Search Results (1,845)

The postnatal period involves significant emotional and relational shifts that can challenge early mother–infant interactions, particularly under conditions of psychosocial vulnerability (e.g., maternal anxiety/depression) or infant-related risk (e.g., preterm birth). Maternal mentalization, operationalized as Parental Reflective Functioning (PRF), is a key protective factor for sensitive caregiving and dyadic regulation. Objectives: This protocol describes a multicenter, open-label, single-arm feasibility study evaluating a brief, fully online, mentalization-based video-feedback intervention (VFI-RF). The study is designed to assess the feasibility and acceptability of the intervention, rather than its efficacy. We aim to recruit 48 mothers, 24 in each of two risk groups, through socio-health services and neonatal intensive care units. Risk Group 1 will include mothers with clinically significant depressive and/or anxiety symptoms, defined as EPDS > 9 and/or GAD-7 ≥ 10, whereas Risk Group 2 will include mothers of preterm infants, defined as infants born before 37 weeks of gestation. Methods: The intervention consists of 8 + 2 synchronous online sessions over approximately 5 months. Mothers record brief everyday caregiving interactions (~5 min) to review with a trained clinician, focusing on the infant’s internal states and reflective meaning-making. Assessments occur at baseline (T0, infant age ~3 months), post-intervention (T1, ~8 months), and follow-up (T2, ~12 months). Primary feasibility outcomes include recruitment/referral metrics, uptake, retention, assessment completion, missing data, and participant-reported acceptability. Secondary exploratory clinical outcomes include maternal PRF, symptoms, parenting stress, social support, and mother–infant attachment, evaluated via validated self-report questionnaires. Results: The study is designed to evaluate referral and recruitment patterns, intervention uptake, and participant retention, as well as the acceptability and suitability of study procedures and outcome measures for a future controlled trial. Preliminary trajectories of change in maternal reflective functioning and early relational indicators will be examined descriptively and exploratorily. Conclusions: Findings will inform the feasibility and refinement of a brief online mentalization-based video-feedback intervention to support at-risk mother–infant dyads during the first postnatal year. Trial registration: Registered on Open Science Framework, osf.io/6g9ja, date of registration 4th March 2026. Full article

Background: Gestational diabetes mellitus (GDM) is one of the most common medical complications of pregnancy and has a high prevalence in Saudi Arabia. GDM increases the risk of adverse maternal and fetal outcomes and is associated with cardiovascular risk factors. Glycemic severity, represented by the continuous 1 h plasma glucose value from the diagnostic two-hour 75 g oral glucose tolerance test (OGTT), may provide additional insight into glycemic status among women with GDM. Physical activity (PA) plays a vital role in maternal health. Therefore, the aim of this study was to identify the associations between PA and glycemic severity among pregnant women with GDM in Saudi Arabia and to identify factors associated with glycemic severity. Methods: This cross-sectional study enrolled 96 pregnant women during routine second-trimester visits at a maternity clinic in Riyadh. PA was assessed using the Pregnancy Physical Activity Questionnaire (PPAQ). Glycemic severity was assessed using the continuous 1 h plasma glucose value obtained from the diagnostic two-hour 75 g OGTT. Results: One-way ANOVA demonstrated a significant association between PA levels and glycemic severity (F = 2.78; p < 0.04). Multiple linear regression identified low-intensity PA, non-employment, and smoking during pregnancy were significantly associated with higher glycemic severity (p < 0.05). Conclusions: The study identifies a significant association between PA and glycemic severity. Furthermore, employment status and smoking were also significantly associated with glycemic severity. These findings suggest that PA and other modifiable lifestyle factors play role in glucose regulation during pregnancy. However, the cross-sectional design precludes any inference of causality. Full article

Background/Objectives: Social isolation is a significant risk factor for child maltreatment. However, few studies have examined this relationship across multiple ecological levels, including neighborhood, family, and individual factors. This cross-sectional study operationalized social isolation using social cohesion, social support, and loneliness, and aimed to examine how their inter-relationships influence child maltreatment among Japanese mothers. Methods: Data were collected through an anonymous online survey of 330 Japanese mothers of children aged under six years, conducted April–May 2025. Structural equation modeling was employed in a two-step analytic approach. First, a confirmatory factor analysis was conducted to establish construct validity. Second, the hypothesized structural model was tested to examine the proposed pathways among social cohesion, social support, loneliness, parenting stress, and child maltreatment. Analyses were conducted using weighted least squares with mean and variance adjustment estimation. Results: Higher social cohesion was indirectly associated with reduced child maltreatment via two pathways. First, higher social cohesion was associated with lower loneliness, reduced parenting stress, and decreased child maltreatment (β = −0.063, p < 0.001). Second, higher social cohesion was associated with greater social support, reduced loneliness, lower parenting stress, and decreased child maltreatment (β = −0.043, p < 0.001). Conclusions: These findings highlight that enhancing neighborhood connectedness and alleviating maternal loneliness are key changes that may help to prevent child maltreatment. Full article

Preeclampsia is a leading cause of maternal and perinatal morbidity and mortality worldwide. This significant burden necessitates effective early identification of pregnancies at high-risk for preeclampsia. Accurate prediction is essential in order to develop and optimize preventive strategies. The evolution of preeclampsia screening has progressed from a traditional checklist-based approach to individualized, multivariable models. The first-trimester triple test, which was developed by the Fetal Medicine Foundation (FMF), represents this advancement. It utilizes Bayes’ theorem to calculate patient-specific risks by integrating maternal factors, mean arterial pressure, uterine artery pulsatility index, and serum placental growth factor. This model, called “first trimester FMF triple test”, has undergone successful internal and external validation for the prediction of preterm preeclampsia. To ensure the reliability of biomarker measurements and achieve an optimal screening performance, it is essential to implement standardized measurement protocols and rigorous quality control processes in biomarker testing. The triple test could also be utilized in the 2nd and 3rd trimester, and the addition of biomarkers such as soluble fms-like tyrosine kinase-1 further improves risk stratification assessment and continued surveillance of high-risk pregnancies. Full article

Dental caries is the world’s most common non-communicable disease with a complex etiology including social, behavioral, medical, biological and economical elements. The distribution among populations and age groups is skewed, which calls for validated clinical tools to identify those with increased caries risk. The aim of this article was therefore to review risk factors for caries development in children, based on global prospective birth cohorts, genetic proceedings and data from validated risk assessment tools. The genetic elements involve four main categories comprising enamel quality, salivary composition, dental biofilm function and taste preferences. Recent studies suggest that genes may account for 35–55% of the variation in caries scores in the young permanent dentition. Prospective birth cohorts have pointed out poverty, socioeconomic level, early introduction and excessive sugar intake as significant factors for a child’s dental caries trajectory up into adulthood. Moreover, prolonged breastfeeding, child obesity and maternal oral conditions are linked to the caries burden later in life. In the clinic, the strongest predictors are past caries history and selected behavioral and social factors. The performance of the validated caries risk assessment models is far from perfect, but still acceptable in terms of reliability during childhood. These tools are the best clinical practice since they add objectivity, consistency and documentation to the clinical routines. In addition, the dental staff has the advantage of using the outcome of the assessment for a structured risk communication with the caregivers. The protocol should also form the basis for a personalized intervention program addressing the entire family, with particular focus on maternal oral health and sugar reduction. Full article

Objective: This study evaluated hepatitis B vaccine (HepB) uptake, associated influencing factors, and post-vaccination immune responses among preterm infants residing in Fujian Province. The findings can support targeted improvements in hepatitis B prevention and control strategies tailored for this high-risk neonatal population. Methods: We conducted a multicenter cross-sectional study combined with short-term prospective serological follow-up across five counties, cities and districts of Fujian Province between 2022 and 2023. A total of 779 eligible preterm infants were enrolled in this study. We collected demographic information of participating mothers and infants, as well as complete HepB vaccination records throughout the study period. For 363 enrolled infants, we performed serological tests to detect hepatitis B surface antigen (HBsAg) and hepatitis B surface antibody (HBsAb) at 1–2 months after they completed the full HepB vaccination series. To explore factors linked to timely administration of the first HepB dose (HepB1), completion of the full vaccination course and HBsAb serostatus, we adopted a set of statistical approaches including descriptive statistics, the chi-square test (Fisher’s exact test was used for groups with small sample sizes) and binary logistic regression. Results: The timely HepB1 vaccination rate among all preterm infants was 78.18%, while 63.80% completed the full vaccination schedule as required. In the serology cohort, the HBsAb positive rate was 90.91%, and 8.82% of infants showed double-negative HBsAg and HBsAb results, indicating susceptibility to HBV infection. Multivariate analysis identified multiple risk factors for delayed vaccination. Preterm infants were more likely to receive vaccinations late if their mothers tested HBsAg-negative (HepB1: OR = 25.231, 95%CI: 4.997–127.406; full-course HepB: OR = 2.440, 95%CI: 1.395–4.269), were delivered in county-level or lower-tier medical facilities (HepB1: OR = 3.724, 95%CI: 2.107–6.580), or were born via cesarean section (HepB1: OR = 3.460, 95%CI: 2.169–5.520; full-course HepB: OR = 1.954, 95%CI: 1.411–2.704). Additional risk factors included a gestational age below 34 weeks (HepB1: OR = 4.369, 95%CI: 1.894–10.081; full-course HepB: OR = 2.237, 95%CI: 1.148–4.359) and a birth weight less than 2500 g (HepB1: OR = 2.251, 95%CI: 1.397–3.629; full-course HepB: OR = 1.513, 95%CI: 1.065–2.150). Conclusions: Preterm infants enrolled from five regions in Fujian Province achieved robust immune protection following standard HepB vaccination. However, timely first-dose coverage and on-schedule full-course vaccination remain suboptimal in this cohort. Observed gaps in routine vaccination management at primary care settings highlight a key area for improvement in local hepatitis B prevention. Targeted standardized training for maternity care staff at county-level facilities, paired with a full-cycle follow-up system for preterm infant vaccination, may further strengthen hepatitis B mother-to-child transmission (MTCT) interruption in the study regions. Full article

Background: Maternal postpartum hospital readmissions represent profound implications for maternal health outcomes and potential gaps in quality of maternal care. Objective: This study aims to synthesise evidence on risk factors for maternal postpartum hospital readmissions within 42 days of discharge following birth hospitalisation. Methods: An electronic database search utilised CINAHL, EMBASE (Ovid), and MEDLINE for relevant studies published from 1 January 2010 to 30 June 2024. The studies that investigated the prevalence and risk factors for 42-day postpartum maternal readmission and reported risk estimates, published in English, were included. The risk of bias was assessed using the Newcastle–Ottawa Scale (NOS) for case-control studies and cohort studies. The PRISMA guidelines were followed in reporting this review. The review protocol was registered on PROSPERO (CRD42023442269). Results: A total of 7758 articles were retrieved, ultimately including 60 studies. The rate of maternal postpartum readmissions varied from 0.1236‰ to 26%. Significant risk factors were extracted and categorised into five groups: maternal demographic and socio-economic factors; behavioural and lifestyle factors; health institution structural factors; obstetric and delivery characteristics; as well as maternal morbidity The most frequently cited risk factors which contributed to maternal postpartum hospital readmissions were age, race/ethnicity, substance use, caesarean delivery, length of maternal hospital stay, premature birth, and all maternal morbidities, especially mental health disorders, severe maternal morbidity, and hypertensive disorders of pregnancy. Conclusions: This systematic review identified complex and diverse risk factors associated with maternal postpartum hospital readmissions within 42 days after discharge following birth hospitalisation. This helps our understanding of the risk factors and the strength of association with maternal postpartum hospital readmissions. Future research should develop a multidimensional risk assessment framework to guide clinical practice in adopting holistic individualised approaches for postpartum risk evaluation, thereby reducing readmission rates and improving maternal health outcomes. Full article

Gestational diabetes mellitus (GDM) is an increasingly prevalent metabolic disorder of pregnancy, driven by rising maternal age, obesity, and complex metabolic–inflammatory interactions. Emerging evidence implicates the maternal microbiome as a key modulator of metabolic adaptation during gestation; however, its precise role in GDM pathogenesis remains incompletely defined. This narrative review synthesizes current knowledge on microbiome alterations across gut, vaginal, and oral niches, focusing on their contribution to insulin resistance, metabolic endotoxemia, and immune dysregulation. GDM is consistently associated with reduced microbial diversity, depletion of beneficial taxa (e.g., Akkermansia, Bifidobacterium, Faecalibacterium), and expansion of pro-inflammatory pathobionts, which collectively may impair intestinal barrier integrity and promote low-grade systemic inflammation. These mechanisms are linked to altered insulin signaling and adverse maternal–fetal outcomes. In parallel, microbiome-derived metabolites and early taxonomic signatures have been proposed as potential biomarkers for first-trimester risk stratification, offering an opportunity to overcome the limitations of late diagnostic approaches such as the oral glucose tolerance test. Despite these advances, most available evidence remains associative, with substantial heterogeneity across studies and limited mechanistic validation. The clinical utility of microbiome-based interventions—including dietary modulation, prebiotics, and probiotics—remains promising but inconclusive, with outcomes highly dependent on individual, microbial, and methodological factors. Overall, the maternal microbiome represents a compelling but still evolving target in GDM research. Future progress will depend on standardized methodologies, longitudinal multi-omics studies, and the development of precision medicine approaches capable of integrating microbial, metabolic, and host data. Such advances may enable earlier diagnosis, targeted prevention, and ultimately the disruption of intergenerational metabolic risk. Full article

Background/Objectives: Exclusive breastfeeding improves infant health and development, while suboptimal breastfeeding increases risks of hyperbilirubinemia and neonatal hypernatremic dehydration (NHD). This study aims to estimate the prevalence of NHD associated with exclusive breastfeeding and to identify maternal and neonatal risk factors through a systematic review and meta-analysis. Methods: This systematic review followed PRISMA 2020 guidelines. A comprehensive search was conducted in PubMed, Scopus, Web of Science, LILACS, and the Cochrane Central Register of Controlled Trials from February to March 2025 without language or publication year restrictions. Observational studies evaluating healthy term neonates exclusively breastfed and diagnosed with NHD within the first 28 days of life were included. Two independent meta-analyses were performed to estimate pooled prevalence and associated risk factors using random-effects models. Methodological quality was assessed using the Newcastle–Ottawa Scale (NOS) and the Joanna Briggs Institute (JBI) tool. Results: A total of 97 studies were identified, and 13 met the inclusion criteria. Ten studies were included in the prevalence meta-analysis and seven in the risk factor meta-analysis. The pooled prevalence of NHD was 1.4% (95% CI: 0.0–5.0%), with high heterogeneity (I² = 99.6%). Delayed initiation of breastfeeding (OR 6.02; 95% CI: 2.85–12.73), excessive neonatal weight loss > 10% (OR 69.28; 95% CI: 0.00–1.87 × 10¹²), low urine output (OR 8.51; 95% CI: 2.86–25.29), and maternal primiparity (OR 3.66; 95% CI: 1.67–8.02) were identified as the main risk factors. Poor breastfeeding technique, inadequate latch, and lack of early postnatal follow-up were consistently associated with NHD. Conclusions: NHD is a clinically relevant condition among exclusively breastfed term newborns. Early breastfeeding assessment, monitoring of neonatal weight loss and hydration status, and strengthened maternal support are essential to prevent severe complications. Full article

Every year, respiratory syncytial virus (RSV) causes an estimated 33 million lower respiratory tract infections in children under five years of age, driving millions of hospitalizations worldwide and substantial mortality in developing countries. For 28 years, the monoclonal antibody (mAb) palivizumab has been the principal agent for RSV immunoprophylaxis, reducing hospitalization in defined high-risk groups through monthly intramuscular dosing. The recent approval of two second-generation long-acting mAbs, nirsevimab and clesrovimab, and maternal preF vaccine has fundamentally changed the RSV prevention landscape. In contrast to palivizumab, the long-acting mAbs offer single-dose seasonal protection across a broader infant population, enabling universal immunization programmes for the first time. In this review, we conjointly examine nirsevimab and clesrovimab across their mechanisms of action, pharmacokinetics, efficacy, safety and cost-effectiveness, using palivizumab as the reference standard. Cross-trial efficacy comparisons are complicated by differences in study populations and endpoint definitions; however, when these factors are considered, the available evidence suggests that all three agents offer broadly comparable protection against severe RSV disease. All three agents also demonstrate favourable and comparable tolerability profiles. Nirsevimab is now supported by a substantial body of real-world evidence confirming effectiveness in routine immunization programmes that closely align with registrational studies. Clesrovimab, as the newest agent, currently lacks real-world effectiveness, and both long-acting monoclonals require further confirmatory evidence in high-risk groups. Overall, existing data support that both monoclonals have equivalent efficacy and safety profiles as palivizumab, and choice should be based on cost-effectiveness and local availability, with consideration given to optimal integration of infant immunoprophylaxis alongside maternal RSV vaccination programmes. Full article

Background/Objectives: Dental fear and anxiety (DFA) in children can negatively affect oral health behaviors and dental care utilization. Family-related factors, particularly parental anxiety, parenting styles, and socioeconomic characteristics, may be associated with DFA. This study aimed to investigate the association between family-related factors and DFA among children aged 6–8 years in Jakarta, Indonesia. Methods: A cross-sectional study was conducted among 294 child–parent pairs recruited from 10 primary schools using multistage cluster sampling. Children’s DFA was assessed using the Children’s Fear Survey Schedule–Dental Subscale (CFSS-DS), whereas parental dental anxiety was measured using the Modified Dental Anxiety Scale (MDAS). Sociodemographic and family-related characteristics, including parenting styles, were collected using self-administered questionnaires. Data were analyzed using chi-square tests and multivariable logistic regression. Results: Overall, 34.7% of the children were classified as having DFA. Maternal employment was significantly associated with children’s DFA, with children of formally employed mothers having higher odds of DFA (aOR = 2.01, 95% CI: 1.05–3.85; p = 0.034). Parental dental anxiety was associated with children’s DFA. Children whose fathers and mothers reported high levels of dental anxiety had 4.68-fold (95% CI: 1.64–13.33; p = 0.004) and 2.50-fold (95% CI: 1.10–5.74; p = 0.029) higher odds of experiencing DFA, respectively. Dental drilling and injections were the most frequently reported fear-provoking stimuli. The final regression model explained 13% of the variance in children’s DFA. Conclusions: Parental dental anxiety and maternal employment were significantly associated with DFA among children aged 6–8 years. Family-centered preventive strategies and early identification of at-risk children may help reduce DFA and promote positive dental experiences and oral health outcomes. Full article

Persisting ethnic disparities in pre-eclampsia (PE), cardiovascular disease (CVD), and maternal mortality call for a paradigm shift in how ethnicity is understood as a risk factor for PE. Starting from a migrant perspective, we argue that the transgenerational experience of maternal stress within shared, yet dynamic ecosocial contexts can be linked to core pathophysiological features of PE. A growing body of evidence suggests how a vicious cycle of chronic maternal stress, cardiovascular dysfunction, placental ER stress, and endothelial dysfunction may serve as a catalyst for the transmission of altered cardiovascular and neuro-endocrine stress reactivity patterns across generations, with a seemingly important role for foetal programming and epigenetics. As these alterations in stress reactivity patterns have in turn been associated with an increased risk of PE and CVD later in life, the resulting transgenerational chain reaction may ultimately allow for ethnic disparities in PE to be traced back to historic, stressful moments in the shared ecosocial contexts of ethnic minority women. Reconceptualising ethnicity as a proxy for the stratified and embodied experience of transgenerational maternal stress within its unique ecosocial contexts, rather than a stand-alone, non-modifiable risk factor, will therefore open new directions for future research, clinical care, and policy interventions aimed at advancing maternal health equity. Full article

Background: Gestational diabetes mellitus (GDM) affects between 1% and 14% of pregnancies worldwide. Major risk factors include advanced maternal age, excess adiposity, family history of type 2 diabetes, and unhealthy dietary habits. In Mexico, evidence on the association between dietary patterns and GDM remains scarce, particularly in socioeconomically vulnerable populations with limited access to specialized nutrition services. This study aimed to evaluate the association between dietary patterns and the presence of GDM in pregnant women attending the outpatient obstetrics clinic of a teaching public hospital in Guadalajara, México. Methods: We conducted a case–control study including 169 pregnant women: 71 with GDM confirmed by the ADA one-step 75 g oral glucose tolerance test OGTT criteria and 98 without GDM based on a negative OGTT, recruited consecutively from the same clinic during the same period. Dietary intake was assessed using a culturally adapted and validated Food Frequency Questionnaire. Dietary patterns were identified through Principal Component Analysis, and associations were examined using logistic regression adjusted for maternal age, pregestational BMI, and family history of type 2 diabetes. Results: Women with GDM had higher maternal age, greater pregestational BMI, and more frequent family history of type 2 diabetes compared with controls. Three dietary patterns were identified: Western, Healthy, and Dairy/Refined. High adherence to the Western pattern was inversely associated with GDM (aOR = 0.36; 95% CI: 0.16–0.78; p = 0.010); however, this finding most likely reflects post-diagnosis dietary modifications rather than a protective effect, while maternal age remained the strongest risk factor (OR = 1.09; 95% CI: 1.03–1.16; p = 0.002). The Healthy pattern (aOR = 1.25; 95% CI: 0.55–2.82; p = 0.593) and the Dairy/Refined pattern (aOR = 0.80; 95% CI: 0.39–1.66; p = 0.554) were not significantly associated with GDM in the adjusted model. Conclusions: GDM was associated with older maternal age, higher pregestational BMI, and family history of T2DM. The inverse association with the Western pattern may reflect post-diagnosis dietary changes rather than a protective effect. Due to the retrospective design, causal inference is not possible, highlighting the need for longitudinal studies. Full article

Background: Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality worldwide, accounting for approximately 27% of maternal deaths. In Spain, its incidence ranges from 2.5% to 5.2%. Clinical management has evolved toward a stepwise approach integrating pharmacological, mechanical, and surgical interventions. This study aims to analyze the evolution of these techniques during the 2020–2024 period to optimize decision-making and maternal outcomes. Methods: A systematic review was conducted following the PRISMA 2020 guidelines. Comprehensive searches were performed in PubMed, Scopus, and the Cochrane Library for studies published between 2020 and 2024 in English and Spanish. The PICO framework was utilized to evaluate interventions including intrauterine balloon tamponade (UBT), compression sutures, and arterial embolization, prioritizing outcomes such as bleeding control and fertility preservation. Out of 34 identified records, 13 studies met the final inclusion criteria. Results: The findings demonstrate a clear trend toward conservative management. Intrauterine balloon tamponade reported success rates of 80–90% in controlling refractory bleeding and significantly reduced the hysterectomy rates. B-Lynch compression sutures showed success rates between 68.4% and 100%, with generally favorable fertility outcomes. However, combining these sutures with devascularization increased the risk of uterine necrosis. Additionally, the early administration of tranexamic acid (TXA) within 3 h of birth was confirmed as a critical factor in reducing mortality. Conclusions: Acute PPH management has shifted toward protocol-based, sequential, and less invasive strategies. The implementation of standardized algorithms, care bundles, and simulation-based training is essential to reduce decision inertia and improve obstetric safety. While conservative mechanical and surgical techniques are effective, institutional protocols must be regularly updated to consolidate these technological and organizational advances. 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