring of data disaggregated by race are essential. Full article

Background/Objectives: Women’s health has historically lagged behind other medical specialties in transformative innovation, despite significant technological advances in adjacent fields. In this collection of papers, we examine the current state of innovation in women’s health and maternal–fetal medicine, identify barriers to transformation, and propose strategies for accelerating breakthrough developments. This paper presents an overview of multiple forces and their often-competing relationships that influence the environment in which advances in multiple areas of healthcare have had to navigate to enter mainstream practice. An understanding of these forces is essential to explain why some new technologies are readily deployed into clinical practice while others take many years to be adopted. Understanding the entire “echo-system” around any specific technology provides a much fuller understanding of how any individual advance can make its way into actual utilization. Methods: We synthesized current literature on innovation in women’s health, analyzing technological advances in artificial intelligence, precision medicine, non-invasive diagnostics, and surgical robotics. We examined patterns of innovation adoption and barriers to implementation across multiple domains. Results: Several key areas presented in this paper and the following show promise for transformative change: artificial intelligence (AI)-driven diagnostics achieving expert-level performance in prenatal screening, precision medicine approaches transforming genetic disease management, and non-invasive monitoring technologies revolutionizing maternal–fetal care. However, systemic barriers including regulatory complexity, liability concerns, and institutional inertia continue to limit widespread adoption of numerous breakthrough technologies. Conclusions: The convergence of multiple technological advances, particularly artificial intelligence and precision medicine, positions women’s health for unprecedented transformation. Success requires fostering innovation-ready environments, embracing systems-awareness approaches, and maintaining focus on human-centered care while leveraging technological capabilities with continual feedback and course corrections. Full article

Background/Objectives: In Japan, hospital births predominate, with home births comprising only 0.1% of deliveries. This study assessed how documented practices for planned home births attended by independent midwives align with national guidelines and WHO intrapartum care recommendations, and assess maternal and neonatal differences before and after the COVID-19 pandemic. Methods: Records of 430 low-risk pregnant women who received continuous care at a private midwifery home over 25 years were reviewed. After excluding 8 maternal and 22 neonatal transfers, 400 records were analyzed. Descriptive statistics were compared with WHO recommendations and between the pre-pandemic (1999–2019) and post-pandemic (2020–2024) periods. Results: All women experienced spontaneous singleton cephalic labors with intermittent fetal heart rate auscultation. The mean gestational age was 277.3 days and the median labor duration was 303.5 min. Labor onset was spontaneous in 83.5% of cases. Nearly half of the women had no perineal lacerations. Postpartum blood loss ≥500 mL occurred in 14.1% of cases. Family presence was nearly universal. Neonates had a mean birth weight of 3129.0 g and high Apgar scores. Skin-to-skin contact occurred in 52.9%; exclusive breastfeeding reached 93.8% at 1 month. Post-pandemic births showed higher maternal age and higher neonatal birth weight, although these differences should be interpreted cautiously due to the small post-pandemic sample. Conclusions: Independent midwives provided evidence-based, physiologically oriented care, partially aligning with selected WHO intrapartum recommendations during planned home births. Midwife-led home births may support positive childbirth experiences and favorable maternal/neonatal outcomes for low-risk women. Post-pandemic shifts underscore the need for continued monitoring and flexible, community-based perinatal support, while recognizing the limitations of retrospective, single-site data. Full article

Background: Hypothyroidism is one of the most common endocrine conditions during pregnancy and has been associated with poor obstetric and perinatal outcomes. There is still a lack of data from Middle Eastern populations, despite its clinical significance. This study aimed to evaluate thyroid management patterns during pregnancy and examine the association between thyroid function control and maternal and perinatal outcomes in women with hypothyroidism at a tertiary care center in Qatar. Methods: A retrospective cohort study including 379 pregnant women with hypothyroidism diagnosed between January 2019 and November 2022 was conducted at Sidra Medicine in Doha, Qatar. Based on trimester-specific Thyroid-stimulating hormone (TSH )reference values, participants were categorized as having adequately or inadequately controlled thyroid function. Data on obstetrics, biochemistry, and demographics were taken from electronic medical records (EMR). Statistical analyses were performed using chi-square tests for categorical variables and t-tests for continuous variables, with a significance threshold of p < 0.05. Results: Participants had a mean Body Mass Index (BMI) of 30.33 ± 6.14 kg/m² and an average age of 32.65 ± 4.99 years; 54% of them were Qataris. Of the patients, 58.5% had positive thyroid antibodies and 55.7% had pre-gestational hypothyroidism. Women with pre-gestational hypothyroidism required significantly higher levothyroxine doses compared with those with gestational hypothyroidism (93.2 ± 47.5 mcg/day vs. 67.6 ± 30.1 mcg/day; p < 0.001). Treatment adjustment was demonstrated by the improvement in TSH normalization from 51.3% in the first trimester to 64.2% in the third trimester (p = 0.041). No significant associations were observed with pre-eclampsia, preterm delivery, hypertension, or placental abruption. However, women with normal third-trimester TSH had a higher prevalence of gestational diabetes mellitus (GDM) compared with those with elevated TSH (51.6% vs. 36.8%; p = 0.013). Conclusions: Appropriate trimester-specific monitoring and timely levothyroxine titration was associated with improved biochemical control without adverse maternal outcomes. Greater levothyroxine requirements in women with pre-gestational hypothyroidism emphasize the importance of early intervention. These findings highlight the potential benefit of structured thyroid monitoring and multidisciplinary care approaches in pregnancy and may help inform future regional clinical practice guidelines. Full article