Search Results (978)

This study examines whether stricter enforcement of mandatory social insurance contributions affects corporate income tax behavior in China. In the Chinese institutional context, mandatory social insurance refers to payroll-based employer and employee contributions to five statutory programs: basic pension insurance, basic medical insurance, work-injury insurance, unemployment insurance, and maternity insurance. These programs are directly related to social sustainability because they finance old-age income security, medical protection, workplace injury compensation, unemployment support, maternity protection, and labor-market stability. Using China’s 2018 social insurance collection reform as a quasi-natural experiment, we analyze A-share listed companies from 2014 to 2024 through a difference-in-differences design based on differential exposure between private firms and state-owned enterprises. To assess the reliability of the identification strategy, we employ firm and year fixed effects, event-study analysis, placebo tests, alternative measures of tax avoidance, and propensity score matching difference-in-differences robustness checks. The findings show a tax-fee seesaw effect: private firms subject to extensive regulatory scrutiny respond to more rigorous enforcement of social insurance contributions by increasing corporate income tax avoidance. Analysis of the mechanisms shows that the Whited-Wu index of financial constraints partially explains this phenomenon. The effect is more pronounced in firms with higher labor costs and greater administrative expense intensity, indicating that the increased response is driven by labor cost exposure and organizational discretion. By contrast, the effect is weaker among firms audited by the Big Four accounting networks—Deloitte, PricewaterhouseCoopers, Ernst & Young, and KPMG—indicating that high-quality external audits constrain aggressive tax planning. Regionally, the effect is most pronounced in eastern China, where markets, labor costs, and tax-planning services are more developed. The findings contribute to the sustainable development literature by demonstrating that reforms designed to strengthen social insurance sustainability can unintentionally weaken tax compliance if payroll contributions, tax administration, and corporate financial pressures are not coordinated. The study highlights the importance of integrated fiscal governance for achieving socially sustainable and fiscally balanced development. Full article

Parent–child sexual communication plays a central role in adolescents’ sexual socialization, yet little research has examined whether frequent communication fosters adolescent disclosure of sexual behaviors and how disclosure relates to sexual debut. This study investigated whether the frequency of parent–child sexual communication is associated with adolescent disclosure and examined relationships between disclosure and age at first intercourse. Data from the Healthy Sexuality Pilot Study included 2044 adolescents (1030 males, 1014 females). Structural equation modeling with multi-group comparison revealed parent-specific pathways: maternal communication frequency was associated with disclosure to mothers (β = 0.66–0.69, p < 0.001), and paternal communication was associated with disclosure to fathers (β = 0.83–0.90, p < 0.001). Cross-parent effects were minimal, suggesting disclosure develops through specific parent–child dyadic communication. Invariance testing supported equivalent model functioning across male and female adolescents. Unexpectedly, greater disclosure to mothers was associated with earlier age at first intercourse for both males (β = −0.08, p < 0.05) and females (β = −0.15, p < 0.05). One possibility is that adolescents who become sexually active subsequently seek parental support, increasing disclosure after debut. Findings indicate that frequent sexual communication is associated with disclosure through parent-specific relational pathways but suggest the disclosure–behavior relationship is more complex than protective models predict. Results underscore the importance of promoting not only communication frequency but also quality and effective parental responses. Full article

Electronic waste (e-waste) recycling releases heavy metals into surrounding environments, creating potential health risks for nearby populations, particularly pregnant women and developing fetuses. This systematic review evaluated human evidence linking prenatal exposure to heavy metals originating from informal e-waste recycling with adverse pregnancy and neonatal outcomes. Electronic databases, including PubMed and Scopus, were searched through 23 September 2025, for studies measuring heavy metal exposure among pregnant women or neonates living in e-waste–affected communities. Following the Navigation Guide methodology, eight observational studies met the inclusion criteria and were assessed for risk of bias and strength of evidence. Across studies, concentrations of heavy metals were higher in exposed populations and were detected in maternal blood, placenta, cord blood, urine, and meconium samples from exposed populations. Prenatal exposure was consistently associated with adverse outcomes, with many studies reporting statistically significant associations between heavy metal exposure and reduced birth weight, length, head circumference, gestational age, neonatal body mass index, lower Apgar scores, impaired neonatal neurobehavioral development, placental molecular alterations, endocrine disruption, and increased neonatal DNA damage. Overall, the evidence was rated as moderate quality with sufficient evidence linking prenatal heavy-metal exposure from e-waste to impaired fetal growth and neonatal development, and limited evidence for pregnancy complications. These findings highlight the need for improved regulation of e-waste recycling and strengthened public health protections for vulnerable populations. Full article

Human milk (HM) is recognized as the optimal source of nutrition for infants, providing essential nutrients, bioactive compounds, and immunological protection crucial for proper growth and development. However, due to increasing environmental pollution, HM may also serve as a vector for exposure to toxic substances, including heavy metals. These contaminants originate from both current environmental exposure and long-term accumulation in maternal tissues, which may be mobilized during pregnancy and lactation. Objectives: The aim of this review was to comprehensively analyze the occurrence, sources, and determinants of heavy and toxic metals in human milk, with particular emphasis on maternal–infant transfer pathways and geographical variability of exposure. Methods: A structured narrative review with systematic literature search elements was conducted using PubMed, Scopus, and Web of Science databases. The search covered studies published between 2010 and 2025 and was limited to articles written in English. The search strategy included terms related to human milk and heavy metal exposure (Pb, Cd, Hg, As, Cr, Al). Predefined inclusion and exclusion criteria were applied, and a qualitative synthesis of environmental, dietary, physiological, and lifestyle-related determinants, as well as geographical variability, was performed. Results: The available evidence indicates that heavy metals are commonly detected in human milk worldwide, with concentrations strongly influenced by environmental pollution, maternal diet, and lifestyle factors. Under typical exposure conditions, reported concentration ranges are approximately 2–5 µg/L for lead (Pb), 1.4–1.7 µg/L for mercury (Hg), and below 1 µg/L for cadmium (Cd). However, substantially higher levels have been reported in highly contaminated regions, with extreme values exceeding 1000 µg/L for Pb and 100 µg/L for Hg in isolated cases. Key exposure pathways include contaminated food, drinking water, air pollution, and endogenous mobilization of metals stored in maternal tissues (particularly bone and adipose tissue). Significant geographical variability was observed, with higher concentrations reported in industrialized and mining regions. Infants represent a highly vulnerable population due to immature detoxification systems, increased gastrointestinal absorption, and ongoing neurodevelopment, which may amplify toxic effects even at low exposure levels. Conclusions: Although human milk remains the gold standard for infant nutrition, the presence of heavy metals highlights the need for continuous environmental monitoring and preventive strategies aimed at reducing maternal exposure. The benefits of breastfeeding clearly outweigh the potential risks; however, minimizing environmental contamination remains a critical public health priority. Future research should focus on standardizing analytical methods, improving biomonitoring strategies, and better characterizing long-term health outcomes associated with early-life exposure to toxic metals. Full article

Background: Mechanical trauma during pregnancy from motor vehicle accidents, falls, and maternal seizures poses significant risks to fetal development. The fetus is protected by multiple hierarchical layers including the uterine wall, amniotic fluid, and cerebrospinal fluid surrounding the brain. Despite the clinical significance of maternal trauma occurring in approximately six to eight percent of pregnancies, previous computational studies have focused primarily on amniotic fluid protection while treating the fetus as a homogeneous structure, without examining the nested protective architecture comprising both amniotic fluid and cerebrospinal fluid as an integrated system. Methods: This investigation implements a nested fluid–structure interaction framework simultaneously capturing three hierarchically organized systems: the uterine wall interacting with amniotic fluid, amniotic fluid interacting with the fetal body, and the cranial system comprising skull, cerebrospinal fluid, and brain tissue. The computational architecture employs smoothed particle hydrodynamics for fluid domains coupled with finite element methods for solid structures. Boundary conditions representing traumatic forces were obtained through experimental protocols using an instrumented medical simulation mannequin performing seizure movements. Results: Computational simulations predicted that amniotic fluid absorbed the majority of impact forces through hydraulic cushioning, while cerebrospinal fluid provided additional stress reduction through pressure redistribution, with model predictions suggesting total stress reduction exceeding ninety percent. Peak fetal brain stress values predicted by the model were below injury thresholds reported in adult neural tissue literature, though direct applicability of these thresholds to fetal tissue remains uncertain. The fetal brain exhibited minimal movement relative to the skull despite complex force cascades. Stress distributions showed elevated values in the frontal lobe and brainstem, though magnitudes remained within ranges that the model suggests may be tolerable. Conclusions: Computational modeling suggests that the nested fluid protection architecture operates as an integrated hierarchical system providing potential mechanical protection through sequential energy dissipation. These findings represent model predictions requiring experimental and clinical validation before translation to clinical practice. Full article

This paper examines male characters in Nilakshi Chaliha Gogoi’s Assamese novel Oiya Mor Dibru-Saikhowa (Oh, My Dibru-Saikhowa) through the lens of Eco Masculinity, drawing primarily on Hultman and Pulé’s tripartite typology of industrial, eco-modern, and ecological masculinities. The study reads the novel’s two principal male characters—Bakul Bora and Seuj—as contrasting masculine trajectories shaped, respectively, by socio-economic deprivation, displacement, patriarchal conditioning, and legal criminalization on the one hand, and by maternal ecological ethics, generational mentorship, and affective formation on the other. The analysis proceeds through three connected registers. First, it attends to the novel’s narrative form, arguing that its principal focalizing consciousness is Dr. Irina Baruah, a physician through whose perception the male characters are largely presented. Second, it develops the political ecology of the Dibru-Saikhowa region—its colonial and postcolonial conservation history, the institutional gap between the Wildlife (Protection) Act 1972 and the Forest Rights Act 2006, and the slow violence visited on the Mising villagers of Laika and Dadhiya. Third, it engages intersectional critiques of eco-masculinity and confronts the structural tension of applying a male-centered framework to a female-focalized novel. The paper argues that Eco Masculinity, applied with due attention to narrative form, historical specificity, and eco-feminine agency, offers a productive tool for South Asian ecocritical scholarship, and it suggests two modifications to the framework that follow from this application. Full article

Background: The immediate postpartum period is a critical window for maternal mental health, with many women experiencing transient depressive disturbances that can predispose them to perinatal depression. Protective factors such as social support and religiosity may mitigate these depressive symptoms, yet their combined role in the early days after childbirth remains insufficiently explored. This study aimed to assess the relationship between perceived social support, religiosity, and postpartum blues during the first three days postpartum. Methods: A cross-sectional study was conducted with 294 postpartum women (mean age 30.2 ± 5.02 years) at the University Hospital Centre Osijek, Croatia. Participants completed the Edinburgh Postnatal Depression Scale (EPDS), Religiosity Scale (RS), and Social Support Scale (SSS). Nonparametric tests, correlation analyses, and linear regression were used to identify predictors of postpartum blues. Results: Depressive disturbances (EPDS > 10) were observed in 28.2% of participants, while 8.2% had scores suggestive of clinically significant depression. Higher perceived social support correlated with lower EPDS scores (ρ = −0.130, p < 0.05). Religiosity showed modest inverse associations with depressive symptoms. Caesarean section was associated with higher EPDS scores compared to vaginal delivery (p = 0.029). Conclusions: Social support and religiosity appear to be protective factors against depressive disturbances in the early postpartum period. Early screening and culturally sensitive interventions that integrate psychosocial and spiritual dimensions may promote maternal mental well-being. Full article

Endocrine-disrupting chemicals (EDCs) are a diverse group of environmental pollutants capable of interfering with hormonal and immune system regulation. In recent years, increasing concern has been raised about the effects of chemicals, including bisphenols, phthalates, per- and polyfluoroalkyl substances (PFAS), insecticides, and parabens, on maternal and fetal health, primarily due to their widespread exposure in human populations. Pregnancy represents a critical window characterized by tightly regulated hormonal and immunological adaptations. Emerging evidence suggests that EDC exposure during this period may alter maternal microbiota, disrupt immune responses, and interfere with endocrine signaling. These changes may increase susceptibility to bacterial and viral infections, including bacterial vaginosis, urinary tract infections, and intrauterine infections, all of which are associated with adverse pregnancy outcomes. This review summarizes the current evidence on the sources and mechanisms of exposure to endocrine disruptors during pregnancy and examines the potential biological pathways linking endocrine disruption to the development of infections. Particular emphasis is placed on the interactions between immune regulation, hormonal signaling, and changes in the microbiome, which may contribute to increased susceptibility to infections. A deeper understanding of these complex mechanisms is critical to improve risk assessment, develop effective public health strategies, and ultimately protect maternal and fetal health in an environment of increasing chemical exposure. A literature search was conducted using PubMed/MEDLINE, Scopus, and Web of Science, including studies published up to January 2026. Full article

Inflammation is a physiological and tightly regulated component of normal pregnancy, contributing to implantation, placental development, and the initiation of parturition. The placenta functions as an active immunological hub, coordinating innate and adaptive immune responses to maintain tolerance while protecting against infection. Preeclampsia and fetal growth restriction (FGR) are major causes of maternal and perinatal morbidity worldwide and represent central manifestations of placental disease. Increasing evidence indicates that these conditions share key pathophysiological mechanisms, including placental dysfunction and maladaptive maternal immune responses. When immune regulation at the maternal–fetal interface becomes disrupted, inflammatory pathways contribute to impaired placental development and vascular maladaptation. In this context, excessive immune activation—driven by inflammasome signaling, Th1/Th17 polarization, and altered natural killer and macrophage function—can compromise placental perfusion, promote antiangiogenic imbalance, and lead to systemic endothelial dysfunction. This review, therefore, focuses on how immune dysregulation contributes to placental dysfunction in preeclampsia and FGR, synthesizing current knowledge of the maternal–fetal immune interface and exploring therapeutic strategies that link pathogenic mechanisms to targeted interventions. A deeper understanding of placental immunology and inflammatory signaling is essential to develop precision therapies. Established therapies, including low-dose aspirin, low-molecular-weight heparin, and antenatal corticosteroids, aim to mitigate inflammation and optimize fetal outcomes, while adjunctive strategies target oxidative stress, nutritional deficits, and the maternal microbiome. Emerging approaches such as cytokine-targeted biologics, inflammasome inhibitors, and mesenchymal stem cell therapies show promise but require rigorous safety and efficacy evaluation. Future research should prioritize biomarker validation, pathway-specific interventions, and equitable implementation to reduce inflammation-driven pregnancy complications. Full article

Neonatal puppies and kittens face a critical period after birth, during which their health depends heavily on the microorganisms they acquire from their mothers and environment. These microorganisms, known as the gut microbiota, help newborns develop their immune systems, digest nutrients, and protect against disease. This review explores how these microorganisms are transferred from the mother to her offspring before, during, and after birth, including the process of delivery, nursing, and maternal care. It also examines how factors such as birth type, hygiene, feeding, and maternal health can influence the development of these microbial communities. When this process is disrupted, it may lead to health problems such as infections, diarrhea, and immune disorders. Understanding how and when these microbes are passed to newborns, and how to support this process, is essential to improving survival rates and long-term health in puppies and kittens. Full article

Objective: Influenza and pertussis vaccines are recommended during pregnancy; however, uptake remains insufficient in many European countries, increasing the risk of preventable infections. Recent recommendations for maternal respiratory syncytial virus vaccination have been endorsed by scientific societies. This study evaluated maternal vaccination coverage, knowledge, attitudes, and factors influencing vaccine uptake among Lithuanian women. Methods: A retrospective cross-sectional online survey was conducted between 4 and 14 November 2025 in Lithuania among women aged 18–55 years with at least one previous pregnancy. The questionnaire contained 29 questions on sociodemographic characteristics, obstetric history, vaccination history, attitudes, and informational sources influencing decisions. Internal reliability was confirmed (Cronbach’s α = 0.83). Descriptive statistics were used to summarize the data. Associations between categorical variables were assessed using the Chi-square test or exact tests (Fisher’s exact or Fisher–Freeman–Halton). Binary and multivariable logistic regression analyses were performed to evaluate factors associated with self-reported vaccination uptake and the relationship between influenza and pertussis vaccination. Odds ratios with 95% confidence intervals were calculated. Statistical significance was set at p < 0.05. Results: A total of 241 women participated. Self-reported vaccination coverage during pregnancy was 28.7% for influenza, 43.8% for tetanus–diphtheria–pertussis, and 4.2% for respiratory syncytial virus. Physician’s recommendation was the strongest predictor: women advised to vaccinate were 17.0 times more likely to receive influenza, 16.5 times more likely to receive pertussis, while RSV vaccination occurred almost exclusively among women who reported receiving a physician’s recommendation. Higher uptake was associated with younger maternal age and university education. Reasons for declining vaccination were avoidance of medical interventions and concerns about safety or side effects. Conclusions: Maternal vaccination coverage in Lithuania remains low despite public funding and national recommendations. Strengthening provider communication, improving information strategies, and integrating vaccination counseling into routine antenatal care may increase uptake and enhance maternal and neonatal protection. Full article

Background/Objectives: Elevated central adiposity (ECA) in childhood is associated with early cardiometabolic risk and hemodynamic alterations. However, evidence in Spanish schoolchildren regarding the relationship between eating behavior traits and central adiposity is limited, particularly across developmental stages. This study aimed to examine the association between Children’s Eating Behaviour Questionnaire (CEBQ) subscales and ECA, and to explore potential differences by age group. Methods: A cross-sectional study was conducted in 496 rural schoolchildren aged 6–15 years. ECA was defined using the waist-to-height ratio (WHtR) and sex-specific cut-offs validated for the Spanish pediatric population. Eating behavior was assessed with the CEBQ (Z-scores), and diet quality was measured using the KIDMED index. Multivariable logistic regression models were adjusted for sex, KIDMED score, and maternal education. Analyses were subsequently stratified by age (6–9 and 10–15 years). Results: The prevalence of ECA was 45.90%. In fully adjusted models, higher Food Responsiveness (FR) was associated with increased odds of ECA, while Satiety Responsiveness (SR) acted as a protective factor; sex also showed an independent association. After stratification, sex remained the only significant predictor in children aged 6–9 years. Among those aged 10–15 years, FR was significantly associated with ECA (p = 0.008), while Slowness in Eating (SE) showed a borderline positive association in the adjusted model (p = 0.049) and was therefore interpreted cautiously. SR and Emotional Undereating (EU) showed protective trends near significance (p = 0.081 and p = 0.082, respectively). Conclusions: The association between eating behavior traits and ECA varies by age. In older children, FR showed a robust association with ECA, whereas no behavioral predictors were observed in younger children. The protective role of SR in the global model and the emergence of behavioral predictors in older participants highlight the importance of targeted interventions during late childhood. 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: The steady increase in allergic diseases among children has coincided with increased global vaccination coverage and the expansion of routine childhood immunization programs. This has contributed to the widespread belief that there is a possible link between immunoprophylaxis and allergic diseases. However, a number of scientific studies have demonstrated the protective effect of early neonatal immunization on the development of nonspecific immunological protection against infections. This is believed to be due to a shift in the immune response from the Th2 type, traditionally predominant in newborns, to the Th1 type, which reduces the risk of developing allergic diseases. Methods: This prospective cohort study analyzed the medical records of 2279 children born between 2018 and 2022 to evaluate the impact of neonatal BCG-M and hepatitis B (HepB) vaccination on the incidence of atopic dermatitis (AD) by 36 months of age. Factors analyzed included family history of allergy, cesarean section, prematurity, delayed initiation of breastfeeding, maternal antibiotic use during pregnancy, and antibiotic use in the child during the first three years of life. Results: The cumulative incidence of AD by 36 months of age was 19.9%. Timely neonatal vaccination coverage was 76.2% for BCG-M and 69.2% for HepB; by 12 months of age, these rates increased to 90.2% and 88.5%, respectively. A full-term birth demonstrated a significant protective effect (OR 0.52; 95% CI 0.30–0.93). A positive family history of allergy was the strongest predictor of AD (OR 21.49; 95% CI 14.4–32.9). Cesarean section was also significantly associated with AD (OR 1.30; 95% CI 1.01–1.65). AD incidence was comparable between vaccinated (20.5%) and non-vaccinated (17.5%) children (chi-squared with Yates’ correction, p = 0.192), indicating no statistically significant overall impact of immunization on AD risk. Conclusions: The development of AD is primarily driven by hereditary predisposition and specific perinatal factors rather than by routine immunization. These findings confirm that neonatal BCG-M and HepB vaccination does not increase the risk of AD, providing a scientific basis to address vaccine hesitancy. Full article

Herpes simplex virus (HSV) infection is highly prevalent worldwide and poses important risks during pregnancy due to the potential for vertical transmission and severe neonatal disease. HSV-1 is traditionally associated with orofacial lesions and HSV-2 with genital infection; however, HSV-1 has emerged as a significant cause of genital and neonatal herpes. Physiological immunomodulation during pregnancy may facilitate viral reactivation and replication. Vertical transmission may occur intrauterinely, intrapartum, or postnatally, with approximately 85% of neonatal infections acquired during delivery through contact with infected genital secretions. The risk is highest when primary maternal infection occurs in the third trimester, before adequate transplacental transfer of protective antibodies. Neonatal infection may present as disease limited to the skin, eyes, and mouth; central nervous system involvement; or disseminated multiorgan disease, the latter associated with high morbidity and mortality. Maternal infection ranges from asymptomatic viral shedding to painful vesiculoulcerative lesions and, rarely, disseminated disease. Because asymptomatic shedding is common, diagnosis relies on laboratory confirmation using polymerase chain reaction (PCR) or viral culture, with type-specific serology aiding in distinguishing primary from recurrent infection. Management aims to reduce symptoms, viral shedding, recurrences near delivery, and vertical transmission. Acyclovir and valacyclovir are safe and effective in pregnancy. Suppressive therapy from 36 weeks’ gestation reduces recurrences and viral shedding at delivery and decreases the need for cesarean delivery, which is recommended when active lesions or prodromal symptoms are present at labor. Neonatal herpes requires prompt recognition and intravenous acyclovir therapy to reduce mortality and neurological sequelae. Preventive strategies include counseling, behavioral risk reduction, suppressive antiviral therapy, and avoidance of neonatal exposure to active lesions. Full article